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ON EMBRYONAL TRACES IN ACUPUNCTURE ⊗⊗⊗⊗ Francisco ABAD-ALEGRÍA, M.D., Ph.D. and Carlos POMARÓN, M.D., Ph.D.

© GIAZ – Zaragoza University (Spain), 2006. SUMMARY Our purpose is a trial to systematize the relation of acupuncture active areas and its corresponding organ of action, from an embryonal perspective. On the basis of well accepted data on acupuncture points relative to their effect upon viscerae, drawings were done in adult and its corresponding embryo steps, until the five weeks of conceptional age. We represented the point´s cloud on surface for each organ studied. We found that for viscerae, the main location of points proceeds from a common location in embryo. We found also distal zones in the limbs, which are complementary in action to precedent areas. Those areas are narrow and corresponding to the same metameric levels than the viscerae implied. So, in the control of organs by acupuncture, some common embryonal origin is clear. Complementary areas of action may be considered as less specific additional control. We discuss the ways in which such findings may be confirmed by experimental designs.

KEY WORDS Acupoints. Acupuncture and sensorial control. Acupuncture and visceral control. Autonomic control. Embryonal references for acupoints. Embryology. Metameric organization and acupuncture.

INTRODUCTION

Reflections on how some cardiac function values can be modified by puncture in areas as distant from the organ concerned as the forearm, produced an anatomically coherent image, when the treatment points most commonly used in cardiac pathology and their equivalence in the embryo were represented. This led us to consider that the relation between the viscera and adjacent areas in embryonal phases is quite probable in cases other than that of the heart.

There are few bibliographical data available on the subject. Zhan and Zhu 1 demonstrated a fixed relation between the location of acupoints, channels and dermatomes, regardless of sex and body size. Patole-Lissac 2 goes into further depth in the search for a connection between embryology and acupuncture. He finds that the Governor vessel and Conception vessel channels apply, respectively, to the ectodermic and endodermic closing lines, converging in a cephalic pole (oral cavity, incisor area) and a caudal pole (anus). Finally, Milani 3 studies the possible embryonal genesis of the Governor vessel and Bladder channel, which run through the back by the medial and paramedial line. The author finds metameric correspondence in over 80 % of the points of these channels and, moreover, points out that the location of governor vessel points is exactly on the ectodermic closing line, while those that are located on the two

⊗ For references, please use: Abad-Alegría F. and Pomarón C. On embryonal traces in acupuncture. GIAZ- Zaragoza University (Spain), 2006. http://www.unizar.es/giaz/

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bladder vessel branches are situated on the somitic structures, on the medial limit (medial branch of the channel) and the limit of the division of the tonic and kinetic axial somitic musculature (lateral branch of the channel).

In this paper, within the framework of a broader future project, we propose to study the possible relation between the heart, stomach and genito-urinary system and adjacent locations, in the early embryonic life, by means of the therapeutic points that are used in these organs.

METHOD

Acupoints have been represented on the basis of traditional anatomical references 4,5, taking the points that are usually used in treatment for the heart, stomach and genito-urinary system, as listed in Ross’s list 6 and corrected subsequently in two further therapeutic treatises of recognized prestige 7,8. The corresponding data are reflected in table I.

Table I

Commonly accepted points active upon heart LU 9 HT 5, 6, 7, 8, 9 LI 5 PC 2, 3, 4, 5, 6, 7, 8 ST 40 BL 15, 40 CV 12, 14, 15, 17 KI 25, 27 Commonly accepted points active upon stomach BL 18, 19 ST 19, 20, 21, 22, 23, 24, 25, 34, 36 CV 12, 13, 14, 15, 16, 17 Curious points 19, 20, 21, 22, 23, 24, 25, 34, 36 Commonly accepted points active upon genitourinary system ST 29, 30, 36, 39, 40 KI 1, 2, 3, 4, 10, 14 BL 22, 23, 28, 31, 32, 33, 34, 54 CV 1, 2, 3, 4, 5, 6

Finally, the anatomic representations appear in inverse order, from the adult to the 5 and 4 week-old embryo 9,10, which can be observed as a whole in figures 1 to 3. In such images, the cloud of acupoints involved, were plotted as a solid surface, in adult (A), embryo 5 weeks old (B, lateral –l- frontal –f- and dorsal –d- aspects) and embryo 4 weeks old (C, lateral aspect).

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RESULTS

Fig. 1 Heart

Fig. 2 Stomach

Fig. 3 Genito-urinary

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RESULTS

On appraisal of the graphic representations referred to above, we find that the three organic structures under consideration accumulate points of acupunctural action mainly in three positions: a compact mass, embryologically enveloping the structure considered and belonging to the same level, a narrow area of variable length located on the back of the organism and clusters of active points in the areas applying to the distal development of the four limbs. Moreover the presence of point 20 of the Governor vessel is added to this. Thus, a triple schema of acupunctural control of visceral functions appears: by embryonal level points that are common to the organ involved; by points located on dorsal levels, which are widely dispersed and situated mainly between the metameric levels which in the adult would be equivalent to segment T1-L3, and by points situated on the extremities, in areas applying to segments C6-C8 and L4-S1 in the adult.

