Introduction to Neuropuncture’s Theory and Development
Neuropuncture is a special system of acupuncture that combines neuroscience, other Western medical sciences, and current evidence-based acupuncture clinical research with the classical TCM acupuncture model. It is my belief that a deeper understanding of acupuncture’s underlying mechanisms empowers the practitioner with knowledge in treatment. Once we understand these mechanisms, we can apply these findings in the area of diagnosis and treatment of pain cases, internal medicine cases, sports medicine cases, and orthopedics; and this is truly only the beginning. Understanding these concepts creates an extremely effective approach to modulating the nervous system. Finally, we can intentionally target specific receptors for the release of particular neuropeptides, reset dysfunctional visceral autonomic reflexes for improved organ function, and depolarize excited, overstimulated nerve roots for pain management. Neuropuncture works by predominantly targeting and stimulating specific neuro-tissue.
When we take a look back to 5000+ years ago when TCM was being developed, the physicians of that time did not have the understandings and advancements in the study of anatomy and physiology, cellular biology, molecular biology, molecular genetics, and especially neuroscience that we have benefited from in the past 75 years. When these new scientific models are applied to classical TCM acupuncture theory, the “Ah-ha” light bulb goes on, and a lot of the mystery and smoke clears away, revealing an absolutely amazing neuro-medical treatment modality. Neuropuncture is the outcome of the weaving of two very different but also very similar medical theoretical sciences: Traditional Chinese Acupuncture and Western neuroscience.
Acupoints, meridians, and neuroscience
Let’s look at an example: LI4, He Gu, is a very popular acupuncture point in TCM with many functions and traditional indications ranging from any pathology in the face, teeth, throat, neck, stomach, and intestines, to specifics such as headaches, redness with swelling and pain in the eye, epistaxis, toothache, facial swelling, sore throat, contracture of the fingers, pain in the arm, trismus, facial paralysis, febrile diseases with anhidrosis, hidrosis, amenorrhea, delayed labor, abdominal pain, constipation, and dysentery (Cheng & Deng, 1999). Many texts refer to its benefits; for example, Maciocia (1989, p.376) notes that “it can be used in many painful conditions located anywhere in the body” and “it has a strong influence on the face and eyes…and is often used as a distal point when treating problems of the face, including the mouth, nose, and eyes.” It is known variously as He Gu, Joining Valley, Uniting One’s Mouth, Tiger’s Mouth, and Holding Mouth (Bensky & O’Connor, 1991).
Acupuncture point LI4 is located in the dorsal interosseous muscle, between the first and second metacarpal bones; its deep position is in the transverse head of the adductor pollicis muscle (Bensky & O’Connor, 1991). It has a radius of about the same size as a dime, nickel, or a quarter, depending on the patient. TCM uses a unique body measuring system to locate an indvidual’s acupuncture points (from early times TCM observed differences in anatomy from patient to patient, just as this is confirmed today with autopsies, gross and molecular anatomy, and physiology). The TCM Large Intestine meridian travels up the radial side of the arm and into the face. When we apply all of these findings, we begin to understand the deeper mechanisms of LI4. What we find is that the afferent delta fibers of the superficial radial nerve travel under and through the classical TCM acupuncture point LI4/He Gu, which is supplied by a dorsal branch of the radial nerve, and in its deep position by a palmar digital branch of the median nerve (Bensky & O’Connor, 1991). The radial branch, He Gu’s main innervation, branches from and creates a large part of the brachial plexus of C5–T1 (Rohen, Yokochi & Lutjen-Drecoll, 2003). It also has A-delta fibers that terminate in the hypothalamus. When the hypothalamus is stimulated, beta-endorphins are released, which then stimulate the periaqueductal gray (PAG), creating a strong systemic pain-relieving effect (White, Cummings & Filshie, 2008). The fact that the brachial branch innervates C5–T1 tells us that all other nerve innervations will be affected at this spinal segmental location (see Figure 1.1).
Theoretical nerve physiology can be applied, and we notice that a range of conditions can be treated, ranging from cervical pain to facial pain, ear pathology, and eye pathology; and since that pathway influences the chest, cardiac and gastric conditions can also be treated. Therefore, it’s no surprise when we look back and see that the single distal acupoint LI4/He Gu affects all these areas of the body and is used to treat so many different, same-side facial complaints, since the superficial radial nerve has an effect on the brachial plexus and together with the nerve branches, distal and terminal, exerts influence over the side of the head and face. Segmentation above the thoracic spinal column therefore, in accordance with neuroanatomical dorsal horn theory, will influence anything below that segment (White et al., 2008).
In an effort to examine this further, we must not omit the fact that if we align a chart of the Yin meridians with a chart of the upper arm nerve pathways, they are almost identical (see Figure 1.2).
