Acupressure for Chronic Illnesses

Session 3

- Handouts -

Dr. Teresa Clarke

groups@greenleafmc.ca

greenleafmc.ca/physician-led-group-classes

toll free: 1-877-513-4769 fax: 1 (604) 371-2044

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Highlights● Wellness as a journey to optimal wellbeing and function

● Integrative medicine - how acupressure fits in

● History of acupuncture and Chinese medicine

● Practices and techniques of acupuncture

● Benefits to chronic pain and complex chronic patients

● Autonomic nervous system – homeostasis/balance

● Modern neuroscience studies on acupuncture

● Chinese Medicine framework and Five Element acupuncture theory

Branches of Acupuncture● Traditional Chinese Medicine (herbs, moxibustion, cupping)

● Japanese acupuncture, Shiatsu

● Korean hand acupuncture

● Acupressure, Chinese massage

● Auriculotherapy (Dr. Paul Nogier, France, 1908-1996, author of “The Man in the Ear”)

● Five Element acupuncture (JR Worseley, UK physiotherapist, 1923-2003, credited with bringing FEA to the west, author of “Classical Five-element Acupuncture”)

● Tapping therapy (Roger Callahan, US psychologist,1925-2013, founder of Thought Field Therapy), evolved into EFT in 1990's

● Medical Acupuncture, “dry needling”, Intramuscular Stimulation (Dr. Chan Gunn, founder of Institute for the Study and Treatment of Pain, Vancouver)

Meridian massageLightly pat with a open hand in the following sequence::1. Front of the shoulder and down the inside of the upper arm

and forearm toward the open palm.

2. Turn the palm over and pat the back of the hand upwards over

the back of the forearm and upper arm until the top of the shoulder.

3. Change hands and pat the other arm.

4. Use both hands and pat from the pelvis down the outer front of the

thighs down the outside of the lower legs until the outer ankle.

5. Pat both legs in an upwards direction from the inner ankle up the

inner lower leg and thighs to the pelvis.

Neurophysiological studies on acupuncture

● Endorphins● Brainwaves (Delta 2 Hz, Theta 3-7 Hz, Alpha 8-12 Hz, Beta 16-25 Hz, HiBeta 28-40 Hz )

● Vagus nerve● Oxytocin● Default Mode Network● Endocannabinoid system

Acupuncture Endorphin Hypothesis● Supported by several hundred papers published in western journals

since 1976

Pomeranz B, Stux G: Scientific bases of acupuncture. Springer Verlag, Berlin, 1989

-at least 6 different opiate antagonists block acupuncture

-endorphin levels rise in blood and CSF during acupuncture

-acupuncture analgesia is enhanced by protecting endorphins from enzymatic breakdown

-acupuncture analgesia can be transferred to a second animal by CSF transfer and this effect is blocked by naloxone

Surgery under acupuncture

Neurophysiological studies cntd-Acupuncture effects brainwave activity

Brainwave patterns analyzed with acupuncture

● Stimulation of acupuncture point P6 increases slow-brainwave amplitude and has a calming effect. Stimulation of P6 used in conjunction with neurotherapy (brainwave biofeedback).

● GV26 used traditionally as “emergency” point for syncope. Acupuncture at GV26 causes immediate drop in slow-brainwave amplitude.

Dr. Paul Swingle, “Biofeedback for the Brain”, 2010

Neurophysiological studies cntd-Acupuncture modulates vagus nerve

Auricular Acupuncture and Vagal RegulationWei He, Xiaoyu Wang, Hong Shi, Hongyan Shang, Liang Li, Xianghong Jing, Bing Zhu

Evidence-Based Complementary and Alternative Medicine Nov. 2012

Anti-inflammatory Effects of Acupuncture Stimulation via the Vagus NerveHee-Don Lim, Min-Hee Kim, Chan-Yong Lee, Uk Namgung

March 18, 2016

Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing

Vagus nerve innervation of auricle

Auricular dermatomes

Acupuncture reduces vomiting

Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study.

Carlsson et al., J Pain Symptom Management, 2000 Oct;20(4):273-9

Acupuncture as a complementary therapy in chemotherapy-induced nausea and vomiting.

