Fig.1: Diaphragm, Anterior and Superior view, from Grant's Atlas of Anatomy. |
The respiratory diaphragm is a large, complex and extremely influential muscle. Its unrestrained movement is essential for proper breathing. This involves not only freedom in the muscle itself for it to ascend and descend, but also freedom in related structures which, when restricted, can act as a clamp and prevent expansion of the abdomen and thorax. Structures such as the the abdominal muscles, pectoral muscles, serratus anterior, and certain cervical muscles are among those that can be particular detrimental to breathing when they are restricted. In addition, the visceral organs move with each breath, so freedom in the diaphragm requires good circulation and unrestrained mobility in the organs for proper response to the diaphragmatic movement. Cervical pain, low back pain, thoracic outlet syndrome, and hypochondriac and rib joint pain are just some of the many conditions that can occur with poor breathing due to dysfunction associated with the diaphragm.
From a Traditional
Chinese Medicine standpoint, the ascending and descending of the
diaphragm is important as it regulates the ascending of Spleen Qi and
descending of Stomach Qi. Vietnamese educator and Classical Chinese
medicine scholar Nguyen Van Nghi described the acupuncture point
BL-17 from this standpoint, indicating that the reason it was both
the Back Shu of the diaphragm and such an influential point of blood
production was tied to the fact that it regulated the upward and downward movement of the diaphragm, thus regulating the upward and downward movement of the Spleen-Stomach
Qi mechanism, both being so integral to the production of blood.
This and the next post will look at the relationship of the sinew channels to the diaphragm, especially those of the Spleen and Liver sinew channels. I have been
exploring the sinew channels for about 15 years, first as a taiji and qigong practitioner, then as structural
integration practitioner (the body of work that includes Rolfing) and then as an acupuncturist. I was not
thinking about these directly as sinew channels when I practiced
structural integration, but was very influenced by Tom Myers' development of Anatomy Trains as these seem to relate to the 'tendons' we referred to in our 'tendon changing' exercises in taiji and qigong practice. As I transitioned into acupuncture, I
noticed a lack of description of these sinew channels and have been
working to develop these more thoroughly. I feel there is enormous
potential in having a more detailed anatomical knowledge of them, and in using this specificity of detail to inform clinical decisions.
Much of this material is influenced by my practice first in structural integration and then in acupuncture, specifically through my work with Matt Callison and Sports Medicine Acupuncture®. This information is condensed from a lecture I have been giving in the certification program for Sports Medicine Acupuncture®. This primarily explores the sinew channels from the perspective of fascial planes, how these channels relate (internally-externally, six division, midday-midnight, five elements), and how they communicate proprioceptively through the fascia.
Much of this material is influenced by my practice first in structural integration and then in acupuncture, specifically through my work with Matt Callison and Sports Medicine Acupuncture®. This information is condensed from a lecture I have been giving in the certification program for Sports Medicine Acupuncture®. This primarily explores the sinew channels from the perspective of fascial planes, how these channels relate (internally-externally, six division, midday-midnight, five elements), and how they communicate proprioceptively through the fascia.
Fig 2: Cross section above the umbilicus which highlights the fascia anterior
and posterior to the rectus abdominis. This fascia is associated with the
Stomach and Spleen sinew channels.
|
The fascia associated with the rectus abdominis muscle is particularly relevant to these channels. The fascia of the external obliques travels anterior to this musclel the fascia of the internal obliques bifurcates, half of it travels anterior, half posterior. The transverse abdominis travels completely posterior to the rectus abdominis. Note: this changes below a structure called the arcuate line, which is roughly in the region of Ren-6, at which point the rectus abdominis becomes deep to all of this fascia and continues to connect to the pelvic floor.
