While acupuncture is grounded in millennia-old practices, today's practitioners increasingly integrate modern research to support and enhance traditional methods.

Acupuncture research has grown rapidly and exponentially in recent years, increasing at twice the research rate in conventional biomedicine(1). As of July 2023, there are over 18,000 studies listed in the Cochrane database of clinical trials!

In 2017, a Comparative Literature Review, “The Acupuncture Evidence Project” (2), was published and found evidence of acupuncture's effectiveness for 117 conditions.  The review assessed acupuncture as safe in the hands of a well-trained practitioner and cost-effective for certain conditions.  

Click here to: learn more about the scientific evidence for acupuncture

The quality and quantity of research into acupuncture’s effectiveness is continually increasing.   

So, how does Acupuncture work?

When explaining acupuncture, practitioners often draw on traditional concepts, principles & philosophy to explain how Acupuncture works. We might say that acupuncture promotes harmony between physical, emotional, and spiritual aspects or that we are restoring the balance between substances or enhancing the free flow of Qi through the channel system.

The beauty of modern practice is that these traditional explanations remain true, whilst being enhanced by a modern scientific understanding.

Although no one definitive explanation exists, numerous complementary theories coexist to create an answer to this question.

The research

The mechanisms underlying how acupuncture works have been researched for more than 60 years. It’s helpful to look at these mechanisms across four areas;  the central nervous system, pain, biochemical & signalling pathways, and the immune system.

Central nervous system

Studies demonstrate the direct effects of acupuncture on the central nervous system. These include spinal reflex effects, where acupuncture stimulates muscle relaxation and changes in visceral organs. 

In the brain, acupuncture has been shown to change functional connectivity, decreasing activity in limbic structures associated with stress and illness while improving the hypothalamus-pituitary-adrenal (HPA) axis regulation. The HPA axis is the primary system that the body uses to regulate hormones and the physiological stress response (3). 

By enhancing parasympathetic activity, acupuncture helps shift the body out of 'fight or flight' mode, promoting a state conducive to rest, relaxation, and healing. The parasympathetic system is the nervous system branch associated with rest, relaxation, digestion, tissue healing and immune function (4).

Acupuncture tends to lead to a deeply relaxing and restorative state.

Pain

Acupuncture's impact on nerves & nervous system pathways has been scientifically mapped. Additionally, its influence on various biochemicals has been identified, encompassing opioid and non-opioid neuropeptides, as well as neurotransmitters such as serotonin, norepinephrine, dopamine, cytokines, glutamate, nitric oxide, and gamma-amino-butyric-acid (GABA).

For pain relief, acupuncture engages several classes of naturally produced opioid neuropeptides, including enkephalins, endorphins, dynorphins, endomorphins, and nociceptins. Additionally, investigations have focused on non-opioid neuropeptides like substance P, vasoactive intestinal peptide, and calcitonin gene-related peptide to understand their contributions to acupuncture's analgesic and anti-inflammatory effects (2, 5).

This is a complicated way of saying that acupuncture has been clinically and scientifically shown to be effective at reducing pain.

Biochemical & signalling pathways

Acupuncture's clinical effects involve numerous biochemical and signalling pathways. A central pathway responsible for its diverse efficacy is purinergic signalling. This system utilizes adenosine and ATP for signalling and regulation throughout the body's tissues and organs.

ATP acts as a co-factor for nerve transmission, and purine levels serve as crucial signals for healthy function and tissue damage. Purinergic signalling plays a significant role in various clinical areas, including migraines & headaches (6), immune dysfunction & inflammation (7), cancer (8), autism (9), Alzheimer’s (10), cardiovascular disease (11, 12), endocrine function (13), and embryological development (14).

Acupuncture treatment stimulates the self-regulation of purinergic signalling, thus affecting a diverse array of body systems.

Immune system

Acupuncture has been found to have a significant impact on the immune system. Studies indicate that acupuncture modulates various aspects of immune function, enhancing immune responses and overall immune system regulation. Acupuncture has been shown to trigger the release of various immunomodulatory substances, such as cytokines, which play crucial roles in immune cell communication and regulation.

Additionally, acupuncture has been observed to promote the activity of natural killer cells, T cells, and other immune cells, strengthening the body's defence against infections and diseases. Moreover, it can reduce excessive inflammation by influencing the production of anti-inflammatory mediators (16).

Acupuncture (and Chinese medicine generally) wants to keep you healthy (not just make you feel better temporarily).

