Myofasciitis, also known as myofascial pain syndrome, myalgia syndrome, and myofatigue syndrome, occurs mostly in the scapula, neck, lumbar hip, and other muscular areas [1]. Among them, patients have obvious limited painful points with palpable hard nodes or fascicles as their most prominent clinical features. There are more studies on the limited pain points in patients with myofasciitis, which are known as pressure points, provoked pain points, trigger points, etc.
Many scholars have treated them from different aspects, but numerous clinical reports have shown that small acupuncture therapy is effective in treating myofasciitis because it is less traumatic to the tissue, quick, efficient, and safe. According to Liu Baiji, acupuncture is a method of treating diseases mainly by cutting and releasing the needle knife deep into the body under the guidance of the theory of acupuncture (such as the theory of closure). This article reviews the mechanism of treating this disease with small acupuncture needles in recent years.
1.Releasing the energy crisis of myofascial pressure point
Wang Yansong et al. believe that soft tissue injury can release 5-hydroxytryptamine, histamine and kinin, which can cause local ischemia and hypoxia and nerve sensitivity, leading to the shortening of muscle fibers, and the shortening of muscle fibers leads to a lack of oxygen and energy, thus forming a vicious circle, resulting in an energy crisis, the stimulation of local pressure and pain points by acupuncture can cause the decomposition of histone, produce vascular and nerve active substances, reduce the pain-causing substances The stimulation of the local pressure point by acupuncture can cause the breakdown of tissue proteins, produce vascular and neuroactive substances, and reduce the content of pain-causing substances such as bradykinin and 5-hydroxytryptamine in the serum.
At the same time, according to the analysis of bioelectric principle and piezoelectric principle, the mechanical energy generated by needle knife stimulation of soft tissues can be converted into heat energy, which can dilate capillaries and accelerate blood circulation, thus enhancing the nutrient supply of local lesions.
Mechanical stimulation can also greatly improve the metabolic capacity of the diseased tissue and accelerate the absorption of harmful substances. Thus, it can adjust the nerve function, release the energy crisis and achieve the purpose of analgesia.
2.Reduce the afferent signal of injurious stimulation
Hong C-Z et al [8] suggested that myofascial pathology may be related to the integration of sensory nerve fibers and dysfunctional endplates in the spinal cord. Histological studies have shown that myofascial pressure points are sensitive receptors or sensitive nerve endings.
Acupuncture therapy may achieve central analgesia by inhibiting the release of the central octapeptide cholecystokinin (CCK-8), which is antagonistic to opioid peptides [10]. Xu ZN [11] suggested that acupuncture treatment stimulates the function of the analgesic system (gate control function) in the spinal cord and the anti-cancer system in the brain, through diffuse
3, Injury inhibitory control
A study of the effect of small needle knife on substance P in the spinal cord and dorsal root ganglion of rats with increased muscle tone found that small needle knife acupuncture can significantly reduce the synthesis of excitatory transmitters (substance P, SP) in primary sensory neurons in the dorsal root ganglion (DRG) after skeletal muscle compression, thus achieving pain relief. The needle knife cuts off the sensitive nerve endings during the treatment process, thus reducing the afferent of injurious stimulus signals and achieving the purpose of treatment. 3.Inhibit sterile inflammation
Xuan sting believes that myofasciitis pain is caused by trauma, chronic strain and injury that causes edema, exudation and decomposition of necrotic material in myofascial and muscle tissues, so that the nerve endings at the attachment are stimulated by sterile inflammation. Liu Cankun et al] demonstrated that acupuncture intervention on the levels of IL- 1β, IL-6 and TNF- α in rabbits with L3 transverse process syndrome effectively inhibited the levels of inflammatory cytokines IL-1β, IL-6 and TNF-α in an animal model of third lumbar transverse process syndrome, thereby suppressing the occurrence of aseptic inflammatory responses.
Zhao Yanxia believes that acupuncture therapy is injected with biological enzymes through the open “enzyme pathway” to produce immune function and eliminate inflammation through the biological “stress response” of cells.
4.Regulate the balance
Zhu Hanzhang proposed that the root cause of chronic soft tissue injury disease is the theory of dynamic balance imbalance of the human body. The basic pathological factors that cause the imbalance of dynamic balance are adhesions, contractures, scarring and blockage. Li Feng et al [18] found that the effect of small needle knife therapy on collagen type I and III in human skin hyperplastic scar tissue transplanted in nude mice had a certain inhibitory effect on collagen type I and III in hyperplastic scar tissue, and could reduce excessive collagen deposition in hyperplastic scar.
