Evidens för akupunkturpunkter

Av: Helene M. Langevin* and Jason A. Yandow
Relationship of Acupuncture Points and Meridians
to Connective Tissue Planes

Acupuncture meridians traditionally are believed to constitute channels connecting the surface of the body to internal
organs. We hypothesize that the network of acupuncture points and meridians can be viewed as a representation of
the network formed by interstitial connective tissue. This hypothesis is supported by ultrasound images showing
connective tissue cleavage planes at acupuncture points in normal human subjects.

To test this hypothesis, we
mapped acupuncture points in serial gross anatomical sections through the human arm. We found an 80%
correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular
connective tissue planes in postmortem tissue sections. We propose that the anatomical relationship of acupuncture
points and meridians to connective tissue planes is relevant to acupuncture’s mechanism of action and suggests a
potentially important integrative role for interstitial connective tissue. Anat Rec (New Anat) 269:257–265, 2002.
© 2002 Wiley-Liss, Inc.
KEY WORDS: acupuncture; meridians; connective tissue; anatomy; fascia; signal transduction
INTRODUCTION
During acupuncture treatments, fine needles traditionally are inserted at specific locations of the body known as acupuncture points. According to classic Chinese theory, acupuncture
points are linked together in a network
of “meridians” running longitudinally
along the surface of the body
(Figure 1). Despite considerable efforts
to understand the anatomy and
physiology of acupuncture points and
meridians, the definition and characterization
of these structures remains
elusive (NIH Consensus Statement,
1997). The goal of this article is to
present evidence supporting a conceptual
model linking traditional Chinese
acupuncture theory with conventional
anatomy. We hypothesize that the
network of acupuncture points and
meridians can be viewed as a representation
of the network formed by
interstitial connective tissue and that
this relationship is relevant to acupuncture’s
therapeutic mechanism.
TRADITIONAL CONCEPTS
Acupuncture meridians are traditionally
thought to represent “channels”
through which flows “meridian qi”
(Kaptchuk, 2000). Although the concept
of meridian qi has no known
physiological equivalent, terms used
in acupuncture texts to describe the
more general term “qi” evoke dynamic
processes such as communication,
movement, or energy exchange
(O’Connor and Bensky, 1981). Disruption
of the meridian channel network is
believed to be associated with disease,
and needling of acupuncture points is
thought to be a way to access and influence
this system (Cheng, 1987).
Charts representing acupuncture
points and meridians date as far back
as 300 B.C. (Veith, 1949). Modern
acupuncture charts indicate 12 principal
meridians “connecting” the
limbs to the trunk and head. In addition,
many other “accessory” meridians
are also described, as well as deep
“internal branches” starting at specific
points on the principal meridians and
reaching internal organs. The names
of the principal meridians (e.g., lung,
heart) represent physiological functions
thought to be specifically related
to each meridian, rather than the actual
lung or heart organ itself. One
meridian named Triple Heater is
thought to be related to temperature
Dr. Langevin is a Research Assistant
Professor of Neurology at the University
of Vermont College of Medicine, as well
as a licensed acupuncturist. Her research
interests are the mechanism of
acupuncture, connective tissue-nervous
system interactions, and pain
mechanisms. Mr. Yandow is the Research
Assistant who produced the
photomontages shown in this study.
*Correspondence to: Dr. Helene M. Langevin,
Given C 423, Department of Neurology,
University of Vermont College of
Medicine, Burlington, VT 05405. Fax: 802-
656-8704; E-mail: hlangevi@zoo.uvm.edu
DOI 10.1002/ar.10185
Published online in Wiley InterScience
(www.interscience.wiley.com).
Despite considerable
efforts to understand
the anatomy and
physiology of
acupuncture points and
meridians, the definition
and characterization
of these structures
remains elusive.
THE ANATOMICAL RECORD (NEW ANAT.) 269:257–265, 2002
© 2002 Wiley-Liss, Inc.
balance between different parts of the
body. Acupuncture points are mostly
located along the meridians, although
“extra” points outside the meridian system
are also believed to exist. Although
acupuncture texts and atlases generally
agree on the location of the principal
meridians, considerable variability exists
as to the number and location of
internal branches and extra points.
