So…. you stick people with needles?

by Mary Beth Ladenheim

Welcome to the first post of Valley Classical Acupuncture’s blog about health, wellness, and life in general.

The main purpose of this blog is to help us meet our goal of integrating acupuncture and herbal medicine into modern American life in a practical, accessible way for people.  We intend to address questions, share observations, and offer tips for self-care at home. We hope the content we generate here can be useful to you regardless of where you are on the path to wellness, and regardless of your familiarity with acupuncture and herbal medicine. If there’s a topic you’d like us to write about, please send us a note.

I should probably say explicitly (since I was raised, in part, by a lawyer) that this blog should not be construed as medical advice, and information provided here does not take the place of a consultation with your physician or other healthcare provider. Rather, it is intended as food for thought.

Being an acupuncturist in a small town means that I’m often on the receiving end of lots of questions about what I do. The answers to most of those questions are not simple sound-bytes or distilled messages conducive to radio ads. The answers are, instead, conversations. Though a blog is not a conversation, it can be a place to start. So in this first entry, I’m going to answer the questions we’re most frequently asked about acupuncture. If you have comments or more questions, please put them in the comment bar, and I’ll respond.

Acupuncture FAQs:

About those needles: Does it hurt? How do you decide where to put them? How deep do they go? Do you reuse them?

Do you have to believe in acupuncture for it to work?

How long do you have to be still during an acupuncture treatment?

Is acupuncture simply tapping into the placebo effect?

Does acupuncture treat the nerves?

Is acupuncture only for pain?

What does acupuncture treat?

How much does an acupuncture treatment cost, and is it covered by insurance?

My doctor/chiropractor/PT does acupuncture; why should I come to you?

What kind of training have you had?

What’s “qi?”

Does acupuncture work for children?

How many acupuncture treatments will I need to see/feel results?

 

Does it hurt?

Not usually, and not really.

Firstly, acupuncture needles are completely different from hypodermic needles. In acupuncture, we’re not inserting anything foreign into the body other than the needle itself. Hypodermic needles are hollow so that something can be administered (immunizations, fluids, etc.) or withdrawn (blood.)

Acupuncture needles, by contrast, serve only to stimulate the point into which they are inserted. They don’t insert or remove anything, so they don’t need to be hollow. They are solid, very thin, and flexible.

Secondly, “pain” is more interesting here than in other situations. I promise.

Pain from an acupuncture needle is nothing like other kinds of pain you may think of and want to avoid– stubbing your toe, burning your hand, dry-heaving, or breaking a bone. If there is pain, it usually subsides either instantaneously or very quickly morphs into something else.

That something else is highly personal. People report different sensations regularly – heaviness, tingles, a kind of hum or buzz, warmth, coolness, a flowing feeling, or nothing at all.

In general, there are certain acupuncture points that get a reputation for being sensitive. The tips of the fingers, for example, are not very fleshy and stimulation by an acupuncture needle can be strong for some, but not all, people. Some barely notice – which may or may not be a sign of health. Needles in hips and abdomens often go unremarked-upon.

Furthermore, points are often sensitive when the person has a problem area associated with that point. For example, there’s a point on the hand that is associated with the back of the head and the spine. If I needle it on someone who has occipital neck tension, the point is often very strong and tender. If I’m needling it simply to access the spine and the person’s neck is not especially painful, the point usually goes unnoticed.

Do you have to believe in acupuncture for it to work?

No. Your belief is not required in order for the needles to do their work. You don’t have to know what qi is, or that your gallbladder has acupuncture points on your foot. Many people who have experienced great relief initially came to us feeling either very skeptical or completely unsure of the process.

That being said, there are ways you can participate in the healing process, and actually enhance it. This primarily starts when you begin connecting the dots between your acupuncture treatment and how you feel when you’re not on the table. Similar to exercise and meditation, acupuncture increases a person’s physical and mental awareness – both as independent forces (“Wow, my balance is better. Wow, my mind is clearer,”) and as related entities (“Gee, when I feel anxious, my stomach is also upset.”)

