Jeff Rippey

Acupuncture may help relieve your symptoms of depression and it might also help to reduce any side-effects you may be experiencing from your medications.

As for how it works, well, to be honest that's anyone's guess at the moment. In fact, if you read the mechanism of action section in the patient information leaflets for the prescription medications you're taking, you'll see statements to similar effect; in other words - we don't really have a handle on exactly how drugs work in depression either.

As with the pharmaceuticals, we do have some ideas though. In comparison studies acupuncture appears to be regulating genes in the pituitary in a similar way to fluoxetine (Prozac). In fact, studies have shown that acupuncture usually at least matches the effectiveness of selective serotonin reuptake inhibitors (SSRIs like Paxil, Prozac and Zoloft) in mild to moderate depression.

I would absolutely recommend you try acupuncture for your depression. A good chunk of my practice are depression/anxiety patients and I'm usually able to help them out quite a bit. For best results, please make sure you're seeing an NCCAOM board certified and state licensed acupuncturist.

Infection due to acupuncture is extremely uncommon. Most acupuncturists utilize single use, factory sterilized needles. These needles are used one time on one patient and then discarded, so cross contamination is very rare.

If it's still a concern due to the cut on your palm, try to find someone who practices a distal form of acupuncture. These practitioners can treat your hand pain without putting needles in your hand. I know, to most folks it sounds weird, but this is the form of acupuncture that I practice and, particularly for pain, it's very effective.

Yes, acupuncture will probably help your knee pain. If you haven't already, you might also want to visit your primary care physician and have x-rays or an evaluation done. A lot depends on your personal history, but 28 is fairly young to be having knee problems.

Where the needles will go depends largely on the type of acupuncturist you see. Some will insert needles in or around the painful knee and others may treat the pain by putting needles elsewhere on the body - typically the opposite elbow.

I hate to be the one to say this but hemophilia is one of the few contraindications for acupuncture.

You still have a couple of options:

1. You could find someone who is well versed in auricular (ear) acupuncture and make sure they only use seeds or pellets - these do not break the skin, they merely apply pressure to a particular point.

2. You could also look for someone who has been trained in Korean hand acupuncture and uses the Korean press pellets - again, these do not break the skin they only apply pressure.

I've gotten very good results for several pain patients using only ear points or only Korean press pellets on hand points. The advantage to these systems for any patient is: the seeds/pellets can be left in place for up to several days and the patient can be trained to apply the seeds/pellets to themselves and then provided/sold a supply. This makes it easier for some to manage their pain and cuts down on overall visits which can help out financially.

In addition to acupuncture, you will want to avoid cupping, scraping (usually referred to as guasha) and the more intensive forms of massage. Any of these has the potential to cause bruising which, for you, could result in an uncontrolled subcutaneous bleed.

If this is something you decide to pursue, please make sure the practitioner knows up front about your condition. Most of us will ask about clotting disorders and blood thinners up front, but it's better to be safe than sorry.

So long as you're seeing a board certified and state licensed acupuncturist (in other words: someone who attended Chinese medical school and now practices acupuncture as part of Chinese medicine), yes, it's totally safe.

Anemia can have a couple different causes. Sometimes it's insufficient iron in the diet and sometimes it's insufficient B12. Vitamin B12 helps the digestive tract absorb iron in the first place. If your B12 levels are low, then you're not absorbing enough iron and you won't be able to produce sufficient hemoglobin/red blood cells. If your iron intake is low, again, you won't have enough raw material to product hemoglobin/red blood cells.

Anemia tends to fall in to a syndrome in Chinese medicine that we refer to as "blood deficiency". This is more of a catch all for a variety of blood issues including low blood volume. There are lots of acupuncture points which can address the problem, although exactly how some of these points function is still in question. Having a solid Chinese differential diagnosis as to why you're experiencing anemia (blood deficiency) is going to be critical to getting good results.

If you were my patient, I'd probably also use moxibustion. Moxibustion is the burning of powdered Artemisia vulgaris (Chinese wormwood) leaves - either directly on the skin (which we don't tend to do in the US), near the skin using a cigar-like roll of moxa (very common in the US) or on top of an inserted needle (also fairly common). Studies from Japan have shown that using moxibustion can increase the production of both red and white blood cells making it a useful addition to a treatment for anemia.

