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Acupuncture Styles: What is the Difference between Chinese, Japanese and Electroacupuncture?
We have received many inquiries regarding acupuncture styles so we summarized some of the popular acupuncture systems used in North America below.
Tim H. Tanaka, Ph.D. D.Ac., RMT,RNCP, BCIAC
Acupuncture has developed in the past few thousand years, through a rich tradition of trial and error, into an 'empirical' medicine. In the United States and Canada, many different styles of acupuncture have been introduced such as TCM acupuncture, Japanese acupuncture, electroacupuncture, auricular acupuncture, trigger point acupuncture, Korean hand acupuncture, etc. Although there are practitioners religiously devoted to one particular style and there are practitioners who only strictly follow the exact protocol of his/her mentor, many acupuncturists today incorporate a variety of techniques and treatment styles creating their own unique protocols by considering the condition of each individual patient. Therefore, it is hard to make a generalized classification and discuss pros and cons of each acupuncture style. Keep in mind that there are always exceptions and the following information is provided in order to give readers a general idea about different acupuncture styles.
Traditional Chinese Medicine (TCM) Style
The foundation and basis of acupuncture developed in China over thousands of years (see also History of Acupuncture). Traditional Chinese Medicine (TCM) style is by far the most common system of acupuncture taught and practiced in North America today. TCM acupuncture as stated by Flaws is a particular style of acupuncture developed in the People’s Republic of China after 1949. In China it is also referred to as “New Acupuncture” (Xin Zhen Jiu). This is an herbalized acupuncture based on diagnosis by Bian Zheng or discrimination of patterns (of disharmony).
Chinese herbal medicine is considered one of the most integral parts of TCM and acupuncture point selection and protocol is formulated based on Chinese herbal diagnosis. TCM acupuncturists use thicker and longer needles and almost always attempt to produce a de-qi sensation (a sensation of numbness, heaviness, or distention at the area of needle insertion). They believe that the de-qi sensation is essential for producing acupuncture's benefits. In addition, many TCM practitioners emphasize the importance of taking herbs in order to obtain the full benefit from TCM style acupuncture.
Japanese Style
 Chinese acupuncture was introduced into Japan about 1500 years ago. The basic principles remained similar to the Chinese meridian system, but the treatment style became quite different. Although an acupuncture treatment procedure varies from practitioner to practitioner among “Japanese style” acupuncturists*, Japanese practitioners generally use much finer needles, stimulate more superficially and gently, and often do not consider the strong de-qi sensation of importance, while TCM acupuncturists tend to use bigger needles, deeper stimulation, and attempt to induce the de-qi sensation.
These differences may be the result of social differences between mainland China and the island of Japan and may also be a matter of simple economics. In China, the Western methods and pharmaceuticals are expensive and hard to obtain. When ill, the first place one goes to in China is the acupuncturist. Partly because it is most affordable, but also because it is the most readily available form of medical treatment in many areas. Acupuncture is so commonly practiced and the stream of patients is so voluminous that a patient's comfort has actually become secondary in this training and system. Furthermore, according to Flaws, Chinese patients are schooled to believe the “no pain, no gain” dictum and therefore, the strong needle technique employed in China is acceptable. In Japan especially in the last 100 years, acupuncture has thrived in the private practice sector. Western medicine has proved highly economical and is the central paradigm for Japanese government-supported healthcare. Practitioners of acupuncture in Japan have had to compete by developing traditional methods into highly effective and comfortable treatments.
Most TCM acupuncturists are trained to treat patients using Chinese herbs. In fact, some TCM practitioners believe TCM style acupuncture without herbs is of limited benefit. In Japan over the past several decades, Chinese herbs can only be prescribed by licensed physicians or pharmacists and therefore, most Japanese acupuncturists are not trained to use herbs. Over the years under the challenge of the current healthcare system, many groups of Japanese acupuncturists have refined the acupuncture protocol and formulated a sophisticated acupuncture treatment system in order to effectively deal with a variety of internal and external conditions using acupuncture alone and without relying on herbs.
* It should be noted that not all Japanese practitioners treat their patients with the same technique, and treatment protocol greatly varies among Japanese acupuncturists. In North America, classical acupuncture where treatment is based on meridian system is usually referred to as Japanese style acupuncture. However this type of Japanese acupuncture is not the style of acupuncture most commonly taught and practiced in Japan. In 1994 a publication surveyed 2184 acupuncturists in Japan and reported that 33% Japanese acupuncturists treat patients primarily by a medical based system, 23% by meridian therapy, 14% systemic regulation method, 12% tender point approach, and the remaining 18% uses TCM or several other unique style of treatment methods.
Electro-Acupuncture
Since electricity did not even exist during most of the historical era of acupuncture, electroacupuncture is, as you might imagine, an acupuncture technique that has only recently come into use. Electroacupuncture has become an increasingly popular form of treatment since the 1960’s mainly as a form of pain relief. Electroacupuncture is commonly practiced by medically trained acupuncturists (Physicians, Physical Therapists, Chiropractors, etc.) and to the surprise of many, most of the traditional Chinese medicine practitioners. In electroacupuncture, needles are inserted on specific points on the body, and the needles are then attached to a device that generates continuous electric pulses using small clips. These devices are used to adjust the frequency and intensity of the impulses being delivered, depending on the condition being treated. Electroacupuncture is a similar therapy to transcutaneous electrical nerve stimulation (TENS), which became widely available and known to consumers through TV infomercials. The main difference is that electroacupuncture uses acupuncture needles as the electrodes instead of electrode pads which are used with the TENS units. Electroacupuncture, therefore should not be classified under the umbrella of acupuncture when discussing about the action and mechanism of acupuncture.
In the United States, electroacupuncture treatment has been studied for a variety of conditions. Electroacupuncture is often the preferred form of acupuncture among researchers simply because the type and amount of stimulation administered to each subject can be much more easily standardized among acupuncturists compared to individualized or artistic forms of classical manual acupuncture. For technical and safety reasons, needles used with electroacupuncture are larger in diameter (>0.20mm) and are inserted into a sufficient depth of the tissue (typically 1-2 inches). Electroacupuncture should not be used on patients who have a history of seizures, heart disease, or on patients with pacemakers.
Which acupuncture style is best for you?
As discussed, there are varieties of acupuncture styles exist and moreover, assessment and treatment procedure can actually be quite varied even among the practitioners of the same discipline. One of the prime objectives in the acupuncture field today is to further verify and refine acupuncture methods using scientific research data and comparative studies. However, it will be a while before we hear any meaningful conclusive results. Although a more unified and standardized assessment/ treatment system is needed, the artistic element of acupuncture will still exist and should remain as an integral part of patient care.
So which acupuncture style or acupuncturist is best for you? This really depends on your condition and personal preferences. You are encouraged to try out different practitioners until you feel that you have found the right one. Some health problems may be more responsive to one style of acupuncture (or practitioner), while some other conditions (or patients) may respond favorably to other acupuncture styles (or acupuncturists). Some conditions may respond well to any acupuncture style, while some conditions may not respond to acupuncture treatment at all. Some patients may find strong de-qi sensation to be too uncomfortable and the treatment to be stressful while some other patients may find the feeling of de-qi rather enjoyable. Some acupuncture systems are designed more to provide temporary relief of symptoms; other acupuncture protocols are designed to address the root cause of the symptoms. Lastly, although acupuncture is generally considered safe, some acupuncture techniques have been more frequently linked to certain adverse events than other acupuncture techniques. Patients should make sure to discuss the potential risks and benefits with their practitioner before trying acupuncture or any other treatment modality.
REFERENCES
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Gwei-Djen, L., Needham, J. Historical growth of the system. In Celestial Lancets: A history and rational of acupuncture and moxa, Cambridge University Press, 69-167, 1980
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Flaws, B. American acupuncture education: Has a wrong turn been taken? American Journal of Acupuncture, Vol. 9, No. 1, 1991
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Ogawa, T. Gendai shinkyu gyoutai enquette. The Journal of Japanese Acupuncture and Moxibustion, Vol. 53, No. 8, 471-618, 1994
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Dr. Tim Tanaka is the director of The Pacific Wellness Institute in Toronto and Visiting Research Fellow at the Tsukuba University of Technology, Department of Acupuncture in Japan.
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