About Acupuncture

Introduction:

In this article, we discuss the origin theory, channels and points of acupuncture; the philosophical roots of acupuncture; the main meridian or channel system; the western acupuncture; mechanisms of action; The World Health Organisation recommends acupuncture for over one hundred conditions; the acupuncture evidence project about acupuncture and my own thoughts.

Origin theory, channels and points of acupuncture

How acupuncture points were discovered can be tracked back to Stone Age. It is thought that stone knives and sharp tools were used to relieve pains and diseases. Often this were used just for lancing boils and primitive surgery, however it is thought that patients may have noted sensations or changes on other parts of the body subsequent to treatment with his “needles”. Later there’s needles or replaced by bone or bamboo.

Some theories states that monks would notice energy moving in specific areas when they would perform meditation techniques. Over centuries this energy movements were painstakingly noted, and the channel system was gradually elaborated. Other theory states that constipation was frequent, owing to primitive Stone Age diet. People found certain points tender when constipated and that manipulating them with pressure or pricking them brought relief.

It was noted that an individual point could affect many different symptoms. Symptoms could be treated that were near to and a distal from the actual point itself, including internal organ pathology. It was natural therefore to assume that point with common symptomatology could somehow be related. In other words, the therapeutic potential extended over a considerable distance within the body. This was confirmed by the transmission of needle sensation along specific pathways. A therapeutic property could be achieved by a number of different points. From this evidence they inferred the existence of channels and the flow of Qi along them. As location and therapeutic characteristics of points was gradually discovered, they were named.

Acupuncture is not exclusive to China, only in the East was it so highly developed, this occurred because of observation by ancient Chinese over hundreds and even thousands of years.

Philosophical roots:

TCM is heavily rooted in traditional eastern philosophy. The philosophy was not a single one and did not originate in only one area of Chinese history, but it was built, added to, and modified throughout history. The typical Chinese, who are very programmatic people. They have no problem of accepting a wide variety of philosophies into their culture and not seeing any conflict between them. For example, we can see the Three Teachings: Taoism, Confucianism and Buddhism coexisted harmoniously in Chinese paintings, all depicted together.

Confucius was born at the end of Eastern Chou period and beginning of Warring State period, we know about him from the “Analects”, a series of passages written by his disciples. He wanted to be an advisor to a monarch and travelled around in search of such a monarch. Confucius believed one should behave as one is supposed to according to one’s station in life, and not to be ambitious. He envisaged a harmonious society kept together by a tight hierarchical system of precisely defined social roles and mutual obligations. He thought that people should be bound by respect for rituals and customs, laws would then be unnecessary. He stressed honour, the importance of being a gentleman-scholar, learning. He stressed also “ren”, which means compassion and humane action. He emphasised filial piety and the Five Relationship—a system of social mores that would establish social order. He stressed moderation; his disciples stated: Confucius did not go to extremes. But no one wanted his ideas, he was too moral. Everyone wanted pragmatic techniques for use in winning the wars. He therefore became a teacher. His ideas were taken seriously after his death 200 years later. Eventually his idea became the imperil creed.

Taoism is not a religion, more a philosophy based on the concept of Tao. Tao manifested as the universe (comparable to the modern “big bang” theory). Tao expresses through the duality of Yin-Yang, Tao is like the eternal primeval law of nature. He wrote the Tao Te Ching, he promoted love of nature and simplicity, expand consciousness, and rejection of worldly ambition. The Tao Te Ching is a composite text probably dating from 3^rd century BC.

Taoism espouses not doing, or non-purposive action. Being without plans, going with the flow, not surprisingly, Taoism was a popular philosophy mainly with the aristocracy. Taoists advocated simplicity, living according to the Tao, according to the laws of nature. Taoism had a strong influence on medicine: the idea of humans being part of nature and needing to remain in harmony with nature was fundamental. The medicine that developed during Warring States Period of intense philosophical activity is the central of what traditional Chinese medicine is today, it has referred to as the medicine of systematic correspondences.

