Anatomic Survey Of Homeostatic Acureflex Points

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The human nervous system develops in segments, and acu-reflex points (ARPs) are distributed all over the body according to the neural segments. The head segments are fused together and expand to form the cerebral hemispheres and brainstem. Twelve pairs of cranial nerves exit these segments.

The spinal nerves arise from the segments of the spinal cord. Each segment gives rise to both sensory and motor nerve roots on each side of the body (Fig. 8-1). Through all the segments of the spinal cord, motor systems tend to be more ventral and sensory systems more dorsal. Because of this scheme, dorsal nerve roots convey mainly afferent sensory information into the dorsal spinal cord, whereas ventral nerve roots carry mainly efferent motor signals from the ventral spinal cord to the periphery. The segments and nerve roots of the spinal cord are named according to the level at which they exit the bony vertebral canal: cervical, thoracic, lumbar, and sacral nerve roots.

A spinal nerve divides into two primary rami: the dorsal (posterior) ramus and the ventral (anterior) ramus. The short (posterior) ramus, with its two end branches, innervates the muscles and skin of the back. The ventral (anterior) primary ramus travels within the body wall to innervate the skin and muscles of the lateral and anterior parts of the body (Fig. 8-2).

During development, the bony vertebral canal increases in length faster than the spinal cord; as a result, the spinal cord ends at the level of the first or second lumbar vertebral bones (L1 or L2). Below this level, the spinal canal contains a collection of nerve roots known as the cauda equina. The sensory and motor nerve roots join together a short distance outside the spinal cord and form a mixed sensory and motor spinal nerve.

The distribution of ARPs follows the same segmental scheme as do the peripheral nerves. After exiting from the spinal cord, many fibers of nerve roots, both sensory and motor, are mixed to form a mesh that is called the plexus (Fig. 8-3).

Facial ARPs are formed by cranial nerves. Clinically important cranial nerves that form the facial points are the trigeminal nerves (Fig. 8-4) and facial nerve (Fig. 8-5). Neck ARPs are innervated by cervical plexus from C1 to C5 (Fig. 8-6).

Arms and legs, because of their importance in movement, provide much more signal flow to the central nervous system and therefore require more neural control and coordination than do muscles of the chest and abdomen. Therefore the enlarged segments of C5 to T1 give rise to the brachial plexus

Spiral ganglion

Bineuronal

Spiral ganglion

2 = Interneurons

3 = Motoneuron of anterior horn

4 = Motor end-plate

5 = Muscle spindle

Figure 8-1 Reflex at the spinal cord. Left, Monosynaptic reflex: bineuronal reflex: patellar tendon and Achilles tendon reflex. Right, Polyneuronal reflex: abdominal and plantar reflex.

2 = Interneurons

3 = Motoneuron of anterior horn

4 = Motor end-plate

5 = Muscle spindle

Figure 8-1 Reflex at the spinal cord. Left, Monosynaptic reflex: bineuronal reflex: patellar tendon and Achilles tendon reflex. Right, Polyneuronal reflex: abdominal and plantar reflex.

Serratus anterior

Lateral cutaneous nerve

Intercostal nerve

Branches of dorsal ramus

Vertebra

Erector spinae

Scapula

Branches of dorsal ramus

Vertebra

Erector spinae

Scapula

Serratus anterior

Lateral cutaneous nerve

Intercostal nerve

Intercostal vein, artery, and nerve (cutaway view)

Dry Needling Homeostatic Points

Internal intercostal

Anterior cutaneous nerve

External intercostal

Sternum, xiphoid process

Figure 8-2 Diagram of a section of a spinal nerve. A spinal nerve divides into two primary rami: the dorsal (posterior) ramus and the ventral (anterior) ramus. The short dorsal primary ramus with its two end branches innervates the muscles and skin of the back. The ventral primary ramus travel within the body wall to innervate the skin and the muscles on the lateral and anterior parts of the body.

Internal intercostal

Lateral cutaneous nerve

External oblique

External intercostal

Intercostal vein, artery, and nerve (cutaway view)

Anterior cutaneous nerve

External intercostal

Sternum, xiphoid process

Figure 8-2 Diagram of a section of a spinal nerve. A spinal nerve divides into two primary rami: the dorsal (posterior) ramus and the ventral (anterior) ramus. The short dorsal primary ramus with its two end branches innervates the muscles and skin of the back. The ventral primary ramus travel within the body wall to innervate the skin and the muscles on the lateral and anterior parts of the body.

