Cortisol and Stress: How Acupuncture Regulates the HPA Axis
By Dr (TCM) Attilio D'Alberto | Traditional Chinese Medicine Practitioner, Wokingham
Cortisol — the primary stress hormone produced by the adrenal glands — is one of the most widely searched health topics in the UK. In small, acute doses it is essential for survival. Chronically elevated, it is one of the most destructive forces in modern health, contributing to anxiety, insomnia, weight gain, hormonal disruption, immune suppression and cardiovascular disease. Acupuncture is one of the most well-evidenced interventions for regulating the stress response and lowering chronically elevated cortisol.
What does cortisol do?
Cortisol is released by the adrenal cortex in response to activation of the hypothalamic-pituitary-adrenal (HPA) axis — the body’s central stress response system. In its acute role, cortisol mobilises energy, raises blood pressure, suppresses digestion and immune function, and prepares the body for a fight-or-flight response. It follows a diurnal rhythm, peaking in the early morning to help the body wake, and declining through the day to its lowest point at night. When chronic psychological stress, poor sleep, blood sugar dysregulation or inflammatory conditions keep the HPA axis chronically activated, this diurnal rhythm becomes dysregulated — cortisol is elevated when it should be low (at night, preventing sleep) and potentially depleted when it should be high (in the morning, contributing to fatigue).
Signs of chronically elevated cortisol
- Difficulty falling asleep or waking between 1 and 3am unable to return to sleep
- Anxiety, racing thoughts, inability to wind down
- Weight gain around the abdomen despite unchanged diet
- Fatigue that does not improve with rest (often diagnosed as adrenal fatigue)
- Frequent infections and slow recovery from illness (immune suppression)
- Menstrual irregularity and worsened PMS (cortisol disrupts the HPO axis)
- High blood pressure and elevated fasting blood sugar
- Poor memory and brain fog (cortisol damages hippocampal neurons over time)
Cortisol and stress in TCM
In traditional Chinese medicine, the physiological system governed by chronically elevated cortisol corresponds most closely to what TCM calls the Liver-Kidney axis and its relationship with the Heart and Shen (Mind-Spirit). The Kidney in TCM governs the adrenal glands and the constitutional reserve of energy (Jing). The Liver regulates the smooth flow of Qi and the emotional response to stress. When chronic stress depletes Kidney Yin and Yang and disrupts Liver Qi, the internal environment that modern medicine describes as HPA dysregulation emerges. Specifically:
- Kidney Yin deficiency — the pattern most closely corresponding to HPA overactivation; the Kidney’s “cooling, anchoring” function is depleted by chronic stress, allowing Empty Fire (corresponding to elevated cortisol and sympathetic hyperactivation) to rise upward, disturbing sleep, causing night sweats, anxiety and racing thoughts
- Liver Qi stagnation — emotional tension and the inability to discharge stress causes Liver Qi to stagnate; the Liver’s failure to regulate cortisol pulsatility corresponds to the erratic cortisol rhythms seen in chronic stress
- Heart and Kidney not communicating — the inability of Kidney Yin to cool and anchor the Heart’s Fire produces the insomnia, palpitations and restlessness of chronic HPA activation; Tian Wang Bu Xin Dan re-establishes this axis
- Spleen Qi deficiency with Phlegm-Damp — cortisol-driven abdominal weight gain and digestive disruption corresponds to the TCM pattern of Spleen Qi failing to transform and transport, generating Dampness and Phlegm accumulation
How acupuncture lowers cortisol
The evidence that acupuncture regulates the HPA axis and reduces cortisol is well established. Acupuncture activates the parasympathetic nervous system, directly counteracting the sympathetic activation that drives cortisol release. It normalises CRH (corticotrophin-releasing hormone) release from the hypothalamus, reducing the cascade that leads to cortisol secretion. Multiple clinical trials have measured significant reductions in salivary and serum cortisol following acupuncture at specific points including HT 7 (Shenmen), PC 6 (Neiguan), SP 6 (Sanyinjiao), ST 36 (Zusanli) and GV 20 (Baihui). Electroacupuncture has particularly strong evidence for HPA axis regulation. Regular acupuncture also improves sleep quality and reduces anxiety, both of which further reduce the cortisol burden.
Chinese herbal medicine for stress and cortisol
Several Chinese herbal adaptogens — herbs that modulate the stress response by normalising HPA axis activity — have substantial modern research supporting their use. Huang Qi (Astragalus membranaceus) supports adrenal function, modulates cortisol production and strengthens immune resilience; it is the principal herb in Bu Zhong Yi Qi Tang. Wu Wei Zi (Schisandra chinensis) is the key herb in Sheng Mai San and has documented cortisol-modulating, adaptogenic and neuroprotective properties. Ren Shen (Panax ginseng) is the most extensively researched TCM adaptogen, with strong evidence for normalising HPA axis function, improving cognitive performance under stress and restoring adrenal reserve. Formulae are individually prescribed based on the specific TCM pattern identified on consultation.
See also: Anxiety treatment | Insomnia treatment | Burnout treatment | Adrenal fatigue | Stress and belly fat
To discuss stress and cortisol management at my clinic in Wokingham, contact me or book a consultation.