We also notice that people accelerate and enhance their healing when they rid themselves of the negative things in their lives – whether it’s giving up fast-food, getting out of a moldy house, leaving an unfulfilling job, or dropping a miserable relationship. Each of these things powerfully reinjures the qi on a daily basis. Removing such things from one’s life is a powerful augmentation of acupuncture’s benefits.

You can also sabotage your progress. This is quite common in the beginning; people unintentionally run themselves down after they start feeling good again. It can take a little practice, getting used to managing the renewed sense of health. But it should be done, otherwise it’s kind of like winning the lottery and blowing it all.

And sometimes – this is a bit more complicated – people unconsciously slow their progress because they’re actually more comfortable feeling terrible than feeling great. It’s like the old saying, “the devil you know is better than the devil you don’t.” A familiar routine is comforting, and changing that routine can be frightening, … even if you hate the routine. Acupuncture can be very helpful in untangling this kind of pattern.

How do you decide where to put the needles?

The body has hundreds of acupuncture points that we can use in combination to affect a certain change. The points we choose and how we needle them depends upon the patient’s unique presentation. In addition to the information we obtain during our intake and gather through conversation with the patient, we take pulses at both wrists and observe the tongue.

We usually spend about 3-5 minutes or so “listening” to the pulses, as it is sometimes called. This is a different process from what happens at your MD’s office; we’re not counting beats per minute in one wrist. Rather, we feel three different pulse positions in each wrist. Rate is part of what we look for, but that’s generally relative to the breath – not beats per minute. We also notice the pulse’s overall qualities – is it forceful, weak, strong on top, empty down below, thin, wide, etc. We’re interested both in how the pulse appears as a whole and how the three different positions feel individually.

There’s a lot that goes into pulse diagnosis – there are books written on the subject – so suffice to say here that we are able to gather substantial information both about the current state of affairs in the body, and about the subtle direction of health.

The same can be said for the tongue. We look at its overall character – is it red, pale, shiny, wet, dry, covered in a thick coat, puffy, thin, quivering, stiff, speckled, cracked? This gives us clues as to the state of fluids in the body. As the beginning of the digestive system, the tongue gives us insight into the health of overall digestion. The tongue is also understood as a type of map that reflects the health of the body’s other systems.

How deep do the needles go?

This depends both on what our treatment focus is, and where the needle is. Obviously a needle in a finger doesn’t have far to go, whereas the belly of the calf muscle is a different story.

Sometimes we needle very superficially, other times we needle more deeply. All of this is relative to the point in question. Some points should never be needled deeply for safety, such as points around the eyes and lungs.

Do you reuse the needles?

No. The needles are sterile, single-use. We dispose of them in a biohazard container after we remove them from the skin.

How long do you have to be still?

Firstly, you never have to be stock-still and rigid. You can relax without hurting yourself during an acupuncture treatment. Most people find treatments to be very calming, and often fall asleep on the table or in the chair. In sliding scale acupuncture, the patient sits in a chair or lies on a treatment table. In individual acupuncture, we use the table exclusively. We treat people lying face-up and/or face-down, depending on what’s needed.

Though the length of time needles are retained depends upon the type of treatment, an average answer is about 20 minutes. For certain types of muscular injuries, pain, and sleep problems, we might do a treatment in which we’re in the room with you for almost the whole hour, putting in needles and taking them out – leaving you to rest for 10 minutes or so with a few needles that are retained. For other types of issues, such as menstrual problems, infertility, prostatitis or certain mood disorders, the needles may stay in for 40 minutes from the time of the first insertion.

Does acupuncture work by using the nerves?

No. Acupuncture theory is based on a channel system that is neither separate from, nor dependent upon, nerves. These channels connect the whole body and are conduits of qi; points are areas where the qi is accessible.

Channels aren’t anatomical parts; their existence depends upon the life they circulate. A corpse, for example, has no channels and no acupuncture points because it has no qi. So the channels are in part what enervate us, but they are not synonymous to nerves.

Here’s an example: a channel runs along the spinal column, an area replete with spinal nerves that affect the entire body. When we access the acupuncture points of the area, we are not attempting to influence the nerves. Likely the nerves respond in one manner or another, but that response is, for us as acupuncturists, of peripheral significance. The nerves are just one instrument of qi; they are not anything final in themselves. If the qi changes, so will the nerves.

