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I.Knowing the concept of Meridians and Acupoints. II.Learning the composition of Meridians. III.Understanding the formation of Meridians.

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Presentation on theme: "I.Knowing the concept of Meridians and Acupoints. II.Learning the composition of Meridians. III.Understanding the formation of Meridians."— Presentation transcript:

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2 I.Knowing the concept of Meridians and Acupoints. II.Learning the composition of Meridians. III.Understanding the formation of Meridians.

3 Use of Meridians and Acupoints in Tuina: Clinical use Point “ 点 ” Line; Route“ 线 ” Surface; Range“ 面 ” Acupoint Meridians Twelve sinews/ skin division

4 Concept of Meridians : Consists of meridians and collaterals which are the essential component parts of human body structure. It serves as the pathway for the transportation of qi and blood throughout the body, thus connecting the viscera with extremities, the interior with the exterior as well as the upper with the lower. The interconnection of meridians with collaterals throughout the body integrates the viscera, limbs and orifices, muscles and tendons into an organic whole, thus ensuring the normal performance of body activities. Meridians: longitudinal trunk parts of the meridians, run deeply inside and follow certain routes. Collaterals: branches of meridians running reticular over the body.

5 Meridians system Meridians Collaterals Minute collaterals Fifteen main collaterals Superficial collaterals Twelve regular meridians Eight extraordinary meridians Subsidiary part of meridians Twelve divergent channels Twelve cutaneous regions Twelve sinews regions Governor Vessel Conception Vessel Thoroughfare Vessel Belt Vessel Yang-Heel Vessel Yin-Heel Vessel Yin-Link Vessel Yang-Link Vessel Three Yang meridians of hand Three Yang meridians of foot Three Yin meridians of hand Three Yin meridians of foot Lung meridian of hand-Taiyin Pericardium meridian of hand-Jueyin Heart meridians of hand-Shaoyin Large Intestine meridian of hand- Yangming Triple Energizer meridian of hand- Shaoyang Small Intestine meridian of hand-Taiyang Stomach meridian of foot-Yangming Gallbladder meridian of foot-Shaoyang Bladder meridian of foot-Taiyang Spleen meridian of foot-Taiyin Liver meridian of foot-Jueyin Kidney meridian of foot-Shaoyin Composition of meridians system

6 (1)Hand-taiyin (Lung)(2)Hand-yangming (Large Intestine) (3)Foot-yangming (Stomach)(4)Foot-taiyin (Spleen) (5)Hand-shaoyin (Heart)(6)Hand-taiyang (Small Intestine) (7)Foot-taiyang (Bladder)(8)Foot-shaoyin (Kidney) (9)Hand-jueyin (Pericardium)(10)Hand-shaoyang (Triple Energizer) (11)Foot-shaoyang (Gallbladder) (12)Foot-jueyin (Liver) The flow of Qi in cyclical order:

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8 Acupoints, “acupuncture points” Places for acupuncture and moxibustion. Locations where Qi and blood from the viscera and meridians effuse and infuse in the body surface. Acupoints Channel Points Extra points Ashi-Points -points that have definite locations not in fourteen channels have specific names and effective indications -points distributed along the course of the fourteen channels -refers to the site which neither a point of the fourteen channels nor an extra point but solely the tender spot

9 Examination of: Head and Face Chest and abdomen Spine The upper limbs The lower limbs Shoulder Elbow Wrist, palm and fingers Hip Knees Malleolus

10 Examination methods used:  Inspection  Palpation  Motor examination  Special examination

11 Importance of Examination methods:  determine whether a patient is eligible for Tuina.  Use the correct manipulation for a certain disease.  Perform the right mechanism of Tuina for the treatment on a disease.  Coordinate with other therapies like acupuncture and moxibustion.  Judgment of prognosis.

