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of Acupuncture:
TheNeurophysiology i
a Viewpoint
MiltiadesKaravis
A.upuncturc in Medicine 34 M a y 1 9 9 7V a l 1 5 N o . l
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M a y 1 9 9 7V o l 1 5 N o . l 35 Acupuncturc in Medicine
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_l_hc
a c u p o i n t s " .L i a o h a s a i s o r e p o r t e dt h a t m a n y irorn reflexpheromcna). fociccptivcimpulscs
a c u p o i n t sc o i n c i c l ew i t h t h e m o t o r p o i n l s ( E r b frornthe aifectedviscerapassto thc dorsalhornand
points)of skeletalmux,)e(17). thenceio the anteriorhorn of the spinalcorclvr.1
The simpleplacementol a needleat thesepoinb i n t e r n e L r r o n cVsi.s c e r a a i l er en t n o c i c e p t o r s
achievesboth the inactivationof the triBgerpoinl convergeon the sanrepain projectionfeurons as
(reduction of the lntensityand discharSe rateof pain the afierents irom the sk.n(20-27).
s t i m u l if r o m t h e m u s c l et o t h e h i B h e rs e n s o r y A n e x a r . p l eo l a n o n p a i n i u ls k i n r e s p o n s e to
centres),anclthe activatronol spinalreflexe!.The visceralstimLrlatiof is the actior]of bariumchloridc
receptoror8ansof the muscularshait(propioceptive on the descendjng colon, in blanchinga skin area
s e n s ea ) n d t h e c e l s o f t h e a n t e r i o rh o r n so f t h e wilhin the T9 l2 dermalonres. Also, adrcnalineon
s p i n a l c o r d p a r t i c i p a t ei n t h i s p r o c e s s T . h i s the gaslricmLrcosa, the gall bladderor thc fasciaof
m e c h a n i s mw i l l b e a n a l y s e di n d e t a i l i n t h e the spleen,causesa shinypatchon skinsuppliedin
discussion aboutthe regionaactiof of acLrpuncture.' h a . . r . . a1 e \ F . n . d . , l n . e . r 8 " - / 2 4 .
Painirornthe gall bladderis projectedto thc sl(irr
Regionalaction of the righl hypochondrium and thc top of the right
Thereis much evidencethat acupuncture actsal a s h o u l d e rS. t o m a c hu l c c r p a i n j s f e l t o n_tlh' 1e s_kl _r nh e
s p i n a ls e g ne n t a l( r e g i o n a l e ) v e l .N o x i o u ss t i m u l i s L r r f a cw e i t h i n l h e i n n e r v a t i o na r e ao i l.
from the peripherylead to releaseof peptidesat a v i s c e r oc L r t a n e o urse l l e x i s l r a n s r n i t t e vd r a t h e
s p i n a lc o r d l e v e l .T h e s ep e p t i d e s( t a c h y k i n i n ssympathelic chain.Thus il is unaffecledby section
substanceB neurokininA, calcitoningene-related of the spinalcord, but will be abolishedby scction
p e p t i d e , s o m a t o s t a t i ne i c . ) r n o d u l a t et h e o l t h e s y m p a t h e t icch a i n .T h i s r e f l e xm a y b e o f
transmission oi nociceptiveinformation to the CNS- diagnoslic help.
