A system built on observation

What Chinese medicine is

Chinese medicine is a complete medical system with more than two thousand years of continuous practice behind it, still in wide use in modern China and still absorbing new material, including Western science and research. Acupuncture and herbal therapy are its best known branches. The system also includes moxibustion, dietary therapy, tui na bodywork, and therapeutic exercise.

It matured in a period when technology was minimal and daily life was closely tied to the natural environment, and that shaped it in ways that remain useful. Without imaging or laboratory work, practitioners built a detailed system of observation and internal correspondence instead. Small signs that carry little meaning in a conventional examination can carry a great deal here. Differences in the quality of sleep, in digestion and elimination, in emotional pattern, and in temperature and sweating in specific regions of the body all contribute to identifying an underlying pattern. Practitioners also developed ways of assessing the whole body by examining the tongue and by palpating the pulse and abdomen, procedures that look simple and are not.

What acupuncture is

Acupuncture is the insertion of very fine needles at specific points near the surface of the body, selected according to the diagnostic pattern rather than according to the location of the complaint. There are roughly five hundred named points. A single treatment typically uses ten or twelve of them, and the selection changes over a course of treatment as the picture changes.

Because point selection follows the pattern rather than the symptom, needles are often placed some distance from where the problem is felt. Someone with headaches may be needled in the hand or foot. Treatment is usually given lying down, though in some cases, particularly with pain, the patient is asked to move the affected area while a related area is treated.

Whether it hurts, and whether it is safe

Acupuncture needles are thin, flexible, sterile, and single use. They are not hypodermic needles, which is where most of the apprehension comes from. Hypodermics are considerably thicker and are built to carry fluid. What people usually notice from acupuncture is a sensation of heaviness, a dull ache, warmth, or movement rather than a sharp pain. Most find the experience relaxing once the expectation of pain has been set aside.

Acupuncture is suitable for most people, including children and the elderly. It is not appropriate on an empty stomach, while intoxicated, or when someone is unusually weak or debilitated.

What a consultation involves

A first consultation runs longer than later ones. The practitioner needs to assess general health, identify the pattern or patterns underlying the current complaint, and understand the patient's constitution before treating.

That means questions about current symptoms and prior treatment, medical history including close family, diet, digestion, sleep, and emotional state. The practitioner takes the pulse at both wrists, noting quality, rhythm, and strength, and examines the shape, color, and coating of the tongue. Those findings are read alongside any conventional testing that already exists. Because the terminology is unfamiliar to most patients, the resulting picture is explained in ordinary language and in terms of the patient's own body rather than in technical vocabulary.

Treatment may combine acupuncture, a custom herbal formula, other Chinese medical methods, and dietary or supplement recommendations. Acupuncture is sometimes supplemented with moxa, the smoldering herb mugwort, used to warm specific points.

How long a course of treatment runs

This depends on how severe and how long standing the complaint is, and on what the patient is trying to achieve. Acute problems may need only one or two treatments. Chronic or degenerative conditions generally require a longer course. Practitioners often recommend dietary changes, relaxation techniques, self massage, or herbal medicine alongside acupuncture, partly to maintain progress between treatments. Some patients continue at a reduced frequency after the original complaint has settled in order to work on less pressing imbalances.

Herbs and acupuncture

Acupuncture and Chinese herbal medicine are two branches of the same system with different strengths, and they work well together. Acupuncture is best known for musculoskeletal work, for pain, and for its effect on stress and relaxation. Chinese herbal medicine is particularly suited to internal medicine, from respiratory complaints to gynecological and digestive problems, though it is less widely recognized for that in the West.

Chinese herbal medicine has become considerably more visible in the West over the past two decades. That visibility makes it more important, not less, that herbs be prescribed by someone with formal training and licensure in the system they come from.

Herbs alongside prescription medication

Acupuncture rarely interacts with medication. Chinese herbs can. Herb and drug interactions are real and have to be respected, which is why it is generally advised to leave roughly two hours between taking herbs and taking pharmaceuticals.

Many Chinese herbs are also ordinary foods. They are nonetheless treated as medicine here. Tell your practitioner about everything you are taking, prescription and otherwise, so that formulas can be written with that in mind. Decisions about starting, stopping, or changing prescription medication belong with the prescribing physician.

Children

Children as young as one month can be treated with a non-insertion technique called shonishin. The method originated in southwestern Japan several hundred years ago and consists of light tapping or stroking at specific points along the meridians. Children tend to respond to very little input, and shonishin works on that principle. Herbs are sometimes used alongside it, usually at small doses, and dietary adjustments may be suggested.

Pills, tinctures, and bulk herbs

Most people meet Chinese herbs first as patent medicines, which are ground herbs in pill form. They are inexpensive, largely because they contain comparatively little herb. Their popularity has an unflattering history: traveling sellers wanted fast acting products and began adding Western pharmaceuticals to their pills, a practice that has not entirely disappeared, so brand matters.

There are four practical limitations to pills. A prepared formula cannot be designed for the individual patient. The quantity of herb per dose is substantially lower. There is some possibility of undeclared ingredients. And the herbs are usually unprocessed, so the body has to do work that decoction would otherwise have done in advance.

The differences in quantity are larger than most people assume. A tincture contains roughly five to ten grams of herb per ounce. A week's bottle of pills might contain twenty-eight grams. A bulk herb prescription commonly runs fifty to one hundred grams per day. Preparation method also changes the result, since alcohol extracts different constituents than water does. A formula designed as a decoction and delivered as a tincture or a pill is not quite the same formula. A few traditional formulas were designed as pills and work best that way, but most were meant to be taken as a tea.

Bulk herbs are the standard method of prescribing in China and the method used in this practice. They demand more of the practitioner in diagnosis and theory, which is the point. Prepared forms have their place, provided the dose is adjusted honestly and the change in preparation is accounted for.

Choosing a practitioner

Look for formal graduate training, national board certification, and an active state license. In New Jersey, acupuncture is a licensed profession and Chinese herbal medicine requires an additional certification beyond the acupuncture license, so it is reasonable to ask which of the two a practitioner holds.

Beyond credentials, ask about your specific condition. There are many styles of acupuncture and many levels of advanced training, and experience treating something similar to what you have matters more than general reputation. Any patient is entitled to ask about the training and credentials of any health care practitioner, and a good one will answer plainly.