The San Jiao Organ System Found Within
The Extracellular Matrix and Collagen Fibers of Connective Tissue
By
Jamie L. Davis, MA, MSA, LAc.
Table of Contents
Introduction
3
Section 1:
The Current Understanding of the San Jiao
5
Exploring the Name of the San Jiao
5
Exploring the Location of the San Jiao: Channel, Organ or Both?
8
The Three Burners
11
Upper Burner
13
Middle Burner
13
Lower Burner
14
Exploring the Functions of the San Jiao
15
Exploring the Function of Immunity
16
Exploring the Function of Water Metabolism
18
Exploring the San Jiao Pattern Identification
19
Summary
21
Section 2:
Fascia, Connective Tissue, & Redefining the San Jiao
22
An Explanation of the Environments
24
Connective Tissue
25
Dense Connective Tissue
26
Loose Areolar Connective Tissue
28
The Lymphatic System
29
Copyright Jamie L. Davis 1
Going Deeper than the Fascia: Looking at the San Jiao Within the Collagen Fibers and the
Extracellular Matrix
31
The Extracellular Matrix
32
Collagen Fibers and Fibroblasts
33
Exploring the Mechanisms of Acupuncture
37
Section 3:
The Machinery of Life Within the Cell
45
The Beginning of Life
46
Molecular Machinery
48
Tensegrity at the Cellular Level
48
Section 4:
Final Discussion and Conclusion
53
Clinical Relevance
53
References
56
Tables & Figures:
Fig. 1: The San Jiao Channel
11
Table 1: The Lymphatic System
30
Fig. 2: Myofascial Planes and Acupuncture Channels
38
Table 2: Organelles and their Functions
47
Copyright Jamie L. Davis 2
Introduction:
The history of Traditional Chinese medicine (TCM) is a long one, with roots that are both
extensive and deep. With a history this vast and ancient, there are bound to be inconsistencies,
misunderstandings, and even controversy. The concept of the San Jiao, which is also known as
the Triple Burner or Triple Energizer, is one such controversy. From the meaning of its name, to
its location, to its very physical existence, much of the written texts that discuss the San Jiao
have been inconsistent and even contradictory.1 There is little that is universally clear about this
unique and clinically-effective organ, making the San Jiao one of the most debated topics in
TCM.2
While the historical record may be inconsistent, it does provide a plethora of vital
information as to the function and purpose of the San Jiao within a clinical context. By diving
into the biomedical understanding of anatomy and weaving it into what is already known of the
San Jiao, from both historical and modern interpretations, an opportunity presents itself to both
understand a heretofore controversial topic, as well as to solidify acupuncture within the
integrative medicine model. This paper will explore the meaning of the San Jiao, its functions,
and the possibility of its anatomical equivalent being found within the connective tissue at the
cellular level,1,2,3 as well as the impact that these theories have on understanding the mechanistic
effectiveness of acupuncture.
Using the information available from historical and modern TCM and biomedical
constructs, the San Jiao emerges as a distinct and clinically-relevant organ in that it is a specific
entity of defined tissue types. Furthermore, the San Jiao is located systemically throughout the
body and can be anatomically recognized as the collagen fibers and the ground substance in the
extracellular matrix of connective tissue. As such, the functions of the San Jiao include water
Copyright Jamie L. Davis 3
metabolism, homeostasis, immunity, and cellular communication. To support the San Jiao within
the extracellular matrix hypothesis, this paper will explore in depth three distinct aspects: 1) the
current understanding of the San Jiao, from past to present; 2) a discussion of the fascia and
connective tissue, as well as the theories regarding the mechanism of acupuncture lying within
the fascia; and 3) exploring the cell as the mechanism of life, and how cellular communication
supports the mechanism and functions of the San Jiao. In the final section there will be a
discussion of how these lines of discovery can be woven back to the concept of the San Jiao
within TCM theory, and how this can transform clinical practice.
We may never know exactly what was meant by the ancients when they described the
San Jiao, but there is much that can be learned from this concept, in both historical and modern
language, that can be transformed into a deep well of modern medical concepts applicable in
today’s clinical practice. When concepts like the San Jiao are taken out of the ethereal and down
to their microscopic constituents, a real-world model appears that allows for better research and
better applications of TCM theory into biomedical disease models. As we grow our depth of
knowledge within the microscopic level, and combine it with the many years of wisdom
achieved in TCM theory, we can begin to explore a mechanism for combatting chronic illness at
the cellular level through the San Jiao. This is but one of the many possibilities available to
medicine when the San Jiao is transformed into modern anatomical and microscopic
applications.
Copyright Jamie L. Davis 4
Section 1:
The Current Understanding of the San Jiao
Introduction:
Before diving into an explanation of a new paradigm for the San Jiao, there needs to be a
discussion on what it is now and how it came to be known that way. There are several different
ways of looking at the San Jiao: the San Jiao organ; the channel system; the three burners (upper,
middle, and lower); and, finally, the San Jiao Pattern differentiation. These are all pieces to a
complicated puzzle and are often used interchangeably despite their distinct differences. In
addition, the English translations of the name itself have several variations, all of which could be
interpreted to mean something different, thereby negating the insight inherent in the translations.
It is perhaps this variability in the English name that has led to most of the confusion
surrounding the organ system. So let us unpack what is currently known and understood about
the San Jiao from a TCM perspective.
Exploring the Name of the San Jiao:
The San Jiao has many translations of its name, thus adding to its mystique and confusion
in the English interpretations of its functions. All organ systems in TCM theory involve
functions that are more complex than the physical, anatomical organ; yet there seems to be less
confusion about the other organs of TCM theory in Western practice. For example, when the
Heart is talked about in the classics, we are familiar with the physical heart, so despite the fact
that all organs in the TCM system have much more depth than their anatomical equivalent, there
is more agreement upon the translation of the organ location and meaning.
Copyright Jamie L. Davis 5
The ideograms that originated the name of San Jiao, on the other hand, have multiple
interpretations. When basic anatomy ran out of identifiable organs that fit the description, we
were at a loss as to which specific anatomical part of the body the ancients were referring.
Depending on which definition of the ideogram you go with, the name can arguably have more
to do with its function and less to do with its physical location or vice versa. The question
becomes did the name provided in the classics describe an action, or was it describing a physical
organ? Already there is an opening for confusion and debate among modern practitioners, as not
every acupuncturist agrees with the answer to this question.
The name San Jiao has been translated to Triple Warmer, Triple Energizer, Triple Burner,
and Triple Heater, to name a few. For simplicity and clarity, this paper has chosen to speak of it
exclusively as the San Jiao. It should be understood, however, that the fact that it has so many
names lends to a minefield of miscommunication. Typically in medical systems you do not see
multiple names for one organ or function as this leads to a language barrier in the practice of
medicine internationally. The World Health Organization (WHO) recognized the inherent
difficulties of multiple translations, and in their 2010 Meeting on the International Classification
of Traditional Medicine, in Tokyo, Japan, it was suggested that the word be translated strictly as
“Sanjiao” to avoid further confusion.4
The original character for Jiao 焦 shows a bird being roasted above a fire.5,6 It is typically
translated as burned, worried, or agitated.2 This gives the sense of something being scorched or
burned; therefore, the word “burner” became one of the translations.2 Kendall sees the ideogram
of the bird over a flame as meaning the inner membranes, or omenta, within the body, because in
ancient times when a bird was butchered, the membranes were removed and became hardened
and brittle by the sun, and would be translated as “scorched.”5 Larre and de la Valle see more in
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this character and add that it is also the character for bananas attached at the center, meaning
attachment, joining, or a cord within a net.6
The character San 三, three lines, has not been under contention as it clearly means three.
In their work on channel theory, Wang Ju-Yi and Jason Robertson point out that the aspect of
three may actually be the most important component of describing the meaning of the San Jiao,
and it is the most overlooked by practitioners.2 No other organ that is described in the classics
has a number before its name, so the inclusion of the number three should be considered vital to
understanding the nature of the San Jiao. Wang goes further to say that “burner” should actually
be thought of as “environment,” and, therefore, the San Jiao should be seen as consisting of three
different environments within the abdominal, pelvic, and thoracic regions.2
It is the hypothesis of this author that we do not choose one definition, but instead accept
them all in order to provide a much bigger picture of the meaning behind the name. “Three” or
“Triple” is vitally important as it gives us the clue that the organ itself is not in situ to one
physical location, but actually encompasses a wider range throughout the body. The ancients saw
the number three to represent the heaven, the earth, and man; i.e. it encompasses all. This clues
us into thinking broader—what do we know of anatomy that traverses throughout the entire
body?
If we look at the word Jiao 焦 as meaning all of the proposed translations, then we see
scorched, burned, agitated, connected, and cord as the translated meanings. This is very telling
about the nature of the San Jiao: here is an organ that stretches throughout the body like a cord, is
connected throughout, and has the nature of heat and agitation. Clearly a lot of thought was put
into naming the organ as its name encompasses its location, function, and nature.
Copyright Jamie L. Davis 7
Zhang Jiebin in the 17th century explained, “the triple heater, its upper limit and its extreme point
below, make it similar to the six reunions or junctions, liu he, of the universe, and there is
nothing that it does not envelop or surround.”6 From this explanation, and the combination of all
the translations, the name San Jiao implies an entity that envelops the entire body, is connected
throughout, and provides three distinct environments. This creates one possible answer to the
name: that the San Jiao is found within the connective tissue which wraps, binds, and connects
the physical and anatomical frame. Section 2 of this paper will explore that possibility in more
depth.
Exploring the Location of the San Jiao: Channel, Organ, or Both?
How is the triple burner supplied and what does it generate? Where does it begin and end? At
which places might one treat the triple burner? Is it even possible to know these things?—
Chapter 31, Nan Jing.2
The Organ:
The San Jiao is described throughout ancient texts as one of the six Fu organs, meaning
an organ that does not store, but instead is hollow, and acts in transmission and transportation of
fluids.7 Zhang Jiebin stated, “The triple heater, although it is the Fu of all drainage and irrigation
in the middle, is also that which gathers together and protects all the yang.”6 Chapter 11 of the Su
Wen lists the Stomach, Large Intestine, Small Intestine, Bladder, and the San Jiao as the five Fu
“produced by the qi of Heaven, and the qi is in the image of Heaven and thus diffuses, but does
not keep or store.”6 This begs the question that if the San Jiao was not seen to be an actual
tangible organ, would they have named it a Fu in the same category of other physical Fu organs?
