1. Anatomy of the hand:

The fantastic structure and nature of the hand is not well known to most people or even most scientists, although it is the part of the body most frequently used.

The human hand is a tool that has evolved along with the brain and is closely correlated with it. The dexterous structure of the human hand is the most advanced among all creatures.

People should become familiar with their hands. In normal humans the hand is composed of 27 bones. There are 8 carpal bones including the scaphoid, lunate, triangular, pisiform, greater and lesser trapezium, capitate and hamate bones. They are connected together by ligaments to perform various delicate movements of the palm and fingers. The palm is composed of 5 metacarpal bones which are connected to the 5 fingers. The thumb is composed of 2 phalangeal bones, and each of other 4 fingers is composed of 3 phalangeal bones, so there are 14 phlangeal bones in all. The phalangeal bones of a finger are numbered as first, second and third from the proximal to the distal end of the finger. The first segment is also called the proximal phalanx, and the third one is also called the distal phalanx. All hand bones are connected by muscles, ligaments and fibrous bundles to perform various delicate movements (Fig. 2-1).

1-scaphoid 2-cpitate 3-greater trapezium 4-lesser trapezium 5-first metacarpal 6-proximal phalanx 7-distal phalanx 8-lunate 9-triangular 10-pisiform ll-hamate 12-base 13-body 14-caput 15-fifth metacarpal 16-first (proximal) phalax 17-second (middle) phalanx 18-third (distal) phalax

The hand is innervated by the brain to carry out various movements and is very sensitive to sensations constantly sending sensory nerve impulses to the brain. The hand can be divided into several layers including the skin, subcutaneous tissue, pal-mar aponeurosis, superficial palmar arch of blood vessels, nerves, tendons, deep palmar arch of blood vessels, metacarpal bones and interosseous muscles from superficial to the deepest layer. The palmar skin is covered with a thick layer of keratinized epithelium. The central part of the palmar skin is less movable because it is fixed by tense subcutaneous tissue and many fibrous septa, connected with the palmar aponeurosis. Thereby things can be held tightly in the hand. The palmar aponeurosis is a white, firm, triangular plate of dense connective tissue, tightly connected with the skin and subcutaneous tissue to assist wrist extension and finger flexibility. The hand is sup-plied with nuerous blood vessels and nerves. The superficial and deep palmar arches are mutually connected and send forth arterioles to supply nutrients to the parts of the hand. Although blood circulation through the superficial arch is blocked when something is held tightly in the hand, blood can still pass through the deep arch to the tips of the fingers without interfering with the blood supply to the rest of the hand. The nerves of the hand originate from the median, radial and ulnar nerves of the arm to innervate the hand muscles and skin. The numerous nerve endings gathered on the fingertips are very sensitive to pain and tactile sensations. There are many fibrous bundles in the subcutaneous tissue firmly connecting the skin of the distal phalanx with its periosteum. The central canaliculi of fibrous bundles are filled with fatty tissue and the arterioles passing through the fibrous bundles nourish the distal phalanx. Themspaces in joints between the bones are filled with synovial fluid to facilitate nimble hand movement (Fig. 2-2).

Fig. 2-2 Diagram of local anatomy of the palm

1-median nerve 2-radial artery, vein and nerve 3-ulnar artery, vein and nerve 4-superficial palmar arch 5-deep palmar arch 6-proper artery and nerve beside finger

The nails are a specific structure without sensory nerve endings (Fig. 2-3) and are attached to the distal phalanx with vital tissue at their base which shows the state of a person's health over a period of time. Therefore, it is useful indiagnostics since the color and shape of the nails can show sufficiency or deficiency of the nutrients being supplied to the limbs, as well as the condition of the entire body.

Fig. 2-3 Fingertips and nail structure

1-nail base 2-nail bed 3-nail 4-fibrous bundle 5-blood vessel of finger 6-phalan-geal bone, 7-nerve 8-fibrous septum

The construction of the palm is compact, while the dorsal skin of the hand is thinner and its subcutaneous tissue is looser to allow flexible hand movement. The dorsum of the hand is arrayed with numerous veins and nerves to enable the hand to carry out its delicate functions.

