On Monday, I went over the article, “The Neuroimmune Basis
of Anti-inflammatory Acupuncture”. I’m just going to go over the basics of what
I took from the article and what I thought of it.
Acupuncture is an ancient Far East healing process that
dates back somewhere between 8000-5000BC. Its main objective was originally to
help open up the 12 main channels of Qi (“chee”) through insertion of needles
into 360 principle points. These needles could then be stimulated through
heating and, more recently, by sending a small electric shock through them. The
ancient way of heating the needles involved the use of mugwort (plant) incense.
I pointed out in class that this might not be the best way to heat up the
needles if one was trying to use acupuncture as an anti-inflammatory because
plants contain allergens.
It doesn’t seem to have been until recently that some of the
anti-inflammatory effects of acupuncture have really been published in the United
States. In 1997, the National Institute of Health published about its
usefulness in a variety of conditions, some of which are nausea/vomiting
induced by operation and chemotherapy, post-operative dental pain, and as an
anti-inflammatory.
One of the mechanisms proposed as the pain-relieving effect
of acupuncture was “counter-inflammation” (or “counter-irritation”, seems more
common). A harmful/noxious stimulus is known to cause a sort of rebound or
reactive analgesic effect immediately following the stimulus. This is known as “diffuse
noxious inhibitory control” or DNIC.
A simple view of this mechanism: DNIC -> opioid neuropeptide release -> pain relief
DNIC is proposed to be the cause of this counter-inflammatory response that acupuncture seems to cause. Say, for instance, one has pain and inflammation in the hand. This individual goes to get acupuncture treatment. This individual gets a few needles stuck in his/her back. The pain and inflammation in the hand dissipate or disappear completely and now the pain and inflammation is localized to the area of the acupuncture needles.
As Dr. Cohen said, it works as stomping on your toe might relieve one of his/her headache because (s)he is now focused on his/her toe pain.
So, my two ways of seeing this is (1) your brain absolutely does focus on the most recent stimulus and/or (2) the macrophages that were at the sight of the original pain are now traveling to the site of the most recent stimulus, due to recruitment.
A simple view of this mechanism: DNIC -> opioid neuropeptide release -> pain relief
DNIC is proposed to be the cause of this counter-inflammatory response that acupuncture seems to cause. Say, for instance, one has pain and inflammation in the hand. This individual goes to get acupuncture treatment. This individual gets a few needles stuck in his/her back. The pain and inflammation in the hand dissipate or disappear completely and now the pain and inflammation is localized to the area of the acupuncture needles.
As Dr. Cohen said, it works as stomping on your toe might relieve one of his/her headache because (s)he is now focused on his/her toe pain.
So, my two ways of seeing this is (1) your brain absolutely does focus on the most recent stimulus and/or (2) the macrophages that were at the sight of the original pain are now traveling to the site of the most recent stimulus, due to recruitment.
More recent research has shown that, when an injury occurs,
sensory C-fibers (in most major tissue and organs) send signals to the brain,
informing it about the injury, then the brain leads an inflammatory response to
that site. These sensory C-fibers release substance P and other tachykinins
that induce vasodilation, increased vascular permeability, and leukocyte
margination. According to Figure 1 in the article, it’s substance P that binds
to macrophages that triggers the release of proinflammatory cytokines that
travels through the afferent vagal pathway, notifying the brain of the injury
and causing the overall inflammatory response.
This process is mediated efferent vagal stimulation causing acetylcholine to bind to β2-adrenergic receptors on immune cells. This inhibits the production of proinflammatory cytokines. The signal is also relayed to the hypothalamus and dorsal vagal complex, which causes a release of adrenocorticotropic hormone, which activates the humoral anti-inflammatory pathway.
This process is mediated efferent vagal stimulation causing acetylcholine to bind to β2-adrenergic receptors on immune cells. This inhibits the production of proinflammatory cytokines. The signal is also relayed to the hypothalamus and dorsal vagal complex, which causes a release of adrenocorticotropic hormone, which activates the humoral anti-inflammatory pathway.
Another pathway that has immunoregulatory pathways is the
cholinergic anti-inflammatory pathway. This is show in Figure 2 in the article.
In a nutshell, efferent vagal activity causes acetylcholine to α7nicotinic receptors on macrophages, which inhibits the production of proinflammatory cytokines. It actually only takes nanomolar amounts of acetylcholine to inhibit the production of proinflammatory cytokines in human macrophage cultures challenged with lipopolysaccharide.
In a nutshell, efferent vagal activity causes acetylcholine to α7nicotinic receptors on macrophages, which inhibits the production of proinflammatory cytokines. It actually only takes nanomolar amounts of acetylcholine to inhibit the production of proinflammatory cytokines in human macrophage cultures challenged with lipopolysaccharide.
