The Science

“Health is a state of body, wellness is a state of being”

The Science Behind Chinese Medicine

What Is Acupuncture?

In terms of Western Medicine the physiological function of acupuncture is still being studied at length. There are many hypothesis on the therapeutic mechanisms behind acupuncture but the main hypothesis and scientific explanations are as follows

  • Acupuncture may work by triggering neuro-hormonal pathways. This means that through stimulation of the nerve supply your body will release endorphins and create a happy, relaxed state and an increased pain threshold.
  • Another hypothesis is that it decreases pro-inflammatory markers such as TNF to decrease inflammation and thus pain. Inflammation is a healthy response to tissue damage and should stimulate our self-healing response. Lifestyle factors can increase our inflammation to where it’s markers can over activate and prevent healing.
  • Acupuncture may regulate the immune system through T-cells and nitric oxide. It may stimulate the production of red and white blood cells protecting individuals from colds, flus and viruses.
  • Acupuncture is often used for muscular tension as it may help release pain and discomfort by accessing trigger points and stimulating release.

Where’s the research?

Chinese Medicine has been used for thousands of years to help treat people with a range of conditions including but not limited to digestive disturbances, gynaecological conditions, pain and mental health issues. In modern times acupuncture especially has been researched to test its physiological methods of efficacy. New research is being completed on a year by year basis and the results are positive. Unfortunately the scientific research is not progressing as quickly as desired, due to certain limitations in retrieving accurate data. The limitations in the research being conducted are explained in detail below;

1

The unique nature of Chinese Medicine means treatments are tailored especially to each client. What may be appropriate for one client may not be for another, even if they present with a similar condition. This means that generally no two clients are treated the same and a treatment plan is based on the treating practitioner’s observations and extensive questioning. According to that principle treating a large pool of people with the same acupuncture or herbal medicine will often yield mass discrepancies.
2

Often in research studying acupuncture, sham or fake acupuncture is used as a placebo. This means that instead of inserting the acupuncture needle into a pre-specified anatomical position it is inserted into an area nearby. This is difficult to assess as there are over 400 acupuncture points on the body and it cannot be determined that the sham acupuncture is not activating a different acupuncture point. A lot of studies found improvement with sham acupuncture as well as real acupuncture and this has made it difficult to interpret the results.
1

Most Chinese Medicine results are subjective to the client. Internal examinations and blood testing are usually not used as a health marker. Only when the presented condition is external (i.e a skin condition) can there be visible evidence of success. Therefore, practitioners can only use the guidance of the client to establish the success of a treatment plan and unfortunately client reporting is open to individual interpretation.
2

Any perceived positive effect can be easily influenced by the placebo effect as well as individual client bias. This needs to be managed in the RCT’s to ensure that systematic reviews are accurate when assessing all the data.

Due to these factors, majority of systematic reviews suggest more data is necessary to make conclusive statements on the beneficiary effects of acupuncture and herbal medicine. In spite of these set-backs, there is some promising research that has come to positive conclusions about Chinese Medicine. In the last 10 years there has been a huge leap forward in solidifying Chinese Medicine’s place as a modern medicinal tool.

The Research

Pain

In 2013 a systematic review discovered that;

“The current evidence is encouraging in that acupuncture may be more effective than medication for symptom improvement or relieve pain better than sham acupuncture in acute LBP”

(conducted by Lee JH1, Choi TY, Lee MS, Lee H, Shin BC, Lee H)

In 2015 further analysis showed;

“Systematic reviews of variable quality showed that acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBP” (Liu L1, Skinner M1, McDonough S2, Mabire L1, Baxter GD1)

 

And this was followed up by a 2017 systematic review that stated;

“The SMDs between real acupuncture and control sham acupuncture were lower than those between real acupuncture and a no-acupuncture control. In addition, acupuncture appeared to be more effective than analgesic injection (at intragluteal site with analgesic or local infiltration with anesthetic) in reducing pain” (Anfeng Xiang, Ke Cheng, Xueyong Shen, Ping Xu, and Sheng Liu)

*They all suggested that more data was necessary to make a more conclusive statement

Women’s Health

In 2014 A Systematic Review for Chinese herbal medicine for Oligomenorrhoea and Amenorrhoea in Polycystic Ovarian Syndrome found that although;

“preliminary evidence suggests CHM may help regulate menses and correct endocrine abnormalities in PCOS”

it also suggested that “these results should be interpreted with caution owing to the small number of studies and high risk of bias found”

In 2017 A systematic review of Acupuncture for Polycystic Ovarian Syndrome showed;

“There was evidence of an improvement in monthly menstruation rates in women who received acupuncture compared to those who received metformin” and

“There was evidence of an improvement in fasting insulin levels between women who received true versus sham acupuncture” (Junyoung Jo, KMD, PhDa , Yoon Jae Lee, KMD, PhDb , Hyangsook Lee, KMD, PhD)

However the overall conclusion was that due to the poor quality of trials and potential bias that the evidence was inconclusive. They suggested more RCT’s with strict guidelines and larger pools of people.

