Chinese Medicine Book Club Issue 2356
Daily updates to accompany the growth of TCM practitioners
IIntroduction: Deep needling with long needles can injure the lungs; appropriate responses can turn danger into safety.（Editor/Qian Cheng）
Acupuncture Treatment of Suspected Pneumothorax Caused by Acupuncture
Author/Yuan Bingsheng
An, a 72-year-old female patient, visited a physician in the same department at around 4 PM on a summer day in 1991 due to pain in the head, neck, shoulder, and arm. She was seated and had acupuncture at the right Jianjing (Shoulder Well) point, and half an hour later, another colleague removed the needles. Immediately after needle removal, the patient developed pain in the right chest and side, progressively worsening, accompanied by difficulty breathing. The physician immediately notified me and the then hospital director, a Western surgical attending physician, to consult and handle the emergency in the acupuncture department.
Due to the physician’s clinical habit of using long needles (3-inch acupuncture needles), this time, after needling the right Jianjing point, the patient immediately experienced severe pain in the right chest and difficulty breathing. Based on the cause and clinical presentation, it fits the characteristics of pneumothorax caused by acupuncture; I believe we should immediately treat it as pneumothorax caused by needling without hesitation. Given the patient’s advanced age and the sudden onset of severe chest pain and significant difficulty breathing, I advocated for immediate acupuncture treatment to alleviate the condition; if acupuncture was ineffective, we would consider other treatments, which received support.
Treatment Process:
First, I gently massaged the needled Jianjing point, instructing her to take a deep breath while enduring the pain, holding her breath slightly, repeating this three to five times; then I needled the same side’s Shizhu (Cubital Marsh), Kongzui (Palace of the Air), Zusanli (Leg Three Miles), as well as Feishu (Lung Shu), Ge Shu (Diaphragm Shu), Sanyinjiao (Three Yin Intersection), Hegu (Union Valley), and Taichong (Great Surge) points, while continuing to encourage slow, deep breathing, pausing slightly after inhalation before exhaling. After needling and performing twisting and lifting techniques at these points, the patient’s severe chest pain was significantly alleviated immediately. I instructed her to drink half a cup of warm water and applied moxibustion at Qihai (Sea of Qi) for over ten minutes.
After approximately 20 minutes of treatment, the patient’s breathing was basically unobstructed, and the chest pain was no longer significant. I left the needles in for 30-40 minutes before removing them. After an X-ray examination at our hospital and a consultation with a surgical physician, it was determined that after acupuncture treatment, the main symptoms of chest pain and dyspnea due to pneumothorax had disappeared, breathing was normal, and the X-ray showed no significant gas leakage, indicating that there was no major issue.
Subsequently, I prescribed Xuefu Zhuyu Decoction (Blood Mansion Decoction) with added Ren Shen (Ginseng) and Zi Wan (Aster) for quick decoction and administration, and continued to observe the patient in the outpatient department for 2 hours. After no discomfort, the patient requested to go home. A colleague then took her home, and upon follow-up the next day, she continued treatment for her head, neck, and shoulder pain, with no recurrence of chest tightness or pain.
Insights:
The Jianjing point is located at the midpoint of the line connecting the Dazhui (Great Vertebra) and the acromion of the clavicle, directly opposite the apex of the lung; it is said in ancient texts that “needling five fen” (now 13mm) should not be done directly or deeply, for fear of injuring the lung and causing pneumothorax. The Huangdi Neijing states, “Needling the lung leads to death in three days” and “Needling the supraclavicular fossa (the center of the supraclavicular fossa, deep to the apex of the lung) can cause air leakage (now referred to as lung injury leading to pneumothorax), resulting in coughing and wheezing.” This serves as a warning for future practitioners to be cautious when needling the supraclavicular fossa and lung shu points. Zhenjiu Daceng states that when needling the Jianjing point, “if the needle is inserted too deeply, urgently supplement Zusanli.” The term “urgent” refers to the closure of qi, indicating severe pain, which should be attributed to pneumothorax caused by lung injury; thus, I advocate for the needling of Zusanli to supplement treatment.
Although this patient was elderly, thin, and had little subcutaneous fat, making deep needling with long needles more likely to injure the lung, she fortunately had a robust constitution. Zhenjiu Daceng cites Daoyin Benjing stating: “To clear the metal, one must first regulate the breath; when the breath is regulated, the disease does not arise,” which is indeed a valuable experience in treating lung diseases. Therefore, I first instructed her to breathe slowly and evenly to self-regulate her breath.
Due to lung injury from needling, lung qi leakage, and gas leakage can compress the lung leading to atelectasis, I first pressed the needled area while instructing her to take a deep breath to promote lung expansion; with significant chest pain and difficulty breathing, the urgent onset indicated that the Taiyin Lung Meridian “is responsible for diseases of the lung,” so I first needled the Xue point Kongzui, which is deeply concentrated with qi of the lung meridian, and the He point Shizhu, to urgently regulate lung qi, restore its dispersing and descending functions, and alleviate coughing and pain; since lung injury leads to lung qi leakage, it should be classified as a qi deficiency syndrome, thus I followed the principles of Zhenjiu Daceng to needle Zusanli (the Stomach Meridian of Yang, which can generate metal and supplement lung qi deficiency) and moxibustion at Qihai to enhance the qi of the previous two days; needling Feishu and Ge Shu to regulate the qi mechanism of the lung and chest, assisting in the clearing and restoring of lung qi’s dispersing and descending functions.
Qi and blood, liver and lung work together, so I also selected Sanyinjiao, Hegu, and Taichong points to harmonize blood and regulate qi, balancing the internal organs’ qi and blood, supporting the righteous and expelling the evil, treating both locally and holistically to promote recovery; thus, within minutes, chest pain and tightness significantly improved; after over 30 minutes of treatment, all symptoms disappeared, demonstrating the effectiveness of these points.
Additionally, I prescribed Xuefu Zhuyu Decoction, which includes Sijunzi Decoction to regulate the qi mechanism and Taohong Siwu Decoction to invigorate the blood; Jie Geng and Niu Xi to regulate the qi mechanism’s rising and falling, further enhanced with a large dose of Ren Shen and Zi Wan to strongly supplement lung qi. Regulating qi should not neglect blood regulation, which also promotes the recovery of both qi and blood.
Recommended Reading
TCM Treatment of Acute Conditions: Clinical Applications of the Twelve Well Points
Discussing three acute condition treatments, emphasizing the respect that TCM practitioners should have in clinical practice.
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