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Workbook for
Clinical Anatomy of Acupuncture
Heming Zhu, PhD
Kimberly Duncan, PhD
January 2010
September 2009
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Contents
Chapter one -----------------------------------------------------------------------------------------------4 The coverage -----------------------------------------------------------------------------------------4 The critical aspects ---------------------------------------------------------------------------------4 The additional materials --------------------------------------------------------------------------4 The exercises for Class 1 --------------------------------------------------------------------------10
Chapter Two ----------------------------------------------------------------------------------------------12 The coverage ----------------------------------------------------------------------------------------12 The critical aspects ---------------------------------------------------------------------------------12 The additional materials --------------------------------------------------------------------------12 The exercises for Class 2 --------------------------------------------------------------------------15
Chapter Three --------------------------------------------------------------------------------------------16 The coverage ----------------------------------------------------------------------------------------16 The critical aspects ---------------------------------------------------------------------------------16 The additional materials --------------------------------------------------------------------------16 The exercises for Class 3 --------------------------------------------------------------------------16
Chapter Four ---------------------------------------------------------------------------------------------20 The coverage ----------------------------------------------------------------------------------------20 The critical aspects ---------------------------------------------------------------------------------20 The additional materials --------------------------------------------------------------------------20 The exercises for Class 4 --------------------------------------------------------------------------24
Chapter Five ----------------------------------------------------------------------------------------------25 The coverage ----------------------------------------------------------------------------------------25 The critical aspects ---------------------------------------------------------------------------------25 The additional materials --------------------------------------------------------------------------25 The exercises for Class 5 --------------------------------------------------------------------------26
Chapter Six ------------------------------------------------------------------------------------------------28 The coverage ----------------------------------------------------------------------------------------28 The critical aspects ---------------------------------------------------------------------------------28 The additional materials --------------------------------------------------------------------------28 The exercises for Class 6 --------------------------------------------------------------------------39
Chapter Seven -------------------------------------------------------------------------------------------31 The coverage ----------------------------------------------------------------------------------------31 The critical aspects ---------------------------------------------------------------------------------31 The additional materials --------------------------------------------------------------------------31 The exercises for Class 7 --------------------------------------------------------------------------35
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Chapter Eight ---------------------------------------------------------------------------------------------36 The coverage ----------------------------------------------------------------------------------------36 The critical aspects ---------------------------------------------------------------------------------36 The additional materials --------------------------------------------------------------------------36 The exercises for Class 8 --------------------------------------------------------------------------39
Chapter Nine ---------------------------------------------------------------------------------------------41 The coverage ----------------------------------------------------------------------------------------41 The critical aspects ---------------------------------------------------------------------------------41 The additional material ---------------------------------------------------------------------------41 The exercises for Class 9 --------------------------------------------------------------------------43
Chapter Ten -----------------------------------------------------------------------------------------------44 The coverage ----------------------------------------------------------------------------------------44 The critical aspects ---------------------------------------------------------------------------------44 The additional materials --------------------------------------------------------------------------44 The exercises for Class 10 ------------------------------------------------------------------------46
Appendix. The material for the final review ------------------------------------------------------47
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Chapter One
The Coverage:
1. The textbooks: 1) Netter’s Clinical Anatomy (NCA). 2) Surface Anatomy of Acupuncture (SAA).
2. Introduction of branches of Human Anatomy and Physiology, Clinical Anatomy and Surface Anatomy of Acupuncture.
3. Skin 4. SAA: the upper limbs (visual inspection). 5. NCA: p2-6, 8-10, p14, 126, 151, 164, 6. SAA: p6-10, 44-46
The critical aspects:
1. Definition of Gross Anatomy, Physiology, Clinical Anatomy and Surface Anatomy of Acupuncture.
2. 11 systems in human body. 3. Definition of Homeostasis and internal environment. 4. Anatomical position. 5. Terminology of orientation in human body. 6. Terminology of movement in human body. 7. Two layers of the skin. The structures in the dermis. 8. The bones and bony structures in the upper limbs (see the list).
The additional materials:
Anatomy Study of structures and the relationships among the structures.
Gross Anatomy Study of structures that can be examined by eyes (based on systems).
Surface Anatomy Study of the landmarks of the surface of the body and the corresponding underlying structures.
Regional Anatomy Study of a specific region of the body like the head or chest.
Clinical Anatomy Study of structures that are closely related to clinical implications.
Radiographic Anatomy Study of structures that includes the use of X-ray.
Embryology Study of development from the fertilized egg through the eight weeks in utero.
Histology Microscopic study of the structure of tissues.
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Physiology Study of functions of the body parts (based on systems).
Cell Physiology Study of the function of cells.
Systems Physiology Study of the operation of the system organs.
Neurophysiology Study of the functional characteristics of nerve cells.
Pathophysiology Study of functional changes associated with diseases and aging.
Sports Physiology Study of changes in cells and organ fcuntions during muscular activity.
6 levels of structural organization
1. Organism level: organism – one living individual. 2. System level: A system consists of several related organs that have a common
function. 11 systems. 3. Organ level: Organs are structures that are composed of two or three tissues,
have specific functions, and usually have recognizable shapes. 4. Tissue level: Tissues are groups of similar cells. 5. Cellular level: Cells are the basic structural and functional units of an organism. 6. Chemical level: Includes all atoms and molecules essential for maintaining life.
