Explanation of Theory and the Clinical Application of Neuropuncture
Our body is the most powerful manufacturer of natural pharmaceutical drugs, homeostatic neuropeptides and healing biochemicals in the world, and we need to find a way to access these natural physiological processes. Research shows that the human body, particularly the human brain, when given the correct stimulation in the right environment, can produce practically any compound necessary for healing (Frisaldi, Piedimonte & Benedetti, 2015). Placebos have clearly illustrated this notion. Masters of meditation have been able to produce special immunoglobulins under deep meditation (Fernandes, Nóbrega & Tosta, 2012).
I have personally analyzed the specific neurophysiological process of acupuncture and research into the neuroscience of specific acupuncture protocols, and put it into a highly effective and reproducible system of treatment. When applying Neuropuncture to a medical case, you must apply a special mindset. It will take some time to adjust from the classical TCM energetic viewpoint to the neuroanatomy viewpoint, but what you will find is a concise, reproducible, exciting approach to treating patients. If your back studies are in TCM and classical acupuncture, trust me, it may be a difficult transition—but well worth it! You can still practice classical TCM with the addition of being aware and applying this information to the actual location and neurophysiological matrix of an acupuncture acupoint.
First determine the targeted neural-complex structures of the pathological condition, then choose the Neuropuncture acupoints that you want to stimulate to affect the pathological neurostructures or produce and release specific biochemicals. You can also employ any of the five neurophysiological mechanisms described in Chapter 4 and even combine several of them at once to really amplify the healing force. Applying the Neuropuncture theory of needling in several ways can include the following.
The five Neuropuncture treatment principles (NTPs)
The five NTPs are designed to apply the five neurophysiological mechanisms clinically to medical cases. Through understanding the mechanisms of how acupuncture works, the true pathways of electrical transmission, you can apply the treatment principles to your cases to focus that electrical transmission properly and with intent.
1.Focus on harnessing the “local effect.”
2.Target a specific nerve (e.g. median, sciatica, facial).
3.Target a specific neural plexus. The idea is to stimulate a distal branch nerve that innervates the targeted nerve or neuro-complex.
4.Target a specific segment of the spine.
5.Target the CNS. Focus on specific receptors or areas of the brain.
|
Table 7.1 The five Neurophysiological mechanisms, five NTPs, and four EN treatment principles |
|
|
Neurophysiological mechanisms |
Neuropuncture treatment principles |
|
1. Local effect 2. Spinal segmental 3. EOC 4. CNS 5. Neuromuscular |
1. Harness local effect 2. Target specific nerve 3. Target specific neural plexus 4. Target specific spinal segment 5. Target CNS (release of specific neuropeptides) |
|
Electrical Neuropuncture treatment principles |
|
|
1. Reduce inflammation and begin repair of soft tissues, vs. strengthening soft tissues. 2. Targeting specific receptors for specific neuropeptide release. 3. Interrupt visceral dysfunctional autonomic reflexes. 4. Depolarize specific nerve pathways. |
|
Understanding the NTPs then, after you have determined which neural tract is pathological (e.g. median nerve in carpal tunnel syndrome) or where the pathology exists neuroanatomically (e.g. herniated nucleus prolapse at L4/L5), and which tract can be targeted to be stimulated, choose the specific Neuropuncture acupoint that will accomplish the task. Below are examples of how to apply the NTPs:
NTP 1: Use local needling into, or on the border of, the site of trauma, pathology, and local infections. Use general local needling, superficial or deep, and “osteopuncture” (see later in this chapter) for accessible bone pain/arthritis and tendinitis. This NTP has been used for simple conditions, from swollen inflamed joints, sinus infections, and stubborn non-healing surgical incisions, to skin infections or burns.
NTP 2: After determining the root pathological nerve, you can needle distal, “above and below,” Neuropuncture points to affect that connected pathological nerve. A great example is carpal tunnel syndrome. Needling the carpal tunnel release Neuropuncture point and then needling the median Neuropuncture point, and running 25 HZ microcurrent through those points directly targets the median nerve and the carpal tunnel. Another few examples are the trigeminal nerve for trigeminal neuralgia, or the facial nerve for Bell’s palsy.
