1. Modernization of Ancient Wisdom
Acupuncture Part 1
Modernization of Ancient Wisdom

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

3. What is Acupuncture? Acus meaning needle Pungare meaing 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 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 Central 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. Pain
Pathogenic factors
Meridian
No free flow
Pain

33. Meridians Where there is free flow, there is no pain. Pain Normal
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. EA: Low Frequency ± Naloxone
Electro-acupuncture
4 Hz + saline
4 Hz + Naloxone

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

43. Mediators of AP Analgesia
Enkephalins & Dynorphins  Spinal Cord (Substantia Gelatinosa)
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