Management of Spasticity: The Sinew Channels (jing jin) in Traditional Chinese Medicine

Providing effective treatment in TCM for patients with neurogenic trauma and spasticity involves a deep dive into the ancient wisdom of the sinew channels (jing jin), which are integral to the circulation of Wei qi that permeates muscles, tendons, and the entire fascial network. Historically, treatments focusing on these channels, as taught by Sun Simiao and detailed in texts like the "Ling Shu," were central to managing external pathogenic factors and systemic health issues. Sun Simiao, a renowned Chinese physician of the Tang Dynasty, emphasized the importance of maintaining the health of the sinew channels for overall physical well-being. He provided detailed descriptions of various techniques to treat disorders related to these channels, such as acupuncture, moxibustion, and herbal therapies, highlighting their role in managing pain, enhancing mobility, and restoring balance within the body.
Sun Simiao’s contributions laid the groundwork for the subsequent exploration of the sinew channels in TCM. His holistic approach, which considered both the physical and energetic aspects of health, has influenced generations of practitioners. The sinew channels have traditionally been approached by focusing on their ability to store and mobilize qi and blood, ensuring the proper function of the musculoskeletal system. Techniques such as tui na (Chinese therapeutic massage) and specific acupuncture protocols targeting the jing jin have been used to release tension, improve circulation, and enhance the flow of qi and blood within these channels.

Modern Approaches and Integrative Insights

Over time, the use of the jing jin fell out of fashion with the addition of filiform needles and more symptom-point prescriptions, shifting the practice towards symptom alleviation rather than addressing underlying causes. However, modern TCM practitioners continue to build on the foundations laid by Sun Simiao and other classical scholars. There is a growing recognition of the sinew channels' relevance in treating contemporary health issues, particularly those related to chronic pain, musculoskeletal disorders, and stress-induced conditions. Integrating insights from osteopathic medicine and myofascial trains theory, practitioners are developing more refined methods to address dysfunctions within the sinew channels.

As we explore the correlates, it becomes apparent that the language used to describe the effects of qi, blood, and body fluid derangement in the sinew channels mirrors our current understanding of physiological processes, even if our predecessors did not have the terminology for biochemistry.   The challenge lies not in the absence of these concepts in classical texts, but in learning how to translate and apply the effects described by our predecessors.

Revitalizing our understanding of the sinew channels offers several unique advantages:

1.    We now have an effective treatment for neurogenic diseases that include spasticity as a clinical marker.

2.    We can effectively address sympathetic dominance or retained fight-flight-freeze responses through a defined pathomechanism.

3.    We can treat the cascade of events in the fight-flight-freeze response, as outlined in Polyvagal Theory, including the myriad of sub-patterns in Zang-fu derangement of the middle jiao.  By mitigating chronic sympathetic dominance, we also prevent numerous long-term complications.

4.    The restoration of proper vagal tone demonstrates an objective, visible aspect of Polyvagal Theory (PVT) that was previously misunderstood. It is commonly believed that vagal tone is invisible and its quantity cannot be directly measured, but we can observe its effects and presence visibly in the fascia. This observation provides a tangible indicator of parasympathetic nervous system activity. Both patients and providers can objectively observe, feel, and experience the results of TCM treatments.  This approach illustrates for the first time a verifiable pathomechanism for TCM.  

5.    The integration of modern neuro principles into our understanding of TCM not only expands our knowledge but also illustrates objective aspects that were qualitatively described in the classics but poorly understood. For instance, the concept of zhong qi, which traditionally was difficult to quantifyor describe can be refined to include an understanding of the PANS. 

6.    TCM practitioners with a deeper knowledge of neurology, trauma, and neuroplasticity can be at the forefront of providing supportive care for information that has not made it into the curriculum of many medical styles. The understanding of neuroplasticity is being driven by somatic clinicians and, from a trauma perspective, by psychotherapy.

We use the same orthopedic tests and clinical markers employed in neurology, physical therapy (PT), and occupational therapy (OT) to accurately assess the impact of our work. This includes evaluating cognition, fine motor function, and vestibular work, enabling us to verify that our treatments promote neuroplasticity by restoring vagal tone. Additionally, by deeply understanding the TCM correlates, we gain a clearer comprehension of clinical terms in TCM that are often poorly understood, such as phlegm misting the mind or running piglet syndrome.