Is acupuncture only for pain?

No. Acupuncture is often presumed to be simply a pain management technique because it is commonly used that way, and that use is getting some credible reports in scientific journals.

But pain relief is only a small part of what acupuncture can do. In fact, pain is usually the signal that something’s not right – something other than the pain, I mean. For example, if you come in with knee pain, we’re not simply seeking to alleviate that pain. Rather, we want to know why your knee hurts, and we’ll examine you for the cause.

Our diagnoses reflect these findings, and may sound strange to the modern ear: qi stagnation in the stomach channel, blood deficiency, gallbladder empty luo, to name a few. By correcting the pathology that’s causing the knee pain, the knee pain diminishes or departs.

More importantly (in terms of the big picture,) the progression of pathology stops so that nothing more complicated or serious develops. All this brings us to the next question.



What does acupuncture treat?

We often explain it this way: acupuncture treats people, not diseases. That means that no matter who you are or what you’re suffering from, acupuncture is an option for you – not just an alternative or a last-ditch attempt, but an actual, serious, thoughtful medicine.

We’ve helped people aged 1 month – 87 years with conditions such as fatigue, headaches, menstrual problems, joint injuries and pain, HIV, digestive complaints, back pain, earaches, nosebleeds, nightmares, constipation, anxiety, cancer, insomnia, nausea, neuropathy, pregnancy, depression, and smoking.

Of course we can’t legally guarantee a cure and wouldn’t want to make such a claim. What we do put forth is that even if acupuncture doesn’t cure your disease, save your life, or remove your symptoms, it will very likely change the way you feel about your disease, life, and symptoms. In this way, it greatly reduces suffering.

Some people wonder, “is acupuncture for me?” The short answer is “yes.” Acupuncture is for anyone who wants it. Maybe you’re in the best shape of your life, or maybe you feel like you’re falling through the cracks of modern healthcare. Maybe you don’t notice your body unless it’s hurting you. Maybe you have a vague sense that something is lacking in your health. Maybe you’re very sick. Acupuncture is multi-dimensional; it has something to offer every one of those “maybes,” because it is a medicine that takes the full constellation of the individual into account.

How much does acupuncture cost and is it covered by insurance?

Initial appointments are 2 hours long and cost $140. Follow-up appointments are 1 hour long and cost $80. Most insurance companies don’t include acupuncture, and we aren’t set up to bill directly with any insurance companies. Some of our patients have Flex plans that allow for acupuncture, but most people pay out-of-pocket. We are happy to provide you with a receipt that you can submit to your insurance company for reimbursement.

My doctor/chiropractor/physical therapist does acupuncture; what’s the difference?

Although other healthcare providers may be legally allowed to put acupuncture needles in the skin, only licensed acupuncturists have received in-depth training in acupuncture.  There’s a lot to know about acupuncture, especially to get optimum results.

We graduated from a four-year Master’s level program in acupuncture and herbalism. This means that we are acupuncturists and herbalists, and that is all we do.

What kind of training have you had, and what are your qualifications?

We both completed a four-year Master’s level program in Oriental Medicine with a focus on classical studies at Daoist Traditions College of Chinese Medical Arts in Asheville, NC. As part of the 3,000+ hour program, we completed a 2-year internship during which we practiced acupuncture and herbal medicine under supervision.

Graduating from a school is not enough to legally practice in most states; candidates must pass national board exams in order to be eligible for licensure. The National Certification Commission of Acupuncture and Oriental Medicine (NCCAOM) designs the boards and provides national certification. NCCAOM offers different types of certification; at VCA we are diplomats in Oriental medicine (Dipl. OM.,) which means that we are nationally certified to practice acupuncture and herbal medicine.

Different states give their acupuncturists different titles, but most states require NCCAOM certification, so the level of training among most entry-level acupuncturists is about the same. In Virginia, we are regulated by the Virginia Board of Medicine, and our official title is “licensed acupuncturist” (L.Ac.)

What’s “qi?”