11 systems in Anatomy & Physiology
1. Skin 2. Skeleton system 3. Muscular system 4. Digestive system 5. Respiratory system 6. Urinary system 7. Reproductive system 8. Cardiovascular system 9. Lymphatic system 10. Nervous system 11. Endocrine system
4 types of tissues in Histology
1. Epithelial tissue: e.g. epidermis 2. Muscle tissue: e.g. heart muscle, smooth muscle, skeleton muscle 3. Connective tissue: e.g. subcutaneous tissue 4. Nervous tissue: nervous system
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The list of the skeleton:
1. Frontal bone 2. Parietal bone 3. Occipital bone 4. Temporal bone 5. Zygomatic bone 6. Nasal bone 7. Mandible 8. Hyoid 9. Cervical vertebrae 10. Thoracic vertebrae 11. Lumbar vertebrae 12. Sacrum and coccyx 13. Sternum 14. Ribs
15. Clavicle 16. Scapula 17. Humerus 18. Radius 19. Ulna 20. Carpals 21. Pelvic bone 22. Femur 23. Patella 24. Tibia 25. Fibula 26. Tarsal bones 27. Metatarsal bones 28. Phalanges
Anatomical layers in the upper limbs:
1. Skin 2. Subcutaneous tissue: fat, blood vessels, nerves 3. Muscle or bone
The bones and bony structures that you should know:
1. Scapula: 3 angles, 3 borders, spine of scapula, acromion, coracoid process 2. Clavicle: 2 ends 3. Humerus: head of humerus, medial and lateral epicondyle, shaft 4. Radius: styloid process of radius, shaft 5. Ulna: styloid process of ulna, shaft 6. Carpal bones: 8, pisiform, scaphoid, triquetrum 7. Metacarpal bones: 5, head, base, shaft, 8. Phalanges: 3/2 each finger, head, base, shaft
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Clinical Correlation
Carpal tunnel syndrome: On the anterior side of the wrist, the concavity formed by the carpals plus the flexor retinaculum (deep fascia) constitute a space called carpal tunnel. Through it pass the flexor tendons of the digits and thumb and the median nerve. Narrowing of the carpal tunnel gives rise to a condition called carpal tunnel syndrome.
Pathology: the median nerve is compressed.
Symptoms: paresthesia (burning and tingling sensation), numbness and muscle weekness in hand.
The Exercises for Class 1:
1. Gross Anatomy and Physiology is to study the structures and functions of human body
based on ____:
A. systems. B. regions.
2. Clinical Anatomy is to study structures of human body based on ____:
A. systems. B. regions.
Surface Anatomy of Acupuncture is to study ____________based on____:
A. systems. B. regions.
3. 11 systems in human body are skin, ____________, ______________, ______________,
_________________, __________________, ________________,__________________,
_________________, __________________, ____________________.
4. Homeostasis is a condition in which the body’s __________________________ remains
within certain physiological limits. Internal Environment is also called
____________________, _______________________ or ________________________.
5. Anatomical Position: standing ________, face__________, arms__________,
palms___________, feet_______________.
6. Skin consists of two layers____________ and _______________. _________ contains
nerves, blood vessels, special receptors, sweat glands, oil glands and hair follicles.
7. Four general anatomical layers of human body (from the superficial to the deeper):
_____________, __________________, _________________, ________________.
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8. When doing acupuncture, you want to avoid needling _____________, _____________,
_____________, _____________, ______________.
9. Identify the orientation in the figure A.
The shoulder is ________to the chest, __________to the elbow and ___________to the
neck. The nipple is on the ________surface of the body. The thumb is on the _________
side.
10. Identify the movement in the figure B.
The shoulder joint ______. The elbow________. The fingers______. The wrist_______.
Fig. A Fig. B
11. The bones of the upper limbs: _____________, _____________, ___________,
_______________, and _______________in the wrist, _______________in the fingers.
12. The _________and __________ constitute the shoulder joint.
13. The _________, _________ and __________ constitute the elbow joint.
14. The __________ and carpals constitute the wrist joint.
15. How will you palpate your partner when examing the structures? (Read SAA, page 10)
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Chapter Two
The Coverage:
1. The skeleton. 2. The muscles: The upper limbs. 3. The upper limbs. 4. NCA: p16, 17, 134-135, 142, 144-146, 155, 157, 5. SAA: p47-52
The critical aspects:
1. The bones of the list. 2. The muscles of the list. 3. SAA: The list of the upper limbs.
The additional materials:
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The list of the muscles:
Head and face 1. Frontalis 2. Orbicularis oculi 3. Orbicularis oris 4. Temporalis 5. Masseter
Neck Sternocleidomastoid Thorax and abdomen 1. Deltoid 2. Pectoralis major 3. Rectus abdominis 4. Linea alba Back 1. Trapezius 2. Latissimus dorsi 3. Erector spinae 4. Interspinal ligament, supraspinal ligament
Upper limbs 1. Biceps brachii 2. Triceps brachii 3. Pronator teres 4. Brachioradialis 5. Flexor carpi radialis 6. Palmaris longus 7. Flexor carpi ulnaris 8. Flexor digitorum 9. Extensor digitorum 10. Extensor carpi ulnaris Lower limbs 1. Quadriceps femoris 2. Sartorius 3. Adductor longus 4. Gluteus maximus 5. Gluteus medius 6. Biceps femoris 7. Semitendinosis 8. Semimembranosis 9. Gastrocnemius 10. Soleus 11. Flexor digitorum longus 12. Tibialis anterior 13. Extensor hallucis longus 14. Extensor digitorum longus 15. Peroneus longus 16. Peroneus brevis
Clinical Correlation
Shoulder pain is very common in clinic. Tendinitis and bursitis in shoulder are often caused by repeated motion (sports and occupation).
