How was acupuncture scientifically tested

Acupuncture: pricked well

The systematic canon of pricking and burning ": The title of the first Chinese work on acupuncture sounds rather rabid. In the 3rd century AD, Huangfu Mi described several hundred points on the body that should be pricked with fine needles in order to achieve a certain effect To date, not very much has fundamentally changed. Numerous studies suggest that the millennia-old healing method from traditional Chinese medicine (TCM) works with certain symptoms. But how it works exactly is not fully understood - and that continues to cause skepticism on the part of many orthodox doctors.

Since 2007, all statutory health insurance companies have only covered the therapy costs for chronic knee joint pain and chronic back pain. Meanwhile there is also a lot of evidence that acupuncture can be an effective remedy for tension headaches and migraines, for nausea and vomiting after operations and chemotherapy, as well as for hay fever.

Blocked life energy

TCM explains symptoms of illness with the fact that the life energy Qi can no longer flow freely in the body. Its channels, the meridians, are blocked, causing a symptom or illness. These blockages would be released by means of the targeted needle pricks in certain points. Symptoms subside and at best go away. According to TCM, 361 of these points are distributed over the entire body: on the face, arms, hands, legs, feet and trunk. But why should the needles be set exactly there? And what happens at the puncture sites and from there in the organism?

"At the end of the 1980s, a German anatomist dissected all 361 acupuncture points as described in the body atlases," explains Dr. Jan Valentini. The specialist in general medicine and acupuncture heads the complementary and integrative medicine team at the Tübingen University Hospital. "The result: They very often lie over gaps in the fascia. There are vascular and nerve bundles, many free nerve endings that can pick up signals, and a high density of tactile bodies." These anatomical and histological properties are well examined and visible under the microscope, says Valentini. In addition, the conductivity of the skin is significantly greater in the areas described.

A firework of messenger substances

If a needle is inserted there, something similar happens to what happens when you cut yourself: "For example, histamine, nitrogen monoxide, adenosine and substance P are released - a real firework of messenger substances starts," says Valentini. Among other things, these locally cause the vessels to widen and provide better blood flow. "The messenger substances also dock at synapses, i.e. nerve transmission points, so that signals are sent via the peripheral nervous system to the spinal cord and from there on to the brain," explains general practitioner Valentini. The existence of the meridians as energy channels, however, has not yet been proven. In the meantime, TCM experts are also increasingly questioning them.

"You have to take into account that some of the TCM concepts arose before our era," explains internist Professor Gustav Dobos, who heads the specialist clinic for naturopathy and integrative medicine at the Essen-Mitte clinics. "They are based on a completely different anatomical or scientific understanding that we have to adapt today." As a professor of naturopathy at the University of Duisburg-Essen, he researches how experience-based traditional healing systems such as TCM can be converted into evidence-based medicine on the basis of scientific testing.

The stitch alone works

"In research, for example, we have come to the conclusion that the action of an acupuncture needle - pricked at any point - triggers a pain relief process in the body," says Dobos. There is much to suggest that this process reacts to diffuse stimuli, i.e. that it is only partially linked to special acupuncture points. "This phenomenon can be paraphrased as 'pain inhibits pain'", says Dobos: "New pain stimuli are differentiated from old ones, and the already known ones are thereby weakened." So he meets the main criticism of acupuncture opponents who consider the effectiveness of the application to be a pure placebo effect.

Because at the beginning of the 2000s, the large-scale German Art and Gerac studies compared acupuncture with so-called sham acupuncture. Here needles were placed at "wrong" points on the skin - and still achieved similar effects as the traditional treatment.

Acupuncture works stronger

Nevertheless: Due to their special characteristics, there is usually a stronger reaction at the acupuncture points described, says Valentini. More recent studies have also shown this using functional magnetic resonance imaging: areas of the brain activated by real acupuncture are larger than those from sham acupuncture. "In addition, today we speak less of acupuncture points measuring millimeters than of acupuncture areas," he adds.

Because sham acupuncture for migraines and headaches also achieved good results in the two studies, the health insurance companies still do not cover the costs, criticizes Dobos. Acupuncture is very successful in the treatment of migraines and headaches - especially episodic tension headaches. "An update published in the Journal of Pain in 2018 on the effects of acupuncture on chronic pain describes a lasting effect that goes beyond a pure placebo effect," says Gustav Dobos. "Another important point is that it has significantly fewer undesirable effects than the sometimes heavy medication and at the same time is not addictive." According to the Cochrane Review, updated in 2009, acupuncture is a valuable non-pharmacological therapy option and at least as effective, possibly even more effective, than prophylactic drug therapy.

Millennia of experience

According to Valentini, the challenge is this: "In drug research, the exact causes of the disease are often known. The remedies are constructed hypothetically for a certain key function and then tested." With acupuncture, on the other hand, there is 3,000 to 6,000 years of practical experience. "For them we are looking for the underlying theory and the exact mechanism of action."

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