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Needle Shock: Adverse Effect
Or Transformational Signal
Michael T. Greenwood, MB (MD)
ABSTRACT
"Needle shock" is a syndrome that occurs in about 5% of acupuncture patients. It presents as general malaise, cold perspiration, nausea, and, in extreme situations, loss of consciousness. Traditional teaching suggests that when needle shock occurs, all needles should be removed, the session terminated, and the patient informed that he/she may not be a good candidate for acupuncture. The author suggests that needle shock may simply be a signal for a large energy shift and not necessarily a negative effect.
KEY WORDS
Acupuncture, Needle Shock, Transformation, Original Energy
INTRODUCTION
As most physician-acupuncturists know, acupuncture is a safe intervention. This has been confirmed by 2 major studies that recorded no serious adverse events from acupuncture in tens of thousands of patients. The few minor events that were recorded mostly consisted of nausea, fainting, and heavy sweating. Of those, the majority were immediate reactions, making them likely to be varieties of the "needle shock" phenomenon.1,2
But is needle shock really an adverse effect because the textbooks say so? Or is it, in fact, a marker for something quite the opposite, i.e., something positive, a large energy shift that might be transformational if allowed to evolve in a safe manner? Indeed, does anyone really know?
Helms describes needle shock as a vasovagal reflex that manifests as lightheadedness, general malaise, cold perspiration, nausea, and, in extreme situations, loss of consciousness.3 It occurs most often in young, fit, healthy males at the 1st or 2nd visit, especially in those who have a strong psychological investment in their bodies and especially if the needles are placed in the upper back with the patient sitting. However, it can occur in any position. Helms' suggested treatment includes removing the needles, lying the patient down, maintaining verbal communication to allay patient anxiety, and tonification of various acupuncture points such as GV 26 (RenYing), ST 36 (Tsu San Li), and LI 4 (Hegu)3 (Table 1).
Differential Diagnosis
Needle shock has been attributed to a vasovagal reaction, which is a complex neurovascular reflex mediated by efferent autonomic fibers to the heart and blood vessels. In vasovagal syncope, usually there is a well-defined clinical trigger followed by preliminary warning symptoms related to overactivated sympathetic tone.4 The trigger usually involves an increase in the stress burden coming about as a result of pain, sight of blood, fright, or distressful thought. The result is a syndrome consisting of bradycardia, hypotension, cool and pale skin, nausea, and sweating. In extreme situations, there may be loss of consciousness, accompanied with or followed by myoclonic shaking, nausea, or vomiting.
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Table 1. Needle Shock Treatment
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Symptom
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Treatment
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Chinese Name
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English Name
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Loss of consciousness
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Tonify GV 26
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Renzhong
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Philtrum
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Precipitating needles in upper body
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Tonify ST 36
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Zusanli
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Three Measures on the leg
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Precipitating needles in the lower body
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Tonify LI 4
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Hegu
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Adjoining Valleys
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Usually, it is clear what is transpiring; however, there is always the potential for the unusual or catastrophic. For example, one patient developed a severe headache, nausea, and vomiting following the needling of GV 16 for chronic neck pain. A computed tomographic scan showed a hemorrhage in the 4th ventricle. The headache lasted 28 days.5 In another case, an emaciated 83-year-old woman developed bradycardia and syncope 20 minutes after acupuncture needles were inserted perpendicularly at CV 17 (Shanzhong). At thoracotomy, a 2-3 mm perforation was found in the anterior wall of the right ventricle.6 That patient survived, but others have died from a needle passing through sternal foramina under CV 17, which apparently occurs in 9% of men and 4% of women.2,7,8 Pneumothorax is a well-known adverse effect and can present with chest pain, sweating, and shortness of breath.9 Other conditions in the differential diagnosis might include cardiac arrhythmias, myocardial ischemia, pulmonary embolism, seizure disorders, and various somatiform disorders such as factitious anaphylaxis and pseudoseizures. Anaphylaxis can produce cardiovascular collapse and loss of consciousness, but it is hardly a complication of acupuncture; unlike the vasovagal reaction, it presents with tachycardia, hypotension, and warm, flushed skin.10 History and situation generally rule out these other possibilities.
Terminate or Proceed
It can be disconcerting to see a patient sweating, choking, vomiting, or having myoclonic activity on the treatment table. But in the absence of a serious pathology, the question is whether it is always a reason for terminating the session. Termination is going to abort whatever is happening, leaving no way of knowing whether a positive outcome would have occurred had the situation been allowed to evolve without interference. The difficulty lies in that in order to find out, the practitioner would have to allow the situation to continue to its own resolution. In my experience, such an unusual course of action can catapult people into significant energetic experiences associated with expanded states of consciousness.11
Should the treatment be terminated or not? It is the discretion of each practitioner to decide depending on the situation and context. Stopping is the safer course, but continuing might be an option if practitioner and patient were appropriately prepared for any chaotic energies that might emerge.
