44 S.H. Hsiao, L.J. Tsaicarries the oxygen complexed with Hb to all partsof the body where it is required for metabolismand also returns carrying carbon dioxide back tothe lungs, where gaseous exchange occurs withthe atmosphere. The peripheral chemoreceptorslocated in the carotid bodies respond primarily tohypoxemia. Central chemoreceptors located in theregion of the brainstem respond to hypercapnia.Activation of either the hypoxic or hypercapnicchemoreflex elicits both hyperventilation and sym-pathetic activation . There is evidence fromanimal and human studies that NO may play a role inhypercapnia induced vasodilation [18,19]. Recently,nNOS has been identified as a source of NO in thevicinity of microvessels and has been shown toparticipate in vascular function. Thus, NO can beproduced and transported to the vascular smoothmuscle cells from endothelial cells and perivascularnerve fibers, mast cells and other NOS-containingsources .In Chinese terms, “acupuncture is a healing artof inserting a needle into an acupuncture point in themeridian to correct an imbalance of Qi. The aim of acupuncture is to stimulate the flow of Qi throughthat meridian.” To explain the meridian pheno-menon, we proposed a neurovascular transmissionmodel for acupuncture induced NO.
2.1. Acupuncture inducedmechanotransduction
Immediately after a needle is inserted into connec-tive tissue, the mechanical force is transferred tothe extracellular matrix (ECM). The ECM is a multi-component tissue that is able to transduce internaland external mechanical signals into changes inthe tissue structure and function through a processtermed mechanochemical transduction [21,22].
2.2. Mechanical force is able to changeNO production, the blood vessels’local circulation and skin sympatheticnerve activation
Through the ECM, the mechanical force stimuluscan travel across the acupuncture point into thelocal tissue cells. The local tissue cells includingarterioles, nerve terminals and mast cells can stim-ulate vascular nerve fibers; this will trigger nNOSand eNOS induced NO production . Other tis-sues that may be involved include smooth musclecells and endothelium cells; this is because theacupuncture is able to produce NO and this in-creases the blood flow, which change the local cir-culation [8,23]. Thus, mechanotransduction is ableto trigger these cells to produce a burst of NO pro-duction, which diffuses into the vascular smoothmuscle and change blood flow and local circulation.L-arginine-derived NO synthesis appears to medi-ate the noradrenergic function that is part of skinsympathetic nerve activation and this contributesto the skin electrical resistance at acupuncturepoints and meridians .
2.3. The mechanical force of the needlecoupled with cyclic strain of bloodvessels changes the hemodynamicbalance of the artery tree
Blood vessels are permanently subjected to mechan-ical forces in the form of stretching, which includecyclic mechanical strain. When acupunctured at aspecific acupuncture point, the local mechanicalstress produced is coupled with a cyclic strain of the blood vessel and this may change the resonancefrequency.According to the resonance theory , a merid-ian can be classified according to its effects on thepulse spectrum and all meridian related effects,including those caused by acupuncture, are fre-quency specific. Therefore, the artery tree wouldchange the blood distribution and microcirculationof various organs and further affect the productionof NO by eNOS.
2.4. An oscillatory pattern of NO formationin a specific organ
For both agonist and hemodynamic stimuli, an oscil-latory pattern of NO formation might occur with aburst of duration of a few seconds and a stimuli-dependent frequency in the order of tens of secondsto a few minutes . Thus, by changing the hemo-dynamic state of the organ, an oscillatory patternof NO formation might be created at a particularfrequency in a specific organ . In such a case,the frequency in the stomach ought to be differentto that of the liver and therefore the NO productionwill also be different.
3. Evaluation of the NeurovascularTransmission Model of Acupuncture
Over the past 30 years, studies aimed at understand-ing the acupuncture point/meridian system havemainly looked for distinct histological features thatmight differentiate acupuncture points from thesurrounding tissue. Several structures, such as neu-rovascular bundles [27
29], neuromuscular attach-ments [30
32] and various types of sensory nerveendings [33,34], have been described at acupuncturepoints.