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Many of my patients come into my office not knowing what to expect. They think acupuncture, I've heard it works for this and that, but does it really? In this article, I am going to go over basic philosophy, illustrate a session, and explain how acupuncture works and the conditions it treats from a Functional Perspective.
Before we explore the mechanisms behind how acupuncture works, it is important to note that acupuncture is only a piece of Chinese Medicine. Chinese Medicine in it of itself is a full and complete system that includes acupuncture, herbal medicine, tui na, cupping, moxibustion, stress, dietary, and lifestyle counseling- and it can be used to treat any imbalance/ disease pattern within the system.
From a Functional Perspective, the primary objective and focus of an acupuncture treatment is to restore balance within the system to attain homeostasis. In order to do this an Acupuncturist will ask you a series of questions, sort of like an investigation, to find out what exactly is going on. The objective here is to identify the imbalances at play by looking at the patient's mind, body and life as a whole as we delve into the mental, emotional, and physiological structure and function of your thoughts, feelings, dietary, environmental and other applicable lifestyle patterns. Then, we will ask to feel your pulse and observe your tongue. The tongue and pulse relay more information, on internal standings, as we continue to evaluate.
As we proceed with a diagnosis and treatment plan, we identify what systems are out of balance and move to resolve those patterns. It is important to note that if your Acupuncturist says your "Kidney Qi is weak" or that you have "Kidney Qi Deficiency", it most likely does not indicate kidney failure or mean that your kidneys are in fact weak. It does however mean that you have a collection of symptoms associated with the Kidney Channel and it's related systems. More specifically, the Kidney Qi Deficient patient (similar to Adrenal Fatigue) can look more or less like this: sore/ weak low back and knee joints, clear and frequent urination, enuresis, possible prolapse, possible hair loss, decreased libido, low energy, fatigue especially in the afternoon, along with a tongue that is pale and a pulse that is deep and weak.
After reaching a diagnosis, we then must come up with a treatment plan that will resolve this pattern and prevent it from repeating itself in the future. The treatment plan will most likely include acupuncture, herbal medicine, dietary and lifestyle counseling. We then proceed to monitor your response to the treatment with a series of follow ups dependent on the objective and all of the relevant variables.
Conditions Acupuncture Can Treat
Now that I have provided a big picture lens in which to look through, we can now zoom in to look at how acupuncture works as a modality on its own.
Acupuncture has been studied and used in practice since its early beginnings, 8,000 years ago, and its reach has only increased with time, spreading to every corner of the globe touching the lives of billions across cultures. The numbers continue to rise as people seek effective treatment in holistic healthcare outside of the broken, disease oriented medical model that began less than 700 years ago. So the question to explore cannot be, "does acupuncture work", but rather "how does it work"?
Acupuncture affects every system of the body, and it has been proven effective in controlled clinical trials in the treatment of over 40 different medical conditions stated by World Health Organization, including but not limited to all of the following:
Addiction, Mental & Emotional Disorders
Endocrine, Reproductive & Genitourinary Disorders
Immune & Respiratory Disorders
Detoxification, Gastrointestinal/ Digestive Disorders
Musculoskeletal & Pain Disorders
Acupuncture has also been shown to be at least as effective as a number of pharmaceutical drugs on the market without all of the nasty side effects including but not limited to the following:
- Fluoxetine Hydrochloride (aka Prozac for depression) and all SSRI's
- Metformin for obesity type PCOS
- Flunarizine and Metoprolol (for migraines)
- Omeprazole (for GERD)
- Low dose Prednisone
- Drugs for gastric emptying (metoclopramide, cisapride, erythromycin)
- Motilium (for diabetic gastroparesis)
Acupuncture has also been proven to work well as a complementary modality, or adjunct treatment, that complements and works alongside conventional medicine to mitigate side effects and address the root cause. Examples include but are not limited to the following:
- IVF support 1, 2, 3, 4, 5, 6, 7, 8
- Chemotherapy/ cancer treatment support
- Endometriosis and Dysmenorrhea associated with Endometriosis
Acupuncture has also been proven to be beneficial and effective when studied as an adjunct treatment alongside pharmaceutical drugs. Examples include the following:
- In the treatment of GERD, Acupuncture was shown to be more effective than doubling Proton Pump Inhibitors (aka PPI's) use in patients who fail the standard dose of proton pump inhibitors. Doubling the dose is the current standard of care despite the lack of therapeutic value.
