1 Acupuncture Part 2 Physiologic Mechanisms

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

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

4 Local Effects: De Qi Sensation

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

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

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

8 Local Effects: Event Sequence b Vasoconstriction15-30 sec b Quasi-control10 sec-2 min b Vasodilatation2 min-2 wk  local immune status  local immune status  local BF  local BF  local muscle and tissue relaxation  local muscle and tissue relaxation

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

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

Types & Speed of Axons 11

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

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

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

15 Humeral Mechanisms b Interaction of AP point with Spinal CordSpinal Cord BrainstemBrainstem Higher CentersHigher Centers b Mediated through neurochemical interactions

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

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

18 5HT Humeral Mechanisms b [5HT]  in systemic circulation by 30-40% following AP b CNS maintains balance between 5HT and ß-endorphins endorphins alter 5HT release (regulating pain threshold in spinal cord)endorphins alter 5HT release (regulating pain threshold in spinal cord)  5HT blocks effects of naloxone  5HT blocks effects of naloxone

19 Other Humeral Mechanisms b Potentiators of AP effects substance Psubstance P histaminehistamine cGMPcGMP b Antagonists of AP effects GABA cAMP

20 Other Humeral Mechanisms b Non-Responders High levels of cholecystokinins in the hypothalmusHigh levels of cholecystokinins in the hypothalmus Thought to be the anti-AP hormone that block effects of acupunctureThought to be the anti-AP hormone that block effects of acupuncture b Can block this with l- phenylalanine Turns non- responders to responders

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

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

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

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

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

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

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

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

29 Autonomic Effects b Potentiators of AP effects ß-adrenergic *ß-adrenergic * eserineeserine b Antagonists of AP effects  -adrenergic * atropine

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

31 Bioelectric Theory b DC energy channels correspond to AP meridians b Points of low electrical resistance on the skin correspond to AP points Bioelectric AmplifierAmplifier ConductorConductor BioelectricityBioelectricityAcupuncture AP pointAP point MeridianMeridian QiQi

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

Order of effectiveness b Western Approach b First Local Points b Next segmental points b Finally distant points b Local & Segmental points activate brain areas directly related to point function b Distant points activate placebo areas of the brain 33

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

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