Acupuncture is a form of medical treatment which has been practised in China for over two thousand years and which is becoming increasingly popular in the West. Because of its evident effectiveness, it is now utilised by some western medical practitioners such as GPs, physiotherapists and chiropractors; however, most of these practitioners, whilst utilising acupuncture as a technique, discard the traditional Chinese context in which acupuncture has been practised. This article elaborates on the difference between acupuncture as practised within this context and without it. It is important to understand this difference: for example, it would be wrong for someone to conclude that ‘acupuncture doesn’t work’ after a session of acupuncture with a physiotherapist had not produced any improvement in their condition – what the physiotherapist is doing with the needles they use may well be significantly different from what a traditional acupuncturist does with them.

WESTERNISED FORMS OF ACUPUNCTURE

Acupuncture shorn of its traditional context is sometimes known as ‘dry needling’, to distinguish it from the usual way in which needles are used in western medicine – injections! ‘Dry needling’ is usually used as a method of pain relief by chiropractors, physiotherapists, GPs and others; an acupuncture needle is inserted into a tight band of muscle fibre known as a ‘trigger point’, with the aim of releasing the tightness and relaxing the muscle. Usually dry needling is used in conjunction with other techniques such as chiropractic manipulation or massage therapy.

A small number of GPs and other western medical practitioners also practice acupuncture; whilst a very small fraction of these are trained in and utilise classical Chinese medical ideas, the majority of them practise what they call ‘medical acupuncture’. ‘Medical acupuncture’ involves an attempt to understand the mechanisms of how acupuncture works using the framework of western medicine, rather than the classical Chinese framework. ‘Medical acupuncturists’ mainly use acupuncture in the treatment of pain, but also use it for a few other conditions such as nausea and menopausal problems.

TRADITIONAL CHINESE ACUPUNCTURE

There are two kinds of acupuncture practised in the West which continue to utilise the traditional Chinese ideas which gave rise to acupuncture. These are Traditional Chinese Medicine (TCM), and Five Element Constitutional Acupuncture (FECA), which are based on a system of medicine whose roots date back at least 2500 years, and which is still evolving today. Within these forms, acupuncture is used to treat a very wide range of ailments. In this article we shall refer to these two forms as ‘traditional acupuncture.’

WHAT’S THE DIFFERENCE?

The main difference between traditional acupuncturists on the one hand and GPs, physios and chiropractors who use acupuncture on the other, is that the former practice acupuncture broadly within the context in which acupuncture was developed in China, whilst the latter abandon this context and attempt to relocate acupuncture within a western medical context.

Thus when you go for treatment to a traditional acupuncturist, you are going to someone who will understand your health and any health problems you have from a very different point of view from that of a western medical practitioner. A traditional acupuncturist will probably have completed a degree or postgraduate level course in traditional acupuncture, and thus will have spent at least three years studying and training in acupuncture and its application within its classical Chinese medical context. Western medical professionals who use acupuncture may have only done as little as a few days training in acupuncture.

To begin with, the traditional acupuncturist thinks in terms of ‘Qi’ (pronounced ‘chee’.) Qi is a key concept in understanding how acupuncture has been used over the millennia in China and other parts of Asia, but it is quite difficult to translate into English. Broadly speaking we can say that a healthy being has abundant Qi which flows freely – a living being is characterised by constant movement on all levels of their being. Qi is an important concept not only in classical Chinese medicine, but in things like martial arts and philosophy. What a traditional acupuncturist is doing when they insert a needle into the skin, is seeking to influence the Qi; the needle is usually inserted at an ‘acupuncture point’, a specific site on the body at which the Qi can be influenced in various ways. Most traditional acupuncturists will insert the needle until the patient actually feels their Qi responding, when a dull achy feeling, or perhaps a numb or tingling sensation, is felt in the vicinity of the point. Sometimes, especially if the acupuncturist is experienced and skilful, the Qi will be felt to move along a local pathway, called a meridian. The attention of the acupuncturist is focused on the tip of the needle, which provides a point of communication between the Qi of the acupuncturist and the Qi of the patient.

Western medical acupuncturists and dry needlers do not, on the whole, think in terms of Qi. They may be thinking rather in terms of needling into a trigger point to loosen a tight muscle, or possibly in terms of influencing the peripheral and/or central nervous system. Whilst to a casual observer what the western acupuncturist is doing and what the traditional acupuncturist is doing may look similar, there is a considerable difference in what each thinks of themselves as doing. At least from the point of view of traditional acupuncture, this is important; traditional acupuncture stresses the necessity of the acupuncturist having a focused intention on the needle and the effect he or she is trying to have on the patient’s Qi; it also stresses the importance of the acupuncturist’s Qi being free flowing, as the treatment is seen very much as an interaction between the Qi of the clinician and the patient. Many traditional acupuncturists practice disciplines such as T’ai Chi, Chi Kung and meditation which they see as virtually indispensible support for the healing work they do with acupuncture. Of course a good western medical acupuncturist may indeed have this kind of focused intention without thinking of it in these terms; however, the framework of modern western medical science, still not free of the Cartesian separation of mind and body1, might be considered to undervalue the effect of the mental and emotional state of the healer, so that acupuncture can come to be seen as a mere technique not significantly affected by the mental state of the person administering it.

