For students preparing for exams, there are only a little over 10 days left, and time is tight. Here are the 7 essential points for practicing acupuncture techniques in Traditional Chinese Medicine (TCM) that you should keep and share!
Interpretation of the first station of the 2019 Practical Skills for Practicing Physicians (12)
1. Preparation Before Acupuncture
(1) Disinfection of the doctor’s fingers before acupuncture: Before acupuncture, wash your fingers with soapy water, then wipe with a 75% ethanol cotton ball, and try to avoid direct contact between fingers and the needle body.
(2) Disinfection of the acupuncture site before the procedure: Use a 75% ethanol cotton ball to disinfect in a circular motion from the center of the acupoint outward.
2. Needle Insertion Techniques
Clinically, the right hand is generally used to hold the needle, primarily using the thumb, index, and middle fingers to grip the needle handle, hence the right hand is called the “insertion hand.” The left hand is used to press the acupuncture site or assist with the needle body, thus referred to as the “supporting hand.”
(1) Single-hand insertion technique:
Hold the needle with the thumb and index finger of the right hand, with the tip of the middle finger resting against the acupoint, pressing down with the thumb and index finger while bending the middle finger to insert the needle to the required depth. This is mainly used for shorter needles.
(2) Two-hand insertion technique:
① Finger-cut insertion technique: Use the thumb or index finger of the left hand to press beside the acupoint, while the right hand holds the needle, inserting it close to the left hand’s fingernail. This method is suitable for inserting short needles.
② Pinching insertion technique: Use the thumb and index finger of the left hand to hold a disinfected cotton ball, pinching the lower end of the needle body, fixing the needle tip on the skin surface of the acupoint, and using the right hand to twist the needle handle to insert it into the acupoint. This method is suitable for long needles.
③ Stretching insertion technique: Use the thumb and index finger of the left hand to stretch the skin at the acupoint to make it taut, while the right hand holds the needle to insert it between the left hand’s fingers. This method is mainly used for acupoints on loose skin.
④ Pinch insertion technique: Use the thumb and index finger of the left hand to pinch the skin at the acupoint, and the right hand inserts the needle from the top of the pinch. This method is mainly used for acupoints with thin flesh, such as Yintang (印堂) point.
3. Needle Direction and Angle
(1) Needle direction: This refers to the orientation of the needle tip during insertion, generally determined by the direction of the meridian, the characteristics of the acupoint, and the treatment needs.
(2) Needle angle: This refers to the angle formed between the needle body and the skin surface during insertion.
① Vertical insertion: The needle body is inserted at a 90° angle to the skin surface. This method is suitable for most acupoints.
② Oblique insertion: The needle body is inserted at an angle of about 45° to the skin surface. This method is suitable for areas with shallow muscles or where important organs are located, or where direct or deep insertion is not advisable.
③ Horizontal insertion: This refers to inserting the needle at an angle of about 15° or at a smaller angle along the skin. This method is suitable for acupoints with thin skin and little flesh, such as those on the head.
4. Needle Manipulation Techniques
① Lifting and thrusting technique: After inserting the needle to a certain depth, perform lifting and thrusting movements. When using this technique, the force applied should be even and consistent, with a range of about 3-5 mm, and a frequency of about 60 times per minute, keeping the needle body vertical without changing the direction and angle of insertion.
② Twisting technique: After inserting the needle to a certain depth, perform forward and backward twisting movements, allowing the needle to rotate back and forth within the acupoint. When using this technique, the force should be even, and the angle should be appropriate, avoiding unidirectional twisting to prevent the needle body from becoming entangled in muscle fibers, causing local pain and difficulty in withdrawing the needle.
5. Achieving Qi
The concept of achieving Qi: This refers to the sensation of Qi at the acupuncture site after the needle has been inserted to a certain depth and specific manipulation techniques have been applied.
Manifestations of achieving Qi: The patient may experience sensations such as soreness, numbness, distension, heaviness, and sometimes sensations of heat, cold, itching, pain, twitching, or ants crawling, or sensations that radiate and diffuse in a certain direction and area. The practitioner may also feel the needle sinking, tightness, or vibration under the skin.
6. Supplementing and Draining Techniques with Needles
① Twisting for supplementing and draining
Supplementing technique: After achieving Qi, twist with a small angle, slow frequency, and light force, primarily using the thumb to push forward and the index finger to pull back.
Draining technique: After achieving Qi, twist with a large angle, fast frequency, and heavy force, primarily using the thumb to pull back and the index finger to push forward.
② Lifting and thrusting for supplementing and draining
Supplementing technique: After achieving Qi, start shallow and then deep, with heavy thrusting and light lifting, focusing on thrusting.
Draining technique: After achieving Qi, start deep and then shallow, with light thrusting and heavy lifting, focusing on lifting.
③ Even supplementing and draining: After achieving Qi, perform even lifting, thrusting, and twisting.
7. Handling Abnormal Situations During Acupuncture
(1) Needle fainting: Immediately stop acupuncture and withdraw all needles. Have the patient lie flat and keep warm.
If mild, the patient can lie down for a moment and drink warm water or sugar water to recover. If severe, in addition to the above measures, acupuncture points such as Ren Zhong (人中), Su Liao (素髎), Nei Guan (内关), and Zu San Li (足三里) can be stimulated to help recovery. If the patient remains unresponsive, with weak breathing and pulse, consider additional treatments or emergency measures.
(2) Stuck needle: If the patient is tense and the local muscles are overly contracted, extend the needle retention time slightly, or apply pressure or tap the needle handle near the stuck needle point, or insert another needle nearby to disperse Qi and relieve muscle tension. If improper manipulation or unidirectional twisting caused the issue, twist the needle back in the opposite direction and use scraping or tapping techniques to release the entangled muscle fibers, thus eliminating the stuck needle.
(3) Bent needle: Once a bent needle occurs, do not perform lifting, thrusting, or twisting techniques. If the needle handle is slightly bent, slowly withdraw the needle. If the bend is severe, withdraw the needle in the direction of the bend. If caused by the patient moving, allow the patient to slowly return to the original position, relax the local muscles, and then gently withdraw the needle. Avoid forcibly pulling the needle to prevent breaking it and leaving it inside.
(4) Broken needle: The practitioner must remain calm and instruct the patient not to change their position to prevent the broken needle from sinking deeper into the muscle. If part of the needle is exposed, it can be removed with fingers or tweezers. If the broken end is level with or slightly recessed into the skin, use the thumb and index finger of the left hand to press down on either side of the needle hole to expose the broken needle, and use tweezers to remove it. If the broken needle is completely embedded in the skin or deep muscle, it should be located under X-ray and surgically removed.
(5) Hematoma: If there is a small amount of subcutaneous bleeding resulting in a small bruise, it generally does not require treatment and will resolve on its own. If there is significant swelling and pain, and the bruise affects functional movement, apply cold compresses to stop the bleeding, followed by warm compresses or gentle massage to promote the absorption of the local bruise.
【Exam Strategy】Master the insertion techniques, manipulation techniques, and supplementing/draining techniques! Remember them! Get them right! Handling needle fainting also seems to be a favorite topic for examiners. If you are fortunate enough to draw a specific acupoint for needle operation during the exam, be sure to disinfect! Disinfect! Disinfect! Not only the acupoint but also your hands! Finally, I wish everyone success in passing the medical licensing exam.
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Editor: Liu Xuan
