Contemporary Medical Acupuncture A Systems Approach
Higher Education Press
Guan-Yuan Jin, MD, L.Ac. International Institute of Holistic Medicine Ace Acupuncture Clinic of Milwaukee 8412 W, Capitol Drive, Milwaukee, W153222, USA
Telephone: 414-438-9488 E-mail:
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I ~ : : 01--2007-2195 Copyright 9 2007 by Higher. Education Press 4 Dewai Dajie, Beijing 100011, P. R. China
Distributed by Springer Science+Business Media, LLC under ISBN 978-0-387-71028-0 worldwide except in mainland China by the arrangement of Higher Education Press.
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without permission in writing from the publisher. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express of implied, with respect to the material contained herein. ,ISBN 978-7-04-019257-8
Printed in P. R. China 9
To our teachers and colleagues who have devoted themselves to clinical and laboratory studies of acupuncture as well as greatly contributed to the contemporary development of acupuncture theories and techniques, and to our loved ones, Songshou Jin and Ruiwen Mao, Dequan Xiang and Guangyu Geng, Jin Zheng and Bonnie X. Jin.
About the Authors
Guan-Yuan Jin, MD, L.Ac., is one of world's forefront medical acupuncturists besides a physiologist and chronobiologist. With a rich clinical and research experience of over 40 years in both Chinese medicine and Western medicine, he has authored 18 academic/professional books, including representative works of
ClinicalReJlexologyofAcupuncture and Moxibustion, Self-Healingwith ChineseMedicine, Acupuncture and Cybernetics, Whole Body Reflex Zones, Contemporary Chronomedicine, and BiologicalClockand Health. In the late 1960s, Dr. Jin began to study and practice acupuncture and TCM by completing an apprenticeship under Master Jiao, Mianzhai as well as Profs Zheng, Kuishan, Wei, Jia, etc. In 1982, he graduated from Zhejiang Medical University, China, where he later taught Physiology and engaged in numerous researches on acupuncture. After coming to US in the late 1980s, Dr. Jin completed post-doctoral fellowship at Medical College of Wisconsin and became one of 'grandfather' acupuncturists and Chinese herbologists certified by NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine), USA. At his private practice (www.AceAcupuncture.com), Dr. Jin specializes in treating intractable cases with acupuncture, Chinese herbs, and Qigong therapy, striving for "Highest Successes with Least Sessions." Dr. Jin is currently an Honorary Professor at Guangzhou University of TCM, China. As the president of International Institute of Holistic Medicine, Dr. Jin is a strong advocate in raising public awareness of TCM through lectures at local communities as well as national and international conferences. From 1993-2005, he served as an Acupuncture Advisor for the State of Wisconsin, and under his efforts, the Governor of Wisconsin, and Mayors of Milwaukee and Brookfield proclaimed "Acupuncture and Oriental Medicine Day" and "World Tai Chi and Qigong Day", respectively.
O O NO
Jia-Jia x. Jin, OMD, L.Ar is a NCCAOM board certified and Wisconsin licensed acupuncturist, Chinese herbologist, as well as Qigong instructor. She has been working in the medical field for over three decades. Since coming to USA in 1990, she and her h u s b a n d Dr. Jin co-founded Ace A c u p u n c t u r e Clinic of Milwaukee, one of the most reputable TCM clinics in the Midwest. Jia-Jia specializes in caring for the pediatric, female, and elderly patients with gentle needling techniques or acupressure. Jia-Jia was a co-author of Clinical Reflexology
of Acupuncture and Moxibustion, Self-Healing with Chinese Medicine, Contemporary Chronomedicine, and Whole Body Reflex Zones, as well as an instructor in a series of Dr. Jin's self-healing classes.
Louis L. Jin, MS, BS., has a unique background of both Information Technology and Chinese Medicine. He holds a Master's degree in Computer Science and Software Engineering, and has completed a four-year a p p r e n t i c e s h i p in Acupuncture and Chinese Medicine under the tutelage of his father Dr. Jin. Louis has been dedicating his efforts at advancing the modernization of classical diagnostic and therapeutic means in the field of TCM, such as developing computerized technologies of tongue and pulse diagnoses, as well as investigating scientific bases of Qigong therapy. Louis was a co-author of Whole Body Reflex
Zones, Clinical Reflexology of Acupuncture and Moxibustion, and Self-Healing with ChineseMedicine, as well as an instructor in a series of Dr. Jin's self-healing classes.
Pre-publication REVIEWS COMMENTARIES EVALUATIONS
"To create a textbook of acupuncture that includes both classic and modern theories and therapy is a formidable task. The authors can rightly lay claim to the premier position held by this textbook as the most authoritative and current source of information about acupuncture, the meridian, and the whole body reflex zones, a unique term originally coined by the authors. As a respected resource, it has covered the key concepts and topics that acupuncture practitioners and students will experience in their studies and working environment. The beginning part introduces readers to the current challenges and modernization of acupuncture therapy and its scientific bases, as well as acquaint with the concepts of meridians, the whole body reflex zones, and reflexotherapy. The later part explains the systemic or cybernetic method including the black box theory and its applications in guiding clinical acupuncture and raising curative effects, as there may be an uncertain outcome. The last part describes the indications of acupuncture, their treatment, and rehabilitation. Advanced students will learn how to choose acupoints and use appropriate techniques to attain optimal acupuncture effects. Acceptance of acupuncture as both an art and a science helps to create an integrating link between oriental medicine, contemporary medicine, and the principles of holistic care, thus fostering the well-being, the care, and the cure of patients worldwide."
