Liver Qi Stagnation & Fascia

In Chinese medicine, we speak of liver qi stagnation, which is a common pattern associated with many conditions including musculoskeletal pain, digestive problems, menstrual disorders, headaches, and more. In this blog post, I will discuss how qi stagnation relates to pain in the myofascial system, as well as how fasciae surrounding the organs correlate with meridian connections such as internal-external relationships.

Pain in the musculoskeletal system may result from problems originating in the muscles, bones, joints, fascia, and even the internal organs.

In TCM theory, we often think of pain as being due to liver qi stagnation or qi and blood stagnation in general. We should also recall that the liver has associations with the tendons, which along with fascia, are a kind of connective tissue. In this regard, let's begin by reviewing a few key topics about fascia, musculoskeletal pain, and how movement can be used with acupuncture.

Generally, pain that is caused by a muscular or joint problem will be worse with movement. However, if the pain improves with movement, then the culprit may be the fascia. It is also important to know that fascia should be hydrated, lubricated, and flexible. However, dehydration, a lack of movement, repetitive movements, surgery, traumas, or injuries can lead to adhesions in the fascia. When the fascia starts to tighten up due to any of the above factors, it can lead to trigger points or muscular pain and appear as a qi stagnation pattern.

Acupuncture has a direct effect on the fascia, and twirling the needles in a clockwise or counter-clockwise fashion can apply a gentle stretch through the fasciae. This can translate into fast and often dramatic clinical results, especially when distal acupuncture is combined with movement.

• A major advantage of doing distal needling is that you can have the patient do movements with the affected area while the acupuncture needles are retained. (Movement helps to improve qi circulation.)

  
  

• When the problem originates in the fascia, movement will help to decrease pain, and non-local needles will work through the fascia to release tension systemically.

  
  

• Qi stagnation is a condition that affects various systems of the body. Similarly, since the fascia provides structural support to the body, fascial tension in one region often gets transmitted to other areas.

Liver Qi Stagnation, Fascia, and Internal Connections

Liver qi stagnation is an imbalance that gets transferred throughout the body, and this can affect distant areas such as the head, eyes, shoulders, GI system, reproductive system, and more. Similarly, tension in the fascia gets relayed through the fascial network, and this can affect the musculoskeletal system as well as the internal organs.

Connective Tissues Attaching the Liver to Other Organs: Note the Similarities with the Meridian Systems Approach

According to a meridian systems approach, the liver connects to the PC (jue yin), LI (system 2), GB (int.- ext.), SI (horary cycle), and LU (horary & meridian cycle).

When we map the fascial connections from the organs, we find that the visceral fasciae connect to external muscles and other structures in a similar way as described in TCM theories.

For instance, the large intestine is provided structural support by the fascia and ligaments that connect it to various other structures. In meridian theory, we find that the LI meridian connects to the LU meridian via the internal-external relationship. Anatomically, the transverse colon attaches to the diaphragm via the phrenicocolic ligament. Therefore, we can appreciate a direct anatomical and connective tissue relationship between the large intestine, diaphragm, and lungs.

There is also a relationship between the LI and LV meridians via the system two connection in the Balance Method (Zang Fu Bei Tong Theory). This connection between the LI and LV meridians is best known through the use of Four Gates (LI 4 and LV 3), but there are other ways to utilize these meridian connections. Anatomically, the LI and LV connect through the hepatocolic ligament. It is interesting and clinically relevant to note the fascial and ligament connections that correspond with traditional meridian theories linking the various organs.

Liver Qi Stagnation and the Neck and Shoulders

Liver qi stagnation and tension in the fascia are synonymous, and understanding this has wide clinical applications. For instance, pain at GB 21 may be seen as a sign of liver qi stagnation and occur with other symptoms such as temple headaches, jaw pain, TMJ, stress, neck pain, and upper back pain. For a person who carries stress and tension in their shoulders by elevating and contracting the trapezius muscle, pain will often develop at GB 21. Understanding the anatomy of the head, neck, and shoulders, as well as the meridians and myofascial lines, provides us with the structural framework to see how tension moves from GB 21 to the jaw, temples, and neck.

Is it Qi Stagnation or a Forward Head Shift?

Myofascial lines - and fascial connections in general - provide an anatomical basis for many TCM theories. Additionally, equating meridians to myofascial lines also provides acupuncturists with a foundation for understanding structural disorders. For instance, qi stagnation may be recognized in many cases of neck and shoulder tension, but this does not give us any insights into what is going on structurally.

A common pattern for many people with neck and shoulder pain, which could be diagnosed as qi stagnation, occurs with a forward head shift. In this pattern, the head is forward of the shoulders, and this often results in chronic tightness in the neck, shoulders (GB 21), and upper back muscles.

Forward Head Shift - Pain at GB 20 and GB 21

If the pain in a forward head shift is most prominent at the points GB 20 and GB 21, acupuncturists may diagnose this as a liver qi stagnation pattern. However, they may not notice that the structure of the head and neck is compromised. (In this modern world, likely due to long hours peering into screens.)

While a traditional approach to alleviating pain by needling points such as LI 4, LV 3, GB 20, GB 21, may provide some temporary benefit, it will not correct the underlying forward head shift pattern. Getting to the root of this problem may also require working with points in the anterior neck muscles where there is chronic contraction of the SCM, scalenes, and other muscles. I could continue with this analysis, but what I want to emphasize is that myofascial anatomy provides acupuncturists with the structural frameworks for integrating TCM theories with postural assessments and more. This kind of inquiry is not limited to musculoskeletal conditions, but as mentioned in the section above, also relates to internal medicine, visceral fascia, and various meridian connections.

Summary

When we compare meridian pathways to myofascial lines, we see a lot of overlap between them. By learning the anatomy of the myofascial lines, we have a more complete view of how qi and tension move through the body via the myofascial system. There are many more examples of fascial connections between muscles, organs, and other structures that provide an anatomical basis for nearly every aspect of various meridian theories. Additionally, equating meridian theory to myofascial lines and internal visceral fascial connections gives us many insights into referred pain and various disease patterns.

We can better comprehend the functional basis for why acupuncture points work the way they do when we integrate myofascial anatomy with TCM and meridian theory. The structure of meridians and myofascial lines is in direct relationship to the function of points because there is always a close connection between structure and function.

Read more about internal visceral fascial connections here.

Acupuncture and Visceral Fascia