Acupuncture:

New and Old Concept for Healthcare

Chong-Bin Zhu, PhD, OMD, LAc

Associate Professor
Vanderbilt Center for Integrative Health
Nashville, TN 37203

April 25, 2014

What is Acupuncture

• is one of the key components of

traditional Chinese medicine (TCM)

• is a family of procedures to stimulate

points on the body (acupoints)—most
commonly is the insertion of thin, solid metallic
needles.
• is intended to remove blockages in the
flow of energy (“Qi”), restore and
maintain health
• is with thousands of years’ history
 Types of Acupuncture

Classical Electroacupuncture Laser

acupuncture acupuncture

Cupping Acupoint Moxibustion

injection
 Acupuncture: A New Concept for
HealthCare in US
Acupuncture?
…never heard of
it
Current health care:
”mainstream” medicine—
Conventional or Western Medicine

 Prevention: vaccination, isolation…

no acupuncture
 Diagnosis: Not use TCM method

 Treatment: Not include as a routine method

 Healing: Not include as a routine method
 Insurance: No cover for prevention, no cover for acupuncture
Acupuncture: An old Concept for
HealthCare in the East
How Old Is Acupuncture?

Bone needles

“Bian” Stone and

Bone needles
New Stone Age 5000BC

New Stone Age

5000BC 6
Acupuncture: An old Concept

Ancient Needles Modern Needles

Gold needle

Silver needle 7
Han Dynasty, 200BC-220AD
 Acupuncture: An old Concept for
HealthCare in the East

• Acupuncture is a key component of traditional

Chinese medicine (TCM)
• TCM had been a main healthcare system for
thousands of years before western medicine
introduced
 Prevention: Diet, herbal remedies, qigong, acupuncture,
TuiNa…
• Diagnosis: Use all TCM methods: yin-yang, tongue, pulse,
Meridian, five elements…
 Treatment: Acupuncture, moxibustion, herbal remedies,
TuiNa, Diet, qigong …
 Healing: All TCM modalities including acupuncture
 Insurance: Cover All TCM modalities including
acupuncture
What Is Traditional Chinese Medicine (TCM)

A whole medical system that originated in China. It is based on

the concept that disease results from disruption in the flow of
qi and imbalance in the forces of yin and yang. Practices
including acupuncture, herbs, meditation, massage, and diet
seek to aid healing by restoring the yin-yang balance and the
flow of qi. --NCCAM
• A medical system with 3,000+ year’s history for prevention,
diagnosis, treatment and rehabilitation of illness
• Holistic perception of mind, body, health and
diseases
• Unique terminology and medical theories

• Individualized (personalized) medicine

• Comprehensive plan for healthcare
Comparison of East & West

East West
 Empirical  Scientific Method
Observations over & Case-Based
Thousands of Medicine
Years  Technology of
 Art of Medicine Medicine
 Holistic View  Molecular and
 Circular Logic Organ View
 Energetic  Linear Logic

 Mechanistic 10
 Modalities of TCM

 Acupuncture, moxibustion and cupping

 Chinese Materia Medica and Prescription:
1. Botanical Sources -Herbology
(root, stem, bark, leaf, flower, fruit and seeds)
2. Zoological sources
( antilope/buffalo horn, chicken gizzard membrane,
musk, turtle shell, oyster shell etc.)
3. Mineral- (Gypsum, mirabilite, borneol, cinnabar, etc.)
 Tui Na/Body manipulation (massage, acupressure,
corrective manipulation)
 Qigong/Tai’Chi
 Diet/nutrition
Traditional Chinese Medicine

Alimentotherapy
 Basic Principles of TCM

• Ying-Yang
• Qi, Xue (blood), Jing
(Essence), Ye (body fluid)
• Zang-Fu (Internal Organ)
• Maridian (Channel)
• Five element
 •The Tao of Universe

Yin-Yang •The principle of all matters

•The parentage of all change
•The origin of birth and death
--Su Wen

The Tao is the One,

From the One come Yin and Yang;
From these two, creative energy; lLight/Bright/Sun
Strong/Assertive
From energy, ten thousand things; Dry/Hot/Fire
Male
The forms of all creation. Positive Charge
Heaven
Spring & Summer
All life embodies the yin Dark/Moon
And embraces the yang, Recessive/Nuturing
Damp/Cold/Water
Through their union Female
Negative Charge
Achieving harmony. Earth
Fall & Winter

--Tao Te Ching, C42

Yin-Yang
• Concept describing how things function in relation to each
other and to the universe
• complementary opposites as parts of whole

Yin-Yang balance Yin-Yang imbalance

Yin Yang
Yin Yang Yin Yang

Yin-Yang relationship:
• Opposition
• Interdependence
• Mutual consumption
• Inter-transformation
 Application of Yin-Yang

YIN YANG
•Structure of human body front, interior back, exterior
•Physiology structure function
•Pathology hypo-function hyper-function
•Diagnosis exterior, heat, excess interior, cold, deficiency
•Chinese medicine cold/cool, sour, salty, bitter hot/warm, pungent, sweet
•Treatment replenish Yin/Yang deficiency, reducing excessive heat or
fire with cold drug; treating excessive cold with warm drug
Application of Yin-Yang
Eat balanced

Yin
Yang
Application of Yin-Yang
Keep fit physically and mentally

Yang Yin
 Brain Yin-Yang

Yin Yang Stress

Chemicals Chemicals Nicotine

GABA Glutamate
Glycine NE
5-HT Ach
DA Adenosine
Endorphin Testo-
Estrogen sterone
Melatonin
…

Yin Yang

Sleep/memory Yin-Yang Balanced Imbalanced

 Qi (Chi 气)

Qi --life energy, moving force (Yang)

Types of Qi:
Origin: Yuan Qi (prenatal-parents),
Zong Qi (postnatal-breathing),
Ying Qi (nourishing Qi-food)
Wei Qi (defending Qi-food)
Structure: Zang-Fu Qi (Qi of internal organ)
Meridian Qi
Function of Qi: Promoting, defending, warming,
consolidating and governing, “Qi Hua” (metabolizing
and transforming)
Meridian Systems--Pathways for “Qi”
Flow & Links of All Systems

• 14 regular meridians
• All acupoints distribute
along meridians
• Bridge in and out of the
body
• Reflect patho-
physiology of the inside.
• Guide the treatment

Lung meridian--yin LI meridian--yang

Meridians
 Where there is no free flow
(blockage), there is pain.

Pathogenic factors
Meridian

No free flow
(blockage) Pain

22
Meridians

 Where there is free flow, there is

no pain. No free flow Pain
Pathogenic factors (blockage)

Meridian

Acupuncture Stimulation
Eliminating

Meridian

Normal 23
 Zang-Fu (脏腑)--
Internal Organs
Functional systems, not pure anatomical ones

Five Zang Six Fu Extraordinary

(Yin organs) (Yang organs) Organs

Liver (Gan ) Gallbladder Brian

Heart (Xin ) Small intestine Medulla
Spleen (Pi ) Stomach Bone
Lungs (Fei ) Large intestine Vessel
Kidneys (Shen) Bladder Gallbladder
Three warmers Uterus
Mind-body connection
 Heart (心):
The monarch of all organs

• Controls blood and

vessels
• Houses mind and governs
mental activity
• Controls sweat
• Opens into tongue
• Manifests in complexion
 Kidneys (肾):
Root of life, Root of Yuan Qi

• Store Essence and govern birth,

growth, reproduction and
development
• Produce marrow, fill up brain
and control bones
• Govern water
• Control reception of Qi
• House Will power,
• Open into ears and manifest in
hair
 Liver(肝): The general of
organs from whom the strategy is
derived

•Stores blood,
•Ensures smooth flow of Qi and blood
•Houses Ethereal Soul
•Regulating mind and mood
•Promoting digestion and absorption
•Controls sinew
•Opens into eyes
•Manifests in nails.
Peak time for each organ

Breakfast

28
Five Elements

Anger/Anxie
Wood ty

Water Insomnia
Fire

Poor appetite

Short breath
Metal Earth
Urination
disorder
29
Five Elements

30
 Acupuncture:
What Conditions Commonly Treated

• Health maintenance and promotion

• Prevention—boost immune function, anti-aging, anti-oxidation…
• Complement to western medicine
• Therapeutic—
-- Chronic pain (headaches, joints, back, neck, sciatica, TGN,
TMJ, arthritis pain…)
-- Emotional/mental conditions (stress, anxiety, depression,
insomnia)
--PMS, dysmenorrhea; menopausal syndromes; fertility
--GI dysfunction
--Cardiovascular conditions
--Respiratory ailment (sinus allergy, asthma)
--immunological/endocrinological conditions
• Others—sport injury, military use, cosmetic
Acupuncture:
What Conditions Commonly Treated

WHO: recognizes acupuncture's common use in treating

over 100 conditions.
Acupuncture: review and analysis of reports on
controlled clinical trials
(WHO:
http://www.who.int/iris/handle/10665/42414 ,
2002 )
Randomized controlled trial
studies
Individualized Treatment with
Acupuncture/TCM
Insomnia
YIN YANG
Patterns: Heart/Spleen deficiency Liver-qi stagnation
Symptoms: Excessive dream, hard to Excessive dream, hard to fall
stay asleep, fatigue, poor asleep, irritation, bitter taste,
memory, dizziness, pale headache, impatience, red tongue
tongue with thin coating, with yellow coating, string-pulse
fine and weak pulse
Treatment: Replenish heart and spleen Promote liver qi

Patterns: Yin deficiency Liver-fire

Symptoms: Excessive dream, hard to Excessive dream, hard to fall
stay asleep, fatigue, poor asleep, irritation, bitter taste,
memory, dizziness, red headache, impatience, thin/yellow,
tongue, weak thin pulse coating, rapid string-like pulse
Treatment: replenish Yin Clear up liver fire
How Does Acupuncture Work?

From TCM perspective:

•Unblock meridian
•Enhance “Qi”
•Modulate “Zang-Fu”
•Optimize “In” and “out”
•Balance “Yin-Yang”

From biomedical perspective:

•Improve local condition
•Regulate nervous system
•Modulate neurotransmission
•Enhance immune function
•Regulate endocrine activity
•And more…
Overview of Acupuncture Action
--Peripheral Nervous system

– A-delta fibers – smaller, fast

transmitting, myelinated fibers
that transmit sharp pain
– Mechanoreceptors –
Triggered by strong
mechanical pressure and
intense temperature
– C-fibers – smallest, slow
transmitting unmyelinated nerve
fibers that transmit dull or
aching pain.
– Mechanoreceptors –
Mechanical & Thermal
– Chemoreceptors –
Triggered by chemicals
released during
inflammation
– A-alpha/beta fibers – large
diameter, fast transmitting,
myelinated sensory fibers
Overview of Acupuncture Action
--Central Nervous system
 Overview of Acupuncture Action
--Central Nervous system

Thalamus:
•The sensory switchboard
of the brain
•Located in the middle of the brain

Somatosensory Cortex:
Receives all info on touch and pain. Somatotopically organized
Overview of Acupuncture Action
Yin Yang

Soft
tissues
nerves
Glands

Heart & vessls

Yin Yang lungs

liver

Endorphines
, IL-1 Kidney/bladder

GI

Acupuncture
Adapted from Benarroch 2008
At the tip of a needle—local
improvement

Connective tissue stretches

by physical extension(1)
or acupuncture (2)

Fibroblasts enlarged &flattened

Rho signaling (3)

ATP release

Change cell shape Cell focal adhesion

Analgesic effect 4) Remodeling (5)

Connective tissue
relaxation Langevin HM, 2013
Acupuncture modulation on HPO/HPA axis

A-β & δ fibers

Yu JS et al: International Review of Neurobiology, 2013

Acupuncture modulation on HPA axis

Spinal Cord

Acupuncture
A-β & δ fibers
Zhu CB, 2013
Neuroendocrine modulation of blood
pressure by acupuncture

Zhou and Longhurst 2012

Acupuncture modulation on affective disorder via
immune system and central 5HT,NE and DA

Immunological Stress
(viral, bacterial, chemical..) IL-1 IL-1R

p38 MAPK/ERK

Acupuncture
Midbrain SERT, NET and DAT

Altered 5HT-NE-DA homeostasis

Increased risk for

affective disorders
Zhu CB, 2011
Acupuncture and Pain
Gate Control Theory
Proposed by Melzack and Wall in the 1960's

