An Anatomical and Clinical Examination of Meridian and Meridian Point / 全日本鍼灸学会雑誌

Six members of the Research Committee for the Meridian Point (former Committee for the Meridian Point) reported on three themes regarding meridian and acupuncture point at Workshop II of the 54th Science Rally of The Japan Society of Acupuncture and Moxibustion held in Fukuoka.<BR>1st theme : Anatomical examination of the meridian and meridian point.<BR>1) Anatomic structure showing path and meridian running. (Kenji Matsuoka) : Similarity of meridian pathway and course of nerve and blood vessels in cadaver.<BR>2) Gross anatomical study of meridian and acupuncture point in upper limbs (Kansho Yamada) : Doctoral study of Katsuyosi Toyoda, former Nagoya City University School of Medicine researcher and Yamada's study (Relation between running of meridian & acupuncture point and subdermal nerve & blood vessels) were reported.<BR>2nd theme : Study of acupuncture safety depth in Japan and China.<BR>1) Research and progress situation of acupuncture safety depth in China. (WANG Cai Yuan) : Data of Yan Zhenguo, professor of anatomy at Shanghai University of Traditional Chinese Medicine, an authority on the study of acupuncture safety depth and progress situation of recent study of acupuncture safety depth in China.<BR>2) Retrospective study of acupuncture safety depth (Tomofumi Ozaki) : Study of acupuncture safety depth published by Ozaki to date and comparative study alongside Prof. Yan Zhenguo data.<BR>3rd theme : Examination of clinical effect of a few meridian points.<BR>1) Acupuncture clinical effect using a few meridian points (Syunji Sakaguchi) : Paper research and analysis of acupuncture clinical effects using 1-4 meridian points of Japana Centra Revuo Medicina.<BR>2) Inflence on skin energizing current by various acupuncture stimulation of LI4 (Gokoku) (Kazuhiro Morikawa) : Influence on the amount of skin energizing current by acupuncture stimulation, direct current electricity stimulation and stimulation of electroacupuncture to LI4.

A Consideration of Safely Applying Acupuncture of the Meridian Point (Gaohuang, Koko, BL43) based on Dissection of a Cadaver, and Clinical Findings and CT Radiographic Findings in Vivo / 全日本鍼灸学会雑誌

Acupuncture to Gaohuang carries a risk of causing pneumothorax because it reaches the lungs at deep portion. This study was designed to consider a safe depth for acupuncture to Gaohuang.<BR>1) We inserted a needle to Gaohuang on both sides of a cadaver to examine the location of the needle tip and measure the distance from the body surface of the left Gaohuang to the pleura. The tip was located at the fifth intercostal region on both sides, and the distance was 44 mm with a rib thickness of 10 mm. 2) Using 104 students, we inserted a needle to the left Gaohuang until the tip reached the rib, and measured the distance between the bodysurface and rib. The minimal distance was 14 mm. 3) We inserted a needle to Gaohuang on both sides of two males and took CT-radiographs to examine the location of the needle tip and measure the distance from the body surface of Gaohuang to the pleura. In a man of standard body size, the needle reached the rib on the left and the intercostal region on the right. The thickness of the left rib was 10.9 mm, and the distance from body surface to pleura was 33.6 mm on the left and 28.4 mm on the right. In a man of thin body size, the needle reached the rib on both sides, with the rib thickness was 9.8 mm on the left and 8.8 mm on the right. The distance from body surface to pleura was 29.4 mm on the left and 31.8 mm on the right. The above results showed that needle insertion within 19 mm (the minimal value of the measured distance between the body surface and rib + the half thickness of the rib) is safe.

