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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

Modernization of Ancient Wisdom


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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


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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


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Moxabustion

  • Applied either moxa or heated element (1500° F) to arthritic joints

    • Moxa burned in room

  • Moxa was better & longer lasting



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What Scientific Evidence Exists?

  • Total Medline Cites for Acupuncture to Date Represents 7107 Publications

  • 62 Double-Blind Studies


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Animal Acupuncture Studies

  • Represent 1/10th of all Cites

  • Parallel Human Acupuncture Studies in Frequency

  • No Double-Blind Studies


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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.


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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


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NIH ‘97 Consensus on AP

  • Effective for Immunomodulation

    • reduces inflammation, elevates WBC,  interleukin-2 production

  • Effective for Reproductive Disorders

    •  uterine bleeding, ovulation


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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


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AP Events

  • Simple in concept, complex in action

  • Starts from Local Effects

  • Expands to involve the entire Neural Axis


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AP Events

  • Local effects

  • Segmental effects

    • Pain control

    • Organ effects

  • Central effects

  • All take place at once


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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


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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


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Effects of Acupuncture

  • Activation of cortex is site specific

  • Leads initially to specific effects

GB34

ST36


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Effects of Acupuncture

  • Activation has temporal effects

  • Longer stimulation activates more cortical structures

  • Leads to broader effects

5 minutes

20 minutes


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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


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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.



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Anatomical Considerations

  • Acupuncture point

  • Meridians

  • Reflex Connections

  • Central Connections


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Shu Xue (communication outlet)

  •  Electrical resistance

  •  Electrical conductivity

  • High density of

    • free nerve endings

    • arterioles

    • lymphatic vessels

    • mast cells


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AP Point Locations

  • Points where neurovascular bundles where nerves penetrate the body fascia

  • Points where nerves bifurcate


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AP Points- -Bladder Meridian

  • Inner and Outer Bladder Meridian Points


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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)


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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


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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


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Anatomical Considerations

  • Acupuncture point

  • Meridians

  • Reflex Connections

  • Central Connections


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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


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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


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Lung Meridian: LU other meridian points

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


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Meridians other meridian points

  • 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


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Meridians other meridian points

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

Pathogenic factors

Meridian

No free flow

Pain


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Meridians other meridian points

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

Pain

No free flow

Pathogenic factors

Meridian

Acupuncture Stimulation

Eliminating

Meridian

Normal


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Anatomical Considerations other meridian points

  • Acupuncture point

  • Meridians

  • Reflex Connections

  • Central Connections


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AP Effects other meridian points

  • Needle insertion stimulates afferent A-delta nociceptive fibers which leads to

    • Local Effects

    • Spinal Cord Effects

    • Brainstem Effects


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Acupuncture Pathway other meridian points

  • 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


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Acupuncture Pathway other meridian points

  • Stimulus enters the spinal cord

  • Integrated information ascends the spinal cord to the brainstem, thalamus and cerebral cortex


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Gate Theory of Pain other meridian points


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Acupuncture & Pain other meridian points

  • Responses to

    • heat

    • electricity

    • pinprick

    • pinch

AP

Naloxone

 PT

Analgesia


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EA: other meridian pointsEffect of Increasing Frequency

200 Hz

4 Hz

0.2 Hz

Electrical Acupuncture


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Electro-acupuncture other meridian points

4 Hz + saline

4 Hz + Naloxone

EA: Low Frequency ± Naloxone


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EA: other meridian points High Frequency ± Naloxone

Electro-acupuncture

200 Hz + saline

200 Hz + naloxone


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Mediators of AP Analgesia other meridian points

  • Enkephalins & Dynorphins  Spinal Cord (Substantia Gelatinosa)

  • Endorphins  Brainstem (Periaqueductal Gray Matter)

  • 5HT  Brainstem (Raphe Nuclei)


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AP Analgesia other meridian points

  • Varies among patients (species specific)

  • Varies from location of AP point

  • Varies with proximity to AP point


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