The Connective Tissue Hypothesis for Acupuncture Mechanisms JCM

8/12/2019 The Connective Tissue Hypothesis for Acupuncture Mechanisms JCM

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Journal of Chinese Medicine Number 93 June 201014 The Connective Tissue Hypothesis for Acupuncture Mechanisms

Introduction

This paper is a review of evidence regardingthe correlation of acupuncture channels withanatomical structures known as connectivetissue planes 1,2 or myofascial trains. 3 Assertions have been made that correlate fascia or loose connectivetissue with acupuncture channels, 4, 5 and suggestionsput forward regarding their contribution to thephysiological basis of acupuncture effects. 6, 7, 8, 9 Theendeavour to investigate the relationship betweenfascia and acupuncture takes place in a wider contextof acupuncture mechanism research, which alsoincludes examining neurological and endocrinemodels. 10 Although there is evidence that acupuncturecauses changes within the central nervous system andendocrine system, 11 how this occurs is not understood;it is generally thought to be neurally mediated. 10

Acupuncture channels do not always follow thepathways of major nerves or blood vessels, which hasled some to conclude that the channel system doesnot physically exist. 12 There is currently a paucity ofgood quality evidence con rming the relationshipof connective tissue to acupuncture; what there is,however, is compelling and suggestive. Establishinga biological mechanism for acupuncture is likelyto increase acceptance by the medical orthodoxy; ifsuch evidence encompasses traditional channels andpoints then Chinese medical theory is also more likelyto become more widely accepted.

What is an acupuncture channel?The channels used in Chinese medicine are conceivedas conduits along which physiological substances -qi and blood - ow. This concept is usually regardedas energetic rather than structural. 13, 14 That is, whilst blood is thought to actually physically move throughthe blood vessels, the primary function of the qi and

blood owing through the channels is thought to bethat of providing nourishment. The Chinese view ofthe body differs culturally from that of the Westernmedical tradition; whilst in the West the focus tendsto be on reductive physical anatomy, the Chinese tendto view the body in terms of its growth, function andmovement as an integrated whole. 15 The truth of thechannels was not determined by dissection but bylived experience and reference to ancient knowledge.

Acupuncture channels are properly viewed not asindividual anatomical entities, but as a physiologicalsystem unifying the other systems of the body intoa cohesive whole; they are, amongst other things acommunication system. 16 The channels are describedin the Han dynasty classic Nei Jing Su Wen (YellowEmperors Inner Classic Plain Questions) 17, 18 - thought todate from around 200BCE - as being within the bodylining.9 In the Nei Jing Ling Shu (Yellow EmperorsInner Classic Spiritual Pivot) they are described aslying between the muscle layers which can hardly beseen.17 In the Nan Jing (Classic of Dif culties)the yang qiis said to ow in the space between the organs, bonesand esh 19 - which is where the connective tissue islocated. The channel pathways used today wereformalised during the Song dynasty (around 1026CE),at the inception of Chinese state medical education; 20 prior to this they were not usually formally described but were rather found by palpation. 9

What is fascia or loose connective tissue?Fascia is the name given to the connective tissuethat forms planes in the body surrounding musclegroups, organs and blood vessels. It is composed ofcollagen, elastic and lattice bres, ground substance (atransparent uid constituent) and also contains cells(e.g. broblasts, myo broblasts). 21 Until recently thepurpose of fascia had been thought to be something

The Connective Tissue Hypothesisfor Acupuncture Mechanisms

By: DuncanMcGechie

Keywords:Acupuncture

mechanismresearch,

fascia, jingluo,meridian,

channel theory,

connective tissue planes,

anatomy trains.

AbstractThis article examines whether there is evidence to support the idea that acupuncture channels have an anatomicalreality as fascia or connective tissue planes. An examination of what is meant by acupuncture channel and towhat the terms fa scia and connective tissue plane refer is followed by an analysis of evidence published over thelast ten years; the ar ticle concludes with a summary of what can be said to be proven, and the implications of suchproof for acupuncture research and practice. The paper f inds that there is little good quality conclusive evidenceavailable; what little there is, however, is compelling and suggests that there is much more to find out - information

that could potentially explain more about acupunctures physiological mechanisms. Two case studies are included to illustrate how knowledge of connective t issue planes can be integrated into acupuncture practice.


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Journal of Chinese Medicine Number 93 June 2010 15The Connective Tissue Hypothesis for Acupuncture Mechanisms

that lled the gaps between individual structures -thus forming a displacement layer 22 - and as a force

transmission structure. 23 This is no longer understoodto be the case, as it seems fascia has elastic 24 andcontractile qualities, 25, 26 as well as possibly functioningas a body-wide signalling network. 27

Since the study of fascia is relatively new, there issome discrepancy between the de nitions given by thesources studied here. 28 According to recent literature,fascia is an uninterrupted three-dimensional web ofconnective tissue that maintains structural integrity,provides support and protection, contributes tohaemodynamic and biochemical processes, defendsagainst infection and assists with tissue repair. 29 More

recently in the eld of fascia research the names ofdifferent kinds of fascia have been proposed in orderto facilitate clearer communication on the subject;most of the research presented here refers to whathas been termed areolar connective tissue. 30 This ischaracterised by a non-dense irregular arrangementof collagen bres in the fascia which allows movement between adjacent dense connective tissue layers; forexample, the epimysium is a dense connective tissuelayer surrounding muscle units - the areolar layerconnects the muscle units together in such a way thatthey can still slide past each other. This movementshould be free and easy, but in the case of damageor long-term misuse (poor seated posture and lack ofactivity for example), changes in the fascia cause thetissue to become restricted.

Historical and cultural considerationsThe research reviewed here can be seen in the widerhistorical context of the scientisation of Chinesemedicine 31 since the Qing Dynasty (1644-1911CE).There is evidence that the Chinese court was exposedto Western anatomy and medical ideas as early as thelate 17th century, 32 although it was not necessarilyincorporated into medicine at the time. In the 19thcentury, as the truth of Western anatomy becameharder to ignore, discourses were published thatinitially criticised Western anatomy, but then movedtoward ideas of convergence and double truths 33 inwhich both the Chinese and Western systems wereseen to be correct. One product of this discourse wasTang Zonghais concept in his Zhong Xi Hui Dao Yi Jing Jing Yi (Essential Meanings of the Medical Classicsin Light of the Convergence of China and the West ,1892CE) that Chinese anatomy is the anatomy of qitransformation as opposed to crude matter, 33 and thatchannels are the pathways for the qi transformationof the organs; such channels could not be discovered by dissection because they are only present in living bodies.

The process of scientisation took on political

dimensions in 20th century China when, despite theapparent rejection of bourgeois Western in uencesduring the 1970s, the scienti c reinterpretationof Chinese medicine formulated during the 1950sremained essentially intact. 31 Unschuld, who

describes Chinese medical theory as the theoryof systematic correspondence, states that oneshould regard all those attempts as questionableand misleading that try to eliminate this distinctivefeature [i.e. systematic correspondence] of traditionalChinese thought by arti cially isolating a coherentand - in the Western sense - consistent set of ideas andpatterns from ancient Chinese sources. 31 Thereforeall of the research reviewed here, including thispaper, might also be seen as an attempt to legitimiseChinese medical theory by translating it into Western biomedical language under the modern project ofintegration. To describe something that is functionaland relational in structural terms is likely to causeit to ultimately lose its meaning and signi cance.Some sources assert that looking for anatomicalacupuncture channels constitutes a fundamentalmisunderstanding of the nature of the channels andwhat they represent. 35 This should be borne in mindwhen reading any research in this area of study; evenif an anatomical correlate is identi ed in the fascia,it does not necessarily encompass all that a channelactually is. That said, there is clearly something to begained by establishing the biological mechanisms ofacupuncture.

Review of the literature

The papers reviewed here were found by searchingthe PubMed, AMED and Cinahl databases andfollowing references cited in relevant papers. Theresulting body of research varies in its pertinence andspeci city to the topic, but all good quality relevantstudies have been included for completeness.

Review articlesA systematic review (Ahn et al) looking at the electricalproperties of acupuncture points and channels 36 is wellconducted but limited to English language studies.The authors acknowledge that it does not constitutea comprehensive review, however, and point out thesmall sample sizes, poor quality and limitations in

Fascia is an uninterrupted three-dimensional web of

connective tissue that maintains structural integrity, provides support and protection, contributes to haemodynamic and biochemical processes, defendsagainst infection and assists with tissue repair.


