1. 1 Acupuncture Part 1 Modernization of Ancient Wisdom

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

3. 3 What is Acupuncture? b Acus meaning needle b Pungare meaing to pierce b Zhenjiu meaning needle (zhen) and moxabustion (jiu) b Manipulating body balance through regulating flow of Qi

4. 4 Moxabustion b Applied either moxa or heated element (1500° F) to arthritic joints Moxa burned in roomMoxa burned in room b Moxa was better & longer lasting

5. 5 Scientific Evidence ?

6. 6 What Scientific Evidence Exists? b Total Medline Cites for Acupuncture to Date Represents 7107 Publications b 62 Double-Blind Studies

7. 7 Animal Acupuncture Studies b Represent 1/10th of all Cites b Parallel Human Acupuncture Studies in Frequency b No Double-Blind Studies

8. 8 Placebo Effect b Study showed that, if something specific is measured, then there is no placebo effect. Only if the measure is subjective. b So, “blindness” may not be valid in all cases.

9. 9 NIH ‘97 Consensus on AP b Effective for Osteoarthritis and Musculoskeletal Pain b Effective for many GI Problems IBD, diarrhea, ulcerative colitis, peptic ulcers, dyspepsia, abdominal pain, nausea and vomitingIBD, diarrhea, ulcerative colitis, peptic ulcers, dyspepsia, abdominal pain, nausea and vomiting b Effective for Pulmonary disease asthma, coldsasthma, colds

10. 10 NIH ‘97 Consensus on AP b Effective for Immunomodulation reduces inflammation, elevates WBC,  interleukin-2 productionreduces inflammation, elevates WBC,  interleukin-2 production b Effective for Reproductive Disorders  uterine bleeding, ovulation  uterine bleeding, ovulation

11. 11 How Does AP Work? b The physiologic effects of acupuncture therapy cannot be explained by a single mechanism, but rather a series of interactions among the Nervous SystemNervous System Endocrine SystemEndocrine System Immune SystemImmune System

12. 12 AP Events b Simple in concept, complex in action b Starts from Local Effects b Expands to involve the entire Neural Axis

13. 13 AP Events b Local effects b Segmental effects Pain controlPain control Organ effectsOrgan effects b Central effects b All take place at once

14. 14 Basic Tenets of AP b Based upon the AP point selected b Based upon the method of stimulation Dry needlesDry needles Electrical APElectrical AP AquapunctureAquapuncture HemoacupunctureHemoacupuncture b Based upon the length of stimulation b Low-rate, twisting stimulation of GV26 leads to endorphin response, while high- frequency needling of GV26 leads to epinephrine response

15. 15 Effects of Acupuncture b Using manganese- enhanced fMRI (functional magnetic resonance imaging), visual effects can be seen in human and animal neural tissues BaselineMannitol Mn Infusion EA GB34

16. 16 Effects of Acupuncture b Activation of cortex is site specific b Leads initially to specific effects GB34ST36

17. 17 Effects of Acupuncture b Activation has temporal effects b Longer stimulation activates more cortical structures b Leads to broader effects 5 minutes 20 minutes

18. 18 Effects of Acupuncture b In separate study, analgesic AP points were compared to non-analgesic points Analgesic AP altered brain regions involved in pain modulationAnalgesic AP altered brain regions involved in pain modulation –PAG, MnR, hypothalamus, thalamus Non-Analgesic AP did not activate same areasNon-Analgesic AP did not activate same areas

19. 19 Method of Stimulation b Stimulation of BL-20 (the SP association point) in horses led to analgesia using dry needles or electrical AP. b Only EA increased release of endrophins into the blood.

