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How to Evaluate an Acupuncturist

by Cyndi Norwitz
March 1997


I have just come back from my initial visit to an acupuncturist and have several questions. Essentially, I need to determine if I am in good care with this practitioner.
It's a reasonable query. It's very hard to tell if the doctor you have is a good one when you're new to Chinese Medicine treatment in general. It takes a while to get a feel for the new map of your body and to be able to feel the changes associated with CM.

Most acupuncturists are mediocre, in my opinion. Very few are outright bad, though of course you can't avoid either unethical or incompetent behavior in at least a few of any large group of practitioners of any medical field. And very few are superb healers. I've been finding that out as I search for someone local to me to replace the fantastic doctor I had in San Diego. I guess I was spoiled in having her for my first CM doctor. Fortunately, CM is powerful enough that even a mediocre doctor should be better than no treatments at all.

Keep in mind also that there are different levels of acupuncturists What you want is a CM doctor. Someone who has gone through the full 3-year (more if part-time) masters equivalent training program and passed whatever exams are required for licensure in the state/country where s/he is practicing. Almost all MD's who also do acupuncture do not know much about CM. This is because they are allowed to take a shortened training program in order to be licensed to perform needle treatments. Also beware of anyone who does acupuncture "on the side" or in conjunction with a different medical paradigm (like homeopathy). Even if they've had the full training program, they probably don't take CM seriously. They should be fine in terms of needle technique so there isn't a safety issue or anything, but your results wont be as good.

First, I have a number of Problems: 1. allergy and various EI symptoms; Fibromyalgia pain and associated symptoms; 3. monthly migraine headaches; 4 sleep problems. There are others associated with EI/MCS but this gives you the picture.
Sounds like me, only I had daily migraines when I started getting acupuncture Everything you have listed is related. I had had all sorts of problems when I tried acupuncture out of desperation (even after 5 years of treatments, I am terrified of needles). No one could even diagnose me, let alone treat me. In my first visit, the doctor said, yeah, you have complex problems but basically you are a textbook case. I figured that even if the treatments did no go, they would be worth it just for that! But they helped tremendously.

At the first visit the acupuncturist indicated he would not treat specific symptoms but use points that would bolster my general immune system. This may only have been his initial strategy, but in any event I need to know several things.
This is good. Sometimes the body is so weak that you have strengthen it first before proceeding to more specific problems.

A. Were you treated in this manner or were you treated for specific symptoms or problems (such as 1-4)?
A good doctor will treat your whole body, with perhaps some extra needles or other treatments to take care of immediate symptoms that bother you. A mediocre doctor will treat specific symptoms/problems only. Also, remember that just because Western Medicine considers what you have to be many different problems that this does not mean that CM will. For example, I mostly get treated for the single diagnosis liver chi stagnation. This includes such WM diagnoses as, migraines, breast cysts, menstrual pain and clotting, MCS, and others.

B. Were you treated for more than one problem at a single session? and Can one be treated for special problems simultaneously with treatment for improving the general immune system?
You have to look at the big picture, as your CM doctor does. All of your problems are the result of an imbalance of the chi (energy) flow. In CM the chi flow is well described and very complex. Your diagnosis will be in terms of the problems in chi flow and this is how your treatment will go. No good CM doctor would treat one element of the imbalance without considering its effect on the rest of the chi.

But there is also a limit to how much you can treat at once. For people like us, with very imbalanced chi, you just can't treat all the imbalances at once and so you have to choose which ones to treat in that session. My doctor will often treat those systems which are causing me distress at the moment/past few days. You also have to choose between treating the patient on her/his back vs stomach. And sometimes treatments are contraindicated (for example, if you are weak you can not be treated in your lower back during menstruation. And lots of points are dangerous during pregnancy). It's an extremely complex system and that's one of the reasons you need a good and experienced practitioner.

C. Is once per week standard or advisable for EI/MCS types?
No. Twice a week is standard. Now, this does depend. In China, treatment is usually about a dozen needles per session once a day over a short period of time. In a hospital setting you might get far fewer needles several times a day. In the US, and elsewhere, this is of course impractical. Treatments usually involve more needles (my standard treatment is 20-30 needles) and are done less often. Twice a week is good for acute problems or for people with chronic severe problems. Once a week is okay for lesser problems (cost and time are factors of course). Once a month is for people needing periodic "tune-ups." I saw my doctor twice a week for 3 years. This was wonderful. Now I see her every 3-5 months for 2-3 sessions a time. This helps me a lot but a lot of my problems that were under control before have returned.

