“Does acupuncture hurt?” and “What can acupuncture treat?” are the two questions we hear most, usually as soon as someone sits down. The first is fairly quick to answer. The second is harder, because two people with pain in the same spot may need two quite different ways of needling.
Take neck and shoulder pain as an example. One person hurts after months of sitting at a computer leaning to one side. Another hurts from poor sleep and worry, with the neck muscles tensed all night without realizing it. If we looked only at where it hurts, both would get the same set of points around the neck and shoulders. At Tam Duc, points are chosen after the examination finds the cause, so those two sets of points usually differ.
How acupuncture and moxibustion work
Acupuncture means inserting very fine needles into points on the body to prevent and treat illness. Moxibustion means warming the points with heat, usually from dried mugwort leaves processed into moxa wool and rolled into sticks. In Vietnam, the technical procedures for the field are set out by the Ministry of Health in Decision 792/QĐ-BYT of 2013.
Traditional medicine explains how acupuncture works through the idea of qi. Points lie along the meridians, and needling a point serves to regulate qi. When qi is in harmony, blood is in harmony; when blood is in harmony, the meridians flow freely, yin and yang gradually return to balance, and the body has the conditions to heal itself.
Modern medicine sees a point as a place where the needle stimulates nerves, muscle and connective tissue. That stimulation is thought to activate the body’s own pain-relief mechanisms and help tight muscle fibers relax, while also acting on the autonomic nervous system and the endocrine system. These mechanisms are still being studied, so we only go as far as saying there is a basis for them, not that they are fully understood.
One sore shoulder, two sets of points
Before picking up a needle, the doctor examines you. The first visit usually takes 30 to 45 minutes. It includes a clinical examination by modern medicine, the four examinations of traditional medicine (looking at the complexion and tongue, listening to the voice and breathing, asking about your health, taking the pulse), a functional neurology examination and muscle testing according to Applied Kinesiology. When needed, the doctor suggests lab tests or an ultrasound first and only then discusses treatment.
The clinic looks at pain through the “health triangle.” The structural side is bones, joints, muscles and posture. The chemical side is nutrition, micronutrients and hormones. The mental side is stress and emotions held in over a long time; we believe the body stores memories in many areas outside the brain, so an old worry sometimes shows up as stiffness in the shoulder. A pain may belong to just one side, or it may involve all three.
Back to the two people with neck and shoulder pain. The one who sits lopsided needs points around the muscle group that is carrying the load and the related area of the spine, plus advice on correcting the sitting angle. The one with insomnia and worry needs extra points aimed at sleep and the nervous system; sometimes sleep has to be dealt with first before the shoulder will soften. If the cause lies largely on the chemical side, acupuncture is only one part, alongside herbal decoctions or changes in nutrition. Other methods are on our Treatment methods page.
“Treat it where it hurts”
Older generations like to criticize the approach of “treating wherever it hurts,” and that criticism is only half right. Traditional medicine does have points taken right at the painful spot, called ashi points (阿是穴, ā shì xué), and needling locally often eases the pain noticeably. The problem comes when only the painful spot is needled while the root of the problem lies elsewhere, because then the pain easily comes back. We usually combine local points with distant points, so needles in the forearm or the foot for a sore shoulder are quite common.
Your arm is tested again after the needles come out
Muscle testing is the step you will probably find most unfamiliar at Tam Duc. The doctor places a hand on your arm or leg, asks you to hold the position, then pushes gently in a set direction to see whether the muscle holds firm or “gives way.” Schmitt and Yanuck (1999) describe muscle testing as a way to recognize when a muscle is facilitated (becomes stronger) or inhibited (becomes weaker) as the body receives a stimulus, and then to relate this to anatomy and neurophysiology.
Sometimes the doctor asks you to place your own hand on an area, such as the painful shoulder, and then tests the same muscle again. This technique is called therapy localization, and it helps narrow down where treatment is needed.
Before needling, muscle testing finds a muscle that has weakened in connection with your problem. After needling, the doctor tests again. If the muscle responds better, the set of points is heading in the right direction. If the muscle is unchanged, the doctor reviews the points, and sometimes reexamines the cause, rather than adding more needles just to be safe.
Muscle testing is used as an addition; it does not replace lab tests, imaging or medical diagnosis. Read more in our article Is Applied Kinesiology safe? Understanding muscle testing correctly.
Moxibustion is done by the doctor personally
Mugwort is a familiar plant in many families. When the weather turns cold, some grandmothers and mothers roast mugwort leaves with salt, wrap them in a cloth and press them on a family member’s belly or back. In Vietnamese, the plant’s name literally means “mugwort for moxibustion,” so the name itself tells you how it was used in the old days.
Traditional medicine often uses moxibustion when an illness is of the cold type or when the body is deficient and weak. The doctor moves the heat along the area being treated, asking as they go whether you feel warmth spreading or only heat at one spot, watching where the skin flushes, and sometimes retesting a muscle to find the point where the body responds most clearly.
Some people are very sensitive to heat; others have numbness and notice heat later than most. Everyone’s nervous system responds differently, so the doctor holds the moxa stick personally to adjust the distance according to your feedback.
