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Ancient
Science
After
more than two millennia, modern research is providing insight
into the physiology and efficacy of acupuncture
By
Kathryn Lange
In 1997, the National Institutes of Health, the division of
the U.S. Department of Health and Human Services responsible
for conducting and supporting medical research, released a
landmark report on the effectiveness of the much-disputed
practice of acupuncture. Based primarily on clinical trials,
the report concluded there was definitive evidence that acupuncture
was successful in the treatment of postoperative, chemotherapy-
and pregnancy-related nausea and vomiting, and postoperative
pain. The report also stated that, while more scientific data
was needed, acupuncture was worth perusing as a primary or
adjunct therapy for treating myriad other medical problems,
from infertility to tennis elbow. The government statement
contributed to the broadening acceptance of acupuncture and
fueled a decade of in-depth research into the physiology of
one of the oldest healing practices in the world.
This past November, to mark the 10-year anniversary of the
NIH consensus, the Society for Acupuncture Research held a
four-day conference, presenting hundreds of different studies
and highlighting the most groundbreaking acupuncture research
of the past decade. In addition to continued clinical trials,
contemporary technologies, such as neuroimaging, are providing
quantitative evidence that acupuncture works—and why.
The
ancient theory of acupuncture, one branch in the complex tradition
of Chinese medicine, can be traced to the text Huang Di Nei
Jing (Yellow Emperor’s Inner Classic), which dates to the
Han Dynasty in the second century B.C. The authors of the
Nei Jing viewed the human body as a microcosmic representation
of the universe and believed that health was achieved by maintaining
a harmonious balance between the internal and external environments.
The traditional understanding of acupuncture (so named by
16th-century French Jesuits from the Latin for needle and
puncture) is that channels of vital energy or chi (pronounced
“chee”) run in specific patterns throughout the body. In Taoist
philosophy, the flow of chi is created by polarity of yin
and yang, the two extremes found in all of nature. According
to the American Academy of Medical Acupuncture, “These energy
channels, called meridians, are like rivers flowing through
the body to irrigate and nourish the tissues. An obstruction
in the movement of these energy rivers is like a dam that
backs up the flow in one part of the body and restricts it
in others. . . . Acupuncture unblocks the obstructions at
the dams, and re-establishes the regular flow through the
meridians.”
The National Center for Complementary and Alternative Medicine
describes these meridians as “14 main channels connecting
the body in a weblike interconnecting matrix of at least two
thousand acupuncture points.” Modern-day acupuncture treatment
differs from the practice described in the Nei Jing and other
ancient texts mainly in material. Thin stainless-steel needles
are inserted into the skin at a number of specific points
along the meridians, the selection of which varies with the
symptoms and treatment goals.
Accounts of acupuncture practice in the United States began
to appear in medical texts in the mid-1800s, but remained
uncommon until 1971, when New York Times reporter James Reston
had emergency surgery for acute appendicitis while on assignment
in Beijing. Reston’s firsthand account of acupuncture for
postoperative pain management ran on the front page of the
Times and ignited public interest in the practice. However,
medical theories centered on “balance” and “obstructed energy
rivers” were not easily embraced by Western culture or physicians
and remain highly controversial today.
The practice of acupuncture predates the scientific method
and therefore has received intense criticism for the lack
of anatomical evidence of the existence of meridians. While
many acupuncturists still ascribe to the ancient philosophies
of flowing chi, some contemporary acupuncture practitioners
have condemned the traditional theories. In his book Reinventing
Acupuncture: A New Concept of Ancient Medicine, Felix Mann,
founder of the Medical Acupuncture Society, boldly stated,
“The meridians of acupuncture are no more real than the meridians
of geography. If someone were to get a spade and try to dig
up the Greenwich meridian, he might end up in a lunatic asylum.
Perhaps the same fate should await those doctors who believe
in acupuncture meridians.”
Other acupuncturists at-tempt to maintain a balance between
ancient and physiological theories, and believe the practice
is strengthened by the union of Eastern and Western medical
philosophies. After studying acupuncture practices in China,
the Committee for Skeptical Inquiry concluded that “although
[chi] is merely a metaphor, it is still a useful physiological
abstraction…The related concepts of yin and yang parallel
modern scientific notions of endocrinologic and metabolic
feedback mechanisms.”
