In 1991, on a trail high in the Austrian-Italian Alps, two hikers stumbled onto a man’s 5,000-year-old corpse. Now known as “Ötzi” the Iceman, the corpse bore more than a dozen clusters of skin tattoos.
Experts first assumed the tattoos were ornamental. But researchers have since noted that many of Ötzi’s inkings are located in places along his back and spine that correspond with traditional Chinese acupuncture points—points targeted for the treatment of digestive disorders. An analysis of Ötzi’s gut turned up the remnants of parasitic worms, and Ötzi’s pack contained a fruit known to help treat GI problems.
Experts broadly agree that acupuncture has been around since at least 100 B.C. While controversial, the Ötzi tattoo researchers say their findings suggest that a “treatment modality similar to acupuncture” may have existed more than 5,000 years ago.
If nothing else, acupuncture qualifies as a “time-tested” form of therapy. And while many conventional doctors and scientists dismiss it as pseudo-medicine, it’s hard to believe acupuncture could have persisted for millennia if there weren’t something to it. The research to date, while incomplete, suggests acupuncture may provide real therapeutic benefits.
What is acupuncture?
Traditional Chinese medicine holds that a sort of vital energy or life force—known as a person’s qi (pronounced or also known as "chi")—flows through the body along defined pathways or “meridians.” Diseases are believed to cause (or be caused by) disruptions or “disharmonies” in the flow of a person’s qi. The needle pokes we all associate with acupuncture are meant to correct or influence these disharmonies.
Some contemporary acupuncture practitioners play down the stuff about qi and meridians. Also, acupuncture comes in many shapes and sizes: for example, some acupuncturists incorporate electrical stimulation. But needle insertions in specific points are a universal trait of the therapy.
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From the perspective of conventional medicine, a therapy doesn’t “work” unless it both outperforms a placebo and does so via an identifiable “mechanism of action.” Like a high schooler taking a math exam, it’s not enough to for acupuncture to come up with the right answer—it also has to show its work.
A lot of researchers have gone looking for evidence that acupuncture “works,” but experts disagree in their interpretations of the study results. “There have been several recent meta-analyses [on specific conditions] that concluded acupuncture had a statistically significant benefit,” says Vitaly Napadow, an acupuncture researcher and director of the Center for Integrative Pain Neuroimaging at Massachusetts General Hospital and Harvard Medical School. “But depending on who you talk to, you’ll get different answers about whether they believe in specific acupuncture effects or if they think the role of placebo effect or expectancy made the difference.”
Napadow’s take: It’s not a panacea that will cure all ills, but there are some areas where acupuncture is promising and, given its safety profile, should be recommended. “I think its mechanisms depend on the disease it’s trying to treat,” he says.
For nausea- or pain-related conditions, acupuncture may activate nerve receptors in the skin that modulate levels of nervous system chemicals or signals involved in these ailments, he explains. Meanwhile, for conditions like arthritis or tendonitis, the micro-injuries caused by acupuncture pin pricks may draw blood and its healing elements to the affronted area—causing a temporary reduction in symptoms, he says.
But as of today, all these mechanisms are speculative and need to be confirmed by more research. There’s also debate over whether the stuff about qi or meridians is useful. Some studies that have compared sham acupuncture—basically, needles stuck in at random—to true acupuncture have failed to find a difference in patient outcomes, while others have concluded that legit acupuncture outperformed the sham procedure.
To sum all this up, everything to do with acupuncture is controversial. But for some conditions, the existing research suggests the practice may confer real and meaningful benefits.
Does acupuncture work for pain?
“This is the area where we have the most data,” Napadow says. And the results are encouraging.
A comprehensive 2018 review found that, for patients managing chronic pain, acupuncture outperformed a sham procedure and “standard” care, which usually meant pain pills. “If our study had been on a drug, we’d say the drug works—there’s a statistically significant effect there,” says Andrew Vickers, first author of that study and a biostatistician at Memorial Sloan Kettering Cancer Center in New York City.
Vickers' study focused on patients suffering from pain associated with four common ailments: back and neck pain, arthritis, shoulder pain, and headaches. Acupuncture was similarly effective for each of these conditions, his study found. Also, acupuncture’s benefits were durable: After a year of treatment, the average patient reported only a minor drop it its efficacy.
“It could be that acupuncture is just a very effective placebo,” Vickers says. But when you consider the lack of good treatment options for long-term pain—and the risks associated with prescription pain pills or surgeries—acupuncture is “a reasonable referral option” for patients with chronic pain, he says.
Can acupuncture treat gut disorders?
The evidence on acupuncture for gut problems is mixed. A 2017 study in Annals of Internal Medicine found that, for patients suffering from severe constipation, acupuncture significantly outperformed a sham procedure when it came to improving the frequency of bowel movements. But more research is needed to assess the long-term effects of acupuncture, that study’s authors write.
Meanwhile, a 2013 review from a group of Chinese researchers found evidence that acupuncture may beat out some common prescription drugs for the treatment of inflammatory bowel disease (IBD). But the authors of that review say the studies they turned up were generally of “low” quality. A 2007 review from a German team linked acupuncture with significant improvements in quality of life and “disease activity scores” (a measure that determines whether symptoms have reduced) among patients with Crohn’s disease and ulcerative colitis—the two most common forms of IBD. But the authors of that review say the studies they turned up were generally of “low” quality—meaning the design or execution of the studies was poor, and so the results are shaky.
Long story short, the jury’s still out.
Does acupuncture work for fertility?
Proponents of acupuncture have long recommended it for female menstrual health and fertility. And a 2014 research review from Australia found “preliminary” evidence that acupuncture could help regulate a woman’s menstrual cycle and “assist” healthy ovulation.
How (in the hell) could it do that? Some research has hypothesized that acupuncture may help stimulate and also regulate uterine and ovarian blood flow, which could help thicken the lining of a woman’s uterus, which in turn could facilitate embryo implantation and successful pregnancy. But all this is theoretical.
A 2018 study, also from Australia, tracked more than 800 women undergoing in vitro fertilization (IVF). It found no significant uptick in successful births among those who underwent acupuncture versus those who didn't.
Can acupuncture treat depression?
Again, the research is all over the map. A 2010 review found “insufficient” evidence backing acupuncture for the treatment of depression. But, more recently, a team of UK academics determined that there was “promising” clinical evidence showing acupuncture could help treat depression—enough to warrant further research.
It’s probably worth noting that, even when it comes to prescription antidepressants (namely, SSRIs), there’s considerable expert disagreement about whether these pills outperform placebos. While the data on acupuncture for the treatment of depression is inconsistent, some studies suggest it’s “at least” as effective as prescription drugs.
Does it work for anything else?
Pick a medical condition or mental health disorder, and there’s probably some evidence suggesting acupuncture may help treat it. But the reality is that, as of today, experts are still trying to wrap their heads around acupuncture and its role in medicine.
There are two things that can be said for acupuncture: It’s relatively inexpensive, and it comes with very few side effects, Napadow says. If the alternative is an expensive procedure or pills—especially opioids or other medications with serious side effects—you lose very little by giving acupuncture a try first, he adds.
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This article originally appeared on VICE US.