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Chinese Medicine Demystified (Part IV): How Acupuncture Works


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Note: This is the fourth article in an ongoing series. Make sure to read the previous articles before reading this one, and check out the next articles in the series afterwards.

In this post we’re going to explore how acupuncture works from a western scientific perspective. As I’ve argued in the previous articles, there is no disagreement between the fundamental anatomical and physiological concepts of western and Chinese medicine. However, as methods of scientific inquiry have progressed, the mechanisms of acupuncture are beginning to be more clearly understood.

Acupuncture effects every major system of the body, including the cardiac, gastrointestinal, circulatory, cerebral, genitourinary, endocrine and immune systems.

It would take an entire book to describe all of the mechanisms involved, and in fact there is such a book for those who are interested in that level of detail. In this post my purpose is to summarize that research in a way that’s easy for lay people to understand, while providing links to more technical resources for medical professionals and others that might be interested.

Broadly speaking, acupuncture has three primary effects:

  1. It relieves pain.
  2. It reduces inflammation.
  3. It restores homeostasis.

Homeostasis refers to the body’s ability to regulate its environment and maintain internal balance. All diseases involve a disturbance of homeostasis, and nearly all diseases involve some degree of pain and inflammation. In fact, research over the last several decades suggests that many serious conditions like heart disease previously thought to have other causes are in fact primarily caused by chronic inflammation. If we understand that most diseases are characterized by pain, inflammation and disturbance of homeostasis, we begin to understand why acupuncture can be effective for so many conditions.

Several modes of action have been identified for acupuncture, which I’ll discuss below. The mechanisms can get quite complex.

But ultimately acupuncture is a remarkably simple technique that depends entirely upon one thing: the stimulation of the peripheral nervous system. It’s important to point out that when nerves supplying acupoints are cut or blocked there is no acupuncture effect.

A large body of evidence indicates that acupoints, or “superficial nodes” as they are more accurately translated, have abundant supply of nerves. According to Chen Shaozong, “For 95% of all points in the range of 1.0 cm around a point, there exist nerve trunks or rather large nerve branches.” 1

The following is a list of mechanisms that have been identified so far:

  • Acupuncture promotes blood flow. This is significant because everything the body needs to heal is in the blood, including oxygen, nutrients we absorb from food, immune substances, hormones, analgesics (painkillers) and anti-inflammatories. Restoring proper blood flow is vital to promoting and maintaining health. For example if blood flow is diminished by as little as 3% in the breast area cancer may develop. Blood flow decreases as we age and can be impacted by trauma, injuries and certain diseases. Acupuncture has been shown to increase blood flow and vasodilation in several regions of the body.
  • Acupuncture stimulates the body’s built-in healing mechanisms. Acupuncture creates “micro traumas” that stimulate the body’s ability to spontaneously heal injuries to the tissue through nervous, immune and endocrine system activation. As the body heals the micro traumas induced by acupuncture, it also heals any surrounding tissue damage left over from old injuries.
  • Acupuncture releases natural painkillers. Inserting a needle sends a signal through the nervous system to the brain, where chemicals such as endorphins, norepinephrine and enkephalin are released. Some of these substances are 10-200 times more potent than morphine!
  • Acupuncture reduces both the intensity and perception of chronic pain. It does this through a process called “descending control normalization”, which involves the serotonergic nervous system. 2 I will explain this process in further detail in the next post.
  • Acupuncture relaxes shortened muscles. This in turn releases pressure on joint structures and nerves, and promotes blood flow.
  • Acupuncture reduces stress. This is perhaps the most important systemic effect of acupuncture. Recent research suggests that acupuncture stimulates the release of oxytocin, a hormone and signaling substance that regulates the parasympathetic nervous system. You’ve probably heard of the “fight-or-flight” response that is governed by the sympathetic nervous system. The parasympathetic nervous system has been called the “rest-and-digest” or “calm-and-connect” system, and in many ways is the opposite of the sympathetic system. Recent research has implicated impaired parasympathetic function in a wide range of autoimmune diseases, including arthritis, lupus, rheumatoid arthritis and inflammatory bowel disease.

Several other mechanisms have been identified, but the ones I’ve listed above are the most relevant and clearly understood.

Some purists object to acupuncture being described in biomedical terms. They claim that such descriptions are “reductionistic” and narrow-minded, and don’t take into account those aspects of acupuncture that we may not yet understand.