Numerous hypotheses have been proposed to explain the physiological
mechanisms of acupuncture. To date, more than 10,000 scientific
studies on acupuncture have been published and catalogued
with the National Library of Medicine. Neurohormonal theory
currently provides the most widely accepted clinical explanation
of the body’s response to acupuncture treatment. According
to neurohormonal theory, the insertion of acupuncture needles
stimulates the pathways of the peripheral nervous system of
the somatosensory system. In turn, peripheral nerves transfer
that stimulation to the brain and brain stem, which control
all of the body’s systems through the release of hormones.
Specific acupuncture points correspond to specific areas of
the brain and result in the release of different hormones
affecting distinct body systems.
Recent developments in neuroimaging have opened new doors
for acupuncture researchers. Investigations into acupuncture
using brain imaging techniques like positron emission tomography
(PET), magnetic resonance imaging (MRI), and electroencephalography
(EEG) have provided quantitative evidence supporting neurohormonal
theory and the general effectiveness of acupuncture in treating
a variety of ailments. These neuroimaging studies generally
compare the brain activity of an untreated control group,
a test group undergoing proper acupuncture treatment, and
a placebo group treated with “sham acupuncture,” the insertion
of acupuncture needles at non-acupuncture points. The “sham”
treatment of the placebo group compensates for outcomes that
are based on the subjects’ expectations of results, not the
acupuncture treatment itself.
Dr. Vitaly Napadow, a practicing acupuncturist, physician,
and radiology professor at Harvard Medical School, is one
of the preeminent researchers of acupuncture brain imaging.
His most recent paper, “Neuroimaging Acupuncture Effects in
the Human Brain,” published in the Journal of Alternative
and Complementary Medicine, summarizes the results of multiple
studies, and concludes that stimulation of different acupoints
elicits significant responses in multiple brain structures.
Most notably, imaging revealed that acupuncture treatment
modified activity in the areas of the brain that control pain
perception, memory, and mood. Significant response was also
seen in the in the hypothalamus, which modifies the endocrine
functions that control hormone output. Napadow’s imaging research
has shown that the heightened activity in the cortical “pain
matrix” of carpel tunnel patients was modified to reflect
healthy brain activity after acupuncture treatment.
Other studies, including findings published by the National
Academy of Science, indicate that the visual cortex is activated
by acupuncture point stimulation in the foot in the same way
it would respond to a light source shone in the eyes. Similar
results demonstrated the connections between acupuncture and
the auditory and language cortexes, and documented significant
clinical response to acupuncture in nausea patients.
Over the past 2,000 years, acupuncture has been used as a
treatment for hundreds of medical problems. Contemporary research
had discredited the effectiveness of acupuncture for some
of those indications and strengthened the argument for others.
A 2007 survey conducted by Tufts University estimates that
there are 17,000 practicing acupuncture professionals in the
United States today. Requirements for acupuncture licensure
vary by state. In New York, applicants must have completed
at least 60 college credit hours, nine of them in the biosciences,
and more than 4,000 hours of professional acupuncture education
at an accredited institution, including instruction in anatomy,
physiology and pathology, acupuncture theory and technique,
and active clinical experience. Many acupuncturists are licensed
physicians and, for nonphysicians, acupuncture education can
be pursued to the postdoctoral level.
Despite the stringent licensure requirements, mounting research,
and two millennia of anecdotal evidence, acupuncture practitioners
continue to struggle for credibility. One of the most significant
challenges to the field is that, while the accessibility of
coverage is increasing, medical insurance for acupuncture
remains inadequate. Many private health-insurance providers
do not offer coverage for acupuncture treatment, and neither
Medicare nor Medicaid recognize acupuncture as an insurable
medical practice. The uninsured cost of acupuncture prohibits
many people from exploring potentially effective treatment
options, including, possibly, the one with history’s most
impressive track record: According to the American Academy
of Medical Acupuncture, “In the past 2,000 years, more people
have been successfully treated with acupuncture than with
all other health modalities combined.”
klange@metroland.net
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