Visualized regional hypodermic migration channels of interstitial fluid in human beings: are these ancient meridians?

Regulation of interstitial fluid flow in adventitia along vasculature by heartbeat and respiration

Converging studies showed interstitial fluid (ISF) adjacent to blood vessels flows in adventitia along vasculature into heart and lungs. We aim to reveal circulatory pathways and regulatory mechanism of such adventitial ISF flow in rat model. By MRI, real-time fluorescent imaging, micro-CT, and histological analysis, ISF was found to flow in adventitial matrix surrounded by fascia and along systemic vessels into heart, then flow into lungs via pulmonary arteries and back to heart via pulmonary veins, which was neither perivascular tissues nor blood or lymphatic vessels. Under physiological conditions, speckle-like adventitial ISF flow rate was positively correlated with heart rate, increased when holding breath, became pulsative during heavy breathing. During cardiac or respiratory cycle, each dilation or contraction of heart or lungs can generate to-and-fro adventitial ISF flow along femoral veins. Discovered regulatory mechanisms of adventitial ISF flow along vasculature by heart and lungs will revolutionize understanding of cardiovascular system.

Stimuli-induced NOergic Molecules and Neuropeptides Mediated Axon Reflexes Contribute to Tracers along Meridian Pathways

An abundance of studies from different international groups have demonstrated tracers along linear pathways resembling meridians over the body surface of humans. All experiments of the studies have been conducted by injection of a radiotracer solution or tracer dyes in a volume of solution into acupuncture points (acupoints). The solution injected into acupoints produces much stronger mechanical stimuli than acupuncture, which causes axon reflex. Anatomical studies have demonstrated that acupoints/meridians exist higher number of small nerve fibers and blood vessels with rich nitric oxide (NO) and neuropeptides in the cutaneous tissues as structures for the biomolecules mediated axon reflexes. Recent advances have determined that NO and calcitonin generelated peptides play crucial roles in the comprehension of the axon reflex. The stimuli-evoked axon reflex and NOergic biomolecules/neuropeptides increase local blood flow with higher levels in acupoints/meridians, which move radioactive substances or tracer dyes in the skin and subcutaneous tissue under a linear path resembling acupoints and meridians, the important phenomena of meridians induced by the stimuli. The evidence and understanding of the biomolecular processes of the tracers along linear pathways resembling meridians have been summarized with an emphasis on recent developments of NO and neuropeptides mediating stimuli-evoked axon reflexes to increase local blood flow with higher levels in acupoints/meridians, which move radioactive substances or tracer dyes in the skin and subcutaneous tissue contributing to tracers along linear pathways resembling meridians in this mini-review.

Pilot Study of Blood Perfusion Changes at PC4 and Its Surrounding Points Induced by Acupuncture and Moxibustion

Acupuncture and moxibustion are widely used in clinical practice; however, the differences between their mechanisms are unclear. In the present study, the response of blood perfusion resulting from acupuncture or moxibustion at Ximen (PC4) and its surrounding points was explored. Using the wavelet method, the differences in the frequency interval of blood flux were observed. Furthermore, the correlations between these points were analyzed. The results suggested that moxibustion could significantly improve blood flow perfusion at PC4 compared to acupuncture; however, there was no significant difference around PC4. The response of blood flux at PC4 to different stimulations was related to the frequency V (0.4–1.6 Hz) component. However, a difference in response at other points was not observed. Correlation analysis showed that both acupuncture and moxibustion could cause a decline in the correlation of blood flux signals at these recorded points, but there was no significant difference between these techniques. The results suggested that, at least in the forearm, the acupuncture or moxibustion only influenced the level of blood perfusion locally.

