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Research Article

2020; 13(6): 174-179

Published online December 1, 2020 https://doi.org/10.1016/j.jams.2020.11.003

Copyright © Medical Association of Pharmacopuncture Institute.

Locating Specific Acupoints Large Intestine 4 (LI4) and Large Intestine 6 (LI6) in Cadavers Using Anthropometric and Cun Measurement Systems

Gregory P. Casey

Departments of Cell Biology and Anatomy, Louisiana State University Health Sciences Center, New Orleans, LA, USA

Correspondence to:E-mail address: gcasey@lsuhsc.edu.
† Department of Cell Biology & Anatomy, 1901 Perdido Street, LSU Health Sciences Center, New Orleans, LA 70112, USA.

Received: January 24, 2020; Revised: November 11, 2020; Accepted: November 22, 2020

Abstract

Background: Anthropometric and anatomical Chinese inch measurement (CUN) systems are useful in understanding the location of acupoints; however, locating acupoints is challenging.
Objectives: The study aimed to locate LI4 and LI6, to measure differences and similarities in body dimensions based on sex using anthropometric and CUN systems, and to observe the relationship between f-cun and b-cun.
Methods: 25 forearms and hands from 16 embalmed cadavers had body dimensions measured using anthropometric and CUN systems. LI4 and LI6 were located using a combination of both systems. Data were compiled and calculated to observe any variation in means and ranges. Statistical analysis was performed using a paired t-test.
Results: LI4 was found on the skin at the lateral border of the midpoint of the second metacarpal bone. LI6 was found 3 cun or 74 ± 8 mm from LI5. Differences were observed between male and female cadavers and a large difference between f-cun and b-cun measurements of 1.5 to 3 cun. There were positive correlations between several body dimensions observed.
Conclusions: LI4 was located on the dorsum of the hand, radial to the midpoint of the second metacarpal bone. LI6 was located 3 cun from LI5 with an error of 1 to ½ cun variation. The differences in f-cun and bcun in isolating LI6 seem to account for this error. Future studies using cadavers may need to take this error into consideration for variation and measuring differences.

Keywords: acupoint, acupressure, acupuncture, anthropometric, cun, measurement

1. Introduction

In medieval times before modern measuring devices, systems were crude. In antiquity, there were measuring systems that were derived from the human body. The anatomical inch “cun” system has persisted for thousands of years in China and continues in practice to this day in various forms of Chinese medicine [1]. Trying to standardize this system of measurement is extremely challenging because there is a historical presence and a conventional use in practical clinical application [2,11]. There is also poor characterization between body dimension measuring methods between east and west modalities. In this study, acupoints Large Intestine 4 (LI4) and Large Intestine 6 (LI6) were located using a combination of anthropometric and the Chinese anatomical inch measurement (CUN) systems to determine accuracy and precision, verify the world health organization’s guidelines for the location of these acupoints, and to observe any variation in the location in male and female cadavers. By combining methods of directional (f-cun) and proportional (b-cun) measurements with anthropometric data, a range was found where LI4 and LI6 can be located in cadavers for more detailed research on specific structures.

2. Materials and Methods

Embalmed cadavers were used in this study instead of living participants because subsequent dissection can reveal underlying structures that may be involved in specific mechanisms associated with LI4 and LI6. There is also a need in the literature to characterize acupoints with underlying structures that may or may not cross more than one acupoint. Abreviations of anthropometric and cun measurements are found in Table 1, Table 2. Sixteen cadavers (7 female, 9 male; 14 Caucasian and 2 African American) were embalmed and processed according to the Environmental Health and Safety Department at the LSU Health Sciences Center (LSUHSC) in New Orleans and under Occupational Safety and Health Administration’s policy and guidelines. Cadavers were hyperperfused with a mixture of formaldehyde, glycerin, phenol, and water for long-term use in gross anatomy teaching courses. Prior to embalming, the age ranges for the cadavers were from 50 to 95 years old, with a mean age of 80 ± 12 years. The height ranges for the cadavers were 1.8 m to 1.5 m, with the mean height of 1.7 ± 0.1 m. The weight ranges for the cadavers were 81.6 kg to 45.4 kg, with the mean weight of 59.4 ± 12.3 kg. The BMI ranges for the cadavers were between 29.3 kg/m2 to 15.2 kg/m2, with the mean BMI of 21.4 ± 3.9 kg/m2. A total of 25 hands and forearms were observed to determine the location of LI4 and LI6. Measured body dimensions were compared between male and female cadavers. Lastly, similar anthropometric and CUN body dimensions were compared and correlated to observe any relationship between them. Body dimensions and acupoint identification were collected in the gross anatomy laboratory facilities at LSUHSC.

