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TCM Wisdom TubeTM

Intro to How Acupuncture Works:


Simplify How You Educate
Patients and Colleagues

by
David Karaba, OMD, LAc

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Items Covered in this Webinar


Intro to How Acupuncture Works:
Simplify How you Educate
Patients & Colleagues
David Karaba, OMD, LAc

Tel: (626) 780-7182 Fax: (626) 609-2929


Web: www.elotus.org Email: info@elotus.org

Tissue Response
Simplified Explanation
Technical Neuro-endocrine-immune response
Basic Neurological Activation and Response

8 hour course
Detailed Neuro pathways and responses
Effects on Autonomics
Understanding the physiology of Master Tungs
method of distal pts and how to explain how they
work.
And More (Reviewed and expanded at conclusion)

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine

Patient Question:
So

How Does Acupuncture Work?

Usually after:
Does It Hurt?

Puncture Wound
Acupuncture is a Puncture Wound.
A puncture wound is a serious threat to the Body.
It is a breach of the skin barrier system
The body mounts a major response to neutralize any potential
pathogens

What I tell my patients

Puncture Wound
The Body responds to investigate and
neutralize any Pathogens or Toxins
Vasodilation / Inflammation (initial part of healing)
Allow WBCs to migrate out of vessels to find any bacteria,
venom, or poison.
Mast cells, basophils
Histamine
Heparin
Leukotrienes
Arachidonic Acid
Prostaglandins
Immune compliment
Chemotaxis (i.e. tells WBCs where to go)

Venom
Snake bite
Insect bite
Bacteria
Abrasion
Nail
Poison
Plant thorn, Animal, etc.

Puncture Wound
The Body doesnt find any pathogens or toxins
Only a Stainless Steel Sterilized - One-Time Use Needle

Investigation takes some time (~15 min)


When the body realizes that its a false alarm
it turns off the inflammation.
It does by creating anti-inflammatory substances
This is natural part of homeostasis
Otherwise we would be inflamed all the time.

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

Puncture Wound
These anti-inflammatory substances circulate in local
tissue and reduce inflammation that may be present

Muscle Injuries
Arthritis
Tendonitis
Etc.

Puncture Wound
Further still, the body creates natural pain
killers (opioids, endorphins, enkephalins, etc.)
to turn off the False Alarm signal as well.

Further, sometimes the body forgets or doesnt


remember to turn off inflammation (i.e. chronic
inflammation)
Chronic pain that is filtered (i.e. ignored)
Acupuncture (needling) evokes a high enough threshold to
re-investigate

Puncture Wound
Note:
Alternatively Occasionally there are pathogens in the body as is
the case when someone is sick with a cold or flu.
(Provided the Root is Strong)

We want to stimulate aggressively and remove


needle quickly so the body goes out and seeks
pathogens and puts out the fire

Needle Manipulation
Characteristics of treatment controlled by
strength of needling, insertion depth, and
retention time
Stronger stimulation produces more needle
induced tissue damage products
Longer needle retention time favors restorative
anti-inflammatory response

Leaving needles in situ may calm body to much and allow


pathogens to enter further into the body.

Muscle Spasms

Muscle Spasms

Injured muscles or joints can result in


spasmodic muscles that tighten to reduce
movement as one heals (guarding
phenomenon).
Chronic tightness in muscles (and m. spindle
fibers) can hinder rehabilitation.

Needling (puncture wound) is higher priority


than guarding phenomenon.
Allowing blood flow necessitates relaxation of
the muscles
As WBCs looks for any venom, bacteria, or poison.

Blood flow allows metabolitic build up (i.e.


lactic acid, etc.) to be released from m. cells
And allows re-supply of oxygen and nutrients
to nourish m. cells

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

Muscle Spindles
and Golgi Tendon
Organs

Muscle Spasms
Resetting of muscle spindle cells allows
stretch and consequent progress towards
restoration of full range of motion

Effects can be immediate


Known as quick needle technique
Oblique Acupuncture
Also called trigger point therapy
Trigger response or muscle twitch is to resetting of
muscle spindle and tendon spindle fibers.

It has been calculated that


only 1/3 of the fibers of a
muscle nerve consists of
motor axons connected to the
muscle fibers,
While more than an half
consists of fibers conveying
signals from the
neuromuscular spindle to the
spinal marrow and vice
versa.

Known as Gamma Loop Reflex

HDNJ: Jing Jin treatment: 3 or 2 needles

Muscle Spindle Fibers


Spinal Reflexes
1. Myotatic (stretch) reflex
Monosynaptic
Muscle spindle afferents (1A)

Principles of Anatomy & Physiology, 10th E., Tortora, Grabowski

Spinal Reflexes

Spinal Reflexes

2. Inverse myotatic (tendon organ)

3. Gamma-loop reflex

Golgi tendon organ receptors


Inhibitory input to same muscle
Protects tendon and muscle from
injury due to excessive tension

33% of ventral root axons are from


gamma motor neurons
Gamma motor neurons innervate
intrafusal muscle fibers
Maintain sensitivity of spindle during
contraction of muscle
Increase muscle tone by triggering
myotatic reflex contraction of muscles
(postural)

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

Muscle Spindle Afferents


Static load spindle serves as feed back control
sensor essential to motor function
Disorders in this system can result in paralysis,
stiffness, pain and tenderness
Static load fibers needed to provoke PS
Spindle affected by local temperature and
pressure which can influence PS

Puncture Wound

Muscle spindles
It has been calculated that only 1/3 of the
fibers of a muscle nerve consists of motory
axons conducing to the muscle fibers, while
more than an half consists of fibers conveying
signals from the neuromuscular spindle to the
spinal marrow and vice versa.
The neuromuscular spindle is richly supplied
with nerve fibers and blood vessels.

Organ Referred Pain Patterns

How it works to treat organs


Anti-inflammatory substances may also go to other areas
at the same segmental level (region of the spinal chord)
(Enhanced by propagated sensation, PS)

Organ referred pain concept (viscero-somato effect)


Originating from the same segmental level of the spine
Somato-Visceral effect:
Because a puncture wound is serious (high enough threshold),
the brain isnt sure where signal is coming from and sends
resources (&/or has specified CNS neurological responses) that
effect both regions to produce the desired effect.
Desired effect is at the discretion of Doctor
(i.e. Technique employed and used)
Neuroendocrine Mechanisms of Acupuncture in the Treatment of Hypertension
Wei Zhou, John C. Longhurst. Evid Based Complement Alternat Med. 2012; 2012: 878673.
Published online 2011 December 18.

Visceral
Relationships
|

Recognized in terms of
organ referred pain
reflecting in certain body
regions

Also produce organ traction


as noted during surgery

Viscerovisceral
relationships occur as well
where function or treatment
stimulation of one organ
produces autonomic
reflexes in another organ

Puncture Wound
Basically, Acupuncture is an ingenious way to
trick the body into healing itself by bringing
blood flow to the region and related areas
Providing Oxygen, nutrients, defensive substances,
and endocrine substances to these regions

Its all about the blood flow

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

How to Explain it to Kids

Fine Vessels-Sunmai
Arterioles, Venules
and Capillaries

Critical Nodes-Jie
Propagated Sensation Pathway

Fire Alarm analogy

Fire Alarm
Fire Drill at school (or accidental)
Everybody moves to designated spaces
Fire fighters come to investigate
Fire fighters dont find a fire
May find other areas of concern and remedy

Fire alarm turns off


Fire fighters go back to station
Kids and teachers go back to class

Superficial
Lymphatics

Skin

Muscle
Tissue

Veins
Arteries

Longitudinal Distribution
Vessels-Jingmai

Collateral Vessels-Luomai
at each Node

Connecting-Luomai
Between Paired Zangfu
Vessels in the Extermeties
and Other Regions of Body

Basic Concept of Jingluo Theory

Tendency to remember such special (or unusual) days


Dao of Chinese Medicine. Donald Kendall, Oxford University Press, 2002

Defensive Role of Skin


Chinese noted skin has primary defensive role
Body evolved efficient defense against pricking
injuries, pathogenic assault, insect bites, and
animal bites
Involves many factors of blood coagulation
system which then triggers immune complement
system

Needling Therapy
Needling therapy
effects the body first
at the capillary /
cellular level
Sun Mai

Second sensory
nerves that affect the
CNS

Defensive Role of Skin


Has complex neurovasculoimmune network of
cutaneous tissues, fine vessels, immune cells,
somatic afferents, and SNS fibers
Important mediators include substance P (NK 1),
bradykinin (B1 & B2), and cytokines

How Does Acupuncture Work?


