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    (Kuliah 3) Mekanisme Akupunktur Medik Sari18

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    The document discusses the biological mechanisms of medical acupuncture based on molecular biology. It explains that puncturing acupoints stimulates skin, subcutaneous tissues, muscles, nerves, blood vessels and periosteum. This leads to local inflammatory reactions and the transmission of neural signals to the brain. On a cellular and molecular level, acupuncture has been shown to balance neurotransmitters like beta-endorphins, enkephalins, and 5-HT, regulating various systems and conditions. The effects of acupuncture include analgesia, anti-inflammation, immune response modulation and homeostasis regulation mediated by the nervous, endocrine and chemical mediator systems of the body.

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    (Kuliah 3) Mekanisme Akupunktur Medik Sari18

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    call
    13 views65 pages
    The document discusses the biological mechanisms of medical acupuncture based on molecular biology. It explains that puncturing acupoints stimulates skin, subcutaneous tissues, muscles, nerves, blood vessels and periosteum. This leads to local inflammatory reactions and the transmission of neural signals to the brain. On a cellular and molecular level, acupuncture has been shown to balance neurotransmitters like beta-endorphins, enkephalins, and 5-HT, regulating various systems and conditions. The effects of acupuncture include analgesia, anti-inflammation, immune response modulation and homeostasis regulation mediated by the nervous, endocrine and chemical mediator systems of the body.

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    [KULIAH 3] MEKANISME AKUPUNKTUR MEDIK SARI18

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    The document discusses the biological mechanisms of medical acupuncture based on molecular biology. It explains that puncturing acupoints stimulates skin, subcutaneous tissues, muscles, nerves, blood vessels and periosteum. This leads to local inflammatory reactions and the transmission of neural signals to the brain. On a cellular and molecular level, acupuncture has been shown to balance neurotransmitters like beta-endorphins, enkephalins, and 5-HT, regulating various systems and conditions. The effects of acupuncture include analgesia, anti-inflammation, immune response modulation and homeostasis regulation mediated by the nervous, endocrine and chemical mediator systems of the body.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    13 views65 pages

    (Kuliah 3) Mekanisme Akupunktur Medik Sari18

    Uploaded by

    call
    The document discusses the biological mechanisms of medical acupuncture based on molecular biology. It explains that puncturing acupoints stimulates skin, subcutaneous tissues, muscles, nerves, blood vessels and periosteum. This leads to local inflammatory reactions and the transmission of neural signals to the brain. On a cellular and molecular level, acupuncture has been shown to balance neurotransmitters like beta-endorphins, enkephalins, and 5-HT, regulating various systems and conditions. The effects of acupuncture include analgesia, anti-inflammation, immune response modulation and homeostasis regulation mediated by the nervous, endocrine and chemical mediator systems of the body.

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    of 65

    DASAR BIOLOGI MOLEKULER

    AKUPUNKTUR MEDIK, APLIKASINYA DI KLINIK


    KULIAH PENUNJANG BLOK AKUPUNKTUR MEDIK

    Paramasari Dirgahayu, dr., PhD

    Program Studi Pendidikan Dokter


    Fakultas Kedokteran Universitas Sebelas Maret
    NOVEMBER 2020
    AKUPUNKTUR DI
    INDONESIA ?
    ?
    ?
    ?
    ?
    ? ??
    ? ?
    ? ?
    Peraturan Menteri Kesehatan RI
    No. 1186/Menkes/Per/XI/1996
    tentang
    Pemanfaatan Akupunktur
    di Sarana Pelayanan Kesehatan
    12 Nopember 1996
    Bab 4
    PELAYANAN KESEHATAN BPJS
    ACUPUNCTURE ???
     Is the insertion of dry needles (involving various
    methods such as penetration by thin needles or the
    application of heat, pressure, or laser light)
     into the body at specially chosen sites
     for the treatment or prevention of symptoms and
    condition, to modify the perception of pain,
     to normalize physiological functions, for the
    treatment of certain diseases

    Filshie,J,White,A,Medical Acupuncture, A Western Scientific Approach, 1998


    ACUPUNCTURE
    < 1981
    Does acupuncture work ?
    > 1981
    How does acupuncture work ?
    United States of America
    Acupuncture remained relatively unheard of until 1974 when James
    Reston, a reporter for the New York Times accompanied President
    Nixon on a trip to China where they witnessed an appendectomy
    and several demonstrations of serious surgeries being performed
    with acupuncture as the only anesthetic using Acupuncture
    Anesthesia.
    Despite many efforts to prove it's efficiency, Western science has
    never been able to reconcile how Acupuncture works. They can
    prove "that" it works, but not "how" it works.

