Work in Progress: Safety/Risk Continuum for Acupuncture Styles

One of the distinctive features of POCA Tech is that our school recognizes that there are many different ways to practice acupuncture, but no one right way. As part of encouraging a neutral, analytical, non judgmental, safety-positive relationship to risk, it seems like it’s worth describing a safety/risk continuum for acupuncture styles. There’s no one right way to practice acupuncture AND certain styles are clearly less risky than others.

This post will be revised (and maybe eventually turned into a diagram?) Please send comments or suggestions if you have them.

This continuum assumes all needles are sterile and single-use and that the patient’s skin is clean and intact. It takes into account, but isn’t limited to, the list of needle adverse events from the CNT Manual: bruising/bleeding, needle site pain/sensation, fainting, stuck needle, failure to remove needles, aggravation of symptoms, pneumothorax, injury to other organs, traumatic tissue injury (peripheral nerves or blood vessels), infection, and broken needle.

So without further ado, from least risky to most risky:

Non-insertion techniques (the needle doesn’t break the skin), utilized by styles such as Toyohari Acupuncture. POCA Tech doesn’t teach this approach but it’s obviously as valid as any other.

Auricular (ear) acupuncture.
The National Acupuncture Detox Association (NADA) has an excellent safety record.

Distal acupuncture with thin needles and gentle (if any)needle stimulation.
This is the main style taught at POCA Tech and practiced in many community acupuncture clinics. It emphasizes the treatment of toxic stress, which means prioritizing patients’ ability to relax deeply and even fall asleep.

Distal acupuncture with thicker needles and more needle stimulation.

Local acupuncture with thin needles and gentle (if any) needle stimulation.
Sometimes the results are dramatic and justify the risk.

Local acupuncture with thicker needles and more needle stimulation.
Dry needling would fall into this category. POCA Tech doesn’t teach this approach either.

And on the far end of the risk continuum...

Deep needling in the vicinity of organs.
For me, this end of the risk spectrum will be forever represented not by reckless physical therapists, but by my much-loved acupuncture teacher Yoshi who taught at a respected acupuncture school in the early 1990s. His tenure there ended because Yoshi’s approach to acupuncture included needling organs on purpose. He believed that beneficial results could be obtained by using an extremely thin, extremely long Japanese needle to “tickle” the surface of organs, particularly the lungs. When the school administration found out, they demanded that he publicly recant and apologize, and he ultimately left the school because of it.

I remember one class where I sat behind a student who told me that he’d needled her heart. It felt amazing, she said, glowing.

I’ve never needled anyone’s organs, intentionally or otherwise, but some of Yoshi’s other students did. I never heard of any negative consequences (possibly due to the extreme thinness of the needles?) which is a good reminder of the nature of risk. And I don’t know what Yoshi’s general attitude toward risk was; I was too young and too wrecked at that time to even grasp the concept, let alone ask him. When I saw him many years later, he wasn’t into that technique anymore; he’d moved on to o-ring diagnosis.

It makes me think of the book In the Footsteps of the Yellow Emperor, which suggests that J.R. Worsley might have been influenced in the development of Five Element or Traditional Acupuncture by a Japanese acupuncturist who adopted the practice of using very few needles, and emphasizing counseling rather than needling, as a result of experiencing an acupuncture adverse event. It seems like that couldn’t have been a minor adverse event, right? Intentionally needling organs isn’t something most people associate with Japanese acupuncture, but Yoshi’s practice suggests that at least occasionally it was a thing. I wonder if J.R. Worsley’s teacher had a bad experience with it or something like it and swung to the opposite extreme as a result. We’ll never know.

But getting back to our continuum:

In general, the more needles you use and the deeper you insert them, the more risk of needle safety issues you’ll have; it’s just math. Similarly, the more needle stimulation you do (dipping, twirling, thrusting) the more risk of tissue damage you’ll have.

Some safety considerations are specific to the style of acupuncture, but most safety considerations for acupuncturists are global (see the rest of this blog). Making safety is something a practitioner needs to do no matter what style of acupuncture they practice.

It isn’t possible to practice acupuncture without risk. Even with non-insertion techniques, you have to prepare for the possibility of aggravation of symptoms. If you define your practice as energetic medicine, then you should expect energetic adverse events. IMHO, the more you think of your practice as energetic medicine, the more open you need to be to patients telling you about perceived adverse events.

One helpful development that has emerged from COVID is neutral, detailed ways to think about risk, as demonstrated by the concept of “COVID risk budgets”. Here’s an excellent article about an extremely nerdy -- and collective -- approach to that topic.

I think the concept of risk budgeting is useful to apply to acupuncture safety. There are many factors that go into an acupuncturist’s decision about what style of acupuncture to use, and it’s okay to make those decisions by factoring in your personal “risk budget”.

Stay tuned for future posts on the safety/risk continuum of social safety and talking/counseling/lifestyle advice.