|Year : 2020 | Volume
| Issue : 1 | Page : 33-38
Acupuncture mechanism, applications, and future development
Department of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
|Date of Submission||21-Jan-2020|
|Date of Acceptance||21-Jan-2020|
|Date of Web Publication||27-Mar-2020|
Ms. Jiayao Qu
Department of Acupuncture and Moxibustion, Shandong University of Traditional Chinese Medicine, Lixia, Jinan, Shandong
Source of Support: None, Conflict of Interest: None
Researches about ancient needling, technique, have been made for many decades, whereas the results are discrepant. People tried to use modern science to explore thoroughly about the real structure of acupuncture functions. Much more progress has been made than the last century. This review summarized some of the most prevailed theories about the mechanisms of acupuncture and their common applications. And lastly, this article discussed the future development for acupuncture.
Keywords: Acupuncture, application, development, mechanism
|How to cite this article:|
Qu J. Acupuncture mechanism, applications, and future development. Chin Med Cult 2020;3:33-8
| Introduction|| |
Acupuncture, an essential component of traditional Chinese medicine (TCM), has developed for 1000s of years. Due to the obvious efficacy and fewer side effects, acupuncture is welcomed by many people. Even in Western countries, it is used as a common complementary treatmentsor an independent therapy compared to some conventionalmethods. With its popularity increased, scientists started toexplain its underlying action mechanism andapply these new findings to a modern version of acupuncture. Researchers first look into the entity, the concrete substance acupuncture takes effect on, and then gradually shift into a certain body system to explain it. In this way, some explanations can be isolated and cannot outline the whole process perfectly. In other words, there are always some factors which can be overlooked during the research process. However, through clinical acupuncture applications, there are chances that researchers can verify some theoretical mechanisms and conversely have great improvements in clinical applications using verified mechanisms. There is a close connection between the mechanism and applications of acupuncture. Recent researches have a new trend to use using precision apparatus to monitor the dynamic body system and record real-time data. Although we are in modern times, we cannot abandon the ancient Chinese old theories about acupuncture. It is necessary to choose the proper materials and make explorations to recreate these old chapters into a better, understandable shape. Some valuable information from the past might help us get to the acupuncture mechanism much closer. Adequate collaboration between traditional-based acupuncture and modern medicine might create more benefits for patients.
This article will summarize ancient understandings and modern researches about acupuncture. Moreover, it outlines some mechanisms with more value in clinical applications.
| Background Of Acupuncture Research|| |
Some ancient Chinese concepts and recent history about acupuncture
Along the long history of Chinese acupuncture, the basis is on Meridian theory which is described in the Huang Di Nei Jing (《黄帝内经》 Yellow Emperor's Classic of Internal Medicine). In TCM, the meridians are considered as channels which carry Qi (气) [Figure 1] and blood, balance Yin and Yang, and connect organ systems. Qi is defined as a dynamic substance that fills in the human body and operates most of the body functions. When people get ill, Qi is not in balance and needs modulations. Needles inserting in the specific acupoints along the pathway of meridians can adjust Qi to restore balance. De Qi (得气) is a critical process when twisting the needle. Patients will experience soreness, numbness, heaviness, or even an electrical sensation. “The fish taking the bait” is used to describe this process. After the arrival of Qi, pain from many diseases can be relieved in a short time.
Until the early 1950s, this technique in China started to have deep researches under the policy “Chinese medicine is a great treasure and should be more developed and explored.” In 1958, Doctor H. Z. Yin from the Ear, Nose, and Throat Department of Shanghai First People's Hospital performed a tonsillectomy using acupuncture analgesia [Figure 2]. During the 1970s, propagated sensation along the pathway of channels was discovered by doctors from 301 Hospital of PLA and loads of researches around this subject blossomed. The mechanism of the transmission phenomenon is based on the theory of neuroanatomy and neurophysiology. This unique phenomenon promoted the process of mechanism research about acupuncture.
Acupuncture, Chinese treasure, gradually known worldwide is developing its own value among many medical fields.
Western country viewpoints about acupuncture effectiveness
A New York Times journalist James Reston first introduced acupuncture to the American public. President Nixon's visited China, pushed to the forefront, since then, acupuncture has been a popular discussion topic for American media.
Since acupuncture came to Western countries, researches have been done to prove whether it is effective. Current acupuncture research is most often based on the sham needle which was first designed by K. Streitberger and J. Kleinhenz in 1998. This idea compared two groups of people which were using different needling methods. One group was performed the real needle inserting treatment, whereas the other group was using a sham needle (considered as of placebo devices) which did not penetrate the skin. The outcomes of this research indicated that there is no significant difference in treatment results between these two groups, which means the real needle inserting method has no effectiveness. In fact, this conclusion cannot be convincing because the research design overlooked many influencing factors. The most important fact is that they did not realize that acupuncture started using a noninsert skin needle (Blunt needle, Di Zhen, one of the Ancient Nine Needles [Figure 3]) more than a 1000 years ago. Sham needle accidentally has the same effect as the Blunt needle, which results to the same efficacy in two groups. These two acupuncture groups are actually comparing two types of acupuncture techniques. Through this case, we need to pay full attention to the various shapes of acupuncture and their broad utilization.
