of Acupuncture:

TheNeurophysiology i
a Viewpoint
MiltiadesKaravis

Thispaper waspresentedat the |CMART'96 World AcupunctureCongressin Copenha1en

Summary circuits;alsothe character of the stimulusis likelyto
Acupuncture is a specialised sensory stimulation be of primaryimportance for the therape!ticresult
that is analysedthrough sensoryneural pathways By character of stimulation llable 7)is meant:
Therefote to understand its action we have to i . T h e d e p t h o f s t i m u l a t i o n( s k i n ,r n u s c l e s ,
analysethe anatomv physiologyand pharmacology periosteum, ganglia)
of the nerious system,aided with a knowledgeot' l i . T h e i n t e n s i t y o f s t i m u l a t i o n ( d e g l ,
neuroendocrinologyand the chemoarchitectureof electroacupuncture, laser)
t h e b r a i n . V a r i o u sn e u r a l t h e o r i e sh a v e b e e n iil. The areaof stimulation(acupoint,dermatome,
d e v e l o p e d t o e x p l a i n t h e m e c h a n i s m so f myotome)
acupuncturc.lt is now evident that acupuncture iv Thecombination of stimulation points.
reactsat local, regional (spinal cord) and Seneral
(brain) levels. Thetefore,insertingone or more
IHE NATUR[ OT STIMULATION
needlesat particulat poitlts (or areas)of the body
actlvatesneural pathwayson three different levels, DpthofStimulaiion
ptovoking local, re7ional,and Eeneralreactions
drmatornes 0 . 5 1 c m ,s ! p e r f i c i anle e d l i n S ,
The local reactionis a multifactorialphenomenon. Skin moxa 2cm (sNT)
The electric injury potential due to the needle, the Mls.les myotomes deepneedilng(motorpoi.G)
presenceand synthesisof opioid peptidesat the site Ligaments sclerotomes deepneedins, 2 scm,
of injury, andsubstanceP, histaminelikesubsknces, periarticuar, He points
badikinin, serctoninand prcteolitic enzymerelease Bones sclelotomes verydepneedln8 (SNT),
around the needle,alloccur during needlinS.
canSlionv sceraviscerctomes I 6cm needling(SNT)
The reg,ionalreactionconcens the activationof a Pefiphera nurolomes very deep,very stronS
larger area (2 3 dermatomes)via reflex arches.we
can analysethe viscero-cutaneous, cutaneo-visceral, Ve$eis,Eands viscerotomesveryliBhtstimulation,
cutaneo-muscularand viscero-muscularreflexes
and also the vegetative,stretch and polysynaptic sNI = Specir/Need/ingle.hnique
segmentalrcflexes.
The general reaction mainly activatesthe brain lfltensityof Stimulation
Lishtnimulation thin needle,no de qi
cenlralmechanismof internalhomoeostasiswe M;dium nirn!lat on thln needle,lnstantaneous de ql
can explain the action ol acupuncturcln acute and Stron8stimulaton th ck needle,stronSde gt, rnor
c h t o n i c p a i n s y n d r o m e s ,i n a d d i c t i o n a n d i n thanone ne--dleto lhe samePoint,
psychiatric diseasethrou7h the role of central painfulst mulation
neurotransmitters and the modulatory systemsthat Electrost mulation specia parameters (ako moxa,
are activateclby acupoints:opioid, non-opioid and cupPinS,ma$a8eet .)
centralsympatheticinhibitory mechanisms.
AnatomicreSionof stimulation
Motor points "jumpirg" acupuncture, musce points
Kev words (1t.4,St36)
Acupuncture,AnalSesia,Brain, Electroacupuncture, ' ' i c g " r t o r ' 1 - e p o r , { r h e f " i i " dp d r ' 7 ^ n F
Neuroanatomy, NeurophysiologY Pain, Spinal Tenderpoints subcutaneolsnodes
segmentS. PaEvertebfal po nt dorsalspinalnerue,(1stbranchof
B a d d eM
r e rd i a n )
lntroduction Zonetherapy zone5of Head,Zarlcott,shu-mutheorv,
The insertionof a needlesuperficially to the skin,or
Skinpo nts freenerveendin8siunrnyelnatedor
deep into muscular or nervous tissLle or onto bone, mye inated)
is a s e n s o r y
s t i m u l a t i o nN. e e d l i n gi s n o r m a l l ya t Refex points auriculaf,naso,cranioactpornts
several p o i n t s a t t h e s a m et i m e a n d v a r y i n gt h e poinis
Energe(ic ancientpointsofTCM
combinations of points probably activates different

