Circa 2010-11
Is acupuncture an art? A science? A religion? Hey, as long as it works, who cares? Whatever it is, acupuncture has been used to treat a variety of ailments for about 2,000 years. Though it doesn’t stop cancer cells from dividing or make transected nerves in an injured spinal cord regenerate, acupuncture has been proven to alleviate the symptoms commonly associated with these conditions. For many people, however, the process remains shrouded in mystique. So let’s take a closer look at how it all works.
Acupuncture is the application of small needles, pressure, stroking, or electrical stimulation at distinct locations on the body, generally for the alleviation of pain. Some theories hold that the general effects of acupuncture activate nerve signals to the brain that in turn release substances like hormones or endorphins to affect areas elsewhere in the body. Endorphins act as the body’s natural morphine—they can reduce pain or even elevate mood. Acupuncture may also lead to the release of anti-inflammatory substances, resulting in relief for symptoms of such inflammatory diseases as arthritis and asthma.
Though acupuncture is still not precisely understood by modern medicine, it is not irrational to believe that this sort of treatment can be beneficial to a patient. Changes in brain activity have been reported on the positron emission tomography (PET) scans of patients receiving acupuncture, although scientific studies to prove the effectiveness of acupuncture are difficult to perform because no effective placebo is available, and because there is no way to “double-blind” the subjects or examiners.
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Acupuncture is known to affect different locations on the body in various ways. The complexity of acupuncture treatment stems from the variety of effects that can be achieved by accessing different combinations of pressure points on the body. Acupuncture needles, typically made of stainless steel, are much smaller than the needles Western doctors and nurses use for administering injections. To make the needles more easily handled by an acupuncturist, the upper segment of an acupuncture needle is wound in bronze wire or is covered in plastic. Since acupuncture needles penetrate the skin and are not disposable after use, they must be sterilized in the same manner as surgical instruments.
The concept of acupuncture centers around the flow of “energy” (called Qi) through the human body. The movement of the Qi is defined by twelve channels that are comprised of internal and external pathways. The external pathway, existing on the surface of the body, is what is often depicted on an acupuncture chart. Qi channels are described as coursing in the body and are associated with different organs. Treatment of some symptoms relates directly to the organ typically associated with that symptom (i.e., acupuncture pressure on the stomach may be applied to treat indigestion), however, other symptoms may be associated with one or a combination of organs that aren’t commonly linked with such symptoms in Western medicine. For example, pressure on a combination of acupuncture points near abdominal organs like the liver and pancreas may result in elevation of mood in a person with depression.
Acupuncture points are located along several layers of pathways throughout the body, specifically along twelve primary channels called mai. These twelve channels correspond to the major organs: Lung, Large Intestine, Stomach, Spleen, Heart, Small Intestine, Bladder, Kidney, Pericardium (the tissue sack around the heart), San Jaio (an intangible, also known as “the triple burner”), Gall Bladder, and Liver. These organ systems are capitalized to distinguish them from the actual organs and to allude to the flow of energy between organ pathways. Additional pathways include the Eight Extraordinary Pathways (Qi Jing Ba Mai), the Luo Vessels, the Divergents and the Sinew Channels. Ashi, or “tender” points, are generally used for treatment of localized pain.
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In traditional Chinese medicine, health is a condition of balance within the body of the “yin” and “the yang”. Particularly important in acupuncture is the free flow of Qi. Qi, which forms the yang, is the body’s “vital energy” and, as such, is intangible. The tangible counterpart of the yang is Blood, which is referred to as the yin. Acupuncture treatment regulates the flow of Qi and Blood, enhancing where there is deficiency, “draining” where there is excess, and promoting free flow where there is stagnation.
Although acupuncture points are spread over the surface of the body, a large number of these points can be found along the spine. Additionally, an entire subset of acupuncture focuses on points in and around the ear. You might notice that the outer perimeter of your ear forms a spiral—in acupuncture, this is referred to as the “helix”. If you study a friend’s ear closely, you will see another spiral curve in the opposite direction. This is referred to as the “anti-helix”. An entire set of stimulation points over the front and back of the outer ear serves as an important part of acupuncture treatment for many ailments. Some acupuncturists focus on these areas, others combine them with the major body pathways.
In 2003, a team of doctors directed by Alice M.K. Wong, M.D., treated a group of patients who were recovering from spinal cord injuries. The doctors incorporated acupuncture in the treatment regimens, as well as standard Western modalities such as physical therapy. The team of doctors used mild electrical stimulation at several key acupuncture points, including the bilateral Hou Hsi (SI3), Shen Mo (B62), the antihelix, helix, and the lower portion of the ear-back areas. These points are significant because they are all found on Qi pathways related to the spine.
Neurological functions, including sensory and motor skills, improved greatly in patients whose treatments included acupuncture. Researchers concluded that the use of acupuncture, when combined with massage and physical therapy, can be beneficial soon after spinal cord injury.
Though acupuncture cannot make paralyzed people walk again, patients whose spinal cord injuries are not complete may find that acupuncture treatment leads to improvement in their daily functions. In some studies, patients with incomplete spinal cord injury found that sensation improved as a result of acupuncture treatment. Improved sensation in a mostly immobilized individual can reduce bed sores (called “decubitus ulcers”) that may lead to infection and possibly end the life of a spinal cord injury victim. In other studies, spinal cord injury patients experienced improvement in bladder control after acupuncture treatment at sites near the tailbone, not far from where the nerves to the bladder exit the spinal column.
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Although it can occasionally result in small amounts of bleeding and bruises, acupuncture has minimal risks as a mode of treatment. Moreover, it is fairly inexpensive, which is particularly good since few insurance companies cover the procedure. I often tell my patients that, since acupuncture is not risky and is not costly, there is little to be lost by exploring it as a treatment possibility. When I speak with a patient about undergoing major surgery on his spine, I make every effort to help him to feel better without surgery, so acupuncture often registers as a viable option. At least two major studies in Western medical literature suggest that more than half of patients with back pain experience significant benefit after acupuncture treatment.
You need not “go East” to receive acupuncture treatment. Many Western clinics now offer various elements of traditional Chinese medicine, including acupuncture. In most metropolitan areas in the United States, acupuncturists practice their skills in small offices throughout their communities. Acupuncturists are trained practicioners and must be licensed in most states. When looking for the acupuncturist who best suits you, use due diligence, just as you would in the search for any physician. And, just as you might during any visit to a doctor, remember that not every treatment will be effective. Don’t give up after one or two unsatisfactory experiences with acupuncture.
For most of us, science is comforting, particularly in respect to the treatment of our diseases. However, much of Western medicine remains a delicate balance between art and science. While acupuncture is considered by many to be an ancient medical art, it is well established, is not totally inconsistent with scientific principles, and is not risky or expensive. For those who suffer from pain or discomfort, it is a viable, practical option that is often well worth consideration.
by Thomas Chappell, MD
