Acupuncture and Immune Modulation
— Joseph Audette, MA, MD, AAMA Treasurer
In reflecting over the last few years about the role of acupuncture in medicine, I have become convinced that more than pain modulation, acupuncture can play an important role in immune modulation.
When we view the immune system through the lenses of acupuncture, we think initially of the organ function of Lung in Chinese medicine. But even with the enhanced view that the Chinese have of the Lung, including that Lung is integral to the creation of Wei (defensive) and Ying (nutritive) Qi and so is instrumental in the function of our immune system. The beauty of Chinese medicine is that you cannot think about the function of Lung without immediately bringing in its yang pair Large Intestine. Then, when we energetically connect these two meridians of the hand to their corresponding meridians of the leg, we have the circuit of Yang Ming paired with Tai Yin. This points in the direction of bringing in Stomach and Spleen as part of a comprehensive approach to using acupuncture to modulate the immune system. This holistic view of the immune function parallels our growing modern scientific understanding of the importance of the Gut and the microbiome to our immune function.
The gut microbiome can be affected by infections including bacterial, parasitic and importantly viral. The response can vary depending on an individual’s environmental and genetic make-up as well as overall gut health. There is a complex interplay between the gut microbiome and an individual’s immune system, as demonstrated by studies showing associations with allergy, inflammatory conditions, and respiratory diseases. It is now clear that COVID-19 can lead to GI symptoms but importantly, the state of an individual’s microbiome will have a major effect on the response of that individual to a COVID-19 infection. Some of the medical conditions that have been found to be major risk factors for severe COVID-19 infections including age, diabetes, cardiovascular, stroke, respiratory, and obesity are also conditions where there is a significant adverse alteration in the gut microbiome composition.
The autonomic nervous system plays a critical role in regulating our immune response. In particular, the cholinergic anti-inflammatory pathway involving activation of the vagus and parasympathetic system ties in well with the Chinese view of the Yang ming/Tai Yin circuit. There is evidence that many of the immune effects of acupuncture, which are believed to be mediated by the down-regulation of specific cytokines, such as IL-6 and IL1β, can be regulated through the vagus. One can hypothesize that the effect of acupuncture on the gut microbiome is also connected to vagus nerve modulation. More research is clearly needed to understand the mechanism by which acupuncture stimulation can influence the gut microbiome. However, a recent study of patients with Crohn’s disease showed that acupuncture was able to cause a significant enrichment of intestinal microorganisms.
All of these leads to consideration of treatment options to help strengthen the Gut-Immune access to help reduce inflammation and potential disease in our patients. Classically, the point Large Intestine 10 (LI10) is used to expel heat from the lung (reduce inflammation in the body). According to Nagano, a famous Japanese master, LI10 should be combined with KD6, GV14 and TW16 (Master Nagano’s immune points). Other points to consider are LU5 or the Lung He sea point, which is the influential point regulating the Lung organ. LU 8 is the metal on metal point in the five-element system and can be very tonifying to Lung. However, we also have to consider other aspects of the Yang Ming/Tai Yin circuit. In particular, we will want to regular the gut with key points on the Stomach and Spleen meridian. Classically SP6 and ST 36 are used to regulate digestion and help build Qi through the digestive function and can be combined with the Lung and Large Intestine points to enhance the immune modulatory effect with more direct influence on the gut. However, there are other options including SP 3 which is the source point and SP 8 which is the Xi cleft point. In Japanese acupuncture, instead of using ST 36 a set of points are used along the lateral aspect of the tibia called the Stomach Qi line.
When treating the Stomach Qi line, you are in effect stimulating the Lower He Sea points of the Large and Small intestine. In Chinese Medicine, the points are BL 37 and BL 39 respectively. However, the Japanese approach it to stay closer to the tibia and find fascial holes as you drag your finder down the enthesis of the tibialis anterior muscle and place the needles down with the flow of the meridian superficially in these points (see Diagram 1).
Another approach to regulate the Yang Ming/ Tai Yin circuit is to use an extraordinary vessel (EOV) combination of Chong Mai with Ren Mai. This is regulating to the Gut (Chong Mai) and the Lung (Ren Mai). Based on Master Kawai theory, when combining the command and couple points of two EOVs, it is energetically better to cross the points from, for example, the right foot to the left hand. I usually check which side of the body has greater tightness in the region of ST 30 and use that side to treat SP 4, the command point of Chong Mai. Then I cross over to the left arm to add the coupled point PC 6. That leaves the right arm for the command point of Ren Mai, LU 7 and the left foot for the coupled point KD 6 (see Diagram 2).
In summary, acupuncture can play a vital role in regulating the immune system and part of the mechanism may in fact be by regulating the gut microbiome. More research is needed, but early studies reinforce the Chinese theories of the energetic Yang Ming/ Tai Yin relationship.