U s i n gt r e a t r n e nm t o d a l i t i e s i l ( et f a n s c u t a n e o u s
eleclricalnervestinrulation (TENS), acupunctufe and CutaneousvisceraI reilex
electroacupuncture, we can block the nociceptive T h e i r r i t a t i o no f a s k i n p o i n i r . a y i n l l u e n c et h e
s i S n a l sa, c t i v a t i n g d c s c e n d i np g a i n i n h i b i t o f y f u n c t i o no f a n o r g a ns u l ) p l i e db y t h e s a r r en e r v e
s y s t e n r sw h i c h a c t a t t h e l e v e l o f t h e s p e c i f i c ' u o t L p p i - * r r l l ) . r J , a r r e n t..1 l L o , L I F r 1 8 r o
nryelotome-AcLrpufctLrre and electroacupuncturepectoris,the injectionol procaineinto cutaneoLrs
h a v e a n i n h i b i t o r ye l f e c lo n i n t e r n e L r r o on fs t h e t e n d e rp o i n t so f t h e a n t e r i o trh o f a c i cw a b n S s
s p i n a lc o r d ( l a m i n aV ) a n d l h i s i n h i b i t i o ni s a b o u tf a s i r e l i e fo f t h e p r e c o r d i apl a i n . E l e c t r i c a l
m e d i a t e db y o p i a t et ) a i n - r ei e v i n gs y s l e r . sl / 8 ) - stirnulation of the poirt Frliu(LJ.1B) on both sides,
A l s o , m a n y a b o r a t o r i ehsa v e s h o w nc h a n g e si n providesanalgesia _fhis suffjcient for surgical fenroValol
dorsa horn cel activity(SatinB) dLrrinB mechanical, thelhyroid. poiJltis foundjn an .rfeainner!,ated
chemicaland e ectricalsiimLrlalion of sonralicand by the third dorsalcervicalspinainerve.The fascia
visceralfie ds. TENSto somaticareasclecreases the ol lhe lhyroidglandand the above y ng skin area,
s p o n t a n e o uasn d n o x i o u s l ye v o k e da c t r v i t yo l a wherethe specilicacupLrrclLrre point is found,have
m a j o r i t yo f d o r s a lh o r n n e u r o n sw : i d e d y n a m i c - s e n s o r yi n n e f v a l i o nf r o n r t h e s a n r ec e r v i c a l
range(WDR) ce ls, high threshoid(HT) ce ls, and m y e l o t o n r eT. h i s r e i l e xd o e s r ] o l d e p e n do n t h e
h i g h t h r e s h o l di n h i b i t o r y( H T i )c e l s , r e d u c i n gt h e higherbrain cenlres:seclionof the visceralnerves
perception of painf/9J. abolishes the refex and sectionol the !,a8lrsferve
Thisspinalactionis likelyro be the mechanism ot does not inflLrence the healingelfect.lt looks ike
manyphysicair.ethodsof anal€iesia wh ch are usecl the myotatic,monosynaptic reflexes. Thisreflexmay
r o u t i n e l yi n p h y s i o t h e r a p A y .n o t h e rr e g i o n a l be usedfor therapeutic purposes.
reactionconcernsthe activationoJ an areathrough
r e f l e x a r c h e s .T h e s ea r e p r o d u c e da l t e r t h e Viscero-nLtscularand viscero-vitaeral ot sanala-
s t i m u l a t i oon f a p e r i p h e r asl e n s o r yr e c e p t o rT. h e attktnctmicreflexes
stimulusis directedrvith alferenlneuralfibresto a T h e s ea r e i n t e r n a lr e f l e x e sw h i c h c a u s et h e
sensoryor fnotornuc eus of the spinalcorcland a muscularcontraction and vasoconstriction observed
responsereactionis producedthere.The fol owing in disease of the internalorgans.Sensory fibresfrom
arethe varioustypesof reflexinvolved: the muscles, vessels and the affectedorSanoriginate
from the samemyelotomeon neighbouring nuclei
Visceracutaneausreflex or splachDoJascial re ex w h i c h a r e f u n c t i o n a l l yi n t e r c o n n e c t ef d
2 5 J .T h i s
F u n c i i o n a ol r o r g a n i cd i s e a s eo f a v i s c e r am a y reflexproducesreflexspasnrof the sl<eletamuscle
inducereferredpain,hypalgesia, tensionof irritation ( t r i S g e pr o i n t so i t h e p e c t o r a l i sr . u s c l e )d L r r i n g
in a panicularareaof the skill.As a genefalrule,the myocardialischaemia. Also, thfoughthis ref ex we
s k i n a r e a w h e r e p a i n i s p r o j e c t e dh a s c o m m o n can inlerpfetmLrscLrlar paif durinBr.uscularactivity
e m b r y o n i cs o m o t o m i co r i g i nw i t h t h e p a i n f u l while underconditionsof limitedbloodsupply(26).