Frances Talaska Fischbach, RN, BSN, MSN
Associate Professorof Nursing University of Wisconsin-Milwaukee Author of A Manual of Laboratory and Diagnostic Tests 0 o r
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"After reading the manuscript carefully, I can say it is truly going to be an outstanding book compared to its counterparts on acupuncture. It has abundant contents and data, a distinct theme, innovative theories, and simple but in-depth analyses. This book systemizes, summarizes, and develops the acupuncture therapy and its theoretical basis, the meridian theory from the perspective of contemporary acu-reflexology, making a great milestone toward modernizing classical acupuncture. Today, as the "acupuncture fever" continues to prevail worldwide, increasingly Western doctors are aspiring to learn and integrate acupuncture into the mainstream of contemporary medicine. The publication of this book will definitely provide them with an excellent reference. Moreover, realizing the standardization of acupuncture therapy is an essential component of propagating medical acupuncture internationally and making its prospective progress. The authors of this book have made a penetrating analysis about how to control the randomness of the acupuncture therapy and enhance its effectiveness and reproducibility. Thus, this book is a must-read for all acupuncture practitioners, medical professionals, and researchers in the field of acupuncture, as well as students of TCM. "
Xuemin Shi
Academician of China Academy of Engineering Vice President of China Association of Acupuncture Professor & Vice President of Tianjin University of TCM, China
"The birth of ContemporaryMedical Acupuncture fully reflects the authors' unique background and expertise. Dr. Jin possesses a profound knowledge of both Chinese medicine and Western medicine, and he has a rich clinical expertise of acupuncture practice for many years, including over two decades of practice in China and seventeen years of practice in the USA. These kinds of integration between Chinese medicine and Western medicine, scientific research and clinical expertise, plus his background on scientific methodology, make him a qualified authority with full capability of clarifying classical acupuncture systemically and scientifically through this book. Personally, I have a master-apprentice relationship with Dr. Jin, and I am grateful to see that he has finally completed this masterpiece for publication. This work is based on inheriting the meridian theory of Chinese medicine as well as citing numerous scientific references through many years of research. Its content is comprehensive and refreshing, and its recommended methods are simple and practical. No doubt, the publication of this authoritative book will promote the development of medical acupuncture, benefit our fellow acupuncture practitioners, enhance the effectiveness of acupuncture therapy, as well as have a profound influence on the academic exchange between Eastern and Western medicine. It will certainly be a useful reference for anyone engaged in academic study, scientific research, and clinic practice with acupuncture. "
Kuishan Zheng
Professor & Honorary Chair Dept. of Acupuncture, Gansu College of TCM, China Honorary President of Gansu Acupuncture Society
o o ol
Forewords
Acupuncture, which originated in China more than 2 000 years ago, is the most commonly used alternative medical procedure worldwide. America's keen interest in this modality intensified in the 1970s. During this era, New York Times reporter James Reston wrote a pivotal story about how Chinese practitioners used needles to ease his postoperative pain. Since that time, physicians and their patients have generated more inquiries about acupuncture. A 2002 comprehensive survey indicated an estimated 8.2 million of USA adults had used acupuncture, according to study sponsor National Center for Comparative and Alternative Medicine (NCCAM), a component of National Institutes of Health (NIH). A similar national survey found that approximately one in 10 adults had received acupuncture at least one time with good results. The potential for acupuncture is vast, as a 1997 NIH Consensus Statement on Acupuncture indicated. Documented results indicate that this procedure can reduce the side effects of cancer treatment and provide analgesia during surgical procedures. Patients with drug and nicotine addictions, stroke, asthma, and pain benefit from alternative therapy. In January 2005, a NIH-funded clinical trial at the Univerity of Maryland, Center Integrative Medicine (UMCIM), showed that acupuncture could provide pain relief, while improving the function of patients with osteoarthritis of the knee. Acupuncture clearly serves as an effective complement to conventional care. International academic and clinical studies, supplemented by the contributions of acupuncture practitioners and physicians, have generated greater acceptance of this treatment. For this reason, NCCAM and other NIH-affiliated research institutions continue to fund a variety of research projects on acupuncture. These
efforts have received attention, not only from NIH, but also from many public or private organizations. UMCIM received $10 million federal grant in October 2005 a
to build two new centers to study complementary and alternative medicine (CAM), specifically acupuncture and Chinese herbal medicine for pain relief. The university is also forming an international collaboration with Chinese scientists to examine methods in treating bowel disorders. Many medical schools nationwide are integrating acupuncture programs into their curricula. For example, the University of Pennsylvania (UPenn) has initiated collaborative undertakings with Tai Sophia Institute, a CAM school in Maryland, USA. Since that time, the primary focus of the UPenn program has been to teach medical students about holistic approaches. A number of other schools are initiating their own CAM programs or working with consultants to this end. Many faculty members and students in my school (Medical College of Wisconsin) are interested in incorporating CAM programs into their practice or curricula. Despite the growing interest and demand for knowledge about acupuncture, there is a profound lack of availability of reference textbooks. Dr. Guan-Yuan Jin has stepped forward to meet this need by writing Contemporary Medical
Acupuncture. Medical students and practitioners will find this book unique in that it introduces the principles of contemporary medicine as a means of understanding the mechanisms of an ancient therapy. It lends insight into its theoretical basis by summarizing and reviewing the advances regarding the meridians and specific mechanisms. Dr. Jin concludes that the former is simply a system of physiological and pathological reflexes in the body and that acupuncture is actually a type of reflexotherapy. By utilizing the systems theory, he outlines the entire acupuncture process and the specific factors that elicit acupuncture's therapeutic effectiveness. The book's emphasis on clinical applications is particularly valuable in that he provides case studies and the latest clinical trials in the West. I believe that this book will significantly advance the clinical practice of acupuncture because its cutting-edge material will promote academic research in the area of acupuncture mechanisms. Because of Dr. Jin's work, and others like him, acupuncture will progress from an ancient healing art to a modern scientific therapy in the West, and across the globe.
Shi-Jiang Li, PhD
Professor of Biophysics Medical Collegeof Wisconsin, USA
A late night in March, I finally flew home after a 30-hour trip from Argentina, and found a book entitled Clinical ReJlexology of Acupuncture and Moxibustion by Prof. Jin and his colleagues delivered to my door. As I glanced through the first few pages, novel perspectives about acupuncture therapy and the meridian theory immediately caught my attention and I could not put it down until the wee hours of the next morning, almost forgetting my fatigue due to the long trip. In this book most theories and principles proposed by the authors are creative and convincing. Especially the viewpoint of realizing the impending leap of acupuncture from art to science through establishment and development of contemporary medical acupuncture is indeed relevant. I could identify with Prof. Jin as I had similar clinical experiences in the past. In early 1970s, I engaged in numerous studies of clinical acupuncture, especially of the auricular acupuncture, and experienced both its benefits and limitations. Since 1980s, in my medical practice as a neurosurgeon, acupuncture has also been extensively applied to rehabilitate patients with various cerebrovascular diseases. Currently, in my hospital, like most hospitals in China, acupuncture therapy has become a routine method of treatment in the fields of neurosurgery and neurology. However, we also met those challenges of classical acupuncture mentioned in the book by Prof. Jin. Thus, I believe that those acupuncture techniques with consistent or reproducible effects will definitely benefit patients. This summer, it was my pleasure to meet Prof. Jin in person at Milwaukee, USA after attending an international conference in Hawaii. I was not only deeply impressed with his rich expertise in medicine, including acupuncture, but also awed by his expert knowledge in science, education, and methodology of the
9 O
systems theory or cybernetics. His book Best Methods of Learning published in O O
1986 was just another example in applying a systems approach in the field of education. Currently, he is dedicating his energy and enthusiasm to the study of integrative medicine, and together, we are exploring potential research collaborations. In short, this book takes a systems approach to learning yet is comprehensive enough to teach the fundamentals as well as venturing into the advanced concepts of acupuncture. In my opinion, few today's acupuncture books are like this one that is written in such concise, modern, evidence-based, and scientific language. This book is suitable to all medical professionals, I highly recommend it as an advanced textbook or reference guide to surgeons, physicians, and other medical doctors interested in integrating acupuncture into their clinical practice and research.
