What's In An Acupuncturist's Toolkit?!

💼 This week, Ben asks Gabriella, What's In An Acupuncturist's Toolkit?! Gabriella highlights the characteristics of acupuncture needles, emphasising their fine and solid nature. Gabriella explains the minimal sensation during needling and the technique of brief needle insertion in Five Element Acupuncture.

They touch on moxa, a herb used to heat points before needling, mentioning its warming effect and pleasant fragrance. Beyond physical tools, Gabriella emphasises the importance of the acupuncturist's senses—sight, sound, smell, and touch—in diagnosing and treating patients holistically. She discusses how these sensory tools help perceive subtle changes in a patient's condition, from detecting imbalance through Colour, Sound, Odour and Emotion to gauging the state of a patient's energy through touch and understanding the emotional aspects of their well-being.

Transcript

Pt. 1

Ben: So, What is in an Acupuncturist’s Toolkit?!

Gabriella: Well, not surprisingly perhaps, a needle is an acupuncturist’s toolkit. But it’s not the only tool. Today, I’m going to talk about not only our needles, but other things we use in order to restore balance and therefore the potential of health in our patients, a herb called moxa for example.

So, first let’s talk about needles. For some this is a scary word, but compared to many needles in the world-

Ben: Cleopatra’s needle?

Gabriella: You’re needling me now Ben. No, we don’t use national landmarks carved out of stone, strangely. Anyway, as I was saying, out of all the needles in the world, acupuncture needles are probably some of the least scary.

Ben: Right. I’m not sure I’d come back if you were sticking Cleopatra’s needle in me every time, Gabriella!

Gabriella: Haha, and I might find myself in a bit of trouble with the police, too! I’m not sure that stone is the best medium to craft a needle from, but the very earliest ‘needles’ that have been discovered were made of pottery, bamboo, animal bones and horn, sometimes even the thorns of spiky plants were used, and later on metals such as bronze, iron, tin, copper and even precious metals like silver and gold!

Ben: Oooh nice! Can’t I have gold needles in my treatments?

Gabriella: Ben, as far as I know, your ancestors weren’t the imperial royal family of China?

Ben: Well I am yet to do a DNA test!

Gabriella: I suppose nowadays dynasty isn’t so important…well I could use gold needles but let’s face it, it’s going to bump up the price of a session by a bob or two!

Ben: Maybe I’ll just stick to the regular ones for now until I’m an international rock star… So what are the needles that you use made of then?

Gabriella: Most acupuncture needles today are made of steel. And here are some facts about acupuncture needles:

No. 1. As opposed to the hollow hypodermic needles used in Western medicine, acupuncture needles are solid. We’re not injecting any substance into a person, so they don’t need to be hollow. The aim when we use a needle is simply to make contact with a little hub of energy that we call an acupuncture point, to encourage it to release a little of that energy.

No. 2. Acupuncture needles are very fine.

Ben: Not like knitting needles then?

Gabriella: No, Ben. And funnily enough, no ball of wool attached to them either. They’re not even like a sewing needle, they are much finer. Most of the needles I use have a thickness of around point 2 of a millimetre. So with a good needling technique, and a good quality needle, most of the time people don’t feel the needle going through the skin, they just feel a sensation when the needle hits the point. This sensation can range from a slight, dull ache to a strong, almost electric sensation, depending on the person and also on the point. Some points do seem to feel much stronger than others. How would you describe the sensation Ben?

Ben: Well, it can feel different each time, sometimes it feels like electricity, or a whirlpool of energy. Sometimes it feels like it’s outside of my body, sometimes I feel a rush of energy going through my body. I wouldn’t describe it as pain exactly, it’s another type of sensation, visceral or sharp but sometimes it can be dull too.

Gabriella: Well thanks for the sell Ben! That’s really going to encourage people into the clinic right?

Ben: Ah but it’s not about what it feels like, it’s about how it makes me feel afterwards. The sensation only lasts a second or two maximum, whereas the effects last for weeks if not years!

Gabriella: That’s more like it!

Ben: So what else can you tell me about acupuncture needles Gabriella?

