How Does Acupuncture Work?

A growing body of Randomized Controlled Trials (RCTs) continues to prove that the millennia-old practice of acupuncture can be an effective treatment for numerous conditions and illnesses. Because of a burgeoning interest in acupuncture research among some of the world’s top medical research centers such as Stanford, Harvard, UCSF, etc, it has become known that acupuncture does work. The question, however, remains how?

Acupuncture has been shown to create various physiological and biological changes in the body on numerous levels simultaneously, therefore, mapping out its systemic effect on the mind-body is quite a complex process. It is a common belief that the concept of energetic channels within the body (meridians), which convey and transport subtle bodily mechanisms thoughout was developed thousands of years ago by sages and ascetics who could feel these subtle processes within their own bodies.

Acupuncture points, in general, were considered way stations along these energetic highways (meridians) where Qi or energy congregated or pooled in larger quantity in relation to other places along the meridians (places along the meridians where no points were designated). Generally-speaking, these places where Qi tends to pool along a meridian (acu-points) are considered more therapeutic than non-Qi-pooling places.

In my humble opinion, modern science is not yet quite sophisticated enough to detect the subtle systemic changes toward health and homeostasis that acupuncture can produce. To really map out all of the changes produced by one acupuncture session, for instance, modern science would need to invent a machine that can somehow monitor physiological and biological changes within the body for an extended period of time. A diagnostic device like this- if ever produced- might look like a wear-able functional MRI (fMRI) machine that also can monitor subtle biological and physiological changes such as changes in inflammation levels, hormone and endorphin levels, immune response, etc.

Mapping these physiological changes has started to happen to an extent with Dr. Sean Mackey’s work at Stanford University, using functional MRI (fMRI) machines in conjunction with acupuncture. However, despite illuminating the fact that physiological and brain activity in the body does occur with the insertion of acupuncture needles, even this type of research does not clearly display how acupuncture works in a simplified way. This is, in my opinion, the conundrum. It is, seemingly, still too complex to map out as acupuncture creates changes on multiple levels simultaneously.

Despite this complexity, when patients, friends or colleagues ask, I do still often try to explain some of the ways in which acupuncture can effect change within the mind-body continuum. There are a number of modern theories that explain ways in which acupuncture is thought to effect positive change towards health in humans and animals (vertebrates).

To explain this, I’ve found a helpful article by Netherlands-based acupuncturist, Johanna Biemans, which can be found online here: https://www.linkedin.com/pulse/top-5-theories-explained-how-acupuncture-works-johanna-biemans/

The following is from acupuncturist Johanna Biemans’ article, ‘Top 5 Theories That Explained How Acupuncture Works‘:

“1. Endogenous endorphin release

The all time number one when it comes to explaining how acupuncture could influence our bodies is the triggering of the endogenous endorphin release. Endorphins are our bodies own painkillers and are produced in the midbrain. Bruce Pomeranz was the first to describe the relation between acupuncture and the painstilling effect due to endorphin release. He specifically draw attention to the delay time of 20 min. between stimulation and the onset of the analgesic effect. The time necessary for processing the endorphin from the precursor pro-opiomelanocortin (POMC). The endorphins involved are most likely beta-endorphin.

2. Triggerpoint deactivation

A definite second place belongs to the popular triggerpoint theory (our bodies expression of pain by hypersensitive knots in striated muscles). Unlike the endorphin theory, this theory has caused a lot of debate amongst acupuncturists and the so called dry needling therapists about ownership. Basically acupuncturists are familiar with treating painspots or “Ashi”points as it is defined in the original theory. Deactivation of myofascial triggerpoints resolves stifness and pain. This can be achieved by specific needling techniques.

3. Modulation of nerve activity

In third place I chose neuromodulation: acting upon nerves to alter nerve activity. Neuromodulation is a fast growing field and when we consider the therapeutic impact that came along with it. this theory deserves a place in the Top 5. Some of the modalities are originated or closely related to acupuncture. The explanation holds that needling in the close surroundings of mostly peripheral nerves, effects can be evoked at a spinal or supraspinal level. This antidromic stimulation presumably has a modulating effect through a segmental way on organs or body functions. The most known are stimulation of n.medianus in cases of PONV ( Postoperative Nausea and vomiting) and n. tibialis posterior stimulation (PTNS) in the treatment of pelvic disorders. Discussion continues about the frequencies, intensities and duration of stimulation. Because manual needling requires a very precise craft these kind of stimulations are mostly performed with electrical devices: electroacupuncture. Very, very speculative but worth mentioning is the riddle of “Bagdad’s Batteries”. On a site near Bagdad Archeologists found battery like objects. And in close surroundings some needle like objects. One theory states that they might have been used for electrostimulation according to acupuncture principles.

4. Counterstimulation at spinal level

From the fourth place on choosing becomes harder. If I take into account: “times cited in literature” I guess counteracting deserves a place in the Top 5. Many times in a negative connotation though. Acupuncture is no more than counterstimulation. Counterstimulation is based on the wellknown gate control theory of Melzack and Wall. Different stimuli from the periphery can inhibit each other at spinal level and thus painful stimuli can be suppressed.

5. Increase of blood flow.

At fifth place I firstly selected ‘balancing the autonomous nerve system” which is frequently quoted. But then I realised that this mode of action comes very close to the ones (3 en 4) mentioned above. And merely is a different angle of referring to similar mechanisms. I considered influencing ‘hormonal balance’ or ‘immune functions’. Then of course I came up with the mostly local effect of increasing the blood flow. The puncturing of soft tissues and muscles brings forward a production of adenosine which binds to the ephitelium of bloodvessels and induces the release of nitrooxygen which causes a vasodilatation of the bloodvessel. It’s usage preferred in local ischaemic conditions.

The most close explanation of acupuncture is likely a combination of mechanisms plus the missing link that is expressed in it’s original concepts.”

http://cim.ucsd.edu/clinical-care/acupuncture.shtml

https://www.mskcc.org/cancer-care/integrative-medicine/herbs/acupuncture#msk_professional

https://www.sciencedirect.com/science/article/pii/S2005290110600234

https://www.sciencedirect.com/science/article/pii/S200529011300174X

https://www.news-medical.net/health/Acupuncture-Theories.aspx