Acupuncture is an ancient medical treatment that dates back close to 2,500-3,000 years. It is one of the oldest, consistently practiced, medical techniques in the world to date. To clearly understand those time frames I like to correlate 2,500 years ago, or about 500 BC, to more familiar historical events for clear reference. The birth of Jesus Christ stands out at around 2018 years ago, the Roman empire was beginning to form as a concept, the Classical medical text the Huangdi NeiJing was just beginning to be written, Ancient Egypt was drastically changing to what we understand of them today, and the world’s view was that we were the center of the universe with the Sun traveling under the ground at sunset through rivers of lava, and arising in the morning on the other side at sunrise.
Acupuncture’s rich ancient history is reflected in the medicine. The stories of acupuncture’s powerful healing have been told about curing the crippled and taking pain away from the suffering. Continuing today with reports of dramatically reducing, and in many cases totally alleviation of, severe and chronic crippling nerve pain, to the walking of recent paralyzed patients, to the healing of tissues never thought could be healed. All of these anecdotally stories do not fall short in the area of miraculously fantastic, ‘mystical’, pre-scientific era, and even totally unbelievable, but is there any real science that explains how this powerful ancient art of healing works, and equally important, can we communicate that to our patients and other professional healthcare practitioners?
Traditional Chinese medicine’s first classical medical text named the Huangdi NeiJing dates back to around 2,200-2,500 years ago. Most scholars of today will place the composition around the late Warring States of Sun Tzu, 475-221 BC, through to the Han dynasty around 206-220 BC. This medical classic has two sections, namely the Su Wen and Ling Shu. The Ling Shu is the first medical text to describe and outline acupuncture techniques and acupuncture treatment principles, even listing acupuncture point prescriptions for specific medical conditions. This specific section seems to be where, we, the West, receive a lot of our fundamental information about the mechanisms, and applications for acupuncture. It is in this text where we find the important terms of de qi, mai, and jing luo.
The term de qi is recorded hundreds of times in the Ling Shu, and it states how important it is that the patient must feel a de qi sensation in order for the treatment to be effective. De qi is simply translated as “big qi”, or more commonly as a qi sensation. There are even classical acupuncture de qi sensations recorded over the millennium that are considered optimal for patients to feel to achieve success with treatment, such as feelings of:
- Dull, achy
- Fullness, distension
- Pin prick, slight pain
In my book, “Neuropuncture: A Clinical Handbook of Neuroscience Acupuncture,” second edition, I clearly correlated each specific de qi sensation with the specific neural fiber that transmits that exact sensation.1 Whenever our patients feel that heavy de qi sensation, then it can only occur if the A-delta fibers have been stimulated by the needle, or more accurately by the local chemical soup that is produced when needling, that stimulates the transmission of that sensation to the brain. I look at this as when my patient feels the de qi sensation, then I have reached my target, the brain. We all remember the multiple hand needle stimulation techniques that are taught to us to generate different de qi sensations that are associated with specific treatment principles, such as wagging the blue-green dragon’s tail, siphoning, rotation, twisting, fire on the mountain, pounding, scrapping, etc. Well, those hand techniques all produce a special chemical soup locally that initiates the profound healing reaction that occurs with acupuncture.1
This chemical soup has been analyzed and confirmed to include red blood cells, white blood cells, excitatory amino acids, prostaglandins, histamine, NGF (nerve growth factor), and CGRP (calicitonin gene-related peptide).1 CCRP is one of the body’s strongest natural vasodilators, which locally encourages more ‘pooling’ of that soup. We sometimes can see this during a treatment as the redness that circles the needle after insertion. This helps to explain how and why local needling is so effective for conditions such as infections, inflammation, and for treatments for conditions such as plantar fasciitis, and even tennis elbow. In the treatment of acute and chronic pain it has also been confirmed that with electroacupuncture techniques, a trained practitioner can target specific endogenous opioid receptors for the release of specific endogenous opioid peptides.1 For example 2hz millicurrent has been shown to target the Mu receptor for the release of beta-endorphins. Just as 4hz targets the Delta receptor for enkephalin release, and 100hz targets the Kappa receptors for dynorphin release in the spinal cord.1 A skillful practitioner can apply this neuroscience knowledge to their clinical practice quite easily with great effect. What is important is that the practitioner understands why these effects occur, so adjustments can be made from treatment to treatment for maximum clinical outcomes.
