The 1st edition of Congress The Journey of the Needle was held in Maastricht the Netherlands 8-9 Oktober 2016. TJotN objective is to focus on the use of acupuncture needles in Healthcare.

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The focus of tJotN is the use of acupuncture needles in Healthcare.  Acupuncture needles or needle like instruments have been a part of the medical instrumentarium throughout centuries in the East as well as the West, but the most detailed  contribution comes from TCM (Traditional Chinese Medicine). And most of us will make associations of this kind. But in fact the use of acupuncture needles is much broader. It covers a whole lot of styles and along with it possibilities of treating your patients.
Could we define commonalities and differences?


1.The use of acupuncture needles or needle like devices.

Roughly speaking needle types range from non-invasive ones used in soft needling like japanese techniques to the more aggresive ones used in acupotomology

Other examples ( in miscellaneous order and not complete!):

2. Mode of action

Definition of  the overall mode of action:
To evoke a therapeutic response either local or at a defined target in a body structure, with the use of an acupuncture needle or needle like instrument via points or areas on the body.

3. Hands on.

A typicality that is shared in needling is the feature of being a hands on intervention. This implies that the specific effect lies within the hands of the therapist rather than in the intervention itself like in medication or is a responsibility of the patient as is the case in excercise or lifestyle changes. From a scientific standpoint this makes needling a more closer resemblance to surgery than to pharmaceuticals. Hence the way of scientific conduct should be different.

And How do styles differ?

1. Although all needling evokes a therapeutic response either local or central, needling styles mainly differ in the way how modes of action are explained.
As in all interventions, needling styles are based on theories that define the manner (how and why) of the specific style of needling. They explain the effect of the needling. Theories can be roughly divided in traditional ones and western medical ones. The style of the traditional ones are embedded in eastern cosmological frameworks whereas the western medical ones uses the body’s anatomy and physiology. E.g. points in acupuncture are meaningful units that all have a relation with a mind body interconnected perception of the human body. In contrast with the  western medical deductive view which uses a biomedical or neurophysiological viewpoint of the human body.  The choice of style is mainly a personal choice.

2. Manipulations

Although the overall aim is shared in needling styles the specific manipulation techniques can differ . Manipulation can be performed by hand or by a device.

With each theory comes a different prescription of manipulation of the needle.

3.Type of needle
There is a huge variation in needle types linked to the different styles of needling.


Johanna Biemans

evoluon eindhoven

The choice for this years congress venue Evoluon Eindhoven hasn’t been accidental. The dutch Evoluon is the iconic place to be in The Netherlands when it comes to sharing of (scientific) knowledge and innovation.

Read here some of its history.
During the past decades, The Dutch Evoluon Eindhoven has had various destinations. In the first place, dr. Ir. Frits Philips (from Philips* company) had in mind a permanent exhibition space for the general public.
Years later, the Evoluon got a new destination. The futuristic building started to function as the Philips Competence Center. From this capacity, the Evoluon has grown to the multifunctional conference center and event location that it is now.

Opening Evoluon Prins Bernhard, Philips FJ, 24-9-1966 Left Prince Bernhard, right Frits Philips
“It would be wonderful if the Evoluon became a meeting place where people can share and exchange their knowledge, experiences, enthusiasm and inspiration in a way that pays off on multiple fronts, socially and economically.”
Frits Philips
CEO of Philips 1961-1971
Visionary & initiator Evoluon


*Philips is a Dutch technology company headquartered in Amsterdam with primary divisions focused in the areas of electronics, healthcare and lighting. It was founded in Eindhoven in 1891, by Gerard Philips and his father Frederik. It is one of the largest electronics companies in the world and employs around 105,000 people across more than 60 countries. Philips is a leading health technology company focused on improving people’s lives and enabling better outcomes across the health continuum.

