Fine Needle Technique
The fine needle technique refers to the use of fine needles to stimulate acupuncture points on the body through specific methods, aiming to unblock meridians, regulate the internal organs, and achieve the purpose 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, pediatrics, and other fields.
1. Commonly Used Instruments and Basic Operation Methods
(1) Commonly Used 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. The specifications are mainly distinguished by the diameter and length of the needle (see Table 1 and Table 2).
Table 1: Fine Needle Diameter Specification Table
|
Specification/Number |
22 |
24 |
26 |
28 |
30 |
32 |
34 |
|
Diameter/mm |
0.50 |
0.45 |
0.40 |
0.35 |
0.30 |
0.25 |
0.22 |
Clinically, the most commonly used fine needles are of diameter 32 to 26 (0.25mm to 0.40mm). Thicker needles are often used for acupuncture points on the limbs and lower back, as well as for patients with numbness or dull sensation; thinner needles are used for acupuncture points on the head, face, and for children or patients with weak constitutions.
Table 2: Fine Needle Length Specification Table
|
Specification/Inch |
0.5 |
1.0 |
1.5 |
2.0 |
2.5 |
3.0 |
4.0 |
5.0 |
|
Length/mm |
15 |
25 |
40 |
50 |
65 |
75 |
90 |
100 |
Clinically, the most commonly used fine needles are of length 1.0 to 3.0 inches (25 to 75mm), with 1.5 inches (40mm) being the most frequently used. Longer needles are used for deep insertion in areas with thick muscle, while shorter needles are used for shallow insertion in areas with thin muscle, such as acupuncture points on the head and face.
(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 practitioner’s fingers.
2. Needle Insertion Method
During needle insertion, both hands are generally used. 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. The following methods of needle insertion are commonly used:
(1) Fingernail Cutting Insertion Method
Using the fingernail of the left thumb or index finger to cut and press the skin at the acupuncture point, the right hand quickly inserts the needle tip 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 at the acupuncture point, the right hand inserts the needle. This method is used for acupuncture points on loose 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 acupuncture points on thin flesh, such as Yintang (Yin Hall) point.
(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 to tonify or reduce. Obtaining Qi, also known as “needle sensation,” refers to the sensation of meridian Qi response after the needle is inserted into the acupuncture point. When this sensation occurs, the practitioner feels a tightness under the needle, while the patient experiences sensations such as soreness, numbness, distension, or heaviness. The presence and speed of obtaining Qi 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 area of 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 considered thrusting; withdrawing from a deeper layer to a shallower layer is considered 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 practitioner can determine the needle retention time based on the patient’s condition, generally retaining the needle for 15 to 30 minutes for common conditions. 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. Common Diseases Treated with Fine Needle Techniques
(1) Stroke (Acute Cerebrovascular Disease)
Stroke is characterized by sudden fainting, loss of consciousness, hemiplegia, facial drooping, and speech difficulties, or it may present with facial drooping and hemiplegia without fainting. The formation of this disease is mainly due to an 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. The diagnosis of this disease refers to the diagnostic criteria for stroke established by the National Administration of Traditional Chinese Medicine in 1996.
Clinically, it is classified based on the presence or absence of consciousness disturbance into central organ involvement and meridian involvement; this section mainly discusses the fine needle treatment for meridian involvement.
[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 (Union Valley), Huantiao (Jumping Circle), Yanglingquan (Yang Mound Spring), Zusanli (Leg Three Miles). Points can be selected according to symptoms; for foot inversion, add Qiuxu (Hollow Mound) and Zhaohai (Shining Sea); for constipation, add Tianshu (Heavenly Pivot); for speech difficulties, add Lianquan (Lian Spring).
Needling Method: Direct insertion, using lifting, thrusting, and twisting techniques. When operating on Fengchi point, the needle tip is inserted obliquely towards the tip of the nose at a depth of 0.8 to 1.2 inches, and Lianquan point is inserted obliquely towards the root of the tongue at a depth of 0.8 to 1.5 inches.
Treatment Course: During the acute phase, acupuncture is performed once daily; during the recovery and sequelae phases, it is performed 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. The brain is considered the “sea of marrow,” and the head is the meeting place of all Yang and the residence of clear Yang, where the Qi of the five organs and six bowels converges. External pathogens or internal injuries can lead to Qi and blood disturbances, obstructing the brain’s meridians, resulting in headache. The diagnosis of this disease refers to the relevant standards in the Clinical Research Guidelines for New Chinese Medicines.
Headaches are divided into two main categories: external and internal causes; this section mainly discusses fine needle treatment for internal cause headaches.
[Treatment Principle] Unblock the meridians and activate collaterals, promote Qi and invigorate blood to relieve pain.
[Operation Steps]
Acupuncture Points: Baihui (Hundred Meetings), Fengchi (Wind Pool), Hegu (Union Valley), Taichong (Great Surge), Touwei (Head Maintain), with additional points based on symptoms; for Shaoyang headache, add Shuaigu (Leading Valley) and Jiao Sun (Angle Grandson); for Taiyang headache, add Tianzhu (Heavenly Pillar) and Taiyang (Sun); for Yangming headache, add Zanzhu (Gathering Bamboo) and Yintang (Yin Hall).
