So today we’re going to be looking at the stomach and spleen and kidney channel, primarily the stomach channel.
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Hi, I’m Brian Lau. I’m an instructor with AccuSport Education with the Sports Medicine Acupuncture Certification Program. I’m also help lead the dissection classes. We do a lot of dissection within the program, which is something that’s very relevant to my discussion today. And I’ve been also working on a lot of functional movement patterns organized through the channel sinews which is through Jing Jin movement training.
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So I’m going to present on some of this information today. I want to thank American Acupuncture Council for having me back. I always appreciate this opportunity. So today we’re going to be looking at the stomach and spleen and kidney channel, primarily the stomach channel. We’ll have a part two of this webinar, which will go more into the spleen and kidney channels.
But specifically the abdominal points, a little bit of the anatomy, the depth of the fascial layer that we’re reaching with the needle or manual techniques. Or really your exercise or whatever intervention we’re doing. We want to understand a little bit about the depth, the layer, the target tissue, all of those things.
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So let’s look today at the stomach channel primarily. I have an image up here from Netter’s Atlas of Human Anatomy. So this image doesn’t have these acupuncture points on. It doesn’t have the stomach 27, stomach 25, etc. I put those in manually. Let’s play. But the netter image is really good anatomical illustrations that can give us a little bit of a understanding of the anatomy.
So first thing to notice that the primary aspect of the stomach channel is going right into the midline of the rectus abdominis until I get down lower, we’ll talk about those lower aspects. It also changes as I get up to stomach 18 and goes more to the edge of the rectus abdominis, but by and large.
They’re running up and down the rectus abdominis right along the midline. Another thing to note, looking at the anatomy, is that the rectus abdominis is our six pack ab muscle. For a very lean and muscular, you can see those six pack abs. You can take note that it’s actually eight packs.
There’s a pack up here that’s not very visible, even when people are very muscular and lean. It’s a very flat sort of pack, so there’s actually four on each side, but people see these three. That would give that appearance of the six pack ab muscles. And with that, you can notice these tendinous inscriptions.
So we’ll talk about some of these points that lie right on these tendinous inscriptions. Much more fascial it has a little stronger connection with the surrounding fascial structures. And sometimes I think there’s a little bit more bang for the buck on these points stomach 25, obviously a very big point.
So we can feel and palpate for these tendinous inscriptions. They’re not super obvious in palpation, but you can sense them, you can feel them. You can fall into a slight little valley. off the muscle and that can help guide your palpation and guide your needle angle, needle technique, et cetera.
So we can just initially take note of that, that the points are either in the belly of the rectus abdominis or in these tendinous inscriptions. There’s some variation on the themes lower, And some variation on the themes higher, but by and large, that’s where the territory that we’re going to be in today.
Next webinar, we’ll jump over to the spleen channel and the kidney channel on the abdomen and look at some of the variations of that theme there. So where are we needling? What are we affecting? Multiple things. One is that we have these branches of the thoraco abdominal nerves that wrap around.
They actually travel between the internal and external obliques. They pierce the semilunar line the fascial seam that’s right at the lateral edge of the rectus abdominis. We’ll come back and talk a little more about that next time. And then they, from there, they innervate the rectus abdominis muscle.
They also come back superficial and have cutaneous branches pretty much along right where the stomach channel is. So these would be for T7, T8, T9, 10, 11, and all the way down to 12. Important to note that the, those levels are also the levels where there are innervations for the celiac plexus, for the stomach organ, for multiple organs in our digestive tract, the intestines, et cetera.
So there’s going to be a lot of communication through the nervous system between this innervation of the rectus abdominis and the innervation of things like the stomach organ. So that’s going to be helpful to understand that there can be various visceral, somatic, and somato visceral type reflexes.
Organs are cranky, the muscle is going to get cranky. If the muscles are cranky, the organs are going to get cranky. There’s communication between the two. So that’s going to be part of our effectiveness of needling. These abdominal points is their relationship to the organs. It’s also worth taking note that some of these branches of nerves, like the subcostal nerve has a a bondage.
cutaneous branch that travels in the front through kind of ASIS region, anterior hip, GB29, that kind of area. There’s other nerves from the ilioinguinal and hypogastric that also become cutaneous. So abdominal muscles and the back muscles that are innervated in this area can often refer along these cutaneous branches.
