Jeff Rippey

Unlike the western conception of it, acupuncture is actually composed of multiple different systems. One of those systems is referred to as auricular or ear acupuncture. In this system, the entire body is mapped on to the ear and points on the ear alone can be used to treat issues in the entire body.

There are a few ways we utilize ear points: very small needles, tacks and seeds. The needles we use in the ear are quite small and are inserted and removed during the course of your office visit - in other words, you don't typically leave the office with any needles still in your ear.

Tacks are also very small. They're inserted in the office but, unlike most needles, you wear them home and can leave them in for a few days.

Then we have seeds. These are exactly what they sound like: it's a seed from a plant in the Vaccaria family (cow herb or prairie carnation). The seed is stuck on a small band-aid like square of adhesive and is applied to points on the ear. Similar to tacks, patients can wear the seeds for a few days before removing them. They can be very effective for pain patients because the seed can be squeezed to relieve a pain flare up. Unlike tacks or needles, seeds are non-invasive - they do not break the skin, they simply apply pressure to a point in the ear.

Good question. We've had several well designed studies, particularly this one from Germany (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4479426/), showing acupuncture does a good job of providing relief from seasonal allergies. Unfortunately, this is one of those places where the exact mechanism of action is still largely unknown.

The German study referenced above hinted at the fact that acupuncture may be regulating certain cytokines and reducing IgE. Cytokine is kind of a catch all term for substances secreted by the immune system. IgE is an anti-body produced by the immune system and is typically elevated in people who suffer from seasonal allergy.

Since allergy and allergic reaction are, more or less, an out of control or out of proportion immune response, it appears that acupuncture is somehow calming the immune system so the response is more moderate.

Acupuncture performed by a state licensed graduate of Chinese medical school is generally safe and can be very effective in the treatment of a wide variety of health issues - including allergies.

The first question is: why do you have back pain? Not all pain has the same cause and some causes are more easily treated with one style of medicine vs another.

If you haven't already, I'd suggest seeing your MD and having some x-rays/CT/MRI done to see if imaging can shed any light on the cause.

Both acupuncture and chiropractic may be able to help. Sometimes the combination is better than either method alone. If you do decide to try acupuncture, please make sure you're seeing someone who attended Chinese medical school and is licensed in your state as an acupuncturist.

How a practitioner of Chinese medicine would treat knee pain is going to depend on a lot of different variables. Broadly speaking, you are going to encounter to kinds of practitioners:

1. Those who will treat locally by placing needles in or around the knee.
2. Those who will treat distally by putting needles in other parts of the body.

Both methods can be very effective.

If you're asking how would acupuncture relieve knee pain, that's a bit more complicated. Acupuncture in pain patients appears to be doing two things:

1. Regulating a set of neurotransmitters which are responsible for the transmission of pain signals in the central nervous system.

2. Altering the way pain information is processed in the brain.

Good question. In studies acupuncture has been shown to have a dose dependent effect. What this means is, to a point, more treatments will give superior/longer lasting results.

With pain patients, a lot depends on how long you've been experiencing the pain and how severe the pain currently is. A typical course of therapy might be 5-7 treatments spaced 1 week apart followed by increasing the time between treatments until some maintenance interval is found which gives you sufficient pain relief.

The maintenance interval is mostly an individual thing. I've had patients whose interval was monthly and patients who came to see me twice a year after we got their issue under control.

When you start seeing an acupuncturist, expect a little up and down in your pain levels as you progress. Typically my patients experience a sharp reduction in pain after the first or second treatment. This initial reduction will last a day or two and then the pain returns. Each subsequent treatment reduces the pain a little more and/or extends the time for which the pain is either relieved or reduced. When the patient can go 5-7 days with either no or minimal pain, then we start to space the treatments out.

Generally speaking, no, acupuncture doesn't hurt. Some points can be more tender than others and you might feel a slight pinching sensation in initial insertion of the needle. If this occurs, it should fade within seconds.

This is a great question. Having a western diagnosis in hand can sometimes be useful when visiting someone who practices Chinese medicine, but it's not necessary. The Chinese diagnostic model is very different from conventional medicine and, frankly, the case as you've described it is perfect for acupuncture/Chinese medicine. Because we diagnose in a different way, we can often identify the root cause of an issue even though conventional diagnosis can't pinpoint the problem. If I were you, I'd start with the "Find a Practitioner" link at NCCAOM.org. Get a list of board certified practitioners in your area and see if you can find someone who specializes in pain management.

Yes, acupuncture will probably help. You're still fairly close in time to the injury, and the sooner you start treatment the better your long term results will be.

