Dermatomas en Acupuntura

Sánchez‐Araujo Max1,2, Luckert‐Barela Ana J21 Complementary Therapy Research Unit,

Francisco de Miranda University, Coro, Venezuela.2 Instituto de Investigación de Salud y Terapéutica.

Caracas, Venezuela.

On Dermatomes, Meridians & Points: A puncture for TCM

model?

Introduction

After TCMstatements, trunk’s ‘channels’ and acupoints run vertically along the body.

02/11/2009 2Acupuntura/Acupuncture Barcelona, 2009.

Introduction

• The Clinical mission of a given acupoint or meridian woulddepend specifically on the corresponding Zang‐Fu

• An eventual Meridian‐derived effect (MDE) of the puncture.

. 02/11/2009 3Acupuntura/Acupuncture Barcelona, 2009.

Introduction

• In contrast, the trunk’s anatomy instead shows an horizontal distribution of the somato‐visceral innervation.


02/11/2009 Acupuntura/Acupuncture Barcelona, 2009.

Introduction

That neurobiological body architecture would determines that structures innervated by the same spinal segment tend to behave as a whole.BOSSY J. et al. Neuro‐anatomie, Haug‐Verlag, Paris, 2001

Introduction

• Thus, acupoints pertaining to a given dermatome may have similar effects or indications, depending on their somatic‐visceral substrate.

• An eventual Neurobiology‐derived effect, (NBE) of any puncture.


Objective: Evaluating both visions through a cognitive strategy.

Objective: Evaluating both visions through a cognitive strategy.

To respond the question: "¿Would acupoint’s clinical effects depend, either on their meridian’s clinical vocation or on their viscero‐somatic substrate and innervations?”

Null hypothesis: “Acupoint’s clinical behaviour will depend on their effect on energy flow in agreement with TCM"


Material & methods:

A simple 'experiment' was performed:

• From information obtained through a search on emblematic Chinese texts we performed:– Assessment of clinical indications of acupointslocated on trunk’s dermatomes

– Assessment of the prevalence of local orsystemic effects for both acupoints and dermatomes


Chinese texts


Two prestigious atlas


Material & Methods

• All clinical indications or effects available for each point of the trunk were arbitrarilyseparated into two categories:

a. Systemic or extra‐segmental effects taken as Meridian‐derived effects (MDE).

b. Segmental or local indications considered as Neurobiology‐derived effects (NBE).


Spinal segment & Acupuncture


AssumptionsAssumptions

A. For a given point: 1. Predominance of MDE > NBE over

80%, as consistent with MTC statements; conversely,

2. Prevalence of NBE > MDE > 80%, as compatible with a neurobiology‐derived effect.


AssumptionsAssumptions

B. For a given dermatome: 1. Prevalence of MDE > NBE indications

over 80% of its points, would validate the TCM energy model; conversely,

2. Predominance of NBE > MDE > 80%, would support the neurobiological approach.


Procedures

1. We performed a comprehensive search of acupoints pertaining to the 22 trunk’s dermatomes.

2. After grouping them within 22 tables we carried out a comprehensive search of clinical indications or potential effects for each point.

3. Which were then, independently, classified as either Systemic (Meridian‐derived) effect or segmental (Neurobiology‐derived) effect.

02/11/2009 Acupuntura/Acupuncture Barcelona, 2009. 15

Procedure

• In order to make it easy and simple Systemic effects were shown in red bold letters.

Let’s see an example:


Acupoints indications on T2DERMATOME ACUPOINTS INDICATIONS MDE NBE

PU 1 Zhonfu Cough, asthma, Chest and shoulder pain, lung congestion

0 5

BP20 Zhourong Chest and hypochondria Congestion, cough.

0 3

ES15 Wuyi Cough, asthma, chest congestion and pain, mastitis

0 5

T2 RN25 Shencang Cough, asthma, chest pain, 0 3

VC19 Zigong of Chest Cough, asthma, chest pain. 0 3

VU12 FengmenCold flu*, cough, fever, headache*, cervical stifness, dorsalgia.

3 2

VU41 Fufen Neck, dorsal and shoulder rigidness. arm numbness

0 4

02/11/2009 Acupuntura/Acupuncture Barcelona, 2009.

*Red Letters indicate Meridian Derived Effect.

Acupoints indications on T2 (Cont)DERMATOME ACUPOINTS INDICATIONS MDE NBE

VU12 FengmenCold flu*, cough, fever*, headache*, cervical stifness, dorsalgia.

3 3

VU41 Fufen Neck, dorsal and shoulder stiffness, arm numbness.

0 4

T2 ID 9 Jianzhen Omalgia, pain and motor dysfunction of upper limb.

0 3

ID10 Naoshu Shoulder and upper arm pain. 0 2

ID12 Bingfeng

Escapulobrachial pain, parestesia and weakness of the arm, chest pain, cough and distension of hipocondria*.

1 5

ID 13 QuyuanWeakness and pruritus* of shoulder and arm.

Total:

1

8

2

39


*Meridian Derived Effect. Total: (47) 7% 83%

Results


Results:

On 22 dermatomes

• 148 points

• Total indications

N = 902


POINTS ON DERMATOMESDermatom

e N° Points % total NBET1 11 70,90T2 11 83,00T3 8 83,80T4 8 82,50T5 7 81,80T6 9 82,90T7 9 94,30T8 5 82,10T9 9 89,10

T10 10 90,90T11 12 92,20T12 13 100,00L1 9 93,10L2 3 78,60L3 9 86,80L4 3 100,00L5 2 95,00S1 3 96,70S2 2 95,80S3 2 86,20S5 3 96,40

TOTAL 148 89,64

Results:

• MDE criteria: +

n = 94 (10,4%)

• NBE criteria: +n = 808

(89.6%)

• P < 0.001


POINTS ON DERMATOMESDermatom

e N° Points % total NBET1 11 70,90T2 11 83,00T3 8 83,80T4 8 82,50T5 7 81,80T6 9 82,90T7 9 94,30T8 5 82,10T9 9 89,10

T10 10 90,90T11 12 92,20T12 13 100,00L1 9 93,10L2 3 78,60L3 9 86,80L4 3 100,00L5 2 95,00S1 3 96,70S2 2 95,80S3 2 86,20S5 3 96,40

TOTAL 148 89,64

That means that:


• Contrary to MTC postulates, acupoints effects for any dermatome are remarkably akin, regardless of their meridian mission.

That means that:

Therefore, acupoints effect derives from their underlying neural and somato‐visceral substratum.

Therefore, acupoints effect derives from their underlying neural and somato‐visceral substratum.


So, NB substrate emerges as determinant factor for acupuncture action mechanisms

Conclusions:

These findings:

1.May contribute to our understanding of acupuncture’s neurobiology

2. Could clarify some confusing results of acupuncture’s clinical trials

3.Excluding by the way sham‐acupuncture as suitable placebo for future studies.


Muchas gracias!Thanks, a lot!


Dermatomas en Acupuntura

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