ACUPUNCTURE FROM A
PATHOLOGIST'S PERSPECTIVE:
LINKING PHYSICAL TO ENERGETIC

By Amelia Lynn Dolson, M.D., Private Practice, Pathology, Tallahassee, Florida

ABSTRACT
Mesenchyme contains energetically-active material, and would be a logical affector through which the myriad secondary effects of acupuncture may take place. This simple line of reasoning unifies embryology, pathology, and human biology, helping to link our understanding of the physical manifestations of disease with the energetic.

KEYWORDS
Mesenchyme, Acupuncture, Ground Substance, Egg, Ear, Collagen, Branchial Arches, Embryology, Germ Layers, Trophocollagen, Connective Tissue, Morphogenesis, Piezoelectric

INTRODUCTION
Understanding the human body requires multi-faceted, diverse approaches to different paradigms. If there is truth to the paradigms, they must be mutually compatible; otherwise, they are only elaborate sets which contain such themes as the explanation of the movements of the heavens before the Copernican Revolution. Individually, the paradigms resemble the blind man in the Buddhist story of six blind men and an elephant. Each of the men, reflecting his own perspective of the world, has a different interpretation of what an elephant is: a rope, a hose, a wall, a fan, and a tree. Nonetheless, it is the same elephant.

Similarly, many different perspectives on health and disease exist: Ayurvedic medicine, traditional Chinese medicine, Western science, acupuncture energetics, homeopathy, and numerous theologies. Assessing the credibility of these perspectives requires mutual compatibility. It is one and the same body.

The purpose of this article is to explore an evolving attempt to reform the different paradigms into a unified whole. My own perspective as a pathologist trained in acupuncture allows me to examine acupuncture from a Western science point-of-view.

The general concept for discussion is that the energetic system was critical embryologically as an electromagnetic map; the points are the residual of organizing centers in the electromagnetic field. These were critical to guide morphogenesis and to coordinate development. In the fully-formed human, they maintain their original embryologic connection and function to nourish the tissues and integrate the systems of the organism.

A review of embryology is in order. We each began life as a single cell. Upon fertilization, cortical granules are extruded, and the perivitelline space forms. In some species, research has shown that the egg rotates under the influence of gravity within the perivitelline space, not unlike a rotating car compass. The fertilized egg also coordinates itself into an animal pole, which develops into the embryo proper; and a vegetal pole, which gives rise to supporting tissues, including trophoblast and yolk. The animal pole maintains an upward orientation; the vegetal pole, a downward one.

In acupuncture energetics, it has been hypothesized that there is an energy matrix in each cell, in a form analogous to the exceptional or curious meridians (1). There is a central axis, Chong Mo; an equatorial belt, Dai Mo; and front and back circumferences, Ren Mo/Du Mo (Governor and Conception Vessels). Experiments with frog eggs suggest how this may be set up. Gerhart showed that the egg's ability to move within and respond to the gravitational field is impor tant (2). The perivitelline space (lubricant) was dehydrated and the eggs rotated 90-180 degrees, which held them fixed and unable to correct for gravity. The embryos that developed were very abnormal compared to the unrotated controls; the most common abnormality being imbalanced Siamese twins. In various experiments, the polarity of the egg is also shown to be influenced by direct electrical current, unilateral light, presence of neighboring eggs, acidity differences, temperature gradients, Ca++ ions, and the site of sperm entry (3).

After the fertilized egg divides, the cells of the developing embryo communicate via gap junctions, beginning at the 8-cell stage (4). This can be demonstrated by the cell-to-cell transfer of fluroscein dye. As the embryo becomes more complex, this dye transfer becomes limited to presumptive lobules. Ionic communication, by contrast, continues throughout embryonic development. This communication is essential for coordinating cellular differentiation, directing synchronized growth, organogenesis, and morphogenesis. Without communication, the growing cells would grow more as a tumor mass, with growth and cellular necrosis dictated heavily by the availability of local nutritive materials.

