Fascia Science Meets Acupuncture

You're listening to the Yoga Medicine Podcast. I'm your host, Tiffany Cruikshank. Our podcast brings you information and resources to enhance the therapeutic effects of your practice based on a deeper understanding of anatomy, physiology, and the integration of modern science and research with traditional practices and experiences. Join me and my co-host Rachel Land and Katja Bartsch as we dive into all things yoga, research, and wellness. All right, we're back and we're headed into a topic that's near and dear to my heart, as I guess all the topics we choose are. But this one in particular, really looking at where the fascia and acupuncture worlds collide. And, you know, there's a lot of information on possible mechanisms behind acupuncture, nothing that's really conclusive, but a lot of different theories. But what we want to look at today is really specifically that overlap of fascia and acupuncture, what we know so far, and also really leave room for the mystery. Because I think as an acupuncturist myself, with over 20 years of experience working with thousands of patients, I think, you know, there is a lot to the mystery and a lot of potency within that as well. I personally always love to have science and research inform what I do, both as an acupuncturist and as a yoga teacher. But there's always a lot that we may never know. And in the body too, you know, the more we learn about the body, the same thing. So I'll start just by talking really briefly about the meridians, and then we're going to go into look at these anatomical correlations between the fascial channels or the fascia itself as a system. And acupuncture, we'll look at the mechanism, the possible mechanism. And then we'll talk about the fluid spaces and channels within that as well. And kind of break it down into these three different categories. So before we get into the research and some of the interesting information that we have now, none of which is super brand new, but I think brand new in the world of acupuncture in the last 10 to 20 years, five to five to 20 years. And so I guess it all seems new to me since I started my career 20 some years ago. But when we talk about meridians, what we're talking about here is, and I think that the easiest way to talk about this in a very general and simplistic sense, keep in mind, we can elaborate on this in a lot more detail and we do in our Chinese medicine teacher training. But in a very simplistic sense, this Chinese medicine lens looks at the meridians as channels of energy that really help to connect, that help to communicate. And really at its kind of bare bones essential ideas here is that when this system is flowing freely, the body is able to heal and regulate and repair. It has all of the tools it needs to be able to do that. So you kind of think of it, this analogy, like back in the day when rivers used to deliver essential things to different communities, whether that be food or supplies, before we had all the intelligent transportation we have now, these rivers were ways of both bringing in all of these essential tools for these communities and also potentially taking waste and things that were no longer needed away. And the meridians are very similar to that. And they have very much like a river tributary. So they have larger meridians, which turn into smaller meridians, which are very similar to our circulatory system and our lymphatics as well. And they have this ability to both provide the essential nutrients in Chinese medicine, qi, blood, yin, yang, all of the important things so that the local tissues and the organs can heal and repair and thrive and create this kind of homeostasis environment. Now, the meridians that we talk about are more on the surface. And so they're the ones that we can palpate and needle with acupuncture, but there's also meridians that dive through every layer of the body, including internally into the organs, which is how these meridians are able to communicate with the organs. So we might needle something on the forearm that's influencing one of our organs deep. And that's kind of this idea of this, how they work, of being able to communicate and regulate from the surface to the interior, and why potentially dysfunction on the interior of the body might manifest as tenderness on some of these acupuncture points or acupressure points. And that's a question a lot of times too, is acupressure the same as acupuncture? And yes, it's just same points, just different mechanism of stimulating them using a hand or a ball versus a needle. So really just a method for regulating. And in Chinese medicine, the qi in the meridians is actually what moves the blood. And so there's this correlation between the two of them that helps to create this good circulation, good flow through the body that again, allows the body to self-regulate and create homeostasis on pretty every level, whether that's physical or physiological or emotional as well. So there's a lot of emotional connection to these. I think that's perfect. And I think that lays the land perfectly for kind of the discussion, how research in the last couple of decades has attempted to bring those two together. So the TCM system, more of an Eastern view of energy flow, and