As a practitioner of traditional Chinese medicine, one question I contend with regularly is “how does acupuncture work?” I can offer a variety of explanations based on either the latest modern theories or the classical ideas and concepts of Chinese medicine. Both are compelling, but for different reasons.
Educated people in most parts of the world have some basic knowledge of anatomy and physiology, and people with difficult-to-treat health conditions have often carried out a good deal of research in their search for advice and relief. For them, knowing that scientific experiments have shown that acupuncture acts on connective tissue and extra-cellular fluid to set off a cascade of events that leads to healing is both understandable and somewhat persuasive. The studies that show inserting a needle in the lower leg activates the visual cortex, as seen on an MRI, are reassuring to modern patients-and practitioners.
The classical explanations appear quite simple, by contrast, and, because they are embedded in an unfamiliar set of ideas about life, health and healing that give them their sense and significance, we need to work a bit to understand them. What does it mean when we say that “blood and Qi move within the channels” and the “Qi" should travel to the source of disease”? After unpacking classical concepts, we need to keep working to apply them in useful ways in the clinic and to communicate about them in ways that are relevant to our patients. It seems like a tall order sometimes, but what is the alternative? The vastness of the knowledge and experience contained in the oral and written traditions cannot be contained in any single, modern explanation of why and how acupuncture provides relief from such a wide array of ailments. So we keep studying and grappling with what we find.
“The vast amount of knowledge and experience contained in the oral and written traditions of Chinese medicine cannot be contained in any single, modern explanation of why and how acupuncture provides relief from such a wide array of ailments.”
Inserting Needle Like Butter
A patient recently remarked that I insert needles like butter into his limbs with an air that makes it seem like a completely normal and natural thing to do. However, he went on, asking people to lie on a massage table while you stick small pins in their bodies is a rather odd form of work. I laughed because I can remember a time when it was less than second nature to me and that strangeness was still present. But the question for me now is not why does it work or how does it work, but rather “how can I make it work better for this patient?” Basic efficacy can be achieved through study and practice, but mastery is something that we re-define as we move closer to it, realizing again and again how far we are.
Fortunately, patients teach us every day. Each needle I insert should lead to a sensation of “de Qi” or Qi moving in the body. It can manifest as warmth, tingling, electricity or just a feeling that something is radiating though it’s hard to articulate exactly it is. Often I will insert a needle into a forearm and my patient will say “it goes down to my 4th finger,” or, I will needle above the ankle and the person will report that it moves up to their abdomen. These are exciting moments, well, for me anyway. We memorize the pathways of the acupuncture channels and all their connections in our professional training, but patients are blissfully naive of this map of the body, so when patients report that the Qi goes where it’s “supposed” to go, it’s like a constant affirmation of the wisdom of the ancients. It’s also a sign that I, though the medium of the needle, have successfully contacted the Qi in the channel and coaxed it into moving.
The Movement of Qi for Chronic Support
Moving Qi is cool, but people come though the clinic door because they need help with a physical, mental or emotional ailment. I once treated a nurse for tennis elbow using a technique that involves palpating for tender points on the diagonally opposite limb, in this case her knee and lower leg. After testing her response to a few points, I inserted two needles and asked her to move her elbow in ways that had previously caused pain. She looked at me with wonder and irritation, “Where is it? It seems to be gone!.” She had started off the interview stating her skepticism, letting me know that she was only trying this due to her husband’s insistence. She was caught between her desire to have her beliefs confirmed and her need to find relief from her pain. The fact that I used points far away from the area of pain only made it more unbelievable (and unacceptable). Actual experience won out over concepts and she continued a course of treatment until the pain was resolved.
Many people think acupuncture is only effective for pain. I think this misconception is due to a combination of the fact that the greatest volume of clinical studies have been done on orthopedic conditions, acupuncture is in fact very effective for many orthopedic conditions, and it’s somehow easier to accept that it may work on pain pathways or nerves rather than all systems of the body. Another factor is that chronic conditions related to the endocrine, circulatory, digestive or immune systems, for example, also change over time without treatment and often involve periods of remission and recurrence, making it harder to gauge improvements due to acupuncture.
I have received several lessons affirming the advice of my teachers to stay steady in what you know and always do what seems most reasonable in the moment. Once, a patient came in for help with fertility issues. She described how she had mid-cycle bleeding every month and felt that the uterine lining could therefore not support a pregnancy even if they did conceive. The day of our meeting was day 18 of her cycle and, as usual, she had light bleeding. However, I could not rule out pregnancy because she and her partner had tried to conceive that month. I therefore used a heat treatment (moxibustion or dried mugwort) on a point on her big toe to stop the bleeding. My primary objective was to stop the irregular bleeding so that we could move towards normalizing her cycles, but I also chose this point because it can help prevent miscarriage in early pregnancy. By coincidence, she was going on vacation. Three weeks later, she called to say that the treatment had stopped the bleeding that day and she just had a positive pregnancy test. Nine months later she sent me a picture of her smiling with her beautiful, healthy baby.
“Why” is asking for meaning over and above processes and procedures. I don’t really know why the body can be described in terms of channels and points, or why they can be used to heal such an array of types of human suffering. I can give you an academic explanation using classical acupuncture texts from the Han Dynasty or I can explain the trains of connective tissue in the body and what we see happens to them when we use ultrasound imaging while needling. But ultimately, I think it’s more important to know that my patients and I find wonder in the acupuncture clinic every day.
These statements have not been evaluated by the FDA and are not intended to treat, mitigate or cure any disease or symptom.