Osteopathic regulation of major body systems through Extraordinary Vessels Part 5: osteopathic regulation protocol

With Osteopathic Mechanical Link, which could be described as digital osteopathy[1], it is possible, and even recommendable, to integrate acupuncture points and the tissue pathways of the meridians into general treatment.

In practice, the therapeutic choice of osteopathic regulation of the Extraordinary Vessels will essentially be made in three cases.

1. After failure of a global or symptomatic osteopathic treatment.

2. When frequent recurrences of the same complaint occur (recurrent disorders).

3. As a first-line treatment for certain chronic or complex pathologies, to “clear the terrain”.

In all cases, we will only opt for this type of regulation if osteopathic tests (tissue palpation of points and pathways) confirm the dysfunction of one or more EV.

The great symptomatology of the Extraordinary Vessels calls for discernment.

The same reason for consultation may depend on different EV in diverse cases.

Example: low back pain.

- The Governor Vessel for chronic, usually symmetrical, back pain.

- The Yang Heel Vessel for lateralized low-back pain secondary to physical activity or overwork, with sciatic radiation and aggravation on movement.

- The Conception Vessel for lumbar pain associated with menstruation in a young girl, or low back pain during pregnancy.

- The Yin Heel Vessel for diffuse low-back pain, with hyperlordosis, visceral ptosis and dorsolumbar retrolisthesis (post-menopausal trophostatic syndrome), possible radiating pain to the testicle in men.

- The Penetrating Vessel for lumbar pain with a vascular component (lumbar arteries and veins) radiating to the sides or front of the thighs, lumbago with difficulty standing up, post-spinal surgery with scarring fibrosis.

- The Yin Linking Vessel for low-back pain with psoas spasm, following emotional upsets or disturbing emotions (pent-up anger).

- The Girdle Vessel for “lumbago”, low-back pain or sacroiliac pain radiating into the girdle, deficient abdominal girdle or narrow lumbar canal with leg weakness.

- The Yang Linking Vessel for sacroiliac pain radiating to the lateral aspect of the thigh.

Complex pathologies sometimes make it difficult to decide which points to treat on the basis of clinical signs alone.

As mentioned, the patient's morphotype can be an indication, but will not be sufficient, let alone necessary, to make a diagnosis.

In practice, testing of the master points and palpatory evaluation of the Extraordinary Vessels remain the best diagnostic tool for setting up a suitable osteopathic treatment.

[1]A term used by Frederick P. Millard, one of Still's students, which we are happy to adopt, as LMO tests and recoil treatment are most often applied with the fingers and on specific points.

Golden rule

To decide whether to treat an opening point and the corresponding EV structures, at least two out of three of the following criteria must be met.

1. Fixed point in tension test (light pressure and circumduction).

2. Tenderness of point with pressure.

3. Clinical signs consistent with disturbance of the EV in question.

The osteopathic examination and treatment protocol proposed is divided into 3 steps.

Following the procedure described for the examination of peripheral nerves, we evaluate each opening point using a pressure/circumduction test.

With patient in supine, we can start with the 4 points on the foot, then the 4 points on the hand, or vice versa. Each point is tested symmetrically and bilaterally, comparing the right and left sides.

For the test, we first recommend a light, superficial touch, like a brushing. This initial contact enables the practitioner to feel immediately if there is a tissue fixation at the point.

Secondly, the pressure applied to the point is increased slightly, to “provoke” the tissues. Usually, dysfunctional points are much more sensitive, even painful, to pressure (compared to other points).

When several points are positive, the inhibitory balance test identifies the dominant point which will become the starting point for treatment. This dominant point is usually not only fixed, but also highly sensitive[1].

In the case of a positive test, tensioning the point often triggers borborygmus[2], confirming the involvement of the autonomic nervous system in the dysfunction of the EV solicited.

[1] Sometimes, the point is fixed (but not very sensitive) on one side, while it is painful to pressure (but less fixed) on the other. The treatment procedure remains unchanged, i.e. start by treating the dominant opening point (the most fixed) and the points located in the path of the corresponding EV. It is also possible to combine a recoil on the fixed point with an inhibitory counter bearing (without recoil) on the sensitive point. After adjustment, the 2 points should be balanced, i.e. neither fixed nor painful to pressure.

[2] Intestinal gurgling is very noticeable, and is often questioned by the patient. A good opportunity for the practitioner to explain the action of osteopathic treatment on the nervous and digestive systems!

Osteopathic regulation of an Extraordinary Vessel in dysfunction takes place in the following way.

For example, the Penetrating Vessel (vascular system) and its opening point (5 SP)

1. Opening point treatment.

Traditionally, in acupuncture, we prick the points of the Extraordinary Vessels to open them, so that they exert a regulating action. No attempt is made to stimulate or disperse the point.

