There are many different theories and ideas these days about how acupuncture may work, and consequently the definitive mechanism of acupuncture remains unclear. This is, in part, because acupuncture does not have one singular mechanism. The aim of acupuncture is to assist the body in restoring its own systems and processes back to a state of balance, or homeostasis, so when defining the mechanisms of acupuncture we must consider all of these systems if we are to make a comprehensive conclusion.
According to Traditional Chinese Medicine (TCM) theory, there are 12 primary channels, or meridians, that follow specific pathways throughout the body and comprise the physical form. It is at specific points along these meridians that the body’s Qi (vital force) concentrates into wells of activity known as the primary acupuncture points. The location of these points are identified by areas that are more tender in response to firm touch than surrounding areas, or by their placement in relation to specific anatomical landmarks such as skin creases, bony joints and skin pigment borders. By stimulating these points either by applied pressure or insertion of acupuncture needles, pain and disease may be treated by relieving the stagnation of Qi and blood in the channels and associated organs.
A common viewpoint of the existence of these channels is that they are proposed to be energetic, invisible and therefor non-quantifiable. This means that we as acupuncturists sometimes have a difficult time convincing the general public and the scientific establishment that our medicine is not dependent on placebo, voodoo potions or merely the power of intention. If the only explanation I had received throughout my degree was that acupuncture helps to heal people through subtle changes in energetic pathways that cannot be seen or proven, there is a good chance that I would not have completed my studies and have opted for something a little more concrete. For me, I needed something more to explain what was happening beneath the surface on the physiological level.
Of course, while I believed that there were currents of energy that could be manipulated for better health, I surmised that acupuncture relied on more than just a tweaking of channels in the human energy field to obtain results. Surely there had to be a physical component to them as well. And so I sought to gain a better understanding by seeking out physiological comparisons for the ancient Chinese theories of meridians, Qi, Yin and Yang. What I found was that the Chinese had developed an elegant framework of knowledge and diagnoses of the body that, for most part, holds up to many aspects of contemporary physiological understanding. In fact, these theories still have such an influence within the study of modern acupuncture and Chinese herbal medicine that they remain an integral part of the course curriculum alongside biology and pathology, anatomy and physiology. It is the marrying of these two schools of thought – the traditional Chinese theory with modern Western science – that has only helped to make TCM an effective form of modern medicine. Unfortunately for some people, this theory of energy and the meridians is all they need as a basis to argue its inefficacy.
It is interesting that people who wish to tear acupuncture and TCM down focus so narrowly on these ancient theories as if acupuncture has not made any advances since its inception thousands of years ago. This would be akin to saying that modern medical science should not be trusted because doctors used to treat syphilis with mercury and asthma with heroin, despite the advances that have been made since. Around the time the Western world still had no idea about the function of the heart or cardiovascular system, the Chinese had already developed treatments that are still effective and in use today. But like modern medicine, acupuncture has also evolved and is far more different today than it was even just a century ago. The introduction of the modern precision-made filiform acupuncture needle, for example, was unlikely to be part of an acupuncturist’s toolkit until recent times.
Granted, the diagnosis system along with some of the theories can be a little confusing for one unfamiliar with terms such as Liver Qi stagnation or Yang rising. Yet while the elusive substance known as Qi remains in the realm of qualitative evidence and therefore difficult to prove scientifically (for the time being), acupuncture continues to produce positive and quantifiable results. In fact, a great deal of the effects of acupuncture can also be measured and explained via the systems and processes of the human body. Two such systems that help to shed light on how acupuncture generates positive effects are the fascia network and the nervous system. One comprises the connective tissue that is continuous from our skin down to our organs, while the other is the electrical conduction system responsible for sending signals throughout the body.
Fascia/ Connective Tissue Involvement
There has been a great deal of research in recent years about the body’s connective tissue network known as fascia and its involvement in acupuncture mechanisms. Fascia and connective tissue surrounds every structure within the body from muscles to organs and form a continuous network (1). This network is proposed to act as an internal sensory matrix that connects every organ and bone, muscle and nerve, blood and lymph vessel (2), and is now believed to be a single connecting organ and communication system within the body that unifies every aspect involved in human physiology (3). As for the connection with ancient Chinese medicine theory, evaluations of connective tissues have revealed that acupuncture points and meridians have been found to overlie fascial planes between muscles (4). This implication suggests that this complex network of connective tissue may, in part, be the physical manifestation of the acupuncture meridians.
For many years, fascia was seen as an inert tissue that acted merely as padding and insulation for the internal structures of the body (5). It is now understood to contain a complex matrix of cellular material which forms a cell-to-cell communication network that is highly responsive to mechanical stimulation (6). It is this matrix that is now being considered to be one of the primary mechanisms for how acupuncture stimulates the body’s physiological processes. Following the insertion of the needle, an acupuncturist may stimulate the point through several different methods which involve either rotating or lifting and thrusting the needle in order to obtain the ‘de qi‘ sensation (7). This sensation is felt by the patient as an ache or heaviness in the area surrounding the needle and has a biomedical component called ‘needle grasp’ that can be felt by the acupuncturist (8). This sensation can be perceived as increased resistance to movement of the needle as the underlying tissues grasp the point, and has long been understood as the sign that the point has been activated (9).
