History Of Clinical Practice Research Articles

Gender and Sexual Orientation in Family Therapy: Toward a Postgender approach

Abstract: We examine how the issues of gender and sexual orientation have been addressed in family therapy and identify critical issues as the field defines itself in a postmodern, inclusive era. We show how unintentional bias and creation of the category of “other” persist throughout the history of clinical practice despite a rise of interest in diversity. We suggest that family therapy approaches have been based on a view of sex‐gender that creates dichotomous categories, confounds gender and sexual orientation, and limits flexibility. A postgender approach organized around a relationship model based on equality rather than gender is advocated. Obstacles to postgender practice are identified, and guidelines for practice and challenges for the future are discussed.

Neural mechanisms of the effect of acupuncture on cardiovascular diseases

The long history of clinical practice has proven that acupuncture has curative effects, but the physiological basis needs more scientific study. Since the 1980s, we have demonstrated that several kinds of experimental hypertension, arrhythmias and the defense reaction-induced pressor responses could be inhibited by electroacupuncture (EA, 1–3 mA, 2–5 Hz) while hypotension and bradycardia could be alleviated by EA (4–6 mA). Further studies have shown that cardiovascular neurons in the rostral ventrolateral medulla (rVLM) receive inputs from hypothalamic and midbrain defense areas, the splanchnic nerves, and Neiguan and Zusanli acupoints. EA applied to these acupoints for 20–30 min inhibits the excitatory effects of the former three inputs to the rVLM. Inhibition on these neurons lasts for 1–2 h, and is related to activation of opioid receptors. Analysis of the neural pathways has shown that EA activates the nucleus arcuatus (ARC) in the hypothalamus, which sends excitatory projections to the ventral periaqueduct gray (vPAG) and, in turn, to the nucleus raphe obscurus (NRO). Excitation of NRO neurons inhibits cardiovascular neurons in the rVLM by activating opioid, GABA and 5-HT receptors to reduce sympathetic outflow, which ultimately exerts a therapeutic effect on hypertension, arrhythmias and cardiac ischemia. Conversely, EA with high current stimulation activates the cholinergic system and excites rVLM neurons, leading to an increase in blood pressure (BP), to alleviate shock and bradycardia.