Anatomical reason: the shoulder is the most movable joint and unstable. To remain stable, the shoulder must be anchored by its muscles, tendons and ligaments.
Pathology: injury and inflammation.
Symptoms: pain, redness, soreness, swelling, and reduced motion.
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SAA: the list of the Upper Limbs, page 47-52 1. Axillary folds 2. Deltoid muscle: Anterior border 3. Acromion 4. Biceps brachii muscle and tendon , the two heads 5. Triceps brachii muscle 6. Shaft of humerus 7. Medial and lateral epicondyles of humerus 8. Olecranon of ulna 9. Styloid process of radius 10. Shaft of radius 11. Styloid process of ulna 12. Shaft of ulna 13. Radial artery 14. Tendons on palmar surface of the wrist
1) Tendon of palmaris longus 2) Tendon of flexor carpi radialis 3) Tendon of flexor carpi ulnaris
15. Tendons on dorsal surface of the wrist 1) Tendons of the extensor 2) Tendon of extensor pollicis longus 3) Tendon of extensor pollicis brevis 4) Tendon of abductor pollicis longus
16. Anatomical Snuffbox 17. Pronator muscle 18. Brachioradialis 19. Extensor digitorum 20. Extensor carpi ulnaris 21. Wrist crease(distal) 22. Carpal bones: scaphoid, pisiform, triquetrum. 23. Metacarpal bones: Head (distal head), shaft, base(proximal head) 25. Phalanges 26. Nails: nail bed, flare
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The Exercises for Class 2:
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Chapter Three
The Coverage:
1. The muscles 2. The Upper limbs 3. NCA: p90, 92, 214, 218, 221, 248, 249, 250, 310, 388, 530, 556, 607 4. SAA: p47-52
The critical aspects:
1. The muscles of the list. 2. SAA: The upper limbs.
The additional materials:
Clinical Correlation - 1
Tennis elbow or lateral epicondylitis: is a condition where the outer part of the elbow becomes sore and tender. It is commonly associated with playing tennis and racket sports. The injury can happen to almost anybody due to repeated extending and rotating elbow.
Anatomical reason: the forearm extensors (extensor carpi ulnaris, extensor carpi radialis, extensor digitorum) are inserted into the lateral epicondyle of the humerus.
Clinical Correlation - 2
Golfer’s elbow or Pitcher’s elbow or medial epicondylitis: is an inflammatory condition of the elbow that often occurs in golfers and Pitchers due to repeated extending elbow and flexing wrist.
Anatomical reason: the forearm flexors (flexor carpi radialis, flexor carpi ulnaris, palmaris longus and pronator teres) form a common tendon which is inserted into the medial epicondyle of the humerus.
The exercises for Class 3:
1. The three tendons can be palpated on the anterior side of the wrist:
_______________, ________________, and _____________. Among them,
____________________ inserts to the pisiform; ___________________ aligns with
scaphoid. The middle tendon is ___________________, in line with the center of the
palm.
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2. Triquetrum is located on the medial-posterior side and between _______________
and ________________.
3. The pisiform is at the base of the ________ and at the medial end of the
____________.
4. The scaphoid is at the base of the ________ and at the lateral end of the
____________.
5. The tendon of the ______________can be located in the elbow fossa.
6. The styloid process of the radius is on the ________side of the wrist; the styloid
process of the ulna is on the _________side of the wrist.
7. Three bony landmarks can felt on the posterior side of the elbow, they are
___________, _______________________, and __________________.
8. Flexing the elbow can help identify ______________ bulging on the lateral side of
the forearm.
9. Flexing the wrist can help identify three tendons on the anterior side of the wrist.
They are ________________, ____________________ and
______________________.
10. _________(what movement) the wrist can help identify extensor digitorum and
_____________ on the posterior side of the forearm. The latter muscle covers the
bone _________posteriorly.
11. Three creases can be seen on the palm. They are __________________,
_______________ and ________________________.
12. The bone ________ is the border between the flexors and extensors of the forearm.
The full length of this bone can be palpated. The inferior end of the bone is
__________ and the superior end is ______________.
13. The medial side of the forearm is _________________muscle. The lateral side of the
forearm is ______________ muscle.
14. What movement can help you identify the muscles and/or tendons you have learned
in SAA of the Upper Limbs? Please design an action for each movement.
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1. Identify the muscles(10 muscles):Soleus; Gastrocnemius; Pectoralis major; Deltoid; Sternocleidomastoid; Biceps femoris; Semitendinosus, Semimembranosus; Trapezius; gluteal maximus
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2. Draw the muscles/tendons(10):Biceps brachii tendon; Palmaris longus tendon; Flexor carpi ulnaris tendon; Flexor carpi radialis tendon; Trapezius; Deltoid; Pectoralis major; Quadriceps tendon; Patella tendon(ligament); Tibialis anterior.
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Chapter Four
The Coverage:
1. Cardiovascular system: blood, heart, arteries and veins. 2. The Lower limbs. 3. NCA: p20, 21, 23, 25, 28, 207, 214, 217, 218, 232, 248-252, 259-260 4. SAA: p59-66
The critical aspects:
1. The components and functions of the blood; 2. The cavities and openings of the heart. 3. The list of the bones and bony structures in the lower limbs. 4. SAA: The list of the lower limbs.
