a prospective view of the oriental medicine meridians: pathway in which the qi and blood are...

A prospective view of the Oriental medicine Meridians: pathway in which the Qi and blood are circulated in the human body express physiological and pathological phenomenon in the human body The network of the meridians plays an important role in the diagnosis and treatment of a human body Understand diagnostic and therapeutic theory of oriental medicine acupuncture is known to balance the yin and the yang principles of the human body. Muscle meridians: Each meridian has their specific meridian muscle group

Meridians 14 basic meridians: simplified from a complicated Jing-Lo system having 12 regular meridians plus the CV and the GV Upper limb: 3 yin meridians (LU,PC,HT), 3 yang meridians (LI,TE,SI) Lower limb: 3 yin meridians (SP,LR,KI), 3 yang meridians (ST,GB,UB) Linked with others like a net in the whole body Circulation of the Qi and blood the meridians in the human body do not exist independently but they are linked with one another like a net in the whole body

Diagnostic and Therapeutic theory of Oriental medicine ( ) ( ) MMST( ) ( )

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MMST( ) ( ) ( ) ( );ying ( );yang HypomobileHypermobile ( ) ( );inner ( );outer Visceral lesion Somatic lesion ( ) ( );cold ( );heat NeuropathyInflammation ( ) ( );weak ( );strong ChronicAcute

Balance of the yin and the yang acupuncture is known to balance the yin and the yang principles of the human body. This is compatible with the idea of normalization of the sympathetic and parasympathetic dysfunctions of the human body. For improvement of autonomic nervous dysfunction, we use sympathetic switch points and parasympathetic switch points introduced by Joseph Y. Wongs neuro-anatomical approaches. Sympathetic switches: LI4,LI11,LV3,ST36,UB23,GV3,GV14,GV26 etc. Parasympathetic switches: CV24,PC6,HT7,SP6,SP9,UB31 to UB34 etc.

Sympathetic switch point Arteries are rich in sympathetic nerve fibers, particularly the smaller arteries. In the extremities, when the arteries come down to the hands or feet, they form superficial and deep arterial arches. very reactive to sympathetic stimulation(radial artery and deep peroneal artery) The most commonly used sympathetic switches are: 1) LI4,LI11 in the upper extremity 2) LV3,ST36 in the lower extremity

LI4,LI11 in the upper extremity LI4 LI11 LI4 LI11

LV3 in the lower extremity LV3

ST36 in the lower extremity ST36

Para-Sympathetic switch point The parasympathetic nerve fibers are located within the venous and lymphatic system. mainly distributed in the medial aspect of the upper and lower extremities The three yin meridians run along the medial aspect of the extremities and the acupuncture points in these meridians appear to be able to normalize parasympathetic dysfunction The most commonly used parasympathetic switch points: 1)HT7, PC6 in the upper extremity 2)SP6, SP9 in the lower extremity

SP6 in the lower extremity SP6

SP9 in the lower extremity SP9

HT7, PC6 in the upper extremity HT7 PC6

Relation of the meridians and the meridian muscles LULU meridian muscle Biceps brachii Brachioradialis Thenar muscles Pectoralis minor LU10 LU5 LU2 We also use the concept of meridian muscle to explain the methods of assessment about limitation of movment

Myofascial Meridian Test(MMT) If symptoms of musculoskeletal pain and dysesthesia are examined from the above concept ie the expression of tissue strain or failure by limitation of movement on some part of body, this limitation on movement can be examined in association with the myofascial tension line and the meridian line. Objective diagnosis by selecting a specific myofascial tension line related to limitation on certain movement Treatment point selection by applying similarity between the myofascial tension line and the meridian muscle line Myofascial connections postural alignment

The analogy between the myofascial line and the meridian muscle Deep front arm lineLU meridian muscle The meridians, more specifically the meridian muscle group, is also a network system in the human body which controls physiological function similar to myofascial tension lines Deep front arm line travels very similar to Lu meridian muscle.