Another challenging example about Western cognition in acupuncture is the dry needling (DN). DN is a new therapy which has been brought up against the present acupuncture system. DN practitioners claimed that DN is not acupuncture because DN does not follow the principle of TCM meridians. DN is a type of modern acupuncture, which is also called trigger points' acupuncture [Figure 4]. A trigger point is basically defined as a tender spot in the muscle, whereas an acupoint can be found anywhere in the body. Trigger points have many overlapping parts compared to acupoints which are largely distributed in the body. Hence, DN has no reason to de-acupuncture, at most, it can be called de-meridians. Apart from the normal acupoints along meridians, there are other acupoints such as Ashi points and extra points on the body. It is unquestioned that DN is a part of TCM acupuncture as the instrument used is acupuncture instrument and the acupoint stimulated is within the TCM acupoints. Nevertheless, through this challenge from Western countries, TCM acupuncture strongly needs to explore further about the theoretical basis for Ashi point and other extra points.
Most acupuncture researches in Western countries are not firm enough to stand up against arguments, whereas some theories might have a certain influence and are worthy to be debated.
| Main Theories About Acupuncture Mechanism|| |
Central nervous system
Numerous researches have concentrated on neurophysiology and imaging studies to verify the activation of the brain which acupuncture produces. These viewpoints are based on the anatomical structures of acupoints which may include nerve and nerve endings underneath the skin. Acupoints and internal organs are integrated by the central nervous system (CNS), hence the functional relationship between them is effectively formed. The CNS regulates the various nerves, endocrine, and humoral networks, and then affects target organs to perform the effect of acupuncture. Acupoints' effectiveness may depend on the convergent inputs of these somatic areas and the related organs in the brain as well as the integrative function of the brain neurons. The stimulation of acupoints can tranmit signals along the relevant nerves to the central structure. Then it can achieve analgesic function through the pain sensation conduction pathway, which is included in the CNS conduction pathway. Some recent imaging studies have further explored that acupuncture and pain have common central pathways [Figure 5].
Functional resonance magnetic imaging (fMRI) is a newly applied technical apparatus to monitor the activated regions of the brain. Studies have shown that there may be a specific correspondence between acupoints, meridians, and functional areas of the brain, suggesting that acupuncture at different acupoints can cause functional changes in different areas of the brain. The fMRI technique detects the different ratios between hemoglobin and deoxyhemoglobin in the local blood flow of the brain-activated area and the inactive area. Moreover, the difference of hemoglobin leads to different signals, which reflects the area and characteristics of brain function changes, and then carries out real-time functional imaging of brain tissue. The application of brain functional imaging to the study of acupuncture on the CNS plays an important role in further revealing the essence of acupuncture and meridian phenomena.
However, these interactions in the CNS are complicated and yet to be fully understood. IN addition, present imaging studies simply focused on some specific acupoints, thus the outcomes are not common in use. Moreover, the presence of De Qi is mostly based on the subjective sensation of people; consequently, the research outcome can be influenced due to lack of objective criteria.
In 1984, Dung listed the following anatomical structures observed near acupoints: peripheral nerves, nerves emerging from a deep to a superficial location, cutaneous nerves emerging from the deep fascia, motor points of neuromuscular attachments, blood vessels, fibers of varying sizes, ligaments, and much more other tissues. These observations indicated that there were no unique structures beneath the acupoints.
One of the first human studies to scientifically investigate the effects of acupuncture was conducted in 1973, which tested the analgesic effects of acupuncture against morphine. This research not only supported the finding that acupuncture raises the pain threshold but also revealed evidence that acupoints may be related to peripheral nerve sensory fibers.
In 1978, Kline et al. reported that electrical stimulation of Zusanli (ST 36) decreased arterial blood pressures and heart rate significantly when the tip of the needle was close to branches of the peroneal nerve. Their results indicated that it is the activation of motor fibers that resulted in the muscle contraction and subsequent excitation of muscles and/or joint receptors, which produced an inhibitory reflex in the relevant response.
In 1988, academician Han proved that acupuncture stimulation can activate the opioid system in body, which can increase the concentration of endorphins in the brain. And for the first time, a new way of acupuncture analgesia has been elucidated from the neurotransmitter point of view. Apart from the activation of opioid receptors, some of the well-known acupuncture mechanism researches in this area include inhibition of NADPH oxidase-mediated oxidative stress, activation of cholinergic muscarinic receptors, and anti-inflammatory signaling (reversible with atropine). Main investigations assessing the acupuncture needling effects on amino acids, monoamines (serotonin, dopamine, and norepinephrine), peptides (opioid peptides and substance P), purines, and inflammatory markers have been conducted. These researches are aiming at the substances in humor structures of related acupoints and their transmission function to CNS or organs.
