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Chapter 13 of 81
黄帝内经·灵枢
Overall Paraphrase
The Ling Shu·Jingjin discusses the Twelve Sinew Channels (shí'èr jīngjīn) — which can be understood as the sinew-muscle systems connected to the twelve primary channels (including muscles, tendons, and fascia). They originate from the extremities of the limbs, run centripetally, and converge at joints, bones, and the body surface, without directly entering the viscera. The entire chapter follows the order of Foot Three Yang, Foot Three Yin, Hand Three Yang, and Hand Three Yin, recording their pathways, pathological manifestations, and nomenclature, and concludes with a summary of the general rules of cold, heat, deficiency, and excess. As the original text contains numerous transcription errors, the following is an interpretive translation based on the standard received edition.
The frequently repeated phrase "cauterized needle swift needling, with patient's arrival of qi as the criterion and pain as the point selection" (fánzhēn jiécì, yǐ zhī wéi shù, yǐ tòng wéi shū) means: use a heated needle for rapid needling🔥, with the patient's sensation of qi arrival or alleviation of symptoms as the limit, and the site of pain as the treatment point—similar to the later concept of "ashi points" (tender points)🩺. This belongs to ancient therapeutic principles and is not presented as a clinical recommendation.
Essential Points by Channel
Foot Taiyang Sinew Channel: Originates at the small toe, ascends to bind at the lateral malleolus, knee, popliteal fossa, and buttocks, then runs alongside the spine up to the neck; branches distribute to the root of the tongue, occipital bone, side of the nose, upper eyelid, shoulder (Jianyu), supraclavicular fossa, mastoid process, and cheek region. Pathological manifestations include stiffness of the small toe, swelling and pain of the heel, cramping of the popliteal fossa, opisthotonos (backward arching of the spine), tightness of the neck sinews, inability to raise the shoulder, pulling sensation in the axilla, knotting pain in the supraclavicular fossa, and inability to turn left or right. The ancients called this "mid-spring bi syndrome."
Foot Shaoyang Sinew Channel: Originates at the second toe, binds at the lateral malleolus, lateral knee, thigh (biguan area), and sacrum, then ascends over the floating ribs, anterior axilla, chest and breast, and supraclavicular fossa; it runs along behind the ear, to the forehead angle, vertex, chin, and cheek, and binds at the outer canthus. Pathological manifestations include cramping of the second toe, pulling the lateral knee into cramping, inability to flex and extend the knee, pulling anteriorly to the thigh and posteriorly to the sacrum, and upward to the floating ribs, supraclavicular fossa, chest/breast, and neck. With "crossing sinew intersection" (wéi jīn xiāng jiāo), there may be crossed left-right involvement: injury to the left forehead angle with inability of the right foot to function. The ancients called this "early spring bi syndrome."
Foot Yangming Sinew Channel: Originates at the three middle toes, binds at the dorsum of the foot, fibular bone, lateral knee, hip joint, ribs, and spine; ascends along the quadriceps (Futu), converges at the genitals, ascends and spreads over the abdomen, reaching the supraclavicular fossa, neck, mouth, nose, and lower eyelid; a branch binds anterior to the ear. Pathological manifestations include stiffness of the middle toes, cramping of the shin, jumping and rigidity of the foot, cramping of the quadriceps, swelling of the anterior thigh, hernia-like swelling (tuī shàn), abdominal sinew tension, pulling into the supraclavicular fossa and cheek, and sudden deviation of the mouth and eye. With cold, the facial sinews tighten and pull the mouth; with heat, the sinews become lax and unable to contract. The chapter records an ancient method: apply horse fat (mǎ gāo) externally to the contracted side, mix white wine with cinnamon for the relaxed side, use mulberry hooks for traction, and use mulberry ash for warming fomentation, accompanied by dietary regulation with wine and food🌿. This is an ancient external treatment approach for scholarly study only. The ancients called this "late spring bi syndrome."
Foot Taiyin Sinew Channel: Originates at the medial aspect of the great toe, ascends to bind at the medial malleolus, medial knee condyle, medial thigh, and hip, converges at the genitals, ascends the abdomen to bind at the navel, follows the interior of the abdomen to bind at the ribs, disperses into the chest, and the internal branch attaches to the spine. Pathological manifestations include stiffness of the great toe, pain of the medial malleolus, cramping pain, pain of the medial knee condyle, pulling pain from the medial thigh to the hip, knotting pain of the genitals, pulling downward to the navel and pain of both flanks, and pulling pain into the chest, spine, and interior. The ancients called this "early autumn bi syndrome."
