ACUPUNCTURE - BEYOND NEUROHUMORAL THEORY*
Charles Shang, MD
at the 1999 Annual Symposium of the American Academy of Medical Acupuncture.
Acupuncture points and meridians have been
discovered to have high electrical conductance, which is related to
high density of gap junctions. A neurohumoral approach was instrumental
in establishing the scientific validity of acupuncture. However, it
is largely descriptive with little prediction power. It also has not
been able to explain many observations in acupuncture. Based on the
morphogenetic singularity theory, acupuncture points originate from
the organizing centers in morphogenesis. This theory explains several
long-standing puzzles in both developmental biology and acupuncture
research, including the distribution and non-specific activation of
organizing centers and acupuncture points, the high electrical conductivity
of acupuncture points, the polarity effect of electroacupuncture, and
the adverse effect profile of acupuncture, as well as the ontogeny,
phylogeny, and physiological function of the meridian and chakra systems.
Most of these concepts have not been explained by any neuroliumoral
theory. In several prospective blind trials, mainstream biomedical researchers
have confirmed its corollary on the role of singularity and separatrix
in morphogenesis, the predictions on the high electrical conductivity,
and the high density of gap junction at the organizing centers. These
advances have profound implications in biomedicine.
Neuroliumoral Theory, Meridians, Electrical Conductivity
to the standard acupuncture nomenclature proposed by the World Health
Organization (WHO),1 the meridian
system in acupuncture consists of about 400 acupuncture points and 20
meridians connecting most of the points. Since the 1950s, researchers
in several countries have discovered and confirmed with refined techniques2
that most acupuncture points correspond to the high electrical conductance
points on the body surface,3-7
and vice versa.8 The high skin
conductivity of the meridian system is further supported by the finding
of high density of gap junctions at the epithelia of the acupuncture
Gap junctions are hexagonal protein complexes that form channels between
adjacent cells. It is well established in cell biology that gap junctions
facilitate intercellular communication and increase electrical conductivity.
Acupuncture and meridian points also have been found to have a higher
temperature,13 higher metabolic
rate, and greater carbon dioxide release.8
The Neurohurnoral Approach
In acupuncture analgesia, the peripheral
nervous system has been shown to be crucial in mediating the effect.
The analgesia can be abolished if the acupuncture site is affected by
postherpetic neuralgia14 or
injection of local anesthetics.15
In other areas of acupuncture such as antihyperglycemic effects, studies
have shown that local blockade of peripheral nerves or denervation did
not interfere with the acupuncture effect.16,17
In the 1970s, the relationship between cerebral cortex and acupuncture
alteration of visceral function was explored by examining the cortical
evoked potentials, single unit discharges, and neurochernistry associated
with acupuncture. From these studies was formed the meridian-cortex-viscera
correlation hypothesis18: The
meridian system is independent and connected via the nervous system
to the cerebral cortex, and it acts through neurohumoral mechanisms.19
Recently, a more generalized acupoint-brain-organ model was proposed
stating that acupuncture first stimulates the corresponding brain cortex
via the nervous system, thereby controlling the chemical or hormone
release to the disordered organs for treatment.20
In the mid-1970s, the discovery of endorphin
induction in acupuncture analgesia and its blockade by naloxone played
a key role in establishing the validity of acupuncture in mainstream
science.21 Animals that respond
poorly to acupuncture analgesia can be rendered good responders by treatment
with D-phenylatanine, which inhibits the degradation of met-enkephalin.22
A close relationship between acupuncture
and the nervous system is also indicated by the large overlap between
acupuncture points and trigger points (points of maximum tenderness
in myofascial pain syndrome).23
These results have led some practitioners to believe that the meridian
system as described in the classic acupuncture literature does not exist,
and that all the effects of acupuncture are mediated through the nervous
Other scholars regard the neurally mediated acupuncture phenomena as
"not the central core of the mechanism of acupuncture."26
neurohumoral theory of acupuncture has been mostly descriptive with
little prediction power. It has difficulty explaining a number of phenomena
- The distribution of acupuncture points.
