Acupuncture Techniques – Discussion on Needle Insertion Techniques: Fine Needle Insertion Method [Part 1]

Needle Insertion Techniques

1. Structure, Specifications, Inspection, and Maintenance of Fine Needles

1. Structure of Fine Needles

(1) Needle Material: Fine needles are primarily made of metal, with stainless steel being the most commonly used material, although gold, silver, and other metals are also utilized.

(2) Structure of Fine Needles: The structure of fine needles can be divided into five parts, as shown in Figure 5-1.

① Needle Tip: The sharp end of the needle is referred to as the needle tip, also known as the needle point, which is the critical area for penetrating the skin at acupoints.

② Needle Body: This refers to the main part between the needle tip and the needle handle, also known as the needle shaft, which is the primary section of the fine needle that penetrates to the appropriate depth at the acupoint.

③ Needle Root: This is the part connecting the needle body to the needle handle, serving as an external marker for observing the depth of needle insertion and the amplitude of lifting and thrusting.

④ Needle Handle: The end of the needle wrapped in metal wire in a spiral shape for ease of holding, it is the part where the practitioner holds and manipulates the needle.

⑤ Needle Tail: The end of the needle handle, generally wrapped with metal wire (copper or aluminum), in a cylindrical shape, also known as the needle top.

2. Specifications of Fine Needles

The specifications of fine needles are primarily distinguished by the diameter and length of the needle body, as detailed in Tables 5-1 and 5-2.

Table 5-1: Length Specifications of Fine Needles

Inches	0.5	1.0	1.5	2.0	2.5	3.0	3.5	4.0	4.5
mm	15	25	40	50	65	75	90	100	115

Table 5-2: Thickness Specifications of Fine Needles

Number	26	27	28	29	30	31	32	33
Diameter (mm)	0.45	0.42	0.38	0.34	0.32	0.30	0.28	0.26

In clinical practice, the most commonly used needles are of thickness 28-30 (0.32-0.38mm) and length 1-3 inches (25-75mm).

3. Inspection of Fine Needles

The inspection points and requirements for fine needles are detailed in Table 5-3.

Table 5-3: Inspection Points and Requirements for Fine Needles

Inspection Point	Inspection Requirements
Needle Tip	Should be straight and not skewed, without barbs, high smoothness, rounded at the tip, sharp but not dull, shaped like a “pine needle”, sharp enough to minimize resistance during insertion.
Needle Body	Smooth, straight, round, uniform, strong, and elastic.
Needle Root	Firm, without corrosion or scars.
Needle Handle	The metal wire should be evenly and securely wrapped, not loose or broken, with appropriate length and thickness for ease of holding and manipulation, minimizing patient discomfort.

4. Maintenance of Fine Needles (excluding disposable needles)

2. Practice of Fine Needle Insertion Techniques

The practice methods for fine needle insertion techniques are detailed in Table 5-4.

Step	Finger Strength Practice	Hand Technique Practice	Self-Practice
Tools	Paper Pad	Cotton Ball	Self
Tool Preparation Method	Use soft paper to fold into a block approximately 8cm long, 5cm wide, and 2-3cm thick, tightly tied in a “井” shape.	A ball of cotton, wrapped with cotton yarn, loosely inside and tightly outside, made into a sphere about 6-7cm in diameter, covered with a layer of white cloth.
Practice Method	Hold the paper pad flat with the left hand, and with the right hand, hold the needle handle with the thumb, index, and middle fingers as if holding a pen, positioning the needle tip vertically against the paper block, then twist the needle handle with the thumb and index/middle fingers while gradually applying pressure until the needle penetrates the paper pad, then change to another spot and repeat practice, as shown in Figure 5-2.	Rotate and lift the needle in the cotton ball, practicing various needle insertion techniques and operational requirements repeatedly. When practicing lifting and inserting the needle, hold the needle as if holding a pen, inserting it into the cotton ball, performing lifting and inserting actions at the same spot, requiring appropriate depth, uniform amplitude, and straight needle body, as shown in Figure 5-3.	Experience the strength of finger pressure, the sensation of needle insertion, and the technique of needle manipulation. When practicing on oneself, aim to gradually achieve painless or minimally painful insertion, with a straight needle body, smooth insertion, and controlled lifting and twisting, with even finger strength and proficient technique.

