TCM vs WM -=- RE: Digest number 735

January 24, 2003

I think Hugo is right.

We need to use the very best of western science to underpin the unique

nature of TCM so it does not become diluted to fit western tastes. I believe

TCM is a precious gift - a 'world treasure' - that embodies a unique

paradigm and methodology. [ Maybe like the Latins & The Rest of the World

who are now the keepers of soccer skills that were born in England,

non-China will have to be the repository of the original TCM as Chinese TCM

becomes more and more commercialised and westernised. Just the other day I

spoke to an orthopedic surgeon from the PRC. Unless he was being exquisitly

inscrutable he displayed no interest or understanding of the TCM meridian

system - he was concerned purely with the structure and function of the

'known' body tissues nerves, muscles, cartilage, tendons and bone. ]

The writing is on the wall. Here is a point I'd like to make for TCM, and a

question about TCM to put to you.

POINT: The Lung - Large Intestine - Skin system seen from embryology :

Acupuncture Felix Mann 1964 ISBN 0 433 20303 X QUOTE: "

The large intestine and lungs are both derived from endoderm: The large

intestine is formed from the caudal part of the primitive gut; the lung bed

which develops into the bronchial system is a ventral evagination of the

primitive foregut.

Endoderm - also mucous membrane of the tongue is derived thus. The mucous

membrane covering the tongue is derived from endoderm, just as the lining of

the the whole of the gastro-intestinal tract. The oral membrane divides the

tongue into an internal and external portion in front of the row of vallate

papillae, the former being covered by endoderm, the latter by ectoderm. At a

later stage of embryonic development though, the endoderm covering of most

of the tongue slips forward to coat the whole of the (embryo) body as well.

ENDQUOTE.

My understanding of this is the visceral connections embodied in the Five

Element System are no accident. They are primordial connections found in

every living creature (possible plant as well). If we ever come into contact

with extraterrestrials the one thing we will have in common is a system of

meridians and collaterals !

Below is copied a recently published paper which takes off from Felix Mann's

'early' western writing on the meridian system. I regret that I have not

asked the author for permission to copy; however I feel that its

dissemination is in the interest of our education, perhaps the survival of

an intact TCM: and this is an overriding priority.

SUMMARY: The paper goes a long way to explaining how the meridian system

develops, and gives us an insight into why the viscera in the five elements

(plus the triple burner & et) should be intimately linked through

'conductive channels' that conduct neither blood nor lymph, or nerve

messages ! I am talking about the conduction of Qi through meridians and

collaterals of course.

Again, consider the embryo: A small collection of cells that rapidly

increases in size and complexity. A visible feature of the developing embryo

is the periodic folding over of the surface layer so that it becomes

internal, exposing a new outer layer of membrane. The outer membrane is

dense in gap-junction cells forming a layer of high conductivity over the

cell. This high conductivity membrane is repeatedly internalised as the

embryo folds, maintaining the connection between parts of the organism that

were once on the surface and later embedded as organs, muscle and bone and

other tissue.

The purpose of this highly conducting membrane around and laced through the

developing embryo is understood to coordinate the differentiation, growth

and movement of cells, and the budding of organs and limbs. So for example,

the membrane exhibits strong potential gradients around the position of limb

buds hours before the buds themselves are visible. OK read it yourself and

feed back any understanding you have. But don't forget to answer thuis

question if you can:

QUESTION:

One of the problems as I see it is that we do not have a complete

understanding of TCM and need to ask the experts. Now if these experts are

not forthcoming then the cause is lost! In my own experience I don't get

much help from my TCM doc. He is happy to prescribe 'pills' and reluctant to

prescribe herbal formulations that need cooking because patient compliance

is low for the old way. On the other hand, even if I show enthusiasm for

taking a herbal mix that needs cooking, he will be reluctant to write down

the names of the herbs used. I don't think he keeps a record anywhere - is

this a skill or a practice that is dying out because of the availability of

pills ? Surely *record keeping* is part of good practice in or is

there a tradition of doing everything 'on the fly' like the shamans of old

would have done. Perhaps Victoria or anyone else familiar with TCM practice

could answer this one.

Basically, I need to know if I am being considered 'pushy' or 'rude' from an

oriental point of view by asking my TCM doc for a list of herbs used in a

formulation ? Do I need to reassure the TCM doc that I need the names for

record purposes in case I have to ask him to make up the same concoction

again, or will this 'go against the grain' in the context of a TCM doc who

prescribes according to an ever changing symptom pattern within the

patient's syndrome ?

Cheers, and thanks for your help. This is a good list - let's keep it

'cooking on gas' ;-)

Sammy.

Clinical Acupuncture Scientific Basis C. Shang ISBN 3-540-64054-1

CHAPTER 4 pp69-82

The Past, Present, and Future of Meridian System Research

4.1 Acupuncture and the Meridian System

In 1996, the U.S. Food and Drug Administration reclassified acupuncture

needles and substantially equivalent devices from class III (premarket

approval, investigational use) to class II (special controls), which

includes medical devices for general use such as scalpels and syringes [1].

Hundreds of randomized controlled trials on acupuncture have been published

[2]. Positive results of acupuncture were demonstrated in a variety of

conditions such as renal colic (3], migraine [4], osteoarthritis [5],

Raynaud's syndrome [6], stroke [7, 8], and low sperm quality [9]. A

systematic review of the high quality randomized controlled trials for

acupuncture antiemesis showed consistent positive results across different

investigators, different groups of patients, and different forms of

acupuncture point stimulation such as electroacupuncture, laser,

acupressure, and manual acupuncture [10]. The success of acupuncture has

sparked many studies on the nature of the meridian system - the foundation

of traditional acupuncture theory. According to the Standard Acupuncture

Nomenclature proposed by the World Health Organization (WHO) [11], there are

about 400 acupuncture points and 20 meridians/vessels connecting most of the

points. Since the ' 1950s, it has been discovered and confirmed by

researchers in several countries with refined techniques [12] that most

acupuncture points correspond to the high electric conductance points on the

body surface [13-17] and vice versa [18]. The high skin conductance of the

meridian system is further supported by the finding of a high density of gap

junctions at the sites of acupuncture points [ 19-22]. Gap junctions are

hexagonal protein complexes that form channels between adjacent cells. It is

well established in cell biology that gap junctions facilitate intercellular

communication and increase electric conductivity. Acupuncture and meridian

points have also been found to have higher temperature [23], metabolic

rates, and carbon dioxide release [24].

