A Brief Overview of Medical Acupuncture

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A Brief Overview of Medical Acupuncture

Acupuncture has been practiced in Asia for thousands of years and spread to Europe in the 17th century. One of the earliest detailed report on Chinese and Japanese medicine to be written by a European was by Willem ten Rhyne, a Dutch physician who published Dissertatio de Arthritide: Mantissa Schematica: De Acupunctura: Et Orationes Tres (Dissertation on Arthritis, Logarithmic Text, Acupuncture and Three Subjects) in 1683 (Bivins, 2001; Carrubba & Bowers, 1974). In this book Willem ten Rhyne documented the practice of acupuncture in detail, this was the first time that Europeans were introduced to the practice of acupuncture. The term ‘acupuncture’ was coined in the 1680s, ‘acu’ is derived from the Latin ‘acus’, needle (Birch et al., 2022)

Since the adoption of acupuncture in Western society there have been specific branches of acupuncture that have developed in Europe and North America independent of traditional narratives. The practices are often referred to as medical acupuncture or western medical acupuncture. Regardless of its theoretical basis and based on the traditional definition, the term acupuncture refers to the insertion of a needle into the body.

“The term ‘acupuncture’ is a translation of 针刺术 (zhen ci shu in Chinese pin yin) or in short 针 (zhen), and is literally equivalent to the term ‘needling’ or ‘needling technique’. Based on the traditional and official definition, the term acupuncture refers to the actual insertion of a needle (usually a solid needle) into the body, which describes a family of procedures involving the stimulation of points on the body using a variety of techniques” - (Fan et al., 2016). 

"The term translated as ‘acupuncture’ in Chinese is ‘zhen’ (Japanese ‘shin’, Korean ‘chim’) a noun that means needle or pin. The character zhen is a composite of two characters: ‘jin’ which means ‘gold or metals in general’, and ‘xian’ which means ‘together, all, completely, united’. The two components together as zhen came to refer to metal objects used in treatment." - (Birch et al., 2022)

Following the European lineage, the concept of Medical Acupuncture was pioneered by Felix Mann who began to view acupuncture as a form of peripheral nerve stimulation. Fast forward to contemporary times and Medical Acupuncture is a precise peripheral nerve stimulation technique, in which acupuncture needles are inserted into anatomically defined sites and stimulated manually or with electricity. Needle insertion is based on an understanding of anatomy and neurophysiology and acknowledges the fact that, regardless of where the needle is inserted (skin, fascia, muscles, tendons, periosteum, joint capsules, etc.), there will be a number of physiological and psychological responses.

Convergent Thinking: Ashi Points and Myofascial Trigger Points

The concept of sore spots that can be leveraged for therapeutic purposes have been independently discovered by several different cultures in Europe, Africa and Asia. One of the oldest examples on record is a 5,300 year old naturally preserved human body discovered in the Tyrolean Alps of Austria called Otzi “The Iceman”. This frozen body has 61 tattoos that correspond to myofascial trigger points and traditional acupuncture points that are commonly utilized to treat musculoskeletal pain. This 5300 year old preserved body gives insight into ancient medical practices, as it is believed that these tattoos represent an early form of therapeutic treatment similar to acupuncture used to treat low back and knee pain (Zink et al., 2019).

It is well documented in Asian cultures that traditional healers would therapeutically treat sore spots with manual therapy or acupuncture needles, one example is ASHI (ah yes!) points, a central tenant in acupuncture for over two thousand years (Lee et al., 2022). Many years later in the 1930's Jonas Henrik Kellgren started the scientific investigation into these sore spots or what he called Referred Pain from Muscle (Kellgren, 1938). This was then followed up by years of research and documentation by Janet Travell and David Simons, the result of their cumulative work was the textbook - Travell, Simons and Simons’ Myofascial Pain and Dysfunction (now in its 3rd edition).

The term “myofascial trigger points” describes a phenomenon: sore, stiff, aching spots; Traditional Chinese Medicine have a similar phenomenon referred to as ashi points (阿是穴).

An Evidence-based Approach: Evidence-based clinicians explain the mechanism of action in biopsychosocial terms.

