Part 2: Get More Out of Your Zang Fu Treatments: Emphasis on the Middle Jiao

This short article on how to get more out of your Zang Fu treatments, with an emphasis on the middle Jiao is a second part of an initial piece posted in March 2022, entitled “Get More Out Of Your Zang Fu Treatments“ and can be used as an addendum to it.

This article is adding a frequently observed postural disparity that a practitioner can assess with observation and motion palpation and discusses the specialized needling to the Huatuojiaji points in a vertebral fixation complex to avoid patient discomfort and pain. This combined series of information is what is taught in the Sports Medicine Acupuncture Certification Program Module I: The Spinal Column (click here for descriptions of the courses in this module).

Figure A. Patient with chronic digestive disturbances. The horizontal line shows the elevated ilium on the right. The two small vertical lines indicates a compensatory spinal side bend. The top of the side bend comes back to the center in the region of T9-T11.

As a licensed acupuncturist for 30 years, I have found that patients with chronic digestive disturbances will frequently have a common postural disparity that can be contributing to their pain and dysfunction.

Examining the posterior view of a patient with chronic digestive disturbances, it is common to find and elevated ilium, a compensatory lateral tilt of the lumbar spine and a spinal side bend that comes back to the sagittal plane in the region of the Liver, Gallbladder, Spleen and Stomach back shu points level at T9, T10, T11 and T12. As we know in TCM theory, these organs are the major players in healthy digestion.

The practitioner should examine where the spinal bend begins and ends, i.e. where the spine tilts away from and back to the center line (sagittal plane). Vertebral fixations and offsets are commonly found at these regions creating a hypomobile segment of the spine and potentially decreasing neural signaling to the innervated organs of the middle jiao. (Fig. A). This association of spinal postural disparity and organ dysfunction is more commonly seen in the 40+ age group because spondylosis is known for decreasing neural signaling and an important factor for the acupuncturist to consider.

T9-T11 Spinous Process and Motion Palpation

The practitioner stands next to the seated patient with one hand placed on the patient’s shoulder and with the practitioner’s other hand, three fingers are placed on the spinous processes (SPs) of T9-T11. The patient is asked to rotate left and then right. The practitioner feels for the SPs to point away from the side of rotation. Vertebral rotation is described according to the side to which the anterior surface (vertebral body) faces. If there is a right rotation of T4, the anterior surface turns to the right and the SP points to the left. The right transverse process (TP) would move posteriorly. Note: The practitioner can apply this spinal motion technique on all vertebrae but becomes more difficult with palpation in the upper cervical region.

An Adjunctive Treatment Technique

A goal of treatment is to decrease the elevated ilium, restore mobility of the fixated segments and provide exercises that maintain the mobility. The beauty of this technique is that it can used as a compliment to a practitioners existing treatment strategy for patients with chronic digestive disturbances. This technique is accomplished with acupuncture, manual mobilization techniques and corrective exercise prescription. This treatment is enhanced when the acupuncture treatment includes points for constitutional patterns and appropriate herbal/nutritional advice based on a TCM differential diagnosis.

In the original article, the treatment strategy that has helped many of my patients with this condition is to combine acupuncture point protocols that includes the yin-yang therapy point combination, specific du mai and Huatuojiaji needling and combined with thoracic mobilizations. In this article, we will add specific needling of the Huatuojiaji points based on assessment findings.