4.2 Neurobiology and Acupuncture

In acupuncture analgesia, the peripheral nervous system has been shown to be

crucial in mediating the effect. The analgesia can be abolished if the

acupuncture site is affected by postherpetic neuralgia [25] or injection of

local anesthetics [26]. In other effects of acupuncture such as

antihyperglycemic effects, studies have shown that local blockade of

peripheral nerves or denervation did not interfere with the acupuncture

effect [27]. In the 1970s, the relation between cerebral cortex and

acupuncture alteration of visceral function was explored by examining the

cortical evoked potentials, single unit discharges, and neurochemistry

associated with acupuncture. For example, the projecting area of pe. 6

{pericardium point#6} was mapped at the cortex and found to overlap with the

cortical splanchnic projection area. It was proposed that the cerebral

cortex plays an important role in the mechanism of acupuncture inhibition of

visceral pain (28]. These studies brought forth the meridian-cortex-viscera

correlation hypothesis [29], which states that the meridian system (1) is an

independent system connected via the nervous system to the cerebral cortex

and (2) acts through neurohumoral mechanisms [30]. Recently, the activation

of visual cortex by stimulation of Bl. 67 {bladder point #67} was mapped by

functional MRI [31]. The result showed that the activation of visual cortex

by stimulation of Bl. 67 - a point at the little toe used to treat

eye-related disorders - is similar to that of visual light stimulation. A

generalized acupoint-brainorgan model was proposed in which acupuncture

stimulates the corresponding brain cortex via the nervous system, thereby

controlling the chemical or hormone release to the disordered organs for

treatment.

In the mid-1970s, the discovery of endorphin induction in acupuncture

analgesia and its blockade by naloxone marked a milestone in establishing

the validity of acupuncture in mainstream science [32, 33]. Animals that

respond poorly to acupuncture analgesia can be rendered good responders by

treatment with D-phenylalanine, which inhibits the degradation of

met-enkephalin [34]. A close relation between acupuncture and nervous system

is also indicated by the considerable overlap between acupuncture points and

trigger points - points of maximum tenderness in myofascial pain syndrome

[35]. These results have led some practitioners to believe that the meridian

system as described in the classic acupuncture literature does not exist and

that all the effects of acupuncture are mediated through the nervous system

[36, 37]. Other scholars regard the neurally mediated acupuncture phenomena

as possibly " minor or secondary effects " and " not the central core of the

mechanism of acupuncture " [38]. The neurohumoral theory of acupuncture has

been mostly descriptive, with little predictive power.

{Sammy: My understanding so far is that, despite physiologically

identifiable parameters such as high electrical conductance between

acu-points, anatomical correlates of the meridians such as nervous tissue,

lymph or blood vessels do not exist. The meridians and collaterals exist in

their own right. }

4.3 Developmental Biology and the Meridian System

The traditional concepts of the meridian system have been studied from the

perspective of morphogenesis. The relation between the meridian system and

embryogenesis has been noted for decades [39]. The " gap junction embryonic

epithelial signal transduction model " in the mid-1980s [19] proposed that

the meridian system contains relatively underdifferentiated epithelial cells

connected by gap junctions which transduce signals and play a central role

in mediating acupuncture effects. The morphogenetic singularity theory [40]

published in the late 1980s applied the singularity theory of mathematics to

explain the origin, distribution, and nonspecific activation phenomena of

the meridian system, as described below.

4.3.1 Acupuncture Points Are Singular Points in the Surface Bioelectric

Field

Epithelia usually maintain a 30-100mV voltage difference [41]. This voltage

is the potential difference across cell layers, not membrane potential. An

acupuncture point with high density of gap junctions and high electric

conductance will also have loCal maximum electric current density - a

converging point of surface current. This is a singular point of abrupt

change in electric current flow. A singular point is a point of

discontinuity as defined in mathematics and indicates a point of abrupt

transition from one state to another. Small perturbations around singular

points can have decisive effects on a system. As James Maxwell observed:

" Every existence above certain rank has its singular points... At these

points, influence whose physical magnitude is too small to be taken account

of by a finite being may produce results of the greatest importance " [42].

The electromagnetic field pattern on the human scalp mapped by a

superconducting quantum interference device (SQUID) [43] shows a singular

point at the surface electromagnetic field where the surface magnetic flux

trajectories converge and enter the body. This point coincides with the

acupuncture point GV2O Baihui (Dr. Magnus Lou, personal communication). The

converging pathway of magnetic flux on the scalp coincides with the governor

vessel in the meridian system. This is a separatrix dividing the surface

magnetic field into two symmetrical domains of dif ferent flow directions. A

separatrix is a trajectory or boundary between different spatial domains

[44] and often connects singular points. Morphologically, the governor

vessel is also the axis of symmetry on the scalp. This pattern is consistent

with the pattern of the meridian system but different from the distribution

of any major nerve, lymphatic, or blood vessel on the scalp.

4.3.2 The Role of Electric Field in Growth Control and Morphogenesis

A variety of cells are sensitive to electric fields of physiological

strength [45]. Somite fibroblasts migrate to the negative pole in a voltage

gradient as small as 7 mV/mm [46]. Asymmetric calcium influx is crucial in

the migration, which can be blocked or even reversed by certain calcium

channel blockers and ionophores [47]. In most cases, there is enhanced cell

growth toward the cathode and reduced cell growth toward the anode in

electric fields of physiological strength [48, 49]. Fast-growing cells tend

to have relatively negative polarity. This polarity is due to the increased

negative membrane potential generated by the mitochondria at a high level of

energy metabolism [50]. Imposed electric fields can cause polarization of

mouse blastomeres [51]. The anterior-posterior polarity [52] and

dorsal-ventral polarity [53] in lower animal morphogenesis can be reversed

when the polarity of the imposed external electric field is opposite to that

of the intrinsic bioelectric field.

