What is acupuncture?

Acupuncture is a modality that falls under the branch of Chinese medicine which also incorporates, Chinese herbal medicine, exercise therapy (tai chi), tui na (massage), gua sha (scraping), cupping, moxibustion, diet, meditation (qi gong) and lifestyle adjustment.

 

Acupuncture is the use of fine needles, much thinner than hypodermic needles, which are inserted into specific points on the body that have been shown to elicit a therapeutic response. The aim of acupuncture and of Chinese medicine is to stimulate the body’s own functional systems to adjust and correct any disturbance or dysfunction.

 

The earliest reference in texts of acupuncture comes from the Huang Di Nei Jing – The Yellow Emperors Classic thought to be written between 475B.C and 220A.D. This is the time acupuncture and Chinese herbal medicine appear to have become a systematised form of medicine including diagnostic methods and treatment approaches. There is varying evidence to suggest acupuncture and Chinese medicine may be significantly older however it appears at this time they became more structured.

 

How does acupuncture work?

What is the Chinese explanation of acupuncture?

Chinese medicine views the body as a whole. Essentially an entire organism with complex inter-relationships between different organs and body systems. These organs obviously perform specific roles however they are always seen in context with the rest of the body. No disease state or symptoms is ever seen in isolation but as an element of a large picture. The body also cannot be seen in isolation from the environment in which it resides. This is the foundation of the concept of holistic medicine that was introduced by Hippocrates in the 4thcentury B.C. Holistic medicine stresses the self-healing or self-correcting capability of the body and of nature.

 

Because Chinese medicine is so old often the language used is misunderstood as being unscientific, however the terms used predate modern scientific terminology and so are essentially just a different way of expressing observations, theories and hypotheses. There is also more recently some debate as to the correct translation of some of the Chinese terminology. There is some suggestion that the term ‘qi’ may not necessarily mean life force as it has been translated.

 

One perspective is that the body is made up of a series or organs and channels very much like the organs and the nervous system defined by western science today. The channels are seen as pathways of communication between different parts of the body. These pathways allow the flow of qi to occur throughout the body providing the energy for vital functions. When there is not enough qi or there is a blockage in the flow disease will occur. Acupuncture and Chinese medicine aim to correct the flow of qi throughout the body to ensure normal function and health returns.

 

What does the western science say about acupuncture?

 

The current thinking of how acupuncture works with regard to the western scientific model is much like many western medicine treatments. They are not entirely clear. However there are some discoveries using western scientific methods that point us in a direction. Recently a new organ called the interstitium was discovered. This organ is made up of the fluid filled spaces that exist between the organs and connective tissue. It is perceived that this may very well be the channel system the ancients talked about that interconnects the body that allows therapeutic changes to occur via the transmission of neurotransmitters.

 

Dan Keown who wrote The Spark In The Machine’ also brings up the role fascia may play in creating a wide range of connections throughout the body that can be used to create a therapeutic effect via the fact that facia has been found to conduct electricity and is piezo electric, that is it can create a charge. This suggests that the rapid speed of effect that can be experienced using acupuncture could be explained by this electrical pathway and the fluid pathway via neurotransmitters. Dan also talks about in this video how acupuncture affects the hypothalamus which is the control of our endocrine system (hormones). If you take these two aspects into account, the nervous system and the endocrine system they essentially control everything in the body. The fact that acupuncture influences these two systems suggests acupuncture is a tertiary or third control mechanism.

 

Ok so now let’s get super geeky about the mechanisms of acupuncture.

The mechanism of acupuncture appears to influence:

  • Adenosine release– increases blood flow to the periphery and is useful for assisting with transportation of nutrients to tissue and waste from it. Adenosine is also integral in energy transfer between cells. Adenosine suppresses the central nervous system promoting sleep and assists with glucose conversion from glycogen.
  • Nitric Oxide release – increases blood flow and reduces plaque that can form blood clots dangerous to your body.
  • Sympathetic nerve regulation – the sympathetic nervous system is related to our stress response or our fight flight mechanism. Effective regulation of the sympathetic nervous system reduces the negative impact of external stressors.
  • Limbic system regulation – this assists with our response to stress and illness.
  • Hypothalamus, pituitary, adrenal axis regulation – this is responsible for the connection between our nervous system and endocrine system response to stress and if overused can lead to long term chronic illness.
  • Immune system regulation and activation – hyper-immune responses are seen in autoimmune diseases like Rheumatoid arthritis, Crohns disease, Asthma, Lupus, Graves disease, Hashimotos disease and others. The immune system needs regulation to prevent these types of disease and prevent external viral or bacterial infections.
  • Regulates parasympathetic nervous system – for our body to function effectively it needs to be able to shift into a more relaxed state. Just like the sympathetic nervous system prepares us to fight or run the parasympathetic nervous system allows our system to return to vital functions such as digestion and reproductive function.
  • Regulation of the prefrontal cortex – this part of our brain is responsible for planning, decision making, personality, social interaction and drive.
  • Regulation of pain
  • Regulates reward and mirror system – this relates to our ability to understand the actions and intentions of others. More on this function

 

What’s does the research say about acupuncture?

