Acupuncture Without Meridians – Is It Possible?

Charts of Acupuncture Meridians. Photo by Wonderlane via Flickr, reproduced under Creative Commons licence CC BY 2.0.

I do not believe that there are special channels (“meridians“) in the body for the circulation of qi (vital energy). I believe that the organisation of the body’s resources is a more intricately complex and less contrived affair than this.

This organisation is controlled by the central nervous system (CNS). It is mediated by information flow, rather than “energy” flow. Information is transmitted by means of nerve impulses, the flow of cytoplasm along neurons (axonal flow), chemical messengers, communication involving components of the immune system, and by mechanical transduction. There may be other means, some of which as yet unknown, but the word is information, not energy.

Nerves, blood and lymph vessels, and connective tissues are the structures by which this transmission is achieved. This is what we know from scientific investigation, which has found no sign of any physical structures corresponding either to meridians or to any physiological phenomena that could be uniquely related to them.

I shall hazard a guess (unverifiable alas!) that the whole theory of meridians came into being through a process of fallacious associations, perhaps such as the following. People in ancient China noticed that there were certain points on the surface of the body which seemed to be significant either in diagnosis or treatment. They also noticed that some of the points seemed to be functionally associated in some way or the other, for example in the distribution of pain. One such association they may have observed is the one we know now as myofascial trigger points and the areas to which they refer pain. An active trigger point can generate pain and activate secondary trigger points in its area of referral. They observed too the patterns of pain or sensory changes occurring in the distribution of nerves from the spine (spinal nerves) to the skin and muscles (like sciatica), and the phenomenon of pain from internal organs that is experienced in the surface structures of the body (visceral referred pain). They observed human anatomy and found organised networks of fascial planes connecting up the body. Then they simply joined the dots, in ways that seemed reasonable to them considering the symptom patterns, the topography, the anatomy, and their world view. I say they seemed reasonable. We must however allow for the human mind’s predilection for recognising meaningful patterns even where there is only randomness (apophenia). The constellations of stars in the night sky is one example of this. Just as the stars in the sky can be connected by imaginary lines to form imaginary constellations, so could the points on the body’s surface be connected to form imaginary meridians.

Thus, my contention is that disparate classes of information about body connectivity and a significant dose of fancy combined to produce maps of meridians. However, the attribution of physiological functions to meridians is a very imperfect affair. The shared association of certain functions with a discrete “meridian” is in good part a product of the imagination. The lines, as such, are imaginary: they do not exist either as structures or discrete functional entities. Even though they are supposed to denote functional arrangements, they are merely some kind of map, not the territory itself. In that respect, they are like the contour lines showing elevation on a geographical map. If you went to a hill shown on the map and dug for the lines, you would not find them, just as you cannot find dedicated qi channels (“meridians”) in the body.

I do not say this map is without use. Just like isobars on the cartographer’s map, they are indicative of the terrain even though they do not exist in the terrain! One notices on many occasions how they seem to account for some symptom pictures in the way a traditional Chinese physician may have predicted. Why does this person have a cramp-like pain half way down his left calf at the same time as he has pain in his left lower abdomen? There is, currently, a stone passing down his left ureter. I have never seen calf pain described as urinary referred pain in the Western medical literature, but to the traditional Chinese physician, it is well established knowledge that the back of the calf is on the “urinary bladder meridian”. Why has this lady who underwent cholecystectomy (surgical removal of the gallbladder) 40 years ago had pain affecting the side of her thigh and leg, first on the left, two years later on the right? It is the territory of the “gallbladder meridian”. The clinical examples are countless. However, what I do say is that the maps of meridians and their points attempt excessive precision, which can easily be interpreted too closely and too literally. It is like confusing a rough rule of thumb with a precise physical law.

To practise acupuncture just as effectively and more efficiently, I believe we would do better to refer to more realistic theories about the anatomical and functional arrangements that link the body’s surface with its wider workings. The practice of acupuncture does not necessarily have to refer to the classically described meridian system. In fact, today, I think it can be done without it, more efficiently and at least as effectively.

Adapted from my book Acupuncture: A Stress-Based Model (2019), Avicenna.

Copyright © Robert Hale 2021.

This Ain’t No Party!

Not infrequently someone tells me they’d be interested in an acupuncture treatment because they love it. To be honest this sounds a bit odd to me. Like you telling your doctor you want a prescription because you love taking pills.