4.3.3 Organizing Centers Have High Electric Conductance

In development, the fate of a larger region is frequently controlled by a

small group of cells which is termed an organizing center (54]. Organizing

centers are the high

************************************************

Fig. 1. Illustration of singular points and separatrices (modified from

Fig.2.1 [117] (courtesy of John Wiley and Sons)) This also approximates the

pattern of acupuncture points and meridians - the singular points and

separatrices of electromagnetic field on the body surface

U "

V '' \

***********************************************

electric conductance points on the body surface [40]. The amphibian

blastopore, a classic organizing center, has high electric conductance and

current density [55]. Similar phenomena have also been observed in higher

vertebrates [56]. The high conductance phenomenon is further supported by

the finding of high density of gap junctions at the sites of organizing

centers [57-60). At the macroscopic level, organiz

***********************************************

Fig.2. Ionic currents traversing an embryo [118] (courtesy of John Wiley and

Sons) The blastopore, a classic organizing center, has high electric

conductance and current density. A steady blastopore current persists after

early embryogenesis. The electric fields polarize the embryo and serve as

cues for morphogenesis. These results confirmed earlier predictions [116]

blastopore

***********************************************

ing centers are singular points in the morphogen gradient and

electromagnetic field [40). The electric potential gradient and chemical

morphogen gradient are likely to enhance each other, as morphogens are

usually charged molecules or ions and can form a more stable gradient over

long range guided by electric field than by reactiondiffusion alone. The

effect of morphogens on ion channels and pumps can modify the electric

field. Disruption of the intrinsic electric field at the organizing

center'can cause malformation [55]. A change of electric activity at the

organizing centers correlates with signal transduction and can precede

morphologic change [61, 62]. For example, an outward current can be detected

at the site of a future limb bud (an organizing center) in amphibians

several days before the first cell growth [63].

4.3.4 Acupuncture Points - Organizing Centers

Both acupuncture points and organizing centers have high electric

conductance, current density, high density of gap junctions, an~l can be

activated by nonspecific stimuli. A therapeutic effect of acupuncture can be

achieved by a variety of stimuli [10, 64], including electricity, needling,

temperature variation, laser [65], and pressure. Similarly, morphogenesis of

organizing centers can be induced by various stimuli such as mechanical

injury and injection of nonspecific chemicals [54, 66].

Based on the phase gradient model in developmental biology (40, 67], many

organizing centers are expected to be at the extreme points of curvature on

the body surface, such as the locally most convex points (e.g., the apical

ectodermal ridge and other growth tips) or concave points (e.g., the zone of

polarizing activity). Similarly, almost all the extreme points of the body

surface curvature are acupuncture points. For example, the convex points

include EX-UEl1 Shixuan, EX-LEl2 Qiduan, St.l7 Ruzhong, St.42 Chongyang,

St.45 Lidui, SP 1 Yinbai, SP 10 Xuehai, GV2S Suliao, and more. The concave

points include CVl7 Danzhong, KI.1 Yongquan, SI.l9 Tinggong, GB.2O Fengchi,

BL.4O Weizhong, HT.1 Jiquan, BL.1 Jingming, CV8 Shenque, among others. These

similarities between acupuncture points and organizing centers suggest that

acupuncture points originate from organizing centers.

4.3.5 Why Do Auricles Have the Highest Density of Acupuncture Points?

The distribution of acupuncture points and organizing centers is closely

related to the morphology of the organism. For example, the auricle, which

has the most complex surface morphology, also has the highest density of

acupuncture points. According to the WHO, 43 auricular points have proven

therapeutic value [11] and comprise 10 % of the acupuncture points of the

whole body. Although an auricle has no important nerves or blood vessels and

no significant physiological function other than sound collection, auricular

morphology is one of the most sensitive indicators of malformations in other

organs. Auricular malformation has been observed in Turner's syndrome,

Potter's syndrome, Treacher-Collins syndrome, Patau's syndrome, Edwards'

syndrome, Noonan's syndrome, maternal diabetes, atherosclerosis [68],

Goldenhar's syndrome, Beckwith's syndrome, DiGeorge syndrome, cri du chat

syndrome, and fragile X syndrome. It is recommended in a standard textbook

of pediatrics that any auricular anomaly should initiate a search for

malformations in other parts of the body [69].

4.3.6 Meridian-Separatrix Boundary

At early stages of embryogenesis, gap junction-mediated cell-to-cell

communication is usually diffusely distributed, which results in the entire

embryo becoming linked as a syncytium. As development progresses, gap

junctions become restricted at discrete boundaries, leading to the

subdivision of the embryo into communication compartment domains [70]. These

high conductance boundaries or separatrices are also major pathways of

bioelectric currents and likely to be the precursors of meridians.

Separatrices can be folds on the surface or boundaries between different

structures [40, 71]. It was proposed that interconnected cells in the

meridian system remain underdifferentiated and maintain their regulatory

function in a partial embryonic state [20, 40]. Consistent with this theory

it has been observed that the most apical parts of folds remain

undifferentiated in morphogenesis [72], as well as organizing centers such

as the zone of polarizing activity [73] and the apical ectodermal ridge

[74]. The separatrix attributes are consistent with the observation in the

Inner Classic (Nei Jing) that meridians are distributed along the boundaries

between different muscles. For example, part of the lung meridian runs along

the borders of the biceps and brachioradialis. Part of the pericardium

meridian runs between the palmaris longus and flexor carpi radialis. Part of

the gallbladder meridian runs between the sternocleidomastoid and trapezius.

Trigger points also tend to be located at the free borders of muscles (75].

The governor vessel and the conception vessel are the axis of symmetry on

the body surface. They form the boundaries between many different

structures. They are also regarded as the convergence of all meridians in

traditional acupuncture.

