Category Archives: Research

The Neuron Whisperer, Part I

OK OK – Not a cheesy post about psychic horse connection. BUT STILL… that is the look on my face when whispering to neurons.

The evidence is mounting that I am in fact, a Neuron Whisperer. I am prepared to back this up with a couple of solid peer-reviewed papers, as well as an anecdote, but I think that this clip from the Mighty Boosh sums up the idea the most effectively:

In this clip, tiny Howard and Vince’s white blood cells “crimp,” (parody of rap?) a synchronized rhyme which accesses memory and reflex simultaneously. They begin to re-enact the crimp, which helps them to recognize Howard as a friendly agent and to create further communication which can be propagated into the neural network. To the Brain!

You may remember a similar post using the Mighty Boosh’s “crimping” practice, when speaking about neural mirroring and group exercise, HERE.

Neural mirroring has been postulated as an evolutionary trait that allows us to learn extremely quickly via mimicry. It also allows us to function optimally in social settings by actually experiencing in our own minds the mental state of someone else by observing the physical manifestation of that mental state in another person. This is one definition of empathy. Here is a fantastic video by NOVA that explains neural mirroring (the transcript is a nice summary as well).

The concept of neural mirroring emphasizes the importance of having a medical provider who is in a good state of health and excellent state of mind and spirit. But acupuncture takes this a step further and directly impacts the function of the nervous system. In the video clip above, Howard is using a technique that resonates with how acupuncture communicates with the nervous system- by stimulating a previously used pathway (neurotransmitter release) in order to gain access to the deeper pathways of neural network function (neural repair, hypothalamic-limbic system access).

Acupuncture has been shown to promote nerve repair, in response to both traumatic injury (such as spinal cord damage or stroke) and neurodegenerative disease (such as Parkinson’s). One proposed mechanism of acupuncture’s action is the stimulation of the release of neurotransmitters such as endorphins and adenosine. The Mighty Boosh video should feature this adenosine molecule rather than white cells:

Or this beta-endorphin molecule (in the form of a beautifully tooled choker):

Acupuncture’s adenosine-releasing effect can treat many things, from pure pain relief to repairing nerve damage, reducing the severity of autoimmune disease, post-stroke recovery, and wound healing. Quite a laundry list of actions, there. I take this to mean that performing acupuncture (to release neurotransmitters such as adenosine) is a form of Neuron Whispering!

Monty Roberts, Horse Whisperer. KIND OF LIKE THIS! Except with NEURONS!

Part 2 will outline the details of how specific acupuncture points have been proven to affect neural function, and we will discuss what the experience looks and feels like in a clinical setting. Until then, here are some academic papers to make all of you nerds happy.

Here is a note about acupuncture’s effect on neurotransmitters, addressed in a lecture given to the American Academy of Medical Acupuncture in 1999: “Acupuncture can speed up the wound healing process92 and cause an exaggerated systemic wound healing and stress response.93,94 The response can include excessive release of endorphin, which stimulates epithelial cell growth,95 as well as analgesia. Other neurohumoral factors induced by acupuncture such as serotonin96 and adrenocorticotropic (ACTH) hormone97 also have growth-control effects.98 (1)”

A 2010 article in Science Daily News goes into some detail regarding the most current research on acupuncture’s mechanism of action:

The research focuses on adenosine, a natural compound known for its role in regulating sleep, for its effects on the heart, and for its anti-inflammatory properties. But adenosine also acts as a natural painkiller, becoming active in the skin after an injury to inhibit nerve signals and ease pain in a way similar to lidocaine.