There’s just a lot of communication through the nervous system that’s relevant to the pain patterns. and the dysfunction that we see that would lead us to using these points. So that’s something to notice. These nerves travel between the internal and external obliques. Let’s look at another image and talk about the fascia layer.
All right, so this is an image, both of these are images that I made, so it has a little bit more channel specific language in here. This would be the territory that those nerves are running between the internal and external obliques. If we follow this fascia layer, let’s look at what happens. This fascia, external oblique, all of it goes above the rectus abdominis.
Internal oblique, the fascia actually bifurcates. Some of it goes on top, some of it goes underneath, deep to the rectus abdominis. So for the stomach channel, we’re following this fascia that goes on top of the rectus abdominis. It becomes the anterior rectus sheath. And this is the territory, in my opinion, of the stomach channel is that needle penetrates or as I’m palpating or if I’m doing manual techniques.
I want the target to be that anterior rectus sheath, possibly the muscle itself. So this portion right here. So that’s the territory very frequently. I’ll just bring the needle to that first density on that anterior rectus sheath and try to stimulate a sensation, see if I can get a traveling sensation.
We’ll talk about where we want those to travel to, what we might be looking for those points here in just a moment. But that’s it. That territory of the anterior rectus sheath. Consistent with the external obliques, somewhat the internal obliques also. If I look at that image on the right here.
You can see that would travel through this external oblique fascia. That external oblique muscle does not fascially connect with the spine. As we get into the deeper points in the spleen and kidney, we’ll look at how that really has a much stronger connection into the lumbar region and into the spine through the fascia.
We’ll come back to this next time. But we’re on that target tissue just on top of the rectus All right, so if I follow that anterior rectus sheath and the rectus abdominis up through this channel sinew, if I wanted to look at it that way, the stomach sinew channel, that’s going to travel on top of the ribcage.
So that continuous fascial plane that’s coming up the thigh meets at the abdominal muscles with the rectus abdominis and that anterior rectus sheath will then travel on that uppermost end eight pack muscle, so to speak that goes on top of the ribcage and that’ll follow up into the sternalis and pectoral fascia and then up into the neck.
So it’s superficial to the ribcage, anterior to the ribcage. That’s the full plane. I will bring our focus back here. There is a nice connection to the lumbar spine through the stomach channel, especially the sinew channel that travels up the vastus muscles and into the thoracolumbar fascia here. So this is nice territory.
To consider for lumbar pain, especially when the pain is at the sort of lateral raffae, lateral edge of the the erector to go back to the image just before, when the pain is at the seam right here, that’s a very commonly, you’ll find tension and restriction at the lateral quadricep, that could be a nice distal point to work with that thoracolumbar fascia up here.
But in terms of rectus abdominis, we’re going to put our focus here. That’s going to be consistent with that superficial plane up into the chest as we look at a corrective exercise for abdominal restrictions for the stomach channel. We’ll come back to that idea in a second. All right. So let’s look at some trigger point referral patterns that would give us some indications of when we would consider these points.
Thanks. Locally, at least, we could also add distal points, but we’re going to keep the conversation on the local needling. So let’s start with the upper portion of the rectus abdominis muscle. This is from Travell and Simmons, Myofascial Pain and Dysfunction, Trigger Point Manual, excellent book.
I’m sure many people are familiar with that. This is an older edition image. The newer third edition, they don’t have the X’s on here anymore. This was common areas. where trigger for trigger point formation might form. They weren’t exactly like target tissues, measurable type things. They could, had quite a variability from person to person.
But it was through primarily Janet Trevelle’s experience. Dr. Trevelle would find common areas where trigger points formed and she put the X to somewhat signify that. They’ve taken the Xs out because trigger points can form anywhere in the muscle. I the old version to be honest.
Because there are norms, I guess you can make an argument that if you’re looking for something that you think should be there and it’s not, it can lead you astray. I think that was some of the argument for taking them out. But but I do think that there’s some value in having the kind of go to areas that are fairly consistent.
And this is the case for this upper abdominis muscle. It can have, first of all, a bilateral referral to the mid thorax region, pain that travels horizontally across both sides, pretty common pain pattern that people would obviously think, they would want massage on the back or acupuncture on the back and oftentimes those erector spinae might get a little cranky in response to that because of that noxious kind of irritating signal from the referral of the erector subdominus.
