1. Precautions for Acupuncture with Filiform Needles①. Patients should not undergo acupuncture when overly hungry, fatigued, or excessively nervous. For patients who are weak, with qi deficiency and blood loss, the technique should not be too strong, and a lying position should be preferred.②. Women in the first three months of pregnancy should not have acupuncture on the lower abdomen. For those over three months pregnant, acupuncture on the abdomen and lumbar-sacral areas is also not advisable. Points such as Sanyinjiao (Three Yin Intersection), Hegu (Union Valley), Kunlun (Kunlun), and Zhiyin (Ultimate Yin), which promote circulation and invigorate blood, should be avoided during pregnancy. Women during menstruation should also avoid acupuncture unless it is for regulating menstruation.③. Acupuncture should not be performed on the head when the fontanelle of infants has not closed.④. Patients with a history of spontaneous bleeding or prolonged bleeding after injury should not undergo acupuncture.⑤. Areas of the skin with infections, ulcers, scars, or tumors should not be needled.⑥. For patients with urinary retention, when needling the lower abdomen, the appropriate direction, angle, and depth of needling should be carefully controlled to avoid injuring organs such as the bladder and causing accidents.⑦. Points located on the chest, sides, waist, back, and where internal organs reside should not be needled directly or deeply. Special caution is required for patients with liver or spleen enlargement and emphysema.⑧. When needling points in the eye area and the neck, such as Fengfu (Wind Palace) and Yamen (Mute Gate), as well as points along the spine, care should be taken to control the angle. Large movements of lifting, thrusting, and twisting should be avoided, and needles should not be retained for long periods to prevent injury to vital organs.⑨. Acupuncture instruments should be strictly sterilized. It is recommended to use disposable sterilized acupuncture needles to avoid cross-infection.
The angle, direction, and depth of acupuncture refer to the specific operational requirements after the filiform needle is inserted subcutaneously. Mastering the correct angle, direction, and depth during acupuncture is crucial for achieving the desired sensation, performing tonification or sedation, maximizing the therapeutic effects of acupuncture, and preventing accidental injuries. The accuracy of point selection not only refers to the surface location on the skin but must also be combined with the correct angle, direction, and depth to exert the therapeutic effect of the acupoint. Therefore, acupoints should not be viewed merely as small dots but should be understood in a three-dimensional context. In clinical practice, needling the same acupoint with different angles, directions, and depths can lead to variations in the tissue structures reached, the sensations produced, and the therapeutic outcomes. For clinicians, the proficiency of acupuncture operations is closely related to their ability to appropriately master the angle, direction, and depth of needling. The angle, direction, and depth of needling taken during clinical practice should be flexibly adjusted based on the specific conditions of the treatment area, therapeutic needs, and the patient’s constitution and body shape. 1. The Angle of Needling The angle of needling refers to the angle formed between the needle shaft and the surface of the skin during insertion. The size of this angle should be determined based on the characteristics of the acupoint location, the nature of the disease, and the requirements of the technique. Needling angles are generally classified into three types: direct, oblique, and horizontal. 1. Direct needling means inserting the needle at a 90-degree angle to the skin surface, vertically into the acupoint. This method is suitable for most acupoints, especially those in areas with abundant muscle. 2. Oblique needling means inserting the needle at an angle of about 45 degrees to the skin surface. This method is suitable for needling areas with thinner flesh, where important internal organs are located, or where direct deep needling is not advisable, as well as for acupoints located at joints. It is also commonly used when applying certain techniques to regulate qi. 3. Horizontal needling, also known as lateral needling or along-skin needling, means inserting the needle at an angle of about 15 degrees to the skin surface. This method is suitable for acupoints with thin skin and little flesh, such as those on the scalp, face, and sternum. The horizontal needling technique is used in methods such as transverse needling and scalp acupuncture. 