Abstract
Though contemporary research meta-analyses and large randomized controlled trials of acupuncture demonstrate its efficacy and efficiency in pain and non-pain conditions, the lack of a defined mechanism for how needling an acupuncture point produces beneficial clinical effects has hindered acupuncture’s integration into allopathic medical practices.
This paper provides a neuroanatomic model of acupuncture signaling that is consistent with acupuncture basic and clinical studies, and that may also potentially provide answers to 2000 year-old paradoxes contained in the Huangdi Neijing treatise.
Zusammenfassung
Aktuelle Metaanalysen der Forschung und große randomisierte kontrollierte Akupunkturstudien belegen zwar ihre Wirksamkeit und Effizienz bei Schmerzzuständen und schmerzfreien Zuständen, doch das Fehlen eines definierten Mechanismus, wie das Nadeln eines Akupunkturpunktes vorteilhafte klinische Effekte erzeugt, hat die Integration der Akupunktur in allopathische medizinische Praktiken behindert.
Dieser Artikel stellt ein neuroanatomisches Modell der Akupunktursignalgebung vor, das mit grundlegenden und klinischen Studien zur Akupunktur übereinstimmt und das möglicherweise auch Antworten auf 2.000 Jahre alte Paradoxa geben kann, die in der Abhandlung „Innerer Klassiker des Gelben Fürsten“ (Huangdi Neijing) enthalten sind.
Similar content being viewed by others
References
A Brief History of Chinese Acupuncture and Moxibustion. http://www.china.org.cn/archive/2006-10/27/content_1185663.htm, accessed 8/27/2020.
Baldry PE. Acupuncture, trigger points, and musculoskeletal pain. 3rd edition. London: Elsevier, 2005. pp. 14–16.
Beal MC. Viscerosomatic reflexes: a review. J Am Osteopath Assoc 1985;85(12): 786–801.
Beltaief K, Grissa MH, Msolli MA, Bzeouich N, Fredj N, Sakma A, Boubaker H, Bouida W, Boukef R, Nouira S. Acupuncture versus titrated morphine in acute renal colic: a randomized controlled trial. J Pain Res 2018 Feb 13; 11:335–341. doi: https://doi.org/10.2147/JPR.S136299. PMID: 29483783; PMCID: PMC5815470.
Cheng KJ. Neuroanatomical characteristics of acupuncture points: Relationship between their anatomical locations and traditional clinical indications. Acupunct Med 2011; 29(4):289–294.
Cheng X. Chinese Acupuncture and Moxibustion 3rd Edition, 19th Printing, Dec. 2018, first published 1987, Beijing Foreign Language Press.
Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med 2009; 169(9):858–866. doi:https://doi.org/10.1001/archinternmed.2009.65.
Chiang CY, Chang CT: Peripheral afferent pathway for acupuncture analgesia. Sci Sin 1973; 16(2):210–217.
Chiang P. What is the point of acupuncture? Med Acupunct 2015; 27(2):67–69. doi:https://doi.org/10.1089/acu.2015.1093.
da Silva MA, Dorsher PT. Neuroanatomic and clinical correspondences: acupuncture and vagus nerve stimulation. J Altern Complement Med 2014;20(4):233–240. doi:https://doi.org/10.1089/acm.2012.1022.
Deadman P, Al-Khafaji M, Baker K. A Manual of Acupuncture. East Sussex: Journal of Chinese Medical Publications, 1998. ISBN-13: 9780951054659.
de Mairan J. Observation botanique. In Histoire de l’Academie Royale des Sciences 1729; pp 35–36.
Dorsher PT, Cummings M. Anatomy for Acupuncture [DVD]. Primal Pictures: London, UK, 2008. ISBN 9781904369707 available through Primal Anatomy.TV. https://www.anatomy.tv/anatomytv.
Dundee JW, Ghaly G. Local anesthesia blocks the antiemetic action of P6 acupuncture. J Clin Pharm Ther 1991;50:78–80. doi:https://doi.org/10.1038/clpt.1991.106.
el Hayderi L, Nikkels-Tassoudji N, Nikkels AF. Incidence of and risk factors for cutaneous scarring after herpes zoster. Am J Clin Dermatol 2018;19: 893–897. https://doi.org/10.1007/s40257-018-0385-2.
