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Acupuncture Getting to the Point

Four years ago, John Pacharis crashed his off-road motorcycle on a rough stretch of trail, tearing his ACL, MCL, and PCL — three of the four major ligaments in his knee. He needed surgery, and afterward he plummeted into a period of pain and depression that lasted for weeks.

“I did everything wrong,” says the 42-year-old from Saint Lawrence, Penn. “I just sat on the couch feeling depressed, taking too many painkillers. Then I found out I needed a second surgery and was determined to do it better.”

He began searching online for ideas about how to better manage his recovery and came across a support group where someone suggested acupuncture. “I was very skeptical but figured I might as well try it,” recalls Pacharis. “The first thing the acupuncturist did was put needles in my hands to calm me down and lower my heart rate. I felt an immediate, amazing flow of euphoria. It was like Dilaudid — but obviously so much better for me.”

Pacharis received weekly acupuncture treatments for two months, both to keep swelling under control and to manage pain with fewer drugs. He still gets treated on occasion, and says he’d do more if it were covered by his insurance.

“I don’t know how it works,” he says. “But it definitely works.”

Time for Acupuncture

Once regarded as alternative medicine in the United States, acupuncture has repeatedly been proven successful in treating cases like Pacharis’s. Today it’s no longer confined to specialized clinics; acupuncturists now work side by side with physicians in many hospitals and other medical settings.

“The current opioid epidemic has opened the door for safer, more natural ways to reduce pain,” says acupuncturist Adam Reinstein, LAc. He was hired in 2013 to work in the emergency room at Abbott Northwestern Hospital in Minneapolis as part of the hospital’s campaign to integrate Eastern techniques with a Western medical approach. He’s the first acupuncturist on an ER hospital staff in the United States.

During one shift, he might treat a car-accident victim and someone suffering complications from chemotherapy with the same basic approach. “We look at acupuncture as the first level of pain and anxiety relief,” he says. “Pain, anxiety, and nausea are the big three I treat most in this setting. In many cases, I can help patients start to feel better in the first two to five minutes.”

As patients like Pacharis will attest, acupuncture can provide as much relief as painkillers. A preliminary observational study Reinstein conducted at Abbott Northwestern, which was published in the journal Pain Medicine in February 2016, found that among 182 patients tracked over the course of 13 months, those who received acupuncture alone reported reduced pain scores equivalent to those who received a combination of acupuncture and analgesic painkillers. Reinstein notes that acupuncture has even preempted the need for prescription painkillers for some patients.

Acupuncture’s efficacy in relieving acute and chronic pain has also made it standard practice for many professional sports teams: The Kansas City Chiefs hired the NFL’s first acupuncturist 23 years ago. In 2008 the U.S. Air Force announced it would train medics in the use of battlefield acupuncture (BFA), using points based in the ears, because of its proven efficacy in relieving acute pain. The VA hospital in Boston began offering acupuncture to veterans in 2013 because of its ability to reduce dependence on opioids for chronic pain and to manage posttraumatic stress.

Though pain relief is still the primary reason many Westerners seek acupuncture, more have discovered what people in China, where acupuncture is part of routine medical care, have long understood: Acupuncture can offer relief from a vast array of health problems, including digestive issues; stress, anxiety, and depression; respiratory disorders, such as asthma and allergies; hormone-related issues like infertility, PMS, and menopausal symptoms; and more. Read on to explore whether it might be right for you.

Qi: Your Energetic Force

Acupuncture Energetic Force

Even people who receive regular acupuncture treatments often wonder how they work. One reason for the mystery is that Western cultures don’t readily comprehend or embrace some of acupuncture’s central tenets, like qi (pronounced “chee”).

A key concept of Traditional Chinese Medicine (TCM), qi is often described as a universal or energetic “force.” Grasping energetic forces is challenging for many Western minds: We tend to trust only what we can see, touch, or measure.

Still, according to TCM, qi drives all our biological processes. It’s considered the body’s dynamism, moving blood, prompting organ function, and changing food into energy. Ted Kaptchuk, OMD, professor of medicine at Harvard and the author of The Web That Has No Weaver, defines qi as “the fundamental quality of being and becoming.”