Fertility/IVF Support

A 2011 Systematic Review conducted by Karin Reid & Keren Stewart found that;

“management of female infertility with Chinese herbal medicine can improve pregnancy rates 2-fold within a 3-6 month period compared with Western medical fertility drug therapy. In addition, fertility indicators such as ovulation rates, cervical mucus score, biphasic basal body temperature, and appropriate thickness of the endometrial lining were positively influenced by CHM therapy, indicating an ameliorating physiological effect conducive for a viable pregnancy.”

Although previous systematic reviews found the evidence for acupuncture and IVF to be unclear a 2017 a systematic review of 30 trials and 6344 participants had a concluded that;

“based on the analysis of the studies, acupuncture improves the Clinical Pregnancy Rate among women undergoing IVF” (Qian et al, 2017)

While another review studied the importance of timing with acupuncture application (2014)

“Our study showed that acupuncture did not significantly improve the IVF clinical pregnancy rate when performed only at the time of ET, while we found pooled benefit of acupuncture for IVF when performed at follicle phase and 25 min before and after ET, as well as 30 min after ET and implantation phase” (Shen C, Wu M, Shu D, Zhao X, Gao Y, 2014)

What’s the lingo?

Randomised Control Trial (RCT): A randomised control trial is a type of scientific or medical experiment that aims to test the efficacy of a new treatment. In this type of trial there is an experimental group (which receives the treatment) and control group (which receives the standard treatment). This standard treatment may be the best existing treatment, no treatment or a placebo. It is important to ensure that the people in each group are as similar as possible to eliminate variations.

Double Blind Study (DBS): A double blind study is a type of experiment where neither the participants or the researchers conducting the experiment know which treatment group has received which treatment. This attempts to eliminates variables such as bias and placebo.

Systematic Review (SR) : A systematic review is a review of a clearly formulated question (i.e does acupuncture assist in the management of lower back pain). A systematic review uses methods to select and critically analyse all relevant data, studies and research pieces on a particular question and come up with a conclusive summary and answer.

Bias: Bias in medical research is a systematic error that distorts study findings. This is mainly cause by flaws in the study design, data collection and analysis. This can be sub categorised into selection bias (choosing specific people for certain treatment groups), detection bias (observations in treatment group are more diligently pursued) and observer bias (the observer makes subjective decisions about the outcome).

Placebo: The placebo effect is a beneficial effect that cannot be contributed to the drug or treatment being administered but is instead attributed to the patient’s belief in the treatment.

References
  1. Lee JH1, Choi TY, Lee MS, Lee H, Shin BC, Lee H.
  2. Evid Based Complement Alternat Med.2015;2015:328196. doi: 10.1155/2015/328196. Epub 2015 Mar 4. Liu L1, Skinner M1, McDonough S2, Mabire L1, Baxter GD1.\
  3. The Immediate Analgesic Effect of Acupuncture for Pain: A systematic Review and Meta-Analysis (AnfengXiang, Ke Cheng, Xueyong Shen, Ping Xu, and Sheng Liu)
  4. In 2014 A Systematic Review for Chinese herbal medicine for Oligomennorrhoea and Amenorrhoea in Polycystic Ovarian Syndrome-Lily Lai, Xun Li, Andrew Flower, Michael Moore, Jianping Liu, George Lewith.
  5. Acupuncture for Polycystic Ovarian Syndrome: A Systematic Review and Meta-Analysis. Junyoung Jo, KMD, PhDa , Yoon Jae Lee, KMD, PhDb , Hyangsook Lee, KMD, PhD.
  6. Ried K, Stuart K.  Efficacy of traditional Chinese herbal medicine in the management of female infertility: a systematic review. Complementary Therapies in Medicine 2011
  7. Qian, Y., Xia, X.R., Ochin, H., Huang, C., Gao, C., Gao, L., et al (2017).Effect of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis. Arch Gynecol Obstet, 295(3), 543-558.S
  8. Shen, C., Wu, M., Shu, D., Zhao, X. & Gao, Y. (2015). The role of acupuncture in in vitro fertilization: a systematic review and meta-analysis. Gynecol Obstet Invest, 79 (1), 1-12.

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