Americans aren’t huge fans of needles... culturally, we grow up scared of them... I will never forget taking my three year old son in for a vaccination - there were two medical assistants in the lab area. One of them grabbed the vaccine out of a cabinet, and the other quickly exclaimed, "no! you need to hide it! It will scare him!"
Quickly, I jumped in, "no! it's fine! He's fine! Making it a big deal is what scares kids! You're teaching them to be scared. There is nothing scary about a vaccine, he's fine!" Then I turned to kiddo, "Right buddy? Maybe a quick little pinch, and then it's over. It's all good."
We are taught to be scared of pain, so naturally, the idea of doing something that may cause some temporary discomfort is not on the top of our list...
This idea leads many people to be resistant to trying acupuncture, generally speaking, but the medical practice still continues to grow in the US. (Why? Because it works!) And as more information and education about the practice comes out, more people are opening up their minds to giving it a try for their ailments.
To help with some of that education, here is an acupuncture Q&A session with GoodMedizen's licensed acupuncturist (in Washington State, called Acupuncture & Eastern Medicine Practitioner) Courtney M. Zeller, AEMP, LAc, MS, who practices in Seattle, Wa. Below she explains which conditions respond best to acupuncture and what happens at a typical appointment.
Q: How did you become an acupuncturist?
A: Migraines. I was studying at the University of Washington for my bachelors, with plans on continuing to Medical School. I had been experiencing migraines since childhood (you can read more about her migraine journey here), and in my early adult life they became debilitating. I tried EVERYTHING, and nothing really worked. I was terrified of needles, and I mean TERRIFIED, but I was at my wits' end, and willing to try anything... With acupuncture and herbs, my migraines were "essentially cured." I know we can't use that language, but it's really true. Other than while I was pregnant, I haven't had migraines since. This "magical" experience changed my life, and I just fell in love with Chinese Medicine. So, instead of going to allopathic medical school, I studies Chinese Medicine and earned my Masters in Acupuncture.
There’s a lot of theory, clinical science, and practical application behind the practice of Acupuncture and Chinese Medicine. I have found that most people think you can take a 9 month training, or even a few weekend classes and call yourself an acupuncturist, but this is far from accurate. It is a full time (and I mean full-time, we're talking 6-9+ hour days, 5+ days a week for 3-4 years) Masters program that is required before sitting for Board Examinations. We take thousands of hours’ worth of courses in both Eastern and Western science, while also learning the actual skills of the modalities (including actual acupuncture, as well as palpation and examination techniques, cupping, tuina massage, moxibustion, and more), and having clinical rounds. And, at the end of the day, the required schooling is just learning the basics, how to keep patients safe, and when to refer them to other medical professionals - most of the effective clinical practice training comes from continuing education, internships, and a lot of experience.
Q: What happens at the first appointment?
A: A typical visit lasts 45 minutes to an hour. The first acupuncture appointment is longer, usually between and hour to and hour and a half. I’ll do an health history interview, where I listen to the person's medical history and gather less formal clues to what’s happening with them. For instance, people will say, “I don’t know if this helps but…” Those moments can give me a huge amount of information. Every sign and symptom your body gives is a little piece of the puzzle... often times something that the patient may think of as "normal" or insignificant, can be the last piece needed to solve the mystery!
Often times, our fist office visit interview is the most in depth health history intake that the patient has ever had. We start with them describing the symptoms that brought them to our office, then we dive deeper into potential associated symptoms, and finally, do a Chinese Medical Review of Systems, that touches on all of the organ systems to give us a good idea of what is going on.
We also perform observational tests including taking the pulse on both sides - we palpate the pulse in three locations (on each side) and three depths, observing the quality of the pulse which can give us an incredible amount of information. We also look at the tongue. The tongue is the beginning of the digestive tract, so it reveals a lot of what’s going on internally. If energy is moving backward ― as with nausea or reflux ― it’ll show up on the tongue. Looking at the sublingual blood vessels on the underside of the tongue also can give us a ton of information about how blood circulation is in different organs and areas of the body. We may also look at your gait, perform orthopedic tests, and/or look at other specific areas (I personally, really like to look at the ear - the ear has a map of the whole body on it, this map was created via embryology, and different structural changes in the ear can give many clues into what is happening in different area of the body. The ear is also called the auricle, which I think is amazing as we can use it as an oracle!) Often, I will see redness or a distended blood vessel in an area of the ear and will ask the patient, "have you been having any trouble with your lower back?" (or neck, or whatever area has the sign), and they are typically shocked, "Actually, yes! How did you know that?!"