The additional materials:
Cardiovascular System 1. Blood 2. Heart 3. Blood vessels: artery and vein 4. Lymphatic system
Cardiovascular System
Whole blood8% body weight
Plasma55%
Formed elements45%
Platelets(thrombocyte): 250,000-400,000/mm3
Water: 91.5%
Protein: 7%, albumins, globulins
Others: 1.5%, electrolytes, nutrients, gas, hormones, vitamins, waste
Red blood cell(RBC): 4.8-5.4 million/mm3
White blood cell(WBC): 5,000-10,000/mm3
Neutrophils:60-70%Lymphocytes:20-25%Monocytes:3-8%Eosinophils:2-4%Basophils: 0.5-1%
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Clinical Correlation
Anemia: anemia is a condition in which the oxygen-carrying capacity of the blood is reduced; it is a sign, not a diagnosis. Many kinds of anemia exist, all characterized by reduced number of RBCs or decreased amount of hemoglobin in the blood. These conditions lead to fatigue and intolerance to cold, both of which are related to lack of oxygen needed for ATP and heat production, and to paleness, which is due to low hemoglobin content.
WHO's Hemoglobin thresholds used to define anemia
Age or gender group Hb threshold
(g/dl) Hb threshold
(mmol/l)
Children (0.5–5.0 yrs) 11.0 6.8
Children (5–12 yrs) 11.5 7.1
Children (12–15 yrs) 12.0 7.4
Women, non-pregnant (>15yrs)
12.0 7.4
Women, pregnant 11.0 6.8
Men (>15yrs) 13.0 8.1
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Heart Four cavities/chambers 1. Right atrium, right ventricle, left atrium, left ventricle. 2. The right atrium is open to the right ventricle. 3. The left atrium is open to the left ventricle.
Blood in the heart: 1. Vein blood: in the right half heart - right atrium, right ventricle. 2. Artery blood: in the left half heart - left atrium, left ventricle.
Openings (10): 1. Superior and inferior vena cava go into the right atrium. 2. Pulmonary artery leaves the right ventricle. 3. Pulmonary veins go into the left atrium. 4. Aorta leaves the left ventricle. 5. Right and left coronary artery leave the aorta for the heart muscle.
The bones and bony structures in the Lower Limbs:
1. Iliac crest 2. Anterior superior iliac spine (ASIS) 3. Posterior superior iliac spine (PSIS) 4. Pubis symphysis 5. Greater trochanter 6. Medial and lateral condyle of the femur 7. Medial and lateral condyle of the tibia 8. Tibial tuberosity 9. Tibial crest 10. Medial surface of the tibia 11. Medial malleolus 12. Head of the fibula 13. Lateral malleolus 14. Calcaneus 15. Navicular bone, tuberosity 16. Cuneiforms 17. Cuboid 18. Metatarsal bones 19. Tuberosity of 5th metatarsal bone 20. Phalanges 21. First metatarsalphalangeal joint
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SAA: the list of the Lower Limbs, page 59-66
1. Groin groove 2. Gluteal fold 3. Pubic crest 4. Pubic symphysis 5. Iliac crest 6. Anterior superior iliac spine (ASIS) 7. Posterior superior iliac spine(PSIS) 8. Ischial tuberosity 9. Gluteal maximus 10. Quadriceps femoris muscle(4 heads) 11. Quadriceps tendon 12. Greater trochanter of femur 13. Patella 14. Patella tendon
15. Medial and lateral condyle of femur 16. Medial and lateral condyle of tibia 17. Tibial tuberosity 18. Crest of tibia 19. Medial malleolus 20. Head of fibula 21. Lateral malleolus 22. Knee crease 23. Popliteal crease 24. Biceps femoris 25. Semitendinosus and semimembranosus 26. Gastrocnemius muscle 27. Soleus muscle 28. Calcaneal tendon 29. Tendons at ankle:
tibialis anterior, extensor hallucis longus, extensor digitorum longus 30. Tendons of peroneus longus and brevis 31. Tuberosity of navicular bone 32. Metatarsal bones, tuberosity of 5th metatarsal bone
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The exercises for Class 4:
1. Blood is consists of two parts________ and formed elements that include ___________,
________, and _______. The functions of blood are ________, ________, and ________.
2. A heart has four cavities________, _______, ________, _______. Among them, _______
and ________ contain vein blood and ________ and ______ contain artery blood. The
flow of blood in the heart is from right atrium to _________, then to the pulmonary
artery and from the left atrium to ___________, then to the aorta.
3. Identify or draw the structures
1) Distal palmar crease (Fig. A) 2) Proximal palmar crease(Fig. A) 3) Wrist crease(Fig. A) 4) Thenar eminence(Fig. A) 5) Scaphoid bone(Fig. B) 6) Pisiform bone(Fig. B) 7) 5th metacarpal bone(Fig. B) 8) Styloid process of the ulna (Fig. C) 9) Styloid process of the radius(Fig. C) 10) Lateral epicondyle of the humerus(Fig. C)
Fig. A Fig. C Fig. B
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Chapter Five
The Coverage:
1. The cardiovascular system: Vein, lymphatic. 2. The lower limbs. 3. NCA: p21, 23, 28 4. SAA: p59-66
The critical aspects:
1. The path of the blood circulation. 2. SAA: The list of the lower limbs.
The additional materials:
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Significance of blood circulation:
Blood picks up oxygen from the lungs, nutrients from the gastrointestinal tract (GI), and hormones from endocrine glands. It transports these substances to the tissues, where they diffuse from capillaries into tissue fluid. From the tissue fluid, needed substances enter cells and cellular wastes enter the blood. Blood carries carbon dioxide and metabolic wastes to the lungs, kidneys and sweat glands for elimination from body. Certain wastes must be detoxified by the liver before can be excreted.
Lymph picks up materials, including wastes, from the tissue fluid, cleanses them of bacteria, and returns them to the blood.
