On the Architecture of Belief and Acupuncture's Tangible MOA
In this article I will outline tangible theories on how acupuncture works. To begin though, I'll address the greater context of why this question is so important to us. If you're looking for a neat, concise answer: see our FAQs article.
Skip to Part B if you want to get straight to it.
PART A: FOREIGN AND FAMILIAR
Most of us have a deep desire to understand the world around us, to categorize it into departments of belief. We know that we believe in this, and we don't believe in that. We are part of this group and not part of that group. This makes us feel safe. The dominant medical paradigm of our time is Western medicine, which is assumed to be based in purely scientific understanding. To base our understanding on a purely scientific view of the world makes rational sense, yet in practice it is full of contradiction and bias.
The more foreign something is, the more important this question becomes. Acupuncture is foreign to the US, therefore we MUST know how it works to accept it. Let's examine our beliefs on that for a moment.
Do you know how your car works? Some of you do, but most of us do not understand how cars work yet we trust them with our lives every day.
Do you know how electricity works? How about the internet? These things have major impacts on our lives yet most of us actually understand them very little.
Let's take a look in the medicine cabinet. You probably know Tylenol, acetaminophen. Yes you know it's a pain-reliever, fever-reducer because the box says so. But HOW does it work? What is its mechanism of action? Your pharmacist can't tell you, your doctor can't tell you, because it's not actually understood. The mechanism of action of acetaminophen is listed as unknown, as are hundreds of other commonly used pharmaceutical drugs.
The undercurrent of our comfort with these common things that we don't truly understand is that 1) they are familiar and 2) we know that someone, some expert, understands them and theoretically could explain it to us.
This is problematic when it comes to Chinese Medicine and Acupuncture. Chinese Medicine experts understand how acupuncture and Chinese Medicine work. But the context is understood from the perspective of Chinese Medicine, which does not easily translate into Western ideas of how things work. So I can explain that your migraines are caused by Taiyang Shang Han, and the herbal formula I will prescribe based on that understanding will work and the migraine will go away. But that explanation sounds like shamanic gibberish to most people and doesn't satisfy the western mind's understanding of how the world works.
It's also problematic if we dig deeper into our western medicine experts.
IT'S 2018. DOESN'T WESTERN MEDICINE HAVE IT ALL FIGURED OUT YET?
So the point I'm making here is that if we are actually claiming that we are rational scientists, we have to examine both foreign and familiar with equal levels of skepticism or acceptance. So if you don't buy acupuncture because you don't know how it works, you should also toss out about 40% of all pharmaceutical drugs that are on the market today.
The truth, however unsettling, is that medicine still contains a great deal of mystery no matter how you slice it.
Let's take an example: acid reflux. 20% of Americans suffer from acid reflux. So you go to the doctor, they prescribe a drug. Most likely a proton-pump inhibitor, to block acid production. If you ask your doctor why he prescribed that, they might say that this drug therapy is based on our understanding of the disease. Does that drug therapy work? No, it really does not work. Short term symptom relief, sure. But PPIs like omeprazole are only FDA approved for 4-8 weeks maximum. So how come so many Americans are prescribed omeprazole for 10 to 20 years, and they still have problems with reflux? That drug therapy is based on a theory of how acid reflux works. And, based on the outcomes you can clearly see that the theory is wrong, because it does not hold up in real life practice.
Another example: cardiovascular disease. Heart disease is the number one cause of death worldwide. Many of you know someone with high blood pressure, ie hypertension. Ask your doctor what's causing that? Well, 95% of hypertension cases are classified as "essential hypertension." The cause of essential hypertension? Unknown.
What if I told you that Chinese Medicine has a better understanding of cardiovascular disease?
Where did we get noodles? China. Gunpowder? China. Paper? China. Silk? China. An anatomically correct model of the cardiovascular system? Well, our western medical textbooks will say William Harvey (finally) figured out venous blood return out in 1600 AD. But China had it accurately recorded in the Nei Jing in 300 BC. Until Harvey, the western medical world had Galen's theory that the heart pumped blood out and it somehow magically just made it back to the heart to get re-oxygenated. That's a 1900 year lead on understanding heart function. Which medicine sounds dated now?
Even today with all our sophisticated equipment, the gold standard for evaluating heart function (EKG stress test) can only detect blockages in the heart that are 70% occluded or greater. That means you can have a coronary artery that's 60% blocked and the test will give you the good-to-go green light. A well-trained Chinese Medicine practitioner can detect early signs of cardiovascular problems long before they reach this stage of severity.
RESULTS ARE OUR PROOF OF UNDERSTANDING
Your mechanic might be able to fix your car problem, that doesn't mean they can explain it to you in a way that makes sense. What matters is that your problem got fixed. And it's proof that the mechanic knew what they were dealing with.
When I see a patient in atrial fibrillation with a rapid, irregular heart rate of 110, and within minutes of inserting a few acupuncture needles their heart rhythm stabilizes, I know that the treatment worked. I know why it works based on Chinese Medicine principles and acupuncture channel theory. In western terms I can speculate, but it's honestly not that important to me or to the patient. Or when a patient with acid reflux has taken PPIs for 20 years and still has reflux, and I treat them with herbs for 8 weeks and the reflux is completely gone, I know that we used the right treatment principle. If it doesn't work, we know that we used the wrong treatment principles. Our understanding of a problem is directly proportional to our ability to apply an effective solution.