The goal of acupuncture is to promote the free, robust flow of qi throughout your body. It’s like a river, explains Katherine Flesher, LAc, an acupuncturist who runs Three Treasures Natural Healing, a community clinic in Minneapolis.

“When the river is low, the trash bags and algae sit in the stagnant waters, creating a mess,” Flesher explains. “When it’s rushing and high, it’s beautiful. Nothing gets stuck in there. It’s the same with qi. When it’s low, waste products get stuck and you have illness. When it’s high, you feel energetic and healthy.”

Kaptchuk adds that “whether qi is some kind of ‘real’ quantitative energy in the Western sense… or a metaphoric way of depicting and experiencing interconnection” is not a major concern for most practitioners. As acupuncture becomes more mainstream, many practitioners may not mention qi at all.

“I explain it in whatever language works best for who I’m talking to,” says Rhonda Hogan, LAc, an acupuncturist in Somerset, N.J. “I can talk about it in oriental-medicine terms, or I can explain it from a Western physiological perspective.”

In their explanation of acupuncture’s efficacy, researchers at the National Institutes of Health (NIH) cite studies showing how acupuncture influences blood flow, hormone secretion, and immune function.

In their explanation of acupuncture’s efficacy, researchers at the National Institutes of Health (NIH) cite studies showing how acupuncture influences blood flow, hormone secretion, and immune function.

Those studies include a meta-analysis of randomized control trials with 18,000 total participants, financed by the NIH and published in JAMA Internal Medicine in 2012. This large study shows that acupuncture outperforms “sham” treatments (where needles are placed at random points or not far enough into the skin) in treating osteoarthritis, chronic headaches, and chronic back, neck, and shoulder pain.

Regardless of the precise terms used to describe how it works, acupuncture usually speaks for itself.

According to biologist Kelly Boggs, LAc, DiplAc, CH, who practices Chinese medicine, herbal medicine, and acupuncture in Phoenixville, Pa., “you’re helping the body to function optimally and heal itself.

Yin and Yang: Your Body’s Scale

Acupuncture Yin Yang

Chinese medicine views the body as an anatomical whole, with organs defined in terms of yin and yang. Like qi, yin and yang might sound esoteric, but Kaptchuk simply calls them “convenient labels used to describe how things function in relation to each other.”

Yin qualities are night-like: cool, dark, restful, and passive. By contrast, yang qualities are like the sun: hot, stimulating, vigorous, and active.

When we’re healthy, we maintain a balance of the two. When we have symptoms of illness, we usually have too much of one and not enough of the other. Hormonal cycles of all kinds readily reveal the interplay of yin and yang.

“There is a constant struggle to keep these two in balance, which is the root of all diagnosis and treatment in Traditional Chinese Medicine,” says Boggs. “For example, yin works to cool the body and maintain a constant temperature. So if yin becomes depleted or is insufficient, yang will increase, which increases body temperature.”

She explains how this works during menopause. “Our bodies are typically more yang during the day and yin at night. During menopause you have kidney yin deficiency, so your yang persists into the night and you have insomnia and hot flashes.”

Research bears this out. In one yearlong study of more than 200 women ages 45 to 60, acupuncture treatments reduced hot flashes and night sweats by as much as 36 percent, and improved sleep, memory, and anxiety.

Heewon Lee, 41, of Minneapolis, sought treatment for reproductive issues. “My husband and I were trying to get pregnant, but my periods were long and somewhat irregular,” she recalls. A friend referred her to acupuncture.

“Through regular treatment, we were able to make my cycles very regulated and keep my hormones at the right levels, so I could get pregnant and sustain the pregnancy,” she says. Two healthy boys later, Lee still seeks regular acupuncture treatments for long-term health and wellness.