At the tissue level, this movement causes winding of the subcutaneous connective tissue around the head of the needle while leaving the superficial skin in place (10). Stimulation, in turn, causes the cells within the connective tissue to undergo remodelling processes (11) as well as biochemical cascades that stimulate the cellular environment on many different levels (12). This indicates that the degree of mechanical stimulation of the needle may greatly influence the treatment and the importance of the various needling technique employed in acupuncture.
If we compare the proposed purpose of the acupuncture meridians to the functions of the fascia network, we can see a number of similarities. The acupuncture meridians integrate and connect the entire body, forming a network through which Qi and blood are transported, organ pathologies may be diagnosed and needle sensation transmitted (13). The fascia network is continuous throughout the whole body, integrates all of its systems and participates in haemodynamic processes (14). Through superficial myofascial restrictions and deformations, practitioners may be able to determine the health of underlying organs and structures via careful palpation, and fascia is highly responsive to needle sensation (15). The fascia network also allows for stimulation of one area of the body to cause an effect in another area (16). This suggests an explanation for how stimulation of an acupuncture point can affect distant and seemingly unrelated regions of the body.
Nervous System Involvement
One of the core concepts of TCM is the constant interplay of Yin and Yang. Two complementary yet opposing forces that can be observed in nature through the turning of the seasons, the cycle of day and night, and the life cycles of the human body. Where Yin represents rest and Yang represents activity, this theory can be applied to the physiological functions of the human being via the patterns of the autonomic nervous system (ANS). The parasympathetic nervous system switches our body to rest and digest mode (Yin), while our sympathetic nervous system allows us fight or flight (Yang). More and more studies are demonstrating that acupuncture directly influences ANS functions such as blood pressure, heart rate and heart rate variability, skin conductance and temperature, pupil size and muscle sympathetic nerve activities (17), and can provide relief from various forms of autonomic nerve-related disorders (18). This is thought to be due to acupuncture modulating imbalances between sympathetic and parasympathetic activity (19).
Extensive research on the effects of acupuncture on the central nervous system has indicated its influence on brain structures such as the hypothalamus (20). The hypothalamus is the most important site in the brain for ANS regulation and has been proven to be involved in the pathway activated by electro acupuncture in managing hypertension by reducing sympathetic activity (21). Stimulation of acupuncture points that activate other structures such as the medulla oblongata and midbrain also indicate the potential for effective management of high blood pressure (22). The fact that acupuncture can modulate activity within specific areas of the brain has been concluded in a systematic review and meta-analysis of 149 studies detailing the results of fMRI imaging of the brain during acupuncture (23).
The effect of acupuncture also extends to modulation of neurohumoral activity (sympathetic nervous system activity) and the regulation of neurotransmitters such as serotonin, opioid peptides, catecholamines and amino acids in the brain (24). Enkephalin is a naturally occurring peptide with powerful painkilling effects (25). It is closely related to beta-endorphins and is released by the central nervous system (26). This powerful neurotransmitter, which also helps to regulate the sympathetic nervous system, was found to be produced in response to electrical acupuncture stimulation of acupuncture points PC-5 and PC-6 (27). This means that a person’s mood and ANS can be balanced following a single treatment of acupuncture using just 2 points. Trials for the use of ST-36 have shown interesting results that confirm its strong connection to the gastrointestinal system. It was found to induce peristalsis in postoperative ileus (malfunction of intestinal motility following surgery) in humans (28), and enhance the presence of gastric acid in rats (29). These results suggest that ST-36’s strong affinity for the stomach and bowel were due to activation of certain somatic nerves and branches of the vagus nerve that directly communicate back to the stomach (30).
These are thought provoking concepts when you consider that what has been common knowledge in TCM for centuries may now be given credit with modern scientific analysis. An increased number of studies of the fascia network has helped to shed new light on old concepts. They provide scientific reasoning for the functioning of the acupuncture meridians and mechanisms of acupuncture consistent with the traditional theories. Research with fMRI and acupuncture gives consistent evidence that certain acupuncture points elicit specific repeatable responses in areas of the brain that help to balance the nervous system. From the effect of acupuncture points on distant areas of the body to the flow of Qi and blood through the channels, insights into the fascia network and nervous system are providing a more substantial basis for these concepts to be quantified and proven. Clearly, there is something more going on here than just invisible energy channels.
Having had years of practice with various forms of energy healing, I know from first-hand experience that there is a very present energy field that can be felt and interacted with. It forms the basis of Reiki and practices such as Qigong and Taiji which are still effective forms of healing today. It takes practice to cultivate it, but no special ability to feel it – you first just need to be open to it.
So of course, there is an aspect where we are working on the energetic level of a patient’s health with any medicine, and this is because our energetic bodies are continuous with our physical and emotional bodies. There may well be energy meridians that make up the human form, but these meridians are merely one level of the multifaceted human body which also include other complex systems such as the nervous, lymphatic or cardiovascular systems etc. They are all different levels and systems of the same body and they cannot be separated. One only needs to glance at the pathways of the body’s blood vessel, muscles and ligaments, and nerve networks to note a direct correlation with the proposed map of acupuncture meridians.
