Acupuncture for the Lay Person

Frequently Asked Questions About Medical Acupuncture

What is acupuncture?

Acupuncture is the insertion of fine needles into the body at specific points shown as effective in the treatment of
specific health problems. These points have been mapped by the Chinese over a period of two thousand years.
Recently, electromagnetic research has confirmed their locations.

How deep do the needles go?

That depends upon the nature of the problem, the location of the points selected, the patient’s size, age, and
constitution, and upon the acupuncturist’s style or school. Usually, needles are inserted from ¼ to 1 inch in depth.

Does it hurt?

If your practitioner has obtained the correct stimulus of the needle, the patient should feel some cramping,
heaviness, distention, tingling, or electric sensation either around the needle or traveling up or down the affected
meridian, or energy pathway. In Chinese, acupuncture is bu tong, painless. Some Western cultures may
categorize these sensations as types of pain. In any case, if you experience any discomfort, it is usually mild.

Are the needles clean?

The best practice among acupuncturists in America today is to use sterilized, individually packaged, disposable
needles. Needles should not be saved and reused for later treatments. This eliminates the possibility of
transmitting a communicable disease by a contaminated needle.

Are there different styles of acupuncture?

Yes, there are. Acupuncture originated in China but has spread to Korea, Japan, Vietnam, Europe, the British
Isles, and America. In different countries, different styles have developed based on differing opinions as to theory
and technique. Patients should talk to their practitioners about their particular style and learn as much as
possible about the treatment being proposed.

What criteria should one use in choosing an acupuncturist?

Patients should ask about where the practitioner trained, how long the training was, how long he or she has been
in practice, and what experience the practitioner has had in treating the patient’s specific ailment.

Acupuncture is a licensed and regulated health care profession in about half the states in the U.S. Ask your
practitioner if your state requires a license to practice. In states that do not currently require licensing, patients
should ask their practitioner if they are certified by the National Commission for the Certification of
Acupuncturists. Acupuncturists who have passed this exam are entitled to add Dipl. Ac. (Diplomate of
Acupuncture) after their name.

How many treatments will I need?

The number and frequency depends on various factors:

duration, nature and intensity of condition
age, constitution and desired outcome

Dr. Naddaf is concerned with all aspects of your health - body, mind, emotions. Details of your medical, surgical
and family history are relevant, as are your lifestyle, exercise habits, diet and work. Some degenerative
conditions may require many treatments over time.

Is there anything I need to do before receiving an acupuncture treatment?

Yes, the following suggestions will help you get the maximum benefits from your treatment.

Maintain good personal hygiene to reduce the possibility of bacterial infection.
To prevent loss, do not wear jewelry.
Wear loose clothing. Women should not wear one-piece dresses. Avoid wearing tight stockings.
Avoid treatment when excessively fatigued, hungry, full, emotionally upset, or shortly after sex.

Is there anything I need to do while receiving acupuncture? Yes.

Relax. There is no need to be frightened. Ask your practitioner any questions you have along the way so
that you can get the most benefit possible from the treatment.
Do not change your position or move suddenly. If you are uncomfortable, tell your practitioner.
Some people experience dizziness, nausea, cold sweat, shortness of breath, or faintness during treatment.
This often occurs if you are nervous. Inform your practitioner immediately so he or she can readjust or
withdraw the needles. Also let your practitioner know if you feel an increasing amount of pain or burning
sensation during the treatment.
If you find your treatment unbearable at any point, be sure to speak up so that your practitioner can make
the proper adjustments or stop the treatment.

Acupuncture originated in China 5,000 years ago and is part of Traditional Chinese Medicine. It is a form of
healing which has major benefits:

drug free pain relief
disease prevention
treat the cause as well as the symptom so re-occurrence is less likely
holistic approach linking body, mind and emotion
treat specific disorders to reduce symptoms.
maintenance of long-term problems to promote a more comfortable way of living and reduce the need for
medication and surgery.
an effective form of preventative medicine because energy imbalances can be treated before disease
appears.

What does acupuncture treat?

There are a wide range or disorders that can be treated. The World Health Organisation (December 1979)
recognises a number of disorders that have been successfully treated by acupuncture. These are emphasised in
bold print in the following list which also includes other common disorders that respond well to acupuncture.

NEUROLOGICAL
Headaches, migraines, difficulty sleeping, nervous tension, stroke, some forms of deafness, facial and inter-costal
neuralgia, trigeminal neuralgia, peripheral neuropathy, dizziness.

CARDIO-VASCULAR SYSTEM
High or low blood pressure, fluid retention, chest pain, angina pectoris, poor circulation, cold hands and feet,
muscle cramps.

RESPIRATORY SYSTEM
Bronchial asthma, acute and chronic bronchitis, acute tonsillitis, rhinitis, sinusitis, hay fever, chronic cough,
laryngitis, sore throat, influenza and the common cold.