Others who are still committed to the “energy meridian” model are opposed to the biomedical descriptions because, in their eyes, such scientific inquiry “takes the magic” out of acupuncture.

While I agree that there we don’t yet fully understand how acupuncture works, I think it’s vital that practitioners of acupuncture are able to explain what we do know about it from a biomedical perspective to their patients and colleagues in the medical profession.

As practitioners we have a moral obligation to provide each patient with the latest medical understanding available in terms they can understand and relate to. Doing this will improve patient outcomes and open the door for acupuncture to be integrated into the healthcare system, which is needed now more than ever.

I would also suggest that explaining the mechanisms of acupuncture in scientific terms should not in any way lessen our appreciation of its uniqueness. The fact that inserting fine needles into the skin can have such a broad range of powerful effects is just as remarkable when those effects are explained in terms of the nervous system as when they are explained in terms of “energy” and “meridians”. When you consider that the Chinese made these discoveries hundreds of years before the birth of Christ, acupuncture is even more impressive.

What’s more, as others have pointed out, acupuncture is inherently holistic even without the “energy meridian” theory because it restores internal homeostasis through the simple act of piercing the skin with a needle.

In the next article I’ll explain the latest theory on how acupuncture relieves pain in more detail. Stay tuned!

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  1. Shaozong, C. Modern acupuncture theory and its clinical application. (Chapter 5 The Morphologic Relationship between Points and Nerves). International Journal of Clinical Acupuncture. 2001;121(2):149-158
  2. Dung HC. Anatomical features contributing to the formation of acupuncture points. American Journal of Acupuncture. 1984;12:139-143
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Join the conversation

  1. Really!!!!!! Wow you are very intelligent person

    Its absolutely Hilarious how one uses means to clarify things one does not understand in an attempt to look educated!!!
    The same principles can be applied to your information. How about researching both side of a topic before you act like you know something about it.
    Take some time out to research who actually controls the publishing of content and how many versions of the content gets revised / translated etc.
    Arrogant and ignorant people like you have to start showing some mutual respect for those who actually rely on articles like this for valid information.

  2. Thank you for that nice article. I am a family physician and even though there is so much more to acupuncture, I agree we need to be able to explain acupuncture’s effects in terms that our patients and providers can understand. This article does just that!

  3. Really wow, some of it is true but the beauty of TCM is that it does not fit the Western Mold and it NEVER should it fits the Mold of being Human…I have had plenty of treatments where I did not feel a single needle go in but can feel the energy move along the channels…Our continued need to define everything in Western Terms is what is slowly destroying the ability to have truly Skilled TCM Practitioners and instead end up with Symptom chasers. I have tried multiple herbs without knowing what they are suppose to do before in small quantities and can feel there effects on the different channels in some cases not all but enough.

  4. I’m really enjoying your articles as I just love TCM and it’s so intriguing to get a Western Scientific explanation on some of the concepts involved. However the concept I’m most intrigued by in TCM is Jing. Pre natal and Post natal Jing, similar to the Ojas in Ayurveda. And, more specifically, if one was born with a congenital defect (like say of the heart for instance) that ran in the family, would that be a sign of poor pre natal Jing passed down or would the person’s Jing be a separate thing like how strong their resolve was? And hence they may still live a good quality life then from good Jing regardless of having been born with a defect?
    Is there any ‘western’, de-mystified / literal, or scientific take on the ‘Jing’ that you can share with us? Thanks in advance!

  5. This has been an enthralling, highly informative read, written with much clarity and wisdom. Thank you Chris for helping me to understand and dispel my fears. Really enlightening when you examine the wwetern historical misunderstanding and context, thank you.

  6. The best thing I’ve read lately. Succinct, practical and informative. I love your style Chris. Thank you for tackling the tough topics for us and giving us something we can use.

  7. There are three ways that acupuncture is known to reduce pain perception, involving blood flow, nerve signals and the relief of natural pain-killers. I don’t know anything about meridians and find it hard to relate to notions of energy flow and qui, but the scientific explanations do make sense to me. For a simple break-down of the three explanations, I suggest the following link: http://www.theedinburghmassage.co.uk/acupuncture/default.htm

  8. “Acupuncture promotes blood flow. This is significant because everything the body needs to heal is in the blood, including oxygen, nutrients we absorb from food, immune substances, hormones, analgesics (painkillers) and anti-inflammatories. Restoring proper blood flow is vital to promoting and maintaining health. For example if blood flow is diminished by as little as 3% in the breast area cancer may develop. Blood flow decreases as we age and can be impacted by trauma, injuries and certain diseases. Acupuncture has been shown to increase blood flow and vasodilation in several regions of the body.”

    I am sorry, I am not sure that is what it does. If so, what acupoint(s) would one apply the needle to make the promotion the blood flow…..???

    Here is the way that I understand the circulatory system….
    The heart is the only interface between the lungs and rest of the body. Its function is to circulate blood into the lungs to obtain oxygen and rid of carbon dioxide. The heart is made of cardiac muscle cells. In order for the heart to pump blood continuously, the cardiac muscle cells require a large amount of energy constantly. The energy is in a chemical form called adenosine triphosphate(ATP). Mitochondria produces ATP, within the cells, by absorbing oxygen and complete the breakdown of glucose. However, there are thousands of mitochondria in a cardiac muscle cell; and cardiac muscle cell forms the bulk of the wall of the heart. Hence heart contraction requires a tremendous amount of energy which demands a high volume of oxygen consumption.

    The heart is the first organ that uses the oxygen source from the lungs to generate the energy for cardiac muscle contraction; and then send the rest of the oxygen to the rest of the body. If the heart come to a cardiac arrest, all the oxygen will be cut off to the rest of the body. As a matter of fact, the cardiac muscle cells are incapable of mitosis. A heart attack is a portion of cardiac muscle dies because of lack of oxygen. Those cells cannot be replaced, and the heart will be less effective.

    In order to keep the cardiac muscle cells alive and healthy, a constantly source of oxygen to be provided is a must. Regular breathing is only providing a source of oxygen. However, with Chi Kung, it can provide a high volume of oxygen but also achieved abdominal breathing. If abdominal breathing is turned into a regular breathing routine, then all the internal organs are massaged constantly. Especially, the lungs to be filled with air and the heart with blood are more efficiently. In result, as long as the lungs and the heart are in good operational condition for chi(oxygen) flow, the rest of the organs will do the best at their own as well.

    • You started out with clear English then started confusing me with improper and unrelated words resulting in major confusion! Nevertheless, you make a point however, you do not support your argument! You never talk about the process of acupuncture and you never showed how it does not work! You only explained the traditional obvious! I recommend that you review the neurvous system, efferent and afferent processes in the perferal NS!

    • To answer your question, “I am sorry, I am not sure that is what it does. If so, what acupoint(s) would one apply the needle to make the promotion the blood flow…..???”
      **There is a point on the Spleen Meridian, called the SEA OF BLOOD aka Spleen 10. It’s main function is to promote the flow of blood. Please give this man some credit and stop acting like you know everything about TCM… You are speaking purely from the Western perspective, and it has absolutely no relevance here. Because you study a “branch” of medicine does not mean you know and understand ALL aspects of medicine. Have an open mind, and maybe you will learn a thing or two.

    • Accupunture controls the process of blood flow by forming new capilaries. Once a small or even large vein has a leak in it, blood will slip out making its way to the surface. The trail the blood leaves will form new capilary growth, leading to more neuronal growth providing hair, skin, bone, organ, and greater sensitivity/tactile recruitment. Kind of like capilaries being torn in lung tissue after running a 400 meter sprint to failure. The capilary growth in lung tissue is tremendous days following. In the case of the 400 meter run as an example, air is forced through the lung walls, leaving small holes, and blood droplets inside the tissue. Tissue is broken down in accupunture, then rebuilt through inflammation caused by pain and blood loss.

  9. Hi Chris, I am enjoying reading your articles and find the logical thinking and demystfying concepts refreshing and reassuring. I can see Dr Tan system has very popular appeal. I haven’t yet studied his approach. I can see how it might be explained from a channel theory point of view as well as moderating the pain pathway. However I wonder is it enough on its own when dealing with pathological tissue when increasing circulation of local qi and blood would seem logical. Can you recommend your personal view in when Tan is best used or how you integrate it into other treatments? So grateful for your response.

  10. I have. Suffered from depression as long as I can remeber,getting more low as I grow older Im now 62 and thinking of trying acipunture ,what do you think. Please ,

    • Sue….
      I think depression is a psychological problem. Acupuncture is good for innervating the nervous system. Therefore, it may not be helpful to your existing problem.

