Pacific College of Oriental Medicine Alumni

To have peace in one's soul is the greatest happiness. - Oriental Wisdom

Practice Building

Continuing Ed
Pacific Symposium
Additional CEU Events
CEU Tapes

Alumni events

Alumni Profiles

Oriental Medicine News

Update Your Info

Alumni Email List

Request Records

Download Graduate Exit Interview

Alumni Minutes

Classifieds
Jobs
Opportunities
Office Space
For Sale

Research studies show....

By James Poepperling L.Ac., MTOM, B.S., PTA (Currently DPT, Doctorate of Physical Therapy)

Acupuncture originated centuries ago based on the theory that health is determined by a balanced flow of qi, which is considered our vital life energy and is present in all living organisms. In theory, qi circulates in the body along pathways, called meridians. The meridians are linked to specific internal organs and/or organ systems. Along these meridians are acupuncture points. Each point has a set of specific functions and/or indications. Needling points along the meridians allows the practitioners to directly influence an individual's qi. This is one version of many commonly used descriptions practitioners may explain to their patients and/or anyone interested in acupuncture and the theories on how acupuncture works.

The problem when speaking to physicians and other Western trained professionals is that this explanation can seem rather vague. From a physicians point of view this statement is not only indistinct but is based on conjecture with lack of scientific proof. Some common questions that may follow would be, "What is vital energy?" "What is this qi, can you measure it or see it?" "What are meridians; are they palpable and are they visible under the skin?" Initially I would answer these questions using TCM theory and upon completion of my description most Western practitioners shunned acupuncture and based its effectiveness on psychological aspects or simply refused acupuncture as a viable treatment option. Others would look at me and say, "I am sure there is something about acupuncture due to its history. However, how could I refer a patient to you when I myself do not know if it works scientifically?" At first I was taken back by this and said, "How could you refute something that has so much history and has been used as a treatment modality for thousands of years?" Needless to say referrals were not coming in, and as I sat down twiddling my thumbs I decided to start looking at exactly how and why a needle works from a Western point of view.

What did I find? I found three words and they are, "research studies show." These words became my most commonly used phrase when speaking to Western practitioners. By choosing to use these three words you are not claiming acupuncture to be a panacea but simply stating what research has shown acupuncture to effectively treat. Research is the crucial tool needed to validate acupuncture as a treatment modality and to substantiate acupuncture as an occupation here in the United States . Understanding the biological mechanisms by which acupuncture works is not only vital but also necessary when conversing with Western practitioners. Using this knowledge not only enables acupuncturists to bridge that gap between eastern and Western thought but also allows us to speak with confidence based on scientific research.

How does it work? I have already stated the version I used earlier now let me tell you how I answer some of these questions not only from an eastern point of view but also incorporating a Western point of view. When addressed with questions from physicians and oncologists, I first try to answer them using terms they are more familiar with pointing out different neural pathways in which signals are sent from the periphery to the spinal cord and to different areas of the brain. For example, an oncologist wishes to refer a patient for chemo-induced emesis and wants to know if and how acupuncture works. The answer could stem from TCM theory or from a Western point of view based on scientific research. My response is "research studies show", that needling Pericardium 6 shows to have an inhibitory effect on the area postrema (chemo receptor trigger zone for vomiting) located on the dorsal surface of the medulla oblongata . Most times it is not necessary to go into exact neural pathways, but it is important to know them. Using this idea of answering from a Western point of view first and then following with an eastern point of view was more acceptable. It is important to use Western terms because most primary care physicians are trained based on Western philosophy.

