In 1988, I embarked on my first trip to China with the express purpose of improving my needle technique. When I analyzed my abilities at that time after 5 years of clinical practice, I found that diagnosis and treatment plans were easy for me but that my needle technique was less than adequate. For the most part, my patients returned for treatment and got better, but I was tentative with needling and the administration of the treatment. I was an acupuncturist who was nervous and uncomfortable with acupuncture!

Like the experiences of most practitioners who have traveled to China, it is not surprising that there I witnessed a strong needling style by the Chinese doctors I studied with. Large-gauge needles, a de qi sensation that would bring patients to tears, vigorous tonification and dispersion methods, and a general needle retention time of about 20 minutes, regardless of the condition being treated, were typical.

For six weeks I was taught in Beijing how to practice that form of acupuncture on patients who I couldn’t communicate with except in rudimentary Chinese modified by my strong New England accent. Daily I’d ask, “Do you have qi?” or “Do you feel pain?” or more likely, “Do you feel soup?” since the word for pain (tong) I’m sure sounded more like soup (tang) when I said it. No wonder they looked at me askance, shaking their heads in distrust and disbelief. Nevertheless, perhaps it was because of such cultural barriers that I was uninhibited enough to develop a strong Chinese needle technique in contrast to the one I had before going to China, which was to hit the handle extending from the insertion tube, turn away from the patient, and emit a sickly scream!

Of course, there were many styles of acupuncture to observe in China and they were modified by the presentation of the patient as well as the practitioner. I fondly recall the case of an elderly gentleman who had recently had a heart attack. When he came in for treatment, the doctor positioned the man on his stomach, and with a quick in-and-out needle technique, needled Bladder 15 (xin shu), back shu point of the heart. A colleague commented that this different needling style and lack of needle retention must have been done in consideration of the patient’s serious condition so as not to drain his heart qi

Suspicious of this observation, before writing it down as truth in my little pocket notebook, I asked the doctor if this is what he was doing. Instantly, everyone in the room started laughing at our naive conclusion, and the doctor stated matter of factly that this was not the reason for the lack of needle retention. Rather, he had chosen this type of treatment because the patient had to leave the hospital early to catch the bus!

The first day upon my return from China as we were catching up on things, my husband told me that he had injured his back while I was away and he had resigned himself to accepting its residual pain since he had tried many therapies with limited success. Deftly, I pulled out a 30 gauge Chinese Huato needle, stuck it into Small Intestine 6 (yang lou) in the direction of the channel (proximally up the arm), and twirled it dispassionately and painlessly, but evoking so much qi that his consciousness was literally altered and his pain completely disappeared. He then said to me, “You did learn how to needle in China?” I now appreciated everything about acupuncture that made it effective—the length and gauge of the needle, the angle and depth of insertion needed for effective treatment, the proper de qi sensation—in short, the power I knew it possessed if properly engaged.

Witnessing such dichotomous styles of treatment back to back was a turning point in my acupuncture career. Both Chinese and Japanese styles were opposite in execution and feel, but each was grounded in the same ancient theory of contacting the qi. In the Chinese case, needling was for the most part perpendicular and deep so that the qi of the channels could be contacted. In the Japanese system, needling was superficial and thereby transverse or oblique, contacting the superficial qi of the minute, blood and luo vessels (small capillary-like vessels that arise off the main channels and bring qi and blood to every part of the body at the level of the skin). This 180° gamut represented the range of needle options one could select from for a wide range of disorders and patient types and they have served me well. Four technique books, including this one, grew out of my clinical experience with both approaches and I am grateful for those educational opportunities that prepared me to teach and write about needle technique and to treat patients.

In reviewing my educational odyssey, a few basic ideas come to mind concerning needling, and for me they constitute the infrastructure of my treatment approach. These ideas are discussed below as tips for the student and practitioner:

The cumulative effect of this system of needling is multifold:

1. A few points are needled as painlessly as possible. Patients like this.
   
2. The root is treated through the clarity of the diagnosis and the points selected. This increases therapeutic effectiveness.
   
3. Correspondingly, treating the root generally decreases the length and course of treatment. This saves the patient time and money.
   
4. Patients are more likely to continue with therapy because the needling is not uncomfortable, they are experiencing improvement, and they can afford the treatment.
   
5. Competing signals are not given to the body by too many needles about what needs to be corrected. Clinical experience with many therapies demonstrates that, the body in its response to stimuli does not react to multiple stimuli but reacts economically by prioritizing the most threatening or larger stimulus. So, let the body know what you are trying to achieve in the treatment plan by prioritizing the points to be needled.
   
6. Additionally, regardless of the needle technique and point selection, the quality of the practitioner/ patient relationship and their mutual trust and respect is perhaps the most important variable in patient comfort, care, and cure. While this will be discussed in my next book, The Spiritual Practice of Clinical Medicine, for now let me simply recommend—be yourself, be in touch with values that affirm life from conception to natural death, be truthful as you guide your patient back to balance, and be kind and compassionate.

Looking at this strategy in relation to the classics, the brilliant scholars Paul Larre and Elisabeth Rochat de la Vallee agree. They wisely point out: