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Meridian theory is a major part of Chinese medicine and has guided acupuncture and clinical practice for thousands of years. Meridian theory describes many important concepts about the rules of human body function and regulation, but has comparatively huge differences with the basic concepts of modern medicine. These differences have caused deep concern and attracted attention from scholars, both inside and outside of China. The interest in meridian theory lies in determining the structural nature of meridians. Not only is this information still unclear, it is very difficult to achieve clear results in a short period of time. Despite this, the phenomena of meridians can be used as the entry point for meridian studies. After many years of effort, although the physical structure of meridians has not been found, the existence of the meridian phenomena has been fully confirmed. Although there is a lack of morphological evidence for the existence of the meridian, concluding non-existence may be incorrect as morphology techniques develop and structures previously not determined are being found. Since the phenomenon of meridians exists, some biological basis behind its occurrence must be present. This implies that research on meridians needs to continue as research techniques advance and may eventually reveal the biological basis of the meridian phenomenon. In the present review, we analyze the history of meridian studies in China.
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©2010 Korean Pharmacopuncture Institute
J Acupunct Meridian Stud 2010;3(1):19
REVIEW ARTICLE
1. The Origin of Meridian Studies in
China
Meridians are passageways for the flow of “qi” and
“blood”, which are the two basic bodily fluids in
Chinese medicine. These passages include 12 stan-
dard channels, 12 collaterals, 8 extra meridians,
15 large collaterals, musculature of 12 meridians
and 12 skin divisions. Meridians spread on the sur-
face of the whole body vertically and horizontally,
in tegrating the inside with the outside of the body.
They also connect the inner organs, joints and ex-
tremities, thus transforming the whole body into
one entire organ. As Chinese medicine attaches
great importance to the concept that all body func-
tions are under the complete state of one organism,
the black-box theory was adopted in its research
[1]. The theory pays attention to changes in outside
phenomena, as such, its theoretical system lacks
an anatomical basis. However, along with the de-
velopment of modern medicine, people gradually
realized that acupuncture, that follows the meridian
theory, has the best outcomes; traditional Chinese
medicine believes that the therapeutic effects of
acupuncture are achieved through the meridian sys-
tem. Additionally, by studying a number of skin dis-
eases, propagated sensations and the migration of
isotopes along the meridians (Figures 1, 2 and 3,
Abstract
Meridian theory is a major part of Chinese medicine and has guided acupuncture
and clinical practice for thousands of years. Meridian theory describes many impor-
tant concepts about the rules of human body function and regulation, but has com-
paratively huge differences with the basic concepts of modern medicine. These
differences have caused deep concern and attracted attention from scholars, both
inside and outside of China. The interest in meridian theory lies in determining the
structural nature of meridians. Not only is this information still unclear, it is very
difficult to achieve clear results in a short period of time. Despite this, the phe-
nomena of meridians can be used as the entry point for meridian studies.
After many years of effort, although the physical structure of meridians has not
been found, the existence of the meridian phenomena has been fully confirmed.
Although there is a lack of morphological evidence for the existence of the merid-
ian, concluding non-existence may be incorrect as morphology techniques develop
and structures previously not determined are being found. Since the phenomenon
of meridians exists, some biological basis behind its occurrence must be present.
This implies that research on meridians needs to continue as research techniques
advance and may eventually reveal the biological basis of the meridian phenom-
enon. In the present review, we analyze the history of meridian studies in China.
Received: Oct 5, 2009
Accepted: Jan 14, 2010
KEY WORDS:
chemical characteristics;
interstitial fluid;
mask cells;
meridian;
meridian phenomena;
neural aspect
Meridian Studies in China: A Systematic Review
Guang-Jun Wang1, M. Hossein Ayati2, Wei-Bo Zhang1*
1Institute of Acupuncture and Moxibustion, China Academy of Chinese Medicine Science, Beijing, China
2Acupuncture School, Beijing University of Chinese Medicine, Beijing, China
*Corresponding author. Institute of Acupuncture and Moxibustion, China Academy of Chinese Medicine Science, No. 16, Dongzhimennei,
Beijing, 100700, China.
E-mail: zhangweibo@hotmail.com
2 G.J. Wang et al
medical knowledge. Meridian study and research
therefore attracted a lot of interest.
In 1963, Dr Bonghan Kim from North Korea [57]
announced the discovery of the meridian anatomy
and structure, and named them “Bonghan duct”
or “Bonghan capsule”. Bonghan’s work however
failed to be repeated and was widely questioned.
The Austrian expert Kellner stated that the struc-
ture Bonghan found exists, but was only a remnant
from development, and could not support the
function of the meridian system [8,9]. At the same
time, China planned to systematically duplicate
Bonghan’s work but failed to support Bonghan’s
conclusions, and the repeated work has not been
published. Neverthe less, during the repetition of
Bonghan’s work, a meridian research team was or-
ganized and marked the beginning of meridian
study in China. Prior to this, only a few histological
studies into acupoints had been conducted in China
(Table 1 [1021]).
