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Huatuojiaji Points and Facilitated Segments: An Important Diagnostic Concept By Matthew Callison, LAc, MTOM , MS (This article is an excerpt from Matt Callison's soon to be published Sports Medicine Acupuncture text due out in fall of 2005.) It makes one wonder how the great Han dynasty physician Hua To , (A.D. 110-207), understood the importance of using the Huatuojiaji points to treat diseases of the organs and extremities. These points, named after Hua To , are two groups of twenty-four points distributed on each side of the cervical, thoracic and lumbar vertebrae. They are located in the paraspinal region, .5-1 cun lateral to the depression below the lower border of the spinous process of each vertebra. Hua To was one of the first documented anesthesiologists and surgeons in the world who used surgery when acupuncture and herbal medicine would not cure the disease. He performed surgeries on both the abdomen and the back, using herbal anesthetic powder, cleansing the stomach and intestines excising any diseased tissue that needed removal.
Hua To (A.D. 110-207) A recently developed concept of facilitated segments helps to explain, in Western terms, what Hua To knew in effect, was the importance of palpating for tenderness and needling the Huatuojiaji points. A brief explanation of this is needed in order to understand the significance of treating Huatuojiaji points, the associated vertebral segment, in addition to acupuncture and motor points when addressing myofascial and organ-related dysfunction. A facilitated segment is a section of the spine that has become hypersensitive resulting in a lowered threshold of stimulation. In other words, the affected nerve tends to over-react and fire excessively. A facilitated segment creates pathological changes affecting the spinal nerve and all of the tissues innervated at that level. As the nerve branches off of the spinal cord (this can be likened to a freeway off-ramp), it separates into sensory and motor nerves that innervate the skin, bone, muscle, organs and glands. There is a segmental relationship with the spinal cord, the viscera and the myofascial tissues that can be adversely affected by their inherent neural interrelationship. This is detected from various changes in the skin and muscle reflecting the health of the tissue from the innervating segment. For example, the receptors of an organ such as in a stressed liver ( Gan Qi Zhi ) send messages to the spinal cord at its innervating spinal segment between T5-T10. This message synapses at the spinal nerve root relaying information to the myofascia innervated by the same spinal segment. When a visceral organ is affected by a facilitated segment, diagnostic points on the body such as the Front- Mu ( Fu Mu ), Back- Shu ( Bei Shu ), Huatuojiaji and myotomal motor points become tender as these points share the same spinal segment from sensory and motor nerve innervation. In addition, the health of the zang-fu is reflected in its acupuncture meridian manifesting as tenderness and palpable stagnation along its pathway. " The twelve regular meridians connect with the zang-fu organs internally and with the joints, limbs and other superficial tissues of the body. When the ache is located in the organ, the meridian is ill and as a result becomes painful."
Notice the posterior rami branch innervates the tissue associated by the Huatuojiaji and Back-Shu ( Bei Shu ) points. The anterior branch extends to affect the organ and Front- Mu (Fu Mu) points. The origin of nerve facilitation may stem from the spine, the soft tissue or the affected zang-fu . It is difficult to say which structure becomes "facilitated" first, since the spinal nerve root, the viscera or the myofascia send disruptive messages to each other along the neural link. For example, a hyper-acidic stomach ( wei re ) or a chronically tense muscle sends sensory input to its innervating spinal segment; the response is to lower the threshold of reactivity thus a growing cycle of hyperactivity is activated . In another example, Myron Beal, an osteopathic physician and researcher found in a study of patients with cardiovascular disease, that deep paraspinal muscles level with the spinal segment innervating the heart were particularly affected. He states, "it is frequently possible to predict that cardiovascular disease is present (or soon will be present) when two or more segments of the spine in the region of T2, T3, T4 display tense rigid, board like characteristics on palpation." In addition, Beal suggests to pay "special attention" to the paraspinal muscles which are known to contract and shorten as a "reflexive splinting," binding the vertebral joints in the area, thus resulting in less mobility.
Huatuojiaji and Myotomal Motor Points Spondylosis or degenerative changes within the spine affect the nerve root and is a common finding within a facilitated segment. Upon examination, the practitioner can observe the location of Huatuojiaji points directly over the central region of the deep paraspinal muscles; this is where the zone of innervation from the posterior rami is found. These muscles that connect the vertebrae above and below become imbalanced from inadequate nerve impulse. Muscle imbalance between these deep paraspinals can fixate the vertebrae together creating pressure on the disc and nerve root by pulling the adjacent vertebrae together, impeding nerve impulse, thus creating muscle imbalance, organ dysfunction and pain.
Fig. A. Shortening of the muscles can create pressure on the disc and nerve root by pulling the adjacent vertebrae together, which impedes the nerve impulse, thus creating muscle imbalance, organ dysfunction and pain. Fig. B. Changes after acupuncture treatment to the Huatuojiaji points. When pressure on the disc and/or nerve root is great enough, radiculopathic pain is commonly present. Radiculopathy is one form of a facilitated segment and a term used to describe the pain and discomfort radiating along the peripheral nerve originating from the spine. Spinal regions of C5-C7 and L4-L5 endure the most structural stress and therefore common regions that cause radiculopathic pain. When this sensation is present, usually somewhere in the extremity, the spine is normally recognized as the origin, since the referred pain and numbness shows itself somewhere along the nerve pathway as it travels along its distribution. For example, a paresthesia sensation in the thumb and index finger indicates a possible nerve root irritation at the C6 level. This can usually be diagnosed with orthopedic and electromyographical examinations.
