About the needles...
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Acupuncture needles are very different from needles used to give injections or to draw blood. Injection needles are larger guage, thicker, and because they are hollow to allow the fluid to flow through, they must punch out a hole in the skin. Acupuncture needles are much finer, and are solid, so they can pass easily through and into tissues. Only rarely do they cause bleeding or bruising.

Early acupuncture needles were not needles at all, but rounded and pointed stones used to give what we would now consider a vigorous acupressure massage. Later developments included bone and bamboo needles, then as metallurgy developed, iron, gold and silver needles. In the classic Yellow Emperor’s Canon of Internal Medicine (Huang Di Nei Jing Ling Shu), there are nine shapes of needles described, one of which is the one described here (Chinese hao zhen, Japanese goshin, “filiform needle”).

Most needles today are stainless steel, although I do use silver needles and gold-plated needles for certain conditions. All of them are disposable sterile single-use needles. The most common sizes I use are 40-guage (0.16mm or 6/1000" in diameter) and 38-guage (0.18mm or 7/1000" in diameter) and 25mm long (about 1"); although the full range I use spans 44-guage to 34-guage, 3mm to 4 inches long.

Sometimes I treat a point at the surface of the skin using a solid gold or silver tool (Chinese shi zhen, Japanese teishin, “blunt needle”). For treating prepubescent children, I use Japanese tools called shonishin (“children’s needle”), which are not inserted, but are used to massage and stimulate the meridians on the skin surface. Since these gold, silver, copper and stainless steel tools are not inserted into the body, they are cleaned and reused.

Depending on the symptoms and the general condition of the person receiving a treatment, I usually insert between 5 and 20 needles at a time. Because I usually use Japanese techniques, which are gentler and more subtle than Chinese or Korean, the slender needles must be inserted with a shinkan, or guide tube, a device invented by a blind Japanese acupuncturist in the 17th century. These days, many practitioners use guide tubes because it makes insertion more comfortable for the patient, but it is not necessary with the 32-guage needles commonly used in Chinese practice. Since I usually use the thinner 40-guage for the basic treatment, the shinkan helps keep the needles from bending.

The needles are inserted anywhere from 1/8 inch deep to 1 inch or more, depending on the location on the body, the nature of the point, the nature of the symptoms, and the technique being used. Needles used at points on the wrist or the sides of the feet are inserted very shallowly, as there is not much flesh, while pain deep in the buttocks may necessitate a longer needle inserted several inches.

Many times the insertion of the needle isn’t even noticed by the patient; sometimes a mosquito-bite pricking may be felt, but it passes very quickly as the needle goes through the skin layers. Once the needle has been inserted, I gently twirl, flick or peck the needle. Then the patient may feel sensations of warmth, coolness, density, heaviness, expansion, movement, numbness, mild tingling or cramping, or none of these; all are considered normal needle sensations. The needles are left in place for 10-20 minutes while the patient relaxes.

Most patients find acupuncture very calming and relaxing, and I’ve had more than one patient say, “I can’t believe I fell asleep with 15 needles in me!”