Acupuncture, Fibromyalgia, and Cortisol
Levels: Medical Acupuncture Research
Recently a patient of mine who I have been
seeing for fibromyalgia with some success came to me and
told me her doctor had recommended she discontinue acupuncture.
He is an alternative type MD who uses many
naturopathic protocols with his patients. He told her that
a saliva test she had just taken showed a 6x above normal
for cortisol in her body and that the acupuncture was making
that worse by acting as trauma to the body.
This shocked me a little since we actually use
acupuncture to treat inflammation very successfully and have the
opposite effect than he is claiming we have. I know fibromyalgia
patients often have higher than normal cortisol levels. Do you
have some sources on cortisol levels and acupuncture good or bad.
Also, if you have any other input please let me know.
Research on Acupuncture and Cortisol Levels
acupuncture study does appear to support the idea that acupuncture
raises cortisol levels. However, the points they used - ST36,
B23, and B52 - are all tonifying points. It begs the question:
Would sedating points lower cortisol levels?
Are "Sham" Points As Neutral As They Think?
The sham points they used lowered cortisol levels. They believe
these points are not acupuncture points, and were not within 3
cm of a meridians. However, I'm not sure of the accuracy of their
presupposition that non-meridian points are non-points.
There are perhaps 800 "extra" points (points not located
on the meridians). These 'sham' points were located near yang
meridians - between UB57 and GB34, near SI10, and between SI10
and UB46. I think the conclusion not considered by the researchers
was that tonifiying points raise cortisol levels, but sedating
points lower them. Needling "sham" points on yang surfaces
of the body may have a sedating or cortisol-lowering effect. Further
study is needed.
More Studies on Cortisol and Acupuncture
Another study of premature infants (Medical Acupuncture 1999;
10(2): 27-30) showed that e-stim on the 4 gates decreased normal
stress during an eye exam (it dampened the expected increases
in cortisol level) - this supports the idea that sedating acupuncture
would lowered cortisol levels.
A 1993 Randomized Controlled Trial of 78 Kidney Vacuity patients
(Zhen Ci Yan Jiu. 1993;18(4):253-6) showed cortisol level reduction
when reducing (same as sedating) technique was used, but NOT when
reinforcing (same as tonifying) technique was used. I assume since
they were investigating needle manipulation that they used the
same points, but I'm not certain of that.
A 1982 study (Am J Chin Med. 1982;10(1-4):62-9) showed increases
in cortisol levels in patients who were needled with GB20 on the
right, ST36 bilaterally, and P6 bilaterally. This doesn't appear
to be a specifically tonifying or sedating treatment. Two classical
combo's are relevant:
- GB20 + ST36 for Hypertension
- P6 + ST36 for Angina (chest pain)
So it appears to be sedating or regulating for the H, yet it
raised cortisol levels. ST36 was in the other study where cortisol
levels were raised, so one possibility is that ST36 governs a
cortisol-increase... what's confusing about this is that usually
cortisol causes hypertension. So, if ST36 increased cortisol levels,
how could ST36 + GB20 treat HTN?
What's clear from all this is that acupuncture's effect on
cortisol is complex. It cannot be said that all acupuncture
increases cortisol levels. Nor can the opposite be said. Further
study, as usual, is needed.
Is Acupuncture Always Regulatory, Always Benign?
Some acupuncturists assert that all acupuncture is always regulatory
and thus always benign. Supposedly, acupuncture is always good-
you can't hurt the person by choosing the wrong points. If the
acupuncturist knows what they're doing, the effect is really good.
How do you know that's true?
I would challenge those of you who believe that acupuncture is
always regulatory to come up with some evidence-based support
for that idea. After all, we shouldn't have a double standard
about supporting our assertions, should we? Studies are not conclusive
about how acupuncture affects cortisol levels, or which points
do what to cortisol levels. But neither do we have evidence to
support the idea that acupuncture is always regulatory.
Medical Acupuncture and Licensed Acupuncture
I've been wondering lately what the difference is between medical
acupuncture and we 'licensed' or 'traditional' acupuncturists.
Why do we have separate organizations, journals, and conferences?
If you read medical acupuncture journals (see references for
websites), you can see that they they often discuss research and
tradition. MD's - even the holistically oriented ones, whether
they practice acupuncture or not - come from a skeptical and scientific
perspective. Most MD's are not nearly as well grounded in the
theories of acupuncture. On the other hand, many LAc's are happy
to avoid science. Of course there are people from both fields
on both sides of the spectrum. (For more on Medical
Acupuncture vs. Licensed Acupuncture, read this
The first study mentioned above illustrates one occasional fault
of the medical acupuncture researchers; namely, that they don't
always know enough chinese medical theory to thoroughly and accurately
investigate acupuncture. It's arrogant and ignorant to think you
can study a therapy based on thousands of years of well-developed
theory without first studying those theories. Not only that...
the research design won't be that great, and your interpretations
of the resulting data will also suffer.
Acupuncture Research Ideals
We should start with tradition and test it with research. We
shouldn't be so quick to throw out the theories. It's clear from
years of biomedical research that new studies often reverse previous
assumptions. And many studies are needed before real conclusions
can be made. Reviews of previous studies can also be biased, inconsistent,
It will take a long long time to test everything, but I don't
see how it could fail to make chinese medicine stronger, more
accurate, more helpful, and more relevant. In the meantime, we
should continue to practice what is traditional and what has been
proven in randomized controlled trials. That way, we can respect
our chinese medical forebearers AND the wisdom of modern scientific
Medical and Licensed Acupuncturist Cooperation
Professionally, we should respect western medicine for its strengths
and admit with humility the strengths and weaknesses of our own
medicine. I think on both sides of the acupuncture field (medical
and licensed) we need both humility about ourselves and respect
We chinese medicine practitioners may be able to avoid the mistakes
of both DO's and Chiropractors in regard to western medicine;
DO's gave up what was unique about their medicine in order to
be accepted, while Chiro's have consistently fought against western
medicine and have garnered very little support from them. Perhaps
the humility and respect I mentioned could guide us into a cooperative
yet empowered position.
- Acupuncture in Medicine 1997; 15(1). http://www.medical-acupuncture.co.uk/journal/may1997/one.shtml
- Medical Acupuncture 1999; 10(2): 27-30
- Zhen Ci Yan Jiu. 1993;18(4):253-6
- Am J Chin Med. 1982;10(1-4):62-9
- Medical Acupuncture, A Journal for Physicians by Physicians.
- Acupuncture in Medicine 2002; 20(2-3). http://www.medical-acupuncture.co.uk/journal/2002(2-3)/contents.shtml
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