Acupuncture Part 1 Modernization of Ancient Wisdom 1

Acupuncture Part 1 Modernization of Ancient Wisdom 1

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

What is Acupuncture? b b Acus meaning needle Pungare meaing to pierce Zhenjiu meaning needle (zhen) and moxabustion (jiu) Manipulating body balance through regulating flow of Qi 3

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

Scientific Evidence ? 5

What Scientific Evidence Exists? b b Total Medline Cites for Acupuncture to Date Represents 7107 Publications 62 Double-Blind Studies 6

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

Placebo Effect b b 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. 8

NIH ‘ 97 Consensus on AP b Effective for Osteoarthritis and Musculoskeletal Pain b Effective for many GI Problems • IBD, diarrhea, ulcerative colitis, peptic ulcers, dyspepsia, abdominal pain, nausea and vomiting b Effective for Pulmonary disease • asthma, colds 9

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

How Does AP Work? b 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 11

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

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

Basic Tenets of AP b b Based upon the AP point selected Based upon the method of stimulation • • Dry needles Electrical AP Aquapuncture Hemoacupuncture b b Based upon the length of stimulation Low-rate, twisting stimulation of GV 26 leads to endorphin response, while highfrequency needling of GV 26 leads to epinephrine response 14

Effects of Acupuncture b Using manganeseenhanced f. MRI (functional magnetic resonance imaging), visual effects can be seen in human and animal neural tissues Baseline Mn Infusion Mannitol EA GB 34 15

Effects of Acupuncture b b Activation of cortex is site specific GB 34 ST 36 Leads initially to specific effects 16

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

Effects of Acupuncture b In separate study, analgesic AP points were compared to nonanalgesic points • Analgesic AP altered brain regions involved in pain modulation – PAG, Mn. R , hypothalamus, thalamus • Non-Analgesic AP did not activate same areas 18

Method of Stimulation b b 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. 19

Medication Timing & TCM 24 -hour Clock 20

Anatomical Considerations b Acupuncture point b Meridians b Reflex Connections b Central Connections 21

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

AP Points b b Points where neurovascular bundles where nerves penetrate the body fascia Points where nerves bifurcate 23

AP Points b Inner and Outer Bladder Meridian Points 24

Acupuncture points: IV types b 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 ) b Type II: dorsal & ventral midline • superficial nerves in the sagittal plane • #68 (Bai-hui) 25

Acupuncture points: IV types b Type III: superficial nerves / nerve plexuses • GB-34: common peroneal nerve (deep & superficial branches) • PC-6: over the median nerve b Type IV: Muscle tendon junctions • Golgi tendon organ • BL-57: gastrocnemius 26

Hemo. Acupuncture Points b b Most AP points are associated with vascular elements (veins) Blood vessel walls (veins) appear to have AP points directly on or in them 27

Anatomical Considerations b Acupuncture point b Meridians b Reflex Connections b Central Connections 28

Meridians: Myth or Reality? b Close correlation between • AP Meridian • Peripheral Nerve Pathways b Meridians appear to possess bioelectric function similar to PN b Meridians follow PN • • Lung (LU) = Musculocutaneous N Pericardium (PC) = Median N 29

Meridian Research b b Stimulation of AP points on meridian lower resistance at other meridian points Injection of radioisotopes into one point gradually accumulates at other points b Radio signals places over one AP point can be picked up at other AP points along the meridian 30

14 Major Meridians b b b b Lung Meridian: LU b Heart Meridian: HT b Pericardium M. : PC b Spleen Meridian: SP b Liver Meridian: LIV b Kidney Meridian: KID b Conception Vessels: CV b 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 31

Meridians b Energy flow system b Chi (Qi): energy flow b AP points on 14 major meridians b 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 32

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

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

Anatomical Considerations b Acupuncture point b Meridians b Reflex Connections b Central Connections 35

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

Acupuncture Pathway b 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 37

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

Acupuncture & Pain b Responses • • to heat electricity pinprick pinch AP Naloxone PT Analgesia 39

EA: Effect of Increasing Frequency 200 Hz 4 Hz 0. 2 Hz Electrical Acupuncture 40

EA: Low Frequency ± Naloxone Electro-acupuncture 4 Hz + saline 4 Hz + Naloxone 41

EA: High Frequency ± Naloxone Electro-acupuncture 200 Hz + saline 200 Hz +naloxone 42

Acupuncture Analgesia b Enkephalins Cord (Substantia Gelatinosa ) b Endorphins Gray Matter) b 5 HT & Dynorphins Spinal Brainstem (Periaqueductal Brainstem (Raphe Nuclei) 43

AP Analgesia b b b Varies among patients (species specific) Varies from location of AP point Varies with proximity to AP point 44