What are some other areas that research has looked at regarding acupuncture? There is significant research that shows that acupuncture reduces cortisol levels, releases endogenous opiates, affects NE (norepinepherine) and serotonin, increases NK cells (natural killer T-cells) as well as salivary IgA antibodies to name a few. Functional MRIs are a great tool for mapping different areas of the brain that are affected with needle insertions. We know that the point UB (Urinary Bladder) 67 can be used for ophthalmalgia but how? Located in the Human Brain Mapping Journal of 2000 you can find studies that show UB 67 affects our visual cortex . So now when someone asks you how can needling a point on the 5 th metatarsal effect the vision you can answer with a certain degree of confidence that "research studies" show needling this point affects our visual cortex. Functional MRIs have also been done on GB (Gall Bladder) 37 (traditional used for blurred vision, night-blindness, and ophthamalgia) and also effected the visual cortex. Another point tested was GB 43, (traditionally used for auditory problems as well as adjunct to vision), which not only effect the visual cortex but also effected the auditory cortex as well. These tests not only validate our choice in treatment protocols but also increase acceptance by Western practitioners due to the scientific evidence. Most practitioners, once they begin to understand how and why acupuncture works tend to become more interested and want to know more about how a needle at this specific place can affect someone's visual cortex. It is here that you now have one of two options: 1) "explain your theories from a Eastern point of view via meridian pathways, organ connections, etc." :2) "further explain it from a Western point of view detailing its neural pathways."

In lieu of all the controversy concerning Vioxx and Celebrex, I feel it is important for practitioners to fully understand how acupuncture decreases pain from a humoral point of view. When I ask my patients what do they know about acupuncture, a majority of the responses are, "I know it's good for pain". What usually follows is, "How does it work?" Instead of going into a long discussion about qi and blood stagnation, and/or meridians, blood deficiency, postural faults, etc, I respond with "research studies show" a needle insertion sends signals to the spinal cord. From the spinal cord, signals are sent to the brain affecting the release of endogenous opiates. Patients usually respond by nodding their heads as if to say, "I thought that is how it works." Patients are not acquainted with the terms, so I explain to them that our bodies have natural painkillers, known as Beta-endorphins. These natural painkillers are released from the pituitary gland and block the pain signals. Of course when speaking with Western practitioners, I use a more detailed approach explaining how it targets our descending pain inhibition system via endogenous opiates. You can further explain the neural pathways and also point out how it will not negate the effects of other medications and/or can work as complementary adjunct .

In practice, I have found that when speaking with physicians and oncologists, the theory of meridians tends to be the most difficult to explain and accept from a Western point of view. I have had comments in the past, "Can you see a meridian on a cadaver?" my response of course is no. Another response is "Well, if you can't see it or touch it how do you know it is there?" The answer is located in The Anatomical Record , 2002 edition article that describes the relationship of acupuncture points and meridians to connective tissue planes . This article hypothesizes that this relationship between acupuncture points and connective tissue planes is relevant to acupuncture's mechanism of action. I would have to agree with this hypothesis not only did they look at connective tissue planes but they also looked at de qi, the sensation felt when an acupuncturist reaches the level of qi in the body, and the role of the needle under the skin from a microscopic point of view. In areas of loose connective tissue, the twirling or manipulation of a needle creates a whorling effect, a wrapping of connective tissue around the needle. This whorling effect can increase the stimulus or signals sent to the spinal cord creating a staircase effect in theory. Using the analogy that meridians run along these connective tissue planes and that 80 % of the acupuncture points in the upper extremity fall along these connective tissue planes receives more acceptance than the Eastern theory of meridians.

A strong majority of the patients I treat are oncology patients. Several oncologists would ask me how acupuncture would help with depression and quality of life in end-stage oncology patients. I am currently involved in two studies looking at the effects of cortisol and quality of life in end stage colon and pancreatic cancer patients, "research studies show" that acupuncture decreases cortisol levels and also release serotonin. A study in the 2003 edition of Medicine and Science in Sports and Exercise showed that elite soccer athlete's receiving acupuncture post game activity decreased their cortisol levels and increased their salivary IgA antibodies . This study clearly shows that acupuncture is effective in decreasing cortisol and increasing Iga antibodies.

When reviewing research articles, it is important to be mindful of the type of research performed. Issues of concern would be the design of the study as well as the methods used, sample size, significance, bias, variables, and quality of the research. There are many types of research. Consider that acupuncture is based on thousands of years of experience using trial and error, however this type of research lacks the evidence needed for Western approval. Research studies show, should be your preferred opening statement to all Western practitioners when addressing questions. As acupuncturists, we must recognize that Western practitioners are educated solely on evidence-based theory and their training in Eastern medicine is limited. I recognize Eastern theory as I do Western theory. It is the gap between these two trains of thought that I am trying to fill. I am also finding that the more I inform Western practitioners on the benefits of acupuncture, using scientific based research to support my explanations, the shorter that gap becomes. Using this Western- based approach along with scientific research will further validate and substantiate our treatments within a Western setting.