then the Western, more anatomically, physiologically based view and bringing those together and thinking about fascia as a potential substrate for that energy flow. And that's what we're about to discuss today. And I, yeah, I'm excited about that. Yeah. So there's a lot of different ways we can look at this. We've mentioned this already as far as the research goes, but what we want to do is look at how the fascia intersects. And so why don't we start and just dive right into the anatomical correlations, because there are some interesting correlations that happen with the anatomical system and some of these kind of Western imagery systems of looking at the body as well. So how about we start there? Yeah, that's perfect. So what we want to chat about today is that actually some researchers have suggested that fascia as an anatomical structure, fascial planes, fascial sheets, fascial layers, that they could actually be the physical substrate of energy flow and therefore could have a correspondence to meridians and acupuncture points. And there have been a couple of studies being carried out a couple years ago. Maybe to mention before we dive into the details, those are kind of models, computational models that use data from cadavers. So they use maps of the body and kind of paint acupuncture points on those models and paint myofascial trigger points on those bodies and look at where the fascial sheets or layers or planes actually are. So that's how we can analyze in a computational model if there is a congruence between fascia and acupuncture points. And so there are two or three bigger studies that have done that. And one has been done by Helen Langevin, who we've mentioned multiple times, I believe, on this podcast, particularly when we talk about fascia. And they looked at acupuncture points and tried to map them and see if they have a congruence with anatomical fascial planes. And they actually found that, they looked at the arm, so not the whole body, but acupuncture points on the arm. And they found that in 80% acupuncture points and fascial planes or layers matched. So to summarize, what they did in that study was they looked to which extent acupuncture points are located on one of those fascial planes. So they kind of checked, is there a congruence between where an acupuncture point lives and is there a fascial plane present, basically. That's what they did. And they found quite a high number of correspondence between fascial planes and acupuncture points. So they're not using it to predict where acupuncture points might be. They're just looking to see if the acupuncture points live in those fascial planes, basically. Yes, exactly. So basically they used two maps. They have a map of where our acupuncture points, the other map is where our fascial planes, and they put them over each other and saw where they kind of have the same, where they overlap. I love that too. When we were chatting before too, the way you said it was like, it just gives us a zip code. And I think that's a great concept too, because it's not telling us, it's not totally specific, but it's giving, you know, a correlation between the two that maybe there is some correlation between the fascial planes and the location of these acupuncture points. So, you know, that first study just gives us more of a big picture view of anatomical correlations of these points with the fascial system. Yeah, exactly. And I'm going to put the link or the info for the article, which is Langevin 2002, into the references in the show notes. So you can check that one out. There's some nice images in there that make it even more visual and you can understand exactly what they did. And there's another study, they did kind of the same thing, but they didn't do it with acupuncture points and fascial planes, but they did that with acupuncture points and myofascial trigger points. So again, they had kind of two body maps on a computational model and they looked where there are overlaps or where there's congruence between acupuncture points and myofascial trigger points. And I mean, when you do that, when you see, oh, are they in the same zip code or do they live in the same street or is it just the same city? You kind of have to make rules about how you're going to determine that in a study. And what they did was they, the first rule they had is, oh yeah, they are in close proximity, they live in the same street if myofascial trigger point and acupuncture point are at one centimetre at most apart from each other. Then they had a second category where they said, oh, okay, they still live in the same zip code, so they have like a medium distance if they are one to two centimetres apart. And then they had a third category, which is maybe they live in the same village, you could say, and that was two to three centimetres apart. So between the acupuncture point and myofascial trigger point. And if you take all of those distances together, so acupuncture points and myofascial trigger points that live in the same street or in the same zip code or in the same village, they had or found a congruence of over 90%. So there is somewhat of an overlap where acupuncture points and myofascial trigger points live. If we take the ones that live in the same street, so that have