Acupuncture Mechanisms East Meets West

1. Acupuncture MechanismsEast Meets West Thomas Archie, MD, DABFM, DABMA St. Luke’s Wood River Medical Center Integrative Therapies Service

2. Objectives • Discuss proposed mechanisms of action of acupuncture from two points of view: • Western medicine • Chinese medicine • Applications • Complications

3. Acupuncture: China to Europe • Huang Di Nei Jing • “Yellow Emporer’s Inner Classic” • Earliest existing major text on AP • 3rd-1st Century BCE • Europe • 1500-1600s Jesuit missionaries gave earliest reports of Chinese Medicine • 1683 William Tin Rhijne • Dissertation on Arthritis • 1671-1686: Three translations of Chinese medical texts • Detailed AP names, moxibustion, needle manipulation

4. Acupuncture Pre-Research • Soulie de Mourant • Early to mid 1900s • Taught French physicians • Published 3 volumes of L’Acuponcture Chinoise in 1939-1955

5. Early Acupuncture Research • France • Mechanism studies beginning in 1940s • China • Acupuncture pain relief studies started 1965

6. Early Electrical Studies • 1940-50s Niboyet (France) • AP points – decreased electrical resistance relative to surrounding skin • Most points w/ decreased electrical resistance corresponded with Chinese AP charts • AP pts on classically paired meridians have decreased Elect resistance compared with points on unpaired meridians

7. Early Chinese Acupuncture Meridian Chart

8. Neurotransmitters • Endorphin release by acupuncture • Pomeranz 1976 - endorphins (some analgesic effects blocked by Narcan) • Clinical effect lasts much longer than blood levels of endorphins • Seen in low frequency electroacupuncture

9. 1979 – LeBarDiffuse Noxious Inhibitory Control • Inhibit pain by counter-irritation stimulation • Serotonin and Endorphins mediate the response • Pain inhibition is directly related to intensity of stimulus • Distance between conditioned site and site of stimulation is not important • Detailed loop involving spinal tracts, brainstem, and thalamus

10. Neurotransmitters • Known increase in release during AP treatment • Serotonin, NE, Substance P, GABA, dopamine, ACTH • Opioid • B-endorphins, enkephalin, dynorphin

11. fMRI Study • Needle placed in foot Acupuncture point associated with stimulation of brain’s visual cortex

12. fMRI Study • Auditory Complex stimulated by needle placed in AP point on the leg associated with hearing

13. 91% of Acupuncture Points share this Histology

14. Trigger Points • 1977 • 71% correlation between Trigger Points and Acupuncture points

15. Meridians • Meridians have decreased electrical resistance relative to surrounding skin • Qi measured as microelectrical current • Flows in a circuit • Toes to fingers to head to toes • Up on anterior surface of the body • Down on posterior surface of the body

16. Meridians

17. Future Research • Central Nervous System (CNS) as a classic example of a nonlinear system • Billions of neurons and astrocytes • Response to environment is orderly but tends to change with time • Functional MRI - change of CNS with time - important for future research of mechanism • Future research to look at CNS function as a whole, rather than function of its individual components

18. Future Research • Outcomes research using • Existing research models (“sham” AP vs. “usual care”) • Patient-centered, market-based models • Interactive modalities (acupuncture, homeopathy, massage, reiki, healing touch) potentially better analyzed by a yet-undeveloped model • Problems inherent in applying double-blind, placebo-controlled model

19. Dualism vs. Monism • Descartes/Newton designed a Dualist model • Body and Mind are separate • Mind is a product of the Body (esp. Brain) • Study components and understand the whole (ex: block breakdown of serotonin and thus increase longevity of serotonin to produce clinical improvement of depressed patient)

