Acupuncture Part 1

1. Acupuncture Part 1 Modernization of Ancient Wisdom

2. Empirical Observations over Thousands of Years Scientific Method & Case-Based Medicine Comparison of East & West East West • Technology of Medicine • Art of Medicine • Holistic View • Molecular and Organ View • Circular Logic • Energetic • Linear Logic • Mechanistic

3. 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

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

5. Scientific Evidence ?

6. What Scientific Evidence Exists? • Total Medline Cites for Acupuncture to Date Represents 16080 Publications • 2605 Scientific Studies

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

8. 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.

9. 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

10. NIH ‘97 Consensus on AP • Effective for Immunomodulation • reduces inflammation, elevates WBC,  interleukin-2 production • Effective for Reproductive Disorders •  uterine bleeding, ovulation

11. 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

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

13. AP Events • Local effects • Segmental effects • Pain control • Organ effects • Central effects • All take place at once

14. 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 Basic Tenets of AP

15. Effects of Acupuncture • Using manganese-enhanced fMRI (functional magnetic resonance imaging), visual effects can be seen in human and animal neural tissues Baseline Mannitol Mn Infusion EA GB34

16. Effects of Acupuncture • Activation of cortex is site specific • Leads initially to specific effects GB34 ST36

17. Effects of Acupuncture • Activation has temporal effects • Longer stimulation activates more cortical structures • Leads to broader effects 5 minutes 20 minutes

18. 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

19. 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.

20. Medication Timing & TCM 24-hour Clock

21. Anatomical Considerations • Acupuncture point • Meridians • Reflex Connections • Central Connections

22. Shu Xue (communication outlet) •  Electrical resistance •  Electrical conductivity • High density of • free nerve endings • arterioles • lymphatic vessels • mast cells

23. AP Point Locations • Points where neurovascular bundles where nerves penetrate the body fascia • Points where nerves bifurcate

24. AP Points- -Bladder Meridian • Inner and Outer Bladder Meridian Points

25. 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)

26. 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

27. 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

28. Anatomical Considerations • Acupuncture point • Meridians • Reflex Connections • Central Connections

29. 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

30. 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 Meridian Research

31. 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 14 Major Meridians

32. 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->LI->ST->SP->HT->SI->BL->KID->PC->TB->GB->LIV

33. Meridians • Where there is no free flow, there is pain. Pathogenic factors Meridian No free flow Pain

34. Meridians • Where there is free flow, there is no pain. Pain No free flow Pathogenic factors Meridian Acupuncture Stimulation Eliminating Meridian Normal

35. Anatomical Considerations • Acupuncture point • Meridians • Reflex Connections • Central Connections

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

37. 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

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

39. Gate Theory of Pain

40. Acupuncture & Pain • Responses to • heat • electricity • pinprick • pinch AP Naloxone  PT Analgesia

41. EA: Effect of Increasing Frequency 200 Hz 4 Hz 0.2 Hz Electrical Acupuncture

42. Electro-acupuncture 4 Hz + saline 4 Hz + Naloxone EA: Low Frequency ± Naloxone

43. EA: High Frequency ± Naloxone Electro-acupuncture 200 Hz + saline 200 Hz + naloxone

44. Mediators of AP Analgesia • Enkephalins & Dynorphins  Spinal Cord (Substantia Gelatinosa) • Endorphins  Brainstem (Periaqueductal Gray Matter) • 5HT  Brainstem (Raphe Nuclei)

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