How Does Acupuncture Work?
This is a question I, as well as most acupuncturists, get asked frequently. Along with another very popular and related question, "Does Acupuncture Work?,” our days and conversations are filled with educating others about our medicine. To be an acupuncturist, you have to be an educator, this is a given. The problem with these questions, however, is that precise answers are not available. Certainly within itself Chinese Medicine has strong sets of theories which guide diagnosis and point selection, but to understand and explain this in exact Western terms is difficult at best. In this article I am going to offer my usual array of responses along with some of the more plausible theories and related research for those who would like to probe more deeply into the issue. For those in a hurry, the short answer is yes it works but we don't know how – exactly....
Before I offer the “answers” to this question, I would like to start with asking - why ask the question at all? As individuals we are looking for answers to our various health issues, as practitioners we are looking for the most effective treatments, and as researchers we are looking at the how and why of the results that appear in clinics around the world. From many perspectives a strong western scientific understanding of acupuncture is unnecessary and possibly even impractical if not detrimental. After all, the medicine has survived for over 3000 years without detailed western scientific understandings. There have been no problems calling depression “Liver Qi Stagnation” or fatigue “Kidney Qi Deficiency” and using those patterns to create appropriate treatments. It has only been within the last 50 years or so that anyone was even concerned with trying to understand the biochemical mechanisms of acupuncture. Most people just ask the question out of curiosity or to pass the time with other fear driven questions until the first needle is inserted and they realize it doesn't hurt.
From my perspective, so long as we don't lose our strong and deep roots, there is value in understanding the mechanisms of acupuncture in western terms. Not to create a new personal acu-pen gadget, or to figure out how to make a machine do acupuncture, but to help us create more effective treatments.
How does acupuncture work?
I usually begin to answer this question with the little that we do know. Certainly in a clinical setting we see all types of conditions respond from allergies and asthma to anxiety and depression to fertility and menstrual issues and, of course, pain among many others. So we know it “works”, but how is a gray area. Many studies have shown that acupuncture releases endorphins (our body's natural morphine). A release of endorphins would help explain how acupuncture treats pain and also the extremely relaxed feeling most people have after an acupuncture treatment. This alone, however, does not explain how it may help with depression or autoimmune conditions or fibroids as random examples.
Looking At Specific Effects:
In recent years, researchers have begun looking at specific reactions from individual points. One study using a PET scan (shows brain activity) found measurable changes in the areas of the brain related to gastric control when ST 36 was needled. ST 36 is used for a broad range of issues such as: nearly all digestive issues (reflux, cramping, bloating, weak digestion, etc.), lower leg pain, asthma, fatigue, low immunity, and depression to name a few. This study shows that the point has a measurable effect on brain function which then stimulates the body to correct itself internally. While it shows an effect, it still does not show how it relieves symptoms? Studies like this would have to be repeated numerous times with people with varying conditions to see if acupuncture merely offers a “regulatory effect” or if it is a “fixed effect”.
Regulatory vs. Fixed Effects:
This relationship is an important one for understanding how acupuncture works. If you have bloating, for example, does acupuncture just send a signal of some kind and the body figures out how to stop the bloating, or does it send the same signal every time meaning the point may be better for some types of bloating than others – or only for bloating when you also have cramps? In other words, does the body respond in a purely regulatory fashion with acupuncture - that is, if something (a chemical, hormone, etc.) is high, does it make it lower and vice versa – or does one point always make that chemical or hormone level higher and another point make it lower? These types of understandings will involve years of research but are explained well in Chinese Medical terms minus the a precise “how.”
Similar to the study above, another using a PET scan looked more generally at the effects of needling SP 6. SP 6 has a broad range of uses including digestive problems, prolapsed organs, sexual issues, skin disorders, insomnia and anxiety. This study found changes in 10 areas of the brain including the prefrontal cortex (social behavior, depression, anxiety) and the hippocampus (memory, stress, epilepsy, etc.). Generally the areas that were stimulated matched up with the broad range of effects the point has. Again, however, does it always effect those areas and how does that stimulation lead to a cessation of symptoms in a patient?
An entirely different study used both of those points but didn't look at brain function mechanisms at all – instead they looked at knee pain. This study is an example of looking at “local needling” (vs. using a point for a systemic change like the studies above illustrate). The study found that needling (ST 36 and SP 6) led to increases in synovial fluid in the joint which aids arthritic knees. Did it do this by triggering a part of the brain to draw attention to the knee, or was it just because these rats (in this study) had arthritic knees – what would the effect be on someone with “perfect” knees? There are no clear answers yet to these types of questions.
So What Do These Studies Show?
These types of studies show that acupuncture can and does stimulate the bodies natural functions to heal and regulate. At this time, however, only the vast theories of Chinese Medicine explain how best to accomplish this for a given set of symptoms. For practitioners that understand the complex set of theories underlying Chinese Medicine we see somewhat of an endless labyrinth with studies of this nature. We know from clinical experience that we may use a particular point to create a particular effect, but that same point will have a different effect when used with a related point, and yet another with a different point --- and so on. In other words, there are a multitude of relationships that are accounted for through thousands of years of observation, use, and clinical research that are very difficult to study using western techniques and terminology.
Other Ways of “Explaining” Acupuncture:
The “Endorphin” Theory:
As mentioned above, one theory that attempts to explain the “how” of acupuncture is the endorphin theory. Studies have shown that acupuncture leads to the release of endorphins and these are powerful natural pain killers. Some studies, however, have shown no release of endorphins during treatment. The endorphin view, even if the sole “how” of acupuncture, would only explain effects on pain and perhaps inflammatory related conditions but would be difficult to explain how it may help with anxiety or fertility or parkinsons.
The “Gate Control” Theory:
Acupuncture is also thought to work through the “Gate Control” theory of pain. This theory presented by Patrick Wall and Ronald Melzack in 1965, states that pain is a function of the balance between messages in the central nervous system (brain and spinal cord) and the peripheral nervous system (branching nerves within the body). In essence the theory is about how many messages the body can carry and listen and respond to at one time. By stimulating the large nerve fibers (as acupuncture appears to do) you can essentially block the bodies ability to experience “pain”. As with the endorphin theory, this theory does not explain acupunctures effect on other chemistry and other non-pain related conditions. Nor does it explain why the effects of acupuncture can last for significant periods of time following a treatment.
The “Nerve-Reflex” Theory:
This theory, proposed by a team of Japanese physiologists in the 1950's, showed a relationship between the surface of the skin and the state of internal organs. Essentially an imbalance of an organ, the stomach for example, would send messages to the brain about it's “problem”, during this it would also send information to the skin that could cause tension, color changes, or other signs that are viewable or “feel”-able by the patient or a practitioner. Needling these areas on the skin would create an inverse reaction directing the healing potential of the body to that organ. This is likely a part of how acupuncture points were ever found to begin with and also how techniques such as abdominal palpation (common in Japanese acupuncture) give valid clinical information. Again, though, it doesn't explain how we would effect brain chemistry, or even how, exactly, it would lead to the healing of an internal organ.
So, What Do We “Know” About Acupuncture?
As stated at the very beginning of the article we simply don't know how acupuncture works in measurable western scientific terms. What we “know,” but find difficult to measure, is that acupuncture appears to:
- Have a regulatory effect generally. Raising some brain chemicals, hormones, etc. when they need to be raised and lowering others when they need to be lowered. This is done, most likely, by stimulating the natural innate knowledge of our bodies – our innate drive towards homeostasis or “balance.”
- Offer a calming effect generally. We all have heard about the detrimental effects of stress and stress related hormones. Acupuncture appears to offset these reactions in the body not only calming the person temporarily but possibly protecting the person from damage from stress over extended periods of time.
- Has a reducing effect on inflammation locally and throughout the body. Certainly in pain cases it appears that acupuncture reduces inflammation and promotes healing. Modern research has shown detrimental effects of chronic systemic inflammation (fibromyalgia, parkinson's, heart disease, diabetes, etc.) and acupuncture's ability to treat these conditions must in some way be related to offsetting these systemic responses.
While we can observe these changes and theorize about them based on clinical experiences we still do not have a “how” with acupuncture. For now, as practitioners, it is important to stay firmly rooted in the thousands of years of Chinese Medical history, theory, and techniques of application. And, as others have done before us, to work to extend and “perfect” these theories as we mature as practitioners. For the public, this is a crucial reason why acupuncture should only be performed by fully trained acupuncturists who have the theoretical backing to properly apply acupuncture. As you may know, in some areas people from other medical fields (MD's, DC's, etc.) are allowed to practice acupuncture with little or no training. While many of these practitioners may have the medical knowledge to not hurt someone with acupuncture they rarely have a grasp of the deeper theories of the medicine which will lead to inferior results in many cases. Perhaps more importantly for the field, they will not be as able to share their experiences as practitioners because they do not speak the “language” of Chinese Medicine.
So, for now, just know that acupuncture does work on a broad range of cases but you will see differences from practitioner to practitioner, from style to style, and what works one time may not work another time. There is no fault in exploring various practitioners as a patient and various styles of acupuncture as practitioners and patients. Communicating with your practitioner about what felt most effective or what didn't feel right is useful as we are all explorers to some degree in this medicine. Knowing that we all want the same thing from this vast array of theory and techniques – that is to be well – it is an exciting journey. So while I cannot tell you exactly how we are going to accomplish health in precise western terms, a strong root in the long history of this medicine can certainly help to get us there.