There is no simple way of explaining what acupuncture does or why it is effective. Simplistic explanations, invariably lead to misunderstandings which, in turn, can lead to sceptical and dismissive attitudes. However, some facts about the known mechanisms of effectiveness can be enlightening and a discussion of the development of acupuncture theory and its parallels with conventional medical models can make it easier for western trained practitioners and inquisitive patients to achieve a more open minded perspective.
Mechanisms of Effectiveness
The question, ‘Does acupuncture work?’ has long been answered in the affirmative. Despite ongoing controversy regarding which research methodologies can best evaluate effectiveness and a large number of poorly designed, misleading trials, a beneficial effect has been demonstrated for many different conditions. As research methods are improved, it appears likely that many more conditions will be shown to respond positively to acupuncture.
The predominant question occupying researchers today is, ‘How does acupuncture work?’ It comes as a surprise to many just how much research has been conducted, revealing a plethora of details about what happens when a needle is inserted beneath the skin. The scope of this information is way beyond what can be delivered here, but here are some of the best understood mechanisms:
Needling influences pain by:
- Eliciting neurological responses at different levels in the CNS that act antagonistically towards afferent pain signals: http://www.sciencedirect.com/science/article/pii/S0301008208000579
- Promoting the secretion of pain relieving endorphins such as; encephalin, β-endorphin, endomorphin and dynorphin : http://www.sciencedirect.com/science/article/pii/S0304394003014009
- Release of anti-inflammatory cytokines such as TNF-α, Interleukin-10.
- Release of anti-inflammatory neuropeptides such as Calcitonin Gene Related Peptide (CGRP).
- Needling promotes vasodilation, improving blood flow, reducing the build-up of pro-inflammatory substances in affected tissues.
- A useful summary of the extensive research is here: http://downloads.hindawi.com/journals/mi/2003/807126.pdf
Needling can be effective for various immunological diseases, potentially influencing allergic disorders, infections, autoimmune diseases and immunodeficiency-syndromes via the following mechanisms:
- Enhancing natural killer cell activity
- Influencing T Helper cell activity through modulation of Th1/Th2 balance
- Modulating immune function via neuro-immune systems (i.e. strengthening immune deficiency and attenuating immune over activity): http://www.sciencedirect.com/science/article/pii/S1566070210000573
- Needling has been demonstrated to influence the secretion of oxytocin, adrenocorticotropic hormone, gonadotropin-releasing hormone, corticotrophin-releasing hormone, cholecystokinin, and acetylcholine, implying multiple, wide-ranging effects on many systems: https://www.researchgate.net/profile/Bai-Yun_Zeng/publication/258443654_Acupuncture_Stimulation_and_Neuroendocrine_Regulation/links/54e35d790cf201fe67ec95a3.pdf
Multiple System Regulation
- fMRI has demonstrated that acupuncture modulates the activity of the limbic system and subcortical structures suggesting that this may be an important mechanism by which acupuncture exerts its complex multisystem effects: http://onlinelibrary.wiley.com/doi/10.1002/(SICI)1097-0193(2000)9:1%3C13::AID-HBM2%3E3.0.CO;2-F/full
An Incomplete Reductionist Model
It is clear that great strides have been taken in understanding the biological mechanisms of acupuncture’s effectiveness. The reductionist approach has provided many fascinating and useful discoveries that will increasingly influence treatment approaches, continuing to distil and fine tune the delivery of acupuncture.
However, this model is far from complete and provides patchy guidance for the practitioner presented with a typical patient, exhibiting numerous signs and symptoms often affecting multiple physiological systems. Trying to apply it to complex cases, often leads to overly simplistic choices for needling sites that may fail to achieve the full potential of acupuncture. In this situation, it seems sensible to draw on the insights gained over many centuries of clinical observation by thousands of experienced practitioners, knowledge that has been systematically condensed into the model of Chinese medicine.
A Complete Holistic Model
It is easy to dismiss the ideas contained in Chinese medicine after superficial exposure to its concepts. This is understandable, as they are couched in a language that belongs to a very different culture and its translation is often misleading.
It helps to remember that, whilst these ideas were created before we had the finer details of modern anatomy, physiology and pathology, this does not mean that they are inaccurate. Practitioners were not blind to the situations and environment in which symptoms arise, how those symptoms progress, how and when associated symptoms appear and eventually become chronic or resolve. They were also very capable of perceiving when specific interventions could influence those symptoms and systematically passing that information on to their students.
In the absence of large scale clinical trials and meta-analysis, many generations of practitioners and scholars have pragmatically fine-tuned the various methods of treatment, sifting out those concepts that did not accurately describe the disease and healing process, as well as, those techniques that were less effective.