The fundamental principles of this medicine arose from divergent influences, including Taoist and Confucian ideas. The neutralist school was responsible for systematically elaborating the concepts and theories of Yin-Yang, which had to be an ancient idea that was now fully developed and recorded. Acupuncture is mainly mentioned in the Ling Shu, one commentary published in the same period was the NAN JING. Points for acupuncture and moxibustion are discussed, as well as physiological and pathological conditions of the eighth Extra Vessels.

The main meridian or channel system:

The Chinese words for the meridian system are Jing Luo, these words together emphasise the concept of connectivity within the body and the provision of a theoretical pathway for Qi to travel within the body, through the organs, along a path, but with constant tributaries and connections.

There are twelve primary channels running vertically, bilaterally, and symmetrically. Each channel corresponds to, and connects internally with, one of the twelve Zang Fu. Each of the Zang Fu organs has a meridian associated with it. These are called the main meridians and it is on these meridians that the majority of acupoints are found. There are some extra points and these are given names rather than numbers.

There are also eight extraordinary meridians, as well as Divergent, Luo-Connecting meridians or Collaterals, Sinew Meridians, and the Cutaneous Regions.

Western Acupuncture:

Western medicine is characterised by the use of the scientific method, and in the modern day, the use of evidence-based practice. Drugs, surgery, radiotherapy, and a manual therapy also play a role. Interestingly, much like Chinese medicine, the Western approach has a long tradition of development, starting with the use of plants and herbs in pre-history. This remains a common thread throughout its development, as many of the drugs we used today are plant based.

One comparison which may be made between Western and Chinese approaches is that the western approach and focus on the pathology of the disease that is giving the symptoms in the patient, whereas the Chinese modern focuses on the health, healing and long-term management of the patient as an individual.

Western medicine has been forced to look outside of the body, to the environment, and to the mind/body more so in recent years. Instead of focusing purely internal disease and positive factors, examining ever smaller and smaller pathogenic factors, such as bacteria and viruses, it has had to take a leaf out of the eastern tradition, it has had to look around at that effect on the environment has on the health of both of the mind and the body and take a more holistic approach that considers the patient rather than the disease.

Acupuncture in the west is called medical acupuncture or clinical acupuncture, but it is only the reasoning behind needling that is different rather than the needling itself.

Suggested mechanisms of action:

The discovery of endogenous opioids, such as endorphin, dynorphin and enkephalin- and the evidence that they have an effect on pain relief and well-being, and are released into the bloodstream in response to acupuncture, has opened a real window into understanding the biology of acupuncture.

As these substances are produced and circulate, there is a reduction in the chemistry of stress biology, a reduction in pain perception and a switching-on of descending inhibitory neural impulses that travel down the spinal cord and affect aberrant incoming neural messages as well.

In addition, they are documented favourable effects of acupuncture on gut motility, natural killer cell activity within the immune system and on mast cell activation, which account for the anti-inflammatory effects of acupuncture. The immune system is challenged into action with acupuncture, and so there is the switching-on of the self-healing mechanisms.

Neurohumoral effects I also seen in response to the neural messaging of acupuncture to various parts of the brain after the primary sensory cortex, causing a release of hormones. The hypothalamus in particular has a key role to play in switching on many hormones via the pituitary gland. The crossover in terms of definition between neurotransmitters and hormones may be contrived, but what is clear is that the stimulus that acupuncture creates causes a chemical release of various substances, from within the brain and in the local tissue, and this can affect very specific target organs and bring about a change in an individual’s health.

Intimately linked with neurobiology, the increased knowledge about the spinal and the central nervous systems’ anatomy and where neural connections are made within the brain, from the use of fMRI and other investigations, has helped us understand how an individual’s behaviour may change as a result of acupuncture. Stimulation of this inhibitory systems of the brain has a role in pain relief. Areas such as the hypothalamus, the raphe nucleus magnus in the medulla, the insular cortex, the pre-frontal cortex and the cingulate gyrus all have connections with the primary sensory cortex, where the sensation of acupuncture is first received into the brain.

The World Health Organisation recommends acupuncture for over 100 conditions:

In 1979, the World Health Organisation (WHO) held a symposium on acupuncture. They created a list of 43 diseases that acupuncture can help with. In 1997, along with several National Institutes of Health, they published a Consensus Statement on acupuncture. This summarised the current understanding on acupuncture, based on the research that was available at the time.