The Chinese character signifying
acupuncture point also means “hole”
(O’Connor and Bensky, 1981), conveying
the impression that acupuncture
points are locations where the needle
can gain access to some deeper tissue
components. Modern acupuncture
textbooks contain visual charts as well
as written guidelines for locating each
acupuncture point. These guidelines
refer to anatomical landmarks (such
as bony prominences, muscles, or tendons)
as well as proportional measurements
(e.g., fraction of distance
between elbow and wrist) (Cheng,
1987). During acupuncture treatments,
acupuncturists use these landmarks
and measurements to determine the location
of each point within approximately
5 mm. Precise point location
within this range is achieved by palpation,
during which the acupuncturist
searches for a slight depression or yielding
of the tissues to light pressure.
ARE ACUPUNCTURE POINTS
DIFFERENT FROM SURROUNDING
TISSUE?
Over the past 30 years, studies aimed at
understanding the acupuncture point/
meridian system from a “Western” perspective
mainly have searched for distinct
histological features that might
differentiate acupuncture points from
surrounding tissue. Seveal structures,
such as neurovascular bundles (Rabischong
et al., 1975; Senelar, 1979; Bossy,
1984), neuromuscular attachments
(Liu et al., 1975; Gunn et al., 1976;
Dung, 1984), and various types of sensory
nerve endings (Shanghai Medical
University, 1973; Ciczek et al., 1985),
have been described at acupuncture
points. However, none of these studies
included statistical analyses comparing
acupuncture points with appropriate
“nonacupuncture” control points.
Other studies have turned their attention
to possible physiological differences
between acupuncture points
and surrounding tissues. Skin conductance
has been reported by several
investigators to be greater at acupuncture
points compared with control
points (Reishmanis et al., 1975; Comunetti
et al., 1995). Several factors,
on the other hand, are known to affect
skin conductance (e.g., pressure,
moisture, skin abrasion; Noordegraaf
and Silage, 1973; McCarroll and Rowley,
1979), and to date, no study has
both controlled for these factors and
included sufficient numbers of observations
to confirm these findings. Attempts
to identify anatomical and/or
physiological characteristics of acupuncture
points, therefore, have remained
mostly inconclusive.
Ancient acupuncture texts contain
several references to “fat, greasy
membranes, fasciae and systems of
connecting membranes” through
which qi is believed to flow (Matsumoto
and Birch, 1988), and several
authors have suggested that a correspondence
may exist between acupuncture
meridians and connective
tissue (Matsumoto and Birch, 1988;
Oschman, 1993; Ho and Knight,
1998). Recent work done in our laboratory
has begun to provide experimental
evidence in support of this hypothesis.
We have characterized a
connective tissue response to acupuncture
needling that is quantitatively
different at acupuncture points
compared with control points (Langevin
et al., 2001b) and that may constitute
an important clue to the nature of
acupuncture points and meridians.
Figure 1. Acupuncture meridians of the arm. Acupuncture points were located by palpation
in a living subject, according to anatomical guidelines provided in a major reference
acupuncture textbook (Cheng, 1987). Connective tissue planes associated with Yin meridians
are more inward and deep, compared with the generally outward and superficial
planes associated with Yang meridians.
258 THE ANATOMICAL RECORD (NEW ANAT.) FEATURE ARTICLE
BIOMECHANICAL RESPONSE TO
NEEDLING: “NEEDLE GRASP”
An important aspect of traditional
acupuncture treatments is that acupuncture
needles are manually manipulated
after their insertion into the
body. Needle manipulation typically
consists of rapid rotation (back-andforth
or one direction) and/or pistoning
(up-and-down motion) of the needle
(O’Connor and Bensky, 1981).
During needle insertion and manipulation,
acupuncturists aim to elicit a
characteristic reaction to acupuncture
needling known as “de qi” or “obtaining
qi.” During de qi, the patient
feels an aching sensation in the area
surrounding the needle. Simultaneously
with this sensation, the acupuncturist
feels a “tug” on the needle,
described in ancient Chinese texts as
“like a fish biting on a fishing line”
(Yang, 1601). We refer to this biomechanical
phenomenon as “needle
grasp.”
According to traditional teaching, de
qi is essential to acupuncture’s therapeutic
effect (O’Connor and Bensky,
1981). One of the most fundamental
principles underlying acupuncture is
that acupuncture needling is thought to
be a way to access and influence the
meridian network. The characteristic
de qi reaction, perceived by the patient
as a needling sensation and by the acupuncturist
as needle grasp, is thought to
be an indication that this goal has been
achieved (Cheng, 1987). The biomechanical
phenomenon of needle grasp,
therefore, is at the very core of acupuncture’s
theoretical construct.
