Dry Needling: The Champion in A Race for "Amusing" Patients: Leaving TCM Acupuncture Far Behind
TCM acupuncture is a needle therapy modality established in 1950s in communist China of Mao Era. It was largely based on the Jing Mai (meridian as called in the West) system described in Chinese acupuncture scholar Yang Jizhou's acupuncture text Zhenjiudacheng (1601), with herbal formula theory imposed on acupoints plus a newly invented treatment principle called “bianzheng lunzhi” (treatment based on syndrome patterns instead on disease itself).
A Healing Art Notorious in Torturing Patients
As demonstrated by numerous trials worldwide since 1980s, a notorious feature of TCM acupuncture is its poor efficacy and low reliability which resulted in its great dependency on torturing patients by aggressively stabbing them into feeling a painful or wired sensation called de qi. Many TCM acupuncture researchers and /or practitioners have never suspected TCM acupuncture itself but instead they blame “shortage of, or improperness of de qi” as one of the main causes of the poor efficacy of TCM acupuncture.
For example, acupuncture researchers Wei Zhou and Peyman Benharash (2014) from University of California wrote about their viewpoint on significance of de qi:
“... the efficacy of acupuncture remains controversial ... Some of the controversy surrounding the success of acupuncture can be attributed to its method of delivery and the subjective nature of efficacy. A likely important component of the acupuncture response is known as Deqi, the excitation of qi or vital energy inside meridians. Deqi is considered an important parameter in the process of achieving therapeutic effectiveness in acupuncture treatment.”
Who Should Feel De Qi: Patients or Physicians?
In the TCM acupuncture as taught and practiced today in China, needling is very deep with rotations grabbing fibers and causing a lot of pain. The irony is that such a manipulation of needling was unthinkable to the ancient Chinese doctors of millennia ago in Huandi Neijing era, where de qi simply meant “the change of pulsation” of an artery which was felt only by physicians when he or she palpated the area usually at wrists or ankles, and there was no requirement that the patient must feel something.
At the opposite extreme of the de qi spectrum is Japanese needling which treats a patient as if handling a sleep cat without waking it up: if a patient feels anything, your treatment failed. The reason Japanese acupuncturists believe as such originates from the history of Japanese acupuncture which is greatly different from the history of acupuncture in China. While Japanese acupuncture is a living fossil of ancient Chinese acupuncture, the TCM counterpart is a modern invention (See my earlier posts).
An Extraordinary Needling Art: Dry Needling
Most of other types of acupuncture (Non-TCM) seem to be between the two opposites except dry needling (DN), which requires extraordinarily strong stabbing to be effective, as Lewit's study shows (Lewit, K, 1979).
In TCM acupuncture, patients may feel de qi only for a short moment of 10 – 30 seconds while the needle being twisted by practitioners. But in DN, needles are often inserted deeply with ‘sparrow pecking’ or ‘fast-in & fast-out’ pistoning movement, resulting in excruciating immediate pain plus post-needling pain or soreness which may last up to 72 hours (Aitor M.P., 2018).
In the race of seeking de qi sensation (purposed to improve efficacy), the former champion TCM acupuncture now has fallen way far behind dry needling.
Stabbing A Normally-Walking Patient into A Hobbler
Tylor Phan, PhD, a researcher acupuncturist, witnessed how dry needling was performed at a student clinic in California, America.
As Phan reported (Tylor Phan, 2017), the lecturer, known as one of the pioneers of dry needling, wanted to demonstrate the technique to the class after he talked about how California was one of the states not allowing chiros and physios to practice it. A middle-aged male student with hip pain agreed to be a lab rat. After a few seconds of palpation, the lecturer rubbed alcohol on the painful area and tapped a 6 inch needle (15.24 cm) in a guide tube in and vigorously thrusting the needle up and down.
“The student was clearly in agony and began to scream loudly, but the lecturer did not stop. Instead, the lecturer explained ... it was supposed to be painful. As the student began to scream even louder, the classroom was visibly shocked; the lecturer continued thrusting the needle. After almost a minute of manipulating the needle, the lecturer left it in ...and continued with the lecture.
“After 20 minutes, the lecturer went to see how the student was feeling. The student-patient responded that the pain is worse. The lecturer began to affirm to the class that it was a natural reaction. Roughly an hour after the initial insertion, the lecturer removed the needles. Yet, instead of a cathartic relief that the class was expecting, the student-patient could barely walk.
“I saw the student-patient in class a few days later... he was limping...”, Tylor wrote.
领英推荐
The Most Painful Thing I’ve Ever Loved
What Tylor witnessed might have been just a particular case. Some time in 2015, a patient talked about her experience with dry needling treatment on the internet (AshleyJane Kneeland, 2015):
“After I lie down on a massage table, my physical therapy doctor inserts a thin-filament needle directly into the muscle that is currently tight or spasming. Then she jiggles the needle up and down until my muscle responds with a twitch.
“Dry needling hurts, but for me the hurt is worth it. Because the knots in my shoulders are so severe, I find dry needling extremely painful. I walk out of the office feeling like my nerve endings have been cut and exposed to air. A few hours later, that sensation passes, and my shoulders are noticeably more relaxed. Over time — two appointments a week for six weeks — most of my spasms, and their resulting headaches, fade away.”
The patient's post on the internet titled: “Dry Needling: The Most Painful Thing I’ve Ever Loved”.
Which Benefits Patients Best?
It is true that patients will have to “love” the torture anyway. Just like a stomach cancer patient would “love” to have his or her stomach cut by 80% or even completely removed.
But a question is: will the new champion, i.e., the dry needling be proportionally more effective than the runner-up TCM acupuncture corresponding to the intensity of the torture imposed on the already-unfortunate patients ? If the answer is yes, then would Japanese needling be worthless because patient will feel nothing when being pricked?
So, with the efficacy all the same, which style of acupuncture would benefit the patients best?
For me, as a healthcare practitioner, I always make my patients feel the maximum comfort from the moment he or she entered the door of my clinic until he or she left with a big smile, by all means.
References
Aitor M.P. et al, Post-needling soreness after myofascial trigger point dry needling: Current status and future research, J Bodyw Mov Ther., 2018 Oct;22(4):941-946
AshleyJane Kneeland, Dry Needling: The Most Painful Thing I’ve Ever Loved, 2015, everydayhealth.com
Lewit K: The needle effect in the relief of myofascial pain. Pain 6: 83–90, 1979.
Tyler Phan, 2017, American Chinese Medicine, University College London.
Zhou, Wei and Peyman Benharash, Significance of “Deqi” Response in Acupuncture Treatment: Myth or Reality, Journal of Acupuncture and Meridian Studies, Vol 7, Iss. 4, 2014: 186-189