Needle
Insertion

Causes the production of Bradykinin via the


Blood Coagulation tissue reaction and
Immune Compliment system activation

Stimulation of Substance P containing afferent


nocioceptive pain fibers activating local, spinal and
brainstem restorative processes.
Activates Descending Control from Brain Stem to the
spinal cord and finally to trauma site.
Inhibition of nocioceptive Pain signals
Restoration of blood flow and vascular tone
Relaxation of residual muscular tension (antispasmodic)
Promotes tissue repair

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

Hageman Factor XII


Dependent Reactants

Needling Mechanisms

Kinin Generating
Protease

Kallikrien
Complement Anaphylatoxin
C3a, C5a, or C4a

C5a
CA++

IGE
NA+

Heparin
+
Histamine

IGE
Receptors
Granules

Mast Cells
& Basophils

Dao of Chinese Medicine. Kendall,


Oxford University Press, 2002

Selected
Phospholipids

Mast Cells
and Baosophils

Other Cell
Types

Arachidonic
Acid

Cyclooxygenase (3)

5-HPETE
Leukotriene A4

PGG2
5-HETE

SRS-A
Pathway

LTB4

Cleaved by
Aryl
Arly Sulfatase B

LTC4
LTD4

Modulates motility and


possibly glucose transport
Potent
chemotactic
agent
comparable
to C5A

100X
1000X

More potent than histamine


in producing bronchospasm

100X
100X

More potent than histamine


on vascular permeability

LTE4

Prostaglandin H2

Causes dissagregation
of platelets

PGI2

Potent broncho and


vasodilators that regulate
tissue microenviornment

PGE2

Powerful bronchial
constrictor

PGF2

Potent vasodilator
preferently in human
lung

PGD2

Potent regulators
of blood coagulation
and homeostasis
1. Blocked by steroidal antiinflamatory drugs
2. Blocked by 5-LOX inhibiters
3. Blocked by selective and non-selective non-steriodal antiinflamatory
drugs (NSAIDs) as COX-1 and COX-2 inhibiters

Selected Phosopholipids
Leukotrine (LT A, B)
SRS-A (LT C, D, E)
Prostaglandins
PGE1
GGE2
PGF2a
PGD2
PGI2 - PGF1a
Thromboxane A2
Thromboxane B2
Platelet Activating Factor

Leukotrienes

Phospholipase A2 or
Phospholipase C + Diglyceride Lipase (1)

5 - Lipoxygenase (2)

Histamine
Heparin
ECF-A
NCF-A
Arylsulfatase A&B

Thromboxane A2

LTB4: potent chemotactic agent comparable to


C5a
LTC4 and LTD4: 100 to 1000 times more
potent than histamine in producing
bronchospasm
LTD4 and LTE4: 100 times more potent than
histamine on vascular permeability
LTC4, LTD4, and LTE4 cleaved by arly
sulfatase B from eosinophils

Thromboxane B2

Dao of Chinese Medicine. Kendall, Oxford University Press, 2002

Prostaglandins
PGI2: causes disaggregation of platelets
PGE2: potent broncho and vaso dilators that
regulate tissue microenvironment
PGF2: potent bronchial constrictor
PGD2: potent vasodilator in human lung

Mast Cell
Are heavily granulated wandering cell found
in connective tissue beneath epithelial
surfaces
Granules contain histamine, heparin, and
many proteases
Have IgE receptors and like basophils they
degranulate when IgE coated antigens bind
to their surfaces

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

Mast Cell
Also participate in non-specific natural immunity
activated by Complement
Marked mast cell degranulation produces
allergic reactions and can produce anaphylaxis

Eosinophil
Have a short half life in circulation and
attracted to surface of endothelial cells
Like neutrophils, they release proteins,
cytokines, and chemokines producing
inflammation
Capable of killing off invading organisms

Basophil
Also enters tissue and release cytokines and
proteins
Resemble but are not identical to mast cells,
but do contain histamine and heparin
Participate in immediate-type hypersensitivity
Ranges from mild urticaria, rhinitis, and to
severe anaphylactic shock

Eosinophil
Abundant in mucosa of gastrointestinal tract to
defend against parasites
Circulating eosinophils increased in allergic
reactions
Includes asthma, other respiratory diseases,
and gastrointestinal diseases

Platelets

Platelets

Smallest corpuscular components of human


blood (diameter 2-4m)
Have a half life of about 4 days
About 300,000/mm circulating in blood, and
25% more sequestered in spleen
Have primary role in clot formation
Membrane have receptors for collagen, ADP,
fibrinogen, and vessel von Willebrand factor