Moving the Qi
Oriental medicine's concept of stagnant Qi can produce a mental picture of the needle shock phenomenon by comparing the blockage in energy flow to the blockage of water flow in a river. When the Qi has been stagnant for a long time, there is a buildup of Qi, rather like the buildup of water behind a dam. If the dam gates are opened in the presence of a large reservoir of water, the resulting water movement can be massive. Similarly, if an acupuncture needle opens the doors of stagnation in the presence of a large reservoir of Qi, the energy shift can be dramatic, even overwhelming.
Since the primary purpose of acupuncture is to move energy, the needle shock phenomenon, rather than indicating that something is wrong, may actually indicate that something is right, albeit large and dramatic. It is not necessarily a sign that the patient is unsuitable for acupuncture, but rather that he/she is particularly sensitive to it. Why it happens in young men with muscular bodies may well speak to their general Qi abundance, together with the degree to which they feel the need to control its spontaneous flow.
The Loss of Original Nature
While muscular young men have more Qi than most, the tendency to block the spontaneous flow of energy is common to everyone. Moreover, Oriental philosophy posits that this habitual interference with the spontaneous flow of Qi is at the very root of disease. Blocking original energy, as the experience of unrestricted flow might be termed, leads to loss of "original nature" and separation from the Tao.12 Therefore, healing should involve – among other things – an attempt to reconnect with and integrate original energy so that it can be channeled in ways more creative than simply sustaining an illness. This means that one of the primary tasks of the acupuncturist is to help patients learn how to let go into the experience of unrestricted energy flow.
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Figure 1. Yin/Yang Dynamics of Needle Shock
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Figure 2. The Gate of Birth and Door of Death (Golden Gate)
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Unfortunately, this is not easy and may consume many sessions before a breakthrough occurs. Thus, when something happens that breaks down the ego's barriers in a trice, the astute practitioner should avoid immediate negative conclusions. Indeed, the sudden breaking-down of the barriers to spontaneity through needle shock may be exactly the stimulus necessary to get past entrenched blocks, and the energy shift that occurs while the patient is out of control can be transformational if the practitioner frames the experience in a broad-enough philosophical context.
Misinterpretation of Energetic Phenomena
The touch of the numinous – which, in Oriental medicine parlance, might be called a glimpse of original energy – is a common theme in mythological literature. For example, at the beginning of the Grail myth, the young Fisher King burns his fingers when he innocently eats some salmon roasting on a spit in a forest clearing. At least one author has interpreted this story to indicate touch of the numinous can be too hot to handle if approached without appropriate caution (the fish is a symbol of the numinous and survives today in the bishop's hat).13 Applied to the acupuncture ritual, a strong energetic reaction may have the potential to injure or to heal, depending on the patient's maturity and ability to integrate unusual experiences. Strong energetic reactions can be immensely healing if they are consciously embraced, which means it is probably a mistake to pathologize the unusual.
But medicine has a history of doing exactly that - pathologizing strong energetic reactions instead of considering the possibility of emerging transpersonal phenomena. Stanislov Grof, who pioneered rebirthing and holotropic breathing, has written extensively on this confusion, noting that psychiatry generally does not recognize the difference between mystical and psychotic experiences. He points out that modern medicine considers all unusual states of consciousness as pathological and routinely treats them with suppressive therapies, which often leads to chronicity, long-term dependence on pharmaceuticals with all their associated side effects and impoverishment of the personality.14
Yin-Yang Dynamics
Yin-Yang cycles and reversals form the physiological basis of all the various biological rhythms such as the waking/sleeping cycle, menstrual cycle, etc.15 Usually, the changes are gradual and pass largely unnoticed. In contrast, the needle shock captures attention because the phenomenon presents a sudden reversal of Yin and Yang.
The physiologist would say that prior to the onset of this phenomenon, there is an increase in sympathetic tone which, in Oriental medicine terms, would be termed a buildup of Yang. This is experienced as increasing tension, especially in the middle and upper Jiaos, nausea, sweating, and a feeling of impending doom. When the subsequent parasympathetic outflow occurs, Yang collapses and Yin comes to dominate the physiology. The sudden change of sympathetic to parasympathetic predominance leads to a precipitous decrease in blood pressure and bradycardia. Upper body tension collapses. The Qi in the upper Jiao falls down the Yang Meridians, Tai Yang, Shao Yang, and Yang Ming, leading to hypotension and even loss of consciousness.