Limitation of passive movement focused on the limitation or pain on passive movement for the evaluation of the MMT LPM(limitation of passive movement) stiffness elongation .

The MMT Evaluation Cervical : 1.superficial back line:( + / - ) -neck flexion: UB, SI, GV 2.superficial front line:( +/ - ) -neck extension: LI, ST, CV 3.lateral line: Rt( + / - ), Lt( + / - ) -neck side-bending: GB, TE Thoracolumbar : 1.superficial back line:( + / - ) -trunk flexion: UB, GV 2.superficial front line:( +/ - ) -trunk extension: CV 3.lateral line: Rt( + / - ), Lt( + / - ) -trunk side-bending: GB 4.spiral line:Rt( + / - ), Lt( + / - ) -trunk rotation: both GB, UB Upper extremity 1.deep front arm line: Rt( + / - ), Lt( + / - ) -shoulder extension: LI, LU 2.superficial front arm line: Rt( + / - ), Lt( + / - ) -wrist extension: PC 3.deep back arm line: Rt( + / - ), Lt( + / - ) -shoulder elevation: HT, SI 4.superficial back arm line: Rt( + / - ), Lt( + / - ) -wrist flexion: TE Lower extremity 1.superficial back line: Rt( + / - ), Lt( + / - ) -leg elevation: UB 2.superficial front line: Rt( + / - ), Lt( + / - ) -leg extension: ST 3.lateral line: Rt( + / - ), Lt( + / - ) -fabere test: GB, LR,KI, SP Axis Extremities I focused on the limitation or pain on passive movement for the evaluation of the MMT

Approach of postural alignment Head and Neck: forward head/chin up neck rotation Shoulder girdle: humerus head anterior gliding scapular abduction/upward rotation scapular adduction/downward rotation scapular elevation scapular depression Elbow 1 st phalange flexion/ 5 th phalange extension

Approach of postural alignment Lumbo-pelvic-hip complex: low back hypertrophy low back flat low back arch iliac crest height in faber test, femur head anterior gliding in SLR, femur head posterior gliding in prone position, knee flex and lateral rotation

Approach of postural alignment Knee: bowleg knock-knee Foot and Ankle: pronation(eversion) supination(inversion)

T.P(Trigger Point or Treatment Point) through MMT (myofascial line) , (myofascial line) (meridian line) . Postural alignment . physical examination . , . , Myofascial Meridian Test . MMST( ) T.P. myofascial connection meridian pathway MMT meridian point .

Deep front arm lineLU meridian muscle For maintenance of myofascial meridian balance, we have used meridian points selected by the Myofascial Meridian Test (MMT) applying similarity between myofascial lines and meridian muscle lines LI11 LI4 LU1 0 MMT result: Deep front arm line: Rt( + ) -shoulder extension: LI,LU As limitation on passive shoulder extension, We can explain deep front arm line related to LU and LI through analogy between functional anatomy of myofascial line and pathway of meridian muscle. As a result, Trreatment points are LI4,LI11 and LU10

Common Patterns of the MMT from clinical observation Above 80% of all patients; limitation or pain right shoulder passive extension (+), left trunk passive rotation (+), right trunk passive bending (+), trunk passive flexion or extension (+), right fabere test (+), right > left SLR test (+), left > right knee passive flexion (+)

Low back approach Lumbo-pelvic-hip complex Lumbo-pelvic-hip stabilization Core stabilization Lumbar stabilization Pelvic stabilization Postural rotation

Lumbo-Pelvic-Hip complex Stabilization system(core system) if not functioning optimally will end neuromuscular substituting to utilize the strength power and neuromuscular control in the rest of the body. Neuromuscular inhibition -> CNS will shut down prime movers of LPH complex not stabilized -> minimizing the kinetic chain.

Functional anatomy of LPH complex The LPH complex musculature produces force, reduce force, and stabilizes the kinetic chain during functional movements. The core functions primarily to maintain dynamic postural control by keeping the center of gravity over our base of support during dynamic movements.