M a y 1 9 9 7V o l l 5 N a . l Acupun cture i n Medi cine

 The nervoussystemwith its sensoryperipheral m y e l o t o m e T . h e r e f l e xm u s c l ec o n t r a c t i o nt,h e
r e c e p t o r s ,a f f e r e n ts e n s o r yp a t h w a y s ,c e n t r a l h y p e r a l g e s i tah, e t e n d e r n e sasn d t h e a s s o c i a t e d
c e r e b r a ln u c l e i ,e f f e r e n tp a t h w a y sa n d e f f e c t o r a u t on o m i c m a n i f e s t a t i o n( s y m p a t h e t i ca n d
peripheralorgansdirectsthe mechanisms of action parasyr.pathetic hyperactivity) are locaiisdnot to
a n d r e a c t i o no f l h e b o d y w h e n a n e x t e r n a Jo r the site of the injury, but to an area at a drstance and
interna stir.ulusinfluencesit. The various changes may involve only a small part of a derrnatome- The
in lhe externalor internaienvironment are handled presence of cutaneous hyperalBesia associated with
in this m a n n e r -I n t h e c a s eo f a c u p u n c t u r et h
, e deep somatic or visceral pain disorders had been
stinrulusis external(needJe)and activatesmostly r e c o g n i s e db y m a n y p h y s i o l o g i s t s( e . 9 . H e a d ,
h o m o e o s t a t im c e c h a n i s m sS. t i m u l a t i o nr n a yb e Sherrington, Ross,Sturgeand others).We believe
effectedby simpleneedlepLrnclufe ldry needling), t h a t a c u p u n c t u r ae c t sa t a s p i n a lo r s u p r a s p i n a l
sullcutaneous infusionof pharmaceutical substances level, usingsjrnilarneuralpathwaysthat produce
g i v l n gm e c h a n i c aal n d c h e m i c asl t i m u l a t i o (nw e t referred pain(aniodromic activatlon ol receptors at a
needling),or electficalstirnulation (sensoryblocl<), distance).Also, accordingto the Ieferredvisceral
a n d c o n c e r n sm a i n l y t h e e p i d e r m i sd, e r m i sa n d pain mechanismand 10the proiection-convergence
muscletissue. theoryof Rusck,the sl(in,throu8hthe positioning of
A n i n j u f y t o t h e s k i n 1 iI a c t i v a t e st h e s e n s o r y p a i n f u ls k i n o r m u s c l ea r e a si n v i s c e r a p l ain
receptors of smailaflerentnervefibresof AD and C (diseases of the heart,gall bladder,stomachelc.),
a x o n s i z e ( n e r v ef i b r e sa r e c l a s s i f i ebdy s i z ea n d will show us the exactskin areafor stimulationto
a c c o r d i n gt o w h e t h e ri h e y o r i g i n a t ei n s k i n o r eliminatea viciouscycJeoi pain(2).
muscle:largediarnetermyelinatednervesAp (skin) I shallmentionas an examplethe placementof a
or type I (muscle)carly touch and proproceptron needleat the acLrpuncture point Stomach-16at a
fespectively. Smalldiametefmyelinated 46 (skin)or depthof 3cr.. This point is in the lowef limb, lcm
t y p e sI l a n d l l l ( m u s c l ec) a r r yp a i n . - l h es m a l l e s t outsidethe front marginof the leg and 3cr. below
u n m y e l i n a t eC d ( s k i n )a n d t y p e l V ( m u s c l ea) l s o thetibialconvexity(r.otorpointot the anteriortibial
carry p a i n .T y p e sl l , l l l , l V a n d C a l s oc a r r yn o n muscle). Thisstimulation will cause:
painfulinformation-
/ . L o ,d l . p r - o r ) s l i m L l . u ' r o l l h c ' ' p d o l l - l .l e 8
thal has sensoryinnervation from the cutaneous
Sensorydistribution branch ofthe saphenous nerve(neurotome L3-14).
l h F . l i n , m L . , l - . l ; a m e n t . l ^ t 1 r . b o r e , .\ i - . t s t . r . il. Stimulationoi sensoryreceptorsand mechano
a n d t h e v e s s e l sr e l a t e dt o t h e m a f e f u n c t i o n a l l y r e c e p t o r os f t h e a n t e r i o rl i b i a l m u s c l e( m o t o r
controlledby definedsegmentsof the spinalcord innervation by the deep peronealnerve,14, 15,
c a l l e d n e u r o t o m e sS. e n s o r ya f f e r e nfti b r e sf l o c k 51 neurotorne).
t o w a r d s t h e n u T o t o m e sc,o m i r l Bl r o m t h e iii.Vasoconstriction or vasodilation(dependingon
d e r m a t o m e s , m y o t oT ne s , v r s c e r o t o m e sa n d the stimulation pararneters) of the anteriortibial
s c l e r o t o m e sa c c o f d i n g t o t h e e m b r y o n i c a r t e r y ,t h a t u n d e r t a k e t
s h e c u t a n e o u sa n d
s o m o t o m i u r tnh e y c o m e f r o m . T h e f o r m a i i o no f T . . L d r " r l " d l i r ' : t " n n o [ l l _ c" r e ,
t h e s ep r ' m i t i v es e g m e n t os r s o m i t e sr e f l e c t st h e l l aM y o c h a l a s itsh a t w i l l i n f l u e n c ea l l g r o u p so l
rnetalnersm. r a u s c l e tsh a t h a v e a c o m m o n n e u f o t o m a l
The structureof the nervoussysternis suchthat a d i s t r i b u t i o ni n t h e L 5 m y e l o t o r n ea n d i n
skin area,a muscle,a groupof ligaments, a viscera, p a r t i c u l aor n t h e l o n g e x t e n s oor f t h e b ' 8 t o e
the seSmentof a bone,are servedby one and the (Extensor hallucislongLrs) (14, 15, S1),the onB
s a m e c e n t r ec a l l e d a m y e l o t o m e( M a c k e n z i e ' s d r o s , l o lr b a l m u \ ' P . 1 . 41, , r d l \ e ; l c L .
theory,visceral-so matic convergencetheory and m a x i m um s uscle ( 1 5 ,S 1 ,5 2 )a n df i n a l l ,
p e r i p h e r anl e r v eb r a n c h i n gt h e o r y )f 2 - 5 1 I. n t h e
v. Activationof serotonergicand endorphinergic
courseof embryonic1i{e,innervation of the bones, painmodulationsystems (centralaction).
o f t h e r n u s c l e so f t h e s k i n a n d o f t h e v r s c e r ar s Forall thesereasons, this poinl may be selectedfor
symmetrical. But as the organismBrows,it losesits stimulation in casesof backpainor sciaticawith L4-
initialsymmetry.Finally,only lhe intercostal nerves
S 1 p a i nd i s t r i b u t i o n w,i t h o r w i t h o u tn e u r o l o g i c a l
p r e s e r v et h e i n i t i a l s y m n r e t r i c ac lo r r e s p o n d e n c efindings.
betweenneurotomes, dermatomes, rnyotomesand
Stuxand Pomeranza6)formulatedthe hypothesis
s c l e r o t o m e sT.h e k n o w l e d g e o f t h e topographic
that three centresare activatedby acupunctureto
anatomicstructure of thesezonesis indispensable to
r e l e a s ec h e m i c a tl r a n s m i t t e rt sh a t b l o c k p a i n
the acupuncturist as it is of particular clinical value
messaSes.
for the localisationof diseasesof the posterioror
anteriorrootsof the spinalnervesand also for the l. The spinalcord usesenkephalinand dynorphin
c h o i c e o f a c u p u n c t u r ep o i n t s ( o r a r e a s )t o b e ( I o w f r e q u e n c y a) n d p e r h a p sC A B A ( h i g h
strmulated. lrequency).
Thus,accordingto Mackenzie's theory,the sensory / i . T h e r . i d b r a i nu s e se n k e p h a l i nt o a c t i v a t et h e
cutaneousstjmulation(e.g.placementof a needle) r a p h ed e s c e n d i nsgy s t e mw h i c h i n h i b i t ss p i n a l
will causefunctionalreflexreactions to the muscles, cord paintransmission by a synergiceffectof the
the musclevesselsand the ligamentsthat receive monoarnines, serotonin and noradrenaline.
s e n s o r yo r r r o t o r i n n e r v a t i o nf r o m t h e s a m e iil-Thehypothalamus-pituitary Lrses endorphin.

