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J Acupunct Meridian Stud 2010;3(1):19

RE V I E W A RTI CL E

Meridian Studies in China: A Systematic Review


Guang-Jun Wang1, M. Hossein Ayati2, Wei-Bo Zhang1*
1
Institute of Acupuncture and Moxibustion, China Academy of Chinese Medicine Science, Beijing, China
2
Acupuncture School, Beijing University of Chinese Medicine, Beijing, China

Received: Oct 5, 2009 Abstract


Accepted: Jan 14, 2010 Meridian theory is a major part of Chinese medicine and has guided acupuncture
and clinical practice for thousands of years. Meridian theory describes many impor-
KEY WORDS: tant concepts about the rules of human body function and regulation, but has com-
chemical characteristics; paratively huge differences with the basic concepts of modern medicine. These
interstitial fluid; differences have caused deep concern and attracted attention from scholars, both
inside and outside of China. The interest in meridian theory lies in determining the
mask cells;
structural nature of meridians. Not only is this information still unclear, it is very
meridian;
difficult to achieve clear results in a short period of time. Despite this, the phe-
meridian phenomena;
nomena of meridians can be used as the entry point for meridian studies.
neural aspect After many years of effort, although the physical structure of meridians has not
been found, the existence of the meridian phenomena has been fully confirmed.
Although there is a lack of morphological evidence for the existence of the merid-
ian, concluding non-existence may be incorrect as morphology techniques develop
and structures previously not determined are being found. Since the phenomenon
of meridians exists, some biological basis behind its occurrence must be present.
This implies that research on meridians needs to continue as research techniques
advance and may eventually reveal the biological basis of the meridian phenom-
enon. In the present review, we analyze the history of meridian studies in China.

1. The Origin of Meridian Studies in great importance to the concept that all body func-
China tions are under the complete state of one organism,
the black-box theory was adopted in its research
Meridians are passageways for the flow of qi and [1]. The theory pays attention to changes in outside
blood, which are the two basic bodily fluids in phenomena, as such, its theoretical system lacks
Chinese medicine. These passages include 12 stan- an anatomical basis. However, along with the de-
dard channels, 12 collaterals, 8 extra meridians, velopment of modern medicine, people gradually
15 large collaterals, musculature of 12 meridians realized that acupuncture, that follows the meridian
and 12 skin divisions. Meridians spread on the sur- theory, has the best outcomes; traditional Chinese
face of the whole body vertically and horizontally, medicine believes that the therapeutic effects of
integrating the inside with the outside of the body. acupuncture are achieved through the meridian sys-
They also connect the inner organs, joints and ex- tem. Additionally, by studying a number of skin dis-
tremities, thus transforming the whole body into eases, propagated sensations and the migration of
one entire organ. As Chinese medicine attaches isotopes along the meridians (Figures 1, 2 and 3,

*Corresponding author. Institute of Acupuncture and Moxibustion, China Academy of Chinese Medicine Science, No. 16, Dongzhimennei,
Beijing, 100700, China.
E-mail: zhangweibo@hotmail.com

2010 Korean Pharmacopuncture Institute


2 G.J. Wang et al

medical knowledge. Meridian study and research


therefore attracted a lot of interest.
In 1963, Dr Bonghan Kim from North Korea [57]
announced the discovery of the meridian anatomy
and structure, and named them Bonghan duct
or Bonghan capsule. Bonghans work however
failed to be repeated and was widely questioned.
The Austrian expert Kellner stated that the struc-
ture Bonghan found exists, but was only a remnant
from development, and could not support the
function of the meridian system [8,9]. At the same
Figure 1 Skin disease along the meridians. Figure taken time, China planned to systematically duplicate
from Li [2].
Bonghans work but failed to support Bonghans
conclusions, and the repeated work has not been
published. Nevertheless, during the repetition of
Bonghans work, a meridian research team was or-
ganized and marked the beginning of meridian
study in China. Prior to this, only a few histological
studies into acupoints had been conducted in China
(Table 1 [1021]).

