Original paper
On dermatomes, meridians and points: results of a quasiexperimental study Max Sánchez-Araujo,1,2 Ana J Luckert-Barela2
▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ acupmed-2013-010352). 1
Complementary Therapy Research Unit, Francisco de Miranda University, Coro, Venezuela 2 Instituto de Investigación de Salud y Terapéutica, INSYT, Caracas, Venezuela Correspondence to Dr Max Sánchez-Araujo, Unidad de Investigación de Terapias Complementarias, Universidad ‘Francisco de Miranda’ Coro. Ave. Río de Janeiro, Ed San Jacinto, Of 3, Las Mercedes, Caracas 1060, Venezuela; [email protected] Received 28 March 2013 Accepted 5 September 2013 Published Online First 6 November 2013
To cite: Sánchez-Araujo M, Luckert-Barela AJ. Acupunct Med 2014;32:62–69.
62
ABSTRACT Background Traditional Chinese medicine (TCM) meridians and points run vertically, reflecting their function in the Zhang-Fu system (meridian pattern). However, the trunk’s spinal nerves show a traverse orientation, or a ‘horizontal pattern’. Objective The aim of the present work was to evaluate, via a cognitive quasiexperiment, whether the clinical indications of the points on the trunk are associated with their meridian function or with their innervation and visceral– somatic connection. Methods The points in each dermatome of the trunk were considered crosswise, regardless of their meridians. The clinical indications for each point were differentiated into two mutually exclusive categories: (a) vertical distribution effect (VDE) or ‘meridian pattern’, when indications were quite different regarding the indications for the other points on the dermatome; and (b) transverse distribution effects (TDE) or ‘horizontal pattern’, represented by mainly local or segmental indications except for Shu-Mu points. After observing that the proportions between both categories often exceeded 60% in pilot samples, 60% was adopted as the reference value. Results A total of 22 dermatomes accommodated 148 points with 809 indications, of which 189 indications (23.4%) exhibited VDE features, whereas 620 (76.6%) exhibited TDE features. Conclusions A TDE/VDE ratio of 3 : 1 implies that the clinical indications for the points of any dermatome on the torso are similar, regardless of their meridians, and suggests that most of the indications for trunk points involve a ‘horizontal pattern’ due to their neurobiological nature. These findings may help in understanding acupuncture’s neurobiology and clarify some confusing results of clinical research, for example, excluding sham acupuncture as an inert intervention for future clinical trials.
INTRODUCTION Acupuncture clinical research has not been free of pitfalls. Acupuncture randomised controlled trials (RCTs) often produce conflicting results. Nevertheless, many studies have found that treated and control groups experience lasting relief of their symptoms in several contexts.1–10 Despite the abundant data that indicate the remarkable clinical performance of acupuncture in real settings and its superior performance when compared with waiting lists, the trend of conflicting results in RCTs has not substantially changed over time most likely due to methodological and affective discrepancies.11–21 Traditional Chinese acupuncture (TCA) imagines that ‘energy’ flows throughout the body in an intricate network of channels or meridians. Each meridian corresponds specifically to an organ or a viscus (Zhang-Fu), which determines its functional and clinical properties.22 However, neurobiology can be used to explain most of acupuncture’s effects. In this study, we aimed to determine whether the segmental behaviour of acupuncture points on the trunk could explain some of the conflicting results from acupuncture RCTs. In figure 1, a vertical pattern (the black and green dots) in the distribution of acupuncture points can be observed (here called a ‘meridian pattern’). According to TCA, the indications for each point reflect the clinical function of its respective meridian. Therefore, we would expect the points in any dermatome to have different indications that pertain to their meridians running across zones, which we term the vertical distribution effect (VDE). In addition, another pattern can be detected in figure 1. The transverse distribution of the points on the dermatomes (the red dots) displays a ‘horizontal pattern’. Therefore, the orientation of the
Sánchez-Araujo M, et al. Acupunct Med 2014;32:62–69. doi:10.1136/acupmed-2013-010352
Original paper evaluate the VDE, or ‘meridian pattern’, and the TDE, or ‘horizontal pattern’, of the points on the trunk to determine whether the clinical effects of acupuncture points depend on their meridian connections or on their innervation and underlying visceral–somatic substratum. Our null hypothesis was that the clinical indications of diverse points pertaining to different meridians of a given trunk zone will show relevant differences, reflecting a VDE. Design
This quasiexperimental study aimed to assess the VDE and TDE, using the clinical information in three officially recognised books on TCA.22 25 26 The clinical indications for each point are typically listed in acupuncture texts according to the numerical order of each meridian. However, in our study, we considered the points of each dermatome on the trunk crosswise, regardless of their affiliation with the various meridians that traversed each cutaneous band. In addition, the indications for the points were classified into the following two categories: (1) dependent on vertical distribution or (2) dependent on transverse distribution. Procedures
Figure 1 Distribution patterns of acupuncture points. Green and black dots show 'vertical' or meridian pattern, red dots 'horizontal' or segmental pattern. (Based on a figure kindly provided by M Cummings and reproduced with his permission).
points would depend on the segmental architecture of the body, which parallels the symmetrical distribution of the spinal nerves and the vessels. In such an architecture, the somatic and visceral structures that are innervated by the same spinal segment behave as a whole; therefore, a disturbance in any such structure would impact the others.24 A random puncture at any location on a given dermatome would induce similar effects. Consequently, a set or group of points that pertain to a dermatome would have analogous indications depending on their underlying somatic–visceral connection, which would correspond with a neurobiologically derived effect.10 24 We have termed this the transverse distribution effect (TDE). On this basis, a quasiempirical experiment was conducted to determine which effects are observed in real settings. MATERIALS AND METHODS
The points in each of the trunk dermatomes were accurately identified and enumerated according to clear topographical criteria obtained through a comparison of data from two anatomical acupuncture atlases: one from Shandong Medical College25 and another from Jean Bossy, a renowned neuroanatomist from the University of Montpellier.23 The set of points for each dermatome was tabulated for data collection. In addition to the Chinese atlas, two authoritative books on acupuncture were consulted, which were supported by the Acupuncture Institute at the Academy of Traditional Chinese Medicine of Beijing and the Colleges of Traditional Chinese Medicine in Shanghai and Nanking.22 26 A comprehensive collection of indications and potential clinical effects were obtained for each of the points associated with the 22 trunk dermatomes (T1–S5) and were grouped into 22 tables. The table for each dermatome contained a dermatome identification number, a list of points, a comprehensive set of indications for each point, two notation columns for indications of VDE or TDE, a subtotal column and a row total. The clinical indications for each point were differentiated into the two mutually exclusive categories discussed below.
A cognitive quasiexperiment
VDE or ‘meridian pattern’
We used a simple cognitive strategy based on information from traditional Chinese medicine (TCM) sources to assess the classical postulates and the neuroanatomical correlates of acupuncture. Our objective was to
(1) The indication for any point exhibited VDE features when it was unique, or at least very different from the indications for the other points on the dermatome. (2) The indication of any point
Sánchez-Araujo M, et al. Acupunct Med 2014;32:62–69. doi:10.1136/acupmed-2013-010352
63
Original paper demonstrated affinity with its meridian clinical function or corresponded with symptoms or signs that were systemic in nature. TDE or ‘horizontal pattern’
Clinical indications, such as symptoms or signs that were local or regional in nature, represented a transverse effect that was associated with underlying neurobiology (the neural somatic–visceral substrate). Assumptions
The assumed reference value was initially 50%, which indicated the predominance of one effect over the other. However, after observing that the proportions between both categories often exceeded 60% in pilot samples, 60% was adopted as the reference value. For each point: (1) a predominance of the VDE that exceeded 60% was assumed to be consistent with TCA postulates; and (2) a preponderance of the TDE that surpassed 60% was assumed to be compatible with the neurobiological perspective. For each dermatome: (1) a majority of VDE indications that exceeded 60% of its points would endorse the TCM model; and (2) a predominance of TDE indications that exceeded 60% of the points of a dermatome would validate the neurobiological perspective. To facilitate the classification of the effects and simplify the visual appraisal process, indications that exhibited VDE features were recorded in bold in tables. Table 1 illustrates a typical table and the visualisation procedure that was used to distinguish between the nature of each indication and their respective points, using chi square test (the remaining tables can be seen on the web-only supplement). RESULTS In all, 22 dermatomes accommodated 148 points with 809 indications, of