Segmental Anatomy : The Key to Mastering Acupuncture, Neural Therapy, and Manual Therapy

381 Pages·2014·39.85 MB·English

I. Wancura-Kampik
Segmental Anatomy
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Ingrid Wancura-Kampik
Segmental Anatomy
The Key to Mastering Acupuncture,
Neural Therapy and Manual Therapy
1st Edition
In collaboration with Prof. Dr. med. Jochen Fanghänel, universities Greifswald and Regensburg
Translated by Pola Nawrocki, Munich (†)
Reviewed by Sarah Monz, Brunnen/Switzerland
All business correspondence should be made with:
Elsevier GmbH, Urban & Fischer Verlag, Lektorat Komplementäre und Integrative Medizin, Hackerbrücke 6, 80335 Munich, Germany
Original edition
Ingrid Wancura-Kampik: Segment-Anatomie
First edition 2009, Elsevier Urban & Fischer Verlag, München, ISBN 978-3-437-57970-7
Second edition 2010, Elsevier Urban & Fischer Verlag, München, ISBN 978-3-437-57971-4
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Foreword
Great Aristotle once mused: “He who sees things grow from the  Being an anatomist myself, I was mesmerized by the fact 
beginning, will understand them best”. I would like to  apply  that even older literature can yield new findings for modern 
this phrase to segmental anatomy. It can only be understood if  day morphology studies, which lead me to support the author 
one takes into account the embryological processes and the  in her endeavor.  Literature teaches us that the old masters of 
laws of metamerism. segmental anatomy researched groundbreaking basics that are 
The elaborate book by Dr. Wancura-Kampik presents a  still valid today, but have sadly become neglected and forgot-
 synopsis of segmental anatomy which constitutes the basis of  ten.
acupuncture, neural therapy, and manual therapy. As early as 1932, the great neurologist C.S. Sherrington, who 
It is the author’s merit to have compiled and reviewed the  engaged in these studies, was awarded the Nobel prize.
fundamentals of segmental anatomy, and to have supplement- I wish all interested readers much joy in perusing this richly 
ed it with her more than 40 years worth of experience in acu- illustrated volume. May they come to realize that the know-
puncture. In doing so, she has brought to light a treasure trove  ledge of segmental innervation must not be neglected in all 
of literature on segmental anatomy. Of course, some findings  kinds of therapy of the body surface.
in older literature will remain to be revised, discussed, and also 
completed. Additionally, some sources are to be found embed- Greifswald and Regensburg, April 2012
ded within the works of other disciplines. For this reason, the  Prof. Dr. med. Jochen Fanghänel
present volume has come to resemble a kind of almanac.
Author’s note to the 1st English edition
This book is supposed to recall segmental anatomy, this wron- acupuncture and may induce a special fascination with and 
gly “forgotten science”, as it is the key to understanding acu-  adherence to this method, in the 21st century they have ceased 
puncture, neural therapy, and manual therapy, and is therefore  to suffice as the single explanatory model of acupuncture- 
of great importance today. induced reactions.
Segmental anatomy is the prerequisite of understanding and  In contrast, training in neural therapy and manual therapy 
recognizing the painful points and areas on the body surface  has already focused on science in the past.
which resemble algetic and reflex projection signs due to inter- The sinological and psychological overload that has been 
actions within the body, and which determine the clinical   heaped on acupuncture fails to do justice to its meaning and 
 aspect of “ill-being”.  efficiency as a form of therapy. Instead, a deeper understanding 
The basis of these mutual interactions is the spinal vegetative  of acupuncture may be facilitated by an analysis from the point 
nervous system. of view of the  spinal nervous system and the sympathetic. 