With its complex structure the hand can performs various delicate and nimble movements under the control of the brain. According to experimental study, the hand shows a variation of cutaneous electrical activity similar to that of the brain. The mechanism of this similarity between the brain and hand is still unknown, but it demonstrates the specificity of the hand. The hand's tolerance for mechanical strain, its sensitivity to environ-mental changes of temperature and humidity, and its range of self-adjustment are all very remarkable. The complicated structure, functions, and physiological reflexes of the hand are the foundation of its skilful and dexterous activities.

2. Basic principles of acupoints and reflecting areas on the hand:

According to traditional medical theory of the meridian, a mutually connected and crisscrossing network is present in the body as an endless circuit connecting the internal organs and the external limbs. However, according to modern concepts this is a nervelike channel system, temporarily composed of cells, connecting the external and internal structures and adjusting the functions of the entire body. There are 12 regular meridians, and they originate from or stop at limb terminals. Six of these meridins are the hand meridians including the hand Taiyin lung, hand Yangming large intestine, hand Jueyin pericardium, hand Shaoyang triple energizer, hand Shaoyin heart, and hand Tai-yang small intestine meridians. The acupoints and areas on the regular meridians are called regular acupoints, and there are 23 regular acupoints on the hand, 9 on the palm, and 14 on the dorsum of the hand.

With the development of medical practice, people discovered more and more acupoints and their specific therapeutic effects, although they are not located on the meridians. These are called extra acupoints, and there are 77 extra acupoints on the hand, increasing the available locations for the application of therapeutic stimulation.

In addition, another group of reflecting points and areas were proposed by some scholars and given the name holographic points and areas, derived from the idea of the biological holographic phenomenon. These scholars believed that there are local reflecting points on the body corresponding to each independent segment and part of the body. The first group of 12 holographic points was found beside the second metacarpal bone. At the same time, the holographic areas corresponding to different organs and tissues of the body were also found on the hand, and an apparent adjusting effect could be produced in the body by an application of massage to these areas. It seemed very interesting that they could independently produce effects similar to those produced by the regular and extra acupoints. And sometimes stimulation applied to these holographic areas could produce certain effects not reproducible by applying the same stimulation to acupoints located in the same areas. This indicated that the holographic area itself could independently produce different effects, although located in a same region as the acupoints. So we may propose the existence of a health record of the body, from certain developmental stages, retained in the living cells, and the existence of an adjusting mechanism capable of affecting the entire body by stimulating a very limited area.

The regular acupoints, extra acupoints, and holographic points and reflecting areas can be considered as independent "in-formation-inducing units," and through them the adjusting impulse can be transmitted from the local point or area to the rest of the body. Scientific investigators may study the mechanism of this phenomenon if they are interested, but clinicians need only learn and master the acupoints and areas for clinical practice, without necessarily knowing the underlying reasons.

For the convenience of the reader, the proportional unit of the thumb width (Fig. 2-4) should be mentioned first.

The unit of length used since ancient times for locating acupoints is called a "cun," which is equal to the width of the interphalangeal joint of the thumb. There-fore, the exact length of a cun varies from person to person. For convenience in clinical practice, the width of the physician's interphalangeal thumb joint may be used as a cun, if his physique is similar to that of his patient. One cun can be further divided into 10 fractions, and one-tenth of a cun is called one "fen."

3. Distribution of acupoints and areas on palmar side of the hand:

In this section, 9 regular and 34 extra acupoints, and 42 holographic areas are described as follows:

1) Regular acupoints:

(1) Taiyuan (LU 9) :

Location: At the radial end of palmar carpal crease and in a depression on the radial side of radial artery (Fig. 2-5).

Fig. 2-5 Regular acupoints on palmar side of hand

1-Zhongchong (PC 9) 2-Shaochong (HT 9) 3-Shaofu (HT 8) 4-Laogong (PC 8) 5-Shaoshang (LU 11) 6-Yuji (LU 10) 7-Shenmen (HT 7) 8-Daling (PC 7) 9-Taiyuan (LU 9)

Indications: Cough, asthma, hemoptysis, chest pain, sore throat, wrist and arm pain, and pain and distension of breast.

(2) Yuji (LU 10):

Location: Beside the midpoint of first metacarpal bone and on the dorso-palmar boundary of hand (Fig. 2-5).

Indications: Cough, hemoptysis, sore throat, aphonia, fever, headache, chest pain, and pain in breast.

(3) Shaoshang (LU 11) :

Location: It is 0.1 cun beside the radial comer of thumb-nail (Fig. 2-5).