    In 1981 Many doctors studied acupuncture; and did


    experiments especially on pain Acupuncture became
    COMPLEMENTARY MEDICINE
    And plenty of medical article
    in medical journal tried to
    research in acupuncture
    fields:
    Neuroscience, Interna,
    Pediatrics, Anaesthesia,
    ObsGyn, …etc
    what
    is the
    basic mechanisms of
    medical acupuncture

    ?
    akupunktur medik
    akupunktur
    yang dilakukan oleh dokter
    atas dasar
    fenomena yang telah terbukti
    melalui penelitian ilmiah
    yang menghasilkan efek
    terukur, objektif, bisa diulang

    syarif sudirman, 2006


    Puncturing acupoints
    that are located at muscular areas,
    the tip or body of needle
    may stimulates at least six point:
    1. skin
    2. subcutaneous tissues
    3. muscles or tendons
    4. nerve trunks or branches
    5. blood vessels
    6. periosteum
    nerve
    Pucinian
    corpuscle Krause and bulb
    Big picture of protein synthesis
    LPS signaling pathway in macrophages

    TLR LPS/LBP

    Cell membrane

    MyD88
    CD14
    IRAK
    TRAF-6
    NF-kB
    IkB
    P
    50 65 MAPK SB208530
    IkB Translation

    ERK1/ p38 MAPK


    P P 2
    P P
    ribosome
    50 65
    Elk cFoscJunP
    Nucleus
    membrane

    P P P P
    65 P POL.II
    50 cFoscJun TFIID
    Elk
    TBP
    TBP
    kB SRE AP-1
    TATA-BOX
    TNF-a / IL-1promoter
    mRNA
    SIGNALING PATHWAY
    • Perkembangan ilmu biomedik membuka rahasia akupunktur
    medik dalam penggunaaan akupunktur sebagai terapi dari
    berbagai penyakit. Dari kajian baik secara seluler maupun
    molekuler, membuktikan bahwa penusukan jarum akupunktur
    pada titik akupunktur atau meridian menyeimbangkan
    berbagai neurotransmiter di plasma dan jaringan otak seperti
    β-endomorfin, enkefalin, dan 5-HT.

    • Ketidakseimbangan neurotransmiter ini akan berperan dalam


    patologi terjadinya penyakit. Jika ketidakseimbangan ini
    dibiarkan maka segala sistem menyangkut metabolisme dan
    imunomodulator akan terganggu neuropatik maupun
    nosiseptif, gangguan pencernaan, penyakit psikiatrik, penyakit
    gangguan gerak serta penyakit metabolik.
    REAKSI PENUSUKAN DI TITIK AKUPUNKTUR
    1. Reaksi inflamasi lokal
    2. Transduksi interseluler
    3. Refleks kutaneosomatovisera
    4. Transmisi neural ke otak.

    SECARA SUBYEKTIF AKAN DIRASAKAN:


    1. Nyeri tajam (serabut saraf A-group delta)
    2. Nyeri tumpul (serabut saraf C)
    3. Rasa berat (serabut korpuskel peka tekanan)
    4. Rasa pembengkakan (peninggian mikrosirkulasi dan permeabilitas )
    5. Korona kemerah-merahan sekitar jarum masuk
    6. Rasa hangat sekitar jarum masuk (Peningkatan mikrosirkulasi)
    7. Perangsangan lebih lanjut akan menimbulkan peninggian ambang nyeri
    dan apabila diteruskan akan timbul efek analgetik di daerah yang jauh dari
    titik yang dirangsang.
    EFEK AKUPUNKTUR

    Analgesi DAN Regulasi

     Relaksasi otot yang spastik


     Peninggian / perbaikan mikrosirkulasi, baik lokal maupun distal
     Normalisasi tekanan darah
     Penurunan kadar lemak yang tinggi dalam darah
     Penyembuhan hipersensitivitas kulit dan selaput lendir terhadap
    berbagai faktor
     Pemulihan dari dipresi mental, keadaan hiperaktif dan anxiety
     Perangsangan pelepasan hormone hipofise ACTH
     Peninggian reaksi imun dan resistensi terhadap infeksi bakteri
     Normalisasi aktivitas organ viscera
     Normalisasi kadar gula darah
     Perangsangan regenerasi serabut saraf.
    EFEK Rangsangan titik akupunktur (
    1. EFEK REGIONAL
    a. Reaksi jaringan
    b. Reflex axon
    c. Arus listrik

