Correspondences between Myofascial Trigger Points and Ashi Points in Traditional Chinese Medicine
When we practice acupressure and acupuncture or myofascial release, we commonly address tender or painful sites on the horse’s body. But what is the basis for this and what is the difference between modalities, if there is any?
In this blog post, I focus is on the differentiation between Ashi points in Traditional Chinese Medicine and myofascial trigger points as part of Western modalities. The role of Ashi points in relation to other acupoint classifications is also important and I will address this in a separate post.
Ashi Points
“Whatever hurts is the point” is a principle in Traditional Chinese Medicine and acupuncture and acupressure practice which formed the earliest basis in the identification and development of acupoints. Sensitive and painful points on the body were identified as points to be treated during a session. Acupuncture and acupressure practice and the system and nomenclature of acupoints, their location, grouping, characteristics and applications have vastly developed since these times. Yet, this principle, which can be found in several classical texts forming the foundation of today’s acupuncture and acupressure practice, still is part of modern practice. It means that irrespective of regular acupoint locations, points of pain, tenderness or discomfort in a certain area would be taken as the acupoint, i.e. the site of needling or manual application. Such points are referred to as Ashi points.
The term “Ashi” is understood to be a combination of “A” and “shi”, where “A” represents the patient’s scream and “shi” stands for the confirmation of the painful and tender spot or palpation point. Ashi points have no predetermined physical location so they can be found anywhere on the surface of the horse’s body.
Myofascial Trigger Points (TP)
As for myofascial trigger points (TPs), it was found that treatment of extremely tender, palpable hardenings in skeletal muscle brought pain relief to patients. Today, TPs are defined as hyperirritable sites in the taut bands of muscle tissue that can cause local pain and referred pain in other areas of the body. Tenderness at these nodules can cause muscle pain, weakness, spasms, and autonomic symptoms such as piloerection, vasoconstriction, hyperhidrosis, temperature changes, and a variety of somatovisceral responses.
Differences and Correspondences
Ashi points and TPs are both tender points which share common characteristics. Pressure on these points elicits a painful response. Whether someone practices Traditional Chinese Medicine or a Western modality that addresses myofascial pain, palpation is critical for the identification of these points.
There are also some differences between the two systems. TPs are found on the taut bands of muscle tissue, which means that their location is more specific than that of Ashi points which can be located anywhere on the body’s surface. Ashi points may be present in any superficial part of the body without consideration of muscle distribution. Ashi points can reflect diseases from non-muscle regions. TPs are frequently related to pain disorders, such as myofascial pain syndrome, and associated patterns of pain whereas Ashi points may be present in non-pain and non-muscular conditions.
While Ashi points and myofascial trigger points are not the same as they are based on two different treatment modalities and their very different approaches and underlying ways of thinking and viewing the body, there are clear correspondences and common features. Yet, no consent has been reached in medical science. While some identified strong correspondences and links between both point categories, this was negated and rejected by others. In a more recent study, Lee et al (2022) suggest that TPs are muscle-specific Ashi points. TPs and Ashi points share common features and characteristics where Ashi points are a broader category and TPs a subtype.
Irrespective of the scientific views and consensus on this, both Ashi points and TPs are frequently used in clinical practice. They definitely play an important role in my own practice which is focused on traditional East Asian medicine complemented by Western modalities such as myofascial release. And I consider the combination of both approaches and the learnings and insights and developments that come from them as highly beneficial for supporting the horses under my hands.
References:
Alvarez, D. J., and Rockwell, P. G. (2002). Trigger points: Diagnosis and management.
Brazkiewicz, A. (2020). Sports medicine acupuncture: An integrated approach combining sports medicine and traditional Chinese medicine.
Chen, D., Yang, G., Wang, F., and Qi, W. (2017). [Discussing the relationship among the ashi point, tender point and myofascial trigger point].
Frank, E. (2007), Myofascial Trigger Points and Acupuncture.
Lee, S., Lee, I., and Chae, Y. (2022), Similarities between Ashi acupoints and myofascial trigger points: Exploring the relationship between body surface treatment points.
Zheng, C., and Zhou, T. (2022). Effect of acupuncture on pain, fatigue, sleep, physical function, stiffness, well-being, and safety in fibromyalgia: A systematic review and meta-analysis.