Authors: Yanling Huang ¹, Bing Yang ¹

¹ New England School of Acupuncture, MCPHS University

Introduction

One controversial issue that stood out from studying the Huangdi Neijing is the role of classical needling techniques in modern acupuncture practice. In classical texts, acupuncture is not just about selecting points, but also about how the needle is manipulated after insertion. Techniques like Shao Shan Huo and the “Eight Starting Hand Methods” emphasize rhythm, depth, and actively guiding qi during treatment. However, in modern clinical practice, especially in the U.S., acupuncture is often performed in a more standardized and gentle way, with less emphasis on complex manipulation. This raises an important question: Should we continue to use these classical techniques in clinical practice, or should we prioritize patient comfort and simpler methods? This issue feels very relevant to future practitioners because it directly affects how we treat patients and how we understand acupuncture as a whole.

Importance of the Issue

This issue is important because it influences both treatment effectiveness and patient experience. From a classical perspective, needling techniques are essential for regulating qi and achieving therapeutic results. If we simplify acupuncture too much, we might lose an important part of its effectiveness. At the same time, modern patients often have different expectations. Many patients are sensitive to needling or even afraid of strong sensations. If treatments are too intense, it could negatively affect their willingness to continue care.

This also affects how acupuncture is taught. If we focus mostly on safe, standardized needling and don’t practice classical techniques, we may not fully develop the skills described in classical texts. Over time, this could change how acupuncture is practiced in the future.

Perspective Supporting Classical Needling Techniques

From a classical perspective, needling technique is an essential component of effective acupuncture treatment. The Huangdi Neijing emphasizes the importance of deqi (arrival of qi) and differentiates between reinforcing (bu) and reducing (xie) methods. These concepts are not abstract; they are achieved through precise needle manipulation, including lifting, thrusting, twisting, and varying depth. Techniques such as Shao Shan Huo demonstrate how classical acupuncture uses structured, rhythmic manipulation to tonify deficiency conditions. By gradually inserting the needle to deeper levels and applying repeated cycles of lifting and thrusting, the practitioner aims to build warmth and strengthen qi. This reflects a highly intentional approach to treatment, where the practitioner actively engages with the body’s internal processes.

Modern scientific research provides some support for the physiological basis of these techniques. Langevin et al. (2001) found that needle manipulation can influence connective tissue, suggesting a potential mechanism for how acupuncture affects the body. In addition, different needling techniques may activate distinct neurophysiological pathways, further supporting the importance of manipulation in treatment (Zhao, 2008). Neuroimaging studies also suggest that acupuncture can modulate brain activity and pain-related networks, which may vary depending on stimulation methods (Napadow et al., 2009).

Another important aspect of classical techniques is their emphasis on practitioner skills. The ability to sense tissue resistance, adjust needle depth, and respond to patient feedback requires extensive training and experience. These highlights acupuncture as both a technical and experiential practice, where the practitioner’s skill plays a crucial role in treatment effectiveness. From this perspective, reducing acupuncture to simple needle insertion risks losing an essential dimension of the therapy. Classical techniques provide a level of precision and adaptability that may enhance clinical outcomes, particularly in complex or chronic conditions.

Perspective Supporting Modern Patient-Centered Approach

In contrast, the modern approach to acupuncture prioritizes patient comfort, safety, and standardization. This perspective is particularly relevant in Western healthcare settings, where acupuncture is often integrated into multidisciplinary care. One key argument supporting this approach is that patient experience significantly influences treatment outcomes. If patients feel discomfort, anxiety, or fear during treatment, they may be less likely to continue to care. Gentle needling techniques, which minimize strong sensations, can improve patient satisfaction and adherence to treatment plans.

Research also suggests that acupuncture can be effective even with minimal stimulation. Vickers et al. (2012) conducted a large meta-analysis showing that acupuncture is effective for chronic pain conditions, but the study did not emphasize the necessity of strong needling techniques. This raises the possibility that simpler methods may still achieve meaningful clinical results. Additionally, standardization is important for safety and education. Modern acupuncture training programs emphasize consistent needling depth, anatomical awareness, and risk management. These practices help reduce complications and ensure that treatments are safe and reproducible across different practitioners.