In the current study, scientists found that the chemical is also very active in deeper tissues affected by acupuncture. The Rochester researchers looked at the effects of acupuncture on the peripheral nervous system — the nerves in our body that aren’t part of the brain and spinal cord. The research complements a rich, established body of work showing that in the central nervous system, acupuncture creates signals that cause the brain to churn out natural pain-killing endorphins. (2, emphasis added)

An August 2012 study of sciatic nerve damage in mice has come to the conclusion that acupuncture could be used as “a complementary approach to stimulate intrinsic motor fibres regrowth properties in patients…This study demonstrates that electro-acupuncture exerts a positive influence on motor recovery and is efficient in the treatment of pain symptoms that develop during target re-innervation.(3)” In attempting to understand the mechanism of this beneficial effect, the authors posit an association with the opioid-releasing effect of acupuncture as helping stimulate nerve repair, citing a 2007 study published in Brain Research that finds “that morphine may promote the regeneration and synaptic reconstruction of the terminals of injured primary unmyelinated afferent fibers in lamina II of spinal cord, by a process mediated by mu-opioid receptors.(4)”

A 2004 pilot study published in Neurorehabilitation and Neural Repair examined 36 cases of post-stroke motor recovery using acupuncture, and found that specific sensorimotor functions were significantly improved compared to the control group, based on a number of possibly combined mechanisms of action:

Acupuncture may provide a form of sensory stimulation that stimulates polymodaltype receptors providing a source of peripheral afferent stimulation via the spinal cord to central nervous system structures.11-13 After stroke, acupuncture has been found to induce changes in regional cerebral blood flow (rCBF) that may increase flow to hypoperfused areas of the ischemic penumbra.14 Changes in rCBF have also been attributed to acupuncture in the hypothalamus- limbic systems in response to stimulation of analgesic points, providing further support for localized cortical effects attributable to acupuncture stimulation.15,16 Additionally, stroke recovery has also been associated with neurotrophic factors that are capable of supporting neuronal survival after stroke.17 Recent animal work is beginning to demonstrate that acupuncture can enhance neurotrophic factor expression that promotes cell survival and prevents apoptosis.18-20 If the mechanism of acupuncture effectiveness after stroke is related to factors that influence afferent inputs and intrinsic cortical circuits associated with sensorimotor function, then measures of acupuncture effectiveness should be used that are more closely related to neurorecovery.(5)

And finally, to glorify the adenosine molecule to greater heights, I include the following 2008 study which examines the possible use of adenosine in inflammatory and immune pathways.

The effect of adenosine on cytokine production by macrophages has attracted considerable attention, because macrophage-derived cytokines are crucial initiators and orchestrators of immune responses. As tumour necrosis factor-? (TNF-?) was one of the first cytokines to be discovered, a substantial body of information has accumulated regarding the ability of adenosine receptor activation to limit TNF-? production following macrophage activation.

…Although A2A receptors are present on immature dendritic cells, they are expressed at low levels and appear to be silent, as their activation is unable to elicit downstream signalling events such as accumulation of intracellular cAMP25. However, dendritic cell maturation is accompanied by the emergence of A2A-receptor-mediated signalling responses, owing to both increased expression and coupling of A2A receptors25,26. A2A receptor activation on mature dendritic cells shifts their cytokine profile from a pro-inflammatory to an anti-inflammatory one, with reduced IL12, IL6 and interferon-? (IFN-?) production and augmented IL10 production2527. It is likely that dendritic cells in the presence of adenosine have a reduced capacity to induce T helper 1 (TH1) cell versus TH2 cell polarization of naive CD4+ cells27. This is due to the adenosine-induced switch in dendritic cell cytokine production away from the TH1-inducing IL12 towards the TH2-inducing IL10.

In summary, the available data support a dual role for adenosine in dictating dendritic cell function. Adenosine promotes the recruitment of immature dendritic cells to sites of inflammation and injury via A1 or A3 receptors. At these sites adenosine produces, via A2A receptors, an anti-inflammatory dendritic cell phenotype driving T-cell responses towards a TH2 profile.(6, emphasis added)

Acupuncture’s effect on the nervous system has been shown to elevate mood and relieve stress (an increasingly popular conception of acupuncture), but apparently this just scratches the surface. Acupuncture also helps regenerate nerve cells, helps perfuse injured brain tissue with beneficial blood for post-stroke recovery, initiates a strong anti-inflammatory effect and relieves symptoms of autoimmune diseases while strengthening the immune system against attack from outside forces.

Wait, wait… here is a picture of me, ACTUALLY NEURON-WHISPERING A HORSE!

Well, maybe we don’t have the most soulful connection, YET. These things take time.

