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Interactive Medical Acupuncture Anatomy

• An anatomically precise presentation of acupuncture points
and channels
• Complete, 3-dimensional, computer generated images of the
human body
• Permits visualization of the underlying anatomical structures that
acupuncture needles stimulate
• Provides the critical information needed for safer and more
productive acupuncture practice
• Thousands of references supply much-needed evidential support
of acupuncture science and practice
• Provides scientific validation for the effects of acupuncture on
visceral, immune, circulatory and other bodily functions
• National Library of Medicine Visible Human Project images
provided on the DVD provide 3-dimensional, rotatable,
dissectible, Quick Time Virtual Reality images for identification of
acupuncture points and their neural and vascular relationships.

Narda G. Robinson, DO, DVM, MS, FAAMA

Interactive Medical Acupuncture Anataomy is a clear and practical
guide to the practice of medical acupuncture focused on the interrelationship of structure and function.
The 1,051 images in this text delineate the relationships of acupuncture points with nearby anatomy that help to explain the physiological
effects of point activation. This highly detailed investigation of the
neuroanatomical basis and evidential support of acupuncture deeply
informs its clinical application, making this work a “must have” for
your medical practice library.

Interactive Medical
Acupuncture Anatomy
Narda G. Robinson, DO, DVM, MS, FAAMA

3D Interactive Computer Generated Images with Rotate, Discect & Zoom Capabilities DVD Included!

Interactive Medical
Acupuncture Anatomy
Narda G. Robinson, DO, DVM, MS, FAAMA

Teton NewMedia
Teton NewMedia
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© 2016 by Tenton NewMedia
Exclusive worldwide distribution by CRC Press an imprint of Taylor & Francis Group, an Informa business
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data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made.
The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them
and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical,
scientific or health-care professionals and is provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of
the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult
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Awakening to acupuncture as neuromodulation permanently transformed my teaching and practice. In contrast to the early days of
my acupuncture education, when I hungrily consumed and dutifully assimilated the belief systems required to adopt an energy-based
viewpoint, I am no longer willing, nor ready, nor able to accept that acupuncture works through mystical, spiritual processes.
That is, I, like so many others, was taught that needling stirred an unseen electrical force (“Qi”) along invisible lines called “meridians”.
When I learned, through mentors such as Deke Kendall, OMD, PhD, that the notion of acupuncture as “energy medicine” possessed
neither a scientific nor historically accurate basis, I was shocked. How could this entire domain of acupuncture energetics result from
a mistranslation of the Chinese word “Qi” in the early 20th century into “energy”, “for lack of a better word”?
After reviewing the evidence for and against an energy-based mindset in acupuncture, I found no other rational explanation for its
effects other than through, primarily, the nervous system. Intellectual honesty forced me to let go of belief systems entirely and instead
teach only truth based on science and evidence. Intellectual curiosity led me to find far more beauty and wonder in the anatomy of
acupuncture than even the most elaborate fairy tales ever could.
What I discovered inspires me endlessly. The modern science of acupuncture replaces the myths and metaphors of yesteryear with
detectable mechanisms and measurable outcomes. The neurovascular channels beneath the skin allow us to both literally and figuratively “connect the dots”, i.e., acupuncture points. The anatomical structures assembled at each site tell of their function and thus
their effects.
Acupuncture then becomes more accessible, predictable, and sensible. Knowing which nerve pathways to target and why constitutes the cornerstone of noninvasive neuromodulation with acupuncture. Starting at the acupuncture point, one can follow a nerve’s
centripetal course to the spinal cord, autonomic centers, and the brain. The nervous system’s responses to scientific medical
acupuncture and related techniques thereby become clear, as fact replaces fiction.

To my parents, Evelyn and Leonard, who brought me from formless to form, whose love and support gave me the strength and courage
to find my own path.
To my brother, Larry, who inspired me to become not only a physician, but an osteopathic physician.
To the ancient Chinese, whose system of point and channels provides me endless amazement.
To Joseph M. Helms, MD, FAAMA, who flung the door to a life filled with discovery and meaning open wide.
To Deke Kendall, OMD, PhD, who caused me to question and rethink what I’d learned, allowing me to find deep fulfillment in a system
of knowledge based on indisputable facts and realism.
To Joseph Wong, MD, whose clear message concerning the simple truths of neuroanatomical acupuncture stay with me to this day.
To Dave Mishlove, my life partner, who further cultivated in me a taste for authenticity, a penchant for integrity, and the strength to
stand for truth amid staunch opposition.

This book and CD resulted from the extraordinary talents and commitment of several individuals, including:
The Visible Productions team, with special thanks to Stew Crawford who provided the computer programming for the CD and Amanda
S. Almon, the medical illustrator and computer animator, who patiently worked with me to place the points and lines on the Visible
Human anatomy images.
The folks at Teton NewMedia and Fiftysix Forty Design, including Sue Haun, creative director, whose expertise provided a book that is
functionally and aesthetically pleasing, as well as Mike Albiniak, production manager, who worked with the project from start to finish
to produce the internal layout. Special thanks as well to John Spahr, principal owner of Teton NewMedia, and Carroll Cann, the editor
in chief, who saw value in the project and brought it to fruition.

Table of Contents
Section 1:: The Science of Acupuncture Neuromodulation
Chapter 1:: From Metaphors to Modern Medicine................................................................................................................................ 3
Chapter 2:: Function Follows Form......................................................................................................................................................... 13

Section 2:: Acupuncture Points and Channels
Chapter 3:: Introducing the Points and Channels................................................................................................................................35
Chapter 4:: Locating Points on the Body............................................................................................................................................... 37
Chapter 5:: Acupuncture Safety.............................................................................................................................................................45

Section 3:: Twelve Paired Channels
Channel 1:: The Lung (LU)........................................................................................................................................................................ 51
Channel 2:: The Large Intestine (LI)....................................................................................................................................................... 73
Channel 3:: The Stomach (ST)...............................................................................................................................................................119
Channel 4:: The Spleen (SP).................................................................................................................................................................. 225
Channel 5:: The Heart (HT).................................................................................................................................................................... 281
Channel 6:: The Small Intestine (SI).....................................................................................................................................................309
Channel 7:: The Bladder (BL)................................................................................................................................................................ 359
Channel 8:: The Kidney (KI)................................................................................................................................................................... 537
Channel 9:: The Pericardium (PC)........................................................................................................................................................ 627
Channel 10:: The Triple Heater (TH)..................................................................................................................................................... 665
Channel 11:: The Gallbladder (GB)....................................................................................................................................................... 747
Channel 12:: The Liver (LR)....................................................................................................................................................................899

Section 4:: The Eight “Singular Vessels,” “Extraordinary Vessels,” or “Curious Meridians”
Channel 13:: The Conception Vessel (CV)........................................................................................................................................... 951
Channel 14:: The Governor Vessel (GV)............................................................................................................................................. 1039

Index....................................................................................................................................................................................................... 1156

Section 1::
The Science of Acupuncture Neuromodulation

Chapter 1::

From Metaphors to Modern Medicine

Chapter Highlights

To know acupuncture, know anatomy.
To know neuromodulation, know neuroanatomy.
Neuromodulation explains acupuncture.
Neither mysterious nor nebulous, the wisdom of acupuncture
unfolds clearly and readily through the study of anatomy – specifically, neuroanatomy. Acupuncture anatomy eliminates the need
to substitute science with myths and metaphors. Scientific investigations have identified and verified many of the mechanisms by
which acupuncture and related techniques benefit the central,
peripheral, and autonomic nervous systems. Needling results
in neuromodulation. Neuromodulation interlocks the events
that take place from neuron to brain and back again – no belief
systems required.

What Is “Neuromodulation”?

Neuromodulation is a process of engagement with neural structures that helps to normalize nerve function. It reduces excessive
firing of nociceptive pathways and improves the ability of endogenous analgesic mechanisms to counteract spinal cord windup
and dampen the perception of pain. Effective neuromodulation
begins with proper point selection. Neuroanatomically specific
acupuncture protocols pinpoint a patient’s presenting problem
according to where and how it is altering function along the
neuraxis and its peripheral as well as autonomic extensions.
By considering the myriad manners in which neural discord
mediates and perpetuates aberrant signals, a scientifically
based medical acupuncturist outlines neural avenues (i.e.,
acupuncture points and channels) as well as stimulation methods
(e.g., needling alone or the introduction of electrical or laser
stimulation) by means of which to restore harmony and homeostasis.113,114,115,116,117,118,119 That is, neuromodulation impacts sensory,
motor, and autonomic activity based on the nerves targeted.
The modality and settings selected (e.g., intensity, frequency,
and mode of stimulation) further color the patient’s physiologic
response. The input flows throughout the matrix of the nervous
system, from peripheral to spinal nerves, and spinal cord to brain.
Brain sites affected include, but are not limited to, the reticular
activating system, central autonomic network, the limbic system,
brainstem, and the diffuse noradrenergic projection system.135,142,143
Neuromodulation began long ago with acupuncture and electrotherapy;120,121 modern medicine has created more direct interventions through implanted units. Whether they prove more
effective, cost-saving, and safer than manual acupuncture (MA),
electroacupuncture (EA), or laser acupuncture (LA) requires
research comparing techniques head to head.
As with acupuncture, the aforementioned implanted stimulators
have benefited patients with pain,122 epilepsy, neurogenic bladder
secondary to spinal cord injury, fecal incontinence, constipation, erectile dysfunction, interstitial cystitis, and lower urinary
tract dysfunction (incontinence, overactive bladder, urinary
retention).123 Additional conditions include chronic, refractory
angina pectoris,136 migraine,137,138 spinal cord injury,139 and complex
pain problems.140
4 Section 1: Introduction to Interactive Acupuncture Anatomy

Curiously, those who utilize implanted stimulators often insert
them along similar nerve pathways as acupuncturists address.
For example, implant-driven nerve stimulation for refractory
overactive bladder focuses on the posterior tibial nerve.124,144,145
Acupuncture treatments for urinary voiding dysfunction also
focus on the tibial nerve with points such as KI 3, KI 4, KI 5, and
SP 6.125
Vagal nerve stimulation (VNS) for seizure control offers another
example.126,127,128,129 Electrodes implanted in the cervical portion
of the vagus nerve interrupt or abolish experimentally induced
motor seizures.130 Acupuncturists may also choose points on the
face or head that speak to the vagus nerve through crosstalk with
the trigeminal nerve. Auricular acupuncture opens another door
to neuromodulating vagal function. Veterinarian acupuncturists
treating epilepsy in dogs may select ear points such as Shen Men,
a point shown to have value for seizures in rats as well.131,132,133
Auricular Shen Men falls into the zone supplied by the auricular
branch of the vagus nerve (cranial nerve X, or CN X).134 Thus,
whether through implanted electrodes or inserted acupuncture
needles, VNS modifies brain activity and can reduce seizure
activity in some cases.146

“What If I Prefer to Think of
Acupuncture as Moving Energy
Instead of Stimulating Nerves?
Does It Matter?”

Yes, it matters. Shifting the dialogue from metaphors and
metaphysics to meaningful mechanistic concepts requires a
thoroughly different premise. That is, a science-based medical
acupuncturist needs a modern medical education along with
instruction in myofascial palpation and non-invasive neuromodulation skills. Traditional Chinese Medical (TCM) schools
and energy-based physician acupuncture courses continue to
teach that acupuncture moves energy they call “Qi”. The latter
approach demands little verification but much belief. Even today,
after having sufficient opportunity to “get it right”, Traditional
Chinese Medicine (TCM), metaphor-based practitioners are still
struggling to validate their TCM diagnostic approach. In other
words, even experienced TCM acupuncturists cannot come to
agreement in their metaphoric analyses of patients in studies
after studies.147,148,149
Lacking tenable processes, a metaphor-based acupuncturist
has limited rational rationales to rely on when deciding on which
points to choose. Treating a headache of the “Liver Yang Rising”
or “Qi Disturbance” variety affords mostly abstract analysis of the
cause and effect. Although the liver often receives much of the
blame in causing TCM headaches, the physical liver usually has
little to do with producing head pain in most people. Other assessments involving disturbances in Qi, Yang, Yin, and Phlegm also
miss the mark by resorting to stand-ins, i.e., metaphors, in place
of the actual anatomic, physiologic, and pathologic problems.
As such, TCM point selection usually resorts to metaphorical
solutions rather than novel protocols based on the patient’s
actual pathology.150 Point selection relies more heavily on rote
memorization of empirical protocols that give the practitioner

minimal insight into why those protocols work from a biological
perspective. To illustrate the difference between a metaphoric
and scientific view of point effects, review the comparison in
Table 1-1.
In contrast, a science-based medical acupuncturist treating head
pain would, in practice, ordinarily strive to define the true cause,
location, and myofascial relationships to the headache. Even
if s/he defaults to a standard protocol for research or training
purposes, the mechanisms by which acupuncture affects patients
remain clear. To illustrate this, a group of Taiwanese researchers
assembled a group of migraine sufferers in order to compare the
value of acupuncture and a drug (topiramate) for prophylaxis
of headache in chronic migraineurs.151 Points selected for all
sixty-six participants were the same: BL 2, GB 20, Taiyang, and
Yintang. The rationale? “All of the selected acupoints were in
the distribution of trigeminal and cervical dermatomes related to
the trigeminal sensory pathway.” Simple. Again, according to the
authors, “It is assumed that a variable combination of peripheral
effects, spinal and supraspinal mechanisms, and cortical, psychological or “placebo” mechanisms contribute to the clinical effects
of acupuncture. Current theories suggest that migraine is a neurovascular disorder involving cortical spreading depression, neurogenic inflammation, and vasodilation. Sensitization and facilitation
of pain transmission in central trigeminal sensory pathways may
have a particularly important role in the development of CM
(chronic migraine). A recent study suggests that acupuncture
may have anti-inflammatory action via release of neuropeptides
from nerve endings, including calcitonin gene-related peptide
(CGRP), an important mediator of neurogenic inflammation and
a potent dilator during migraine attack. We selected acupoints
in the distribution of the trigeminal and cervical dermatomes
because we postulated that an interaction between trigeminal
and cervical nociceptive inputs to the trigeminocervical complex
via acupuncture may inhibit trigeminal-vascular activation and
thus may inhibit migraine attack….It is…important to understand
what roles the peripheral as well as the central mechanisms have
in CM patients after acupuncture treatment in future studies.”

“Isn’t Medical Acupuncture
“Reinventing” Acupuncture Into
Something It Never Was?”

Absolutely not. Admittedly, those already wedded to the
metaphorical conceptualization brought to us by TCM may resist
the need to learn the biological basis of disease, the anatomical
basis of acupuncture, and the physiology of neuromodulation
because they believe that a scientific approach to acupuncture
is somehow new or foreign to China.152 This is false. In fact,
acupuncturists in China have been striving to practice scientifically for decades, with Zhu Lian making many important strides
back in the 1950s.
That is, while the French were reworking acupuncture into
an abstract system of “French Energetics” (see the section on
George Soulié de Morant, below), Communist China created “The
New Acupuncture” with the help of Zhu Lian, a physician trained
in Western medicine who held several influential medical posts

in China.68 In keeping with the goal of the Communist Party leader
Mao Tse Tung to integrate Chinese medicine with modern science,
Zhu Lian, “strongly advocated the application of anatomy and
western medicine in acupuncture”. Zhu Lian pioneered the neuroanatomic basis of acupuncture well before Mao Tse Tung created
Traditional Chinese Medicine (TCM) in the mid-twentieth century.
In so doing, she unraveled many former mysteries through her
extensive anatomical knowledge.153 She saw acupuncture’s influences as working to “stimulate and modulate the regulatory and
control functions of nerve cells.”154
Scientific research has only bolstered Zhu Lian’s visions from the
1950s, as she hoped would happen. Even back then, however, she
“The locations of the fourteen meridians roughly correspond to the
anatomical distribution of excitors. Responses of the human body
to acupuncture stimulation can basically be explained by neuroscience. Knowledge of higher nerves, however, was not available
to ancient therapists, and hence discrepancies inevitably arose,
because traditional acupuncturists, without a full understanding
of neurology, simply formed associations between acupoints and
internal organs.”155 That is, as aforementioned, non-scientific
acupuncturists are frequently unaware of how their needling
treatments actually work even today. Moreover, although Zhu Lian
wanted acupuncture to survive and felt that exposing its factual,
rational basis would allow it to do so, politics prevailed and TCM
became increasingly engulfed by its murky metaphors.
When it moved west, TCM fell victim to even more myths; the
American and European appetite for metaphysics unfortunately prevailed. The term “TCM” only adds to the confusion.
That is, although the “T” stands for “Traditional”, connoting a
long-standing medical system, the Chinese Communist Party
invented TCM only fifty years ago, during the years 1953-1956.70,71
TCM is “a medical construct distinct to Communist China” and
symbolizes “the standardized, government- created, institutionbound medicine that has existed in the PRC since 1956.”72 The
first Outline of TCM became available in Communist China in
1958, published by the Beijing People’s Health Publishers. It was
designed to help fulfill the government’s goal of having “doctors
of Western medicine study Chinese medicine.”73
In her book, Chinese Medicine in Early Communist China
1945-1963, Kim Taylor described the events surrounding the
creation of TCM. “The formulation of a basic theory of Chinese
medicine was an extraordinary feat, the ultimate in the manipulation of knowledge and its subsequent validation at the hand
of politics.”74 She continued: “In general, the main aim of these
“Basic Theories of TCM” was to simplify Chinese medicine and
to reduce two thousand years of controversy and debate into one
easy-access nutshell. This compromises every level of the physician’s encounter with the patient, from examination to diagnosis
through to prescription. Therefore this newly established theory
of TCM simplifies the process of the identification of illness and
the appropriate dispensation of drugs to a few basic steps. Such
is the structured and measured packaging of a ready-to-use TCM
designed for institutional consumption in twentieth- and twentyfirst century Communist China.”75
On the other hand, both in- and outside of China, science-based
Chapter 1:: From Metaphors to Modern Medicine 5