- In the treatment of alcohol withdrawal symptoms, Acupuncture as an adjunct treatment to Carbamazepine medication was shown to have better outcomes with significantly fewer withdrawal symptoms.
Although we have a substantial amount of research confirming the undeniable efficacy of acupuncture, we lack research in which Chinese Medicine is used as a whole to get patients from A to Z. This is where Acupuncturists tend to branch off and embrace what we have learned and what we know works and has worked clinically for thousands of years. For example, I have seen patients get off PPI's successfully by using Chinese Medicine to its full capacity, utilizing acupuncture, herbal medicine, dietary and lifestyle intervention as a vehicle for change- but most modern research only studies one piece of this whole, rather than in combination with one another, which may benefit scientists but not necessarily clinical outcomes and more importantly, our individual patients. This is where the Functional Medicine Movement becomes important and can embrace acupuncture, along with Chinese Medicine, as a clinically proven, evidence based, safe, effective and inherently holistic solution. It is important to note that Chinese Medicine provides a powerful and complete answer as a tried and true healthcare system to the current predicament in which we lack healthcare entirely.
Clinicians and researchers who keep a holistic perspective grounded in an evidence based, systems approach to understanding the body are able to embrace acupuncture as an effective treatment for many different disease manifestations because they know acupuncture closes in on the root and optimizes the body's own ability to heal itself. In this way, acupuncture is able to zero in on, address and correct the underlying mechanisms that trigger the disease process in the first place.
How Acupuncture Works
Many westernized physicians that practice acupuncture, explain it to be an "energy" medicine where a magical substance, "qi", moves through mystical "meridians". However, this is far from the truth and came to be through a devastating translation error that resulted in mass miscommunication. This error has subsequently excluded acupuncture and Chinese medicine from being accepted and integrated into today's medical model.
Furthermore, this widespread, hollow assumption is quite the leap and frankly a question of one's intelligence when equipped with the fundamental principles of anatomy, physiology, and basic concepts of health and disease that both Western and Chinese Medicine are predicated on. For further explanation, you can check out The Dao of Chinese Medicine by Donald Edward Kendall or Chris Kresser's abbreviated version in his series "Chinese Medicine Demystified". Since these great works have already explained the major mishap and how it came to be, I am only going to focus in on how acupuncture works from a Functional Perspective that recognizes both basic physiological principles and the foundations of Chinese Medicine- which are both based on thorough research, observation and scientific inquiry.
As Kendall states,
"Research so far shows that the true concepts of Chinese medicine operate under known physiological principles, involving the complex organization of the neural, vascular, endocrine, visceral and somatic systems, sustained by the circulation of nutrients, vital substances and oxygen from vital air."
In fact, the ancient Chinese physicians were the first to discover blood circulation, internal organ systems, somatovisceral relationships and the organization of the cardiovascular, immune, and musculoskeletal system.
Kendall goes on to say, "One of the truly unique discoveries of the Chinese was their recognition that those neurovascular nodes (acupoints) located on the body (soma), associated with superficial vessel branching and related nerves, could reflect disease conditions in the internal organs (viscera). Body-organ or somatovisceral relationships were established by the Chinese through correlating the location of body pain with observed problems in particular organs."
It is important to note that the effects that follow provide a framework as to how acupuncture works and are far more general and broad spectrum in nature than the detailed effects described for each point or a specific combination of points in our Chinese Medical textbooks- which link specific points and point combinations to certain patterns and functions that the Chinese observed for thousands of years and modern research is only beginning to look at and understand. For example, our textbooks relay that PC 6 is a comprehensive point in the treatment of cardiac pain, palpitations, tight chest, epilepsy, insomnia, irritability and other mental disorders but often only appears in the research as an effective point for nausea, vomiting and pain in wrist region. This is one of many examples where more research is needed to catch up with and make sense of what we already know clinically. It is also important to note that an Acupuncturist would not just prescribe a point or point combination based on symptoms alone. One would have to look at the whole person (their body, mind and life) through thorough inquiry and evaluation of genetic, environmental, physiological, mental, emotional and psychosocial factors as they go on to identify the root, the manifestations and the relevant patterns in order to come up with a precise and effective treatment plan.
So let's dive in.
Every time a needle is inserted into and punctures the skin at the site of an acupoint, a microtrauma is created and a signal is sent throughout the entire body. This microtrauma generates a local and systemic effect as well as a central and peripheral nervous system response, activating complex defense mechanisms involving tissue reactions, blood vessels, sensory nerves, somatovisceral pathways, the brain and endocrine glands as a cascade of chemical mediators, analgesics, immune substances, hormones and neurotransmitters are released into the bloodstream.
