Primo vascular system: An “explanation” for acupuncture meridians?

I’ve been blogging for nearly 15 years and was active on Usenet combatting pseudoscience and quackery for several years before that. I know I not infrequently say that to introduce a post, but there’s a reason for it this time other than just to pound my readers over the head how long I’ve been at this blogging thing. This time around, I’m making the point that, even after all this time, I discover things that I hadn’t heard about before, woo that I either never heard of before or don’t remember having heard of before because it didn’t make an impression on me. So it was the other day when I discovered something that I don’t remember having heard of before. (Actually, I had heard of it before, but totally forgotten about it and, amazingly, never written about it.) I’m referring to something called the primo vascular system. Invented by someone named Bong-Han Kim in 1963, the primo vascular system is promoted by acupuncture mavens as an anatomic structure/system that “explains” acupuncture meridians, those mystical, magical channels through which qi (or the life energy) supposedly flows but that scientists have been unable to correlate to any known anatomic structure. Anyway, it’s Friday, and I haven’t done a Your Friday Dose of Woo in a while. The primo vascular system (PVS) would seem to be an excellent candidate for one of my uncommon Friday resurrections of an old tradition on the blog.

If you Google “primo vascular system,” Google will return a number of search hits for you, but the most “impressive”- or “authoritative”-looking article that shows up near the top of the first page of search results is a 2013 review article in the Journal of Acupuncture and Meridian Studies (I know, right?) by several Korean authors and a Bulgarian author entitled The Primo Vascular System as a New Anatomical System. Actually, it’s not a review article per se, but listed as a “hypothesis.” Another high-ranking Google search hit is a review article in Evidence-Based Complementary and Alternative Medicine by mainly Korean authors, but one radiologist, Walter Akers, from the Washington University School of Medicine, entitled Primo Vascular System: Past, Present, and Future. A PubMed search brings up 107 articles, the vast majority of them in CAM or “integrative medicine” journals or outright quack journals about alternative medicine. Perusing some of these studies led me down a rabbit hole of alternative anatomy and biology that, as a surgeon and skeptic, I was facepalming myself while wondering why I hadn’t looked into this before.

But first, who was Bong-Han Kim (or, given how Korean names list the family first, Kim Bong-Han)? He actually does have a Wikipedia entry, which indicates that he was a North Korean surgeon, who graduated from Seoul National University in 1946. Apparently, after the Korean War broke out he left his family behind and crossed over into North Korea. While working in North Korea, he proposed the existence of the Chin-Lo or Kyungrak system, a system of pathways which, in his proposal, supposedly provide a basis for acupuncture points and meridians. He also called this the “primo-vascular system.” Suring the early 1960s, Kim was director of North Korea’s Kyung-Rak Institute (KIR), and while there he published five articles about acupuncture, the Kyungrak system, and his “Sanal” theory, articles that laid down the basis for his proposed primo vascular system. Unsurprisingly, his research was supported by the North Korean government for several years, which supplied him with funding, instruments, microscopes, and radiotracers, and Kim won the People’s Prize for his “research” in 1962.

Now here’s where it gets weird. (Yes, even weirder.) Around 1966, Bong-Han Kim disappeared, and around the same time the North Korean government shut down the Kyungrak Institute. Why? I couldn’t find out, but given that this was North Korea it’s not unreasonable to speculate that perhaps Kim somehow managed to get on the bad side of the government or someone powerful in the government and found his career coming to an abrupt and unceremonious end. Of course, having the “inventor” of a concept that would “validate” acupuncture meridians disappear under mysterious circumstances adds just the perfect dash of mystery and conspiracy to the whole tale, particularly given that apparently the Communist authorities said that his work “wasn’t proven.”

Here’s a description of what’s known about Bong-Han Kim’s disappearance:

Then, sometime in 1966, the Kyungrak Institute was suddenly closed. Chiefs who were responsible for the health-related policies and medical research were all removed from their positions. At the end of 1966, the DPRK government proclaimed that it would accept the biological sciences based on genetic theory, i.e., the Western theory of biological sciences. Soon after, B.H. Kim and his publications completely disappeared from the North Korea, but no official statement about the Kyungrak Institute, B.H. Kim, Bonghan theory, or his publications was given by the North Korean government. In 1967, the Russian medical community officially stated that the entity (Bonghan system) that represented the meridian might not have been proved scientifically, indicating that it decided not to accept the Bonghan theory. The North Korean government did not have any official response to that statement [2].

For years, there have been many different speculations and rumors about this strange situation of the complete disappearance of an entire science, the people, and the institute involved, etc. Some stated that B.H. Kim and his team had fabricated their experimental findings. However, the results from recent research activities on the same system have proved B.H. Kim’s research results to be correct, although much is still remaining to be studied to verify all of his study results. Some have stated that the entire scientific findings of B.H. Kim were discarded by the North Korean government because his research team had used humans for the study and had treated them inhumanely. Over the years, the North Korean government has been well known for treating its people very inhumanely in numerous incidents. Therefore, this does not appear to be the reason that the government ceased all those scientific activities that had a high probability of winning a Nobel Prize.

