Episode 1: How does acupuncture work?

Transcript

One of the main inspirations behind starting this podcast was the many amazing conversations that I have with my patients in clinic, and the awesome and insightful questions I get asked both in, and outside of, clinic throughout my daily life. One of the most common of these questions is “how does acupuncture work?” This is an important one to answer, as quite often I’ll be having a conversation with someone and they’ll say “oh, I love acupuncture and I’d love my husband / mother / co-worker to get acupuncture as they’d really benefit, but they don’t believe in it”. I find this to be an interesting statement, because acupuncture isn’t a religion – it’s not something that you believe in – it either does or it doesn’t work. And particularly at this point in time, not only do we have 5,000 years of continuous clinical practice of this modality and many documented clinical studies from those millennia, but we also have literally tens of thousands of research papers published in contemporary scientific journals that discuss the many mechanisms and many pathways through which acupuncture has an effect on the body. So, I thought this was a great question to kick of this podcast, as it can be answered on so many levels. There’s the short answer, long answer, the Chinese Medicine answer and the biomedical / scientific / contemporary research answer. So I’d like to get into all of those, but I think the best place to start is with the short answer.

So, how does acupuncture work? The short answer is that acupuncture works by supporting the body’s innate healing mechanisms. These healing mechanisms are what allow our bodies to heal from cuts and to mend fractured bones, to bounce back from infections and colds, and even in outlying cases it might be what accounts for spontaneous remissions in serious diseases. We all have these superpowers, and in an ideal world, we’d be returning to a state of dynamic balance (or what we also call homeostasis) in the face of life’s various ups and downs. Say we have too many late nights and lots of stressors, and some dietary changes and maybe exposure to some pollutants and toxins: in an ideal world, our body would be able to recalibrate and return to a state of health. But unfortunately, modern life has quite a hectic pace and quite strong demands on us, so we are not always able to live in accordance with both our internal resources (that’s how much energy we have, our current state of emotion and our biochemical reserves, for example) and living in harmony with our external resources (that’s living in harmony with the outside world: harnessing access to sunlight, fresh air and movement). that’s not necessarily always happening – we might forego movement to sit at a desk 12 hours a day, and then drive home through traffic and get stressed, get stuck in a negative mindloop and then come home and have a fight with someone in our family, and have more stresses about money / mortgage / career / all sorts of concerns. So really, we are living in a constant state of constant stress.

What this does is it overstimulates our sympathetic nervous system. This is a component of our body’s autonomic nervous system that is also termed the “fight or flight” system. This is the response that we get in the face of stress: it primes our body to escape and so it might pump more blood to the skeletal muscle of arms and legs, it will allow more energy to go to the heart and lungs to strengthen our ability to run away, but what it does is that it shuts down energy and resources going to areas of the body that it deems not immediately essential for survival, which is areas governed by the parasympathetic nervous system, also called “rest, digest and repair”. What this means is that when we’re in a constant state of stress, hypervigilance or anxiety, then we’re not getting a chance to drop into that parasympathetic nervous system, which is where the healing and repair and restoration of that dynamic balance of that body occurs. Acupuncture is a way to do that. Acupuncture has been shown to encourage parasympathetic activity in the body, and so it’s a way of letting the body – and the whole body’s systems – know that it’s safe, and that it’s able to switch off and divert all that energy away from the “high alert”, and to use those precious resources to start recalibrating.

So that’s the kind-of short answer. The Chinese Medicine is kind of similar to the short answer, just using slightly different terminology or language (and this is what I love so much about Chinese Medicine language: that it offers a shorthand for describing the many complex biochemical and biophysical pathways that are happening in the body, and it offers that in a language that is accessible to all of us, so that we can all relate to it – it’s a really humanist medicine). From a Chinese Medicine perspective, acupuncture works by restoring the flow of Qi in the body, and restoring the balance of Yin and Yang (that’s really talking about homeostasis in the body). And I just want to mention that when we are talking about restoration of the flow of Qi, and balancing Qi in the body, sometimes Qi has been (in my opinion) mistranslated to represent some mystical or magical force that can’t be proven to exist and, while that may be the case, Qi in Chinese language also refers to situations concerning air, pressure, vapours and weather, and in Chinese Medicine when we talk about Qi, we talk about the body’s metabolism and potential for movement: really, it talks about all the different functions and processes that are going on in the body. So when we look at it with that understanding in mind, we see that the Chinese Medicine understanding is that acupuncture restores correct functioning of all the body’s systems and networks. And this is really beautifully aligned with a lot of the latest biomedical understanding of the body, which is starting to view the body as a complex network of information, and interwoven systems

In the past, we had a very mechanistic view of the body – we viewed it as like, say, a mechanic would view a broken car. We’d really drill down on where we perceived the problem would be, we’d remove the broken part or patch it up, and then we’d expect that things would be all good from there. But what that view doesn’t take into account is that all the body systems are not separate, they are actually all beautifully interconnected. And this is really coming through in new fields of science, like psychoneuroimmunology, which talks about the interwoven relationship between “psycho-” (the brain and neural areas), “immuno-“ (which is the immune system) and endocrinology (which is the hormones): all those systems are involved in continual crosstalk. It used be that we thought everything was governed from the brain down, or from the central nervous system, but actually we’re seeing that all of the systems are interwoven with each other, and can affect the other. What that means is that our hormone can affect our immune system, and our immune system can affect our moods, and vice versa. It’s beautiful to see how modern medicine and tradition medicine are aligning in their view of the body.

Another area where we are seeing this is in the exciting and emerging field of epigenetics. Epigenetics just means “epi-“ (above) genetics. Previously we believed that genes were set in stone, so the genes we received from our ancestors would – previously – very much dictate our health outcomes in the future. That kind of took our agency way: it took away our input in being able to generate the health outcomes that we would hope for. But what epigenetics is teaching us, is that our genes are merely a blueprint – they are just a sketch or plan or outline for our health – but how we actually live our lives (the food that we fuel our bodes with; the appropriate rest and the balance that we strive for; even the very thoughts that we think – and that we have as our continual internal dialogue), all of these factors have very potent effects on whether genes get switched on and off (whether they get expressed), and therefore whether certain characteristics, or certain conditions, might get expressed as a result of that. So really, it puts the power much more firmly in our hands.

So that was the Chinese Medicine answer of how acupuncture works (which was followed by a bit of a detour into emerging areas of medicine and system biology). The long answer gets into some really cool biomedical research, and as I mentioned before, there’s literally tens of thousands of papers that look at how acupuncture works. Some of the earliest work in this area comes from Dr. Candace Pert, who was a very highly regarded neuroscientist and pharmacologist, and headed up (a lab) at the US Government’s National Institutes of Health. Dr. Pert was the discoverer of our endogenous opiate receptor. Opiates are painkilling substances, and not only can we be given these from external sources, but we also produce our own endogenous (endogenous means “internally generated”) substances, which means that we have access to an internal pharmacy that we can use to reduce pain. What Dr. Pert found, was that acupuncture was shown to induce the release of these endorphins (these internally-generated painkillers) into the cerebrospinal fluid, and then disseminated through the body. That’s just one of the ways in which acupuncture has been shown to work.

To look at all the many other pathways through which acupuncture has been shown to have an effect on the body, I grabbed a paper that was recently published (this year) in the International Journal of Hypertension (“hypertension” is high blood pressure), and this research paper looks at all of the cumulative research over the last 10 years that shows the various mechanisms of acupuncture for hypertension, and how it can potentially improve the situation for people affected by hypertension. This paper highlights the many pathways through which acupuncture has a positive effect on the body. Tosummarize, they found that it worked on many different systems: they found that it had an endocrine effect (endocrine is the hormone system) – that acupuncture was able to regulate vessel tension and fluid regulation through the balance of specific hormones in the body. Acupuncture was also found to reduce oxidative stress. Oxidative stress is what contributes to aging and cellular damage in the body, and it’s the reason why we hear a lot about antioxidants – and different supplements and superfoods that are great for providing that antioxidant effect; these are things like leafy greens and turmeric, and even red wine. This paper suggested that acupuncture also had an antioxidant effect by inhibiting or mediating oxidative stress.

Acupuncture also had an effect on the molecules of information that work in the body. As I touched on before, the body as we’re now understanding it – and certainly as ancient Chinese medicine for 5,000 years has understood it – is an interwoven network of interlocking body systems. And those systems communicate with each other via molecules of information. And at any given moment, at any given second in time, our body is undergoing 37 billion billion chemical reactions, which is amazing! We’re amazing creations, but it’s also easy for some of these reactions to get dysregulated if we’re not living in optimal conditions, or in a state of balance for our particular body type. What they found is that acupuncture had an effect on some of these molecules of information – these ones in particular (mentioned in the paper) are called gasotransmitters, and these are transmitters of information. And interestingly, there are other studies that show that there’s actually higher concentrations of gasotransmitters along acupuncture channels and certain acupuncture points – really interesting research.

