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Research Article
Anatomical Evidence of Acupuncture Meridians in
the Human Extracellular Matrix: Results from a Macroscopic
and Microscopic Interdisciplinary Multicentre Study on
Human Corpses
Norbert Maurer ,1Helmut Nissel,2Monika Egerbacher,3Erich Gornik ,4
Patrick Schuller,4and Hannes Traxler 5
1Johannes Bischko Institut f ¨
ur Akupunktur/Neurologisches Zentrum am Krankenhaus Rosenh¨
ugel Wien, 1130 Wien,
Riedelgasse 5, Private Practice for General Medicine, Kupelwiesergasse 16, 1130 Wien, Austria
2Johannes Bischko Institut f ¨
ur Akupunktur/Neurologisches Zentrum am Krankenhaus Rosenh¨
ugel Wien, 1130 Wien,
Riedelgasse 5, Private Practice for Internal Medicine, Schleifgasse 7, 1210 Wien, Austria
3Institute of Histology and Embryology, Department of Pathobiology, University of Veterinary Medicine,
Ve te ri n ¨
arplatz 1, 1210 Vienna, Austria
4Institute for Solid State Electronics, Vienna University of Technology, Gußhausstraße 25-25a (Geb¨
aude CH), 1040 Wien, Austria
5Center for Anatomy and Cell Biology, Division of Anatomy, Medical University of Vienna, W¨
ahringer Straße 13, 1090 Wien, Austria
Correspondence should be addressed to Hannes Traxler; hannes.traxler@meduniwien.ac.at
Received 12 October 2018; Revised 22 January 2019; Accepted 26 February 2019; Published 21 March 2019
Academic Editor: Gerhard Litscher
Copyright © Norbert Maureret al. is is an open access article distributed under the CreativeCommons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
For more than years, acupuncturehas been applied to support the healing of dierent diseases and physiologic malfunctions.
Although various theories of the meridian system and mechanisms were formulated to explain the functional basis of acupuncture,
the anatomical basis for the concept of meridians has not been resolved. e aim of the present study was to search for replicable
anatomical structures that could relate to meridians. To this end, four human specimens and additionally two lower legs were
dissected anatomically. Our study found evidence that acupuncture meridians were part of the human extracellular matrix and
that fascia was an important part of the anatomic substrate of acupuncture meridians. At the same time, we found vessel-nerve-
bundles, which were hypothesized to account for % of acupuncture points, only in a few acupuncture points. erefore, our
ndings contradict the theory that acupuncture points are only located along the nervous channels.
1. Introduction
As part of traditional Chinese medicine (TCM), acupuncture
has been an energetic and vibrant treatment with a successful
application for more than years [, ]. Acupuncture is an
ancient aspect of TCM with demonstrated therapeutic eects
[]. By acting (by needles, laser, moxa, pressure, etc.) on
certain areas on the surface of the skin, functional disorders
can be corrected, and pain can be reduced. Such areas are
dened as acupuncture points.
In TCM, meridians are strings connecting acupuncture
points, which are considered as passageways through which
energy ows throughout the body [, ]. e meridian
system is composed of principal meridians, each of which
connects to an organ system and extends to an extremity
and eight collaterals [–]. Acupuncture treatments should
improve the ow of energy through the meridian network [–
].
e morphological basis for the concept of meridians
in TCM has not been resolved. Recent articles support
a relationship between acupuncture points/meridians and
fascia []. Specically, anatomical observations of body scan
data demonstrated that the fascia network resembles the the-
oretical meridian system in salient ways, and physiological,
Hindawi
Evidence-Based Complementary and Alternative Medicine
Volume 2019, Article ID 6976892, 8 pages
https://doi.org/10.1155/2019/6976892
Evidence-Based Complementary and Alternative Medicine
F : VNB distal to the medial side of the le lower leg.
histological, and clinical observations support this hypothesis
[, ].
e aim of the present study was to clarify whether there
was macro- and microanatomical substrate of acupuncture
meridians.
2. Materials and Methods
Four specimens and additionally two lower legs were dis-
sected at the Medical University of Vienna/Division of
Anatomy and Cell Biology.
Our aim was to depict vascular nerve bundles of indi-
vidual acupuncture points in the course of the associated
meridian. A vascular nerve bundle (VNB) was dened as a
combination of nerves, arteries, veins, and lymphatics in the
body that travelled together.
Aer the initial incision, the skin and subcutis were
removed with the help of a scalpel until the supercial fascia
was found. Perforating vascular nerve bundles were carefully
separated from the subcutaneous adipose tissue. e bursa,
such as Bursa patellaris and olecrani, was extirpated. Due to
the lack of a supercial fascia in the facial area, the parotid
fascia and the facial muscles were dened as the supercial
layer.
