MEDICAL ACUPUNCTURE

Volume 29, Number 1, 2017

CME ARTICLE
# Mary Ann Liebert, Inc.
DOI: 10.1089/acu.2016.1210

Neuroembryology of the Acupuncture Principal Meridians:

Part 1. The Extremities

Peter T. Dorsher, MSc, MD

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ABSTRACT

Background: There is accumulating evidence from anatomical, physiologic, and neuroimaging research that
demonstrate Classical acupuncture points stimulate nerve trunks or their branches in the head, trunk, and extremities.
Objective: The aim of this research is to present novel graphic evidence that the embryologic development of
the human nervous system in the extremities provides evidence that the distributions of the acupuncture
Principal meridians correspond closely to those of the major nerves of the arms and legs, suggesting that the
Principal meridians are representations of the human peripheral nervous system in those places.
Materials and Methods: Using Adobe Photoshop software, anterior and posterior perspective diagrams of the
adult human dermatomal patterns were modified to position the upper and lower extremities into their em-
bryonic positions at 6 weeks’ postconception. Dermatomes, major peripheral nerves, limb acupuncture points,
and extremity Principal meridians were applied as separate graphic layers to this model using the anatomy texts
of Netter and Clemente as anatomical references and the Shanghai College of Traditional Medicine text as the
principal acupuncture reference to allow the relationships of these structures to be examined. Acupuncture
cross-sectional anatomy references (Primal and Chen) were used for further confirmation of the findings.
Results: The distributions of the acupuncture Principal meridians and their Classical acupoints in the ex-
tremities corresponded closely to those of the major nerves in these places.
Conclusions: The marked similarities of the distributions of the Principal meridians and the peripheral nerves
in the extremities advance the anatomical and physiologic evidence that acupuncture’s clinical effects arise
from nerve stimulation at Classical acupuncture points.

Keywords: Acupuncture, Mechanism, Peripheral Nerve, Meridians

INTRODUCTION Six of these Principal meridians are located on the pos-

terolateral aspect of the body and are termed Yang meridi-

I
‘‘ t is because of the twelve Primary channels
(meridians) that people live, that disease is formed, that
people are treated, and disease arises.’’ This 2000-year-old
ans, while the other six Principal meridians lie on the
anteromedial aspect of the body and are termed Yin me-
ridians. Two of the miscellaneous meridians (Governing
quote from the ‘‘Spiritual Axis’’ of the Yellow Emperor’s Inner Vessel and Conception Vessel) have clinical importance
Classic clearly illustrates the importance of the acupuncture equal to the Principal meridians with their own Classical
Principal meridians in Traditional Chinese Medicine (TCM) acupuncture points described, so thus are included with the
physiology.1 The TCM Meridian and Organ theories are in- twelve Principal meridians.2
terrelated, so each of the twelve Principal meridians is associ- Blood and Qi (energy) in TCM physiology flow contin-
ated with and influence the Organ for which it is named. uously through these meridians to provide nourishment to

Consultant, Physical Medicine & Rehabilitation, Mayo Clinic in Florida, Jacksonville, FL.

CME available online at www.medicalacupuncture.org/cme Questions on page 18.

