In Chinese medicine, we speak of qi stagnation which is a very 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 visceral fasciae correlate with meridian connections such as internal-external relationships.
Pain in the musculoskeletal system may result from problems originating in the muscles, bones, joints, or fascia. For muscular pain, it can be difficult to determine if the problem started in the muscles or fasciae.
Generally, pain that is due to a muscular or joint problem will be worse with movement, but 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 and muscular pain.
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 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 in distant locations.
When the problem originates in the fascia, movement on its own will help to decrease pain, and non-local needles will work through the fascial system to release tension systemically. Qi stagnation is viewed as a systemic condition that affects various systems of the body, and similarly, because the fasciae provide structural support to the whole body, fascial tension in one region easily gets transmitted to other areas.
Qi stagnation is a condition that gets transferred through the body. Liver qi stagnation 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 occur in the musculoskeletal system as well as in the internal visceral fascia.
In this regard, qi stagnation and tension in the fascia are synonymous, and understanding this has wide clinical applications. For instance, pain at GB 21 is often seen as a sign of liver qi stagnation and may occur with other qi stagnation 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.
In the case of a forward head shift, in which the head is forward of the shoulders, it results in chronic tightness in the neck, shoulders, and upper back muscles. Additionally, pain can develop at GB 21 in people who have forward head shifts, and this may be one of the most prominent places where the tension is held.
When we compare the meridian pathways to the myofascial lines, we see a lot of overlap between them. However, by learning the anatomy of the muscles that make up the myofascial lines, we have a more complete view of how qi and tension move through the body via the myofascial system.
This line of reasoning is not limited to musculoskeletal conditions because fasciae also surround the internal organs (visceral fascia) and attach the organs to more external structures. A primary belief in meridian theory is that the meridians maintain an internal-external connection between the organs and superficial body regions. When we map the fascial connections from the organs, we find that the visceral fasciae connect to more external muscles and other structures in a similar way as described in traditional theories.
For instance, the large intestine is provided structural support via the fascia and ligaments (connective tissues) 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, and while there are other ways to describe the connection between liver patterns and large intestine disorders, it is interesting and clinically relevant to note the fascial/ligament connections that correspond with traditional meridian theories linking various organs.
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. By knowing about these anatomical and structural relationships, we can better comprehend the mechanical and functional basis for why acupuncture points work the way they do.
The structure of meridians and myofascial lines is in direct relationship to the function of points because there is always a close relationship between structure and function.
Read more about internal visceral fascial connections here.
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