CHAPTER 11 Muscular skeletal ailments
Some of the most common muscular skeletal problems that you are likely to see are:
• Repetitive strain injury (RSI)
• Chronic muscular tension and joint restriction
• Pain related to old traumas and injuries
Bi syndrome (painful obstruction syndrome)
Treatment
• Warming, relaxing and releasing the channel sinews (muscles, tendons and ligaments)
• Breaking up, dispersing and dredging stagnation, congestion and accumulation of Qi and Blood
• Breaking up and dispersing fibrous adhesions, caused by injuries, traumas, surgeries, etc.
• Moving and invigorating the flow of Qi and Blood
• Expelling, clearing, dispersing and dredging obstructing pathogenic factors from the channels
• Lubricating and facilitating the movement of joints
• Nourishing, tonifying and supporting Qi, Blood, Yin and Yang
• Bringing the patient’s awareness and breath to areas of habitual holding and/or collapsing
General tips and suggestions
• Take time to observe your patient’s posture; what are your eyes drawn to? Put yourself in the same position, exaggerate it and feel what is happening in your body.
• Ask your patient to perform a range of movements relevant to the affected muscles, tendons and joints and observe what is happening in their body and which movements are restricted. This will help you to find which channel sinews are primarily affected.
• The first time you see a patient, spend a lot of time palpating. Palpate the areas where the patient feels pain. Feel, find and follow along the channel sinews searching for Ah Shi points, tension, adhesion, areas of Emptiness and Fullness, Heat and Cold. Palpate the whole of the affected channel for Ah Shi points.
• Discover the dominant pathogenic factor involved, if there is one. This will help you to choose which Tui na techniques to apply, which ancillary therapies may be useful and which external massage media to use.
• In the treatment of chronic conditions where there is both Excess and Deficiency, clear the Excess factors first, move Qi and Blood, expel pathogens and dredge the channels and then nourish the underlying Deficiency in the second half of the treatment.
• Remember to treat distally as well as locally, for example, in neck problems, treat the forearm channels, and for lower back problems, work in the calf along the Bladder channel.
• If your patient is frail or the problem is either very chronic or connected to an old traumatic injury, especially one involving a break or fracture to the bone, consider working in a Yin style with your attention at the level of the bone.
• Follow the general principles of treatment given on pages 130–133.
Channel sinews
Channel sinew pathways
All channel sinews begin at the Jing Well points:
• Leg Yang channel sinews move up to the face and converge around the area of Juliao ST3
• Arm Yang channel sinews move up to the head and converge around the area of Touwei ST8
• Leg Yin channel sinews move up and converge in the abdomen around Shenque Ren3
• Arm Yin channel sinews move up and converge at Yuanye GB22
Palpation of the channel sinews
When patients come for treatment they describe what they feel and show you where they are feeling their pain, stiffness and aching. This essential information should immediately get you thinking about which channel sinew is affected. Once the patient has described the location and nature of their pain, you then need to feel the area. Palpate the channel sinew that you think is affected. Follow the principle of feel, find and follow, palpating along the channel sinew looking for Ah Shi points, areas of Fullness, Tightness, adhesion and congestion, for Heat and swelling, for places where Wei Qi is obstructed. Feel for Weak, Cold, Empty, numb areas where Wei Qi is insufficient. Palpate the areas where the arm and leg channels meet for tenderness; these are important areas to release in treatment. Although listed in Table 11.1 as points, think of these meeting places more as the whole area around the points.
Suggestions and tips for treating painful obstruction of the channel sinews
• Identify the channel sinew at the root of the problem. This is done through palpation and by discovering which movements are restricted or elicit pain.
• Stimulate the Ah Shi points that you found on palpation as you work along the affected channel. Rou fa and Yi zhi chan tui fa are excellent point stimulating techniques for channel sinew problems.
• Stimulate the Jing Well points of the affected channel sinew with strong Rou fa or direct moxa. Use the Well points as doorways to expel pathogenic factors, and to activate the movement of Wei Qi.
• For all Yang channel sinew problems, release the Governing Vessel first with gua sha and techniques like Gua fa, pinching–grasping, nipping–grasping and kneading–nipping.
• Stimulate the Huatuojiaji points with techniques like Yi zhi chan tui fa, Tan bo fa, An fa, Rou fa and Ji dian fa. For neck and upper limb problems, check the Huatuojiaji points from T1 to T7 for tenderness, tightness and so on and work on the most tender or congested areas. For lower back and lower limb problems, do the same with the points from T11 to L5.
• Release major areas around joints where the channel sinews bind with techniques like Gun fa, compound versions of Na Fa and Rou fa and Tan bo fa.
• Stimulate and release the areas where the channel sinews meet and converge.
• If there is adhesion and a lot of joint restriction, use Zhen fa, Ji dian fa, Tan bo fa and passive movements such as Ba shen fa and Yao fa to break up the adhesions and facilitate the movement of the joints.
• For problems of the leg yang sinews, release Quepen ST12 which is a major binding area. Gua sha is very useful to disperse obstructed Qi in this area.
• Dredge the channels with Gun fa, Tui fa and compound versions of Na Fa and Rou fa.
For all muscular skeletal problems, the area foundation routines will provide a good framework for you to build your treatment around. Stimulate points and channels that are appropriate to the underlying disharmony with relevant techniques and methods. Remember to work on the good side as well as the affected side. For some further suggestions in the treatment of Bi syndrome see Table 11.2.
Table 11.2 Suggestions for the treatment of Bi syndrome
