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A Revisionist’s View on How Acupuncture Works

Based on patient feedback, I have learned that patients are generally interested in having a better understanding of what their practitioners are doing and why. And I think this is particularly applicable to acupuncture because it’s a collaborative process. And you should know more

By now, you might have heard about how acupuncture is a part of the Traditional Chinese Medicine, and it’s based on the principle of yin-yang balance, qi movement, etc. If you found this description to be somewhat esoteric and nebulous, don’t worry, you are not alone. I am ethnic Chinese, I speak the language, I know the culture, I am a trained professional in this field. And 90% of the time, I don’t know what they are talking about.

At least not specifically enough to be helpful in the clinic.

Well, since what we are really interested in understanding of what the needles do to your body and how your body reacts to the needles. Let’s just focus on that, everything else is just idle talk.

So here’s my take, and based on my own experience, it is the most practical and sensible explanation to what acupuncture works.

In general, when the needles go into your body, they pretty much are doing one of the two things: relax you or stimulate you. So for example, in stroke recovery, needles are inserted and manipulated to stimulate the nervous system to encourage new neural connections. For facial rejuvenation cases, the needles are used to stimulate the muscle tone to counter the effect of facial laxity.

However, in most clinic cases, we are aiming to relax the patients. So let’s focus on the relaxation aspect.

Within the realm of relaxation, the needles will relax both locally and systemically, and most of the time, there is a great overlap between local relaxation and systemic relaxation. For an effective clinic session, we have to focus on both.

By systemic relaxation, I am referring to the patient’s nervous system, namely by promoting parasympathetic nervous system. When the patients are mentally relaxed, they are much more present and their bodies and minds fight less. Also, when the mind is relaxed, the basal muscle tone is reduced… Just recall how different your body feels between sitting in an awful traffic and a tranquil beach… Putting the mind at ease is the requisite first step toward healing, and this is the systemic relaxation that I was referring to.

And by local, I mean the muscles of the needled point are relaxed. For example, you might have a sore achy tight spot on your body, and it’s pain when you palpate it. Like a trigger point for example. The direct needling of such a point relaxes the muscle and reduces the tension, just like how massage works. When that is achieved, the cause of the pain is also removed, and it no longer stimulate the nerve receptors to trigger the signals to your central nervous system, and that further enhances the systemic relaxation. Stress doesn’t kill you. It’s your cumulative residual stress responses that are killing you

Muscles are designed to do one thing and one thing only: to contract. When you are stressed, your mind triggers the necessary neurological and hormonal actions to get your body into a state that is appropriate for fight or flight. If you are constantly exposed to stressful stimulants, your mind and body have a hard time relaxing. Your mind is telling your body to gear up for fight or flight. And your constant state of high muscle tension also reminds the mind that the danger is not over yet. So a perpetual vicious circle ensues, even if the stressful stimulants have long passed. The stress has moved on, but the stress responses linger.

So, by being able to relax at both a systemic (nervous system) and local (muscular) level, acupuncture cuts the vicious circle. So if we can peek into your mind, like the movie Inside Out, we can probably see a laundry list that goes on forever… By using acupuncture to cut the psychosomatic vicious circle and reduce the noise coming into the CNS, we effectively reduce this lengthy laundry list for the patient. So metaphorically speaking, your body can focus its limited resources on fewer issues so it can heal better. And that’s what makes acupuncture a versatile modality. Since many pain syndromes we see in the clinic are directly associated to excessive muscle tension, by removing the muscle tension with acupuncture we eliminate the source of the pain. Also, it is important to recognize that pain is a subjective signal of stress, and when it’s well known that when a person is relaxed and centered, the sensation of pain is lessened. It doesn’t matter whether one tries to explain to explain the acupuncture mechanism through Traditional Chinese Medicine, it all essentially comes to down what is described herein.

Why Acupuncture Should Be the First Choice for Low Back Pain

TL:DL Majority of low back pain, especially the acutes ones, are due to excessive muscle contraction. Through the use of needles, acupuncture is a uniquely effective modality in reaching and relaxing the deep troubled muscles, either through direct mechanical contacts/manipulation or supplemented with electrical stimulation.