Fig. 3: Image from www.brucelee.com. |
Fig. 4: Spleen Sinew Channel image from Deadman's A Manual of Acupuncture. |
However, one could also follow the diaphragm up to the central tendon (Fig. 1). The pericardium attaches to the central tendon on its superior surface. The pericardium is in the same fascial layer which comprises the hyoid muscles. This plane (posterior abdominal fascia-diaphragm-pericardium-hyoids) could be considered part of the sphere of influence described by the Chongmai and accessed through SP-4 (Fig. 5). Also included in this layer is the transversis thoracic muscle, an interesting muscle on the posterior surface of the ribcage that shares a similar trajectory to the portion of the Chongmai that disperses in the chest (Fig. 5). For all practical purposes, I consider the Spleen sinew channel to follow this upward trajectory in addition to the attachments at the lumbar spine. And, not surprisingly, SP-4 (paired with PC-6) is a powerful point combination to affect this region.
Fig. 5: Chongmai from Deadman's A Manual of Acupuncture. |
When this layer is
restricted, the abdomen is bowed convex and is distended (not unexpected in Spleen Qi deficiency, for instance). Also the solar plexus region is collapsed inward. Often, there is an appearance of someone being punched directly in
the solar plexus. Simone Lindner, my fellow faculty member in
the Sports Medicine Acupuncture Certification program and a senior
instructor with KMI (the program that teaches Anatomy Trains and
Kinesis Myofascial Integration), often states that when she sees this
pattern, she wonders if, at some influential point in their development,
this person had 'their breath taken away'. This could be physical through some direct trauma or emotional. But it is usually pretty
deeply seated in their physiology. And, more important to the
discussion, it obviously restricts breathing. Patients who present with this pattern generally take very shallow breaths into the belly, with very minimal movement expanding into the chest. It appears that these patients cannot take a full expansive inhale, and are stuck on the exhale portion of the breath. Fig. 6 highlights this, notably the bowing of the abdomen, the collapse of the chest and the general restriction of the ability to take an inhale expanding into the chest.
Fig. 6: Image courtesy Matt Callison / Sports Medicine Acupuncture Used with permission |
In the Sports Medicine Acupuncture Certification program (in 2016 it will be in Chicago), we cover vertebral fixations and their treatment with mobilization techniques, specific needle techniques at Huatuojiaji points and use of extraordinary vessel points. Fixation at specific levels (certain midback and cervical regions) which are treated with SP-4, PC-6 are understood better by thoroughly comprehending the anatomy explained above. And the treatments described in this post can supplement the treatments explored more thoroughly in these classes.
Before moving on to the
Liver sinew channel in the next post, it might be useful to note that the abdominal
obliques do travel around the body to the lumbar region, and their fascia blends in with the
thoracolumbar fascia and attaches to the spine. This accounts for the
Stomach sinew channel attaching to the spine (Figures 7 and 8). This layer also needs
to be open and free for a full expansive breath.
Fig. 7: Abdominal and Thoracolumbar Fascial Layers from John Hull Grundy's Human Structure and Shape. |
Fig. 8: Stomach Sinew Chanel from Deadman's A Manual of Acupuncture. |
There is a beautiful correlation between embryology, the emergence of the layers and organs of the body, and the acupuncture meridians. Dan Keown's work is along these lines and I look forward to a workshop he will be giving at the upcoming AAMA meeting in Anaheim. Thank you for writing this!
ReplyDeleteThanks Anna, I will look into Dan's work.
ReplyDeleteBrian, Than you. This is very helpful.... I cannot find your article about the Liver sinew channel and the diaphragm. Are you teaching this material in NYC at all? I would love to learn more.
ReplyDeleteThanks for the comment. Here is the link for the Liver post http://drbrianlau.blogspot.com/2015/12/the-diaphragm-and-liver-sinew-channel.html
DeleteI will be in New York for a low back and hip class in September. Here is the info for the class. https://www.sportsmedicineacupuncture.com/products/foundational-course-schedule/treating-common-injuries-of-the-low-back-and-hip-duplicate/