HOW TO CHOOSE THE RIGHT ACUPUNCTURE NEEDLE SIZE
The fundamental question: how to do acupuncture? needs a complicated answer, but in a pragmatic way one should always start with: using a needle. This is a straightforward statement which leads nowhere but rather opens a can of interrogations. Being the “king” of instruments in Chinese acupuncture, it is the object of many discussions. Each of the paragraphs below could be lengthened and detailed considerably. Let us say that a combination of history, technical evolution, practicality and adjustments, have made the basic instrument of Chinese and non-Chinese acupuncture more civilized and less feared by western patients.
How to hold the needle, how to insert it, how deep, at what angle, and mostly, should it be manipulated to induce a bigger stimulation? Arguments are still flowing because it used to be a theoretical stronghold of traditional acupuncturists. Moreover the variety of movements of the needle that one can produce is too impressive to be realistic. What they show is most of the time not what they do. This is one of the biggest problems one encounters when teaching acupuncture (much less in herbal medicine): there are many ritual topics that must be covered in order to enhance the value of the practitioners gesture or give apparently more meaning to his diagnosis or treatment decisions.
The needles we use these days are packed in sterilized blisters and are disposable, which means that they should be thrown away after one use. They bear the acronym ISO or CE showing that they have been approved by international or European official agencies. However in some parts of the world, for financial reasons, needles are still reused after having been properly sterilized.
Where can you find needles? In congresses, seminars, big classes of acupuncture. You can also surf on the web and find the names and addresses of many companies who sell them and will send them to you through the post. The needles that are used at the present time are quite thin. The gauge seldom exceeds 0.32mm; the thinnest can have a diameter of only 0.16mm. There are even needles that are short and as thin as a hair, with a gauge of 0.10mm, sometimes coated in gold (you can imagine the thickness of that coating!) used for facial or cosmetic acupuncture.
The shaft is always made of stainless steel and often covered with a layer of silicone so that they slide without difficulty when inserted in the skin and flesh. The hardness, solidity and flexibility of the shaft or body of the needle must be balanced, so as not to break and not to bend too easily. But it is on the tip that the manufacturers have concentrated all their efforts: depending on its shape and sharpness it must glide into the skin effortlessly, and inflict as little pain as possible, if none at all. So there are many kinds of needles, and the manufacturers come from China, Japan, Korea, Germany, and I suppose other countries (I do not pretend to be an encyclopedia).
One can speculate as to the nature of the material used in the beginning for making an acupuncture needle. Bamboo, jade, bronze, copper, gold, silver, other kinds of metals. Already in the Neijing the emperor Huangdi (the Yellow Emperor) declared that he wants the stone needles to be replaced by metal ones. During the seventies there was in some circles the belief that the metal in itself had a specific role to play in the action of the needles. This idea came from the acupuncturist who introduced the technique in a practical way in Europe, Georges Soulie de Morant. This self-taught sinologist, diplomat, prolific writer, published a little book called: “Precis de la Vraie Acupuncture Chinoise”. It came out for the first time in 1934. He had decided that gold and silver needles where the best for strengthening or dispersing, needles made of nickel having a balancing and neutral effect. A few researchers experimented later with all kinds of materials, from zinc to platinum, from manganese to cobalt, from copper to cadmium or molybdenum. The results were not convincing.
Before the use of stainless steel, for centuries simple steel was the favorite metal for manufacturing needles. But iron and copper, bronze, tin, all these metals or alloys had the inconvenience of deteriorating when in contact with oxygen. Only since 1913, when stainless steel, a mixture of iron, chrome and nickel, was invented, were most acupuncture needles made of that very practical combination.
The acupuncture manuals, since the very beginning, describe “the Nine Needles of Acupuncture”. Actually they reflect more the kit of a medical practitioner as some of the needles are obviously used as lancets or as bleeding or massage instruments. Modern replicas of these kits have been manufactured, I hope for decoration purposes, as the length and diameter of even the thinnest of the needles are impressive. In the first book on acupuncture of which we have a copy (printed nearly one thousand years after the original), called the Neijing, the Classic of the Interior, when the authors recommend needling a point, they usually mention only one or two of them, no more. The reason lies probably in the fact that the needles made in those days were certainly much thicker, and the point not so sharp, making the insertion quite painful.