In the formation of the human embryo, day-11 welcomes the development of primitive mesenchyme. Day-16 sees mesoderm as a prominent layer. Mesenchyme forms isolated angiogenctic cell clusters on day-18. The nervous system is first seen on day-19, with the development of the neural plate; day-20, the development of the neural groove; days 20-2 1, the heart tubes fuse. Days 22-23 sees the branchial (pharyngeal) arches begin forming (more about these later); days 24-25, the early circulatory system gets under way with the development of the aortic arches. Note that the circulatory system develops from the mesenchyme. Primitive vessels form from the mesenchyme, and are induced to grow by preexisting areas of mesenchyme (5).

Appreciating this from another perspective requires considering the tunicate egg, whose organ -forming areas are well mappedout (6,7). Figure A, Illustration I shows the locations of prospective parts mapped out on the fertilized egg; Figure A, Illustration 2 depicts the 8-cell stage in side view; Figure A, Illustration 3 shows the larva in transverse section, with the fates of the mapped regions. Notice that the Yang portion of the egg is the area where the epidermis, brain, and neural plate arise; these elements on the larva are on the outside and top. The Yin portion of the egg is where the gut develops; in the larva, this moves to the inside and bottom. Connecting Yang to Yin, and in between, is a part that scientists refer to as the "grey crescent." This is observed soon after fertilization, mapping out to developing muscle, mesenchyme, and notochord. In the larva, these structures continue to connect Yin to Yang; are interposed between Yin and Yang tissues.

Experiments in which tunicate eggs are bisected also show the importance of the three areas (8). When the egg is bisected near the equatorial plane, the portion with the animal pole and little vegetal pole does not develop past an early stage. The portion, with only the vegetal pole, grows into a large blastula. Conversely, if the egg is bisected at the axis, the two portions grow into non-nal larvae, half the normal size.

Interesting to consider, is a passage from the Fifth Century, B.C. author, Laotse's writing in Tao Te King, "The Tao creates the One. The One creates the Two. The Two generates the Three, but the Three generates all things." Regardless of the original intention of this quote, there is a meaning that seems to resonate with embryologic development. The egg in this scenario is the One; it creates the Two, meaning the animal and vegetal poles (which represent Yin and Yang). The Two generates the Three, relating to 10 the development of the grey crescent, and representing the mesoderm. The three germ-cell layers subsequently give rise to all the cells and tissues of the body.

Reviewing these three germ-cell layers, we are reminded that the Yang tissues arise from the ectodenn (epidermis, epithelium of sense organs, nasal cavity, sinuses, mouth, anal canal, and nervous tissue). The Yin tissues arise from the endoderm (epithelium of the pharynx, larynx, trachea, lungs, digestive tube, bladder, and urethra). The mesoderm gives rise to all types of muscle and connective tissue, including cartilage, bone and notochord, blood, bone, bone marrow, lymphoid tissue, epithelium of blood vessels, lymphatics, body cavities, kidney, ureter, gonads, genital ducts, and joint cavities. The mesoderm is first seen in the fertilized egg as the grey crescent in the human embryo at day-11; it is a distinct layer between the endoderm and ectoderm by day-16.

In addition to the cellular components of the mesoderm, very important extracellular ones, commonly called ground substance or extracellular matrix, exist. This material forms and/or responds to the electric field which is guiding morphogenesis. The ground substance is excreted into extracellular space, having been manufactured inside the cell. It consists largely of glycosylaminoglycans (i.e., proteoglycans and glycoproteins), and collagen, providing structural support. In addition, it is informational and modulates the phenotypic expression and growth rates of nearby cells.

