The Great Luo-Connecting Channel of the Stomach and Heart Palpitations

All of the primary channels along with the Du and Ren vessels have luo-connecting points, which are where the luo-connecting channels branch off of the primary channels. In addition to these luo-connecting channels, the Stomach and the Spleen channels each also contain a great luo-connecting channel. The Spleen great luo-connecting channel is the more widely discussed in acupuncture texts, but is still a bit mysterious in its own right. I will discuss this in another post. The Stomach great luo-connecting channel (xu li) is infrequently discussed in acupuncture texts and, possibly has even more mystery associated with it.

Claudia Focks' Atlas of Acupuncture describes it thus: The great luo-connecting channel of the Stomach begins in the Stomach, passes through the diaphragm, intersects with Ren-17, and spreads in the Lungs, trachea, and larynx. From the Lung, it travels to the Heart and emerges in the region of ST-18 where the heartbeat is visible.¹

Pathology, like other luo-connecting channels, can be separated by full and empty conditions and are listed as thus:^1,2,3

Great Luo of Stomach Full: Rapid, irregular breathing, chest congestion, congestive heart failure
Great Luo of Stomach Emptied: Palpitations, fibrillations, tachycardia.

Fig. 1: The heat and stomach in situ

Why would this secondary channel of the Stomach network cause palpitations of the heart? We can gain a more precise understanding by exploring the anatomy of the stomach and the heart, their topography in the body, and the way in which dysfunction of the upper portion of the stomach can contribute to the above symptoms.

Looking at the topography first, one sees that the upper portion of the stomach is in close proximity to the heart. In fact, the upper portion of the stomach is called the cardia due to its close proximity to the heart, as it is essentially just on the other side of the diaphragm (Fig. 1).

While many organs are close to each other, the research about to be published by an osteopath in Italy named A.J de Koning helps illustrate the link between these two organs. De Koning is coordinating with an Italian cardiologist, Dr. Stefano Bianchi, who regularly performs cardiac ablation for irregular heart beat due to atrial fibrillation (AFib).

A.J. de Koning is a visceral manipulation practitioner and teaches with the Barral Institute. Dr. Bianchi invited de Koning to work with him and has him evaluate the patients first using osteopathic 'listening' techniques to feel for dysfunction. When applicable, visceral manipulation techniques are performed, and the result has been a greatly reduced necessity for ablation procedures. In particular, visceral manipulation techniques for the stomach have been particularly beneficial. Many of these patients with atrial fibrillation who benefit from visceral manipulation applied to the stomach have a history of gastric problems such as gastritis.

De Koning theorizes that the effectiveness of this approach is due to the dual innervation of the heart and stomach by the vagus nerve. When the stomach is stimulated, the signal is sent to the CNS to a region in the brain which has an effect on the arrhythmia. Essentially, this is a viscero-visceral reflex between the stomach and the heart.⁴

Here is a summary of de Koning's research

Fig. 2: The Influence of the Chongmai

Now back to the channels. Can we have a similar effect working with acupuncture and the channel system? To regulate the great luo-connecting channel of the Stomach, an acupuncturist could treat the Chongmai via the command point SP-4 along with PC-6 (Fig. 2). SP-4, in addition to being the command point of Chongmai, is also the luo-connecting point of the Spleen channel. Wang Juyi, in his book Applied Channel Theory, discusses how this point has the ability to clear the collaterals of the paired yangming stomach channel to clear heat. Symptoms include nausea/vomiting, stomach pain, insomnia, and irritability, He explains that trapped yangming heat moves upward to affect the heart.⁵

In addition, Dr. Wang likens PC-6, a point that is frequently used for stomach conditions such as gastritis and stomach spasms in addition to heart conditions such as angina, to the parasympathetic nervous system. Jueyin closes inward and is the most yin aspect of the six divisions, describing a physiology that reflects the parasympathetic nervous system regulation. It is worth remembering that 90% of the parasympathetic nervous system is innervated by the vagus nerve.

So, in effect, this point combination can be viewed as having a regulatory effect similar to de Koning's description. It can be especially useful when this link occurs between dysfunction in the Stomach affecting the Heart (history of gastitis, ulcers, acid reflux, etc, might serve as clues) as opposed to dysfunction which comes from problems with the Heart directly and might better be treated with the Heart collateral point, HE-5.

In addition to this point pair, the acupuncturist can consider treating joint fixations in the thoracic spine using huatuojiaji points and tuina mobilizations.⁶ These fixations could manifest anywhere in the thoracic spine, and it would not be surprising to find them in the region of the back-shu of the heart, the stomach, or both.