Foot Shaoyin Sinew Channel: Originates beneath the small toe, runs parallel with the Foot Taiyin sinew channel, obliquely travels below the medial malleolus, binds at the heel, joins with the Foot Taiyang sinew channel, ascends to bind below the medial condyle, follows the medial thigh, binds at the genitals, follows the spine and both sides of the vertebral column up to the neck, and binds at the occipital bone. Pathological manifestations include cramping of the sole of the foot; all areas traversed and bound by the channel are painful with cramping. Conditions of this channel may manifest as epilepsy, convulsions, and opisthotonos. External involvement causes inability to bend forward; internal involvement causes inability to extend backward. If the sinews become folded and broken, with frequent severe recurrences, the ancients considered the prognosis poor. The ancients called this "mid-autumn bi syndrome."
Foot Jueyin Sinew Channel: Originates at the dorsum of the great toe, ascends to bind anterior to the medial malleolus, follows the shin, binds below the medial condyle, follows the medial thigh, binds at the genitals, and connects with all the sinews. Pathological manifestations include stiffness of the great toe, pain anterior to the medial malleolus, pain of the medial condyle, cramping pain of the medial thigh, and dysfunction of the genitals. Injury from internal causes leads to impotence; injury from cold causes retraction of the genitals; injury from heat causes flaccidity and inability to contract. The ancients proposed the treatment principle of "promoting water metabolism to clear the yin qi." For cramping, the same cauterized needle swift needling method applies. The ancients called this "late autumn bi syndrome."
Hand Taiyang Sinew Channel: Originates at the small finger, binds at the wrist, behind the medial ulnar condyle (sharp bone), and the axilla; a branch circles the scapula, follows the neck, and binds at the mastoid process behind the ear; a branch enters the ear; the direct branch emerges above the ear, descends to bind at the chin, and ascends to connect with the outer canthus. Pathological manifestations include stiffness of the small finger, pain along the posterior border of the medial elbow bone, pain in the axilla and posterior axillary border, pain circling the scapula and pulling into the neck, ringing and pain in the ear, and eyes that close for a long time before being able to see. If the neck sinews are tense, there may be sinew fistulas and neck swelling. The ancients called this "mid-summer bi syndrome."
Hand Shaoyang Sinew Channel: Originates at the tip of the ring finger, binds at the wrist, elbow, and lateral upper arm, ascends to the shoulder and neck, joining the Hand Taiyang sinew channel; a branch enters and connects with the root of the tongue; a branch ascends to the curved cheekbone (zygomatic), follows anterior to the ear, connects with the outer canthus, ascends to the mandible, and binds at the temple (corner of the head). Pathological manifestations include stiffness and cramping of areas traversed, and curling of the tongue. The ancients called this "late summer bi syndrome."
Hand Yangming Sinew Channel: Originates at the tip of the index finger, binds at the wrist, lateral elbow, upper arm, and shoulder (Jianyu); a branch circles the scapula and runs alongside the spine; the direct branch ascends from Jianyu to the neck; a branch ascends to the cheek and binds at the cheekbone; the direct branch ascends to the left forehead angle, connects with the head, and descends to the right jaw. Pathological manifestations include pulling pain and cramping of areas traversed, inability to raise the shoulder, and inability to turn the neck to look left and right. The ancients called this "early summer bi syndrome."
Hand Taiyin Sinew Channel (originally mistakenly written as "Hand Taiyang"): Originates at the great finger, binds posterior to the thenar eminence, runs along the lateral aspect of the wrist (Cunkou), follows the arm to bind in the elbow, ascends the medial upper arm, enters the axilla, emerges at the supraclavicular fossa, binds anterior to the shoulder, descends to bind in the chest, spreads through the diaphragm, and reaches the floating ribs. Pathological manifestations include cramping pain of areas traversed; in severe cases, there may be respiratory accumulation (xī bēn, a mass causing panting), hypochondriac tension, and vomiting of blood. The ancients called this "mid-winter bi syndrome."
Hand Pericardium Sinew Channel: Originates at the middle finger, runs parallel with the Hand Taiyin sinew channel, binds at the medial elbow, ascends the medial upper arm, binds at the axilla, descends and disperses anterior and posterior flanking the ribs; a branch enters the axilla and disperses into the chest. Pathological manifestations include cramping of areas traversed, pain extending to the chest, and respiratory accumulation (xī bēn). The ancients called this "early winter bi syndrome."
Hand Shaoyin Sinew Channel: Originates at the medial aspect of the small finger, binds at the styloid process (sharp bone), ascends to bind at the medial elbow, ascends into the axilla, crosses the Taiyin channel, flanks the breast, binds in the chest, follows the chest downward to connect with the navel. Pathological manifestations include internal tension, a sense of abdominal mass (fú liáng) below the heart, the elbow feeling as if caught in a net; cramping and sinew pain of areas traversed. If it develops into a fu liang mass with spitting of blood and pus, the ancients considered the prognosis poor.
Summary at Chapter End: In diseases of the sinew channels, cold causes contraction, tension, and opisthotonos; heat causes sinews to become lax and flaccid, with impotence and dysfunction. When the yang sinews are tense, the back arches backward; when the yin sinews are tense, the body bends forward and cannot extend. "Tempered needling" (cuì cì) refers to rapid fire-needle application, suitable for cold-type sinew tension; for heat-type sinew flaccidity, the fired needle🔥 should not be used. When the Foot Yangming and Hand Taiyang sinew channels are tense, there may be deviation of the mouth and eyes, and tightness of the eye corners preventing sudden vision.
