Does Acupuncture Work? Let's Talk About Evidence Based Healthcare

Fifty-five year old Andy came to came to see me with chronic back pain. He’d tried a few other treatments without success. Now, with the tough physical challenge of a sailing race looming, he desperately needed help.

Could acupuncture help him?

It’s one of the questions I’m most often asked …… “will acupuncture work for me and my problem?”.

And it’s understandable. No-one wants to waste their hard-earned cash on an ineffective treatment. In answer, I usually give an indication of the likelihood of acupuncture helping someone. But I also add that I can’t guarantee it - and nor can any other practitioner. Here’s why…..

I know I get good results in clinic, but I often think the question is really “ is there evidence for acupuncture and my problem?” . To answer, firstly we need to look at what evidence-based medicine IS. This blog dives into the principles of evidence-based medicine and the challenges of research. In my next blog we’ll talk about where acupuncture fits into this picture.

What is Evidence Based Medicine?

Western medicine can often seem to be all about “the science” or evidence-based medicine, a concept developed by Canadian epidemiologist David Sackett.

Back in 1981 he and his colleagues at McMaster University began publishing a series of articles in the Canadian Medical Journal advising physicians how to appraise medical literature. But an evidence-based medicine approach doesn’t rely solely on research. Sackett also advocated using the physician’s expertise, considering the individual needs of the patient, and the patient’s wishes.

Challenges in Evidence-Based Medicine 

Once Sackett had given us a starting point for evidence-based medicine, you’d think it would be easy to understand what “works” But no, the research aspect of evidence-based medicine is a minefield.

Firstly, there needs to be a hypothesis – an assumption that can be tested to see if it’s true or not.

Secondly, you need to test that hypothesis. There are many different ways to research a treatment; case studies, cohort studies, randomised controlled trials (RCT’s), systematic reviews, and many more. These studies are not all equal - some are far more rigorous than others. A randomised controlled trial (RCT) is considered the “gold standard” of research.

Thirdly you need money. A condition affecting a big chunk of the population is likely to attract more research funding than a rare illness. Decent trials cost money, lots of it. And the better-quality trials like RCT’s cost more. Because these trials are so expensive it makes sense to make sure that someone will benefit from doing them (if the hypothesis is right!), whether in terms of prestige or financial gain. This could explain the dominance of pharmaceuticals in medicine nowadays.  

AND THEN once you’ve for the money, you must find a big enough chunk of similar folk to test your hypothesis on. Only then can you say the result was due to the treatment, not chance.

 The big question – will it work for you?

Let’s imagine that, like Andy, you’ve hurt your back. Your neighbour tells you that she saw someone who helped her. It’s always good to have a personal recommendation, so you make an appointment.

But will it work for you? The reality is you don’t know. One person’s experience carries little weight in scientific terms.

Let’s add more people, perhaps everyone in the town with back pain, and do a proper study. That will give us more information. It might be that 50% improve with treatment.

Evidence based medicine is not “cookbook” medicine. Because it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients’ choice
— David Sackett

But will it work for you? You still don’t know, you might in the portion of people the treatment is successful for, you might not. And something else might work better in any case.

Let’s make it a bit trickier. We’ll add in some comparisons, like a placebo or another treatment. That other treatment might be whatever is on offer now, often known as ‘standard care’. We might find that 60% of people in the new treatment group see an improvement- but so do 45% in the standard care group, and 30% of the folk in the placebo group. Again, you don’t know which camp you would fall into.

The downsides

We’ve started to see some of the issues with research. The huge amount of expense and time required for good quality research such as randomised controlled trials means that only a fraction of the options available to you could be “evidence based”. And even then, evidence-based treatments take time to filter into common usage – usually about 17 years, according to the British Medical Journal.

And, as American astronomer Carl Sagan put it, “Absence of Evidence is not Evidence of Absence” . A lack of research for a treatment doesn’t mean it’s not effective. It could be that the evidence isn’t there because researchers don’t see a benefit from doing the research. Remember though, that if something has been tested and found wanting, that could be a different matter.

Absence of Evidence is not evidence of absence
— Carl Sagan

Also remember, researchers need to ask the right question (the hypothesis) and test it on the right group of people. It’s not unusual to find studies with conflicting results because researchers have chosen to test a different group of people, or asked the question in a slightly different way.

The existence of an evidence base can give you some confidence to make an informed decision, based on the likelihood of a positive impact against any potential side effects, but finding a definite answer is a tricky business.

The U.K position - N.I.C.E

In April 1999 The National Institute for Clinical Excellence was created to create consistent guidelines and end “postcode rationing “across the U.K. Now known as the National Institute for Health and Care Excellence (NICE) , they continue to provide standard guidance for treatment of a range of conditions. This guidance is given in relation to the evidence base and to cost. But it rarely takes into account the expertise of the physician or the individual patient, as David Sackett suggested.