As I alluded to in my first paragraph, having sufficient raw material is key - no matter what other treatments you add. B12 comes mainly from meat, so if you're vegan/vegetarian you may need to consider supplementation. Iron has lots of different dietary sources - from leafy greens like spinach to meats like beef or buffalo.

Acupuncture can help and any good acupuncturist is probably also going to suggest some dietary changes. You'll see the best results if you can incorporate both.

For the best results, please make sure you're seeing an NCCAOM board certified and state licensed acupuncturist. Particularly if you're open to moxibustion, you need to make sure you're seeing someone who went to Chinese medical school and understands how to diagnose, choose a modality, use that modality and what the cautions and contra-indications might be.

A lot depends on the person being treated, what they're being treated for, what acupuncture points were used, whether other modalities were used during treatment and, if other modalities were used, what other modalities were used (cupping, massage, scraping, bleeding, etc.).

I'm a less is more type of practitioner: I use few needles with long retention times and not much else unless the patient's condition is fairly severe. I rarely get people who complain of fatigue post treatment, but it does happen. Usually when it occurs it's related to one of two things:

1. I missed something during my evaluation and choose points poorly. At that point, a patient who reports fatigue after a session is giving me extra diagnostic information that I can use to adjust my next treatment such that fatigue does not occur. In other words: assuming the provider is asking for feedback and the patient is providing information regarding previous sessions, this is an easy fix.

2. The patient came to the session fairly run down. This is also an easy fix: make sure you have a light snack either just before or just after your session.

A final note on this subject: most studies of acupuncture fairly consistently show that it stimulates the parasympathetic nervous system. This is the "rest and digest" side of the autonomic nervous system and acts in opposition to the "fight or flight" sympathetic system (with which you may be more familiar). For so-called "type A" personalities who always feel like they need to be on the go (and hence are mostly in the "fight or flight" mode), increasing the activation of the "rest and digest" system can feel like they've walked off a cliff compared to their usual higher energy state. In the long run, continuous activation of the "fight or flight" system is a recipe for disaster - it can lead to adrenal fatigue and heightened stress states have been linked to a laundry list of chronic disease.

All that is a complicated way of saying a little fatigue may be just what you need after an acupuncture session. If it happens to you, try to schedule your next session at the end of the day so you can go home and rest.

I've treated people taking blood thinners before and I know other practitioners of Chinese medicine that treat folks who are taking blood thinners. To be honest, a lot depends on what blood thinner(s) you're on and at what dose.

The risk is an uncontrolled or extended bleed as a result of a poorly placed needle. Acupuncture needles are extremely fine and, generally speaking, the goal of insertion is to avoid internal structure. What we call 'acupuncture points' in the western world are actually small cavities or spaces between fascial layers. Usually there isn't much structure to speak of in these spots and a good acupuncturist isn't going to be hitting blood vessels.

That being said, there are probably not many practitioners of Chinese medicine who are familiar with all the ins and outs of the various blood thinners on the market and how the dosing and possible combination of these drugs are going to affect any given patients' clotting ability.

In this case, as much as I hate to say it, I'd err on the side of your doctor and suggest you should try something non-invasive like TaiJi, QiGong, yoga, meditation or mild exercise to manage your work stress.

It's a good question, the problem is it's very difficult to answer. I have a 250'ish page book which attempts to define 'qi' in western terms. Some concepts simply do not translate well from Chinese and this is one of them.

Let's step back for a minute and provide a little understanding of the landscape. Just like with the English language where we have old English, middle English and modern English, in Chinese we have old Chinese, middle Chinese and modern Chinese. Also similar to the English situation, no one outside of certain scholars reads or speaks ancient Chinese.

This is compounded by the fact that written Chinese is not phonetic. In English, each letter represents a sound, the sounds together are a word and the word stands for an idea. In China, they cut out the middle man. Each symbol represents an idea - more similar to a hieroglyph - and that symbol has a pronunciation.

