Acupuncture 

By: Michelle Hessberger, ND, Dipl Ac, LAc, MS Cellular and Molecular Biology 

While the exact date of acupuncture’s inception is uncertain, archaeological findings of stone shaped into acupuncture needles have been unearthed from the Shang Dynasty circa 1000 B.C.E. in China along with inscriptions discussing medical conditions (O’Connor 1981). Hieroglyphs of acupuncture were also discovered on bones and tortoise shells from this time period (Xinnong 2007).

Acupuncture became increasingly prevalent in China during the Warring States Period (475 B.C.E. – 221 B.C.E.) with the development of metal needles, which were much easier to produce than the previous stone needles. In fact, there are several stories where famous physicians like Bian Que and Chunyu Yi used acupuncture to treat patients. One well-known Chinese story discusses how Bian Que treated the comatose crown prince of the Kingdom of Guo and cured him with the use of acupuncture and herbs (Liao 2011). Among the earliest written medical classics in China during the Warring States Period were theLingshu Jing (Classic of the Miraculous Pivot) and the Su Wen (Questions of Fundamental Nature). Both of these compilations discussing acupuncture and other medical therapies were later combined to form the Huangdi Neijing(Yellow Emperor’s Canon of Internal Medicine), which is still quoted today.

Although acupuncture has evolved since its inception and the Huangdi Neijinghas been edited to incorporate those changes, much of the original concepts of Chinese medicine over its initial 1,500 years have remained and can be found today, over 3,000 years later. Along with other therapies in Traditional Chinese Medicine (TCM), acupuncture is rooted in the beliefs that balancing different aspects of life and energy can optimize health and prevent disease. Common concepts in TCM acupuncture today include asking about symptoms, taking the patient’s pulse, looking at a patient’s general constitution and tongue to aid diagnosis, treating diagnostic patterns like invasion of pathogens or deficiencies of specific organ systems by needling points along specific channels located on the body, and working to harmonize physical and energetic imbalances (Xinnong 2007). China, however, is not the only country that has influenced and shaped how acupuncture is used today. The Japanese were introduced to acupuncture by a Chinese monk, Zhi Cong, in 562 C.E. via the Ming Tang Tu(Illustrated Manual of Channels, Collaterals and Acupuncture Points), and Korea also assimilated acupuncture into their medical practices around this time.

Acupuncture was brought to Western civilizations by the Jesuits in the sixteenth century, became adopted by France, and used widely by clinicians in the seventeenth century (White 2004). News about acupuncture appeared in the British medical journal, the Lancet, in the early nineteenth century England but did not really become known to the U.S. public till after 1971 when James Reston reported about his successful acupuncture treatment while in China as part of the US press corps preparing for President Nixon’s visit, where he developed pain and bloating post-surgically (Yang 2011). Although Chinese immigrants in the U.S. regularly used acupuncture prior to this event, Mr. Reston helped to bring acupuncture to the forefront of the English-speaking populace in his “obituary” to his appendix. Other forms of acupuncture also became increasingly utilized around this time. Ear acupuncture originating as scattered Chinese acupuncture points later became their own micro-system when Dr. Paul Nogier of France, in 1957 (Oleson 2003), mapped ear points according to body part impacted and discovered they correlated to a picture of an inverted fetus. His ear map has been standardized by the World Health Organization (WHO) and is still utilized today. Scalp acupuncture, although mentioned in the Huangdi Neijing as part of TCM acupuncture, has flourished since the 1950s, forming an independent micro-system based upon specific functional areas of the brain (Liu 2012). As interest in acupuncture has risen, more research has gone into understanding its mechanisms.