The answer to this is under debate among acupuncturists, mostly due to the statement in chapters
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25 and 38 of the Nan Jing, “San Jiao has a name but no physical form.”7,8, This statement would
seem to imply that this particular Fu does not have an anatomical equivalent, once again leading
to confusion among modern practitioners about what the San Jiao is in the sense of physicality.
For some TCM practitioners the Nan Jing quote means that the San Jiao is not an organ at
all, but more of a concept or pattern;1,9 for others it means that the San Jiao actually takes the
shape of the organs that are within each cavity, therefore becoming the organs in those cavities.8
Still others believe the San Jiao is in fact the peritoneal lining encapsulating the organs1,5,10 or the
spaces between the organs called “Cou Li” or cavities.7,10 Finally, a new prevailing theory is that
this statement means that the San Jiao is within the cellular matrix of the connective tissue,
which is technically shapeless, but is infinite throughout the body.2,3,11
One theory to explain what was meant in the Nan Jing is that the ancients regarded the
San Jiao as the largest Fu organ in the body, a literal organ that was inside the body but outside
the other Zangfu, and that it had no “form” because it took the form of the surrounding organs.7
In chapter 8 of the Su Wen, which predates the Nan Jing, Qi Bo clearly lists the San Jiao among
the 12 Zangfu organs.12 It seems highly unlikely that an ethereal concept would be designated a
Fu organ title in the Su Wen if it did not adhere to what classified as a Fu, which is a hollow
organ with the function of reception and passage.12 For the purpose of this paper, we can be
certain that the San Jiao is in fact a living, functioning, single organ, despite it being classified
into three separate environments. Factoring in both seemingly contradictory concepts introduced
in the Huang Di Nei Jing and the Nan Jing would mean that the San Jiao is a literal organ while
simultaneously having no form. This leads us to the fascia as one possible explanation that fits
both criteria, and this concept will be discussed further in Section 2.
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The Channel:
There are plenty of descriptions of the channel of the San Jiao in classic texts, but some
of the texts have been corrupted throughout time, and it is unclear with which channel(s) the San
Jiao channel is paired, whether it is the Foot Taiyin, Shaoyin, or possibly both.6 The Ling Shu,
chapter 2, talks about the San Jiao accompanying the Shao Yang and Tai Yin of the foot, and that
the channel connects into the big toe; however, according to Larre, the text has been corrupted
and there is debate as to which toe the channel is rooted—if not all the toes in a more general
sense—and if the text actually meant Shao Yin.6 If the text actually referred to the Shao Yin, this
would be vital information as it would pair the San Jiao not with the Gall Bladder as it is known
today, but with the Kidney, which is more in line with the functions of water metabolism and
circulating vital energy, as well as the description in the Su Wen, chapter 8, that links the Kidney
with the San Jiao organ.13
Either way, chapter 2 of the Ling Shu discusses the San Jiao as originating in the
extremity of the ring finger and becoming rooted in the legs, with specific affinity to Weiyang
BL 39,6 the Lower He-Sea point of the San Jiao.14 This makes sense as, throughout the Nei Jing
Su Wen, the San Jiao and the Urinary Bladder often have many of the same water passageway
functions.14 In addition, BL 39 is said to “harmonize the San Jiao,” and specifically treat urinary
disorders.14 Therefore, the connection between these channels, specifically within this one point,
indicates that fluid retention and flow is specific to the function of the San Jiao, and, once again,
a connection is made between the Kidney and the San Jiao.
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Figure 1: The San Jiao Channel, from the Manual of Acupuncture 14
Nan Jing chapter 1 discusses the Pericardium channel and the San Jiao channel
simultaneously, saying that both of them—referred to as “the hand minor yang”—correspond to
“the fire, the South, and the diagram li.”15 What is interesting about this is that the Pericardium is
another example of confusion in TCM literature among modern practitioners. In addition, the
Pericardium channel has a branch that follows the radial side of the ring finger to its tip,14 which
would therefore connect with the origination of the San Jiao channel. As the upper burner (which
will be discussed below) encompasses the Heart, it may be that the San Jiao and Pericardium are
mirror organs with overlapping functions.
The Three Burners:
Typically the San Jiao is separated into three distinct locations or environments. These
locations are the upper, middle, and lower burners, and all have their own distinct functions and
Copyright Jamie L. Davis 11
environments and encapsulate different organs within them. The concept of the three burners is
explained in chapter 18 of the Lingshu:
“The upper jiao comes from the pylorus to the throat above, distributing in the chest and
reaching the armpit, and follows the branches of the taiyin as it travels. It turns to reach
yangming, ascends to the tongue, then descends the leg yangming. The middle jiao is also
together with the middle of the Stomach. It comes from the Stomach under the upper jiao. The
lower jiao separates around the intestine, water comes out from the lower jiao and permeates the
urinary bladder…the functional state of the upper jiao looks like mist, the middle jiao, soup; the
lower jiao, ditch.”7
It is generally understood that the San Jiao is divided into three sections within the
thoracic and abdominal cavities, and that the Heart and Lung reside in the upper burner, the
Spleen and Stomach reside in the middle burner, and, the Kidney, Liver, and Bladder reside in
the lower burner.7 There has often been debate, however, on which burner the Liver truly
belongs as it has functions belonging in all three, and its physical location more accurately
belongs in the section described as the middle burner.10
For several centuries many authors attempting to explain the San Jiao and the three
burners have referred to the burners as membranes or “greasy tissues” called gao, huang, or mo.1
Anatomically the abdominal cavity consists of two mesenteries, a greater and lesser omentum,
which are membranes containing large collections of fat deposits, lymph nodes, and immune
cells, and act as support walls containing the abdominal organs while simultaneously aiding in
their function.16,17 These omenta are a type of fascial tissue that separate the abdominal cavities,
with the lesser omentum covering from the liver to the lesser curvature of the stomach; and the
greater omentum covering from the stomach to the small intestine and spleen, and then merging
Copyright Jamie L. Davis 12
with the mesocolon, which is the mesentery lining covering the large intestine which connects it
to the posterior abdominal wall.16 According to Kendall, the San Jiao organ and the three burners
are these omenta as well as the pleurae,5 which are the thin, serosa layers that produce pleural
fluid and encapsulate the heart, lungs, and diaphragm.16
Upper Burner:
The Upper Burner opens outwards, spreads like the five flavours of the food essences, pervades
the skin, fills the body, moistens the skin and it is like a mist.-- Chapter 30, Ling Shu.10
Here the San Jiao encapsulates the lungs, heart and esophagus, and is anatomically found
within the pleural cavity. It is likened to “mist” in the Ling Shu, and provides an environment of
light pressure around the lungs to allow for inhalation and exhalation.2 Here in the upper burner,
the essential nutrients of food, water, and oxygen circulate as a vapor and is distributed, via the
San Jiao organ, throughout the body to warm and nourish the skin, muscles, tendons, and
bones.18 Knowing these functions, it is not hard to direct our attention to the pleurae and its
moistening and circulating functions around the lungs and heart and see the thoracic pleurae as
being the environment of the upper burner.
Middle Burner:
The Middle Burner is situated in the Stomach…it receives Qi, expels the wastes, steams the body
fluids, transforms the refined essences of food and connects upwards with the Lungs.—Chapter
18, Ling Shu10
The middle burner encapsulates the digestive organs and has the job to “receive and
decompose food and water.”2 The digestive functions of the middle burner are the same as those
Copyright Jamie L. Davis 13
of the TCM Spleen and Stomach in that it digests food and absorbs the essential nutrients into
the blood, leaving behind the “froth of bubbles” (i.e. decomposing food), as it is so eloquently
described in the Ling Shu.18 If you take the leap that the middle jiao is not the organs themselves,
but actually the connective tissue membranes wrapping these organs, i.e. the omentum,5 then it
would make sense that the functions of the San Jiao within the middle burner would mimic the
encapsulated organs as they in fact anatomically aid those very organs.
In chapter 38 of the Nei Jing Su Wen, there is a discussion that all organs can present
with a cough, and if the illness of the Zang organs is prolonged and becomes chronic, the Zang
cough will be transferred to the Fu.12 If the Fu organ cough is prolonged, it can pass to the San
Jiao within all three burners.12 “The appearance of triple burner cough: [Patients] cough and
[experience] abdominal fullness. They do not wish to eat or drink.”15 Here you can see one
symptom wrapping between two distinct systems: the pleural cavity and the abdomen. Why
would a cough that could originate from any TCM organ settle in the San Jiao and then be
associated with abdominal fullness if there were not some linking connection of communication
between the chest and abdomen affecting the interior organs? This is explained through the
connectedness of the omentum and pleural membranes as both communicate with and pull on the
thoracic and abdominal organs.
Lower Burner:
Food and drink first enter the stomach, the waste products go to the large intestine in the Lower
Burner which oozes downwards, secretes the fluids and transmits them to the bladder. –Chapter
18, Ling Shu.10
Copyright Jamie L. Davis 14
The lower burner is described as “the drainage ditch.”18,19 Anatomically it encapsulates
the bladder and intestines, and functionally it serves as the final processing center for separating
the “clear from the turbid.”2 These functions are often how we view the Small Intestine in TCM,
and it is unclear how much of this is a shared responsibility or if the Small Intestine is
conducting the actual process of separating fluids and the San Jiao is simply holding space for it
to do so. One way of looking at it would be seeing the Small Intestine as the processing plant and
the San Jiao as the motive force initiating the action.
