[Repost] Preface to 'Anatomical Atlas of the Five Shu Points'

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Many TCM scholars and acupuncturists who genuinely practice acupuncture clinically, diligently study classical texts, and deeply appreciate the value of classical acupoints wish to clarify precisely what anatomical structures these acupoints correspond to.

Some skepticism and opposition toward this research stem more from entrenched conceptual habits and interpretive frameworks formed under the long-standing absence of a clearly revealed physical basis for acupoints. Because the precise anatomical nature of acupoints remained undefined in the past, some gradually interpreted them as invisible, non-dissectible, and unverifiable entities—eventually developing highly individualized theoretical systems detached from both classical literature and clinical evidence. Once research on the physical structure of acupoints demonstrates an observable, palpable, and verifiable anatomical foundation, naturally, certain interpretations built upon the premise of “unclear physical basis” lose their original explanatory space—and inevitably challenge existing concepts and discursive frameworks. Thus, during the early stages of this research—especially around the time of the “Press Conference on Anatomical Findings of Common Structural Features of the Five Shu Points”—external criticism and pressure were intense. Some failed to understand why a surgeon would study TCM acupoints; others hastily labeled this rigorous clinical anatomical research with various superficial tags. Faced with such voices, we neither had the energy nor the need to respond to each one individually. Ultimately, only facts, methodologies, and empirical evidence can truly answer such criticisms.

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Preface

It has been over four years since we began investigating the physical anatomical structures of classical acupoints.

As the first volume of Anatomical Atlas of Physical Structures of Classical Acupoints—titled Anatomical Atlas of Physical Structures of the Five Shu Points—is about to be published, reflecting on the path traveled over these years evokes profound emotion. A surgeon who has long stood beneath the surgical microscope, specializing in hand and foot micro-reconstructive surgery and clinical anatomy, has ultimately entered the ancient, complex, and controversial domain of classical acupoints—an outcome that, looking back, indeed seems astonishing. In the past, I was unfamiliar with Traditional Chinese Medicine (TCM), and even held certain preconceptions; prior to this, I never imagined I would one day engage in research on TCM acupoints.

Micro-reconstructive surgery is my primary clinical specialty, and clinical anatomy has been a major focus of my work for decades. Whether it is total thumb/finger reconstruction, complex limb reconstruction, or clinical anatomical research in hand/foot microsurgery and microsurgery, these have all formed a relatively clear and stable academic trajectory for me. Judging from this established academic path, I seemingly had no reason to suddenly shift into a research field entirely outside my original expertise—one fraught with controversy and considerable uncertainty. Moreover, as a “Western medicine” surgeon studying classical acupoints, misunderstanding was almost inevitable: the TCM community might not initially trust that a surgeon could truly comprehend classical acupoints; meanwhile, Western medical colleagues might likewise struggle to understand why a surgeon already deeply engaged in microsurgery and clinical anatomy would turn to acupoint research.

This path was neither a pre-planned academic direction nor an intentionally arranged interdisciplinary pivot. Over several years, I gradually entered this field, step-by-step, propelled continuously by specific individuals, events, and concrete questions. Initially, I did not anticipate undertaking a systematic investigation into the physical anatomical structures of classical acupoints—let alone foresee that this work would later evolve into a relatively comprehensive research methodology. It was simply because people repeatedly raised questions, persistently encouraged dialogue, and—through repeated observation, comparison, and verification—I myself observed phenomena worthy of deeper inquiry. Thus, I was incrementally drawn into this domain. Only later, when I truly realized that “Do acupoints possess physical anatomical structures?” might be a foundational question affecting the entire field of classical acupoint research, had I already unknowingly walked far down this path.

Someone once jokingly remarked that I seemed like the “chosen one” for researching the physical anatomical structures of classical acupoints. Of course, this was merely a jest. Yet, looking back now, I have pursued medicine for over forty years, spending extensive time observing human vascular, neural, muscular, bony, and fascial structures beneath the surgical microscope—accumulating vast quantities of clinical anatomical images, microscopic anatomical videos, and hands-on experience in human structural observation. These skills and experiences—originally cultivated for hand/foot surgery, micro-reconstructive surgery, and clinical anatomical research—later unexpectedly intersected with research on the physical anatomical structures of classical acupoints. Perhaps precisely this long-term engagement with minute human anatomical structures enabled me, when confronting the ancient question of acupoints, not to view them merely as abstract concepts or theoretical terms—but instinctively to ask: What anatomical structures do they correspond to within the human body? Why does pressing or needling certain specific locations produce distinct, unusual sensations unlike those elicited by surrounding tissues?

Thus, the inception of this research was indeed highly serendipitous; yet its subsequent deepening was closely tied to my longstanding professional training and scholarly accumulation. My work in microsurgery and clinical anatomy trained me to understand function through structure—to seek explanations for clinical phenomena in tissue layers, neural-vascular pathways, and local anatomical relationships. It was precisely this training that, through repeated examination of acupoint localization, pressure-induced sensation, needle insertion depth, and underlying tissue structures, gradually led me to suspect: classical acupoints may not merely be functional, experiential, or surface-localized concepts; rather, they likely possess tangible, palpable, demonstrable, and verifiable physical anatomical foundations.

I. Origins

The person who first drew me toward anatomical research on acupoints’ physical structures was Dr. Ding Zhiwei.

Dr. Ding Zhiwei himself was originally a microsurgeon who, in his spare time, studied TCM acupuncture and long pondered the essential nature of acupoints. After reading Clinical Anatomical Atlas of Microsurgery, which I co-edited, he noticed a high degree of spatial overlap between the cutaneous perforator vessels’ exit points on the skin surface—depicted in the atlas—and the locations of certain TCM acupoints. He thus proposed a hypothesis: acupoints are likely associated with cutaneous perforator vessels—or perhaps even coincide precisely with the anatomical regions where such vessels emerge. Furthermore, he argued that such research should be conducted by someone thoroughly familiar with microanatomy and possessing extensive accumulated human anatomical data. Starting in 2017, he approached me repeatedly, urging me to undertake anatomical research on cutaneous perforators at acupoint sites. This “persuasion” continued for several years.

At that time, I was unfamiliar with TCM and held little interest—or even harbored certain preconceptions—toward it. Micro-reconstructive surgery was my core clinical specialty, and my responsibilities—including clinical work, research, writing, and teaching—were extremely demanding. I also had well-established research directions and work plans. Consequently, when Dr. Ding first proposed his idea, I felt no genuine motivation to pursue it. I told him plainly: “I don’t understand TCM, nor do I have time for acupoint research; I suggest you conduct it yourself—or collaborate with anatomy departments at medical schools or TCM universities.”

Dr. Ding informed me that he had investigated related possibilities but found that many anatomy instructors had shifted focus toward molecular biology—a field offering easier publication opportunities—while few still performed extensive hands-on human dissection, especially microdissection. Likewise, finding researchers willing to systematically undertake such human anatomical studies within TCM institutions proved difficult. He emphasized repeatedly: if acupoints indeed possess physical anatomical structures, then the research must be carried out by someone truly proficient in human anatomy, skilled in microstructural analysis, and possessing abundant clinical anatomical data. He explained that his insight linking acupoints to cutaneous perforators originated from reading Clinical Anatomical Atlas of Microsurgery, and that my decades-long clinical anatomical research in microsurgery uniquely qualified me for this work.

I still declined. Partly because I was genuinely overwhelmed with work; partly because I did not believe a surgeon should rashly enter an unfamiliar TCM domain without proper grounding. Each time our discussion concluded, I typically deflected with: “I’m quite busy recently—let’s talk again later.”

Dr. Ding did not give up. He called me multiple times, reiterating his views on the relationship between acupoints and cutaneous perforators. When he saw my continued hesitation, he enlisted other influential figures to persuade me from different angles. Among them, the person who contacted me most frequently was Mr. Yuan Siwen, Chief Editor of Shandong Science and Technology Publishing House. Mr. Yuan called me several times, urging me to seriously consider Dr. Ding’s proposal. Later, Dr. Ding also asked Professor Wang Jianli, formerly of the PLA 89th Hospital, to help contact me. Professor Wang, my university classmate and former colleague, discussed the matter with me. Since several friends kept raising the issue, I decided to meet Dr. Ding in person. Thus, our first formal meeting occurred.

During that meeting, Dr. Ding systematically presented his ideas regarding the relationship between acupoints and cutaneous perforators. He argued that traditional acupoints have long lacked explicit physical anatomical evidence, whereas cutaneous perforators might provide a crucial clue toward explaining their physical anatomical basis. He hoped I could leverage my accumulated microanatomical expertise and image datasets to verify this hypothesis anatomically. Frankly, that meeting did not immediately prompt me to launch acupoint research—but it did bring the question, “Do acupoints and cutaneous perforators bear any relationship?” firmly into my field of vision.