Needle grasp is enhanced clinically
by manipulation (rotation, pistoning)
of the acupuncture needle. In previous
human and animal studies using a
computerized acupuncture-needling
instrument (Langevin et al., 2001b,
2002), we have quantified needle
grasp by measuring the force necessary
to pull the acupuncture needle
out of the skin (pullout force). We
have shown that pullout force is indeed
markedly enhanced by rotation
of the needle. Needle grasp, therefore,
is a measurable tissue phenomenon
associated with acupuncture needle
manipulation. In a quantitative study
of needle grasp in 60 healthy human
subjects (Langevin et al., 2001b), we
measured pullout force at eight different
acupuncture point locations, compared
with corresponding control
points located on the opposite side of
the body, 2 cm away from each acupuncture
point. We found that pullout
force was on average 18% greater at
acupuncture points than at corresponding
control points. We also
found that needle manipulation increased
pullout force at control points
as well as at acupuncture points. Needle
grasp, therefore, is not unique to
acupuncture points, but rather is enhanced
at those points.
ROLE OF CONNECTIVE TISSUE
IN NEEDLE GRASP
Although previously attributed to a
contraction of skeletal muscle, we
have shown that needle grasp is not
due to a muscle contraction but rather
involves connective tissue (Langevin
et al., 2001a, 2002). In both in vivo and
in vitro experiments, we have found
that, during acupuncture needle rotation,
connective tissue winds around
the acupuncture needle, creating a tight
mechanical coupling between needle
and tissue. This needle-tissue coupling
allows further movements of the needle
(either rotation or pistoning) to pull and
deform the connective tissue surrounding
the needle, delivering a mechanical
signal into the tissue.
Observation under a microscope of
an acupuncture needle inserted into
dissected rat subcutaneous tissue reveals
that a visible “whorl” of tissue
can be produced with as little as one
turn of the needle (Figure 2A). When
the needle is placed flat onto the subcutaneous
tissue surface and then rotated,
the tissue tends to adhere to and
follow the rotating needle for 180 degrees,
at which point the tissue adheres
to itself and further rotation results
in formation of a whorl. This
phenomenon can be observed to varying
degrees with acupuncture needles
of different materials (stainless steel,
gold) as well as with other objects not
customarily used as acupuncture
tools such as regular hypodermic needles,
glass micropipettes, siliconized
glass, and Teflon-coated needles. An
important factor appears to be the diameter
of the rotating needle. Acupuncture
needles are very fine (250–
500 _m diameter). With needles
greater than 1 mm in diameter, the
tissue invariably follows the rotating
needle for less than 90 degrees and
then falls back, failing to stick to itself
and initiate winding. Initial attractive
forces between the rotating needle
and tissue, thus, may be important to
initiate the winding phenomenon.
These may include surface tension
and electrical forces and may be influenced
by the material properties of
the needle.
When we compared two equal diameter
acupuncture needles, one reusable
needle made of gold (ITO, Japan)
and one disposable made of
stainless steel (Seirin, Japan), the gold
needle appeared to initiate winding
more readily than the stainless steel
one. Scanning electron microscopy
images of the two needles (Figure
2B–D) showed that the gold needle
had a rougher surface, which may
have more successfully “engaged” the
tissue during the initiation of winding.
These observations also suggest
that mechanical coupling between
needle and tissue can occur even
when the amplitude of needle rotation
is very small (less than 360 degrees) as
commonly used in clinical practice.
We have also shown that, with backand-
forth needle rotation, which is
generally preferred clinically over rotation
in one direction, winding alternates
with unwinding, but unwinding
is incomplete, resulting in a gradual
buildup of torque at the needle–tissue
interface (Langevin et al., 2001b).
The importance of establishing a
mechanical coupling between needle
and tissue is that mechanical signals
(1) are increasingly recognized as important
mediators of information at
the cellular level (Giancotti and Ruoslahti,
1999), (2) can be transduced
into bioelectrical and/or biochemical
signals (Banes et al., 1995; Lai et al.,
2000), and (3) can lead to downstream
Needle grasp is not
unique to acupuncture
points but rather
is enhanced at
those points.
FEATURE ARTICLE THE ANATOMICAL RECORD (NEW ANAT.) 259
effects, including cellular actin polymerization,
signaling pathway activation,
changes in gene expression, protein
synthesis, and extracellular
matrix modification (Chicurel et al.,
1998; Chiquet, 1999). Changes in extracellular
matrix composition, in
turn, can modulate the transduction
of future mechanical signals to and
within cells (Brand, 1997). Recent evidence
suggests that both tissue stiffness
and stress-induced electrical potentials
are affected by connective
tissue matrix composition (Bonassar
et al., 1996) and that changes in matrix
composition in response to mechanical
stress may be an important
form of communication between different
cell types (Swartz et al., 2001).
Acupuncture needle manipulation,
thus, may cause lasting modification
of the extracellular matrix surrounding
the needle, which may in turn influence
the various cell populations
sharing this connective tissue matrix
(e.g., fibroblasts, sensory afferents,
immune and vascular cells).
In addition, we have hypothesized
previously that, in the vicinity of the
needle, acupuncture-induced actin
polymerization in connective tissue fibroblasts
may cause these fibroblasts
to contract, causing further pulling of
collagen fibers and a “wave” of connective
tissue contraction and cell activation
spreading through connective
tissue (Langevin et al., 2001a). This
mechanism may explain the phenomenon
of “propagated sensation,” i.e.,
the slow spreading of de qi sensation
sometimes reported by patients along
the course of an acupuncture meridian
(Huan and Rose, 2001).
CORRESPONDENCE OF
ACUPUNCTURE POINTS AND
MERIDIANS TO CONNECTIVE
TISSUE PLANES
Acupuncture meridians tend to be located
along fascial planes between
muscles, or between a muscle and
bone or tendon (Cheng, 1987). A needle
inserted at the site of a connective
tissue cleavage plane will penetrate
first through dermis and subcutaneous
tissue, then through deeper interstitial
connective tissue. In contrast, a
needle inserted away from a connective
tissue plane will penetrate dermis
and subcutaneous tissue, then reach a
structure such as muscle or bone. Because
needle grasp involves interaction
of the needle with connective tissue
(Langevin et al., 2002), the
enhanced needle grasp response at
acupuncture points may be due to the
needle coming into contact with more
connective tissue (subcutaneous plus
deeper fascia) at those points. The
presence of needle grasp at control
points as well as at acupuncture
points is consistent with some
amount of connective tissue (subcutaneous)
being present at all points.
This concept is illustrated in Figure 3,
which shows ultrasound images of the
same acupuncture point and corresponding
control point in two normal
human subjects. The acupuncture
point is located on the skin overlying
Figure 2. A: Formation of a connective tissue “whorl” with needle rotation. Rat subcutaneous connective tissue was dissected and placed
in physiological buffer under a dissecting microscope. An acupuncture needle was inserted through the tissue and progressively rotated.
Numbers 0 through 7 indicate numbers of needle revolutions. A visible whorl of connective tissue can be seen with as little as one revolution
of the needle. B: Scanning electron microscopy imaging of reusable gold (left) and disposable stainless steel (right) acupuncture needles.
Original magnification, 350_. C,D: Scanning electron microscopy of gold (C) and stainless steel (D) needles. Original magnification, 3,500_.
The surface of the gold needle is visibly rougher than that made of stainless steel. Scale bars _ 2.5 mm in A, 100 _m in B, 10 _m in C,D.
260 THE ANATOMICAL RECORD (NEW ANAT.) FEATURE ARTICLE
the fascial plane separating the vastus
lateralis and biceps femoris muscles.
The control point, located 3 cm away
from the acupuncture point, is located
over the belly of the vastus lateralis
muscle.
To investigate the hypothesis that
acupuncture points are preferentially
located over fascial planes, we marked
the location of all acupuncture points
and meridians in a series of gross anatomical
sections through the human
arm (Research Systems Visible Human
CD, Boulder, CO) (Figure 4). The
interval between sections corresponded
to one “cun” or anatomical
inch (a proportional unit measurement
used in acupuncture textbooks
to locate acupuncture points) representing
1/9 of the distance between
the elbow crease and the axially fold
(in this case 2.5 cm). This section interval
allowed us to include all acupuncture
points located on the six
principal meridians of the arm between
the olecranon (Figure 4, section
0) and the superior edge of the humeral
head (Figure 4, section 12). In
each section, we marked all acupuncture
points and the intersection of all
meridians with the plane of section
(meridian intersection).