The character we render in English as 'qi' is an ancient symbol that has changed over the years. There's no guarantee the idea it conjures to a modern reader is the same as the idea the ancients had when they coined the term. Also, it's a term that is used in lots of different places - its use is not solely limited to Chinese medicine. Lastly, it's a culturally loaded term - the Chinese know exactly what they mean when they use it and they don't really have to explain things to another Chinese reader/listener. Most western practitioners of Chinese medicine don't understand the culture and don't speak or understand the language (NOTE: this does not mean they cannot be effective practitioners, it just means they have a very difficult time explaining what they're doing).

The ancient Chinese tended to describe natural processes in terms of metaphor - as being 'like' or 'similar' to some other thing they understood better. It's a technique many ancient peoples employed, in fact we still use many of those definitions today in conventional medicine. The word 'pelvis' comes from the latin for 'washbasin' - a reference, no doubt, to the general shape of the bone. The word 'acetabulum' (the hip socket where the thigh bone 'plugs in') also comes from latin and means 'small cup of vinegar'. Did the ancient Romans literally mean washbasin and cup of vinegar when referring to these structures? Probably not, it's a descriptive metaphor and the Chinese did the same thing - it's just that Chinese doesn't form part of the root for modern western languages and hence the concepts seem strange.

Which is a long and winding way back around to 'qi' and what does it mean? In my opinion, there are two good analogies for qi: function or information.

Organs in the body have a function and when that function is compromised in some way the Chinese modeled things in terms of excess and deficiency. We could have function excess giving rise to pathology - as in the case of hyperthyroidism. The thyroid is producing too much thyroid hormone which causes systemic problems. We can also have function deficiency giving rise to pathology - as in the case of hypothyroidism. In this case the thyroid is not producing enough thyroid hormone which causes a different set of systemic problems.

Information is a useful analogy because in order to function properly, each tissue needs to know where it is, what it is and what it's supposed to be doing. If this information becomes scrambled, then the tissues cannot perform their function properly and, again, we see pathology.

The important thing here is not the language, it's the result. If your practitioner is able to achieve good outcomes for your health issues, then I wouldn't be too concerned about the fact that they don't have a solid handle on Chinese linguistics.

Chinese medicine focuses on individualized treatments as opposed to conventional medicine where every condition has a protocol or short list of protocols for treatment. The points used by your practitioner will be related to two things:

1. The root cause for your issue - in this case fertility. There are a few reasons in Chinese medicine why you might experience difficulty conceiving and they'll have different treatments.

2. The kind of practitioner you're seeing. Generally speaking there are two different kinds of practitioners - those who use local needles and those who use distal needles. For a practitioner who uses local needles, you can expect to receive a few needles on the low abdomen (roughly in the area of the uterus). For practitioners who focus more on distal treatments, you can expect needles mostly in the arms and legs.

Other than these rough guidelines, it's hard to say where your provider might choose to place needles.

Acupuncture can probably help with your issue and it's certainly worth a shot if you don't like the medication side-effects.

Acupuncture stimulates the parasympathetic side of the autonomic nervous system. By way of a brief explanation: the autonomic nervous system is essentially in charge of those functions over which we do not typically exert conscious control. It has two divisions: the sympathetic nervous system and the parasympathetic nervous system. These divisions can be thought of, more or less, as acting in opposition.

The sympathetic system is also known as the "fight or flight" side. It functions to increase heart rate, breathing rate and it shifts blood flow away from internal organs to prepare us to either fight or run for our lives.

The parasympathetic side is also known as the "rest and digest" side. It functions to decrease heart and breathing rate and it shifts blood flow to internal organs in order to help us digest food and assimilate nutrients.

Modern life has a tendency to place us in unending "fight or flight" mode. Our jobs, daily commute and so on do not leave us much downtime. Society tells us we have to be go-go-going all the time which doesn't allow the parasympathetic to kick in. This creates a problem because the "fight or flight" side of the system is only meant to be engaged temporarily, not all the time. Our bodies are adapted to be spending most of their time in the "rest and digest" mode.

And this is where acupuncture comes in. The needles strongly promote the parasympathetic ("rest and digest") system. This shifts blood flow towards the internal organs promoting digestion as well as the digestive muscle contractions which move food and waste through the system and out.

A good practitioner of Chinese medicine will discuss both diet and lifestyle with you during your initial intake. It's highly likely they'll also suggest diet and lifestyle changes to help with your issue. You'll get the best results from treatment if you can incorporate some of these changes.