Subsequently, scholars and researchers from diverse fields further pushed me toward this question. Professor Zhang Qiming of China Academy of Chinese Medical Sciences has long engaged in morphological TCM research. In 2021, he invited me to deliver a presentation on acupoint anatomy at an academic conference he organized. He learned of my clinical anatomical work in microsurgery—particularly the anatomical image data on cutaneous perforators in Clinical Anatomical Atlas of Microsurgery—through Dr. Ding. At that time, I had not yet begun systematic acupoint anatomical research, and I explicitly informed him that I was not a specialist in acupoint anatomy and was unfamiliar with acupoints. Nevertheless, Professor Zhang believed that the anatomical structures at acupoint sites themselves possessed significant research value and hoped I would address them from a clinical anatomical perspective. Although I missed that conference due to scheduling conflicts, this incident made me realize that morphological TCM researchers were indeed concerned about whether acupoints possess observable, explainable morphological foundations.

Professor Ouyang Hui has long practiced, taught, and engaged in academic leadership in acupuncture and TCM in the United States. Around 2021, he learned of my work in clinical and microsurgical anatomical atlases—particularly the image data on cutaneous perforators—through Dr. Ding, subsequently added me on WeChat, and initiated discussions on acupoint anatomy. I explained to him that I was not an acupoint anatomy specialist, but rather a hand/foot and micro-reconstructive surgeon whose anatomical work primarily served my own clinical specialty. Yet he maintained that, given my long-standing clinical anatomical research, I could still discuss potential anatomical structures at acupoint sites from an anatomical standpoint. Thereafter, he occasionally contacted me to discuss acupoint anatomy. Though I had not yet formally entered classical acupoint physical structure research, these exchanges gradually made me aware that acupoint physical structure was not merely Dr. Ding’s personal interest—it was a longstanding, unresolved issue within acupuncture and morphological TCM research.

Professor Hu Jinlian of City University of Hong Kong also placed great importance on Dr. Ding’s proposed link between acupoints and cutaneous perforators. She supported her graduate student Tang Zitian to travel to Jinan and utilize my previously accumulated microanatomical image data on cutaneous perforators to statistically analyze the relationship between acupoint surface localization and cutaneous perforator exit points. In early 2022, amid severe pandemic conditions in Hong Kong, Tang Zitian arrived at my laboratory in Jinan. With only months remaining before his thesis defense, completing a full-body acupoint study was clearly impossible. I suggested focusing first on hand acupoints to allow concentrated statistical analysis within the limited timeframe. Later, Professor Hu proposed initiating the study with the Five Shu Points, statistically analyzing the spatial overlap between their surface localization and cutaneous perforator exit points. Ultimately, Tang Zitian’s research commenced precisely with the Five Shu Points.

During that period, Tang Zitian spent days compiling literature on the Five Shu Points; evenings, I joined him in reading and discussing these sources, interpreting and determining the surface localization of the Five Shu Points based on classical texts and modern literature, then comparing them against my previously accumulated microanatomical image data on cutaneous perforators. This work initially focused solely on exploring “whether any correlation exists between acupoints and cutaneous perforators”—not yet entering the phase of investigating Ji Men (muscle gates) or Gu Men (bone gates). Eventually, we found a high degree of spatial overlap between the surface localization of the Five Shu Points studied and cutaneous perforator exit points; the resulting paper was later published in the U.S. journal Clinical Anatomy. During peer review, the editor asked why no cutaneous perforator appeared at Hegu (LI4); we replied that Hegu is not among the Five Shu Points. At that time, we mistakenly believed there were only 60 Five Shu Points. Later, after meeting Professor Huang Longxiang, we learned that there are actually 66 Five Shu Points—and Hegu is indeed one of them.

It was precisely while assisting and guiding Tang Zitian in completing this research that I began systematically reading literature on the Five Shu Points, repeatedly comparing classical textual localization, surface landmarks, and microanatomical image data—gradually transforming the physical anatomical structure of classical acupoints into a topic of genuine interest.

After Tang Zitian returned to campus for his thesis defense, this question did not conclude. Thereafter, during routine clinical and micro-anatomical dissections, I consciously paid attention to deep anatomical structures beneath certain classical acupoints.

These observations were not yet systematic research nor comprehensive validation across all acupoints—merely noticing, within daily anatomical accumulation, an intriguing phenomenon: beneath certain classical acupoints, one often observes gate-like structures where nerves and vessels enter muscles, or gate-like structures where nutrient vessels and accompanying nerves enter bone or localized bone surfaces. Repeated manual palpation of these areas on oneself frequently produces an intense, distinctive sensation markedly different from pressing surrounding tissues; similarly, accurately pressing these points on others often triggers sudden, overwhelming, yet peculiar sensations—prompting exclamations of “Ai-yao-wei!” (“Ouch!”) and immediate requests to “Stop!” or “Don’t move!” This sensation differs both from ordinary pressure pain and from simple nerve-trunk stimulation producing electric-shock-like radiation—it is a more complex, distinctive “acupoint sensation.”

This reminded me of martial arts novels and films I read and watched as a child—the fictional concept of “dim mak” (point striking). While such literary and cinematic works hold no medical evidentiary value, they left a deep impression on many Chinese people: applying pressure or stimulation to specific human body locations elicits abnormally intense reactions. Now, witnessing correlations between special anatomical structures and distinctive sensations during real human dissection and surface palpation, I found this profoundly fascinating—and well worth documenting.

However, I did not immediately elevate this observation to the status of systematic classical acupoint physical structure research. At that stage, I had only identified similar structures beneath some acupoints—not yet systematically observed all classical acupoints, nor completed subsequent ultrasound observation, needle-stimulation validation, fresh-cadaver microdissection, and repeated verification. More importantly, lacking formal TCM training, I dared not rashly claim I had “found the acupoints.” Thus, my initial intention was simply to compile these points—already noted during dissection and capable of eliciting strong, distinctive sensations upon surface palpation—into a small booklet for sharing. It was not intended as a systematic acupoint monograph, but rather as a preliminary record of special surface reaction points and their anatomical localization. Since subjects often spontaneously exclaimed “Ai-yao-wei!” when these points were pressed, I provisionally named them “Ai-yao-wei Points,” and tentatively titled the booklet Anatomical Localization Atlas of Ai-yao-wei Points.

II. From “Ai-yao-wei Points” to Classical Acupoints

Initially, Anatomical Localization Atlas of Ai-yao-wei Points was conceived merely as a small booklet I wished to share with others. Its purpose was not to formally discuss the physical anatomical structures of classical acupoints, but rather to preliminarily document these special reaction points I discovered through surface palpation and anatomical observation: their surface locations, how to press them to evoke distinctive sensations, and possible underlying anatomical structures. By then, I had already noticed high similarity between these points’ locations and those described for certain acupoints in classical texts—but systematic validation remained incomplete, and I hesitated to directly label them “acupoints.”

The turning point again involved Chief Editor Yuan Siwen. The Clinical Anatomical Atlas of Microsurgery, which inspired Dr. Ding’s “acupoint–cutaneous perforator” hypothesis, was published by Shandong Science and Technology Publishing House. Holding a Ph.D. in TCM, Chief Editor Yuan recognized the significance of my accumulated data and believed this work warranted treatment beyond a mere entertaining booklet. He argued that if these points indeed matched classical acupoints and possessed observable, verifiable physical anatomical foundations, the research should be rigorously pursued according to academic monograph standards.

Accordingly, Chief Editor Yuan convened a discussion involving Professor Zhang Xiaoxia of Shandong University of Traditional Chinese Medicine and myself. Professor Zhang, a long-time researcher in TCM literature and theory, had authored articles I read during my literature review—deeply enriching my understanding. After reviewing the anatomical data on these “Ai-yao-wei Points,” Professor Zhang concluded that what I had discovered likely represented the physical anatomical structures of classical acupoints—and that this work held substantial significance. He advised us to continue the research and ultimately publish Anatomical Atlas of Physical Structures of Acupoints. Chief Editor Yuan also strongly advocated publishing a rigorous, systematically documented, methodologically sound anatomical atlas—not just a simple booklet.

At this juncture, I grew somewhat apprehensive. Once the term “acupoint” appeared in the title, the work ceased being merely a booklet about special surface reaction points and entered the core—and most controversial—domain of TCM acupuncture. I worried that TCM practitioners might deem me—a surgeon unfamiliar with TCM—as presumptuously interpreting acupoints; simultaneously, Western medical colleagues might perceive me as straying from my specialty—or even mock me for “neglecting my proper duties.” Professor Zhang Xiaoxia countered that if this work truly rested on evidence from classical literature, surface palpation, needle-sensation reports, ultrasound observation, and microdissection, then it deserved to proceed openly and confidently. He further offered to write a detailed preface for the book, explaining its significance from TCM literature and theoretical perspectives to minimize unnecessary misunderstanding and criticism.

