Electrical impedance along connective tissue planes associated with acupuncture meridians

Background  

Acupuncture points and meridians are commonly believed to possess unique electrical properties. The experimental support for this claim is limited given the technical and methodological shortcomings of prior studies. Recent studies indicate a correspondence between acupuncture meridians and connective tissue planes. We hypothesized that segments of acupuncture meridians that are associated with loose connective tissue planes (between muscles or between muscle and bone) visible by ultrasound have greater electrical conductance (less electrical impedance) than non-meridian, parallel control segments.     

人体筋膜重建经线与经典经线走行路线对比

目的:探讨经络与人体筋膜重建经线的解剖学位置关系。方法:首先在数字人研究的基础上利用计算机三维重建人体全身的筋膜网状支架,并对人体肢体和躯干的肌间隙结缔组织进行标记和三维重建,构成与古代文献记载经络走行相似的串珠状连线,应用计算机三维图像处理软件结合数学分析方法,在重建的虚拟人体上对筋膜重建经线与经典经线体表走行路线进行对比研究。结果:人体筋膜重建经线与中医古代文献记载的经脉体表走行路线基本相似。结论:人体筋膜三维重建经线与中医经络线在形态上相似,两者之间存在密切的解剖学位置关系。     

数字人体下肢筋膜重建经线与经络线形态学相似性的计算机化研究

目的利用计算机自动标识与三维重建技术,探索人体下肢筋膜类间隙结缔组织与经络经线形态位置相似性的证据及规律。方法获取虚拟中国人男1号(VCH-M1)数据集,截取左腿区域,利用计算机软件,首先提取肌肉信号,完成去噪处理;然后通过边缘检测,求出肌肉轮廓点的凸包;最后完成对间隙结缔组织的标记,并对标记的间隙结缔组织利用3D-Doctor软件进行三维重建。结果通过对虚拟人体下肢间隙结缔组织计算机自动识别标记,并对标记的间隙结缔组织进行三维重建,得到了与传统中医经络图谱描述相似的重建虚拟经线。结论本实验结果说明,南方医科大学人体解剖学教研室和中山大学科学计算与计算机应用研究所合作开发的将虚拟人体数据集应用于经络研究的计算机工具,可对虚拟人体下肢间隙结缔组织进行自动识别标记,并三维重建出虚拟筋膜经线,在一定程度上避免了筋膜重建手工识别过程中产生的人为因素误差,对于研究人体筋膜类间隙结缔组织与经络是否存在形态位置相关性有重要意义。     

针灸经穴的数字解剖学研究

目的 探索人体经穴的解剖学构成和针灸疗法的机制。方法 在男、女图像数据集的基础上，通过图像分割和三维重建，构建了人体全身筋膜结缔组织的网状结构支架，与传统中医针灸疗法的刺激部位进行对比分析。结果 根据筋膜所处的解剖学部位可分为5类：1．真皮的网状层和乳头层致密结缔组织；2．皮下疏松结缔组织；3．肌间隔疏松结缔组织；4．神经血管束疏松结缔组织；5．内脏器官门及被膜疏松结缔组织。将构建的筋膜与中医针灸的刺激部位进行比较，数字人研究结果显示，中医针灸治疗的解剖学基础可能是分布于全身的筋膜结缔组织。结论 人体可能存在由结缔组织筋膜构成的维持机体内环境稳定的功能系统——自体监控系统。该系统可能是针灸疗法的解剖学基础。     

Is the Newly Described Interstitial Network the Anatomical Basis of Acupuncture Meridians? A Commentary

A network passing through interstitial tissues of the human body has been recently described. Despite its functional importance is yet unknown, we try to briefly summarize the known data and to interpret it from the viewpoint of Traditional Chinese medicine. We consider the peculiarities of the interstitium to be the morphological basis of at least some of the known phenomena along acupuncture meridians.     

Was acupuncture developed by Han Dynasty Chinese anatomists?

