Persistent median artery may explain the transition from 11 to 12 meridians in ancient Chinese medicine

Abstract

Recently, persistent median artery (PMA) has been recognized as a major arterial variant of the forearm in about 30% adults and it also shows a continuously increasing trend in the last two hundred years (Lucas et al., 2020). This may explain well the mystery why a "new meridian" was added to the older 11-meridian system over two thou-

Possible relationship of upper limb arteries, median and brachial to the twelfth meridian of the human upper limb

“…The observation in Chinese medicine that the 12th meridian, Hand Jue Yin Meridian runs along the path taken by the persistent median artery (Li 2021) is very interesting. According to the diagram presented in Li (2021), the segment of the 12th meridian from the elbow region to the distal end of the carpal tunnel could be in the path of the median artery of the palmar phenotype. Thereafter, the median artery either forms the superficial palmar arch with the ulnar artery or directly forms one or more of the common digital arteries 1–3 (Claassen et al, 2008; Cheruiyot et al, 2017; Lucas et al, 2020; Rodriguez‐Niedenfuhr et al, 1999).…”

“…The observation in Chinese medicine that the 12th meridian, Hand Jue Yin Meridian runs along the path taken by the persistent median artery (Li 2021) is very interesting. According to the diagram presented in Li (2021), the segment of the 12th meridian from the elbow region to the distal end of the carpal tunnel could be in the path of the median artery of the palmar phenotype.…”

Three hand yin meridians in ancient Chinese medicine were established initially based on arterial structures

“…It was also stated in the silk books (Ma, 1980) that (1) pulses can be detected in yin meridians (no mention of yang meridians); (2) both hand yin meridians start from the heart and end at the wrists; (3) the pathology of hand yin meridians includes angina and necrosis of internal organs, and (4) patients suffering from acute illness of yin meridians (not yang meridians) may die quickly in days (heart attack?). In addition, the added 12 th meridian, Hand Jue Yin Meridian, in the middle line of the forearm, also starts at the pericardial vessel of the heart and correlates well with the persistent median artery (PMA) in the forearm (Kumaratilake et al, 2020; Li, 2020). The later appearance of the 12 th meridian or PMA was most likely due to the relatively low incidence of its presentation as an arterial variant.…”

“…The drawing of 11 meridians based on silk books from Mawangdui Han Tomb (221-168 BC), photo taken from Hunan Museum, Changsha, China added 12 th meridian, Hand Jue Yin Meridian, in the middle line of the forearm, also starts at the pericardial vessel of the heart and correlates well with the persistent median artery (PMA) in the forearm (Kumaratilake et al, 2020;Li, 2020). The later appearance of the 12 th meridian or PMA was most likely due to the relatively low incidence of its presentation as an arterial variant.…”

“…It may be of interest to add that after the submission of my previous paper (Li, 2020), a survey conducted via WeChat was completed in a group of doctors in Chinese medicine studying pulse diagnosis (Li, 2021). Without pre‐describing the latest literature with regards to PMA, they were asked to feel pulses on Hand Jue Jin Meridian (in the inner middle longitudinal line of the forearm) from themselves or their patients.…”