Table 5-4: Practice Methods for Fine Needle Insertion Techniques

3. Selection and Disinfection of Fine Needles

1. Selection of Fine Needles

In clinical practice, stainless steel needles are commonly selected.

(1) Choose needle length and thickness based on the patient’s gender, age, body type, constitution, condition (deficiency or excess), depth of the lesion, and the location of the acupoint.

For males, robust body types, and deeper lesions, slightly thicker and longer needles may be selected.

For females, weaker body types, and shallower lesions, shorter and thinner needles should be chosen.

(2) Select needles based on the specific location of the acupoint.

For areas with thin skin and little flesh, shorter and thinner needles are preferred.

For areas with thick skin and more flesh, longer and thicker needles should be used.

In clinical practice, it is common to select a needle that, when inserted to the required depth, still has a portion of the needle body visible above the skin. For example, if the required insertion depth is 0.5 inches, a 1.0-inch needle may be selected; if the required depth is 1.0 inches, a 1.5-2.0 inch needle may be chosen.

2. Disinfection

Strict disinfection must be performed before acupuncture treatment. Disinfection includes sterilizing the needles, the practitioner’s fingers, the treatment area, and the treatment room.

3. Disinfection of Needle Instruments

The best method is high-pressure steam sterilization. Specific methods are detailed in Table 5-5.

Table 5-5: Disinfection Methods for Needle Instruments

Name	Method
High-Pressure Steam Sterilization	Wrap the fine needles and other instruments in cloth and place them in a sealed high-pressure steam sterilizer. Generally, at a pressure of 94-147kPa, maintain a temperature of 115℃-123℃ for over 30 minutes to achieve sterilization.
Alcohol Soaking Disinfection	Soak the instruments in 75% ethanol for 30-60 minutes, then remove and dry with a sterile cloth or gauze before use. They can also be soaked in disinfectant solutions like “84” disinfectant for about 60-120 minutes. Instruments that directly contact the fine needles, such as needle trays and tweezers, should also be disinfected, which can be done by soaking in glutaraldehyde solution (e.g., PAA) for 10-20 minutes. Only after achieving sterilization can they be used. Sterilized fine needles must be placed in a needle tray and covered with a sterile cloth or disinfected gauze.
Boiling Disinfection	Wrap the fine needles and other instruments in gauze, place them in a pot of clean water, and heat until boiling, then boil for 10-15 minutes. However, sharp metal instruments may become dull; adding sodium bicarbonate to the water to create a 2% solution can raise the boiling point to 120℃ and reduce corrosion of the instruments.

4. Disinfection of the Practitioner’s FingersBefore acupuncture, the practitioner’s fingers must be thoroughly washed with soapy water, dried, and then wiped with a cotton ball soaked in 75% alcohol before handling the needles.5. Disinfection of the Acupuncture SiteAt the selected acupoint, disinfect with a cotton ball soaked in 75% alcohol, or first apply 2% iodine tincture, allow it to dry slightly, and then wipe with a cotton ball soaked in 75% alcohol to remove the iodine. Wiping should be done in a circular motion from the center of the acupoint outward. The disinfected area should avoid contact with contaminants to prevent re-infection.6. Disinfection of the Treatment RoomThe disinfection of the acupuncture treatment room includes regular washing and airing of items such as mattresses, pillowcases, blankets, and mats. Using disposable disinfected mats, papers, and pillowcases is preferable. The treatment room should also be regularly disinfected and purified, maintaining good air circulation and cleanliness.4. Selection of Patient PositionThe choice of patient position during acupuncture significantly affects the accurate localization of acupoints, the operation of needle insertion, the duration of needle retention, and the prevention of needle fainting, stagnation, bending, or even breakage. For patients who are weak or mentally tense, sitting may cause fatigue and increase the likelihood of needle fainting. Additionally, if the position is not chosen properly, during needle insertion or retention, the patient may move and cause bending, stagnation, or even breakage of the needle. Commonly used positions are shown in Figure 5-4.5. Fine Needle Insertion Techniques1. Needle Insertion MethodThis refers to the technique of inserting the fine needle under the skin at the acupoint.(1) Insertion Hand and Supporting Hand: See Table 5-6.

Table 5-6: Concepts and Functions of Insertion Hand and Supporting Hand

Insertion Hand	Supporting Hand
Concept	Refers to the hand holding the needle; most practitioners use the right hand for this, hence it is called the “insertion hand”.	Refers to the hand that presses on the acupoint or assists the needle body; usually the left hand is the “supporting hand”.
Function	It is responsible for controlling the needle, performing operational techniques, applying finger pressure to the needle tip during insertion, facilitating twisting, lifting, and thrusting during manipulation, and executing techniques during needle removal.	Primarily serves to stabilize the acupoint position, hold the needle body to assist the insertion hand, ensuring the needle remains vertical, allowing force to reach the needle tip, facilitating insertion, reducing pain, and assisting in adjusting and controlling needle sensation.

In clinical practice, the insertion hand and supporting hand are often used in conjunction. During insertion, pressure is applied while inserting the needle, allowing the needle tip to penetrate the skin, followed by various operational techniques. Thus, it is stated in the “Lingshu: Nine Needles and Twelve Origins” that “the right hand is responsible for pushing, while the left hand holds and guides.” The “Nanjing: Difficulties 78” states, “Those who know the needle trust their left hand, while those who do not trust their right hand.” The “Needle Classic Guide: Marking and Ghosts” states, “The left hand is heavy and presses more, wanting to disperse qi; the right hand is light and enters slowly, causing no pain.” This emphasizes the importance of using both hands in acupuncture.(2) Needle Insertion Methods: The methods of needle insertion can be categorized into single-hand insertion, double-hand insertion, and needle tube insertion.① Single-Hand Insertion Method: Using the insertion hand to insert the needle into the acupoint.Insertion Method: The right hand’s thumb and index finger hold the needle handle, with the middle finger’s tip near the acupoint, the fingertip resting on the needle tip and lower end of the needle body, the thumb and index finger flexing to apply finger pressure without twisting to insert the needle into the skin.Twisting Method: The right hand’s thumb and index fingers hold the needle handle, when the needle tip is against the skin at the acupoint, slight twisting is applied to insert the needle into the skin.② Double-Hand Insertion Method: Coordinating both hands to insert the needle into the acupoint, see Table 5-7.

Table 5-7: Different Methods of Double-Hand Insertion

Name	Key Points of Operation	Usage
Finger Cutting Insertion Method	Also known as the claw-cut insertion method, the left hand’s thumb or index finger presses beside the acupoint, while the right hand holds the needle, inserting it closely against the left hand’s nail surface, as shown in Figure 5-5.	Suitable for inserting short needles.
Clamping Insertion Method	Using the left hand’s thumb and index fingers to clamp the lower part of the needle body, exposing the needle tip, fixing the needle tip on the skin surface of the acupoint, while the right hand holds the needle handle, ensuring the needle body is vertical, applying pressure with the right hand while the left hand simultaneously exerts force, coordinating both hands to insert the needle into the skin, as shown in Figure 5-6.	Suitable for inserting long needles.
Stretching Insertion Method	Using the left hand’s thumb and index fingers to stretch the skin at the acupoint, making the skin taut, while the right hand holds the needle, inserting it between the left hand’s fingers, as shown in Figure 5-7.	Primarily used for acupoints with loose skin.
Pincing Insertion Method	Using the left hand’s thumb and index fingers to pinch the skin at the acupoint, while the right hand holds the needle, inserting it from the upper end of the pinched skin, as shown in Figure 5-8.	Used for inserting needles into acupoints with thin skin and flesh, such as Yintang (Yin Tang) acupoint.