Feng Ling, MD Professor & Director of Institute of Cerebrovascular Diseases Director of Neurosurgery and Intervention Center at Xuanwu Hospital Capital University of Medical Sciences, Beijing, China Honorary Chair, Asia-Australian Society of Interventional Neuroradiology
In order to advance acupuncture and its theory, merely relying on the inheritance isno longer sufficient; and it is time to strive for innovation. As one of such innovations, the book ContemporaryMedical Acupuncture has unique features and is still a gem among the existing boatload of books on acupuncture. Never before have we seen a book like this one that applies the perspective of acu-reflexology to clarify the meridian phenomena, summarize the meridian theory, and guide the process of clinical acupuncture. The authors classified all acupoints of the 14 meridians, extraordinary and new points distributed on body surface into three main types of reflex zones: somatic, visceral and central, as well as proposed that acupuncture therapy is actually a type of reflexotherapy. The word reflex simply reveals the essence of meridians and the mechanism of acupuncture. During acupuncture therapy, no medication has been administered into the body, its therapeutic effectiveness are purely resulted from the reflex, whether through the viscera-body surface correlation or the body surface-body surface correlation. To propose the novel theory of acu-reflexology, Dr. Jin spent almost 40 years in actively researching and applying to clinical studies. Because he is one of my former pupils, his talent and creativity exhibited in the field of acupuncture have impressed me for many years. You might have realized that the theory of acu-reflexology is actually derived from the perspective of reflex point, while the notion of ancient Ashi point is the primitive description about the modern reflex point. In the early 1960s, I began analyzing Ashi points including the relationship between their appearance and the illness course in one of my articles published
o
in the Journal of TCM. Later on, this article became the "media" that lead to my O I,o
discovery of Dr. Jin, who wrote a letter to me after reading the article. Our karma in the field of acupuncture began ever since then. In his clinical practice, Dr. Jin has paid great attention to the study of Ashi or reflex points. In scores of published reports by Dr. Jin in 1970s, selecting reflex points, controlling the propagation of needling sensations and the arrival of qi at the diseased region were the primary factors for his successes. Accordingly, classical traveling courses of the meridians and locations of acupoints becomes a mapping-system on the body surface that could indicate reflex points or zones. There are incisive discussions about the relationship of reflex points and acupoints in this book. Most acupoints are reflex points, tender spots, electropermeable points with a low electrical resistance, or those sensitive to thermal stimulation. On the other hand, reflex points mostly possess the features of tenderness, low electrical resistance, or local hard nodules. Moreover, their locations are mostly in accordance with those of classical acupoints. Of course, this does not mean acupoints are just reflex points, as there is a large difference between them. Many reflex points are located completely out of traveling courses of the meridians. Therefore, the authors emphasized that point selection must not be tied up by the meridians. As w~ know, a classical TCM statement better missing acupoints than
the meridian emphasized the importance of the meridians over acupoints during point selection process. In Dr. Jin's book however, a complementary statement
better missing the meridian than reflex points to arose, namely, no matter where reflex points may appear on the meridians or not, they all can be selected for acupuncture. I strongly support the above perspective about reflex points. Not only locations of reflex points have great individual differences in various patients or diseases, but also their sensitivities may vary with disease courses and treatments. I recently proposed the notion of dynamic points, namely, most acupoints possess dynamic characteristics. Perhaps this notion can be used in conjunction with acu-reflexology to clarify the relative specificity in actions of acupoints.
Jia Wei
Professor o/Acupuncture, Jiangxi College of TCM, China Board Member of China Association o/Acupuncture
Foreword by Zhao It is well known that science means reducibility, reproducibility, and predictability. In certain fields, various correlated phenomena could be reduced into a model or a theory; based on theory and its methodology, others should reproduce same expected results. Moreover, certain related but unclear mechanisms can be explained, and even unknown phenomena can be predicted. That is science. These criteria posed enormous challenges to the ancient theory and practice of classical acupuncture. Some phenomena related to acupuncture were reduced into yin and yang and the meridians theory, in which qi, a kind of energy stream, flows through the meridians that are composed of acupoints on the body surface. Under such theories, the reproducibility and predictability of acupuncture therapy are questionable. However, this book Contemporary Medical Acupuncture is a breakthrough. The authors, Dr. Guan-Yuan Jin and his collaborators, have initiated and led this revolution. First, based on the knowledge of modem science and contemporary medicine, combining their 40 years of clinical expertise and research accomplishments, the authors have proposed a new concept of whole body reflex zones to replace the meridians. This key concept has built a bridge between medical theories and practices in the West and East while creating a very natural connection between the ancient meridian system and contemporary recognition about physiological and pathological functions of the human body. Moreover, it inherited the rational but eliminated unscientific components of the meridian theory, and fttrther paved a scientific platform for global discussion and exchange in the field of acupuncture. Second, based on the systems and information theories as well as cybernetics,
the authors proposed a new approach or methodology to deal with the acupuncture O
process. Black box, not new in computer science or in engineering fields, is actually proper and innovative in dealing with the incredibly complex human body, as well as the coupling system between patients and doctors. Let us consider the following facts: the human body has not changed significantly in the past 40 000 to 50 000 years; our body consists of roughly 50 trillion cells, each cell has an order of 1013 components, many of which are proteins. In order to simulate the activity of a single protein, even using a computer of speed 10~5calculations per second, it would take several months. Black boxes always exist in our body no matter how deeply recognitions about the body are progressing. Third, authors have explicitly pointed out indications, effectiveness, and the limitation of classical acupuncture. Indeed, in the ancient acupuncture therapy, there are many uncertainties coexisting with its scientific core, as well as some ambiguous terminologies, classical literature flavors, philosophic explanations, superstitions, or fictional stories. This book has "filtered" and "thrown away" all the "garbage" portions and given classical acupuncture a fresh, objective position in contemporary medical field. I am proud of the authors' contribution to the global community. They have applied an internationally acceptable and simple language to describe and express acupuncture theories and practice, which is indeed a very firm, important and significant step.