20. Dualism vs. Monism • Dualism: parts make up the whole (body vs. mind/soul) • Allopathic Medicine – Descartes, Newton • Study components and understand the whole • Example: Serotonin enhanced via depression drugs • Monism: body, mind, consciousness, universe are continuous and interactive • Traditional Chinese Medicine, Ayruveda • Example: Weather-related Wind invasion in person with Liver Qi stagnation with Yin or Yang Deficiency as risk factor • Cold/Flu vs. Vertigo vs. Autoimmune Disease • The individual is reflective of the universal, and vice-versa

21. Eastern Mechanisms Vapor Qi Rice

22. Eastern Mechanisms • Qi (Character with vapor rising above cooking rice) • Early 1900s - Soulie de Mourant- Qi = “energy” and Jing = “meridian” • Simplified translation of complicated terms • “Life Force” made up of air and food transformed by body into blood and body fluids • Nei Jing written during 3rd – 1st Century BCE • Chinese physicians & cadaveric dissections • Using needles of glass, metal and bone to influence neurovascular system

23. Meridians • Acupuncture points linked together in lines called “meridians” • Meridians named for associated Organ • Kidney, Heart, Small Intestine, Bladder • Liver, Pericardium, Triple Energizer, Gallbladder • Spleen, Lung, Large Intestine, Stomach

24. Meridians

25. Different Acupuncture Models • Traditional Chinese Medicine (“TCM”) • Eight Principles (Yin/Yang, Damp/Dry, Cold/Heat, Interior/Exterior) • Zhang-Fu organ pairings blends Yin-Yang and 5 Element • Five Element (Korean) • Wood, Fire, Earth, Metal and Water • Meridian-based: Japanese, Vietnamese, French • Different schools of thought regarding etiology of disease (Kidney versus Spleen/Stomach) • Neuroanatomical - CraigPENS, osteopuncture

26. Meridian-Based Acupuncture • Blockage in meridian flow produces disease • Therapeutic action of “unblocking” meridian flow (Relieving Stagnation) • Pain • Asthma • Heavy, Painful, or Irregular Menstrual Periods

27. TCM Qi Physiology • Stomach separates pure from impure Qi of food • Pure Qi to Spleen • Impure to Small Intestine (process repeats again) • Spleen sends Food Qi to Lung • Lung combines it with pure Qi extracted from air • Food/Air Qi “heated” by Yuan Qi (ancestral pilot light) provided by Kidney to make “Nutritive Qi” • In Heart to make Blood • In Meridians

28. Fire Five Elements System of Correspondences Earth Wood Water Metal

29. Five Element Acupuncture • Imbalance between Elements causes Disease • Example • Chronic overwork/abuse/disease leads to deficiency of Water (fatigue, chronic UTI/stones/incontinence, joint pains, low back pain, fear, low self-esteem) • Water controls Fire (Water Def – Fire Excess) • Excess Fire symptoms result (anxiety, hot flashes, palpitations, insomnia, inflammation)

30. Five Element Acupuncture • Patient Evaluation • Pattern Recognition • Treatment • Reassessment for clinical effect

31. Patient Evaluation • Evaluate history of medical/surgical diagnoses • Patterns • Sleep, pain, digestion, emotional responses to stressors, self-organization, flavor and color affinities, menstrual patterns, timing of symptoms (24hr, monthly, seasonal variations)

32. Pattern Recognition • Five Elements • Interconnections between Patterns • TCM Eight Principles

33. Treatment • Treat by “Tonifying” deficiencies and “Dispersing” excesses • Release excess Fire • Tonify deficient Water • Use Acupuncture and Chinese Herbs in combination

34. Fire Five Elements System of Correspondences Earth Wood Water Metal

35. Five Element Correspondences • Wood (Liver, Gallbladder) • Driven, multiple projects, movement, anger/anxiety, tight traps/lateral neck/IT band, TMJ, migraines, caffeine sensitivity, fibromyalgia, blue/green, sour/citrus, Spring, expansion, insomnia (esp. sleep maintenance 11pm-3am), east • Augments Fire, controls Earth, augmented by Water and controlled by Metal • Coupled with Fire