The function of the San Jiao drawing downward is such a vital aspect to the lower burner
that any obstruction within the San Jiao leads to urinary retention, dysuria, and edema.18 Often in
patterns of urinary retention or edema, practitioners can quickly jump to a diagnosis of the
Spleen and Kidney and overlook entirely the clinical effectiveness of the San Jiao. In actuality,
however, the San Jiao is the primary distribution center of fluids, 7,8,10 specifically the function of
the lower burner in its processing of fluids for waste and excretion, and should therefore be
addressed first when treating water metabolism dysfunctions. This is why, once again, the Lower
He-Sea point of the San Jiao, Weiyang BL 39, is used for urinary disorders.14
Exploring the Functions of the San Jiao
Introduction:
The functions of the San Jiao are plentiful and interrelated to almost all other organ
systems within the TCM model. From homeostasis and hormone balance,1,11 to filtration and
water metabolism,1,7,8 to nutrient distribution and digestive catalyst,1,10 and even to being the
original source of all life,1,7,8,18 the San Jiao is involved in arguably all organ systems.
Copyright Jamie L. Davis 15
In chapter 11 the Nei Jing Su Wen describes one of the functions of the San Jiao to be the same
as the Stomach, Large Intestine, and Small Intestine in that “it drains but does not store, and is in
transmission, transformation, and transportation related in drainage.”15 In other words, the San
Jiao is a Fu organ whose purpose is to provide communication, diffusion, and filtration.2,7-9,19
Therefore the functions of the San Jiao begin with the functions of the Fu organs, which
primarily involves digestion and filtration.
Furthermore, the San Jiao is associated with the circulation of all nutrients in the body.
“The Triple Energizer is the ambassador of Yuan qi. It circulates the three kinds of qi and
distributes them to the five Zang and six Fu organs,” Sixty-sixth Question, Nan Jing.18 In TCM,
the concept of Yuan qi could be thought of as the foundation of life. Yuan qi is defined as the
original essence of the Kidneys that provides the motive force behind all circulation.10 The
Source points on each channel of the body contains this original essence, and the role of the San
Jiao is to spread the “Yuan source qi” to the source points.10 This is a very ethereal concept, and
one that leads to confusion and debate among TCM practitioners. In the third section of this
paper, the meaning of Yuan qi will be introduced as being the ions stored within the cells as
potential energy. For the purpose of this section, however, suffice it to say that a primary
function of the San Jiao is the circulation of Yuan qi from the Kidneys to the rest of the internal
organs and channels.
Exploring the Function of Immunity:
The source of the triple burner is the shen that protects against evil.1
An important aspect of the San Jiao is seeing it through the lens of immunity and
protection from pathogens. As its name “burner” indicates, the San Jiao is associated with heat
Copyright Jamie L. Davis 16
and dysfunctions of temperature or homeostasis.19,20 A fever is a form of this heat, which would
indicate that the initial stage of illness leading to fever has actually initiated the San Jiao
response and can be treated at this level.9 As an organ systemic throughout the body, it is the
first-line defense against invading pathogens and organisms; therefore, the immune system
closely parallels the function of the San Jiao.
“People’s diseases take place in the skin spaces. External cold attacks the spaces under
the skin resulting in fever, headache, carbuncles, and skin infections,” chapter 71, Nei Jing Su
Wen (italics added).7 The key to this statement is the “spaces under the skin.” What does that
mean? What is under the skin? What they were referring to was most likely the extracellular
matrix and lymphatic system within the connective tissue where the immune system is stored.
Therefore, this statement is saying that once the San Jiao (i.e. extracellular matrix of the
connective tissue) is penetrated by disease, symptoms of disease take shape because the pathogen
has infiltrated past the immune system.
“The cold evil attacks the channels and lodges in the muscle spaces; ying qi circulation
is blocked in the muscle textures causing cysts and suppurative swellings. When the body tissues
are clear and quiet, the skin and muscles [the spaces of muscles] are closed and protected.
Strong wind and toxins cannot injure the body.” – Chapter 3, Nei Jing Su Wen.7
Once again the “spaces” of muscles refers to the protective wrapping around the muscles,
and when this wrapping is strong and protected, so, too, is the immune system so that pathogens
and microorganisms cannot penetrate. In TCM the concept of immunity is multifaceted and
complicated. One aspect of it, called “wei qi,” is said to circulate above the muscles throughout
the body creating a protective field of defensive support.7 In chapter 27 of the Su Wen,
pathogens are discussed as traveling from the channels and lingering in the blood vessel, and that
Copyright Jamie L. Davis 17
here the “battle,” meaning immune response, occurs between the wei qi and the pathogen.12 This
would indicate that the wei qi would be analogous to the lymphocytes and macrophages of the
lymph, the cells responsible for destroying microorganisms. As the wei qi is also said to circulate
within the San Jiao,7,8 then logic would follow that the San Jiao would be the connective tissue
within which the immune cells travel.
Exploring the Function of Water Metabolism:
The triple burner is the official functioning as opener of channels. The paths of water originate
in it, --Chapter 8, Nei Jing Su Wen.15
Throughout several texts, and several translations of those texts, there is a lot of
connection between the concept of the San Jiao and the function of water metabolism.1 Chapter 8
of the Nei Jing Su Wen states that “the job of the San Jiao is to work as a water passage.”8
Another translation describes it as, “The San Jiao is the officer who is in charge of drains and
irrigation: it is the place from which water pathways emerge.” 7
Throughout the Nei Jing the San Jiao is described as the three burners working in
harmony to receive and digest water and to pass it to the Urinary Bladder.8 The Ling Shu,
chapter 47, explicitly states that the San Jiao has a close relationship with the Bladder and
Kidney, and that the San Jiao serves as a passageway of fluids and water metabolism.7 Once
again we refer back to the symptoms of dysuria, urinary retention, and edema as being symptoms
of dysfunction of the San Jiao, not the Spleen and Kidney. These urinary disorders are fluid
metabolism dysfunctions, and these symptoms can be treated on the Bladder channel at the San
Jiao He Sea point, Weiyang BL 39.6,14 While the classic texts never really make it clear how the
San Jiao is responsible for water pathways, it is explicit that controlling water is an essential
Copyright Jamie L. Davis 18
function of the organ, therefore should be thought of first in the clinical treatment of urinary
disorders and edema.
The San Jiao Pattern Identification:
To further complicate an already complicated subject, there is a whole other branch to
this organ called the San Jiao Pattern Differentiation. This is a warm disease theory that evolved
in the Qing Dynasty by Wu Tang and combines the three burners discussed in the Nei Jing with
what was then understood of warm disease, wei qi, and blood patterns.1,9 This closely parallels
what we now know of the immune response. The San Jiao Pattern presents in all three burners in
a predictable pathway from the upper burner to the lower burner. The pattern begins as a warm
heat disease entering the upper burner through the skin and infiltrating the Lung as an upper
respiratory infection; if not treated properly or at all, the pathogen then deepens internally to the
level of the middle burner (Spleen and Stomach); and if still not addressed or treated improperly,
the pathogen and Pattern will continue deeper internally until the deepest, most recalcitrant level
of the lower burner (Liver and Kidneys).4,9
More recently the San Jiao Pattern has become akin to the concept of inflammation.
Korngold and Cowan liken inflammatory conditions (stress, vaccines, illness) to that of excess
heat, and that this excess heat/inflammation will follow a predictable course by entering the
terrain of the San Jiao and thus becoming systemic.20 Their work focuses on pediatrics, and they
show that the San Jiao is the linking element of childhood growth from the Jing at birth, through
the development of the middle burner (Spleen and Stomach), until finally the capacity of the
mind/shen is developed in the upper burner (Heart).20 In essence, they trace the triple burner
pattern differentiation backwards, beginning at the root. Because children are still developing
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their three burners (i.e. filtration, digestive, and cognitive systems), they are especially
susceptible to hot diseases, inflammation, and the various manifestations of the San Jiao Pattern
of warm disease.20 If the San Jiao is seen as a cellular process, then this theory clarifies how an
inflammatory warm disease can become systemic inflammation.
Using this model of inflammation, and seeing the three burners as the filtration, digestive,
and cognitive systems, the San Jiao Pattern differentiation can be seen as the inflammatory
response created by the invasion of microorganisms. Most points along the San Jiao channel are
used to clear heat and/or fever,14 so clearly internal heat—whatever the cause or mechanism—
involves the San Jiao. When the San Jiao is in balance, the response to microorganisms or
pathogens is seen as a fever, which recedes once the pathogen is resolved; the fever in this case
is a natural and beneficial response of the body’s immune system to the pathogen. When the San
Jiao is compromised or out of balance, the immune response (i.e. internal heat) is not turned off,
and this heat becomes more systemic, more recalcitrant, and more damaging.
Theoretically we can imagine the San Jiao Pattern as being a possible mechanism for
autoimmune and even cognitive diseases. We could see the autoimmune condition beginning
within the three burners from the initial exposure to a microorganism to a continual and
dysfunctional cycle of immune response. As toxins from an infection accumulate in the blood,
due to an issue in filtration, (which would be the lower burner in TCM theory), the toxins will
affect cellular mechanisms and damage tissues.21 An example of this is seen in diarrhea brought
on by the rotavirus, where the rotavirus has created toxicity that is causing cellular damage and
ion blockage within the cell.21 If TCM theory of the San Jiao Pattern differentiation is used, then
any pathogen that has affected the digestive level or middle burner, if not treated, will infiltrate
the upper and lower burners as well. As more recent research and data is demonstrating,
Copyright Jamie L. Davis 20
environmental and dietary glycotoxins may be one of the root causes of dementia,22 and dementia
would fall under the purview of the upper burner or cognitive level in the San Jiao Pattern
differentiation model. By studying the pathway and cellular process through the San Jiao Pattern
differentiation, TCM may provide valuable insight to the treatment and prevention of immune,
digestive, and cognitive disorders. This opens up a fascinating avenue of future research to test
this theory connecting the San Jiao, autoimmune, and cognitive diseases.
Summary:
There is much that is written about the San Jiao in both historical and modern contexts.
Some of it is contradictory and controversial, (like the meaning of its name and whether or not it
is a literal organ),2,19 but much of it is in agreement, especially the associated functions. The key
themes throughout all discussions of the San Jiao is that (1) it is involved (somehow) in water
metabolism and drainage; (2) it is linked to some or all aspects of the immune response; (3) that
internal heat is involved; and that (4) the San Jiao is systemic and not located in one single focal
area.
By examining these themes as necessary requirements of the San Jiao organ, a clear and
distinct set of requirements and classifications materialize when attempting to understand what
the organ is and how it functions within anatomical and biomedical terminology. In addition, by
understanding these themes and how they relate to cellular function, a clinical relevance emerges
in how the San Jiao affects acupuncture interventions. In other words, it is not just a channel with
points; it is an entire system located throughout the body useful in the underlying mechanisms of
immune response conditions, and should be thought of as systemic, foundational, and
interrelated with all other channels.
Copyright Jamie L. Davis 21
Section 2:
Fascia, Connective Tissue, and Redefining the San Jiao
The continuum of connective tissue throughout the body, the mechanical role of fascia and the
ability of fibroblasts to communicate with each other via gap junctions, mean that fascia is likely
to serve as a body-wide mechanosensitive signaling system with an integrating function
analogous to that of the nervous system.23
Introduction:
For decades now it has been proposed that one of the mechanisms behind the therapeutic
effectiveness of acupuncture lies in the fascia, which is the connective tissue that wraps, binds,
and insulates the body.1,3,5,24-29 Fascia is a living web of connective tissue that connects all
aspects of internal anatomy.24 There are many different types of fascia, but the umbrella term of
fascia refers to the undifferentiated mesenchymal tissue that forms the packing material between
organs, muscles, and sinews and provides communication and connection between tissues.23 It is
defined as “an uninterrupted viscoelastic tissue which forms a functional 3-dimensional collagen
matrix.”30 While once considered to be simply a tissue type, which varies greatly depending on
location,28,31 the fascia is now known to be an organ in and of itself in biomedical anatomy.23-29
This revelation opens up a whole new avenue of investigation for finding the San Jiao as a
distinct, literal organ within the TCM paradigm.
An interesting parallel between the San Jiao and the fascia is that both are not well
understood in their respective medical systems despite the fact that both are used daily in almost
all aspects of medical intervention. Surgeons know they must cut through it and to follow certain
Copyright Jamie L. Davis 22
lines to prevent keloiding;32 however, historically there was a disconnect between the area of
incision with possible systemic repercussions to the musculoskeletal system, and, concomitantly,
other visceral, somatic, and autonomic functions.33 Even physiatrists, practicing a medicine
based in musculoskeletal manipulation, were typically not trained in the direct correlation of
fascia as a whole organ system and its systemic effects throughout the multiple body systems,
although this is currently changing in the direction toward direct training in the fascia.33
Parallel this to acupuncturists, who, by the very nature of needle insertion, work with and
manipulate the fascia daily. Not only is there debate and confusion surrounding the San Jiao, but
there is also a lack of truly exploring the effects of manipulating the fascial network. It is an
organ system that is all but ignored, despite the fact that it is the one with which acupuncturists
work directly.
Modern research has demonstrated that deformations or obstructions within myofascial
tissue have been linked to visceral and autonomic nervous system dysfunctions, and that these
dysfunctions resolve when the myofascial tissue is repaired.25 This provides explanation as to
why so many different organ functions can be manipulated through acupuncture interventions. It
is through the myofascial connectedness and communication that visceral change is initiated,
which is the direct link between the needle and the organ being treated.3, 24-29
If the fascia, or, as will be discussed later, an aspect of the fascia, should prove to be the
San Jiao, then here emerges a pervasive theme of confusion that can quickly be eradicated. This
paper will discuss fascia in the broad sense as the mechanistic effect of acupuncture, as well as
define it more narrowly to the cellular level when defining what the San Jiao is specifically
within this vast fascial network.
Copyright Jamie L. Davis 23
An Exploration of the Environments:
Dr. Jean-Claude Guimberteau describes the fascia as a single organ connecting every
aspect of the body’s physiology, providing separate environments within each body system.25
Marshall McLuhan describes the fascia as “environments [which] are not passive wrappings, but
are, rather, active processes which are invisible. The groundrules, pervasive structure, and
overall patterns of environments elude easy perception.”31 Compare this to the description
provided by Wang and Robertson, that the three burners of the San Jiao should be translated into
“environments,”2 and a picture emerges of a literal organ system providing insulation and
cellular atmospheres within the body’s systems, which has essentially been described in the
classics for millennia. The key to understanding both the fascia and the San Jiao is to see it as a
continuum of conditions and surroundings—an atmosphere, not a structure. If an environment
that “eludes easy perception” exists in the anatomical model of present day, it is easy to see how
the San Jiao would defy understanding among acupuncturists.
The more we learn about fascia the more the term has become a buzz word. Within the
vast amount of knowledge and insight that has been gained, to call it simply “fascia” without
qualifiers is essentially meaningless, as it could be talking about either an anatomic entity or a
tissue type.28 Langevin and Huijing in their 2009 article go into great detail describing the many
different distinct classifications of fascial structures and provide their recommendations on how
to accurately discuss fascia.28 Using their definitions, the author of this paper will focus
specifically on areolar or loose connective tissue, and the dense fascia, as well as the cell itself,
specifically fibroblasts. It is the theory of this paper that the organ of the San Jiao, as we know it
within the concept of TCM, is found within these specific aspects of the fascia and connective
Copyright Jamie L. Davis 24
tissue, and, more specifically, within the collagen fibers created by the fibroblasts, and the
extracellular matrix.
Connective Tissue:
Connective tissue…binds every cell in the body to its neighbors and even connects…the inner
network of each cell to the mechanical state of the entire body.31
Connective tissue itself is an incredibly broad term, as most tissues of the body consist of
different forms of connective tissue. There are four main classes, including: connective tissue
proper (fat and fibrous tissues), cartilage, bone, and blood.16 All connective tissues originate
from mesenchymal or embryonic tissue and contain an extracellular matrix (a fluidic
background) between cells, which provide more durability to strain, stress, and traumas than any
other tissue type in the body.16 The level of vascularity, however, is quite different in each type
of connective tissue, from highly vascularized (bone) to avascularized (cartilage); and each type
of connective tissue arises from a different cell type, i.e. fibroblasts, chondroblasts, osteoblasts,
and hematopoietic stem cells.16 It is the descendent of the fibroblast, connective tissue proper, in
which this paper is focused.
The cells within connective tissue have many different functions. Specifically of
importance for this paper are the macrophages and lymphocytes, which are immune system cells
that ingest foreign materials, and mast cells, which release inflammatory chemicals used in the
process of inflammation.17 Both of these cell types are highly relevant to understanding the San
Jiao and connective tissue, as we know from the classics that the requirements of the San Jiao
include immunity and heat-generating inflammation; therefore, any environment within the body
pertaining to the San Jiao must be rich in these cell types.
Copyright Jamie L. Davis 25
Dense Connective Tissue:
Connective tissue containing closely packed, irregularly arranged (that is aligned in many
directions) collagen fibers.28
The dense connective tissue fascia is highly concentrated with collagen fibers, which
provides it with strength and tensile force, typically found in tendons, ligaments, and
aponeuroses.28 This tissue type is further classified as either regular or irregular depending on the
direction of the collagen fibers: parallel arrangement is regular, and irregular is an alternating
crossing arrangement that provides for more tensile load bearing, as seen in ligaments. 28
Collagen fibers along intermuscular planes typically align longitudinally to follow the course of
neurovascular bundles.34
The deep fascia is a type of dense irregular connective tissue in a continuous sheet around
structures (typically muscle),28 and it serves as a retaining wall between muscle compartments.
This fascia not only separates the muscle groups into well-defined structures, but also integrates
the compartments and transmits load bearing between them.23 In addition, as the muscles
contract against the fascia; they create a pumping mechanism that is squeezing against the blood
and lymph vessels, which, due to their unidirectional valves, pushes the blood and lymph toward
the heart.23
In the 1940’s, Wood Jones had hypothesized that the deep fascia in the lower limbs were
more prominent because the lower limbs are furthest from the heart.23 If the San Jiao is found
somewhere in the dense connective tissue, this could explain the correlation between the San
Jiao and the Heart in classic texts when describing the upper burner, as well as the Pericardium
and the San Jiao being “linked” or “paired” channels. Essentially and anatomically, the heart is
dependent on the function of the San Jiao as the deep fascia for the mechanical pump responsible
Copyright Jamie L. Davis 26
for venous return. It would also explain the connection to the Shaoyang of the leg, also known as
the Gallbladder channel, as this covers an extensive fascial plane in the lower legs and is
therefore pivotal in the lower leg venous return mechanism.
It is here in the dense connective tissue that we find myofascial trigger points, which is of
interest to most types of bodyworkers, including acupuncturists. The syndrome referred to as
myofascial pain syndrome “is a collection of sensory, motor, and autonomic symptoms that
include local and referred pain, decreased range of motion, and weakness.”35 Jafri hypothesized
that trigger points are increased fiber tension leading to localized hypoxia, and that this reduced
oxygen leads to a disruption in the mitochondrial metabolism of adenosine triphosphate (ATP)
that further leads to malfunctioning acetylcholine release.35 It is the dysfunction of the cellular
and biochemical response that causes the muscle fibers to adhese, and the connectedness of the
fascia being pulled that leads to the pain referring out.
Myofascial trigger points are important because they could provide a possible mechanism
of disease manifestations beyond pain that should be explored. It has been shown that adhesions
in the myofascial planes, which include trigger points, can adversely affect autonomic and
visceral function; furthermore, once the myofascia is restored to normal, the dysfunctions
reverse.25,31 The needle insertion of acupuncture is directly working with the fascia and has the
ability to reverse adhesed fibers.34 Using Jafri’s work on trigger points, we can adapt that line of
reasoning to include that the key to maintaining healthy internal functioning occurs at the cellular
level; and therefore, the mechanism of the San Jiao, which is found in the dense fascia, must be a
cellular process.
Copyright Jamie L. Davis 27
Loose, Areolar Connective Tissue
Loose, or areolar, connective tissue is located all over the body, specifically under the
epithelial tissue and between muscles, nerves, and glands.17 It contains an extracellular matrix
filled with fibroblasts, as well as macrophages and lymphocytes (the immune system), and
collagen and elastic fibers.17 Its functions are many, including: “(1) supporting and binding other
tissues; (2) holding body fluids (the ground substance’s role); (3) defending against infection (via
the activity of the white blood cells and macrophages); [and] (4) storing nutrients as fat (in fat
cells).”16 There are a lot of similarities in this definition to the classical functions of the San Jiao
listed in section 1, especially immunity and water metabolism.