Indications: Sore throat, nasal bleeding, fever, coma, respiratory failure, cough, hoarseness of voice, swelling of cheek, syncope, severe stroke, epilepsy, and psychosis.

(4) Shenmen (HT 7) :

Location : At the ulnar end of palmar carpal crease and in a depression on the radial side of ulnar flexor muscle of wrist (Fig. 2-5).

Indications: Heart pain, irritability, insomnia, poor memory, heart palpitations, epilepsy, and dementia.

(5) Shaofu (HT 8):

Location: Between the 4th and 5th metacarpal bones and on the crease passing through the center of palm; or at a spot between the 4th and 5th metacarpal bones where the tip of little finger just reaches when the hand is clenched in a fist (Fig. 2-5).

Indications: Heart palpitations, chest pain, spasm of little finger, vulvar itching, incontinence of urine, and difficult urination.

(6) Shangchong (HT 9) :

Location: It is 0.1 cun beside the radial comer of nail of little finger (Fig. 2-5).

Indications: Heart palpitations, heart pain, febrile diseases, psychosis, coma, and pain and distension of chest and flanks.

(7) Daling (PC 7):

Location: At the midpoint of palmar carpal crease and between the tendons of long palmar muscle and radial flexor muscle of wrist (Fig. 2-5).

Indications: Hematemesis, restlessness, psychosis, heart pain, heart pacpitations, pain of wrist, unconsciousness, stomachache, vomiting, and pain of chest and flanks.

(8) Laogong (PC 8) :

Location: At the midpoint of a palmar crease passing through the center of palm; or at a spot between 2nd and 3^rd metacharpal bones where the tip of middle finger just reaches when the hand is clenched in a fist (Fig. 2-5).

Indications: Epilepsy, psychosis, hysteria, vomiting, foul odor in mouth, aphtha of mouth, hiccups, and hotness in palm.

(9) Zhongchong (PC 9) :

Location: At the tip of middle finger (Fig. 2-5).

Indications: Coma, convulsions, night crying in babies, stiff tongue, heart pain, febrile diseases, and prodromal symptoms of stroke.

2) Extra acupoints:

(1) Shixuan acupoint (EX-PH 1) :

Location: At all 10 fingertips and 0.1 curt from the edge of nail border (Fig. 2-6).

Indications: Coma, epilepsy, hysteria, high fever, convulsions in children, and tonsillitis.

(2) Sifeng acupoint (EX-PH 2) :

Locations: At the midpoint of palmar crease of proximal interphallangeal joint of index, middle, ring, and little fingers of both hands (Fig. 2-6).

Fig. 2-6 Shixuan and Sifeng acupoints

Indications: Indigestive malnutrition and whooping cough.

(3) Endocrine acupoint (EX-PH 3):

Location: At the top of thenar prominence (Fig. 2-7).

Indications: It can be used to treat endocrinal diseases and adjust function of adrenal gland, thymus, and thyroid gland.

(4) Chest pain acupoint (EX-PH 4):

Location: At the radial border of interphalangeal joint of thumb and on the dorso-palmar boundary of hand (Fig. 2-7).

Indications: Contusion of chest, intercostal neuralgia, herpes zoster with chest pain, vomiting, diarrhea, and epilepsy.

(5) Uterus acupoint (EX-PH 5) :

Location: At the midpoint between the junction of ring and little fingers and the first distal palmar crease (Fig. 2-7).

Indications: Diseases of reproductive system including diseases of ovary, testis, and menstruation

Fig. 2-7 Extra acupoints on palmar side of hand

1-endocrine 2-chest pain 3-uterus 4-hyperhidrosis 5-toothache 6-stomach and intestine pain 7-Laogong (PC 8) 8-Daling (PC 7) 9-heel pain 10-cough and asthma 11-oral aphtha 12-bed-wetting 13-heart palpitations 14-colon 15-urethra 16-anti-convulsion 17-spleen 18-heart 19-lung 20-Mingmen 21-liver 22-pelvic cavity

(6) Hyperhidrosis acupoint (EX-PH 6):

Location: At the center of palm (Fig. 2-7).

Indications: Hyperhidrosis and mental anxiety.

(7) Toothache acupoint (EX-PH 7) :

Location: It is 1 cun proximal to the junction of middle and ring fingers (Fig. 2-7).

Indications: Dull and continuous toothache.