36. Five Element Correspondences • Fire (Heart, Small Intestine, Pericardium, Triple Energizer) • Creative, CEO, joy, palpitations, insomnia (esp. sleep initiation), hot flashes, night sweats, cardiac disease, dysrhythmias, mania, red/orange, bitter/roasted, summer, south • Augments Earth, Controls Metal, Augmented by Wood, Controlled by Water • Coupled with Wood and Water

37. Five Element Correspondences • Earth (Spleen, Stomach) • Nurturing, worry/obsession, GI issues (loose stools, gastritis, bloating, abd pain), sinusitis, cysts, tumors, lumps, dampness, obesity, chronic fatigue(multifactorial), sweet, dampness (cysts, edema), yellow/brown, transitions of seasons, center of compass positions • Nurtures Metal, Controls Water, Controlled by Wood • Coupled with Metal

38. Five Element Correspondences • Metal (Lung, Large Intestine) • Respiratory, skin disorders (“3rd lung”), constipation, dryness, sense of duty, grief, loss, depression (multifactorial), flavorful/spicy, white/grey/colorless, autumn, west • Nurtures Water, Controls Wood, Controlled by Fire • Coupled with Earth

39. Five Element Correspondences • Water (Kidney, Bladder) • UTI, Kidney stones, incontinence, joint pain, low back pain, inner chill, abuse, philosopher, music, hearing problems, throat, winter, black, north, salty, motivation/willpower • Nurtures Wood, Controls Fire, Controlled by Earth • Coupled with Fire

40. Eastern Microsystems • Holographic/fractal representation of homunculus on skin surface • Tongue, Ear, hand, foot, scalp • Auricular medicine highly specialized by French • Ancient Egyptian paintings depict auricular cautery • Nogier (FR) 1950s investigated history of ear cautery for back pain

41. Homunculus

42. Chinese Diagnostics • Tongue • Color, size, wetness/“scalloping”, coating, cracks • Geographic representations of organs • Clinical changes occur slowly (weeks) • Pulses • Radial artery • Organ assessment at certain positions/depths • Clinical changes occur quickly (during treatment)

43. (KI) Yang deficiency Swollen, pale, scalloped, thin clear coat Kidney Yin Deficiency Excess Heat in Heart Invasion of Wind Long, thin, dry, red body with lateral deviation Dry yellow coat Heart Yin and Blood Deficiency Tongue body pale and tip red and pointed No coat Severe Yin Deficiency Long-standing heat or fire (LR or ST) Red tongue body with black, dry central coat

45. Acupuncture Microsystems • Auricular points (low electrical resistance) 90% accurate in recognizing past or present organ diseases (gastritis, asthma, past orthopedic surgeries) – Nogier (France) • Recent randomized, double blinded, placebo-controlled study on pediatric bed wetting using Korean Hand AP system

46. So What Is It Good For?

47. Applications • Studies of various standards • Value of RDBPCT design for interactive modalities dubious • Internal Medicine • Asthma, nausea, IBS, Crohn’s/UC, anxiety, depression, epilepsy, chronic UTI, eczema, sinusitis, allergies, headache, TMJ, Bell’s Palsy, neuropathy, stroke (scalp acupuncture) • Substance abuse - smoking, chewing, opiates, alcohol, craving

48. Applications • OB/GYN • Premenstrual syndrome, (peri)menopausal symptoms, dysmenorrhea, menorrhagia, oligomenorrhea, infertility, labor pain, breech presentation • Pain • Epicondylitis, plantar fasciitis, arthritis, low back pain, neck pain, pelvic pain, zoster

49. Applications • Essentially, any medical problem should be accessible with AP • Issues are practicality and density of disease • Acupuncturist training and experience • Role in Cancer • Helpful for decreasing side effects of chemo/radiation • Especially with herbal therapy • Facilitating spiritual transition to interaction with mortality

50. Veterinary Acupuncture