Modernization of Ancient Wisdom: A Comparison of Acupuncture in East & West

1. Acupuncture Part 1 Modernization of Ancient Wisdom

2. Comparison of East & West East West • Scientific Method & Case-Based Medicine • Empirical Observations over Thousands • Art of Medicine • Technology of Medicine • Molecular and Organ View • Holistic View • Circular Logic • Linear Logic • Energetic • Mechanistic

3. What is Acupuncture? • Acus meaning needle • Pungaremeaing to pierce • Zhenjiu meaning needle (zhen) and moxabustion (jiu) • Manipulating body balance through regulating flow of Qi

4. Moxabustion • Applied either moxa or heated element (1500° F) to arthritic joints • Moxa burned in room • Moxa was better & longer lasting

5. Scientific Evidence ?

6. What Scientific Evidence Exists? • Total Medline Cites for Acupuncture to Date Represents 26950 Publications (7085 non-human) • 6430 Scientific Studies (376 non-human) 26,950 Total Sites About 1500/yr 25% Science About 300/yr 5% Science About 20/yr

7. 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.

8. 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

9. NIH ‘97 Consensus on AP • Effective for Immunomodulation • reduces inflammation, elevates WBC,  interleukin-2 production • Effective for Reproductive Disorders •  uterine bleeding, ovulation

10. 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

11. AP Events • Simple in concept, complex in action • Starts from Local Effects • Expands to involve the entire Neural Axis

12. AP Events • Local effects • Segmental effects • Pain control • Organ effects • Central effects • All take place at once

13. 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

14. Effects of Acupuncture Baseline Mannitol • Using manganese-enhanced fMRI (functional magnetic resonance imaging), visual effects can be seen in human and animal neural tissues Mn Infusion EA GB34

15. Effects of Acupuncture • Activation of cortex is site specific • Leads initially to specific effects GB34 ST36

16. Effects of Acupuncture 5 minutes 20 minutes • Activation has temporal effects • Longer stimulation activates more cortical structures • Leads to broader effects

17. 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

18. 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.

19. Medication Timing & TCM 24-hour Clock

20. Anatomical Considerations • Acupuncture point • Meridians • Reflex Connections • Central Connections

21. Shu Xue (communication outlet) •  Electrical resistance •  Electrical conductivity • High density of • free nerve endings • arterioles • lymphatic vessels • mast cells

22. AP Point Locations • Points where neurovascular bundles where nerves penetrate the body fascia • Points where nerves bifurcate

23. AP Points- -Bladder Meridian • Inner and Outer Bladder Meridian Points

24. 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)

25. 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

26. 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

27. Anatomical Considerations • Acupuncture point • Meridians • Reflex Connections • Central Connections

28. 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

29. 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 Injection at acupoint Migration 6 cm/minute

30. 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

31. 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

32. Meridians • Where there is no free flow, there is pain. Pathogenic factors Meridian No free flow Pain

33. Meridians • Where there is free flow, there is no pain. Pain No free flow Pathogenic factors Meridian Acupuncture Stimulation Eliminating Meridian Normal

34. Anatomical Considerations • Acupuncture point • Meridians • Reflex Connections • Central Connections

35. AP Effects • Needle insertion stimulates afferent A-delta nociceptive fibers which leads to • Local Effects • Spinal Cord Effects • Brainstem Effects

36. 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

37. Acupuncture Pathway • Stimulus enters the spinal cord • Integrated information ascends the spinal cord to the brainstem, thalamus and cerebral cortex

38. Gate Theory of Pain

39. Acupuncture & Pain • Responses to • heat • electricity • pinprick • pinch AP Naloxone  PT Analgesia

40. EA: Effect of Increasing Frequency 200 Hz 4 Hz 0.2 Hz Electrical Acupuncture

41. Electro-acupuncture 4 Hz + saline 4 Hz + Naloxone EA: Low Frequency ± Naloxone

42. EA: High Frequency ± Naloxone Electro-acupuncture 200 Hz + saline 200 Hz + naloxone

43. Mediators of AP Analgesia • Enkephalins & Dynorphins Spinal Cord (SubstantiaGelatinosa) • Endorphins  Brainstem (Periaqueductal Gray Matter) • 5HT  Brainstem (Raphe Nuclei)

44. AP Analgesia • Varies among patients (species specific) • Varies from location of AP point • Varies with proximity to AP point