At this point the research was not yet based on well-designed clinical trials. Even so, the statement concluded that there were ‘promising results showing efficacy of acupuncture’, for postoperative pain, nausea and vomiting from chemotherapy. It stated that acupuncture also ‘might be useful as an adjunct treatment or an acceptable alternative’, for a variety of other conditions, mainly different types of pain. Then, this was a bold statement. However, the World Health Organisation now recommends acupuncture for over 100 conditions.

Around the same time as they were drafting the Consensus Statement, the WHO also put together a team of scientists to produce a consultation paper on acupuncture. This was published in 2003. It brought together evidence from 255 clinical trials that were published before the beginning of 1999.

The paper firstly lists 28 conditions for which acupuncture was ‘proven – through controlled trials – to be an effective treatment’. There are also 63 for which acupuncture was shown to have a ‘therapeutic effect’, although they would like to see more evidence. For another 9 conditions, acupuncture showed ‘some therapeutic effect’, meaning that it is worth trying when other treatments are less desirable. I’ve listed all the conditions for which the World Health Organisation recommends acupuncture below.

The research sparked a great deal of credence and interest in acupuncture at the time, and so it was very powerful. Some people accepted it, while others refuted it. Yet without it, there would still not be nearly as much research into acupuncture to date.

The World Health Organisation recommends acupuncture for these diseases, symptoms or conditions, because acupuncture has been ‘prove[d] – through controlled trials – to be an effective treatment’:

Adverse reactions to radiotherapy and/or chemotherapy
Allergic rhinitis (including hay fever)
Biliary colic
Depression (including depressive neurosis and depression following stroke)
Dysentery, acute bacillary
Dysmenorrhoea, primary
Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
Facial pain (including craniomandibular disorders)
Headache
Hypertension, essential
Hypotension, primary
Induction of labour
Knee pain
Leukopenia
Low back pain
Malposition of fetus, correction of
Morning sickness
Nausea and vomiting
Neck pain
Pain in dentistry (including dental pain and temporomandibular dysfunction)
Periarthritis of shoulder
Postoperative pain
Renal colic
Rheumatoid arthritis
Sciatica
Sprain
Stroke
Tennis elbow

Diseases, symptoms or conditions for which The World Health Organisation recommends acupuncture because its therapeutic effect has been shown, although further proof is needed:

Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
Acne vulgaris
Alcohol dependence and detoxification
Bell’s palsy
Bronchial asthma
Cancer pain
Cardiac neurosis
Cholecystitis, chronic, with acute exacerbation
Cholelithiasis
Competition stress syndrome
Craniocerebral injury, closed
Diabetes mellitus, non-insulin-dependent
Earache
Epidemic haemorrhagic fever
Epistaxis, simple (without generalised or local disease)
Eye pain due to subconjunctival injection
Female infertility
Facial spasm
Female urethral syndrome
Fibromyalgia and fasciitis
Gastrokinetic disturbance
Gouty arthritis
Hepatitis B virus carrier status
Herpes zoster (human (alpha) herpes virus 3)
Hyperlipaemia
Hypo-ovarianism
Insomnia
Labour pain
Lactation, deficiency
Male sexual dysfunction, non-organic
Ménière disease
Neuralgia, post-herpetic
Neurodermatitis
Obesity
Opium, cocaine and heroin dependence
Osteoarthritis
Pain due to endoscopic examination
Pain in thromboangiitis obliterans
Polycystic ovary syndrome (Stein–Leventhal syndrome)
Postextubation in children
Postoperative convalescence
Premenstrual syndrome
Prostatitis, chronic
Pruritus
Radicular and pseudoradicular pain syndrome
Raynaud syndrome, primary
Recurrent lower urinary-tract infection
Reflex sympathetic dystrophy
Retention of urine, traumatic
Schizophrenia
Sialism, drug-induced
Sjögren syndrome
Sore throat (including tonsillitis)
Spine pain, acute
Stiff neck
Temporomandibular joint dysfunction
Tietze syndrome
Tobacco dependence
Tourette syndrome
Ulcerative colitis, chronic
Urolithiasis
Vascular dementia
Whooping cough (pertussis)

Diseases, symptoms or conditions for which only individual controlled trials report some therapeutic effects. The World Health Organisation recommends acupuncture for these when treatment by conventional and other therapies is difficult:

