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Meridian therapy

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meridian therapy
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What is Meridian Therapy
What is meridian massage therapy?
Meridian therapy side effects

What is Meridian Therapy

Meridian therapy is better known as acupuncture derived from traditional Chinese medicine. In traditional Chinese medicine, meridians are channels that form a network in your body, through which the body’s vital energy known as “qi” flows  flows and that connect the body’s acupuncture sites 1. Blocked qi causes pain or illness. The flow of qi is restored by using pressure, needles, suction, or heat at hundreds of specific points along the meridians. Meridians are not real anatomical structures, scientists have found no evidence that supports their existence 2. Major proponents of their existence have not come to any consensus as to how they might work or be tested in a scientific context. Some advocates of traditional Chinese medicine believe that meridians function as electrical conduits based on observations that the electrical impedance of a current through meridians is lower than other areas of the body. A 2008 review of studies found that the studies were of poor quality and could not support the claims 3. The National Council Against Health Fraud concluded that “the meridians are imaginary; their locations do not relate to internal organs, and therefore do not relate to human anatomy” 4.

According to the Chinese meridian theory, there are 12 primary meridians or channels (also called Principal Meridians) and eight additional meridians, each following a particular directional course along the body 5. A vital energy known as qi flows through these meridians and participates in the homeostatic regulation of various bodily functions. Along the meridians are approximately 360 points that serve as both pathognomonic signs of disorder and as loci for acupuncture treatments 6. When the normal flow of energy over a meridian is obstructed (e.g., as a result of tissue injury or a tumor), pain or other symptoms result. Chinese medicine proposes that the purpose of acupuncture therapy is to normalize energy flow, thereby relieving the symptoms by stimulating specific sites (acupuncture points) on the meridians 7. In acupuncture treatment, stainless steel needles, usually ranging from 0.22 mm to 0.25 mm in diameter, are inserted into relevant acupuncture points to stimulate the affected meridians. A needling sensation known as de qi sensation occurs, in which the patient may feel heaviness, numbness, or tingling during an acupuncture treatment. Length and frequency of treatment vary according to the condition being treated. An acupuncture treatment course for cancer symptoms or treatment of side effects is often given as multiple sessions per week 8. Needles are typically left in place for 15 to 30 minutes after insertion, and their effects may be augmented with manual or electrical stimulation and/or heat (e.g., moxibustion or heat lamps).

The 12 standard meridians are divided into Yin and Yang groups. The Yin meridians of the arm are the Lung, Heart, and Pericardium. The Yang meridians of the arm are the Large Intestine, Small Intestine, and Triple Burner. The Yin Meridians of the leg are the Spleen, Kidney, and Liver. The Yang meridians of the leg are Stomach, Bladder, and Gall Bladder 9.

Figure 1. Human body meridians

Human body meridians

Table 1 below gives a more systematic list of the 12 standard meridians 10:

Table 1. 12 Standard Meridians (Principal Meridians)

