In the last blogpost, I discussed the muscles of mastication with an emphasis on the
masseter and the pterygoids. Also, the channel relationships were
discussed, including a look at the Large Intestine sinew
channel and its possible trajectory traversing the pterygoids.
In this post, we
will explore ways in which these muscles of mastication can be
influenced with an acupuncture needle directly. Some of these
techniques are very straightforward and will be in the range of
techniques that are taught in school, though I often find that the
actual anatomy is not emphasized. So, it will be useful to look at
the specific anatomy associated with common acupuncture points.
Other techniques
might be beyond the skill set taught in school and I advise you to
use your own judgment when using these, as they involve deeper
needling and a more precise understanding of anatomy.
First and foremost, in the last blog post we discussed certain Stomach channel points and their
relationship to the masseter muscle. These were ST-5, ST-6 and ST-7.
Depending on the source you look at, the masseter has two or three
layers of muscle fibers. I described three layers in the last post, a
superficial, an intermediate, and a deep layer. I locate ST-5 just
anterior to the superficial fibers of the masseter and just superior
to the angle of the mandible. The superficial fibers create a very
palpable border and the intermediate fibers are less distinct at
ST-5. However, a palpable taut band of the masseter is usually apparent
if you crossfiber it in an anterior-posterior direction. And you can
feel that this band is still anterior to the much more obvious
superficial fibers. So, needling ST-5 perpendicularly directly into
this taut band will access a common trigger point in this region, one that often refers to the eyebrow and can be a contributing factor to
headaches that project pain to the eye region. Another possible
needle method would be to thread from ST-5 to ST-6 which would
crossfiber the masseter.
ST-6 would be in the
belly of the masseter and is another common pain generator, often
referring into the teeth, especially the lower teeth. This can be
needled at ST-6. The needle direction is mostly perpendicular.
Palpation with the finger first can fine tune needle direction, and I
often find a slight medial direction slightly angled to ST-4 often
elicits the strongest sensation.
ST-7 has the ability
to address two muscles depending on depth and angle. It can address
the deep fibers of the masseter and a common trigger point with
referral to the ear. However, deeper needling can access the lateral
pterygoids. The lateral pterygoids refer pain to the ear and to the
upper teeth or maxillary sinus region. Pain from the lateral
pterygoids can contribute to TMJ disorder and can be a contributing
factor to sinus pain.
Dr. Janet Travell,
MD describes injection at a region consistent with ST-7 (she does not
reference specific acupuncture points, however) for both the medial
and lateral pterygoids, but she keeps the patient's mouth in an open
position by having a cork between the upper and lower teeth. This is
especially necessary for the medial pterygoids. While this is an
appropriate method for accessing the medial pterygoids, this would be
much more valid if there were not needle retention. She is describing
injection, so there would obviously not be needle retention in this
case. If however, the plan was to retain the needle, there is another
method for accessing the medial pterygoids and that is from an
inferior direction by coming below the ramus of the mandible to the
medial surface. If you palpate with your finger or thumb, you will
feel a space. Your finger is much too large to get deep enough to
reach the medial pterygoid, but you might be able to feel the lower
attachment and you might note that this is very sore, especially if
you have jaw issues.
A 1.5 (40mm) can be
used to reach the medial pterygoids from this inferior direction
below the angle of the mandible. The direction will be superior in
the same direction as your finger would push to reach the inferior
attachment of the medial pterygoids and the needle will cross fiber
the muscle and will elicit a strong Qi sensation.
Another muscle of
mastication which should be assessed when working with TMJ disorder,
muscle tension headaches and other related disorders would be the
temporalis muscles. The temporalis muscle differs from the masseter
and pterygoids, in that it is more in the distribution of the
Gallbladder channel. This muscle will be discussed in another post.