Acupuncture for Nerve Pain & Sciatica in San Francisco

New weakness needs medical assessment before acupuncture

Call 911 for sudden facial drooping, weakness on one side or trouble speaking. Do not assume a new drooping face is Bell's palsy. With back or leg pain, new bladder or bowel problems, numbness around the groin, or severe or worsening weakness in both legs need emergency care.

Sources: NINDS stroke warning signs; NHS sciatica guidance.

I start with the diagnosis and what you cannot comfortably do

I spend 30 minutes on the examination. Bring the date symptoms began, your medication list and any neurological assessment, scan or nerve-test report. We talk about where the pain or numbness travels, whether it is changing, and what it interrupts: walking to the bus, fastening a button, sleeping or eating.

I check the affected area's movement and sensation and compare these with your medical assessment. Pain, numbness and weakness need separate attention. Feeling less pain after a visit does not show that a damaged nerve has healed, and new or increasing weakness goes back to your medical clinician.

Before treatment, we choose a goal and a reassessment date. For sciatica, that might be walking farther with less leg pain. For shingles pain, it might be tolerating clothing or sleeping with fewer interruptions. If there is no useful change, we reconsider treatment rather than keep adding visits.

The evidence and treatment course differ by diagnosis

Sciatica treatment should improve leg pain and daily movement

Drawn front of a lower leg with GB 34 marked below the outer side of the knee and GB 39 above the outer ankle. — Two lower-leg points used in the sciatica trial. Point selection also depended on where the leg pain travelled. This illustration explains treatment locations, not a home-needling routine.

Acupuncture has trial evidence for chronic sciatica caused by a herniated disc. In a 2024 trial across six Chinese hospitals, leg pain fell by about 31 points on a 100-point scale after acupuncture, compared with 15 after sham treatment. The study used ten sessions over four weeks; a difference remained at one year.

Leg pain drop at four weeks, chronic sciatica from a herniated disc

Millimetres on a 100 mm visual analogue scale; larger is more relief

Tu and colleagues, JAMA Internal Medicine, 2024. Six hospitals in China; 220 people randomised, 216 analysed. Ten sessions over four weeks. Patients and assessors did not know the assignment. The chart shows average pain reduction, rounded; it does not show how many patients were cured.

That supports a defined trial of treatment for this diagnosis. It does not show that acupuncture repairs the disc or treats every cause of pain down a leg. Your exercise, rehabilitation and medical plan remain part of care.

For pain after shingles, the average added benefit is modest

Postherpetic neuralgia is nerve pain that persists after shingles. The 2026 Chinese multidisciplinary consensus brings medical assessment and Chinese medicine together; it is not a reason to stop prescribed pain care.

A 2026 Chinese trial of 448 adults compared electroacupuncture, a mild current through the needles, with sham treatment. After twenty sessions over four weeks, about 47% versus 24% had at least a 30% reduction in pain. The average difference between groups was only 0.53 points on a ten-point scale, below the authors' later estimate of a meaningful difference. Follow-up lasted another four weeks.

We discuss that time commitment and track your own response, including sleep and sensitivity to touch. The study tested body electroacupuncture, not cheek acupuncture. A new shingles rash needs medical care; this evidence concerns persistent pain, not treatment of the infection.

Trigeminal neuralgia care stays coordinated with your prescriber

Drawn front view of a face with four points marked on one side: ST 2 below the eye, ST 7 in front of the ear, ST 4 beside the mouth and ST 6 at the angle of the jaw. — The facial points shown were among those used in the Zhejiang study. Treatment was adapted to the painful branch of the nerve; not every patient received the same set.

Trigeminal neuralgia causes brief attacks of facial pain that can make chewing, speaking or brushing your teeth difficult. A medical diagnosis matters before treating facial pain as a nerve problem.

In a 2024 trial at two Zhejiang hospitals, 120 people received active or sham electroacupuncture and low-dose carbamazepine or a placebo tablet. The combination of active needling and medication produced the largest pain reduction. Treatment ran three times a week for four weeks, with follow-up to week 28.