Q: Everyone wants to know if the needles hurt.
A: People should know that acupuncture needles are very different from other needles. The needles I use are very thin, they are about the width of a strand of hair. Most people tolerate them very well, many don't feel them at all. However... at the end of the day, they are still needles... so there may be a spot or two that are a little sharp. If anything is sharp, it should go away within a moment or two. If something stays sharp for more than a moment or two, I ask the patient to let me know. There is nothing "wrong" with the sharpness, however, I think it 99.9% of cases, that discomfort is unnecessary, so I would rather take the needle out and either change the angle of the insertion, or choose a different point.
Some points can have a dull, achy sensation. This dull, ache is actually a good thing (also called de qi), however, if the sensation is too strong - as in if the patient feels tense or stressed because of it - then again, I would rather remove it and chose an alternative point location.
My goal is always to use points that are strong enough to produce a functional change in the body, but that are gentle enough that the patient can relax and ENJOY their treatment (yes, almost everyone enjoys and looks forward to their appointments!). It's all about balance. Most patients are coming in to reduce pain and/or stress, so creating a painful and/or stressful treatment does not seem right to me - it may help their health in general, but if I can produce great results without it, then that's what I am going to do!
I always tell patients in the beginning that the first one or two sessions, people tend to be more alert on the table while the needles are in (typically, patients will rest with the needles in for about 40 minutes). This is also true for patients who have had acupuncture before, but it's been awhile, or if their trying a new practitioner who uses a different style. The first couple sessions you might be experiencing new sensations, might be a little nervous, or just more aware that you are trying this new, weird thing! But almost always, by about the third session, people fall asleep - it is typically a very relaxing experience.
The first few sessions are also about getting to know each other. Every individual will respond differently to acupuncture, so it can take a few visits to figure out what is going to work best for you.
Q: What else should people be prepared for?
A: Acupuncture is one arm of Traditional Chinese Medicine (TCM), which encompasses other areas of wellness. Depending on your state laws and your acupuncturist's training, your acupuncturist might suggest several other modalities.
You may be advised to get tuina massage, cupping, moxibustion, or other treatment modalities.
You may get nutrition suggestions - these suggestions will likely be very different from what a registered dietician might give. It is based on TCM, and for some practitioners, also based on Functional Medicine.
You may get homework that includes breathe work, stretches and exercises, topical treatments, or other things for you to do at home in between sessions.
Many acupuncturists also have training in Chinese Herbal Medicine and/or functional medicine, so you may be suggested herbal supplements in tea, powder, or pill form. These formulas may be for a short or long period of time and they may change often depending on what your body needs, what stage it is in, or what symptoms you are experiencing. If your acupuncturist practices function nutrition, you may also be suggested nutritional supplements.
*While your acupuncturist should be trained in herb-drug interactions and contraindications, you should always check with your doctor before taking any new herbs or supplements.
Q: Here’s the million dollar question: How does acupuncture work?
A: Acupuncture is the practice of inserting small needles into the body to treat symptoms and conditions - aches, pains, fatigue, stress, and even deeper issues like chronic illness. Needles are placed in specific areas to elicit specific responses from the body. In Eastern terms we talk about pathways called meridians, which, in Western terms, we are just barely starting to understand. From a more Western prospective, we can look at a long list of functional changes that the needles produce, instantly. We have been able to review and study hundreds of different (and predictable) reactions including: immediate reduction of inflammation in a specific area, changes in brainwave formation, release of cellular substances (natural pain killers like endorphins and dynorphins, cortisol, epinephrine, and MANY more), up and down regulation of nervous system, and many more.
Scientists struggle to explain how acupuncture works "overall", but as we continue to learn these individual, measurable actions that predictably occur when when we insert needles into specific location, we get closer to a larger scale understanding about how acupuncture works. Regardless of the understood science, it is well documented that patients experience real, measurable benefits. Doctors and alternative practitioners alike agree that acupuncture unlocks the body’s own potential for healing.