Shensheng Zhao, PhD Professor of Computer Science Governors State University, IL, USA
Preface
Acupuncture, as a kind of ancient external therapy, is a jewel of traditional Chinese medicine (TCM). Spanning over several thousands years of history since
the first usage of bianzhen (flint needle), it has made tremendous contributions toward preventing and treating diseases as well as promoting the well-being of the humankind. Even today, when contemporary medicine is highly developed, the unique functions of acupuncture therapy still stand irreplaceable by any other therapeutic means. The meridian theory is the basis of acupuncture therapy and is the collection of wisdom, experience, and results of research from generations of pioneering acupuncture practitioners. Ever since the beginning, when I first started to learn acupuncture nearly four decades ago, I have paid much attention to the inheritance of classical theories and techniques of acupuncture. However, as I gained more experience through years of clinical acupuncture and scientific research, especially after I graduated from studies of Western medicine, my recognition about acupuncture has been evolved and deepened. In current studies of the meridian theory and mechanisms of acupuncture, the greatest challenge is that there have not been any special structures of the meridians discovered that are unknown to anatomy. In addition, increasing extraordinary points or newer points found later are excluded from the meridian system, while most original acupoints have multiple functions that are complex and uncategorized. In fact, the therapeutic intervention of acupuncture is a nonspecific physical stimulation compared with medications. Its curative effects can be markedly influenced by many factors, either individual differences of patients or therapeutic techniques of acupuncture practitioners. Thus, classical acupuncture therapy involves great uncertainty in its curative effects. In other words, various types of randomness during acupuncture restrict the
reproducibility of such effects. 03
~o
Reproducibility is one of the most distinguishable characteristics of science. Obviously, given the current state of acupuncture therapy, to date, it shows a less proportions of science component (the certainty of effectiveness) than art component (the randomness of techniques). In order to integrate classical acupuncture into contemporary medicine, the key is to raise its certainty of effectiveness and to reduce its randomness of techniques, i.e., enlarge its proportions of science. Modem scientific knowledge and methodologies must be applied to examine this ancient therapy and to probe its rational core. Motivated by this, I have engaged in numerous clinical acupuncture trials and dove into many studies on the mechanisms of acupuncture as well as the essence of meridians, and set my life-long goal to develop the field of contemporary medical acupuncture. Because contemporary medical acupuncture focuses on the latest, evidencebased achievements in experimental or clinical aspects of acupuncture, it has been widely accepted by many Western medical professionals. During the past few decades, there have been numerous scientific studies on the clarification of the essence of meridians and mechanisms of acupuncture as well as trials on the clinical applications of acupuncture. However, until now, the majority of these studies is rather scattered, localized, or limited in some aspects; often lack a central theme and a scientific methodology that allows full integration of these achievements. On the other hand, some research accomplishments, particularly from China, are overly academic, thus become limited in guiding clinical acupuncture, while high-quality clinical trials done in the West are almost completely disassociated from the meridian theory. Although there have already been several pioneering books published on medical acupuncture, the objective of this book is to instill a new vision into medical acupuncture from the systems level. In the late 1970s, by studying the principles and methodology of systems theory or cybernetics, I began to realize that applying a systems approach to develop acupuncture and the meridian theory is a truly enlightened direction. Meanwhile, the perspectives of systems theory just began to be used to simplify and advance acupuncture in China. In 1976, along with my colleague Dr. Bao, Wenjun, we proposed a new theory, information zone theory to extract the essence of meridians. We also established a simplified model of the meridians and illustrated an atlas of whole body information zones for clinical applications. The traveling courses of meridians on the body surface composed of acupoints were considered a type of manifestation within information zones. Our book entitled Acupuncture
and CyberneticsI~lpublished in 1978, has clarified the meridian system, mechanisms of acupuncture, and the process of the acupuncture therapy, and so on.
Through over three decades of clinical applications, the rationality of whole body information zones and their distribution rules have successfully passed the test of practice. In 1998, we further adopted the term reflex zone, which is recognized internationally, to replace the term i n f o r m a t i o n z o n e . In addition, we reproduced a full-colored atlas entitled whole body reflex zones E21.In 2004, our latest book entitled Clinical Reflexology of Acupuncture and Moxibustion I31was published in China. It applied the perspective of systems theory/cybernetics and contemporary physiology, established a novel theory of acu-reflexology to elucidate and simplify the meridian theory, and guided clinical treatments of intractable cases. Since its publication, we have received numerous enthusiastic reviews from our acupuncture peers and other medical professionals, which greatly inspired us to complete this book on time. This book is a continuation and advance of the above studies Of course, since the mechanisms of acupuncture and the essence of meridians are very complicated, many viewpoints proposed in this book may not be fully developed, and some hypotheses may still need to be validated. However, we deeply believe that by conducting further studies under the guidance of modem science, the eventual integration of ancient acupuncture therapy and contemporary medicine will arrive shortly.
Synopses of the Units and Appendices The pedagogical process of this book begins from the fundamental theories to the methodology of acupuncture, then to its clinical applications. It is organized into three main parts with three appendices. Part One: Overviews of the current state and challenges of classical acupuncture and its theoretical basis-the meridian theory. Examines the anatomophysiological basis of the acupuncture therapy and extracts the essence of meridians. Proposes the novel theory of acu-reflexology and clarifies the formation of meridians and acupuncture mechanisms through a series of models and hypotheses. Introduces classifications and distribution rules of whole body reflex zones, as well as analyzes their relationships with the meridian system. Part Two: Analyzes the coupling system of patient-acupuncturist and the entire therapeutic process. Discusses acupuncture techniques, including the collection of pathological information from the body surface, application of acupuncture intervention, timely adjustments of the treatment plan, as well as control of various influencing factors. Introduces the strategy to enhance clinical effectiveness and covers advanced needling techniques, including increasing stimulation amount, altering preexisting functional states of patients, point-associations, heat-or
-,a
cool-producing methods, and control of propagating needling sensations, and so 00~
on.
Part Three: Focuses on the treatment of common indications of acupuncture, especially applying theories or principles introduced in previous units for intractable cases. Presents up-to-date references on clinical trials of acupuncture and case studies from our clinical expertise of 40 years. Contains treatment strategies for each indication of acupuncture and their mechanisms, the handling of clinical scenarios, and predicted effectiveness. Appendix A: Describes in detail and illustrates whole body reflex zones (visceral, somatic, and central zones) and their distribution territories, which are mapped by the meridian system and their main acupoints. Appendix B: Lists all 361 classical acupoints and most-commonly used extraordinary points or new points, including their anatomic locations. Appendix C: Provides a FAQ (Frequent Asked Questions) on the book.
Readership By utilizing medical terminology and scientific methodology, this book can guide both the clinical practice and scientific research of acupuncture, and is ideal for both Western and Eastern medical professionals. It is a practical, advanced, and valuable resource for acupuncture practitioners who seek to sharpen clinical skills. It can help them either repeat the past successful experiences or seek novel solutions for intractable cases. It is an essential and comprehensive text for medical doctors, dentists, psychologists, chiropractors who are interested in integrating acupuncture into their clinical practice and research. It may also serve as a suitable reference for medical students, TCM students, and other healthcare professionals such as nurses, physical or occupational therapists, massage therapists, and reflexologists who desire to learn more about acupuncture.
Correspondence All books of this nature and magnitude will invariably contain errors of omission and commission. Any constructive comments, corrections, and suggestions about the book as well as any proposals for collaborative research are welcome. E-mail:
[email protected] Acknowledgments This book is only made possible by numerous scientific achievements of many internationally renowned acupuncture practitioners, physiologists, and clinical practitioners. Our personal contribution is only a very small part among them. Therefore, we salute those contributors who made substantial achievements in the development of theories and techniques of acupuncture, especially those authors of the references used in the book. On behalf of the authors, I would also like to acknowledge experts who reviewed the manuscript and have provided forwards: Profs. Shi-Jiang Li, Xuemin Shi, Frances Talaska Fischbach, Feng Ling, Kuishan Zheng, Jia Wei, and Shensheng Zhao. Finally, our special thanks go to Ms. Mary Ann Brennell, RN, Ms. Trudy Munding, and Ms. Xin Yu for their dedicated efforts in editorial assistance of the manuscript.
Guan-Yuan Jin, MD, L.Ac.
