I recently came across an article by an MD, who studied naturopathy and acupuncture. She is ostensibly very well trained and experienced in a range of medical fields, and yet still fails to talk sensibly about acupuncture.
In reference to a workshop she ran for non-professionals, dubbed “Acupuncture 101”, this medical professional said:
“In theory, what acupuncture does, is you insert tiny needles along the meridian system. By inserting these very small needles you are allowing the body’s natural energy source to align and fix things on its own.
“The number one question I get in my office is how does acupuncture work?” Liles said. “I can tell you with 100 percent certainty that we have no idea right now.”
While this practitioner’s intentions are in the right place, the substance needs some updating. “Meridians” is a poor translation of the Chinese 經絡 jingluo, the “natural energy source” is a vague expression that seems to refer to 氣 qi, but I think many TCM practitioners would raise an eyebrow at this translation. Others have written about translating these terms, and maybe I’ll get into it later. For now, I want to say a few things about this practitioner’s last comment: the idea that we have no idea how acupuncture works. This is flat-out wrong. I’ll assume she doesn’t mean an understanding within Eastern medical theory, which is very clear about exactly how acupuncture (as well as cupping, gua sha, etc.) affects physiology, and I don’t think it’s about a “natural energy source”, though it’s hard to say what she means.
So the question is, does modern Western medical science have any understanding of how acupuncture works?
There are many biological mechanisms that have proven to be influenced by needling specific areas. Just to give you an idea, when a needle is inserted below the skin, the following effects have been studied: brain activity increases in one place and decreases in another place showing CNS activation, neurotransmitters and hormones are regulated (and research has identified many specific agents in these processes, having a wide effect on illness and healing), inflammation is reduced through various identified mechanisms, IgE is down-regulated to treat allergic rhinitis, endorphins are released to treat pain, connective tissue (fascia) is manipulated (which influences bioelectrical conductivity and triggers the release of crucial cellular products like adenosine from surrounding tissues), etc.
If you are so inclined, just hop over to PubMed and see for yourself, or type “acupuncture” plus any of the key words above into Google Scholar.
And that’s just about the mechanism. There are many well-designed studies that support the use of acupuncture to treat many health conditions, regardless of what specific mechanism is at play. At the present moment, there is strong evidence to show it is affective for chemotherapy-induced nausea and vomiting, chronic low back pain, tension headache, chronic headache, migraine prophylaxis, allergic rhinitis, knee osteoarthritis, postoperative nausea/vomiting, and postoperative pain. There is moderate evidence for additional 38 conditions. And crucially, this list grows as more and better studies are done.
Modern Western science is only beginning to understand ancient Eastern science. As the former improves its grasp on complex systems, and the latter becomes more accessible to us through better translations of the source material and intelligent application in modern settings, the two find more and more common ground.
So why do people still say we don’t know how acupuncture works? One likelihood is that some critics are simply not reading the growing number of well-constructed studies about acupuncture. Others are not actually thinking scientifically, which is to say, thinking with a critical yet open mind. Being honest and open about what we do in fact know and what we do not know is a fundamental tenet of science. And there are many, many things we do not know.
For others, the reason they refuse to believe that acupuncture works is that it works in more than one way. Is the “placebo effect” part of this? Yes, as much as it is part of every pill you take. Can you say that acupuncture works only through the placebo effect? Categorically no. There is simply to much scientific data supporting the contrary.
Acupuncture is not a linear treatment. One symptom does not equal one point. The body does not correct its pathologies this way. Many mechanisms are adjusting and counterbalancing simultaneously. My personal belief is that this is the reason acupuncture has few to no side effects while most pharmaceutical drugs, which often to target a single process, have many side effects.
Dealing with Complexity
The reason why we have trouble understanding the mechanism of acupuncture, and proving its efficacy through double-blind randomized controlled trials, is exactly the reason why we need acupuncture and Eastern medicine frameworks in our health care system.
Eastern medicine is designed for complexity. Its founders used the patterns of natural systems like climate, watersheds, and temporal rhythms to make sense of the patterns within our bodies. Western medicine specializes in reduction, in finding the one single thing that causes that excruciating pain in your abdomen, or the handful of environmental triggers for your allergic rhinitis. No one denies that Western medicine has achieved amazing things with this approach. However, it simply cannot handle the huge number of variables in real life.
Weather prediction is an easy example. There are too many variables in weather systems to really accurately predict whether it will rain tomorrow (or even in 10 minutes). But that does not mean that the weather does not have definable factors. We even know what they are (temperature, humidity, wind currents, water currents, etc.), but our computing systems cannot handle so many moving parts.
The human body is similar. There are so many things at play, so many pieces in constant movement, that the scientific method struggles to understand how all these things interact with each other in a living human being.
Weather patterns are similar in their complexity to the internal landscape of the human body.
Eastern medicine has developed through many generations of recorded observations in the patterns of movement, within an individual's own body (and mind) and in their interactions with their environment. The diagnostic framework has a place for all these variables.
One More Possibility
There is one more possibility for not believing that acupuncture works, and this one is personal. Someone tried it and they didn’t get better. This is a valid concern, but it is not founded on clinical experience. Results from an acupuncture treatment depend on the chronicity/severity of the condition, the diagnostic skill and technique of the practitioner, and the patient’s commitment to the treatment.
One treatment cannot show you whether the medicine as a whole works.
I have met people who tried it once, didn’t get better, and decided that acupuncture doesn’t work. This is like getting a prescription for Zoloft to treat depression, taking it for one day, still feeling depressed, and deciding that pharmaceutical drugs don’t work.
Acupuncture treatment, in most cases, has a cumulative effect. Results are built over time and respond best to regular, repeated treatments. In China, most patients are seen daily or every other day, so the course of treatment is concentrated. However, in the West where many practitioners have settled for a weekly treatment model, it takes months to resolve what is treated in a week or two in China.
For others, they gave it an honest go, and didn’t see the results they hoped for. It could also be the practitioner misdiagnosed and you need a second opinion. It could be that the treatment modality was simply incorrect—somethings respond to internal medicine or movement exercises better than acupuncture.
Finally, there are of course some conditions that acupuncture does not generally do well at, and there are others that medicine as a whole has yet to get a grasp on. These should be addressed in your first conversation with your acupuncturist when you talk about what your course of treatment will look like.