Reflexology: The Definitive Practitioner's Manual: Recommended by the International Therapy Examination Council for Students and Practitoners

Note. It is important that the practitioner is aware of the cranial nerves at all times. There is a simple way of remembering these. I think of a very dear friend of mine from the early days – this lady’s name was OOOTTA FAGVSH. The letters of this name correspond to all the cranial nerves. The cranial nerves are given roman numerals, I—XII. We only have three sensory nerves (S), five motor (M), and four mixed (MX) both sensory and motor. Of these cranial nerves, four are parasympathetic nerves (P/S/N) – these are nerves III, VII, IX and X. The nerves are as follows:

By remembering the above name you will always ensure you never miss out on a brain region as it is so important.

The functioning of the autonomic nervous system is closely linked to the pituitary, the adrenal gland and many other specialized nerve cells that secrete their hormones at the nerve endings. Our sensory system makes us aware of changes; these elaborate sense organs receive stimuli from outside of our body. These are then transmitted to our brain. An enormous amount of information is fed into our nervous system; all this sensory information allows the organism to change and correct the internal environment. Interpretation by the brain depends on the connections through the many nerve pathways. If these connections are not co-ordinated the parts of our body fail to respond.

The autonomic nervous system (seefigure 2.4 (#litres_trial_promo)) depends on the co-ordinated and opposing regulatory functions of the sympathetic and parasympathetic divisions of the nervous system. Each of the organs of the body is supplied with a dual set of nerves from each of these branches; the overall commander of the autonomic nervous system is the hypothalamus, which ensures the interdependence and co-ordination of functions within this system. We do not need to think consciously of which branch of the autonomic nervous system we need to stimulate during treatment, because the brain centre decides which section of it will be dominant when the system is stimulated. If the person is tired, lethargic or sluggish the sympathetic stimulation results in an improvement to all activities, with the person having more energy and sparkle. The body has remarkable powers to protect and heal itself. If the need is for the body to be calmed down, then the parasympathetic branch comes to the fore, slowing the heartbeat, inducing deep physical relaxation, promoting the digestion and increasing the tone and motility of the whole gastrointestinal tract and its eliminating process. If there is also a depletion or loss of energy, the parasympathetic division will help to conserve and restore the energy we need while we sleep. It is only when we are physically or emotionally stressed that the sympathetic nervous system may override the parasympathetic nervous system. This action may inhibit many functions, and the whole gastrointestinal tract may slow down, often decreasing motility and tone – hence the many digestive disorders that are evident in people who are extremely stressed.

The overseer of this dual innervation is the hypothalamus, which lies at the back of the forebrain in the floor of the third ventricle (seefigure 2.23 (#ulink_6f872807-8502-585e-bb69-19038915b2e4)). This small portion of the brain controls the vital processes, acting as a regulatory centre of thirst, hunger and temperature, thus moderating the water and food intake. It also regulates the emotions and our sleep patterns and it governs the pituitary body, the major endocrine gland that releases many regulatory hormones directly into the bloodstream. If there is an imbalance in these hormones there can be a decline in the state of health. Ill-health can take many forms, from the simple headache to a complete breakdown in many of the functions of the body.

When the body is totally relaxed, its healing mechanism is given a chance to right itself as blood flow and nerve transmission are allowed to occur unimpeded. The benefits of reflexology are therefore manifold; all parts of the body can be reached through precise stimulation of the reflexes through the feet and hands. A return to homeostasis can be achieved after approximately 40 minutes of such stimulation.

The autonomic nervous system is not separate from the central nervous system; there are many interconnections. It was once thought that we have no control over the autonomic nervous system as most of its responses are involuntary. However, the Hindu system of yoga exercises appears to develop some degree of control and influence over it. Also the Chinese exercises of Tai Chi and Qigong (Chi Kung), popularly practised for health and relaxation, demonstrate that relaxation of the mind improves the natural flow of energy, which in turn stimulates all the internal organs. It seems that the health benefits are considerable when the body is relaxed, and many disorders benefit from the reduction of anxiety or stress.

Dermatomes

Every area of skin is supplied by a spinal nerve, and each segment supplies a dermatome (figure 2.6 (#litres_trial_promo)), the deeper layers of the skin and its underlying connective tissue. Each individual dermatome is designated by the number of the spinal nerve root (cervical, dorsal, lumbar or sacral). If an area of skin is stimulated and there is no response, it is assumed that the nerve supplying the dermatome may be damaged.

Sclerotomes

There are also areas of division of the nerve supply of a bone, called sclerotomes. Each muscle fibre is served by at least one nerve fibre, which ends in a neuromuscular junction. (This is where the stimulus to contract is passed to; almost the meeting point of a nerve fibre and the muscle fibre that it supplies.)

