In this post, I want to make a point (pun intended) for considering the feasibility of six lower leg yang lines. This should clear up some confusion about both TCM points and Master Tung points on the lower leg, and it will also be a good lesson in anatomy.
Traditionally, we think of the stomach meridian points like ST 36, ST 37, ST 38, and ST 39 as being one cun away from the edge of the tibia. This places these points in the tibialis anterior muscle as we can see in the image below.
In the Tung system, the Four Flowers (77.08, 77.09, 77.11) are located closer to the tibia, either along the edge of the bone, or between the bone and the tibialis anterior muscle. This is an area rich in connective tissue and it is common to feel nodules and tender points in this region. With palpation, patients may even feel more sensitivity at the Four Flowers than at ST 36, ST 37, and ST 38.
The Four Flowers function much like the stomach meridian acupuncture points and essentially have the same indications. In some cases, stronger therapeutic benefits may be noticed by needling the Four Flowers, and I have also noticed that it is advantageous to needle the Four Flowers after having already needled the traditional stomach points several times on a patient. This is because patients tend to develop tolerances to the benefits of acupuncture points after they have been needled 3 - 6 times. This varies from person to person and depends on other factors as well such as overall sensitivity, frequency of visits, etc.
Considering that the stomach meridian points from ST 36 - ST 39 are located in the tibialis anterior muscle, we can note that this is the most well-known and commonly used line. Distinguishing the ST meridian from the line between the edge of the tibia and the tibialis anterior muscle, we can observe that there are two lines with similar functions. However, clinical differences can be observed in patient reactions to these two lines. Some clients respond best with the traditional stomach meridian points, while others get a stronger effect by needling the Four Flowers between the tibia and tibialis muscle. This is why it is important to palpate along these two lines and determine what points and lines are most sensitive in each patient.
The Third Line - Between the ST and GB Meridians and in the Extensor Digitorum Longus Muscle
Another line can be found in the region of the Besides Three Miles points (77.22 - 77.23); anatomically, these points are located in the extensor digitorum longus muscle between the tibialis anterior and the fibularis longus (peroneus longus).
What makes these points so special is that they function much like ST 36 - ST 40, but they also benefit the gallbladder meridian. In the Tung system, they speak of these points as affecting the leg yang-ming and shao-yang channels and they are used for conditions like facial paralysis, hemiplegia, migraines, and shoulder pain. As these points are located between the stomach and gallbladder meridians they treat patterns and conditions related to both of these channels.
Distinguishing this line from the previous two increases the lower leg yang line count to three distinct lines based on anatomical divisions of muscles. The first line is between the tibia and tibialis anterior, the second line includes the points in the tibialis anterior, and the third line between the ST and GB meridian includes the points 77.22 and 77.23 which are located in the extensor digitorum longus muscle.
The Fourth Line - The Gallbladder Meridian and Lateral Line (LL)
The fourth line is the traditional GB meridian and runs from the head of the fibula down the fibularis (peroneus) longus muscle. In myofascial anatomy, this muscle is part of the lateral line and is most closely associated with points like GB 35, GB 36, GB 37, GB 38, GB 39, and the Lateral Three Passes (77.27).
The Fifth Line - Between the GB and UB Meridians
The fifth line is located between the GB and UB meridians and includes the 7 Tigers (77.26) in the UB 58 - UB 60 region and a special group of points that I discovered just below the lateral aspect of the knee. These special points are located 2, 4, and 6 cun below the head of the fibula and between the peroneus longus and gastrocnemius muscles. This places them directly in the soleus muscle which is accessible in this area. Similarly, the 7 Tigers are in the soleus but at the distal end of the lower leg. The special points function much like the 7 Tigers and may be used for pain in the neck, upper back, shoulders, hips, lumbar region, and spine. As they are located between the GB and UB meridians, I like to use them for back, hip, and spinal conditions when both the tai yang and shao yang meridians are involved.
The Sixth Line is the UB Meridian
The sixth line is the traditional urinary bladder meridian and in the lower leg it runs from UB 40 - UB 62. This line is distinct from the fifth line, and acupuncture points like UB 55, UB 56, and UB 57 are directly in the gastrocnemius. With deep needling, the soleus muscle may also be reached through the above points.
Summary
As we can see from the images and descriptions we can think of six distinct lines on the lower leg channels, with each of them affecting different muscles. The first line is located at the edge of the tibia and between the bone and tibialis anterior muscle. The second line is the ST meridian and includes traditional points from ST 36 - ST 39 which are located in the tibialis anterior muscle.
Moving 1.5 cun lateral to ST 36 we find the Master Tung point 77.22 (Ce San Li) which is located in the extensor digitorum longus. This muscle is also between the tibialis anterior and fibularis longus, which places the points in this muscle between the ST and GB meridians.
In the lower leg, the GB meridian is most closely associated with the fibularis longus muscle on the lateral myofascial line. These points have distinct functions from other points on the lower leg and appear to affect the whole lateral line and gallbladder meridian.
Between the GB and UB meridians is the soleus muscle, and the points in this region can benefit both the tai yang and shao yang channels. This makes them useful for patients who have both hip and lumbar pain, as well as shoulder and neck pain affecting both the UB and GB meridians.
The final line is the urinary bladder meridian which is similar to the Superficial Back Line in myofascial anatomy.
By learning to distinguish these lines and the points within each line, it is possible to greatly improve your clinical skills. Learning to palpate these lines, muscles, and points has numerous advantages and can help acupuncturists better determine what points will produce the best results. While I have presented the points and lines primarily in terms of what muscles the points affect, it is advantageous to integrate this into a holistic understanding of myofascial anatomy. By associating myofascial lines with acupuncture meridians, numerous benefits can be realized that help with diagnosis, pattern identification, and treatment outcomes.
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In light,
Jim