Commonly Used Meridian Points
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“Applied Physiotherapy in Chiropractic”
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Chapter 3: Commonly Used Meridian Points
This chapter delineates a few of the many theories attempting to explain the mechanisms of acupuncture point (acupoint) stimulation and meridian therapy. Stimulation of specific points on the body as a mechanism for pain control has achieved great interest in this country in recent years. The majority of studies center on stimulating endorphin production in the body. See Table 3.1. Antidotal and clinical evidence as well as patient records from Oriental cultures point to numerous cases where specific point stimulation has affected visceral and functional disease processes. In the context of physiologic therapeutics, the location, primary indications, and precautions associated with the major points (ie, those most commonly used) are reviewed.
Both Western and Eastern cultures developed systems for treating specific points on the body. It is hoped that future generations will be able to integrate the best of traditional Western and Oriental medicine into a single health-care delivery system for all people. 
THE THEORETICAL BASIS OF MERIDIAN THERAPY
Forms of stimulation to specific sites on the skin have been used for at least 3000 years. However, it is only in the last 25 years that comprehensive studies of acupuncture as an alternative therapy have been seriously undertaken in this country. The fact that meridian therapy has a beneficial effect on the control of disease processes seems evident today on the basis of empiric evidence and clinical studies.
Although it generally matters little to patients as to why they get well under a certain therapy, they do, however, expect that the doctor rendering that therapy has an acceptable explanation and understanding of the biologic mechanisms that are probably involved. That is, the patient has a natural tendency to believe that their doctor selects a particular procedure of treatment for their condition on the basis of his or her knowledge of the nature of their problem, and the knowledge of the underlying principles behind a particular method of therapy. Also, since the study and effective application of meridian therapy require some basic knowledge of its theoretical scientific basis, the need for this explanation is established.
In the case of meridian therapy, a number of theories have been advanced that generally fall under the headings of “Neural” or “Nonneural” concepts. These concepts attempt to explain the scientific basis for the biologic effects of meridian therapy in terms of our present understanding of human anatomy and physiology. Although scientific verification of the concept of “vital energy” as a physiologic probability and the “meridian” system as an anatomical fact have yet to be conclusive, verification for some of the effects of meridian therapy does exist on the basis of these concepts. 
The Nonneural Theories
One of the most commonly mentioned nonneural concepts attempts to explain the meridian system by proposing an elaborate conducting system of what is referred to as “Bong Han Ducts and Corpuscles.” This theory, put forth by a North Korean physiologist and acupuncturist, Kim Bong Han, is a histologic description of elongated tubular cells lying deep in the skin. Han also thinks that a “unique” fluid circulates through these channels, which contains a high concentration of ribonucleic and other amino acids. Han believes that this fluid travels slowly through the meridians, completing a cycle each 24 hours. [3, 4]
Han’s theory, however impressive as it might be, has for all practical purposes been refuted by other investigators. Kellner has shown that some of this theory is based on artifacts occurring in preparation of the histologic slides, and other attempts at duplicating the work of Han reveal that he was probably describing the lymphatic channels of the body. [5, 6]
Various other theories have attempted to explain acupuncture and the existence of the meridians.  For example, magnetic fields, quantum mechanics, contraction waves of skeletal muscles, discharging of electrical potentials, and the release of histamine and epinephrine by stimulation of points have all been put forth as possible mechanisms. Others have likened the pinprick in the body to the electrical discharge of a condenser. At one time, Felix Mann proposed a theory based on the lateral line system in fish. These theories, along with others, have now been dismissed in favor of one of the neurologic explanations.
One of the most recent theories has been postulated by Koyo Takase in Japan who concluded that the so-called Qi energy circulating through a “meridian” in acupuncture therapy is actually extravascular sodium.  His studies involved the use of radioisotopes.
The Neural Theories
It is generally conceded that the mechanisms of many effects of acupuncture are similar to but not identical to those of the nervous system. There are many questions, however, that remain unanswered. 
When an acupuncture point is stimulated, it has been observed that the patient will often experience a change in seconds and this change frequently occurs at the opposite end and contralateral side of the body from the point stimulated. The exact mechanism of this action is not yet fully understood, although certain aspects appear to be based on established neurophysiologic concepts. This indicates that some type of nerve conduction occurs, as nerve fibers transmit impulses at an extremely rapid rate through their pathways. Such a rapid speed of conduction excludes the blood and lymphatic systems as possible mediators of this response.
THE CUTANEOVISCERAL REFLEX
Acupuncture is founded on the premise that stimulation of the skin has an effect on distant internal organs and functional mechanisms of the body. Various experimental data tend to support the involvement of a cutaneovisceral reflex. [10–13]
Proof for the existence of such a reflex has strong scientific support. In a series of experiments, Kuntz and Hazelwood stimulated the skin on the back of rabbits and rats and noted changes in various parts of the gastrointestinal tract that were related to the dermatomal segment stimulated. [14–16] In Germany, Wernoe stimulated a small segment of the skin of fish and amphibians with silver nitrate and, after a delay of several months, demonstrated vasoconstriction of the part of the intestine dermatomally related.  After these experiments, he deduced that vasodilation was mediated by a spinal reflex and that vasoconstriction was mediated by a postganglionic sympathetic reflex.
Travell and Rinzler found that complete and prolonged relief resulted when trigger points on the front of the chests of patients with angina pectoris or acute myocardial infarction were infiltrated with procaine or cooled with ethyl chloride.  Thus, the cutaneovisceral reflex is of prime importance in acupuncture. It is strongly believed that, by its mediation, an acupuncture needle placed in the correct part of the skin is able to influence the related organ or diseased part of the body.
New hypotheses are being brought forth rapidly. For example, it has been established for years that the ear is a hologram of the body as a whole, and this is the basis of auriculotherapy. However, Dale has recently proposed an elaborate hypothesis that most any part of the body is a hologram of the body as a whole. 
THE VISCEROCUTANEOUS REFLEX
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