Anatomical dissection has begun to reveal striking similarities between gross anatomical structures and the system of nomenclature used in traditional Chinese acupuncture. This paper argues that acupuncture point nomenclature is rooted in systematic anatomical investigation of cadaveric specimens, and that acupuncture points and meridians are purposefully named to reflect observable physical form. Two types of evidence are compared: observations of physical structures based on anatomical dissection, and translation and analysis of original Chinese texts. Evidence is contextualized through in‐depth practical understanding of acupuncture. Points designated as 天 tian (heavenly/superior), 下 xia (below/inferior), 髎 liao (bone‐hole), 飛 fei (flying), 委 wei (bend), and 谿 xi (mountain stream/ravine) are investigated. These acupuncture point names: (a) specify position; (b) reflect function and/or form; (c) indicate homologous structures; (d) mark unusual structures; and/or (e) describe the physical appearance of a deep (dissected) structure by likening it to a homologous everyday object. Results raise intriguing possibilities for developing an understanding of acupuncture points and meridians firmly based in the material and functional anatomy of the human body. Such an understanding has the potential to open new fields of thought about functional anatomy. It also has implications for future investigations into the mechanisms of acupuncture, and gives some insights into the possible origins of this iconic area of Chinese medicine. Anat Rec, 299:643–659, 2016. © 2016 Wiley Periodicals, Inc.     

Connective tissue: A body-wide signaling network?

Unspecialized "loose" connective tissue forms an anatomical network throughout the body. This paper presents the hypothesis that, in addition, connective tissue functions as a body-wide mechanosensitive signaling network. Three categories of signals are discussed: electrical, cellular and tissue remodeling, each potentially responsive to mechanical forces over different time scales. It is proposed that these types of signals generate dynamic, evolving patterns that interact with one another. Such connective tissue signaling would be affected by changes in movement and posture, and may be altered in pathological conditions (e.g. local decreased mobility due to injury or pain). Connective tissue thus may function as a previously unrecognized whole body communication system. Since connective tissue is intimately associated with all other tissues (e.g. lung, intestine), connective tissue signaling may coherently influence (and be influenced by) the normal or pathological function of a wide variety of organ systems. Demonstrating the existence of a connective signaling network therefore may profoundly influence our understanding of health and disease.     

人体四肢经穴筋膜基础的医学影像学研究

目的:本研究尝试采用医学影像学方法,对人体四肢经穴的解剖结构加以观察,结合计算机三维重建技术,重点探索经络走行与筋膜分布密切相关的规律,为揭示经络的解剖学实质提供新的依据。方法:通过超声影像学观察、采用CT、MRI手段和把CT、MRI与三维重建技术相结合引进经络研究领域,为揭示经络与穴位的解剖学实质进行方法学上的创新性研究。结果:与传统中医记载的经络机理和走行线进行对比分析,发现有相似性。结论:中医经络的解剖学基础可能是分布于全身的筋膜结缔组织。     

Preliminary embryological study of the radiological concept of retroperitoneal interfascial planes: what are the interfascial planes?

Purpose

Recently, the radiological concept of retroperitoneal interfascial planes has been widely accepted to explain the extension of retroperitoneal pathologies. This study aimed to explore embryologically based corroborative evidence, which remains to be elucidated, for this concept.

Methods

Using serial or semi-serial transverse sections from 29 human fetuses at the 5th–25th week of fetal age, we microscopically observed the development of the retroperitoneal fasciae and other structures in the retroperitoneal connective tissue. A hypothesis for the formation of the interfascial planes was generated from the developmental study and analysis of retroperitoneal fasciae in computed tomography images from 224 patients.

Results

Whereas the loose connective tissue was uniformly distributed in the retroperitoneum by the 9th week, the primitive renal and transversalis fasciae appeared at the 10th–12th week, as previous research has noted. By the 23rd week, the renal fascia, transversalis fascia, and primitive adipose tissue of the flank pad emerged. In addition, the primitive lateroconal fascia, which runs parallel to and close to the posterior renal fascia, emerged between the renal fascia and the adipose tissue of the flank pad. Conversely, pre-existing loose connective tissue was sandwiched between the opposing fasciae and was compressed and narrowed by the developing organs and fatty tissues.