Meridian name (Chinese)Quality of Yin or YangExtremityFive ElementsOrganTime of Day
Taiyin Lung Channel of Hand (手太阴肺经) or Hand’s Major Yin Lung MeridianGreater Yin (taiyin, 太阴)Hand (手)Metal (金)Lung (肺)寅; yín; 3 a.m. to 5 a.m.
Shaoyin Heart Channel of Hand (手少阴心经) or Hand’s Minor Yin Heart MeridianLesser Yin (shaoyin, 少阴)Hand (手)Fire (火)Heart (心)午; wǔ; 11 a.m. to 1 p.m.
Jueyin Pericardium Channel of Hand (手厥阴心包经) or Hand’s Absolute Yin Heart Protector MeridianFaint Yin (jueyin – 厥阴)Hand (手)Fire (火)Pericardium (心包)戌; xū; 7 p.m. to 9 p.m.
Shaoyang Sanjiao Channel of Hand (手少阳三焦经) or Hand’s Minor Yang Triple Burner MeridianLesser Yang (shaoyang, 少阳)Hand (手)Fire (火)Triple Burner (三焦)亥; hài; 9 p.m. to 11 p.m.
Taiyang Small Intestine Channel of Hand (手太阳小肠经) or Hand’s Major Yang Small Intestine MeridianGreater Yang (taiyang, 太阳)Hand (手)Fire (火)Small Intestine (小肠)未; wèi; 1 p.m. to 3 p.m.
Yangming Large Intestine Channel of Hand (手阳明大肠经) or Hand’s Yang Supreme Large Intestine MeridianYang Bright (yangming, 阳明)Hand (手)Metal (金)Large Intestine (大腸)卯; mǎo; 5 a.m. to 7 a.m.
Taiyin Spleen Channel of Foot (足太阴脾经) or Foot’s Major Yin Spleen MeridianGreater Yin (taiyin, 太阴)Foot (足)Earth (土)Spleen (脾)巳; sì; 9 a.m. to 11 a.m.
Shaoyin Kidney Channel of Foot (足少阴肾经) or Foot’s Minor Yin Kidney MeridianLesser Yin (shaoyin, 少阴)Foot (足)Water (水)Kidney (腎)酉; yǒu; 5 p.m. to 7 p.m.
Jueyin Liver Channel of Foot (足厥阴肝经) or Foot’s Absolute Yin Liver MeridianFaint Yin (jueyin, 厥阴)Foot (足)Wood (木)Liver (肝)丑; chǒu; 1 a.m. to 3 a.m.
Shaoyang Gallbladder Channel of Foot (足少阳胆经) or Foot’s Minor Yang Gallbladder MeridianLesser Yang (shaoyang, 少阳)Foot (足)Wood (木)Gall Bladder (膽)子; zǐ; 11 p.m. to 1 a.m.
Taiyang Bladder Channel of Foot (足太阳膀胱经) or Foot’s Major Yang Urinary Bladder MeridianGreater Yang (taiyang, 太阳)Foot (足)Water (水)Urinary bladder (膀胱)申; shēn; 3 p.m. to 5 p.m.
Yangming Stomach Channel of Foot (足阳明胃经) or Foot’s Yang Supreme Stomach MeridianYang Bright (yangming, 阳明)Foot (足)Earth (土)Stomach (胃)辰; chén; 7 a.m. to 9 a.m.

The eight additional meridians are of pivotal importance in the study of Qigong, Taijiquan and Chinese alchemy 11. These eight extra meridians differ from the standard twelve organ meridians in that they are considered to be storage vessels or reservoirs of energy and are not associated directly with the Zang Fu, i.e. internal organs.

The eight extraordinary vessels are 12:

  1. Conception Vessel (Ren Mai) – 任脈; rèn mài
  2. Governing Vessel (Du Mai) – 督脈; dū mài
  3. Penetrating Vessel (Chong Mai) – 衝脈; chōng mài
  4. Girdle Vessel (Dai Mai) – 帶脈; dài mài
  5. Yin linking vessel (Yin Wei Mai) – 陰維脈; yīn wéi mài
  6. Yang linking vessel (Yang Wei Mai) – 陽維脈; yáng wéi mài
  7. Yin Heel Vessel (Yin Qiao Mai) – 陰蹻脈; yīn qiāo mài
  8. Yang Heel Vessel (Yang Qiao Mai) – 陽蹻脈; yáng qiāo mài

Classical techniques of acupuncture include the following:

  • Needling
  • Moxibustion
  • Cupping

Acupressure, using fingers or mechanical devices to apply pressure on acupuncture points is based on the same principles as acupuncture. Moxibustion is a method in which an herb (Artemisia vulgaris) is burned above the skin or on an acupuncture point for the purpose of warming it to alleviate symptoms. Cupping promotes blood circulation and stimulates acupuncture points by creating a vacuum or negative pressure on the surface of the skin 7. During the past several decades, various new auxiliary devices have been developed. Acupuncture devices such as electro-acupuncture machines and heat lamps are commonly used to enhance the effects of acupuncture.

