Dr. Edward Atkinson in his Antarctica lab circa 1910. Investigations
Art. 19:  THE THREE PHASES OF CHIROPRACTIC STUDY 1. Study of the Immaterial. 2. Study of the Material. 3. Study of Art. St...
Study of the Material In order that the chiropractor know something about the material and structure of the body,  it is a...
The Challenge Patient has acid stomach. Patient takes Pepcid (famotidine). After adjusting T6 he no longer needs Pepcid. I...
If it's true that these “work,”
then it should follow that ... … there is some overlapping mechanism of action that can be identified. … a review of the p...
What is Pepcid? Pepcid is in a group of drugs called  histamine-2 blockers .  It works by decreasing the amount of acid pr...
What is the Source of the Histamine? Enterochromaffin-like cells or ECL cells are a type of  neuroendocrine  cells found i...
What is the Relationship of Parietal and ECL Cells? In Practice 2010;32:478-483 doi:10.1136/inp.c6670
An ECL Cell is a TMC Tissue Mast Cell Enterochromaffin-like Cell
What are the Neural Connections to the Parietal Cell? Ach or acetylcholine is the neurotransmitter of the  postganglionic ...
What are the  Autonomic  Connections to the Enterochromaffin-like Cell? Vagal motor fibers  synapse to the Enterochromaffi...
Autonomic System Review Parasympathetic <ul><li>Preganglionic  Cholinergic  System
Postganglionic  Cholinergic  System </li></ul>Sympathetic <ul><li>Preganglionic  Cholinergic  System
Postganglionic  Adrenergic  System (predominantly) </li></ul>The Autonomic System is defined based on its motor function. ...
Subluxation Induced Vagal Irritation ... … could result in  postganglionic,  cholinergic  stimulation of the parietal cell...
But, the Patient Improved with a Thoracic Adjustment ... NE or  norepinephrine  is the neurotransmitter of the postganglio...
Splanchnic & Cranial Nerves Autonomic motor fibers travel through  peripheral nerves  called splanchnic and cranial nerves...
Dr. Bonci, Please! Get to the POINT!
Carpe Lucem
What was I Missing? There are  no noradrenergic (sympathetic) inputs  to the parietal cells nor to the enterochromaffin-li...
Neurokinin Receptors <ul>histamine-secreting cell </ul><ul>Acetylcholine  </ul><ul>PARIETAL cell </ul><ul>histamine recept...
Neurohormonal Modulation of Rat Enterochromaffin-like Cell Histamine Secretion. Gastric mucosal cells and nerve terminals ...
Sensory-Effector Innervation Enterochromaffin-like Cells /Tissue Mast Cells receive  sensory c-fiber innervation . Sensory...
Sensory fibers can play a  nontraditional  “motor” function. In this case,  sensory fibers  carried by the splanchnic nerv...
Neurogenic Inflammation
Neurogenic Inflammation The role of sensory nerves and axon reflexes in  producing inflammation  was recognized in the ear...
On the origin from the spinal cord of the vaso-dilator fibres of the hind-limb, and on the nature of these fibres. Bayliss...
Further researches on antidromic  nerve-impulses. Bayliss WM. J Physiol.  1902  Jul 21;28(4):276-99.
The Science of Chiropractic DD Palmer 1906; p. 36 Looking over our immense vertebral collection […] we find  caries  limit...
Triple Response of Lewis <ul><li>Red reaction -red line(transient local vasodilation due to histamine)
Flare -spreading redness extending beyond the red line(due to axon reflex)
Wheal -Swelling/localized edema in the region of the redline(increased capillary permeability due to histamine)  </li></ul...
Nerve Irritation circa 1910 “Nerve  irritation creates heat  by increasing molecular vibration.  An excess of heat  distur...
Uninhibited reversible antidromic vasodilation in pathophysiologic diseases: Arteriosclerosis, carcinogenesis, neuritis, a...
Antidromic vasodilatation and neurogenic inflammation. Szolcsányi J. Agents Actions.  1988  Feb;23(1-2):4-11.
