From Oct. 20-22, 2007, the World Federation of Acupuncture-Moxibustion Societies (WFAS) held an international conference celebrating its 20th anniversary in Beijing. At this meeting, a forum of contemporary acupuncture mechanisms and meridian research with a system biology theme sparkled a high volume of interest from attendants.
I was honored to meet its co-chair, Guan-Yuan Jin, MD, LAc, author of Contemporary Medical Acupuncture - A Systems Approach. Dr. Jin is recognized as one of the world's pioneers in systems theory and contemporary medical acupuncture. He is the director of Ace Acupuncture Clinic of Milwaukee, where he has been practicing for the past 20 years. Among his many accomplishments, he served on the Acupuncture Advisory Committee for the state of Wisconsin for more than 15 years and helped gain statewide proclamations for "Acupuncture and Oriental Medicine Day" in 2004. He currently serves as an honorary professor of Guangzhou University of Chinese Medicine in China and is the founding president of the International Institute of Holistic Medicine.
Yun-tao Ma (YTM): Dr. Jin, your forum of contemporary acupuncture mechanisms and meridian research during WFAS' 20th anniversary meeting received high praise and remarks from its attendants due to its systems biology theme. Does that mean our fellow TCM colleagues are finally catching on the importance of applications of systems theory in the research fields of TCM?
Guan-Yuan Jin (GYJ): I believe so. It is about time that TCM research, including acupuncture and meridian theories, moves through loopholes and fruitless cycles, and enters a higher, more systems level of pondering.
YTM: Systems ideologies have always been one of most valuable wisdoms deeply rooted in TCM. Why is systems biology now being re-emphasized in the research of acupuncture/meridian mechanisms?
GYJ: While it is true that we have more knowledge about the essence of meridians or the mechanisms of acupuncture today than before, the challenges of conducting a systemic consideration for both of them remain similar to the recent progress in the field of biology. Because a system of cell or organism is not just an assembly of genes and proteins, its properties cannot be fully understood merely by drawing diagrams of their interconnections. While an understanding of genes and proteins continues to be important, the focus is on the understanding of a system's structure and dynamics, rather than just the characteristics of isolated parts of a cell or organism.
Just a few years ago, a theory of "systems biology" [was] created and made an instant impact on the pharmaceutical industries. Similarly, an understanding of ancient theories and techniques of acupuncture at the system level can propel the modernization of acupuncture. Applying a systems approach to develop acupuncture and the meridian theory is a truly enlightened direction and shall be the one we need to focus on.
YTM: Can you briefly go over the evolution of systems theory and its latest applications in TCM?
GYJ: Well, it goes back to the late 1970s in China. The meridian phenomenon was primarily studied using cybernetics back then and was categorized as a type of information exchange within the body. Over time, the view of whole-body reflex zones was further innovated to replace the meridians, and a systems methodology was proposed to overcome various challenges in applying this external therapy. The perspective of systems theory/cybernetics and contemporary physiology establish a novel theory of acu-reflexology and show that the meridians are merely systems of physiological and pathological reflexes in the body, and that acupuncture therapy belongs to a type of reflexotherapy.
YTM: I read that you always try to use a systems approach to deal with acupuncture processes and meridian mechanisms in your clinical practice. What's the main difference between your systems approach and the classical systems theory?
GYJ: In the classical systems theory, including the information theory as well as cybernetics, complex mathematical models were often used to study the transmission, storage and alteration of information during the controlling process, while less attention is paid to the biological meanings of that information. My systems approach, however, is much simpler, as it focuses on establishing practicable models of biology or physics, and typically deals without mathematical models. For example, the phrase acupuncture information is used to represent various acupuncture signals with a certain stimulation amount or other characteristics of the sequence. These signals may be from different types of physical stimulation, such as manual acupuncture, thermal stimulation from moxibustion, electrical stimulation from electrical acupuncture, and so on.
In addition, the pathways of acupuncture information and their feedback circuits are used to represent tissue structures of components in reflex arcs and their biological characteristics. Actually, many contemporary studies in physiology are accomplished this way. In the field of contemporary acupuncture, application of the systems methodology is helpful not only in clarifying the essence of meridians and mechanisms of acupuncture, but also in guiding acupuncture and raising its level of certainty in clinical effectiveness.
YTM: You mentioned that the reflective connection between the body surface and the interior is considered the basis for all meridian phenomena and acupuncture effects. Can you explain the reasoning behind it?
GYJ: Until now, many studies on the essence of meridians have been done via modern anatomical or chemical-tracing methods. However, no particular structures other than those recognized in modern anatomy have yet been found within acupoints or along the traveling courses of the meridians. Moreover, numerous clinical practices have demonstrated that the effects of acupuncture depend on intact neural reflex arcs. When any part of the reflex arc is disconnected, such as the blockage of sensory afferent or motor-efferent nerves by local anesthesia or pressure interventions, or lesion of the reflex centers, all needling sensations and acupuncture effects will be lost.
YTM: You defined reflex zones as those regions of the body surface where reflex points or acupoints with similar efficacies lodge, or where referred pains and other reflex phenomena appear frequently. What are the differences among reflex points, sensitive points, tender spots and trigger points?
GYJ: In the modern clinical acupuncture, many alternative names of acupoints are proposed to describe the properties of stimulation locations. These include reflex points, sensitive points, tender spots, and trigger points that often appear in miscellaneous publications. However, generally speaking, their definitions are vague and frequently confuse the readers. Strictly speaking, those locations on the body surface with a detectable response due to reflective mechanisms should be called reflex points. In my opinion, I believe reflex points are the most appropriate in expressing reflective connections between certain locations on the body surface with corresponding viscera or other tissues. Clinically, reflex points are often found within the scopes of acupoints (i.e., locations where most reflex points appear are consistent with that of classic acupoints or extraordinary points). However, this does not indicate that acupoints are just reflex points, because many reflex points reside off the meridian courses.
YTM: "Better missing acupoints than the meridian" is a classical TCM statement. You proposed an alternative statement: "Better missing the meridian than reflex points." Why the dispute?
GYJ: The classical statement indicates that the courses of meridians are more important than the locations of acupoints. In other words, acupoints at the same meridian mostly have similar effects, or they may have certain variations of the locations throughout the meridian courses. However, based on my clinical experience, I propose an alternative statement with a more extensive connotation: Better missing the meridian than reflex points. Reflex points should always be chosen regardless of where they appear, on or off of the meridian courses.
Lately, large quantities of clinical studies have demonstrated that in order to propagate needling sensations to arrive at the diseased region easily, one must select corresponding reflex points as stimulation locations. Apparently, there are shortcuts between reflex points and corresponding organs or tissues located at other portions of the body, so as long as a mild stimulation is applied, intense needling sensations and sometimes even warmness can be generated and propagated toward distal reflective organs or tissues.
YTM: Certainly, the concept of the reflex points is a big leap forward in acupuncture medicine. It is important to all acupuncture clinicians because it is based on clinical evidence. Thank you, Dr. Jin, for your time. I hope that our peers will join in the effort in closing the gap between East-West medicines.
GYJ: You're welcome. Indeed, there are still many challenges ahead in the development of TCM and the full integration of East-West medicines, I believe everyone associated with acupuncture and TCM research has a responsibility to contribute and continue to do their part in moving it toward a science-based, art-propelled popular health care for mankind.
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