Qi (“chee”) is a way of understanding the body’s interconnectedness. Like electricity, qi is not a substance but rather a dynamic exchange between positive and negative states called yin and yang. It is essential to anything that lives and grows. It is the force that means we are alive. All living things have qi – birds, dogs, plants, fish.

Because humans are conscious, we have a more complex expression of qi than, say, marigolds, and this is not always to our advantage. This more complex expression gets tripped up and pathological in more ways and in more places. When this happens, an acupuncture needle can restore the proper flow of qi in the body and move out obstructions.

Does acupuncture work for children?

Yes. We treat children and even infants. Kids are incredibly quick to integrate acupuncture – generally they are far quicker to heal than adults, as anyone with children knows!

(Visit this NY Times blog for info.)

A typical treatment for a child is different than a treatment for an adult.  There are some points that we avoid for children who haven’t yet hit puberty, and of course we don’t needle infants’ heads since their fontanels remain soft.

Typically children don’t need as many needles as adults, and generally we don’t retain needles for very long – or at all. We also use other ways to stimulate acupuncture points, such as a tuning fork, essential oils, pressure, or any combination of the above.

Another useful resource for kids is herbal medicine. We have access to glycerin-based tinctures that we really like. We use them for our daughter for teething and digestive upset, and have been very impressed by the quality. Because they’re glycerin-based, they are sweet, thus patient compliance is generally not a problem.

How many treatments will I need to see/feel results?

This is a tough one to answer, because the answer depends on a variety of factors. Generally, acupuncture is a process. In other words, unlike treatments that numb or mask the body’s illness, acupuncture reintegrates and resolves; this can take time.

It’s also not always immediately comfortable. For example, if a patient comes for knee pain, she may notice that her knee has improved after one treatment, but that her ankle now hurts. This happens sometimes, and it’s typically good news. It means that the obstruction or pathology that’s blocking the channel and causing the pain has been moved, and is traveling down the channel to its exit point. Subsequent treatments generally encourage the process and resolve the issue.

Sometimes people come in with something that’s been plaguing them – typically pain of some sort– and it is gone by the end of the treatment or the next day, never to return. These are great fun, and we enjoy them… but they’re not the norm. Usually the body needs time to figure itself out and get a new, healthier pattern working.

The length of time you’ll need to start feeling better also depends upon the focus of the treatment. If we’re working on shoulder pain that you’ve had since you broke your collarbone 39 years ago, it may take a little longer than treating a week’s worth of constipation.

Typically we expect some sort of change after the first treatment, but not a full recovery. Most people’s situations improve incrementally, and by the third treatment they are more fully aware of their progress. Generally people come 4-6 times for their initial issue, and then come regularly for other things. But that’s just a ballpark figure in an attempt to answer the question; within that estimate is always the element of unknown potential. Sometimes the body responds with such swiftness and grace that it almost seems magical.

Is acupuncture a placebo treatment?

No, according to the NY Times blog post about a recent study.

This is an interesting subject, and one that is deserving of its own post (stay tuned.) But for now, let’s just start here. It’s true that studies are mixed on the efficacy of acupuncture; our theory for why this is so is that the nature of successful acupuncture does not lend itself to evidence-based clinical trials.

Effective acupuncture is specifically tailored for an individual at a certain place in time. This means that if 5 people came to me today for treatment of headaches, they would not all receive the same points. Each individual’s point prescription would depend upon the very detailed picture of pathology – the location of the headache, the type of pain, the time in which it occurs, the triggers, the pulse picture, the tongue… each of these components is significant both in its own right, and in relationship to the other components.

Furthermore, if those same 5 people with headaches came again next week, they would not receive the same points they received today. We reevaluate each individual each time; and though we may keep the treatment targeted toward the same general channels, we won’t necessarily do so. Studies that require the repeated use of designated points to treat a condition are not, by their nature, going to appropriately or accurately gauge what acupuncture is capable of.

3 thoughts on “So…. you stick people with needles?

  1. Mary Beth, you write well and eloquently!! Brian, glad you told me about the blog…I’ll share with Ed. (And, I still think it’s a wee bit great magic!!) 🙂 Appreciate you, Pat

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