Chloasma
Choroidopathy, central serous
Colour blindness
Deafness
Hypophrenia
Irritable colon syndrome
Neuropathic bladder due to spinal cord injury
Pulmonary heart disease, chronic
Small airway obstruction

The acupuncture evidence project:

The Acupuncture Evidence Project supports the use of acupuncture for headaches, migraines, back pain, knee pain, nausea and vomiting (post-operative and during chemotherapy), allergic rhinitis and post-operative pain. The Acupuncture Evidence Project also spent some time analysing the mechanisms behind acupuncture’s pain reducing effect, essentially there are multiple biochemical pathways in which acupuncture is active and produces both analgesic and anti-inflammatory effects.

“Mechanisms underlying acupuncture analgesia have been extensively researched for over 60 years. In animal models, acupuncture and/or electroacupuncture have been shown to be effective for the alleviation of inflammatory, neuropathic, cancer, and visceral pain. Ascending neural pathways involving Aδ, Aβ and C sensory fibres have been mapped, the mesolimbic loop of analgesia in the brain and brain stem has been identified and descending pathways have also been mapped.

Numerous mediators have been identified including opioid and non-opioid neuropeptides, serotonin, norepinephrine, dopamine, cytokines, glutamate, nitric oxide and gamma-amino-butyric-acid (GABA). Acupuncture analgesia has been shown to involve several classes of opioid neuropeptides including enkephalins, endorphins, dynorphins, endomorphins and nociceptin (also known as Orphanin FQ).

Among the non-opioid neuropeptides, substance P (SP), vasoactive intestinal peptide (VIP) and calcitonin gene-related peptide (CGRP) have been investigated for their roles in both the analgesic and anti-inflammatory effects of acupuncture. Two recent reviews of acupuncture analgesia research further demonstrate the complexity of this area of study.

The anti-inflammatory effects of acupuncture involve numerous mediators, receptors and signalling pathways, as outlined in two recent reviews. The anti-inflammatory effects of acupuncture have particular relevance to allergic rhinitis, irritable bowel syndrome, post-surgical recovery, migraine, osteoarthritis and inflammatory aspects of a range of musculoskeletal conditions. In allergic rhinitis, acupuncture has been shown to down-regulate total and specific IgE, as well as SP and VIP.

Acupuncture has been shown to down-regulate transient receptor potential vanilloid 1 (TRPV1) in inflammatory pain and there is indirect evidence to suggest that acupuncture may down-regulate TRPV1 expression and sensitivity in allergic rhinitis. In irritable bowel syndrome, acupuncture has been shown to down-regulate SP, VIP and CGRP. In migraine, acupuncture has been reported to down-regulate CGRP and SP which are also powerful vasodilators.’

There is list from the Acupuncture Evidence Project, which proved the World Health Organization recommendation of treatments list, is such a diversity of conditions, it covers pain relief and anti-inflammatory conditions, and also mental ill-health conditions, hormonal conditions and complicated, chronic conditions.

With such high-quality research from the Acupuncture Evidence Project concerning acupuncture and its effects, and the experience of practitioners over the centuries now being ratified, it is an exciting time indeed to be an acupuncturist.

My thoughts on Acupuncture:

Whilst still on this topic, I would like to add a couple of my own thoughts about acupuncture. It is, of course, great that such research is coming out and that it will hopefully allow policy makers to begin recommending acupuncture for more conditions. However, as an individualised acupuncture practitioner, in my own experience, many of the conditions listed in the WHO benefit most from the approach of acupuncture. Acupuncture is a forgiving and extremely flexible science. The insertion of a needle into the body in order to contact the Qi will usually produce some changes, whichever the points selected.

Obviously, the Zang Fu (TCM Meridians) need to work together as one for health to be present, to live a long and healthy life the aim is to maintain and enhance the levels of your own Qi in your system, ensuring that it flows smoothly through both physical and mental exercises, good diet, lifestyle changes and avoidance of excess.

The rapid development of acupuncture both within and outside of China over the last few decades has itself led to great innovation in practice, I will be continue learning and practicing acupuncture to make changes in people’s lives, especially after treating many of my clients with great results.