How does acupuncture work?


Most people are very curious about acupuncture when they first hear about it. Sticking needles in people, not injecting medicine, and yet expecting to see improvement in disease is an odd concept to the Western mind. For people like me who aren’t fond of needles in the first place – the idea can seem downright preposterous!

So, it’s very natural to wonder what it is and how it works!

In this article, I’ll first just give an overview of Chinese medicine treatment and what it involves. Some of this you’ll know, and some will be new to you. Then, I’ll attempt to help you understand exactly what the heck is going on when you’re lying on the table with needles in various places on your body. Here, we’ll look chiefly at the perspective of Chinese medicine theory, as opposed to a more modern biomedical perspective.

First – what’s included in Chinese medicine treatment?

If you’re reading this, you’ve most likely had acupuncture or a similar therapy at least once. So, you probably have a sense of what treatment involves. But, “Chinese medicine” and even the narrower “acupuncture” is a broad group of treatment modalities and approaches, some of which you may never have experienced.

A Chinese medicine treatment can involve any of the following activities – not all are utilized by all practitioners at all times. Some of these may not be currently practiced by WW practitioners, but it’s good for you to know what is possible!

  • Acupuncture, including electroacupuncture
  • Acupressure, stimulation of acupuncture points with the hands
  • Tuina and other forms of SE Asian massage
  • Cupping and Guasha, both massage-like modalities using tools
  • Micro bloodletting
  • Qigong healing or teaching, using the energy of the body directly to impact health
  • Lifestyle guidance including Chinese dietary therapy & instruction on movement
  • Topical herbal applications including salves, oils, ointments and other substances, usually containing Chinese herbs as well as strong smelling menthol compounds
  • Heat applications including moxibustion
  • Prescription of herbal formulas or herbal teas
  • Some practitioners may incorporate modalities and tools that are not explicitly included in Chinese medicine such as Western forms of massage, various types of energy work and the use of Western herbs or dietary supplements

Despite the diversity of treatment types, all of these things fall under the same Chinese medicine umbrella. That’s because they are all rooted in the same way of understanding the body, the world, and the interaction between them. Different therapies are chosen based on patient goals, practitioner skills & the suitability of treatment for the presenting condition.

In the rest of this article, we’ll be focusing mostly on acupuncture since it’s the most well-known and well-researched aspect of Chinese medicine. However, much of what I discuss is relevant to most of what is listed above.

Before we proceed – it’s important to understand that there is no totally unified “Chinese medicine theory.”

As Chinese medicine has developed – moving through different nations and different time periods – it has been changed as a result. Further, the nature of classical Chinese scholarship allows for a diversity of opinions to coexist, making finding any one “true” explanation nearly impossible. That said, there ARE many things we can state with some confidence, and that’s what I’ll be sharing here.

The acupuncture channels & points

rough illustration of the primary acupuncture channels on a masculine body
A very rough overview of the primary channels

One of the most important things to understand is that most Chinese medicine practitioners are using an entirely different understanding of the body than your conventional biomedical doctors utilize. While of course we are trained in the fundamentals of modern Western anatomical and physiological science, it is typically not the basis of our clinical reasoning nor our treatments. Instead, we utilize traditional anatomical understanding as our guide. While a fuller explanation will unfold during this entire email series, I’d like to give you the fundamentals now to enhance your understanding.

The ancient Chinese, over generations, intuited and then further developed a system of channels running through every part of the body that are responsible for the energetic regulation of every facet of our physiology. These channels, sometimes erroneously called “meridians,” can be used both for diagnosis (through palpation and observation) and of course for various types of treatment.

The channels are roughly divided into two groups. The primary channels, named after organ systems you would recognize, and the extraordinary channels, which are less frequently needled. Check out this image for an overview of the channel system. You’ll see that there are very few parts of the body that aren’t reached by one channel or another! The system of channels is like a system of rivers in a watershed – they are all hooked up together and have particular flows, eddies and tendencies, just like bodies of water.

It’s likely that originally, the channels were the only or primary way of understanding the flow of energy through the body. The “points” that modern practitioners use probably came much later in the development of the medicine.

The points are concentrations of the body’s energy that are roughly at the same places on everyone. By using these points rather than other places on the channels, a practitioner can more efficiently and powerfully impact the patient’s physiology. Despite this, practitioners in certain lineages do use places on the channel other than the pre-defined points. And some therapies, like moxibustion and tuina, work on broader areas of the channel than the point can encompass.

What’s up with qi?

So far, I’ve used the word “energy” quite a bit. I’m actually not a huge fan of this word, as it can be used to describe almost anything, and everyone understands it a bit differently! What I was attempting to do is avoid the use of the word “Qi” as much as possible. But now let’s face it head on!

Qi is probably the most unique concept in Chinese medicine that most people have heard about. The character for qi – 氣 – depicts steam or vapor coming off of cooking rice. What does this tell us about qi? Steam is moist and can be thought of the union between water, air and fire. Coming off of rice tells us that it could be nourishing. Beyond that we could guess that it is somewhat insubstantial, moving, dynamic, and that it is created and so must also be possible to be destroyed.

artistic rendering of qi used in acupuncture treatment
An artistic rendering of the character qi

There are many types of qi in the body, from more substantial / material to less so. Qi is responsible for the majority of the body’s functions, in concert with other substances and structures. Acupuncture has a direct impact on qi – either moving it or gathering & concentrating it, depending on what the practitioner intends.

Qi can be felt, both by the practitioner and the patient. If you’ve had many treatments, you may have experienced sensations in your body that couldn’t readily be explained by the simple reality of a stainless steel needle being stuck in your skin.

Sometimes you feel a sensation far away from a needle, or you might feel movement all along a channel or other part of your body. This is the movement of qi. On the practitioner side, we can often feel a kind of pulling or tugging on the needle that indicates we’ve interfaced appropriately with the qi – and some very sensitive practitioners can feel more.

Ok, so how does acupuncture work, then?

At the simplest level, acupuncture works through impacting the patient’s qi. That’s it!

But, of course, there’s a lot more to it than that. Through the pulse, tongue and other diagnostic techniques, the practitioner utilizes aspects of Chinese medicine theory like the five phases and the twelve organ systems to understand what imbalance or disharmony is creating the symptoms the patient is experiencing. The rest of this email series will help you understand more about these parts of the process.

Then, by utilizing this information, they determine the channels and points that must be used in order to restore balance to the body. Using various techniques, the practitioner can “ask” the qi to go from one place to another, to build up the body’s qi or to reduce places where it’s become inappropriately blocked. The practitioner may focus on just one channel or organ system, or may work to improve interaction between several. The qi can be moved up, down, deeper into the body, or more towards the surface, depending on the need.

But, in the end, the effect in acupuncture is actually done chiefly by the body’s own qi! It just needs a little help from the practitioner to know what to do. While this is an intentionally simple explanation, that simplicity actually reflects the true reality of Chinese medicine treatment. It’s really nothing more fancy than assisted self-healing in a certain way of thinking about it.

This is just the beginning

As I hope I’ve made clear, there is MUCH more to Chinese medicine, including acupuncture, than this brief article can hope to explain. Future articles will help fill in some of the blanks, and complicate some of what I’ve described here. The deep complexity and sometimes contradiction of Chinese medicine can be a bit frustrating, but is also part of why it’s so fun to learn about.

If you have questions about what I’ve shared here, don’t hesitate to reach out!

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