Researchers have found that acupuncture points, or superficial nodes, form where collateral branches of deeper distribution blood vessels supply the body surface, which involve afferent and efferent neural properties (Kendall). The acupoints contain a significantly higher concentration of mast cells, fine lymphatics, blood capillaries, venules, and converging arterioles, along with sympathetic nerves supplying the vessels, nerve bundles, nerve plexuses, and free nerve endings (Kendall). This makes acupoints extremely reactive to the needle insertion.
We now know that acupuncture through the activation of these systems increases vasodilation, promotes blood flow, relaxes the muscles, reduces pain, relieves stress, decreases inflammation and restores homeostasis. If we understand that a disturbance of homeostasis and more specifically these functions are at the physiological root of pathological disease and disorder, we begin to understand how acupuncture can play an important role in the healing process and be a beneficial part of the solution. In this next section, we will delve into and explore how acupuncture elicits these responses in the body. It is also important to point out that these effects work synergistically.
- Acupuncture increases vasodilation and promotes blood flow. When the tissue is injured via needle insertion, mast cells help to increase the initial vasodilation phase by releasing histamine, heparin and kinin protease. This keeps the blood from clotting and acts as an anticoagulant. It is also important to point out that the blood carries everything the body needs to heal including nutrients, analgesics, anti inflammatories, immune substances and other chemical mediators.
- Acupuncture relieves stress by promoting parasympathetic function, or the "calm and connect" mode, while decreasing sympathetic function, or the "fight or flight" response through the release of opioid peptides (enkaphalins, endorphins, and dynorphins), serotonin (5HT), neurohypophysial hormones (oxytocin and vasopressin)- as seen recently in research studying acupuncture analgesia. The effects of acupuncture become even more clear when we look at the link between stress related disorders and inflammation.
- Acupuncture relaxes muscles through vasodilation and the other effects listed primarily as an adaptive response to work the needle out of the body subsequently repairing the surrounding tissues.
- Acupuncture reduces pain through the activation of the immune system and the peripheral and central nervous system. More specifically, acupuncture relieves pain through the endogenous opioid system. By inserting a needle into the skin, opioid peptides (enkaphalins, endorphins and dynorphins) are released into the bloodstream. These peptides immediately reduce and in many cases stop pain by attaching to local and systemic pain receptor sites. It is this same mechanism, the release of opioid peptides, that has also been shown to increase pleasure, and decrease anxiety, depression, and gastrointestinal discomfort 1. When we experience pain, two types of nerves are involved, sensory (nocioceptive) and position (proprioceptive). These nerves register pain by quickly relaying information to the spine and onto the neurons in the spinothalamic tract. This information is then transmitted up the spinal cord to the midbrain. There are two different types of sensory nerves involved in the acupuncture response, A-Delta Fibers (acute pain) and C-Fibers (chronic pain). If all goes well, acupuncture will remind the body what it is like to function without pain. It is also important to note that if the nerves are damaged, acupuncture will not be able to help.
- Acupuncture decreases inflammation through a cascade of chemical mediators released into the blood including prostaglandins, leukotrienes and substance P.
- Acupuncture restores homeostasis intrinsically via the effects stated above.
In conclusion, Acupuncture and Chinese Medicine meet the three scientific standards Claude Bernard set in 1865 as a tried and true form of healthcare. He stated that medicine must have an experimental base derived from anatomical and physiological studies, disease must be described in terms of physiological mechanisms and manifestations, and medicine must have a clinical practice essential to restoring or normalizing physiological function.
I would also like to make mention of the interaction and exchange between the patient and healthcare provider. I am not going to explore this relationship here in this article, but we now know scientifically, and many of us know intuitively, that this is an incredibly important part of the healing experience and journey back to health and happiness. I will however definitely be exploring this topic in the future.
I know that when I sit down with my own patients, allow them to tell their story and give them a place in which they are heard, something special happens, as tears flow and transformation begins. Although Acupuncture may not be as mystical as you once thought, I hope you are able to appreciate the innate beauty of this powerful system and your body's ability to heal itself given the right conditions, tools, and treatment- and find reverence in that.
Finally, I hope this article has provided insight and equipped you with a basic understanding of Acupuncture and Chinese Medicine, as well as opened your eyes to an alternative option that you and your loved ones can now choose with confidence to heal and be well.