Active interfacial dynamic transport of fluid in a network of fibrous connective tissues throughout the whole body

Fluid in interstitial spaces accounts for ~20% of an adult body weight and flows diffusively for a short range. Does it circulate around the body like vascular circulations? This bold conjecture has been debated for decades. As a conventional physiological concept, interstitial space is a micron‐sized space between cells and vasculature. Fluid in interstitial spaces is thought to be entrapped within interstitial matrix. However, our serial data have further defined a second space in interstitium that is a nanosized interfacial transport zone on a solid surface. Within this fine space, fluid along a solid fibre can be transported under a driving power and identically, interstitial fluid transport can be visualized by tracking the oriented fibres. Since 2006, our data from volunteers and cadavers have revealed a long‐distance extravascular pathway for interstitial fluid flow, comprising at least four types of anatomic distributions. The framework of each extravascular pathway contains the longitudinally assembled and oriented fibres, working as a fibrorail for fluid flow. Interestingly, our data showed that the movement of fluid in a fibrous pathway is in response to a dynamic driving source and named as dynamotaxis. By analysis of previous studies and our experimental results, a hypothesis of interstitial fluid circulatory system is proposed.

Potential of emotional freedom techniques to improve mood and quality of life in older adults

Emotional freedom techniques (EFTs) are an innovative combined somatic and cognitive therapy. Derived from key principles within traditional Chinese medicine, they incorporate elements of exposure, cognitive and other conventional psychotherapies. Increasing evidence suggests that EFTs are effective in treating various physical and psychological conditions and across several population groups. Studies indicate that the somatic component is essential to its ease of use, rapid effect and durability of results. EFTs can be used as self-help tools or applied therapeutically in groups or individually. There is a lack of research specifically examining its applicability to older adults, but a ground-breaking project with nurses in France suggests that EFTs may offer significant potential to moderate pain and stress levels and to improve mood, interaction and quality of life among this group, including those with multiple and complex comorbidities.

Changes of Blood Flux at BL21 and Points along BL Meridian Resulted from Acupuncture or Moxibustion: Case Cross Design Study

Acupuncture (Acup) and moxibustion (Moxi) are commonly used interventions in clinical practice. However, the difference between Acup and moxibustion mechanisms is unclear. In current study, blood perfusion responses resulted from Acup or Moxi at Weishu acupoint (BL21) and control points were explored, respectively. The time series of blood flux signals at BL21 and control points were transformed with Morlet wavelet, and the differences in each frequency interval were observed. The results suggested that acupoint response to different stimulation is a comprehensive process which related to all components of blood perfusion signals. Whereas the different response at control points was not observed, there has been significant difference coherence value between Acup and Moxi stimulation. The results suggested the influence of Acup and Moxi not only on the level of blood perfusion at local area; the intrinsic relevance after stimulation which can be evaluated by coherence analysis is also an appropriate index to distinguish different stimulations.

Is There Volume Transmission Along Extracellular Fluid Pathways Corresponding to the Acupuncture Meridians?

Volume transmission is a new major communication signaling via extracellular fluid (interstitial fluid) pathways. It was proposed by the current authors that such pathways can explain the meridian phenomena and acupuncture effects. To investigate whether meridian-like structures exist in fish body and operate via volume transmission in extracellular fluid pathways, we injected alcian blue (AB) under anesthesia into Gephyrocharax melanocheir, which has a translucent body. The migration of AB could be seen directly and was recorded by a digital camera. The fish was then embedded and cut transversely to observe the position of tracks in three dimensions. Eight longitudinal threadlike blue tracks were recognized on the fish. The positions of these threadlike tracks were similar to meridians on the human body. Transverse sections showed that these tracks distributed to different layers of distinct subcutaneous loose connective tissues and intermuscular septa. Lymphatic vessels were sometimes associated with the extracellular blue tracks where the migration of AB occurred. Extracellular fluid pathways were found on fish through their transport of AB. These pathways operating via volume transmission appeared to be similar in positions and functions to the acupuncture meridians in Chinese medicine.