During this period of collapse, muscular resistance dissipates and as a result, the Qi begins to flow chaotically (Figure 1). Without the Yang muscular tension to control the flow of Qi, a general discharge of blocked energy can involve every body system, with a variety of phenomena ranging from myoclonic shaking to emotional releases, regressive experiences, coughing, vomiting, and even loss of bladder and bowel control. Because these chaotic phenomena represent unrestricted energy flow, they can be understood as an experience of original energy and an immersion in the Water element, which has been deemed the "void."16
Five Elements and the Golden (Metal) Gate
In terms of the Five Elements, needle shock might be understood as a doorway to the transformational vortex of the Water element, a rapid transit through the biggest barrier to original energy. In a previous article, I discussed the concept of a narrow passage that must be negotiated by the patient to achieve transformation.17 To summarize, most patients with chronic symptoms usually present in the region of the Metal element and must move forward through a psychic constriction known as the Golden Gate (Jin Men) into the apparent chaos of Water to find transformation. This process is universally frightening and is usually vigorously resisted by an ego bent on maintaining its own illusory existence.
As the ego moves closer and closer to the Gate, symptoms of fear loom larger and manifest as pain, sweating, terror, dizziness, etc. – phenomena that reflect the increasing sympathetic tone. The entrance to the gate is marked by a radical reversal of polarity, with a collapse of Yang into the formlessness of Yin. The reversal marks the end of a complete cycle of the Five Elements, after which the chaotic energies reorder themselves into a new dynamic stability.
The Younger Patient: Wood Collapses Back Into Water
In the younger patient, the situation is often more effervescent. Younger patients are generally in the process of building an ego (rather than letting go of an outmoded one) and tend to have symptoms that are primarily energetic in nature. They are more likely to present in the Wood sector, with stagnation of Qi rather than the deeper disharmony of Blood stagnation one might expect in someone with chronic multifactorial illness presenting in the Metal sector. As a result, younger patients tend to be more sensitive to acupuncture needles and will have more movement of Qi with fewer needles.18
No sooner is the young man/woman out of the starting gates of ego-building that an acupuncture needle inadvertently engenders a collapse of Yang that reverses him/her back to the beginning. It could be said that they get a glimpse of their original energy before they know its significance. In this way, they touch the transformational vortex unconsciously and in the process, they might get burned. But, by assuming the experience is bad, they miss the point that they have actually touched their original energy.
The Golden Gate is also known as the gate of birth and the door of death (Figure 2), which could be interpreted to mean that it represents both the entry and exit points to the experience of original energy.19 The doorway into and the doorway out of the void is, in fact, the same door. Both entry and exit involve a Yin/Yang polarity reversal. The only thing that changes is our direction, whether going in or coming out.
Interpretation
Later in the Grail myth, the young Parsifal arrives at the Grail castle for dinner, but forgets to ask 2 key questions of his host (as he had been admonished to do) and instead, engages his dinner companions in idle chatter (the first of these 2 questions was, "What is the meaning of the Grail?"). Through this oversight, Parsifal loses the opportunity to avail himself of the healing properties of the Grail – which is precisely what may happen if the physician dismisses the needle shock experience and forgets to help the patient inquire into the real meaning of the experience. It is here that the astute physician has a remarkable opportunity to reframe the experience in a positive way and encourage the patient to understand the deeper significance of the experience. The physician can frame it in terms of the Grail myth or whatever analogy might be appropriate, and then suggest ways the patient can make a more conscious foray into the experience of original Energy – to approach it in such a way that he/she does not have a negative experience.
If the physician is successful, the patient's intent will shift from "moving away" to "moving toward;" then, it is just a question of providing an appropriate context in which to express that intent. Since the energies can be chaotic, a location away from the normal office routine may be appropriate. In my experience, when this is done, it is not difficult for many patients to experience the flow of original energy in a positive way.
CASE REPORTS
Head Injury and Insomnia
The patient was a 36-year-old man who came to a 10-day residential chronic pain program with right-hand chronic regional pain syndrome (RSD, now called CRPS type 1) stemming from an industrial injury 3 years previously, several surgeries to repair his thumb, including 2 tendon transfers, and a fusion of the metacarpophalangeal joint. He had a remote head injury 10 years previously, chronic insomnia, and would not permit even light touch on his thumb.
