Acupuncture’s Effect on the Autonomic Nervous System

How Acupuncture Influence Your Body’s Autonomic Balance

Acupuncture is the use of an acupuncture needle across hundreds of techniques—from electroacupuncture and dry needling to traditional acupuncture that uses meridians and acupoints. One of its most compelling benefits involves modulating the autonomic nervous system (ANS). This system oversees involuntary functions like digestion, blood pressure, and heart rate, and research indicates that acupuncture helps balance sympathetic and parasympathetic activity to restore homeostasis.

Key Points

• Broad Range of Techniques: Acupuncture includes traditional meridian-based methods, electroacupuncture, and dry needling, all of which use the same fundamental instrument—an acupuncture needle.

• Targets the ANS: Stimulation at specific points can shift sympathetic (fight-or-flight) and parasympathetic (rest-and-digest) responses.

• Multiple Mechanisms: Effects are seen in brain regions (e.g., ventrolateral medulla, hypothalamus, amygdala) as well as in peripheral pathways (e.g., vagus and sympathetic nerves).

• Frequency Matters: Low-frequency stimulation may activate parasympathetic pathways, while higher frequencies can recruit sympathetic pathways in specific contexts.

• Clinical Range: Conditions related to stress, pain, cardiovascular health, digestion, and inflammation show notable improvements with regular acupuncture treatment.

Understanding the ANS in Plain Terms

The autonomic nervous system automatically regulates vital bodily processes, such as:

• Heart rate and blood pressure

• Digestion and gut motility

• Respiratory rate

• Body temperature

It has two major branches:

1. Sympathetic Nervous System (SNS) – Activates “fight-or-flight” responses (elevating heart rate, dilating pupils, etc.).

2. Parasympathetic Nervous System (PSNS) – Encourages “rest-and-digest” (slowing heart rate, stimulating digestion, etc.).

Because the ANS works mostly outside our conscious control, therapies that can influence it (like acupuncture) are highly valuable in healthcare.

How Acupuncture Modulates the ANS

• Local Sensation and Nerve Activation

  • When a needle is inserted and stimulated (manually or with electricity), specialized nerve endings around the acupoint detect the mechanical and/or electrical stimulus.

  • These signals travel through peripheral nerves to the spinal cord and onward to the brain.

• Central Integration

  • In the brainstem, areas like the ventrolateral medulla (VLM), dorsal motor nucleus of the vagus (DMV), and nucleus tractus solitarius (NTS) act as critical hubs for autonomic control.

  • Higher structures such as the amygdala (AMG), anterior cingulate cortex (ACC), and hypothalamic nuclei can process these signals, influencing both mood/pain perception and physiologic reflexes.

• ANS Output

  • Depending on the frequency and intensity of stimulation—as well as the particular acupoint used—acupuncture can:

    • Increase parasympathetic (vagal) output, aiding digestion and relaxation.

    • Decrease sympathetic overactivity, reducing blood pressure or stress responses.

  • In certain models, high-frequency stimulation can also engage sympathetic pathways beneficially (e.g., to release protective catecholamines in specific inflammatory conditions).

Acupoints Highlighted in Studies

Numerous studies show that certain acupoints consistently demonstrate ANS-modulating properties:

• ST36 (Zusanli)

  • Commonly used in gastrointestinal regulation, pain management, and inflammation control.

  • Can enhance vagal activity, reduce sympathetic overactivity, and improve gut motility.

• PC6 (Neiguan) & PC5 (Jianshi)

  • Linked to cardiovascular regulation and pain relief in the chest or upper body.

  • Often tested in research involving blood pressure modulation and cardiac reflexes.

• ST25 (Tianshu)

  • Noted for its influence on bowel function and anti-inflammatory effects.

  • Sometimes requires higher-intensity stimulation to activate sympathetic anti-inflammatory pathways.

• HT7 (Shenmen) & HT5 (Tongli)

  • Used in studies of myocardial ischemia and stress-induced cardiac dysfunction.

  • Associated with boosting vagus nerve activity to protect the heart.

Clinical & Preclinical Evidence

• Cardiovascular Benefits:

  • In hypertensive animal models, stimulating PC6 or ST36 has led to reduced sympathetic tone, decreased blood pressure, and suppressed excitatory reflexes in the brainstem.

  • Some clinical trials also report improvements in heart rate variability (HRV), indicating a healthier autonomic balance.

