THE NERVOUS SYSTEM

An Introduction
GENERAL STRATEGY
 We need to start with how the brain works and how it
produces behaviour
 We will first study a single brain cell and move on to
how they communicate with each other
 We will then look at very simple networks of neurons

 I then want to introduce some concepts relating to

acupuncture
NEURONS

 Split into two groups to answer the following:

 What do you know about neurons so far?

 E.g. Where are they in the body? What do they do? How
do they work?
NEURON
THE NEURON
 Cannot be seen by the
naked eye
 Microscope

 All shapes and sizes

 Common features
THE CELL BODY
 Metabolic centre of the
neuron
 Contains nucleus. What
does the nucleus do?
 Nucleus contains genetic
material
 Used in cell division and
growth
 In mature cells used to
produce proteins in
response to stimuli
THE SYNAPSE

 Most cells are not touching.

 Membrane of terminal button known as presynaptic.

 Membrane of receiving neuron known as postsynaptic.

 Synaptic gap contains fluid through which chemicals can

diffuse.
A SYNAPSE
THE SYNAPSE
A SINGLE NEURON’S
SYNAPSES
NEURAL
COMMUNICATION
COMPLEX BRAINS

 100 billion neurons

 1000 billion brain support cells

 135,000 km nerves in brain

 Each neuron has on average 1000 synapses

 Total number of synapses 10,000,000,000,000,000

 Total number of connections 1 with 10.5 km noughts

after it.
DENDRITES
 Dendrites are specialised projections from the cell body
 They receive chemical messages from other neurons

 This branching allows many different neurons to

converge on a single cell
 This facilitates the integration of complex messages
THE AXON HILLOCK
 Axon is long neuronal projection
 Axon hillock is transitional point between cell body and
axon
 When there is a wave of enough depolarisation at the
axon hillock, an action potential fires
AXON
 A long slender process extending from the cell body
 It carries information from the cell body to the terminal
buttons
 Chemicals such as neurotransmitters are transported
along the axon
 It also propagates nerve impulses
TERMINAL BUTTONS

 Bulbous structures at end of axons.

 Chemical signaling molecules stored in vesicles here.

 When signal arrives chemicals released into synapse.

NEUROTRANSMISSION - THE ACTION
POTENTIAL

 When there is enough depolarisation to reach the axon

hillock it decides whether or not to act
 The action potential is non decrementing
CHANGING NEURON
FUNCTION

 Using our knowledge of:

 Pharmacology

 Neuronal physiology

 How could we alter neuronal function using drugs?

NEUROTRANSMISSION - THE ACTION
POTENTIAL
 Possible because the selectively permeable cell
membrane maintains a chemical and electrical gradient
(voltage) known as the membrane potential.

 At rest the membrane is polarised.

 During an action potential it is depolarised
MYELIN

 Myelin is electrical insulation

 It speeds up the conduction of nerve impulses

 Fibres can conduct at speeds up to 130 metres per second

 Demyelination can lead to disease

GROUP WORK
 Group one:
 Describe the structure of a neuron

 Group two:
 Describe how a neuron transmits a message from one to
another
THE ROLE OF
NEURONS
NERVE TYPES

 Sensory
 Bring information in to the CNS

 Motor
 Send information out of the CNS
SOMATIC SENSORY
NEURONS
 Think of some examples of somatic sensory
information?

 Pain
 Touch

 Heat

 Cold

 Receptors located in the skin and a few in the viscera

PROPRIOCEPTOR
NEURONS

 What is proprioception?
 Helps us balance and maintain posture

 Receptors located in muscles and joints

SPECIAL SENSES
 What are the special senses?

 Sight
 Hearing

 Balance

 Smell

 Taste
AUTONOMIC SENSORY
NERVES

 What information might these gather

 Blood pressure

 Chemicals
MOTOR NERVES
 2 types:

 Somatic - Voluntary and reflex muscle contraction

 Autonomic - Involuntary muscle contraction and
glandular secretion
THE CNS
THE CNS
THE MENINGES
 What disorder do you
know that affects the
meninges?