Since, in most cases, no bundles of vascular nerve
bundles were found at the supposed acupuncture points,
we determined the acupuncture point lege artis on the
section preparation and dissected until the panniculus fascia
(fascia supercialis corporis). e sites were documented
photographically.
e collected tissue samples were xed in formalin and
embedded in paran for histological section production.
Sections were stained with haematoxylin & eosin (HE) and
stained for neuronal expression by immunohistochemical
detection of S- (DAKO, Glostrup, DK, dilution :,
detection substrate DAB).
3. Results
e main results from our anatomical and morphological
investigations can be found in the photographs from Figures
–. In Figure , diverse vascular nerve bundles (VNBs)
distal to the medial side of the le lower leg are depicted.
In Figure , we can recognize a VNB at the acupuncture
point and, proximal of it, we can see another VNB on the
ledorsum,butwithoutanacupuncturepointnearby.In
Figure , we see a VNB without a reference to a known
acupuncture point; the next known acupuncture point lies
distal to the VNB and dorsal to the lateral malleolus sinistra.
References of the detected VNBs to the anatomy of the
acupuncture meridian can be established with the help of the
investigations of Dr. Heine [, ]. Vascular nerve bundles
are dened according to Heine as a structural principle of
the acupuncture point. It is a perforating structure consisting
of a vegetative nerve, artery, and vein, surrounded by loose
connective tissue.
In Figure , the fascia course of the stomach meridian
can be seen. In Figures (a) and (b), we can perceive the
typical course of the stomach meridian in “Z-form” ST -
ST on the le (a) and right (b) lower leg. Figure
represents a preparatory presentation of the fascia of the
stomach meridian (supercial fascia cristis sinistra).
In Figure , we can discern the fascia course of the
gallbladder meridian between GB and GB
In Figure we can see the fascia course of the small
intestine meridian SI to SI at the fascia above the right
scapula. In Figure , we can discern the fascia course of
the large intestine meridian LI to LI on the right arm
laterally.
Figure shows that the structures of the external fascia
corporis cross the course of the gastric meridian at right
angles at the thigh. e fascia lata would correspond to the
course of the gallbladder meridian.
Figure shows that at the forefoot no courses of the fascia
corporis externa corresponding to the gastric meridian can
be found. e aponeuroses tendinum extensorum digitorum
pedis follows in one of its parts the course of the gastric
meridian.
In Figure , representative microphotographs of fascia
on the gastric and small intestine meridian are summarised.
In the verum, the change in the direction of the collagen
Evidence-Based Complementary and Alternative Medicine
F : VNB at the acupuncture point and proximal of it without acupuncture point on the le dorsum.
F : VNB without acupuncture point, acupuncture point distal to the VNB, and dorsal to the lateral malleolus sinistra.
bres is clearly visible (arrow), which is not present in the
preparation of placebo. In Figure , representative photomi-
crographs of fascia on the gastric and small intestine meridian
are indicated. Nerve bre bundles of approximately the same
calibre or vascular nerve were found in all preparations.
Two sections of the same piece of fascia were pho-
tographed each time, to make it clear that the fascia super-
cialisisnotofthesamesizeorstructurethroughout.Atthe
acupuncture point SI , the change in the bre direction was
particularly well represented. ere was no histological dif-
ference between verum (acupuncture meridian) and placebo.
Collagen was found as a morphological substrate for the
fascia of the meridians shown.
e fascia at the examined localisations varied in thick-
ness and consisted of two to three layers of collagen bres.
On the samples of both the gastric meridian and the small
Evidence-Based Complementary and Alternative Medicine
F : Fascia course of the stomach meridian.
(a) Typical course of the stomach meridian in “Z-form” ST -ST on the
le lower leg
(b) Typical course of the stomach meridian in “Z-form” ST -ST on the
right lower leg
F
F : Preparatory presentation of the fascia of the stomach meridian (supercial fascia cristis sinistra).
Evidence-Based Complementary and Alternative Medicine
F : Fascia course of the gallbladder meridian between GB and GB .
F : Fascia course of the small intestine meridian within the region of SI to SI at the fascia above the right scapula.
F : Fascia course of the large intestine meridian LI to LI on the right arm laterally.
Evidence-Based Complementary and Alternative Medicine
F : Fibre course of the fascia corporis externa on the right thigh. e bres run at right angles to the course of the stomach meridian.
e fascia lata corresponds to the course of the gall bladder meridian.