10
 PRINCIPAL MERIDIANS NEUROEMBRYOLOGY 11

all bodily tissues. The 361 Classical acupuncture points MATERIALS AND METHODS
described more than 2000 years ago were assigned on the
basis of similar therapeutic properties to one of these sixteen Using Adobe Photoshop Elements software (Adobe Sys-
meridians.2 tems, Inc., San Jose, CA), anterior and posterior perspective
Since that time, there has been ongoing speculation about diagrams of the adult human dermatomal patterns were
whether the Principal meridians represent only a conceptual modified to position the upper and lower extremities into their
construct3 or have an anatomical basis. Potential anatomical embryonic positions at 6 weeks’ postconception.16 Derma-
bases of the meridians have been offered, such as Bonghan tomes, major peripheral nerves, limb acupuncture points, and
channels4 and interstitial fluid channels.5 Other researchers extremity Principal meridians were applied as separate gra-
have postulated that the meridians may exist in the myo- phic layers to this model, using the anatomy texts of Netter
fascial layer of the body.6 The anatomically derived con- and Clemente17,18 as anatomical references and a Shanghai
cepts of myofascial meridians described by Myers have College of Traditional Medicine text as the principal acu-
distributions similar to those of acupuncture Principal me- puncture reference.2 This permitted the superimposition of
ridians.7,8 Each of the Principal meridians is associated with dermatomes, peripheral nerves, cutaneous nerves, and/or
a pulse, implying that they have at least some relationship to acupuncture Principal meridians over the extremities to allow
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the vascular system.2 Some degree of overlap of the me- visual comparisons of the anatomical relationships of these
ridians and the peripheral nervous system in the extremities structures. Additional confirmation of anatomic relationships
has been described,2,9–11 and Chiang12 has demonstrated with acupuncture anatomy references was obtained using the
anatomically and electrophysiologically that Classical acu- primal Anatomy for Acupuncture’s19 virtual human and
puncture points are on different nerve branches and produce Chen’s20 cadaveric analyses that provided cross-sectional
distinct responses to electrical stimulation. anatomical analysis of acupuncture points.
Physiologically, human and animal experimental evi-
dence demonstrates that anesthetic block of, sectioning of,
or capsaicin application to the nerve innervating a Classical RESULTS
acupuncture point eliminates that point’s acupuncture an-
algesia when it is subsequently stimulated,13,14 while oc- Developmental Evidence of the Neural Basis
clusion or isolation of the acupoint’s vascular supply has no of the Principal Meridians in the Extremities
effect on its analgesic effects.15 These studies thus dem-
onstrate that peripheral nerve stimulation is necessary to Human embryonic arm and leg buds in their early de-
achieve acupuncture analgesia at Classical acupoints while velopment 4–6 weeks’ postconception can be visualized as
their vasculature has no influence on their analgesic effects. growing in a linear manner anteriorly perpendicular to the
One of the great mysteries of TCM theory is that it describes longitudinal axis of the body, positioned so that the devel-
all the major organs of the human body, yet it presents no oping palm of the hand and sole of the foot oppose each
representation of the central or peripheral nervous system. other in a sagittal plane with the thumbs and great toes,
This is difficult to understand since there is evidence that the respectively, pointing cephalad (Fig. 1).16 This results in
ancient Chinese had extensive knowledge of human anatomy homologous positioning of the developing arms and legs.
based on dissections of executed criminals,2 so it seems im-
probable that the peripheral nerves and brain were not visu- Figure 1. During the seventh week postconception, the
alized during these autopsies. Why were the central and extremities form joint articulations.16 In the following week,
peripheral nervous systems not described in TCM physiology? the upper extremities internally rotate and flex at the elbow
The likely reason for this paradox can be explained by to bring the hands over the chest region. At the same time,
analysis of human developmental neuroanatomy. TCM had the lower extremities internally rotate, the developing knee
no need to describe a nervous system in its model of human joint flexes to *90°, and the developing ankle joint bends
physiology, as the acupuncture Principal meridians— *90° to result in positioning of the sole of the foot inferiorly
previously thought to be only conceptual pathways that link in a transverse plane, which is necessary later for the ability
acupuncture points with related clinical functions—are to stand (Fig. 1). If the adult human body is placed in 6th
demonstrated herein to overlap fundamentally in their dis- week developmental position (Fig. 2) by de-rotating the
tributions to those of the human peripheral nervous system. extremities and flexing the limbs at the shoulders and hips,
This, in conjunction with corroborating anatomical and important neuroanatomical relationships of dermatomes and
physiologic evidence, is consistent with a neurologic basis peripheral nerves in the extremities become evident.
for the Principal meridians and acupuncture’s clinical ef-
fects. This article also reviews this evidence for the ex- Figure 2. Figure 2 shows that, in this sixth week de-
tremities, with future articles to cover the head/neck and velopmental position, the dermatomes in the extremities
trunk regions separately, as, embryologically, these regions approximate linear bands. Only on the anterior surface of
develop differently from the extremities. the lower extremity does this relationship not hold true.
 12 DORSHER
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FIG. 1. Human fetal development at 6–8 weeks’ gestation.

