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What is acupuncture, and what conditions does it treat?

George Wang, MD, PhD

What is acupuncture? How does acupuncture work?

Acupuncture is an ancient therapeutic method that is a part of Traditional Chinese Medicine (TCM), a holistic system of treating and preventing diseases, a system of healing and health recovery. TCM’s paradigm of understanding the human body and disease pathogenesis is quite different from the paradigm of Western or allopathic medicine, so much so that studying the mechanisms of action of acupuncture using the tools and conceptual models of Western medicine has its inherent limitations.

Paradigms are how we conceptualize and understand reality, including, in this case, the human body. Paradigms allow us to represent a potentially infinitely complex part of reality into simpler models that we can potentially comprehend and work with. Without paradigms, scientific and medical advancement would not be possible. In fact, significant scientific advancements throughout history occur when there is a paradigm shift (Thomas Kuhn, The Structure of Scientific Revolutions, 1962).

 

The current paradigm of modern Western medicine is based on an understanding of the human body using atoms, molecules, cells, tissues, organs, and organ systems, while the paradigm of TCM conceptualizes the human body using qi (pronounced “chee”, often translated as vital energy), organs and organ systems, and intricate interactions and balance among the organ systems. In the paradigm of TCM, symptoms and signs arise as a result of dysregulations in qi, body fluids, and organ systems, and most importantly, perturbations from the original homeostatic state and balance among the organ systems. When these dysregulations are allowed to progress, disease manifests, and when disease is allowed to progress, life, of course, is threatened. Acupuncture aims to correct these dysregulations and perturbations in the body and, thereby, restore health.

 

The World Health Organization (WHO) recognizes more than 360 standardized acupuncture points located throughout the body and 14 meridians, which are channels through which qi may flow. The meridians, in turn, are associated with different organ systems. In an acupuncture treatment, very thin needles (often hair thin) are inserted through the skin at these and other points. A skillful acupuncturist would use the paradigm of TCM to understand and explain how certain symptoms and conditions may arise through dysregulation within and among organ systems, and devise a treatment strategy that takes into account the actions and effects of various acupuncture points and meridians.

 

As a physician acupuncturist, I am trained in both Western Medicine and TCM, and I view the human body through both lenses. Despite the disparate paradigms on which these two systems of medicine are based, electromagnetic energy may be a common thread that links both. Having done cutting-edge research in immunology and having a deep appreciation of molecular and cellular mechanisms of action through the Western medicine perspective, I am humbled in recognizing that our understanding of acupuncture’s mechanisms of action (at least through the Western medicine lens), is still limited, while marveling at how effectively a two- thousand-year-old healing system can treat human pain and disease in this modern age, often when patients find no relief, or minimal relief, through Western medicine. Therefore, I find that integrating the TCM paradigm, on which acupuncture is based, with that of Western medicine, provides the maximum benefits to patients.

 

Because these two paradigms of medicine (TCM and Western medicine) are fundamentally different, it might be difficult, at present, to fully understand the mechanism of action of acupuncture using the vocabulary and conceptual tools of Western medicine, unless further evolution, or even shift, in the Western medicine paradigm allows researchers and physicians of Western medicine to better understand the vocabulary and conceptual tools of TCM, and thereby integrate the two systems of the medicine better than we are able to do now. Regardless, in the spirit of integrative medicine, it behooves us in the field of health care to take advantage of the respective strengths of these two systems of medicine and integrate them in the interest of patients’ relief of suffering and wellbeing.

What conditions does acupuncture treat?

The World Health Organization (WHO) and the National Institutes of Health (NIH) recognize the effectiveness of acupuncture for many symptoms and conditions.

Clinical trials have provided varying levels of evidence for the effectiveness of acupuncture in a wide range of conditions across many organ systems and disease categories, including:

 

Pain: back pain, neck pain, knee pain, hip pain, sciatica, headache, facial pain (including craniomandibular disorders), dental pain, myofascial pain syndrome, cancer pain, fibromyalgia, post-operative pain

Cancer-related: chemotherapy-associated nausea and vomiting, adverse reactions to radiation therapy, adverse reactions to chemotherapy

Musculoskeletal: rheumatoid arthritis, tennis elbow, sprains, osteoarthritis, temporomandibular joint (TMJ) dysfunction, periarthritis of the shoulder, carpal tunnel syndrome

Neurologic: stroke, migraine, tension headache

Cardiovascular: essential hypertension

Gastrointestinal: acute and chronic gastritis, irritable bowel syndrome, gastroesophageal reflux disease (GERD), peptic ulcer, biliary colic

Pulmonary: asthma

OB/GYN: induction of labor, correction of malposition of fetus (breech presentation), morning sickness, primary dysmenorrhea, hot flashes associated with menopause

Allergic/immunologic: seasonal allergies (allergic rhinitis or hay fever)

Hematologic: leukopenia (low white blood cell count)

Urologic: Urinary incontinence, renal colic

Psychiatric: depression (including depression following stroke), smoking cessation

In my practice, I find that the patients’ experiences in the real world, compared with data found in clinical trials, often suggest even greater effectiveness from acupuncture, probably because in clinical trials (even many “high-quality” randomized controlled trials), the treatment is often standardized, without the flexibility of allowing the treatment strategy to be tailored according to patients’ individual needs and differences—among other research design challenges.

Take chronic back pain, for example. In clinical trial reports, study results may indicate certain degrees of “improvement” in chronic back pain compared with the control group, while I often see patients’ back pain completely resolved with acupuncture treatments rather than just see an “improvement.”

Nevertheless, clinical trial results inform practice and policy. Clinical trials of acupuncture continue to be planned and conducted. The results from these studies will add to our understanding of the effectiveness of acupuncture in the future. It is my hope, as well, that other types of research, such as studies of acupuncture’s mechanisms of action, will advance our understanding of the paradigm of TCM and foster a better integration of TCM and Western medicine—integrative medicine to the fullest extent.

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