There are several theories regarding how acupuncture works. The original historical references describe how energetic channels travel along specific parts of the body, contain points where the body’s energy pools, and how acupuncture needles could access this pooled energy, called qi (pronounce chee), to enhance health (Xinnong 2007). Qi comes in several forms, such as nourishing gu qi found in food, kong qi found in air, and congenital yuan qipassed down from parents to offspring. Qi is believed to be the energy that helps the body move and organs function appropriately. In acupuncture theory, disease is often caused by problems with qi or blood, which is moved and created by qi. By accessing the body’s qi, acupuncturists can move stuck energy, build energy that was depleted, or even reduce excessive energy in order to restore health. With over 18,200 peer-reviewed medical articles on acupuncture in the PubMed database (consisting of 22 million citations maintained by the U.S. government’s National Center for Biotechnology Information), science is elucidating some of the biochemistry and physiology behind these ancient concepts.

For instance, acupuncture channels and points have been identified using infrared thermal imaging (Yang 2007). Studies by Chen found that acupuncture can significantly increase oxygen utilization and energy metabolism along the needled channel (Chen 2010) and Wang discovered acupuncture could increase calcium ion potentials, which control numerous cellular reactions locally (Wang 2008). On a broader basis, needling acupuncture points altered blood circulation, hormones and neurotransmitter levels, nerve function, brain function, and the overall immune system (Li 2003, Li 2011). As shown via functional magnetic resonance imaging (fMRI), a procedure measuring brain activity through changes in blood flow, acupuncture stimulates these multiple systems by accessing nerves connecting to the brain’s cortex (Li 2003). Acupuncture even changed delta brain waves, causing increased exchange of information and connectivity of different brain regions (Li 2011). Yang found that acupuncture increased beta-endorphin, a naturally occurring analgesic, which explains some of the pain-relieving benefits of acupuncture (Yang 2011). Placebo-based acupuncture called “sham” acupuncture, performed by using points not located along designated energetic channels, had minor benefits when compared to true acupuncture (Yang 2011). Another aspect of Chinese acupuncture is repeatedly moving the needle in and out after insertion to get a “deqi” (pronounced deh chee) sensation. Deqi is where the patient feels numbness, tingling, heaviness, soreness, pressure or a moving sensation at the insertion site, and the acupuncturist feels the “needle grasp,” which is likened to catching a fish on a fishing line. Scientific evidence found the deqi action triggered increased adenosine outside the cell, which is known to reduce inflammation, prevent tissue damage and promote sleep (Goldman 2010). This explains how acupuncture relaxes patients and reduces symptoms of inflammation.

Acupuncture has been useful in reducing symptoms of a variety of different medical conditions. Randomized control trials (RCTs) showed acupuncture reduced back pain and osteoarthritic knee pain at 8 weeks, and even greater benefit was achieved when treatment duration was increased to three and six months (Cherkin 2009, Witt 2005). Melchart reported that many types of chronic headaches reduced in frequency by half after acupuncture treatments (Melchart 2005). Witt found 3 months of acupuncture alleviated neck pain, with effects lasting for six months after treatment ceased (Witt 2006). Fibromyalgia, a multidimensional pain disorder, along with associated depression, has been effectively treated via acupuncture (Vas 2011). Many studies have found acupuncture to be better than no treatment, routine care, and even enhanced outcomes of western treatments, making it a reasonable adjunctive treatment or alternative for patients with pain conditions (Mao 2010). Beyond pain conditions, digestive complaints such as Irritable Bowel Syndrome, was reduced by 90 percent after biweekly acupuncture treatments for 2 months (Lu 2011). 6 weeks of acupuncture reduced heartburn more effectively than the drugs omeprazole and mosapride (Zhang 2010). Acupuncture has been found to alleviate constipation (Du 2012) and symptoms of Crohn’s disease and Ulcerative Colitis (Schneider 2007). Other conditions that benefited from acupuncture include depression and anxiety (Jiang 2012), allergy symptoms (Kim 2009), drug addiction (Yoon 2012), insomnia (Jiang 2010), stroke (Hsing 2012), Parkinson’s disease (Joh 2010), painful menses (Wu 2012), and infertility (Huang 2011). Post-surgical and cancer therapy-related nausea and vomiting were alleviated via acupuncture (El-Deeb 2011, Lin 2012) and acupuncture has been successfully used as an alternative form of anesthesia pre- and post-surgically (Chernyak 2005). With improved nerve and muscle function in athletes after a single treatment, acupuncture may be utilized for sporting activities and to improve injury recovery (Hubsher 2010).