which 189 indications (23.4%) exhibited VDE features, whereas 620 (76.6%) exhibited TDE features. DISCUSSION A TDE/VDE ratio of approximately 3 : 1 was observed. The clinical indications for the points of any dermatome on the torso were similar, regardless of their meridians, which suggests that most of the indications for trunk points involve a ‘horizontal pattern’ due to their neurobiological nature. Therefore, the null hypothesis can be reasonably rejected. Trunk point effects depend on the overlapping distribution of sensorimotor and autonomic visceral innervations that originate from the segmental architecture of the body (see tables 2 and anatomical atlases 27 28). Therefore, our results suggest that the most significant factor for the clinical properties of each acupuncture point, in this context, could be the location of the point on a trunk dermatome. The repetition of indications for the set of points found on the dermatomes of the torso may be due to
64
the segmental array of the trunk, which functions as a whole. Therefore, needling the dermatome at any location or acupuncture point will induce a global response. Because needling impacts the singular structure of the peripheral, autonomic and central nervous systems,27 28 the non-specific healing potential of the body can be modulated by activating inbuilt selfregulating processes through neural, neurochemical, neuroendocrine and neuroimmune mechanisms29–34 whose integration occurs at the solitary tract nucleus and the medulla.35 36 Our results can elucidate certain ‘research paradoxes’ of acupuncture, such as the alleged specificity of points, which is not supported by neurobiology. In addition, our results can explain the inconsistency and non-specific behaviour of several distinctive points, such as the Back Shu points and the Front Mu points, regarding their respective Zhang-Fu.37 Curiously, our data show that their indications are indistinguishable from those of other nearby points. These points and the Head’s areas share the same behaviour based on the body’s neurobiological structure, as suggested by Western researchers.38 39 The interconnections and the diversity of responses induced by peripheral sensory stimulation (PSS) and the non-specific effects of this procedure may be too complex to be fully elucidated in biomedical experimentation models, which are influenced by ethics and by technical and methodological limitations.
In the footsteps of shamans
Ancient Chinese Wu healers could have derived the segmental (metameric) architecture of the body through a lengthy and disciplined observation and deduction process. Earlier doctors, in a shamanic context, used bloodletting to ‘placate ancestors and remove demons’40–42 but ultimately turned to punctures as an instrument. Through trial and error using a binomial characterisation of observed outcomes as a yang/yin method, Wu healers learned to pragmatically take advantage of innate on/off phenomena. Using PSS, they could elicit central nervous system (CNS) interneuron activation/inhibition ‘deciphered’ as yang/ yin responses on suitable medullar segments.43 44 Chinese philosophers and scholars created the ‘Channels/Meridians theory’, with its inherent shortcomings, using a heuristic process and their sociohistorical backgrounds to explain such phenomena. The first part of the process could be referred to as the discovery of early ‘protoscience’, that is, a set of beliefs or theories that are aimed at establishing its legitimacy.45 46 In contrast, the second part corresponded with a complex metaphysical construct was a mixture of empirical observations and heuristic reasoning, which negatively impacts current acupuncture clinical research.18–21 47–53
Sánchez-Araujo M, et al. Acupunct Med 2014;32:62–69. doi:10.1136/acupmed-2013-010352
Original paper Table 1
Indications of acupuncture points of dermatome T2 and L1
Acupuncture points
Chinese term
Dermatome T2 LU1 SP20 ST15 KI25 CV19 BL12 BL41 SI9 SI10 SI12
Zhongfu Zhourong Wuyi Shencang Zigong Fengmen Fufen Jianzhen Naoshu Bingfeng
SI13 Total % Dermatome L1 CV2
