Ah! The biggest question we get asked. We’ve got two approaches. Firstly the Traditional Chinese Medicine (TCM) explanation involving Qi flowing in meridians, originating thousands of years ago. This certainly has its place, even in today’s modern world. The beauty of Traditional Chinese Medicine (TCM) is that it is applicable throughout our daily life, not just when things go wrong. It links up seemingly unrelated symptoms and the language really expresses how we experience ill health. Ahead of the time – it has long emphasised the link between physical and mental wellbeing. It is truly ‘ big picture’ medicine.
However, our modern minds now want to know – what exactly is happening at a physiological level during an acupuncture treatment? Does the concept of Qi flowing in meridians have an alternative explanation?
Acupuncture is thought to work through several overlapping biological mechanisms, not a single one. When a thin needle penetrates the skin and is rotated or stimulated, it triggers a cascade of local chemical releases – let’s look at each of these.
1. Starting right at the needle tip. When an acupuncture needle is inserted and rotated, it physically winds the connective tissue beneath the skin. This mechanical action causes fibroblasts to react in a way that stimulates inflammatory and immune cells locally.
2. Tissue around the needle releases adenosine, a naturally occurring molecule that dampens pain signals. In a human study, adenosine concentrations at the needle site rose to roughly 178% of baseline during acupuncture and stayed elevated afterward at about 153% of baseline. This increase was localised: the opposite leg, which had no needle, showed no change. The adenosine binds to receptors on nearby pain-transmitting nerves and temporarily reduces the signals they send to the spinal cord. Notably, when needles were inserted without rotation, adenosine levels didn’t rise at all. And inserting the needle just two centimetres away from the intended point also failed to produce the effect, which suggests point location and needle technique both matter.
3. Another theory is that acupuncture also works at the spinal level through a principle called gate control. Your spinal cord contains neurons that act as relay stations for pain. These neurons receive input from both pain fibres and non-pain sensory fibres. When acupuncture activates larger, faster sensory nerve fibres, their signals block out the slower pain signals at the spinal cord, reducing what gets passed up to the brain.
4. Beyond the spinal cord, acupuncture triggers the release of the body’s own painkillers. The central endorphin system is a major player. When needles are stimulated electrically at different frequencies, the brain releases different types of endogenous opioids, including enkephalins and dynorphins. Some patients feel extremely relaxed and sleepy with acupuncture.
5. Acupuncture affects the circulatory system by dilating the blood vessels through nitric oxide release, ultimately increasing blood flow and oxygenation to local tissues and muscles. The insertion of needles creates a “micro-trauma” to the body that increases the amount and migration of white blood cells to the area that helps improve immune function, removes metabolic waste, and reduces inflammation in the local area.
So – there are measurable effects from acupuncture needling and these can to some extent explain the pain relieving properties of acupuncture. They can also explain why people find it so relaxing and good for managing stress – the endorphins and dilation of blood vessels ( we can see blood pressure and blood sugar go down during treatments). Remember, there is nothing in the needle! Acupuncture is stimulating your body to release multiple substances, so the healing really does come from within you.
The meridians of Traditional Chinese Medicine have not been identified as distinct anatomical structures. However, the acupuncture points mapped along them consistently overlie major nerve bundles so the correlation cannot be overlooked. Modern Western-style acupuncture often bypasses meridian theory entirely, selecting points based on neuroanatomy, targeting trigger points or areas near specific nerves.
A great example of traditional acupuncture theory vs modern western acupuncture theory would be the using acupuncture point San Yin Jiao which is a few inches up from the ankle on the inner leg. Traditional acupuncturists have been using this point for hundreds of years to affect the area around the bladder and reproductive organs. There have been studies using electro-acupuncture at this point and measuring changes in uterine blood flow. Now, more recently, a technique called Percutaneous Tibial Nerve Stimulation (PTNS) has become available on the NHS throughout the UK for managing symptoms related to Overactive Bladder (OAB). It’s actually the same acupuncture point and the same procedure. One group is calling it ‘electro-acupuncture’ and the other group is calling ‘nerve stimulation’.
Members of The British Acupuncture Council are trained in both TCM and Western style acupuncture and can move seamlessly between the two. When treating a simple condition such as tennis elbow, a Western style acupuncture outlook may be the easiest approach. When managing a more complex multifaceted case for example, cyclical migraines with joint pain – that’s when the ‘big picture’ approach of TCM really starts to shine.
To find out more about modern theories of acupuncture, please visit Evidence Based Acupuncture. To find out more about the training to become an acupuncturist please visit The British Acupuncture Council.
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