Let’s start out this post by stating our intent here first.  Our intent is not to ruffle any feathers.  Our intent is to critically discuss the methods, mechanisms and theories of acupuncture.  Our intent is to show that whatever form of  needle insertion that you the practitioner or you the patient choose, it can have huge affects on the body.

Please no yelling and no ruffling of feathers!

Please no yelling and no ruffling of feathers!

For those that don’t know, there is a huge battle raging across the nation.  This is a “turf war” for who controls the right to practice  needle insertion techniques (aka acupuncture).  Traditional Chinese medicine practitioners and acupuncturists have issues with physicians (medical doctors, osteopaths and chiropractors) practicing needle insertion techniques.  Physicians have issues with physical therapists practicing needle insertion techniques (aka acupuncture).  Physical therapists have issues with traditional Chinese medicine practitioners and acupuncturists attempting to limit them from practicing needle insertion techniques.  Some state practice laws for health care practitioners are conflicting.  Some state practice laws are ambiguous.  These debates could go on and on, but we won’t bore you with all the details.

Before we get too far into this debate, let’s define terms.  Acupuncture is the insertion of small, fine needles into the body

Acupuncture = Insertion of fine, thin needles to produce a desired therapeutic effect

Acupuncture = Insertion of fine, thin needles to produce a desired therapeutic effect

 

to stimulate a therapeutic effect such as treating disease or reducing pain (1)  .  The concept was originally based on Chinese theories, but has been adapted into several styles (Japanese, Korean, Vietnamese, Western, Biomedical, and Dry Needling).  Each style has their own spin on theory and mechanisms behind why acupuncture works, but all styles have one overwhelming similarity and that is needle insertion to generate a desired therapeutic effect.  

Therapeutic effects from acupuncture may be reduction of pain, restoration of qi (“energy”) flow, decreasing global or local nervous system sensitivity, stimulating blood flow to an injured area,  reduction of trigger points (sensitive and tender areas within muscles and fascia), balancing of hormones and neurohormones, improving the homeostatic conditions of the body, inducing the body’s self healing mechanism,  etc.   Nowhere in this definition of acupuncture (needle insertion to stimulate a therapeutic effect) does it say who owns the right to practice it.  We all do.  Duly licensed and credentialed practitioners all own the right to practice needle insertion techniques (aka acupuncture).

Patients across the United States are demanding acupuncture.  Patients’ own personal views, opinions and biases ultimately select which style of acupuncture is best for them.  Practitioners should be able to respect that.  After all, the reason why every health care practitioner has the ability to practice their craft is because of the patient.  The patient has a medical or health care need to be addressed.  They select the health care practitioner.  The patient then empowers and entrusts the health care practitioner to help them.  Without patients and without a demand we wouldn’t be having this discussion.

Which style works best?  That depends.  All styles work.  They work for the right patient, at the right time, with the right practitioner.  If any one of those three (right time, right patient, right practitioner) isn’t present, then the chances for a successful outcome go down for any acupuncture practitioner or patient.

We all recognize and respect the lineage.  We recognize that the ancient Chinese were the first to use this healing modality.  We respect that there had to be a therapeutic benefit from needle insertion (aka acupuncture) or else it wouldn’t have lasted this long nor would there be a “turf war” over who owns the right to practice this modality.

Now that everything is out in the open let’s get beyond the needles, energy flow, trigger points and politics.  The common ground that needle insertion (aka acupuncture) practitioners have is that they seek to stimulate a therapeutic effect in the body.  Call the explanation of that effect what you will (Qi, innate intelligence, balancing of neurohormones, restoring homeostasis, gate control theory of pain, reducing global or local sensitivity, reducing trigger points, etc.)  The explanation (“why”) depends on the practitioner and patient.  The “what” (inserting needles into the skin for therapeutic benefit) is still the same.  The best way of looking at this is the coin analogy.   One side of the coin is Eastern Acupuncture  and the other side is Western Acupuncture.