Areolar connective tissue can contain a large volume of white blood cells from the
capillaries that pass through it, and these numbers will increase when infection is present.28
Therefore, the immune system is highly at play within the loose connective tissue fascia. This
fits in nicely with what we know of the San Jiao. White blood cells are an important aspect of the
immune system, and having a type of tissue systemic throughout the body offering the immune
system response is key to our understanding of the San Jiao.
Throughout the classics and modern interpretations of TCM, there has been a close
connection between the San Jiao and the concept of wei qi, which was discussed earlier as the
protective layer of the body analogous to the immune system in some aspects. It is often difficult
to tweeze the two apart in our understanding of modern physiology and classical systems. It
would be going too far to combine the two as one entity; however, if you see the wei qi as the
white blood cells, and the San Jiao as an aspect of the connective tissue, then the link becomes
the white blood cells are the wei qi circulating near the skin level and the San Jiao is the material
that holds it.
Copyright Jamie L. Davis 28
Often the San Jiao was described as a passageway of water, or as “irrigation” in the
classic texts. Looking at the role of the loose connective tissue as holding body fluids, another
pattern emerges linking the San Jiao with this tissue type. The ground substance, or interstitial
fluid, which will be described in more detail below, is the fluidic backdrop of loose connective
tissue, also called the lymphatic system, and all fluids of the body interact here. 36-38 Hence the
idea that all pathways of water originate in the San Jiao, as told by the Nei Jing Su Wen,12
parallels perfectly with the connective tissue as the lymph and lymphatic tissues are connective
tissue and they are the pathways of water movement within the body.
The Lymphatic System
In the 1800’s, Kaitai Hatsumou proposed that the San Jiao is in fact the lymphatic
system, specifically the lymph vessels within the thoracic cavity.1 This is an intriguing
hypothesis because the lymphatic system is quite complicated, involving different structures,
tissue types, and organ systems, including the spleen and thymus gland, which all work to move
fluid from the blood into the tissues.17 It is closely connected to the circulatory system, and acts
as a fluid transport from the vascular system to the blood through the lymphatic vessels, while
simultaneously providing immune system cells (phagocytes and lymphocytes).16 The functions
of the lymphatic system parallel closely with the San Jiao, including fluid balance, fat absorption
from the digestive tract, and immunity from invading microorganisms.17 Clearly, the lymphatic
system and the San Jiao are mirrored in their descriptions; however, the lymphatic system has a
passivity to it as it requires compression from the skeletal muscles and pressure changes from
respiration in order to circulate;17 whereas, the San Jiao in its historical descriptions has an
inherent, active, and self-sustaining energy and motive force.
Copyright Jamie L. Davis 29
Lymph
3L of fluid circulating the body, containing water, plasma, ions,
nutrients, gases, proteins, hormones, enzymes, and waste products.
Passes from blood capillaries to interstitial spaces to lymph capillaries
back to the blood.
Lymphocytes
Immune cells capable of destroying microorganisms and foreign
substances. Originates from red bone marrow.
Lymphatic Vessels
Drainage vessels, similar to veins, with one-way valves, moving the
lymph toward the heart, by collecting excess interstitial fluid and
returning it to the bloodstream. Useful in fat absorption, the lymph
fluid in the vessels can have chyle, which is a milky fluid due to fat
content. Utilizes compression from the skeletal muscles.
Lymphatic Capillaries
Simple squamous epithelium tissue closed-ended vessels. Fluid moves
easily in and out of the lymph capillaries, as they are more permeable
than blood capillaries. Located in all body tissues except the nervous
system, bone marrow, epidermis, and cartilage.
Lymphatic Tissues
Tissues in the lymphatic organs containing lymphocytes and other
cells.
Lymph Nodes
Rounded structures throughout the body that act as way stations for the
passing lymph. Immune system is activated here.
Lymph Organs
Tonsils, lymph nodes, the spleen, and thymus gland. Organs
containing lymphatic tissues, so highly involved in immunity.
Table 1: Lymphatic system16,17
Copyright Jamie L. Davis 30
The lymphatic system does not need to be seen separately from the fascia because
lymphatic tissues are a type of loose connective tissue called reticular connective tissue.16 It is
helpful to see the lymphatic system as an integral component of the fascia and the connective
tissue as opposed to being considered a separate system. The lymph and interstitial fluids are the
cellular backdrop of connective tissue proper and the fascial network; all fascia contain lymph
vessels and act, through fascial compression, as the vessels’ mechanical pumps by pushing the
lymph past the one-way valves.16,17,23,39 The fascial and lymphatic systems are intrinsically
connected, and both contain the functions of the San Jiao; however, the former provides a
mechanism of action (compression) while the latter provides the substance and container (lymph
and lymph vessels). In other words, the lymphatic system is the San Jiao, but the San Jiao is
more than the lymphatic system.
Going Deeper Than Fascia: Looking at the San Jiao within the Collagen Fibers and the
Extracellular Matrix
To say that the San Jiao was simply the fascia or connective tissue, or even the lymphatic
system, would clear up the mystery of whether or not the San Jiao was an organ and would wrap
things up nicely. However, while there are many similarities thus far discussed, the fascia is too
wide a scope to be the San Jiao and the San Jiao alone. It is the hypothesis of this author that all
organ systems manipulated through the technique of acupuncture are manipulated through the
fascia; that the channels themselves are the fascial planes, with points located along the gap
junctions, and that the San Jiao is found within the fascia, specifically within the collagen fibers
and the extracellular matrix. This means that all acupuncture interventions take place within the
fascia, and, therefore, the San Jiao as the extracellular matrix is the linchpin to all organ function
and is the key to cellular communication.
Copyright Jamie L. Davis 31
Extracellular Matrix
Extracellular matrix (ECM)….consists of a system of insoluble protein fibrils and soluble
complexes composed of carbohydrate polymers linked to protein molecules…which bind water.
Mechanically, the ECM has evolved to distribute the stresses of movement and gravity while at
the same time maintaining the shape of the different components of the body. It also provides a
physico-chemical environment of the cells…through which metabolites and nutrients can diffuse
freely.31
The extracellular matrix (ECM) is a rich nutrient environment surrounding the human
cell; it provides nutrient transfer, the transduction of nerve signals, cellular communication, and,
most importantly, the management of the mechanical stresses put on the cytoskeleton of the
cell.24,31,36-38 The ECM is very important in understanding connective tissue and the fascia. It is
the viscid fluid that insulates in between the fibers of the connective tissue37 and the link between
the fascia and the process of cellular nutrient absorption and breakdown.25 The nerves and blood
vessels are not directly in contact with individual cells, so the ECM acts as the intermediary.25
The ECM consists primarily of two parts: (1) insoluble protein fibrils (collagen), as well
as soluble carbohydrate polymers linked to proteins, all of which bind water; and (2) the watery,
viscid, gel-like fluid called ground substance.31,37 The ground substance is a shapeless
background to the cells and fibers16 and is the end point for all systems—vascular, nervous, and
lymphatic.26
Understanding the ECM is a vital component of understanding the San Jiao. Its functions
are many, and its location is everywhere. It was once believed to be a static, fluidic background
with no particular life of its own or specific function,39 but through microscopy research we now
see the ECM very differently. It is its own world full of cellular and biomechanical responses.
Copyright Jamie L. Davis 32
From immunity to inflammation to being the origin of water, the definition of ECM so parallels
with what we know of the San Jiao classically.
The ECM is its own environment, not a static focally located thing, but the surroundings
and conditions within which a myriad of processes and functions take place. What was said in
the classics of the San Jiao was that it “is the beginning and end of the pathways of qi,”2 the
“passageway for water and grains,”2 and that “the San Jiao has a name but no shape.”8 The ECM
is shapeless as it is the fluidic background to the entire organism. What shape would you give the
ocean? The same applies to the ECM and the San Jiao—a shapeless organ system that is all
encompassing. Furthermore, as the intermediary of all hormone and enzymatic passages,31,40 as
well as the venous and lymphatic systems, it is literally the passageway of all life taking place
within the organism.
Collagen Fibers and Fibroblasts
Collagen is a protein and is one of the main proteins found in connective tissue,31,40
making up more than 70% of all the protein in connective tissues.41 Their job is a complicated
and vital one: as fibrils cross-linked throughout connective tissue they provide structure for the
tissues as well as mechanical function.40 Collagen fibers are extremely strong and able to resist
longitudinal stress through their high tensile strength.16 There are 27 known forms of collagen
fibrils; however, type 1 is the most abundant in the human body and found throughout all
structural tissues, including the cartilage of the blood vessels.40 This is important because one of
acupuncture’s most powerful physiological effects on the body is regulating blood
microcirculation of the tissues.5,25,42
Copyright Jamie L. Davis 33
Fibroblasts are the primary cell in fascia, and have the ability to remodel and organize
collagen based on the tension that exists between the cell and the ECM.39 Fibroblasts in the loose
connective tissue rapidly respond to external forces, more so than the dense connective tissue,
and will change their cell shape within minutes of tissue stretching.27,29 They also have the ability
to communicate with each other via gap junctions, allowing for an interconnected network of
cellular communication systemic throughout the connective tissue.23 Langevin et al. conducted
research on the biochemical response of acupuncture needle stimulation, which showed
specifically two rotations of the inserted needle led to the fibroblast cell bodies becoming large
and “sheet-like.”29 What this means exactly for our health remains unexplored, but what it does
show is that a biochemical change is happening at the cellular level through the manipulation of
loose, and, to a lesser extent, dense connective tissue.
The living cell follows the principles of what is known as tensegrity where structure in
the cell is created by actomysosin filaments and microtubules acting as support beams and
compression wires.36 Tensegrity in all structures, whether architectural or anatomical, is defined
“as systems that gain their load support function and mechanical stability from continuous
tension and local compression.”38 Tensegrity is a balancing system, using the pull of tension
matched by the push of compression to maintain structure. This is an important concept when
ascertaining the functions of the San Jiao within the concept of the fascial network and collagen
fibers.
The San Jiao, in classical terms, is also responsible for homeostasis of the body by
regulating internal heat mechanisms.1,11,20 Homeostasis implies a balance, or status quo, within
body systems: structure, fluid flow, and cellular balance. To maintain all these things means that
the San Jiao must be cellular, systemic, and connected, and it would need a mechanism to signal
Copyright Jamie L. Davis 34
changes in balance. The compression/tension balance inherent in the fibroblasts and collagen
fiber network provide just such a system.
Since acupuncture involves needle insertion into the fascia, then what is the catalyst to
take that needle insertion in one part of the body and create a reaction systematically to all organ
systems? With needle insertion the fibroblast responds to the needle by changing its tensegrity;
its cell shape enlarges and flattens out in response to mechanical stress, which, in this case, is the
needle.29 The fibroblast will then remodel the surrounding collagen fibers based on the tension
between the cell and the ECM.39 Therefore, the catalyst or systemic connection we are looking
for must reside in the collagen fibers and can be found by the pull of tensegrity on a cellular
level.
The tension created between collagen fibers has another important function. The ground
substance, which is the fluidic background to the ECM, directly affects fluid flow in the body.39
Typically the ground substance is held back from taking on extra fluid by the collagen fiber net;
but if there is a change in the tension, the ECM swells and absorbs more fluid like a sponge.39
This may also be the mechanism of cupping techniques, which uses glass or plastic suction cups
on muscle bellies to break surface tension on the fascia and aid in healing. Findley hypothesizes
that cupping produces local edema through collagen fiber re-tensioning, which allows for healing
and temporarily readjusts fluid flow.39 Once again, we see the San Jiao, “the origin of the
pathways of water,”1,7,8 in the function of collagen fibers and the ECM. Edema, or swelling, is a
malfunction in the ground substance/collagen retaining wall function of the ECM, and, through
realignment of the collagen, the edematic fluids can be reabsorbed back into the ECM.39 This
helps to explain the mechanism behind using the Lower He-Sea point of the San Jiao, Weiyang
BL 39, to treat fluid dysfunctions because the insertion of a needle at this point is remodeling
Copyright Jamie L. Davis 35
collagen fibers while simultaneously activating a fascial plane of the leg, which, as discussed
earlier, is responsible for venous return.
The structure of collagen is a triple helix structure, surrounded by populations of three
different water types: interstitial water tightly bound within the collagen, bound water on the
surface of the collagen, and free water filling the spaces between fibers.41 This triple-helix
structure, along with the bound and free water molecules, allows for proton jumps to occur
between the collagen fibers, which is a way for chemical and bioelectrical cellular
communication to occur systemically throughout the body within milliseconds.41 Specifically
this means that the collagen fibers are passageways of water conducting communication
throughout the entire organism.
In addition, the name “San” means three, and here we see a triple helix structure. The
words from the past have found an almost shocking parallel to a biomedical equivalent which
has been discovered through modern microscopy. The San Jiao “drains but does not store, and is
transmission, transformation, and transportation related to drainage,”15 and that “there is nothing
that it does not envelope or surround.”6 These definitions make perfect sense when looking at the
San Jiao through the lens of the water-bound, triple-helix collagen fibers that envelope the entire
body providing water metabolism and bioelectrical conductivity.3,41
Conductivity of the collagen fibers increases at temperatures equal to or above our body
temperature, as collagen “melts” at these temperatures, and melting collagen allows for the fibers
to actually realign and improve communication.41 This may be the very mechanism behind
massage, ultrasound, infrared laser, and myofascial bodywork techniques in that they are heating
up the tissues with manual manipulation, which releases the inflammatory chemicals within the
extracellular matrix, which then realigns the collagen fibers for better cellular and fascial
Copyright Jamie L. Davis 36
communication. Here we have heat being the vital component of collagen remodeling, and, with
the cytokines and other inflammatory chemicals located directly in the ECM, a potential pathway
of imbalance and autoimmune inflammation emerges. This heat/inflammation aspect could be
why the ancients named the San Jiao with a word that can be translated as “scorched.” If an
imbalance occurs in the San Jiao, which we can now see as the collagen fibers and ECM, then a
type of inflammation from a cellular release of cytokines is analogous to a systemic burning
taking place inside the body.
Exploring the Mechanisms of the Therapeutic Effectiveness of Acupuncture:
If a clinician applies a treatment strategy that is based upon some explanation of the mechanism
of treatment and finds the treatment to be somewhat effective, then the effectiveness of the
treatment is assumed to validate the explanation.25
The key to understanding the San Jiao within the ECM, and/or within the collagen fibers,
is in understanding the mechanisms behind acupuncture. Without this piece of the puzzle, the
value of this clinically vital information is lost as just another attempt to translate a TCM concept
into biomedical terminology. The San Jiao within the collagen is so much more than that and has
the potential to be the linchpin to the field of integrative medicine.
One of the most highly controversial topics in TCM is the hypothesis that our entire
understanding of “qi” as “energy”, as well as the entire channel system, is wrong. For decades
now, certain acupuncturists and philologists have proposed that the ancients never intended to
say that the channels of TCM were invisible energy lines, but were, in fact, referring to the blood
vessels, lymphatic system, nervous system, and/or the fascial planes.3,5,23-25,41 There is
compelling evidence to support any one or all of these theories.
Copyright Jamie L. Davis 37
The fascial planes, called “meridians” by Meyers,31 line up very closely to the channels in TCM
theory, with between 50-80% accuracy,24,26,42,43 and are lines of pull that transmit tension and
movement through the myofascial layer that covers the entire body.30 These planes are based
purely on Western anatomy; and, while there are some definite differences in location compared
with TCM channel theory, there are startling similarities that, at the very least, should inspire
further research.
Fig. 2. On the left are the myofascial planes by Thomas Meyer;31 on the right are the acupuncture channels.45
An important aspect behind acupuncture needling is the intent to stimulate blood flow, so
logic would dictate that the channels which acupuncturists work with would have a specific
effect on the blood vessels and circulatory system. Fascia is directly connected to venous and
lymphatic circulation on both a structural level (the vessels), and a biochemical level,23 as well as
creating a manual pumping mechanism in returning the venous supply back to the heart.23 In
addition, deformations in the myofascial tissue have been linked to visceral and autonomic
Copyright Jamie L. Davis 38
dysfunction which can be reversed through the repair of the myofascial tissue.25 This would help
explain why organ function is affected when needling a limb or area distal to the organ or the
dermatome that innervates it.
Another leading theory in acupuncture research is that the acupuncture channels, called
jingmai 经脉, have been mistranslated, and that the ancients in classical texts were in fact
describing the blood vessels and the circulatory system in their description of the channels.5,42
When classical texts were translated in the 20th century, the word jingmai was translated to mean
meridian or conduit.42 The word mai 脉 is typically understood to mean blood vessel, but there is
some controversy as to the word jing 经.5 Harper and Unschuld translated jing to mean
“conduit,” but even Unschuld admits that this could be incorrect.42 Kendall proposes that most
likely the word jing actually means “longitudinal,” and that the texts were referring to blood
vessels running longitudinally throughout the body, and that the acupuncture points are located at
neurovascular nodes, resulting in tissue reactions directly affecting the underlying fine vessels
(capillaries), as well as biochemical and nociceptive nerve responses.5,42 For example, research
done specifically on the “Chong” channel, which is also called Xue Hai (Sea of Blood), show
that the channel location description closely tracks along the pathway of the vena cava and that
any point listed bearing Chong in its name corresponds with terminal arteries.46
This paper’s focus is not on the circulatory system, as it is a lengthy subject in and of
itself, but suffice it to say that there is an extraordinary connection between the channel
pathways, the point functions, and the pathways of the venous and arterial vessels.5,42,46 As
dissection was not a primary tool of investigation in ancient Chinese anatomy,46 and microscopy
was obviously not in existence, it is logical to assume that the channels would need to be a more
obvious and observable structure, like the blood vessels; and, therefore, it is possible that when
Copyright Jamie L. Davis 39
the ancient physicians described the channels they were in fact discussing the circulatory system.
On the other hand, the fascial planes are also longitudinal and involve a more complex picture of
activity that includes the blood vessels as well as the nervous and lymphatic systems. As has
been discussed at length, the fascial planes are both a physical entity as well as a mechanism
since the compression of the fascia allows for circulation of the vessels. Having an aspect of
anatomy that also contains a mechanism of action seems more in line with TCM theory than
strictly the blood vessels alone.
At this point it is near impossible to be absolutely sure what was meant by jing mai
originally, whether the circulation of longitudinal vessels refers to fascial planes or to the
circulatory system, but either explanation helps the Western mind grasp the concept of the
channels a little more clearly. The acupuncture channels and acupuncture points exist within and
are manipulated through the fascia during needle insertion, and so our focus should be placed on
the physiological effects that take place in the fascia and throughout the organism.
If so much evidence is found in either fascial planes and/or the circulatory system as
being the acupuncture channels, then where did the concept of ethereal energy running through
invisible lines come from that is so pervasive in TCM theory, as it is practiced in the West? It is
believed that this concept is actually completely modern and was derived by a French physician
named Soulie de Morant.5,24,42 In the beginning of the 20th century, he was searching for a way to
explain an Eastern medicine concept to a Western world. At the time science was beginning to
unravel the concepts of atoms and atomic structure, so using the word “energy” was completely
rational in the cultural context of the time period.24 As science, microscopy, and MRI technology
advanced, this explanation for invisible or “insubstantial” substance has fallen short and has led
to confusion among acupuncturists and condescension among scientists as to what acupuncture is
Copyright Jamie L. Davis 40
even doing. What is even more interesting about this is that it is wholly a Western phenomenon,
as currently Eastern tradition does not view qi in such ethereal terms.5,24,42
While qi understood as ethereal energy does not truly make sense or align in biomedical
terminology, the concept and description of qi found in the classic texts does make sense when
seen as meaning a substance that provides communication, movement, and energy exchange
within the organism.27 If qi actually means “all there is,”24 a concept of action in the form of
movement, and of substance in the broadest of meanings, then we can shift away from viewing
qi as one literal, ethereal “thing,” and see it more as an all-encompassing metabolic catalyst
taking place within all living organisms.
