Acupuncture and Moxibustion Techniques.pdf

8/19/2019 Acupuncture and Moxibustion Techniques.pdf

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Chapter 5

Acupuncture and Moxibustion Techniques

5 ．1 Acupuncture Techniques of Filiform needle

The filiform needle ，also known as the“ tiny needle” ，is the needle most commonly used in the

clinical setting ．Due to its minuteness and various skills and methods ，the acupuncture techniques

are exquisite ，and thus require excellent skills ．Acupuncture techniques form the f oundation f or

using other types of needles and therefore constitute the primary ，technical training in acupuncture

education ． Ling Shu · Jiu Zhen Shi Er Yuan says ：“ I want to dredge the meridians with a tiny

needle ，make t he blood and qi flow smoothly and harmoniously ，and regulate the movement of qi

and blood along the meridians ．” Biao You Fu（ Lyrics of Standard Profundities） says ：“ A m on g

the manipulating techniques included wit h the nine needles ，the ones associated with handling the

tiny needles are the most exquisite ；they interact with the seven stars in the sky and control all

the acupoints ．”

5 ．1 ．1 Structure ，Specifications ，Inspection and Storage of Filiform Needles

5 ．1 ．1 ．1 Structure

A ． Material ：Filiform needles are made of metal ．Although the modern filiform needle

models follow the example of one of the nine needles in H u an g D i N ei J i n g ，there are great

differences between them in material ，techniques ，and specification s ．Nowadays ，various materials

are used to make filiform needles ．Those made of stainless steel ，which accounts for its straightand s m ooth s hape ， high quality of strength and tenacity ， formidable resistance to high

temperature ，rustiness ， and chemicals are comm only used in the clinical setting ； filiform

needles made of gold or silver have the advantage of heat conductivity ，a s w e l l a s t h a t o f

electricity ，b u t th ey ar e n ot as ch eap ，thin ，strong or tenacious as stainless steel needles ，

therefore ，they are only used for special treatments ．Normally ，steel ，copper and iron needles

are used even less clinically ，because o f their poor flexibility ， tenacity ，elasticity and high

inclination to rust ．

B ． The Structure of Filiform Needles ：Filiform needles are divided into five parts ： the t ail ，

handle ，body ，root ，and the tip（Fig ．５１）．


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Chapter ５ Acupuncture and Mox ibustion Techniques 417

Fig ．５２ The Shape of Filiform Needles摧 HandleFig ．５１ The Structure of Filiform Needles

The tip／ zhen mang is the sharp point of the needle ，also known as the key part of the needle that

is punctured through the skin ．The body（ z hen t i） is the main part between the tip and the handle ，it is

used to determine suitable depths into the acupoints ．The root connects the body and the handle ，which

is the external sign that indicates the depth of the body punctured and the range of lifting and

thrusting ．The handle ，the end of the needle from the root to the tail ，is usually wrapped in a helical

style with wire ；this is the place where the practitioner holds and manipulates the needle ，as well as

location for fixing moxa ．The tail／end of the handle ，is also known as zhen ding ；it indicates the angle

of the needle following insertions and during manipulations ．

Filiform needles ，based on the structure and shape of the handle and tail ，can be classified

as follow s ： coiled needles ，which are wrapped by gilded silver or oxidated wire ；needles with

ornamental designs on the handles （needles decorated with a coiling dragon on the handle），

which is t wisted across like a coiling唱dragon by two wires ；flat唱bodied needles which are flat at

their tails ；and tubed needles ，that have metal tube唱like handles ．Flat唱bodied and tube needles

are mainly used with insertion tubes（Fig ．５２）．

5 ．1 ．1 ．2 Specifications of Filiform Needles

The specifications of filiform needle are distinguished by the diameter and length of thebody ，see the Table １ and Table ２．

Table 5 1 Length of Filiform Needles

Inch ０畅５１畅０１畅５２畅０２畅５３畅０３畅５４畅０４畅５

Length（mm）１５２５４０５０６５７５９０１００１１５

Table 5 2 Diameter of Filiform Needles

No ．２６２７２８２９３０３１３２３３

Diameter（mm）０畅４５０畅４２０畅３８０畅３４０畅３２０畅３００畅２８０畅２６


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418 Part Two Needling and Moxibustion Techniques

T h e N o ．２８～３０（０畅３２～０畅３８ m m）and １～３ inch（２５～７５ m m）filiform needles are the most

comm only ones used in t he clinic ．Shor t filifor m needles are primarily used for shallow needling

of body and auricular points ；long filiform needles are mainly used for acupoints located on

thickly muscled body parts and for horizontal needling ．

5 ．1 ．1 ．3 The Inspection of Filiform Needles

The quality of a filiform needle can affect the treatment during both insertions and

manipulation ．We should inspect the filiform needle before t reatments so as to enhance the

effect ，relieve pain and avoid undesirable incidents ．

The tip should be straight ，shiny and clean ；as sharp and smooth as a pine needle ．These

qualities decrease resistance during insertions ． T h e b od y s hould b e s traigh t ， s m ooth and

symmetrical ，as well as tenacious and flexible ．The root should be solid and without rust or

scratches ． T h e ha ndle w ir e s ho uld be w r ap ped a ro un d t he ha ndle e venl y ， t igh tly and

continuously ；the len gth and diam eter of the h an dle s hould be s uitable for h olding andmanipulating ．

5 ．1 ．1 ．4 Storage

With the exception of one唱time use ，disposable ，filiform needles ，reusable needles should be

stored properly so as to avoid damage to the tip ，bending ，rust or contamination ．They are

usually kept in a needle box ，needle tube or needle clip ．Needles should be put in a container

that corresponds to their length after they have been washed and dried ．Needle boxes and needle

clips should be padded and covered with gauze ，needle t ubes should be plugged with dried

cotton ball ．Needles and con tainers should be sterilized in an autoclave ．

5 ．1 ．2 Needling Practice

Besides maintaining Shen ，technical practice mainly involves building up good finger force

and developing skillful manipulations ． Fin ge r f o rce is t he s tren gt h g enera ted b y t he

practitioner 摧s hand when handling a needle ．Good finger force is the basis for good techniques ，

while skillful techniques are essential in treating diseases with needles ．Practitioners must

practice to develop good finger force and techniques frequently until they become adept ，after

which time they will be able to swiftly insert a needle through the skin without causing pain ，

and easily withdraw it ，as well as freely manipulate it to produce reinforcing or reducing effects ．Otherwise ，they will have difficulty controlling the needle ．The therapeutic effects will be

dramatically diminished if insertions cause obvious pain and needle manipulations feel

awk war d ．Therefore ，it is imperative that beginners put forth great effort to develop good finger

force and skillful manipulations ．

Needling Practice唱Three Steps ：

5 ．1 ．2 ．1 Finger Force Practice

Practicing with sheets of paper ：Fold a sof t piece of paper into a small packet about ５ cm ×

８ cm in size and ２～３ cm thick ，then bind the packet with gauze ．Hold the paper packet in one

hand and the needle handle in t he ot her ．Rotate the needle in and out with the thumb ，index and


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middle finger of your needling hand ，applying enough pressure for the needle to penetrate the

paper ；then change to another point ．Repeat this practice until you feel it is easy to do ．

Practicing needling through sheets of paper is the basic process done to develop finger force ，as

well as to practice manipulations such as twirling method（Fig ．５３）．

Fig ．５４ Practicing with a Cotton CushionFig ．５３ Practicing with Sheets of Paper

5 ．1 ．2 ．2 Manipulation PracticePracticing with a Cotton Cushion ： Make a cushion ，about ６～７ cm in diameter ，by

wrapping a bunch of cotton with cotton thread and covering it with a piece of cloth ．A s th e

cotton cushion is soft ，various stimulating techniques such as lifting and thrusting ，twirling and

rotating ，as well as insertions and withdrawals can be practiced with it ． When practicing

thrusting ，handle the needle like handling a pen ；insert it into the cushion and make lifting and

thrusting movement in the same place with appropriate and even depths ；the needle body

needs to be held perpendicularly ．A fter th at ，lifting and thrusting and twirling and rotating

can be practiced simultaneously ．T r y to m ak e th e l i f t in g an d th r u s tin g even in d ep th wh en

goin g u p an d d ow n ，and the twirling and rotating at angles when going back and forth ．Be

sure the frequency is always the same to achieve harmony and facility during manipulations

（ Fi g ．５４）．

5 ．1 ．2 ．3 Needling Practice on a Body

This practice should be done only after you have developed good finger force and skillful

manipulations from practicing on paper packets and cushions ．The goal is so to gain personal

experiences of finger force ，needling sensations and manipulations ．When practicing ，t ry t o

obtain painless ，perpendicular ，smooth insertions ，with facile lifting ，thrusting ，tw irling and

rotations using even finger force and skillful manipulations ．Also ，carefully experience therelationship between finger force ，insertions and manipulations to obtain qi ，a s w ell a s t he

sensations o f the fingers holding the needle ，the fingers of the pressing hand and the parts of the

body being needled ．

5 ．1 ．3 Preparation

5 ．1 ．3 ．1 Selection of the Filiform Needle

Selecting the Filiform Needle of Suitable Material and Specifications ：Nowadays ，stainless

steel filiform needles are widely used ．Before using ，the quality of the needle should be given

close a ttention to avoid unnecessary pain and accidents ．


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The filiform needle specifications are based on sex ，age ，physique ，constitution ，the nature

of disease ，the interior or exterior location of the disease and the location of the acupoints ．T he

selection of an appropriate needle is not something to be taken lightly ． L ing S hu G uan Zhen

says that ：“each of the nine needles ，long ，short ，large or small ，has its specific usage ” ．For

example ，we use longer and larger filiform needles on male patients who are strong ，fat and

female patient whose disease is much deeper ．As far as selecting filiform needles according to

the location of the acupoints ；longer ， thicker ，filiform needles are usually used on thickly

muscled areas o r places that require deep needling ；not on thin muscles or areas requiring

shallow needling ．The suitable filiform needle摧s len gth u su ally eq uals th e depth th at th e

acupoint should be punctured plus ０畅５ cu n ，the amount that should be visible above the skin ．

For example ，one should use a １畅０ cun filiform needle t o puncture an acupoint a depth of ０畅５

cu n ，an d a １畅５～２畅０ cu n filiform needle to puncture an acupoint a depth of １畅０ cu n ．In

conclusion ，it is necessary to select filiform needles of suitable specifications to assure thedesired needling sensations and therapeutic effects ．

5 ．1 ．3 ．2 Disinfection

Strict aseptic technique must be faithfully observed throughout every treatment to avoid

unnecessary incidents ．The following things should be disinfected before doing acupuncture ： the

medical treatment room ，needling appliances ，both hands of the practitioner ，and the patient摧s

skin over selected acupoints ． I n addition to th at ， it is a dv isa ble t o u se o ne唱t im e on ly ，

disposable ，filiform needles for some diseases ，and to assign a separate set of needles for each

patient ．

A ．Disinfection of Needling Appliances ：An Introduction to Common Methods of Disinfection ：

a ． Autoclave Sterilization ：Needles should be sterilized in an autoclave at １畅０～１畅４ kg／cm２

an d １１５～１２３ ℃ for ３０ minutes to satisfy the requirements for sterilization ．

b ．Chemical Disinfection ：Needles should be placed into a ７５％ solution of alcohol for ３０～

６０ minutes ，after which time they should be taken out and wiped off with a sterile towel or

sterile cotton ball before using ．Needles may also be put into a disinfectant such as Pasteur 摧s

solution（disinfector ），and processed according to the instructions on the manufacturer 摧s label ．

Appliances w hich come into direct contact with the filiform needles ，such as needle trays ，tubes ，

boxes and tweezers ，should be soaked in the glutaraldehyde for １０～２０ minutes ．Disinfectedneedles should be put in disinfected needle trays and covered with a sterile to wel or sterile

gauze ．

c ．Boiling ：Needles and ot her instruments can be boiled in water for １５～２０ min ．However ，

it should be noted that boiling can blunt the sharp metal appliances ．Adding ２％ Sodium

Bicarbonate can raise the boiling point to １２０ ℃ and prevent corrosion ．

B ． Finger Disinfection ：Practitioners should wash and brush their hands and fingernails

with soap and water before treatments ，followed by rubbing their hands with a cotton ball

soaked in a ７５％ solution of alcohol ，after their hands have dried ．During the treatment ，the

practitioner should avoid touching the body of filiform needle directly with their fingers ；if some


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manipulations require direct contact ， a dry ， disinfected ， co t t on ball sh o uld be u sed f o r

insulation ．

C ． Skin Disinfection ：The skin t o be needled should be wiped wit h a cot ton ball soaked in a

７５％ solution of alcohol ，or it can be wiped with a ２％ tincture of iodine ，which should then be

removed after a few minutes ，with a cotton ball soaked in a ７５％ solution of alcohol ．When

wiping the skin ，one should start from the center of the skin ，and continue ，working outward

using circular motions ．Care should be taken to keep the disinfected areas clean and to avoid re唱

contamination ．

D ． Disinfection of the Medical Treatment Room ：Disinfection of the medical treatment

room includes the sheets ，pillow cases ，blankets ，bolsters／cushions ，et c ．；those items should also

be changed and washed regularly ．It is better to use sanitized ，disposable sheets ，pillow cases

and towels ．The medical treatment room should also be cleaned and disinfected regularly ．A

filtration system can be used to clean and re唱circulate the air in the room ．5 ．1 ．3 ．3 Postural Alignment and Positioning

Proper positioning of the patient is an important consideration to facilitate the accurate

location of acupoints ，facilitate needle insertions and manipulations ，increase patient comfo rt

during and after needling ，and to minimize the incidence of fainting and bent／broken needles ．

The tw o primary positions most commonly used in t he clinic are prone and seated ．

A ． Supine Position aka Back唱Lying ：This position is suitable for gaining easy access to

the acupoints on the head ，face ，chest ，abdomen and some acupoints on all four extremities

（ Fig ．５５）．

Fig ．５５ Supine Po sition aka Back唱Lying

B ． Lateral Recumbent aka Side唱Lying ：T his position is suitable for accessing the acupoints

on the lateral side of the body and some acupoints on the ext remities（Fig ．５６）．

Fig ．５６ Lateral Recumbent aka Side唱Lying

C ． Prone Post ure aka Belly唱Lying ：This po sition is suitable w hen needling the acupoints on

the head ，nape ，upper ／middle and lumbar region of the back ，para唱sacral area ，buttocks ，the

p oster ior as pects of th e lower extr em ities and s ome acup oints on th e u pp er extremities

（Fig ．５７）．


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Fig ．５７ Prone Posture aka Belly唱Lying

D ． Seated in the Upright Position with the Back Leaning Against a Chair ：This position is

suitable for accessing the acupoints on the forehead ，face and neck（Fig ．５８）．

Fig ．５９ Side唱Prone SittingFig ．５８ Seated in the Upright Position with the

Back Leaning against a Chair

E ． Side唱Prone Sitting ：（ S ea te d U p ri gh t w i t h t he H e ad R es ti ng t o t he S ide o n O n e

A r m）：This position is suitable for accessing the acupoints on the lateral head ，cheeks ，an d

ears（ Fig ．５９）．F ． Prone唱Torso Sitting ：（Seated with the Back towards the Practitioner ）：This position is

suitable fo r accessing t he acupoints on the occiput ，nape and back（Fig ．５１０）．

In addition to the positions discussed above ， doctors can select different postures／

Fig ．５１０ Prone唱Torso Sitting

positions t o needle specific acupoints ．When preparing

point prescriptions ，basically ，one should try their best

to select the acupoints which can be punctured without

repositioning the patient ．Patient positioning should be

done with the patient摧s condition in mind w henever it is

n ece ssa ry t o ch an g e t h e p o si tio n d urin g t he sa m e

treatment ．

To avoid fatigue or fainting during acupuncture ，one

should consider selecting the lying position as much as

possible for patients receiving their first treatment ，or for

those who are nervous ，old ，weak ，or seriously ill ．Patients

should be instructed to avoid moving or suddenly changing

positions after the needles have been inserted ，to maximize

the effectiveness of the treatment and minimize the incidence


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of bending or breaking the needles ．

5 ．1 ．4 Acupuncture Techniques

Needle manipulations usually involve the use of both hands wo rking in concert with each

other ． N an J in g · Q i S hi B a N a n says ：“ Those who know a lot about acupuncture believe in

their left hands ，while the ones who do not ，believe only in their right hands ．” Biao You Fu

explains ：“Press heavily with the left hand several times ，s o a s t o l e t t h e qi disperse ；insert

slowly and lightly with the right hand so as to cause no pain ．” The coordinated movements of

both hands together are of great importance to insure successful manipulations ，as well as to

mitigate discomfort and enhance the effects ；so ，much attention should be paid ．

The hand holding the needle is generally known as the“puncturing（ needling） hand” ，while

the hand that assists or presses the body part to be punctured is the“pressing（palpating）hand” ．

Fig ．５１１ The hand holding

the needle

T he puncturing（needling） hand mainly holds the handle of a n eed le with the th u m b ， index finger and the middle

finger ，like handling a pen（ Fig ．５１１）．The function of

t his hand is t o hold t he needle and t o perfo rm

manipulations ． During insertions ， the puncturing hand

generates focused force on the tip of the needle to make it

penetrate the skin ．During manipulations ， i t twirls and

rotates ， lif t s an d t h ru st s ， p luck s and vib rates and

withdraw s the needle ．By contrast ， th e fun ction of the

pressing（ palpating） hand is to fix the location of a point

and to grip the needle body to help the puncture／needling hand insert the needle ．It can support

the body of the needle ，keep it straight and focus the strength directly to the tip of the needle ，

resulting in a good insertion ，less pain ，while facilitating the regulation and control of the

needling sensations ．

5 ．1 ．4 ．1 Insertions

There are various ways of doing an insertion ．Generally ，they are classified into single唱

handed insertions ， double唱handed insertions and tube insertions ， depen din g o n h o w t he

puncturing and pressing hands are used ．A ． Single唱Handed Insertions ：This met hod mainly applies to the insertion o f sho rt needles ．

Fig ．５１２ Single唱Handed Insertions

The body of the needle is grasped with the thumb and

index finger ， w it h t he pad o f t he middle fin ger

approximately supporting the middle of the needle

body ．While pushing down with the thumb and index

finger ，the middle finger is flexed as you insert the

needle to the appropriate depth （Fig ．５１２）．Since

this method only involves the use of three fingers ，it

is especially applicable for doing insertions into two


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points simultaneously ．It is done with the thumb and index finger grasping the needle body ，

using the tip of middle finger as a prop on the point ；the tip of the needle is then quickly

inserted into the point ．The middle finger is removed from the point as soon as the needle is

inserted ，then the fingers are free to do manipulations as needed ．

B ．Double唱Handed Insertions

a ． Fingernail唱pressing needle insertion ：Press the acupuncture point with the thumbnail ，or

the index finger of the pressing（palpating）hand ．Hold the needle with the puncturing（needling）

hand and keep the needle tip closely against the border of the nail of the pressing hand （Fig ．５

１３）．This method is suitable for puncturing with short needles ．

Fig ．５１４ Hand唱holding needle insertionFig ．５１３ Fingernail唱pressing needle insertion

b ． Hand唱holding needle insertion ： H old a d r y ，sterile ，cotton ball around the needle tip

with the thu mb and index finger of the pressing（palpating）hand and fix the needle tip directly

over the selected point ．Twirl the needle handle with the puncturing（needling）hand and insert it

into the point ．This method is suitable for puncturing with long needles（Fig ．５１４）．

Fig ．５１５ Stick method

T he stick method is also in clinical use ．H old a d r y ，

sterile ，cotton ball around the needle tip w ith t he thum b and

index finger of one hand ，allow the needle tip to extend out

beyond the finger tips ２～３ f en at length ．Guide the needle

over the selected point and insert the needle swiftly（Fig ．５

１５）．

c ． Skin唱spreading needle insertion ：Put the thumb andindex fingers of the pressing （palpating） hand on the skin

where the point is located and separate the two fingers to

tautly stretch the skin ．Hold the needle with the puncturing

（needling）hand and insert the needle into the point through

th e sp ace b etween the tw o f in gers （ Fig ．５１６）． This

method is suitable for needling acupoints on areas where the skin is loose ．

d ．Pinching insertion method ：Pinch the skin up around the point with the t humb and index

fingers of the pressing（palpating）hand ．Hold the needle with the puncturing（needling）hand and

insert the needle into the point in pinched skin （ Fig ．５１７）．This method is suitable for


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Fig ．５１６ Skin唱spreading needle insertion

puncturing／needling acupoints on areas w here the muscle and skin is thin ，such as Yintang（EX唱

H N３）．

Fig ．５１８ Needle in tube insertionsFig ．５１７ Pinching insertion method

The methods listed above should be adopted in the clinical setting according to the

anatomical features of the areas where the acupoints are located ，as well as needling depth and

manipulation requirements so as to facilitate smooth ，painless insertions ．

C ． Needle in Tube Insertions ：Put the needle into a glass ，plastic or metal tube（note ： the

tube should be shorter than the needle by about ３ f en in lengt h）and put them on the skin w here

the point is located ．Press the tube with the pressing （palpating） hand ，tap the needle摧s tailswiftly with index finger of the puncturing（needling）hand to insert the tip of needle into the

skin ．Remove the tube over the needle and insert the needle into the point to the appropriate

depth（Fig ．５１８）．This method causes less pain ，so it is often used when treating children and

those who are afraid of needles（needlephobic）．

5 ．1 ．4 ．2 Angles ，Directions and Depths of Insertion

During t he pr ocess of insertion ，angle ，direction and depth are especially important in

acupuncture ．Correct angles ，directions and depths help to induce needling sensations ，bring

about the desired therapeutic results and guarantee safety ．Accurate point locations not only

refer to correct locations on the body surface ，but also t o integrating the proper angle ，direction


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and depth ．Only then will the intended effect of acupuncture be well exerted ．Clinically ，using

different angles ，directions or depths of insertions ，e ve n o n t h e sa m e p oin t s ，will lead to

needling sensations that have obviously different intensities ， transmission directions and

therapeutic effects ．The angles ，directions and depths of insertions are decided according to

specific acupoint locations ，the physical condition of a patient ，the nature of an illness and

needling manipulations ．

A ． Angles of Insertion ：The angle of insertion refers to the one formed by the needle and

Fig ．５１９ Angles of insertion

the surface of the skin as the needle is

inserted （ Fi g ．５１９）． It is decided in

consideration of both the location of the

point and the doctor 摧s purpose ．Generally ，

there are three options ：

a ． Perpendicular Insertion ： The needleis inserted perpendicularly ， forming a ９０°

angle with the surface of the skin ．Most

points on the body can be needled in this

way ．

b ． Oblique Insertion ： The needle is inserted obliquely to form an angle of approximately

４５° with the skin摧s surface ．This is suitable for acupoints where there isn摧t much underlying

tissue ，w here internal organs are close to the surface of the body ，or where perpendicular or deep

insertions are inadvisable ．

c ． Horizontal Insertion ： Transverse or subcutaneous insertion ．The needle is inserted

horizontally to fo rm a １５° ，or even smaller angle with the skin ．This method is suitable for

points w here t here is little underlying tissue and／or bone ，for instance t he points on the head ．

B ．Direction of Insertion ：The direction of insertion refers to the direction of the needle tip

during acupuncture ．Generally ，it is decided according to the direction in which the meridians

and blood vessels flow ，the location of a point and the desired therapeutic requirements of an

illness ．

a ． In Accordance with the Meridian Flow ： By virtue of the direction of the needle tip ，

needling a point by going in the direction of the normal flow of the course of its meridian ，or against its meridian course ，will yield reinforcing or reducing effects ．

b ． In Accordance with the Location of the Acupoint ：Deciding the direction of insertions

according to the location of acupoints ensures safety when needling ．For instance ，the needle

s h ould b e in ser ted s low ly with th e t ip p ointin g in th e direction of th e m andible w h en

puncturing Yamen（ G V１５），h owever ，tow ards the spinal column w hen puncturing acupoints

on the back ．

c ． According to the therapeutic requirements of a disease ： In order to make t he needling

sensation transmit to the diseased region ，or “ to promote the movement of the meridian qi to

reach the diseased area” ，so as t o achieve a bet ter therapeutic effect ，the direction the needle tip


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is pointed in can be adjusted to correspond to the affected area ，and the related qi唱moving and

qi唱hastening manipulations can be done at the same time ．For example ，when treating nose

diseases with needles insertingyamen（G V１５），the needle tip should point to the root of the

nose ．

C ．Depth of Insertion ：Depth of Insertion refers to how deep the needle body is pushed into

the skin ．Generally ，each acupoint has its definitive needling depth（see Acupoints）．Clinically ，

the depth of insertion is also determined by the constitution of the patient ，their pathological

condition and the location of the points ．

a ． A ge ： Elderly patients often suffer from qi and blood deficiencies ，and infants have

delicate constitutions ，deep insertions are inadvisable where they are concerned ．However ，

young and middle唱aged patients are usually able唱bodied ；therefore ，appropriate deep insertions

may be practiced on them ．

b ． The Location of the Points ： Points on the head and face ，chest and belly ，and areaswhere the skin and muscles are thin should be punctured superficially ；while deep insertions are

appropriate f or points on the four extremities ，the abdomen and thick ，bulky areas ．

c ． The Constitution of the Patient ： Relatively shallow insertions should be done on lean

an d（or ）weak patients ，and deep insertions on strong ，robust patients ．

d ． The Pathological Co ndition ： Yang syndro mes and acute diseases should be t reated wit h

shallow insertions ；while Y in syndro mes and chronic illnesses with deep insertions ．

The angle of insertion relates closely to the depth of insertion ．Generally speaking ，deep

insertions often go with perpendicular insertions ，while shallow insertions go hand in hand with

oblique or horizontal insertions ．The angle and depth of insertion must be well mastered when

needling points such as Tiantu（ C V２０），Feng f u（ G V１６） an d Yamen（ G V１５），and points on

the areas around the eyes ，on the back and points close to internal organs ．T h e d ep th of th e

insertion is also influenced by seasonal factors ． Therefore ， w e s ho uld t hin k it m uch

more ．

5 ．1 ．5 Manipulations and the Arrival of Qi （Needling Sensation）

5 ．1 ．5 ．1 Manipulation Techniques

Manipulations ，also known as needling transmissions ， are maneuvers done followinginsertions designed to produce needling sensations ， r egulate th e inten sity of n eedling

sensations ，or to transmit needling sensations in specific directions ．Generally ，manipulation

techniques can be divided into t w o catego ries ： Fundamental and Auxiliary ．

A ． The Fundamental Manipulation Techniques ：The fundamental manipulations refer to

the basic maneuvers done in acupuncture that involve the technique of lifting and thrusting ，

and the technique of twirling and rotating ，both of which are commonly used in the clinical

setting ．T hese t w o basic techniques can either be u sed separately or in conjunction with each

other ．

a ． Lifting and Thrusting ： This is a method whereby the needle body is lifted and thrusted


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perpendicularly into the point after the needle has been inserted to a certain depth ．Thrusting

involves inserting the needle from the superficial layer down to the deep layer ．By contrast ，

lifting involves withdrawal of the needle from the deep layer up to the superficial layer ．

Essentially ，the lifting and thrusting technique incorporates the action of moving the needle up

and down alternately and repeatedly（Fig ．５２０）．

Fig ．５２１ T wirling and rotatingFig ．５２０ Lifting and thrusting

The extent of moving up and down ，changes within the levels of tissue beneath the skin ，

frequency and time of this manipulation should be determined according to the constitution of

the patient ，the pathological condition ，the location of the points and the intended purpose for

acupuncture ．Finger force should be even during this manipulation ．The extent of movement up

and down should be moderate ，about ３～５ f en in depth ；the frequency should also be moderate

at about ３０～６０ times per minute ．Care should be taken to keep the needle straight to avoidchanging its angle and direction ．Generally ，large ，fast movements lead to heavy stimulation ；

while cont rarily ，small ，short ones result in t o light stimulation ．

b ． Twirling and Rotating ： This is a method that involves twirling or rotating the needle

body continuously backward and forward after it has reached its desired depth ；in other words ，

the t wirling and r otating technique involves moving the needle back and f orth alternately and

repeatedly（Fig ５２１）．The amplitude ，frequency and duration of these manipulations depend on

the constitution of the patient ，the pathological condition ，the location of the points and the

intended purpose for doing acupuncture ．Finger force should be even during this manipulation ，

and the amplitude should be moderate at about １８０° ～３６０° ．T wirling should not be done in only


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one direction to avoid getting the needle stuck as a result of tissue entanglement ．Generally ，

large angles and high frequencies lead to strong stimulation ；while small angles and lo w

frequencies yield gentle stimulation ．

B ． Auxiliary Techniques ：The auxiliary techniques are supplements to the fundamental

ones for the purpose of promoting the arrival and movement of meridian qi and enhancing

needling sensation ．The ones that are commonly used in the clinical setting are as follows ：

a ． Pressing ： Pressing involves pushing and sliding along the pathway of a meridian while

lightly press the skin up and down along the course of the meridian with the fingers（Fig ．５

２２）．Zhen Jiu Da Cheng points out ：“Whenever the meridian qi does not arrival after insertion ，

press the skin up and down along the course of the meridian with fingers to make the qi an d

blood flow smoothly ．By doing so ，consequentially ，the meridian qi will arrive and bring about

heavy and tight sensations that can be felt by the doctor in the fingers holding the needle ．”So ，

this method is employed to invigorate the qi ，and thereby promote the circulation of qi an dblood ，by means of mechanical pushing ．Moreover ，pressing will accelerate the movement of the

qi through the meridian ，after it has arrived ．

Fig ．５２３ PluckingFig ．５２２ Pressing

b ．Plucking ： This technique involves plucking the needle摧s tail or handle slightly with the

fingers ，causing it to gently vibrate（ Fig ．５２３）．It strengthens the needling sensation and

facilitates the movement of meridian qi ．Z h en J i u W en D u i says ；“If the meridian qi does not

move ，pluck the needle slightly and hasten the movement of the meridian qi ．” That is to say ，

plucking has the function of stimulating and invigorating qi ．

c ． Scraping ： After the needle has been inserted to a specific depth ，support the tail of the

needle with the pads of the index finger and thumb while scraping the handle of the needlefrequently from top t o botto m ，up and dow n ，with the nail of the thumb ，index finger or middle

finger （Fig ．５２４）．If the needle sensation does not arrive ，it can be stimulated using this

technique ；if the needle sensation has already arrived ，it will transmit and diffuse it with more

intensity ．

d ． Shaking ： After the needle has been inserted to a specific depth ，hold the handle and

shake it gently（Fig ５２５）．There are tw o ways of shaking ．One is to shake the needle with it

standing up straight to intensify the needling sensation ；or shake the needle during withdrawal

to enlarge the opening as a means of facilitating the dispersal of pathological qi ．The other

option is to shake the needle while it摧s lying obliquely or transversely ，so as to transmit the


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Fig ．５２４ Scraping

needle sensation in a specific direction ．

e ． Flying ：Grasp the needle handle between thumb and index finger and twirl it slightly

Fig ．５２５ Shaking

several times ．Next ，release the thumb and index finger while

twirling ．Repeat this action several times ． T h is m eth od is

ter med f lyin g b ecau se th e tw o f in gers s ep ar ate fr om th e

needle just like bird spreading its wings and flying （ Fig ５

２６）． Y i X u e R u M en （ Elementary Course for Medicine）

says ：“ Flying is the separation of the thumb and index finger

f r o m t h e n eed le w h ile co n tin uin g t o t w i rlin g ， just likevib ratin g th e h an d ．” T h is m et h od h as t he f unctio n o f

stimulating and invigorating the qi ，as well as enhancing the

needle sensation ．

f ． T rembling ： After the needle has been inserted to a

certain depth ，hold the needle with the fingers of the right

hand and apply quick lifting and thrusting ，or twir ling and r otat in g m ovements in s mall

amplitudes to create gentle vibrations（Fig ．５２７）．This promotes the arrival of qi or intensifies

the needling sensation ．

Fig ．５２６ Flying


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Lifting and thrusting and twirling and rotating are fundamental manipulation techniques

Fig ．５２７ Trembling

t ha t a re s up ple me nt ed w it h co r resp o ndin g a ux ilia ry

techniques in accordance with clinical situations ． Fo r

example ，scraping and plucking can be applied to acupoints

where t wirling with large angles is inadvisable ．Flying is

suitable for needling points on areas where the muscles

（ tissues）are thick or dense ．Shaking and trembling can be

adopted when needling points on areas where the skin and

u nderlying t is su e is th in ． Fundamental and auxiliary

techniques are primarily employed to promote the arrival of

meridian qi and to intensify the needling sensation ．

5 ．1 ．5 ．2 The Arrival of Qi

The arrival of qi ，k n own in ancient t imes as “ q i z h i” ，and recently termed “ needlingsensation” ，refers to the responses produced in the meridian qi after a needle has been inserted

into an acupoint to a certain depth and then manipulated ．There are tw o ways of determining

whether the qi has arrived or not ： judging by the reaction of the patient ，and judging by the

feelings transmitted through the needle to the puncturing （needling） hand of the practitioner ．

When the qi arrives ，the patient will have one or more of the following sensations around the

point of insertion ： soreness ，distension ，numbness or heaviness ．Sometimes they may feel

warmth ，coolness ，itching ，tingling ，twitching or crawling sensations ．These feelings may radiate

in a specific direction or to a specific place ，a p henom en on wh ich is k n own as m er idian

transmission ，another sign of the arrival of qi ．Some patients might even feel a vibration or thrill

along the meridian pathway ，or in some cases develop a rash along the meridian ．One might even

witness the phenomenon of the appearance of a red and white line following the meridian path ．

As the patient becomes aware of the sensation ，the practitioner may also feel a tension or

dragging sensation around t he needle ，or the needle might begin to shake ．Sometimes t he patient

will have no corresponding feeling or reaction ，and you might feel an emptiness ，or loose ，

slippery sensation ar ound the needle ．Dou Hanqing stated in Biao You Fu ： if you feel a loose ，

slow ，slippery sensation around the needle ，qi has not yet arrived ；if you feel a tight ，sinking ，

taut sensation aro und the needle ，qi has arrived ．．．when qi arrives ，you feel like a fish hasswallowed your bait ，or else you jus t feel as s til l as s tanding b y a lak e ．T h is is a vivid

description of the arrival of qi ．

Whether the arrival of qi can be obtained or not and t he speed at which it occurs ，directly

influences the therapeutic effect of acupuncture ；it is also t he basis for determining the patient摧s

prognosis ． Ling Shu · Jiu zhen Shi Er Yuan says ： The key t o acupuncture摧s therapeutic effect

is the arrival of qi ．Jin Zhen Fu（The Golden Needle O de）says ：“The rapid arrival of qi suggests

good effects during a treatment ；the slow arrival of qi is an indication of retarded effects in a

treatment ．” The two texts quoted above emphasize that the key to acupuncture is associated

with the arrival of qi ．Usually the faster qi arrives ，the better the therapeutic effect will be ；if qi


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does not arrive ，it is possible that there will be no beneficial effect ．Therefore ，if the qi does not

arrive in your clinical practice ， you m u st analyze and discover th e r eason （ s ）： w hether

inaccurately acupoint location ， improper needle manipulation ， or incor r ect angles and／or

needling depths may be at the root of the problem ．Once any of these problems has been

rectified ，the qi will usually be obtained ．If not ，you may wait for the qi or accelerate the flow of

qi ．

It must be pointed out that we should not overly pursue stimulating the arrival of qi ，

because the strength of the arrival of qi differs from patient to patient and disease to disease ．

With the enervated we ought to let qi arrive gently ，with th e vi tal we ou gh t to let i t ar r ive

strongly ；as such ，bi syndrome should be treated with strong needling sensations ，while only

mild needle sensations are necessary to treat facial spasms ．

5 ．1 ．5 ．3 Waiting for Qi Arrival ，Promoting Qi Arrival ，Maintaining Needle Sensations ，and

Activating Qi Flow

A ． Waiting for the Arrival of Qi ：Zhen Jiu Da Chen says ： Waiting for qi arrival is a priority

in all techniques of acupuncture ．Waiting for qi arrival means that when the qi does not arrive

when needling ，one should allow the needle to stay in the acupoint for a longer period of time ；

you can also manipulate it at intervals to wait for the arrival of qi ．The former method is called

quietly waiting for qi ，the latter is called actively waiting for qi ．Be patient when retaining the

needle and waiting for qi ，and do not hurry ．

B ．Promoting the A rrival of Qi ：This involves accelerating the arrival o f qi by using various

types of manipulation ．Shen Ying Jing（The Classic of Shen Ying）says ：“Hold the needle with

the puncturing（needling）hand摧s thumb and index finger ，slightly shake ，lift and thrust ，or rotate

the needle so that it trembles ．This is called promoting the arrival of qi ．”Moreover ，scratching

the handle ，vibrating and shaking the body or pressing and kneading can also promoting the

arrival of qi ．

C ． Maintaining the Needling Sensation ：This method is designed to maintain and promote

the arrival of qi ．Once the qi has been obtained ，and t he patient is comfortable ，the practitioner

should use some supplementary techniques to maintain t he needling sensations ．In chapter ２５ of

Su Wen ，it says ： Maintain the meridian qi when it has arrived ． L ing Shu · X i ao Z hen J i e

（ S p i r i t u al Pivot · The Explanation of the Small Needle） says ：“Conserving the needle qi canhelp conserve the vital qi ．Maintain the qi carefully and do not lose the qi when it has arrived” ．

As long as you maintain qi around the needle ，you can apply different techniques and regulate

the qi ．

D ． Activating or Stimulating the Flow of Qi ：This method accelerates the transmission of

needling sensations along the meridians to reach the affected site by utilizing corresponding

techniques ．Pressing ，vibrating ，scraping ，shaking ，and twisting all have certain effects related to

activatin g th e f low of qi ．Our clinical observations demonstrate that needling sensations

generated on the affected site for certain distances and in specific directions can enhance the

therapeutic effects ．


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5 ．1 ．6 The Reinforcing （Tonification） and Reducing （Dispersal） Methods of

Acupuncture

L in g S hu · J i ng M ai p oin ts ou t that ：“ Deficiency syndromes should be reinforced

（ tonified），w hile excessive syndromes should be reduced （ dispersed）．” This established the

principle of tonifying deficiencies and reducing excesses when performing acupuncture

manipulations ． L in g S hu · J i u Z h en S h i E r Y u a n points out that ：“ The nine needles are most

effective in regulating deficiencies and excesses ． Just by using the needles to reinforce or

reduce ．” The pathological mechanism of disease progression and development is due to hyper 唱

activity or hypo唱activity in the viscera ，the meridians and collaterals ， y in an d yang an d qi and

blood caused by various diseases ． The reinforcing and reducing methods of acupuncture is

intended to stimulate acupoints w hile adopting feasible manipulations in order to restore t he

normal functions of the viscera ，supplements the right（ zheng） q i to balance y in and yang byregulating the meridian qi that helps streng thening the weakened phy siological function and

eliminates pathogenic facto rs ．Therefore ，reinforcing and reducing in acupuncture is of great

importance in treating diseases with acupuncture and is one of the essential parts of acupuncture

techniques ．

Since the reinforcing and reducing methods of acupuncture were created and summarized

by various doctors from past dynasties ，some of the ones most commonly used in the clinical

setting are introduced as follows ：

5 ．1 ．6 ．1 Single Methods

A ．Basic Reinforcing and Reducing Met hods

a ． Twirling and Rotating （ Nian Zhuan）： After the needle has been inserted to a given

depth and the qi has arrived ，rotate the needle slowly and gently with small amplitudes for a

relatively short duration ．When manipulating ，rotate the needle relatively more forcefully with

the thumb moving forward ，the index finger moving backward and t he finger strength directed

downward ．This is called reinforcing ．Conversely ，reduction is done by rotating the needle

strongly and rapidly with large amplitudes for a relatively long duration ．When turning

backward ，rotate t he needle relatively more forcefully with the thu mb moving backward ，the

index finger moving forw ard and the finger f orce directed upward ．b ． Lifting and Thrusting（ T i C ha）： Following the insertion of a needle to a given depth

and after obtaining the needling sensation ，reinforcing is achieved by lifting the needle slowly

and gently ，while thrusting the needle rapidly and strongly ．Reducing is achieved by lifting the

needle rapidly and forcefully ，while thrusting the needle slowly and gently ．Comparatively

speaking ，reinforcing t akes less time than reducing ．

B ．Other Reinforcing and Reducing Methods

a ．Rapid and Slow Insertions and Withdrawals（ X u J i）： This method of reinforcing and

reducing is distinguished by the speed of insertion and withdrawal of the needle ．During

manipulations ，reinforcement is achieved by inserting the needle superficially ，and pushing it


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slowly down to a certain depth as soon as the qi ar rives（ from L i n g S h u · J i u Z h en S h i E r

Yuan）；then lifting it rapidly to the layer just beneath the skin ．It 摧s like sticking your hand in

hot water and quickly withdrawing it ．Reduction is perfor med by inserting the needle rapidly to

a deep po sition ，then lifting it slowly to the layer just beneath the skin （ from L i n g S h u · J iu

Zhen Shi Er Yuan）．This is like lingering around and being reluctant to go ．

b ．Directing t he Needle Tip（Ying Sui）：Pointing the tip of the needle ，during an insertion ，

in th e s ame direction of th e n or mal f low or cour se of th e m er idian p ath way is k n own as

reinforcing ．Conversely ，when the needle tip is pointing in the opposite direction ，going against

the normal course of the meridian pathway ，it is considered reducing ．This method should

coincide with other reinforcing and reducing methods ．

c ．Breathing／Respirations（ H u X i）：With this method ，reinforcing is achieved by inserting

the needle when the patient breathes in and withdrawing the needle when the patient breathes

out ．The reducing is achieved in an opposite way ．This method should also coincide with other reinforcing and reducing methods ．

d ． Open唱Close Method（ K ai H e）：Covering and pressing the needle hole to quickly close it

upon withdrawal is called reinforcing ； s ha kin g t he needle t o enla r ge t he h ole p ri or t o

withdrawing it ，and not covering and pressing the hole is known as reducing ．This method

should coincide with other reinforcing and reducing methods ．

e ．Even Method（ P i n g B u P i n g X i e）： When t he needle is inserted into the point and t he

needle sensation is achieved ，lift ，thrust and rotate the needle evenly ，then withdraw the needle ．

This method is suitable for treating inconspicuously deficient or excessive syndromes ，or

syndromes with both deficiency and excess ．

5 ．1 ．6 ．2 Comprehensive Reinforcing and Reducing Methods

A ． Setting the Mountain On Fire（ Shao Shan H uo）：Divide the needling depth into three

equal portions ，the upper （ heaven）１／３，middle（human）１／３ and lower （ earth）１／３．A fter th e

needle has been inserted ，push it to the upper ／heaven por tion ，employ the reinforcing method by

lifting and thrusting or t wirling and rotating after t he qi ar rives ；then strongly insert the needle

to the middle（human）portion ，using the reinforcing method by lifting and th rusting or t wirling

and rotating after the qi ar rives ；finally ，strongly insert the needle to the earth portion ，use the

reinforcing method by lifting and thrusting or twirling and rotating after the qi arrives ；following that ，lift the needle slowly back to the middle（human）portion and one operation is

finished ．Repeat the above唱mentioned process ２～３ t imes and thrust the needle to the lower

（earth）portion and retain it there ．This process can be done in conjunction with reinforcing by

means of respiration and by covering and pressing the hole upon the withdrawal of the needle ．

This method is suitable for treating paralysis and numbness due to cold syndromes and Yang

deficiency ．

B ． Penetrating唱Heaven摧s Coolness（ T o u T i a n L i a ng）：Divide the puncturing depth into

three equal portions ，the upper （heaven），middle（human）and lower earth segments ．After the

needle has been inserted ，push it directly down to the lower （earth） portion ，use the reducing


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method by lifting and thrusting or twirling and rotating after the qi arrives ．Next strongly lift

the needle to the middle（human）portion ，employ the reducing method by lifting and thrusting

or t wirling and r otat in g af ter th e qi arrives ．Finally ，strongly lift the needle to the upper

（heaven）portion ，adopt the reducing method by lifting and thrusting or twirling and rotating

after the qi ar rives ．Following that ，insert the needle slowly back to the earth portion and one

operation is finished ．Repeat the process mentioned above ２～３ times and lift the needle to the

upper （heaven）portion and retain it there ．Reducing by means of respiration and by the open

method（not covering and pressing the hole）can be done in conjunction with this process ．This

method is suitable fo r treating excessive heat syndromes like paralysis and numbness caused by

heat and acute carbuncles ．

5 ．1 ．6 ．3 Factors that can Influence the Therapeutic Effects of Reinforcing and Reducing

Accurate differentiation and proper manipulations are the basic principles that will

guarantee getting the desired effects from reinforcing and reducing ．While the condition of thebody ，accurate location of the acupoints and reasonable application of needle appliances and

manipulation are all closely related to achieving the desired results ，careful attention should be

paid t o manipulations ．

A ． Physical and Mental Status ：The mental and physical conditions of the doctor and

patient and the struggle betw een the vital qi and evil pathogenic factor s are significant and will

influence the therapeutic effects of reinforcing and reducing ．

Maintaining the Shen（spirit） is indispensable during manipulations ；the practitioner needs

to be able to feel the needling sensation ，have a good sense of timing ，modify the mental status

of the patient and establish clear ，effective communication with the patient ．Essentially ，

carefully monitoring the mental status of both ，practitioner and patient ，can enhance the

therapeutic effect involved with reinforcing and reducing ．

One can regulate the different therapeutic effects of acupuncture by using the reinforcing

or reducing method according to the patient摧s pathologic condition ．When the body is weak and

deficient ，acupuncture can strengthen the right（ zheng qi）；on the other hand ，when there are

exuberant pathogens ， s uch as with excess h eat ， acupuncture can clear heat ， dredge the

obstruction ，expel pat hogens and reduce t he excess ．In t he case of cramps due to gastrointestinal

hyperactivity ，acupuncture can alleviate the cramps and pain by reinforcing the function of thedigestive tract ．If the peristaltic action of the patient摧s intestines is retarded ，acupuncture can

promote peristalsis and digestive function ，eliminate abdominal distension ，and increase the

appetite ．A great deal of practical experience confirms that the condition of the body has a

strong relationship to the therapeutic effect of reinforcing or reducing ．

B ． The Relative Specificity of Acupoints ：The indications of acupoints not only have

universality ，but also relative specificity ．Relative specificity is also known as the point摧s

properties ．Some acupoints ， such as Guanyuan （ C V４）， Qihai （ C V６）， M ingmen （ G V４），

Gaohuang（BL４３） an d Zusanli（S T３６），can invigorate the right （ zheng qi） and strengthen the

body ，making them suitable to treat deficiency syndromes ．Some other acupoints ，such as


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Ren z hong（G V２６），Weizhong（BL４０），S h i er j i n g（the １２ Well points），an d Shixuan（EX唱U E１１）

dispel pathogens ，and restrain hyperactive functioning in the body ，therefore they are good for

patients w ith conditions associated w ith pathogenic excesses ．When practitioners manipulate

needles using the reinforcing and reducing technique ，the therapeutic effects o f acupuncture will

be elevated w hen it is combined with the relative specificity of acupoints ．Besides ，it is noted

that the combination of points（point prescription）also has an influence on the effect ．

C ． Needles and the F orce of Manipulation ：Needles can also influence the therapeutic effect

of acupuncture in many ways ，such as the material ，the specifications ，and so on ．Whether the

manipulation is correct or not directly influences the therapeutic effects of acupuncture ；

adequate attention should be given to each ．

5 ．1 ．7 The Retention and Withdrawal of Needles

5 ．1 ．7 ．1 Needle Retention

The purpose of retaining the needles in the acupoints is to strengthen the effect by

prolonging the needling sensation and facilitate furt her manipulation ．In general ，the reinforcing

or reducing method is applied after obtaining the needle sensation ， then the needles are

withdrawn or retained for １０ to ３０ minutes after they have been inserted and manipulated ．

When treating certain diseases ，such as acute abdominal pain ，cold symptoms ，persistent pain or

spastic cases ，retention time may be prolonged to ６０ minutes ，or even several hours ，during

which time ，intermittent manipulations should be done to strengthen the therapeutic effects ．If

the qi does not arrive ，passive retention of the needle is appropriate until the arrival of

the qi ．5 ．1 ．7 ．2 Withdrawal

W it hd ra w al r ef er s t o t akin g o ut o r r em o vin g a needle ． Following the insertion ，

manipulation and retention ，the needle can be withdrawn or removed ．

T o d o s o ，the skin around the acupoint should be pressed with a piece of cotton held

betw een the thumb and index finger of the pressing／holding hand ，then slowly and gently

rotated and lifted up to the subcutaneous layer ，followed by a brief pause prior to withdrawing

the needle ．Various methods of withdrawal may be utilized here ，based on the need to reinforce

or reduce ．

With the exception of special treatments ，upon withdrawal ，every acupoint needled shouldbe momentarily pressed with a sterilized cotton ball to prevent bleeding and／or pain ．Prolonged

pressure should be applied to acupoints on the head／scalp as these areas have a tendency to

bleed ．After the needles have been withdrawn ，it is appropriate to ask the patient how they are

feeling ，check for bleeding at the insertion sites ，count the number of needles which were used ，

and observe the patient for any signs that might indicate a delayed reaction associated with

fainting ．

5 ．1 ．8 Management and Prevention of Accidents

Acupuncture accidents can be the result of carelessness ，violation or neglect of the rules ，


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inappropriately strong manipulations ，or inadequate knowledge of human anatomy ．If they are

not well唱handled ，the patient摧s situation may worsen causing undue pain and／or suffering ．One

should be thoroughly acquainted with common acupuncture accidents in order to manage them

appropriately in the event that they occur ．

5 ．1 ．8 ．1 Fainting During the Acupuncture Treatment

Fainting during the acupuncture treatment refers to the swoon which patients have in the

process of the acupuncture treatment ．

Causes ： Weak constitutions ，nervous tension ，fatigue ，hunger ，severe diarrhea ，needling

done after profuse sweating or bleeding ，improper positioning（posture），fear of needles（needle

phobia）or overly唱forceful manipulations done by the practitioner ．

Symptoms ： Dizziness ，blurred vision ， lassitude ，pallor ，nausea and possibly vomiting ，

profuse s weating ，cold extremities ，sudden drop in blood pressure ，a deep ，thin pulse ；mental

disorientation ，cyanotic lips and／or nails or sudden loss of consciousness ，fecal and urinaryincontinence and acrotism ．

Management ： The treatment should be stopped immediately and all needles quickly

withdrawn ．Assist the patient to lie flat ，or if they are seated ，have them hold their head down

and between their legs ；keep him or her warm ．In mild cases ，the patient will recover after lying

flat for a few minutes and drinking warm or dextrose water ．In a severe cases ，you can needle

Ren z hong（G V２６），Suliao（G V２５）， N ei guan（PC６），Zusanli（ S T３６）；mild manipulations are

strongly suggested ；or moxibustion can be done at Baihui（G V２０），Guanyuan（CV４），an d Qihai

（CV６）．If the condition gets worse or the patient is unresponsive ，it摧s suggested to call for help

an d／or perform emergency first aid ．

Prevention ： Fainting ，associated with acupuncture treatments ，is avoidable if the following

rules are observed ：During the initial visit for first唱time patients ，give a detailed explanation of

the pr ocess of acupuncture ，what it is ，how it works and what patients usually experience or can

expect during a treatment ，in an effort to dispel their fears ．It should be noted that there is a

higher incidence of fainting with patients who are nervous or weak ．A comfortable position

should be selected ；many times the prone position is preferred ．A minimal number of acupoints

should be selected to needle first唱timers ，using slow and gentle manipulations ．The patient

should be treated when he or she is not hunger ，thirsty or fatigued ．During the t reatment ，closeattention should be paid to the patient摧s facial expressions ，body language and verbal feedback ．

There should be an immediate response to any preliminary signs or symptoms precluding

syncope ，i ．e ．dizziness ，and in the event that there is an incident ，it should be managed quickly ，

and with a sense of urgency ，to nip it in the bud ．

5 ．1 ．8 ．2 Stuck Needles

If it is difficult to manipulate or withdraw a needle after it has been inserted ，or the patient

has intense pain ，it摧s a sign that the needle is stuck ．

Causes ： The patient摧s nervous tension can cause the local muscles to contract tightly

around a needle following an insertion ．If the intensity of the manipulations is too strong ，they


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can induce local ，muscular contractions ，as can rotations of the needle in only one direction ，so

much so ，that the muscular tissues unduly wrap around the body of the needle ．Also ，prolonged

retention of a needle or undue movement by the patient can cause them to become stuck ．

Manifestations ： When this happens ，it is difficult for the practitioner to rotate ，lift or

thrust the needle during manipulations ．

Management ：One or more of the following manipulations can be done to reduce excessive

nervous tension in the local treatment areas of the body that results in overly contracted

muscles ： Allow the inserted needle to be retained a little longer ；massage around the affected

area of the body or tap the handle of the stuck needle ；or insert ano ther needle near the pr oblem

area ．If the stuck needle was caused by rotating the needle in only one direction ，twirl it back in

the opposite direction while scraping and tapping the needle handle to facilitate loosening and

unwinding the twisted muscle fibers ．

Prevention ： Nervous patients should be encouraged to relax ，and reassured that worryingis unnecessary ．Care should be taken during manipulations ，to avoid rotating the needle in only

one direction ． If rotating the needle in one direction is necessary ， i t sh o ul d be d one i n

conjunction with lifting and thrusting the needle ．

5 ．1 ．8 ．3 Bent Needles

Bent needles occur during the unusual situations where the angle of the body of the needle

changes while or after it has been inserted into an acupoint ．

Causes ： Unfamiliarity with the anatomical structures associated with the acupoints ，

inappropriate use of force ，needle insertions into hard body tissues ，and changes in the patients摧

body position during insertions or while the needles are being retained can result in bent

needles ．Other causes may include external forces accidentally ，forcefully pressing or pushing

the handle（s） of the needles while being retained ．

Manifestations ： The desired direction and angle of the needle摧s handle following insertion

and retention is thus changed ，making it difficult to lift ，thrust ，r otate or withd raw withou t

causing intense pain to the patient ．

Management ： When a needle is bent ，manipulations like lifting ，thrusting and rotating etc ．

should no longer be done ．If the handle of the needle is only slightly bent ，it can be slowly

withdrawn ．However ，if the needle has been dramatically bent ，it should be slowly withdrawnfollowing the course of the bend ．If a bend is caused by the patient changing body position ，

assist them to assume their former position ，and then slowly withdraw the needle w hen the

surrounding muscles have fully relaxed ．It should be noted that it is inappropriate to forcibly

withdraw a needle to avoid breaking it ，which would leave remnants of the needle in the body ，

and possibly below the skin ．

Prevention ： Skillful manipulations are required of all practitioners ，which include the

steady application of finger force instead of sudden ，rapid thrusting ，and familiarity with the

associated anatomical structures ．Appropriate body positions should be selected prior to

treatments ，and patients should be instructed not to change them after the needles have been


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inserted ．Also ，all areas being treated should be protected so that the handle of the needles

wouldn摧t be accidentally pressed or pushed deeper than desired by external forces ．

5 ．1 ．8 ．4 Broken Needles

This means an inserted needle is accidentally broken during acupuncture and the remnant

of the needle is left in the body ，possibly above o r below the surface of the skin ．

Causes ：Broken needles can be the result of the following circumstances／conditions ：poor needle

quality／integrity that can lead to erosion in the body or at the base of the needle ；failure to carefully

examine needles prior to insertions ；inserting the entire body of the needle below the surface of the

skin ；inappropriately lifting ，thrusting or twirling the needles too strongly during manipulations causing

intense muscular contractions ；sudden changes in the patient摧s body position during retention and

inappropriate management of bent or stuck needles ．

Manifestation ： The needle body is broken during a manipulation with a remnant partially

left in the body ，above or below the skin ．Management ：Both the practitioners and the patient should remain calm when dealing with

this situation ．The patient should be requested to remain in the same body position to avoid the

remnant from sinking deeper into the body ．If the broken end is still protruding from the skin ，

it should be withdrawn with the fingers or a pair of forceps ．However ，if it is already beneath

the skin ，but still visible ，press the area of the body surrounding the acupoint perpendicularly

with thumb and index finger of one hand ，to e xpose the broken end ，and withdraw it with a pair

of forceps using other hand ．In the event that of the broken needle is deeply submerged ，it

should be surgically removed after locating its position with an X唱ra y ．

Prevention ： Accidents can be prevented by carefully inspecting needles for quality ，an d

disposing of those that are substandard ．Needle manipulations should be done gently ，with

careful attention paid to avoid using inappropriately strong manipulations and／or rapid force ．

The patient should be instructed and reminded ，before and during the course of the treatment ，

not to change his／her po sition af ter the needles have been inserted ．Also ，it should be noted that

the needle body should not be completely inserted below the surface of the skin ；p ar t of i t

should be left outside ．In the event of a bent needle ，the insertion or manipulation should be

discontinued ，and the needle withdrawn immediately ．Stuck and bent needles should be properly

managed ，and never forcibly withdrawn ．5 ．1 ．8 ．5 Hematomas

A hematoma is a bruise with swelling and pain ，produced by bleeding beneath the surface

of the skin after a needle has been removed ．

Causes ： This may arise fro m injuries to the skin or underlying tissue ，especially if the tip of

the needle is bent or hooked ，or from puncturing blood vessels during insertions ．