      • yeah don’t listen to this idiot. psychological problems has a lot to do with the nervous system. Imbalance in the brain chemicals (serotonin, dopamine, etc.) will cause one to feel sadness, hopelessness, anxiousness and so on. Acupuncture is very safe and effective method to help regulate the autonomic nervous system, whether to sedate the sympathetic nervous system or to activate the parasympathetic system. Please choose a practitioner who specializes in this branch of medicine, as they will have extensive research and experience in treating this condition.

    • i’ve had acupuncture for depression and it was very effective. Depression can be caused by an imbalance just the same as many other things. Worth a try i would say as it’s helped me so much!

    • Sue,
      You have nothing to lose try it.
      You would also benefit from Yoga once a week.
      Walking 40 minutes every day.
      Drinking 3 cups of green tea a day and eating food with vitamin B and Omega 3
      Diet and exercise better then the pills

      • Before you do this look into the fact whether or not a person has dysautonomia,
        You’ll find knowledge of it on the internet. Much of what you say is ok for some, very dangerous for others. Because today there are estimated 70,000,000 people living with this condition, it is poorly diagnosed because it can be the basis of so many diseases, Basically because life today is so highly active mentally and physically that the sympathetic nervous system becomes permantly hyperactive, and cannot completely be fully shut off by the parasympathetic nervous system, so it slowly starts to damage so many areas of the body and mind. I have been trying to close the sympathetic system down for a long time. Only recently have I started to achieve it,
        I was a qualified acupuncturist for 25 years. And still studying it now after 15 years in retirement.
        Often the yin of the system has not diminished, so there are no signs, but the yang aspect becomes hyperactive it can be caused in many ways. It’s as though one has ones foot always slightly on the accelerator pedal ad at the slightest sign of, thought or continuous movement the sympathetic reacts again. Put a needle in the skin to sedate, and the sympathetic reacts immediatey until it settles down again, but it doesn’t last long. It takes a long time to balance the autonomic system again. I have only recently achieved a modicum of success with low level lasers on hyperactive yang points, but it must be done with a sapphire blue laser which disperses the energy. Don’t tonify with red lasers. To me sedation is wrong because if you sedate something you get rid of it, but you don’t loose anything from the body when performing acupuncture.

    • Sue,

      Acupuncture is very effective at helping to lift the spirits. Many people receive acupuncture for mental disorders, including PTSD. Qi stagnation can cause one to feel stuck and that can progress to feeling down. The longer one has had the issue, the longer it normally takes to see improvement, but I’m pretty sure it’ll lift your spirits. Find a practitioner and ask them their opinion. It’s worth a shot.

    • Sue! Try it! What have you got to lose! The function of the needles may be limited for your condition, however, there are many chinese herbs that are dedicated to calming the spirit and mind that may prove to be very beneficial for your condition. The great part is that these herbal formulations are also without any major side effects, and if for any reason you are not happy with the results, you can stop and any time without having to worry about withdrawals or harmful side-effects.

    • Sue,
      I have treated patients with depression very successfully. It would be to your benefit to seek out a licensed, TCM practitioner. I treated depressed patients as their only healthcare provider, as well as worked with patients who were also on medications prescribed by their MD’s. Some patients use only herbs and acupuncture, while others use TCM to support other therapies (i.e. psychotherapy and pharmacological intervention)– it all depends on your symptoms, which could be diagnosed and clearly defined by a TCM practitioner. Hang in there! You are not alone.

  11. Hello Chris!
    I first heard your name mentioned in the Paleo circles and have enjoyed your posts on the subject. You earned a bit more respect than others since you are an acupuncturist, like me. 🙂
    I started practicing in 2004 and loved every minute of it. I wanted to pursue my passions for integrative medicine decided to go back to school. This summer, I will be licensed as a physician assistant. My dream would be to find a pain management group with which to practice holistically.
    This note is to tell you that I’ve learned more about the art and medicine of acupuncture in your series of articles than I did in school. THIS is the information that I’ve been craving! I always felt a little silly explaining the concept of energy and meridians to my patients, particularly those that were more educated. I would smile sheepishly and say, “We don’t know how, but it DOES work.”
    This information is exciting and reignites my love for this profession. Thank you!