Indications Asthma, cough, chest pain, lung congestion, shoulder pain Cough, chest and hypochondria congestion Asthma, cough, chest congestion and pain, mastitis Asthma, cough, chest pain Asthma, cough, chest pain Cold/flu, cough, fever, headache, stiff neck, upper back pain Neck, dorsal and shoulder rigidness, arm numbness Omalgia, pain and motor dysfunction of upper limb Shoulder pain and upper arm pain Cough, chest pain, hypochondrial distension, scapular-brachial pain, numbness of the upper limb, arm weakness Weakness in upper arm, and itching in shoulder and arm
Quyuan
Qugu
GV5
Xuanshu
ST30 SP12
Qichong Chongmen
SP13 KI11 GB29 LR12 BL23
Fuche Henggu Juliao Jimai Shenshu
Spermatorrhoea, impotence, leucorrhoea, irregular menstruation, dysmenorrhoea, pelvic inflammation, hernia, incontinence, urinary retention, diarrhoea, enteritis with indigestion, back pain and stiffness Pain of external genitalia, swelling of external genitalia, hernia, irregular menstruation, urogenital diseases Abdominal pain, hernia, urinary retention, orchitis, epididymitis, endometritis Abdominal pain, hernia, urinary retention, painful haemorrhoids, dysuria, orchitis, spermatitis, endometritis Abdominal pain, hernia, appendicitis, constipation, splenomegaly External genital pain, spermatorrhoea, dysuria, enuresis, impotence, urinary retention, hernia Back pain, pain and/or paralysis of lower limbs, hip arthritis External genital pain, hernias, uterine prolapse, hypogastric pain, inner thigh pain Kidney Shu point. Blurred vision, deafness, oedema, enuresis, impotence, nephritis, tinnitus, chronic diarrhoea, irregular menstruation, leucorrhoea, low back pain, spermatorrhoea, weakness of the knee
Total % Words in bold indicate vertical distribution effect (VDE). TDE, transverse distribution effect. **p
On dermatomes, meridians and points: results of a quasiexperimental study Max Sánchez-Araujo,1,2 Ana J Luckert-Barela2
▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ acupmed-2013-010352). 1
Complementary Therapy Research Unit, Francisco de Miranda University, Coro, Venezuela 2 Instituto de Investigación de Salud y Terapéutica, INSYT, Caracas, Venezuela Correspondence to Dr Max Sánchez-Araujo, Unidad de Investigación de Terapias Complementarias, Universidad ‘Francisco de Miranda’ Coro. Ave. Río de Janeiro, Ed San Jacinto, Of 3, Las Mercedes, Caracas 1060, Venezuela; [email protected] Received 28 March 2013 Accepted 5 September 2013 Published Online First 6 November 2013
To cite: Sánchez-Araujo M, Luckert-Barela AJ. Acupunct Med 2014;32:62–69.
62
ABSTRACT Background Traditional Chinese medicine (TCM) meridians and points run vertically, reflecting their function in the Zhang-Fu system (meridian pattern). However, the trunk’s spinal nerves show a traverse orientation, or a ‘horizontal pattern’. Objective The aim of the present work was to evaluate, via a cognitive quasiexperiment, whether the clinical indications of the points on the trunk are associated with their meridian function or with their innervation and visceral– somatic connection. Methods The points in each dermatome of the trunk were considered crosswise, regardless of their meridians. The clinical indications for each point were differentiated into two mutually exclusive categories: (a) vertical distribution effect (VDE) or ‘meridian pattern’, when indications were quite different regarding the indications for the other points on the dermatome; and (b) transverse distribution effects (TDE) or ‘horizontal pattern’, represented by mainly local or segmental indications except for Shu-Mu points. After observing that the proportions between both categories often exceeded 60% in pilot samples, 60% was adopted as the reference value. Results A total of 22 dermatomes accommodated 148 points with 809 indications, of which 189 indications (23.4%) exhibited VDE features, whereas 620 (76.6%) exhibited TDE features. Conclusions A TDE/VDE ratio of 3 : 1 implies that the clinical indications for the points of any dermatome on the torso are similar, regardless of their meridians, and suggests that most of the indications for trunk points involve a ‘horizontal pattern’ due to their neurobiological nature. These findings may help in understanding acupuncture’s neurobiology and clarify some confusing results of clinical research, for example, excluding sham acupuncture as an inert intervention for future clinical trials.
