Alternative Natural Therapy Relaxation and Acupuncture Clinic Logo

TCM Acupuncture Triple Warmer Fu Definition & Function. What do the Couli Element of the TCM Sanjiao Fu and the Extracellular Matrix (ECM) have in Common?  


I am Dr Louis Gordon and I am an acupuncturist. I practice acupuncture from ANTRAC Acupuncture Clinic in Middle Ridge, Toowoomba, 4350, Queensland, Australia. Just as fresh clean life-giving water bubbling up from a natural spring is vital to sustain life, my WELLNESS information will help YOU to sustain a healthy vibrant life beaming with optimal wellness. Call for more information on (07) 4636 6100.

MISSION STATEMENT: “I aim to get my patients as WELL as possible, as quickly as possible, and then keep them WELL”.

1360310678_Facebook1360314606_Twitter1360314763_youtube_oldAcupuncture YouTube video channel for Acupuncture videos.1360323267_Linkedin

  The Couli Element of the TCM Sanjiao and the Extracellular Matrix (ECM) Both Maintain Structural Integrity, Connection to the Environment, Communication, Immune Response and Tissue Growth and Development of Cells.


Is Sanjiao aka Triple Energizer, Triple Warmer the Extracellular Matrix (ECM)?

Researchers have recently confirmed that interactions occur between cancer cells and their local environment. In the article titled Cancer cells ‘talk’ to their environment, and it talks back, author Tom Fleischman (1) stated, ‘Interactions between an animal cell and its environment, a fibrous network called the extracellular matrix, play a critical role in cell function, including growth and migration. But less understood is the mechanical force that governs those interactions’. In the study of Biology, the Extracellular Matrix (ECM) is a non-cellular assemblage of extracellular molecules that are secreted by cells that allow structural scaffolding and biochemical support to the surrounding cells. The main fibrous ECM proteins are collagens, elastins, fibronectins and laminins.

Authors (2) of The extracellular matrix at a glance state, ‘Collagen is the most abundant fibrous protein within the interstitial ECM and constitutes up to 30% of the total protein mass of a multicellular animal. Collagens, which constitute the main structural element of the ECM, provide tensile strength, regulate cell adhesion, support chemotaxis and migration, and direct tissue development.’ They further state, ‘To date, 28 types of collagen have been identified in vertebrates. The majority of collagen molecules form a triple-stranded helix that subsequently can assemble into supramolecular complexes, such as fibrils and networks, depending on the type of collagen’ (emphasis is mine). Note later in the article that the term “li” in “Couli” means network.

I have written a book dedicated to vindicate the uniqueness of the Sanjiao aka Triple Warmer or Triple Energizer. The book titled The ‘Mystical’ TCM Triple Energizer. Its Elusive Location and Morphology Defined is an original book full of fascinating information that confirms that the ancient authors of many traditional Chinese medicine (TCM) classics knew amazing facts about the human body that medical and scientific research is only now discovering and vindicating. Collagen is the most abundant protein in the body and is a key constituent of all connective tissues. This easy-reading enlightening book is perfect for anyone wanting to know more about the intricacies that are being unravelled regarding the collagen-dominant Extracellular Matrix (ECM), which I believe is a major constituent of the mysterious TCM organ metasystem that ancient TCM practitioners called Sanjiao or Triple Warmer, and the World Health Organisation (WHO) terms the Triple Energizer. Note what these ancient scholars believed the Sanjiao was. In the commentaries for the 31st Difficult Issue in Unschuld’s (3) translation of the Nan-ching (page 355), Huang Wei-san said, ‘The Triple Burner . . . is a fatty membrane covering the entire physical body from the inside.’ And in the commentaries for the 38th Difficult Issue (1), on page 396, Li Chiung states, ‘The Triple Burner represents nothing but membranes’. This enlightening book can be securely purchased by clicking the ‘BUY NOW’ button at the bottom of this page.

Role and Importance of the Collagen-Dominant ECM

The article titled Extracellular matrix (4) states:

Due to its diverse nature and composition, the ECM can serve many functions, such as providing support, segregating tissues from one another, and regulating intercellular communication. The extracellular matrix regulates a cell’s dynamic behavior.

Formation of the extracellular matrix is essential for processes like growth, wound healing, and fibrosis. An understanding of ECM structure and composition also helps in comprehending the complex dynamics of tumor invasion and metastasis in cancer biology as metastasis often involves the destruction of extracellular matrix by enzymes such as serine proteases, threonine proteases, and matrix metalloproteinases.

