1. Physiologic Mechanisms
Acupuncture Part 2
Physiologic Mechanisms

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

3. 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

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

5. 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

6. 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

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

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

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

10. 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)

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

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

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

14. Opioid Humeral Mechanisms
Take 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

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

16. 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

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

18. 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

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

20. 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

21. 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

22. 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

23. 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

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

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

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

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

28. 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

29. 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

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

31. 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!!!