Finding Blue Tracks in Gephyrocharax melanocheir Fish Similar to the Locations of Acupuncture Meridians after Injecting Alcian Blue

This study investigated whether a meridian-like distribution of Alcian blue (AB) existed after it was injected into a fish's body and suggested a new animal model for meridian study. Twenty Gephyrocharax melanocheir fish with translucent bodies were injected with AB at a point near the spinal column or the dorsal fin. Distribution of AB was observed using a digital camera and a stereomicroscope. Three or more obvious blue tracks were found: one along the spinal column, another along the posterior margin of the abdomen extending to the superior margin of the anal fin, and a third along both sides of the dorsal fin. They were similar to the locations of the governor, conceptual vessel, and urinary bladder meridians, respectively, on the human body according to the classic theory of traditional Chinese medicine. A few other blue tracks were also found, which apparently did not correspond to any known meridians. The results show that the tracks of AB share important similarities with the locations of classically described meridians and that they are mainly distributed in the interstitial space around bones and blood vessels and inside muscular interstices. This study may provide a new experimental animal model for exploring acupuncture meridians.

Influence of age, gender, and race on nitric oxide release over acupuncture points-meridians

This study examined the influence of age, gender and race on nitric oxide (NO) release over acupuncture points, meridian without acupoint, and non-meridian regions of the Pericardium (PC) and Bladder (BL) meridian as well as aging on LU meridian in 61 healthy subjects. Biocapture tubes were attached to the skin surface, and total nitrite and nitrate was biocaptured and quantified using chemiluminescence. In elder ages compared to adults, NO levels over the ventral forearm were significantly decreased over LU on radial regions but not altered over PC on medial regions. Conversely, NO content was elevated over BL regions only in overweight/obesity of elder ages. NO levels over PC regions were marginally elevated in overweight/obese males compared to females but did not alter between races. These results suggest a selective reduction of NO release over LU meridian with aging, which is consistent with a progressive decline in lung function and increase in chronic respiratory disease in elder ages. Increased NO levels along the BL meridian in older obese subjects may reflect a modified NO level along somatic-bladder pathway for counteracting bladder dysfunctions with aging. Both of them support somatic-organ connections in the meridian system associated with potential pathophysiological changes with aging.

Understanding Fibroblasts in Order to Comprehend the Osteopathic Treatment of the Fascia

The osteopathic treatment of the fascia involves several techniques, each aimed at allowing the various layers of the connective system to slide over each other, improving the responses of the afferents in case of dysfunction. However, before becoming acquainted with a method, one must be aware of the structure and function of the tissue that needs treating, in order to not only better understand the manual approach, but also make a more conscious choice of the therapeutic technique to employ, in order to adjust the treatment to the specific needs of the patient. This paper examines the current literature regarding the function and structure of the fascial system and its foundation, that is, the fibroblasts. These connective cells have many properties, including the ability to contract and to communicate with one another. They play a key role in the transmission of the tension produced by the muscles and in the management of the interstitial fluids. They are a source of nociceptive and proprioceptive information as well, which is useful for proper functioning of the body system. Therefore, the fibroblasts are an invaluable instrument, essential to the understanding of the therapeutic effects of osteopathic treatment. Scientific research should make greater efforts to better understand their functioning and relationships.

Classic and Modern Meridian Studies: A Review of Low Hydraulic Resistance Channels along Meridians and Their Relevance for Therapeutic Effects in Traditional Chinese Medicine

Meridian theory is one of the core components of the theory of traditional Chinese medicine (TCM). It gives an integral explanation for how human life works, how a disease forms, and how a therapy acts to treat a disease. If we do not understand the meridians, it is hard to understand the TCM. People in China and abroad had been working hard for 50 years, trying to understand the meridians; then 15 years ago a breakthrough idea appeared when we realized that they are low resistance fluid channels where various chemical and physical transports take place. The channel is called low hydraulic resistance channel (LHRC) and the chemical transport is named volume transmission (VT). This review aims to give a full understanding of the essence of meridian and its works on the therapies of TCM.