An Anatomical Consideration on the Safety of a Meridian Point (Danchu, CV17) in Acupuncture Therapy / 全日本鍼灸学会雑誌

Aim : Since it was reported that acupuncture at Danchu (CV17) was critical when the needle penetrated through the congenital sternal foramen, we decided to study the incidence of the congenital sternal foramen, as well as the distance between the body surface and the back side of the sternum at Danchu, in order to know the safe depth of acupuncture penetration.<BR>Method : 1) We selected 51 cadavers to examine the incidence of congenital sternal foramen and, if any, to study its structure. We also selected 21 cadavers to measure the cadaveric thickness of the sternum. 2) We selected 31 people to measure the incidence of the congenital sternal foramen and the distancebetween the body surface and the back side of the sternum at the point of Danchu.<BR>Results : 1) We found one out of 51 cadavers which had congenital sternal foramen. The location of the foramen was at the height of the fourth intercostal space. It was round-shaped, 9mm in diameter, and filled with hard connective tissue. The thickness of the sternum ranged from 9 to 15mm with an average of 11.5 ± 2mm. 2) There was no one who had the congenital sternal foramen among the 32 people. The distance between the body surface and the back side of the sternum ranged from 11 to 31mm with an average of 18.8 ± 5mm.<BR>Conclusion; 1) The incidence of the congenital sternal foramen in this study was one in 51 cadavers and zero in 32 people. 2) We concluded that acupuncture at Danchu within a depth of 10mm is sufficiently, even if congenital sternal foramen exists.

An Anatomical Study of the Projection Region of the Dome of the Pleura to the surface of the Anterior Neck. (Part II). Geographical Relationship with the Sternocleidomastoid Muscle, Clavicle, and Acupuncture Points of the Lower Anterior Neck / 全日本鍼灸学会雑誌

Twenty-six domes of the pleura of thirteen cadavers were investigated. The summits of all domes protruded above the clavicle. Mediolateral positions of the summits were located between the lateral edge of the origin of the sternal head of the sternocleidomastoid muscle (CL3) and the lateral edge of the origin of its clavicular head (CL5), and their craniocaudal positions were located between the Point “Suitotsu” (S₁₀) and the medial edge of the origin of the clavicular head (CL4). The lateral edges of the domes did not reach the level of the clavicle. Their mediolateral positions were located between CL4 and the Point “Ketsubon” (S₁₂), and their craniocaudal positions were located between CL5 and the sternal extremity of the clavicle (CL2). The medial edges of the domes were both mediolaterally and craniocaudally located between CL2 and the suprasternal point. Projection regions of the domes of the pleura to the surface of the anterior neck were included, in all cases, within the quadrate region connecting the following four points: the Point “Suitotsu” (S₁₀), a point of intersection between the median line and a line drawn vertically from the Point “Suitotsu” (S₁₀) toward the median line, the suprasternal point, and a point on the clavicle corresponding to the medial one-third of the half shoulder width.

Anatomical consideration of the acupuncture to the pudendal nerve / 全日本鍼灸学会雑誌

The lower one-third point of a line connecting the posterior superior iliac spine and the middle of the lower margin of the ischial tuberosity is used as the acupuncture point to the pudendal nerve. The present study anatomically examined the positional relation between a needle inserted in the acupuncture point and the pudendal nerve as well as examined the projection region of the nerve to the body surface, using the bilateral pudendal nerves of 18 Japanese cadavers.<br>The needle inseted in the acupuncture point to the pudendal nerve missed the nerve caudally or laterocaudally in many cases, but with twelve cases directly pricking the caudal portion of the nerve. The pudendal nerve lying on the sacrospinous ligament was projected just on or lateral to a line connecting the posterior superior iliac spine and the medial edge of the lower margin of the ischial tuberosity, and in rostro-caudal direction the pudendal nerve was situated in a range 50 to 60% from the top of that line. The height of the sacral cornua corresponded to that of the rostral half of the pudendal nerve lying on the sacrospinous ligament or that more rostral than the rostral tip of the nerve, and the height of the lower tip of the coccyx corresponded to that more caudal than the caudal tip of the nerve.

Anatomical study of the projection region of the dome of the pleura to the surface of the anterior neck / 全日本鍼灸学会雑誌

The projection region of the dome of the pleura to the surface of the anterior neck was investigated in 31 domes of 17 cadavers. The point “Tentotsu”, and a line connecting that point and the most lateral edge of the acromion were adopted for a basis of measurement of the projection region. The mean length of the Tentotsu-Acromion line was 185mm on either side of the body. Its upward angle to the horizontal plane was 22° and 23° in average on the right and left sides, respectively, while its backward angle to the frontal plane was 23° on the right and 25° on the left. The right pleural domes (17 cases) were included within a range 0-58mm lateral to the Tentotsu and lower than 44mm above, and on the left side (14 cases), these values were 5-58mm and 49mm, respectively. On the other hand, when adopting the Tentotsu-Acromion line as the basis, the pleural domes were located within the medial one-third of the line. Their summits lay on the point of its medial one-fourth in medio-lateral direction, and were situated at levels lower than about 35 (on the right) or 32mm (on the left) above the line.

