Fascias and acupuncture: the channels

On November 8-9-10, 2024, the 12th CFMTC congress was held in Aix-en-Provence, France, bringing together acupuncturists and practitioners of Chinese medicine from all over the world to share their respective fields of expertise. It was an opportunity to present my research on fascias and acupuncture, and more specifically on the often controversial notion of channels traditionally known as jīng luò mài. The very positive reception from the audience and the professionals present at this plenary session gave rise to very rich exchanges and promising collaborations.

Huangdi Nèijīng: Mankind's first anatomical work

The need to redefine the anatomical and physiological bases of the jīng luò mài channels concept is urgent and necessary for the recognition of acupuncture practice by the public and by the various stakeholders at therapeutic, medical and political levels.

 It's important to recognize that ancient Chinese medical theorists had a much clearer understanding of anatomy than is generally acknowledged.

The concept of channels or channels has probably been the subject of the most speculation and debate since the introduction of Chinese medicine to the West. These paths of Qi “energy” have raised many theoretical and practical questions since Georges Soulié de Morand first translated the founding texts of Chinese medicine almost 100 years ago. Lacking a theoretical and anatomical equivalent in the West, attempts to translate such a complex and profound concept have led to numerous misunderstandings and confusions on the part of both the general public and the medical and scientific community. The energetic language adopted at the time, and which has endured since our first contacts with acupuncture, corresponds neither to the descriptions in ancient Chinese medical texts nor to contemporary anatomical reality.

 It's important to recognize that ancient Chinese medical theorists had a much clearer understanding of anatomy than is generally acknowledged. The very first work of Chinese medicine: The Classic of the Yellow Emperor - (Huangdi Nèijīng), -168 is indeed considered by many to be mankind's very first anatomical work [1]. 

The Nèijīng, some chapters of which were found in their entirety when the tomb of Mawangdui was discovered in the archaeological site of Changsha, in China's Hunan province, contains chapters dedicated to very precise descriptions of organs, the musculoskeletal system, the blood network and also the jīng luò mài meridians. Contrary to popular belief, there are also clear references to anatomical dissections. This compendium of medicine and natural sciences offers new paradigms on fundamental concepts such as health, anatomy, physiology, philosophy and the relationship of humans to nature and their environment [2].

A global, integrated network

The terms jīng luò mài refer to an organizational framework, a woven, interwoven and interconnected network. This system of distribution and communication is central to the body's physiological organization, enabling it to function in a global and integrated way. It's also important to understand that the meridian system is divided into two main families:

- Jing Jin (myofascial network): Organize and coordinate movement.  Ensures mobility, support, contraction, protection and sensitivity of its interfaces.

- Jing Luo Mai (physiological network): A “global and continuous” system interacting with every cell in the body and linking internal and external organs. Forms a network for storing, communicating and distributing Qi and blood.

Although the link between acupuncture meridians and fascia has long been suggested [3], it's only in recent years, with the explosion of new research into fascia structure and physiology, that a new theory has emerged which doesn't replace, but rather modifies the “Qi” paradigm, offering a source of explanation for the mechanisms of acupuncture and the nature of jīng luò mài [4].

Since the beginning of the 21st century, the fascial system has gradually made its appearance, with its main qualities being continuity and three-dimensionality. This new definition of fascia and the human body now enables us to consider the human body as a whole, i.e. as a decentralized, sensitive and contractile system enabling the body to function in a global and integrated way [5]. This definition dovetails perfectly with that of the channels system. There is also an almost perfect correspondence between the therapeutic approaches of the two systems. 

From micro to macro

The relationship between channels and fascial planes has been widely documented. [6,7]. Most of these studies focus solely on the macroscopic, structural and palpable aspect of fascia. However, another strand of connective tissue research is dedicated to its microscopic anatomy. This three-dimensional network extends not only around all the visible structures of the human body, but also branches out around every muscle fibre, nerve and blood vessel, right down to the extracellular matrix and its fundamental substance [8]. This little-studied aspect of fascia seems to correspond at many points to the physiological side of the jīng luò mài meridian distribution network.

