Bridging Ancient Wisdom and Modern Neuroscience: Acupoints, Ashi Points, and Myofascial Trigger Points

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The concept of sore spots that can be leveraged for therapeutic purposes have been independently discovered and used as a treatment for musculoskeletal pain by different cultures in the middle east, Europe, Africa and Asia.

Otzi “The Iceman” believed to be 5,300 years old had 61 tattoos corresponding with acupuncture points and myofascial trigger points. Adapted from (Kean et al., 2013).

Bridging Ancient Wisdom and Modern Neuroscience: Acupoints, Ashi Points, and Myofascial Trigger Points

Using localized tender spots for therapeutic benefit was independently discovered and refined across the Middle East, Europe, Africa, and Asia. Across centuries and continents, diverse healing traditions recognized that targeted pressure on specific bodily sites could relieve musculoskeletal pain.

One of the earliest physical records of this phenomenon belongs to Ötzi "The Iceman," a 5,300-year-old human mummy naturally preserved in the Tyrolean Alps. Ötzi’s body features 61 distinct tattoos located over areas corresponding to modern myofascial trigger points and classical acupuncture points. Researchers believe these tattoos represent an early form of therapeutic treatment to alleviate chronic low back and knee pain (Kean et al., 2013).

The Historical Parallel: Acupoints, Ashi Points, and Myofascial Trigger Points

Unearthed in Chengdu, Sichuan, the Tianhui medical bamboo slips (dating from 202 BC to 25 AD) contain some of the oldest surviving clinical guides in Traditional Chinese Medicine. These texts introduce the concept of ying shu (应输), which describes immediate pain alleviation or a restorative sensation triggered by palpatory pressure on specific tender points (Liu & Liu, 2026).

The concept of Western Medical Acupuncture was pioneered by Felix Mann who began to view acupuncture as a form of peripheral nerve stimulation. Today, this practice uses neurophysiology and complex systems theory to map acupoints to nervous system pathways, local microvascular changes, and whole-body network regulation, bridging traditional concepts with modern medical science. Image From: Mann, F. (1962). Acupuncture: The Ancient Chinese Art of Healing. Heinemann.

Ying shu served as a conceptual precursor to Ashi points (阿是穴)—literally translating to "Ah, yes!" points—which traditional practitioners targeted to manage localized and regional musculoskeletal conditions. Centuries later, Western physicians independently re-examined these same pressure points:

  • 1930s: Jonas Henrik Kellgren began systematically investigating "referred pain from muscle."

  • Mid-20th Century: Janet Travell and David Simons built upon Kellgren’s work, mapping what we now define as myofascial trigger points. The result of their cumulative work was the textbook - Travell, Simons and Simons’ Myofascial Pain and Dysfunction (now in its 3rd edition).

These myofascial trigger points which are characterized by a taut band, a hypersensitive spot, and a predictable pattern of referred pain frequently mirror classical Ashi points and traditional acupoints in both anatomical location and clinical presentation (Lee et al., 2022). While nomenclature and underlying theoretical frameworks vary across cultures, the core clinical practice of identifying and treating focal tender spots remains a universal practice in pain management.

The term “myofascial trigger points” describes a phenomenon: sore, stiff, aching spots; Traditional Chinese Medicine have a similar phenomenon referred to as ashi points (阿是穴).

Pathophysiology: Moving Beyond the Localized Pathology

Historically, explanations for myofascial trigger points revolved around localized mechanical tissue hypotheses, such as focal muscle spasms or localized ischemia. However, research suggests these traditional narratives are incomplete. Rather than viewing these spots as localized muscular "knots," trigger points and Ashi points may be better understood as secondary hyperalgesia (increased sensitivity) involving diverse peripheral and central mechanisms rather than a “knot” being the root cause of pain.

Reactive loci are hyperirritable spots that cause local pain, referred pain, and tenderness when pressed (e.g., Ashi points, myofascial trigger points, neurogenic inflammatory spots, etc.). Rather than viewing these spots as localized muscular "knots," trigger points and Ashi points may be better understood as secondary hyperalgesia (increased sensitivity) involving dynamic peripheral and central mechanisms rather than a “knot” being the root cause of pain. Managing this and other musculoskeletal conditions requires an integrated systemic approach with considerations for brain, sensory, psychological, motor, and tissue factors.

Clinical Implications: Reframing How We Communicate

Hands-on therapy targeting these tender spots can benefit people suffering from musculoskeletal conditions such as temporomandibular disorders, tension-type headaches, and low back pain. However, the mechanisms driving this relief are far more complex than simple mechanical "release." Massage therapy, just like any other intervention cannot be explained by a single mechanism. Instead, it acts through a complex interplay of interconnected responses. This aligns with the concept of a "whole-person approach," which emphasizes the interconnectedness of biological, psychological, and social factors that contribute to our overall health and well-being.

Key Findings & Takeaways

  • Historical Continuity:

    The therapeutic use of localized tender spots is an ancient phenomenon. The 5,300-year-old mummy Ötzi "The Iceman" displays tattoos aligned with classical acupuncture and trigger point locations. Furthermore, over 2000 years ago ancient TCM texts such as the Tianhui medical bamboo slips explicitly describe ying shu—the relief of pain upon palpating tender points—which are a precursor to the concept of Ashi points and myofascial trigger points.

  • Anatomical & Clinical Overlap:

    Western mapping of myofascial trigger points by Kellgren, Travell, and Simons heavily mirrors the anatomical distribution and clinical behaviors (referred pain, local tenderness) of traditional Ashi points and acupoints.

  • Pathophysiological Shift:

    The international consensus criteria for myofascial trigger points require a taut band, a hypersensitive spot, and referred pain. However, legacy hypotheses blaming isolated mechanical "knots" or sustained local tissue contraction are insufficient. Modern evidence indicates myofascial trigger points and Ashi points reflect neurogenic inflammation involving a dynamic interface between localized tissue distress, peripheral sensitization, and central nervous system processing.

  • Clinical & Communication Strategy:

    While hands-on point therapy can effectively modulate musculoskeletal pain (e.g., temporomandibular disorders, tension headaches, low back pain), clinicians should avoid outdated mechanical narratives ("breaking up knots"). Instead, tender spots should be viewed as sensory convergence zones that can help people ‘reset’ how they experience pain and tension in the body.

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