There is a story in China about a peasant who worked as a maintenance man in a newly established Western hospital. When he retired, he took some hypodermic needles and antibiotics with him to his village. People came to him when they had ailments and he would inject them with the drugs he had procured. Although this peasant had no knowledge of Western medicine or how to practice it, he used the supplies he had to cure most of the people who came to him for help (Pearl, and Schillinger 176). In the West, the general level of understanding of Chinese medicine is not very different from the limited knowledge the peasant had of Western medicine. Unlike the peasant, Western doctors are wary of using unfamiliar techniques present in Chinese medicine because the fundamental theory seems to lack a scientific basis. For example, acupuncture is a complex medical practice, but Western medical practitioners tend to dismiss it due to a belief that Chinese acupuncture is an archaic procedure based on superstition in which needles are inserted into the skin over imaginary channels (Ulett 50). The idea of inserting needles into the body without injecting antibiotics seems not only strange, but also pointless to most American physicians. Western doctors have difficulty comprehending how acupuncture works because concepts such as meridians, qi, and acupoints seem to lack a scientific foundation in modern physics, chemistry, genetics and molecular biology (Wolfson 984). Although skeptics doubt the credibility of acupuncture because it is based on metaphysical concepts, the theory and the effects of acupuncture have a scientific basis.
Acupuncture is a form of therapeutic traditional Chinese medicine used to treat a variety of diseases and is often utilized as an analgesic. It is based on the meridian theory of traditional Chinese medicine and involves the insertion of needles at specific points along meridians on the body in order to fix imbalances of energy flow (Zhou, and Longhurst 288). The meridian theory states that there are about “400 acupuncture points in the body” (Cai 331), and they are along different areas of the body called meridians. Each meridian is named after the organ that is affected when the acupoints along it are stimulated. The meridians that are most commonly used in acupuncture are:
Meridian Lung, Meridian Colon, Meridian Stomach, Meridian Spleen, Meridian Heart, Meridian Small Intestine, Meridian Urinary Bladder, Meridian Kidney, Meridian Vascular, Meridian Metabolism, Meridian Gall Bladder, Meridian Liver, Meridian Sex, and Meridian Brain (Wensel 18-45).
The meridians are the channels in which the bodily energy system, qi, flows, and they connect all the tissues and organs found in the body. According to the Chinese, disease or illness arises when there is an imbalance of qi along the meridians.
The Chinese believed that qi could be separated into Yin and Yang energy, and there must be a balance of the two energies for the body to function properly (Wensel 8). Yang is associated with an excess of certain qualities in the body such as temperature and energy. Examples of yang energy are “heat, light, stimulation, excess, assertion, dominance, movement, [and] arousal” (Kaptchuk 375), and common symptoms of a Yang condition are “fever and restlessness” (375). Yin is of the opposite of Yang qualities and includes “cold, darkness, passiveness, receptivity, [and] tranquility” (Kaptchuk 375). A Yin condition is characterized by “weakness, muscle wasting, pallor, and depression” (Wensel 66). Needle stimulation at acupoints found along the meridian can have a therapeutic effect because it either increases or decreases qi flow, rectifying the imbalance of energy. Accurate needle placement at the acupoints creates a feeling called “de qi” which includes the feelings of “warmth, numbness, heaviness, and radiating paranesthesia” (Zhou, and Longhurst 288). Unlike Western medicine, which cures ailments by focusing on the specific location of the problem, acupuncture reduces pain by stimulating acupoints along meridians throughout the body.
Several aspects of Eastern medicine are contradictory to the foundations of Western medicine. The theories found in acupuncture cannot be readily explained in terms of Western biomedical concepts of anatomy, physiology, and science. For example, Western medicine is based on hypothetical deduction in which conclusions are drawn from statistical analysis of research data. The Eastern approach, however, uses the inductive method in which conclusions are based on qualitative observations collected from practitioners throughout thousands of years. The main emphasis in Western medicine is to fix the specific area of the body that is causing the disease, whereas Eastern medicine focuses on the disease as an ailment of the body as a whole. The chief role of the Eastern physician is to strengthen the internal defenses of each patient rather than simply cure the specific disease. Western medicine focuses on the body as the root of the disease, but Eastern medicine views disease as an imbalance between the body and environment (Tsuei 551-553). While some Western doctors have started to utilize the theories found in Eastern medicine – such as incorporating osteopathic medicine, the holistic study of the body, into medical practice – the chief focus for the majority of doctors in the West continues to be science-based allopathic medicine. Although there are significant differences between Eastern and Western medicine, both accomplish the same result—healing the patient. Westerners may believe acupuncture concepts such as meridians, qi, and acupoints lack a scientific basis, but all three seem to correspond to physiological aspects of Western medicine.