Gabriella: No. 3. Acupuncture needles are sterile and disposable, so they’re not for re-use.

Ben: And how far do they go in?

Gabriella: That varies according to the point itself and we also take into account the person we’re treating. Some of us are perhaps a little more - fleshy, let’s say, than others. Most points though range from between 3 and 5 millimetres below the skin, some a little more, again depending on where in the body.

Ben: And how come I never see any blood when you’ve needled?

Gabriella: That’s because of the fineness of the needle. They’re so fine that really, they’re just pushing cells apart rather than actually puncturing a hole. Mostly you can’t see any evidence of needling after the event. Very occasionally a patient can bruise but most of the time not.

Ben: And how come you don’t leave needles in?

Gabriella: See I told you he asks loads of questions! Ben, why don’t you just join my next cohort of students?

Ben: Haha

Gabriella: Joking aside, you’ve raised an important point, and one of the big differences between Five Element Acupuncture and other types of acupuncture. It’s very rare for me to leave a needle in!

Ben: Yeah most images of acupuncture show pictures of someone lying down with sometimes dozens of needles in! I can see how it could look a bit scary!

Gabriella: In Five Element, we often say less is more. The less we intervene with nature, the better. So in an average treatment, I needle someone between let’s say 6 and 10 times during the session, depending on my findings, based on talking to the patient for a few minutes at the beginning of the session, and then what presents when I feel their pulses. And the needle stays in for no more than a second, maybe two, but very little.

Ben: Why don’t you leave them in for longer? Wouldn’t that be of more benefit?

Gabriella: What we’re doing when we make contact with the point is quite dynamic. It’s a deliberate stimulation, asking, or we could even say commanding that point to release some energy. So a brief connection is enough to achieve that. And it still amazes me that I can feel a change immediately in the patient’s pulses after such a brief action, but it really happens! I love the moment when my students first start treating patients in the student clinic. Up to that point, they’ve been practicing taking hundreds of pulses, but they haven’t really had the experience of feeling pulses before and after treatment. They are quite in awe of the fact that they can feel a tangible difference.

Because of the fact we don’t leave the needles in, Five Element Acupuncture can even be palatable for needle phobics! They can reach a point where they’re so debilitated by whatever symptoms they have, and found nothing that has really helped, that they decide to brave the needles of acupuncture. They’re often very surprised at how different it is to needles they’ve experienced in the past, and often say they wished they’d come a long time back!

Ben: So why do other types of acupuncture leave the needles in?

Gabriella: I’d prefer a trained practitioner of another discipline answered that for you Ben. We do have a few cases where in Five Element we leave needles in, and I can explain those when we come to them, but for the most part, we use this brief but extremely effective needling technique.

Ben: So what’s moxa?

Gabriella: God these relentless questions! Perhaps we should go into moxa, a herb we use to heat the points before needling them, after a break?

Ben: Ok, but you’re not going to escape my questions!

Gabriella: Hahaha… Damn!

Pt. 2

Ben: So, what about moxa then?

Gabriella: Moxa is a herb that we use to heat up the points before we needle them. One of my teachers once said that the Chinese used to say ‘you should never invite a guest into a cold home’. So moxa warms up the ‘home’ before the needle is inserted. But warming the point isn’t the only reason we use moxa.

Ben: Ooh, tell me more.

Gabriella: Ok, but first, let’s go back to your original question, what is moxa? Moxa is a herb, known as Chinese Mugwort. The Latin name for it is Artemisia Vulgaris Latiflora (see I KNEW my Latin would come in useful one of these days!)

Ben: I thought you told me it was just so you could translate the Latin quotes in Asterix?

Gabriella: Well yes, that was the original plan, but it happened to come in handy for my life’s work too - all that Latin terminology in the anatomical descriptions! I love it!

So, apparently Chinese Mugwort grows wild all over China. The Chinese discovered it had unique properties and could be an effective tool to use in medicine.

Ben: How so?

Gabriella: Well, firstly, it does warm up the point, so enhancing the effect of the needle. We make little cones of moxa and place them directly onto the site of the point, and burn a few-

Ben: Burn?