less than a centimetre between them, it was about 37%. Oh, I was going to say before you tell, don't give them away. I think this one's really interesting because it made a big splash in the acupuncture community. It came out in 2008. And I think in the beyond acupuncture community of people who wanted to easily understand what acupuncture does. And I'm a huge fan, as you know, of myofascial trigger points. We use them in our myofascial release trainings to create maps for the body. And I'm also a huge fan of acupuncture. But I think what's really interesting about this one is as an acupuncturist myself, when you're using a needle, you do have to be super specific to the point. And it definitely needs to be less than a centimetre, especially in some areas. There's the body where, yeah, you know, maybe it's a little more vague when you're talking about the, you know, the back of the hip or something like that. Then if you're on the hand or something smaller, you know, if I'm a centimetre off of the point on the hand, I fail my point location exam as an acupuncture student. And so, you know, I do think it's interesting because there are some of these overlaps. And I think they're really interesting when we see a myofascial point and acupuncture point in the same place. I think that's really spectacular because we're looking at through different, very different lenses to see how this point might be useful. And now we're seeing an overlap. Like one of my favourites is bladder 58, which is a point about a third to halfway up the lateral posterior calf. So kind of like the outer part of soleus right above, you know, where the Achilles thickens. And in that general area, and it's a really interesting one because as a trigger point, it's one of the furthest, it has one of the furthest referral sites. So it's one that refers into the SI joint, which is kind of unheard of for something to refer that pain that far away when we look at trigger points. And in Chinese medicine, it's also used for low back pain, headaches in particular. So it's a really interesting one to, you know, I think we could see biomechanically how the calves can be really influential on the hip function and connect to the lower back issues and lower back function as well. So there's a lot of interesting tie-in there, but I think in my perspective, I would say if I had to like take a guess at the overlap of trigger points and acupuncture points, I would have probably guessed 20 to 30%. So not too far off what they said, but it is just a really small percentage. And, you know, it doesn't really, again, give us a direct correlation to all of the points. But an interesting one, and keep in mind that these myofascial trigger points are just points people always ask. I think we should definitely do a whole episode on those at some point. But those are just points that have been documented over time to, you know, look at these common areas of dysfunction within different muscles. So yeah, I don't know. I think this one's an interesting one, but I think everyone got all excited about 93%. And so a lot of times I hear doctors and like non-Chinese medicine people, and sometimes Chinese medicine people kind of correlate the effect of acupuncture points with myofascial trigger points, which I think is great, but I think it also minimizes a lot of the other things that Chinese medicine can offer besides just working on the physical body too. Yeah, I'm so happy and grateful that you're making that translation into practice, also clinical practice as an acupuncturist, and also generally. I think it's so important to put out that caveat, and if you wouldn't have done it, I would surely have talked about the difference between a street and a village, because obviously there is a difference. And I think that makes this conversation so rich and interesting, because of course in research you have to go out with a certain kind of metric or assumption about a certain measurement, but then you always have to relate it to what's clinically relevant. And the 37% that live in the same street seem to be so much more clinically relevant than the 60-something percent or 50-something percent that are in the same zip code or in the same village. So yeah, I think that puts it into perspective quite nicely. And I think it brings us back to like, hey, research is really great, but you do need to dig in the details. That was what we kind of started. One of our first episodes we recorded was ready to research in two parts, because it was so long, to really help people understand, like, I can't just look at the headline or even the abstract sometimes and really draw good information from it, because I could see this headline, 93%, and be like, acupuncture points are trigger points. They're the same thing. And if I don't look into the details or understand some of the nuance there, and sometimes it requires subject matter expertise, people with subject matter expertise to really decode that. So it can be a little tricky. And I will add one other caveat, too, is that even in acupuncture, different styles of acupuncture, in particular Chinese versus Japanese, can have different point locations, sometimes just slightly different, sometimes completely different. So I'm assuming they were