 3 layers of meninges:
 Dura mater

 Arachnoid mater

 Pia mater
EPIDURAL SPACE
CEREBROSPINAL
FLUID (CSF)

 Produced by choroid
plexus
 Completely surrounds
brain and spinal cord
 Can be extracted by
lumbar puncture
CSF

 Acts as a shock absorber for the brain

 Substances can be exchanged between CSF and neurons

 Provides nutrition and removes waste

THE CEREBRUM
CONNECTIVITY
THE CEREBRUM
AREAS OF THE
CORTEX
MOTOR PATHWAYS
MOTOR HOMUNCULUS
SENSORY AREAS
 Specific areas for special
senses:

 Sight
 Smell

 Taste

 Audition

 Somatosensory area
receives information
about bodily sensations
SENSORY PATHWAYS
SENSORY
HOMUNCULUS
IF WE LOOKED LIKE
THE HOMUNCULUS!
GROUP WORK

 Group one explain:

 The motor system

 Group two explain:

 The sensory system
HIGHER FUNCTIONS
SPINAL CORD
SPINAL CORD
SIMPLE CIRCUITS:
THE STRETCH REFLEX
SIMPLE CIRCUITS:
THE REFLEX ARC
GROUP WORK
 Group one explain:
 In certain severe conditions, the function of the brain can
be totally lost. Can you think how such severe damage
will affect the patient?

 Group two explain:

 Why do you think it is that in some cases we can prevent
ourselves from withdrawing from a sudden painful
stimulus such as an acupuncture needle?
THE PNS
PERIPHERAL
NERVOUS SYSTEM

 Consists of:
 31 pairs spinal nerves

 12 pairs cranial nerves

 Autonomic nerves
PERIPHERAL NERVES

 Each nerve made of a bundle of nerve fibres

 Each nerve fibre is made of a bundle of axons

 They are mostly mixed sensory and motor

PERIPHERAL NERVE
SPINAL NERVES

 Arise from both sides of

the spinal cord
 Formed by union of
sensory and motor nerve
roots
SPINAL NERVES
 21 pairs:

 8 cervical
 12 thoracic

 5 lumbar

 5 sacral

 1 coccygeal
SPINAL NERVES
 Branch like a tree to supply a particular portion of the
body
 In cervical, lumbar and sacral regions nerves intermingle

 These areas are called a plexus

 Nerve branches from a plexus will have originated from

more than one spinal nerve
PLEXUS EXAMPLE
DERMATOMES
 Areas of skin and tissue supplied by sensory nerves of
each spinal nerve have been mapped

 These are dermatomes

 Diagrams indicate which nerve branch supplies an area

 This information can be used in acupuncture treatment

REFERRED PAIN
 Pain felt in area
(dermatome) that is not
the site of disease
 Can you think of some
examples?
 Sciatica for example

 Spinal nerve that carries

sensory messages from
area of leg irritated
NERVES OF THE LEG
DISTRIBUTION OF
NERVES IN THE LEG
MAIN NERVES OF THE
ARM
GROUPWORK
 Use your knowledge of dermatomes to work out what: Nerve
branch, and What spinal nerve is carrying the nerve fibres to
the affected area

 Group one:
 A patient with a bad back is feeling pain which radiates down
the back of the outer part of the calf to the outer edge of the
calf. He calls this sciatica.

 Group Two:
 A pregnant patient is complaining of aching and tingling in the
front part of her right wrist, the palm of her hand and the
thumb and forefinger.
REFERRED PAIN
REVISITED

 Referred pain can originate from deep organs

 Signals from the organ and surrounding tissue travel to
spinal cord
 Brain interprets these as coming from nerves supplying
dermatome
 Vague and hard to localise
AUTONOMIC NERVOUS
SYSTEM
THE ANS
THE ANS

 Involuntary control of body

 What functions might be included?

 Allows body to respond to requirements

 Returns the body to homeostasis
THE ANS

 What 2 parts make up this system?

 When do these predominate?

 Sympathetic - Stress

 Parasympathetic - Rest

 What are these in Yin/Yang terms?

SYMPATHETIC
NERVOUS SYSTEM

 Neurons in brain stem

 Descend to spinal cord between T1 and L3

 Synapse either side of spinal column in sympathetic

chain
 Known as sympathetic ganglia

 What channel/meridian overlies this chain?

PARASYMPATHETIC
NERVOUS SYSTEM

 More Yin aspect

 Predominates when mind and body at rest

 Neurons originate in brain stem and sacral part of spinal

cord
 Affects parts of body that nourish and build reserves

 Digestion

 Clearance of waste
BALANCE
 Periods of sympathetic activity should be short
 Modern society does not promote parasympathetic
stimulation

 Can lead to high BP, poor digestion, high blood sugar

and muscle tension

 More Tai ji and Qigong?

ACUPUNCTURE AND
THE NERVOUS SYSTEM

A Brief Introduction
NEURAL ACTION?

 Acupuncture has no effect if needles inserted into area

anaesthetised
 Action potentials detected in nerve trunks leading away
from area treated
 Acupuncture stimulates nerves
DE QI

 Numbness
 Distension

 Heaviness

 Ache

 Different to needle prick

DE QI
 Nerve conduction studies show de qi accompanied by
action potentials in A-delta fibres

 De qi means the gathering of qi

 It could indicate the correct fibres are being stimulated

NEUROPEPTIDE
RELEASE

 Needle stimulates nerve endings

 Neuropeptides released

 Cause vasodilation and increase in local blood flow

PEPTIDES

 CGRP
 NGF

 VIP

 Neuropeptide Y

 Acupuncture improves local blood flow and promotes

healing
CLINICAL
APPLICATION

 Local needling around injury

 Fencing the dragon
SEGMENTAL
ANALGESIA
SEGMENTAL
ANALGESIA

 Inhibition of the nociceptive pathway at a given level in

the dorsal horn
 Spinal segment that supplies a joint also supplies
muscles that act on it
 Needling those muscles suppresses pain in joint

 Needles have local and segmental effect

EXAMPLE
 Patient has osteoarthritis in knee
 Pain from synovium, joint capsule and bone travel in C
fibres
 Go to dorsal horn L3/L4 and L5/S1

 Needle vastus medialis (L2/-4) and tibialis anterior (L4-

5)
 Sp.10 and St.36
VISCERAL AFFERENTS

 Nerves from GI tract go to T5 to L1

 Bladder to S2-4

 Nerve branch to brain and also autonomic efferent

 Autonomic reflex
CONVERGENCE

 Dorsal horn receives afferents from viscera and somatic

structures
 Converge on same pathway at dorsal horn

 One signal whatever the origin

 Needling muscle at same segmental level can treat

visceral pain
GROUP DISCUSSION
 Work out where pain in the following organs might be
felt

 Group one:
 The heart is supplied by fibres from C3 to C6 and T2 to
T5.
 Where might the pain of a heart attack be felt?

 Group two:
 The gall bladder is supplied by fibres from T7 to T10
and C3 to C5. Where might cholecystitis be felt?
NOTE
 Site of pain from deep organs can relate to the position
of channels and points
 These might be used in the treatment of these conditions
in TCM
 Think about not only the superficial channels but also
the deep pathways.
EXTRASEGMENTAL
ANALGESIA

 How can needling the foot help a headache?

 Can’t be same segment of dorsal horn

 Neuromodulator release
OPIATE PEPTIDES

 Beta endorphin - Brain

 Enkephalin - Spinal cord

 Dynorphin - Spinal cord and brainstem

 Orphanin - Wide distribution

 Acupuncture proven to release these

DESCENDING PAIN
INHIBITION

 Acupuncture activates midbrain

 Signals descend to inhibit spinal cord
CENTRAL
REGULATORY EFFECTS

 Hypothalamic stimulation influences pituitary

 Release ACTH and beta endorphin

 Hypothalamus also releases GnRH

 Leukocytes have beta endorphin receptors

TRIGGER POINTS

 MTrPs
 Hyper-irritable locus in skeletal muscle

 Caused by muscle injury

 Higher density substance P

 Also TNF-alpha