Part III: AcupunctureMar 16, 2021 by Jason Gauruder
Tags: Acupuncture, chinese medicine
Acupuncture has become the most popular technique of Chinese Medicine available in the US. Its applications have become broad and like other parts of the medicine have changed over time. In my clinic, acupuncture is most frequently used for pain, Musculo-skeletal dysfunction, neuropathic problems, and helping with internal symptoms like sinusitis, acid reflux, and women’s health complaints related to infertility and cycle dysfunction.
In today’s blog I will dive into how acupuncture works, various types of acupuncture, and the history of this technique that has unfortunately been steeped in misinformation and poor translation.
First and foremost, it must be understood that acupuncture is NOT a metaphysical energy technique. Contrary to popular notions that are often published even on acupuncturist’s own websites, this idea of magic running through energy meridian lines in the body is the result of the first translation being incorrect and carelessly reproduced. Acupuncture is a physiology-based medicine that stimulates the nerves of the body to influence blood flow and the movement of nutrients contained in the blood vessels to an area of dysfunction.
When the first written text on acupuncture is translated correctly (Yellow Emperor’s Canon) it is blatantly evident that even 2000 years ago there was an understanding from dissection that pricking the body affected the blood vessels and by stimulating one section of the piping you could affect the entire network. As with the rest of Chinese Medicine, countless physicians over the generations would utilize the skill and publish commentary on how to best use acupuncture to treat various conditions and through years of clinical practice understand the acupuncture points as we now call them.
The reason we know acupuncture is physiologically based medicine is because it requires a physical tool that is inserted into the body. In the past all kinds of metals and even animal bones could be sharpened into needles. Today we use sterile stainless steel as the tool of choice and they are much finer than the needles of the past, so much so that their tips blunt making them single use.
When a needle is inserted into the skin the stimulation of the body occurs because of the nervous system. Tiny nerve fibers under the skin called nociceptor and proprioceptive fibers fire an electrical signal in response to a foreign object piercing the skin. Like a telephone wire, the nerve carries this signal from the site of needle insertion to the spine where the spinal cord relays the information to the midbrain. The midbrain has several functions one of which being reflexes and motor control, in response to the needle a cascade of factors occur that allow the midbrain to push a naturally occurring opioid called enkephalins to the site of where the needle is located in order to reduce the sensation of pain and allow healing to begin. To accomplish this the opioids are sent through the blood vessels that follow along the nerve or set of nerves that fired the initial impulse. More simply, by needling the body an entire network of nerves is fired up to the brain and in response the brain moves pain killers through the blood vessels down to the needle site.
Acupuncture also has shown to have a powerful effect on the autonomic nervous system allowing people to fall into a restful state and reorganize how the brain experiences pain, as well as effecting the mechanisms that control inflammation and immune response. In a future blog I will discuss pain more in depth, but for brevity’s sake the important thing to understand is that by needling a nerve network you can cause a healing response not only in the area of where the needle was placed, but the entire network of cables leading up to the brain. This is where leaving acupuncture needles in for at least 40 minutes comes from. Around this time is when we find the stimulation from the needle allows for maximum dilation of the blood vessels and for a transition into an autonomic state of rest so the body can start to heal itself. (It usually leads to the euphoric sensation people experience getting off the table when a session has concluded)
The Chinese designated these networks as the 12 pathways usually seen on acupuncture models. It also allows for needling a part of the body to influence another. For example, trigeminal neuralgia is a very painful condition where the trigeminal nerve of the face becomes so painful people often harm themselves to alleviate the suffering.
One could stick a needle in the area where one is having this pain, but it would more likely cause more localized inflammation and pain which would further damage the patient’s psychology.
Luckily, because we can needle away from the site of the pain and still have a positive response, we can needle on the nerve/blood vessel pathway that leads up to the face. This technique is called distal acupuncture and is the basis of acupuncture in my clinic as it is tremendously effective and the best tool I know of for neuropathic pain. Distal acupuncture helps the body alleviate pain immediately so the patient knows the treatment is working, something that cannot be done if a needle is stuck in the area where a patient is having pain. It also allows the body to move fresh blood supply into the pain area to help clean up the damage causing the pain whether its nerve or muscle related, so that over time the body actually heals itself and no longer needs treatment or only infrequent maintenance visits to remind the nervous system there is no longer a threat in an area it has guarded for so long. This YouTube video is one of my favorites in explaining the technique:
In some patients a considerable amount of muscle “knots” may form that contract around a nerve and constantly fire a pain signal. In most cases distal acupuncture as described above will alleviate this condition as the body will relax the muscles and bring in new supplies to repair the overused or damaged muscle cells.
However, there are conditions where years of rigid position, overuse, or a serious traumatic injury will create a chaotic network of adhesive muscle tissue, scar tissue, and destroyed nerve tissue. This makes it difficult for the body to resupply the area with healthy resources even with acupuncture stimulation.
This is when a more aggressive form of needling called trigger point acupuncture is utilized. An acupuncture needle is inserted directly into the area having pain to break up the adhesive muscle tissue or scar tissue to more aggressively stimulate a healing response in the area and release the rigid positioning of a muscle that may be constricting nerves or pulling on the surrounding the viscera creating referred pain. For example, I have found clinically that most headaches and migraines are actually problems with the circulation to the head from rigid or knotted muscles in the neck.
In general, distal acupuncture can correct the blood flow to the skull, but in some patients, you can feel the immobile deposits of a lifetime of muscle rigidity in their neck and they require a needle to help break up this physical barrier that is impeding blood flow to the head that results in headaches.
I also generally do not start with this technique as the jump in the muscle tissue or sensation of the needle breaking up these knots can be unnerving to a new patient, but if it is necessary I do advise it with a disclaimer that there will be discomfort from the needling and soreness afterwards, but in this case the needle does not need to remain in the tissue for 40 minutes and is removed after the trigger point is hit.
Another form of acupuncture that has become famous is simply using the scalp or ear to stimulate the body. Scalp acupuncture or auricular acupuncture seem to have a direct effect on the cranial nerves to elicit a systemic response. Several acupuncturists have become famous over the last few decades for utilizing scalp acupuncture for stroke recovery and auricular acupuncture for detoxification protocols in those suffering from substance addiction and soldiers suffering from combat PTSD.
If you want to know a more detailed understanding of how this all works, there is an entire chapter in the Dao of Chinese Medicine by Donald Kendall that was peer reviewed by Oxford University Press on the subject. If you want to write a research paper or explain acupuncture to a group of medical professionals, it is a requirement that you read this chapter first so you know what you are talking about!
In my clinical experience distal acupuncture works for most conditions, but sometimes utilizing all three methods is necessary. I also never refuse other modalities to help with recovery such as massage, chiropractic, or osteopathic manipulation. Therefore, I utilize acupuncture primarily for structural disorders and pain problems. Acupuncture certainly helps stimulate organs and other pathways, but is inferior to herbal medicine for internal problems, but superior in its speed to helping with pain and trauma.
I will repeat myself in that simply because we have a modern understanding of how aspects of Chinese Medicine works do not mean we can ignore the lengthy history of the medicine just because some of the language is older or concepts different from Western ones. To not waste years of making the same mistakes that have already been made in the past from previous clinicians it is best to understand some of the history of acupuncture and how it came to be as it is today.
Acupuncture could be far older and more widespread than we know. The famous Otzi man from over 5000 years ago was found in the Alps with burned tattoos on various joint regions of his body where MRI found it was likely he was having arthritic related pain (these spots also correlated with modern acupuncture points). Early man probably tried to cut out or burn away areas of pain and settled on piercing select spots with a hot poker leaving a type of tattoo. It was the Chinese who first wrote down about the practice and continued a clinical practice of various techniques up to the modern day.
Over the centuries finer metals were fashioned to be used for acupuncture and countless records on spots that had particular effects when pierced or needled. These became what we know today as acupuncture points. Many points were named off their anatomical position and some for their function. The early Chinese even realized that twelve discernable pathways could be stimulated from acupuncture. Without realizing it was the work of the nervous system three branches on the lateral portion of the arm influenced the muscles and fascia from the fingers to the face, three branches influenced the medial portion of the arm influenced the hands to the chest, three branches on the lateral region of the leg influenced the foot to the head, and three branches on the medial region of the leg influenced the sole of the foot to the diaphragm.
They categorized each three segments by yin or yang and knew that needling one segment of the neuro-vascular pathway would stimulate the rest of the pathway. A famous acupuncture point we now refer to as Stomach 36 is located below the knee but has repeatedly shown in studies to have beneficial effects on the digestive tract as the Yang Ming pathway of the leg runs from the dorsal portion of the foot through the abdomen to the face.