The first ground substance materials to consider are glycosylaminoglycans (mucopolysaccharides or GAGS). These are large sugar polymers, formed of a repeating disaccharide, where one sugar is an amino sugar. These GAGS are extremely acidic and heavily charged. Often associated with protein complexes and named proteoglycans or glycoproteins, they are amorphous, extremely viscous, and occupy a huge volume. They have electrostatic interactions with collagen (9); provide hydration and swelling pressure to withstand compressional forces. Research has shown that GAGS are physiologically very important in a wide variety of functions. They are responsible for charge selectivity in glornerular filtration. White blood cells are primed for inflammatory mediator and cytokine production by binding to proteoglycans. Therefore, they can profoundly affect the progress of an inflammatory response. Once outside, they are self-organizing. GAGS also have measurable electrostatic interactions with collagen. Histologically, they are seen as the delicate ground substance between embryonic cells. Much of this is replaced in later development by collagen fibers.

Conversely, collagen, the other major component of ground substance (extracellular mesenchyme), is along fibrous protein of very high tensile strength. It is the major component of connective tissues of the skin, cartilage, bone, tendon, and cornea. Figure B depicts it as a superhelix, a helix formed of three helical units in short segments (10). It has a very unusual amino acid sequence which cannot form alpha-helical or other secondary structures. It must remain at least partially in its fully-extended configuration. There is periodicity on several levels: the amino acid sequence, its construction in short pieces made inside the cell, and postsynthetic modifications outside. This periodicity is seen on electron micrographs as a regular banding pattern.

Several researchers have discovered how collagen appears to play an important role in this story. Becker noted that when examining the electron paramagnetic resonance spectra of bone components, a distinct difference exists between the signals exhibited by water-immersed, and nonwater-immersed, collagen (11, 12). He attributed this difference to the ability of the collagen fiber to structure absorbed water to a high degree. In 1956, Luyet and Rapataz examined ice crystals in different materials, and found that they looked the same in all (Figure C), except for gelatin (i.e. collagen), which was remarkably different (13). Gelatin polarizes water in multilayers; with an increase in concentration, there was a decrease in the freezing point and the rate of freezing. If concentrated enough, it will not freeze at all. Both findings demonstrate that water in the body is not in solution, but heavily organized. Interestingly, in 1972, when Albert Szent Gyorgyi was asked how he defined life, he said, "Life is water dancing to the tune of solids" (14). This "dance of the water" molecule provides the physical basis for every image obtained by magnetic resonance imaging (15).

Collagen is also piezoelectric, resembling quartz crystal (16) The piezoelectric effect is the appearance of electric charges on the opposite faces of a crystal of low symmetry, when it is subject ed to a mechanical strain. The opposite also occurs when the deformation or strain results when an electric field is applied to the crystal. Therefore, the piezoelectric effect links mechanica strain and electrical polarization. It converts electrical informa tion into mechanical information, and vice versa. Several biolog ical compounds known to possess this property include: collagen myosin, actin, fibrin, wood, and silk. Thus, collagen is a biologic transducer, capable of converting environmental stimuli into bio logically recognizable signals for controlling growth and resorp tive processes. Where collagen fibers meet the mineral apatite crystals of bone is a PN junction diode (17, 18).

Collagen is made intracellularly as trophocollagen. After it is exported, it self-assembles in extracellular space. When experi menting with trophocollagen in solution, Becker found that i assembled randomly when free in solution. This was very differ ent (Figure D) from when it assembled under the influence of an electric field (19). He applied this information to understand how collagen enters into bone-healing. It is also interesting to compare collagen deposition in normal skin versus scar tissue (Figure E) The two collagen deposition patterns (random when free in solution and parallel to each other, but perpendicular to the field) are demonstrated in two portions of a skin re-excision. When scar tissue forms at the site of injury, there is parallel uniform orientation of collagen fibers and fibroblasts, parallel to the skin surface, and perpendicular to the electric field of injury. Normal skin has a more random orientation of collagen. The randomness appears to reflect collagen deposition in fetal development and early childhood, when extracellular water is similar to being in solution.

