Medical-Terminology-Online.com

It’s not easy to find online resources for this.

Here’s a page on the kinin forming system. The pathway we’re interested in involves Hageman Factor and Bradykinin.

Here’s a nice overview of the complement system and help understanding the c3 and c5 roleplayers.

Here’s a diagram of plasminogen to plasmin:

Revelation: this could be the biological correlate to xue yu leading to heat. Xue yu or clotting requires plasmin, and plasmin sets off the inflammatory cascade.

A picture of plasmin:

somatosomatic - muscle problem affecting adjacent problem
viscerovisceral - one organ problem affecting another organ
viscerosomatic - organ disease producing body pain, e.g. heart attack pain down left arm or pancreatitis sharp stabiing pain to back
somatovisceral - acupuncture affecting organ

psychosomatic is yet another category- e.g. anxiety leading to stomach pain or diarrhea

stage 6 of tissue response to needling = inactivation (cortisol release) after 30-45 minutes
short period of needling = inflammation
long period = anti-inflammatory
histamine, inflam agent-
benadryl (antihistamine) makes you sleepy, so it’s yin
histamine is yang
short time is tonifying
long is sedating

Needling starts party that grows in the area
C3 makes it bigger, he’s the party promoter
vasodilation makes the party area bigger
sympathetic neurons define the other side (boundary upstream) of the party
heparin helps it flow, he’s the DJ
histamine is the reason “it’s gettin hot in here”
neutrophils and eosinophils are the busboys/cleanup crew
later on, cortisol shuts the party down- the police or Dad coming home!

The lecture uses an outline I made of a bunch of parts of chapter 14 (Mechanisms of Action) of Donald Kendall’s book, the Dao of Chinese Medicine. This book is one of the most scientific and rational I’ve seen of American acupuncture books, and this chapter, though dense and hard to understand, is a significant contribution to the profession.

What I am doing in the lecture is explaining the basics, or an overview of how acupuncture works in the body- and I don’t mean in terms of qi, but in terms of the body’s response to needling with the:

• immune complement system, .
• nervous system, and
• blood coagulation system.

A rudimentary knowledge of the nervous system is required, so you should first study nervous system terms and listen to my lecture on that. Even then, this lecture will stretch your knowledge. I believe all the relevant immune system elements are discussed in the acupuncture lecture, and the blood coagulation system is not covered in detail, so that other lecture is probably all you need to start with.

I also have created a dictionary of nervous system, immune system, etc. terms in this lecture for you to refer to.

1. plasmin
2. C3
3. complement proteins
4. produce C3, C5 and C9
5. C3 and C5 vasodilate and degranulate mast cells and basophils
6. Mast cells and basophils release histamine, heparin, kinin protease, and chemotactic factors
7. Heparin increases blood flow at site of needling (inhibits thrombin production)
8. Chemotactic factors attract neutrophils and eosinophils that control and mediate repair phases 5 & 6
9. kinin protease produces plasmin (which produces more C3) and bradykinin
10. bradykinin stimulates the substance P nociceptive neurons
11. resulting axon reflex sustains needling reaction

Dao of Chinese Medicine by Donald Kendall
Chapter 14 Mechanisms of Action
Highlights/Outline

Roleplayers p 256-7· Naloxone – opiate antagonist – stops analgesic effect of acu
· Periaqueductal gray, etc. – descending inhibitory pathways
· Neurotransmitters
· FMRI – CNS – major integration centers of brain, esp brainstem which integrates visceral and somatic
· Nociceptive DRG neurons in skin - required for de qi sensation
o Two A delta neurons
o C substance P neurons
o Inhibition of them negates acu effect
o Distribute to specific segmental levels of spinal cord
o Proximity to afferent sympathetic visceral neurons allows for somatovisceral/viscerosomatic communication
· Parasympathic afferents
· Group II (secondary) proprioceptive intrafusal neurons of muscle spindles [cause propagated sensation (PS)]
o Patient may or may not be aware of PS
o Normally participate in defensive spinal reflexes such as stabbing by thorn or exposure to hot object – also transmit signals to maintain bodily balance and function
o Needling activates these propriospinal pathways, which promote restorative processes