Note that in this developmental position the arm and leg their developing muscles and neurovascular bundles) de-
myotomes also will approximate linear bands lying under velop initially as linear structures until the sixth week of
their corresponding segmental dermatomes. If the courses of development.
the major peripheral nerves of the arms and legs are then
applied to the model in Figure 2, then these nerves’ distri- Table 1. As shown in Table 1, the following ana-
butions also become mostly linear and follow extremity tomical relationships thus develop: The musculocutaneous
dermatomes. This likely follows from the finding that em- nerve courses superiorly in the brachium and near the el-
bryologically the fetal peripheral arm and leg buds (with bow its sensory branch, the lateral antebrachial cutaneous

FIG. 2. Adult dermatomes in derotated developmental positions (left), peripheral nerves of extremities superimposed on dermatomes
(right).
 PRINCIPAL MERIDIANS NEUROEMBRYOLOGY 13

Table 1. Dermatomal, Motor. and Sensory Peripheral Nerves, and Acupuncture Principal Meridian Relationships

Dermatome Mixed nerve Sensory nerve Meridian

C6 dorsal Radial Radial sensory Large Intestine

C7 dorsal Radial/posterior interosseus Dorsal branch of ulnar sensory Triple Energizer
C8 dorsal Ulnar Dorsal branch of ulnar sensory Small Intestine
C8 ventral Ulnar Palmar branch, ulnar sensory Heart
T1 ventral Median/anterior interosseus Median sensory Pericardium
C6 ventral Musculocutaneous Lateral antebrachial cutaneous/median sensory Lung
L2,3 ventral Obturator/ tibial Obturator/saphenous/deep peroneal Liver
L4 ventral Femoral (medial branch) Saphenous Spleen
L4 dorsal Femoral (lateral branch)/deep peroneal Superficial peroneal, medial crural branch/ deep peroneal Stomach
L5 dorsal Sciatic/superficial peroneal/medial plantar Lateral femoral cutaneous/lateral sural cutaneous/ Gallbladder
superficial peroneal, lateral crural branch
S1 Sciatic/tibial/lateral plantar Posterior femoral cutaneous/lateral sural cutaneous/lateral Bladder
plantar
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S2 Sciatic/tibial/lateral plantar Posterior femoral cutaneous/medial sural cutaneous/medial Kidney

plantar

nerve, originates to supply sensory innervation to the su- Note that the peripheral nerves (motor and sensory
perior/radial forearm to the level of the wrist (all on the portions) overlie the appropriate dermatomes/myotomes
*C6 dermatomal band). The radial nerve courses poster- in the 6th week developmental position. The funda-
iorly in the brachium to become in the forearm the poste- mental overlap of acupuncture Principal meridians and
rior interosseus nerve. Near the elbow, the radial nerve’s the peripheral nervous system in the extremities as de-
sensory branch (the radial sensory nerve) originates that scribed in Table 1 is shown visually in Figure 3, where
supplies sensation to the radial 3½ digits of the dorsal the distributions of the acupuncture Principal meridians
hand (all on the *C7 dermatomal band). The median literally superimpose on the distributions of the periph-
nerve courses anteriorly in the brachium; and, near the eral nerves there.
elbow, its motor branch (the anterior interosseus nerve)
originates to innervate the deep volar forearm muscula- Figure 3. In this developmental position, all the Yin
ture. The median nerve courses in the anterior forearm meridians are on the anterior surface of the body, and all the
with its terminal fibers supplying sensory innervation to Yang meridians are on the posterior surface of the body.
the radial 3½ digits of the palmar aspect of the hand (all This is in accordance with TCM anatomy and physiology.2
on the *T1 dermatomal band). The ulnar nerve courses Acupuncture points on the anterior (Yin) meridians affect
over the inferior brachium and forearm to the ulnar side of primarily the parasympathetic nervous system in producing
the hand, with its terminal fibers supply sensation to the their somatovisceral effects, while the posterior (Yang)
little finger and the ulnar half of the ring finger (all on the meridians primarily affect the sympathetic nervous system
*C8 dermatomal band). in producing their somatovisceral effects.11
In the lower extremity, the obturator nerve courses an- Given that *20% of the spinal nerve fibers that form the
teriorly in the thigh (over the L2 and L3 dermatomal bands). peripheral nerves are autonomic nervous system fibers,21 a
The femoral nerve and its terminal sensory branch the sa- plausible anatomical basis for autonomic innervation of the
phenous nerve course superiorly in the thigh and calf to the peripheral nerves’ corresponding Principal meridians exists.
medial aspect of the foot (mostly on the *L4 dermatomal The major peripheral nerves of the body are accompanied
band). The lateral femoral cutaneous nerve and the super- by vasculature (neurovascular bundles) as they course
ficial peroneal nerve course on the posterior aspect of the through the body. Sympathetic fibers invest these arterial
thigh and calf, respectively, and provide sensation to the walls,22,23 providing autonomic nervous system innervation
dorsum of the foot (all on the *L5 dermatomal band). to regulate vasoconstriction of those vessels.
The sciatic nerve courses inferiorly over the thigh and calf
with one terminal branch being the lateral plantar nerve
Anatomical Evidence That Classical
which supplies sensation to the fibular/inferior aspect of the
Acupuncture Points Exist on Peripheral Nerves
foot to the fifth toe (all on *S1 dermatomal band), while its
or Their Branches
other terminal sciatic branch is the medial plantar nerve that
supplies sensation to the medial aspect of the heel and at Acupuncturists have long known that some important
times the proximal medial aspect of the plantar foot (all on acupuncture points are located directly on major nerve
the *S2 dermatomal band). trunks.2 For example, PC 6 is located on the median nerve
 14 DORSHER
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FIG. 3. Acupuncture meridians (left) superimposed on the peripheral nerves of the arms and legs (right).

above the wrist crease, BL 40 is located in the popliteal

crease and contacts the tibial nerve, and KI 3 is located pos-
terior to the medial malleolus and contacts the tibial nerve.2
The Anatomy for Acupuncture virtual human anatomical
software19 and Chen’s cross-sectional anatomy of acupoint
reference20 provide independent lines of evidence demon-
strating that needles entering the Classical acupuncture points
approximate peripheral nerves whose anatomic distributions
match those of their corresponding Principal meridians.

Figure 4. As examples, for the head and neck region,

BL 2 above the orbit approximates the supratrochlear nerve
and GB 14 approximates the supraorbital nerve (Fig. 4).19
The supratrochlear nerve courses over the medial aspect of
the frontal region mirroring the distribution of the Bladder
meridian there, while the supraorbital nerve courses more
laterally over the frontal region mirroring the distribution of
the Gallbladder meridian there.19

Figure 5. In the trunk, LU 2 is near the coracoid pro-

cess and approximates the lateral cord of the brachial plexus
(Fig. 5),19 from which arises the musculocutaneous nerve in
the upper arm whose lateral antebrachial sensory nerve in-
nervates the radial forearm to the wrist, mirroring the dis- FIG. 4. BL 2: Anatomical relationship to supratrochlear nerve
tribution of the Lung meridian in those regions. (V1) and GB 14 anatomical relationship to supraorbital nerve (V1).
 PRINCIPAL MERIDIANS NEUROEMBRYOLOGY 15

Figure 7. In the lower extremities, GB 27 near the an-

terior superior iliac spine approximates the lateral femoral
cutaneous nerve (Fig. 7),19 whose distribution in the lateral
thigh mirrors that of the Gallbladder meridian there. SP-12 is
below the inguinal ligament and approximates the femoral
nerve,19 whose distribution extends along the anteromedial
thigh to the medial knee with its sensory saphenous nerve
branch extending along the anteromedial calf to the instep of
the foot. This distribution mirrors that of the Spleen meridian
in these regions.