The organs that meridians are named after do not indicate the physical area in which the meridian is located; instead, the organ refers to the body function that the meridian affects. According to Peter Dorsher, the meridians utilized in acupuncture correspond with the trigger point patterns associated with myofascial pain. Myofascial pain is a form of chronic muscle pain that is elicited when sensitive points on the muscle, called trigger points, are touched. This condition has been studied for over a century in the West within the medical and dental profession. The trigger points (TrPs) cause pain and muscle stiffness in varying areas of the body including the jaw, lower back, pelvis, arm, neck and leg (Delgado, Romero, and Escoda 495). Myofascial pain is a “dull, non-pulsating pain” (495) that ranges from mild to incapacitating. The location of the trigger points, as well as descriptions of the associated pain, can be found in Travell and Simons’ book Myofascial Pain and Dysfunction the Trigger Point Manual (Hazlewood, and Markov 233). In 2006, Dorsher conducted a study that compared the location of 238 trigger pain patterns from the Myofascial Pain and Dysfunction the Trigger Point Manual to the “Bladder, Gallbladder, Heart, Kidney, Large Intestine, Liver, Lung, Pericardium, Small Intestine, Spleen, [and] Stomach” (Dorsher 723) meridians used in acupuncture. He created a virtual human model and mapped specific TrP regions as well as the corresponding locations of pain. Afterwards, he superimposed the locations of acupuncture meridians on the virtual human model (724). After the study, Dorsher concluded that TrPs and the referred pain anatomically correspond to the location of all 12 meridians. For example, TrP regions located on the “intermediate sternal section of the pectoralis major muscle” (726) cause chest constriction and pain as a result of inadequate blood flow to the heart. These TrP regions correspond to stomach acupoints ST 14-16 on the Stomach Meridian and the imbalance of qi at these locations is associated with “chest pain [and] shortness of breath” (726). Another TrP region known as “McBurney’s point” is associated with pain that results from acute appendicitis. McBurney’s point is anatomically similar to Stomach Meridian acupoint ST-27, which can cause lower abdominal pain and distension (726). TrP regions located in the upper abdominal muscles are associated with “heartburn,” and these regions correspond with the GB-24 acupoint along the Gallbladder meridian. When a qi imbalance occurs at this acupoint, common symptoms are acid regurgitation and vomiting (727). The myofascial referred-pain data from Dorsher’s study provides physiologic evidence of acupuncture meridians qi travels through.
Qi acts as a chemical substance in the body that can either promote health or cause disease. According to researchers Chen and Ma, qi acts as an informational signaling molecule and functions as a communication system along meridians in the body (Ralt). Signaling molecules are chemicals that are transmitted amongst cells and transmit information when they react with a receptor molecule on another cell surface (Purves, and Williams 167). Ma et al. performed several electro-acupuncture trials on the stomach 36 acupoint on hamsters and rats. Electro-acupuncture stimulates the acupoints using acupuncture needles connected to a device that delivers a direct electrical current (Li et al.) After the acupuncture trials, they discovered that nitric oxide (NO) and nitric oxide synthase (NOS) were typically found in greater concentrations at acupoints and along meridians (Kim et al. 583). NO is a commonly found signaling molecule and it “regulates blood pressure, contributes to the immune responses, controls neurotransmission and participates in cell differentiation” (Ralt). NOS is an enzyme comprised of 20 proteins that regulate the activity and location of NO synthesis within a cell. Ma concluded that NO was a possible chemical equivalent of qi because there was an abundance of NO at locations where qi is believed to be located. Furthermore, he stated that NO and qi both share the dual nature of being either beneficial or detrimental. A certain amount of NO is essential for intercellular communication, but in large quantities it can be highly toxic. Similarly, specific amounts of qi must be present for the body to function, but illnesses are thought to occur when there is either a deficiency or excess of qi within the meridians (Ralt).
Acupuncture can either increase or decrease NO production in order to correct an imbalance. When Ma stimulated the stomach 36 acupoint with electro-acupuncture in rats and hamsters with medically induced hypertension, he observed an increase in the production of NO and NOS in the organs along the stomach meridian. Hypertension is characterized by a deficiency in NO. The resulting increase in the production of NO and NOS from acupuncture balances the deficiency and appears to reduce the symptoms of hypertension. In contrast, Jang et al. discovered that acupuncture suppressed the synthesis of nitric oxide in rats that were induced with diabetes, which is a disease that is typically characterized by excess NO. Acupuncture at specific acupoints, rather than at random points on the skin, can create chemical changes within the body.
