Acupuncture For Vāta
An examination of whether acupuncture is an appropriate therapy for vāta constitutions
As the oldest system of medicine, Āyurveda is also considered the origin of “surgery”. Suśruta’s Samhita describes various surgical procedures, ranging from bloodletting to cataract correction. Heralded as the father of surgery, Suśruta was also the first to describe points of energetic focus on the body which he referred to as marmāni––literally “vulnerable points”.
Suśruta’s Marma Paradigm
Suśruta described 107 marma points in his text, but he did not describe specific therapeutic interventions in relationship to them. Rather, his descriptions primarily serve mostly as a cautionary tale for surgeons. Suśruta advised that marma points should not be punctured while performing surgical procedures. The inadvertent puncturing of marma points would result in a weakening of the patient’s life-force and thus impede their recovery. In the worst cases, puncturing of certain marma points could be fatal. This understanding was also active in the context of Indian martial arts where the knowledge of marma may have originally come from.
Although Suśruta does not give us a clinical technique for treating marma points, he does give the theoretical basis for doing so. Suśruta describes marma points as the intersection of dosha, dhātu, and nādi. Similar to acupuncture points, marma points are regarded as physiological junctures from which systemic balance can be directly influenced. In contemporary Āyurvedic practice, marma points are treated with essential oils, herbal pastes, acupressure, and energetic touch. This approach is described in Vasant Lad’s text, Marma Points of Ayurveda. My teacher, Vaidya Mishra, taught a form of marma therapy preserved in his family lineage. Vaidya described marma points as the intersection of microcosm and macrocosm. He taught that by influencing marma points, we can treat imbalances of all kinds and re-connect the human being to the larger flow of universal energy. The concept of treating energetic loci as a means for influencing physiological balance is, in fact, central to the practice of acupuncture .
Āyurvedic views of acupuncture
The rise of acupuncture in the West raises questions for modern Ayurvedic practitioners. For one, Suśruta’s caution against needling leads Ayurvedic practitioners to develop a bias against needle therapies. A theoretical explanation for this bias is the perception of acupuncture as an invasive and rough therapy, categories of intervention that Āyurveda supposedly avoids. However, Āyurveda actually features a multi-modal approach that includes rough and invasive therapies. Ayurveda’s hallmark pañcakarma therapy is certainly invasive and intensive, featuring a succession of emetic, purgative, diaphoretic, and laxative therapies. Additionally, Ayurvedic classics describe practices such as bloodletting (rakta mokshana) and metal-rod cauterization therapies, although these therapies are not practiced in the West.
Dr. Vasant Lad speculates that Āyurveda disfavors needling because of the principles of ahimsa. I can appreciate the idea of puncturing as “violent” and akin to warfare, but Āyurveda is neither wholly ahimsa nor against the idea of "warfare” given its emphasis on treating with opposites. Interestingly, my teacher, Vaidya R.K. Mishra, also spoke critically of acupuncture. He re-iterated Suśruta’s dictum that marma points were by definition “vulnerable” and absolutely should not be needled.1
Āyurvedic Anatomy
The objection to acupuncture on the grounds of it being a rough and invasive therapy is not a truly Āyurvedic form of logic. A more reasonable explanation for this suspicion is the fact that Suśruta’s clinical interventions have been lost in contemporary Āyurvedic practice.2 Given this, it seems the Āyurvedic context could easily accommodate the notion of a needling therapy, as the methodology of skin-puncturing in various forms is classically established.
Āyurveda describes the human being a multi-dimensional process. In recent time, Āyurvedic anatomy has been influenced by Vedānta, specifically Shankara’s exposition on the five koshas. This model establishes the human being as a primarily subtle process. The prānic body is described as a sheath that immediately surrounds and pervades the physical body through of a network of 72,000 nādis. The term nādi means “current”, “channel”, or “river”. This fluid metaphor for energetic flow would also be envisioned by the Chinese when they described the twelve meridians as rivers. Although Āyurveda asserts a complex subtle anatomy, it clinically emphasizes three primary channels3 (suśumna, ida, pingala) and six chakras which serve as “wheels” of energetic focus with accompanying elemental correspondences. For this reason, Chinese meridian theory has no parallel in Āyurvedic anatomy or physiology. Marma theory can be seen in parallel with acupuncture points, but marma points are not described in relationship to energetic channels of any kind.4
A constitutional approach to acupuncture
Some Āyurvedic practitioners express concern that acupuncture aggravates vāta and therefore is not an appropriate therapy for vāta constitutions or during times of vāta imbalance. This is a reasonable position, but it overlooks the mechanism and dynamic of acupuncture. In Āyurvedic terms, the mechanism and dynamic of acupuncture is directly linked to prāna. Of the three doshas, vāta’s function is closely linked with the circulation of prāna. Therefore, acupuncture can be argued for as a direct treatment for vāta itself. However, vāta is comprised of rough, light, dry, and mobile qualities and needles are also rough, light, dry, and mobile. Since Ayurveda functions in a therapeutic paradigm of opposites, it sees the interaction of similar natures as inherently imbalancing. Thus, vāta benefits from gentle, smooth, stabilizing, and unctuous therapies such as oil massage and steam therapy. In this line of thinking, acupuncture would be considered more suitable for kapha and pitta constitutions.