References [3,4,5,6,7]..

&md=tbl&idx=1' data-target="#file-modal"">Table 1

Anthropometric measurements..

Dimension of anthropometric measurementAbbreviationDefinition
Hand lengthHLThe distance from the middle of interstylion to the tip of the middle finger
Index finger length2DLThe distance from the proximal flexion crease of the tip of the index finger
Palm lengthPLThe distance from the middle of interstylion to the proximal flexion crease of the middle finger
Hand breadthHBThe distance from the most lateral point on the head of the 2D metacarpal to the most medial point on the head of 5D metacarpal
Index finger proximal breadth2D2BThe distance from the most lateral point on the index finger proximal joint to the most medial point of the index finger proximal joint
Index finger distal breadth2D1BThe distance from the most lateral point on the index finger distal joint to the most medial point of the index finger distal joint
Wrist breadthWBThe distance from the most lateral point on the wrist to the most medial point of the wrist
Wrist depthWDThe distance from the most anterior point on the wrist to the most posterior point of the wrist
Maximum hand breadthMHBThe distance from the most lateral point on the head of the 1D metacarpal to the medial point on the head of 5D metacarpal with closing fingers
Hand thicknessHTThe distance from the back of the middle finger to the most medial point of the palm
Maximum hand thicknessMHTThe maximum distance from the back of the hand to the most projected point of the abductor policies brevis
Hand circumferenceHCThe superficial distance around the edge of the metacarpals
Wrist circumferenceWCThe superficial distance around the edge of the wrist
Maximum hand circumferenceMHCThe maximum superficial distance around the edge of the hand with closing fingers
Little finger proximal circumference5D2CThe superficial distance around the edge of the proximal joint in the little finger
first metacarpal boneMC IThe distance of the first metacarpal bone from the proximal base to distal head
second metacarpal boneMC IIThe distance of the second metacarpal bone from the proximal base to distal head
Forearm (Elbow to wrist) lengthFLThe distance from the olecranon process to the distal end of the styloid process of the ulna.
Maximum forearm circumferenceMFCThe maximum circumference of the forearm perpendicular to its long axis.
Elbow breadthEBThe distance across the medial and lateral epicondyles of the humerus
Elbow depthEDThe distance between olecranon process of the ulna and the biceps brachii tendon in the cubital fossa

References [3,4,5,6,7]..



References [10,12,13]..

&md=tbl&idx=2' data-target="#file-modal"">Table 2

Chinese Anatomical inch measurements and acupoint locations..

Dimension of Chinese Inch MeasurementAbbreviationDefinition
Chinese anatomical inch site 1ACUN 1AThumb width of the interphalangeal joint
Chinese anatomical inch site 1BCUN 1BLength between the skin creases of the middle phalanx of the middle finger
Chinese anatomical inch site 1.5CUN 1.5The width of the index and middle finger, measured at the level of the proximal interphalangeal joint of the index finger
Chinese anatomical inch site 2CUN 2the length of the distal and middle phalanges of the index finger
Chinese anatomical inch site 3CUN 3Width of all four fingers, measured at the level of the proximal interphalangeal joint of the index finger
Chinese anatomical inch site 4CUN 4Width of all four fingers, measured at the level of the metacarpophalangeal joint of the index finger
Chinese anatomical inch site 12CUN 12Length of transverse cubital crease to the transverse carpal crease
Distance along Large Intestine Meridian between LI5 and LI11LI5 to LI11Length between two anatomically distinct points from the depression at the lateral end of the transverse cubital crease and lateral epicondyle to the depression between the tendons of the extensor pollicis brevis and longus muscles (anatomical snuffbox) cun 12
Location of Large Intestine 4 AcupointLI4On the dorsum of the hand, radial to the midpoint of the second metacarpal bone. Between the first and second metacarpal bones, approximately in the middle of the second metacarpal bone on the lateral side
Location of Large Intestine 5 AcupointLI5On the posterolateral aspect of the wrist, at the radial side of the dorsal wrist crease, distal to the radial styloid process, in the depression of the anatomical snuffbox.
Location of Large Intestine 6 AcupointLI6On the posterolateral aspect of the forearm, on the line connecting LI5 to LI11,3 B-cun superior to the dorsal wrist crease.
Location of Large Intestine 11 AcupointLI11On the lateral aspect of the elbow, at the midpoint of (he line connecting I.U 5 with the lateral epicondyle of the humerus. When the elbow is fully flexed. LI11 is located in the depression on the lateral end of the cubital crease.