acupuncturists continued to pursue acupuncture demystification.
As one practitioner in the mid-1960s stated:
“If we wish to be taken seriously, and not to be confused with
bone-setters or faith-healers, we must abandon the whole more
or less Chinese mass of philosophy, cosmogony and mythology
in which we have been entangled these forty years past. Let us
clear the decks, and look at our problems without preconceived
ideas. The study of the anatomy and physiology of the skin, and of
the central and sympathetic nervous systems, the investigation of
the physico-chemical and enzymic reactions in the body, all these
should provide us with the means of solving the problem of what
acupuncture really is and does.”1
Scientific acupuncturists agree that acupuncture depends on
nerve function. In 1972, the Peking Acupuncture Anesthesia
Coordinating Group reported, “About half of the known
acupuncture points are located right over various nerves and the
rest are within half a centimeter of one or another nerve. From
this, the conclusion was drawn that acupuncture acts in fact on
the nervous system, and it is through a nerve that the stimulus
produced by needling or applying a mild electric current is transmitted to a certain part of organ of the body where it effects a
cure or brings about a state of analgesia.”21 The number of reports
showing that acupuncture works via the nervous system began its
rapid expansion in the mid-1970’s and has continued ever since.5,6

Indeed, if acupuncture worked by moving energy, not nerves,
then severing nerves should not abolish the body’s reaction to
needling. However, complete transection abolishes its effects and
partial injuries minimize them.2 This is not to say that acupuncture
treatment should be avoided in cases of peripheral nerve, brain,
or spinal cord injury, because needling therapy plays an important
role (when given the opportunity) in helping patients recover
from or contend with these conditions. Rather, it is intended to
emphasize the central significance of the nervous system in
medical acupuncture and related techniques.
In fact, by now, the neural basis of acupuncture has become so
clear that certain authors are replacing the conventional alphanumeric naming system of acupuncture points and channels with
nerve names – not remote and possibly imaginary organs as is now
the case with commonly accepted nomenclature.3 This idea,of
revising and updating the acupuncture lexicon has a precedent;
i.e., over thirty years ago, Dr. Patrick Wall, the co-developer of the
gate control theory, felt that a new classification system based on
acupuncture points and nerves was overdue.4

“You Say “To-May-To” and I Say
“To-Mah-To”: Don’t Scientists
and Energy-Based Acupuncturists
Arrive at the Same Points?”

No, not always. Acupuncturists from either perspective may or
may not select similar points. As indicated earlier, a TCM trained
practitioner may view headache as Liver Yang dysfunction and
select LR 3, LI 4, and GV 20. While the TCM rationale may involve
statements about balancing Yin and Yang, expelling evil influ6 Section 1: Introduction to Interactive Acupuncture Anatomy

ences from the liver, or eliminating wind,156 a neuroanatomic
acupuncturists sees the process much differently. Both LR 3 and
LI 4 relate to double arterial arch systems in the foot and hand,
respectively. These vascular circuits receive heavy investment
of sympathetic fibers. Thus, needle stimulation in their vicinity
modulates autonomic function throughout the body. GV 20 impacts
vagal function through crosstalk along trigeminovagal and cervicovagal routes. It also lies along the sagittal cranial suture
overlying the sagittal venous sinus, thereby further impacting
autonomic function and cerebral venous drainage. GV 20 overlies
the galea aponeurotica as well; needle stimulation at this site aids
in reducing occipitofrontalis muscle restriction that produces a
“tension headache” type of pain. For migraine headaches per
se, a scientifically based medical acupuncturist might add points
to address trigeminal nerve dysfunction, as illustrated above.
The weight of evidence supporting a neuroanatomic approach
emphasizes the importance of selecting points according to actual
patient pathophysiology. To wit, chronic migraine sufferers who
received acupuncture at points supplied by the trigeminal nerve
experienced a significantly larger reduction in moderate/severe
headache days than did those in the topiramate group with far
fewer side effects.157
Even if a metaphoric practitioner chose the same points as
the science-based practitioners did in the migraine study just
described, an accurate understanding of the ways in which
acupuncture improves acupuncture’s legitimacy. Quoting Kendall:
“Why does anyone care whether Chinese anatomy and physiology are explained as energy flowing through meridians, or by
the circulation of blood, nutrients, other vital substances, and vital
air (qi) through the vascular system? The answer to that lies in
the moral obligation of every practitioner to provide each patient
with the latest medical understanding available. The need to
continually search for the truth is the most fundamental principle
of science and medicine. If the functioning of the human body
cannot be understood under normal physiological conditions,
then there is little hope of knowing how to treat it when disease
conditions exist. Research so far show that the true concepts of
Chinese medicine operate under known physiological principles,
involving the complex organization of the neural, vascular,
endocrine, visceral, and somatic systems, sustained by the circulation of nutrients, vital substances, and oxygen from vital air.”22

Why Researchers Need to Recognize
the Scientific Basis of Acupuncture

Ongoing research in Asia and on other continents focuses on
measurable, physiologic changes due to acupuncture, not the
vague nuance and mysticism so commonly found in Western
acupuncture literature. According to Kendall, the abstract,
unscientific idea that acupuncture has an immaterial basis
“has kept Chinese medicine on the fringes of conventional
care since the 1930s and 1940s”.23 Countless research dollars
and hours disappear in the misguided mission of searching
for invisible, energy-conducting pathways, yielding little to
benefit patients and further the understanding of acupun
cture.24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44 Moffet appears to
concur, criticizing methodologic approaches that cling to “unsubstantiated traditional acupuncture theories”.158 He continues:
“When comparing acupuncture interventions [e.g., verum and

sham approaches], investigators should offer a biologic rationale
to support a hypothesis that the exposures are truly different. A
clinical trial with indistinguishable exposures is a poor use of
resources…If the acupuncture exposures are indistinguishable,
then the investigators have failed to control for the placebo
effect.” Many examples of inadequate sham selection exist in the
medical literature. Most commonly, researchers fail to consider
the neuromodulatory overlap that happens when verum (real
acupuncture) and sham (placebo acupuncture) excite similar
nerve pathways.

Why Today’s Clinicians Need to
Espouse a Rational Premise for

The demystification of acupuncture in no way diminishes its
brilliance. Rather, identifying the structure-function relationships
between acupuncture point anatomy and clinical indications
brings acupuncture closer to its ancient roots than do musings
about energetic evolutions. Clinging to outdated jargon may, in
fact, prevent patients from seeking appropriate medical attenti
on.45,46,47,48,49,50,51,52,53 For example, informing a patient complaining
of chest pain and shortness of breath that they have “Qi and Yin
Deficiency”54 may have been adequate during the Han dynasty, but
not today. Rather, prompt medical attention is in order. Similarly,
“Liver Fire blazing with Phlegm-Heat” could indicate Graves’
disease or even papillary thyroid cancer, and require treatments
other than, or in addition to, acupuncture.55 Patients with “Kidney
Yang Deficiency”56 may actually be experiencing adrenal insufficiency or crisis. One should neither delay nor preempt further
diagnostic workup and appropriate medical intervention by
seeking to balance an abstract Yin and Yang.57,58,59,60
Why, then, do schools and postgraduate courses promote
acupuncture metaphysics? Perhaps too few instructors and
students have learned about the actual origin of the energymeridian misconception. Not thousands of years old, not even
hundreds, the Qi-as-energy myth was born less than a century
ago, a brainchild of a French citizen residing in China by the name
of George Soulié de Morant.

