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
China
Meridians are passageways for the flow of qi and
blood, which are the two basic bodily fluids in
Chinese medicine. These passages include 12 stan-
dard channels, 12 collaterals, 8 extra meridians,
15 large collaterals, musculature of 12 meridians
and 12 skin divisions. Meridians spread on the sur-
face of the whole body vertically and horizontally,
integrating the inside with the outside of the body.
They also connect the inner organs, joints and ex-
tremities, thus transforming the whole body into
one entire organ. As Chinese medicine attaches
great importance to the concept that all body func-
tions are under the complete state of one organism,
the black-box theory was adopted in its research
[1]. The theory pays attention to changes in outside
phenomena, as such, its theoretical system lacks
an anatomical basis. However, along with the de-
velopment of modern medicine, people gradually
realized that acupuncture, that follows the meridian
theory, has the best outcomes; traditional Chinese
medicine believes that the therapeutic effects of
acupuncture are achieved through the meridian sys-
tem. Additionally, by studying a number of skin dis-
eases, propagated sensations and the migration of
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
Figure 1 Skin disease along the meridians. Figure taken
from Li [2].
Figure 2 Pagated sendation travelling along the Urinary
Bladder Channel. Figure taken with permission from Hu
and Cheng [3].
Figure 3 Migration of an isotope along meridians. Figure
taken from with permission from Meng et al [4].
respectively [2,3,4]), the existence of the merid-
ian phenomenon was confirmed. Ultimately, this
kind of regulating and controlling channel parallel to
the body surface cannot be explained by current
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
time, China planned to systematically duplicate
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
neural reflection [22]. From a gross anatomy per-
spective, meridian and acupoint regions are always
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
window for revealing the substance of the merid-
ian. However, this propagated sensation is a sub-
jective feeling, and must therefore be associated
with the central nervous system, particularly the
sensory cortex. This has led some researchers to be-
lieve that PSCs are an expanding excitement oc-
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-
tions accompany reactions of the skin, blood ves-
sels and nerves. Furthermore, PSC can be blocked
by mechanically pressing on the meridians [24]. As
PSC can be stopped by outside pressure, it is rea-
sonable to presume that a form of active factor
is involved in the formation of PSC [25]. Myoelec-
tricity along meridians could be one such factor
[26]. Another explanation for propagated sensa-
tion caused by acupuncture may be related to the
axon reflection of the peripheral nerves and the mi-
gration of histamine between the peripheral nerve
terminals due to nerve-mast cell interaction [27].
Alternatively, the characteristic order of PSC could
happen between motor neurons, based on the col-
umn structure in the spinal cord [28]. However, the
involvement of peripheral motive factor in propa-
gated sensation still does not explain this phenom-
enon in pseudomelia; therefore, when elucidating
the mechanism of propagated sensation, some re-
searchers place an emphasis on central nervous
processes [13,2930]. The question is whether it is
truly necessary to have a unique mechanism that
explains all the phenomena of PSC. Perhaps multi-
ple substances exist within both the peripheral and
the central nervous systems to give rise to the dif-
ferent aspects of PSC.
2.2. Comments on the essence of meridians
as a circulatory system
Neurology is a significant component in meridian
research, and raises important questions in de-
veloping the research. Meridians certainly shares
some common components with the nervous sys-
tem. Furthermore, meridians certainly do not pos-
sess all nervous system structures and functions, or
vice versa [31]. Thus, the study of meridians from
4 G.J. Wang et al

the perspective of neurophysiology is unilateral.
Classic medical books show that meridian and blood
vessel naming are closely related, especially in older
texts [32,33]. The original meaning of Mai is blood
vessels [34]; studying the meridians as a circulatory
system may also be valid [35,36]. From a functional
point of view, not only vessels themselves [37], but
also the nerves in the vessel walls [38], and even
the rhythm in the microvascular networks of the
meridian system [39] have gradually become areas
of interest for researchers. Moreover, the lymphatic
system is also closely related to the meridian sys-
tem [40,41]. However, some academics oppose the
theory that a relationship exists between meridi-
ans and the circulatory system. They believe that
the movement of liquid in the vessels cannot form
the propagated sensation, and hence the circulatory
system cannot be equated to meridians [42,43].