4.3.7 The Role of the Meridian System in Evolution and Physiology

In ontogeny, the development of organizing centers in the growth control

system precedes the development of the nervous system and other

physiological systems. The formation and maintenance of all the

physiological systems are directly dependent on the activity of the growth

control system. Based on the morphogenetic singularity theory, the meridian

system originates from a network of organizing centers. As the individual

embryonic development recapitulates the evolution of the species, (ontogeny

recapitulates phylogeny), the evolutionary origin of the meridian system is

likely to have preceded all the other physiological systems, including the

nervous, circulatory, and immune systems. Its genetic blueprint might have

served as a template from which the newer systems evolved. Consequently, it

overlaps and interacts with other systems but is not simply part of them.

The growth control signal transduction is embedded in the activity of the

function-based physiological systems. Many neural, circulatory, and immune

processes are regulated through growth control mechanisms such as

hypertrophy, hyperplasia, atrophy, apoptosis with shared messenger molecules

and common signal transduction pathways involving growth control genes such

as proto-oncogenes [76-80]. Acupuncture also induces the expression of

protooncogene c-fos [81, 82]. Many " nonexcitable " cells have shown

electrochemical oscillation, coupling, long range intercellular

communication [62, 83, 84], and can participate in the meridian signal

transduction

4.3.8 Unified Basis of the Meridian and Chakra Systems

Based on the morphogenetic singularity theory, the distribution of the

meridian system is related to both internal and external structures and not

solely determined by nerves, muscles, or blood vessels. The distribution is

a result of morphogenesis. Therefore, acupuncture points which are not at

obvious extreme points of surface curvature or meridians which are not at

obvious boundaries can be vestigial or more related to internal structures.

The underdifferentiated, interconnected cellular network is not limited to

the body surface. One type of least differentiated cell is the germ cell.

The primary tumor distribution pattern of a certain cell type reilects the

distribution of its normal counterpart. For example, the distribution of

primary pheochromocytoma reflects the distribution of normal sympathetic

ganglion cells. The germ cell tumors [85, 86] have a midline and para-axial

distribution pattern which extends from the sacrococcygeal region, through

the anterior mediastinum, toxigue, and nasopharynx to the pineal gland. It

appears to concentrate at seven locations: sacrococcygeal region, gonads,

retroperitoneum, thymus [87], thyroid [88], suprasellar region, and pineal

gland [89]. The pattern resembles the chakra system

***********************************************

7th chakra 6th chakra 5th chakra 4th chakra 3rd chakra

__~11~-Pineal gland ,~.l ~

Base of skull Thyroid Mediastinum

Retroperitoneal Gonads Sacrococcygeal ®//`

Distribution of germ cell tumors

Fig. 3. Just as tbe distribution of pheochromocytoma correlates with the

distribution of sympathetic ganglions, the distribution of germ cell tumors

correlates with undifferentiated cells in human body which are likely to be

involved in the regulation of growth control and physiology as part of the

" inner meridian system " . This distribution also correlates well with the

chakra system used in yoga and acupuncture, suggesting a unified structural

basis for chakra system and meridian system. Figure modified from: Govan

ADT, MacFarlane PS, Callander R et al (1995) Pathology illustrated, 4th edn.

Churchill Livingstone, London, p 150 and from: Stux ( 1997) Basics of

acupuncture, 4th edn. Springer, Berlin, p 287. Courtesy of Churchill

Livingstone and Dr. Gabriel Stux

2nd chakra lst chakra Distribution of charkas

***********************************************

used in yoga and acupuncture [90], suggesting the existence of

underdifferentiated cells which may be highly interconnected in a normal

state as part of the " inner meridian system " and provide important

regulatory functions [91]. It is likely that there is a hierarchy in the

degree of cell differentiation and function in the meridian system, with the

germ cell system (major chakra system) as the least differentiated and

constituting the central core of the regulatory system. The more superficial

meridians and acupuncture points are more differentiated and lower in the

hierarchy.

4.3.9 Mechanism of Meridian System-Based Diagnosis and Therapy

As the electric conductance of organizing centers varies with morphogenesis,

the conductance of acupuncture points also varies and correlates with

physiological change [13] and pathogenesis [92, 93]. The facts that the

change in electric field precedes morphologic change [63] and that

manipulation of the electric field can affect the change [94] may shed light

on the diagnosis [93, 95] and treatment of many diseases. According to the

morphogenetic singularity theory [40], the network of organizing centers

retains its regulatory function through high levels of intercellular

communication correlated with relatively low levels of cell differentiation

during and after embryonic development. This prediction is consistent with

the finding that underdifferentiation and high electric conductance persists

at the organizing centers after early embryogenesis [96]. The organizing

centers communicate with other parts of the body to maintain proper forms

and functions. Gap junctional communication has been shown to play a crucial

role in morphogenesis [97J. The gap junction genes can also behave as

classical tumor suppressor genes in both culture and animal tests in

restoring growth regulatory properties to metastatic cancer cells [98]. An

anomaly inside the organizing center network may be detected by measuring

the electric parameters of some points on its surface at the early signal

transduction stage and treated by manipulation of the interconnected

organizing centers.

The activation of organizing centers is likely to be involved in the

restoration of proper form and function in wound healing and stress

response. Acupuncture can speed up the wound healing process [99] and cause

an exaggerated systemic wound healing and stress response [100, 101]. The

response can include excessive release of endorphin, which stimulates

epithelial cell growth [102] as well as analgesia. Other neurohumoral

factors induced by acupuncture such as serotonin [103] and ACTH [104] also

have effects on growth control [105].

In acupuncture, the often nonspecific perturbation at singular points

(acupuncture points) may not directly antagonize a pathological process but

may indirectly adjust the process and restore normal function by activating

the network of organizing centers in the organism. For example, acupuncture

at ST36 suppresses hyperfunction and stimulates hypofunction of gut motility

[106]. The activation of organizing centers to elicit a normalizing function

as explained above is less likely to cause the side effects resulting from

directly antagonizing a pathological process which often overlaps with other

normal and beneficial physiological processes. Therefore, proper use of

these meridian system-based techniques causes few side effects [107-110], as

demonstrated in randomized controlled trials [3, 4].