Contents
C H A P T E R 1 C H A L L E N G E S IN A D V A N C I N G CLASSICAL A C U P U N C T U R E ................................................ 3 1.1
THE C U R R E N T STATE OF A C U P U N C T U R E T H E R A P Y ............................................................................. 3
1.2
M E T H O D S OF S T U D Y I N G C O M P L I C A T E D SYSTEMS ............................................................................... 5
1.3
M O D E R N EXPRESSION OF A N C I E N T T E R M I N O L O G Y ............................................................................ 7
1.4
A SYSTEMIC VIEW OF M E D I C A L A C U P U N C T U R E ................................................................................... 9
CHAPTER 2
REFLEX ARCS: BASIS OF A C U P U N C T U R E .................................................................................. 12
2.1
H O M E O S T A S I S A N D REFLEX ........................................................................................................................12
2.2
S T I M U L A T I O N SIGNALS OF A C U P U N C T U R E .......................................................................................... 15
2.3
TISSUE STRUCTURES A N D SENSORY RECEPTORS OF A C U P O I N T S .................................................. 17
2.4
AFFERENT P A T H W A Y S OF N E E D L I N G S E N S A T I O N S ........................................................................... 24
2.5
STRETCH REFLEX A N D R E A C T I O N S A R O U N D NEEDLES .................................................................... 26
2.6
I N P U T L O C A T I O N S OF A C U P U N C T U R E S T I M U L A T I O N S .................................................................... 32
2.7
REFLEX CENTERS A N D A U T O N O M I C EFFERENT P A T H S OF A C U P U N C T U R E ............................. 35
2.8
L O N G REFLEXES OF N E R V E - H U M O R A L R E G U L A T I O N ....................................................................... 37
2.9
T H E R A P E U T I C F U N C T I O N S OF A C U P U N C T U R E ................................................................................... 39
2.10
A C U P U N C T U R E A N E S T H E S I A ......................................................................................................................42
CHAPTER 3
REFLEX ZONES: ESSENCE OF THE M E R I D I A N S ........................................................................ 44
3.1
C O N T E M P O R A R Y STUDIES OF THE M E R I D I A N P H E N O M E N A ......................................................... 44
3.2
REFERRED P A I N A N D VISCERA-BODY SURFACE C O R R E L A T I O N .................................................... 48
3.3
R A D I A T I N G P A I N A N D BODY SURFACE-BODY SURFACE C O R R E L A T I O N .................................... 52
3.4
R E V O L U T I O N I Z E THE M E R I D I A N THEORY .............................................................................................56
3.5
REFLEX Z O N E : A SUBSTITUTABLE C O N C E P T FOR THE M E R I D I A N ................................................. 59
3.6
F O R M A T I O N OF REFLEX Z O N E S OR THE M E R I D I A N S ......................................................................... 62
3.7
CLASSIFICATION A N D DISTRIBUTION RULES OF REFLEX Z O N E S ................................................... 65
3.8
R E L A T I O N S H I P S BETWEEN REFLEX Z O N E S A N D THE M E R I D I A N S ................................................ 74
3.9
L O C A L O V E R L A P P I N G A N D LAYERING OF REFLEX Z O N E S .............................................................. 77
3.10
R E L A T I O N S H I P S BETWEEN M I C R O A N D M A C R O REFLEX Z O N E S ................................................... 80
3.11
A SIMPLIFIED M O D E L OF REFLEX Z O N E S OR THE M E R I D I A N S ........................................................ 82
3.12
REFLEXOTHERAPY: THE A S C R I P T I O N OF A C U P U N C T U R E ................................................................ 85
CHAPTER 4
M E C H A N I S M S OF A C U P U N C T U R E F U N C T I O N S ..................................................................... 88
4.1
RELATIVE SPECIFICITY IN A C T I O N S OF A C U P O I N T S ........................................................................... 88
4.2
M E C H A N I S M S OF REGULATORY F U N C T I O N S OF A C U P U N C T U R E ................................................. 93
4.3
M E C H A N I S M S OF A C U P U N C T U R E A N A L G E S I A .................................................................................... 96
4.4
M E C H A N I S M S OF A C U P U N C T U R E R E H A B I L I T A T I O N ....................................................................... 108
C H A P T E R 5 M E C H A N I S M S OF P R O P A G A T I O N OF N E E D L I N G S E N S A T I O N S ....................................... 112 5.1
C L A S S I F I C A T I O N OF P R O P A G A T I O N OF N E E D L I N G S E N S A T I O N S ............................................... 112
5.2
P R O P A G A T I O N OF EXCITATION INSIDE N E R V O U S CENTERS ........................................................ 114
5.3
A C T I V A T I O N OF P E R I P H E R A L FACTORS ................................................................................................119
5.4
HYPOTHESIS: P R O P A G A T I O N OF MUSCLE T E N S I O N WAVES ......................................................... 121
5.5
HYPOTHESIS: T R A N S M I S S I O N A M O N G SENSORY NERVE E N D I N G S ............................................ 125
5.6
HYPOTHESIS: THE RETRIEVAL OF SENSORY M E M O R Y ..................................................................... 128
C H A P T E R 6 BLACK BOX OF THE P A T I E N T .......................................................................................................135
C H A P T E R 7 G A T H E R I N G REFLEX I N F O R M A T I O N F R O M THE BODY SURFACE .................................. 138 7.1
SKIN T E M P E R A T U R E .....................................................................................................................................139
7.2
A P P E A R A N C E A N D T E N S I O N OF L O C A L SOFT TISSUES ................................................................... 141
7.3
T E N D E R SPOTS ................................................................................................................................................142
7.4
ELECTRICAL RESISTANCE OF THE SKIN .................................................................................................144
C H A P T E R 8 I N P U T OF I N T E R V E N I N G I N F O R M A T I O N OF A C U P U N C T U R E .......................................... 146 8.1
O P T I M A L S T I M U L A T I O N L O C A T I O N S .....................................................................................................146
8.2
TYPES OF S T I M U L A T I O N ..............................................................................................................................149
8.3
INTENSITY A N D D U R A T I O N OF S T I M U L A T I O N ................................................................................... 152
8.4
S T I M U L A T I O N FEATURES OF BASIC N E E D L I N G M E T H O D S ............................................................. 155
8.5
PROPERTIES A N D G E N E R A T I O N S OF N E E D L I N G S E N S A T I O N S ..................................................... 157
8.6
S E P A R A T I O N OF EFFECTS A N D N E E D L I N G S E N S A T I O N S ................................................................ 162
8.7
TREATMENT
CHAPTER 9
C O U R S E A N D I N T E R V A L S B E T W E E N S E S S I O N S ......................................................... 163
FEEDBACK PRINCIPLE OF TREATMENT
166
9.1
THE ASSESSMENT OF ACUPUNCTURE
9.2
T I M E M O D E L S O F T H E E F F E C T I V E N E S S ....... .............. .... ........ . ....................... , ........................................ 169
9.3
INDICATORS OF REVISING TREATMENT
9.4
S E L F - C O N T R O L A N D I N S T A N T R E S P O N S E S .......................................................................................... 173
9.5
RAPIDLY REVISING TREATMENT
9.6
THE FLOW CHART OF ACUPUNCTURE
E F F E C T I V E N E S S .................................................................... 166
P L A N ................................................................................... 171
P L A N ................................................................................................. 174
CHAPTER 10 FACTORS INFLUENCING
T H E R A P Y .............................................................................. 175
EFFECTIVENESS OF ACUPUNCTURE
...................................... 179
10.1
T H E S E N S I T I V I T Y O F T H E B O D Y S U R F A C E ............................................ , .................................. , ............. 179
10.2
P R O P E R B O D Y P O S T U R E S ............................................................................................................................ 182
10.3
PSYCHOLOGICAL
10.4
M E N T A L S T A T E O F T H E P A T I E N T .......................................................... .................................................. 187
10.5
THE FINGER STRENGTH OF THE PRACTITIONER
10.6
PAINLESS NEEDLE-INSERTION
10.7
THE SETTINGS OF THERAPEUTIC
10.8
T H E O R D E R O F S T I M U L A T I O N ................................................. , .............................................. . .................. 193
10.9
THE AREA OF STIMULATION
F A C T O R S ....................................................................................................................... 186
TECHNIQUES
................................................................................ 189
...................................................................................... 190
ENVIRONMENT
............................................................................. 192
...................................................................................................................... 196
10.10 T H E S I Z E O F N E E D L E S ................................................. ............................ ...... ,... ...................... ..................... 198 10.11 T H E A N G L E , D E P T H A N D D I R E C T I O N O F N E E D L I N G
C H A P T E R 11
STRATEGIES TO RAISE THERAPEUTIC
....................................................................... 199
E F F E C T I V E N E S S ..................................................... 203
11.1
S E L E C T I O N O F T E N D E R S P O T S .........................................................................................