2.3. Investigating the substance of
meridians from the aspect of
interstitial fluid flow
Since meridian function is identical to neither the
nervous system nor the circulatory system, then
why do meridians transport qi and blood as de-
scribed in the classic Chinese medicine theory and
how is this accomplished? The most direct way to
solving this issue is to observe how radio-labeled
material migrates in meridian lines. One study using
this technique showed 14 meridian lines in more
than 90% of cases based on a sample of 1000 par-
ticipants [44]. The migration routes were neither
blood nor lymph vessel [45]. Only micromolecules can
migrate along the meridians, and this migration is
powered by the different pressures generated by
blood and lymph circulation [46]. The migration
routes are not only continuous [47], but also consis-
tent with meridian lines [48]. Based on the above
experiments, Professor Wei-Bo Zhang proposed the
Low Hydraulic Resistance Channel Theory [49]. He
believes that the interstitial substance is hetero-
geneous, meaning that some parts have high perme-
ability and low resistance to the flow of interstitial
fluid, and thus form a low hydraulic resistance point
[50]. Adjacent low hydraulic resistance points can
transfer the hydraulic wave, indicating the connec-
tion among these points, thereby forming a chan-
nel [51,52]. By measuring hydraulic resistance,
transmission of the pressure wave and migration of
the isotope, low hydraulic resistance channels were
found along meridians which are believed to be the
main body of the meridians [5356]. Zhang also
put forward a neural-fluid transmission model to ex-
plain the effect of acupuncture and PSC, based on
the low hydraulic resistance channel (Figure 4 [57]).
From the perspective of modern microcircula-
tion, there is a minute gap between end capillary
vessels and interstitial fluid cells. The transporta-
tion of nutrients, exchange of information, as well
as the removal of metabolic waste not only depend
on the diffusion gradient, but also convection of
interstitial fluid. However, the process of intersti-
tial fluid flow still remains unknown. In recent
years the concept of a tissue channel has provided
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
It allowed the movement of interstitial fluid path-
way to be shown [58], and illustrated that the
function of the interstitial fluid pathway coincided
with the function of meridians [59]. Furthermore,
based on the fact that capillary vessels and colla-
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
is closely associated with meridians [60]. Professor
Wei-Sheng Yang has performed skin impedance stud-
ies for many years and found that meridian lines
have low impedance [61,62]. The cause of this low
resistance characteristic was thought to be due to
the relatively high amount of interstitial fluid and
the histological nature of the meridians, which are
rich in loose connective tissue [63,64].
As interstitial fluid pressure is lower than at-
mospheric pressure, and the changes in interstitial
hydraulic pressure have a direct impact on the lym-
phatic return and efficiency, an objection against
the view that interstitial fluid flow along the me-
ridian line was raised. Researchers Wei-Bo Zhang,
Guang-Hong Ding and Wei-Sheng Yang all have a
solid background in physics, yet proposed different
opinions on the same issue. W.B. Zhang put forward
the view that meridians are open channels of inter-
stitial fluid, without giving the direction of flow;
Ding emphasized a certain direction for interstitial
fluid flow; Yang emphasized the accumulation of
interstitial fluid in the connective tissue, neither
considered the movement of the interstitial fluid
or its direction.
2.4. Studying the substance of meridians
from the perspective of connective
tissue
In the early times, some studies noted the rela-
tionship between meridians and connective tissue,
suggesting that the meridians and connective tis-
sue are similar in many areas [65,66]. While inter-
preting the meridian phenomena, many theories
such as the quantum theory [67] and the structure
of crystal fluid [68], emphasized the role of con-
nective tissue. According to anatomical studies, the
shape and structure of meridians is closely related
to the connective tissue in parts of the lung merid-
ian [69], gall bladder meridian [70,71], and stomach
meridian [72]. In functional studies, the relation-
ship between the direction of collagen fibers along
the meridian and acupoints, and the function of
meridian and acupoints have been particularly em-
phasized [73]. A number of studies using automatic
computerized markers and three-dimensional re-
construction techniques, found an extreme simi-
larity between the interval connective tissue fascia
and the meridian longitudinal position. A model
5
was then proposed for the study of the fascia of me-
ridians [7476], as the function of this membrane
structure is to maintain the stability of the interior
body, and also is the specific reflection of merid-
ian substance in the human body.
3. The Relationship Between Mast Cells
and Meridians
As mast cells are widely distributed in connective
tissue and are also involved in various rapid physi-
ological responses, their relationship with the merid-
ians has received attention. Mast cells are thought
to play a key role in acute allergic reactions. They
also participate in delayed type hypersensitivity
[77], and fighting against bacterial [78,79] and par-
asitic infections [80]. Studies focusing on mast cell
function have clearly shown that their role is far
beyond what was previously understood. Mast cells
are now considered to be multi-potent and in-
volved in maintaining the stability of the interior
body [81,82].
