- Anna Lunaria, L.Ac.
Mind-Body Medicine: Acupuncture is Applied Psychoneuroimmunology
What is PNI?
Did you know there is abundant high quality biomedical scientific and clinical research that specializes in exploring how Mind-Body Medicine works? This innovative interdisciplinary field of medical research is called Psychoneuroimmunology (PNI) (more accurately is PNEI, or PsychoNeuroEndoImmunology). PNI research studies how the mind, emotions, behavior, nervous, endocrine and immune system interact. Scientific, clinical, epidemiological and empirical evidence is accumulating that verifies that human emotions/mind and physiological health have a bidirectional influence on one another.
PNI scientific research provides evidence that both informs and validates Mind-Body Medicine (MBM). Examples of ancient MBM include Acupuncture and Yoga, which predates PNI by thousands of years. Evidence informed MBM treatments that integrate PNI research can optimize patient outcomes: restoring health and wellbeing with evidenced based protocols. PNI research provides evidence for how and why we have profound interconnection between psychological states and behavior and the functioning of our nervous, endocrine and immune systems. This integrative fields of study are the scientific foundation of the modern MBM.
Why is PNI revolutionary field of research for biomedical medicine? There are two reasons: one philosophical and the other pathophysiological. During the dawn of science, Rene Descartes posited that our thoughts and our emotions were non-physical and the physical body and pathology were non-emotional. There is speculation that DeCarte declared this in order to win the consent of the Church to continue his research. This set up a mind-body dualism that continues to influence both research and the practice of allopathic, biomedical medicine. This mind-body dualism created a heavy bias against ancient medical traditions to espouse Mind-Body unity. Scientifically PNI is revolutionary because bodily systems that were once considered independent of one another, such as the nervous system and the immune system, are actually integrated and bidirectionally influenced.
PNI researchers come from many different fields including: immunology, neurology, endocrinology, genetics, molecular biology, neurobiology, neurochemistry, psychopharmacology, psychology, behavioral medicine, infectious diseases. rheumatology, oncology and more. A key central insight is that chronic stress leads to chronic inflammation, dysregulated immunity and suppressed neurotransmitters. A pioneer in the PNI field was Dr. Candace Pert who discovered opioid receptors in the brain in 1978 as a graduate student in Neuroscience. Dr. Pert posited that if illness has a psychosomatic component we can also harness the bidirectional influence to create psychosomatic wellness.
What is Applied PNI?
Applied PNI channels this bidirectional influence to heal chronic health concerns and promote enhanced wellness for healthy people. Applied PNI encourages patients to acknowledge and consciously process and resolve stuck emotional states to positively influence health. Examples of PNI include: meditation, deep breathing, creative visualization, hypnosis, yoga, tai chi, Qi Gong, progressive relaxation, neurofeedback. Being in a ‘flow state’ for example while running, hiking, forest bathing, gardening, creating art when the mind is in the present moment unified with the actions or sensations in the body is Applied PNI.
Acupuncture is excellent example of Applied PNI: we have abundant evidence that Acupuncture is excellent in the treatment of body-mind issues. A recent systemic review of clinical research for anxiety found good evidence that electroacupuncture is effective in the treatment of anxiety (Amorim, 2018). Another recent systemic review and meta-analysis found that acupuncture is effective for depression related insomnia (Dong, 2017). Acupuncture is rooted in centuries of empirical clinical efficacy: this ancient medical tradition has been handed down from generation to generation. Acupuncture is one branch of Traditional East Asian Medicine (TEAM). TEAM medical theory states that the internal cause of disease can be due to stuck intense emotional states. Acupuncture has been helping humans resolve health by resolving stuck emotional states that cause dis-ease for over 2,500 years. TEAM and Acupuncture are cost-effective and pragmatic clinical applications of MBM/PNI evidence and theory.
Why do we need PNI/MBM?
Modern society is plagued by chronic stress. Stress causes a cascade of physiological changes in the body that debilitate health. Stress is health epidemic: 77% of people experience stress that effects their health. 73% of people says stress effects their mental health. 75% of all doctor visits are often for stress related or stress exacerbated health conditions. PNI research has found that stress can lower your immune system and make you more susceptible to pathogens like viruses (Calabrese, 1987). Our grandmothers and Eastern Medicine practitioners were right! Exposure to cold is a stressor that can make you more susceptible to catching a cold or flu!