But as you’re working in this region manually with acupuncture, whatever, people frequently feel it refer back to that site of complaint. So first thing is to find it with palpation. The other thing is this area can be common for epigastric type pain, especially in that region locally. Nausea even just irritation of fullness, abdominal fullness difficulty taking a deep breath.
This area can really lock the breath down. Those are all symptoms that I would be considering that would lead me to palpate up in this area. And generally stomach 20, which is one of the points right on this tendinous inscription would be a very powerful point for that. She has the X a little higher up.
Those can be along the rib attachments can also be. Trigger point formation, but I find stomach 20 is the most common sort of go to for that region. So back to Netter, stomach 20, can’t really see that tendinous inscription here. It’s hidden under the fascia in this illustration, but it’d be in this general region as I go.
get into that even with pressure, it feels like it pulls all that tissue down. Almost feels like you’re pulling the diaphragm down. It helps the diaphragm descend a little bit. So this is really useful point needling also with manual therapy, but again, the target tissue would be into that tendinous inscription for stomach 20.
But also I do a lot of manual work here and you can look at the fiber direction that I would want to be able to free the fascia up at this connection of the external obliques and the rectus sheath. So this area can get very congested, narrowed, pulled in, looks like the chest sinks in that region, and I often want to broaden that area by doing a nice deep myofascial stroke away from the midline.
Whoops, sorry, I didn’t mean to click there. But also working on the stomach 20, I’ll show you some variations of some manual techniques I do here in just a moment that I can just do seated on myself. All right, next region is we have this peri umbilical region. This to be honest will be a bigger player when I get into the next webinar it covers the spleen channel because very frequently these will be on the edge of the muscle, but it’s not uncommon to be on the stomach channel stomach 25 in particular can be a really big source of what we’re about to describe.
This can give a very gassy, internal bloated type sensation when there’s trigger points there. And pressure on it will refer all throughout the abdomen, sometimes even into the hip, deep into the pelvis, wrapping around to the back. It can be a pretty broad pain referral. Stomach 25, very useful.
Stomach 27 region is another one that, that’s quite frequently again along that tendinous inscription can be a big component of that type of pain, but we’ll come back and talk about it. Along this lateral edge in the spleen channel and look at the difference in the anatomy next time, right?
So just again back to Netter so we can see the territory for today. Stomach 25 into that tendinous inscription. We’ll look at palpating that. 26, 27, that’s another one that tends to be in that tendinous inscription. So those 27, 25 are the ones that I most frequently find in the stomach channel that gives that kind of gassy, bloated, distended area can be involved with things like constipation working on that area can make it easier for people to have bowel movements.
So there’s just a lot of reflexes between these areas and the internal organs, right? Another kind of region of common trigger point formation we’ll come back to when we look at the kidney channel, these tend to be more medial along the kidney distribution. We’ll talk about the difference in anatomy next time.
So final one, final region is the lower portion of the muscles. And this could be anywhere from stomach 30, which now, because the rectus abdominis is narrowing, now we’re going to be at the edge of the rectus abdominis. The spleen channel travels along that edge, but when the muscle gets closer to the pubic bone attachment, it narrows quite a bit.
The line of the stomach channel falls on the edge of the rectus abdominis there. So it’d be more of a lateral kind of edge of the muscle very frequent area of trigger point formation for low back pain. So that’s going to create this sort of horizontal band of pain into the sacrum and along the iliac crest, oftentimes bilateral, just like this.
It can be a very similar pain to lumbar facet joint pain. And sometimes those two go hand in hand, that it could be a little bit of both. contributing to that horizontal band. But easy to think about the lumbar facets for that and do tests for the lumbar facets. Maybe not quite as apparent to consider the rectus abdominis muscle.
So definitely when you have this type of pain distribution in including palpation and orthopedic evaluation for the lumbar spine, I would encourage you to look at the rectus abdominis if you’re not already. All right, and here’s just an image. You can see what I’m talking about. Spleen channel follows along that lateral edge, stomach channel right in the middle.
But as the muscle becomes narrower and I get down to stomach 30, then I’m on the lateral edge. So trigger points form on that lateral edge, sometimes in the belly of the muscle. It’s a little trickier to distinguish. between the kidney channel and the stomach channel there. But to be honest, I think it’s more often the kidney channel.