Antidromic Vasodilatation and Neurogenic Inflammation. Antidromic stimulation of the lumbosacral dorsal roots of the rat  ...
induces  plasma extravasation  in the innervated skin areas and various pelvic organs.  </li></ul>This local  neuroregulat...
Sensory Nerve-Mast Cell Communication <ul>Saban R et al. Am J Physiol Renal Physiol 2002;283:F616-F629 </ul>
Obscured from View In the 1970s one can find  no references to neurogenic inflammation  or its synonyms among the subject ...
Neurogenic Inflammation Review
Neurogenic Inflammation Summary End-Organ Changes #3 #1 #5 #4 #2
Nociceptive Threshold “[I]njection of  PGE2  at the sight of receptor terminals fails to evoke any response in the fiber, ...
Neurogenic Inflammation Summary End-Organ Changes #1 #3 #1 #5 #4 #2
Neurogenic Inflammation Emergence  and the Sensory-Effector System To The CNS Release of Substance -P & other tachykinins ...
Neurogenic Inflammation Summary End-Organ Changes #1 #3 #1 #5 #4 #2
Sensory Nerve-Mast Cell Relationship J Dermatol Sci. 2006 Apr;42(1):47-54.
Neurogenic Inflammation Summary End-Organ Changes #1 #3 #1 #5 #4 #2
Neurogenic Inflammation Summary End-Organ Changes #1 #3 #1 #5 #4 #2
Tissue Injury <ul><li>Toxic Oxygen Metabolites
Proteases
Neurtophil Chemotactic Factors
CoagulationFactors
Arachidonic Acid Metabolites
Nitric Oxide </li></ul>Fibrosis <ul><li>Growth Factors (PDGF, FGF, TGF-B)
Fibrogenic Cytokines
Angiogenesis Factors (FGF)
&quot;Remodeling&quot; Collagenases </li></ul>Mechanisms of End-Organ Transformation http://www.robbinspathology.com/ SP
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2-Neuroimmune Mechanisms of the Subluxation Complex

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We will explore the pertinent evidence in the peer-reviewed literature and integrate the following:
The neuroscience underlying neurogenic inflammation, antidromic vasodilation, tachykinin release and pathophysiologic end-organ changes.
The immunology underlying neuronal monoamine oxidation, lymph node denervation and loss of immune competence.
The neuroimmune characteristics of connective tissue and its influence on nerve function.
Contextualize these understandings into the philosophy, art and science of chiropractic and nutritional recommendations.

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2-Neuroimmune Mechanisms of the Subluxation Complex

  1. 1. Dr. Edward Atkinson in his Antarctica lab circa 1910. Investigations
  2. 2. Art. 19: THE THREE PHASES OF CHIROPRACTIC STUDY 1. Study of the Immaterial. 2. Study of the Material. 3. Study of Art. Stephenson RW. Chiropractic Text Book. Freshman Text. 1927.
  3. 3. Study of the Material In order that the chiropractor know something about the material and structure of the body, it is advisable for him to study the materials in order to understand the actions of structures in function; to better understand the effects of causes, and to trace to causes from the effects . Stephenson RW. Chiropractic Text Book Freshman Text. 1927.
  4. 4. The Challenge Patient has acid stomach. Patient takes Pepcid (famotidine). After adjusting T6 he no longer needs Pepcid. It would be nice if you could explain that one.
  5. 5. If it's true that these “work,”
  6. 6. then it should follow that ... … there is some overlapping mechanism of action that can be identified. … a review of the pharmacological mechanisms of action of Pepcid can help in our understanding of chiropractic. … deductive reasoning can serve as our methodology in this pursuit.