The stiffness and elasticity of the ECM has important implications in cell migration, gene expression, and differentiation. Cells actively sense ECM rigidity and migrate preferentially towards stiffer surfaces in a phenomenon called durotaxis. They also detect elasticity and adjust their gene expression accordingly which has increasingly become a subject of research because of its impact on differentiation and cancer progression.

The article (4) further states, ‘Collagens are the most abundant protein in the ECM. In fact, collagen is the most abundant protein in the human body and accounts for 90% of bone matrix protein content’. Regards the issue of stiffness and elasticity, the article (4) notes ‘The ECM can exist in varying degrees of stiffness and elasticity, from soft brain tissues to hard bone tissues. The elasticity of the ECM can differ by several orders of magnitude. This property is primarily dependent on collagen and elastin concentration, and it has recently been shown to play an influential role in regulating numerous cell functions’.

Note that the diversity of the location where the ECM or Connective-Tissue Metasystem is present e.g. “soft brain tissues to hard bone tissues” is also the defined location of the Sanjiao, and that many of the functions of the ECM including “providing support, segregating tissues from one another, and regulating intercellular communication” are all defined functions of the Sanjiao. I do not believe that is a coincidence.

A Modern Method for Measuring the Force Exerted by a Cell has been Devised

Fleischman (1) reported, ‘A multidisciplinary team of Cornell engineers and colleagues from the University of Pennsylvania has devised a method for measuring the force a cell – in this case, a breast cancer cell – exerts on its fibrous surroundings’. These forces are poorly understood, and comprehending these forces would have profound implications for many scientific disciplines, including the fields of immunology and cancer biology research, and could greatly assist scientists to design superior biomaterial scaffolds for tissue engineering projects.

The team was led by Mingming Wu, who is associate professor in the Department of Biological and Environmental Engineering. Fleischman (1) reports that the group ‘developed 3-D traction-force microscopy to measure the displacement of fluorescent marker beads distributed in a collagen matrix. The beads are displaced by the pulling of migrating breast cancer cells embedded in the matrix. An important part of the puzzle was to calculate the force exerted by the cells using the displacement of the beads. That calculation was carried out by the team led by Vivek Shenoy, professor of materials science and engineering at the University of Pennsylvania’.

The group published their findings online 21 November 2016 in Proceedings of the National Academy of Sciences. The article was titled “Fibrous nonlinear elasticity enables positive mechanical feedback between cells and extracellular matrices.” Professor Wu advised that the group’s work was based around a basic question: ‘How much force do cells exert on their extracellular matrix when they migrate?’ ‘The matrix is like a rope, and in order for the cell to move, they have to exert force on this rope,’ she said. ‘The question arose from cancer metastasis, because if the cells don’t move around, it’s a benign tumor and generally not life-threatening.’

It’s only on the instances when cancerous cells migrate that serious complications can occur. The group found that cancer cell migration occurs through communication or “cross-talk” as they called it, between the individual cell and the surrounding matrix. They found ‘as the cell pulls on the matrix, the fibrous matrix stiffens; in turn, the stiffening of the matrix causes the cell to pull harder, which stiffens the matrix even more. This increased stiffening also increases cell force transmission distance, which can potentially promote metastasis of cancer cells’.

The team reported, ‘We’ve shown that the cells are able to align the fibers in their vicinity by exerting force.’ They further stated, ‘We’ve also shown that when the matrix is more fibrous – less like a continuous material and more like a mesh of fibers – they’re able to align the fibers through the production of force. And once the fiber is aligned and taut, it’s easier for cells to pull on them and migrate.’

Professor Wu stated, ‘I’m a strong believer that every new science discovery goes hand-in-hand with new technology development’, and ‘with every new tool, you discover something new.’ I too believe that this research will shine light on the remarkable Connective-Tissue Metasystem which I believe the ancient Chinese practitioners called the Sanjiao or Triple Warmer, with its smallest components called the Couli. 

Original Meaning of the Chinese Word Li is ‘Network’ and Cou is ‘Spaces’

Most living tissue is not composed only of tightly packed cells. Most tissues volume is made up of extracellular space, called the extracellular matrix. The extracellular matrix is the major determinant of the mechanical properties of most connective tissues. Fibroblasts within ordinary connective tissue secrete the extracellular matrix that produces the mechanical properties of connective tissue and membranes. Likewise, osteoblasts and chondroblasts secrete the extracellular matrix that produces the mechanical properties possessed by bone and cartilage respectively.

