Medical Acupuncture
A Journal For Physicians By Physicians

Spring / Summer 2000- Volume 12 / Number 2
"Aurum Nostrum Non Est Aurum Vulgi"

ARTICLES

Osteopathic Vertebral Manipulation
And Acupuncture Treatment
Using Front Mu And Back Shu Points
David E. Teitelbaum, DO

ABSTRACT
    Osteopathic medicine recognizes a correlation between the musculoskeletal condition of the vertebral column and visceral function. Abnormally positioned vertebrae and hypertonic area musculature participate in segmental sympathetic nervous system hyperactivity, which adversely impacts the innervated organ. Front Mu and Back Shu points are anatomically located at vertebral segment levels that correlate to the sympathetic innervation of their related organs. It is proposed that acupuncture treatment using Front Mu and Back Shu points has a similar mechanism to osteopathic manipulation in improving afferent and efferent function so that sympathetic hyperactivity is alleviated.

KEY WORDS
    Osteopathic Manipulation, Acupuncture, Front Mu, Back Shu, Segmental Sympathetic Innervation

INTRODUCTION
    In osteopathic medicine, specific vertebrae are manipulated in the treatment of visceral disease. This treatment is based on the recognition that a vertebra in altered position facilitates continued stimulation on its related segmental nerves. This condition leads to impairment of optimal organ function so that healing and recovery from disease are prolonged or prohibited.
    Since the sympathetic nervous system controls instantaneous adjustments of the circulatory system and metabolic functions of skeletal musculature, segmental pathology also impairs somatic energy expenditure and exchange.
    These facilitated segments can become chronic and self-sustaining either through secondary afferent discharge from tissues subjected to the sympathetic stimulation, or by an enduring increase in central excitability within the spinal cord itself.1 This central excitability is also induced by sympathetic hyperactivity as well as other facilitative or sensitizing factors. This chronic, self-sustaining situation results in an exhausting hypersympathetic state.
    Many therapeutic benefits of osteopathic manipulation have been recognized; in visceral disease, the most critical clinical effect is the quieting of this sympathetic hyperactivity with its deleterious effects.
Correlation to Front Mu and Back Shu Subsystem
    In the Chinese medicine parallel to this approach, the Front Mu and Back Shu subsystems are used to effect visceral function. Anatomic examination of Back Shu points reveals each to be located at a vertebral level consistent with sympathetic output to its associated organ (Table 1).2 The singular exception to this is the Back Shu point for Small Intestine, located at the first sacral segment. There is no sympathetic output to the SI from this vertebra.
    Front Mu points are anatomically located in dermatomes3 (Figure 1) that are consistent with segmental sympathetic output to their related organs. There are no exceptions to this among the Front Mu points.

Figure 1. Points of the Front Mu Shu Subsystem Located in Dermatomes

    The use of osteopathic manipulation in treating vertebrae is believed to favorably impact the efferent output of the associated spinal nerves. Interestingly, the Chinese word "Shu" translates as "to transport." The concept of transporting neurologic information from the spine to the organ is in keeping with a Western understanding of efferent stimulation. The Chinese word "Mu," however, translates as "to collect." The Front Mu points are located in dermatomes that collect neurologic input and transfer that input to the spine for processing. This parallels our understanding of afferent nerve function. Thus, it is hypothesized that the Back Shu system has effect primarily through direct efferent stimulation, whereas the Front Mu system has effect through afferent input.

    Further analysis of the anatomic location of these points and their sympathetic relationship reveals an apparent association between the TCM concept of the Triple Heater and the adrenal gland. Shu and Mu points for the Triple Heater are located in the range of sympathetic output to the adrenal medulla. These points are used in acupuncture to coordinate the activity of the organs found in the upper, middle, and lower heaters. This is similar to the Western understanding of a coordinated sympathetic control of these same organs effected through release of epinephrine by the adrenal gland.

Clinical Applications
    Therapeutic implications of these parallel systems include the following. First, in an organ treatment in which Back Shu points are used, it is reasonable to also picure any Ashi (tender) point of the inner Bladder meridian found in the range of sympathetic innervation to the organ.
    Second, there are a number of organs listed in Table 2 for which there are no classic Back Shu points. It is reasonable to picure Ashi points of the inner BL meridian in the range of sympathetic innervation to any of these organs to obtain a Shu effect.
    Third, in an organ treatment in which Front Mu points are used, it is reasonable to also picture any Ashi point in the same dermatome as that Mu point.
    Fourth, in treating the organs listed in Table 2 for which there are no classic Front Mu points, it is reasonable to picure any Ashi point in the dermatome of sympathetic innervation to those organs.

CONCLUSION
    Osteopathic manipulation of vertebrae is used therapeutically to impact viscera through the calming of hyperactive sympathetic output to specific organs. A parallel approach in acupuncture uses the Front Mu and Back Shu subsystems. Anatomic analysis of these point locations reveals them to be in the range of sympathetic innervation to their associated organs. It is proposed that acupuncture treatment using Front Mu and Back Shu points has a similar mechanism to osteopathic manipulation in improving afferent and efferent function so that sympathetic hyperactivity is alleviated.

REFERENCES

1. Korr IM. The spinal cord as organizer of disease processes, II: the peripheral autonomic nervous system. J Am Osteopath Assoc. 1979;79:82-90.
   
2. Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, Ca: Medical Acupuncture Publishers; 1995:26-29, 157-172.
   
3. Chen E. Cross-Sectional Anatomy of Acupoints. Edinburgh, Scotland: Churchill Livingstone; 1995.

AUTHOR INFORMATION
Dr David Teitelbaum practices Osteopathic Manipulative Medicine and Medical Acupuncture in his private practice in Fort Worth, Texas.
Dr Teitelbaum is an Associate Clinical Professor in the Department of Osteopathic Manipulative Medicine at the University of North Texas Health Science Center.

David E. Teitelbaum, DO
3230 Camp Bowie Blvd, Suite D
Fort Worth, TX 76107
Phone: 817-335-4220
Fax: 817-335-3171

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