Criticisms of research

Firstly we need to assess the western scientific model for it’s true accuracy.

Limitations of evidence based medicine
The difficulty is that the western scientific model when analysing the effects of a medical intervention aim to remove all human subjective elements. However whenever a research trial is proposed and implemented at every step of the process there is an element of human input that is subjective. As a result the entire premise of the western scientific method whilst a useful tool has it’s limitations. These need to be taken into account whenever assessing the effectiveness of a medical intervention regardless of it’s philosophy.

 

Reductionist versus holistic
Another issue with regard to the western scientific method is it works off a reductionist theory. That is it tries to isolate single elements of the body and disease state, in some cases down to the cell,  in order to understand disease and assess whether a particular medical intervention is effective or not. The problem is that other functions of the body and external variables cannot be taken into account with respect to our understanding of the disease, the method of healing or recovery. On the other hand Chinese medicine recognises that the whole body needs to be taken into account when assessing and treating disease. Chinese medicine considers all aspects of function within the body, external environment and habits not just the specific area of the symptom or disease. It will also take into account contributing factors that may affect diagnoses, treatment and outcome. These are essentially two very different paradigms. As a result a Chinese medicine practitioner may use very different treatment methods for the same disease states with different people. This means standardisation and a reductionist approach such as used in current western clinical trials are likely to dramatically limit the effectiveness of the treatment prescribed as it is not holistic nor in keeping with the method.

 

The funding problem
One glaring disparity between western medical research, acupuncture research and Chinese medicine research is the private commercial value. The money that funds western medical and pharmaceutical research is significant as when discoveries of new interventions occur they can be patented. This means no one else can use the technology for a certain period of time. Once patented a product can be sold at much higher prices to recoup development costs and of course make a profit. Chinese medicine and acupuncture are not able to be patented therefore have less commercial value, leading to less money for research. Funding for research is more likely to come from government or public funding bodies. Considering the huge cost of healthcare spending by governments and private health insurers and their want to spend less the potential benefit in research is far more likely to be found in proving that interventions like acupuncture and Chinese medicine save money on health care over time.

 

The evidence on acupuncture
Currently there is a huge amount of research on acupuncture and it’s effects in treating a wide variety of conditions. The most recent  systematic review is the Acupuncture Evidence Project, which has brought together a large body of Randomised Control Trials, Systematic reviews and Meta-analyses to highlight the very positive effect acupuncture has. There is also more research and mechanisms of acupuncture can be found via covered by Evidence Based Acupuncture.

Acupuncture research

 

Does acupuncture hurt?

When we think of needles we always think of the ones we get from the doctor, painful right? However the needles used by your doctor are significantly different to the ones acupuncturists use. Firstly they are not sharpened to cut through tissue like hypodermic needles are. Secondly they are so much smaller in diameter. The average acupuncture needle is 0.25mm in diameter while the average hypodermic needle is 2.85mm so that is less than 1/10ththe size.

Does acupuncture hurt?

 

No really do they hurt? Of course they can however being so much thinner than hypodermics and designed more to separate the fibres of the skin it is rare. You may however feel strange sensations like spreading, warmth, travelling or electrical.

 

Is acupuncture the same as dry needling?

The answer is yes and no. Dry needling is a term that was coined in the 1940s and was a technique using a hypodermic needle to insert into tight muscle knots. The needles have now changed to the same ones used by acupuncturists. The technique was first documented in approximately 100A.D. as a technique called ‘ashi’ needling. The approach is identical.

The difference is the amount of training required to use the title acupuncturist here in Australia. In total not including the rest of the subjects in the Bachelor of Health Science of 4 – 5 years is approximately 900 – 1200 hours of needle specific training including clinical supervision. Dry needling practitioners can have as little as 16 hours. Ashi needling, dry needling, is only one of many needling techniques that can be employed by a registered acupuncturist. Find out more here.

 

What does acupuncture treat?

In general acupuncture and Chinese medicine do not ‘treat’ specific conditions. Taking a holistic approach they treat the body and aim to resolve symptoms associated with conditions.

 

Acupuncture statistics

  1. Acupuncture first arrived in Australia in 1850
  2. 10% of the population receive acupuncture each year (1)
  3. 80% of general practitioners referred to acupuncture practitioners (2)
  4. To become registered under the Australian Health Practitioner Regulation Agency (AHPRA) a graduating practitioners have to have completed a 5 year Bachelor of Health Science.
  5. There are currently over 12,000 published research trials on acupuncture

 

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References:

  1. CCL Xue, TL Zhang, V Lin, R Myers, B Polus, DF Story Acupuncture, chiropractic and osteopathy use in Australia: a national population survey BMC Public Health, 8 (2008), pp. 105-112
  2. G Easthope, B Tranter, G Gill Normal medical practice of referring patients for complementary therapies among Australian general practitioners Complement Ther Med, 8 (2000), pp. 226-233