How Does Acupuncture Work?

This is a common question that comes up in clinic.

From the traditional perspective, acupuncture aims to regulate and modulate the flow of 'qi' (which may be translated as 'energy' or 'vital air,' which some have proposed to mean circulation), the function of which is required for good health.

In terms of our biology, a cascade of events happens after needle insertion. I usually summarise these as nervous system, immune system and hormonal system effects, but there are effects that have been observed on fascia (connective tissue) as well.

Impacts on these systems can have far reaching effects in the body and can account for some of the mechanisms of action of acupuncture.

It's fascinating to see the microscopic mechanics of what an acupuncture needle can do to connective tissue. Inserting and rotating the needle can create a 'whorl' in connective tissue.

Click to see how manipulating an acupuncture needle can affect connective tissue.

Stretching and deforming connective tissue like this has flow on effects.

When fascia is manipulated by an acupuncture needle it triggers chains of events in different cells:

🧨Keratinocytes: release endogenous opioids (your body's natural pain killers) and anti-inflammatory hormones (i.e. CRH, ACTH and glucocorticoids)*.

SIDE NOTE: THIS IS SUPER COOL! 🤓 turns out CRH is not just made by your Hypothalamus; ACTH is not just made in your Pituitary, and glucocorticoids are not just made by your Adrenal glands (did you see HPA axis there?). But - these substances are also made in keratinocytes - which exist all throughout your skin and can be activated by acupuncture 🤯 your skin has its own HPA axis (!)

🧨Mast cells: release chemical messengers (e.g. histamine, interleukin, platelet activating factor (PAF), serotonin, tryptase, herparin, substance P), which then affect nearby nerves, blood vessels and muscles.

🧨Macrophages: you might remember these as the Pac-man guys that chomp up the bad guys (part of your immune system). Acupuncture stimulates macrophages to release substances (inflammatory compounds and chemokines) that help cells talk to each other.

🧨Fibroblasts: are stretched (increased surface area = greater area of action), multiplied and re-positioned with acupuncture needle manipulation. Fibroblasts are involved in making and reconstructing the extracellular matrix (the network that surrounds and supports cells and tissues), regulating inflammation, and repairing tissue injury.

Amazing!

There's not one simple way that "acupuncture works." Acupuncture's effects are complex, much like our bodies.

There's a beautiful summary diagram that captures what we know of how acupuncture affects the body (so far): a reminder of how complex, integrated and incredible our bodies are.

Click here for a summary diagram of the neuro-immune microenvironment of acupoints.

 References:

1. Langevin, H.M. and Yandow, J.A. (2002), Relationship of acupuncture points and meridians to connective tissue planes. Anat. Rec., 269: 257-265. https://doi.org/10.1002/ar.10185

2. Gong Y, Li N, Lv Z, et al. The neuro-immune microenvironment of acupoints—initiation of acupuncture effectiveness. J Leukoc Biol. 2020; 108: 189–198. https://doi.org/10.1002/JLB.3AB0420-361RR