Like a thread, the spinal nerves connect the parts of a single  nervous system.
segment that have, due to embryonic development, come to lie  Having immersed myself in the concept of “segments” for 
far apart from each other, yet react synchronously (derma- about 40 years, and having collected all accessible literature by 
tome, myotome, sclerotome, enterotome), and they therefore  the European anatomists and neurologists who, between 1850 
make the interrelation between areas of referred pain, skin  and 1960, founded segmental anatomy, and after I was able 
 alterations, and internal diseases understandable.  during  my  studies  at  the  College  of  Traditional  Chinese 
Just one example: Since the deep hand muscles, according to   Medicine at Beijing University (1975/76 and 1980) to confirm 
Braus and Elze, are singularly made up out of C8- and T1 myo- my suspicion that Chinese acupuncture represents a segmental 
tomes, and  since the caudal part of the latissimus dorsi muscle,  therapy, I decided to write a book on this topic.
according to Herringham’s laws of metamerism, is also made  Some of the pictures are based on drawings by European 
up of C8- and T1-myotomes, a deep stimulation on the back  anatomists from 1850–1900. As they are exceptionally precise, 
side of the hand (for instance, on acupuncture point SI 3, or  I have deliberately kept them in their original form, without 
Hand Point 1) can influence the lumbal area. revisions, even if they may not live up to our present-day 
The vegetative nervous system, especially the sympathetic   optical expectations and requirements.
root ganglia, transforms these spino-segmental interrelations  I hope that my own fascination with the subject will, once 
into a Gestaltkreis with social and psychosomatic determina- again, prove as “contagious” as it did in the case of our acupunc-
tion by influencing the subconscious facial expression, gesture,  ture books (König, Wancura, Maudrich Verlag Vienna) in the 
and body language. 70s, and that once again, it will spark an interest in segmental 
Another example: while the spinal segments C8/T2 supply the  anatomy which represents the most ancient architectural concept 
extensor muscles on the upper extremity (triceps C7/C8/T2) with  in evolution, determining health and sickness, psyche and soma, 
spino-segmental impulses necessary for fighting and defending  and resembling the basis of our spontaneous behaviour, our 
movements, also the eyes and hackles are activated via the cilio-  “vertebrate language”, by way of our unconscious social stimuli.
spinal center (C8/T2), causing the pupils to dilate and the hairs to  I would like to thank my husband, Dr. Bernhard Kampik, for 
stand on end. Together with the movement of the arms, this  his perseverance and his assistance, without which I would 
completes the movements of imposing, fighting, and defending.  never have either started or finished this book.
With  this,  movements  become  gestures,  and  segmental  I thank Prof. Dr. J. Fanghänel for his gracious support and 
 interrelations can be understood as the evolutionary equivalent  his constructive criticism as an anatomist.
of psychosomatic phenomena. I would extend my thanks to Sabine Zieger for her relentless 
In this way, knowledge of segmental interrelations can serve  patience and diligence in writing the manuscript, and to the 
as a map for diagnosis and treatment, with muscular tensions  editors, their team, and to the producer.
and  pains,  posture  anomalies  and  skin  alterations,  facial  At last, I shall not forget to acknowledge the many hints and 
 expression and gestures leading the way for a segmental thera- clues I already received  in the 70s from professors of the 
py via acupuncture, neural therapy, and manual therapy.  University of Vienna School of Medicine (from university pro-
Furthermore, segmental anatomy can substitute with scientific  fessors Dr. Auerswald, Dr. Seitelberger and Dr. Tilscher), 
facts the Chinese medical philosophy as the only theoretical  which encouraged me to continue on my journey of reinter-
 explanation of acupuncture-associated phenomena that has so  preting acupuncture from the point of view of segmental ana-
 often been gravely misunderstood in the West, and knowledge of  tomy.
segmental anatomy may even improve the efficacy of this method.