A Nobel Prize? The grandiosity amuses me. Regarding the Soviet connection, though, it is noted in this review:

For the 40 years between the 1960s and the 2000s, several scientists in foreign countries had great interest in Bong-Han Theory and tried to reproduce his results, but they failed. The main reason for this failure was the lack of details in Bong-Han Kim’s research reports concerning the scientific materials and methods that he used in his research. For example, from 1963 to 1965, some top-ranked Chinese medical scientists working for the Institute of Meridian-Collaterals, China Academy of Chinese Medical Sciences, Beijing, actively tried to find Bong-Han Kim’s proposed circulatory system in human corpses, rabbits, rats, guinea pigs, cats, dogs, and monkeys after having twice visited Bong-Han Kim’s laboratory at Pyongyang Medical University [8]. This required great efforts because of the lack of details on the materials and the methods; nevertheless, they only discovered some superficial and deep corpuscular, duct-like structures, which were similar to those proposed by Bong-Han Kim, in young rabbits. However, they could not distinguish the deep structures proposed by Bong-Han Kim from coagulation, and they could not find any structures proposed by Bong-Han Kim in other animals, including human corpses, or in acupoint regions.

Again, I can’t help but wonder if the disapproval of a Soviet scientist, Vladimir Yakovlevich Alexandrov, who had won the Stalin Award in 1943 and was been one of the powerful leaders in the USSR’s scientific community since the 1960s, had something to do with his ultimate “disappearance”:

He [Alexandrov] said in the book that in May 1966, he sent a two-page petition on behalf of the Scientific Council on Cytology of the USSR, warning against the absurd and dangerous knowledge of Bong-Han Kim, to the president of the USSR’s Academy of Sciences, the Minister of Health, the leading newspaper Pravda, the publishing house Mir, and some magazines dealing with information related to Bong-Han Theory. At the end of the petition, he wrote, “I could not be indifferent to the false biology and medicine of Bong-Han Kim in North Korea” [9].

Alexandrov denied that a new system different from the blood, lymphatic, and nervous systems existed in higher vertebrates, including humans. His book contained no specific comments about what kinds of photographs he had looked at. He just insisted that the photographs depicting the Bong-Han System were not new, but well-known, histological structures: for example, “collagen, elastin, hair root sections, nerve fibers, and encapsulated nerve endings” [9]. Therefore, he was deeply concerned about introducing incorrect scientific knowledge into the USSR’s academic fields.

Given that Alexandrov was a cytologist and anatomist, he would probably have known. Of course, that never stopped cranks from pursuing a lovely sounding bit of pseudoscience, pseudoanatomy, or pseudophysiology. Elsewhere, it’s speculated that somehow Bong-Han Kim’s “fame” was threatening to North Korean dictator Kim Il Sung, who encouraged scientists “envious” of Kim’s success to “openly criticize B.H. Kim’s work on the Kyungrak system for being based on deception,” even, if you believe the account, going so far as to denounce Bong-Han Kim as a spy based on his having come from Seoul.

But enough about Kim. Let’s get back to his “discovery.” In the review mentioned above, the primo vascular system is described thusly:

The PVS consists of three subsystems, which are summarized in Fig. 2. The external subsystem of the PVS (ePVS) has external PVs (ePVs) and external PNs (ePNs) and lies in the hypodermal layer of the skin and in the superficial fascia. The internal subsystem of the PVS (iPVS) includes internal PVs (iPV) that lie inside blood vessels and lymphatic vessels, inside the heart chambers, and inside and on organs. The internal primo nodes (iPNs) exist inside and on organs. The nervous subsystem of the PVS (nPVS) includes nervous primo vessels (nPVs) and nervous primo nodes (nPNs), which are distributed in the brain cavities and in the spinal cord channel. PVS are associated with epinervium and perinervium of the nerves. As a whole, the PVS is distributed throughout loose connective tissue, fat tissue, serous membranes, and in some cavities and lumens, as previously described. The external subsystem has “receiving” primo nodes (rPN) and “receiving” primo vessels (rPV). They connect with each other on the superficial layer and have a connection through “communicating” primo vessels (cPV) to deeper PNs that are named “communicating” primo nodes (cPN). The cPNs are “extraorgan” PNs (eoPN). The cPN and cPV are connecting parts of the internal PVS and make connections between the external subsystem and the organs. The internal subsystem has a “communicating” PVS and an “organ” PVS (oPVS). The oPVS net consists of “organ” primo vessels (oPVs) and “organ” primo nodes (oPNs). The organ part of the PVS is inside organs and on the superficial serous coverings of organs. As mentioned previously, the nervous subsystem has PVs along the nerves, in the brain cavity, in the spinal cord channel, and in the nervous system covers. The PNs in the nervous subsystem are in the brain covers (meninges) and in the brain. The main organ of the external and the internal subsystems is the heart, and the two subsystems communicate in the heart wall through the thebesian veins (TVs; vv. Cordis minimae). The embryonic development of the TVs in the heart is similar to the development in thebesian definite channels that remain after birth connected to the heart wall. In the earliest stage of embryonic development, the primordial PVS is probably connected to the TVs, which establishes a connection between the PVS and the heart [6]. The main organ of the nervous subsystem is the brain. The different parts of the nPVS communicate through the sinuses and the cisterns of the dura mater. External signals are accepted from the rPN; through the rPV, the signals are distributed in the ePVS. Through the cPN and the cPV, the signals reach an organ’s tissues via the oPN and oPV.

