The meridian system is a systematic order of empirical knowledge functioning as a rational ground for a balanced treatment by combining meridians. In TCM theory, a continuous circulation of Qi through 12 meridians is postulated, described as the Chinese clock (CC). On this basis, combinations of meridians and acupoints had been described in historical writings. The most common is the interior/exterior system beside the neighbouring system, the opposite clock system, and three systems, developed out of the theory of the six stages. All of these represent symmetrical combinations, which were defined by the steps in the CC. We calculated the possible combinations that fit into the systematics of the historical descriptions, leading to 19 systems. Merging the data of the 19 systems, possible steps in the CC clock for balancing a meridian are 1, 2, 3, and 6. Step 4 is not possible. Step 5 is a combinatory possibility but has no widespread tradition except for activating the yin extraordinary vessels. These possibilities can be plotted on the CC as a powerful tool for daily practice. Only two meridians might be excluded as potentially balancing meridians, so it seems almost impossible to define noneffective acupuncture points as controls in clinical trials.
This circle of meridians in the Chinese clock is divided into three cycles, cycle 1 (LU, LI, ST, SP), cycle 2 (HT, SI, BL, KI), and cycle 3 (PC, TE, GB, LR) [19, 20]. A logical explanation for dividing the circle into three cycles is hard to find. We think there is a connection to the three human body surfaces by using an anatomical model of an upright standing person with the arms hanging down on the side, with the thumbs pointed frontwards and the 5th finger pointed toward the back. This is exactly the stance of most bronze models used for training acupuncture, especially since the redefinition and compilation of Wang Wei-yi, which was described in the Illustrated Manual on the Points for Acupuncture and Moxibustion on the New Bronze Model in about 1026 [21]. Cycle 1 can be connected to the frontal part of the body, cycle 2 can be connected to the dorsal part of the body, and cycle 3 can be connected to the lateral/medial side of the body. By dividing the Qi-flow into three cycles, circulation of Qi through three body surfaces, the frontal, dorsal, and lateral/medial parts of the human body, makes most sense to us (Figure 1).
Acupuncture 1 2 3 Richard Tan Pdf 89
Cross needling in general was first described in Chapter 63 of Suwen. Applying this to the meridian circle is very popular and is called the opposite clock needling in one school [36] and is a basis for special techniques in Japanese acupuncture [24]. This system combines LU and BL, LI and KI, ST and PC, SP and TE, HT and GB, and SI and LR. Anatomically very distant areas of the human body are connected in a Yin-Yang combination.
The possibilities for finding a balanced treatment strategy can be described by the steps that have to be taken in the Chinese clock to combine acupuncture points. Merging the data of all systems, the steps in the Chinese clock showing a possibility for balancing are the following. Step 1, 2, and 3 are possible as well as Step 6. Step 4 is not a combinatorial possibility. Step 5 is a combinatorial possibility but has no tradition in TCM, except in the theory of the extraordinary vessel. A summary is given in Table 3. In addition, the affected meridian itself can be treated. In practice, when the affected (painful) area has been identified, (sensitive) ashi points on one or several of the chosen associated meridians can be found in correlated regions to the affected area. Pain can be reduced instantly by needling these ashi points [36].
In some patients painful affections can be found not only on a defined meridian area but also in regions between meridians. In these cases, pain-releasing ashi points are often needled between associated meridians, which was already described and discussed in the Systematic Classic of Acupuncture and Moxibustion [23] and is consistently used in some modern schools [36, 46, 47]. Additionally we can learn from acupuncture microsystems and related techniques, for example, Chinese and French ear acupuncture, Korean hand acupuncture, hand and foot reflexology, that other somatotopies exist which partly overlap with the classical meridian system. In consequence, defining anatomical regions without any influence on other regions seems extremely difficult. The use of needle insertions at locations distant from acupuncture points defined in acupuncture textbooks as controls in clinical trials is not suitable as an inert placebo [48].
Increasing the number of treatment options does not mean that all treatment strategies have similar power, but it shows that manipulation in multiple areas of the body surface can be potentially effective in acupuncture treatment. Generally a case can be solved successfully by different treatment strategies, but it is good to know which treatment is not very likely to solve a problem or could do some harm to the patient. Knowing different treatment possibilities is especially helpful in pain management, where usually a fast effect is needed for quick pain relief. There might be an area of repletion (fullness) on the body surface which helps to choose the right meridian. But the search should not be limited to the painful meridian and its interior/exterior partner as practised by acupuncturists still at the beginning of their careers. The search for an effective treatment should be more extended to find all treatment possibilities. Further research is necessary to distinguish which system might be most useful for different clinical conditions.
Following these considerations only two meridians might be excluded as potentially balancing meridians on the basis of TCM theory. For application in treatment further appraisal of the results is necessary. For acupuncture trials most meridians and acupuncture points must be considered as potentially effective, so it seems almost impossible to define noneffective acupuncture points as controls. 2ff7e9595c
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