Time efficiency is another practical consideration. In busy clinical settings, especially in integrative or hospital-based environments, complex classical techniques may not be feasible due to time constraints. In fact, studies of contemporary acupuncture practice suggest an increasing emphasis on consistency, safety, and patient comfort in clinical settings (MacPherson et al., 2017). Simpler approaches allow practitioners to treat more patients while maintaining quality of care. From this perspective, classical techniques may be viewed as valuable but not always necessary. The priority is to provide effective, safe, and patient-centered care that aligns with modern healthcare standards.

Key Differences Between the Two Perspectives

The primary difference between these perspectives lies in their underlying priorities and definitions of effective treatment. The classical approach is technique-centered, emphasizing the importance of skilled manipulation in regulating qi. It views acupuncture as an interactive process that requires active engagement from the practitioner. In contrast, the modern approach is patient-centered, focusing on comfort, accessibility, and measurable outcomes. It prioritizes consistency and safety, often simplifying techniques to make acupuncture more approachable for a broader patient population.

Another key difference is how each perspective conceptualizes the role of the practitioner. In classical acupuncture, the practitioner is highly involved in guiding the treatment through technique and tactile feedback. In modern practice, the practitioner’s role may be more standardized, with less emphasis on individualized manipulation. There is also a difference in how knowledge is validated. Classical approaches rely on traditional texts and clinical experience, while modern approaches emphasize scientific research and evidence-based practice. These differing frameworks can lead to different conclusions about what constitutes effective treatment.

Ultimately, this difference reflects a broader tension between preserving traditional knowledge and adapting to modern healthcare systems. Both perspectives offer valuable insights, but they also highlight the challenges of integrating different paradigms.

Conclusion

The debate between classical needling techniques and modern patient-centered approaches reflects a deeper question about the future of acupuncture. Classical methods offer depth, precision, and a strong theoretical foundation rooted in the regulation of qi. Modern approaches, on the other hand, emphasize safety, comfort, and accessibility, which are essential in contemporary healthcare environments.Through examining both perspectives, it becomes clear that neither approach is inherently superior. Instead, effective practice requires integration. Practitioners should develop a strong foundation in classical techniques, including the ability to perform reinforcing and reducing methods, while also adapting their approach based on patient needs and preferences.

This process of balancing tradition and modernity is essential for the continued development of acupuncture as a profession. By combining classical knowledge with modern research and patient-centered care, practitioners can provide treatments that are both effective and accessible. The process of researching this topic also highlights the importance of critical thinking and objective analysis. Understanding both perspectives allows for a more nuanced approach to clinical practice and opens opportunities for future research. Ultimately, the goal is not to choose between classical and modern approaches, but to integrate them in a way that enhances both therapeutic effectiveness and patient experience. adapting to modern healthcare systems. Both perspectives offer valuable insights, but they also highlight the challenges of integrating different paradigms.

References

Langevin, H. M., Churchill, D. L., & Cipolla, M. J. (2001). Mechanical signaling through connective tissue: A mechanism for the therapeutic effect of acupuncture. The FASEB Journal, 15(12), 2275–2282.

Vickers, A. J., Cronin, A. M., Maschino, A. C., et al. (2012). Acupuncture for chronic pain: Individual patient data meta-analysis. Archives of Internal Medicine, 172(19), 1444–1453.

Napadow, V., et al. (2009). The status and future of acupuncture neuroimaging research. NeuroImage, 47(S1), S86–S97.  

MacPherson, H., et al. (2017). The practice of acupuncture: Who are the practitioners and what do they do? Pain, 158(7), 1230–1237.  

Zhao, Z. Q. (2008). Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology, 85(4), 355–375.

About the authors:

Yanling Huang is currently a graduate student in the Acupuncture and Oriental Medicine program at the New England School of Acupuncture at MCPHS University and is expected to receive her Master’s degree in August 2026. She holds a Bachelor’s degree in Rehabilitation Therapy and completed a one-year clinical internship at Fujian Provincial Hospital, where she developed a strong interest in acupuncture and its clinical applications. Her training integrates classical Chinese medical theory with modern clinical approaches. Yanling is dedicated to providing patient-centered, holistic care and is particularly interested in incorporating traditional acupuncture techniques into modern practice to improve patient outcomes.

Bing Yang is a licensed acupuncturist and herbalist in Massachusetts. She received her Bachelor’s and Master’s degrees in Acupuncture and Chinese Medicine from Beijing University of Chinese Medicine in the 1990s and her Doctoral degree from Massachusetts College of Pharmacy and Health Sciences (MCPHS). Currently she is the associated professor and Director of Chinese Herbal Programs of New England School of Acupuncture, MCPHS and also maintains a private practice in Boston.