Let’s dig a little deeper into some of the proposed mechanisms of how acupuncture work.  On initial examination, it would appear that there are no similarities.  On deeper inspection, similarities exist.  This is what we mean by going beyond needles, energy flow, trigger points or politics.

1. Energy Flow:  Traditional Chinese acupuncture explains the therapeutic effects of acupuncture by aligning the patient’s qi (energy).  When qi flows properly through the body, health is maintained.  When qi is interrupted, disease can set in.  Western theory explains the energy concept a little different.  Lesions in tissues induced by needle insertion send signals towards the spinal cord and brain.  These lesions trigger a cascade of electrochemical reactions in the body.  The electrochemical reactions can be observed with tools such functional MRI of the brain, PET scans and EMG/NCV (2).  We have clearly seen with our high priced imaging tools specific areas of the brain and spinal cord process these electrochemical signals differently when needles are inserted into the skin and subcutaneous tissues.  Think of the body as a battery.  A battery uses electrochemical reactions to create energy for a car to run, to power a flashlight, or keep your laptop powered on an airplane.  The body uses electrochemical reactions to make its normal processes work.  Maybe, just maybe these electrochemical reactions are the “qi” or energy flow that the ancient Chinese stumbled upon thousands of years ago.

Energy Pathways

Energy Pathways

2. Body Wall Relationships:  The ancient Chinese formed meridians.  Meridians are channels of energy that tie specifically to an organ (liver, gallbladder, spleen, kidney, etc.).  The thought was that the internal organs could be treated via tapping into the various points on the body.   A respected acupuncture historian, Professor Long-xiang Huang of the Acupuncture Research Institute of the Academy of Traditional Chinese Medicine in Beijing, states, “The most valuable discovery in acupuncture theory is the interrelatedness between the parts of the body surface, and between the parts of the body surface and the internal organs.  These are the immortal pearls of classic acupuncture.” (2)  Western medicine has its own take on the relationship between the body wall and the internal organs.  Western medicine instructs on the concept of referred pain.  In particular, organs of the body can refer pain to local or distant sites on the body wall (skin and subcutaneous tissues).  Some examples include the heart and gallbladder.  Patients experiencing a heart attack may complain of pain down the L arm as well as pain in the neck and jaw area.  Gallbladder referred pain from gallstones or other gallbladder pathology can occur in between the shoulder blades or into the tip of the R shoulder.  Please keep in mind the location of the pain is far away from the actual site of the problem.  The ancient Chinese were on to this long before Western medicine even existed, but both styles had a methodology for explaining the same concept of referred pain.  Sounding more and more like 2 sides of the same coin now isn’t it?

Areas of Referred Pain

Areas of Referred Pain

3. Homeostatic Processes:   The ancient Chinese forwarded the concept of yin and yang.  This refers to the balance that exists in nature.  Normal processes are interrupted without balance.   These opposing forces should balance each other other out in nature and in the patient.  Perhaps, the best explanation for some of the mechanisms of Western style acupuncture is the methodology that acupuncture taps into the body’s homeostatic, self regulatory processes.  Needle induced lesions into the tissues stimulates many of the survival mechanisms of the body including the self healing mechanisms, restoring homeostasis, facilitating repair mechanisms such as antiinflammatory reaction, tissue regeneration and pain modulation (2).  These processes involves the nervous system, cardiovascular system, endocrine system and immune system.    Our body is always in a flux of breaking down vs. building up (catabolic vs. anabolic states).  This is analogous to yin and yang.  We need to have both states working well in our body to have homeostasis.  What you have are 2 concepts from 2 areas of the world that explain the similar idea of balance.

