Acupuncture, Part II: The Clinic Visit

After receiving quite a few comments and emails about the difficulty some readers have with the pictures with needles, a needle-free version with the disturbing photos removed is provided here. The text and links are all the same, you will just be spared the sight of any needles!

Although non-TCM physicians and licensed clinicians also offer acupuncture, I can only speak to the experience of receiving acupuncture in the traditional Chinese medicine (TCM) setting.

Our experience began with T seeking relief for recurring knee pain, the result of abuse on the racquetball court and from jogging. Not having yet read Dr. Kidson’s book with her helpful advice on finding an acupuncturist (see the Overview), our major criteria at the time were that the practitioner was licensed, spoke English and could provide a receipt we could submit for reimbursements. Not very enlightened, I know, but we lucked out anyway.

When you first enter Dr. Clara Wong’s (D.Ac.) well-lit and air-cooled clinic on Smith Street, you are met with the familiar sight of the Chinese herbal pharmacy — a massive dark cabinet with its dozens of labelled herb- and spice-filled square drawers for the herbologists, and shelves of boxed patent medicines for over-the-counter sales. Colorful diagrams outlining acupuncture meridian points cover the passage from the front waiting area to the treatment rooms.

Dr. Wong is trained in both Western and Traditional Chinese Medicine (TCM) with a specialty in acupuncture, but her practice in Hawaii is limited to acupuncture and Oriental medicine, including herbology. Each visit begins with a meeting with the doctor in her small office. The most important part of the entire visit actually takes place here, not the treatment rooms. As was mentioned in the earlier post, diagnosis in TCM has many facets: listening to the patient; gauging appearance, smell, and demeanor; examining the tongue; and taking the pulses. Yes, pulses, plural! In TCM, the physician listens for six distinct pulses in the same radial artery with which a Western-trained nurse will count your pulse. But even before the doctor gestures for you to place your wrist on her desk to check your pulses, she has probably already noted many things about the color and condition of your skin, hair, eyes and face, and your demeanor that has escaped most people’s attention, including yours!

Questioning usually begins on a general level, how do you feel? Is there anything bothering you today? Follow-up questions have often surprised us both by how pointed and specific they can be, and how they often touch on areas we haven’t mentioned at all. If this is your first visit, it is appropriate to ask how long the full course of treatment is expected to take (for me, it is about 4-6 months with twice-monthly visits; for T, as long as 9 months). Prognoses will also be affected by how often you can come in for treatment, and how well you follow up your clinic visit with appropriate steps at home. The interview will often end with the doctor asking you to stick out your tongue — the color (pale, pink, gray, red, etc.), condition (dry, flaccid, wet, etc.), and coating (its thickness, color, spread) are important diagnostic indicators to her trained eye. Usually this last step serves to confirm a diagnosis the doctor has already reached.

Before you proceed to the treatment room, you may be advised about steps you should take at home to assist your recovery, and asked whether you are willing to make and take medicinal herbs to supplement your treatment. This will require you to boil a jumble of assorted roots, twigs, seeds and leaves according to very specific guidelines. Then you have to strain and drink it. More on this in the next post, Brewing Teas at Home.

Each of the three treatment rooms has a massage table and curtain for privacy. You don’t have to disrobe as long as you can expose the limb or body part that will require treatment (we usually just wear loose-fitting shirts and pants). Using disposable, stainless steel needles, Dr. Wong quickly and painlessly inserts each implement in place. I hate needles, and I can’t watch the doctor perform this procedure (I usually have my eyes closed, and take deep breaths).

What you might feel is a small sting, akin to an insect bite, as the needle is inserted, then maybe a tingle. Tingling sensations are good, but sometimes a kind of ache settles in at the insertion point instead — this will usually require manual stimulation of the needle or re-insertion at a different angle. If you’re not familiar with meridians, it may be surprising to find needles at far distances from the organ or body part that you thought was being treated. In my case, for the stomach and digestive tract, I have needles in my arms and legs!

After the doctor has inserted all the needles necessary for your treatment, one of her aides will connect small electrodes to each needle. This was the biggest surprise for T on his first visit because the first acupuncturist he had visited (a year earlier) had used only manual stimulation of the needles. I asked Dr. Wong about the voltage and she explained that the small electrical current provides consistent stimulation at the meridian points for the set time, which is more comfortable for the patient. (I have to admit that I usually fall asleep during the 40-minute treatments.)

Each area of the body will have a separate meter that controls the intensity of the current. The aide will ask you to let her know when you begin to feel the current, then will slowly increase the flow until it is comfortable but still tingly. Feedback between patient and aide is very important here — tingling sensations are good, aches or sharp pain mean adjustments are necessary. I often have needles in my hands and on or near my feet (my needle placements are usually symmetrical but not always), and often a hand or foot on one side but not the other (it’s always my right side), will twitch or “jump” (see photos below). Dr. Wong identified these as areas with blockage of Chi — the twitching is caused by the current pushing its way through the blockage (imagine water accumulating behind a blockage and a small amount finally pushing its way through; it comes out in a forceful gush on the other side). For me, it’s a source of amazement how the theoretical meridians become concrete when you can see a physical manifestation of your condition jumping so vividly!

Once you’re comfortably stimulated, lights are lowered and a heat lamp is turned on if you feel a chill, then you are left in quiet peace for 30-40 minutes. At some point you may be roused and asked whether you are still comfortable (“I was asleep!”) and whether you still feel a tingle in each area. If tingling has subsided, the current may be increased.

At the end of the session, the meters are turned off and disconnected by an aide, but the doctor will return to remove and dispose of each needle herself. If she hasn’t already discussed how to follow up treatments at home, Dr. Wong will often take this time to advise on appropriate home care. In addition to taking herbal brews, this may include foods to limit or increase in your diet, and appropriate types of exercise. The difference between these recommendations and those in Western practices is that they, like the diagnoses, are discussed in terms of Chi. For instance, a person with a strong Fire element and an excess of Yang may be told to limit red meat, and spicy foods and herbs, and to swim in the ocean (Water) or take walks in the woods (Earth) to calm the strong Fire.

Both T and I usually feel very relaxed after a session, and “lightened” as if a heaviness has been lifted from somewhere. I sometimes feel an ache in my right arm at the site of one of the needle insertions. The ache will come and go depending on how active that arm is (am I using it for writing, typing, or stirring pots), and whether it is exposed to a draft or cold; it tends to dissipate after tai chi exercises, Reiki, and drinking my prescription “tea.” According to the doctor, these are long-standing blockages in the affected meridian and active meditative practices such as tai chi or Qi Gong do help to clear these blocks.

As you return to the front room, if you’ve agreed to take an herbal “tea” you will find small paper bags which an herbologist has carefully weighed and assembled containing the assortment the doctor has prescribed for you. Each bag will brew 1-3 doses, and each prescription will have specific instructions on how to boil the mixture. If this is your first visit, take a moment to read the directions and ask the herbologist any questions you may have.

Now you’re ready to continue your journey to better health at home. See you by the teapot in the next part of the series…

Dr. Clara Wong, D.Ac., is at Acupuncture & Herbs from China at 1112 Smith Street, between Hotel and Pauahi Sts., in Honolulu. Telephone for appointments only: (808) 524-8837 (phone consultations not available).

See also:
Acupuncture, Part I: An Overview
Acupuncture, Part III: Brewing Teas at Home