Figure 2.6 Dermatomes

Peripheral nerve innervation of a muscle is very closely followed by innervation of the appendicular skeleton. Any injury of these peripheral nerves may lead to fibrosis, a thickening or scarring of the connective tissue, most often as a result of injury or in the healing stage of inflammation. This often accounts for the referred areas of pain felt in the skin.

Neurotransmitters

An essential part of the working of the nervous system is a group of chemicals known as neurotransmitters. There are excitatory and inhibitory neurotransmitters in the parasympathetic and sympathetic nervous systems. Excitatory transmitters stimulate action; inhibitory neurotransmitters inhibit it. When an impulse passes down a parasympathetic nerve, acetylcholine appears at nerve endings and then it transmits the effects of the parasympathetic impulse. This system is involved in maintaining normal levels of activity. The same happens with the sympathetic nervous system, which works in conjunction with the former. At the nerve endings the chemical noradrenaline (a hormone closely related to adrenaline) is released as a neurotransmitter by sympathetic nerve endings. Among its many actions are constriction of swollen blood vessels, often leading to an increase in blood pressure. Increasing the blood flow through the coronary arteries and slowing of the heart rate increases the rate and depth of breathing and complete relaxation to the smooth muscle of the intestinal walls.

Even today there is still a lot to learn about their different types and what each individual chemical does. Most nervous disorders are linked to the homeostatic imbalance of these substances. Many of the 50 or so neurotransmitters of the nervous system are thought to be neuromodulators; the largest group is known as the neuropeptides, which are thought to include both excitatory and inhibitory factors. One particular neuropeptide found within the sensory nerves, the spinal cord pathways and certain portions of the brain is known as substance P; it is thought to stimulate the perception of pain. It is also thought to be involved in the spinal cord pathways and certain portions of the brain that are associated in pain transmission. Conversely, it is known that substances called encephalins have their powerful analgesic effects on the body by inhibiting pain impulses; the endorphins also possess strong analgesic and behavioural effects. The analgesic compounds are concentrated in the thalamus, the hypothalamus and the pituitary gland. This correlates with what Fitzgerald said in those early years, that stimulation to the pituitary gland reflex point is thought to block or suppress pain. He also elaborated: ‘these functions were carried out by the pituitary body and multiple nerve pathways from it’. It may be that stimulation of the pituitary reflex causes the pituitary body to release adrenocorticotrophic hormone (ACTH), which is released in response to stress, and which controls the release of corticosteroid hormone from the adrenal cortex, a powerful anti-inflammatory substance that helps many of the disorders of the body.

Reflexes

Another function of the autonomic nervous system is that of reflex nervous action. A reflex is an automatic involuntary activity brought about by a relatively simple nervous circuit without conscious control being involved. Thus a painful stimuli will bring about a reflex of withdrawing even before the brain has had time to send a message to the muscle involved. This is a reflex action that has been conditioned by other considerations, it is a protective reflex.

Reflex actions are extremely important. They adjust the tone of muscles, particularly those used in posture. It is for this reason I think reflexology has such a dynamical effect on all the spinal nerves of the vertebrae, improving all back and neck related problems.

The medical profession use reflexes for diagnosing many disorders of the nervous system. The most used one, often referred to in reflexology, is the Babinski reflex sign or plantar reflex; this is brought about by drawing a blunt instrument or stroking the lateral side of the plantar area of the foot from the heel to the little toe. In any person over the age of 18 months old, the normal flexor response would be a downward bunching of all the toes. When there is a reverse upward action of the great toe this is indicative that there may be some evidence of a disorder in the brain or spinal cord.

The hypothesis of reflexology is that the medical fraternity expect a reflex on the foot to indicate some clinical significance enabling them to assess a condition in the body (i.e. they are ‘reading’ the message coming out); a reflexologist uses the same sensory pathway of stimulation to send a message into the peripheral nervous system, which is a two-way circuit, and on into the central nervous system, a vast nerve network, and through the many interconnections here to reach the autonomic visceral reflexes of the sympathetic and the parasympathetic nervous systems that adjust the activity of the organs of the body cavities in the torso.