Overview of process p257
o Superficial stimulation (acupuncture, etc.) affects viscera and CNS via:
1. At same segment of spinal cord that receives sensory input from needling site
a. Somatovisceral responses (certain pts affect certain viscera, especially ones adjacent to pt)
b. Activated ascending spinal cord pathways
c. Supraspinal descending restorative control to affected level
i. Includes pain relief
ii. Control may depend on function of pt
2. Responses involving PS, propriospinal system, CNS processes
3. Method, strength, and duration of manipulation and retention
a. Skin/superficial tissue role in mediating CNS response to needling

Tissue Response to Needling p257-
· Body’s defense and immune functions in response to damage, puncture wounds, insect bites, etc.
o Can be activated by needling

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o Skin contains complex neurovasculoimmune regulatory network
§ Can you say “wei qi”?
§ Cutaneous tissues
§ Fine arterial and venous blood vessels
§ Lymphatic tissue
§ Immune cells
§ Afferent somatic neurons
§ Sympathetic neurons
§ Cutaneous immunity includes mast cells, bradykinin, cutaneous substance P neurons, sympathetic neurons to local blood vessels
· Epidermal cytokines induce and regulate immune responses of skin
§ Skin function associated with neuromodulators, neurohormones, hormones
· Tachykinin substance P stimulates
o Neurokinin 1 (NK1) receptors and
o Kinins, including bradykinin, b1 and b2 receptors
· Needling stimulates afferent substance P neurons VIA cutaneous immune features
o This stimulation of subst P neurons provokes CNS-mediated effects and antidromic axon reflexes
§ Centrally, this influences the HPA axis, which helps maintain homeostasis and immune system function
o Needling anywhere in body produces local acute inflammatory defensive response
o Acupuncture points have more skin sensors and cell types
§ because they are parts of the body that require more or specific types of information from the environment for protection, etc.
§ pricking, wounds, etc. more harmful at these pts than others
§ some are motor pts or golgi tendon organs
§ have higher electrical conductance (also higher along meridian pathways than non points 1 cm lateral)
§ lower electrical impedance
§ tapping along pathway being stimulated can provoke conscious PS (propogated sensation, what is traditionally called ‘qi traveling along the channel’)
§ larger concentration of neural and fine vascular components
§ greater distribution of mast cells
· Acupuncture sensations and associated neurons
o Touch, pressure, numbness – group II neurons
o Pricking sensation – A delta and group III nociceptive neurons
§ Distention and heaviness – group III
o Soreness – group IV
§ Includes unmyelinated cutaneous C neurons
o Most dominant in needling reactions, in order:
§ Lightly myelinated cutaneous A delta neurons (grp III)
§ Unmyelinated cutaneous C neurons (grp IV)
§ Group II fibers

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§ Pain relief effects of these neurons can be blocked with naloxone
· Needle insertion results in visible flare response (reddened area) p259
o Flare response can be inhibited with capsaicin, a crystalline compound that depletes substance P
o Thus the flare response is mediated by cutaneous nociceptive (subst P) afferents
o If nerve function to needling site is interrupted, flare response is absent, and therapeutic influence of needling is negated
o Size, character, and behavior of flare response can indicate vacuity or repletion, and correlate with effectiveness of acupuncture
· This needling response and local inflammatory reaction involves
o Superficial subst P nociceptive and sympathetic neurons
o Interaction between
§ Blood coagulation system (ying) and
§ Immune complement system (wei)
· Six phases of needling induced tissue reaction (only some of activities and role players in each one mentioned here) p 260
1. Vasodilatory – bradykinin and subst P released
2. Nociceptive Excitation – bradykinin B2 excites subst P A delta and C fibers, sustains reaction
3. Chemotactic – attracts immune cells
4. Solubility – clears needle damage products
5. Tissue Repair – local vascular constriction, formation of fibrin and clots
6. Inactivation – degradation of inflammatory agents- cortisol release
· In phase two, the immune defense reaction to the needle is enhanced by the local vasodilatation and stimulates nociceptive neurons, producing de qi, initating stimulation of spinal afferent nerves
· In phase six, inflammatory reactions are shut down, and humoral pathways release substances into blood and CSF
o Pituitary hormones, including ACTH bound with beta lipotropin (LPH)
§ Adrenocorticotropin (ACTH) stimulates the adrenal cortex to produce cortisol and aldosterone.
§ Lipotropic hormone (LPH) may be cleaved to form melanocyte stimulating hormone and endorphins which have analgesic effects
· You can choose needling time according to these 6 phases
o Strong stim and short retention time favors initial phases – true heat, pathogenic factors
§ Strong stim enhances inflammation
§ Short ret time prevents overproduction of anti-inflam properties
o Mild stimulation with long retention assures corticosteroid production