For example, an auricle has no important nerves or blood vessels and
no significant physiological function other than sound collection;
it, nevertheless, has the highest density of acupuncture points. According
to the World Health Organization, 43 auricular points have proven
of therapeutic value,1 which
make up 10% of the acupuncture points on the whole body.
- The nonspecific activation of acupuncture
points. Each type of nerve usually responds to certain specific modalities
of stimuli. The therapeutic effect of acupuncture can be achieved
by a variety of stimuli27,28
including needling, temperature variation, laser,29
ultrasound, vacuum, and pressure.
- The bi-directional regulation effect
of acupuncture. Conventional nerve stimulation usually results in
a unidirectional effect. For example, vagal stimulation slows down
the heart rate. Opioids inhibit gut motility. However, acupuncture
at PC 6 accelerates bradyeardia and decelerates tachycardia. Acupuncture
at ST 36 suppresses hyperfunction (as in diarrhea), and stimulates
hypofunction (as in constipation) of the gut motility.30
Therefore, proper use of acupuncture causes few adverse effects31-34
as demonstrated in randomized controlled trials,35,36
unlike most of the conventional nerve-stimulation therapies.
The Morphogenetic Singularity Theory
morphogenetic singularity theory,37
developed over the last 2 decades, is compatible with the neurohumoral
findings of the acupuncture effect, and also can explain many phenomena
in acupuncture beyond the neurohumoral theory.
Acupuncture Points Are Singular Points
in the Surface Bioelectrical Field
usually maintain a 30-100 mV difference across themselves.38
This voltage is the potential difference across cell layers, not membrane
potential. An acupuncture point, which has high density of gap junctions
and local maximum electrical conductivity, will also have locally maximum
electrical current density, a converging point of surface current. It
is a singular point of abrupt change in electrical current flow. A singular
point is a point of discontinuity as defined in mathematics. It indicates
abrupt transition from one state to another. Smal I perturbations around
singular points can have decisive effects on a system. As James Maxwell
observed, "Every existence above certain rank has its singular points
... At these points, influence whose physical magnitude is too small
to be taken account of by a finite being may produce results of the
The pattern of electromagnetic field on the human scalp mapped by SQUID
(superconducting quantum interference device)40
shows that the acupuncture point GV 20 Baihui is a singular point at
the surface magnetic field where the surface magnetic flux trajectories
converge and enter the inside of the body (Dr Magnus Lou, personal communication).
The Governor Vessel is a converging pathway of magnetic flux on the
scalp and also a separatfix that divides the surface magnetic field
into 2 symmetrical domains of different flow directions. (Separatrix:
a trajectory or boundary between spatial domains in which other trajectories
have different behavior.41)
Morphologically, the Governor Vessel is also the axis of symmetry on
the scalp. This pattern is consistent with the pattern of the meridian
system, but different from the distribution of any major nerve, lymphatic,
or blood vessel on the scalp. The morphogenetic singularity theory suggests
that the meridian system is related to the bioelectrical field in morphogenesis
and growth control.37
The Role of Electrical Field in Growth
Control and Morphogenesis
of cells are sensitive to electrical fields of physiological strength.42
Somite fibroblasts migrate to the negative pole in a voltage gradient
as small as 7 mV/mm.43 Asymmetrical
calcium influx is crucial in the migration, which can be blocked or
even reversed by certain calcium channel blockers and ionophores.44
In most cases, there is enhanced cell growth toward cathode and reduced
cell growth toward anode in electrical fields of physiological strength.45,46
Fast-growing cells tend to have relative negative polarity due to the
increased negative membrane potential generated by the mitochondria
at a high rate of energy metabolism.47
Imposed electrical fields can cause polarization of mouse blastomeres,48
reversal of anterior-posterior polarity,49
and dorsal-ventral polarity50
in lower animal morphogenesis.