Acupoint Activation: Response in Microcirculation and the Role of Mast Cells

BACKGROUND

According to Traditional Chinese Medicine (TCM) theory, acupuncture effects are based on the integrity function of meridians. Meridians are thought to regulate body function through the normal flow of qi and/or blood. Disturbances in this flow are thought to cause disease, and acupuncture techniques are believed to cure disease by regulating this flow. However, it is still difficult to understand the exact meaning of qi and to evaluate the activation of meridians. Thus, more and more attention has been focused on the relationship of acupuncture and circulation.

METHODS

In this narrative review, the authors focus on the state of the art in acupoint activation, microcirculation response, and on investigation of mast cells, based on current literature research.

RESULTS

Altogether, 52 references are cited and discussed critically. A schematic diagram of the relationship between acupuncture stimulation, changes of microcirculation and mast cells is presented as result.

CONCLUSION

The block diagram presented in this review article shows that mast cells might play an important role in circulation response after acupoint stimulation.

Clinical and symptomatological reflections: the fascial system

Every body structure is wrapped in connective tissue, or fascia, creating a structural continuity that gives form and function to every tissue and organ. Currently, there is still little information on the functions and interactions between the fascial continuum and the body system; unfortunately, in medical literature there are few texts explaining how fascial stasis or altered movement of the various connective layers can generate a clinical problem. Certainly, the fascia plays a significant role in conveying mechanical tension, in order to control an inflammatory environment. The fascial continuum is essential for transmitting muscle force, for correct motor coordination, and for preserving the organs in their site; the fascia is a vital instrument that enables the individual to communicate and live independently. This article considers what the literature offers on symptoms related to the fascial system, trying to connect the existing information on the continuity of the connective tissue and symptoms that are not always clearly defined. In our opinion, knowing and understanding this complex system of fascial layers is essential for the clinician and other health practitioners in finding the best treatment strategy for the patient.

Scientific Basis of Auriculotherapy: State of the Art

Background: Using a modern scientific basis, this article examines clinical findings and experimentally reproducible data that demonstrate reliably the objective reality of the auriculotherapy procedures initiated by Paul Nogier, MD, of Lyon, France. Objective: The aims of this review are to: (1) identify the Chinese acupoints and all relevant related subjects; (2) offer a critical analysis of different auricle cartographies or ear maps; and (3) evaluate evidence for auriculotherapy with respect to the constant progress of our knowledge of nervous-system organization. Discussion: Acupuncture points have lower electrical impedance than nonacupoints. This was demonstrated by Niboyet and Terral, utilizing a sinusoidal current with the technical arrangements of different equivalent circuits made at Unit 103 of the French National Institute of Health and Medical Research (INSERM), Montpellier, France. This work demonstrated that physical behavior associated with acupuncture corresponds to a specific histologic structure located within the dermis termed the neurovascular complex (NVC). The concept of using sham points for testing acupuncture needs to be criticized. A reproducible experimental model of analgesia has been produced using the hind limb of a rabbit; this model is a proven demonstration of the positive action of acupuncture on pain. Acupuncture analgesia is a technique that has been used effectively by Chinese researchers in the 1970s for surgical applications. The different ear maps may have to be significantly modified because of the paucity of scientific validation of most of the localizations of organs or functions and, particularly, of nervous structures. Increased knowledge about complex nervous interactions should facilitate formulation of some scientifically acceptable hypothesis to explain the action of auriculotherapy. Conclusions: More scientific research should be performed to improve the scientific credibility of auriculotherapy.

Mechanisms of Qi-blood circulation and Qi deficiency syndrome in view of blood and interstitial fluid circulation

OBJECTIVE

Based on comparison between fundamental theories of Traditional Chinese Medicine (TCM) and Western Medicine (WM) and modern scientific research on meridians, we find that "Qi" in TCM is closely related to tissue fluid. In this study, the essence of Qi is explored in the view of circulation of blood and interstitial fluid.