Figure 8. BL 60, which is located posterior to the

lateral malleolus, approximates the sural nerve (Fig. 8),19
which courses along the posterolateral calf to the lateral
ankle and foot. This distribution mirrors that of the Bladder
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meridian in the lateral calf and foot.

Note. It is important to emphasize that, for each of

these examples in the head and extremities, the acupuncture
points’ Principal meridians mirror the distributions of the
FIG. 5. LU 2: Anatomical relationship to lateral cord of brachial peripheral nerves they approximate.
plexus (in anterior view of left shoulder).

DISCUSSION
Figure 6. In the posterior shoulder, SI 9 in its deep
position approximates the ulnar nerve (Fig. 6),19 which The fundamental correspondence of the Principal me-
extends along the posteromedial arm and medial fore- ridians with the peripheral nervous system in the extremities
arm to innervate the last two fingers. This nerve dis- as previously outlined derives from indepth analyses of
tribution mirrors that of the Small Intestine meridian in human embryologic development, human anatomy, and the
these regions. cross-sectional anatomy of acupuncture needle passages at
Classical acupoints described in widely available refer-
ences.16–20 A limitation of the present study is that these
relationships have not been demonstrated for every Classi-
cal acupuncture point in the extremities, and some of the

FIG. 7. GB 27: Anatomical relationship to lateral femoral cu-

FIG. 6. SI 9: Anatomical relationship to ulnar nerve (in poste- taneous nerve. SP 12: Anatomical relationship to the femoral
rior view of right shoulder). nerve (anterolateral view of right hip).
 16 DORSHER

small myelinated and unmyelinated fibers that penetrate

fascia at acupuncture points.25 The slow spread of the
acupuncture Qi sensation along a meridian would reflect
the slow transmission of unmyelinated autonomic fibers as
well as central nervous system mechanisms. The auto-
nomic nervous system innervation of acupoints would also
serve to explain the edema, vasomotor, sudomotor, and
pilomotor changes that may be seen at acupuncture points
when needled.
A neurologic model of acupuncture effects would also
provide a potential mechanism of how acupuncture styles
that use subcutaneous needling (e.g., Japanese style) could
produce their effects. Needling in the same cutaneous nerve
and/or dermatome distribution that a Classical acupuncture
point enters might then produce similar clinical effects.
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In terms of research, then, placebo acupuncture point