So this is another one we’ll come back to in just a bit. All right. So last thing I’m going to come back up to the stomach region up to that upper part of the erectus abdominis and notice underneath that the stomach organ is there. In this area, if there’s a lot of restriction in the rectus abdominis it can impair just normal, good, healthy stomach motility.
So as you take a deep breath in, that stomach has a various ranges of motion. It does rotation in the transverse plane. It kind of moves in the sagittal plane, rolling forward. And it creates sort of a rotation in a diagonal aspect also. So I don’t know if you need to memorize all of the different ranges of motion unless you do visceral based osteopathic type techniques or Tui Na techniques that work with the organ motility, but just having an appreciation for that motility is really very important because as we open up the organ.
The rectus abdominis create more space, create more potential for movement here. That’s going to encourage a little better stomach movement with the breath. It’s going to allow for a deeper breath and really help that healthy motion that kind of massages and mobilizes the stomach organ. So let’s take the PowerPoint away.
We’ll look at a couple manual techniques. And then we’ll look at an exercise to work with this anatomy, especially that upper part of the channel for this class. All right, so we’ll look at an exercise, but let’s first talk about a manual technique. Obviously, this would be done with a patient prone, but it’s easy enough to do on yourself, even standing or seated.
Xiphoid, I need to be careful of the xiphoid process, not putting a lot of pressure on the xiphoid. I’m actually over the rib cage. So just lateral to the xiphoid process, I want to hook into that fascia and mobilize and move that fascia like I’m pulling open the ribcage, moving it lateral, spreading along that lower portion of the ribcage, pretty sensitive area on a lot of people, but I’m not putting a ton of pressure, just sinking to the level of depth to the ribcage, angling, spreading, opening.
So really nice technique that I teach. Very simple to create more space and more openness there. I could also find that tendinous inscription. I can feel the muscle. If I’m careful, I can notice a little dip into that tendinous inscription at stomach 20. Same thing at stomach 25 would be the same technique.
And I just want to press Soften that tissue. It almost feels like I’m pulling that tissue away from the costal margin, creating space. So just some holding pressure there or I could also spread laterally in that same way if I wanted to. Very easy techniques that you can follow up with after needling, and they can give a lot of assistance with creating space, more movement, freeing the tissue after the needling.
So the last thing, we’ll look at a corrective exercise to move and stretch the rectus abdominis, but especially this upper portion. This is from eight pieces of brocade. It’s called Separate Heaven and Earth. I want to start. With my rectus abdominis slightly contracted, pulling up on the pubic bone attachment, that’ll take me into a slight posterior tilt.
Rib cage is slightly pulled down, so I’m bringing my upper and lower attachments closer together. Bottom hand facing up, top hand facing down. My hands change, but think that the hands are moving because I’m opening the front of the body up. Pelvis goes to neutral. Rib cage lifts. and push. My hands are on the midline.
Hands come together because I engage the rectus abdominis. That’s going to start to tuck the pelvis under slightly, bring the ribcage down. Hands separate because my ribcage is lifting away from my pelvis.
Exhale, everything comes together. Inside, inhale, everything comes apart. So the main thing with this exercise is I don’t want my hands to get too much to the side. I want them to be on the midline so that I can encourage that movement in the stomach region, mobilize the stomach organ, stretch the rectus abdominis upper fibers.
So I displace that to the side, I lose that stretch in that midsection. I need to also lift the chest so that everything separates. Everything comes together,
inhale, separate, exhale. Ten times would be a nice nice amount for patients just to open that structure up. Last one is the first move of eight pieces of brocade. Two hands hold up the heavens. I’m going to clasp my fingers, turn my palms up, reach the hands, lift the chest, same thing. Opening of the front of the body helps lift the hands.
If somebody has decent enough balance, they can follow it up on their toes.
Hands come in, spines coming together, lift, press, lift,
and back down. Easy exercises. Patients usually are able to do those quite well. They can really supplement the treatment. Fun to, to go into the abdominal fibers, like I said, we’ll look at a little bit more on that lateral edge and medial edge, looking at the kidney channel and spleen channel.
Difference in the anatomy, we’ll look at that in the next webinar. So thanks again for American Acupuncture Council, and I look forward to the next time.