The transition from Anatomical Localization Atlas of Ai-yao-wei Points to Anatomical Atlas of Physical Structures of Acupoints involved far more than a title change. The former merely informed readers where on the body surface pressing elicited strong, distinctive sensations; the latter must answer: Are these points truly classical acupoints? Do they conform to classical textual localization and needle-insertion depths? What anatomical structures does the needle tip contact? Can the relationship between such structures and acupoint sensation be repeatedly verified? Precisely because of these demands, this work evolved from an exploratory, interest-driven record into a systematic investigation requiring integrated support from TCM literature, clinical anatomy, ultrasound observation, needle-stimulation validation, and microdissection.

From this point onward, the research’s nature changed. We no longer simply recorded where “Ai-yao-wei” reactions occurred upon pressing—we returned to classical texts to locate acupoints according to traditional methods; tested palpation and needle stimulation on living subjects; observed needle-tip/deep-structure relationships via ultrasound; and traced and visualized these structures’ true morphology in fresh human cadavers. It was precisely during this process that the initially playful “Ai-yao-wei Points” gradually transformed into serious, systematic research on the physical anatomical structures of classical acupoints.

III. Formation of the Research Team

Once research shifted from casual recording of “Ai-yao-wei Points” to systematic investigation of classical acupoints’ physical anatomical structures, the problem’s complexity rapidly emerged. It was no longer merely about recording whether special sensations occurred upon pressing a surface point, nor describing a single deep anatomical structure. Rather, it demanded answers to specific questions: Does this point conform to classical textual descriptions of surface localization and acupoint-finding methods? Within this surface region, what pressing direction and force pathway reliably elicit distinctive acupoint sensation? When inserting needles to the classical textual depth, what structure must the needle tip contact to suddenly produce typical, intense acupoint sensation? If the needle tip deviates from this structure, does the sensation weaken or disappear? Can ultrasound dynamically visualize exactly which deep structure receives pressure from finger palpation or needle insertion? In fresh human cadavers, can microdissection visually reveal the actual morphology of the structure targeted—and provoking acupoint sensation—by palpation or needle insertion seen on ultrasound? Can this correspondence among surface localization, pressure-induced sensation, needle-induced sensation, ultrasound findings, and microanatomical structure be repeatedly validated across different volunteers and cadavers? Clearly, answering these questions exceeded the capacity of individual curiosity and fragmented observation.

Therefore, upon entering the systematic research phase, we quickly recognized the necessity of establishing a multidisciplinary research team. Such a team required members familiar with TCM literature and classical localization methods, as well as experts in clinical anatomy, microanatomy, and imaging observation. It needed personnel to organize literature and verify localization, as well as participants for live-subject palpation, ultrasound observation, needle-stimulation validation, and fresh-cadaver dissection. Only by integrating classical textual records, surface palpation, pressure- and needle-induced sensations, ultrasound observation, and microdissection within a unified research framework could research on classical acupoints’ physical anatomical structures meaningfully advance.

During the summer vacation of 2022, Professor Meng Xianguo of Shandong First Medical University’s College of Sports Rehabilitation, along with her undergraduate students, came to Jinan to join the research. My students Dong Likun, Wang Qiang, Zhao Zuyao, and Wang Chunlin; Professor Zhang Xiaoxia and his student Kang Ziyou; Professor Meng Xiangguo and her students Zhao Yanru, Zhang Xiaokun, Deng Yuzhen, Hu Xiaosai, Si Jiayuan, and Wang Hongyuan—all collectively formed the early research team on acupoint physical anatomical structures. This team comprised clinical physicians, TCM literature researchers, graduate students, and undergraduates—individuals with long-standing microanatomical experience alongside others joining from TCM, acupuncture, sports rehabilitation, and related disciplines. Their professional backgrounds varied, and their assigned tasks differed accordingly—but they jointly confronted the same fundamental question: Do classical acupoints possess physical anatomical structures that are observable, palpable, and verifiable?

Early-stage work was extremely labor-intensive. Some members compiled classical and modern literature, comparing differing textual accounts of the same acupoint’s localization and needle depth; others determined preliminary localization based on classical descriptions and modern surface landmarks; some participated in volunteer surface palpation, documenting distinctive sensations; others assisted ultrasound observation, recording relationships among finger pressure, needle entry, and deep-tissue deformation; still others conducted microdissection on fresh human cadavers, tracing fine structures where nerves/vessels entered muscle or bone. Frequently, validating a single acupoint required repeated cross-checking across literature, living subjects, ultrasound, needle stimulation, and cadaveric specimens before reaching a reasonably reliable conclusion.

It was precisely through such collaborative teamwork that we gradually established the core research methodology underlying this book: First, return to classical texts to clarify traditional acupoint localization and needle depth; second, return to living subjects to palpate and needle within the corresponding surface region, seeking locations and structures that reliably elicit distinctive acupoint sensation; third, use ultrasound to observe dynamic relationships among applied pressure, needle tip, and deep tissues; finally, employ microdissection on fresh human cadavers to reveal the true morphology of these structures—and continue repeated validation on living subjects. This process transformed the research from initial personal curiosity and localized observation into a systematic, interdisciplinary project featuring multi-stage mutual verification. The formation of this team proved decisive for this book. Without TCM literature compilation, we could not determine whether a point conformed to classical localization; without live-subject palpation and needle experience, we could not grasp the origin of acupoint sensation; without ultrasound observation, we could not confirm in vivo which structure received pressure or needle insertion; without fresh-cadaver microdissection, we could not visualize these structures’ true morphology and neurovascular relationships. It was precisely the combined participation of these diverse components that gradually transformed research on classical acupoints’ physical anatomical structures from an intriguing hypothesis into practical, observable, recordable, comparable, and verifiable scientific work.

IV. Research Methodology and Literature Scope

Upon entering systematic research, we gradually realized that investigating classical acupoints’ physical anatomical structures cannot rely on a single method, nor can it directly “map” classical acupoints onto modern anatomical concepts. Acupoints represent discoveries transmitted across generations through prolonged clinical practice by ancient practitioners. Ancient physicians lacked modern imaging and microanatomical techniques, as well as today’s precise anatomical terminology. Instead, they developed a relatively stable acupoint-finding methodology using surface landmarks, bone-length measurements, descriptive phrases like “in the depression” (xian zhe zhong) or “in the hollow” (wan wan zhong), and experiential techniques including palpation, needle insertion, and de qi (arrival of qi). To investigate the physical anatomical structures of classical acupoints today, we must first respect classical textual records and traditional acupoint-finding experience—then apply modern medical technology to ask: What anatomical structures within the human body correspond to the acupoint described by ancient physicians?Therefore, we gradually established a relatively rigorous research pathway:
First, we consulted, organized, and analyzed classical texts regarding the location, palpation methods, and needling depth of corresponding acupoints;
Second, based on the locations described in classical texts, we performed manual palpation on volunteers’ bodies to identify sites that distinctly differed from surrounding tissues and consistently elicited unique acupoint sensations;
Third, under real-time B-mode ultrasound (B-US) observation, we recorded tissue deformation, force direction, and potentially stimulated deep structures during palpation;
Fourth, we performed acupuncture at the surface locations identified above and under B-US monitoring observed which deep structure the needle tip contacted when the acupoint sensation became most distinct—and whether the sensation weakened or disappeared once the needle tip moved away from that structure;
Fifth, on fresh human cadaveric specimens, we first used B-US to observe deep structural anatomy and layer relationships in the same region, then conducted microdissection under an operating microscope to confirm the true morphology, anatomical layer, and neurovascular relationships of the structure in question;
Sixth, we returned these anatomical findings to living subjects and repeatedly verified—via palpation and acupuncture under B-US—the correspondence between the surface location, needling depth, acupoint sensation, and the identified deep structure.

Throughout this process, B-US was not merely employed for observing acupuncture in vivo, but also served for pre- and post-dissection structural localization and layer assessment on fresh cadavers. In vivo B-US enabled us to visualize the dynamic relationship among fingertip palpation, needle tip entry, and underlying tissue structures; while B-US on fresh cadavers helped confirm the position and depth of relevant structures before dissection—transforming microdissection from blind searching into image-guided structural tracing. Microdissection further clarified what the structures observed under B-US actually were—whether they belonged to “myo-gates,” “osteo-gates,” or a few special neurovascular structures. Only then could classical textual descriptions, surface palpation, palpation-induced acupoint sensations, needling-induced acupoint sensations, B-US observations, and microdissection on fresh cadavers form a mutually corroborating chain of evidence.