Overall, large prospective studies elucidated by Mao found acupuncture to be quite safe, calming, and relaxing, with typical treatment length from 15–45 minutes and continuing for an average of ten sessions (Mao 2010). While daily acupuncture treatments are routine in China, this schedule is impractical in the U.S., and hence weekly, biweekly, or tri-weekly sessions are recommended. Side effects are very rare in acupuncture, with the most common side effects of pain at the site of needling, mild bruising, and dizziness occurring in less than four percent of patients (Mao 2010). To avoid possible increases in sensation or pain during treatment, the patient’s needled body parts should remain relatively still and relaxed, and the patient should notify the practitioner of a continued burning sensation typically elicited when the needle is too close to a blood vessel or nerve. Along with use of TCM body points, practitioners may use electrical stimulation, ear or scalp points, or different diagnostic theories such as Five Element Theory, which groups organs according to elements to determine imbalances. Acupuncture has also been adapted to veterinary medicine and may be utilized in “wet” acupuncture, where acupuncture points are used as sites to inject pain relievers or other drugs. Common acupuncture practitioners may include licensed acupuncturists (LAc) who have completed over 1900 hours of master’s degree clinical and educational training, medical physicians with 100-300 hours training, and diplomates (Dipl Ac) who have completed their master’s degree and additional training. According to the National Health Interview Survey administered by the CDC, the popularity of acupuncture has steadily increased, with over 28,000 licensed acupuncturists treating 14.01 million Americans in 2007, health insurance companies beginning to cover this medical service for several conditions, and many physicians recommending it to their patients as a safe CAM therapy (Zhang 2012).

Finding a Good Practitioner:
The most highly trained acupuncturists are those with a “Diplomate of Acupuncture” in the United States (requiring a Master’s degree in acupuncture, passing of national exams, and additional continuing education). Visit the NCCAOM at  http://mx.nccaom.org/FindAPractitioner.aspx to find a licensed acupuncturist near you.

Further Reading:
Kaptchuk T. The Web That Has No Weaver: Understanding Chinese Medicine. New York: McGraw-Hill; 2000.
Hicks A. The Acupuncture Handbook: How Acupuncture Works and How It Can Help You. London: Piatkus; 2005.

References
Chen M, Hu XL, Wu ZX. Observation on changes of oxygen partial pressure in the deep tissues along the large intestine meridian during acupuncture in healthy subjects. Zhen Ci Yan Jiu 2010 Jun;35(5):231-216.

Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Archives of Internal Medicine 2009 May 11;169(9):858-866.

Chernyak GV and Sessler DI. Perioperative acupuncture and related techniques. Anesthesiology 2005 May;102(5):1031-1078.

Du WR, Lu XK, Wang FC. Met-analysis on randomized controlled clinical trials of acupuncture and moxibustion on constipation. Zhongguo Zhen Jiu 2012 Jan;32(1):92-96.

El-Deeb AM, Ahmady MS. Effect of acupuncture on nausea and/or vomiting during and after cesarean section in comparison with ondansetron. Journal of Anesthesia 2011 Oct;25(5):698-703.

Goldman N, Chen M, Fujita T, Xu Q, Peng W, Liu W, et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience. 2010 Jul;13(7):883-8.

Hsing WT, Imamura M, Weaver K, Fregni F, Azevedo Neto RS. Clinical effects of scalp electrical acupuncture in stroke: a sham-controlled randomized clinical trial. Journal of Alternative and Complementary Medicine 2012 Apr 10. Epub ahead of print.

Huang DM, Huang GY, Lu FE, Stefan D, Andreas N, Robert G. Acupuncture for infertility: is it an effective therapy? Chinese Journal of Integrative Medicine 2011 May;17(5):386-395.

Hubsher M, Vogt L, Ziebart T, Banzer W. Immediate effects of acupuncture on strength performance: a randomized, controlled crossover trial. European Journal of Applied Physiology 2010 Sep;110(2):353-358.

