Before I start with an explanation of how acupuncture works I would like to provide some background information regarding the processing of sensory information by your sensory systems and brain. First, your sensory systems can easily be fooled. You may think that when you feel, hear, or see something that you know it is real. This may be why we think that eye-witness testimony is so valuable. However, any police officer or lawyer can tell you that eye witnesses are not always accurate with their depictions of events. Moreover, we have all seen visual illusions such as impossible shapes that reveal our vulnerabilities to visual illusions. Something I find interesting about visual illusions is that even when we know, or have been shown, that what we are seeing is impossible we continue to see it anyway. For example we have all seen impossible shapes like the impossible triangle or the object that appears to be rectangular on one end and then turns into three round tubes on the other. Even when we know that this shape is impossible we continue to see it anyway. Why? We see visual illusions because our brain takes short cuts when creating a visual image so that our brain produces the image it thinks makes the most sense. That’s right, our visual system does not take an exact image of the scene in front of us but instead provides a fast approximation of that scene. For most visual images the image that is created is based upon our past experience with that scene/object and for most visual scenes that created image is good enough.
I am sure that it is easy to convince you that visual illusions exist because we have all seen them. However, if I tell you we are also susceptible to somatosensory illusions you may become incredulous. After all, if we feel something it must be real. Right? The truth is that our sensory systems are capable of making the same mistakes as our visual system thereby creating sensory illusions. Now this may not be as intuitive as the visual illusions because we seem to think that if we feel something it must be real but I assure you they do occur. In fact, sensory illusions are quite common. Simply put, we feel what the brain wants us to feel. You may still not believe this so let me provide some examples. Somatosensory illusions in the form of hallucinations are actually quite common. If you were to consume a drug called methamphetamine for a few days in a row one of the hallucinations you may encounter is that bugs are crawling on top of, or under, your skin. Moreover, if you were not on drugs and you were watching a movie of a spider and I lightly touched your arm with a feather you would most likely report that a spider had just crawled over your arm. It is actually quite easy to fool your somatosensory system.
Let me provide a more specific example involving the perception of pain. Imagine that a soldier is fighting side by side with his buddies that he has been with since boot camp and that they are under a heavy barrage of incoming fire. Now imagine that this soldier has his left arm blown off by a grenade. This soldier however does not feel that his left arm is missing and keeps right on fighting in order to save his own life as well as the lives of his friends. His brain simply chooses not to feel the pain at this time. Now imagine that this soldier comes back home to the states and is having pain in his missing arm. That’s correct, he is having pain in the arm that is no longer there! Let me digress in order to ask you a question. Do you think that pain medications would relieve his pain? The answer is yes. The fact that phantom-limb pain can be relieved by medication should suggest to you that the perception of pain is in his brain and not in his arm. When we hurt an appendage such as a finger we intuitively think that the sensation of pain is in our finger but in reality the perception of that pain is really in our brain. Moreover, I could easily fool your brain into thinking that you are experiencing pain when in fact you are not. I would start by running some boiling hot water from a faucet into a bowl (the bowl is just out of your field of view). I then take hold of your arm and lift it over the barrier that blocks your view of the bowl of boiling water and then thrust your hand into a bowl of freezing cold water that is next to the bowl with the boiling hot water in it. You will claim that you have been burned! You “feel” the burning “heat” because your brain tells itself that the water is hot.
Now let’s return to the soldier experiencing the phantom-limb pain. This type of phantom pain is often reported to be an itching dull pain rather than a sharp pain. I imagine that having a permanent itch like this that you cannot scratch is really disturbing. Some physicians have devised a clever way to treat this type of phantom-limb pain and I believe that reviewing this treatment will shed some light on how the brain perceives pain. First, the afflicted person, our soldier from the example above, places his right arm inside a mirror box. This box has an angled set of mirrors that create an illusory effect such that the image of his arm is reflected back so that his right arm appears to be on the left side where his arm is missing. A false arm can then be placed inside the box so that when the soldier looks into the box he appears to have two arms. Now the Doctor reaches in and controls the false arm and scratches the arm that appears to be the left arm. The result is that the soldier now gets relief from the itching in his phantom-limb. To the soldier it feels as if his left arm, the missing arm, is being scratched. We have fooled the brain into thinking that not only does the soldier have his arm back, but that we are scratching it which makes the pain go away. Now if we can trick the brain into relieving pain in a limb that no longer exists then certainly we can trick the brain into relieving pain in a limb that is actually present. The key concept here is that the pain in the missing arm is not real and that in fact the sensation of pain itself is not real. Pain is a perception of the somatosensory signals sent from various parts of your body and this perception is created by your brain.
