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Chinese Medicine Demystified (Part VI): 5 ways acupuncture can help you where drugs and surgery can’t

March 16, 2010 in Myths & Truths | 36 comments

person receiving acupunctureNote: This is the sixth article in an ongoing series. If you haven’t read the first five, I recommend doing that before continuing:

Most people in the US don’t know much about acupuncture. They might have heard it’s good for pain, that it can treat infertility, or that it can help you relax. What most people don’t realize is that acupuncture is a more complete and effective method of healthcare than western medicine.

Here’s why.

#1: Acupuncture treats your whole body

Acupuncture isn’t directed toward a particular disease or condition. It works instead by activating the body’s self-healing ability. This is why acupuncture can address everything from irritable bowel syndrome to back pain to the side effects of chemotherapy.

When you get an acupuncture treatment for elbow pain, your elbow pain will go away but it’s also likely that you’ll see improvements in other areas. The headaches you’ve had for ten years will get better, you’ll have more energy, you’ll be better able to handle stress, and you’ll sleep better.

The reason acupuncture can do this is that it focuses on treating the root cause of your health problems. The ancient Chinese knew that symptoms don’t arise out of nowhere. Symptoms are manifestations of an underlying malfunction and disease process. The progression from malfunction > disease process > symptom can take many years. If you just address the symptom without addressing the malfunction or disease process, healing doesn’t occur.

The Chinese also knew that a malfunction or disease process can give rise to many different symptoms that may seem unrelated. For example, headaches, heartburn and skin rashes may all be expressions of the same underlying problem.

Western medicine, on the other hand, often mistakes symptoms for disease. Treatment is almost always directed at the symptom, not the disease. Western medicine is based on the Cartesian paradigm that has dominated both scientific and philosophical views of the body for the past three hundred years. This philosophy created the notion that the body is a machine composed of many separate parts, and that health can be achieved by simply addressing each part in isolation. There is no consideration for how the parts are connected and related.

This is why in western medicine we have doctors for every different part of our body. We’ve got cardiologists for our hearts, gastroenterologists for our guts, podiatrists for our feet, gynecologist for female reproductive organs, neurologists for our brains, etcetera. We’ve carved our body up into various parts and put different doctors in charge of taking care of each part. In a perfect medical system these doctors would be communicating frequently and sharing ideas about their patients. While this does happen in some cases, all too often it doesn’t. I don’t believe this is the fault of the doctors themselves. They are as much victims of the deficiencies of our healthcare system as patients are.

Acupuncturists have a different perspective, because Chinese medicine is based not on Cartesian dualism but on Chinese philosophy, which is inherently holistic. Acupuncturists look at the body as one interconnected whole. From this viewpoint it is impossible to consider a specific part (like the knee, or the heart) without considering it in relation to the whole. This is of course much more consistent with what we know about how ecological and biological systems (which the body is an example of) operate. And it explains why a single therapy like acupuncture can treat your entire body at the same time.

#2: Acupuncture cures disease

What is a cure? One definition is that a cure has been achieved when the treatment is removed and the dysfunction or illness doesn’t come back.

With the exception of antibiotics, chemotherapy and selective surgery, western medicine does not cure disease. It suppresses symptoms.

How do we know this? If you take a drug for a problem you generally have to take it for the rest of your life. The problem doesn’t go away – it’s being suppressed by the drug. The drug has just replaced a certain function of your body. But as soon as you stop taking that drug, the problem will come back. And often it will be worse than before.

Blood pressure medication is the perfect example of this. It will certainly lower your blood pressure, but it doesn’t do anything to fix whatever was causing your high blood pressure in the first place. People find this out the hard way when they try to stop taking their medication, and their blood pressure skyrockets to a level higher than it was before they started taking the drug.

Why does the problem get worse after taking a drug? Because drugs don’t only suppress symptoms. Drugs also suppress functions. Though drugs provide symptom relief in the short term, over time they may worsen the underlying condition because they interfere with our body’s self-healing mechanisms.

For example, many people take ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) to cope with arthritis and inflammatory conditions. While NSAIDs are effective in reducing pain and inflammation in the short-term, they are also known to reduce blood flow to cartilage. Since blood carries all of the nutrients and immune substance necessary for tissue repair, NSAIDs can actually worsen the original problem when taken chronically.

Drugs also have side effects. Drugs may correct a specific imbalance, but in the process they cause at least one other and often several other imbalances. When this happens in western medicine, other drugs are prescribed to address the side effects caused by the first drug – and so on until the patient ends up on a cocktail of drugs treating the side effects of drugs. (See my article Problem With Your Pill? Take Another Pill! for more on this phenomenon.)

There’s nothing wrong with symptom relief. Anyone who has suffered from a debilitating health condition can tell you that. I believe that symptom suppression with medication is necessary, and even life saving, in certain cases. The problem occurs when symptom suppression with drugs takes the place of other approaches (such as nutritional and lifestyle changes) that address the root of the condition.

Acupuncture, unlike most drugs, has the potential to cure disease. Why? Because as I mentioned above, acupuncture stimulates the body’s self-healing mechanisms. And the body’s ability to heal itself far surpasses anything western medicine has to offer.

The discovery of antibiotics is certainly one of the greatest achievements of medicine (though not without problems, as the recent phenomenon of antibiotic resistance indicates). However, these medications are like children’s toys compared with the extraordinary complexity of the immune system’s ability to heal disease.

The body is capable of spontaneously healing wounds, regenerating tissue, neutralizing toxins, and keeping cancer cells at bay – all while we catch the latest episode of Lost on TV or pick up the kids from soccer practice.

