Structure-Based Medical Acupuncture: New Perspective on an Ancient Technique.

With more recent research into the neuromyofascial system, one can begin to surmise how acupuncture may work through modulating nerves, muscles, and fascia. Pain relief from acupuncture is thought to involve the release of endogenous opioids and monoamines. Various different peripheral nerves are stimulated with acupuncture, and there are also specific effects on the brain that can be seen on functional magnetic resonance imaging. Acupuncture has long been used to treat muscular pain from trigger points, and there is now research that can objectively quantify these trigger points. Needling therapies have been shown to improve trigger point status and improve patients' pain and function. Fascia is an often overlooked structure that can contribute to pain and various other symptoms. Fascia is a multilayered structure that interpenetrates and surrounds muscles, bones, nerves, and blood vessels, binding all of these together, and acupuncture has been shown to have specific effects on the fascia. There is evidence for the existence of myofascial meridians that span the body where separate muscles are mechanically linked through the fascia. Structure-based medical acupuncture (SMA) is based on the idea that the targets for acupuncture treatment are actual structures. Some meridians are myofascial meridians such as the Bladder (BL) and Gallbladder (GB) meridian, whereas others may be blood vessels or nerves, such as the Lung (LU) and Pericardium (PC) meridians, respectively. SMA was developed in China but utilizes both ancient and modern, Chinese and Western medicine concepts and understandings of human structure. Principles include that anatomy is foundational, manual manipulation is essential, tools (the needle) are an extension of the hand, and exercise and rehabilitation are the ways to prevent recurrences and maintain efficacy. SMA differs from more traditional TCM acupuncture in that imaging and physical exams are used to guide treatment, immediate pain relief is expected after treatment, and fewer treatment sessions are typically needed.