    2. EFEK SISTEMIK
    a. Efek analgesi
    b. Efek regulasi

    1. Efek regional
    a. Reaksi jaringan
    Cedera dinding sel akibat rangsangan titik akupunktur membebaskan
    asam arakidonat  dihasilkan lekotrin, prostaglandin E-2, tromboksan dan
    prostasiklin  inflamasi lokal dan agregasi trombosit, Kerusakan endotelium
    pembuluh darah halus dan kapiler serta jaringan ikat  menginduksi fragmen
    kolagen, miofibril dan membran basal, yang mengakitivasi sistim pembekuan darah
    secara bertingkat.

    Reaksi inflamasi buatan akan dilanjutkan dengan proses lain berupa


    reaksi anti-inflamasi.
    b. Refleks akson

    Rangsangan penjaruman pada reseptor polimodal oleh saraf


    sensorik diteruskan selain ke medula spinalis, juga ke akson
    kolateral yang mengandung CGRP (calcitonin gen related
    peptide) dan bersinaps akso-aksonik dengan akhiran saraf
    simpatis di sekitar pembuluh darah. = Pelepasan asetilkolin
    = vasodilatasi lokal di sekitar lokasi penjaruman dan
    peningkatan permeabilitas kapiler,
    c. Arus listrik dari perlukaan

    Titik akupunktur mempunyai tegangan listrik lebih tinggi dari


    kulit sekitarnya (20 - 90 milivolt), dengan kutub positif di
    dalam dan kutub negatif diluar. Pelukaan kulit akan
    menimbulkan arus pendek.

    Penjaruman menurunkan tahanan listrik berbarengan


    dengan menghasilkan arus listrik searah sebesar 10
    mikroamper dimana kutub negatif berada di bekas lubang
    tusukan dan kutub positif terletak di tepi luka.
    Fenomena ini berlangsung selama lebih kurang 48 jam
    yaitu waktu yang dibutuhkan tubuh menyembuhkan luka
    tusukan memicu proses regenerasi saraf.
    Efek sistemik
    a. Efek analgetik
    Efek analgetik tindakan akupunktur dimediasi oleh
    endorfin atau oleh serotonin.
    karena rangsang penjaruman  menuju substansia
    grisea periakuaduktus release opiat endogen.

    b. Efek regulasi
    Tubuh manusia mempunyai kecenderungan
    mempertahankan homeostasis yang
    melibatkan : Sistem saraf, endokrin, dan
    mediator kimiawi.
    Neurotransmitter yang merangsang nyeri:
    1. Endogenous opioid (enkefalin, dinorfin, endorfin)
    2. Somatostatin
    3. Serotonin
    4. Noradrenalin
    5. Gamma Aminobutyric Acid (GABA)
    6. Galanin.

    SG Subst Grycea
    Wide Dynamic Range
    M: Marginal cel
    St: Enkepalin Stalk Cel
    ENK:Enkepalin
    Mekanisme heterosegmental
    a) Adrenergik
    b) Serotoninergik
    c) Adrenergik (diffuse noxious inhibitori controls)
    Gellman, H, Acupuncture Treatment for Musculoskeletal Pain, 2002
    REAKSI AKIBAT AKUPUNKTUR
    1. Reaksi anti inflamasi
    Cedera dinding sel akibat perangsangan titik akupunktur  membebaskan
    asam arakidonat; yg dengan bantuan lipoksigenase diubah menjadi lekotrin;
     menjadi prostaglandin E-2, tromboksan dan prostasilin;  memicu
    terjadinya reaksi inflamasi lokal dan agregasi trombosit.

    Reaksi inflamasi buatan berikut semua mediator kimiawi, ditindaklanjuti


    oleh tubuh dengan reaksi anti-inflamasi yg menyeluruh.