Acupuncture may help relieve your symptoms of depression and it might also help to reduce any side-effects you may be experiencing from your medications.

As for how it works, well, to be honest that's anyone's guess at the moment. In fact, if you read the mechanism of action section in the patient information leaflets for the prescription medications you're taking, you'll see statements to similar effect; in other words - we don't really have a handle on exactly how drugs work in depression either.

As with the pharmaceuticals, we do have some ideas though. In comparison studies acupuncture appears to be regulating genes in the pituitary in a similar way to fluoxetine (Prozac). In fact, studies have shown that acupuncture usually at least matches the effectiveness of selective serotonin reuptake inhibitors (SSRIs like Paxil, Prozac and Zoloft) in mild to moderate depression.

I would absolutely recommend you try acupuncture for your depression. A good chunk of my practice are depression/anxiety patients and I'm usually able to help them out quite a bit. For best results, please make sure you're seeing an NCCAOM board certified and state licensed acupuncturist.

Infection due to acupuncture is extremely uncommon. Most acupuncturists utilize single use, factory sterilized needles. These needles are used one time on one patient and then discarded, so cross contamination is very rare.

If it's still a concern due to the cut on your palm, try to find someone who practices a distal form of acupuncture. These practitioners can treat your hand pain without putting needles in your hand. I know, to most folks it sounds weird, but this is the form of acupuncture that I practice and, particularly for pain, it's very effective.

Yes, acupuncture will probably help your knee pain. If you haven't already, you might also want to visit your primary care physician and have x-rays or an evaluation done. A lot depends on your personal history, but 28 is fairly young to be having knee problems.

Where the needles will go depends largely on the type of acupuncturist you see. Some will insert needles in or around the painful knee and others may treat the pain by putting needles elsewhere on the body - typically the opposite elbow.

I hate to be the one to say this but hemophilia is one of the few contraindications for acupuncture.

You still have a couple of options:

1. You could find someone who is well versed in auricular (ear) acupuncture and make sure they only use seeds or pellets - these do not break the skin, they merely apply pressure to a particular point.

2. You could also look for someone who has been trained in Korean hand acupuncture and uses the Korean press pellets - again, these do not break the skin they only apply pressure.

I've gotten very good results for several pain patients using only ear points or only Korean press pellets on hand points. The advantage to these systems for any patient is: the seeds/pellets can be left in place for up to several days and the patient can be trained to apply the seeds/pellets to themselves and then provided/sold a supply. This makes it easier for some to manage their pain and cuts down on overall visits which can help out financially.

In addition to acupuncture, you will want to avoid cupping, scraping (usually referred to as guasha) and the more intensive forms of massage. Any of these has the potential to cause bruising which, for you, could result in an uncontrolled subcutaneous bleed.

If this is something you decide to pursue, please make sure the practitioner knows up front about your condition. Most of us will ask about clotting disorders and blood thinners up front, but it's better to be safe than sorry.

So long as you're seeing a board certified and state licensed acupuncturist (in other words: someone who attended Chinese medical school and now practices acupuncture as part of Chinese medicine), yes, it's totally safe.

Anemia can have a couple different causes. Sometimes it's insufficient iron in the diet and sometimes it's insufficient B12. Vitamin B12 helps the digestive tract absorb iron in the first place. If your B12 levels are low, then you're not absorbing enough iron and you won't be able to produce sufficient hemoglobin/red blood cells. If your iron intake is low, again, you won't have enough raw material to product hemoglobin/red blood cells.

Anemia tends to fall in to a syndrome in Chinese medicine that we refer to as "blood deficiency". This is more of a catch all for a variety of blood issues including low blood volume. There are lots of acupuncture points which can address the problem, although exactly how some of these points function is still in question. Having a solid Chinese differential diagnosis as to why you're experiencing anemia (blood deficiency) is going to be critical to getting good results.

If you were my patient, I'd probably also use moxibustion. Moxibustion is the burning of powdered Artemisia vulgaris (Chinese wormwood) leaves - either directly on the skin (which we don't tend to do in the US), near the skin using a cigar-like roll of moxa (very common in the US) or on top of an inserted needle (also fairly common). Studies from Japan have shown that using moxibustion can increase the production of both red and white blood cells making it a useful addition to a treatment for anemia.

As I alluded to in my first paragraph, having sufficient raw material is key - no matter what other treatments you add. B12 comes mainly from meat, so if you're vegan/vegetarian you may need to consider supplementation. Iron has lots of different dietary sources - from leafy greens like spinach to meats like beef or buffalo.

Acupuncture can help and any good acupuncturist is probably also going to suggest some dietary changes. You'll see the best results if you can incorporate both.