Ji-Mei Song [83] in 1977 first proposed that mast
cells participate in the propagation sensation. This
is followed by a series of studies which showed
that the trend in the distribution of mast cells is to
follow the meridian line [8485]. Moreover, along the
low impedance line of the meridians, the number
of mast cells in different layers of skin was signifi-
cantly higher than the control area [86]. Some re-
searchers have questioned the role of mast cells in
the function of meridians [87], but evidence that
mast cells are involved in the activities and func-
tions of meridians has been found. In many organs
mast cells are located very close to the nerves
[88,89], and these nerves often contain substance P,
peptides related to the calcitonin-gene, and other
neurotransmitters and neuromodulators [90]. Under
appropriate stimulus, the nerve endings would re-
lease peptide-like substances, and mast cells would
express the receptors for these substances [91,92].
The activity of neurons would then lead to activa-
tion of mast cells to release granules or neuromodu-
lators [93]. Substances released by mast cells would
in turn act on nerves, and affect their function [94].
On the meridian line, skin nerves and mast cells can
establish functional links [9598]. Acupuncture stim-
ulation can act to increase not only the number of
mast cells [99], but also promote mast cell degran-
ulation [100103]. Acupoint injection with mast cell
granule contents, such as substance P, histamine
[104] and neurokinin-A [105] have been reported to
cause a significant increase in afferent nerve dis-
charge, indicating that active substances released
by mast cells participate in the formation of prop-
agated sensation [106].
6 G.J. Wang et al
4. Detecting Special Chemical
Characteristics Along the Meridians
Since meridian channels have their special path
and function, the composition of the material
found in the meridians might be different from
their surrounding areas. The effect of acupuncture
can be transferred through the meridian path, sug-
gesting that these paths have a higher excitability,
which may be due to the excitatory threshold de-
termined by trans-membrane ion concentration dif-
ference and ion flow. The transmission of information
necessarily has its carrier. Therefore, it seems that
investigating the structure and function of meridi-
ans by studying the changes of chemical substances
along the meridians is particularly important.
Among all basic ions, calcium ions are involved
in the meridian activities [107,108]. Acupoints are
Ca2+ enriched [109,110]; acupuncture can also fur-
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
of Ca2+ [112]. Ion-specific research on meridian
lines has not been limited to Ca2+. Other ions, such
as Na+ and K+, are also involved in the functional
activities of meridians [113115]. Based on the
above understanding, it has been suggested that
the human body meridian system is the bodys bio-
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
impedance and high electrical conductivity prop-
erties [116]. The organism excitatory threshold is
directly related to the accomplishment of energy
metabolism, the higher the excitability, the more
vigorous the metabolism should be, which in turn
directly relates to both oxygen consumption and
carbon dioxide production. Therefore, the pres-
ence of carbon dioxide along the meridians would
be an important indicator for meridian activity.
Transcutaneous CO2 emission (TCE) refers to the
CO2 emitted from skin and produced from the tis-
sue when the citrate cycle takes place in living
cells. TCE along the meridians is higher in healthy
people [117]. Moreover, the relativity of TCE is higher
between Yuan-points of the exterior-interior me-
ridian couples and same name meridian couples
[118]. Also the relativity of TCE is higher on the
acupoints in one meridian [119].
Under pathological conditions, there is an im-
balance in the TCE between the left and right acu-
points with the same name [120]. Acupuncture can
act to increase the TCE [121] and diminish the oxy-
gen from the meridians [122]. This decrease in ox-
ygen content is definitely not due to reduced blood
flow, but an indication that acupuncture can en-
hance organic metabolism. Vigorous metabolism in
the organism implies an abundant blood supply,
leading to a rise in temperature, causing a stronger
infrared radiation. Research has shown the exist-
ence of linear bands of infrared radiation orbits
on a healthy body, and these radiation bands are
highly similar to the routes of ancient meridians
[123126]. The high temperature strips along me-
ridians can be induced by different types of acupunc-
ture [127]. The strips become more striking when
heating the acupoints or meridians [128]. When
there is pathology in internal organs, higher tem-
perature along the meridians may occur [129,130].
Rabbits with cholecystitis present with a high tem-
perature reaction along the gall bladder meridian
[131]. From the above analysis we can see that in
both physiological and pathological conditions, high
temperature response along meridians can occur,
suggesting that meridians have infrared or near in-
frared radiation characteristics.
5. Conclusion
Meridian study in China has a long, rich history and
is multi-directional. Obtaining a unique understand-
ing of meridians in a short time is difficult. Research
is continuing to determine the correct answer to
the age old question, What is the meridian?.
Acknowledgments
This work was supported by a 973 project grant
from the Ministry of Science and Technology of
China (2010CB530507) and by an independent
project grant from the China Academy of Chinese
Medical Science (ZZ2006089).
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