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Letter

Acupuncture points and skin impedance

I enjoyed reading the recent article by Rezaei et al1 in your journal. The authors measured skin impedance on the anterior forearm of 18 participants and found that the impedance of the acupoint PC4 and pericardial meridian were significantly lower than that of the surrounding skin. I would like to express my opinions as follows.
OVERLAPPING OF MERIDIAN AND VEIN A superficial vein named the median vein located on the midline of the anterior forearm is a common site for phlebotomy.2 It is rather parallel to the invisible PC4 and pericardial meridian (figure 1), although individual mappings of the vein are not uniform.

The veins have thin elastic walls and blood flowing inside; electrically they are very conductive.3 Mechanically, a skin portion with superficial veins is more compressible than skin without veins.2 Rezaei et al1 used a 15 mm Hg blood pressure cuff to stabilise the impedance probe on the forearm; the skin on the top of the median vein would form a closer electrodeskin interface than the adjacent skin, so a greater efficiency of current flow is allowed through the interface as well as a lower reading of skin impedance.4 These electrical and mechanical considerations may explain the skin impedance of PC4 and pericardial meridian being significantly different from that of the surrounding area.
SUMMARY Skin impedance has been proposed as indirect evidence of the specificity of acupuncture points. Based on the

above, a caution is essential for interpretation that acupuncture points or meridians are electrically distinguishable when anatomical components underneath the acupuncture points and non-acupuncture points are distinct. Rezaei et al presented an appealing study and I would not hesitate in recommending their article to anyone interested in the field of alternative medicine.
Yiu Ming Wong Correspondence to Dr Y M Wong, Health Science Unit (PEC), Hong Kong Physically Handicapped and Able Bodied Association, S102, G/F, Lai Lo House, Lai Kok Estate, Shamshuipo, Kowloon, Hong Kong; pt@hkphab.org.hk

Competing interests None. Provenance and peer review Not commissioned; not externally peer reviewed. To cite Wong YM. Acupunct Med Published
Online First: [ please include Day Month Year] doi:10.1136/acupmed-2013-010322 Received 29 January 2013 Accepted 4 February 2013

REFERENCES
1 Rezaei S, Khorsand A, Jamali J. Characterisation of human skin impedance at acupuncture point PC4 Ximen and pericardium meridian using the four-electrode method. Acupunct Med 2012;30:12731. 2 Millam D, Hadaway L. On the road to successful I.V . starts. Nursing 2005;35: S114. 3 Hull R, Taylor DW , Hirsh J, et al. Impedance plethysmography: the relationship between venous filling and sensitivity and specificity for proximal vein thrombosis. Circulation 1978;58:898902. 4 Venables PH, Christie MJ. Electrodermal activity. In: Martin I, Venables PH. Techniques in psychophysiology. New York: John Wiley & Sons, 1980:3 67.

Figure 1 Infrared vein imaging shows the median vein; the forearm skin is marked the same as in the experiment of Rezaei et al.1 The acupuncture point PC4 is illustrated on the right.

Acupunct Med 2013;0:1. doi:10.1136/acupmed-2013-010322

Copyright 2013 by British Medical Journal Publishing Group.

Downloaded from aim.bmj.com on February 27, 2013 - Published by group.bmj.com

Acupuncture points and skin impedance

Yiu Ming Wong Acupunct Med published online February 26, 2013

doi: 10.1136/acupmed-2013-010322

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