Regarding documentary basis and research scope, we ultimately adopted the principle of “returning to classical sources.” This does not negate modern developments in acupuncture, but rather reflects the inherent complexity of acupoint research itself. Since the modern era, as clinical applications of acupuncture have expanded continuously, new acupoints—including extra-meridian points, empirically derived points, local stimulation points, and reaction points within various micro-acupuncture systems—have been proposed repeatedly. As a result, both the number and names of acupoints have proliferated, while their origins, schools, naming rationales, localization methods, and theoretical interpretations remain inconsistent. Whether certain so-called “new” acupoints or empirical points truly qualify as traditional acupoints is itself difficult to determine. Including all such content in our initial investigation would not only render the workload unmanageable but also make it extremely challenging to establish relatively stable and reproducible research standards.

By contrast, classical acupoints emerged from long-term ancient clinical practice and were systematically documented and transmitted across generations through canonical works such as Huangdi Neijing (The Yellow Emperor’s Inner Canon) and Zhenjiu Jiayi Jing (The ABC Classic of Acupuncture and Moxibustion), as well as numerous subsequent medical texts. Although variations exist across different historical sources concerning nomenclature, surface location, needling depth, and palpation techniques, classical acupoints collectively possess a comparatively clear historical lineage and relatively stable transmission foundation. Constrained by historical conditions, ancient practitioners could not precisely describe the fine deep-tissue structures corresponding to acupoints; instead, they commonly relied on surface landmarks, bone-length measurements (“cun”), phrases like “in depressions” (xian zhe zhong) or “in gentle hollows” (wan wan zhong), palpation-induced responses, and needling sensations (de qi) to convey and transmit knowledge. Our “reconstructive research” aims precisely to re-examine—on the basis of respecting these classical descriptions—where exactly the acupoints referred to by ancient practitioners were located, what structures the needle tip contacted, and why specific acupoint sensations arose—using modern imaging, microanatomy, and in vivo sensory validation methods.

The classical textual sources cited in this book follow the principle of “approaching original texts as closely as possible.” Wherever original editions or facsimiles are available, they are prioritized—especially those preserving original layout, character forms, and phrasing. When original facsimiles are temporarily inaccessible, reliable standard editions, collated and annotated versions are consulted instead. Relevant literature was primarily drawn from professional digital TCM databases such as DuXiu Academic Search and Zhonghua Yidian (The Chinese Medical Canon), as well as full-text searchable resources including CNKI (China National Knowledge Infrastructure) and Wanfang Data Knowledge Service Platform. For cases where acupoint locations differ across editions, this book avoids simplistic merging; rather, it weighs edition reliability, textual provenance, and transmission history to reconstruct accounts as close as possible to the original records—free from later rewriting, copying errors, or excessive interpretation. Modern TCM and acupuncture textbooks, along with scholarly works by Professors Longxiang Huang and Deshen Wang, serve mainly to inform understanding of acupoint origins, historical transmission, and contemporary localization standards—providing contextual references for classical text analysis and physical structural identification.

V. Preliminary Findings on the Physical Structures of the Five Shu Points

Anatomical research into the physical structures of acupoints is time-consuming, labor-intensive, and costly. To approximate in vivo conditions as closely as possible, many dissections must be carried out on fresh human cadavers under low-temperature conditions. During dissection, hands and arms remain bent over the cold dissection table for extended periods while performing layered tissue separation, vascular and neural tracing, and identification of myo-gates or osteo-gates under an operating microscope—all synchronized with photography, documentation, and specimen comparison. Microdissection of a single acupoint typically requires over ten hours; for complex, deeply layered, or repeatedly confirmed structures, it may exceed twenty hours. Moreover, each acupoint must be observed repeatedly across multiple cadavers to assess structural consistency and commonality.

These dissections were primarily conducted collaboratively by my students Guo Chaoshuai, Zhao Zuyao, Dong Likun, Wang Qiang, Li Mengzhi, Zhao Ruyuan, Wang Chunlin, Shu Zhaoyu, Wang Linjiang, Liu Zhimeng, and myself. Their professional specialization lies in hand surgery and micro-reconstructive surgery. Despite heavy clinical, research, and academic responsibilities, they devoted extra time and energy outside their regular duties to complete this foundational yet arduous research. Prolonged low-temperature microdissection poses considerable demands on physical stamina, endurance, and sustained concentration. Their diligence, meticulousness, and proactive spirit continually inspire me. In vivo B-US validation constitutes a critical step ensuring the rigor and practical relevance of this study. Dr. Hengtao Qi, Director of the Ultrasound Department, and Dr. Tiezheng Wang, Director of the Ultrasound Department at our hospital, generously contributed their after-work hours over an extended period to assist with dynamic observation and repeated verification of relationships among acupoint palpation, acupuncture, and deep structures—enabling key phenomena to be clearly visualized in living subjects. We extend our sincere gratitude.

Funding pressure for this research has also been substantial. Microsurgical instruments wear out rapidly during repeated dissections; multiple photographic flash units have already failed; low-temperature dissection tables required custom design and fabrication; and equipment such as operating microscopes, B-US machines, and electrophysiological instruments all demanded creative solutions. Several team members from other cities visited Jinan successively to participate in the research, incurring real expenses for accommodation, meals, and round-trip travel. A rough estimate indicates that completing the physical-structural study of a single acupoint often costs tens of thousands of RMB. For a prolonged period, no dedicated project funding supported these expenditures; they were largely borne personally by me.

Physical-structural research on acupoints necessarily involves palpation and acupuncture validation on human volunteers. Early volunteers were primarily members of the research team, along with their classmates and colleagues. When a filiform needle accurately contacts a specific structure, the subject’s sensation is often intense; if B-US is simultaneously used to monitor needle-tip position, even slight probe movement may contact the needle and further intensify stimulation—making the experience difficult to tolerate in many cases. Each acupoint requires repeated acupuncture validations. Ms. Zi-Yu Kang, a graduate student supervised by Professor Xiaoxia Zhang of Shandong University of Traditional Chinese Medicine, was among the earliest and most frequently needled volunteers. She underwent multiple acupuncture validations for nearly every one of the more than 66 Five Shu Points and other classical acupoints studied.

After a sustained period of focused research on the Five Shu Points—including in vivo palpation, B-US observation, acupuncture validation, and microdissection on fresh cadavers—we gradually recognized that although the Five Shu Points belong to different meridians and distribute distally beyond the elbow joints (upper limbs) and knee joints (lower limbs), with differing traditional attributes and clinical applications, their physical structures are not random but exhibit striking commonalities. The core physical structures of most Five Shu Points reside either in gateway-like regions where nerves and vessels enter muscle (“myo-gates”) or in localized zones around bone nutrient vessels and accompanying nerves entering bone tissue—including adjacent periosteum and bone-surface neurovascular structures (“osteo-gates”). During acupuncture, the filiform needle can directly contact these structures at a certain depth; when the needle tip touches such a structure, subjects report clear, intense acupoint sensations; when the needle tip moves away from the structure—or shifts to contact surrounding tissues—the sensation markedly weakens or disappears.

Palpation validation likewise revealed analogous patterns. Although palpation acts upon the skin surface, acupoint sensation does not depend solely on compressing skin or subcutaneous tissue; rather, it depends on whether mechanical force—transmitted via a specific direction and through particular tissue layers—ultimately reaches the target deep physical structure. Under real-time B-US observation, we observed that tissue deformation and force-line transmission pathways varied depending on the surface location and angle of finger pressure; only when this mechanical action ultimately converged upon and influenced the relevant myo-gate, osteo-gate, or associated neurovascular structure did subjects report clear, specific acupoint sensations. In other words, surface palpation points may vary, and pressure directions may differ—but as long as mechanical force converges upon the same deep structure, the resulting acupoint sensation remains consistent. Conversely, even if surface locations are proximate, deviation of the force line from the target structure leads to marked weakening or disappearance of sensation. Thus, surface localization, palpation direction, needling depth, and deep physical structure of the Five Shu Points are not isolated phenomena, but interrelated manifestations pointing collectively toward a single observable, palpable, and reproducibly verifiable structural foundation.