• Pain and Stress Reduction:

  • Research on visceral hypersensitivity (e.g., IBS models) shows that acupuncture at ST25 and ST37 may relieve pain by dampening overactive sympathetic responses and reducing inflammatory mediators in the brain and spinal cord.

  • For stress-related conditions, points such as PC6 can help by reducing the release of stress hormones and promoting parasympathetic dominance.

• Gastrointestinal Regulation:

  • Studies involving rats with gastric distention demonstrate that acupuncture at RN12 (Zhongwan) and BL21 (Weishu) can enhance vagus-mediated gut motility.

  • Similar effects are seen at ST36, which can improve digestion and alleviate constipation or other GI complaints.

• Inflammatory Modulation:

  • Animal models of sepsis and endotoxemia reveal that electroacupuncture at ST36 or ST25 may reduce circulating inflammatory cytokines by engaging vagal and/or sympathetic routes, often referred to as the cholinergic anti-inflammatory pathway.

  • This can protect organs from damage and improve survival rates in severe infection models.

Highlights from the Research

• Pain and Inflammation Regulation

  • Studies on rats with fibromyalgia, neuropathic pain, and inflammatory conditions like paw inflammation show that electroacupuncture (EA) at points such as ST36 and GB34 can decrease pro-inflammatory markers (e.g., TNF-α, IL-1β) and reduce hyperalgesia (heightened pain sensitivity).

  • Activation or inhibition of specific brain regions such as the amygdala or anterior cingulate cortex correlates with reduced pain signaling and improved emotional well-being.

• Cardiovascular Modulation

  • Multiple cat and rat models indicate that stimulating points like PC5 and PC6 with low-frequency EA dampens sympathetic outflow, resulting in lowered blood pressure and suppressed pressor reflexes.

  • Brainstem structures (such as the ventrolateral medulla and nucleus tractus solitarius) show changes in neurotransmitters (e.g., glutamate, opioids, serotonin) that align with cardiovascular regulation.

• Gastrointestinal and Vagal Enhancement

  • For conditions involving gastric motility (e.g., visceral hypersensitivity, motion sickness, or stress-induced gastric lesions), acupuncture at points such as ST36, RN12, and PC6 can enhance vagal tone (parasympathetic activity).

  • Enhanced vagal activity has been linked to improved digestion, reduced inflammation in the gut, and better maintenance of the gut barrier function.

• Anti-Inflammatory Effects and Immune Response

  • In sepsis or endotoxemia models, EA at ST36 or ST25 increases vagus nerve activity, thereby suppressing excessive inflammatory responses.

  • This vagal-mediated pathway is a major mechanism for modulating systemic inflammation and protecting organ function.

• Stress and Emotional Regulation

  • Studies involving stress-induced hypertension and depression demonstrate that acupuncture can modulate hypothalamic-pituitary-adrenal (HPA) axis dysfunction.

  • Decreases in sympathetic overdrive and enhancements in parasympathetic (vagal) tone help rebalance the body’s stress response.

Mechanistic Insights

• Neurotransmitter and Hormonal Shifts
  Acupuncture affects the release of neurotransmitters such as serotonin, GABA, and endorphins, altering pain perception and stress responses.

• Brain Circuit Modulation
  Specific brain regions implicated in the regulation of the ANS, including the ventrolateral medulla (VLM), arcuate nucleus (ARC), dorsal motor nucleus of the vagus (DMV), and others, show changes in neuron firing rates and receptor expression following needling.

• Sympathetic vs. Parasympathetic Balancing
  Many studies point to a decrease in sympathetic nerve (SN) activity and an increase in parasympathetic nerve (PSN or vagus) output, contributing to overall homeostasis.