In addition to classical acupuncture techniques, other techniques have been developed. These include trigger point acupuncture, laser acupuncture, acupuncture point injection, and techniques focusing on particular regions of the body such as:

  • Auricular acupuncture
  • Scalp acupuncture
  • Face acupuncture
  • Hand acupuncture
  • Nose acupuncture
  • Foot acupuncture
  • Wrist-ankle acupuncture

Of these, auricular acupuncture is the most commonly used.

In clinical practice, most acupuncturists in the United States practice the traditional theories and principles of Chinese medicine. A 2017 survey of 472 licensed acupuncturists in the San Francisco Bay area reported that 77% were caring for patients with cancer, and 44% have training that is specific to the needs of patients with cancer 13.

Although acupuncture has been practiced for millennia, it has come under rigorous scientific investigation only recently. In 1976, the U.S. Food and Drug Administration (FDA) classified acupuncture needles as investigational devices (class III), resulting in a number of research studies on the effectiveness and safety of acupuncture 14. In November 1994, the Office of Alternative Medicine (the predecessor of the National Center for Complementary and Integrative Health) at the National Institutes of Health (NIH) sponsored a workshop on the status of acupuncture needle usage. Two years later, the FDA reclassified acupuncture needles as medical devices (class II) without, however, giving specific indications for their use 15. In 1997, National Institutes of Health held a Consensus Development Conference on acupuncture to evaluate its safety and efficacy. The 12-member panel concluded that promising research results showing the efficacy of acupuncture in certain conditions have emerged and that further research is likely to uncover additional areas in which acupuncture intervention will be useful. The panel stated that “there is clear evidence that needle acupuncture treatment is effective for postoperative and chemotherapy nausea and vomiting.” It also stated that there are “a number of other pain-related conditions for which acupuncture may be effective as an adjunct therapy, an acceptable alternative, or as part of a comprehensive treatment program,” and it agreed that further research is likely to uncover additional areas in which acupuncture intervention will be useful 14. The NIH Consensus Panel concluded that “acupuncture can cause multiple biological responses,” local and distal, “mediated mainly by sensory neurons…within the central nervous system” 14. Acupuncture “may also activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects,” including “alterations in peptides, hormones and neurotransmitters and the regulation of blood flow” 14. The effect of acupuncture on chronic inflammatory pain has been studied 16. Evidence suggests that acupuncture operates through the autonomic nervous system to balance the sympathetic and parasympathetic systems and suggests that the anti-inflammatory effects of acupuncture are mediated by its electrophysiologic effects on neurotransmitters, cytokines, and neuropeptides 17. Many studies provide evidence that opioid peptides are released during acupuncture and that acupuncture analgesia is mediated by the endogenous opioid system 18.

Although the mechanism of acupuncture is not fully understood, it has been proposed that beneficial results are mediated by changes in neurohormones and cytokines. Animal research suggests that acupuncture achieves its anesthetic effect by stimulating nerves in the muscle, which then relay the signal to the spinal cord, midbrain, and hypothalamus-pituitary system, ultimately triggering release of neurotransmitters and hormones, such as endorphins and enkephalins 19, 20.

Laboratory and animal cancer studies have also explored the mechanisms of acupuncture through the activation and modulation of the immune system. Previous animal and human studies have suggested that acupuncture worked through immunomodulation, with significant changes in cytokines including interleukin (IL)-1, IL-6, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-alpha) 21. These studies were limited by small sample size and occasional conflicting results. Acupuncture has been associated with significant changes in proinflammatory cytokines including IL-1-beta, IL-6, IL-17, and TNF-alpha 22. In addition, studies showed that acupuncture needle manipulation stimulated surrounding connective tissues and sensory nerves 23 and affected adenosine-mediated peripheral sensory modulation 24.