A.upuncturc in Medicine 34 M a y 1 9 9 7V a l 1 5 N o . l
 JohannesBischkofZ),analysinSthe control loop Substance P (andperhapsotherpeptides) may have
t h e o f y( f e e d b a c km e c h a n i s m s) t a t e st h a t e v e r y a r o l e i n i n f l u e n c i ntgh e r n i l i e uo f t h e p e r i p h e r a l
acupuncture point displaysai least4 criteria:local afferentterminals,and thus in the transductionof
action,regionalaction, an action extendingbeyond nociceptiveinformation.Like other peptides,it is
ihe region,and a generalaction.Watkinsand Mayer synthesised in the ceil bodiesof smallcells(typeB)
( 8 , 9 )i n a p a p e rp u b l i s h e di n s c i e n c e( ' 1 9 8 2 ) of spinalgangliaand the gasserian ganSlionby the
proposedthe possibleactivationby acupuncture ribosornal synthesis of largeprecursorprehormones
( a n d o t h e r p h y s i c a l a g e n t s )o f s i x d i f f e r e n t f 1 4 ) . A s a c u p u n c t u r ei s a t y p e o f n o c i c e p t i v e
e n d o g e n o u sa n a l g e s i cs y s t e m s n : e u r a lo p i a t e , stirnulation,we can hypoihesisethe presenceot
hormonalopiate,neuralnon opiate,hormonalnon- thesesubstances at the siteof the needle-
opiate,unknown opiateand unknown non-opiate Therefore,the main neurotransmitter of pain at the
systems- peripheryis substanceB a peptidetransportedby
Thuswe could saythat by insertin8 a needleai a the neuralfibresup to the lastnerveterminalsof the
particularpoint, nervouspathwaysare activatedon c fibres.About20% of the cell bodiesin the spinal
three different Ievels,provoking:local reactions dorsalroot Sangliaconiainsubstance P Thesecells
involving a small area ol 1-3cfi, regional h a v e s m a l l s o m a sa n d s m a l l u n m y e l i n a t e da n d
( s e g m e n t a l )r e a c t r o n sw i t h i n a n a r e a o f 1 - 3 finely myelinatedaxons.Their peripheralprocesses
dcrndio.np(.andBcnpralre"clion,SivirSd ma(si\e havebeenfoundin the epidermis and in the wal15of
response{rom the central nervoussystem(CNS).Let blood vesselsand glands.Their centralprocesses
us analysethe actionof acupuncture at thesethree projectto the superficial layersof the dorsalhorn of
levels:periphery,spinal cord and centralnervous the spinalcord. Also, opioid receptorsare present
system. on primaryafferentneurones (thinlymyelinated and
unmyelinated cutaneous nerves) and on sympatheiic
Localaction p o s t S a n g l i o nni ce u r o n sT. h e r ea r e m a n y f i n d i n S s
The local effect of acupLrncture occurs within a that indicatethe presenceand synthesis of opioid
smallskin area,and is due in the mainto the tissue peptidesin differenttypesof inflammatoryceils at
lesioncausedby prickingthe needleon the skin.It t h e s i t e o f t i s s u ei n j u r y ,a n d b e c a u s et h e I o c a l
is a non specificactioncommonto all acupuncture reactionis a kind of small inflammatoryreaction,
points. the peripheralantinociceptiveeffectof exogenousor
endogenous opioidswill be enhanced, especially 3-
Deactivationof painful skinpoints 4 daysafterthe acupuncture treatment. Substance B
The local reaction is the result of many factors. together with the above mentioned substances,
lnitially,the differencein electricpotentialexisting provokeslocal clinicalphenomenaof inflammation
betweenthe needleand the layersof the skinwhere suchas swelling,redflare,itchingor burningpain.
it is placed,the differencein temperature between A f t e r w i t h d r a w i n gt h e n e e d l e ,t h e u n e q u a l
t h e n e e d l ea n d t h e s k i n , a n d t h e q u a l i t y o f t h e distributionof electricalpotential(becauseof the
needle,createa Salvaniccurrentof low intensity. high concentration of K+ions)round the edgesof
T h a t m e a n s t h a t t h e n e e d l e i s a s o u r c e o f the injury createsan electric flux potential field
mictoenet4y(10,11). which actsas stimulatorof the free nerveendingsof
This electriccurrentis capableof stimulating the t h e s k i n f o r 7 2 h o u r s a f t e r t h e a p p l i c a t i o no f
cell membrane,of increasingiis permeabilityand acupuncture. The natureof the stimLrlation varies
finallyof transforming the accumulation of Na- and accordingto the needle,the depthof the injury the
K+ions in the two polesof the membrane(intraand q u a l i t y o f t h e t i s s u e sa n d t h e r e a d i n e s so f t h e
extracellulad, Ieadingthe cells,the adlacentsensory nervoussystemof the patient.
receptorsand the free nerveendin8sto a stateof
excitability. Moreover,cell injuriesof the skin (and Deactivationof painful musclepoints
in particularof the mast cells of the Lewis layer) The qualityof the stimulusdependsprimarilyon the
provokea secretionof bradykinin,sefotoninand depthof entryof the needleand the qualityof the
proteolytic enzymes,ACTH and also of histarnine- tissuein which it is placed (target-tissue). Otten, the
like substances around the needle f12). needle is placed in muscular tissue to specific points
Yakshet a/. f73) point out that three types of local that are painful to pressurecalled triggerpoints (15),
substances participatein peripheraltransduction of or in specificmusclepointscalledmotorpoints(etb
nociceptive stimuli into nociceptive impulses (pain): porntsl.
i. Those that activate nociceptive afferent fibres and Triggefpointsare painfulspotsin musculartissue
p r o d u c ep a i n ( b r a d y k i n i na, c e t y l c h o l i n e a n d and are detectedin many degenerativedisordersof
polasslum)/ the spinalcord, in all casesof musculoskeletal pain
ii. Those that facil'iaie the pain evoked by chemical of radiculopathic origin (neuropathic pain) and in
and p h y s i c a l stimuli b y s e n s i t i s a t i o o
n f local muscle, ligament or joint inl'uries (especially
nociceptorsbut are ineffectivein evokingpain overusesyndromes). About 70'l" of all acu-points
themselves (prostaglandins), and coincide with trigger points. Melzack,Stillwelland
p r o d u c e Fox demonstrated, "A remarkablyhigh degree
i i i . T h o s et h a t extravasation, s u c h a s f/6)
substance P (71/") of correspondencebetween trigger points and

M a y 1 9 9 7V o l 1 5 N o . l 35 Acupuncturc in Medicine
 _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 ht 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 pain f/9J. abolishes the refex and sectionol the !,a8lrsferve
Thisspinalactionis likelyro be the mechanism ot does not inflLrence the healingelfect.lt looks ike
manyphysicair.ethodsof analiesia 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