Ling, M, Proceedings (Baylor Univ Med Center) 2009 Apr; 22(2): 138-141

Polyvagal Theory

Dr. Stephen Porges “The Polyvagal Theory” 2011● 3 phylogenetic stages of development of ANS with distinct circuits:

1) Unmyelinated vagus (reptilian) most primitive and promotes immobilization (freeze, vaso-vagal syncope, behavioural shut-down)

2) Spinal sympathetic nervous system for fight/flight survival. HPA axis releases catecholamines and cortisol

3) Higher mammalian vagus is myelinated and “brakes” the sympathetic influence promoting calmness and social communication (facial expression, vocalization, listening).

● Myelination occurs in 3rd trimester and early childhood. Highest evolutionary development of ANS.

● When higher function is rendered functionless the lower rise in activity

Other vagal influences - Dr. Stephen Porges

● Increased vagal influence supports social engagement behaviours. Social behaviours regulate physiological activity and vice versa

● Reduces inflammation by modulating cytokines

● Vagus connects to thymus gland and influences immunity

● Vagus is linked to oxytocin production and influences pain thresholds

● Right brain has greater influence on vagus

Anatomy of brain stem and cranial nerves

Porges' PVT summary

Myelinated fibers of the vagus nerve:

● Inhibits fight/flight of sympathetic system

● Dampens stress response of HPA axis

● Linked with muscles that regulate eye gaze, facial expression, prosody and inner ear muscles to tune into voice frequencies

Bottom line:Safe environment and social engagement promotes

visceral homeostasis, growth and restoration

Neurophysiological studies cntd-

Acupuncture moderates oxytocin

Acupuncture or acupressure for induction of labourCochrane review, Smith et al, Oct.2017

22 trials reporting on 3456 women

Conclusion: Benefit from acupuncture in improving cervical readiness for labour

Neurophysiological studies cntd-

Acupuncture may “reset” the Default Mode Network and

increase brain connectivity.

Default Mode Network

● Coined by Dr. Marcus Raichle in 2001 who received the Kavli Prize in Neuroscience for the discovery of specialized brain networks for memory and cognition

● DMN is composed of several areas of the cortex that are active when no external tasks demand our attention. When involved in tasks we use the attention network of the cortex. After tasks are completed the brain reverts back to a default activity level

● When we relax the DMN is the most active areas of the brain

● Attention network makes it possible to relate to the world. DMN makes it possible to relate to ourselves, our past and our future

DMN structures

● Medial pre-frontal cortex● Bilateral temporoparietal

cortices

● Precuneus● Posterior cingulate cortex● Hippocampal formation

Neurophysiological studies cntd-

Acupuncture mobilizes the brain's default mode network in healthy subjects

K. Hui et al. Brain Res. 2009 Sep.1; 1287:84-103

● 48 subjects underwent functional MRI analysis while treated with acupuncture at LI4, St36, Liv3

● Regional correlations showed virtual identity with the core regions of the DMN

● Deactivation of limbic system played the predominant role in acupuncture action

● Deactivation of the amygdala and hypothalamus (activated by stress, pain, negative emotions or other negative stimuli)

● Amygdala, hypothalamus, brain stem nuclear groups also demonstrated coherent activity with DMN core regions

● General pattern was similar for all 3 points studied but subtle differences between acupoints not explained by study

Functional Reorganization of the Default Mode Network across Chronic Pain Conditions

AbstractChronic pain is associated with neuronal plasticity. Here we use resting-state functional magnetic resonance imaging to investigate functional changes in patients suffering from chronic back pain (CBP), complex regional pain syndrome (CRPS) and knee osteoarthritis (OA). We isolated five meaningful resting-state networks across the groups, of which only the default mode network (DMN) exhibited deviations from healthy controls. All patient groups showed decreased connectivity of medial prefrontal cortex (MPFC) to the posterior constituents of the DMN, and increased connectivity to the insular cortex in proportion to the intensity of pain. Multiple DMN regions, especially the MPFC, exhibited increased high frequency oscillations, conjoined with decreased phase locking with parietal regions involved in processing attention. Both phase and frequency changes correlated to pain duration in OA and CBP patients. Thus chronic pain seems to reorganize the dynamics of the DMN and as such reflect the maladaptive physiology of different types of chronic pain.

