Complimentary Therapies

These differences are theoretical, but there are also practical differences. Whereas traditional acupuncture practitioners, at least today in the West, tend to insert large numbers of needles and leave them in place for at least 20 minutes, sometimes longer, some Western acupuncturists use many fewer needles (sometimes only one) and practise brief insertion (from two or three minutes right down to one second). This modern technique is also used by those traditionally trained, though it may be less common.

Medical acupuncture lends itself to use in a busy practice where there is little time to spend on each patient. It also has the advantage that it can be learned much more easily than traditional acupuncture by modern health practitioners such as doctors, physiotherapists, osteopaths, chiropractors, and podiatrists. Such people do not have to learn another system of thought or technique; rather, they see acupuncture as an extension of what they are already doing.

For traditionalists, medical acupuncture appears to be a watered-down version of "real" acupuncture, having at best a limited degree of effectiveness in certain situations. However, there is little good research evidence to support the use of any form of acupuncture, traditional or modern, and even less to show that one kind is better than the other. Research dollars are not imminent in medicine that does not show large profits.

Choosing where to needle

If acupuncture is not to be based on the traditional ideas, how can we choose where to insert the needles? There are several possibilities. One popular idea is to use the concept of trigger points. These are tender areas, mostly in muscles, from which pain and other sensations may radiate to distant areas. Some studies have shown a considerable degree of correspondence between the locations of trigger points in the Western literature and classic acupuncture points.

Another idea is to base the needling on body segments. The spinal cord is arranged segmentally, with pairs of nerve roots emerging from it along its length. These nerve root pairs supply the skin in a series of stripes, so that it is possible to say which spinal segments supply sensation to different parts of the body. A similar arrangement exists at deeper levels, so that we may speak of myotomes (related to the muscles) and sclerotomes (related to the bones and joints). In some versions of medical acupuncture the needles are inserted in segments that are related to the internal organs that one wishes to treat.

Other ways of choosing where to needle also exist. However, some medical acupuncturists think that it often makes relatively little difference where the needles are inserted, at least in quite broad terms. Certainly there seem to be some patients who react very strongly to needling and in whom the actual site of treatment is not very important. A traditionally-trained acupuncturist, however, might consider this belief heresy, and consider this random approach dangerous.

Mechanism

Assuming that acupuncture has more than a placebo effect, how can we explain its action? Two main kinds of scientific medical explanation have been suggested:

The gate theory of pain, first put forward some thirty years ago by Patrick Wall and Robert Melzack, postulates the existence of gates or filters in the spinal cord that can modulate (increase or decrease) transmission of pain information within the nervous system.
The second explanation is based on the existence of natural opiates (pain-relieving substances such as endorphins and enkephalins) in the central nervous system and elsewhere in the body.
Although both these mechanisms may well be involved, they are probably not the whole story. Science has yet to be able to fully understand acupuncture. There is increasing evidence today to suggest that various areas of the brain, such as parts of the limbic system (especially the anterior cingulate cortex) are important. Another idea which is currently attracting attention is the role of oxytocin, a pain-relieving hormone that also causes feelings of relaxation and tranquillity.

In summary, while it is possible to put forward a reasonably plausible explanation for how acupuncture may work, we have to acknowledge that much of this theorizing may be wrong or based on inadequate information. One difficulty to date is that much of the experimental work has been done on short-term pain relief in animals, whereas what happens when acupuncture is used clinically in humans is different in a number of ways. For example, in clinical acupuncture the pain relief may take several hours or even days to develop, but may then continue for long periods or even permanently. There is also a build-up effect with repeated treatments. And whereas the animal experiments have mostly used strong electrical stimulation of the needles, much clinical acupuncture is brief and gentle, using minimal manual stimulation. For all these reasons it is doubtful how far the available research into acupuncture mechanisms is really applicable to clinical acupuncture in humans.