Introducing Acupuncture

1. Introducing Acupuncture By--Dr. Raman Kapur Senior Consultant Department of Acupuncture Sir Ganga Ram Hospital Awarded “Padmashri” by President of India

2. Today’s Agenda • Belief system • What is Acupuncture • Where is it most effective • Theory of Acupuncture • Technique of Acupuncture • Types of Acupuncture • Experience based results • Limitations of Acupuncture • Typical treatment plan – overview • FAQs

3. Belief System

4. FIVE ELEMENT IN NATURE & HUMAN BODY

5. The Concept of Qi • Qi is ‘energy’ • Qi is the movement factor in life • It is activating, enlivening, and animating • It comes from three sources: • Prenatal Qi • Food Qi • Air Qi

6. The Energy Channels Qi flows along the energy channels like blood, producing warmth and supplying energy which keeps human beings alive.

7. The Biological Clock

8. Qi or energy flows and circulates through the body in a network of meridians

9. What is Acupuncture ?

10. “ACUPUNCTURE”, a traditional oriental art of healing, is not an enigma, but an art and a science all by itself. The action of acupuncture is no more shrouded in myths and misconceptions, but is based on actual experimental and scientific research studies as in any other branch of medicine.

11. Acupuncture=‘acus’ + ‘puncture’ Where,acus=‘needle’, and puncture=‘to penetrate’ Nearly 800 points and 12 primary channels identified

12. Acupuncture Points Different points on the human body have similar healing effects. Over a period of time it was discovered that there existed many points located near the nerve endings, which when stimulated, has therapeutic effects.

13. Where is it most effective?(According to W.H.O.) a. Respiratory System • Common Cold • Acute sinusitis, rhinitis, tonsillitis • Acute bronchitis • Bronchial asthma (most effective in children and in uncomplicated cases). b. Disorders of Eye • Acute conjunctivitis • Central retinitis • Myopia (in children) c. Disorders of Mouth& throat • Toothache, post-extraction pain • Gingivitis • Acute and chronic pharyngitis

14. d. Gastro-intestinal Disorders • Reflux oesophagitis • Hiccups • Acute and chronic gastritis • Chronic duodenal ulcer (pain relief) • Acute duodenal ulcer (without complications) • Acute and chronic colitis • Constipation • Diarrhea • Paralytic ileus

15. e. Neurological and Musculo-skeletal Disorders • Headache and migraine • Trigeminal neuralgia • Facial palsy (early stage, i.e., within three to six months) • Paresis following stroke • Peripheral neuropathies • Sequelae of poliomyelitis (early stage, i.e., within six months) • Meniere's disease • Neurogenic bladder dysfunction • Nocturnal enuresis • Intercostal neuralgia • Cervicobrachial syndrome • "Frozen shoulder," "tennis elbow“ • Sciatica • Low back pain • Osteoarthritis

16. f. GYNAE and OBS diseases • Amenorrhoea • Oligomenorrhoea • Dysmenorrhoea • Irregular menstruation • Malposition of foetus • Painless delivery • Infertility g. Skin diseases • Psoriasis • Eczema • Urticaria

17. Since  Acupuncture can be used in large number of diseases, it has a wide scope amongst doctors of different specialities.They can use it in their practice for different conditions :-

18. A. Cardiologists can use it for • Angina Pectoris • Hypertension • Hypotension • Palpitations • B. Paediatrician can use it for • Infantile Paralysis • Autism • ADHD • Behaviour disorder in children • Bed wetting in children • Childhood asthma • To increase concentration • C. Cosmetologist can use it for • Wrinkles • Face lift • Cosmetic use of lasers • Dark circles under the eye • Breast augmentation for underdeveloped breast • D. Ear specialist can use it for • Tinnitus • Deafness, nerve • Meniere’s syndrome • Mastoiditis • Vertigo • Earache

19. E. Eye specialist can use it for • Blepharo spasm • Retinopathy • Twitching of eyelids • Glaucoma, open angle • Optic nerve atrophy • Ptosis • Retinitis pigmentosa • Conjunctivitis • Excessive lacrimation • F. Urologist can use it for • Retention of Urine • Prostate enlargement • Cystitis • Enuresis • Prostatitis • Stress Incontinence • Neurogenic bladder • Dysphagia • Diarrhoea, chronic • Irritable bowel syndrome • Indigestion • Chronic pancreatitis • Ulcerative colitis • H. Physician can use it for • Loss of appetite ( Anorexia) • Addiction- Alcohol, Betel leaves, Drugs, Nicotine, Food • Allergies • Diabetes (Non-insulin dependent ) • Poor Immune System • Chronic fatigue syndrome • High cholesterol • Hypothyroidism • To increase height • Hormonal Imbalance • Increasing vitality • Jet lag & travel sickness • Stress, Nervousness & emotional instability • G.Gastroentrologist can use • it for • Gastritis • Abdominal Pain • Abdominal distension • Acid Regurgitation • Constipation

21. M. Chest specialists can use it for • Asthma • Bronchitis • Hiccups • N. Sexologists can use it for • Impotence • Oligospermia • Premature ejaculation • Poor sexual desire • Seminal emission • K. ENT specialists can use it for • Allergic rhinitis • Anosmia • Common cold • Hay fever • Hoarse voice • Laryngitis • Sinusitis • Sore throat • Tonsilitis • Vocal cord nodule • L. Psychiatrists can use it for • Anxiety • Depression • Nervousness • Panic attacks • O. Dermatologist can use it for • Acne • Alopecia • Contact dermatitis • Eczema • Excess sweating • Herpes • Pruritus • Premature greying of hair • Urticaria • Vitililgo