As evolutionary biologist Paul Ewald puts it:

Put bluntly, medicine’s success at vaccination and antibiotic treatment are trivial accomplishments relative to natural selection’s success at generating the immune system… We will probably obtain much better disease control by figuring out how to further tweak the immune system and capitalize on its vastly superior abilities than by relying on some human invention such as new antimicrobials (antibiotics, antivirals or antiprotozoal agents).1

Acupuncture does just that: it “tweaks” the immune system and capitalizes on the body’s vastly superior ability to heal itself. That is the strength of acupuncture. However, this strength can also be a limitation. Since acupuncture works by stimulating the body’s built-in healing capacity, if that capacity is impaired or damaged (by poor nutrition, excessive stress, etc.) then the healing power of acupuncture will be limited.

#3: Acupuncture prevents disease

The superior physician makes it his prerogative to treat disease when it has not yet structurally manifested, and prevents being in the position of having to treat disorders that have already progressed to the realm of the physical. The low level physician finds himself salvaging what has already manifested in physical form, and treating what is already ruined. 2

Amazingly enough, this quote comes from a medical text in China written 2,500 years ago! The idea of “preventative medicine” has received a lot of attention in the west during the past decade. But as the quote above indicates, the Chinese have been aware of the importance of preventative medicine for thousands of years.

Acupuncture and the other branches of Chinese medicine (nutrition, herbal medicine, tai qi, qi gong) restore homeostasis and keep the body functioning at an optimal level. When the body is functioning at an optimal level, we’re far less likely to get sick, and far more likely to recover quickly when we do get sick.

Another way to put it: acupuncture is an effective method of healthcare.

Healthcare, which may be defined as a method of promoting and maintaining health, is not the focus of our current medical system. A more accurate term for the focus of Western medicine would be disease management.

Disease management is important and we certainly need it in the modern world. Yet it’s a mistake to confuse disease management with healthcare. They aren’t the same thing at all.

Western medicine is focused on the treatment of serious disease. Many of the tests, for example, performed in western medicine will not be triggered as abnormal unless the person being tested is already very sick. If a person goes to see a doctor complaining of headaches, digestive problems, fatigue and insomnia, the doctor will run some tests. If the tests come back “normal”, the patient is told that there’s nothing wrong with them! But of course the patient knows that’s not true. They know it’s not normal to have all those problems, and they know that something is wrong.

In fact, until recently doctors thought serious health conditions such as irritable bowel syndrome and fibromyalgia, and physiological changes related to normal life stages like menopause, were “all in the patient’s head”.

Why is western medicine so oriented towards serious disease? Part of the reason is that there is no concept of health in western medicine. If you look in the index of any western medical textbook, you’re not going to find a definition of health. Doctors don’t study health, and what it takes to be healthy, in medical school. They study diseases and the drugs that are used to treat those diseases. This puts western medicine at a serious disadvantage when it comes to promoting health.

I want to emphasize that I am making generalizations here. There are surely many doctors (and I have seen quite a few of them myself) that are deeply committed to the health and well-being of their patients, recognize the interconnectedness of the body and mind, emphasize the importance of preventative care, and prescribe nutritional and lifestyle changes to their patients. In particular I see this with many younger doctors who have graduated from medical school in the past ten to fifteen years. They tend to be much more open-minded to alternatives to drugs and surgery, and more inclined to recommend these alternatives when appropriate. This is an encouraging trend in medicine.

#4: Acupuncture makes your life better

The goal of Chinese medicine is to improve your quality of life and keep you healthy right up until the end. This means you’re rock climbing, snowboarding, playing with your grandchildren, or doing whatever else you enjoy until you pass away in your sleep at a ripe old age.

Western medicine, on the other hand, is focused on the treatment of serious, life-threatening conditions. It is an unsurpassed intervention for trauma and acute emergencies. Doctors can achieve almost miraculous feats to keep people alive, including reattaching severed limbs and literally bringing people back from the dead. It’s also true that antibiotics have nearly eliminated the risk of dying from the infections that were the primary cause of death all the way up until the mid-20th century, and that medications like insulin for Type 1 Diabetes have made a normal life possible for people who otherwise would have died at an early age. These interventions have extended our average lifespan considerably, and their contributions to our quality of life shouldn’t be underestimated.

So I’m certainly not “against” Western medicine. Believe me, if I get in a car accident or someday have a heart attack, I’ll go straight to the hospital. However, if I were to develop type 2 diabetes, I would begin by changing my diet because in many cases type 2 diabetes can be completely controlled with diet alone. (Of course it’s very unlikely that I will ever get diabetes, because my diet and lifestyle make it virtually impossible for that kind of blood sugar dysregulation to occur.) These examples explain my guiding principle in making decisions about my health care: for any given condition, I will choose the treatment that does the most good and causes the least harm. In my experience, acupuncture and Chinese medicine fits this guiding principle far more often than drugs and surgery.

#5: Acupuncture won’t kill you or make you sick

Primum non nocere, or “first, do no harm” is one of the principal precepts of medical ethics that students are taught in medical school. Another way to state this principle is, “given an existing problem, it may be better to do nothing than to do something that risks causing more harm than good.”

Somewhere along the line this important precept got swept under the rug. While western medicine has made tremendous contributions to disease management, it has also proven to be dangerous to our health.

We may have the most advanced disease management system in the world, but the US is far behind most other industrialized countries when it comes to health. The U.S. ranks just 34th in the world in life expectancy and 29th for infant mortality. Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from bottom) for 16 available health indicators. 3

Even worse, a recent study (PDF) by Dr. Barbara Starfield published in 2000 in the prestigious Journal of the American Medical Association demonstrated that medical care is the 3rd leading cause of death in this country, causing more than 250,000 deaths per year. Only heart disease and cancer kill more people. Although this study was published in one of the most reputable medical journals in the world, it received little media attention and my guess is that few doctors have heard of it.

Dr. Starfield estimates that, each year, medical errors and adverse effects of the health care system are responsible for:

  • 116 million extra physician visits
  • 77 million extra prescriptions
  • 17 million emergency department visits
  • 8 million hospitalizations
  • 3 million long-term admissions
  • 199,000 additional deaths
  • $77 billion in extra costs

As grim as they are, these statistics are likely to be seriously underestimated as only about 5 to 20% of medical-care related incidents are even recorded. Analyses which have taken these oversights into consideration estimate that medical care is in fact the leading cause of death in the U.S. each year. 4

I ask you this: can a medical system that potentially kills more people each year than any other cause of death else be considered “healthcare”?

In contrast to western medicine, acupuncture is extremely safe and well-tolerated. A recent cumulative review published in the British Medical Journal examined the incidence of adverse effects with acupuncture in more than one million treatments.

According to the evidence from these studies, the risk of a serious adverse event with acupuncture is estimated to be 0.0005% per 10,000 treatments, and 0.0055% per 10,000 individual patients.

The authors conclude:

The risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments. The range of adverse events reported is wide and some events, specifically trauma and some episodes of infection, are likely to be avoidable.

The incidence of milder side effects during acupuncture is also relatively low. In a study of 230,000 patients who received an average of 10 treatments each, 8.6% reported experiencing at least one adverse effect and 2.2% reported one which required treatment. Common adverse effects were bleedings or hematoma (6.1% of patients, 58% of all adverse effects), pain (1.7%) and drowsiness (0.7%).

To put that in perspective, a review of more than a hundred phase I double-blind, placebo-controlled trials reported that 19% of those receiving placebo experienced side effects, with higher rates following repeated dosing and in the elderly. 5

This suggests that placebos (sugar pills) may cause more side effects than acupuncture.

I hope this article has helped you to understand the power of acupuncture and Chinese medicine and its relevance as a genuine system of healthcare. And I hope this series of articles has made clear that acupuncture is not a “woo-woo” energy therapy, but a complete system of medicine based on known anatomical and physiological principles.

I would love to hear your feedback on how these articles have affected your perception and understanding of acupuncture. Please leave a comment!

If you’d like to refer people to this series of posts in the future, I’ve created a special “acupuncture” page on the blog with an index of all of the articles in the series. It’s listed on the right hand side of the page, in the sidebar, under “Health Reports”.

  1. Ewald, P. Plague Time. p.64 ↩
  2. See chapter 2 of the Suwen, in Nanjing Zhongyi Xueyuan, ed., Huangdi neijing suwen yishi (An Annotated Text With Translation of the Yellow Emperor’s Classic of Medicine: Plain Questions) (Shanghai: Shanghai Kexue Jishu Chubanshe, 1991), p. 16; ↩
  3. Starfield B. Primary Care: Balancing Health Needs, Services, and Technology. New York, NY: Oxford University Press; 1998. ↩
  4. General Accounting Office study sheds light on nursing home abuse. July 17, 2003 . Available at: http://www.injuryboard.com/view.cfm/Article=3005. Accessed December 17, 2003 ↩
  5. Rosenzweig P, Brohier S, Zipfel A. The placebo effect in healthy volunteers: influence of experimental conditions on the adverse events profile during phase I studies. Clin Pharmacol Ther 1993;54:578-83. ↩

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Chinese Medicine Demystified (Part V): A Closer Look At How Acupuncture Relieves Pain

March 14, 2010 in Uncategorized | 64 comments

woman in painNote: This is the fifth article in an ongoing series. If you haven’t read the first four, I recommend doing that before continuing:

In this article we’re going to take a closer look at one of the latest theories on how acupuncture relieves pain. I’m going to break it down in plain language for my readers who don’t have a scientific background, but I’ll also provide references at the end of the article for those of you that want the nitty-gritty detail.

Keep in mind that pain research is a constantly evolving topic, and more is being learned each year about the mechanisms of pain relief via acupuncture. (Although as an interesting side note, according to Professor Bruce Pomeranz of the University of Toronto, we know more about acupuncture analgesia than many chemical drugs in routine use. For example, we know little about the mechanisms of most anesthetic gases but still use them regularly. 1)

What I’m going to share with you here represents the latest information from the American Academy of Pain Management and papers published in major peer-reviewed journals.

The physiology of pain

Before I explain the mechanism, I have to give you a little background on the physiology and neurology involved.

There are two types of nerves involved in our perception of pain: sensory (nocioceptive) and position (proprioceptive) nerves. Both of these nerve types are firing at the same time in an area where we’re experiencing pain. These nerves travel to the spine and pass their information on to neurons in the spinothalamic tract. This tract travels up the lateral dorsal horn of the spinal cord to the mid-brain.

The sensory nerves register pain. The position nerves tell the brain where that pain is coming from. So the sensory nerves say “ouch!” and the position nerves say “my knee!”.

There are two different types of sensory nerves involved in the acupuncture response. There are A-Delta fibers, which transmit sharp, burning pain messages. And there are C-fibers, which transmit dull, throbbing pain messages. A-Delta fibers are responsible for acute pain, and the signals they send are short-lived. They fire for a while and then the signals die off. C-fibers are responsible for chronic pain, and fire over an extended period of time.

