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

12 questions

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, www.acupuncture.org.uk, 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

https://www.amazon.co.uk/Understanding-Acupuncture-Joanna-Trevelyan/dp/1904439268/ref=sr_1_4?ie=UTF8&qid=1496646368&sr=8-4&keywords=understanding+acupuncture

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 www.acupuncturesafety.org.uk 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.  



Q: I have had complicated hand surgery which has left my hand very tender and easily hurt. I would be very reluctant to have needles in my hand because I think this would be very painful. Is it still possible for me to have effective acupuncture avoiding the hand? My most obvious problem is catarrh and chest problems. 

A:  Many people are worried about acupuncture needles without really having come across them. The majority of needles in use are about 0.18mm to 0.25mm in diameter, which is finer than the average sewing needle, but the crucial factor is that they are solid. Most people have experiences of hyopdermics which, being hollow, are a great deal more uncomfortable when they break the skin. Solid needles cause less discomfort, and this is further reduced when they are inserted by the use of a guide tube which is positioned on the skin and the needle gently tapped in. The 'distraction' caused by the pressure of the tube makes the needle insertion less palpable.

However, there are prospective patients like yourself who have good reason to be fearful of needles, however small the impact might be, and there are a number of ways of getting around this. Most points on the body are bilateral and although traditional use says that the left side is for tonifying energy and the right side for reducing energy, in practice they are interchangeable, and it is the needle action and direction which determines what effect is achieved. There is, then, nothing that a practitioner may want to do that will be ruled out by having no access to the left hand.

Indeed, even if both your hands were sensitive, there are ways around the problem by using points elsewhere on the body which have a direct connection with the channels and organs you are trying to influence. This is very much the case with post-mastectomy patients where we cannot needle the arms and hands below where lymph nodes have been stripped out in the armpit. Where someone's constitution would normally require the use of needles on the arm, we have to use our knowledge and skill to generate the same effects by the use of leg and body points.

The bottom line is that there is nothing which would impair the quality and effect of treatment by protecting your hand. You may even find, though, when you have needles inserted elsewhere that you might be able to tolerate needles in the left hand. It may also be worth discussing with a practitioner what might be done to render the area more benign. We occasionally treat amputees who have a continuing neuropathy from the severed nerves, and we are quite often able to turn the volume down.

As far as chest problems and catarrh are concerned, there are many clearly defined patterns recognised in Chinese medicine for the treatment of problems like this, and it may well offer a solution. However, the strength of Chinese medicine lies in the fact that it treats each patient as a unique combination of energy, with the same symptom often being treated differently from person to person, so the only sensible advice we can offer is to visit a BAcC member local to you to discuss whether they might be able to help.

Q: I had acupuncture today, the lady used re-usable needles instead of disposable ones. She assured me they were sterilised using the appropriate machine. Is this ok?  Shouldn't all acupuncture needles be disposable?

A:  The BAcC's Code of Safe Practice could not be more explicit on this:

You must only use single-use pre-sterilised disposable solid needles which, if in multipacks of five, ten or more needles, must not be used or stored for use after the session in which the seal on the package is broken. Any needle with damaged packaging seal must not be used.

The only exceptions which we ever allowed were when the transition to guide tube needles was introduced in the late 1990s and some of the longer needles were not available at that stage. We allowed members who purchased these to use them only after they had been sterilised before use and then only used a single time as if they were single-use needles. In modern times all sizes are available as single use needles and there is no excuse for re-using needles.

The ban on the use of re-useable needles was introduced for safety reasons. It transpired that prions, the proteins involved in the transmission of Variant CJD, the 'mad cow' disease human equivalent, were not killed by autoclaving, and there was always a theoretical risk that someone could unwittingly spread the disease by needle re-use. Subsequent investigation revealed that it required more than simply exposure to the prion to create the condition in another subject, but by this stage the change to single use needles had become firmly established and patients and practitioners alike were reassured by the safety that this provided. The growing market also meant that needle prices dropped and quality improved, where the earlier disposables had been shockingly poor. Nowadays a needle can cost as little as 2p, and there really is no justifiable reason not to use single use needles.

If the practitioner is a BAcC member, you would be well advised to report them to the Professional Conduct Officer or Safe Practice Officer immediately. The chances that you have been put at risk are minimal, but that does not change the fact that this is a breach of one of the more strict rules under which we operate. If the practitioner is not a BAcC member, you should take the matter up with their professional body, or should that not be something you want to do, then you could contact the local authority Environmental Health Department. The law relating to skin piercing does embrace the possibility of re-using needles, but this is because the new byelaws were extended to covering all skin piercing and many tattooists and body piercers do use re-useable equipment. Had it been an acupuncture-only law, we would have insisted on single use disposable equipment being the legal norm. If someone is re-using needles, then their autoclaving equipment has to be maintained in an exemplary fashion to guarantee that it delivers what it is supposed to.

Aside from anything else, inserting a needle can do considerable damage to the point, as this recently published paper shows

http://aim.bmj.com/content/20/1/11.full.pdf

and creating small fish-hook ends which go in easily but tear tissue on the way out is not a great option for patients. Needle breakage is almost unknown in modern times, but where this used to happen in the old days, it was usually related to the over-use of needles with autoclaving which made the steel become more brittle. Single use needles have all but eradicated this problem.

   

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