A biopsychosocial clinical reasoning model for Western acupuncture

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Journal Article
Physical Therapy Reviews, 2011, 16 (2), pp. 138 - 146
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© 2011, © W. S. Maney & Son Ltd 2011. Background: The ‘layering method’, a clinical reasoning model for Western acupuncture, is a theoretical framework based on pain and tissue mechanisms. This focus on the mechanics of disability is a limitation of the original model. From a holistic viewpoint, the psychological status of an individual should be considered in clinical reasoning models. Objectives: The first objective was to summarize the original layering model. The second was to determine mechanisms underlying integration of sensations and emotions in the human brain and their effect on the body via output transfer systems of the autonomic, immune, and endocrine systems. The third objective was to determine whether acupuncture can modulate similar regions in the brain and to formulate appropriate clinical reasoning questions. Major findings: Interoceptive sensory stimuli and emotions are integrated in limbic and frontal brain regions to allow emotional responses to feedback from the body and provide the individual with a ‘sense of self’. A strong connection with brainstem nuclei modulating output transfer systems allows emotions to regulate homeostatic balance. Acupuncture may be interpreted as an interoceptive stimulus by the brain. Neuroscience research has shown that acupuncture can modulate neural activity in similar brain regions to those processing emotional responses to sensory inputs. Conclusions: Acupuncture may influence emotional responses and their impact on the neurobiology of the human body. A biopsychosocial clinical reasoning model based on the modulation of emotional processing in the brain is proposed. This suggests that acupuncture may be used as an adjuvant to other therapies in disorders with a biopsychosocial component.
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