• This is a special chapter which could need a whole lesson.

• Briefly: it’s impossible to have an emotion without a reflex response of muscles and the Autonomous nervous system.

• In the opposite direction, you can not act on muscles or the autonomous nervous system without having an emotional modification.

The cholinergic anti-inflammatory system:

• Reflex loop mediated by the vagus nerve.

• Inflammation releases cytokines; cytokines activate vagus nerve afferents, and the vagus nerve will respond by the

release of acetylcholine ,which will act on the nicotinic receptors of the inflammatory cells, inhibiting the release

of cytokines.

• The response can be global or local.

• Acupuncture has a cholinergic effect.

Activation of the cholinergic anti-inflammatory system.

Aspirin and ibuprofen found to substantially increases vagus nerve activity.

Acupuncture, meditation, hypnosis, and relaxation therapies can stimulate vagus nerve.

Exercise raises vagus nerve activity and decreases cytokine levels.

Fish oil, soy oil, olive oil increases vagus nerve activity through cholecystokinin. ^[2]

Kevin J. Tracey (b. 10 December 1957, Fort Wayne, IN, USA) is Director of The Feinstein Institute for Medical Research and Professor and President of the Elmezzi Graduate School of Molecular Medicine in Manhasset, NY. Although trained as a neurosurgeon, he is an immunologist known for his physiological and molecular studies of inflammation and disease and, in particular, for investigating how the nervous system controls the responses of the immune system to threat.

Ben Kavoussi, MS

Southern California University of Health Sciences, College of Acupuncture and Oriental Medicine, Whittier, CA, kavoussi@ucla.edu

B. Evan Ross, DOM, LAc

Cedars-Sinai Medical Center, Department of Medicine, Los Angeles, CA

This review article presents the evidence that the anti-inflammatory actions of acupuncture are mediated via the reflexive central inhibition of the innate immune system.

Both laboratory and clinical evidence have recently shown the existence of a negative feedback loop between the autonomic nervous system and the innate immunity.

There is also experimental evidence that the electrical stimulation of the vagus nerve inhibits macrophage activation and the production of TNF, IL-1ß , IL-6, IL-18, and other proinflammatory cytokines.

It is therefore conceivable that along with hypnosis, meditation, prayer, guided imagery, biofeedback, and the placebo effect, the systemic anti-inflammatory actions of traditional and electro-acupuncture are directly or indirectly mediated by the efferent vagus nerve activation and inflammatory macrophage deactivation.

In view of this common physiological mediation, assessing the clinical efficacy of a specific acupuncture regimen using conventional double-blind placebo-controlled trials inherently lacks objectivity due to (1) the uncertainty of ancient rules for needle placement, (2) the diffuse noxious inhibitory control triggered by control-needling at irrelevant points, (3) the possibility of a dose-response relationship between stimulation and effects, and (4) the possibility of inadequate blinding using an inert sham procedure. A more objective assessment of its efficacy could perhaps consist of measuring its effects on the surrogate markers of autonomic tone and inflammation.

The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity.