The Science Behind Acupuncture: Exploring its Mechanisms
How does acupuncture actually work? An important and interesting question that many have pondered and investigated but yet no single definitive explanation has been agreed upon to date.
Before I explore some of the potential mechanisms, my scientific brain (I studied Immunology at Birmingham University and subsequently worked in the pharmaceutical industry for over a decade) notes with interest that although paracetamol has been studied for over 150 years, how it actually works remains a mystery. Yes it’s true - no single mechanism has been found to account for its analgesic activity and ability to reduce high temperature, though there are plenty of hypotheses. That’s food for thought…
To go back to the question, there are two ways to answer this. The first is to use the traditional theory of acupuncture, which uses the concept of Qi. For example, when somebody is in pain, this is considered to be a blockage in flow of Qi. A traditional acupuncturist will select points along the meridian that is affected in order to encourage the Qi to flow more freely.
The overall aim is to direct the flow of Qi to trigger your body’s healing response and to restore equilibrium on all levels: physical, emotional and mental. Treatment aims to affect your whole being, not just your symptoms so, as the condition being treated improves, you may notice other health problems improve and an increased feeling of general wellbeing.
The second is from the perspective of modern science. The most popular explanation is that it works through the release of endorphins. However, as with the humble paracetamol, it is unlikely that the effects of acupuncture can be attributed to one single mechanism. There are a number of possibilities which include a range of effects on the nervous, endocrine and immune systems. The British Acupuncture Council cites the following as potential mechanisms [1]:
· Peripheral effects (release of adenosine and nitric oxide by axonal and dorsal root reflexes)
· spinal effects (modulation of sympathetic tone and motor reflexes)
· modulation of endogenous descending paying inhibitory and facilitatory systems
· changing the functional connectivity of the brain. Activation/deactivation of limbic structures involved in stress/ illness responses
· the hypothalamus pituitary adrenal axis
· the prefrontal and frontal cortices
· restoration of the default mode state
· modulation of parasympathetic activation
· activation of the reward and mirror systems
· modulation of activation of the immune system
· expectation, attention, conditioning an extinction of conditioned responses
I particularly like the reference to restoring the default mode state as, to me, this represents the concept of homeostasis from a modern science perspective, and balance from a traditional acupuncture perspective, bringing these two points of view together.
I am also particularly interested in the hypothesis that acupuncture modulates the activation of the immune system, as so many diseases, disorders and condition stem from an improperly modulated immune system.
The modulation of the parasympathetic/sympathetic activation angle is also extremely interesting to me as I believe that so many people can achieve health benefits from switching away from the fight or flight (sympathetic) response to rest and digest (parasympathetic). If you ever wonder why you notice tummy rumbling during treatment it may well be because you are turning up the volume on the parasympathetic response and resting and digesting on the couch!
Furthermore, a landmark study published in the prestigious journal, Nature, showed a mechanism that is related to a specific acupuncture point but not to another. This study demonstrated that vagal-adrenal anti-inflammatory axis in mice was driven by the stimulation of the point ST36 but not ST25 [2]. The importance of this study is that it suggests a specific effect of an acupuncture point. In other words, the mechanisms of acupuncture are not simply general effects which occur regardless of where the needles are inserted. This is the premise on which traditional acupuncturists work, and we select points according to the individual presentation, to meet individual needs rather than using set protocols.
As time goes on, the science may well become more clear on this question, but for now, we at least have some very good insights.
1. Lund I, Lundeberg T. Mechanisms of acupuncture. Acupuncture and Related Therapies 2016;4(4):26-30. doi: https://doi.org/10.1016/j.arthe.2016.12.001
2. Liu S, Wang Z, Su Y, et al. A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis. Nature 2021;Oct;598(7882)(1476-4687 (Electronic)):641-45. doi: doi: 10.1038/s41586-021-04001-4
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