A prospective view of the Oriental medicine Meridians: pathway in which the Qi and blood are...
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A prospective view of the Oriental medicine • Meridians: pathway in which the Qi and blood are circul ated in the human body express physiological and pa thological phenomenon in the human body • The network of the meridians plays an important role in the diagnos is and treatment of a human body • Understand diagnostic and therapeutic theory of oriental medicine • acupuncture is known to balance the yin and the yang principles of t he human body. • Muscle meridians: Each meridian has their specific merid ian muscle group
A prospective view of the Oriental medicine Meridians: pathway in which the Qi and blood are circulated in the human body express physiological and pathological
A prospective view of the Oriental medicine Meridians: pathway
in which the Qi and blood are circulated in the human body express
physiological and pathological phenomenon in the human body The
network of the meridians plays an important role in the diagnosis
and treatment of a human body Understand diagnostic and therapeutic
theory of oriental medicine acupuncture is known to balance the yin
and the yang principles of the human body. Muscle meridians: Each
meridian has their specific meridian muscle group
Slide 2
Meridians 14 basic meridians: simplified from a complicated
Jing-Lo system having 12 regular meridians plus the CV and the GV
Upper limb: 3 yin meridians (LU,PC,HT), 3 yang meridians (LI,TE,SI)
Lower limb: 3 yin meridians (SP,LR,KI), 3 yang meridians (ST,GB,UB)
Linked with others like a net in the whole body Circulation of the
Qi and blood the meridians in the human body do not exist
independently but they are linked with one another like a net in
the whole body
Slide 3
Diagnostic and Therapeutic theory of Oriental medicine ( ) ( )
MMST( ) ( )
Balance of the yin and the yang acupuncture is known to balance
the yin and the yang principles of the human body. This is
compatible with the idea of normalization of the sympathetic and
parasympathetic dysfunctions of the human body. For improvement of
autonomic nervous dysfunction, we use sympathetic switch points and
parasympathetic switch points introduced by Joseph Y. Wongs
neuro-anatomical approaches. Sympathetic switches:
LI4,LI11,LV3,ST36,UB23,GV3,GV14,GV26 etc. Parasympathetic switches:
CV24,PC6,HT7,SP6,SP9,UB31 to UB34 etc.
Slide 8
Sympathetic switch point Arteries are rich in sympathetic nerve
fibers, particularly the smaller arteries. In the extremities, when
the arteries come down to the hands or feet, they form superficial
and deep arterial arches. very reactive to sympathetic
stimulation(radial artery and deep peroneal artery) The most
commonly used sympathetic switches are: 1) LI4,LI11 in the upper
extremity 2) LV3,ST36 in the lower extremity
Slide 9
LI4,LI11 in the upper extremity LI4 LI11 LI4 LI11
Slide 10
LV3 in the lower extremity LV3
Slide 11
ST36 in the lower extremity ST36
Slide 12
Para-Sympathetic switch point The parasympathetic nerve fibers
are located within the venous and lymphatic system. mainly
distributed in the medial aspect of the upper and lower extremities
The three yin meridians run along the medial aspect of the
extremities and the acupuncture points in these meridians appear to
be able to normalize parasympathetic dysfunction The most commonly
used parasympathetic switch points: 1)HT7, PC6 in the upper
extremity 2)SP6, SP9 in the lower extremity
Slide 13
SP6 in the lower extremity SP6
Slide 14
SP9 in the lower extremity SP9
Slide 15
HT7, PC6 in the upper extremity HT7 PC6
Slide 16
Relation of the meridians and the meridian muscles LULU
meridian muscle Biceps brachii Brachioradialis Thenar muscles
Pectoralis minor LU10 LU5 LU2 We also use the concept of meridian
muscle to explain the methods of assessment about limitation of
movment
Slide 17
Myofascial Meridian Test(MMT) If symptoms of musculoskeletal
pain and dysesthesia are examined from the above concept ie the
expression of tissue strain or failure by limitation of movement on
some part of body, this limitation on movement can be examined in
association with the myofascial tension line and the meridian line.