Although the ancient Chinese ways of thinking with their  Bayreuth, April 2012
 archetypical images have proven quite helpful in the practice of  Dr. med. Ingrid Wancura-Kampik
Contents
1 Segmentation and Metamerism ........ 1 3.2.5 Evolutionary Importance ................. 80
What is a Segment? .................... 1 3.2.6 Sympathetic Nerve Supply to the Head,
The Significance of Segments ............ 12 Neck, and Limbs . . . . . . . . . . . . . . . . . . . . . . . 81
3.2.7 The Efferent Sympathetic Nerves ........... 85
2 The Role of the Peripheral Spinal Nervous 3.2.8 The Afferent Sympathetic Nerve Pathways .... 114
System in Segmentation .............. 15 3.2.9 The Large Sympathetic Ganglia and
2.1 The Spinal Nerve Defines the Segment ..... 15 Their Projections onto the Skin ............ 119
2.2 The Spinal Nerves ..................... 17 3.3 The Peripheral Parasympathetic Nervous System
2.2.1 The Spinal Nerve and Its Segment .......... 17 and Its Role in Segmental Theory .......... 124
2.2.2 Cranio-Caudal Arrangement .............. 20
2.2.3 Vertical Spinal-Segmental Arrangement ...... 22 4 The Dermatomes ..................... 127
2.2.4 The Root Fibers of the Spinal Nerves ........ 23 4.1 Radicular Innervation of the Integument .... 127
2.2.5 Types of Fibers in the Spinal Nerves and 4.1.1 Clinical Relevance ...................... 136
Relationship to the Autonomic 4.2 Parts of a Dermatome .................. 138
Nervous System ....................... 25 4.3 The Sensory and Autonomic-
2.3 The Branches of the Spinal Nerves ......... 27 Motor Dermatomes .................... 141
2.3.1 The Three Spinal Nerve Branches as Basis 4.3.1 Sensory Dermatomes .................... 141
of the Threefold Longitudinal Division 4.3.2 Autonomic-Motor Dermatomes ............ 142
of the Body Surface ..................... 29 4.3.3 Physiological Hyperesthesia ............... 143
2.3.2 The Regions Innervated by 4.3.4 The Maximum Points of the Dermatomes ..... 143
the Spinal Nerves ...................... 32 4.3.5 The Maximum Areas of the Dermatomes ..... 148
2.3.3 The Relations of the Metameric 4.4 The Hiatus Lines ....................... 150
Spinal Nerve Branches ................... 36 4.5 Individual Groups of Dermatomes,
2.4 The Branches of the Spinal Nerves and “Autonomic Facial Expression” ........ 156
in Detail ............................. 42 4.5.1 Dermatomes of the Head and Neck ......... 158
2.4.1 The Dorsal Branches of the Spinal Nerves .... 42 4.5.2 Dermatomes of the Trunk T 1 to T 12 ........ 169
2.4.2 The Dorsal Branches in Psychosomatic 4.5.3 The Lumbar and Sacral Dermatomes ........ 174
Medicine and Evolution .................. 47 4.5.4 Dermatoses and Segmentation ............ 178
2.4.3 The Ventral and Lateral Spinal Nerve
Branches and Plexuses .................. 49 5 The Myotomes ....................... 181
2.4.4 Plexus Formation from the Point of View of 5.1 Radicular Innervation of the Muscles ....... 181
Segmental Anatomy .................... 50 5.1.1 Segment-Identifying Muscles .............. 181
2.4.5 The Individual Plexuses .................. 54 5.2 Metameric Order of the Myotomes ........ 183
2.5 The Preaxial and Postaxial Lines, 5.3 Herringham’s Rules of Location and
Basis of the Meridian “Lines” ............ 68 Distribution of Myotomes in the Muscles ... 185
5.3.1 Herringham’s First Rule .................. 185
3 The Role of the Peripheral Autonomic 5.3.2 Herringham’s Second Rule ................ 185
Nervous System in Segmental Theory ... 71 5.3.3 Herringham’s Third Rule ................. 186
3.1 Anatomy ............................ 74 5.4 The Muscles of the Upper and Lower Limbs
3.2 The Peripheral Sympathetic Nervous and Their Corresponding Myotomes ....... 189
