Hello, friends! My sincere apologies for immediately breaking my promise in my last post to write more regularly. Once again, school and work have been very busy. I’m excited about today’s post, however. This post is actually part of an assignment for one of my classes. Many of the doctoral classes emphasize the importance of evidence-informed practice. This is a fancy way of saying that clinical research and trials should have an influence on how we practice Chinese medicine. This can sometimes be a controversial idea, especially since many in the TCM field feel that we don’t need clinical trials to prove that something that has been done for thousands of years works. However, I think using this type of scientific consideration is actually important. An assignment for one of my classes asked us to write an article or handout of some sort that uses evidence-based medicine to explore a topic in Chinese medicine. So here we are today!
Acupuncture is definitely an art, but there is a very real scientific aspect to it that is being explored more and more frequently. This is personally exciting to me, because the more research that is done in the field of acupuncture, the more information I have to give to patients and other medical professionals about how and why acupuncture should be considered a valid system of medicine. We’ve talked about qi and the meridians here before, and let’s face it- those concepts sound a little odd to most people. If we don’t have a scientific aspect involved, it doesn’t look great for us to say, “Hey, you should totally just trust me that this invisible substance that moves through these invisible channels and can be influenced at these tiny invisible points is super important to your health.” That’s a quick way to alienate people and, frankly, to make us look like a bunch of patchouli-ensconced weirdos within the medical community.
This is where research comes into play. One of the most interesting components I have found within the field of acupuncture research is studies explaining exactly what happens when the acupuncture needles themselves are inserted into the body. There is a doctor named Helene Langevin who is both an M.D. and an acupuncturist who has done a lot of fascinating work on connective tissue and the mechanism of acupuncture. Dr. Langevin has spent much of her career exploring these topics, and she has found that acupuncture has an effect on the cells involved in connective tissues.
Let’s talk about connective tissue for a minute before we go further. Connective tissue is a very broad term, but the most important thing to understand is that it is the most widely found tissue in the body, and it is responsible for holding aspects of the body together, insulating and protecting parts of the body, and moving substances everywhere they need to go. Connective tissue is very adaptable and varies a great deal depending on what it needs to do. The type of connective tissue most important to acupuncture research is what is referred to as “connective tissue proper,” which can be classified as loose or dense. Within the classification of loose connective tissue is the subclass of areolar connective tissue.
This type of tissue is mostly commonly made up of a type of cell called fibroblasts (this will be important to remember later). The main function of this type of tissue is essential for holding our bodies together- it sort of works like packing peanuts to keep our organs, etc. in place. It keeps our bodies together while simultaneously allowing us to move around freely. It surrounds everything within our body and keeps things safe and well nourished.[i]
“Ok,” (you might say here) “thanks for the science lesson, Sarah. Just what I was hoping for on a holiday weekend- a really fun reminder of high school bio.” Bear with me…understanding just how important connective tissue is makes understanding the mechanism of acupuncture much easier.
In her research, Dr. Langevin discusses the idea that acupuncture points are areas where connective tissue can be easily affected. She proposes the idea of understanding these points as intersections on highways that travel all over the body. This is supported by her findings that acupuncture points themselves seem to often be located at areas of the body where different sections of connective tissue either meet or cross.[ii]
When an acupuncture needle is inserted into the skin, an acupuncturist usually moves it around a little- either we move the needle up and down a bit or we twirl the needle around. Research has shown that this changes the structure of the connective tissue on a cellular level- a “whorl” is shown around the tip of the needle that sort of looks like a whirlpool. The idea then is that this change in the connective tissue around the tip of needle acts as a signal to the cells of other connective tissues.
Remember the idea of acupuncture points as intersections; when you have something happen at one of those intersections (i.e. the insertion of an acupuncture needle), information can travel along the connective tissue highways and have an effect on different tissues all over the body. By influencing the connective tissue through a needle insertion, cells such as fibroblasts (see, I told you would see that word again) can potentially change their actions and send out signals to influence other types of cells around them, thus providing an explanation for how inserting a needle at one point can influence all different parts of the body. Because the cells of connective tissue are responsible for keeping everything together, they are also naturally responsible for sharing information between parts of the body. This can further explain how acupuncture might even influence the perception of pain in the body, as causing a change in these cells might influence how pain signals are received and sent.[iii]
Let’s break this down with a food-based analogy (my favorite type of analogy). Picture a delicious plate of spaghetti. That spaghetti is your connective tissue (metaphorically speaking of course, not Hannibal Lector-style). When you twirl a fork into that spaghetti (like an acupuncture needle going into an acupuncture point), more and more strands will start to wind around the tines of the fork. Twirl hard enough and the whole plate of pasta begins to change shape. You might even splatter sauce everywhere as you move the pasta around. This is what happens when you insert the needle and move it around- the connective tissue itself is changed by that mechanical stress and can send out signals to the surrounding areas.
For those science-minded types, you might notice that the research on this is a little old. There are still lots of studies being done to further explore Dr. Langevin’s theories for how acupuncture works. As you know, each small aspect of any biological mechanism must be thoroughly explored before any final conclusions can be made- it’s not as easy as designing one study to definitely confirm how acupuncture works (although that would be terrific). For example, one of her additional studies is really just to confirm that connective tissue, as opposed to muscle, is what is actually affected by needle insertion and manipulation. This study was able to show that needle manipulation does indeed affect the connective tissue, which means that it is very possible that acupuncture then influences the information sent along the connective tissue pathways. Because other research has shown that this sort of mechanical stress influences cellular communication, this experiment supports her earlier theory that by inserting a needle, something happens along that cellular pathway to make a change in the body.[iv] Also important to consider is that, although research done fifteen years ago may be considered “old” within most academic circles, it’s still pretty young for a system of medicine that’s been around for thousands of years. Distilling this much history into neat studies takes a whole lot of time and effort on the part of those researchers.
So research continues to be done in this field, but it takes time. You can check out the hyperlink on Dr. Langevin’s name to see her bio at the University of Vermont and check out some of her latest work in the field if you’re interested in learning more. This is intended to just be a little introduction into the research surrounding how acupuncture works. Thanks for hanging in there with me on this today- I know it’s a little different from my normal posts but I think it’s always a good thing to introduce the harder sciences into discussions about Chinese medicine and acupuncture. I hope everyone has a great rest of your weekend, and be well!
[i] Marieb, E. & Hoehn, K. (2007). Human Anatomy & Physiology (7th ed). San Francisco, CA: Pearson Benjamin Cummings.
[ii] Langevin, H. & Yandow, J. (2002). Relationship of acupuncture points and meridians to connective tissue planes. The Anatomical Record 269(6), 257-265. doi: 10.1002/ar.10185
[iii] Langevin, H., Churchill, D., & Cipolla, M. (2001). Mechanical signaling through connective tissue: A mechanism for the therapeutic affects of acupuncture. The FASEB Journal 15(12), 2275-2282. doi: 10.1096/fj.01-0015hyp
[iv] Langevin, H., Churchill, D., Wu, J., Badger, G., Yandow, A., Fox, J., & King, M. (2002). Evidence of connective tissue involvement in acupuncture. The FASEB Journal (published online). doi: 10.1096/fj.01-0925fje