probably using traditional Chinese medicine acupuncture points, which are very well agreed upon for the most part. But then there's also what's called usher points, spelled A-S-H-I. And the joke is it's kind of like, ah, sure, you know, here's the point. And basically what you're looking for is the tender spot near it. And, you know, I think that when I'm using myofascial points or, you know, more physical points for physical pain or discomfort or function, you know, I am looking for the usher, the tender points, which is probably more of a trigger point, you know, it is probably more connected to that. So, you know, there is some gray area there, but we're talking about classical acupuncture points. Yeah, you would definitely fail your exam if you were a centimeter away from the point. So let's talk about, oh, sorry, go ahead. Yeah, I just wanted to say, yeah, it's, I think we have like some attempts and I appreciate them a lot to kind of see if there is that congruence between acupuncture between TCM meridians and the fascia, but that's surely not like the whole story and not like a conclusive finding we have there. So I do very much appreciate that line of thinking to see if there is congruence. Also, I would assume that with time, with more complex computational models, and also more understanding of the architecture and anatomy of fascia, because that is still developing in some ways that we could refine that, or maybe hopefully that would be refined in the next couple of years. And I will be very excited to see future studies on this because that's maybe a side note also for the one with the acupuncture points and the trigger points. The data that was used, and that's data that is often used in projects like that, is the so-called visible human project. And if you've never heard of that, I encourage you to look for it online. It's, some discuss it quite controversially, that is data stemming from two imprisoned people, a female and a male, that had been sentenced to death and gave away their bodies for research. And just right after their death, their bodies were frozen and then cut so that pictures were being made for a lot of slices of the body. And actually, a lot of early algorithms and still a lot of research data, like the one we just presented, are based on those data, on those two bodies. And of course, they're not representative for all the bodies out there, and they're also already a bit older. But I think that's also nice to think about that or to, A, appreciate that we have that data, but also, B, put into context that this is not a complex computational model considering different body types, ethnicities, et cetera. Yeah, I think it's fairly safe to say that we're just capturing a glimpse of, and we're grasping as a society, grasping at ways to understand something that maybe is not understandable in our scientific lens. And so I do think it's helpful to catch these data points, like there's some correlation with fascia, there's some correlation with trigger points. And next we'll look at the mechanism and see, there's some correlation there. None of them are really directly showing us exactly what's happening and all of the mechanism behind things and everything around it, but they're kind of capturing some concepts that can help us maybe understand at least some of the connections with this system. So when we talk about mechanism, we see a little bit more of that too. So for this next one, what we have to first understand is this idea of needle grasp. And as an acupuncturist, basically what you're trying to do is feel for what's called the grasp of the needle. I think the best way this was explained to me when I was in acupuncture school that really made sense, and especially if you've ever needled someone, all the acupuncturists out there will know this firsthand because you feel it right away, is it's kind of like feeling a fish on the end of your fishing line, which my husband would really appreciate that analogy as a dive art fisherman, but it really is. So it's this little catch that you feel at the end of the needle. Once you've felt it as an acupuncturist, it's very distinct. Some people will compare it to vesiculation, which is a twitching of the muscle, but it can be much more subtle than that. It's not necessarily actually just the muscle twitching as much as just feeling that catching of the needle. And the idea in Chinese medicine is that you're tapping into the qi there, that you're kind of feeling that connection to the qi. So you are looking for a little response on the needle. And again, not necessarily the muscle actually twitching. And as a client, if you've ever, probably a lot of people listening to this have had acupuncture and felt, sometimes you can feel that grasp of the needle, which is really usually more the muscle actually vesiculating, which is kind of like the muscle contracting or twitching a bit. And that's a more gross version of that. What we're feeling for is that catching of the needle, which is actually pretty subtle. And a lot of times as a patient, what you would probably feel is a little bit of warmth there. You know, you might feel some needles more than others to experience that grasp a little bit more, but you might have a little sensation there afterwards as well. So yeah, that's needle grasp. And why we're mentioning this or explaining this is because that's another idea how fascia or fascia research and TCM acupuncture might be related. And again, the name Helen Langeberg comes up because she has really been essential in the whole field of fascia research, but also when it comes to that connection between those two fields. And what she looked at was the potential or a potential mechanism of action behind acupuncture. And that was exactly related to that needle grasp phenomenon. So what they looked under the microscope was what would happen in the tissues when the needle is kind of holding onto the tissues or pulling. And my understanding is, Tiffany, maybe you can speak to that a second or two, that is being created by a little rotation or a little pull on the needle. Yes. Yeah. I mean, sometimes it's like a little in and out. Sometimes it's a twisting and, and, you know, I'd love, I love this study by Helene Langevin because it does give that visual of like the wrapping of those collagen fibers around the needle. And, and that really, I think of more the twisting of the needle, but there are a lot of different ways to manipulate the needle besides just twisting. So. So I think that's what exactly what you're mentioning. I think they looked at that twisting or slight rotation of the needle in the, in the tissues and what they found under the microscope was that actually the connective tissues, the fascial tissues are involved in what happens as a result of that twisting, namely, and you already gave it away, the tissue, the fascial tissue, the connective tissue structures kind of wrap around the needle as if they would hold onto it. And that nicely explains that needle grasp, but also we can kind of go down the line further what happens with that. So how that is explained or how that might affect the tissues and affect the things, the effects we see through acupuncture is that this twisting, that pulling or wrapping off the connective tissue structures around the needle, we could equate them a little bit with a stretch, a local micro stretch of those connective tissue fibers or structures. And that is a mechanical signal. A stretch is a mechanical signal. And that mechanical signal can then be translated into changes that are biomechanical, biochemical, that are bioelectrical, or they can also directly affect the cell. And that is called, that overall effect is called mechanotransduction. That's not only happening in response to acupuncture, but generally in response to mechanical stimuli that you apply to the body. So that stretching of the connective tissue structures through the rotating needle leads to mechanical signal, leads to mechanotransduction. And that then can have a number of effects. Among them is that the connective tissue structures, the extracellular matrix, which is part of the fascial tissue, that this modifies or changes its composition. So the tissue actually changes, the fascial tissue actually changes as a result to that micro mini stretch that is happening through rotating of the needle. And part of this is, and correct me if I'm wrong, because you're more familiar with the study, but one of the things that was floating around a lot in the acupuncture world was this idea that, you know, we're winding up the collagen fibers, which is creating that piezoelectricity in the tissues, because we know collagen has piezoelectric qualities to it. Is that your interpretation? That was discussed at the time. In the meantime, I would say that our understanding of what happens in terms of bioelectrical signaling in the fascia has progressed a little bit. So what we do know is that, for instance, fibroblasts, they do react to electrical current in the tissues, but not because of piezoelectricity, but just how the electricity is in the fascial tissues. But that could also be changed with that mechanical signal. So the pathway is a little bit different, but still it's bioelectrical as a title or header over that. I love that. You were very careful with your language too, because I was like, there must be a reason she's doing this. So, I mean, we are talking about the fibers and the winding up and this mechanotransduction, which is this idea that as we mechanically stimulate the tissues, it's turned into this electrochemical information. And so, you know, she's using broad language here purposefully because we're still trying to figure all of this out. You know, what does this mean? There are definitely changes happening. What we know now is that there is an effect on the fibers and the structure of the connective tissue, not only with the winding itself, but then as an effect, some electrochemical changes or mechanotransduction changes from that as well. And so, a really interesting one. Actually, I loved this study when it came out. It actually changed my acupuncture practice forever. And ever since then, I've always, and this is just my own interpretation of it, of something that I've found really clinically relevant. I go in and get what we call the da qi, so that sensation of needle grasp. Again, there's a lot of different techniques to do that winding, but sometimes looking for vesiculation. And I'll leave that in. And then