2. The Direction of Needling The direction of needling refers to the direction the needle tip is facing during and after insertion, abbreviated as the needle orientation. The direction of needling is generally determined based on the flow direction of the meridians, the distribution of acupoints, and the target tissue structures to be reached. Although the direction of needling is related to the angle of needling, for example, horizontal needling is often used for acupoints on the head and face, while horizontal needling is commonly used for neck and throat acupoints, and oblique needling is often used for lateral chest acupoints, and vertical needling is often used for abdominal acupoints, while the lumbar and back acupoints can use either oblique or vertical needling, the angle of insertion is primarily based on the characteristics of the acupoint location, while the direction of needling is determined by the therapeutic needs for different diseases. For instance, when using the acupoint Jiache (Cheekbone) to treat jaw pain, the needle tip should be directed towards the temple at an oblique angle to allow the sensation to radiate throughout the cheek area; when treating facial paralysis or crooked mouth, the needle tip should be directed horizontally towards the mouth; when treating mumps, the needle tip should be directed obliquely towards the parotid gland; but for toothache, direct needling should be used. 3. The Depth of Needling The depth of needling refers to how deep the needle penetrates the skin and flesh at the acupoint. Mastering the depth of needling should adhere to the principle of achieving a sensation under the needle without injuring tissue or organs. The depth of needling for each acupoint must also consider various factors such as the patient’s age, constitution, condition, acupoint location, the depth of the meridian, seasonal factors, the practitioner’s experience, and the need to achieve sensation. As stated in the “Su Wen: On the Essentials of Needling”: “Needling has its shallowness and depth, each according to its principle… If the depth is not appropriate, it can become a great thief,” emphasizing that the depth of needling must be appropriate. To correctly master the depth of needling, attention must be paid to the following aspects. 1. Age: The “Ling Shu: On Reversal and Order” states: “Infants and thin individuals should be needled shallowly and quickly; strong and overweight individuals can be needled deeper and left in place; the elderly are weak, with declining qi and blood; children are delicate, with immature yin and yang, and should not be needled deeply. Young adults, with robust qi and blood, can be needled deeper.” 2. Constitution: The patient’s constitution and body shape vary in terms of thinness and strength. The “Su Wen: On the Three Parts and Nine Pulses” states: “One must first assess the thinness and strength of the body to adjust the qi’s deficiency and excess,” and Zhang Zhicong also said: “Knowing the thinness and strength of the body helps determine the depth of needling.” Therefore, for thin and weak individuals, shallow needling is advisable; for strong and robust individuals, deeper needling can be appropriate. 3. Location: For acupoints on the head, face, and chest, needling should be shallow; for acupoints on the limbs and abdomen, deeper needling can be appropriate. 4. Meridians: The distribution and attributes of meridians in the human body vary in depth, with differences between yin and yang. Ancient literature suggests that deeper meridians can be needled deeper, while superficial meridians should be needled shallowly; yang meridians, being superficial, should be needled shallowly, while yin meridians, being internal, should be needled deeper. As stated in the “Ling Shu: On Yin and Yang’s Clarity and Turbidity”: “Needling the yin should be deep and left in place; needling the yang should be shallow and quick.” Generally, meridians running through the elbow, arm, and knee areas are deeper, so they should be needled deeper; those running through the wrist, ankle, and finger areas are shallower, so they should be needled shallowly. 5. Condition: The “Ling Shu: On the Abnormalities of Defensive Qi” states: “Diseases change, floating and sinking, shallow and deep, cannot be exhausted, each in its place. For intermittent diseases, needle shallowly; for severe cases, needle deeply; for intermittent cases, needle lightly; for severe cases, needle heavily, adjusting qi according to changes.” The “Ling Shu: On the Beginning and End” also states: “For a full pulse, needle deeply to release its qi; for a weak pulse, needle shallowly to prevent the essence from leaking out, nourishing the pulse, and expelling the evil qi.” This indicates that the depth of needling must be based on the differentiation of the disease and its mechanism. 6. Technique: The “Medical Human Door” states: “To tonify, one should take qi from the defensive level, needle lightly and shallowly, following the defensive qi to nourish the deficiency; to drain, one should abandon the qi from the nourishing level, needle heavily and deeply, taking the nourishing qi to drain it.” The “Nan Jing” states: “Needling the nourishing level should not harm the defensive level, and needling the defensive level should not harm the nourishing level,” indicating that the depth in needling techniques must be well understood and targeted. If one needles deeply when they should needle shallowly, they may not reach the nourishing level and instead harm the defensive level; if they needle shallowly when they should needle deeply, they may excessively drain and harm the nourishing level. 