References [10,12,13]..



The author supervised all anthropometric and CUN measurements done by others [1,4,5,6,7,8,9]. The author is a licensed massage therapist, a certified practitioner in the American Organization for the Bodywork Therapies of Asia with 9 years of private practice experience, and a gross anatomist with over 10 years of teaching and dissecting experience. Two undergraduate students measured body dimensions with a Neiko Tools digital caliper (model 01408A, ∼0.01 mm) and a body measuring ruler sewing tailor tape measure (∼0.1 cm). The undergraduate students were a junior (third year) nursing student and a senior (fourth year) respiratory therapy student. Both students had taken an anatomy dissection course at LSUHSC prior to assisting in the research project. Each undergraduate student collected measurements for one cadaver at a time, which included the left and/or right sides. Each student never overlapped measurements with the other student on the same cadaver. Each anthropometric and CUN dimension was measured five times. The mean, standard deviation, and range of the sample group were calculated.

Subsequently, the author located LI4, LI5, LI6, and LI11 on each cadaver’s hand and forearm in accordance with the World Health Organization standards and textbook descriptions (Fig. 1) [10,12,13]. The second metacarpal bone (MC II) was outlined on the dorsum skin of the hand to locate LI4, and help visualize the acupoint. The author measured the MC II from the proximal base to the distal head in each hand by palpating the bone and using the caliper. At half the distance measured, the acupoint was located on the skin lateral to the middle lateral posterior border of the MC II. This point was marked with a black marker on the skin for visualization. Subsequently, the distance from marked LI4 acupoint to the proximal base and distal head of the MC II was measured. The author compiled and graphed the data to determine the approximate precision and accuracy in locating the acupoint. The mean, standard deviation, and ranges were calculated for LI4.

Figure 1. Location of LI4 on the posterior hand and LI6 on the pronated forearm in relation to bony structures along the large intestine meridian.

In order to locate LI6, the author first located LI5 in the depression of the anatomical snuffbox with the tendons of extensor pollicis longus and brevis muscles around the depression, and then LI11 at the lateral end of the transverse cubital crease anterior to the lateral epicondyle. LI5 was marked with a black marker on the skin in the depression where the radial styloid process could be palpated in the anatomical snuff box. LI11 was also marked with a black marker where the lateral extensor group muscles attached anteriorly to the lateral epicondyle. The author drew a straight line connecting LI5 to LI11. For each specimen, the width of all four fingers measured at the level of the proximal interphalangeal joint of the index finger or the millimeter equivalent of 3 CUN was used to locate LI6 on the line. The acupoint was identified and marked with a black marker.

Statistical analysis, correlations, and graph generation was done using Graphpad Prism software. Standard t-tests were done comparing body dimensions. Diagrams and selected figures were made in Adobe Photoshop 2020. Tables were made using Adobe InDesign 2020.

3. Results

Several body dimensions were statistically significant between male and female cadavers (Table 3). Hand Length (HL), Maximum Hand Breadth (MHB), Hand thickness (HT), and the length between the skin creases of the middle phalanx of the middle finger (CUN 1B) were not significant between male and female cadavers (Table 3). Cun ratio measurements had no significant difference between male and female cadavers when calculated (not shown). The mean cun was calculated by dividing the millimeter equivalents of all CUN measurements to CUN 1A and then comparing them to traditional measurements. The variability mean cun (normalized to CUN 1A) and traditional cun measurements increased with the measuring distance (Fig. 2A).

* = 0.005, ** = 0.01, *** < 0.001..

&md=tbl&idx=3' data-target="#file-modal"">Table 3

Sex differences of anthropometric and cun measurements (mean and SD in mm)..