Marwan N. Baliki, Ali R. Mansour, Alex T. Baria, A. Vania Apkarian Published: September 2, 2014

DMN may be modulated by:Acupuncture (deactivates limbic system and resets DMN)

MeditationHypnosisSleeping (sleep deprivation causes decrease in connectivity of DMN)

Psychedelic drugs (Ayahuasca, THC)

Photobiomodulation

Neurophysiological studies cntd- Endocannabinoid system

The endocannabinoid system, a novel and key participant in acupuncture's multiple beneficial effects.

Hu,B et al Neurosci Biobehav Rev. 2017 Jun;77:340-357

Abstract:

.....an emerging role for the endocannabinoid system (ECS) in the regulation of a variety of physiological/pathological conditions has been identified....ECS may be a primary mediator and regulatory factor of acupuncture's beneficial effects...

This review seeks to provide a comprehensive summary of the existing literature concerning the role of endocannabinoid signaling in the various effects of acupuncture, and suggests a novel notion that acupuncture may restore homeostasis under different pathological conditions by regulating similar networks of signaling pathways, resulting in the activation of different reaction cascades in specific tissues in response to pathological insults.

Summary of Neurophysiological effects of Acupuncture

● Increase endorphins● Balance brain wave (alpha/beta/delta/theta) ratios● Strengthen vagal brake to dampen fight/flight● Increases oxytocin● Integrate DMN● Likely promotes homeostasis in endocannabinoid

system

Questions

Did the ancient Chinese discover a theoretical framework for acupuncture to improve homeostasis, visceral regulation, resilience, and physical and mental health?

Can myth, metaphor and poetic language describe the human condition?

Jumping into the Yellow Emperor's rabbit hole

“Like a circle in a spiral Like a wheel within a wheelNever ending or beginningOn an ever spinning reel...As the images unwindLike the circles that you findIn the windmills of your mind”Sung by Dusty Springfield

Huang Di Nei Jing 500 BC / Power of the 5 Elements 2010

Five Elements of Nature

Five Element Acupuncture

● Person centred approach

● FE theory and cycle● Features of the

elements● A few acupressure

points

John Thie, “Touch for Health”

Default Mode Network Connections

Five Element Acupuncture(Default Mode Network?)

John Thie, “Touch for Health”

Person Centred Approach

“It is much more important to know what sort of patient has the disease than what sort of disease the patient has.”

Sir William Osler, MD (1849-1919) Canadian physician and a founding professor of Johns Hopkins Hospital

The Five Elements

● Wood: frustration, irritation, impatience, argumentative manner, interruptions, indecision, lack of direction, loud voice

● Fire: sadness and flatness of affect when dysfunctional, seductive, joking, laughing voice

● Earth: hunger for sympathy, being understood, neediness, singing voice

● Metal: grief, aloof, distant, sarcasm, negative, critical, intellectual, weepy voice

● Water: frightened, shaky, easily startled, fragile, groaning voice

Wood Element

● Allows for healthy decision making, planning, and a balanced and well coordinated lifestyle

Effective treatment results in:● Improved judgment and healthier decision making

process● Less hostility, less need for control● Clearer vision of future needs● Growth and maturity● Improvement in well being and ability to cope

Fire Element

● Allows for self-expression, joy, laughter, love, warmth, friendships, affection, excitement, creativity, enthusiasm, passion

● Effective treatment results in:● Improvement in anxiety, depression, dysphoria● Enjoyment of love from others● Improvement in well being and aliveness● Return of joy, laughter, creativity, enthusiasm, passion,

joie de vie

Earth Element

● Allows for self-care, service, altruism, stability, groundedness, contentment, empathy and caring

● Effective treatment results in:● Improvement in contentment, empathy, security● Engagement in self-care and self-nourishment● Understands needs of self and of others● A sense of fulfillment and commitment to something

larger than self, service

Metal Element

● Allows for resilience, strength, endurance, self-worth, respect for self and others,capacity to grieve, letting go, inspiration, values, meaning and purpose

Effective treatment results in:● Improvement in self-worth and self-efficacy● Recovery from grief and loss● Improvement in resilience and adaptability● Connection to values, meaning and purpose

Water Element

● Allows for trust, faith, will power, survival, self- preservation, reserves and resources, ability to overcome, persistence, confidence, setting limits, self-actualization

Effective treatment results in:● Improvement in will to survive, fighting spirit● Reduction in fears● Improvement in perseverance with self-care and

manageability of limits of energy envelope

Causative Factor

● The predominant Element● Either inherited or acquired● If acquired often the result of early childhood

experiences which create a disequilibrium● Traumas of a physical, emotional, infectious

or climactic nature will bring CF into a pathological state leading to onset of symptoms

“The first method of acupuncture is to cure the spirit, the second is to give knowledge of how to restore the body, in order to make acupuncture effective, one must first cure the spirit.”