  7. 7. What is Pepcid? Pepcid is in a group of drugs called histamine-2 blockers . It works by decreasing the amount of acid produced by the parietal cells of the stomach. http://www.drugs.com/pepcid.html
  8. 8. What is the Source of the Histamine? Enterochromaffin-like cells or ECL cells are a type of neuroendocrine cells found in the gastric glands of the gastric mucosa beneath the epithelium, in particular in the vicinity of parietal cells . http://en.wikipedia.org/wiki/ECL_cell
  9. 9. What is the Relationship of Parietal and ECL Cells? In Practice 2010;32:478-483 doi:10.1136/inp.c6670
  10. 10. An ECL Cell is a TMC Tissue Mast Cell Enterochromaffin-like Cell
  11. 11. What are the Neural Connections to the Parietal Cell? Ach or acetylcholine is the neurotransmitter of the postganglionic parasympathetic fibers. These fibers derive through the Vagus Nerve (CN X) <ul>Acetylcholine </ul><ul>PARIETAL cell </ul><ul>ACh receptor </ul><ul>HCl secretion </ul>
  12. 12. What are the Autonomic Connections to the Enterochromaffin-like Cell? Vagal motor fibers synapse to the Enterochromaffin-like cells and Parietal cells. <ul>histamine-secreting cell </ul><ul>Acetylcholine </ul><ul>PARIETAL cell </ul><ul>histamine receptor </ul><ul>ACh receptor </ul><ul>HCl secretion </ul><ul>ECL cell </ul>
  13. 13. Autonomic System Review Parasympathetic <ul><li>Preganglionic Cholinergic System
  14. 14. Postganglionic Cholinergic System </li></ul>Sympathetic <ul><li>Preganglionic Cholinergic System
  15. 15. Postganglionic Adrenergic System (predominantly) </li></ul>The Autonomic System is defined based on its motor function. It is visceromotor ONLY. Its function is derived from the postganglionic neurotransmitter/end-organ interaction.
  16. 16. Subluxation Induced Vagal Irritation ... … could result in postganglionic, cholinergic stimulation of the parietal cell. … could result in postganglionic, cholinergic stimulation of enterochromaffin like cell.
  17. 17. But, the Patient Improved with a Thoracic Adjustment ... NE or norepinephrine is the neurotransmitter of the postganglionic sympathetic fibers. These fibers are derived through the Celiac Plexus . <ul>histamine-secreting cell </ul><ul>Acetylcholine </ul><ul>PARIETAL cell </ul><ul>histamine receptor </ul><ul>ACh receptor </ul><ul>HCl secretion </ul><ul>ECL cell </ul>
  18. 18. Splanchnic & Cranial Nerves Autonomic motor fibers travel through peripheral nerves called splanchnic and cranial nerves to innervate internal organs. These peripheral nerves also convey sensory fibers .
  19. 19. Dr. Bonci, Please! Get to the POINT!
  20. 20. Carpe Lucem
  21. 21. What was I Missing? There are no noradrenergic (sympathetic) inputs to the parietal cells nor to the enterochromaffin-like cells. What could be the role of the thoracic adjustment in normalizing stomach acid?
  22. 22. Neurokinin Receptors <ul>histamine-secreting cell </ul><ul>Acetylcholine </ul><ul>PARIETAL cell </ul><ul>histamine receptor </ul><ul>ACh receptor </ul><ul>HCl secretion </ul><ul>ECL cell </ul><ul>Neurokinin <li>Receptor </li></ul><ul>Tachykinin </ul>
  23. 23. Neurohormonal Modulation of Rat Enterochromaffin-like Cell Histamine Secretion. Gastric mucosal cells and nerve terminals contain ... substance P ... These data are consistent with the hypothesis that substantial neurohormonal modulation of ECL cell function exists. Sandor A, et. al. Gastroenterology. 1996 Apr;110(4):1084-92.
  24. 24. Sensory-Effector Innervation Enterochromaffin-like Cells /Tissue Mast Cells receive sensory c-fiber innervation . Sensory fibers have an effector function with the release of a a class of neurotransmitters known as tachykinins .