ItemFemale (n = 12)Male (n = 13)T-Statisticp


MeanSDRangeMeanSDRange
HL170.8710.64185.00–144.20181.2217.93235 00–164 001.74ns
2DL65.727.6681.66–58.5176.4112.84109.52–63.22250*
PL93.997.08103 61–79.3299 632.31101 63–93 32272*
HB70.803.9976.19–61.5879.365.4489.22–/1.544.46***
2D1B14.461.2416.36–12.7317.861.1919 58–15.877 00***
2D2B16.821.6719.54–14.5620.071.3323.84–18.395.42***
WB47.945.4955.92–34.7356.923.4964.24–51.38493***
MHB81.0911.11100.11–63.9886.769.77101.44–68.141.36ns
HT24.405.6533.98–14.5827.245.3836.09–19.331.29ns
MHT40.354.7147.30–34.0950.294.7260.41–43.745.27***
HC181.4711.46199.20–157.60212.359.84230.60–199.607.25***
WC150.2011.65166.80–128.40167.4810.09189.80–154.403.97***
MHC211.7514.70236 60–192 0238921.49267 20–219 20447***
5D2C53.654.0959.00–44.8061.923.1266.80–56.405.71***
FL246.789.68264.60–225.802627218.64295.2–236 2265*
EB66.777.1078.17–53.3677.708.39103.32–72.173.50**
MFC220.1724.01256.6.–177.80245.0728.33301.40–205.002.36**
ED64.228.6377.00–52.5674.5112.31101.34–62.19240*
WD33.572.6937.62–27.8140.141.8543.68–37.217.17***
MC I42.875.4051.28–31.5551.594.7159 00–41.384 32***
MCII61.155.6467.61–50.4268.356.7978.10–55.22287**
CUN 1A17 861.221967–15.5921 871.6824 97–18 586 75***
CUN 1B21.243.5828.06–16.1823.713.7233.41–19.261.62ns
CUN 1.534.053.3638.65–27.6340.302.9245.97–36.254.98***
CUN 241.743.8445.80–32.1846.693.7653.06–42.703.26**
CUN 367.204.8575.69–60.9180.012.7485.69–76.20823***
CUN 471.153.7978.20–63.2181.944.7489.46–74.966.24***
CUN 12218.228.85237.00–204.40249.4915.81268.20–221 00564***
LI5 to LI11215.0819.85239.00–171.00241.4217.66280.00–214.003.51**

* = 0.005, ** = 0.01, *** < 0.001..



Figure 2. Correlation of f-cun and Anthropometric measurement in locating LI4 and LI6. (A) Sample and traditional f-cun. Sample measurement has a degree of variability from traditional measurements as distance increases. (B) The approximate location of LI4 is between 50 mm to 23 mm, with the mean range between 36 ± 6 mm (distal head) to 30 ± 4 mm (proximal base) along the distance of the second Metc. (C) The approximate location of LI6 is between 201 mm to 61 mm, with a mean range between 156 ± 22 mm (from LI11) to 74 ± 8 mm (from LI5). (D) CUN 1A vs CUN 1B had a positive correlation, r(23) = 0.69, p = 0.0002. (E) HB and CUN 4 had a significant positive correlation between the two measurements, r(23) = 0.86, p = 0.0001. (F) FL vs CUN 12 had a significant positive correlation between the two measurements, r(23) = 0.73, p = 0.0001.

Between measured f-cun and calculated b-cun, 1.5 to 3 cun were significantly different. Thumb width of the interphalangeal joint (CUN 1A) and the width of all four fingers, measured at the level of the metacarpophalangeal joint of the index finger (CUN 4), were not statistically significant between measured f-cun and calculated b-cun (Table 4).

* = 0.05, ** = 0.01, *** < 0.001; = CUN 1B was compared to B-cun 1..

&md=tbl&idx=4' data-target="#file-modal"">Table 4

Comparison of measured F-cun and calculated B-cun (Mean and SD in mm)..

