Ep. 12: Exploring the Science of How Acupuncture Works

Welcome to Notes From Your Acupuncturist, the podcast for anyone who's interested in acupuncture, complementary medicine, holistic, health, and self care. I'm your host, Alexa Bradley Hulsey. If you enjoy this show, you can help other people discover it by leaving a rating or a review, by following or subscribing on your favorite podcast listening app, or simply by by telling someone about it. And if you'd like to support this show financially, you can become a paid subscriber on Substac for just a few dollars a month. Just head over to substac.com and search Notes From Your acupuncturist or click the link in the show Notes. And one more thing before we get started, just a disclaimer that this podcast is for educational purposes only and is not a replacement for medical care from a qualified healthcare provider. Okay, on with the show.

Hello, everyone. Welcome to Notes from Your Acupuncturist. I'm Alexa, and I am very thankful to you for tuning in today. Before I get started, just a quick shout out to Dr. Jen So, who gave the show a five star review on Apple podcasts. Thank you so much, Dr. Jen So. Ratings and reviews help other people discover the show. So if you enjoy what you hear, please leave a rating or a review wherever you listen.

Okay, on to today's episode. Today is a solo show where I answer listener questions or just share something I find fascinating about the medicine I practice. And today I'm going to answer a question I get a lot, which is how does acupuncture work? And specifically, I'm going to talk about the scientific perspective on how acupuncture works. If you have a question or a topic you'd like to learn more about, I would love to hear from you. If you're a substac subscriber, you can get in touch by commenting on any of my posts or replying to any of my emails. You can also message me on Facebook or Instagram at Notes from your ACU. And you can also go to the website Notes From Youracupuncturist.com to send a message or a voicemail. And if you send a voice memo, I will play that on the air.

So, onto today's topic, how acupuncture Works, according to the scientists, I wanted to do an episode on this topic because sometimes acupuncture is criticized for being unscientific and non evidence based, and therefore somehow an illegitimate or inferior form of medicine. And that's partly because acupuncturists tend to speak the language of our own medicine. So we talk about qi and flow and meridians, and that's all great. But today I want to present to you what the scientific research shows, because acupuncture has actually been extensively researched, and it continues to be researched because scientists want to understand how it works and why it works. So I'll talk about some of those studies and what the research shows, and I will put links to all of the studies I'm citing in the show Notes.

So the first physiological effect of acupuncture that I want to discuss is that it has the effect to increase circulation. So the way that we look at it is acupuncture stimulates the flow of Qi. And in traditional Chinese medicine theory, we say that the Qi moves the blood. And the research actually bears this out. So there was one study done in Japan in 2012 which used color Doppler imaging to evaluate blood flow in real time. And it showed that acupuncture produced changes in blood flow in peripheral mesenteric and retrobulbar arteries. So these are arteries on the extremities supplying the intestines and then retro bulbar means behind the eyeball. Now, what I find interesting about this study is that different points they studied produced different changes in blood flow. So they looked at two points in particular liver three, which is on the top of the foot, and stomach 36, which is below the knee. And in this study, liver three increased blood flow in the retrobulbar arteries. And again, these are artery supplying the eyes, but it produced no significant change in the super mesenteric artery. And again, that's an artery carrying blood to the intestines. Stomach 36 had basically the opposite effect no significant change to the retrovulbar arteries, but increased blood flow through the superior mesenteric artery. Okay, so let me explain why that's interesting. In acupuncture theory, these two points have very different functions. And in this research study, these two points both increase circulation, but in different ways and in different arteries. Liver three increased blood circulation to the eyes. And in Chinese medicine theory, the liver energetic system includes the eyes and the liver channel begins on the foot and flows upward to the eyes. So an acupuncturist looking at this study says, of course, stimulation of a point on the liver channel will increase circulation to the eyes because that's where the liver channel flows. And then stomach 36, which in this study increased blood flow in their artery supplying the intestines. Stomach 36 is the point for any problems related to digestion. So of course, it increases blood flow to the intestines. So when we take into consideration how these points function, the findings from this study aren't the least but surprising. And it really supports the approach we take in acupuncture, which is to select points according to the therapeutic response we want to bring about. No two points are the same. And the study seems to show that. There was another study in Israel in 2016 which showed that acupuncture produced an increase in cerebral blood flow for post stroke patients. And there have also been a number of studies showing that acupuncture increases nitric oxide levels in the local regions where the needles are inserted, which in turn increases local circulation. So nitric oxide is a gas that is naturally produced in the body and it relaxes the blood vessels, which then in turn increases circulation. You'll often find nitric oxide in supplements that claim to boost athletic performance because of this effect to enhance circulation. But it turns out you can get acupuncture to increase your levels of nitric oxide without needing a supplement.