Cytoplasm contain actin, myosin, glycogen,


lysosomes, and two types of granules
including serotonin
Aggregation fostered by platelet activating
factor (PAF) secreted by neutrophils,
monocytes, and platelets

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

Nociceptive Activation

Bradykinin B2 from blood coagulation triggers


nociceptive fibers
This activates three difference key events that
mediate needling response:
1. Activates axon reflex to sustain inflammation
2. Sends nociceptive signals to spinal cord and
ascending tracts in spinal cord
3. Provokes muscle spindle mediated reflexes
activating propriospinal system

Blood Coagulation System


Needle damage products activate Hageman
Factor XII
XIIA simultaneously activates the kinin,
fibrinolytic, and coagulation features of blood
coagulation system
Principal effect is a localized immune defense to
needle involving vasodilatation, immune cell
egress, nociceptive excitation

Needle Insertion

Slide Title

Damage to Endothelium of Small


Blood Vessels and Capillaries

Collagen, Microfibrils
and Basement Membrane

Text

XIIa

Hageman Factor XII

Text

Kinin Protease
from Mast Cells
& Basophils

(Plasma & Tissue Zymogen)

Text

Plasmin

Plasmingen

Text
Text

Inhibited by Heparin

XIIa

Prothrombin

Thrombin
XIIa

Blood Coagulation
System Provokes
Needling Response

Kallikrien

Chemotaxis

Plasma Kininogen

Bradykinin
Potent Vasodilation and
Smooth Muscle Contraction

Nociceptive
Excitation

Dao of Chinese Medicine. Kendall, Oxford University Press, 2002

Immune Complement System


Basic defense mechanism that uses at least 30
proteins in circulating blood
Named "complement" because system helps
antibody kill invaders
Marks any cell that does not have certain
protective protein coatings
However, has an alternative pathway that is
activated by minute tissue trauma

Immune
Compliment System
Classical Pathway
involves attack by C1 when
antibody bound to antigen in
an antigen-antibody complex
is encountered

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

Immune Compliment System


Immune Complement System

Alternative Pathway
C3

Plasmin

C3b

Factor B

C3b,B

Fractor D

Thrombin
Amplification

C3b,Bb
C3

Activated by Plasmin
to Provoke Immune
Response to Needling

Anaphylatoxin

C3bn,Bb

Alternate pathway is activated by the blood


coagulation system response to tissue damage
Does not require antibody to function
Interacts with blood coagulation system to
amplify inflammatory response

Properdin

C3bn,P,Bb

C5
C6
C7
C8
C9

Anaphylatoxin
Chemotaxis

Lysis, Cytotoxicity

Dao of Chinese Medicine. Kendall


Oxford University Press, 2002

Immune Compliment System:


Alternative Pathway
Plasmin

Complement Alternative
Pathway

+ =

C3 activated by Plasmin
immediately forms C3b
binding with Factor B
which then activates more C3
in a feed-forward amplification

Combined Action
Blood coagulation system and alternative
pathway immune complement system interact
to amplify response
C3 causes mast cell and basophils
degranulation and release of kinin protease
This preferentially causes more production of
bradykinin to stimulate nociceptive fibers

Complement Alternative
Pathway
Plasmin activates C3 provoking the immune
complement system
Complement proteins C3 and C5 cause potent
vasodilatation by degranulating mast cells and
plasma basophils
Released heparin inhibits thrombin

Needling Mechanisms
Needle
Insertion
Hageman
Factor XII

Microfibrils and
Basement Membrane
Damage Products
Factor XIIa

Plasminogen
Kininogen

Plasmin
Activates C3

Prothrombin
(Inhibited by
Heparin from
Mast Cells)

C3

Immune
Complement System
Alternative Pathway

Blood Coagulation
System

Kinin
Protease
Bradykinin

C3

C5

Amplification
Loop
C3b,Bb

Mast Cell and


Arachidonic Acid
By-products
Histamine
Heparin

Nociceptive Excitation
Via B2 Receptors

ECF-A
NCF-A
LT C, D & E
PGE2

Potent Local
Vasodilation

Immune Cell
Attraction

Dao of Chinese Medicine, Figure 14.1,


Oxford University Press 2002

Dao of Chinese Medicine. Kendall, Oxford University Press, 2002

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

Sensory Neuron Fiber Types

Spinal Chord
Dorsal Horn
I, II, III, IV, V, VI

Intermediate Zone
VII

Ventral Horn
VIII, IX

Grey Matter
(surrounding
central canal)
X
Neuroanatomy through Clinical Cases. Blumenfeld, 2002

Nocioceptive Fibers Subgroups


A-Delta

Neuroanatomy through Clinical Cases. Blumenfeld, 2002

Nociceptive Fibers

C-Fiber

Myelinated, Large

Non-Myelinated, small

Respond to mechanical stimuli


and some to thermal also

Responds to any noxious stimuli.

