The Science of Acupuncture

I get asked all the time… “How does acupuncture work?” Modern science is catching up with 10,000 year old acupuncture. I’ve said for years that we just don’t have the method for seeing the structures yet – just as we didn’t understand the minute complexities of the human body – or imagine MRIs! – 200 years ago. It looks like we are slowly figuring it out! Here are a handful of recent articles exploring the science of acupuncture (if you scroll past them, there’s more of my thoughts on the science of acupuncture). These are just the ones that I stumbled across. If I had to time to do an exhaustive search this would be a much longer blog post. :)

From the second article below: Oxygen pressure is higher at acupuncture points!

p6oxygen

A “new organ” that Acupuncturists have been calling the San Jiao for thousands of years! 

 Acupuncture Biochemically Reduces Pain and Inflammation

MRI Reveals Acupuncture Modulates Brain Activity

CT Scans Reveal Acupuncture Points

New Brain Study – Acupuncture Fights Depression

Acupuncture Holds Promise for Treating Inflammatory Disease

Acupuncture Beats Gabapentin for Hot Flashes in RCT

Acupuncture as effective as drugs in treating pain, trial shows

Biological Evidence for the Existence of Acupuncture Meridians inside lymphatic vessels

Curtin researchers unlock the scientific reasons why acupuncture works – C fibers (nerve branches)

But what about “all those studies” that show it’s not effective?

First of all, there are plenty of studies that prove it works. Insurance companies (even the conservative ones) now cover needles for neck and back pain, because studies have specifically proved it, although some deny claims for, say, shoulder pain, because it hasn’t specifically been studied. Makes me want to roll my eyes. Ug.

Secondly, many of the studies that “prove” it doesn’t work are deeply flawed. They have doctors doing a few recipe points they learned in a 20 – 300hr class, rather than an actual acupuncturist. Sometimes the points they choose are completely mystifying to me – not only do they leave out important ones, but there are always one or two just make no sense at all.

Thirdly, TCM differentiates the cause of disease, but lots of studies don’t. You can have a headache due to Yang rising, or Heart xu (deficiency). When a study gives the same treatment to everyone with a headache, of course it’s not effective! The western medical equivalent is putting people with viruses, bacterial infections, and allergies in one group, giving them all an antibiotic, then declaring that drugs don’t work for runny noses.

There are other problems too, like “sham” acupuncture doing “too well” so there isn’t a statistically significant difference. In one study I read back in school, they basically compared acupressure to acupuncture… then declared nothing worked since they both did. That’s just bad study design. There should have been a third control group with no treatment.
equine acupuncture

Equine acupuncture points from the Bagyuiho (Chinese horse and cow acupuncture text), 1399

And that whole placebo thing? It may play a part, as it does with every medical procedure, but it’s not the whole story. In other states (where it was legal without a vet supervising) I have successfully treated animals – there’s no placebo effect there! When a dog, lying limply on the floor and moaning, after 15 min of needles is bouncing up and down, jumping to kiss her owner’s face… that’s not a placebo. Neither is a rabbit regaining bladder and bowel control after a spinal injury. Of course those are anecdotal evidence, but they’re pretty compelling when they repeatedly happen in front of you. Googling for animal studies quickly gave me a whole new batch of data: Horses are studied most often because they have money-making “careers.” Even penguins benefit!

I’ll be perfectly honest – I’m not sold on some of the more esoteric aspects of TCM (Traditional Chinese Medicine). I don’t twirl my needles in a specific direction, for example. Thousands of years ago, when it was developed, there was philosophy as well as medicine involved, and like all ancient sciences, it could use a little update. But acupuncture itself is amazing. It stimulates neuromuscular junctions, which resets neurons (nerves control muscles, which in turn pull on bones). This helps break the cycle of spasms, or activate a non-firing muscle bundle. It reduces inflammation. It distracts nerve receptors and blocks transmission of pain signals. It helps break up fascial adhesions. With older, chronic problems it creates a microtrauma and alerts the body to a “cold case,” which restarts healing. It’s tremendous for nerve repair – check out my paper on stroke recovery. I’ve seen some truly stunning results from people who were locked inside their bodies, long after Western medical science said there would be no more improvement.