Objective diagnosis by selecting a specific myofascial tension line
related to limitation on certain movement Treatment point selection
by applying similarity between the myofascial tension line and the
meridian muscle line Myofascial connections postural alignment
Slide 18
The analogy between the myofascial line and the meridian muscle
Deep front arm lineLU meridian muscle The meridians, more
specifically the meridian muscle group, is also a network system in
the human body which controls physiological function similar to
myofascial tension lines Deep front arm line travels very similar
to Lu meridian muscle.
Slide 19
Limitation of passive movement focused on the limitation or
pain on passive movement for the evaluation of the MMT
LPM(limitation of passive movement) stiffness elongation .
Slide 20
The MMT Evaluation Cervical : 1.superficial back line:( + / - )
-neck flexion: UB, SI, GV 2.superficial front line:( +/ - ) -neck
extension: LI, ST, CV 3.lateral line: Rt( + / - ), Lt( + / - )
-neck side-bending: GB, TE Thoracolumbar : 1.superficial back
line:( + / - ) -trunk flexion: UB, GV 2.superficial front line:( +/
- ) -trunk extension: CV 3.lateral line: Rt( + / - ), Lt( + / - )
-trunk side-bending: GB 4.spiral line:Rt( + / - ), Lt( + / - )
-trunk rotation: both GB, UB Upper extremity 1.deep front arm line:
Rt( + / - ), Lt( + / - ) -shoulder extension: LI, LU 2.superficial
front arm line: Rt( + / - ), Lt( + / - ) -wrist extension: PC
3.deep back arm line: Rt( + / - ), Lt( + / - ) -shoulder elevation:
HT, SI 4.superficial back arm line: Rt( + / - ), Lt( + / - ) -wrist
flexion: TE Lower extremity 1.superficial back line: Rt( + / - ),
Lt( + / - ) -leg elevation: UB 2.superficial front line: Rt( + / -
), Lt( + / - ) -leg extension: ST 3.lateral line: Rt( + / - ), Lt(
+ / - ) -fabere test: GB, LR,KI, SP Axis Extremities I focused on
the limitation or pain on passive movement for the evaluation of
the MMT
Slide 21
Approach of postural alignment Head and Neck: forward head/chin
up neck rotation Shoulder girdle: humerus head anterior gliding
scapular abduction/upward rotation scapular adduction/downward
rotation scapular elevation scapular depression Elbow 1 st phalange
flexion/ 5 th phalange extension
Slide 22
Approach of postural alignment Lumbo-pelvic-hip complex: low
back hypertrophy low back flat low back arch iliac crest height in
faber test, femur head anterior gliding in SLR, femur head
posterior gliding in prone position, knee flex and lateral
rotation
Slide 23
Approach of postural alignment Knee: bowleg knock-knee Foot and
Ankle: pronation(eversion) supination(inversion)
Slide 24
T.P(Trigger Point or Treatment Point) through MMT (myofascial
line) , (myofascial line) (meridian line) . Postural alignment .
physical examination . , . , Myofascial Meridian Test . MMST( )
T.P. myofascial connection meridian pathway MMT meridian point
.
Slide 25
Deep front arm lineLU meridian muscle For maintenance of
myofascial meridian balance, we have used meridian points selected
by the Myofascial Meridian Test (MMT) applying similarity between
myofascial lines and meridian muscle lines LI11 LI4 LU1 0 MMT
result: Deep front arm line: Rt( + ) -shoulder extension: LI,LU As
limitation on passive shoulder extension, We can explain deep front
arm line related to LU and LI through analogy between functional
anatomy of myofascial line and pathway of meridian muscle. As a
result, Trreatment points are LI4,LI11 and LU10
Slide 26
Common Patterns of the MMT from clinical observation Above 80%
of all patients; limitation or pain right shoulder passive
extension (+), left trunk passive rotation (+), right trunk passive
bending (+), trunk passive flexion or extension (+), right fabere
test (+), right > left SLR test (+), left > right knee
passive flexion (+)
Lumbo-Pelvic-Hip complex Stabilization system(core system) if
not functioning optimally will end neuromuscular substituting to
utilize the strength power and neuromuscular control in the rest of
the body. Neuromuscular inhibition -> CNS will shut down prime
movers of LPH complex not stabilized -> minimizing the kinetic
chain.