George Soulié de Morant’s Hope of
Acupuncture Metaphysics

No convincing evidence exists that acupuncture works by pushing
energy through invisible transmission lines.61 As the inventor of
the energy-meridian concept, George Soulié de Morant, stated,
“Having observed the existence of “something” that passes
through a meridian when a point is stimulated, the ancients gave
this fluidity, this flux, the name qi, which we translate, for lack of a
better word, “energy”.62 Because Soulié de Morant lacked medical
training and in that he wanted to present Chinese medicine in
ways he thought his French audience would understand, he introduced his own bias about how acupuncture worked, i.e., through
unseen energies moving through intangible pathways.63
Living within the European cultural and philosophical context
when he wrote his landmark text, l’Acuponcture Chinoise

(Chinese Acupuncture), Soulié de Morant relied on his readers
believing his claim of a metaphysical basis for acupuncture.
After all, the concept of “élan vital”, or immaterial life force, had
spread and grown popular throughout Europe. Élan vital was to
have produced and shaped all life; notions about this vivifying
impulse permeated the philosophy of that era.64 Yet, not all were
convinced; the British biologist Julian Huxley once commented
that élan vital offers no better an explanation of life than élan
locomotif accounts for the motion of a train.65
Nor was Soulié de Morant’s book translator, Paul Zmiewski,
convinced of the author’s claims. Zmiewski noted in his introduction, “While ideas found in modern English texts are often
expressed in English words derived from l’Acuponcture Chinoise,
these words do not always mean what was meant in the classic
works upon which l’Acuponcture Chinoise is based.”66 About
Soulié de Morant’s selecting the term “energy” for “Qi”, Zmiewski
wrote, “At the beginning of the twentieth century concepts like
“human energy” were referenced in dictionaries and were
considered valid matters for scientific inquiry. Many nineteenth
century ideas of nature were still broadly regarded as truths.
Today, however, the scientific era that had just begun when Soulié
de Morant chose to use the term “energy,” has left that word
with new and different associations in both popular and scientific writing.” As such, even Soulié de Morant’s own idea behind
the Qi translation has undergone an evolution, independent of its
original meaning in ancient China.
Reinventing acupuncture into an “energy medicine” required
that Soulié de Morant downplay the importance of anatomy and
physiology in Chinese medicine.76,77 He did not include The Yellow
Emperor’s Classic of Internal Medicine among his translations.
Had he done so, as Kendall indicated, he would have found that
the early Chinese physicians living between 600 and 300 BCE had
compiled “surprisingly accurate and detailed information on the
human body, with some of the ideas clearly equivalent to those
of modern Western physiology.”78 Unfortunately, this disregard of
acupuncture anatomy and physiology promulgated by Soulié de
Morant led to an ensuing disinterest by future acupuncturists in
the material foundation of acupuncture.
Some even assert, although incorrectly, that ancient Chinese
investigators never performed anatomical investigations.79
Kendall offers two possible reasons for this misconception.80 First,
historians may have assumed that since Confucian teachings
proscribed postmortem dissections, they were not performed.
Alternatively, some believe that since ancestor worship pervaded
the culture especially strongly many centuries ago, those
dissecting the body after death would have likely incurred a
great degree of ancestral displeasure. Nevertheless, postmortem
autopsy likely occurred long before Confucius existed (551-479
BCE), and still took place during his lifetime. Furthermore,
the prohibition on autopsies that occurred in some dynasties
happened several hundreds of years after the studies mentioned
in the Nei Jing were already documented. Information encountered in the Nei Jing attests to the fact that anatomical dissections took place, producing insights into the size, weight, and
capacity of all internal organs.81
Even the acupuncture channels (jingluo), which many now
Chapter 1:: From Metaphors to Modern Medicine 7

Table 1-1
Metaphorical “Actions” of LI4 stimulation, according to Chinese

Effects of LI4 stimulation, according to Scientific Studies*

Autonomic Influences
“Regulates the defensive qi and adjusts sweating”

Both high and low frequency electroacupuncture (EA) stimulation of LI 4 (with
SI 3) produced short-term cooling.86
Manual and EA stimulation of LI 4 produced long-lasting warming (indicating
a sympatholytic effect) after the transient, segmental increase in sympathetic
activity that caused a localized, short-term cooling.87
Acupuncture at LI 4 caused an increase in palm temperature, probably due to
cutaneous vessel dilation.88
EA at LI 4 selectively activated the sympathetic, but not parasympathetic,
nervous system. In so doing, the rhythmic micturition contraction cycle
lengthened and urine excretion increased, as did renal sympathetic nerve
activity and blood pressure. These results indicated that EA at LI 4 may benefit
patients with hyperactive bladder problems.110
EA at LI 4 and LI 11 increased both pain thresholds and muscle sympathetic
nerve activity.111

“Expels wind and releases the exterior”; “Regulates the face, eyes, nose,
mouth and ears”; “Activates the channel and alleviates pain”

EA diminished dental pain perception; high intensity EA was most effective.89
Naloxone failed to reverse elevated pain thresholds induced by EA, indicating
that non-opioid transmitters are involved in dental analgesia.90
Nitrous oxide blocked the effects of electrical stimulation at LI 4.91
Needle manipulation at LI 4 significantly increased pain pressure thresholds.92
Unilateral EA at LI 4 (and LI 11) transiently inhibited the motoneuron pool in the
extensor digitorum communis muscle of the contralateral arm, suggesting that
EA operates by central effects, instead of or in addition to peripheral influences.93
Transcutaneous electrical nerve stimulation (TENS) at LI 4 reduced the sensation
of pain but not vibration.94

Effects on the Central Nervous System
“Restores the yang” (i.e., “for the treatment of collapse of yang characterised
by loss of consciousness, aversion to cold, cold counterflow of the limbs,
purple lips etc.”)

Manual and EA stimulation of LI 4 produce differential brain activation. Manual
needle manipulation caused prominent functional magnetic resonance imaging
(fMRI) signal decreases in the posterior cingulate and superior temporal gyrus as
well as the putamen/insula. EA caused signal increases in the precentral gyrus,
the postcentral gyrus/inferior parietal lobule, and the putamen/insula.100
Somatosensory evoked potentials obtained after EA at LI 4 (which activates
radial nerve fibers) differ markedly from those obtained after EA at the median
Needle manipulation at LI 4 modulated activity in limbic and subcortical gray
structures of the brain, as shown by fMRI.102
Brain magnetic fields measured by SQUID (Superconductive Quantum Interference Device) after acupuncture at LI 4 revealed changes in the biomagnetic
fields relating to the projection areas of the face and jaw.103
LI 4 stimulation caused a significant increase in the latency and decrease in the
amplitude of peaks reflecting primary cortical afferent activities.104
Needle manipulation of LI 4 activated the hypothalamus, supporting the notion
that this classical analgesic point works at least in part to reduce pain through
hypothalamic activation.105,106
Manual acupuncture to LI 4 activated both somatosensory cortical areas and the
periaqueductal gray.107
High-frequency EA at LI 4 induced specific electroencephalographic (EEG)
modulation of Theta activity in the midline frontal region. This may reflect
reduced activity in the anterior cingulate cortex, resulting in antinociception.108
Needle manipulation at LI 4 activated structures in the descending antinociceptive pathway (i.e., the hypothalamus and nucleus accumbens) and

8 Section 1: The Science of Acupuncture Neuromodulation

Effects on the Central Nervous System, Continued
deactivated multiple areas in the limbic system associated with pain (rostral
part of the anterior cingulate cortex, amygdala formation, and hippocampal
complex), indicating ways in which endogenous pain modulation circuits in
the brain may function.109
EA at LI 4 and LI 11 caused a positive spread of activation across the spinal cord
segments C5 to T1, with peak activity taking place at C7. Activation occurred at
both the dorsal and ventral parts of the cord, indicating that LI 4 and LI 11 can
indeed modulate specific spinal cord regions. This study suggests that individuals
with sensorimotor deficits arising from these spinal segments may benefit from
acupuncture at these points.112
Magnetic stimulation of LI 4 affected specific brain areas, such as the anterior
cingulate cortex, that differed from those influenced by a “mock” point, also on
the hand.159
Obstetrical Influences
“Induces labour”

Acupuncture at LI 4 suppressed uterine contractions induced by oxytocin in
pregnant rats.95
Acupuncture at LI 4 inhibited the expression of the cyclooxygenase-2 (COX-2)
enzyme and reduced uterine motility significantly.96
Acupuncture at LI 4 (and SP 6) helped ripen the cervix at term and shortened
the time interval between estimated date of confinement (EDC) and delivery.97
Ice massage on LI 4 reduced labor pain during contractions.98
Acupressure at LI 4 and BL 67 reduced labor pain during the active phase of
the first stage of labor, but did not significantly affect uterine contractions.99

call “meridians”, originally pertained to actual blood vessels
and their accompanying nerves. This makes sense given that
acupuncture started as bloodletting. In his essay, “Bloodletting in early Chinese medicine and its relation to the origin of
acupuncture”, Epler wrote, “The vessels are organic structures,
not functional pathways as they were later to become, blood is
a fluid, and pneuma is, certainly in part, a material substance,
not the “energy” it was later to become.”82 In his Dao of Chinese
Medicine, Kendall noted, “Replacing the blood vascular system
with nonexistent meridians is the single greatest translation error
to befall Chinese medicine.”83
In the context of his nonmedical background and the times
in which he lived, Soulié de Morant’s mistranslation of “Qi” as
“energy” seems forgivable. What is less “okay” is the perpetuation of this mistranslation by educators today, instead of
acknowledging the truth, i.e., that in the acupuncture matrix originally referred to the vascular network with its circulating gases,
cells, and nutrients. Forcing acupuncture to stay stuck inside a
mystique and superstition it long outgrew binds its natural development like foot-binding did to maturing anatomy, unable to reach
its full expression.67 In both the metaphor-based acupuncture
model and the torturous practice of foot-binding, the ideal represented a culturally repressed esthetic as opposed to reality, a
system of sustained immaturity weakened by those who curtail
proper expansion and innate capacity.
How do acupuncture researchers, educators, and clinicians undo
the damage done by this prodigious misstep in acupuncture’s
history? Like most recovery programs would insist, those addicted
to the energy-meridian paradigm need to begin by telling the truth.
The time is now to set the record straight and acknowledge the
rational, anatomic, and scientific basis of acupuncture.


