Jeff Rippey

Interesting question.

In the Chinese medical model there are a few reasons why someone might experience fatigue or chronic fatigue. Each of those reasons has a different core treatment. The trick, then, is to be able to differentiate why a particular patient is experiencing fatigue so we can apply the correct treatment.

Unfortunately, when it comes to Chinese medicine, we have a couple of issues;

1. There are people in the US who are practicing 'acupuncture' under the scope of some other medical license. These are people who are often well intentioned, but they don't bother to study the details of Chinese medicine and often deliberately ignore Chinese diagnostics in favor of an approach where acupuncture points are mapped to symptoms. They simply needle all the points that someone told them deal with fatigue. Basically, they've westernized the practice of Chinese medicine and apply symptomatic based treatments - which is not the point of acupuncture or Chinese medicine.

2. As much as I hate to admit it, even many people who attend and graduate from schools of Chinese medicine also don't have a good grasp on diagnostics. These folks too will often needle points that someone told them have an effect on the issue at hand.

Without knowing whether or not you're seeing a board certified and state licensed acupuncturist, how that person practices, what their diagnosis was, and what points they used it's hard to say why you're experiencing the insomnia.

To the core of your question though - can acupuncture cause insomnia? Yes, it certainly can. The knee-jerk reaction would be to place the treatment into a category called 'wrong treatment'. It is possible, however, that the treatment is mostly right and is just missing that small something that would prevent you waking in the middle of the night.

Most people think that acupuncture is completely benign and will often discount adverse patient experiences. The problem is, this isn't true. It is possible to either worsen the patient's situation or create a new situation through the incorrect application of acupuncture.

Situations like this happen to all of us practicing this medicine eventually, and the key is in how we respond. When things like this happen to patients I'm treating, I take it as an indication that I've missed something somewhere, and spend some time reviewing the patient's entire presentation and their chart to that point. This may include going back and revisiting some of my earlier intake questions to figure out what I've missed.

I suggest 2 things:

1. Make sure you're seeing an actual acupuncturist rather than a chiropractor, physician, or physical therapist who might be offering 'acupuncture' under the scope of some other license. Your provider should have either a Dipl Ac or Dipl OM national credential along with an L.Ac. or R.Ac. state credential.

2. At your next treatment, spend some time speaking with your provider about what you're experiencing. If they dismiss the insomnia as unrelated, find another provider and get a second opinion. They should go back to their diagnosis, ask you a few questions about your experience of both the fatigue and the insomnia, and then adjust what they're doing.

How long a session lasts depends on what kind of treatment you've singed up for. Broadly speaking, there are two different models for the application of acupuncture:

1. Community style
2. Scheduled appointments

Community style acupuncture is usually done semi-privately. You might speak to the provider initially in a private space, but the treatments are usually done on chairs or tables in a common room. Treatment times in this style can range from 15 minutes to 30 minutes.

With scheduled appointments, the entire treatment is usually private. You'll be taken to a private room where only you and the provider will discuss your health issue and then treatment will be provided. Initial intake and treatment usually runs a little longer since we're gathering your entire health history in order to make an accurate Chinese diagnosis. A 90 minute initial intake seems to be the norm, but I've heard of folks using a 2 hour initial visit. Followup treatments are usually around 60 minutes.

So, on the low end you could be looking at 15-20 minutes. On the high end you could be looking at 2 hours - at least for an initial diagnosis and treatment. If the length of a session is important to you either because you have a lot of commitments and not a lot of time or because you want the provider to maximize their time with you, call around and talk to a few local providers to see what their typical appointment runs.

Generally, it's not an issue for a patient to make small adjustments or scratch an itch while the needles are in place. There are a few acupuncture points on the outside of the shin that would require the patient not move the low leg/foot while the needles are in place. This warning has more to do with needles getting bent and being difficult to withdraw than a patient creating a dangerous situation by moving.

Since the needles are typically placed in spaces between muscle groups and, occasionally, in trigger/motor points directly in muscle, movement can result in discomfort or pain. Excessive movement can cause a needle to fall out where it either ends up in the patient's clothing, tangled in the table or chair covering, or on the floor. These needles will need to be located prior to patient movement or there's a risk of getting stabbed elsewhere with a random needle.

I usually tell people when it's ok to move and what limbs are ok to move while the needles are in place. If there's any question, ask your provider before they leave the room.

Usually, a patient can carry on with their usual day after an acupuncture treatment. If a patient has received cupping or guasha (scraping) during the treatment, there can be some aftercare instructions. If the treatment was only needles, then there's usually no issues with regular activities.