F-cun measuredB-cun calculated measured from - CUN 12pExpected


ItemMeanSDItemMeanSD
CUN 1A19.952.47B-cun 119.501.70ns12X
CUN 1B 22.523.79---**12X
CUN 1.537.374.45B-cun 1.529.102.30***8X
CUN 244.354.50B-cun 239.103.50***6X
CUN 373.847.46B-cun 358.605.20***4X
CUN 476.967.06B-cun 478.206.90ns3X

* = 0.05, ** = 0.01, *** < 0.001; = CUN 1B was compared to B-cun 1..



The approximate location of LI4 was found along the lateral border of the second metacarpal bonés midpoint with a mean of 33 ± 4 mm. The mean range from the distal head to LI4 was 36 ± 6 mm and from the proximal base to LI4 was 30 ± 4 mm (Fig. 2B). The approximate location of LI6 had a mean distance of 74 ± 8 mm from LI5, which was the mean equivalent of the width of all four fingers measured at the level of the proximal interphalangeal joint of the index finger (CUN 3). LI6 had a mean distance from LI11 of 156 ± 22 mm and a mean distance from LI5 of 74 ± 8 mm (Fig. 2C).

There was a positive correlation between CUN 1A and CUN 1B measurements (r(23) = 0.69, p = 0.0002, Fig. 2D). The mean measurements of CUN 1A (20 ± 2 mm) and CUN 1B (23 ± 4 mm) were statistically significant from each other (p = 0.007). Hand breadth (HB) and CUN 4 had a significant positive correlation with each other (r(23) = 0.86, p = 0.0001, Fig. 2E). The means of HB (75 ± 3 mm) and CUN 4 (77 ± 7 mm) were not statistically significant from each other (p = 0.3872). There was significant positive correlation between forearm length (FL) and the length of transverse cubital crease to the transverse carpal crease (CUN 12) (r(23) = 0.73, p = 0.0001, Fig. 2F). The means of FL (257 ± 20 mm) and CUN 12 (234 ± 21 mm) were statistically significant from each other (p = 0.0003).

4. Discussion

When comparing f-cun measurements with b-cun calculated measurements, there were statistically significant differences of 1.5 to 3 cun (Table 4). Other investigations have reported similar findings with different body region measurements within f-cun and b-cun [1]. CUN 1A and CUN 4 were not statistically significant from the calculated b-cun (Table 4). These measurements may be a better internal correlation between f-cun and b-cun in the hand and forearm. For other body regions, more investigation needs to be done.

There were differences based on sex in the location of LI4 that were similar to other anthropometric dimensions (Table 3). Based on the distances between the distal head and proximal base of the MC II, LI4 appears to fall within a select anatomical range (Fig. 2B). There are likely several anatomical variations of structures located at this point, such as the superficial radial nerve and the dorsal venous plexus, which warrant further study [15,16].

The determination of LI6 was more challenging. LI6 was estimated to have an overall mean distance of 74 ± 8 mm from LI5 (Fig. 2C). There were differences based on sex in the location of LI6 that were similar to other anthropometric dimensions (Table 3 and Fig. 2C). In female cadavers, LI6 had a mean distance from LI5 that was smaller by about 8 to 6 mm than the overall sample. This difference may be related to the use of CUN 3 to locate LI6. There was a statistical difference in the means of 3 cun between f-cun and b-cun. This creates approximately a 1 to ½ cun measurement in error when using CUN 3 (Table 4). This finding may pose challenges in future research in locating LI6. This error may need to be taken into consideration when studying structures at this point in detail. This relationship may not be feasible with other acupoints such as Heart (HT) 4–7 since there would be an overlap between adjacent acupoints. Specific anatomical structures are in line with specific acupoints, such as dorsal rami of spinal nerves [14] or other structures deep to LI6. These anatomical relationships may offer insight into how these points relate to one another.

Body dimension differences in sex were observed and verify other studies [4]. HL, MHB, HT, CUN1B were not statistically significant between male and female cadavers (Table 3). There were also similar measurements between CUN 3 and CUN 4 (Table 3, Table 4). These results would also explain as to why there may be 1 to ½ cun error in locating LI6. There are two major factors that can contribute to these findings that may need to be taken into account when measuring LI6 for future studies:

  • 1) Cadavers are embalmed, and no dynamic processes are taking place. The embalming method at LSUHSC uses a hyperperfusion technique that adds volume to the cadaver, whereas other institutions will remove blood to offset the volume being injected. The embalming process for the cadavers creates a greater volume of fluid to penetrate into the tissues for long-term study in selected gross anatomy dissection courses. The pooling of fluid regularly occurs in all parts of the soft tissue in the cadavers and is most pronounced in the extremities. This is also dependent on the cadaver’s height, weight, and BMI.

