Medical Acupuncture Treatment Guidelines Using An Integrated Segmental Approach

What follows is a variation on a mechanisms based approach to the use of Medical Acupuncture with particular emphasis on the role of the spinal segments.

1. According to this approach, we may start by using local points such as myofascial trigger points (MTrP) and taut bands related to the patients presenting complaint. This would take into account referred pain patterns, altered muscle length and function. Manual needling as well as point stimulation using the Pointer Excel II or EA at 2 Hz may be used to augment the sensory neuro-modulatory and mechanical needling effects.

2. If too sensitive to treat locally or for enhanced modulatory effects use somatic segmental points to suppress nociceptive transmission and influence muscle tone through the related segments.

For example:

  • Paravertebral segmental points via the dorsal rami - corresponding with segmental innervation of muscles containing MTrP and/ or other tender areas

    • C3-C7 for upper limb dysfunction
    • L1-L5/S1 lower limb dysfunction
    • Adjacent to the spine at corresponding tender spinal segments

  • Peripheral segmental points via the ventral rami - in the local or referred pain zones and/or muscles acting on painful or tender joints

3. For chronic conditions where vaso-reflexive autonomic nervous system changes are more likely use sympathetic segmental points. This would involve assessment of the segment/s giving information on chronicity and possibly impaired vascular supply to the affected extremity/extremities resulting in deep muscle ischaemia and perpetuation of the MTrP energy crisis. Increased level of circulating catecholamines may also promote chronic sensitization through affected segments.

Signs of peripherally mediated increases in sympathetic tone through the dorsal and/or ventral segments include:

    • Positive skin roll test
    • Hyperhidrosis
    • Skin mottling
    • Positive matchstick test- trophoedema

  • If segmental sympathetic dysfunction is identified on assessment a paravertebral needling approach may be used to modulate sympathetic tone via primary dorsal rami

    • Upper limb T1-T9
    • Lower Limb T10-L2
    • Head and neck T1-T5

  • Or a peripheral needling approach which may modulate sympathetic tone via primary ventral rami. In this case the aim would be to stimulate somatic muscular afferents close to nerves which carry a high percentage of peripheral sympathetic (motor and sensory) fibres to ensure convergence at correct spinal segment/s

    • Upper limb – median and ulnar nerves (below elbow)
    • Lower limb – tibial nerve (below knee)
    • Head and neck LI4 may used (C8-T1 myotome)

4. For centrally mediated increases in sympathetic tone often associated with higher levels of cognitive affective dysfunction use central regulatory points e.g. ST36, LR3, and LI4 to modulate autonomic function centrally via the hypothalamus.

By Simon.

References:

  • Watkin, Hywel. "Segmental dysfunction." Acupuncture in Medicine 17, no. 2 (1999): 118-123.
  • White, Adrian, and Jacqueline Filshie, eds. An introduction to western medical acupuncture. Edinburgh: Churchill Livingstone/Elsevier, 2008.
  • Pinto MD, Hugo. “Sports Medical Acupuncture.” Course notes, January 2015.
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