When I studied acupuncture in the early 1980s we learned about a system of meridians permeating the human body and involved in the distribution of ‘qi’. Acupuncture points along the meridians were used to adjust the balance and distribution of qi using fine needles or heat. Back then we thought of these meridians as invisible channels unknown to Western anatomy and of qi, which translated as breath or vital energy, as a mysterious life force that Western medicine refused to or was unable to acknowledge.

Twenty years on much has changed in our understanding of Traditional Chinese Medicine. In part this is thanks to an extraordinary exchange of knowledge between Western and Eastern medical practitioners and in part because of incredible scientific advances that allow us to observe in the human body what was once only discerned by the senses of our ancient forebears.

We once referred to qi with a vagueness that feigned superior knowledge and disguised ignorance. It is now understood that qi manifests in the human body in many forms and with many functions. Its forms include original qi, food qi, gathering qi, true qi, nutritive qi and defensive qi; while its functions include transforming, transporting, holding, raising, protecting and warming (Maciocia 1991). We now understand that qi is not simply a generic ‘energy’ but a way of describing and understanding the myriad exchanges and transformations occurring within the living body as it converts air, food, water and light into growth, activity and behaviour. James Oschman, a researcher in the field of life energy, has described qi as consisting, ‘at least in part, of bioelectric, biomagnetic, biomechanical, and bioacoustic signals moving through collagen fibres, ground substance, and associated layers of water molecules’ (Larson 1990, p. 25).

We find a similar concept to qi in the yogic system where it is referred to as ‘prana’. Like qi, prana also has a number of different forms and functions. The five primary functions of prana all relate to the breath and it is these aspects that gave rise to pranayama or breath control, one of the eight aspects of yogic practice mentioned in the previous chapter (Feuerstein 1990, p. 258).

The complexities of qi are beyond the capacities of this massage therapist’s mind but the medium of transmission is what fascinates this massage therapist’s hands. As we have seen, Traditional Chinese Medicine refers to an intricate web of smaller and smaller channels branching from the 14 main channels used in acupuncture. These channels may not have been invisible to our Western eyes so much as overlooked. There is a growing conviction that they relate to the connective tissue network, the ubiquity of which is so complete as to ­‘connect the various branches of medicine’ (Juhan 2003, p. 63).

Our body comprises four principal types of tissue. These are muscle, nervous tissue, epithelial tissue and connective tissue. Of the four, connective tissue is the most abundant and widely distributed. Connective tissue, along with all skeletal muscles, most smooth muscles, all cardiac muscles, bone, blood and cartilage derives from the embryological mesoderm. Although bone, blood and cartilage are types of connective tissue these three are so specialised that they are usually treated separately from connective tissue proper.

Connective tissue proper comprises a matrix of three basic elements. These are ground substance, fibres and cells. Ground substance is a gel-like fluid with a consistency that ranges from a viscid state to a more fluid state depending on the fibres it contains (Juhan 2003, p. 64). As well as providing support and binding for cells it is also the medium of exchange between cells and blood and is significant in processes such as tissue development, migration, proliferation and metabolism.

The cells of the connective tissue are macrophages, plasma cells, mast cells and fibroblasts. Macrophages provide defence by engulfing invading bacteria and cellular debris. Plasma cells aid defence through the secretion of antibodies. Mast cells produce histamine, which dilates small blood vessels during the process of defence and repair in response to injury or infection (Tortora & Grabowski 1996, p. 104).

Fibroblasts have a unique place in our cellular world with their ability to migrate anywhere in the body and modify their activities according to local need. Fibroblasts secrete ground substance and synthesise the various fibres that give each type of connective tissue its special quality. These fibres are collagen, elastin and reticular fibres. The type and arrangement of these fibres within the ground substance vary according to location and purpose (Juhan 2003, p. 66).

There are two general types of connective tissues, loose and dense. Loose connective tissue includes the subtypes of areolar, adipose and reticular. Areolar is the most widely distributed. It contains collagen, elastin and reticular fibres in a loose and random arrangement. This structure suits its role of holding organs and epithelia in place and as the subcutaneous layer attaching the skin to the underlying tissues and organs (Tortora & Grabowski 1996, p. 107).

Adipose connective tissue is always found in the company of areolar connective tissue. It contains adipocytes, derived from fibroblasts. These cells are adapted for the storage of fats and oils. This makes adipose tissue especially suited to cushioning and supporting organs, thermal insulation, lubrication (primarily in the pericardium) and energy storage.

Reticular connective tissue contains a network of fine interlacing reticular fibres that forms a soft framework known as a ‘stroma’ found in the lymph nodes, red bone marrow, liver and spleen (Tortora & Grabowski 1996, p. 108).

Dense connective tissue includes two subtypes, dense regular and dense irregular. Dense regular connective tissue is packed with collagen fibres arranged in parallel bundles. This gives it the great strength necessary for its role of providing attachments between structures. As tendon it attaches muscle to bone and as ligament it attaches bone to bone. Aponeuroses are sheet-like tendons that attach muscle to muscle or muscle to bone.

Dense irregular connective tissue is usually found as sheets. It contains randomly arranged collagen fibres giving it great strength as well as flexibility. This suits its role as the major part of the dermal layer of the skin. It also forms the strong, protective membrane wrapping cartilage, bones, joints, kidneys, liver, testes, lymph nodes and heart valves as well as the dura mater, the membrane that protects the brain and spinal cord (Tortora & Grabowski 1996, p. 109).

Fascia is the general name for the dense, irregular connective tissue layer surrounding muscles, bones and joints. It provides support and protection and gives structure to the body. Ida Rolf says of it, ‘fascia forms an intricate web coextensive with the body, central to the body, central to its well-being, central to its performance. Clearly fascial tone, fascial span, is a basic contributing factor to bodily well-being’ (Rolf 1989, p. 39).

Fascia consists of three layers: the superficial, the deep and the subserous. The superficial fascia is located directly under the subcutis of the skin. Its functions include the storage of fat and water and it provides passageways for nerves and blood vessels. In some areas of the body, it also houses a layer of skeletal muscle, allowing for movement of the skin.

The deep fascia lies beneath the superficial fascia. It aids muscle movement and, like the superficial fascia, provides passageways for nerves and blood vessels. In some areas of the body, it also provides an attachment site for muscles and acts as a cushioning layer between them.

The subserous fascia lies between the deep fascia and the membranes lining the cavities of the body. There is a potential space between it and the deep fascia that allows for flexibility and movement of the internal organs.

Myofascia extends from the deep fascia as a thin, elastic and dynamic membrane that covers, supports and separates the skeletal muscles. As endomysium it wraps and separates each muscle fibre. As perimysium it wraps each bundle of muscle fibres into a fascicle. As epimysium it wraps each muscle itself. These three varieties of myofascia each contribute collagen fibres to the connective tissue that attaches the muscle either to bone or to other muscles. These attachments may also extend beyond the muscle as tendon or aponeurosis (Tortora & Grabowski 1996, pp. 240–241).

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