Dry Needling versus Acupuncture in Oregon: What’s Changing and Why It Matters

Recently, there has been a lot of discussion in the acupuncture community about the passage of Oregon House Bill 3824, which allows physical therapists (PTs) to perform a technique called dry needling. The bill generated so many public comments that, when it reached Governor Tina Kotek for signature, she took extra time to consider whether there were legitimate safety concerns. Ultimately, she determined there were not and, like many debates in healthcare, concluded that this was largely a territorial dispute. These disputes aren’t necessarily in the public’s best interest, but they do shape the healthcare environment we all work in. (For example, why your acupuncturist can’t order lab tests!)

Starting July 1, 2027, PTs in Oregon will be able to perform dry needling.

What HB 3824 Actually Says

Governor Kotek’s signing letter clarified two important points:

  1. Dry needling will be limited to treating musculoskeletal pain and movement issues. PTs cannot treat the broader range of conditions addressed by acupuncture.

  2. The state will issue an official bulletin emphasizing that dry needling is not the same as acupuncture for insurance purposes.

What this means in practice:

  • Licensed acupuncturists can perform acupuncture, which includes dry needling techniques,  but must bill under acupuncture codes. As a note to those of you with insurance, these are typically processed as alternative medicine benefits.

  • Licensed PTs can only perform dry needling, but they can bill under a dry needling code (20560/1). This code is often reimbursed at a higher rate and processed under standard PT benefits, bypassing many of the restrictions and third-party administrators (like American Specialty Health) that your acupuncture claims face.

HB 2143 and the Five-Needle Protocol (5NP)

In addition to HB 3824, the Oregon legislature passed HB 2143 (effective March 1, 2026), which creates a registration process for non-acupuncturists to be trained in and provide the Five-Needle Protocol (5NP). This is a standardized ear (auricular) treatment using five specific points: shen men, sympathetic, liver, kidney, and lung.

This is exciting, because the 5NP is most often used to support people experiencing anxiety, trauma, or substance use disorders.

Under HB 2143:

  • Non-acupuncturists, including laypeople, can provide 5NP if they complete approved training and are registered with the Oregon Medical Board.

  • The bill sets sanitation, safety, and disciplinary rules for those registered.

  • Only these five ear points may be used. Registered providers cannot present themselves as practicing acupuncture or use other points.

From a patient’s perspective:

  • HB 3824 expands musculoskeletal dry needling to PTs.

  • HB 2143 opens a pathway for trained, registered providers to offer a mental health–oriented ear protocol.

What’s the Difference Between Dry Needling And Acupuncture? 

I’m going to get there for you! But first, let’s look at what acupuncture points are. 

Understanding Acupuncture Points

In Chinese, an acupuncture point is called a 穴 (xué), meaning cave, den, or hole. This is a spot on the body where sensation, circulation, and physiology converge in a way that can be therapeutically influenced.

There are three main categories:

  • Classical Acupuncture Points — The numbered points along the main meridians, each with unique names, locations, and classical functions.

  • Extra Acupuncture Points — Recognized therapeutic points outside the main meridians, documented in traditional sources.

  • Ashi Points (阿是穴) — Literally “Ah-yes” points, tender spots found through palpation. They are not fixed and may arise anywhere pain, tension, or pathology occurs.

Ashi Points and Global Parallels

Ashi points were among the earliest recognized therapeutic sites, predating the formal meridian system. In ancient China, practitioners pressed or massaged these spots with smooth bian stones before eventually using pine needles, bone and then metal needles inserted into the points.

The concept of treating specific points on the body is not uniquely Chinese and some examples of that are below:

  • Ötzi the Iceman (5,300 years ago) had tattoos aligning with known acupuncture points, likely used to address arthritis, intestinal parasites, and Lyme disease (Kean, 2013; Solly, 2018).

  • India’s Marma points mark vital intersections of muscles, veins, ligaments, bones, and joints, sites said to house prāṇa, or life force (Wu, 2023).

  • Ancient Egypt’s Ebers Papyrus (~1550 BCE) describes targeted therapeutic points (Metwaly, 2021).

  • Hippocrates and Galen in Greece and Rome documented cauterization and venesection points for specific ailments (Craik, 2009).

  • Polynesian healers used thorns or bone needles to stimulate pain-relieving points (Chassagne, 2023).

  • Koryo Hand Acupuncture in Korea maps the body onto the hand (Choi, 2010).

  • Auricular acupuncture as a microsystem was codified in France by Dr. Paul Nogier in the mid-20th century (Nogier, 1972; Oleson, 2014).

While the Ancient Chinese formalized the meridian system and much of the theoretical framework, acupuncture today reflects contributions from many cultures and continues to evolve. We’re seeing that evolution now in Oregon with the passage of these new laws! 

So then, what does this have to do with acupuncture and dry needling?

Acupuncture

Acupuncture is the insertion of fine, solid needles into specific points to influence the body’s systems and restore balance. Licensed acupuncturists draw from three primary categories of points (Classical, Extra and Ashi). This breadth allows treatment of a wide range of conditions beyond musculoskeletal pain, including digestive disorders, insomnia, anxiety, menstrual irregularities, immune dysregulation, and more.

The origins of acupuncture lie in ancient China, where early practitioners used sharpened stones (bian shi) and bone needles to stimulate therapeutic sites. Over centuries, this practice was refined into the meridian system, mapped in detail by the Han dynasty, and further developed through contributions from other cultures. For example, Ayurveda’s marma points in India, Japanese meridian therapy (Keiraku Chiryo), Korean hand acupuncture (Koryo Sooji Chim), and modern French auricular acupuncture each added new microsystems and interpretations. Today’s acupuncture draws from this living tradition, incorporating both historical knowledge and ongoing innovation.

From a biomedical perspective, acupuncture points are not always easy to classify in purely anatomical terms. Since the 1950s, research has shown that some points exhibit distinct properties such as lower electrical skin resistance or higher conductance compared to surrounding tissue (Ma, 2021). Other studies suggest that points may correlate with areas of higher nerve density, vascular structures, or connective tissue planes. However, because not all points share the same measurable markers, acupuncture cannot be reduced to a single mechanistic explanation.

Instead, acupuncture views the body as an interconnected web, where physical, mental, emotional, and environmental factors are inseparable. Treatment is not about chasing symptoms, but about restoring systemic balance and supporting the body’s innate capacity for healing. When selected and applied strategically, acupuncture points can regulate the nervous system, modulate inflammatory pathways, improve circulation, release myofascial tension, and influence hormonal and immune function. These effects are increasingly supported by research.

Dry Needling

Dry needling is the insertion of a thin, solid (non-hollow) needle into soft tissue without injecting fluid or drawing blood. Because it’s a kind of acupuncture, an acupuncture needle is used. In most physical therapy contexts, the needle is directed into muscle tissue, aiming to release areas of tightness, spasm, or pain.

The primary targets are myofascial trigger points, a concept popularized in the mid-20th century by Dr. Janet Travell, physician to U.S. presidents John F. Kennedy and Lyndon B. Johnson. Trigger points are palpable knots or taut bands within muscle fibers that can produce referred pain patterns when pressed or needled. In East Asian medicine, these are equal to Ashi points, reactive or tender spots that ancient Chinese practitioners palpated, needled, or stimulated using sharpened stones (bian shi) for pain relief and functional restoration.

Seen in this light, Travell’s trigger point model is not an isolated “discovery” but one contribution to a much longer, cross-cultural history of point-based therapies. Similar traditions include auricular acupuncture developed in France in the 1950s–70s, Koryo hand acupuncture in Korea, Shonishin (pediatric non-insertive acupuncture) in Japan, and diverse Indigenous practices using thorns, bone needles, or pressure techniques to treat localized pain.

Key distinction: Dry needling focuses on Ashi/trigger points to produce localized musculoskeletal effects (often within a narrow treatment scope) whereas licensed acupuncturists integrate all three categories of points (Classical, Extra, and Ashi) within a holistic diagnostic framework. This broader approach addresses not only pain but also systemic issues involving the nervous, digestive, hormonal, immune, and emotional systems (Lee, 2022; Nugent-Head, 2013).

The passage of HB 3824 and HB 2143 marks a moment of change for point-based therapies in Oregon. Dry needling by PTs will soon be available for musculoskeletal pain within the conventional PT insurance structure, while the new 5 Needle Protocol registration will allow more trained providers to offer a focused, ear-based treatment for stress, trauma, and recovery support.