A-Delta fibers are surrounded by a fatty, myelin sheath and the signals they send travel at 60 ft/second (that’s fast!). C-fibers are unmyelinated and their signals travel at 20 ft/second.

The A-Delta fibers mediate what is known as the “gamma loop”. The gamma loop is what gets activated when you stick your hand in a fire and your hand jumps back. These nerve fibers respond so quickly that your hand is immediately pulled back out of the fire. Chronic pain is a C-fiber problem, so C-fiber signals don’t travel quite this quickly.

Now, if the signal strength of the position nerves (the ones that register the location of pain) is what it’s supposed to be, the brain will release powerful natural pain relieving substances called enkephalins when it starts to receive those C-fiber messages. The enkephalins then plug up pain receptor sites in the brain, spine and capillary beds where the pain is located. This stops the pain in its tracks.

When things go wrong

Unfortunately, this is not what happens in people with chronic pain. Why? The current explanation is that the position nerve signal going up to the brain is too weak. The mid-brain can’t figure out where the pain is coming from, so the enkephalins don’t get released. This is why people in chronic pain often have trouble identifying exactly were the pain is. The neural threshold of the position nerve pathway is too low, so these people aren’t getting a clear signal where the pain is emanating from.

Because the brain isn’t getting the message, the nerves keep firing. And keep firing. After a while the nerves become inflamed, which in turn further weakens the signal’s ability to jump the threshold and get the message to the brain.

So that’s the first problem. The nerve signals are too weak and aren’t stimulating the brain to release the natural painkillers.

The second problem involves a survival mechanism that the brain evolved a very long time ago. Let’s take a knee injury as an example. When we bang our knee into something, the brain immediately takes measures to protect it. The brain doesn’t know what happened to the knee, but it assumes a worst-case scenario. Maybe you were bitten by a poisonous snake, or perhaps you seriously cut your knee and are losing a lot of blood.

What the brain does in this situation is restrict the blood supply going into the knee and the blood return coming out of the knee. This is actually a very intelligent choice. If you were bitten by a venomous snake, reducing blood flow around the knee will lessen the chance that the poison will spread. And if you were cut badly, reducing the blood flow will lessen your chances of bleeding to death.

This phenomenon is known as “guarding”. One of the results of reducing blood flow to the knee is that it becomes stiff and weak (sound familiar?). The brain wants it to feel weak because it is attempting to protect the knee. The brain doesn’t want whatever happened to the knee to threaten your chances for survival. So the brain sacrifices the health of the knee in order to keep you alive.

This was a great strategy before the advent of western emergency medicine. Almost everyone would prefer to lose function in their knee to death. But this isn’t a choice most of us have to make anymore, because when we cut our knee or get bitten by a snake we can go to the hospital and they can save our lives. And the problem is that cutting off blood flow to the knee – while it may have saved our lives in times past – dramatically limits the knee’s ability to heal.

Why? Because everything we need to heal is in the blood. The blood contains analgesics (painkillers), anti-inflammatories, nutrients absorbed from food, oxygen, hormones and immune substances to fight infection. If the blood flow is restricted to a particular area, healing won’t occur. No blood flow, no healing.

Stop and think about this for a minute. It’s such an obvious fact that it’s often overlooked in medicine. It’s not taught in such a direct way in medical school, but when I’ve explained it to a couple of doctors they both said something to the effect of, “Huh. I never thought of it that way, but it makes perfect sense.”

How acupuncture helps

Okay, now we’re finally coming to the part where I explain how acupuncture fits into this picture. Inserting needles into the skin at peripheral sites “jumps” the neural threshold on the position nerve pathway, so that the signal can reach the brain. Once the signal reaches the brain, the whole series of events I described in the paragraphs above kicks in. The brain recognizes there is pain and where it’s coming from and releases enkephalins (painkillers).

This initial response is very fast. It should be perceived as almost instantaneous by the patient. But after the needling therapy the patient goes home and the pain comes back. The old bad habit of the nerve chronically firing below the threshold re-establishes itself. The body, just like the mind, has a hard time breaking bad habits.

But if the patient returns in a couple of days to get another treatment, the neural threshold will be jumped again. And if you keep jumping the neural threshold, eventually the central and peripheral nervous system figure out that it’s better to operate in the non-pain state than in the pain state. The technical term for this is re-establishment of neurological homeostasis.

Once this happens, the brain is no longer receiving pain signals from the knee. It no longer thinks the knee is injured or threatening the survival of the body. Now, instead of restricting blood flow to the knee, the brain does the opposite. It immediately vasodilates the capillaries and venules around the knee, which increases blood flow and begins the healing process.

What I’ve described above is how acupuncture relieves pain via the peripheral and central nervous system. There’s another pain relief mechanism that involves activating the immune system. Acupuncture needles are seen as foreign invaders to our body. Inserting a needle into the skin creates a micro-trauma that in turn stimulates the activity of immune cells that control inflammation.

There are millions of immune cells called mast cells in the dermis of the skin. These cells are like water balloons full of fatty molecules called leukotrienes and prostaglandins A & B. When a needle is inserted into the skin, it pops the mast cells and releases the leukotrienes and prostaglandins. Prostaglandins cause the cutaneous nerve in the area to fire (which activates the process described in the previous paragraphs). Leukotrienes are the strongest anti-inflammatory substance the body can produce.

