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Acupuncture employs the use of fine needles along defined meridians in the body. Acupuncture can be very effective in reducing or eliminating pain, but is also instrumental in treating internal medicine issues as well.
A common misconception about Acupuncture is that there are specific Acupuncture points that cure specific diseases. In fact, the treatments and needling points are custom tailored for the individual. It is more accurate to say that there are specific Acupuncture points which cure specific imbalances. Two patients with the same illness or symptom may have totally different imbalances and therefore totally different Acupuncture treatments.
How does acupuncture work?
TCM Perspective: Treatment of acupuncture points may be performed along several layers of pathways, most commonly the twelve primary pathways, known as meridians, or channels located throughout the body .Ten of the primary pathways are named after organs of the body (Heart, Liver, etc.), one is named for the serous membrane that wraps the heart (Heart Protector or Pericardium), the last is the three spaces (San Jiao). . The two independent extraordinary pathways Ren Mai and Du Mai are situated on the midline of the anterior and posterior aspects of the trunk and head respectively. The twelve primary pathways run vertically, bilaterally, and symmetrically and every channel corresponds to and connects internally with one of the twelve Zang Fu ('organs'). This means that there are six yin and six yang channels. There are three yin and three yang channels on each arm, and three yin and three yang on each leg.
The movement of qi through each of the twelve channels is comprised of an internal and an external pathway. The external pathway is what is normally shown on an acupuncture chart and it is relatively superficial. All the acupuncture points of a channel lie on its external pathway. The internal pathways are the deep course of the channel where it enters the body cavities and related Zang-Fu organs. The superficial pathways of the twelve channels describe three complete circuits of the body, chest to hands, hands to head, head to feet, feet to chest, etc.
Chinese medical theory holds that acupuncture works by normalizing the free flow of qi ( commonly translated as 'vital energy'), blood and body fluids (jin ye) throughout the body. Pain or illnesses are treated by attempting to remedy local or systemic accumulations or deficiencies. Pain is considered to indicate blockage or stagnation of the flow of qi, blood and/or fluids. The delicate balance between qi and blood is of primary concern in Chinese medical theory and both qi and blood work together to move (qi) and to nourish (blood) the body fluids.
Many patients claim to experience the sensations of stimulus known in Chinese as 'deqi' ('obtaining the qi' or 'arrival of the qi'). This kind of sensation was historically considered to be evidence of effectively locating the desired point. There are some electronic devices now available which will make a noise when what they have been programmed to describe as the 'correct' acupuncture point is pressed.
The acupuncturist decides which points to treat by observing and questioning the patient in order to make a diagnosis according to the tradition which he or she utilizes.
After acupuncture you may experience soreness, minor bleeding and/or bruising at the needle sites.
In a clinical setting we see all types of conditions respond from allergies and asthma to anxiety and depression to fertility and menstrual issues and, of course, pain among many others. So we know it “works”, but how is a gray area. Many studies have shown that acupuncture releases endorphins (our body's natural morphine). A release of endorphins would help explain how acupuncture treats pain and also the extremely relaxed feeling most people have after an acupuncture treatment. This alone, however, does not explain how it may help with depression or autoimmune conditions or fibroids as random examples.
Looking At Specific Effects: In recent years, researchers have begun looking at specific reactions from individual points. One study using a PET scan (shows brain activity) found measurable changes in the areas of the brain related to gastric control when ST 36 was needled. ST 36 is used for a broad range of issues such as: nearly all digestive issues (reflux, cramping, bloating, weak digestion, etc.), lower leg pain, asthma, fatigue, low immunity, and depression to name a few. This study shows that the point has a measurable effect on brain function which then stimulates the body to correct itself internally. While it shows an effect, it still does not show how it relieves symptoms? Studies like this would have to be repeated numerous times with people with varying conditions to see if acupuncture merely offers a “regulatory effect” or if it is a “fixed effect”.