Feng S, Han M, Fan Y, et al. Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy. 2015;29(1):57–62. doi:https://doi.org/10.2500/ajra.2015.29.4116.
Fu LM, Li JT, Wu WS. Randomized controlled trials of acupuncture for neck pain: systematic review and meta-analysis. J Altern Complement Med. 2009 Feb; 15(2):133–45. doi: https://doi.org/10.1089/acm.2008.0135.
Gu W, Jiang W, He J, Liu S, Wang Z. Blockade of the brachial plexus abolishes activation of specific brain regions by electroacupuncture at LI4: a functional MRI study. Acupunct Med 2015; 33:457–464. doi:https://doi.org/10.1136/acupmed-2015-010901.
Haake M, Muller HH, Schade-Brittinger C, Basler HD, Schäfer H, Maier C, Endres HG, Trampisch HJ, Molsberger A. German acupuncture trials (GERAC) for chronic low back pain: a randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Int Med 2007; 167(17):1892–1898. doi:https://doi.org/10.1001/Archinte.167.17.1892.
Haker E, Egekvist H, Bjerring P. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. J Auton Nerv Syst 2000; 79(1):52–9. doi:https://doi.org/10.1016/S01651838(99)000909.
Harvey W. Exercitatio anatomica de motu cordis et sanguinis in animalibus (An anatomical exercise on the motion of the heart and blood in animals), 1628. Frankfurt - The Warnock Library. http://www.rarebookroom.org/Control/hvyexc/index.html.
Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Stuttgart: Thieme Publishing Group, 2007. ISBN 978-1-57250-706-3.
Kaynar M, Koyuncu F, Buldu L, et al. Comparison of the efficacy of diclofenac, acupuncture, and acetaminophen in the treatment of renal colic. Am J Emerg Med 2015 Jun;33(6):749–753. DOI: https://doi.org/10.1016/j.ajem.2015.02.033.
Kim MC, Nam TC, Kim MK, Kim JM, Kim DH, Lee KY, Song CW. Histological observation of canine acupoints. The Medical Acupuncture Web Page. Accessed 11/15/2015.
Ko HY, Shin YB, Sohn HJ, Chang JH, Ahn YH, Ha YH. Unmyelinated fibers in human spinal ventral roots: C4 to S2. Spinal Cord 2009; 47:286–289. doi:https://doi.org/10.1038/sc.2008.97.
Lam M, Galvin R, Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine 15 November 2013; 38(24): 2124–2138. doi: https://doi.org/10.1097/01.brs.0000435025.65564.b7.
Langevin HM. Connective tissue: A body-wide signaling network? Med Hypotheses 2006; 66: 1074–1077.
Lee A, Chan SKC, Fan LTY. Stimulation of the wrist acupuncture point PC6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 2015, Issue 11. Art. No.: CD003281. DOI: https://doi.org/10.1002/14651858.CD003281.pub4.
Lee M, Longenecker R, Lo S, Chiang P. Distinct neuroanatomical structures of acupoints Kidney 1 to Kidney 8: a cadaveric study. Med Acupunct 2019 Feb 1;31(1):19–28. doi: https://doi.org/10.1089/acu.2018.1325. Epub 2019 Feb 7. PMID: 30805076; PMCID: PMC6386779.
Levine J D, Gormley J, Fields HL. Observations on the analgesic effects of needle puncture (acupuncture). Pain 1976; 2:149–159.
Li A-H, Zhang JM, Xie Y-K. Human acupuncture points mapped in rats are associated with excitable muscle/skin—nerve complexes with enriched nerve endings. Brain Res 2004. 1012(1-2): 154–159.
Linde K, Allais G, Brinkhaus B, Manheimer E, Vickers A, White AR. Acupuncture for migraine prophylaxis. Cochrane Database of Syst Rev 2009, Issue 1. Art. No.: CD001218. DOI: https://doi.org/10.1002/14651858.CD001218.pub2.
Liu L, Skinner M, McDonough S, Mabire L, Baxter GD. Acupuncture for low back pain: an overview of systematic reviews. Evid Based Complement Altern Med 2015; Article ID 328196, 18 pages. doi:https://doi.org/10.1155/2015/328196.
Loukas M, Ferrauiola J, Shoja MM, Tubbs RS, Cohen-Gadol AA. Anatomy in Ancient China: The Yellow Emperor’s Inner Canon of Medicine and Wang Qingren’s Correcting the Errors in the Forest of Medicine. Clin Anat 2010; 23:364–369.