2. The Main Significance of Meridian


Studies in China
2.1. Investigations into propagated
sensation along meridians

The effects of acupuncture rely on the integrity of


the nervous system, thus the study of meridians
focusing on the neural aspect has become common-
place. In the 1950s, Professor Xi-Jun Zhang stated that
action of the meridians is accomplished through
Figure 2 Pagated sendation travelling along the Urinary neural reflection [22]. From a gross anatomy per-
Bladder Channel. Figure taken with permission from Hu spective, meridian and acupoint regions are always
and Cheng [3]. richly innervated. Moreover, the meridian and pe-
ripheral nervous systems are roughly very similar
in their path around the body, especially below the
elbow and knee joints where the meridians are al-
most along the path of the nerve trunks and their
main branches. Descriptions of meridian function
in classical Chinese medical records are also closely
related to the nervous system. Therefore, merid-
ian research from the neural perspective may still
be highly fruitful.
Propagated sensations along channels (PSC) is a
meridian phenomenon which was investigated in
over 100,000 people over 20 provinces in China in
1970s. These studies revealed that approximately
0.3% of people exhibited PSC. PSC is considered a
Figure 3 Migration of an isotope along meridians. Figure window for revealing the substance of the merid-
taken from with permission from Meng et al [4]. ian. However, this propagated sensation is a sub-
jective feeling, and must therefore be associated
respectively [2,3,4]), the existence of the merid- with the central nervous system, particularly the
ian phenomenon was confirmed. Ultimately, this sensory cortex. This has led some researchers to be-
kind of regulating and controlling channel parallel to lieve that PSCs are an expanding excitement oc-
the body surface cannot be explained by current curring within the sensory cortex [23]. However,
Meridian studies in China 3

Table 1 Landmark events of meridian study in China

Time Landmark events

1955 Study of Meridian was translated from Japanese to Chinese by Dan-An Chen.
1956 The study of meridian essence was classified as a key project of Natural Science Development
Plan in China, where histological studies were carried out on acupoints.
1963 BHC and BHD structures were reported by Bonghan Kim in North Korea.
19641970 Meridian essence was studied mainly using morphological methods.
1971 America president Nixon visited China; this induced the study of acupuncture-anesthesia widely.
19721987 Propagated sensation along channels and other meridian phenomena were studied widely.
19881992 Meridian study was classified as 7th five plan, and the main content was migration of isotopes
along meridians.
Biophysics of Acupuncture-Meridians: The verification of the first invention in China was
published (Zu et al, 1989 [10]).
Modern Research of Meridians in TCM Theory was published (Hu et al, 1990 [11]).
Structure and Function of Meridians was published (Zhang, 1992 [12]).
19931997 Meridian study was classified as 8th five plan, and the research content involved three parts:
the mechanism of propagated sensation along meridians; the relationship between meridians
and viscera; and the physical and chemical characters of meridians.
Clinical Meridians Phenomenology was published (Liu, 1994 [13]).
What is the Meridians was published (Zhang, 1997 [14]).
Soul of Gold Needle: The study of meridians was published (Hu, 1997 [15]).
Classical Meridian Theory and Modern Meridian Theory was published (Liu, 1997 [16]).
19982002 Meridian study was classified as 9th five plan, and the research content still involved the same
three parts: the mechanism of propagated sensation along meridians; the relationship between
meridians and viscera; and the physical and chemical characters of meridians.
Discovery of Fourteen Meridian Channels Image was published (Meng et al, 1998 [17]).
2002present Discovery of Meridians in TCM Theory was published (Li et al, 2003 [18])
Science of Meridians was published (Zhang et al, 2003 [19]).
Meridians Medicine: The decode of meridians cipher code (Liu et al, 2007 [20]).
Meridians and Collaterals are the Water Passages was published (Zhang 2009 [21]).

