1. Group III & Group IV afferent neurons (via substance P)
2. CNS activation via HPA axis, homeostatic effect
3. studied immune effects include stimulation of mast cell, bradykinin, cytokines
4. needle insertion at specific segmental level (and via dermatomal distribution) stimulating CNS descending control mediates some of the immune response to acupuncture
5. activate the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects,
6. alter the secretion of neurotransmitters/neurohormones, regulate circulation & blood rheology, both centrally and peripherally,
7. PET-Scans of the brain during acupuncture (Dold, 1998): University of California Irvine professor and physicist Zang-Hee Cho, a member of the National Academy of Science, inventor of an early version of the PET scanner and a pioneer of the MRI scanner, found that stimulation of the vision-related acupoint showed the same reaction in the brain as stimulation of the eye. As the acupuncture signal passes to the brain via nervous system, it possibly stimulates the hypothalamus, responsible for the production and release of hundreds of neurochemicals.
8. Acupuncture: pain management coupled to immune stimulation (Gollub, 1999): “The phenomenon of acupuncture is both complex and dynamic. Recent information demonstrates that acupuncture may exert its actions on pain and immune processes. The coupling of these two systems occurs via common signaling molecules, i.e., opioid peptides. In this regard, we surmise that
1. opioid activation leads to the processing of opioid peptides from their precursor, proenkephalin
2. the simultaneous release of antibacterial peptides contained within the precursor as well.
3. central nervous system pain circuits may be coupled to immune enhancement.
4. Furthermore, acupuncture needle manipulation elicited signal increases bilaterally in the region of the primary and secondary somatosensory corticies in human brain as determined by magnetic resonance imaging.
5. The maps reveal marked signal decreases bilaterally in multiple limbic and deep gray structures including the nucleus accumbens, amygdala, hypothalamus, hippocampus, and ventral tegmental area.

Taken together, we surmise a major central nervous system pathway as well as local pain and immune modulation during acupuncture.”

1. (Fu, 2000): “In recent years, more and more laboratory proof has accumulated that acupuncture can
1. change the charge and potential of neurons,
2. the concentrations of K(+), Na(+), Ca(++) and
3. the content of neuro-transmitters such as aspartate, and taurine and
4. the quantities of neuro-peptides such as beta-endorphin and leu-enkephalin.
5. All these phenomena are directly related to nerve cells.”
2. Immune System effects of Acupuncture (Joos, 2002): “The following changes were found in the TCM group: within the lymphocyte subpopulations the CD3+ cells (p = 0.005) and CD4+ cells (p = 0.014) increased significantly. There were also significant changes in cytokine concentrations: interleukin (IL)-6 (p = 0.026) and IL-10 (p = 0.001) decreased whereas IL-8 (p = 0.050) rose significantly. Additionally, the in vitro lymphocyte proliferation rate increased significantly (p = 0.035) while the number of eosinophils decreased from 4.4% to 3.3% after acupuncture (p > 0.05). The control group, however, showed no significant changes apart from an increase in the CD4+ cells (p = 0.012).”
3. Difference between Manual and Electro Acupuncture (Kong, 2002): “Results showed that electroacupuncture mainly produced fMRI signal increases in precentral gyrus, postcentral gyrus/inferior parietal lobule, and putamen/insula; in contrast, manual needle manipulation produced prominent decreases of fMRI signals in posterior cingulate, superior temporal gyrus, putamen/insula. These results indicate that different brain networks are involved during manual and electroacupuncture stimulation. It suggests that different brain mechanisms may be recruited during manual and electroacupuncture.”
4. Use of Auricular Acupuncture with Anesthesia (Taguchi, 2002): “Acupuncture thus reduced anaesthetic requirement by 8.5 (7) %.”
5. In Parkinson’s Disease (Wang L., 2002): “Under the auditory evoked brain stem potential (ABP) examination, the latent period of V wave and the intermittent periods of III-V peak and I-V peak were significantly shortened in Parkinson’s disease patients of the treatment group (N = 29) after acupuncture treatment. The difference of cumulative scores in Webster’s scale was also decreased in correlation analysis.”

References
Dold C. Needles & Nerves. Discover. September, 1998.

Fu H. What is the material base of acupuncture? The nerves! Med Hypotheses 2000 Mar;54(3):358-9

Gollub RL, Hui KK, Stefano GB. Acupuncture: pain management coupled to immune stimulation. Zhongguo Yao Li Xue Bao

Joos S, Schott C, Zou H, Daniel V, Martin E. J Altern Complement Med 2000 Dec;6(6):519-25. Immunomodulatory effects of acupuncture in the treatment of allergic asthma: a randomized controlled study.

