Neuroanatomic Acupuncture for Neurologic Conditions
Western Veterinary Conference 2004
Narda G. Robinson, DO, DVM, DABMA, FAAMA
Colorado State University College of Veterinary Medicine and Biomedical Sciences
Fort Collins, CO, USA
- Describe how acupuncture treats neurologic conditions from a neuroanatomic perspective.
- Review the evidence related to acupuncture treatment for neurologic conditions.
- Neuroanatomic acupuncture is perfectly suited for the treatment of neurologic problems, as the analysis of the underlying neurologic deficit can lead directly to the selection of specific and appropriate acupuncture points.
- Cranial nerve deficits require stimulation of acupuncture points overlying cranial nerves, either as they exit foramina in the skull or along their course.
- Peripheral neuropathies call for stimulation of points related to the defective peripheral nerve and their related spinal nerves.
- The treatment of spinal cord injury with acupuncture frequently involves point selection cranial and caudal to the spinal cord lesion, along with selection of distal points.
- Motor dysfunction may involve point selection ranging from scalp acupuncture over the motor cortex, to spinal nerves, and finally to motor endplate zones within muscles.
- Autonomic problems (primary or secondary) may benefit from treatment of points near autonomic ganglia or related peripheral nerves, or of points associated with spinal nerve root levels corresponding to the autonomic distribution within the spinal cord.
Why Neuroanatomic Acupuncture?
Neuroanatomic acupuncture correlates traditionally described points and channels with actual anatomical structures (nerves, nerve plexuses, etc.). Most acupuncture points are closely associated with one or more types of nerves; it is stimulation of these nerves that produces the acupuncture effect. Neuroanatomic acupuncture involves selection of points that relate neurologically or physiologically to the clinical problem. As such, neurologic problems are specifically well suited to a neuroanatomically based treatment design.
What Neurologic Structures Are Associated with Acupuncture Points?
- Cranial nerves
- On the face, the trigeminal nerve and the facial nerves have many acupuncture points associated with both their emergence through cranial foramina and sites along the courses of the nerves to their final destinations. Acupuncture points may also be located at locations where two different nerves meet, or where nerves branch.
- Peripheral nerves
- On the thoracic and pelvic limbs, acupuncture points related to peripheral nerves may occur either at supracondylar or infracondylar locations. They may also lie in interosseous grooves, such as between the radius and ulna, or between the tibia and fibula.
- Spinal nerve roots
- From the neck down to the tail, acupuncture points occur near the dorsal and ventral primary rami at almost every spinal segment.
- Motor endplate zones within muscles
- Many acupuncture points can be found at the site where the motor nerve enters its affiliated muscle, near the endplate zone of the motor nerve endings. These sites relate to myofascial trigger points, which become tender to palpation with neuropathic pain or myofascial strain patterns.
- Autonomic pathways
- Acupuncture stimulates nerves as well as vessels, since both types of structures often lie in close proximity. Vessel wall stimulation activates the sympathetic nerve fibers that regulate vessel diameter and smooth muscle activity. In keeping with the observation that acupuncture most often causes a reduction (as opposed to an increase) in sympathetic tone, the effect of acupuncture is predominantly vasodilatory. The double arterial arch systems of the distal extremities carry substantial autonomic input. Acupuncture points near these arterial structures provide an opportunity to impact regional, even systemic autonomic tone through needling therapy.
Evidence for Acupuncture in Specific Neurologic Conditions
Most systematic reviews and critical analyses of acupuncture research draw the conclusion that the evidence for acupuncture for a given clinical problem is “mixed.” In large part, this is due to the nearly infinite number of possibilities for acupuncture point selection and needling style. The mechanics of needling during acupuncture treatments vary widely according to depth, site selection, total number of needles, addition of other vehicles of stimulus delivery instead or in addition to needling (e.g., laser, electricity, heat, etc.), degree of stimulation of the needle following insertion, adjunctive modalities (massage, herbs, etc.). It is no surprise, therefore, that research results are “mixed.” Nevertheless, research evidence continues to grow, allowing practitioners to refine their approaches according to proven benefits from certain applications of acupuncture.
The following conditions have received research attention, primarily in humans. In general, the nearly universal conclusion by reviewers evaluating these studies is that more research with improved methodology is necessary.
- Neck pain
- Back pain
- Stroke rehabilitation
- Parkinson’s disease
- Multiple Sclerosis
- Spinal cord injury
- Facial nerve paralysis
- Memory Loss
The ability to make treatment recommendations regarding acupuncture for neurologic (and most other) conditions will improve as the quality of research advances.
Systematic application of acupuncture according to neuroanatomic rationales provides the opportunity to standardize acupuncture treatment interventions, and in so doing will improve the quality of acupuncture research.
Few treatments assist neurologic recovery better than physical medicine interventions. Of these, acupuncture possesses the unique characteristic of immediate and specific neurological stimulation of involved dysfunctional structures.
1. Rabinstein AA and Shulman LM. Acupuncture in clinical neurology. The Neurologist. 2003;137-148.