Linking physical stimulation to molecular responses: The role and value of exosomes in mediating the systemic effects of Chinese Tuina

Abstract

Chinese Tuina, a fundamental manual therapy technique in traditional Chinese medicine (TCM), treats diseases by applying precisely regulated mechanical forces to the human body. Although its clinical benefits have been extensively documented across a range of conditions—from musculoskeletal pain to neurological disorders—the molecular mechanisms underlying its systemic effects remain partially understood. Meanwhile, exosomes, ubiquitous nanoscale extracellular vesicles, have emerged as key mediators of intercellular communication. These vesicles transfer proteins, lipids and nucleic acids to coordinate bodily homeostasis and responses to stimuli. This review integrates these two fields, proposing that the mechanical forces generated by Chinese Tuina (pressure: 50–300 kPa; shear force: 10–50 dyn/cm²; tension: 5%–20% strain; typical session duration: 15–45 min) constitute an efficient, non-invasive physiological stimulus capable of systemically regulating the production and release of functional exosomes. We systematically dissect the complete pathway initiating from the perception of mechanical forces at the site of manipulation, followed by exosome release from target cells, distribution via the circulatory system, and finally, the multi-dimensional impacts on distant organs. By defining Chinese Tuina as a “mechanical stimulator of the exosome network,” this review aims to establish a novel biological paradigm for manual therapy, providing profound insights into understanding its mechanisms of action and advancing the development of precision rehabilitation medicine.