The Channel-Sinews (Jingjin) of the Pericardium and Liver Channels rotate the pelvis, ribcage and shoulder girdle
Pericardium Jingjin Torso
Take a look at the channel-sinews of the two jueyin channels. In Chinese medicine, the jueyin channels are the pericardium channel and the liver channel. Both of these channels wrap around the body and perform rotation. Let's first look at the pericardium jingjin. It involves the serratus anterior, but it also continues to wrap around the torso to link with the rhomboids and connects with the contralateral side to connect with the splenii muscles of the neck. This interpretation of the channel is influenced by the spiral line described by Thomas Myers, author of Anatomy Trains.
The serratus anterior is part of many channel-sinews. It exerts its influence as part of the pericardium channel when it protracts one shoulder girdle while the other shoulder girdle is retracting, in other words when the shoulder girdle rotates.
Pericardium Jingjin Arm
When looking at the upper extremities, the pericardium jingjin includes the pronators of the forearm (pronator teres and pronator quadratus) and also the adductor of the arm, the coracobrachialis. Collectively, these muscles can all work together to pronate the forearm, adjust the position of the humerus and protract the scapula; all motions employed when pushing in activities like martial arts training or any activity which would require pushing with force.
What happens when rotation goes beyond just the upper extremities and shoulder girdle. In this case, the pericardium jingjin links with the liver jingjin which includes the external oblique and crosses over to the opposite side adductors (particularly adductor longus, brevis, pectineus, and gracilis). This entire jueyin network would be active when there is rotation in the shoulder girdle, ribcage, and pelvis; all regions involved with the third exercise in the video in the top of the post. .
Pericardium and Liver Jingjin
Beyond mobilizing the pelvis, ribcage and shoulder girdle, it is also the case that these rotational patterns move and massage the liver and pericardium organs to increase circulation and health.
It's said that a picture is worth a thousand words. As an educator and anatomist, I find this is especially true. I have often found that very complex anatomical relationships can be understood much more easily by a very good illustration or image. Cadaver dissection is probably the best way to appreciate these relationships, but here are several images that are most certainly better than 'a thousand words and can help until you can get to a dissection.
Note: we are working on scheduling a 3 day cadaver lab on the East Coast with Sports Medicine Acupuncture and I will be doing a 1 day in Miami in September 2023 with Michael Corradino. Also note that I will be speaking on the QL and the LIV jingjin at the upcoming FSOMA conference in August 2023
Now on to the anatomy!
Classically, the Liver sinew channel terminates at the groin. Above is a wonderful illustration from Jennifer Black at Holism Prints which shows the classical view described in Ch 13 of the Lingshu. Below is my anatomical interpretation of this portion of the channel at the groin which involves the anterior adductors (adductor longus, brevis, pectineus, gracilis). All attach to the pelvis on it's inferior surface. This matches the classical view, but does this sinew channel end there?
To the left is an image from Toldt's Atlas of Human Anatomy. The patella is facing to the left in this illustration. The perspective is anteromedial which gives a great view of the region of the Liver sinew channel. I produced the labels of the adductor attachments in the intermuscular septum, sometimes referred to as the subsartorial canal (it is deep to the sartorius muscle) and also it is known as Hunter's canal. I teach some manual techniques to open this space and also needle from it angled either anterior into trigger points of the quadriceps or posterior into the adductors. There are blood vessels and nerves running in this space and I feel this canal is where the Liver primary channel runs.
I love this image since is depicts how this myofascial plane continues beyond the groin and into the anterior portion of the pelvis. This entire atlas is amazing!
Toldt's Atlas is from the early 1900s. Let's go back a bit further to 18th century to view an image from Bernhard Siegfried Albinus, a German anatomist, who guided engraver Jan Wandelaar to make a series of fantastic engravings portraying different layers of the body. Here is the deepest layer which beautifully depicts the liver sinew channel all the way up through the anterior pelvis and into the spinal column to the diaphragm!