Figure 1.2 Upper extremity nerves and upper extremity acupuncture pathways
A re-analysis of all TCM acupuncture theory and TCM acupuncture classics such as Huang Di Nei Jing and Ling Shu, in conjunction with these neuroanatomy understandings, is necessary in order to catapult acupuncture into the future along with present-day medicine. It also means we can begin to understand acupuncture’s unique and extremely powerful effects in the hope of maximizing these effects and expounding on them. Neuropuncture is the beginning of this process. It is important to understand that this does not take any credit away from classical TCM acupuncture, but only strengthens its value and appreciation due to its undeniable relationship with neuroscience and consistent clinical outcomes when applied. Examining the theory and art of TCM and tracing its patterns and cross-referencing them with modern-day neurophysiology and Western medical science as a whole is an integrative science that will truly help to enlighten this medical science and art. These classical TCM principles have achieved clinical success for thousands of years. Saying that we cannot understand all of the mechanisms does not dismiss its effectiveness in any way. We may not currently have a “complete” Western medical scientific explanation of all acupuncture’s phenomena, but that only helps to encourage us to take a deeper look. Neuropuncture is the beginning of this journey.
Qi and afferent neurophysiology
The TCM classics state that the patient must feel the Qi sensation in order for the treatment to be effective. Some have interpreted this as meaning that the practitioner should feel the Qi grip the needle. Nearly every clinical trial and study completed today on acupuncture is performed with the protocol calling for the needle to be stimulated until De Qi (“Big Qi Sensation”) has been obtained by the patient. There are two fascinating points of view to consider here and neuroanatomy underlies them both. The first is the De Qi sensations experienced by the patient, as explained in the Nan Jing (Unshuld, 1986) and Ling Shu (Wang & Wang, 2007). These classical sensations are: Ma (numbness), Chang (distension), Suan (an ache, muscular ache), and Chung (heaviness); also warmth, cold, the sensation of ants crawling on the skin, and slight pain (a prick). The second point of view of the De Qi sensation is that felt by the practitioner when needling and manually stimulating the needle. Qi has many translations, including vital breath, air, vapor, atmosphere, and energy (Jing-Nuan, 1993).
Many different styles of acupuncture require stimulating the needle with different needle techniques to stimulate the Qi in various ways, resulting in different effects (Cheng & Deng, 1999). The Ling Shu says: “Once the Qi has been reached, do not repeat” (Wang & Wang, 2007, p.332). This illustrates that the ancient masters of acupuncture were aware of the sensitive nature of the underlying neuroanatomy and that it was not to be harassed or insulted. Correlating the different De Qi sensations with different therapeutic actions (a warm De Qi sensation treats a cold condition) further shows that different Qi sensations were known to result in different physiological effects. This also illustrates the ancient practitioners’ understanding that when Qi was felt, the stimulation was complete.
When an acupuncture needle is inserted into the desired acupoint, there are several different peripheral afferent fibers that can be found in the area of insertion. These are the true A-delta, A-beta, and A-gamma fibers in the skin, C-fibers, and II and III muscle fibers that create this neuro-network underneath the surface (Filshie & White, 1998). Patients report experiencing sensations such as pressure, tingling, radiating, spreading, heaviness, deep ache, and even traveling sensations. The free nerve endings of those small myelinated and unmyelinated fibers are organized into broad networks and produce sensations exactly like the ones that the masters in our classics report: light touch, pressure, vibration, numbness, deep pressure, heaviness in muscle, pinprick in skin, cold, soreness, aching, itch, and heat (Bensky & O’Connor, 1991).
These different sensations are directly associated with different neural tracts, with different terminal endings producing different outcomes. Also these tiny nerve fibers get wrapped around an acupuncture needle shaft during needle stimulation and give the practitioner the “grasped” feeling. At the local insertion site there can be up to 15 different neurochemicals, amino acids, cellular enzymes, and red and white blood cells, which produce a unique healing chemical soup (Filshie & White, 1998). So, to go back to LI4/He Gu, we can stimulate that area differently, using different needle techniques, and produce several different sensations, stimulating several different nerve tracts and thus producing several different physiological responses to treat several different conditions. Also, as we mentioned, the superficial radial nerve travels up the arm and continues to merge with the brachial plexus and innervates C5–T1. This branch will affect all the nerve roots that merge and enter into the face, neck, and shoulder; some merge with cranial nerves that affect organs in the thoracic cavity, and all of these exit the cervical spine from C5–T1 (Marieb & Hoehn, 2009). So, indirectly, you can absolutely affect the facial nerves by stimulating the superficial radial nerve distal branch at LI4/He Gu, as well as affecting internal visceral structures while producing several different sensations (see Table 1.1).
|
Classical De Qi sensation |
Associated nerve fiber |
|
Soreness |
C-fiber |
|
Numbness |
A-gamma |
|
Vibration |
A-beta |
|
Heaviness |
A-delta, III muscle fiber |
|
Achy |
IV muscle fiber |
|
Cold |
A-delta |
|
Hot |
C-fiber, IV muscle fiber |
|
Pinprick |
A-delta |
Neuropuncture has been in the “researching and organization” stage for the past 10+ years, and is still developing. I wholeheartedly believe that this material and its future work will enhance your understanding and practice of acupuncture, as well as aid in carrying you into the future of acupuncture in our Western and global medical science society.