During the 1st acupuncture treatment, which included 3 of the 4 gates (LV 3 bilaterally and contralateral LI 4) plus local needles in trigger points in the head and neck area, the patient abruptly lost consciousness. We removed the needles, checked his vital signs, laid him on his side, and pondered what to do next. With some trepidation, we decided to take a wait-and-see approach and he woke up an hour later feeling good. For the next 10 days, the patient spent much of his time sleeping, waking only to eat or smoke a cigarette. After 10 days, he looked more rested and remarked that he had not slept properly in 10 years.
This patient returned for a 2nd program; he then permitted needles in the injured arm. He was treated with N-N+1 circuits and local needles. At each treatment session, he exhibited some myoclonic shaking in the right arm and went into an altered state and into a void for several minutes. He later described re-experiencing aspects of his various traumas during these periods of dissociation. However, we were less concerned with this phenomena and made certain he was lying safely on his side when it occurred. At the end of the program, the patient was pain-free and 2 years later, was running a successful business.
Post Motor Vehicle Accident Pain
The patient was a 45-year-old man who was involved in a motor-vehicle accident a year previously. During the crash, he put his right hand out to protect his son (who was in the right front seat), and braced his left hand on the steering wheel while slamming his right foot on the brake. He had a severe trigger point in the thoracic spine at T5-6, and his left arm felt as if it was pinned to his chest; he held it awkwardly and did not like to move it away from his chest.
During the first session, needles were placed in the 4 gates (LV 3, LI 4) and local points in the upper back at T5-6 (BL 15) and trapezius area (GB 21). He began to sweat, complained of feeling nauseous, and his head and arms began to shake. We removed the needles and laid him down, but encouraged him to continue shaking so long as the impulse was present. We framed the myoclonic activity in a positive manner, suggesting it represented a release of the energetic imprint from the trauma.
With this understanding, the patient agreed to engage the process more deeply. In subsequent sessions, his right hand went out as if to protect his son, the left hand braced against an imaginary steering wheel, and his right leg started to move as if pumping the brakes. Each time, he sweated, shook, and felt nauseous. After these kinds of experiences, his pain levels dropped dramatically. In time, he learned the significance of what was happening and was able to develop a home dynamic meditation which included some myoclonic shaking. Furthermore, the patient settled his insurance claim, and after 6 months of acupuncture and home routine, he was pain-free.
DISCUSSION
Although needle shock is generally regarded as a negative effect of acupuncture, there are good experiential and philosophical reasons for questioning that assumption, especially when one considers that acupuncture is not simply a symptomatic approach to disease. Indeed, if needling can be a doorway to an experience of original energy, then what is generally regarded as an adverse effect may well be a transformational experience in process. To miss this point may be a grave error.
Needle shock is simply a large energy shift and if framed that way, can lead to a good outcome with considerable changes in symptoms. To engage this idea in a session can be challenging, but the rewards can make it well worth the effort.
Another question is, are there really adverse effects? One practitioner used this example: if a pneumothorax occurs during an acupuncture treatment for chronic bronchitis, but the patient's ensuing hospital experience prompts him to stop smoking, then is it an adverse effect?20 In the immediate sense of things, yes; but in the larger sense of things, no. Because the outcome was ultimately good. Therefore, from a transformational perspective, one cannot make the judgment that something is good or bad – since, what appears to be bad today may turn out to be good later.
CONCLUSION
In an era of evidence-based medicine and outcome studies, these philosophical musings may seem irrelevant to clinical practice. But when it comes to energy medicine, everything is in transformation and nothing exists in isolation. If we miss that point, perhaps we miss the whole essence of the art of acupuncture.
ACKNOWLEDGEMENT
Richard Greenwood, Dr Greenwood's son, is responsible for all the graphics herein.
REFERENCES
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- Johnson RA. The Fisher King and the Handless Maiden – Understanding the Wounded Feeling Function in Masculine and Feminine Psychology. New York, NY: HarperCollins Publishing; 1993.
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- Guicheng X. The menstrual cycle and the cycle-regulating treatment. J Chin Med. 2001;67:28-31.
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AUTHOR INFORMATION
Dr Michael Greenwood is Medical Director of the Victoria Pain Clinic, a residential facility in Victoria, British Columbia, Canada. Dr Greenwood specializes in chronic pain/chronic illness patients, developing techniques integrating the body, mind, and spirit. His books, Paradox and Healing, co-authored with Dr Peter Nunn, and Braving the Void, reflect this interest.
Michael T. Greenwood, MB (MD), BChir, CCFP, CAFCI, DABMA, FRSA*
Victoria Pain Clinic
365 Hector Rd, RR#3
Victoria, BC, Canada V9E 2C3
Phone/Fax: 250-727-2975 • E-mail: michaeltgreenwood@shaw.ca
*Correspondence and reprint requests
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