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Ancient Science

After more than two millennia, modern research is providing insight into the physiology and efficacy of acupuncture

By Kathryn Lange

 

In 1997, the National Institutes of Health, the division of the U.S. Department of Health and Human Services responsible for conducting and supporting medical research, released a landmark report on the effectiveness of the much-disputed practice of acupuncture. Based primarily on clinical trials, the report concluded there was definitive evidence that acupuncture was successful in the treatment of postoperative, chemotherapy- and pregnancy-related nausea and vomiting, and postoperative pain. The report also stated that, while more scientific data was needed, acupuncture was worth perusing as a primary or adjunct therapy for treating myriad other medical problems, from infertility to tennis elbow. The government statement contributed to the broadening acceptance of acupuncture and fueled a decade of in-depth research into the physiology of one of the oldest healing practices in the world.

This past November, to mark the 10-year anniversary of the NIH consensus, the Society for Acupuncture Research held a four-day conference, presenting hundreds of different studies and highlighting the most groundbreaking acupuncture research of the past decade. In addition to continued clinical trials, contemporary technologies, such as neuroimaging, are providing quantitative evidence that acupuncture works—and why.

The ancient theory of acupuncture, one branch in the complex tradition of Chinese medicine, can be traced to the text Huang Di Nei Jing (Yellow Emperor’s Inner Classic), which dates to the Han Dynasty in the second century B.C. The authors of the Nei Jing viewed the human body as a microcosmic representation of the universe and believed that health was achieved by maintaining a harmonious balance between the internal and external environments.

The traditional understanding of acupuncture (so named by 16th-century French Jesuits from the Latin for needle and puncture) is that channels of vital energy or chi (pronounced “chee”) run in specific patterns throughout the body. In Taoist philosophy, the flow of chi is created by polarity of yin and yang, the two extremes found in all of nature. According to the American Academy of Medical Acupuncture, “These energy channels, called meridians, are like rivers flowing through the body to irrigate and nourish the tissues. An obstruction in the movement of these energy rivers is like a dam that backs up the flow in one part of the body and restricts it in others. . . . Acupuncture unblocks the obstructions at the dams, and re-establishes the regular flow through the meridians.”

The National Center for Complementary and Alternative Medicine describes these meridians as “14 main channels connecting the body in a weblike interconnecting matrix of at least two thousand acupuncture points.” Modern-day acupuncture treatment differs from the practice described in the Nei Jing and other ancient texts mainly in material. Thin stainless-steel needles are inserted into the skin at a number of specific points along the meridians, the selection of which varies with the symptoms and treatment goals.

Accounts of acupuncture practice in the United States began to appear in medical texts in the mid-1800s, but remained uncommon until 1971, when New York Times reporter James Reston had emergency surgery for acute appendicitis while on assignment in Beijing. Reston’s firsthand account of acupuncture for postoperative pain management ran on the front page of the Times and ignited public interest in the practice. However, medical theories centered on “balance” and “obstructed energy rivers” were not easily embraced by Western culture or physicians and remain highly controversial today.

The practice of acupuncture predates the scientific method and therefore has received intense criticism for the lack of anatomical evidence of the existence of meridians. While many acupuncturists still ascribe to the ancient philosophies of flowing chi, some contemporary acupuncture practitioners have condemned the traditional theories. In his book Reinventing Acupuncture: A New Concept of Ancient Medicine, Felix Mann, founder of the Medical Acupuncture Society, boldly stated, “The meridians of acupuncture are no more real than the meridians of geography. If someone were to get a spade and try to dig up the Greenwich meridian, he might end up in a lunatic asylum. Perhaps the same fate should await those doctors who believe in acupuncture meridians.”

Other acupuncturists at-tempt to maintain a balance between ancient and physiological theories, and believe the practice is strengthened by the union of Eastern and Western medical philosophies. After studying acupuncture practices in China, the Committee for Skeptical Inquiry concluded that “although [chi] is merely a metaphor, it is still a useful physiological abstraction…The related concepts of yin and yang parallel modern scientific notions of endocrinologic and metabolic feedback mechanisms.”

