The tendino-muscle meridians (TMM) are one of the first techniques to consider in treating sports injuries and pain. Their treatment is often overlooked and frequently under-utilized by the practitioner of acupuncture. The activation of these important pathways can be crucial to effectively treating patients with acute trauma or repetitive stress injuries.

Let us start with a description of the tendino-muscle meridian (jin mai, jin jing). The TMMs are described as a channel network that circulates qi over the superficial aspect of the body. This includes the skin, the muscles, and the tendons. As described in The Secondary Vessels of Acupuncture, they travel in the “depressions and planes between muscles and tendons”. Furthermore, the muscle meridians are comprised of wei qi (“protective” qi), which is not “contained” within a vessel. Thus, their pathways have a bit more freedom and flexibility. The tendino-muscle meridians in this regard act as a general pathway of qi in the muscles, the fascia, and the tendons. They are responsible for many functional activities of the musculo-skeletal system, and are therefore involved in many sprains, strains, and other traumatic injuries.

The jing-well point is the only acupuncture point directly shared by both the primary meridian and the tendino-muscle meridian. After the jing-well point, the TMM follows the path of the primary meridian past the first, second, and third joints of the extremity (i.e., the ankle or wrist, the knee or elbow, the hip or shoulder). Because the wei qi of the meridian is not contained within a vessel, its pathway is superficial, broad, and diffuse. If we think of the primary meridian as a freeway, then the tendino-muscle meridian is the frontage road that parallels it, where so much of the business activity occurs.

Most texts describe the pathology of the tendino-muscle meridians as syndromes of either excess (shi) or deficiency (xu). For this article, we will cover the excess syndromes, as this is the primary diagnosis in trauma and injury. And as you can guess, an excess syndrome of the TMM produces pain! It is usually described as diffuse and distending, and frequently found at multiple ahshi points in the affected muscle, fascia, or tendinous areas. Most sources emphasize that pain is elicited by light palpation and pressure. Remember, the tendino-muscle meridians are superficial and thus the pain will not manifest as fixed, localized, and deep. Other accompanying symptoms include stiffness, swelling, spasm, and contraction. You may observe inflammatory signs of a yang nature, including heat and redness.

A typical clinical picture is the downhill skier who has been on the slopes all day long. He or she complains of pain, tightness, and a feeling of fullness in the quadriceps muscle group – that typical and predictable ache after a good hard workout. Upon palpation, there are numerous ahshi points on the anterior thigh, elicited using relatively light pressure. These painful points are found in the superficial layers of the muscle, along the Stomach channel. This may be diagnosed as an acute excess condition of the tendino-muscle meridian of the Stomach. Simply bleeding St 45 Lidui, the jing-well point, should improve the condition significantly, possibly without any further treatment. 

If, however, our ambitious skier had taken a hard fall, the quadriceps could have sustained a slight strain or tear in the muscle tissue. This case would present quite differently. Palpation would reveal fixed pain at the site of the tear, elicited with deep pressure. While the TMM may also be involved, the primary lesion is not in the superficial tissues of the muscle, and treatment to the jing-well point would not be sufficient to fully heal this case. You would undoubtedly need additional points and techniques in the treatment protocol for the patient.

Treatment of the Jing-Well Point

Bleeding technique is my preferred way to treat a jing-well point. Using sterile lancets and surgical gloves, swiftly needle-prick the point while holding firm pressure on the finger or toe. Try to get 10 large drops of blood to drain from the point. If the quantity of blood is not sufficient, a simple trick is to lower the patient’s foot or arm off the table. Gravity works wonders, and this will often get the necessary drops of blood.

In sports medicine acupuncture, I generally organize treatment into a systematic approach using Four Steps. Activation of the TMM is one of the techniques of Step One. With all the techniques of this initial step, the practitioner is looking for an immediate effect on the patient. Carefully observe if there is a decrease in pain or an increase in range of motion. My experience is that up to 80 percent of patients with pain due to injury or trauma will have some degree of improvement from bleeding the indicated jing-well point(s). Patients with qi stagnation and blood stasis in the deeper tissues – conditions like sprained ankle, shoulder tendonitis, or joint pain – will often experience a 15 to 25 percent improvement. Not bad for a few minutes of work!

Clinical Comments on the TMM

The most important technique is treatment to the jing-well point:

1. Jing-well points are treated on the same side as the site of injury.
2. The yang tendino-muscle meridians are usually more responsive and clinically effective than those of the yin meridians.
3. Treatment may include more than one jing-well point when the site of injury extends to multiple meridian pathways.
4. Care should be taken in bleeding yin meridian jing-well points, considering all of their contra-indications.

The following are additional techniques commonly included in the texts to activate the TMM. These may be included with the treatment of the jing-well point, if indicated. However, it is beyond the scope of this article to discuss their use in detail.

1. Treat the ahshi points: When the tendino-muscle meridian is affected, ahshi points may be found in the superficial tissues of the muscle, fascia, and tendons. Thus, shallow insertion of the needle is usually recommended. Many sources consider other techniques, such as cupping, gua sha, and massage to these affected tissues.
2. Treat the “insertion” or “binding” points: The texts refer to the “insertion” or “binding” points of each tendino-muscle meridian. These are located at the three major joints of each extremity. Generally, the insertion points “above and below” the injury are recommended for treatment.
3. Treat the “convergent” or “meeting” points: The “convergent” or “meeting” point is where the TMM unites with the two other yin or yang meridians that traverse the extremity of origin. While I rarely use this technique, some practitioners insist that treatment of the convergent point clinically improves results. These points are summarized as follows:

Meridian Grouping                     Convergent point

Three Arm Yin (Lu, H, P)             The region of GB 22 (Yuanye)

Three Arm Yang (LI, SI, SJ)         The region of GB 13 (Benshen)

Three Leg Yin (Sp, Kid, Liv)         The region of CV 3 (Zhongji)

Three Leg Yang (St, GB, Bl)         The region of SI 18 (Quanliao)

Conclusion

In conclusion, don’t underestimate how much improvement can be achieved by the simple technique of bleeding one or more jing-well points. So important in treating sports injuries and pain, this point category is often the first technique I use to start a treatment.