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Acupuncture Part 2

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Title: Acupuncture Part 2


1
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 Hagemans 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 15-30 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 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

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 100
  • 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
  • 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
  • DC energy channels correspond to AP meridians
  • Points of low electrical resistance on the skin
    correspond to AP points
  • Bioelectric
  • Amplifier
  • Conductor
  • Bioelectricity
  • Acupuncture
  • AP point
  • Meridian
  • Qi

29
Other AP Effects
  • 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!!!
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