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How Does It Work?

Acupuncture, How It Works,

The Mystery

            Whether I can help them or not — and for the most part I do — almost everyone pretty much asks the same questions, first among them, “how does it work?” Actually, I really do not know; although, I do have my suspicions.

Just saying you do not understand how something works in medicine is not a good answer especially when you are about to or already have  inserted needles into somebody’s body and on some level promised them or just suggested to them that this might be good for them. How many doctors, even if they did not know the exact biochemical reason a particular drug works, would say sheepishly but without hesitation “I just don’t really know, but it might have a ton of side effects, but it will be OK and help you anyway.”  They might say “you would not understand” — we all believe that a scientific doctor is very smart and dealing with issues and tissues and organic chemistry and all that that is more than likely above our heads even if we have a PhD in sociology or an MBA in finance — or give a made up but very scientifically complex sounding reason hoping we do not call the bluff or know the bluff to call it.

So what do I say? Well, I say, “scientifically speaking we do not really know.” Notice I have used the collective “we” to spread the guilt around, to deflect doubts that my poor patient might now have — given that I have said “I do not know” — about my competence and intelligence and to identify myself, my poor unconventional-alternative-medicine-self with science and scientists, who are still relatively esteemed in the culture even if, or especially because, they invented atomic bombs and weather reports and iPads and oil spill disasters.

Yet, I do not stop there. I direct them to the web, of course. “If you go to Medline,” I say, “you will find ten thousand research studies (a gross exaggeration but nobody has called my bluff on this one and actually counted) about why acupuncture works for pain problems and there are about 5 different theories, scientific theories, about how it works, neuro-gate theories, endorphin theories ….”

And then I add, “the ancient Chinese had an idea how this all worked (the ancient Chinese may not be quite as esteemed as modern scientists in our culture, but between Confucius and Eastern Wisdom and mystery I can get away with a lot, this not being a bluff so much as argument from revered ancestors — even if they are not mine by blood but only by translated readings —  whose great grand children are cleaning our capitalist clocks and selling us production of our own inventions); the ancient Chinese believed and most modern acupuncturists believe that there is another circulatory system and it runs in lines across your body like a New York City subway map superimposed on your flesh and there are points along those lines, acupuncture points where I stick needles and what runs through these lines is what the ancient Chinese call ‘qi’ which we might call and translate as ‘energy’ or more properly ‘life force’ although it is not completely translatable and a bit of a mystery, and what I am doing by putting needles in these points along lines we call ‘meridians’ is to unblock your ‘qi’ and therefore since these ‘qi meridians’ control the systems of your body, by unblocking your ‘qi’ I can help free your body from pain.” Having said that all in one sentence, I take a deep breath. And then I pull out charts of a naked person with the subway map superimposed on their body with the stops on the train line as colored small points that are numbered and assigned internal organ names, like gallbladder 34 (GB 34 on the chart) and so on.

Everyone seems to get it.

Whether it is true or not, that there are “meridians,” that “qi runs through meridians,” that there are “points along meridians” and so on, I do not really know, it being about theoretical entities, like physics entities “quarks” or “muons” which are such infinitesimally small atomic parts that we cannot see them either, all of which “qi” and “muons” might be figments of our imagination or actual factual stuff that underlies and constitutes the material from which our mind and imagination emerge from. I just cannot say for sure.

And by the way, recent studies of acupuncture conducted in Europe while showing that acupuncture is an extremely effective means of treating low back pain and migraine headaches, nonetheless, bring into question whether the meridian-point system has any validity.

I rather think they are correct. My own experience of acupuncture after 28+ years of practice suggests to me that while my therapy is good and effective, the reasons for it working need some rethinking. The European studies show that regardless of where you put needles, in points along meridians or on other areas of the body that are not points along meridians, acupuncture works. Somehow just the act of needling works.

I have been to innumerable continuing education workshops and been exposed to many different schools of Chinese Medicine. For the same medical problem, different practitioners from different schools of Chinese Medicine may use mutually exclusive point formulas. Somehow everyone gets the same good results. That even if they did not use points they would get the same results does not seem to me a big shock. No matter what the point, no matter where the point, results happen.

