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.

Interpreting the research:

When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms.  The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment).  In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.

The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control).  Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.

The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.

The Research:

Acupuncture use is well-documented for digestive system conditions. A large body of research supports the hypothesis that acupuncture influences digestive tract physiology in a number of ways. Significant portions of the neural pathways for these effects have been shown in animal model studies. Studies have examined acupuncture for the expulsion of gallstones (Diehl, 1999).

The WHO (1996) has said that “acupuncture shows good analgesic and antispasmodic effects on the biliary tract […] not only effective for relieving the colicky pain, but is also useful for expelling the stones”.  62-64, 138, 139

An RCT (Wu, 1987; n=365) looked at auricular (ear) points for gallstones and looked at stool samples to see whether gallstones has been excreted, finding that they were more likely to have been passed by the acupuncture patients than the controls, hinting that the acupuncture had helped the excretion process.  Checks with ultrasound confirmed this.

Song et al (2006; n=120) compared 2 groups, acupuncture versus a Chinese medicine protocol, finding positive effects for acupuncture in gallstones and improving spasm and pain.  Other similar studies looked at how acupuncture could strengthen gallbladder contraction and bile secretion to clear gallstones, finding positive trends for acupuncture in these regards (e.g. Zhao, 2017; Wang et al, 2011; Xuemei et al, 2006).

Chen et al (2019), in a review of TCM and acupuncture for gallstones, also hypothesise that as well as the regulation of gallbladder motility, acupuncture’s known anti-inflammatory effect may also be at play.

Mechanisms of Action:

Zhao et al, 2017  used acupoints ST25, LR14, GB34 and ear point CO11 in an animal model to investigate its effect on gallbladder pressure and Sphincter of Oddi (SO) motility.  Whilst ST25 or LR14 increased SO myoelectrical activity and decreased gallbladder pressure; points GB34 or CO11 decreased SO myoelectrical activity and increased gallbladder pressure, showing a direct physiological connection with acupoint use and physiological response in the gallbladder.

Hao at al, 2022 theorised that improving gallbladder motility is a key part of managing gallstones, and they used an animal model, looking at the mechanisms of action of this process, using RNA sequencing to see which genes in the gallbladder are influenced by electroacupuncture at  the Gallbladder 34 acupoint, and suggesting that that EA achieved the effects by modulating the metabolism. 

Earlier animal models had shown similar promise, for example Ma and Yang (1996), where electroacupuncture at GB34 and 24 increased the action and electromyogram of SO, as well as the secretions of hepatic bile, and decreased the formation of gallstones, and the cholesterol content of the bile, all helping to discharge any gallstones.

A study is awaited, the protocol for which was published in the BMJ (Sun et al, 2022); to investigate the prompt pain-relieving qualities of acupuncture for of biliary colic (BC), and its impact on peripheral acupoint sensitivity and brain activity. A RCT (n=72), will involve acu-puncture vs placebo. Brain activity will be monitored using functional near-infrared spectroscopy (fNIRS), during treatment, and pain related measures will be examined.

A further study (protocol Sun et al, 2021) is awaited where the researchers will look at brain scans (fMRI) in the use of acupoints GB34 and EX-LE6 for biliary colic, to see what is occurring in which areas of the brain upon treatment, and which point is more effective. 

References:

Chen, Q., Zhang, Y., Li, S., Chen, S., Lin, X., Li, C. and Asakawa, T., 2019. Mechanisms underlying the prevention and treatment of cholelithiasis using traditional chinese medicine. Evidence-Based Complementary and Alternative Medicine, 2019.

Diehl, D.L., 1999. Acupuncture for gastrointestinal and hepatobiliary disorders. The Journal of Alternative and Complementary Medicine, 5(1), pp.27-45.

Hao, M., Dou, Z., Xu, L., Shao, Z., Sun, H. and Li, Z., 2022. RNA Sequencing Analysis of Gene Expression by Electroacupuncture in Guinea Pig Gallstone Models. Evidence-Based Complementary and Alternative Medicine, 2022.

Ma, C. and Yang, W., 1996. The preventing and treating effects of electro-acupuncture on cholelithiasis in golden hamster. Zhen ci yan jiu= Acupuncture Research, 21(4), pp.68-72.

Song, M.P., 2006. Clinical observation on frequency-changeable electroacupuncture for treatment of cholelithiasis. Zhongguo Zhen jiu= Chinese Acupuncture & Moxibustion, 26(11), pp.772-774.

Sun, N., Zhou, Y.F., Zhou, J., Zuo, W.W., Ye, X.Y., Deng, X.D., Li, Z.J., Cheng, S.R., Qu, Y.Z., Zhou, J. and Sun, R.R., 2021. The cerebral mechanism underlying the acupoints with specific effect for gallbladder stone disease: protocol for a randomized controlled task-fMRI trial. Trials, 22(1), p.399.

Sun, N., He, D.M., Ye, X., Bin, L., Zhou, Y., Deng, X., Qu, Y., Li, Z., Cheng, S., Shao, S. and Zhao, F.J., 2022. Immediate acupuncture with GB34 for biliary colic: protocol for a randomised controlled neuroimaging trial. BMJ open, 12(1), p.e050413.

Wang, G.M., Wen, F.Y., Li, L.X., Zheng, H., Huang, Y.H. and Song, Y.Q., 2011. Observation of effect on contraction function of gallbladde by acupuncture at Jianjing (GB 21). Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 31(10), pp.910-912.

WHO (1996) Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials By World Health Organization

Wu, X., 1987. Auricular pressure in the treatment of gallstones: A randomized, clinical trial of traditional chinese medicine. Hepatology, 7(4), pp.781-784.

Xuemei, C., Jiaping, T. and Ling, W., 2006. Treatment of cholelithiasis by acupuncture and oral decoction. Journal of Traditional Chinese Medicine= Chung i tsa Chih Ying wen pan, 26(3), pp.167-169.

Zhao, J., Yu, Y., Luo, M., Li, L. and Rong, P., 2017. Bi-directional regulation of acupuncture on extrahepatic biliary system: an approach in guinea pigs. Scientific Reports, 7(1), pp.1-11.

Resources: British Acupuncture Council evidence based factsheet about Kidney Stones, which also covers Gallstones research, including specific research, trials and mechanisms of action for acupuncture in this condition.