by Eric Brand

Last week, I had the opportunity to translate a class on acupuncture for Dr. Shi Xue-Min. Dr. Shi is the head of the Tianjin TCM Hospital, one of China’s most advanced clinical and research institutions. In fact, the acupuncture department at Dr. Shi’s hospital is the largest in the world, and they are building a new 22-story acupuncture facility across the street. I’ve blogged in the past about Shi Xue-Min after visiting his hospital in Tianjin, and it was great to get the chance to study with him in more detail (in beautiful Northern California, no less).

Shi Xue-Min is arguably the most famous acupuncturist in China. Five Branches in San Jose recently brought him out to teach at their doctoral program, and I was happy to have the opportunity to translate his class. Given that Dr. Shi is in his seventies and is an extremely important and busy hospital head, it is nearly impossible to sit next to him for 24 hours of lecture, regardless of whether one is in Tianjin or California.

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Mind you, the translation itself was brutal; between eight hour shifts spent navigating his thick Tianjin accent, the technical vocab of neurology, and his tendency to talk directly to the Chinese students for long periods without waiting for translation, it was one of the toughest translation jobs that I’ve ever had to do. But the content was awesome and it was a great opportunity to get the chance to see him in action. I really respect Five Branches for their decision to bring a world-class expert like Shi Xue-Min out to California; top teachers like this really make their program stand out.

At any rate, Shi Xue-Min is the chief editor of many important acupuncture texts in China, including the “gold standard” yellow hardbound Acupuncture Treatment (Zhen Jiu Zhi Liao) textbook that is found in any good Chinese TCM library. One thing that stands out when reading Chinese acupuncture textbooks (in comparison with English ones) is the emphasis on needling sensation and stimulation methods. Many English textbooks say “needle point x” while Chinese texts say “needle point x with even supplementing and draining technique for 30 seconds of continuous stimulation, until the qi sensation propagates to the lower abdomen.” Similarly, Shi Xue-Min’s lecture placed a tremendous emphasis on HOW the points should be needled, which techniques were appropriate, how long the stimulation should be, etc.

One interesting point that he mentioned related to the intensity of needling technique. He mentioned that for a healthy person, the technique may be gentle, but for serious conditions the required technique can sometimes be quite strong. He compared the intensity of needling technique to the dosage of a pharmaceutical drug; serious cases need higher doses than mild cases. Conducting acupuncture research without attention to the intensity and type of needle stimulation would be akin to conducting a drug trial without attention to dosage.

Dr. Shi has been involved in research for decades, so he mentioned a lot of interesting material related to acupuncture research. In fact, Dr. Shi’s own creation of the Xing Nao Kai Qiao (Arousing the Brain and Opening the Orifices) acupuncture method for treating stroke has been the subject of intense research in China. Over 10,000 patients have been treated with this method in clinical trials, and Dr. Shi’s technique is now a standard piece of the curriculum at schools across China.

One interesting research tidbit related to the duration of acupuncture response. Like intensity and needle technique, attention to the issues of treatment frequency and the duration of effects are often poorly controlled in Western clinical trials of acupuncture. To illustrate his point, Dr. Shi brought up some comparative research that they had performed using acupuncture vs. anti-hypertensive pharmaceutical medications.

In this particular trial, they had inpatients with acute episodes of hypertension that were constantly monitored. Acupuncture was administered to one group and pharmaceuticals were given to the other group. Both groups had a significant drop in blood pressure, but acupuncture outperformed the drug in virtually every way. The onset of action was faster (5 min as opposed to 15 min), and after four hours and even six hours the acupuncture far surpassed the drug. Nonetheless, between 4-6 hours after administration, both treatments were clearly beginning to wear off. By six hours, the patients in both groups had nearly returned to their baseline hypertension. The acupuncture group still had lower blood pressure than the drug group by hour six, but the effects were obviously wearing off for both methods.

From this study, we can come to a number of interesting conclusions related to timing and frequency. For example, the five minute onset shows that the effect of acupuncture on lowering blood pressure is not instantaneous, but rather takes a few minutes to begin setting in. Interestingly, the subjective effects of acupuncture (the “high,” if you will) also take a few minutes to start sinking in.

Most importantly, the six hour duration of the blood pressure reduction gives us an understanding of how long the effect lasts for this given condition, at least based on the treatment administered in the study. Both the pharmaceutical and the acupuncture lowered the blood pressure to a satisfactory degree. It is a given that the pharmaceutical drug would require the administration of a second dose six hours later. After all, the duration of action and dosages of pharmaceutical drugs are well-characterized; doctors even have a shorthand form of QD, QID, BID, TID, etc. to indicate how often a drug should be given over the course of a day (reflecting its duration of action). Dr. Shi was trying to make the point that we need to think about acupuncture in the same way, we need to learn how long it lasts for which types of conditions, so that we can determine the frequency of administration.

In this particular scenario, acupuncture would optimally be given every six hours, just like the drug (in which case it would be expected to outperform the drug). While we know from clinical experience that many patients get a good response from acupuncture even at relatively low treatment frequencies, we cannot ignore the fact that the Chinese standard of care often uses a higher intensity of stimulation and a higher frequency of treatment that we often provide in the West.

To a certain extent, this reflects differences in the cost of care; certainly both China and the U.S. have healthcare systems that are fraught with problems, but the relatively low cost of acupuncture care in China does make higher frequency treatment more accessible. Perhaps the new trend of low-cost “community acupuncture” in the West will help patients have cost-effective methods of using acupuncture at higher treatment frequencies, since the overwhelming evidence base in China assumes a higher frequency of treatment than we often give in the West. As has been noted before on this blog, the once-a-week treatment model that dominates in the West primarily reflects a decision based on convenience and finances rather than any medical precedence.

It was really an honor to translate for Dr. Shi, and I really enjoyed listening to his experiences. I’m following up this blog with another blog on Dr. Shi’s thoughts on needling technique, specifically with regard to needle rotation. Dr. Shi is also mentioned in this blog on new acupuncture techniques in China.

Thanks for reading!