Acupuncture

Yin Yang
Acupuncture and Pain
Gate Control Theory
Proposed by Melzack and Wall in the 1960's

Acupuncture
closes the gate
 Conditions that open or close the gate

Conditions that open Conditions that close

the gate the gate

Physical Extent of the injury Medication

conditions
Inappropriate activity level Counter stimulation, eg
Acupuncture, massage

Emotional Anxiety or worry Positive emotions

Conditions
Tension Relaxation

Depression Rest

Focusing on the pain Intense concentration or

Mental conditions distraction (meditation)

Boredom Involvement and interest in

life activities
 Acupuncture and Pain
Molecules involved:

• endogenous opioid
•CCK
•5-HT
•DA
•NE
•IL-1
•GABA
…

Evid Based Complement Alternat Med. Jun 2004; 1(1): 41–47.

 Acupuncture and Pain
Opioidergic Mechanisms for Analgesic Effect of
Acupuncture

Han JS, 2003

 Acupuncture and Pain
Acupuncture up-regulates opioid receptor

Zhu CB, 1995

 Acupuncture Analgesia

 Enkephalins & Dynorphins  Spinal

Cord (Substantia Gelatinosa)

 Endorphins  Brainstem (Periaqueductal

Gray Matter)

 5HT  Brainstem (Raphe Nuclei)

Acupuncture and Pain

Neurotransmitters in hippocampus Zhu CB, 1995

 Imaging Studies on Acupuncture
Systematic review and meta-analysis

Activation: information processing and control centers--

supramarginal gyrus (language center), SII, pre-supplementary
motor area (pre-SMA), middle cigulate gyrus, insula, thalamus,
precentral gyrus

Deactivation: limbic system—amygdala, hippocampus, vmPFC,

posterior cingulate cortex (PCC).
Huang et al. 2012
Imaging Studies on Acupuncture
“Deqi” deactivation of brain

Asghar, MacPherson et al. Brair Res 3 1 5 ( 2 0 1 0 ) 1 1 1 – 1 1 8

Imaging Studies on Acupuncture

Activation on Deqi Deactivation on Deqi

MacPherson et al. 2006

Imaging Studies on Acupuncture
“Deqi” deactivation of brain

Insula

MPC

MPFC
MTL
BA22

BA4
3

Acupoint (Liv3) Hui KS, Napadow V, Kwong K et al. 2010, JOVE

Monitoring Acupuncture Effects on Human Brain by fMRI
Imaging Studies on Acupuncture
carpal tunnel syndrome (CTS) treated by acupuncture

L R
Healthy control
Napadow, V, et
al.,Neuroimaging, 2005

L R
CTS: Baseline

L R
CTS: Post-Acupuncture

Human Brain Mapping; 28:159-131, 2006

 Summary on how acupuncture works

Somatosensory cotex
Soft
tissues
nerves
Glands
Thalamus/hypothalmus
Heart & vessls

Yin Yang lungs

Brain Stem liver

Endorphines Kidney/bladder
, IL-1
Spinal Cord

GI
Sensory signal
Peripheral organs

Acupuncture Acupuncture
Adapted from Benarroch 2008
 Stresses Acupuncture
Infection/Irritation/Injuries…

Loss of bone
Increase minerals
cholesterol

Inflammation Insulin
resistance
•Heart
Disease Inflammatory cytokines
(IL-1, IL-6, TNF-, CRP…)
•High BP “Switch on”
•Stroke oncogenes “Chew up” Diabetes
Nerve cells
“Mess up” CNS
Cancer
Alzheimer’s Osteoporosis

Affective disorders
Depression
OCD
PTSD
Cognitive impairment
…
 Acupuncture:
Keep Brain Yin-Yang Balanced

Yin Yang
Chemicals Chemicals

GABA Glutamate
Glycine NE
5-HT Ach
DA Adenosine
Endorphin
Estrogen
Yin Yang Testo-
sterone
Melatonin
…

Keep free flow of energy

Keep body healthy
Keep life quality