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With an evolution exceeding well over 2000 years, acupuncture is a practice whose roots lie in cultural ideologies that are almost inconceivable to us now. In the 21^st century we can best understand acupuncture (at least in terms of its physical delivery) as a technique of neuro humoral modulation, but this interpretation has only been possible through modern advances in understanding the body’s physiological mechanisms through science. For most of its history, acupuncture been couched in naturalistic, cryptic and seemingly mystical language; and while the rich metaphorical imagery of Chinese medicine is poetic, useful, and sufficient as a standalone way of delivering treatment, it does in a scientific epoch all too frequently garner misunderstanding, confusion and misinterpretation.

As such, some of the most interesting work developing in the field is the work done in reconceptualising acupuncture so that it can be understood in scientific terms. For me, this marriage of understanding both the benefits and the limitations of a traditional approach is an essential part in the ongoing evolution of acupuncture. Over the coming months I’ll be blogging and linking to some excellent resources that demonstrate the work going on in this area. Hopefully, this will illustrate how we now no longer need to refer to acupuncture solely in terms that are at odds with biomedicine, but rather in terms that are consistent with it.

The history of Acupuncture and Chinese Medicine

Acupuncture, which is one branch of Chinese medicine, has a very long history. The practice of needling patients for therapeutic benefit has existed for thousands of years and has descended through time periods and cultures in which ideas of health, illness and their causes differed drastically from our modern day perspective. Although there is no historical record of acupuncture needling before 90 years BC, the roots of Chinese medicine and early concepts of health and illness can be traced back to the Shang dynasty (1600BC – 1046BC).

Shang Dynasty medicine (1600BC – 1046BC)

In Shang dynasty culture there was only one possible cause of illness – injury from an ancestor. For us living in the 21^st century this world view seems extraordinary, but in Shang dynasty China the dead were considered as real as the living and ancestors were seen to require constant propitiations and offerings. Failure to do so could end up in offending the ancestor which therefore resulted in illness. Although there was no medicine as such in this time period, divination was a common way of deeming the ‘will of the ancestors’ and the splitting of tortoise shells and the subsequent patterns of the cracking were reflections of their desires.

Over time, concepts of illness evolved from ancestor worship in the Shang dynasty to demonological medicine which came to prominence in the Chou Dynasty (1050BC – 256BC)

Chou/Zhou Dynasty Medicine (1050BC – 256BC)

While divination as practiced in the Shang dynasty continued into this era, communal attitudes to the apparent existence of the non living members of community changed. Ancestors were deemed less important in the intervention of one’s health and fortune, and there grew a greater emphasis on demons as the cause of illness – an interesting but no less strange development!

During cultural festivals exorcists would charge the streets of the community to thrust spears into the air in order to rid the town of its evil demons. This early theory that illness causing agents could be vanished through piercing and stabbing may have been the early origins of acupuncture. The Chinese character for healer also originated at this time and the character depicts a shaman (doctor) with a quiver and an arrow on the left, and a spear on the right. Thus we have the concept of the healer who heals through exorcism by piercing. (This is obviously not the modern day view of an acupuncturist!)

By the end of the 2^nd century BC ideas on illness and health were evolving further. Medicine was moving away from the ideas of demons as the cause of illness and more toward nature and environment as sources of disease. At this time wind was seen to be a powerful component of illness and over time that evolved to include heat, damp, cold and dryness as well as various emotional states. Medicine was moving away from metaphysical assumptions about the cause of illness, to the realisation that man’s earthly and emotional environment may be more important in the patterns of his health.

The Huangdi Neijing

The Huangdi Neijing is a seminal text of Chinese medical practice and its formulation is dated at somewhere around the 2^nd century BC. This text represents the first compendium of Chinese medicine as an organised practice and was strongly influenced by Confucianism at the time. It presents the theory of systematic correspondence which forms a cornerstone of Chinese medical thinking. The theory of systematic correspondence details an intricate network of relationships between physical organs, the emotions they affect and are affected by, and the environmental influences which contribute to the disease of the organs. Many schools of acupuncture base their practice on these theories but developed and expanded them in their own way.

The origins of acupuncture

The origins of acupuncture are actually not very clear but many theories abound. There appears to be a significant hazy period in the history of the evolution of acupuncture. The Huangdi Neijing makes an appearance somewhere around the 2^nd century BC (although this is debated by historians) and is a highly organized text mentioning acupuncture practice, however very little other textual evidence of the use of acupuncture exists prior to this.

