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This is a very basic question, but


#1

Hello,

This is a basic question about acupuncture frequency, but I've been struggling with it lately.

I've beed practicing acupuncture for about a year now, and I mostly treat elderly patients with arthritis (Bi syndorme). I have found that what works best for most of my patients is to see them twice a week (some three times a week, if their pain is more acute) for the first 4-5 weeks (this seems to suit them the best, both financially and travel-wise), and then, depending on the results, see them once a week, then once every two weeks, and eventually taper it down to a "tune-up" session once a month. If the symptoms come back, which they rarely have so far, we do a few sessions together again.

I have been told recently that this approach is wrong, and that what I should be doing is around 12 sessions very close together, and then do a pause of at least 3 months or more. And then repeat the cluster of sessions when necessary. I have of course heard of this approach before, but I haven't really thought it was so set in stone. Is there some significance in waiting the 3 months? Am I doing damage, or dampening the results by needling every month?

I am happy to do it either way, if one way is for some reason superior to the other.

What do you think?

Thank you very much!


#2

I don&#39t think that is a basic question at all - the true answer to this question is quite important for patients results and their pocketbooks. I also don&#39t think it has a clear answer so all I can share is my opinion - and the true answer would be that it depends greatly on the patient. The short part of the story is that no one really knows what is required as there hasn&#39t been enough researching comparing treatment frequency and most anything said on the subject is just peoples opinions and nothing more.


Many of these treatment frequency ideas come out of China where people are treated within an hospital/outpatient setting and then not seen again until necessary - sort of how we do PT in this country. The reality of this is that even if it were necessary it&#39s not a financially viable program for most people. Even if/when insurance begins paying as freely as they do for PT on acupuncture it still might not be the right idea.


Personally except in the most acute of situations we never treat more than once a week and we only do that in most cases for 3-8 times before pushing the appointments further apart. The exceptions to this would be acute injuries (2x/week occasionally, but not always) and cancer and auto-immune conditions where we might see people weekly for 1-2 years. In one of my previous clinics 90% of our patients had cancer or auto-immune conditions and never felt a need to alter from the once weekly (and less as soon as possible) paradigm.


It&#39s not just to save people money, however, it&#39s about what is absolutely necessary to get the changes you want. Personally with the proper combination of acupuncture, moxibustion, tuina, cupping, herbal medicine, etc. (i.e. the full gamut of Chinese Medicine) - I&#39ve yet to see any case do any better once weekly compared to multiple times per week. The people whom I consider my true teachers have been in practice for more than 40 years and they used to experiment considerably with what worked and what didn&#39t and along with the once weekly paradigm they also found that tuina was crucial. So that&#39s more or less what I do now.


Personally I feel like we get excellent and efficient results on a really broad range of cases with what we do, but that is just my experience and others will vary considerably no doubt.


#3

Dear Chad,


that is so interesting, and thank you for your thorough answer (your thorough answers over the last year really made a difference for me, I learned a lot!)


Well, I am glad you said it was not such an straightforward topic, I have felt guilty for not knowing a "true" answer, and I now see it is not entirely my fault, it is, in fact, a subject to continute to explore, as you said. I was confused because my course taught me the once a week system, and to then do it by ear from them on, while my mentor (who was trained in a very traditional Chinese way) does it completely differently (every day at first, and then makes long pauses).


Some decent research points to needling every 72 hours at the beginning (based on pure muscle biology, apparently the muscles need that much to register, respond and regenerate between needling).


I suppose it also might depend on the thickness of the needles, the depth of the insertion, the number of needles, the points used, the illness, the response etc...


I gues for now, for the older bi syndrome patients, I shall continue with my twice a week system, (for a 2-3 weeks) and then once a week, once every two weeks, and finally once a month or once every few months...I do moxibustion and some herbal, and have started doing massage as well, which the patients love, yet I am just doing gentle massage (not tuina, since I haven&#39t learned it yet), which probably just feels good and relaxes a bit, without having much other benefit (but it&#39s a start)...


I shall try a few on the once a week system, as you do in your clinic, and see how it goes, if it shows the same results, I am happy to switch to that, since it is easier on the clients...


Thank you again!


#4

This really is a great topic! I too have wrestled with this in my practice. My school also taught a once per week system. Personally, I have found this to be either inadequate and/or too slow for most of my patients.


When it comes to treating pain, I find it best to hit it hard and fast. I really don&#39t like to see people having pain past 4-6 weeks, unless the case is really severe, but in these cases the pain is usually minimal by this time. I will almost always start patients 2-3 times per week with pain issues. Most seasoned clinicians I have talked to do something similar regardless of their style (balance method, TCM, Japanese style, etc.).


You really can&#39t generalize number of treatments in my opinion. Every case is different and everyone heals at a different pace (I do find that patients with good diets heal much faster though). I have seen some pain cases resolve in 1 treatment, others in 7+ treatments. You really need to be responsive to your patients. Monitor their pain, function, and pulse. Often you can tell how much better something is by the pulse.


As far as "tune-up" treatments, I try to avoid them. If we are truly getting the body to heal itself, they shouldn&#39t need a "tune-up". Of course we all have patients that have severe structural abnormalities, or who have constant aggravators that they can&#39t seem to avoid (like sitting at a desk 8 hours per day), but in cases of old injury or digestive problems, for example, the problem should stay away unless something else happens that injures or effects the problem area.


But again, I really love this topic and I hope many more practitioners will offer their opinions on this! It&#39s easy to talk about application and theory, but this gets down to the nuts and bolts of what we do.


#5

The ~70 hour idea is a very interesting one. The way I always thought of that is to also keep in mind that acupuncture is not a needles in -- then effect -- then needles out modality. It is needles in -- the brain and body are stimulated to do things and these effects can then last for hours to days stimulating changes that then last days to months to years. Personally from what I&#39ve read and see I think the effects from one acupuncture session are probably still affecting the body for 2-3 days at a minimum. Which is why clinically people will often feel less dramatic changes immediately after the treatment, but more so after a couple days after the treatment -- because the body has been prompted to change internally and then those internal changes are making more systemic permanent adjustments that deal with the health issues at hand. With that in mind I certainly don&#39t think 2x week is excessive or possibly even unnecessary - but personally more than 2/x week probably is.



#6

I've enjoyed reading these posts on how often to treat. I wasn't given any guidance on this during my course in Medical Qigong, but have been using my instincts for the past few months and my initial findings are that for some kinds of pain, like sciatica or a frozen shoulder, twice in the first week followed by weekly until completely cured seems to work. I've only done this on 3 occasions, but each time 3 sessions were sufficient. For people with chronic conditions like CFS I've done 6 weeks weekly followed by every second week then once a month and this seems to be working well too. I think the 'top-up' will probably eventually stop as they start including the prescribed qigong and relaxation techniques. I have one client who has chronic pancreatitis and pneumothorax, and he is treated weekly. He has started doing a 100 days qigong prescription and has in 3 weeks already noticed marked differences.
I was going to start going for an energy 'top-up' to my acupuncturist every month, but am still unsure if this is the right thing to do.


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