viscera,and consequently its sensoryinneNationis The sensation of needleinsertioninto somaticnerve
from the same neurotomeof the spinalcord. The e n d i n S si n t h e m L r s c l a e s c e n d sw i t h a f f e r e n t
s k i n a n d t h e r e a t e d v i s c e r ah a v e t h e s a r n e i m p u l s e st o t h e a n t e r i o rh y p o t h a l a m u sE. i l e r e n l
seBrnenta i nl n e r v a l i o nU, s u a l l yf r o m d o r s a lr o o t s , impulses originatefron]the samereflexcentreof the
s p i n a ln e r v e sa n d n u c l e i( r e f e r r e d p a i n r e s u l t i n g h y p o t h a l a m u sd, e s c e n dt o t h e c h o l i n e r g i c
N l . i r1 9 9 7v o l 1 5 N o . l 39 Acupun.tLrc in Medicine
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arcLrsedon patiertsw th ntensey somatsedmenta T r8ovisre| (lll9l) reotia .i pt,).t.a .cupdh.tutii naderne.
dr9.]rders. A . i d - " n r i - "R o f r i n e ,B ! . ! r e n i : 2 0 l , 1 8
l l R o s c n t h aS R ,5 o n f . n s c h cI R R ( 1 9 4 8 1H r n a m r f ea s a
p o s sb l . c h c mc a n e d i i t o i t . , r c l t a n e o l s p a i n .A , r e r i . a n
Conclusion l . i r n d l a i P h r s b l o r r .t 5 5 : 1 8 6 ' r A
l ' h er e s t o r a t i oonf n r o r p h o l o cg a l a n d l u n c to n a I I L l o i . i l , Y l a h I I e L r e snkd l C , P e . h nc k R N , L r e p i h t iAs
h o m o c o s t a s i s . l ftdh c r n a i n t c f a n coc l a c l v n a m i c ( r 9 9 0 ) l l i o c h e n i s l r r, r n , Jr n o d ! a l i o n o i n o c i ( e p i i o ni n d
cquilibriumin thc bod,v,lhat is gfadualy festored p r i i n : B o . . i l , e d f t e M a r a A € / r e r lo t P a i r . L e a &
l:cb P h . d . l p h i a :9 6 l - 1 0
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c o n s i d e trh e b o d v a s a n o p e n t h e r m o d v n a n r i c s u b s i a n c ien . c r t r i n t i s s u ee r L r r c L ih u . n a l a t P h y t b l o g r
s ! s i e f rt h a t c a n c o a t e e x t e r n ai n f o r m a t i o fa n c l
m o d i i , vt h e i u n c t i o n o l i t s s y s t e m sa c c o r d i n g l v . r 5 r r , v e I l a i . S n r o n sD C l l 9 . r 2 r M y o f a s c i a ip a i n e n d
A c u p u n c t u r c im s c c h a n i s mo l a c t i o n . r n dt h e drsiDn.tlan. V.lulne. t and 2. Will am, and W lklfs,
B J l l o r e ,U S A
l r a d i t i o n acl o f c c p t o i v i t a l c n c r g ,cvi f c u l a ot n a r e l a M c z a c k R . S t i l w c l l D M , [ o \ t J ( ] 9 7 7 )T r B s e rp o n t s r n d
often diriicLrltiof doctorsto accept.Nonetheess, a c ! p u n . t u r ep o i n t st o r p r l f : . o t e b l i o n a f t l i n r pi . a l o n s .
ifadition.a r lp p lc a t i o f so i t h i s t h e f a p e u t iscy s t e m , t'atn3: a-21
derivedfrom soufcesost in the depthsof time but l i I r o S l l l 9 i J l A . ! p ! n c l u r e p o n t sa n d t r E g c rp o i n t s .
c J n i c a l y v c r i f i c di n c v c r y d a ym c d i c a lp r a c t i c e , t ' t . r r ? e . 1i n a ; . i t \ n ) e .i . . n . . n g t e s s o t r c h a b iI l t a t i a n
,redn:r/rp.t.sl-"rnse.f on ain!a mccting.Washln8ton
shouldbc a startintpointfor cor]lcnrporary nrcdical I t i C h e i g R S S( 1 9 8 9 )N c ! r o p h y s i o l o goyf e l e c t r o i c ! p ! n c t ! r e
rcscarch. Notc lvc l, thatthc physcjan s not obl ged anals.s.. li: PomcranzU, Stu\ C, els -s.l..nriin:brses of
t o s t u d yC h i n c s cp h o s o p h yi n o r d e ft o p r a c t i s e , . ! p ! r . & / e . 5 p r r g e . V e r i a EB,e ri . r 1 1 9 l i
.lCUpUnClUrC. l ! L n r i s o r U / ) , F o r e n r a iD R ( 1 9 9 4 )D e c r e a s e d a.ti! ty ot
I shouldpoint out that the unfeasoned fejectionof s p o . 1 . . e o u sa n . l f o r o l s f c v o k c dd o E a h o r nc e l l sd l r n g
L f r n s . u l a n - p o -upse . t r . a n c r v c s t m ! l a t l o n ( T t N 5 l . P r i r .