We use the best available evidence to develop guidance to improve health and social care
— National Institute for Health & Care Excellence

Limitations of NICE Guidelines

Sadly, NICE hasn’t stopped the postcode lottery as each area manages its own funds. As an example, treatment offered to people struggling with fertility varies across the country. As I write this, NICE recommend 3 cycles of IVF for women struggling to conceive, but only one cycle is offered in Harrogate and the rest of North Yorkshire.

 Where does that leave you?

Western science is a wondrous thing. The experimental approach means that new ideas are tested, and many a life has been saved by interventions developed following scientific studies. Studies also help organisations such as The National Centre For Care and Excellence (NICE) to decide what treatments to recommend when there are a myriad of options available and budgets are tight, but they can’t promise every treatment will work for everyone. Nor can they factor in the skill of the person treating you,  or your individual wishes, the two strands of David Sackett’s model of ‘Evidence Based Medicine’ that are so often forgotten. Remember too, that not every treatment is tested for every condition.

Did acupuncture help Andy? Yes! His pain started to decrease after his first treatment. Six sessions later, he was pain free, and looking forward to his epic sailing challenge.

Does that mean I can promise to help you, as I have helped Andy and many others? No, I can never promise a result as everyone is unique. But I can promise that if I think a different treatment would be better for you, I’ll tell you. I can promise that I’ll give you an honest opinion of the likelihood of success based on my clinical experience, and I can promise that I’ll give you the best treatment possible for you, based on my experience and the experience of other acupuncturists over the last two thousand years.

Your Chinese Medicine Diagnosis

Imagine a healthcare system that has been used for over 2,000 years—one that sees not just your symptoms, but the whole you. This is the essence of Chinese medicine.

Traditional Chinese Medicine (TCM) offers a holistic approach to health. It doesn't rely on lab tests or imaging, as Western medicine does. Instead, TCM uses ancient diagnostic methods like questioning, observation, and palpation to uncover the root causes of imbalances in the body. This approach doesn’t just look at physical symptoms but also considers your emotional, mental, and spiritual well-being, offering a truly comprehensive view of health.

 

What is a Chinese Medicine Diagnosis?

In Traditional Chinese Medicine (TCM), diagnosis revolves around understanding the functional roles of internal organs, the intricate network of channels that connect these organs to the body’s exterior AND to one another, and the “fundamental substances” that sustain them. These substances—Qi, Blood, and Jing—play a vital role in ensuring the organs operate in harmony, supporting overall health and balance.

 

Why is a TCM Diagnosis Different?

One of the first things many people share with me is their Western medical diagnosis. While this can be helpful, it’s not essential in TCM. This system views health and illness through a different lens.

Rather than identifying a specific disease, TCM seeks to uncover patterns of disharmony—underlying imbalances that lead to symptoms. That disharmony may manifest in one or more organs, fundamental substances may be off kilter, or both organs and fundamental substances may be involved.

The organ system

Organs are understood not just anatomically but functionally; for example, the Heart in TCM is far more than the muscular pump we think of in the West. It encompasses emotional well-being, memory, sleep and even fertility, as emotional disturbances can affect the balance of hormones.

Fundamental substances

Qi, Blood, and Jing – the “three treasures”

What is Qi?  Ask one hundred Chinese Medicine practitioners and you could get one hundred different answers! The translation can be as basic as “energy”. To me, Qi is a concept that explains how well the body is functioning. For example, if your Lung Qi is strong, you will breathe easily, if your Heart Qi is robust that important muscle is beating regularly, and you are emotionally stable.

The concept of Blood is similar to the Western understanding; a vehicle to move nutrients and oxygen around the body. TCM also sees Blood as a vehicle to house the mind. The quality of Blood is very much determined by the quality of the food we eat, and the connection between blood and the mind isn’t completely at odds with Western thinking. There is now a growing understanding of the connections between mental health and diet.

And Jing? Think of your constitution. Some lucky souls are born with a super strong constitution and seem to be able to withstand anything life throws at them, , whereas others are hit by everything that comes along. We can’t change what we’re born with, but most of us can look after our reserves of Jing with good lifestyle choices.

 

When things go wrong

Imagine your body as a house. The walls create a barrier between the interior and exterior protecting you from the environment. Inside, you have systems in place to make sure the atmosphere is just right; not too hot or cold, not too dry or damp. But if the heating system isn’t working well, the house can become icy or overheat, the atmosphere may become too dry or damp can breach the boundaries. And if the windows cannot withstand the elements, wind will whip through the house.

Natural metaphors such as Damp, Heat, Dryness, and Wind, help us understand how your body functions in TCM terms.

These terms may seem abstract, but they are grounded in a structured diagnostic process. And it’s not too hard to see how they came about. Before there was any understanding of bacteria and viruses, infections were seen as an invasion of Wind. And the resulting raised temperature of an infection can clearly be seen as excess Heat in the body.

Ancient Chinese medicine had no knowledge of bacteria or viruses and acute respiratory were considered to be due to an invasion of ‘Wind’ or other climatic factors
— Giovanni Maciocia
 

What to expect during your session

Your first session in TCM might surprise you with its depth. It’s all about getting to know you, your body, and your life. The process typically includes:

Pulse Diagnosis The pulse is a treasure trove of information in TCM, far beyond just heart rate and rhythm.

 I’ll feel the pulse in three positions on each wrist and at three depths in each position. Each position corresponds to an organ and provides insights into your Qi (energy), Blood, and the health of your organs.

Questioning: We’ll have a chat about your lifestyle, medical history, sleep, diet, digestion, emotions, and more. If you have pain, I’ll want to know when it occurs, how it feels, and what makes it better or worse.

Tongue Examination

The tongue reflects the state of your internal organs. Its colour, shape, coating, and moisture level give clues about your overall health. Remember those climatic factors such as Damp and Dryness – they can be seen quite clearly on the tongue. If you’re brave enough to ask to examine your friends’ tongues, you’ll begin to see how different they are – you may notice how ‘dried out’ one looks, or a thick greasy coat on another showing Damp in the body.

Palpation: Palpating acupuncture channels can uncover more information about your body’s imbalances. Channels may also seem an abstract concept, but these are real places linking the exterior of the body to the interior, with many connections between them. Channels spread throughout the body, but are usually easy to locate on the limbs, in the spaces between muscle and bone.

What am I looking for? The texture of the skin, how firm the channel is, and if there are any lumps and bumps along the way. They all help me to work out what’s going on.

 
Tong bing yi zhi, Yi bing tong zhi,
— Different Diseases, One Treatment; Same Disease, Different Treatments

Different Diseases, One treatment, Same Disease, Different Treatments

This classic saying in Chinese medicine, “Tong bing yi zhi, Yi bing tong zhi,” captures its essence.

Two people with the same Western diagnosis, for example migraines, may receive entirely different treatments because their underlying patterns differ. Conversely, two people with completely different issues might benefit from similar treatments if their patterns of disharmony are the same.

Let’s look at some examples. It’s  winter time as I write this, we’ll look at a couple of simple cough scenarios !

 1.        John has a dry tickly cough, feels thirsty, and has a hoarse voice.

He doesn’t have a temperature or any other signs of illness. John is suffering from “Lung dryness” caused by spending too much time in overheated and dry environments, such as his office and the pubs and clubs he’s gone to for Christmas parties.

 

  2.        Sarah also has a cough. She can’t stand the cold, she has an itchy throat, she’s breathless, has a blocked nose and her head and body aches. Sarah has an Invasion of the Lungs by Wind-Cold!

 In this case, Wind means a pathogen such as a virus or bacteria has entered the body – when Chinese Medicine was developed over 2,000 years ago, there was no knowledge of such things.

 

Likewise that migraine may show up as a Liver issue, or it could have more to do with the function of the Stomach. There may be some Heat or there could be Damp, or even Damp’s uglier relative, Phlegm. The possibilities are almost endless, so we need to look for and treat the underlying cause of the migraine -  “same disease, different treatments “

 

And the “Different Diseases, One Treatment “ side of the equation?  Let’s take Damp as an example. Damp can be caused by exposure to Damp environments or by eating a Damp-forming diet (lots of wheat, dairy, and sugar!). It can show up as a feeling of heaviness in the limbs, a fuzzy head, or it might affect the stools or urination. Either way, the treatment is likely to involve fortifying the body’s warming systems to clear the Damp, much as you would do in a damp house.

 

A Treatment Tailored to You

After gathering all this information and making your diagnosis, I’ll develop a treatment plan that’s unique to you. This includes selecting acupuncture points on specific channels to address the root cause of your imbalance. Everything—needle placement, depth, and technique—is carefully chosen to suit your needs.

Your acupuncture treatment plan evolves as your body responds, reflecting a dynamic and personalised approach to healing.

 

Helping Yourself Heal

Healing is often a collaborative effort. Alongside acupuncture, I may recommend lifestyle or dietary adjustments to support your recovery. This could include:

• Eating or avoiding certain foods to support your recovery.

• Incorporating relaxation techniques to reduce stress.

• Trying gentle movement practices like Qi Gong, or yogic breathing techniques, to enhance your treatment.

These small changes, combined with regular acupuncture, can make a big difference in restoring harmony to your body and mind.

If you're ready to explore a personalised treatment plan, I’m here to help guide you on your journey toward balance and well-being..

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