2. The Main Significance of Meridian
Studies in China
2.1. Investigations into propagated
sensation along meridians
The effects of acupuncture rely on the integrity of
the nervous system, thus the study of meridians
focusing on the neural aspect has become common-
place. In the 1950s, Professor Xi-Jun Zhang stated that
action of the meridians is accomplished through
neural reflection [22]. From a gross anatomy per-
spective, meridian and acupoint regions are always
richly innervated. Moreover, the meridian and pe-
ripheral nervous systems are roughly very similar
in their path around the body, especially below the
elbow and knee joints where the meridians are al-
most along the path of the nerve trunks and their
main branches. Descriptions of meridian function
in classical Chinese medical records are also closely
related to the nervous system. Therefore, merid-
ian research from the neural perspective may still
be highly fruitful.
Propagated sensations along channels (PSC) is a
meridian phenomenon which was investigated in
over 100,000 people over 20 provinces in China in
1970s. These studies revealed that approximately
0.3% of people exhibited PSC. PSC is considered a
window for revealing the substance of the merid-
ian. However, this propagated sensation is a sub-
jective feeling, and must therefore be associated
with the central nervous system, particularly the
sensory cortex. This has led some researchers to be-
lieve that PSCs are an expanding excitement oc-
curring within the sensory cortex [23]. However,
Figure 1 Skin disease along the meridians. Figure taken
from Li [2].
Figure 2 Pagated sendation travelling along the Urinary
Bladder Channel. Figure taken with permission from Hu
and Cheng [3].
Figure 3 Migration of an isotope along meridians. Figure
taken from with permission from Meng et al [4].
respectively [2,3,4]), the existence of the merid-
ian phenomenon was confirmed. Ultimately, this
kind of regulating and controlling channel parallel to
the body surface cannot be explained by current
Meridian studies in China 3
this viewpoint may not stand as propagated sensa-
tions accompany reactions of the skin, blood ves-
sels and nerves. Furthermore, PSC can be blocked
by mechanically pressing on the meridians [24]. As
PSC can be stopped by outside pressure, it is rea-
sonable to presume that a form of active factor
is involved in the formation of PSC [25]. Myoelec-
tricity along meridians could be one such factor
[26]. Another explanation for propagated sensa-
tion caused by acupuncture may be related to the
axon reflection of the peripheral nerves and the mi-
gration of histamine between the peripheral nerve
terminals due to nerve-mast cell interaction [27].
Alternatively, the characteristic order of PSC could
happen between α motor neurons, based on the col-
umn structure in the spinal cord [28]. How ever, the
involvement of peripheral motive factor in propa-
gated sensation still does not explain this phenom-
enon in pseudomelia; therefore, when elucidating
the mechanism of propagated sensation, some re-
searchers place an emphasis on central nervous
processes [13,2930]. The question is whether it is
truly necessary to have a unique mechanism that
explains all the phenomena of PSC. Perhaps multi-
ple substances exist within both the peripheral and
the central nervous systems to give rise to the dif-
ferent aspects of PSC.
2.2. Comments on the essence of meridians
as a circulatory system
Neurology is a significant component in meridian
research, and raises important questions in de-
veloping the research. Meridians certainly shares
some common components with the nervous sys-
tem. Fur thermore, meridians certainly do not pos-
sess all nervous system structures and functions, or
vice versa [31]. Thus, the study of meridians from
Table 1 Landmark events of meridian study in China
Time Landmark events
1955 Study of Meridian was translated from Japanese to Chinese by Dan-An Chen.
1956 The study of meridian essence was classified as a key project of Natural Science Development
Plan in China, where histological studies were carried out on acupoints.
1963 “BHC” and “BHD” structures were reported by Bonghan Kim in North Korea.
19641970 Meridian essence was studied mainly using morphological methods.
1971 America president Nixon visited China; this induced the study of acupuncture-anesthesia widely.
19721987 Propagated sensation along channels and other meridian phenomena were studied widely.
19881992 Meridian study was classified as “7th five” plan, and the main content was migration of isotopes
along meridians.
Biophysics of Acupuncture-Meridians: The verification of the first invention in China was
published (Zu et al, 1989 [10]).
Modern Research of Meridians in TCM Theory was published (Hu et al, 1990 [11]).
Structure and Function of Meridians was published (Zhang, 1992 [12]).
19931997 Meridian study was classified as “8th five” plan, and the research content involved three parts:
the mechanism of propagated sensation along meridians; the relationship between meridians
and viscera; and the physical and chemical characters of meridians.
Clinical Meridians Phenomenology was published (Liu, 1994 [13]).
What is the Meridians was published (Zhang, 1997 [14]).
Soul of Gold Needle: The study of meridians was published (Hu, 1997 [15]).
Classical Meridian Theory and Modern Meridian Theory was published (Liu, 1997 [16]).
19982002 Meridian study was classified as “9th five” plan, and the research content still involved the same
three parts: the mechanism of propagated sensation along meridians; the relationship between
meridians and viscera; and the physical and chemical characters of meridians.
Discovery of Fourteen Meridian Channels Image was published (Meng et al, 1998 [17]).
