From time to time, practitioners of acupuncture ask whether it is desirable for patients to do their own treatment. This suggestion sometimes elicits cries of horror, mainly from traditionalists who regard acupuncture as an esoteric affair requiring years of study before it can be practised adequately. This does not apply to my view of acupuncture, so the question is mainly one of safety. Considering that diabetic patients give themselves insulin injections daily or more frequently, and other classes of patients are also taught to inject themselves, I find it hard to understand why an intelligent patient can’t be taught to insert a plain needle fairly superficially, perhaps only once a month. At any rate, I, in common with other acupuncture practitioners at our hospital and elsewhere, have taught a good number of patients to do their own acupuncture, and in many years no problems have arisen.
There are two main sets of circumstances in which self-acupuncture may be appropriate. Some patients have difficulty in attending for treatment regularly for one reason or another. Other patients suffer from disorders that respond quite well to acupuncture but only for short periods, sometimes for just a week or two. When I first started practising acupuncture I thought that if one gave such patients more frequent or even daily treatment for a time, perhaps as inpatients, there would then be a carry-over for some months after the intensive course. However, this never worked; the duration of any remission appears to be pretty well fixed for each patient, and this pattern of response is nearly always apparent after about six treatments or fewer. In such cases self- acupuncture seems like a good option.
Naturally, certain precautions have to be taken. Not every patient is happy about the idea of self-treatment, although a perhaps surprisingly large number are; if patients are reluctant it is sometimes possible to find a family member or a friend to do the treatment. The disorder for which the patient is being treated must have been shown to respond adequately in this instance. The patient (or other person who is to do the treatment) must be of reasonable intelligence. Finally, it is of course essential that the site to be needled is anatomically safe and easily
accessible. In practice, I have most frequently used LR3 in this way, although other sites have been the target on occasion; for example, some patients with ulcerative colitis have been taught to do their own treatment by needling the lower abdomen, which is perfectly safe provided there is adequate subcutaneous tissue in this region. For self- acupuncture, patients are taught to use short (15 mm) needles, so as to reduce still further the risk of anatomical damage.
Having decided, after discussion with the patient, that this is the best plan to follow, I then make a slightly longer than usual appointment for the instruction to be given. The patient will already be familiar with the procedure, having had acupuncture several times previously, but on this occasion I repeat the treatment on one side, explaining what I am doing, and then the patient needles the opposite side under my supervision. If all goes well, as it nearly always does, the patient is told how to obtain a supply of needles. (The hospital pharmacy used to sell them for our patients.) The patient then goes home and carries out the treatment as prescribed for a few weeks. The frequency of needling varies according to the individual case; it might be as often as once a week, or it might be less frequent or might even be done on an occasional ‘as required’ basis. The patient is then seen again, and provided all is going well a further appointment is made for a few months ahead. After that it is often possible to discharge the patient.
It’s important to make sure that there are suitable arrangements for disposing of used needles. When I first started teaching patients to treat themselves I used to tell them to put the needles in a tin or a jar with a top and bring them back to us for disposal. Nowadays some local authorities have arrangements in place for diabetics to dispose of used needles, or alternatively the local GP centre may be willing to take the needles.
Patients are told that they are able to telephone for advice at any time, although in practice they hardly ever feel the need to do this. They are also told not to change the site of needling without advice from us and to let us know if the symptoms change or the acupuncture ceases to be effective. I think it is essential to give them a leaflet (see below) summarizing all the points they have been told about. This leaflet mentions all the possible complications that might occur, including bleeding, infection, and broken needles, although it is emphasized that, apart from slight bleeding, these things are very unlikely to happen.
Experience with self-acupuncture has been good. Patients generally find it to be effective, although in some cases they report that it is not as effective as when they have acupuncture in the clinic, and they therefore like to come in for an occasional ‘top-up’. This suggests either that they do the acupuncture less skilfully than we or, alternatively and more probably, that there is an element of placebo in the response in these cases and that having acupuncture in the clinic is more effective for that reason.
Self-treatment with acupuncture 155
Instructions for self-acupuncture
䊉 Wash your hands in the usual way.
䊉 Remove the needle from its envelope without bending it. (If you do bend it, discard it and use a fresh one.) Hold it in one hand (the right if you are right-handed).
䊉 Stretch the skin with the other hand. 䊉 Rest the tip of the needle against the skin.
䊉 Press the needle quickly right through the skin, without hesitating. 䊉 If necessary, push the needle more until it has gone in about a
quarter of an inch (6 mm).
䊉 Twist the needle gently a few times in both directions for 10–20 seconds.
䊉 Withdraw the needle.
䊉 Dispose of the needle safely. Possible problems
䊉 A small drop of blood appears when you remove the needle. Remedy: Wipe it away with a clean tissue and press the site gently for a minute or so. If the site you needled was your foot, keep the leg up until the bleeding has stopped.
䊉 A small ‘bump’ appears when the needle is removed. Remedy: Press and flatten it gently with a tissue for a minute or two. 䊉 Needle breakage (extremely unlikely). Remedy: Try to pull the end
out with a pair of clean tweezers or similar implement. If this fails, consult your doctor or a hospital casualty department.
䊉 Infection (extremely unlikely): The acupuncture site becomes red, hot and swollen, and/or red streaks appear running up the limb. Remedy: consult your doctor or a hospital casualty department. Important notes
If any difficulty due to acupuncture occurs, please feel free to telephone this hospital to ask for advice. Ask to speak either to the doctor who treated you or to the doctor on duty.
Please follow the instructions given to you exactly, especially as regards frequency of treatment and site(s) of needle insertion. Do not change these without consulting the doctor. If at any time the treatment ceases to be effective, ask the hospital to give you a fresh outpatient appointment.