[Objective]Traumatic pneumothorax in acupuncture treatment should be avoided. This study was designed to detect the safe depth of the thoracic area with acupuncture and was compared with other studies in the past.
[Methods]The Subjects were 187 cases, male: 90, female: 97, mean age: 67.8 (min-max: 23-91) and classified into 3groups (thin, normal, fatty) from BMI. MultiCT images were filmed in 3anatomical levels (the tracheal point (TP), scapular point (SP), shortest point (MsP) of the thoracic area and the distance between the skin and lung tissue on the display was measured (Osirixver3. statistics:ANOVA).
[Results]The distance between the skin and lung tissue were, average ±SD, TP 3.01 ± 0.79, SP 2.34 ± 0.65, MsP 2.14 ± 0.61 cm. The longest distance was 5.5 cm (TP), and the shortest was 0.9 cm (MsP). The differences between the body depths and TP and SP, and MsP were statistically significant (TP >SP >MsP). There was a positive correlation between BMI and body depth, and a negative correlation between age and body depth. From an anatomical point of view, TP seemed to coincide with BL38, SP seemed to coincide with BL40, and MsP seemed to coincide with BL41 or BL42.
[Conclusions]MultiCT was very useful for a measurement of the distance between skin and lung tissue scientifically. The results of this study were almost in agreement with other studies in the past. The results are informative in showing that the risk of traumatic pneumothorax might be reduced clinically. But it is too difficult to confirm what is a safe depth, and it is recommended to measure the body depth under the conditions that include clinical problems, for example, the positioning in the treatment of acupuncture. The concept of safe depth should be changed to a dangerous depth with acupuncture treatment.

A pressure pain, frequently associated by an induration, is usually perceptible in the suprascapular region of the normal subjects. We considered the relation of the pressure pain with the anatomical structures of that region, firstly by investigating the locus of the pressure pain and whether it is associated by an induration or not, using the living subjects and in several cases, followed by a X-ray examination of the final destination of the needle which was inserted in the pressure pain zone; and lastly by dissecting the anatomical structures penetrated by that needle in a woman's cadaver.
We obtained the follwing three results from the above investigation and observations. (1) The most conspicuous pressure pain was perceptible in the middle of the upper margin of the suprascapular region, and a long and slender induration extending sagitally was palpable there. (2) The second rib lay in the deepest layer of the pressure pain zone, the layer which were overlain by the serratus posterior superior muscle, the serratus anterior and the omohyoid, many branches of the transversus colli artery and vein and the accessory nerve, and the trapezius muscle with the posterior suprascapular nerves running on its superficial surface, in order of lower to upper layer. (3) The transversus colli vessels, which forms a complex network of branchings crossing sagitally above the second rib, was suggested to have some relationship to the occurence of the pressure pain associated by the induration, because only the formation of such vascular network was peculiar to the pressure pain zone.

The Committee for the Meridian Point (Chairman, Kansho Yamada) focused on the significance of “the Meridian denial theory” which Hirohisa Yoneyama announced in 1952. Pros and cons emerged, and the so-called “Meridian controversy” raged for about two years. Documents relating to this controversy along with basic research on the meridian and the meridian point during the period were collected, arranged, examined, and presented at Workshop i of the 51st Annual Meeting of the Japan Society of Acupuncture and Moxibustion which was held in Tsukuba in June 2002. This is a condensed version of the reports.

The positional relation of the superior cervical ganglion with different anatomical structures were investigated, using cadavers, in order to devise the methods of acupuncture to the superior cervical ganglion. Furthermore, the anatomical structures penetrated by a needle which was inserted with the methods of acupuncture thus devised were investigated using another group of cadavers. The results obtained are as follows.
1) The superior cervical ganglion was located just above the bifurcation of the common carotid artery and medial to the angle of the mandible. The height of location of the ganglion was 30mm below the mastoid process, 21mm below the transverse process of the atlas, and 40mm above the lateral edge of the body of the hyoid bone.
2) From the above positional relation, we devised the method of acupuncture in which a needle was horizontally inserted from the lateral surface of the neck to the front of the transverse process of the cervical vertebra at the height 30mm below the mastoid process. We named this method the lateral acupuncture.
3) When considering on the basis of the lateral edge of the body of the hyoid bone, the superior cervical ganglion was located at the angles 15° lateral and 45° above.
4) From the above angles, we devised the method of acupuncture in which a needle was inserted from the lateral edge of the body of the hyoid bone at the angles of 45° above and 15° lateral. We named this method the anterior acupuncture.
5) The inserted needle of the lateral acupuncture reached the superior cervical ganglion at high frequency, it, however, had high possibility of penetrating the external and internal carotid arteries and the internal jugular vein.
6) The inserted needle of the anterior acupuncture reached the ganglion at slightly lower frequency, it, however, had lower possibility of penetrating the large vessels.

Aim : Since it was reported that acupuncture at Danchu (CV17) was critical when the needle penetrated through the congenital sternal foramen, we decided to study the incidence of the congenital sternal foramen, as well as the distance between the body surface and the back side of the sternum at Danchu, in order to know the safe depth of acupuncture penetration.
Method : 1) We selected 51 cadavers to examine the incidence of congenital sternal foramen and, if any, to study its structure. We also selected 21 cadavers to measure the cadaveric thickness of the sternum. 2) We selected 31 people to measure the incidence of the congenital sternal foramen and the distancebetween the body surface and the back side of the sternum at the point of Danchu.
Results : 1) We found one out of 51 cadavers which had congenital sternal foramen. The location of the foramen was at the height of the fourth intercostal space. It was round-shaped, 9mm in diameter, and filled with hard connective tissue. The thickness of the sternum ranged from 9 to 15mm with an average of 11.5 ± 2mm. 2) There was no one who had the congenital sternal foramen among the 32 people. The distance between the body surface and the back side of the sternum ranged from 11 to 31mm with an average of 18.8 ± 5mm.
Conclusion; 1) The incidence of the congenital sternal foramen in this study was one in 51 cadavers and zero in 32 people. 2) We concluded that acupuncture at Danchu within a depth of 10mm is sufficiently, even if congenital sternal foramen exists.