A principle in electroacupuncture is that positive (anode) pulse stimulation

of a point inhibits its corresponding function while negative (cathode)

pulse stimulation enhances that function [111]. This polarity effect is

similar to the finding that cell growth is enhanced toward cathode and

reduced toward anode [48, 49] and consistent with the theory that the

mechanism underlying acupuncture overlaps with that of growth control.

4.4 Conclusions

The morphogenetic singularity theory outlines the common ground shared by

the meridian and chakra systems and modern science. It is compatible with

the findings from neurohumoral studies. It explains several phenomena and

puzzles in developmental biology and acupuncture research, including the

distribution of the meridian and chakra systems and germ cell tumors, the

nonspecific activation of acupuncture points and organizing centers, the

high electric conductance of acupuncture points, the polarity effect and

side effect profile of electroacupuncture, and the ontogeny, phylogeny, and

physiological function of the meridian system. Most of these have not been

explained by any neurohumoral theory. In several prospective blind trials

[55, 57-59, 71], researchers unaware of the theory confirmed its corollary

on the role of singularity and separatrix in morphogenesis and its

predictions of the high electric conductance and high density of gap

junctions at organizing centers such as blastopores and zones of polarizing

activity.

Techniques involving the stimulation of the meridian system such as

acupuncture and qigong [112, 113] may activate the self-organizing system of

an organism and improve its structure and function at a more fundamental

level than symptomatic relief. Development of these techniques may enable

the diagnosis and treatment of a pathologic process at the early signal

transduction stage prior to the anatomical or morphological change.

4.5 Prospects

The advances reviewed above have broad implications in biomedicine beyond

acupuncture. The current stage of meridian system research is analogous to

that of physics in the early nineteenth ceritury - during the transition

from Newtonian mechanics to electromagnetics. More spectacular advances

similar to those of relativity and quantum physics may await in the

twenty-first century and will depend on the further development of meridian

" electromagnetics:' Many other areas related to the meridian system such as

psychophysiology, chronobiology [114], and pulse analysis (115) await more

rigorous studies. Many details of the current theories remain to be

clarified and tested.

Besides neurohumoral studies, the following directions of research are

likely to be important in further understanding acupuncture and the meridian

system:

1.Mapping of the meridian system and the dynamics of its electromagnetic

field with high resolution techniques such as SQUID

2.The relation between the physical parameters of the meridian system and

various pathological or physiological changes, including changes during

acupuncture and qigong practice

3.Development of acupuncture-related techniques of ear]y diagnosis and

treatment and establishing their cost effectiveness

4.Clarifying the role of the meridian system in morphogenesis and growth

control

5.Exploring ce]I differentiation and signal transduction in the meridian

system

6.Mapping the body surface curvature through embryonic deveJopment and study

of its re]ation to the meridian system

Acknowledgements. I thank Drs. David Diehl, James Gordon, Richard

Hammerschlag, Magnus Lou, and San Wan for their help and Drs.

Mesterton-Gibbons and Gabriel Stux for permission to use figures from their

books.

References

l. Food and Drug Administration (1996) Medical devices: Reclassification of

acupuncture needles for the practice of acupuncture. Federal Register 61:

64616-64617

2. Kaptchuk TJ, Edwards RA, Eisenberg DM (1996) Complementary medicine:

Efficacy beyond the placebo effect. In: Ernst E (1996) Complementary

medicine - an objective appraisal. Butterworth-Heinemann, Oxford, pp 42-70

3. Lee YH, Lee WC, Chen MT, Huang JK, Chung C, Chang LS (1992) Acupuncture

in the treatment of renal colic. J Urol 147:16-18

4. Hesse J, Mogelvang B, Simonsen H (1994) Acupuncture versus metoprolol in

migraine prophylaxis: A randomized trial of trigger point inactivation. J

Intern Med 235:451-456

5. Christensen B~; Iuhl IU, Vilbek H, Bulow HH, Dreijer NC, Rasmussen HF

(1992) Acupuncture treatment of severe knee osteoarthrosis. A long-term

study Acia Anaesthesiol Scand. 36(6):519-525

6. Appiah R, Hiller S, Caspary L, Alexander K, Creutzig A (1997) Treatment

of primary Raynaud's syndrome with traditional Chinese acupuncture. J Intern

Med 241:119-124

7. Naeser MA, Alexander MP Stiassny-Eder D, Galler V Hobbs J, Bachman D

(1992) Real versus sham acupuncture in the treatment of paralysis in acute

stroke patients: A CT scan lesion site study. J Neuro Rehab 6:163-173

8. Hu HH, Chung C, Liu TJ, Chen RC, Chen CH, Chou=P et al (1993) A

randomized controlled trial on the treatment for acute partial ischemic

stroke with acupuncture. Neuroepidemiology 12:106-113

9. Siterman S, Eltes F, Wolfson V Zabludovsky N, Bartoov B (1997) Effect of

acupuncture on sperm parameters of males suffering from subfertility related

to low sperm quality. Arch Androl 39:155-161

10. Vickers AJ (1996) Can acupuncture have specific effects on health? A

systematic review of acupuncture antiemesis trials. J R Soc Med 89:303-311

11. World Health Organization (1991) A proposed standard international

acupuncture nomenclature: Report of a WHO scientific group. World Health

Organization, Geneva

12. Pomeranz B (1997) Scientific basis of acupuncture. In: Stux G (ed)

Basics of acupuncture. Springer-Verlag, New York, pp 30-32

13. Comunetti A, Laage S, Schiessl N, Kistler A (1995) Characterisation of

human skin conductance at acupuncture points. Experientia 51:328-331

14. Bergsman O, Wooley-Hart A (1973) Differences in electric skin

conductivity between acupuncture points and adjacent skin areas. Am J

Acupunct 1:27-32

15. Wensel LO (1980) Acupuncture in medical practice. Reston Publishing,

Reston, p 128

16. Nakatani Y, Yamashita K (1977) Ryodoraku acupuncture. Ryodoraku Research

Institute, Osaka 17. Reichmanis M (1988) Electroacupuncture. In: Marino AA

(ed) Modern Bioelectricity. Dekker, New York pp 762-765

18. Eory A (1984) In-vivo skin respiration (COi) measurements in the

acupuncture loci. Acupunct Electrother Res 9:217-223

19. Mashansky VF, Markov UV et al (1983) Topography of the gap junctions in

the human skin and their possible role in the non-neural signal

transduction. Arch Anat Histol Embryol 84:53-60

The Past, Present, and Future of Meridian System Research 79

20. Cui H-M (1988) Meridian system-specialized embryonic epithelial

conduction system. Shanghai J Acupunct 3: 44-45

21. Fan JY (1990) The role of gap junctions in determining skin conductance

and their possible relationship to acupuncture points and meridians. Am J

Acupunct 18:163-170

22. Zheng JY, Fan JY, Zhang YJ, Guo Y, Xu TP (1996) Further evidence for the

role of gap junctions in acupoint information transfer. Am J Acupunct

24:291-6

23. Zhang D, Fu W Wang S, Wei Z, Wang F (1996) Displaying of infrared

thermogram of temperature character on meridians [Chinese]. Chen Tzu Yen

Chiu Acupuncture Research 21:63-67 24. Eory A (1984) In vivo skin

respiration (COZ) measurements in the acupuncture loci. Acupunct Electrother

Res 9:217-223

25. Bowsher D (1998) Mechanisms of acupuncture. In: Filshie J, White A,

(eds) Medical Acupuncture. Churchill Livingston, Edinburgh, pp 69-80

26. Chiang CY Chang CT (1973) Peripheral afferent pathway for acupuneture

analgesia. Scientia Sinica 16;210-217

27. Liu Z (1998) Meridian pharmacology research [Chinese]. Jinluo Luntan

Meridian Forum S:1-4 28. Chen P, Chen Z, Weng J, Ren H, Zhang J, Zhang J,

Feng J (1986) Relationship between cerebral cortex and acupuncture

inhibition of visceral pain. In: Zhang X (ed) Research on acupuncture,

moxibustion, and acupuncture anesthesia. Science Press, Beijing and

Springer-Verlag, Berlin, p 227

29. Anonymous (1976) A preliminary investigation of the mechanism of

antipain and counterinjury effects of acupuncture anaesthesia. Scientia

Sinica. 19:529-556

30. Chang HC, Xie YK, Wen YY Zhang SY, Qu JH, Lu WJ (1983) Further

investigation on the hypothesis of meridian-cortex-viscera

interrelationship. Am J Chin Med 11:5-13

31. Cho ZH, Chung SC, Jones JP Park JB, Park HJ, Lee HJ et al (1998) New

findings of the correlation between acupoints and corresponding brain

cortices using functional MRI. Proc Natl Acad Sci ilSA 95:2670-2673

32. Pomeranz B, Chiu D (1976j Naloxone blocks acupuncture analgesia and

causes hyperalgesia: Endorphin is implicated. Life Sci 19:1757-1762

33. Mayer DJ, Price DD, Raffii A (1977) Antagonism of acupuncture analgesia

in man by the narcotic antagonist naloxone. Brain Res 121:368-372

34. Takeshige C, Tanaka M, Sato T, Hishida F (1990) Mechanism of individual

variation in effectiveness of acupuncture analgesia based on animal

experiment. Eur J Pain 11:109-113

35. Melzack R, Stillwell DM, Fox EJ (1977) Trigger points and acupuncture

points for pain: Correlations and implications. Pain 3:3-23

36. Ulett GA (1992) Beyond yin and yang: How acupuncture really works.

Warren H. Green, St. Louis

37. Mann F (1998) A new system of acupuncture. In: Filshie J, White A, (eds)

Medical acupuncture. Churchill Livingston, Edinburgh, p 63

38. Pearson P (1987) An introduction to acupuncture. MTP Press, Norwell. p

75 39. Mann F (1971) Acupuncture. Random House, New York, p40

40. Shang C (1989) Singular point, organizing center, and acupuncture point.

Am J Chin Med 17:119-127

41. Jaffe LF (1977) Electrophoresis along cell membranes. Nature 265:600-602

42. Winfree AT (1980) The geometry of biological time. Springer-Verlag, New

York, p 71

43. Cohen D, Palti Y Cuffin BN, Schmid SJ (1980) Magnetic fields produced by

steady currents in the body. Proc Natl Acad Sci USA 77:1447-1451

44. Vinogradev IM, Adyan SI, Alesandrov PS, Bakhvalov NS et al (1992)

Encyclopaedia of mathematics Norwell, MA: Kluver Academic, Norwell, pp 276,

346

45. Erickson CA (1985) Morphogenesis of the neural crest. In: Browder LW

(ed),Developmental biology. Plenum, New York, p 528

46. McGinnis ME, Vanable 1W jr (1986) Voltage gradients in newt limb stumps.

Prog Clin Biol Res 210:231-238

47. Cooper MS, Schliwa M (1986) Transmembrane Caz' fluxes in the forward and

reversed galvanotaxis of fish epidermal cells. Prog Clin Biol Res

210:311-318

48. Nuccitelli R (1984) The involvement of transcellular ion currents and

electric fields in pattern formation. In: Malacinski GM (ed),Pattern

formation. Macmillan, New York

49. McCaig CD (1987) Spinai neurite regeneration and regrowth in vitro

depend on the polarity of an applied electric field. Development 100:31-41

50. Chen LB (1989) Fluorescent labeling of mitochondria. Methods in Cell

Biology 29:103-120

51. Wiley LM, Nuccitelli R (1986) Detection of transcellular currents and

effect of an imposed electrlC f eld On mOnsr hlacr~...o.o~ n~,.,- w- n.-, ,.

