Feiyang BL-58 is an acupuncture point on
the Urinary Bladder channel. It is on the posteriolateral portion of the leg.
In A Manual of Acupuncture, Peter
Deadman locates this point on the lower leg, 7 cun directly superior to Kunlun
BL-60, lateral to and approximately 1 cun inferior to Chengshan BL-57. This
places the point about halfway up the leg (a bit inferior to this) and posterior
to the peroneal muscles. BL-58 is the Luo-connection point of the Urinary
Bladder channel. Deadman lists its actions as:
Fig. 1: BL-58 at the myotendinus junction of the gastrocnemius. Note the deeper soleus which is more visible in fig. 2 as the gastrocnemius is removed. |
- Harmonise the upper and lower
- Expel wind from the taiyang channel
- Treat hemorrhoids
- Activate the channel and alleviate pain
The indications of this point
relate to these actions, particularly:
- Harmonize the upper and lower: Many indications are listed involving the head and neck and symptoms associated with the sense organs such as the eyes. These include things such as headaches and dizziness, visual dizziness, and pain in the neck and occiput.
- Expel wind from the taiyang channel: Indications include lumbar pain, heaviness of the body with inability to sit or stand, difficulty walking, sciatica, and inability to flex and extend the toes.
- Activate the channel and alleviate pain: This also incorporates many of the indications above.
Fig.2 BL-58 with the muscle belly of the more superficial gastrocnemius removed. This illustrates the location at the belly of the deeper soleus. |
Fig. 3: TrP 3 as described by Travell, and its referral to the SI joint region. |
This discussion of Dr.
Travell’s trigger point referral patterns leads me to the next reference,
Andrew Nuget-Head. I have not yet had the opportunity to work with Andrew (though
I hope to in the near future), but have had the good fortune to discuss much of
his work with Sean McCann, L.Ac., a good friend of mine who studies and works
closely with him in his clinic. Much of their training focuses on the
importance of needle manipulation to propagate sensation to the desired place
(creating a warming sensation in the abdomen for cold in the Stomach by
manipulating ST-36, for instance). While a major skill set taught is how to
properly propagate sensation, and the explanation is that this can be
accomplished at just about any point, the reality is that certain points are
much easier to work with in this way and yield better clinical results for the
task at hand. Deadman’s A Manual of
Acupuncture offers a tremendous range of points for things such as lumbar
pain. While all of these points might be useful to a skilled practitioner, the
challenge is to discern which will be the best and easiest to use for the
‘flavor’ of lumbar pain presented by a particular patient. I feel that the
particular ‘flavor’ of lumbar pain for BL-58 is the treatment of pain associated
with sacroiliac dysfunction, and this is consistent with the general natural
tendency of referral of the point when it is reactive.
With the pain referral in mind,
it is useful to explore some of the indications associated with BL-58 listed
above. One sees sciatica, inability to sit or stand, difficulty walking. All of
these are consistent with pain that can be experienced with sacroiliac joint
dysfunction.
Matt Callison describes vertebral
facet fixations and their impact on particular muscle weakness. He finds that
certain muscles will test bilaterally weak in manual muscle testing when there
are corresponding vertebral facet fixations in particular regions. In the
presence of sacroiliac joint fixation, the cervical extensors will test weak
when testing the left and the right side individually. Releasing the fixation
will turn the weak muscles back on and they will test strong when performing
manual muscle tests after treatment. (In Sports Medicine Acupuncture, we teach
particular Extraordinary Vessel pairs,
local needle techniques, and joint mobilization techniques to accomplish this.)
With this relationship between
the sacroiliac joint and the cervical extensors, one can again explore the
indications for BL-58 and see the action of harmonizing the upper and lower
with indications present such as pain in the neck and occiput, dizziness, etc.
Note that BL-58 is not one of the
Extraordinary points taught by Matt Callison for sacroiliac joint fixation. The
combination of GB-41/SJ-5 and specific
local needle technique associated with the sacroiliac joint, along with joint
mobilization, is taught within Sports Medicine Acupuncture® classes. GB-41/SJ-5,
via its relationship with the Daimai, has effect on different sinew channels and, therefore,
affects sacroiliac
balance in a different way than do points affecting the Urinary Bladder and
Kidney sinew channel (remember that BL-58 is the Luo-connecting point—more on
this in a bit). But additional
points are added to expand the therapeutic outcome, such as BL-58; this is
not commonly used to affect the cervical spine, and I personally rarely use it for
this, but I list the description above to illustrate the relationship between
the sacroiliac joint and the posterior cervical extensors and tie the anatomy
into the classical indications of BL-58.
