Advanced Search

Journal of Traditional Chinese Medicine >

2025 , Vol. 45 >Issue 4: 867 - 872

DOI: https://doi.org/10.19852/j.cnki.jtcm.2025.04.016

Original Articles

Novel insight into the site-specificity of Hegu (LI4): morphological, biomechanical, and histological analyses

  • Umemoto Kanae ,
  • Xiyao SHAN ,
  • Ishikawa Takuro ,
  • Watsuji Tadashi ,
  • Watanabe Yasuharu ,
  • Naito Munekazu
Expand
  • 1 Department of Anatomy, Aichi Medical University School of Medicine, Aichi 480-1195, Japan
    2 Department of Health Promoting and Preventive Medicine, Meiji University of Integrative Medicine, Kyoto 629-0301, Japan
Kanae Umemoto, Department of Anatomy, Aichi Medical University School of Medicine, Aichi 480-1195, Japan. kanaeteru13@yahoo.co.jp,Telephone: +81-561-62-3311

Received date: 2024-05-16

  Accepted date: 2024-10-11

  Online published: 2025-07-25

Fold

Abstract

OBJECTIVE: To investigate the site specificity and differences of the Hegu (LI4) located on the midpoint of the second metacarpal and the point where the bases of the first and second metacarpal bones on the dorsum was historically used as Hegu (LI4) in Japan, through morphological, biomechanical, and histological analyses.

METHODS: We defined distally located Hegu (LI4) as Hegu (LI4)-D and proximally located Hegu (LI4) as Hegu (LI4)-P. The distance from the skin surface to the blood vessels as well as the biomechanical properties of the two Hegu (LI4) samples were measured using an ultrasound device and MyotonPRO (MyotonAS, Tallinn, Estonia), respectively, in 20 healthy adult volunteers. Sympathetic fibers under the two Hegu (LI4) samples were histologically observed using tyrosine hydroxylase (TH) immunostaining in 10 cadavers.

RESULTS: Hegu (LI4)-D was classified into type 1 with blood vessels < 4 mm away from the skin surface, and type 2 with blood vessels > 10 mm away from the skin surface. In Hegu (LI4)-P, blood vessels were approximately 10 mm away from the surface. Further, Hegu (LI4)-P had significantly higher tone, stiffness, and elasticity than Hegu (LI4)-D (P < 0.0001). TH-positive fibers were present near the artery in Hegu (LI4)-P.

CONCLUSION: Hegu (LI4)-D and Hegu (LI4)-P differed in terms of hardness and the distance between the skin surface and blood vessels. Furthermore, sympathetic nerve fibers were present near the artery in Hegu (LI4)-P. Taken together, these results suggest that there is site specificity of morphological, biomechanical, and histological differences between the Hegu (LI4)-D and Hegu (LI4)-P.

Key words： acupuncture; ultrasonic therapy; metacarpal bones; histology; morphology; biomechanism

Cite this article

Umemoto Kanae , Xiyao SHAN , Ishikawa Takuro , Watsuji Tadashi , Watanabe Yasuharu , Naito Munekazu . Novel insight into the site-specificity of Hegu (LI4): morphological, biomechanical, and histological analyses[J]. Journal of Traditional Chinese Medicine, 2025 , 45(4) : 867 -872 . DOI: 10.19852/j.cnki.jtcm.2025.04.016