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the research covered. Dividing the studies into thoselooking at the properties of points and those lookingat channels, they nd that the studies into channels areof better quality and show more evidence of electricalimpedance differences between the channels and theirimmediate physical surroundings than with points.They conclude that the available data is inadequateto draw clear conclusions, but that the evidence

supports the notion of channels being electricallydistinct and thus they recommend further research.Their interpretation of the data suggests that deeper,subcutaneous tissue layers may be an importantcomponent of acupuncture mechanisms. 36 The reviewis thus suggestive of the presence of an anatomicallymeasurable substrate corresponding to the channels,although connective tissue involvement is merelyhinted at rather than de nitively con rmed.

Napadow et al 11 summarise a selection ofpresentations from the 2007 Society for AcupunctureResearch conference. Each presenter is given a sectionand many outlooks are included. Of relevance tothe current paper is Ahns assessment of points andchannels, which discusses evidence of connective tissuecorrelation with acupuncture channels by looking attracer migration along channels that seem to indicatesome form of uid ow along connective tissueplanes. Langevin, who has contributed substantiallyto this eld of research, also has a section in this paperin which she suggests that connective tissue may bethe mechanism linking acupuncture stimulationand neurological effects; she also encourages furtherresearch into the eld.

Both review articles included here are reasonablein their own right, essentially summarisingLangevins body of work and making cautious,logical conclusions. They are thus not particularlyuseful in establishing the credibility of the hypothesisthat connective tissue is correlated with the physicallocation of the acupuncture channels, although theyshow this hypothesis in the context of a wider eldof research.

Anatomical studiesThe anatomically-focused papers are perhaps of thegreatest relevance to this review, since they focusdirectly on fascial anatomy. Stecco et al. look at thefascial continuity of the upper limb through thedissection of 15 unembalmed cadavers. 2 The authorsprovide enough background information and are

suf ciently methodical in describing their processesto make their experiments repeatable. They roughly

follow the anatomy of the Lung channel, testing forfunctional continuity by measuring force transmissionat different points along the course of the connectivetissue planes. They nd that connective tissueforms a continuous line of force transmission acrossmuscles, from the wrist to the pectoralis major, withminor variations between all subjects. They discussthe implications of this for biomechanics and thetreatment of myofascial pain syndromes. They de nethe area they are studying in terms of the acupuncturechannels of the exor aspect of the forearm, anatomychains 3 and the antemotion sequence (the work of

L. Stecco37), noting that all of these models overlap -although they avoid drawing conclusions as to theirrelative accuracy.

Another study looks mainly at the upper limb but also the presents some data on the thigh. 1 The background information provided covers the historyof acupuncture and outlines some historical issuesrelating to studies that aim to explain the mechanismsof acupuncture and the channel system. Otherresearch into connective tissue by the authors is cited,which supports their hypothesis that acupuncturechannels follow the course of fascial planes betweenmuscle, bone or tendinous structures. They assertthat points needled in acupuncture therapy aremore likely to be at junctions between fascial planes,where there is theoretically more connective tissueand therefore a stronger physiological effect. Thisstudy involves locating points and channels in thetraditional manner - using palpation and locationon a live human arm - and then transposing this topost-mortem tissue sections. They look at the upperarm merely to simplify the study and use ultrasoundand MRI (magnetic resonance imaging) to examinethe anatomy. They nd that 80 per cent of points and50 per cent of channel intersections coincide withintramuscular or intermuscular connective tissuecleavage planes, calculating that the probability ofthis occurring by chance is P


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biological reactions. There is, however, the possibilitythat this study is biased in terms of where in the body

the researchers conducted their investigations; theymay have found other connective tissue pathways thatdo not correspond with classically described channelsif they had looked elsewhere. They also do not presentany data to support their conclusion regarding pointsproducing stronger biological reactions than theirimmediate physical surroundings.

Clinical researchLangevin et al. 40 show how needling a traditionallylocated acupuncture point (on the Gall Bladderchannel along the iliotibial band of the thigh) causes

connective tissue displacement further up thechannel - as con rmed by ultrasound elastographytechniques; such changes were signi cantly differentat a control point on the biceps femoris muscle belly.The authors build on their previously developedhypothesis - that the mechanism of acupunctureeffects is via connective tissue. It is a well designedand fully described study, controlling reasonablyfor confounding factors by using computerisedequipment and doing so in vivo on live humans. Only12 subjects are tested, but the results are consistentand additionally show that ultrasound techniques arepotentially useful for researching connective tissue.Konofagou and Langevin 41 refer to the latter study intheir paper, in which they conduct similar researchon a different part of the leg, including further workon the use of ultrasound. They bring together a body of evidence dealing with the distant effects ofacupuncture along tissue planes and the reactions ofconnective tissue to needling, and draw conclusionsabout the implications of this for acupuncture researchas well as speculating on whether this explains themechanism of acupuncture.