Nei Ching

Examples of weakened “spirit”

● Loss of connection with their vitality, inner light, and the deeper purpose and meaning of their lives

● Early traumatic physical or sexual abuse. The spirit is buried, childhood innocence gone, “inner child” is wounded and in hiding

● Involved in abusive relationships, power given away● PTSD -memories persistent and taken over the

person's conscious and sub-conscious processes● Never the same after the event: car accident, surgery,

child birth etc.

Dr. Charles Moss, author of : “Power of the Five Elements”

Benefits of FE acupuncture treatment

● Can see a major change in presence of person

● Emotional release over period of time

● Improvement in self-efficacy, motivation, self-management and self-care

● Improvement in relationships or contentment with divorce and able to move forward

● Improvement in ability to connect with others

● Improvement in future orientation and hope

● No longer obsessed with illness and symptoms

● Improvement in resilience and adaptability

Resilience

Ability to adapt in the face of adversity, tragedy, threats or significant stress – such as family and relationship problems, serious health problems, workplace and financial stressors.

American Psychological Association

Acupressure points for balancing emotional stresses

Point Ancient names Gall Bladder 41 (GB41) Foot above TearsLiver 2 (LR2) Walk betweenStomach 40 (ST40) Abundant SplendourConception Vessel 6 (CV6) Sea of ChiSmall Intestine 6 (SI6) Nourishing the OldStomach 9 (ST9) People WelcomeTriple Warmer 17 (TW17) Wind ScreenStomach 8(ST8) Head TiedGoverning Vessel 20 (GV20) Hundred Confluences

Acupressure points for balancing emotional stresses

Apply gentle pressure for 10-20 seconds or tap about 10 times on desired points ending with tapping on GV 20 on the top/crown of head

Gall Bladder 41 - “Foot above tears”JR Worsley, “Classical Five Element Acupuncture, volume 1, Meridians and Points”

Grounding and allows for emotional release of frustration/anger

Liver 2 - “Walk between”JR Worsley, “Classical Five Element Acupuncture, volume 1, Meridians and Points” Enables benevolence

Stomach 40 - “Abundant Splendour”JR Worsley, “Classical Five Element Acupuncture, volume 1, Meridians and Points”

Provides feeling of contentment, resolves dampness and phlegm

Conception Vessel 6 - “Sea of Chi”JR Worsley, “Classical Five Element Acupuncture, volume 1, Meridians and Points”

For spiritual and mental exhaustion, depression and lack of will

Small Intestine 6 - “Nourishing the Old”JR Worsley, “Classical Five Element Acupuncture, volume 1, Meridians and Points”

Nourishes us in the face of old pain and empowering the assimilation of life’s lessons from past traumas

Stomach 9 - “People Welcome”JR Worsley, “Classical Five Element Acupuncture, volume 1, Meridians and Points”

Allows us to set boundaries, resolve resentment and welcome others

Triple Warmer 17 - “Wind Screen”JR Worsley, “Classical Five Element Acupuncture, volume 1, Meridians and Points”

Empowers us to be less susceptible to other people’s opinions about us

Stomach 8 - “Head tied”JR Worsley, “Classical Five Element Acupuncture, volume 1, Meridians and Points”

Unbinds the mind and eases worry, ruminations, obsessive thinking

Governing Vessel 20 - “Hundred confluences”JR Worsley, “Classical Five Element Acupuncture, volume 1, Meridians and Points”

Lifts the spirits when depressed, dejected

Some symptoms may remain

Integrative Medicine Factors contributing to health

Medical Cognitive treatments Acupressure

Family/social Alternative treatments

Lifestyle/ Emotional sleep

Meaning & Spirit purpose

Journey of wellness

illness optimal wellbeing

The journey of a thousand miles starts with a single step.

Lao Tzu, Tao Te Ching (600 BCE)

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