Exploring the Essence of Acupuncture Part 1

Yang Yang, L.Ac, DACM

This article also published in Acupuncture Today with audio

https://acupuncturetoday.com/article/39611-exploring-the-essence-of-acupuncture

Young practitioners of Chinese medicine often struggle to find their path and purpose, frequently questioning themselves: "What am I doing? Why am I doing it?" "Is acupuncture truly miraculous? Can it cure all ailments?" "Why do the same acupuncture points sometimes yield excellent results and sometimes not?" This is largely related to the systemic approach in traditional Chinese medicine (TCM) education, especially for those studying in the United States.

Studying TCM in the United States has its unique advantages: broader perspectives and a more inclusive culture. Here, we have access to various TCM systems, such as Japanese Kampo and shallow-needling techniques（kiiko style), Korean medicine (Hanbang), and Korean Four-Point Therapy. We also learn about TCM developments in India and Russia, incorporating localized herbal medicine and acupuncture approaches, as well as different theories of auricular acupuncture in France and Germany. This wealth of learning resources helps TCM students broaden their perspectives, providing more options for applying acupuncture techniques. However, one major drawback of studying TCM in the U.S. is the lack of in-depth exposure to classical TCM texts and traditions. In four years of TCM education, with over 3,000 hours of various courses, few classical courses are offered. Only a handful of excerpts from the "Huangdi Neijing" or "Shang Han Lun" appear in scattered PowerPoint slides across different instructors’ lectures, often without thorough explanation.

But without studying the classics, can one truly understand acupuncture and herbal medicine? Neglecting the classics leaves many overseas TCM graduates unclear about their practice: Why choose specific acupuncture points? What is the basis for modifying herbal formulas? What effects do we aim to achieve with acupuncture and herbs? Do we anticipate outcomes? Do we understand the depth of needle insertion—whether it reaches the skin, connective tissue, muscle, or bone? Such questions remain unanswered, leaving many practitioners unsure about their purpose and methods.

As a young TCM practitioner trained in the United States, I recognized my own limitations and began to systematically study the classics. I was also fortunate to learn from overseas TCM masters. My goal is to understand and interpret TCM through the lens of ancient thought while using Western medical language to decipher its complexities. Here, I’ll share some insights, using "Ling Shu" and acupuncture as example.

The first chapter of "Huangdi Neijing’s Ling Shu" opens with a dialogue between the Yellow Emperor and Qi Bo, clarifying the essence of acupuncture: to unblock meridians and regulate qi and blood. "The meridians decide life and death, treat hundreds of diseases, regulate deficiencies and excesses, and must not be obstructed. The meridians carry qi and blood, nourishing the yin and yang, moistening tendons and bones, and benefiting joints." Through acupuncture's regulation of qi and blood, we can "strengthen the weakness, drain the fullness, eliminate the stagnation, and weaken excess." The "Neijing" describes the essentials of needling and the approach of the practitioner, which requires long-term understanding and practice for young TCM doctors. Yet, the classics also provide guidance for us in treating illness effectively, including descriptions of needle types, needling techniques, and standards of effectiveness—like "qi zhi."

When I first studied acupuncture, my teachers taught that "qi zhi”(zhi means arrival) also refers to “de qi” was the sensation of soreness, numbness, heaviness and radiating pain, serving as a marker of correct needling. In the classics, however, "qi zhi" is the standard of efficacy. "Ling Shu" notes: "If the needle is inserted but qi does not arrive, do not count the insertions. If qi arrives, withdraw the needle without further needling. Each needle has its purpose, and each application differs in form. If qi arrives, efficacy is assured; its effect, like wind dispersing clouds, is immediate." Thus, acupuncture’s effectiveness depends not on the number of needles but on achieving qi chi; if qi zhi, further needling is unnecessary, and the effect is swift and evident.

My preliminary understanding of "Ling Shu" allowed me to categorize the classic descriptions of needles, needling methods, and techniques:

• Among the Classical Nine Needles, the Chan Needle, Round Needle, and Di Needle do not penetrate the skin. The Chan Needle drains yang qi for skin conditions without fixed locations, unsuitable for fair-skinned individuals. The Round Needle drains interstitial qi, applied between flesh layers, and does not harm muscle. The Di Needle presses on the pulse to guide qi, used when the illness is in the vessels with qi deficiency. The Di Needle can also serve as a positioning tool to locates acupoints.

  
  

• Among the Nine Needles, the Feng Needle, Yuanli Needle, and Hao(fine) Needle are dedicated to eliminating Bi Syndrome (pain and obstruction). The Feng Needle, with a tri-edge blade, is used for persistent diseases affecting meridians or viscera. The Yuanli Needle removes sudden qi stagnation in acute conditions. The Hao Needle works slowly to nourish and alleviate persistent pain and deficiency-type Bi Syndrome. In the Nine Needles, the Pi needle is a two-edged needle, used to remove abscesses or discharge pus; the Chang (long) needle is used to address distal obstructions; and the Da (large) needle is utilized to drain accumulated fluids, specifically to relieve edema.

In "Ling Shu," different syndromes require different needling techniques, while different acupoints involve distinct needling methods. Five-Shu points are treated with Shu Needling, Source/Yuan points with Remote Needling, Sinews Meridian with Sinews Needling, open Luo points with Ju Needling, Sun Luo points with Luo Needling, Superficial with Mao Needling, subcutaneous with Fen Needling, purulence with Draining Needling, and Fire needling.

In acupuncture techniques, Ou needing for paired meridian, while Bao and Hui needling techniques are used for pain not along the meridian. In areas with multiple needles to intensify stimulation called Qi, Yang, and adjacent needling techniques. Superficial needling includes direct and floating needling, Deep needling includes Shu needling or peri-osteal needling. For treating cold extremities, Yin needling is used, and for abscesses, Zan needling is used.

Acupuncture techniques align with the five organs: half-needling (Ban Ci)corresponds to the lung, inserting shallowly to access the skin Qi; leopard-spotted needling(Bao Ci) aligns with the heart, needling around a central channel to access blood from the meridians; Guan needling (Guan Ci)corresponds to the liver, targeting tendinous blockages; He Gu needling(He Gu Ci) for the spleen addresses muscular blockages; and Transport needling(Shu Ci) for the kidney reaches the bone, targeting osseous blockages.

Acupuncture can achieve various effects, such as tonifying deficiency, draining excess, breaking up stagnation, and dispelling pathogenic Qi. In cases of deficiency, Hao/fine needles and retaining needles with tonifying techniques are effective, and Di or plum-blossom needles can guide Qi and blood back to the meridians. The Ling Shu also advises against needling for patients with both Qi and blood deficiency, where a weak pulse suggests using tonifying herbs rather than needles. Diagnosing the nature of “zang-fu disorders,” “sinews disorders,” “meridian disorders,” or “collateral disorders” is crucial for accurate acupuncture point selection.

In the United States, we may have limited access to all the traditional needles but we can still utilize the available tools and needle techniques presented in the Ling Shu to achieve our treatment goals.