  25. 25. Sensory fibers can play a nontraditional “motor” function. In this case, sensory fibers carried by the splanchnic nerves can indirectly trigger the release of protons from the parietal cells. This is a significant piece of the chiropractic puzzle . Sensory-Effector Trigger
  26. 26. Neurogenic Inflammation
  27. 27. Neurogenic Inflammation The role of sensory nerves and axon reflexes in producing inflammation was recognized in the early 1900s. Nevertheless, neurogenic inflammation captured the interest of the international scientific community only during the 1980s . Neurogenic inflammation CRC press; 1996: page 33
  28. 28. On the origin from the spinal cord of the vaso-dilator fibres of the hind-limb, and on the nature of these fibres. Bayliss WM. J Physiol. 1901 Feb 28;26(3-4):173-209.
  29. 29. Further researches on antidromic nerve-impulses. Bayliss WM. J Physiol. 1902 Jul 21;28(4):276-99.
  30. 30. The Science of Chiropractic DD Palmer 1906; p. 36 Looking over our immense vertebral collection […] we find caries limited, as a rule, to the bodies and articular processes. The laminae, transverse and spinous processes are rarely affected. Various reasons have been assigned by various authors […] until I discovered that heat was produced by nerves. Excessive heat softens bone , producing caries . Articular and intervertebral cartilages become fibrillated, disintegrated, and the adjacent parts of the bodies affected by caries .
  31. 31. Triple Response of Lewis <ul><li>Red reaction -red line(transient local vasodilation due to histamine)
  32. 32. Flare -spreading redness extending beyond the red line(due to axon reflex)
  33. 33. Wheal -Swelling/localized edema in the region of the redline(increased capillary permeability due to histamine) </li></ul>Sir Thomas Lewis Circa 1927
  34. 34. Nerve Irritation circa 1910 “Nerve irritation creates heat by increasing molecular vibration. An excess of heat disturbs circulation, innervation and the cellular process of metabolism .” DD Palmer. Chiropractor's Adjuster. 1910; page 26.
  35. 35. Uninhibited reversible antidromic vasodilation in pathophysiologic diseases: Arteriosclerosis, carcinogenesis, neuritis, and osteoporosis. Hackett GS. Angiology. 1966 Feb;17(2):109-18.
  36. 36. Antidromic vasodilatation and neurogenic inflammation. Szolcsányi J. Agents Actions. 1988 Feb;23(1-2):4-11.
  37. 37. Antidromic Vasodilatation and Neurogenic Inflammation. Antidromic stimulation of the lumbosacral dorsal roots of the rat <ul><li>evokes a long-lasting increase in cutaneous microcirculation of the paw and
  38. 38. induces plasma extravasation in the innervated skin areas and various pelvic organs. </li></ul>This local neuroregulatory mechanism mediates neurogenic inflammation, cutaneous vasodilatation ... Szolcsányi J. Agents Actions. 1988 Feb;23(1-2):4-11.
  39. 39. Sensory Nerve-Mast Cell Communication <ul>Saban R et al. Am J Physiol Renal Physiol 2002;283:F616-F629 </ul>
  40. 40. Obscured from View In the 1970s one can find no references to neurogenic inflammation or its synonyms among the subject indexes of published works on inflammatory processes. Neurogenic inflammation CRC press; 1996: page 33 It's as if the key to understanding this has been lodged up the ass of science for decades
  41. 41. Neurogenic Inflammation Review
  42. 42. Neurogenic Inflammation Summary End-Organ Changes #3 #1 #5 #4 #2
  43. 43. Nociceptive Threshold “[I]njection of PGE2 at the sight of receptor terminals fails to evoke any response in the fiber, yet the nociceptive threshold to mechanical and chemical stimuli is decreased .” Pitchford S., Levine JD. Prostaglandins sensitize nociceptors in cell culture. Neuroscience letters 1991; 132:105-108.
  44. 44. Neurogenic Inflammation Summary End-Organ Changes #1 #3 #1 #5 #4 #2
  45. 45. Neurogenic Inflammation Emergence and the Sensory-Effector System To The CNS Release of Substance -P & other tachykinins from free nerve Ending. &quot;Axon Reflex&quot; The orthodromic impulse is &quot;reflexively&quot; converted into an antidromic impulse at the level of the axon. This is accomplished without spinal cord assistance. Nociceptive, Orthodromic Input DRG Irritation results in both orthodromic AND antidromic impulse propagation. Orthodromic Orthodromic Antidromic Tissue Mast Cell Stimulation with resultant release of histamine, heparin and proteases.
