An Introduction to Acupuncture
David A. Dawson, Ph.D.,
Please see the Introduction to Chinese Medical Theory page, and the Modalities of Chinese Medicine page for background to this page. For a less in-depth discussion of acupuncture and its effects, please see the FAQ page.
What is acupuncture? How did it develop?
Acupuncture is the insertion of extremely thin, sterile needles into specific locations on the body to regulate the flow of energy and produce specific effects.
The exact origins of acupuncture predate written records (as long ago as the late Stone Age, 9000 BCE), but the earliest evidence indicates the use of sharpened stones that were pressed onto points on the body for the purposes of expelling demonic influences. Over time, sharpened bamboo replace stone, and eventually these were refined into extremely thin metal needles, which have been the standard tool for acupuncture ever since.
The oldest surviving acupuncture needles come from the tomb of a Chinese prince, Liu Sheng, who was buried in 113 BCE. The four needles vary in length (6-7 cm) and thickness, but are surprisingly fine, considering they were made by hand more than 21 centuries ago. (The thumbnail on the right links to a full-size photo of these needle; see the source website for more information on the time period, other artifacts found in the tomb, photos of the actual dig, and so on).
Today's Acupuncture Needles
As beautifully crafted as the needles from Liu Sheng's tomb are, today's acupuncture needles are much finer. They range from ultra-fine (0.12 mm / 44 guage / 0.0047 in.) to fine (0.40 mm / 26 guage / 0.0157 in.), and in lengths from just a few millimeters all the way up to 8" or longer, in a variety of metals. The extra-short and extra-long needles are for specialized treatments, and don't often show up in regular acupuncture practice. For most purposes, I use stainless steel needles between 0.18 mm and 0.25 mm diameter, and 1/2" to 2" long.
The needles are precision-made to the highest standards, and packaged in sterile packaging. They are used once, then disposed of in 'sharps containers,' just like in a nurse's office.
Acupuncture needles are not simply inserted randomly into the body. The locations are determined by the effects the practitioner wants to produce.
One of the main principles of Chinese medicine is that the body has an energy system that allows all the changes and movements of the body to take place. Although all parts of the body are supplied with this energy ('Qi'), there are special locations where that energy can be accessed and balanced - adding more, where energy is lacking, or dispersing, where it is stuck or 'in excess' (think of a headache, or the swelling of a bee-sting). In addition, many of these points are connected with each other by 'channels,' which have internal connections to the organs of the body, allowing us to balance internal functions with acupuncture as well.
Many parts of the body also serve as a kind of map for the whole body. This is similar to the idea behind reflexology, in which areas on the soles of the feet are said to correspond to other parts of the body. In Chinese medicine there are similar systems (on the hands, the back, the ear), which represent the whole body. Acupuncturists use these microsystems freqently.
The needles are inserted into specific points, which are chosen according to their ability to produce the healing needed for the individual patient's body (or mind, or spirit). The acupuncturist usually selects five or six points (and since a point on the knee, for example, may be needled on both sides of the body, a treatment may involve ten or twelve needles). Occasionally, a treatment may only use two or three needles, or may use many more, depending on the nature of the concern, and the kind of treatment approach chosen.
The areas to be needled are cleaned with alcohol, then sterile needles are taken from their packaging one at a time and inserted gently into the acupuncture point. Given how thin the needles are, and the sophistication of design of the needle tips, there is usually very little sensation.
After the needles are inserted, the patient sometimes feels a 'tugging' or a 'heaviness,' sometimes even a sensation of warmth or coolness, at the site of the needling. These are normal, and indicate that the energy of that point is responding to the treatment.
Typically the needles remain in place for ten to twenty minutes, during which time the patient tends to experience a profoundly restful feeling, and may even fall asleep for a few minutes. After the needles are removed, there is occasionally a 'spacey' kind of feeling for a few minutes, but most people feel a restored energy, and a kind of quiet recharging as a result of the treatment.
How does it work?
How does sticking a piece of metal into somebody's hand help get rid of a sore throat? How does acupuncture on the little toe turn around a baby that's in breach position? It just sounds crazy....
Yes, it does sound crazy. And it is very difficult to explain in terms that someone with a western upbringing can make sense of. The Chinese, of course, have their own way of explaining it all, but sometimes the explanations just don't quite cross the cultural divide.