12 The spirit Visual expression (1)Keen and bright(2)Quick response and normal speech Spirit is normal (1)Dull and sleepy(2)Weak breathe and slow response (3)floccillation(4)Involuntary discharge of urine Spirit is lost

13 The facial expressions Color and luster Bright and lustrous Mild disease Qi and blood not impaired Favorable prognosis Dull and lusterless Serious disease Impairment of disease Unfavorable prognosis

14 The shape of the head and face Rickets: a disease of children caused by vitamin D deficiency, characterized by imperfect calcification, softening, and distortion of the bones typically resulting in bow legs. (1)Rickets -Protrusion of frontal bone and temporal bone at both sides and flat vertex

15 (3)Stiff neck Cervical spondylosis (2)Myogenic touticollis -Head turns to the affected side and face to the healthy side -Mild anterior bending of the head with rigidity The shape of the head and face

16 (5)Facial paralysis (6)Central neural facial distortion -inability to close the eye of one side -disappearance of wrinkles -deviation of mouth corner to the healthy side -disappearance of nasolabial groove -Paralysis of the lower part of the body and deviation of the mouth corner to the affected side The shape of the head and face

17 The tongue Mild white tongue Deep red tongue Bluish and purplish tongue Normal- slightly red -weakness of Qi and blood -insufficiency of Yang Qi accompanied by cold -excess heat syndrome -Yin deficiency -fever, infection, trauma, operation -unsmooth flow of Qi and blood -blood stasis

18 The tongue coating Normal- thin, white and slippery Scanty, no coating Thick and greasy coating White coating Yellow coating Red tongue no coating -weakness of spleen and stomach -Excessive dampness -deficiency of stomach Qi and body fluid -Cold dampness or cold phlegm -external heat syndrome -heat dampness

19 Palpation methods: -pulse taking -touch and feel Purpose of palpation to differentiate: -cold -warmth -moisture -dryness -distension -pain

20 Infantile fontanel Steps: (1)doctor may put his palm at both sides of the temple (2)examine the fontanel with the middle finger and index finger (the artery fontanel can be felt pulsating) (3)anterior fontanel is at same level with cranium

21 Protrusion of anterior fontanel -high fever -bleeding inside cranium (Increased of intracranial pressure) Retard closure of anterior fontanel Depression of anterior fontanel -rickets -vomiting and diarrhea -loss of body fluid

22 Length of mouth opening Normal length: -the length of upper teeth to the lower teeth is about the width of middle, index and the fourth fingers putting together Disorder of mandible -length narrow -lockjaw Traumatic Injury Steps: -depression in cranium -fracture in deep region of subcutaneous hematoma -cranial depression or deformity Dislocation of mandible -marked by emptiness of articular fossa -condyle anterior to it

23 Chest Steps: -local redness -swelling -mass and visible veins -changes of thoracic and abdominal shapes

24 Portal hypertension in liver Malnutrition Emphysema Tuberculosis Rickets -protrusion of veins -ascites -splenomegaly -infantile emaciation with swollen abdomen -visible veins MastitisBronchial asthma -hardness of breast -obvious tenderness and fever -barrel chest -flat chest -chicken breast

25 Abdominal Gastroptosis EmaciationPyloric obstruction/ Intestinal obstruction -abdominal depression and protrusion of navel -Abdominal peristaltic wave can be seen

26 Thoracic Tracheal rupture -cutaneous emphysema Pinching or Extrusion Test Steps: -patient is asked to sit or stand -the doctor pinch the thorax of the patient from both sides -pain will be felt if there is costal fracture Costal fracture

27 Abdominal Extrapyramidal bundle injury Abdominal wall reflex test Steps: -patient lies in supine position, with knees bent -relax the abdominal muscle -the doctor quickly and mildly draw a line from hypochondrium to the navel and abdomen with a stick -observe for muscular reflex *loss of abdominal wall reflex at certain horizontal level suggest injury of spinal cord at the corresponding section Indications: -upper abdominal wall  T7-T8 -middle abdominal wall  T9-T10 -lower abdominal wall  T11-T12

28 Cremasteric reflex test Steps: -used a stick of match to draw the skin over the inner thigh -draw from lower thigh to upper thigh -to induce the contraction of scrotum Indications: -contraction of scrotum  L1-L2

29 Physiological curvature and spinal deformity Physiological curve of Spine: -Cervical curvature (lordosis) -Thoracic curvature (kyphosis) -Lumbar curvature (lordosis) -Sacral curvature (kyphosis) Pathological abnormal changes: -Scoliolosis -humpback -lumbar lordosis -wry pelvis