  • 2) A few cadavers were observed. Most of the data collected were similar to results of other researchers who measured the same anthropometric or cun measurements in living human beings with a greater number of participants [1,4,5,8]. The results do support these measurement systems as valid methods to locate acupoints in cadavers for further investigation into the anatomical relationships of specific points [14]. The amount of error seen in this study can offer an opportunity to better visualize structures closely associated with specific acupoints. Anatomical relationships need good visualization in order to fully document the structures involved.

There were several CUN measurements that had positive correlations with other measurements (Fig. 2D–F). CUN 1A and CUN 1B were compared to see if they had the equivalent of 1 cun and could be used interchangeably in future studies. The challenge was that these two measurements rely on different landmarks. CUN 1A depends on the distance on the first interphalangeal joint, whereas CUN 1B depends on the skin folds of the middle interphalangeal joint, which may account for the larger degree of variation (Table 3). CUN 1A was more consistent between f-cun and calculated b-cun measurements, whereas CUN 1B was not (Table 4). Both of these findings could be interpreted that CUN 1A measurement may be more consistent and precise than CUN 1B in cadavers.

FL and CUN 12 were compared to see if these body measurements could act as equivalent measurements between anthropometric and cun measurements. The challenge for these two measurements was the size of the forearm. FL is limited by the length of the ulna bone and is not affected by muscle mass or fluid retention, whereas CUN 12 and the distance between LI5 to LI11 are. As different parts of forearm circumference increase, the length will increase. Individuals with the same height, weight, and bone proportions will have similar dimensions skeletally; however, muscle tone, hypertrophy, or atrophy will affect the distance in CUN 12. This may also contribute to the challenges seen in using f-cun and b-cun in locating specific acupoints in the forearm [8,9,10].

When HB and CUN 4 were compared, there seems to be some similarities between anthropometric and cun measurements (Table 2, Table 3). Statistically, they are identical, and they have similar descriptions when measuring. CUN 4 also was more consistent between f-cun and b-cun measurements in the hand and forearm (Table 4). The relationships observed here give strong support that HB and CUN 4 have common measurements that can overlap between cun and anthropometric systems.

When comparing cun and anthropometric dimensions, there is a degree of variability that seems to reflect normal anatomical variation (Table 3 and Fig. 2). This degree of variability may only be specific for the upper extremity, as seen in this study. The data presented verify the location of LI4 with a small variable range. The location of LI6 has more variability in discerning the location with f-cun and b-cun methods. This variability should be taken into account in future studies.

Acknowledgments

The author sincerely thanks those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude [17].

Undergraduate students Lauren Bridevaux (third-year nursing student) and Dominic Neil (fourth-year respiratory therapy student) collected the anthropometric and Chinese inch data under the author’s direction and supervision. They had both previously enrolled in an anatomy dissection course using cadavers at LSUHSC prior to their involvement in this study.

Anthony Wells, Shenell Thomas, and Maggie Hales embalmed and prepared the cadavers according to the Environmental Health and Safety Department at the LSU Health Sciences Center in New Orleans and under Occupational Safety and Health Administration’s policy and guidelines.

Dawn Woods and the Louisiana Bureau of Anatomical Services provided age and demographic data on each of the cadavers in the study.

The author supervised and/or coordinated with all contributors to the project. He located LI4 and LI6 on all cadaveric specimens for this study. He compiled, analyzed, and tabulated all the data, reviewed the literature, and wrote the manuscript.

Funding


The Louisiana State University Health Sciences Center in New Orleans and the Department of Cell Biology and Anatomy provided the facility to perform measurements on the cadavers.

Conflicts of interest


There is no conflicts of interest involved in the development and production of this research.

Fig 1.

Figure 1.Location of LI4 on the posterior hand and LI6 on the pronated forearm in relation to bony structures along the large intestine meridian.
Journal of Acupuncture and Meridian Studies 2020; 13: 174-179https://doi.org/10.1016/j.jams.2020.11.003

Fig 2.