 It is at this level that the correspondences with the circulatory system of the jīng luò mài channels find a genuine hypothesis for contemporary explanation.

 Jean Claude Guimberteau's work describes a storage, distribution and communication network in which energy, information and materials are stored and distributed [9]. While Neil Theise, in his publication on intersticium, describes liquid-filled spaces subjected to cycles of compression and distension, with dense, porous walls in constant structural adaptation. His observations raise questions about the impact of mechanical forces on fluid flow in the structures and cells of this space [10]. 

It is at this level that the correspondences between the circulatory system of the jīng luò mài channels find a genuine hypothesis for contemporary explanation. At this microscopic level, where we observe all cellular and capillary exchanges, we find a global and continuous matrix capable of communication, sensitivity and structural adaptation.

Therapeutic perspectives

Since there are many anatomical and physiological similarities between the fascial system and that of the acupuncture channels, an understanding of fascial anatomy and organization should be central to the choice of therapeutic strategy and puncture sites. Ultimately, the main thrust of any treatment lies in the free circulation and permeability of the body's interstices to ensure the irrigation of extracellular matrices for optimal physiological functioning.

 The anatomical reality and surprising properties of the fascial system provide us with a tremendous opportunity to popularize knowledge of a medical system that has been marginalized for too long. Redefining and updating the concept of the jīng luò mài channels could finally enable the various players in the health sector to share important knowledge and clinical information, with the aim of helping human health.

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References

1 - Shaw V, Diogo R, Winder IC. Hiding in Plain Sight-ancient Chinese anatomy. Anat Rec. 2020;1–14.

 2- Edward Neal, Journal of Chinese Medicine | Issue125 | February 2021 Twenty Years of Nèijīng Research: What Has Been Learned? Part 1. Background and Principles

3- Yu Bai, Jun Wang, Jin-peng Wu, Jing-xing Dai, Ou Sha, David Tai Wai Yew, Lin Yuan,and Qiu-ni Liang. “Review of Evidence Suggesting That the Fascia Network Could Be the Anatomical Basis for Acupoints and Meridians in the Human Body.” Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2011, Article ID 260510, 6 pages doi:10.1155/2011/260510

4- Steven Finando Ph.D., L.Ac. and  Donna Finando, M.S., L.Ac., L.M.T, FASCIA: THE MEDIATING SYSTEM OF ACUPUNCTURE  CLINICAL AND RESEARCH IMPLICATIONS   Workshop Presented at the Second International Research Congress Vrije Universiteit, Amsterdam,  October 31, 2009  

5- Sue Adstrom, Gil Hedley, Robert Schleip, Carla Stecco, Can A Yucesoy, ‘’ Defining the fascial system’’, Journal of bodywork movement therapy, Jan 2017, 173-177, PMID: 28167173  

6 -J. C. Longhurst, “Defining meridians: a modern basis of understanding,” JAMS Journal of Acupuncture and Meridian Studies, vol. 3, no. 2, pp. 67–74, 2010.

7- Guang-Jun Wang1, M. Hossein Ayati2, Wei-Bo Zhang1, Meridian Studies in China: A Systematic Review, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medicine Science, Beijing, China, Acupuncture School, Beijing University of Chinese Medicine, Beijing, China,  Acupunct Meridian Stud 2010;3(1):1−9, ELSEVIER

 8- H. M. Langevin, N. A. Bouffard, G. J. Badger, J. C. Iatridis, and A. K. Howe, “Dynamic fibroblast cytoskeletal response to subcutaneous tissue stretch ex vivo and in vivo,” American Journal of Physiology, vol. 288, no. 3, pp. C747–C756, 2005.

9- J-C Guimberteau, C Armstrong, ‘’L'architecture du corps humain vivant: Le monde extracellulaire, les cellules et le fascia révélés par l'endoscopie.’’, Sully, France Canada; 2016.