The specificity and multiplicity of verifiable and reliable outcomes
obtained by scientifically studying a point such as LI 4, as outlined
in Table 1-1, illustrate the advantages of allowing acupuncture to
mature into a modern medical treatment based on neuromodulatory actions. The steps toward manifesting this transformation
first require a comprehensive grasp of neuroanatomy as it relates
to acupuncture points, thus the purpose of the book.


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111. Knardahl S, Elam M, Olausson B, and Wallin BG. Sympathetic nerve activity after
acupuncture in humans. Pain. 1998;75(1):19-25.
112. Li G, Ng MC, Wong KK, Luk KD, and Yang ES. Spinal effects of acupuncture stimulation assessed by proton density-weighted functional magnetic resonance imaging at 0.2T.
Magnetic Resonance Imaging. 2005;23:995-999.
113. Dung HC. Anatomical features contributing to the formation of acupuncture points.
American Journal of Acupuncture. 1984; 12:139-143.
114. Matsumoto T and Lyu B. Anatomical comparison between acupuncture and nerve block.
The American Surgeon. 1975;41:11-16.
115. Shaozong C. Modern acupuncture theory and its clinical application (Chapter 5 The
Morphological Relationship between Points and Nerves). International Journal of Clinical
Acupuncture. 2001;12:149-157.
116. Shaozong C. Modern acupuncture theory and its clinical application. (Chapter 5 The
Morphologic Relationship between Points and Nerves). International Journal of Clinical
Acupuncture. 2001;121(2):149-158.
117. Li A-H, Zhang J-M, and Xie Y-K. Human acupuncture points mapped in rats are associated
with excitable muscle/skin-nerve complexes with enriched nerve endings. Brain Research.
118. Lu G-W. Characteristics of afferent fiber innervation on acupuncture points zusanli. Am J
Physiol. 245 (Regulatory Integrative Comp Physiol. 14): R606-R612, 1983.
119. Zaslawski CJ, Cobbin D, Lidums E, and Petocz P. The impact of site specificity and
needle manipulation on changes to pain pressure threshold following manual acupuncture: a
controlled study. Complementary Therapies in Medicine. 2003;11:11-21.
120. Gildenberg PL. Evolution of neuromodulation. Sterotact Funct Neurosurg.
121. Fandel T, Tanagho EA. Neuromodulation in voiding dysfunction: a historical overview of
neurostimulation and its application. Urol Clin N Am. 2005;32:1-10.
122. Elkersh MA, Simopoulos TT, and Bajwa ZH. Fundamentals of interventional pain
medicine. The Neurologist. 2005;11(5):285-293.
123. Bernstein AJ and Peters KM. Expanding indications for neuromodulation. Urol Clin N
Am. 2005;32:59-63.
124. Daneshgari F, and Moy ML. Current indications for neuromodulation. Urol Clin N Am.
125. Ellis A, Wiseman N, and Boss K. Fundamentals of Chinese Acupuncture,Revised Edition.
Brookline: Paradigm Publications, 1991. Pp. 248-251.
126. DeGiorgio CM, Schachter SC, Handforth A, Salinsky M, Thompson J, Uthman B, Reed R
et al. Prospective long-term study of vagus nerve stimulation for the treatment of refractory
seizures. Epilepsia. 2000;41:1195-2000.
127. Murphy JV and Patil AA. Stimulation of the nervous system for the management of
seizures. Current and future developments. CNS Drugs. 17(2):101-115.
128. Zabara J, Chaffee RB Jr, Tansy MF. Neuroinhibition in the regulation of emesis. Space
Life Sci. 1972;3(3):282-292.
129. Zabara J. Inhibition of experimental seizures in canines by repetitive vagal stimulation.
Epilepsia. 1992;33(6):1105-1012.
130. Zabara J. Inhibition of experimental seizures in canines by repetitive vagal stimulation.
Epilepsia. 1992;33(6):1001-1012.
131. Panzer RB and Chrisman CL. An auricular acupuncture treatment for idiopathic canine
epilepsy: a preliminary report. Am J Chin Med. 1994;22(1):11-17.
132. Van Niekerk J, Eckersley N. The use of acupuncture in canine epilepsy. J S Afr Vet Assoc.
133. Shu J, Liu RY, and Huang XF. The effects of ear-point stimulation on the contents of
somatostatin and amino acid neurotransmitters in brain of rat with experimental seizure.
Acupunct Electrother Res. 2004;29(1-2):43-51.
134. Still J. Chapter 27, Ear Acupuncture. In Schoen AM (ed). Veterinary Acupuncture –
Ancient Art to Modern Medicine. St. Louis: Mosby, Inc. 2001. p. 335.
135. Henry TR. Therapeutic mechanisms of vagus nerve stimulation. Neurology. 2002;59(Supp
136. Ballegaard S, Jensen G, Pedersen F, and Nissen VH. Acupuncture in severe, stable
angina pectoris: a randomized trial. Acta Med Scand. 1986;220(4):307-313.
137. Bernstein AJ and Peters KM. Expanding indications for neuromodulation. Urol Clin N
Am. 2005;32:59-63.
138. Allais G, De Lorenzo C, Quirico PE, Airola G, Tolardo G, Mana O, and Benedetto C.
Acupuncture in the prophylactic treatment of migraine without aura: a comparison with flunarizine. Headache. 2002;42:855-861.
139. Li G, Ng MC, Wong KK, Luk KD, and Yang ES. Spinal effects of acupuncture stimulation assessed by proton density-weighted functional magnetic resonance imaging at 0.2T.
Magnetic Resonance Imaging. 2005;23:995-999.
140. Costantini A. Spinal cord stimulation. Minera Anestesiol. 2005;71:471-474.
141. Keats J. Ode on a Grecian Urn. In Quiller-Couch A. (ed.) The Oxford Book of English Verse:
1250–1900, 1919.
142. Zhang JL, Zhang SP, and Zhang HQ. Antiepileptic effect of electroacupuncture vs. vagal
nerve stimulation in the rat thalamus. Neurosci Lett. 2008;441(2):183-187.

Chapter 1:: From Metaphors to Modern Medicine 11

143. Cakmak YO. Epilepsy, electroacupuncture and the nucleus of the solitary tract. Acupunct
Med. 2006;24(4):164-168.
144. Van der Pal F, van Baiken MR, Heesakkers JP, et al. Implant-driven tibial nerve stimulation
in the treatment of refractory overactive bladder syndrome: 12-month follow-up. Neuromodulation. 2006;9(2):163-171.
145. Peters KM, Macdiarmid SA, Wooldridge LS, et al. Randomized trial of percutaneous
tibial nerve stimulation versus extended-release tolterodine: results from the overactive
bladder innovative therapy trial. J Urol. 2009;182(3):1055-1061.
146. Manni L, Albanesi M, Guaragna M, et al. Neurotrophins and acupuncture. Auton
Neurosci. 2010;157(1-2):9-17.
147. Manni L, Albanesi M, Guaragna M, et al. Neurotrophins and acupuncture. Auton
Neurosci. 2010;157(1-2):9-17.
148. Hogeboom CJ, Sherman KJ, and Cherkin DC. Variation in diagnosis and treatment of
chronic low back pain by traditional Chinese medicine acupuncturists. Complement Ther Med.
149. Mist SD, Wright CL, Jones KD, et al. Traditional Chinese medicine diagnoses in a sample
of women with fibromyalgia. Acupunct Med. 2011;29(4):266-269.
150. Coeytaux RR, Chen W, Lindemuth CE, et al. Variability in the diagnosis and point selection
for persons with frequent headache by Traditional Chinese Medicine acupuncturists. J Alt
Comp Med. 2006;12(9):863-872.
151. Yang C-P, Chang M-H, Liu P-E, et al. Acupuncture versus topiramate in chronic migraine
prophylaxis: a randomized clinical trial. Cephalalgia. 2011;31(15):1510-1521.
152. Morris W. Medical epistemology: a bias of culture? Acupuncture Today.
2011;12(3). Accessed at
php%3Fid%3D32371%26no_paginate%3Dtrue on 12-18-11.
153. Fan K-W. Discussion on scientification of acupuncture in Hong Kongin 1950s: with special
reference to Zhu Lian’s The New Acupuncture. Asian Culture and History. 2011;3(2):2-8.
154. Fan K-W. Op cit.
155. Zhu Lian. Xin Zhenjiu Xue (The New Acupuncture). Beijing: People’s medical publishing
house, 1951. Cited in Fan K-W. Discussion on scientification of acupuncture in Hong Kongin
1950s: with special reference to Zhu Lian’s The New Acupuncture. Asian Culture and History.
156. Deadman P, Al-Khafaji M, and Baker K. Some acupuncture points which treat headache.
J Chin Med. 1997; 55. Accessed on 1-1-12 at
articles/56-5.pdf .
157. Manni L, Albanesi M, Guaragna M, et al. Neurotrophins and acupuncture. Auton
Neurosci. 2010;157(1-2):9-17.
158. Moffet HH. Acupuncture study hypotheses should rely on scientific, not imaginary,
models. [Letter to the editor]. Arch Phys Med Rehabil. 2008;89:194.
159. Yu H, Xu G, Yang R, et al. Somatosensory-evoked potentials and cortical activities evoked
by magnetic stimulation on acupoint in human. 31st Annual International Conference of the
IEEE EMBS Minneapolis, Minnesota, USA, September 2-6, 2009:3445-8.

