 |
 |
 |
 |
 |
 |
An
introduction to the autonomous nervous system. 2. Detoxification: activity of the liver cells, kidney cells and secreting
cells in the gut wall; motility of the gallbladder (and gallbladder ducts),
of the gut, the bladder; activity/contractility/vascular tone of the lymphatics;
again voltage control of the cell walls of every body cell: opening or
closing channels needed for detoxification; activation of sweat glands,
dilating skin vessels for outgasing of toxins and many more. 3. Healing: activation of fibroblasts in the connective tissue (Pischinger
and Heine)for tissue repair; dilation of blood vessels in areas of need
for building materials and oxygen; dilation and pulsation of lymphatics
for transport of waste products away from site of injury; activation of
immune competent cells in the general circulation through ANS mediated
communication substances/neurotransmitters (C. Pert, H. Siegen) and many
more. 4. Preparation for fight and flight: increase of cardiac output, increase
of muscle tone (D. Hubbard) by sensitizing muscle spindles in the relevant
skeletal muscles, dilating the blood vessels and bronchial tree of the
lungs for higher absorption of oxygen, immobilizing the gut and all healing
functions of the immune system, contracting the blood vessels in the skin
anticipating probable impending blood loss; increasing blood supply to
the skeletal muscles, sensitizing relevant portions of the 5 senses, such
as hearing and eyesight, but decreasing sensitivity for fine touch and
pain. If arousal of the ANS continues and becomes chronic, the effect
on the pain receptors changes paradoxically; now the ANS has a "wind-up"
effect on the nociceptors and other portions of the nociceptive system
(Melzack and Wall).
Dietrich M. Klinghardt, MD, PhD
History:
The term "autonomic" implies the fact that this part of the nervous
system is functioning independently of the conscious mind. This means that
the motor portion of this system does not obey the will as the ordinary
motor nerves do (which receive their commands from the motor cortex of the
brain) and that the sensory portion does not send its final messages to
the sensory cortex of the conscious portion of our brain as the more well
understood and well defined sensory nerves do. The reason for this appears
to be evident: efficiency! The sensory-
motor system has the job of dealing largely with the outside world: perceiving
with the 5 senses the condition of the external environment and - after
processing this information in the Central Nervous System (CNS) - mobilizing
the musculo-skeletal system to respond and interact with the perceived environment.
The autonomic nervous system (ANS) has the job to perceive the internal
environment and - after processing the information in the CNS - regulating
the functions of the internal environment.
Physiological considerations: What are these functions then? A computer
company was given the task in 1987 to figure out what it would take to build
the smallest supercomputer (accord-ing to the standard of 1987) that would
perform all the tasks and functions of the ANS. A review of the scientific
data of what the known functions actually are comprised several hundred
pages. The conclusion: the computer performing these functions would be
100 stories high and cover the surface of the state of Texas. Therefore,
I will give here only a small selection of the more well known functions:
1. regulation of body temperature by a variety of mechanisms: vasoconstriction
or dilation, activation of sweat glands (evaporation of fluid/sweat cools
the skin), regulating the arterial blood supply and nutrient delivery to
the thyroid gland (if an organ cell, i.e. a thyroid hormone producing cell
is exposed to a higher concentration/ supply of nutrients or substrate,
the cell will produce more of the substance that it is specialized to produce.
Higher circulating levels of thyroid hormone elevate the body temperature).
The ANS also upregulates the voltage-dependent ionic channels in the cell
wall, facilitating the substrate transport into the cell and the product
and waste transport out of the cell. Other ANS dependent temperature mechanisms
include a variety of things such as urination (by decreasing the total volume
of circulating
fluid the skin becomes dryer and less conductive to cold), hunger, which
is caused by a complex process in the ANS and which leads to eating in a
healthy organism under healthy circumstances (the breakdown of food in the
liver causes the so-called "specific dynamic effect" - the creation
of heat, following the laws of thermodynamics
in chemical reactions) and many others. Other ANS functions:
Anatomy: Most of the original anatomy of the ANS was described by anatomists
using nothing but the naked eye to describe what creation had intended
here. Most anatomy authors of the century have copied the original drawings
from last century that came from brilliant-however limited-
folks such as the British surgeon, Sir Henry Head, (coming up with ever
increasing nicer ways of portraying the same thing) without doing any
more original research. Since the 2nd World
War, there was little interest in the scientific community in the ANS
(with maybe two out-
standing exceptions - Ferdinand Huneke in Germany and Irvin Korr in the
US). Only lately this has changed again with a number of papers published
mostly by Japanese researchers using new neurotransmitter staining techniques.
