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Acupoint Specificity and the Modern Age of Technological Innovation

Posted by:  Scott Stewart, MSAc., Dipl. Ac., LAc.

Introduction

Acupuncture Classics
For thousands of years Acupuncture practitioners have been guided by family knowledge passed down from one generation of doctor to the next, by invaluable manuscripts  -  many of which have been destroyed, and more recently, by the Chinese medical classics, which have guided modern practitioners in every aspect of Traditional Chinese Medicine (TCM), even in the midst of our modern age of science and technology. 

Our knowledge of point locations comes from the same classical books, and the wisdom from present day lineages that share their observational & clinical experiences.  For the most part, the methods and techniques of the modern day practitioner are still the same as they were thousands of years ago; the only difference is that we have more sophisticated technologies that can illuminate the internal world of our bodies by displaying it on a computer screen.  These high-resolution three dimensional images show us what the ancient ones amazingly discovered through much cruder means.

Shaman
For example, around 2200 BCE, there was no technology to aid primitive man in their exploration of the human body, but yet they still found a way to discover some of its secrets.  At that time, tribal shaman were responsible for healing the sick.  Amazingly, they had no tools or innovative pieces of equipment to help them distinguish one acupoint from another or even a real acupoint from a non - acupoint.  Instead, they used their tactile sense of touch as they palpated the patient’s skin and body, noticing differences in skin texture, temperature, resilience and shape.  They used this information to formulate therapeutic strategies, and as hundreds and thousands of years went by they began to record this data into manuscripts; depicting the location, actions and indications of each point they had carefully discovered.

bronze needles
Later, during the Shang Dynasty (1700 - 1100 BCE) a new technology emerged that reshaped every one’s life, including acupuncturists.  The Bronze Age had arrived and the stone needles & animal quills of the past were being replaced with bronze medical needles, and later these would be followed by iron, and then gold and silver needles.  The use of metal needles, which were heated up, led to the discovery of the meridians; because the patient was able to sense the heat as it flowed through the body along specific pathways. 

This is just one of many examples that can be found all over the world, in which technology led to new discoveries that essentially propelled, in this case, acupuncture into a new era of diagnoses and treatments. 

Now, fast forward to our modern medical age, in which we are on the cup of a new futuristic era that is being driven by microprocessors, complex algorithms, higher resolutions, advanced 3D imaging, and the start of a new biotech chapter with the integration of artificial intelligence, nanotechnology and 3D printing.  These technological innovations will have positive repercussions throughout both Eastern and Western medicine.

Recent Technological Innovations and Acupoint Research​

fMRi
Over the last few decades one of the biggest driving forces behind the success in acupuncture point research, has been due to the progress made in imaging technologies.  A considerable amount of the accumulated data that we have on point specificity has been the result of these improved imaging devices like Functional Magnetic Resonance Imaging (fMRI), Positron Emission Tomography (PET), and the latest in the state - of - the - art computerized tomography (CT) scans with enhanced 3D imaging capabilities.  As these devices continue to develop, ​they provide researchers with powerful and invaluable tools that can be utilized in the investigation of the intricacies that underlie acupuncture’s therapeutic influence over the body.  

"Fast forward to our modern medical age, which is driven by microprocessors, complex algorithms, higher resolutions and 3D imaging."
New discoveries almost always follow technological innovations, and this is no different in the field of acupuncture research.  Over the past 10 years, there has been increased interest in using the latest advances in diagnostic imaging technologies to study acupuncture points and meridians, in order to reveal their morphological structures, their unique features, and their hidden mechanisms.  In the following paragraphs, you will read about some of the most important research of the last decade that has exploited these new technologies and led investigators to a more profound understanding of the mechanics that govern acupuncture. 