Organizing Centers Have High Electrical
In development, the fate of a larger region
is frequently controlled by a small group of cells, which is termed
an organizing center.51
Organizing centers are the high electrical conductance points on the
body surface.37 The amphibian
blastopore, a classic organizing center, has high electrical conductivity
and current density.52 Similar
phenomena also have been observed in higher vertebrates.53
The high conductivity phenomenon is further supported by the finding
of high density of gap junctions at the sites of organizing centers.54-57
At the macroscopic level, organizing centers are singular points in
the morphogen gradient and electromagnetic field.38
Disruption of the electrical field at the organizing center can cause
A change of electrical activity at the organizing
centers correlates with signal transduction and can precede morphologic
For example, in amphibians, an outward current can be detected at the
site of a future limb bud (an organizing center) several days before
the first cell growth.60
Acupuncture Points Originate From Organizing
Both acupuncture points and organizing
centers have high electrical conductivity, current density, and high
density of gap junctions, and can be activated by nonspecific stimuli.
The therapeutic effect of acupuncture can be achieved by a variety of
stimuli, as mentioned above. Similarly, morphogenesis of organizing
centers can be induced by various stimuli such as mechanical injury
and injection of nonspecific chemicals.51,61
Meridian - Separatrix Boundary
stages of embryogenesis, gap junction mediated cell-cell communication
is usually diffusely distributed, which results in the entire embryo
becoming linked as a syncytium. As development progresses, gap junctions
become restricted at discrete boundaries, leading to the subdivision
of the embryo into communication compartment domains.62
These boundaries are major pathways of bioelectrical currents and divide
the body into domains of different electrical currents. Separatrices
can be folds on the surface or boundaries between different structures,
and often connect singular points.37,63
Meridians are separatrices37
and related to an underdifferentiated,9
interconnected cellular network that regulates growth and physiology.
The attributes of separatrix are consistent with the observation in
the Inner Classic (Nei Jing) that meridians lie at the boundaries between
different muscles. For example, part of the lung meridian runs along
the borders of the biceps and brachioradialis muscles. Part of the pericardiurn
meridian runs between the palmaris longus and flexor carpi radialis
muscles. Part of the gallbladder meridian runs between the sternocleidomastoid
and trapezius muscles. Trigger points also tend to locate at the boundaries
of muscles.63 The Governor
Vessel and the Conception Vessel are the axis of symmetry of the body
surface and the boundaries of many different structures. They are also
regarded as the convergence of all meridians in traditional acupuncture.
Consistent with the under-differentiation of the meridians, it has been
observed that the most apical part of folds remains undifferentiated
in morphogenesis,64 including
organizing centers such as the apical ectodermal ridge.65
Why Do Auricles Have the Highest Density
of Acupuncture Points?
The distribution of acupuncture points
and organizing centers is closely related to the morphology of the organism.
For example, the auricle, which has the most complex surface morphology,
also has the highest density of acupuncture points. Although an auricle
has no important nerves or blood vessels and no significant physiological
function other than sound collection, its morphology is one of the most
sensitive signs of malformations in other organs. Auricular malformation
has been observed in maternal diabetes, atherosclerosis,66
and the following syndromes: Turner, Potter, Treacher Collins, Patau,
Edwards, Noonan, Goldenhar, Beckwith-Wiedemann, DiGeorge, Cri-du-chat,
and fragile X. It is recommended in a standard textbook of pediatrics
that any auricular anomaly should initiate a search for malformations
in other parts of the body.67
Based on the phase gradient model in developmental
many organizing centers are at the extreme points of curvature on the
body surface such as the locally most convex points (e.g., the apical
ectodermal ridge and other growth tips), or concave points (e.g., the
zone of polarizing activity). Similarly, almost all the extreme points
of the body surface curvature are acupuncture points; for example, the
convex points include EX-UE 11 Shixuan, EX-LE Qiduan, ST 17 Ruzhong,
ST 42 Chongyang, ST 45 Lidui, SP I Yinbai, SP 10 Xuehai, GV 25 Suliao,
and EX-HN3 Yintang. The concave points include CV 17 Danzhong, KI 1
Yongquan, LI 5 Yangxi, LU 5 Chize, LU 7 Lieque, LU 8 Jingqu, LU 10 Yuji,
Sl 19 Tinggong, TE 21 Ermen, GB 20 Fengchi, GB 30 Huantiao, BL 40 Weizhong,
HT I Jiquan, SI 18 Quanliao, BLI Jingming, CV 8 Shenque, and ST 35 Dubi.