And for your gratuitous viewing pleasure, a riveting TED talk about the process of having a stroke, as experienced and recounted by a brain researcher!

References:

1. Shang, Charles MD. MECHANISM OF ACUPUNCTURE – BEYOND NEUROHUMORAL THEORY; Lecture at the 1999 Annual Symposium of the American Academy of Medical Acupuncture.  Medical Acupuncture: A Journal For Physicians By Physicians. “Aurum Nostrum Non Est Aurum Vulgi” Fall 1999 / Wiinter 2000 Volume 11 / Number 2. http://www.medicalacupuncture.com/aama_marf/journal/vol11_2/conduct.html

2. Acupuncture’s Molecular Effects Pinned Down: New Insights Spur Effort to Boost Treatment’s Impact Significantly. ScienceDaily. 2010 May 31. http://www.sciencedaily.com/releases/2010/05/100530144021.htm (original article: http://www.nature.com/neuro/journal/v13/n7/full/nn.2562.html)

3. Ngoc S Hoang1,4, Chamroeun Sar1, Jean Valmier1,3, Victor Sieso1,2 and Frédérique Scamps1Electro-acupuncture on functional peripheral nerve regeneration in mice: a behavioural study. BMC Complementary and Alternative Medicine. 2012, 12:141 doi:10.1186/1472-6882-12-141 Published: 31 August 2012

4Zeng YSNie JHZhang WChen SJWu W.  Morphine acts via mu-opioid receptors to enhance spinal regeneration and synaptic reconstruction of primary afferent fibers injured by sciatic nerve crush. Brain Res. 2007 Jan 26;1130(1):108-13. Epub 2006 Dec 13. http://www.ncbi.nlm.nih.gov/portal/utils/pageresolver.fcgi?recordid=1354160406485082

5. David N. Alexander, Steven Cen, Katherine J. Sullivan, Gitu Bhavnani, Xiuling Ma, Stanley P. Azen and ASAP Study. Effects of Acupuncture Treatment on Poststroke Motor Recovery and Physical Function: A Pilot Study.  Neurorehabilitation and Neural Repair. 2004; 18; 259. DOI: 10.1177/1545968304271568 http://nnr.sagepub.com/cgi/content/abstract/18/4/259

6. György Haskó,* Joel Linden, Bruce Cronstein,§ and Pál PacherAdenosine receptors: therapeutic aspects for inflammatory and immune diseases. Nat Rev Drug Discov. 2008 September; 7(9): 759–770.  doi:  10.1038/nrd2638 PMCID: PMC2568887 NIHMSID: NIHMS71616 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2568887/


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Flying Home: Starting an Acupuncture Practice

In which I digress from informative posts in order to express my excitement, apprehension, and good-old-fashioned dorkiness about starting an acupuncture practice (or a couple of them) in Portland, Oregon, the land of acupuncturists…

When I started this blog, I was an excited student learning about the systems of acupuncture, Traditional Chinese Medicine, and various Western medical ideas and research. Now I am a rookie acupuncturist, still learning but in more detail, and also running a business. Well, running 1.5 businesses and working for 2 more businesses. For better or for worse, business has entered my world in a major way, and it kind of feels like I’ve been given a power-wedgie by the finance and marketing sectors.

Appropriately, this image is from the Big Brother tv show.

I’m sure it’s counterproductive to view myself in some kind of power dynamic with these abstract concepts, especially with myself initially as the victim. But after going through the motions of creating business entities and then promoting them, I am sooo ready to be the one who surprises ‘finance’ and ‘marketing’ by pulling their underwear above their waistline and deftly depositing them both on matching fenceposts, dangling by their underwear.

To create a more natural metaphor, I will give you a peek into what my past three months have looked like, approximately:

The noble Goshawk, pursuing a Rabbit

I would like to picture myself as the goshawk here, but I am also a bit like the rabbit. This is the world of business, goshawk-eat-rabbit. If I am the goshawk, financial security must be the rabbit. Or “finishing that stupid google ad” may be the rabbit. Whatever. My job as an acupuncturist is to reach the greatest number of people that need my help, and to provide them with the best medical care possible. However, the way this looks in the real world involves a lot of publicity-creation and seeming self-aggrandizement, just to let people know that I exist. Unfortunately as acupuncturists, we don’t have an established system of facilities into which we are funneled. So we get to reinvent the wheel nearly every time.

We don’t have residencies (or very few), nor old-timey apprenticeships (unless we’re really old school), nor large institutions that will hire us as employees and send a reasonable flow of patients our way. No, we must reach out and educate nearly every patient that comes through our door about this form of medicine and how we can help them. I enjoy outreach and education as much as the next person, and I feel like I can execute a plan of action fairly well, so I’m not complaining about actually doing this work. Instead, I am pointing out the differences between how acupuncturists build their practices and how nurses or doctors build theirs.

As acupuncturists, we must set up elaborate schedules full of health fairs, farmers markets, free acupuncture happy hours, and lectures at local libraries. We must lurk around in coffee shops and surprise innocent latte-sippers with our bursts of enthusiasm about the healing power of tea, or coffee, or how seasonal changes effect allergies and how we can treat these flare-ups. We must memorize the locations of all the natural food markets in our metropolitan area and regularly give talks or post flyers in these locations. Really.

Coffee Talk from SNL. They just learned about the benefit of green tea. I think.

There is a good side to the lack of infrastructure in the acupuncture field: we don’t fall prey to bureaucratic profit-harvesting and the streamlining of services to the patients’ neglect or dismay. But in many other ways it creates a huge waste of time and effort, and the process of building a clientele culls the acupuncturists who may be fantastic clinicians but ineffective business-people. Not everyone knows how to make Linda Richman all verklempt over Chinese Medicine.

This is a sad state of affairs, and in extra-sad news, acupuncturists can’t seem to organize themselves into effective advocates for their own industry. We joke with each other about the difficulty of “herding cats,” but the fact is that we are either too busy trying to build a patient base or too busy treating the patients that have found us, since we generally work diligently and passionately to provide exceptional medical care. Our colleges are just beginning to build real equity and gain foundation-level support, and we have very few acupuncture-specific research institutions.

Why am I bemoaning this state of affairs? To give greater importance to the progress that is being made currently in our field of medicine. It takes a gargantuan effort to educate the public about our form of medicine with the minimal level of funding that we currently have. But we are doing a fairly good job of this. Furthermore, our clinical researchers and leading practitioners in the field have done an excellent job of collaborating with leading colleges and universities to create robust studies of acupuncture’s effectiveness. So, there is a silver lining.

We can still shape the field of acupuncture and Traditional Chinese/East Asian/Oriental Medicine in the United States. We can create an effective organizational structure that maintains the integrity of our approach to medicine (hopefully). As more MDs and NPs, NDs and DOs and RNs gain more knowledge and experience with acupuncture, they have begun to create close referral relationships with acupuncturists and TCM practitioners. Hospitals are hiring acupuncturists for their pain management/pre and post-operative/oncology/ rehabilitation wards. And acupuncturists are finally becoming successful enough to hire associate acupuncturists at a fairly living wage.

Here are a few institutions in the US that are pursuing top notch acupuncture research:

Columbia University College of Physicians and Surgeons

Massachusetts General Hospital

Harvard University Medical School

The University of Maryland

University of North Carolina

University of Washington

Helfgott Institute

Duke University

The Oregon College of Oriental Medicine

The New England School of Acupuncture

And now we have a listing of integrative medical centers featured in the Bravewell Collaborative’s 2012 report “Mapping the Field of Integrative Medicine”- most of which are pursuing research in acupuncture and TCM.

