10 things to expect at your acupuncture appointment

High Resolution -7For most people, going to see a Chinese medicine (CM) practitioner is a new experience. Because of this there is often a degree of trepidation as the day of the appointment approaches. What will happen? What should you expect?

Before I attempt to answer some of the most common questions, a caveat. Each acupuncturist is different just as every patient is different. The interaction between practitioner and patient has a lot to do with the way the appointment proceeds and whether it turns out to be a mutually agreeable experience or not. However, there are some basic elements that really should be present in every case. Hopefully, my brief explanation of these will be helpful to you as you pursue Chinese medicine treatment.

Prior to the appointment

1. A pleasant experience in setting up your appointment and getting your questions answered.

You should be able to expect an effortless appointment set-up process, possibly the mailing of pre-appointment paperwork and related informational materials and a kind reception with plenty of willingness to answer questions. You may even be referred to a website for more information and for downloading paperwork – that’s a sign of someone who’s been doing their business homework!

You should also feel free to ask questions of your practitioner to help alleviate concerns or prepare the practitioner for any special needs you may have. This may be done by phone, email, or if you live in the neighborhood, by a quick stop by the office. Of course CM practitioners are busy people, like most of us, but the needs of the patient are always primary in our minds.

During the appointment

2. A lengthly interview process including questions that you may have never been asked before!

Although every practitioner has a slightly different interviewing process based on their training and personality, there are standard questions that most every practitioner will ask. She will begin with learning more about your chief complaint and possibly more detail about your health history. If you are on medication or under the supervision of other physicians, she will likely ask you questions about this. Then she may begin to ask you questions that may appear to be irrelevant to your chief complaint.

These questions may address your sleeping patterns, digestive and urinary function, level and location of pain in your body, emotional health and basic level of stress.  You may be asked about your thirst, hunger, typical daily diet, and seemingly strange questions like whether your body temperature tends to fluctuate or if you have any funny tastes in your mouth. Most practitioners will also ask about sexual function and, if you have or have had menses, about their quality.

Rest assured that these questions are not meant to make you feel uncomfortable! Many conditions that manifest in a non-digestive/urinary/menstrual way (such as skin conditions) may have a basis in your basic digestive function or other apparently unrelated system. Answering these questions honestly will increase the accuracy of diagnosis and help your practitioner to craft an excellent treatment. Believe me, it won’t be anything your practitioner hasn’t heard. She is used to it. 🙂

3. Diagnostic modalities you may not have heard of before including a very detailed taking of the pulse, looking at your tongue, and other palpation techniques including abdominal palpation.

The cornerstone of most Chinese medicine practitioners’ diagnosis is the pulse. This, combined with the other diagnostic modalities and the patient questioning, fine tunes the decision about what acupuncture points and Chinese herbal formulas to use. The process is simple. Generally, the pulse is taken while you are sitting, but some acupuncturists prefer the patient to lie on the treatment table for pulse taking. Pulses on both sides are felt, often for several minutes. Your practitioner is feeling for rate, rhythm, strength and other qualities – not just counting beats per minute. Just relax and follow the practitioner’s lead.

Another very important diagnostic technique is the observation of the tongue. In CM, the tongue is thought to be a “microcosm” of the entire body. This means that the entire body is reflected onto the tongue in such a way that observing the quality of the tongue in particular areas tells the practitioner something about the corresponding area of the body. They will look at the color of the tongue body, the quality and color of the “fur” on the tongue as well as the general shape and any deviations in form. It can be a little embarrassing to show your tongue to someone you don’t know – but it is important and the practitioner will appreciate your cooperation.

As a quick note – it is important not to scrape or brush your tongue on the day of your treatment. Additionally, eating highly colored foods or drinking highly colored drinks (like orange soft drinks or coffee) can impede diagnosis.

4. The treatment itself including a variety of modalities that will be best for your particular situation.

Treatment will consist of the use of needles or pressure (with hand or other implement) to access the Qi of the channels, usually at specific points along the body. It may also involve the use of moxibustion (the burning of a medicinal herb either directly on the body or indirectly from an inch or so away), cupping (glass cups placed on the skin with a negative pressure, producing suction) or other techniques specific to the practitioner’s training. Many practitioners combine various bodywork/massage methods into their treatments as well.

