CreatingaModernModelfortheAssessmentandTreatmentoftheSinewChannels(Jingjin):Part1Authors:BrianLauAP,C.SMA and MattCallisonL.Ac OneofthemostcommonreasonsWesternersvisitacupuncturistsisforhelpwithacuteandchronicmusculoskeletalinjuryandpain.Often,thesepatientsseekacupuncturetreatmentafternotfindingrelieffromWesternmedicaltherapies.WhileourTCMtrainingdoesofferinsightstohelpimproveinjuryoutcomes,manydifficultcasesarebeyondwhatanacupuncturist'strainingmayinvolve. Mostcurrentacupunctureeducationhasminimalfocusonfunctionalanatomy,orthopedicassessment,mechanismofinjuryandtherolethatposturalandmuscleimbalancesplayinsportsinjuryandorthopedicconditions.ThisismostlikelybecausethesetopicshavenotbeenpartofTCMtrainingsinceacupunctureschoolswerefoundedintheUSover40yearsago.Thishasproducedapopulationoflicensedacupuncturistsmanyofwhomdonotknowhowtodiagnose,treatandmanagesportsandorthopedicinjuries.Afewcurrentpost-graduatetrainingprogramsdoteachthecombineduseofWestern-basedphysicalassessmentsandTCMtreatmentsformusculoskeletalinjuries.1IntheSportsMedicineAcupunctureCertificationProgram,webelievethatinformationgainedfromtheseWestern-basedassessmentscangivevaluableinsightintodevelopingtreatmentprotocols.Everyposturaldysfunction,muscleimbalance,positiveorthopedicevaluation,manualmuscletestandrangeofmotiontestwillprovideasetofpointsthatcanbeusedtotreatpainanddysfunction.TheseprotocolsarecombinedwiththeassessmentoftheindividualwithaTCMdifferentialdiagnosisresultinginacomprehensivetreatmentplan. OneofthetreatmentprotocolswecontinuetodevelopistheuseofWestern-basedphysicalassessmentswiththesinewchannels(jingjin).WestartedourexplorationwithwhatiswritteninChapter13oftheLingshu,theonlychapterinalloftheNeiJingthatdiscussesthesinewchannels.2Someofthedescriptionsinthisclassicaltextdelineatesinewchanneltopographywithclarity,however,manyofthedescriptionsarevagueandcanbeleftuptogreatinterpretation.Therearemodernreferencestothejingjinavailablethatlistmusclegroupsforthesinewchannels,3,4,5butduetothefactthatmuscles,asdescribedinWesternanatomy,werenotdiscussedintheLingshu,someofthemusclesarebasedonauthor'sinterpretation.Itisnotaneasytasktoresearchandinterpretsomeoftheclassicaldescriptionsintocompletemusclelistsbelongingtoeachsinewchannel. Wehavebeenworkingtofurtherdevelopthesinewchannels,andourgoalistodevelopthisintoaclearandcomprehensivemodelwhichisconsistentwithbothtraditionalChinesechanneltheoryandwithmodernWesternanatomicalresearchandfunctionalanatomy.Thisprocessinvolveslistingtheanatomicalstructuresthatareineachchannel,describinghowtheyarelinked,andexploringhoweachsinewchannelfunctionallyinteractswithoneanothertocreatebalancedpostureandmovementor,whenchannelimbalanceexists,canpredisposethebody

toinjury.Part1ofthisarticlewilldiscusshowthesinewchannelsarelinkedthroughthefasciaandhowtheycommunicatefromonemuscletothenext.Part2(inafuturepublication)willdiscusshowcorrespondingsinewchannelsinteracttomaintainpostureandcreatebalancedmovementpatterns.Clinicalexampleswillbegivenillustratinghowdysfunctioncanoccurinasinewchannelandinrelatedsinewchannels.AllofthismaterialwillbepresentedbytheauthorsatthePacificSymposiuminSanDiegothisFall.

Anatomically,thesinewchannelscanbeviewedasmyofasciallycontinuousstructureslinkedthroughthefibrousnetworkoffascia(Fig.1).Whileanatomytextslistmuscleattachmentsthroughthetendonsfromonebonetothenext,therealityismorecomplex:aportionofthemechanicalpullthatamuscleproducesistransferrednottotheoriginandinsertionofthatmuscle,butthroughfascialconnectionstoother muscles.6,7,8Itistheorizedthattheseforcetransmissionscommunicateproprioceptiveinformationbetweenmusclegroupsinordertoperformcoordinatedmovement.9,10,11,12 InThomasMyers’book,AnatomyTrains,MyofascialMeridiansforManualandMovementTherapists,he

categorizesthesemuscleandfasciaconnectionsasmyofascialmeridians.Myersisnotusingtheterm

'meridian'todenoteacupuncturechannels,but,insteadisdescribinginterconnectedmyofasciallycontinuousstructures.13Thesemyofasciallycontinuousstructures,linkedthroughafibrousnetworkoffasciaandhavingadirectconnectionfromonemuscletothenextalongthemyofascialchain,formaclosecomparisontothetraditionalandmoderndescriptionsofthesinewchanneltopography.Inotherwords,myofascialmeridiansare,uptoapoint,congruenttothetraditionallydescribedjingjin. DavidLegge,inhisbookJingjin:AcupunctureTreatmentoftheMuscularSystemUsingtheMeridianSinews,hasexploredthesemyofascialmeridianstocategorizemusclesintothesinewchannels.14Thissourcehasbeeninfluentialtoourwork;however,areviewoffascialresearch,15,16functionalanatomy,ongoingcadaverdissectionsofmyofasciallycontinuousstructures,17andourinterpretationoftheclassicaldescriptions,haveledustosomedifferentconclusionsastowhichmyofascialstructuresbelongtoeachsinewchannel.

