Acupuncture and the 50-Minute Hour

As a teacher of acupuncture and Chinese medicine on the post-graduate level, it is my impression that once-per-week acupuncture treatments are the norm among many North American practitioners. However, nowhere within the Chinese acupuncture literature (pre-modern or contemporary) have I read any suggestion that acupuncture should be given once per week. Similarly, I have never seen acupuncture being done once a week at any clinic I have ever visited in China. So where did this idea come from and what impact might it be having on acupuncture's efficacy in the West?

As one of the first generation of American acupuncturists in the 1970s, I believe the adoption of once-per-week treatments was part of a historical accident. Those of us in this first generation of non-Asian practitioners were, by and large, part of the New Age/counterculture/transpersonal psychology movement. Many of us were massage therapists, chiropractors, Rolfers, Feldenkries practitioners or practitioners of other styles of bodywork where once-per-week treatments were the norm. Many of us studied various kinds of Asian martial arts, such as tai ji quan, where once-per-week classes were the norm, and many of us were either practitioners or patients of various forms of psychotherapy, such as Gestalt and bioenergetics, where once-per-week sessions were also the norm.

When I first studied acupuncture with Eric Tao of Denver, the emphasis was on learning the channels and acupoints, their locations, indications, contraindications and needling methods. "Dr." Tao left it pretty much up to us to figure out how to actually practice acupuncture. Without giving it much thought, we assumed treatment should be given once per week, since that's how we scheduled any number of other activities in our lives. This assumption also was reinforced by the fact that most of our patients at the time could not or would not have afforded anything else in terms of time and money. Therefore, when my generation became the clinical teachers and preceptors at the many second-generation acupuncture schools that popped up in the 1980s, this is what we taught our students and how we scheduled these schools clinics.

Because I believe this method of scheduling patient treatments was an unconscious carry-over from massage, Rolfing and psychotherapy, I refer to it as the 50-minute hour of psychotherapy. For the past 30 years, many North American acupuncturists have been scheduling patients once per week without asking themselves where this practice came from and, more importantly, if this is the best practice for patients' health. One of the selling points we use in our promotion of acupuncture in North America is that this healing art is more than 2,000 years old. Therefore, it is time-tested in a way that few other therapies are, and we hold out to our patients the promise of the fruits of experience of these two millennia of unbroken clinical practice. However, for this promise to be realized, it seems only reasonable that we should practice the same way that 2,000 years of experience suggests gets the best results.

The first time I studied acupuncture in China was in 1982. I already had been practicing acupuncture professionally since 1978, routinely and unquestioningly scheduling my patients once per week. However, in China, the only thing I ever saw was treatment either scheduled once per day or once every other day. This was in every acupuncture clinic I visited, in every city and province I went. Never did any teacher suggest anything other than once-per-day or every-other-day treatment when it came to acupuncture-moxibustion. For internally administered Chinese herbal medicine, it was an entirely different story. There, patients were seen once per week. So the concept of seeing a patient once per week was not something unheard of. It was only something unheard of when it came to acupuncture and, as far as I know, this still is how acupuncture is taught and practiced in China today.

When I returned to the U.S. from China that first time, I completely reorganized my practice, treating the way I had been taught in China. I scheduled all new patients for acupuncture once every other day if they were chronically ill, and once per day if they were acutely ill. If the patient showed signs of improvement after two to three weeks of this schedule, I then recommended treatments only twice per week. After a few weeks of doing this, I then recommended treatment once per week. However, what I soon learned from experience was that once I went to treating once per week, I might as well have not continued with acupuncture at all. I generally saw no further improvement, and it became harder and harder for me to rationalize this approach in terms of the patient's time and money. Instead, I eventually came to rely on Chinese herbal medicines to continue and consolidate therapeutic effects after I no longer felt that twice-per-week acupuncture was necessary or beneficial. In other words, I eventually gave up administering acupuncture once per week - week after week.

My guess is that some, if not many, readers may be saying at this point that their patients simply cannot afford more than once-per-week treatment, and that probably is true if one is seeing only one patient at a time and charging $60 to $100 (or more) per treatment. However, in China, I never saw an acupuncturist who only treated a single patient at a time. All the acupuncturists I saw in all the clinics I visited were always treating three to four patients simultaneously.

When I returned to the U.S., what I found was that as long as I was treating three to four patients at a time, I could make a very comfortable living charging $60 to $100 for an initial take, but then charging only $60 to $90 per week for three treatments per week. (These adjusted numbers reflect what I would charge now as opposed to what I charged back in 1982.) It only took me five minutes to get a previously diagnosed patient onto the table from the time they came in, and they were on the table for 20 minutes per session. That meant that I was not spending an inordinate amount of time with each patient for each treatment.

Like such famous Chinese acupuncturists as Golden Needle Wang Le-ting, I realized that if I were going to treat the front of the body, I only treated the front and vice versa for the back. On those occasions when I really did want to treat points on both the front and back of the body, I passively retained the needles on the front and only used in-and-out (aka one needle) method on the points on the back. If I wanted to do cupping, moxibustion or some other time-intensive adjunctive modality, I usually had an assistant do this, as well as taking needles out at the end of treatments. These assistants were either paid (at $9 to $12 per hour) or student interns working for free. My point is that there are ways that one can make once-per-day or once-every-other-day treatment financially viable if one simply thinks outside the box and works from a can-do point of view. Further, if you get better clinical results with this approach to treatment scheduling, as was definitely my experience, this will increase your word-of-mouth reputation and patients' desire to receive treatment at your clinic.

In my experience, many of the clinical failures of acupuncture in North America have nothing to do with the style of acupuncture, the size of the needle, depth of insertion or choice of points. It has mostly to do with insufficiently frequent treatment. Not too long ago, a student asked me about a case of theirs. They said the patient got better for a day or two after each treatment but that, by the time they came back in again the next week, they were right back where they had started, in terms of pain and disability. The student wanted to know if their Chinese pattern discrimination was wrong or their point selection was off. However, the first and most obvious thing (which they had failed to notice) was that their treatment frequency was inadequate. If one waits till the patient's condition has returned to where they started, there's no way to build a healing momentum. It's like starting over fresh each time. In China, they don't allow the patient to backslide. They keep the momentum going from day to day or from day to every other day. Therefore, I would recommend North American acupuncturists treat more often. If your experience is anything like mine (as well as 2,000 years of Chinese practitioners), you and your patients will see a big difference in treatment outcomes. Acupuncturists often say, "Acupuncture works!" I would add, "Yes, especially if you do it often enough."