The result is a model of human health that works, providing explanations for disease causation, progression and resolution that seem strange to our modern western minds, but are non the less, often able to provide an accurate prognosis and treatment strategy. This system is dependent on a perception of patterns of related signs and symptoms (syndromes), the use of analogous descriptions of the process of pathology and recovery, as well as, a set of prescribed interventions that will influence the outcome in a relatively predictable and repeatable way.
A Different Paradigm
If we can get beyond the first hurdle and explore this different paradigm in greater depth, a fuller grasp of the scope of traditional Chinese medical thought is possible. One quick way to get past the first hurdle is to think of the traditional descriptions as analogies. As an example, I will briefly explore one of the fundamental concepts of Chinese medicine and the one most often rejected by those new to the idea; Qi (pronounced Chee)
In Chinese thinking, both ancient and modern, Qi is considered to be an animating force, giving us energy, life-force or vitality. Qi is thought to be essential for life to persist and is divided up into different types, each associated with different organs or body functions. At first hearing this sounds fanciful, even ridiculous to our modern minds, like some sort of magic.
However, consider the portion of our Qi that the ancient Chinese called Lung Qi. This was thought to consist of energy that we draw in from the air through our lungs, energy which is diffused throughout the whole body, combining with other sources of Qi to maintain the health of all our tissues and organs. Without Lung Qi, we will not have life-force for very long.
Now consider Lung Qi as an analogy for oxygen and read the last paragraph again….
Lung Qi as oxygen is a simple example of analogous thinking, necessarily adopted by a culture that had no access to modern, technological assessment of biological and pathological processes. Clearly, the ancient Chinese were well aware of the importance of oxygen to our health, but they just had another name for it.
There are plenty of other examples; think about something called Nutritive Qi, said to be the energy we derive from the food we eat, as a metaphor for blood sugars; think about the Liver Qi, said to promote the smooth flow of all other Qi as a description of the liver’s ability to store and release blood sugars as they are required; think about the bio-electric energy that innervates our nervous systems, could Qi be an early description of this?
This is an incomplete and relatively superficial explanation of a profound subject, about which a great deal more could be said. However, it is one simple way of seeing through the mists of cultural translation that often obscure the casual viewer’s perception of ancient ways of thinking.
It is tempting to think that the modern ideas of acupuncture’s mechanisms of effectiveness should replace the finely crafted traditional ideas of Oriental medicine, but to do so would be a mistake. Far better is to overlay them, one on top of the other, to reveal the similarities.
For example: My research on subclinical haemostasis, considered in modern medicine to be instrumental to the progression of diseases such as Rheumatoid Arthritis.
Subclinical haemostasis is a situation where the blood interacts with inflamed and damaged tissue in a way that sets up a vicious cycle of degeneration. In RA, this occurs in the joint surfaces. It is a partial activation of the coagulation cascade that results in fibrin being deposited in articular cartilage. Fibrin then attracts pro-inflammatory substances, which in turn promote a continued activation of the coagulation cascade, leading to further fibrin deposition. Thus, the cycle becomes self-perpetuating, regardless of the original trigger, a situation common to many chronic inflammatory conditions.
Interestingly, much attention is given to this subject in the Chinese medical text book, ‘The Divine Fulcrum’ or ‘Spiritual Axis’, first compiled in 305-204 B.C.
Chapter 47 examines chronic joint disease and is best summed up in the quote, ‘When the blood moves freely, the sinews are strong and the joints supple’. It is a discussion of how the ‘stagnation of blood’ is pivotal to the development of syndromes that present with painful, swollen, stiff and deformed joints.
Further, the traditional techniques applied to such diseases involve methods described as ‘moving the blood’ or ‘clearing blood stagnation’, methods that when examined by modern experimentation, are shown to increase blood flow through a variety of mechanisms from vasodilation to biochemical changes that counteract the progression and self-sustaining nature of the coagulation cascade.
In other words, in the 1st Century B.C., oriental physicians had accurately identified one of the primary causes for the chronicity and progression of Rheumatoid Arthritis and had correctly assessed effective techniques to counteract the pathology, all of which is now being reinforced by relatively recent medical research.
There are many other examples of these bridges between ancient and modern medical thinking and, I am certain, many more to be discovered.
Of course, there will be details of Chinese medical theory that do not stand up to reductionist analysis and will ultimately be demonstrated as incorrect. This is as welcome to practitioners of Chinese medicine as it has always been. Refinement through observation has been the driving force that has shaped the development of traditional theories for centuries.
In the modern world we are in a unique situation where we can accelerate that refinement through the application of science, guided by established traditional theory, to distil the truth from ancient wisdom. It is my conviction that such an approach, one that bridges the chasm that exists between Oriental and Western medicine will serve us best, by both informing future research directions, as well as, further honing the traditional model.
© Andy Green 2017