“Yang rising headaches,” is just a term for a diagnosis. It’s no more mysterious than “orthostatic hypotension’” for example, if you understand the language of TCM. The articles above show that we are just starting to understand how points work anatomically. I am confident that science will catch up and we’ll have a clear understanding of this system within my lifetime.

The good news is that it doesn’t really matter whether you believe acupuncture works… because it’s medicine, not voodoo, and it will anyway. :) The science of acupuncture is still evolving, but its effectiveness is clear.

“Dry Needling” vs. Acupuncture

I had a gentleman ask me last week if I had heard of “dry needling” and if I ever did it. I was flabbergasted… Dry needling is what acupuncture is called when non-acupuncturists do it. Wait – that’s not quite right. It’s what using acupuncture needles is called when someone else does it… but that doesn’t make it acupuncture. True acupuncture requires an understanding of a complex system, while most “dry needling” courses are surprisingly brief.

When comparing acupuncturists vs other practitioners as providers of therapeutic needling, some interesting things come to light. I feel very strongly that the various types of medical providers each have their areas of expertise. A bad injury, a serious infection, and organ failure are just a few of the problems that would send me running to “Western” modern medicine. But in some cases – chronic pain, healing after an injury, neurological repair, anxiety, etc. – acupuncture is highly effective. So….Why not just have your doctor do it?

There are some advantages to doctors doing acupuncture. First, they have a more extensive knowledge of anatomy than the average acupuncturist. I was very lucky to get to work with cadavers when I was at chiropractic school – most don’t. Secondly, the procedure is more likely to be covered by health insurance.

Unfortunately, there are also some disadvantages. Doctors are usually MDs first, and have taken a seminar on acupuncture. This course is a few weekends of instruction. They learn a handful of “recipe” points that are based on symptoms. Some people doing “dry needling” are physical therapists or chiropractors. As a comparison, I have a Master’s degree from OCOM, which consisted of 3,344.5 total hours, including 996 clinical hours. I learned about the Zang Fu organs, the channels, and the 1000 points and how they interact.

Doctors usually don’t spend much time getting to know every detail of your medical history. They tend to have 10 minutes for the whole appointment, and focus purely on your “chief complaint” as we call it in medicine: the main reason you came in. Traditional Chinese Medicine (TCM) is holistic. I prefer to take an hour with my patients. We examine the entire body, not just an isolated part, and our diagnosis is dependent upon that global perspective. For example, you may have a headache due to Liver* Yang Rising, or Qi deficiency, or a Wind Invasion. Or look at it from the other direction: A single diagnosis, such as Kidney Yin Deficiency, can cause varied symptoms like menstrual irregularity, anxiety, vertigo, night sweats… you see the problem. This is why I ask all those rude questions (sorry) in a 10 page form when you come in. What your menstrual cycle is like can actually help me determine how to treat your digestive disorder.

When doctors, chiropractors, and physical therapists use dry needling, especially for internal medicine, their results are not as strong as when a TCM trained practitioner wields the needles. I see this in a lot of research studies that “prove” acupuncture “doesn’t work.” It’s roughly equivalent to testing antibiotics for a runny nose, without separating out bacterial infections from viruses and allergies, then claiming that pharmaceutical drugs aren’t effective.

In this article, a doctor writes about needling. The myofascial part is spot on, but he’s missing the energetic component. Some of the points work on areas far away from where the needle goes! LI-4 and LV-3 are beautiful examples of powerful points that don’t really make sense with the Western understanding of anatomy. If distal points like the hands, feet, scalp and ears are neglected, the treatment may be weaker than ideal. It’s something to think about when comparing someone offering dry needling vs a true acupuncturist.

People with only basic anatomy training like massage therapists, and physical therapists doing dry needling? Super bad idea – and the reason there are so many news stories about dry needling pneumothorax (collapsed lung) problems created by physical therapists. Acupuncture needles are controlled as a medical device, because they really shouldn’t be used by amateurs.

Dry needling is a bad idea, m'kay?

Dr. Andrew Weil, M.D., agrees that TCM training should be comprehensive.

*Remember that in Chinese medicine, capitalized organs are energetic concepts and should not be confused with your anatomical organs.