Acupuncture, Fibromyalgia, and Cortisol Levels: Medical Acupuncture Research by Brian Benjamin Carter

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.

Thanks
J

Research on Acupuncture and Cortisol Levels

One Medical 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 article.)

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, and inaccurate.

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 rigor.

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 for others.

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.

References

1. Acupuncture in Medicine 1997; 15(1). http://www.medical-acupuncture.co.uk/journal/may1997/one.shtml
2. Medical Acupuncture 1999; 10(2): 27-30
3. Zhen Ci Yan Jiu. 1993;18(4):253-6
4. Am J Chin Med. 1982;10(1-4):62-9
5. Medical Acupuncture, A Journal for Physicians by Physicians. http://www.medicalacupuncture.org/aama_marf/journal/
6. Acupuncture in Medicine 2002; 20(2-3). http://www.medical-acupuncture.co.uk/journal/2002(2-3)/contents.shtml
   

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