Q&A
HOW DOES ACUPUNTURE WORK?
Despite having been practice for over 3,000 years, scientific research of the mechanism of acupuncture was started only a half century ago, first in Japan and China, then gradually in France, Germany, Russia and the other European countries. Since the USA has joined the main stream of scientific research of acupuncture for the past two decades, new discoveries and theories on its mechanism have ever been increasing every year. In spite of a great amount of research has been done all over the world, no one can yet explain the conclusive mechanism of acupuncture. There are, however, some theories that are widely accepted as quite valid to explain many different aspects of acupuncture mechanism
Nerve-Reflex Theory
This theory was developed by Japanese doctors of physiology (Ishikawa and Fujita et al ) who were deeply involved in acupuncture research in 1950s.
It holds that when an abnormal condition occurs in an internal organ, alterations take place in the skin and muscles related to that organ by means of the autonomic nervous system. The autonomic nervous system extending through the internal organs, skin, subcutaneous tissues and muscles, constantly transmit information about the physical condition to the spinal cord and the brain. These information impulses set up a reflex action that cause symptoms of internal organ's disorders to manifest themselves on the surface area as hyper or hyposensitivity, spasm, contraction, tightness or lumping of the muscles, discolouration, dryness or oiliness of the skin,etc. This phenomena is called"Viscera-Cutanous Refelx". At the same time, this intimate relation can exert the reverse effects too. That is, stimulation of the skin and muscles can cause dilation or contraction of the vessels to change the blood and limp flow of the internal organs, activate the endocrine (hormone) and immure system,etc. This phase is called "Cutanous -Viscera Reflex". According to this theory, Acupuncture is defined as the most effective systematized stimulation therapy to utilize these reflexes for restoring the homeostasis of the body and acceralate the healing process.
The Gate Control Theory of Pain
In the west, especially in the USA, media has popularized the amazing effect of acupuncture for pain relief, therefore, it is understandable that most scientific research has been focussed on the mechanism of acupuncture for pain relief
In 1965 Drs. Melzack and Wall won scientific acclaim by proposing a theory called "Gate Control Theory of Pain", which was eventually hailed to be the best model to explain the mechanism of acupuncture for pain relief. This theory was the first serious attempt to unify the many ideas that existed about the mechanism that perceives and transmits pain through the nervous system. It holds that there are some specific nerve fibres that transmit pain to the spinal cord, while the input of other nerve fibres inhibits the transmission of pain. Both of these groups of fibres meet at an area called the "substantia gelatinous" in the spinal cord. The substantia gelatinous controls the integration of pain and pain inhibitory stimuli. If the pain input is excessive, then it is transmitted up the spinal cord to the brain to be perceived as pain. This theory proposes a balance between stimulation of the pain fibres and inhibition of that stimulus, so that pain is perceived only if the pain input overrides the inhibition of pain.
The problem with this theory is that it does not explain the full spectrum of the effects of acupuncture. Acupuncture excites the pain inhibitory nerve fibres for a short period of time, thereby blocking pain, but the effects of acupuncture can last much longer than that, quite often for some months after the acupuncture needle has been removed, and nothing in the Gate Control Theory really explains this prolonged effect. The mechanism of pain perception and transmission has not been clearly and completely defined, and in the light of the current state of knowledge about the basic mechanism of pain, it is a little unreasonable to expect an explanation of the effects of acupuncture on pain.
Endorphin
The worsening problem of drug addiction in the West has provided a great impetus for research into the mechanism of morphine action and addiction. (Morphine, heroin and opium are all related chemicals, collectively called opiates.) Morphine-like substances have recently been discovered in the central nervous system (the brain and the spinal cord). These substances are called endorphin, or naturally-occurring morphine,, and they have been found to be very effective in blocking pain. It is also verified that acupuncture stimulation can trigger the release of endorphin into the central nervous system, and the effects of acupuncture anaesthesia can be reversed by the use of anti-morphine drugs. However, recent research shows that not all types of acupuncture anaesthesia can be blocked by anti-morphine. e.g. If a patient has a painful arthritic knee, and acupuncture provides relief for the knee pain, then anti-morphine do not usually block the effects of this type of acupuncture therapy. The effects of acupuncture can be very swift (in terms of seconds) and it seems that the release of chemicals might possibly be too slow a process to have such a swift action. The endorphin theory again only deals with pain and makes little attempt to explain the use and effects of acupuncture in non-painful diseases.
Implicit Order of "X-Signal System"
This is one of the latest theories proposed by Dr. Yoshio Manaka (1911-1989), an internationally renowned MD (surgeon & acupuncturist) who had made great contribution in both clinical applications and research of Japanese acupuncture for almost 40 years.
This theory holds that acupuncture works not only on physiological systems of the body but also would work on bio-informational system or "X-Signal System" with a primary regulatory function; primarily hemostatic functions, regulating the overall energetic condition and the overall physiological condition. This information system is essentially not anatomical (though in microscopic structures it may have some physical expression), just as the various theories of the "Qi", meridian (energy channel), yin-yang, and the five phases are not clearly anatomical. This information system can be described as being hidden or enfolded or implicit order of primitive biological properties which might arose through various stages of evolution and were then masked by the development of the more efficient automation systems such as the nervous and endocrine systems. This process of enfoldment probably involves their being absorbed into the body of information stored, for example, in the genetic information of DNA. These potential information could be unfolded only with the correct internal and external stimulus, and in that process we can see manifestations of the clinical laws of acupuncture that were classically formulated as "Qi", meridian, ying-yang, five phase, and biorythmic theories. Treatment that takes advantage of, and activate changes in this system, can produce diverse effects because potentially the whole biological system can be affected. If the function of this information system stays in the ideal condition, then the body will function optimally.