Based on the bowstring mechanics system and mesh theory, Zhang Tianmin used the needle knife to regulate the abnormal stresses by cutting and separating the adhesions, scarring and contractures in the bowstring union and the route of the string, so as to restore the mechanical balance of human soft tissues.
5.Adjustment of pain threshold
The closed treatment of myofasciitis by small needle knife is performed without local anesthesia, and the patient will feel more distension and pain in the process of needling, and the intensity of stimulation often exceeds the threshold of pain threshold of the patient, and the stimulation of small needle knife achieves the effect of raising the threshold of pain threshold.
Sun Hongmei et al [21] found that the effect of needle knife therapy on the pain tolerance threshold and the spinal cord and hypothalamic enkephalin (ENK) and β-endorphin (β-EP) in the rats with the 3rd lumbar transverse process syndrome model was reduced by the needle knife relaxation method, and the pain threshold tended to increase, thus relieving the patients’ pain.
6.Relief of dermal nerve entrapment
Some scholars believe that the pain of myofasciitis is due to the tension and spasm of the muscle tissue and the thickening of the fascial tissue in the area, resulting in increased pressure and surface tension in the fascial cavity, and the sensory nerves traversing it are stretched and compressed, which leads to pain, i.e., dermatomal nerve entrapment [22]. Numerous scholars [23-25] have used small needles to cut subcutaneous tissues, fascia and muscles, and to release adhesions, so that the pressure in the fascial cavity is reduced and the fascial surface tension is lowered, thus eliminating the stimulation and compression of sensory nerve endings and relieving pain.
7.Acupuncture effect
Myofasciitis belongs to the category of “paralysis” in Chinese medicine. The “Nei Jing” cloud “wind, cold and damp three gas mixed to the combination of paralysis also ……”, the onset of more blame on the external wind, cold and damp evil or trauma, strain and injury caused by meridians paralysis, blood stagnation is not smooth, “not pass is pain “If it does not pass, it hurts, and over time, the muscles and tendons contract and stiffen into knots. He Jianzheng believes that small acupuncture knife can play the overall effect of acupuncture to unblock the meridians, move the qi and blood, and support the positive and eliminate the evil according to the principle of “following the meridians and taking the points” and “taking the pain as the loss” in acupuncture therapy.
The small needle knife stimulates the diseased meridian or transfusion point, which can adjust the balance of yin and yang, qi and blood in the internal organs of the meridian or transfusion point, so as to achieve the effect of helping the positive and dispelling the evil. According to Zhang Yi et al, the shape of the needle knife is similar to that of the milli-needle, and the way of needle knife treatment is also similar to that of the milli-needle lifting and inserting technique, so it can be assumed that needle knife treatment must have the acupuncture effect. Therefore, it can relax the local spastic soft tissues and achieve the purpose of regulating qi and blood and unblocking the meridians.
8.Jacking of meridians and tendons
The “Spiritual Pivot – Tendons” records that “when the disease is over, the branch pain and turn tendons”, “when the disease is over the branch turn tendons pain”; “the disease of the tendons, cold, tendons are urgent, hot, tendons relaxed and not closed, impotence. Yang anxiety is reflexive, Yin anxiety is not stretching”. This indicates that “pain”, “tendon contracture”, “tendon rotation”, “tendon urgency” “tendon longitudinal” are all pathological states of the meridian tendons.
In the clinical observation, the instructor found that the pain and sensory abnormalities of peripheral nerves caused by abnormal tension in soft tissues are very close to the meridian tendons in terms of disease location. In the treatment of the twelve “paralyses” in the “Spiritual Pivot”, it is repeatedly pointed out that the main treatment is: “The treatment is to rob the stab with burnt needles, to know as the number, and to use pain as the acupoint.”
Summary
Small needle knife therapy is a type of semi-invasive therapy between surgery and non-surgery, and is a product of the combination of Chinese medicine and Western medicine. Although small needle knife closed treatment of myofasciitis has unique efficacy and scholars have explored its therapeutic mechanism through their own clinical observations or experiments, however, there are fewer clinical reports of small needle knife treatment of myofasciitis based on the meridian tendon theory.
This is the direction of our future work, while inheriting the valuable experience of our predecessors, we strive to develop and innovate, and make new breakthroughs in both the theory and practice of meridian tendon. We will also actively introduce and combine new treatment mechanisms to explore a more perfect theoretical mechanism of myofasciitis treated with small acupuncture.