Leukotrienes cause local capillaries to vasodilate and become permeable. White blood cells called macrophages leak out through the capillaries and immediately begin to heal the damage caused by the needle stick.

However, the healing caused by the needle insertion isn’t limited to the damage caused by the needle. If there is other damage in the area from previous traumas or injuries, that will also be addressed by the immune chemicals released by the needle insertion.

What’s more, the micro-trauma caused by the needle starts a systemic immune response. This promotes healing of the soft tissue throughout the body – not just at the needling site. After the needles are removed, the needle-induced lesions continue to stimulate the body until the lesions heal. This means that the anti-inflammatory effect of acupuncture persists for 2-3 days (and sometimes as long as a week) after the needle is withdrawn.

Summary

Genetically the body is not designed to be in chronic pain. It will do everything it can to get us out of pain. Acupuncture “reminds” the body how it should be functioning, and helps its powerful inbuilt pain relieving mechanisms kick into gear. It’s a bit like jump starting a car. You’re not changing how the car works, or even adding anything to the engine. You’re just giving the battery a little jolt so the car can run how it’s supposed to.

It’s important to understand that this neurochemical mechanism not only provides pain relief, but also promotes homeostasis and tissue healing and regulates the immune, endocrine, cardiovascular and digestive systems. This explains why getting acupuncture treatment for your knee pain also addresses other problems you might have, such as asthma, irritable bowel, high blood pressure, anxiety and insomnia.

In the next and final article of this series, I’ll explain the advantages of Chinese medicine over western medicine for the prevention and treatment of most common health conditions.

Recommended resources for more information

  1. Pomeranz B. Acupuncture analgesia – basic research. In Stux G, Hammerschlag R, editors: Clinical acupuncture scientific basis. Berlin 2001. Springer. ↩

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Chinese Medicine Demystified (Part IV): How Acupuncture Works

March 11, 2010 in Myths & Truths | 24 comments

person receiving acupunctureNote: This is the fourth article in an ongoing series. Make sure to read the previous articles before reading this one, and check out the next articles in the series afterwards.

In this post we’re going to explore how acupuncture works from a western scientific perspective. As I’ve argued in the previous articles, there is no disagreement between the fundamental anatomical and physiological concepts of western and Chinese medicine. However, as methods of scientific inquiry have progressed, the mechanisms of acupuncture are beginning to be more clearly understood.

Acupuncture effects every major system of the body, including the cardiac, gastrointestinal, circulatory, cerebral, genitourinary, endocrine and immune systems. It would take an entire book to describe all of the mechanisms involved, and in fact there is such a book for those who are interested in that level of detail. In this post my purpose is to summarize that research in a way that’s easy for lay people to understand, while providing links to more technical resources for medical professionals and others that might be interested.

Broadly speaking, acupuncture has three primary effects:

  1. It relieves pain.
  2. It reduces inflammation.
  3. It restores homeostasis.

Homeostasis refers to the body’s ability to regulate its environment and maintain internal balance. All diseases involve a disturbance of homeostasis, and nearly all diseases involve some degree of pain and inflammation. In fact, research over the last several decades suggests that many serious conditions like heart disease previously thought to have other causes are in fact primarily caused by chronic inflammation. If we understand that most diseases are characterized by pain, inflammation and disturbance of homeostasis, we begin to understand why acupuncture can be effective for so many conditions.

Several modes of action have been identified for acupuncture, which I’ll discuss below. The mechanisms can get quite complex. But ultimately acupuncture is a remarkably simple technique that depends entirely upon one thing: the stimulation of the peripheral nervous system. It’s important to point out that when nerves supplying acupoints are cut or blocked there is no acupuncture effect.

A large body of evidence indicates that acupoints, or “superficial nodes” as they are more accurately translated, have abundant supply of nerves. According to Chen Shaozong, “For 95% of all points in the range of 1.0 cm around a point, there exist nerve trunks or rather large nerve branches.” 1

The following is a list of mechanisms that have been identified so far:

  • Acupuncture promotes blood flow. This is significant because everything the body needs to heal is in the blood, including oxygen, nutrients we absorb from food, immune substances, hormones, analgesics (painkillers) and anti-inflammatories. Restoring proper blood flow is vital to promoting and maintaining health. For example if blood flow is diminished by as little as 3% in the breast area cancer may develop. Blood flow decreases as we age and can be impacted by trauma, injuries and certain diseases. Acupuncture has been shown to increase blood flow and vasodilation in several regions of the body.
  • Acupuncture stimulates the body’s built-in healing mechanisms. Acupuncture creates “micro traumas” that stimulate the body’s ability to spontaneously heal injuries to the tissue through nervous, immune and endocrine system activation. As the body heals the micro traumas induced by acupuncture, it also heals any surrounding tissue damage left over from old injuries.
  • Acupuncture releases natural painkillers. Inserting a needle sends a signal through the nervous system to the brain, where chemicals such as endorphins, norepinephrine and enkephalin are released. Some of these substances are 10-200 times more potent than morphine!
  • Acupuncture reduces both the intensity and perception of chronic pain. It does this through a process called “descending control normalization”, which involves the serotonergic nervous system. 2 I will explain this process in further detail in the next post.
  • Acupuncture relaxes shortened muscles. This in turn releases pressure on joint structures and nerves, and promotes blood flow.
  • Acupuncture reduces stress. This is perhaps the most important systemic effect of acupuncture. Recent research suggests that acupuncture stimulates the release of oxytocin, a hormone and signaling substance that regulates the parasympathetic nervous system. You’ve probably heard of the “fight-or-flight” response that is governed by the sympathetic nervous system. The parasympathetic nervous system has been called the “rest-and-digest” or “calm-and-connect” system, and in many ways is the opposite of the sympathetic system. Recent research has implicated impaired parasympathetic function in a wide range of autoimmune diseases, including arthritis, lupus, rheumatoid arthritis and inflammatory bowel disease.

