Wednesday, December 14, 2016

Reunion Zones (Muscle Meridian Meeting Points) and Myofascial Anatomy

In Chinese medicine school, many of us have studied reunion zones, which have also been called "muscle meridian meeting points." They involve the following points:

  • Three Arm Yang: The temporal region. Points are ST-8 or GB-13 (depending on the source).
  • Three Arm Yin: Under the axilla. Point is GB-22.
  • Three Leg Yang: Cheek bone. Points are SI-18 or ST-3 (depending on the source).
  • Three Leg Yin: Above the pubic bone. Point is Ren-3.
If you are like me, you memorized these points in school, possibly seeing them on the "Big Picture" chart that you diligently memorized in preparation for the boards. Chances are, nobody explained the significance of these, where this information came from, or whether it was even relevant. Why, for instance, is GB-22, a Yang channel point, the muscle meridian meeting point for the three Yin arm sinew channels?

To answer these questions, it is important to understand where this information comes from in the first place. These reunion zones or meeting points first appear in a specific translation and commentary of the Lingshu, in Chapter 13, which discusses the sinew channels or Jingjin. I refer to paragraph 13 of this chapter, as translated by Vietnamese scholar Nguyen Van Nghi.

The interesting thing is that this paragraph from the Lingshu is quite short and Van Nghi extrapolates significantly more in his commentary than is explicit in the original information. The actual text (translated into English) of the paragraph reads:

"In cases where the Zu Yangming (ST) Jing Jin and the Shou Taiyang (SI) Jing Jin are concomitantly affected, with deviation in the face and eyes accompanied by visual disturbances... the treatment is the same as that which was previously indicated."

Leading up to this, paragraphs 1-12 have outlined the topography of the 12 sinew channels along with basic symptoms of dysfunction and treatment. Treatment mostly involves fire needling of ashi points.

Van Nghi gives four pages of commentary on this short passage. In it, he defines these reunion zones based on regions (temporal, below the axilla, etc.), but does not indicate specific points (though images he uses do show points). Looking at the basic topography allows one to see that these pairings of 3 arm and leg Yin and Yang channels would all involve the above reunion zones, as all of these channel end at these sites. Van Nghi further states that, when all of these channels are involved (all of the 3 arm Yang channels, all of the 3 arm Yin channels, etc.) together, then these reunion zones become painful. More specifically, he states that when there is invasion of pathogenic factors in these pairings, then these reunion zones are always painful.

So, what is the relevance of these points? First, it is important to note that they do not appear in the Lingshu or the classics of Chinese medicine. But they are brought forward and discussed by Van Nghi, a well-respected scholar and physician of the past century. His commentary, with its descriptions of reactivity and pain associated with these pairings of three sinew channels, appears to convey that the relevance is its value in diagnostic work. In his commentary, he further discusses the season in which disorders generally appear for these pairings (for example, "Disorders in the Jing Jin of the three Yin hand channels generally appear in the course of the three months of winter.")

I feel an understanding of the underlying anatomy gives some perspective on these regions or points, and can help guide you as to when and if to use them. At the least, the anatomy can help understand how these pairings of channels meet in these regions. Let's take GB-22 or the region under the axilla as an example.

In my listing, the three arm Yin sinew channels include the following muscles and fascia:
  • Lung sinew channel includes the pectoralis minor and the clavipectoral fascia.
  • Heart sinew channel includes the pectoralis major
  • Pericardium sinew channel includes the serratus anterior
The clavipectoral fascia (which envelopes the pectoralis minor muscle), the fascia of the pectoralis major, and the fascia of the serratus anterior all blend together in the region of GB-22. This is seen in the diagram below in the region of the suspensory ligament of the axilla which unites all of these channels and helps form the base of the axilla. GB-22 is one of several motor points of the serratus anterior (SP-21 is another). It, therefore has a direct influence on this muscle, but I feel that it influences all three muscles and associated channels. Although GB-22 is a Yang channel point, it is a motor point of a Yin sinew channel muscle (Pericardium) and exists at a region where the other Yin arm sinew channels meet.

These images highlight the merging of fascial planes of the 3 arm Yin sinew channels. The image on the left is from Netter's Atlas of Human Anatomy. The two images on the right are from Functional Atlas of the Human Fascial System by Carla Stecco.

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Sunday, December 11, 2016

The Sinew Channels at the Pacific Symposium

I have not posted in a while and plan on starting up again. Below is a bit of a summary of what I have been doing and some thoughts on future posts.

On Saturday, October 29th, Matt Callison and I presented at the Pacific Symposium. We presented on the work we have been developing on the sinew channels (some of which has been featured on this blog). This presentation covered background on sinew channel study from the Lingshu to the present, and discussed what we are using to further expand this concept. This includes modern functional anatomy, fascial research, ongoing cadaver studies, and clinical observation, among other things.

We then explored a few channels (Urinary Bladder sinew channel, Liver sinew channel, Gallbladder sinew channel, Small Intestine sinew channel) and looked at some clinical examples. We performed a few demonstrations on volunteers from the audience for Iliac Crest Syndrome (we referred to this as Yaoyan syndrome, as the pain presents at the extrapoint Yaoyan) and on Levator Scapula Syndrome. In both examples, we looked at the common muscle imbalances and, through the lens of the sinew channels the channel imbalances associated with these pain syndromes individually. These pain syndromes tend to be associated with an elevated ilium (with Yaoyan syndrome) and a elevator scapula (for levator scapula syndrome). 

Finally we discussed how these two syndromes are commonly seen together, and specifically how assessment and treatment of the quadratus lumborum (part of the Liver sinew channel, Fig. 1.) and the levator scapula (part of the Small Intestine sinew channel) represents a midday-midnight channel relationship (Fig. 2).

Recently (12/1-12/4), I retook a visceral manipulation course through the Barral Institute. I have been interested and influenced by this work for a long time and plan on studying it in earnest this coming year. While this blog focuses on the development of a more anatomically precise model for the sinew channels, I believe that visceral manipulation gives much insight into how the internals relate to the myofascia (how the primary channels nourish and influence the sinew channels). This will be discussed further in a future post. For now, I will share an image of the liver and its relationship to the diaphragm and the quadratus lumborum. Jean-Pierre Barral, the developer of visceral manipulation, feels that excessive energy in the liver disperses into the quadratus lumborum and psoas muscles (Fig. 3). Again, more discussion on this is to come.

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