Figure 2.Correlation of f-cun and Anthropometric measurement in locating LI4 and LI6. (A) Sample and traditional f-cun. Sample measurement has a degree of variability from traditional measurements as distance increases. (B) The approximate location of LI4 is between 50 mm to 23 mm, with the mean range between 36 ± 6 mm (distal head) to 30 ± 4 mm (proximal base) along the distance of the second Metc. (C) The approximate location of LI6 is between 201 mm to 61 mm, with a mean range between 156 ± 22 mm (from LI11) to 74 ± 8 mm (from LI5). (D) CUN 1A vs CUN 1B had a positive correlation, r(23) = 0.69, p = 0.0002. (E) HB and CUN 4 had a significant positive correlation between the two measurements, r(23) = 0.86, p = 0.0001. (F) FL vs CUN 12 had a significant positive correlation between the two measurements, r(23) = 0.73, p = 0.0001.
Journal of Acupuncture and Meridian Studies 2020; 13: 174-179https://doi.org/10.1016/j.jams.2020.11.003

Table 1 . Anthropometric measurements..

Dimension of anthropometric measurementAbbreviationDefinition
Hand lengthHLThe distance from the middle of interstylion to the tip of the middle finger
Index finger length2DLThe distance from the proximal flexion crease of the tip of the index finger
Palm lengthPLThe distance from the middle of interstylion to the proximal flexion crease of the middle finger
Hand breadthHBThe distance from the most lateral point on the head of the 2D metacarpal to the most medial point on the head of 5D metacarpal
Index finger proximal breadth2D2BThe distance from the most lateral point on the index finger proximal joint to the most medial point of the index finger proximal joint
Index finger distal breadth2D1BThe distance from the most lateral point on the index finger distal joint to the most medial point of the index finger distal joint
Wrist breadthWBThe distance from the most lateral point on the wrist to the most medial point of the wrist
Wrist depthWDThe distance from the most anterior point on the wrist to the most posterior point of the wrist
Maximum hand breadthMHBThe distance from the most lateral point on the head of the 1D metacarpal to the medial point on the head of 5D metacarpal with closing fingers
Hand thicknessHTThe distance from the back of the middle finger to the most medial point of the palm
Maximum hand thicknessMHTThe maximum distance from the back of the hand to the most projected point of the abductor policies brevis
Hand circumferenceHCThe superficial distance around the edge of the metacarpals
Wrist circumferenceWCThe superficial distance around the edge of the wrist
Maximum hand circumferenceMHCThe maximum superficial distance around the edge of the hand with closing fingers
Little finger proximal circumference5D2CThe superficial distance around the edge of the proximal joint in the little finger
first metacarpal boneMC IThe distance of the first metacarpal bone from the proximal base to distal head
second metacarpal boneMC IIThe distance of the second metacarpal bone from the proximal base to distal head
Forearm (Elbow to wrist) lengthFLThe distance from the olecranon process to the distal end of the styloid process of the ulna.
Maximum forearm circumferenceMFCThe maximum circumference of the forearm perpendicular to its long axis.
Elbow breadthEBThe distance across the medial and lateral epicondyles of the humerus
Elbow depthEDThe distance between olecranon process of the ulna and the biceps brachii tendon in the cubital fossa

References [3,4,5,6,7]..


Table 2 . Chinese Anatomical inch measurements and acupoint locations..