Receptive fields consist of


cluster of small spots

Receptive field is a single area


rather than clusters

May be sensitized

May be sensitized.

Resistant to local anesthetics


but susceptible to pressure

Susceptible to local anesthetics

Inactivated with higher temp

Inactivated at temp 55C

Responsible for 1st pain (early,


sharp, brief pain)

2nd pain (dull, prolonged pain)

Acupuncture studies have consistently shown


both A and C fiber participation
Typically more A fibers then C fibers
C fibers clearly participate in axon reflexes
Both A fibers and C fibers can activate
propriospinal afferents

Dao of Chinese Medicine. Kendall, Oxford University Press, 2002

Nociceptive Fibers

Neurogenic Inflammation

A fibers have a broader area of coverage and


wider distribution in spinal cord laminae
A fibers provide quick proprioceptive
response, especially to pricking injuries
These features may favor A fibers in
mediating propagated sensation and directing
descending control responses

C fibers are interconnected with process of


inflammation
Action potentials in certain branches cause
axon reflexes
Releases Substance P on capillary bed and
mast cell to cause degranulation
Sympathetic activate axon reflex to constrict
deeper veins to enhance cell egress

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

10

Somatosensory Pathways
Posterior Column
Medial Lemnisical
Pathway
Sensory
Vibration
Joint Position
Proprioceptive
Muscle Spindle
Golgi Tendon

Fine Touch

A-alpha, I
A-beta, II

Ascending Pathways
ALT comprised of spinothalamic (STT),
spinorecticular (SRT), and spinomesencephalic
(SMT) tracts
Somatic and visceral nociceptive signals
synapse on ALT crossed fibers
Major portion of SRT and SMT fibers project to
the pons, midbrain, and medulla
A small portion of STT fibers projects to the
thalamus, which sends fibers to sensory cortex

Neuroanatomy through Clinical Cases. Blumenfeld, 2002

Proprioception
Sherrington: defined proprioceptors as
sensory receptors for stimuli that "are
traceable to actions of the organism itself, and
since the stimuli to the receptors are delivered
by the organism itself, the deep receptors may
be termed proprioceptors...
(1906) Brain 29:467-482

Proprioception Receptors
Joint receptors: sensory endings in joint
Cutaneous receptors: movements and
postures cause deformations of skin
(mechanoreceptors)
Specialized muscles receptors:
Muscle spindles respond to stretch
Golgi tendon organs sensitive to changes in tension

Essential Properties
Proprioception
Amount of muscle activity mobilized by
proprioceptive inputs is small
Adequate stimuli for proprioceptors arise from
actions of organism itself
System can be stimulated by needling
superficial body

Slide Title
Anterior Lateral
Pathways
Sensory
Pain
Temperature
Crude Touch
Pressure

A-delta, III
C, IV

Neuroanatomy through Clinical Cases. Blumenfeld, 2002

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

11

The Yin and Yang of the Spinal Chord

Corticospinal
Tract
Descending
Motor
Pathway

Text
Text
Text
Text
Text

Neuroanatomy through Clinical Cases. Blumenfeld, 2002

Descending Tracts from


Primary Motor Cortex

Neuroanatomy through Clinical Cases. Blumenfeld, 2002

Somatotopic Organization of
Spinal Chord
Motor:

85%

Descending

Corticospinal
Cross over
pyramidal
decussation to
form:
Lateral
Corticospinal
Tract.
Remaining
Make Anterior
Corticospinal
Tract.

