Science of Acupuncture Part 1

Acupuncture Part 1

Modernization of Ancient Wisdom

Comparison of East & West
Empirical Observations over Thousands of YearsScientific Method & Case-Based Medicine
East

West
Art of MedicineHolistic ViewCircular LogicEnergeticTechnology of MedicineMolecular and Organ ViewLinear LogicMechanistic

What is Acupuncture?
Acus meaning needlePungare meaing to pierceZhenjiu meaning needle (zhen) and moxabustion (jiu)Manipulating body balance through regulating flow of Qi

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

Scientific Evidence ?

What Scientific Evidence Exists?
Total Medline Cites for Acupuncture to Date Represents 7107 Publications62 Double-Blind StudiesChart1196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920001723222191896210244212198185194200229230221245268317293323321296313279295283220236270223264260270Sheet1CABtotalanimal1972+8397951972219731pain74197414arthritis13197526epilepsy7197619laminitis6197724diarrhea7197817cough1197914immunity29198027analgesia98198144asthma2198228heart28198341skin53198434treatment699198538198623198732198846198937199037199118199237199325199424199525199627199730199866199937200045Medlinetotalanimal71071991966-700d-blind621971-75151976-80261981-85341986-90381991-95541996-2000321966171967231968221969219219709780197118100619729612811973210154619742441313197521212871976198197718519781941979200198022919812301982221198324519842681985317198629319873231988321198929619903131991279199229519932831994220199523619962701997223199826419992602000270Sheet1Sheet2Sheet3172322219189621024421219818519420022923022124526831729332332129631327929528322023627022326426026

Animal Acupuncture Studies
Represent 1/10th of all CitesParallel Human Acupuncture Studies in FrequencyNo Double-Blind StudiesChart21966-701966-701971-751971-751976-801976-801981-851981-851986-901986-901991-951991-951996-20001996-200009215780261006341281381546541313441287Sheet1CABtotalanimal1972+8397951972219731pain74197414arthritis13197526epilepsy7197619laminitis6197724diarrhea7197817cough1197914immunity29198027analgesia98198144asthma2198228heart28198341skin53198434treatment699198538198623198732198846198937199037199118199237199325199424199525199627199730199866199937200047Medlinetotalanimal71071991966-700d-blind621971-75151976-80261981-85341986-90381991-95541996-2000441966171967231968221969219219709780197118100619729612811973210154619742441313197521212871976198197718519781941979200198022919812301982221198324519842681985317198629319873231988321198929619903131991279199229519932831994220199523619962701997223199826419992602000270posnegneurologic1150pain161159nausea5362tinitis40pulmonary7654443230sleep11005060100headache1100Sheet10000000000000000000000000000000000000000000000000000000000Sheet200000000000000Sheet30000000000000000000000000000000000000000000000000000000000000000000000000000000000000000Precent Positive

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
Effective for Osteoarthritis and Musculoskeletal PainEffective 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 AP
Effective for Immunomodulation
reduces inflammation, elevates WBC, interleukin-2 production
Effective for Reproductive Disorders
uterine bleeding, ovulation

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
Simple in concept, complex in actionStarts from Local EffectsExpands to involve the entire Neural Axis

AP Events
Local effectsSegmental effects
Pain control

Organ effects
Central effectsAll take place at once

Basic Tenets of AP
Based upon the AP point selectedBased upon the method of stimulation
Dry needles

Electrical AP

Aquapuncture

Hemoacupuncture
Based upon the length of stimulationLow-rate, twisting stimulation of GV26 leads to endorphin response, while high-frequency needling of GV26 leads to epinephrine response

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

Activation of cortex is site specificLeads initially to specific effects
GB34

ST36

Activation has temporal effectsLonger stimulation activates more cortical structuresLeads to broader effects
5 minutes

20 minutes

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
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.

