Visual abstract

Introduction

Meridians are the channels through which qi or vital energy flows and represent a key concept in traditional East Asian medicine (TEAM). Meridians, collaterals, and subcollaterals form a hierarchical network called the meridian system. It functions as an individual’s entire system, and serves as the theoretical and phenomenological background for acupuncture, the main treatment method of TEAM [1]. For the past half century, there has been research performed to discover and understand meridians in vitro, and it has been explained as a low hydraulic resistance channel [2], the primo vascular system (i.e., the Bonghan duct) [3], and the fascia network [4]. In addition, various biophysical properties of meridians and acupoints have been described and include their electrical, thermal, acoustic, optical, magnetic, isotopic, and myoelectric properties [5]. A systematic review by Wang et al [6] published in 2010 comprehensively examined meridian studies conducted in China, and included propagated sensation along meridians, relevance to the circulatory system, interstitial fluid flow, connective tissue, and mast cells, and special chemical characteristics along the meridians. In addition, a recent study [7] reviewed studies on the meridians through systems biological analysis using omics data which included transcriptional, proteomic, and metabolomics data.

Bibliometric analysis refers to the quantitative analysis of publications and is actively used in medical [8] and health technology research [9]. In the medical research field, bibliometric analysis has the advantage of making it easy to identify related research in a specific field of interest, explore research trends, and visualize them [8]. VOSviewer is freely available software that enables visualization of bibliometric analysis, and is particularly useful for constructing and displaying large bibliographic maps in an easy-to-interpret way [10]. Though meridians have classically existed as a functional concept, their substance and function are being reported in modern studies. Employment of bibliometric analysis of studies on meridians to examine changes in topics, relevant biomarkers, methodologies, and authors, over time, may be useful. In addition, the topography and prospects of meridian research in the future may be elucidated. Furthermore, there is the potential to help expand and deepen the research field of meridian-based therapeutic interventions such as acupuncture, traditional exercise (e.g., qigong and Taichi), and other meridian-based techniques (e.g., thought field therapy and emotional freedom technique). Despite the diversity of research approaches applied to understand meridians, spanning several decades, from anatomical studies of the primo vascular system to recent computational analyses, there has been no comprehensive bibliometric analysis examining research focus, the methodologies employed in meridian studies, and how they have evolved.

This gap in our understanding limits our ability to identify emerging trends and potential future directions in this field. Therefore, this study aimed to: (1) analyze the temporal evolution of meridian research focus over the past 5 decades; (2) identify key research clusters and their interconnections; (3) examine international collaboration patterns in meridian research; and (4) suggest future directions based on emerging trends and current gaps in the field. This comprehensive bibliometric analysis was conducted using VOSviewer to visualize and analyze publication patterns, research themes, and collaboration networks in meridian studies.

Materials and Methods

1. Data sources

MEDLINE, via PubMed, was selected as the database for the bibliometric analysis review. This database was chosen primarily due to its standardized Medical Subject Headings (MeSH) terminology, which enables precise and consistent keyword analysis. The MeSH search tool is a controlled vocabulary thesaurus produced by the National Library of Medicine, featuring a hierarchical structure that allows for systematic categorization of research topics [11]. While other databases, such as the Web of Science Core Collection, are frequently used in bibliometric analysis, they do not provide the MeSH search functionality, and this makes MEDLINE the most suitable choice for this study.

2. Search strategy

The search was conducted using the MeSH term "meridians," which is defined in MEDLINE as, "the main and collateral channels, regarded as a network of passages, through which vital energy (qi) circulates and along which acupoints are distributed. The meridians are a series of 14 lines upon which more than 400 acupoints are located on the body." Given the hierarchical nature of the MeSH structure, where "acupuncture point" is included under meridians, we used the search strategy meridians (Mesh:NoExp) to focus specifically on meridian-related research. No filters were applied regarding text availability, article attributes, or article types. The search covered studies published from January 1, 1975, to December 31, 2024, with data collection performed on January 1, 2025. The bibliographic data were downloaded in text format for subsequent analysis in VOSviewer.

3. Inclusion/exclusion criteria

Meridian research was defined as studies focused on the TEAM concept of meridians as channels of qi flow. The following inclusion criteria were applied: (1) studies indexed under the MeSH term meridians [except autonomous sensory meridian response (ASMR) studies]; (2) published between January 1, 1975, and December 31, 2024; and (3) all study types (except Conference Abstracts and Letters to the Editor).

