How Acupuncture Works

by John G. Connor, M.Ac., L.Ac. edited by Barbara Connor, M.Ac., L.Ac.

Chinese Medicine is based on a functional system comprised of the theories of Yin and Yang, Five Elements, Zang Fu, Meridians, Spirit, Qi, Blood, Body Fluids, Five Emotions, Six Exogenous Pathogenic Factors, etc. The five Zang organs are the lung, heart, spleen, liver and kidney; and the six Fu organs are the large intestine, small intestine, stomach, gallbladder, urinary bladder and triple burner. The acupuncturist characterizes the functional disturbances of the Zang-Fu organs with the help of eight diagnostic criteria, namely: Yin and Yang, Interior and Exterior, Deficiency and Excess, Cold and Heat.

How does acupuncture work? When a needle is inserted into an acupuncture point you will usually feel a sensation of warmth, slight numbness, heaviness or mild achiness at the point of insertion. This is known as obtaining the Qi. According to Chinese medicine Qi is the vital energy which flows through a system of channels called meridians and regulates the bodily functions. All the vital activities of the human body are explained by changes and movement of Qi. The activities of the Zang Fu organs, maintaining the normal temperature and defensive systems of the body all depend on the promoting and stimulating effect of Qi.

The meridians are the transmission lines among the various parts of the body, making the organism a unified whole. The meridians and their tributaries provide Qi and Blood and thus warmth and nourishment for the whole body and also serve as lines of communication among the organs and the body. They adjust the ebb and flow of Qi in the body and help maintain a balance of yin and yang, blood and Qi and defense and construction.

What happens in disease? In disease, exogenous pathogens, such as wind, cold, dampness, heat, dryness or fire, invade the body through the exterior and penetrate into the interior via the meridians in turn, affecting the organs. Organ pathologies, such as Liver Wind, may spread to other parts of the body through the channels. Through channel transference, disease in the organs may also be reflected in areas of palpatory tenderness, swellings, indentations, nodules and red areas on the skin.

There can be many disharmonies involving Qi. We speak of deficient Qi, stagnant Qi, collapse of Qi and rebellious Qi. The following metaphor is very helpful in understanding how acupuncture can affect Qi flowing through the meridians. Imagine the flow of Qi to be like water flowing in a stream. Just as the flow of water can be affected by an obstruction in the stream so can the flow of Qi be obstructed in the meridians. Qi in meridians can be blocked by becoming stagnant, by being obstructed by dampness, phlegm, cold, etc. When a stream is blocked by debris it floods upstream from the debris and becomes dry downstream from it. If one clears the debris away the water in the stream can resume its normal and natural flow. In a like manner, if the Qi in a meridian is blocked the body suffers disharmony. And if the blockage from the flow of Qi within a meridian is removed, the natural flow is restored and the part of the body affected by the blockage regains its natural harmony and state of balance.

How can this flow be restored by acupuncture? Imagine making a small hole in the pile of debris which is blocking the stream. It will often clear the entire stream path, because the force of the water gushing through the hole will widen continuously until eventually all the debris is washed away and the normal course of the stream is restored. Similarly by inserting a needle into an acupoint of the blocked meridian it will have a similar effect. And just as a stream may have certain points more easily accessed or more easily blocked, the meridians have certain points which, when needled, will have a significant impact on the flow pattern. In this way by needling acupuncture points it is possible to exert a direct therapeutic effect on the channels and organs, and thus in turn on bodily functions. (2)

It is theorized that the meridian system lies in the superficial fascia of the connective tissue just a few millimeters below the surface of the skin, and the Qi circulating within these channels is in fact the bioelectric energies associated with the connective tissue structures of the fascia. When a needle is inserted into a point it creates electrical potential changes. The generation of these small electrical currents from needle insertion results from the interaction of the needle with the interstitial fluids that bathe and nourish the connective tissue fibers. The fluids which surround the fibers contain a vast array of chemicals, ionically charged particles, molecules and atoms. (5)

WESTERN SCIENTIFIC RESEARCH

Research has shown that acupuncture increases the microcirculation and vasomotion throughout the body which in turn increases oxygenation of the tissues which will help flush toxins, waste products, and other accumulated particles and chemicals from the tissues improving their overall function. Therefore, the small electrical currents generated by the insertion of a needle into the fascia or connective tissues can indeed have beneficial effects. And because of the nature of the connective tissues, it is quite plausible that these effects could occur both locally at the site of needle insertion or at a distance from the acupoint. (8)

According to one scientific study on pain relief induced by acupuncture it was concluded that acupuncture works by stimulating nerve fibers in the muscles, which send impulses to the spinal cord, midbrain and hypothalamus-pituitary. These centers in turn release endorphins and monamines which block the pain impulses. (8)

While it cannot be said that an exact mechanism, or a precise Western description of acupuncture function has been discovered, it can be said that many phenomena that could play a part in such a definitive description have been demonstrated. Western science is beginning to accept that needling of a specific point does direct a stimulus to certain responsive parts of the nervous system setting off a biochemical cascade which enhances healing. Many of the ideas in the classical Chinese texts may be justified by Western theories and methods.

