How (I think) Acupuncture Works

Pam Chang, LAc

Sarana Community Acupuncture, August 2025

When I, a civil engineer by prior training, started studying acupuncture 20+ years ago, I had two questions:

1. Does acupuncture work?

2. And, if so, how does it work?

As to whether it works, experience has shown that acupuncture often works, sometimes immediately, sometimes gradually, sometimes not noticeably, and sometimes profoundly. In any case, people have subjected themselves to acupuncture for millenia-1 and my clients keep returning, so I have to assume that they are finding acupuncture beneficial. 

According to Traditional Chinese Medicine theory, acupuncture works by unblocking stuck energy. Energy flows continuously through the body, following the pathways of the acupuncture meridians, from internal organs to fingertips, from fingertips to head, from head to toe, and back to the internal organs, from meridian to meridian. When the flow is smooth and unobstructed, we experience good health. When the energy gets stuck, we feel pain, illness, and malaise. 

In acupuncture school and subsequent training, I learned where to place the needles. Over generations, acupuncturists have created a variety of methods for choosing where to insert needles. Many systems focus on meridian theory, thus, for example, needling a point in the hand along the lung meridian can treat a respiratory issue. Sometimes needle placement is based on ‘mirroring’ principles where, say, needles in the right elbow might treat left knee pain or top-of-the-head points might treat foot pain. Similarly, there are ‘hologram’ systems, like foot reflexology or Korean hand acupuncture, or ear acupuncture where the entire body can be mapped onto the foot, or hand, or ear, so that an issue anywhere in the body can be treated just by needling the foot (or hand, or ear). With scalp acupuncture, points on the scalp superficial to western-medicine - defined brain structures are needled to stimulate sensory and motor neurons. And finally, there are ‘empirical points’, ones that prior acupuncture masters have discovered as ‘go-to’ points for specific ailments. All of these systems seem to work. As community acupuncturists, we often mix and match systems depending on our own preferences and the specifics of each situation. 

In terms of western medicine, how acupuncture works remains speculative. Western anatomists have failed to find evidence of acupuncture channels although some acupuncture points have been found to be near bundles of nerves and blood vessels. Investigators surmise that acupuncture stimulates the body to release endorphins, the naturally-produced hormones that elevate mood and reduce pain. And blood tests in people and animals have shown that endorphin levels remain elevated for several hours after acupuncture treatment. But western science has not yet discovered the precise physiological mechanisms for how this happens.

Possibly, as one of my early clients stated, acupuncture is all placebo effect, another little-understood but powerful self-healing tool that we would do well to exploit-2. Perhaps community acupuncture taps into the placebo effect naturally by creating a setting where people feel supported as they connect with their own inner-calm and well-being.

Recently, I’ve found Daniel Keown’s 2014 book “The Spark in the Machine” which attempts to explain acupuncture in western medicine terms. Keown is a British physician, surgeon, and acupuncturist. He writes that acupuncture meridians exist in the interfascial spaces, the areas between the shrink-wrapping created by the connective tissue surrounding our muscles, tendons, bones, vessels, and organs. If you’ve sliced raw meat, you’ve encountered fascia, the clear membrane surrounding muscle compartments. According to Keown, anatomists fail to appreciate the interfascial spaces because these spaces appear collapsed and empty in dead specimens. Surgeons, however, see these spaces in living patients as expandable pockets for snaking laparoscopes or performing cuts without damaging adjacent muscles. And it turns out that interfascial spaces are conduits where hormones, fluids, and electricity can travel rapidly throughout the body. Moreover, they occur everywhere in the body, from fingertips to toes, to internal organs and around bones. Apparently, acupuncture needles may stimulate the body to send signals through the interfascial spaces to trigger a healing response.

While I still can’t know the mechanism for how acupuncture needles work, I can believe that needling causes body-wide electrical and/or chemical communication. In short, I can confidently believe that acupuncture unblocks stuck energy.

Notes:

1. Őtzi, the 5300 year-old mummified body of an ice age man, was found in the Tyrolean Alps in 1991. His body shows tattoos at 61 places, many of which are known acupuncture points. Researchers speculate that he used a form of acupuncture.

2. I recommend the book “Meaning, Medicine, and the ‘Placebo Effect’”, by Daniel E. Moerman, Cambridge University Press, June 2012