Today’s topic is important to me because as I talk to the people around me about my Traditional Chinese Medicine (TCM) consultations, I get asked this set of questions a lot. I personally think it’s a relevant one that deserves an entire post to answer. What exactly is the difference between acupressure and acupuncture? How does it work and is one more effective than the other? In what cases are these practices useful? I will give you some foundational explanations to help you understand these healing modalities, how they relate to the TCM system, as well as some personal insights with them to better understand what my practice looks like. Let’s jump right into it and take a look at acupuncture and acupressure.
When I applied for a scholarship to study mandarin and TCM in Shanghai, I had no idea of what that actually implied. My first real encounter with TCM was on a school trip to China where we got to visit a Chinese pharmacy and wander around looking at the glass jars filled with herbs and insects (and more strange medicinal ingredients). I got to learn about the basic theories of yin and yang, of the five elements and of the cooling and warming properties of foods. So as I signed up, this was the mental image I had formed: I was going to learn some theory, and if I was lucky I would perhaps be introduced to some herbs I could use in my daily life. Acupuncture was not part of the picture at that point. When my course started and I began to learn more, my understanding of TCM expanded. I was taught that decoctions and acupuncture are part of a greater set of TCM practices.
In my very first class, I was immediately captivated by the holistic approach to health and well-being. TCM is so much more than bitter-tasting herbs and needles. It can be thought of as a pyramid of practices, arranged from the most foundational to the most potent practice.
At the base of the pyramid is what they call Diet Therapy and Health Cultivation. This stresses how important diet and every day healthcare are important in this system. If you step foot in China or in a Chinese environment, it’s obvious to see how deeply embedded in the food culture this is. Although they didn’t have extensive knowledge about vitamins or micronutrients back in the day, the TCM nutritional principles are impressively comprehensive and detailed. There are so many minor imbalances which can be addressed with food, and they seem to have figured that out very well. The nutritional principles they use make a lot of sense to me. Apart from food, it’s to this day pretty common for Chinese people to do regular warm foot baths, lymphatic self-massage, oilation of hair and skin and more. Most of these are nowhere to be found in the western habits (especially in my generation and my parents’). Having these principles as a foundation illustrates well the preventative nature of this healthcare system.
Second comes Tai ji 太极拳 and Qi Gong 气功, the movement practices connecting the mind and body through breath. I won’t go into the details of it as my knowledge and experience is minimal. Because Qi Gong was restricted and repressed for many years by the government, Tai ji is way more democratized than Qi Gong and practiced everywhere in China, as a (sometimes) mandatory practice at school, or by (mostly) older people in public parks. It makes me so happy to see how democratized and accessible this subtle energetic practice is! This cultivates a knowledge and sensitivity to energy beyond the physical, which is what then brings people to the other practices of TCM.
Third comes Tui Na 推拿, the Chinese massage and bodywork. Again, I have not formally learnt how to practice this, but it is where acupressure would fit in. There are multiple massaging techniques, practiced without oil, mainly through a cotton sheet placed on the patient. Tui Na helps release tension in muscles, tendons and connective tissue. It uses the meridians and acupoints to do therapeutic treatments beyond body aches. Emotions are believed to be stored in the organs and the connective tissues, which are prevalent in literally any part of your body to some extent. This is why bodywork like Tui Na, which emphasizes on stimulating connective tissues, is effective to release emotions. As we speak of acupressure in a western context, it’s interesting to note that acupressure per say doesn’t count as a stand-alone pillar of TCM, but it’s definitely practiced within Tui Na.
Forth comes acupuncture. Its main use is to even out the yin and yang aspects of our existence and restore the free flow of qi and blood, which regulates all physical and emotional functions of the body. All disease and dysregulation comes from a relative imbalance of yin and yang, where one part may be in relative excess or in relative deficiency, leading to the dominance of either yin or yang. According to the diagnosis, certain acupressure points located on different meridians are punctured with thin (0.20 to 0.30 mm) single-use needles. Depending on the location, the needle goes either just through the skin or into muscle fibers, tendons and ligaments. Sometimes it lightly pokes (but doesn’t damage or penetrate) a nerve or an organ on purpose. In fact, that nervous stimulation is part of the treatment! In modern clinics, it is common to have electrodes connected to the needles which send out tiny electrical current spurts to enhance the treatment. Traditionally the doctor stays with the patient for the duration of the treatment to regularly tap, twist and lightly lift up and down the needles to keep the stimulation steady. But considering the average number of patients doctors treat per hour it’s simply impossible to give that kind of individual attention, hence the electrical stimulation.
Each point has a specific function and is used for a variety of pathologies, either directly in the local area or on the meridian related to the disease patterns. By stimulating a point, the blood flow increases in that area, which efficiently removes qi stagnation or any excess of qi in a meridian (which often but not exclusively manifests as pain). Despite the different needling techniques that help achieve different results, acupuncture isn’t that efficient to build yin or yang qi in case of a deficiency. That’s why in clinical practice it is almost systematically complemented by moxibustion, also called moxa. A thick stick of dried mugwort, a Chinese medicinal herb, is burnt to create radiating heat and is placed over certain points or areas of the body. The warming and drying nature is especially effective at building yang qi.
Other practices like Gua Sha 刮痧 (scraping) and cupping, which I’ll get into some other time, are practiced within acupuncture clinics as complimentary modalities.
