The first thing to say is that acupuncture needles these days are very, very fine (you wouldn’t want to be looking for one in a haystack). They are also very sharp, which sounds like a bad thing, but is a good thing, since it means they pass through the surface of the skin very smoothly, so the sort of pain you would expect if, for instance, you pricked your finger with a sewing needle, which is thicker and relatively blunt, is not felt at all. So when people say that you don’t feel anything they are right in that there is no pain on insertion by a well-trained acupuncturist; when the needle goes in, you will probably just feel a faint tap.
But for most acupuncturists, there is more to acupuncture than simply inserting the needle. Subsequent to the insertion, there may come what the Chinese call ‘deqi’, which means something like ‘the arrival of the qi’. This may be sensed by the acupuncturist and/or felt by the patient. In the latter case, it will be an unusual sensation, which may be a dull or achy feeling around the needle, or a tingling feeling, or a heavy kind of feeling. Sometimes this feeling may seem to travel away from the needle, up the leg or arm for instance.
Not all acupuncturists are concerned with feeling this deqi; there are different styles and traditions of acupuncture, some of which stress the importance of deqi, and some which do not. If you have acupuncture in China, for instance, you are likely to have a treatment in which you feel deqi quite strongly. If on the other hand you have a treatment in Japan, you may not feel much. In the UK there are a range of different styles, some of whom value deqi more than others. For my part, I consider deqi important for most patients. In part I’m swayed by the western scientific research into how acupuncture works which seems to imply that deqi is important and corresponds to the needle stimulating certain kinds of nerve endings in the skin and/or muscle.
But what makes the difference between whether the patient feels deqi or not? The first thing I do with my patients is to begin to explain to them what deqi feels like so that they can begin to recognise it and tell me whether they are feeling it or not (although sometimes I can tell without them saying anything.) Beyond that it varies a lot from patient to patient. Some people experience deqi almost immediately after the needle in inserted without me having to do anything apart from insert it. Some people (for example perhaps, people taking painkiller medications) don’t experience deqi very easily at all. Often people feel deqi more fully on one side of the body than on the other side, for instance it may be stronger in the left leg and arm than in the right, or vice versa. Also they may feel it differently at different times – for instance in my experience women tend to feel deqi a little more in the days running up to their period. If the deqi does not come, I will usually gently manipulate the needle a little, maybe twirling it and lifting it slightly, until it does.
It also depends on where the needle is. If it is in your hand or foot (where there are a number of important acupuncture points) the chances are that deqi will come quickly. If it is in your abdomen, deqi may only come after a little while, and will probably be quite faint. In general the sensations associated with acupuncture are more pronounced towards the extremities than on the trunk.
In my opinion, the intensity of the deqi is partly equivalent to what you might call the dose of acupuncture. So for some patients, who as it were need only a low dose, it will be sufficient to generate just a mild feeling of heaviness or tingling. This is the case, for instance, with people who are quite sensitive, the sort of people who easily develop side effects to pharmaceutical drugs, people who may be inclined to be a bit highly strung or anxious. With such people, a subtle treatment involving just a few needles and mild deqi may well be all that is required to effect the changes needed to restore health. Such people often respond very well to acupuncture.
Other people may need a stronger treatment with stronger deqi. It also of course depends on the problem they come for treatment with. If I am treating a sports injury, a knee ligament sprain for instance, I would probably want to elicit strong deqi in the acupuncture points in the vicinity of the ligament in question, so as to improve the blood flow to the damaged tissue and promote more rapid healing – but of course it depends on who is the owner of the knee! Part of the skill of acupuncture is knowing what is right for each individual patient, tailoring the treatment for their particular kind of energy.