stimulation in the extremity, whether it penetrates the skin
or not (e.g., Park or Streitberger needles), is not physio-
logically inert if applied in the same dermatome, myotome,
and/or mixed motor/sensory nerve innervation as the Clas-
sical acupuncture point studied.
FIG. 8. BL 60: anatomical relationship to sural nerve (lateral
Melzack et al. in 1977 stated that ‘‘acupuncture points are
view of right ankle).
associated with an ancient conceptual but anatomically non-
existent system of meridians which carry Yin (Spirits) and
graphics (Figs. 2 and 3) were created by the author and not Yang (Blood).’’3 The anatomical evidence outlined in the
validated at this point. current study contradicts that statement. The authors of the
Embryologically, up to *6 weeks postconception, the Nei Jing 2000 years ago were seemingly aware of the ner-
human dermatomes, myotomes, and peripheral nervous vous system through their dissections, but had no need to
system of the extremities develop in a largely linear fashion describe a discrete peripheral nervous system given that
before the extremities develop joint articulations that allow acupuncture Principal meridians are the expression of the
limb bending and rotation into their approximate newborn peripheral nervous system and their accompanying vascu-
positions. The distributions of the Principal acupuncture lature in the extremities.
meridians mirror those of the peripheral nerves in the ex- The Dutch physician Willem ten Rhijne, who observed
tremities when the fully developed human body is posi- acupuncture practice in Japan in the 1670s, was critiqued
tioned akin to a 6-week embryo, and the cross-sectional by Baldry26 for reporting repeatedly that Chinese and
anatomy of the Classical acupuncture points from Chen20 Japanese acupuncturists used the terms artery, vein, and
and the Primal virtual human anatomical reference19 pro- nerve interchangeably when describing the target of an
vide independent confirmation of the fundamental overlap acupuncture needle. The results of the present neuroem-
of the Classical acupuncture points and peripheral nerves. bryologic and anatomical analysis of acupuncture merid-
Sympathetic nervous system fiber distribution parallels the ians in the extremities (in conjunction with physiologic
Principal meridians as well, via their innervation of the data) supports strongly that the acupuncture needle target
spinal nerves, their branches, and the walls of the arteries appears to be the neurovascular bundles that course
that accompany these peripheral nerves (neurovascular through the myofascial layers of the body and penetrate
bundles).21–23 its fascia. Thus, ten Rhijne’s descriptions actually would
The results of this study have importance for acupunc- then be accurate descriptions of proper acupuncture
ture practice and research. These findings suggest that the technique. Indeed, in concordance of the results of the
target structures for needling in the extremities should not present analysis, in the mid-1700s the famous Dutch
be muscles or fascia but rather peripheral nerves. The De physician Gerhard van Swieten stated that ‘‘the acu-
Qi sensation would then be postulated to represent acti- puncture of the Japanese and the cautery of various parts
vation of nerve fiber endings when contacted by the needle, of the body with moxa seems to stimulate the nerves and
as confirmed by Hui et al.24 The needle ‘‘grab’’ or muscle thereby to alleviate pain and cramps in quite different
fasciculation would represent the result of stimulation of a parts of the body in a most wonderful way.’’26 Thus, the
motor axon due to acupuncture needle contact with the TCM description that Qi (energy) and Blood circulate in
acupoint’s nerve. Mechanical twisting of the needle in the acupuncture meridians (i.e., neurovascular bundles)
the fascia could be postulated to mechanically activate the appears to reflect anatomical reality.
 PRINCIPAL MERIDIANS NEUROEMBRYOLOGY 17

CONCLUSIONS 11. Wong JY. A Manual of Neuro-Anatomical Acupuncture, vol 1:

Musculo-Skeletal Disorders. Toronto: Toronto Pain and Stress
The acupuncture Principal meridians (and hence their Clinic; 2001.
Classical acupuncture points) in the extremities have strong 12. Chiang P. What is the point of acupuncture? Med Acupunct.
anatomical correlations to the neurovascular bundles of the 2015;27(2):67–80.
13. Research Group of Acupuncture Anesthesia, PMC. Effect of
arms, which embryologic analysis demonstrates appears to
acupuncture on the pain threshold of human skin [in Chinese].
derive from the linear development of the limbs and their Zhonghua Yi Xue Za Zhi 1973;151–157.
dermatomes, myotomes, and nerves. This suggests that the 14. Chiang CY, Chang CT. Peripheral afferent pathway for acu-
Principal meridians and their Classical acupoints’ functions puncture analgesia. Sci Sin. 1973;16(2):210–217.
derive from neural stimulation. This has implications for acu- 15. Lu GW. Characteristics of afferent fiber innervation on acu-
puncture techniques and research, especially when choosing puncture points Zusanli. Am J Physiol. 1983;245(4):R606–R612.
points for placebo interventions. 16. Moore KL, Persaud TVN, Torchia MG. The Developing
Human: Clinically Oriented Embryology, 9th ed. Philadel-
phia: Elsevier Saunders; 2013.
17. Netter FH. Atlas of Human Anatomy. Summit, NJ: Ciba–
AUTHOR DISCLOSURE STATEMENT
Downloaded by Guangxi University for Nationalities from online.liebertpub.com at 02/23/18. For personal use only.