Acupuncture points and meridian intersections
were located according to
written guidelines (based on anatomical
landmarks and proportional measurements)
and acupuncture charts
provided in a major textbook of traditional
Chinese acupuncture (Cheng,
1987). Because connective tissue planes
were visible on the anatomical sections,
every attempt was made to minimize
bias by adhering to these guidelines as
objectively as possible. In a live subject,
palpation is used to locate acupuncture
points precisely once the approximate
location has been determined by using
anatomical landmarks and proportional
measurements. For some points,
body parts are manipulated and positioned
in a specific way to perform this
palpation. In the case of our postmortem
sections, the points needed to be
located in the anatomical position without
the benefit of palpation. When written
descriptions referred to anatomical
landmarks palpable in the anatomical
position (such as the olecranon or biceps
tendon), we used the position of
the bones, tendons, and muscles in the
cross-sections to determine where these
landmarks would have been palpable
on the surface of the body. For those
points where palpation is traditionally
performed in a position other than the
anatomical position, we guided ourselves
on (1) charts from acupuncture
textbooks drawn in the anatomical position,
and (2) a live human model on
which we located acupuncture points
by palpating them in the position specified
in the textbook, and then placed
the model’s arm in the anatomical position
(Figure 1). Textbook guidelines
referring to proportional measurements
(such as a fraction of the distance
between the elbow crease and axially
fold) are traditionally defined in
the anatomical position. We, therefore,
were able to apply these measurements
directly to the postmortem tissue sections
by determining appropriate section
numbers based on the section interval,
and making measurements on
individual cross-sections.
By using these guidelines, we
marked three acupuncture points on
the heart meridian (H3, H2, H1), two
points on the pericardium meridian
(P3, P2), five points on the lung me-
Figure 3. Ultrasound imaging of acupuncture (AP) and control (CP) points. Acupuncture point GB32 was located by palpation in two
normal human volunteers, as well as a control point located 3 cm away from the acupuncture point. After marking both points with a skin
marker, ultrasound imaging was performed with an Acuson ultrasound machine equipped with a 7 MHz linear probe. A visible connective
tissue intramuscular cleavage plane can be seen at acupuncture points but not at control points. V.Lat, vastus lateralis; B.Fem, biceps
femoris; Sc, subcutaneous tissue.
FEATURE ARTICLE THE ANATOMICAL RECORD (NEW ANAT.) 261
Figure 4. Location of acupuncture points and meridians in serial gross anatomical sections through a human arm. The interval between
sections corresponds to one “cun” or anatomical inch representing 1/9 of the distance between the elbow crease and the axially fold (in
this case, 2.5 cm). Sections begin at the olecranon (0) and end at the superior edge of the humeral head (12). Acupuncture points,
meridian intersections, and specific meridians are labeled according to the legend.
262 THE ANATOMICAL RECORD (NEW ANAT.) FEATURE ARTICLE
ridian (L5, L4, L3, L2, L1), five points
on the large intestine meridian (LI11,
LI12, L113, LI14), five points on the
triple heater meridian (SJ10, SJ11,
SJ12, SJ13, SJ14), and four points on
the small intestine meridian (SI8, SI9,
SI10, SI11) for a total of 24 acupuncture
points. Meridians intersected
with the plane of section at 51 other
sites that were not acupuncture
points.
As shown in Figure 4, three of six
meridians included portions that followed
fascial planes between muscles
(biceps/triceps [heart meridian, Figure
4, sections 2–7], biceps/brachialis
[lung meridian, Figure 4, sections
4–5], and brachialis/triceps [large intestine
meridian, Figure 4, sections
3–5]). Some points on those meridians
(H2, LI14, H1) also appeared to be
located at the intersection of two or
more fascial planes. Two other meridians
included portions that followed
intramuscular cleavage planes [between
heads of biceps (pericardium
meridian, Figure 4, sections 5–7) and
triceps (triple heater meridian, Figure
4, sections 2–6)]. One meridian (small
intestine meridian) did not itself follow
any recognizable inter- or intramuscular
plane. However, three out of
the four acupuncture points on this
portion of the meridian (SI9, 10, and
11) clearly coincided with the intersection
of multiple fascial planes.
Overall, more that 80% of acupuncture
points and 50% of meridian intersections
of the arm appeared to
coincide with intermuscular or intramuscular
connective tissue planes.
To estimate the probability that
such an event would be due to chance,
we tested a model representing the
middle portion of the arm (sections
2–7) approximated to a cylinder 12.5
cm long and 30 cm in circumference,
and including eight acupuncture
points and 28 meridian intersections.