Check out my video that covers this sinew channel from the toes all the way to the diaphragm. Make sure to like the video and let me know if you have any thoughts, questions or considerations in the comment section.
If you are an acupuncturist, then you learned a portion of the above image. You learned this as the circadian cycle where energy is at is peak during a 24 hour time period. You also learned various channel correspondences. For instance, the following are internally-externally related channels: LU-LI, ST-SP, HT-SI, KID-UB, P-SJ, LIV-GB. And, finally, you learned the following six divisions: Taiyang (UB-SI), Shaoyang (GB-SJ), Yangming (ST-LI), Taiyin (SP-LU), Shaoyin (KID, HT), Jueyin (LIV-P). You already know that the channels in each of the 3 grouping above share many relationships.
What you have not been taught, at least in a Chinese Medical Curriculum, is that movement is integrated around these 3 groupings. To fully understand this, you need to dive into the sinew channels (jingjin) and this is exactly what I have been exploring for the last 20+ years. This started with my interested in movement (taiji, qigong, bodyweight calisthenics), developed with my interest in fascial systems such as Anatomy Trains, and continued with exploration on approximately 100 cadaver dissections. This has led to the development of a comprehensive sinew channel model that is taught in the Sports Medicine Acupuncture Certification program where I am a faculty member.
The Channel Sinew Groupings & Functional Movement Patterns
While you can explore what an individual sinew channel does in terms of movement, there is greater benefit in understanding that functional movement patterns are organized by the groupings above. Most movements, especially full body movements are too complex to analyze with a single channel. Take, for instance, something relatively simple such as a pull up. This movement engages many muscles of the back and involves the UB sinew channel. But the external shoulder rotators are also engaged which would be part of the SI sinew channel. And, if your form is good, there is engagement of core structures such as the transverse abdominis, part of the KID sinew channel. This relatively straightforward movement primarily involves expansive movements that lift and propel the body forward. These movements lift the body up (literally, in the image below), but also lift you into an upright posture, and they also stabilize the spine. They are controlled by the Taiyang and Shaoyin channel sinews.
Photo by Ruslan Khmelevsky:
https://www.pexels.com/photo/muscular-sportsman-doing-pull-up-exercise-in-gym-4608157/
Other movement patterns guided by the Yangming-Shaoyin channels compress and hollow the body. They protract the scapulae, depress the chest, and flex the torso and hip. Hollow body holds, L-sits, a front kick, and many other movements fall into this category. These movements balance the expansive ones described above and there are many exercises that move back and forth between these two groupings. For instance, rowers would move back and forth between these phases; going into a compression so that they have more range as they engage the back, expand and propel forward as they pull the paddle through the water. You have to compress and load the spring before you expand, especially if you want to do it explosively. The spinal wave from White Crane qigong is another example of this ebb and flow and you can watch my video by clicking here.
Photo by Andrea Piacquadio:
https://www.pexels.com/photo/photo-of-male-gymnast-practicing-on-gymnastic-rings-3763702/
The final grouping involves the Shaoyang and Jueyin channels which execute two very related movement patterns; sidebending and rotation. This involves trunk and neck sidebending, but also abduction and adduction of the limbs, along with rotational movements. A very simple example is in a video below where I am swinging on monkey bars. This exercise illustrates both rotation, but you will also see sidebending if you watch the video; all engagements of the Shaoyang and Jueyin channels. Note: I mention the Gallbladder sinew channel in this video, but all of the channels in this category are involved. I was simplifying since it is hard to describe these types of concepts in a video without being distracting.
Photo by Los Muertos Crew:
https://www.pexels.com/photo/woman-doing-sports-at-sports-hall-10039561/
Check out my Youtube channel where I will be exploring many of these concepts. If you do visit, especially if you find the information useful, please subscribe, like the videos, and comment on the videos. All of this helps build my channel and allows me to put the time into producing more content. Besides this, I appreciate the comments since it helps be continue to organize this information and we can all learn together!