Acupun.10rciD Me.licine 36 Mif 1997 Val 1J No.1

vasodilator nerveand dilatethe bloodvessels o{ the vagovagalreflex).lt producesseverebrachycardia,
muscle.Section of the dorsal spinal roots and that of peripheralvasodilation,severehypotensionand
the visceral nerves abolishes this reflex. A modified a t r i o v e n t r i c u l abr l o c k . T h e s e f e f l e x e si n v o l v e
viscero-visceral reflex is activated dufing the direct afferenisand efferentsof both cardiacva8lrsand
excitationof a ganglion by placing a needle deeply c a r d i a c s y m p a t h e t i cn e r v e sw h i c h p r o d u c e
in the ganglion or all around it. For example, the s y m p a t h o - s y m p a t h e t irce f l e x e s .A l s o i n A M I
pointS1.18, which is a meetingpointon the headof s u p r a s e g m e n t arle f l e x r e s p o n s e sr e s u l t l r o m
the 3 yangmeridiansof the arm,may be needledin nociceptively inducedstimulationof the medullary
acute musculo skeletal pain. Application of local and hypothalamic centres,limbic structuresand
anaesthetic t o t h e m u c o s a o v e r l y i n g t h e neuroendocrine systems f3o).
sphenopalatine ganglioncan block pain 127)and According to Cunn (31,32),some other common
rnay be surprisinglyeffectivefor musculo-skeletalconditionsof autonomicdysfunctionthat respond
painespecially of the neckand back. well to acupuncturetreatmentare the vasomotor,
T h e a c u p u n c t u r ep o i n t S I . l B a n d t h e s u d o m o t o rg, l a n d u l a rh y p e r a c t i v i i a ynd smooth
sphenopalatine Sanglion coincide. ln this area, there m u s c l e s p a s m o b s e r v e d i n s pondylotic
existsthe largest collection of neurons in the head radiculopathy. When pain disappears, so do the
outsidethe brain itself; it is intimately connected lo autonomrc phenomena,
the trigeminalnerveand nucleusand the superior Vegetativereflexescan be activatedby local,
cervicalsympathetic ganglion,and may be regarded generaland regionalstimuli. Researchfrom the
asthe final switch between the bodyand the brain. Universityof Coteborg a.l3)showsthat acupuncture
may affectthe sympathetic systemvia mechanisms
Somatomotor or cutaneo-muscular segmental ai hypothalamic and brainstem levels,and that the
rcflexes p o s t s t i m u l a t o r y
s y m p a t h e t i ci n h i b i t i o nt h a t i s
A noxiousstimuJus to the skin stimulates axonsof induced,may persistfor more than 12 hoursafter
s e n s o r yf i b r e so f g r o u p sl l l a n d l V o f p e r i p h e r a l acupuncrure,
nerves.The impulseentersthe posteriofhorn of the Vegetativereflexesare the clearestevidenceot an
s p i n a lc o r d a n d i s t r a n s m i t t e dv i a i n t e r m e d i a t e o r g a n i s m i rse a c t i o na s a n o p e n t h e r m o d y n a m i c
neuronsto the motor neuronsof the anteriorhorn. system.We know very little about these retlexes.
T l ^ i sp d l l - \a ) i c p o l y s ) 1 a p l r (p. F r m r l l i r go n o n e The major problemis in describinS the connections
hand controland on the otherdeviationof sensory b e t w e e nt h e h u m a n c o r t e x a n d t h e p e r i p h e r a l
s t i m u l a t i o nT. h u s ,t h e s t i m u l a t i o no f a g r o u po f o u t f l o w t o s m o o t h m u s c l e s ,c a r d i a c m u s c l e s ,
sensoryreceptorson the muscles,tendonsor skin secretory Slands,sensoryorgansand vessels. Some
will causecontractionor relaxationof musclesin organs(heart,gut, spleen, kidney) receive both
the stimulatedarea (segmental distributionof the sympathetic and parasympathetic innervation, while
r e f l e x ) .I n t h i s m a n n e f ,a s e n s o r ys t i m u l u s otherorgans(adrenalmedulla,vasculartissue,skin
(acupuncture) may enlist neuronson the sameor and muscles)haveonly a sympatheiicsupply.The
opposite s i d eo f t h e i n i t i a ls t i m u l a t i o nT.h e u s u a l vegetative nervoussystem,clinicallyspeaking, is not
responseto the sensorystimulusis the ipsilateral so autonomousas has been believedand seemsto
stirnulation of flexorsand the inhibh,on(relaxation) be synergisticratherthan antagonistic(34-36).
o f e x t e n s o r sw, i t h t h e c o n t f a l a t e r ai nl h i b i t i o no f
f l e x o r sa n d s t i m u l a t i o no f e x t e n s o r (sf l e x o ra n d segmental distribution of acupoints
cross-extensor rcflex)(28,29).Most rehabilitation Themainacupuncture meridians crossing the frontal
treatments by electrophysical agentsand of course t h o r a c i ca n d a b d o m i n a w
l a l l a r e t h e Spleen,
a c u p u n c t u r eu, s e c u t a n e o - m u s c L l l a r r e f l e x e s
t o S t o m a c h , K i d n e y a n d t h e C o n c e p t i o nV e s s e l
achievemuscle relaxationand to ameliorate the Meridians. During their course over the abdominal
intramuscular blood supplyto individualmusclesor a n d t h o r a c i cw a l l , t h e s em e r i d i a n sd e v e l o p6 6
muscular groups. The selectionof the area to be p o i n t s( 1 1 0b i l a t e r a l l y A ) .p p l y i n ga c u p u n c t u rteo
stimulated dependson the targetmuscle. points on the thoracic area. irrespective of which
m e r i d i a n st h e y a r e o n , i n f l u e n c e st h e t h o r a c i c
VegetativercIlexes visceraor their functions,and needlingpointson
T h e s e a c t v i a t h e v e g e t a t i v en e r v o u s s y s t e m a n y o f t h e m e r i d i a n tsr a n s v e r s i nt h Be a b d o m i n a l
(sympathetic and pafasympathetic). Thereis a large wall affects the abdominal viscera or their functions.
numberof shortand long vegetative reflexeswhich Moreover, all the meridians follow a course towards
c l o s et h e n e r v o u sc i r c u i ti n t h e b r a i n a n d s p i n a l the middle frontaland dorsal lines, similar to ihe
c o r d ,a n d i n t h e b i g n e r v o u s g a n S l i ao r s m a l l e r segmentaldistribution of deep pain that Kellgren
peripheralganglia.There are not only seSmental (37)chartedafter injection of NaC/ in the interspinal
reflexes,many other vegetativereflexeshave been l i g a m e n t so f t h e v e r t e b r a e .T h e d e r m o t o m a l
describedin medicine.For example:the segmental distribution of the sympathetic fibrescoincideswith
and suprasegmental reflexesthat are produced due the distr;bution of acupuncture pointson the second
to local biochemicalchangesand tissuedamage in branch ofthe Urinary Bladder Meridian.
patientswith acute myocardialischaemia(AMl). The same accurate,neurotomicdistributionof
This is known as the Bezold-Jarisch reflex (abnormal acupuncture pointson the UrinaryBladderMeridian