22. Q. Vascular Surgeon can use it for • Buerger’s disease • Leg ulcers, non healing • Diabetic ulcers, non healing • Peripheral vascular disorders • Raynand disease • Thrombophlebitis • Varicose veins • P.Gyanecologist can use it for • Infertility • From conception to birth • Dysmenorrhoea • Amenorrhoea • Premenstrual syndrome • Lactation deficiency • Dysfunctional uterine bleeding • Irregular menses • Leucorrhoea • Menopausal syndrome • Polycystic ovarian disease • Morning sickness

23. Acupuncture – A stand alone therapy • Lumbago , Sciatica • Cervical spondylosis • Mild to moderate Arthritis of all joints • Bell’s Palsy • Sports injuries • Post –Herpetic Neuralgia • Headache • Insomnia • Allergies • Vocal cord nodule • Addictions ( Food, Cigarette, Alcohol, Drugs) • Optic Nerve Atrophy • Chronic fatigue syndrome • Diabetic Neuropathy • Dysmenorrhoea

24. Theory of Acupuncture

25. Discovery of Endorphins & Serotinins • According to Chinese medicine, health is the result of balance between yin and yang systems of the body. • Confirmed by: • the balance between serotinin and norepinephrine in pain control, and • balance between endorphins ( opioid peptides) and cholecystokinin ( anti-opioid peptides) in the CNS.

26. Discovery of Endorphins & Serotinins • Functional balance between opioid and anti-opioid peptides determine the efficacy of acupuncture analgesia in different individuals. • Opioid peptides are released during acupuncture which are responsible for its analgesic effect. • This hypothesis is strengthened by the fact that opioid antagonists such as naloxone reverses the analgesic effects of acupuncture.

27. Electrical Stimulation of Acupuncture Points induce Chemical Mediators • Frequency-dependent release of neuropeptides in CNS. • Signals induced by low-frequency and high frequency peripheral stimulation are transmitted along different neural pathways.

28. MRI connects Acupoints with Brain Cortex • Needling specific Acupoints in foot and lower leg (specially used for eye disorders) increased blood flow to visual cortex as recorded by f-MRI. • Needling non-acu points or different points does not lead to any visual cortex activity. • Needling specific acupoints in foot (specially used for hearing problems) increased the f MRI documented activity in the auditory lobes of the brain.

29. Effect of Acupuncture on Different Areas of the Brain • Real Acupuncture had an impact on limbic areas of brain which are associated with pain perception. • It activates hypothalamus & nucleus accumbens and deactivates rostral part of the anterior cingulated cortex, amygdale formation and hippocampus complex. • Control acupuncture on non- acu points or superficial needling on acu points did not result in such activation + deactivation.

30. Technique of Acupuncture

31. Analgesia & Anaesthesia Immune Enhancing Effect Effects of Acupuncture Psychological Effects Motor Recovery Homoeostasis

32. Effects of needling Subjective Effects Objective Effects

33. Subjective Effects These are felt by the patient Numbness Soreness Heaviness Distension Some other sensations are also experienced by the patient at the site of needling.  In Chinese Deqi(Which means-arrival of qi.)

34. Objective effects Analgesic effects increases pain threshold Sedative effects decreases Delta & Theta wave Immune –enhancing Increases IgG Antibody titre Psychological Calming & Tranquilizing Motor recovery Antidrome reflex

35. Mechanism of action Neurological theory Hormonal theory Psychological theory

36. Neurological theory Gate control theory Descending system of pain suppression Visero Somatic reflex Antidrome reflex Analgesic effects Motor recovery

37. Neuromodulation of Pain Peripheral level Spinal segmental level Supraspinal level Cortical level

38. Peripheral level Reduction of chemicals responsible for action potential Application of heat SW, Hot pack Other modality is U. sound Acupuncture

39. Spinal segmental level Physiological blocking effects Segmental inhibition/ Gate control theory

40. Supraspinal level Placebo effect Counter irritation

41. Cortical level Behavior modification Psychological

42. Mechanism of neuro-modulation relevant to Acupuncture Physiological blocking effects Electro acupuncture Using High Frequency current reduces conduction velocity Spinal segmental level Gate control theory

43. Segmental inhibition/ Gate control theory Central control GATE CONTROL SYSTEM L Action system + - S.G. T INPUT - - S

44. Descending system of pain suppression • The periaqueductal grey matter an area rich in opioid receptors. • 2) Rostral ventral medulla , nucleus raphe magnus & adjacent reticular nuclei • 3) Spinal dorsal horn

45. Antidrome reflex

46. Hormonal Theory (Neuro Humoral Mechanism) Endorphins Substance P 5 Hydroxytryptamine ( 5 HT) Acetylcholine Dopamine Noradrenalin in cerebrum

47. Types of Acupuncture

48. Acupuncture with needles

49. Ear Acupuncture Ear points are also used for diagnosis and treatment

50. Scalp Acupuncture • Scalp Acupuncture consists of needling areas rather than points on the skull according to the brain’s neuroanatomy and neurophysiology. • These areas correspond to the cortical areas of the cerebrum and cerebellum responsible for central nervous system functions such as motor activity, sensory input, vision, speech, hearing, and balance.