By Capt. Elwood W. Hopkins, Neurologist, Naval Hospital Bremerton, Wash.
After 40 years of practicing neurology it was only natural to begin thinking about something else and when the e-mail arrived from our Specialty Leader announcing the opportunity to learn how to do acupuncture, I submitted my application to the Navy Bureau of Medicine and Surgery that same day.
Having been trained both as a biochemist and a neurologist my requirement was to establish a fundamental scientific understanding of acupuncture. I needed to see the supporting research and data, if any existed, if I was going to embrace this mysterious tool.
Happily, my intellect was actively engaged by the charismatic master acupuncturist, Dr. Alejandro Claraco, call sign “The Matador”. His lectures laid a neurophysiologic foundation for our class, emphasizing the contemporary understanding of how acupuncture works at distinct loci within the nervous system.
Traditionally identified, clinically effective acupuncture points exist at neurovascular bundles where a number of neurochemical changes are elicited by acupuncture. Local physiologic changes such as vasodilatation, suppression of prostaglandins and cytokines, inhibition of substance P secretion, and reversal of tissue acidosis are just a few of the measurable effects along the needle tract.
Further, at the level of the dorsal horn in the spinal cord, where convergence of sensory inputs are sorted, the acupuncture signals being carried by non-nociceptive fibers activate the “gate control” system for suppressing painful stimuli entering via the slow, unmyelinated c-fiber pathways.
At the segmental level of the spinal cord, chronification of pain signals is executed by “winding up” of second order neurons (also seen in post-tetanic potentiation occurring at peripheral neuromuscular junctions to effect stronger muscle contractions, and as may occur in the cerebral cortex in some forms of epilepsy). This “wind-up” can be blocked by acupuncture, facilitating local relaxation of muscles that may be in spasm as well as suppressing recurring peripheral pain signals that have been augmented by the “wind up” process.
Perhaps even more compelling evidence for how acupuncture works comes from functional MRI observations and central samplings of neurosecretory events that reveal activation of the hypothalamus, suppression of the amygdala and increased secretions of beta-endorphins; all beneficial in not only pain control, but resetting normal controls within the autonomic nervous system and maintaining CNS homeostasis.
Accelerated bone healing of fractures and inhibition of bone demineralization in a zero gravity environment are just some of the other convincing effects of acupuncture demonstrated in animal models. The extensive reference library provided by the course included many excellent research papers covering a vast array of topics dealing with acupuncture.
Was my intellect whetted? You can probably sense by now that it was indeed. But, although a sound foundation for any endeavor is scientifically satisfying, actually seeing and experiencing the clinical application of this ancient art was yet to occur.
Part two will run on Thursday, Dec. 29.