CHAPTER 2

QI, MOVEMENT, AND HEALTH

As acupuncturists and practitioners of Oriental manipulation therapies for over twenty-five years, our introduction to patient evaluation and treatment has been through the perspective of Oriental medicine. Unlike modern Western medical arts, Oriental medicine was developed at a time when it had neither the advantage of extensive knowledge regarding anatomy and physiology nor the burden of understanding underlying physiological mechanisms of disease and treatment. The result was a very practical medicine, refined by millennia of experience.

Years of study of Eastern philosophies have shown us how, in the ancient Orient, metaphor was used to describe the nature of the world. One of the great mistakes made by modern students of Oriental medicine and body therapies, both in the East and West, is thinking that Oriental medical principles are actual descriptors of a physical reality rather than ideas or metaphors that serve to guide treatment. In keeping with the most ancient roots of Oriental medicine, this book addresses what we, as practitioners, do behaviorally to effect change in the muscles and fascia, and to ultimately reduce or terminate the experience of pain for our patients. Thus, in part this manual is designed to address the following questions: How do we approach a patient who is experiencing pain? What do we look for? Where do we touch? How do we untie the myofascial Gordian knot that is so often the physical reality of one who has been in pain for an extended period of time? These are the questions that guide our approach to our patients.

Perhaps no area of Western medicine so parallels the pragmatic Eastern approach as the treatment of myofascial pain. Dr. Janet Travell, the brilliant physician who made a life’s work of studying trigger points and the myofascia, was an extremely pragmatic and behaviorally oriented individual. Her careful documentation of myofascial pain patterns and associated causes and perpetuating factors represents decades of clinical experience. Without any knowledge of Oriental medicine she discovered meridian therapy in Western terms. This was a monumental feat of careful clinical observation, integrating the diverse experiences of patients in pain. Her work with Dr. David Simons, a landmark in the field, is ultimately decidedly behavioral and pragmatic in approach.¹

On several occasions between 1991 and 1994 we had the remarkable experience of observing Dr. Travell at work; it was the opportunity to observe a master practitioner. Watching Dr. Travell treat patients was a joy. She understood what to do, where to touch, how to move, how to feel; and she ultimately helped her patients. She understood what was of benefit and hypothesized about why. The concepts and approaches that she utilized simply work; they help change lives and alleviate suffering. In our work with Dr. Travell it became clear to us that the field of pain management is one in which practices that benefit patients are shared between Eastern and Western approaches. It is curious to note, however, that practitioners of both of these systems don’t really understand the nature of that which unites them.

During our first fifteen years in practice we studied and utilized both traditional Chinese medicine (TCM) and an ancient style of acupuncture that actually represents a group of methods collectively known as meridian acupuncture. Traditional Chinese medicine, primarily based upon an internal medical model, considers the practices of acupuncture and herbology to be inseparable. TCM emphasizes assessment through the evaluation of signs and symptoms, including the evaluation of pulse and tongue characteristics, in an effort to diagnose some internal condition.²

All acupuncturists study the meridians. However, unlike the practitioner of TCM, the practitioner of meridian acupuncture utilizes needles first and foremost to open constrictions along the pathways of the meridians. He generally relies on palpation skills to locate constriction, sets needles related to areas of constriction, and often identifies distal constrictions related to local ones. In practice, however, we found that the use of acupuncture techniques, both those outlined in TCM as well as those employed by meridian acupuncturists, were limited in their ability to aid patients suffering from either chronic or acute myofascial pain, regardless of the location of that pain. Neither the TCM treatments utilizing the internal medical model nor the treatments utilizing techniques based on meridian acupuncture were sufficient to completely alleviate that pain. Something was missing. When we encountered the work of Dr. Janet Travell we discovered what was clearly needed. Since that first introduction we began evolving a practice that utilizes both the Eastern perspective of meridian therapeutics and the myofascial perspective outlined so extensively by Travell and Simons. In developing this practice we perceived and treated our patients through two “lenses,” and so began to see the real similarities between the patterns of pain resultant from myofascial trigger points as catalogued by Travell and the pathways of the meridians as they lie along the limbs and torso.³ By directly treating the source of the pain—the specific muscle harboring trigger points as identified through palpation—and then supporting that with treatment along related meridian pathways, we found that we were able to greatly alter our patients’ conditions, allowing them far greater freedom from pain. Employing this integration of Eastern and Western perspectives, the work we have developed is called myofascial meridian therapy. This merging of Eastern and Western points of view is useful: simply put, it works.