  46. 46. Neurogenic Inflammation Summary End-Organ Changes #1 #3 #1 #5 #4 #2
  47. 47. Sensory Nerve-Mast Cell Relationship J Dermatol Sci. 2006 Apr;42(1):47-54.
  48. 48. Neurogenic Inflammation Summary End-Organ Changes #1 #3 #1 #5 #4 #2
  49. 49. Neurogenic Inflammation Summary End-Organ Changes #1 #3 #1 #5 #4 #2
  50. 50. Tissue Injury <ul><li>Toxic Oxygen Metabolites
  51. 51. Proteases
  52. 52. Neurtophil Chemotactic Factors
  53. 53. CoagulationFactors
  54. 54. Arachidonic Acid Metabolites
  55. 55. Nitric Oxide </li></ul>Fibrosis <ul><li>Growth Factors (PDGF, FGF, TGF-B)
  56. 56. Fibrogenic Cytokines
  57. 57. Angiogenesis Factors (FGF)
  58. 58. &quot;Remodeling&quot; Collagenases </li></ul>Mechanisms of End-Organ Transformation http://www.robbinspathology.com/ SP
  59. 59. Article 134: Accumulative Destructive Survival Value It is the result of unsuccessful adaptation ; has to do with destruction or depletion . Stephenson RW. Chiropractic Text Book. Sophmore Text. 1927.
  60. 60. Dr. Bonci, Please! Get to the POINT!
  61. 61. Carpe Lucem
  62. 62. Awareness of Illusion There is a powerful temptation to see biological mechanisms in a sequential, linear fashion when, in fact, they are nonlinear, parallel, and emergent in nature .
  63. 63. Amit Goswami The current worldview has it that everything is made of matter, and everything can be reduced to the elementary particles of matter ... [a]nd cause arises from the interactions of these basic building blocks. &quot;Scientific Proof of the Existence of God : An interview with Amit Goswami&quot; by Craig Hamilton in What Is Elightenment? magazine (Spring-Summer 1997)
  64. 64. Outside-In, Below-Up This is what we call ' upward causation .' So in this view, what human beings — you and I think of as our free will –- does not really exist.” &quot;Scientific Proof of the Existence of God : An interview with Amit Goswami&quot; by Craig Hamilton in What Is Elightenment? magazine (Spring-Summer 1997)
  65. 65. Emergence: Upward Causation Organism Organ Systems Organs Tissues Cells Organelles Molecules Atoms Subatomic Particles Consciousness Intelligence
  66. 66. Intelligence is Behind It All “Now, the opposite view is that everything starts with consciousness. That is, consciousness is the ground of all being.” &quot;Scientific Proof of the Existence of God : An interview with Amit Goswami&quot; by Craig Hamilton in What Is Elightenment? magazine (Spring-Summer 1997) Video intelligence intelligence
  67. 67. Biological Emergence “ Emergence is a potentiality becoming an actuality when local conditions are favorable and facilitated.” ~ David R. Hawkins ~
  68. 68. A B C A B C
  69. 69. Above-Down, Inside-Out “In this view, consciousness imposes &quot; downward causation .&quot; In other words, our free will is real. When we act in the world we really are acting with causal power .” &quot;Scientific Proof of the Existence of God : An interview with Amit Goswami&quot; by Craig Hamilton in What Is Elightenment? magazine (Spring-Summer 1997) intelligence
  70. 70. Emergence: Downward Causation Organism Organ Systems Organs Tissues Cells Organelles Molecules Atoms Subatomic Particles Consciousness Intelligence
  71. 71. Old Dad Chiro The All-Wise Creative Intelligence is as expressed. The Creator is unfolding creation , developing it toward perfection. The Chiropractors' Adjustor, 1910.

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