Another way of looking at the concept of qi is to see it as bioelectricity. What we now
know about collagen fibers is that their alignment within the connective tissue allows for
electrical intercommunication, and, with the work being done by Ho,41 Mentre,47 Langevin,29 and
Oschman,37 it can be shown that these electrical intercommunication highways along bound
water molecules running along the fibers actually line up with acupuncture channels.3,24-26,40,46
Furthermore, it is demonstrated that most acupuncture points fall upon locations where there are
local gaps in the collagen fibers as they converge on one another at right angles, meaning that by
stimulating that area with a needle you are essentially providing a gap jump connection to allow
for the continuation of electrical communication.41 This means we can essentially throw out the
window the idea of qi being an ethereal energy outside the realm of science and possibly replace
it with electrical energy that is indeed measurable and predictable.3,41
Compare this to what is known about the meaning of the acupuncture “point.” It is
translated as cave or hole.25 As Jason Robertson points out in his translation of Wang’s work, the
acupuncture point lies not in the muscle, vessel, or any literal structure, but it is in fact in the
Copyright Jamie L. Davis 41
empty spaces between the tissues.2 So what does that mean? Well, we know that the collagen
fibers, in a massive unit of tensegrity, line up at right angles to provide strength to the unit as a
whole34 and are channels of electrical and biochemical communication;3,41 therefore, a plausible
argument can be made that the definition of acupuncture “hole” or point is literally the hole left
between collagen fibers, otherwise known as gap junctions.
Another way of looking at it is through the eyes of a surgeon attempting to avoid
keloiding. In relaxed skin, the elastin and the single collagen fibers are located in the concavity
of the largest bundles of collagen, and it is here that they look for the incision lines.32 It is in the
hole, gap, or concavity that we insert the needle. By exact placement within the concavity of
collagen fibers, the needle is able to assist the electrical communication to continue along
predictable pathways of cellular communication.3
A needle inserted into the body penetrates the fascia, and, therefore, fibroblasts and
collagen fibers.24,29,34 All mesenchymal cells react physiologically to stress,32 including “signal
transduction, gene expression, growth, differentiation, and survival,”38 and the insertion of an
acupuncture needle is definitely a type of mechanical stress. We know that fibroblasts have the
ability to break down and remodel local collagen,40 which then can spread throughout the
collagen/fascial network resulting in large scale matrix contraction.39 It is therefore plausible that
mechanical transductions and biochemical reactions have been occurring on the cellular level in
fascial therapeutic interventions (acupuncture) for millennia, but was unable to be observed or
properly explained because it was occurring at the microscopic level.3,24-29,39
Copyright Jamie L. Davis 42
Summary:
The connective tissue known as dense fascia has been demonstrated to be a unique organ,
providing separate environments throughout the organism yet connecting the system as a whole.
All acupuncture interventions occur within the fascia because it is the layer of tissue directly
penetrated by the acupuncture needle. Deep to that is the ECM, the fluidic matrix of cells and
collagen fibers that provide communication and tensile strength within the fascia. Through
needle insertion and manipulation, the fibroblast cells change shape, leading to an ionic energy
release and tensegrity pull on the matrix leading to collagen remodeling and the repair of fascial
deformations.34 This creates a systemic change in the environment, changing the very cells
themselves, which improves blood and lymph circulation and even organ function. It is here in
the matrix that the San Jiao emerges as its own unique organ system, the environmental
foundation and catalyst for cellular change and communication throughout the fascial network.
It is through the study of fascia that science has brought acupuncture to the precipice of a
revolution. By viewing the channels not as energy lines, but as living, breathing fascial planes
that affect circulatory, lymphatic, and nervous systems simultaneously within predictable
pathways, then point selection no longer falls across measurements, but instead becomes a
palpatory area specific to the individual and their current disease presentation. By
acknowledging that the points are less about physical location in regard to bony landmarks, but
more about palpable concavities within the fascia, and that through the insertion of a needle,
these concavities provide a gap junction connection between the collagen fibers to initiate
systemic collagen remodeling, we provide a stronger rationale for point combinations in both
research and clinical practice, as well as a mechanism for their action.
Copyright Jamie L. Davis 43
If we see the San Jiao not as an amorphous and ethereal conglomeration of other organs,
but instead as the extracellular matrix, we begin to truly understand the purpose of the San Jiao
in the TCM framework as controlling water metabolism in the lymphatic fluid of the ECM and in
controlling the inflammatory response that occurs from the release of cytokines from the cells of
the ECM. Inflammatory disease processes are understood across disciplines, and demonstrating
TCM’s unique ability to manipulate the inflammatory process through the San Jiao, by reversing
the fibroblasts’ release of cytokines in the ECM, brings new light to the inclusion of acupuncture
within the integrative medicine model.
Beyond the scope of a better understanding of the fluidic and inflammatory control
provided by the San Jiao, acupuncturists will have more success in their patient’s treatment
process by coordinating the effects of the fascial mechanisms through palpatory point location,
as opposed to relying on static point models using obscure measurements. These concepts not
only revitalize the clinical practice of acupuncture, but also bridge the gap of communication
between acupuncturists, the biomedical community, and the public.
Copyright Jamie L. Davis 44
Section 3:
The Machinery of Life within the Cell
We never experience ourselves as the multiplicity that we are, but always in the singular “I”—
Schrodinger.41
Introduction:
Throughout this paper we have discussed the San Jiao in its classical terms, its modern
interpretations, and then, finally, the hypothesis of how it can be viewed in biomedical terms.
What is central and basic to these concepts, and to all life, is the cell. All aspects of human
anatomy are, at the foundation, a compilation of billions of cells, all with different functions yet
all functioning together. Through advanced microscopy we have seen down into the depths of
the cell—the building block of all tissues—and discovered billions of uniquely functioning
machines, a world unto itself and on their own, yet, somehow, all working together. It seems
fitting, then, to end this discussion with an examination of the mechanism of the cell as both a
starting and endpoint for understanding complicated concepts within TCM and biomedicine,
especially the San Jiao.
When thinking of the human body, it is easy to see the structures as structures and neglect
the fact that all units within the organism originate from the same basic properties. A muscle, for
example, is actually a chemical machine in and of itself as well as a collection of chemical
machines, meaning the individual fascicle and the bundles of fascicles bound together are
separate units functioning as one.48 It is one thing to know the attachments, fascial pulls, and
range of motion for each of the muscles, but it is another entirely to observe dysfunction in the
muscle from a cellular dysfunction in ATP, which is used as the source of energy for the
Copyright Jamie L. Davis 45
molecular machinery.48 In bodywork-based medicine it is the opposite of the analogy of not
seeing the forest for trees, as we tend to only see the forest (in this example the muscle) and not
see the trees at all (individual cells). In the practice of acupuncture, the more useful information
clinically is not just knowing what is inside the cell, but how the cells interact and communicate
with one another. How is it that billions of independent cells can communicate in what seems
like instantaneous responses when there is no direct contact between them? What are the
molecular machines driving all life within the cell? It is in the investigation of the cellular
process, binding, and communicating that a unifying bridge emerges across all life.
The Beginning of Life
The constituents of all organisms, from their shape to their functions, are determined by
their chemical makeup.17 All lifeforms on planet Earth have come together through the mass
attraction of like things in a grand hierarchy, from the tiniest divisible atom to the largest blue
whale swimming in the ocean. All life is composed of the same material, just constructed in
different ways. Atoms, the smallest level of material we have thus far discovered, combine in
various groupings to form molecules; molecules come together to form organelles (the smallest
structures of the cell, like the nucleus or mitochondria); similar cells arrange themselves together
to form tissues; similar tissues combine into organs; organs arrange into a collaborative
organization known as organ systems; and, finally, organ systems make up an organism.17,36,38 In
other words, life is an intricate dance of momentum and pull, establishing a hierarchy of
molecular cohesion.
Copyright Jamie L. Davis 46
Table 2: Organelles and their functions within the cell17
Nucleus
Contains DNA or genetic material; this is also the site of ribosome and
messenger RNA synthesis.
Nucleolus (in the
nucleus)
Ribosomal subunit assembly site and RNA synthesis.
Rough Endoplasmic
Reticulum (rough ER)
Site of protein synthesis.
Smooth Endoplasmic
Reticulum (smooth ER)
Site of lipid synthesis and cellular detoxification.
Golgi apparatus
Modifies and packages proteins.
Secretory vesicle
Site of cellular secretion.
Lysosome
Digests material taken into the cell.
Mitochondrion
Site of ATP synthesis.
Microtubule
Structural component to support cytoplasm.
The cell is extremely complicated and important. Each tiny cell is its own world. The
molecules that arranged together to form the organelles did so in specific patterns, so that each of
the organelles has a different function; for example, the nucleus contains genetic and hereditary
codes, and the mitochondria manufactures adenosine triphosphate (ATP), which is
used as the energy source.17 Each cell contains many organelles as well as its own ground
substance, called the cytoplasm, which is a rich hyaluronic fluid similar to the ECM 35 that
contains the many different types of organelles.17 It was once believed that this fluid was
essentially water and had no purpose other than to hold the organelles;47 however, recent
research has discovered that this fluid is just as alive and functional as the organelles and
respond, through the principles of tensegrity, to the external environment.36
Copyright Jamie L. Davis 47
Molecular Machinery
The organization of molecules to cells to tissues provides a valuable insight to
understanding the mechanism animating the San Jiao. Systems self-organize depending upon the
flow and dissipation of stored and kinetic energy.41 The enzymes and proteins within the cell act
as “molecular energy machines” that transfer energy from the original cell to the target cell,
sometimes instantaneously, to initiate change from one end of the body to the other, despite the
fact that there is no direct cell to cell contact between the “point of release” to the “point of
utilization.”41 Furthermore, the communication between cells, although initiated by an ion
(calcium, for example), does not transfer through the cells to communicate with the same ion.47
When a signal—the ion—is introduced to the first cell in the chain of command, the cell
sequesters that specific ion within its cytoskeleton as stored energy and liberates the same kind
of ion to the next cell. This creates a chain reaction that causes each cell to sequester the
introduced ion and release an ion to the next cell.47
In other words, signal transport is not occurring as diffusion of ions into the cell, or as a
matter transport, but rather is occurring as an energy transfer known as transduction.47 The
kinetic energy or force of the ion is transferred, but not the specific ion itself. Here the cells have
created a closed loop of energy transfer where energy is stored, trapped, and mobilized in a
circulating self-sustaining loop called a life cycle, and the more cycles there are the more energy
is stored, and the longer it would take for that energy to dissipate.41
Tensegrity at the Cellular Level
Every system in the body, from respiratory to circulatory to endocrine, is a compilation of
billions of cells acting out their own enzyme activities in the microscopic level while
Copyright Jamie L. Davis 48
simultaneously harmonizing to the macroscopic function of the whole system. In addition to
energy transduction, cells—all systems for that matter—are constructed within the same pattern
of tensegrity discussed above, and it is through using the principles of tensegrity that the
individual microscopic level initiates change across the macroscopic level.37 Tensegrity moves,
adapts, and integrates all aspects of anatomy. If we are hypothesizing that the San Jiao is the
extracellular matrix, then we need to understand how tensegrity shapes and reshapes
physiological function.
