Bizarre Acupuncture: What Is Considered A Failure to You, A Success to Me

In today's acupuncture world, the most widely accepted and practiced style of this healing modality is TCM acupuncture. In TCM acupuncture community, no one is not familiar with an esoteric terminology “de-qi” (得气 in Chinese) which means: Deliberately torturing patients by strongly stabbing their bodies by twisting / thrusting needles until the patients feel a weird painful or unpleasant sensation. It is widely believed, particularly by the Chinese medicine practitioners in today's China, that “the stronger the weird sensation, the better the efficacy”. “De qi” seems to have become one of the essential golden rules in today's acupuncture medicine.

But in the acupuncture of ancient China millennia ago, the thing was entirely different. Three key issues are related to the difference:

1. What "de qi" means;
2. Who should feel “de qi”;
3. How important “de qi” is.

What De Qi Means

The acupuncture in ancient China had never required such patient-torturing manipulation in the era when Chinese medicine classic Huandi Neijing (Neijing) came into place. When the chapter Lingshu 1 of Neijing says “Effective needling depends on the arrival of qi”(刺之要,气至而有效), the “arrival of qi” means “the arrival of the change of a patient's pulse” after needle insertion.

Who Should Feel “De Qi”: Patients or Physicians?

A patient's “pulse change” was simply what a physician feels under his or her fingers when palpating the pulse, but not something felt by the patients.

The Neijing described some simple and straightforward manipulation of needles (twisting or thrusting). Suwen 27 says: Twist the needle while patient inhaling for arrival of qi, and lift up the needle when patient exhales and take out the needle at the end of exhale (吸则转针, 以得气为故；候呼引针，呼尽乃去). However, the purpose of such needle manipulation in Neijing acupuncture always remained to be for the physicians to feel a patient's “pulse change” but had nothing to do with how patients will feel.

If you read Neijing, you could not find any thing from the entire book which says that patients MUST feel something when being stabbed by needles.

How Important De Qi Is

Furthermore, in Neijing acupuncture, the requirement of “arrival of qi” felt by physicians was only limited to the condition when the illness was believed to be related to a Jing Mai (经脉) which was assigned to a specific organ.

The “Jing Mai” in Neijing refers to large blood vessels (arteries). The ancient Chinese doctors were amazingly scientific in that they already identified that the beating of pulse at the radial side of the wrist is an artery, as Suwen 27 says: The artery of Jing Mai … goes to wrist area called Cunkou (寸口) (Suwen 27: 经之动脉，...其至寸口中手也). Here note “Cunkou” is the location at the radial side of the wrist where beating of the pulse can be felt by palpation.

In Neijing acupuncture, for all ailments not related to any of the 12 (so believed) “large blood vessels”, a needling technique called “Miu Ci ( 缪刺)” was always employed which does not need any pulse palpation to feel the “arrival of qi” ( SW63).

So, in Neijing acupuncture, when “arrival of qi” is required, Chinese doctors just let the needles quietly stay and the patient relax after needle insertion. This idea is clearly stated in Suwen 27: Leave the needle stay undisturbed for a long time, so that the evil not spread out by any disturbance … [again] leave the needle stay undisturbed for a long time, wait until arrival of qi (静以久留, 无令邪布... 静以久留，以气至为故).

The Development of The Modern Conception “De Qi”

But from where came the idea that “patient must feel something called de qi” ? The story can be traced back to the work by an extremely smart Chinese doctor Dou Hanqing 窦汉卿 (1196—1280) who wrote a very sophisticated poetry style essay titled Biaoyoufu 标幽赋, in which he described many fancy needle manipulation techniques. Later the techniques were further developed or modified in Jinzhenfu 金针赋 (1439) by Xu Feng 徐凤 (1390-1450) and finally systematically arranged in Zhenjiudacheng 针灸大成 (1601) by Yang Jishou 杨继洲 (1522 – 1620).

Thus, a complicated and extremely esoteric set of “needle manipulation” techniques were eventually established. These techniques requires a physician with his/her fingers to feel how the needle inserted into the body is grabbed or pulled by the patient's cramped muscle. The cramped muscle of the patients, as we can reasonably infer, could be the result from aggressively stabbing patients with a variety of needle manipulation techniques.

However, although these Chinese scholar physicians contributed a lot to the development of needle manipulation techniques, they never mentioned anything to the effect that “patients must feel the arrival of qi” .

The clear idea that “prick the patient until they feel soreness or pain (酸麻胀痛) ” was first time proposed in the book “Inside Acupuncture” (针灸内篇) written in the late years (1900s) of Qing Dynasty by a Chinese 林屋江上外史 whose life was unknown.

In 1950s when the first acupuncture textbook for university education in China was created (by the Chinese herb medicine doctors), the idea that patients must feel de qi together with those fancy needle manipulation techniques established in 1200s to 1600s was accepted as a golden rule for the efficacy of acupuncture. This idea was later transmitted from China to the Western world in early 1980s under the system called TCM acupuncture.

Why Torturing Patients Was Believed to Be Necessary?

The background of the emergence of such fancy “needle manipulation” was that the poor performance of acupuncture in post-Neijing era had been plaguing Chinese physicians and they tried to find a way through.