Fig. 3: Convergence of the Heart and Stomach
sinew channels

Assessment and treatment of the sinew channels can also be useful for these types of arrythmias; especially assessing for dysfunction in the region of the convergence of the Stomach and Heart sinew channels (Fig. 3). Both of these channels include the rectus abdominis and rectus fascia. This would cover the region of the front-mu points of the Stomach and the Heart, but it would also include the area under the abdominal portion of the pectoralis major which extends all the way to rib 5. Myofascial release and/or motor point and trigger point work to this region allows more space and freedom on the outside and will reinforce any internal work performed with acupuncture, visceral manipulation, or other techniques that are addressing the zangfu.

Fig. 4: Cardiac arrythmia TrP

located on right side at the 5th

intercostal space. The vertical line

indicates the midpoint between the

sternal margin and nipple and the

horizontal line indicates the lower

border of the xiphoid process.

One final thought: Dr. Janet Travell, in her book Myofascial Pain and Dysfunction: The Trigger Point Manual, mentions a pectoralis major trigger point (TrP) which can develop on the right side in the 5th intercostal space and can contribute to arrhythmia of the heart (Fig. 4). Travell suggests that this TrP might be in the intercostals rather than the pectoralis major.⁷ I think it is also possible that this TrP is in the superior rectus abdominis attachments. Either way, it is at the area where the rectus abdominis meets the pectoralis major, or, to put it another way, where the Stomach and Heart sinew channels converge.

Dr. Travell discusses treatment of this TrP and its effect on heart rhythm as a somato-visceral reflex. Her colleague and co-author, Dr. David Simons, describes witnessing several occasions of conversion of atrial fibrillation to normal rhythm with the application of a vapo-coolant to deactivate this TrP and he states that pressure or needling could also be employed.⁸


References:

1. Focks, Claudia, Ulrich März, Ingolf Hosbach, and Johanna Schuster. "Acupuncture points of the twelve primary channels." Atlas of Acupuncture. Edinburgh: Churchill Livingstone/Elsevier, 2008. 125. Print.

2. Maciocia, Giovanni. "Identification of patterns according to the 12 channels." The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists. Edinburgh: Elsevier Churchill Livingstone, 2005. 751-55. Print.

3. Cecil-Sterman, Ann, and Pat Didner. "The luo channels. Advanced Acupuncture: A Clinic Manual. New York: Classical Wellness Press, 2012. 49-128. Print.

4. "Atrila fibrillation, the stomach and visceral manipulation." International Alliance of Healthcare Educators. N.p., n.d. Web. 28 Dec. 2016. https://www.barralinstitute.com/docs/articles/atrial-fibrillation-aj-de-koning-research.docx

5. Wang, Ju-Yi, and Jason D. Robertson. "The source, cleft, and collateral points." Applied Channel Theory in Chinese Medicine: Wang Ju-Yi's lectures on channel therapeutics. Seattle: Eastland Press, 2008. 513-15. Print.

6. Lau, Brian. "The sinew channels & vertebral fixations." The Illinois Acupuncturist 1 (Mar. 2016): 24-27. Print.

7. Simons DG, Travell JG, Simons LS. Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual, Volume 1, Upper Half of Body. 2nd ed. Baltimore: Williams & Wilkins; 1999. p.821-2, 829-30.

8. Simons, David G. “Cardiology and Myofascial Trigger Points: Janet G. Travell’s Contribution.”Texas Heart Institute Journal 30.1 (2003): 3–7. Print.

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LI 15 (Jianyu) and Channel Relationships: A Point Reached by the Lung sinew channel and the Small Intestine Luo-Connecting Channel

"Jianyu L.I.-15, a meeting point of the Large Intestine channel with the Yang Motility vessel, is also reached by the Lung and Bladder sinew channels, the Large Intestine divergent channel and the Small Intestine luo-connecting channel. Jianyu L.I.-15 is considered the preeminent point for treating the shoulder, and clinically the majority of shoulder disorders affect this region."1 This is a quote from the commentary of LI 15 in A Manual of Acupuncture by Peter Deadman. There is a lot of information in this opening paragraph; a look at the anatomy will help to elucidate it. 

Fig. 1: Image from A Manual of Acupuncture,
by Peter Deadman. Illustrating the
The Lung sinew channel which
"enters the bottom of the armpit"
 but also "connects to the front 
of the shoulder joint"

In this post we will start with the Lung sinew channel and the Small Intestine luo-connecting channel. This will highlight the relationship of LI 15 to shoulder problems. The Lung sinew channel includes the biceps brachii. The Lung sinew channel is continuous, via myofascial connections, from the thenar muscles to the pectoralis minor, subclavius, and intercostal muscles. The biceps brachii are part of this sinew channel and it is specifically the short head of the biceps which blends with the pectoralis minor. However, as described classically and seen in the illustration from A Manual of Acupuncture, the long head of the biceps can be interpreted to be included. The long head has a fascial connection to the supraspinatus.2

Interestingly, the supraspinatus muscle is part of the Small Intestine sinew channel and its muscle belly is accessible at SI 12 (which is the motor point of the supraspinatus).3 However, its musculotendinous junction is reached by LI 16 and its humeral attachment is reached from LI 15.

Fig 2: Note the transverse ligament which is illustrated
as a separate structure. Compare it to Fig 3. where it
does not appear to be a separate structure. In a cadaver
specimen, it is observed to be a continuous sling as describe
in this post.

The long head of the biceps brachii (part of the Lung sinew channel) lies in the bicipital groove where it is held in place by a ligamentous structure called the transverse humeral ligament. While not described this way in anatomy texts, the transverse ligament is actually a fascia sling composed of the superficial fibers of the subscapularis tendon, a muscle of the Heart sinew channel, and longitudinal fibers of the supraspinatus tendon.4,5 Overactivity in the subscapularis muscle can contribute to pain in the long head of the biceps as the additional tension, transmitted through the transverse ligament, compresses the muscle and its tendon sheath and can be an aggravating factor for bicipital tenosynovitis (inflammation of the tendon sheath of the long head of the biceps).

So LI 15 is a fascial meeting point of the supraspinatus (SI sinew channel) and subscapularis (HE sinew channel), and this point is classically described as a meeting point of the Small Intestine luo-connecting channel, a point that would connect the Small Intestine channel with its internally related Heart channel.

Fig. 3: The anterior view of the scapula and humerus with the rib cage removed.  This image is modified from Atlas of Human Anatomy by Frank Netter.  LI 15 is on the anterolateral border of the acromion process of the scapula. When located this way, there is little space felt between the acromion process and the greater tubercle of the humerus. Anatomy illustrations are somewhat misleading and the above illustration seems to put LI 15 much farther inferior to the acromion. This is not the case. If the tip of your finger is on the point, it side should be in contact with the acromion process

Needling at LI 15 accesses the region where the supraspinatus tendon attaches and where the transverse ligament crossed over the biceps tendon. Therefore this point can be used when there is pain from supraspinatus tendinopathy and/or from bicipital tenosynovitis. These are two of the most frequent shoulder conditions, so it can be seen why LI 15 is so useful. Which other points are used in addition will be based on which pathology is being treated, which muscles are overactive and which are inhibited, and, based on this, how well the glenohumeral joint is functioning. Frequently used points include SI 12 (the motor point of the supraspinatus), SI 11 and the motor points of the infraspinatus, SI 9.5 (the motor point of the teres minor and half way between 9 and 10), and HE 1 (the motor point of the subscapularis).6 There are other direct techniques which can be used for specific conditions.

Many practitioners would agree that distal LI channel points are often used for shoulder problems such as supraspinatus tendinopathy and bicipital tenosynovitis. Obviously the LI channel flows through LI 15. But, as mentioned above, LI 16 accesses the myotendinous junction of the supraspinatus and the Large Intestine channel then intersects with SI 12 en route to LI 17.

A specific distal point commonly used for shoulder problems is LI 11. This point can be threaded to connect with HE 3 (or vice versa) which would help connect the Large Intestine channel (which intersects with SI 12 and the supraspinatus) with the Heart channel (which connects with the subscapularis) and helps balance the relationship of these to important shoulder joint muscles.

References:

^{1. Deadman, Peter, Mazin Al-Khafaji, and Kevin Baker. A Manual of Acupuncture. Hove, East Sussex, England: Journal of Chinese Medicine Publications, 2007. Print.}

2, Myers, Thomas W. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. 3rd ed. Edinburgh: Churchill Livingstone, 2014. Print.

3 Lau, Brian. "Anatomy of the Sinew Channels: Head, Neck and Upper Extremities." Sports Medicine Acupuncture Certification: Module 2 Anatomy/Palpation/Cadaver Lab. Pacific College of Oriental Medicine, Chicago. 24 Apr. 2016. Lecture

4, Gleason, P.D. "The Transverse Humeral Ligament: A Separate Anatomical Structure or a Continuation of the Osseus Attachment of the Rotator Cuff?" American Journal of Sports Medicine 34.1 (2005): 72-77. Web.

5, Stecco, Carla, and Warren I. Hammer. Functional Atlas of the Human Fascial System. Edinburgh: Elsevier, 2015. Print.

6. Callison, M. (2007). Motor Point Index: An Acupuncturist's Guide to Locating and Treating Motor Points. San Diego, CA: AcuSport Seminar Series LLC.

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