Functionally, the ANS is still divided into 2 portions even though there
are no more clear distinctive borders. The sympathetic portion of the
ANS has its motor center in the posterior hypothalamus with a host of
interactions with other brain centers. From here the message travels,
(1) biochemically via the releasing factors to the pituitary gland where
hormones and hormone precursors are released into the blood stream (this
leads to a fairly slow response of the system and has been elaborated
on by other authors) and, (2) down the spinal cord. The sympathetics emerge
from T1 to L2. Some of these emerging fibers form the sympathetic paravertebral
chain of ganglia. Ganglia are accumulations of cell bodies (the nerves
emerging from these are the dendrites). Some fibers bypass the ganglia.
From here the sympathetics follow blood vessels, motor and sensory nerves,
lymphatics and fascia. Every cell of the human body is surrounded by a
mash of fine conductive fibers (Dosch) which are in contact with the sympathetic
nerve ending which lies in the extracellular space. The sympathetics in
the extracellular space "end" at the vessels, the fibroblasts
and the cell walls (Pischinger), doing their respective jobs here. Places
with high sensory sympathetic innervation, that have been recently highlighted
in the literature, are the musculo-skeletal structures of the spinal column:
the facet joint capsules, the intervertebral discs and the spinal ligaments.
The sensory fibers of the sympathetic nervous system emerge from virtually
every cell-neighborhood, following the same pathways into the spinal canal,
from here up to the brain where they terminate at various structures of
the limbic system. That's why we cannot consciously feel all the ANS activity
in us - the sympathetics don't terminate in the sensory cortex!
The parasympathetics are much less researched, but the following picture
is emerging: even though the anterior portion of the hypothalamus is considered
the chief-commander of the motor portion of the parasympathetics, the
motor nucleus of the vagus and the nucleus ambiguus in the brainstem are
directly responsible for all downgoing signals in this portion of the
ANS. The signals travel in the parasympathetic fibers of (1) the vagal
nerve to the viscera piggyback on several cranial nerves to glands, skeletal
muscles and other structures of the face/neck region,
and (2) inside the spinal cord to the sacrum, where the fibers emerge
to participate in the innervation of the bladder, rectum and sexual organs
of the pelvis. The upgoing sensory signals take the same pathways and
terminate at the nucleus solitarius in the brainstem. 80-90% of all vagus-fibers
are sensory! The neurons of the viscera, which are mostly made up of para-sympathetic
elements, outnumber the neurons in the spinal cord! This part of the ANS
has,
therefore, been honored and given it's own name: Enteric Nervous System
(ENS). The motor fibers coming from the nucleus solitarius and those coming
from the motor nucleus of the vagus can have some opposing actions (which
have been especially demonstrated on the breath dependent variability
of the heart rate). Also several facial muscles, the vocal chords and
the muscles needed for swallowing are all innervated by the parasympathetic
fibers coming from the nucleus ambiguus. These are all muscles which are
under control of our conscious mind - not "autonomic." Therefore,
this portion of the vagus has been named the "smart vagus."
Since the function of these vagal fibers appears to differ completely
from the function of the fibers coming from the motor nucleus, the vagus
is now considered to be actually 2 nerves (poly-vagal
theory).
Most important is the hierarchical organization of the ANS inside the
brain. Several structures in the limbic system have a strong regulating
influence on the ANS. E. Rossi has coined the term"limbic-hypothalamic
axis." Any unresolved emotion or trauma can have a chronic "wind-up"
effect on portions of the ANS, which can express itself in a huge number
of ways as illness (caused by autonomic dysfunction). The emotional memory
of an accident is a more common cause of chronic post-traumatic neck pain
than the physical trauma itself. New evidence suggests that emotions are
primarily electric events inside the brain. The message travels down the
"smart vagus" to the viscera, where the entire spectrum of neurotransmitters
is released, that have been until now associated only with the brain (more
than 70). There is no neuro-transmitter or other informational substance
in the brain that has not also been found in the ENS. Each emotion has
a specific target organ and set combination of released substances.
The biochemistry: My own original research in the early 70s confirmed
that norepinephrine was the main neurotransmitter used at the sympathetic
vasomotor terminals and acetylcholine at the parasympathetic nerve terminals.
Today we know that a large number of informational substances are transported
up and down the axons of the autonomic nerves serving a wide variety of
functions (axonal transport). Some of these are shared with the sensory-motor
nervous system, others are unique to the ANS. The ANS has not only nerve
terminals at the junction with the smooth muscle of the vascular walls,
but also on the surface of the endothelium where substances are released
into the bloodstream. Some of these have the job to activate or inactivate
certain circulating immune cells. (C. Pert, H. Siegen). These facts have
not yet been generally accepted in ANS research. The "wind-up"
effect of the ANS on the nociceptive system (the cause of "sympathetically
maintained pain-S.M.P.") does not appear to be caused by norepinephrine
alone, but by some other messenger-substances traveling in the axons of
the ANS. Yet the research trying to disprove the concept of S.M.P. was
done using phentolamine, a substance that blocks norepinephrine but not
other pain inducing neuro-
transmitters!
Treatment considerations: A host of serious studies, mostly done at Chinese
universities, has shown conclusive evidence that the acupuncture system
is nothing but a functional description of the ANS. The acupuncture meridians
are comprised of various components of the ANS, the acupuncture point
is an area of dense autonomic innervation, often at a crossing point of
an artery, nerve, lymphatic underlying a small opening in the fascia (Schnorrenberger).
Therefore, we can take from the acupuncture research an immense amount
of information that pertains to the ANS. The ANS appears to be responsive
to a large number of stimuli:
1. physical: such as pressure, stretching, percussion, rhythm, vibration
2. thermal: heat, cold (the underlying reason why warm water bottles and
ice work some
of the time)
3. biochemical: neurotransmitters, local anesthetics, saline, highly diluted
herbs and
minerals ("homeopathy"), toxins - such as mercury -, acidity,
and many others
4. electromagnetic waves: the following frequencies of the spectrum have
been shown to
cause action potentials in the ANS: infrasound (Chi Gong), sound (music),
ultrasound,
electric frequencies, radiowaves, microwave, infrared (heat), colored
light (P.Mandel),
UV-light, X-ray (Kluemper), Gamma-rays (Reich), magnetic fields.
Only three of these many ways of influencing the ANS are routinely used
in Medicine today:
1. The injection of local anesthetics used in pain-management (nerve blocks,
Neural
Therapy, epidural injections, etc.),
2. The use of acupuncture needles (dry needling of trigger points),
3. Osteopathic or Chiropractic manipulation.
All the other possible techniques are used by a variety of practitioners,
however, usually without the correct physiological understanding of the
underlying mechanism.
Recommended reading in order of importance:
1. P. Dosch: Manual of Neural Therapy. Haug Publishers. 1984.
2. E. Rossi: The Psychobiology of Mind-Body Healing. W. W. Norton &
Co., 1986.
3. H. Barop: Lehrbuch und Atlas der Neuraltherapie nach Huneke. Hippokrates.
4. Melzack and Wall: The Challenge of Pain.
5. A. Pischinger: Matrix and Matrix Regulation/Basis For A Holistic Theory
in
Medicine. Haug, 1991.
6. F. M. Pottenger: Symptoms of Visceral Disease. Mosby, 1944.
7. H. Heine: Lehrbuch der Biologischen Medizin. Hippokrates, 1991.
8. S. Porges: Emotion - An Evolutionary By-Product Of The Neural Regulation
Of the
Autonomic Nervous System. Inst. For Child Study, University of Maryland,
1994.
9. B. Hille: Ionic Channels of Excitable Membranes, Bantham, 1994.
10. C. Pert: Neuropeptides And Their Receptors: A Psychosomatic Network.
J. of
Immunology, #135, pp 8205-8265, 1985.
11. F. Willard, M. Patterson: Nociception And The Neuroendocrine-Immune
Connection.
1992 International Symposium, Am. Acad. Of Osteopathy, University Classics,
LTD.
Athens, OH 1992.
12. D. Klinghardt: Lehrbuch der Psychokinesiologie. Bauer, 1996.
13. D. Hubbard: Chronic And Recurrent Muscle Pain: Pathophysiology And
Treatment
And Review of Pharmacological Studies. Journal of Musculoskeletal Pain.
Vol 4,
No. l/2, 1996, pp 123-143. Haworth Med. Press, 1996.
14. I. Korr: The Collected Papers. Am. Acad. of Osteopathy, 1989.
15. J. Sarno: Mind Over Back Pain. Berkeley Books, 1986.
16. H. Renck: Management Of Abdomino-Visceral Pain By Nerve-Block Techniques.
Mediglobe SA, 1992.
17. G. Cramer, S. Darby: Basic And Clinical Anatomy Of The Spine, Spinal
Cord And ANS.
Mosby, 1995.
18. P. Low: Clinical Autonomic Disorders. Little, Brown and Co., 1993.
19. Xiangton, Zhang: Research On Acupuncture And Acupuncture Anesthesia.
Berlin, 1986.
20. C. Hockmann: Essentials Of Autonomic Function. C. Thomas, 1987.
21. R. Bannister: Autonomic Failure. Oxford Univ. Press, 1992.
22. H. Hooshmand: Chronic Pain/Reflex Sympathetic Dystrophy. CRC Press,
1993.
23. R. DeJong: Local Anesthetics. Mosby, 1994.
24. D. Goleman: Emotional Intelligence. Bantam Books, 1995.