Assuming that the average width of
the five major fascial planes of the
arm (triceps/triceps, biceps/brachialis,
brachialis/triceps, between heads
of triceps, and between heads of biceps)
is 1/60 of the circumference of
the cylinder (or approximately 5 mm),
1/12 of the surface of the cylinder will
intersect with a fascial plane. If we
also assume that the “width” of an
acupuncture point is 5 mm, the probability
that a random point in any
given section of the cylinder will fall
on a fascial plane is 1/12 or 0.083.
Using the hypergeometric distribution
(sampling without replacement),
the probability that either six or seven
of eight points (75 or 87%) randomly
distributed in six sections through the
cylinder would fall on fascial planes is
P _ 0.001. Likewise, taking 5 mm as
the “width” of a meridian, the probability
of 14 of 28 meridian intersections
(50%) falling on fascial planes is
also P _ 0.001.
These findings suggest that the location
of acupuncture points, determined
empirically by the ancient Chinese,
was based on palpation of
discrete locations or “holes” where the
needle can access greater amounts of
connective tissue. Some portions of
meridians clearly follow one or more
successive connective tissue planes,
whereas others appear to simply “connect
the dots” between points of interest.
On the basis of these findings and
our previous experimental results
(Langevin et al., 2001b, 2002), we propose
that acupuncture charts may
serve as a guide to insert the needle
into interstitial connective tissue
planes where manipulation of the needle
can result in a greater mechanical
stimulus. A greater therapeutic effect
at acupuncture points may be at least
partly explained by more powerful
mechanical signaling and downstream
effects at those points.
We chose the arm for this study because
it offers relatively simple anatomy
and widely spaced fascial planes
(compared with, for example, the
forearm) and also because the arm
illustrates how both meridians and
connective tissue planes “connect” the
arm with the shoulder girdle and
chest (see below). We, however, expect
that similar results would be obtained
in other body regions. In the
forearm, leg, and thigh, meridians
also appear to generally follow connective
tissue planes separating muscles
or within muscles. On the trunk,
meridians close to the midline (kidney,
stomach, spleen, and bladder)
run longitudinally in the front and
back, whereas more laterally placed
meridians (liver, gall bladder) run obliquely,
paralleling the orientation of
main muscle groups and the connective
tissue planes separating them. On
the face, meridians criss-cross each
other in an intricate pattern compatible
with the complexity of facial muscular
and connective tissue structures.
MERIDIAN/CONNECTIVE TISSUE
NETWORK
Acupuncture meridians are believed
to form a network throughout the
body, connecting peripheral tissues
to each other and to central viscera
(Kaptchuk, 2000). Interstitial connective
tissue also fits this description.
Interstitial “loose” connective
tissue (including subcutaneous tissue)
constitutes a continuous network
enveloping all limb muscles,
bones, and tendons, extending into
connective tissue planes of pelvic
and shoulder girdles, abdominal and
chest walls, neck, and head. This tissue
network is also continuous with
more specialized connective tissues
such as periosteum, perimysium, perineurium,
pleura, peritoneum, and
meninges. A form of signaling (mechanical,
bioelectrical, and/or biochemical)
transmitted through interstitial
connective tissue, therefore,
may have potentially powerful integrative
functions. Such integrative
functions may be both spatial (“connecting”
different parts of the body) as
well as across physiological systems
(connective tissue permeates all organs
and surrounds all nerves, blood
vessels, and lymphatics). In addition,
because the structure and biochemical
composition of interstitial connective
tissue is responsive to mechanical
Because the structure
and composition of
interstitial connective
tissue is responsive to
mechanical stimuli, we
propose that it plays a
key role in the
integration of several
physiological functions
with ambient levels of
mechanical stress.
FEATURE ARTICLE THE ANATOMICAL RECORD (NEW ANAT.) 263
stimuli, we propose that connective
tissue plays a key role in the integration
of several physiological functions
(e.g., sensorineural, circulatory, immune)
with ambient levels of mechanical
stress.
One of the salient features of acupuncture
theory is that the needling of
appropriately selected acupuncture
points has effects remote from the site
of needle insertion, and that these effects
are mediated by means of the acupuncture
meridian system (O’Connor
and Bensky, 1981). To date, physiological
models attempting to explain these
remote effects have invoked systemic
mechanisms involving the nervous system
(Ulett et al., 1998; Pomeranz,
2001). A mechanism initially involving
signal transduction through connective
tissue, with secondary involvement
of other systems including the
nervous system, is potentially closer
to traditional Chinese acupuncture
theory, yet also compatible with previously
proposed neurophysiological
mechanisms.