Orthopedic examinations can detect nerve root irritation by reproducing nerve pain along it's distribution. However, with many musculoskeletal complaints, nerve involvement may exist even when paresthesia signs and symptoms are not present. Such as, a patient complaint of pain somewhere in the extremity without subjectively or objectively produced spinal radiculopathic symptoms of numbness and tingling. Spondylosis (primarily found over the age of thirty)can produce a facilitated segment that persists without a subjective complaint of pain in the affected spinal segment. A radiological examination may show normal and benign degenerative changes at the spinal level that are associated with the patient's pain, and yet, the practitioner will usually notice various innervated muscles from the affected spinal root are found to be imbalanced. The spinal segment may be "asymptomatic" although, the myotomal muscle group will often have limited range of motion, muscle weakness and motor points that are tender to palpation. This is a neuropathic condition that precedes the probable subjective awareness of radiculopathic nerve pain.
The spinal segment may be asymptomatic without radiculopathic symptoms although from spondylosis, the myotomal muscle group will often have limited range of motion, muscle weakness and motor points that are tender when palpated. The circle indicates spondylosis of the C5-C6 segment. A normal functioning nerve supplies its innervating tissue with an adequate amount of electrical input for regulation and maintenance of cellular function and integrity. Any circumstance that impedes the flow of neural impulses for a period of time can rob the innervated tissue of its nourishment, and cause a disuse supersensitivity. Even slight irritation of the spinal nerve can disrupt the nutritive factor that supplies the innervated tissue without reproducible radiculopathic pain patterns. Whether it is mild compression of the nerve root as it exits the intervertebral space, or a tethering of the neural tissue from hypermobility of the degenerative spine, the nerve and all of the innervated tissue at that level may become affected. Muscle and zang-fu reaction to inadequate neural stimulus is to shrivel and shorten, comparable to that of a plant's leaf without enough water. Muscle shortening is found in many types of myofascial pain syndromes creating muscle imbalance leading to inadequate movement patterns, in addition to placing mechanical stress on the tendinous attachment site. For example, shortening of the wrist extensors may develop into lateral epicondylitis (Fig. A); thumb extensors can create a tenosynovitis as in De Quervain's syndrome (Fig. B) or shortening of the rectus femoris may develop into patellar tendonitis (Fig. C)
Signs of Facilitated Segments : • The body's response is to lower the threshold of reactivity, thus a growing cycle of hypo-hyperactivity or an excess ( shi ) and deficient ( xu ) condition is capitulated. • Tender Front- Mu ( fu mu ), Back- Shu ( bei shu ), myotomal motor and Huatuojiaji points for zang-fu related conditions. • Tender Huatuojiaji and myotomal motor points for extremity related conditions. • Vertebral fixations • Palpable meridian imbalances. • Muscle imbalance with possible tendinopathy. • Roughness or dryness of the skin ( Xue xu ). • Sponginess or dampness ( Shi Xie ) feeling at the associated points. • Heat ( Re Zheng ) conditions from inflammation at associated points. • Vasoconstriction ( Han Zheng ). • Possible radiculopathy and paresthesia. As aforementioned, a facilitated segment will create an imbalance within the deep paraspinal muscles that connect the vertebrae above and below. This fixates the vertebrae together eventually developing into spondylosis that further perpetuates the impedance of nerve impulse creating muscle imbalance, organ dysfunction and pain. Normally, each vertebra of the spine moves independently from the vertebrae located above and below by means of deep paraspinal muscles located at the Huatuojiaji points. Together, all of the vertebrae move as one unit, creating functional motion of flexion, lateral flexion, extension and rotation of the spine. A vertebral fixation complex does not allow the spine such freedom. It is the compression and torquing of one vertebra on top of the other, locking them together creating a hypomobile segment in the spine. One vertebra torques to the right and the vertebra below torques to the left, and so on and so forth (Fig. D).
Vertebral fixations are often found in sets of two or three due to the attachment sites of the deep paraspinal muscles (multifidus, rotatores brevis and longus, to name a few). These muscles traverse and act on the vertebrae located above and below affected by the facilitated nerve fixating the vertebrae together. Upon palpation to Huatuojiaji points level with the vertebral fixation complex, the practitioner will find on one side of the vertebra an excess ( shi ), tight and hypertonic deep paraspinal muscle that is rigid to digital pressure. On the other side of the vertebra, there is a deficient ( xu ), stretched and hypotonic deep paraspinal muscle pliable in sensation. The excess and shortened muscle keeps the vertebra torqued to the side from where it's pulling, whereas the deficient and hypotonic muscle is struggling to maintain the position.
Assessment and Treatment It is important to remember, that the health of the musculoskeletal system is directly proportional to the health of the zang-fu . A facilitated segment affecting the organ systems such as a middle-jiao disharmony ( zhong jiao bu he ) will directly affect the jing-luo and the corresponding soft tissue. Treating a facilitated segment with vertebral mobilizing techniques in conjunction with acupuncture to the involved Huatuojiaji, Front- Mu ( Fu Mu ), Back- Shu ( Bei Shu ) and myotomal motor points, is a powerful approach that helps to interrupt and reduce its self-perpetuating nature. Assessment of a vertebral fixation is based on the innervating spinal level for which the pathology is being treated (Fig. F). For example, the lower lumbar and sacral spinal levels innervate the lower extremity and would be assessed in a case of chronic hamstring strain. Or, a TCM diagnosis of Liver invading Spleen ( Gan Fan Pi ) producing digestive complaints, the practitioner will look at the spinal segments level with the Back- Shu ( Bei Shu ) points of these organs, T9 and T11 respectively. In addition, the spinal levels that innervate the affected organs will need to be assessed such as T5-T10 for the Liver ( Gan ) and T7-T12 for the Spleen ( Pi ). |
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Fig. D 
Fig. E 
