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During my thirteen years as a physician specializing in acupuncture,
I have come to expect my patients' most common question: "How does
acupuncture work?"
How
strange! They never ask how aspirin works, even though no one can give
a satisfactory answer WHY aspirin works! They never ask how digitalis
works on the heart. They know it works by slowing down the rate of
beating and increasing its force, but its exact mechanism remains a
matter of empirical conjecture. No one asks how adrenaline works or
cortisone or any medicine; yet, everyone asks, "How does acupuncture
work?"
I
believe their intention in asking is twofold. One: The questioner simply
accepts that a modern medicine works, but he or she wants to know how
acupuncture works to satisfy their curiosity. Acupuncture seems "mysterious."
Second: They think the doctor of acupuncture must know how it works.
By asking this "sacred" question," they are giving the doctor the chance
to "redeem" himself with the answer.
Following
are three ways I have found of answering the question.
1.
We can answer in the traditional Chinese way, by explaining how energy
travels along meridians, what meridians are, what acupuncture points
are, all about "Chi," how pulse diagnosis is used, how energy flow
transmits at the periphery of arms and legs from one meridian to another,
how poetic five-element theory works, etc., etc.
Do
they appreciate what they hear? Not usually! Confused, shaking their
heads, most say, "I don't really care HOW acupuncture works, as long
as it helps the pain in my back!" At least, they are very appreciative
patients, who only asked this question out of respect for the doctor.
But
if the questioner happens to be a modern medical doctor, the reaction
can be entirely different. He doesn't even finish listening; but just
says, "By God! Acupuncture is the biggest fake..." and lumps the acupuncturist
with others he considers charlatans. In this way, some modern medical
practitioners attempt to put acupuncture down, without even trying
to understand it.
2.
Another way of answering, "how does acupuncture work?" is to explain
my Mediator Theory (1, 2, 3) in
the easiest way possible. Stimulating the acupuncture point with a
needle transmits a signal to the portion of the brain, especially the
hypothalamus, where signals by acupuncture are interpreted and decoded.
Newly found messages are sent to Mother Nature, that is, our own body's
defense mechanism, through the autonomic nervous system. This in return
enhances the natural healing process of the body to relieve pain and
help cure the disease.
Happily,
half the patients understand this theory. They will say, "Ah, acupuncture
helps our natural healing power. I thought so! That's the only way
to go... without drugs! Thanks, Doctor!" Or they may say, "You mean
it works through nerves?" When I reply, "Yes, through involuntary nerves,"
they grin and say, "Well, I'll be damned! Thanks, Doctor. I thought
so!"
3.
Recently I have found another effective answer to "How does acupuncture
work?" The answer is simple: "Acupuncture works-like a computer!" At
this, the patient nods approvingly and says, "Works on nerves, huh?"
I say, "Yes." And would you believe, many seem to understand how a
computer works. This is what sparked my interest in explaining that
"Acupuncture Works Like a Computer."
In
some ways, my new theory resembles the Mediator Theory, (1,
2, 3) already mentioned in the second answer to the question
under discussion.
A
computer recognizes the "bit," which is short for binary digit. It
can have only two possible values - 0 or 1. All data (letters, numerals,
symbols) handled by computers are digitalized and expressed as combinations
of bits - 0 's and 1's. Another way of expressing this is (-) or (+),
negative or positive, or Yin and Yang.
However
complex the computer appears to be, it boils down to a byte which contains
eight bits of information. A byte is to a bit what a word is to a letter
--- the tiniest unit of memory. It then becomes apparent that inserting
a needle into an acupuncture point is like typing on a computer keyboard.
Signals given at a local point will be transmitted to the hypothalamus
instantly, through different routes, as will be explained.
The hypothalamus contains the memory bank of the autonomic nervous
system. There, signals from the peripheral nerves are decoded, requiring
a positive or negative electronic interchange, signaling back the body's
defense mechanisms to adjust its balance.
Sutherland's
great discovery of 3',5'-adenosine monophosphate and its role as "second
messenger" mediating hormone, epinephrine and again the recent discovery
of 3',5,-guanosine monophosphate by Goldberg, et al., and its possible
role as "second messenger" mediating acetylcholine action, were fortunate
findings; these two opposing cyclic nucleotides may be the second mediators
of acupuncture, acting in a "push-pull" fashion. This seems to fill
the gap of a "Yin and Yang" concept of acupuncture.
Local
tissue injury will set off a chain of events. It will first produce
chemical mediators of local tissue injury, e.g., histamine, kinin,
prostaglandin E, and 5- hydroxytryptamine. These chemical mediators
will then signal the autonomic nervous center and hypothalamus via
the humoral autonomic nerve reflex route. Depending upon the tones
of sympathetics and para-sympathetics, either adrenergics or cholinergic
receptors of target organs or immunological receptors are activated,
through sympathetic neurohormone (catecholamine) and para-sympathetic
neurotransmitter (acetylcholine). This varies the amount of either
cyclic AMP or cyclic GMP intracellularly, and suppresses or aggravates
the immunological assault of tissue injury.
At
the same time, an increased amount of circulating epinephrine, coinciding
with the "alarm reaction" of Selye, followed by an increased amount
of corticosteroids in accordance with Selye's "state of resistance,"
will find its way toward the target organ or cells, and influence the
intracellular level of cyclic AMP, thus inhibiting the release of histamine
from mast cells, stabilizing cell membrane and lysozyme and bringing
immunological assault under control.
It
is not too far-fetched to compare the events occurring during an acupuncture
treatment to computer analogy.
References:
1.
Kim, S.S.: Acupuncture Mode of Action in Migraine Headache. Amer. J.
Acupuncture, Vol. 3. No.2, April-June 1975, pp. 108-114.
2.
Kim, S.S.: Mediators of Acupuncture. Amer. J. Acupuncture, Vol. 4.
No.1, Jan.-March 1976, pp. 25-32.
3.
Kim, S.S.: The Mediator Theory of Acupuncture and Its Practical Application
in Bronchial Asthma and Myasthenia Gravis. Amer. J. Acupuncture, Vol.
9. No.2, April-June 1981, pp. 101-116.
This
article was originally published in the American Journal of Acupuncture,
Vol. 14, No. 2, April-June 1986.
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