In observing the fields of acupuncture and Oriental medicine over the past decade, we have seen unprecedented growth in the numbers of people who wish to learn about its principles and practices. These numbers include physicians, dentists, chiropractors, osteopaths, physical therapists, and massage practitioners who are seeking out additional, and perhaps more effective, means of treating their patients; as well as people who have personally benefited from acupuncture and who wish to change their career, perhaps to help others as they have been helped. In so many (if not all) cases, these people are interested in caring for the whole person, no longer satisfied with the focused specialization within the medical community in which a patient is defined by his presenting condition. Health care practitioners of all types are embracing a newfound, but old-fashioned, respect for the individual, holding a view in which a physical condition represents dysfunction within the whole and is considered within the context of its effects on the whole.

Myofascial meridian therapy is a form of treatment in which addressing a patient’s pain is done within the context of treating the whole person. Because myofascial meridian therapy utilizes aspects of both Eastern and Western approaches to patient care, it can provide the basis of treatment—the meeting point—for those whose orientation lies in either Oriental medicine or allopathic medicine. Those whose background is Oriental medicine can broaden their approach to patient care and the treatment of pain by delving more deeply into the study of the myofascia, increasing their understanding of the musculature and the fascia and the complex role those play in human health and well-being. Just so, those whose background is in the Western perspectives of health care can broaden their perspective of the human experience by embracing some basic concepts utilized in the practice of Oriental medicine.

One of the most basic of those Oriental medicine concepts is that of qi, popularly conceived of as “life force.” It is in the consideration of qi, redefined in Western terms, that we once again find a meeting place for both the Eastern and Western perspectives. However, in order for qi to be considered as a unifying principle for guiding treatment, its definition must be expanded and refined.

It is important to preface this discussion with the statement that Chinese philosophical concepts are extremely fluid: ideas change relative to their context and application. The point here is to provide a way in which the concept of qi may be particularly useful to the practitioner of myofascial meridian therapy, regardless of orientation. Hopefully the result will simultaneously elevate qi to a more complex concept while making its application in meridian therapies, and pain management specifically, far more pragmatic.

Perhaps the most intriguing and powerful aspect of Oriental medicine is its direct connection to universal principles. The Taoist application of cosmology to human health—the view of the human being as a part of a much broader universal system—is foundational to understanding the ancient Oriental approach to health care. Seeing the human being as a microsystem that is part of a macrosystem is intrinsic to understanding how to treat health problems. Indeed, the principles used by acupuncturists are not so much acupuncture principles as they are universal tenets applied to acupuncture.

Let us consider universal principles as described in Taoist cosmologies. Taoist cosmology begins with the idea of Wu Qi, sometimes described as Emptiness, the Void, or Nothingness. This is the universe a priori to existence. Think of what an extraordinary idea this is: it is the concept of some “thing” before anything exists. This is the idea of the unmanifest God, the Absolute, Unity, or Nirguna Brahman (in Hinduism), which refers to God without attributes. It is perhaps more accurately discussed as a dynamic that is in perfect balance. When there is a change in this delicate balance, some movement occurs. Movement is a relative concept—it only exists in relation to something else; therefore, movement implies duality. This is the beginning of existence, the Tai Qi, the Yin/ Yang, a concept similar to the big bang theory of creation. And so we have the Wu Qi, movement as potential only, giving rise to the Tai Qi, movement made manifest in the form of duality.

Now consider the idea that, following this first movement, everything that subsequently comes into existence can only function under this universal principle of duality, Yin/Yang. All that exists is a function of, and therefore reflects, this first principle, this first movement, the beginning of duality. Existence can be viewed as a continuum of energy, starting with the highest energetic level of the Tai Qi and moving outward, slowing down, and becoming more material. The Tai Qi pervades everything, including its ultimate manifestation as the “ten thousand things,” the Chinese euphemism for the material world.

Applying this idea to our work, we can therefore see that the concept of qi that is particularly useful to myofascial meridian therapists is this notion of impetus toward movement. Organic life exists as a particular vibration, or level of movement, on this universal continuum of energy; health is intimately connected with this movement. We are not referring here to the movement of qi but rather to movement itself, with qi being the source of such movement. Qi as impetus toward movement may be equated, then, with the Tao, the “way of all things.” As the Tao te Ching begins: “The Tao that can be named is not the eternal Tao.”⁴ If we try to name qi we have begun to bring the concept down and, in some sense, make it more “material.”

Viewed from this perspective, qi is a metaphysical—rather than a physical—concept; it thus cannot be understood in physical terms or through customary language. Because language is generally developed in the context of physical reality, we are in a linguistic quandry when we enter the world of metaconcepts. Considered in this way, however, qi cannot be described or held to a specific definition, though it can be alluded to through metaphor, parable, or similar constructs. Unfortunately it is the history of such ideas to be reduced, brought down to the way we, as human beings, easily understand, and made into something physical rather than metaphysical. While the idea that qi is some sort of invisible “stuff” flowing through the meridians can have its uses, it should be understood that this is a materialized concept of qi.

The fundamental characteristic of energy is movement, and the quality and nature of this movement defines the continuum of energy and matter. This continuum can be observed by looking at water, that remarkable substance that is both the basis and the reflection of life. In its most energetic state water exists as steam; in its least energetic and most material state it exists as ice. The metaphors of qi applied in a number of Oriental medical contexts—such as immune, muscular, and soft-tissue functions (wei qi); nutritive functions (ku qi); or genetic predispositions (yuan qi)—are all about harmonious movement: life connected to balanced activity; open, flowing movement. It is no wonder that qi is often connected to water metaphors (sea, river, spring, and so forth).

Conceptualizing qi in terms of movement rather than substance marries it into a philosophy of life and health held by all medical systems. Consider the words of reknowned osteopath and educator John McMillan Mennel in his discussion of the musculoskeletal system:

The musculoskeletal system has two equally important functions. The first is movement, and the second is support (or containment). The most important part of its movement function is perhaps that its absence is associated with death (emphasis ours). As movement becomes more and more impaired, the functions of the systems that the musculoskeletal system is designed to contain cannot be maintained, and these other structures themselves become dysfunctional. This in itself contributes to and may hasten the final loss of function of the contained systems.⁵

Health requires movement; when movement ceases, life ceases. When the human organic system is functioning properly, things move well and in a coordinated, homeodynamic manner. Blood moves in a steady tidal flow, connected to such diverse and changing conditions as muscular contraction and release, digestion, and mentation. Nerves signal through electrochemical flows in a coordinated system of activity; endocrine glands provide well-timed secretions related to the requirements of the whole. Muscles, fascia, tendons, and ligaments direct lubricated joints through complex movements. The respiratory system moves gases in coordinated quantities, while cilia and mucus provide the first line of defense against pathogens. Digestive enzymes are secreted, and harmonious peristaltic action allows for the transformation of materials into energy. Lymph is pumped and circulated as the body moves. All of this is taking place in an interactive symphony that we call life, from the cellular level to the cosmological level.

A central principle of tai qi quan holds that the universe is this all-pervasive movement, or activity, and it is that movement which we experience as our human bodies. Human beings are loci of this activity; the more a person is capable of relaxing, both physically and psychologically, the more he becomes a locus through which more of this movement can take place. The more constricted a person is (both physically and psychologically—which are, in fact, interdependent), the more movement is impeded. Such impediments produce consequences that affect health and well-being. Consider the words of a great taijiquan master, Dr. Jwing-Ming Yang, as he discusses the fact that many qigong practitioners mistakenly take the feeling of heat that they experience as qi:

Actually, warmth is an indication of the existence of Qi, but it is not Qi itself. This is just like electricity in a wire. Without a meter, you cannot tell there is an electric current in a wire unless you sense some phenomenon such as heat or magnetic force. Neither heat nor magnetic force is electric current; rather they are indications of the existence of this current. In the same way, you cannot feel Qi directly, but can sense the presence of Qi from the symptoms of your body’s reaction to it, such as warmth or tingling [emphasis ours].⁶

Once again we see the struggle to deal with an experience that is both physical and metaphysical. The associated warmth to which Dr. Yang refers is connected to increased circulation of blood and lymph and increased nerve conduction that occur as a result of the release that takes place during the practice of tai qi quan; that is, to the effects of improved movement.

Giovanni Maciocia, author of The Foundations of Chinese Medicine, correctly identifies the enormous difficulty in defining qi, which he describes as something that is material and immaterial at the same time. One interpretation he offers is “moving power.”⁷ He, like many others who have closely examined the idea, decides to leave the term qi untranslated.

A similar problem of definition occurs when we consider other metaconcepts, such as the idea of higher dimensions of space. Concepts such as a fourth- or fifth-dimensional space can be represented mathematically or can be discussed in metaphor (see Abbott’s Flatland or Bragdon’s A Primer of Higher Space⁸), but they cannot be imaged or described. Try to picture a direction perpendicular to all three spatial dimensions (that is, image the fourth dimension), and you confront the difficulty. Qi, like other metaconcepts, is in the same category of definitional complexity. However, once we relate the concept of qi to movement, we hold a rather elegant idea that bridges Eastern and Western views of life and health.