Okay, so that's circulation. Another physiological effect of acupuncture is that it reduces inflammation. This is actually one of the most extensively researched effects of acupuncture. So let's talk about inflammation for a second. There are five hallmark signs of inflammation pain, swelling, redness heat, and loss of function. These are signs of what we call excess heat in Chinese medicine. So say you twist your ankle. Your body produces an inflammatory response as a way to stabilize the area and prevent you from injuring yourself further. And then the body does the same thing in response to an infection or a foreign pathogen. Inflammation is an essential function of the immune system, and it's a natural part of healing. It's a great short term solution to the problem of an injury or an infection. But chronic inflammation can damage healthy cells and tissues and organs and can cause a lot of problems, including pain, and also severe or even life threatening health conditions like heart disease or cancer. So researchers are very interested in looking at ways to reduce inflammation, and it turns out acupuncture is great at that. A 2021 paper published by Chinese researchers looked at over 350 studies on acupuncture and inflammation from the previous five years and concluded that, quote, acupuncture indeed exerts strong antiinflammatory effects in multiple biological systems, namely the immune, digestive, respiratory, nervous, locomotory, circulatory, endocrine, and genital urinary systems, end quote. Sorry, that was kind of a mouthful. But it shows that acupuncture has a very widespread antiinflammatory effect. Another paper published in 2022 by researchers in Korea looked at the research on the antiinflammatory effects of acupuncture at just one specific point, stomach 36, and concluded that, quote, acupuncture at specific acupoint, stomach 36 showed antiinflammatory properties by regulating inflammation related genes in body fluids, the digestive system, the nervous system, and other tissues or organs unquote. And stomach 36 is the same point I talked about earlier, which was shown to increase circulation to the mesenteric arteries. Summit 36 actually comes up a lot in these studies because it's one of the most commonly used acupuncture points. There was a Song Dynasty physician named Chin Chung Zhu who said that all diseases could be treated with stomach 36, and so far, the research is kind of showing that. So anyway, many, many studies out there show that acupuncture reduces inflammation, which explains why acupuncture is so effective for treating pain. People who are skeptical about acupuncture will say that its pain relieving effects are just a placebo. But the research shows that it does cause physiological changes in the body, which reduce inflammation. Over the counter pain meds like aspirin and ibuprofen do the same thing. They reduce inflammation, but they have side effects, and acupuncture doesn't.

So that's inflammation. Now, let's talk about the nervous system. People sometimes will ask if the acupuncture needles stimulate the nerves or if we're trying to touch the nerves with the needles. So acupuncture needles don't make direct contact with nerve fibers. When we insert a needle, we're not aiming for the nerve. And if we did, actually, that would be extremely painful. But acupuncture does affect the nerves and the nervous system indirectly. And I want to share a few studies that look at that connection between acupuncture and the nervous system. So one study in 2020 looked at the effects of acupuncture on the vagus nerve. So the vagus nerve is a really long nerve and it regulates a number of body functions, including heart rate. And in this particular study, participants in the acupuncture group were needled at a point on the ear that corresponds to the vagus nerve. And then heart rate was measured and compared to the placebo and the control groups. The acupuncture group showed, quote, significant reduction in heart rate, unquote. So it demonstrated a connection between that vagus nerve point on the ear and the function of the vagus nerve to regulate heart rate. Another article, which was published in Frontiers in Science in 2022, looked at all of the research published in PubMed in the last 20 years on the connection between acupuncture and the autonomic nervous system. The autonomic nervous system regulates all of the body's involuntary functions and it's divided into two branches the sympathetic and the parasympathetic. So the sympathetic nervous system is the body's fight or flight response, and the parasympathetic is the rest and digest response. Together, these two branches really maintain homeostasis in the body. And this review of studies published over the last 20 years found that acupuncture effectively alleviates autonomic nervous system dysfunction and modulates patterns of sympathetic and parasympathetic nerves. So essentially, the research shows that acupuncture helps your nervous system switch out of its fight or flight response and into rest and digest mode. That's one of the reasons why acupuncture is so relaxing. People say acupuncture helps them feel less stressed and less on edge. Well, this autonomic nervous system modulating effect is one of the reasons why.