There was actually shown to be an effect on the brain. FMRi scans were able to show that different acupuncture points lit up different parts of the brain. In Chinese Medicine, we have a well-documented system of acupuncture points, and different acupuncture points at different locations in the body have different effects on regulating different body systems -and up-regulating or down-regulating metabolism in various areas. And this correlated with current research that showed that different parts of the brain would light up depending on which acupuncture points we used – it’s not just that the body was responding to local pain due to needling of a site – there was a greater physiological and therapeutic response occurring. The review went on to discuss the epigenetic benefits of acupuncture in respect to hypertension. It showed that with acupuncture, there was a down-regulation of genes that code for certain symptoms. And epigenetics, as we touched on before, is this exciting new field of science that talks about how our genes are not set in stone, and how they can be changed by lifestyle factors such as meditation, organic diets, and so on. The review paper also mentioned that there was shown to be an effect on target organ damage, as one of the secondary effects of hypertension is damaged to certain related organs (as a result of the increased pressure of blood, and the increased demands on pumping that blood against a high pressure). One of those organs that can be affected is the heart – we might see a thickening of the heart wall (which is called cardiac hypertrophy); there might also be potential inhibition of blood flow to the brain, or there might be damage to the renal tubules (in the kidneys) because of the force of the pressure moving through them. What they found was that with acupuncture, there was a positive effect on target organs implicated in hypertension, i.e. there was a protection of blood vessels and renal tubules, there was improved blood flow in the brain, and there was an improvement in the cardiac wall thickness as well.

As we can see, there’s so many different ways that acupuncture exerts a positive influence on the body, and this has just been a brief “dipping our toe into the water” of the how and why! This is just taking one review paper about acupuncture, but as I mentioned before, there’s literally tens of thousands out there now. I could talk about acupuncture and the intersection of modern and ancient medicine for days, but I’d like to hear from you – what would you like me to talk about? What health and wellness questions would you like answered?

Research & Reference

Pert, A., Dionne, R., Ng, L., Bragin, E., Moody, T.W. and Pert, C.B (1981). Alterations in rat central nervous system endorphins following transauricular electro-acupuncture. Brain Research. 224: 83-93.

Zhang, Q., Li, A., Yue, J., Zhang, F., Sun, Z. and Li, X. (2015) Using functional magnetic resonance imaging to explore the possible mechanism of the action of acupuncture at Dazhong (KI 4) on the functional cerebral regions of healthy volunteers. Internal Medicine Journal, pp. 669-671

Juan Li, Mingsheng Sun, Jing Ye, Yuxi Li, Rongjiang Jin, Hui Zheng and Fanrong Liang (2019) The Mechanism of Acupuncture in Treating EssentialHypertension: A Narrative Review. International Journal of Hypertension.

Seorim Min, Koh-Woon Kim, Won-Mo Jung, Min-Jung Lee, Yu-Kang Kim, Younbyoung Chae, Hyangsook Lee and Hi-Joon Park (2019) Acupuncture for Histamine-Induced Itch: Association With Increased Parasympathetic Tone and Connectivity of Putamen-Midcingulate Cortex. Frontiers in Neuroscience, March 2019, Vol. 13, Article 215

Cho ZH, Hwang SC, Wong EK, Son YD, Kang CK, Park TS, Bai SJ, Kim YB, Lee YB, Sung KK, Lee BH, Shepp LA, Min KT (2006) Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms. Acta Neurologica Scandinavia, 2006: 113: pp. 370–377

Hugh MacPherson, PhD,  Richard Hammerschlag, PhD,  Remy R. Coeytaux, MD, PhD, Robert T. Davis, MS,  Richard E. Harris, PhD,  Jiang-Ti Kong, MD,  Helene M. Langevin, MD, Lixing Lao, PhD,  Ryan J. Milley, MAcOM, Vitaly Napadow, PhD,  Rosa N. Schnyer, DAOM, Elisabet Stener-Victorin, PhD, Claudia M. Witt, MD, MBA, and Peter M. Wayne, PhD (2016) Unanticipated Insights into Biomedicine from the Study of Acupuncture, The Journal Of Alternative And Complementary Medicine. Volume 22, Number 2, 2016, pp. 101–107

Andrew C Ahn, Junru Wu, Gary J Badger, Richard Hammerschlag and Helene M Langevin (2005) Electrical impedance along connective tissue planes associated with acupuncture meridians. BioMed Central Complementary and Alternative Medicine.

Young-Chang P. Arai, Yoshikazu Sakakima, Jun Kawanishi, Makoto Nishihara, Akihiro Ito, Yusuke Tawada, and Yuki Maruyama (2013) Auricular Acupuncture at the ‘‘Shenmen’’ and ‘‘Point Zero’’ Points Induced Parasympathetic Activation. Evidence-Based Complementary and Alternative Medicine.

Sheng-xing, M. (2017). Nitric Oxide Signaling Molecules in Acupuncture Points: Toward Mechanisms of Acupuncture.Chinese Journal of Integrative Medicine, 2017 Nov; 23(11): pp. 812–815.

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Disclaimer

Chinese Medicine is a personalised, functional medicine that treats the individual and the root cause of their presenting imbalance (what conventional medicine would call the symptom, disease or condition). This means that your doctor of Chinese Medicine will work one-on-one with you to achieve a personalised treatment plan. As such, this podcast is for informational purposes and is not intended to diagnose, prescribe or substitute existing medical advice.

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