Myofascial meridian therapy operates from this simple unifying construct. Movement, harmonious activity, unimpeded flow of bodily fluids, unimpaired nerve transmission, and the free range of motion of muscles and joints are all connected to health and life: this movement can be collectively described as qi manifesting. Constriction, impingement, entrapment, ischemia, and excessive tightness, all associated with dysfunction and pain, can thus be considered in terms of some reduction in movement. Be it of an organ, muscle, fluid, or electrochemical impulse, with pathology there is some interference with flow, with movement, with qi. Death is the result of its ultimate withdrawal.

Given the functional definition of qi as movement, myofascial meridian therapy is concerned not with “moving” some substance called qi, but rather with removing or minimizing disruptions to movement itself. Our inclination is to trust the inherent wisdom of the body; we endeavor to provide an optimum environment in which the body can heal itself. Therefore it is the role of the myofascial meridian therapist to release constrictions and promote flow. While the fundamental approach is myofascial, the broad concepts and patterns of the meridian system are also embraced. The successful release of myofascial constriction comes from applying knowledge and understanding of these meridian patterns in conjunction with the ability to palpate and release constrictions within the muscular and fascial systems.

Diagnosis, therefore, is intimately associated with treatment, since the diagnosis is neither of internal diseases or patterns of disharmony as theorized from an Eastern perspective nor the expression of Western medical pathologies. Rather, to diagnose from a myofascial meridian perspective the practitioner palpates the body to locate patterns of constriction and then uses acupuncture or manual techniques to release these constrictions. Principles of Oriental medicine guide the direction of care.

Myofascial meridian therapy is concerned with constriction not only in the muscles but also in the fascia. The fascia is unique in human physiology, existing as a single continuous sheath that extends from the head to the toes, encasing every organ, muscle, and muscle fiber as it winds through the body. Consider the definition of fascia as proposed by Dr. William Henry Hollinshead:

When the normal connective tissues of the body are arranged in the form of enveloping sheaths, they are usually known as fasciae (fascia means a bandage or band, and thus connotes a layer binding together other structures). Thus, the subcutaneous tissue or tela subcutanea is frequently called the superficial fascia. Numerous examples of well developed, tough, deep fasciae occur, especially in the limbs, where fascia forms heavy membranes surrounding the entire limb. Individual muscles are also surrounded by thin fascia called perimysium and are separated from each other by looser connective tissue. . . . From the fascia surrounding a muscle, connective tissue septa pass into the muscle and subdivide it into bundles; these septa, in turn, divide until delicate connective tissue fibers surround each muscle fiber within a muscle.⁹

The superficial fascia covers the entire body subcutaneously. It is composed of two layers: the outer layer contains fat; the inner layer is thin and elastic. Lying between the layers of superficial fascia are the arteries, veins, lymphatics, mammary glands, and facial muscles. The deep fascia lines the body wall and the extremities; it holds the muscles together and separates them into functional groups. Deep fascia allows for the movement of muscles. It assists in support and stabilization, aiding in the maintenance of balance. It carries nerves and blood vessels, fills spaces between the muscles, and sometimes provides attachments for muscles. Fascia facilitates circulation of the lymphatic and venous systems. Differentiation of the deep fascia begins with the envelopment of the individual muscle by the epimysium, the external sheath of connective tissue. The epimysium further differentiates into the perimysium, the fascia that wraps bundles of muscle fibers (fascicles), and this further differentiates into the endomysium, which penetrates the interior of each fascicle to enwrap each muscle cell. This system is continuous with the structure of tendons that attach muscle to other structures.

Doctor of osteopathy John Upledger describes the fascia as “a maze which allows travel from any one place in the body to any other place without ever leaving the fascia.”¹⁰ Fascia’s pervasive, continuous nature may explain many of the distal effects of acupuncture or other meridian-based forms of bodywork. Paula Scariati, D.O., observes that changes in the fascia due to age or trauma “set off chain reactions that may compromise the vasculature, nervous system and muscle as well as change the movement of body fluids through the fascia.”¹¹ It logically follows, then, that if constriction of fascia can produce dys-function, the release of constriction within the fascia can lead to a return of function.

There has been much speculation on the functional mechanism of acupuncture; much has been made about the activation of betaendorphins, a powerful pain supressant, resulting from acupuncture treatment. Actually, the experience of any systematic minor pain will give rise to the inhibitory response of endorphins—pinching the skin anywhere will produce endorphins. It is conceivable that endorphin activity is a pleasant secondary effect of acupuncture treatment and is unrelated to the mechanism that underlies its more powerful effects.

It is more probable that the answers to the question of how acupuncture works lie in the study of the little understood and complex mechanisms that govern the fascia, muscles, skin, and adipose tissue of the body. The fact that dramatic releases of muscular constriction can be affected by surface needling is well documented by Travell and Simons on a muscle-by-muscle basis. Such release is also capable of exerting powerful visceral effects. The probability of understanding acupuncture lies in the reality of what is actually being done to the patient: a needle is being inserted into tissue, and such insertions and manipulations have extensive local and distal effects.

Ultimately we should consider the simple fact that, in the realm of acupuncture treatment and bodywork, practitioners insert needles or apply manual-therapy techniques to skin, adipose tissue, fascia, and muscle. Significant effects are exerted by such treatment. Practitioners can say they are manipulating qi by treating points on the meridians, but they cannot deny that they are also manipulating skin, adipose tissue, fascia, and muscle.

What is the difference? Why make an issue about qi? Consider this perspective: Rather than moving some invisible, untouchable “substance” (that is, qi), treatment tissue opens constrictions and promotes the movement of all bodily functions and activities. The point is to focus our attention, and therefore of the skin, muscle, fascia, and adipose to focus our skills, on what we definitely can and do affect: physical structures, such as the muscles and fascia. Just as qi cannot be experienced directly, in a model where qi cannot be manipulated directly the increase in movement, or flow, occurs as a consequence of releasing myofascial constrictions. The easing of myofascial restriction therefore results in improved circulation, lymphatic drainage, and nerve conduction. Additional results may include improved organ function (such as lung tidal volume, digestive activity, or uterine function), depending upon the location of release. Such focus on myofascial constriction, instead of on qi, allows for a shift of perception to a readily identified source of pain or pathology, which, when released, results in improvement of the condition.

These basic tenets of such a physical medicine underlie treatment effects that go beyond pain management. This is best understood by considering the somatovisceral and viscerosomatic reflex connections—that is, the relationships between the soma (the musculature) and the viscera (the organs), a phenomenon recognized by the fields of osteopathy and chiropractic and utilized in their diagnoses and treatments. The somatovisceral reflex connection is defined as muscular disruptions that alter the ability of related visceral organs to function properly. These are situations in which myofascial constriction directly results in visceral symptoms such as tachycardia, angina pectoris, diarrhea, vomiting, food intolerance, and dysmenorrhea. (The phenomenon of somatovisceral effects is also discussed in detail by Travell and Simons.) Conversely, the viscerosomatic reflex connection is defined as dysfunction of the myofascia resulting from disease or dysfunction of a related visceral organ. When applying the basic principle of myofascial meridian therapy, the identification and release of patterns of myofascial constriction includes but is not limited to the release of trigger points in individual muscles. Myofascial meridian therapy involves the release of a region, a quadrant, and ultimately the complete body. This leads to freedom of movement throughout the organism on multiple levels, superficially as well as deeply, directly or indirectly affecting the viscera and resulting in improved health.

Clearly this physical approach to diagnosis and treatment differs from the traditional Chinese medical model in that the prominent use of herbs parallels the use of pharmaceuticals in Western conventional medicine; neither has proven to be markedly effective in treating chronic and acute myofascial pain. This failure lies in the inability of such medications, Eastern or Western, to focus on the central issue of these patterns of pain. Acupuncture and associated bodywork therapies, when utilized as myofascial meridian therapies, do in fact focus on the central issues of movement and constriction, and as a result have demonstrated that their greatest power lies in their specifically physical approach.

Many within the conventional medical establishment have noted the often remarkable effects of acupuncture and bodywork therapies on patients who suffer from chronic pain. Herein lies the source of increased communication among practitioners. Medical doctors are beginning to recognize the difficulties in the medical/surgical approach to treatment of chronic pain and are viewing, with greater respect, meridian acupuncture and bodywork therapies as effective physical treatment methodologies.