Evidence on acupuncture for chronic pain
In 2018, Vickers and colleagues pooled individual patient data from 39 trials, 20,827 people in total, covering nonspecific musculoskeletal pain, osteoarthritis, chronic headache and shoulder pain. Acupuncture gave better results than sham acupuncture, and also better results than no acupuncture. After 12 months, the effect of acupuncture had decreased by only about 15%. The authors concluded that this effect cannot be explained by placebo alone, and that acupuncture is a reasonable option for people with chronic pain.
This study covers only the four groups of chronic pain listed above, not every illness. It is also an average result across tens of thousands of people; each person responds more or less, and some do not respond. If your symptoms have not changed after a reasonable period, the doctor will tell you plainly so the two of you can work out another approach.
Is acupuncture safe?
Witt and colleagues (2009) followed 229,230 patients who received acupuncture from physicians in Germany, about 10 sessions per person on average. In all, 8.6% of people had at least one adverse effect, and 2.2% needed treatment for it. The most common were minor bleeding or bruising at the needle site (6.1% of patients), followed by pain (1.7%) and autonomic symptoms such as dizziness and sweating (0.7%). The whole study recorded 2 cases of pneumothorax (collapsed lung). The authors concluded that acupuncture performed by physicians is relatively safe.
The clinic uses sterile, single-use needles that are discarded after use. A few people get mild redness or itching around the needle site because their skin is sensitive to the antiseptic alcohol; this usually goes away on its own. Lightheadedness, sweating and a racing heart are more common in people who come for acupuncture on an empty stomach or who are very anxious. If you feel your heart pounding, just tell the doctor.
An acupuncture session at the clinic
After the examination, the doctor tells you which area will be needled and whether you need to change clothes. The doctor does the acupuncture and moxibustion personally. You lie on the bed and are muscle tested before needling. When a needle reaches the depth needed, you may feel tension, pressure or heaviness around it. While the needles are in, you only need to lie still and breathe evenly. After the needles are removed, the doctor tests the muscle again, then does moxibustion if it is indicated.
Before you come
- Have a light meal before your appointment; don’t come on an empty stomach;
- Wear a loose top, and pants that roll up easily to the knee;
- Wear less jewelry on your wrists and ankles;
- Bring your test results, scans and the medicines you are currently taking.
If this is your first visit, see also our article What to bring and how to prepare for an Applied Kinesiology examination.
Tell the doctor if you
- Are taking anticoagulant or antiplatelet medicines (such as warfarin or aspirin), or have a blood clotting disorder;
- Are pregnant, or think you might be, because the clinic does not use acupuncture needles during pregnancy;
- Have ever felt faint or fainted during a blood draw, an injection or acupuncture.
When the doctor usually suggests acupuncture
At Tam Duc, acupuncture is usually prescribed in the following areas:
- Musculoskeletal pain;
- Headaches;
- Functional nervous system disorders;
- Insomnia;
- Menstrual disorders.
Frequently asked questions
Does acupuncture hurt?
Acupuncture needles are much finer than injection needles. Most people feel only a slight prick as the needle passes through the skin at a few spots, followed by a feeling of tension or pressure. If you feel sharp pain or discomfort that keeps building, tell the doctor right away so the needle can be adjusted.
How many sessions will I need?
We don’t give one number for everyone. The number of sessions depends on the cause, whether the problem is recent or has lasted for years, and how your body responds. After the examination, the doctor explains the expected plan and sets a time to reassess; muscle testing at each session also lets both of you see how your body is changing.
Can I go to work after acupuncture?
Usually, yes. Some people feel relaxed and a little sleepy; others feel more alert. Once the needles are out, sit up slowly and rest for a few minutes until you feel steady before you leave.
Worth keeping
- Ask the doctor why these point areas were chosen for you;
- Have a light meal before your appointment; don’t come for acupuncture hungry;
- Write down the names of the medicines you take, and mark any anticoagulants;
- Tell the doctor right away if you are pregnant;
- Choose loose clothes, with pant legs that roll up to the knee;
- After the needles come out, lie a little longer, then sit up slowly before you stand;
- Each evening, rate your pain from 0 to 10 in a notebook, and bring it next time so the doctor can compare.
Your set of points starts from the cause behind your own problem. Doctor responsible for the medical content of this article: Dr. Dinh Ngoc Duc (MD, MSc in Traditional Medicine).
References
- Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, Irnich D, Witt CM, Linde K. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain. 2018;19(5):455-474. https://doi.org/10.1016/j.jpain.2017.11.005
- Witt CM, Pach D, Brinkhaus B, et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed. 2009;16(2):91-97. https://doi.org/10.1159/000209315
- Schmitt WH, Yanuck SF. Expanding the neurological examination using functional neurologic assessment: part II, neurologic basis of applied kinesiology. Int J Neurosci. 1999;97(1-2):77-108. https://doi.org/10.3109/00207459908994304
- Bộ Y tế. Quyết định 792/QĐ-BYT năm 2013 ban hành tài liệu Hướng dẫn quy trình kỹ thuật chuyên ngành châm cứu.