Nociceptive Activation p263

· Needling produces
· Bradykinin B2, which excites

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· afferent nociceptive subst P neurons that supply acupoint, which send high threshold signals to
· several laminae of spinal cord dorsal horn, where
o synaptic junctures stimulate neurons in the
o dorsal lateral funiculus (DLF) and cross
o neurons that ascend along the anterior lateral tract (ALT) on the opposite side of the spinal cord.
· Messages are sent to spinal afferent processing circuits involving
o Various centers of the brain,
o spinal cord,
o muscles,
o blood vessels, and
o internal organs.
· Propriospinal circuits are provoked, which then activate
o spinal motor reflexes and PS along the body surface.
· Sympathetic neural reflexes are also provoked.
· Only a few of these signals are transmitted to the sensory cortex. Most info is directed to the brain stem to activate
o Descending control signals that are sent back down the spinal cord. These supraspinal signals bring about restorative descending control processes.
· (p 264) Substance P nociceptive neurons amplify and sustain tissue reactions to prolong activation of spinal afferent processing systems
o subst P released at needle site and in paravertebral ganglia

· afferents – sensory nerves that send signals from the PNS to the CNS
· analgesic – pain relieving
· antagonist – opposes the action of something else
· anterior lateral tract (ALT) of spinal cord dorsal horn - tracts to the front and side of the spinal cord- that is, if there were front-right and front-left corners, that’s where they’d be. Includes the spinothalamic and spinoreticular tracts, numbers 15 and 13 respectively in the drawing below check out this great page of nervous system definitions and some good, some funny drawings
· blood coagulation system – series of linked glycoproteins that upon activation induce the generation of downstream enzymes ultimately forming fibrin. This process is primarily important to arrest bleeding (hemostasis).
· bradykinin - A nonapeptide (Arg-Pro-Pro-Gly-Phe-Ser-Pro-Phe-Arg) produced by activation of the kinin system in a variety of inflammatory conditions. It is a potent vasodilator and also increases vascular permeability, stimulates pain receptors, and causes contraction of a variety of extravascular smooth muscles. It is produced by the action of plasma kallikrein, trypsin, or plasmin on high-molecular-weight kininogen, a plasma a2-globulin, and is destroyed by several kininases in the lungs and other tissues.
· Chemotactic – Relating to the characteristic movement or orientation of an organism or cell along a chemical concentration gradient either toward or away from the chemical stimulus.
· Cytokines - Any of several regulatory proteins, such as the interleukins and lymphokines, that are released by cells of the immune system and act as intercellular mediators in the generation of an immune response.
· dorsal horn of spinal cord – longitudinal subdivision of gray matter in the dorsal part of each lateral half of the spinal cord that receives terminals from some afferent fibers of the dorsal roots of the spinal nerves called also dorsal column, posterior column, posterior gray column, posterior horn