PART B: ACUPUNCTURE'S MECHANISM OF ACTION
Now that you read through all that, I'll present some explanations that will probably make a good deal of sense. But, like all medical understanding, these are theories.
Acupuncture works via stimulation to the nervous system, cardiovascular system, and connective tissue (fascia). The insertion of an acupuncture needle into the body stimulates the nerves where the needle is inserted and this stimulus travels from the peripheral nerves to the central nervous system and on to the brain. The stimulation causes the release of endogenous pain-killers from the brain, and increases blood flow to the needle site and the entire dermatome and fascial train on which the needle lies. Increasing blood flow to the diseased body part allows new healthy blood to nourish the targeted organs and tissues, and increased blood flow also allows waste products to be more efficiently carried away from the diseased area. Acupuncture stimulation of the nervous system promotes regulation of the autonomic nervous system and endocrine system, ie homeostatic balance.
THE BODY AS AN ELECTRICAL CIRCUIT
In addition to stimulation to the nerves and blood vessels, stimulation to the connective tissue is an essential mechanism of acupuncture's effects. How can an acupuncture needle inserted in the lateral side of your foot relieve pain and tension in your occiput? Because it's all connected. I'm not talking about the cosmos or psychic energy, I mean it's literally all physically connected.
Fascia. Every muscle in the body is wrapped in connective tissue known as fascia. You won't see fascia in a a cadaver lab anatomy class, because it is all removed in order to better see the different muscle groups. It's removed because if it was there, it would be hard to see the division in body parts. (Yes, that is indeed a major oversight in the education of medical professionals) The fascia that wraps the muscles on your lateral foot is connected to the fascia that wraps a bundle of muscles in the calf which is connected to the fascia on the adjacent muscle and so forth, creating what are known as fascial trains. There is a fascial train that runs from the lateral foot up the posterior leg and all the way to the base of the skull. Well, that fascial train happens to be in the same location as an acupuncture channel.
Electricity. The collagen matrix that makes up this connective tissue has been shown to be electro-conductive, transferring what is known as piezoelecticity throughout the body. Fascia transmits electrical signals from one body part to another faster than nerve conduction. The human body is an organic electricity generator. The heart muscle generates the largest electromagnetic field in the body, and heart rhythms are based on normal electrical signal flow.
Together now. An acupuncture needle is metal, and electro-conductive. The human body is electro-conductive via fascial trains. It has been shown that inserting an acupuncture needles stimulates an electrical response in the fascia that can travel, extremely quickly, from one part of the body to another part that seemed to be "completely separate" such as the hand to the jaw muscles. Acupuncture needles have been shown to change signal strength along these fascial trains, which suggests a means by which acupuncture can regulate flow of electricity throughout the body.
ACUPUNCTURE AND PAIN
The role of pain. Let's examine the role of pain in our bodies. Pain is a sensory stimulus that functions to protect us from harm. Touch a hot stove? Pain. Snake bites your ankle? Pain. Pain signals the body that something is wrong, so we can avoid it or so the body can protect itself. Acute pain is a healthy, functional response. Chronic pain, however, is not.
Let's say you fall and injure your ankle. The body knows something just went wrong, but it doesn't know exactly what. So the first response is down-regulate blood circulation to the affected area. Inflammation and swelling results as the tissues mobilize to heal damaged tissue. Maybe you sprained your ankle, maybe you got bit by a venomous snake. Your brain doesn't know the difference, so it plays it safe by slowing down circulation to the area in the short term until the local area can heal. After this short-term inflammation and swelling passes, normal blood circulation returns and allows the area to complete the healing process.
But how about chronic pain? Chronic pain is essentially a process where this normal healing has been interrupted. Some part of the body tissues are damaged, but the body is still in lock-down mode. The brain is still getting a pain-signal however, and the body does not resume complete normal blood flow to the area which is necessary to repair damaged tissue, carry away metabolic waste, and vitalize the tissue with fresh blood and nutrients.
Acupuncture and chronic pain. Acupuncture essentially is signaling the body to complete the healing process in the problem area. The acupuncture needle provides a stimulus. Acupuncture is painless, but not sensation-less. The sensation signals the brain to kick off endogenous pain-killing compounds. As the sensation of pain is removed, the body resumes normal blood circulation to the affected area to complete the healing process. Chronic pain is a dysfunction in the healing process where a step has been skipped over, leading to incomplete healing. Acupuncture is an excellent tool to stimulate the body to finish it's work.
Now, we have an understanding of how acupuncture works via several different pathways. This explanation is by no means exhaustive. In my opinion the confusion lies in people trying to find one, single, specific way in which acupuncture works. Like most things in life, it's not quite that simple. Acupuncture stimulates the peripheral nervous system which signals the central nervous system. It stimulates capillaries to stimulate blood circulation. It stimulates fascia that carry electrical signals throughout the entire body. It is working through multiple, overlapping body systems that ultimately all deal with homeostatic balance and natural healing mechanisms. Are there even more ways in which acupuncture influences the body that we have yet to understand and quantify? Certainly! Mystery will always be a part of life and of medicine, no matter how far science and knowledge takes us. You need not believe in acupuncture for it to work. In fact, most people I see do not believe in it at all! They're looking for a way out of pain, a solution to a problem, a way to feel more alive and vibrant with health. So, if you can, try thinking about it like you are taking your car to an expert mechanic. We will use our clinical experience and knowledge of Chinese Medicine to get you feeling better. Explaining it? We'll do our best, but that part is actually often harder than helping you.