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Promoting Qi, Retaining Qi, and Guiding Qi
(1) Promoting Qi Method
Promoting Qi refers to various techniques used to hasten the flow of meridian Qi. The Shen Ying Jing states: “Using the right thumb and index finger to hold the needle, gently shake, advance and retreat, and twist; the needle should tremble as if shaken by the hand, this is called promoting Qi.” Additionally, methods such as scraping the needle handle, flicking the needle body, and following the meridian path also serve to promote Qi. Commonly used methods in clinical practice include:
1. **Searching Qi Method**: If Qi does not arrive or is not obvious after the needle reaches the designated depth, the needle can be withdrawn to a shallower level, change the direction of needling, and reinsert. If Qi is still not obtained, the needle can be purposefully inserted straight or obliquely in various directions to search for Qi.
2. **Guiding Method**: If Qi is not flowing smoothly after needling, or if Qi disappears immediately after being obtained, the practitioner can use their fingers to press and guide around the acupuncture point, moving up and down or side to side, to encourage Qi to arrive.
3. **Flicking and Shaking Method**: “Flicking” involves using the fingers to flick the needle handle to promote Qi and make the needle sink; “shaking” involves using the right hand in a half-fist position to strike around the acupuncture point or flick to vibrate the meridian Qi and encourage its arrival.
(2) Retaining Qi Method
Retaining Qi refers to the method used after obtaining Qi through waiting or promoting techniques, where the practitioner must take measures to retain the Qi under the needle while the patient feels comfortable, to maintain the sensation for a longer duration. The Suwen: Baoming Quansheng Lun states: “Once the meridian Qi has arrived, be cautious to retain it and not lose it,” and the Ling Shu: Xiao Zhen Jie also states: “To retain Qi is to know how to guard it… Once Qi is obtained, it is essential to carefully guard it.” Only by retaining the Qi under the needle can different techniques be applied to continue affecting the body. Common methods for retaining Qi include:
1. **Pushing Method**: This involves pressing the needle tip against the responsive area, pushing the needle handle forward or backward with the thumb, ensuring the needle tip does not leave the area of Qi sensation, and waiting for 1-3 minutes to prolong the sensation.
2. **Moving and Supporting Method**: After obtaining Qi and when the patient feels comfortable, the practitioner can move the needle handle to one side while placing a finger between the needle body and the acupuncture point to support the area of sensation. For example, if using the thumb to move the needle, the index finger supports it. Conversely, if using the index finger to move the needle, the thumb supports it to enhance the Qi sensation. When combined with tonifying or draining techniques, during tonification, the needle tip should press inward, and the angle of support should be small; during draining, the needle tip should be lifted outward, and the angle of support should be larger.
(3) Guiding Qi Method
Guiding Qi refers to specific techniques used by the practitioner to promote the transmission or diffusion of the sensation from the needle to the affected area based on the obtained Qi. The purpose of guiding Qi is to further stimulate the meridian Qi and promote its movement to the “Qi reaches the disease location.” The Zhen Jiu Da Cheng: Jing Luo Ying Sui She Wei Wen Da states: “For diseases far from the path, Qi must first reach the disease location,” indicating that after obtaining Qi, it is necessary to guide it to the disease location for effective treatment. Various needling techniques that promote the movement of meridian Qi are collectively referred to as guiding Qi methods. Common guiding Qi methods include:
1. **Following and Supporting Method**: The Jin Zhen Fu states: “Follow and support it, this is the method of guiding Qi.” This is commonly used in cases of insufficient Qi and slow Qi movement. During the procedure, the practitioner uses the left hand’s index, middle, and ring fingers to gently press along the meridian pathway of the acupuncture point, moving up and down in the direction of the meridian to accelerate Qi movement to the disease location.
2. **Pressing Needle Method**: If Qi does not move or does not move far after obtaining it, the practitioner can hold the needle tip at the point of Qi and keep it still, slightly angling the needle tip upward to guide Qi upward, or downward to guide Qi downward. The practitioner should concentrate and focus on the needle, pausing for a moment to encourage Qi movement. The Xi Hong Fu states: “To press the needle to drain Qi, one must inhale; for tonification, exhale to adjust,” indicating that guiding Qi techniques should be coordinated with breathing.
