The idea that there is a relationship between the fascia and acupuncture is not a new one. The earliest reference to the fascia can be found in centuries-old Oriental medical literature. One of the oldest known classics on acupuncture, the Nei Ching (The Yellow Emporer’s Canon of Internal Medicine), circa 200 BC, consisted of two fundamental sections,
the Su Wen, (Fundamental Questions) and the Ling Shu, (Spiritual Axis). As was common at that time, language couched in metaphor and metaphysics was used to describe anatomical structures and functions. However, it is important to recognize that medical thinkers of the time had a clearer understanding of human anatomy than is generally recognized. The classical texts contain information that indicates that the ancient Chinese physicians had considerable awareness of the body’s inner structure. Tissues and fasciae were known to have an important role in human function, such as forming enclosures for each of the organs and connecting the organs to one another. The size, shape and functions of the organs and blood vessels were identified, as well as the pathways between organs and membranes (Matsumoto and Birch, 1988). The Ling Shu describes ‘fatty, greasy’ tissues and connecting membranes. Channels are described as keeping the bones and sinews moistened and the joints lubricated (Matsumoto and Birch, 1988, p. 133). In the Su Wen we find a statement indicating that the channels are located within the ‘body lining.’ Early physicians were locating the theoretical channels within the fascia. Thus, we can see that there is an ancient notion that channels are located within the fascia. We can also say that while the locus of treatment, the fascia, was clearly identified, it appears that a belief was held that a separate system was being affected: the channel system1.
In a later classic, the Nan Jing (Classic of Difficult Issues), circa 20 AD, we see that the channel system had evolved into one that included fourteen interconnected channels. A significant phrase taken from the Nan Jing describes the ‘fat, greasy membranes’ as the ‘space between the organs, bones and flesh…..through which the yang qi streams’ (Matsumoto and
Birch, 1988, p 136). Channels had taken on definition and purpose. Acupuncture points were defined and the notion of the circulation of qi via the channels had been developed (Birch and Felt, p 19). Acupuncture points were chosen for use by skilled palpation of the body and were treated with the aim of balancing the flow of qi throughout the channel system.
Some modern acupuncturists have suggested that acupuncture might be referred to as connective tissue therapy (Nagahama, 1958). Yet, with some exceptions, very few acupuncturists have embraced such ideas, although the research community is coming close to achieving the critical mass of scientific evidence to make definitive statements regarding the mechanisms underlying acupuncture therapy. The following discussion is an effort to integrate recent fascia research with ancient acupuncture philosophy and principles.
One of the great difficulties of acupuncture research is that the practice of acupuncture is far from homogeneous. Acupuncture has undergone numerous transformations over the centuries, and the sources of such transformation have been varied. Chinese thinkers were immensely practical and capable of absorbing apparently opposing ideas without replacing or negating earlier ones. They integrated whatever worked, hence the coexistence and influence on the practice of acupuncture of each of the Three Pillars of Chinese thought: Confucianism, Taoism and Buddhism. Not only has it been influenced by religious philosophy, but by political, economic and social circumstances as well. The result is a vast array of practices and principles that are all called ‘acupuncture.’
Paul Unschuld (1986) states: “A third major distortion encountered in nearly all European and American attempts to characterize traditional Chinese medicine is related to the issue of terminology; it results from efforts to squeeze an enormous array of concepts and schools of thought in traditional Chinese medicine (which are sometimes mutually contradictory, antagonistic or exclusive) into the kind of homogeneous, logically coherent system of ideas and practices that is so attractive to the Western mind.” (p. 5)
The most common conception of acupuncture today refers to an approach to treatment that was created in the middle of the twentieth century. Today, many practitioners and the lay public commonly refer to acupuncture as Traditional Chinese Medicine (TCM). TCM includes the use of traditional herbal medicines. Few realize this specific term and associated practice was a creation of the Cultural Revolution, a product of the People’s Republic of China (PRC). It was, in some sense, the effort of a reluctant Mao, who was skeptical about acupuncture, to retain the identity of Chinese medicine in a rapidly evolving trend toward modern Western medicine. The PRC established standards for the development of TCM. The first requirement was the integration of acupuncture and herbal medicine under a single set of fundamental principles. At that time, herbalists were more politically powerful than acupuncturists. The result was an acupuncture practice that was grounded upon principles that had previously been applied to the application of herbal medicines, focused on organ function rather than channel/qi disruption, and strongly connected to modern biomedicine. This approach was more conducive to large classroom instruction than apprenticeship training. It connected pattern pathology to modern disease diagnosis, and textbooks were produced that described treatments for asthma, gastritis, arthritis and a host of Western-defined diseases. In many ways this shift helped to promote and make acupuncture understandable in the West. Moreover, other forms or styles of acupuncture were banned in the PRC. Schools taught only TCM and practitioners were only allowed to practice TCM. In the West, there were very few acupuncture texts written in English, so by the 1970’s, when English translations of TCM texts were published, they quickly became the basis of many newly forming schools of acupuncture.
TCM is clearly the predominant approach to acupuncture for the PRC and much of the West. This is important, because TCM marks a major departure from the classical emphasis on palpation. It is less connected to the skill and sensitivity of the practitioner and the evaluation of channels and constriction through touch, and more reliant on the conceptualization of symptom patterns. Because it is so pervasive, many Western researchers use TCM acupuncture as the independent variable in acupuncture studies. As we will see later, the construct validity of the independent variable (acupuncture) could be greatly improved if researchers chose a more classical approach of treatment utilizing meridian-based styles as their independent variable.
A new theory must provide better explanation of phenomena and improved prediction of outcomes. For the clinician, better prediction refers to treatment outcomes. For the researcher, it is established through testable hypotheses. A theory that provides better explanation may provide new or modified clinical approaches, and can imply future directions for research. A theory, therefore, must confine itself to observable phenomena that may be explained or predicted.
While the connection between acupuncture and the fascia has been suggested for a long time, it is only in recent years, with the explosion of new research on the structure and physiology of the fascia, that a new theory, one that does not replace, but modifies the qi paradigm, can become a source of explanation and prediction regarding acupuncture practice. Extraordinary new conceptions of the fascia lend powerful evidence to the theory that the fascia is the mediating system of acupuncture. However, we must first address the issue of defining what we mean by acupuncture if we are to propose new explanations regarding its mechanism of action.