NTP 3: Sometimes you may come across a nerve that is pathological but you cannot directly access that nerve root. So, determine what nerve, distally, you can stimulate that runs up and into the same neural plexus that will affect the pathological nerve. The pudendal nerve is a great example. I will use the tibial Neuropuncture point (SP6), to access the sacral plexus and affect the pudendal nerve indirectly. Another example is the sciatic nerve, and needling the common peroneal nerve, a distal bifurcation of the sciatic nerve.
NTP 4: First determine the exact spinal segment that you need to target. You can use the dermatome and visceral charts (Tables 2.2 and 2.3) at the beginning of the book for easy reference. Then needle motor points or Neuropuncture acupoints that innervate the desired spinal segment and EN them. Using MRI imaging can determine the exact level of disc pathology, and if you are focusing on organ health the visceral tomes must be used for accurate, focused treatment.
NTP 5: This NTP is knowing how and when we apply the specific frequencies to target and release specific neuropeptides. In this NTP we are focusing on the stimulation directly to the CNS, the most powerful producer of neurochemicals in the world. Utilizing specific electrical frequencies on specific Neuropuncture points focuses your treatment in a very special way. A great example of this is with Parkinson’s—by needling the Neuropuncture protocol we are targeting the tyrosine hydroxylase enzyme and also issuing a neuroprotective property to the brain itself. All of this is being completed utilizing specific electrical frequencies on specific points. Another simple example is targeting any of the three endorphins with specific electrical frequencies.
Once you have determined which neural tract is pathological (e.g. median nerve in carpal tunnel syndrome) or where the pathology exists neuroanatomically (e.g. herniated nucleus prolapse at L4/L5), and which tract can be targeted to be stimulated, choose the specific Neuropuncture acupoint that will accomplish the task. Below are examples of applying the neurophysical mechanisms of acupuncture to clinical treatments.
•Mechanism 1: Use local needling into, or on the border of, the site of trauma, pathology, and local infections. Use general local needling and osteopuncture (see later in the chapter) for accessible bone pain/arthritis and tendinitis.
•Mechanism 2: After determining the root pathological nerve, you can needle distal Neuropuncture acupoints to affect that connected pathological nerve.
•Mechanism 3: Access these spinal segments by needling large muscle groups whose motor nerve innervates that targeted spinal segment. You can also needle the Neuropuncture acupoints that innervate the targeted nerve plexus directly, and both approaches will affect the associated viscera (protocols are in Chapter 8).
•Mechanism 4: For a general systemic effect, needle bilateral points or ipsilateral ones (i.e. superficial radial nerve, deep peroneal nerve, tibial nerve). Usually, two limb Neuropuncture acupoints, bilateral ones, are needled and EA applied so that the muscle contraction is visible and a nice De Qi sensation is produced (protocols are in Chapter 8). This will ensure the maximum release of endorphins for systemic pain relief. Auricular EA can be applied to enhance the effect.
Below is an example of combining several of the NTPs for a sciatica case:
1.Local needling: HTJJ L3–L5/S1.
2.Distal needling: Common peroneal Neuropuncture acupoint and saphenous Neuropuncture acupoint.
3.Then apply ea: 2–100 Hz millicurrent to target the mu and delta receptors for the release of beta-endorphins, enkephalins, and dynorphins. It has been shown that burst stimulation results in the largest release of neuropeptides. In this example you are directly depolarizing the sciatic nerve and stimulating the maximum cerebral release of endorphins (Filshie & White, 1998).
Also, remember that in applying this new treatment it is effective to take another, different look at diagnosis and pathophysiology. Nowadays, with an accurate Western medical diagnosis, we can modify very specific neural tracts and target receptors to influence physiology.