Conclusion

Through this developmental study, we provided the hypothesis that the compressed loose connective tissue and both opposed fasciae compose the interfascial planes. Analysis of the thickened retroperitoneal fasciae in computed tomography images supported this hypothesis. Further developmental or histological studies are required to verify our hypothesis.     

Varying Assay Geometry to Emulate Connective Tissue Planes in an In Vitro Model of Acupuncture Needling

During traditional acupuncture, fine needles are inserted subcutaneously and rotated, which causes loose fascial tissue to wind around the needle. This coupling is stronger at acupuncture points, which tend to fall above intermuscular fascial planes, than control points, which lay above skeletal muscle. These different anatomical constraints may affect the mechanical coupling. Fascia at acupuncture points is bounded on two sides by skeletal muscle, but at control points is essentially unbounded. These differences were approximated in simple in vitro models. To emulate the narrower boundary within the intermuscular plane, type I collagen was cast in circular gels of different radii. To model the channel‐like nature of these planes, collagen was cast in elliptical gels with major and minor axes matching the large and small circular gels, respectively, and in planar gels constrained on two sides. Acupuncture needles were inserted into the gels and rotated via a computer‐controlled motor while capturing the evolution of fiber alignment under cross‐polarization. Small circular gels aligned faster, but failed earlier than large circular gels. Rotation in elliptical and planar gels generated more alignment‐per‐revolution than circular gels. Planar gels were particularly resistant to failure. Fiber alignment in circular gels was isotropic, but was stronger in the direction of the minor axis in elliptical and planar gels. In fibroblast‐populated gels, cells followed the alignment of the collagen fibers, and also became denser in regions of stronger alignment. These results suggest that the anatomy at acupuncture points provides unique boundaries that accentuate the mechanical response to needle manipulation. Anat Rec, 2011. © 2010 Wiley‐Liss, Inc.     

Pulmonary oedema at necropsy: a combined pathological and radiological method of study.

Fixation of lungs at necropsy by inflation with formaldehyde vapour was used in a combined radiological and pathological study of pulmonary oedema. Pulmonary oedema was found in 79% of lungs examined. The earliest phases affect the interstitial tissue with oedematous connective tissue planes and distension of pulmonary lymphatics. These changes may be associated with reduction in the compliance of the lung. Alveolar filling is a late stage in the accumulation of oedema fluid in the lungs.     

针刺过程中的针体受力分布

背景：针刺过程针体受力分布,不仅取决于不同穴位处组织结构,更受行针手法的影响。 目的：就一般穴位所共有的表皮、真皮和皮下结缔组织的组织结构和力学性质,分提插和捻转法进行针体受力研究。 方法：以提插法和捻转法为前提,以表皮组织、真皮组织和皮下结缔组织为区域对象,在前期研究的基础上建立类固体和软物质两种生物力学模型,对行针过程中的针体阻力分布进行分析,以得出定性化的结论。 结果与结论：表皮无血管无神经,致密而坚硬,可以看作类固体;真皮及皮下结缔组织中血管神经等分布广泛,疏松而柔软,是典型的软物质。提插行针过程中非“得气”时阻力主要来自表皮部分,在“得气”状况下阻力应该来自表皮和结缔组织中的纤维细胞共同作用,对针体而言,进入皮肤的所有针体部分都是受力点,只是靠近针尖部分的针体受力稍大一些,但是随着提插操作,进入皮肤的针体长度不断在发生变化。捻转法行针的主要阻力来自胶原纤维和弹性纤维的缠绕,对针体而言受力点主要集中在针尖及附近部位。     