Reference	Model	Acupoints	Intervention Parameters	Effects	Neuron Activity in Autonomic Brain Regions	Autonomic Nerve Activity
Zhao et al., 2020	Visceral hypersensitivity rats (IBS)	ST25, ST37	EA: 2/100 Hz, 2 mA, 20 min	Improves IBS visceral hypersensitivity	MT/ACC: Inhibition of astrocyte activity ↓	/
Weng et al., 2015	Visceral hypersensitivity rats (IBS)	ST25, ST37	EA: 2/100 Hz, 2 mA, 20 min	Reduces visceral pain sensitivity	PFC/ACC: P2×3 ↓	/
Dhond et al., 2008	Healthy volunteers	PC6	MA: Manually twirled (±180°) at 0.5 Hz	Enhances post-stimulation resting brain network connectivity	DMN connectivity with AMG/ACC/PAG/hippocampus ↑	SN ↓, PSN ↑, HRV (LFu ↓, HFu ↑)
Pang et al., 2021	Premenstrual syndrome patients	SP6	EA: 1 Hz, 2 mA, 6 min	Enhances amygdala functional connectivity	AMG-ACC: FC ↑	/
Zhang X. H. et al., 2021	Neuropathic pain rats	ST36, GB34	EA: 2 Hz, 0.5–1.5 mA, 30 min	Analgesia; reduces pain-related emotion	AMG: TNFα/IL-1β/GFAP/dopamine system ↓	/
Hsu et al., 2020	Fibromyalgia mouse model	ST36	EA: 2 Hz, 1 mA, 15 min	Analgesia	AMG/somatosensory cortex/thalamus: TRPV1-ERK ↓	/
Zhou et al., 2007	BK-induced increase of BP in cats	PC5, PC6	EA: 2 Hz, 1–4 mA, 30 min	Suppresses pressor reflex	VLM: Glu ↓	SN ↓
Cui et al., 2018b	Acute myocardial ischemia rats	HT7, HT5	EA: 2 Hz, 1.1 mA, 30 min	Reduces myocardial ischemic injury	PVN: Neuronal discharge ↓	SN ↓
Cui et al., 2018a	Acute myocardial ischemia rats	HT7, HT5	EA: 2 Hz, 1 mA, 30 min	Reduces myocardial ischemic injury	Hippocampus/NTS: Neuronal discharge ↑	Vagus ↑
Zhang et al., 2022	Hypertensive rats	ST36, ST40	EA: 2/15 Hz, 4 mA, 30 min	Antihypertensive, sympathetic suppression	PVN: NPY ↑	SN ↓
Tjen-A-Looi et al., 2016	BK-induced increase of BP in cats	PC5, PC6	EA: 2–4 Hz, 2–4 mA, 30 min	Reduces cardiovascular excitatory response	Cardiovascular barosensitive VLM neurons ↓	SN ↓
Guo and Longhurst, 2010	Healthy rats	PC5, PC6	EA: 2 Hz, 30 min	Attenuates sympatho-excitatory responses	ARC/vlPAG: VGLUT3 ↑	SN ↓
Li et al., 2010	BK-induced increase of BP in cats	PC5, PC7	EA: 2 Hz, 1–4 mA, 30 min	Suppresses elevated blood pressure	ARC/vlPAG: VGLUT3 ↑	SN ↓
Tjen-A-Looi et al., 2006	BK-induced increase of BP in cats	PC5, PC6	EA: 2–4 Hz, 4 mA, 30 min	Reduces cardiovascular excitatory response	vlPAG: Neuronal discharge ↑; VLM: Neuronal discharge ↓	SN ↓
Tjen-A-Looi et al., 2013	Hypercapnic acidotic rats	PC5, PC6	EA: 2–4 Hz, 1–4 mA, 0.5 ms, 30 min	Alleviates cardiovascular depressor responses	VLM/cVLM/AMB: GABA ↑	SN ↓, Vagus ↑
Zhang et al., 2013	Stress-induced hypertensive rats	ST36	EA: 4/20 Hz, 4 mA, 0.5 ms, 30 min	Antihypertensive	VLM: Apelin ↓	/
Li et al., 2001	BK-induced increase of BP in cats	PC5, PC6	EA: 5 Hz, 10–20 V, 1–2 mA, 0.5 ms	Suppresses pressor reflex	VLM: m-opioid receptors ↑, δ-opioid receptors ↑	/
Tjen-A-Looi et al., 2003	BK-induced increase of BP in cats	PC5, PC6	EA: 2 Hz, 1–4 mA, 0.5 ms, 30 min	Suppresses pressor reflex	VLM: Neuronal excitability ↓	SN ↓
Moazzami et al., 2010	BK-induced increase of BP in cats	PC5, PC6	EA: 2 Hz, 2–4 mA, 0.5 ms, 30 min	Suppresses pressor reflex	NRP: 5-HT ↑; VLM: 5-HT1A receptors ↑	SN ↓
Moazzami et al., 2010	BK-induced increase of BP in cats	PC5, PC6	EA: 2 Hz, 2–4 mA, 0.5 ms, 30 min	Suppresses pressor reflex	NRP: 5-HT ↑; VLM: 5-HT1A receptors ↑	/
Guo et al., 2012	Cat treated with colchicine	PC5, PC6	EA: 2 Hz, 1–4 mA, 0.5 ms, 30 min	Regulates cardiovascular function	AMB: Excitability of preganglionic parasympathetic neurons ↑	PSN ↑
Chen et al., 2016	Myocardial ischemia rats	PC5, PC7	EA: 2 Hz/15 Hz, 0.5 mA, 30 min	Anti-myocardial ischemic effect	AMB: Number of c-fos positive neurons ↑	Vagus ↑