a n r c t h o ds | l o ta s c i e nitj c p o s i l i o nl f. t h c h l s t o r y o i
sr_ience, llre molive forceol progresshas lleef thc 2 ( l F e l d sH L ( 1 9 7 8 )P i t r M . C r a w l l l . N e w Y o r < : 9 0 - l
i f n a l e t e r ) a l e r i at o y w , a r d si n l e r p r e l a t i o rarn d 2 l M c ) . r R A , C a n p b e J N , R r j . 5 N l l 9 8 5 l P e r i p h e f an - " ! r a l
ifvcstigation oi natura phenonrena. No mattcrhow nrechJnlsrn o si c ! l . i f e o ! s h y p e r a l g e s i lai :. F e l d s H L ,
l r l n . , l . , , " l \ / . , t " t P e p " t , ], d
r r a n y p r o h l e m sw e i a c e i r l h e p r e p a r a t i o on f
IheL'p\., vohnrp 9 ltave. l'fe$, New York:51 71
r e s e a rhc p r o t o c o l st o e s t r b l i s ht h e a c l i o r r , 2 : . K e l l se f
l t s ( l r l ! r ) O . l h - "d i s l f i b ! lo n o f p a n a r s i n St r o m
i n d i c . r t i o n sc ,o n t f a i n d i c i r t i oanns d s i c l ee f i e c l 5o l l e e p \ o m . t i c s L r u . lfLe sw t h . h a r t so f s e g m . n t apl a n a r e a s .
acul)uncture, their solutionmust remnina tarS-.tof CIi n i'al S. i -"n.-. I : ) 5
2 l K e l B r e f l H ( 1 9 i 7 ) O b s . r ! . t l o n s o n r e t e n e dp r n . r l s n g
r r o n rn r l s c. . C / n r i . as/ . i c r . e . J i I 7 6
"Fa(h ad(litiotl of knon'lecle,-- : : . 1 l a n i I ' ( 1 9 7 7 )5 . i e r 1 i l t . i i p e . r s . t t A c u p u n . t u r e
is at1additiotl t:'l H e i n e n r r nlno,f d o n rl 0 -l 8
hunanpo\/er."H()talio, _, L r . , t b . v 6 .1 . .t,n ' ! .dr,.d
b J s e do f i n i d , j l e \ ] ) e r i n r e f bI n , P o m e r a nB z , Stlx C, cds.
Miltiades Y Karavis S . i e n t i i i r l l . t e s d A . u p u n c t u t e .S p r i n g e F v ear g , B c r n
D i rector,HelIeni c AcupunctureReser/chCentrc
2, Alkmanos Sbeet 2 6 .L e B a E D , W I c r l C , d . B r o r c k e rT , V i l a n e l v a L (p9a8i .9- )
N . ! r o p h y so l o E . a l m c c h a ns n r si n v o l v e d i n t h e
I 1528 Athens,Creece r c l i c ! n E . f i . c t s o f c o u n t e r i n i t a t i orn d r e n t e dt e c h n i q l e s
i n c u d i n si L ! L r !r c t ! r e I n : r ' o m e r a n T B, St!x C, eds
I 5 1 ! x C , ' o . r e r . d r B 1 l 9 ( ) ) 8 r r l . r o / A . ! p ! n . / o e . 5 pr i n 8 e . 5.i.-nliiir utse5ol Adtlnn'.i,.e. SpringerVer ag Berlinr79
Vefl.BB , -.rn l :.1l9 0i
2 . B o n i . aL P r o . a c . P 1 l 9 . r 0 rC c n c L r cl o n s l d c r aotn so i a c ! t . 2 7 l t ! 5 s e A , S c ! d d r A R 1 1 . r 9 . 1S)p h e i o p a l a t n c g a n g o n
pa n n: Eon .a l, ctl Ttu Mana\cnent oi Pr,r. Lea& b . . k , t h . i i n a l S a t et o e w i t c h i n E a i l p a i . l l o u . n a lo i
F e l i s e rP, h . d e l p h . :r 5 ! 7 8 Mut.ulaskclctalPain.2: 117 41
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| n , + i T a 1 r 9 6 t i rf ' a i h o p h y s b
er) tr1.dn.l t'ltbiolorr .txl Bi.)pltbi.t. tath edltb.: )ai N c u r o i . t e n . ei n t t l e d i . i n eJ. t sl i p p i c o l l C o . , P h l a d e l p h l a l
t9;:09
.1 l o r e v J A r r 9 r 7 r V i s . - p f apl a i . . B t i t i s hM e d n e l l o u n ) a | .2 : 29. r.,\min CS, l)e airoot I 11995raotplatlve NeutuaDatanv.