.... " ..- --

80 C. Shang

52. Marsh G, Beams HW (1952) Electric control of morphogenesis in

regenerating Dugesia tigrina. J Cell Comp Physiol 39:191

53. Kolega J. The cellular basis of epithelial morphogenesis. In: Browder LW

(eds),Developmental Biology. Plenum, New York, pp 112-116

54. Meinhardt H (1982) Models of biological pattern formation. Academic,

London, p20

55. Hotary KB, Robinson KR (1994) Endogenous electric currents and voltage

gradients in Xenopus embryos and the consequences of their disruption. Dev

Biol 166:797

56. Jaffe LF Stern CD (1979) Strong electric currents leave the primitive

streak of chick embryos. Science 206:569-571

57. Laird DW Yancey SB, Bugga L, Revel JP ( 1992) Connexin expression and

gap junction communication compartments in the developing mouse limb. Dev

Dyn 195:153-161

58. Ya~cey SB, Biswal S, Revel JP (1992) Spatial and temporal patterns of

distribution of the gap junction protein connexin 43 during mouse

gastrulation and organogenesis. Development 114:203-212

59. Coelho CN, Kosher RA (1991) A gradient of gap junctional communication

along the anteriorposterior axis of the developing chick limb bud. Dev Biol

148:529-535

60. Meyer RA, Cohen MF, Recalde S, Zakany J, Bell SM, Scott WJ jr, Lo CW

(1997) Developmental regulation and asymmetric expression of the gene

encoding Cx43 gap junctions in the mouse limb bud. Dev Genet z1:290-300

61. Nelson PG, Yu C, Fields RV Neale EA (1989) Synaptic connections in vitro

modulation of number and efficacy by electric activity Science 244:585-587

62. Shang C (1993) Bioelectrochemical oscillations in signal transduction

and acupuncture-an emerging paradigm. Am J Chin Med 21:91-101

63. Nuccitelli R (1988) Ionic currents in morphogenesis. Experientia

44:657-666 64. Altman S (1992) Techniques and instrumentation. Probl Vet Med

4:66-87

65. Hornstein OP (1997).Melkersson-Rosenthal syndrome-a challenge for

dermatologists to participate in the field of oral medicine. J Dermatol

24:281-296

66. Toivonen S (1978) Regionalization of the embryo. In: Nakamura O,

Toivonen S (eds) Organizer-A milestone of a half-century from Spemann.

Elsevier, Amsterdam, p.132

67. Winfree AT (1984) A continuity principle for regeneration. In:

Malacinski GM (ed) Pattern formation. Macmillan, New York, pp.106-107

68. Petrakis NL ( 1995) Earlobe crease in women: Evaluation of reproductive

factors, alcohol use, and quetelet index and relation to atherosclerotic

disease. Am J Med 99:356-361

69. Cotton RT (1996) The ear, nose, oropharynx, and larynx. In: Rudolph AM,

Hoffman JIE, Rudolph CD (eds) Rudolph's Pediatrics. Appleton and Lange,

Stamford, p 945

70. Lo CW (1996) The role of gap junction membrane channels in development.

J Bioenerg Biomembr 28:379-385

71. Lee D, Malpeli JG (1994) Global form and singularity: Modeling the blind

spot's role in lateral geniculate morphogenesis. Science 263:1292-1294 .

72. Toivonen S (1978) Regionalization of the embryo. In: Nakamura O,

Toivonen S (eds) Organizer-a milestone of a half century from Spemann.