The Lateral Raphe, Quadratus Lumborum and the 2023 FSOMA conference
I will be presenting about the lateral raphe and the quadratus lumborum at the 2023 Florida State Oriental Medical Association )FSOMA) annual conference on Aug. 27. Details are available here. This post and the video below will give a preview of a portion of this presentation. I hope to see you there!
The Lateral Raphe and Low Back Health
Many manual therapists use high velocity low amplitude (HVLA) adjustments (such as a chiropractic or osteopathic adjustment) to move the body frame and reposition joints. I follow more of the structural integration model where I use the fascia as a lever to move and mobilize the body's skeletal framework. The lateral raphe of the low back is one of these important levers that can influence so much of the low back that it is important to understand the anatomy and use this understanding to better mobilize and move the body.
Netter Image showing TLF
The lateral raphe is part of the larger thoracolumbar fascia (TLF). The TLF is the diamond shape aponeurosis (wide, flat tendon) seen in musculature illustration of the back. These illustrations don't do it justice since this isn't simply a single layer structure, but is, instead, a multilayer fascial structure with attachments to so many prominent structures of the low back.
From Human Structure and Shape by John Hull Grundy
The fascia from the abdominal muscles, primarily the internal obliques and transverse abdominis continue to wrap around to the back to join with the TLF. Specifically, these fascial layers converge into a seem at the lateral edge of the iliocostalis lumborum and the quadratus lumborum. This seem then separates again into two layers with one layer traveling superficial to the erector spinae to connect with the spinous processes of the lumbar vertebrae, while the second layer travels deep to the erector spinae and between the erectors and the quadratus lumborum (so, superficial to the QL) to connect with the transverse processes of the lumbar vertebrae. This seem is the lateral raphe. It has connections to the abdominals all the way to the rectus abdominis; it has connections to the erector spinae and QL, and it has connections to bony landmarks of the lumbar spine and even the deep lumbar multifidi muscles.
This fascial seem helps integrate and balance pushes and pulls produced by all of these structures while providing a stable support for the muscles to pull on. You want the lateral raphe to be supple and strong so that it can be a structure that supports the spine while allowing the various muscles that attach to it to communicate mechanically with each other. This mechanic communication is how the myofascial knows where they are in space compared to their functional partners.
Here is a video featuring palpation and giving a brief demo of techniques to affect the lateral raphe and influence low back health.
The Lateral Raphe and its Sinew Channel Relationships
The lateral raphe is a meeting point in the fascial system. This plays out also when looking at its channel relationships, particularly looking at the sinew channels/ The following jingjin meet at the lateral raphe:
Urinary Bladder jingjin - via pull from the erector spinae
Stomach jingjin - following the lateral branch that travels up the vastus lateralis and into the gluteus medius and minimus fascia to the TLF and LR
Liver jingjin - via the pull from the quadratus lumborum
Kidney jingjin - via the pull from the lumbar multifidi
We will explore this more at the FSOMA conference and look at both local treatment and distal points to influence this important structure/
Joint mechanics of the spine and pelvis: Coupling Side Bending and Rotation.
In clinical practice, we see things like an elevated ilium quite frequently. With the elevated ilium, there is almost always some aspect of pelvic torsion. This word can mean different things, but what I mean is that one ilium will be significantly different than the other in terms of anterior and posterior tilts. One side will be significantly more anteriorly tilted or posterior tilted than the other. There will also frequently be rotations in the pelvis and spine.
Why is this? It really has to do with the mechanics of the spine, sacrum and innominate bones. In movements such as walking and running, the body features a combination of side bending and rotation. As the hip flexes and the leading leg reaches out, that innominate bone will roll into a posterior tilt and it will move anterior. Conversely, the opposite innominate will go into an anterior tilt and shift posterior as it follows the back leg in extension. The sacrum will be part of this complex movement and will 'nod' as it rotates and side bends. This nodding is called nutation and counter-nutation and I will not go into detail here other than noting that that the side bending and rotation are coupled in this movement.
