Acupuncture Part 2

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Acupuncture Part 2

• Physiologic Mechanisms

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Physiologic Mechanism

• Local inflammation and muscular effects
• Neural (non-opioid) segmental gate theory
• Neural (opioid) humeral theory
• Somatovisceral (autonomic) effects
• Bioelectrical theory

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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

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Local Effects De Qi Sensation
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Local Effects De Qi

• PRABM response in horses (pilomotor reaction
  along bladder meridian)

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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

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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

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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

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Physiologic Mechanism

• Local inflammation and muscular effects
• Neural (non-opioid) segmental gate theory
• Neural (opioid) humeral theory
• Somatovisceral (autonomic) effects
• Bioelectrical theory

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Segmental Analgesia

• Evoked by high frequency, low intensity
  stimulation of AP point
• Rapid onset
• Diminishes after cessation
• Not reversed by naloxone

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Types Speed of Axons
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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)

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Gate Theory of Melzack Wall

• Fast transmitting fibers lead to pre-synaptic
  inhibition

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Physiologic Mechanism

• Local inflammation and muscular effects
• Neural (non-opioid) segmental gate theory
• Neural (opioid) humeral theory
• Somatovisceral (autonomic) effects
• Bioelectrical theory

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Humeral Mechanisms

• Interaction of AP point with
• Spinal Cord
• Brainstem
• Higher Centers
• Mediated through neurochemical interactions

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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

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Opioid Humeral Mechanisms

• Dexamethasone ? ß-endorphin levels and ? AP
  analgesia
• Adrenalectomy ? ß- endorphins and ? AP analgesia
• Hypophysectomy eliminates AP analgesia

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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

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Other Humeral Mechanisms

• Potentiators of AP effects
• substance P
• histamine
• cGMP

• Antagonists of AP effects
• GABA
• cAMP

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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

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Physiologic Mechanism

• Local inflammation and muscular effects
• Neural (non-opioid) segmental gate theory
• Neural (opioid) humeral theory
• Somatovisceral (autonomic) effects
• Bioelectrical theory

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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

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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

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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

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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

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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

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Autonomic Effects

• Stimulation of PC6
• ? lipid peroxidation of the heart
• ? coronary blood flow
• improved cardiac rhythm

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Autonomic Effects

• Potentiators of AP effects
• ß-adrenergic
• eserine

• Antagonists of AP effects
• ?-adrenergic
• atropine

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Physiologic Mechanism

• Local inflammation and muscular effects
• Neural (non-opioid) segmental gate theory
• Neural (opioid) humeral theory
• Somatovisceral (autonomic) effects
• Bioelectrical theory

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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

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Other AP Effects

• Anti-fever
• GI regulation
• Anti-inflammation effect
• Blood pressure regulation
• Stress relief

• Aging prevention
• Performance enhancement
• Improving microcirculation
• Face lift

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Transcutaneous Nerve Stimulation (TENS units)

• Well accepted method to produce analgesia
• Electrodes hard to apply to haired animals
• May just be acupuncture without needles

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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!!!