Collagen being piezoelectric is important to our undertanding of orthopedic pathology, particularly in bone and soft tissue disease, and relating to bone fracture and scar healing. In the late 1800s in Germany, Dr. Wolff noted that the growth response of living bone was along lines of mechanical stress. This is known as "Wolff's Law." In the late 1960s, Becker, an orthopedic surgeon, related this process to the semiconducting properties of the bone matrix itself (20). He described how a mechanical stress causes a physical deformation of collagen which, through the piezoelectric effect, results in a biphasic signal. This is rectified through the apatite-collagen PN junction diode providing a direct current signal, which results in either bone growth or bone absorption. If the pathways are taken together, the body is analogous to a large computer. Stressed to osteopathic physicians is the theory that all the fascia in the body are connected as a unit.

Some aspects of aging also relate to collagen. Aging has been shown to increase the covalent cross-linking of collagen (which is at least partially reversible). This has profound effects on the physiochernical and biological properties of collagen. It includes the ease with which collagen can be extracted and dissociated, dropping markedly with age, until it is essentially insoluble by the time of maturity in mammals (2 1). Collagen accounts for 30-40% of the body protein.

Marsh and Beam conducted very simple but elegant experiments with planaria [flatworms] (22). They found that planaria possess a natural polarity. Cut pieces will re-grow a complete worm with the same orientation. This orientation could be reversed with an artificial electric field. They concluded that an animal's electric field was the morphogenetic organizing principle.

Consider the body's electric field, our rules of needle manipulation (i.e., clockwise-tonify, counterclockwise-deplete), and, the right hand rule from physics (Figure F). The latter is used to determine the direction of current flow in a magnetic field. When the right hand conceptually grasps an electric field with the thumb pointing in the direction of the current, the fingers curl in the direction of the magnetic field. It appears the rules of needle manipulation are a corollary of this. By turning (torquing) the electric field in one direction or another, current is moved either in or out of the body at that point, depending on the direction of the rotation applied.

In embryology, as the embryo develops, large and small connective tissue pathways become apparent. Wherever there are vascular structures, there is a comparable amount of connective tissue. This mesenchyme arises at a very early stage, and it is apparent soon after fertilization as the grey crescent. With development, mesenchyme envelops muscle fibers and organ lobules; it precedes the introduction of vascularization and nervous system development. It includes complexes that are heavily-charged and electrically-active. It forms the basis of, and/or responds to, the electric field of the body. It is an inducer of epithelial differentiation (embryonic induction), acting in concert with extrinsic agents. It forms a communication network between cells involved in the process of coordinating synchronous growth and communication. Changes in the electrical field precede the changes in morphology, and correlate with signal transduction.

Electrically, acupuncture points are seen as sinks or sources in the morphogen gradient, phase gradient, and electromagnetic field (23). Acupuncture points are thought to represent the organizing centers in morphogenesis and growth control. The meridian system, therefore, is a network of organizing centers.

When acupuncture points are examined in tissue specimens, it is clear how anatomically pin-pointed the locations are. Grossly and histologically, the points are major surface-accessible connective tissue pathways (Figure G); linking the body with its distant parts, as well as the energy mainframe (i.e., curious meridian network).

Ear acupuncture is a well-established modality, with full homuncular representation. Does embryology shed any light on this? The external ear develops from the branchial or pharyngeal arches (Figure H), which are swellings, or bars of mesenchymal tissue in the neck area of the embryo. They begin on day 22-23 in the human, and are first visible externally as pharyngeal pouches on day-25. Branchia, literally, means gill; in fish, the second branchial arch, the operculum, grows over and protects the others, which become the gills. In humans, the arches contribute to the formation of the head and neck, and are crucial to the formation of the circulatory system.

The mesenchyme of each arch gives rise to, receives, and directs a branch of the very primitive arterial system, the aortic arches. The final circulatory system bears only some of the original aortic arches (Figure I).

The external ear forms from six mesenchymal swellings, the auricular hillocks, which are produced by proliferation of mesenchyme from the first and second branchial arches. The lobule is the last to form. A cross section of the base of the ear, where it connects to the scalp, demonstrates the mesenchymal connections (Figure J).