Acupuncture can help with tinnitus. In my experience, this is an issue that requires extended treatment times. Occasionally I'll get tinnitus under control in a few (3-5) treatments. More commonly patients are looking at months of treatment to provide relief.

Please see the following blog post: https://www.findatopdoc.com/Expert/81225813-Jeff-Rippey/Why-It-s-Difficult-to-Answer-Acupressure-Pressure-Point-Questions

Short'ish answer: from the perspective of acupuncture/acupressure, there are two channels which are thought to have something to do with the teeth/jaw and are commonly used for tooth pain. One channel handles upper row tooth pain and the other is typically used for lower row tooth pain. You question gives no indication as to where you're experiencing the problem, so there's no way I could provide a useful answer.

This is ultimately the problem with these kinds of question. There is a lot more information I'd require in order to arrive at something moderately useful to the questioner. Since most folks don't have a lot of experience with Chinese medicine, they have no way of knowing what I'd need to know in order to provide a useful answer. This is why it's best to actually visit a board certified and state licensed provider if you're interested in trying Chinese medicine to help with your issue.

Go to NCCAOM.org, select their 'Find a Practitioner' link, and plug in your zip code to get a list of local providers.

Yes, I typically get excellent results for people with toothache. You'll still want to follow-up with your dentist, you may have a cracked tooth or other issue requiring repair or treatment outside the scope of acupuncture.

Acupuncture is generally safe over the entire course of a pregnancy with one caveat: patients need to make sure they're seeing an actual board certified, state licensed acupuncturist. In the US acupuncture/Chinese medicine is currently in a weird position - there are many different providers who can technically offer 'acupuncture' without attending or graduating from an accredited school of Chinese medicine. These other providers sometimes have minimal training and, particularly in the case of pregnancy, there are safety concerns.

From the perspective of classical Chinese medicine, there are points which should be avoided in pregnancy. Often someone not fully trained in Chinese medicine isn't aware of this fact and doesn't know which points to avoid.

Sometimes, yes, trigger finger can be treated with acupuncture. There are also some topical liniments which can be utilized along with TuiNa (Chinese therapeutic massage) to provide relief.

Define 'quickly'.

Probably the best analogy here is to compare acupuncture to a course of antibiotics. Only taking one antibiotic is unlikely to resolve the problem. In the same way, only having one acupuncture treatment is unlikely to resolve the problem. Both antibiotics and acupuncture require a course of therapy.

For acupuncture that's typically 10 treatments or so - a lot depends on what we're trying to treat, how long the patient has been experiencing the issue, whether or not they're seeing an actual board certified and state licensed acupuncturist (as opposed to someone who is operating under the scope of some other medical license and has a weekend seminar's worth of training), and how good the provider is at treating the issue at hand.

If the patient isn't willing to commit to at least 3 treatments, acupuncture is probably not for them.

First, I'm profoundly sorry you and your wife are having to deal with such a debilitating disease.

I've never dealt with a neuromyelitis optica patient personally, but the explanatory/diagnostic model of Chinese medicine is different from conventional and, after looking up NMO and getting a handle on the typical symptoms, I think I see what might be going on from the standpoint of Chinese medicine. That gives some hope that acupuncture or Chinese herbal medicine might offer relief.

Given your wife's current level of pain, it might be better for both of you if she started with Chinese herbal medicine rather than directly with acupuncture. Often times when people are experiencing severe chronic pain, their entire body becomes sensitized and even the lightest touch is interpreted as painful. I suspect that, initially, the needles might cause increased pain or discomfort. Herbal medicine would provide the opportunity to reduce some of the pain which may make acupuncture more tolerable.

Here's what you need: a provider with an L.Ac. state credential and a Dipl OM national board credential. You can find folks with these credentials at NCCAOM.org by using their "Find a Practitioner" lookup - just plug in your zip code to get people local to you.

Get a list of local providers, and then call them. You're looking for someone who specializes in pain management and who has a good track record with neurological issues or neuralgia. Don't be super concerned if you can't find someone who has worked directly with NMO - like I said, the Chinese explanatory and diagnostic model differs from conventional medicine and we need a Chinese diagnosis in order to apply the appropriate Chinese treatment. Sometimes you can also find someone who will be willing to make a house-call. I suspect this will be much easier versus getting your wife out of the house.

So, yes, I think Chinese medicine can help. In this case, I'd start with herbal medicine and add acupuncture as some of the pain and other symptoms start to come under control. Best of luck to both you and your wife.