30 Scoliosis- Functional Functional scoliolosis test (1)Steps: -asked the patient to pull the horizontal bar with both hands -the spinal curve disappear (2)Steps: -asked the patient to bent anteriorly for 80° -functional curve disappear *shows no structural deformity

31 Scoliosis- Structural Characteristics: -irreversible -server curve and fixated -appears prominent -accompanied by deformity of thorax -caused by disorders of vertebrae, ligaments, intervertebral disc, nerve and muscles *not allowed to rectify through posture adjustment

32 Scoliosis- Structural Pathological factors: -improper posture -non-symmetry of the lower limbs -deformity of the shoulders -breaking of the lumbar intervertebral fibers -infantile paralysis -chronic thoracic diseases *deformity due to improper posture disappears in supination or when waist is bent

33 NeurofibromaProliferative fivrosis Congenital fissure of sacral vertebrae Spinal meningocele Wandering abscess -different size coffee spots over the waist and back -long body hair, thick skin color over the lumbosacral region -swollen and distending soft tissues around middle waist Swelling in the triangular region at one side of the waist

34 Tenderness Shallow tenderness Deep tenderness Intermittent tenderness Superficial disorders in supraspinal and interspinal ligament Deep disorders of vertebrae, small joints and intervertebral discs

35 Tenderness- Sprained of lumbar soft tissue Interspinal ligament injury Supraspinal ligament injury Lumbar myositis -interspinal tenderness -supraspinal tenderness -lumbar tenderness

36 Neck movement Physiological motion bends anteriorly for 35°-45° posteriorly for 35°-45° moves left and right sides respectively 45° turns to the left and right 60°-80°

37 Lumbar movement Physiological motion: bending anteriorly for 90 ° posteriorly for 30° moves left and right sides respectively 30° turns to the left and right 30° * fracture lest spinal cord, nerves or vessels be impaired should avoid motor examination.

38 Vertex percussion test Steps: -the patient is asked to sit straight with the head turning to he affected side -doctor put his left palm on the vertex of the patient -performs percussion with his right hand * Positive: patients will feel pain or radiating pain due to foramina stenosis Impairment of nerve root

39 Brachial plexus pulling test Steps: -the patients bends his neck anteriorly -the doctor supports one side of the patient’s head with one of this hand -grasps the wrist of the patient with other hand -pulling towards the opposite direction *positive: arm is painful or numb  pressure on the brachial plexus Compression on brachial plexus

40 Neck rotation test Steps: -the patient is asked to raise his head slightly to the posterior side -and turns the neck automatically to the right and left sides *positive: dizziness, vomiting or faint (suggest insufficient of blood in basilar artery) Vertebral arteryNeck bending test Protrusion of lumbar intervertebral disc Steps: -the patient lies supination -the doctor puts one of his hands at the occipital side -the other over the chest of the patient -then bending the patient’s head anteriorly *positive: appear lumbago and sciatica (radiating pain occured)

41 Abdomen straightening test Steps: -the patient lies in supination -tries to straighten the abdomen by raising the waist and pelvis over the bed -ask the patient to cough at the same time *positive: radiating pain in the waist and lower limbs Pressure of the lumbar nerve roots

42 Leg raising and foot dorsum test Steps: Leg raising  Tension of iloitibial tract and hamstring muscle -the patient lies supination with both legs stretched straight, then raising the legs -the doctor examines the range of rising without pain (the angle between the raised leg and the bed) *Positive: -pain occurs in the range of 60° and below when the respective nerve roots are compressed (5°-10° the pain will disappear) Foot dorsum  Intervertebral fiber breaking syndrome -foot dorsum bent upwards *Positive: -sciatica appears

43 Femoral nerve pulling test Steps: -the patient lies in prone position -the doctor fixates the pelvis of the patient with one hand -holds the affected shank of the patient with the other hand -then pulling the leg of the patient with great strength *Positive: Radiating pain in the anterior part of the thigh Compression of femoral nerve

44 Pelvis rotating test Steps: -the patient lies in a supination -the doctor bends the hips and knees of the patient as much as possible -raise the buttocks of the patient over the bed -enable the waist of the patient to bend passively to the anterior direction *Positive: pain appears in the lumbosacral part Lumbar soft tissue injury, lumbosacral vertebral disorder