lvlay1997 Vol l5 No.l 37 Acupuncture in Medlcine

o c c L r rw s i l h l h e C o v e r n i n gV e s s eM l e r i d i a n l. h e li,er , and Pericanliun)6. The syslenrsirclivated
acupLrnclLrre points lrlrg l ard 2, Urinary Bladdet l h r o u i thh e s p o i n i sm a y l l e e f d o 8 e r r o l rosp i o i d
Il-1.5 and 4l and Coverrl/)gyesse//.1,havelong analgesicsystcms,fon opioid systerrs,ar)clcenlral
b e e n u s e d f o r t h e l r e a l m e n ol f l u n g d i s e a s eA. I J sympathetic pair inhibitiof syslemsaclifg Ihrolrgh
t h e s e p o i n t s c o n c e r nl h e T 2 - 4 n e r v e r o o l s a n d I h er e t i c u l aI or r m a l i ooni t h eb r a i n .
c o r r e s p o n d e r m a t o m i c a l ltyo t h e o u t l e t so i t h e I n r e c e n t y e r r s , i h e a n a l S e 5 i ca c t i o n o i
sympathetic chainol the dorsallung plexus(2nd lo acupLrnctLrre hasbeer usedmainlyiof lhe lrealmenl
4lh thoracicsympatheticBanglion).The trronchae of acuteand chfonicpain,and to a smallerlent ior
a r e a u t o n o n r i c a l il ny n e r v a t ebdy l h i s s y m p a t h e l i . s r r g i c a l a n a l g e s i a w h j c h i s e i l e c t i v e
plexus,as are lhe divisionol the tracheaand all the n e u r o c h e m i c a ltlhy r o u g ht h e d e s c e n d i npga i n
vessels which transpodl)loodto the bronchialtree. conlrolsyslenr. I his consists ol loLirparls:lhe spinal
F r o m t h e s a m e a n a t o n r i c nrl e S i o n s t a f l l h e sysler.(dorsalho ), lhe codicaland diencephalic
preganglionic branchesol the low,ercervicalancloi syslenr, the mesencephalic (PACand PVC)system,
t h e f i r s t a n d s e c o n dt h o r a c i cg a n g l i ao l t h e a n d l h e p o n l i n e( n L l ce u s r a p h en r a g n u ss)y s t e m .
s y m p a t h e t icch a i n ,w h i c h w i l l i o r m t h e s t e l l a r F . l c hs y s L e mU s e sd i f f e r e n te n d o g e n o u so p l o l d
ganglionin the depthsol the dorsalcervicaltriangle. p e p l i d e sl , J 0 , , l t )T. h e r ei s c l e a r e v i d e n c eo i l h e
The shu mu technique(synchronous stirnulirtion of anirlBesic actionoi acLrpun(ture in thisfield:of 1500
abdominalmu and thoracic,back'5hL/ points)is ir aclrpuncture arti(leson the Me.//iredntabdse, 1100
s p e c i a l a, n c i e n tm e t h o dt h a t L r s etsh e s e S m e n t a l c o n c e r na n a l B e s i n lm . p o r t a niln l h e l i t e r a t u r ae r e
distributionof acupointsto treatdiseases ol Internal a b o r a l o r ys l u d i e so n e x p e r i r l l e l l t a ln i r . a l sa f d
abdominalorSans. ( l i n i c a l r e p o r t sf r o m v e t e r i n n rcyl i n i r : s.,r s. r n i m a l
. , U l o . . ' r e l e . . I r l * l ) t o L r e\ . r Lcr , t , , - . r s b a . t r n
General aclion oI acupun( lure ,limulalion hypnosis, or placeboeifect.
_lhe
integrityof the peripheralnervoussystemand Pomeranz16)detailsexperimental suplrortfor the
spinalcord is considered necessafy for the effective e n d o r p h i n e r g ai cn a l g e s iec f f e c t so f a c u p u n c t u r e .
applicationol acupuncture, AcupLrncture pointsare T h e a n a g e s i ca c t i o n o f a c u p u f c t L r f cea n b e
1 c f [ ' | \ . i n p : r " p i e 6 i ,l i m b ' ' , o m o l e , -. c r . r , r v ' . d I i " d i n . . n r m b . r u \ ^ .\ ' . l h . o p . r l n
motorparaplegia) and in experirnental aninrals$,ith afLrgonist,,a/oxoDe,abolishes the analgesic eflecl,
sur8icalsectionof the spinalcord fl8). A peripheral eithersysLemical y or as a microinfusion lo theCNS.
s t i m L r l Ld r se,p e n d i n Eon ilsqualityn , r a ys t i m u l a l e Also,iniLrsion ol endorphinantibodiesinto lhe CNS
speciiicnucieiof lh-.CNSand provokesecrelionor c a r ra b o l i s hL h ea n a l B e s ieci l e c t .M i c e w i l l l a
q u a l i t a t i v em o d i i i . a l i o no l r e u r o l r a n s m i t l e rg e r ] e l i . a l l yr e d u c e dc o n c e n l r a l i o no l o p i a l e