12 Section 1: The Science of Acupuncture Neuromodulation

Chapter 2::

Function Follows Form

Key Points

The science of neuromodulation endows acupuncture with
a factual, rational basis and a neuroanatomic framework.
Together, the science of neurophysiology and the instructional
attributes of anatomy inspire cogent and sophisticated protocols
for scientific, medical acupuncture and related techniques
The outcome of a neuromodulation treatment depends on the
regions, types, and number of nerves activated, as well as the
method of stimulation selected.
Acupuncture stimulation most immediately affects one or more
of the three types of peripheral nerves:
• Motor
• Sensory
• Autonomic
Stimulation methods involved in medical acupuncture include
but are not limited to:
• Dry needling, otherwise known as manual acupuncture (MA)
• Electroacupuncture (EA)
• Laser acupuncture (LA)
• Acupressure
Comprehensive treatment entails three steps:
• Determine the problem; understand its nature, location,
and origin
• Identify neural avenues that produced and perpetuate the
problem; consider how neuromodulation can affect these or
other nerves to undo the damage and promote recovery
• Influence nerves from the peripheral, central, and autonomic
nervous systems

Understand the Function of
Acupuncture Points through their
Anatomy (Form)

For ages, philosophers and physicians have recognized the inseparable partnership of anatomy and physiology.282,283 Investigating
ways in which form meets functions in acupuncture illuminates
the wealth of wisdom layered into each needling site. Systematic
analysis of the local anatomy uncovers the effects of stimulating
a point with delightful directness. Metaphorical medicine then
dissipates and dissolves like fog in the morning after a night of
rain; science, like the sun, burns away clouds of uncertainty with
beams shining light on the ways in which acupuncture actually
Not merely an intellectual exercise, the anatomy of acupuncture
impels clinicians to ask more precise questions about their
patients and informs their thinking fingers during myofascial
assessment of them.
In the examination process, one asks, “Is this where it hurts?” as
the examiner’s hands seek to find tension and tenderness. Threedimensional anatomy reveals underlying reasons for numbness
and weakness by disclosing regions where muscles course over
and around nerves. Structure and function show why tension and
14 Section 1: The Science of Acupuncture Neuromodulation

pain result and where they require intervention. In other words,
myofascial impediments may impair nerve communication. Nerve
entrapment due to myofascial restriction, fascial bands, or scar
tissue may block a signal from reaching its destination or alter
its message. Thorough, informed palpation frequently allows
the medical acupuncturist to detect sites of nerve compression
through findings of tissue tension and tenderness.
Nerves that have suffered from excessive or prolonged pressure,
overstretching, or starvation from of insufficient oxygenation
and nutrients through poor circulation can become neuropathic.
Neuropathic nerves transmit erroneous information. Like trying
to carry on a conversation along a poor cell phone connection,
injured nerves relay distorted or interrupted messages.
Depending on the nerve’s job in life and specialization, the patient
may experience alterations in sensory, motor, and/or autonomic
message delivery. As a result, instead of accurately reporting
information about position sense, pain, touch, and so on, neuropathic nerves may cause the patient to feel pain instead of touch
or pressure (allodynia) or find a mildly uncomfortable stimulus to
cause unbearable pain (hyperalgesia).
Dysfunctional muscle tissue and related neural networks
produce myofascial trigger points. Myofascial trigger points, a
nearly ubiquitous phenomenon, can cause peripheral nerves to
become neuropathic and inflamed due to their chronic nature and
tendency to worsen and multiply if left untreated. Attending to
trigger point dysfunction with neuromodulation through needling
and related techniques is a major process by which acupuncturists benefit their patients.
Where do trigger points occur? One finds most myofascial
trigger points in the middle of the muscle belly where the majority
of muscle spindles and motor endplates lie as well as in the
myotendinous junctions, occupied by Golgi tendon organs. Due
to their profound roles in producing and perpetuating pain and
dysfunction, these sites of highly specialized nerve endings in
muscles and tendons become critical targets for acupuncturists.
For example, an acupuncturist may select Gallbladder 20 and 21
(GB 20, GB 21) for myofascial pain the shoulder-neck region. GB
20 is located at the myotendinous attachment of the upper portion
of the trapezius, and GB 21 lives in the middle of its muscle belly.
On a broader scale, truncal anatomy (as shown in the layered
as well as cross-sectional anatomy in the upcoming chapters)
bespeaks how form and function affect both soma and viscera.
How do the nerves occupying BL 23 on the body wall affect the
kidney? The answer becomes clear when considering the spinal
segmental nerve supply that both sites share. Interneurons in the
spinal cord yoke neural traffic from the small of the back with
signals stemming from the depths of the abdomen and pelvis.
Palpation of the paraspinal muscles along the entire back reveal
results of aberrant neural traffic from facilitated spinal segments
in the form of tissue tenderness, tension, and restriction. These
findings of myofascial dysfunction along certain spinal segments
serve to raise our awareness of potential somatic and/or visceral
disturbances in the body realms subserved by this spinal cord
“real estate”. This then informs both our diagnosis and treatment
of the patient.

Layered and cross-sectional anatomy images also uncover structures beyond our fingers’ reach. The bony calvarium keeps us from
touching the brain and its vessels. Through the translucent skull
in the Visible Human images in this book, connections between
channels and vessels such as the Governor Vessel (GV) and the
superior sagittal venous sinus remind us of the original, vascular
basis of acupuncture as a whole and the eight singular vessels
in particular. The Governor Vessel’s counterpart, Conception
Vessel (CV), represents the vena cava, whose relationship to
the overlying central CV on the surface of the anterior (ventral)
trunk now makes sense. Clinically, one may detect expansions of
the often forgotten collateral venous drainage pathways when
the vena cava obstructs, making the connection between deep,
interior processes and the body surface, visually striking. In this
way, channels’ interconnections from deep to superficial and
from one to another bring to life the meaning behind the metaphor
in ancient writings on acupuncture. Today, scientific pursuits
elaborate on these early insights and draw detailed descriptions
of how acupuncture and related techniques influence form and
function. Let us begin at the point-stimulus juncture.

The Needle-Tissue Interface

In acupuncture, the “rubber meets the road” at the needle-tissue
interface. Like tires on pavement, the acupuncture needle must
engage with its surroundings in order to gain traction and cause
change. When rotated, the acupuncture needle attracts and pulls
on collagen and possibly muscle fibers, causing them to grab
its shaft. This bond between metal and fibers forces the tissue
to respond and initiates a conversation with neighboring nerves,
fascia, and fibroblasts.
The message spreads to nearby cells, culminating in a wave of
tissue deformation and neural discourse that travels beyond the
immediate vicinity. If the needle has reached muscle, the impact of
treatment intensifies.284 Nerves ferry information about the event
in both an orthodromic (toward the spinal cord) and antidromic
(toward the nerve’s terminals) direction along a channel.

The Peripheral Nervous System’s
Subspecialists: Nerve Endings

In addition to proprioceptors such as muscle spindles that respond
to changes in length and Golgi tendon organs that assess tension,
a number of other receptors in tissue act as an interface between
the external environment and the nervous system. This allows the
acupuncturist to employ treatments that adjust or alter sensory
input with the aim of supporting the healing process. Knowing
the types of nerve endings typically found at acupuncture sites
gives the medical acupuncturist a better understanding of the
likely outcome of stimulating those points. For instance, if the
acupuncture point overlies a blood vessel, a needle tugging on
fascia nearby may stimulate its nervi vasorum (vascular nerves).
These adrenergic fibers control vessel wall tone. As such, the
effects of needling this site could involve neuromodulation of
circulation and blood pressure regulation. An example of this type
of point is Lung 9 (LU 9).