To facilitate description of such structures, we term gateway-like regions where nerves and vessels enter muscle—and their surrounding related structures—as “myo-gates”; and we define the channels through which bone nutrient vessels and accompanying nerves enter bone, together with periosteum and bone-surface neurovascular structures within a defined vicinity—as “osteo-gates.” While “myo-gate” corresponds to concepts previously described in anatomical literature, “osteo-gate” is a descriptive term newly introduced herein, specifically to meet the needs of acupoint physical-structural research. Further analysis of structural characteristics of the Five Shu Points allowed us to broadly classify them into two categories: those whose core physical structure is a myo-gate are termed “myo-points”; those whose core physical structure is an osteo-gate are termed “osteo-points.” This classification is not a theoretical renaming based on traditional attributes, but rather an empirical structural categorization grounded in observations from surface palpation, acupuncture-induced sensations, B-US imaging, and microdissection. It suggests that the Five Shu Points—the most important group within the classical acupoint system—are not merely collections of empirical surface locations and functional descriptions, but possess shared, tangible, observable, palpable, and reproducibly verifiable anatomical foundations.

VI. Announcement of Common Structural Features of the Five Shu Points and Academic Exchange

In January 2023, the Annual Meeting of the American Society for Reconstructive Microsurgery (ASRM) convened in Miami. That year marked the Society’s 40th anniversary, and the conference featured a “Master Session” inviting ten world-renowned experts to deliver keynote presentations—one of whom was myself. It was during this trip to the U.S. that Dr. Bin Cai specially flew from New York to Miami to discuss our acupoint physical-structural research in person. Dr. Cai earned his bachelor’s degree in Acupuncture and Tuina from Anhui University of Chinese Medicine, then pursued doctoral studies in Clinical Anatomy under Academician Shizhen Zhong. Academician Zhong is a pioneering figure in clinical anatomy in China—and also my mentor. From this academic lineage perspective, Dr. Cai is my junior colleague. Having received systematic training in both TCM acupuncture and rigorous clinical anatomy—and subsequently practicing TCM acupuncture education and clinical work in the United States—Dr. Cai is uniquely positioned to understand this research from both acupuncture and anatomical perspectives. Many issues difficult to clarify solely from TCM or purely anatomical viewpoints become immediately intelligible to him. After meeting in Miami, I outlined to him the fundamental rationale, observational methodology, and preliminary findings of our Five Shu Points physical-structural research. He recognized this work not as ordinary “acupoint anatomical description,” but as a potentially pivotal research direction capable of redefining classical acupoints at the structural level. Thereafter, he actively participated in discussions and research, providing financial support. Portions of the lower-limb Five Shu Points acupuncture demonstration videos included in this book feature Dr. Cai himself as a volunteer undergoing acupuncture validation.

Professor Hui Ouyang has provided continuous support throughout my entire acupoint physical-structural research. He currently serves as Vice President and Secretary-General of the American Federation of Chinese Medicine (AFCM), and has long practiced TCM acupuncture in the United States. Even before I formally embarked on acupoint physical-structural research, he learned about my clinical anatomical work through Dr. Zhiwei Ding and engaged me repeatedly in discussions on acupoint anatomy. Later, during my U.S. visit, I met him in person at his clinic. We discussed not only relationships among classical textual localization, surface palpation, acupuncture-induced sensation, and anatomical structures, but also exchanged hands-on palpation and acupuncture experiences. Through such direct observation and personal experience, he gained deeper, more concrete understanding of the “physical structures of acupoints” we described. Subsequently, he reported this work to AFCM and jointly promoted—with Shandong Science and Technology Press—the “Announcement of Anatomical Findings on Common Structural Features of the Five Shu Points.” Former AFCM President Professor Haihe Tian and current President Professor Hui Wei expressed explicit support for this research on various occasions. Professor Baoyan Liu, President of the World Federation of Acupuncture-Moxibustion Societies (WFAS), affirmed its significant importance and offered encouragement and support.

VII. Book Writing and Support from All Sides

In 2022, Professor Longxiang Huang traveled specially to Jinan to attend the “Announcement of Common Anatomical Structural Features of the Five Shu Points” and engaged in in-depth academic exchange with us. Thereafter, he visited Jinan multiple times to discuss classical acupoint literature, origins and evolution of the Five Shu Points, rationale for acupoint location, and relationships between anatomical findings and classical textual descriptions. Professor Huang, Chief Expert at the Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, has long specialized in research on acupoint literature, acupuncture history, and classical theory, possessing profound expertise in the origins, nomenclature, localization, and historical evolution of classical acupoints. He believes the myo-gates, osteo-gates, and related structures we identified in dissection are not novel acupoints invented independently of classical texts, but likely represent the very physical foundations of classical acupoints long recognized by ancient practitioners through palpation, acupuncture, and clinical practice. He repeatedly emphasized to me that this work holds great academic significance and should not be treated merely as a sideline to microsurgical clinical anatomical research. Upon recommendation by Professor Xiaoxia Zhang, Professor Huang and I co-edited Anatomical Atlas of the Physical Structures of the Five Shu Points. Thus, this book now rests on a firmer academic foundation spanning three dimensions: TCM literature, acupuncture theory, and clinical anatomy.

Professor Tao Wang of the Affiliated Acupuncture Hospital of Anhui University of Chinese Medicine was introduced to me by Dr. Bin Cai following the “Announcement of Common Anatomical Structural Features of the Five Shu Points.” He and Dr. Cai were university classmates and have long engaged in acupuncture clinical practice and teaching. After our introduction, Professor Wang visited Jinan several times to discuss classical acupoint physical-structural research and dispatched students to participate. He voluntarily served as a volunteer for the upper-limb Five Shu Points acupuncture demonstration video included in this book—personally undergoing acupuncture validation for each upper-limb Five Shu Point. For a clinician deeply experienced in acupuncture practice and teaching, personally experiencing differences in acupoint sensation when the needle tip contacts different structures—and then integrating these insights back into clinical acupoint location and needling practice—is highly valuable.

Mr. Qingguang Zhang, alumnus of the Second Military Medical University and former Director of the Medical Office of the Chinese People’s Political Consultative Conference (CPPCC) National Committee, has maintained frequent telephone communication with me over the past two years, offering broad perspectives on the current state of acupuncture in China, major scholars’ academic contributions, and potential impacts of this research. Though not directly involved in dissection experiments, he has been among the most active individuals urging me persistently to advance both the acupoint physical-structural research and book writing. We communicate almost weekly. On many occasions, it was precisely due to his repeated reminders and encouragement that I continued progressing this research and manuscript despite heavy clinical and other research commitments. Indeed, the completion of this book owes much to his sustained impetus.

Over the past four-plus years of acupoint physical-structural research, we have received assistance from numerous institutions, faculty, students, colleagues, peers, friends, and family members. Some support came through academic discussion and inspiration; some through experimental facilities and equipment; some through funding, literature, imaging, photography, volunteer cooperation, and daily-life assistance; and many others took the form of simple encouragement, timely reminders, or patient listening. These supports varied widely in form and weight, yet all proved vital for advancing an original, exploratory research project—beginning essentially from zero and evolving through constant trial and refinement. Leaders and colleagues at Shandong Provincial Hospital have consistently shown understanding, tolerance, and support; the hospital’s relaxed, open, and exploration-friendly research environment has formed a crucial foundation enabling this research to launch and continue. Faculty, physicians, PhD candidates, master’s students, and undergraduates from numerous domestic universities, hospitals, and research institutes have also participated in or supported this work in diverse ways—ranging from TCM colleges’ acupuncture scholars and students, to faculty and students from medical universities, comprehensive universities’ medical departments, and clinical hospitals. Some assisted with classical text retrieval and organization; others helped with volunteer palpation, acupuncture, and B-US observation; some contributed to image recording, data compilation, and result discussion; still others raised questions and offered suggestions during academic exchanges. Faculty and students from Shandong University and Shandong First Medical University, clinical peers from Shandong Provincial Hospital and sister hospitals, domestic and international colleagues in microsurgery, as well as friends from the acupuncture community, anatomy field, publishing industry, and broader society—all offered help and encouragement at various stages and levels. Due to space constraints, many individuals and details cannot be listed individually, yet I hold each one deeply in memory.

Among these supports, several incidents remain especially memorable. Mr. Yifa Xu, Chairman of Shandong Digital Human Technology Co., Ltd., after learning about our research, provided partial financial support; the sectional anatomical illustrations in this book were supplied by his company, which also lent us certain photographic equipment. Mr. Jiu-Hong Song, an old friend from Wuhan, highly affirmed the significance of our research, offered consistent moral encouragement, and arranged for us to borrow a high-value B-US machine—enabling real-time in vivo observation and validation of acupoint structures in our laboratory. Such support—both spiritual and material—proved indispensable to our research, and I remain profoundly grateful. Another friend repeatedly lent us electrophysiological instruments and provided practical life assistance. Later, my colleagues and I from the Department of Hand and Foot Surgery & Microsurgery at Shandong Provincial Hospital received the Shandong Provincial Science and Technology Progress Award (Second Class) for our “Key Technical System Development and Clinical Application for Total Thumb and Finger Reconstruction.” Team members voluntarily waived their award bonuses to support purchasing electrophysiological instruments and other equipment for acupoint research. These colleagues include Lei Zhu, Wenhai Sun, Liwen Hao, Chao Chen, Shenqiang Qiu, Linfeng Liu, Lishan Zhang, Yunpeng Wang, Zhidian Hou, Di Zhang, and Huanlong Liu—among whom Lei Zhu later founded the Department of Hand Surgery at Qilu Hospital of Shandong University, and Wenhai Sun joined the Department of Plastic and Reconstructive Surgery at Shanghai Ninth People’s Hospital, affiliated with Shanghai Jiao Tong University School of Medicine. Though their award recognized achievements in thumb/finger reconstruction, they willingly redirected funds toward supporting another nascent, uncertain research endeavor—demonstrating exceptional trust and camaraderie that I cherish deeply.