With acupuncture and Chinese medicine, we are looking at the whole body, as opposed to treating individual signs and symptoms. We are looking for patterns that indicate the causes of those symptoms. We are trying to identify the mechanism that is causing malfunction, and the use techniques that essentially give the body triggers to heal itself.
There are many different types of acupuncture - and when employed well, they all seem to work, which adds to the mystery of how, as a whole, it actually works. Some acupuncturists will choose points locally - right on or around the area of the symptom. Some acupuncturists choose distal points - these points are typically far away from the area of the symptom but rather are connected to that area in some way (IE nervous system, connective tissues, etc.). I, personally, use a combination depending on what I am treating and the individual. Most often, I start with distal because, in my experience, a good 90% of patients respond to it better than local needling - they typically get better, faster results with less side effects. Some patients respond better to local needling, so if I am not getting the results I expect within a few treatments, then I will switch. This is one of the reasons why it is so important to give acupuncture a number of sessions when "trying" it. While we often get quick results, sometimes it can take several sessions to elicit the desired response from your body.
Q: Some people who are curious about acupuncture may also be somewhat skeptical ― is that a problem?
A: Not at all. Sometimes there can be some friction or defensiveness in the beginning, but typically we break through that pretty quickly once they start getting results. The problem only occurs if we can't break through that - the acupuncturist will need to get good information in order to create the right treatment, so if the patient can't open up, then we may not get enough information to get the treatment right. We also aren't psychics, we need you to tell us if something is working or not working, if something is uncomfortable, etc. We can employ or change a treatment to suit your needs if we don't know there is a problem. Always try to be open and communicative with your practitioner.
That being said, you don't need to "believe" in acupuncture for it to work. Acupuncture works AMAZINGLY on animals, and they don't get to believe or disbelieve in it - I actually get a lot of patients coming in to try acupuncture for the first time because it works so well on one of their animals!
I welcome skeptics, I just ask that people try to come in with, at least, a sense of curiosity - even if it's just an openness to learn about something that has been around for thousands of years. If you are completely closed off, we may not get the information we need to treat you.
Q: What sort of health conditions do people most often come in for?
A: While I see and treat some of EVERYTHING, the most common symptoms people initially come in for are pain (acute and chronic) and stress symptoms like anxiety and poor sleep.
Acupuncture is a great treatment for pain because we can often give relief in that first visit (not always, but more often than not). We don't expect to completely resolve the issue causing the pain in one visit, but we can usually get some relief right away, and then continue to resolve the issue over the course of the individual treatment plan. How many sessions you will need, and whether or not you will need maintenance, depends on many factors that you and your acupuncturist will discuss.
Often times people will come in for an individual area of pain, but discover that while getting treatment, other symptoms they had been experiencing also are getting better - like sleep, energy, and even digestion. Most of my patients continue care with me will after their initial reason for coming in has resolved. Acupuncturists, and other "alternative or complementary medicines," fill an important gap in medicine today. When we are able to see patients on a regular basis, we can catch and treat things before they develop into larger problems. We are highly trained diagnosticians that can see signs of organ malfunction before it becomes organ damage - we are like an auxiliary triage system, evaluating, treating what we can, and referring patients where they need to go.
Acupuncture is also a great adjunctive medicine to other treatments - it can help with the side effects of cancer treatments, reduce post-surgical pain, and aid in recovery from PT and OT. It can also provide relief and support for complex conditions that often confuse medical doctors like autoimmune problems, multi-system symptoms, or conditions that seem resistant to medications.
Q: Do you see acupuncture playing more of a role in health care in the future?
A: YES! We are already seeing the AMA recommend acupuncture as a first line treatment for many conditions. It is being approved, left and right, for conditions to be covered by medical insurances, and even Medicare. Hospitals are starting to employ acupuncturists in their ERs. As more and more research comes out, we will continue to grow - I believe it is inevitable for acupuncture to become a staple in our medical system, it just works too well for too many things to not get there. It is only a matter of time.
Almost all Washington State plans cover acupuncture!
Call your health insurance provider to find out if your plan covers acupuncture for your condition - or give us a call or email and we can check your benefits for you!
GoodMedizen's acupuncturists are preferred providers with most insurance plans.