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HOW DOES

ACUPUNCTURE
WORK ?

Dharma K. Widya
Acupuncture Department , Dr. Cipto Mangunkusumo Hospital
Jakarta
 
ACUPUNCTURE

- Acus - needles and punctura - to penetrate :


first used by VOC Doctor - Wilhem Ten Rhyne
(1683)

- Treatment in which needles are inserted into the skin at certain


points to relieve pain and treat certain health conditions

- Began as a kind of traditional medicine based on the existence of


bioenergy which flows in meridian channels along the human
body
Nowadays acupuncture is increasingly used
worldwide in the treatment of many disorders

Late 1970s : Work by Pomeranz and others


elucidated some of the physiologic mechanisms of
acupuncture and fueled acceptance by Western
practitioners and the public
1997 : the National Institutes of Health Consensus
Conference on Acupuncture determined that there
was scientific evidence of acupuncture's efficacy
in some clinical situations

Medical Acupuncture is a part of Physical


Medicine and based on Neuroscience, treating
patients according to medical principles and
evidence based
ACUPUNCTURE POINT

According to the Standard Acupuncture


Nomenclature proposed by the World Health
Organization (WHO), the meridian system in
acupuncture consists of about 400 acupuncture
points
Electrical properties of acupuncture points:

- High electric capacity (0.1-1 micro-farad).


- High electric potential (up to 350 βmV).
- Low electric resistance, explored either by DC or
AC current (20 to 250 kilo-ohms).
Biochemical/physiological properties of acupunc- ture points
:

- There are measurable changes in the


sodium/potassium concentration in an acupoint,
at a depth under the skin, as compared to the
tissue around the point.
- Increased "cutaneous respiration" (great uptake
of CO2 at the level of the points).
- High local temperature.
- Low threshold of painful sensitivity.
Histological properties of acupuncture points:

On biopsies, there is a structure described as a


"neurovascular hemolymphatic complex“ :
- a plexus of arteriovenous capillaries;
- a rich lymphatic drainage;
- cutaneous nerves (myelinated and
unmyelinated) emerging from deep fascia, from
bone foramina, and motor points of
neuromuscular attachments.
- Acupuncture points are rich in Aβ neural fibres
(thick, medullated and fast) which are responsible
for transmitting the touch and tactile signals

- They are poor in Aδ (medullated), and C (non


medullated) neural fibres (thinner, slower), which
are responsible for transmitting the sensation of
pain
Specifically, Aδ fibres are responsible for acute
localised pain, while C fibres transmit diffused
blunt pain
This explains why acupuncture is generally
painless; inactive acupuncture points do not
have many neural fibre endings that transmit pain
signals
Anatomical properties of acupuncture points:

- The acupuncture points and meridians lie along the


fascial planes, the cleavage or dividing planes
between muscle groups and tissues
- Point maps correspond to motor points, neuro-
vascular points, and trigger points
MECHANISM OF ACTION

It is now quite clear that acupuncture reacts in


local, regional (spinal cord) and general (brain)
levels
Local mechanism

- Inducing an acute local inflammatory defencive response


 appearance of redness around the needle (flare
response)

- Inducing immune reaction which is triggered by mast


cells  histamine, bradykinin, serotonin, platelet
activating factor (PAF), leukotrienes etc

- Activating interaction between the blood coagulation


system and the immune complement system

- Stimulating of afferent somatic neuron fibers (cutaneous


Aδ and C-fibers) and sympathetic neuron fibers (for
controlling the sweat glands and fine blood vessels)
Regional (segmental) mechanism

- Stimulates Aδ or Group III small myelinated primary


afferents in skin and muscle  marginal cells in the
medulla spinalis  sends serotonergic (5-HT) fibers to
stalk cells
 inhibit substansia gelatinosa (SG) cells by an
enkephalinergic mechanism  prevent noxious
information arriving in C primary afferent nociceptors from
being transmitted to wide dynamic range (WDR) cells
deep in the spinal grey matter, which send their axons to
reticular formation (RF)
- The stimulation also triggers gamma loop efferents in
the ventral horn  activates somatic motor nerves to
muscles, and autonomic motor nerves to peripheral
blood vessels and to the internal organs

- Afferent information is also transmitted up and down


the spinal cord  muscle, nociceptive, and visceral
reflexes along the cord remote from the spinal
segmental level at which the stimulation is provided.
The neurons associated with the muscle system
comprise a pathway known as the gamma loop, which
is necessary for muscle function even though voluntary
motor signals are provided by descending response
pathways from the brain.
The regional reaction concerns the activation
of an largest area (2-3 dermotomes) through
reflex arches
There are viscero-cutaneous, cutaneo-
visceral, cutaneo-muscular and viscero-
muscular reflexes and also the vegetative,
stretch and polisynaptic segmental reflexes
Central Mechanism

- From marginal cells  ventroposterior thalamic


nucleus  cortex

- In the midbrain : collateral branch to the


periaquaductal grey matter (PAG)  nucleus raphe
magnus (NRM) and nucleus reticularis
paragigantocellularis (NRPG) in medulla oblongata
 sends serotonergic (5-HT) fibres and
noradrenergic (NAD) fibres  stalked cells 
inhibit substansia gelatinosa
One descending neuronal mechanism :
DNIC (diffuse noxious inhibitory controls) which
comes from subnucleus reticularis dorsalis in the
caudal medulla oblongata and inhibits substansia
gelatinosa.
- The pituitary-hypothalamus : activated by the
needling signals from the spinal cord  releases
beta-endorphin into blood and cerebral spinal fluid
 promoting physiologic analgesia and homeostasis
of numerous systems, including the immune system,
cardiovascular system, respiratory system, and
tissue healing.
- It also secretes ACTH  activates the adrenal
gland to modify pain sensation and immune reaction
and other hormones  Thyrotropin Releasing
Hormone, Growth Hormone, Anti Diuretic Hormone,
Follicle Stimulating Hormone, Luteinizing Hormone,
Steroid hormones etc

- The long-term effects of the neuropeptides,


endorphins and enkephalins  explain the pain
reducing, sedating and euphoria-inducing effects of
acupuncture.
Copyright © 2007
Lippincott Williams & Wilkins
From: www.intl.elsevierhealth.com/e-
books/pdf/131.pdf
THEORY AND BASIC SCIENCE p.69
83
CORTEX

THALAMUS

HYPOTHALAMUS
PITUITARY ANALGESIA
ENDORFIN BLOOD
-CSF HOMEOSTASIS :
IMMUNE SYST
PAG ACTH etc C.V. SYST
RESP SYST
TISSUE HEALING

NRM-NRPG
SKIN
NEEDLE
HISTAMIN    R
SEROTONIN
DLT HORMONES
KININ
LIMFOKIN DNIC
LEUKOTRIN AFFERENTS
PROSTAGLAN ENK SE NE MODIFY PAIN 
CORTI
DIN DYN SENSATION
SOL
IMMUNE
REACTION
ALT
ORGAN
AUTONOMIC 
MOTOR
GAMMA LOOP
BLOOD
MOTOR SPINAL CORD
MUSCLE