The bulk of the studies below focus on validating point location by comparing verum (real) acupoints to sham points (non-acupoints) in terms of whether they activate the same areas of the brain or not.  This indicates that needling at a particular point location as opposed to a randomly chosen area of the body elicits a very specific effect that can only be obtained by needling that acupoint.  ​

FMRI evidence of acupoint's specificity in two adjacent acupoints

​In this first study, Chinese researchers were investigating the specificity of two verum acupoints compared to a non – acupoint.  The two verum points chosen were Liver 3 (LR3) and Somach 44 (ST44) as seen in figure 1, which are located on the dorsal aspect of the foot and adjacent to one another, while the non-acupoint lies in the same area and adjacent to both LR3 and ST44.  
Manual acupuncture was performed on the three points during an fMRI scan.  As seen in figure 2 and figure 3, Both LR3 and ST44 were shown to activate specific cerebral patterns in the contralateral primary somatosensory area (SI) and the ipsilateral cerebellum.  LR3 and ST44 also elicited specific regions in the brain that were distinct from one another. [1] 

Verum and sham acupuncture exert distinct cerebral activation in pain processing areas: a crossover fMRI investigation in healthy volunteers

Figure 1 ST 44 and ShamFigure 1
Another study examined ST44 compared to a sham point (figure 1), using fMRI to investigate neural activity.  Stimulation of ST44 showed increased activity in the prefrontal cortex, parietal cortex and the temporo-occipital regions of the brain.  (figure 2, A. ST 44) 

Remarkably, the sham point also showed stimulation, but this occurred in the primary and secondary somatosensory (s1 and s2) cortex areas.  (figure 2, B. Sham) 

 Fig. 3 Cerebral effects of acupuncture, contrasting verum and sham stimulation. Blue-coded activation sites: increase for Sham minus ST44; red-coded sites: ST44 minus sham. The most important activation sites were marked with a circle and indicated by a number: 1—primary somatosensory cortex (S1); 2 post—posterior insula (y>0); 2 ant—anterior insula (y
These findings validate the location and therapeutic potential of ST44, and interestingly demonstrate the possible reason why some sham procedures produce some therapeutic value.  The brain region associated with the stimulation of the sham point is known for being responsible for affective pain processing.  Whereas, the true (verum) acupuncture point elicited a reaction from parts of the brain that process discriminative somatosensory and cognitive pain. [2]

Point Location and Action

Specific cerebral activation following true and sham Waiguan (SJ 5) needling functional magnetic resonance imaging evidence

In 2010, research was conducted with fMRI on 18 healthy student volunteers, who were put into 3 groups of 6.  One group received true acupuncture at Triple Energizer 5 (TE5, a.k.a. Waiguan).  Sham needling was administered to the second group at TE5, and the third group was treated with true acupuncture at a nearby sham acupoint. 

​The fMRI demonstrated that stimulation of TE5 compared to sham needling activated the right superior frontal gyrus (BA8), and the left cerebellum.  More specifically, needling at TE5 activated the right parietal lobe pertaining to the post-central gyrus (BA2), left cerebellum, and the right inferior semi-lunar lobule. [3]
 
This area of the brain is referred to as the Broadmann area (BA8).  It’s responsible for writing, language and auditory functions [4], movement of the upper limbs [5], impulsive and aggressive behavior (via the insular cortex) [6]; the cerebellum controls coordination in the limbs and trunk, as well as, playing a role in posture & maintaining balance.  BA2 as part of the post-central gyrus is related to the appreciation of sensation on the opposite side of the body.
 
According to TCM theory, TE5 or Waiguan is indicated for pain of the neck, shoulder and arm, impaired movement of the arm, shaking of the hand, impaired hearing and other ear disorders, as well as, anger, headache, dizziness, redness, pain and swelling of the eyes, etc. [7]

Summary

As the field of medicine becomes more entwined with technology, we will read about many more new discoveries and validations of theories in both Eastern and Western medicine.  These high tech developments, which arise in exponential waves, can expand our knowledge of human anatomy and neuroscience, as well as, all other corners of medical science, aiding researchers in making new discoveries and clarifying misconceptions.  This is certainly the case in Eastern medicine, in which we now are slowly uncovering the magnificent truth about the mechanics of acupuncture which operate at many different levels of physiology, ranging from the grossest materialism to the other extreme of immaterialism, which was once considered occult, but now more appropriately may be associated with the realm of quantum mechanics.  The horizons are grand, but there is still much work to do in terms of fine tuning research designs and diversifying study participants.