Numerous hypotheses have been proposed to explain the physiological mechanisms of acupuncture. To date, more than 10,000 scientific studies on acupuncture have been published and catalogued with the National Library of Medicine. Neurohormonal theory currently provides the most widely accepted clinical explanation of the body’s response to acupuncture treatment. According to neurohormonal theory, the insertion of acupuncture needles stimulates the pathways of the peripheral nervous system of the somatosensory system. In turn, peripheral nerves transfer that stimulation to the brain and brain stem, which control all of the body’s systems through the release of hormones. Specific acupuncture points correspond to specific areas of the brain and result in the release of different hormones affecting distinct body systems.

 

Recent developments in neuroimaging have opened new doors for acupuncture researchers. Investigations into acupuncture using brain imaging techniques like positron emission tomography (PET), magnetic resonance imaging (MRI), and electroencephalography (EEG) have provided quantitative evidence supporting neurohormonal theory and the general effectiveness of acupuncture in treating a variety of ailments. These neuroimaging studies generally compare the brain activity of an untreated control group, a test group undergoing proper acupuncture treatment, and a placebo group treated with “sham acupuncture,” the insertion of acupuncture needles at non-acupuncture points. The “sham” treatment of the placebo group compensates for outcomes that are based on the subjects’ expectations of results, not the acupuncture treatment itself.

Dr. Vitaly Napadow, a practicing acupuncturist, physician, and radiology professor at Harvard Medical School, is one of the preeminent researchers of acupuncture brain imaging. His most recent paper, “Neuroimaging Acupuncture Effects in the Human Brain,” published in the Journal of Alternative and Complementary Medicine, summarizes the results of multiple studies, and concludes that stimulation of different acupoints elicits significant responses in multiple brain structures. Most notably, imaging revealed that acupuncture treatment modified activity in the areas of the brain that control pain perception, memory, and mood. Significant response was also seen in the in the hypothalamus, which modifies the endocrine functions that control hormone output. Napadow’s imaging research has shown that the heightened activity in the cortical “pain matrix” of carpel tunnel patients was modified to reflect healthy brain activity after acupuncture treatment.

 

Other studies, including findings published by the National Academy of Science, indicate that the visual cortex is activated by acupuncture point stimulation in the foot in the same way it would respond to a light source shone in the eyes. Similar results demonstrated the connections between acupuncture and the auditory and language cortexes, and documented significant clinical response to acupuncture in nausea patients.

Over the past 2,000 years, acupuncture has been used as a treatment for hundreds of medical problems. Contemporary research had discredited the effectiveness of acupuncture for some of those indications and strengthened the argument for others. A 2007 survey conducted by Tufts University estimates that there are 17,000 practicing acupuncture professionals in the United States today. Requirements for acupuncture licensure vary by state. In New York, applicants must have completed at least 60 college credit hours, nine of them in the biosciences, and more than 4,000 hours of professional acupuncture education at an accredited institution, including instruction in anatomy, physiology and pathology, acupuncture theory and technique, and active clinical experience. Many acupuncturists are licensed physicians and, for nonphysicians, acupuncture education can be pursued to the postdoctoral level.

Despite the stringent licensure requirements, mounting research, and two millennia of anecdotal evidence, acupuncture practitioners continue to struggle for credibility. One of the most significant challenges to the field is that, while the accessibility of coverage is increasing, medical insurance for acupuncture remains inadequate. Many private health-insurance providers do not offer coverage for acupuncture treatment, and neither Medicare nor Medicaid recognize acupuncture as an insurable medical practice. The uninsured cost of acupuncture prohibits many people from exploring potentially effective treatment options, including, possibly, the one with history’s most impressive track record: According to the American Academy of Medical Acupuncture, “In the past 2,000 years, more people have been successfully treated with acupuncture than with all other health modalities combined.”

klange@metroland.net


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