Fig.1:Fascialfibersaresharedbetweenthelateralintermuscularseptum,thedeltoids,andthetrapezius.Thisformspartofthecontinuous,meridian-likestructuresoftheLargeIntestinesinewchannel.

Thecontinuousnatureofthesinewchannelscanbestbevisualizedwithasimpletensegritymodel.Thetermtensegrityisderivedfromthetermtensionalintegrityandimpliesthattensionproducestheintegrityofthestructure;theshapeofthestructureisdeterminedbythiscontinuoustension.Thesinewchannelsactasthecontinuoustensionelements(liketheelasticbandsinFig.2a)andthebonesactasthediscontinuouscompressionelements(likethe

woodendowels).Whenthechannelsarebalanced,correctpostureismaintained,allowingforefficientmotionandadequatespacefortheorganstomaintainhealth.Posturalandmuscleimbalancescreateobstructionsinthesinewchannelsthatcanleadtopainanddysfunction(Fig.2b).Theseimbalancescanbetestedwithwestern-basedphysicalassessments(Fig.3)thatleaddirectlytoacupuncturetreatmentprotocols. Strainanddysfunctioncanbeassessedandtreatedprimarilyalongasinewchannel(forexample,asseeninFig.2bwheretheentirebluecordisstrainedfromtoptobottom).AclinicalexampletotreatasinewchannelforthecommoncomplaintofpainatthelevatorscapulaattachmentnearSI13(quyuan)isdescribednextinthisarticle.

Fig.3:Shorteningofthepectoralisminor(LUjingjin)causesscapularprotractionindicatedbyaraisingofLI16(jugu)whenthepatientissupine.

Fig.2aand2b:Tensegritystructurewhichisbalanced(left)andimbalanced(right),illustratingsomeregionsthatareshortenedandothersthatarelengthened.

Strainanddysfunctioncanalsobeassessedandtreatedalongtherelatedsinewchannelswhichareaffected(suchastheothercordsinFig.2b,someofwhicharepulledintoalengthenedpositionandothersintoashortenedposition).Clinicalexamplesofthiswillbeinpart2ofthisarticleandwillexamineinternal/external(biaoli),sixdivision(liujingbianzheng),andmidday-midnight(ziwuliuzhu)sinewchannelcorrespondences. AclinicalexampleoftreatingtheSmallIntestinesinewchannelforpainattheattachmentofthelevatorscapulaintheregionofSI13(quyuan)willhighlighthowthistechniqueisapplied.Orthopedicevaluation,posturalassessment,andpalpationshouldbeusedtodifferentiatethecauseofthepainandcanhelpthepractitionerdeterminewhichchannelisaffected. TheSmallIntestinesinewchannelisamyofasciallylinkedcontinuitythatincludes,fromdistaltoproximal,thefollowingmuscles:

• Abductordigitiminimi • Flexorcarpiulnaris(ulnarhead) • AnconeusandTriceps(medialandlonghead) • Supraspinatus,infraspinatusandteresminor • Levatorscapula

ThepractitionercanpalpatethemotorpointsofthemuscleslistedintheSmallIntestinesinewchannel.Ifthepointsarefoundtobetender,thepractitionercanusethetraditionalneedletechnique,channelashipoint(jingluoci)tohelpreleaseobstructions(myofascialadhesions)inthechannelthatwillhelptoalleviatepain.Itisimportanttonote,theflexorcarpiulnarismotorpointhasanexcellenteffectonrelaxingthetissueofthelevatorscapulaattachment.17 Wefeelthatexpandingacupuncturists'understandingofthesinewchannelsenhancestherapeutictreatmentstrategieswhenworkingwithmusculoskeletalpain.Thereisgreatvalueinexpandingtheclarityofthesechannelsanatomically,andapplyingtheapplicationswehavediscussedinthisarticle.AbouttheAuthorsBrianLau,AP,C.SMA,iscertifiedinbothSportsMedicineAcupunctureandStructuralIntegration.HehasbeenonfacultywiththeSportsMedicineAcupunctureCertification(SMAC)programsince2013.HeisalsoonfacultyatEastWestCollegeofNaturalMedicine,inSarasota,FL.Inadditiontoteaching,heownsandoperatesIdealBalance:CenterforAcupunctureandSportsMedicineinTampa,FL.Hecanbereachedatbrian@ideal-balance.netandhisblogisavailableatdrbrianlau.blogspot.com.MattCallisonisthepresidentoftheSportsMedicineAcupunctureCertificationProgramandhasaprivatepracticeinSanDiego,CA.

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