Gabriella: Well I don’t burn the patient! I don’t think it’d be great for repeat business if I was actually burning my patients! Moxa can feel hot but I remove it before the skin would get burnt. So, when I come to insert the needle, which is going to touch a little energy centre, warming it up will soften the energy, allowing the energy the point releases to flow smoother and further. Furthermore, the herbal properties of the moxa have a powerful, stimulating effect on the energy, so it has multiple benefits.

Ben: Cool!

Gabriella: No Ben, warm! Secondly, moxa has a lovely fragrant smell when it burns. It’s quite rare to come across anyone who doesn’t like the smell of moxa, honestly a tiny handful of the hundreds - maybe thousands? Well, quite a few patients I’ve treated over the years. For most, the process of warming moxa on the points before needling is a calming, relaxing part of their treatment. One of my teachers said that moxa releases negative ions as it burns. Negative ions can have a feel-good effect, they’re in the atmosphere and most prevalent around bodies of moving water, but can be found all around in nature, in mountains, forests, waterfalls, beaches, and oceans - so it’s not surprising people often comment on feeling relaxed as they walk into my treatment room, with all the moxa in the atmosphere!

Ben: Yeah it’s well nice! So, is there anything else in your toolkit apart from needles and moxa Gabriella?

Gabriella: Well, yes Ben. But the other tools are found within me.

Ben: How do you mean?

Gabriella: My other main tools, apart from my genuine intention to help each person in whatever way I can using my knowledge of this medicine, my other tools are… my senses!

Ben: What, sight and sound?

Gabriella: Exactly! And… smell!

Ben: You smell your patients? That sounds a bit unsavoury.

Gabriella: Well I’m not sitting there sniffing their armpits, Ben. In fact most patients haven’t got a clue I’m engaging my sense of smell as part of my diagnostic toolkit. And it’s not ‘body odour’ that I’m smelling.

Ben: What are you smelling then?

Gabriella: I’ve talked about balance. Now, when nature starts to go off balance, it emits certain signs that it is doing so. Odour is one of those signs. You know, in the past, when we had one doctor who was the village doctor, and he knew people throughout their lives, sometimes from birth to death if that patient had a short life. Back in those days, a doctor could smell a disease, their sense of smell was engaged in their practice much more than in modern times. And in some forms of medicine, Tibetan for example, the physician might smell or even taste the urine of their patient! Well, I can’t say I do that, but I am engaging my sense of smell while I’m with a patient. Being able to detect a subtle odour that the organs give off is one of my most important diagnostic tools.

Ben: Wow, who’d have known? So what about sound?

Gabriella: Yes, sound is important too, so I’m engaging my sense of hearing. It’s not what you say, it’s the way that you say it!

Ben: There could be a song in that…

Gabriella: Well there could. But as I said, it’s not the words, it’s, well it’s like the music that’s created as you speak. The patterns in your voice that differentiate Ben’s voice from someone else’s.

Ben: Are you in fact listening to my words at all?

Gabriella: I can refer to your grandfather, who I believe once said something like 90% of what comes out of our mouths is garbage! Now, of course I listen to what you say, but I’m also listening for qualities in your voice. Recognising different tones of speech gives me another leg to my diagnostic stool. It’s almost like music, if you listen to a sad piece of music, it evokes sadness, the same is true of voices. If we listen to all those different voices out there, we can all recognise that some for example may have a tone that sounds like they’ve been to a funeral when in fact they’re telling us about the best party they’ve ever been to! Or they’ve been to a funeral and sound like they’ve been to a party!

Ben: Well if it was someone you didn’t like…

Gabriella: Ha! No comment. Right, perhaps that’s taking it a little far, moving on…Sight is the third sense that I use diagnostically.

Ben: OK, so what are you looking for?

Gabriella: You’re probably getting the picture by now, that when nature starts to go out of balance, it emits signs that we can pick up and act on. So, just like odour and sound, a colour starts to show that is a sign of imbalance in that person.

Ben: Hmmmm… does their skin change colour?