Acknowledging that traditional narratives are outdated, medical acupuncture is an approach that is based upon a theory that is in line with current scientific understanding of how the body works (White, 2009). Acupuncture originated in a pre-scientific era - Meridians ought to be replaced by a knowledge of biological systems and their biological subunits (organs, cells, and molecular networks). This biological basis of "meridians" ends up leading to the development of an exciting systems approach to treating diseases and chronic pain.

Acupuncture points are often located along the fascial tissues enriched with nerves, vascular/lymphatic vessels, and immune cells (Cui et al., 2022; Intriago et al., 2022; Ma, 2022). The insertion of an acupuncture needle provides mechanical stimulation of specialized sensory receptors located in the cutaneous and subcutaneous structures. Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia). Based on the biological model, all these areas are highly innervated and as a result there are a number of physiological responses that help modulate the experience of pain. Favorable outcomes may be explained by overlapping mechanisms in the periphery, spinal cord, and brain (Niruthisard et al., 2024).

Acknowledging that traditional narratives are outdated, medical acupuncture is an approach that is based upon a theory that is in line with current scientific understanding of how the body works. Acupuncture can be used to stimulate afferent nerves (A-beta, A-delta, and C fibers), which triggers mechanical, contextual, and neurological responses that help modulate the experience of pain.

Patient Safety and Adverse Events

Informed consent ensures patients understand the treatment plan fully before giving consent to begin. A full informed consent also includes a discussion about the possible risks and benefits of receiving treatment. Most common intervention-related adverse effects are usually mild and transient (Höxtermann et al., 2022). This may include bleeding, needle site pain, and flare around the needle site. Severe adverse events are rare but can happen with certain acupuncture points. Severe adverse events may include pneumothorax, and strong cardiovascular or vasovagal reactions potentially leading to fall or trauma (Bäumler et al., 2021).

Acupuncture Research Has Matured

A comprehensive overview of acupuncture for chronic pain was published in The Journal of Pain, it is a meta-analysis using data from 39 trials and 20 827 patients showing that acupuncture helps with pain and effects exist beyond placebo. In this paper researchers looked at all accumulated randomized controlled trials and examined how acupuncture fared in treating people with chronic pain, what it found was that acupuncture often worked better than sham acupuncture and other control groups (Vickers et al., 2018).

As research into acupuncture continues to mature, more clinical practice guidelines, randomized controlled trials and systematic reviews now support the use of acupuncture as part of a multidimensional approach for patients suffering from common musculoskeletal symptoms including:

The Responses to Acupuncture are Multifactorial - Biological, Psychological, Social and Contextual Factors Interplay in a Complex Manner.

The existence of placebo-induced effects does not negate treatment-induced results, the meaning response, therapeutic alliance, ritual, and other contextual factors all play into the effects, the magnitude of a response may be influenced by mood, expectation, and conditioning. Contextual effects do have a significant impact on the overall treatment effect, which is why some may overlook other subtle physiological responses such as sensory gating. Acupuncture can be used to stimulate specialized sensory receptors located in the cutaneous and subcutaneous structures (A-beta, A-delta, and C fibers). This can have an analgesic & anti-inflammatory effect via the inflammatory reflex, endogenous opioids, endogenous cannabinoids and purinergic signaling. Adopting a neurophysiological explanation can lead to wider acceptance in both research and clinical settings. Primary mechanism of action is through inhibition of nociceptive processing (bottom-up) and stimulation of endogenous pain inhibitory mechanisms (top-down) (Niruthisard et al., 2024).

Key Takeaways

The effects of an intervention (i.e. the total treatment effect) can be broken down into three components: non-specific, contextual and specific effects.

Acknowledging that traditional narratives are outdated, medical acupuncture is an approach that is based upon a theory that is in line with current scientific understanding of how the body works. The clinical response to acupuncture are multifactorial and outcomes may be attributed to specific effects (affective touch, mechanical factors, and neurological factors), contextual effects (patient-therapist relationship, set and setting), and non-specific effects (natural history, regression toward the mean) that help modulate the experience of pain.

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