Additionally, several socially engaged individuals who care about TCM and support original research have expressed willingness to donate personally to this project. Since many of them face financial constraints, we respectfully declined most such offers. Nevertheless, their understanding, trust, and encouragement moved me deeply. Original research is arduous—not only technically and financially, but also demanding perseverance amid incomplete understanding. It is precisely because of support from colleagues, students, peers, friends, and family—and goodwill from the TCM community, anatomy field, microsurgery community, publishing industry, and wider society—that we have incrementally advanced this research. We hereby extend our most sincere gratitude to all institutions and individuals who cared about, assisted, and supported this work.

VIII. Positioning of This Book Within the Series of Atlases

I have practiced clinically for nearly forty years and engaged in clinical anatomical research for thirty years. For seventeen consecutive years, I have hosted and taught the “Advanced Training Program in Microsurgical Anatomy and Clinical Applications,” accumulating millions of anatomical photographs and thousands of hours of anatomical video recordings—and publishing multiple clinical anatomical atlases, including Clinical Anatomical Atlas of Microsurgery. Previously, I never imagined entering the field of acupoint research. Looking back now, decades of clinical microsurgical practice, microanatomical training, and long-term observation of human vascular, neural, muscular, skeletal, and fascial structures appear to have laid unconscious groundwork for later conducting physical-structural research on classical acupoints.

The Anatomical Atlas of Physical Structures of Classical Acupoints is planned as a three-volume series. Volume I is Anatomical Atlas of Physical Structures of the Five Shu Points; Volume II will be Anatomical Atlas of Physical Structures of Acupoints in Huangdi Neijing (The Yellow Emperor’s Inner Canon); and Volume III will be Anatomical Atlas of Physical Structures of Acupoints in Zhenjiu Jiayi Jing (The ABC Classic of Acupuncture and Moxibustion). This book constitutes Volume I—the inaugural volume and starting point of the entire series.

We chose the Five Shu Points as our first focus because they constitute the most important and representative group within the classical acupoint system. Documentation of the Five Shu Points is relatively concentrated in classical literature, their historical transmission has remained comparatively stable, and their surface localization and needling depths are supported by relatively clear classical textual evidence. Furthermore, the Five Shu Points are distributed distally beyond the elbow joints (upper limbs) and knee joints (lower limbs)—a pattern offering sufficient regularity to allow systematic comparative analysis across in vivo palpation, B-US observation, acupuncture validation, and microdissection on fresh human cadavers. Therefore, selecting the Five Shu Points as the starting point for classical acupoint physical-structural research serves both as a focused investigation of an essential subset of classical acupoints and as methodological groundwork for subsequent volumes on Huangdi Neijing and Zhenjiu Jiayi Jing.

IX. Necessity of Research on Physical Structures of Classical Acupoints

Acupoints constitute a vital component of Traditional Chinese Medicine. Clarifying their physical structures and achieving precise localization forms the foundation for acupoint research, acupuncture teaching, clinical practice, mechanism elucidation, and academic exchange. Currently, many acupuncture mechanism studies remain trapped in a “black-box” paradigm—“stimulating acupoint X → observing changes in indicator Y”—while lacking clear answers to fundamental questions such as: “What exact structure lies beneath this acupoint?” “Which tissues does acupuncture actually stimulate?” and “Why do specific physiological responses occur?” Because physical structures and precise localization of acupoints remain insufficiently clarified, the phrase “stimulating acupoint X” in different studies may not, in practice, target identical structures—let alone the core physical structure of that acupoint. This may be a key reason underlying contradictory conclusions and variable efficacy assessments in current acupuncture research. Therefore, whether affirming or questioning acupuncture efficacy, such judgments must rest upon more rigorous localization and reproducible structural foundations—particularly given that acupoint structures remain incompletely defined and stimulation targets imprecise.

We believe classical acupoints are important medical entities discovered and transmitted across generations by ancient practitioners through surface observation, palpation, needling sensation, and clinical outcomes. Research into their physical structures does not undermine TCM nor seek to establish a separate “anatomical acupoint” system using modern anatomy. Rather, it employs modern scientific methods to further recognize, verify, and explain the tangible physical foundations already discovered—but not fully visualized—by ancient practitioners, respecting classical literature and traditional localization experience.

For a long time, because acupoint physical structures could not be clearly visualized, mainstream understanding has tended to treat acupoints as functional concepts centered on surface localization and therapeutic indications. They possess names, locations, and clinical effects—but what deep structures they correspond to, and whether relatively stable physical foundations exist, remain unanswered. Classical acupoints should not remain confined to abstract explanations rooted in philosophy, humanities, or empiricism; rather, they ought to possess tangible, palpable, displayable, dissectible, and reproducibly verifiable structural foundations. Clarifying this issue will enable classical acupoints to evolve from functional, empirical, and surface-location-based concepts into medical entities with definite physical structural foundations—observable, palpable, and verifiable.

X. Multi-Method Validation Pathways for Physical Structures of Classical Acupoints
=================Research on the Physical Structures of Classical Acupoints is not based on a single investigative method, but rather rests upon multi-step, multi-level cross-verification. Our research generally comprises the following sequential steps:

First, we consult, collate, and analyze classical texts describing the location, depth, and palpation methods for the corresponding acupoints;
Second, using the anatomical landmarks described in classical texts, we perform manual palpation on volunteers’ body surfaces to identify sites that exhibit clearly distinguishable tissue properties and consistently elicit distinctive acupoint sensations (“deqi”) compared with surrounding tissues;
Third, under real-time B-mode ultrasound (B-US) observation, we record the deformation patterns, direction of mechanical force transmission, and potential anatomical structures stimulated during manual pressure application;
Fourth, we perform acupuncture precisely at the identified surface locations and apply pressure as previously determined, while monitoring needle tip placement under B-US to verify whether the needle contacts the hypothesized target structure—and crucially, whether the onset or disappearance of “deqi” correlates reliably with needle contact or withdrawal from that specific structure;
Fifth, on fresh human cadaveric specimens, we first use B-US to map the deep anatomical architecture and layer relationships within the same region; then proceed to microscopic dissection to trace and confirm the true morphology, neurovascular relationships, and precise tissue layer of the structure in question;
Sixth, we return to living subjects and—under B-US guidance—revalidate the correspondence between the anatomically confirmed structure and its surface projection, pressure-induced “deqi”, required needle insertion depth, and needle-evoked “deqi”.

Throughout this process, B-US serves not only for real-time observation of acupuncture in vivo, but also for pre- and post-dissection structural localization and layer identification in fresh cadavers. In vivo B-US dynamically visualizes the spatial and functional relationships among the needle tip, finger pressure, and underlying deep tissues; whereas B-US on fresh cadavers aids in pre-dissection confirmation of the target structure’s location and depth—transforming what would otherwise be blind microscopic exploration into image-guided, hypothesis-driven structural tracing. Microscopic dissection, in turn, definitively identifies what the structures observed via B-US actually are: Are they myofascial gateways (“jimen”), osseous gateways (“gumen”), or rare specialized neurovascular structures? Thus, classical textual localization, surface palpation, pressure-induced “deqi”, needle-evoked “deqi”, B-US imaging, and microscopic dissection on fresh specimens collectively form an integrated, mutually reinforcing research chain.

Our findings show that when filiform needles are inserted into the designated acupoint regions according to classical descriptions—and contact a specific physical structure under B-US monitoring—the subjects repeatedly experience clear, acupoint-specific “deqi” sensations. Conversely, when the needle tip withdraws from that structure—or shifts to contact adjacent tissues—this sensation markedly diminishes or vanishes entirely. Notably, the surface projection, depth, and needle trajectory leading to these structures align closely with classical records regarding acupoint location and recommended needle insertion depth. Further microscopic dissection on fresh human cadavers reveals that the physical structures eliciting acupoint-specific “deqi” predominantly correspond to: (1) myofascial gateways—sites where nerves and vessels enter muscle tissue; and (2) osseous gateways—localized regions around bone surfaces where nutrient vessels and accompanying nerves penetrate cortical bone, often accompanied by dense periosteal neurovascular plexuses.