1270 pp el('i & La.ge, USA
5 S n c a i r D C , [ t d d . l C . F c d c W l l l ] 9 . 1 8 1R . i . r r c dp a i i l o . H r m m e r m e i s l eKrE ( 1 . r 9 0C ) a d i a c a n d a o r t i cp a I I n :
afd issociatcd p h e n o n r . n aB. t a h , 1 : 1 8 1 Boi.a l, ed. Ihc /ViraS.ncnt af Pain,2nd edltion. Lea &
6 5 t ! \ C , P o m c r . u l l ( 1 9 9 1) l i . ^ t . s o l A . , p , r . l u - - S p r i n 8 e F F . b i E c rP, h i d c l p h i a . 2 :1 0 0 1l 6
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o p n t e a n d n o n o p a i e p r i f c o n i r . r sl \ ' n c m ! S c r e n ( . -2.1 6 : D {r.l86l Nc!rcv.rgct tl€,esltrre rcuded by rcactomettr
] ] 8 59 2 as indi.atat ai ta.epttrnf lo a.up!n.ture Dissertation,
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t l e . t t a n b B " e t i { n . n d L h el . , n r l . t b n , / / , r e \ / M o t u . i N , l 5 K a r a ! s l ! 1 ( 1 9 8 5 i E e / r l t o r s h i p sb e L u , e eenl e c L . i c asl k i h
patL'ntt.ls,peTeptur thrcsl)aldh an ele.ni..tidulDs ahd
tht: ribrated set*iL.rltr Lo p.tients \rl!h., rrith.\n.1iab.ti. 59. Andetroi F(i, flo!(liiL HK i I irllr r t he titDt1ion.l I ale oi the
,eu/oprr )issenio l d.!li leAilyol Bur.harcn b u l b o s p i n . l t e r e T o n i . e r y i .r e i ! . u r r ) , s r . f i . N ' l T P r c s s ,
16 Brsnrijrrf v) t19n9l Biateedba.k,Jd .dltior. W ll rnr &
w i l k i n r , U S A :l 7 2 7 6 ( r .N i - . u $ , e n h f ! sR i l 9 E i r a h c r r o a r h i t . . t L u e a t t h e L t t . i n
1 7 .K e l l u f e nl l l 1 l 9 l 9 l O n d i n r i b u to n o i p J i f . r i 5 i f s i r . n . l - . - " p 5 p ri 8 c r v c r l a E B . o in
s o m a t j cs | ! . t u r f s w t h c r r r t s o i s e s d r e n l apl. i . a / n r r . r / l l l . I l o l . d a yJ W , L or H H . i C H ( l 9 i 8 r U . i ( t re l ) e h a v i 3 o
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r . u p u n . t u r . .V a n N o n r r r d R e i f h i l dC o , N e w Y o r k : 8 71 2 1 Ihe British Medical Acupundure Society
57 Ed.lman MC 11992)lltirht Ait, Btilliant Firc. Basi. Baok\ Nelvton House, Newton Lane
I n c , r . l 5 A : 4 96 0 Lower Whitley, Warrington
5 8 B a r c h a sl D , A < i l H , E l i o r i ( ; R , H o m a n R B , \ ' V a t s o n5 c Cheshir€ WA4 iUA
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Notes