Finally, at the top of the pyramid, is the most potent healing modality, medicinal herbs (Zhong Yao 中药). Most ailments and imbalances can be treated with Chinese herbs, as there is an immense variety of medicinal compounds which are administrated through powerful decoctions and concentrated extracts. It is an overwhelmingly advanced science which takes years to learn and master all the different decoctions, dosages and combinations. I personally have so much admiration for Chinese herbalists. I got to hang out with proper TCM students on the main campus of my school and I’ve had a glimpse into what it takes to study herbal medicine: a lot of time and memorization skills.
My main points of comparison
The point of presenting you with the whole context of the TCM system was to understand that acupuncture is a stand-alone pillar of this system and considered a very effective practice, while acupressure isn’t recognized as an independent practice, but would fall under the umbrella of Tui Na techniques. When acupuncture is thoroughly taught to competent doctors and needle insertion is commonly accepted by the population for treatment, it only makes sense to use the most effective mode of treatment. Because yes, to put it simply, acupuncture is generally a more effective treatment than acupressure.
What exactly do I refer to when I say acupressure? It’s simply applying the same diagnosis method and instead of using needles, the practitioner presses on one or two acupoints at a time with thumbs, fingers or elbows for at least a minute. It’s less invasive than acupuncture, which makes it accessible to more people. I’ve lost count of the number of people who have told me they’re afraid of needles! In that case acupressure can be an alternative which still achieves similar effects.
Because here’s something cool to know. Acupoints are both an incredibly precise science and an estimated location. When I was taught how to locate points, my teachers were extremely specific in their description and would correct us by pressing into the points on each student to make sure we got it. Which, in the context of acupuncture, is necessary: since the needle is penetrating the skin, it’s important to get the location right to prevent poking veins or delicate tendons. For some points such as on the wrist crease, the needle is inserted between a vein and a tendon, which requires a precise needle insertion. However, the reason why acupressure also works is that many acupoints are found on a “larger” area, and when pressing into a point with a thumb, it’s easier and more likely to get it right. In practice, an acupoint is unique to every individual: sometimes it only takes moving your finger by half a millimetre for the patient to then feel it. What’s important isn’t the location per say, it’s that the patient gets the sensation.
This sensation I’m referring to is called De Qi 得气, which means “needling sensation” or “arrival of qi”. When the needle is inserted, qi rushes through the meridian and blood system to and from the point, creating a sensation described as suan (aching or soreness), ma (numbness or tingling), zhang (fullness, distention, or pressure), or zhong (heaviness). De Qi can also be felt by applying pressure, which explains why acupressure also works. But the feeling of De Qi is most consistently accomplished through acupuncture. What also makes acupuncture more precise are the various techniques that can be applied to enhance stimulation, whereas acupressure is simply about applying pressure and slightly massaging around until it can no longer be sustained. Acupressure is more tiring and demanding on the fingers wrists and arms, which is a limitation of the practice and its efficacy.
If you’ve come so far, it may sound like I’m heavily making a point for acupuncture being the better choice. While this might be mostly true, I want to get into why, as someone who has studied acupuncture, I love acupressure and practice it in my consultations. Firstly, I’ll be very practical and mention that legally, I’m not allowed to practice acupuncture professionally in most EU countries as I do not have a medical license. Acupressure however isn’t state regulated since it’s considered as a “massage” *eye roll*.
Apart from the efficacy factor, what are the benefits of acupressure over acupuncture? Like I mentioned, it’s a great alternative for people who are afraid of needles. Some points, especially on the hands, feet and face, can be painful or scary to puncture. In these cases, acupressure will give access to the healing applications of a point with a lesser intensity, without causing stress and apprehension for the patient.
I also believe that half of the treatment is determined by the practitioner’s actions and the other half is determined by how well the patient can breathe into and concentrate on the point. When we press into a point, a physical sensation arises and it naturally brings the patient’s awareness to the point. We can heal many things, physically or emotionally, by simply bringing our attention to it for some time. Acupressure helps us do just that with minimal interference with the internal body.
Finally, the exchange between the practitioner and patient is very different between these two modalities. During an acupuncture treatment, the practitioner inserts the needles, if not using electrodes they might come move the needles around slightly, but then the contact ends. It’s common that the doctor won’t come check on you until the end of the 20 minutes of needling. When practicing acupressure however, the practitioner stays fully involved with the patient, asking for feedback, interacts and keeps physical contact throughout. I firmly believe in the power of physical touch. As we become more and more individualistic and isolated, we as a society forget how important touch is. Thanks to acupressure’s accessibility, it’s a great practice to normalise non-sensual touch, which we all need more of. Taking the time to sit down with someone and hold space for them to explore sensations through touch is as transformative as the treatment itself.
To conclude, there is no easy answer to this and people’s experience with acupuncture and acupressure will vary greatly. Although I learnt acupuncture first, it has been a revelation to learn how to use my hands in a new way through acupressure. Because of legislation, I sadly cannot practice acupuncture for now (unless we keep it as a secret between you and I ;) ), which is why I’m grateful for acupressure and I hope to introduce more people to it. If you want to be one of them, feel free to reach out to me or book directly here.
Let me know in the comments if you have more questions, or share what your experience with either acupressure or acupuncture, I would love to know!
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