My approach to health is one of problem-solving. There has to be a concrete problem for me to solve or help improve. If something is worth your seeking help, you will be asked to make sacrifices. It will not be “a treatment”, it will be from a few to more than ten. It will not be up from the word go. It will take time and you will spend money before you see results. Also, acupuncture cannot compensate for poor lifestyle patterns or patterns. Only drugs can do that, acupuncture is not that powerful.

This doesn’t look like an advertisement for acupuncture, does it?! And it isn’t meant to be. This ain’t no party, and there’s no messing about.

But if I take you on, it means I am pretty sure I can help.

What Have the “Five Elements” Got To Do With Acupuncture?

The Five Elements Cycle by Manonastreet, reproduced according to Creative Commons licence CC0, via Wikimedia Commons.

In a recent post I talked a little about the five-element system of looking at the world. But what has it got to do with acupuncture? Well, acupuncture is a method used in traditional Chinese medicine (TCM), and as I exemplified in that post the five elements in that system have a very great deal to do with the way the body works in health and disease. One of the major classic texts of Chinese medicine, the Huang Di nei jing su wen or Inner Canon of the Yellow Emperor, describes in detail the various pathological states that are believed to arise from imbalances in the five elements.

In modern acupuncture schools five-element theory is taught as being fundamental to the practice of acupuncture. You puncture this point and you stimulate a “wood” point, that one and it’s an “earth” point and so on. There are complex methods devised to manipulate with needles the laws that govern energy transformation between the phases (“phase” is another, perhaps better word for “element” in Chinese medicine).

However, among scholars doubt exists whether these methods are actually traditional at all. One school of thought has it that for much of the history of acupuncture, points were selected on the basis of what collective experience told about what symptoms they successfully treated, rather than theoretical considerations about the five elements. According to this school of thought, the latter is a quite recent invention stemming from the “Great Leap Forward” and the “Cultural Revolution” (1950s and 60s respectively). I have also read that the relevance of the five elements to clinical practice was transplanted to acupuncture from herbal medicine, where it is more clearly applicable. That certainly makes sense to me.

My reflections on my own experience lead me to believe that five-element theory has little bearing on the success or otherwise of acupuncture treatment, and I do not base my practice of acupuncture on this theory any more.

Copyright © Robert Hale 2021.

The “Five Elements” in Chinese Medicine

Image by Parnassus, CC BY-SA 3.0, via Wikimedia Commons.

The great ancient civilisations developed philosophical models of existence that encompassed the cosmos, living beings, physiology, health, disease and medicines. They were based on fundamental “elements” that made up the universe. The Chinese had and still have a five-element system, Ayurvedic medicine also had and still has five elements, and Ancient Greek and Islamic medicine had four elements. In medicine, all these systems had several things in common, but above all it was their focus on vitality that characterised them and differentiated them from modern medicine.

Let us look at the Chinese system. The Chinese five elements are Wood, Fire, Earth, Metal and Water. These are not to be taken literally. They are more like groups of characteristics, or you could say different “personalities”. Everything that exists in the universe is made up of different combinations of these “personalities”. However, in each thing, one of them is usually dominant.

One can also consider the elements to be different forms of energy. Energy is transformed cyclically from one element to the next in a specific order. In traditional Chinese theory there are universal laws governing this transformation of energy. We won’t go into these here.

Instead, let us take one element and see how it manifests itself in the human body and mind.

The Wood “personality” is dominant in the energy of the liver and gall bladder, the tendons, the nails, the eye, and the emotion of anger. How are these things connected? The liver produces bile which is collected by the gall bladder for release into the duodenum in order for it to carry out its digestive functions. There is an energy channel called the liver meridian which begins in the foot, runs up the body through the liver and ends at the eye. So eye inflammations or other problems are associated with alterations in liver energy. Very often people with liver congestion or disease become irritable and this can easily spark into anger. What about the tendons and the nails? This is an example of association of ideas. Taut tendons and nails are thought to be woody in their appearance and physical characteristics and therefore believed to be associated with the Wood element, and by extension nourished by liver energy.

Now let us look at different kinds of liver problems in Chinese medicine:

If liver energy fails to flow and stagnates, you can experience rib pain, mood swings, nausea, acid reflux, belching, and if you are a woman, premenstrual syndrome. The stagnation may cause the energy to rise (imagine a small river that has become blocked by vegetation and fallen branches – the water rises!). This in turn causes irritability, tension around the temples, dizziness, tinnitus, dry mouth and eyes and insomnia. Liver “Fire” is even worse. The stagnated energy becomes very hot, and rising, it causes anger, headaches around the temples, a red face and eyes, thirst, a bitter taste in the mouth, vertigo, tinnitus, nosebleed, constipation with dry stools, and dark urine. If very serious excessive liver energy can cause convulsions or strokes.

