About Needling Dr Ivo Waerlop The Skin Where the Wei and the Ying meet What s under that needle anyway?
Layers of Epidermis What are you feeling? you should feel 2 distinct resistances as the needle goes through the layers Just how small are those needles?
What is the Patient Feeling? Deqi a small, quick, cramping sensation or electrical sensation at the needling site How does the message get up there? What is the Patient Feeling? muscle, tendon, periosteum soreness and distension nerve numbness blood vessel pain, burning, stinging
It s about the Sclerotomes (and myotomes and dermatomes) It s about the Neuron It s about the Perivascular Plexus
Tigers! Third sign of the Chinese Zodiac Ruler of Beasts on Earth Yang animal associated with courage, bravery, dignity, sternness What should you see? small flare response axon reflex mast cell products degranulated histamine, platelet activating factor, leukotrienes substance P
The Chemical (Cytokine) Culprits (Tachykinin) Substance P stimulates Neurokinin I (NKI) receptors Kinins Bradykinin B1 and B2 receptors Kallidin products of cellular damage fibroblasts, adipocytes, mast cells, collagen fibers, etc Needle Induced Tissue Reaction 1. Vasodilatory 2. Nociceptive Activation 3. Chemotactic 4. Solubility 5. Tissue repair 6. Inactivation 1-4 are early response, 5 and 6 are intermediate and later A painting of a tiger is hung on a wall opposite the entrance in a building to scare away demons so they do not enter
Tissue Responses to Needling local response segmental response long loop/cortical response Local Response Segmental Response
Presynaptic Inhibition Cortical Response
It was believed... tigers turned white after 500 years They could live 1000 years When they died their spirit entered the earth and became amber Soul of the Tiger Depth of Insertion Superficial Medium Deep Shallow Insertion epidemal/dermal, just below skin nutrient response Ying to release blood and eliminate external (Yang) pathogenic factors skin related to lungs in TCM shallow insertion has more effect on somato-visceral responses
Medium Insertion just into muscles defensive Wei response, releasing vital substances and removing internal (Yin) pathogenic factors influences lymphatics reduces swelling and edema (dampness) Deep Insertion deep into muscles promotes flow of nutrients (blood and oxygen) generates internal heat The Tiger is associated with Tsai Shen, the God of Wealth
Strong manipulation Usually for musculoskeletal conditions Activate descending control mechanisms Activate motor and proprioceptive systems Usually for obstructive syndromes More tissue damage = more tissue repair = greater healing response Longer retention times promote more blood flow Gentle Manipulation Less tissue damage Coupled with longer retention time (15-20 minutes) enhances anti inflammatory phase of tissue reaction Strengthens Yin Good for Yin Deficiency Evokes parasympathetic response Treats false heat receptors in brief cholinergic use acetylcholine adrenergic use epinephrine and norepinephrine
cholinergic muscarinic all effector cells stimulated by post ganglionic cholinergics nicotinic between pre and post ganglionic neurons adrenergic alpha norepi excites mostly alpha epi does alpha and beta receptors beta 2 types B1 and B2 epi excites Needle manipulation Strong manipulation induces more tissue damage Enhances inflammation (Builds Yang) Good for Yang deficiency Especially with short retention time 2-4 minutes Used to reduce an excess (like clearing heat) Also builds/restores Yang Stimulates sympathetic responses Inhibits GI system, increases heart rate and blood flow Causes central vasoconstriction, peripheral vasodilation
A Tigers head was painted on warriors shields to terrify the enemy Needle retention time The single most important factor in needling therapy Kendall Long Retention Time Influences tissue reactions in terms of promoting inflammatory (Yang) or anti inflammatory (Yin) responses Strong stimulation/short time = inflammatory response Used to strengthen Yang deficiency Reduces acute condition
Short Retention Time Minimal manipulation/long retention time = anti inflammatory response Used for false heat and Yin deficiency Promotes tissue repair and reduces pain