Acupuncture to Gaohuang carries a risk of causing pneumothorax because it reaches the lungs at deep portion. This study was designed to consider a safe depth for acupuncture to Gaohuang.
1) We inserted a needle to Gaohuang on both sides of a cadaver to examine the location of the needle tip and measure the distance from the body surface of the left Gaohuang to the pleura. The tip was located at the fifth intercostal region on both sides, and the distance was 44 mm with a rib thickness of 10 mm. 2) Using 104 students, we inserted a needle to the left Gaohuang until the tip reached the rib, and measured the distance between the bodysurface and rib. The minimal distance was 14 mm. 3) We inserted a needle to Gaohuang on both sides of two males and took CT-radiographs to examine the location of the needle tip and measure the distance from the body surface of Gaohuang to the pleura. In a man of standard body size, the needle reached the rib on the left and the intercostal region on the right. The thickness of the left rib was 10.9 mm, and the distance from body surface to pleura was 33.6 mm on the left and 28.4 mm on the right. In a man of thin body size, the needle reached the rib on both sides, with the rib thickness was 9.8 mm on the left and 8.8 mm on the right. The distance from body surface to pleura was 29.4 mm on the left and 31.8 mm on the right. The above results showed that needle insertion within 19 mm (the minimal value of the measured distance between the body surface and rib + the half thickness of the rib) is safe.

The Research Committee for the Meridian Point held its third workshop at the 57th Annual Meeting of the Japan Society Acupuncture and Moxibustion in Kyoto. Evaluations and reports were presented on two topics.

The first topic:Study of PSC in Japan and China.
1) Literature search on PSC in China (Wang):A literature search on major studies on PSC in China since 1979 was conducted. The report introduces the definition, characteristics and the mechanism of PSC development together with meridian phenomena.

2) PSC in reference to the ryodoraku (Morikawa):Development of the reactive ryodo point in patients under hemodialysis or those who have had a total gastrectomy and the cases in which reactive ryodo points or needle sensation developed when specific regions were stimulated were reported. The relationship between reactive ryodo points and PSC was examined.

3) The mechanism by which PSC develops (Yamada):Neurotransmitter substances are released from sensory nerve endings during acupuncture stimulation. Absorbed by lymphatic vessels, these substances stimulate the smooth muscle of these vessels, thus causing the PSC. Based on factors such as transmission velocity and inhibitory factors, the mechanism by which PSC develops was investigated.

The second topic:Specific locations of meridian points and clinical effects of the meridian point.
1) Anatomical regions for GB 30 huantiao (Ozaki and Matsuoka):In establishing the international standard for the meridian points under the guidance of WHO, both Chinese and Japanese proposals were listed for GB 30. The clinical effects-presumably emanating from the subcutaneous structure when acupuncture stimuli are applied to these points in a direction perpendicular to the body surface-were comparatively evaluated.

2) Transition in the regions and main effects of GB 30 (Sakaguchi):As stated above, both Japanese and Chinese definitions were cited in establishing the international standard for GB 30 under the guidance of WHO. By quoting the classic literature from China and Japan, changes in the regions and main effects of GB 30 were comparatively evaluated.

Six members of the Research Committee for the Meridian Point (former Committee for the Meridian Point) reported on three themes regarding meridian and acupuncture point at Workshop II of the 54th Science Rally of The Japan Society of Acupuncture and Moxibustion held in Fukuoka.
1st theme : Anatomical examination of the meridian and meridian point.
1) Anatomic structure showing path and meridian running. (Kenji Matsuoka) : Similarity of meridian pathway and course of nerve and blood vessels in cadaver.
2) Gross anatomical study of meridian and acupuncture point in upper limbs (Kansho Yamada) : Doctoral study of Katsuyosi Toyoda, former Nagoya City University School of Medicine researcher and Yamada's study (Relation between running of meridian & acupuncture point and subdermal nerve & blood vessels) were reported.
2nd theme : Study of acupuncture safety depth in Japan and China.
1) Research and progress situation of acupuncture safety depth in China. (WANG Cai Yuan) : Data of Yan Zhenguo, professor of anatomy at Shanghai University of Traditional Chinese Medicine, an authority on the study of acupuncture safety depth and progress situation of recent study of acupuncture safety depth in China.
2) Retrospective study of acupuncture safety depth (Tomofumi Ozaki) : Study of acupuncture safety depth published by Ozaki to date and comparative study alongside Prof. Yan Zhenguo data.
3rd theme : Examination of clinical effect of a few meridian points.
1) Acupuncture clinical effect using a few meridian points (Syunji Sakaguchi) : Paper research and analysis of acupuncture clinical effects using 1-4 meridian points of Japana Centra Revuo Medicina.
2) Inflence on skin energizing current by various acupuncture stimulation of LI4 (Gokoku) (Kazuhiro Morikawa) : Influence on the amount of skin energizing current by acupuncture stimulation, direct current electricity stimulation and stimulation of electroacupuncture to LI4.