Bruce Pomeranz at the University of Toronto has written a very nice summary of current research on how acupuncture analgesia works in an article entitled “Acupuncture Analgesia – Basic Research” (9).  He says that acupuncture stimulates nerve fibers in the muscle which send impulses to the spinal cord and activate the spinal cord, midbrain and hypothalamus/pituitary to cause analgesia.  The spinal site uses enkephalin and dynorphin to block incoming messages.  The midbrain uses enkephalin to activate the raphe descending system which inhibits spinal cord pain transmission.  And at the hypothalamus/pituitary center the pituitary releases β-endorphin into the blood and cerebrospinal fluid to cause analgesia at a distance.

Pomeranz found that when needles are placed close to the site of pain or in the tender (trigger or Ah Shi) points, they are maximizing the segmental circuits operating within the spinal cord (cell 7) while also bringing in other cells in the other two centers (cells 11 and 14).  Whereas he observed that when needles are placed far away from the site of pain they only activate cells 11 and 14.   Cells 11 and 14 produce analgesia throughout the body, while cell 7 produces analgesia only locally.

According to Pomeranz, Melzack et al have found that 71% of acupuncture points coincide with trigger points.  This suggests that needles activate the sensory nerves which arise in muscles.  When sites are tender they are known as Ah Shi points in TCM, and needling them is recommended.  Trigger points can often be found outside muscle bellies, in skin, scars, tendons, joint capsules, ligaments and periosteum.  Travell stresses the importance of precise needling of trigger points, as missing the tense knotted muscle fiber could aggravate the problem by causing spasms.
How does acupuncture compare with conventional Western medicine in the treatment of pain? Acupuncture has been shown to be very effective in treating chronic pain, helping in 55% to 85% of the cases. This compares favorably with the effects of morphine which helps in 70% of the cases. However, acupuncture has the distinct advantage of having very few side effects in comparison with drugs.

For more information on the results of scientific studies on the health benefits of acupuncture please read our article entitled Research on the Health Benefits of Acupuncture.

THE MORPHOGENETIC SINGULARITY THEORY ON THE ORIGIN OF ACUPUNCTURE POINTS AND MERIDIANS

There is a very interesting theory proposed by Charles Shang of the Emory University School of Medicine on the relationship between the meridian system and embryogenesis. (7, 9)  He states that the “gap junction embryonic epithelial signal transduction model” in the mid-1980s proposed that the meridian system contains relatively under differentiated epithelial cells connected by gap junctions which transduce signals and play a central role in mediating acupuncture effects.

Shang explains that the morphogenetic singularity theory published in the late 1980s applied the singularity theory of mathematics to explain the origin, distribution and nonspecific activation phenomena of the meridian system.  In development, the fate of a larger region is frequently controlled by a small group of cells which is termed an organizing center.  Organizing centers are the high electric conductance points on the body surface.  The high conductance phenomenon is further supported by the finding of high density of gap junctions at the sites of organizing centers.  Both acupuncture points and organizing centers have high electric conductance, current density, high density of gap junction, and can be activated by nonspecific stimuli.  Acupuncture points, which also have high electrical conductance and high density of gap junctions originate from organizing centers.

Shang concludes that based on the morphogenetic singularity theory, the meridian system originates from a network of organizing centers and the evolutionary origin of the meridian system is likely to have preceded all the other physiological systems, including the nervous, circulatory, and immune systems.  Its genetic blueprint might have served as a template from which the newer systems evolved.  Consequently it overlaps and interacts with other systems but is not simply part of them.

THE BALANCING EFFECT OF ACUPUNCTURE

A study done by Alavi et al (1996) and reviewed by Z. H Cho et al (9) in their article entitled “Functional Magnetic Resonance Imaging of the Brain in the Investigation of Acupuncture” four of the five patients in the study had a marked left/right asymmetry in blood flow in the thalamus prior to acupuncture treatment.  (The thalamus is, a major site in the neural integration of pain sensation.)  Following the acupuncture treatment in which all five of the patients reported pain relief, it was observed that the left/right asymmetry was greatly reduced.  (Control subjects showed no blood flow asymmetries either before or after acupuncture.)

Hammerschlag and Lao (9) review two separate studies by Nishijo et al (1997) and Tayama (1984) in an article entitled “Future Directions for Research on the Physiology of Acupuncture”.  They observe that when one looks at these trials from the point of view of the individual  it becomes apparent that those individuals whose pretreatment heart rates were in the lowest third of the normal test group had their rates increased by acupuncture, whereas those with initial values in the highest third experienced a decrease.