Stagnated energy, as we have said, can overheat. It can also cause congestion. When this happens with the liver, it is called “Damp-Heat in the liver” and may result in jaundice, bloating, nausea and vomiting, scanty dark urine, and inflammation or infection of the genitals.

A deficiency of Yin energy in the liver can allow the liver’s Yang energy to rise, too. (If you don’t know what Yin and Yang are, see my posts here and here). This time too you can experience dizziness, tinnitus and insomnia, but also weak vision, night sweats, and thirst during the night.

Liver symptoms plus respiratory symptoms such as a chronic cough, asthma, shortness of breath, or yellow or bloody phlegm are believed to result from excessive liver energy affecting the lungs.

There is another syndrome called “Liver Blood Deficiency” which is basically anaemia together with liver symptoms like dizziness, insomnia, brittle nails, and weak or blurred vision.

Now I have said not to regard the five elements too literally. These descriptions of liver problems are a coherent way of explaining things that are nevertheless completely different to what we know from anatomy and physiology. I view them as symbolic rather than literal. One example of the difference in thinking is strokes: in Chinese medicine, symptoms of stroke like hemiplegia (one-sided paralysis) are explained by hot, rising liver energy blowing up an “internal wind”. Today we know that strokes are caused by the blockage of an artery in the brain or, less commonly, bleeding in the brain.

Copyright © Robert Hale 2021.

What have Yin and Yang Got to Do with Acupuncture?

In my last post but one I wrote about Yin and Yang and what they mean in the context of the human body. But I didn’t mention acupuncture. So how do Yin and Yang relate to this therapeutic practice? In Traditional Chinese Medicine (TCM) theory, Yin and Yang are fundamental. Imbalances in Yin and Yang in the body as a whole, or in a part of the body, cause disease. These imbalances can be corrected by the stimulation (by various means including the insertion of needles) of well-selected points located on “meridians” (energy channels) that run through the body. Such stimulation must be done at a few specific points among the 360+ points (depending on the authority) and in specific ways determined by the diagnosis, otherwise it will not work or may even make matters worse. In my view this is not so. The trouble with it is that if you go with your problem to several different acupuncturists from several different cultures (Chinese, Japanese, Korean, Vietnamese, etc.) or schools of thought (or even the same culture and school of thought!) you will likely receive several different diagnoses and several different treatments, and all of them will be making a living and claiming good results with their patients. As I explain in my book, Acupuncture: A Stress-Based Model, the specificity of acupuncture treatment is overstated, and is largely an illusion. And as I explained in my post on Yin and Yang, I consider these to be useful linguistic concepts rather than universal forces. But let us get down to essentials, the essential bit where TCM theory and I agree with each other. Health is a question of physiological balance, which can be described in terms of Yin and Yang. When acupuncture is effective, it is because it has helped to restore physiological balance.

Copyright © Robert Hale 2021.

Image from Pxfuel.com. Reproduced with permission.

Yin and Yang Demystified

There can’t be many people who have not seen at some time the Chinese Yin-Yang symbol. There are many versions of it, and I have chosen this one with fish as it is attractive, different, and I have always liked fish!

According to Chinese philosophy everything that exists is a product of two mutually antagonistic but complementary forces, Yin and Yang, which by feeding on each other keep each other in check. You most probably know this already. If you do not, please see here.

I am assuming that much is known, because I don’t wish to spend words on the basics here. What I want to do here is to demystify Yin and Yang. Much that I see written on Traditional Chinese Medicine insists on using Chinese words, or literally translated terms that obscure what are actually very practical and ordinary ideas. The context I am going to use to demystify Yin-Yang is the human body (and mind) in health and disease.

In the human organism for Yin think:

  • Substance: flesh and bone, blood and fluids.
  • Nourishment1 for the above.
  • Stillness.
  • Slowness.
  • Hardiness.
  • Cooling down.
  • In the mind think groundedness, stability, resilience, calmness, practicality.

In the human organism for Yang think:

  • Energy2: activity (movement), heat.
  • Reactiveness.
  • Intensity.
  • Speed.
  • Transformation.
  • Heating up.
  • In the mind think creativity, movement, responsiveness, emotionality, expressiveness.

You can be born more Yinny or more Yangy. After forty years of age these tendencies may start to cause health problems. If you are very Yin, you may gain weight and slip into obesity. This may have knock-on effects like wear-and-tear on your knee joints (osteoarthritis) and diabetes. If you are very Yang you may have begin to experience troubles of excess like stomach acidity and high blood pressure.