Subcostal nerve Lateral cutaneous branch Iliohypogastric nerve (T12, L1) Ilio-inguinal nerve (T12, L1)

Genitofemoral r Femoral branch nerve (L1, 2) I Genital branch Lateral cutaneous nerve of thigh (L2, 3) Femoral nerve (L2-4) Obturator nerve (L2-4) Superior gluteal nerve (L4, 5; S1) —

Lumbosacral trunk-

Inferior gluteal nerve (L5; S1, 2) Common j fibular nerve .Tibial nerve

Posterior cutaneous nerve of thigh (S1-3)

Posterior cutaneous nerve of thigh (S1-3)

Anococcygeal nerve

Coccygeal nerve Figure 8-3 The lumbosacral and coccygeal plexus.

Pudendal nerve (S2-4) Inferior anal [rectal] nerves

T12 L1

L2 L3 L4

55 Co

Lumbar plexus

Sacral plexus

„ Coccygeal plexus

Anococcygeal nerve

Coccygeal nerve Figure 8-3 The lumbosacral and coccygeal plexus.

Nerve to mylohyoid

Submandibular ganglion

Figure 8-4 The trigeminal nerve.

Ophthalmic nerve [V/1]

Trigeminal ganglion Maxillary nerve [V/2]

Mandibular nerve [V/3]

Deep temporal nerve

Auriculotemporal nerve Inferior alveolar nerve

Nerve to mylohyoid

Submandibular ganglion

Frontal nerve Supra-orbital nerve Supratrochlear nerve - Ciliary ganglion Infra-orbital nerve Infra-orbital foramen

Greater palatine nerve Buccal nerve Lingual nerve Mental nerve

Figure 8-4 The trigeminal nerve.

Temporal branch

Posterior auricular nerve

Facial nerve [VII]

Temporal branch

Posterior auricular nerve

Facial nerve [VII]

Dry Needling Homeostatic Points

Zygomatic branches

Buccal branches

Marginal mandibular branch

Cervical branch ■

Figure 8-5 The facial nerve.

Zygomatic branches

Buccal branches

Marginal mandibular branch

Cervical branch ■

Figure 8-5 The facial nerve.

for the arm (Fig. 8-7) and lumbosacral plexus from T12 or L1 to S3 for the leg (Fig. 8-8).

In addition to the sensory and motor pathways, the peripheral nervous system includes some specialized neurons involved in controlling such auto-nomic functions as heart rate, peristalsis, sweating, and smooth muscle contraction in the walls of blood vessels, bronchi, sex organs, pupils, and other areas. These neurons are part of the autonomic nervous system.

The autonomic nervous system provides the tissue-, organ-, and system-level integration of the body's physiologic processes to achieve homeostasis and to support the activities of human behavior. With the endocrine system, the autonomic nervous system coordinates the continuous adjustments in blood chemistry, respiration, circulation, digestion, reproductive status, body temperature, elimination of metabolic wastes, and immune responses that protect homeostasis. The autonomic nervous

Platysma Facial vein

Facial nerve [VII], cervical branch Retromandibular vein Ramus communicans

External jugular vein Transverse cervical nerve Anterior jugular vein

Sternocleidomastoid Jugular venous arch Medial supraclavicular

Lesser Auricular Nerve

Figure 8-6 The cervical plexus. Acu-reflex points are formed by greater auricular nerve, lesser occipital nerve, transverse cervical nerve, and supraclavicular nerves.

Posterior auricular vein

Lesser occipital nerve Occipital artery Occipital vein Greater occipital nerve Greater auricular nerve Splenius capitis

Levator scapulae Trapezius

Accessory nerve [XI] Lateral cervical lymph nodes, superficial nodes

Lateral supraclavicular nerves Omohyoid Brachial plexus Transverse cervical vein

Intermediate supraclavicular nerves

Figure 8-6 The cervical plexus. Acu-reflex points are formed by greater auricular nerve, lesser occipital nerve, transverse cervical nerve, and supraclavicular nerves.

Ventral rami of spinal nerves

Trunks

Divisions

Cords

Branches

- Dorsal scapular Upper

Dry Needling Homeostatic Points

Medial cutaneous, nerve of forearm

Thoracodorsal

Figure 8-7 The brachial plexus.