METHODS

Because the concept of Qi is complicated, Qi deficiency syndrome (QDS) is chosen to probe the relationship between of Qi deficiency and Qi-blood circulation (QBC). We analyze Qi-blood theory in terms of WM, set up a hemodynamic model to describe QBC, and review clinical research on QDS in the view of blood-interstitial fluid circulation.

RESULTS

QDS is caused by imbalances of substance exchanges between blood and interstitial fluid, leading to an increase in the interstitial liquid volume or a decrease and retention of metabolic wastes in interstitial fluid.

CONCLUSION

This study describes the essence of Qi, providing support for further research on theories of Qiand Qi-blood circulation in TCM.

Pilot study of blood perfusion coherence along the meridian in forearm

Background

Many studies have explored the relationship between skin microcirculation and meridian activation. However, few studies have examined blood perfusion coherence along the meridians, and other studies have suggested that the skin vasodilator response relates to age. This study investigated blood perfusion coherence characteristics along the meridian of the forearm in healthy volunteers.

Methods

A total of 15 young subjects (25.53 ± 2.20) and 15 middle-aged subjects (50.07 ± 3.37) were recruited for this study. Before experiments, each subject was placed in a temperature-controlled room for 60 min. Skin blood perfusion from five points was recorded simultaneously using a full-field laser perfusion imager before and after inflatable occlusion. The five points comprised three points located on the pericardium meridian, and two points from different locations. Coherence analysis between these points was performed at different frequency intervals from 0.0095 to 2 Hz.

Results

In young subjects, the coherence value was unchanged before and after occlusion, and there was no significant difference in coherence value between meridian-meridian points (M-M) and meridian-parameridian points (M-P). In middle-aged subjects, the coherence value increased significantly in both M-M and M-P at frequency intervals of 0.14-0.4 Hz, 0.4-1.6 Hz, and 1.6-2 Hz. However, there was no significant difference in coherence values between M-M and M-P.

Conclusions

Inflatable occlusion can increase middle-aged subjects’ blood perfusion coherence value of the forearm. However, there is no specificity in meridian location.

Study on the dynamic compound structure composed of mast cells, blood vessels, and nerves in rat acupoint

Background. Circulation system, immunity system, and nervous system have a close relationship with meridian phenomen. However, there is still lack of the results of dynamic changes of these structures in acupoint. The aim of this study is to explore the interrelationship by composite staining techniques. Methodology/Principal Findings. Twenty rats were separated into electroacupuncture group (EA) and control group (Con) randomly. In EA group, the Zusanli and Weishu were stimulated with the 0.1 mA for 25 min. The tissue of these acupoints was double-stained with acetylcholinesterase and Toluidine blue. The compound structure of mast cells, nervous fibers, and mast cells in the acupoint was observed. Conclusions/Significance. The blood vessels, mast cells and acetylcholinesterase responded nerves were clearly observed in acupoint tissues. EA can result in the mast cell recruitment and migration along the blood vessels and nervous bundle, which conformed the dynamic compound structure and played important roles in acupuncture.

Interstitial fluid flow: the mechanical environment of cells and foundation of meridians

Using information from the deep dissection, microobservation, and measurement of acupoints in the upper and lower limbs of the human body, we developed a three-dimensional porous medium model to simulate the flow field using FLUENT software and to study the shear stress on the surface of interstitial cells (mast cells) caused by interstitial fluid flow. The numerical simulation results show the following: (i) the parallel nature of capillaries will lead to directional interstitial fluid flow, which may explain the long interstitial tissue channels or meridians observed in some experiments; (ii) when the distribution of capillaries is staggered, increases in the velocity alternate, and the velocity tends to be uniform, which is beneficial for substance exchange; (iii) interstitial fluid flow induces a shear stress, with magnitude of several Pa, on interstitial cell membranes, which will activate cells and lead to a biological response; (iv) capillary and interstitial parameters, such as capillary density, blood pressure, capillary permeability, interstitial pressure, and interstitial porosity, affect the shear stress on cell surfaces. The numerical simulation results suggest that in vivo interstitial fluid flow constitutes the mechanical environment of cells and plays a key role in guiding cell activities, which may explain the meridian phenomena and the acupuncture effects observed in experiments.