This understanding is echoed in Tibetan medical texts which describe bloodletting as a rough therapy, unsuitable in cases of vāta imbalance. This does not mean bloodletting cannot be administered to a person of vāta constitution, rather it indicates the clinical application of bloodletting in excess conditions, whereas vāta conditions are typically deficient in nature and thus aggravated by any loss of blood. Tibetan texts also describes various preliminaries and precautions that are employed to make bloodletting more suitable for all constitutions in the event that it is the indicated therapy. A common convention of Tibetan medical texts is to provide extensive guidelines and proper antidotes that allows all such guidelines to be bypassed. This means that instead of categorizing acupuncture as a rough therapy, we should consider ways these rough qualities can be antidoted, which brings us to the consideration of style and technique.
Choosing the right style of acupuncture
Given the diverse nature of acupuncture styles and techniques, it is difficult to reach a singular conclusion about its compatibility with vāta, doshically and constitutionally. Acupuncture styles that employ deeper needling techniques with stronger stimulus are inappropriate for vāta constitutions, who will find such interventions to be invasive, painful, unsettling, and depletig. Japanese acupuncture styles favor subtle needling techniques, including non-insertive techniques that avoid puncturing the skin. Non-insertive interventions are only energetically perceptible to the patient, allowing the patient to fully relax while still receiving the benefits of acupuncture treatment. The gentle bodywork-oriented approach of the Japanese seems designed with the vāta patient in mind. Japanese acupuncturists also favor the use of moxa more than other practitioners, the use of which is profoundly vāta-pacifying. In fact, practitioners can and should consider treating vāta constitutions entirely with moxibustion.
The importance of considering constitution in treatment is established in the the Chinese classics. The classics state that thin patients only require superficial needling because their qi is on the surface while heavier patients require deep needling because their qi is deeper. But this idea can b
e misapplied based on appearances where anomalies always lurk under the surface. I propose that Āyurvedic constitutional theory can be applied here to determine appropriate style and technique for the patient. Instead, I have often seen acupuncturists persisting in treatment when a sensitive patient is clearly contracting and struggling with painful and stimulating needle sensations, thinking that this is just how acupuncture is. Practitioners should adopt a flexible clinical approach that allows for truly personalized treatment rather than the projection of a personally-favored approach onto patients.
Conclusion
Mysteriously enough, I find that acupuncture accomplishes the goals of Āyurvedic therapies, directly and efficiently. Regulatory laws in the United States prevent Āyurvedic practitioners from practicing acupuncture, but it is something an Āyurvedic practitioner should consider learning to expand their clinical scope. The practice of moxibustion alone is invaluable especially in states where its practice is permitted without licensure. Vāta patients should seek out a gentle Japanese acupuncture style such as Meridian Therapy or Toyohari. (Five-element acupuncture can be very helpful as well depending on the practitioner’s needle technique). Acupuncture can also be done purely with moxa or with a combination of moxa and teishin,5 an approach which deserves serious consideration for the needle-sensitive vāta patient. Ultimately, we may discover how acupuncture can be seen, understood, and appreciated with an Āyurvedic lens. At the very least, my hope is that Āyurvedic practitioners will consider the right acupuncturists in their referral network and that acupuncturists will consider constitution alongside a flexible approach to technique.
Here, one could argue that marma points are not the same as acupuncture points, but they overlap so significantly in theory and anatomy that it is difficult to see them as disparate concepts.
Suśruta’s practices are very well-preserved in Tibetan Medicine and regularly practiced by Tibetan physicians in Himalayan regions.
Suśumna, Ida, and Pingala.
In the Mawangdui silk texts, the earliest record of Chinese medical literature, energetic channels are described without any point descriptions. These texts pre-date the advent of needling acupuncture and only feature descriptions of moxibustion therapy and herbal medicine. This suggests that acupuncture points were a later discovery in the history of Chinese medicine, a theoretical evolution that seems precisely the inverse of Āyurvedic trends which describe points without channels. Tibetan medical texts describe over 500 moxibustion points, none of which are seen in relationship to energetic channels.
Teishin is a needle-like tool made from silver, copper, or gold. It is used with non-insertive techniques on acupuncture points in Japanese styles. If we apply an Āyurvedic understanding to metal alloys, then we gain a further differentiation for the patient: silver is cooling and appropriate for pitta, copper is neutral and appropriate for vāta, gold is heating and appropriate for kapha.
Speaking as an acupuncturist myself and someone who's studied Ayurveda, this is a really thoughtful, insightful post on the relationship between the two. Clinically, I tend to use thinner needles on Vata patients and to choose specific acupuncture treatments that are more supplementing/tonifying in nature. I find Vata patients respond quickly and rapidly to treatment. The downside is things can go downhill just as quickly whether due to a wrong treatment or through the patient's own choices. Slow and steady--and gentle--gets there in the end...