7. Seasonal Factors: The human body is closely related to seasonal changes, and needling must vary with the seasons. The “Su Wen: On the Essentials of Diagnosis” states: “Spring, summer, autumn, and winter each have their own regulations.” In terms of needling depth, it should be based on the condition and combined with seasonal factors. The “Ling Shu: On the Basic Points” states: “In spring, take from the collaterals and the major meridians between the flesh; for severe cases, take deeply; for intermittent cases, take shallowly; in summer, take from the collaterals and the skin; in autumn, take from the collaterals, and the rest follows the spring method; in winter, take from the wells and the collaterals, wanting to take deeply and leave it in place.” It is generally believed that shallow needling is suitable in spring and summer, while deep needling is suitable in autumn and winter. This rule is based on the “Nan Jing” which states: “In spring and summer, the yang qi is above, and the human qi is also above, so it should be taken shallowly; in autumn and winter, the yang qi is below, and the human qi is also below, so it should be taken deeply.” If one does not follow the seasonal rules, it will lead to what the “Su Wen: On the Four Seasons” states: “All needling in these four seasons is a great reverse disease, and it cannot be ignored. Conversely, it will cause chaotic qi to invade the body.” 8. Sensation: During needling, if the sensation under the needle is strong, heavy, and appears quickly, and the patient is mentally tense and fearful of needling, the needling should be shallower; if the sensation is slow or small, the needling should be deeper. As stated in the “Great Compendium of Acupuncture and Moxibustion”: “In all needling, the depth should be determined by the sensation, with the sensation as the measure.” The angle, direction, and depth of needling are interrelated. Generally, deep needling is often done with direct needling, while shallow needling is often done with oblique or horizontal needling. For acupoints located in the medulla, eye area, chest, abdomen, and back, where important internal organs are located, the angle, direction, and depth of needling must be well controlled to prevent accidental injuries.
Handling Accidental Situations During Needling
1. Needle ShockManifestations:During needling or while retaining the needle, the patient suddenly experiences fatigue, dizziness, pale complexion, nausea, excessive sweating, palpitations, cold extremities, decreased blood pressure, a weak pulse, or even loss of consciousness, fainting, cyanosis of lips and nails, incontinence, and a weak pulse that is about to disappear.Management:①. Stop: Immediately stop needling and remove all needles.②. Position: Place the patient supine, with the head lowered, loosen clothing, and ensure warmth.③. Mild cases: For mild cases, have the patient lie down for a moment and drink warm water or sugar water to recover.④. Severe cases: For severe cases, based on the above management, acupuncture points such as Renzhong (Middle of the Human), Sulao (Su Lao), Neiguan (Inner Pass), Zusanli (Leg Three Miles), Hegu (Union Valley), and Taichong (Great Surge) can be needled; moxibustion can be applied to Baihui (Hundred Meetings), Shenque (Spirit Gateway), Guanyuan (Gate of Origin), and Qihai (Sea of Qi) to restore consciousness.⑤. Others: If the patient remains unconscious, with weak breathing and pulse, consider combining other treatments or emergency measures.Prevention:①. For first-time treatments, or for anxious or weak patients, provide thorough explanations to alleviate their concerns.②. The best position is to lie down, select fewer acupoints, and use a gentle technique.③. If the patient is hungry, fatigued, or extremely thirsty, they should eat, rest, and drink water before needling.④. The practitioner should maintain focus during the needling process, observing the patient’s complexion and inquiring about their feelings at all times.2. Stuck NeedleManifestations:During needling or after retaining the needle, the practitioner feels resistance under the needle, difficulty in lifting or withdrawing the needle, and if forced to twist or lift, the patient experiences severe pain.Management:①. If the patient is tense and the local muscles are overly contracted, instruct them to relax.②. The practitioner can apply pressure or tap the needle handle locally, or needle nearby to relieve muscle tension. If the needle was inserted improperly or twisted in one direction, it can be twisted back in the opposite direction, and using scraping or tapping methods can help release the entangled muscle fibers to eliminate the stuck needle.Prevention:①. Provide thorough explanations to alleviate patient concerns.②. Pay attention to the technique of needling to avoid twisting in one direction; if using a rolling technique, ensure it is coordinated with lifting and thrusting techniques.3. HematomaManifestations:After needle withdrawal, bleeding occurs at the needle hole, with swelling and pain at the needling site, followed by the skin turning purple.Management:①. If there is a small amount of subcutaneous bleeding with localized bruising, generally no treatment is necessary.