Nerve Entrapment Syndromes and The Binding Regions of TCM – Introduction

I lived in China from 1986 to 2014, learning Traditional Chinese Medicine from the last doctors born and educated prior to 1949. That means I learned TCM, because that is what TCM stands for: Traditional Chinese Medicine. How people in the west mis-named China's attempt at creating a modern Chinese medicine (MCM) as TCM is an interesting story, but more interesting is finding out what the true TCM I learned and can still be found in China today is. Come join me for a fun, perspective shifting hour on what is Traditional, what it takes to be a traditional practitioner, and why we should all study TCM if we wish to take full advantage of the classic texts in the clinic.

In this presentation, we will discuss anatomical regions that predispose spinal and peripheral nerves toward compression. Often from a narrowed tunnel or due to a thickening of an overlying myofascial structure, nerve compression can decrease the nerve’s potential to nourish the innervated tissue. There are varying levels of nerve compression, which many times can be a silent contributor to musculoskeletal pain located distal to the entrapment site. The anatomical locations of the nerve entrapments can be viewed as “binding regions” of the channel sinews. Traditionally, as discussed in Chapter 13 of the Ling Shu, binding regions are areas in the sinew channels that are susceptible to stagnation of qi and blood. Understanding the anatomy of nerve entrapment can greatly help the TCM practitioner to assess and treat possible binding regions that could be contributing to the patient’s pain and dysfunction.

Manual muscle testing (MMT) is a integral part of assessment that the TCM practitioner can quickly and effectively add to their clinical practice. MMT provides useful information about “how and why” the injury has occurred or if the patient is susceptible toward future injury. Information gained from MMT informs the practitioner about muscle and channel imbalances, the integrity of the contractile tissue (i.e. how much qi is available to the contractile tissue) and identification of the injured channel and affected tissue. In this workshop, we will examine easy to learn testing of key muscles associated with different channel correspondences. For example, examining the Heart and Small intestine channel relationship of the shoulder internal and external rotators, the Liver and Gallbladder relationship of the hip abductors and adductors and the Pericardium and San Jiao relationship of the elbow rotators. In addition, we will cover specific muscles test to help differentiate the exact location of pain. For example, a patient complaining of anterior hip pain could be any one of the following muscles: pectineus, iliopsoas, sartorius, tensor fascia latae. Determining the exact tissue that is causing the pain helps the TCM practitioner differentiate the affected channels and ultimately key choices for local, adjacent and distal points. The workshop will focus on manual muscle testing and acupuncture points that directly affect the muscle’s contractile ability.

In part I of the afternoon lecture, Andrew lays out the path to gaining the perspectives classical practitioners had as they struggled with providing wellness and treating illness. By learning to see the world as they did, we can better understand the words they left us and immediately apply them in the clinic. Without it, their books become classics of complex theory difficult to use flexibly. In Part I, we cover the classical mindset, Yin-Yang/Qi-Blood as the matrix of illness and health, and recognizing how the patient's Qi must be manipulated to quickly and tangibly to treat what they came in for. In part II of the afternoon lecture, Andrew addresses what happens in the clinic once we have returned to the traditional mindset. With the traditional practitioner mindset in place, we can then immediately apply classical thinking to every physical treatment we give. Answering the questions of what we are treating, why it happened, and who it has happened to is no longer a linear progression leading to a fixed diagnosis. Instead, we see the interaction of Upright and Pathogenic Qi as the living, changing dynamic it really is. By seeing it clearly in front of us at the moment of treatment, we can judge what we have to do and why we are choosing the intensity to give based on who is suffering from the condition.

We will use an East-meets-West framework for exploring the nature of trauma and our body’s inherent capacity to restore balance and regulation. Neurobiology describes 5 steps that both “4-leggeds” and “2-leggeds” use to navigate danger. These 5 steps are mirrored in the 5 Elements and the movement through the Shen Cycle. When we move successfully through each of these steps, we are less likely to suffer long term symptoms from a brush with danger. However, if one of those steps is thwarted, the brace or collapse that results will likely be found in a corresponding tissue, organ or function of the Element associated with that particular step. Our medicine opens up a critically useful diagnostic framework to support movement that restores balance and regulation in what is often a hidden-away tissue or function. Integrating Polyvagal Theory with the Shen Cycle informs the critical role that acupuncturists can play in restoring regulation in the Kidney/Heart axis and brings clarity to the role all healers can play in mitigating the impact of ancestral trauma, impulsive violence, and health disparities. Restoring balance and regulation in one individual then influences their family, coworker and community. Our nation needs its healers!

Our practices are filled with people with “strange, rare, and peculiar” symptoms that baffle western providers. Auto-immune illness, chronic pain, metabolic, sleep, and endocrine disturbance, depression and anxiety all have a tendril of connection to autonomic nervous system dysregulation from traumatic stress, known or unknown. Using ancient principles of Chinese Medicine, Acupuncturists are trained to facilitate whole-body coherence between yin and yang; balance and regulation in the Kidney/Heart axis and a smooth flow through the cycle of seasons and Elements. Integrating neurobiology’s 5 Steps of the Self-Protective Response (hint: they mirror the 5 Elements!) and the framework of Polyvagal Theory in the context of the Shen Cycle will illuminate diagnostic information and treatment room skills that will revolutionize your practice, your service to your patients, and your contribution to the healing of our world.