DISCUSSION

While reference to some kind of common locus is plausible in embryonal stages for dermic and visceral structures, it is difficult to ascertain the affinity that might exist between structures of different blastodermic nature, although in the ontogenesis process a sequence structured on metameric differentiation is followed (with regard to the organs concerned). It is known that the central and peripheral nervous system, the epithelia of the sensorial organs, the epidermis and appendages of the skin, the teeth, the hypophysis and mammary glands are generated from the ectoderm; that the connective tissue, the dermis and subcutaneous tissue, cartilages, bones and joints, smooth and striated muscle, blood and lymphatic cells, cardiovascular system, serous membranes, suprarenal cortex and kidneys, gonads and spleen are generated from the mesoderm, and that the intestinal epithelium and the respiratory tree, the tympanic cavity, the cartilaginous part of pharyngotympanic tube, the bladder, the urethra and the tonsil parenchyma, the thyroid and parathyroid, thymus, liver and pancreas come from the endoderm 9,10. In conclusion, since the different visceral structures studied originate from a blastodermic layer other than the skin, their innervation will be different; however, the dermic-subcutaneous tissue, heart and gonads share a common origin, while such affinity does not appear to exist between the peripheral structures, stomach and excretory system.

Another problem is the different innervation between dermatomes and organs. The sensitive somatic endings of a given metameric level apply to one or two rachid ganglions and involve rather broader medullar sensory afferents, while vegetative impulses are very diffuse, both in rachid ganglions and in myelomers 5. However, the study of the maps of active points on the organs under consideration provides curious data. The first is the clearly delimited dermatomic area applying to the organ in the limbs and the second the broad dermatomic area applying to the organ in the trunk. It is as though the representations of visceral impulses were correlated to the adjacent trunk walls and also to their dorsal portion, while possible additional modulation could originate in limb areas. Thus, the spinal convergence of somatic and visceral sensitive impulses, especially in Rexed’s medullar lamina VII, might explain

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how broad or more restricted somatic impulses can influence the organs 11. The broad dispersion of the visceral impulses would also explain how impulses on a given dermatome can simultaneously affect several organs, which is patent when the maps of the stimulus areas are studied. It is striking that the areas of apparent control or modulation that are common to the three visceral structures under consideration are located at the ends of the spinal axis, marking out a broad central area in which the segmental sympathetic branches lie, and that others are observed in the limbs with levels that are typical of parasympathetic innervation 11, which can hardly be a coincidence.

The embryogenic focus that arises from our observation, which involves a connection between structures that are different and distant but share a closely related embryonic origin in space, together with possible areas of modulation in the trunk and limbs, is difficult to approach experimentally. An initial method would be to demonstrate experimental modifications of visceral functions from stimuli on the corresponding points. The effects on some organs are quite simple to quantify but others are not suited to simply conceived experimental models. However, we do have some data, for the stomach 12,13, heart 14,15 and cardiopulmonary function. Embryonal experimentation is another possible means of approach, although it is naturally limited to animals. As a complement to these data, the findings provided by congenital malformations should be evaluated. In pure embryological experimentation, which is extraordinarily difficult, we find Xue’s work 17, in which the trophic effect of acupunctural stimulation in a peripheral area on its corresponding myeloradicular and segmental level appears to be demonstrated; any subsequent migration would thus be affected. Such an effect obviously involves broader levels than mere metameric innervation. A third way of evaluating the real entity of the thesis expounded in this study is neuroanatomical experimentation using marking methods, axonic retrograde degeneration or transport. In this sphere, the pioneering work of Ferré and Gonzalo 18 demonstrates the possibility of a remote effect in the rabbit, linking the algogenic stimulus in the hind leg with a sudomotor response in the auricular pavilion, by means of the perivascular nervous network. It is quite plausible to transpose these data to visceral levels. More recently, Chang et al. 19 study the sympathetic chain that enables the Zusanli effect (S36) on the intestine to be objectified, by means of neural and viral immunohistochemical marking systems, finding common afferences on medullar (Rexed’s laminae IV, V and VII), brainstem and diencephalic levels. The recently demonstrated 20 existence of sensitive afferences that are complementary to those that are usually accepted as posterior root afferences with anterior root entry, should be added to the above; this would enable rapid circuits towards lateral horn to be established, in addition to the already known transganglionary vegetative pathways 11.

Data 21,22 emphasising the basic role of neurovascular clusters of dermic and deep facial location and the surrounding connective structures, such as the seat of the acupoints, the microstructural peculiarities of which belong to the already accepted knowledge of acupuncture, must be added to the role of the perivascular nervous path in the periphery-organ 18 interaction complex. The main consequence is the fundamental role played by structures that are directly linked by a basically mesodermic origin in their interaction with ectodermic nervous migrations. One should recall in this regard that the most likely origin

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of acupuncture would seem to lie in phlebotomy, which was initially practiced in areas adjacent to the diseased structure; the remote effects were discovered subsequently, a long time before the bases of classical acupuncture 23 were established a little over 22 centuries ago.

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