The Sinew Meridians are described in Ling Shu, ch. 13 and effectively follow their associated Primary except in wider bands with a few unique branches. They do not contain any specific points besides the Jing-Well where they connect to their associated Primary Channel and Ashi painful points which appear during movement and palpation. They relate to the Wei Qi, the Protective or Defensive aspect, that moves outside the Primary Meridians and more superficially, under the skin in the region governed by the Lungs and includes both the ability to defend ourselves from illness and by moving ourselves away from danger. Pathology of these meridians is determined by pain along their associated pathway and the movement it governs. By using Six Division pairings the majority of the body's surface is covered by the three Yang Divisions, each of which govern a specific movement, while the Yin Divisions cover a relately small area and are concerned more with pain from internal deficiencies:
Several methods of treatment for the Sinews are mentioned in the Ling Shu. Since the Sinews are closely related to the skin, which is seen as the walls around which the Guard patrol, the pores being the gates by which Pathogens gain entry and are expelled, many of the methods are related to the Lungs and Liver which govern the Wei Qi:
- "Burnt Needle Thief Pricking" (燔鍼劫刺 Fan Zhen Jie Ci), also known as "Scorched Needle" (焠鍼 Cui Zhen), "Burnt Needle" (燒鍼 Shao Zhen), "Warm Needle" (溫鍼 Wen Zhen) or "Fire Needle" (火鍼 Huo Zhen).
"Burnt Needle Thief Pricking" is mentioned in Su Wen ch. 62 to prick below areas of tension in the Sinews and again in Ling Shu ch. 13 where the Sinew pathways are described in detail. It is so called because a needle is heated in a flame and then swiftly pierced and withdrawn repeatedly at the area of tension until the patient starts sweating.This opens the pores in the skin and pushes Pathogens out.
However, burning the tip of a needle prior to insertion is not considered a clean technique in most countries, so other methods must be employed to initiate a sweat. Fortunately, the Shang Han Lun warns of "Burning Needles" (5:30 & 8:46) or "Warm Needles" (9:5) being employed to force an excessive sweat which can rob a person of their fluids and Yang Qi and includes alternative suggestions with warm, acrid herbs and covering with a blanket to achieve the same effect. This suggest that other methods that initiate sweating (e.g. exercise, saunas, etc.) may also be equivalent and more suitable today.
The following line of Su Wen ch. 62 also advises "Scorched Needling with Medicinal Hot Press" (焠鍼藥熨 Cui Zhen Yao Yun), for treating "disease of the bones" (病在骨 Bing Zai Gu). It is interesting that a different term is used for the same technique to treat a different region of the body in two consecutive lines. The most likely reason is that they are related but slightly different techniques. Both use a heated needle but this latter may have been left to cool until it can be inserted without inducing a sweat, hence the removal of "Thief Pricking" from this description. This would mean it can be retained to allow the warmth to penetrate into the joint, and avoid depleting the Yang Qi through sweating when the Cold is in the Bone, not the Sinews. Instead the Cold is scattered from the Bone, while also supporting the patient's Yang. The hot compress helps to retain the heat for even longer, for a condition that is deeper and likely more chronic. Moxa on top of needles, although probably not invented at this time, might be a suitable modern alternative.
- "Half Pricking" (半刺 Ban Ci).
Described in Ling Shu ch. 7 as the needling method for the Lungs which govern the skin which works together with the Sinews and Wei Qi to facilitate the release of Pathogens from the Superficial layers. The needling is superficial and quick, not harming the muscle, and can be seen as Ahshi point needling or trigger point therapy where needles are not retained.
- "Close Needling" (關刺 Guan Ci).
Also mentioned in Ling Shu ch. 7 as related to the Liver and Sinews. It uses needles to the left and right of the Sinew to remove a Sinew Obstruction (筋痺Jin Bi) and be a suitable technique for tendon related pain, encouraging pain relief and healing but avoiding inserting directly into the tendon which is painful and ineffective.
- "Ironing": (熨引 Yun Yin).
Ling Shu ch. 78 refers to using this method when the disease originates in the Sinews. It refers to the use of heated iron rollers, such as moxa rollers.
- "Massage" (按摩 An Mo, more commonly referred to as 推拿 Tui Na today) and Liniments (謬藥 Miu Yao) or "Herbal Compresses" (藥熨 Yao Yun):
For pain of the Sinews and Vessels (筋脈不通 Jin Mai Bu Tong), Ling Shu ch. 78 also refers to using massage (按摩 An Mo) and topical herbs (謬藥 Miu Yao, lit. "false medicines," maybe because they do not address root patterns, or because 謬 has a root of "twisting" and refers to wrapping medicines around an injury, or wringing the fresh herbs for juice to apply on the skin). Herbal compresses (藥熨 Yao Yun) are also mentioned in Su Wen ch. 62, combined with scorched needles, to treat pain of the Bones, suggesting they are useful for chronic conditions like arthritis, and injuries like joint sprains and broken bones where the rapid resolution expected of a Sinew contraction is unlikely.
Additionally, as the discussion of initiating sweating shows, other techniques may also be equivalent, providing they achieve the same result. Therefore methods that work on the Exterior and Superficial layers of the body, inducing sweating or resolving pain can also be seen as affecting the Sinews Meridians.
The Sinews also share a close connection with the Luo Mai, being supported by the tiny blood vessels (the "Granchild" Luo 孫絡 of Su Wen ch. 63) that permeate the Sinews. These provide the Ying Qi (營氣, lit. the "Camp") to support the Wei Qi (lit. "Guard") in the Sinews. Therefore methods like spot pricking, derma-rolling, Gua Sha and cupping will also affect the Sinews and are discussed in the section on Luo Mai. The arrival of redness from using Heat or massage is also an indication that the Ying in the Blood is being recruited at assist the Wei.
Modern neurological theories suggest manual therapies are unlikely to be operating on the underlying muscle structure but find interacting with nerve receptors in the skin to be a more likely mechanism (i.e. dermoneuromodulation) and more effective when combined with active movement providing some evidence for this method of working superficially and actively with pain and injury.
Reference Notes: (click to display)
Basic information on location, needle depth, actions and indications is taken from Deadman (2001) A Manual of Acupuncture which was the bible of acupoints at my college and all BAcC accredited courses that I'm aware of. Additional anatomical information is researched by reference to Gray's Anatomy (38th Ed., 1995). Other sources should be quoted in the text.
With reference to different traditions: the descriptions of acupoints, trigger points, marma and other "vital spots" vary both within and between systems. Few use the anatomical precision of TCM and many, including older acupuncture texts, are vague or inferred from a spot on a picture. As such my decision to include information about other traditions under any specific point is often my own approximation based on sources I try to reference.