And related to that, another way that acupuncture works is by increasing endorphins. So endorphins are chemicals that are naturally produced by the body and they act as natural painkillers. They are often referred to as the feel good chemicals because they can also produce feelings of pleasure and feelings of euphoria. So endorphins produce a happy, warm, fuzzy feeling in the body. You feel this after you exercise or after you laugh really hard or listen to music you love or maybe go to a concert or a sports event. Patients sometimes say that acupuncture gives them a natural high and that's because of endorphins. And there have been many studies linking acupuncture to increased endorphin levels. One study published in 2020 found that acupuncture and electroacupuncture treatment, quote, had profound therapeutic effects on acute withdrawal symptoms in patients who are addicted to heroin. And that's because endorphins are opioid proteins that originate within the body. So they're essentially the body's natural painkillers, like the body producing its own morphine. And acupuncture increases levels of those natural painkillers, which is another reason why it's so effective for pain. At my clinic, we observe this very specific pattern on a pretty regular basis. A patient will come in in a bad mood because they've had a stressful day, or they got stuck in traffic and they're frazzled or they're in pain, and so they're just cranky. And when they leave an hour later, they're like a different person. They're relaxed, they're smiling, they're happy. And it's because of this effect of acupuncture to increase endorphins. So next time you're in a bad mood, go get some acupuncture.

Okay, moving on to the next area where acupuncture has physiological effects. It's the endocrine system. So the endocrine system is a collection of glands throughout your body that produce hormones that regulate many of the body's functions. You can think of hormones as chemical messengers, and the endocrine system is the system of highways and roads that these messengers travel along. So one study at Georgetown University, which was published in 2013, looked at the effects of acupuncture on rats, and they specifically measured the hormones of the hypothalamus pituitary adrenal axis. And this is an interesting area to study because the interactions of these glands and their hormones control the body's stress response and also regulate digestion, the immune system, mood and emotions, reproductive function and metabolism. So this HPA axis has really far reaching effects on the body. So this Georgetown study looked at the effects of electroacupuncture on the HPA axis. And just a side note about electroacupuncture. So this is a technique that involves attaching leads to acupuncture needles to pass a small electrical current between pairs of needles. It's a low frequency, low intensity current that stimulates the points. Electroacupuncture is often used in research studies to help researchers control the dosage of acupuncture being studied. So what the researchers found in this study is that electroacupuncture blocked the chronic stress induced elevations of the HPA axis hormones, and it also lowered levels of a peptide called NPY, which is secreted by the nervous system in response to stress. So this study found that acupuncture measurably lowers stress by action on both the endocrine and the nervous systems. And guess which point they studied in this experiment. It's our good friend Stomach 36. You know, the one that treats every disease according to Chen Chung Zoo.

