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Ask an expert - about acupuncture - how does acupuncture work?

14 questions

Q. Anxiety where will the needles be put?

A. A very difficult question to answer because of the nature of Chinese medicine. Whereas in the West each condition has a set treatment, in Chinese medicine we treat the person, not the condition. This means that we take everything about someone into account when we make a diagnosis, and then use the theoretical framework of the system to determine where the needles go.

Obviously there are some points which are quite frequently used, and some of the 'cookbook' treatment protocols will say 'for anxiety needle x'. Rather worryingly some modern Chinese practice has become a little similar. These points can sometimes work, even in the absence of a proper diagnosis, but not as well as when someone it treated properly. Many of these points lie on or near the wrist crease.

Generally speaking, though, the majority of points used in the early stages of treatment are on the arm below the elbow and on the leg below the knee. These tend to be the starting point, and very often do all that is needed. Occasionally there are blockages which will see needles used on the torso, and occasionally again on the back, but most practitioners will start off quite gently. As treatment progresses there may be some body points brought to bear, especially on the upper back, but nothing about which anyone needs to feel the slightest bit worried.

The important thing you have to remember is that treatment can only take place with the consent of the patient, and if someone decides that there are 'no go' areas, then they can ask that this be acknowledged and followed. If a practitioner says that they cannot work under those circumstances, and some might, then it's just a matter of finding a new practitioner. We can't compel someone to treat a patient, a practitioner can't compel a patient to have a treatment they don't want.

The short answer is 'no'. Traditional Chinese acupuncture has always been a generalist practice, and in that sense every practitioner should in theory be able to treat every person who comes to see them. The reason lies in the fact that each person's energy is unique and different, so somewhat confusingly to the western mind twenty people with the same named western condition might be treated in twenty different ways. Symptoms remain symptoms in all systems of medicine, but the paradigm of Chinese medicine weaves them into a great many more patterns for which other diagnostic signs like the pulse and tongue are the ultimate arbiters of choice. That is not to say it is an exclusively eastern preserve; the great Canadian physician William Osler used to say 'The good physician treats the disease; the great physician treats the patient who has the disease'.

This is particularly important in treating something like PTSD. Not only are there many different ways in which the condition can be expressed by the body, but also the precipitating cause can have an impact on the emotions and deeper aspects of the personality. From a Chinese medicine perspective the body mind and spirit are an indivisible whole, so it is able to make sense of the more subtle impacts of trauma and see the patterns which manifest on all levels.

That said, it can often be good to talk to someone who has experience of working with other patients with similar problems, and although we are in the process of formally recognising only paediatrics and obstetrics we are also aware that complex mental issues can potentially form another area of specialism. So while we would unhesitatingly recommend all of our members to be able to offer you help we suspect there may be one or two in your area who are the 'go to' practitioners for more complex problems, and these will be well known to any local member you call.

Our advice would be to contact one or two BAcC members local to you and see if they are prepared to offer you a few minutes face to face without charge to discuss whether and how they might be able to help you. This is far better than just booking in sight unseen, and will give you a sense of whether the practitioner is someone you can do business with. This may not be the most experienced or skilled, but can often be someone  with whom a prospective patient feels a level of empathy, which can be very helpful in the healing process.

Q: What are the principles and practices of acupuncture?

A: We like a challenge but this is a little steep even for us. Not that we can't answer your question, but because the answer would run to several thousand words, which is a little beyond our remit.

Our website,, has a number of sections under the 'about us' and 'traditional acupuncture' buttons which provide a very brief and rudimentary explanation of what we do. For something more comprehensive, though, you would probably need to get hold of a book which explains in greater detail how the systems we use where and how they originated. The 'go to' text when we all trained in the latter part of the last century was Ted Kaptchuk's book 'The Web that has no Weaver' but since that time there have been a few more books by senior practitioners like John and Angela Hicks, or Peter Mole, which give thorough explanations of what we do and why we do it.

The challenge for any author in the West is how to present a 2500 year tradition in a comprehensible way when the very culture in which the original theories was embedded is vastly different from the western culture in which we live. Chinese language is able to express subtle shades between black and white in a way our language cannot, and the kind of internal logic of the language and concepts of yin and yang are embedded in the way that people actually think. Getting this across in a language and structure of thought which is very different can be a problem.

Not only this, whereas western medicine can be viewed as an expanding ball developing from a commonly agreed centre, Chinese medicine is inherently pluralistic. This arises in part from the fact that until the mid-1950s it was very much an apprentice trained tradition. There are many textbooks which have been handed on for thousands of years, but the basic principles have been applied in a myriad ways, some of which can actually be contradictory but nonetheless part of a practitioner's basic skill set. You can imagine the challenge that this represents even to learn the various systems, let alone try to explain the whole field thoroughly to an interested party.

If you are trying to get hold of a much briefer introduction there is a small pocket book which cnan be found here

We used to sell copies of this from the office to members who wanted something small to lend or sell to prospective patients. While it could do with a minor update it still offers a very simple but useful overview of what we do.

We are sorry that we can't go into much greater depth here, but the resources available online and in books are now so good that it wouldn't make sense to give a partial and over-short explanation here. We hope that you enjoy finding out about what we do.

Q: Does acupuncture have a gradual or immediate effect on the body?

A: We suppose the clearest expression would be that the effect of using the needles is immediate, but the changes experienced by the patient can often take a while to be felt.

We think that a major challenge in helping the public understand the system of Chinese medicine is that the acupuncture points and the channels which connect them often look like an electrical wiring diagram when they are shown in books, and people have a sense that putting a needle in a point immediately activates the whole channel at once. Now this can be the case; we have had many sensitive patients over the years who have been able to describe in detail the whole pathway of a meridian including the deep internal pathways. However for the majority of people, although they will feel where the needle is placed, they are not going to experience changes immediately.

Some of the very ancient and beautiful Daoist paintings show the body as a landscape, with the stomach as a granary and so on, and the channel system is shown as a drainage and irrigation ditch. Needling a point is rather like opening a sluice gate and starting a flow which will have an immediate effect at the gate (which is why a practitioner will take a pulse at the wrist and pronounce themselves satisfied that something is happening) but take a while longer to reach the areas that matter. Otherwise it would be like watering a plant and seeing the leaves suddenly spring into life again.

Clearly there are some conditions where a change can be pretty fast, especially where the problem has been caused by blockage. Some acute short term problems can be reversed incredibly quickly if a patient is lucky, and we have seen headaches and backaches almost magically disappear. For the majority of patients, though, change is more evenly paced, and for many reasons this is a more natural way to recover good health. It can take a while to adjust to the stages of recovery, and having more time means that the system does not get 'jolted' back to good health.

The skill and art of the practitioner lies in using their experience to judge which people are likely to experience change quickly and which may have to wait a while for changes to happen. The longer the problem has existed and the deeper it has gone into the system, the longer it will usually take to address, however well the person may look on the outside. The Chinese tend to use the 'shen' or spirit seen in the eyes as a determinant of who will be most likely to recover well.

The depth of needle insertion depends both on the location of the point and also on the style of treatment.

Most points are needled to a depth of between 3mm and 5mm, with some in quite bony places, like fingers and toes, slightly less, and some in the hip and buttock a considerable amount more, as much as 1 to 2 cm.  Although it is difficult to make generalisations about styles, many Japanese styles of acupuncture use superficial needle insertions almost everywhere on the body, often using quite oblique insertion, whereas some of the medical acupuncture techniques are much more invasive, often needling to a depth of an inch or more.

Practitioners are usually guided by the sense of contacting the energy of the patient, and if this is achieved at relatively superficial levels that is far as they will needle.

A:  Inserting anything deeply into the body is potentially dangerous, which is why we regard our degree level training as the minimum requirement for the safe practice of acupuncture. This is why we take issue with short courses and people who decide to 'have a go'; needling safely and without risk of infection requires attention to a more detail than can be bolted on to short courses. 

There are some areas of the body where deep needling is especially risky, but thousands of years of practice and experience of the variation in the shapes and sizes of patients has led to some very specific guidelines for how deeply to needle and at what sorts of angles. Deep needling is particularly dangerous on the thorax, and along with the two leading medical acupuncture organisations we have created a website which has a safety chart to encourage safe practice by health professionals who decide to add acupuncture to their repertoire. Needling in this area requires oblique insertion of needles, and extreme care in needling  the elderly, the thin and those with a history of bronchial problems.

In the hands of a fully trained and qualified professional you are safe. The number of serious adverse events each year is very small indeed when you think that over 4,000,000 treatments are administered, with only a dozen or so requiring more than short term first aid. However, our aim is to bring this number down even smaller, which is why we are combining with our medical colleagues to make acupuncture one of the safest healthcare modalities around.  

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