The Philips Company was founded in 1891, by Gerard Philips and his father Frederik. Frederik, a Jewish banker based in Zaltbommel, financed the purchase and setup of an empty factory building in Eindhoven, where the company started the production of carbon-filament lamps and other electro-technical products in 1892. This first factory has been adapted and is used as a museum which might be of your interest to visit

In this Evidence Based area where we’re trapped in literature and administrations, we almost would forget that treating patients with ‘hands on’ interventions like acupuncture (and massage or manipulations), the effect (or efficacy) of the treatment has to be initiated right on the spot. When the patient consults you presenting with pain, discomfort, fatigue or else, we as acupuncturists have to do this something thats gonna intervene in this person to counteract and solve the aching. Apart from explaining what is happening we have to make it happen. Explanations of ‘how acupuncture or needling works’ changed over time (as theories always do), but the human body seems to respond quite consistent . So, apart from this huge amount of theoretical models and research that has to guide healthcare workers, hands on professionals have to manage skills.  Its not uncommon that each practitioner develops its own favourite ‘tricks’ and abilities.


I believe that the latter ( which is also part of the EBM triad) is vastly underestimated. Not only based on my own experience but I observed this at the first edition of The Journey of the Needle. Whether it be a more traditional theory based on Qi concepts or a more biomedical oriented one, palpation in the end seems to be  crucial for the final needle placement. The identification of these ‘ashi points or areas’ is the first step and often precondition for the requested outcome. Instantaneous (pain) relief can be obtained when appropriate needling is performed. This direct feedback in fact forms the cornerstone of best practice.

Besides those ‘palpation’ related diagnoses, other practitioner features like intention and needling techniques come into play in the hands on practice of acupuncture[1,2,3]. The impact on outcomes isn’t yet studied thoroughly. And should deserve more attention.




Figure extracted from ‘Precision in needling’ while needling ‘MTrP. See below for link[3]
Johanna Biemans

1. Pereira JABarkham MKellett SSaxon D. The Role of Practitioner Resilience and Mindfulness in Effective Practice: A Practice-Based Feasibility Study.

2. Chae Y, Olausson H. The role of touch in acupuncture treatment.  Acupunct Med. 2017 Feb 1. pii: acupmed-2016-011178. doi: 10.1136/acupmed-2016-011178.
3. Precision needling in myofascial pain. Mike Cummings 2017 BMJ Blog

Acupuncture needle usage

Acupuncture needles used for therapeutic aims is the theme during the Congres The Journey of the Needle. Plotted on a timeline the Bian stone and the Percutaneous Electrolysis are to my knowledge the extremes at this moment in time. The Bian stone (left side picture) marks the early beginnings and is depicted as the precursor of Acupuncture crafts and dates back to before 2500 BC. The one on the right is the most sophisticated and recent development in acupuncture needle use: Percutaneous Electrolyse Therapy

Bian stone [1]

Bian stones are pointed stones that were historically used in traditional Chinese medicine. They are generally considered to be a precursor to acupuncture, utilising heated pointed stones (instead of acupuncture needles) in the treatment of back and neck pain. The stones are made from a variety of materials found along the coastline of Shandong,China.

Bian stone therapy is one of humanity’s oldest medical practices. The Bian-stone technique refers to the use of stone-based equipment to perform massaging, heating and other operations. The devices are called bian stone tools. Bian-stone includes both the bian-stone technique and the tool. When used in medical institutions for therapeutic purposes, it is referred to as Bian-stone treatment.

Before acupuncture and moxibustion appeared, ancient Chinese people selected certain kinds of stone and ground it into a therapeutic tool that featured a sharp tip or an edge. Such shapes allowed the stone to be applied to the human body in different ways. The puncturing and pressing methods eventually evolved into acupuncture, while the heated-stone application evolved into moxibustion.

Percutaneous Electrolysis Therapy [2]

Or EPTE is an innovative technique that involves applying a modulated direct electrical current directly to damaged soft tissue via an acupuncture needle , inducing the tissue’s recovery. Percutaneous Electrolysis Therapy induces our body’s own healing reaction in the treated area. The whole procedure is performed under guidance of echo.

