The Identification Of The Acupuncture Point

A major contribution was made by a group of clinicians from the Groupe Lyonnais d'Etudes Medicales (GLEM) and by researchers, particularly Claudie Terral6,7,8 and Odile Auziech,9 working in Unit 103 of the Institut National de la Sante et de la Recherche Medicale (French Institute of Health and Medical Research; INSERM) in Montpellier, France. The essence of the research program using physical, his-tological and physiological data collected between 1973 and 1983 can be summarized as follows:

l Following the demonstration by Niboyet10,11 in

1963 that there was less electrical resistance in

Chinese acupuncture points, the most acceptable hypothesis was to consider either a skin surface effect related to the secretion of sweat glands, as pointed out by some researchers, or more consistently to consider the possibility of a specific subcutaneous structure, since cleaning the skin with ether/acetone did not change either the electrical properties or the detection of points on fresh cadaver skin (Fig. 2.5). More precise investigations were performed by Claudie Terral using both direct and sinusoidal (alternating) current. For this investigation, a curve plotter was built allowing recording of the instantaneous variability of intensity as a function of applied sinusoidal voltage of the electrical equivalent circuit changes. All those parameters were visualized on the oscilloscope with the output voltage in the X axis and the output current in the Y axis. A special exploratory electrode was designed, equipped with a strain gauge bridge measuring the pressure on the skin. It was able

Fig. 2.5 Electrical detection of a skin acupuncture point using a detector equipped with a strain gauge bridge measuring the applied force on skin (Unit 103, INSERM, Montpellier, France).

to identify 'stable low electrical resistance points' of the order of 10-560 kfi with short latency detection and with a low level of mechanical pressure. These specific cutaneous points correspond to the traditional Chinese points and have a small surface area of around 1 mm2. They can be surrounded by unstable points depending on the duration of the detection and the diffusion of the charge. With sinusoidal current it was possible by changing the metal of the electrode (pure magnesium, dural) and the duration of the point stimulation to describe a diode effect, thyristor effect as a marker of analgesia, and a tunneling effect as well as generator and supra-conductive effects. This very interesting investigation clearly suggests a complex electrical activity at the level of the point.

• Logically suspecting a structural phenomenon to be accountable for this electrical behavior, a histo-logical investigation was carried out in 1975 by Odile Auziech and Claudie Terral in the laboratory of Rene Senelar of the Faculty of Medicine of Montpellier. Black ink was injected at the level of the electrically detected point in rabbit and human skin in order to be sure to localize the right area precisely on serial histological sections. Using different staining methods such as Coujard-Champy or silver staining permits the description of the specific components of what we called 'neurovascular bundles': lax connective tissue with a shaft in the dermal layer/fibro-blasts, fibrocytes, mastocytes, histocytes as well as mobile and fixed Langerhans cells and APUD

Fig. 2.5 Electrical detection of a skin acupuncture point using a detector equipped with a strain gauge bridge measuring the applied force on skin (Unit 103, INSERM, Montpellier, France).

cells/neurovascular complex made by the intricate arrangement of myelinated and unmyelin-ated fibers within and around micro blood vessels (arterioles, veins and lymphatics)/ radiating matrix into the basal layer of the epidermis (Figs 2.6, 2.7, 2.8, 2.9). Observations made using an electron microscope revealed some local endocrine substance activity as well as some enzyme activity after electrical stimulation, particularly adrenaline secretion in the neural network. In 1984 Odile Auziech made special histological investigations on the auricle in vivo on rabbits and post mortem in human, with the outcome that three different types of neurovascular bundles located in three areas corresponding roughly to the three territories of innervation could be described: posterosuperior (^ the surface), anterosuperior (M) and anteroinferior (M). In 75 biopsies corresponding to 20 different points on the anterior aspect and three on the posterior, some typical features were described: medium size (80 m) and horizontal shape within fatty connective tissue for type I; small size (60 m) with many capillaries for type II; and large size (100 m) and vertical shape in adipose tissue for type III (Fig. 2.10). Some holes through the cartilage in front of the point were observed in 2% of the cases and some typical aspect of glomus in 10%.

• The third approach was to build a physiological reproducible model to study analgesia12 in the rabbit, which is particularly convenient for its type of symmetrical locomotion by simultaneous

Fig Rabbit Skin
Fig. 2.6 Neurovascular bundle on rabbit skin showing the modification of the connective tissue and, deeper, the microvessel with myelinated and unmyelinated fibers: (A) histological section; (B) drawn representation.

Ae =

artery

AVA =

arteriovenous anastomosis

Cap =

capillary

D =

dermis

E =

epidermis

FN =

nervous fiber

H =

hypodermis

NC =

cutaneous fiber

Ve =

vein

propulsion of the hind limbs. Therefore a pain test was done through painful mechanical skin prick with a force transducer in order to calibrate the stimulus which, applied to the hind limb, generates a bilateral withdrawal reflex. Two points, Yishe and Tsusanli, were electrically detected in one hind limb and needles implanted and connected with an electrical stimulator. The interesting observation was that after 20 minutes of electrical stimulation a true analgesia of the stimulated limb was created, validated by the absence of the withdrawal reflex after mechanical painful puncture on this side and the persistence of the withdrawal reflex by puncture on the opposite side (Fig. 2.11). This demonstrates without doubt real skin analgesia on one side without

Fig. 2.9 Biological sample of the full neurovascular complex extracted from the skin of a human volunteer after electrical detection of the acupuncture point on the leg.

Fig. 2.10 The zonal distibution of the three histological types of neurovascular bundles within the auricle (from O. Auziech9). I = 'horizontal' type; II = 'compact' type; III = 'vertical' type.

Fig. 2.9 Biological sample of the full neurovascular complex extracted from the skin of a human volunteer after electrical detection of the acupuncture point on the leg.

Fig. 2.10 The zonal distibution of the three histological types of neurovascular bundles within the auricle (from O. Auziech9). I = 'horizontal' type; II = 'compact' type; III = 'vertical' type.

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Painful stimuli: prick right heel

10-1 daN 2kg/mm2

10-1 daN 2kg/mm2

Withdrawal LHL

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No reaction

ai

nf

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ili

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rick right heel

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Fig. 2.11 Experimental demonstration of the analgesia induced by electrostimulation of needles placed in two neurovascular bundles of the posterior hind leg of a rabbit, validated by measuring the withdrawal reflexes (RHL = right hind limb; LHL = left hind limb) after painful skin stimulation (A) and by observing the lack of reflexes after 20 minutes of electrostimulation (B) (Unit 103, INSERM, Montpellier, France).

paralysis. A secretion of a neurotransmitter being suspected, 2 cm3/kg of the serum of rabbits with induced analgesia was injected into naive rabbits demonstrating a transfer of the analgesia into almost the same territory with diverse local variations. Opiate antagonists (nalorphine and naloxone) did not change the phenomenon and we suggested the possible action of an enkepha-line neurotransmitter with a possible specific metameric action. Obviously more experimental investigations are needed and the reproducibility of the rabbit model will hopefully elicit new motivation for this work somewhere.

Finally, it is possible to summarize the results of these scientific researches as follows:

• the acupuncture point undoubtedly exists in view of the electrical, histological and physiological arguments presented above

• the auricle has a particular structural profile with a very rich vascular network and typical neurovascular bundles.

Acupuncture For Cynics

Acupuncture For Cynics

Have You Always Been Curious About Acupuncture, But Were Never Quite Sure Where To Stick The Needles? If you associate acupuncture with needles, pain and weird alternative medicine then you are horribly misinformed about the benefits of the world's oldest form of medicinal treatment.

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