Needling Method: Head acupuncture points are often inserted obliquely or horizontally, while limb acupuncture points are usually inserted directly. When operating on Fengchi point, the needle tip is inserted obliquely towards the tip of the nose at a depth of 0.8 to 1.2 inches, or horizontally through Fengfu (Wind Palace) point. After needle insertion, perform lifting and thrusting and twisting techniques.
Treatment Course: Each session retains the needle for 30 minutes, performed 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, shallowing of the nasolabial fold, drooping of the mouth 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 meridians, leading to Qi stagnation and insufficient nourishment of the muscles and tendons, resulting in the disease. The diagnosis refers to the relevant standards in the Clinical Research Guidelines for New Chinese Medicines.
[Treatment Principle] Invigorate blood and unblock collaterals, regulate the meridians and tendons.
[Operation Steps]
Acupuncture Points: Fengchi (Wind Pool), Yifeng (Wind Screen), Dicang (Earth Granary), Jiachuan (Cheek Car), Hegu (Union Valley). Additional points based on symptoms: for flat nasolabial folds, add Yingxiang (Welcome Fragrance); for skewed nasal groove, add Shuigou (Water Ditch); for skewed mentolabial groove, add Chengjiang (Cheng River); for inability to close the eyes, add Yangbai (Yang White), Zanzhu (Gathering Bamboo), or Shenmai (Shen Pulse), Zhaohai (Shining Sea).
Needling Method: For facial acupuncture 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, performed 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 increased pain at night, reduced pain after morning joint activity, and widespread tenderness in the local area, with limited 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 formation of this condition. The diagnosis refers to the relevant standards in the Clinical Research Guidelines for New Chinese Medicines.
[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 (Tender Points), Tiaokou (Channel Mouth). Additional points based on symptoms: for upper arm pain, add Binao (Upper Arm); for scapular pain, add Quyuan (Scapula).
Needling Method: Direct insertion.
Treatment Course: Each session retains the needle for 20 to 30 minutes, performed 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 and injuries. The diagnosis refers to the relevant standards in the Clinical Research Guidelines for New Chinese Medicines.
This condition is divided into three main categories: cold-damp low back pain, blood stasis low back pain, and kidney deficiency low back pain; this section mainly discusses fine needle treatment for blood stasis low back pain.
[Treatment Principle] Relax the meridians and collaterals, invigorate blood and resolve stasis.
[Operation Steps]
Acupuncture Points: Shenshu (Kidney Shu), Yaojiaji (Lumbar Spine), Weizhong (Middle of the Knee), Ashi points (Tender Points).
Needling Method: Direct insertion.
Treatment Course: Each session retains the needle for 20 to 30 minutes, performed once daily, with 10 sessions constituting one treatment course.
3. Contraindications
1. Pregnant women should avoid acupuncture in the lower abdomen, lumbar sacral region, and points such as Hegu (Union Valley), Sanyinjiao (Three Yin Intersection), and Zhiyin (Reaching Yin).
2. For infants with unclosed fontanelles, acupuncture points on the top of the head should be avoided.
3. Acupuncture should not be performed on areas with skin infections, ulcers, or tumors.
4. Caution should be exercised in patients with bleeding tendencies.
4. Precautions
1. Patients should not undergo acupuncture immediately when overly hungry, fatigued, or excessively tense.
2. For patients with weak constitutions or Qi and blood deficiency, the acupuncture technique should not be too strong, and patients should be encouraged to lie down.
3. Deep insertion should be avoided for acupuncture points located in the chest, ribs, waist, and back.
4. When needling around the eyes and neck (such as Fengfu (Wind Palace), Yamen (Mute Gate), 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 insertion should be avoided when needling 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 tension, improper positioning, or excessive stimulation, 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 (Water Ditch), Suyuan (Sublime Source), Neiguan (Inner Pass), Hegu (Union Valley), Taichong (Great Surge), Zusanli (Leg Three Miles), and Yongquan (Bubbling Spring) can be needled, along with other necessary measures.
2. Stuck Needle: This occurs due to patient tension, local muscle spasms from pain after needling, or changes in patient position after needle insertion, causing muscle fibers to entangle the needle, making manipulation or removal difficult and causing pain. 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: This occurs due to unskilled technique, or if the needle encounters hard tissue, or if the patient changes position during needle retention, or due to improper handling of a stuck needle, causing the needle handle to change direction during insertion or removal, making it difficult and painful. Manipulation should be stopped, and the needle should be slowly withdrawn in the direction of the bend.
4. Broken Needle: This occurs due to poor needle quality or excessive force during manipulation, causing the needle to break inside the body. The left hand should press the skin next to 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 and surgically removed.
5. Hematoma: This occurs due to 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: This occurs when acupuncture points on the chest, back, and near the collarbone are punctured too deeply, penetrating the thoracic cavity and lung tissue, leading to air accumulation in the thoracic cavity and causing 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, if the air leakage is minimal, it can be absorbed naturally; for severe cases, timely rescue measures such as thoracic drainage and slow oxygen supplementation may be required.