When a public health problem is clearly understood, such as chronic stress, we can direct people to the best therapeutic interventions. PNI research reveals that a stressed person exhibits both mental and physical symptoms: depression, anxiety, disturbed sleep patterns along with impaired immunity and dysregulation of neuroendocrine and sympathetic nervous system. Stressed and depressed animals and humans both tend to have elevated levels of a neuropeptide called Corticotropin Releasing Hormone, CRH. CRH has been shown to influence behavior as well as regulates the sympathetic (fight, flight or freeze) nervous system and neuroendocrine functions. CRH influences digestion and eating behavior, arousal, energy metabolism and cardiovascular function. CRH is the precursor to the release of cortisol during the fight-flight-freeze sympathetic nervous system response. CRH and cortisol are part of the hypothalamic-pituitary-adrenal (HPA) axis. CRH is higher in depressed and anxiety prone people. CRH is higher in those prone to addiction. High levels of CRH suppress immunity. (Irwin, 2008) Research indicates Acupuncture increases resilience to stress by blocking the elevated levels of CRH, the HPA stress neuropeptide (Eshkevari, 2013).
A study done at Carnegie Mellon University by Dr. Sheldon Cohen showed that chronic stress that lasted longer than a month doubled the risk of catching a cold. Their investigation lead to the discovery that chronic stress causes higher levels of pro-inflammatory cytokines and that elevated levels of cytokines determined the severity of cold symptoms (Cohen, 2012). Elevated levels of inflammatory cytokines are also found in those with depression, anxiety, Bi-Polar and PTSD (Fleger, 2018).
The interaction between the body’s current state of health and the immune system’s interaction with a virus is relevant for Covid-19 complications via cytokine ‘storms’ and bradykinin driven inflammation. A recent Harvard study published in Neuron confirms previous research that Electroacupuncture downregulates cytokine driven inflammation before and after infection. Animals who received electroacupuncture before infection increased survival rates from 20% to 80% by preventing the proinflammatory response (Liu, 2020).
There is good evidence that acupuncture attenuates the immunosuppression effects of stress during perioperative (before, during, after) surgical experiences. Acupuncture reduces the release of cytokines and other pro-inflammatory cells while increasing Natural Killer (NK) and other immune cells as well as ‘feel good’ endorphins and endogenous opioids. Receiving acupuncture before surgery correlates with needing less anesthesia, reduced nausea and vomiting post-operatively, decreased post-op pain, more quickly normalized bowel movements post-op while accelerating healing (Xu, 2020).
PNI research found those with emotions such as depression and another risk factor such smoking increases the likelihood of disease developing. Repressed emotions are one factor of chronic stress. Repressed emotions have been linked to cancer because stress lowers our natural NK cells. NK means Natural Killer, these cells recognize and destroy cancer cells. Electro-Acupuncture promotes the production and release of NK cells while also lowering inflammation and modulating the immune, nervous and endocrine system. (Francis, 2010 and Johnston, 2011).
Benson MD & colleagues designed a study about what happens during an 8-12 Week Relaxation Response class. They took a DNA sample before and after. The results were dramatic. In just 8 weeks 1,561 genes changed expression. The probability of this happening randomly was less than 5 in 100. The genes that got turned on were health associated: telomere repairs and lengthening, lowered psychological stress, regulation of immune system, decreased oxidative stress and reduced premature aging. The genes that got turned off are associated with energy/metabolism, cardiovascular disease, insulin secretion and inflammation (Bhasin, 2013). Any form of consistent relaxation response activity will induce these changes. It can be hard for many people to relax. Acupuncture is naturally sedating as it releases adenosine, a natural sedative, analgesic and vasodilator (Goldman, 2010). Acupuncture also well-established releases endorphins and endogenous (self-made) opioids.
In a systemic review of clinical treatments of applied PNI treatments, acupuncture was found to be helpful for anxiety and depression. ((Liu, 2015, Irwin, 2007). A randomized controlled clinical trial measuring neuro-inflammatory markers for depression, acupuncture was found to be better than medication. This cross sectional study measured cortisol and anxiety found that anxiety patients had elevated markers of tumor necrosis factor (TNF-a: an type of inflammatory cytokine) and cortisol and had lower levels after acupuncture (Arranz, 2006).
An important caveat: PNI and MBM should not be used to ‘blame’ patients with diseases for their illness by acknowledging underlying mental/emotional components of illness. Doing so is a distortion of PNI/MBM and can undermine treatment and prognosis if either patient or practitioner embrace black and white dogmatic belief. For example. pilots and flight attendants have a higher than average rate of cancer. Research into why this occurs include both physiological and emotional factors such as exposure to jet fuel and cosmic radiation, circadian dysrhythmia, mild hypoxia, stress and many other factors. While airline employees can do nothing about the physical factors of potential illness, they can be encouraged to use MBM to manage the impact of stress emotional and become more physiologically resilient to stress.