For the best results, please make sure you're seeing an NCCAOM board certified acupuncturist. To find someone local, go to NCCAOM.org and click their "Find a Practitioner" link.

Yes, it's possible acupuncture increased your friend's blood pressure. Acupuncture has been shown to have homeostatic effects - in other words: if your friend's blood pressure was low, for whatever reason, acupuncture may have had the side-effect of bringing the pressure up.

It's difficult to say much more than this because I don't know what your friend was being treated for, what the practitioner's assessment was, what acupuncture points were used or whether or not your friend saw a board certified acupuncturist.

The last point is particularly important. Whether we believe it or not and whether we like it or not, acupuncture has systemic effects. Providers who are not fully trained in the system have no way to predict whether or not those effects might occur and, if they do, how to mitigate them. Unfortunately, at the moment, there are a lot of providers out there who are trying to cash in on acupuncture - they take a weekend seminar and then offer services. This isn't nearly enough training, especially when compared to the thousands of hours a board certified acupuncturist typically has.

All that being said, I have two suggestions for your friend:

1. Make sure they're seeing an NCCAOM board certified acupuncturist.

2. Talk to their provider about what happened after the acupuncture session. Sometimes these events can be diagnostic and might provide that last clue the provider needs to be able to adjust the points used and get better results.

Sometimes, yes, a patient will feel a little lethargy or low energy after an acupuncture session. For folks that report this issue I usually recommend having a small snack either right before or just after treatment.

If having a little food around treatment time doesn't clear the issue up, have a conversation with your provider about what you're experiencing. Acupuncture treatment is often also diagnostic. It's important to provide feedback on your experience so your provider can make any adjustments that might be necessary.

This is one of the few cases where I can be relatively definite: yes, acupuncture would be a much better choice for managing your post-op pain. I'm surprised your surgeon/physician didn't recommend it.

For the best results, please make sure you see an NCCAOM board certified acupuncturist. To find one close to you, go to NCCAOM.org and click their "Find a Practitioner" link.

For pain and chronic pain patients, the interval between treatments is partly dependent on the level of pain the patient is experiencing. If we use the standard 0 to 10 pain score - where 0 is no pain and 10 is the worst possible pain a patient can imagine - my general rule of thumb is: I see patients who score 5 or less once a week until the pain is either resolved or consistently around 1-2, then we talk about maintenance.

For patient scoring between 5 and 7 or so, I like to get them in twice a week for two to three weeks. This lets us get the pain knocked down to below 5 and then we can back off to weekly until we're at a place where, again, we can start thinking about maintenance intervals.

For pain levels over 7, I try to get patients to come in three days in a row for two to three weeks. After this we evaluate the overall pain levels and decide if we can go to two days a week for a week or two or if the patient is ready to go to weekly treatments.

Studies of acupuncture in chronic pain almost always show a dose dependency. This means, to a point, more acupuncture sessions provide superior results. Of course, we have to balance this against the individual patient's financial situation/tolerances. But, in general, if your pain is severe, once a month probably isn't going to get you where you want to be.

You may be able to return to a once a month schedule after an intensive set of sessions brings your pain under control. This is the other big advantage to acupuncture: it's a front loaded process, but saves money in the long run - once we get things under control and start spreading treatments out to find the optimal maintenance interval for a given individual.

For the best results, you need to make sure you're seeing an NCCAOM board certified acupuncturist. To find one near you, go to NCCAOM.org and click their "Find a Practitioner" link. If your pain is fairly severe, probably best if you can find someone who specializes in pain management

Yes, acupuncture works very well for spasm/cramping/restlessness. What, exactly, acupuncture is doing for these conditions is still somewhat an open question.

We know acupuncture regulates a set of neurotransmitters at the level of the brain and spinal cord. We know that acupuncture is affecting brain structure and how sensory signals are processed in the brain. Acupuncture can also be used to release tight muscle through the use of trigger points. Any or all of these could be playing a role in symptom relief.

For the best results, please make sure you see an NCCAOM board certified acupuncturist. To find someone in your area, go to the "Find a Practitioner" link at NCCAOM.org.