45 Pelvis separating and pressing test Steps: -the patient lies in a supination -the doctor pressing the wing of iliac crest of the patient from the opposite sides (pelvis separating test) -the doctor presses the wing of ilium with both hands towards the central (pelvis pressing test) *Positive: pain appears Disorder of articulatio sacro-iliaca, pelvic fracture

46 4-shaped test Steps: -the patient lies supination -stretching the healthy lower limb straight -laterally bending the affected limb to put the foot over the knee of the healthy limb -the doctor presses the knee of the affected limb of the patient with the other hand to rotate the articulatio sacro-iliaca *Positive: pain appears Disorder of articulatio sacro-iliaca, Sciatica

47 Bed side test Steps: -the patient lies supination -turns the buttock against the side of the bed -bending the knee of the healthy limb to fixate the pelvis -the doctor moves the affected limb of the patient to the edge of the bed -pulls as much as possible in order to move the the articulatio sacro-iliaca *Positive: pain appears Disorder of articulatio sacro-iliaca

48 Heel-buttock test Steps: -the patient lies in prone position and stretch the lower limb -the doctor grasps the heel of the patient -to bend the knee till the heel touches the buttock *Positive: pain appears in lumbosacral region, pelvis or waist Disorder in lumbosacral joint

49 Essentials symmetry between the two shoulders development of the deltoid muscle, superclavicular and infraclavicular fossae at both sides the symmetry between both sides of scapular distance between the medial border of scapular and the spinal vertebrae

50 Congenital tall scapular disease Paralysis of serratus anterior muscles Dislocation of shoulder jointFracture of scapular Dislocation of clavicular joint -scapular is prominent -the medial border of the scapular is protruding -the back of shoulder is swollen with acute injury -bulge of deltoid muscle -prominence of the lateral side of clavicle

51 Tenderness Steps: -the doctor uses the thumb to seek for tenderness around the shoulder joint -trials to be made to exclude fractures -examine the functions and mobility of the joint *Positive: Tenderness appears at certain examined region Disorder of lesser tuberosity of humerus -tenderness anterior and inferior to acromion Disorder of greater tuberosity of humerus -tenderness lateral to acromion

52 Anteflexion movement Steps: -range of movement can reach 90°. -the doctor fixates the shoulder with one hand and ask the patients to raise the upper limb anteriorly -muscles involved: anterior of deltoid muscle and coracobrachial muscle Retro-extension movement Steps: -range of movement can reach 45°. -the doctor asks the patient to raise the upper limb posteriorly -abduct the upper limb -muscles involved: musculus teres major

53 Abduction movement Steps: -range of movement can reach 90° -the patient is asked to abduct the upper limb -muscles involved: deltoid muscle and supraspinous muscle Endoduction movement Steps: -range of movement can reach 45° -the patient is asked to bend the elbows and move the upper limbs medially -muscles involved: greater pectoral muscle

54 Extorsion movement Steps: -range of movement can reach 30° -the patient is asked to bend the elbow for 90° -the doctor holds the elbow with one hand, and wrist with the other hand -to rotate the upper arms laterally -muscles involved: infraspinous muscle and musculus teres minor

55 Adduction movement Steps: -range of movement can reach 80° -the patient is asked to bend the elbow for 90° -adduct the forearm to the front of the chest -or to touch the subscapular muscle with the forearm from the back -muscles involved: subscapular muscle Rotation movement Steps: -to rotate the upper arms around the acromiobrachial joint -muscles involved: subscapular muscle

56 Dugas syndrome test Steps: -the patient bends the elbow -puts the hand at the affected side on the shoulder at the opposite side -touches the elbow against the chest *Positive: pain appears, unable to complete the movement Dislocation of shoulder joint Arm drop test Steps: -the patient stands up -passively abducts the affected limb for 90° and then slowly put it down *Positive: arm suddenly drops to the side of the body Injury of supraspinous muscle

57 Pain circle test Steps: -the patient is asked to abduct the affected shoulder -when it is abducted to 60°-120°, the tendon of supraspinous muscle will cause friction below the acromion *Positive: pain appears in the shoulder Myotenositis