What ties all of this to acupuncture are the similarities in
the stomach and spleen acupuncture pathways and the vagus nerve pathway. This
can explain why the stimulation of ST-36, a key point on the stomach
acupuncture channel, has been shown to induce peristalsis in the post-operative
ileus of men and rabbits. What is most likely happening is the acupuncture is
stimulating the vagus nerve, which can induce peristalsis. More evidence that
this is what is happening showed up in a 1996 article that showed gastric acid
secretion enhancement in rats after stimulation of ST-36, but not in rats that
had their vagus nerve removed. If there’s not vagus nerve to be stimulated, the
ST-36 point has no nerve to directly stimulate.
The final findings of this articles talked about how frequencies
in electrical stimulation (electro-acupuncture) is much more effective than the
actual placement of the needle; most likely due to the electrical current
traveling to and along the vagus nerve. This was confirmed in another study
that told how many irrelevantly placed needles can cause a broad array of
physiological effects, “although perhaps to a lesser degree.” The “lesser
degree” is likely due to the proximity of the needles the nerve pathways.
The article ends on a couple of things that require more
research:
(1) Are the effects amplified by the number of needles inserted?
(2) Does more intense electrical stimulation amplify the effects?
(1) Are the effects amplified by the number of needles inserted?
(2) Does more intense electrical stimulation amplify the effects?
I have to say- I would have never expected ANTI-inflammatory
actions coming from acupuncture, but this article sure made a believer out of
me.
I actually feel that this article really goes to show that
we need to further explore our methods of treatment in the medical field.
I hope you all enjoyed the article as much as I did.
What do you think about acupuncture as an anti-inflammatory? What about acupuncture as a different kind of treatment?
Would you try it? Why or why not?
Original article can be found online at: http://ict.sagepub.com/content/6/3/251.full.pdf+html
What do you think about acupuncture as an anti-inflammatory? What about acupuncture as a different kind of treatment?
Would you try it? Why or why not?
Original article can be found online at: http://ict.sagepub.com/content/6/3/251.full.pdf+html
One of the things that struck me when I was studying in China was how heavily they still rely on Traditional Chinese Medicine, including acupuncture. One of the provincial hospitals that I went to had a whole building devoted to it, full of patients. I believe that the evidence presented in the article you reference is compelling, and goes a long way towards getting a more "scientific" way to explain why so many people have success with acupuncture.
ReplyDeleteAs to your question "would you try it", I think I probably would if I was in enough pain. I've seen it done on multiple people and it's true that the needles are very small and the recipients appear to be in no pain (or at least, less than when they started). While I'm wary of trusting most TCM techniques, I think acupuncture is one that has a lot of promise.
I feel the same way about acupuncture and Traditional Chinese Medicine, as well. I would certainly be wary of most of it, but after reading this article, I am much more comforted by the idea of acupuncture.
DeleteHaving never been to China, I wasn't really very aware of how relevant TCM still is, so thank you for sharing that. This article really makes me wonder, if we look at more acupuncture pathways, how well they would line up to other nerve pathways. Having been such an early technique, it's really quite incredible that they were able to find entire pathways that were effective in treating pain and inflammation.
I am really curious to see other studies of other types of traditional cultural medicine.
I always found acupuncture interesting and wondered if it actually did something. It probably does have some sort of effect if the Chinese culture has been doing it for many many years. The article also presents a lot of information on how it works and the different pathways. I think its definitely something to look more into and I think that if I were in a lot of pain I would definitely consider trying it to see if it helped. I would rather try that before turning to medicine or other treatments. It would be interesting to see much more studies being done on traditional medicines.
ReplyDeleteMy personal thoughts on acupuncture before reading this article was that- it has probably been around so long because it's part of Chinese culture and culture is a lasting thing; also, it being a cultural act, it was more likely to yield a placebo effect on individuals that hold onto Chinese culture. That's why I was so impressed with this article pointing out that the stomach and spleen acupuncture pathway was so similar to the vagus nerve pathway. There's more than a mere placebo effect to acupuncture; there is a science to it. I really do hope that this sparked more research into different types of traditional medicine.