Meridians: Your Energy Channels

Acupuncture Meridians

Meridian” is a French translation of the Chinese term jing-luo (pronounced jing-low). Jing means “to go through”; luo is akin to “network.” Meridians pass through and connect various organs and parts of the body, acting as channels for qi to flow. (See “Making the Acupuncture Connection,” below, for the potential role of fascia in this process.)

There are 14 meridians in our bodies that correspond to particular organs and systems, including the lung, large intestine, heart, stomach, spleen, kidney, bladder, gallbladder, liver, and small intestine. They sit close to the body’s surface.

This is why an acupuncturist may place needles in your hands or feet to treat problems with, say, your liver. The effects reach the organs through the meridians. “You can see an acupuncturist for shoulder pain, and she or he may or may not touch your shoulder,” says Hogan. In the battlefield acupuncture used by the military, for example, it’s not practical to place needles all over the body — but practitioners access meridians through pressure points in the ears to help ease pain in multiple areas.

When meridians become blocked by stress, fatigue, or poor nutrition, energy can’t flow to organs. This sets the stage for physical and emotional illnesses. Like Flesher, Reinstein uses the image of an ­obstructed river.

“When a tree falls in a river, it begins catching debris and creates a logjam, which in turn affects the ecosystem downstream,” he says. “My goal is to open the channels, clear out the garbage, and create an even flow of energy throughout the system.”

Acupoints: Your Body’s Hot Spots

Acupuncture Hot Spots

Acupuncturists insert needles at specific points, called acupoints, located along the meridians just beneath the skin. The goal is to clear obstacles in the meridians to help restore the flow of qi.

Your body has hundreds of acupoints. Most have local as well as distal effects. This means a practitioner may insert a needle in your back to relieve local pain there. Or he may use that same point to treat pain farther down the channel, like sciatica, or even use it to help relieve depression, if the point lies on the same meridian that channels energy to the brain.

Not all points are created equal. Some — called antique or transporting points — are especially powerful. These are located on the arms between the elbows and fingertips, and on the legs between the knees and toes.

“Stimulating these points has strong, far-reaching action that can help treat most anything, as it stimulates energy throughout the entire channel,” explains Flesher.

Acupuncturists might also focus their treatment on trigger points — tight knots in muscles that can restrict range of motion and cause pain at the site of the point. (This is the treatment commonly used in the NFL, where two minutes of “dry needling” can restore as much flexibility to a muscle as up to 30 minutes on a foam roller.) Untreated trigger points can also cause referred pain in other parts of the body when the tight muscles tug you out of alignment.

“Trigger-point acupuncture is a more aggressive, direct manipulation of these knots,” says Hogan. “Tennis elbow, for example, is caused by a tight forearm muscle. Plantar fasciitis is caused by trigger points in the midcalf muscle. By inserting an acupuncture needle in those trigger points, we can eliminate the tightness and its related problems over time.”

Getting Started With Acupuncture

Finding an acupuncturist is similar to looking for any other healthcare practitioner: It involves some research. Referrals from your primary doctor or friends and family who have experience with acupuncture are good places to start. You also can search online for acupuncturists in your area.

Look for a practitioner who is certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM); has a searchable database. Certification means the practitioner has completed three to four years of training and has passed NCCAOM examinations. Also check that the practitioner is state-licensed, which is generally designated by the credentials “LAc.”

Consult with your insurance provider as well as the practitioner to determine whether your treatment will be covered. Some more-progressive providers do pay for it, though you may need a referral from your regular doctor. Flexible spending plans and Health Savings Accounts may also be used to cover acupuncture.

If money is an issue, a community acupuncture clinic can be a great option. In this model, a group of patients is treated simultaneously in one room, and the cost is significantly less than with individual treatments. (A treatment at a community clinic can cost as little as $15.)

You may feel better after just one session, but resolving a persistent health condition typically requires a series of treatments. Your acupuncturist will be able to estimate your treatment course during your initial consultation.

Finally, the question everyone asks is: “Does it hurt?” The needles are a very fine gauge, so acupuncture is different from getting a shot. You may feel a brief sting, especially if you’re a bit dehydrated or otherwise inflamed. Once inserted, the needles also may cause slight achy or itchy sensations, but this is rare.