The simplest explanation is that certain combinations of points on the body have been shown to have specific effects, such as speeding up or slowing down the digestive system, or clearing heat (such as from a fever), or generating heat. Acupuncture stimulates the energy systems of the body to restore healthy balance - whether that pertains to heating and cooling, or fluid metabolism, or psychological and spiritual well-being (all of which are seen as intimately connected in Chinese medicine).
Beyond this simplistic explanation, though, other ways of thinking about these things show some promise of explaining how acupuncture works. German researchers have tested the electrical conductivity of the surface of the skin, and found that where an acupuncture channel is said to be, there is a different level of conductivity than in 'regular' skin; in addition, when they went up or down the channel and crossed an acupuncture 'point,' an even greater change in conductivity was registered. This suggests some kind of connection with the micro-electrical currents of the body, but even so, does little to explain why one point on a channel will clear phlegm from and strengthen a weakened lung system, while another point on the same channel, less than a half-inch away, will take the fire out of a severe sore throat.
The explanation of 'channels' and 'microsystems' given above, only begins to scratch the surface of the matter. The ancient Chinese system of medicine is a finely-detailed and richly-nuanced understanding of the systems of the body - to gain even the basic level of understanding required to be a licensed acupuncturist requires thousands of hours of coursework and clinical training (the Master of Acupuncture is a three-year graduate degree) - and this website doesn't allow us to go into that much detail.
In the clinical setting, however, it is much easier to explain some of these nuances, as they will address specific acupuncture points, and will pertain to the condition the individual patient is being treated for. A much better understanding of these things can be conveyed in that setting than I am able to do here.
The Patient's Involvement in the Treatment
Many patients experiencing acupuncture for the first time are a little overwhelmed by the idea. I try to make sure I tell each patient that they are in charge of the treatment. I have the training, and can make the educated choices about how to treat something, but it is the patient's body, and he or she always has the final say in what we do. If we start a treatment, and the patient doesn't want to continue, we will remove the needles and discontinue the treatment (this has only happened once in 10 years of practice, by the way). Or if a certain acupuncture point is uncomfortable (this, too, is an uncommon occurrence), we will adjust or remove that needle. It is always the patient's right to have the final say.
As I said, it is rare that a patient decides to forego a treatment. On the other hand, more often than not the patient simply enjoys the relaxation of the acupuncture experience. The patient may choose to participate in other ways, however - he or she may want to know more about what we are trying to accomplish with the treatment, and add his or her mental focus to what the needles are doing. This can be an enriching experience, but is not a necessary part of the treatment.
The Patient's Response to the Treatment
Patients will often tell me they feel an immediate change in the concern they are being treated for (especially if it has to do with so-called acute conditions, such as a head cold, or musculo-skeletal disorders, such as knee pain). After the first treatment, this sense of improvement may not last a long time, but after a few treatments, the results should be more enduring.
It is not uncommon for patients to express a sense of wonder at how relaxed they feel after a 15- or 20-minute treatment. I have had more than one person tell me that he or she would come back for treatments 'even if it didn't help' their main concern, just because the sense of well-being they experienced during and after the treatment was so pleasant. (Fortunately, their 'main concern' also responded to the treatments!)
How many treatments does it take to fix something?
The answer to that is impossible to predict at the beginning, and depends on a wide range of factors. To use an unflattering analogy, acupuncture is like training a puppy - you may have good success the first or second time you tell the dog to sit, but the results will be much more satisfactory if you practice with your dog. The body, too, must be trained in order to hang onto the healthy balance acupuncture seeks to restore.
One rule of thumb is that the longer a patient has had a condition, the longer it will take to restore balance. But that has its exceptions - some people respond very quickly to acupuncture, and others more slowly. During my clinical experience in acupuncture college, I treated a patient dealing with severe, continuous back pain due to a vehicular accident 20 years earlier. We were short on time during her first visit, and I was able only to do a 7-minute treatment with four needles; the following week she reported that she had been entirely pain-free for three whole days. She continued to improve until she was pain free most of the time. This was a remarkably quick response, however, and not everyone has such stellar results from the first treatment.
Generally, though, we can assume that if we are doing things right, we should see a change for the better in terms of frequency, intensity, and/or duration of the symptoms (the three cardinal measures of improvement) within three or four treatments. If we do not, we will talk about other options - either a different acupuncture approach, adding other options to the plan (such as moxa, massage, or herbal medicine), or recommending an alternative to Chinese medicine.