In TCM Spleen 6 (SP 6) and Spleen 9 (SP 9) are well-known points used for a variety of disorders. They are best known for treating abdominal, digestive, gynecological, reproductive, and urinary conditions. Lesser known is that these points can be used for lumbar, back, shoulder, neck, and spinal pain.
In this article, we will explore the anatomical and myofascial basis for points in the SP 6 - SP 9 region for being beneficial for back, shoulder, neck, and spinal pain. To begin, let's remember that Spleen 6 is named San Yin Jiao, which means Three Yin Crossing. This name is derived from the belief that the leg yin meridians including the spleen, liver, and kidney channels all cross at this point. In the Master Tung system, there are several points from SP 6 to SP 9 that are believed to influence both the spleen and kidneys as well as benefit the back and spine.
The Lower Three Emperors (SP 9, SP 7, SP 6 aka 77.17, 77.19, 77.21)
In the Tung system, SP 9 is numbered 77.17, SP 7 is 77.19 and SP 6 is 77.21. (This system of numbering is actually very brilliant and can teach us a lot about point functions, but I will save that for another article.) These three points are often needled together in the Master Tung system and are known as the Lower Three Emperors. Like the TCM points, they are indicated for treating a variety of reproductive, urinary, pelvic, and abdominal conditions. Additionally, the Lower Three Emperors (SP 9, SP 7, and SP 6) can be effectively used for neck, shoulder, and back pain. (eLotus)
Before getting into the anatomy we need to discuss two other points along this line from SP 6 - SP 9. Just below SP 9 is another point unique to the Tung system known as Shen Guan/Kidney Gate (77.18). Often this point is needled with SP 9 for treating shoulder pain, and it can be effective for anterior, lateral, and posterior shoulder pain. Additionally, these two points can be used for lumbar and neck pain. When using SP 9 and Shen Guan together it is also advantageous to include one more distal point such as SP 6, or 77.20 which is located one cun above Spleen 6.
The way I like to approach the Lower Three Emperors in the clinic is to find the three most sensitive spots between SP 6 and SP 9 and needle those. I do not stick to textbook point locations, but rather I palpate to find the ashi points and observe the patients' reactivity and responses. When I use the term Lower Three Emperors I am referring to any three points between SP 6 and SP 9 located adjacent to the tibia and on the spleen meridian.
Myofascia Anatomy and the Deep Front Line
Taking a myofascial perspective, we find that when needled properly, any of the points between SP 6 - SP 9 can affect what is known as the Deep Front Line (DFL). The DFL includes muscles and fascia that are located deep in the legs, thighs, pelvis, abdomen, chest, and neck. These muscles and fascia include the tibialis posterior, thigh adductors, pelvic fascia, diaphragm, visceral fascia, lung pleura, scalenes, and more. The image below shows the DFL.
Clinically, we observe that points from SP 6 - SP 9 affect many of the tissues that are a part of the DFL. For instance, these points are used for a variety of disorders involving the pelvis, urinary, and reproductive systems. Also located on the DFL are the anterior sacral fascia and the anterior longitudinal ligament (ALL) which runs along the front of the spine. The ALL plays a major structural role in supporting the whole length of the spine as it travels from the sacrum all the way up to C1 and the base of the skull.
When we needle points between SP 6 and SP 9 it causes electrical and neurological signals to be sent to the spinal cord and CNS. Similarly, these points will influence body mechanics through the myofascial lines, and we can trace these effects through the DFL. Also part of the DFL is the pre-vertebral fascia which is a layer of deep cervical fascia. When we consider the neurological/electrical and myofascial/mechanical mechanisms we can begin to appreciate how points from SP 6 - SP 9 can benefit the neck, shoulders, back, and spine. In summary, we find that fascia in and around the sacrum, spinal column, and cervical vertebrae have a direct myofascial connection to points on the DFL and in the region from SP 6 - SP 9.
The Psoas, DFL, and Lower Three Emperors
The psoas muscle as shown above is also a part of the DFL. Additionally, lumbar pain may be due to psoas syndrome and occurs when the psoas is injured. Though this condition is rare, it does occur in athletes, runners, and dancers. (Dydyk) Additionally, chronic contraction of the psoas and other hip flexors can also result in lumbar pain. As the psoas is part of the DFL, acupuncture along this line and at distal regions such as at SP 6 and SP 9, may produce myofascial changes in the psoas and other DFL muscles and tissues.
Final Remarks
When using these points for neck, back, and spinal pain it is typically necessary to needle three points along the SP 6 - SP 9 line. If only one or two points are used it will often not provide enough stimulation to get the desired results. After many years of using these points, I have also found that the best results are obtained when the ashi points are needled rather than using textbook locations to select three points.
It is also essential to do proper syndrome differentiation to determine what other points should be selected or added to the overall point protocol. While the Lower Three Emperors work on the deep layers of muscles and fascia, when treating neck and back pain it is also crucial to determine if more superficial levels and structures are involved in the pathology. For cases involving back muscles such as the latissimus dorsi and erector spinae, other meridians and myofascial Iines should be used which will reach those levels and muscles.
It is also advantageous to use acupuncture with movement therapies and teach the patients postural balance and restoration. When a myofascial model is applied to acupuncture therapy, it offers many benefits for helping to correct postural imbalances through the use of movement, stretches, and muscle-strengthening exercises. To obtain the most effective and lasting results in treating muscle-skeletal conditions, it is highly suggested that acupuncturists also prescribe proper movement therapies to their clients. Doing so allows the patients to practice corrective care and assists in getting to the root imbalances.
To take a deep dive into how the myofascial lines relate to meridians and acupuncture point functions, check out my various online acupuncture classes. They are approved by the NCCAOM and offer a detailed examination of how TCM points and Master Tung's points can be better understood through anatomy.
Sources
eLotus; Master Tung Acupuncture Points; www.mastertungacupuncture.org
Psoas Syndrome; Dydyk, Alexander; Sapra, Amit; National Library of Medicine
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