And, in my practice, when I have deliberately switched points on a patient from one treatment to the next, although the patient still has the same condition — although a bit alleviated form my previous treatment — I still get good results. It just does not seem to matter. It is all good medicine regardless. Regardless.

So while I do not know how acupuncture works, I do have my suspicions. The standard explanations, East and West, have not worked for me even though acupuncture has quite wonderful and wondrous effects. Aspirin works no matter whether I understand its salycilate structure or not, wonderful and wondrous effects, nonetheless.

My experience of acupuncture both as a practitioner and one who, too, has been treated with it, is that in general acupuncture is anti-inflammatory, relieves pain and is relaxing. With a small or even a great number of needles inserted through the body’s skin, many of my clients have fallen asleep. Eyes closed, snoring asleep, needles waving in the breeze.

Does this make any sense whatsoever? Why would needles in the body be anti-inflammatory, relieve pain and be relaxing? I know that it happens. I do not second guess it, really. But it just does not make sense. It would seem to me that, in fact, sticking people with needles, unless someone told me otherwise or proved to me otherwise beforehand, would have the opposite effect. When I inadvertently get a wooden splinter embedded in my skin, my body’s inflammatory system is aroused and there is inflammation around the wound, it hurts and I get a bit more tense. If someone on the street started needling me just as I do my patients, except they did not tell me they were doing me a favor I would suspect that I would go into what we now refer to as “fight or flight,” I would either punch their lights out so that they would stop the needle sticking or run away from them to avoid more. I would not be relaxed nor snoozing, but the opposite.

Yet, what if I could not “fight or flight” or did not believe that that was the appropriate response, what if I told my brain that what was going on was as it should be, that it is OK to be invaded acupuncture-wise, that penetrating my skin armor was a good idea, that I should neither run and hide, nor start grappling with the acupuncturist who was not assaulting me? In other words, what if I accepted a kind of defeat? What if I accepted defeat in the sense that a set of little bitty needle-swords has gotten past my defenses and has beaten me. I am not dead as I would be with a bunch of big knifes getting through, but, again in a sense, that makes only partial difference to the body, that is, no permanent damage is occurring as it would with a bigger sword — or a metal bullet for that matter — but what is the body’s typical reaction to defeat. Some adrenaline still pumps. There is still inflammatory response, but ….

I call the reaction The Needled Dead Possum Effect.

Acupuncture is half physical needling and half psychological fake-out. Without the therapists injunction to relax and the social understanding that the patient is not to go into any version of “fight or flight,” psychologically and then physically the person’s body and mind does something counter to commonsense. The possum, seeing a superior predator and no means of escape, plays dead. The body and mind of the patient plays dead, goes to sleep, takes a break, loosens up as if there were nothing to be tense about at all. And in this false dead and restful state, as in actual nightly sleep, healing can take place, because the body permits the flow of blood and nervous system electricity and it all moves in the direction of resetting to normal and healthy. Endorphins, the body’s natural pain killers come out to lessen the pain of the needles, the heart rate slow, the breathing slows. When the needles are taken out, patients report a kind of lightness and euphoria.

You have just been needled. Why are you so relaxed? Makes no sense? Makes perfect sense, possum. How does the possum feel after the wolf has gone over the hill and is far away? I will bet you pretty light and euphoric. How do you feel in life anytime you have dodged one kind of bullet or another? Phew, pretty good.

But also perhaps a bit tired as all that nice adrenaline that you pumped out in response to a “fight or flight” scenario is making its way out of your system and the fatigue means you need to rest and make more. So acupuncture is still for the body and mind a “fight or flight” situation, but you do not run, but play possum Well, that adrenaline did fire when you had an acupuncture treatment and the inflammatory system did wake up in response to the needles, but once the needles were out and the wolf was over the hill, phew, you will feel a bit tired, too, even though you have just been snoozing. And the temporary and minor inflammation gives way to extra relaxes flow and the blood can move out of the area and inflammation overall decreases.

It is an odd collection of responses, a combination of fright and hiding out, but it does account for what is going on without fancy and frankly erroneous neuro-gate theories or meridians and mystical energies like ‘qi.”

But, then again, you are perfectly safe thinking no body knows what is really going on in acupuncture, but know this: darned if it does not work and, maybe — or maybe not —  that is all any of us really need to know anyway.