Assessment utilizing a 1–4 Pain Upon Palpation (PUP) scale
Dissecting an acupuncture point’s anatomy and physiology shows us that the location of classical acupuncture points consists of a unique neural matrix network, lying under the surface of the skin. Research has examined acupuncture points thoroughly and has concluded that a “functional” acupuncture point is the specific area where bone, muscle, nerve, fascia, and skin conjugate. It is here that neurovascular bundles and connective tissue contain abundant nerves and blood vessels. It is also here that these acupoints have the nodes and terminal ends where the classical Zang-Fu organs, meridians, Qi, and blood were thought to infuse at the body’s surface. I have always applied the PUP scale for assessing a patient’s pain. Applying that PUP scale to Neuropuncture acupoints is a simple way to assess the state of the point.
The PUP scale is a simple way of locating your Neuropuncture acupoint of choice before needling. The practitioner utilizes a 2 lb of pressure scale and a clinical PUP scale of 1–4. When applied to the location of interest, it is a simple clinical way of determining the proper location and status of the Neuropuncture acupoint. You want to target the nerve by trapping it between the bone, or between your fingers gripping the muscle, and eliciting a sensory response from the patient. In doing this, you can determine the phase that the Neuropuncture point is in, as well as the location to needle. I personally assess it by how much neural inflammation is present. Based on the pain scale throughout the entire assessment, you can incorporate dietary recommendations—alkaline vs. basic diet—EPA/DHA dosage, and so on.
You may ask yourself: “How do I measure 2 lb of pressure?” What I did for a while was this: Whenever I was in the grocery section of the food store I would use my index and middle fingers and apply 2 lb of pressure on the produce scale. After a while, I became familiar with the proper amount of pressure to apply. Remember that this is the pressure applied directly to the nerve, and in some cases pressure is applied against the bone. It is a subjective measure—and I really try to avoid subjective techniques—but after training your sensitivity skills, it becomes quite accurate.
1 = light, barely noticeable
2 = moderately bothersome
3 = very uncomfortable
4 = patient jerks away from pressure with facial and possibly vocal display of discomfort.
After reviewing the pathological neuropathology of your patient’s chief complaint, next begin to assess the Neuropuncture acupoints in referencing and applying the five NTPs (see earlier).
What remains is the construction of your protocol from your assessment. While assessing Neuropuncture acupoints, apply pressure to the points and observe the patient’s reaction (see Table 7.2; a scale of 0 would be no reaction, indicating a latent phase).
|
Table 7.2 Pain Upon Palpation (PUP) scale |
|
|
Scale number 1 (latent phase) |
Light, barely noticeable. |
|
Scale number 2 (passive phase) |
Moderate, bothersome. |
|
Scale number 3 (initial active phase) |
Very uncomfortable. |
|
Scale number 4 (full active phase) |
Patient jerks away from pressure with facial and possibly vocal display of discomfort. |
Neuropuncture acupoint assessment
The latent phase (scale number 1) is when a 2 lb pressure is applied to the Neuropuncture acupoint and there is no reaction from the patient. For comparison, in the passive phase with 2 lb of pressure, there is a perception of discomfort by the patient but nothing on a grand scale. In the latent phase there is no reason to needle these Neuropuncture acupoints unless you are applying one of the five NTPs accordingly.
The passive phase (scale number 2) is when 2 lb of pressure is applied to the Neuropuncture acupoint and there is an obvious sensation of discomfort reported by the patient, but no physical pulling away. The patient may say: “Yes, I feel that but there is not too much pain.” This indicates the level of neural inflammation and that this specific Neuropuncture acupoint needs to be needled. Remember, the first Neuropuncture mechanism illustrates the effects of local needling.
The initial active phase (scale number 3) is when with 2 lb of pressure applied the patient feels very uncomfortable and reports a feeling of pain. These Neuropuncture acupoints are excellent to needle due to the fact that they will enter the fully active phase if not treated.
The full active phase (scale number 4) is when without any pressure the Neuropuncture acupoint is in a constant state of pain. These Neuropuncture acupoints need to be needled, and the sensitivity only confirms, and diagnostically illustrates, the necessity of needling these Neuropuncture acupoints in systemic pain cases such as fibromyalgia syndrome.