4. System of Diagnosis and Treatments:  Both Eastern and Western styles of acupuncture have a process to assess patients.  The Eastern style uses a patient history (question and answer session), tongue diagnosis, pulse diagnosis and palpation to find areas of the body for needle insertion.  The Western style uses a patient history, physical exam procedures, palpation, and other Western based methodologies (movement analysis, anatomy, neurology) to select points for needle insertion.  Both styles favor the assessment and the reassessment to guide the practitioner in the process of acupuncture point selection and obtaining a favorable outcome for the patient.   The main point we are trying to make here is that a system is in place in both styles to assess, reassess and modify treatment if needed.  These are similar concepts from 2 different parts of the world.   Are you getting the initial reference to the same coin with 2 different sides now?

5. Ah Shi – The Trigger Point: Classical Chinese theory recognizes the presence of Ah Shi points.  These points are sensitive and tender areas of tissue that are palpable.  These areas often presented as rigid or semi rigid bands.  The Western school of thought classifies these areas as trigger points.  Effectively, the Chinese discovered the concept of the trigger point and a created a system to treat it (acupuncture/acupressure)  long before the rest of the world.  Western science further advanced the concept of the trigger point with the classic work of Travell & Simons’ – Myofascial Pain and Dysfunction: The Trigger Point Manual (http://www.amazon.com/Travell-Simons-Myofascial-Pain-Dysfunction/dp/0683307711/ref=sr_1_3?ie=UTF8&qid=1365243415&sr=8-3&keywords=travel+simons+trigger+point).   Where you live in the world and how you think explain what you call it (Ah Shi or Trigger Point), but the end result is the same and that is that both styles identified the issue (sensitized, tender bands of connective tissue) and have a methodology to treat that tissue (needle insertion).  Just one more example of the point we are trying to make.

Got a "migraine?"  Maybe it's just trigger point referral from the neck into the temples, top of the head or above the eyes

Got a “migraine?” Maybe it’s just trigger point referral from the neck into the temples, top of the head or above the eyes

We hope you’ve enjoyed this post.  Our intent was not to ruffle any feathers.  Please don’t send us any hate mail.  Feel free to share if you’re passionate on this subject.  Our intent was to critically discuss the methods, mechanisms and theories of acupuncture.  Our intent is to show that whatever form of  needle insertion that you the practitioner or you the patient choose, it can have huge affects on the body.  Clearly acupuncture works or else it wouldn’t have lasted this long and we wouldn’t be having this discussion right now.  Let’s get beyond the needles, energy flow, trigger points or politics.

*** Note:  If this post interested you and you are curious to know if our style of acupuncture (biomedical acupuncture) is for you, give us a ring at 708-532-CFIM (2346).  We use this style for general health conditions, chronic pain, acute pain,  headaches, fibromyalgia, stress relaxation, trigger points, myofascial pain and many other problems. ***

References

1).  http://www.merriam-webster.com/medlineplus/acupuncture

2). Ma, Y.T, Ma, M. & Cho, Z.H.  2005. Biomedical Acupuncture for Pain Management: An Integrative Approach

St. Louis: Elsevier.

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  • Adam

    Hey Dr. Dino. A great book to read for anyone practicing acupuncture is “The Dao of Chinese Medicine” The actual insertion of meridians into acupuncture is not a Chinese concept. It was French. Here is a little description. Dao of Chinese Medicine is the first Western text to shed light on the reality of the ancient healing arts of China, revealing that Chinese medical theories are based on important physiological findings. This is in contrast to the Western interpretation, popularized since the 1940s and 50s that Chinese medicine and acupuncture involve undefined energy and blood circulating through imaginary meridians. Unfortunately, the energy-meridian idea condemned Chinese medicine to be viewed in terms of metaphysical beliefs, limiting its acceptance into mainstream health care. It also led to a growing frustration to reinvent acupuncture in Western terms before understanding the true way (dao) of Chinese medicine. Dao of Chinese Medicine sets the record straight, explaining how ancient Chinese physicians developed a physiologically based medicine with the theories supported by human dissection studies and how Chinese medical theories are consistent with 21st century explanations about how acupuncture works.

    Great write up!

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