Overall, structures near acupoints are the direct areas that acupuncture has effects on. They can be part of the CNS process or have functions on their own.
With the further study of meridians, scientists started to concentrate on a more comprehensive perspective to explain the essence of acupuncture structure. In 2008, Wang Chunlei put forward the Fascia System to explain the anatomical essence of meridians and acupoints. Through “China digital virtual human model,” they found out that some parts of the body have connective tissue in streak distribution, and its position and direction are in accordance with the classical meridian routes. It seems that the meridians and acupoints are located in the connective tissue of the human fascia. Study by Langevin and other studies have also found that there is a close relationship between the connective tissue of the fascia and the meridian acupoints. It is suggested that the connective tissue spreads throughout the body and connects the organs and tissues of the whole body. Most of the acupoints are located in the connective tissue between muscles or between muscles and bones. From the viewpoint of fascia anatomy, the essence of meridians in TCM is actually the fascia structure composed of nonspecific connective tissue, and the acupoints are located in it, which can produce strong biological information when stimulated. Because the fascia connective tissue is like a network throughout the human body, it can be concluded that the whole body is spread of acupoints. Acupuncture and other relevant therapies make biological changes of the local fascia structure in the stimulating acupoint area and produce biological information such as neural electrical and chemical ones, resulting in a series of physiological and biochemical changes including microcirculation, membrane permeability, receptor configuration, channels opening and closing, and signal transduction. Furthermore, activating and enhancing the self-monitoring and controlling functions of the fascia system, mobilizing the stem cells reserved in the fascia to differentiate into functional cells and repair the damage. Under the participation of the nervous system and immune system, acupuncture regulates the body functions (repair, regeneration, and activation) through the fascia system.
The research of fasciaology laid the foundation for ancient acupuncture of the basis on a modern biological level. And, it provides a theoretical evidence for acupuncture research to transform from the traditional empirical medical model to the biomedical model. This field holds a broad prospect and is worthy of further exploration.
| Relevant Applications|| |
Early in 1979, the WHO recommended worldwide 43 types of indications for acupuncture, which effectively promoted acupuncture to enter the public view. In 2011, the WHO's “Clinical practice guidelines for TCM (Acupuncture)” formulated a standard acupuncture treatment program for five diseases (migraine, Bell palsy, herpes zoster, pseudobulbar paralysis after stroke, and depression), which gradually standardized acupuncture treatment. However, through the long history of acupuncture clinical experience, acupuncture applications cover a wide range of diseases due to the widespread acupoints on the body and various types of needles or therapies.
This is one of the greatest fields of acupuncture. Although acupuncture has been applied for treating different illnesses or symptoms, its application in treating pain is likely more accepted by patients than any other indications. A 2010 survey of hospitals in the United States showed that the top four uses of complementary and alternative medicine were pain related, and that analgesia was one of the main reasons for patients to seek acupuncturists to either complement or substitute conventional care. Yin et al. revealed that mounting evidence supports the use of acupuncture for chronic pain in the low back, neck, shoulder, and knee, as well as for headaches and migraines. From a perspective of physics, inserting a needle can adjust the pressure under the skin. Sometimes, pain is originated from too much pressure.
In general, acupuncture's achievements in analgesia are obvious to all.
Relieve acute diseases
Acupuncture is effective in many diseases that suddenly occur: diarrhea or bellyache (results from unclean food or bad eating habits), acute lumbar/ankle sprain, a suddenly stroke, and more. If these illnesses are happening within a week, choosing timely acupuncture therapy can acquire an ideal treatment outcome. In Fletcher Kovichan' research, he indicated that a organ communicates its state to its related acupoints as the tissue at those acupoints becomes tender when the organ is stressed; further, this tenderness rapidly clears once the organ's function has been corrected by acupuncture. The time is about one second or so. Thus, the speed of acupuncture effect is obvious. One of the worthy researches for acupuncture application is first-aid treatment. For instance, Renzhong (DU 26), Shixuan (Extra points), and Neiguan (PC 6) are frequently used to perform first aid for heart disease. However, these acupoints do not get the chance to give function under most of the situations.
Modulate chronic diseases
Due to the close connection between external acupoints and internal organs (traditionally by meridians and modernly by nerves or other biological substances), acupuncture also has great ability to treat various types of splanchnic diseases. In most cases, these organ illnesses have a long period of degeneration before finally break out. Thus, during the chronic changing sessions, acupuncture's effect works again. For instance, Parkinson's disease, a progressive neuro-degeneration of multiple system damaging motor and nonmotor functions, affects individual and societal dimensions negatively. In Fung Kei Cheng's research, acupuncture at specific acupoints along the body indicates positive outcomes in this illness.