Significance of hepatic portal circulation (vein/system):
The hepatic portal vein carries blood between two capillary networks, from capillary of GI tract to sinusoids of the liver. The liver stores some and modifies others before they pass into the general circulation. It modifies some digested substances so they can be used by cells, detoxifies harmful substances that have been absorbed by the GI tract and destroys bacteria by phagocytosis.
Lymphatic system
Organization1. Lymph;2. Lymphocytes: T, B, NK cells;3. Lymph vessels: network of vessels and capillaries;4. Lymphoid organs: lymph nodes, aggregation of lymph
tissue, tonsile, thymus, spleen, and bone marrow
Functions1. Collect tissue fluid;2. Transport fat from GI;3. Immunity: Immune system.
Clinical ApplicationCancer cells may travel via the Lymphatic systemand produce a secondary tumor where they lodge.
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The exercises for Class 5:
1. Please describe the blood circulation path:
Start from the left ventricle of the heart---_________---_________---_______________--
-____________---___________---____________---____________--- right atrium ---
_____________---___________---____________---____________---________________.
2. In _____, vein blood becomes artery blood because of rich _____ gas. In ___________,
artery blood becomes vein blood that collects ____gas from tissues.
3. Arteries are the vessels that carry blood from heart to tissues. Veins are the vessels that
convey blood from the tissue back to ______.
4. Lymph starts from intercellular fluid and flows through ___________ and ________, and
joins vein in ____________.
5. The bony structure iliac ________ is the border between the hip and the waist. Its
anterior end is ____________________ and its posterior end is ___________________.
6. The tendon superior to the patella is _____________. The tendon inferior to the patella
is ___________________ also called ____________________. The two tendons are
formed by the _______________ muscle.
7. The two condyles beside the patella are _________________ and __________________.
8. The two condyles beside the patella tendon are _____________ and ________________.
9. The medial surface of the tibia is extending inferiorly to the __________________.
10. The head of the fibula is ____________, _____________ and ___________ to the lateral
condyle of the tibia.
11. The lateral malleolus is formed by the ______ end of the _____ on the ________ side of
the ankle.
12. In the popliteal fossa, three tendons can be palpated, they are _______________ and
_____________ medially and ______________ laterally.
13. ___________ muscle and __________muscle form the_____________ tendon inserting
to the calcaneus.
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14. On the lateral side of the lower leg, two muscles ____________ and ______________
cover the fibula. Their tendons go down posterior to the _____________then turn into
the foot.
15. The tibial tuberosity can be palpated inferior to the ________ tendon. It is running
downward into a sharp crest called _______________________.
16. Three tendons can be palpated in the anterior aspect of the ankle, they are __________
medially, ______________ in the middle and ____________________________laterally.
What movement can help identify these tendons?___________
17. With the hand on the midpoint of the iliac crest and fingers pointing downward, the
middle finger reaches a bony structure of the femur ______________________.
18. ____________(what movement) the knee helps identify three muscles in the front of
the thigh _____________________, ____________________, and __________________
and two tendons _________________ and ___________________.
19. ____________(what movement) the knee helps identify the three tendons:
_________________, ________________ medially and ________________laterally in
the popliteal fossa.
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Chapter Six
The Coverage:
1. Digestive and respiratory system. 2. NCA: p29, 47
The critical aspects:
1. The path of food. 2. The path of air.
The additional materials:
Digestive system: 1. Digestive tract(GI): mouth-anus 2. Digestive glands:
1) liver/gallbladder, 2) pancreas, 3) salivary glands: parotid gland, sublingual gland, submandibular gland.
Function of digestive system
1) Digestion: the process in which food is broken down into molecules small enough to enter body cells.
2) Absorption: nutrients
Digestive system
Enzymes substrates product
1 Salivary juice starches maltose
triglycerides Fatty acid
2 Gastric juice proteins peptides
3 Pancreatic juice Starches maltose
Proteins peptides
triglycerides Fatty acids*,monoglycerides*
DNA, RNA nucleotides
4 Small intestine juice
Maltose, Sucrose, Lactose
Glucose*Glucose and fructose*Glucose and lactose*
Peptides Amino acids*
Nucleotides Nitrogenous bases*,phosphates*, pentoses*
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Pleural cavity:
Lungs are enclosed by two layers of serous membrane, named by pleural membrane, outer pleura and inner pleura. Between the pleurae is a potential space, the pleural cavity, which contains lubricating fluid allowing lungs to move easily during breathing and is negative pressure compared to the air guaranteeing lungs to expand.
The exercises for Class 6:
1. Describe the path of food:
Mouth---_______---___________---________---________---_________---_______.
2. Liver excretes _______that is stored in _______. This fluid can emulsify the large fat
globules into a suspension of fat droplets.
3. The functions of digestive system are __________ and ____________.
4. Path of air: Nose ---________---__________---________---_________---________---
_________.
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5. Identify or draw the structures: 1) Quadriceps tendon (Fig. A) 2) Patella tendon (Fig. A) 3) Lateral condyle of the femur (Fig. A) 4) Semitendinosus tendon (Fig. B) 5) Semimembranosus tendon (Fig. B) 6) Tendon of the biceps femoris (Fig. B) 7) Tuberosity of the tibia (Fig. C) 8) Head of the fibula (Fig. C) 9) Lateral melleolus (Fig. C) 10) First metatarsal bone (Fig. C) Fig. A Fig. B
Fig. C
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Chapter Seven
The Coverage:
1. Urinary and reproductive system. 2. Head and neck. 3. NCA: p49-51, 475, 498, 530, 536, 541, 558, 4. SAA: p12-16, 21-23
The critical aspects:
1. The path of urine. 2. The path of ova. 3. The path of sperm. 4. The landmarks on the head and neck.
The additional materials:
kidneys
Urinary system
ureter
bladder
urethra
Path of urine:
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Functions of urinary system:
The primary function is to maintain homeostasis.