As reflexologists we work on the feet, dealing mostly with the minute reflexes. The nerve pathways are thought to traverse through the feet and body. Because of this, often when working on patients they feel a shock or stimuli on the opposite side of the body. This is considered to be crossed reflexes. The term ‘crossed reflex’ is often used in zone therapy and reflexology. The original neurological term refers to a response that is brought forth on the opposite side of the body to that on which the stimulus was administered, from ascending nerve tracts entering the opposite side of the brain. The term ‘crossed reflex’ in reflexology indicates an area of referral. This connection affects not only the corresponding organ that has an anatomical connection but also the represented area of the body; for instance, in the case of the head area, we know that if we stub our toe a headache may often develop. Cross reflexes can be used when it is unsuitable to work on a corresponding area, especially if there is any injury or damaged skin; for instance, if the patient has a broken toe, you could get an equal relief of pain by working on the thumb, so the injured part can be avoided. These reflexes can also be used as an area of assistance if the corresponding area is too tender. An area of assistance or helper area is another part of the body that may support or relieve the organ that is injured or has an imbalance through its anatomical connections.

Fitzgerald spoke of the following anatomical correspondences (figure 2.7 (#litres_trial_promo))

• arms and legs correspond

• palms and soles correspond

• dorsal hands and dorsal feet correspond

• fingers and toes correspond

• wrists and ankles correspond

• hips and shoulders correspond.

This anatomical connection has always been part of TCM.

We know these reflexes are highly complicated and are still not fully understood. As therapists we need to have a knowledge of all these systems of the body thus enabling us to have a greater understanding of how reflexology works. For instance, why is the relaxation on the solar plexus area done on both feet? It was traditionally explained that it was concluded together so as not to cause an imbalance, even though we have only one solar plexus. When we rotate the pressure on the solar plexus point it can be explained in two ways: stimuli to the foot between zones 2 and 3 has a direct connection to the coeliac plexus because we are also rotating on the same area on the right foot. This area on the feet and hands is important when treating depression. The reason for solar plexus relaxation must be that both feet benefit from this dual stimulation. We know that the solar plexus is a strong network of sympathetic nerves and ganglia located high at the back of the abdomen. On the feet and hands the corresponding area lies between zones 2 and 3, just below the diaphragm line. This same area on the feet is the first point of the Kidney meridian (KI-1) according to TCM; it is an essential point for all acute problems, and it is a very effective point for all cases of any urgency. The corresponding point on the hands is PE-8; this is also a very potent effective point and is very dynamic in clearing excess heat from the heart and it has a wonderful calming effect on the mind. The Pericardium meridian originates from the chest area and descends through the diaphragm to the abdomen, another branch shoots off to the nipple and then to the axillary area to descend down the arm to terminate in the large finger (seefigure 2.10 (#litres_trial_promo)); this channel is often considered to be connected to the emotions of elation and contentment.

Figure 2.7 Corresponding cross reflexes

Also when working on a person why does the heart rate slow down? We know that normally cardiac muscle contracts rhythmically without nervous stimulation. The pace is controlled by the autonomic nerves supplying a microscopic group of cells in the upper wall of the right atrium near the entry of the superior vena cava called the sinoatrial node. This area is supplied with parasympathetic fibres from the vagus nerves (tenth cranial nerve) and sympathetic fibres from the cardiac plexus and both end at this point, again receiving this dual stimulation. When stimulated each releases a different neurotransmitter; parasympathetic stimulation releases acetylcholine, slowing the heart rate, and sympathetic stimulation releases adrenaline and noradrenaline, speeding up the heart rate so the rate and depth of breathing are also increased. When working on the reflex points that correspond with these organs the body’s systems know whether the heart needs a boost or needs to be calmed down.

Pressure is known to relieve pain. Fitzgerald spoke of how he induced a state of inhibition throughout a zone when he used pressure, and then many of the pathological processes would disappear. He said, ‘We know lymphatic relaxation follows pressure’. He was repeatedly being called upon to expand on the theory of zone therapy and he stood by the idea that certain control centres in the medulla oblongata are stimulated, or more shocked, when pressure is applied to corresponding areas; alterations in function are then carried out by the pituitary body secretions affecting the many nerve pathways. He believed man to be of chemical formation but controlled by electrical energy and vibration. When Fitzgerald was in Europe he must have come into contact with many articles and papers that were published in those days, by the many neurologists who were studying the disorders of the nervous system.

Fitzgerald stated in his book Zone Therapy that manipulation of the fingers or hand over any injured place prevents a condition known as venous stasis, a state in which the injured surface becomes discoloured. Pressure helps inhibition of the nerve pathways to the brain; also when applied over any bony prominence that corresponds to the location of injury it will tend to relieve pain. If the pressure is correct and long enough it will produce a condition of anaesthesia. This is what led to the discovery of zone analgesia. Fitzgerald also emphasised that it made a difference whether the upper, lower or side surfaces of the joint were pressed. He stated that this pressure therapy had a great advantage over any other method of pain relief because this zone pressure not only relieved the pain, it also removed the cause of pain, no matter where it originated from.