So, utilizing this scale, if a particular Neuropuncture acupoint is in the passive phase, it can still be needled but may not have a great amount of inflammation in that area. You would needle a passive phase Neuropuncture acupoint if it was dependent on the five NTPs being applied. If a Neuropuncture acupoint is in the active phase, then you should definitely consider needling and properly stimulating it. You can use this assessment scale to give you a preliminary scan of your patient’s potential Neuropuncture acupoint status and overall neural health. I find this palpation assessment to be very useful in chronic pain cases.
Remember that you do not needle directly into the nerve itself! When you insert the needle and guide it along the targeted nerve root or at the targeted nerve, it is important to understand that you stop just above or in front of any large nerve roots (the aim is to stimulate the underlying delta fibers). Remember to ask for feedback from the patient. You know you have hit your mark when the patient feels the stimulation (i.e. the afferent fibers have been stimulated). Be sure not to directly puncture the nerve! You need to be gentle and mindful while needling. Make sure your patient reports a De Qi comfortable sensation after needle stimulation. An achy, sore, deep muscle ache or distension are all excellent signs. A sharp or very uncomfortable sensation comes from the C-fiber, which you do not want to stimulate. If at the time of insertion your patient feels a sharp, painful sensation, just remove the needle, relocate the acupoint and re-needle. Sometimes that initial painful sensation is felt by the patient due to a local hair follicle or a small C-fiber accidently being hit.
You can utilize any of the classical needle techniques: lift and thrust, wagging the blue green dragon’s tail, siphoning, and twirl. If you get a local muscle fasciculation, that’s great; and if your patient at first feels a “prick,” that is fine, as long as the prick sensation does not continue. Warmth and coolness are also acceptable. You do not want any strong, painful, stabbing, excessively sharp or burning sensations. Again, this guidance coincides with that found in the TCM classics.
Needle properly, in a non-aggressive manner. Due to the manufactured structural design of an acupuncture needle, it is difficult to cause serious tissue damage. However, you must approach with “cautioned confidence.” It is important to know about anatomy and, in particular, the specific neuroanatomy underlying the Neuropuncture point—or, for that matter, any acupuncture acupoint that you tend to needle. Remember that the classic TCM acupoints are fantastic areas to examine for the underlying neurophysiology. The technique for needling Neuropuncture acupoints that may be sensitive or lie in congested areas is to gently lift the skin and needle perpendicularly. Once the needle is inserted, slide the needle between the layers of tissue and then release the skin and allow the connective tissue to gently pull the needle into the point. You can further stimulate gently to obtain De Qi.
The acupuncture needle can be inserted utilizing traditional hand insertion or guide-tube insertion. If utilizing hand insertion, make sure to grip the needle firmly to support the shaft while inserting the needle. In either technique, the needle, after insertion, must be stimulated until the patient feels a De Qi sensation. Remember, a comfortable Qi sensation is propagated, not a sharp, stabbing, or burning painful sensation. A desired sensation is one of a dull muscle ache, a sore-achy sensation, warmness, heaviness, distension, gentle traveling, fullness, or even a small muscle fasciculation. As explained above, these classical sensations are the small delta, peripheral, and afferent nerve fibers firing and eventually hitting their mark, targeting a nerve tract or specific areas of the brain. When you apply electricity to the point, as in EA, again it still must produce a nice achy, dull, sore sensation to maximize the benefits.
When it comes to the size and gauge of needles, I sometimes like to use 0.5 x 20 gauge needles. These are very tiny, so they are not used for large neuromuscular points; the superficial nerves have been shown to affect the larger nerve tracts. But, with thicker muscle layers and denser tissue, longer and thicker gauged needles are needed. The needle gauge used depends on the patient’s body type and size, as well as the Neuropuncture acupoint under assessment.
