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Anatomy of Acupuncture

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1 Anatomy of Acupuncture
Important Pathways for Pain Control & Acupuncture Relief

2 Spinal Cord A. Spinal cord anatomy 1. Protection and coverings
a. Vertebral column b. Meninges 2. External anatomy of the spinal cord 3. Internal anatomy of the spinal cord B. Spinal cord physiology 1. Reflexes 2. Reflex arc and homeostasis a. Physiology of the stretch reflex b. Physiology of the flexor (withdrawal) reflex and crossed extensor reflexes C. Spinal nerves 1. Composition and coverings 2. Distribution of spinal nerves 3. Dermatomes

3 The Spinal Cord 1. is continuous with brain
2. mediates spinal reflexes 3. is site for integration 4. provides the pathways

4 Protection and Coverings
1. vertebral canal 2. meninges 3. cerebrospinal fluid

5 Meninges and Spaces 1. epidural space 2. dura mater 3. subdural space
4. arachnoid membrane 5. subarachnoid space 6. pia mater -- denticulate ligaments

6 External Anatomy 1. cylindrical 2. flattened A-P
3. foramen magnum to L2 4. differential growth 5. cervical enlargement 6. lumbar enlargement 7. conus medullaris 8. filum terminale 9. cauda equina 10. functional segments

7 Internal Anatomy 1. gray matter 2. white matter 3. gray commissure
4. central canal 1. gray matter 2. white matter 3. gray commissure 4. central canal

8 Gray Matter 1. nuclei 2. horns a. dorsal -- sensory
b. ventral -- motor c. lateral -- autonomic

9 Spinal Cord Grey Matter
Spinal Layers Spinal grey matters divided into 10 layers Substantia Gelatinosa Composed of a layer of cell bodies running up and down the dorsal horns of the spinal cord Receive input from A and C-fibers Activity in SG inhibits pain transmission

10 Spinal Nerve Roots 1. dorsal root (axons of sensory neurons)
-- dorsal root ganglion (cell bodies of sensory neurons) 2. ventral root (axons of motor neurons) Dorsal roots Dorsal root ganglion Ventral roots

11 White Matter 1. columns a. anterior b. posterior c. lateral 2. tracts
a. ascending b. descending Posterior columns Lateral columns Lateral columns Anterior columns

12 Tracts of the Spinal Cord

13 The Spinal Cord Has Two Essential Functions
1. convey impulses between the periphery and the brain 2. provide integrating centers for spinal reflexes

14 Reflexes are… 1. inborn 2. unlearned 3. unconscious

15 Somatic Reflexes Versus Visceral Reflexes
Somatic reflexes involve the somatic nervous system. Visceral reflexes involve the autonomic nervous system.

16 Reflex Arc 1. receptor 2. sensory neuron 3. integration center
sensory receptor 1 2 3 4 5 sensory (afferent) neuron center of integration with association neuron motor (efferent) neuron effector 1. receptor 2. sensory neuron 3. integration center 4. motor neuron 5. effector sensory receptor 2 3 4 5 sensory (afferent) neuron center of integration with association neuron motor (efferent) neuron effector

CONTROLLED CONDITION RETURN TO HOMEOSTASIS The action of the effector returns the body process to within its normal homeostatic range A stimulus or stress disrupts membrane homeostasis by altering some controlled condition EFFECTORS The motor neurons initiate some response by an effector (muscle or gland) to counteract the stimulus that originally disrupted homeostasis RECEPTOR The receptors in a reflex are sensory neurons associated with a receptor device (transducer) and which relay nerve impulses to a central control center CONTROL CENTER The control center is an integrating center of neurons in the CNS. It relays the information to motor neurons

18 Stretch Reflex 1. monosynaptic 2. muscle spindle 3. muscle tone
4. ipsilateral 5. reciprocal innervation

19 The Flexor and Crossed Extensor Reflex
Intersegmental Polysynaptic Ipsilateral Pain receptor Role of association neurons Reciprocal innervation Intersegmental Polysynaptic Contralateral Pain receptor Role of association neurons Reciprocal innervation excitatory neurons inhibitory neurons

20 The Nervous System and Pain
Somatosensory System Brain Cortex Thalamus Spinal Cord Ventral Root Dorsal Horn PNS Efferent Neuron Afferent Neuron A-delta Fibers C-Fibers

21 Pain Pathways – Going Up
Pain information travels up the spinal cord through the spinothalamic track (2 parts) PSTT Immediate warning of the presence, location, and intensity of an injury NSTT Slow, aching reminder that tissue damage has occurred

22 Pain Pathways – Going Down
Descending pain pathway responsible for pain inhibition

23 The Neurochemicals of Pain
Pain Initiators Glutamate - Central Substance P - Central Brandykinin - Peripheral Prostaglandins - Peripheral Pain Inhibitors Serotonin Endorphins Enkephalins Dynorphin


25 Theories of Pain Specificity Theory Gate Control Theory
Began with Aristotle Pain is hardwired Specific “pain” fibers bring info to a “pain center” Refuted in 1965 Gate Control Theory

26 Gate-Control Theory – Ronald Melzack (1960s)
Described physiological mechanism by which psychological factors can affect the experience of pain. Neural gate can open and close thereby modulating pain. Gate is located in the spinal cord. It is the SG

27 Opening and Closing the Gate
When the gate is closed signals from small diameter pain fibres do not excite the dorsal horn transmission neurons. When the gate is open pain signals excite dorsal horn transmission cells

28 Three Factors Involved in Opening and Closing the Gate
The amount of activity in the pain fibers. The amount of activity in other peripheral fibers. Messages that descend from the brain.

29 Conditions that Open the Gate
Physical conditions Extent of injury Inappropriate activity level Emotional conditions Anxiety or worry Tension Depression Mental Conditions Focusing on pain Boredom

30 Conditions That Close the Gate
Physical conditions Medications Counter stimulation (e.g., heat, massage) Emotional conditions Positive emotions Relaxation, Rest Mental conditions Intense concentration or distraction Involvement and interest in life activities

31 Mechanisms that Regulate AP
Inhibitor of AP Cholecytokinin Enhancer of AP L-phenylalanine

32 Conclusion Knowledge of the functional anatomy of the nervous system may be useful in determining how acupuncture works since all evidence suggests that the effects acupuncture can be explained only by its affects on the nervous system.

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