4. Analytical strategy

The bibliometric analysis was performed using the VOSviewer (Version 1.6.19; developed by van Eck and Waltman in 2010 at the Centre for Science and Technology Studies, Leiden University, Leiden, The Netherlands). A frequency analysis of publications was conducted (by year) to identify temporal trends in meridian research. For the analysis of research topics, a co-occurrence analysis of MeSH keywords was performed using the full counting method, with a minimum occurrence threshold of 15 keywords. The mapping was constructed with a resolution of 0.60 and a minimum cluster size of 1. The threshold values were empirically determined through iterative testing to achieve optimal cluster visualization. These values were selected as they provided the most meaningful and interpretable clustering patterns while maintaining sufficient data density for analysis. The keyword co-occurrence network analysis identifies patterns of keywords that frequently appear together in publications, revealing thematic relationships in the research field of choice. The resolution parameter (0.60) determines the level of detail in the clustering, with higher values resulting in more clusters. The minimum cluster size of 1 was selected to ensure that potentially important nodes were not excluded from the analysis, even if they formed isolated clusters.

For examining research collaboration patterns, author cooperation patterns were analyzed using the full counting method, setting the minimum number of authors per document to 5. The cooperation pattern analysis examines author collaboration networks to show how researchers are connected through coauthored publications. Both analyses utilized 2-dimensional mapping with the same resolution and cluster size parameters. Additionally, the overlay visualization function was employed to track temporal changes in both keyword use and author collaboration patterns, with color coding from blue (older) to yellow (newer). The overlay visualization network adds a temporal dimension, using color coding to show when different research themes emerge or peak. In these visualizations, node size represents the number of related studies, and the connection strength between nodes was quantified using the total link strength (TLS). TLS represents the cumulative strength of connections between a given node and all other nodes in the network. Higher TLS values indicate nodes that are more central to the research field and more strongly connected to other nodes.

Results

1. Publications of articles

Of the 1,474 studies retrieved from MEDLINE via PubMed, there were 1,446 studies which were included in the final analysis (28 studies related to ASMR, that were not related to the meridian of interest were excluded; Figure 1). The included studies were published between 1992 and 2024. The number of studies in this field has gradually increased, reaching a peak of 101 studies in 2015, and has remained at around 70–90 studies per year. Research studies on the meridian concept of TEAM have been described since the early 1990s and includes The Myth of Meridian Therapy published in 1992 [12]. A significant breakthrough came in 2006 when Ogay et al characterized the flow of DNA-containing granules in a meridian-like system in rabbits [13], and discovered novel threadlike structures in brain ventricles that were consistent with, but distinct from, nerves, and were named Bonghan ducts [14]. This discovery was further expanded with the identification of a new type of muscle fiber, in rat studies, in the subcutaneous layer, which was named as an acupuncture muscle channel [15]. A review by Longhurst in 2010 concluded that the peripheral and central nervous systems were the most rational basis for defining meridians [16]. In 2012, Chang published a comprehensive review of the meridian system and described the essence of the meridian system as a complex network of neurovascular bundles and their smaller branches of fractal continuum [17]. In 2015, Zhang et al [1] proposed meridians as low hydraulic resistance channels. The most frequently reported structure related to the identity of meridians is the primo vascular system derived from the Bonghan duct, and 70 studies related to this system (i.e., primo or Bonghan duct) were published from 2006 to 2023 (Figure 2).

2. Keyword co-occurrence analysis

A total of 76 MeSH terms were associated with meridians and occurred more than 15 times. The MeSH terms related to meridians are those that frequently co-occur with the primary term in the indexed articles. Among them, the top 5 MeSH terms most frequently related to meridians were as follows: "humans" (occurrence: 1,180, TLS: 5,844), "acupuncture points" (occurrence: 819, TLS: 4,253), "acupuncture therapy" (occurrence: 719, TLS: 3,682), "male" (occurrence: 377, TLS: 2,742), and "female" (occurrence: 371, TLS: 2,672; Table 1). Excluding MeSH terms representing basic demographic information (e.g., humans, male, female, and "adult"), the top 10 popular terms included "China" (occurrence: 134, TLS: 775), "treatment outcome" (occurrence: 101, TLS: 684), "rats" (occurrence: 90, TLS: 571), and "electroacupuncture" (occurrence: 85, TLS: 580; Supplementary Material 1).

The MeSH terms indexed in the involved studies were classified into 3 clusters. Firstly, the MeSH term humans, which exhibited a high magnitude (i.e., frequent occurrence) with the closest topological relationship with meridians. This can be interpreted as meaning the field of clinical research on meridians, and nodes occupying an important size included male, female, adult, "middle aged," "young adult," and "aged." The latest MeSH terms for this cluster identified by the overlay visualization function were "massage," "stroke," "emotions," and "depression." Meanwhile, the older MeSH terms in this cluster comprised "skin temperature," "heart rate," and "pain measurement" (Figure 2B). Secondly, the core node was the MeSH term acupuncture points. The size of this node was smaller than humans, but the node occupied a topological position close to meridians. The central nodes of this cluster were acupuncture, "moxibustion," China, and "history," "ancient," and this cluster encompassed research on the characteristics of acupuncture points or meridians from a historical point of view. Based on the overlay visualization function, this cluster contained more up-to-date nodes than the other 2 clusters. The current MeSH terms for this cluster identified by the overlay visualization function included acupuncture, moxibustion, "needle," and "data mining." Meanwhile, the older MeSH terms in this cluster included "yin-yang." Thirdly, the center of the cluster was the MeSH term "animals" as the core node. This node was further away from meridians than humans or acupuncture points, and its size was small. The vital nodes of this cluster included rats, "mice," "staining and labelling," "skin," and "electroacupuncture." This cluster contained preclinical trials to elucidate the biological basis of meridian. Based on the overlay visualization function, current MeSH terms for this cluster were "pericardium," and "microcirculation." Meanwhile, the older MeSH terms in this cluster included skin and "connective tissue" (Figure 3). In the subgroup centered around the node humans, the clinical topic nodes exclusively related to and included stroke and "low back pain." Meanwhile, in the subgroup centered around the node animals, the clinical topic node exclusively related to and included "myocardial ischemia." The clinical topic node related to both subgroups was "pain management" (Supplementary Material 2). Excluding MeSH terms representing basic demographic information, the clusters were divided into 3 clusters centered on acupuncture points, acupuncture, and animals. Each cluster appeared to encompass clinical interpretations of meridian, literature-based studies, and animal experiments (Supplementary Material 3).

3. Cooperation pattern analysis

A total of 119 authors appeared at least 5 times in the studies in this review. Among them, the 5 top authors most frequently related to the MeSH term meridians were as follows: Soh, Kwang-Sup (occurrence: 35, TLS: 50), Zhao, Jing-Sheng (occurrence: 28, TLS: 8), Zhang, Wei-Bo (occurrence: 22, TLS: 30), Wu, B (occurrence: 17, TLS: 44), and Hu, X (occurrence: 17, TLS: 42; Table 2).

In the connected network, authors in this field were divided into nine clusters. Except for the cluster centered on Kwang-Sup Soh, all other clusters consisted of Chinese authors. Kwang-Sup Soh and Byung-Cheon Lee were the only Korean authors with links to China (Figure 4A). From the overlay visualization function, Kwang-Sup Soh and Jing-Sheng Zhao, who have the largest node sizes in this field of research, are established researchers. The analysis revealed that Prof. Soh's early work (published mainly between 2006–2012) focused on elucidating the meridian's anatomy, particularly the primo vascular system [13,14,18]. In parallel, Prof. Zhao's contributions (primarily from 2008–2013) centered on the development and significance of meridian theory in medical classics [19–21]. Prof. Zhang, whose work spans the last 25 years (1998–2023), bridged these approaches by analyzing both the medical classics [22] and the biological entities in meridians [23]. In addition, (although the size of the node was relatively small), Chun-Sheng Jia from China was the newest researcher in the field (Figure 4B). Recent studies by Prof. Jia et al used text mining and complex network techniques [24–30].

Discussion

This bibliometric analysis revealed 3 significant trends in meridian research development over the past 3 decades. Firstly, while early studies focused heavily on uncovering the biological basis of meridians, through the discovery of the primo vascular system and low hydraulic resistance channels, recent research has shifted towards clinical applications and data-driven approaches. Secondly, there has been a notable transition from investigating meridian systems as a whole to focusing on specific acupuncture points and the affect their stimulation can deliver. Thirdly, despite the growing amount of research, international collaboration remains limited primarily to East Asian countries, particularly South Korea and China. These patterns provide important insights into both the progress and limitations in meridian research.

As a result of analyzing the publication status of the included studies, by year, the meridian of TEAM was actively reported from the early 1990s. However, since peaking in 2015, the number of relevant studies per year has remained in the boxed range of 70–90. Effort has been made to uncover the biological basis of meridians, initially considered mysterious [13], now considered to be part of the primo vascular system [14], and have low hydraulic resistance channels [1]. More recently, text mining or data mining research on meridians has been published [31–33]. The emergence of data mining approaches in recent studies [31–33] represents a significant methodological evolution in the field. While these computational methods offer powerful tools for analyzing traditional text and clinical patterns, their increasing prominence may partially reflect the limitations encountered in traditional experimental approaches to meridian research. This suggests a need to balance data-driven insights with continued investigation of physiological mechanisms.