Regulatory vs. Fixed Effects: This relationship is an important one for understanding how acupuncture works. If you have bloating, for example, does acupuncture just send a signal of some kind and the body figures out how to stop the bloating, or does it send the same signal every time meaning the point may be better for some types of bloating than others – or only for bloating when you also have cramps? In other words, does the body respond in a purely regulatory fashion with acupuncture - that is, if something (a chemical, hormone, etc.) is high, does it make it lower and vice versa – or does one point always make that chemical or hormone level higher and another point make it lower? These types of understandings will involve years of research but are explained well in Chinese Medical terms minus the a precise “how.”
Similar to the study above, another using a PET scan looked more generally at the effects of needling SP 6. SP 6 has a broad range of uses including digestive problems, prolapsed organs, sexual issues, skin disorders, insomnia and anxiety. This study found changes in 10 areas of the brain including the prefrontal cortex (social behavior, depression, anxiety) and the hippocampus (memory, stress, epilepsy, etc.). Generally the areas that were stimulated matched up with the broad range of effects the point has. Again, however, does it always effect those areas and how does that stimulation lead to a cessation of symptoms in a patient?
An entirely different study used both of those points but didn't look at brain function mechanisms at all – instead they looked at knee pain. This study is an example of looking at “local needling” (vs. using a point for a systemic change like the studies above illustrate). The study found that needling (ST 36 and SP 6) led to increases in synovial fluid in the joint which aids arthritic knees. Did it do this by triggering a part of the brain to draw attention to the knee, or was it just because these rats (in this study) had arthritic knees – what would the effect be on someone with “perfect” knees? There are no clear answers yet to these types of questions.
So What Do These Studies Show? These types of studies show that acupuncture can and does stimulate the body’s natural functions to heal and regulate. At this time, however, only the vast theories of Chinese Medicine explain how best to accomplish this for a given set of symptoms. For practitioners that understand the complex set of theories underlying Chinese Medicine we see somewhat of an endless labyrinth with studies of this nature. From clinical experience we know that we may use a particular point to create a particular effect, but that same point will have a different effect when used with a related point, and yet another with a different point --- and so on. In other words, there are a multitude of relationships that are accounted for through thousands of years of observation, use, and clinical research that are very difficult to study using western techniques and terminology.
Other explanations of how Acupuncture works
The “Endorphin” Theory: As mentioned above, one theory that attempts to explain the “how” of acupuncture is the endorphin theory. Studies have shown that acupuncture leads to the release of endorphins and these are powerful natural pain killers. Some studies, however, have shown no release of endorphins during treatment. The endorphin view, even if the sole “how” of acupuncture, would only explain effects on pain and perhaps inflammatory related conditions but would be difficult to explain how it may help with anxiety or fertility or parkinsons.
The “Gate Control” Theory: Acupuncture is also thought to work through the “Gate Control” theory of pain. This theory presented by Patrick Wall and Ronald Melzack in 1965, states that pain is a function of the balance between messages in the central nervous system (brain and spinal cord) and the peripheral nervous system (branching nerves within the body). In essence the theory is about how many messages the body can carry and listen and respond to at one time. By stimulating the large nerve fibers (as acupuncture appears to do) you can essentially block the bodies ability to experience “pain”. As with the endorphin theory, this theory does not explain acupunctures effect on other chemistry and other non-pain related conditions. Nor does it explain why the effects of acupuncture can last for significant periods of time following a treatment.
The “Nerve-Reflex” Theory: This theory, proposed by a team of Japanese physiologists in the 1950's, showed a relationship between the surface of the skin and the state of internal organs. Essentially an imbalance of an organ, the stomach for example, would send messages to the brain about it's “problem”, during this it would also send information to the skin that could cause tension, color changes, or other signs that are viewable or “feel”-able by the patient or a practitioner. Needling these areas on the skin would create an inverse reaction directing the healing potential of the body to that organ. This is likely a part of how acupuncture points were ever found to begin with and also how techniques such as abdominal palpation (common in Japanese acupuncture) give valid clinical information. Again, though, it doesn't explain how we would effect brain chemistry, or even how, exactly, it would lead to the healing of an internal organ.
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