However, ironically, the fancier the needle manipulation techniques were developed, the less interest aroused in patients. The decline of acupuncture in China thereafter had sped up until 1780s to the point that the eminent physician Xu Dachun (1693–1771) in his essays “On the Origins of Medicine " (医学源流论) (1775) lamented that “the true healing art of acupuncture is lost” (针灸失传). Xu Dachun was also the first physician who systematically questioned and criticized the post-Neijing acupuncture's numerous conflicts against the Neijing acupuncture.

In 1822, acupuncture was flatly banned from Imperial Medical Institute of Qing Dynasty, officially marking the death of acupuncture in China. Further in 1929, the practice of acupuncture (and herb medicine as well) came to the point being outlawed in China, at a time when a healer who uses needles was seen as no different from a fortune teller.

De qi, a fancy needle manipulation technique initially established by Dou Hanqing and applauded by many Chinese scholar physicians in the later times, seemed to have contributed nothing to preventing the arrival of eventual demise of acupuncture in China that happened in 1930s.

On the Other End of The Spectrum

In terms of the intensity of forcing a patient to feel “de qi”, on the other end of the spectrum there is Japanese acupuncture in which:

1. Patient does not feel anything when needled. Physicians must treat patients as if taking care of a sleeping cat without waking it up;
2. It is the physician who are required to feel “arrival of qi” by palpation of the pulse or the skin textures.

American veteran acupuncturist, integrated Chinese medicine Doctor Felice Dunas, PhD, hit the point in her article published in Acupuncture Today (2006):

• “Chinese needling technique works on the premise of 'no pain, no gain'. In Japan, the opposite is true. If the patient even feels needle insertion, the treatment is less effective. If the patient experiences pain upon the rising of chi, you may as well pack up and go home, because no benefit will come from the work.
• “The Chinese practitioner fails if the patient feels nothing; the Japanese practitioner fails if the patient feels anything. Same patient; same syndromes. Go figure.”

Sounds interesting? But how come such a “conflict” like bulls head to head between the two styles of acupuncture in these two Asian countries close to each other?

A Living Fossil of Neijing Acupucture

The answer is that the Japanese acupuncture is actually a small piece of living fossil of Neijing acupuncture. The acupuncture in China was introduced to Japan in 600s. Note, this was a time prior to when, in China, Dou Hanqing (1200s), Xu Feng (1400s) and Yang Jizhou (1600s) developed the “needle manipulation techniques”.

Further note that it was also a time long before the 350 plus acupoints known by that time were “precisely” assigned to the imaginary 1 mm wide 12 Jing Mai lines by Chinese scholar physician Wang Weiyi in 1026, which was another acupuncture-related fancy art that went astray from the true jewel of wisdom of Neijing acupuncture.

The patients in Japan who are needle phobic but need an acupuncture treatment are lucky: they can always enjoy a short nap like a sleeping cat while lying on a treatment table, instead have to keep themselves alerted like a scared dog.

Be Considerate of Our Patients

Regarding the efficacy of the acupuncture practiced in today's China, Dr Felice Dunas in Chinese medicine with 40 years of experience in acupuncture continued to write in Acupuncture Today (Felice Dunas, 2006):

• ...Chinese needling technique works, for the most part, on the premise of "no pain, no gain." If there is no sensation of chi for the patient, the treatment is ineffectual. Acupuncturists who practice Chinese technique intentionally manipulate needles well beyond the comfort zone of most Americans.

There was once a survey in the US showing that over 60% of the public is needle phobic. Such patients rather continue to put up with their suffering from illness than being pricked by a needle (John Amaro, 2004).

In my clinical experiences, there are about 30% of patients who are remarkably scared of needles, and also interestingly, more so in male patients than female ones. The patients' scare of needles may negatively affect the therapeutic effectiveness of acupuncture. At least I often see patients who are needle phobic beg for less needles even when I told them they need far more.

In one of my earlier posts “How to instantly relieve low back pain at L5/S1 90% crack shot”, I stressed not to twist or thrust the needles to force patients to feel de qi. Actually, in that post I should have also pointed out one more thing: the size of the needle should be as fine as possible. The most frequently used needles in my clinic have a diameter of 0.16 mm (G40) and 0.18 mm (G38), about as twice thick as a human hair.

As a health care practitioner, let us be considerate of our patients as much as we can. Stabbing your patients into a scared dog, or tapping your patients (with a tiny needle) into a sleep cat, which one is your choice?

References

Felice Dunas, Adventures With Captain X, Acupuncture Today. April, 2006, Vol. 07, Issue 04

John Amaro, Acupuncture vs. Meridian Therapy: Is There a Difference? Dynamic Chiropractic 2004, Vol. 22, Issue 16

Huangdi Neijing: Linshu 1 九针十二原; Suwen 27 离合真邪论; Suwen 63 缪刺论, 100 BC

Dou Hanqing 窦汉卿, 针经指南 - 标幽赋, 1220?

Xu Feng 徐凤, 针灸大全 – 金针赋, 1439

Xu Dachun 徐大椿，On the Origins of Medicine 医学源流论, 1775

Yang Jishou 杨继洲, Zhenjiudacheng 针灸大成, 1601

Linwujiang Shangwaishi 林屋江上外史, 针灸内篇, 1900s?