Physiologic Mechanisms Acupuncture Part 2 Physiologic Mechanisms

Physiologic Mechanism Local inflammation and muscular effects Neural (non-opioid) segmental gate theory Neural (opioid) humeral theory Somatovisceral (autonomic) effects Bioelectrical theory

Local Effects: De Qi Sensation Caused by sequential activation of A-delta * C-fiber * Group II fiber * Blocked by local anesthesia Requires intact nervous system Not seen at non-AP points

Local Effects: De Qi PRABM response in horses (pilomotor reaction along bladder meridian)

Local Effects Muscle Reaction contraction around the needle ipsilateral flexion contralateral extension Leads to tissue relaxation and relief of muscle spasm Principle of trigger point therapy

Local Effects Anatomically, AP points are sensitive to microtrauma Releases Hageman’s Factor XII activates clotting cascade, complement cascade, plasminogen and kinins Produces local PGs Mast Cell degranulation histamine, heparin and kinin protease Releases Bradykinin

Local Effects: Event Sequence Vasoconstriction 15-30 sec Quasi-control 10 sec-2 min Vasodilatation 2 min-2 wk  local immune status  local BF  local muscle and tissue relaxation

Physiologic Mechanism Local inflammation and muscular effects Neural (non-opioid) segmental gate theory Neural (opioid) humeral theory Somatovisceral (autonomic) effects Bioelectrical theory

Segmental Analgesia Evoked by high frequency, low intensity stimulation of AP point Rapid onset Diminishes after cessation Not reversed by naloxone

Gate Theory of Melzack & Wall A-delta fibers conduct information to spinal cord before slow conducting C fiber information arrives These fibers lead to inhibition (pre-synaptic) of information carried by the C fibers (pain)

Gate Theory of Melzack & Wall Fast transmitting fibers lead to pre-synaptic inhibition

Physiologic Mechanism Local inflammation and muscular effects Neural (non-opioid) segmental gate theory Neural (opioid) humeral theory Somatovisceral (autonomic) effects Bioelectrical theory

Humeral Mechanisms Interaction of AP point with Spinal Cord Brainstem Higher Centers Mediated through neurochemical interactions

Opioid Humeral Mechanisms Take 30-40 minutes Persists for hours Generalized effect which is reversed by naloxone Transferable from one patient to another Tolerance to and cross tolerance with morphine develops

Opioid Humeral Mechanisms Dexamethasone  ß-endorphin levels and  AP analgesia Adrenalectomy  ß- endorphins and  AP analgesia Hypophysectomy eliminates AP analgesia

5HT Humeral Mechanisms [5HT]  in systemic circulation by 30-40% following AP CNS maintains balance between 5HT and ß-endorphins endorphins alter 5HT release (regulating pain threshold in spinal cord)  5HT blocks effects of naloxone

Other Humeral Mechanisms Potentiators of AP effects substance P histamine cGMP Antagonists of AP effects GABA cAMP

Humeral Mechanisms: Systemic Endocrine Effects Improves BF to pituitary axis and  capillary wall [enzyme] Releases somatotropin in chronic pain patients Induces LH release Stimulates prolactin and oxytocin release Modulates thyroid function

Physiologic Mechanism Local inflammation and muscular effects Neural (non-opioid) segmental gate theory Neural (opioid) humeral theory Somatovisceral (autonomic) effects Bioelectrical theory

Somatovisceral Reflex: Autonomic Effects AP stimulation converges with visceral efferent resulting in reflexive interactions with internal organs (along internal connecting meridians) Regionally located Referred pain regions

Autonomic Effects Indication of certain AP points correlate with symptoms for viscera at the same spinal segment Bring descending influence only to the level of stimulation, ipsilaterally Specificity of AP points related to somatotropic location

Autonomic Effects Referred pain Convergence of Somatic and Visceral inputs in CNS dorsolateral funiculus spinothalamic tracts Visceral A-delta fibers reflexively affect muscles inflammation and cramping

Autonomic Effects AP of somatic structures can treat internal organs (through meridian connections) AP modulates both arms of ANS Segmental sympathetic vasodialation Highly specific Stimulate a specific AP point, get a specific physiologic change

Autonomic Effects AP stimulation of GV26 altered BP, HR and RR in dogs undergoing induced shock Mortality in controls = 100% Mortality in AP-treated = 25%

Autonomic Effects Stimulation of PC6  lipid peroxidation of the heart  coronary blood flow improved cardiac rhythm

Autonomic Effects Potentiators of AP effects Antagonists of AP effects ß-adrenergic * eserine Antagonists of AP effects -adrenergic * atropine

Physiologic Mechanism Local inflammation and muscular effects Neural (non-opioid) segmental gate theory Neural (opioid) humeral theory Somatovisceral (autonomic) effects Bioelectrical theory

Bioelectric Theory Acupuncture Bioelectric DC energy channels correspond to AP meridians Points of low electrical resistance on the skin correspond to AP points Acupuncture AP point Meridian Qi Bioelectric Amplifier Conductor Bioelectricity

Other AP Effects Aging prevention Performance enhancement Anti-fever GI regulation Anti-inflammation effect Blood pressure regulation Stress relief Aging prevention Performance enhancement Improving microcirculation Face lift

Transcutaneous Nerve Stimulation (TENS units) Well accepted method to produce analgesia Electrodes hard to apply to haired animals May just be acupuncture without needles

Conclusions AP represents part of an ancient system of comprehensive health care As scientific knowledge expands, modern correlations are being developed which help translate this ancient wisdom into today's terms May the Qi be with you!!!