substances in lhe blood ar]dCSF-Besides this,each r e c e p l o r si n t h e C N S h a v e a p o o r r e \ p o n \ e t o
c o n b i n a t i o no l a c u p u n c l u r p e o i n l sm a y a c l i v a l e a c L r p L r n c t L rarse c, l o r a b b i t sw i t h e n d o f p h i n
differentnervecircuits.Thisview is basedon experi' deiic ency.Endorphinlevelsincreaseconsiderably
mentalresults from the University of Pekingf39). in peripherablood anclin the cerebrospinal fluid
Experiments on rabbitshaveshownthat following duringelectroacupuncture, while at the sametime
arterialanatomosis of two rabbits(crosscircLrlation),levelsin the CNSare reduced.The irnal8esic effect
a n a l g e s i ai s a c h i e v e dn o t o n l y f o f t h e f a b b i to n o f a c u p u n c t u r el a s t sl o n g e rw h e n e n z y n r a t i c
\ , v h i c ha c u p u n c t u r ei s a p p l i e d b u t a l s o f o f t h e degradation of endorphinis inhibited.The analgesic
s e c o n dr a b b i ti n w h i c h t h e b l o o d o f t h e f i r s t a g e n to f a c u p u n c t u r e i s t r a n s m i t t e tdh r o u g ht h e
c i r c u l a t c dt h f o u g ht h c a n a s t o m o s iFs u . r t h e r m o r e ,blood (crosscirculation) and the ccrebrospinal f uid.
C S Ft r a n s f u s i o fnr o m a c a t r , v h i c hh a d r e c e i v e d I h e e l i m i n a i i o no f p i t u i t a f y e n d o r p h i n b y
a c u p u n c t u r ea n a l g e s i at,o a n o t h e fc a t j n d u c e s hypophysectomy abolishesthe acupunctureeffcct.
analgesia in this secondcat after l0 minutes.Since A n i n c r e a s eo f t h e n r e s s e n g eRr N A i o r p r o
t h e s ee a r l y C h i n e s ee x p e r i m e n t st h, e r c i e a s e en<ephalin jn the bfain(pjtuitaryJ is observed ior 24
followingacupuncture oi analgesic neurotransrnitter'18hoursfollowingacupuncturc.
s u b s l a r - r cteost h e C S Fa n d p e r i p h e r abl l o o d h a s A b o u l 6 0 % o f p . r t i e n t s u i f e r i n gi r o n r c h r o r r i c
been r e p e a L e d l c
y o D f i r m e d d
, e m o n s l r a t i n g
l h e nryofascial pain relatcdto the lumbarportionof lhe
a c t i v a t i o no l c e n t r a l p a i n c o n t r o Js y s l e m s( a n d s p i n a l c o r d a r e c o n s i d e r a b l yr e l i e v e da l t e r t h e
others) t h r o u B ha c L r p o i n l s
T .h e n a m i n g o i l h e s e a p p l i c a t i o no f w a r n rc o n r p r e s s e( a s t 4 3 - 5 1 " Co) r
p o i n t s i s a c c o r d i n go n o f e h a n d l o l h e i r ultrasound, and the improver.enloi symptomslasts
t o p o S r a p h i c aplo s i t i o na n d o r ] t h e o i h e r t o i h e i r from 90 minLrtes to 7 days;Priceet a/- iound that
main therapeuticaction. Their has
specificity Lreen application of electroaclrpLrncture to localacupoints
i n v e s t i g a t e ed x p e r i m e n t a l l oy n a n i m a l sa n d relieved587. of the patientsfor weeksor months,
c l i n i c a l l yo n p a t i e n t sa, n d i t h a s b e e nf o u n dt h a t up to 3 yearsf,l2).Han sug8ests that the specific,
r a n d o n r l ys e l e c t e d s, h a m a c L r p o i n thsa v e a n lon8-termanal8esic effectof acupunctureis due to
analgesic effecton 28 35% of patients, comparedto two factorsf,l-lJ.The activation of a serotoner8ic and
kaditionaJ acupointsthat havean analgesic effectin m e t e n k e p h a l i n e r g ince u r o l o g i c acl i r c u i t i n t h e
5 5 8 5 ' %o f t h e p a t j c n t s .P a p e r sp u b l i s h e dh a v e upperpartof ihe descending pain inhlbitorysystem
involvedthe acupoints:lung 7, Stontach 36, Lar1e ( i n t h e m i d d i e n e c e p h a l o nt h) ;i s r e s u l t si r t h c
intestine1 and 10, Splcen6, Triple Enertiser5, c o n t i n u o u si n h i b i t i o no f n o c i c e p t i v e s t i m u l ia t a