This supports discussing acupuncture as an addition, not changing a prescription to match a trial. I ask you to track the attacks and the activities that trigger them, and share progress with your prescriber.

Diabetic neuropathy needs foot protection as well as symptom relief

Drawn front of a lower leg with ST 36 marked below the kneecap, outside the shin bone. — ST 36 below the knee and SP 6 above the inner ankle are among the points in the Shanghai consensus. These are examples of treatment locations, not instructions to treat a numb foot yourself.

Drawn inner side of a lower leg with SP 6 marked above the inner ankle bone, behind the shin bone. — ST 36 below the knee and SP 6 above the inner ankle are among the points in the Shanghai consensus. These are examples of treatment locations, not instructions to treat a numb foot yourself.

Numb or burning feet need a medical assessment, even when you already have diabetes. The Shanghai Society of Traditional Chinese Medicine's 2025 acupuncture consensus calls for checking other possible causes and assessing sensation and reflexes before choosing treatment. It describes acupuncture care and ways to measure response; it does not establish that needling reverses nerve damage.

At Puzzle, we track pain, sleep and everyday function alongside your diabetes care. Nerve-conduction tests, when your clinician needs them, measure electrical signals; they are not interchangeable with how safely you walk or whether you can feel an injury. Keep your diabetes team's foot checks and foot-protection advice, and have a sore or wound assessed rather than needling over it.

Bell's palsy needs prompt medical treatment and eye protection

Points near the ear used in the Jiangsu study. The researchers changed the treatment as recovery progressed; the illustration is not a universal first-week prescription.

Once Bell's palsy is diagnosed, medical care should start promptly. The American Academy of Otolaryngology guideline recommends steroids within 72 hours for eligible patients aged 16 and older, and eye protection when the eyelid cannot close. Your medical clinician decides about medication; acupuncture must not delay it.

A 2025 Jiangsu hospital study found better four-week facial-function outcomes among people who began acupuncture in the first week than among those who began later. This was a matched observational study, not a randomised trial, and both groups received medical treatment. It cannot show how much recovery came from acupuncture itself.

If we add treatment, we track eye closure, drinking and facial movement alongside your clinician's assessments. Persistent weakness or new symptoms need follow-up, not an assurance that more needles will restore the nerve.

Chemotherapy symptoms and stroke recovery stay with the specialist team

Report new numbness, burning or difficulty walking during chemotherapy to your oncology team. The 2022 Society for Integrative Oncology–ASCO guideline allows acupuncture to be offered for chemotherapy-related neuropathy, with a weak recommendation based on low-quality evidence. We discuss whether it fits your treatment, blood counts and infection or bleeding risks. I do not promise to prevent chemotherapy nerve damage.

After a stroke, physiotherapy, occupational therapy and the medical rehabilitation plan lead care. If you want to add acupuncture for a particular symptom, we agree on that goal with the rehabilitation team. A reduction in pain is different from regaining strength or relearning a movement.

Chinese medicine patterns guide treatment, not the medical diagnosis

I also ask about sleep, digestion, fatigue and how symptoms change through the day. Chinese medicine groups these findings into patterns such as heat, stagnation or deficiency. These are traditional ways of planning treatment, not proof that a nerve is blocked, starved or damaged by cold air.

Herbs need a separate decision and a complete medication list

I may consider a formula alongside acupuncture, but herbs are not an automatic part of nerve-pain care. The choice depends on your symptoms and the medicines you take, including blood thinners, diabetes medicines and cancer treatment. Your prescriber or pharmacist should review the complete ingredients and doses before a formula is added.

The photographs show ingredients used in Chinese formulas. They are not six individual remedies for neuropathy, and a traditional description such as “moving blood” is not evidence that an herb restores circulation to a damaged nerve.