Ahn et al. 42 measure electrical impedance andtissue displacement along connective tissue planescorresponding to two acupuncture channels in 24human subjects. They nd a signi cant difference between one channel (Pericardium) and a control (aparallel line 0.8cm medial to the channel), but sucha difference is not evident in another channel (theSpleen). The authors posit the lack of a signi cantdifference as being due to the control needle alsopenetrating the connective tissue.

The other group of papers in this section 43, 44, 45, 46

focus on the effects of needling connective tissuerather than on the question of the existence of planesthat correspond to acupuncture channels. They areall rigorously performed, with clear descriptions ofmethods and equipment; ndings and appropriatestatistical analysis are also clearly presented. Theyexamine the physical coupling of connective tissue

to a needle (needle grasp) in animals and humans,its relation to the felt sense of spreading (deqi) in apatient, cytoskeletal remodelling in connective tissue(where cells change shape and exert tension on theirsurroundings) and broblast migration (where more

broblasts are found in a speci c area of connectivetissue after needling). References are made in all of

these studies to the effects of needling on the widertissue matrix and the possibility of connective tissueplaying a role in biological communication throughdistant effects produced along these planes. As suchthey are judged to support the primary evidence inthe current review.

Theory articlesThe rst article dealing with connective tissue theoryconsidered here 47 summarises the research completedto-date on signalling through connective tissue andincludes a preliminary hypothesis of how acupunctureworks. As with some of the clinical studies, theevidence of a myofascial correlation with acupuncturechannels is not the main point of this paper, althoughsuch a relationship is outlined. Because this paperprimarily uses the papers considered above as sources,it does not as such add to the evidence base but ratherconstructs theoretical bases for future research.

Another paper 27 focuses on biomedical physiologyin order to explain acupuncture mechanisms, anddraws on recent research into the cellular physiologyof skin, nerves and connective tissue. The authorrefers to the conclusions made in other research - thatconnective tissue forms a continuous network aroundand through all of the other tissues and organs, thatit has contractile qualities and that it is importantin mechanotransduction. Most important is thesuggestion that connective tissue acts as a medium forcommunication between cells and distant parts of the body, and that this happens most directly along theplanes which correspond to acupuncture channels.

Langevin 47 posits connective tissue as a possibleunifying key to understanding cross-system integrationin medicine, presenting the body as a uni ed relationalwhole - a concept that is in keeping with new ideas insystems biology. The argument is built logically andreaches reasonable conclusions from the evidencegiven. Although this paper does not add to the sum ofknowledge on connective tissue-channel correlations,its hypothesis is possibly a useful one to explore. She

The anatomical fascial planes constitute a continuous

network throughout the body around muscles, bonesand organs; the 12 main channels may constitute the keyfunctional places where these fascial planes intersect.


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takes the extant knowledge and proposes a theory thatexplains it coherently and more comprehensively than the

paper considered above.The nal paper considered here 12 consists of a complex

combination of theories regarding the correlation ofacupuncture channels with connective tissue planestogether with theories of embryology and growthcontrol factors at a cellular level. It proposes that aswell as corresponding with connective tissue planes,acupuncture channels relate to growth control boundariesin embryogenesis (termed separatrices) and that at suchplaces acupuncture can alter gene expression and producemechanical and neurohumoural effects.

SynthesisThe studies detailed above form a body of usefulevidence covering an array of related areas and establishappropriate systems of measurement, suitable researchprotocols and reliable methods. In terms of research intoacupuncture mechanisms, studying the relationship ofacupuncture and connective tissue may be a more sensibleway to proceed than trying to establish a mechanismfor acupuncture without knowing what to measure orhow to best control for it; such studies may look in thewrong place to assess the physiological effects produced by acupuncture and then conclude that it does not havea therapeutic value. For example, many studies haveshown acupuncture causes changes in hormone andneurotransmitter activity, 36 although what these changesrepresent is frequently not understood. The approachsuggested above may contribute to establishing the link between the physiological and therapeutic effects.