②. If there is significant swelling and pain, and the area of bruising is large enough to affect function, apply cold compresses to stop bleeding within 24 hours, and after 24 hours, apply heat or gently massage the area to promote the absorption of the bruise.Prevention:①. Carefully check the needles, familiarize yourself with human anatomy, and avoid blood vessels during needling.②. When needling in areas rich in blood vessels, such as the eye area, use a gentle technique.③. For patients with a history of frequent bleeding, conduct hematological examinations.④. Immediately apply pressure with a sterile cotton ball to the needle hole after withdrawal.4. Traumatic PneumothoraxManifestations:Mild cases present with chest tightness, chest pain, palpitations, and difficulty breathing; severe cases present with respiratory distress, cyanosis of lips and nails, and decreased blood pressure. Physical examination may reveal widened intercostal spaces on the affected side, hyper-resonance on percussion of the lung, and diminished or absent breath sounds on auscultation. In severe cases, the trachea may shift towards the healthy side, and imaging may show compression of lung tissue on the affected side.Management:①. If pneumothorax occurs, immediately withdraw the needle.②. The patient should rest in a semi-reclined position.③. Closely monitor the condition and provide symptomatic treatment, such as cough suppression and anti-infection therapy.④. For severe cases, timely rescue is required, such as closed chest drainage or low-flow oxygen therapy.Prevention:①. Practitioners must be familiar with human and acupoint anatomy.②. Ensure the patient’s position is appropriate.③. Strictly control the depth and angle of needle insertion, and be aware of special contraindications for needling specific acupoints.
5. Injury to Internal OrgansManifestations:Injury to internal organs primarily presents with pain and bleeding:①. Injury to the heart may cause severe stabbing pain in the chest; in severe cases, it can lead to intense tearing pain, causing external bleeding and resulting in immediate shock or death.②. Injury to the liver or spleen may cause internal bleeding, with the patient experiencing pain in the liver or spleen area, or radiating to the back; if bleeding is excessive, symptoms such as abdominal pain, tense abdominal muscles, tenderness, and rebound tenderness may occur.③. Injury to the kidneys may present with low back pain, tenderness in the kidney area, or percussion pain, and in severe cases, may lead to hypotension and shock.④. Injury to hollow organs such as the gallbladder, bladder, stomach, or intestines may cause localized pain, tense abdominal muscles, tenderness, and rebound tenderness.Management:①. For mild injuries, bed rest is usually sufficient for self-healing.②. For severe injuries or those with ongoing bleeding tendencies, hemostatic agents and symptomatic treatment should be applied, with close monitoring of the condition and blood pressure changes.③. If the injury is severe with significant bleeding, rapid blood transfusion or surgical intervention is necessary.Prevention:①. Practitioners must be familiar with human anatomy and acupoint anatomy.②. Understand the structure of acupoints and the organs beneath them.③. When needling acupoints on the chest, abdomen, and back, control the direction, angle, and depth of needling, and avoid excessive movements.Due to excessive force during needling, patients may also experience a lingering discomfort known as post-needling sensation. If this occurs, gentle massage of the area can help alleviate it.
In summary, throughout the treatment process, the practitioner’s responsibility, seriousness, attention to detail, and concentration are all crucial in preventing accidents. However, acupuncture treatment should ideally be performed by professionals, and patients should not attempt to perform it at home to avoid accidental harm to their bodies.
Acupuncture is a unique therapeutic method with significant effects, economical and convenient, and widely applicable. As long as it is used correctly, it is safe and reliable, without any toxic side effects, which is something that pharmacological therapies cannot compare to. However, this does not mean that acupuncture is absolutely safe; if not mastered properly, or if the technique is incorrect, accidents may occur, leading to medical mishaps. Mild cases may cause temporary suffering for the patient, while severe cases may result in lifelong disability or even immediate death. Since the founding of the country, rough statistics indicate that thousands of people have suffered accidental injuries due to improper acupuncture, and many have died as a result. In foreign countries, nations that commonly use acupuncture therapy have also experienced similar lessons, raising widespread concern. The occurrence of acupuncture-related medical accidents is damaging the reputation of acupuncture and affecting its further promotion and development. Therefore, correctly mastering acupuncture techniques and preventing medical accidents has become an increasingly important practical issue.