Regarding the original meaning of the Chinese word li, in the article titled ‘The location and function of the Sanjiao’, the authors, Qu Lifang and Mary Garvey (5), explain that the ancient meaning of li signified the intrinsic pattern or markings within entities—for example, the natural markings in the mineral jade or the muscle fibers within muscle tissue. In the author’s note in the study of the Mawangdui medical manuscripts by Donald Harper, he interprets the word li to mean ‘network’, which conveys the concept that li pertains to an intrinsic pattern or a system. The authors note that when the Neijing and later medical classics were written, the term li was equated to a network or a prevailing pattern in things, and within the medical context, li pertains to a pattern of textures that relate to the zang, fu, tissues, muscles, and skin areas of the body. This construct endorses the five-phase (wu xing) association and affiliation of specific organs, tissues, and body areas in accordance with TCM. Subsequently, the terminology couli exactly describes the highly structured Extracellular Matrix network system which is distributed throughout the entire body. The authors state, ‘The li-textures, their associations and distribution, thereby connect upper and lower, external and internal, shallow and deep. The cou, the spaces, are located between the body tissues and their textures: their existence is dependent on this association.’

The structural ‘Network’ and the intermediate ‘Spaces’ pertaining to the Couli can be clearly discerned in the graphical representation of the Extracellular Matrix above. I believe that this network of structural solid components and intermediate spaces that modern science calls the extracellular matrix is what the ancient Chinese scholars called the Couli, which was the microscopic embodiment of the Sanjiao or Triple Warmer, and subsequently I believe that the Connective-Tissue Metasystem is the Triple Energizer Metasystem.

Vindication that the Triple Energizer Fu is a Literal Amorphous Organ Metasystem

It is ironic that while the Extracellular Matrix largely determines the shape and the function of each tissue type, it has no defined morphology or ‘form’ itself, and was subsequently described in the Nan Ching as ‘having a name but no form’, which is absolutely correct. It does not have a form of its own, but is displaced externally by the organs and structures that it creates and supports. In the commentaries on the 38th Difficult Issue on page 396 of Unschuld’s (3) translation of Nan Ching, Ting Chin states ‘“It has a name but no form” because it encloses everything else like a cover on the outside. Hence, the text speaks of an “external palace.” In the twenty-fifth difficult issue, my commentary stated that the Triple Burner holds all the depots and palaces like a large bag’.

Unfortunately, students incorrectly inferred that if it has ‘no form’, then it must not exist as a literal organ. I aim to set the record straight and vindicate this misunderstood literal organ metasystem which is devoid of a defined morphology, and hence has “no form”.


(1) Fleischman, T. Cancer cells ‘talk’ to their environment, and it talks back. Cornell Chronicle. Nov. 21 2016. Available at: <>

(2) The extracellular matrix at a glance. Christian Frantz, Kathleen M. Stewart, Valerie M. Weaver. J Cell Sci 2010 123: 4195-4200; doi: 10.1242/jcs.023820

(3) Unschuld, P. U., Nan Ching: The Classic of Difficult Issues (e-book edn, Los Angeles: University of California Press, 1986), 771. With commentaries by Chinese and Japanese authors from the third through the twentieth century.

(4) Wikimedia Foundation Inc., ‘Extracellular matrix’ (2016). Available at: <>

(5) Lifang, Q. and M. Garvey, ‘The Location and Function of the Sanjiao’, Journal of Chinese Medicine, 65 (2001), 26–32.


I wish to sincerely thank Dr Paul U. Unschuld for the selfless and tireless work he has committed to make many ancient Chinese medical classics available in English for study and research. My book is based predominantly around his scholarly work ‘Nan-Ching: The Classic of Difficult Issues’. I also wish to sincerely thank Professor Unschuld for permission to use citations of his translation in my book. His translation of ‘Nan-Ching: The Classic of Difficult Issues’ can be purchased from the following link:

To Securely Purchase the Book, Click the ‘BUY NOW’ Button!




             Sanjiao’s Mystique Demystified


I supply WELLNESS Newsletters to my patients and all other parties who are interested in optimizing their health and wellness potential.  ANTRAC WELLNESS Newsletters are jam-packed full of current powerful health-related information to help you attain optimal wellness and vitality and start living life to the full. Did I mention that the Newsletters are FREE?  To confirm my promise of supplying vital information on all health issues, CLICK on “Wellness Newsletters” Navigation Bar above to sample the rich contents of the Newsletters.

If YOU haven’t already signed up and you would like to receive future ANTRAC WELLNESS Newsletters every 3 weeks hot off the press to your inbox, just click the Opt-In link below and supply your Email Address, First Name and Last Name. Subscription is absolutely FREE. How easy is that? I do NOT send out SPAM or supply your details to anyone else.