Bibliography

Alimi D, Rubino C, Pichard-Leandri E, Fermand-Brule S, Dubreuil-Lemaire ML, Hill C. Analgesic Effect of Auricular Acupuncture for Cancer Pain: A Randomized, Blinded, Controlled Trial. Journal of Clinical Oncology 2003; 21: 4120-4126.

Cho ZH, Chung SC, Jones JP, Park JB, Park HJ, Lee HJ, Wong EK, Min BI. New findings of the correlation between acupoints and corresponding brain cortices using functional MRI. Proceedings of the National Academy of Sciences 1998; 95: 2670-2673

Hui K, Liu J, Makris N, Gollub R, Chen A, Moore C, Kennedy D, Rosen B, Kwong K. Acupuncture Modulates the Limbic System and Subcortical Gray Structures of the Human Brain: Evidence from fMRI Studies in Normal Subjects. Human Brain Mapping 2000; 9: 13-25.

Kwon YB, Kang MS, Ahn CJ, Han HJ, Ahn BC , Lee JH. Effect of High or Low Frequency Electroacupuncture on the Cellular Activity of Catecholaminergic Neurons in the Brain Stem. International Journal of Acupuncture and Electro-Therapeutics Research. 2000; 25: 27-36.

Langevin H, Yandow J. Relationship of Acupuncture Points and Meridians to Connective Tissue Planes. The Anatomical Record 2002; 269: 257-265.

NIH Consensus Conference: Acupuncture. Journal of the American Medical Association 1998; 280: 1518-1524.

Shen J, Wenger N, Glaspy J, Hays R, Albert P, Choi C, Shekelle P. Electroacupuncture for Control of Myeloablative Chemotherapy-Induced Emesis: A Randomized Controlled Trial. Journal of the American Medical Association 2000; 284: 2755-2761.

Shlay J, Chaloner K, Max M, Flaws B, Reichelderfer P, Wentworth D, Hillman S, Brizz B, Cohn D. Acupuncture and Amitriptyline for Pain Due to HIV-Related Peripheral Neuropathy: A Randomized Controlled Trial. Journal of the American Medical Association 1998; 280: 1590-1595.

Streitberger K, Diefenbacher M, Bauer A, Conradi R, Bardenheuer H, Martin E, Schneider A, Unnebrink K. Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: A randomized placebo-controlled patient and observer blind trial. Anaesthesia 2004; 59: 142-149.

Ulett G, Songping H, Han J. Electroacupuncture: Mechanisms and Clinical Application. Society of Biological Psychiatry 1998; 44: 129-138.

Vickers A, Zollman C. ABC of complementary medicine: Acupuncture. British Medical Journal 1999; 319: 973-976.

Weiger W, Smith M, Boon H, Richardson MA, Kaptchuk T, Eisenberg D. Advising Patients Who Seek Complementary and Alternative Medical Therapies for Cancer. Annals of Internal Medicine 2002; 137: 889-913.

Yu Y, Kasahara T, Sato T, Asano K, Yu GD, Fang JQ, Guo SY, Sahara M, Hisamitsu T. Role of endogenous interferon-? on the enhancement of splenic NK cell activity by electroacupuncture stimulation in mice. Journal of Neuroimmunology 1998; 90: 176-

Effects of electrical stimulation of SII and electroacupuncture on beta-endorphin contents in the perfusate from the nucleus centrum medianum of the thalamus in cats
Zhen Ci Yan Jiu. 1996;21(4):25-7.

Effects of electrical stimulation of SII and electroacupuncture on beta-endorphin contents in the perfusate from the nucleus centrum medianum of the thalamus in cats
Zhen Ci Yan Jiu. 1996;21(4):25-7

Langevin H, Yandow J. Relationship of Acupuncture Points and Meridians to Connective Tissue Planes. The Anatomical Record 2002; 269: 257-265.

Akimoto T, Nakahori C, Aizawa K, Fuminori K, Toru F, Ichiro K. Acupuncture and Responses of Immunologic and Endocrine Markers during Competition. Medicine and Science in Sports and Exercise 2003; 35: 1296-1302.