2002present Discovery of Meridians in TCM Theory was published (Li et al, 2003 [18])
Science of Meridians was published (Zhang et al, 2003 [19]).
Meridians Medicine: The decode of meridians cipher code (Liu et al, 2007 [20]).
Meridians and Collaterals are the Water Passages was published (Zhang 2009 [21]).
BHC = Bonghan corpuscle; BHD = Bonghan duct.
4 G.J. Wang et al
the perspective of neurophysiology is unilateral.
Classic medical books show that meridian and blood
vessel naming are closely related, especially in older
texts [32,33]. The original meaning of “Mai” is blood
vessels [34]; studying the meridians as a circulatory
system may also be valid [35,36]. From a functional
point of view, not only vessels themselves [37], but
also the nerves in the vessel walls [38], and even
the rhythm in the microvascular networks of the
meridian system [39] have gradually become areas
of interest for researchers. Moreover, the lymphatic
system is also closely related to the meridian sys-
tem [40,41]. However, some academics oppose the
theory that a relationship exists between meridi-
ans and the circulatory system. They believe that
the movement of liquid in the vessels cannot form
the propagated sensation, and hence the circulatory
system cannot be equated to meridians [42,43].
2.3. Investigating the substance of
meridians from the aspect of
interstitial fluid flow
Since meridian function is identical to neither the
nervous system nor the circulatory system, then
why do meridians transport qi and blood as de-
scribed in the classic Chinese medicine theory and
how is this accomplished? The most direct way to
solving this issue is to observe how radio-labeled
material migrates in meridian lines. One study using
this technique showed 14 meridian lines in more
than 90% of cases based on a sample of 1000 par-
ticipants [44]. The migration routes were neither
blood nor lymph vessel [45]. Only micromolecules can
migrate along the meridians, and this migration is
powered by the different pressures generated by
blood and lymph circulation [46]. The migration
routes are not only continuous [47], but also consis-
tent with meridian lines [48]. Based on the above
experiments, Professor Wei-Bo Zhang proposed the
Low Hydraulic Resistance Channel Theory [49]. He
believes that the interstitial substance is hetero-
geneous, meaning that some parts have high perme-
ability and low resistance to the flow of interstitial
fluid, and thus form a low hydraulic resistance point
[50]. Adjacent low hydraulic resistance points can
transfer the hydraulic wave, indicating the connec-
tion among these points, thereby forming a chan-
nel [51,52]. By measuring hydraulic resistance,
transmission of the pressure wave and migration of
the isotope, low hydraulic resistance channels were
found along meridians which are believed to be the
main body of the meridians [5356]. Zhang also
put forward a neural-fluid transmission model to ex-
plain the effect of acupuncture and PSC, based on
the low hydraulic resistance channel (Figure 4 [57]).
From the perspective of modern microcircula-
tion, there is a minute gap between end capillary
vessels and interstitial fluid cells. The transporta-
tion of nutrients, exchange of information, as well
as the removal of metabolic waste not only depend
on the diffusion gradient, but also convection of
interstitial fluid. However, the process of intersti-
tial fluid flow still remains unknown. In recent
years the concept of a tissue channel has provided
a breakthrough point for solving these problems.
Afferent signal
Stimulate Mask cells P substance
Interstitial fluid increase
(impedance decrease)
Afferent nerve
To cortex
Meridian
Capillary expands
Needle
Histamine
Skin surface
New axon reflection
Axon reflection New afferent signal
Figure 4 Mechanism for the effect of acupuncture along meridians. Figure taken with permission from Zhang et al [57].
Meridian studies in China 5
It allowed the movement of interstitial fluid path-
way to be shown [58], and illustrated that the
function of the interstitial fluid pathway coincided
with the function of meridians [59]. Furthermore,
based on the fact that capillary vessels and colla-
gen fibers at the location of acupoints are arranged
in the direction of the meridians, it has been pro-
posed that the directional flow of interstitial fluid
is closely associated with meridians [60]. Professor
Wei-Sheng Yang has performed skin impedance stud-
ies for many years and found that meridian lines
have low impedance [61,62]. The cause of this low
resistance characteristic was thought to be due to
the relatively high amount of interstitial fluid and
the histological nature of the meridians, which are
rich in loose connective tissue [63,64].
As interstitial fluid pressure is lower than at-
mospheric pressure, and the changes in interstitial
hydraulic pressure have a direct impact on the lym-
phatic return and efficiency, an objection against
the view that interstitial fluid flow along the me-
ridian line was raised. Researchers Wei-Bo Zhang,
Guang-Hong Ding and Wei-Sheng Yang all have a
solid background in physics, yet proposed different
opinions on the same issue. W.B. Zhang put forward
the view that meridians are open channels of inter-
stitial fluid, without giving the direction of flow;
Ding emphasized a certain direction for interstitial
fluid flow; Yang emphasized the accumulation of
interstitial fluid in the connective tissue, neither
considered the movement of the interstitial fluid
or its direction.