1. Produce urine and eliminate metabolic waste, metabolites, foreign chemicals;
2. Regulate fluid volume, composition and pH;
3. Reabsorb important ions, organic molecules and vitamins, and water;
4. Secrete hormones to regulate blood pressure, erythropoesis, calcium metabolism.
How do we eliminate the metabolic wastes?
In metabolizing nutrients, body cells produce wastes:
1. Carbon dioxide; 2. Excess water; 3. Heat; 4. Toxic nitrogenous wastes such as ammonia and urea; 5. Excess ions such as Na+, Cl-, SO4
2-, HPO42- , H+.
Four systems are involved in the job of waste elimination from the body:
1. Kidneys: Excrete water, ammonia, urea, salts, hydrogen, carbon dioxide, heat, bacteria toxins;
2. Lungs: Excrete carbon dioxide, heat, water; 3. GI tract: Eliminates solid, undigested wastes and excess carbon dioxide,
water, salt, heat; 4. Skin: Excrete heat, water, carbon dioxide, salts, urea.
Reproduction is the process by which new individuals of a species are produced and the genetic material is passed from generation to generation. This maintains continuation of the species.
The testes and ovaries, also called gonads, produce gametes – sperm cells and ova, respectively. The gonads also secrete sex hormones.
The functions of the male sex hormone (androgen):
1. Development of male pattern; 2. Secondary male characteristics: strong muscles and bone, wide shoulders and
narrower hips, thicker skin, larger larynx and deep voice; 3. Sexual activity: sex drive (libido) in both males and females; 4. Protein synthesis metabolism: heavier muscle and bone mass.
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The function of the female sex hormone – Estrogen: 1. Development of female pattern; 2. Secondary female characteristics; 3. Help control fluid and electrolyte balance; 4. Protein synthesis metabolism.
The function of the female sex hormone – Progesterone: Progesterone works with estrogen to prepare the endometrium for implantation of a fertilized ovum and the mammary glands for milk secretion.
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SAA: List of the head and neck
1. Eyebrow 2. Glabella 3. Medial and lateral canthus of the eye 4. Nasal apex, root and back 5. Ala nasi 6. Philtrium groove 7. Nasolabial groove 8. Lingual and labial frenulum 9. Mentolabial groove 10. Mastoid process 11. Orbital margins 12. Zygomatic bone and arch 13. Mandible: body, angle and ramus, condylar process, notch 14. Masseter muscle 15. Temporalis muscle 16. External occipital protuberance
17. Adam’s apple 18. Clavicle 19. The root(base) of the neck 20. Suprasternal notch and fossa 21. Sternocleidomastoid (SCM) muscle 22. Anterior border of the trapezius muscle 23. Supraclavicular fossa 24. The 6th and 7th cervical vertebrae
SAA: Application in acupuncture
Anatomical layers in the front and lateral region of the neck: 1. Skin; 2. Subcutaneous tissue; 3. Superficial muscles; 4. Large vessels and nerve plexus: carotid artery and vein, cervical plexus. 5. Thyroid gland, trachea and deep muscles.
The dangerous areas when needling: 1. The root (base) of the neck: the top of the lungs. 2. The sternocleidomastoid muscle: the large vessels. 3. The back neck under the back skull: the spinal cord.
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The exercises for Class 7:
1. Path of urine: Kidneys ---_________---____________---______________.
2. The primary function of the urinary system is to maintain __________________.
3. Path of ova: Ovary --- ovulation (oocyte)—in __________fertilized by sperm---
_____________. If not fertilized by sperm, the __________ produces.
4. Path of sperm: testes ---___________---_____________---___________________---
______________---__________.
5. If insert the needle too deeply in the area of sternocleidomastoid muscle, it may
injure ___________ and _________, in the root of the neck, it may injure _________,
and in the upper nape, it may injure ________.
6. Identify the following structures: 1) Sternocleidomastoid muscle 2) Tapezius 3) Zygomatic arch 4) Cheek bone 5) Mastoid process 6) External occipital protuberance
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Chapter Eight
The Coverage:
1. Nervous system: brain, cranial and spinal nerves. 2. Thorax and abdomen. 3. NCA: p32, 35-38, 301, 308, 310, 311, 314-316, 340, 388, 397, 571-573 4. SAA: p26-28, 32-33
The critical aspects:
1. The organization and function of nervous system. 2. Four parts of the brain. 3. Protection of the brain. 4. Anatomical layers in the thorax and abdomen. 5. Possible dangerous area in the thorax when needling. 6. How to locate the ICS.
The additional materials:
Functions of the NS 1. Regulates and integrates body activities; 2. Modulates effects of the endocrine and immune systems.
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Comparison of somatic nerve system and autonomic nerve system
Somatic Nerve System Autonomic Nerve System
1 Sensory input Special senses*, General somatic senses** Proprioceptors ***
Special senses, General visceral senses****, General somatic senses
2 CNS centers Voluntary control via cerebral cortex, Spinal cord
Involuntary control via limbic system, hypothalamus, spinal cord
3 Motor output Somatic motor nerves from CNS, release ACh
Visceral motor nerves from postganglionic neurons, release ACh or NE.
