How does acupuncture work?


This question often comes up in the clinic.

Frequently, it seems to come up a few minutes after I have put the needles in…perhaps given a few moments to reflect, we become acutely self-aware of subtle changes in the body, awakening mental curiosity?!

(This post refers to acupuncture, and not ‘Chinese Medicine’)

My answer to the question that is the title of this post is often “Well, that depends..:”

By this I mean that there are at least two ways of explaining ‘how’ acupuncture works. The usual place to start is from within the context of Chinese Medicine, while the default alternative is from the point of view of modern medical science. I find both of these paradigms explain sufficiently how acupuncture works for most people. Both explanations have advantages, and disadvantages, and in the end, an integrated view is the most informed.

The first explanation employs more esoteric language. Often this means more poetic, traditional language, usually based in metaphors of nature that convey the wholistic approach in which TCM is rooted. This explanation is interspersed with Chinese terms that are sometimes mis-translated, translated differently by different authors, over-simplified, or simply not understood by lay people. Some of the terms can lead to confusion, as they are commonly used in english (or french) but hold special meanings in Traditional Chinese Medicine (TCM). 

A simple example explanation might be something like, “We place the needles in ‘acupoints’ that are located on ‘meridians’. The ‘meridians’ are pathways under the skin that carry ‘Qi’, and are associated with the various ‘organ systems’ of the body (e.g. heart, lungs, liver…). Each system is responsible for performing various homeostatic functions according to TCM (for example, the ‘Heart’ is the ‘monarch’ or ’emporer’ and has two functions; to govern the blood and the vessels, and to house the mind’). Acupoints are chosen in combinations that seek to return balance to the ‘qi’ of the organ systems involved in the disease pattern.”

Although seemingly more, or at least as complex an explanation as that of TCM, a modern scientific understanding of how acupuncture works is starting to take shape. This is largely based on research that has been performed over the last 50 years, establishing the various physiological effects of acupuncture. An example explanation in these terms might go something like, “The needles are placed at specific sites, usually just under the skin, that can be found over the whole body. These points are known to have a specific functions in terms of TCM. From a scientific point of view, they have both a local and global action in the body. Globally, acupuncture has been shown to trigger the release of endorphins, dopamine, and serotonin, as well as other neurotransmitters in the Central Nervous System. Locally, at the site of the needle insertion, there is known to be a change in cell chemistry, increased blood flow, and decreased inflammation. Generally, acupuncture is thought to provoke both a specific and a non-specific healing response due to signaling in response to what could be refered to as a ‘micro-trauma’ caused by the insertion of fine needles.”

In summary, quickly explaining how acupuncture works is not easy. Training in Chinese Medicine usually takes a minimum of 3 years full time, so it is no wonder that from a traditional point of view the explanation can be long and complicated.  To fully explain it in terms of modern science is not yet possible, however the picture is becoming clearer and clearer as more and more research is carried out.

Some interesting theories and research on ‘how acupuncture works’ include: 

  • Neurohumeral theory
    • This theory suggests that the effects of acupuncture are due to signaling in the CNS, rather than due to ‘qi’ and ‘meridians’. The theory encompasses many modern theories that seek to explain more specifically how acupuncture functions in terms of modern scientific understanding.
    • signaling through neurotransmitters…endorphins, dopamine, serotonin, enkephalin, adrenaline, noradrenaline
    • signaling through hormones…cortisol, estrogen, progesterone, testosterone
    • Purinergic signaling…ATP, adenosine
    • Gate control theory
      • This is a theory of pain modulation that applies to acupuncture, where pain is understood as signals moving through nerve pathways. These signals may be blocked, or modulated, as the pathways may be open or closed, like ‘gates’, in the nervous system. Acupuncture allows us to control these gates to some degree.
  • Embryological generation theory
    • This theory seeks link between differentiated tissues of the body through common origins existing during embryonic development. This common origin, for example of the skin and CNS, could explain the relationship of various locus points on the body surface with parts of the CNS
  • Fascial-mechano-transduction theory
    • this theory suggests signaling along connective tissue pathways
    • fMRI studies
      • Numerous studies have shown direct correlation between stimulation of acupoints, and activity in the brain and peripheral CNS. Often the stimulated brain region is known to have a funtion that corresponds with the empirically known function of the acupoint.