For the longest time, medical community has always attributed low back pain to herniated discs, which essentially means that the cartilaginous discs, that are sandwiched between two bony vertebrae, somehow get squeezed out of their proper snug space and start making uninvited contact with the touchy-feely nerves that are found on both sides of the spinal column. So clinicians used to perform a variety of physical exams such as the straight leg raise (SLR), toe resistance test, etc., to help to determine the location(s) of the disc herniation. Then MRI came along. And it provided the holy grail of what clinicians have been looking for all this time: evidence of disc herniation. Finally, the clinicians can see exactly where a herniation and assign a the cause of the patient’s suffering to a proper culprit. So, what’s the solution? On one hand, there is discectomy, which surgically shaves off the protruding portion of the disc so there is nothing physically irritating the nerve. For people who are avoiding surgery at all cost, they are referred to the physical therapists (PT) for rehabilitation, which consists of manual manipulation of the muscles in the affected area and exercises that help reconfigure the patient’s movement patterns.

So what is there left to discuss?

Well, the outcome of the aforementioned approaches is mixed at best. And to be fair, there is no such thing as a 100% solution. Every approach, every modality brings something useful to the table. But whether it is the right tool for the right problem, it’s open for debate. Here are a few questions and facts that challenge their applicability.

First, if disc herniation is the cause then a pointed discectomy should remove the problem. But I have seen my share of patients who are still suffering from back pain after the surgery. And take Steve Kerr’s case, back pain surgery, as a traumatic and invasive procedure to the body, is not the savior as one might think.

Second, as MRI becomes more sophisticated, the MRI laboratory has found high prevalence of disc herniation of varying degree in general population. But not all of them manifest as back pain. So as if the Heisenberg’s Principle of Uncertain is at play here: the more closely you observe the data and the symptom, the more uncertain the postulation of herniated disc causes back pain becomes. People with disc herniation do not experience pain; people with back pain may or may not exhibit pain; people with disc herniation but do not experience the predicted pain pattern and location…

Third, even if disc herniation is the culprit, how exactly is PT helping? Yeah, you can learn to use your body differently so you can minimize certain movements or postures that might provoke the unpleasant sensation. But the pain is still there. And what is the purpose of the manual manipulation? What exactly are they trying to manipulate? Shove the disc back in its proper place? Of course not. Adjust the lumbar vertebrae? How? As you might recall from the spinal model you’ve seen in a doctor’s office or your last biology or anatomy class, the lumbar vertebrae are HUGE! And something with that enormity in such a tight snuggedly fitting configuration is not to be manually adjusted. So what are the PT’s and the chiros trying to achieve with their manual manipulations?

Fourth, disc herniation is essential a degenerative process. Cartilaginous structures are much more prone to wear and tear than their ossified counterpart and as they wear out, they gradually lose their structural integrity and make themselves more vulnerable for shifting out of place. But this is a long and gradual process. It doesn’t happen in a snap of a finger as the onset of most acute back pain.

So after all my insightful but less than helpful comments, am I offering anything tangible? Well, if you have read this far, of course I am going to give you more pieces of my mind. So here’s the punch line. The first line of treatment for low back pain should target the soft tissues, meaning the muscles on the back, and acupuncture is the best modality for this job.

Sunday Clinic

New Sunday ritual: croissant, coffee and acupuncture. Or pu’er tea, dim sum, and acupuncture. Either is great. I can’t help you with the food and drinks, but I can definitely help you restore your wellness with acupuncture.

If you work a 9-5 job, like most people, you must have known what a hassle it is trying to go to a doctor’s appointment, or any kind of appointment for that matter, during regular working hours.  It completely disrupts your work schedule.  And that is assuming that you can even pull yourself away for a couple hours, and that’s certainly not a given.  And Saturday is the day you try to catch up on things, or maybe socialize or just try to catch a breather, so Saturdays are hard for you to seek medical attention too.  So yes, Sunday sounds like the ideal day for you to finally relax a bit and afford yourself the care you need and deserve.

Except so are all the medical professionals. They too want their Sundays.

Well, I love working with patients on Sunday. The building is quiet, the parking lot is empty. The foot traffic through the building is light. The energy is just mellow – just the right energy for healing.

So if you have been struggling with finding the right practitioner and time to take care of yourself, my Sunday Clinic just might be what you’ve been missing!

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