As to the question of whether connective tissue planes arethe same as acupuncture channels, it would be necessaryto consider that these planes are three dimensional sheetsof tissue which surround physiological structures in the body - more like tents than two-dimensional lines. Thehypotheses made in the literature are that where planescome together they have more connections, and that this iswhere the channel and point correspondences appear to be. 1 As such they are not so much like the 12 main acupuncturechannels, but more akin to the jingluo network. Theanatomical fascial planes constitute a continuous networkthroughout the body around muscles, bones and organs;the 12 main channels may constitute the key functionalplaces where these fascial planes intersect.

Channels were not conceived by the ancient Chinese asstructural, but rather as functional manifestations of theassociated organ systems. 16 The question of what theyare in reality contains the theoretical bias that Western biomedical anatomy is the truth and that the ancientChinese system is somehow mistaken; 33 caution shouldtherefore be employed when directly equating the two. 31 The evidence collected here implies some structuraloverlap, 1, 2 as well as a broader physiological similarity that

is in keeping with classical ideas about the channels. 27,45 The evidence is provocative and shows the promise of

discovering more about human physiology and health, aswell as the possibility of understanding the mechanismsof acupuncture in biomedical terms. Although it cannotnecessarily be said that channels and connective tissue arethe same thing, establishing their relationship could be both useful and interesting.

Case study onePatient one presented with a three year history of plantarfasciitis. He complained of excruciating sharp, burningpains on the soles of his feet that would come and go butwere usually worse in the morning. The right foot was

worse than the left and the right hamstrings, lower back,soleus and medial head of gastrocnemius were all verytight. The pain extended to the medial heel in the area ofZhaohai KID-6. He had dry skin, but slept well and wasotherwise healthy. His tongue was pale and dry with a redtip and his pulse was wiry (xian) and deep (chen) in bothproximal positions.

The plantar fascia is said to connect to the musclesof the calf, including the deep posterior compartmentmuscles exor digitorum longus, exor hallucis longusand plantaris. 22 Such fascial theory directed the focusof treatment towards points along the Bladder channellocal to these muscles, in order to release the constrictioncausing the pain (diagnosed as qi and blood stagnationwith underlying blood de ciency). In addition to thesepoints others were used local to the pain to invigorateqi and blood in the channels, support the blood andharmonise qi. The points needled were as follows:

Weizhong BL-40 to release popliteus, activate the channeland clear heat.

Chengshan BL-57 to release gastrocnemius and soleusand activate the channel.

Heyang BL-55 to release plantaris and tibialis posteriorand activate the channel.

Yinmen BL-37 to release the hamstrings and activate thechannel.

Zhaohai KID-6 as a local point for pain and to support blood production by nourishing the Kidneys.

Zhongdu LIV-6 (the xi-cleft point) to move blood. Sanyinjiao SP-6 to harmonise qi in the three yin channels

and support blood.

This treatment was intended to produce an immediateeffect, with a view in subsequent treatments to workingto balance his posture and underlying Chinese medicalpatterns. Needle technique was even or reducing; in thecase of Chengshan BL-57 and Yinmen BL-37 the needletechnique blue turtle nds the cave was used to disperseqi and blood stagnation - and because it contacts more ofthe local fascial planes. The patient returned one week


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later, reporting a signi cant reduction in the sole pain, butstill complained of tight calves and tightness in his right

hip. Based on this, the next two treatments included thefollowing points:

Juliao GB-29 Yanglingquan GB-34

These points were included in order to release the tightnessaround the hips that was biomechanically contributingto his dysfunction to produce backache. After threetreatments all his musculoskeletal problems were muchimproved and he was able to remain pain-free by regularstretching alone.

Case study twoPatient two had been coming for acupuncture to treatmenstrual problems, but on this occasion presented witha recurrence of acute lower back pain. It had startedsuddenly after bending over to pick something up. Herlower back was tight and the pain was located primarilyat the left sacroiliac joint (SIJ), radiating out into the lower back. The pulse was wiry (xian) overall, less forceful (wuli) on the left than on the right and con ned (lao) in bothproximal positions, indicating qi or blood constraint in thelower jiao. Her tongue was pale and swollen with toothmarks and a purple area at the rear.

Notwithstanding her underlying condition of Liver blood de ciency and Liver qi stagnation, my diagnosiswas of qi and blood stagnation in the Bladder channel ofthe lower back. Musculoskeletal examination revealedthat piriformis and gluteus medius were involved, as werethe lumbar paraspinal muscles; the root of the problem,however, seemed to be a xation of the left SIJ, whichwas con rmed by seated and standing nutation andcounternutation tests (testing the small anterior- posteriorgliding movements of the sacrum between the ilia). Thetreatment administered was as follows:

Shangliao BL-31 to release the deep fascia on the ventralsurface of the sacrum.