Manual pressure validation is equally critical. Although pressure is applied superficially, the resulting “deqi” does not necessarily originate from skin or subcutaneous tissue itself. B-US observations—performed from multiple surface positions and angles—reveal that distinctive, reproducible “deqi” occurs only when the line of pressure force converges upon and mechanically influences either a myofascial or osseous gateway, or associated neurovascular structures. When pressure is applied nearby but the force vector deviates from the target structure, “deqi” significantly weakens or disappears. This demonstrates that classical surface localization, finger palpation–induced “deqi”, needle insertion depth, needle-tip contact with physical structures, and microscopic dissection findings are not isolated phenomena—but instead converge upon one common, observable, palpable, and empirically verifiable deep anatomical substrate.

This multi-modal verification framework enables a pivotal shift in classical acupoint research: from sole reliance on surface-based empirical observation and functional description, toward precise deep-structural localization; from indirect inference, toward direct empirical evidence combining in vivo dynamic imaging with microscopic dissection on fresh cadavers; and from functional statements such as “What does this acupoint do?” toward foundational anatomical questions: “What physical structure lies beneath this acupoint?”, “What structure does the needle contact when reaching the depth specified in classical texts?”, and “Why does contact with this specific structure generate robust ‘deqi’, whereas contact with neighboring tissues does not?” These are precisely the core questions that physical-structure research on acupoints seeks to answer.

XI. The Significance of Acupoint Physical-Structure Research in Traditional Chinese Medicine and Western Medicine

At the outset of this research, I indeed harbored concerns. As a surgeon specializing for decades in hand and foot micro-reconstructive surgery and clinical anatomy, stepping unexpectedly into the domain of classical acupoint physical-structure research inevitably invited misinterpretation from scholars across disciplinary backgrounds. Some TCM practitioners might question: How can a “Western medicine” surgeon—who lacks formal training in acupuncture theory and classical literature—legitimately interpret the physical substrates of acupoints? Moreover, once such physical structures become objectively demonstrable, they may challenge long-standing explanatory frameworks and academic viewpoints. On the other hand, I worried that Western medical colleagues might misunderstand the authentic motivation behind this work. Micro-reconstructive surgery remains my primary clinical and scholarly focus—a field in which I have accumulated decades of systematic, original contributions, especially in thumb/finger total reconstruction and complex limb salvage. Precisely because of this, I feared being misperceived by peers as having abandoned my established specialty to pursue an unrelated topic—or worse, having conflated this rigorous clinical anatomical investigation with superficial, conceptualized, or commercially driven notions of “integration of TCM and Western medicine” lacking empirical grounding.

In reality, my gradual immersion in this research was neither motivated by a quest for new academic labels nor by alignment with any transient research trend. Rather, it arose directly from empirical evidence observed across multiple modalities: high-resolution ultrasound imaging, live-subject palpation, acupuncture experience, and microscopic dissection—all pointing toward stable, reproducible physical structures underlying classical acupoints. Simultaneously, I came to recognize that the significance of this research extends far beyond acupuncture science itself.

For Traditional Chinese Medicine (TCM), clarifying the physical structures of classical acupoints helps ground classical descriptions of location, needle depth, “deqi” sensation, and clinical technique in concrete anatomical foundations. Through prolonged clinical practice, ancient physicians discovered acupoints and documented them using surface landmarks, bone-length measurements (“gudu cun”), phrases like “in the depression” (“xian zhe zhong”) or “in the gentle hollow” (“wan wan zhong”), needle insertion depth, and subjective “deqi” responses. For centuries, however, the inability to visualize their physical substrates led mainstream understanding to treat acupoints primarily as functional concepts defined by surface location and therapeutic indications—possessing names, locations, and clinical effects, yet without definitive answers to questions about their deep anatomical correlates or existence of relatively stable physical bases. What we undertake today is precisely to re-examine, with due respect for classical texts and traditional experience, what physical structures ancient physicians were referring to—using high-resolution ultrasound, microscopic dissection on fresh human cadavers, and live-subject validation. Once clarified, classical acupoints cease to be merely functional, experiential, or surface-localized abstractions—and evolve into medically tangible entities possessing identifiable physical structures, accessible to observation, palpation, and empirical verification.

For Western medicine and modern clinical anatomy, this research likewise holds profound significance. Conventional anatomy typically describes which nerve branch innervates which muscle, which vascular group supplies which muscle, skin, or bone, and outlines gross pathways and distribution territories of those nerves and vessels. However, the precise entry zones where nerves and vessels penetrate muscles—the exact channels through which nutrient vessels and accompanying nerves enter bone—and the localized periosseous regions surrounding these entry points—have not been systematically mapped with precision across many anatomical sites, nor has their correlation with surface topography been rigorously established. In other words, traditional anatomy largely answers “Which nerve innervates which muscle?” and “Which vessels supply which tissues?”, but inadequately addresses “Where exactly do nerves and vessels enter the muscle?”, “Through which precise osseous channels do nutrient vessels and accompanying nerves enter bone?”, and “How are these entry zones located relative to surface landmarks?” Such questions remain insufficiently refined.

Myofascial and osseous gateways—key discoveries emerging from acupoint physical-structure research—are also critically important anatomical regions demanding heightened attention in surgical practice. Precise knowledge of their locations facilitates intraoperative identification, protection, or strategic utilization of these neurovascular gateways. For example, in muscle flap, bone flap, or composite tissue transplantation, accurate understanding of myofascial and osseous gateway locations and neurovascular entry configurations enables more rational flap design and ensures preservation of full vascularity and neural innervation. In trauma repair, tumor resection, internal fracture fixation, percutaneous pinning, and various minimally invasive percutaneous procedures, ignorance of these critical structures’ precise locations risks iatrogenic injury during incision, dissection, drilling, pinning, or tract creation. Conversely, establishing comprehensive atlases mapping myofascial and osseous gateways—including their surface projections—would allow surgeons to integrate this information into existing anatomical knowledge, thereby improving preoperative planning and intraoperative navigation: reliably avoiding or deliberately targeting these vital structures to enhance both surgical safety and precision.

Thus, classical acupoint physical-structure research does not represent a deviation from my original professional focus—it may instead constitute a deepened extension of clinical anatomy into a long-overlooked, highly specialized domain. It simultaneously advances structural elucidation of classical acupoints and potentially catalyzes renewed recognition within modern clinical anatomy of myofascial and osseous gateways and related neurovascular portal structures. As more acupoint physical structures become confirmed, it becomes entirely plausible to develop a “Human Myofascial and Osseous Gateway Atlas with Surface Localization Maps”, providing novel anatomical foundations for TCM acupuncture, surgical interventions, ultrasound-guided procedures, interventional therapies, rehabilitation medicine, and related clinical disciplines.

XII. Academic Responses, Research Stance, and Tribute

Naturally, our research has encountered diverse opinions—including skepticism and opposition. It must be emphasized that such dissent does not stem from classical TCM theory itself. Quite the contrary: classical textual records concerning acupoint location, palpation techniques, needle depth, and “deqi” responses constitute precisely the starting point and essential foundation of our physical-structure research. Our endeavor aims to provide clearer structural interpretations of acupoints—long discovered and clinically utilized by ancient practitioners—using modern imaging and microscopic anatomical methodologies. Many TCM scholars and acupuncturists actively engaged in clinical practice, deeply versed in classical texts, and appreciative of the intrinsic value of classical acupoints, genuinely wish to understand what anatomical structures acupoints correspond to—and have explicitly supported this research. They readily grasp that if ancient physicians truly discovered and transmitted acupoints through sustained clinical experience, then utilizing modern technology to reveal their physical substrates is not only legitimate but imperative.

Certain reservations and objections arise more from entrenched conceptual habits and interpretive frameworks formed under historical conditions wherein acupoint physical substrates remained obscure. Because earlier eras lacked means to specify what anatomical structures acupoints actually were, some gradually redefined acupoints as invisible, non-dissectible, unverifiable entities—eventually building personal theoretical systems detached from classical texts and clinical evidence. Once acupoint physical-structure research demonstrates observable, palpable, and empirically verifiable anatomical foundations, explanations predicated on “unclear physical basis” inevitably lose explanatory space—and established conceptual frameworks and discourses naturally face challenge. Consequently, during the early research phase—particularly around the time of the “Common Structural Anatomy Findings of the Five Shu Points Press Conference”—external skepticism and pressure were substantial. Some questioned why a surgeon would study TCM acupoints; others hastily labeled this serious clinical anatomical research with reductive tags. Facing these voices, we lacked both time and necessity to respond individually. Ultimately, only facts, methodologies, and empirical evidence can authentically address skepticism.