AcupunctLrcln Mcdicina 38 ^.1at1997 \/al 15 No.1

 s p i n a lJ c v c l ,a n d t h u s n o n p e r c e p t i o o l l f p a i n enhancingelfectsof MENSon wound healing,on
c e n t r a l l yA. 1 1 dt h e p e r i p h e r a l
a c t i v a l i o no i l o w tendonrepairin animalmodels,and on the recovery
lhrcsholdmuscularnrechanorcccpiors,incrcasing of injlrredathletessuffering from rupturedligarnents
the activityof largcdiameterncrvcfibres(thepain a n d t e n d o n s A . l s o , l a b o r a t o r ys t u d i e ss h o w t h e
m o d u l a t i n gs y s t e m )a n d g j v i n g l o r ] Bl a s t i n g a b i l i t yo f t h e M E N Sd e v i c et o s t i m u l a t ec e l l u l a r
inhibilionof nlLrscular pain.The long{ermanalBesic physiologyand growth: increasedATP by almost
effectof acLrpufctLrre is the rnostdiificult area to 500%, increasedmembranetransportby 30,10%
p r o v i d ea n a d c q u a t es c i c n t i f i ch y p o t h e s i sH. a n ' s afd increased pfoteinsynthesis by up to 73%.
' " ' o r y o l l u u - r . o \ , B h ' n n r o lm b i , " r : l g ' r T h c e n d o g e n o uosp i o i d p e p t i d e se, n d o r p h i n s ;
s y s t e mn r a y c x p l a i n o l l e o i t h e a c u p u n c l u r c c n k e p h a l i n sa n d d y n o r p h i n s a, r e n o t a c t i v e
anaigcsicmechanismsa,l4l-Activationoi "Dit'iuse e x c l u s i v e liyn t h e l i e l d o l p a i n .T h e y h a v ec l r r e c t
Noxiouslnhihilor),Colrlrols"(DNIC) triggeredby eiiect in all forrrs of dependence: drugs,smoking
n o c i c e p l i vpee r i p h e r aslt i m u l ai c t i v a l i r gA 5 a n d C a n d a l c o h oi s m . L o w l e v e l s o f m e t h i o n i n e
fibrcscan be allolhermechanism lor a ceftralaction enkephalinhave been found in patientssuffering
ol acuput'lcture, and involvescompler Joopsfrom f r o m P a r k i r s o n i sd i s e a s e ,a n d v e r y h i g h
s p i n a l a n d s u p r a s p i n asl t r u c i u r e s1 , r 5 , 1 7 )f.h j s c o n c c n t r a t i o nl e v e l sh a v e b e e n r e p o r t e d' n t h e
s u g g e s ltsh a l n e L r r o t r a n s n ] i t tsiunbgs t a n c eosf t h e dorsalcochear nucleusand intermediate genicuiate
spinalcord and CNS, both opioid and non-opioid, body in patienls suffering lrom schizophrenia. There
a r e l l r e m a i r c o - o r d i n a t o r sa l a " s t i n r u l a l i a n- i s a l s o s i g n i f i c a f te v i d e n c ef o r a r o l e i n t h e
analysis response" phenomenofand thal theyare regulationof food inlakc f54J.In particularwjth
responsible lor the generalised internalreactionof regard1o obesity,jt has beenfound that there is a
theorganismthalfollowsan acLrpuncture treatment. l a r 5 1 en u m b e r a f " s a t i a t i a n " p e p t r c l e sa n d
" stit1tu |ati nI .rppelile"peptidesin the hypothalamic
Electroacupuncture nucleiof the brainand in the gastro-intestinal tract,
Electroacupunctlrre ana gesia is a well established f u n c t i o n i n g a s h o r r n o n e i n h i b i t o r s o r
phenoinenon148-501. In Seneral,a lower (1-15Flz)
p u l s er e p e t i t i o nr a t e o i e l e c t r i c a s t i n l u l a t i o nr s
" . . o , r _ . d $ t h . l u 1 6 - . i m _ u r p r ,l - n " r i m . - r n
LOWfRTQUENCY ( H I C HI N T E N S I T Y )
anal8esia, and a longerlastingeffect.A high p!lse
ELECTROACUPUNCTURE (4HZ)
fate (100 200H2)rapidlyinducesa maximumpain
threshold,but the effectslast for a shofterperiod AcLivationol efdotti neic sy5lenr
i T a b l e s 2 a n d - : l ) . A l s o , s t i m u l a t i n gt h e S l o so, n s eo L I . n r l 8 e sa
p e r i a q u e d u c t acle n t r a lg f a y ( P A C )p r o d u c e s - o n gh n n Br f a B e s i ce i i e c l
anagesiasimilarto acupuncture anallesia in many Ceneralisedafa Besiceilecl kl Ii!se ana gesia)
rcspccrs.
Accordingto otherstudiesby Han Ji-Sheng and Xie N./orore reversibe analgesia
C u o X i ( l 9 8 5 ) h i g h i r e q u e n c ys t i m u l a t i o no f PeEisclonSafterterminationoi the nim!lus
acupuncture pointshasa mainlylocalaction,while 5 t i m ! l a t etsh e s e n s o rrye c e p t o rosf d e pm u s ce sc a u s i n g
Inu ipquer, 1 l^a a g"ne13'.od drd BA' d' r ^r thc midbrainPACto releaseenkephains, activatesthe
'q/ . \rlF p r r a l , o r d . " ' f i . r . d l i r e q L r e nr, p d r F r a p h en u c e u sa n dr c t c ! a r m i g n o c el u l a rn l c e ! s , i n d
inefieclive. act vatesthe PACendorphinsynem
E ectroacupunctlfe at a frequencyoi 2llz provides A f a l g e s i am a i nv d l c t o m c t h i o n i n c. n k p h a l i n .
a n a l g e s i a. n a i n l yt h r o u g hr e l e a s eo f m e t ho n r n e
e n k e p h a l i n1,0 0 H 2a c t sm a i ny t h r o u 8 hr e l e a s oe f
dynorphin A, while with 15Hz both
neurotransmittinB substances are detectedIn almost
equalquantities.Recentunpublished work suSgests H I C H F R E Q U E N C( Y L O WI N T E N S I T Y )
that stimulationat a frequencyif excessof 1oHz ELTCTROACUPUNCTURE (2OOHZ)
lncreasee s n z y m a t i cd e g r a d a t i o no f c i r c u l a t i n g Activationof monoamines(serotonin,norddrenalineerc.l
opio d. l5L- .dJ, 18 rhp.rn. 8F.i' FhF,. Rapidld y e v e l o p i naSn ag e s i a
A l s o , n e w e l e c t r o t h e r a ptye c h n i q u e ss u c h a s Shorllastinganalgesc effect
" M i c r a c ur t e n t E l e c t t i c a I N e u r a m u s c u l a r
Segmental y disft blted ana Sesia(locn ised)
Siimu/at/on"(MENS),and elcctroacupuncture with No c!m!lative effect
currentintensitiesin the order of 400pA at 10-60 Nol ,a/orone reveEble
Volts(low voltagepulsedmicroampstimulation) and N o p e 6 i s l n caef l e rt e n n i n a t i ooni t h e s t i m u l r s
a n e x l r e m e l yl o n g p u l s ed u r a t i o nw i t h t h e t o t a l No m!s.le tw tch lttaniccontraciures)
currentequalto 5x10' coLrlombs/sec, are awaiting A ,t \ . t 6 \ . 6 . . r ' p h p ." n d d i r . ,t ) r - ' , . ' l r
the resuLts ol cjinica tesEf5253).Thistechniqueis d o r s o l a l e r ia! n i . u l ! s s e r o t o n i n o r a d r e n anle d e s c e n d i n S
b a . c do r \ c q r rL l t - Sh,u l z l . r \ ' \ u n i , r o d m p a r a i n h i b i t o r sy y s l mlsb y p a s n 8 t h P A Cc n d o r p h i ns y n e m )
( p A )c u r r e n t sa r e b e t t e ra t e n h a n c i n gc e l l u l a r a- . ,. 1." , , r ,l\' .orin \"ndDr.r;l\
physiologythan are cu[ents of highef amplitude.
S e v e r acl l i n i c a ls t u d i e sh a v e d o c u m e n t e tdh e

