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Earlier this month, during a 4th-year medical school elective, I worked with a 45-year old phlebotomist (Ms. Y), who had a total gastrectomy (complete stomach stapling) seven years ago. She openly shared that there was a time when she carried 300+ pounds on her 5’5” frame – since the surgery, she had dropped about half of that weight.

Although Ms. Y was thrilled – proud, even – of her newfound figure, the gastrectomy came with a price. She was now burdened with significant digestive dysfunction, and have been suffering from severe indigestion and colicky pain after meals. I was accustomed to Ms. Y’s bombastic personality, full of playful sense of humor with a touch of hubris. On one particular afternoon, however, she walked into the clinic not her usual playful self, and doubled-over in pain. She had eaten a grilled cheese sandwich with bacon, at 3am that morning, and have not been able to eat anything else thereafter. Her pain felt gassy, and the gas in her digestive tract seemed to be stagnant; she had not belched or passed gas for hours. For a full two hours, she was completely unable to work, and sat at her station with one hand clutching her belly and the other holding her head up.

After seeing that her symptoms did not improve, I approached her and asked her if I might try something unconventional. She gave me her permission, so I asked her to hand me her left arm.

What I was looking for was soft tissue congestion (knots, tightness, tenderness, etc.) along one of the Sen lines in the body, as they are called in Thai yoga therapy. The Sen lines are pathways through which the physiology of the body can be influenced, and anatomically they correspond to the planes of the muscular system, the fascia, and the blood vessels of the circulatory system. In many Eastern bodywork and acupuncture-like modalities, these lines are used to guide practitioners in the individualization of therapy. Although each line spans a large distance in the body, they each has branches corresponding to different major organs (heart, colon, liver, etc.) or organ systems. Additionally, each has branches passing through multiple pressure points (marmani (pl. of marma) in the Indian tradition), as I will discuss in later post.

The lines that run along corresponding upper and lower limbs (e.g. left arm to left leg) are analogous, and along the lines of each limb, energetic trigger points can be located that affect various aspects of the relevant organ’s physiology. In general, the more proximal (the closer to the heart) you are along the line of an organ, the more you are dealing with the structural components of that organ. In the middle of each line (closest to the elbow or knee) can be found physiological function (e.g. in the liver line, the detoxifying and nutrient extracting functions of the liver), while the distal (most distant from the heart) segment of each line corresponds with the space-occupying (e.g. gas-containing) and mobility (e.g. peristaltic in the case of the small intestine) qualities of the organ.


Fig. 1: Sen Kalathari, a major Sen line, with branches along the medial and lateral extremities that correspond to different organs. The branches of the lateral left arm and leg correspond to the stomach.

On Ms. Y, I was looking for her stomach line, which runs along the lateral left leg and arm as part of Sen Kalathari (mapped above in Fig. 1). Why? Her gastrectomy left her with no stomach remaining, so she was missing the primary digestive functions of the stomach. Since there was effectively empty space where her stomach once was, and the pain she described was gassy in nature, I anticipated that I would find some irregularities closer to the wrist and hand (distally). Sure enough, I located two rather big knots in the soft tissue close to the wrist as I massaged the line with my thumbs from elbow to hand. I worked on these for approximately two minutes each before she let out one of the loudest belches I’ve ever heard, stood up, and proceeded to dance the running man (you can’t make this stuff up). Another co-worker, Ms. L, seemed surprised by the whole process, so I showed Ms. L. what I was doing by having Ms. L feel for the knots on Ms. Y’s stomach line, and then I palpated Ms. L’s stomach line and had her do the same. Sure enough, Ms. L had no irregularities on her stomach line.

Ms. Y’s case was a special one because of her history of having her stomach removed, but the stomach line can be a powerful tool to help manage digestion and digestive ailments in all of us. You can massage your own stomach line (either on the leg, arm, or both) for therapy. Try thumbing the line (or having someone do it for you) when you are experiencing some of the following (see Fig. below):


Fig. 2: The stomach line visualized.

  • Stomach distension following a heavy or large meal – proximal line, above the elbow nearer the shoulder
  • Stomach heaviness or a feeling that the stomach is not emptying – proximal line, above the elbow nearer the shoulder
  • Acid reflux or heartburn/indigestion – middle line, near the elbow
  • Nausea – mid-distal line, halfway between the elbow and wrist (where the line between middle line and distal line is in Fig. 2)
  • Gassy upper abdominal pain – distal line, near the wrist/hand
  • Excessive belching – distal line, near the wrist/hand

Happy digesting!

– Arjuna

(Matthew Van Auken, RYT500, CAWC, TYT, MD/MPH Candidate 2014)