20. 20 Medication Timing & TCM 24-hour Clock

21. 21 Anatomical Considerations b Acupuncture point b Meridians b Reflex Connections b Central Connections

22. 22 Shu Xue (communication outlet) b  Electrical resistance b  Electrical conductivity b High density of free nerve endingsfree nerve endings arteriolesarterioles lymphatic vesselslymphatic vessels mast cellsmast cells

23. 23 AP Points b Points where neurovascular bundles where nerves penetrate the body fascia b Points where nerves bifurcate

24. 24 AP Points b Inner and Outer Bladder Meridian Points

25. 25 Acupuncture points: IV types b Type I: motor point; 67% of all the points maximal contraction with minimal intensity of stimulationmaximal contraction with minimal intensity of stimulation the nerve enters the musclethe nerve enters the muscle LI-4 ( He-gu)LI-4 ( He-gu) b Type II: dorsal & ventral midline superficial nerves in the sagittal planesuperficial nerves in the sagittal plane #68 (Bai-hui)#68 (Bai-hui)

26. 26 Acupuncture points: IV types b Type III: superficial nerves / nerve plexuses GB-34: common peroneal nerve (deep & superficial branches)GB-34: common peroneal nerve (deep & superficial branches) PC-6: over the median nervePC-6: over the median nerve b Type IV: Muscle tendon junctions Golgi tendon organGolgi tendon organ BL-57: gastrocnemiusBL-57: gastrocnemius

27. 27 HemoAcupuncture Points b Most AP points are associated with vascular elements (veins) b Blood vessel walls (veins) appear to have AP points directly on or in them

28. 28 Anatomical Considerations b Acupuncture point b Meridians b Reflex Connections b Central Connections

29. 29 Meridians: Myth or Reality? b Close correlation between AP MeridianAP Meridian Peripheral Nerve PathwaysPeripheral Nerve Pathways b Meridians appear to possess bioelectric function similar to PN b Meridians follow PN Lung (LU) = Musculocutaneous NLung (LU) = Musculocutaneous N Pericardium (PC) = Median NPericardium (PC) = Median N

30. 30 Meridian Research b Stimulation of AP points on meridian lower resistance at other meridian points b Injection of radio-isotopes into one point gradually accumulates at other points b Radio signals places over one AP point can be picked up at other AP points along the meridian

31. 31 14 Major Meridians b Lung Meridian: LU b Heart Meridian: HT b Pericardium M.: PC b Spleen Meridian: SP b Liver Meridian: LIV b Kidney Meridian: KID b Conception Vessels: CV b Large Intestines M.: LI b Small Intestines M.: SI b Triple Heater M.: TH b Stomach Meridian: ST b Gallbladder M.: GB b Bladder Meridian: BL b Governing Vessels M.: GV

32. 32 Meridians b Energy flow system b Chi (Qi): energy flow b AP points on 14 major meridians b 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

33. 33 Meridians b Where there is no free flow, there is pain. Meridian No free flow Pain Pathogenic factors

34. 34 b Where there is free flow, there is no pain. Meridian No free flow Pain Pathogenic factors Meridian Eliminating Normal Meridians Acupuncture Stimulation

35. 35 Anatomical Considerations b Acupuncture point b Meridians b Reflex Connections b Central Connections

36. 36 AP Effects b Needle insertion stimulates afferent A-delta nociceptive fibers which leads to Local EffectsLocal Effects Spinal Cord EffectsSpinal Cord Effects Brainstem EffectsBrainstem Effects

37. 37 Acupuncture Pathway b AP Stimulus is carried by afferent peripheral nerve Can be blocked by ProcaineCan be blocked by Procaine No AP analgesia on paralyzed limbs (somatosensory paralysis)No AP analgesia on paralyzed limbs (somatosensory paralysis) Most profound AP analgesia is from points overlying major peripheral nervesMost profound AP analgesia is from points overlying major peripheral nerves

38. 38 Acupuncture Pathway b Stimulus enters the spinal cord b Integrated information ascends the spinal cord to the brainstem, thalamus and cerebral cortex

39. 39 Acupuncture & Pain b Responses to heatheat electricityelectricity pinprickpinprick pinchpinch  PT Analgesia AP Naloxone

40. 40 EA: Effect of Increasing Frequency 200 Hz 4 Hz 0.2 Hz Electrical Acupuncture

41. 41 EA: Low Frequency ± Naloxone Electro-acupuncture 4 Hz + saline 4 Hz + Naloxone

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

43. 43 Acupuncture Analgesia b Enkephalins & Dynorphins  Spinal Cord (Substantia Gelatinosa) b Endorphins  Brainstem (Periaqueductal Gray Matter) b 5HT  Brainstem (Raphe Nuclei)

44. 44 AP Analgesia b Varies among patients (species specific) b Varies from location of AP point b Varies with proximity to AP point