2.4. Studying the substance of meridians
from the perspective of connective
tissue
In the early times, some studies noted the rela-
tionship between meridians and connective tissue,
suggesting that the meridians and connective tis-
sue are similar in many areas [65,66]. While inter-
preting the meridian phenomena, many theories
such as the quantum theory [67] and the structure
of crystal fluid [68], emphasized the role of con-
nective tissue. According to anatomical studies, the
shape and structure of meridians is closely related
to the connective tissue in parts of the lung merid-
ian [69], gall bladder meridian [70,71], and stomach
meridian [72]. In functional studies, the relation-
ship between the direction of collagen fibers along
the meridian and acupoints, and the function of
meridian and acupoints have been particularly em-
phasized [73]. A number of studies using automatic
computerized markers and three-dimensional re-
construction techniques, found an extreme simi-
larity between the interval connective tissue fascia
and the meridian longitudinal position. A model
was then proposed for the study of the fascia of me-
ridians [7476], as the function of this membrane
structure is to maintain the stability of the interior
body, and also is the specific reflection of merid-
ian substance in the human body.
3. The Relationship Between Mast Cells
and Meridians
As mast cells are widely distributed in connective
tissue and are also involved in various rapid physi-
ological responses, their relationship with the merid-
ians has received attention. Mast cells are thought
to play a key role in acute allergic reactions. They
also participate in delayed type hypersensitivity
[77], and fighting against bacterial [78,79] and par-
asitic infections [80]. Studies focusing on mast cell
function have clearly shown that their role is far
beyond what was previously understood. Mast cells
are now considered to be multi-potent and in-
volved in maintaining the stability of the interior
body [81,82].
Ji-Mei Song [83] in 1977 first proposed that mast
cells participate in the propagation sensation. This
is followed by a series of studies which showed
that the trend in the distribution of mast cells is to
follow the meridian line [8485]. Moreover, along the
low impedance line of the meridians, the number
of mast cells in different layers of skin was signifi-
cantly higher than the control area [86]. Some re-
searchers have questioned the role of mast cells in
the function of meridians [87], but evidence that
mast cells are involved in the activities and func-
tions of meridians has been found. In many organs
mast cells are located very close to the nerves
[88,89], and these nerves often contain substance P,
peptides related to the calcitonin-gene, and other
neurotransmitters and neuromodulators [90]. Under
appropriate stimulus, the nerve endings would re-
lease peptide-like substances, and mast cells would
express the receptors for these substances [91,92].
The activity of neurons would then lead to activa-
tion of mast cells to release granules or neuromodu-
lators [93]. Substances released by mast cells would
in turn act on nerves, and affect their function [94].
On the meridian line, skin nerves and mast cells can
establish functional links [9598]. Acupuncture stim-
ulation can act to increase not only the number of
mast cells [99], but also promote mast cell degran-
ulation [100103]. Acupoint injection with mast cell
granule contents, such as substance P, histamine
[104] and neurokinin-A [105] have been reported to
cause a significant increase in afferent nerve dis-
charge, indicating that active substances released
by mast cells participate in the formation of prop-
agated sensation [106].
6 G.J. Wang et al
4. Detecting Special Chemical
Characteristics Along the Meridians
Since meridian channels have their special path
and function, the composition of the material
found in the meridians might be different from
their surrounding areas. The effect of acupuncture
can be transferred through the meridian path, sug-
gesting that these paths have a higher excitability,
which may be due to the excitatory threshold de-
termined by trans-membrane ion concentration dif-
ference and ion flow. The transmission of information
necessarily has its carrier. Therefore, it seems that
investigating the structure and function of meridi-
ans by studying the changes of chemical substances
along the meridians is particularly important.
Among all basic ions, calcium ions are involved
in the meridian activities [107,108]. Acupoints are
Ca2+ enriched [109,110]; acupuncture can also fur-
ther increase Ca2+ concentration in the area of the
acupoint [111], which has given rise to the belief
that the effect of acupuncture relates to a surge
of Ca2+ [112]. Ion-specific research on meridian
lines has not been limited to Ca2+. Other ions, such
as Na+ and K+, are also involved in the functional
activities of meridians [113115]. Based on the
above understanding, it has been suggested that
the human body meridian system is the body’s bio-
electrical network of ion channels, within which the
flowing substances are K+, Na+, Cl, Ca2+ and other
ions. As a result acupoints, the meridians have low
impedance and high electrical conductivity prop-
erties [116]. The organism excitatory threshold is
directly related to the accomplishment of energy
metabolism, the higher the excitability, the more
vigorous the metabolism should be, which in turn
directly relates to both oxygen consumption and
carbon dioxide production. Therefore, the pres-
ence of carbon dioxide along the meridians would
be an important indicator for meridian activity.
Transcutaneous CO2 emission (TCE) refers to the
CO2 emitted from skin and produced from the tis-
sue when the citrate cycle takes place in living
cells. TCE along the meridians is higher in healthy
people [117]. Moreover, the relativity of TCE is higher
between Yuan-points of the exterior-interior me-
ridian couples and same name meridian couples
[118]. Also the relativity of TCE is higher on the
acupoints in one meridian [119].
