Osteopathic regulation of major body systems through Extraordinary Vessels Part 3: clinical study Sympathetic system

From an osteopathic point of view, each Extraordinary Vessel could be described with the following characteristics

1. An opening point (or master point) used both for diagnosis (control point) and for treatment (command point).

2. A complementary point, coupled with the previous one, in order to strengthen its action.

3. A main pathway with secondary branches.

4. Key points to investigate, because they are susceptible to present osteopathic lesions along the EOV’s pathway.

5. Warning signs, symptoms most often encountered in case of dysfunctions.

6. A specific morphotype, revealing à dominant EOV[1], as far as we always find the same pair of points over time.

In this article, we will present an anatomical and clinical study of the Extraordinary Vessels that regulate the sympathetic system (EOV1).

[1]We are aware that the concept of morphotype remains questionable and would require a real study. It serves here as an “educational caricature” to illustrate the dominance of an EOV.  Observing a patient’s morphotype requires nuance and should not be considered an essential element of the diagnosis. A presentation of the psychological profil (temperament and character) attributed to each EOV would be beneficial but this would go beyond the limited scope of this chapter.

GOVERNING VESSEL (Du Mai)

OML: unit 1 (occipito-vertebro-pelvic axis) and unit 4 (cranium + brain).

1. Opening point 3 SI: ulnar nerve (proper palmar digital nerve for the medial side of the 5th finger), epiphyseal line of the 5th metacarpal bone, abductor digiti minimi muscle.

Ulnar nerve and 3 SI point

Test for opening point 3 SI

2. Complementary point 62 BL.

3. Main pathway

The posterior midline starting from the anococcygeal raphe, going up along the spine and following the sagittal line of the skull to end at the junction between the gum and the superior lip (prosthion craniometric point).

Main pathway of the Governing Vessel and its opening point 3 SI

4. Key points to investigate

At the vertebral axis’ level:

The posterior perineum, the coccyx, the filum terminale, the spinal dura mater, all spinal levels, the diaphragmatic crura and the arch of the psoas, the costovertebral joints with the sympathetic paravertebral chain. 

At the head’s level:

The middle and superior floors of the cranium, the facial mask of the orbital group (procerus, corrugator supercilii, levator labii superioris and depressor septi nasi).

5. Warning signs

- Chronic spinal pains with muscular tensions, restless legs syndrome, vertebral deviations (kyphosis, lordosis), low back pains, vertebral compressions, vertebral osteoporosis, cervical pains, Chiari syndrome.

- Occipital or frontal headaches, often ancient, with neck stiffness.

- Flu syndrome (myalgia, night sweats), stuffy nose, conjunctivitis, sensibility to cold and wind.

- Post-infection fatigue (flu, mononucleosis, Covid), mental overdrive, hyperactivity and/or psychasthenia.

6. Morphotype

More often a man, slender and tall. Possible amplification of physiological vertebral curvatures (lordosis, kyphosis) if asthenic type. The woman will rather have a more androgynous silhouette, with a small breast.

The upper level of the face dominates, with a large forehead and big eyes.

The hands are slender, with elongated fingers (pianist’s hand).

YANG MOTILITY VESSEL  (Yang Qiao Mai)

OML: unit 2 (peripheral) and unit 6 (nervous system)

1. Opening point 62 BL: sural nerve, fibular tendons.

Sural nerve and 62 BL point

Test for opening point 62 BL

2. Complementary point3 SI.

3. Main pathway

The lateral line which starts at the fibular malleolus, runs up along the lateral aspect of the lower limb and the trunk,  goes around the shoulder posteriorly then up the neck and face up to the eye and finishes on the posterior occiput.

Yang Motility Vessel’s main pathway with its opening point 62 BL

4. Key points to investigate

At the level of the lower limb and pelvic girdle:

Sural nerve, calcaneum, fibular tendons, fibular nerve, fibula, fascia lata, gluteus medius and coxal bone.

At the level of trunk and scapular girdle:

Lateral aspect of thorax, shoulder (quadrilateral space, acromioclavicular joint, axillary and supraclavicular nerves).

At the level of head and neck:

Brachial and cervical plexus, cervical sympathetic chain, scalene muscles, sternocleidomastoid and omohyoid muscles, facial mask, trigeminal nerve, suboccipital muscles, cranial dura mater and brain.

5. Warning signs

- Stability disorders, lower limbs asymmetry and dysmorphosis[1], muscular contractures, cramps, limbs’ stiffness or pains worsened by movement, fibromyalgia, iliotibial band friction syndrome, gluteus medius tendonitis, sacroiliac pains, torticollis, scapulohumeral periarthritis.

- Neuralgia, sciatica, cervicobrachial neuralgia, facial neuralgia.

- Neurological syndromes of central origin, consequences of hemiplegia, spasmodic paresis, multiple sclerosis, Parkinson’s[2].

- Unilateral headaches, weekend headaches, ophthalmic migraines, visual disturbances, conjunctivitis, tinnitus, dizziness.

- Infectious, purulent cutaneous conditions, abscesses, furuncles (boils), eczema or psoriasis, etc.