Okay, so one more area where acupuncture affects the body physiologically. And I saved my favorite for last Brayden weights. I had a patient, we'll call him Bob, and he would talk about how he'd go to La La Land during acupuncture. And he liked to rest with the needles in for exactly 40 minutes because that was the perfect amount of time to send him to La La Land. And he loved going to La la Land. He'd talk about it and say, where do I go with this sort of childlike wonder in his voice? And then I started to wonder the same thing. Like, where does Bob go? And I noticed something else, too. So the style of acupuncture I practice is community acupuncture, which means multiple patients are getting treated together at the same time in one big room. So, depending on the day, there might be five or ten or even 20 patients in the treatment room at one time, all in various stages of their treatment. And I've always got my eyes on patients. I pretty much just spend my day traipsing back and forth across the treatment room floor. It's kind of like waiting tables at a restaurant. And what I've noticed over the years is that some patients seem to disappear from the room while they're resting. It's like I walk right past them, and my brain doesn't even register that they're there. Like they go somewhere else. So I started to wonder, where do they go? Maybe they go to La la Land like Bob. And, you know, a lot of patients report feeling kind of disembodied during acupuncture. So I started to wonder, maybe La La Land is a brainwave state. Let's talk about brainwaves for a minute. There are five known brainwave types alpha, beta, gamma, delta, and theta. And each type corresponds to a different level of brain activities. The highest frequency waves are gamma waves, and these are produced during periods of problem solving and concentration, say, if you're taking a test or focused intently on a specific task. Beta waves are the next highest frequency. And these are produced when your mind is busy and active, but not intensely focused. So, like, if you're scrolling through social media, alpha waves take it down a notch. They're associated with a relaxed meditative state. I think of alpha waves as the shower brainwaves. You know how you often get a good idea when you're in the shower? It's because your mind is relaxed and in that alpha brainwave state. Next are theta waves. To me, this is where things get interesting. Theta is a dreamy zoned out state where you're not fully alert, but not completely asleep either. Some studies have shown that theta waves are produced during meditation. Finally, the lowest frequency waves are delta waves, which are produced during deep sleep. So those are the brainwave types. And based on what patients tell me and my own experience getting treated, it seems like acupuncture produces alpha, theta and delta brainwaves. And I believe that La La Land that Bob always loved going to is actually a theta brainwave state. And it turns out there is some scientific research that supports my hypothesis. One study in 2013 compared the effectiveness of acupuncture versus Clonazapam for patients with anxiety. And first of all, it showed acupuncture to be more effective than Clonazepan, aka Clonapin, for general anxiety disorder. But it also showed that acupuncture produced an increase in alpha brain waves. And another study in 2017 showed an increase in both alpha and theta waves with acupuncture. So acupuncture gets the brain into a relaxed, meditative or even dreamy subconscious state. I would love to see more research on acupuncture and brainwaves because I think it's just a really interesting area of study. So if there are any neuroscientists out there listening to this episode, get in touch. Let's design a research study. Let's help more people get into la la land with acupuncture.

Okay, deep breaths. This has been a lot of science talk for one episode, and there is so much more acupuncture research out there. I've talked about acupuncture's effects on improving circulation, reducing inflammation, regulating the nervous system and endocrine system, and even modulating brainwaves. And I haven't even gotten into the research on acupuncture for specific health conditions. It's been studied extensively for the treatment of conditions like pain, migraines, hot flashes, IBS and anxiety, just to name a few. So the next time someone tells you that there is no scientific basis for acupuncture, just tell them to listen to this episode. And if you're wondering about a more esoteric explanation for how acupuncture works, that will be coming up in a future episode. So stay tuned. If you have a question about acupuncture and holistic health, I would love to hear from you. You can comment on substac, message me directly on Facebook or Instagram, or get in touch via the website Notes From Youracupuncturist.com bonus points if you share a voice memo, because then I can share it on the air. Thanks for listening. Be well out there. Friends. Thank you for listening to today's episode.

If you liked what you heard, please follow this show, leave a rating or review, or just tell someone about it. And if you want to join the conversation, you can subscribe to Notes From Your Acupuncturist on Substac, where you can comment, ask questions, participate in discussion threads, watch videos, and read more of my reflections on acupuncture and healing. Huge thanks as always to our paid subscribers for helping keep this work sustainable. You too can become a paid subscriber for just a few dollars a month. Just head over to Substac.com and search Notes From Your Acupuncturist or click the link in the show Notes. Until next time, this is Alexa Bradley Hulsey, your acupuncturist, signing off with love and gratitude.