Lumbo-pelvic-hip stabilization Two important group: inner unit and outer unit Inner unit: pelvic floor, transversus abdominis, multifidus, diaphragm Outer unit: posterior oblique system, deep longitudinal system, anterior oblique system, lateral system Weakness, or insufficient recruitment and/or timing, of the muscles of the inner and/or outer unit reduces the force closure mechanism through the sacroiliac joint.

Lumbo-pelvic-hip stabilization: Inner unit The levator ani and multifidus act as a force couple to control the position of the sacrum. -> the base of the spine is more stable. Contraction of transversus abdominis increases the tension laterally in the thoracodosal fascia and helps to increase the intra- abdominal pressure. -> role in stabilization of the lumbar spine transversus abdominis with outer unit -> increase the tension in the posterior SI ligaments through thoracodorsal fascia ->force closure mechanism

Lumbo-pelvic-hip stabilization: Outer unit posterior oblique system: contralateral latissimus dorsi, gluteus maximus, intervening thoracodorsal fascia ->SI joint compression: contralateral latissimus dorsi, gluteus maximus contract deep longitudinal system: erector spinae, deep lamina of the thoracodorsal fascia, sacrotuberous ligament, biceps femoris ->increase tension in the thoracodorsal fascia and facilitate compression through the SI joint anterior oblique system:oblique abdominals, contralateral adductor, intervening anterior abdominal fascia lateral system:gluteus medius and minimus, adductor, contra-lateral quadratus lumborum

Lumbo-pelvic-hip stabilizing model:force closure mechanism

Lumbo-pelvic-hip stabilizing model: form closure mechanism Trabecular system of the pelvis follows Weight Bearing Lines B.W.

Definition of Core lumbo-pelvic-hip complex with 29 attached muscles where bodys center of gravity is located and where all movement begin in the kinetic chain maintains postural alignment and dynamic postural equilibrium during functional activities provide optimum neuromuscular efficiency by improving dynamic postural control

Composition of Core Inner unit transverse abdominis multifidus pelvic and respiratory diaphragm

Role of Core stabilization Improve dynamic postural control Ensure appropriate muscular balance and joint arthrokinematics Allow functional strength Provide intrinsic stability to the lumbo-pelvic-hip complex, which allows for optimum neuromuscular efficiency of the rest of the kinetic chain

Lumbar stabilization Posterior shearing force Anterior shearing force Compression force DES pull Iliopsoas pull

Pelvic stabilization: locking mechanism Iliolumbar ligament Sacrotuberous ligament Nutation Counter-nutation * More stable than counte-rnutation *Sacratuberous ligament and interosseous ligament tighten *Increasement of ligamentous tension: force closure and compression Efficient load transfer: through pelvic girdle to lower extremity *Long dorsal sacroiliac ligament tightens *SI joint is less compressed and more motor control is required for load transference. Many low back injuries occur in this position

Pelvic tilting mechanism

Lumbo-pelvic-hip muscle imbalance

Exaggerated anterior pelvic tilt with lumbar extension during active knee flexion Compensatory reaction -> lumbar extension Posterior pelvic tilt due to contraction of hamstring -> contraction of hip flexor and paraspinal muscle flexibility stabilizing muscle

Left postural rotation 1.limitation of right rotation -> left side bending (coupling movement) 2.Left DES hypertrophy -> abnormal posterior shearing force & compression Right rotation DES elongation restrict 3.Left side bending limitation - >Quadratus lumbarum elongation TL junction stress - >segmental hyperactivity External & contrallateral Internal oblique m ->rotation

Spinal stenosis Spinal canal or intervetebral foramen: narrowing -> symptom Complex dysfunction: degenerative disc, arthritis, subluxation -> lamina of vertebral arch -> facet joint nerve root Lumbar extension -> symptoms occur

LR3: LR7: LR8:

GB34: GB30: GB28: GB26: GB21: GB20: GB29: GB14: GB43: GB31:

a prospective view of the oriental medicine meridians: pathway in which the qi and blood are...

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lower extremity sp6

muscle meridians

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