They go on to note that indications of the normalizing or balancing effect of acupoint stimulation have also been detected in immune system responses.  They cite the case in which the levels of IgA (the main class of salivary immunoglobulins) increased after 30 minutes of acupuncture and at 24 hours post-treatment in healthy individuals whose initial levels were low and decreased in those whose initial levels were high.
Ultimately we may find that acupuncture acts as an elegant bridge between the various physical sciences and energetic medicine.  As Hammerschlag and Lao so eloquently state: “It may also become clearer that acupuncture triggers homeostatic regulation by acting on an integrative system that is separate from but interfaces with the known autonomic and humoral systems.”

THE DYNAMICS BETWEEN PATIENT AND PRACTITIONER

The processes whereby the acupuncturist arrives at the information on which he bases his diagnosis consists of visual observation (including looking at the tongue), listening and smelling, palpation (including pulse and abdomen) and questioning. The most crucial part of the treatment is to make the correct diagnosis. Palpation of areas of the body, of the meridians, and of the acupoints is useful because it provides clues to the patient’s condition including the condition of the meridians and organs.

In contrast to obtaining the Qi, which is felt by the patient, the arrival of Qi is something that the practitioner feels. So even if the patient feels no needle sensation, as long as the practitioner feels it, the treatment will be effective. The arrival of Qi is felt as a pulsation or sensation of warmth in the thumb or fingers of the practitioner. The feeling of the arrival of Qi is similar to what might be felt if you are holding a fishing pole at the moment when a fish starts pulling the fishing line away from you. You feel a sort of grabbing or pulling sensation in your fingers. But if the Qi has not yet arrived, the needle will move freely back and forth as if it were in a piece of tofu, and you will not feel any pull or grabbing sensation in your fingers. (1)

Acupuncture is also a very useful form of preventive care. For example, by employing the palpatory technique of eliciting pressure pain in one’s diagnostic protocol one can treat problems before they develop into diseases or syndromes. Both Western and Eastern concepts of disease imply a certain pathology with measurable or definable parameters, e.g., the disease of pneumonia or the syndrome of Lung Qi Deficiency. However, because pressure pain elicited by palpation does not always reflect any obvious known disease or syndrome it can serve as a useful sign that there is an underlying imbalance that, although not revealing any symptoms yet, if treated will prevent the condition from progressing further. Disorder, imbalance or disease can be present in a person for some time before becoming obvious, and Western medicine has yet to reach that point whereby it can identify and treat such disorders at an early stage.

Part of being a good acupuncturist is to be able to see the bigger picture. And many times diseases result from a lack of awareness of the primacy of the needs of one’s higher self over the lower self. Many times disease is an indicator helping us to took at an underlying emotion or thought pattern and encouraging us to progress into a more positive or higher intuition of ourselves. Once we recognize this and begin working towards our positive reality the problem begins to resolve itself and real healing takes place. The practitioner acts as a facilitator towards the recognition of the higher self. So this dis-ease in which we find ourselves becomes a real ally in our journey towards our own reality.

The dynamics between the practitioner and the patient, the practitioner’s recognition of energetic flows in each body, as well as his or her intention, palpatory and needling skills are ail important factors that determine the success or failure of an acupuncture treatment. There are as many styles of acupuncture treatments as there are practitioners.

It is one’s innate healing potential that cures disease. Acupuncture is simply a means to assist the body in activating one’s own innate healing potential. We talk about being centered or staying focused from the center of our being. In Oriental thought not being centered is the same as being out of balance, and being centered is the same as being in a state of balance or wellness which is the natural function of the body and goal of acupuncture treatment. Health is not simply a composite of quantifiable entities such as chemical levels in the blood and urine. It is ultimately a state of perfect balance – physical, mental, emotional and spiritual.

REFERENCES

  1. Denmai, Shudo, Japanese Classical Acupuncture, Introduction to Meridian Therapy, Seattle: Eastland Press 1990
  2. Dharmananda, Subhuti, Ph.D., “An Introduction to Acupuncture and how it Works”Portland, OR: Institute for Traditional Medicine, 1996
  3. Kaptchuk, Ted J., O.M.D., The Web That Has No Weaver, Chicago: Congdon and Weed 1983
  4. Maciocia, Giovanni, The Foundations of Chinese Medicine, Edinburgh: Churchill, Livingstone 1989
  5. Matsumoto, Kiiko and Stephen Birch, Hara Diagnosis: Reflections on the Sea, Brookline, MA: Paradigm Publications 1988
  6.  Ross, Jeremy, Acupuncture Point Combinations, Edinburgh: Churchill, Livingstone 1995
  7. Shang, C., “Electrophysiology of growth control and acupuncture” Life Sci. 2001 Feb 9;68(12):1333-42,
  8. Stux, Gabriel, Bruce Pomeranz, Basics of Acupuncture, Berlin: Springer-Verlag 1995
  9. Stux, Gabriel, Richard Hammerschlag (Eds.), Clinical Acupuncture, Scientific Basis, Berlin: Springer-Verlag 2001
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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-309-7753.

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