Wang et al., 2015	Gastric distention rats	RN12, BL21	EA: 20–100 Hz, 2 mA, 20 min	Regulates gastric motility	PVN/DVC: Neuronal discharge ↑; GI hormones & receptors ↑	Vagus ↑
Wang et al., 2013	Gastric distention rats	RN12, BL21	EA: 20/100 Hz, 2–2.5 mA	Regulates gastric motility	DVC: GI hormones ↑	Vagus
Lu M. et al., 2019	Gastric distention rats	PC6	EA: 2/15 Hz, 2 mA, 2 min	Promotes gastric motility	DMV: GABA neurotransmitter ↓	PSN ↑, Vagus ↑
Gao et al., 2012	Gastric distention rats	ST36	EA: 4 Hz, 2–3 mA, 0.5 ms, 20 min	Promotes gastric motility	DMV: NMDAR ↑	/
Wang et al., 2007	Healthy rats	ST36, ST37	EA: 50 Hz, 20 V, 30 min	Regulates gastric motility	NTS/DMV: Neuronal discharge ↓	Vagus ↑
Tian et al., 2018	Motion sickness rats	PC6, ST36	MA: Sparrow pecking, 30 times/min, 30 min	Increases p-IRβ- and p-ERK1/2-positive cells & insulin levels in DMV	/	/
He et al., 2018	RWIS rats	ST36	EA: 2/100 Hz, 1 mA, 0.5 ms, 30 min	Ameliorates RWIS-induced gastric mucosal lesions	PVN/CNA: Number of CRH neurons ↓	/
Wu et al., 2010	NMSS-induced visceral hyperalgesia rats	ST36	EA: 10 Hz, 0.18 ms, 20 min	Attenuates visceral hyperalgesia	Brainstem and spinal cord: 5-HT ↓	/
Zhou et al., 2013	LPS-induced tight junction injury in mice	/	VNS: 1 Hz, 5 V, 2 ms	Attenuates disruption of intestinal epithelial tight junctions	/	Vagus ↑
Du et al., 2013	Hemorrhagic shock rats	ST36	EA: 2–100 Hz, 2 mA, 1.5 h	Improves gut barrier dysfunction	/	Vagus ↑
Tatewaki et al., 2003	Rats with strain sensors implanted	ST36	MA: Twisting once every second for 30 s	Regulates gastric motility	/	/
Li et al., 2007	Spinalized rats; splanchnic denervation in rats	LI11, ST13, ST36, CV6, BL21, ST21	MA: Rotated at 2 Hz for 30 s	Regulates gastric motility	/	LI11, ST13, ST36: SN ↓, Vagus ↑; CV6, BL21, ST21: SN ↑, Vagus ↓
Torres-Rosas et al., 2014	LPS-induced endotoxemia mice	ST36	EA: 10 Hz, 4 V, 40 mA, 50 μs	Anti-inflammatory	/	Vagus ↑
Liu S. et al., 2020	LPS-induced endotoxemia mice	ST25, ST36	ST35: 10 Hz, 0.5 mA, 15 min ST25: 10 Hz, 3 mA, 15 min	Anti-inflammatory	DMV: Neuron excitability ↑	Vagus ↑, SN ↑
Lim et al., 2016	Endotoxemia mouse	ST36	MA: Slow rotation every 5 min, 30 min EA: 1 V, 1 Hz, 2 ms, 30 min	Anti-inflammatory	NTS/DMV: Neuron excitability ↑	Vagus
Yang et al., 2021	Post-operative ileus mouse	ST36	EA: 10 Hz, 1 mA, 0.4 ms, 20 min	Ameliorates intestinal inflammation	DMV: GABAA ↓	Vagus ↑
Torres-Rosas et al., 2014	Sepsis mice	ST36	EA: 10 Hz, 40 mA, 15 min	Anti-inflammatory	/	Vagus ↑
Song et al., 2015	Rats with thermal injury	ST36	EA: 3 Hz, 3 V, 2 ms, 12 min × 8	Anti-inflammatory	/	Vagus ↑
Chi et al., 2018	Ischemic stroke rats	GV20, GV14	EA: 2/15 Hz, 1 mA, 30 min	Neuroprotective effect	DMV: Neuronal excitability ↑	Vagus ↑
Kim et al., 2008	Carrageenan-induced paw inflammation mice	ST36	EA: 1/120 Hz, 0.5 ms, 1–3 mA, 30 min	Anti-inflammatory	/	SN ↑
Li et al., 2008	CFA-induced inflammation and hyperalgesia rats	GB30	EA: 10 Hz, 3 mA, 0.1 ms	Inhibits inflammatory edema	PVN: CRH neuron excitability ↑	/
Zhang M. et al., 2021	Surgical trauma after hepatectomy patients	ST36, SP6	EA: 2/15 Hz, 2 mA, 30 min	Normalizes HPA axis dysfunction post-surgery	PVN: SCGN ↓	/
An et al., 2007	CCK-induced acute pancreatitis	ST36	EA: 2/100 Hz, 3–5 V, 10 min	Anti-inflammatory, protects pancreas	PVN: ACTH ↑	/
Noda et al., 2015	Patients with depression	PC4, LI10, SP9, SP6	Press needle stimulation	Antidepressant effect	/	Vagus ↑
Liu et al., 2018	Ischemic stroke patients	ST36	TEA: 25 Hz, 10 mA, 1 h	Prevents stroke-induced constipation	/	Vagus & SN ↑