Topographic anatomical observations of the points of the posterior neck / 全日本鍼灸学会雑誌

The relation of needles inserted to the points of the posterior neck with the anatomical structures was investigated with dissection of four cadavers. The points investigated here are the five points of “Amon”, “Tenchuu”, “Fuuchi”, “Kankotsu”, and “Eifu”. The needles inserted to the respective points of the former three were found to penetrate the posterior atlantooccipital membrane and then the dura mater, and finally to reach the medulla oblongata. The depth from the inserted spots on the surface of the skin to the dura mater are 50, 51, and 49mm in the Amon, Tenchuu, and Fuuchi, respectively, in a cadaver with 39.1cm of circumference of the neck. Furthermore, it was found that the vertebral, the occipital, and the external carotid and the maxillar arteries were penetrated by or located near the needles which were inserted to the Fuuchi, Kankotsu, and Eifu, respectively.

Anatomical consideration to an acupuncture near the middle cervical or the vertebral ganglia / 全日本鍼灸学会雑誌

The incidences of the middle cervical and the vertebral ganglia and their sizes were investigated bilaterally during dissection of 18 cadavers. Furthermore, the positional relations of each ganglion to the vertebral column, the point Tentotsu, the anterior tubercle of the sixth cervical (C₆) vertebra, and the cricoid cartilage were investigated along with the relations of the anterior tubercle of the C₆ vertebra to the point Tentotsu and the cricoid cartilage. The middle cervical ganglion was 14, 4 and 2mm in average length, width and thickness, respectively, on the right, and on the left these values were 14, 5 and 2mm. The ganglion was found in about half the cases, and it was located at about the level of the cricoid cartilage and close laterally and above to the anterior tubercle of the C₆ vertebra. In the cases lacking the middle cervical ganglion, the sympathetic trunk passed immediately medial to the tubercle. The vertebral ganglion was found in almost all cases, with its mean size 8, 5 and 3mm on the right and 9, 5 and 2mm on the left in lenght, width and thickness, respectively. The ganglion was included in many cases within a range 15 to 30mm lateral and 20 (the left) or 25 (the right) to 45mm above the point Tentotsu, and it lay at the level of the C₇ vertebra. The anterior tubercle of the C₆ vertebra was within a range 20 to 30mm lateral to that point, and in the upper to lower direction, it lay at the level slightly upper than the cricoid cartilage in the male and at about the level of the cartilage in the female.

An anatomical observation of the pressure pain zone in the suprascapular region / 全日本鍼灸学会雑誌

A pressure pain, frequently associated by an induration, is usually perceptible in the suprascapular region of the normal subjects. We considered the relation of the pressure pain with the anatomical structures of that region, firstly by investigating the locus of the pressure pain and whether it is associated by an induration or not, using the living subjects and in several cases, followed by a X-ray examination of the final destination of the needle which was inserted in the pressure pain zone; and lastly by dissecting the anatomical structures penetrated by that needle in a woman's cadaver.<br>We obtained the follwing three results from the above investigation and observations. (1) The most conspicuous pressure pain was perceptible in the middle of the upper margin of the suprascapular region, and a long and slender induration extending sagitally was palpable there. (2) The second rib lay in the deepest layer of the pressure pain zone, the layer which were overlain by the serratus posterior superior muscle, the serratus anterior and the omohyoid, many branches of the transversus colli artery and vein and the accessory nerve, and the trapezius muscle with the posterior suprascapular nerves running on its superficial surface, in order of lower to upper layer. (3) The transversus colli vessels, which forms a complex network of branchings crossing sagitally above the second rib, was suggested to have some relationship to the occurence of the pressure pain associated by the induration, because only the formation of such vascular network was peculiar to the pressure pain zone.