Acupuncture/TEAM is Applied PNI
According to Acupuncture and Traditional East Asian Medicine (TEAM) theory: there are both external and internal causes of disease. The internal causes of disease are linked to getting ‘stuck’ in an intense emotional state(s). It’s normal and healthy to experience a broad spectrum of feelings. Imbalance and disease results from getting ‘stuck’ in an emotional pattern. When we become stuck in any emotional state it has a ‘toxic’ effect leading to disease and chronic pain/disease. Chronic stress induces a ‘stuck’ mental/emotional state and causes myriad health concerns.
Acupuncture and Eastern Medicine theory have always correlated stuck emotions with specific organs and body functions. Acupuncture points are selected to return balance to the body-mind. According to Acupuncture theory, the Shen must be treated first. Shen means heart but it also means Mind. Honoring this tradition means creating patient centered treatments that acknowledge a patients mental-emotional state as a primary and initiating factor for treating their bodily health concerns.
Long before emotions cause disease, they affect the flow of our Qi. In this context, it is most helpful to interpret Qi as energy flow, even though it’s more complex than this and can also be understood as peptides, metabolism, cellular function, thought process, intelligence and ability to reason and be creative. There are specific acupuncture points to ‘release’ us from and liberate our Mind-Body from toxic emotions and restore health!
Before anxiety and stress lead to disease, these chronic emotions disturb our ability to enjoy a calm, focused, alert state of mind. We might experience an inability to focus, a chronically distracted state of consciousness, forgetfulness and memory impairment.
Acupuncture points along the Heart, Small Intestine, Pericardium, and Triple Warmer (also known as Triple Burner or San Jiao) meridians help to quell anxiety and stress. These points calm the mind and regulating ability to shift from the sympathetic nervous system (the fight, flight or freeze function) into the parasympathetic nervous system (the rest, digest, and restore function). These points help us dwell in the Present moment and let go of the future.
“If you are depressed you are living in the past.
If you are anxious, you are living in the future.
If you are at peace, you are living in the present.”
Chronic worry depletes Qi. Imagine a hamster on a wheel: spending Qi going nowhere. Those who worry constantly tend to have very low energy. This makes it hard to change habits.
Acupuncture points along the Stomach and Spleen meridians can free us from chronic worry and instead shift the mind to positive and productive mental executive function. Imagine how much you could accomplish if you could have more energy and apply your mind in a positive direction!
Grief scatters Qi with feeling unable to gather momentum and feel as insubstantial as a ghost: this makes it easy to get stuck in the maze of grief. Grief is a multi-emotional experience over time. Acupuncture points along the Lung and Large Intestine channel helps us heal during the grieving process, gathering and boosting our protective(immunity) Qi. These points return our vitality: they can help us shift from merely surviving the loss of a loved one to once again thriving. Grief is a many layered ‘sticky’ emotional ‘soup’ and includes feelings of sadness, denial, anger, depression, anxiety. Unresolved grief has been shown to increase pro-inflammatory cytokines (O/Conner, 2009). PTSD and Complex PTSD are unresolved grief responses.
Anger makes Qi and Blood stagnate. Stagnate Qi is the biggest cause of most pain, tumors and gallstones (and other forms of ‘phlegm stagnation; including ‘plum pit Qi’ a sensation that something is caught in the throat but being unable to completely clear it). Anger zaps our ability to plan and erodes our courage to act in the world. Acupuncture points along the Liver and Gallbladder transforms anger into inspired vision with the sustained energy and courage needed to manifest this vision into reality. Depression is often internalized anger. Electroacupuncture decreases depression by regulating proinflammatory cytokines (Song, 2009)
Unresolved anger is often the underlying root cause of PTSD (Durham, 2018) and Complex PTSD. In a randomized control study acupuncture was found to be effective in improving PTSD symptoms (Engel. 2014). Evidence indicates that PTSD is not merely a behavioral and psychological phenomenon but also associated with dysregulated immune and inflammatory conditions. Acupuncture helps move and resolve anger while also resolving pro-inflammatory markers that contribute to the pathological development of autoimmune, cardiovascular and metabolic disorders (Hori, 2019).
Fear makes Qi sink. When Qi sinks, we lose inspiration, creativity, and faith. We lose hope. It’s hard to imagine a positive future. We lose our connection to something greater than ourselves and feel lost, alone, isolated. This makes is challenging to ask for help or to see beyond the ‘filter/blinders’ of our fear. Acupuncture points along the Kidney and Bladder meridians can restore the flow of Qi. Reinvigorating our drive to live. Revitalizing faith/inspiration that life has purpose and our experiences/action have meaning. Oxytocin reduces anxiety and fear. Electro-Acupuncture prompts the body to releases oxytocin (Zhang, 2015).
Receiving acupuncture regularly helps us keep our emotional Qi flowing by improving our ability to discern the nuances of our emotional experiences while simultaneously liberating us from getting stuck in the quagmire of toxic emotions.
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