Acupuncture Points as
3-D Structures

Acupuncture points are three-dimensional events, not static dots
on the skin surface. This fact converts the rather simple activity
of inserting a needle into a multilayered excursion into a patient’s
bodily habitus. The dialogue between form and function deepens as
the needle traverses skin, then fat, then fascia, muscle, and maybe
periosteum. At each level, tissue resistance to the needle tip’s travel
tells of the tension and tone it encounters. Too much or too little of
either tension or tone can signify dysfunction and/or disease.
When the treatment involves trigger point deactivation, attention to
tissue texture and tension changes becomes paramount. Isolating
a patient’s source of pain precedes its elimination. When patients
exclaim, “That’s it! That’s where the problem is!”, it confirms
palpatory findings. Re-examination through palpation and patient
feedback after dry needling verifies or denies that the trigger point
has responded. Trigger point deactivation serves as a profound
example of the dynamism between form and function that takes
place through the needle conduit.

Nerve Chat

Nerves serve as the body’s social medium. Not shy, they publicize
their messages broadly, speaking to everyone who will listen,
whether organs, glands, vessels, muscles, fascia, and other nerves.
The messages they send may be momentary, such the faint brush
of a breeze going by, or lifelong, as in the case of childhood onset
Crohn’s disease. Similarly, their emotional and somatic sequelae
may place a temporary or permanent imprint, depending on how
many signals they send each time they complain, and how long
their upset lasts. The “complaint department”, i.e., the central
nervous system (CNS), responds to neural reports of pain and
distress with attempts to alleviate them. If unsuccessful, neural
plasticity makes the CNS a codependent partner by prolonging the
problem, leading to hyperalgesia, allodynia, inflammation, sympathetic hyperactivity, muscle tension, and long-term stress.285
By the time a patient presents for treatment, pain and dysfunction
have usually existed long enough to cause a collection of
problems. This behooves the medical acupuncturist to develop
a neuromodulatory intervention that addresses several levels. It
is therefore not enough to ask how the chief complaint started
and where it hurts, but also why is it continuing and how does it
express itself in the structure (myofascia, posture, joint mobility),
viscera (organ, metabolic, and glandular activity), and emotions
(anxiety, depression, withdrawal, confusion)? Has the problem not
only influenced function, but is it also now altering form?
Acupuncture neuromodulation should, to the degree possible,
address each aspect of a patient’s discord; i.e., its central,
peripheral, and autonomic components. This likely will require
several treatments.

Acupuncture Neuromodulation

Neuromodulation is a naturally occurring phenomenon, allowing
the body to respond and adapt to endogenous and exogenous
stimuli. It provides for the protection, homeostasis, and repair of
Chapter 2:: Function Follows Form 15

the organism.2,3,4,5,6 Sometimes, though, autoregulatory processes
either falter or fail. Acupuncture is simply a somatosensory input
that assists the body in making the neuromodulatory changes
necessary to regain health and homeostasis.7
Acupuncture neuromodulation signals initiated near needling
sites propagate along nerves toward the CNS.1 Connections at the
spinal cord can course in several directions. The cord may 1) send
efferent signals back out to the periphery (leading to antidromic
activation of free nerve endings at the site of needling), 2) loop into
related visceral neural networks and alter internal organ function
in a spinal segmental manner, 3) foster endogenous opioid release
in the dorsal horn of the spinal cord to reduce spinal facilitation,
or “wind-up”, and block pain, and/or 4) proceed to higher centers
in the brain, altering neural and hormonal functions. When these
impulses arrive at the brain, they influence activity there as well,
usually in a beneficial manner.
Exactly how the body responds and which parts of the body react
depend on the nerves stimulated.8 However, the body’s pre-needling state may also influence outcomes.9,10 For example, the
point ST 36 treats both diarrhea and constipation, depending on
pre-treatment gastrointestinal motility status.11,12 In this way, the
same point can either “quiets things down” in cases of hyperfunction, or “fire them up” in hypofunction.

Yin and Yang in the Modern Era

TCM terms such as “Yang Excess” and “Yin Deficiency” can
now be viewed as sympathetic hyperfunction or parasympathetic hypofunction.13,14 Disease states that illustrate Yang Excess

The Tai Ji symbol illustrates the balanced, intertwining, and evolving
relationship between Yin (black) and Yang (white), with elements of the
complementary partner held by each component (represented by the
small circles).

include hyperthyroidism and acute fever. “Deficient Yin” describes
parasympathetic hypofunction, most dramatically depicted by
toxic exposure to anticholinergics, or parasympathetic antagonists. In this case, the victim turns “red as a beet, blind as a bat,
dry as a bone, mad as a hatter, and hot as hell”.15
Conversely, “Excess Yin” connotes just the opposite, i.e.,
parasympathetic hyperfunction and/or sympathetic hypofunction.
One might even see a concatenation of autonomic disruption,
as in cluster headaches. These patients exhibit both sympathetic hypofunction, manifesting as miosis and ptosis, along with
parasympathetic hyperfunction, with rhinorrhea and lacrimation.

Table 2-1 Sympathetic and Parasympathetic Functions18,19

Effects of Sympathetic System (Yang)

Effects of Parasympathetic System (Yin)

Adipocyte metabolism

Causes lipolysis


Adipocyte, brown

Causes heat production


Adrenal medulla

Causes adrenaline/epinephrine (80%) and
noradrenaline/norepinephrine (20%) secretion


Arteries in cranium


May vasodilate

Arteries in erectile tissue (helical arteries
and sinusoids in penis and clitoris)



Arteries in heart20 (coronary arteries)

Transient vasoconstriction, followed by vasodilation

Some vasodilation

Arteries in skeletal muscle

Vasoconstricts (via adrenergic fibers) under resting tone
and vasodilates large arteries (via cholinergic fibers)
during exercise


Arteries in skin and mucosa of face



Arteries in skin of trunk and limbs



Arteries in viscera




Motility decreases

Motility increases

Sphincters contract

Sphincters relax

Pupillary dilator muscle dilates pupil

Pupillary sphincter muscle contracts pupil

Contracts tarsal muscle (lifts lid)

Contracts ciliary muscle


Ciliary muscle relaxes for far vision
Gallbladder and biliary ducts


16 Section 1: The Science of Acupuncture Neuromodulation


Table 2-1 Sympathetic and Parasympathetic Functions, Continued

Increases heart rate

Decreases heart rate

Increases atrial and ventricular contractility

Decreases atrial contractility

Motility decreases

Motility increases

Sphincters relax

Sphincters contract

Secretion decreases

Secretion increases


Arterioles constrict

Arterioles dilate

Lacrimal gland



Liver metabolism

Causes glycogenolysis, gluconeogenesis



Relaxes tracheobronchial muscles

Contracts tracheobronchial muscles


Increases mucous secretions from
bronchial glands
Lymphoid tissue

Reduces activity (e.g., of natural killer cells)


Nasopharyngeal glands




Increases circulating glucose

Increases insulin secretion

Inhibits insulin secretion from the islet beta cells

Dilates pancreatic blood vessels


Constricts pancreatic blood vessels
Piloerector muscles



Pilomotor muscles of the skin

Causes contraction


Pineal gland

Increases synthesis of melatonin


Prostate, seminal vesicle



Salivary glands

Weak serous secretion (submandibular salivary gland)

Profuse serous secretion

Sparse, thick secretion
Splenic capsule




Motility decreases

Motility increases

Sphincters contract

Sphincters relax

Secretion is inhibited

Secretion increases

Sweat glands of the skin

Induces profuse secretion


Thyroid gland

Becomes stimulated


Decreases ureteric tone and motility

Increases ureteric tone and motility

Urinary bladder

Relaxes detrusor muscle (small amount)

Contracts detrusor muscle

Increases internal sphincter tone and trigone

Relaxes internal sphincter tone and trigone

Contracts pregnant uterus



Relaxes or contracts the non-pregnant uterus
Vas deferens






Instead of relying on abstract concepts of Yin and Yang, studying
the autonomic nerve supply to organs and glands yields insights
into ways in which illness manifests neurophysiologically. This
then opens the door to acupuncture neuromodulation by outlining
neuroanatomic expressways that revise neural traffic. Table 2-1
compares the complementary actions of the two limbs of the
autonomic nervous system (ANS), designated by tissue or organ.
Most viscera receive dual innervation from both sympathetic and
parasympathetic limbs of the ANS.17

How Acupuncture Points Affect
Internal Organs

While needling neuromodulates nerve activity in local structures

through direct effects on tissue, its broader, homeostatic value
results from reflexes in the spinal cord and brain.

