Abstract
BackgroundA conceptual model of lateral muscular tension in patients presenting thyroid associated ophthalmopathy (TAO) has been recently described. Clinical improvement has been achieved by using acupuncture on points belonging to the so-called extraordinary meridians. The aim of this study was to characterize the anatomical structures related to these acupuncture points by means of 3D MRI image rendering relying on external markers.MethodsThe investigation was carried out the index case patient of the lateral tension model. A licensed medical acupuncture practitioner located the following acupuncture points: 1) Yin qiao mai meridian (medial ankle): Kidney 3, Kidney 6, the plantar Kidney 6 (Nan jing description); 2) Yang qiao mai meridian (lateral ankle): Bladder 62, Bladder 59, Bladder 61, and the plantar Bladder 62 (Nan jing description); 3) Dai mai meridian (wait): Liver 13, Gall bladder 26, Gall bladder 27, Gall bladder 28, and Gall bladder 29. The points were marked by taping a nitro-glycerin capsule on the skin. Imaging was done on a Siemens Magnetom Avanto MR scanner using an array head and body coil. Mainly T1-weighted imaging sequences, as routinely used for patient exams, were used to obtain multi-slice images. The image data were rendered in 3D modus using dedicated software (Leonardo, Siemens).ResultsPoints of the Dai mai meridian – at the level of the waist – corresponded to the obliquus externus abdominis and the obliquus internus abdominis. Points of the Yin qiao mai meridian – at the medial side of the ankle – corresponded to tendinous structures of the flexor digitorum longus as well as to muscular structures of the abductor hallucis on the foot sole. Points of the Yang qiao mai meridian – at the lateral side of the ankle – corresponded to tendinous structures of the peroneus brevis, the peroneous longus, and the lateral surface of the calcaneus and close to the foot sole to the abductor digiti minimi.ConclusionThis non-invasive MRI investigation has revealed the anatomical relations of acupuncture points belonging to 3 of the so-called extraordinary meridians. We conclude that the clinically developed "WOMED concept of lateral tension" is related to tendino-muscular structures.
Highlights
A conceptual model of lateral muscular tension in patients presenting thyroid associated ophthalmopathy (TAO) has been recently described
Acupuncture is a fundamental component of Traditional Chinese Medicine (TCM) used in therapeutical settings
The naming of the acupuncture points reflects the knowledge of the universe, i.e. the structures found in Heaven and Earth, of early Chinese medicine such as described in the Nan jing textbook [2,3]
Summary
A conceptual model of lateral muscular tension in patients presenting thyroid associated ophthalmopathy (TAO) has been recently described. Textbooks on acupuncture describe a learning process based on the observation of changes of the surface of the body in relation to disease conditions. Based on these clinical experiences, the so-called meridians have been classically recognized and described [1]. Langevin and Yandow have described an intramuscular connective tissue cleavage plane at an acupuncture point based on ultrasound examination with a 7 MHz probe [14]. Besides these attempts, little has been done to implement high resolution imaging technology for the description of the anatomy of acupuncture points in-vivo
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