Elsevier, Amsterdam, p.124

73. Ros MA, Sefton M, Nieto MA (1997) Slug, a zinc finger gene previously

implicated in the early patterning of the mesoderm and the neural crest, is

also involved in chick limb development. Development 124:1821-1829

74. Carlson MR. Bryant SV Gardiner DM (1998) Expression of Msx-2 during

development, regeneration, and wound healing in axolotl limbs. J

Experimental Zool 282:715-723

75. Baldry P (1998) Trigger point acupuncture. In: Filshie J, White A

(eds),Medical Acupuncture. Churchill Livingston, Edinburgh, p 35

76. Baldwin AS jr (1996) The NF-kappa B and I kappa B proteins: New

discoveries and insights. Annu Rev Immunol 14:649-683

77. Berczi I ( 1994) The role of the growth and lactogenic hormone family in

immune function. Neuroimmunomodulation 1:201-216

78. Bailey CH, Bartsch D, Kandel ER (1996) Toward a molecular definition of

long-term memory storage. Proc Natl Acad Sci USA 93:13445-13452

79. Miano JM, Topouzis S, Majesky M, Olson EN (1996) Retinoid receptor

expression and all-trans retinoic acid-mediated growth inhibition in

vascular smooth muscle cells. Circulation 93:1886-1895

80. Tanaka H, Samuel CE (1994) Mechanism of interferon action: Structure of

the mouse PKR gene encoding the interferon-inducible RNA-dependent protein

kinase. Proc Natl Acad Sci USA 91:7995-7999

81. Pan B, Castro-Lopes JM, Coimbra A (1996) Activation of anterior lobe

corticotrophs by electroacupuncture or noxious stimulation in the

anaesthetized rat, as shown by colocalization of Fos

The Past, Present, and Future of Meridian System Research gl

protein with ACTH and beta-endorphin and increased hormone release. Brain

Res Bull 40:175-182

82. Lee JH Beitz AJ (1993) The distribution of brainstem and spinal cord

nuclei associated with different frequencies of electroacupuncture

analgesia. Pain 52:11-28

83. Rink TJ, Jacob R (1989) Calcium oscillations in nonexcitable cells.

Trends Neurosci 12:43-46 84. Nedergaard M (1994) Direct signaling from

astrocytes to neurons in cultures of mammalian brain cells. Science

263:1768-1771

85. Azizkhan RG, Caty MG (1996) Teratomas in childhood. Curr Opin Pediatr

8:287-292

86. Kountakis SE, Minotti AM Maillard A, Stiernberg CM (1994) Teratomas of

the head and neck. Am J Otolaryngol 15:292-296

87. Deh~er LP (1990) Germ cell tumors of the mediastinum. Semin Diagn Pathol

7:266-284

88. Gonzalez-Crussi F (1982) Extragonadal teratomas. Armed Forces Institute

of Pathology, Washington, p.118

89. Kretschmar CS (1997) Germ cell tumors of the brain in children: A review

of current literature and new advances in therapy. Cancer Invest 15:187-198

90. Stux G (1997) Chakra acupuncture. In: Stux G (ed) Basics of acupuncture.

Springer-Verlag, New York, pp 298-302

91. Nichols CR, Timmerman R, Foster RS, Roth B], Einhorn LH (1997) Neoplasms

of the testis. In:. Holland JF, Basst RC jr, Morton DL Frei E III, Kufe DW

Weichselbaum RR (eds),Cancer medicine. Fourth edn. Williams and Wilkins,

Baltimore, p.2206

92. Saku K, Mukaino Y, Ying H, Arakawa K (1993) Characteristics of reactive

electropermeable points on the auricles of coronary heart disease patients.

Clin Cardiol 16:415-419

93. Oleson TD, Kroenig RJ, Bresler DE (1980) An experimental evaluation of

auricular diagnosis: The somatotopic mapping of musculoskeletal pain at

acupuncture points. Pain 8:217-229

94. Smith SD (1988) Limb regeneration. In:Marino AA (ed),Modern

bioelectricity. Dekker, New York, p.526-SSS

95. Ishchenko AN, Kozlova VP Shev'yev PP (1991) Auricular diagnostics used

in the system of screening surveys. Med Prog Technol 17:29-32

96. Shi R, Borgens RB (1996) Three-dimensional gradients of voltage during

development of the nervous system as invisible coordinates for the

establishment of embryonic pattern. Dev Dynamics 202:101-114

97. Ewart JL Cohen MF, Meyer RA, Huang GY, Wessels A, Gourdie RG et al

(1997) Heart and neural tube defects in transgenic mice overexpressing the

Cx43 gap junction gene. Development 124:1281-1292

98. Hirschi KK Xu CE, Tsukamoto T Sager R ( 1996) Gap junction genes Cx26

and Cx43 individually suppress the cancer phenotype of human mammary

carcinoma cells and restore differentiation potential. Cell Growth Differ

7:861-870

99. King GE, Scheetz J, Jacob RF, Martin JW (1989) Electrotherapy and

hyperbaric oxygen: Promising treatments for postradiation complications. J

Prosthet Dent 62:331-334

100. Wong WH, Brayton D (1982) The physiology of acupuncture: Effects of

acupuncture on peripheral circulation. Am J Acupunct 10:59-63

101. Lin tvtT, Liu GG, Song JJ, Chen YF, Wu KM ( 1980) Effects of

stimulation of acupuncture Ta-Churi, Nei-Kuan, and Tsu-San-Li points on

physiological function of normal adults. Acupunct Res Quarterly 4:11-19

102. Kishi H, Mishima HK, Sakamoto I, Yamashita U (1996) Stimulation of

retinal pigment epithelial cell growth by neuropeptides in vitro. Curr Eye

Res 15:708-713

103. Cheng RS, Pomeranz B (1979) Electroacupuncture analgesia mediation by

endorphin and nonendorphin systems. Life Sci 25:1957-1962

104. Malizia E, Andreucci G Paolucci D (1979) Electroacupuncture and

peripheral endorphin and ACTH levels. Lancet 2:535-536

105. Pakala R Benedict CR (1998) Effect of serotonin and thromboxane A2 on

endothelial cell proliferation: Effect of specific receptor antagonists. J

Lab Clin Med 131:527-537

106. Li Y Tougas G, Chiverton SG Hunt RH (1992) The effect of acupuncture on

gastrointestinal function and disorders. Am J Gastroenterol 87:1372-1381

107. Holden C (1994) Acupuncture: Stuck on the fringe. Science 264:770 108.

Carneiro NM, Li SM (1995) Acupuncture technique. Lancet 345:1577

109. Shiraishi T, Onoe M Kojima T, Sameshima Y, Kageyama T (1995) Effects of

auricular stimulation on feeding-related hypothalamic neuronal activity in

normal and obese rats. Brain Res Bull 36:141-148

110. Marwick C (1997) Acceptance of some acupuncture applications. )AMA

278:1725-1727

111. Kenyon JN (1983) Modern techniques of acupuncture. Thorsons,

Wellingborough, pp SI-58

a u~n.~-l.A~L~vYvD~.. .. .,

' g2 C. Shang

112. McGee CT, Sancier K, Chow EPY ( 1996) Qigong in traditional Chinese

medicine. In: Micozzi MS (ed),Fundamentals of complementary and alternative

medicine. Churchill-Livingston, New York, pp.225-226

113. Lu Z (1997) Scientific qigong exploration. Amber Leaf Press, Malvern

114. Li L, Chen H, Xi Y Wang X, Han G, Zhou Y, Yang D et al (1994)

Comparative observation on effect of electric acupuncture of PC6 at 7-9 AM

vs. 7-9 PM on left ventricular function in patients with coronary artery

disease. J Tradit Chin Med 14:262-265

115. Wang WK, Hsu TL, Wang YY (1998) Liu-wei-dihuang: A study by pulse

analysis. Am J Chin Med 26:73-82

116. Shang C (1989) Singular point, organizing center, and acupuncture

point. Am J Chin Med 17:119-127

117. Mesterton-Gibbons M (1995) A concrete approach to mathematical

modeling. Wiley, New York 118. Shi R, Borgens RB (1996) Three-dimensional

gradients of voltage during development of the nervous system as invisible

coordinates for the establishment of embryonic pattern. Dev Dynamics 202:102

iI

I. i

~ I,. .

~r

y1 F

s k4 ,

Clinical Acupuncture Scientific Basis 3-540-64054-1

CHAPTER 4 pp69-82

The Past, Present, and Future of Meridian System Research

C. Shang