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For those seeking acupuncture therapy

• Discuss with your primary medical physician your illness and treatment options.
• Be sure to inform him or her of the desire to seek alternative therapy. 
  
• In your initial meeting with an acupuncturist, ask about his or her training,
  quantity of experience, philosophy and technique.
  
• Prior to initiating therapy, make sure you understand the proposed benefits and risks of acupuncture.  Address all issues that may concern you, such as pain, positioning, type of needles used, form of stimulation, duration of treatments, and number of treatments he or she believes will be necessary.

What to expect

Positioning
The practitioner will place you so that the needles will not be disturbed
following placement.  This may include lying, sitting, and/or disrobing. 
Occasionally, a practitioner will place the needles through your clothes.

Locating acupoints
Provided your practitioner adheres to traditional practice, he or she will
locate acupoints locally and distally along your specific dysfunctional channel.  The practitioner will palpate bony landmarks to guide their way.  Occasionally,
an electronic device may be used to locate acupoints.

Preparation
Some practitioners will swab the areas prior to needle insertion.  However, this may or may not be important as alcohol takes nearly 10 minutes to cleanse the area.  Your practitioner may or may not use gloves as the needles are so thin, gloves offer no protection from puncture. 

Insertion of the needles
A plastic sheath surrounding the needle, or introducer, may be used.  This aids the practitioner as he or she taps the needle into place.  Insertion may be painless, or may be accompanied by a sharp sensation.  Once in place, usually a certain dull, achiness or tingling (known as De Qi) develops at the site and may radiate about the site or through a channel, depending on the stimulation.  Occasionally a dimple or erythema may develop about the needle.  This may be normal and not a cause for concern.

Stimulation and duration of therapy
The type and duration of the stimulation is practitioner-dependent and should be discussed prior to initiation. 

• Manual:  Needles will be rotated in place at various intervals and intensities, which may or may not increase the dull achiness perceived at initial insertion.
• Electrical:  Needles will be attached to an electrical output device which is usually controlled by the patient.  With the application of current, a tingling achiness is generally perceived by you, the patient. 
• Pecking:  Needle is gently pulsed up and down.  Generally used for periosteal stimulation.  May elicit brief, sharp sensations of pain.
• Warming: (Moxibustion) Needles are warmed by smoldering herbs.
• Aculaser: No needles are used. The acupuncture points are stimulated by a laser.

With stimulation the dull achy sensation may progress to drowsiness or euphoria.  It is also possible to not have any sensation at all.  Duration of therapy is also at the practitioner's discretion.  Usually the needles will remain in place for 15-20 minutes.

Withdrawl
Needles should be withdrawn in rapid, single-handed movement by your practitioner.  This should be relatively painless.  Occasionally a needle is gripped by the muscle and is difficult to remove.  Do not panic!  Usually it takes just a few minutes for the muscle to relax and release the needle.  Rarely the practitioner will place another needle locally to induce relaxation.  Occasionally a small lump will develop under the skin, called a hematoma.  A hematoma formation or slight bleeding is no reason for concern, as these do not constitute serious complications, but may leave a bruise.

Results
Most patients experience a transient improvement of symptoms for 2-3 days.  It usually requires 3-6 treatments to achieve longer-lasting results.  Some
conditions (usually chronic) require additional treatments at longer intervals
to maintain relief.  Occasionally patients experience an initial aggravation of symptoms.  This is self-limited, lasting 2-3 days.  If this occurs again following the second treatment, therapy should be stopped.  Rarely it occurs that a patient has no response at all.  This should not be determined by lack of immediate response to local therapy but the persistence of symptoms.  If there has been no progress following the third treatment, acupuncture should be abandoned. 

Strong Reactors to Acupuncture
These patients are characterized by liveliness and an artistic temperament. 
They are described as alert (all children considered strong reactors) and often
have environmental sensitivities or a history of reactions to drugs and/or
alcohol.  These patients need to be treated lightly and instructed not to drive
home immediately following therapy.  Their sensitivity tends to be persistent
over time. 

For further internet references see:

www.acupuncture.com

www.medical-acupunctur.co.uk/

www.acupuncture.edu/layman's

www.demon.co.uk/acupuncture/