The shao yang meridians include the triple warmer and gallbladder channels which transverse the lateral regions of the body. Examining the myofascial anatomy of these lines we find correlations between traditional viewpoints and anatomical structures. For instance, GB 41 is known to be the confluent point for the Dai Mai, or belt meridian, which as the name implies transverses around the waist like a belt.
The Dai Mai and Transverse Abdominal Muscle
In the image, we can see the lateral line (LL) and the transverse abdominal (TVA) muscle which is a part of this line. Above the TVA the intercostals are also a part of the LL and GB meridian, and below the TVA we find the glutes and IT band. The LL and GB meridian continue to extend down to the head of the fibula, GB 34, and the peroneus longus muscle. Gallbladder 41 which is located just distal to the junction at the base of the 4th and 5th metatarsals is used for opening the Dai Mai and treating lumbar pain, gynecological disorders, headaches, and more.
Like the Dai Mai, the TVA wraps around the waist connecting and supporting the anterior, lateral, and posterior regions. In the back, the TVA blends into the thoracolumbar fascia, and in the anterior region, it inserts on the xiphoid process, linea alba, and pubic crest. In the image below we can see the TVA in red and its fascial connections in white.
In fusing with posterior and anterior structures the TVA, and more generally the lateral line, corresponds with our traditional theories about the GB, Dai Mai, and Yang Wei Linking meridians. It is said that the Dai Mai binds and connects all the other meridians that pass through the abdomen and back and that it connects the top and bottom of the body. The structural and functional roles of the TVA are an essential aspect of shao yang anatomy and demonstrate how the concept of the Dai Mai relates to muscles and fascia.
The popular point combination of Gallbladder 41 (GB41) and Triple Warmer 5 (TW 5) "opens" the Dai Mai and Yang Wei which connect and bind various meridians and myofascial lines. The idea of the Yang Wei being the "linking" meridian further conveys this idea of the Dai Mai and Yang Wei mutually connecting and binding the other channels.
The Lateral Line (LL) Balances the Superficial Front Line (SFL)
and Superficial Back Line (SBL)
One of the functions of the LL is to coordinate and integrate the activities of the SBL and SFL, or in the words of Tom Myers, "The LL functions posturally to balance front and back, and bilaterally to balance left and right. The LL also mediates forces among the other superficial lines - the Superficial Front Line, the Superficial Back Line, all the Arm Lines, and the Spiral Line. The LL fixes the trunk and legs in a coordinated manner to prevent buckling of the structure during any activity with the arms." Tom Myers, Anatomy Trains pg. 115
In integrating our understanding of traditional theories with modern anatomical research on myofascial lines, we can develop and refine our use of single points, point combinations, and treatment protocols. The rest of this article will dive deeper into the use of GB 41 and TW 5 and explore variations of this point combination.
Gallbladder 41, GB 31, and the Treatment of Lumbar Pain, Headaches, and More
One thing we observe in meridian theory and clinical practice is that points on the same meridian often have similar functions and can affect other areas along the channel pathway.
Integrating meridian theory with a myofascial perspective, we can find that needling into a myofascial line can affect other structures and muscles on that line. While meridian theory states that points can be used for channel-related symptoms, applying a myofascial model to this allows us to understand this in mechanical terms. This is important to comprehend because it can give us a better appreciation for point functions, treating structural disorders, and creating effective points prescriptions.
A question to ask, is if GB 41 can open the Dai Mai to affect the waist and lumbar regions, is it possible that other GB / LL line points can do the same?
To this end, GB 31 is indicated for lumbar pain and is especially effective when there is excessive tightness or tension in the IT band. Similarly, if lumbar pain presents with external rotation in the hip joint or leg, GB 31 can be a key point to use as it can release chronic tightness.
If lumbar pain presents with external rotation in the hip joint or leg, GB 31 can be a key point to use as it can release chronic tightness. For this type of lumbar pain pattern, GB 31 is usually even more effective than GB 41.
Comparing GB 41 to GB 31 for hip and lumbar pain we may find that GB 31 is actually more effective for these conditions. There are several two and three-point combinations that are effective for lumbar pain such as Yao Tong Xue (two points) or Ling Gu, Da Bai, and Xia Bai (22.04, 22.05, 22.07). Using only two or three points on the bladder meridian and on the lumbar region, hamstrings, or calves can also be effective for both upper and lower back pain. However, needling two points such as GB 41 and SJ 5, or GB 41 and GB 42 as a Dao Ma, is typically not as effective as the above point combos for lumbar pain or hip pain.
Needling GB 31 (88.25) as done with the Master Tung's three-point unit Thigh Nine Miles Three (88.25, 88.26, 88.27) can be very effective for various patterns of hip and lumbar pain. The point group combines GB 31 with one point 1.5 cun anterior to GB 31 and another point located 1.5 cun posterior to GB 31. For just the right pattern, these 3 points, and only these 3 points alone, can provide powerful relief for hip and lumbar pain.
These points tend to work best on lateral line sciatica, IT band syndromes, and when there is external rotation in the hip. For these reasons, I tend to like to needle GB 31 or Thigh Nine Miles Three when I am using gallbladder meridian points for hip or lumbar pain, and I often prefer these over GB 41.