· dorsal lateral funiculus (DLF) – longitudinal bundle of thin, unmyelinated and poorly myelinated fibers capping the apex of the posterior horn of the spinal gray matter, composed of posterior root fibers and short association fibers that connect neighboring segments of the posterior horn.
· DRG – dorsal root ganglion, aka spinal ganglion - ganglion of the posterior root of each spinal segmental nerve, containing the cell bodies of the unipolar primary sensory neurons. Any of the sensory ganglia situated on the dorsal root of each spinal nerve.
· Fasciculus - bundle of anatomical fibers, as of muscle or nerve
· Fibrin - An elastic, insoluble, whitish protein produced by the action of thrombin on fibrinogen and forming an interlacing fibrous network in the coagulation of blood.
· Funiculus - A slender cordlike strand or band, especially a bundle of nerve fibers in a nerve trunk. Any of three major divisions of white matter in the spinal cord, consisting of fasciculi.
· Ganglion - A group of nerve cells forming a nerve center, especially one located outside the brain or spinal cord.
· Golgi tendon organ - A proprioceptive sensory nerve ending embedded among the fibers of a tendon, often near the musculotendinous junction. a spindle-shaped sensory end organ within a tendon that provides information about muscle tension called also neurotendinous spindle
· Gray matter - an area of unmyelinated neurons where cell bodies and synapses occur. In the spinal cord the synapses between sensory and motor and interneurons occurs in the gray matter. The cell bodies of the interneurons and motor neurons also are found in the gray matter.
· HPA axis - The hypothalamic-pituitary-adrenal axis (HPA axis) is a major part of the neuroendocrine system that controls reactions to stress. It is the mechanism for a set of interactions among glands, hormones and parts of the mid-brain that mediate a general adaptation syndrome. [FYI, research shows that at 10 Hz but not 100 Hz, EA suppresses inflammation by activating the hypothalamus-pituitary-adrenal axis (HPA) and the nervous system.]
· Humoral pathways – In humoral immunity, as opposed to cell mediated immunity, antibodies are secreted (in response to an antigen) by B cells circulate as soluble proteins in blood plasma and lymph. Some immunoglobulins will cross the blood brain barrier. Acupuncture therapy has been shown to produce global changes in immunological function including stimulation of circulating cytokine concentrations.
· Immune complement system – aka the complement system - Immune system blood proteins, produced in the liver, that circulate in the blood and tissues.
· Intrafusal muscle - modified muscle fibers which, surrounded by fluid and enclosed in a connective tissue envelope, compose the muscle spindle. Muscle spindles are found within the fleshy portions of muscles, composed of 3-10 intrafusal muscle fibers. Muscle spindles are encapsulated by connective tissue, and are aligned parallel to extrafusal muscle fibers, unlike Golgi tendon organs, which are oriented in series. The muscle spindle has both sensory and motor components. Primary and secondary sensory fibers spiral around and synapse on the central portions of intrafusal fibers, providing the sensory component of the structure via stretch-sensitive excitatory ion-channels of the axons. The motor component is provided by a gamma motoneuron that innervates the spindle and causes a slight contraction of the end portions of the intrafusal muscle fibers when activated.

· Kinins - Kinins are blood plasma proteins that influence smooth muscle contractions, affect blood pressure (especially hypotension), increase blood flow throughout the body, increase the permeability of small capillaries, and stimulate pain receptors.
· LPH - Lipotropic hormone (LPH) may be cleaved to form melanocyte stimulating hormone and endorphins which have analgesic effects
· Mast cells - Resident cell of connective tissue that contains many granules rich in histamine and heparan sulphate. Release of histamine from mast cells is responsible for the immediate reddening of the skin in a weal and flare response. Very similar to basophils and possibly derived from the same stem cells.
· Motor point - A point on the skin where the application of an electrical stimulus, via an electrode, will cause the contraction of an underlying muscle.
· Myelinated nerves - Not all fibers in a nerve will be myelinated, but most of the voluntary fibers are. The myelin sheath does several things: 1) It provides insulation to help prevent short circuiting between fibers. Diseases which destroy the myelin sheath lead to inability to control muscles, perceive stimuli etc. One such disease is multiple sclerosis, an autoimmune disorder in which your own lymphocytes attack the myelin proteins. [See Beta Interferon and Multiple Sclerosis]. 2) The myelin sheath provides for faster conduction. 3) The myelin sheath provides for the possibility of repair of peripheral nerve fibers. Schwann cells help to maintain the micro-environments of the axons and their tunnel (the neurilemma tunnel) permits re-connection with an effector or receptor. (See below) CNS fibers, not having the same type of myelination accumulate scar tissue after damage, which prevents regeneration.