③ Needle Tube Insertion Method: Utilizing a needle tube to insert the needle into the acupoint.Method: Insert the needle into a small tube made of glass, plastic, or metal that is about 3mm shorter than the needle, place it on the skin at the acupoint, press the tube firmly with the left hand, and with the right hand, quickly strike the needle handle to allow the needle tip to penetrate the skin, then remove the tube and insert the needle into the acupoint.Suitable for: Often used for children and those who fear needles.2. Angle and Depth of Needle InsertionDuring the needle insertion process, correctly mastering the angle, direction, and depth of insertion is key to enhancing needle sensation, improving efficacy, and preventing accidents. The correct localization of acupoints should not only be limited to surface positions but must also be organically combined with the correct angle, direction, and depth of needle insertion to fully exert its intended effects. In clinical practice, the same acupoint prescription may yield significant differences in needle sensation strength, sensory direction, and therapeutic effects due to variations in the angle, direction, and depth of insertion. Correctly mastering the angle, direction, and depth of needle insertion should be flexibly adjusted based on the specific location of the acupoint, the patient’s constitution, the condition of the patient, and the techniques used.(1) Angle of Needle Insertion: Refers to the angle formed between the needle body and the skin surface during insertion.This is primarily determined based on the location of the acupoint and the intended purpose of the practitioner during needle insertion. Generally categorized into perpendicular, oblique, and horizontal insertion, as shown in Table 5-8 and Figure 5-9.

Table 5-8: Different Angles of Needle Insertion

Name	Key Points of Operation	Usage
Perpendicular Insertion	Insert the needle at an angle of approximately 90° to the skin surface.	Suitable for most acupoints on the body.
Oblique Insertion	Insert the needle at an angle of approximately 45° to the skin surface.	Suitable for areas with shallow muscles or where important organs are located, or where direct or deep insertion is not advisable.
Horizontal Insertion	Also known as lateral insertion, insert the needle at an angle of approximately 15° along the skin.	Suitable for acupoints with thin skin and little flesh, such as acupoints on the head.

(2) Depth of Needle Insertion: Refers to how deep the needle body penetrates into the body.Mastering the depth of needle insertion should generally adhere to the principle of achieving a sensation of qi without injuring important organs. The depth of insertion for each acupoint has been detailed in the discussions on acupoints; here, we will provide an overview based on the patient’s age, constitution, condition, and location.Age: Elderly and weak patients and young children should be inserted shallowly; young and robust individuals should be inserted deeply.Constitution: Thin individuals should be inserted shallowly; overweight individuals should be inserted deeply.Condition: Yang conditions and new illnesses should be inserted shallowly; Yin conditions and chronic illnesses should be inserted deeply.Location: Acupoints on the head, face, and chest/back, as well as those with thin skin and little flesh, should be inserted shallowly; acupoints on the limbs, abdomen, buttocks, and those with ample muscle should be inserted deeply.The angle and depth of needle insertion are interrelated. Generally, deep insertion is often performed with perpendicular insertion, while shallow insertion is often performed with oblique or horizontal insertion.Disclaimer:The content on this site is added and organized by users for learning and reference purposes only. The information on the site may not be accurate, comprehensive, or up-to-date, and the content should not be considered the final basis for diagnosing or treating diseases.Shanhe Traditional Chinese Medicine Networkwould like to remind users that if you experience any discomfort, please seek medical attention promptly. Thank you for your support and love; we will strive to do better~!!!