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Acupuncture Part 1 Modernization of Ancient Wisdom 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

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acupuncture part 1

Acupuncture Part 1

Modernization of Ancient Wisdom

comparison of east west
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
what is acupuncture
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
moxabustion
Moxabustion
  • Applied either moxa or heated element (1500° F) to arthritic joints
    • Moxa burned in room
  • Moxa was better & longer lasting
what scientific evidence exists
What Scientific Evidence Exists?
  • Total Medline Cites for Acupuncture to Date Represents 7107 Publications
  • 62 Double-Blind Studies
animal acupuncture studies
Animal Acupuncture Studies
  • Represent 1/10th of all Cites
  • Parallel Human Acupuncture Studies in Frequency
  • No Double-Blind Studies
placebo effect
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.
nih 97 consensus on ap
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
nih 97 consensus on ap10
NIH ‘97 Consensus on AP
  • Effective for Immunomodulation
    • reduces inflammation, elevates WBC,  interleukin-2 production
  • Effective for Reproductive Disorders
    •  uterine bleeding, ovulation
how does ap work
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
ap events
AP Events
  • Simple in concept, complex in action
  • Starts from Local Effects
  • Expands to involve the entire Neural Axis
ap events13
AP Events
  • Local effects
  • Segmental effects
    • Pain control
    • Organ effects
  • Central effects
  • All take place at once
basic tenets of ap
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
effects of acupuncture
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

effects of acupuncture16
Effects of Acupuncture
  • Activation of cortex is site specific
  • Leads initially to specific effects

GB34

ST36

effects of acupuncture17
Effects of Acupuncture
  • Activation has temporal effects
  • Longer stimulation activates more cortical structures
  • Leads to broader effects

5 minutes

20 minutes

effects of acupuncture18
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
method of stimulation
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.
anatomical considerations
Anatomical Considerations
  • Acupuncture point
  • Meridians
  • Reflex Connections
  • Central Connections
shu xue communication outlet
Shu Xue (communication outlet)
  •  Electrical resistance
  •  Electrical conductivity
  • High density of
    • free nerve endings
    • arterioles
    • lymphatic vessels
    • mast cells
ap point locations
AP Point Locations
  • Points where neurovascular bundles where nerves penetrate the body fascia
  • Points where nerves bifurcate
ap points bladder meridian
AP Points- -Bladder Meridian
  • Inner and Outer Bladder Meridian Points
acupuncture points 4 types
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)
acupuncture points 4 types26
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
hemoacupuncture points
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
anatomical considerations28
Anatomical Considerations
  • Acupuncture point
  • Meridians
  • Reflex Connections
  • Central Connections
meridians myth or reality
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
meridian research
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
14 major meridians
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
meridians
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

meridians33
Meridians
  • Where there is no free flow, there is pain.

Pathogenic factors

Meridian

No free flow

Pain

slide34

Meridians

  • Where there is free flow, there is no pain.

Pain

No free flow

Pathogenic factors

Meridian

Acupuncture Stimulation

Eliminating

Meridian

Normal

anatomical considerations35
Anatomical Considerations
  • Acupuncture point
  • Meridians
  • Reflex Connections
  • Central Connections
ap effects
AP Effects
  • Needle insertion stimulates afferent A-delta nociceptive fibers which leads to
    • Local Effects
    • Spinal Cord Effects
    • Brainstem Effects
acupuncture pathway
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
acupuncture pathway38
Acupuncture Pathway
  • Stimulus enters the spinal cord
  • Integrated information ascends the spinal cord to the brainstem, thalamus and cerebral cortex
slide40

Acupuncture & Pain

  • Responses to
    • heat
    • electricity
    • pinprick
    • pinch

AP

Naloxone

 PT

Analgesia

ea effect of increasing frequency
EA: Effect of Increasing Frequency

200 Hz

4 Hz

0.2 Hz

Electrical Acupuncture

slide43

EA: High Frequency ± Naloxone

Electro-acupuncture

200 Hz + saline

200 Hz + naloxone

mediators of ap analgesia
Mediators of AP Analgesia
  • Enkephalins & Dynorphins  Spinal Cord (Substantia Gelatinosa)
  • Endorphins  Brainstem (Periaqueductal Gray Matter)
  • 5HT  Brainstem (Raphe Nuclei)
ap analgesia
AP Analgesia
  • Varies among patients (species specific)
  • Varies from location of AP point
  • Varies with proximity to AP point
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