The Spinal Cord Connects the Soma
with Viscera

One of the most salient depictions of how the ancient Chinese
linked anatomy (structure) with physiology (function) comes
from the Back Shu and Front Mu points. These twelve pairs of
points (one Back Shu and one Front Mu for each organ) act upon
certain sections of the spinal cord. Their associated spinal cord
levels house interneuronal connections connecting pathways
that produce reflexes between acupuncture points on the body
surface (soma) and internal organs (viscera).
Chapter 2:: Function Follows Form 17

The paraspinal Back Shu points run along the inner Bladder
channel from the thorax to the sacrum. The Front Mu points occur
on the lateral or anterior aspects of the trunk and generally receive
nerve supply from spinal cord segments that overlap with those of
the Back Shu points.122 Back Shu points receive innervation from
the dorsal (posterior) ramus of a spinal nerve, while the Front Mu
points occur along dermatomes of the same, or neighboring, spinal
nerve, supplied by either the lateral or ventral (anterior) ramus.
Because each organ and its associated pair of Back Shu and Front
Mu points often share innervation from similar or overlapping
spinal cord levels. In the spinal cord, neurons in the deep layers
of the dorsal horn receive convergent input from somatic structures and viscera.124
Unhappy nerves arise from unhappy organs and body wall structures such as tense or painful muscles and fascia. Nociceptive
neurons, when activated, bombard the spinal cord with tales
of woe.123 They become more excitable and fire more readily in
response to stimuli. This phenomenon of central nervous system
excitation is known as “wind-up” or “facilitation”.125,126 Sensitized
neurons will, in some cases, trigger impulses spontaneously, long
after the initiating insult has ceased causing tissue damage or
irritation. Cells receiving muscle input in the intermediolateral
gray column of the spinal cord, where preganglionic autonomic

cell bodies reside, become hyperactive as well, propelling a loop
within the sympathetic system that participates in the process of
referred hyperalgesia.127
Central sensitization amplifies output to both visceral and somatic
structures. Sympathetic efferent neurons in the thoracic and
lumbar spinal cord segments join in this dysfunctional dance.
Muscles supplied by sensitized segments become tense due
to increased output through somatic motor neurons, causing
sustained muscle contraction. This engenders myofascial
dysfunction and trigger points.128 Heightened sympathetic tone
drives vasoconstriction and edema; it also amplifies tissue
tenderness and texture changes.129,130,131,132,133
Organs receiving neural input from “wound up” spinal segments
experience decreased perfusion due to sympatho-excitation.134,135
Conceivably, compromised blood flow in an organ could, over
time, lead to insufficiency or, ultimately, failure in that structure.
In the kidney, for example, activated renal sympathetic nerves
reduce renal blood flow, increase renin secretion, and increase
renal tubular sodium reabsorption.136 Should counteracting
autoregulatory controls falter or prove insufficient, hypertension
may result.137
In practice, an acupuncturist palpates the entire group of Back

Table 2-2
Sympathetic Input to the Back Shu and Front Mu Points157,158


Site of Synapse of
Pre- and Post-Ganglionic Sympathetic

Course of
Nociceptive Afferent
Pathways into the
Central Nervous

Associated Back Shu
Point and Vertebral

Associated Front Mu
Point and Dermatome

Lungs (including the
trachea and bronchi)

T2-T7, to upper thoracic
sympathetic ganglia

T2-T6 sympathetic

Afferents travel with
the sympathetics to the
dorsal root ganglion
neurons from T2-T7
and the vagus nerve
to the nucleus tractus
solitarius (NTS) in the

BL 13; T3

LU 1; C4,T2


T1-T5, to upper thoracic All cervical sympathetic
and cervical sympathetic ganglia and T1-T5
sympathetic ganglia

Afferents travel with the BL 14; T4
afferents in the middle
and inferior cervical
sympathetic cardiac
nerves and the thoracic
sympathetic cardiac
nerves and enter the
cord from T1-T5

CV 17; T4


T1-T5, to upper thoracic All cervical sympathetic
and cervical sympathetic ganglia and T1-T5
sympathetic ganglia

Afferents travel with the BL 15; T5
afferents in the middle
and inferior cervical
sympathetic cardiac
nerves and the thoracic
sympathetic cardiac
nerves and enter the
cord from T1-T5

CV 14; T7


T5-T10, to superior
thoracic (greater)
splanchnic nerves and
celiac plexus

Afferents travel with the BL 18; T9
sympathetics and enter
the cord from T5-T10

LR 14; T8, T9

Celiac ganglion

18 Section 1: The Science of Acupuncture Neuromodulation

Table 2-2 Sympathetic Input to the Back Shu and Front Mu Points, Continued

T5-T10, to superior
thoracic (greater)
splanchnic nerves and
celiac plexus

Celiac ganglion

Afferents travel with the BL 19; T10
sympathetics and enter
the cord from T5-T10

GB 24; T9

Spleen (Pancreas)

T5-T11, to superior
thoracic (greater)
splanchnic nerves and
celiac plexus

Celiac ganglion

Afferents travel with the BL 20; T11
sympathetics and enter
the cord from T5-T11

LR 13; T10, T11

Stomach and

T5-T11, to superior
(greater) and middle
(lesser) thoracic
splanchnic nerves and
celiac plexus

Celiac ganglion

Afferents travel with the BL 21; T12
sympathetics and enter
the cord from T5-T11

ST 25; T10

Triple Heater

T7-L2, to superior
(greater), middle
(lesser), and inferior
(least) thoracic
splanchnic nerves and
the first +/- second
lumbar splanchnic

Chromaffin cells of
adrenal medulla

None reported


T10-L2, to middle
(lesser) and inferior
(least) thoracic
splanchnic nerves and
the first +/- second
lumbar splanchnic
nerves → celiac and
renal plexuses

Celiac and aorticorenal

Afferents travel with the BL 23; L2
sympathetics and enter
the cord from T10 to L2

GB 25; T12

Large Intestine

• Cecum and
appendix: T10-T12
(cecum, appendix) to the
superior (greater) and
middle (lesser) thoracic
splanchnic nerves →
celiac and superior
mesenteric plexuses

Superior and inferior
mesenteric ganglia and
ganglia in superior and
inferior hypogastric

• Cecum and
appendix: Afferents
travel with the sympathetics and enter the
cord from T10 to T12

BL 25; L4
(receives sympathetic
supply from T10-L2)

ST 25; T10

BL 22; L1

CV 5; T11, T12

• Colon to the splenic
flexure: Afferents travel
with the sympathetics,
course through the
superior and inferior
mesenteric plexuses
and splanchnic nerves,
and into the cord from
T10 to L1

• Colon to the splenic
flexure: T10-L1 to
the middle (lesser)
and inferior (least)
thoracic and first lumbar
splanchnic nerves
• Splenic flexure
to the rectum: L1-2
through to the S2-S4
sacral chain ganglia, to
the lumbar and sacral
splanchnic nerves →
inferior mesenteric and
inferior hypogastric
pelvic plexuses, to the

• Splenic flexure to
the rectum: Travel with
the parasympathetic
nerves and the pudendal
nerves, into the cord at

Small Intestine

T8-12 right, T8-T11 left,
to the superior (greater)
and middle (lesser)
thoracic splanchnic
nerves to the celiac

Celiac and superior
mesenteric ganglia

Travel with the
sympathetics through
the celiac and inferior
mesenteric plexuses,
into the cord from

BL 27;
(receives sympathetic
supply from T10-L2)

CV 4; T12


T11-L2 to the middle
(lesser) and inferior
(least) thoracic
splanchnic nerves

Inferior mesenteric
ganglion and sacral
paravertebral ganglia

Travel with the
parasympathetic nerves
and some sympathetic
afferents, to enter the
cord at S2-S4 and L1-L2

BL 28;
S2 (receives sympathetic supply from

CV 3; L1

*The afferent pathways listed in this table only pertain to the nociceptive avenues. Afferent fibers carrying other sensory information exist but have not been included here.
**Note: Sympathetic input to each spinal level is generally multi-segmental. That is, the tissues located in the vicinity of the Back Shu points along the inner line of the Bladder channel
likely receive sympathetic supply from a spinal segment above and below that noted in the table.

Chapter 2:: Function Follows Form 19

Shu and Front Mu points in order to indirectly assess the function
of the related organs. The point-organ relationships in the Shu-Mu
system are arranged in a topographical fashion, with more cranial
organs such as the lung and heart relating to more upper thoracic
Shu-Mu point pairs, and more caudal organs such as the urinary
bladder and large intestine showing up in the caudal point pairs.
(See Table 2-2.)
Shu-Mu palpation should assess tension and tenderness in the
muscles beneath the point, rather than merely the skin or subcutaneous tissue. Pain referred from an irritated viscus begins in deep
somatic structures.138 However, trophic changes in the skin follow
visceral disturbances, as evidenced by thickened subcutaneous
tissue and atrophic skeletal muscle.139 When both members of the
Shu-Mu pair demonstrate tenderness to palpation, assessment of
that organ system would be prudent, since this may suggest visceral,
rather than predominantly somatic dysfunction.140,141,142,143,144
Upon finding tender