Using Acupuncture in Practice: Taking a Contemporary Neurological and Physiological Perspective

A local surgeon stood in my office in obvious distress. He and I have been casual friends for many years. He had come to see me once before, several years ago, about neck pain. He recalled that the treatment had been helpful, so this time when he had severe lower back pain he again sought my care.

I invited him to sit in my consultation room. "If you don't mind, I'd rather stand," he replied. "I can sit down, but it hurts so much to stand again I have learned to avoid sitting."

He told me he had been in pain for more than three weeks. After a few days he had seen a local respected neurosurgeon and had been told that his lower back pain would "go away after six weeks." He had been taking 600-800 mg ibuprofen three times per day. The medication helped, but obviously didn't help enough. He was avoiding taking anything else that might impair his surgical skills.

He said, "I don't want to wait another three weeks. You helped me before. What can you do to help?" Examination revealed a sacroiliac joint sprain and strain to the gluteus maximus muscle origin along the sacrum and ilium. Palpation along the line of the injury evoked sharp pain that made him writhe to avoid the pressure of the palpating hand.

I explained what I had found and told him I would recommend manual therapy and acupuncture, to be followed next week by manipulation. He agreed, saying, "Do whatever you think is best. That's why I am here."

I proceeded to perform manual procedures to reapproximate the tissues and reduce the accumulation of the inflammatory fluids, gradually increasing the intensity of pressure. I limited this to about a minute. I followed this with the insertion of two 5 cm acupuncture needles using clean needle technique.

The first needle was directed medial-inferior along the outer border of the sacrum toward the coccyx. It was withdrawn after about 10 seconds. The second needle was inserted at the center of the most tender aspect of the gluteal muscle and then withdrawn almost out of the tissue, then pressed into the muscle again from a different angle. This process was repeated four times without total withdrawal until the last time. This needle was in the tissue for less than a minute.

I asked him to stand and then squat. He did so with ease. I asked him to sit on a very low bench in the room. He sat there for about three minutes before I asked him to stand. He did so with no sign of pain.

I asked him if this procedure would have previously been painful. "It would have killed me, if I could have done it at all," he responded. I followed up with electrical stimulation and advice to apply a cold gel pack five times during the following 24 hours. He made an appointment to see me next week.

I called his cell phone the next day to follow up. I asked how he was feeling. "I am in Mississippi cycling with my son-in-law!" he laughed. "We were just talking about you. This is amazing. I feel great. I have no pain at all. Thank you for helping me. I'll see you Tuesday!"

This story, or one like it, could be told by thousands of chiropractic physicians who have learned various methods to resolve pain and initiate healing in acute situations. The fact that this patient was a surgeon and our conversation in the exam room is the part that is relevant to this article.

He had seen me perform similar treatment with a similar outcome several months previously on the very son-in-law he was visiting. In that case, it was a cervical spine issue, but the treatment and results approximated this experience.

After his treatment, he asked me, "How does that work?" He wasn't asking me if it worked. He was sincerely asking for an explanation of the mechanism of action; something that he would understand from his perspective.

Had that been your patient, how would you have responded? For those of you trained in acupuncture, would you have addressed his question couched in traditional Chinese medicine (TCM) terms? Would you have begun with a description of energy meridians that course unseen throughout the body, weaving in and around the various organs, rising to the surface to follow theoretical pathways along an extremity until they synapse with another meridian? Would you have advised that his chi was stagnant, deficient or otherwise impaired? Or would you have conversed in terms of connective-tissue injury, inflammation cascade, gate-theory of nerve blockade, neuromodulation effect of needle insertion, healing response to micro-injury or some other more neurophysiologically based response?

Across the country, thousands of chiropractic physicians and other Western-trained specialists have taken postgraduate courses in acupuncture and are using it daily. Many Dynamic Chiropractic readers have already taken acupuncture courses or soon will be. These courses are taught primarily from a TCM perspective.

The topics included in the courses involve the location of acupuncture points, the nature of chi, meridian pathways and the characteristics of these mysterious meridians, organs (representing philosophical aspects of the meridians that are associated with the organs, not the anatomical organs themselves), energy patterns, tongue and pulse examination, meridian imaging, and understanding the philosophy that was prevalent during the ancient era in China as acupuncture was being developed.

In spite of the fact that chiropractic physicians are educated in contemporary neurological and physiological aspects of human function, only minimal attention is given to attempting to understand the effects of acupuncture from a scientific perspective. Meanwhile, physiology dominates the courses that some physical therapists, chiropractors and others are taking in a procedure known as dry needling. Dry needling involves inserting acupuncture needles into particular points of the body corresponding to locations of specific neurological loci.

Regardless of what the therapy is called, acupuncture needles stimulate nerve endings that send impulses up ascending tracts, eventually reaching the central nervous system. In various brain centers, synapses occur that modulate the secretion of hundreds of neurotransmitters. This neuromodulation results in the activation of processes that affect energy production and cause effects such as decreased pain perception, restoration of hormone regulation, mood and alertness, regulation of digestive processes and many other physiological processes.

I use acupuncture techniques daily in my practice. I have two rooms in my office reserved solely for acupuncture treatment. Acupuncture is just as important in my daily work with patients as are chiropractic procedures. In most cases, when I am treating patients with acupuncture techniques I am focused on Western physiological thinking, rather than TCM philosophical thinking. I have found that adding to my understanding of the neurological and physiological aspects of acupuncture is much more productive in the course of operating a busy practice than trying to ground myself in ancient TCM philosophy.

In some cases, however, I assess the patient primarily from a more traditional perspective. I find that it is still useful to sometimes treat patients based on traditional acupuncture methods. From my perspective, both approaches (traditional and contemporary) are valid tools to help the clinician treat patients.

This discussion is not intended to be critical of those who choose to continue to practice acupuncture based completely on the traditional TCM tenets. Acupuncture treatment can be extraordinarily effective if practiced from a number of perspectives. However, I have spoken with many chiropractors who have abandoned acupuncture or have become frustrated as a result of trying to adapt to a system of evaluation and treatment that is not based on the function of the human body as they know it from their years of study.

It is time for our discussion of acupuncture to include a viewpoint from a contemporary Western physiological basis while continuing to respect and value the ancient traditions. This article is intended to initiate that conversation.

Author's note: The next article in this series will discuss three primary neurological responses to acupuncture stimulation. Understanding these responses can enhance the outcomes of your clinical treatment.