1. Scope of Acupuncture Accidents
Acupuncture accidents refer to unexpected injuries to the body caused by the practitioner’s technique or the patient’s own reasons during acupuncture treatment.
Strictly speaking, acupuncture accidents are different from “acupuncture abnormal situations.” Abnormal situations during acupuncture, such as needle shock, bent needles, stuck needles, broken needles, or minor bleeding at the needle hole, are all considered “acupuncture abnormal situations”. These situations are common but not difficult to manage and generally do not have serious consequences. However, if a technical error occurs during acupuncture that worsens the patient’s condition, causes unexpected disability, or even death, it is classified as an “acupuncture accident.” Of course, in some cases, the two cannot be completely separated. For example, a broken needle in a critical area that cannot be removed by conventional methods must be resolved through surgical intervention, which should also be considered an acupuncture accident.
The injuries caused by acupuncture can be broadly classified into three categories:
One category is “reactive injuries,” which refers to a series of functional disorders caused by acupuncture that lead to reflexive fainting, commonly known as “needle shock.” These injuries are relatively mild and can generally be easily treated without leaving lasting effects.
Another category is “biological injuries,” which occur when pathogenic microorganisms are introduced into the patient’s body through acupuncture, leading to infections. These injuries are also not severe and can be completely avoided with proper disinfection of needles and the treatment area before acupuncture.
The third category is “mechanical injuries,” which occur when the mechanical stimulation of acupuncture disrupts the anatomical integrity of the patient’s tissues and organs, leading to worsening conditions, disability, or death. These injuries are not only common but also the most harmful, representing the main content of “acupuncture accidents” that we should focus on.
Mechanical injuries caused by acupuncture typically manifest relatively quickly after the procedure, making it easier to establish a causal relationship. The damage can involve internal organs, nerves, blood vessels, etc., and the severity of the injury is related to the affected organ or tissue, with damage to the central nervous system and vital organs resulting in the most severe consequences, often leading to death.
Among central nervous system injuries, there are those that injure the medulla oblongata, the brain, and intracranial blood vessels. From the perspective of clinical accidents, the most common is subarachnoid hemorrhage caused by injury to intracranial blood vessels. In operations involving vital organs, almost all organs have been reported to have suffered injuries from acupuncture, with the highest incidence of pneumothorax resulting from lung injuries, followed by intestinal perforation and gallbladder perforation.
Additionally, there are other medical accidents, such as acupuncture-induced cerebral hemorrhage, which are not directly caused by acupuncture but are instead indirect triggering factors, as the strong stimulation raises the patient’s blood pressure, leading to the rupture of cerebral blood vessels. Although it cannot be classified into any specific category, it is still fundamentally an injury caused by acupuncture.
In terms of classification, acupuncture injuries can generally be divided into reactive injuries, physical injuries, chemical injuries, and biological injuries.
1. Reactive Injuries
Reactive injuries refer to a series of functional disorders caused by the patient’s unstable psychological state, hunger, fatigue, allergic constitution, or excessive stimulation during acupuncture, leading to various bodily responses.
The most common reactive injury is reactive fainting, which can occur during acupuncture, moxibustion, or cupping. Although this type of injury is generally mild, there can be severe cases, especially with some patients experiencing delayed needle shock, which can present with serious symptoms.
Allergic reactions can occur when the injected medication contains allergens during acupoint injections, or when moxa is used, as mugwort may contain certain allergens, leading to reactions that manifest as allergic rashes. In severe cases, systemic symptoms such as fever, severe itching, or pallor, profuse sweating, and weak pulse may occur. The “light needle reaction” that occurs during laser acupuncture, particularly when irradiating the head and face, can lead to dizziness, dry eyes, thirst, lip numbness, ear fullness, nasal itching, and other local reactions, or systemic reactions such as nausea, palpitations, chest tightness, cold sweat, urinary incontinence, and altered consciousness.
Meridian adverse reactions refer to damaging responses that occur due to the stimulation of acupuncture and other acupoint stimulation methods, which some refer to as “negative effects of meridian sensation transmission.” These primarily manifest as pain, numbness, spasms along the meridian, or dysfunction of internal organs, as well as organic changes such as rashes or bleeding along the meridian. Due to the unclear nature of these reactions, they are temporarily classified into this category.
2. Physical Injuries
Physical injuries refer to damage caused by improper use of acupuncture, moxibustion, or cupping, where excessive physical stimulation (including mechanical and thermal stimulation) disrupts the anatomical integrity of tissues or organs.
Currently, direct moxibustion is rarely used, so injuries from thermal stimulation are not common. Although improper cupping can lead to blisters, the overall damage to the body is minimal. Therefore, the most common and harmful physical injuries are those caused by acupuncture.
Mechanical injuries caused by acupuncture can involve internal organs, nerves, blood vessels, etc. The characteristic of mechanical injuries is that the time from injury to the appearance of corresponding clinical symptoms is generally not long, making it easy to establish a causal relationship.
Mechanical injuries are very common in acupuncture, with pneumothorax being the most common type of mechanical injury, and the consequences are often the most severe, with the severity related to the affected organ. Generally, damage to central nervous tissue and vital organs (such as the heart and liver) results in the most severe consequences, often leading to death.
3. Chemical Injuries
Chemical injuries refer to damage to bodily tissues caused by the injection of certain chemical drugs during acupuncture treatment.
Chemical injuries have emerged alongside the development of acupoint injection therapy. They can be broadly classified into three categories based on the injection site: first, “soft tissue injuries,” which often occur during injections in the forearm and hand, leading to deformities and functional impairments; second, “peripheral nerve injuries,” which commonly affect the radial, ulnar, median, and tibial nerves, resulting in corresponding clinical symptoms; and third, “vascular injuries,” with the highest incidence of thromboangiitis obliterans.
The incidence of chemical injuries is quite high, with the number of cases surpassing those of various stimulation methods, including traditional acupuncture. In particular, cases of soft tissue injuries leading to hand deformities due to acupoint injections of irritating drugs are the most common.
For example, a 5-year-old girl experienced a fever and was treated with multiple acupoint injections of 0.5 ml of 12.5% aminopyrine at the bilateral Hegu acupoints. Initially, there were no special abnormalities, but a year later, she developed fibrous bands in the Hegu area, leading to limited thumb movement. Surgical treatment was required, and during the procedure, white fibrous scars were found in the adductor muscle near the thumb’s metacarpophalangeal joint.
This case illustrates that repeated needling and injection of irritating drugs can lead to soft tissue injuries in the hand. The Hegu acupoint is located between the first and second metacarpals, with the superficial layer being the first dorsal interosseous muscle and the deep layer being the transverse head of the adductor muscle. The muscles in the hand are small and delicate (especially in children), but their function is crucial. If irritating drugs such as aminopyrine, phenacetin, or compound quinine are injected, they can affect these two muscles and cause damage, leading to functional impairments and deformities.
Peripheral nerve injuries from acupoint injections are more common than those from simple filiform needle stimulation. Reports of such injuries have reached hundreds in China, affecting various nerves such as the sciatic, peroneal, common peroneal, deep peroneal, radial, median, and ulnar nerves, leading to various peripheral nerve disorders. The acupoints most commonly associated with these injuries include Huanjiao, Zusanli, Yanglingquan, Quchi, Neiguan, Shenmen, and Lieque.
For instance, a 1.5-year-old child with diarrhea was treated with oral “Aminopyrine” and later received injections of 12.5% aminopyrine at the bilateral Zusanli acupoints. After two days, the child exhibited difficulty in leg movement and a limp, with symptoms of foot drop. After thorough examination, it was determined that the child had suffered traumatic paralysis of the bilateral deep peroneal nerve due to the injection.
This case highlights that improper acupoint injections can lead to peripheral nerve injuries, particularly in children, and emphasizes the need for caution.
In acupoint injections, failure to follow standard procedures, such as not aspirating to check for blood return, can lead to vascular injuries, with thromboangiitis obliterans being the most common. When injected into a blood vessel, the drug can irritate the vessel wall, causing vasospasm and resulting in inflammatory reactions, leading to thrombosis and eventual vascular occlusion, which can cause tissue necrosis. Reports of such cases have been documented in both upper and lower extremities.
For example, a middle-aged woman with post-cholecystectomy abdominal distension and pain was treated with injections of 12.5 mg of chlorpromazine at the bilateral Zusanli acupoints. After the second injection, the patient experienced discomfort, pallor, and loss of consciousness. Examination revealed that the left great toe was swollen and purple, with loss of sensation. This was diagnosed as “thromboangiitis obliterans” caused by the injection of chlorpromazine.
