How Does Acupuncture Work?

Chanta Sloma, DACM, LAc

If you’ve ever experienced acupuncture—or are simply curious—you may have found yourself wondering: How does placing hair-thin needles into the body actually affect health? While acupuncture has been practiced for thousands of years, modern science is just beginning to uncover how it works.

fMRI Images of brain activity changes with acupuncture points Liver 3 (LV3), Liver 2 (LV2), Stomach 44 (ST44), and a sham acupuncture point (Sham). Hui KK‑S et al. Limbic‑paralimbic‑neocortical network modulation by acupuncture. Hum Brain Mapp. 2005.

A Skeptic Acupuncture Student

When I was learning acupuncture needling techniques, I was the skeptical one. I can still hear Dr. San Hong Hwang, one of the most respected and beloved teachers at SCU, saying “More! Deeper!” while coaching students practicing needle insertion and manipulation for the first time. Every time Dr. Hwang insisted we had to elicit the “qi sensation” or “deqi”—that distinctive heaviness, warmth, or dull ache signaling “the Qi has arrived”—I quietly rolled my eyes, assuming this was surely a “smoke and mirrors” tactic. It wasn’t until years later, reading a stack of acupuncture research studies, I discovered that deqi, the qi sensation, actually signals we are communicating with the patient’s central nervous system and their brain is lighting up in real time! The experience reminded me that tradition often leads the way long before science catches up, and it taught me to honor both the clinical wisdom of my teachers and modern data.

Two of my teachers, Dr. San Hong Hwang (right) and Dr. WenShou Wu (left). Source Link

Four Major Pathways

Acupuncture’s effects are multifaceted; no single mechanism explains everything we observe clinically. Below is a overview of four major pathways, each backed by peer‑reviewed research.

1. Neurochemicals

   Acupuncture can prompt the body to release its own pharmacy of chemicals:

   • Endorphins & enkephalins – natural painkillers that dampen pain signals.

   • Serotonin & dopamine – mood‑regulating neurotransmitters that can improve sleep and emotional well‑being.

   • Cortisol modulation – helping fine‑tune the stress response and inflammation.

   Han 2004; Zhao 2008; Ulett et al. 1998

   
   

2. Nervous System “Reboot”

   Needle stimulation travels via A‑delta and C fibers to the spinal cord and brainstem, damping pain pathways (the “gate‑control” effect”) and re‑calibrating how the brain processes discomfort and stress. Zhao 2008; Chae 2013; Zhang et al. 2021

   
   

3. When Qi Arrives: fMRI Glimpses of Deqi

   Those Deqi sensations Dr. Hwang was so eager for? Functional MRI studies show they coincide with:

   • Activation of somatosensory cortex (body awareness)

   • De‑activation of limbic structures tied to pain rumination and stress

   • Modulation of the default‑mode network, a hub for self‑regulation

   These patterns correlate with both pain relief and that unmistakable post‑treatment calm.

   Furthermore, each acupuncture point has a unique imprint on brain activity, which may explain why acupuncture can treat so many different internal medicine disorders – it affects the central nervous system’s processing and regulation of many bodily functions.

   Hui et al. 2005; Napadow et al. 2009; Kong et al. 2013

   
   

4. The Connective‑Tissue Network

   Rotating a needle gently winds collagen fibers, sending mechanical signals along fascia—the body‑wide web that wraps every muscle and organ. Fibroblasts respond by reshaping their cytoskeleton and adjusting cytokines, a possible route for reducing inflammation and improving mobility.

   Langevin et al. 2001; Langevin et al. 2011; Subcutaneous‑Tissue Fibroblast Study 2006

   
   

Why Multiple Mechanisms Matter

Think of acupuncture as a well‑conducted orchestra: endorphins, nerve pathways, brain networks, and connective tissue all play their parts. Together they create a therapeutic harmony greater than any single instrument could achieve.

Tradition Meets Tomorrow

My own journey—from raising an eyebrow in class to relishing the look of relief on a patient’s face—mirrors the field’s evolution. Ancient practitioners described Qi flow; today’s researchers map neurotransmitters and neural circuits. Different languages, same song.

So the next time you feel that gentle tug, spreading warmth, or heavy dull ache during treatment, know that your body and brain are engaged in a measurable conversation—one that spans millennia and cutting‑edge science alike.

Selected References

• Han JS. Acupuncture and endorphins. Neurosci Lett. 2004.

• Zhao ZQ. Neural mechanisms underlying acupuncture analgesia. Prog Neurobiol. 2008.

• Ulett GA, Han S, Han JS. Electroacupuncture: mechanisms and clinical application. Biol Psychiatry. 1998.

• Chae Y et al. An fMRI study of acupuncture analgesia in experimental pain. Pain. 2013.

• Zhang R et al. Central mechanisms of acupuncture analgesia: neuroimaging evidence. Front Neurosci. 2021.

• Hui KK‑S et al. Limbic‑paralimbic‑neocortical network modulation by acupuncture. Hum Brain Mapp. 2005.

• Napadow V et al. Brain correlates of acupuncture: fMRI studies in humans. Neuroscientist. 2009.

• Kong J et al. Exploring the brain in pain: activations, deactivations & network switching. Brain Imaging Behav. 2013.

• Langevin HM et al. Mechanical signaling through connective tissue. FASEB J. 2001.

• Subcutaneous‑tissue fibroblast cytoskeletal remodeling induced by needle rotation. J Cell Physiol. 2006.

• Langevin HM et al. Connective tissue: a body‑wide signaling network? Med Hypotheses. 2011.