Pangguangshu BL-28 and Xiaochangshu BL-27 on theleft hand side using a strong unidirectional rotation torelease the fascia around the SIJ.

Shenshu BL-23 to release the lumbar muscles andnourish the Kidneys.

Sanyinjiao SP-6 as a distal yin channel point to balance thepoint prescription, harmonise the Liver and support theKidneys (to regulate the underlying menstrual problem).

Zusanli ST-36 to nourish qi and blood.

The day following treatment she felt stiff in the SIJ area andthen the pain disappeared completely. It has not returnedin the six months since treatment.

It would of course be entirely possible to come to similar

decisions regarding point selection by purely relying ontraditional Chinese medicine channel theory (which in

itself perhaps con rms the close relationship of channeland fascial dynamics). To have similar success usingdifferent approaches might also be possible. Having adeep awareness of the anatomy and interrelationship offascial structures and acupuncture channels, however, canhelp to clarify the clinical decision-making process, informneedle technique and help focus the intent to produce better results from treatment.

Conclusions

There is evidence to support the anatomical realityof acupuncture channels and their association with

connective tissue planes, although more studies withgreater subject numbers studying other areas of the bodywould make the case stronger. It seems from the evidenceavailable that connective tissue may play a role in thephysiological mechanisms of acupuncture. The studiesshow that needling acupoints affects connective tissue andhas distant effects along the connective tissue planes. Thereis some evidence, although less convincing, that needlingmay interact with neurohumoural systems, 27 with theconnective tissue functioning as a communication systemsimilar to the traditional Chinese idea of channels. 16

Implications for practiceIf the anatomical location of acupuncture channels is better understood it could re ne acupuncturists methodsof palpation and the subsequent accuracy of their pointlocation. The ability to feel a point or changes along achannel is important in acupuncture practice, and wasapparently particularly so in the way it was originallypractised. 9 If practitioners can relate what they feel alonga channel to a physical correlate - the fasciae and muscles- it could improve point location and treatment ef cacy.Further understanding of the anatomy of channels mightalso re ne a practitioners needle technique and diagnosis,depending on the treatment aims in question. Wideracceptance of acupuncture therapy in general biomedicalcare is also more likely if the anatomical structure ofchannels can be identi ed, since it renders traditionaltheory more plausible.

The ndings of these studies could in uence researchdesign to be more accurate in terms of measuring the effectsof needling, and thus in selecting appropriate controlmethods for clinical trials. If it is accepted that acupuncturechannels follow connective tissue planes, then it followsthat the real acupuncture arm of a trial should be locatedon these interstices and the sham control points distantfrom them. 47 If the sham points are placed on the fascialplane, they are more likely to have a therapeutic effectand thus constitute a poor control. In addition to this,if in a trial both the real and sham points are located offthe connective tissue plane without palpatory or other


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anatomical con rmation, the statistical signi canceof the effect of acupuncture is likely to be minimal

(as neither point is at the fascial plane where a strongeffect would be expected).

Researchers should consider how the informationpresented here affects their understanding of whatthey are studying, as well as their conception of themechanism of the effects of acupuncture. Researchneeds to be conducted to establish whether myofascialcontinuity correlates to channels in areas of the bodynot already examined - notably the torso, wheresomato-visceral connections have been hypothesised. 6

More research looking into mechanotransductionalong connective tissue planes may in uence

acupuncture practice in the future, and research intofascia itself how it acts as a communication network

and interfaces with the nervous system - also has thepotential to be clinically useful.

Duncan McGechie rst studied philosophy and religiousstudies in Lancaster, where he began to take a special interestin traditional Chinese thought, and has been studyingChinese medicine since 1999. He has been practising Chinesemedicine, acupuncture and bodywork (including sportstherapy, myofascial release and neuromuscular techniques)since 2003. Studies in the UK and China recently culminatedin completing an MSc in Chinese herbal medicine. Specialinterests include connective tissue in musculoskeletal painand rehabilitation, menstrual dysfunction, shen disharmonyand qigong. For comments or questions contact [email protected].

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The Connective Tissue Hypothesis for Acupuncture Mechanisms JCM

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