In osteopathic practice, recoil is a technique of choice for treating these opening points. Even if the focus is on the nerve pathway, the initial tension applied prior to the recoil can include, with discernment, all or part of the point's fascial environment: dermis, neighboring tendon, satellite artery, bone periosteum.

The opening point of the Penetrating Vessel (vascular system)

It is essential to set the recoil correctly, so that the impulse is always directed against the resistance. Analytical tests using distal/proximal traction and clockwise/counterclockwise rotation tell us exactly which direction to treat the point.

To enhance the sympathetic or parasympathetic action, we can also use the patient's breathing. If the tissue resistance of the point to be treated manifests itself more on inspiration, the recoil will have a sympathetic effect. Conversely, a recoil performed on exhalation will have more of a parasympathetic effect.

Do not hesitate to make several recoils to release the tissue attachment and open up the point. To do this, you can use the tip of your finger, right up to the nail, a bit like an acupuncture needle.

2. Adjustment of osteopathic lesions in the path of the Extraordinary Vessel.

The path of the Extraordinary Vessel involved forms the common thread of the osteopathic treatment.

From a technical point of view, the palpation of a meridian requires a special touch. The meridian must be considered not as a line, but as a tissue space encompassing all the structures it passes through. This approach requires lightness, but also depth and width, to enter the meridian's three-dimensional space[1]. It also involves a “dynamic palpation”, where the hand glides along the meridian, stopping on fixed areas (technic of cutaneous depressions). In this way, all the anatomical structures traversed by the meridian are evaluated, from its starting point to its ending (tension test).

[1] A palpatory approach found in shiatsu. W. Rappenecker, Atlas de Shiatsu, les méridiens du zen shiatsu, Ed. Maloine, 2010.

Evaluation and treatment of the abdominal vascular system (Penetrating Vessel)

Evaluation and treatment of the cardiac vascular system (Penetrating Vessel)

If a fixation is found, it is treated immediately (recoil). Then you continue to follow the path of the meridian, always correcting the osteopathic lesions encountered, until the end. Note that here, fixations are released one after the other, in the order in which they are found, with no inhibitory balance test to prioritize them.

3. Verification of primary opening point.

If this point remains somewhat fixed and/or sensitive, it is an indication that going back to work on the point and the path of the Extraordinary Vessel in question is to be done. Several passes may be necessary.

4. Control of opening points that tested positive.

In general, the complementary point, coupled with the initial opening point, also needs to be adjusted with a recoil to reinforce the effect of regulation.

Checking the complementary opening point 6 MC

At the end of the osteopathic treatment, all these master points should be perfectly balanced[1].

[1] In other words, neither fixed nor sensitive to palpation. A good way to verify as the patient can also assess the efficacy of the treatment.

The regulation of Extraordinary Vessels generally has a powerful effect and corrects a large number of dysfunctions, including those outside the treatment axis.

However, we must avoid becoming “monomaniacal” and think that all problems have been solved. To this end, we complete this general regulation by integrating the patient's reason(s) for consultation with a local treatment of any secondary osteopathic lesions present (symptomatic targeting).

If the reason for consultation has been taken into account in regulating the EV involved, there's no need for a symptomatic targeting. For example, if the patient consults for a shoulder problem and you have treated the Yang Linking or Yang Motility Vessels, then there's no need to return to the shoulder girdle.

If, however, like in the case of the Penetrating Vessel, the regulation does not include the shoulder, symptomatic treatment of the shoulder must be envisaged at the end of the session.

In this case, particular attention should be paid to the vascular system of the pectoral girdle.

Evaluation and treatment of the axillary artery

This osteopathic regulation protocol has many advantages.

- It is relatively simple to apply, with only 8 control points to test.

- It quickly directs the osteopathic treatment towards units requiring a regulation.

- It reveals hidden tissue fixations that could easily go unnoticed on general examination.

- It stimulates the body's vital forces, reinforces the terrain and gives excellent results in chronic or recurrent conditions.

- It can be used by all osteopaths trained in point location and palpation, even those with no knowledge of acupuncture.

The few clinical examples mentioned in the previous articles, to which there are many more to report, illustrate the therapeutic potential of osteopathic regulation of the body's major systems by means of the Extraordinary Vessels.

We are aware of the limitations of this presentation.  The subject is vast, requiring further development, and will be the subject of future publications.

The Extraordinary Vessels live up their name!

Eric Prat, ostéopathe DO (FRA)

Dr René Descartes, médecin-interniste et acupuncteur (CHE)

English translation, Chantal Fillon DO (CAN)

Previous articles

Part 1: traditional concept of Extraordinary Vessels.

Part 2: anatomical and physiological reading of Extraordinary Vessels.

Part 3: clinical study of the Extraordinary Vessels (sympathetic system).

Part 4: clinical study of the Extraordinary Vessels (parasympathetic system).