With approximately two months remaining until the 2021 TCM Practicing Physician Skills Examination, I recommend candidates review the comprehensive written content. Here, I summarize the important examination points for the practical skills exam—“Seven Essential Points for Needle Insertion Techniques in the 2021 TCM Practicing Physician Skills Second Station”.
01Preparation Before Needling
(1) Disinfection of the doctor’s fingers before needling: Before needling, wash the fingers with soapy water, then wipe with a 75% ethanol cotton ball, avoiding direct contact of the fingers with the needle body.
(2) Disinfection of the needling site before needling: Use a 75% ethanol cotton ball to disinfect in a circular motion from the center of the acupoint outward.
02Needling Technique
Clinically, the right hand generally holds the needle, primarily using the thumb, index, and middle fingers to grip the needle handle, resembling holding a brush, hence the right hand is called the “insertion hand.” The left hand presses down on the needling site or assists with the needle body, thus referred to as the “supporting hand.”
(1) Single-hand insertion technique: The right hand holds the needle with the thumb and index finger, the tip of the middle finger close to the acupoint, pinching the lower end of the needle body with the fingertip. When the thumb and index finger press down, the middle finger bends, inserting the needle to the required depth. This is often used for shorter needles.
(2) Two-hand insertion technique
① Finger-cut insertion technique: The left hand’s thumb or index finger presses beside the acupoint, while the right hand holds the needle, inserting it close to the left fingernail into the acupoint. This method is suitable for short needle insertion.
② Pinching insertion technique: The left hand holds a disinfected cotton ball with the thumb and index finger, pinching the lower end of the needle, fixing the needle tip on the skin surface of the acupoint, while the right hand twists the needle handle to insert it into the acupoint. This method is suitable for long needle insertion.
③ Stretching insertion technique: The left hand’s thumb and index finger stretch the skin at the acupoint to tighten it, while the right hand holds the needle, inserting it between the left hand’s fingers. This method is mainly used for acupoints on loose skin.
④ Pinch insertion technique: The left hand’s thumb and index finger pinch the skin at the acupoint, while the right hand inserts the needle from the pinched upper end. This method is mainly used for acupoints with thin flesh, such as Yintang (Yintang Point).
03Needling Direction and Angle
(1) Needling 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) Needling 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 perpendicularly 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 shallow muscle areas 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 acupoints on the head.
04Manipulation 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, generally controlled between 180º-360º, avoiding unidirectional twisting to prevent the needle body from becoming entangled in muscle fibers, causing local pain and difficulty in withdrawing the needle.
05Obtaining Qi
The concept of obtaining Qi: This refers to the sensation of meridian energy at the needling site after the needle has been inserted to a certain depth and specific manipulation techniques have been applied.
Manifestations of obtaining Qi: The patient may experience sensations of 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 needle.
06Supplementing and Draining Techniques
① Twisting for supplementing and draining
Supplementing technique: After obtaining Qi, twist at a small angle, with a slow frequency and light force, primarily using the thumb to push forward and the index finger to pull back.
Draining technique: After obtaining Qi, twist at a large angle, with a 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 obtaining Qi, start shallow and then go deep, with heavy thrusting and light lifting, primarily using downward force.
Draining technique: After obtaining Qi, start deep and then go shallow, with light thrusting and heavy lifting, primarily using upward force.
③ Even supplementing and draining: After obtaining Qi, perform even lifting, thrusting, and twisting.
07Handling Abnormal Situations During Needling
(1) Needle fainting: Immediately stop needling 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, needles can be inserted into Ren Zhong (Ren Zhong Point), Su Liao (Su Liao Point), Nei Guan (Nei Guan Point), and Zu San Li (Zu San Li Point), or moxibustion can be applied to Bai Hui (Bai Hui Point), Guan Yuan (Guan Yuan Point), and Qi Hai (Qi Hai Point) to restore consciousness. 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 perform circular pressing or tapping on the needle handle near the stuck needle site, or insert another needle nearby to disperse Qi and relieve muscle tension. If improper manipulation or unidirectional twisting causes it, 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 bending angle is too large, withdraw the needle following the direction of the bend. If caused by the patient moving positions, help the patient slowly return to the original position, relax the local muscles, and then gently withdraw the needle. Avoid forcibly pulling out 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 original position to prevent the broken needle from sinking deeper into the muscle. If part of the needle is exposed outside, it can be removed with fingers or tweezers. If the broken end is level with or slightly recessed into the skin, use the left hand’s thumb and index finger to press down vertically on both sides of the needle hole to expose the broken needle, and use tweezers with the right hand to remove it. If the broken needle is completely embedded under the skin or deep in the 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, generally no treatment is necessary as it will resolve on its own. If there is significant local swelling and pain, and the bruise area is large affecting movement, apply cold compresses to stop bleeding, followed by warm compresses or gentle massage to promote the absorption of the local bruise.