The Role of the Meridian System in Evolution
In ontogeny, the development of organizing
centers in the growth control system precedes the development of the
nervous system and other physiological systems. The formation and maintenance
of all the physiological sy stems are directly dependent on the activity
of the growth control system. As the individual embryonic development
recapitulates the evolution of the species (ontogeny recapitulates phylogeny),
the evolutionary origin of the meridian system as an intercellular signal
transduction system of growth control is likely to have preceded
all the other physiological systems, including the nervous system. Its
genetic blueprint might have served as a template from which the newer
systems evolved. Consequently, it overlaps and interacts with other
systems but is not simply part of the nervous system. The meridian signal
transduction is embedded in the activity of the function-based physiological
systems. The regulation of many neural, circulatory, or immune processes
is through growth control mechanisms such as hypertrophy, hyperplasia,
atrophy, apoptosis with shared messenger molecules, and common signal
transduction pathways involving growth control genes such as proto-oncogenes.69-73
Acupuncture also induces the expression of the proto-oncogene c-fos.74,75
Many "nonexcitable" cells have shown electrochemical oscillation, coupling,
long-range intercellular communication,59,76,77
and can participate in the meridian signal transduction.
A Unified Basis of Meridian and Chakra
Based on the morphogenetic singularity
theory, the distribution of the meridian system is related to both internal
and external structures, and not solely determined by nerves, muscles,
or blood vessels. The distribution is a result of morphogenesis. Therefore,
acupuncture points that are not at obvious extreme points of surface
curvature, or meridians that are not at obvious surface boundaries,
may be vestigial or more related to internal structures. The under-differentiated,
interconnected cellular network is not limited to the body surface.
The distribution pattern of a certain type of primary tumors reflects
the distribution of its normal counterpart. For example, the distribution
of primary pheochromocytoma reflects the distribution of normal sympathetic
ganglion cells. One type of the least differentiated cells is the germ
cell. Germ cell tumors78,79
have a midline and para-axial distribution pattern that spans from the
sacrococcygeal region, through anterior
mediastinum, tongue, nasopharynx, to pineal gland. It appears to concentrate
at 7 locations: sacrococcygeal region, gonads, retroperitoneum, thymus,80
thyroid,81 suprasellar region,
and pineal gland.82 The pattern
resembles the chakra system used in yoga and acupuncture,83
suggesting the existence of under-differentiated cells that may be highly
interconnected in a normal state as part of the "inner meridian system,"
and provide important regulatory functions.84
Mechanism of Meridian System-Based Diagnosis
As the electrical conductance of organizing
centers varies with morphogenesis, the conductance of acupuncture points
also varies and correlates with physiological change3
The fact that the change in electrical field precedes morphologic change,60
and manipulation of the electrical field can affect the change,87
may shed light on the diagnosis86,88
and treatment of many diseases. According to the theory,37
the network of organizing centers retains its regulatory function through
high levels of intercellular communication correlated with relatively
low levels of cell differentiation after embryonic development. This
prediction is consistent with the finding that the high electrical conductivity
persists at the organizing centers after early embryogenesis.89
The organizing centers may communicate with other parts of the body
to maintain proper forms and functions. Gap junctional communication
has been shown to play a crucial role in morphogenesis.90
The gap junction genes also can behave as classic tumor suppressor genes
both in vitro and in animal tests in restoring growth regulatory properties
to metastatic cancer cells.91
An anomaly inside the organizing center network may be detected by measuring
the electrical parameters of some points on its surface at the early
signal transduction stage, and treated by manipulation of the interconnected
The activation of organizing centers is likely
to be involved in the restoration of proper form and function in wound
healing and stress response. Acupuncture can speed up the wound healing
process92 and cause an exaggerated
systemic wound healing and stress response.93,94
The response can include excessive release of endorphin, which stimulates
epithelial cell growth,95 as
well as analgesia. Other neurohumoral factors induced by acupuncture
such as serotonin96 and adrenocorticotropic
(ACTH) hormone97 also have
in clectroacuptincture is that positive (anode) pulse stimulation of
a point inhibits its corresponding function, while negative (cathode)
pulse stimulation enhances the function.99
This polarity effect is similar to the finding that cell growth is enhanced
toward cathode and reduced toward anode,45,46
and consistent with the theory that the mechanism underlying acupuncture
overlaps with that of growth control.
