HOW DOES ACUPUNCTURE WORK ? - Scientific Basis Of Acupuncture : AcuMed Veterinary Specialty

Perhaps the most commonly asked question Acupuncturist have to face...

"How does Acupuncture Work " . Here I try to explain the Scientific Basis of Acupuncture.

Modern experiments have shown that Acupuncture points occur where nerves penetrate tissue planes or where nerves, themselves divide. 

There are 4 major types of Acupuncture points.

1. Type - I (motor) points are most points are most common and exist where Nerves penetrate muscles.
2. Type - II points are located where Nerves  intersect on the dorsal and ventral midlines of the body.
3. Type - III points are located where superficial nerves branch.
4. Type - IV points are located where nerves penetrate tendons ( Golgi Tendon Organ)

Most Acupuncture points are located at areas of low electrical resistance and high electrical conductance of the skin.  Deep into the point,there are accumulations of free nerve endings, small arterioles,veins,lymphatics and tissue mast cells. 

LOCAL EFFECTS OF ACUPUNCTURE :

When a needle is placed in an Acupuncture point , there is local tissue micro-trauma which activates Hageman s' tissue factor XII. This inturn results in the activation of local coagulation cascade and the complement cascade, leading to the production of plasminogen , protein kinins and prostaglandins . Further the trauma causes mast cell degranulation which releases histamine,heparin, proteases and bradykinin. 

Thus the local effect of Acupuncture involves in setting up a micro inflammatory process which results in increased tissue blood perfusion , increased immune responsiveness, relaxation of muscles and tissues in the area. To sum it up this pic explains how local effects of Acupuncture needle insertion.

SEGMENTAL AND SUPRASEGMENTAL RESPONSES :

PAIN MANAGEMENT : Acute pain is mediated by A delta fibers which are myelinated and are fast conducting, in muscles they are categorized as Type II & Type III fibers. The purpose of these fibers is to signal potential or actual tissue damage. Where as C fibers are unmyelinated and slow conducting . C fibers conduct chronic pain.

When an Acupuncture point is stimulated , as discussed above it sets up a same response the same response in the brain and body that would be stimulated by a potential or actual tissue damage without that damage actually occurs , because this potential damage is more important to the body than the pain from the chronic condition, the acupuncture stimulus from A delta fibers get a priority in terms of recognition . A delta fibers stimulated by needle activate the interneurons in the dorsal horn that produce Enkephalins. These Enkephalins are inhibitory to any C fiber activity going on in the same dorsal horn. Thus C fiber pain is "switched off" or more accurately its impulse importance is decreased thus controlling Pain at the level of the Spinal Cord.

EFFECTS BEYOND THE DORSAL HORN OF THE SPINAL CORD : After synapsing in the dorsal horn, A delta fiber transmission continues upto the spinaothalamic tracts to the BRAIN. Various interactions at this level stimulate release of the following neurotransmitters.

1. Beta Endorphin from Peri Aquaductal Grey 
2. Nor-Adrenaline indirectly from the gigantocellular reticular region.
3. Serotonin from the raphae nucleus magnus of the Medulla Oblongata..
4. Oxytocin from Vagal Nucleii and Adernocorticotrophic Hormone from the pitutary gland.

Some of these neurotransmitter act humerally , some via descending inhibitory control system. These systems 'damp down' the pain perception at every spinal segment by inhibiting the transmission of painful stimulii by various mechanisms. Serotonin and Nor-Adrenaline are involved with and potentiate the effects of descending  inhibitory control and thus inhibiting pain.

EXPERIMENTAL EVIDENCE :

In an experiment using Manganese enhanced Functional MRI (f-MRI) visual effects were seen  in human and animal neural tissues.

above pic : fig A : Baseline ;
                  fig B : Mannitol Infusion
                  fig C : Manganese infusion
                  fig D : After Electro-Stimulation of an Acupuncture point GB-34.


ACTIVATION OF CORTEX IS ACUPUNCTURE SITE SPECIFIC

                                           

Stimulation of different Acupuncture points activates different areas in the cortex.

ANALGESIC V/S NON ANALGESIC ACUPUNCTURE POINTS :

In a separate study Analgesic acupuncture points were compared to the non analgesic points .

• Analgesic acupuncture points altered Brain regions involved in pain modulation like Peri Aquaductal grey, Hypothalamus and Thalamus.
• Non- analgesic points did not activate the same areas

 A COMMON MISCONCEPTION THAT ACUPUNCTURE WORKS ONLY IN PAIN CONTROL IS NOT TRUE AS NUMEROUS RESEARCHES HAVE PROVED THE NON-ANALGESIC PROPERTIES OF ACUPUNCTURE  & ON THE CONTRARY TO  A FEW MYTHS THAT ACUPUNCTURE IS NOTHING MERELY BUT A PLACEBO HAS BEEN PROVED WRONG BY THE FACT THAT THERE IS NO PLACEBO IN ANIMALS. 

 NON ANALGESIC PROPERTIES OF ACUPUNCTURE : 

There have been several researches to demonstrate the non analgesic properties of Acupuncture . I have listed a few,

1. The Acupuncture point Pericardium-6 (PC-6) is well known for its anti-nausea effects and has been shown to be helpful in controlling postoperative and postchemotherapy nausea in human. A new research showed it resulted in decrease in lipid peroxidation of the heart and increase in coronary flow and stabilization of cardiac rhythm.
2. Governing Vessel-26 (GV-26) when rapidly manipulated results in release in Epinephrine,which results in revival of a patient. In an experiment in a group of dogs with Hyopvolemic shock 75 % of the dogs who received stimulation of GV-26 acupoint survived compared to 100% mortality in the control group.
3. Speeds recovery from Paralytic stroke as acupuncture provides an enriched sensory environment and has been showed that animals that receive Western medicines along with Acupuncture have a better recovery than those who receive only Western Medicine .
4. Autonomic modulation in Detrusor muscle inability in human, Acupuncture was shown to have the same effect as the standard treatment drug ,Oxybutinin.
5. Governing Vessel-14 (GV-14), LI-11 have shown to have a role in Immunomodulation .
6. Promotes Wound healing by second intention to speed up Acral Lick lesions and to improve healing of ulcers.
7. Management of Behavioural problems by release of neurotransmitters Serotonin and Nor-Adrenaline.
8. DERMATOLOGY PROBLEM management by reducing Pruritis as "ITCH" is caused by C-fiber stimulation and inhibition of C-fiber thus prevents self-mutilation in addition to the immunomodulatory effects promote faster recovery.
9. Governing Vessel-4 (GV-4) has shown to have an effect on the delayed Hypersensitivity reaction by a mechanism involving release of Opoids.

CONCLUSION : The effects of Acupuncture cannot be explained by a single mechanism. What starts as a Local event spreads by the nervous system to affect most of the body . Ultimately the Nervous system effects create changes in the Endocrine system and Immune-System. While the knowledge and the theory behind application of Acupuncture in a clinical setting may be derived from antiquity , it has been modified and improved over the years.

The Western Veterinary Medicine & the Traditional Chinese Veterinary Medicine have their own strengths and weakness . However they can be successfully Integrated so as to Multiply their strengths and Divide their weakness.  

INTEGRATIVE MEDICINE CAN BE THE FUTURE OF VETERINARY SCIENCES .

"A MIND THAT OPENS TO NEW IDEAS, NEVER RETURNS TO ITS ORIGINAL SIZE " 

                               - Albert Einstein