Please see the blog post at this link: https://www.findatopdoc.com/Expert/81225813-Jeff-Rippey/Why-It-s-Difficult-to-Answer-Acupressure-Pressure-Point-Questions

There are a couple of ways we could think about knee pain:

1. A channel problem
2. An internal problem

Purely from a channel perspective, there are 6 primary channels and 5 of the 8 extraordinary channels running through the knee. In order to even begin to give you a halfway useful answer to your question, any decent acupuncturist is going to need to know where, exactly, you experience knee pain.

From the perspective of an internal problem, there are several organs in the Chinese medical model which are thought to exert an influence either on the knees or on joints in general. These range from Kidney to Spleen and each of those organs will present a certain constellation of symptoms if there's an issue. So, in oder to differentiate where the problem might lie any decent acupuncturist is going to need to be able to ask a whole lot of questions that would be seemingly unrelated to knee pain. We do this because we're trying to get at that constellation of other symptoms a patient might be experiencing so that we can differentiate the problem, get a correct diagnosis, and then go about treatment.

In short, this is a lot more complicated question than you (or really anyone else) think it is, and it's not something that could be reasonably answered by an acupuncturist who has never seen and diagnosed you. Basically any answer is going to be a guess.

Lastly, acupuncture (using needles) is going to provide far superior effects and is going to be a lot more comfortable. If you want to try Chinese medicine, go to NCCAOM.org, use their "Find a Practitioner" lookup and get a list of local, board certified, providers.

Impossible to say without seeing or treating you. There are a lot of factors which can affect how long it might take for acupuncture/Chinese medicine to resolve an issue. These range from:

1. What, exactly is wrong with the knee?
2. How long has the patient been experiencing this issue?
3. What other treatments has the patient tried and how have those worked?
4. Is the patient seeing an actual board certified, state licensed acupuncturist or are they seeing an MD/DC/PT who is offering 'acupuncture-like' services under the scope of some other licensure?
5. How good is that provider at treating pain conditions?

I'm a board certified, state licensed, doctor of acupuncture. I specialize in pain management. Generally speaking, most of my patients are experiencing some level of pain relief by the 3rd or 4th treatment. A usual course of therapy might be 8-10 treatments.

A provider who isn't a pain specialist might need more time. A provider who didn't attend and graduate from an accredited school of Chinese medicine might need more time.

Assuming there isn't a serious/severe structural issue like a torn meniscus or a tendon/ligament tear, yes.

I'm going to assume this question has to do with pain management. Acupuncture is not going to correct any structural issues.

What, exactly, acupuncture is doing in terms of pain management is still somewhat an open question. The crux of the issue is that acupuncture and Chinese medicine are looking at the body from the standpoint of an integrated whole while conventional medicine and science are using reductionism.

In order to be generally accepted, acupuncture studies have to conform to a reductionistic point of view. It's a little like trying to put a square peg in a round hole - the two methodologies are fundamentally different and it's very hard to reconcile one in terms of the other.

The studies we have are looking at acupuncture in terms of biochemistry. They do this because conventional medicine thinks in terms of biochemistry. Are there measurable changes in biochemistry which occur as a result of needle insertion? Yes. In pain management we see increases in endogenous opiate peptides, we see regulation of neurotransmitters involved in the propagation of pain signals in the brain and spinal cord. Functional MRI studies show us changes to brain structure with up-regulation of mu-opiate receptors and these studies also show changes in how the brain is processing pain signals after acupuncture. Is this the exhaustive list of everything acupuncture is doing? In my opinion, no. Do we know if acupuncture is doing all these things all the time? No, we don't - core study methodology doesn't align with a study that looks at everything at the same time (to put it another way, a study that attempted to look at all possible outcomes would be invalid under current study construction rules).

None of these studies answer the logical follow-on question: why should the insertion of a solid needle stimulate these effects in the first place?

It's a complicated situation. Patients often need or want to know what's happening as a result of acupuncture, and they want that explanation in a language that makes sense to them. Unfortunately, the ultimate answer is neither simple nor short. So, given that, how should we proceed? I have two suggestions:

1. Many of the approved prescription medications used in pain conditions are not fully understood in terms of their mechanism of action. You can ask your pharmacist for the patient information leaflets, go to the pharmacology/mechanism of action section and see for yourself. I used to work in pharmacy and I can tell you with a high degree of confidence that there are a large number of approved prescription medications where we do not fully understand how the drug is exerting its effect. In this way, acupuncture isn't really any different and has the added benefits of being [usually] cheaper in the long run and often has much less risk of side effect or adverse event.