11.2
M U L T I P L E N E E D L E S A T A S I N G L E P O I N T ............................................................................................... 205
11.3
SINGLE NEEDLE THROUGH
11.4
INTEGRATING
11.5
TECHNIQUES
11.6
PROLONGING
11.7
POINT-ASSOCIATIONS
11.8
ALTER PREEXISTING FUNCTIONAL
11.9
MISCELLANEOUS
C H A P T E R 12
M U L T I P L E P O I N T S ................................................................................... 207
WITH ELECTRICAL STIMULATION OF HEAT-PENETRATING STIMULATION
NEEDLING
POINT-PROBING
12.2
NEEDLE-MANIPuLATIONS
12.3
POINT-PROBING
12.4
NERVE-STIMuLATION
............................................................... 213
........................................................................
THROUGH
12,1
............................................................................. 210
MOXIBUSTION
......................................... 215
M U L T I P L E P A S S A G E S ................................................................. 217 S T A T E S O F T H E P A T I E N T ....................................................... 223
NEEDLE-MANIPULATION
ADVANCED
203
TECHNIQUES
TECHNIQUES
227
................................................................................. 229
AND REPEATEDLY NEEDLE-THRUSTING
METHODS
........................................ 229
W I T H B O T H H A N D S ................................................. . ............................... 231
WITH ELECTROACUPUNCTURE
.............................................................................. 232
T E C H N I Q U E S ....................................................................................................... 233
12.5
P U L S A T I N G RESPONSES A N D P U L S A T I N G P O I N T S ............................................................................ 235
12.6
B L O O D VESSEL S T I M U L A T I O N T E C H N I Q U E S ....................................................................................... 239
12.7
R E S I S T A N C E - N E E D L I N G M E T H O D ........................................................................................................... 241
12.8
H E A T / C O O L - P R O D U C I N G T E C H N I Q U E S ............................................................................................... 243
12.9
C O N T R O L T H E P R O P A G A T I O N OF N E E D L I N G S E N S A T I O N S .......................................................... 245
C H A P T E R 13 D I S O R D E R S OF THE M U S C U L O S K E L E T A L SYSTEM ............................................................. 253 13.1
F R O Z E N S H O U L D E R / S H O U L D E R P A I N .................................................................................................. 253
13.2
C E R V I C A L S P O N D Y L O P A T H Y / C H R O N I C N E C K P A I N ...................................................................... 256
13.3
STIFF N E C K / W H I P L A S H
13.4
L U M B A G O ......................................................................................................................................................... 262
13.5
H I P O S T E O A R T H R I T I S / G R O I N P A I N ........................................................................................................ 268
13.6
K N E E A R T H R I T I S / K N E E P A I N ................................................................................................................... 270
13.7
R H E U M A T O I D A R T H R I T I S / A R T H R I T I S OF S M A L L JOINTS ............................................................... 274
13.8
F I B R O M Y A L G I A .............................................................................................................................................. 277
13.9
T E N D O N I T I S / H E E L P A I N ............................................................................................................................ 279
.............................................................................................................................. 259
13.10 T E N N I S E L B O W / E P I C O N D Y L I T I S .............................................................................................................. 281 13.11 C A R P E L T U N N E L S Y N D R O M E ................................................................................................................... 284 13.12 T E N O S Y N O V I T I S / T R I G G E R F I N G E R / G A N G L I O N ................................................................................ 286 13.13 I N J U R E D SOFT TISSUES O R S P R A I N E D A N K L E ..................................................................................... 289 13.14 S C I A T I C A ........................................................................................................................................................... 290
C H A P T E R 14 D I S O R D E R S OF T H E N E R V O U S SYSTEM .................................................................................. 295 14.1
I N T E R C O S T A L N E U R A L G I A / C H E S T P A I N ............................................................................................. 295
14.2
L A T E R A L F E M O R A L C U T A N E O U S N E U R I T I S ........................................................................................ 298
14.3
P E R I P H E R A L N E U R O P A T H Y ....................................................................................................................... 299
14.4
REFLEX S Y M P A T H E T I C D Y S T R O P H Y ....................................................................................................... 301
14.5
T R I G E M I N A L N E U R A L G I A .......................................................................................................................... 304
14.6
BELL'S PALSY ................................................................................................................................................... 307
14.7
F A C I A L S P A S M ................................................................................................................................................ 310
14.8
H E A D A C H E ...................................................................................................................................................... 312
14.9
A P O P L E X Y / H E M I P L E G I A ............................................................................................................................ 316
14.10 T R E M O R / P A R K I N S O N ' S DISEASE ............................................................................................................. 324 14.11 M U L T I P L E SCLEROSIS ................................................................................................................................... 327 14.12 A L Z H E I M E R ' S DISEASE ................................................................................................................................. 329 14.13 EPILEPSY ........................................................................................................................................................... 330
C H A P T E R 15
M E N T A L D I S O R D E R S ................................................................................................................... 333
15.1
I N S O M N I A ........................................................................................................................................................ 333
15.2
NEUROSIS/NERVOUSNESS/ANXIETY
15.3
H Y S T E R I A .......................................................................................................................................................... 339
15.4
DEPRESSION/SCHIZOPHRENIA/PSYCHIATRIC
..................................................................................................... 336
C H A P T E R 16 D I S O R D E R S OF O P H T H A L M O L O G Y
D I S O R D E R S ........................................................... 340
......................................................................................... 344
16.1
M Y O P I A / A M E T R O P I A ................................................................................................................................ 344
16.2
R E T I N O P A T H Y / O P T I C A T R O P H Y / G L A U C O M A .............................................................................. 347
C H A P T E R 17 D I S O R D E R S OF O T O R I N O L A R I N G O L O G Y
.............................................................................. 352
17.1
T I N N I T U S / N E U R O S E N S O R Y D E A F N E S S ................................................................................................. 352
17.2
M E N I E R E ' S D I S E A S E ...................................................................................................................................... 354
17.3
R H I N I T I S / S I N U S I T I S ...................................................................................................................................... 355
17.4
D Y S P H O N I A ..................................................................................................................................................... 357
C H A P T E R 18 D E N T A L D I S O R D E R S ..................................................................................................................... 360 18.1
TOOTHACHE/DENTAL
P A I N ..................................................................................................................... 360
18.2
D Y S F U N C T I O N OF T E M P O R O M A N D I B U L A R J O I N T ............................................................................ 362
C H A P T E R 19 D I S O R D E R S OF C I R C U L A T O R Y SYSTEM .................................................................................. 364 19.1
H Y P E R T E N S I O N .............................................................................................................................................. 364
19.2
A N G I N A P E C T O R I S / C O R O N A R Y A R T E R Y D I S E A S E S ......................................................................... 367
19.3
A R R H Y T H M I A S ............................................................................................................................................... 369
19.4
R A Y N A U D ' S S Y N D R O M E ............................................................................................................................. 370
C H A P T E R 20 D I S O R D E R S OF R E S P I R A T O R Y SYSTEM .................................................................................... 373 20.1
C O M M O N C O L D / T O N S I L L I T I S .................................................................................................................. 373
20.2
ASTHMA/BRONCHITIS
C H A P T E R 21
................................................................................................................................ 374
D I S O R D E R S OF D I G E S T I V E SYSTEM .......................................................................................... 378
21.1
NAUSEA/EMESIS/HICCUPS
........................................................................................................................ 378
21.2
G A S T R I T I S / P E P T I C U L C E R / R E F L U X E S O P H A G I T I S ............................................................................ 382
21.3
ULCERATIVE COLITIS/IRRITABLE BOWEL SYNDROME/CROHN'S
21.4
C H O L E L I T H I A S I S ............................................................................................................................................ 386
21.5
H E P A T I T I S ......................................................................................................................................................... 388
DISEASE .............................. 384
C H A P T E R 22 D I S O R D E R S OF U R O G E N I T A L SYSTEM .................................................................................... 391 22.1
U R I N A R Y R E T E N T I O N .................................................................................................................................. 391
_
Neck > Chest > Abdomen > Lower Limbs > Upper Limbs
pain), while in acupuncture anesthesia, needling is applied just prior to surgery (i.e., the surgical pain)
From the above, we can clearly see the highest
and sustains during the entire process of surgery to
success rate is for craniocerebral surgeries, the second
ensure anesthetic effects. In other words, the sub-
highest is for cervical (e.g., the thyroidectomy) and
sequent surgical pain is inhibited by acupuncture
thoracic surgeries, and then abdominal surgeries.
signals inputted before (through an inductive
The lowest is for the lower and upper limbs. Another
period) and during surgery. Nevertheless, the
study also revealed the same sequence for the pain
efficacy of acupuncture anesthesia is also realized
threshold raised by acupuncture in the entire body
through the stimulation of sensory receptors on the
except the head, namely under the same stimulation
body surface and the activation of reflex arcs like
intensity, the increased pain threshold is most re-
that of acupuncture therapy in spite of their time
markable at the skin of the neck t~091.
differences of stimulation signals inputted to the
It must be noted that the processes of acupuncture
body.
Since the ancient times, acupuncture therapy has
inheritance and development of the meridian theory.
been practiced under the guidance of the meridian
It can be used to substitute the meridian theory and
theory. However, with clearer understanding of their
to guide the entire process of acupuncture therapy
therapeutic mechanisms and numerous contem-
scientifically.
porary studies on the essence of meridians along with the discovery of many new points, the meridian theory begins to show certain signs of scientific deficiencies. In order to modernize acupuncture therapy, the meridian theory must be revolutionized. To facilitate this revolution, we have applied
3.1 Contemporary Studies of the Meridian Phenomena
perspectives of cybernetics and contemporary reflex theory to clarify the meridian system and proposed
Over the half century, although a great deal of
the concept of whole body reflex zones (WBRZ) to
clinical and experimental studies have been con-
substitute the meridians. The essence of meridians
ducted on the meridian phenomena, resulting in a
is merely connection pathways between upper and
much clearer understanding including charac-
lower, left and right, internal and external portions
teristics of propagating needling sensations along
of the body that reciprocally reflect on each other.
the meridians (PNSAM). Until now, not a single
Acupoints are either outputting areas (reflex points)
specific anatomical structure of meridians could be
of internal information onto the body surface, or
detected.
inputting areas of therapeutic acupuncture infor-
The phenomena of meridians can be manifested
mation into the body. The WBRZ composed of
mainly in two aspects. The first is PNSAM, a kind of
merging reflex points or acupoints with similar
subjective propagating sensation spontaneously
functions may be categorized into three major types
induced or activated by needling, moxibustion, or
of reflex zones: somatic, visceral, and central, all have
other methods of stimulation. Depending on means
their unique distribution patterns and characteristics,
of stimulation and individual differences, PNSAM
and may even overlap at certain portions on the body
may vary, including soreness, numbness, heaviness,
surface. The above contents have been defined as a
coldness, warmness, or other sensations like worm
novel theory titled acu-reflexology resulted from the
crawling, water flowing, pulsing, and so on. The
second is the external a p p e a r a n c e of objective
0.5~5 cm or greater. When PNSAM is in zone-shape,
changes either along or near the meridian course on
there is a more distinct central line within it. When
the body surface. They mainly include the color (red
the sensations traveled through the chest, abdomen,
or white) of the flesh, papule, and vesicula that are
head, or face, there could be a greater diffusing area.
visible with the naked eye and reduction of electric
Some sensations traveled superficially on the body
resistance of the skin. These two kinds of meridian
surface, while others were deeply rooted in the body
p h e n o m e n a may occur either alone or in combi-
cavity. In short, description about traveling courses
nation. Actually, observing the meridian pheno-
of the 14 meridians in the meridian system is mostly
mena is an approach to study the traveling courses
accurate and reliable, though there is a great amount
of the meridian system, and serves as an evidence
of variations. Furthermore, most of their distri-
to verify the existence of the meridians.
butions across the body surface are in either zone-
Before the 1970s, there were only some scattered reports of PNSAM in China. However, since then,
shape or slices rather than in line-shape. In some people with sensitive meridians phe-
subjects,
studies on PNSAM grew at a m u c h faster rate.
