Acupuncture Part 1
Modernization of Ancient
Wisdom
1
Comparison of East & West
East





Empirical
Observations over
Thousands of
Years
Art of Medicine
Holistic View
Circular Logic
Energetic
West

Scientific Method
& Case-Based
Medicine
Technology of
Medicine
Molecular and
Organ View
Linear Logic

Mechanistic



2
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
3
Moxabustion

Applied either
moxa or heated
element (1500° F)
to arthritic joints
• Moxa burned in
room

Moxa was better
& longer lasting
4
Scientific Evidence ?
5
What Scientific Evidence
Exists?

Total Medline Cites for Acupuncture to
Date Represents 7107 Publications
62 Double-Blind Studies
400
300
200
100
0
19
66
19
69
19
72
19
75
19
78
19
81
19
84
19
87
19
90
19
93
19
96
19
99

6
Animal Acupuncture Studies



Represent 1/10th of all Cites
Parallel Human Acupuncture Studies in
Frequency
No Double-Blind Studies
2000
60
50
40
30
20
10
0
1500
1000
500
0
1966- 1971- 1976- 1981- 1986- 1991- 199670
75
80
85
90
95
2000
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
• 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 highfrequency needling of
GV26 leads to
epinephrine response
14
Effects of Acupuncture

Using manganeseenhanced fMRI
(functional magnetic
resonance imaging),
visual effects can
be seen in human
and animal neural
tissues
Baseline
Mn Infusion
Mannitol
EA GB34
15
Effects of Acupuncture


Activation of
cortex is site
specific
GB34
ST36
Leads initially to
specific effects
16
Effects of Acupuncture



Activation has
temporal effects
5 minutes
20 minutes
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
LIV
GB
TH
1-3 AM
LU
3-5 AM
LI 5-7
11-1AM
9-11 PM
PC
7-9 PM
KID
BL
ST
7-9 AM
SP
9-11 AM
HT
5-7 PM
3-5 PM
SI
AM
11-1 PM
1-3 PM
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 Points


Points where
neurovascular
bundles where
nerves
penetrate the
body fascia
Points where
nerves
bifurcate
23
AP Points

Inner and
Outer
Bladder
Meridian
Points
24
Acupuncture points: IV 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: IV 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
30
14 Major Meridians



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
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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.
Pathogenic factors
Meridian
No free flow
Pain
33
Meridians

Where there is free flow, there is
no pain.
Pain
Pathogenic factors
No free flow
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
Acupuncture & Pain

Responses to
•
•
•
•
heat
electricity
pinprick
pinch
AP
Naloxone
 PT
Analgesia
39
EA:
Effect of Increasing Frequency
200 Hz
4 Hz
0.2 Hz
Electrical Acupuncture
40
EA:
Low Frequency ± Naloxone
Electro-acupuncture
4 Hz + saline
4 Hz + Naloxone
41
EA:
High Frequency ± Naloxone
Electro-acupuncture
200 Hz + saline
200 Hz + naloxone
42
Acupuncture Analgesia

Enkephalins & Dynorphins  Spinal
Cord (Substantia Gelatinosa)

Endorphins  Brainstem

5HT  Brainstem
Gray Matter)
(Periaqueductal
(Raphe Nuclei)
43
AP Analgesia


Varies among
patients (species
specific)
Varies from
location of AP
point
Varies with
proximity to AP
point
2.5
Pain Threshold

2
1.5
1
0.5
0
baseline horses
mules
cattle
44