1 Acupuncture Part 2 Physiologic Mechanisms. 2 Physiologic Mechanism b Local inflammation and...

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Acupuncture Acupuncture Part 2Part 2

Physiologic MechanismsPhysiologic Mechanisms

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Physiologic MechanismPhysiologic Mechanism

Local inflammation and Local inflammation and muscular effectsmuscular effects

Neural (non-opioid) segmental Neural (non-opioid) segmental gate theorygate theory

Neural (opioid) humeral theoryNeural (opioid) humeral theory Somatovisceral (autonomic) Somatovisceral (autonomic)

effects effects Bioelectrical theoryBioelectrical theory

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Local Effects: Local Effects: De Qi De Qi SensationSensation

Caused by sequential activation Caused by sequential activation ofof• A-delta *A-delta *• C-fiber *C-fiber *• Group II fiber *Group II fiber *

Blocked by local anesthesiaBlocked by local anesthesia Requires intact nervous systemRequires intact nervous system Not seen at non-AP pointsNot seen at non-AP points

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Local Effects: Local Effects: De Qi De Qi SensationSensation

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Local Effects: Local Effects: De QiDe Qi

PRABM response in horses (pilomotor PRABM response in horses (pilomotor reaction along bladder meridian)reaction along bladder meridian)

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Local EffectsLocal Effects

Muscle ReactionMuscle Reaction• contraction around the needlecontraction around the needle• ipsilateral flexionipsilateral flexion• contralateral extensioncontralateral extension

Leads to tissue relaxation and Leads to tissue relaxation and relief of muscle spasmrelief of muscle spasm

Principle of trigger point Principle of trigger point therapytherapy

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Local EffectsLocal Effects

Anatomically, AP points are Anatomically, AP points are sensitive to microtraumasensitive to microtrauma• Releases Hageman’s Factor XIIReleases Hageman’s Factor XII

– activates clotting cascade, complement activates clotting cascade, complement cascade, plasminogen and kininscascade, plasminogen and kinins

• Produces local PGsProduces local PGs• Mast Cell degranulationMast Cell degranulation

– histamine, heparin and kinin proteasehistamine, heparin and kinin protease

• Releases BradykininReleases Bradykinin

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Local Effects: Local Effects: Event Event SequenceSequence

VasoconstrictionVasoconstriction 15-30 sec15-30 sec Quasi-controlQuasi-control 10 sec-2 min10 sec-2 min VasodilatationVasodilatation 2 min-2 wk2 min-2 wk

local immune statuslocal immune status local BFlocal BF local muscle and tissue relaxationlocal muscle and tissue relaxation

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Segmental AnalgesiaSegmental Analgesia

Evoked by high frequency, low Evoked by high frequency, low intensity stimulation of AP pointintensity stimulation of AP point

Rapid onsetRapid onset

Diminishes after cessationDiminishes after cessation

Not reversed by naloxoneNot reversed by naloxone

Types & Speed of Types & Speed of AxonsAxons

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Gate Theory Gate Theory of Melzack & of Melzack & WallWall

A-delta fibers conduct A-delta fibers conduct information to spinal cord information to spinal cord before slow conducting C fiber before slow conducting C fiber information arrivesinformation arrives

These fibers lead to inhibition These fibers lead to inhibition (pre-synaptic) of information (pre-synaptic) of information carried by the C fibers (pain)carried by the C fibers (pain)

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Gate Theory Gate Theory of Melzack & of Melzack & WallWall

Fast transmitting fibers lead to Fast transmitting fibers lead to pre-synaptic inhibitionpre-synaptic inhibition

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Humeral MechanismsHumeral Mechanisms

Interaction of AP Interaction of AP point withpoint with• Spinal CordSpinal Cord• BrainstemBrainstem• Higher CentersHigher Centers

Mediated Mediated through through neurochemical neurochemical interactionsinteractions

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Opioid Humeral Opioid Humeral MechanismsMechanisms

Take 30-40 minutesTake 30-40 minutes Persists for hoursPersists for hours Generalized effect which is Generalized effect which is

reversed by naloxonereversed by naloxone Transferable from one patient to Transferable from one patient to

anotheranother Tolerance to and cross tolerance Tolerance to and cross tolerance

with morphine developswith morphine develops

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Opioid Humeral Opioid Humeral MechanismsMechanisms

Dexamethasone Dexamethasone ß-endorphin ß-endorphin levels and levels and AP analgesia AP analgesia

Adrenalectomy Adrenalectomy ß- endorphins ß- endorphins and and AP analgesia AP analgesia

Hypophysectomy eliminates AP Hypophysectomy eliminates AP analgesiaanalgesia

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5HT Humeral 5HT Humeral MechanismsMechanisms

[5HT] [5HT] in systemic circulation in systemic circulation by 30-40% following APby 30-40% following AP

CNS maintains balance CNS maintains balance between 5HT and ß-endorphinsbetween 5HT and ß-endorphins• endorphins alter 5HT release endorphins alter 5HT release