DIGESTIVE SYSTEM
Toothache, post-extraction pain, gingivitis, mouth ulcers, hiccough, spasms of the oesophagus, gastric and
duodenal ulcers, gastric hyperacidity, gastritis, heartburn, hiatus hernia syndrome, flatulence, paralytic ileus,
colitis, diarrhoea, constipation, haemorrhoids, liver and gall bladder disorders, weight control.

URO-GENITAL SYSTEM
Cystitis, prostatitis, orchitis, low sexual vitality, urinary retention, kidney disorders, nocturnal enuresis,
neurogenic bladder dysfunction.

GYNAECOLOGICAL AND OBSTETRIC DISORDERS
Premenstrual tension, painful, heavy or irregular, or the absence of periods, abnormal uterine bleeding or
discharge, hormonal disturbances, disorders associated with menopause, prolapse of the uterus or bladder,
difficulty with conception, morning sickness.

SKIN
Eczema, dermatitis, psoriasis, nerve rash, herpes zoster, acne, scar tissue and resultant adhesions, hair loss and
dandruff.

EYES
Visual disorders, red, sore, itchy or watery eyes, conjunctivitis.

MUSCULO-SKELETAL SYSTEM
Osteoarthritis, sciatica, lumbago, weak back, low back pain, rheumatoid arthritis, gout, tenosynovitis, shoulder
and neck pain, cervicobrachial syndrome, "frozen shoulder", "tennis elbow".

SPORTING INJURIES
Sprained ankles and knees, cartilage problems, corking and tearing of muscles, torn ligaments and bruises.

PSYCHOLOGICAL
Depression, phobias, emotional disturbances, anxiety, nervousness and addictions such as smoking.

What Happens When You Have Acupuncture?

Some people are frightened by the thought of acupuncture and may feel that it takes a great deal of courage to
inflict 'the needles' on themselves. The first, and probably the most important fact to understand about
acupuncture, is that it is not a frightening experience. It does involve the insertion of fine needles through the
skin, and most acupuncturists use between six and eight acupuncture needles at each treatment session. The
needles used are smaller than injection needles, in fact an acupuncture needle fits into the central hole of a
normal injection needle. Acupuncture needles have a doweled end, not a cutting end like most hypodermic
needles, and therefore are far less likely to cause tissue damage or bruising when inserted.

Needle Insertion
The insertion of an acupuncture needle is not a painful
experience. Patients sometimes sit with eyes closed
and teeth clenched asking, 'When are you going to put
the needles in?', and are often surprised to learn that
the needles are in place before they have finished
asking the question. It would be wrong to suppose that
the insertion of an acupuncture needle is devoid of any
sensation, but those who experience acupuncture do
not usually describe it as a painful sensation.

Needling Sensation
The Chinese state that if acupuncture is to achieve its maximum effect it is necessary for the acupuncturist to
obtain a 'needling sensation', over each acupuncture point that is used. This involves the needle being moved
slightly while it is in the skin, and the sensation experienced by the patient will vary. Needling sensation is not
painful but it is a dull, bursting or numb sensation around the site of the inserted needle. The sensation may
also travel up or down the channel being treated; the stimulation of an acupuncture point on the right knee may
precipitate the experience of a strange burning or numb sensation in the right ankle. Needling sensation is
probably best defined by the statement, 'When needling sensation is experienced the needle no longer feels like
a needle!'

Some acupuncturists use an electrical stimulator to excite acupuncture points as a substitute for obtaining
needling sensation. Electro-acupuncture causes a tingling sensation over the acupuncture points that are being
stimulated, but the Chinese believe that this does not replace the need to obtain needling sensation. If the
stimulator is mistakenly turned to a very high intensity then the patient will experience some discomfort, so it is
wise to be cautious when using electrical stimulators, and to adjust the intensity slowly and carefully.

Belief
Another common misconception is that patients must 'believe' in acupuncture to enable it to work. This is
similar to the idea that acupuncture is a complex form of suggestibility, but this is quite wrong. Like any other
type of medicine acupuncture works on those who believe in it and those who do not. The mechanism of
acupuncture is not clearly understood but, as has already been mentioned, it is quite clear that reproducible
biological changes occur when an acupuncture needle penetrates the skin. Whilst accepting that all medical
treatment is more effective if the doctor is trusted by the patient, this trust is not a prerequisite for the
physiological changes that occur during and after acupuncture.

Will I Get Better?
No medical treatment works all the time, and acupuncture is no exception to this rule. There are many problems
in assessing acupuncture as a form of treatment for any disease. First of all the doctor must have a clear idea of
the natural history of the disease; if the disease is going to get better anyway, it is a little presumptuous to claim
that the cure is due to acupuncture, just because the patient has received acupuncture. Furthermore vast
number of statistics must be collected and analyzed before any treatment can be adequately assessed, and in the
field of acupuncture the research has not yet been satisfactorily completed. This makes the question 'What
chance of improvement do I have?' a very difficult one to answer exactly for specific condition. In the West, the
condition that is most commonly treated is by acupuncture is pain and, in general, acupuncture has a significant
effect in about seventy per cent of painful diseases. The results and data available about 'success rates' will be
discuss in detail in later sections.