4 Effectors Skeletal muscle Smooth muscle, cardiac muscle, glands
5 Responses Excitation(contraction) Excitation or inhibition
* Vision, hearing, taste, smell and equilibrium; ** Pain, temperature, touch, pressure; *** Muscle and joint position; **** Chemical (CO2) and mechanical (BP). Four parts of the brain: 1. Cerebrum : 2 hemispheres 2. Diencephalon: thalamus, hypothalamus 3. Brain stem: midbrain, pons, medulla oblongata 4. Cerebellum
Brain is made up about 100 billion neurons.
The functions of the parts of the brain: 1. Cerebrum : The cortex is the highest center of the motion, sensory and mental
activities. 2. Thalamus: The relay of the sense transmission in CNS. 3. Hypothalamus: The highest center of the visceral activities. 4. Brain stem: The center of the vital activities like breathing, heart beating, BP. 5. Cerebellum: Coordination of movement. 6. Limbic system: “emotional brain” and functions in memory.
Limbic system includes cingulate gyri, hippocampus, dentate gyrus, amygdala, mammillary bodies of hypothalamus, anterior nucleus of thalamus.
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The protection of the brain 1. The brain is protected by the cranial bones, cranial meninges and cerebrospinal
fluid(CSF). 2. The cranial meninges surround the brain. They are continuous with the spinal
meninges. 3. The meninges have three layers:
1) The outer dura mater 2) The middle arachnoid 3) The inner pia mater
4. CSF: It continuously circulates through the subarachnoid space (between the arachnoid and pia mater) around the brain and spinal cord and through cavities within brain.
Application in acupuncture Anatomical layers in the thorax: 1. Skin; 2. Subcutaneous tissue; 3. Muscles; 4. Ribs and intercostal space and muscles; 5. Lungs and heart.
Anatomical layers in the abdomen: 1. Skin; 2. Subcutaneous tissue; 3. The muscles of the abdominal wall; 4. The visceral organs, liver, kidneys, digestive tract, bladder.
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SAA: List of the thorax and abdomen
1. Clavicle: medial and lateral ends
2. Acromion
3. Coracoid process
4. Suprasternal notch
5. Sternum
6. Sternal angle (angle of Louis)
7. Xiphoid process
8. Xiphisternal joint
9. Intercostal spaces: 1-9
10. 11th and 12th rib
11. Lateral border of rectus abdominis
12. Costal arch
13. Iliac crest
14. ASIS
15. Pubic symphysis
The exercises for Class 8:
1. Central nervous system includes _________ and _____________.
2. Four parts of the brain: _________, _____________, ___________ and ____________.
3. Generally, the _________ nerves distribute in the head, neck and viscera. The
_________ nerves distribute in the trunk and four limbs.
4. The brain is protected by ___________, ___________ and ___________________.
5. The two major functions of the nervous system _______________________________
and _____________________________________________.
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6. The anatomical layers in the thorax ___________, _________________________,
_________________, ______________________ and ______________________.
7. When you needle the patient in the thorax, what internal organs may you injure if the
insertion is too deep: __________ and _______________? which areas are the most
dangerous ____________________, __________________, __________and _________?
The most common problem when needling in the thorax is lung injury. If air enters
pleural cavity, it may bring about __________________.
8. What organs may be injured if the needles are put in the following areas incorrectly?
Please write the answers at the end of the arrow lines.
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Chapter Nine
The Coverage:
1. Nervous system: ANS. 2. Back. 3. NCA:p40-44, 67, 90, 92, 98 4. SAA:p37-39
The critical aspects:
1. The major effects of the sympathetic division. 2. The major effects of the parasympathetic division. 3. How to locate the IVS.
The additional materials:
Summary of parasympathetic and sympathetic responses
Parasympathetic division:
1. Regulates those activities that conserve and restore body energy during times of rest or recovery. It is an energy conservation-restorative system.
2. Parasympathetic responses: survival activities. SLUDD - Salivation, Lacrimation, Urination, Defecation, Decrease in heart rate.
Sympathetic division:
1. Prepares the body for emergency situations. It is an energy expense system. During physical or emotional stress, the sympathetic dominates parasympathetic.
2. Sympathetic responses: Fight or flight responses. EEE – Emergency, Exercise, Embarrassment.
Application in acupuncture
Anatomical layers in the back: 1. Skin; 2. Subcutaneous tissue; 3. Ribs and ICS or muscles and ligaments; 4. Visceral: lungs, kidneys.
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Clinical Correlation: Back pain (also known "dorsalgia") is pain felt in the back that usually originates from the muscles, nerves, bones, joints or other structures in the spine. The pain can often be divided into neck pain, upper back pain, lower back pain or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place or radiate to other areas.
Back pain is one of humanity's most frequent complaints. In the U.S., acute low back pain (also called lumbago) is the fifth most common reason for physician visits.
Anatomical reason: The spine is a complex interconnecting network of nerves, joints, muscles, tendons and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can make pain radiate to the extremities.
The important level lines on the back:
1. T2: the external end of the scapular spine;
2. T3: the internal end of the scapular spine;
3. T8: the inferior angle of the scapula;
4. L2: the lower margin of the thorax;
5. L4: the highest point of the iliac crest;
6. L5: the upper border of the PSIS.
Note: T2 means the spinous process of T2 or
the space between the spinous processes of T2 and T3.
SAA: List of the back
1. Vertebrae and IVS: C6-7, T1-12, L1-5
2. Scapular spine: medial and lateral end
3. The inferior angle of the scapula
4. 12th rib
5. Iliac crest: the highest point
6. PSIS
7. Coccyx
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The exercises for Class 9:
1. Autonomic nervous system includes two parts ____________________________ and
__________________________. Their function is to govern visceral _____ or somatic
_____activities.
2. The sympathetic division acts globally to mobilize the body in “___________________”
situation. For example, heart rate would ________, bronchi tree would ____________,
peripheral vessels would _______________.