  12. Yup, you are right Google is the most excellent in support of blogging, Google webpage Chinese Medicine Demystified (Part IV): How Acupuncture Works as well appear quickly in search engines too.

  13. Hi,
    Chris I am incredibly inspired and impressed by your articles and current research on how to explain Acupuncture.I also love how informative your website is.Keep up the great work. I hope it is ok I sited some of your articles onto a blog website, with of course a direct link to your article.let me know if that was ok.

  14. Hi Chris. I am a 21 year-old student and injured my back/shoulder area almost two years ago working out with weights. Of course, by now, most of the pain from the injury has subsided as I am assuming most of the tissue has repaired itself. However, I still feel a bit of inflammation around my rhomboids/latissimus dorsi area. I am not sure what the cause is. Could I still just need further rest, or would you recommend seeing an acupuncture therapist for this kind of situation? Thanks, Andrew.

  15. Hi Chris,

    I’ve recently starting getting acupuncture and am wondering how frequently I should get it done. I’m 22 years old but have had gut issues–digestive problems, anxiety, etc.–my whole life. For these reasons, as well as articles such as yours that I’ve read, I’m thinking I should get acupuncture done several times a week, at least in the beginning. However, my university only offers acupuncture treatments once a week. I’m wondering, is it worth it to only get acupuncture once week if, based on my conditions, I should really be getting it done more often?


  16. Interesting approach Chris. I agree with the misuse of the word “energy” it is too loose a definition and in the context of Acupuncture ends up meaning very little. However I think that Western science still has some work to do to explain acupuncture fully.

    Question: your statement “when nerves supplying acupoints are cut or blocked there is no acupuncture effect.” is fundamental to your thesis. I have seen research that indicates cutting off areas of the CNS can prevent acupuncture responses, but I havent read anything about nerves directly at the acupuncture point affecting the treatment. Can you point me to the research where this statement comes from?

  17. A collegiate hello from Finland.

    I stumbled into your blog researching paleo diet related longevity articles. Nice work.

    Regarding acupuncture, I think it is fair to admit that we probably don’t yet have all the objective correlates of that system mapped out in a Western style (as the Eastern systems haven’t been that keen on looking for mechanistic explanations on everything and also haven’t had the methods to dig really deep).

    Have you seen these new studies which suggest there actually might be something going on in the ancient meridian theory that we haven’t seen in Western medicine. Interesting times as developing methods of science show us more and more of Nature 🙂


    Vilho Ahola, M.D.

    • Welcome! I absolutely agree we don’t have all the answers, and it may never be possible to completely map the Eastern perspective with Western correlates.

  18. Great series of articles. I would, however, caution against throwing out the baby with the bath water. The concept of qi as it relates to human beings can, for the most part, be explained by physiological processes explained by modern medical science. It is important to promote this fact to the public and other healthcare providers. It is equally important to counter the bs out there. However, the Chinese word ‘qi’ is not only a medical term. It was used extensively in philosophical texts to explain the interconnectedness of phenomenal existence (see Hall and Ames Dao De Jing). The concept of qi absolutely cannot be translated as ‘oxygen’ or any other fixed entity for that matter, as it is the common ‘fabric’ of all existence. This is demonstrated in Laozi, Liezi, Chuangzi and several other classical Chinese philosophical texts. We need to make clear that the concept of qi AS APPLIED TO MEDICINE can be understood as oxygen, glucose, neural conduction, etc., but that the larger concept of qi as a philosophical term has much broader meaning. Not having the quantitative understanding of biology that we have today, the Chinese refered to unidentified form and function as ‘qi’ – the stuff of the universe. Thanks for your work!

  19. Hi Chris,

    You mention that you’re a longtime practitioner of qigong and ba hua. I know many people describe it as a sort of a cure-all, but I was wondering, as a health care provider, are there specific conditions that you think qigong is a useful treatment for? Would you prescribe it to a patient for specific conditions, or do you see it as just helpful for general health upkeep?

    Also, in the previous comments you discussed contact needling vs. acupuncture. I’ve been looking into trigger point therapy, whose purpose seems to be more limited (releasing muscle contractions). I was wondering if you have any experience with it and if you can comment on its efficacy relative to acupuncture. I know from first-hand experience that it does work well for pain or strained muscles, at least for me. Is it something that you would use or recommend in your practice, or is it unnecessary if you have acupuncture in your toolkit, so to speak?