There’s even a fancy-looking set of figures that represent an anatomic fantasy:

The main points of Bong-Ham Kim’s “hypothesis” are:

1. The PVS is an independent functional morphological system.
2. The superficial PVs and the extravascular PVs are connected by superficial nodes.
3. The deep PVs are connected by intravascular PVs, deep PNs, and organ nodes.
4. The superficial PNs have a muscular layer and various cells inside, and their structure is different from the deep PNs
5. The PNs have different kinds of nucleic acids, primarily DNA.

Different kinds of nucleic acids, you say? I say: Nonsense!

But the woo gets thicker:

The PVS has bioelectrical activity, excitatory conductivity, and mechanical motility. The bioelectrical signals of the endothelial cells of the PVs are similar to the signals of the smooth muscle cells [20]. Changes in a bioelectrical impulse may indicate the existence of other kinds of physical influences on the PVS, other than influences by the nervous and cardiovascular systems [6]. There is a hypothesis that DNA may act as a photon store and coherent radiator [55]. We offer a new point of view concerning the type of vital energy Qi is. Because the PVS may be an optical channel for photon emission, an electromagnetic field that travels throughout the PVS and throughout the DNA in the PVS may be the mysterious vital energy Qi that can be distributed throughout the entire body. Based on a previous hypothesis 2, 55, we believe the function of the PVS as an optical channel is closely related to the DNA in the PVS. We hypothesize that DNA carries genetic information and its structure is capable of storing information obtained from environmental physical fields such as electromagnetic fields. We support the previous hypothesis that Qi is an electromagnetic standing wave [56]. We can add that these electromagnetic waves may be transformed into information and that this information is stored in the DNA granules of the PVS.

In other words, the primo vascular system is magic! It’s the repository of that mystical magical “life energy” in traditional Chinese medicine known as qi, which, if you believe acupuncturists, this qi flows along meridians and its flow is “unblocked” by sticking needles into the meridians. (I know, I know, it doesn’t even make superficial sense, but that’s the idea.) Even better, the “energy” is stored electrically in DNA and transmitted as “information.” Yes, when you wave your hands without respect to whether what you are proposing is even slightly plausible or not given current knowledge of human anatomy, physiology, and biochemistry. Of course, this is very different from Bong-Han Kim’s original description of the primo vascular system, which he originally called the Bonghan ducts and Bonghan corpuscles, corresponding to acupuncture meridians and acupoints. His work was originally published in five publications, summarized here:

The first report was very brief and mostly about the electric response of acupoints, which was probably not considered very exciting. The second report, however, contains the discovery of a completely new system, constituting node-like anatomical structures at the acupoints and the tube-like structure (Kim claimed it to be the AM) connected to the nodes in the skin [2]. The research team named the nodes the Bonghan corpuscles (currently renamed as primo nodes) and the tubes the Bonghan ducts (primo vessels). They also found that this new system existed not only in the skin but also throughout the body, including on the surfaces of body organs and inside the blood and lymph vessels. This new discovery became the foundation of the Bong-Han theory. To publicize its scientific achievements, the North Korean government translated Kim’s second report in various languages including English and disseminated it to most major libraries in the world [6]. The third report was an extension of the second one, observing the entire network of the Bong-Han system (renamed as primo vascular system (PVS)) in the mammalian body [3]. The fourth one was about the “Sanal,” (renamed to be Primo-microcell (P-microcell)), whose functions, he claimed, were regeneration and/or repair, as totipotent stem cells [4]. Sanal is a Korean word and its direct translation in English is “live egg.” The last (fifth) one was a brief report about the hematopoietic function of the Sanal [5]. These five publications were reports rather than journal articles, and they described mainly results with insufficient information on methods and materials. The introduction and discussion sections were very short.