Yes, it could be a reaction to the treatment itself. A person can, technically, be allergic to anything. If there was something on your skin, something on the needle or you're allergic to the stainless steel most needles are made of, then you could easily experience a reaction.

It's difficult to provide a course of action for you for a couple of reasons:

1. I don't know what you were being treated for, what points were used or what brand needle your provider was utilizing.

2. If it was an allergic reaction, it may escalate to a more serious condition called anaphylaxis with repeated exposure to the allergen. In other words: you want to pin down the cause of the reaction before you try another round of acupuncture.

To be 100% on the safe side, I'd suggest you find an allergist and have some allergy testing done. If you can, you're going to want to rule in/out steel or stainless steel - and I have no idea if this is even in the scope of most allergy testing. You also may want to try to rule in/rule out silicone (for reasons explained below).

Another important thing to note here is: Seirin brand needles, which many acupuncturists use, contain a small drop of medical grade silicone at the tip. If your provider is using Seirin needles, it's very possible that your reaction was to the silicone rather than the needle itself. If this is the case, then switching to another brand of needle should resolve the issue.

Whatever you decide, make sure you talk to your acupuncture provider about what happened.

Interesting question. Let's address a linguistic issue first. The Chinese character we render in English as 'acupuncture point' is "xue". This doesn't meant 'point' per se, it actually has more the sense of 'depression' or 'cavity'. So 'point' is something of a misnomer - even though I'm going to use 'point' myself in the explanation that follows; it has become somewhat of a standard in English speaking countries.

The second thing we need to address is the western idea of acupuncture as a monolithic system. There are actually multiple systems of acupuncture which have slightly different needling locations. Some of these recognized locations overlap and some locations are unique to a given system.

We also have so-called micro-systems, the most common being auricular acupuncture and Korean hand acupuncture. These systems map the entire body or parts of the body on to smaller areas like the ear or hand, and have an entire set of corresponding acupuncture points in these smaller spaces.

And finally we have so-called 'extra points'. These are locations with classically recognized function which often aren't located along any particular acupuncture channel.

All of the above makes it extremely difficult to pin down a concrete number of recognized needling locations. If we consider the classical channels (the channels most often taught in Chinese medical school) and the commonly accepted needle locations on those, we get roughly 362 points. Adding in the commonly taught 'extra points' gives roughly another 23 for a grand total of 385.

Lastly, the placement of needles does not 'fully depend' on recognized acupuncture points. There is a long tradition in Chinese medicine of 'ahshi' or 'ashi' points. These are locations on the body which do not necessarily correspond to a channel or a recognized needling location but which are sensitive to palpation (i.e. the location causes pain when pressed).

It would be very unusual for an acupuncturist in the US to re-use needles. The vast majority of us utilize single-use disposable needles; they're used one time on one patient and then thrown away in to an appropriate sharps container which is then treated as biomedical waste.

If you have any questions at all, talk with your provider before your treatment session. No provider should take a question like this personally - I've fielded this one before for my patients and it's part of my acupuncture informed consent form.

I'm a little unclear as to what you mean by 'achy feeling'. Did you have a generalized achy feeling in the body or was it more of an achy feeling around one or more of the needles?

If it was an achy feeling around one or more of the needles, yes, that's totally normal. Your acupuncturist should have given you some guidelines as to what normal and abnormal needle sensations might feel like so that you could gauge what was going on.

There are several sensations a patient might experience during acupuncture: a dull ache around the needle site, a distending feeling around the needle (like someone is blowing a balloon up under the skin), a short lived electrical sensation that propagates up or down the limb/body - these are all normal needle sensations.

After insertion, any needle that feels sharp or stabbing is not normal and should be addressed by the practitioner through repositioning or removal.

Now, if we're talking about a more generalized body ache after the needles were all in, that could be a different thing. Most of the time, we want the patients to have a mild sensation around one or more of the needles, but we also want you to be able to relax while you're resting with the needles in. A generalized body ache could be indicative of a few different things. Without seeing you and evaluating your presentation against the treatment provided it's difficult to speculate what might have happened.

My best suggestion would be for you to have a conversation with your provider and see what they think. It may be that they need to modify the points they're choosing and your feedback might give them the pieces of information they need to correct their diagnosis and make sure this doesn't happen again.