Meridians and nerves (#ulink_95cbbf6a-5596-5f43-9def-df6a08395fa7)

The philosophy of acupuncture and acupressure relies on the connection between a specific area on the skin and a specific organ (seechapter 1 (#u8a322ebf-5ee3-5814-94f6-0289533f72f0)). Traditionally these are through the meridian pathways that link the organs. According to some TCM authors, these meridians are not the same as the neural pathways; however, that is a theory expounded by some Western acupuncturists. For example, according to Dr Felix Mann in Acupuncture, How it is Used Today: ‘Nowadays acupuncture can be explained by a wave of electrical depolarisation that travels along a nerve’. This author also refers to the similarity between the TCM idea of Qi transmission along the meridians being like water flowing along a river bed, and the propagation of a nerve impulse along a nerve. Further on in the same book he states:

The mechanism of acupuncture is elusive. Nevertheless, I have developed the following theory which I think will soon be generally recognised as the scientific basis of acupuncture – albeit with modifications and considerable clarification in detail.

If a patient has a pain in the head or neck, it may under certain circumstances be alleviated in one second, by putting an acupuncture needle into the correct acupuncture point in the foot. This speed of conduction, from one end of the body to the other, is only possible in the nervous system. It would take about half a minute for the blood to flow such a distance, and the lymphatic system is even slower.

Acupuncture is based on the fact that stimulating the skin has an effect on the internal organs and other parts of the body.

Many of the meridians follow the line of a nerve, so the neural pathways must be involved; the above theory is open to conjecture, but the evidence is almost conclusive. The same hypothesis is appropriate for reflexology. By stimulating the precise point a response is felt in the body. In an example that Dr Mann gave, if a person had a headache one would work on the brain reflex and head-related areas; the trigeminal nerve reflex has a definite effect on head-related problems, and these points are on the big toe. Also the liver reflex would be worked as the toxin levels would be quite high; this point is on the plantar area of the foot, but there is no meridian depicted here, showing that the response obtained is from the nerve pathways.

Looking at each meridian in detail reveals that many of them follow nerve pathways; these connect with all the structures along their course: the bones and the deeper muscular branches of their respective muscles, organs, arteries and veins. Thus the pathway could be seen as a direct line to the area of the problem and everything connecting with this pathway is potentially helped. Also, a particular nerve pathway goes in one direction, but a two-way transmission is set up through returning nerve pathways. The following looks at each meridian in detail, typical associated disorders and the nervous connections.

The Lung meridian

The Lung meridian (figure 2.8 (#litres_trial_promo)) is a Yin channel with 11 points. This meridian originates in the stomach and then communicates with the paired organ, the large intestine. As it ascends it connects with the relevant organ, the lungs, the first surface point on this meridian is above the nipple in the first intercostal space. The meridian then passes to the throat from the chest and clavicle along the radial border of the arm, to the middle of the elbow, back to the radial border descending to the thenar eminence and ends at the thumb on the lateral edge of the nail bed. This channel not only communicates with its paired organ the large intestine, but also associates with the kidneys and stomach. So points on this meridian (e.g. LU-10) will help fluid problems as well; it is ideal for oedema and retention of urine.

The nerve line arises from the lateral cutaneous branches of the first intercostal nerve, the medial and lateral pectoral nerves, median, radial, interosseus and cutaneous nerves of the arm, which then connect with the dorsal digital branches of the palmar digital nerve.

Figure 2.8 The Lung meridian (the dotted line shows how it connects with its paired organ, the large intestine)

Disorders of this meridian, with signs and symptoms, include: chills, fevers, hidrosis, anhidrosis; pain above the clavicle, or in the chest, upper back, shoulder, forearm, elbow, wrist and hand; headaches; any nasal obstruction, asthma, cough, dyspnoea; fever; sore throat; trigeminal neuralgia, or any twitches in the face. The thumb point is helpful for any cerebral congestion, insomnia, headache, or nervous anxiety.

The Large Intestine meridian

The Large Intestine meridian (figure 2.9 (#litres_trial_promo)) is a Yang channel with 20 points. It commences on the tip of the radial side of the index finger. It ascends the arm on the lateral surface up to the shoulder connecting to the cervical spine and the Governing Vessel on the back. From here it descends to the clavicle and communicates directly with the paired organ, the lungs, and passing through the diaphragm it connects with the relevant organ, the large intestine, to terminate on the face near the nose.

Figure 2.9 The Large intestine meridian (the dotted line shows how it communicates with its paired organ the lungs and connects with the large intestine)