Other microsystems have a similar embryologic origin. The tongue has tremendous diagnostic utility and likewise, develops from the branchial arches. The oral portion develops from the mandibular arches; the pharyngeal portion from the union of the second branchial arch, with important contributions from the third and fourth. The neck diagnostic zone of Yamamoto's system of scalp acupuncture, is on the lower neck in the same area as the fifth branchial arch. Apparently, the branchial arches maintain their early embryonic connections, becoming the basis for some of the microsystems in acupuncture.

The scalp in Yamamoto's new scalp acupuncture has very powerful microsystems for neurological conditions in the form of homunculi (i.e., organized collections of points in the configuration of the human body). The mesoderm of the face and scalp develops immediately next to the early developing brain, perhaps forming direct connections. Possibly, the frontal prominence (and posterior scalp) have similar mesenchymal connections as the other microsystems, not unlike a branchial arch 0. There is a wellaccepted homunculus in Western science literature in the motor and sensory cortexes of the brain.

The hands and feet also have fascinating energetic connections. The limb buds first appear on day-28 as lateral swellings, with cores of mesenchyme and a covering of ectoderm. Limbs appear as paddles, with differential growth and progression forming the fingers.

Salamander limb regeneration appears to be an identical process (24). Two weeks after amputation, the blastema develops. This is a cellular ball of undifferentiated, totipotent cells resulting from cellular de-differentiation. The capacity to form the distal parts resides in a limited mesenchymal region at the apex of the elongating bud. A currently popular analogy is to explain the phe nomena of human fingers and toes as programmed cell death an( growth (implying genetic control). Not only is this difficult to believe, but the "programming" of the blastema may or may not b. "lost" if it is moved to a different region of the embryo. This further supports the notion of an electric morphometric field guiding the process. Perhaps the microsystems of the hands and feet are the residua of this mesenchymal field with its retained connections.

Histology provides many interesting demonstrations of ener getic physiology. For example, there is a Yin and Yang relation ship between normal breast lobules and ducts, and the surround ing mesenchyme. It has been hypothesized that the mesenchyme plays an important role in inducing breast disease, including breast cancer (25).

Consideration of the cytoskeleton is also interesting. There is an intracellular framework formed of actin and myosin, both of which have the same piezoelectric properties as collagen (26 This indicates that the energy system of the entire body is not only continuous throughout, but that it also continues into every cell.

It is established in literature that neuropeptides are involved in the response to acupuncture treatment. However, the association appears too complex and the list of players too long to be the pri- mary affector. There does seem to be, however, no doubt as to its importance as a secondary role.

Connective tissue, including the extracellular matrix, has a extraordinary role in development. It is structural, informational modulates phenotypic expression, and modulates the growl rates of cells adjacent to it. The popular notion of connective tis- sue in Western science is analogous to filler material not unlit that used for packing boxes for shipping, with additional glue-lit properties for tissue repair. It is ironic that there is a more profound meaning to connective tissue... that it is the conduit of the energy network, literally, connecting the body. It is also logic that the major conduits of information and nutrients would travel together. Furthermore, it should come as no surprise that what began as a unified whole, the egg, should remain unified throughout development.

CONCLUSION
Incorporating energetic mechanisms with biochemical, genetic, cellular, immunologic, and mechanical ones allows a more complete understanding of disease pathogenesis and health, Varied approaches to the body fit together like the pieces of a puz-zle. No one aspect by itself is complete without the others.

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AUTHOR INFORMATION
Dr. Amelia Lynn Dolson is a pathologist in private practice in Tallahassee, Florida. She is boarded in anatomic and clinical pathology and cytopathology. Dr. Dolson trained in acupuncture in 1995 at UCLA College of Medicine.

Amelia Lynn Dolson, M.D.
1899 Elder Court
Tallahassee, Florida 32308-4389
Phone: 850-893-1637 - Fax: 850-942-6622 - Email: Amiddleway@IBM.net