Source: Li YW, Li W, Wang ST, Gong YN, Dou BM, Lyu ZX, Ulloa L, Wang SJ, Xu ZF, Guo Y. The autonomic nervous system: A potential link to the efficacy of acupuncture. Front Neurosci. 2022 Dec 8;16:1038945. doi: 10.3389/fnins.2022.1038945. PMID: 36570846; PMCID: PMC9772996.

Conclusion

Acupuncture’s ability to influence the autonomic nervous system is central to its diverse therapeutic effects—ranging from stress reduction and pain relief to improved cardiovascular function and immune regulation. Through modulating both sympathetic and parasympathetic outflow, acupuncture (in all its forms) offers a unique blend of localized and systemic benefits. As research continues, we gain clearer insights into how specific acupoint selections, stimulation parameters, and electroacupuncture frequency settings can optimize outcomes for various health conditions, all by tapping into the body’s own autonomic control networks.

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Frequently Asked Questions (FAQ)

What is the autonomic nervous system (ANS)?

The ANS is the body’s involuntary control center, regulating vital functions like heart rate, digestion, and blood pressure. It consists of two main branches: the sympathetic (fight-or-flight) and the parasympathetic (rest-and-digest).

How does acupuncture affect the ANS?

Acupuncture can increase or decrease activity in sympathetic and parasympathetic nerves, depending on factors like the acupoint chosen and stimulation parameters. This helps restore balance and supports normal physiological processes.

Do different acupuncture techniques (dry needling, electroacupuncture, etc.) have similar effects?

All techniques involve inserting an acupuncture needle, but their specific effects can vary. For instance, electroacupuncture applies electrical currents for stronger stimulation, which may recruit certain autonomic pathways more effectively than manual methods alone.

Which acupoints are most commonly used to influence the ANS?

Points such as ST36 (Zusanli), PC6 (Neiguan), PC5 (Jianshi), and ST25 (Tianshu) are frequently cited in studies for their roles in modulating the ANS and improving conditions like hypertension, GI dysfunction, and inflammation.

Can acupuncture help with stress-related conditions?

Yes. By affecting the parasympathetic branch, acupuncture often promotes relaxation and reduces elevated sympathetic tone. This leads to improved heart rate variability, reduced stress hormones, and an overall calming effect on the body.

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Sources:

• Li YW, Li W, Wang ST, Gong YN, Dou BM, Lyu ZX, Ulloa L, Wang SJ, Xu ZF, Guo Y. The autonomic nervous system: A potential link to the efficacy of acupuncture. Front Neurosci. 2022 Dec 8;16:1038945. doi: 10.3389/fnins.2022.1038945. PMID: 36570846; PMCID: PMC9772996.

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