The sensations are almost never as bad as people expect, says Tomás Flesher, LAc, of Three Treasures Natural Healing in Minneapolis, and the relief acupuncture provides usually overrides those concerns.

“For most people, it takes only one treatment to overcome whatever fear or anxiety they have,” he says. “Once they relax and start feeling the power of what acupuncture can do, any fear they did have completely goes away.”

Making the Acupuncture Connection

Western medical experts don’t have an explanation for how energy travels from a point, through a meridian, and into the related organs and body parts. As acupuncture continues to prove effective, however, more scientists are studying how it works.

One theory proposes that acupuncture transmits signals through the body’s fascia network, the layers of connective tissue surrounding muscle groups, organs, and blood vessels. Fascia acts as a support system as well as a medium of communication between cells. Some researchers believe that the meridians represent myofascial chains, which would explain how placing a needle in a point along the fascia in the forearm could transmit signals to the shoulder, or an organ along the chain.

At the University of Vermont in Burlington, Helene Langevin, MD, led a study in which researchers mapped two dozen acupuncture points on cadavers and examined the tissue beneath the points. Notably, more than 80 percent of the points were located where connective tissue planes or networks converged. Langevin’s research also found that turning the needles in those major connective-tissue intersections (as acupuncturists often do during treatment) stimulated a reaction in the tissue that traveled to areas of the body far from the insertion site.

“She proposed that these planes were in fact the channels described in traditional East Asian medicine,” says Arya Nielsen, PhD, director of the Acupuncture Fellowship Program for Inpatient Care at Mount Sinai Beth Israel Department of Integrative Medicine in New York City. “This connective-tissue system is now the object of study by the Fascia Research Society.”

Even if the meridians cannot be solely explained by connective-tissue pathways, that doesn’t make them any less legitimate, says Adam Reinstein, LAc, an acupuncturist at Abbott Northwestern Hospital in Minneapolis. “Acupuncture was developed over centuries of practice and study and can’t be easily explained in Western terms,” he says. “We don’t really know how everything works in Western medicine either, but people question it less because it’s what they are accustomed to.”

A Timeline of Acupuncture’s Development

2697–2597 BC: The Yellow Emperor’s Classic of Internal Medicine, the first text to set down the theoretical basis of acupuncture, is compiled.

1000 BC: Hieroglyphs from the Shang dynasty show evidence of acupuncture; bronze needles are excavated from the ruins.

1368–1644: The basis of modern acupuncture is established during the Ming dynasty.

1810: Acupuncture is first recorded in Europe.

1929: Acupuncture is labeled “irrational” as Western medicine begins to be deployed in Chinese clinics and hospitals. It is soon outlawed along with other forms of Traditional Chinese Medicine.

1949: The newly communist Chinese government revives traditional forms of medicine, including acupuncture. Acupuncture-research institutes are established shortly thereafter.

1971: An article in the New York Times by columnist James Reston describes how doctors in China used acupuncture to ease his post-appendectomy pain, spreading the word about acupuncture in the United States.

1993: The NFL’s Kansas City Chiefs hire alternative-sports-medicine consultant Evan Mladenoff, DC, who provides alternative therapies, including acupuncture.

1995: The U.S. Food and Drug Administration classifies acupuncture needles as medical instruments.

1997: The National Institutes of Health Consensus Development Program recognizes acupuncture as an effective therapy for a wide range of conditions.

2012: The Journal of Pain publishes a study finding that needling muscles stimulates the release of adenosine, which reduces the severity of chronic pain, at the site of the punctured acupoint.

2013: Abbott Northwestern Hospital in Minneapolis becomes the first in the nation to add an acupuncturist to its ER staff.

This article originally appeared as “Acupuncture: Getting to the Point”.

Illustrations by: Stephanie Dalton Cowan

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  1. Superb article! educative and helpful piece of content. Keep updating the good article like this. Please add me to your email list so next time if you publish an article like this then I will keep updated about that post.

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