CONCEPTUAL MODEL FOR
ACUPUNCTURE POINTS AND
MERIDIANS
Rather than viewing acupuncture
points as discrete entities, we propose
that acupuncture points may correspond
to sites of convergence in a network
of connective tissue permeating
the entire body, analogous to highway
intersections in a network of primary
and secondary roads. One of the most
controversial issues in acupuncture
research is whether the needling of
acupuncture points has “specific”
physiological and therapeutic effects
compared with nonacupuncture points
(NIH Consensus Statement, 1997). By
using the road analogy, interaction of
an acupuncture needle with connective
tissue will occur even at the smallest
connective tissue “secondary road.”
Needling a major “highway intersection,”
however, may have more powerful
effects, perhaps due to collagen fiber
alignment leading to more effective
force transduction and signal propagation
at those points.
In summary, the anatomical correspondence
of acupuncture points and
meridians to connective tissue planes
in the arm suggests plausible physiological
explanations for several important
traditional Chinese medicine
concepts summarized in Table 1. We
propose that acupuncture needle manipulation
produces cellular changes
that propagate along connective tissue
planes. These changes may occur
no matter where the needle is placed
but may be enhanced when the needle
is placed at acupuncture points. This
conceptual model would be further
strengthened by an expanded investigation
of the whole body, including
lower extremity, trunk, and head. The
anatomy of acupuncture points and
meridians, thus, may be an important
factor that will begin to unravel the
veil of mystery surrounding acupuncture.
ACKNOWLEDGMENTS
We thank James R. Fox, M.S., Bruce J.
Fonda, M.S., John P. Eylers, Ph.D.,
Gary M. Mawe, Ph.D., William L.
Gottesman, M.D., Junru Wu, Ph,D.,
and Douglas J. Taatjes, Ph.D. for their
valuable assistance. Data from the
Visible Human Project Initiative was
made available through the National
Library of Medicine and the University
of Colorado. This study was
funded in part by National Institutes
of Health Center for Complementary
and Alternative Medicine Grant
RO1AT-00133.
LITTERATURE CITED
Banes AJ, Tsuzaki M, Yamamoto J, et al.
1995. Mechanoreception at the cellular
level: The detection, interpretation and
diversity of responses to mechanical signals.
Biochem Cell Biol 73:349–365.
Bonassar LJ, Stinn JL, Paguio CG, et al.
1996. Activation and inhibition of endogenous
matrix metalloproteinases in articular
cartilage: Effects on composition
and biophysical properties. Arch Biochem
Biophys 333:359–367.
Brand RA. 1997. What do tissues and cells
know of mechanics? Ann Med 29:267–
269.
Bossy J. 1984. Morphological data concerning
the acupuncture points and
channel network. Acupunct Electrother
Res 9:79–106.
Cheng X. 1987. Chinese acupuncture and
moxibustion. Beijing: Foreign Language
Press.
Chicurel ME, Chen CS, Ingber DE. 1998.
Cellular control lies in the balance of
forces. Curr Opin Cell Biol 10:232–239.
Chiquet M. 1999. Regulation of extracellular
matrix gene expression by mechanical
stress. Matrix Biol 18:417–426.
Ciczek LSW, Szopinski J, Skrzypulec V.
1985. Investigations of morphological
structures of acupuncture points and
meridians. J Trad Chin Med 5:289–292.
Comunetti A, Laage S, Schiessl N, Kistler
A. 1995. Characterization of human skin
conductance at acupuncture points. Experientia
51:328–331.
Dung HC. 1984. Anatomical features contributing
to the formation of acupuncture
points. Am J Acupunct 12:139–143.
Giancotti FG, Ruoslahti E. 1999. Integrin
signaling. Science 285:1028–1032.
TABLE 1. Summary of proposed model of physiological effects
seen in acupuncture
Traditional Chinese
medicine concepts Proposed anatomical/physiological equivalents
Acupuncture meridians Connective tissue planes
Acupuncture points Convergence of connective tissue planes
Qi Sum of all body energetic phenomena (e.g.
metabolism, movement, signaling, information
exchange)
Meridian qi Connective tissue biochemical/bioelectrical signaling
Blockage of qi Altered connective tissue matrix composition leading
to altered signal transduction
Needle grasp Tissue winding and/or contraction of fibroblasts
surrounding the needle
De qi sensation Stimulation of connective tissue sensory
mechanoreceptors
Propagated de qi
sensation
Wave of connective tissue contraction and sensory
mechanoreceptor stimulation along connective
tissue planes
Restoration of flow of qi Cellular activation/gene expression leading to
restored connective tissue matrix composition and
signal transduction
264 THE ANATOMICAL RECORD (NEW ANAT.) FEATURE ARTICLE
Gunn CC, Ditchburn FG, King MH, Renwick
GJ. 1976. Acupuncture loci: A proposal
for their classification according to
their relationship to known neural structures.