When Chinese archeologists unearth a needle, or several of them, or simply a fairly thin and pointed instrument in a site they are prospecting, they often declare that they have found an acupuncture instrument, usually because they were put together with other medical instruments or medicines. The sites often go back to the Neolithic period, making the assumption rather dubious because it is unlikely that acupuncture existed already as a coherent and sophisticated technique.
Often the question comes up as to what is acupuncture. All civilizations have been using pointed and sharpened instruments for rudimentary medical purposes like piercing an abscess. But only in China, and much later than Neolithic times, have needles been associated with a complex technique supposed to manage the flows of energy in the body. So many questions rise around the main instrument of Chinese acupuncture: material, sizes, numbers, qualities, manufacturing, hygiene, techniques of insertion, intrinsic properties, adaptation to times and countries. If one searches for all the texts where the topic is mentioned in a not too repetitive way it would be possible to write hundreds of pages, and I feel frustrated not to be able to give here everything I know, including anecdotes and stories, of which I have many. On the other hand many claims and statements are questionable. It is necessary to keep our feet on the ground and be as pragmatic as possible.
Acupuncture, a procedure that invites healing through stimulation of anatomical locations on or in the skin, evolved out of Chinese medicine over 2500 years ago. There are a variety of approaches to diagnosis and treatment in American acupuncture that incorporates medical traditions from China, Japan, Korea, and other countries. The most studied mechanism of stimulation of acupuncture points employs penetration of the skin by thin needles, which are manipulated manually or by electrical stimulation.
It is believed that the earliest acupuncture needles were sharp pieces of bone or flint called bian stones. Early acupuncture needles were made from iron, copper, bronze, and even silver or gold. During the Iron and Bronze Ages, metal acupuncture needles began to surface. However, it is not unusual for contemporary acupuncturists to employ gold acupuncture needles to treat certain ailments.
The needles employed by acupuncturists today are stainless steel, solid (unlike standard needles used for drawing blood which are hollow) and vary in size or width gauge. Acupuncture needles consist of a stainless steel shaft and a handle made out of copper or steel. There are nine types of needles used in acupuncture; however, only six are commonly used.
Needles are inserted at points from 15 to 90 degrees in relation to the skin’s surface. Once the needle has been inserted there are a variety of techniques that aid in the stimulation and sensation. The technique used by the acupuncturist will depend on the ailment that is being treated. Acupuncture is essentially pain-less, some people may experience a slight pinch as the needle is inserted. Once inserted, the needles remain in place for approximately 20-30 minutes.
On March 29, 1996, the Food and Drug Administration bestowed the Class 2 status of “medical tools” to acupuncture needles. Acupuncture needles were previously listed under Class 3, or “experimental devices.” The change of classification means that needles used for acupuncture will be subject to FDA approval to ensure quality control and “single use only” labeling. Most significant, the ruling could make acupuncture treatments eligible for coverage under insurance policies which exclude alternative medicine.
The FDA ruling indicates that acupuncture is a safe and effective medical treatment. Because modern acupuncture needles are disposable and used only once, there is no risk of transmitting infections from one person to another.
Acupuncture Needles – Frequently Asked Questions
Are Acupuncture Needles Reused?
In my practice I use only individual packaged sterile stainless steel needles. These are single use needles made from stainless steel that are disposed of immediately after use. In the state of California, reusable needles are illegal. In my opinion there is no reason to use reusable needles. Single use needles are fairly inexpensive and eliminates the risk of cross contamination.
How Thick Are The Needles?
The needles are very thin, not much thicker than hair. The most commonly used needles are between 38 and 32 gauge. They are not like the needles used for injections which are hollow for the transmission of medicine or the withdrawal of body fluids. Most people associate needles with getting an injection or having blood drawn which is generally painful. Most patients are usually pleasantly surprised that the insertion of the fine acupuncture needles are virtually painless.
How Deep Are The Needles Inserted Into The Body?
The needles are generally inserted very shallow. The depth is going to vary depending on the part of the body that is being treated. The average point is inserted to the depth of 1/4 to 1/2 inch. This is going to vary according to different styles of acupuncture. The more fleshy regions of the body, like the gluteus maximus may have an insertion depth of up to a couple of inches depending on the size of the patient.
Do The Needles Hurt?
The insertion of acupuncture needles is generally pain free. You may feel a slight discomfort upon insertion that will quickly dissipate. The level of sensitivity varies among patients, but the majority do not experience any significant discomfort.