In summary, chemical injuries from acupoint injections are common and can lead to significant complications, necessitating careful attention and adherence to proper procedures.
4. Biological Injuries
Biological injuries primarily refer to secondary infections caused by acupuncture, where pathogenic microorganisms are introduced into the patient’s body through various needles (filiform needles, three-edged needles, skin needles, and injection needles).
Biological injuries can be divided into two categories: one is due to inadequate disinfection of needles, leading to infections such as various purulent infections and sepsis, which are mostly bacterial infections; the other is due to the transmission of pathogenic microorganisms from other patients to the current patient through inadequately sterilized needles, with viral hepatitis B being the most common.
It is important to note that in clinical practice, these four types of injuries can occur independently or in combination. When they occur together, the consequences can be more severe, and the diagnosis and management become more challenging, requiring heightened vigilance.
The causes of acupuncture accidents are multifaceted, including errors in point selection and technique by the practitioner, as well as certain factors related to the patient. Understanding the causes of accidents can lead to appropriate management and preventive measures, thus avoiding future occurrences. Below, we will analyze some actual cases of acupuncture accidents that have occurred in clinical practice, as each incident provides valuable lessons. By synthesizing these causes, we can gain a more comprehensive and systematic understanding of this issue.
1. Rough and Blind Needling
Analysis of many acupuncture accidents reveals that many occur among grassroots medical personnel, as well as among individuals with only a basic understanding of medicine, including quacks and shamans. They lack knowledge of anatomy and physiology and do not master the basic skills of acupuncture, leading to reckless needling and serious accidents.
For example, a middle-aged male patient with chest pain and cough sought treatment at a local clinic. The practitioner needled over 30 points on his chest and back without proper assessment, resulting in a severe pneumothorax that led to the patient’s death before timely rescue could be administered.
In some remote areas, the practice of needling through clothing still exists. Some practitioners, either due to cold weather or patient embarrassment, needle through shirts, sweaters, or even pants. This not only increases the risk of infection but also makes it difficult to accurately locate acupoints and control the direction and depth of needling, leading to accidents. Recent reports have documented several cases of serious accidents caused by needling through clothing, including injuries to the liver and even the heart, resulting in death.
In another case, a 9-year-old boy with a history of poor health, including tuberculosis and heart disease, underwent acupuncture treatment. After several sessions without incident, the practitioner needled through clothing at the Jiache acupoint. The needle was inserted at an upward angle, and during retention, the child experienced severe pain and discomfort. Despite immediate removal of the needle, the child developed respiratory distress and subsequently died. Autopsy revealed no damage to the underlying organs, but significant adhesions in both lungs were noted.
These cases illustrate the dangers of improper needling techniques and the importance of thorough assessments and adherence to safety protocols.
2. Inaccurate Point Selection and Operational Errors
Acupuncture is performed directly at acupoints, but each acupoint is not merely a point on a flat surface; it must be combined with the correct angle, direction, and depth of needling. Moreover, the underlying organs and tissues vary, and precise identification is crucial; otherwise, “a slight deviation can lead to a significant error.” Many reported acupuncture accidents have resulted from inaccurate point selection and improper techniques.
For instance, an elderly patient with a chronic cough was treated at an acupuncture training class. A trainee needled the Tiantu acupoint but mistakenly targeted the third cricoid cartilage instead of the center of the suprasternal notch, leading to a puncture of the trachea and subsequent respiratory distress and death.
Practitioners must be aware of the anatomical structures beneath the acupoints to ensure accurate needling. This includes understanding the anatomy of vital organs, major blood vessels, and nerves that may be affected. If the acupoint is misidentified, it can lead to severe consequences.
For example, a 60-year-old man with a history of chest tightness sought treatment for chest pain and discomfort. The practitioner needled the Qimen acupoint but did so at an incorrect location, leading to a puncture of the aorta and subsequent death.
In summary, accurate point selection and adherence to proper techniques are essential to prevent serious accidents during acupuncture.
3. Hitting Vital Areas and Worsening Conditions
The most critical areas of the human body are the central nervous system, including the brain and medulla oblongata, which are located within the cranial cavity and spinal canal. Therefore, when needling points in the neck and spine, it is crucial to master the direction and depth of needling based on anatomical structures. A slight error can lead to serious accidents.