The vertebral joints also couple side bending and rotation. For the lumbar and thoracic spine, these movements are coupled in opposite directions. This means that if a vertebra such as T9 right side bends it will also left rotate. This happens at the individual joint level, but you can see the general global spinal pattern in this video where I am demonstrating an exercise called Windmills.
The Gallbladder Sinew Channel performs Side Bending and Rotation.
There are many channels that are involved with these movements. Even the individual muscles of the transversospinalis group (multifidi, rotatores) contribute to the these coupled movement. The attach from inferior transverse processes and reach up to superior spinous processes, pulling the vertebra they insert on into a side bend to that side and a rotation to the opposite side.
The Gallbladder sinew channel supports this and one of its primary actions is to side bend and rotate the torso. Or it stabilizes to prevent excessive side bending and rotation. Either way, it is intimately involved in this movement pattern. Let's look at some key muscles of this channel.
Consider the abdominal obliques. These muscle both side bend the torso, but also rotate the torso. Another example would be the serratus anterior. This muscle abducts the scapula (this is a type of rotation as it rotates around the ribcage) and it also upwardly rotates the scapula (a side bending movement which medially tilts the scapula). We could continue with other examples such as the piriformis, gluteus maximus, gluteus minimus and gluteus medius; and see that all of these muscles have some action that contributes to rotation and side bending. Sometimes these muscles perform side bending and rotation. Other times they stabilize and prevent side bending and rotation. But, their attachments dictate these movements. Here is another video which highlights a training progression to train the stabilization role of this channel. In these exercises, the starting position is side bending and the channel is then engaged to bring the torso back into alignment against gravity. Again, you will see the coupled movement of side bending and rotation.
Reflecting on my fifth day of week two teaching the 2022 Cadaver Lab.
On the fifth day of lab, we have the donors turned back into a prone position to complete the dissection of the posterior portion of the body. This is actually the first half of the day. For the second half, students are able to finalize any project that they are working with and start exploration to study anything. This week involved exposing the cranial cavity and brain, cutting the vertebral arch to expose the spinal cord and cauda equina, exploring the ligaments of the hip and knee, and dissecting deep into the medial thigh to get to the very deepest layer here. Here are some reflections:
I am teaching, so am back and forth between tables constantly to help advise, help with the dissection, and help identify structures. In some ways this slows down for me during the second half of the day. My colleague that I teach with frequently opens the cranial cavity and highlights structures of the brain. As one would expect, this generates a lot of enthusiasm, and I am usually working to complete a project while he is doing this. This year, I reflected back the muscles of the hip down to the level of the ligaments. This provided a very nice model for these ligaments. I was also able to reflect back to the deepest layer of the groin and expose the obturator externus and also get a very good model of the obturator nerve which could then be followed from the abdominal cavity medial to the psoas and into the medial thigh. This nerve has something to do with the Kidney divergent channel. I feel this is the case because I think that the du mai has something to do with the nerves which exit from the lumbar plexus and wrap around the abdomen to innervate the lower portion of the abdominal muscles such as the internal and external obliques and the transverse abdominis. Specifically, the ilioinguinal, iliohypogastric and subcostal nerve follow the trajectory and describe function of this vessel. I wrote a post about this recently, and you can find this here.
The Kidney divergent channel is said to intersect with the dai mai at L2, which is exactly what the obturator nerve does. This is why I feel it is part of the Kidney divergent channel, at least the lower half of this secondary channel.
The lumbar plexus is houses between the anterior and posterior layers of the psoas major. We discuss this on an online recorded class available here. I was able to reflect back this anterior layer of the psoas and reveal the lumbar plexus nerves. On this specimen, the psoas was different than I have seen. It had two main grouping of fascicles and almost looked like two separate muscles. This muscle has an interesting fascicle arrangement all of the time, but this was different. I had two distinct branches that then blended with the iliacus muscle. The best I could tell was that the anterior and posterior layer were more distinct from each other than usual, but I was not able to return and figure this out because I got called to other areas for assistance.
