AC 521L Anatomical AC 521L Anatomical Acupuncture IIIAcupuncture III

THE TWELVE MUSCLE THE TWELVE MUSCLE REGIONSREGIONS

•• They circulate on the periphery of the body.They circulate on the periphery of the body.

•• Do not pertain to the ZangDo not pertain to the Zang--fu.fu.

•• They are associated with and take their names from the They are associated with and take their names from the twelve regular meridians.twelve regular meridians.

•• There are three Yin and Yang muscle meridian of the There are three Yin and Yang muscle meridian of the arm, and three Yin and Yang muscle meridian of the leg. arm, and three Yin and Yang muscle meridian of the leg.

•• All originate at the All originate at the extremitiesextremities (unlike regular meridians) (unlike regular meridians) and ascend to the head and trunk.and ascend to the head and trunk.

•• They usually follow the course of their associated regular They usually follow the course of their associated regular meridians but are wider.meridians but are wider.

•• They are more superficial and include major muscles They are more superficial and include major muscles and muscle groups, tendons, ligaments etc.and muscle groups, tendons, ligaments etc.

PathwayThey tend to follow the distribution of their respective regular meridians. The yang muscle regions are distributed along the back, head and posterior aspect of the limbs, while the Yin muscle regions are distributed along the anterior aspect of the limbs and enter thoracic and abdominal cavities.

They originate in the extremities and ascend to the head and trunk.

The three Yang muscle region of foot are distributed in the anterior, lateral and posterior aspect of the trunk, all connecting with the eyes.

The three Yin muscle regions of the foot connect with the genital regions.

The three Yang muscle region of hand connect with the angle of forehead.

The three Yin muscle regions of hand connect with the thoracic cavity.

THE LUNG SINEW CHANNEL

• originates on the thumb at Shaoshang LU-11 and ascends to bind at the thenar eminence,• follows the radial pulse and ascends the flexor aspect of the forearm to bind at the centre of the elbow,• continues along the antero-lateral aspect of the upper arm to enter the chest below the axilla,• emerges in the region of Quepen ST-12 and travels laterally to the shoulder, anterior to L.I.-15,

• returns to the supraclavicular (Quepen ST-12) region and descends into the chest,

• spreads over the diaphragm and converges in the region of the floating ribs.

Pathological symptoms of the Lung sinew channelCramping and pain along the course of the channel.When severe there is accumulation of lumps below the right lateral costal region, tension along the lateral costal region and spitting of blood.

THE LARGE INTESTINE SINEW CHANNEL• begins at the tip of the index finger at Shangyang L.I.-1 and binds at the dorsum of the wrist,• ascends the forearm and binds at the lateral aspect of the elbow,• ascends the upper arm to bind at the shoulder,• a branch winds around the scapula and attaches to the upper thoracic spine,• from the shoulder the main channel ascends to the neck from where a branch ascends across the cheeks to bind at the side of the nose, whilst,• the main channel ascends anterior to the Small Intestine sinew channel, crosses the temple to the corner of the forehead, and crosses over the top of the head to connect with the mandible on theopposite side.

Pathological symptoms of the Large Intestine sinew channelCramping and pain along the course of the channel, inability to raise the shoulder, inability to turn the neck to the left or to the right.

THE STOMACH SINEW CHANNEL

• begins at the middle three toes and binds on the dorsum of the foot,

• ascends along the lateral aspect of the tibia and binds at the lateral aspect of the knee, connecting with the Gall Bladder sinew channel,• ascends to bind at the hip joint,• passes through the lower ribs into the spine.

A branch• runs along the tibia and binds at the knee,• ascends the thigh and binds in the pelvic region above the genitals,• ascends the abdomen and chest and binds at Quepen ST-12,• ascends the neck to the jaw, mouth and side of the nose and binds below

the nose,• joins with the Bladder sinew channel to form a muscular net around the eye, known as the 'lower net' (the Bladder sinew channel forms the ‘uppernet').A sub-branch• separates at the jaw and binds in front of the ear.

THE STOMACH SINEW CHANNEL

Pathological symptoms of the sinew channel

Strained middle toe, cramping of the lower leg, spasmodic twitching and hardness of the muscles of the foot, spasm of the thigh, swelling of the anterior inguinal region, shan disorder, abdominal sinew spasm that extends to the Quepen [supraclavicular fossa] region and cheek, sudden deviation of the mouth, [if cold] inability to close the eye, [if hot] laxityof the sinews and the eye cannot be opened. If the cheek sinew has cold, it will be tense and pull the cheek, and the mouth will be deviated; if there is heat then the sinews become flaccid and this will result in deviation of the mouth.