Is acupuncture safe?

In Australia, acupuncture has been a registered profession (with AHPRA) since 2012. This means that as well as complying with the same professional standards as other registered healthcare professionals like GPs & psychologists, an Acupuncturist is at a minimum degree qualified, has met a required number of hours training under direct supervision, and is educated in Western Medicine as well as Eastern Medicine. 

In the hands of a properly trained practitioner, Acupuncture is amongst the safest interventions in modern medicine, with a very low occurrence of serious adverse events (17).

You can rest assured that for many people and health conditions, acupuncture is a safe, cost-effective, and evidence-based recommendation.

Read more here about the safety of acupuncture: is acupuncture safe?

References:

1. Ma Y, Dong M, Zhou K, et al. Publication Trends in Acupuncture Research: A 20-Year Bibliometric Analysis Based on PubMed. PLoS ONE 2016;11:e0168123. doi:10.1371/journal.pone.0168123

2. The Acupuncture Evidence Project – A Comparative Literature Review 2017 – Acupuncture.org.au. 2017;:1–81. https://www.acupuncture.org.au/resources/publications/the-acupuncture-evidence-project-a-comparative-literature-review-2017/

3. Cho ZH, Hwang SC, Wong EK, et al. Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms. Acta Neurol Scand 2006;113:370–7. doi:10.1111/j.1600-0404.2006.00600.x

4. Lund I, Lundeberg T. Mechanisms of Acupuncture. Acupuncture and Related Therapies Published Online First: 2016. doi:10.1016/j.arthe.2016.12.001

5. Fan AY, Miller DW, Bolash B, et al. Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management–White Paper 2017. Journal of Integrative Medicine 2017;15:411–25. doi:10.1016/S2095-4964(17)60378- 9AcupunctureEvidenceProject.aspx

6. Fried NT, Elliott MB, Oshinsky ML. The Role of Adenosine Signaling in Headache: A Review. Brain Sci 2017;7. doi:10.3390/brainsci7030030

7. Faas MM, Sáez T, de Vos P. Extracellular ATP and adenosine: The Yin and Yang in immune responses? Molecular Aspects of Medicine 2017;:1–11. doi:10.1016/j.mam.2017.01.002

8. Whiteside TL. Targeting adenosine in cancer immunotherapy: a review of recent progress.Expert Review of Anticancer Therapy 2017;17:527–35. doi:10.1080/14737140.2017.1316197

9. Masino SA, Kawamura M Jr., Cote JL, et al. Adenosine and autism: A spectrum of opportunities. Neuropharmacology 2013;68:116–21. doi:10.1016/j.neuropharm.2012.08.013

10. Woods LT, Ajit D, Camden JM, et al. Purinergic receptors as potential therapeutic targets in Alzheimer’s disease. Neuropharmacology 2016;104:169–79. doi:10.1016/j.neuropharm.2015.10.031

11. Burnstock G, Ralevic V, Perez DM. Purinergic Signaling and Blood Vessels in Health and Disease. Pharmacol Rev 2014;66:102–92. doi:10.1124/pr.113.008029

12. Burnstock G. Purinergic Signaling in the Cardiovascular System.

Circulation Research 2017;120:207–28. doi:10.1161/CIRCRESAHA.116.309726

13. Burnstock G. Purinergic signalling in endocrine organs. Purinergic Signalling 2013;10:189–231. doi:10.1007/s11302-013-9396-x

14. Oliveira Á, Illes P, Ulrich H. Purinergic receptors in embryonic and adult neurogenesis. Neuropharmacology 2016;104:272–81. doi:10.1016/j.neuropharm.2015.10.008

15. Borea PA, Gessi S, Merighi S, et al. Adenosine as a Multi-Signalling Guardian Angel in Human Diseases: When, Where and How Does it Exert its Protective Effects? Trends Pharmacol Sci 2016;37:419–34. doi:10.1016/j.tips.2016.02.006

16. Cui, J., Song, W., Jin, Y., Xu, H., Fan, K., Lin, D., Hao, Z., & Lin, J. (2021). Research Progress on the Mechanism of the Acupuncture Regulating Neuro-Endocrine-Immune Network System. Veterinary Sciences, 8(8). https://doi.org/10.3390/vetsci8080149

17. White, A. (2006). The safety of acupuncture – evidence from the UK. Acupuncture in Medicine, 24(Suppl), 53–57. https://doi.org/10.1136/aim.24.Suppl.53