Several other mechanisms have been identified, but the ones I’ve listed above are the most relevant and clearly understood.

Some purists object to acupuncture being described in biomedical terms. They claim that such descriptions are “reductionistic” and narrow-minded, and don’t take into account those aspects of acupuncture that we may not yet understand.

Others who are still committed to the “energy meridian” model are opposed to the biomedical descriptions because, in their eyes, such scientific inquiry “takes the magic” out of acupuncture.

While I agree that there we don’t yet fully understand how acupuncture works, I think it’s vital that practitioners of acupuncture are able to explain what we do know about it from a biomedical perspective to their patients and colleagues in the medical profession. As practitioners we have a moral obligation to provide each patient with the latest medical understanding available in terms they can understand and relate to. Doing this will improve patient outcomes and open the door for acupuncture to be integrated into the healthcare system, which is needed now more than ever.

I would also suggest that explaining the mechanisms of acupuncture in scientific terms should not in any way lessen our appreciation of its uniqueness. The fact that inserting fine needles into the skin can have such a broad range of powerful effects is just as remarkable when those effects are explained in terms of the nervous system as when they are explained in terms of “energy” and “meridians”. When you consider that the Chinese made these discoveries hundreds of years before the birth of Christ, acupuncture is even more impressive.

What’s more, as others have pointed out, acupuncture is inherently holistic even without the “energy meridian” theory because it restores internal homeostasis through the simple act of piercing the skin with a needle.

In the next article I’ll explain the latest theory on how acupuncture relieves pain in more detail. Stay tuned, and as always, I welcome your comments!

  1. Shaozong, C. Modern acupuncture theory and its clinical application. (Chapter 5 The Morphologic Relationship between Points and Nerves). International Journal of Clinical Acupuncture. 2001;121(2):149-158 ↩
  2. Dung HC. Anatomical features contributing to the formation of acupuncture points. American Journal of Acupuncture. 1984;12:139-143 ↩

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Chinese Medicine Demystified (Part II): Origins of the “Energy Meridian” Myth

March 5, 2010 in Myths & Truths | 13 comments

energy meridiansNote: This is the second article in an ongoing series. Make sure to read the first article before reading this one, and check out the next articles in the series afterwards.

As an acupuncture student, I often like to ask people if they know what the word qi (sometimes spelled “chi”) means.

I get all kinds of answers. Some people don’t have any idea. Some guess it’s a kind of tea, like chai tea. Some say it has something to do with martial arts. Others say it means balance or flow. But those who’ve been to an acupuncturist, or at least know someone who has, say that qi means energy.

They say that because that’s what their acupuncturist told them. And their acupuncturist told them that because that’s what the acupuncturist was taught in school. That’s the definition of qi in the textbooks about Chinese medicine that we study in the west.

These textbooks teach that qi is an energy that moves through your body in meridians. A meridian is a metaphysical line “juxtaposed” on the body. It has no actual location inside of the body. In other words, it’s not really there. According to these textbooks this mysterious energy called qi flowing through these nonexistent lines called meridians forms the conceptual basis of Chinese medicine.

This is the definition of Chinese medicine that causes snickers, smirks and shaking heads amongst the scientific crowd – which is to say almost every doctor or medical professional trained in the west. But is this definition even accurate?

Much of what we know about Chinese medicine comes from a book called the Huangdi Neijing (HDNJ), or Yellow Emperor’s Internal Classic. There’s some controversy about when it was written, but most scholars agree that it was about 2,000 years ago, sometime between the second and first century BCE. The HDNJ is a massive encyclopedic text of Chinese medicine. You can think of it as their version of the Merck Manual.

The HDNJ had several sections. One was on anatomy. If you recall from the previous post in this series, the Chinese were performing detailed dissections 500 years before the birth of Christ. They listed the average weight, volume and measurements for all of the internal organs. They named the organs and described their functions. (In fact, they knew that the heart is the organ that pumps blood through the body more than 2,000 years ago. This wasn’t discovered in western medicine until the early 16th century.) They knew which vessels flowed away from the heart, which vessels flowed toward the heart, and which vessels supplied which organs.

The HDNJ also had detailed sections on pathology. They described how diseases develop and how to treat those diseases with acupuncture, herbal medicine, massage and dietary and lifestyle changes. In short, the Chinese were practicing truly preventative medicine 2,500 years before the term was even coined.

The HDNJ is a remarkable book. But early western scholars had a problem. The HDNJ is written in a dialect of Chinese that hasn’t been in common use in China for more than a thousand years. You could show it to a modern Chinese person and they wouldn’t be able to read it.

Several westerners took a crack at translating it. One of the first was a Dutch physician named Willem ten Rhijne. Ten Rhijne worked for the Dutch East India Company in Japan from 1683-1685. He reported clinical success by Chinese and Japanese practitioners in treating a wide range of disorders, including pain, internal organ problems, emotional disorders and infectious diseases prevalent at the time. Interestingly enough, Ten Rhijne accurately translated the Chinese character for qi as “air”, not energy, in his reports to the Dutch government.

But the translation we’re most familiar with, and the one that became the source for all of the textbooks used in western schools of Chinese medicine, was done by a man named Georges Soulie de Morant.