Participating “Integrative Medicine in America” Centers:

  • Alliance Institute for Integrative Medicine
  • University of Maryland Center for Integrative Medicine
  • Arizona Center for Integrative Medicine
  • Cancer Treatment Centers of America
  • Integrative Medicine Program, Mayo Clinic
  • The Center for Integrative Medicine at the University of Colorado
  • Integrative Medicine Center at MD Anderson Cancer Center
  • Center for Life, University of New Mexico
  • Northwestern Integrative Medicine
  • Cleveland Clinic Center for Integrative
  • OSU Center for Integrative Medicine Medicine
  • UCSF Osher Center for Integrative Medicine
  • Continuum Center for Health and Healing
  • Osher Clinical Center
  • Duke Integrative Medicine
  • Penny George Institute for Health and Healing
  • 11th Street Family Services of Drexel University
  • Scripps Center for Integrative Medicine
  • GW Center for Integrative Medicine
  • Simms-Mann Health and Wellness Center at Venice Family Clinic
  • Greenwich Hospital Integrative Medicine Program
  • Center for Integrative Medicine and Wellness at Stamford Hospital
  • Institute for Health & Healing at California Pacific Medical Center
  • Stanford Center for Integrative Medicine
  • Jefferson-Myrna Brind Center of Integrative Medicine
  • Susan Samueli Center of Integrative Medicine
  • University of Wisconsin Integrative Medicine
  • Marino Center for Integrative Health
  • Vanderbilt Center for Integrative Health

So back to the image of the Goshawk and the Rabbit. As you know, my articles here are longer than the normal blog article, so of course I’m including a personal story regarding the goshawk, Accipiter gentilis. The goshawk’s name is derived from “goose-hawk,” since it is used in falconry to hunt large birds and mammals. Yet its scientific name gentilis derives from the same latin root as ‘gentle,’ or ‘noble.’ The largest of the Accipiters, the goshawk exemplifies concepts of the precision and endurance of hunting, the grace of flying through dense coniferous forests at high speeds, the gentleness of a highly devoted parent, and the mystery of a bird that only appears when its young are threatened (and when they appear, they will relentlessly attack anything in a two mile radius of their nest, including humans).

caw caw

So I was attacked by one such goshawk several summers ago. This particular goshawk was famous in the area for making its valley debut by cold-cocking the owner of a local dude ranch on his morning stroll. He was knocked unconscious and awoke in the trail-dust to the warning call of the female goshawk. Unfortunately the goshawk’s nest was located about 500 yards from my family’s cabin, so we commonly crossed its territory on hikes into the mountains. We gradually became accustomed to its warning call after a few instances of dive-bombings in which my brothers were attacked but I was not present. One morning I brazenly took our dog for a walk up the mountain, and I remember its warning call nearby, as usual. This time, the call was cut short, followed by a pregnant silence through which it swiftly winged its hooked beak and knuckled-up talons directly towards my low back at a ridiculous speed. After a moment in which I felt my brain explode in mortal (yet absurd) terror, I hit the ground, flopping down by a log, and felt the bird pass a foot above me. I proceeded to alternately laugh at myself and gulp in hysterics as the bird chased me down a hillside, and I tumbled through bushes and downed trees to avoid the female goshawk’s repeated attacks with fierce speed.

I found myself completely humbled and in awe of an animal that hurled itself bodily towards its source of threat. Goshawks apparently defend their nests from bears and other large animals regularly. They mate for life and have a large range, requiring large tracts of wilderness to successfully reproduce. How does this relate to me? Well I shall tell you. I do not require large tracts of land in order to reproduce, but I do understand the idea of hurtling directly at the goal with fierce speed. As I returned from Bangkok in May of this year, I felt inspired to collaborate with a variety of medical professionals in Portland, rather than just hang my own shingle and build up a practice around myself. This task is daunting to someone completely new in this field of medicine. I took creative collaboration as my goal, and this spirit of hurtling myself precisely towards this achievement has helped me to work with a wonderful team of practitioners here. The goshawk also embodies the idea of creating and protecting a home, and I feel like I have created this home in Portland. Now if the field of acupuncture can learn to gather our resources in a similar way to achieve a larger goal, we could create true collaboration on a larger scale!

So I am going to take the next few posts to investigate and interview in greater detail some of the structures and people in the acupuncture field (US and internationally) that are inspiring to me. Stay tuned!

Now as a reward for yet again making it through the ramblings of my article, please go to 5:41 in this video and watch for 6 seconds. Thank you!

And for another bird of prey’s insights: Thank you Sam the Eagle: