Fine needle technique refers to the use of fine needles to stimulate acupuncture points on the body through specific techniques, aiming to unblock the meridians and regulate the internal organs, thereby achieving the goal of strengthening the body and expelling pathogens to treat diseases.The fine needle technique has a wide range of indications and is used to treat various common and frequently occurring diseases in internal medicine, surgery, gynecology, and pediatrics.
1. Common Instruments and Basic Operation Methods
(1) Common Instruments
The fine needles used in clinical practice are mainly made of stainless steel, with types primarily including ring handle needles and flat handle needles, and specifications mainly distinguished by the diameter and length of the needle body.
(2) Basic Operation Methods
These include disinfection, needle insertion, manipulation, retention, and needle removal.
1.Disinfection
Before acupuncture, it is essential to disinfect the needles, the acupuncture points, and the physician’s fingers.
2.Needle Insertion Method
During needle insertion, both hands are generally used in coordination. The right hand holds the needle, with the thumb, index, and middle fingers gripping the needle handle, while the left hand presses the acupuncture point to stabilize the skin over the point. The following methods of needle insertion are commonly used:
(1) Finger Cutting Insertion Method
Using the left thumb or index finger’s nail to cut and press the skin over the acupuncture point, the right hand holds the needle, and the needle tip is quickly inserted close to the edge of the left fingernail.
(2) Stretching Insertion Method
Using the left thumb and index finger to stretch and tighten the skin over the acupuncture point, the right hand inserts the needle. This method is used for acupuncture points on relaxed skin.
(3) Pinching Insertion Method
Using the left thumb and index finger to pinch the skin on both sides of the acupuncture point, the right hand inserts the needle from the top of the pinched skin. This method is used for shallow acupuncture points, such as Yintang (Hall of Impression).
(4) Holding Insertion Method
The left hand holds a disinfected cotton ball wrapped around the lower end of the needle, exposing the needle tip, fixing the needle tip on the skin surface of the acupuncture point, while the right hand twists the needle handle, applying force with both hands to insert the needle. This method is used for longer fine needles.
3.Needle Manipulation and Obtaining Qi
After the fine needle is inserted, manipulation techniques such as lifting, thrusting, and twisting are performed to obtain Qi and conduct tonification or sedation. Obtaining Qi, also known as “needle sensation,” refers to the sensation of meridian Qi response produced after the needle is inserted into the acupuncture point. When this meridian Qi response occurs, the physician feels a heavy and tight sensation under the needle, while the patient experiences sensations such as soreness, numbness, distension, and heaviness. The presence or absence of Qi and the speed of its occurrence directly relate to the therapeutic effect of acupuncture.
Common manipulation techniques include the following two:
(1) Lifting and Thrusting Method
The lifting and thrusting method involves inserting the needle into a specific depth at the acupuncture point and then performing upward and downward lifting and thrusting movements. Inserting the needle from a shallow layer to a deeper layer is called thrusting; withdrawing from a deeper layer to a shallow layer is called lifting.
(2) Twisting Method
The twisting method involves inserting the needle to a certain depth and then using the right thumb and index and middle fingers to hold the needle handle, performing a front-and-back twisting motion.
4.Needle Retention and Removal
The physician can determine the needle retention time based on the patient’s condition, generally retaining the needle for 15 to 30 minutes for common diseases. When removing the needle, the left hand presses the skin around the needle hole, while the right hand gently twists the needle and slowly withdraws it just beneath the skin, then removes the needle and applies pressure with a sterile dry cotton ball to prevent bleeding.
2. Fine Needle Treatment Techniques for Common Diseases
(1) Stroke (Acute Cerebrovascular Disease)
Stroke is characterized by sudden fainting, loss of consciousness, hemiplegia, facial drooping, and speech difficulties, or simply facial drooping and hemiplegia without fainting as the main clinical symptoms. The formation of this disease is mainly due to the imbalance of Yin and Yang, or due to emotional distress, overwork, or sexual exhaustion, leading to the stirring of wind Yang, excessive heart fire, and the combination of wind and fire, causing Qi and blood to rebel upwards; or due to excessive alcohol consumption and rich food, leading to spleen deficiency and internal phlegm-heat, transforming into fire and stirring wind, with wind-fire and phlegm disturbing the clear orifices, resulting in stroke.
Clinically, it is divided into stroke affecting the internal organs and stroke affecting the meridians, with this section mainly discussing the fine needle treatment for stroke affecting the meridians.
[Treatment Principle] Unblock the meridians, promote Qi and invigorate blood.
[Operation Steps]
Acupuncture Points: Baihui (Hundred Meetings), Fengchi (Wind Pool), Quchi (Pool at the Crook), Waiguan (Outer Pass), Hegu (Joining Valley), Huantiao (Jumping Circle), Yanglingquan (Yang Mound Spring), Zusanli (Leg Three Miles). Points can be selected according to symptoms, such as adding Qiuxu (Hollow Valley) for foot inversion, Tianshu (Heavenly Pivot) for constipation, and Lianquan (Lian Spring) for speech difficulties.
Needling Method: Direct insertion, using lifting and thrusting and twisting techniques. For Fengchi, the needle is inserted obliquely towards the tip of the nose at a depth of 0.8 to 1.2 cun, and for Lianquan, it is inserted obliquely towards the root of the tongue at a depth of 0.8 to 1.5 cun.
Treatment Course: During the acute phase, once daily; during the recovery and sequelae phase, every other day, with each session retaining the needle for 20 to 30 minutes, and 10 sessions constitute one treatment course.
(2) Headache (Tension-Type Headache, Vascular Headache)
Headache refers to a condition characterized by pain in the head as the main clinical manifestation. The brain is the “sea of marrow,” the head is the meeting of all Yang, and the residence of clear Yang, with the Qi of the five organs and six bowels converging in the head. External pathogens or internal injuries can lead to Qi and blood disturbances, obstructing the brain’s meridians, resulting in headache.
Headaches are divided into two main categories: external and internal injuries, with this section mainly discussing fine needle treatment for internal injury headaches.
[Treatment Principle] Unblock the meridians and collaterals, promote Qi and invigorate blood to relieve pain.
[Operation Steps]
Acupuncture Points: Baihui, Fengchi, Hegu, Taichong (Great Surge), Touwei (Head Maintain), with additional points selected according to symptoms, such as adding Shuaigu (Leading Valley) and Jiao Sun (Angle Grandson) for Shaoyang headaches; Tianzhu (Heavenly Pillar) and Taiyang (Sun) for Taiyang headaches; and Cuanzhu (Gathering Bamboo) and Yintang for Yangming headaches.
Needling Method: Head points are often inserted obliquely or horizontally, while limb points are usually inserted directly. For Fengchi, the needle is inserted obliquely towards the tip of the nose at a depth of 0.8 to 1.2 cun, or horizontally through Fengfu (Wind Palace). After insertion, perform lifting and thrusting and twisting techniques.
Treatment Course: Each session retains the needle for 30 minutes, once daily, with 10 sessions constituting one treatment course.
(3) Facial Paralysis (Peripheral Facial Nerve Palsy)
Facial paralysis is a condition characterized by the mouth and eyes being skewed to one side. Symptoms include relaxation of one side of the face, disappearance of forehead wrinkles, widening of the eye fissure, flattening of the nasolabial fold, drooping of the mouth corner towards the healthy side, and inability to perform actions such as frowning, raising eyebrows, showing teeth, or puffing cheeks. Some patients may initially experience pain behind the ear, and may also have reduced taste or hypersensitivity to sound, and even develop herpes in the external ear canal. This condition is often caused by the deficiency of the collaterals, with wind-cold invading the Yangming and Shaoyang collaterals, leading to Qi stagnation and insufficient nourishment of the muscles and tendons, resulting in the disease.
[Treatment Principle] Invigorate blood and unblock the collaterals, regulate the meridians and tendons.
[Operation Steps]
Acupuncture Points: Fengchi, Yifeng (Wind Screen), Dicang (Earth Warehouse), Jiachao (Cheek Car), Hegu. Additional points can be selected according to symptoms, such as adding Yingxiang (Welcome Fragrance) for flattening of the nasolabial fold; Shuigou (Water Ditch) for deviation of the nasal groove; Chengjiang (Cheng River) for deviation of the chin; and Yangbai (Yang White), Cuanzhu, or Shenmai (Shen Pulse) for inability to close the eyes.
Needling Method: For facial points, initially use shallow and light insertion, and after one week, consider horizontal or oblique insertion.
Treatment Course: Each session retains the needle for 20 to 30 minutes, once daily, with 10 sessions constituting one treatment course.
(4) Shoulder Pain (Shoulder Periarthritis)
Shoulder pain is characterized by diffuse pain in the shoulder accompanied by limited movement. Symptoms include pain that is worse at night, reduced pain after morning activity, and localized tenderness, with restricted movements such as external rotation, abduction, elevation, and backward rotation of the arm. In the later stages, the affected tissue may become adhesively bound, leading to progressively worsening functional impairment, resulting in “frozen shoulder” and ultimately loss of shoulder joint function. This condition is primarily characterized by pain in the early stages and functional impairment in the later stages. It is generally believed that exposure to cold, excessive fatigue, and chronic strain are related to the development of this condition.
[Treatment Principle] Unblock the tendons and collaterals, promote Qi and invigorate blood.
[Operation Steps]
Acupuncture Points: Jianyu (Shoulder Bone), Jianliao (Shoulder Cavity), Jianqian (Front of Shoulder), Ashi points, Tiaokou (Channel Mouth). Additional points can be selected according to symptoms, such as adding Binao (Upper Arm) and Quchi for upper arm pain; and adding Quyuan (Channel Edge) and Tianzong (Heavenly Center) for scapular pain.
Needling Method: Direct insertion.
Treatment Course: Each session retains the needle for 20 to 30 minutes, once daily, with 10 sessions constituting one treatment course.
(5) Low Back Pain (Acute Lumbar Strain, Lumbar Disc Herniation)
Low back pain is characterized by self-reported pain in the lower back, presenting as heavy pain, soreness, and stiffness that restricts bending and stretching, or pain radiating to the buttocks and legs. The occurrence of this condition is mainly related to exposure to external pathogens, falls, and injuries.
This condition is divided into three main categories: cold-damp low back pain, blood stasis low back pain, and kidney deficiency low back pain, with this section mainly discussing fine needle treatment for blood stasis low back pain.
[Treatment Principle] Unblock the meridians and collaterals, invigorate blood and resolve stasis.
[Operation Steps]
Acupuncture Points: Shenshu (Kidney Shu), Yaoyang (Lower Back), Weizhong (Middle of the Knee), Ashi points.
Needling Method: Direct insertion.
Treatment Course: Each session retains the needle for 20 to 30 minutes, once daily, with 10 sessions constituting one treatment course.
3. Contraindications
1. Pregnant women should avoid acupuncture in the lower abdomen, lumbar region, and points such as Hegu, Sanyinjiao, and Zhiyin.
2. Children with unclosed fontanelles should avoid acupuncture points on the top of the head.
3. Areas with skin infections, ulcers, or tumors should not be needled.
4. Caution should be exercised in patients with bleeding tendencies.
4. Precautions
1. Patients should not undergo acupuncture when overly hungry, fatigued, or under excessive mental stress.
2. For patients with physical weakness or Qi and blood deficiency, the needling technique should not be too strong, and patients should be encouraged to lie down.
3. Deep needling should be avoided for acupuncture points located over the chest, ribs, waist, and back.
4. When needling around the eyes and neck (such as Fengfu, Yamen, etc.), care should be taken to control the angle and depth, avoiding excessive lifting, thrusting, and prolonged retention to prevent injury to important tissues and organs.
5. For patients with urinary retention, deep needling should be avoided in the lower abdomen.
5. Management and Prevention of Abnormal Situations During Acupuncture
1. Needle Shock: Commonly seen in patients receiving acupuncture for the first time, due to mental tension, improper positioning, or excessive stimulation from the needle, patients may suddenly experience dizziness, pale complexion, palpitations, sweating, and fainting. Acupuncture should be immediately stopped, all needles removed, and the patient should be laid flat. Emergency points such as Shuigou, Suli (Inner Pass), Hegu, Taichong, Zusanli, and Yongquan (Bubbling Spring) can be needled, along with other necessary measures.
2. Stuck Needle: Due to patient tension, or muscle spasms from pain after needling, or changes in patient position after insertion, muscle fibers may wrap around the needle, causing difficulty in manipulation or removal. The patient should be instructed to relax, or gentle pressing or tapping on the needle handle near the stuck point can be performed, or another needle can be inserted nearby.
3. Bent Needle: Due to unskilled technique, or the needle encountering hard tissue, or changes in patient position during retention, or improper management of a stuck needle, the needle handle may change direction, making manipulation and removal difficult and causing pain. Manipulation should be stopped, and the needle should be slowly withdrawn in the direction of the bend.
4. Broken Needle: Due to poor quality of the needle or excessive force during manipulation, the needle may break inside the body. The left hand should press the skin around the needle to expose the broken end, and the right hand should use tweezers to remove it; if the broken part is deeply embedded, it should be located under X-ray for surgical removal.
5. Hematoma: Caused by puncturing a blood vessel, leading to minor subcutaneous bleeding, resulting in local bruising or swelling, which generally resolves on its own. If there is severe swelling and pain, cold compresses followed by heat compresses can be applied.
6. Pneumothorax: Deep needling in the chest, back, and near the clavicle may puncture the thoracic cavity and lung tissue, leading to pneumothorax, with symptoms such as chest pain, tightness, and difficulty breathing. If pneumothorax occurs, the needle should be immediately removed, and the patient should be placed in a semi-reclining position to rest, avoiding panic and changing positions. Generally, small amounts of air can be absorbed naturally; for severe cases, timely rescue measures such as thoracentesis and slow oxygen supplementation may be required.