System and Its Role in Segmental Theory .... 75 5.5 The Individual Myotome Groups .......... 191
3.2.1 The Origin of the Sympathetic 5.5.1 The Cervical Myotomes .................. 191
Nervous System ....................... 76 5.5.2 The Thoracic Myotomes (T 1 to T 12) ........ 202
3.2.2 Sympathetic Innervation of the Limbs ....... 77 5.5.3 The Lumbosacral Myotomes .............. 208
3.2.3 Sympathetic Effects on the Dilator
Pupillae Muscle and on the Effector Organs 6 The Sclerotomes . . . . . . . . . . . . . . . . . . . . . 215
of the Integument ...................... 78 6.1 Radicular Innervation of the Bones ........ 215
3.2.4 On the Dimensions of the Sympathetic 6.2 The Spinal Column and Its
Nuclei ............................... 79 Segmental Relations ................... 217
VIII Contents
6.3 The Individual Sclerotomes .............. 222 10 The Visceral Organs – the Enterotomes
6.3.1 The Sclerotomes of the Upper Limb and from the Viewpoint of Segmental
the Shoulder Girdle ..................... 222 Anatomy ............................ 279
6.3.2 The Sclerotomes of the Lower Limb and 10.1 The Heart: Algetic and Autonomic Reflexive
the Pelvis ............................ 229 Projection Areas ....................... 280
10.1.1 Algetic Signs in Heart Disease ............. 280
7 The Enterotomes ..................... 237 10.1.2 Autonomic Reflexive Projection Signs in
7.1 Relationships ......................... 237 Heart Disease ......................... 286
7.2 “Transformation” of Internal Organs into 10.1.3 Viscero-Visceral Reflexes or Autonomic Organ
Enterotomes ......................... 242 Reflexes in Heart Disease ................ 289
10.2 Lungs and Bronchi: Algetic and Autonomic
8 Conduction of Impulses between Reflexive Projection Areas ............... 292
Segments ........................... 243 10.2.1 Algetic Signs in Disorders of the Lungs and
8.1 Multisynaptic, Proprioceptive, and Bronchi .............................. 292
Viscerogenic Reflexes .................. 243 10.2.2 Autonomic Reflexive Projection Signs in
8.2 Differentiation of Direct, Indirect, and Bronchial and Pulmonary Disorders ......... 297
Referred Pains ........................ 247 10.2.3 Viscero-Visceral Reflexes or Autonomic
8.2.1 Direct Organ Pain ...................... 247 Organ Reflexes in Disorders of Lungs
8.2.2 Indirectly Conducted Organ Pain and Bronchi .......................... 299
(Projected Pain) ........................ 247 10.3 The Esophagus: Algetic and Autonomic
8.2.3 Referred Pain ......................... 247 Reflexive Projection Areas ............... 300
10.3.1 Algetic Signs in Disorders of the
9 Referred Pain ........................ 249 Esophagus ........................... 300
9.1 Pain Projected to the Body Surface 10.3.2 Autonomic Reflexive Projection Signs ....... 300
in Visceral Disease ..................... 249 10.3.3 Viscero-Visceral Reflexes in Disorders
9.2 Projected Symptoms ................... 251 of the Esophagus ...................... 300
9.2.1 General Aspects of Projected 10.3.4 Analogies Between Segmental Anatomy
Algetic Symptoms ...................... 251 and Acupuncture ....................... 300
9.2.2 General Aspects of Projected Autonomic 10.3.5 Projection of the Digestive
Reflexive Symptoms .................... 251 Tract to the Limbs ...................... 302
9.2.3 Synopsis ............................. 254 10.4 Stomach and Duodenum ................ 303
9.3 On the Location of Projected 10.4.1 Algetic Signs in Disorders of the Stomach and
Symptoms ........................... 255 Duodenum ........................... 303
9.4 Clinical Significance of Projected 10.4.2 Autonomic Reflexive Projection Signs in