Huáng qí astragalus root

Bái sháo white peony root

Gān cǎo licorice root

Táo rén peach kernel

Hóng huā safflower

chuanxiong rhizome, dried rhizome slices

Chuān xiōng chuanxiong rhizome

Photographs: An.ha (CC BY-SA 3.0), via Wikimedia Commons. Each is a round crop from the source photograph.

Bring supplements as well as prescriptions. Natural products can interact with medication, and ingredient quality matters. NCCIH's herb–medicine interaction guidance explains why the full list needs review.

Cheek acupuncture and FSN have different roles from the body-needling trials

Cheek acupuncture can avoid an area that is too sensitive to touch

Cheek acupuncture uses a small number of shallow needles on the face, following a treatment map for other parts of the body. It is not cosmetic facial acupuncture. I hold the Level 3 certificate and may offer it when direct needling of a painful area would be uncomfortable.

The map explains the technique; it is not a map of anatomical nerve connections. Published nerve-pain case reports cannot establish how reliably it works. The sciatica, shingles and facial-pain results above do not prove the same results for cheek acupuncture.

How cheek acupuncture works

FSN may help accompanying muscle pain, without proving nerve repair

Illustration of the muscles of the upper back seen from behind, with an FSN needle entering at the top of the shoulder. An enlarged cross-section beside it shows the needle lying flat in the myofascial layer between the skin and the muscle. — FSN works in the shallow tissue beneath the skin. The illustrations compare its placement with conventional needling.

Cross-section of skin comparing two needles. A traditional acupuncture needle goes straight down through epidermis, dermis and myofascial layer into the muscle. The FSN needle enters at a shallow angle and stops in the layer above the muscle. — FSN works in the shallow tissue beneath the skin. The illustrations compare its placement with conventional needling.

FSN means Fu's Subcutaneous Needling. I use a shallow needle beneath the skin while guiding movement, then check whether that movement is more comfortable. I hold the FSN certificate.

A 2024 Chengdu trial of 100 people with lumbar disc herniation found better pain and back-movement results with FSN than conventional acupuncture after a two-week course. It did not compare FSN with sham treatment or show that the disc or nerve had healed.

I may use it when muscle pain accompanies a medically assessed nerve problem. An easier movement on the table is worth recording, but we also check what lasts between visits.

How FSN needling works

Frequently Asked Questions

Does it hurt?

Less than people expect. You may feel a brief prick, ache or heaviness; tell me if anything feels sharp or uncomfortable. A numb area still needs careful treatment, and I avoid needling directly into infected or damaged skin. Temporary soreness or a small bruise can occur.

How soon will I know if it is working?

We agree on a goal and a review date at the first visit. The sciatica and facial-pain trials described here assessed four-week courses, but that is not a fixed prescription for every nerve problem. We track what changes between visits, including pain, sleep and activity. New weakness or worsening numbness needs medical reassessment rather than waiting for the course to finish.

It has been years. Is it too late?

Long-standing symptoms can still be worth discussing, but I cannot promise to reverse nerve damage. The diagnosis, remaining function and treatments already tried matter more than the number of years alone. If we try acupuncture, we set a specific goal and stop or reconsider if it is not helping.

Do I keep taking my medication?

Yes, unless the person who prescribed it says otherwise. I do not adjust gabapentin, pregabalin, carbamazepine or other prescriptions. If reducing medication is your goal, your prescriber decides whether and how to do that. With your permission, I can share what changes during treatment.

Can I have acupuncture during chemotherapy?

Sometimes, with your oncology team's agreement. Tell them about new nerve symptoms first. Whether and when to needle depends on your treatment, current blood counts, skin condition and infection or bleeding risks. Bring your latest results and medication list. Do not add herbs without the oncology team's review.

How many needles?

The number depends on the condition, the technique and your comfort. Most patients are surprised how little is used. We discuss the plan before starting and can adjust or stop if you are uncomfortable.

What does it cost?

The first consult is free. A new patient visit is $255 for 75 minutes and follow-ups are $205 for 60 minutes. Current rates are on the pricing page.