Naloxone - Narcan counters the effects of overdosing on opioids like heroin and morphine- it also antagonizes enkephalin (ENK) and endorphin and causes acupuncture no longer to relieve pain.
· Neuron - An excitable cell specialized for the transmission of electrical signals over long distances. Neurons receive input from sensory cells or other neurons and send output to muscles or other neurons. Neurons can be the longest cells known, a single axon can be several metres in length. Although signals are usually sent via action potentials, some neurons are nonspiking.
· Neuromodulator - something (as a polypeptide which is a chain of amino acids) that potentiates or inhibits the transmission of a nerve impulse but is not the actual means of transmission itself. Secreted in larger amounts and diffuse for longer distances than NTs, modulating activity of many neurons in particular area (most composed of peptides)
· Neurohormone - any hormone produced by neurosecretory cells, usually in the brain. Neurohormonal activity is distiguished from that of classical neurotransmitters as it can have effects on cells distant from the source of the hormone. Neurohormones include: Gonadotropin releasing hormone (GnRH), Corticotropin releasing hormone (CRH), Thyrotropin releasing hormone (TRH), Prolactin inhibiting hormone, Dopamine
· Neurokinin 1 (NK1) - The neurokinin-1 (NK-1) receptor and its ligand, substance P, are important to both nociception and hyperalgesia (altered perception of pain, pain from normal sensations).
· Neurotransmitter - Neurotransmitters are chemicals that are used to relay, amplify and modulate electrical signals between a presynaptic and a postsynaptic neuron. A chemical is classified as a neurotransmitter if it meets the following conditions: It is synthesized endogenously; It is available in sufficient quantity in the presynaptic neuron to exert an effect on the postsynaptic neuron; Externally administered, it must mimic the endogenously released substance; A biochemical mechanism for inactivation must be present. Detected by receptors in membrane of another cell located short distance away.
· Nociceptive – pain sensing or pain perceiving.
· Paravertebral ganglia - also termed the sympathetic chain or trunk, are a series of ganglia which lie in a line lateral and parallel to the vertebral bodies of the spinal column. The ganglia are interconnected to each other and extend from the base of the skull to the sacrum. They make contact with: ganglia which lie superiorly or inferiorly within the chain, the spinal cord and associated spinal nerve via grey and white rami communicantes, prevertebral ganglia.
· Proprioception - The unconscious perception of movement and spatial orientation arising from stimuli within the body itself; composed of information from sensory neurons located in the inner ear (motion and orientation) and in the joints and muscles (stance). There are specific nerve receptors for this form of perception.
· Spinal motor reflexes - much motor behavior is based on spinal reflexes; reflex arc: sensory input –> neural integration –> motor output; may be simple or complex pattern of output- more
· Spinal nerves - At 31 places along the spinal cord the dorsal and ventral roots come together to form spinal nerves. Spinal nerves contain both sensory and motor fibers, as do most nerves. Spinal nerves are given numbers which indicate the portion of the vertebral column in which they arise. There are 8 cervical (C1-C8), 12 thoracics (T1-T12), 5 lumbar (L1-L5), 5 sacral (S1-S5), and 1 coccygeal nerve. Nerve C1 arises between the cranium and atlas (1st cervical vertebra) and C8 arises between the 7th cervical and 1st thoracic vertebra. All the others arise below the respective vertebra or former vertebra in the case of the sacrum. Since the actual cord ends at the second lumbar vertebra, the later roots arise close together on the cord and travel downward to exit at the appropriate point. These nerve roots are called the cauda equina because of their resemblance to a horses tail. More spinal cord and peripheral nerves
· Substance P - neurotransmitter that, among other things, plays an essential role in transmitting pain signals. Antagonized by capsaicin.
· Supraspinal – above the spine… where descending control comes from.
· Sympathetic neural reflexes - stimulate sympathetic NS?
· synaptic junctures
· Tachykinin – Any member of a group of polypeptides, widely scattered in vertebrate and invertebrate tissues, that have in common four of the five terminal amino acids: Phe-Xaa-Gly-Leu-Met-NH2; pharmacologically, they all cause hypotension in mammals, contraction of gut and bladder smooth muscle, and secretion of saliva… fast contraction of smooth muscle – subst P is one kind
· unmyelinated cutaneous neurons
· vasodilatory - something that dilates blood vessels.
· White matter - an area of myelinated fiber tracts. Myelination in the CNS differs from that in nerves.

