© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Acupuncture Treatment of

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The 经 Jīng 筋 Jīn

(“Sinew Meridians”):

Introduction

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© Anthony Von der Muhll, L.Ac., DAOM, DNBAO, FAIPM

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AOM ⇒ AIM, TEAHM

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• “Oriental” (as in “Acupuncture and Oriental Medicine (AOM)) has both historical and contemporary pejorative and racist uses by Euro-American colonialists in the Far East.
• Many US-based medical organizations (including AOM Professional) have historically used “Oriental” and “AOM” as standard terminology without ill intent, but now recognize that they must be replaced by terms intended to better describe without offending.
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My Journey to Teaching this Material

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• Worked as sports massage therapist, physical therapy aide, and athletic training assistant, 1998-2005
• Graduated from Five Branches University, (FBU), California w/MTCM & licensed in 2003; 1st grad of FBUs’ Sports Medicine Certification Program. Supervised in FBU’s Sports Medicine clinic 2005-2018
• Founded Santa Cruz Acupuncture Orthopedics & Sports Medicine Clinic in 2003; continuous practice, including in physician-led physiatry and pain clinics
• National Board Certification in Acupuncture Orthopedics (300 hours) 2006, through Lerner Education.
• Certified Personal Trainer, American College of Sports Medicine, 2006
• Integrative Acupuncture Orthopedics program (96 hours) with Alon Marcus, L.Ac., 2006
• Self-study and use of gua sha, cupping, myofascial trigger and motor point needling 2012+
• Fellow, Academy of Integrative Pain Management (multi-disciplinary, now defunct), 2014
• Certified as Myofascial Trigger Point Therapist, Myopain Seminars (90-hour Dry Needling program) 2017
• Teaching integrative acupuncture orthopedics and pain management in DACM and DAOM programs of Five Branches University, Academy of Chinese Culture and Health Sciences, American College of Traditional Chinese Medicine, and Virginia University of Integrative Medicine
• And most important: injuries from running, cycling, swimming, rock climbing, sitting, driving, intermittent stress, performing acupuncture and massage, picking up babies, etc., i.e. life!

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经 jīng 筋 jīn:

“Sinew Meridians?”

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12 jing-jin first described in Nei Jing Ling Shu (NJLS) Ch. 13, as paired with the 12 jing-luo

• No elaboration re: relationships between jing-luo (“primary meridians”) and jing-jin
• Jing-jin do not have their own xue (“points”)
• Most xue are located within the jing-jin
• No further known mention of jing-jin in Chinese texts, until modern summaries of classics appear in late 20th century

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

经 Jing: Mis-translations?

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• “Meridians?” (Merriam-Webster.com)
• “Any imaginary semicircle on the earth's surface reaching from the north pole to the south pole. 2 : Representation of a meridian on a map or globe numbered according to degrees of longitude.”
• “Vessels?” (Merriam-Webster.com)
• “A ship or large boat”
• “A hollow container used to hold liquid, a bowl or cask”
• “Channels?” (Merriam-Webster.com)
• “A length of water wider than a strait, joining two larger areas of water, especially two seas.”
• “A band of frequencies used in radio and television transmission, especially as used by a particular station.”

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

筋 Jing: How about “tracts?”

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• “A major passage in the body, large bundle of nerve fibers, or other continuous elongated anatomical structure or region” (Google.com)
• “A system of body parts or organs that act together to perform some function: the digestive tract; a bundle of nerve fibers having a common origin, termination, and function.” (Merriam-Webster.com)
• “A definite region or area of the body, especially a group, series, or system of related parts or organs” (dictionary.com)

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

筋 Jīn: Translation?

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• Complex ideograph composed of:
• Rou = flesh, including muscular tissue
• Li = tendons, physical strength and power
• Zhu = literally “bamboo;” used to denote jointed chain of segments
• Sinew? Archaic literary term that doesn’t include muscles...
• Myofascial: “Of or relating to the fasciae of muscles” (Merriam-Webster)
• Jing-jin: “Myofascial tracts?”

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Sources

& Resources for Studying the Jing Jin

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Nei Jing translations and commentaries:

• Acupuncture A Comprehensive Text. Shanghai College of Traditional Medicine. Trans. O'Connor, John, Bensky, Dan, 1981.
• The Dao of Chinese Medicine: Understanding an Ancient Healing Art, Donald E. Kendall.
• Peer-reviewed, rigorously-referenced translation and discussion of the Neijing Suwen
• Jing Jin: Acupuncture Treatment of the Muscular System using the Meridian Sinews. David Legge.
• Translation and detailed analysis with treatment protocols as described in the NeiJing SuWen.

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Contemporary correlates:

• Anatomy Trains: Myofascial Meridians for Movement Therapists, Thomas Myers
• Dissection-based analyses that closely resemble the “sinew tracts.” Excellent graphics.

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Modern Description of the Jing Jin

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“Every joint has groups of counter-functioning, yet complementary muscles (i.e., the muscles of extension and flexion, abduction and adduction, internal and external rotation) whose balanced interaction maintains normal movement. When the Yang is distressed, [the muscles] over-extend; when the Yin is distressed, [the muscles] over-contract….When there is Cold, the muscles become tense; when there is Heat, the muscles become lax.”

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Acupuncture: A Comprehensive Text. Shanghai College of Traditional Chinese Medicine. O’Connor and Bensky, trans. Eastland Press, 1981.

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Structure of the Jing-Jin (NJLS Ch. 13)

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• Follow roughly the same pathways as associated jing-luo, along both the torso and extremities
• Areas of “knotting,” “tying” or “binding;” to what is unclear
• Some jing-jin have branches
• Not described as “more superficial” or “secondary” to the jing-luo (which are not described as “primary”)
• Su Wen Ch. 43 places the jing-jin at deepest level, just above bones

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Deep/

Central

Superficial/

Peripheral

Why Study and Treat the Jing-Jin?

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• Myofascial pain and disability may not respond adequately to treatment of the jing-luo xue, zang-fu, shen, etc. unless the jing-jin are examined and treated directly
• Classical xue locations do not always correlate with the underlying jing-jin (see next slide) and may be less clinically-significant than locations discovered by examining the jing-jin

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• Injuries and imbalances (pain and disability) in the jing-jin can affect the jing-luo, zang-fu, shen, etc. -- and vice-versa

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

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3 Yin jing-jin

Deep posterior compartment

Invertors/

flexors

Yangming jing-jin

Anterior

Dorsiflexors

Shaoyang jing-jin

Lateral

Evertors

Taiyang jing-jin

Superficial posterior Plantarflexors

K 9

Jing-Jin: Western Correlates

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• Structural: “Anatomy Trains...a ‘longitudinal anatomy’ [of] tensile straps and slings” (Meyers 2009); continuities of muscles & fascia
• Identified by dissection studies
• Functional: Kinematic chains: an assembly of bones connected by joints, spanned by muscle-tendon units, produce & control motion
• Identified by kinesiological analysis
• Muscle electro-myelogram (EMG) studies
• Force output measurements
• Videography studies

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Jing-Jin as Kinematic Chains

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• Biomechanical movements, forces, loads are transmitted through joints from segment to segment along the jing-jin
• Joint and muscle abnormalities affect stability and transmission of forces along the jing-jin
• Pain and disability propagate longitudinally, and can affect adjacent jing-jin
• Limb joints are convergences of the jing-jin
• Small joints may involve just 1-2, eg. thumb IP joint: hand taiyin, yangming
• Larger joints involve all 6, e.g. knee, shoulder

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• Clinically-useful descriptions focus on muscle functions that are:
• Primary, frequent and clinically-significant;
• Distinctive, unique or near-unique;
• Agreed-upon and non-controversial;

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Which Jing-Jin does this muscle “belong” to...?

vs. secondary, uncommon, clinically-insignificant, duplicative, or controversial functions

Muscle Functions: Multiple, Controversial

Factors include:

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• Whether they are contracted unilaterally vs. bilaterally
• Whether the limb position/motion is:
• Closed-chain (e.g. leg planted on ground) vs.
• Open chain (e.g. foot waving in air)
• Whether the muscle is contracting to:
• Produce motion (shortening, concentric)
• Maintain current position (no change in length, isometric)
• Decelerate motion (resisting elongation, eccentric)
• What role they are playing in movement and how other muscles are/are not being co-contracted

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Agonists, Antagonists, Synergists, Fixators

Any given muscle can function as:

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• Agonist: primary muscle performing a motion
• Antagonist: opposing action of another muscle
• Synergist: assisting or collaborating with agonist
• Fixator: stabilizing a joint or other structure, so that other muscles can contract more efficiently

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Which muscles are functioning as agonists, antagonists, synergists, and fixators during a push-up?

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Agonist: triceps

Synergist: anconeus

Synergist: extensor carpi radialis longus

Antagonists: biceps, brachialis, brachioradialis

Fixators: pectoralis minor

serratus anterior

(+ abdominal & spinal musculature)

Can a muscle form part of > 1 jing-jin?

Yes....the erector spinae, for example:

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• Primary function: contract bilaterally as agonists to extend and maintain the spine in upright posture against gravity: open-chain, concentric, isometric, or eccentric contraction
• Taiyang jing-jin function
• Also contract unilaterally as synergists to assist the oblique abdominals with rotating the spine, particularly when against resistance: closed-chain
• Shaoyang jing-jin function
• Act as fixators to hold the spine neutral during “push-up:” isometric
• Shaoyin jing-jin function
• ES are most usefully and ordinarily considered taiyang,
• (ES are also superficial at the posterior aspect of the body: taiyang location)

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Reconciling Translations & Contemporary Studies

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• Discrepancies exist among translations of NJLS Ch. 13 re: jing-jin
• Contemporary anatomy and kinesiology studies also show controversies and variability
• Functional/kinesiological analysis is more clinically relevant than static anatomy and dissection studies

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

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3 Yang Jing-jin: The Big Picture

© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

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3 Yin Jing-jin: the Big Picture

© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

How Useful are These “Big Picture” Images?

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• Where to examine along longitudinal myofascial tracts for problems that contribute to a symptomatic region
• Provide an approximate sense of functional relationships between tracts
• Missing precision regarding muscles, joints, fascia: where to needle
• To guide clinical treatment, we need more detailed descriptions and analysis of muscle, joint and fascia structure and function
• Consistency regarding which jing-jin a muscle, joint or fascia “belongs” to is less important than understanding how to find and treat them effectively

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Example: Leg Taiyang

Posterior Myofascial Tract

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• Posture: counterbalances against gravity to keep us upright and prevent collapsing into fetal position
• At ankles and above knees: counterbalance dorsiflexion or ankles, flexion of hips & spine
• At knees: counterbalances knee extension
• Movement:
• Below knees: forward and upward propulsion
• Above knees: extend hips, spine; restrain flexion

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Plantar fascia

Soleus

Gastrocnemius

Hamstrings

Sacro-tuberous ligament

Gluteus maximus

Erector spinae

Trapezius

Splenius & semispinalis cervicis & capitis

Gala aponeurosis

Thoraco-lumbar fascia

Latissimus dorsi

Muscles

Connective tissue

Achilles tendon

Suboccipitals

Leg Taiyang

Occipito-frontalis

© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Classical Symptoms of Jing-Jin Disorders

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• Pain, contractures, cramps, spasms, stretching or pulling sensations
• Sometimes described as “wrapping around,” “following” “traveling” along specific routes...
• Myofascial trigger point referred pain?
• Sclerotomal pain from deep connective tissue structures?
• Dermatomal (neuropathic) pain?
• Motion dysfunctions and limitations: “inability to…”
• Swelling
• Tremors

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Unique Symptoms of Yang Jing-Jin Disorders

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• Symptoms of the eye, mouth and tongue suggestive of strokes and facial paralysis

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Classical Physical Exam

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“Before using needles, one must first scrutinize the channels to determine excess or deficiency. One must separate and palpate. One must press and pluck. Observe how the channel responds and moves before continuing.” Ling shu Ch. 75.

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© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Classical Interpretation of Palpatory Findings

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• Unilateral, asymmetric, localized findings: suggests jing-jin disorder
• Bilateral, symmetrical widespread findings: suggests zang-fu disorder
• Superficial, small, soft, mobile abnormalities: recent, functional, mild disease
• Qi stagnation > blood stagnation; dampness
• Deep, large, hard, immobile nodules: chronic, structural injury; serious disease
• Blood stasis
• Phlegm nodules
• Blood & phlegm knotted together ( ~ scar tissue, arthrosis)
• Unevenness, bumpiness of channel: zang-fu disorder

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Uh oh….

© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Clinically-Significant Tenderness

“Ah-shi” = “Eureka!” (not just any tender area)

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• Pressure reproduces patient’s key/typical symptoms and/or propagation of sensation along jing-jin
• Myofascial trigger point referred pain patterns?
• Sclerotomal patterns of pain referred from injured joint structures?
• Neural patterns: plexotomes, dermatomes, or peripheral nerve distributions?
• Pressure may provoke numb, tingly sensations
• Pressure provokes reflexive responses: wincing, flinching, withdrawal
• No tenderness ≄ not injured
• Old ligament sprains can be “silent,” but cause biomechanical problems

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Classical Treatment of the Jing-jin:

Nei jing ling shu Ch. 13

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“Apply rapid insertion and withdrawal of...the heated needle✱, and cease when the puncturing begins to effect a cure, irrespective of the period of treatment. Insert needles into tender spots on the diseased area.”

Trans: David Legge (emphasis added)

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Modern survivals:

• Channel palpation acupuncture (Dr. Wang Juyi)
• Ah shi acupuncture (Jing Chen/Eric Schanke)

✱ Note: cauterization outside of L.Ac. scope

Jing Jin Treatment Methodology

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Identify symptomatic jing-jin

Palpation & inspection examination findings

Treatment of all abnormalities identified on exam

Re-examination

Emphasis on skilled physical examination and treatment of abnormal findings. Diagnosis “through treatment” may emerge through inductive reasoning, but is not necessary for treatment.

TCM Treatment Methodology (Simplified)

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Symptoms

TCM Pattern

(eg yin xu)

Treatment Principles

TCM Disease

(eg bi syndrome)

Signs

(Exam findings)

(Western Disease, eg arthritis)

Prescriptions

Treatments

(Signs and symptoms that don’t appear to be part of primary pattern/disease may be neglected)

Emphasis on theoretical knowledge, formulating hypothesis, and skillful application of protocols (deductive reasoning).

Diagnosis is necessary to guide treatment.

© Anthony Von der Muhll, L.Ac, DNBAO, FAIPM ☯ info@aomprofessional.com

Treating the Jing-Jin

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• Ahshi/trigger point treatment
• Trigger point and fascial plane needling
• Gua sha, tui na, cross-fiber massage, myofascial release
• Orthopedic cupping: passive and active mobilization w/suction cups
• Stretching (dao yin), strengthening exercises
• Joint stabilization and mobilization needling: for ligaments, meniscii, joint capsules (“prolo-acupuncture”)

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Orthopedic Acupuncture: Ancient & Modern

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Locating AhShi/Myofascial & Joint Trigger Points:

Recognizing the target zone when needling

Reproduct- ion of typical Sx: THE pain

Provocation of

referred pain

Twitch responses

Significant tenderness: reflexive grimacing, wincing

Mild or no tenderness; no twitch response, symptom reproduction, or referred pain

Additional Safety Training for L.Ac.s?

• Needling locations/angles/depths in some muscles/joints may require additional safety training in ogaan & neuro-vascular anatomy, for needling
• Face: medial pterygoids, digastric
• Neck: rectus capitis, scalenes, SCM, longus colli, levator scapula, trapezius; facet joints
• Shoulder: subscapularis, serratus anterior, t. Major; sterno- and acromio-clavicular joints
• Arm: biceps brachii, brachialis
• Torso: pecs. minor & major; subclavius; abdominals, lat. dorsi, intercostals;
• Thoracic spine: rhomboids, erector spinae, multifidi, mid-lower trapezius; facet joint contraindicated
• Lumbo-pelvis: iliacus, psoas, quadratus lumborum, pelvic floor; hip joint
• Thigh/knee: proximal ⅓ of adductors, popliteus
• Calf: deep flexor compartment contraindicated
• With hands-on training, these muscles and joints can be safely needled
• (Until then, safest to stay with classic acupuncture xue locations/ angles/depths, or non-needling methods for these muscles)

Thank you for your attention!

For more advanced clinical training in treatment of orthopedic conditions, we invite you to consider our class offerings at:

www.aomprofessional.com

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Please feel free to contact me:

info@aomprofessional.com

www.aomprofessional.com

1-800-499-1438

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