Geigy Corporation; 1989.

18. Clemente CD. Anatomy: A Regional Atlas of the Human Body,
No competing financial interests exist. 2nd ed. Baltimore & Munich: Urban and Schwarzenberg; 1981.
19. Dorsher PT, Cummings M. Anatomy for Acupuncture. Lon-
don: Primal Pictures; 2006.
REFERENCES 20. Chen E. Cross-Sectional Anatomy of Acupoints. Edinburgh:
Churchill Livingstone; 1995.
1. Zhu M (transl). The Medical Classic of the Yellow Emperor. 21. Ko HY, Shin YB, Sohn HJ, Chang JH, Ahn YH, Ha YH.
Beijing: Foreign Languages Press; 2001. Unmyelinated fibers in human spinal ventral roots: C4 to S2.
2. O’Connor J, Bensky D, eds. Acupuncture: A Comprehensive Spinal Cord. 2009;47(4):286–289.
Text. Chicago: Eastland Press; 1981. 22. Birch DJ, Turmaine M, Boulos PB, Burnstock G. Sympathetic
3. Melzack R, Stillwell DM, Fox EJ. Trigger points and acu- innervation of human mesenteric artery and vein. J Vasc Res.
puncture points for pain: Correlations and implications. Pain. 2008;45(4):323–332.
1977;3(1):3–23. 23. Gray H. The sympathetic nerves. In: Anatomy of the Human
4. Soh KS. Bonghan circulatory system as an extension of acu- Body. Philadelphia: Lea & Febiger; 1918. Online document at:
puncture meridians. J Acupunct Meridian Stud. 2009;2(2):93– www.bartleby.com/107/pages/pages974-5.html Accessed July
106. 13, 2016.
5. Fung PC. Probing the mystery of Chinese Medicine me- 24. Hui KK, Nixon EE, Vangel MG, et al. Characterization of the
ridian channels with special emphasis on the connective ‘‘deqi’’ response in acupuncture. BMC Complement Altern
tissue interstitial fluid system, mechanotransduction, cells Med. 2007;7:33.
durotaxis and mast cell degranulation. Chin Med. 2009; 25. Senelar R. The morphological characteristics of the Chinese
4:10. points. In: Niboyet JEH, ed. New Acupuncture Treatments.
6. Langevin HM, Yandow JA. Relationship of acupuncture points [in French] Paris: Maisonneuve; 1979; pp 249–277.
and meridians to connective tissue planes. Anat Rec. 2002; 26. Baldry PE. How news of acupuncture and moxibustion spread
269(6):257–265. from China to the outside world. In: Acupuncture, Trigger
7. Myers TW. Anatomy Trains: Myofascial Meridians for Points and Musculoskeletal Pain, 3rd ed. London, UK: Elsevier;
Manual and Movement Therapists. New York: Churchill Li- 2005:13–20.
vingstone; 2001.
8. Dorsher PT. Myofascial meridians as anatomical evidence of Address correspondence to:
acupuncture channels. Med Acupunct. 2009;21(2):91–97. Peter T. Dorsher, MSc, MD
9. Cho ZH, Wong EK, Fallon J. Neuro-Acupuncture: Scientific Physical Medicine & Rehabilitation
Evidence of Acupuncture Revealed. Los Angeles: Q-Puncture; Mayo Clinic in Florida
2001. 4500 San Pablo Road
10. Chan SH. What is being stimulated in acupuncture: Evalua- Jacksonville, FL 32224
tion of the existence of a specific substrate. Neurosci Biobe-
hav Rev. 1984;8(1):25–33. E-mail: [email protected]
 18 DORSHER