It was not until the last few hundred years that the standard acupuncture model was created with a map of the acupuncture points with lines connecting them to show these pathways was created. The muscle distribution charts found in the Dao of Chinese Medicine are superior by today’s anatomy standards, but these mostly accurate bronze cast statues were the first anatomically correct teaching aids on acupuncture.
It should also be mentioned that if you overlay the acupuncture points of this statue on top of a modern trigger point model of all the major muscles of the body, you will notice a striking correlation. Acupuncture points were known for their dynamic function, but also for their ability to affect a localized region of pain from a trigger point.
So how is it we live in a world where acupuncture is seen as a New Age medicine and some Western physiologists claim to have discovered trigger point needling (they call it dry needling) only 40 years ago?
Unfortunately, it’s due to one man who has until recently never been corrected. George Soulie de Morant was a French diplomat at the beginning of the 20th Century who was one of the first people to get his hands on various volumes of classical Chinese acupuncture texts during his time working in China.
Although he was skilled in the Chinese language that allowed to him to work for the government, he did not have any background in medicine or the sciences. His expertise in translating court documents ended when it came to the Chinese characters explaining anatomy and physiology, so by sheer ignorance instead of consulting with any medical scholars he simply began making up words and believed he had discovered some new mystical art of medicine. His translations on acupuncture made him extremely popular with the New Age groups of French aristocracy so his promotion of acupuncture became one of notoriety rather than accuracy and clinical relevance.
The biggest mistake however came after his death in that western practitioners and publishers who continued promoting acupuncture did so using his unfounded terminology and continued to promote acupuncture using an energy meridian model that has never existed.
Today’s most respected philologists (Paul Unschuld being the most authoritative) all agree that the Chinese characters used to explain acupuncture do so by utilizing the characters for blood vessel and the understanding the word Qi means vital air and metabolic energy. I believe it is a huge insult to boil down thousands of years of clinical practice down to energy medicine that cannot be proven unless by its intended anatomically based physiology.
Furthermore, that by doing so upholds the translation of Morant who associated with the same group of people who believed strongly in the racist theory of phrenology and eugenics, who even made their ideas into his work where several acupuncture points are noted in that they uphold “purity of race.”
Unfortunately, many acupuncturists are still themselves ignorant to this and keep perpetuating myth. I have written several letters to the national association on the matter, but there is push back to change. I believe the schools should be teaching the correct language from the start as it would tremendously help the profession gain respect and help with funding for more access. It would also keep acupuncture in the hands of the skilled practitioners who know how to needle and its dynamic effects, as opposed to those who take weekend courses in dry needling and claim to be experts. (I’m serious that’s a real thing that happens and people frequently get injured).
However, those who have upheld the energy meridian model their whole life find it difficult to give it up, especially if they have a vested financial interest such as books or seminars that have been teaching incorrectly for decades.
The same goes for the Communist government of China that knows and teaches acupuncture as a physical medicine technique in their medical schools and hospitals, but when talking to foreign practitioners or publishers’ default to the energy meridian translations. This is because it allows their government to control the access and financially benefit as the source of the medicine, when ironically a majority of those who were experts in the medicine fled to Taiwan and Hong Kong when Mao took over mainland China.
There is no doubt that acupuncture will play a fundamental role in the overall picture of healthcare in the future, so hopefully this article will help curious minds understand the technique better and help others understand it has basis in science and repeatable procedure. It is also important to note that acupuncture has continued to gain acceptance because although the translation is incorrect leading people to believe it is pseudo-science or placebo, acupuncture continually outperforms many other therapies in double blind studies on pain and internal disorders.
I believe if the correct information gets out, acupuncturists will be a central component to healthcare in the future that helps bring down cost for everyone and results in clinical success for everyone in the field of pain, rehabilitation, and even internal medicine.
In China, because of their full integration of acupuncture with Western medicine you can see it in every part of the hospital system there. From outpatient treatments that keep people from needing invasive surgeries, to using electroacupuncture in place of anesthesia in the operating room and using acupuncture in rehab centers for stroke and recovery.
Here is one video of anesthetic acupuncture for open heart surgery. However, at the end of the video you see a perfect example of a western journalist grappling with trying to explain Qi and how acupuncture works as it has not been explained to her correctly:
Join me next time as we conclude our series with Part 4 on herbal medicine.