At the first consultation a detailed case history will be taken. This will cover presenting signs and symptoms as well as medical history, lifestyle, diet and your health generally. Your tongue will be examined and your pulses will be felt on both wrists. Both these methods of Chinese diagnosis give valuable information on the presenting imbalance, and are carried out at every consultation. For certain conditions, areas of the body may be palpated to check for pain, temperature, swellings or stiffness. Range of movement may also be checked. When a diagnosis has been reached a number of needles will be inserted into particular acupuncture points and left in place for a length of time (usually somewhere between 10-20 minutes). Initial treatments last 1 ½ hours, subsequent treatments up to 1 hour. Moxibustion (the use of a burning herb held just above or around areas of the body to create warmth and energy), cupping (suctions cups that draw out toxins or pathogenic factors- disease causing substances) or massage may be used in some cases.