Cannabis and Acupuncture

Cannabis and Acupuncture: These Ancient Approaches to Health and Healing Share Commonalities That Are Being Scientifically Validated Today

Acupuncture, a tool of Traditional Chinese Medicine (TCM), involves the use of very fine needles that are placed very specifically on strategic points along or near the body’s subtle-energy channels or meridians. TCM posits that our life force, called qi (or chi), circulates through the meridians. In the Mandarin language, qi is synonymous with breath. According to TCM, if qi is blocked, out of balance, or weak, pain or disease results as a warning that something is wrong and needs adjusting. The general idea here is that to attain and maintain health and vitality, one must unblock, balance, and cultivate a healthy and free-flowing chi. 

Graphic 1: Vitruvian wo/man by Tim Sunderman.

Many of you may know that acupuncture has been used for thousands of years to reduce pain and treat a large number of conditions. What you may not know is that in a recent human trial (2016) conducted on hundreds of emergency-room patients with acute pains from various origins, acupuncture actually worked better than morphine.¹ Some may argue that this must be the “placebo effect,” which would make sense if the trial was conducted in a culture where belief in the healing effects of acupuncture is commonplace, such as China or Vietnam. However, this trial was conducted in emergency rooms in Northern Africa, thus shooting a hole in the placebo/belief-based theory. 

Until very recently, the underlying mechanism—or the scientific, molecular, and physiological basis for acupuncture’s therapeutic effects—was poorly understood by orthodox Western medicine (though the TCM-based paradigm has always understood the mechanism in its own terms). Generally it has been hypothesized in the West that acupuncture produces common therapeutic effects such as pain relief, nausea reduction, or anti-inflammatory actions via the activation of endogenous opioids aka endorphins: healing and “feel-good” substances that are released (activated) when particular receptor sites are targeted by a medicine, food, chemical, or by the impact of a tiny acupuncture needle. Importantly, receptors are also key to the efficacy of cannabis.

The study of cannabis offers a fresh perspective on the ability of acupuncture to heal the human body. Research on cannabis and cannabis-containing products by the emerging cannabinoid health sciences is bringing new insights to many old puzzles. Consider this: It is estimated that the human body is composed of approximately 20 trillion individual cells, which are roughly divided into 11 organ systems. And one of the major forces that produce homeostasis (balance) among all the body’s systems is the recently discovered regulatory mechanism called the endocannabinoid system. Embedded in the cellular membranes of a majority of the cells that make up each of these organ systems are the “doorways” called receptor sites. Once a door is opened (i.e., once a receptor is chemically engaged), a number of specific physiological changes occur that can affect body, mind, and emotions. 

There are multiple types of doorways/gateways, each producing a specific effect. For example, if you wish to realize an anti-inflammatory effect, you need to unlock the proper door. To achieve analgesia you need to open yet another one, and so forth. To date, science has demonstrated the existence of more than 30 endocannabinoid system-based gateways or doors that, once opened, produce a distinct effect. As you might imagine, every door requires a specific key to unlock it. 

Graphic 2: Endocannabinoid receptor sites are abundantly distributed in every organ system. 

The Keys to Healing

The myriad different cannabinoids work as keys to the receptors’ doors. Cannabinoids can be categorized in three forms: those primarily found in cannabis (phyto-cannabinoids), those made by the human body itself (endocannabinoids), and those that are man-made in a lab (synthetic cannabinoids). To date, four endocannabinoids have been discovered (a couple of prospective ones are waiting to be confirmed), a little less than 150 cannabinoids are found in cannabis, and hundreds of synthetic ones have been isolated. 

Not all cannabis constituents are of equal importance. Some occur only in very small amounts. The two plant-based cannabinoids that tend to occur most abundantly are THC and CBD. As it turns out, these are responsible (alone and in certain ratios to each other) for producing the majority of effects on human physiology and the psyche that cannabis is capable of. Thus far more than fifty mechanisms and pathways of therapeutic action have been ascribed to THC alone and more than thirty to CBD. 

Similarly, to acupuncture, one of the primary reasons why cannabis works for so many different patient populations is because it affects the body and mind in such a way as to support and fortify the body’s capacity for self-healing. The right type of cannabis, at the appropriate dosage, matched to meet the specific need of each individual patient, will do so in two ways. One, it will produce a deep sense of relaxation, and two, it will produce multiple-system homeostasis at a cellular level. 