Gabriella: Well it’s not really the skin itself. It’s more a hue or let’s say a sheen or iridescence that shows on the surface of the skin. The best place to see it is around here, on the temples.

Ben: Ummm… it just looks like your complexion

Gabriella: It takes time to train to see this Ben. We say you have to lose your mind and come to your senses, it’s not a 5 minute or even an overnight process. Often, it’s when you’re not looking that you actually see.

Ben: Right….

Gabriella: I remember the first time I was aware that I’d actually ‘seen’ a colour on someone. It was a rather unsuccessful date. Anyway, that’s by the by. He was sitting on my sofa, the sun was shining and as he turned his head, I saw this flash of yellow come and go. I wasn’t looking for it, it just appeared and then went. I couldn’t wait to get to college the following week to tell my classmates I’d seen a colour!

Ben: Well at least something came of the date then

Gabriella: Ha well I guess so. The fourth sensory tool I’m going to touch on is… well, touch!

Ben: I’m touched

Gabriella: Lol… Ok well touch is important. It’s not a diagnostic tool per se, but it conveys a lot of information. Things like relative hot and cold, or the texture of someone’s skin can give clues - do they feel dry, or waterlogged for example. Does the person like touch or do they shrink back from it?

Touch is crucial in finding the acupuncture points. I’m not aiming a dart at a target on my patients!

Ben: Could’ve fooled me

Gabriella: There’s a meticulous process to finding the points. We learn to recognise subtle, as well as more obvious nuances in anatomy and also what an acupuncture point feels like. And really importantly, we can feel relative strengths and weaknesses in the person’s energy by taking the pulses, which is a large part of what guides my choice of points. I’ll explain more about pulses and why they are so important in the treatment process later in the series.

Ben: So you hear, you smell, you see and you touch. Aren’t there five senses?

Gabriella: Indeed there are, but we don’t actually taste our patients.

Ben: Phew that would just be weird!

Gabriella: Indeed it would! So, before we go on: we have four diagnostic tools. Touch is not diagnostic but essential for all the reasons listed above, it gives us all sorts of information. So, the three we’ve covered so far are colour, sound and odour.

The fourth is emotion. And emotion is something we feel with our whole bodies. We don’t think emotions, they don’t happen in the brain. So we learn to recognise how we feel in the presence of a patient. We’ll feel differently with different people.

We’re going to go more into these sensory tools in their own episode, later in the series.

Conclusion

Ben: So What’s the point?! What’s the point of acupuncturists having so many tools at their disposal?

Gabriella: In this episode we explored how the toolkit of an acupuncturist encompasses a range of unique and finely tuned skills and tools. This includes the use of acupuncture needles, which are solid, fine, and designed for precise stimulation of acupuncture points. Moxa, or Chinese Mugwort, is another essential element of their practice, employed to warm and prepare points for needling while also offering a pleasant aroma and relaxing ambiance in the treatment room.

Ben: We touched upon how beyond physical tools, acupuncturists rely on their own senses—sight, sound, smell, and touch—to diagnose and treat patients effectively. These sensory tools help them perceive subtle changes in a patient's condition, from detecting imbalance through colour, sound, odour and emotion to gauging the state of a patient's energy through touch and understanding the emotional aspects of their well-being.

Gabriella: Each of these sensory tools is vital in providing holistic care and ensuring that the treatment aligns with the individual's unique needs and imbalances. In upcoming episodes, further exploration of these senses and their role in acupuncture will shed light on the depth and complexity of this ancient healing art.

Ben: We hope you enjoyed this exploration of the acupuncturist’s toolkit, we invite you, whether you’re a seasoned acupuncture enthusiast, or a skeptic, to continue to join us on this journey of exploration and discovery.

Gabriella: Feel free to get in touch with us if you have any questions or suggestions. Stay tuned for our upcoming episodes and please consider subscribing or becoming a patron to gain access to our bonus episodes and have your questions answered by us.

Ben: And with that, we'll say goodbye for now. We look forward to having you join us in the next episode, where we'll be asking What Are The Tao, Yin/Yang & Qi Energy?! Until then, take care and don’t go needling each other!

Gabriella: Bye for now!