Am J Chin Med 4:183–195.
Ho MW, Knight DP. 1998. The acupuncture
system and the liquid crystalline
collagen fibers of the connective tissues.
Am J Chin Med 26:251–263.
Huan ZY, Rose K. 2001. A brief history of
Qi. Brookline, MA: Paradigm Publications.
Kaptchuk TJ. 2000. The web that has no
weaver. Understanding Chinese medicine.
Chicago: Contemporary Publishing
Group, Inc.
Lai WM, Mow VC, Sun DD, Atesian GA.
2000. On the electric potentials inside a
charged soft hydrated biological tissue:
Streaming potential versus diffusion
potential. J Biomech Eng 122:336 –346.
Langevin HM, Churchill DL, Cipolla MJ.
2001a. Mechanical signaling through
connective tissue: A mechanism for the
therapeutic effect of acupuncture.
FASEB J 15:2275–2282.
Langevin HM, Churchill DL, Fox JR, Badger
GJ, Garra BS, Krag MH. 2001b. Biomechanical
response to acupuncture
needling in humans. J Appl Physiol 91:
2471–2478.
Langevin HM, Churchill DL, Wu J, Badger
GJ, Yandow JA, Fox JR, Krag MH. 2002.
Evidence of connective tissue involvement
in acupuncture. FASEB J 16:872–
874.
Liu KY, Varela M, Oswald R. 1975. The
correspondence between some motor
points and acupuncture loci. Am J Chin
Med 3:347–358.
Matsumoto K, Birch S. 1988. Hara diagnosis:
Reflections of the sea. Brookline:
Paradigm Publications.
McCarroll GD, Rowley BA. 1979. An investigation
of the existence of electrically
located acupuncture points. IEEE Trans
Biomed Eng 26:177–182.
Noordegraaf A, Silage D. 1973. Electroacupuncture.
IEEE Trans Biomed Eng 20:
364–366.
NIH Consensus Statement. 1997. Acupuncture.
Bethesda, MD: NIH. 15:1–34.
O’Connor J, Bensky D. 1981. Acupuncture,
a comprehensive text (Shanghai College
of Traditional Medicine) Seattle: Eastland
Press.
Oschman JL. 1993. A biophysical basis for
acupuncture. Proceedings of the First
Symposium of the Committee for Acupuncture
Research.
Pomeranz B. 2001. Acupuncture analgesiabasic
research. In: Stux G, Hammerschlag
R, editors. Clinical acupuncturescientific
basis. Berlin: Springer-Verlag.
Rabischong P, Niboyet JEH, Terral C,
Senelar R, Casez R. 1975. Bases experimentales
de l’analgesie acupuncturale.
Nouv Presse Med 4:2021–2026.
Reishmanis M, Marino AA, Becker RO.
1975. Electrical correlates of acupuncture
points. IEEE Trans Biomed Eng 22:
533–535.
Senelar R. 1979. Les characteristiques
morphologiques des points chinois. In:
Niboyet JEH, editor. Nouveau traite
d’acupuncture. Paris: Maisonneuve.
Shanghai Medical University, Human
Anatomy Department. 1973. A relationship
between points of meridians and
peripheral nerves: Acupuncture anaesthetic
theory study. Shanghai: People’s
Republic Publishing House.
Swartz MA, Tschumperlin DJ, Kamm RD,
Drazen JM. 2001. Mechanical stress is
communicated between different cell
types to elicit matrix remodeling. Proc
Natl Acad Sci USA 98:6180–6185.
Ulett GA, Han S, Han JS. 1998. Electroacupuncture:
mechanisms and clinical
applications. Biol Psych 44:129–138.
Veith I. 1949. The yellow emperor’s classic
of internal medicine. Berkeley: University
of California Press.
Yang J. 1601. The golden needle and other
odes of traditional acupuncture, 1601.
Translated by R Bertschinger. Edinburgh:
Churchill Livingstone.
FEATURE ARTICLE THE ANATOMICAL RECORD (NEW ANAT.) 265
Publicerad: |2008-05-22|