Among the many proven therapeutic benefits of relaxation, a deeply relaxed mind allows for the emergence of otherwise intolerable emotional material without the recoil or aversion so commonly associated with addictive behavior or certain anxiety disorders such as PTSD. Many cannabis-using patients report that this simple process itself—this cannabis-induced mental-emotional more relaxed attitude—can be cathartic and therapeutic. An open and relaxed frame of mind allows for the release of emotional blockages and a shift from the commonly fear-based beliefs that often give rise to disruptive emotions. Even a temporary shift in the internal architecture of the mind can unblock, balance, and cultivate freely flowing emotions, and with this comes change in the emotions’ biological counterparts (i.e., neurotransmitters, hormones, signaling proteins). This process contributes to homeostasis at a cellular level in all organ systems. It can be posited that it is this capacity of emotions and physiology to align that is the biological basis for mind-body medicine.

Indeed, what is truly new and exciting in medicine at this point in time is that we can now see in a number of very specific ways how both acupuncture and cannabis-based approaches to healing pain, illness, and disease are based on similar mechanisms. 

Acupuncture, Cannabis, and the Endocannabinoid System: Today’s State of Science 

To better understand the potential practical implications for patients and health care providers alike, it may help to consider the following recent scientific discoveries (presented in mostly chronological order as a mini-review).

One of the earlier modern scientific papers published about the mechanism by which acupuncture is able to produce analgesic effects comes to us from Shanghai, China (2009), where researchers discovered that electroacupuncture (EA) works well in reducing inflammatory pain (in rats) because it activates the endocannabinoid system (ECS). More specifically, it was determined that EA increases the level of the body’s own endocannabinoid anandamide, which in turn produces analgesic effects via CB2 abundantly present in the periphery and in cells of the immune system.²

By now you may wonder if there is a difference between manual acupuncture and electroacupuncture? While the therapeutic placement of acupuncture needles utilizes the same points on the body there are a number of differences. Manual stimulation usually last only a moment or a relatively short time while electroacupuncture is usually applied for 15-20 minutes or longer. Depending on the underlying technique or style used by the practitioner manual stimulation may include needle rotations (clock or counterclockwise),  hooking, lifting, thrusting the needle in a great variety of combinations while EA technique variations are primarily defined by amplitude, frequency (measure in Hertz), and waveform for example.³ 

Roughly at the same time, on the other side of the globe, scientists from UC Irvine, California, found another mechanism that may help us understand the complex interactive nature of EA and endocannabinoids. The study (conducted on rodents) suggests that EA releases endocannabinoids that interact via CB1 in the modulation of the neurotransmitter GABA in the brainstem (i.e., ventrolateral periaqueductal gray). GABA has been shown to produce therapeutic effects by inhibiting sympathetic cardiovascular action.⁴ This discovery adds to the already existing literature aiming to explain the potential cardioprotective effects of cannabinoids.

Another condition commonly treated with acupuncture and cannabinoid-based therapies is that of alcohol withdrawal. Researchers from Brazil may have uncovered a potential mechanism by which the two approaches are both able to modulate the condition’s complex neurological symptoms. This animal trial⁵ (2012) discovered that EA reduces the upregulation of CB1, thus implicating this receptor in the mitigation of withdrawal symptoms. These results find support in about a dozen pre-clinical trials that have been conducted to determine potential therapeutic ECS-based effects in patients with alcohol intoxication, withdrawal, and dependence.^6-8

Results from the next trials that were conducted come to us from Brazil (2012)⁹ and China (2013)¹⁰ where researchers looked at the overlapping acupuncture/cannabinoid-induced mechanism by which both in combination are thought to produce therapeutic effects in the treatment of animal-based experimental models of arthritis. 

Another study from China (2014) elucidates the growing understanding of the complexity that underlies EA/ECS-based therapeutic effects. Results from this trial conducted on mice suggest that EA-induced analgesia is due to the activation of orexin (a neuropeptide) neurons in the hypothalamus via CB1.¹¹ A later study (2018) conducted by an international team of researchers 

presents EA as an alternate pain-management strategy, especially in patients for whom the use of opioids is a concern, because in this study EA-induced analgesia involves an opioid-independent and orexin-initiated endocannabinoid pathway.¹²

A meta-analysis of the available scientific literature (2017)¹³ summarizes the knowledge up to that point in time, and results are included in the sections below.  