Blue:
Ant. Cortico Red:
Rubrio Note:
Assoc.
Neurons
Crossing to
opposing sides
Neuroanatomy through Clinical Cases. Blumenfeld, 2002

Neuroanatomy through Clinical Cases. Blumenfeld, 2002

Acupuncture and Internal Medicine


Descending control from
the brain returns to the
specific level where
activation occurred
Restorative processes
are activated for both
muscles [motor] and
internal organs (along
with related vessels)
[autonomic motor]

Somatic Afferents
Nociceptive (1)
Needle
Insertion

Skin and
Superficial
Tissue
Gamma
Loop

Ascending

(4)

Pathways (3)
Motor (5)

Muscle

Autonomic
Motor (6)

Blood
Vessels

Inhibition (9)

Spinal Cord
Dorsal Horn
Proprioceptive
(2)

Spinal Cord
Ventral Horn

Brain

Response (8)

Autonomic
Motor (7)

Visceral
Afferent (10)

Dao of Chinese Medicine, figure 14.4,


Oxford University Press 2002

Internal Organs

Dao of Chinese Medicine. Kendall, Oxford University Press, 2002

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

12

Acupuncture and Internal Medicine


Needle insertion along
vessel pathway relative
to location of problem

Proximal
Nodes

Descending
Inhibition

Detailed schematic
shows specific neural
pathways along with
specific
neurotransmitters

Brain
Stem

Segemental
Level

Area Proximal
to Problem

Afferent
Signals
Local and
Adjacent
Nodes

Region of
Problem

Segemental
Level

Distal
Nodes

Area Distal
to Problem

Segemental
Level
Dao of Chinese Medicine, Figure 15.1,
Oxford University Press 2002

CNS Descending
control is shown as
separate from stress
analgesia which
utilizes
norepinephrine rather
than natural opiates
Dao of Chinese Medicine. Kendall, Oxford University Press, 2002

Propagated
Sensation
Sensations of energy
moving up or down the
arm (or leg) are properly
known as propagated
sensation

SENSORY CORTEX

Dao of Chinese Medicine, Figure 14.3,


Oxford University Press 2002

Norepinephrine
Neurons
Dorsal Root Ganglia
A- and C Nociceptive Neurons
& Group II Static Load Neurons

Node 3

PS

Automatic reflexes
occurring in the spinal
cord levels reverse the
flow of sensory nerves
and activate adjacent
areas of skin along the
longitudinal pathway of
related vessels and
nerves

Node 2

Antidromic
Pathway

THALAMUS
PERIAQUEDUCTAL GRAY
DORSAL RAPHE

PS as Neural Reflex

Serotonergic
Neurons
Enkephalin
Interneuron

Anterior
Lateral
Tract

Propriospinal
Pathways

DRR

Tract of Lissauer
and DLF

Antidromic
Pathway

DRR

Dorsal
Columns

PS

Node 1
Needling Sensation &
Proprioceptive Signals
Ventral
Funiculi

Result of stimulating high threshold SP


nociceptive fibers to activate muscle spindle
afferents to produce DRRs the DLF
Afferent neural signals enter spinal cord over
several segmental levels
This overlap allows higher and lower levels to be
activated if threshold conditions permit
Progressive activation of overlapping segments
produces PS along nodal pathways

Spinal Cord
Segment

Skin, Muscle, Connective


Tissue, Fine Vessels, Afferent
Nerve Endings, & Intrafusal
Muscle Spindle Fibers

Acupuncture evidence for


Restorative Effects in CTS

Saturday Lecture
CNS / Brain pathways
Acu Mechanisms and pathways
Significance to Tx

HDNJ
(LAPD)

Balance Method / Master Tungs Points


Acupuncture may benefit CTS patients via both peripheral (e.g.
increased blood flow to median n. via vasodilatative peptide
release) and central mechanisms (e.g. the cholinergic antiinflammatory pathway 5 via hypothalamic activity).

Proprioception
Embryology

Cerebellar coordination patterns


Association neurons on midbrain tracts

Central Processing of Acupuncture Stimuli in Carpal Tunnel Syndrome


Vitaly Napadow, et al

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

13

Saturday Lecture (cont.)

Questions /Comments

Propagated Sensation (PS)


ANS
Sedation and Tonification
Sympathetic activation
Pathogenic response
Predation nerve block

Parasympathetic
Relaxation Restoration
Chronic conditions
Inflammation

David Karaba, OMD, LAc


Pacific Center for Optimum Health
250 E. 17th St., #220
Costa Mesa, CA 92627
pacificacupuncture@gmail.com

PENS Perspectives

This webinar is sponsored by:

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Email: sales@evherbs.com

Lotus Institute of Integrative Medicine, PO Box 92493, City of Industry, CA 91715


Tel: 626-780-7182 Fax: 626-609-2929 Website: www.eLotus.org Email: info@eLotus.org
Shall not be copied, duplicated, or distributed in any format or be used for teaching without prior written consent from Lotus Institute of Integrative Medicine.

14

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