Critics have doubted the neurological effects of stimulating specific acupoints because clinical trials have shown that patients reported an alleviation of symptoms regardless of whether the acupoint was true or sham. The results from true and sham acupuncture are similar because placebo effects commonly occur in acupuncture clinical trials. A placebo response occurs when patients exhibit an alleviation of symptoms merely from believing in the curing qualities of acupuncture rather than from the treatment itself (Hall 8-10). Researchers attempted to limit the occurrence of placebo effects by distinguishing between the results from sham acupuncture and true acupuncture. In 1998, the first functional magnetic resonance imaging (fMRI) study on acupuncture illustrated the specificity of acupoint stimulation and activation in certain areas of the brain. Cho et al. discovered that needle stimulation at the vision-related acupoint, BL67 resulted in activity within the visual cortex on the fMRI scan. Another acupoint, PC6, is associated with nausea induced by motion sickness (Chae et al. 43). Yoo et al. demonstrated that the cerebellum, a part of the brain essential to balance, showed significant activity when the acupoint PC6 was stimulated. In addition, Wu et al. specifically compared the difference in activity between a sham acupoint and a true acupoint, GB34. After electroacupuncture at GB34, the fMRI scan illustrated high levels of activity in the hypothalamus and somatosensory motor cortex, which are areas of the brain that process pain. However, when electroacupuncture was used at the sham acupoint, which was a few millimeters away from GB34, there was very little to no stimulation of either location in the brain (44). The contrast in activity in the fMRI scans indicates that needle stimulation at acupoints, rather than the mere act of inserting needles in the skin, creates physiologic changes and activates areas of the brain that reduce the perception of pain.
According to the gate theory, acupuncture anesthesia occurs due to direct stimulation of surrounding “nerve fibers or somatosensory receptors” (Wensel 91). The sensation of pain travels along a nerve fiber and comes to the dorsal horn at the spinal cord. The dorsal horn acts as the “gate” from the opening of the spinal cord to the brain. If the gate is left open, the sensation is able to travel to the brain and is interpreted as pain within the central nervous system; however, if the gate is closed, the sensation will not be processed in the brain. The gate is comprised of thin, “unmyelinated C-fibres responsible for prolonged pain” (Pyne, and Shenker 1134) and thick, “myelinated A-fibres” (Pyne, and Shenker 1134) that can close the gate within the spinal cord. Unmyelinated C-fibres prolong the perception of pain because they lack myelin sheath, which is essential for quick signal conduction. When an acupuncture needle is rotated within the acupoint or if electroacupuncture is used, the larger A-fibres vibrate within the dorsal horn and synapse. The stimulation of the A-fibres creates an inhibitory effect on the C-fibres and prevents an opening from forming within the gate (Rose-Neil 54). The inhibition of the C-fibres, as well as the closing of the gate, blocks the perception of pain. The lack of pain perception may also be due to the release of endorphins and opioids within the body.
Several studies have indicated that acupuncture stimulates the nervous system to release “enkephalins and endorphins” (Wensel 79). When the acupuncture needle stimulates the sensory nerves in the muscle, the spinal cord, midbrain, and pituitary gland are activated. These areas of the brain release neurochemicals–such as endorphins, serotonin, and norepinephrine–to block pain messages from reaching the brain. JiSheng Han of Beijing Medical University was able to successfully transfer the spinal fluid of an acupuncture patient to an untreated animal suffering from chemically induced pain (Ulett 50). He confirmed the neurochemical basis of acupuncture when the animal showed no signs of pain after the infusion of the spinal fluid. Mayer et al. was able to verify the presence of endogenous opioids and oxytocin in acupuncture analgesia when he partly reversed the effects of acupuncture with naloxone, which is an opiate antagonist. Mayer also attempted to reverse the analgesic effects of hypnotic analgesia, but he was unable to do so (Han, and Terenius 194). This indicates that acupuncture induces a chemical change within the body in order to produce analgesia rather than producing it through hypnosis or “faith healing”.
Acupuncture has long been criticized because its theories seem to be based on metaphysical concepts rather than those that are scientifically verifiable. Although the terms meridian, qi and acupoints are rarely found in Western medicine, they each have a biochemical basis. Meridians correspond to myofascial pain trigger points, qi is a signaling molecule that is most likely nitric oxide, and acupoints can be described in terms of neurological brain activation. If Western doctors make a more committed attempt to comprehend the neurobiological mechanisms of the effects of acupuncture, this practice may become a more reputable treatment option in the West. Acupuncture can become a more widely referred treatment for medical conditions such as acute pain and chronic illness that lack effective Western treatment options. Acupuncture can also become an effective supplement to alleviate the negative side effects of current Western medicines such as nausea from chemotherapy and addiction to painkillers. Both the Eastern and Western fields of medicine fall short in providing cures and therapies for all existing diseases, but when techniques from both fields are utilized, there are more treatment options available for patients. The peasant in China utilized unfamiliar but effective medical techniques in order to cure a greater number of individuals, and now Western doctors should do the same.
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