Under pathological conditions, there is an im-
balance in the TCE between the left and right acu-
points with the same name [120]. Acupuncture can
act to increase the TCE [121] and diminish the oxy-
gen from the meridians [122]. This decrease in ox-
ygen content is definitely not due to reduced blood
flow, but an indication that acupuncture can en-
hance organic metabolism. Vigorous metabolism in
the organism implies an abundant blood supply,
leading to a rise in temperature, causing a stronger
infrared radiation. Research has shown the exist-
ence of linear bands of infrared radiation orbits
on a healthy body, and these radiation bands are
highly similar to the routes of ancient meridians
[123126]. The high temperature strips along me-
ridians can be induced by different types of acupunc-
ture [127]. The strips become more striking when
heating the acupoints or meridians [128]. When
there is pathology in internal organs, higher tem-
perature along the meridians may occur [129,130].
Rabbits with cholecystitis present with a high tem-
perature reaction along the gall bladder meridian
[131]. From the above analysis we can see that in
both physiological and pathological conditions, high
temperature response along meridians can occur,
suggesting that meridians have infrared or near in-
frared radiation characteristics.
5. Conclusion
Meridian study in China has a long, rich history and
is multi-directional. Obtaining a unique understand-
ing of meridians in a short time is difficult. Research
is continuing to determine the correct answer to
the age old question, “What is the meridian?”.
Acknowledgments
This work was supported by a 973 project grant
from the Ministry of Science and Technology of
China (2010CB530507) and by an independent
project grant from the China Academy of Chinese
Medical Science (ZZ2006089).
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... There are 12 principal meridians, each extending from an organ system to an extremity (Bai et al. 2011), with additional collateral channels and extra meridians forming a network that covers the whole body. It is argued that this network integrates the inside and outside of the body, thus transforming it into a single organ (Wang et al. 2010). In TCM, acupoints are said to be sites where the flow of Qi can be influenced, and pain is caused by a blockage of Qi (Hopwood 2004). ...
... The primo fluid has also been found to have directional flow, with a potential connection to the meridians (Cai et al. 2013). Interstitial fluid itself has been researched with reference to meridians (Wang et al. 2010) but it is unclear whether or not this is the same interstitial fluid found within the interstitial space described by Benias et al. (2018). Tomov et al. (2019) suggest that the interstitial fluid found in this new interstitial space could be the morphological substrate of the meridians. ...
... Langevin (2006) suggests that the connective tissue network forms a communications network for the whole body. The meridian pathways have certainly been previously linked to nervous, circulatory and lymphatic systems (Wang et al. 2010;Chang 2012). Since loose connective tissue infiltrates every system, it is possible that the PVS is also distributed among all the tissues and organs of the body (Stephanov et al. 2013). ...
Article
Full-text available
Over the last 20 years there have been advances in understanding the biochemical reactions involved in acupuncture, and attempts made to link traditional Chinese medical theories to scientific findings. The meridians have been linked to tissues in the body including perfora-tor blood vessels, the primo vascular system, the interstitial space and fascia. These tissues have, in the main, been linked to meridian theory independently, with discussion of overlapping areas in a few articles. This article attempts to describe these structures and tissue systems and analyze the similarities between them, linking them to Chinese concepts around acupuncture such as the meridians. This paper theorizes that the substrate of the meridians and flow of Blood and Qi is due to a combination of all these tissue structures working together, because they are significantly interlinked.
... e second hypothesis revolves around the electrical characteristics of acupuncture points/ meridians. As early as the 1950s, points and meridians were identified as localized sites with increased electrical conductivity, reduced resistance, and increased capacitance [1,10,11]. Furthermore, these electrically distinct points were associated with unique histological, functional properties such as increased gap junctions [12,13], nNOS expression [12,14], and subcutaneous collagenous bands [15]. e third hypothesis, which has garnered more interest recently, is the notion that acupoints are sites with increased pressure sensitization, which are further accentuated by the presence of clinical pathology [16][17][18][19]. ...
... One potential candidate for this role is the flow of interstitial fluids through connective tissues [15]. Past studies found that injection of tracer dyes at acupuncture points led to linear migration of the dye along a path aligning with acupuncture meridians [11,[20][21][22][23][24][25][26][27][28]. e observed migratory speed, path trajectory, and selective association with technetium-99 ( 99m TcO 4 , and not other nuclear dyes) led authors to speculate that paths were attributed to a yet undescribed channel with low hydraulic resistance through the extracellular matrix [29,30] and not to known vessels-vein or lymphatics [22,28]. ...
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Full-text available
The anatomical basis of acupuncture meridians continues to be enigmatic. Although much attention has been placed on potential correlations with inter/intramuscular fascia or lower electrical impedance, animal studies performed in the past 40 years have shown that tracer dyes—specifically Tc-99m pertechnetate—injected at strategic skin points generate linear migrations closely aligning with acupuncture meridians. To evaluate whether this phenomenon is also observable in humans, we injected two fluorescent dyes—fluorescein sodium and indocyanine green (ICG)—into the dermal layer both at acupuncture points (PC5, PC6, and PC7) and a nonacupoint control. Fifteen healthy volunteers were enrolled in this study. Of the 19 trials of fluorescein injected at PC6, 15 (79%) were associated with slow diffusion of the dye proximally along a path matching closely with the pericardium meridian. Furthermore, the dye emerged and coalesced proximally at exactly acupoint PC3. Injections of ICG at the acupoints PC5, PC6, or PC7 showed a similar trajectory close to the injection site but diverged when migrating proximally, failing converge on acupoint PC3. Injections of either dye at an adjacent PC6-control did not generate any notable linear pathway. Both ultrasound imaging and vein-locating device did not reveal any corresponding vessels (arterial or venous) at the visualized tracer pathway but did demonstrate correlations with intermuscular fascia.
