Sketchbook entry

Practice insight into the issue of whether to needle on both sides

by Fletcher Kovich


There are two meridians that correspond with each of our twelve organs; the meridians are a mirror image of one another, with one on the left of our body and the other on the right; and the same acupoints are located along both meridians. In Chinese acupuncture, when a particular acupoint is needled, it is customary to needle the same acupoint on both the left and right meridians. But is this necessary?

As a new practitioner, I soon became aware that many patients would rather I used as few needles as possible. If I chose to use six acupoints in a particular treatment and needled each point on both sides, this amounted to twelve needles.

As a new practitioner, it is not easy to trust that if you do less, the patient will respond just as well, and may even respond better. But after a few years of practising, I started to experiment with using less needles. The first, most obvious way to cut down the number used was to needle each acupoint on one side only, choosing either the left or right meridian. With most patients, I found this was just as effective as needling the acupoint on both meridians. But how do you choose which side to needle, and how do you know the treatment is effective?

There are several ways to make this decision, and also to verify the effect of the treatment.

In my practice, I quickly got into the habit of re-taking the pulses on the appropriate side after needling an acupoint, so as to detect any immediate effect on the particular organ’s function. I found that in many cases, needling the acupoint on either the left or right side had the desired effect; and that then needling the same acupoint on the other side had little, if any, extra effect. But this was not always the case. Sometimes, the first acupoint appeared to have little effect on the organ function, but when then needling the same acupoint on the other side, this began to have the desired effect.

A rule of thumb I began to use was to select either the left or right acupoint depending on whether the organ I was treating was a Yin or Yang organ; when Yin, I selected the left, and when Yang, the right. The lungs are the only exception to this; they are a Yin organ, but I tended to select an acupoint on the right meridian. The lungs are the most Yang of the Yin organs (since they are the most “hollow” of the Yin organs, are the highest in our torso, and the substance they process has a direct link with the outside world—the air we breath—all of which makes them more Yang than all the other Yin organs[1]). This seems to place the lungs at the cross-over point between the Yin and Yang organs, and suggested to me that acupoints on the right meridian ought to be selected to treat the lungs. Hence, when treating the liver, kidneys, heart, or pancreas (usually called the “spleen” in TCM), I select an acupoint on the left meridian; and when treating the stomach, lungs or gallbladder, I select an acupoint on the right.

This rule of thumb has worked well for myself; but one of the beauties of Chinese acupuncture is that its practice is an art, and therefore different practitioners will develop different approaches.

With some new practitioners, they may not be as confident in their ability to accurately read a patient’s pulses, which is a skill that can take some years to properly acquire. In such instances, how would a practitioner know what effects the needling of a single acupoint had had on the particular organ’s functions?

Another experimental habit I adopted could be used to determine this. There is a basic principle in Chinese acupuncture that provides a powerful diagnostic tool. When any particular organ is not functioning properly, this always causes a tender location to appear along its associated meridian, usually at an acupoint (but not always). And different types of malfunction usually cause a different acupoint to become tender.

These acupoints can be used diagnostically; when you press one of them, if it is tender, this means the associated organ is malfunctioning (and malfunctioning in a particular way, depending on the acupoint), and the degree of tenderness usually corresponds to the degree of malfunction.

Of course, you cannot press an acupoint while the needle is still in place (and pressing an acupoint after the needle has been removed is not good practice), but testing the same acupoint on the opposite meridian can give some indication; if the organ has responded, the acupoint on the side that was not needled would be less tender than it was before you needled the acupoint on the opposite side.

However, a particular organ malfunction can often be treated by selecting one of several different acupoints, some on the meridian associated with that organ and some on other meridians. This means that a particular diagnostic acupoint, even when tender, often does not need to be needled in order to treat the corresponding malfunction—which means that the diagnostic acupoint can still be used to test whether the needled acupoint has successfully treated that organ.

For example, when a patient has stagnated liver function (“Liver Qi Stagnation”) one or more of the following acupoints would usually be tender when pressed: Liver-3, Gallbladder-41, Gallbladder-34, Pericardium-6, Liver-14, and Bladder-18 (though this article is focusing on the front acupoints); and with each acupoint, the left and right one would often be tender to a different degree. With some patients, when Liver-3 is particularly tender, I would often select perhaps Gallbladder-34 or Pericardium-6 to treat their liver (depending on various factors). Suppose the left Liver-3 were very tender and I needled the right Gallbladder-34. When immediately re-testing the left Liver-3, I would often find it was either not now tender at all, or the tenderness was very much reduced. And this would be accompanied by an immediate change in the patient’s liver pulse, all of which would indicate that their liver was now functioning smoothly.

Such experimentation can enable practitioners to reduce the number of needles they use in a treatment, but with new practitioners it is important to introduce such experimentation gradually, to only make small changes to your technique, and to test the effectiveness of any changes by monitoring the results from treatment to treatment with each patient.

All the above relates to treatments that use the acupoints on the front of our body. In my own practice, when needling the “back shu” points of the main organs, I still opt to needle both the left and right points for each organ treated. Until writing this article, I had not even considered this matter; the choice was instinctive. The back shu points provide a particularly “deep” treatment, directly to each main organ, and this single pair of points (the left and right) can therefore treat any type of malfunction in that organ. I still think that the Yin-Yang rule appears to apply, where the left back shu point treats the Yin aspect of the related organ’s malfunction, while the right point treats the Yang aspect. But my instinctive notion about this is that the back shu points have such a deep and powerful effect that it is best to needle both, so as to rectify both the Yin and Yang aspects of the related organ’s function—rather than inducing a deep, powerful effect on only one aspect, which may not be the best way to encourage the organ to assume an overall balance.

31 March 2016

1. See Chapter 18 of my book, Secrets of the Hidden Vessels.

[FK Dec 2018. In my recent research, experimental data has demonstrated that the left and right instance of the same acupoint show notably different impedance characteristics. This implies that the left and right instance of an acupoint treat different aspects of the same organ. And the data has also demonstrated that the left acupoint treats the yin aspect, while the right acupoint treats the yang aspect. This seems to confirm that in many circumstances, it would only be necessary to use either the left or right acupoints, depending on the particular state in the organ.]