In this technique, you needle directly into the periosteum of the bone. You do not needle deeply though. It is effective to just insert the needle with a guide tube just above the targeted bone and tap several needles into the bone gently. This is a great way to treat most orthopedic bone conditions, ligament issues, and any stubborn fractures that have periosteum access.
Electro-Neuropuncture (EN)
This is the application of electricity through the Neuropuncture acupoints at specific frequencies, for specific intervals of time, for the purpose of targeting specific neuro-tissue (e.g. receptors, areas of the brain). EA applied to the referenced Neuropuncture acupoints can maximize the desired effect and allow us to measure closely the exact amount of stimulation for reproducible outcomes. Remember, in the 1950s EA was used in China to replace manual stimulation for doctors. This has led to an application of protocols that are reproducible and measurable. In many cases, you can add some form of electricity—millicurrent, microcurrent, piezo, pachipachi—to maximize the benefits of treatment.
Always be careful in choosing which current. You do not want to aggravate the condition with excessive or too powerful stimulation at the wrong time of the treatment plan. When applied correctly, this will help to stimulate the Neuropuncture acupoints, and when applied appropriately it enhances the outcome by stimulating the neuropathways in a controlled, focused, homeostatic way. It is important to use EA as a tool to target a focused electrical current. In this way, the intensity does not have to always be a comfortable, strong sensation; it can be just barely perceivable.
It is also common for the muscles innervated by the nerve to contract, fasciculate, and “jump” to the frequency. That is ideal! Just be sure that your patient is comfortable. In most of my treatments I have my patients “dancing.” I have had very few complaints and the outcomes are highly effective. For example, while treating migraines, if you are applying EA to the superficial radial Neuropuncture acupoint or to the greater auricular Neuropuncture acupoint, and the superficial radial Neuropuncture acupoint begins to “tap” to the frequency, then that is ideal. Similarly in the treatment of sciatica, if the common peroneal Neuropuncture acupoint begins to “jump” to the frequency, then again that will yield the desired outcome.
Table 7.3 is a reference chart of the electrical acupuncture protocols for targeting receptors in the endorphin system for maximum pain relief.
|
Table 7.3 EA protocols for targeting receptors |
|||
|
Neuropeptide |
Receptor |
Frequency/amperage |
Location |
|
Beta-endorphins |
Mu/delta |
2–4 Hz millicurrent |
Midbrain/PAG/pituitary |
|
Enkephalins |
Mu/delta |
2–4 Hz millicurrent |
Dorsal horn of spinal cord |
|
Dynorphins |
Kappa |
50–100 Hz millicurrent |
Brainstem/spine |
|
5-HTP |
5-HTP receptor |
20–50 Hz millicurrent |
cns |
|
Oxytocin |
– |
15–30 Hz millicurrent Max Hz 2–30 millicurrent |
cns |
Clinically, when I have applied EA to my Neuropuncture protocol, I have found it to be effective to begin with microcurrent and then slowly change to millicurrent. There are several reasons for this—for starters, microcurrent has been proven scientifically to help to reduce inflammation, stimulate cellular respiration via increased ATP production and help to repair tissue damage (Cheng et al., 1982). Millicurrent is what has been mainly used throughout the scientific community in clinical trials and has been shown to strengthen tissues, break up adhesions and be highly effective in targeting the release of specific neuropeptides.
Table 7.4 is an example of a treatment protocol utilizing EN.1 Remember it is always important to adjust your treatments according to your clinical assessment.
|
Table 7.4 Electro-Neuropuncture treatment protocol |
||
|
Treatment |
Frequency/amperage |
Duration |
|
1st treatment |
25 Hz microcurrent |
25–30 min |
|
2nd to 3rd treatment |
Single stimulation 2 Hz millicurrent |
25–30 min |
|
4th to 5th treatment |
Burst stimulation 2–15 Hz mixed millicurrent |
25–30 min |
|
6th to 8th treatment |
Burst stimulation 2–100 Hz mixed millicurrent |
25–30 min |
1For more information on needling techniques and video demonstrations, visit www.neuropuncture.org.