References

1. World Health Organization. WHO standard acupuncture point locations in the western Pacific region. Geneva: World Health Organization, 2008: 1-258.
2. Yamada K, Hoshino T, Watari N. Relation between substance P-immunoreactive nerve fibers and lymphatic system in the human Goukoku (LI4)-corresponding area. J Jpn Soc Acupunct Moxibustion 1994; 44: 149-54.
3. Watari N, Kurono Y, Ishigami T, et al. morphological analysis of mouse acupuncture points. J Jpn Soc Acupunct Moxibustion 1982; 31: 310-4.
4. Katai S, Shinohara S, Sakaguchi S, et al. The aim of WHO and the circumstances and prospects of activity of the second Japan acupuncture points committee. JJSAM 2006; 56: 755-66.
5. Omole FS, Lin JS, Chu T, et al. Raynaud’s phenomenon, cytokines and acupuncture: a case report. Acupunct Med 2012; 30: 139-41.
6. Furuse N, Tsuru H and Sumiya E. A literature review on acupuncture for eye strain (asthenopia). J Jpn Soc Integr Med 2020; 13: 12-23.
7. Gaido KK. The complete detailed guide to meridian points. Tokyo: Ishiyaku Publishers, 2009: 29.
8. Ernst M, Lee MHM. Sympathetic vasomotor changes induced by manual and electrical acupuncture of the hoku point visualized by thermography. Pain 1985; 21: 25-33.
9. Sato R, Fujimoto T, Mukouyama M, et al. The effect of indirect moxibustion on cerebral circulation. Neurosonology 2000; 13: 175-8.
10. Fukuno A, Tsuru H, Ikushima M, et al. Acupuncture stimulation effects to the sensitivity threshold of the retina. JJSAM 2006; 56: 628-35.
11. Song JG, Li HH, Cao YF, et al. Electroacupuncture improves survival in rats with lethal endotoxemia via the autonomic nervous system. Anesthesiology 2012; 116: 406-14.
12. Chang TT, Feng YN, Zhu Y, et al. Objective assessment of regional stiffness in achilles tendon in different ankle joint positions using the MyotonPRO. Clinical Trial Med Sci Monit 2020; 26: e926407.
13. Li YP, Liu CL, Zhang ZJ. Feasibility of using a portable myotonpro device to quantify the elastic properties of skeletal muscle. Med Sci Monit 2022; 28: e934121.
14. Yu S, Lin L, Liang H, et al. Gender difference in effects of proprioceptive neuromuscular facilitation stretching on flexibility and stiffness of hamstring muscle. Front Physiol 2022; 13: 918176.
15. Cruz-Montecinos C, Antúnez-Riveros MA, Tapia C, et al. Gender differences on effects of forearm rotation on compressive stiffness of flexor carpi ulnaris during submaximal handgrip contractions. J Anat 2023; 243: 886-91.
16. Zhang Y, Chen M, Liu H, et al. Effect of different isometric trunk extension intensities on the muscle stiffness of the lumbar and lower limbs. Front Physiol 2024; 14: 1337170.
17. Shan X, Otsuka S, Yakura T, et al. Morphological and mechanical properties of the human triceps surae aponeuroses taken from elderly cadavers: implications for muscle-tendon interactions. PLoS One 2019; 14: e0211485.
18. Shan X, Umemoto K, Ishikawa T, et al. Biomechanical assessment of gastrocnemii and Achilles tendon using MyotonPRO: in vivo measurements, and preliminary in situ measurements using formalin-fixed tissues. Connect Tissue Res 2024; 65: 16-25.
19. Balogh B, Valencak J, Vesely M, et al. The nerve of Henle: an anatomic and immunohistochemical study. J Hand Surg Am 1999; 24: 1103-8.
20. Nguyen AP, Detrembleur C, Fisette P, et al. MyotonPro is a valid device for assessing wrist biomechanical stiffness in healthy young adults. Front Sports Act Living 2022; 4: 797975.
21. Roch M, Morin M, Gaudreault N. The MyotonPRO: a reliable tool for quantifying the viscoelastic properties of a trigger point on the infraspinatus in non-traumatic chronic shoulder pain. J Bodyw Mov Ther 2020; 24: 379-85.
22. Orner S, Kratzer W, Schmidberger J, et al. Quantitative tissue parameters of Achilles tendon and plantar fascia in healthy subjects using a handheld myotonometer. J Bodyw Mov Ther 2018; 22: 105-11.
23. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J Chiropr Med 2016; 15: 155-63.
24. Hopkins WG. Measures of reliability in sports medicine and science. Sports Med 2000; 30: 1-15.
25. Wong YM. An understanding of anatomy under the LI4 acupuncture point. Acupunct Med 2013; 31: 333.
26. Wong YM, Hobara H. Hand acupuncture and vascular injury. J Nippon Med Sch 2012; 79: 246-7.
27. Arima Y. Objectification of hardness information of palpation. Bull Meiji Univ Orient Med 1997; 21: 25-9.
28. Yamanaka I, Watsuji T. Study of transport point hardness: comparison of healthy and unhealthy groups. J Jpn Trad Acupunct Moxibustion Soc 2022; 48: 235-48.
29. Agyapong-Badu S, Warner M, Samuel D, et al. Measurement of ageing effects on muscle tone and mechanical properties of rectus femoris and biceps brachii in healthy males and females using a novel hand-held myometric device. Arch Gerontol Geriatr 2016; 62: 59-67.
30. Umemoto K, Naito M, Tano K, et al. Comment on "acupuncture point "Hegu" (LI4) is close to the vascular branch from the superficial branch of the radial nerve. Evid Based Complement Alternat Med 2021; 2021: 9857079.
31. Umemoto K, Naito M, Tano K, et al. Acupuncture point "Hegu" (LI4) is close to the vascular branch from the superficial branch of the radial nerve. Evid Based Complement Alternat Med 2019; 2019: 6879076.
32. Kramer JG, Todd TW. The distribution of nerves to the arteries of the arm, with a discussion of the clinical values of results. Anat Rec 1914; 8: 243-55.
33. Pick J. The innervation of the arteries in the upper limb of man. Anat Rec 1958; 130: 103-23.
34. Umemoto K, Naito M, Hatayama N, et al. A part of the medial branch of the deep peroneal nerve distributes the dorsal pedis artery and its distribution area is close to the acupuncture point LR3 (Taichong). Evid Based Complement Alternat Med 2020; 2020: 6760958.
35. Rankin G, Stokes M. Reliability of assessment tools in rehabilitation: an illustration of appropriate statistical analyses. Clin Rehabil 1998; 12: 18799.
36. Stratford PW, Goldsmith CH. Use of the standard error as a reliability index of interest: an applied example using elbow flexor strength data. Phys Ther 1997; 77: 745-50.
Options
Outlines

/

〈 〉