Why Does Acupuncture Have a Normalizing
Effect and Few Adverse Effects?
the often nonspecific perturbation at singular points (acupuncture points)
may not directly antagonize a pathological process, but may indirectly
adjust the process and restore normal function by activating the network
of organizing centers in the organism. The activation of the self-organizing
activity is less likely to cause the adverse effects resulting from
directly antagonizing a pathological process, which often overlap with
other normal and beneficial physiological processes.
morphogenetic singularity theory outlines the common ground shared among
the meridian system, chakra system, and modem sciences. It is compatible
with the findings from neurohurnoral studies. It explains several long-standing
puzzles in both develop mental biology
and acupuncture research, including the distribution of the meridian
and chakra systems, germ cell tumors, the nonspecific activation of
acupuncture points and organizing centers, the high electrical conductivity
of acupuncture points, the polarity effect of electroacupuncture and
adverse effect profile of acupuncture, as well as the ontogeny, phylogeny,
and physiological function of the meridian system. Most of these have
not been explained by any neurohumoral theory. In several prospective
mainstream biomedical researchers who were unaware of the theory confirmed
its corollary on the role of singularity and separatrix in morphogenesis,
and its predictions of the high electrical conductivity and high density
of gap junctions at the organizing centers such as blastopore and zone
of polarizing activity.
Techniques involving the stimulation of the
meridian system such as acupuncture and qigong 100,101
may activate the self-organizing system of an organism, and improve
its structure and function at a more fundamental level than symptomatic
relief Development of these techniques may enable the diagnosis and
treatment of a pathologic process at the early signal transduction stage
prior to the anatomical or morphological change.
advances reviewed above have broad implications in biomedicine beyond
acupuncture. The current stage of research on acupuncture and medicine
is analogous to that of physics in the early 19th century, at the transition
from Newtonian mechanics to electromagnetics. Many questions remain
unanswered. More spectacular advances similar to that of relativity
and quantum physics may await us in the next century, and will depend
on the further development of meridian "electromagnetics." Many other
areas such as psychophysiology, chronobiology,102
and pulse analysis103 related
to the meridian system are awaiting more rigorous studies. Many details
of the current theories remain to be clarified and tested.
the neurohumoral studies, the following directions of research are likely
to be important in further understanding acupuncture and the meridian
- Mapping of the meridian system and
the dynamics of its electromagnetic field with high-resolution techniques
such as SQUID.
- The relationship between the physical
parameters of the meridian system and various pathological or physiological
changes, including changes during acupuncture and qigong practice.
- Developing acupuncture-related techniques
of early diagnosis and treatment; establishing their cost-effectiveness.
- Clarifying the role of the meridian
system in morphogenesis and growth control.
- Cell differentiation and signal transduction
in the meridian system.
- Mapping the body surface curvature
through embryonic development with imaging techniques; studying its
relation with the meridian system.
Dr David Diehl, Dr James Gordon, Dr Richard Hammerschlag, Dr Magnus
Lou, Dr San Wan, and others for their advice.
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C. Shang is a Primary Care physician in the Dept of Medicine at Emory
University School of Medicine. He was a featured speaker at the annual
conference of the Society for Acupuncture Research last year, and the
Annual Symposium of the American Academy of Medical Acupuncture (Chicago,
Charles C. Shang, MD
Dept of Medicine
Emory University School of Medicine
69 Butler St Atlanta, GA 30303
Phone, Fax: 770-457-7743 - E-mail: firstname.lastname@example.org