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.
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.
The
carpal tunnel is created by the concave shape of the volar (palmar side)
surface of the carpal bone which makes up the floor of the carpal
tunnel, and the thick, fibrous flexor retinaculum which makes up the
roof (Fig.1). This structure is like a bow, with the carpal bones forming the
body of the bow and the retinaculum forming the bowstring. If the bow
becomes too flat and looses its concavity, the tunnel becomes narrowed
and the neurovascular structures passing through this tunnel can
become entrapped (particularly the median nerve).
Proper
shape of this bow-like structure is influenced by the Pericardium and
Sanjiao sinew channels. Both of these sinew channels include the
finger and thumb flexors and extensors (P – flexors, SJ –
extensors) and the forearm pronators and supinators (P –
pronators, SJ – supinators). How these muscles interact affect the
relationship of the radius and ulna which, in turn, affects the shape
of the tunnel.
Fig. 2: Pronator quadratus on the
volar side of forearm.
Imagine
that you are typing with the wrist extended and the forearm pronated.
The extension of the wrist tends to flatten the carpal tunnel and
rolls the ulna and radius away from the volar side of the arm. The
pronator quadratus muscle, located at the distal portion of the
forearm, is uniquely positioned to pull the radius and ulna in the
opposite direction, rolling them towards the volar side and
maintaining the integrity of the tunnel (Fig. 2). If this muscle becomes
inhibited, it fails to maintain the proper relationship between the two
bones, and the carpal tunnel loses its depth leading to a compression
of the median nerve and a greater possibility of paresthesia in the
median nerve distribution of the palm and fingers.
Many
acupuncturists use a threading technique through the flexor
retinaculum at P-7. This technique is effective in creating space in
the carpal tunnel. An additional technique, developed by Matt Callison and taught in the Sports
Medicine Acupuncture Certification program, addresses the inhibited pronator quadratus muscle. This is
done if it is determined that the pronator quadratus is indeed
inhibited. The needling technique for the motor point of this muscle,
which will help to wake it back up and bring it back into the
neurological loop, is a bit tricky as the motor point lies directly
deep to the median nerve at P-6. So, one can't simply drive the
needle deep into P-6 to reach it without risking damage to the median
nerve. This technique is best discussed and demonstrated in a class
setting. It is a very effective technique and can improve clinical
results because of its strong action on the pronator quadratus, so that it can have a profound effect on the relationship of the radius and ulna, and can add integrity to the carpal tunnel.
Fig. 3: An old-fashion pup tents which is a tensegrity structure. The tension from the guy wires give the structure integrity, much like the shape of the carpal tunnel is given integrity by the balanced pull of the pericardium and sanjiao sinew channels.
An
analogy to consider for proper balance and integrity of the carpal
tunnels is an old-fashioned pup tent. These tents require a balanced
tension in the guy wires to stabilize the shape of the tent (Fig. 3). This
balanced tension creates an open space inside the tent. If the guy
wire tension is unbalanced, one side is too short and tight and the
other too slack, the tent will lose its shape and sag. This is very
much the same with the open shape of the carpal tunnel, and it is the
muscles of the pericardium and san jiao sinew channels that create a
balancing pull to maintain the integrity of the tunnel. Imbalance
between these channels will lead to a less than optimal shape and
increase the chance of compression of the structures traveling
through the tunnel. So it is important to look for imbalances
between these two channels and treat accordingly.
The rhombo-serratus
muscle sling is a fascially bound structure consisting of the
serratus anterior and the rhomboid major.1 The serratus
anterior travels anterior to the scapula to attach to the medial
border of the scapula, just next to the attachment of the
rhomboids. Fascial fibers are shared between these two structures and
their continuity can be observed in dissection (Fig. 1).
Fig. 1
Fig. 2: From A Manual of Acupuncture
by Peter Deadman
This sling can be
considered as part of the Pericardium sinew channel, though its
function is more consistent with the Sanjiao sinew channel, and it
plays an important role in scapular movement during overhead
activities. The Pericardium sinew channel is described in the Lingshu
as traveling from the arm and
“ascends the yin side of the upper arm to connect with the bottom
of the armpit, and spreads down to the front and the back by clasping
ribs.2 Deadman, in A Manual of
Acupuncture, describes it like this: “follows the antero-medial
side of the upper arm to disperse over the anterior and posterior
aspects of the ribs.3
Fig. 3
Functionally,
this sling works synergistically both to move the scapula into upward
rotation (primarily controlled by the serratus anterior) while also
stabilizing against the lateral pull (primarily controlled by the
rhomboids).4
In other words, the serratus
anterior is the prime mover for upward rotation, while the rhomboids
fire to a lesser degree to resist the lateral pull on the scapula
produced by the serratus anterior.
This
entire action takes place with abduction of the humerus at the
shoulder joint and is an important movement as it prevents impingment
of the rotator cuff, subacromial bursa, and biceps tendon. With
abduction past 30o,
there is 1o
of upward rotation or the scapula for every 2o
of abduction or flexion
of the humerus. This 2:1
ration is known as scapulohumeral rhythm, and it
keeps the subacromial space open, as can be seen in the animation
below.
The
serratus anterior often becomes inhibited and fails to take the
scapula into upward rotation, therefore contributing to impingement.
The upper
trapezius also assists with this movement and it can be part of the
problem, too. The
upper trapezius is a muscle where the Sanjiao and
Gallbladder sinew channels converge.
Fig. 4
So,
the rhombo-serratus
sling and the upper trapezius
coordinate to produce upward
rotation of the scapula. When
these structures do not fire properly, they fail to bring the scapula
into upward rotation with either humeral abduction or flexion.
Although the rhombo-serratus
sling is best attributed to
the Pericardium sinew channel, SJ-5/GB-41
is a useful point combination to use distally to assist when there is
inhibited action of these muscles. These points can be used with one
of the motor points of the
serratus anterior (SP-21 and GB-22, 23 are often reactive motor points) along with the motor point of
the upper trapezius which is often needled by threading from
SJ-15-GB-21.5 Proper training is required for all of these techniques so that the needle does not advance into the pleural space.
References
1.
Myers,
Thomas W. Anatomy
Trains: Myofascial Meridians for Manual and Movement Therapists.
3rd ed. Edinburgh: Churchill Livingstone, 2014. Print.
2.
Legge,
David, and Karen Vance. Jingjin:
Acupuncture Treatment of the Muscular System Using the Meridian
Sinews.
Sydney: Sydney College, 2010. Print.
3.
Deadman, Peter, Mazin Al-Khafaji, and Kevin Baker. A Manual
of Acupuncture. Hove, East Sussex, England: Journal of Chinese
Medicine Publications, 2007. Print.
4.
Phadke,
V, PR Camargo, and PM Ludewig. “Scapular and Rotator Cuff Muscle
Activity during Arm Elevation: A Review of Normal Function and
Alterations with Shoulder Impingement.” Revista
brasileira de fisioterapia (Sao Carlos (Sao Paulo, Brazil))
13.1 (2009): 1–9. PMC.
Web. 21 Mar. 2016.
5.
Callison,
M. (2007). Wrist and fingers. In Motor
point index: An acupuncturist's guide to locating and treating motor
points(p.
90). San Diego, CA: AcuSport Seminar Series LLC.