Frankly, early progress proved difficult. There was no dedicated funding, no ready-made research infrastructure, and no mature, specialized team. Much work depended on self-organized efforts: securing funds, purchasing or borrowing equipment, and mobilizing students and volunteers—incrementally advancing step-by-step. As a clinical surgeon whose primary commitment remains micro-reconstructive surgery, I also bear heavy clinical, teaching, and pre-existing research responsibilities—and worried whether this interdisciplinary project might invite misunderstanding, or impose additional burdens on my department and colleagues. During the initial phase, external skepticism, financial and infrastructural constraints, clinical workload pressures, and repeated self-questioning about whether the research path was truly viable all imposed significant psychological strain. Precisely because of this, each subsequently verified acupoint-related structure eliciting reproducible “deqi”, every clear B-US visualization of needle tip–structure interaction, and each confirmed myofascial or osseous gateway in fresh cadavers became exceptionally precious.

We welcome scholarly discussion grounded firmly in classical texts, clinical facts, in vivo observations, acupuncture responses, and anatomical evidence—but insist that academic discourse must center on facts and methodology, rather than substituting evidential research with label-based judgments or idiosyncratic interpretations. Acupoint physical-structure research does not depart from TCM tradition; rather, it returns to classical acupoints themselves. It does not simply “Westernize” TCM, but rather employs modern scientific tools to re-observe and reinterpret realities already discovered by ancient practitioners.

Subsequent developments have greatly encouraged me. Many TCM scholars and acupuncturists actively practicing clinically and valuing classical acupoints did not dismiss this work as mere “boundary-crossing by a surgeon”; instead, they welcomed modern imaging and microscopic anatomical approaches to clarify acupoint physical foundations. Similarly, Western medical colleagues in clinical practice, anatomy, ultrasound medicine, microsurgery, orthopedics, and rehabilitation medicine—after hearing my presentations on research methodology and observational results—did not regard this as unserious “disciplinary redirection.” Rather, they recognized genuine scientific questions and research value in terms of structure-function relationships, surface-topographic correlations, and clinical verifiability. In 2024, recommended by Professor Liu Cunzhi of Beijing University of Chinese Medicine, I was appointed Standing Committee Member of the Acupoint Branch of the China Association of Acupuncture-Moxibustion. This profoundly moved me: a surgeon long devoted to microsurgery and clinical anatomy being accepted and entrusted with academic responsibilities by the Acupoint Branch of China’s premier acupuncture association signals that classical acupoint physical-structure research is increasingly viewed by the acupuncture community with openness, rationality, and constructive engagement.

Meanwhile, Western medical colleagues have offered active attention and support. Professor Zhao Dewei, President of the Microsurgery Branch of the Chinese Medical Doctor Association, fully endorsed this research direction after learning about my anatomical studies on acupoints, and dispatched students and experts from his institution to Jinan for exchanges and collaboration. In 2025, Professor Liu Yan of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, invited me to present this research at Ruijin Hospital’s Multidisciplinary Forum. Professor Cui Ligang of the Department of Ultrasound Medicine, Peking University Third Hospital, invited me to introduce our acupoint physical-structure research findings at the National Ultrasound Training Program hosted by Peking University Health Science Center—and subsequently initiated collaborative research on related acupoint physical structures. These experiences demonstrate that acupoint physical-structure research transcends internal acupuncture discourse, attracting interest and support from microsurgery, ultrasound medicine, reconstructive surgery, clinical anatomy, and related Western clinical disciplines. It is precisely this understanding and encouragement from both TCM and Western medical communities that strengthens my conviction: classical acupoint physical-structure research is neither an isolated nor marginal topic—it is a foundational issue capable of simultaneously advancing both TCM acupoint theory and modern clinical anatomy.

Beijing University of Chinese Medicine, the Acupoint Branch of the China Association of Acupuncture-Moxibustion, the Journal Center of Beijing University of Chinese Medicine, Modern Clinical Traditional Chinese Medicine, Shandong Medical Journal, and other institutions and journals have provided assistance at various stages. Changchun University of Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanxi University of Traditional Chinese Medicine, New York College of Traditional Chinese Medicine (USA), Houston Chinese Medicine Academy (USA), the Chinese Morphological Medicine Conference, and the Young Leading Talent Academic Forum of the China Association of Acupuncture-Moxibustion have successively invited me to present on classical acupoint physical-structure research. Colleagues from microsurgery, ultrasound medicine, orthopedics, and rehabilitation medicine have participated in or supported related research in diverse ways. Such multidisciplinary attention and dialogue have gradually transformed this work from individual curiosity and team exploration into broader academic exchange and collaboration. Over thirty graduate students from various TCM universities contributed their spare time to manuscript compilation and textual verification; among them, Fang Peigang and Zhang Wenxu participated over extended periods.

We live in an era where disciplinary boundaries, technological frontiers, and cognitive limits are continually being challenged and expanded. Ancient physicians did not discover acupoints through pure imagination, but through prolonged clinical practice—systematically identifying specific structural regions distinct from surrounding tissues based on surface landmarks, bone-length measurements, phrases like “in the depression” and “in the gentle hollow,” and special sensory responses elicited by palpation, pressure, and needling. Historical limitations prevented them from directly visualizing what the needle tip contacted inside the body, or articulating the physical basis of acupoints in modern anatomical language. Today, high-resolution ultrasound allows real-time in vivo observation of needle–tissue interactions; microscopic dissection on fresh human cadavers enables tracing and visualization of true structural morphology. Thus, classical textual descriptions, distinctive “deqi” sensations during surface palpation, “deqi” responses during needling, ultrasound-visualized needle-contact structures, and microscopically visible myofascial/osseous gateways can now be integrated within a unified research framework for mutual verification.

Our work does not abandon classical texts and acupuncture practice to construct something entirely new. Rather, it takes classical acupoint localization as its foundation, uses distinctive “deqi” sensations evoked by live-subject palpation and needling as investigative clues, and leverages high-resolution ultrasound and microscopic dissection on fresh human cadavers to trace and visualize the physical structures corresponding to classical acupoints. Its purpose is—to honor ancient discoveries and clinical experience—to answer, using modern anatomical language, what physical structures classical acupoints correspond to, thereby transforming acupoint localization from experiential description toward structural precision, spatial accuracy, and reproducible verification.

An acupoint is neither an abstract concept confined to texts and theories, nor merely a dot marked on the skin. It must possess a physical structural basis that is palpable, visualizable, and empirically verifiable. Therefore, acupoint research should not remain indefinitely anchored in abstract interpretation, functional summarization, or experiential retelling. Philosophical analysis helps us comprehend TCM’s holistic worldview; cultural narratives illuminate acupuncture’s historical value; clinical experience documents long-term accumulations of acupoint application—but none substitutes for scientific investigation of acupoint physical structures. For acupoints, the fundamental questions requiring priority answers extend beyond “What functions does it serve?” to include: “On what basis is it localized?”, “What anatomical structure lies beneath its surface projection?”, “What structure triggers ‘deqi’ upon needle contact?”, and “Can this structure-sensation relationship be independently replicated and verified?” Avoiding these foundational questions risks confining acupoint research to descriptive layers of nomenclature, localization, and functional explanation—preventing genuine engagement with its objective anatomical basis.

Lu Yuanlei once stated: “Today, we employ science to investigate its actual efficacy, explain what is already known, and further discover the unknown. Those who distrust TCM can come to trust it; those unfamiliar with TCM can gain understanding. Only then can TCM’s unique strengths be presented to the global medical community—and the world’s medical sciences, in turn, achieve substantial advancement. This is the true purpose of TCM’s scientific development—how could it possibly consist of empty slogans?” This statement retains profound relevance today. TCM’s vitality lies not in evading scientific inquiry, but in withstanding rigorous scientific scrutiny; the value of acupoints resides not in preserving esoteric obscurity, but in enabling precise localization, clear visualization, reproducible verification—and, upon that foundation, deeper elucidation of their mechanisms of action. Acupoint physical-structure research pursues precisely this aim: respecting classical texts and clinical experience, it seeks to reveal the authentic physical-anatomical foundations underlying classical acupoints—allowing ancient discoveries, preserved through generations, to be newly observed, re-understood, and further investigated under modern scientific conditions.

With this book, we pay tribute to the ancient TCM sages who discovered, named, and transmitted classical acupoints—and document our preliminary explorations, conducted under modern scientific conditions, to uncover their physical structural foundations.

Wang Zengtao
Spring, 2026