Jiang B, Ma ZH, Zuo F. Auricular acupuncture for insomnia: a randomized controlled trial. Zhonghua Liu Xing Bing Xue Za Zhi 2010 Dec;31(12):1400-14002.

Jiang JF, Xu L, Lin YH, Lu JH, Chen LZ, Sun YN. Anti-depression effect of acupuncture and moxibustion based on SSRIs medication. Zhongguo Zhen Jiu 2012 Mar;32(3):219-223.

Joh TH, Park HJ, Kim SN, Lee H. Recent development of acupuncture on Parkinson’s disease. Neurological Research 2010 Feb;32 Suppl 1:5-9.

Kim JI, Lee MS, Jung SY, Choi JY, Lee S, Ko JM, et al. Acupuncture for persistent allergic rhinitis: a multi-centre, randomized, controlled trial protocol. Trials 2009;10:54.

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Li N, Wang P, Deng B, Wei XL, Che YQ, Jia CH, et al. Influence of acupuncture of Zusanli (ST 36) on connectivity of brain functional network in health subjects. Zhen Ci Yan Jiu 2011 Aug; 36(4): 278-287. Article in Chinese.

Liao Y. Traditional Chinese Medicine. New York: Cambridge University Press; 2011.

Lin JG, Chen YH. The role of acupuncture in cancer supportive care. American Journal of Chinese Medicine 2012;40(2):219-229.

Liu Z, Guan L, Wang Y, Xie C-L, Lin X-M, Zheng G-Q. History and mechanism for treatment of intracerebral hemorrhage with scalp acupuncture. Evidence-Based Complementary and Alternative Medicine 2012;2012:895032.

Lu YH, Tang XD. Efficacy observation on the needling depth recorded inLingshu (Miraculous Pivot) for irritable bowel syndrome of diarrhea. Zhongguo Zhen Jiu 2011 Nov;31(11):975-977. Article in Chinese.

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Schneider A, Streitberger K, Joos S. Acupuncture treatment in gastrointestinal diseases: a systematic review. World Journal of Gastroenterology 2007 Jul 7;13(25):3417-3424.

Vas J, Modesto M, Aguilar I, Santos-Rey K, Benitez-Parejo N, Rivas-Ruiz F. Effects of acupuncture on patients with fibromyalgia: study protocol of a multicentre randomized controlled trial. Trials 2011 Feb 28;12:59.

Wang Q, Jiang HZ, Chen SL, Zhang MM, Ding MX, King ES, et al. Effect of Ca2+ complexation on oxygen partial pressure in the Bladder meridian in goats. Zhen Ci Yan Jiu 2008 Feb;33(1):17-21.

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Witt C, Brinkhaus B, Jena S, Linde K, Streng A, Wagenpfeil S, et al. Acupuncture in patients with osteoarthritis of the knee: a randomized trial. Lancet 2005 Jul 9–15;366(9480):136-143.

Witt CM, Jena S, Brinkhaus B, Liecker B, Wegscheider K, Wikkich SN. Acupuncture for patients with chronic neck pain. Pain 2006 Nov;125(1-2):98-106. Epub 2006 Jun 14.

Wu LL, Su CH, Liu CF. Effects of noninvasive electroacupuncture at Hegu (LI4) and Sanyinjiao (SP6) acupoints on dysmenorrhea: a randomized controlled trial. Journal of Alternative and Complementary Medicine 2012 Feb;18(2):137-142.

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Yoon SS, Yang EJ, Lee BH, Jang EY, Kim HY, Choi SM, et al. Effects of acupuncture on stress-induced relapse to cocaine-seeking in rats. Psychopharmacology (Berl) 2012 Jul;222(2):303-311.

Zhang CX, Qin YM, Guo BR. Clinical study on the treatment of gastroesophageal reflux by acupuncture. Chinese Journal of Integrative Medicine 2010 Aug;16(4):298-303.

Zhang Y, Lao L, Chen H, Ceballos R. Acupuncture use among American adults: what acupuncture practitioners can learn from National Health Interview 2007? Evidence-Based Complementary and Alternative Medicine 2012;2012:710750.