3. **Pushing Qi Method**: After obtaining Qi, if it does not move far, the practitioner can gently lift the needle from the Qi point with the thumb and index finger, angling the needle tip in the desired direction for Qi movement, pushing and twisting the needle handle evenly and forcefully with the thumb until the thumb reaches the first crease, then gently retreat and push forward again. This is repeated until the Qi under the needle reaches the disease location. This corresponds to the “moving and advancing method” in the Jin Zhen Fu and the “pushing leads to movement” method in the Zhen Jing Zhi Nan.
4. **Pressing and Cutting Method**: After obtaining Qi, the practitioner holds the needle handle with the right hand and presses above the acupuncture point with the left hand, then applies twisting and lifting techniques to promote downward Qi movement; conversely, pressing below the acupuncture point promotes upward Qi movement. The Jin Zhen Fu states: “Pressing in front makes Qi go behind; pressing behind makes Qi go in front.” When using this method, it is essential to master the direction of needling. For needling below the disease location, the needle tip should be angled upward; for needling above the disease location, the needle tip should be angled downward. Additionally, proper use of pressing techniques is crucial to achieve the goal of guiding Qi.
Weight of Needling Techniques
The weight of needling techniques refers to the amount of stimulation applied during needle manipulation (moving the needle). The amount of stimulation during needling should vary between light, medium, and heavy to produce different effects.
(1) Significance of Weight in Needling Techniques
The purpose of varying the weight of needling techniques is to stimulate meridian Qi, adjust meridian and organ functions, and achieve the goals of tonifying deficiency and draining excess, as well as supporting the righteous and expelling evil. Due to differences in physiological functions, pathological changes, and individual patient factors such as constitution, age, condition, duration, acupuncture point location, tolerance, and whether it is the first or follow-up visit, practitioners must apply appropriate stimulation levels to effectively adjust functions and promote recovery. Therefore, the weight of needling techniques is also a crucial factor determining the effects of acupuncture.
(2) Quantitative Requirements for Weight in Needling Techniques
Currently, there is no unified quantitative standard for the weight of needling techniques. However, if the stimulation levels of needling techniques are categorized into different intensities to meet basic quantitative requirements, it would be more objective than having no quantitative standards. The weight of needling techniques can generally be divided into light, medium, and heavy stimulation levels; light refers to applying slight lifting or twisting techniques based on obtaining Qi, with gentle sensations under the needle and short duration; medium refers to applying moderate stimulation levels during needling with noticeable sensations under the needle and moderate duration; heavy refers to applying greater force during needling based on the presence of Qi, resulting in strong sensations under the needle (within the patient’s tolerance), with longer duration. Establishing a quantitative requirement is beneficial for clinical acupuncture treatment.
(3) Factors Constituting Weight in Needling Techniques
The weight of needling techniques is not a single measure but is directly related to the thickness and length of the needles used, the angle and depth of insertion, and the amplitude and frequency of needle manipulation. Generally, thicker needles require more force and produce greater stimulation, while finer needles require less force and produce less stimulation. The angle and depth of needle insertion also affect the level of stimulation; generally, deeper and straight insertions require more stimulation, while shallow and horizontal insertions require less. The amplitude and frequency of manipulation are closely related to the weight of needling techniques; an amplitude greater than 0.5 cm or a twisting angle greater than 180 degrees results in greater stimulation, while an amplitude less than 0.3 cm or a twisting angle less than 90 degrees results in less stimulation. A frequency of more than 90 times per minute indicates greater stimulation, while less than 60 times per minute indicates less stimulation. Mastering the weight of needling techniques requires familiarity with the various aspects of quantitative requirements and consistent practice to achieve proficiency.
(4) Relationship Between Weight of Needling Techniques and Tonification/Drainage Techniques
Tonification and drainage techniques refer to acupuncture methods applied based on the deficiency or excess of the condition, as stated in the Ling Shu: Jing Mai: “Drain when there is excess, tonify when there is deficiency.” The weight of needling techniques refers to the amount of stimulation applied during needling, and the two are complementary, requiring differentiation in application. Ancient practitioners noted that tonification should be light and drainage should be heavy, while others suggested that tonification could be heavy and drainage could be light, and some believed that both tonification and drainage could be either light or heavy. This indicates that despite differing opinions and experiences, there is a correlation between tonification/drainage and the weight of needling techniques, meaning that the stimulation levels for tonification can vary, and those for drainage can also vary. The weight of needling techniques alone cannot replace the tonification/drainage methods, as the effects of tonification and drainage depend on the stimulation levels applied. In summary, the weight of needling techniques and the amount of stimulation are relative concepts. During treatment, the practitioner’s subjective wishes should not dictate the stimulation levels; rather, they must objectively adhere to the principles of differentiation in treatment, mastering the appropriate stimulation levels to avoid excessive stimulation that could harm the righteous or insufficient stimulation that could leave evil behind, ensuring that Qi reaches the disease mechanism.
Retaining Needle Method
When the needle is inserted into the acupuncture point, and Qi is obtained through needling and either tonification or drainage techniques are applied, leaving the needle in the point is referred to as the retaining needle method. Retaining the needle is an important aspect of acupuncture, significantly enhancing the therapeutic effects. By retaining the needle, the sensation can be strengthened and the stimulating effect prolonged, while also serving the purpose of waiting for Qi and adjusting Qi. Whether to retain the needle after obtaining Qi and the duration of retention should depend on the patient’s constitution, condition, and the location of the acupuncture point. For general conditions, once Qi is obtained and appropriate tonification or drainage techniques are applied, the needle can be removed or retained for 10-20 minutes. However, for certain special conditions, such as chronic, stubborn, or spastic diseases, the retention time may be extended. In cases of acute abdominal conditions or tetanus with opisthotonos, it may be necessary to retain the needle for several hours; conversely, for elderly, pediatric patients, or those experiencing fainting, shock, or collapse, prolonged retention is not advisable to avoid delaying treatment. The main methods for retaining needles include:
1. **Static Retaining Method**: The Suwen: Li He Zhen Xie Lun states: “Retain it quietly for a long time,” meaning that after Qi has arrived, the needle is left in place without further manipulation until it is time to remove it. This method is commonly used for chronic, weak patients with low tolerance to needling. Additionally, if the condition is deficient or cold and requires tonification, this method is also applicable.
2. **Dynamic Retaining Method**: The Zhen Jiu Da Cheng states: “For stagnation, retain the needle for a long time,” meaning that after inserting the needle and obtaining Qi, it is retained for a certain period while manipulating the needle intermittently. This method, also known as intermittent needling, enhances the sensation and achieves the goals of tonification and drainage. Additionally, it is used clinically for cases where Qi does not arrive after needling, allowing for simultaneous manipulation to promote Qi while retaining the needle until Qi arrives. Practitioners must pay attention to contraindications for needle retention, such as uncooperative children, needle-phobic patients, first-time visitors, or those with excessively weak constitutions. They must also avoid inappropriate retention sites, such as the eye area, throat, or chest, and exclude conditions unsuitable for needle retention, such as frequent urination, urgency, cough, asthma, or diarrhea. For patients who require needle retention, practitioners should monitor the patient’s complexion and expression during retention to prevent fainting or other unexpected occurrences.
Needle Removal Method
Needle removal, also known as lifting or withdrawing the needle, occurs after the needling techniques or retention have achieved the intended acupuncture goals and treatment requirements. Needle removal is the final step in the entire acupuncture process, indicating the conclusion of the treatment.
(1) Needle Removal Method**: The method for removing the needle generally involves using the left thumb and index finger to hold a disinfected cotton ball gently against the needling site while the right hand lightly twists the needle and slowly lifts it just beneath the skin (not yanking it out with one hand), allowing it to rest for a moment before removal.
(2) Needle Removal Requirements**: During needle removal, depending on the tonification or drainage requirements, the practitioner may use “quick removal” or “slow removal” as well as “quick pressing on the needle hole” or “widening the needle hole” methods. After needle removal, unless there are special needs, a disinfected cotton ball should be pressed against the needle hole for a moment to prevent bleeding or pain at the site. After the needle is fully withdrawn, the practitioner should carefully check for bleeding at the needle hole, inquire about any discomfort at the needling site, verify the number of needles used to ensure none are left behind, and be alert for any delayed reactions such as fainting.
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