Another one of the hallmarks of the traditional Chinese medical context is that it is holistic. So, for example, suppose you have an ache in your low back. (This is one of the main complaints which acupuncture is used to treat in the UK today – in fact the National Institute for Health and Clinical Excellence recommends that a course of acupuncture is one of the ways in which persistent non-specific back pain is treated within the NHS.) A traditional acupuncturist will, of course, examine your back and ask you about the pain – how long have you had it, what it feels like, what makes it worse, whether there is anything that relieves it, and so on. But they will also be interested in most other aspects of your health – including your digestion, any breathing problems you have, how well you sleep, even what kind of temperament you have and what your emotional life is like. This is because they want to see your back pain in the context of you as a whole person. Let’s say they discover that your digestive system is not working quite as well as it could – maybe you don’t have much of an appetite, but you do have a sweet tooth, you bloat easily and your stools can be a bit loose. Now this has nothing to do with your back ache – or does it? The traditional acupuncturist would consider it likely that there is a knock on effect from this digestive weakness which is affecting your back. After all, the nourishment which the muscles, ligaments and bones of the back need if they are to function properly largely comes from the food we eat – and if we are not digesting that food as well as we could, this will impact negatively on the degree of nourishment. In fact in Chinese medicine there is a well known connection between an impaired digestive system and muscular weakness.

Perhaps also you are under a fair bit of stress – and of course low back pain may add to this. The traditional acupuncturist will probably take your pulse during his or her examination of you, and if they find that the pulse feels ‘wiry’ – a bit like a taut guitar string – and if you report being short-tempered or moody, and get frequent headaches, they will probably conclude that the stress you are under is inhibiting the free flow of your Qi; in plain English, you are uptight and tense. It is again no great surprise that this kind of thing can exacerbate any kind of pain, including back pain. In fact it may even be that the main reason you have got low back pain is because of this up-tightness combined with the digestive weakness.

So what the traditional acupuncturist will probably do is to treat your back with acupuncture, aiming to smooth the flow of Qi through your back, but also will use acupuncture to strengthen the digestive system and promote the smooth flow of Qi throughout your system. That is to say, they will treat the back pain locally, but also address systemic underlying issues which may also be contributing to the back pain and undermining your body’s natural ability to heal itself. They can do this utilising acupuncture points on the lower leg, abdomen and back which in classical Chinese medicine are known to be able to effect the digestive Qi; similarly there are points on the hands and feet which can be used to smooth the flow of Qi throughout the system.

In addition to this they may also suggest dietary changes you may be able to make to help support your digestive system and things you can do, such as Chi Kung exercises or meditation practices, which will help you relax more fully and be able to deal with the stress in your life more effectively. They may also use other classical Chinese medical treatments to help your back, such as moxibustion – the use of mugwort, a warming herb, to improve local circulation and warm and relax the muscles, Chinese massage and cupping therapy.

So when you go to see a traditional acupuncturist for your back problem, you will receive a treatment which addresses the pain directly, but which also seeks to restore balance and harmony to your system as a whole, so that the back pain is less likely to return – and, incidentally, other aspects of your health improve too; in this example, perhaps your bloating disappears, your stools firm up a bit, and you feel more relaxed in general and better able to cope with the strains which life is bringing you.

Of course some chiropractors, physiotherapists and GPs may also be thinking holistically, and they too are unlikely to use acupuncture as a stand-alone treatment. But hopefully the above example makes it clear that there is a considerable difference between western medical acupuncture or dry needling on the one hand, and traditional acupuncture on the other. The point is that it is incorrect to see acupuncture as a technique divorced from the system of medicine in which it is embedded. Traditional acupuncture is acupuncture embedded within the classical Chinese medical context, a holistic form of therapy which seeks to rebalance and strengthen the Qi of the patient through the use of acupuncture and related techniques as well as dietary and other advice; dry needling and ‘medical acupuncture’ use acupuncture as a technique to release trigger points in tight muscles and modify the central and peripheral nervous systems, whilst attempting to understand acupuncture within the framework of western medicine.

1. The Seventeenth century French philosopher Rene Descartes is considered to be at least partly responsible for the way in which western science has tended to view the mind on the one hand, and the body on the other, as separate entities. One consequence of this for medical practice is that people trained in western medicine, which is of course rooted in the western scientific tradition, are not often inclined to consider that their state of mind will have much effect on the treatment they administer. The western doctor, like the western scientist, may tend to think of themselves more as a detached observer who interacts only in a more or less mechanical way with their patient. Although modern scientific advances, such as those in quantum physics, have shown that this tendency to view the scientist/doctor as detached is illusory, the Cartesian legacy remains.