Acupuncture Part 2 Physiologic Mechanisms 1 Physiologic Mechanism

Acupuncture Part 2 Physiologic Mechanisms 1

Physiologic Mechanism b Local inflammation and muscular effects b Neural (non-opioid ) segmental gate theory b Neural (opioid ) humeral theory b Somatovisceral (autonomic) effects b Bioelectrical theory 2

Local Effects: De Qi Sensation b Caused by sequential activation of • A-delta * • C-fiber * • Group II fiber * b Blocked by local anesthesia b Requires intact nervous system b Not seen at non-AP points 3

Local Effects: De Qi b PRABM response in horses (pilomotor reaction along bladder meridian) 4

Local Effects b Muscle Reaction • contraction around the needle • ipsilateral flexion • contralateral extension b Leads to tissue relaxation and relief of muscle spasm b Principle of trigger point therapy 5

Local Effects b Anatomically, AP points are sensitive to microtrauma • Releases Hageman’s Factor XII – activates clotting cascade, complement cascade, plasminogen and kinins • Produces local PGs • Mast Cell degranulation – histamine, heparin and kinin protease • Releases Bradykinin 6

Local Effects: Event Sequence b Vasoconstriction b Quasi-control b Vasodilatation 15 -30 sec 10 sec-2 min-2 wk • local immune status • local BF • local muscle and tissue relaxation 7

Physiologic Mechanism b Local inflammation and muscular effects b Neural (non-opioid ) segmental gate theory b Neural (opioid ) humeral theory b Somatovisceral (autonomic) effects b Bioelectrical theory 8

Segmental Analgesia b Evoked by high frequency, low intensity stimulation of AP point b Rapid onset b Diminishes after cessation b Not reversed by naloxone 9

Gate Theory of Melzack & Wall b A-delta fibers conduct information to spinal cord before slow conducting C fiber information arrives b These fibers lead to inhibition (presynaptic) of information carried by the C fibers (pain) 10

Gate Theory of Melzack b & Wall Fast transmitting fibers lead to presynaptic inhibition 11

Physiologic Mechanism b Local inflammation and muscular effects b Neural (non-opioid ) segmental gate theory b Neural (opioid ) humeral theory b Somatovisceral (autonomic) effects b Bioelectrical theory 12

Humeral Mechanisms b Interaction of AP point with • • • b Spinal Cord Brainstem Higher Centers Mediated through neurochemical interactions 13

Opioid Humeral Mechanisms b Take 30 -40 minutes b Persists for hours b Generalized effect which is reversed by naloxone b Transferable from one patient to another b Tolerance to and cross tolerance with morphine develops 14

Opioid Humeral Mechanisms b Dexamethasone ß-endorphin levels and AP analgesia b Adrenalectomy AP analgesia ß- endorphins and b Hypophysectomy analgesia eliminates AP 15

5 HT Humeral Mechanisms b [5 HT] in systemic circulation by 30 -40% following AP b CNS maintains balance between 5 HT and ß-endorphins • endorphins alter 5 HT release (regulating pain threshold in spinal cord) • 5 HT blocks effects of naloxone 16

Other Humeral Mechanisms b Potentiators AP effects • • • substance P histamine c. GMP of b Antagonists AP effects • • of GABA c. AMP 17

Humeral Mechanisms: Systemic Endocrine Effects b Improves BF to pituitary axis and capillary wall [enzyme] b Releases somatotropin in chronic pain patients b Induces LH release b Stimulates prolactin and oxytocin release b Modulates thyroid function 18

Physiologic Mechanism b Local inflammation and muscular effects b Neural (non-opioid ) segmental gate theory b Neural (opioid ) humeral theory b Somatovisceral (autonomic) effects b Bioelectrical theory 19

Somatovisceral Reflex: Autonomic Effects b b b AP stimulation converges with visceral efferent resulting in reflexive interactions with internal organs (along internal connecting meridians) Regionally located Referred pain regions 20

Autonomic Effects b Indication of certain AP points correlate with symptoms for viscera at the same spinal segment b Bring descending influence only to the level of stimulation, ipsilaterally b Specificity of AP points related to somatotropic location 21

Autonomic Effects b Referred pain b Convergence of Somatic and Visceral inputs in CNS • dorsolateral funiculus • spinothalamic tracts b Visceral A-delta fibers reflexively affect muscles • inflammation and cramping 22

Autonomic Effects b AP of somatic structures can treat internal organs (through meridian connections) b AP modulates both arms of ANS b Segmental sympathetic vasodialation b Highly specific • Stimulate a specific AP point, get a specific physiologic change 23

Autonomic Effects b AP stimulation of GV 26 altered BP, HR and RR in dogs undergoing induced shock • Mortality in controls = 100% • Mortality in AP-treated = 25% 24

Autonomic Effects b Stimulation of PC 6 • lipid peroxidation of the heart • coronary blood flow • improved cardiac rhythm 25

Autonomic Effects b Potentiators AP effects • • of ß-adrenergic * eserine b Antagonists AP effects of • -adrenergic * • atropine 26

Physiologic Mechanism b Local inflammation and muscular effects b Neural (non-opioid ) segmental gate theory b Neural (opioid ) humeral theory b Somatovisceral (autonomic) effects b Bioelectrical theory 27

Bioelectric Theory b DC energy channels correspond to AP meridians b Points of low electrical resistance on the skin correspond to AP points Acupuncture Bioelectric • AP point • Amplifier • Meridian • Conductor • Qi • Bioelectricity 28

Other AP Effects b b b Anti-fever GI regulation Anti-inflammation effect Blood pressure regulation Stress relief b b Aging prevention Performance enhancement Improving microcirculation Face lift 29

Transcutaneous Nerve Stimulation (TENS units) b b b Well accepted method to produce analgesia Electrodes hard to apply to haired animals May just be acupuncture without needles 30

Conclusions b AP represents part of an ancient system of comprehensive health care b As scientific knowledge expands, modern correlations are being developed which help translate this ancient wisdom into today's terms b May the Qi be with you!!! 31