THE SPLEEN SINEW CHANNEL

• begins at the medial side of the big toe at Yinbai SP-1 and ascends the foot to bind at the medial malleolusat Shangqiu SP-5,• ascends the medial aspect of the tibia to bind at the medial side of the knee at Yinlingquan SP-9,• follows the medial face of the thigh to bind in the groin before converging at the external genitalia,• ascends the abdomen to bind at the umbilicus,• enters the abdomen, binds at the ribsand spreads in the chest, • from the inside of the chest a branch adheres to the spine.

Pathological Symptoms of the Spleen sinew channelStrained big toe, pain of the medial malleolus, pain and cramping (along the course of the channel), pain of the medial aspect of the knee, pain of the medial thigh that reaches the inguinal region, twisting pain of the genitals that may reach the navel and the lateral costal region or lead to pain of the chest and interior spine.

THE HEART SINEW CHANNEL• originates at the radial aspect of the little finger and binds at the pisiform bone of

the wrist,• ascends to bind first at the medial aspect of the elbow and then at the axilla,• enters the axilla, intersects the Lung sinew channel and travels medially across the breast region to the centre of the chest,• descends across the diaphragm to terminate at the umbilicus.

Pathological symptoms of the Heart sinew channelInternal tension, accumulation below the Heart, pain, cramping and strain along the course of the channel.

THE SMALL INTESTINE SINEW CHANNEL

• originates on the dorsum of the little finger,• binds at the wrist,• ascends the ulnar side of the forearm to the elbow where it binds at the medial condyle of the humerus,

• ascends the arm to bind at the axilla,• travels behind the axilla and surrounds the scapula,• ascends the neck, anterior to the Bladder sinew channel, to bind at the mastoid process,• ascends to behind the ear where a sub-branch entersthe ear,• continues to ascend behind the ear to the region above the ear where it then descends to bind at the mandible,• ascends across the teeth to bind at the outer canthus,• ascends to bind at the corner of the head near Touwei ST-8.

Pathological symptoms of the Small Intestine sinew channelStrained little finger, pain along the medial aspect ofthe elbow and upper arm, pain below the axilla and onthe posterior aspect of the axilla, pain of the scapulathat reaches the neck, tinnitus, pain of the ear that mayreach the submandibular region, a need to close theeyes for a long period of time before being able to seeclearly, tension of the neck sinews that leads to sinewatrophy and swelling of the neck.

THE BLADDER SINEW CHANNEL• originates at the little toe and ascends past the lateral malleolus, and then ascends to bind at the (lateral aspect of) the knee,• another branch separates below the lateral malleolus and binds at the heel, then ascends along the Achilles tendon to the lateral aspect of the popliteal fossa,• another branch separates from this branch in the calf (at the convergence of the two heads of the gastrocnemius muscle) and ascends to the medial aspect of the popliteal fossa,• the two branches join in the gluteal region and ascend to bind at the buttock,• the channel then ascends laterally along the spine to the nape of the neck, where a branch penetrates to bind at the root of the tongue,• the main ascending branch continues upwards to bind at the occipital bone, and ascends over thecrown of the head to bind at the bridge of the nose, then circles the eye and binds at the cheek bone,• another branch separates on the back and ascends to the medial side of the posterior axillary crease, then binds at Jianyu L.I.-15,• another branch crosses beneath the axilla and ascends the chest to emerge at the supraclavicularfossa, then ascends to bind at Wangu GB-12 behind the ear, and finally another branch, after emerging from the supraclavicular fossa, rises to the cheek bone alongside the nose.

Pathological symptoms of the Bladder sinew channelStrain of the little toe, pain and swelling of the heel, spasm of the popliteal region, opisthotonos, spasm and tension of the nape of the neck, inability to raise the shoulder, strain of the axilla, pain and strain of the supraclavicular fossa.

THE KIDNEY SINEW CHANNEL• begins beneath the little toe and joins the Spleen sinew channel at the inferior aspect of the medial malleolus,• binds in the heel where it converges with the Bladder sinew channel, then ascends the leg and binds at the medial condyle of the tibia,• joins with the Spleen sinew channel and follows the medial surface of the thigh to bind at the genitals.

A branch• travels internally to the spinal vertebrae, ascends the inner aspect of the spine to the nape of the neck where the channel binds to the occipital bone, and converges with the Bladder sinew channel

Pathological symptoms of the Kidney sinew channelCramping of the bottom of the foot, cramping and pain along the course of the channel, convulsion and spasm associated with epilepsy. If the disease is on the exterior the patient cannot bend forward, if the

disease is on the interior the patient cannot bend backwards.Thus in a yang disorder there will be inability to bend the lumbar spine forwards, whilst in a yin disorder here will be inability to bend the lumbar spine backwards.