The latest study (2019) to directly examine the overlap of the mechanisms and effects of acupuncture and components of the endocannabinoid system comes to us in the context of treating allergic contact dermatitis—a condition for which both paradigms show efficacy. Here researchers demonstrated that treatment of rodents with EA reduced physical symptoms (e.g. ear swelling) by increasing CB2 expressions in certain immune cells (e.g. mast cells), thus creating anti-inflammatory effects in allergic contact dermatitis.¹⁴ 

The Evidence-Based Underpinnings of Acupuncture- and Cannabinoid-Based Therapies

All of these study results can be summarized as follows:

• Both acupuncture and cannabis are time-proven and effective in the therapeutic effects they generate. 

• Both affect the body and the mind and as such are commonly used to treat conditions ranging across the full spectrum from physical to mental-emotional health and well-being . In other words, both have practical applications relevant to a great diversity of patient populations.

• Both produce therapeutic effects via activation of different receptor sites (e.g. CB1, CB2) and also via indirect (allosteric) modulation of other neurotransmitter receptors such as dopamine (D1, D2) or endogenous opioids (i.e., endorphins).

• In addition to the effects already mentioned, both acupuncture and cannabinoids produce therapeutic effects via other mechanisms, some of which are well understood (e.g. degrading enzymes) while others are subject to ongoing scientific investigations (e.g. endocannabinoid tone).

• The ECS is the biological basis for cannabinoid-based therapies. Similarly, researchers are positing that the ECS may also be the scientific (molecular, neurological) basis for the effectiveness of acupuncture.

• Even though much of the proposed physiological underpinning of effective acupuncture and cannabis therapy is still being studied by both Western and Eastern medical systems, a simple search using the keywords “acupuncture” and “cannabis” in the US National Library of Health yields tens of thousands of published study results pertaining to the therapeutic effects both are known to produce.

• Pain-relieving mechanisms of both cannabis and acupuncture are more complex than merely relying on co-activation of opioid receptors and the subsequent release of endorphins. Evidence alludes to additional means (yet to be fully understood) to attaining effective pain control.

• Acupuncture and cannabinoid-based healing approaches are used in the treatment of diverse conditions and symptoms, and as a way to improve resilience and balance, and to prevent vulnerabilities to disease. 

• Reducing endocannabinoid deficiencies and balancing endocannabinoid tone are two of the emerging concepts that are beginning to provide a hypothesis for the clinical observations of therapeutic efficacies of both traditions that so many patients are accustomed to.

• To date, there is evidence that cannabinoid-based therapies may produce beneficial effects in the treatment of at least 250 mostly chronic conditions for which in too many cases there is no cure within the orthodox model of medicine. Similarly, the list of conditions that are treatable with acupuncture mirrors this accounting.

• Co-application of the cannabinoid-based therapies and acupuncture may create a therapeutic synergy for a number of different patient populations.

25 Chronic Conditions That Benefit from Acupuncture and Cannabis

Here is a sampling of twenty-five common conditions (in alphabetical order) for which both acupuncture and cannabis or cannabis-based products have demonstrated significant time-proven therapeutic potential: 

1. Acne
2. Addiction, Withdrawal, Dependence (e.g. Alcohol, Opioids, Methamphetamine, Nicotine)
3. Adverse Effects from Chemotherapy or Radiation
4. Anxiety
5. Arteriosclerosis
6. Arthritis
7. Asthma
8. Colitis
9. Coughing
10. Depression
11. Diabetes
12. Heart Disease
13. HIV/AIDS
14. Hypertension
15. Insomnia
16. Irritable Bowel Syndrome
17. Low Libido
18. Menstruation (Painful)
19. Metabolic Syndrome
20. Multiple Sclerosis
21. Muscle Spasms
22. Obesity
23. Pain 
24. Stress
25. Stroke

The present blog article is based (in part) on research conducted for my new book entitled: Healing with Cannabis: Optimizing Your Ideal Ratio of CBD:THC. Published by Ed Rosenthal’s Quick Trading (Spring 2020). Distributed by Publishers Group West. Berkeley, California.