Fluid flow along venous adventitia in rabbits: is it a potential drainage system complementary to vascular circulations?

Background

Our previous research and other studies with radiotracers showed evidence of a centripetal drainage pathway, separate from blood or lymphatic vessels, that can be visualized when a small amount of low molecular weight tracer is injected subcutaneously into a given region on skin of humans. In order to further characterize this interesting biological phenomenon, animal experiments are designed to elucidate histological and physiologic characteristics of these visualized pathways.

Methods

Multiple tracers are injected subcutaneously into an acupuncture point of KI3 to visualize centripetal pathways by magnetic resonance imaging or fluorescein photography in 85 healthy rabbits. The pathways are compared with venography and indirect lymphangiography. Fluid flow through the pathways is observed by methods of altering their hydrated state, hydrolyzing by different collagenases, and histology is elucidated by optical, fluorescein and electron microscopy.

Results

Histological and magnetic imaging examinations of these visualized pathways show they consist of perivenous loose connective tissues. As evidenced by examinations of tracers’ uptake, they appear to function as a draining pathway for free interstitial fluid. Fluorescein sodium from KI3 is found in the pathways of hind limbs and segments of the small intestines, partial pulmonary veins and results in pericardial effusion, suggesting systematical involvement of this perivenous pathway. The hydraulic conductivity of these pathways can be compromised by the collapse of their fiber-rich beds hydrolyzed by either of collagenase type I, III, IV or V.

Conclusions

The identification of pathways comprising perivenous loose connective tissues with a high hydraulic conductivity draining interstitial fluid in hind limbs of a mammal suggests a potential drainage system complementary to vascular circulations. These findings may provide new insights into a systematically distributed collagenous connective tissue with a circulatory function and their potential relevance to the nature of acupuncture meridians.

Review of evidence suggesting that the fascia network could be the anatomical basis for acupoints and meridians in the human body

The anatomical basis for the concept of meridians in traditional Chinese medicine (TCM) has not been resolved. This paper reviews the evidence supporting a relationship between acupuncture points/meridians and fascia. The reviewed evidence supports the view that the human body's fascia network may be the physical substrate represented by the meridians of TCM. Specifically, this hypothesis is supported by anatomical observations of body scan data demonstrating that the fascia network resembles the theoretical meridian system in salient ways, as well as physiological, histological, and clinical observations. This view represents a theoretical basis and means for applying modern biomedical research to examining TCM principles and therapies, and it favors a holistic approach to diagnosis and treatment.

Probing the mystery of Chinese medicine meridian channels with special emphasis on the connective tissue interstitial fluid system, mechanotransduction, cells durotaxis and mast cell degranulation

This article hypothesizes that the Chinese medicine meridian system is a special channel network comprising of skin with abundant nerves and nociceptive receptors of various types, and deeper connective tissues inside the body with the flowing interstitial fluid system. These meridian channels provide efficient migratory tracks mainly due to durotaxis (also including chemotaxis) for mast cells, fibroblasts and other cells to migrate and carry out a number of physiological functions. Acupuncture acting on meridian channel causes cytoskeletal remodeling through mechanotransduction, leading to regulation of gene expression and the subsequent production of related proteins. Also, stimulation on cell surface can trigger Ca2+ activities, resulting in a cascade of intra- and inter-cellular signaling. Moreover, nerve endings in the meridian channels interact with mast cells and induce the degranulation of these cells, leading to the release of many specific biomolecules needed for homeostasis, immune surveillance, wound healing and tissue repair. Acupoint along a meridian channel is a functional site to trigger the above functions with specificity and high efficiency.