Improve emotion state
As mentioned in this literature review, acupuncture has an impact on the functional regions of the brain, which can regulate patients' mood effectively. Simone M. Ormsby's research revealed that the women in their study described gaining benefits from acupuncture that they felt enabled them to better manage their lives and the changes that pregnancy brings. These findings provide a new understanding regarding the possible role acupuncture could provide as a supportive treatment for antenatal depression. Acupuncture is also effective in other types of emotions such as nervous, panic, rage, fear, and more. In this way, patients can be more dynamic in their daily life and do not have to take any side effects.
The application of acupuncture is very broad; while aiming at the same disease, there will be various ways to choose from. Acupuncture treatments are suitable for many kinds of diseases, which will be led to a satisfying outcome with lower cost and higher effects.
| Future Development|| |
In recent decades, the developments of acupuncture at home and abroad are relatively rapid in many ways. Acupuncture is currently widely used in over 180 countries and has gradually become an integral part of the mainstream medical field. However, problems still exist which will prevent acupuncture from developing further. The following summarizes some aspects that are beneficial for the future of acupuncture.
First about the theoretical basis: TCM theoretical system is different from Western medicine; acupuncture combines ancient philosophy and empirical judgment, which is very different from the laboratory science and logical verification in Western countries. This makes acupuncture faced with two choices: bring acupuncture into the laboratory to establish a standard system based on experimental research or follow the original principles of TCM to develop. How to make an appropriate choice has become an important factor affecting the future development of acupuncture. Nevertheless, the great clinical efficacy of acupuncture is unquestionable. It is worthy of recognition that acupuncture therapy is a relatively independent treatment system. The theoretical innovation of acupuncture should lay foundations on the previous studies, even the classic ones. In other words, it is critical to manage the relationship between inheritance and innovation.
Second, about the aspect of acupuncture technique itself: acupuncture is variable during different clinical situations, thus the types of needle/manipulation are different. The most common type of needle is Hao Zhen (Filiform needle), whereas other types of needles are also effective. For instance, using fire needles for rheumatoid arthritis or using Yuan Li Zhen (round sharp needle) for piriformis syndrome. Appropriate combination of some special techniques is conducive to the improvement of clinical efficacy.
Then, another aspect is the acceptability of the public. Acupuncture is known by a large amount of people, but acupuncture's high awareness is often regarded as an antique cultural treasure rather than a practical medical technology. In this case, the obvious function of acupuncture needs to be propagated further. The more people choose acupuncture for treatment, the more chance there is for acupuncture to prove its efficacy.
In my point of view, the future development of acupuncture should focus on improving clinical efficacy, which is the main advantage to back up for it. Furthermore, some effective treatment plans should be integrated for certain diseases (which have poor outcome on taking medicine or do not have proper therapy in Western medicine) in order to promote more estimable acupuncture. “Preventive treatment of diseases” is an important part of acupuncture, which also can be a competitive advantage due to the recent lifestyle of people. To develop acupuncture, we just need to choose the right direction and march forward firmly.
| Discussion And Outlook|| |
This article summarized the general information about acupuncture. As we all know, acupuncture has been widely applied to medical treatment and achieved outstanding effects. However, the convincing effect of the mechanism of acupuncture has not acquired a satisfying explanation. TCM emphasizes the origin of things from the view of unity, entirety, and connection, that is “black box” theory, whereas Western medicine focuses on the “white box” theory, which is reductionism, which treats things according to atomic decomposition. Conducting researches through a microcosmic perspective can be blind in the whole picture of things, while the integral theory of TCM is understandable in whole and vague in detail. Performing microcosmic research to explore the mechanism of acupuncture is inevitable, but these researches need to ascend to an upper level, trying to lean close to a higher integral theory. Nevertheless, the traditional way has obvious efficacy in practice. We may not be able to fully understand it in short times, but we have the ability to conduct this technique to the utmost. Apart from treating common diseases more effective, acupuncture can also treat some tough diseases and put forward their original improving ideas like how to relieve the pain of patients.
Acupuncture has distinctive features. Acupuncture practitioners from all over the world should study from different angles and different levels according to their own advantages. Blindly following the trend is inadvisable. How to actively absorb modern knowledge of life science and maintain the traditional characteristics of acupuncture is an urgent problem that we need to solve. We believe that with the development of systems biology, the unified view of medicine knowledge between the East and West, and the mutual penetration of different science technology, basic clinical research of acupuncture will move forward at a steadier and faster pace and the development of acupuncture will be much better in future.
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Conflicts of interest
There are no conflicts of interest.
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