2. In my opinion, the pieces of the puzzle which would reconcile acupuncture in terms of conventional science exist and, in some cases, have been around for quite some time. If one were to go back and start with Albert Szent-Gyorgyi and work their way forward through Harold Saxton-Burr and Robert Becker. Throw in a little Rupert Sheldrake and then sprinkle on some biophysics (particularly some of the work done at Tufts University from 2011 onward) as well as a systems theory. I think you'd fairly quickly realize what acupuncture is doing, how it's exerting its effect, and why biochemistry is at the tail end of what's going on.

Either way, it's a lot of work and it's somewhat crazy-making. The bottom line is: acupuncture is an excellent treatment for most kinds of pain, including back pain. It's a treatment modality that has been around for at least 3,000 years and, compared to most pharmaceutical pain management options, is very safe.

Not necessarily. Patients will sometimes experience fatigue, especially after an initial acupuncture session and especially if that patient has never had acupuncture before. As the patient undergoes more treatment the post treatment fatigue feeling usually goes away.

If you are feeling fatigue post treatment and you have the time, taking a short nap can help. Having a small meal or snack just before or just after treatment can also help.

The 'how long' question is a good one, but it's almost impossible to answer.

A lot will depend on how long the patient has experienced back pain, whether or not the patient is seeing a licensed and board certified acupuncturist vs someone providing 'acupuncture-like' services after taking a weekend seminar, how good your provider is with pain conditions, what exactly is wrong with the back/spine and is causing the pain, and so on. In order to provide a relatively accurate estimate, I'd have to actually see the patient, review any imaging/testing, and go through my intake process.

Speaking generally, and assuming the provider is an actual board certified and state licensed acupuncturist, patients should be noticing a decrease in pain somewhere between the 3rd and 5th treatment. A complete course of therapy might be something like 10 treatments, after which the pain should be reduced to the point that it has minimal effect on the patient's day to day life.

Once this point is reached, the pain typically stays reduced for several months. Sometimes we hit the nail on the head and the pain goes away and stays away for a fairly long time. Again, without seeing and treating the patient, there's no way to predict what might happen.

If the patient isn't experiencing any change by the 3rd or 4th treatment then we have three possibilities:

1. The person providing the acupuncture doesn't have a good enough handle on the problem and they should re-evaluate their diagnosis.

2. The patient, unfortunately, falls in to that portion of the population who tend not to respond well to acupuncture. Studies show that roughly 5% of the population are in this pool. We don't know why it happens but it does, and the only way to find out is to try acupuncture and see what happens.

3. Whatever is causing the back pain isn't amenable to acupuncture. There are a few structural issues, particularly in the low back, which don't respond well to acupuncture. I've never gotten good results for patients with laminectomy that has later become unstable. Sometimes the degeneration is just too advanced and there's not a lot acupuncture can do.

It depends on what the issue is. If you haven't already done so, I'd suggest first visiting your primary care physician and possibly getting a referral to a GI specialist. There are several gastric/stomach issues which fall outside the scope of acupuncture for treatment, and you need to make sure you're not dealing with one of those.

If it's not something serious like cancer, bleeding ulcer, or bowel obstruction then, yes, acupuncture can often be an effective treatment for stomach issues.

This is one of those cases where it's important to make sure you're seeing a provider who attended and graduated from an accredited school of Chinese medicine rather than someone who took a weekend seminar or two and is now offering 'acupuncture-like' services under the scope of some other licensure. Your provider should have either an L.Ac. or R.Ac. credential from the state and a Dipl Ac or Dipl OM national board certification. To find someone like this near you, go to NCCAOM.org and use their 'Find a Practitioner' lookup.

Please see the following blog post: https://www.findatopdoc.com/Expert/81225813-Jeff-Rippey/Why-It-s-Difficult-to-Answer-Acupressure-Pressure-Point-Questions.

Yes, acupuncture can be a good treatment choice for IBS. I've seen studies showing acupuncture outperforming prescription medication for both IBS-C and IBS-D.

This is one of those cases where you need to make sure you're seeing a provider who attended and graduated from an accredited school of Chinese medicine rather than someone who attended a weekend seminar and is offering 'acupuncture-like' services under the scope of some other licensure. Your provider should have an L.Ac. or R.Ac. credential from the state and a Dipl Ac or Dipl OM national board certification. To find someone like this in your area you can use the 'Find a Practitioner' lookup at NCCAOM.org.