It is through tensegrity—the same pull that provides structure for the entire organism—
that the cells adapt to their environment, communicate, and initiate change;36-38 and it is the
hypothesis of this author that the extracellular matrix surrounding the cell is the San Jiao, a
systemic, living, breathing microcosm effecting change across the macrocosm, and tensegrity is
the mechanism behind its action. Studies have shown that cell shape changes depending on its
environment.37 When on glass or a plastic culture dish, they attach by spreading out and
flattening, when on a rubber substrate, they contract and become spherical, even to the point of
bunching the rubber underneath.36 In the body this translates as the ECM being the environment
that adjusts the shape of the cell.
Inside the cell, microfilaments provide tensile strength for the cytoskeleton, by pulling
the membrane in toward the center or nucleus.36 This pulling is opposed by the fluid of the
cytoplasm within the cell and the outward pull of the fluid of the ECM outside the cell.35 In
addition, the microfilaments not only provide tensile strength, but they also connect the
cytoskeleton directly with the nucleus.36 When changes occur outside the cell, it manipulates the
microfilaments which then signal change within the nucleus. The tensegrity of the cell actually
initiates deep structural changes to the cell.36,38 By altering the external environment, the internal
Copyright Jamie L. Davis 49
environment is simultaneously manipulated; therefore, the insertion of an acupuncture needle,
which creates mechanical stress within the ECM of the fascial network, inextricably changes
cellular shape and function.
As stated earlier, cells that are not in physical proximity with each other communicate
through an ionic cascade of stored energy.47,49 When combined with the local tensegrity model, it
is clear that local changes within the cell do not stay local, but actually create a cascade of
intercommunication across the entire organism.36,41,49 One area of fascia manipulated with a
needle creates a tensegrity change in the environment to stimulate change within the nucleus.
This then sets off a cascade of ion release and protein-to-protein transfer of the stored energy of
that ion.47,49 Applying this to what is known as “distal needling” in acupuncture, where an
acupuncture point is needled distally from the area of pain, usually on the contralateral side of
the body on a limb, the mechanism of instantaneous change across the organism to address the
affected area without direct manipulation makes sense from both a biomedical and TCM
perspective.
Conclusion:
The world thus appears as a complicated tissue of events, in which connections of different kinds
alternate or overlap or combine and thereby determine the texture of the whole.
–Heisenberg, 195837
Throughout the modern and ancient texts there is a concept called Yuan qi in TCM
theory. This is the original substance of action from conception that circulates and provides life
to the body until the organism’s last breath.1 As the Yuan qi declines, so too does the physical
body. The ancient text of the Jingui Yaolue Fanglun discusses that one of the most important
Copyright Jamie L. Davis 50
functions of the San Jiao is to circulate the yuan qi throughout the body.7 What we now know of
the cell is that through a circuit of energy, ions pass into the cells through a cascade of ion-to-ion
communication throughout a cellular network through the vehicle of the extracellular matrix.
Knowing this, it is easy to imagine the Yuan qi as the molecules at the basis of life; it is the cells
and the ions that pass between them. The San Jiao, then, is the matrix that holds these cells and
provides the conduit for communication between them; thus, the San Jiao literally circulates
Yuan qi.
This section has been a cursory glimpse into the infinitely complicated and beautiful
machinery of life—the cell—and has introduced the idea that one need not look at the TCM texts
as metaphor, but as literal material based on observation before microscopy. As acupuncturists
we cannot stay focused on the larger structures—the muscles, the organs, the nerves—without
keeping in mind the machinery and mechanisms behind its smallest constituents. If we begin to
see all acupuncture therapeutic effects taking place within the environment of fascia, then
understanding what fascia is down to its cellular components is crucial. It is looking at the
cellular level’s systemic responses of tensegrity and ion transfer that brings clarity to point
choices and why certain organs in the TCM lexicon have associations to patterns that do not
typically match the anatomical purpose of said organs; for example, knee weakness being
associated with Kidney deficiency, or hypochondriac pain being associated with Liver
circulation. These correlations make sense as symptoms occurring through myofascial
deformations with the symptoms radiating through the corresponding fascial plane bearing that
organ name.
Through the study of the cell, the San Jiao becomes vitally important clinically. As the
extracellular matrix, it holds the key to cellular changes and cellular communication. It is the
Copyright Jamie L. Davis 51
homeostasis of the entire organism. The San Jiao provides structure to the cell, a mechanism of
change within the cell, and the fluidic backdrop of all fascia to allow for energy transfer and
communication between cells.
Copyright Jamie L. Davis 52
Section 4:
Final Discussion and Conclusion
If we scrutinize the unusual functions of the triple burner, we can understand that the viscera
and bowel organs are different, yet the same, the same yet different. Upon dividing it becomes
twelve; upon uniting it becomes the triple burner. The triple burner is also one burner. The (one)
burner is the origin, it is the qi of the one origin. –Li Chan, Yi Xue Rumen, 1575.1
Clinical Relevance
The field of acupuncture lies on the border of new territory, a precipice between the
history and the future of medicine. To boldly enter the conversation of integrative medicine, the
need for truly understanding how and why acupuncture works beyond theory and conjecture
becomes paramount. Throughout time acupuncture and TCM have always been on the leading
edge of technology and medical wisdom, from the Huang Di Nei Jing Ling Shu composed
probably in the first century BCE, and one of the earliest medical texts ever written, to the Wen
Bing, an herbal medicine school of thought developed in the 1700’s to address the plagues of
that time period. Acupuncture and herbal medicine theory have always been innovating by
staying on top of the disease pathogens as they evolved; and innovation is the key to the survival
of any discipline, modality, and even every life form. Therefore, innovation within the field of
acupuncture is vital in providing access to patients within a Western medical framework, which
is vastly different than the framework that evolved millennia ago at the origins of acupuncture
and herbal medicine.
The San Jiao in the ECM is one such avenue of innovation. Neither allopathic nor natural
medicine fields acknowledge the clinical relevance of the ECM, despite the fact that at the core
Copyright Jamie L. Davis 53
of all tissues and functions within the body the ECM lies at its foundation. 36-38 As acupuncturists
we directly manipulate the fascia and are creating a cellular cascade effect within the entire
organism, meaning the ECM is critical in the underlying mechanism of acupuncture
interventions. Seeing the San Jiao as cellular function, and all acupuncture effects occurring
within the fascial network, allows for a deeper understanding of acupuncture’s physiological
effects and TCM organ theory. Cellular and fascial mechanisms are the linchpin to understanding
what the needle is doing, how it is doing it, and the correlation of the channels with anatomical
organs and the TCM functions attributed to each organ, which typically far exceed biomedical
and anatomical associations.
Further, it allows acupuncturists to choose the points based off mechanisms and research
efficacy, rather than rote memorization of point functions. For example, if the patient is suffering
from an autoimmune condition, we know that reducing inflammation is the primary goal of their
treatment. So by addressing that inflammation by needling the San Jiao channel and its paired
channels, specifically Taiyang and Shaoyang of the leg, it is theoretically possible to control that
inflammation by inhibiting the cellular release of cytokines because fascial manipulation will
change the internal environment of the cell and, therefore, the ions released. Certainly this
hypothesis is of value in conducting design studies to test efficacy and treatment protocols in
future acupuncture research.
Based on what we have learned so far from Fox34 and Langevin29 studies, insertion of the
needle followed by two rotations within the collagen fibers is enough to stimulate fibroblast cell
reshaping, leading to restructuring of the collagen fibers; and, as discovered by Mentre,45 once
the cell is manipulated, an ionic cascade of energy transport occurs to signal to the entire
organism of the change that has occurred. Over time this needling will create cell memory, and
Copyright Jamie L. Davis 54
the body will adapt to the changes being signaled.38 Here lies an excellent opportunity to
investigate in future acupuncture research how this mechanism is involved in treating some of
the more recalcitrant and chronic disease processes with TCM.
This is the type of specificity acupuncture can realize as a profession. By exploring these
mechanisms we can formulate research studies that more accurately reflect TCM by using
palpation of the fascia to determine treatment, as opposed to a specific point prescription used
the same way on every patient, and then assessed for efficacy by using “sham acupuncture” as
the control. Sham acupuncture is commonly used in acupuncture research studies and is
considered a placebo modality because it is either not needling the defined point location but
rather a location in proximity to it that is not recognized as an acupuncture point, or an
instrument (often a toothpick) is used just on the skin, which does not penetrate into the fascia
and is designed to make the patient think they are being needled.
Sham may be discovered to be an inefficient test control against acupuncture because any
manipulation of the fascia will result in a physiological effect. This model of the ECM presented
in this paper explains why sham is not a useful control because the ECM is everywhere on the
body, and manipulating the ECM will create some type of physiological effect. Therefore, sham
trials that show no therapeutic benefit of acupuncture over placebo do not demonstrate that
acupuncture is not effective; they actually solidify that acupuncture is extremely effective, but
that points are moving targets and specific to the individual’s fascial network. Knowing this,
research studies can be designed accordingly, providing a wealth of information as to the most
efficient treatment styles, locations, and techniques for specific conditions.
Copyright Jamie L. Davis 55
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