58 Inspection Swelling Deformity Within the joints Outside the joints Whole joints swelling Regional swelling (medial, external condyle of humerus, olecranon) Traumatic swelling Pathological swelling (suppurative infection) Fracture Dislocation

59 Elbow joint Internal humeral condyles  flexor muscle group of forearm (inflammation) External humeral condyles  extensor muscle group of forearm (external humeral epicondylitis) Olecranons  (fracture orbursitis) Tenderness

60 Rotation of forearm Upper and lower joints of radius Upper and lower joints of ulna Interosseous membraneand Flexion (140°) Extension (0°-10°) Humeral joint Ulnar joint Pronation 90° Supination 90°

61 Mill test Steps: -the patient is asked to slightly bend the forearm, slightly clench the fist -flex the wrist joint as much as possible -completely turn the forearm anteriorly and straighten the elbow *Positive: pain appears in the lateral side of the humeral and radial joint External humeral epicondylitis, “Tennis elbow”

62 Forearm flexion and extensor tension test Steps: -the patient is asked to clench the fist and flex the wrist -the doctor presses the hand dorsum of the patient with his hand -ask the patient to stretch the wrist under the pressure *Positive: pain appears in the lateral side of the elbow Steps: -or the doctor may press the palm of the patient -ask the patient to flex his wrist under pressure *Positive: pain appears in the medial side of the elbow

63 Physiological The hand maintains in natural clenching pose and tension of all antagonistic muscles is balanced The dorsiflexion of the wrist ia about 15° The thumb touches the index finger and the rest four fingers are in flexion Rapidly clenching and stretching fingers

64 Oesteonosus and traumatism Distal fracture of radius Distal fracture of ulnar joint Injury of radial nerve Damage of the median nerve -Silver fork deformity -or bayonet shaped deformity -protrusion of styloid process of ulna at the dorsal side -cause drop of wrist -failure of thumb to oppose to the palm and abduct -inability of the thumb and index finger to flex and stretch -atrophy of major thenar -monkey paw deformity Tenovaginitis -swelling along the tendons

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66 Tenderness Tenovaginitis of the short/long extensor muscle of great toe -tenderness at the styloid process of radius Carpal tunnel syndrome -tenderness in the central region of wrist crease at the palmar side -radiating pain and numbness

67 Normal range of wrist joint movement Dorsal extension (80°-90°) Palmar flexion (60°-70°) Radial deviation (25°-30°) Ulnar deviation (30°-50°)

68 Fist clenching test Steps: -when the affected hand clenches into a fist (thumb maintains inside while the rest four fingers outside) -ulnar deviation of the wrist joint *Positive: pain in the styloid process of radius Tenosynonitis of radial styloid Wrist flexion test Steps: -when the wrist joint of the patient is extremely flexed *Positive: numbness and pain Carpal tunnel syndrome

69 Frontal -the groin is asymmetrical in order Swelling of hip joint Severe injury of head femur -the anterior superior iliac spine are not at the same level Lateral Dislocation of the hip joint -anterior protrusion of the waist -posterior protrusion of the buttocks and flexion of hip Rear Chronic disease of the hip joint -disuse atrophy of gluteal muscle (dyskinesia) Unilateral congenital dislocation of the hip joint -transverse crease at one side is thickened, deepened and elevated

70 Tenderness Inflammation of groin -pain occurs when pressing the point 2cm below the middle of inguinal ligament -local swelling, distension or tenderness Disorder of hip joint -pain appears when percussion on the greater trochanter of femur is performed with the fist Bursitis -superficial tenderness in the ateral greater trochanter of femur

71 Normal range of hip joint movement Flexion ( °) Posterior extension (30°) Abduction (35°-45°) Adduction (20°-30°) Extorsion (45°) Intorsion (40°)

72 Palm-heel test Dislocation or fracture of hip joint, paraplegia Steps: -the patient lies in supination with the lower limbs extended -heel put on the palm of the doctor -the lower limbs appear in a vertically median position *Positive: heel will appear in extorsion Heel percussion test Disorder of hip joint Steps: -the patient lies in supination with the lower limbs extended -the doctor lift the affected limb with one hand and knocks the heel of the patient with the other *Positive: pain in the hip joint