(8) Stomach and intestine pain acupoint (EX-PH 8) :

Location: Also called Xiaotianxin, it is at the midpoint between Laogong (PC 8) and Daling ( PC 7) acupoints ( Fig. 2-7).

Indications: Acute and chronic gastroenteritis, gastric and duodenal peptic ulcer, indigestion, intestinal ascaris, coma with fever, and rhinitis.

(9) Heel pain acupoint (EX-PH 9) :

Location: At the midpoint between Daling (PC 7) and stomach and intestine pain point (EX-PH 8) (Fig. 2-7).

Indications: Heel pain of unknown origin.

(10) Cough and asthma acupoint (EX-PH 10):

Location: At the ulnar border of metacarpal joint of index finger (Fig. 7).

Indications: Acute and chronic bronchitis, bronchial asthma, and neurotic headache.

(11) Oral aphtha acupoint (EX-PH 11) :

Location: At the midpoint of palmar crease of carpometacarpal joint of middle finger (Fig. 2-7).

Indications: Oral aphtha and oral ulcers.

(12) Bed-wetting acupoint (EX-PH 12) :

Location: At the midpoint of palmar crease of distal interphalangeal joint of little finger (Fig. 2-7).

Indications : Not awakened by bed-wetting at night and frequent ruination.

(13) Heart palpitation acupoint (EX-PH 13):

Location: At the radial border of carpometacarpal joint of little finger (Fig. 2-7).

Indications: Heart palpitations, profuse menstrual discharge, and dysmenorrhea.

(14) Colon acupoint (EX-PH 14) :

Location: At the midpoint of palmar crease of distal interphalangeal joint of index finger (Fig. 2-7).

Indications: Diseases of colon and rectum, such as colitis and hemorrhoids.

(15) Urethra acupoint (EX-PH 15) :

Location: At the midpoint of palmar crease of proximal interphalangeal joint of index finger (Fig. 2-7).

Indications: Diseases of urethra, small intestine, and lower abdomen.

(16) Anti-convulsion acupoint (EX-PH 16):

Location: At the midpoint between thenar and hypothenar prominence (Fig. 2-7).

Indications: Convulsions due to high fever.

(17) Spleen acupoint (EX-PH 17):

Location: At the midpoint of palmar crease of interphalangeal joint of thumb (Fig. 2-7).

Indications : Diseases of spleen and stomach, edema due to accumulation of water, and spleen dysfunction.

(18) Heart acupoint (EX-PH 18) :

Location: At the midpoint of palmar crease of distal interphalangeal joint of middle finger (Fig. 2-7).

Indications: Diseases of cardiovascular system, such as cardiac arrhythmia, fluctuation of blood pressure, and bradycardia.

(19) Lung acupoint (EX-PH 19):

Locations : At the midpoint of palmar crease of distal interphalangeal joint of ring finger (Fig. 2-7).

Indications: Diseases of respiratory system, such as upper respiratory infection, infection of lungs, and profuse sputum.

(20) Mingmen acupoint (EX-PH 20) :

Location: At the midpoint of palmar crease of proximal interphalangeal joint of little finger (Fig. 2-7).

Indications: Diseases of reproductive system, such as oligomenorrhea, inactive sperm, and urinary tract infection.

(21) Liver acupoint (EX-PH 21):

Location: At the midpoint of palmar crease of proximal interphalangeal joint of ring finger (Fig. 2-7).

Indications : Diseases of liver and gallbladder, reduced bile excretion, and discomfort over liver region.

(22) Pelvic cavity acupoint (EX-PH 22):

Location: Also called Renzhongxin, it is at the midpoint between two interphalangeal creases of middle finger (Fig. 2-7).

Indications: Diseases of abdominal and pelvic cavity, such as discomfort, distension, pain and straining sensation in abdomen, adnexitis, and influenza.

(23) Hypothenar prominence acupoint (EX-PH 23) :

Location: On the palmar side of hand on the radial border of 5th metacarpal bone and at the junction of its middle one-third and lower one-third, and at the midpoint of abductor muscle of little finger (Fig. 2-8).

Indications: Depressive and paranoic psychosis.

(24) Finger and palm acupoint (EX-PH 24) :

Location: On the palmar side of hand, at the junction of middle and ring fingers, and nearer to the former (Fig. 2-8).

Indications: Insomnia, poor memory, epilepsy, and schizophrenia.

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