... The crossing point between contemporary anatomy and the traditional Chinese views is the attempt to describe the morphological nature of the channels, through which the elusive Qi flows. To this moment, numerous studies have attempted to trace the anatomy of the meridians, but no conclusive data has been provided (Wang et al., 2010). The conflicting results can be cleared in the light of a recent finding. ...
... Another confirmatory to our notion data comes from studies suggesting relationship between meridians and connective tissue. The proposed existence of low-resistance routes along meridians and a preferred direction of liquid flow through them (Zhang, 1997;Wang et al., 2010) is highly likely to have a morphological substrate. It is possible that the interstitial network is more permeable in a certain direction. ...
Article
A network passing through interstitial tissues of the human body has been recently described. Despite its functional importance is yet unknown, we try to briefly summarize the known data and to interpret it from the viewpoint of Traditional Chinese medicine. We consider the peculiarities of the interstitium to be the morphological basis of at least some of the known phenomena along acupuncture meridians. This article is protected by copyright. All rights reserved.
... In clinical practice, acupoint massage can unblock meridians and collaterals, smooth qi and blood circulation, and regulate functions of Zang-fu organs through meridian conduction. 14,16,17 To the authors' knowledge, no systematic review that specifically examined the efficacy of acupoint massage in managing cognitive functions in older adults has been performed to date. In this study, they performed a literature search in international and Chinese databases for randomized controlled trials (RCTs) on acupoint massage. ...
... The educational level or literacy of the participants were not described in three studies. 16,17,19 These may result in an over-or underestimation of the results by altering the sensitivity and accuracy of the analysis. Future prospective studies with a larger sample size remain necessary to validate the present findings. ...
Article
Background: Cognitive disorders pose a major problem in the aging population across the globe. Acupoint massage has been used to improve cognitive functions in older adults. In this study, the authors performed a meta-analysis to evaluate the usefulness of acupoint massage in preventing cognitive declines in older adults. Design: The authors searched for randomized controlled trials (RCTs) reporting on the effectiveness of acupoint massage on cognition in older adults in the following literature databases: PubMed, MEDLINE, Embase, CINAHL, ScienceDirect, Foreign Medical Journal Service, Cochrane Library, VIP Information, Chinese National Knowledge Infrastructure, WANFANG, and Chinese Biomedical. Two reviewers independently extracted the data related to the study and participants' characteristics and the cognitive impairment outcomes. Only RCTs meeting the inclusion criteria were used in the present meta-analysis. Results: Eight RCTs with 657 participants in total (age ≥60 years) were included. It is actually 8 for synthetic and 6 in the meta-analysis. The authors calculated the pooled estimates of the random effects of changes in the Mini-Mental State Examination to compare the groups with and without acupoint massage. The merged mean difference (MD) was 1.94 (95% confidence interval, C.I., [1.41-2.47], p < 0.00001) after 3 months of acupoint massage treatment and 3.04 (95% C.I. [2.43-3.64], p < 0.00001) after 6 months of treatment. They also calculated the merged MD of the Wechsler Memory Scale-Revised Chinese version after 6 months of acupoint massage. Visual Reproduction was 2.95 (95% C.I. [1.30-4.60], p = 0.0005), Associate Learning was 1.89 (95% C.I. [1.41-2.37], p < 0.00001), Logical Memory was 2.85 (95% C.I. [2.06-3.63], p < 0.00001), and Digit Span was 3.16 (95% C.I. [2.59-3.73], p < 0.00001). The Cochrane Handbook for Systematic Reviews of Interventions was used to rate the quality of the studies, which was moderate overall. Conclusion: The findings suggested that acupoint massage is an effective intervention for maintaining cognitive functions in older adults.
... For more than half a century, exploring the biological connotation of meridians has been an attractive topic. With the help of modern methods such as biology, physics, and imaging, scholars worldwide have carried out much research to observe the structural characteristics and material basis of meridians [1,2]. Some scholars have carried out research in the field of specific protein and meridian material bases. ...