INTRODUCTION Acupuncture clinical research has not been free of pitfalls. Acupuncture randomised controlled trials (RCTs) often produce conflicting results. Nevertheless, many studies have found that treated and control groups experience lasting relief of their symptoms in several contexts.1–10 Despite the abundant data that indicate the remarkable clinical performance of acupuncture in real settings and its superior performance when compared with waiting lists, the trend of conflicting results in RCTs has not substantially changed over time most likely due to methodological and affective discrepancies.11–21 Traditional Chinese acupuncture (TCA) imagines that ‘energy’ flows throughout the body in an intricate network of channels or meridians. Each meridian corresponds specifically to an organ or a viscus (Zhang-Fu), which determines its functional and clinical properties.22 However, neurobiology can be used to explain most of acupuncture’s effects. In this study, we aimed to determine whether the segmental behaviour of acupuncture points on the trunk could explain some of the conflicting results from acupuncture RCTs. In figure 1, a vertical pattern (the black and green dots) in the distribution of acupuncture points can be observed (here called a ‘meridian pattern’). According to TCA, the indications for each point reflect the clinical function of its respective meridian. Therefore, we would expect the points in any dermatome to have different indications that pertain to their meridians running across zones, which we term the vertical distribution effect (VDE). In addition, another pattern can be detected in figure 1. The transverse distribution of the points on the dermatomes (the red dots) displays a ‘horizontal pattern’. Therefore, the orientation of the
Sánchez-Araujo M, et al. Acupunct Med 2014;32:62–69. doi:10.1136/acupmed-2013-010352
Original paper evaluate the VDE, or ‘meridian pattern’, and the TDE, or ‘horizontal pattern’, of the points on the trunk to determine whether the clinical effects of acupuncture points depend on their meridian connections or on their innervation and underlying visceral–somatic substratum. Our null hypothesis was that the clinical indications of diverse points pertaining to different meridians of a given trunk zone will show relevant differences, reflecting a VDE. Design
This quasiexperimental study aimed to assess the VDE and TDE, using the clinical information in three officially recognised books on TCA.22 25 26 The clinical indications for each point are typically listed in acupuncture texts according to the numerical order of each meridian. However, in our study, we considered the points of each dermatome on the trunk crosswise, regardless of their affiliation with the various meridians that traversed each cutaneous band. In addition, the indications for the points were classified into the following two categories: (1) dependent on vertical distribution or (2) dependent on transverse distribution. Procedures
Figure 1 Distribution patterns of acupuncture points. Green and black dots show 'vertical' or meridian pattern, red dots 'horizontal' or segmental pattern. (Based on a figure kindly provided by M Cummings and reproduced with his permission).
points would depend on the segmental architecture of the body, which parallels the symmetrical distribution of the spinal nerves and the vessels. In such an architecture, the somatic and visceral structures that are innervated by the same spinal segment behave as a whole; therefore, a disturbance in any such structure would impact the others.24 A random puncture at any location on a given dermatome would induce similar effects. Consequently, a set or group of points that pertain to a dermatome would have analogous indications depending on their underlying somatic–visceral connection, which would correspond with a neurobiologically derived effect.10 24 We have termed this the transverse distribution effect (TDE). On this basis, a quasiempirical experiment was conducted to determine which effects are observed in real settings. MATERIALS AND METHODS
The points in each of the trunk dermatomes were accurately identified and enumerated according to clear topographical criteria obtained through a comparison of data from two anatomical acupuncture atlases: one from Shandong Medical College25 and another from Jean Bossy, a renowned neuroanatomist from the University of Montpellier.23 The set of points for each dermatome was tabulated for data collection. In addition to the Chinese atlas, two authoritative books on acupuncture were consulted, which were supported by the Acupuncture Institute at the Academy of Traditional Chinese Medicine of Beijing and the Colleges of Traditional Chinese Medicine in Shanghai and Nanking.22 26 A comprehensive collection of indications and potential clinical effects were obtained for each of the points associated with the 22 trunk dermatomes (T1–S5) and were grouped into 22 tables. The table for each dermatome contained a dermatome identification number, a list of points, a comprehensive set of indications for each point, two notation columns for indications of VDE or TDE, a subtotal column and a row total. The clinical indications for each point were differentiated into the two mutually exclusive categories discussed below.