3. The parasympathetic division usually acts focally and is primarily concerned with
functions related to ________ and _________. For example, heart rate would
___________, bronchi tree would __________, digestive activities would
_____________.
4. During sleeping or recovery, which division of ANS dominates?____________________
5. During physical or emotional stress, which division of ANS dominates?______________
6. Please write the name of the structures labeled in the following picture.
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Chapter Ten
The Coverage:
1. Immune and endocrine system. 2. Review SAA(thorax and back). 3. NCA:p28, 45 4. SAA: SAA: p26-28, p37-39
The critical aspects:
1. The organization and functions of immune system. 2. The organization and functions of endocrine system. 3. AIDS. 4. Alarm reaction and stress.
The additional materials:
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Clinical correlation
AIDS: Acquired Immune Deficiency Syndrome 1. AIDS is caused by human immunodeficiency virus (HIV). 2. HIV destroys the T4 cells population. 3. The primary victims: homosexual men, iv drug users.
Functions of endocrine system:
1. Regulatory functions on target sites(cells, tissues) by hormones; 2. Interacts closely with the nervous and immune system to facilitate communication,
integration, and regulation. Functions of hormones
1. Hypothalamus and pituitary: Secrete releasing or stimulating hormones. 2. Adrenal gland: Secrete adrenaline (epinephrine) /noradrenaline (norepinephine)
and cortical hormones, stress response gland. 3. Pancreas: Pancreatic islets secrete insulin, glucose regulation. 4. Thyroid gland: Secrete T3 and T4, metabolic rate. 5. Thymus gland: Secrete thymosin, T cell maturation. 6. Testis: Secrete androgen, male sexual characteristics. 7. Ovaries: Secrete estrogen and progestin, female sexual characteristics.
Three axes in endocrine system:
1. Hypothalamus – pituitary – adrenal axis 2. Hypothalamus – pituitary – thyroid axis 3. Hypothalamus – pituitary – testes/ovaries axis
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The exercises for Class 10:
1. _____________ produces B and T cells. In spleen B cells proliferate into plasma cell
that produces _________. _________ is the place where T cells mature.
2. AIDS stands for ___________________________________ caused by____________
that destroy _____________.
3. Adrenal gland releases ________________ and _____________.
4. Pancreas, as an endocrine organ, releases _____________ that regulates _________.
5. Stress is stimulation to human body. Three human systems and their messengers are
involved in regulation in the reaction of stress: _______________/_______________,
________________/________________ and ________________/_______________.
6. Hypothalamus and pituitary are the highest center of: a. body movement ; b.
visceral activities; c. growth; d. metabolism.
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Appendix A. Material for the final review
BONES KEY WORDS
Frontal bone Anterior superior skull
Parietal bones Lateral superior skull
Temporal bones
Occipital bone
Zygomatic bones
Maxilla
Mandible
Hyoid bone
Cervical vertebrae
Thoracic vertebrae
Lumbar vertebrae
Sacrum
Coccyx
Clavicles
Scapulas
Sternum
Ribs
Ilium
Ischium
Pubis
Pubic Symphysis
Humerus
Radius
Ulna
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Scaphoid bone
Triquetral bone
Pisiform bone
Metacarpal bones
Proximal phalanges of the hand
Intermediate phalanges of the hand
Distal phalanges of the hand
Femur
Patella
Tibia
Fibula
Calcaneus
Metatarsal bones
Proximal phalanges of the foot
Intermediate phalanges of the foot
Distal phalanges of the foot
**** Note: There will be fill in the blank questions for the following:
ASIS: Anterior Superior Iliac [or Ilial] Spine
PSIS: Posterior superior Iliac [or Ilial] Spine
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MUSCLES KEY WORDS
Frontalis
Orbicularis oculi
Orbicularis oris
Temporalis
Masseter
Sternocleidomastoid
Deltoid
Pectoralis major
Rectus abdominis
Linea alba
Trapezius
Latissimus dorsi
Erector spinae
Spinalis
Biceps brachii
Triceps brachii
Brachioradialis
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Flexor digitorum
Extensor digitorum
Carpal tunnel: carpal bones + flexor retinaculum
Quadratus femorus
Gluteus maximus
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Gluteus medius
Biceps femorus
Semitendinosis
Semimembranosis
Gastrocnemius
Soleus
Flexor digitorum longus
Tibialis anterior
Extensor hallucis longus
Extensor digitorum longus
Peroneus longus
Peroneus brevis
ORGAN KEY WORDS
Cerebrum
Limbic system
Hypothalamus
Pituitary gland
Anterior pituitary gland
Pineal gland
Cerebellum
Pons
Medulla oblongata
Spinal cord
Cranial nerves
Spinal nerves
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Afferent (sensory) nerves
Efferent (motor) nerves
Autonomic nervous system
Sympathetic nervous system
Parasympathetic nervous system
Adrenal gland
Adrenal medulla
Adrenal cortex
Thyroid gland
Thymus gland
Pancreas
MATCHING
Toward the midline
Toward the side
Close to the origin of a body part or the point of attachment of a limb to the body trunk
Below
In front of
Farther from the origin of a body part or the point of attachment of a limb to the body trunk
Moving in from body surface
Above
Behind
Axillary
Tarsal
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Coxal
Orbital
Inguinal
Umbilical
Oral
Femoral
Patellar
Popliteal