Article
Full-text available
In more than half a century, exploring the biological connotation of the meridians was one of the core components of scientific research studies in traditional Chinese medicine (TCM). Based on the previous works of low hydraulic resistance channel (LHRC) along meridians (LHRCM), the differential proteomics between the Alcian blue track (ABT) on LHRC along the conception vessel (CV) and nonmeridians tissue next to the CV were investigated in this study to explore the material basis and biological function of LHRCM. Proteomics based on LC-MS was introduced into the subcutaneous connective tissues (SCT) of ABT along the CV and the adjacent nonmeridian (1 cm from the CV). A total of 2328 proteins were identified from ABT along the CV and adjacent nonmeridian based on data-dependent acquisition (DDA) mode. In total, 1970 proteins were quantified based on the SWATH (sequential window acquisition of all theoretical fragment ions) label-free model, and the nonstandard and quantitative methods of MSALL were applied to analyze the data. There were 468 proteins differentially expressed. GO analytic results showed that the differential proteins were of varieties in molecular function and biological process. Most of differential proteins were involved in metabolic process, cellular process, response to hormone, and response to wounding. Further analysis showed that the upregulated differential proteins involved in ATP metabolism (ATP5E, GAPDH), redox reactions (Gpx-3), and Ca2+ transmembrane transport (CACNA2D1) were closely related to meridian phenomenon and acupuncture effect. These differential proteins would be potential characteristic proteins of the LHRC along the CV in rats which may be useful to deepen the knowledge on LHRCM.
... Convincing evidence based on meta-analyses has proved that acupuncture is effective for treating a wide range of diseases, such as pain conditions [1,2], respiratory diseases [3,4], cardiovascular disorders [5,6], and digestive diseases [7,8]. Although acupuncture is gaining increasing acceptance, as the guidance of almost all acupuncture clinical practices for thousands of years [9], the meridian theory and existence of meridian systems have been questioned abroad [10][11][12]. ...
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Objective. By comparing the differences in microcirculatory responses of the heart and lung meridians induced by moxibustion on these two meridians, respectively, this study aimed to investigate the specificity for site-to-site association on body surface between different meridians. Methods. Eighty healthy adults were enrolled and divided into the lung meridian intervention group and heart meridian intervention group in a ratio of 1 : 1. Three-channel laser Doppler flowmetry was used to monitor microcirculatory responses for the heart and lung meridians. Primary outcome was change of blood perfusion units (PU) of three measurement sites along the two meridians. Results. In the lung meridian intervention group, following moxibustion performed at LU5 of the lung meridian, PU in the distal site of the lung meridian increased significantly. By contrast, the PU of HT3 in the heart meridian, which was nearest to the moxibustion site, did not change significantly. PU in the distal site of the heart meridian declined. Meanwhile, significant difference in PU change was detected between the distal site of the lung meridian and the other two control sites of the heart meridians during moxibustion and postmoxibustion. Alternatively, similar to the results of the lung meridian intervention group, the specificity of microcirculatory response between the heart and lung meridians was observed in the heart meridian intervention group. Conclusions. For the heart and lung meridians, the effect of moxibustion-induced microcirculatory response may be more related to meridian routes than the specific distance between two sites located at different meridians, thereby supporting possible specificity for site-to-site association on the body surface between these two meridians. Nevertheless, given that only two meridians and limited measurement sites were compared, all current findings are not sufficiently robust. Further research should be conducted to investigate more meridians and measurement sites. 1. Introduction In recent years, acupuncture has received increasing attention in many western countries. Convincing evidence based on meta-analyses has proved that acupuncture is effective for treating a wide range of diseases, such as pain conditions [1, 2], respiratory diseases [3, 4], cardiovascular disorders [5, 6], and digestive diseases [7, 8]. Although acupuncture is gaining increasing acceptance, as the guidance of almost all acupuncture clinical practices for thousands of years [9], the meridian theory and existence of meridian systems have been questioned abroad [10–12]. According to the classical theories of acupuncture and traditional Chinese medicine (TCM), meridians distribute on the surface of the whole body vertically and horizontally, integrating the surface of the body with internal organs, thus transforming the whole body into one entire organ. That is to say, the essence of the meridian theory and meridian systems mainly manifests its summaries regarding the fundamental rules for correlation/specificity of different sites of the body. In the past few years, research highlights of meridian studies have focused on the acupoint specificity [13–15] and the correlation between body surface (i.e., meridians or acupoints) and internal organs [16–18]. Apart from these highlights, specificity for site-to-site association on the body surface between different meridians is also a core scientific problem to be solved in meridian studies [19]. A clearer understanding plays an important role in comprehensively revealing the fundamental rules of meridians and underlying mechanism of the specific effect of acupoints. It is also pragmatically valuable for enhancing the therapeutic effect of acupuncture in clinical practice. However, the value of its investigation was always underestimated or ignored in previous studies. To the best of our knowledge, the specificity for site-to-site association on the body surface between two specific meridians has not yet been systematically examined in humans. Therefore, the aim of this pilot study was to investigate the specificity for site-to-site association on the body surface between two specific meridians by using laser Doppler flowmetry (LDF). The heart and lung meridians were chosen as the two studied meridians and healthy adults were enrolled. We hypothesized that moxibustion on the stimulated meridian would induce different microcirculatory responses between the lung meridian and heart meridian. By comparison of microcirculatory response between these two meridians, the specificity for site-to-site association on the body surface between different meridians would be investigated. 