Anatomical consideration of the acupuncture into the stellate ganglion / 全日本鍼灸学会雑誌

The anatomical structures penetrated by a needle which was inserted in an acupuncture point into the stellate gaglion, 1.5cm lateral to and 2.5cm above the point Tentotsu, were studied bilaterally with dissection of 19 cadavers. Furthermore, the size of the dissected stellate ganglion, its anatomical position, and its positional relation to structures located near it were measured or observed.<br>Though 8 out of 38 inserted needles pricked the medial margin of the ganglion, the remaining 30 needles all missed medially from the ganglion. In the cases pricking the ganglion, all of 8 needles penetrated either the vertebral or the subclavian artery before reaching the ganglion, and 7 of these did also the dome of the pleura in addition to the artery. In the cases missing from the ganglion, however, a frequency of penetrating the above structures were considerably lower.<br>The dissected stellate ganglion almost lay on beteen the mid-level of the vertebral body of the 7th cervical vertebra and the upper level of body of the second thoracic vertebra, with their mean size 27.1, 7.7 and 2.8mm in length, width and thickness, respectively. All of the ganglions were located dorsal to the vertebral and subclavian arteries and the dom of the pleura the distances from the median line to their upper and lower extremity being 21.9 and 22.7mm in average, respectively.<br>The pricked point for directly aiming at the stellate ganglion from the body surface is within a range 20 to 30mm lateral to and 10 to 40mm above the point tentotsu on the right, and on the left it is within a range 15 to 25mm lateral and 10 to 35mm above; the depth from the point is about 4.0 and 3.8cm on the right and left, respectively. But when directly aiming at the ganglion, the possibility of injuring the vertebral or subclavian artery and the dome of the pleura was suggested to increase considerably owing to their location ventral to the ganglion.

Anatomical position of the point jingei. (II). Relation between the acupuncture point to the carotid sinus and the bifurcation of the common carotid artery / 全日本鍼灸学会雑誌

The posional relation of the bifurcation of the common carotid artery to the needle which was inserted to the position of the bifurcation presumed from the level of the hyoid bone, as well as its relation to the hyoid bone and the transverse process of the cervical vertebra, has been studied bilaterally with dissection of 19 cadavers.<br>Though most of the inserted needles missed medially from the bifurcation of common carotid artery, all of them were located about the level of the bifurcation in the up-to-downward direction, with two cases directly pricking the bifurcation.<br>The bifurcation of the common carotid artery was mostly located about the level of hyoid bone. Thus, 17 cases out of 19 on the right side and 13 cases out of 18 on the left side were within a range of 1.0mm above or below the hyoid bone.<br>The height of the bifurcation of the common carotid artery against the cervical vertebrae was mostly located between the transverse process of the 3rd and that of the 4th cervical vertebra, 21 cases out of 28 being included within this range.

Anatomical position of the point Jingei. 1 Positional relation between the laryngeal prominence and the bifurcation of the common carotid artery / 全日本鍼灸学会雑誌

The positional relation between the point Jingei and the bifurcation of the common carotid artery was investigated with dissection of the neck after inserting a needle into the bilateral Jingei, using nineteen Japanese cadavers. We determined first the position of the point Futotsu as a point in the sternocleidomastoid lying about 10cm lateral to the laryngeal prominence along the neck wrinkle, and defined the location of Jingei in the cadavers as the mid-point between the laryngeal prominence and Futotsu mentioned above. The common carotid artery shows a dilatation, termed the carotid sinus, at its point of division into the external and internal carotid arteries. The needle did not prick the carotid sinus in all of the thirty-eight cases of insertion; it pricked the common carotid artery at a lower level than the carotid sinus in four of these cases, and in the other cases the needle did not prick the vessel, but rather a portion of the neck medial to the vessel at the lower level, similarly as in the former cases. The points of division of the common carotid arteries of the cadavers dissected were all located at a considerably higher level than the laryngeal prominence; the average level was 32.8mm higher than the prominence on the left, with maximum and minimum values of 52 and 11mm, respectively, and 29.9mm upper on the right (maximum and minimum values: 45 and 8mm). Furthermore, it was suggested that the insertion of a needle at the level of the hyoid bone has a higher possibility of reaching the carotid sinus than that at the level of the laryngeal prominence in acupuncture of the sinus.