Manifestation ： Local swelling ，distension and pain after the withdrawal of a needle ，

followed by the skin around the acupoint punctured turning blue and purplish ．

Management ： A sligh t h ematoma ， caused by subcutaneous bleeding ， will generally

disappear on its own ．If the local swelling ，distension and pain is severe ，or the blue and purplish


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area／b ruisin g i s la rg e e no ug h t o r es t ric t o r i mpai r m o t or f unct io n a nd／or m ovement ，

management is required ．First ，a cold compress should be applied to stop the bleeding ，followed

by a hot compress or light kneading and massage to the local area to facilitate the dissipation of

blood stasis ．

Prevention ： Needles should be carefully inspected before use and practitioners should be

thoroughly familiar with the human anatomy ．Pressured should be applied to the needled area with a

sterilized cotton ball ，as soon as the needle is withdrawn ，to prevent bleeding beneath the skin ．

5 ．1 ．8 ．6 Traumatic Pneumothorax

A pneumothorax is caused by injury to the lung（s），resulting in puncturing ，which allow s

air to escape into the tho rax（chest cavity）．

Causes ：Deep needling in the points of the thorax and back ．

Manifestations ： Chest pain and oppression ，palpitations ，shortness of breath ，shallow

breathing and possibly dyspnea ， tachycardia ，cyanotic lips ，sweating ，a nd a d ro p i n b lo odpressure ．Physical examination of the injured aspect of the lung presents a comparatively wide

intercostal space ，the lung is resonant to percussion ，the breath sounds are obviously reduced or

imperceptible ；in severe cases ，the trachea is even deviated ．A chest x唱ray indicates the presence

of air in the t horax and a collapsed lung ．A diagnosis is made accordingly ．

Management ： Needling should be discontinued and all needles withdrawn ．The patient

should be placed in the lateral recumbent position ．Patients with small amounts of air in the

thorax can recover on their own ，however ，a close eye should be kept on them and preparations

should be made to deal with symptoms ，such as ，medication to stop coughing or antipyrotic

drugs used to prevent enlargement of the injured area in the lung due to coughing ，deterioration

of leakage and infection ．In severe cases ，emergency measures should be taken immediately ，such

as a tho racocentesis ，the insertion of a needle into the chest to aspirate air and reduce the

pressure ，or a slow ，steady supply of oxygen ．

Prevention ： When needling ，practitioners should be focused and properly positioned to

determine and control the appropriate needling angles ，direction and depths ．For acupoints on

the chest ， back ， or supraclavicular fossae ， oblique ， horizontal and superficial needling is

preferable ．It is inadvisable to do deep ，perpendicular insertions ，or large lifting and thrusting

movements w ith the needle ．Also ，prolonged retention time is con traindicated ．

5 ．1 ．9 Acupuncture Treatment Precautions

Attention should be paid to the following precautions to ensure acupuncture safety and

avoid accidents ：

A ． It is inadvisable to give acupuncture to patients who are either hungry ，full ，intoxicated

or exhausted ．For patients with weak constitutions ，or those with severe or chronic illnesses and

deficiencies of qi and blood ，strong needle manipulations should be avoided ，and it is preferable

if the patient is treated in the supine position ．

B ． It is contraindicated to needle the points on the abdomen of wo men w ho are up to three


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months pregnant ．For those who have been pregnant for more than three months ，acupuncture

on poin ts of th e ab dom en or th e lu m bo唱sacral area is contraindicated ．Acupuncture is also

contraindicated on the following acupoints ，since they have the property of promoting blood

circulation and dredging the meridians ，during pregnancy ： Sanyinjiao（ SP６）， H e g u（ LI４），

K un lun（BL６０）an d Zhiyin（BL６７）．

C ． Points on the vertex of the head of infants should not be needled when the fontanels are

not closed ．

D ． Patients with the tendency to bleed spontaneously or who have blood clotting problems

should not receive acupuncture ．

E ． It is contraindicated to do acupuncture on body areas that have infections ，ulcers and

scars ．

F ． It is inappropriate to do deep needling on the acupoints of the chest ，ribs ，lumbar region

or upper back ，especially for patients with swelling and enlargement of the liver or spleen ．If deep needling is done on the chest ，back ，axilla ，ribs and supraclavicular fossae ，it is possible to

injure the lung（s），causing a traumatic pneumothorax ．

G ． To avoid serious injury to the internal organs ，practitioners ought to be careful of the

angles ，direction and depths of needling when needling points around the eyes and along the

spine ，or Feng f u（G V１６）and Yamen（G V１５），at the base of the skull ．Large amplitudes ，lifting

and th rusting ，twirling and rotating or prolonged needle retention is ill唱advised ．

H ． To prevent accidentally puncturing the urinary bladder ，the direction ，angles and depths

of needle insertions should be carefully controlled when needling patients with urine retention ．

5 ．2 Moxibustion

Moxibustion therapy（ j i u f a） literally means the burning of moxa ．It is a therapy that can

prevent and treat diseases with heat stimulation on acupoints or related parts of the body ．Y i X u e

R u M en Zhen J iu（ The chapter on Acupuncture and Moxibustion in Elementary Medicine） said

that when drugs and acupuncture are inapplicable ，mo xibustion must be applied ．It suggests that

moxibustion is a supplementary alternative to acupuncture with its own special benefits in clinicalpractice ．

Though there are quite a few materials used for moxibustion ，moxa ，the leaf of Artemisia

Argyi ，from the compositae family ，a perennial ，herbaceous plant ，remains the chief ingredient ．

M oxa is produced in all parts of China ，yet the name of J in M o x a ，comes from the Jin Zhou

area ，where it is most famous ．Due to its special aroma ，bitter and pungent flavor and warm

nature ，as well as it摧s flammability and moderate heat ，moxa surely is an ideal option — just as

both B en Cao Gang Mu（ The Compendium of Materia Medica）and M i ng Y i B i e L u（ The Great

Physician摧s Additional Records） mentioned ，“ Moxibustion can be applied in various diseases ．”

With dry ，moxa leaves pounded and purified ，fine ，soft ，m o x a w o o l i s t h u s m a d e ；and after


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being dried in the sun it is stored for future use ．The reason for using old ，d r y m o x a w o o l

instead of fresh new wool ，is that the latter contains so much volatile oil that when burned it

gives off too much heat ．So the best choice is m oxa that has been dried for an ex tended period

of time ．

5 ．2 ．1 The Functions of Moxibustion

5 ．2 ．1 ．1 Warm the Meridians to Dispel Cold

Su Wen · Y i F a F an g Y i L u n suggested that distension of the zang organs ，caused by high

altitude and the cold weather of the north ，should be treated with moxibustion ．F r om th is we

could see that indeed ，moxibustion can warm the meridians to dispel cold ．Clinically ，i t i s

indicated for all diseases caused by cold o bstruction ，blood stagnation and blockages of the

meridians ，such as cold唱damp bi唱athralgia ，dysmenorrhea ，amenorrhea ，stomachache ，epigastric

pain and cold herniation（ sh an）．5 ．2 ．1 ．2 Supporting Yang to Strengthen the Original Qi

It is said in B i a n Q ue X i n S h u（ Bian Que摧 s H ea r t y W or ds） that sickness is caused by the

deficiency of qi ，the loss of which can result in death ，and moxibustion is first in line to keep it

sufficient ．Moreover ，moxibustion could be used to treat diarrhea ，coldness of the extremities

and acrotism as written in a chapter of S hang H an Lun Bian Jue Y in Bing M ai Zhen Bing Zhi

（The Differentiation of Jueyin Syndrome in Treatise on Febrile Diseases）．In all ，it has been

widely applied to many serious diseases due to insufficiency ，sinking or depletion of yang qi ．

Among them are enuresis ，rectocele ，prolapse of the genitalia ，menorrhagia ，leukorrhea ，an d

chronic diarrhea ， ju st to na me a fe w ．

5 ．2 ．1 ．3 Remove Blood Stasis and Dissipate Pathological Accumulation

L in g Shu · Ci Jie Zhen Xie suggests that ：T he blood in vessels can be solidificated ，and the

stasis in the blood vessels can o nly be treated with heat This is because“ qi is the commander of

blood ，and blood is the mother of qi”（ here“commander ” means governor and“ mother ” means

source and foundation）．So ，heat stimulation facilitates the normal flow of qi ， the normal

circulation of blood is ensured ．Moxibustion ，with its heat ，has the effect of keeping the actions

of Yin qi an d W e i q i in balance ，and in turn ，it dispels blood stasis and dissipates pathological

accumulation ．In the clinical setting ，it is co

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