- Insomnia, difficulties to fall asleep or waking up with mental excitement.

- Hyperactive child with attention problems.

6. Morphotype

More often a man, naturally muscular, athletic or a woman with a svelte and sporty look that may experience asthenia and weight gain with age and a sedentary lifestyle.

Face with colored, tanned complexion. Active, extroverted temperament.

Skeletal asymmetry with leg length discrepancies are often observed.

[1] Cf. chapitre Traitement neural des asymétries et dysmorphoses du membre inférieur.

[2] With neurological disorders, osteopathic treatment often provides a significant relief for the patient.

Mrs. N.R, 42 years old, has been consulting for many years for multiple sclerosis, wanting follow ups in acupuncture because she refused an interferon treatment. We cautioned her that our approach should not replace official recommendations. She has had many flare ups, including one with spinal demyelination. We accept her choice while continuing monitoring with MRI’s. We almost always treat the 3 SI and 62 BL pair along with the 6 KD and 7LU as well as other points according to the context. Given the situation, the patient has been seen regularly for many years and no more flare ups have been noted.

Young boy L. L., 8 years old, has suffered, since birth, from a left lambdoid suture craniostenosis with a Chiari (stage 1) syndrome and hydrocephalus.  A C1 laminectomy was performed and he still has an external ventricular shunt. The child regularly complains of headaches, more or less painful cracking of the craniocervical junction and fatigue. The osteopathic treatment targets the occipito-vertebro-pelvic axis and the cranium:  opening point 3 SI on the left, filum terminale, left lambdoid suture, right interparietal and squamous sutures, all supplemented with the right 62 BL point. The mother calls 3 weeks later, both happy and surprised, to mention that her son no longer has headaches nor fatigue! The second consultation will strengthen the sustainability of the results.

Mrs. P. Y., 90 years old, has suffered from chronic dorsal and low back pains with weaknesses in the lower extremities for 2 years (after a heart attack leading to a bad fall). The x-ray shows a severe scoliosis with arthrosis and osteoporosis. The 62 BL point (sural nerve) and the right hip are treated first, the complementary point 3 SI and the middle cluneal nerves afterwards. When seen many months later, the patient reported a clear improvement, rather surprising considering the condition of her spine and her age.

Mr. P. C., 54 years old, electrician, consults for recurrent low back pains and a depressive disorder.  He suffers from Parkinson’s disease with fixed facial expression, tremor of the hands and a left head rotation hard to correct because of a sternocleidomastoid muscle’s spasm. Strangely, the first symptoms of Parkinson’s were triggered by an osteopathic session 6 years ago !? The first consultations were difficult with few results. From the day we introduced the 3 SI and 62 BL points (in addition to the usual treatment), a clear improvement of the tremors is noted and the right head rotation becomes possible. Nowadays, the patient is seen 4 times a year and does not suffer from low back pains anymore, his head turns normally and the Parkinson’s does not progress, without modifying the medication dosage. Note that the principal points treated, the sternocleidomastoid muscle and the muscles of the face (facial mask) are found on the Yang Motility Vessel pathway and the vertex point (top of cranium) is on the Governing Vessel’s pathway.

CONCEPTION VESSEL (Ren Mai)

OML: unit 5 (visceral) and unit 6 (vascular).

1. Opening point 7 LU: superficial radial nerve above the radial styloid process, distal radial epiphyseal line, brachioradial and abductor pollicis longus tendons.

Superficial radial nerve and 7 LU point

Test for opening point 7 LU

2. Complementary point 6 KD.

3. Main pathway

The anterior midline of the body from pubic bone to chin (pogonion craniometric point).

Main pathway of the Conception Vessel and its master point 7 LU 

4. Key points to investigate.

At the pelvic level:

The anterior perineum, the bladder and urachus, the uterus and hypogastric plexus.

At the abdominal level:

The prevertebral ganglia (coeliac, superior and inferior mesenteric), the round ligament of the liver and the abdominal viscera.

At the thoracic level:

The xiphoid process, the sternebrae and the tracheobronchial tree.

At the cervical level and head:

The thyroid, the larynx, the hyoid bone, the mandible and the facial mask (oral muscles).

5. Warning signs

- Disorders linked to the menstrual cycle, to puberty (dysmenorrhea, painful periods) and to menopause (hot flushes, night sweats), uterine fibroid, genital prolapse, infertility, difficult pregnancy, risk of miscarriage, etc.

- Visceral pains, functional bowel disorder, slow digestion, swollen abdomen, irritable bowel with colic chords, abdominal masses.

- Sore throat, hoarseness, coughing, pulmonary disorders.

- Thyroid dysfunctions, goiter or thyroid nodules.

6. Morphotype.

More often a young woman, with round and harmonious shapes and generous breasts. Tends to become heavier with age. Or a man with a somewhat feminine appearance.

The face presents a smooth forehead, a gentle gaze.

Generally affectionate, maternal, protective, of cautious nature.

YIN MOTILITY VESSEL  (Yin Qiao Mai)

OML: unit 3 (intraosseous lines) and unit 5 (visceral).