You may feel discomfort during the insertion of the needles – this is normal. The discomfort should not be severe, and should not feel like shooting pins and needles. Your practitioner will be very attuned to your experience, and if you ever want a needle removed, you need only ask. You should breathe gently through the treatment and follow your practitioner’s instructions as to any visualizations that will help the treatment efficacy.

5. A variety of reactions during treatment

People have a variety of reactions to acupuncture treatment. Particularly in the first treatment, or after a particularly stressful or otherwise difficult time in your life – the emotional reaction can be very intense. You may feel like crying, laughing hysterically or expressing yourself in another way. So long as you stay as still as possible (so as not to bend the needles – this can be uncomfortable) please feel free to let your emotions flow out of you. This is part of the treatment. You may also have strange or uncomfortable thoughts, see shapes/colors as if in a semi-dreaming state, or go into a true dreaming state by falling asleep!

All of these reactions are just fine and you shouldn’t stop them unless they cause you an unreasonable amount of discomfort. Your practitioner may help you through these reactions, but most often they will simply leave you to process what is coming up. If you feel that you need help – just ask your practitioner. He will be happy to help you.

6. Possible restimulation of the needles and eventual removal of the needles (if used).

Sometimes the practitioner will come back to restimulate the needle, producing more sensation and more Qi movement. They may use specialized techniques during this time to further encourage your body’s Qi to help in your healing process. The final removal of the needles is usually painless. A little bit of blood at the needle site is not unexpected, but you are equally likely to see none. There will usually be no mark from the needle, and if there is any mark at all, it should disappear within a few hours.

Rarely, there may be a little bruising at the site of a needle. Contact your practitioner if you have any concerns at all.

7. Discussion of the treatment, delivery of herbal formula or other recommended supplements.

After your treatment, the practitioner will probably discuss your future treatment options with you as well as providing you with any recommended supplements or herbal formulas. It is very important that you understand what your practitioner is explaining to you – if you have ANY questions at all, inform her immediately. This is particularly the case if you are being asked to use bulk/crude herbs, boiled at home and drunk over a period of time. There are many important things you should pay attention to, such as: how to boil the herbs (with how much water, in what kind of container), how to drink the herbs (when? what temperature? with food or without?) and how to store the herbs (at room temperature or in the refrigerator?).

Your supplements and herbal formula are an extremely important part of your treatment and they MUST NOT be neglected. IMG_3414If you find the herbs too distasteful, contact your practitioner and ask him about other possibilities. But remember, though the herbs may not always taste the best they are very powerful and will help you immensely in your healing journey.

8. Scheduling of follow-up, possible contact mid-stream if the appointment is far away.

If your practitioner does not talk to you about your treatment plan, solicit the information. Find out when you should come back and if there is anything you should do in the meantime. In some areas, “group acupuncture” may be available, which can be a helpful way to keep the treatment progressing between your more intensive appointments.

Your practitioner may also want to see you briefly if your next appointment is several weeks away in order to take your pulse and observe your tounge and possibly make modifications to your herbal formula.

After the treatment

9. Ongoing shifts and changes in your experience in the time after treatment

People sometimes report feeling a bit spacey after an acupuncture treatment, and for this reason you should give yourself time to relax before driving or jumping straight into work or other duties. The work of acupuncture and related treatment usually continues for several days after the treatment as your body realigns around this “new information.” If you are concerned about your reactions, feel absolutely free to contact your practitioner. In the unlikely situation that the reaction is unanticipated by your practitioner or causing you much distress your practitioner may ask you to come back to the office so she can rectify the situation.

This actually did happen to me once. I received a particularly intense treatment that was meant to “shake up” my body’s energy in the hopes that some long standing negative patterns would release. I was fully informed of the purpose of the treatment and its possible uncomfortable aftereffects. I consented, but found that the resulting emotional and physical sensations were too intense. I called my practitioner and she was more than happy to see me briefly – take my pulse and tongue readings – and retreat me. I felt much better afterwards and actually the original intent of the treatment did occur – freeing me to begin some very important work that has had lasting effects to this day.

10. Availability of your practitioner for questions whenever you have them.

As with the time before your treatment, you should feel free to contact your practitioner with any questions you have between appointments. We are here to help you! If you have questions about your herbal formula, your symptoms or general experience, or anything else related to your treatment – call or email and your practitioner should get back to you as soon as he can.

I hope this has helped you feel more at ease with coming in for your first Chinese medicine appointment. If you have further questions – please don’t hesitate to ask!

Written by Eric Grey