To receive CME credit, you must complete the quiz

online at: www.medicalacupuncture.org/cme

CME Quiz Questions

Article Learning Objectives:

After studying this article, participants should be able to appraise the evidence for a neuroembryological explanation of
acupuncture channels and to distinguish some of the modern scientific attempts to explain the traditional Chinese concept of
acupuncture channels.
Publication date: February 1, 2017
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Expiration date: February 28, 2018

Disclosure Information:
Author has nothing to disclose.
Richard C. Niemtzow, MD, PhD, MPH, Editor-in-Chief, has nothing to disclose.

Questions:
c. twirling of the needle in the fascia is postulated
1. The author offers evidence and an argument that the
to mechanically activate the small myelinated and
ancient concept of acupuncture channels:
unmyelinated fibers that penetrate fascia at the
a. closely follows the distribution of the peripheral
acupuncture points.
nervous system and may actually be referring to
d. the slow spread of ‘‘qi sensation’’ along a channel
this structure.
reflects the slow transmission of unmyelinated
b. has been demonstrated conclusively to be distinct
autonomic fibers.
pathways of energy flow in the body.
e. the ancient concept of Qi flowing in discrete
c. has been demonstrated conclusively to be related to
channels separate from commonly recognized an-
interstitial fluid movements in the body.
atomic structures is an essential aspect of this
d. has been demonstrated conclusively to represent
model.
myofascial planes in the body.
e. The concept of channels is antiquated and does not 4. Choose the one incorrect answer:
offer useful information for the modern physician. a. 20% of spinal nerve fibers that form peripheral
2. The author’s evidence for the fundamental correspon- nerves are autonomic nervous system fibers.
dence of the Principal channels with the peripheral ner- b. The presence of autonomic fibers in peripheral
vous system includes: (choose the one incorrect answer) nerves provides a plausible anatomic basis for the
a. in-depth analysis of human embryologic development. observed autonomic nervous system actions of
b. analysis of human anatomy. classical acupoints.
c. cross-sectional anatomy of acupuncture needle c. PC6 is located along the medial nerve path. Bl 40
passages at classical acupoints. and Kid 3 are located along the tibial nerve course.
d. These relationships have been demonstrated for d. The vasculature that accompany peripheral nerves
every classical acupuncture point. include sympathetic fibers invested in the arterial
e. Analysis of a collection of acupoints demonstrates walls.
that they approximate specific nerves. e. The author’s model does not account for the ob-
served autonomic effects of classical acupuncture
3. In the model presented by the author: (choose the one points.
incorrect answer)
a. the ideal target structure for needling in the ex- 5. Choose the one incorrect answer:
tremities should be peripheral nerves rather than a. The autonomic innervation of acupoints helps to
muscles and fascia. explain the vasomotor, sudomotor, and pilomotor
b. the ‘‘de qi’’ sensation is postulated to represent changes observed when acupoints are needled.
activation of nerve fiber endings when contacted by b. This neurological model of acupuncture provides a
the needle. potential mechanism of how acupuncture styles
 PRINCIPAL MERIDIANS NEUROEMBRYOLOGY 19

that use subcutaneous needling (e.g., Japanese d. The author proposes that the Principal channels rep-
style) produce their effects. resent a discrete system separate from the peripheral
c. According to this neurological model, ‘‘placebo nervous system and its accompanying vasculature.
acupuncture’’ in the research setting, whether it e. The author proposes that the ancient Chinese were
penetrates the skin or not (e.g., Park or Streitberger aware of the peripheral and central nervous system
needles), is not physiologically inert if applied in through forensic cadaveric dissections and that
the same dermatome, myotome, or mixed motor/ acupuncture Principal channels are an expression
sensory nerve innervation as the classical acu- of the peripheral nervous system and their accom-
puncture point. panying vasculature in the extremities.

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