F : In the forefoot area, there are no structures of the fascia corporis externa that would correspond to a meridian course. Striking is
the tendons of the aponeuroses tendinum extensorum digitorum pedis, which in parts follow the gastric meridian.
intestine meridian, it was possible to show histologically the
changeofthebrecourseinaconnectivetissuelayer.iswas
not the case with the placebo preparation. In addition, there
was no histological dierence between verum (acupuncture
meridian) and placebo. In all preparations, smaller nerve
bre bundles or the perivascular plexus could be detected by
staining with S-. ere were no noticeable dierences in
the density or location of nerve bres between the verum and
the placebo.
We dissected four specimens and additionally two lower
legs, in total lower legs. On each shank, ten acupuncture
points ( of the stomach and of the gall bladder meridian)
were evaluated. Only in two of the evaluated acupuncture
points, we found VNBs, corresponding to % of cases.
4. Discussion
ereby, we established a close connection of acupuncture
points with structures of connective tissue. Heine has found
that, in % of acupuncture points, a bundle of vascular
nerves of so connective tissue passes through fascia holes
to the skin. e same anatomical structures were also found
by Egerbacher in cattle and dogs, without specifying a
percentage of the found VNBs per dissected acupuncture
points [].
By nding fascia fractions of the human extracellular
matrix with a bre run as the course of the acupuncture
meridian, we suggest that the anatomical substrate of the
acupuncture meridian is the fascia supercialis corporis
of the human extracellular matrix as it was suggested in
scientic works [–]. At the same time, we found that
parts of muscles, tendons, and ligaments follow the meridian
course (bladder meridian; large intestine meridian).
e histology showed that, between verum (acupuncture
meridian) and placebo, there is no detectable dierence. e
bre folding in the meridian progression could be detected
macroscopically and microscopically. However, aer xation
with formaldehyde %, the proteins of the tissue were
Evidence-Based Complementary and Alternative Medicine
Gastric meridian ST 36 – ST 38
Small intestine meridian SI 11
Gastric meridian Placebo
Small intestine meridian
Placebo
HE HE
F : Representative microphotographs of fascia on the gastric and small intestine meridian. In the verum (le column), the change in
the direction of the collagen bres is clearly visible (arrow); this is not present in the preparation of placebo (right column).
Gastric meridian ST 36 – ST 38 Gastric meridian Placebo
Small intestine meridian SI 11
Small intestine meridian
Placebo
F : Representative photomicrograph of fascia on the gastric and small intestine meridian. Nerve bre bundles of approximately the
same calibre or vascular nerve were found in all preparations. Immunohistochemical staining with an antibody against S-.
Evidence-Based Complementary and Alternative Medicine
denaturated. erefore, further investigations on unxed
tissue samples will be performed in future projects.
In addition, we could not represent fascia of an entire
acupuncture meridian. One of the reasons for this could be
that, in our preparations, the dissection of tissue adhesion
wasnoteasytoperform.Atthesametimewefoundno
corresponding bre courses of the fascia supercialis corporis
on the thigh and the forefoot, which would correspond to a
meridian course. We therefore hypothesize that other parts
of the fascia, but also tendon courses, anatomically depict the
meridian course.
Our study clearly supports the view that the human body’s
fascia network may be the physical substrate represented by
the meridians of TCM []. Specically, this hypothesis is sup-
ported by our anatomical, morphological, and histological
observations made in human corpses.
5. Conclusions
We suggest that not only fascia, especially the fascia corporis
externa, but also deeper parts form the anatomical substrate
of acupuncture meridians. In addition, parts of muscles,
tendons, and ligaments follow the meridian course. Our
observations build an anatomical basis for examining TCM
principles and therapies, and it supports a holistic approach
to diagnosis and treatment of diverse diseases.
SincewefoundVNBsinjustafewoftheacupuncture
points and as we found VNBs even without an acupuncture
point, we are no longer convinced that the sole concept of
the function of the acupuncture system over neural reexes
is valid.
Data Availability
e data used to support the ndings of this study are
available from the corresponding author upon request.
Disclosure
Norbert Maurer and Helmut Nissel shared rst authorship.
Conflicts of Interest
e authors declare that they have no conicts of interest.
Acknowledgments
e authors wish to express their gratitude referring to
Istvan Paraszti who died for his help with their study.
ey also want to express their thankfulness for the private
nancial support to Dr. Burkhard Gantenbein and to Dr.
FlorianKoschat.eirparticularthanksgotoMag.Barbara
Kretschmer MA who helped them with her computer literacy.
She worked for them even if she was sick and twenty-four-
sevenifnecessary.Inaddition,theauthorswanttothank
the photographers Edi Cvillink and omas Posch for their
excellent work.
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