Being able to move and palpate a specimen while seeing the structures helps inform what you feel. For instance, mobilizing the hips with just the ligaments holding the hips helps you feel what just the ligaments feel like in this movement. Or doing a varus and valgus stress test with the ligaments exposed helps refine this test. And doing Lachman;s test while watching a torn ACL move gives so much information.
Reflecting on my fourth day of week two teaching the 2022 Cadaver Lab.
Each year I teach this cadaver lab, I plan on posting some reflections at the end of each day. I did pretty well this year, posting for days 1-4 of the first week. And then I got off track. This is for two reasons. 1) Dissection lab is very tiring both mentally, but also physically. One is standing the entire day and working over a table, accounting for the physical aspect, but it is also mentally tiring due to the sustained concentration. This is especially true when you are teaching. 2) There is really so much to highlight that at the end of the day it almost makes it too difficult to remember what I was planning to post when I get home. This is made worse by point number one.
Day 4 is the same as last week. It is the day that evisceration occurs and the organs are studied. It is not only this, however. The dissection continues into deeper layers of the anterior neck and extremities so that you can follow myoneurovascular structures from the neck and into both the thoracic cavity but also the upper extremities and you can follow myoneurovascular from the abdominal cavity into the lower extremities. Day 4 is really the culmination of the week up to this point.
Here are some reflections:
There are many things I teach to acupuncturists regarding the channel sinews (jingjin) and their myofascial connections. Reflection of the biceps brachii is a great example of this. With the biceps reflected, you get a great view of the coracobrachialis and the brachialis. The brachialis has two myofascial connections. On the lateral side of the humerus, it has a clear myofascial connection to the deltoids, especially the anterior fibers. Following this path highlights the a deep branch of the Lung sinew channel. However, the brachialis also has a clear myofascial connection to the coracobrachialis which highlights the Pericardium sinew channel. This connection is great in anatomy texts, but much more obvious on a fresh tissue dissection when you can put tension into these myofascial planes. Visually it is apparent, but the tactile portion helps solidify the understanding when considering how injury can affect this plane.
The IT band is really a fascinating structure when you do dissection. It is really almost abstract because, to view this structure, you have to remove the fascia lata (the deep fascia of the thigh) while retaining the IT band. This means you cut an artificial line on the anterior and posterior border and remove the fascia lata off up to this line you created. There is a guideline regarding where you make this line and that is the TFL muscle. The ITB does have some variability in tension from specimen to specimen, but nothing like what you feel when you palpate patient's lateral thighs. There is far more variation with patients. So, all of these tight IT bands really has more to do with the baseline tension in the TFL and/or the underlying vastus lateralis. I think the vastus lateralis is the more likely thing practitioners are palpating. When reflecting the IT band, you follow under the TFL to the ASIS to reflect both together. You have to find the fascial plane between the TFL and the underlying gluteus medius when doing this. It is hard to differentiate. Which is also the case when you palpate and needle these structures on patients. I think many times, clinicians are sensing the gluteus medius and advancing the needle to this muscle when they think they are treating the TFL.
The plantar foot is organized in layers which can be followed in dissection. The superficial layer has the plantar fascia which has a very clear connection to the underlying flexor digitorum brevis, but it also has a clear connection to the adductor hallucis. This is the layer of the Kidney sinew channel. The next layer involves has the flexor digitorum longus, quadratus plantae, and lumbricals. This is the layer of the Liver sinew channel. The final layer includes the tibialis posterior, flexor hallucis and adductor hallucis. This is the layer of the Spleen sinew channel. These layers are well depicted in Netter and other anatomy atlases because the plantar foot is so clearly organized this way in dissection. The channels would follow would also be associated with this order.
I saw a pretty odd anomaly of the psoas major. I will look a bit closer and try to describe tomorrow.
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