Sinew channels govern movement and do not directly enter the viscera: The twelve sinew channels are the manifestation of channel qi at the level of sinews, muscles, and joints—operating through "binding, gathering, dispersing, and connecting." Their primary functions are to constrain the bones, govern movement, and protect the body surface. They are related to the twelve primary channels, but their pathways and pathologies lean more toward the body's biomechanical structure.
Cold and heat are the two major pivots of sinew disease: The chapter takes "cold makes sinews tense; heat makes sinews lax" as its general principle. Cold governs contraction, hence cramping, contraction, and opisthotonos; heat governs relaxation, hence sinew flaccidity, failure to contract, and impotence. This aligns with the cold-heat views in chapters such as Su Wen·Bi Lun.
Pain as the point of selection—emphasis on tender points: "Taking pain as the point" is the core principle for point selection in sinew channel disorders: wherever it hurts, treat there. This is the precursor of the later "ashi points." Diagnosis emphasizes "all areas traversed and bound are painful," indicating the need to search for binding points and tender points along the sinew channel pathways.
Differential treatment for cold vs. heat, and differentiation of yin vs. yang: Cold-type sinew tension is treated with fired needles and tempered needling for warming and unblocking; heat-type sinew flaccidity does not use fired needles. Yang sinew disorders often present with back arching and inability to bend forward; yin sinew disorders often present with anterior (abdominal) tension and inability to extend backward—reflecting yin-yang antagonism and the anterior-posterior exterior-interior relationship.
The crossed-left-right observation of "crossing sinew intersection" (wéi jīn xiāng jiāo): The Foot Shaoyang sinew channel disorder mentions "from left to right" and "injury to the left forehead angle with inability of the right foot to function," demonstrating that the ancients observed crossed connections between the left and right sinew-channel systems—an important record at the level of functional observation.
The sinew channel pathways have certain mapping relationships with modern fascial chains and muscle chains. For example, the Foot Taiyang sinew channel's posterior distribution resembles the superficial back line, and the Foot Yangming sinew channel's anterior distribution resembles the superficial front line. This suggests that the body's muscles and fascia do not work in isolation but as coordinated chain-like or meridian-like structures.
"Pain as the point of selection" shares common ground with modern myofascial trigger point and tender point therapy: many chronic pain conditions do not originate from bone pathology but from myofascial binding points. Modern rehabilitation and acupuncture research also recognizes the clinical value of such tender points.
"Cold makes sinews tense; heat makes sinews lax" can be correlated with the physiological responses of skeletal muscle—increasing tension in cold and relaxing with warmth. However, the "cold and heat" of Chinese medicine is not merely a matter of temperature but encompasses the overall pathological state and should not be simplistically equated.
The "crossing sinew intersection" has similarities to the phenomenon of crossed neural innervation—namely, one cerebral hemisphere innervating the opposite side of the body. However, the ancients derived this from symptomatic patterns at a functional level and it should not be forced into direct correspondence with modern neuroanatomy.
Historical limitations: The twelve bi syndromes named after months (early spring, mid-spring, etc.) carry the coloration of ancient temporal medicine and numerology; methods such as horse fat, wine-cinnamon, and mulberry ash lack systematic modern validation; sinew channel pathways are not independent anatomical entities and cannot be point-by-point mapped onto modern structures. These should be viewed with rational perspective.
Avoid cold and keep warm to prevent sinew tension: Pay particular attention to the neck, shoulders, lower back, and knee joints—avoid direct cold drafts and prolonged exposure to cold and dampness. Warm up adequately before exercise and stretch after exercise to reduce muscular tension.
Balance movement and stillness; avoid prolonged sitting and staring: Maintaining a fixed posture for extended periods easily leads to sinew tension. Regularly move the neck, shoulders, lower back, and spine to maintain sinew suppleness.
Moderate diet; reduce raw and cold foods: Overconsumption of raw and cold foods can damage the yang qi of the spleen and stomach, foster cold-dampness, and affect sinew function. The daily diet should be warm and moderate.
Relax the mind; avoid prolonged tension: Long-term mental stress prevents muscles and sinews from relaxing. Incorporate gentle stretching, Baduan Jin, Taiji Quan, and other non-therapeutic exercises to support physical and mental relaxation.
Seek medical attention promptly for abnormal symptoms: If you experience recurrent cramping, facial deviation, joint mobility disorders, or post-traumatic limb dysfunction, seek prompt medical attention rather than self-performing needling, topical applications, or applying ancient methods.
Bugu Note: This content is based on classical Chinese medical texts and is provided solely for traditional cultural study and scholarly appreciation. It does not constitute any medical diagnosis, prescription, or treatment advice. If you feel unwell, please seek timely medical attention.