Acupuncture As A Fascia

Acupuncture as a fascia-oriented therapy
Chapter 7.9
Acupuncture as a fascia-oriented therapy

Dominik Irnich and Johannes Fleckenstein
Introduction
Historical Background
Acupuncture has increasingly been used in Western medicine over the last three decades. It originated with traditional
Chinese medicine (TCM) in the early Han period and has been described systematically for the first time in the medical
compilation “Huangdi Neijing” (Yellow Emperor’s Inner Classic), whose texts date from the Han period (200 BCE to 200 CE)
(Zhu 2001). Acupuncture means in its Chinese translation zhen jiu “needling burning”. However, before the development of
steel needles, acupuncture consisted of skin irritation using sharp objects (e.g., stones), local warming at defined body sites,
and minimal surgical interventions like blood letting.
Nowadays, acupuncture is defined as needling at anatomically defined sites of the body (acupuncture points) or sensitive
spots (ah shi points) for therapeutic purposes including so-called moxibustion, i.e., heating or warming of the skin at
acupuncture points with the help of burning mugwort (Artemisia vulgaris) (Fig. 7.9.1).
FIG. 7.9.1 • Choice of acupuncture instruments: different kinds of needles and of mugwort. From Irnich, 2008, with permission.
Acupuncture includes different techniques of needle stimulation, e.g., repetitive thrusting, twisting, rotating, or electrical
stimulation to achieve different treatment effects according to the theoretical background.
There are different acupuncture related techniques such as laser acupuncture, injection in acupuncture points, and
acupressure. A huge body of further manual or tool-assisted treatment approaches are based on the concept of acupuncture
points and meridians.
The theoretical background of acupuncture is based on Chinese, Confucian-legalistic, social and political philosophy of
the first century CE. Medical acupuncture is based on the subjective aspects of disease, in contrast to the diagnostic and
therapeutic understanding in western medicine, which is based on objective measurable pathologies. Acupuncture consists
of systematic analogy expressed in the early concepts of yin and yang, qi and the internal organs, and results of detailed
observations of nature and life.
Yin and yang
Originally the light and shadow side of a hill, yin and yang are the two opposites of a dual principle as a pattern of
organization for the whole cosmos but also for the physiology and anatomy of organisms.
Qi
Qi expresses an energetic concept of vitality circulating in every body, in the beginning more likely as a living matter. It
might be weak, blocked, accumulated, or misdistributed – all this aiming to describe different subjective symptoms.
Acupuncture points
Acupuncture points are the specific sites through which the qi of the meridians and zang fu organs (see below) is
transported to the body surface. The Chinese characters for an acupuncture point mean, respectively, “transportation” and
“hole”.
Meridians
All 360 classical acupuncture points lie strung together on the body surface according to a yin–yang pattern. They are
arranged in three systems (front, back, and lateral aspects of the body). Qi is supposed to circulate within these meridians
(Fig. 7.9.2).
FIG. 7.9.2 • Meridian system: front, back and lateral aspects of the body. From Irnich, 2008, with permission.
Internal organs (zang fu)