Now here is the secret to how acupuncture works. The performance of acupuncture on someone tricks the brain into relieving pain where the person has the pain. The acupuncture procedure itself does nothing to relieve the pain. What is important here is the belief that the procedure will relieve the pain. The procedure performed could be acupuncture, acupressure, massage with special oil, hot rocks, magnetic balls, or even a form of Reiki where the practitioner does not even touch the patient. The treatment received is meaningless to the outcome. The key to the success of the treatment is the belief that it will relieve the pain. Usually the more elaborate the performance is of the individual performing the treatment on the recipient the easier it is for the receivers of the treatment to believe in the effect. Just as in the example of the mirror box from above we have created an illusory effect that the pain is being relieved.
Well you may think that there have been scientific investigations into the effects of acupuncture and you would be right. To my knowledge there has never been a single randomized double-blind clinical trial that has shown that acupuncture works better than placebo. There have been some very interesting studies performed using acupuncture that have yielded some interesting results. However, before I share these studies with you I think it may be a good idea to define acupuncture.
What is acupuncture?
Acupuncture was invented many years ago in China. Some estimates suggest that it was invented 2000, or even 5000, years ago. The chief premise behind acupuncture is that Qi (chee) is a life force that flows through meridians that are like rivers that carry the Qi to the various parts of the body. Along the meridians there are points that have a counterpoint elsewhere in the body. The treatment of acupuncture is the placement of needles in these corresponding acupuncture “points” in order to free up the flow of Qi to the area that has deemed to be afflicted. The number of meridians in the body is taken from the number of rivers in China as the body was created as a reflection of the world (at this time China was deemed to be the entire world). The number of rivers in China is open to debate depending upon where in China you originate so some schools of acupuncture believe that there are 11 meridians whereas others believe there are either 12 or 13 meridians. Now you can imagine that if the number of meridians differ then so must the number and placement of the acupuncture points that coincide to the various organs and structures of the body. In fact, the points vary depending upon which region of China you hail from. Some have estimated that there are as many as 200 different dialects within China and likewise that there are as many as 200 different maps to acupuncture points on the body. One investigator jokingly stated that if you mapped all these points on a single body there wouldn’t be a single square centimeter on the body that WASN’T an acupuncture point.
Let us think logically about the concepts of acupuncture for just a minute. It is readily apparent that an acupuncture point is not a precise location that corresponds to another point, but is instead somewhat arbitrarily chosen based upon on the traditions of the region of China from which you come. Moreover, we cannot possibly know which one of these schools has the point placement correct. It is logically impossible for all of these points to correspond to the same location. Moreover, because the number of meridians vary it would be impossible to place the points along the meridians and have the points occur in the same places if the number of meridians was changed. It therefore seems that the acupuncture points are not precise locations that are empirically determined. Therefore, it also seems that it is highly unlikely that acupuncture points actually correspond to specific targets in the body such as the liver or lung.
Some other questions that readily come to mind with regards to acupuncture are:
Has anyone ever seen a meridian?
Are humans the only animals with meridians?
Has anyone ever seen or measured Qi in any way?
The fact is that no one has ever seen a meridian. However, just because we cannot see something does not mean that it does not exist. I can think of many examples of things that we know exist that we cannot see. However, it does seem that if a meridian was large enough to carry a vital force in our bodies that it would be comprised of some mass and that it would actually have a physical structure that we could see. I do not know the number of human autopsies that have been performed in the world but I assume it is in the millions and I find it quite puzzling that no one has ever seen a meridian. Moreover, the number of animal dissections that have been performed must also be in the millions and yet no one has ever documented the presence of a meridian in any animal even though the anatomical structure of animal species, such as the rat for example, have been diagrammed in excruciatingly minute detail. Even though we now have microscopes so powerful that we can see a single mitochondrion within a cell which is less than a micron (one millionth of a meter) we have not yet seen a meridian. I guess we will just have to live with the idea that meridians are too small to see.
The fact is that no one has ever measured the existence of Qi. However, just because we cannot measure something does not mean that it doesn’t exist. Perhaps we cannot measure or see Qi because it is a very weak and mysterious force. We humans simply cannot measure something as weak a force as Qi. It does seem odd however that something so powerful would be so weak that we cannot measure it. Conversely, how can something so weak have such a strong effect?
What energy forces can we measure? Well, we can measure galvanic skin response (GSR) which is common in lie detector tests and is a measurement of the resistance of the skin that changes when the ion concentrations in your skin change. We can also measure the electrical currents produced by the firing of groups of neurons in your brain which are known to produce different wave forms depending on your level of cortical excitability. This test of brain activity is called an EEG or electroencephalogram. Well perhaps Qi is weaker than GSR, EEG, EMG (electromyogram), or EKG (electrocardiogram). So what is the smallest form of energy we CAN measure? Well I am not sure, but I know that I can measure a single photon of light in my laboratory. That is a very small amount of energy. We can also measure the amount of energy that is absorbed by DNA when excited by a UV light source with a spectrophotometer. Well, how about something smaller than DNA? The smallest form of energy that exists would have to be smaller than a photon or even an atom. I think that an electron would have to be the smallest amount of energy we know of that we can measure. If we could only get a single atom to give up a single electron from its outer-most shell to another atom, perhaps we could measure this change in energy. This in fact is done all the time and this new atom is referred to as a radio-isotope. You can measure the amount of energy gained by the atom by using a scintillation counter, or even a simple Geiger counter, or even by autoradiography (that is to say that you expose film with the radioactive signal). So we can measure the amount of energy in an electron which is a sub-atomic particle.
Perhaps soon we will have measurements of the amount of energy consumed by anti-matter as the world’s largest Super-Collider begins measuring the collision of atomic particles. This will truly be the smallest measurement of energy ever measured by man. However, until we have this data the electron is the smallest form of measurable energy on the earth. Is the amount of energy in Qi smaller than the smallest form of energy known to be on the earth, the electron? Most likely it is not.
When it comes to performing studies designed to test whether or not a specific chemical or treatment is effective, the first thing you must do is provide a scientific foundation for testing the thing in the first place. Let’s say that we were interested in testing whether a chemical in blueberries is effective for the treatment of some illness or symptom of an illness. Before we could even get approval to test the substance in live cells (let alone live animals) we would need to show the details of exactly how we propose that this substance will work. Now let’s imagine that we want to test whether or not acupuncture works for some illness or symptom. It would not make sense to start with live cells so we would need to start with live animals. We propose that there is an invisible energy source flowing through invisible meridians that is too weak to measure and we want to correct the flow of this energy by sticking pins in an animal such as a mouse. We presume that the flow of energy is blocked and pins will release the blockage because… (sorry, I cannot think of a sensible reason for why pins would release the blocked energy). The scientific precepts in this case are certainly too weak to warrant research on live animals. Before you can perform research on living animals such as mice you must provide valid evidence that the work is worthwhile and that there is strong scientific evidence to back it up. The scientific principles behind the actions of acupuncture are certainly too vague to warrant the afflicting of pain on mice.
Although it seems inappropriate to stick pins in a mouse when there is no logical reason for why sticking pins in an animal would provide relief of anything, this has not stopped researchers from performing studies on humans. I suppose that if you properly acquire informed consent from humans that have been informed that there is no scientific evidence to support how acupuncture might work then it would be appropriate to have them volunteer for such studies. Studies that have compared the use of acupuncture and acupressure have shown that there is no difference between the two treatment modalities. Given that one method involves penetrating the skin multiple times which can obviously lead to infection, it seems curious that acupuncture is preferred over acupressure by practitioners. Other studies that compare real acupuncture to pseudo-acupuncture also show that there is no difference in these treatment modalities. These studies have been performed in a variety of ways. One study that is quite elegant in my opinion used nurses to perform acupuncture with one group of nurses providing pseudo-acupuncture. It is pseudo-acupuncture because the nurses had no training in acupuncture and had no idea where the acupuncture points were located. The nurses simply placed the needles any place they felt like it. In contrast to the pseudo-acupuncture group, the real acupuncture group was comprised of highly trained acupuncture masters. Although supposedly very different, the two groups were dressed identical and the results showed that all of the patients received the same amount of relief from their chronic pain. Another study was performed in a similar fashion except one group received false needles that were specifically designed as false acupuncture needles that do not penetrate the skin. When the results were compared between the groups, where all things were equal with the exception of whether or not the needles penetrated the skin, they showed that the outcomes between the groups were identical.
Something that may have come to mind when you read the depictions of the studies above is that the treatment groups received the same amount of pain relief. That’s correct, the group that received acupuncture did receive relief from chronic pain. That means that acupuncture works. Right? Well I guess it depends on your definition of “works”. People who receive acupuncture as treatment do report pain relief and so do people who receive placebo. If you came to me and told me that you were in pain and I told you that I had something that would definitely relieve your pain and then went into an elaborate story about its origin and then proceeded to perform a long and elaborate ritual, whilst wearing my white lab coat, and then I gave you a sugar cube at the end, you would get the same amount of pain relief. You would also report getting more pain relief if I charged you $300 for the treatment rather than $20. Just as in the example of the mirror box treatment for relief of pain from the story above, we have created a somatosensory illusion that tells your brain that you are no longer going to experience pain. Now it is true that you would get pain relief from the treatment with the sugar cube, however if you asked me if a sugar cube relieves pain, I would say “no”.
Whether or not your brain perceives the somatosensory stimulus it receives as pain is really up to your brain. That is the secret as to how acupuncture works.