73 Excessive extension of the hip joint Disorder in hip joint or sacral and iliac joint Steps: -the patient lies in pronation with the lower limbs extended -the doctor presses the posterior part of the sacrum of the patient -to fixate the pelvis with one hand -lift the affected shank with the other hand to force the hip joint to extend excessively *Positive: pelvis will be raised, pain appears in the sacral and iliac joint

74 Flexion of the hip joint Disorder in hip joint or sacral and iliac joint Steps: -the patient lies in supination with the pelvis in anteversion and excessive flexion of the hip and knee joint of the healthy side *Positive: Flexion deformity appears; the angle between the tigh and the bed is the deformity angle

75 Swelling and deformity Extorsion or intorsion deformity -exceeding of a mild extorsion about 5°-8° in the thigh and shank Bursitis and hydrarthrosis -mass and swelling above synovial bursa Bone tumor -swelling of the condyle and epiphysis of the tibia and femur Dyscinesia of the knee -atrophy of the inner end of the quadriceps muscle of thigh

76 Tenderness Chondromalacia patellae -pressure will lead to slight shift of the patella and cause pain Epiphysitis of tibial tubercle -hard mass can be palpated and obvious tenderness appears Hypertrophy of subpatellar fat pad -hard mass can be sensed in both sides of patellar ligaments Injury of meniscus -tenderness between the interspace of the knee joint

77 Normal range of knees joint movement Flexion (130°)  Hamstring muscles Extension (10°)  Quadriceps muscle of the thigh

78 Patella floating testRetention fluid in the knee joint Steps: -the patient lies horizontal position extends the affected limb -the doctor presses the suprapatellar bursal fluid above the patella into the cavity of the joint with one hand -repeatedly press the patella with the thumb of the other hand *Positive: wave motion in the cavity of the joint indicates retention of fluid

79 Lateral pressure of the knee joint test Ligament injured or broken Steps: -the patient lies in supination with the affected limb extended -the quadriceps muscle of thigh relaxed -perform intorsion and extorsion of the knee joint *Positive: lateral motion and pain appears

80 Drawer test Injury of ligament Steps: -the patient lies in supination and flexes the knee about 90° and feet put on bed horizontally -the doctors holds the shanks of the patient to push and pull repeatedly *Positive: lateral motion and pain appears.

81 Rotation and pinching test of knee joint Injury of meniscus Steps: -the patients lies supination with both limbs extended -the doctor holds the ankle of the patient with one hand to flex the knee joint as much as possible -performing extorsion and of the knee and intorsion of the shank -gradually extending the knee joint to induce crush and friction in the interspace of the knee joint *Positive:

82 Grounding, lifting and pulling test Injury of collateral ligament and breaking of meniscus Steps: -the patients lies a prone position with the patellar joint extended and the knee flexed to 90° -the doctor fixates the thigh of the patient and holds the affected foot with both hands -press the knee joint and rotate the shank -lift the shank and rotate *Positive: (pressing) pain suggests injury of meniscus; (lifting) pain indicates injury of collateral ligament

83 Signs of deformity Drops Intorsion of foot Extorsion of foot Flat foot Carvus foot Traumatism injury Swelling Distension Subcutaneous blood stasis

84 Tenderness Interspace of the joint The end bone The attaching point of tendons

85 Tenderness Bursitis of the Achilles tendon -tenderness in the terminating point of the arhilles tendon Spur or fat pad -tenderness median and posterior to the calcaneus

86 Normal range of knees joint movement Dorsal extension (20°-30°) Flexion (40°-50°) Intorsion (30°) Extorsion (20°)

87 Intorsion and extorsion of foot test Steps: -the doctor fixates the shank of the patient with one hand and -holds the foot of the patient with the other to perform excessive intorsion and extorsion of foot *Positive: pain on the same side  fracture of medial or external malleolus pain at opposite side  injury of collateral ligament

88 Dorsal flexion of foot test Steps: -the patients lies supination with both limbs extended -the doctor use one hand to push the patients foot with dorsal flexion excessive *Positive: pain in the calf muscle Deep vein thrombosis Babinski’s sign test Steps: -the doctor uses a stick with a blunt point to stroke the lateral edge of the sole from back to front *Positive: appears slow dorsal flexion of big toes and mild extorsion of the rest of toes Injury of extrapyramidal bundle


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