Meridian therapies are based upon the palpatory experience. The exacting nature of myofascial meridian therapy requires enormous emphasis on palpation, with the therapist evolving great skill in identifying myofascial constrictions. The charts of meridians and acupuncture points are used as general maps of areas where specific loci may be identified. Locating acupuncture points is thereby not a function of measurement but rather of palpation, connected to the skill of the practitioner’s hands. The points are moving realities that shift on the body landscape. Everything about our bodies is dynamic, moving, changing; in the same way, acupuncture points exist as dynamic rather than static entities. The focus is therefore on constriction, on the real and present reality—treatment decisions are based not on cerebral or intellectual construction but on the practitioner’s palpatory experience. Because a fundamental component in the evolution of palpation skill is the ability to visualize and understand what you are feeling with your hands, a working knowledge of the meridian system is necessary and a careful study of anatomical structure, with an emphasis on myology, becomes crucial.

In the practice of myofascial meridian therapy, assessment and treatment happen differently than they do within the Western medical model. Treatment within the conventional medical model focuses on the administration of a drug to effect a change in the symptoms experienced by the patient, without regard for myofascial constrictions that may accompany the symptoms. For example, it is not uncommon for a patient who is suffering with a digestive disorder, such as esophageal reflux, irritable bowel syndrome, or chronic constipation, to be prescribed a medication without attention being given to concurrent myofascial constrictions. This is not to suggest that medications are unnecessary; however, it is becoming increasingly clear that medications are often overutilized to the exclusion of other treatment methodologies from which the patient may also benefit. Using the myofascial meridian therapy model, diagnosis follows not only from the description of the pathology as experienced by the patient, but also from the practitioner identifying associated myofascial constrictions. Treatment is focused on releasing those myofascial constrictions through needling or through manual techniques.

Successful treatment of a patient who presents with irritable bowel syndrome will thus involve the therapist releasing areas of muscle and fascia that commonly relate to such bowel symptoms, and may in fact be reflections of the bowel symptoms—these areas include the rectus abdominis and external obliques. Utilizing principles rooted in the ancient Oriental texts, treatment might also include needling or massaging areas of the Hand Tai Yang Small Intestine and Hand Yang Ming Colon meridians, which pass along the posterior aspect of the shoulder and thus coincide with the infraspinatus and posterior deltoid. Palpation of this region may identify constrictions within local musculature, which would then be treated with needling or manual techniques. This approach to irritable bowel syndrome might therefore also result in improved movement of the shoulder and arm.

Additionally, in assessing the patient the therapist might note a “tautness” or “fullness” associated with the tissues overlying the tibialis anterior muscle distal to the knee, which coincides with the pathway of the Foot Yang Ming Stomach region that is associated with its Hand Yang Ming Colon pair. Treatment by needling or manual techniques to these areas will result in reduction of fullness or a softening of the tautness. The result of this treatment will likely be a deeper, more complete release of tissues leading to an improvement in the patient’s overall condition. The therapist is guided by such relationships.

Myofascial meridian therapy embraces the concept of qi in a manner that focuses on a clear and present palpable reality: If Qi is life force and life force is movement, then Qi is movement. This model of qi and how it relates to health has a number of distinct advantages over an herbalized acupuncture or bodywork that first and foremost regards pathology from an internal medical model. First, this model of qi is clearly understandable to both patients and other health care practitioners. The focus of treatment is on myofascial release by extremely effective means; and while the mechanism may not be fully comprehended, the concepts of somatovisceral effects and referred pain patterns can be readily understood, particularly once the pathways of the pain patterns are pointed out on pain pattern charts. The effects of this approach are also easily explained, since the rapid myofascial release produced by a needle contacting the fascia or trigger points is well documented by Travell and others, as are the effects of ischemic pressure. Through experience in treatment the effects are also clearly observable, to patient and practitioner alike.

It is also important to recognize that this model falls well within a complementary medical model rather than an alternative medical approach. By and large myofascial meridian therapy is complementary to Western medicine, which does not focus on myofascial problems and associated release of constrictions; often the medical approaches to myofascial constriction, which include medications or surgical intervention, produce unsatisfactory results. Herbal medicine, like Western medicine, is another form of internal medicine. It is alternative to the conventional Western medical model, rather than complementary.

Certainly regarding qi as movement is not the only way to conceive of qi within the framework of Oriental medicine. The fluidity and relativity of the philosophical constructs that underlie Oriental medicine require that ideas such as this one be examined in relation to their applications. Acupuncture and associated bodywork methods have enormous power to heal in a manner that is distinct and separate from internal medicine applications—this is observed repeatedly in a clinical setting. This power can be actualized within an approach that looks at qi in a way that is useful and practical.

Models are ideas that help to frame reality in a complex world, and thereby allow some effective action to be taken. They are not the Truth, but a truth that guides activity.