A cognitive quasiexperiment
VDE or ‘meridian pattern’
We used a simple cognitive strategy based on information from traditional Chinese medicine (TCM) sources to assess the classical postulates and the neuroanatomical correlates of acupuncture. Our objective was to
(1) The indication for any point exhibited VDE features when it was unique, or at least very different from the indications for the other points on the dermatome. (2) The indication of any point
Sánchez-Araujo M, et al. Acupunct Med 2014;32:62–69. doi:10.1136/acupmed-2013-010352
63
Original paper demonstrated affinity with its meridian clinical function or corresponded with symptoms or signs that were systemic in nature. TDE or ‘horizontal pattern’
Clinical indications, such as symptoms or signs that were local or regional in nature, represented a transverse effect that was associated with underlying neurobiology (the neural somatic–visceral substrate). Assumptions
The assumed reference value was initially 50%, which indicated the predominance of one effect over the other. However, after observing that the proportions between both categories often exceeded 60% in pilot samples, 60% was adopted as the reference value. For each point: (1) a predominance of the VDE that exceeded 60% was assumed to be consistent with TCA postulates; and (2) a preponderance of the TDE that surpassed 60% was assumed to be compatible with the neurobiological perspective. For each dermatome: (1) a majority of VDE indications that exceeded 60% of its points would endorse the TCM model; and (2) a predominance of TDE indications that exceeded 60% of the points of a dermatome would validate the neurobiological perspective. To facilitate the classification of the effects and simplify the visual appraisal process, indications that exhibited VDE features were recorded in bold in tables. Table 1 illustrates a typical table and the visualisation procedure that was used to distinguish between the nature of each indication and their respective points, using chi square test (the remaining tables can be seen on the web-only supplement). RESULTS In all, 22 dermatomes accommodated 148 points with 809 indications, of which 189 indications (23.4%) exhibited VDE features, whereas 620 (76.6%) exhibited TDE features. DISCUSSION A TDE/VDE ratio of approximately 3 : 1 was observed. The clinical indications for the points of any dermatome on the torso were similar, regardless of their meridians, which suggests that most of the indications for trunk points involve a ‘horizontal pattern’ due to their neurobiological nature. Therefore, the null hypothesis can be reasonably rejected. Trunk point effects depend on the overlapping distribution of sensorimotor and autonomic visceral innervations that originate from the segmental architecture of the body (see tables 2 and anatomical atlases 27 28). Therefore, our results suggest that the most significant factor for the clinical properties of each acupuncture point, in this context, could be the location of the point on a trunk dermatome. The repetition of indications for the set of points found on the dermatomes of the torso may be due to
64
the segmental array of the trunk, which functions as a whole. Therefore, needling the dermatome at any location or acupuncture point will induce a global response. Because needling impacts the singular structure of the peripheral, autonomic and central nervous systems,27 28 the non-specific healing potential of the body can be modulated by activating inbuilt selfregulating processes through neural, neurochemical, neuroendocrine and neuroimmune mechanisms29–34 whose integration occurs at the solitary tract nucleus and the medulla.35 36 Our results can elucidate certain ‘research paradoxes’ of acupuncture, such as the alleged specificity of points, which is not supported by neurobiology. In addition, our results can explain the inconsistency and non-specific behaviour of several distinctive points, such as the Back Shu points and the Front Mu points, regarding their respective Zhang-Fu.37 Curiously, our data show that their indications are indistinguishable from those of other nearby points. These points and the Head’s areas share the same behaviour based on the body’s neurobiological structure, as suggested by Western researchers.38 39 The interconnections and the diversity of responses induced by peripheral sensory stimulation (PSS) and the non-specific effects of this procedure may be too complex to be fully elucidated in biomedical experimentation models, which are influenced by ethics and by technical and methodological limitations.