For the best results, please make sure you're seeing an NCCAOM board certified and state licensed acupuncturist. Particularly if you're open to moxibustion, you need to make sure you're seeing someone who went to Chinese medical school and understands how to diagnose, choose a modality, use that modality and what the cautions and contra-indications might be.

A lot depends on the person being treated, what they're being treated for, what acupuncture points were used, whether other modalities were used during treatment and, if other modalities were used, what other modalities were used (cupping, massage, scraping, bleeding, etc.).

I'm a less is more type of practitioner: I use few needles with long retention times and not much else unless the patient's condition is fairly severe. I rarely get people who complain of fatigue post treatment, but it does happen. Usually when it occurs it's related to one of two things:

1. I missed something during my evaluation and choose points poorly. At that point, a patient who reports fatigue after a session is giving me extra diagnostic information that I can use to adjust my next treatment such that fatigue does not occur. In other words: assuming the provider is asking for feedback and the patient is providing information regarding previous sessions, this is an easy fix.

2. The patient came to the session fairly run down. This is also an easy fix: make sure you have a light snack either just before or just after your session.

A final note on this subject: most studies of acupuncture fairly consistently show that it stimulates the parasympathetic nervous system. This is the "rest and digest" side of the autonomic nervous system and acts in opposition to the "fight or flight" sympathetic system (with which you may be more familiar). For so-called "type A" personalities who always feel like they need to be on the go (and hence are mostly in the "fight or flight" mode), increasing the activation of the "rest and digest" system can feel like they've walked off a cliff compared to their usual higher energy state. In the long run, continuous activation of the "fight or flight" system is a recipe for disaster - it can lead to adrenal fatigue and heightened stress states have been linked to a laundry list of chronic disease.

All that is a complicated way of saying a little fatigue may be just what you need after an acupuncture session. If it happens to you, try to schedule your next session at the end of the day so you can go home and rest.

I've treated people taking blood thinners before and I know other practitioners of Chinese medicine that treat folks who are taking blood thinners. To be honest, a lot depends on what blood thinner(s) you're on and at what dose.

The risk is an uncontrolled or extended bleed as a result of a poorly placed needle. Acupuncture needles are extremely fine and, generally speaking, the goal of insertion is to avoid internal structure. What we call 'acupuncture points' in the western world are actually small cavities or spaces between fascial layers. Usually there isn't much structure to speak of in these spots and a good acupuncturist isn't going to be hitting blood vessels.

That being said, there are probably not many practitioners of Chinese medicine who are familiar with all the ins and outs of the various blood thinners on the market and how the dosing and possible combination of these drugs are going to affect any given patients' clotting ability.

In this case, as much as I hate to say it, I'd err on the side of your doctor and suggest you should try something non-invasive like TaiJi, QiGong, yoga, meditation or mild exercise to manage your work stress.

It's a good question, the problem is it's very difficult to answer. I have a 250'ish page book which attempts to define 'qi' in western terms. Some concepts simply do not translate well from Chinese and this is one of them.

Let's step back for a minute and provide a little understanding of the landscape. Just like with the English language where we have old English, middle English and modern English, in Chinese we have old Chinese, middle Chinese and modern Chinese. Also similar to the English situation, no one outside of certain scholars reads or speaks ancient Chinese.

This is compounded by the fact that written Chinese is not phonetic. In English, each letter represents a sound, the sounds together are a word and the word stands for an idea. In China, they cut out the middle man. Each symbol represents an idea - more similar to a hieroglyph - and that symbol has a pronunciation.

The character we render in English as 'qi' is an ancient symbol that has changed over the years. There's no guarantee the idea it conjures to a modern reader is the same as the idea the ancients had when they coined the term. Also, it's a term that is used in lots of different places - its use is not solely limited to Chinese medicine. Lastly, it's a culturally loaded term - the Chinese know exactly what they mean when they use it and they don't really have to explain things to another Chinese reader/listener. Most western practitioners of Chinese medicine don't understand the culture and don't speak or understand the language (NOTE: this does not mean they cannot be effective practitioners, it just means they have a very difficult time explaining what they're doing).

The ancient Chinese tended to describe natural processes in terms of metaphor - as being 'like' or 'similar' to some other thing they understood better. It's a technique many ancient peoples employed, in fact we still use many of those definitions today in conventional medicine. The word 'pelvis' comes from the latin for 'washbasin' - a reference, no doubt, to the general shape of the bone. The word 'acetabulum' (the hip socket where the thigh bone 'plugs in') also comes from latin and means 'small cup of vinegar'. Did the ancient Romans literally mean washbasin and cup of vinegar when referring to these structures? Probably not, it's a descriptive metaphor and the Chinese did the same thing - it's just that Chinese doesn't form part of the root for modern western languages and hence the concepts seem strange.