As the field of healthcare continues to evolve, many of us are feeling the strain of constant change. But if we slow down, listen, and keep advocating for each other and for medicines that honor the whole body, reduce pain, and restore connection, there is room for many ways of knowing and practicing in the system.

Biologist Lynn Margulis taught us, “Life did not take over the globe by combat, but by networking.” And as Janine Benyus says, “Life creates conditions conducive to life.”

In that spirit, acupuncture remains the only approach that integrates all categories of points within a holistic framework aimed at restoring balance across the whole body–mind–spirit system. But there should be room for all forms of point-based care. If we can work together across disciplines and focus on what truly matters, we should be able to keep sight of our shared goal: reducing suffering and supporting healing in the world. These changes can become an opportunity rather than a threat. After all, that’s what this work is supposed to be about.

References:

Chassagne, F., Butaud, JF., Ho, R. et al. Traditional medical practices for children in five islands from the Society archipelago (French Polynesia). J Ethnobiology Ethnomedicine 19, 44 (2023). https://doi.org/10.1186/s13002-023-00617-0

Choi, S. M., & Park, J. E. (2010). Korean acupuncture: the individualized and innovative techniques of Saam and hand acupuncture. Acupuncture in Medicine, 28(Suppl 1), 19–22. https://doi.org/10.1136/aim.2009.002295

Craik E. M. (2009). Hippocratic bodily "channels" and oriental parallels. Medical history, 53(1), 105–116. https://doi.org/10.1017/s0025727300003331

Kean, W. F., Tocchio, S., Kean, M., & Rainsford, K. D. (2013). The musculoskeletal abnormalities of the Similaun Iceman ("ÖTZI"): clues to chronic pain and possible treatments. Inflammopharmacology, 21(1), 11–20. https://doi.org/10.1007/s10787-012-0153-5

Nichols, E. The Philosophical Aspects of Cultural Difference.Lee, S., Lee, I. S., & Chae, Y. (2022). Similarities between Ashi acupoints and myofascial trigger points: Exploring the relationship between body surface treatment points. Frontiers in neuroscience, 16, 947884. https://doi.org/10.3389/fnins.2022.947884

Ma S. X. (2021). Low Electrical Resistance Properties of Acupoints: Roles of NOergic Signaling Molecules and Neuropeptides in Skin Electrical Conductance. Chinese journal of integrative medicine, 27(8), 563–569. https://doi.org/10.1007/s11655-021-3318-5

Metwaly, A. M., Ghoneim, M. M., Eissa, I. H., Elsehemy, I. A., Mostafa, A. E., Hegazy, M. M., Afifi, W. M., & Dou, D. (2021). Traditional ancient Egyptian medicine: A review. Saudi journal of biological sciences, 28(10), 5823–5832. https://doi.org/10.1016/j.sjbs.2021.06.044

Nogier, P. (1972). Treatise of Auriculotherapy. Maisonneuve.

Nichols, E. J. (1997, February 10). The philosophical aspects of cultural difference [Lecture]. College of Architecture and Planning Guest Lecture Series Collection, Ball State University. https://dmr.bsu.edu/digital/collection/CAPLectures/id/

Nugent-Head, A. (2013, February). Ashi points in clinical practice. Journal of Chinese Medicine, (101), 5–12. Retrieved from https://www.liveoakacupuncture.com/wp-content/uploads/2021/06/JCM-Ashi-Points-Article.pdf

Oleson, T. (2014). Auriculotherapy stimulation for neuro-rehabilitation. NeuroRehabilitation, 34(4), 785–791. https://doi.org/10.3233/NRE-141086

Solly, M. (2018, September 10). What Ötzi the Iceman’s tattoos reveal about Copper Age medical practices. Smithsonian Magazine. Retrieved from https://www.smithsonianmag.com/smart-news/what-otzi-icemans-tattoos-reveal-about-copper-age-medical-practices-180970244/ smithsonianmag.com

Wu, T., & Wang, X. Y. (2023). A comparative study on marma and acupoints. Journal of Ayurveda and integrative medicine, 14(4), 100769. https://doi.org/10.1016/j.jaim.2023.100769

Bex Groebner