Yin-ness and Yang-ness can also be acquired by lifestyle patterns or choices. For example a hectic life with too much to do and long hours causes Yang-ness: much mental activity, physiological changes like having a lot of adrenalin flowing, and reactiveness to situations, like your heart racing. This will soon lead to depletion of Yin. But Yin provides the nourishment, the fuel for your activity, so you will be running around anxious to get things done but with insufficient physiological resources to do it. Burn-out.

A lack of Yang in your life (e.g. no movement, sedentariness, no physical exercise) will lead to Yin problems like weight gain, osteoporosis, fatty deposits in your arteries (atherosclerosis) and lack of motivation.

Yin and Yang symptoms and diseases have more or less the same characteristics as those listed above, or extensions of them. Yin ones have the characteristics of coldness or getting worse in the cold (e.g. arthritis), stillness and/or stagnation (e.g. swellings), solidity (e.g. tumours) stability (symptoms that don’t move and last a long time, chronic diseases), withdrawal (e.g. depression). Lack in any form in any form is also considered a Yin symptom, e.g. lack of substance (atrophy), lack of strength (paralysis), lack of resilience (susceptibility to infection, small physical or mental traumas).

Yang symptoms and diseases are hot (e.g. acute inflammation, fever) or get worse in hot weather, movement (symptoms that involve movement, e.g. tachycardia, or which move around the body like shifting pains), tension (e.g. tight muscles, intestinal colic, tension headache), pressure (hypertension) reactiveness/intensity (e.g. severe pain), excessive mental activity (e.g. anxiety, mania).

If you think about it, this is all fairly intuitive, right? Personally I regard Yin and Yang not as actual forces in the universe, but as metaphors people use to understand and talk about the world. Yin and Yang represent broad categories of things which people intuitively (if not always logically) see as opposites.

And it is common sense (as well as scientifically accurate) to say that health is defined by balance and is not favoured by extremes.

1 There are two basic kinds of nutrients: those which provides the physical building blocks of life and fuels for their activities – proteins, fats and carbohydrates; and those which catalyse metabolic and other chemical reactions in the body – vitamins and minerals. The former are Yin (flesh, nourishment), the latter Yang (heat, movement, transformation).

2 I was tempted to avoid this word as it is over-used and much misunderstood. Substance too stores energy, in chemical form. However, in common parlance, we all understand what it means to be “energetic”. I use the word in this way here.

Copyright © Robert Hale 2021.

Image of Koi carp from Wallpaperflare.com.

Acupuncture and Pain

Acupuncture and its allied technique, moxibustion (the application of heat to acupuncture points), have been used to treat pain for thousands of years. Until recently, scientific evidence for its effectiveness was lacking. However, in recent years, the sheer numbers of people who have reported gaining relief from pain through acupuncture have stimulated a tsunami of research to find out if acupuncture really works and if so, how.

Is Acupuncture effective in treating pain?

Now we have evidence that acupuncture helps with pain, and that evidence is rated “good” or “moderate”, depending on the kind of pain. The kinds of pain for which there is good or moderate evidence of effectiveness include spinal pain, sciatica, headaches, shoulder pain, tennis elbow, osteoarthritis of the knee, heel pain, pelvic pain, and jaw joint pain (see the table below).

From: McDonald J and Janz S (2017). The Acupuncture Evidence Project: A Comparative Literature Review. Published by the Australian Acupuncture and Chinese Medicine Association Ltd.

How does acupuncture help pain?

The plain truth is that while we know that it does, we are not all that clear about how, at least in Western medical terms. Traditional Chinese explanations focus on the circulation of Qi (vital energy) around the body. Pain can occur in an area if this circulation is blocked or altered, for example if there is too much Qi gathering in an area causing stagnation, or if there is not enough Qi circulating to an area. Pain can also occur if our normal flow of Qi is blocked or shocked by invasions of energy from outside the body, such as heat, cold, damp or wind.

In the Western scientific view, it is believed that acupuncture changes the way pain signals are produced, transmitted and processed by the nervous system. For example, it may reduce pain by stimulating the production in the brain of our own natural pain-killing chemicals such as opioids and cannabinoids. It can also work by reducing muscle tension, thus releasing joints from strain, and it can de-activate “trigger points” – small areas of excessive sensitivity in muscles, tendons and ligaments that produce pain and maintain muscle tension.

So, we know now that acupuncture can help relieve pain, and there is some evidence pointing to mechanisms by which this effect is achieved.

Copyright © Robert Hale 2021.

(Photo de Adobe Stock Images.)