Symptoms ........................... 256 Disorders of the Stomach
9.5 Algetic Symptoms ..................... 257 and Duodenum ........................ 307
9.5.1 Hyperalgesia and Hyperesthesia of the Cutis 10.4.3 Viscero-Visceral Reflexes or Autonomic
and Subcutis (Head's Zones) .............. 257 Organ Reflexes in Disorders of the Stomach
9.5.2 Hyperalgesia of Muscles and Tendons and Duodenum ........................ 308
(Mackenzie's Zones) .................... 260 10.5 Small Intestine (Jejunum, Ileum) .......... 310
9.5.3 Comparison of Referred Pain and 10.5.1 Algetic Signs in Disorders
Pseudoradicular Syndromes ............... 262 of the Small Intestine ................... 310
9.6 Autonomic Reflexive Symptoms ........... 264 10.6 Cecum, Appendix, Ascending and
9.6.1 Autonomic Effects in the Integument ........ 265 Transverse Colon ...................... 313
9.6.2 Effects on the Head ..................... 268 10.6.1 The Algetic Signs ....................... 313
9.6.3 Effects in the Shoulder .................. 274 10.6.2 Autonomic Reflexive Projection Signs ....... 316
9.6.4 Asymmetry of Posture and Movement ....... 274 10.7 Descending Colon, Sigmoid Colon,
9.6.5 Reflexive and Algetic Spinal and Rectum .......................... 318
Syndromes ........................... 275 10.7.1 Algetic Signs .......................... 318
9.6.6 Asymmetry of Proprioceptive and Multisynaptic 10.7.2 Viscero-Visceral Reflexes or Autonomic
Reflexes ............................. 275 Organ Reflexes in Disorders of the Descending
9.6.7 Autonomic Organ Reflexes Colon, Sigmoid Colon, Rectum, and
(Viscero-Visceral-Reflexes) ................ 277 Pelvic Organs ......................... 322
Contents IX
10.8 Kidney, Bladder, Ureter: Algetic and Autonomic 10.11 Prostate Gland: Algetic and Autonomic
Reflexive Projection Areas ............... 323 Reflexive Projection Areas ............... 332
10.8.1 Algetic Signs in Disorders of the Kidney 10.11.1 Observations from Practical Experience ...... 332
and the Ureter ........................ 323 10.11.2 Segmental Relations between Segments
10.8.2 Autonomic Reflexive Projection Signs in of the Lower Limb, Bechterew's Disease,
Disorders of the Kidney, Bladder, and Ureter ... 326 and Prostate Disease .................... 332
10.8.3 Consequences for Treatment .............. 327 10.12 Liver and Gallbladder: Algetic and
10.8.4 Viscero-Visceral Reflexes or Autonomic Organ Autonomic Reflexive Projection Areas ...... 334
Reflexes in Disorders of the Kidney, Bladder, 10.12.1 Algetic Signs in Disorders of the Liver
and Ureter ........................... 327 and Gallbladder ....................... 334
10.9 The Genital Tract: Algetic and Autonomic 10.12.2 Autonomic Reflexive Projection Signs
Reflexive Projection Areas ............... 328 in Disorders of the Liver and Gallbladder ..... 337
10.9.1 Algetic Signs .......................... 328 10.12.3 Viscero-Visceral Reflexes or Autonomic
10.9.2 Autonomic Reflexive Projection Signs Organ Reflexes in Disorders of the Liver
in Gynecologic Disorders ................. 328 and Gallbladder ....................... 338
10.10 Testes, Uterus, Ovaries: Algetic and Autonomic 10.13 Pancreas and Spleen: Algetic and Autonomic
Reflexive Projection Areas ............... 331 Reflexive Projection Areas ............... 340
10.10.1 Algetic Signs in Disorders of the Testes, 10.14 Occurrence of Reflexive and Algetic Symptoms
Uterus and Ovaries ..................... 331 in Other Disorders ..................... 340
10.10.2 Autonomic Reflexive Projection Signs
in Disorders of the Testes, Uterus, Bibliography ........................ 347
and Ovaries ........................... 331
Index ............................... 351