Acupuncture has been used in China for over 4000 years.
Increased understanding of how acupuncture works has led to a growing acceptance by the medical profession in the West, and we now have a strong scientific basis for its use. A great deal of reliable research in the last twenty years allows us to use acupuncture in a modern and effective way for many medical problems, not just for pain relief.
In this practice we use very fine disposable needles which are used once and then destroyed. Most people find acupuncture is almost pain free, and indeed it often produces a sense of relaxation.
How acupuncture works at present there are 2 main theories explaining why acupuncture is effective. The first is the neurohumoral mechanism. Research shows that fine needles inserted into the body stimulate the release of many different chemicals which transmit information in the brain and nervous system (hormones and neurotransmitters).
This neurohumoral approach has been instrumental in establishing the scientific validity of acupuncture, but it has become obvious that it cannot explain all the effects that we observe in acupuncture.
More recently the concept of 'morphogenetic singularity' has emerged which helps to explain several longstanding puzzles in developmental biology and acupuncture research.
In the development of the human from the embryo (morphogenesis), organising centres (known as singularity points) appear and these control and guide the way in which the body is formed. This is thought to be by variations in the bioelectric field of the body. Singularity points have much in common with acupuncture points, and their importance lies in the fact that they may represent a system of control which in evolution preceded all other physiological systems including the nervous system. Acupuncture produces electrical changes locally at these points and generally within the body and so achieves important regulatory and balancing or normalising functions.
A recent report in New Scientist (24 April 2010) remarked "Acupuncture's scientific credentials are growing." The article was drawing attention to a trial that showed that rats with damaged spines showed signs of recovery after acupuncture, and were able to walk again. This was probably due to stopping nerve death by reducing inflammation.
How acupuncture can be used. There are many different ways in which acupuncture can be used, from trigger point needling (which can be deep or superficial), minimal needling, segmental needling, Intramuscular Stimulation (IMS) to Traditional Chinese Medicine. I use Western Medical Acupuncture which is a scientific, research based approach drawing on all of these different strands. (Acupunct Med March 2009 Vol 27 No 1 33-35).
WESTERN MEDICAL ACUPUNCTURE and EVIDENCE BASED MEDICINE
Western Medical Acupuncture (WMA) is an adaptation of Traditional Chinese Acupuncture (TCA) based on a current Western and scientific knowledge of anatomy, physiology and pathology which observes the principles of evidence based medicine. From a large amount of scientific research carried out over the last 30 years we can now explain and understand many of the effects of acupuncture. This understanding leads to a rational and logical basis for applying needling or electroacupuncture to produce largely predictable responses in the body.
"The main therapeutic effects of needling are achieved through stimulation of the nervous system (sensory stimulation), with some overlap with transcutaneous electrical nerve stimulation and spinal cord stimulation. Acupuncture needling has localeffects through local antidromic axon reflexes, releasing neuropeptides such as calcitonin gene related peptide and increasing local nutritive blood flow, improving for example the function of salivary glands. In the spinal cord and brain, there is well established evidence that acupuncture causes the release of opioid peptides and serotonin. The clinical effects on musculoskeletal pain are best explained by inhibition of the nociceptive pathway at the dorsal horn (segmental effects) by activation of the descending inhibitory pathways, and possibly by local or segmental effects on myofascial trigger points" (Acupunct Med March 2009 Vol27 No1, 33-35).
These diverse responses throughout the body inform and explain the improvements that patients report in a wide range of condition. Knowledge of these neurophysiological principles allows acupuncture to take its place in a modern healthcare service, integrated with western medicine not seen as some 'alternative' form of therapy.
EVIDENCE
One of the criticisms persistently levelled at acupuncture by doctors who dismiss it is that there is no evidence that it works. This reveals a blindness to the large number of studies published over the past 3 decades in reputable scientificic journals describing the effects and effectiveness of acupuncture.
Nearly 30 years ago a mechanism of pain relief with acpuncture was demonstrated (Ann Rev Pharmacol Toxicol 1982;22;193-220); since then many other process have been deescribed and very recently another pathway involving adenosine has been revealed (Nature Neuroscience (2010) doi;10.1038/nn.2562). In the last few years we have seen many robust clinical studies published with large numbers of patients (eg more than 5000 patients in an allergic rhinitis study [Annals Allergy, Asthma & Immunology 2008;5;535-543], 659 women with dysmenorrhoea [Am J Obstet Gynecol 2008;198;166,e1-166e8], 3600 patients in a study on hip and knee arthritis [Arthritis & Rheumatism 2006;54(11);3485-3493], and so on). Basic sciences are helping to explain mechanisms of acupuncture, not just on the basis of neurochemical responses but also through real time brain imaging with fMRI.
THE ISSUE OF PLACEBO
Unfortunately, some earlier studies which appeared to show that acupuncture was little or no better than sham or placebo needling have led to acupuncture being dismissed as no better than placebo.Sham acupucnutre refers to the use of a trick needle which touches, but does not penetrate the skin; placebo acupuncture refers to inserting needles into points which are not acupuncture points. As has now been realised, since much of the effect of acupuncture is due to sensory stimulation, it is impossible to have true placebo or sham acupuncture. Even light touch on the skin acitivates some of the same pathways in the spinal cord and brain as real acupuncture (Neuroimage 25(4);1161-1167). In addition, if the non acupuncture points chosen lie within the same spinal segment as the real point they stimulate some of the same effects in the body.
Acupuncture has been practised on a largely empirical basis for the past 4000 years, and empirically its effectiveness has been demonstrated repeatedly. The basic sciences of medicine are revealing the neurophysiological mechanisms underlying it, and now we also see large scale studies supporting and affirming the effects and effectiveness of acupuncture.