Using neuroanatomy we can also examine how distal acupuncture points on the extremities can very much effect visceral function. When we investigate the neuroanatomy of the spinal segments we find several amazing facts. First, specifically at the location of the dorsal horn of the spinal cord the somatic and visceral nerves converge into the one tract leading up to the brain, the spinothamalic tract. This spinal neural reflex is called the muscularvisceral reflex and there is also a cutaneousvisceral (skin to organ) reflex that explains Japanese style acupuncture. What this means is that when needling an acupuncture point, let’s use the traditional acupuncture point Stomach 25, that point is located on the T10 dermatome, when stimulated the neural transmission will enter the spinal cord at the T10 level. So, what visceral nerves also innervate at the level of T10? The stomach, spleen, pancreas, and the small intestine spinal nerves all have branches that innervate at T10. That means when needling and stimulating St 25, you will be also affecting those organs and it isn’t surprising how St 25 is a great point for digestive conditions, especially constipation.
The second powerful neuroanatomical fact is that when a distal acupuncture point is stimulated and the transmission innervates the spinal cord, at the level of the dorsal horn where that afferent transmission innervates, three powerful neuropeptides are released.1 Those neurochemicals are serotonin, noradrenalin, and enkephalin. All three chemicals aid in down regulating ANY pain signals coming in at that specific level, but also any transmission passing through that level ascending up to the brain. We may ask ourselves why, and how, is Large Intestine 4, Hegu, such an incredible point for pain? Or why are some of the “extra” points in that area so wonderful at alleviating ANY pain in the body, even if it is sciatica? Well, when stimulating LI 4, you are directly stimulating the branches of the superficial radial nerve. The radial nerve connects to the brachial plexus and that plexus innervates the spine at the levels of C5-T1 (the radial nerve is the upper branch and is associated with C5 innervation). When that neurotransmission passes thru the radial nerve, along the brachial plexus and then into the spinal cord at C5, those three powerful neurochemicals are released and will then down regulate ANY pain signals passing thru that area of the spine ascending to the brain. If we understand this effect, it does not surprise us that LI 4, or any of the extra points found locally, has a powerful effect on pain anywhere in the body. Another fun fact is that fMRI imaging has revealed that LI 4 has neural branches that terminate in the hypothalamus and when stimulated it releases beta-endorphins that activate the PAG (periaqueductal gray), which is the pain station for the entire body.1 Wow, is that awesome or what? Now communicate that in your next meeting with any western healthcare practitioner and tell me you won’t have their attention!
The TCM energetic model is scientifically controversial, yet to be confirmed, and understood by many to be historically mistranslated. Do we contain electrical energy? Yes. Do we omit electromagnetic fields? Yes. Great white sharks have these anatomical structures named “ampules of lorenzini,” that detects exactly this, the electromagnetic field of their prey. Our heart generates an electromagnetic field that expands about 3 meters in diameter every time our heart beats, and our blood produces an electromagnetic field due to the iron it circulates2. Does this equate to what is commonly understood as ying qi, the qi that circulates in the ‘pathways’ in TCM? I do believe so but not in a mystical, non-scientific realm. In the Ling Shu, it clearly states many times that some of these pathways can be seen with the naked eye under the skin, and that they all once originated from the heart and that they contain the blood and nutrients absorbed by the digestion and then circulated throughout the body for health. If you ask me, I believe that the Chinese ancient physicians had an astute understanding of the circulatory, and nervous system, centuries before the West, and there is not one acupuncture phenomenon that I cannot explain using neurophysiology. The term meridian came from a French physician in 1908, which translated mai and jingluo as ‘meridian’ due to his own personal energetic ideology. I have seen better translations as simply pathway, or vessel. I urge you to replace the term ‘meridian’ with ‘pathway’ or ‘vessel’, the next time you read it in a Chinese medical classic and see how that changes your point of view.
Does reinvestigating acupuncture with neuroscience subtract any of the powerful applications to acupuncture? Does it degrade its long historical presence? Will applying neuroanatomy to the TCM acupuncture model take anything away from this powerful medical treatment? No, No, and NO!!! It only confirms what our Chinese medical forefather’s were observing and illuminates the authenticity of our medicine, and galvanizes acupuncture into the future of mainstream medicine. It is practiced this way in China, Korea, and many European countries, and it seems like Americans missed that subtle, yet powerful, adjustment. I have devoted my professional career to learning and educating my colleagues in this exact area. I am currently involved in ground breaking electroacupuncture research investigating spinal nerve regeneration, stem cell proliferation, and much more. Please continue to educate yourself and raise the bar of standards for our profession by being able to properly communicate the how, and why our medicine works.
1) Corradino M. Neuropuncture: A Clinical Handbook of Neuroscience Acupuncture. 2nd ed. Jessica Kingsley Publishers; 2017.
2) Becker RO. The Body Electric: Electromagnetism and the Foundation of Life. 1st ed. New York, NY: William Morrow & Co., Inc; 1985.