Immune Response to Connective Tissue Components of the Basement Membrane

The immune response to connective tissue components of basement membrane (type IV collagen and laminin) and to interstitial collagen (type I) has been examined in human and murine systems. We also examined the role that immunologic sensitization to autologous connective tissue components might play in inducing an inflammatory response resulting in pathologic sequelae. Mice receiving a single subcutaneous injection of 5 μg type IV or type I murine collagens, or murine laminin in complete Freund's adjuvant mount a delayed-type hyper-sensitivity response characterized by a mononuclear cell infiltrate when challenged in the footpad with the sensitizing antigen. Cell-mediated immunity to these connective tissue antigens can be transferred to normal syngeneic mice with sensitized T-lymphocytes. In addition, repeated immunizations with these homologous connective tissue components elicit antibody responses in mice. Our data demonstrate the immunogenic nature of types IV and I collagen, and of laminin in a syngeneic murine model. We have demonstrated autoantibodies to the basement membrane and interstitial collagens in the sera of patients with scleroderma (systemic sclerosis); ELISA ratios correlate directly with the extent of pulmonary fibrosis in these patients. Anti-type IV collagen autoantibodies were found to be primarily IgM and anti-type I collagen antibodies, primarily IgG. An antibody response to autologous connective tissue antigens could lead to complement activation, immune complex formation, and deposition of the complexes along vascular endothelium with recruitment of blood monocytes in situ, mirroring the early scleroderma lesion (perivascular mononuclear cell infiltrates). In vitro we examined the role of human peripheral blood mononuclear cells in the activation of fibroblasts. Adherent human blood monocytes release mediators which stimulate fibroblast proliferation and collagen deposition. A model is presented for the induction of immunity to autologous connective tissue components, leading to mononuclear cell inflammation, fibroblast activation and fibrosis. Selective immunity to basement membrane collagens may influence the clinical expression of diffuse connective tissue syndromes such as scleroderma (systemic sclerosis).     

Acupoints [corrected] and meridians: a histochemical study

The aim of this study was to elucidate the relationship between the structural specificities of acupoints and meridians as well as their clinical effects. We processed 356 specimens, 287 of which from 48 adult and 2 newborn cadavers and the remaining 69 from living patients; samples were taken at three different levels: (1) beneath acupoints; (2) between meridians; (3) at a distance from meridians. We performed seven different staining to show the distribution of collagen fibers, reticular fibers, mucopolysaccharides (MPS), connective tissue, nerve threads, and blood vessels in specimens obtained from different areas. We found that some structural and biochemical discrepancies associated with acupoints and meridians including: (1) mucopolysaccharides (MPS), in particular acid MPS; (2) collagen fibers; (3) nerve endings. We discussed these findings from an anatomo-clinical point of view.     

Development and Evaluation of a Novel Four-Electrode Device System for Monitoring Skin Impedance

Qi, meridians, and acupoints are important issues in Chinese medicine. One of the theories claims that acupuncture points and meridians have unique electrical properties. The associations between acupuncture points or meridians and special electrical properties are still under debate. In the current study, we introduced and explained a device for this kind of research and evaluated the reliability of this device as well as effects of pressure, cleaning the skin by alcohol and exfoliation on electrical skin measurements. Fifteen subjects (10 female, 5 male) were recruited to participate in the study. An impedance meter based on the four-electrode technique was designed and fabricated specifically for this study. The effects of pressure, cleaning of the skin by alcohol, and exfoliation on electrical skin impedance were evaluated separately. The device repeatability was also evaluated 30 times in a 30 minutes period. Scale weight up to 200 grams, cleaning the skin with alcohol, and exfoliation didn''t affect the performance of this device. The device performance didn''t change significantly during the 30 minutes measurement either. The new system we evaluated can be a reliable tool for researches on electrical skin impedance in acupuncture, as its performance is fairly stable even in the presence of various confounding factors such as various pressures on the probe, cleaning the skin with alcohol and exfoliation.     

The deep fascia and retinacula of the equine forelimb – structure and innervation

Recent advances in human fascia research have shed new light on the role of the fascial network in movement perception and coordination, transmission of muscle force, and integrative function in body biomechanics. Evolutionary adaptations of equine musculoskeletal apparatus that assure effective terrestrial locomotion are employed in equestrianism, resulting in the wide variety of movements in performing horses, from sophisticated dressage to jumping and high‐speed racing. The high importance of horse motion efficiency in the present‐day equine industry indicates the significance of scientific knowledge of the structure and physiology of equine fasciae. In this study, we investigated the structure and innervation of the deep fascia of the equine forelimb by means of anatomical dissection, histology and immunohistochemistry. Macroscopically, the deep fascia appears as a dense, glossy and whitish lamina of connective tissue continuous with its fibrous reinforcements represented by extensor and flexor retinacula. According to the results of our histological examination, the general structure of the equine forelimb fascia corresponds to the characteristics of the human deep fasciae of the limbs. Although we did find specific features in all sample types, the general composition of all examined fascial tissues follows roughly the same scheme. It is composed of dense, closely packed collagen fibers organized in layers of thick fibrous bundles with sparse elastic fibers. This compact tissue is covered from both internal and external sides by loosely woven laminae of areolar connective tissue where elastic fibers are mixed with collagen. Numerous blood vessels running within the loose connective tissue contribute to the formation of regular vascular network throughout the compact layer of the deep fascia and retinacula. We found nerve fibers of different calibers in all samples analyzed. The fibers are numerous in the areolar connective tissue and near the blood vessels but scarce in the compact layers of collagen. We did not observe any Ruffini, Pacini or Golgi‐Mazzoni corpuscles. In conclusion, the multilayered composition of compact bundles of collagen, sparse elastic fibers in the deep fascia and continuous transition into retinacula probably facilitate resistance to gravitational forces and volume changes during muscle contraction as well as transmission of muscle force during movement. However, further research focused on innervation is needed to clarify whether the deep fascia of the equine forelimb plays a role in proprioception and movement coordination.     

Anatomical aspects of postintubational subglottic stenosis

The subglottic regions of 54 human adult male and female larynges were studied with regard to anatomical aspects of postintubational stenosis. Fourteen specimens were impregnated with curable polymers and cut into 600–800 μm sections along different planes. Forty formalin-fixed hemilarynges were dissected. Measurements of the upper cricoid lamina and the thickness of the endocricoid soft tissues were taken for statistical analysis. Immediately beneath the glottis, the upper part of the cricoid lamina consists of two lateral plates with an average angle of 110°. Distally, the cricoid adopts a more and more rounded lumen. At the level of the cricothyroid joint, the definite airway lumen is always laterally narrowed by a prominent thickening of the endocricoid soft tissue. Large amounts of loose connective tissue facilitate the development of edema in case of injury in this region. Dorsally, the submucous stratum is smaller and consists mainly of dense connective tissue. The blood vessels are fixed to the cricoid perichondrium by collagenous fibers. Any pressure applied from the airway lumen will force the vessels against the nonresilient cartilage, resulting in occlusion and ischemia. These pathophysiologic mechanisms are important for the development of early laryngeal damage during endotracheal intubation, possibly resulting in posterior stenosis due to scarring later on. © 1995 WiIey-Liss, Inc.     

Active fascial contractility: Fascia may be able to contract in a smooth muscle-like manner and thereby influence musculoskeletal dynamics

Dense connective tissue sheets, commonly known as fascia, play an important role as force transmitters in human posture and movement regulation. Fascia is usually seen as having a passive role, transmitting mechanical tension which is generated by muscle activity or external forces. However, there is some evidence to suggest that fascia may be able to actively contract in a smooth muscle-like manner and consequently influence musculoskeletal dynamics. General support for this hypothesis came with the discovery of contractile cells in fascia, from theoretical reflections on the biological advantages of such a capacity, and from the existence of pathological fascial contractures. Further evidence to support this hypothesis is offered by in vitro studies with fascia which have been reported in the literature: the biomechanical demonstration of an autonomous contraction of the human lumbar fascia, and the pharmacological induction of temporary contractions in normal fascia from rats. If verified by future research, the existence of an active fascial contractility could have interesting implications for the understanding of musculoskeletal pathologies with an increased or decreased myofascial tonus. It may also offer new insights and a deeper understanding of treatments directed at fascia, such as manual myofascial release therapies or acupuncture. Further research to test this hypothesis is suggested.