DeleteI enjoyed reading this interesting article particularly because it related to my cultural heritage. My family emigrated here from China around 20 years ago but still holds true to traditions and ancient beliefs, especially in regards to medicine. I have been introduced to many different types of traditional Chinese medicines including acupuncture and cupping therapy. Cupping therapy is using heat and flames to induce suction within a glass cup and placing it on the body that needs treatment. This is supposed to increase blood flow, or as Chinese believe, to suck out the toxins in the body that cause the illness. A few of my family members have been treated with acupuncture and my grandparents continue to practice cupping therapy because their ailments have been lessened by the treatments. For most people in China, traditional and herbal medicine is commonly preferred because it has little or no negative effects on the body. I believe that acupuncture and cupping therapy provide certain benefits that are unattainable by western medicine and I would try them if I did not have a fear of needles.
ReplyDeleteThat's very interesting!
DeleteI actually have thought a lot about how traditional medicine and treatment has little to no negative effects and, after research, I would be very apt to try something along the lines of acupuncture or other types of traditional medicine. Again, I wouldn't go ahead and do the first traditional treatment that I found, but I would do some research and choose because I feel that, even if the treatment doesn't work, how bad can the effects be? In terms of acupuncture, it sounds like they have it down pretty well. I suppose the worst thing that one should worry about is what other nerve pathways may be getting activated during therapy. In that case, it might be wise to do a little bit of research on the acupuncture pathways you're planning on getting and comparing them with nerve pathways, if that makes sense. I just wouldn't expect that the efferent vagus nerve pathway is the only pathway capable of being activated through acupuncture when we have plenty of other nerves. Also, in the article, they stated that the ear was specifically the best way to activate the vagus nerve pathway, so it sounds like there is potential to reach other nerve pathways through acupuncture on different parts of the body.
I said this in class, but I'm all for acupuncture! Not that I've tried it...but I've seen many of my friends and family go through with it to take care of any active pain. In Asian cultures, acupuncture is definitely not a new or bizarre technique. I've seen fellow Koreans (especially the elderly!) go straight to acupuncture to care for an injury before even going to the hospital. There are sub-styles of the acupuncture system that target specific complaints, which I think is really interesting (and could use some more research!)
ReplyDeleteI think it's promising that there has been more and more American/Western research done on Eastern medicine. It shows that our country is going through change and that perhaps we are shifting to more natural remedies and even trying out exotic procedures in order to find what's best tolerated by our bodies. From what I have seen, acupuncture has worked well for the Asian population, and they have yet to abandon this method of healing. I think it would be astonishing if we could incorporate this type of healing in Western medicine.
I, too, really like seeing western research in different types of traditional treatments. Before, I always just saw traditional treatments as a way for people to feel like they were doing something about their ailments - especially, because of how old the treatments can be - and really just getting a placebo effect. After reading this, I really feel that all types of traditional medicine needs to be researched to see what physiological mechanisms could be behind them. I really never would have expected inserting tiny needles into one's skin would cause an anti-inflammatory response from the body, but the mechanism explained in the article makes sense. Not only that, but I feel that something like acupuncture, the idea of inserting needles to cure an ailment, would not have become such a practiced and precise act if it didn't really have any beneficial effects. I can only imagine the tireless trial-and-error research that must have been done 8,000 years ago to try to perfect such a act without having an understanding of the mechanism by which it was it working.
DeleteFor some reason I've always been fascinated with acupuncture! I've never tried it, probably because I've never felt the need for it, but I'm sure I wouldn't hesitate to try it if it came down to it. After reading this article I actually believe that it could be a good way of treating inflammation. Regardless of the mechanism, if it works then it works!
ReplyDeleteThere are many 'weird' potential treatments that we've coming across this semester like the bee sting therapy or the sniffing of stem cells, and we've concluded that 'desperate times call for desperate measures'. But to me, this isn't really something I would categorize in the 'desperate' treatments. Acupuncture has been around for SO long and sure, the thought of getting stuck by needles doesn't sound appealing, but if done correctly it shouldn't be uncomfortable, rather be therapeutic instead. All in all, yes I see it as a good alternative measure for treating inflammation, and yes I would definitely try it.
I remember talking about acupuncture a long time ago and the theory was that the tissues around the treated acupuncture gets flooded with adenosine, a chemical that provides relief by preventing pain signals from reaching the brain. This biochemical blockade reduced the animals’ discomfort. The scientists say the pain relief stems from the body’s natural response to minor tissue injury. However, a bit of a placebo effect could also be accompanied with the treatment.
ReplyDeleteI also remember my friend's mom tried acupuncture to relive some of the nausea and vomiting from chemotherapy. I believed it helped, but my guess is the relief lasted for a few days. Anyway, I tried to find some articles on the mechanism of adenosine release but I could only find one. It seems that the research is still in its early days, and one paper isn’t enough body of proof required to prove this mechanism. Still it was interesting, here is the link:
http://www.ancientacu.com/custFiles/files/Acupuncture.pdf
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