Acupuncture treatment points are located by using standard anatomic landmarks and comparative anatomy. Electroacupuncture is the most commonly used treatment intervention; a few studies have used moxibustion 25. These studies show that acupuncture may boost animal immune function by enhancing NK cell and lymphocyte activity 25. According to one animal study 26, acupuncture may be a useful adjuvant for suppressing chemotherapy-induced vomiting.

Although several studies published in China examined the effect of acupuncture on the human immune system 27, most cancer-related human clinical studies of acupuncture evaluated its effect on patient quality of life. These investigations mainly focused on cancer symptoms or cancer treatment–related symptoms, predominantly cancer pain 28 and chemotherapy-induced nausea and vomiting 29. Studies have also evaluated the effect of acupuncture on radiation-induced xerostomia (dry mouth), proctitis, dysphonia, weight loss, cough, thoracodynia, hemoptysis, fever, esophageal obstruction, poor appetite, night sweats, hot flashes in women and men 30, dizziness, fatigue, anxiety, and depression in cancer patients 31. The evidence from most of these clinical studies is inconclusive, despite their positive results; either poor research design or incompletely described methodologic procedures limit their value 32. There is controversy about the most appropriate control for acupuncture, which also limits the interpretability of the results of clinical trials 33. The positive results of the studies on chemotherapy-induced nausea and vomiting, which benefit from scientifically sound research designs, are the most convincing. A 2018 retrospective analysis of prospectively collected data of 375 cancer survivors who received acupuncture treatments at the MD Anderson Cancer Center Integrative Medicine Center outpatient clinic showed that patients experienced short- and long-term improvement in multiple symptoms including hot flashes, fatigue, numbness, tingling, and nausea 34.

What is meridian massage therapy?

During a meridian massage, several acupressure points on your body are massaged with different hand techniques such as kneading, tapping, and cupping. These techniques target the tissue underneath the skin to stimulate the release of tension to cause a state of relaxation throughout the body. Meridian massage therapy is done by a trained massage therapist and aim to help the body’s return to normal health after injury or with muscular-skeletal disorders. It is mainly used to treat chronic muscular-skeletal imbalances, strains, sprains, broken bones, bruising or any injury where the skin is intact.

Some common conditions that may be treated with meridian massage therapy are:

  • Achilles tendon injury
  • Tendinitis
  • Shin splints
  • Groin strain
  • Cartilage damage
  • Tennis elbow
  • Frozen shoulder
  • Hamstring injuries
  • Plantar fasciitis
  • Scar tissue
  • Adhesions
  • Whiplash
  • Carpal Tunnel syndrome
  • Repetitive Strain Injury (RSI)

Meridian therapy side effects

Serious side effects of acupuncture are rare. Reported accidents and infections appear to be related to violations of sterile procedure, negligence of the practitioner, or both 35. A systematic review of case reports on the safety of acupuncture, involving 98 papers published in the English language from 22 countries during the period from 1965 to 1999, found only 202 incidents. The number of incidents appeared to decline as training standards and licensure requirements were enhanced. Among the 118 (60%) reported incidents involving infection, 94 (80%) involved hepatitis, occurring mainly in the late 1970s and early 1980s. Very few hepatitis or other infections associated with acupuncture have been reported since 1988, when widespread use of disposable needles was introduced and national certification requirements for clean-needle techniques were developed and enforced as an acupuncture licensing requirement 36.

Minor adverse effects of acupuncture such as the following, have been reported:

  • Pain at needling sites.
  • Hematoma.
  • Tiredness.
  • Lightheadedness.
  • Drowsiness.
  • Localized skin irritation.

These minor adverse effects can be minimized by appropriate patient management, including local pressing and massage at the needling site after treatment 37.

Acupuncture in children has not been studied extensively; however, adverse effects appear to be rare and limited to the same effects as observed in adults 38. At least one study has shown that there was no increased incidence of adverse events in children with thrombocytopenia or neutropenia 39.

References
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