    2. Imunitas

    Perangsangan titik akupunktur merusak endotelium KAPILER DARAH dan


    jaringan ikat,  dihasilkan fragmen kolagen, miofibril dan membran basalis 
    mengaktivasi sistim pembekuan darah secara bertingkat

    REAKSI IMMUNITASNYA tidak spesifik,  bersama dengan kalikrein dan


    bradikinin menggerakkan reaksi imunitas tidak spesifik melalui pengaruhnya
    pada lekosit (kemotaksis, lekositosis dan fagositosis).
    3. Endokrin
    Mekanisme kerja akupunktur melalui system endokrin dapat dijelaskan melalui
    jalur aksis hipotalamus-hipofisis yaitu:
    Akupunktur manual dan elektro akupunktur frekuensi rendah mencapai
    hipotalamus anterior, merangsang pelepasan releasing hormon lewat jalur vena
    (CRF, GnRH, GHRH, GHRIH, TRH dan Dopamin) dan menghasilkan AVP. Dan
    Oksitosin yang sampai di hipofisis posterior lewat jalur saraf.

    CRH (corticotrophin releasing hormon) bersama dgn AVP (arginin vasopressin)


    dari hipofisis posterior, merangsang produksi beta-lipotrofin dan ACTH; melalui
    pemecahan enzimatik beta-lipotrofin  menghasilkan beta-endorfin.

    4. Sistim Neuroendokrinimun (NEIS)


    Tahun 1936, Hans Selye memperkenalkan konsep Stress. Respons stres
    dimanifestasi dengan perubahan pada sistem saraf, endokrin dan imun, yang
    kemudian dikenal dengan sistem neuroendokrinimun.
    Mekanisme kerja akupunktur pada NEIS :
    1. Akupunktur dapat meningkatkan jumlah sel limfosit T, karenanya dapat
    meningkatkan daya imun sel tubuh.
    2. Efek regulasi akupunktur pada daya transformasi sel limfosit T.
    3. Efek regulasi akupunktur pada jumlah dan daya fagositosis lekosit (neutrofil,
    eosinofil, basofil)
    4. Efek regulasi akupunktur pada daya fagositosis MPS (mononucleus
    phagocyte sistem) mencakup monosit, makrofag.
    5. Efek regulasi akupunktur pada daya pengawasan sel NK
    6. Efek regulasi akupunktur pada cytokine ( IL-2, IFN)
    7. 7. Efek regulasi akupunktur pada imunoglobin
    8. 8. Efek regulasi akupunktur terhadap aglutinin, eritrosit aglutinin, hemolisin,
    bacteriocidin, precipitin.
    9. Efek regulasi akupunktur pada sistem komplemen
    10. Efek regulasi akupunktur terhadap properdin, plasma bacteriocidin.
    what
    kind of stimulation
    can be used
    in acupuncture

    ?
    various acupoints stimulation
    electrical
    infrared rays,
    ultraviolet rays,
    laser
    magnetic field
    electrical stimulation
    electroacupuncture (EA)
    where electricity is connected
    to the inserted filiform needles
    • only when points
    are located accurately,
    • when corresponding reflex layers
    within the points
    are punctured precisely,
    • additional
    electrical stimulation may
    achieve the desired results
    The main indications of
    acupuncture therapy are :

    regulatory actions
    analgesia
    rehabilitation

    Jin,GY,Jin,JX,Jin,LL,Contemporary Medical Acupuncture-A Systems Approach, 2006


    Are
    cosmetic problems
    can be treated by
    acupuncture ?

    SURE, WHY NOT?


    As far as physiologic problem
    Cosmetis problems include

    OBESITY
    COSMETIC
    ANTI AGING
    When external stimulation:

    needling, moxibustion, laser, acupressure,


    massage, cupping, electrical stimulation
    at these specific regions, etc

    The stimulation information will return to the


    viscera through the same pathways
    what
    kind of stimulation
    can be used
    in acupuncture

    ?
    various acupoints stimulation

    1. electrical
    2. infrared rays,
    3. ultraviolet rays,
    laser
    4. magnetic field
    5. electrical stimulation
    electroacupuncture (EA)
    where electricity is connected to the
    inserted filiform needles
    Cosmetis problems include

    OBESITY
    COSMETIC
    ANTI AGING
    Pathophysiology of Obesity
    In this third millennium
    we are witnessing a shift
    in the basic paradigm of medical thinking
    as the best physicians learn to integrate
    Western Medicine
    with
    Complementary Medicine,
    of which acupuncture may be
    the most well known
    and well accepted aspect

    Aung, SKH, Chen, WPD; Clinical Introduction to Medical Acupuncture, Thieme, 2007
    Integrative Medicine
    Combines mainstream
    (conventional) medical therapies
    and complementary/alternative
    therapies for which there is some
    high quality scientific evidence of
    safety and effectiveness
    Thank you 4 attention

    and ….

    see u next ……..


    Akhir kuliah

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