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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The Gluteus Maximus and Converging Sinew Channels

Fig. 1: Image from Functional Atlas of the Human
Fascial System by Carla Stecco

This image (Fig. 1)  is from the excellent book, Functional Atlas of the Human Fascial System, by Carla Stecco. In Manhattan two years ago, during the Sports Medicine Acupuncture Certification (SMAC) program, Matt Callison and I were preparing a fresh tissue cadaver specimen for the Anatomy/Palpation/Cadaver lab for Module 3, which addresses the lower back and hip. In this specimen, we observed an interesting fascial expansion which extended from the deep fibers of the gluteus maximus and connected to the hamstrings and sacrotuberous ligament (STL). This was in the region of BL-36. We saw this as confirmation that the gluteus maximus was part of the Urinary Bladder sinew channel.

Fig. 2: Image from
A Manual of Acupuncture
by Peter Deadman

Maybe this seems like an obvious sinew channel in which to place this muscle, but consider that the gluteus maximus also attaches to the iliotibial band (ITB) which is on the lateral leg. Also, this muscle matches the topography described in the Lingshu, which mentions that the Gallbladder sinew channel has a branch that attaches to the sacrum (Fig. 2 and 3). Both of these vectors of pull are discussed in Stecco's book and seen in Fig. 1. The black line (ITB - gluteus maximus - sacrum) describes the GB sinew channel. The red line (hamstrings - gluteus maximus - STL - thoracolumbar fascia and erector spinae) describes the BL sinew channel. So, the gluteus maximus is an example of where two sinew channels converge. Like the primary channels, this kind of convergence is something that occurs with some regularity.

Fig. 3: Image from
An Atlas of Human
Anatomy for
Students and
Physicians by
Carl Toldt

A few clinically useful things can be taken from this:

1) The gluteus maximus MP can be added to treatments that affect the GB sinew channel. These include trochanteric bursitis, iliotibial band friction syndrome, and asymmetrical pelvic tilts (contributing to a host of potential problems). Treatment can include GB distal points.

2) The gluteus maximus MP can be added to treatments that affect the BL sinew channel. These include hamstring and gluteus maximus strain, hamstring tendinopathy, coccydynia, sacroiliac joint problems, and erector spinae strain. Treatment can include BL distal points. 

3) The gluteus maximus MP has an empirical use, which is that it reduces tension in the upper cervical muscles. This is an example of treating below to affect above on the same channel. 

4) The gluteus maximus MP can be considered as a distal point when treating restriction and pain in the pectoralis muscle. The pectoralis major is on the Heart sinew channel, so this can be considered a midday-midnight (GB-HE) treatment. And, there is a branch of the BL sinew channel which also travels through the pectoralis major via the  thoracolumbar fascia - latissimus dorsi - pectoralis major - SCM branch seen in Fig 4. It is not imperative that you know which channel relationship you are affecting, and this topic can be taken up another time. 

5) Lastly, the gluteus maximus becomes bilaterally weak when there are upper cervical vertebral fixations. This is harder to explain easily; I can refer you to an article I wrote that was in the Illinois Association of Acupuncture and Oriental Medicine Newsletter (The Illinois Acupuncturist) and will be in the upcoming Florida State Oriental Medical Association newsletter. This is also posted on my blog and you can click here to see it. 

Basically, I see this problem as an interaction of the Urinary Bladder sinew channel and the Spleen and Stomach sinew channels, and an example of Earth overacting on Water. These sinew channels have an agonist/antagonist relationship. The Stomach and Spleen sinew channels become bound, which restricts the anterior portion of the diaphragm and the deep anterior myofascia (abdominals below, transversus thoracic and hyoids above). This causes tension in key regions of the spine and can lead to vertebral fixations. Certain muscles on the BL sinew channel then become bilaterally weak (the gluteus maximus in the case of upper cervical fixations). In Sports Medicine Acupuncture, we treat upper cervical fixations by using vertebral mobilization techniques for the affected vertebrae, needling SP-4/P-6 (which affects the deep holding pattern) and needling the MP of the gluteus maximus. 

Fig. 4: Image from A Manual of Acupuncture by Peter Deadman

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