As can be seen in the small sample above, most of the research that has come out over the past 10 years has focused on small populations of healthy individuals and only investigated single, double or triple acupoint cerebral activation. 

There is a strong need to expand and improve study design, by examining unhealthy individuals across different age groups who are suffering from various diseases, including both psychological and physical illnesses, in order to truly understand the significance of acupoints and their affect on varying regions of the brain they activate.

Another area that should be high on the research list, is the investigation of acupoint combinations, especially those that are commonly used in clinical settings.  What is the effect of these combinations when they stimulate multiple brain regions simultaneously?  And do they activate the same regions as they do when stimulated as a single acupoint?  

Afterthought on Technological Innovations and the Human Ego

Even with all the intended benefits, the irony of technological advancement still remains, it will always be limited in its capabilities to keep pace with our own unquenchable curiosities to deconstruct our bodily terrains.  Medical science continues to pursue the reduction of the material body beyond the naked perception which is obliterated by a digitized pixelation under a macro zoom, just so we can better comprehend the body's mysteries; and more to the point, control and manipulate those mysteries.  In this sense, technology becomes irrelevant as a tool due to its failure to keep up with humanities thirst for omnipotence. 


Sources:
1.  Liu H, Xu JY, Li L, Shan BC, Nie BB, Xue JQ. FMRI evidence of acupoints specificity in two adjacent acupoints. Evid Based Complement Alternat Med. 2013;2013:932581. doi: 10.1155/2013/932581. Epub 2013 May 23.
2.  Usichenko TI1, Wesolowski T, Lotze M.  Verum and sham acupuncture exert distinct cerebral activation in pain processing areas: a crossover fMRI investigation in healthy volunteers. Brain Imaging Behav. 2014 Apr 12. [Epub ahead of print]
3.  Huang, Y., Lai, X. S., Shan, B. C., Tang, C. Z., Yang, J. J., Zeng, T., et al. (2010). Specific cerebral activation following true and sham Waiguan (SJ 5) needling functional magnetic resonance imaging evidence. Neural Regeneration Research, 5, 1712–1716.
4.  Marco Lanzilotto,1,2,* Vincenzo Perciavalle,3 and Cristina Lucchetti1,2. Auditory and visual systems organization in Brodmann Area 8 for gaze-shift control: where we do not see, we can hear.  Front Behav Neurosci. 2013; 7: 198. Published online Dec 10, 2013. doi:  10.3389/fnbeh.2013.00198
5.  Nocchi F1, Gazzellini S, Grisolia C, Petrarca M, Cannatà V, Cappa P, D'Alessio T, Castelli E.  Brain network involved in visual processing of movement stimuli used in upper limb robotic training: an fMRI study.  J Neuroeng Rehabil. 2012 Jul 24;9:49. doi: 10.1186/1743-0003-9-49.
 6.  Dambacher F1, Sack AT2, Lobbestael J3, Arntz A3, Brugman S3, Schuhmann T2.  Out of control Evidence for anterior insula involvement in motor impulsivity and reactive aggression.  Soc Cogn Affect Neurosci. 2014 May 16. pii: nsu077. [Epub ahead of print]
 7.  Deadman, Peter, and Manzin Al-Khafaji. A Manual of Acupuncture. East Sussex, England: Journal of Chinese Medicine Publications,
2000. 396. Print.




This post first appeared on Healing Lotus Health, please read the originial post: here

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Acupoint Specificity and the Modern Age of Technological Innovation

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