Triple Warmer 5 (TW 5) and (33.04, 33.05, 33.06)
We can do a similar analysis with TW 5 and see how it is used in the Master Tung system. In this system, rather than needle TW 5 alone, we do another three-point unit known as Hold Three Fires (33.04, 33.05, 33.06) which is also indicated for lumbar pain. The point 33.04 is 3 cun above TW 4, 33.05 is 4.5 cun above TW 4, and 33.06 is 6.0 cun above TW 4. These points are all located on the myofascial line known as the Superficial Back Arm Line (SBAL).
***Note that several other point groups for lumbar pain such as Ling Gu, Da Bai, Xia Bai, and Yao Tong Xue are also located on the SBAL.
In this image, we can see 33.04 and 33.05 in red (33.06 not shown), but it is 1.5 cun proximal to 33.05. This combination is used in the Master Tung system for lumbar pain.
We can also see in blue 22.04, 22.05, and 22.06 (Ling Gu, Da Bai, and Xia Bai) which have similar effects as needling the two-point unit Yao Tong Xue.
As Hold Three Fires is also on the SBAL we can expect them to work in a similar way as the various points on the hand for lumbar pain.
The Superficial Back Arm Line and Acupuncture Points for Lumbar Pain
There are many points on the SBAL and TW/LI meridians that are useful for lumbar pain. These include 22.04, 22.05, 22.07, Yao Tong Xue, 33.04, 33.05, 33.06, 33.08, and 33.09. As they are on the same myofascial line and affect the brachial plexus nerve center, we can expect them to work in similar ways and for similar patterns.
Points on the SBAL are typically the first ones I use for lumbar and hip pain as they are very effective, and I can also have the clients do movements with the needles in. Additionally, I can perform manual therapies on the affected regions. This method of doing distal needling, while combining it with movements, stretches, and manual therapies gives superior results. I also like it because I can teach the client prescriptive movements while the needles are retained in the hands.
TW 5 and GB 41 Variations for Neck and Shoulder Pain Presenting with Headaches
One of my favorite point combinations for shao yang pattern neck and shoulder pain occurring with headaches is to use a variation of the Triple Warmer 5 (TW 5) & Gallbladder 41 (GB 41) point combination. Using GB 41 and GB 42 in combination is effective for many patterns of headaches and migraines. In the Balance Method and Tung style needling, we say that the hands and feet image the head and face, and points on the hands and feet tend to be some of the most effective for problems affecting the head. This likely relates to neurological factors and the greater sensitivity of the points in the hands and feet.
Examining the lateral line we find that it includes two muscles in the neck, the splenius capitis and the SCM. According to both meridian theory and myofascial line models, we find that needling a point group like GB 41 and GB 42 can affect the opposite end of the meridian and regions like the neck, temples, and head. For neck pain, GB 39 is also indicated and this point is at the terminal end of the meridian on the lower leg.
Pain at GB 20 and GB 21 may also be alleviated with points like GB 41 and GB 42, but when pain is present there it is best to combine them with the triple warmer points like TW 5, 33.04, 33.05, and 33.06. Since the triple warmer points are on the SBAL, they will be able to influence the trapezius and points like GB 20 and GB 21.
Triple Warmer Points for Pain at GB 20 and GB 21
A great point prescription for pain at GB 20, GB 21, and UB 10 is to needle Luo Zhen, TW 3, and TW 5 on the opposite side as the pain. This three-point unit is often enough for many patterns of neck and shoulder pain. When headaches are present with this pain pattern add GB 41 and GB 42 on the same side as the pain.
We can see in the image that GB 20, GB 21, TW 5, 33.04, 33.05, and 33.06 are all on the SBAL.
In both traditional meridian theories and myofascial models, needling one end of the line will affect the opposite end of the same line/meridian.
While the above point prescriptions are highly effective they do need to be differentiated from Tai Yang patterns which involve deeper levels of myofascial lines and different neurological circuits. Clearly distinguishing between Shao Yang patterns and Tai Yang patterns is essential to getting the best results.
Summary
The shao yang meridians include the triple warmer and gallbladder channels and are effective for a variety of neurological and musculoskeletal patterns. While the traditional point combination of Triple Warmer 5 and Gallbladder 41 is used for a variety of disorders, it is my goal to shed more light on how to use this combo, and how to apply point variations that work on the shao yang meridians.
While GB 41 is the confluent point for the Dai Mai, and is indicated for lumbar and hip pain, it is often more effective to use GB 31 with 88.26, and 88.27 to treat these conditions. This is because the IT band is susceptible to imbalances when hip and lumbar pain is present, and by needling Thigh Nine Miles Three it directly targets the IT band and surrounding muscles.
I have also discussed how TW 5 and Master Tung's combination of three points near TW 5 (33.04, 33.05, and 33.06) is on the SBAL and how these points are traditionally indicated for lumbar pain. Additionally, we find several other point groups on the SBAL which are effective for hip and lumbar pain. These include 33.08 and 33.09 as a point unit, as well as Ling Gu, Da Bai, Xia Bai, and the Yao Tong Xue combo. *** Note that only one of these point groups on the hands/arm should be done at a time, with a maximum of two or three needles for most patients.
Additionally, because the triple warmer points are on the SBAL we can use them to treat problems at GB 20, GB 21, and pain syndromes involving the trapezius. When neck and shoulder pain presents with Shao Yang headaches and migraines, we can use the triple warmer points with GB 41 and GB 42 for excellent results.
To learn more about integrating traditional theories with myofascial models, while also creating more effective point prescriptions and variations, check out my online classes on acupuncture and myofascial lines. The courses will vastly help you to improve your knowledge of anatomy, point functions, and more. Acupuncture & Myofascial Classes Here
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