Response to Treatment
It is very difficult to be dogmatic about how a patient will respond to acupuncture. Occasionally, one treatment is
all that is required, whilst other people may need a number of treatments to gain the same result for the same
disease. In general most people, and their problems, do not respond magically to one treatment, and between
four and eight treatment sessions may be required in order to obtain the best results from acupuncture.

Acupuncture usually works in stages. The first two or three treatments represent a process of 'understanding
the needs of the patient', and are therefore a sort of experiment designed to assess the specific requirements for
that person in that particular condition. Some people respond to classical Chinese body at puncture, whilst others
respond better to ear acupuncture. This partially reflects the skill of the acupuncturist in the use specific
techniques, but it also represents the fact that the body responds in a slightly different way to slightly different
stimuli. Some people seem to respond to a particular acupuncture technique for one condition, whilst requiring a
completely different technique for another complaint. A patient may even respond to a particular approach for a
specific condition and then stop improving half way through treatment, thus necessitating an alternative
approach to that condition.

If a patient experiences some symptomatic
improvement at the first consultation, then they often
gain considerable relief from a course of acupuncture;
equally, many people who do not obtain symptomatic
improvement at the first consultation may also gain a
great deal from acupuncture. It is a good prognostic
sign if there is some instant improvement, although the
improvement gained at the first consultation rarely lasts
longer than a few hours, and may last only a few
minutes. Each subsequent treatment should then give a better and more prolonged result and, as shown on the
graph, the symptoms should gradually disappear as the treatment becomes effective.

Three treatments should be adequate to assess whether a patient will respond to acupuncture. If there has been
no response to treatment after the first three sessions then it is doubtful whether any response will occur. This
should be taken as a general guideline and not as an unbreakable rule as sometimes the symptoms of a
particular condition may be very fluctuate, and it may be difficult to obtain a clear assessment of the results of
treatment. Occasionally the patient may not find it easy to remember exactly what the condition was like three
weeks before and this too can create difficulties, so it is wise to keep a diary and assess day by day the changes
that are arising in the problem being treated. This will allow the patient and the acupuncturist to develop a clear
idea of the response to treatment, and to assess whether the treatment is worthwhile.

Most acupuncturists continue to treat a patient until there is no further improvement in their condition. The
response, as shown by the graph, tends to 'level off' towards the end of treatment (usually after five or six
treatments) and this 'leveling off' signifies that further treatment will probably not give further benefit.
Acupuncturists in the West tend to treat people on a weekly basis; in China treatment is given daily, but this
seems to be more from habit rather than for any good medical reason. Weekly treatments allow both patient
and acupuncturist to gain a clear assessment of the progress and response to treatment.

Reactions
Sometimes a patient may experience a temporary worsening of symptoms due to acupuncture; this is a response
to treatment and is a good sign. Such 'reactions' to treatment only last for a short time, perhaps a day or two,
and are usually followed by improvement. A 'reaction usually means that the acupuncture needles have been
overstimulated as some patients are very sensitive to acupuncture and may respond to normal stimulation by
overreacting. If a 'reaction' occurs, the patient should be stimulated less at the next treatment session, this
means giving a shorter and less aggressive treatment. Sometimes the improvement may be very delayed and the
condition may not improve until the treatment has ceased. Occasionally patients who have been abandoned, with
no improvement after three weeks, will suddenly find improvement some weeks after the acupuncture has
ceased.

Although I have outlined general guidelines about the response to treatment it is important to take each
problem as it arises. The general rules are not always obeyed, and if they are followed too dogmatically then the
versatility of acupuncture may be lost.

Cure or Symptom Relief?
Acupuncture can be a cure, or it can act as a palliative treatment; this depends on the condition that is being
treated. If a chronically painful arthritic knee is treated with acupuncture then, on average, the improvement
will last about six months and the knee will then require re-treatment. Some acupuncturists treat their patients
every three months or so to avoid any deterioration in their condition. The traditional Chinese approach is to
attempt to maintain the patient in a state of health and a regular three-monthly treatment pattern is therefore
justified; however, many acupuncturists just treat patients when the symptoms recur. If the condition is
self-limiting, such as the pain from an attack of shingles, then no further treatment is required after the pain is
relieved.

Whole Body Therapy
In the West the vast majority of people look upon acupuncture as an alternative treatment for pain; therefore
pain is the most frequently presented complaint at an acupuncture clinic. If the patient is approached from the
traditional Chinese viewpoint then the body is treated as an integrated system. People in pain frequently have
other complaints, such as heartburn or depression, and if the body is treated as a complete system then these
complaints will also be treated, and often resolve during the course of acupuncture. The patient may be quite
surprised to find that some other problem has suddenly improved, as it was not realized it was amenable to
acupuncture treatment and therefore not mentioned to their acupuncturist.