Kong J, Ma L, Gollub RL, Wei J, Yang X, Li D, Weng X, Jia F, Wang C, Li F, Li R, Zhuang D. A pilot study of functional magnetic resonance imaging of the brain during manual and electroacupuncture stimulation of acupuncture point (LI-4 Hegu) in normal subjects reveals differential brain activation between methods. J Altern Complement Med. 2002 Aug;8(4):411-9.

NIH. NIH Consensus Conference on Acupuncture, Programs and abstracts (Bethesda, MD, Nov. 3-5, 1997). Office of Alternative Medicine and Office of Medical Applications of Research. Bethesda

Taguchi A, Sharma N, Ali SZ, Dave B, Sessler DI, Kurz A. The effect of auricular acupuncture on anaesthesia with desflurane. Anaesthesia. 2002 Dec;57(12):1159-63.

Wang L, He C, Liu Y, Zhu L. Effect of acupuncture on the auditory evoked brain stem potential in Parkinson’s disease. J Tradit Chin Med. 2002 Mar;22(1):15-7.

1. Frequency and Types of Adverse Events in 55,291 Acupuncture Treatments (Rosted, 1996 & Yamashita, 1998): 64 minor adverse events. 99.8% of these acupuncture treatments were performed without even minor adverse events; “The most frequent adverse event was failure to remove needles after treatment; no sequelae occurred after removal of the needles. The second most common adverse event was dizziness, discomfort, or perspiration probably due to transient hypotension associated with the acupuncture treatment.”
1. The most serious adverse events during acupuncture are pneumothorax and septicemia. “Instruction is given by both lectures and practical training and includes information about anatomically risky depth of insertion and use of aseptic procedure for puncturing… Most important, no serious events such as pneumothorax, spinal lesion, or infection were reported… We may, therefore, reasonably conclude that serious adverse events in acupuncture treatment are uncommon in the practice of adequately trained acupuncturists.”
2. Acupuncture Safety (White, 2001 & MacPherson, 2001): 2 September 2001 Studies of safety of acupuncture in the British Medical Journal; Details of 43 minor adverse events associated with 34,407 acupuncture treatments; 91 minor events in 31,822 acupuncture treatments; if combined with the other study above, minor adverse event incidence is 0.16%, no pneumothorax noted.
3. Pregnancy and Acupuncture (Smith, 2002): In treatment for nausea and vomiting, “our findings suggest that no serious adverse effects arise from acupuncture administered in early pregnancy.” 593 subjects.

Reference
MacPherson, Thomas, Walters, Fitter. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ 2001; 323: 486-487.

Rosted P. Literature survey of reported adverse effects associated with acupuncture treatment. Am J Acupunct. 1996;24:27-34.

Smith C, Crowther C, Beilby J. Pregnancy outcome following women’s participation in a randomised controlled trial of acupuncture to treat nausea and vomiting in early pregnancy. Complement Ther Med. 2002 Jun;10(2):78-83.

White, Hayhoe, Hart, Ernst. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 2001; 323: 485-486.

Reference
Bier ID, Wilson J, Studt P, Shakleton M. Auricular acupuncture, education, and smoking cessation: a randomized, sham-controlled trial. Am J Public Health. 2002 Oct;92(10):1642-7.

Reference
Berman BM, Lao L, Langenberg P, Lee WL, Gilpin AMK, Hochberg MC. Effectiveness of Acupuncture as Adjunctive Therapy in Osteoarthritis of the Knee: A Randomized, Controlled Trial. Annals of Internal Medicine. 2004; 141(12):901-910.

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Wang SM, Kain ZN. P6 acupoint injections are as effective as droperidol in controlling early postoperative nausea and vomiting in children. Anesthesiology. 2002 Aug;97(2):359-66.

Reference
White, Hayhoe, Hart, Ernst. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 2001; 323: 485-486.

Reference
Kim KS, Koo MS, Jeon JW, Park HS, Seung IS. Capsicum plaster at the korean hand acupuncture point reduces postoperative nausea and vomiting after abdominal hysterectomy. Anesth Analg. 2002 Oct;95(4):1103-7.

Reference
Allais G, De Lorenzo C, Quirico PE, Airola G, Tolardo G, Mana O, Benedetto C. Acupuncture in the prophylactic treatment of migraine without aura: a comparison with flunarizine. Headache. 2002 Oct;42(9):855-61.

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Skilnand E, Fossen D, Heiberg E. Acupuncture in the management of pain in labor. Acta Obstet Gynecol Scand. 2002 Oct;81(10):943-8.

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