at the end of my sessions with people, I always come back in the room, pull the needle almost all the way out. So it's more in the superficial fascia and I twist it and wind it and leave it in for a few more minutes as a way to kind of stimulate this area. You know, it's worked for me. We don't really know, again, a lot of the specific applications of this information, but that's my interpretation. And I really like it if you're an acupuncturist, you can play with it and see what you think. But it feels for me like I'm getting different layers and levels and working with different things there. So yeah, an interesting one. Again, there's something happening. There's something happening that's connected between the acupuncture points and the fascia, not only in the location of the points, but also in the mechanism of potentially, maybe this is part of what's driving the mechanism of action for these points. Again, this might just be one of many things, or it might be the whole shebang. We don't really know, but it's definitely influencing the connective tissue matrix. And just as a side note to finish that one off, because I know there are fellow fascia nerds out there listening to us. The current thinking is it's not just affecting the collagen fibers, but fibroblasts, the cells in the fascia as well, maybe even more so. I love that, which makes sense because we know that the fibroblasts are holding onto the collagen fibers and listening. And that's really what's creating the response there is the fibroblasts. So the more functional unit, the functional unit of connective tissue. I love it. Awesome. So then lastly, we're going to talk about the fluid component. And there's a lot of interesting information. I know Katya and I have been busy updating our myofascial manual because there's been a lot of interesting implications that we're not going to get into today, but on this ground substance and fluid layer. And today, what we're going to talk about is not necessarily the whole system and the myofascial release, but specifically its relation to acupuncture. And this is probably the newest of the things we've talked about. So a really interesting layer to talk about from that perspective as well. Yeah. And again, this is really like bigger picture view still, but I find it interesting. I mean, one relationship or potential relationship between fascia and then TCM in general does relate to the importance of fluids. I mean, in fascia, we know that the extracellular matrix with the interstitial fluid or extracellular matrix with a lot of water bound by, for instance, glycosaminoglycans is a major part of the fascia. So the water content in the fascia, the fluid content in the fascia is really high. And overall, maybe Tiffany, you want to add to that. My understanding is that fluid flow and fluids in general also have a very high relevance. You already mentioned blood and lymph at the beginning. Maybe you want to speak to that a little bit of the importance of fluids. Yeah. Yeah. I would just say, yes, they're absolutely really valuable. There's a preciousness like pretty much every system and style of medicine too, I think can really agree on the preciousness of fluids, which tend again, and just in a general sense, which do tend to decline as we age. And there's ways of supporting that and a lot more to that. But in Chinese medicine, these are all connected to the yin and there's a preciousness to the yin. So yin encompasses the fluids. It's a lot more than that and beyond the extent of this conversation, but fluids are a form of yin and there's a preciousness to it that kind of has this correlation with health, resilience, longevity. Yeah. Without going into a lot of detail, yes, there's definitely a preciousness. And we already talked to the preciousness of the flow of the fluids and qi in the body as well. So those two really important. Yeah. And so that perfectly fits with what is happening or has been happening over the last years in the research. So various different ideas or models of fluid channels have been developed or conduits, conduit light structures that enable that fluid flow. So that's kind of the starting point, a number of different ideas and theories or concepts behind that. And then it almost is kind of becomes obvious that there is a potential hypothesized suggested link between the fluid flow or the fluid state in the fascial tissues, that extracellular fluid or interstitial fluid that I've already mentioned, and the flow in TCM language, if you wish. And so people have been looking at that from different angles. And one thing that has been shown or studied is how fluids from the skin where you actually apply the acupuncture needle from that skin, there is a certain flow of fluids down through the connective tissues. So there is some sort of link or flow through them. And that makes sense with what you said from the beginning, like we do an acupuncture treatment or we put an acupuncture needle. And the idea is that that is then linked through an actual channel or flow to the organ, for instance. And one idea is that happens through that fluid flow. And it has been shown that there is an actual flow of interstitial fluids from the skin layer through the connective tissue layers underneath. And