The MeSH terms co-occurrence analysis revealed distinct evolutionary patterns across 3 research clusters. The most striking finding was the dominance of recent studies on acupuncture points as a cluster, suggesting a shift from theoretical meridian system research to more practical, intervention-focused studies. This transition is particularly evident in the contrast between current nodes like data mining and acupuncture versus nodes with older concepts like yin-yang, indicating a methodological evolution from traditional theoretical frameworks to more evidence-based approaches. Similarly, in clinical research, the emergence of nodes related to neuropsychiatric conditions suggest an important expansion of meridian research into mental health applications, while the declining emphasis on basic physiological measurements (heart rate, skin temperature) reflects a move away from fundamental biological mechanism studies. This transition from fundamental research to clinical applications, particularly evident in the work patterns of major researchers like Soh and Zhang, may reflect both the challenges in establishing definitive anatomical correlates of meridians and a pragmatic shift toward more readily demonstrable therapeutic effects. While this shift has yielded valuable clinical insights, especially in neuropsychiatric applications, it also raises questions about whether fundamental aspects of meridian systems remain inadequately explored.

Topics in the "clinical studies" cluster in meridian studies also indicated changes in the nodes over time. Specifically, as the neuropsychiatric conditions such as stroke, emotions, and depression have received attention, the biological basis of meridians such as heart rate and skin temperature nodes have become dated. In addition, the node pain measurement was considered invalid in clinical studies of meridians. These findings suggest that current clinical studies of meridians are targeted at therapeutic strategies for clinical conditions using the meridian theory, especially neuropsychiatric conditions, rather than revealing the biological basis of meridians. Compared with other clusters, animal experiments was small in size, and the nodes it contained were generally outdated.

The author cooperation pattern analysis revealed significant geographical and generational constraints in meridian research. Firstly, experiments in this field were mainly conducted by researchers in South Korea and China. Among Chinese researchers, the author cluster including Wei Zhang displayed some cooperation with other author clusters. Although some biological basis (e.g., the primo vascular system) to explain meridians had been revealed since the early 1990s, the fact that the studies are still only being carried out in South Korea and China suggests a distinct limitation in the growth of the meridian research field. In addition, considering that research on acupuncture has increased exponentially, worldwide, over the past 20 years [34], the insufficient and unbalanced publication status of meridian research, as compared with acupuncture research, suggests that the meridian concept has not been appropriately associated with acupuncture. This may represent a geographical constraint. East Asian countries benefit from deep historical knowledge of meridian theory, however, this knowledge may be limited in other countries. The concentration of expertise in East Asian regions, though valuable, suggests a need for broader international collaboration to enhance both the scope and credibility of meridian research. This could be particularly important for bridging the current disconnect between traditional meridian theory and the worldwide growth of acupuncture research.

In other words, in order to promote meridian research, Western researchers and funding bodies need to be more aware, through publicity, of the connection between meridians and acupuncture (i.e., the acupuncture point-specific effect of acupuncture, the systemic effect of acupuncture, and the meridian-like system that mediates the treatment mechanism of acupuncture). Secondly, changes in productivity for meridian studies over time were observed. Importantly, the nodes of the authors Kwang-Sup Soh and Jing-Sheng Zhao were the largest in this review and were considered antiquated. A similar trend was observed in the case of Wei-Bo Zhang where a medium-sized node was observed. At the far end of the author cooperation network graph, Chun-Sheng Jia formed a relatively new cluster. None of the large-scale author nodes such as Kwang-Sup Soh, Jing-Sheng Zhao, and Wei-Bo Zhang were directly connected to the emerging author node Chun-Sheng Jia. This may suggest that the work of the masters of meridian studies in South Korea and China has not been adopted by the next generation of researchers in this field. Based on the results of the keyword co-occurrence analysis in this study, the promotion of cooperation among researchers conducting meridian studies of the same cluster is encouraged. At the same time, cooperation among researchers working in different clusters should be fostered through attendance at international conferences or academic associations related to meridian research.