Granted, the course of each individual channel may not follow the exact direction set out in the textbooks, but keep in mind that they were mapped over a great number of centuries by feeling and experience alone. Each practitioner passing knowledge down to the next until enough repeatable evidence was available to conclude the location of a specific channel or point. Despite the absence of computer imaging, these centuries of practice and documentation have formed the basis of a comprehensive system of therapy that modern science is only just now helping to clarify. It seems that the more advanced our technologies become, the more we discover and claim as scientific that which has been common knowledge for millennia. It is as though the world needs the approval of mainstream, commercial science before we should trust in anything. I understand that the purpose of true science itself is to explore the world through observation and experiment, but unless this is done completely free of bias, certain areas of interest are obviously going to prevail.
Ironic though that it is this mainstream scientific paradigm that is only just now catching up to traditional medicine and not the other way around. Perhaps many theories and concepts that are still considered esoteric today may become commonplace once science figures out a way to quantify them via their own systems of measurement.
We wait in anticipation…
- Langevin, H, Rizzo, D, Fox, J, Badger, G, Wu, J, Konofagou, E, Stevens-Tuttle, D, Bouffard, N & Krag, M, 2007, Dynamic morphometric characterization of local connective tissue network structure in humans using ultrasound, BMC Systems Biology, 1:25, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913929/pdf/1752-0509-1-25.pdf, (accessed 27 July 2016), p. 2
- Finando, S & Finando, D 2014, An Introduction to Classical Fascia Acupuncture, Journal of Chinese Medicine, No. 106, pp. 12 – 20, http://www.heightshealthcare.com/An_Introduction_to_Classical_Fascia_Acupuncture_1_.pdf, (accessed 27 July 2016), p. 12
- Ahn, A, Min Park, M, Shaw, J, McManus, C, Kaptchuk, T & Langevin, H, 2010, Electrical Impedance of Acupuncture Meridians: The Relevance of Subcutaneous Collagenous Bands, PLoS ONE, Vol. 5, Issue 7, http://journals.plos.org/plosone/article/asset?id=10.1371/journal.pone.0011907.PDF, (accessed 27 July 2016), p. 2
- Finando & Finando, loc.cit.
- Langevin et al., loc.cit.
- Langevin, H, Churchill, D, & Cipolla, M 2001, Mechanical signalling through connective tissue: a mechanism for the therapeutic effect of acupuncture, The FASEB Journal, Vol. 16, pp. 2275 – 2282, http://www.spinalmanipulation.org/dbmedia/Mechanical%20Effects%20on%20Connective%20Tissue%20with%20Acupuncture%20(2001).pdf, (accessed 3 August 2016), p. 2275
- Langevin, H, Bouffard, N, Badger, G, Churchill, D & Howe, A 2006, Subcutaneous Tissue Fibroblast Cytoskeletal Remodeling Induced by Acupuncture: Evidence for a Mechanotransduction-Based Mechanism, Journal of Cellular Physiology, Vol. 207, pp. 767 – 774, www.ebsco.com, (accessed 5 July 2016), p.767
- ibid, p.769
- Finando & Finando, loc.cit. p. 14
- Li, Q, Shi, G, Xu, Q, Wang, J, Liu, C & Wang, L 2010, Acupuncture Effect and Central Autonomic Regulation, Evidence-Based Complementary and Alternative Medicine, Vol. 2013, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3677642/pdf/ECAM2013-267959.pdf, (accessed 27 July 2016), p. 1
- ibid, pp. 2 – 3
- ibid, p. 3
- ibid, pp. 2 – 3
- Huang, W, Pach, D, Napadow, V, Park, K, Long, X, Neumann, J, Maeda, Y, Nierhaus, T, Liang, F & Witt, C 2012, Characterizing Acupuncture Stimuli Using Brain Imagaing with fMRI – A Systematic Review and Meta-Analysis of the Literature, PLoS ONE, Vol. 7, Issue 4, http://journals.plos.org/plosone/article/asset?id=10.1371%2Fjournal.pone.0032960.PDF, (accessed 27 July 2016), p. 16
- Li et al. loc.cit. p. 3
- Britannica 2016, Enkephalin, https://www.britannica.com/science/enkephalin, (accessed 30 July 2016)
- Li et al. loc.cit. p. 3
- Kavoussi, B & Ross, B 2007, The Neuroimmune Basis of Anti-inflammatory Acupuncture, INTEGRATIVE CANCER THERAPIES, Vol. 6, No. 3, http://ict.sagepub.com/content/6/3/251.full.pdf+html, (accessed 30 July 2016), p. 254, p. 254
- ibid, p 255
Image 1 – https://performance-pilates.com/anatomy-trains/
Image 2 & 3 – Deadman, P, Al-Khafaji, M & Baker, K 2007, A Manual of Acupuncture PDF, Journal of Chinese Medicine Publications
Image 4 – http://www.energyarts.com/medical-qigong
Image 5 – http://www.printablediagram.com/nervous-system-diagram/