In the footsteps of shamans
Ancient Chinese Wu healers could have derived the segmental (metameric) architecture of the body through a lengthy and disciplined observation and deduction process. Earlier doctors, in a shamanic context, used bloodletting to ‘placate ancestors and remove demons’40–42 but ultimately turned to punctures as an instrument. Through trial and error using a binomial characterisation of observed outcomes as a yang/yin method, Wu healers learned to pragmatically take advantage of innate on/off phenomena. Using PSS, they could elicit central nervous system (CNS) interneuron activation/inhibition ‘deciphered’ as yang/ yin responses on suitable medullar segments.43 44 Chinese philosophers and scholars created the ‘Channels/Meridians theory’, with its inherent shortcomings, using a heuristic process and their sociohistorical backgrounds to explain such phenomena. The first part of the process could be referred to as the discovery of early ‘protoscience’, that is, a set of beliefs or theories that are aimed at establishing its legitimacy.45 46 In contrast, the second part corresponded with a complex metaphysical construct was a mixture of empirical observations and heuristic reasoning, which negatively impacts current acupuncture clinical research.18–21 47–53
Sánchez-Araujo M, et al. Acupunct Med 2014;32:62–69. doi:10.1136/acupmed-2013-010352
Original paper Table 1
Indications of acupuncture points of dermatome T2 and L1
Acupuncture points
Chinese term
Dermatome T2 LU1 SP20 ST15 KI25 CV19 BL12 BL41 SI9 SI10 SI12
Zhongfu Zhourong Wuyi Shencang Zigong Fengmen Fufen Jianzhen Naoshu Bingfeng
SI13 Total % Dermatome L1 CV2
Indications Asthma, cough, chest pain, lung congestion, shoulder pain Cough, chest and hypochondria congestion Asthma, cough, chest congestion and pain, mastitis Asthma, cough, chest pain Asthma, cough, chest pain Cold/flu, cough, fever, headache, stiff neck, upper back pain Neck, dorsal and shoulder rigidness, arm numbness Omalgia, pain and motor dysfunction of upper limb Shoulder pain and upper arm pain Cough, chest pain, hypochondrial distension, scapular-brachial pain, numbness of the upper limb, arm weakness Weakness in upper arm, and itching in shoulder and arm
Quyuan
Qugu
GV5
Xuanshu
ST30 SP12
Qichong Chongmen
SP13 KI11 GB29 LR12 BL23
Fuche Henggu Juliao Jimai Shenshu
Spermatorrhoea, impotence, leucorrhoea, irregular menstruation, dysmenorrhoea, pelvic inflammation, hernia, incontinence, urinary retention, diarrhoea, enteritis with indigestion, back pain and stiffness Pain of external genitalia, swelling of external genitalia, hernia, irregular menstruation, urogenital diseases Abdominal pain, hernia, urinary retention, orchitis, epididymitis, endometritis Abdominal pain, hernia, urinary retention, painful haemorrhoids, dysuria, orchitis, spermatitis, endometritis Abdominal pain, hernia, appendicitis, constipation, splenomegaly External genital pain, spermatorrhoea, dysuria, enuresis, impotence, urinary retention, hernia Back pain, pain and/or paralysis of lower limbs, hip arthritis External genital pain, hernias, uterine prolapse, hypogastric pain, inner thigh pain Kidney Shu point. Blurred vision, deafness, oedema, enuresis, impotence, nephritis, tinnitus, chronic diarrhoea, irregular menstruation, leucorrhoea, low back pain, spermatorrhoea, weakness of the knee
Total % Words in bold indicate vertical distribution effect (VDE). TDE, transverse distribution effect. **p