In the past, practitioners were cautious about needling these areas, often opting for shallow needling. However, in recent decades, there has been a trend towards deeper needling, particularly in points like Yamen and Fengfu. This has led to an increase in accidents, including fatalities.
For example, a young male patient with headaches and insomnia was treated at a rural clinic. The practitioner needled the Yamen acupoint with a 26-gauge needle at an upward angle, leading to injury of the medulla and subsequent death.
In another case, a 16-year-old student with schizophrenia underwent acupuncture at the Fengfu acupoint. The practitioner used excessive force, leading to respiratory failure and subsequent death.
These cases highlight the importance of careful technique and awareness of the risks associated with needling in critical areas.
4. Neglecting Diagnosis and Injuring Internal Organs
In traditional acupuncture wisdom, there is a saying that “the abdomen is as deep as a well.” In recent decades, some practitioners have advocated for deep needling in the abdomen, believing it to be safe. However, this is not the case, as deep needling can lead to injuries to internal organs, especially in pathological conditions such as organ enlargement or adhesions.
For instance, a 17-year-old female student with a history of abdominal pain underwent acupuncture treatment. The practitioner needled multiple points in the left upper abdomen, leading to a ruptured spleen and subsequent internal bleeding.
In another case, a woman with a history of gallbladder disease underwent acupuncture treatment. The practitioner needled the upper abdomen, leading to a perforation of the gallbladder and subsequent bile peritonitis.
These cases illustrate the importance of thorough examination and diagnosis before acupuncture, particularly in patients with known abdominal conditions.
5. Excessive Force and Strong Stimulation
Even when point selection is correct and the angle and direction of needling are appropriate, using excessive force can lead to unexpected accidents. This is particularly true for patients who are anxious or fearful of needles, as strong stimulation can lead to adverse reactions.
For example, a 60-year-old patient with a history of hypertension and stroke underwent acupuncture treatment. The practitioner used excessive force during needling, leading to a cerebral hemorrhage and subsequent death.
In another case, a middle-aged patient experienced severe abdominal pain after acupuncture due to excessive force, leading to a diagnosis of acute abdominal pain.
In summary, practitioners must be cautious about the force used during needling, particularly in sensitive areas.
6. Ignoring Contraindications and Violating Precautions
To ensure safety and prevent accidents, ancient practitioners established numerous guidelines, such as avoiding needling patients who are excessively drunk, angry, fatigued, or in a state of extreme hunger or thirst. These guidelines remain clinically relevant today.
For example, a male patient with severe tuberculosis underwent acupuncture treatment after a heated argument. He died shortly after the procedure, highlighting the risks of needling in patients with severe chronic conditions.
In summary, practitioners must be aware of contraindications and exercise caution when treating patients with known health issues.
7. Inadequate Disinfection Leading to Secondary Infections
Inadequate disinfection during acupuncture can lead to secondary infections, which, while often not severe, can cause significant complications. For example, a 16-year-old boy developed a severe infection after acupuncture due to inadequate disinfection of the needles.
In summary, practitioners must adhere to strict disinfection protocols to prevent infections.
8. Improper Use of Electroacupuncture
The emergence of electroacupuncture has brought about new types of accidents. For example, excessive current during electroacupuncture can lead to burns or fractures.
In summary, practitioners must be cautious when using electroacupuncture and adhere to safety protocols.
9. Acupoint Injections Leading to Injuries
Acupoint injections can lead to various injuries, including soft tissue injuries, peripheral nerve injuries, and vascular injuries. For example, a child developed paralysis after an acupoint injection due to improper technique.
In summary, practitioners must be cautious when performing acupoint injections and adhere to proper techniques.
10. Variations in Patient Constitution Leading to Strong Reactions
Patients with allergic constitutions may experience adverse reactions during acupuncture. For example, a pregnant woman experienced severe allergic reactions after moxibustion.
In summary, practitioners must be aware of individual patient differences and adjust their techniques accordingly.
In conclusion, the occurrence of acupuncture accidents is a shared misfortune for both practitioners and patients. By analyzing the causes of these accidents, we can improve our techniques and prevent future occurrences. The goal is to ensure that acupuncture remains a safe and effective treatment method.