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Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
Particular types of studies have shown acupuncture to modulate the body’s system toward normality, or homeostasis. For these reasons acupuncture has been sought by patients both with autoimmune conditions, as well as where the immune system is compromised or underactive.
Compromised immunity or an overactive/autoimmune condition may have many causes, so we will cover the studies that may be linked and of interest, but we are still working on these pages to bring more detail and research.
Immunity is based upon many factors, but measurable aspects of it can include blood levels of particular blood cells, in particular, types of white blood cell.
Anti-Inflammatory Effects of Acupuncture: Neuro-Immune Modulated
A review article (Li et al, 2023) looked at 363 studies about the anti-inflammatory effects and mechanisms of acupuncture from the last five years. They concluded that acupuncture has a strong anti-inflammatory effect in multiple systems and diseases by regulating both local and systemic immune responses via neuro-immune regulation. Acupuncture was shown to modulate the immune cells and cytokines at the acupoint site and the target organs, within the immune, digestive, respiratory, nervous, locomotory, circulatory, endocrine, and genitourinary systems. Further, acupuncture activates the neuro-immune pathways in the brain and spinal cord to regulate inflammation, such as the cholinergic anti-inflammatory, vagus-adrenal medulla-dopamine, and sympathetic pathways, as well as the hypothalamus-pituitary-adrenal axis.
Wang et al (2023) reviewed evidence from animal and human studies regarding the immunomodulatory mechanism of acupuncture, regarding its effects on different components of the immune system, such as mast cells, macrophages, neutrophils, natural killer cells, astrocytes, microglia, CD4+ and CD8+ T cells, and cytokines. They detailed the neuroanatomical mechanisms of acupuncture in immunomodulation, such as the vagal-adrenal pathway, the cholinergic anti-inflammatory pathway, the spinal sympathetic pathway, the brain-gut axis, and the hypothalamus-pituitary-adrenal axis. They concluded that studies to support the role of acupuncture in regulating inflammation, infection, allergy, pain, and tissue repair.
Iatrogenic Bone Marrow Depletion
Shih et al (2023) carried out a systematic review and meta-analysis of the effectiveness of acupuncture in relieving chemotherapy-induced bone marrow suppression due to chemotherapy. Looking at 25 RCT’s (n=1713), they examined outcome measures of G-CSF (a type of protein that helps the body make more blood cells, particularly white blood cells); of white and red blood cell counts, neutrophils and natural killer cells counts. The results showed that acupuncture significantly increased the levels of G-CSF, WBC, RBC, NEU, ANC, Hb, PLT, and NK cells compared with control groups. The levels of PLT and NK cells also increased cumulatively over time. They suggested a role alongside conventional medicine for acupuncture in this area.
Immune Markers in Patients with Vascular Dementia
Zhi et al (2021; n=60) compared a vascular dementia group (VD) with a healthy control group to see if acupuncture can change the number and type of immune cells and molecules in the blood of patients with VD. This wasn’t an RCT, as they did not have a VD control group, so the findings can be interpreted with caution. They used blood tests to measure immune markers; Flow cytometry was used to count different types of immune cells, e.g. T cells, B cells, and natural killer (NK) cells. And ELISA was used to measure different inflammation markers, such as interleukins (IL), tumour necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ).
Acupuncture was found (in Zhi et al’s 2023 study) to increase CD3+ T cells, CD4+ T cells, and regulatory T cells (Tregs) in the blood of patients with VD. These are types of immune cells that help regulate immune responses and prevent excessive inflammation. Acupuncture treatment also decreased the level of TNF-α in the blood of patients with VD. TNF-α is a molecule that causes inflammation and can damage brain cells. The study concluded that acupuncture treatment may improve the immune system of patients with VD by changing the number and type of immune cells and molecules in the blood, the theory being that mediating neuroinflammation would be beneficial to VD patients.
CSR and ERP are blood tests related to the functioning of the immune system, that can measure and monitor inflammation in the body. They are relevant to conditions such as Rheumatoid Arthritis, and other immune and inflammatory conditions. Per a review by Feng at al, (2023) electroacupuncture (EA) plus medication had a significant effect in lowering both ESR and CRP levels in patients with RA compared with medication alone. These results suggest that EA may have an anti-inflammatory effect and improve the immune status of patients with RA.
Surgical Procedures and Immunity
Immune suppression can be a complication of major surgery, so Li et al (2013) carried out an RCT to examine the effect of electroacupuncture (EA) on immune function and point specificity in patients undergoing supratentorial craniotomy. With n=29 in three groups; control, EA group, and sham acupoints. EA partially reduced immune suppression after surgery, as measured by the levels of cytokines and immunoglobulins in peripheral blood, however without point specificity. They concluded EA may be a useful adjunct to general anaesthesia for improving immune function in patients undergoing major surgery, although sham acupuncture also produced some benefits, so further research in larger trials would be needed.
Measures of Immune / Inflammatory Biomarkers
Inflammatory and immune markers: Wang et al (2008) reviewed the evidence from 8 RCTs for acupuncture as a treatment for rheumatoid arthritis (RA) that compared acupuncture with placebo or active drug interventions. Five studies observed a reduction in the inflammatory/immune marker of ESR and three noted a reduction in CRP level after acupuncture treatment.
Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).
Effects upon the Synovial Pathway Activate Immune and Anti-Inflammatory Response
In an animal study, Sun et al, (2023) were able to show that electroacupuncture worked by blocking a pathway in the synovium called TLR2/4, that activates immune response and inflammation. The researchers therefore suggested the anti-inflammatory and analgesic effects of EA were related to the inhibition of TLR2/4 signalling on synovial fibroblasts and macrophages.
Reducing Inflammatory Cytokines in Animal Studies
Qi et al. (2014; n=60) investigated the effect of acupuncture on spastic cerebral palsy rats. The study found that acupuncture reduced the serum levels of inflammatory cytokines, which are molecules that promote inflammation. Acupuncture also improved the blood viscosity and erythrocyte electrophoresis indexes of the rats, which reflect the shape and flow of red blood cells.
Lisboa et al (2015) looked at the effects of electroacupuncture (EA) on experimental periodontitis in 32 rats over 10 days. Rats with induced periodontitis were divided into three groups: electroacupuncture; sham electric needles; or no treatment. A control group of healthy rats without periodontitis was also included. Post treatment measures included alveolar bone loss and periodontal ligament space around the teeth; osteoclast activity and number as indicated by RANKL and TRAP; and cytokine levels (IL-1β, MMP-8, IL-6, and COX-2) in the gums. The electroacupuncture group had less bone loss, less osteoclast activity and number, and decreased inflammatory cytokines; these suggest modulation of the inflammatory response.
Other Anti-Inflammatory Biomarkers in Animal Models
Liu et al (2014) investigated the anti-inflammatory effect of electroacupuncture (EA) in a rat tissue chamber model of inflammation. The study found that EA inhibited the p65 protein from moving to the cell nucleus to activate inflammatory genes. EA also increased the expression of IκBα, which binds to NF-κB and preventing it from entering the nucleus to activate inflammatory genes. These interfere with the IκB/NF-κB pathway that regulates inflammation, indicating one of the mechanisms of acupuncture in modulating immune / inflammatory response.
Mechanisms of Action
Per MacDonald et al (2015), acupuncture may: reduce inflammation by downregulating proinflammatory neuropeptides, cytokines, and neurotrophins; modulate immune function by altering the balance of Th1 and Th2 cells and suppressing mast cell degranulation; influence various receptors and signalling pathways that are involved in inflammatory response, such as TRPV1, opioid, chemokine, dopamine, and cannabinoid receptors; activate a novel cholinergic anti-inflammatory pathway that involves vagal and sciatic nerves and is mediated by dopamine.
Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)
Electroacupuncture (EA) has been shown in a rat model (Li et al, 2008) to have anti-inflammatory benefits by modulating the hypothalamic-pituitary-adrenal (HPA) axis, (HPA axis regulates the stress response and immune function). Specifically, Li et al outlined that EA sets off a cascade in the brain (via corticotropin-releasing hormone, and adrenocorticotropic hormone) to produce cortisol, which reduces inflammation and oedema.
Feng, Y., Zhang, R., Zhao, Z., He, Y., Pang, X., Wang, D. and Sun, Z., 2023. Efficacy and safety of electroacupuncture combined with medication for rheumatoid arthritis: A systematic review and meta-analysis. Heliyon.
Li, A., Lao, L., Wang, Y., Xin, J., Ren, K., Berman, B.M., Tan, M. and Zhang, R., 2008. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complementary and Alternative Medicine, 8(1), pp.1-8.
Li, G., Li, S., Wang, B. and An, L., 2013. The effect of electroacupuncture on postoperative immunoinflammatory response in patients undergoing supratentorial craniotomy. Experimental and Therapeutic Medicine, 6(3), pp.699-702.
Li, N., Guo, Y., Gong, Y., Zhang, Y., Fan, W., Yao, K., Chen, Z., Dou, B., Lin, X., Chen, B. and Chen, Z., 2021. The anti-inflammatory actions and mechanisms of acupuncture from acupoint to target organs via neuro-immune regulation. Journal of Inflammation Research, 14, p.7191.
Lisboa, M.R., Gondim, D.V., Ervolino, E., Vale, M.L., Frota, N.P., Nunes, N.L., Mariguela, V.C., Taba Jr, M., Messora, M.R. and Furlaneto, F.A., 2015. Effects of electroacupuncture on experimental periodontitis in rats. Journal of periodontology, 86(6), pp.801-811.
Liu, F., Fang, J., Shao, X., Liang, Y., Wu, Y. and Jin, Y., 2014. Electroacupuncture exerts an anti-inflammatory effect in a rat tissue chamber model of inflammation via suppression of NF-κB activation. Acupuncture in Medicine, 32(4), pp.340-345.
McDonald, J.L., Cripps, A.W. and Smith, P.K., 2015. Mediators, receptors, and signalling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture. Evidence-Based Complementary and Alternative Medicine, 2015.
Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.
Qi, Y.C., Xiao, X.J., Duan, R.S., Yue, Y.H., Zhang, X.L., Li, J.T. and Li, Y.Z., 2014. Effect of acupuncture on inflammatory cytokines expression of spastic cerebral palsy rats. Asian Pacific journal of tropical medicine, 7(6), pp.492-495.
Shih, Y.W., Wang, M.H., Monsen, K.A., Chang, C.W., Rias, Y.A. and Tsai, H.T., 2023. Effectiveness of Acupuncture for Relieving Chemotherapy-Induced Bone Marrow Suppression: A Systematic Review with a Meta-analysis and Trial Sequential Analysis. Journal of Integrative and Complementary Medicine.
Sun, S.Y., Yan, Q.Q., Qiao, L.N., Shi, Y.N., Tan, L.H. and Yang, Y.S., 2023. Electroacupuncture Alleviates Pain Responses and Inflammation in Collagen-Induced Arthritis Rats via Suppressing the TLR2/4-MyD88-NF-κB Signaling Pathway. Evidence-Based Complementary and Alternative Medicine, 2023
Wang, C., De Pablo, P., Chen, X., Schmid, C. and McAlindon, T., 2008. Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 59(9), pp.1249-1256.
Wang, M., Liu, W., Ge, J. and Liu, S., 2023. The immunomodulatory mechanisms for acupuncture practice. Frontiers in Immunology, 14.
Zhi, H., Wang, Y., Chang, S., Pan, P., Ling, Z., Zhang, Z., Ma, Z., Wang, R. and Zhang, X., 2021. Acupuncture can regulate the distribution of lymphocyte subsets and the levels of inflammatory cytokines in patients with mild to moderate vascular dementia. Frontiers in Aging Neuroscience, 13, p.747673.