2. Materials and Methods 2.1. Sample Size Estimation This is a pilot study for a full-scale trial in the future, the protocol of which has been published [20]. It is a meridian study concerning comparison of microcirculatory characteristic between the heart and lung meridians. Compared with general clinical trials, there was no unified standard for the sample size estimation. Hence, the sample size was mainly estimated according to similar meridian studies [21] and feasibility. Finally, 80 participants were planned. 2.2. Subjects A total of 80 healthy volunteers were recruited and divided into the lung intervention group (20 male and 20 female, aged 27.75 ± 3.79 years) and heart intervention group (20 male and 20 female, aged 27.93 ± 3.35 years) in a ratio of 1 : 1. Ethical approval (approval no.: ZSLL-KY-2019-001A-01) was obtained from the Ethics Committee of the Third Affiliated Hospital of Zhejiang Chinese Medical University. Informed consents were signed by all participants. All included healthy adults should provide a recent medical examination report to confirm that they had not major systemic diseases, such as cardiovascular, respiratory, digestive, urinary, hematological, endocrine, and neurological disease. They should not take any medication in the past three months. Participants who had alcohol dependence or drug abuse were excluded. 2.3. Experimental Procedure To minimize the interference effect induced by confounding factors, all LDF examinations were performed in a quiet experimental room, controlled for temperature and humidity (25°C ± 1°C; relative humidity 30–40%), in the morning at about the same time of day. All subjects were refrained from consuming coffee, tea, alcohol, or smoking cigarettes on the examination day. Exercise and food were also restricted at least one hour before the experiment. The participants were asked to stabilize for 30 mins in a supine position before LDF examination. They were informed to keep silent and breathe normally and avoid limb movement during the whole assessment period. A three-channel LDF (PeriFlux system 5000, Sweden) was used to monitor the microcirculatory flux of the heart and lung meridians, which had a wavelength of 780 nm and time constant 0.2. The fiber probe model attached to measurement sites was 407, which could detect surface microcirculatory flux. The LDF examination involved a 25 min recording of blood perfusion, including 5 min premoxibustion, 15 min moxibustion, and 5 min postmoxibustion phases. In addition, before and immediately after the LDF examination, fundamental physiological parameters of the subjects were measured using a manometer and thermometer, including heart rate, systolic blood pressure, diastolic blood pressure, and body temperature. The intervention procedures and LDF measurement sites of the heart and lung meridians in both groups are shown in Figures 1(a) and 1(b), respectively. The anatomical locations of the acupoints and the LDF measurement sites are displayed in Table 1. (a)
... Apesar disso, pôde-se observar que a maioria dos estudos (18)(19)21,(23)(24)(25)31) optou pela abordagem chinesa de tratamento. Os princípios do tratamento na MTC são baseados na crença de que o pavilhão auricular está relacionado a todas as partes do corpo e dos órgãos internos, e que ao estimular os acupontos auriculares pode-se ativar meridianos (24) , que são passagens para o fluxo de "qi" e "sangue", os dois fluidos corporais relevantes para a MTC, que se espalham por toda a superfície corporal, integrando o interior ao exterior do corpo (39) . ...
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Objective To investigate randomized clinical trials on the action of auricular acupuncture for chronic back pain in adults, and to identify the most commonly used outcomes for assessing this condition, the protocol used for applying the intervention, and the efficacy of the therapy on pain intensity. Method A systematic review and a metanalysis were carried out between June 2017 and May 2018, based on the PubMed, CINAHL, PEDro, Embase, Scopus, and the Virtual Health Library databases. Reference lists of systematic reviews were also explored. Results 427 studies were located, 15 included in the qualitative analysis, and seven in the quantitative analysis. Auricular acupuncture led to positive results in 80% of the studies. The most commonly used outcomes were pain intensity and quality, medication consumption, physical disability, and quality of life. There is a lack of protocol standardization for auricular acupuncture for chronic back pain. The metanalysis results showed that auricular acupuncture was effective in reducing pain intensity scores (p=0.038). Conclusion Auricular acupuncture is a promising practice for the treatment of chronic back pain in adults.
... In Traditional Chinese Medicine (TCM) theory, acupuncture effects are based on the integrity function of meridians, so the meridian might be the core concept of metaphysical acupuncture theory [1]. Because the various meridians are thought to be connected, practitioners usually apply acupuncture along the pathway from one region to another. ...
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Background: According to Traditional Chinese Medicine (TCM) theory, acupuncture effects are based on the integrity function of meridians. Meridians are thought to regulate body function through the normal flow of qi and/or blood. Disturbances in this flow are thought to cause disease, and acupuncture techniques are believed to cure disease by regulating this flow. However, it is still difficult to understand the exact meaning of qi and to evaluate the activation of meridians. Thus, more and more attention has been focused on the relationship of acupuncture and circulation. Methods: In this narrative review, the authors focus on the state of the art in acupoint activation, microcirculation response, and on investigation of mast cells, based on current literature research. Results: Altogether, 52 references are cited and discussed critically. A schematic diagram of the relationship between acupuncture stimulation, changes of microcirculation and mast cells is presented as result. Conclusion: The block diagram presented in this review article shows that mast cells might play an important role in circulation response after acupoint stimulation.
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