Medial cutaneous, nerve of forearm

Thoracodorsal

Figure 8-7 The brachial plexus.

Iliohypogastric nerve

Genitofemoral nerve

Iliohypogastric nerve

Genitofemoral nerve

Superior gluteal nerve

Dry Needling Homeostatic Points

Obturator nerve

Pudendal inerve

Posterior cutaneous nerve of thigh

Figure 8-8 The lumbosacral plexus.

Superior gluteal nerve

Obturator nerve

Pudendal inerve

Posterior cutaneous nerve of thigh

Figure 8-8 The lumbosacral plexus.

system also actively coordinates the function of skeletal muscles involved in behavior.

Impairment of the autonomic nervous system results in a loss of ability to mobilize physiologic responses and adaptations to challenges to homeostasis.

The autonomic nervous system has two major divisions. The sympathetic division arises from thoracic and lumbar spinal nerves T1 to L2 (the thoracolumbar division; Fig. 8-9). It releases the neurotransmitter norepinephrine onto target organs and is involved in such stress-related activities as the "fight or flight" response with its functions, such as increased heart rate and blood pressure, bronchodilation, and increased pupil size. The parasympathetic division, in contrast, arises from the cranial nerves and from sacral spinal levels

S2 to S4 (the craniosacral division). It releases ace-tylcholine onto target organs and is involved in more sedentary and energy-conserving functions, such as increasing gastric secretions and peristalsis, slowing the heart rate, and decreasing pupil size (Fig. 8-10).

The sympathetic and parasympathetic pathways are controlled by higher centers in the hypothalamus and limbic system, as described in previous chapters, as well as by afferent sensory information from the body. According to data from research with functional magnetic resonance imaging, acupuncture needling causes responses in both the hypothalamus and the lim-bic system. The molecular interpretation of those responses is still incompletely understood, but clinical data indicate that needling helps restore homeostasis.

The enteric nervous system is considered a third autonomic division; it consists of a neural plexus lying within the walls of the gut that is involved in controlling peristalsis and gastrointestinal secretions.

In the following description, the general anatomy of each nerve is described first, and then the focus is on the 24 primary homeostatic ARPs.

CUTANEOUS AND MUSCULAR ACU-REFLEX POINTS

A cutaneous sensory nerve innervates a large skin area; for example, the lateral antebrachial cutaneous nerve on the forearm innervates the skin surface along a pathway that extends from elbow to wrist. When this nerve is stimulated, the sensation can propagate along the entire zone (Fig. 8-11). A muscular nerve specifically innervates a particular muscle. When a muscular nerve is stimulated, the sensation and muscular response may be limited to only the particular muscle. However, when a needle is inserted into an ARP, it punctures the skin and distinct layers of muscle and fasciae. Thus the result is complex and includes both cutaneous and muscular responses.

Of the 24 primary ARPs, some are cutaneous nerve points, some are muscular nerve points,

Central sympathetic pathway

Postganglionic fiber

Lateral gray horn

Spinal cord segments T1-L3

Postganglionic fiber

Central sympathetic pathway

Lateral gray horn

Spinal cord segments T1-L3

Dry Needling Homeostatic Points

Adrenal medulla

Intestine

Dry Needling Homeostatic Points

Levator palpebrae

Dilator pupillar

To blood vessels, sweat glands

Brachial plexus

Adrenal medulla

Intestine

Male genital tract

Male genital tract

Pelvic ganglion

Levator palpebrae

Dilator pupillar

To blood vessels, sweat glands

Brachial plexus

TG

Lumbar plexus

Sacral plexus

Intercostal nerve

Lumbar plexus

Sacral plexus

Figure 8-9 General plan of the sympathetic nervous system. Preganglionic neurons are located in the lateral gray horn of the spinal cord. LG, Lumbar ganglion; LSN, lumbar splanchnic nerve; MCG, middle cervical ganglion; SCG, superior cervical ganglia; SG, sacral ganglia; St.G, stellate ganglia; TG, thoracic ganglia; TSN, thoracic splanchnic nerve.

and some points are neither cutaneous nor muscular (e.g., the H1 deep radial nerve point, which is formed at the branching of the deep radial nerve).

The 24 primary homeostatic ARPs are depicted in Figure 8-12. Neural origins and segmentations of ARPs are listed in Table 8-1.

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