The concept of organs is based on the principle of the Five Phases – correlating organ dysfunction to other physiological and
psychoemotional conditions. This traditional concept transcends to a large extent anatomic and physiologic points of view.
Organs and meridians are internally and externally connected.
TCM holds that there is normally a state of relative equilibrium between the human body and the external environment
on the one hand, and among the internal organs within the body on the other hand; i.e., the equilibrium between protective
and pathogenic influences. Pathogenesis may be caused by external (e.g., annual recurrence of hay fever, improper diet) or
internal (e.g., emotions, overstrain) factors. The occurrence of any disease is, therefore, on the basis of the philosophic
background, due to a relative imbalance of yin and yang. This imbalance may result in different symptoms expressed, for
example, as a stagnation of the flow of qi in channels on the body surface or internal organs. Regulation of yin and yang is
therefore a fundamental principle in the clinical treatment. To restore health, acupuncturists insert and manipulate needles
or heat the skin using moxibustion at prescribed acupuncture points to promote the flow of qi and blood so they can
recirculate through the meridians or in the relevant organs.
Patients and the therapist himself may feel a so-called “deqi phenomenon” (needle sensation), which in the framework of
TCM is achieved by needling the acupuncture point. This phenomenon can be felt as propagated sensation along the
meridians and is described as sore, aching, numb, warm, or radiating. Some acupuncturists consider the eliciting of a deqi
response to be a precondition for an effective treatment.
All these concepts described in the “Huangdi Neijing” are still the basis of traditional Chinese acupuncture, but
underwent different interpretations and receptions in past centuries, resulting in many different schools of acupuncture
today. Even if the traditional Chinese acupuncture system is not comprehensible to many western people, it is itself logical
and thoughtful.
Today, needle acupuncture comprehends a broad range of approaches including traditional Chinese acupuncture, with
different understanding and interpretation in its respective schools; treatment includes microsystem acupuncture (e.g., ear
acupuncture [mostly developed in Europe], Yamamoto New Scalp Acupuncture), dry needling of myofascial trigger points,
or acupuncture forms further developed in other countries (e.g., Korea, Germany, Japan, Russia, Taiwan, United States).
Physiologic Background
Acupuncture effects are mediated through different neurophysiologic mechanisms: activation of mechano- and nociceptors,
descending inhibitory pathways (comprising diffuse noxious inhibitory controls), or spinal and supraspinal modulation
form some of the explanations to describe local and distant needling effects. Basic research showed the release of different
neurotransmitters (e.g., norepinephrine (noradrenaline), serotonin), hormones (e.g., estrogen, cortisol), and peptides (e.g.,
endorphin) to be related to acupuncture treatment. Nevertheless, there is no single course of action that explains the
complex neurophysiologic and anatomic responses to acupuncture treatment.
Acupuncture points have been supposed to be spots characterized by a high density of neural receptors. In addition,
acupuncture points have been found to be situated next to vascular, nerve, and ligamentous sheets, despite there being more
than 10 000 sheets in the superficial fascia of the human body, most of them not correlating with an acupuncture point.
Studies of electrical properties of acupuncture points have shown that the electrical skin resistance at these points can be
increased or decreased when compared to the surrounding skin area. None of those findings was able to define acupuncture
points anatomically.
A remarkable observation to explain acupuncture points and meridians comes from myofascial referred pain that was
observed to spread along the supposed meridian courses. Dorsher & Fleckenstein (2008a, 2008b) compared the anatomic
correspondence of the “common” myofascial trigger point locations described in the Myofascial Trigger Point Manual to the
locations of classical acupuncture points (Fig. 7.9.3). Anatomic correspondence of a common myofascial trigger point and a
classical acupuncture point means those points are proximate and are demonstrated by acupuncture and anatomy references
to enter the same muscle region. There is at least a 93.3% correspondence, if the distance between points on the skin is at
most 3 cm; anyhow, points had to enter the same muscle region. At a maximum skin distance of 1 cm, 37% of points can still
be found to correspond. There are marked clinical correspondences of both the pain indications (up to 97%) and
somatovisceral indications (> 93%) of anatomically corresponding common myofascial trigger point–classical acupuncture
point pairs (classical acupoints that are proximate to and enter the muscle region of their correlated common myofascial
trigger points). The spread of deqi along the meridians seems to be the same phenomenon as the physiologically analogous
concept of referred pain arising from myofascial trigger points in the myofascial pain tradition. This provides a clinical line
of evidence that myofascial trigger points and acupuncture points likely might describe the same physiologic phenomena.
FIG. 7.9.3 • Referred pain patterns of myofascial trigger points of the back and their correlation to the bladder meridian and its
respective acupuncture points. From Irnich, 2008, with permission.

These correlations make the explanation of the connecting meridians between acupuncture points more feasible.
Speculation in this regard has continued since acupuncture’s earliest days as to whether acupuncture meridians are
conceptual constructs or have an anatomic basis. Connective tissue might mediate acupuncture effects: Langevin
(2002a) showed that rotation after needling activates fibroblast by mechanosensory transduction. These local effects can be
tracked in distant connective tissue, too. Additionally, some researchers have described a degree of overlap of meridians and
the peripheral nervous system in the extremities, whereas others have postulated that the meridians may exist in the
myofascial layer of the body, reflecting perceived sensations by stimulating fascial structures. An interesting observation
might be that anatomically derived myofascial meridians have distributions similar to those of acupuncture meridians
described by TCM.
However, it remains clear that the target tissue of acupuncture points varies, comprising not only myofascial trigger
points but also nerves, bones, ligaments, vessels, and the autonomic nervous system.
La acupuntura es un enfoque que pone gran énfasis en la tendencia propia del cuerpo a
restablecer su funcionamiento armonioso.
El acupuntor, por lo tanto, no cura, sino que más bien prepara el escenario para que la función
autorreguladora de la fascia se produzca de forma natural. La capacidad de la acupuntura para
resolver una una amplia variedad de disfunciones somáticas y viscerales a través del uso de una
cuidadosa palpación y estimulación de la superficie es extraordinario. En nuestras décadas de
experiencia clínica hemos observado que el uso de un tratamiento basado en la fascia ha
mejorado exponencialmente la eficacia del tratamiento
y eficacia, y lo ha hecho sin el apoyo de medicamentos a base de hierbas. Dejamos de prescribir la

terapia de hierbas hace muchos años y por lo tanto nuestros resultados clínicos no fueron
confundido por el tratamiento de hierbas.
Nos asombra el sistema fascial, el metasistema que afecta, conecta e integra cada aspecto de la
fisiología humana. Entender que la acupuntura es un tratamiento que apoya la actividad adecuada
y las interrelaciones de la fascia nos ayuda a entender la teoría médica china en
nuevas y racionales maneras. El uso del enfoque fascial para el tratamiento continúa siendo
informado por la investigación científica8 , que proporciona un conocimiento y una comprensión
más amplios de este extraordinario metasistema. A medida que nuestra comprensión de la fascia
evoluciona, tal vez podamos llegar a una comprensión racional y científica del mecanismo
de la eficacia de la acupuntura.

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Acupuncture as a fascia-oriented therapy

Acupuncture as a fascia-oriented therapy

Internal organs (zang fu)

respective acupuncture points. From Irnich, 2008, with permission.

y eficacia, y lo ha hecho sin el apoyo de medicamentos a base de hierbas. Dejamos de prescribir la

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