Johanna Biemans

Variations in needling:

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1. Bian stone therapy

2. Percutaneous Electrolysis Therapy

Original blog from John Stan, Eastern currents, Canada

Common knowledge tells us that “you get what you pay for”. In China, while labor is cheap, it is the other aspects of manufacturing that are variable. Those aspects include the type of metal used to make the needle, sharpening methods, the type of Sterile Room the needles are assembled and packaged in, and the quality control standards in place at each level of manufacturing.


Stainless steel comes in a variety of grades and it is one of the key cost factors. Different grades of surgical steel have different properties, which may affect the quality of your treatment.

Lubricants may or may not be used. Types and qualities vary and will affect the cost of the needle.

Manufacturing Facilities:

Manufacturing facilities vary greatly. Very low-end needles are outsourced to individuals for sharpening, or to facilities with little or no quality control, and then brought back to the main factory to be packaged and sterilized. Mid-range facilities use better quality control, and a 100K sterile facility for finishing the needle and packaging. A 100K sterile room allows for 100,000 airborne particles per cubic meter. Better yet, some facilities are manufactured in a 10K sterile room.

Read more

Being sensitive to the effect of the needle

Categories: All about needles
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A publication in the BMJ shows that male and female reactions to acupuncture at the well-known acupuncture point GB 34 might differ.
These findings underline the premises from Chinese Medicine that each individual has to be needled in a individualised manner. This requires the appropriate skills of the practitioner and the choice of the right needle.
The blog below illustrates this sensitivity to the needle very obviously.
from John Stan, Eastern currents, Canada.

As a practitioner, you need to assess your style of needling and challenge yourself to adapt your style to each patient that walks in your door.
Each type of needle has certain features that you can match to the patient and their situation. In many schools, students will use only one or two styles of needles, but are not taught that certain needles are more beneficial for some patients.
Read complete blog

Picture: Acupuncture in Medicine

More than one kind of acupuncture.

Merely by accident I came across two acupuncture books this week. One is the revised and expanded second edition of Medical Acupuncture written by Jacqueline Filshie & Adrian White with co-author Mike Cummings. Medical acupuncture is the branche in acupuncture that takes distance  from the traditional theories and seek explanations from within western medical perspectives. It is promised to be a science-based compendium that provides the trained practitioner with all the latest research on the effectiveness of WMA and its associated mechanisms, techniques, clinical practice and evidence. Medical Acupuncture demonstrates a variety of needling techniques and clinical applications within the context of WMA and its evolution from traditional Chinese acupuncture using current knowledge of anatomy, physiology and pathology alongside the principles of evidence-based medicine.

The other book that caught my eye was intuitive acupuncture by John Hamwee. Herein the role of intuition is  identified in acupuncture training as one of the keys to effective practice. John Hamwee  explores its paramount importance in diagnosis and treatment, showing how development of the intuitive sense, and its appropriate use in the treatment room, is vital to building the most effective individual practice.

The search for the appropriate adjective or what is the true acupuncture?

These are just a grip out of the many adjectives acupuncture might have. Every acupuncturist will have his or her preference and arguments for the  chosen approach or might even combine several in practice. Is one more ‘true’ than the other. And can science give us the answer in this issue? Or is it a matter of taste and are both valid.? In other words: what is the right adjective when it comes to acupuncture. During The Journey of the Needle we will explore several variables and zoom in on these aspects.

Needles with silicone? Really?

I would like to use the occasion to shortly (the subject is vast) address what is perhaps one of the most overlooked elements in acupuncture (at least in the needling aspect of acupuncture). When it comes to the variety of acupuncture needles available in the market, there is a generally ignored detail concerning the silicone coating added to the needles. By far the majority of acupuncture needles sold in Europe comes with a silicone coated tip. This coating is meant to ensure a smooth and painless penetration into the skin. The silicon coating is antiallergic and completely invisible to the human eye. Its use is furthermore common practice in the (western) medical practice for injection needles and cannulae. Still, by dealing with acupuncturists on daily basis I have come to the realization there is a large group of practitioners who simply ignores this detail about the needles they work with.

Read more: Don’t ask don’t tell

Blog from Dirkjan Heijne Docsave GmbH