Acupuncture Part 1

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Acupuncture Part 1

• Modernization of Ancient Wisdom

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Comparison of East West
East
West

• Empirical Observations over Thousands of Years

• Scientific Method Case-Based Medicine

• Technology of Medicine

• Art of Medicine

• Holistic View

• Molecular and Organ View

• Circular Logic

• Energetic

• Linear Logic

• Mechanistic

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What is Acupuncture?

• Acus meaning needle
• Pungare meaing to pierce
• Zhenjiu meaning needle (zhen) and moxabustion
  (jiu)
• Manipulating body balance through regulating flow
  of Qi

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Moxabustion

• Applied either moxa or heated element (1500 F)
  to arthritic joints
• Moxa burned in room
• Moxa was better longer lasting

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Scientific Evidence ?
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What Scientific Evidence Exists?

• Total Medline Cites for Acupuncture to Date
  Represents 7107 Publications
• 62 Double-Blind Studies

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Animal Acupuncture Studies

• Represent 1/10th of all Cites
• Parallel Human Acupuncture Studies in Frequency
• No Double-Blind Studies

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Placebo Effect

• Study showed that, if something specific is
  measured, then there is no placebo effect. Only
  if the measure is subjective.
• So, blindness may not be valid in all cases.

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NIH 97 Consensus on AP

• Effective for Osteoarthritis and Musculoskeletal
  Pain
• Effective for many GI Problems
• IBD, diarrhea, ulcerative colitis, peptic ulcers,
  dyspepsia, abdominal pain, nausea and vomiting
• Effective for Pulmonary disease
• asthma, colds

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NIH 97 Consensus on AP

• Effective for Immunomodulation
• reduces inflammation, elevates WBC, ?
  interleukin-2 production
• Effective for Reproductive Disorders
• ? uterine bleeding, ovulation

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How Does AP Work?

• The physiologic effects of acupuncture therapy
  cannot be explained by a single mechanism, but
  rather a series of interactions among the
• Nervous System
• Endocrine System
• Immune System

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AP Events

• Simple in concept, complex in action
• Starts from Local Effects
• Expands to involve the entire Neural Axis

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AP Events

• Local effects
• Segmental effects
• Pain control
• Organ effects
• Central effects
• All take place at once

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Basic Tenets of AP

• Based upon the AP point selected
• Based upon the method of stimulation
• Dry needles
• Electrical AP
• Aquapuncture
• Hemoacupuncture

• Based upon the length of stimulation
• Low-rate, twisting stimulation of GV26 leads to
  endorphin response, while high-frequency needling
  of GV26 leads to epinephrine response

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Effects of Acupuncture
Baseline
Mannitol

• Using manganese-enhanced fMRI (functional
  magnetic resonance imaging), visual effects can
  be seen in human and animal neural tissues

Mn Infusion
EA GB34
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Effects of Acupuncture

• Activation of cortex is site specific
• Leads initially to specific effects

GB34
ST36
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Effects of Acupuncture
5 minutes
20 minutes

• Activation has temporal effects
• Longer stimulation activates more cortical
  structures
• Leads to broader effects

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Effects of Acupuncture

• In separate study, analgesic AP points were
  compared to non-analgesic points
• Analgesic AP altered brain regions involved in
  pain modulation
• PAG, MnR, hypothalamus, thalamus
• Non-Analgesic AP did not activate same areas

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Method of Stimulation

• Stimulation of BL-20 (the SP association point)
  in horses led to analgesia using dry needles or
  electrical AP.
• Only EA increased release of endrophins into the
  blood.