that flow has been shown to kind of move along the connective tissues that are wrapping around nerves and blood vessels. So nerves and blood vessels are wrapped in connective tissue and along those roads, that fluid flow seems to go or there was some sort of evidence, there is some sort of evidence that potentially along those fluid flow channels, along those vessels and nerves, there could be a relationship that explains that bigger picture, even though the bigger map, the bigger picture, the concrete way from acupuncture point to organ as a whole, in my understanding, has not been shown yet. Yeah, I think it's an interesting one, too, with, you know, the advent of the interstitium and really a lot of attraction to this, this part of the body, you know, really the space between really is what we're talking about here. And everything is not clear at first sight. And I think that's also why this fits perfectly with this episode. There are a couple of correlations we can make. There are a couple of kind of category or buckets that we can put together, like anatomical planes, like mechanisms of action, like fluid flow and TCM. But those are more like buckets. And we want to see if there are correlations, if there is some overlap. But if it was super easy, and if it was obvious at first sight, we would have known, we would have known for a long time. And that's what I like about that discussion. Also, it really is good for thought, because it is not a simple back and forth, black and white, one to one analog relationship. But because those are, per se, very different thoughts of school and concepts. And I understand the need or the idea that we want to match those two to some degree, or we hope to find some correlations. But maybe also it's okay that we will never fully match the two. And that's part of the magic and the mystery. Yeah, that was really well said. And I agree. You know, when you said, you know, I think that there was a clear direct mechanism, we would have found it by now. And I agree, I think what we're looking at is a more complex system. You know, and even when we look at the meridians, we see the meridians that we talk about are just one layer of meridians in the body. If you dig deeper into Chinese medicine, you see there are layers and layers of meridians, maybe similar to the connective tissue, I guess, in some ways, but not directly the same. You know, we're looking at, I think, systems that are layered together and integrating and communicating and maybe dependent on each other and influencing each other. And, you know, I think it's really important to stay open to the mystery. You know, we get a little information from research and science, just like all parts of the body. It doesn't tell us everything. For me, I'm, you know, I love, I love these conversations because you're more of the researcher and I'm more of the clinician. And, and, you know, as a, as a clinician, like what I care about is what works, you know, I don't, I'm not going to base all my treatments on research because the research obviously hasn't really told us too much about the specific applications, but, you know, as a patient, we know what's been helpful or what has worked. And, you know, I think one of the testaments to acupuncture is that it has stood the test of time, you know, and it's undeniable. And I know I couldn't obviously say for myself, it's undeniable, the effects. So I like to stay open to the mystery. I will mention too, there's a, there's a book that's really interesting too, called Spark in the Machine. It's, it's definitely an older book now, but I still think it holds up a lot of interesting. It's not only on acupuncture, but there's some quantum physics and, and, and some things that are a little outdated in it. But I think for the most part, a really interesting way to just embrace the way these systems are and open our minds, different ways of seeing the body. And remember that I think for me, there's a place for everything. There's a place for Western medicine. There's a place for acupuncture. There's a place for all of the different tools within those and the other modalities, chiropractic, naturopathic, you know, all the things they've all stood the test of time. And it's up to us, you know, as, as patients, we're all patients in our own body and to find what's most helpful. So I think this is a really interesting subject. Obviously there's connections and correlations here, you know, within the anatomical locations of these points, as well as in the mechanism potentially between fascia and acupuncture. And now we see maybe within this fluid flow, which is, I think, really interesting to those of you who have done any myofascial release with us or fascia study with us, because we talk a lot about this fluid layer and the importance of it, both in Chinese medicine and in the fascial world. So hopefully this brings a little bit of information together, again, leaving a lot of space for the mystery and for the applications, but maybe feeding your curiosity on these two worlds. So let us know in the comments, and I look forward to our next conversation. Thank you, Katja. Me too. Till next time. Thanks for listening to Yoga Medicine. 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