Notes:

1 Grissa MH, Baccouche H, Boubaker H, Beltaief K, Bzeouich N, Fredj N, Msolli MA, Boukef R, Bouida W, and Nouira S. (2016). Acupuncture vs intravenous morphine in the management of acute pain in the ED. Am J Emerg Med. Nov;34(11):2112-2116.

2 Chen L., Zhang J., Li F., Qiu Y., Wang L., Li Y. H., … Li M. (2009). Endogenous anandamide and cannabinoid receptor-2 contribute to electroacupuncture analgesia in rats. Journal of Pain, 10(7), 732-739.

3 Langevin HM, Schnyer R, MacPherson H, et al. Manual and electrical needle stimulation in acupuncture research: pitfalls and challenges of heterogeneity. J Altern Complement Med. 2015;21(3):113–128.

4 Tjen-A-Looi SC, Li P, Longhurst JC. (2009). Processing cardiovascular information in the vlPAG during electroacupuncture in rats: Roles of endocannabinoids and GABA. J Appl Physiol. 106(6):1793–1799. 

5 Karoly HC, Bidwell LC, Mueller RL, Hutchison KE. Investigating the Relationships Between Alcohol Consumption, Cannabis Use, and Circulating Cytokines: A Preliminary Analysis. Alcohol Clin Exp Res. 2018;42(3):531–539. 

6 Spagnolo PA, Ramchandani VA, Schwandt ML, et al. FAAH Gene Variation Moderates Stress Response and Symptom Severity in Patients with Posttraumatic Stress Disorder and Comorbid Alcohol Dependence. Alcohol Clin Exp Res. 2016;40(11):2426–2434. 

7 Mikuriya, T.H. 1970. Cannabis substitution: An adjunctive therapeutic tool in thetreatment of alcoholism. Medical Times 98(4):187-91

8 Escosteguy-Neto JC1, Fallopa P, Varela P, Filev R, Tabosa A, Santos-Junior JG. Electroacupuncture inhibits CB1 upregulation induced by ethanol withdrawal in mice. Neurochem Int. 2012 Jul;61(2):277-85.

9 Gondim DV, Araújo JC, Cavalcante AL, Havt A, Quetz Jda S, Brito GA, Ribeiro Rde A, and Lima Vale M. (2012). CB1 and CB2 contribute to antinociceptive and anti-inflammatory effects of electroacupuncture on experimental arthritis of the rat temporomandibular joint. Can J Physiol Pharmacol. Nov;90(11):1479-89.

10 Shou Y, Yang Y, Xu MS, Zhao YQ, Ge LB, and Zhang BM. (2013). Electroacupuncture inhibition of hyperalgesia in rats with adjuvant arthritis: Involvement of cannabinoid receptor 1 and dopamine receptor subtypes in striatum. Evid Based Complement Alternat Med.  Volume 2013, Article ID 393-460, 10 pages.

11 Chiou LC, Chen YH, Lee HJ, Wu YT, Lee YH, Hwang LL, Hung MS, Zimmer A, and Mackie K. (2014). A novel mechanism for acupuncture-induced analgesia: Involvement of orexins and endocannabinoids. Journal of Neurochemistry. 130(Aug)(Suppl. s1):38. 

12 Chen YH, Lee HJ, Lee MT, et al. (2018). Median nerve stimulation induces analgesia via orexin-initiated endocannabinoid disinhibition in the periaqueductal gray. Proc Natl Acad Sci U S A. 115(45):E10720–E10729.

13 Bo Hu, Fuhai Bai, Lize Xiong, and Qiang Wang. (2017). The endocannabinoid system, a novel and key participant in acupuncture’s multiple beneficial effects. Neurosci Biobehav Rev. 77(Jun):340-357.

14 Wang Z, Lu M, Ren J, Wu X, Long M, Chen L, and Chen Z. (2019). Electroacupuncture inhibits mast cell degranulation via cannabinoid CB2 receptors in a rat model of allergic contact dermatitis. Acupunct Med. 20(Aug):acupmed2017011506.