BHC = Bonghan corpuscle; BHD = Bonghan duct.

this viewpoint may not stand as propagated sensa- the mechanism of propagated sensation, some re-
tions accompany reactions of the skin, blood ves- searchers place an emphasis on central nervous
sels and nerves. Furthermore, PSC can be blocked processes [13,2930]. The question is whether it is
by mechanically pressing on the meridians [24]. As truly necessary to have a unique mechanism that
PSC can be stopped by outside pressure, it is rea- explains all the phenomena of PSC. Perhaps multi-
sonable to presume that a form of active factor ple substances exist within both the peripheral and
is involved in the formation of PSC [25]. Myoelec- the central nervous systems to give rise to the dif-
tricity along meridians could be one such factor ferent aspects of PSC.
[26]. Another explanation for propagated sensa-
tion caused by acupuncture may be related to the 2.2. Comments on the essence of meridians
axon reflection of the peripheral nerves and the mi- as a circulatory system
gration of histamine between the peripheral nerve
terminals due to nerve-mast cell interaction [27]. Neurology is a significant component in meridian
Alternatively, the characteristic order of PSC could research, and raises important questions in de-
happen between motor neurons, based on the col- veloping the research. Meridians certainly shares
umn structure in the spinal cord [28]. However, the some common components with the nervous sys-
involvement of peripheral motive factor in propa- tem. Furthermore, meridians certainly do not pos-
gated sensation still does not explain this phenom- sess all nervous system structures and functions, or
enon in pseudomelia; therefore, when elucidating vice versa [31]. Thus, the study of meridians from
4 G.J. Wang et al

the perspective of neurophysiology is unilateral. blood nor lymph vessel [45]. Only micromolecules can
Classic medical books show that meridian and blood migrate along the meridians, and this migration is
vessel naming are closely related, especially in older powered by the different pressures generated by
texts [32,33]. The original meaning of Mai is blood blood and lymph circulation [46]. The migration
vessels [34]; studying the meridians as a circulatory routes are not only continuous [47], but also consis-
system may also be valid [35,36]. From a functional tent with meridian lines [48]. Based on the above
point of view, not only vessels themselves [37], but experiments, Professor Wei-Bo Zhang proposed the
also the nerves in the vessel walls [38], and even Low Hydraulic Resistance Channel Theory [49]. He
the rhythm in the microvascular networks of the believes that the interstitial substance is hetero-
meridian system [39] have gradually become areas geneous, meaning that some parts have high perme-
of interest for researchers. Moreover, the lymphatic ability and low resistance to the flow of interstitial
system is also closely related to the meridian sys- fluid, and thus form a low hydraulic resistance point
tem [40,41]. However, some academics oppose the [50]. Adjacent low hydraulic resistance points can
theory that a relationship exists between meridi- transfer the hydraulic wave, indicating the connec-
ans and the circulatory system. They believe that tion among these points, thereby forming a chan-
the movement of liquid in the vessels cannot form nel [51,52]. By measuring hydraulic resistance,
the propagated sensation, and hence the circulatory transmission of the pressure wave and migration of
system cannot be equated to meridians [42,43]. the isotope, low hydraulic resistance channels were
found along meridians which are believed to be the
2.3. Investigating the substance of main body of the meridians [5356]. Zhang also
meridians from the aspect of put forward a neural-fluid transmission model to ex-
interstitial fluid flow plain the effect of acupuncture and PSC, based on
the low hydraulic resistance channel (Figure 4 [57]).
Since meridian function is identical to neither the From the perspective of modern microcircula-
nervous system nor the circulatory system, then tion, there is a minute gap between end capillary
why do meridians transport qi and blood as de- vessels and interstitial fluid cells. The transporta-
scribed in the classic Chinese medicine theory and tion of nutrients, exchange of information, as well
how is this accomplished? The most direct way to as the removal of metabolic waste not only depend
solving this issue is to observe how radio-labeled on the diffusion gradient, but also convection of
material migrates in meridian lines. One study using interstitial fluid. However, the process of intersti-
this technique showed 14 meridian lines in more tial fluid flow still remains unknown. In recent
than 90% of cases based on a sample of 1000 par- years the concept of a tissue channel has provided
ticipants [44]. The migration routes were neither a breakthrough point for solving these problems.

