Acupuncture: one session effective vs. over a year ineffective: Why is the skill of acupuncturists so different?

On February 21, a 52-year-old patient, Ms. T, came to the clinic. She reported that she had been experiencing trigeminal neuralgia on the right side of her face for over five years. Initially, the pain was tolerable and did not significantly affect her daily life or work. However, after undergoing a mastectomy and radiotherapy for breast cancer five years ago, the pain in her right cheek, temple, eyebrow, area beside the nose wing, and jaw gradually worsened, becoming almost constant throughout the day. She experienced over 20 episodes of level 10 pain daily, each lasting about 10 minutes, including 4-5 episodes at night. Western medical examinations ruled out the presence of a tumor, and she was prescribed painkillers. Although the medication slightly reduced the pain, she still woke up 3-4 times every night due to the pain, severely impacting her daily life and work. Over the past year, she had tried three different acupuncturists, receiving treatment from each for at least three months with 1-2 acupuncture sessions per week, but it provided no relief. One acupuncturist explained that it was a chronic condition requiring multiple courses of treatment to see results. Recently, the condition had worsened to the point where she could not touch the right side of her face without triggering pain, making even washing her face difficult. Upon a friend’s recommendation, she came to me.

I treated her with electro-acupuncture and prescribed ten days of Chinese herbal medicine focused on promoting blood circulation, unblocking collaterals, and alleviating pain. The patient mentioned that the previous three acupuncturists had not used electro-acupuncture, and she was somewhat apprehensive about. I assured her that electro acupuncture is safe, painless, and highly effective. Immediately after the acupuncture session, she felt significant relaxation in the muscles on the right side of her face. When she returned for her second session yesterday, she reported that after the first treatment, she was no longer awakened by pain at night and finally slept through the night. During the second session, I performed pricking bloodletting for her.

After two treatments, the patient reported that the episodes of level 10 pain had reduced to 15 times per day, with each episode shortening to 5-6 minutes. At night, she occasionally experienced pain 1-2 times. Unfortunately, she had to cancel her third scheduled acupuncture session yesterday because her elderly mother had accidentally fallen and needed to be taken to the emergency room. I hope her mother recovers quickly so she can continue her acupuncture treatments.

Treatment Follow-Up:

March 4: The patient came for her third acupuncture session today. She reported that the pain had decreased from level 10/10 to level 8/10. What pleased her most was that she was no longer awakened by pain at night and could sleep soundly until morning. When I touched her face, it was no longer as painful as during her first visit. I performed acupuncture and prescribed another ten days of Chinese herbal medicine.

March 7: The patient came for her fourth acupuncture session today. She stated that the pain had reduced to level 6/10 when her face was stationary, and it only became noticeable when eating.

Why is there such a significant difference in the effectiveness of treatments among acupuncturists? Let me analyze the reasons together with you.

First, because Chinese medicine treatment is based on pattern differentiation, which lacks the data-driven standardization of Western medical diagnostics, different practitioners may have vastly different pattern identifications for the same patient.

For the same patient, different acupuncturists may select different acupuncture points due to variations in pattern identification and understanding of the disease. Even if the same points are used, differences in needle length and thickness, insertion direction, depth, and manipulation techniques can lead to vastly different outcomes. Additionally, the effects of traditional acupuncture and electroacupuncture are quite distinct. Electroacupuncture provides continuous stimulation, which is typically different from traditional needle retention. The patient discussed in this article is a typical case.

These differences stem from the acupuncturist’s background and knowledge structure. Below, I will briefly discuss Chinese acupuncturists.

Different Educational Foundations: Some acupuncturists passed the college entrance exam in China, underwent five years of full-time formal education, obtained a medical license, and later acquired an acupuncture license in the U.S. Those who pursued a master’s and/or doctoral degree studied for 8-11 years. Others studied at acupuncture schools in the U.S. and obtained their licenses afterward. Admission to U.S. acupuncture schools does not require a unified exam; anyone meeting the enrollment requirements can study and take the licensing exam after graduation. During the initial legalization of acupuncture in the U.S. in the 1970s and 1980s, only a few months of study were required to obtain a license. As regulations tightened, the required study hours gradually increased. Today, each state has different requirements, generally exceeding 1,800 hours. California requires no fewer than 3,000 hours of theoretical and practical training, typically taking three years or longer to complete.

Different Backgrounds and Experiences: Chinese acupuncturists in the U.S. include those who previously practiced medicine, engaged in clinical work, teaching, or research in China, Taiwan, or other countries; those who learned through apprenticeships; and those who switched careers from business or other fields to study acupuncture.

Different motivations and goals: Some acupuncturists continuously strive to improve their skills through self-study, extensively reading classical medical texts, modern case studies of renowned doctors, and the latest research literature, focusing on how to treat patients as effectively and quickly as possible. Others prioritize business and profitability, telling patients that herbal medicine must take several months to work, or that acupuncture requires multiple courses to be effective, aiming to encourage more frequent visits.

Different understanding and Insight: Insight refers to a person’s ability to think, understand, and analyze what they see and hear. As the ancients said, “The same rice feeds a hundred different people,” meaning that even those living together and eating the same food can have vastly different ways of thinking, cognition, and comprehension. Similarly, everyone understands and absorbs the same lecture or book differently.