“Kunlun BL-60 is
the fire point of the taiyang Bladder channel and an important point
to clear and descend excess wind, fire and yang from the upper part
of the body.” So states Deadman in the commentary for this point in A
Manual of Acupuncture. He goes on: “The principle 'for
disease of the head select [points from] the feet' applies well to
the point. Kunlun BL-60 is able to clear heat and lead down excess
yang from the head in cases of headache, heat in the head, redness,
pain and swelling of the eyes, bursting eye pain, nosebleed and
toothache, and to extinguish wind from the head in cases of epilepsy
and lockjaw.”
What I would like to
consider in this post is the actions of this point on muscle tension
headaches, specifically on reducing tension in a group of muscles
that often become dysfunctional together as part of this pattern of
tension headaches. These muscles individually refer pain to the
posterior neck and occiput, the temple region, and the region of the
orbit of the eye. Collectively, their referral patterns overlap and
can create a composite pattern of pain that many of our patients
describe when they come in for treatment. These muscles are the
trapezius muscles (primarily the upper fibers but also the
lower fibers can contribute to headaches), the suboccipital muscles,
the sternocleidomastoid (SCM), and the temporalis muscle.
 |
| Fig. 1: TrP pain referrals of the upper trapezius, the suboccipital muscles, the SCM (sternal head), the temporalis, and the SCM (clavicular head). Image from Myofascial Pain and Dysfunction: The Trigger Point Manual by Janet Travell and David Simons. |
 |
Fig. 2: Urinary Bladder sinew channel image from
A Manual of Acupuncture, by Peter Deadman |
What unifies these
muscles from a channel theory perspective is the Urinary Bladder
sinew channel. An uprising of Yang, and a flaring of Fire and
stirring of Wind, often with disharmony in
the Liver network, manifests as contraction in the muscles listed
above. These muscles are all part of the Urinary Bladder sinew channel. This
channel unites these muscles together in a type of disharmony that
causes muscle tension headaches.
The sinew channel
would indeed include the suboccipitals along with the chain of
myofascial tissue, creating a myofascial meridian, and rising up the back
of the body (Fig. 4). This is an obvious muscle to include in any
channel description involving the trajectory of the Urinary Bladder
channel. And this myofascial meridian also includes the thoracolumbar fascia, the thick aponeurotic structure in the lumbar region.
But, other structures attaching to the thoracolumbar fascia explain
several branches of this sinew channel. This includes the latissimus
dorsi and the lower fibers of the trapezius (Fig. 3). The latissimus dorsi has
obvious fascial connections to the pectoralis major which, in turn,
connects with the SCM. The trapezius, accounting for the LI-15 and
GB-21 binding regions depicted by Deadman and discussed in the
Lingshu, blends in with the fascia
of the scalp and connects to the temporalis muscle. Excess Yang rises
up and all of these muscles become dysfunctional and contribute to
the building pain many people feel throughout the day. It can also
contribute to the typical guarding posture that is seen with increased
stress which is referred to as
upper cross syndrome (a posture with a forward head and protraction of the scapula).
 |
| Fig.3: Image modified from Netter's Atlas of Human Anatomy. Sinew Channel interpretations by the author, Brian Lau, AP, C.SMA |
 |
| Fig. 4: A dissection of the Superficial Back Line from Anatomy Trains. This image includes, from left to right, the plantar fascia, the fascia of the periosteum of the calcaneus, the Achilles tendon, the gastrocnemius and soleus, the hamstrings, the sacrotuberous ligament and posterior sacral ligaments, the erector spinae and suboccipitals, and the galea aponeurotica or the fascia of the skull. This is very similar to the myofascial of the main branch of the the Urinary Bladder sinew channel. |
According to A
Manual of Acupuncture, actions of BL-60 include:
-
Clears heat
and lowers yang
-
Pacifies wind
and leads down excess
-
Activates the
entire Bladder channel and alleviates pain
-
Relaxes the
sinews and strengthens the lumbar spine
-
Promotes
labor
This point,
frequently combined with SI-3, serves as a great distal point to
treat muscle tension headaches. This should be combined with proper
needling of the motor points of the involved muscles
and with treatment
of the root of the disharmony (BL-60 treats the manifestation of Yang
rising, so the practitioner should look to the pattern of excess and
deficiency present with the patient, also). Many of the motor points
of the muscles involved coincide with points that many acupuncturists
already use, but the techniques and depth required to reach and
affect muscle spindle relationships in the muscles is not always
adequately preformed. The motor points are briefly described, but
this type of information is best left to a classroom discussion. I
will be teaching a foundation course in Sports Medicine Acupuncture
for the neck and shoulder in Manhattan and in the Tampa Bay area in
the new year (dates to be determined soon). For other classes and for Sports Medicine Acupuncture Certification (SMAC), you can look at
the schedule on the SMA website.
-
Upper
trapezius – motor point 2 is GB-21; the muscle can be grasped and
held away from the rib cage, and it can be needled from SJ-15 with the
needle pointed up (away from the pleura) towards GB-21. Motor point 1 is about halfway between SI-15 and -16 and is needled (with the patient supine) through the anterior edge of the muscle from anterior to posterior and with a slightly upward direction. This is through the fibers in the region where the muscle turns from being horizontal to more vertical as it ascends the neck.
-
Suboccipitals
– accessed from GB-20. Deadman describes palpation with the finger
angled towards the nose (this goes into the suboccipital triangle),
the finger angled towards the contralateral eye (this accesses the
rectus capitis posterior major), or the finger angled towards
Yintang (this angles the needle towards the attachments of muscles
such as the trapezius to the occiput). We discuss some other needle
angles and depth in Sports Medicine Acupuncture classes, but there
are safety issues with the vertebral artery that makes a classroom
setting much better for this discussion.
-
SCM – both
heads can be needled from ST-9. However, it is imperative that the
needle direction is lateral and that the needle ascends through the
muscle of the SCM and does not travel medial to the muscle towards
the carotid artery. Note: this is a different technique than ST-9
describe in A Manual of Acupuncture which discusses needling between
the carotid and the thyroid cartilage. SJ-16, though not a motor point, is another reactive point that affects the clavicular head of the SCM. Palpate for the most reactive region and angle slightly anterior into the muscle.
-
Another motor
point to consider is the piriformis motor point. This point is
halfway between BL-54 and BL-53. It is an empirical motor point and
it eases pain in the BL-10 region (describing the method of treating
below to affect above). And it can also reduce tension in the
pectoralis minor (a midday-midnight [zi
wu liu zhu] relationship) and assist in
opening the chest and correcting the typical upper cross syndrome
seen).
- Note: these motor points are listed in Motor Point Index - An Acupuncturist's Guide to Locating and Treating Motor Points.
It is worth noting
that the sinew channels converge and that many of the muscles
discussed are part of other channels and can be addressed via distal
points on other channels. The trapezius, for instance, is a muscle
where the Large Intestine, Sanjiao, and Gallbladder sinew channels
also converge. There are many other instances where you would
consider Shaoyang or Yangming point combinations for other type of
disharmonies affecting this muscles; points such as GB-39 and LI-10 come to mind. The above discussion was specifically about a
series of muscles related to muscle tension headaches and their
dysfunction, which can be seen as a disharmony affecting the Urinary Bladder
sinew channel.
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