De Morant was a French bank clerk who lived in China from 1901 to 1917. He was enamored with Chinese culture and philosophy, and became interested in Chinese medicine during his stay. He decided to translate the HDNJ, in spite of the fact that he had no medical training nor any training in ancient Chinese language.

It was a huge undertaking for a French bank clerk to translate a 2,000 year old medical text written in an extinct Chinese dialect into a modern romance language (French). Under the circumstances, de Morant did well in many respects. But he made some huge mistakes that had serious consequences for how Chinese medicine has been interpreted in the west.

In the next post, we’ll look at those mistakes in more detail. We’ll also replace de Morant’s fictional “energy meridian” model with a new – or rather old – model of Chinese medicine that is both historically accurate and consistent with modern scientific principles of anatomy and physiology.

Continue to the next article.

References

Kendall, Donald, The Dao of Chinese Medicine, Oxford University Press, 2002

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Acupuncture provides headache relief

December 15, 2008 in Health Conditions | No comments

headacheA study published in the December issue of Anesthesia & Analgesia indicated that acupuncture is superior to placebo and medication in treating chronic headaches.

The study reviewed 25 randomized controlled trials in adults that lasted more than four weeks. In seven trials comparing acupuncture with medication, researchers found that 62 percent of 479 patients had significant response to acupuncture, and only 45 percent to medicine.

Fourteen of the studies (with a total of 961 patients) compared acupuncture directly to placebo, or sham acupuncture. 53 percent of people treated with real acupuncture improved, compared to 45 percent of those receiving the placebo treatment.

Acupuncture has far fewer side effects and risks than medication used to treat headaches, and can also produce feelings of relaxation and well-being.

Unfortunately, acupuncture has only been affordable for a relatively small percentage of the population. But a new movement called “community acupuncture” is changing that. In community acupuncture (CA) clinics, several patients are treated simultaneously, often in comfortable reclining chairs arranged in a circle. Points below the elbows and knees and on the head are emphasized, so there is no need for the patient to disrobe.

Because of the higher volume of patients that can be treated in this manner, treatments are offered at a much lower rate – often on a sliding scale between $15-40, or about the same cost as an insurance co-pay.

The community acupuncture model, which was developed by acupuncturist Lisa Rohleder and pioneered in her clinic Working Class Acupuncture in Portland, OR is rapidly expanding across the country. Try Googling “community acupuncture” along with the name of your town to see if there’s a clinic where you live.

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Treating depression without drugs – Part II

August 15, 2008 in Depression | 3 comments

lightboxIn the first article in this three-part series on treating depression without drugs, we established that several non-drug treatments are at least as effective in treating depression than antidepressants – with few, if any of their side effects. Specifically, we learned that both psychotherapy and exercise compare favorably with antidepressants for treating even serious depression in the short-term, and are both more effective than antidepressants in the long-term.

Today we will examine three other drug-free treatments for depression: light therapy, St. John’s Wort and acupuncture. In the final article, we will look at lifestyle-based treatments such as nutrition, adequate sleep and rest, stress management, pleasure and bibliotherapy (prayer or spiritual practice).

Light Therapy

Researchers at the National Institute for Mental Health are credited for the idea that perhaps more people are apt to become depressed during dark, dreary winter days than on bright, crisp spring days because they are not getting enough light. Since then, people around the world have begun to use “light therapy” to overcome Seasonal Affective Disorder. However, light therapy is also being used to successfully treat major depression at any time of the year.

Beginning the day sitting in front of a fluorescent light box that typically emits about 10,000 lux units of light has helped many people who might otherwise struggle with depression throughout the day. Bright light has been shown by numerous studies to act as a specific antidepressant in depressed patients. In a recent meta-analysis of published studies on light therapy and depression which appeared in the April 2005 issue of the American Journal of Psychiatry, the authors found that bright light treatment for nonseasonal depression is efficacious, with effect sizes equivalent to those in most antidepressant studies.

Once again, as was the case with both exercise and psychotherapy, the combining light therapy with antidepressants was no more effective than light therapy alone.

In contrast to exercise and psychotherapy, bright light therapy does occasionally have some side effects, including headache, eye strain, nausea and agitation. But these are very mild when compared against the side effect profile of antidepressants.

It is very important to note that some psychotropic medication (and psychotropic herbs such as St. John’s Wort) may increase sensitivity to light, so light therapy should probably not be combined with St. John’s Wort or antidepressants.

Some critics of light therapy have pointed out that it could be a placebo and there is no way to prove otherwise. It is not possible to keep someone from knowing whether they are being exposed to very bright light or the placebo (dim light). Therefore the “blind” is broken and patients will know whether they are receiving the active or “inert” treatment. Could it be that the positive effects of bright light are simply due to the assumption or expectation of the patients that they will improve, rather than a result of the bright light itself?

Sure it is. But perhaps a more important question is, “does it matter?” If we use Antonuccio’s criteria for evaluating a potential treatment (i.e. 1) first do no harm, 2) cost-benefit analysis) then it becomes clear that light therapy compares very favorably with antidepressants even if it is “merely a placebo”. As you will know if you’ve been following my blog, antidepressants could also be referred to as placebos because they have been shown to be no more effective than placebo in treating depression. The criteria for whether a drug gets approved or not by the FDA is that it must outperform placebo; otherwise, it is simply considered a placebo itself.

Although light therapy may have some side effects, they pale in comparison to those of antidepressants and, unlike antidepressants, light therapy poses no significant risks or long-term complications. A typical light therapy device costs between $200-$300, so over the long-term it is much more cost-effective than medication. Finally, light therapy is just as effective as pharmacotherapy for treating depression.