Medication Timing & TCM 24-hour Clock
Chart6LU 3-5 AMLI 5-7 AMST 7-9 AMSP 9-11 AMHT 11-1 PMSI 1-3 PMBL 3-5 PMKID 5-7 PMPC 7-9 PMTH 9-11 PMGB 11-1AMLIV 1-3 AMGB 11-1AMTH 9-11 PMPC 7-9 PMKID 5-7 PMBL 3-5 PMSI 1-3 PMHT 11-1 PMSP 9-11 AMST 7-9 AMLI 5-7 AMLU 3-5 AMLIV 1-3 AM303030303030303030303030Sheet1ElementSoundEmotionClimateSeasonOdorColorDirectionOpeningSecretionBody PartZang/FuFirelaughjoyheatsummerscortchedredsouthtongueperpirationtongueHT/SI-PC/THEarthsongsympathyhumidlate summersweetyellowcenterlips/gumssalivamuscleSP/STMetalweepinggriefdryautumnrottenwhitewestnosemucousskinLU/LIWatergroaningfearcoldwinterputridbluenorthearssalivaboneKID/BLWoodshoutangerwindyspringrancidgreeneasteyestearsligamentsLIV/GBSheet2LU 3-5 AM3-530LI 5-7 AM5-730ST 7-9 AM7-930SP 9-11 AM9-1130HT 11-1 PM11-130SI 1-3 PM1-330BL 3-5 PM3-530KID 5-7 PM5-730PC 7-9 PM7-930TH 9-11 PM9-1130GB 11-1AM11-130LIV 1-3 AM1-330Sheet2000000000000LIV 1-3 AMLU 3-5 AMLI 5-7 AMST 7-9 AMSP 9-11 AMHT 11-1 PMSI 1-3 PMBL 3-5 PMKID 5-7 PMPC 7-9 PMTH 9-11 PMGB 11-1AMSheet3

Anatomical Considerations
Acupuncture pointMeridiansReflex ConnectionsCentral Connections

Shu Xue (communication outlet)
Electrical resistance Electrical conductivityHigh density of
free nerve endings

arterioles

lymphatic vessels

mast cells

AP Points
Points where neurovascular bundles where nerves penetrate the body fasciaPoints where nerves bifurcate

AP Points
Inner and Outer Bladder Meridian Points

Acupuncture points: IV 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: IV 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
Most AP points are associated with vascular elements (veins)Blood vessel walls (veins) appear to have AP points directly on or in them

Meridians: Myth or Reality?
Close correlation between
AP Meridian

Peripheral Nerve Pathways
Meridians appear to possess bioelectric function similar to PNMeridians follow PN
Lung (LU) = Musculocutaneous N

Pericardium (PC) = Median N

Meridian Research
Stimulation of AP points on meridian lower resistance at other meridian pointsInjection of radio-isotopes into one point gradually accumulates at other pointsRadio signals places over one AP point can be picked up at other AP points along the meridian

14 Major Meridians
Lung Meridian: LUHeart Meridian: HTPericardium M.: PCSpleen Meridian: SPLiver Meridian: LIVKidney Meridian: KIDConception Vessels: CVLarge Intestines M.: LISmall Intestines M.: SITriple Heater M.: THStomach Meridian: STGallbladder M.: GBBladder Meridian: BLGoverning Vessels M.: GV

Meridians
Energy flow systemChi (Qi): energy flowAP points on 14 major meridiansNormal: 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

Meridians
Where there is no free flow, there is pain.
Meridian

No free flow

Pain

Pathogenic factors

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

No free flow

Pain

Pathogenic factors

Meridian

Eliminating

Normal

Meridians

Acupuncture Stimulation

AP Effects
Needle insertion stimulates afferent A-delta nociceptive fibers which leads to
Local Effects

Spinal Cord Effects

Brainstem Effects

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 Pathway
Stimulus enters the spinal cordIntegrated information ascends the spinal cord to the brainstem, thalamus and cerebral cortex

Acupuncture & Pain
Responses to
heat

electricity

pinprick

pinch

PT

Analgesia

AP

Naloxone

EA: Effect of Increasing Frequency

200 Hz

4 Hz

0.2 Hz

Electrical Acupuncture

EA: Low Frequency Naloxone

Electro-acupuncture

4 Hz + saline

4 Hz + Naloxone

Electro-acupuncture

200 Hz + saline

200 Hz + naloxone

EA: High Frequency Naloxone

Acupuncture Analgesia
Enkephalins & Dynorphins Spinal Cord (Substantia Gelatinosa)Endorphins Brainstem (Periaqueductal Gray Matter)5HT Brainstem (Raphe Nuclei)

AP Analgesia
Varies among patients (species specific)Varies from location of AP pointVaries with proximity to AP point
0

100

200

300

400

196619691972197519781981198419871990199319961999

0

500

1000

1500

2000

1966-

70

1971-

75

1976-

80

1981-

85

1986-

90

1991-

95

1996-

2000

0

10

20

30

40

50

60

0

0.5

1

1.5

2

2.5

Pain Threshold

baselinehorsesmulescattle

GB

11-1AM

TH

9-11 PM

PC

7-9 PM

KID

5-7 PM

BL

3-5 PM

SI

1-3 PM

HT

11-1 PM

SP

9-11 AM

ST

7-9 AM

LI

5-7 AM

LU

3-5 AM

LIV

1-3 AM

Documents

Science of Acupuncture Part 1