Dimension of Chinese Inch MeasurementAbbreviationDefinition
Chinese anatomical inch site 1ACUN 1AThumb width of the interphalangeal joint
Chinese anatomical inch site 1BCUN 1BLength between the skin creases of the middle phalanx of the middle finger
Chinese anatomical inch site 1.5CUN 1.5The width of the index and middle finger, measured at the level of the proximal interphalangeal joint of the index finger
Chinese anatomical inch site 2CUN 2the length of the distal and middle phalanges of the index finger
Chinese anatomical inch site 3CUN 3Width of all four fingers, measured at the level of the proximal interphalangeal joint of the index finger
Chinese anatomical inch site 4CUN 4Width of all four fingers, measured at the level of the metacarpophalangeal joint of the index finger
Chinese anatomical inch site 12CUN 12Length of transverse cubital crease to the transverse carpal crease
Distance along Large Intestine Meridian between LI5 and LI11LI5 to LI11Length between two anatomically distinct points from the depression at the lateral end of the transverse cubital crease and lateral epicondyle to the depression between the tendons of the extensor pollicis brevis and longus muscles (anatomical snuffbox) cun 12
Location of Large Intestine 4 AcupointLI4On the dorsum of the hand, radial to the midpoint of the second metacarpal bone. Between the first and second metacarpal bones, approximately in the middle of the second metacarpal bone on the lateral side
Location of Large Intestine 5 AcupointLI5On the posterolateral aspect of the wrist, at the radial side of the dorsal wrist crease, distal to the radial styloid process, in the depression of the anatomical snuffbox.
Location of Large Intestine 6 AcupointLI6On the posterolateral aspect of the forearm, on the line connecting LI5 to LI11,3 B-cun superior to the dorsal wrist crease.
Location of Large Intestine 11 AcupointLI11On the lateral aspect of the elbow, at the midpoint of (he line connecting I.U 5 with the lateral epicondyle of the humerus. When the elbow is fully flexed. LI11 is located in the depression on the lateral end of the cubital crease.

References [10,12,13]..


Table 3 . Sex differences of anthropometric and cun measurements (mean and SD in mm)..

ItemFemale (n = 12)Male (n = 13)T-Statisticp


MeanSDRangeMeanSDRange
HL170.8710.64185.00–144.20181.2217.93235 00–164 001.74ns
2DL65.727.6681.66–58.5176.4112.84109.52–63.22250*
PL93.997.08103 61–79.3299 632.31101 63–93 32272*
HB70.803.9976.19–61.5879.365.4489.22–/1.544.46***
2D1B14.461.2416.36–12.7317.861.1919 58–15.877 00***
2D2B16.821.6719.54–14.5620.071.3323.84–18.395.42***
WB47.945.4955.92–34.7356.923.4964.24–51.38493***
MHB81.0911.11100.11–63.9886.769.77101.44–68.141.36ns
HT24.405.6533.98–14.5827.245.3836.09–19.331.29ns
MHT40.354.7147.30–34.0950.294.7260.41–43.745.27***
HC181.4711.46199.20–157.60212.359.84230.60–199.607.25***
WC150.2011.65166.80–128.40167.4810.09189.80–154.403.97***
MHC211.7514.70236 60–192 0238921.49267 20–219 20447***
5D2C53.654.0959.00–44.8061.923.1266.80–56.405.71***
FL246.789.68264.60–225.802627218.64295.2–236 2265*
EB66.777.1078.17–53.3677.708.39103.32–72.173.50**
MFC220.1724.01256.6.–177.80245.0728.33301.40–205.002.36**
ED64.228.6377.00–52.5674.5112.31101.34–62.19240*
WD33.572.6937.62–27.8140.141.8543.68–37.217.17***
MC I42.875.4051.28–31.5551.594.7159 00–41.384 32***
MCII61.155.6467.61–50.4268.356.7978.10–55.22287**
CUN 1A17 861.221967–15.5921 871.6824 97–18 586 75***
CUN 1B21.243.5828.06–16.1823.713.7233.41–19.261.62ns
CUN 1.534.053.3638.65–27.6340.302.9245.97–36.254.98***
CUN 241.743.8445.80–32.1846.693.7653.06–42.703.26**
CUN 367.204.8575.69–60.9180.012.7485.69–76.20823***
CUN 471.153.7978.20–63.2181.944.7489.46–74.966.24***
CUN 12218.228.85237.00–204.40249.4915.81268.20–221 00564***
LI5 to LI11215.0819.85239.00–171.00241.4217.66280.00–214.003.51**

* = 0.005, ** = 0.01, *** < 0.001..


Table 4 . Comparison of measured F-cun and calculated B-cun (Mean and SD in mm)..

F-cun measuredB-cun calculated measured from - CUN 12pExpected


ItemMeanSDItemMeanSD
CUN 1A19.952.47B-cun 119.501.70ns12X
CUN 1B 22.523.79---**12X
CUN 1.537.374.45B-cun 1.529.102.30***8X
CUN 244.354.50B-cun 239.103.50***6X
CUN 373.847.46B-cun 358.605.20***4X
CUN 476.967.06B-cun 478.206.90ns3X

* = 0.05, ** = 0.01, *** < 0.001; = CUN 1B was compared to B-cun 1..


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