When all of this is taken together, light therapy is superior to antidepressants – even if it is a placebo.

St. John’s Wort

St. John’s Wort (Hypericum) is an herb that can be used to make tea, or the “active ingredients” with the herb that can be extracted and put into capsules. In Europe SJW is widely prescribed as an antidepressant, but in the U.S., it is available over-the-counter.

St. John’s Wort has repeatedly been shown to work as well as or better than antidepressants in double-blind, placebo-controlled studies. For example, compared to Paxil, depression scores fell more (56.6% vs. 44.8%) and side effects were less (Szegedi et al. 2005). Similar results were found for Prozac (Schulz 2002). A comparison with both Zoloft and Celexa found St. John’s Wort again performed as well as the antidepressant drug without as many side effects (Gastpar 2005; Gastpar 2006).

While St. John’s Wort is clearly as effective as antidepressants, the number of adverse effects is ten times less – being essentially equivalent to taking a placebo. The most common adverse events (1 per 300,000 treated cases) concern reactions of the skin exposed to light (due to potential increased photosensitivity caused by SJW and other psychotropic substances).

Please do note that St. John’s Wort is contraindicated for concurrent use with certain medications, including antidepressant drugs, coumarin-type anticoagulants, the immunosuppressants cyclosporine and tacrolimus, protease and reverse transcriptase inhibitors used in anti-HIV treatment and with certain antineoplastic (cancer) agents.

However, these potential interactions can be easily avoided with proper supervision from a health-care professional who is experienced with the use of St. John’s Wort.

Once again, to be accurate we must point out the possibility that St. John’s Wort is merely a placebo. If it is roughly as effective as antidepressants, and antidepressants are themselves placebo, then it follows that St. John’s Wort may also be a placebo. However, the same analyses that we used for light therapy applies here. The question is, how does St. John’s Wort compare against the primary treatment for depression – antidepressants? As we have seen, SJW is just as effective as antidepressants with only a fraction of the side effects, so there is absolutely no reason not to choose it over a synthetic antidepressant.

Before we move on to acupuncture, nutrition, rest and other lifestyle-based treatments for depression, I want to briefly discuss the criteria we’ve used so far for evaluating the effectiveness of a treatment. As I’m sure you’ve noticed, I am primarily basing the determination of the effectiveness (or lack thereof) of a treatment on well-designed, placebo-controlled, double-blind scientific studies.

I obviously have great respect for this method of inquiry and it has led (and continues to lead) to many important advances in medicine. However, it must be pointed out that this standard of proof has limitations. For example, 2/3 of medical research is funded by pharmaceutical companies. This means that the lines of investigations most often pursued in scientific research are those that are likely to lead to new therapies that can be monetized by the drug companies. There is little incentive for a drug company to dedicate research dollars to a study on how nutrition affects depression, unless there’s a product they can imagine marketing based on the study results. The result is that there are relatively few studies evaluating the effect of nutritional intake on depression.

Another limitation of double-blind, placebo-controlled research is that it is difficult (if not impossible) to maintain that standard with treatment modalities that depend on the unique interaction that happens between a practitioner and a patient. Western science is often skeptical, of course, that this interaction that occurs influences the treatment in any way. They do not understand how the interaction could influence the treatment, and what Western science does not understand, is often dismissed as “new-age fluff”.

What is remarkable about this is not just the arrogance of such a position, but also the ignorance it demonstrates. Over the last two decades, research into the placebo effect and growing understanding of how the nervous, endocrine and immune systems are inter-related have proven beyond a shadow of a doubt – according to the most rigorous Western scientific standards – that the interaction between a doctor or clinician and their patient absolutely influences the outcome of the treatment. In fact, many studies have shown that this interaction may be more important than the treatment itself; or, perhaps more accurately, the interaction is the treatment.

With this in mind, it becomes clear that the efficacy of acupuncture as a treatment for depression – or anything else – can never be accurately measured in a double-blind, placebo-controlled study. As much as Western science hates to admit this, we are not machines that respond in entirely an predictable manner given the same circumstances. There is no way to “standardize” the interaction that happens between an acupuncturist (or any healing professional) and a patient, because each person and, therefore, each relationship is unique.

Acupuncture

Considering all of the caveats above, can acupuncture help with depression? According to the Cochrane Database Systematic Review (the gold standard for medical research reviews today), “there is no evidence that medication was better than acupuncture in reducing the severity of depression.” In many of the studies they reviewed, acupuncture and electro-acupuncture either cured or remarkably improved depression scores, performing just as well as synthetic antidepressants.

However, it must also be noted that the studies were few in number, often poorly designed and did not have enough subjects to draw definitive conclusions. The authors of the review concluded that there was “insufficient evidence to determine the efficacy of acupuncture compared to medication”.

And of course, we always have the issue of placebo. It is possible that the benefit the patients are receiving comes from the interaction with the practitioner and their expectation that they will improve – rather than as a result of the needles themselves.

Once again, though, if we evaluate acupuncture based on a “cost-benefit” analysis, it compares very well against antidepressants. It has been shown to be at least as effective as medication in many studies as noted above, and the side effects are minimal when compared with antidepressants. Acupuncture has also been shown to be effective in treating other conditions that may occur alongside of depression, such as pain and stress.

Stay tuned for the third-part of this series which will consider lifestyle-based treatments such as nutrition, adequate sleep and rest, stress management, pleasure and prayer.

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