Also see great Nervous System biology and physiology notes

I teach medical terminology to acupuncturists. This blog won’t focus only on the acupuncturist audience, but this particular post does.

To the new acupuncture student/medical terminology student:

The topic of medical terminology is words from Western medicine. In the Masters program at PCOM, about 17% of the hours in the degree are focused on Western medicine.

Some of you may be fine with that. But if you’re like I was when I came into PCOM, then you might be baffled by that, or think Western medicine is irrelevant. I thought Oriental medicine was good, all-powerful, and never hurt people, and that Western medicine was bad, not too effective, and caused incalculable damage to patients. Let me tell you that as the 4 years of school went on, I realized that both medicines have their strengths and weaknesses. There are certainly areas where herbs and acupuncture don’t have much effect but Western medicine does. And vice versa.

But Western medicine is relevant in other ways- there is a lot of scientific info that comes out of China- they’ve identified a lot of the active and inactive chemicals in herbs- there’s a book in the library with drawings of the chemical structures… they have and are still studying the mechanisms of acupuncture from a physiogical standpoint, looking at what effect it has on nerves, blood, immune system, central nervous system, etc.-

The last day of this class, I’m going to teach you what we know about how acupuncture works from a Western perspective. It’s quite in depth, and you first need to learn the words from the medical terminology classes on blood, lymph, and nervous system to understand it - I’ve also taught it to students about to graduate from PCOM, and they were blown away- they also asked why they hadn’t been taught this before, in all the 4 years they were there- I said it was because they didn’t have me for medical terminology.

So what’s the point of doing scientific research on acupuncture and herbs?

Well, first, there’s nothing wrong with Oriental medicine- it’s not broken. Even without science and Western medicine, you could practice it safely and effectively.

But if you’re interested, you can use research to be more sure of your point selection- for example, if you could choose one of 5 points to help a stroke survivor recover their speaking ability, but one of them in particular had been shown to be effective in research, you could use that one with more confidence than just choosing one at random. In the long run, the very long run, because research takes so long, we may be able to take acupuncture, already a really good healing system, to a new level of effectiveness and specificity- by specificity I mean using the most targeted, appropriate points for the patient’s specific condition- so we can help more patients, more reliably, more often.

Research also has a role in increasing the credibility of our medicine among the scientific minded- but only those with open minds… some people will never be convinced. I’ve learned not to waste my time with those people.

And probably the most important way that medical terminology is relevant to you is that when you graduate and go into practice, you’ll have patients with diagnoses from Western medicine. You can just ignore that, or you can use it. You can request their medical records and read them- but you need to understand medical terminology to read them. You can use this extra information to better understand your patient’s situation and how you might help it.

And if, e.g. you know your patient is immunocompromised, has leukopenia, or low white blood cell count, and that, according to research, an acupoint increases white blood cell count, you make it part of the picture. If you know enough about the effects of Oriental medicine on the body in Western medical terms, you can be more effective.

Because this patient’s regular doctor will be watching the WBC count, and if you watch it, too, you can see the objective effects of your acupuncture. You can also use Oriental medicine techniques like taking the pulse and asking questions, but it’s nice to use lab tests, too- it increases your confidence, not to mention the patient’s confidence that acupuncture is doing something, and maybe impressing the doctor, too.