Needle

Skin surface

Capillary expands

Histamine
Meridian
Stimulate
Mask cells P substance New axon reflection
Interstitial fluid increase
(impedance decrease)
Axon reflection New afferent signal To cortex
Afferent signal

Afferent nerve
Figure 4 Mechanism for the effect of acupuncture along meridians. Figure taken with permission from Zhang et al [57].
Meridian studies in China 5

It allowed the movement of interstitial fluid path- was then proposed for the study of the fascia of me-
way to be shown [58], and illustrated that the ridians [7476], as the function of this membrane
function of the interstitial fluid pathway coincided structure is to maintain the stability of the interior
with the function of meridians [59]. Furthermore, body, and also is the specific reflection of merid-
based on the fact that capillary vessels and colla- ian substance in the human body.
gen fibers at the location of acupoints are arranged
in the direction of the meridians, it has been pro-
posed that the directional flow of interstitial fluid 3. The Relationship Between Mast Cells
is closely associated with meridians [60]. Professor and Meridians
Wei-Sheng Yang has performed skin impedance stud-
ies for many years and found that meridian lines As mast cells are widely distributed in connective
have low impedance [61,62]. The cause of this low tissue and are also involved in various rapid physi-
resistance characteristic was thought to be due to ological responses, their relationship with the merid-
the relatively high amount of interstitial fluid and ians has received attention. Mast cells are thought
the histological nature of the meridians, which are to play a key role in acute allergic reactions. They
rich in loose connective tissue [63,64]. also participate in delayed type hypersensitivity
As interstitial fluid pressure is lower than at- [77], and fighting against bacterial [78,79] and par-
mospheric pressure, and the changes in interstitial asitic infections [80]. Studies focusing on mast cell
hydraulic pressure have a direct impact on the lym- function have clearly shown that their role is far
phatic return and efficiency, an objection against beyond what was previously understood. Mast cells
the view that interstitial fluid flow along the me- are now considered to be multi-potent and in-
ridian line was raised. Researchers Wei-Bo Zhang, volved in maintaining the stability of the interior
Guang-Hong Ding and Wei-Sheng Yang all have a body [81,82].
solid background in physics, yet proposed different Ji-Mei Song [83] in 1977 first proposed that mast
opinions on the same issue. W.B. Zhang put forward cells participate in the propagation sensation. This
the view that meridians are open channels of inter- is followed by a series of studies which showed
stitial fluid, without giving the direction of flow; that the trend in the distribution of mast cells is to
Ding emphasized a certain direction for interstitial follow the meridian line [8485]. Moreover, along the
fluid flow; Yang emphasized the accumulation of low impedance line of the meridians, the number
interstitial fluid in the connective tissue, neither of mast cells in different layers of skin was signifi-
considered the movement of the interstitial fluid cantly higher than the control area [86]. Some re-
or its direction. searchers have questioned the role of mast cells in
the function of meridians [87], but evidence that
2.4. Studying the substance of meridians mast cells are involved in the activities and func-
from the perspective of connective tions of meridians has been found. In many organs
tissue mast cells are located very close to the nerves
[88,89], and these nerves often contain substance P,
In the early times, some studies noted the rela- peptides related to the calcitonin-gene, and other
tionship between meridians and connective tissue, neurotransmitters and neuromodulators [90]. Under
suggesting that the meridians and connective tis- appropriate stimulus, the nerve endings would re-
sue are similar in many areas [65,66]. While inter- lease peptide-like substances, and mast cells would
preting the meridian phenomena, many theories express the receptors for these substances [91,92].
such as the quantum theory [67] and the structure The activity of neurons would then lead to activa-
of crystal fluid [68], emphasized the role of con- tion of mast cells to release granules or neuromodu-
nective tissue. According to anatomical studies, the lators [93]. Substances released by mast cells would
shape and structure of meridians is closely related in turn act on nerves, and affect their function [94].
to the connective tissue in parts of the lung merid- On the meridian line, skin nerves and mast cells can
ian [69], gall bladder meridian [70,71], and stomach establish functional links [9598]. Acupuncture stim-
meridian [72]. In functional studies, the relation- ulation can act to increase not only the number of
ship between the direction of collagen fibers along mast cells [99], but also promote mast cell degran-
the meridian and acupoints, and the function of ulation [100103]. Acupoint injection with mast cell
meridian and acupoints have been particularly em- granule contents, such as substance P, histamine
phasized [73]. A number of studies using automatic [104] and neurokinin-A [105] have been reported to
computerized markers and three-dimensional re- cause a significant increase in afferent nerve dis-
construction techniques, found an extreme simi- charge, indicating that active substances released
larity between the interval connective tissue fascia by mast cells participate in the formation of prop-
and the meridian longitudinal position. A model agated sensation [106].
6 G.J. Wang et al

4. Detecting Special Chemical the organism implies an abundant blood supply,


Characteristics Along the Meridians leading to a rise in temperature, causing a stronger
infrared radiation. Research has shown the exist-
Since meridian channels have their special path ence of linear bands of infrared radiation orbits
and function, the composition of the material on a healthy body, and these radiation bands are
found in the meridians might be different from highly similar to the routes of ancient meridians
their surrounding areas. The effect of acupuncture [123126]. The high temperature strips along me-
can be transferred through the meridian path, sug- ridians can be induced by different types of acupunc-
gesting that these paths have a higher excitability, ture [127]. The strips become more striking when
which may be due to the excitatory threshold de- heating the acupoints or meridians [128]. When
termined by trans-membrane ion concentration dif- there is pathology in internal organs, higher tem-
ference and ion flow. The transmission of information perature along the meridians may occur [129,130].
necessarily has its carrier. Therefore, it seems that Rabbits with cholecystitis present with a high tem-
investigating the structure and function of meridi- perature reaction along the gall bladder meridian
ans by studying the changes of chemical substances [131]. From the above analysis we can see that in
along the meridians is particularly important. both physiological and pathological conditions, high
Among all basic ions, calcium ions are involved temperature response along meridians can occur,
in the meridian activities [107,108]. Acupoints are suggesting that meridians have infrared or near in-
Ca2+ enriched [109,110]; acupuncture can also fur- frared radiation characteristics.
ther increase Ca2+ concentration in the area of the
acupoint [111], which has given rise to the belief
that the effect of acupuncture relates to a surge 5. Conclusion
of Ca2+ [112]. Ion-specific research on meridian
lines has not been limited to Ca2+. Other ions, such Meridian study in China has a long, rich history and
as Na+ and K+, are also involved in the functional is multi-directional. Obtaining a unique understand-
activities of meridians [113115]. Based on the ing of meridians in a short time is difficult. Research
above understanding, it has been suggested that is continuing to determine the correct answer to
the human body meridian system is the bodys bio- the age old question, What is the meridian?.
electrical network of ion channels, within which the
flowing substances are K+, Na+, Cl, Ca2+ and other
ions. As a result acupoints, the meridians have low Acknowledgments
impedance and high electrical conductivity prop-
erties [116]. The organism excitatory threshold is This work was supported by a 973 project grant
directly related to the accomplishment of energy from the Ministry of Science and Technology of
metabolism, the higher the excitability, the more China (2010CB530507) and by an independent
vigorous the metabolism should be, which in turn project grant from the China Academy of Chinese
directly relates to both oxygen consumption and Medical Science (ZZ2006089).
carbon dioxide production. Therefore, the pres-
ence of carbon dioxide along the meridians would
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