Ep. 1: How does acupuncture work?

As a doctor of Chinese Medicine, and a scientist interested in both ancient technologies and the latest biomedical research, this is one of the most common questions I'm asked. And it's a great question to kick off this podcast, as at this point in time, not only do we have thousands of years of continuous clinical practice of this modality and many documented clinical studies from those millennia, but we also have literally tens of thousands of research papers published in contemporary scientific journals that discuss the many mechanisms and many pathways through which acupuncture has an effect on the body. Join me as a I answer this question from both an Eastern and a Western perspective Transcript One of the main inspirations behind starting this podcast was the many amazing conversations that I have with my patients in clinic, and the awesome and insightful questions I get asked both in, and outside of, clinic throughout my daily life. One of the most common of these questions is “how does acupuncture work?” This is an important one to answer, as quite often I’ll be having a conversation with someone and they’ll say “oh, I love acupuncture and I’d love my husband / mother / co-worker to get acupuncture as they’d really benefit, but they don’t believe in it”. I find this to be an interesting statement, because acupuncture isn’t a religion - it’s not something that you believe in - it either does or it doesn’t work. And particularly at this point in time, not only do we have 5,000 years of continuous clinical practice of this modality and many documented clinical studies from those millennia, but we also have literally tens of thousands of research papers published in contemporary scientific journals that discuss the many mechanisms and many pathways through which acupuncture has an effect on the body. So, I thought this was a great question to kick of this podcast, as it can be answered on so many levels. There’s the short answer, long answer, the Chinese Medicine answer and the biomedical / scientific / contemporary research answer. So I’d like to get into all of those, but I think the best place to start is with the short answer. So, how does acupuncture work? The short answer is that acupuncture works by supporting the body’s innate healing mechanisms. These healing mechanisms are what allow our bodies to heal from cuts and to mend fractured bones, to bounce back from infections and colds, and even in outlying cases it might be what accounts for spontaneous remissions in serious diseases. We all have these superpowers, and in an ideal world, we’d be returning to a state of dynamic balance (or what we also call homeostasis) in the face of life’s various ups and downs. Say we have too many late nights and lots of stressors, and some dietary changes and maybe exposure to some pollutants and toxins: in an ideal world, our body would be able to recalibrate and return to a state of health. But unfortunately, modern life has quite a hectic pace and quite strong demands on us, so we are not always able to live in accordance with both our internal resources (that’s how much energy we have, our current state of emotion and our biochemical reserves, for example) and living in harmony with our external resources (that’s living in harmony with the outside world: harnessing access to sunlight, fresh air and movement). that’s not necessarily always happening – we might forego movement to sit at a desk 12 hours a day, and then drive home through traffic and get stressed, get stuck in a negative mindloop and then come home and have a fight with someone in our family, and have more stresses about money / mortgage / career / all sorts of concerns. So really, we are living in a constant state of constant stress. What this does is it overstimulates our sympathetic nervous system. This is a component of our body’s autonomic nervous system that is also termed the “fight or flight” system. This is the response that we get in the face of stress: it primes our body to escape and so it might pump more blood to the skeletal muscle of arms and legs, it will allow more energy to go to the heart and lungs to strengthen our ability to run away, but what it does is that it shuts down energy and resources going to areas of the body that it deems not immediately essential for survival, which is areas governed by the parasympathetic nervous system, also called “rest, digest and repair”. What this means is that when we’re in a constant state of stress, hypervigilance or anxiety, then we’re not getting a chance to drop into that parasympathetic nervous system, which is where the healing and repair and restoration of that dynamic balance of that body occurs. Acupuncture is a way to do that. Acupuncture has been shown to encourage parasympathetic activity in the body, and so it’s a way of letting the body – and the whole body’s systems – know that it’s safe, and that it’s able to switch off and divert all that energy away from the “high alert”, and to use those precious resources to start recalibrating. So that’s the kind-of short answer. The Chinese Medicine is kind of similar to the short answer, just using slightly different terminology or language (and this is what I love so much about Chinese Medicine language: that it offers a shorthand for describing the many complex biochemical and biophysical pathways that are happening in the body, and it offers that in a language that is accessible to all of us, so that we can all relate to it - it’s a really humanist medicine). From a Chinese Medicine perspective, acupuncture works by restoring the flow of Qi in the body, and restoring the balance of Yin and Yang (that’s really talking about homeostasis in the body). And I just want to mention that when we are talking about restoration of the flow of Qi, and balancing Qi in the body, sometimes Qi has been (in my opinion) mistranslated to represent some mystical or magical force that can’t be proven to exist and, while that may be the case, Qi in Chinese language also refers to situations concerning air, pressure, vapours and weather, and in Chinese Medicine when we talk about Qi, we talk about the body’s metabolism and potential for movement: really, it talks about all the different functions and processes that are going on in the body. So when we look at it with that understanding in mind, we see that the Chinese Medicine understanding is that acupuncture restores correct functioning of all the body’s systems and networks. And this is really beautifully aligned with a lot of the latest biomedical understanding of the body, which is starting to view the body as a complex network of information, and interwoven systems In the past, we had a very mechanistic view of the body - we viewed it as like, say, a mechanic would view a broken car. We’d really drill down on where we perceived the problem would be, we’d remove the broken part or patch it up, and then we’d expect that things would be all good from there. But what that view doesn’t take into account is that all the body systems are not separate, they are actually all beautifully interconnected. And this is really coming through in new fields of science, like psychoneuroimmunology, which talks about the interwoven relationship between “psycho-” (the brain and neural areas), “immuno-“ (which is the immune system) and endocrinology (which is the hormones): all those systems are involved in continual crosstalk. It used be that we thought everything was governed from the brain down, or from the central nervous system, but actually we’re seeing that all of the systems are interwoven with each other, and can affect the other. What that means is that our hormone can affect our immune system, and our immune system can affect our moods, and vice versa. It’s beautiful to see how modern medicine and tradition medicine are aligning in their view of the body. Another area where we are seeing this is in the exciting and emerging field of epigenetics. Epigenetics just means “epi-“ (above) genetics. Previously we believed that genes were set in stone, so the genes we received from our ancestors would – previously – very much dictate our health outcomes in the future. That kind of took our agency way: it took away our input in being able to generate the health outcomes that we would hope for. But what epigenetics is teaching us, is that our genes are merely a blueprint – they are just a sketch or plan or outline for our health - but how we actually live our lives (the food that we fuel our bodes with; the appropriate rest and the balance that we strive for; even the very thoughts that we think – and that we have as our continual internal dialogue), all of these factors have very potent effects on whether genes get switched on and off (whether they get expressed), and therefore whether certain characteristics, or certain conditions, might get expressed as a result of that. So really, it puts the power much more firmly in our hands. So that was the Chinese Medicine answer of how acupuncture works (which was followed by a bit of a detour into emerging areas of medicine and system biology). The long answer gets into some really cool biomedical research, and as I mentioned before, there’s literally tens of thousands of papers that look at how acupuncture works. Some of the earliest work in this area comes from Dr. Candace Pert, who was a very highly regarded neuroscientist and pharmacologist, and headed up (a lab) at the US Government’s National Institutes of Health. Dr. Pert was the discoverer of our endogenous opiate receptor. Opiates are painkilling substances, and not only can we be given these from external sources, but we also produce our own endogenous (endogenous means “internally generated”) substances, which means that we have access to an internal pharmacy that we can use to reduce pain. What Dr. Pert found, was that acupuncture was shown to induce the release of these endorphins (these internally-generat