N l . i r1 9 9 7v o l 1 5 N o . l 39 Acupun.tLrc in Medicine
neurotransm ittersf55). lt has also been clinically n e u r o p e p t i dYe, e n k e p h a l i n sa,m i n e se t c . a n d i n
establishedthat acupunctureacts on the systerns t h e i r m o d e o f a c t i o n ,s e c r c t i o n a, c t i v a t i o ra] n d
oulJinedin TableI (56).'fhe acttonon thesesystenrs e n z y m a t i ci n a c t i v a t i o nl .t a p p e a r st h a l t h e s e
must be attributedto the ability of acupuncture to s u b s t a n c easr e s i r n i l a ri n a c t i o i rt o c l a s sc a l
influenceCNSfur]ction. e n d o c r i n ch o r m o n e sa, c t i v a t i n gn e g a t i v ea n d
The Nobelwinningneuroscientisl CeraldEdelman p o s i t i v ef e e d b a c km e c h a n i s m sT. h e r o l e o i
a c u p u n c t u r ien t h e s ed i s e a s e hs a s b e e n o n l y
p a r l i a l l yc l i n i c a l l ye s i a b l i s h c da,n d t h e m o c l eo i
THE SYSTEMIC,
NON-ANALCESICACTION actionis purelyconjectural.
OFACUPUNCTURE
Reticular formation
l h F r p t, u l d f o r n d t i o , n t r . t . t n . f B r nt p -n t r p L |, r .
C a r d i o v a s c u lsJyrs t e n r a n d r - r e u r fai lb r e sw h i c h u n i t et h e c e r e b r anl u c l e i
a f d e a c h s e p a r a i e lw y i t h s u b c o r l i c acl e n t f e s :
t ha l a mu s , c e r e b c l l u r np,a r e n c e p h a l ci ce n t r e s ,
lperiphedl and L)taincnculaLiah) medullaoblongataand spinalcord. Functionally, it
controlsthe mechanisms of wakefLrlness, sleepard
levelof consciousness, and thoseol rnLrscular tone,
cardiacand respiratoryrhythm,and blood vessel
t o r ] e ,r e B u l a t i nagn d m e d i a t i n gm o l o f ,a u t o n o m i c
la.tian on natat netve candu.tion velacitf and sensary ano sensory runclrons_
nervecandu.lbn vehr ity) T h e r e t i c u l a rf o r m a t i o nr e c e i v e si n f o r m a t i o n
R e da n d w h i t eb o o d c e s a n dc e l d i i l e r e n t i a l c o l n t cor]cerninB the senses, analysesit qualitalivelyand
tchanlesin bload chcnistry) q u a n t i t a t i v e l ya n d , t h r o c r g hm u t i p l e s y n a p s e s ,
transforrns it to a slow rhythm.As a resultof this
analysis, \,hen the nervoussignalcominSfrom the
l 5 7 l r n e n t i o n st h a t t h e r e i s n o m o r e c o m p l e x peripheryreaches the uppercentres(bfainnuclei)it
functionalstructurein the universethan the human i s d i f f e r e n t i a t e d f r o m t h e i n i t i a l i m p u l s e .T h i s
brain, which is a networkcommunicating a c c o r d sw j t h t h e h y p o t h e s itsh a t m e c h a n r c a ,
e l e c t r o c h e m i c a lw l yi t h b o t h t h e o u t e r a n d i n n e r t h e r r n a a
l n d c h e m i c a ln o x i o u ss t i m u l i a f f e c t
e n v i r o n m e n l l. t e m i t s a n d r e c e i v e sd y n a m i c n e u f o n a l a c t i v i t y in the medullary and
rom" o,1. n i . i g r a ' . a rd d r ' . s e l o 1 1 . . " . g r ,1.. m e s e n c e p h a lr i c t i c u l a fr o r m a t i o ne, s p e c i a l l y
I t s n e L r r o nisn l l u e n c et h e I u n c t j o no f t h e h e a r t , around the nucleus gigantocelu ar s. Also Melzack
k i d n e y sl,u n g s ,m u s c l e st,h e s k i n a n d g l a n d s .
The and Casey f62) suggest that reticular neuronsrnay
b r a i n r e S u l a t ebsr e a t h i n gd, i g e s t i o n andblood mediate Ihe affeclive/..otivational dimension of the
circulation;and analyses the acupuncture stimulus. p a i n e x p e r i e n c e
a n d p a i n - r e l a l e d
b e h a viour,
r r d r ,a r s ; o l e i o l h p e r , u l r ' f n r r d t i . 1 ' pdrr
Thus,throuBhits neuroloSical action,acupuncture
contributesto the balanceof the chemistryof our perception and modLrlalion.
nervoussystemand can influencethe hundredsof This descendinB modulatorysystemmay produce
neurotransmitting substances that regulatein whole s u b s t a n t i fau l n c t i o n aal l t e r a t i o ni sn p e r i p h e r a l
o r i n p a r t o u r h e a l t ha n d d i s e a s ee, m o t i o n a l or8ans. Indeed, irnplantation of electrodes in certain
b e h a v i o u r i, n s t i n c t s d, e s i r e sa n d p s y c h o l o g i c a l a r e a so f t h e r e t i c u l a rf o r r n a t i o no f t h e rnedulli
d'sposition.Depression is relatedto disorderin the oblongata, partjculafly those oLrtside the cerebral
' r r , l, - , ; u . e o , h . r n u -o' r . r ' e l r l a r . r . . u c .' _ r ; . ,
m e t a b o J i s ronf n o r a d r e n a l i na n d s e f o t o n i n ;
amphetamineshave an antidepressant effect;and a n d f u n c t i o n a l e v e l i n g u i n e ap i 8 s ,s L r c ha s
benzodiazepinereceptorsare to be founcl In the hydronephrosis, organicdysplasia,bone deforrnity
cerebellum and limbic system. Camma e t c . l t s e e r n st h a t t h e a c t i v a t i n gs y s t e mo t t h e
a m i n o b u t y r i ca c i d ( C A B A ) is an inhibitory feticular forrnation regulates the levelof response ot
neuroiransmiller ( t h r o u g h
the K+, Na+ and C/_ the functjonal nuclei of the CNS, dependlfg on the
pumps)and hasintenseanxiolyticacLionf58-67)- information it receives from the sellsorypathways. lt
A c u p u n c l u r e i s L r s e df o r t h e t r e a i n r e n to l a can enhance or repress a multitude of visceral and
m u l t i t u d eo f d i s o r d e r s u c h a s m e t a b o l i ca n d psychological symptomssuchas anxiety,respiratory
endocrinedisease, mental,respiratory and digestive phenomena, sweating, insomJl ia, jrritability, cardiac
disorders,allerties,neurovegetative disordersetc. a n d r e s p i r a t o r y
r h y t h m , a n d v a s c L r l al ro n e .
Reference to the neuroloBical theoryof acupuncture Interference with the homoeostatic mechanisnrs of
for thesedisordersis basedon the one hand on a t h e r e t i c u l a f
r o r n r a t i o n
c a n b e a c h i e v e do n iy
homeostaticrole for the feticularforrnationof the r l _ o L B h . F n - o r ) . i T L l d i . n d ' J p r r ' r r o . \ e r )
b r a i n , a n d o n t h e o t h e r , t h e m u l t i t u d eo f possibly a suitable such stimulus. Particular points
n e u r o t r a n s m i t t i nsgu b s t a n c etsh a t a r e d e t e c t e d such as the auricularpoints Shenn'etl, Jerameand
peripherallyfollowingtreatmentwith acupuncture: Master sensorial point, and somatic points such as
c h ol e c y s t o k i n , b o m b e s i nn, e u r o t n s i n C,R H H T . 3 a n d 7 , 1 1 . 3 C, 8 . 2 0 , 5 T . , + 1 P, C . 6 a n d 81.10
( c o r t i c o t r o p i nr el e a si nI f a c t o r ) ,d y n o r p h i n , have an eqLrilibrating effect on mental diseases and

A.upunctL!rctn Me.licine 40 lr1,iy1997 val 15 No.l

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
.rfieracul)unctLrre tfeatnreft,ma-vbe exp a ned if u,e 1 . 1l o i 8t !c re, r U 5 , C a d d !n J H ( l 9 l r I , \ n ! f i d e f l l i e dl e p r e s s i v e
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
'I 1 8 r \ . 1 ! r r . vr \ 1 ( 1 9 9 5 ) S L r i n J C o r d I n , C o i i P M , - " d .
o r y , ) i p r i . . l n S , r ! n d e r\s' V B ,
| 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 &
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I r . . r i . i D . i r . / R c h a b i l i t a t i a n !. V B S a u n d c r sC o . , s . - " n . - " :F o n . l l o n a lb a c k S r o ! n dt o a c u p ! n c t u r .c f i c c t sl n
P h a d c p h i a r. + 0 :2 7 paif efd .l tat. M.di.:/ / lypathctcs.15tl):271 81
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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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