Luigi Stecco describes how
fascial linkages between muscles are a peripheral source of proprioceptive
communication for the nervous system. What this means is that muscles have many
more ‘attachment’ sites than are listed and shown in anatomy books. About 30%
of the muscle force is transmitted through cross-links to other muscles via
these myofascial fuzz fibers.
Through careful anatomical study,
Stecco has proposed that much of this crosslinkage is used as a way for the
muscles of the body to communicate via tension with each other and coordinate
movement, especially between agonists and antagonists. He describes something
he calls a myofascial unit which describes a particular relationship between
monoarticular muscles (muscles that cross only one joint, the soleus in this
case) and biarticular muscles (muscles that cross two joints, the gastrocnemius
in this case), and attachments between these and their antagonists. He proposes that movements of
joints in particular directions are coordinated by what he refers to as centers
of coordination. These centers of coordination are areas where the
monoarticular muscles and biarticular muscles share a fascial connection which
help direct and coordinate the muscle action via tension acting on muscle
spindles. If the fascia becomes densified in these centers of coordination,
this can disrupt proprioception and can lead to pain and dysfunction.
Fig. 4: Image illustration of a cc for ankle movement from Fascial Manipulation for Musculoskeletal Pain, by Luigi Stecco |
This leads to the work I have
been doing: relating the sinew channels more clearly to actual anatomical
structures. In Sports Medicine Acupuncture Certification, I describe the sinew
channels from a precise anatomical perspective. For the Urinary Bladder and
Kidney sinew channel, I describe myofascial connections in the posterior leg
and thigh. In particular I outline the gastrocnemius connections to the
hamstrings, particularly to the biceps femoris and semitendinosus and into the sacrotuberous ligament
which connects to the posterior sacrum. I ascribe this to the Urinary Bladder
sinew channel. There is another deeper myofascial connection which includes the
soleus attaching to the semimembranosus
and adductor magnus and into the pelvic floor muscles which connect to
the anterior sacrum. I ascribe this to the Kidney sinew channel. Therefore sacroiliac movement, at
least relating to the flexion/extension aspects (called nutation and
counternutation) is moderated by the balance (or dysfunction due to imbalance)
between the Urinary Bladder and Kidney Sinew channels.
It is interesting to see that
BL-58, a Luo-connecting point, is indeed a point at an influential union
between the gastrocnemius and soleus. Needling this point affects a region of
proprioceptive communication between a Urinary Bladder sinew channel muscle and
a Kidney sinew channel muscle. These two sinew channels strongly influence
mobility at the sacroiliac region. Known trigger points described by Dr.
Travell refer pain to the sacroiliac joint. Indications of this point can
certainly be interpreted as sacroiliac joint dysfunction. Actions of this point
include the expulsion of wind, a pathogenic factor that causes rigidity. Anyone
who has diagnosed sacroiliac joint dysfunction would agree that there is a
notable amount of rigidity that is associated with this syndrome. When properly
diagnosed, BL-58 is a useful point in treatment, especially when it propagates
sensation to the sacroiliac joint.
I have been working with the
sinew channels in one capacity or another since 1998, first with my taiji and
qigong practice (where we refer to them as tendons and discuss tendon-changing exercises); then through study of
structural integration and especially the Anatomy
Trains developed by Tom Myers and currently taught in Sports Medicine
Acupuncture by Simone Lindner; and next through my own research as I became a
faculty member in the Sports Medicine Acupuncture Certification program,
especially with the opportunity to closely analyze fresh cadaver specimens. My study
of the sinew channels is a work in progress and I am currently engaged in quite
a lot of research into various sources (Stecco, Tom Myers and his Anatomy Trains; the descriptions from
the Ling Shu and David Legge’s
interpretation of these descriptions; Travell’s groundbreaking work;
acupuncture sources such as Deadman’s A
Manual of Acupuncture, and other sources), while testing these ideas in
clinic to see if they predictably produce results. This will likely be a
lifelong process. While I feel there is a strong basis for what I describe
above, it is subject to change as more clinical data is presented by other
practitioners.
No comments:
Post a Comment