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Medication Timing TCM 24-hour Clock
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Anatomical Considerations

• Acupuncture point
• Meridians
• Reflex Connections
• Central Connections

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Shu Xue (communication outlet)

• ? Electrical resistance
• ? Electrical conductivity
• High density of
• free nerve endings
• arterioles
• lymphatic vessels
• mast cells

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AP Point Locations

• Points where neurovascular bundles where nerves
  penetrate the body fascia
• Points where nerves bifurcate

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AP Points- -Bladder Meridian

• Inner and Outer Bladder Meridian Points

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Acupuncture points 4 types

• Type I motor point 67 of all the points
• maximal contraction with minimal intensity of
  stimulation
• the nerve enters the muscle
• LI-4 ( He-gu)
• Type II dorsal ventral midline
• superficial nerves in the sagittal plane
• 68 (Bai-hui)

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Acupuncture points 4 types

• Type III superficial nerves / nerve plexuses
• GB-34 common peroneal nerve (deep superficial
  branches)
• PC-6 over the median nerve
• Type IV Muscle tendon junctions
• Golgi tendon organ
• BL-57 gastrocnemius

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HemoAcupuncture Points

• Most AP points are associated with vascular
  elements (veins)
• Blood vessel walls (veins) appear to have AP
  points directly on or in them

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Anatomical Considerations

• Acupuncture point
• Meridians
• Reflex Connections
• Central Connections

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Meridians Myth or Reality?

• Close correlation between
• AP Meridian
• Peripheral Nerve Pathways
• Meridians appear to possess bioelectric function
  similar to PN
• Meridians follow PN
• Lung (LU) Musculocutaneous N
• Pericardium (PC) Median N

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Meridian Research

• Stimulation of AP points on meridian lower
  resistance at other meridian points
• Injection of radio-isotopes into one point
  gradually accumulates at other points

• Radio signals places over one AP point can be
  picked up at other AP points along the meridian

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14 Major Meridians

• Lung Meridian LU
• Heart Meridian HT
• Pericardium M. PC
• Spleen Meridian SP
• Liver Meridian LIV
• Kidney Meridian KID
• Conception Vessels CV

• Large Intestines M. LI
• Small Intestines M. SI
• Triple Heater M. TH
• Stomach Meridian ST
• Gallbladder M. GB
• Bladder Meridian BL
• Governing Vessels M. GV

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Meridians

• Energy flow system
• Chi (Qi) energy flow
• AP points on 14 major meridians
• Normal Energy flow all the time on all the
  meridians from one acupuncture point to another

LU-gtLI-gtST-gtSP-gtHT-gtSI-gtBL-gtKID-gtPC-gtTB-gtGB-gtLIV
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Meridians

• Where there is no free flow, there is pain.

Pathogenic factors
Meridian
No free flow
Pain
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Meridians

• Where there is free flow, there is no pain.

Pain
No free flow
Pathogenic factors
Meridian
Acupuncture Stimulation
Eliminating
Meridian
Normal
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Anatomical Considerations

• Acupuncture point
• Meridians
• Reflex Connections
• Central Connections

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AP Effects

• Needle insertion stimulates afferent A-delta
  nociceptive fibers which leads to
• Local Effects
• Spinal Cord Effects
• Brainstem Effects

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Acupuncture Pathway

• AP Stimulus is carried by afferent peripheral
  nerve
• Can be blocked by Procaine
• No AP analgesia on paralyzed limbs (somatosensory
  paralysis)
• Most profound AP analgesia is from points
  overlying major peripheral nerves

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Acupuncture Pathway

• Stimulus enters the spinal cord
• Integrated information ascends the spinal cord to
  the brainstem, thalamus and cerebral cortex

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Gate Theory of Pain
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Acupuncture Pain

• Responses to
• heat
• electricity
• pinprick
• pinch

AP
Naloxone
? PT
Analgesia
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EA Effect of Increasing Frequency
200 Hz
4 Hz
0.2 Hz
Electrical Acupuncture
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EA Low Frequency Naloxone
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EA High Frequency Naloxone
Electro-acupuncture
200 Hz saline
200 Hz naloxone
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Mediators of AP Analgesia

• Enkephalins Dynorphins ? Spinal Cord
  (Substantia Gelatinosa)
• Endorphins ? Brainstem (Periaqueductal Gray
  Matter)
• 5HT ? Brainstem (Raphe Nuclei)

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AP Analgesia

• Varies among patients (species specific)
• Varies from location of AP point
• Varies with proximity to AP point