Acupuncture (cont.)
How does acupuncture work?
Here are current thoughts from the National Institutes of Health on
the manner by which acupuncture might produce beneficial health
results.
Many studies in animals and humans have demonstrated that acupuncture
can cause multiple biological responses. These responses can occur
locally, i.e., at or close to the site of application, or at a
distance, mediated mainly by sensory neurons to many structures
within the central nervous system. This can lead to activation of
pathways affecting various physiological systems in the brain as well
as in the periphery. A focus of attention has been the role of
endogenous opioids in acupuncture analgesia. Considerable evidence
supports the claim that opioid peptides are released during
acupuncture and that the analgesic effects of acupuncture are at
least partially explained by their actions. That opioid antagonists
such as naloxone reverse the analgesic effects of acupuncture further
strengthens this hypothesis. Stimulation by acupuncture may also
activate the hypothalamus and the pituitary gland, resulting in a
broad spectrum of systemic effects. Alteration in the secretion of
neurotransmitters and neurohormones and changes in the regulation of
blood flow, both centrally and peripherally, have been documented.
There is also evidence that there are alterations in immune functions
produced by acupuncture. Which of these and other physiological
changes mediate clinical effects is at present unclear.
Despite considerable efforts to understand the anatomy and physiology
of the "acupuncture points," the definition and characterization of
these points remains controversial. Even more elusive is the
scientific basis of some of the key traditional Eastern medical
concepts such as the circulation of Qi, the meridian system, and
other related theories, which are difficult to reconcile with
contemporary biomedical information but continue to play an important
role in the evaluation of patients and the formulation of treatment
in acupuncture.
Some of the biological effects of acupuncture have also been observed
when "sham" acupuncture points are stimulated, highlighting the
importance of defining appropriate control groups in assessing
biological changes purported to be due to acupuncture. Such findings
raise questions regarding the specificity of these biological
changes. In addition, similar biological alterations including the
release of endogenous opioids and changes in blood pressure have been
observed after painful stimuli, vigorous exercise, and/or relaxation
training; it is at present unclear to what extent acupuncture shares
similar biological mechanisms.
It should be noted also that for any therapeutic intervention,
including acupuncture, the so-called "non-specific" effects account
for a substantial proportion of its effectiveness, and thus should
not be casually discounted. Many factors may profoundly determine
therapeutic outcome including the quality of the relationship between
the clinician and the patient, the degree of trust, the expectations
of the patient, the compatibility of the backgrounds and belief
systems of the clinician and the patient, as well as a myriad of
factors that together define the therapeutic milieu.
Although much remains unknown regarding the mechanism(s) that might
mediate the therapeutic effect of acupuncture, it is encouraging that
a number of significant acupuncture-related biological changes can be
identified and carefully delineated.
Further research in this direction not only is important for
elucidating the phenomena associated with acupuncture, but also has
the potential for exploring new pathways in human physiology not
previously examined in a systematic manner.
- Acupuncture has been shown to be effective for the
treatment of nausea and vomiting in adults following surgery or taking
chemotherapy and post-operative dental pain.
- Acupuncture may be effective in treating a number of
other conditions.
- More research is needed to define more precisely the
role of acupuncture in health care.
Reference: National National Institutes of Health of the U.S.
Last Editorial Review: 4/5/2002
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