Based on the bibliometric analysis findings, several promising directions for future meridian research were apparent. Firstly, considering the current geographical limitation of research, primarily in South Korea and China, there appears to be a clear need to expand international collaboration networks, particularly with Western researchers. This could be facilitated by establishing international research consortiums and standardizing research protocols across different cultural contexts. Secondly, analysis revealed a recent trend towards data mining approaches. This suggested the potential for expanding computational approaches to analyze both classical meridian text and clinical data, helping bridge traditional concepts and modern evidence-based practice. Thirdly, given that current clinical studies are increasingly focused on neuropsychiatric conditions, while basic mechanistic research has declined, there is an opportunity to revitalize fundamental research by specifically investigating the neurobiological basis of meridian function in mental health conditions. Fourthly, the observed disconnect between established researchers' work on the primo vascular system and newer clinical applications has indicated a need for integrated research programs that explicitly connect basic biological findings with clinical outcomes. Additionally, analysis showed that while acupuncture research has grown exponentially worldwide, meridian theory research has not been well integrated with acupuncture and has not experienced this expansion. Therefore, future studies should focus on documenting and investigating the specific relationship between meridian systems and acupuncture mechanisms, particularly in the context of acupuncture point specificity and systemic effects.

This study has the strength of being the first to investigate research trends in meridian studies using bibliometric analysis. The findings of this study present potential barriers and challenges in future meridian research. However, the following limitations should be considered. Firstly, the database used in this study was limited to 1 database (MEDLINE via PubMed). This approach may have missed significant research published in East Asian languages and indexed in regional databases such as CNKI (China), KoreaMed (Korea), and J-STAGE (Japan), particularly given the historical and cultural significance of meridian research in these countries. Additionally, when bibliometric information downloaded through PubMed was analyzed with the software VOSviewer, some analysis options were limited (as compared with the bibliometric information downloaded through the Web of Science database, a popular database for bibliographic analysis). For example, analysis options such as country and journal analysis of publications were restricted. Nevertheless, the affiliation of the authors was searched manually, and most of the studies in this field were conducted in South Korea and China, suggesting that while the database of choice may have limited coverage of regional research, it likely captured the main trends in international academic publications on meridian research. Secondly, although the MeSH terminology is an effective system for identifying the characteristics of individual publications, it should be acknowledged that the MeSH terms may be improperly indexed or there may be missing literature. Thirdly, as a fundamental strength and limitation of the VOSviewer analysis, it is possible to affect cluster formation by manipulating the options of this software such as the resolution of the graph, and this is under the subjective judgment of the author. Finally, we acknowledge that bibliometric analysis based on MeSH terms has inherent limitations. MeSH term assignment can be subjective and may not fully capture the nuances of research content. Additionally, changes in MeSH term definitions over time and variations in indexing practices may affect the consistency of analysis.

Conclusion

In this study, the bibliometric information of relevant published meridian studies until Dec 2024, accessed on MEDLINE, was analyzed based on the MeSH terms. Analysis revealed several key findings: (1) research in this field has not been adopted by Western researchers despite significant biological basis discoveries and achievements from the early 1990s; (2) the focus of current research has shifted from meridian systems to acupuncture points, with data mining emerging as a key methodology; and (3) while interest in preclinical and clinical studies of meridians has declined, promising new applications in neuropsychiatric disorders have emerged. These findings suggest both challenges and opportunities in the development of meridian research. The results of this study may serve as a foundation for promoting meridian research in the future and may provide valuable insights for the broader field of meridian-based therapies, particularly acupuncture.

Supplementary Materials

Article information

Author Contribution

The author confirms sole responsibility for the following: study conception and design, data collection and analysis, interpretation of results, manuscript preparation, and final approval of the version to be published.

Conflicts of Interest

The author has no conflicts of interest to declare.

Author Use of AI Tools Statement

Artificial intelligence tools were not involved in any part of the scientific research, including data interpretation or result formulation.

Funding

None.

Ethical Statement

Not applicable. This study analyzed publicly available bibliometric data and did not involve humans, animals, or any biological materials.

Data Availability

Figure 1

Selection process for studies to be included in the bibliometric analysis of meridian research.

ASMR = autonomous sensory meridian response.

Figure 2

Number of publications on meridian research in MEDLINE via PubMed (from January 1, 1975, to December 31, 2024).

Note. The number above each dot represents the number of related publications in the year.

Figure 3

Keyword co-occurrence analysis of MeSH terms in meridian studies: (A) keyword co-occurrence network graph; and (B) overlay visualization network graph.

Note. Red cluster: humans; blue cluster: animal; green cluster: acupuncture points.

Figure 4

Cooperation pattern analysis of authors in meridian studies: (A) author cooperation network graph; and (B) overlay visualization network graph.

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References

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