(regulating pain threshold in (regulating pain threshold in spinal cord)spinal cord)

5HT blocks effects of naloxone5HT blocks effects of naloxone

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Other Humeral Other Humeral MechanismsMechanisms

Potentiators Potentiators of AP effectsof AP effects

• substance Psubstance P• histaminehistamine• cGMPcGMP

Antagonists Antagonists of AP effectsof AP effects

• GABAGABA• cAMPcAMP

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Humeral Mechanisms: Humeral Mechanisms: Systemic Endocrine EffectsSystemic Endocrine Effects

Improves BF to pituitary axis Improves BF to pituitary axis and and capillary wall [enzyme] capillary wall [enzyme]

Releases somatotropin in Releases somatotropin in chronic pain patientschronic pain patients

Induces LH releaseInduces LH release Stimulates prolactin and Stimulates prolactin and

oxytocin releaseoxytocin release Modulates thyroid functionModulates thyroid function

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effectseffects Bioelectrical theoryBioelectrical theory

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Somatovisceral Reflex: Somatovisceral Reflex: Autonomic EffectsAutonomic Effects

AP stimulation AP stimulation converges with converges with visceral efferent visceral efferent resulting in reflexive resulting in reflexive interactions with interactions with internal organs internal organs (along internal (along internal connecting connecting meridians) meridians)

Regionally locatedRegionally located

Referred pain regionsReferred pain regions

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Autonomic EffectsAutonomic Effects

Indication of certain AP points Indication of certain AP points correlate with symptoms for viscera correlate with symptoms for viscera at the same spinal segmentat the same spinal segment

Bring descending influence only to Bring descending influence only to the level of stimulation, ipsilaterallythe level of stimulation, ipsilaterally

Specificity of AP points related to Specificity of AP points related to somatotropic locationsomatotropic location

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Referred painReferred pain Convergence of Somatic and Convergence of Somatic and

Visceral inputs in CNSVisceral inputs in CNS• dorsolateral funiculusdorsolateral funiculus• spinothalamic tractsspinothalamic tracts

Visceral A-delta fibers Visceral A-delta fibers reflexively affect musclesreflexively affect muscles• inflammation and crampinginflammation and cramping

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AP of somatic structures can treat AP of somatic structures can treat internal organs (through meridian internal organs (through meridian connections)connections)

AP modulates both arms of ANSAP modulates both arms of ANS Segmental sympathetic Segmental sympathetic

vasodialationvasodialation Highly specificHighly specific

• Stimulate a specific AP point, get a Stimulate a specific AP point, get a specific physiologic changespecific physiologic change

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AP stimulation of GV26 altered AP stimulation of GV26 altered BP, HR and RR in dogs BP, HR and RR in dogs undergoing induced shockundergoing induced shock

• Mortality in controls = 100%Mortality in controls = 100%• Mortality in AP-treated = 25%Mortality in AP-treated = 25%

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Stimulation of PC6Stimulation of PC6

lipid peroxidation of the heartlipid peroxidation of the heart coronary blood flowcoronary blood flow• improved cardiac rhythmimproved cardiac rhythm

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Potentiators Potentiators of AP effectsof AP effects

• ß-adrenergic *ß-adrenergic *• eserineeserine

Antagonists Antagonists of AP effectsof AP effects

-adrenergic *-adrenergic *• atropineatropine

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Bioelectric TheoryBioelectric Theory

DC energy channels correspond to DC energy channels correspond to AP meridiansAP meridians

Points of low electrical resistance Points of low electrical resistance on the skin correspond to AP pointson the skin correspond to AP points

BioelectricBioelectric•AmplifierAmplifier

•ConductorConductor

•BioelectricitBioelectricityy

AcupuncturAcupuncturee

•AP pointAP point

•MeridianMeridian

•QiQi

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OtherOther AP EffectsAP Effects

Anti-feverAnti-fever GI regulationGI regulation Anti-Anti-

inflammation inflammation effecteffect

Blood pressure Blood pressure regulationregulation

Stress reliefStress relief

Aging Aging preventionprevention

Performance Performance enhancementenhancement

Improving Improving microcirculationmicrocirculation

Face liftFace lift

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Transcutaneous Nerve Transcutaneous Nerve Stimulation (TENS units)Stimulation (TENS units)

Well accepted method Well accepted method to produce analgesiato produce analgesia

Electrodes hard to Electrodes hard to apply to haired apply to haired animalsanimals

May just be May just be acupuncture without acupuncture without needlesneedles

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ConclusionsConclusions

AP represents part of an ancient AP represents part of an ancient system of comprehensive health system of comprehensive health carecare

As scientific knowledge expands, As scientific knowledge expands, modern correlations are being modern correlations are being developed which help translate developed which help translate this ancient wisdom into today's this ancient wisdom into today's termsterms

May the Qi be with you!!!May the Qi be with you!!!

1 Acupuncture Part 2 Physiologic Mechanisms. 2 Physiologic Mechanism b Local inflammation and...

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