The most commonly accepted theory of the beginnings of acupuncture are that it evolved from boil lancing with perhaps some historical influence from the remnants of demonological medicine. One could propose that lancing boils not only served to visibly drain pathogenic substances from the body, but also that it stimulated endorphin release which contributed to the resolution of additional health problems as well as those connected to the boils. If lancing boils evidently drained illness from the body, it may have been the assumption that illness lying deeper within the body could also be extricated through methods of needling.

How does acupuncture work?

This is perhaps the most simple and natural question about acupuncture but it’s actually more complex than it might seem and the answer depends upon the perspective from which one is asking – there is acupuncture as conceived by the Chinese 2000 years ago, and there is acupuncture as conceived now by conventional medicine in the 21^stcentury. In many ways the two can be seen to overlap and to communicate about the same thing, just in different language. This is the first of two articles exploring how acupuncture works, and here we will focus on the modern day conventional view.

What modern science has to say about acupuncture

Although it is still partial, there is now a good basic understanding of how acupuncture works – particularly in relation to its potential to reduce pain. The wider capabilities of acupuncture are not so well understood, and it is likely that there are additional mechanisms not yet discovered. The mechanisms that are understood can be categorised in the following way:

1)      Local effects in the tissues surrounding the needle

2)      Segmental effects affecting portions of the body supplied by common nerve pathways

3)      Extra segmental effects occurring in the brain in the form of neuropeptide release

4)      Central regulatory effects occurring throughout the whole human system.

Local effects in the tissues surrounding the needle

As soon as a needle is inserted into the body it begins to stimulate the nervous system. A nerve in response to being stimulated by a needle soon begins to release a chemical called calcitonin gene related peptide (CGRP). CGRP is a vasodilator which means it dilates blood vessels thereby increasing blood flow to the immediate area. This stimulates tissue repair and aids recovery.

Segmental effects affecting portions of the body supplied by common nerve pathways

At the same time as CGRP is being released, the stimulated nerve, in what’s known as an axon reflex, continues to propagate the stimulation up into a portion of the spinal cord called the dorsal horn. Here local cells release enkephalin which is a chemical that blocks further stimulation from the nerve. As nerves supply wide portions of the body a needle inserted in one area will hamper further stimulation from a wider area around it. This is termed segmental analgesia and an additional effect of it is to soften muscle tone in the area thereby dissipating tension. One could understand the action of enkephalin in the dorsal horn as the equivalent of a red light at a traffic light that halts the progress of further traffic i.e. it stops the progress of pain messages. As nerves supply and run off organs as well as muscles, acupuncture can help block pain messages coming from both.

Extra segmental effects occurring in the brain in the form of neuropeptide release

It is acupuncture’s effects in the brain that correspond to its capacities to effect change in a wide range of conditions.

Continuing up from the spinal cord the stimulated nerve propagates up and into the brain and across several portions of it. This in turn stimulates the production of:

ACTH (Adrenocorticotropic hormone) – a hormone which increases the production of corticosteroid thereby reducing inflammation

Endorphin – which further increases analgesia and promotes a sense of well being

Serotonin – which increases the further production of enkephalin, thereby reinforcing analgesia and feelings of wellness.

Noradrenaline – which further inhibits pain messages from the dorsal horn in the spinal cord

It is also hypothesised that oxytocin may be an important component in the sedating and calming effects that acupuncture induces, and also that the hypothalamo-pituitary ovarian axis is brought into balance by secretion of endorphin and ACTH. This mechanism may explain how acupuncture is able to regulate menstrual flow and duration and also to reduce the pain associated with the period.

Central regulatory effects occurring throughout the whole human system.

Once the axon reflex affects the brain it exerts an influence over the limbic system. The limbic system is the portion of the brain responsible for the affective component of illness as opposed to the sensory aspect of it, and when affected by acupuncture it typically reduces the sense of distress that pain and ill health can cause. An example would be experiencing a headache but with a reduced sense of distress that the pain might usually cause. It is this mechanism that could account for the sense that many patients get from acupuncture, which is the feeling of being happier, more relaxed, and more able to cope with life.

So to conclude our brief tour of the conventional perspective we can see that acupuncture produces inhibition of pain from peripheral nerve stimulation blocking pain messages from below, and induces the production of pain killing chemicals from above in the brain. This produces typical experiences of calmness and well being. In terms of the wider effects of acupuncture, this is thought to occur through various structures in the brain whose stimulation results in the production and secretion of a variety of different chemicals which exert widespread influence throughout the whole human system.