Slide 29
Functional anatomy of LPH complex The LPH complex musculature
produces force, reduce force, and stabilizes the kinetic chain
during functional movements. The core functions primarily to
maintain dynamic postural control by keeping the center of gravity
over our base of support during dynamic movements.
Slide 30
Lumbo-pelvic-hip stabilization Two important group: inner unit
and outer unit Inner unit: pelvic floor, transversus abdominis,
multifidus, diaphragm Outer unit: posterior oblique system, deep
longitudinal system, anterior oblique system, lateral system
Weakness, or insufficient recruitment and/or timing, of the muscles
of the inner and/or outer unit reduces the force closure mechanism
through the sacroiliac joint.
Slide 31
Slide 32
Lumbo-pelvic-hip stabilization: Inner unit The levator ani and
multifidus act as a force couple to control the position of the
sacrum. -> the base of the spine is more stable. Contraction of
transversus abdominis increases the tension laterally in the
thoracodosal fascia and helps to increase the intra- abdominal
pressure. -> role in stabilization of the lumbar spine
transversus abdominis with outer unit -> increase the tension in
the posterior SI ligaments through thoracodorsal fascia ->force
closure mechanism
Slide 33
Slide 34
Lumbo-pelvic-hip stabilization: Outer unit posterior oblique
system: contralateral latissimus dorsi, gluteus maximus,
intervening thoracodorsal fascia ->SI joint compression:
contralateral latissimus dorsi, gluteus maximus contract deep
longitudinal system: erector spinae, deep lamina of the
thoracodorsal fascia, sacrotuberous ligament, biceps femoris
->increase tension in the thoracodorsal fascia and facilitate
compression through the SI joint anterior oblique system:oblique
abdominals, contra- lateral adductor, intervening anterior
abdominal fascia lateral system:gluteus medius and minimus,
adductor, contra-lateral quadratus lumborum
Lumbo-pelvic-hip stabilizing model: form closure mechanism
Trabecular system of the pelvis follows Weight Bearing Lines
B.W.
Slide 38
Definition of Core lumbo-pelvic-hip complex with 29 attached
muscles where bodys center of gravity is located and where all
movement begin in the kinetic chain maintains postural alignment
and dynamic postural equilibrium during functional activities
provide optimum neuromuscular efficiency by improving dynamic
postural control
Slide 39
Composition of Core Inner unit transverse abdominis multifidus
pelvic and respiratory diaphragm
Slide 40
Role of Core stabilization Improve dynamic postural control
Ensure appropriate muscular balance and joint arthrokinematics
Allow functional strength Provide intrinsic stability to the
lumbo-pelvic-hip complex, which allows for optimum neuromuscular
efficiency of the rest of the kinetic chain
Slide 41
Lumbar stabilization Posterior shearing force Anterior shearing
force Compression force DES pull Iliopsoas pull
Slide 42
Pelvic stabilization: locking mechanism Iliolumbar ligament
Sacrotuberous ligament Nutation Counter-nutation * More stable than
counte-rnutation *Sacratuberous ligament and interosseous ligament
tighten *Increasement of ligamentous tension: force closure and
compression Efficient load transfer: through pelvic girdle to lower
extremity *Long dorsal sacroiliac ligament tightens *SI joint is
less compressed and more motor control is required for load
transference. Many low back injuries occur in this position
Slide 43
Pelvic tilting mechanism
Slide 44
Lumbo-pelvic-hip muscle imbalance
Slide 45
Exaggerated anterior pelvic tilt with lumbar extension during
active knee flexion Compensatory reaction -> lumbar extension
Posterior pelvic tilt due to contraction of hamstring ->
contraction of hip flexor and paraspinal muscle flexibility
stabilizing muscle
Slide 46
Left postural rotation 1.limitation of right rotation ->
left side bending (coupling movement) 2.Left DES hypertrophy ->
abnormal posterior shearing force & compression Right rotation
DES elongation restrict 3.Left side bending limitation -
>Quadratus lumbarum elongation TL junction stress -
>segmental hyperactivity External & contrallateral Internal
oblique m ->rotation