You will find doctors who treat with fewer needles at a time or who recommend less treatment. Sometimes it is because you get someone from China who hasn't yet adapted to making up for less frequent treatments. Other times it is a less experienced (or poorly trained) doctor who just can't orchestrate that many needles.

D. How long as a rule does it take to see some results of treatment?
If you aren't seeing some reduction in at least a few symptoms after about 4 treatments (at least one treatment a week), then this doctor is not very good. BUT, some people are not very in touch with their bodies and may not recognize even large changes. I think those of us with chronic pain and other symptoms tend to tune out what our bodies are telling us. One positive effect of acupuncture for me is it got me talking to my body again.

After I had been seeing my doctor for a couple of weeks, I got a headache. My first thought was, yeck, a headache. My second thought was, wait a minute, I just *got* a headache...this means I didn't have a headache before. That's when I noticed that my daily (all day nearly every day) headaches were gone. I was estatic...this was my notice that the treatments were working.

E. Are there 'rules of thumb' to tell if an acupuncturist is 'good'?
There are basic things to look for in an acupuncturist. First of all, never ever ever ever go to a clinic run by a school. I don't care how cheap or convenient it is. Many of these clinics are poorly supervised at best. Every acupuncture horror story I've ever heard (there aren't many, but there aren't none either) has come from a student clinic. Acupuncture is an art and you don't want to be someone's practice patient.

Nor should you go to someone with fewer than 10 (yes, ten) years of experience as a practicing acupuncturist. Normal people wanting tune-ups or work on an isolated injury or something like that will do fine with new doctors. We are all very complex and need experienced people.

If at all possible, get someone who has had at least one years training in China. A lot of American schools of CM suck, to put it mildly. They don't teach proper technique. Someone trained in China will have at least had the basics in real CM.

Avoid doctors who use 5-element theory (some will use it as a way to explain things to their patients, and this is okay). This is a common but very simplistic reduction of TCM (Traditional Chinese Medicine) theory. Real CM is far more complex. If your doctor disagrees with this paragraph, they may be able to help your symptoms but they won't really understand what's going on.

Your doctor should "get chi" with each and every needle. This is a controversy with no point. For those trained in China, its a no-brainer. Not trying to get chi is like a WM nurse not trying to hit a vein when taking blood. But a lot of American schools (maybe even the majority) actually teach their students that getting chi is not important. I have even had arguments with CM doctors who tell me that the importance of getting chi is overrated and I am wrong to insist on it. But trust me, no competent doctor would not get chi. Lots of otherwise good people get poor training (it's hard to get chi) so it's not always their fault, but it won't help you any. If your doctor does not get chi with every needle (occasional exceptions for some shallow needles like in the scalp or for very very weak people--not like us), walk out. You are wasting your time and money to continue to go to them.

What does it mean to get chi? This means that the needle is placed correctly along the meridian (chi channel) and has tapped into the chi flow. You will feel something definitely. Sometimes it is perceived as pain (most often as that kind of pain when someone pushes hard on a tender spot on your body). Or it can feel tender, or warm, or tingly (sometimes even like a static electricity shock). The feeling can be small (an inch circle) or large (most of your thigh) or it can travel up or down a meridian (you might feel a wrist needle in your fingertips).

It is not the same feeling as a needle prick. This is a different sensation and one that is not desired. A prick feeling may mean the needle is in slightly the wrong place or that it needs to be adjusted. Or it may just disappear in a second. Most acupuncture needles will not result in prick feelings. If they do it's not necessarily a reflection on the skill of the acupuncturist.

If you don't think you are getting chi during treatments, ask your doctor. You may not know what it is you are feeling. It takes a while to be able to separate out the sensations.

In case it is relevant, this person is a practitioner of Japanese-style acupuncture.
Yes. Japanese acupuncture uses the same underlying theory but the techniques are different. Honestly, I don't put much stock in Japanese acupuncture (neither does my CM doctor) and I don't recommend it personally. Japanese doctors use smaller needles (which aren't as strong, though they feel better) and they don't try to get chi. For the latter reason mostly, I don't think Japanese acupuncture does very much. But there are other techniques within that medicine that are fine and if it works for you don't let my predjuices get in the way.

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Cyndi Norwitz / webmaster@immuneweb.org / Last Modified: 1/18/98