1. Opening point 6 KD: tibial nerve beneath the medial malleolus, when exiting the tarsal tunnel (medial plantar nerve), posterior tibialis and flexor hallucis longus tendons.

Tibial nerve (medial plantar) and 6KD point

Test for opening point 6 KD

2. Complementary point 7 LU.

3. Main pathway

This vessel starts under the tibial malleolus, travels along the medial aspect of the lower limb until the genitalia, continues up the abdomen, the thorax and the throat to finish at the medial corner of the eye (dacryon craniometric point).

Main pathway of the Yin Motility Vessel and its opening point 6 KD

4. Key points to investigate

At the level of lower extremity:

All the lower limb osteo-articular system[1], the posterior tibial artery and the saphenous vein, the femoral artery and vein.

At the pelvic level:

The inguinal area, the female genitalia, the prostate and the spermatic cord in men.

At the abdominal level:

The lumbar sympathetic chain, the kidneys and adrenal glands.

Au the level of the neck and head:

The cervical sympathetic chain, the lymphatic system, the cervical visceral sheath (thyroid, larynx, trachea), the eyes, the facial mask (orbicular level) and the brain.

5. Warning signs

- Disorders of the urogenital system, kidney failure, prostate and urinary dysfunctions.

- Consequences of visceral or obstetrical surgery.

- Pathologies due to aging: hypothyroidism, cognitive disorders, slowing of movements, instability and dizziness, decreased vitality, impotence, atonic constipation, peripheral plantar neuropathy, etc.

- Chronic eye disorders: photophobia, dry eye, cataracts, glaucoma, macular degeneration, etc.

- Lower extremity instabilities (fallen arches, genu valgum, hallux valgus), gonarthrosis, chronic rheumatisms with swelling of the joints, gout, low back pains radiating to the inguinal fold or the testicles. Pains are often worse upon awakening and with first movements, improved with gentle and prolonged movements.

- Insomnia at night and drowsiness during the day, sleep apnea.

6. Morphotype

Slightly more often a woman, or an elderly person, overweight with rounded shoulders, knock knees and flat feet.

Slow pace, somewhat clumsy.

Looks older with a dull face and dark circles around the eyes, even if the gaze remains deep. Mostly introvert, with a depressive tendency.

[1] With special attention to intraosseous lesions (lines of force and epiphyseal lines).

Mr. D. D., 68 years old, is an active retiree, unfortunately troubled by many problems: low back pains, right intercostal neuralgia, painful sequelae of a right ankle fracture (operated in 2004), poor digestion as well as a hemochromatosis requiring 2 phlebotomies annually. He has a shorter right leg and wears orthopedic insoles for correction. Osteopathic tests guide us towards the 7 LU and 6 KD axis with a specific treatment of the round ligament of the liver and the pylorus. A month later, all complaints were better to the point the patient decided to stop wearing his insoles. He also mentioned having less blood in his stools.

Mrs. V. C., 6 months pregnant, consults for low back pains. The patient has been suffering, for 4 years, from severe migraines that force her to remain bedridden 2 to 3 times each month. Her migraines appeared, at the time, in a context of domestic violence with a separation of the couple.  The osteopathic treatment focusing on the 6 KD and 7LU points has completely resolved the migraines from the first session.

Mr. G. D., 58 years old, smoker, had aggressive upper respiratory tract cancer that required chemotherapy and extensive surgery with a tracheotomy. He consults, when in remission, for neck pains and stiffness, difficulty swallowing and a feeling of blocked ear on the left. The osteopathic assessment highlights dysfunctions for the 7 LU and 6 KD pair as well as great postoperative adherences at the level of the throat. After a few encounters, the patient’s general condition as well as his symptoms have clearly improved.

Mrs F. M., 60 years old, consults for recurring low back pains and chronic pains in both knees. She has a history of L4-L5 disc herniation operated on 3 years ago, bilateral knee arthrosis with genu valgum, gastric reflux, a general state of depression with a strong desire for sugar and alcohol favorable to weight gain. The osteopathic treatment mainly focuses on the 6 KD and 7 LU points, the visceral system and the knees. A strong fatigue reaction for several days was experienced after the first consultation. After 2 sessions, a clear improvement was perceived by the patient: low back pains were no longer present, the knees’ mobility was increased, there were no residual digestive symptoms, and she got a better moral with regulation of her appetite, without desire for alcohol.

Eric Prat, osteopath DO (FRA)

Dr René Descartes, MD and acupuncturist (CHE)

Translation: Chantal Fillon, osteopath (CAN)

Proofreading:  Ramy Raafat, osteopath (EGY)

Illustrations :

Sarah Stringhetta de P. Chauffour, E. Prat E, LMO Evolutions et perspectives, Sully 2024

Benoit Caillé DO (F) de P. Chauffour, E. Prat, J. Michaud, LMO Points clés du système nerveux, Sully 2017

Previous articles

Part 1: traditional concept of Extraordinary Vessels.

Part 2: anatomical and physiological reading of Extraordinary Vessels.

Articles to come 

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

Part 5: osteopathic regulation protocol of the Extraordinary Vessels.