Loukas M, Tubbs RS, Louis RG Jr, Pinyard J, Vaid S, Curry B. The cardiovascular system in the pre-Hippocratic era. Int J Cardiol 2007; 120:145–149.
Lou XF, Jiang SH. Anatomical characteristics and classification of acupoints [Article in Chinese]. Zhongguo Zhen Jiu [Chinese acupuncture & moxibustion] 2012 Apr; 32(4):319–23.
Maciocia G. The Channels of Acupuncture. Philadelphia: Elsevier, 2006, p.3.
Marcus DM. Is acupuncture for pain a placebo treatment? An examination of the evidence. The Rheumatologist 2010 November 1. Accessed 8/28/2020. [6 screens].
Nurmikko T, Bowsher D. Somatosensory findings in postherpetic neuralgia. J Neurol Neurosurg Psychiatry 1990; 53: 135–141.
O’Connor J, Bensky D. Acupuncture: a comprehensive text. Chicago: Eastland Press, 1981. P. 45.
Park J, White A, Stevinson C, Ernst E, James M. Validating a new non-penetrating sham acupuncture device: two randomised controlled trials. Acupunct Med 2002 Dec; 20(4):168–74. doi: https://doi.org/10.1136/aim.20.4.168.
Research Group of Acupuncture Anesthesia, PMC: Effect of acupuncture on the pain threshold of human skin. Chin Med J 1973; 3:151–157.
Schnorrenberger CC. Anatomical roots of acupuncture and Chinese medicine. Schweiz Z Ganzheitsmed 2013; 25:110–118. DOI: https://doi.org/10.1159/000349905.
Senelar R. Les characteristiques morphologiques des points Chinois [Article in French]. In: Niboyet JEH, editor. Nouveau Traite D’Acupuncture. Paris: Maisonneuve, 1979.
Streitberger K, Kleinhenz J. Introducing a placebo needle into acupuncture research. Lancet 1998; 352(9125):364–5. doi: https://doi.org/10.1016/S0140-6736(97)10471-8.
Tompkins RP, Melling CWJ, Wilson TD, Bates BD, Shoemaker JK. Arrangement of sympathetic fibers within the human common peroneal nerve: implications for microneurography. J Appl Physiol 2013; 115(10):1553–1561. doi: https://doi.org/10.1152/japplphysiol.00273.2013.
Trinh K, Graham N, Gross A, Goldsmith CH, Wang E, Cameron ID, Kay TM, Cervical Overview Group. Acupuncture for neck disorders. Cochrane Database Syst Rev 2006, Issue 3. Art. No.: CD004870. DOI: https://doi.org/10.1002/14651858.CD004870.pub3.
Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K. Acupuncture for chronic pain individual patient data meta-analysis. Arch Intern Med 2012; 172(19):1444–1453. doi:https://doi.org/10.1001/archinternmed.2012.3654.
White JC, Smithwick RH, Simeone FA. The autonomic nervous system. Ed. 3. MacMillan Co., New York, 1952.
Wu C-P, Chao C-C, Zhao Z-Q, Wei J-Y. Inhibitory effect produced by stimulation of afferent nerves on responses of cat dorsolateral fasciculus fibers to nocuous stimulus. Sci Sin 1974; 27(5): 688–697.
Zhu M. The medical classic of the yellow emperor. Beijing: Foreign Languages Press, 2001.
Author information
Authors and Affiliations
Corresponding author
Additional information
About the author
The author is an emeritus physician from Mayo Clinic in Florida, now about to start an integrative medicine practice in Florida. Trained in biomedical engineering and medicine, interests include chronic pain and acupuncture, especially its mechanisms. Publications exceed 80 with 40 peer reviewed articles and numerous national and international presentations on acupuncture and pain issues.
Adherence to ethical guidelines
Peter Dorsher states that there are no conflicts of interest. The manuscript does not include studies on humans or animals.
Rights and permissions
About this article
Cite this article
Dorsher, P. Acupuncture as Neuromodulation: How It Can Explain Ancient and Modern Acupuncture Paradoxes. Chinese Medicine 35, 212–224 (2020). https://doi.org/10.1007/s00052-020-0283-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00052-020-0283-6