THE PERICARDIUM SINEW CHANNEL• originates at the tip of the middle finger and runs together with the Lung sinew

channel to bind at the medial side of the elbow,• follows the antero-medial side of the upper arm to below the axilla where it binds before descending to disperse over the anterior and posterior aspects of the ribs,• a branch enters the chest below the axilla, dispersing in the chest and binding at the diaphragm.

Pathological symptoms of the Pericardium sinew channelStrained and cramping sensation along the course of the channel, pain of the chest with urgent breathing and an ‘inverted cup sensation’ below the lower right ribs.

THE SANJIAO SINEW CHANNEL

• begins at the ulnar side of the ring finger

and binds at the dorsum of the wrist,• follows the posterior aspect of the arm and binds at the tip of the elbow,• ascends the lateral aspect of the upper arm and over the shoulder to the neck where it joins with the Small Intestine sinew channel.A branch• separates at the angle of the mandible and enters internally to link with the root of the tongue.

Another branch• ascends anterior to the ear to join at the outer canthus of the eye,• then ascends across the temple to bind at the corner of the forehead.

Pathological symptomsStrained and cramping sensation along the course of the channel, curled tongue.

THE GALL BLADDER SINEW CHANNEL• begins at the fourth toe and binds at the lateralmalleolus,• ascends the lateral aspect of the leg to bind at thelateral aspect of the knee,A branch• begins in the upper portion of the fibula and ascendsalong the lateral aspect of the thigh.A sub-branch• runs anteriorly to bind in the area above Futu ST-32.Another sub-branch• runs posteriorly and binds at the sacrum.The vertical branch• ascends across the ribs and travels anteriorly to theaxilla, linking first with the breast and then bindingat Quepen ST-12.Another branch• ascends from the axilla and passes through QuepenST-12,• ascends anterior to the Bladder channel, passingbehind the ear to the temple,• continues to the vertex where it meets with itsbilateral counterpart.A branch• descends from the temple across the cheek andbinds at the side of the nose.A sub-branch• binds at the outer canthus.

Pathological symptoms of the Gall Bladder sinew channel

Strain and cramping of the fourth toe leading tocramping of the lateral aspect of the knee, inability toextend and bend the knee, spasm of the poplitealregion, in the front leading to spasm of the upperthigh, and in the back spasm of the sacrum, radiatingto the lateral costal region and the area below thelateral costal region; spasm of the supraclavicularfossa, the sides of the neck and the neck. If one looks to the right, then the right eye will not open and viceVersa.

THE LIVER SINEW CHANNEL• originates on the dorsum of the big toe, and ascends to bind at the anterior aspect of the medial malleolus,• proceeds along the medial aspect of the tibia to bind at the medial condyle,• continues upwards along the medial aspect of thethigh to the genitals where it connects with othersinew channels.

Pathological symptoms of the Liver sinew channel

Strain of the big toe, pain anterior to the medial malleolus, pain of the medial aspect of the knee, spasm and pain of the medial aspect of the thigh, dysfunction of the genitals (with internal injury there is inability to have an erection, with injury by cold there is retraction of the genitals, with injury by heat there is persistent erection).

THE TWELVE CUTANEOUS REGIONS

The twelve cutaneous regions are not channels as such, but skin regions

overlying the broad network of superficial meridians and linked to them. These regions refer to the sites through which the Qi and blood of the meridians are transferred to the body surface.

They are the part of the meridian system located in the superficial layers of the body. They are marked by the regular meridians.Their significance is systemic and local. Systemically, as the most superficial of the body tissues, the skin maintains continuous and direct contact with the external environment.

Locally the cutaneous regions are distinct areas on the skin within the domain of the twelve regular meridians and Collaterals.

Pathological symptoms associated with the Regular and collateral will often appear as local manifestations along the surface of their related cutaneous regions.

THE TWELVE CUTANEOUS REGIONS

Function

Cutaneous regions manifest disorders of the deep lying meridians via abnormal skin sensations, lesions or discoloration.

Bluish-purple indicates pain, red color indicates heat, and white color indicates deficiency and cold.

Recently local fluctuations in the electroconductivity of the skin are all useful signs in diagnosing disease associated with the meridian transversing the affected Cutaneous region.

Protective Qi circulates through the superficial layers of skin; the disease of external origin which first lodges in skin can be expelled by stimulating Wei Qi in the affected Cutaneous region.

The treatment applied at the level of skin (e.g. medicinal ointment, massage, cupping, etc) is able to have a deep therapeutic effect.