Getting the point - acupuncture - includes related information

Harvard Health Letter, August, 1993 by Ann Parson

It's not uncommon these days to hear about someone who turned to acupuncture as a last resort and was rewarded with relief from a nagging health problem: a woman sleeps soundly for the first time in years after a single treatment for insomnia; a man's agonizing back pain subsides after four sessions with an acupuncturist.

Such testimonials naturally cause modern Americans to wonder how a technique that arose in China over 2,000 years ago -- and that works by sticking small stainless steel needles into the skin -- can possibly make people feel better. A few skeptical Western physicians have even derided it as "quackupuncture." But some doctors say that acupuncture would not have survived for so long if it didn't work and claim that it can benefit patients with conditions ranging from arthritis to multiple sclerosis.

In the United States, consumers and scientists are paying more attention to this technique than ever before. Such scrutiny, coupled with an increase in federal funding for research on alternative therapies, may ultimately separate real clinical benefits from bunkum and lead to acupuncture's incorporation into allopathic (Western-style) care.

The Food and Drug Administration (FDA) estimates that 9-12 million acupuncture treatments are now performed annually by U. S . practitioners of traditional Chinese medicine, and a report in the New England Journal of Medicine revealed that a third of 1,539 adults surveyed had used acupuncture or some other unconventional therapy in 1990. People suffering from back problems, anxiety, depression, headaches, arthritis, and insomnia were among those most likely to seek such help.

There is growing evidence that some of these seekers will benefit from acupuncture. Studies now suggest that such treatment works better -- at times significantly better -- than a placebo for chronic pain, drug addiction, certain types of nausea and some neurological disorders. Many other claims have not been substantiated by carefully designed clinical studies.

Going with the flow

The practice of acupuncture springs from an ancient and richly layered view of the world, and whole books have been devoted to explaining how this modality fits into a much larger picture. (See "For More Information.") Traditional Chinese medicine teaches that the body, like all of nature, contains opposite forces known as yin and yang. People are healthy when their relationship is balanced but become ill when yin (characterized as cold, restful, interior) falls out of balance with yang (warm, active, exterior).

Classic theory holds that acupuncture restores harmony by altering qi (pronounced "chee") -- the vital source of movement between yin and yang. Qi flows through the body's 14 meridians, which channel energy to all the organs and systems. Along these meridians are 361 acupoints, at which the insertion of needles -- or the application of heat or pressure -- can alter the flow of qi.

An allopathic analysis

Reconciling these Eastern concepts with Western science is difficult. For years Western scientists were stymied because they couldn't find anatomic correlates for the meridians.

More recently, some researchers who study chronic pain have found that many acupoints lie over or close to neuron motor points, where large peripheral nerves and nerve endings meet muscle or bone. Meridians may be a conceptual forerunner of what we think of as neural pathways, according to George Ulett, a clinical professor of psychiatry at the University of Missouri School of Medicine who has practiced and taught acupuncture. So far, the scant research that has been done has not proved that meridians and nerve paths are one and the same. When French researchers tried to visualize the meridians by injecting radioactive tracer material at acupoints, they found nothing but the blood vessels that are shown on standard anatomic charts.

Physiologist Bruce Pomeranz has observed evidence that acupuncture treatments can trigger the release of end orphins, natural analgesics found in the spinal cord, brain, and pituitary gland. This could explain how such therapy acts to control pain. How needle insertions can alleviate other conditions remains a mystery. "There could be all sorts of other things happening -- a local phenomenon in the skin, an autonomic nervous system reaction, electric field components, reactions in the blood -- we just don't know yet," said Dr. Pomeranz, a professor of physiology and zoology at the University of Toronto.

Other researchers say that what traditional Chinese medicine calls the balance of yin and yang corresponds to what Western physiologists think of as homeostasis -- a living organism's drive to maintain an internal milieu that is constant in terms of temperature, fluid balance, and the like. Instead of talking solely about qi, Massachusetts acupuncturist Stephen Birch says that "the primary function of acupuncture is to persuade the body to return to normal homeostasis." Again, no one has proved that this is how it works.