Since Dr.Manaka was a remarkable figure equipped with profound, diverse knowledge and experiences of both traditional oriental medicine and modern scientific medicine, this model is very convincing and useful to explain various phenomena surrounding acupuncture. However, we still do not have scientific means to prove this model. We might have to wait until much more sophisticated high-tech machines or instruments will prove this theory in the future, like Einstein's "General Theory of Relativity" was finally confirmed many years later after its publication.
Other Ideas
Some research workers, particularly in Russia, have suggested that fields of biological activity exist around all living objects, which is often described as "Kirlian phenomena". The concept of 'biofields' has little hard scientific evidence to support it, but there are people in many countries now who are suggesting that acupuncture may work through these fields. At present there are no good grounds for accepting or rejecting these theories.
The Clinical Application of These Theories
Whatever scientific theories are used to explain the mechanism of acupuncture, not one, at present, explains where to place an acupuncture needle and what kind of needling techniques should be used when the acupuncturist is confronted by a patient. Although acupuncturists learn the anatomical locations of all acupuncture points that cover the entire body and the basic formula of points for various ailments from textbook based on the information obtained from traditional Chinese acupuncture, the choice of which acupuncture point to use and how it should be stimulated is largely dependent on each therapist's own judgement. The acupuncturist's judgement entirely depends on his or her knowledge and clinical experience, therefore, the efficacy of acupuncture treatment tremendously differs from one therapist to another. In other words, there is no universal formula of points selection and stimulation techniques that can be used for a particular disease. For example, in western medicine one pill can be used for "stomach ulcer" regardless of who the patient is, but the choice of acupuncture points and stimulation techniques have to be tailored to each patient according to the overall condition, not to the name of "stomach ulcer".
We will remain dependent on the empirical experience and philosophical theories of the ancient Chinese until a method of point selection can be deduced from an understanding of the scientific mechanism of acupuncture. Science will, and should, provide an explanation for the observations of the ancient Chinese, but in the meantime we should not reject acupuncture just because we cannot explain it completely.
WHY ACUPUNCTURE DOES NOT HURT?
Most people expect acupuncture could be very painful like hypodermic needles used in injections and blood tests. But once they try it, they are usually very surprised to find it hardly causes any pain. Acupuncture needles bear little resemblance to those hypodermic needles that have a hollow cutting-edge. They are much finer and are solid with no hollow cutting-edge, which means they part the tissue rather than cut it. Especially Japanese needles are extremely fine; average gauge is 0.14 ~ 0.18mm thick and 4 ~ 5 cm long, while Chinese ones are 0.28 ~ 0.38mm thick and 7 ~10 cm long. (** The thickness of the smallest hypodermic needle is 0.41mm.) When the needle is inserted, the sensation is often described as a "dull or heavy current-like feeling" or "slight tingling". Beside the shape of the needle tip, acupuncturists learn various needling techniques that minimize inflicting pain during needle insertion. In fact quite a few children visit our clinic for treatment because even they can stand our Japanese style acupuncture.
WHAT SHOULD I EXPECT DURING AND AFTER TREATMENT?
During treatment, you would feel very relaxed or sort of "high". This euphoric feeling is due to the overall increase of blood and Qi energy flow, and release of endorphin in the brain and the spine. Our treatment which usually combines acupuncture and moxibustion can augment this feeling. In fact many patients fall asleep or start snoring during treatment! After treatment, you usually feel not only very relaxed and calm but also more energized. Occasionally you may feel tired or drowsy for a few hours if the treatment has been particularly strong or there may be a short time flair up of your symptoms, especially of pain as a sign of healing reactions, which you do not have to worry about.
MY PRESCRIBED MEDICATION WHILE UNDERGOING
A COURSE OF ACUPUNCTURE?
Yes, you should continue with your medication, at least until careful discussion with your doctor or the practitioner who prescribed it. Many people seek acupuncture treatment because of dissatisfaction with drug therapy - either it does not seem to be working or the side effects are intolerable. If the drug is given purely just for symptomatic relief of your complaint and acupuncture treatment can do the same or work better, then it could be possible to become less dependent on the use of drug. Always discuss in advance withdrawal from any medication with you doctor and practitioner.
SHOULD I TELL MY DOCTOR ABOUT YOUR ACUPUNCTURE?
If you are receiving treatment from your doctor then it makes sense to tell him or her about your plans to have acupuncture. Lately many doctors are more open and understanding about acupuncture and willing to let their patients try it if they think it would be more beneficial for their health problems. In fact several doctors are now referring their patients to this acupuncture clinic. Acupuncture treatment may enable you to reduce or even stop taking some forms of medication, or sometime having treatment from both sides could be much more effective for your health problems.
In any case, it is better to tell your doctor about your plans to have acupuncture treatment.