n o m e n a or called m e r i d i a n - s e n s i t i v e
According to a consistent method and standard, a
p a p u l o i d zones along the m e r i d i a n s could be
nationwide survey was conducted among more than
observed. For example, during a 2-week period in
20 000 Chinese people with different ethnicities, ages,
1972, a male volunteer received six times of pulsate
genders, and residential locations. Results showed
electrical stimulation with low frequency. It included
that there were more than 3 000 people with PNSAM.
five times of stimulation on Jing (well) points with
Among them, over 500 people had sensitive meri-
surface electrodes and one time on Ganshu (BL18)
dians and PNSAM. However, the no differences of
with EA, with total 18 meridians stimulated. Except
PNSAM were observed between various residential
once each for SI, PC and GB, all other 15 meridians
locations, ethnicities, or genders. Some Western re-
showed some degree of papuloid zones along the
searchers also surveyed with a similar method and
meridian 13-16 hours after the stimulation. Among
found PNSAM existed in both Caucasians and
them, appearance of papuloid zones at six meridians
African Americans.
of LI, HT, PC, SJ, SP, and ST were relatively intact.
From the above survey, it was observed that tra-
Observers took photos of them that time f49j.Those
veling courses of propagating needling sensations
papuloid zones were well above the skin surface but
were almost consistent with traveling courses of
still within the skin. They were harder than sur-
meridians, especially on the limbs. However, there
rounding tissues but no cord-like objects could be
were few variations such as extending or shortening
felt beneath the skin. They looked similar to those
of traveling courses, trespassing to other meridians
cutaneous reactions when suffering from urticaria.
or elsewhere, which usually occurred in trunks,
Their widths were about 0.5-0.6 cm. Each time just
especially on the head and face. The propagating
before they appeared, a hot flush was throughout
needling sensation shapes are mostly lines, zones,
the entire body. Their traveling courses completely
or slices. Their widths varied d e p e n d a n t on the
matched the described propagating sensations and
i n d i v i d u a l person, meridian, and the body part,
were almost Consistent with the meridian courses
namely narrower in portions of limbs and wider in
recorded in ancient texts. Papuloid zones usually
portions of the think. Generally, the width is between
lasted for about one or two hours then subsided.
Although this kind of phenomenon is rare, and its
coincided with the classic meridian courses. The
mechanism is still relative unknown, at least it pro-
longest one could cross over multiple body regions,
vides a visible basis for the presence of meridians.
and traveled almost through the entire length of
Other meridian phenomena visible directly include
meridians. Its appearance in healthy subjects is about
skin disorders along the meridians. Except few such
30%, but it varies in different meridians. In a survey
case reports in Japan, former Soviet Union, Germany,
of 113 volunteers, its incidence of IRRTM along GV
and Hungary, there were over 200 meridian-sensitive
over the back was about 77.9%, in which the long dis-
subjects reported in China [so].It was also observed
tance traveling from Dazhui (GV14) to Yaoyangguan
in the clinic that some spontaneous band-shaped
(GV3) was 30.9% and the half distance was 35.4 %. Its
abnormal sensations appeared along the meridians
incidence along CV over the chest and abdomen was
under certain pathological conditions, which com-
26.6%, in which the long distance traveling from Tian-
monly were numbness and tenderness, or a com-
tu (CV22) to Zhongji (CV3) was 5.3% and the half
bination of multiple sensations.
distance was 13.3 %. The incidence of IRRTM along
Regarding other indirect objective indicators of
three-yang and three-yin meridians
of hands in 52
the meridian phenomena, the earliest and most
volunteers was about 30%, in which the incidence
reported studies were on characteristics of low
along lung meridian was the highest, over 50%. The
electric resistance or high potential at acupoints
occurrence of such coincidence was high among
(refer to Section 7.4). Since 1980s, biophysics studies
patients and might bear some relation to the affected
of the meridian obtained a series of new advan-
viscera.
cements in China. For instance, it was found that
Through the preliminary study, it is certain that
areas along the meridian courses had characteristics
IRRTM is not related to large blood vessels running
of projecting a stronger fluorescent light than those
in subcutaneous or deeper tissues, and may not be
outside of the meridian courses. When using a infrared
simply explained with the law of conduction of
thermograph to display changes of temperature in the
thermal energy in thermodynamics. IRRTM is
process of PNSAM, the screen could display higher or
actually a particular living phenomenon under
moderate temperature bands that coincided with
natural conditions. During the process of heating
traveling courses of propagating sensations [5~,52].
acupoints or non-acupoint spots along the meri-
Moreover, tissues at the meridian courses not only
dians, the response of increasing skin temperature
had a specific ability of sound conduction, but also
could extend along the meridians bi-directionally.
could deliver specific, high vibrating sound when
Incidence of IRRTM markedly increased under such
vibrated mechanically. The latter could be measured
conditions. Results of cooling tests in 30 cases sug-
for almost everyone, and the locations were rela-
gested that the thermal source of IRRTM might be
tively fixed [53].
located in tissues beneath the skin at a definite depth.
Recently, there has been much progress using the
As for the underlying mechanism in the formation
infrared thermal imaging technology to study the
of IRRTM, it remains an unsolved mystery. Pre-
meridian phenomena. Under natural condition
liminary results of such experiments showed that
without any external interference, an infrared
oxygen metabolism was more active in those sites,
radiant tracking along the meridians (IRRTM)
which indicated an intensive energy metabolism in
could be observed. Its course almost completely
related tissues or microcirculation state of the skin
along the meridian course might be an important
of meridians on the body surface. Ancient literature
factor resulting in its formation [s4-56j.
about the meridians as well as most modern obser-
On the other hand, numerous clinical practices of
ved meridian phenomena could be considered as a
acupuncture have proven that the significance of
kind of functional expressions of above tissues at
PNSAM is highly and directly correlated with
various body parts through neuralhumoral regula-
needling effects (P---]~~it~) .~,.
~~,k~~~JJ-~J]:~, ,k~I!~~, 1974:20-34.
[501 ~ : ~ . i E ~ ~ N ~ ~ I ' ~ - ] ~ i ~ ~ ~ .
~ll~~ff~,-f
9 N~.~~. ~.~r
(~
~,,- 9 N ~ . ~ ~ ,
1987:203. [51] Liu R, Zhuang D, Yang X, et al. Objective display on phenomena of propagated sensation along channels (PSC)-changes on the infrared thermal image channels pathway of upper extremity. J. Acup. Res, 1990, 15(3):239-244. [52] Liu R, Zhuang D, Yang X. et al.1990 Objective observation on phenomena of sensation along channels (PSC) and QI reaching to affects area (QIRA) -the influence of acupuncture points on infrared thermal image of face. J. Acup. Res, 1990, 15(3):245-249. [531 ~,~,~]~. ~ ~ @ @ ~ ~ J ] : ~ ~ J r ~ J ~ .
9 N~,~~.
~,~T~3~~~.
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1987:203-
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