Manual Acupuncture: What Practitioners Do in General Terms

This page describes manual acupuncture in general terms only. It is not a how-to, and acupuncture should only be performed by a trained, regulated practitioner.

What it is

In manual acupuncture a practitioner places fine needles in the skin and may move or stimulate them by hand. [1] A UK hospital trust describes it as stimulating nerves in skin and muscle; no drugs are injected through the needles. [2] Needles may be placed near the sore area or away from it, for example in the hands and feet. [2] Why particular locations are chosen is explained, traditionally, through points and channels: see Acupuncture Points Explained and Meridians and Channels. Those are traditional frameworks, not established anatomy; see Do Acupuncture Points Exist?.

What a session generally involves

The practitioner asks about your health, medicines and any pregnancy, then examines the area. [2] Needles are usually left in for a period ranging from a few seconds up to 20 minutes, and a visit can take half an hour to an hour. [2] For preparation, see First Appointment and What to Expect and Session Length and Needle Retention.

Sensations and "deqi"

The same trust notes some slight discomfort is possible, and a warm, heavy feeling near the needle is often described as pleasant. [2] Traditional teaching calls a needling sensation "deqi", which one review describes as the excitation of qi inside meridians. [3] Reported sensations include numbness, soreness, distention, heaviness, dull pain and sharp pain. [3] Whether deqi predicts a better outcome is unsettled: one Chinese-language review states the relationship between deqi and effect has not been elucidated. [4]

One 2022 trial of 218 people with chronic tension-type headache compared 20 sessions of acupuncture aimed at deqi with a "superficial" sham that avoided it. The deqi group had a larger fall in monthly headache days at 16 weeks, and four mild adverse events were reported. [5] Because the two arms differed in more than deqi alone, a single trial cannot show deqi is the active ingredient. Evidence label for deqi mattering: insufficient evidence. More on what sensations feel like.

What research shows, and the limits

NCCIH reports that in back or neck pain reviews the difference between acupuncture and no treatment was bigger than the difference between acupuncture and sham. [1] NCCIH also lists nonspecific (placebo) effects among possible ways acupuncture works. [1] Sham and non-blinded designs have limits: a sham comparison can show whether needling adds something beyond expectation and attention, but only as well as the sham was built. Read Sham Acupuncture and Placebo Controls and the specific condition pages, such as chronic pain.

Qualifications

Most US states license acupuncturists, but requirements vary by state. [1] Rules elsewhere differ; see Licensing and Training and How to Choose an Acupuncturist. Never self-needle or use home kits.