This month I’d like to take a break from the usual neural therapy case reports and clinical tips to report on a new book I have been reading. The Integrative Action of the Autonomic Nervous System: Neurobiology of Homeostasis, by Wilfrid Jänig, was released in July by the Cambridge University Press.
Remembering the days of “low-tech” biological science
If you know me, you know I have long been a fan of “old” science—especially that from the first half of the twentieth century. Much of the biological sciences was explored with low-tech equipment, used relatively simple mathematics and was understandable to the average educated lay person, which would include most physicians.
I think of the classical neurophysiology of Pavlov, Sherrington, Brain, Head and Speransky, the nutritional science of Price, Page and Royal Lee and the biochemistry (and world view) of Revici. Of course, the Huneke brothers—who discovered neural therapy—were in this cohort, even though they were clinicians and not professional scientists.
It is a sad fact that much of this very fine basic science has never been applied to clinical medicine. The perennial cry of “more research!” is often an excuse to not truly examine the implications of discoveries already made. I think of the simple neurophysiological principles of temporal and spatial summation and their application to musculoskeletal pain—that there might be a number of converging “pain generators” responsible for a particular pain syndrome.
Neural therapy applies neurophysiology to medicine
Neural therapy is all about applying neurophysiological principles. So it is incumbent on the practitioner to know these principles and be up-to-date on new discoveries. And despite my fondness for “old” science, there is much of value “coming down the pipe”—and some of it actually modifies or even disproves older theories.
The Integrative Action of the Autonomic Nervous System is a big book. It is over 600 pages long, is richly illustrated with line drawings and has 80 pages of references. The author, Wilfrid Jänig, is one of the world’s leading autonomic nervous system physiologists and has 45 years of research and hundreds of scientific papers and textbook chapters behind him.
Jänig’s book is written for scientists. As the author states in his introduction, “This book is not intended to discuss the pathophysiology of the autonomic nervous system; however, it is the basis to understand pathophysiological changes of autonomic functions.”
Gaining insight into the autonomic nervous system
There is much of value for clinicians in this book as well. Over the years, there have been some shifts in understanding of how the autonomic nervous system works, which have not yet been incorporated into medical thinking. Example: The concept of sympathetic and parasympathetic systems being separate systems, to a certain extent in opposition to each other.
A half-century of research has demonstrated that the only consistent difference between the two “systems” is their anatomical origin, i.e., the thoraco-lumbar spine for the sympathetic system, and the cranial and sacral regions for the parasympathetic system.
The former criteria of post-ganglionic neurons being cholinergic or adrenergic has too many exceptions to be useful. In fact, certain pelvic ganglia cannot be assigned to either the sympathetic or parasympathetic system and must simply be called autonomic.
For the neural therapist, this is a liberating concept. The challenge is simply to identify the local autonomic nervous dysfunction, then find and treat the interference field. It matters not whether the dysfunction is “sympathetic” or “parasympathetic” in origin.
Jänig sheds new light on peripheral ANS function
I must admit I have read only some portions of the book so far. Some sections are downright intimidating (at least for me)—especially those pertaining to central anatomy. However “pearls” pop up, particularly in the sections pertaining to peripheral autonomic nervous system function—the primary domain of the neural therapist. Among them are:
- The concept of “sympathetic tone” being a determinant of peripheral vascular resistance, and therefore blood pressure, has been disproven (by Jänig).
- Most target tissues are innervated by only one of the autonomic systems (the main exceptions being the heart and the urinary bladder).
- Fast change in heart rate e.g., during changes of body position and emotional stress, are generated by parasympathetic neurons to the heart. Sustained increase of heart rate during exercise is generated by sympathetic neurons to the heart.
- Neuropeptides have been found in many autonomic neurons that correlate with morphology, electrophysiology and anatomy. However, the function of most of these neuropeptides has not yet been elucidated and they may have nothing to do with neurotransmission.
- Autonomic ganglia regulate the quantity of neural signals being transmitted to the tissues.
- Single peripheral neurons show a wide array of discharge patterns related to afferent and centrally generated events.
This is an expensive book ($170 US), but worth it for any physician wanting an up-to-date review of autonomic nervous system physiology that also includes the discoveries of many years ago. The emphasis on integrative action of physiological processes is an added bonus.
Robert F. Kidd, MD, CM