You see? Nothing about energy in DNA! Of course, in 1962, the genetic code had only recently been elucidated, and there’s nothing that quacks like better than to add DNA to the mix. I’m sure that they must have added epigenetics in there somewhere too, but, for the most part there isn’t a lot to be found on that score. In any event, it’s rather amusing how the primo vascular system went from a hitherto undiscovered entire vascular system through which nucleic acid-rich fluid (the p-fluid) circulated, to an entire bioresonance system with charged DNA storing the life energy. And now, of course, stem cells. Indeed, one Auburn professor, Vitaly Vodyanoy, claims that, using his “patented” special microscope, to have visualized the primo vascular system in rodents. Unsurprisingly, he’s collaborating with the Lake Erie College of Osteopathic Medicine in Pennsylvania and believes that, instead of healing life energy called qi, meridians (which, if you believe Kim and his apostles correspond to acupuncture meridians) circulate a liquid containing stem cells, because of course stem cells have to be involved.

So what is the evidence for the existence of the primo vascular system? Not a lot. There’s Bong-Han Kim’s original work, which scientists couldn’t replicate in part because his descriptions of what he suffered from an extreme lack of detail, but in far greater part because the structures he describes almost certainly either don’t exist or were his misinterpretation of already know structures, as Alexandrov described 53 years ago. After all, Kim didn’t use any special techniques. As this article describes, all he used were routine histochemistry dyes of the time, including Feulgen, Unna-Pappenheim, Brachet, acridine orange, and hematoxylin-eosin stains to characterize nucleic acids and resorcin-fuchsin, Van Gieson, Verhoeff, and Gros-Schultze stains to visualize the various “fibers” he claimed to have discovered. Come to think of it, this would be a lovely point for my pathologist colleagues to jump in and add their expertise. Looking at slides allegedly showing various primo vascular system structures, I’m struck by how many of them look like lymphatic vessels or artifacts of tissue processing:

Indeed, Kim used all light microscopy and various tracers; it beggars the imagination that in the early 1960s, given the century plus of scientists examining human tissues and cells under light microscopy before then, a lone North Korean scientist could discover structures that no one had ever described before using no new or innovative microscopy techniques.

None of this stops acupuncturists and others from exulting:

We strongly believe that complete characterization of the PVS will fully confirm the existence of this vast, distinct vascular system, which will soon create a new paradigm in biology and medicine. It will bring together western and eastern medical philosophies, provide an unlimited source of multipotent stem cells, and bring new diagnostic and therapeutic methods. The highest potential impact is expected in acupuncture [83, 84], osteopathic manipulative medicine [85, 86], pain management, developmental biology [87], tissue regeneration, organ reconstruction, diabetes, and cancer prevention and treatment [88].

It’s not just acupuncture, either:

Another previous guest, Rajan Narayanan, used this system as the basis for his study published in the International Journal of Yoga 2018. https://www.ncbi.nlm.nih.gov/pubmed/29755226

It seems the PVS ties together the endocrine, lymphatic, cardiovascular and nervous systems in an electromagnetic biomatrix that can be measured with Electro-Photonic Imaging. With this integrated perspective, Narayanan was able to use Pranayama (breath work), among other yogic techniques, as a successful and precise intervention for numerous patients.

And, if that’s not enough for you, advocates claim that the primo vascular system can explain evolution:

Because the meridian system exists in the Animalia, Plantae, and Fungi kingdoms [61], an interesting subject would be to investigate the role of the PVS in the evolution of organisms. Based on the PVS, we propose a new point of view concerning Darwin‘s evolutionary theory. The main problem of current evolutionary theory is the lack of intermediate forms between species. We suggest that the PVS—as a primordial body system distributed throughout the entire organism—is capable of capturing and storing information from environmental electromagnetic fields, which would permit dramatic and sudden changes in an organism’s DNA. Such a sudden change of an organism’s DNA may explain why there is a lack of intermediate forms between species.

That one alone is worth a Godzilla-sized facepalm:

After all, there are intermediate forms between species. “Capturing and storing information from environmental electromagnetic fields, which would permit dramatic and sudden changes in an organism’s DNA”? That’s just Lamarckism tarted up with woo about electromagnetic fields.

Reading all the “literature” on the primo vascular system, I can’t help but be reminded of Morgellons disease, in which common fibers found from clothing and the environment are claimed to be “organisms” causing a skin disease. I’m also reminded of the “research” of the current director of the National Center for Complementary and Integrative Health (NCCIH), Helene Langevin. She made her name in acupuncture research using ultrasound and dissection of cadavers to identify “structures” corresponding (according to her) to acupuncture meridians, concluding that acupuncture meridians correspond to areas where two muscles come together. The bottom line is that no one has ever convincingly correlated any anatomic structure with acupuncture meridians, and the primo vascular system is no different. It is, however, some fine woo, all with a dash of conspiracy theories about “suppressed knowledge.”