Which is a long and winding way back around to 'qi' and what does it mean? In my opinion, there are two good analogies for qi: function or information.

Organs in the body have a function and when that function is compromised in some way the Chinese modeled things in terms of excess and deficiency. We could have function excess giving rise to pathology - as in the case of hyperthyroidism. The thyroid is producing too much thyroid hormone which causes systemic problems. We can also have function deficiency giving rise to pathology - as in the case of hypothyroidism. In this case the thyroid is not producing enough thyroid hormone which causes a different set of systemic problems.

Information is a useful analogy because in order to function properly, each tissue needs to know where it is, what it is and what it's supposed to be doing. If this information becomes scrambled, then the tissues cannot perform their function properly and, again, we see pathology.

The important thing here is not the language, it's the result. If your practitioner is able to achieve good outcomes for your health issues, then I wouldn't be too concerned about the fact that they don't have a solid handle on Chinese linguistics.

Chinese medicine focuses on individualized treatments as opposed to conventional medicine where every condition has a protocol or short list of protocols for treatment. The points used by your practitioner will be related to two things:

1. The root cause for your issue - in this case fertility. There are a few reasons in Chinese medicine why you might experience difficulty conceiving and they'll have different treatments.

2. The kind of practitioner you're seeing. Generally speaking there are two different kinds of practitioners - those who use local needles and those who use distal needles. For a practitioner who uses local needles, you can expect to receive a few needles on the low abdomen (roughly in the area of the uterus). For practitioners who focus more on distal treatments, you can expect needles mostly in the arms and legs.

Other than these rough guidelines, it's hard to say where your provider might choose to place needles.

Acupuncture can probably help with your issue and it's certainly worth a shot if you don't like the medication side-effects.

Acupuncture stimulates the parasympathetic side of the autonomic nervous system. By way of a brief explanation: the autonomic nervous system is essentially in charge of those functions over which we do not typically exert conscious control. It has two divisions: the sympathetic nervous system and the parasympathetic nervous system. These divisions can be thought of, more or less, as acting in opposition.

The sympathetic system is also known as the "fight or flight" side. It functions to increase heart rate, breathing rate and it shifts blood flow away from internal organs to prepare us to either fight or run for our lives.

The parasympathetic side is also known as the "rest and digest" side. It functions to decrease heart and breathing rate and it shifts blood flow to internal organs in order to help us digest food and assimilate nutrients.

Modern life has a tendency to place us in unending "fight or flight" mode. Our jobs, daily commute and so on do not leave us much downtime. Society tells us we have to be go-go-going all the time which doesn't allow the parasympathetic to kick in. This creates a problem because the "fight or flight" side of the system is only meant to be engaged temporarily, not all the time. Our bodies are adapted to be spending most of their time in the "rest and digest" mode.

And this is where acupuncture comes in. The needles strongly promote the parasympathetic ("rest and digest") system. This shifts blood flow towards the internal organs promoting digestion as well as the digestive muscle contractions which move food and waste through the system and out.

A good practitioner of Chinese medicine will discuss both diet and lifestyle with you during your initial intake. It's highly likely they'll also suggest diet and lifestyle changes to help with your issue. You'll get the best results from treatment if you can incorporate some of these changes.

For the best results, please make sure you're seeing an NCCAOM board certified acupuncturist. To find someone local, go to NCCAOM.org and click their "Find a Practitioner" link.

Yes, it's possible acupuncture increased your friend's blood pressure. Acupuncture has been shown to have homeostatic effects - in other words: if your friend's blood pressure was low, for whatever reason, acupuncture may have had the side-effect of bringing the pressure up.

It's difficult to say much more than this because I don't know what your friend was being treated for, what the practitioner's assessment was, what acupuncture points were used or whether or not your friend saw a board certified acupuncturist.

The last point is particularly important. Whether we believe it or not and whether we like it or not, acupuncture has systemic effects. Providers who are not fully trained in the system have no way to predict whether or not those effects might occur and, if they do, how to mitigate them. Unfortunately, at the moment, there are a lot of providers out there who are trying to cash in on acupuncture - they take a weekend seminar and then offer services. This isn't nearly enough training, especially when compared to the thousands of hours a board certified acupuncturist typically has.

All that being said, I have two suggestions for your friend:

1. Make sure they're seeing an NCCAOM board certified acupuncturist.

2. Talk to their provider about what happened after the acupuncture session. Sometimes these events can be diagnostic and might provide that last clue the provider needs to be able to adjust the points used and get better results.