Acupuncture Techniques
Acupuncture techniques refer to the use of fine needles to stimulate specific acupuncture points on the body, aiming to unblock meridians and regulate the internal organs, thereby achieving the goals of strengthening the body and expelling pathogens to treat diseases. The indications for acupuncture techniques are extensive, used for treating various common and frequently occurring diseases across internal medicine, surgery, gynecology, pediatrics, and more.
1. Commonly Used Instruments and Basic Operation Methods
(1) Commonly Used Instruments
The acupuncture needles used clinically are primarily made of stainless steel, with types mainly including loop handle needles and flat handle needles, and specifications distinguished mainly by the diameter and length of the needle (see Table 1 and Table 2).
Table 1: Specifications of Needle Diameter
|
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, needles with diameters of 32 to 26 (0.25mm to 0.40mm) are most commonly used. Thicker needles are often used for acupuncture points on the limbs and lower back, as well as for patients with paralysis or numbness where needle sensation is dull; thinner needles are more commonly used for acupuncture points on the head, face, and for children or patients with a weak constitution.
Table 2: Specifications of Needle Length
|
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, needles with lengths of 1.0 to 3.0 inches (25 to 75mm) are most commonly used, with 1.5 inches (40mm) being the most frequently used. Longer needles are often used for deep insertion in areas with thick muscle or for penetrating acupuncture points; 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 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 on 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 areas with 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 area. This method is used for acupuncture points on areas with thin flesh, such as the 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 into the acupuncture point. This method is used for inserting longer needles.
3. Needle Manipulation and Obtaining Qi
After the 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 Qi response produced after the needle is inserted into the acupuncture point. When this Qi response occurs, the practitioner feels a heavy and tight sensation 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 grip the needle handle, performing a front-and-back twisting motion.
4. Needle Retention and Removal
The practitioner can determine the retention time based on the patient’s condition, generally retaining the needle for 15 to 30 minutes for common conditions. During removal, the left hand holds 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, applying pressure with a sterile dry cotton ball to the needle hole to prevent bleeding.
2. Common Diseases Treated with Acupuncture Techniques
(1) Stroke (Acute Cerebrovascular Disease)
Stroke is characterized by sudden loss of consciousness, hemiplegia, facial drooping, and speech difficulties, or it may present with facial drooping and hemiplegia without loss of consciousness. The formation of this condition is primarily due to an imbalance of Yin and Yang, often triggered by emotional distress, overwork, or sexual activity, 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, resulting in spleen deficiency and internal phlegm-heat, transforming into fire and stirring wind, which obstructs the clear orifices, resulting in stroke. The diagnosis of this condition 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 stroke affecting the internal organs and stroke affecting the meridians; this section mainly discusses acupuncture treatment for stroke affecting the meridians.
[Treatment Principle] Unblock the meridians, promote Qi and invigorate blood.
[Operation Steps]
Acupuncture Points: Baihui (Hundred Meetings), Fengchi (Wind Pool), Quchi (Pool at the Bend), Waiguan (Outer Pass), Hegu (Joining 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 Valley) and Zhaohai (Shining Sea); for constipation, add Tianshu (Heavenly Pivot); for speech difficulties, add Lianquan (Lian Spring).
Needle Technique: Direct insertion, using lifting, thrusting, and twisting techniques. For Fengchi, insert the needle at an angle towards the tip of the nose at a depth of 0.8 to 1.2 inches; for Lianquan, insert at an angle towards the root of the tongue at a depth of 0.8 to 1.5 inches.
Treatment Course: Once daily during the acute phase, and every other day during the recovery and sequelae phases, with each needle retained for 20 to 30 minutes, totaling 10 sessions for one treatment course.
(2) Headache (Tension-Type Headache, Vascular-Nervous 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 condition refers to the relevant standards in the Clinical Research Guidelines for New Chinese Medicines.
Headaches are classified into two main categories: external and internal headaches; this section mainly discusses acupuncture treatment for internal headaches.
[Treatment Principle] Unblock the meridians and collaterals, promote Qi and invigorate blood to relieve pain.
[Operation Steps]
Acupuncture Points: Baihui, Fengchi, Hegu, Taichong (Great Rushing), Touwei (Head Maintain), with additional points selected according to 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 Zan Zhu (Gathering Bamboo) and Yintang.
Needle Technique: Head acupuncture points are often inserted at an angle or horizontally, while limb acupuncture points are usually inserted directly. For Fengchi, insert the needle at an angle towards the tip of the nose at a depth of 0.8 to 1.2 inches, or horizontally through Fengfu (Wind Mansion). After insertion, perform lifting and thrusting and twisting techniques.
Treatment Course: Retain the needle for 30 minutes each time, once daily, totaling 10 sessions for one treatment course.
(3) Facial Paralysis (Peripheral Facial Nerve Palsy)
Facial paralysis is characterized by the mouth and eyes being skewed to one side. Symptoms include relaxation of one side of the face, disappearance of forehead lines, widening of the eye fissure, flattening of the nasolabial fold, drooping of the mouth corner towards the healthy side, inability to frown, raise eyebrows, show teeth, or puff cheeks, and some patients may initially experience pain behind the ear, as well as taste reduction or auditory hypersensitivity, and even herpes in the external ear canal. This condition is often caused by the invasion of wind-cold into the Yangming and Shaoyang meridians, leading to Qi stagnation and insufficient nourishment of the muscles and tendons, resulting in the disease. The diagnosis of this condition refers to the relevant standards in the Clinical Research Guidelines for New Chinese Medicines.
[Treatment Principle] Invigorate blood and unblock the collaterals, regulate the muscles and tendons.
[Operation Steps]
Acupuncture Points: Fengchi, Yifeng (Wind Screen), Dicang (Earth Warehouse), Jiachuan (Cheek Car), Hegu. Additional points based on symptoms: for flattening of the nasolabial fold, add Yingxiang (Welcome Fragrance); for deviation of the nasal groove, add Shuigou (Water Ditch); for deviation of the chin-lip groove, add Chengjiang (Cheng River); for inability to close the eyes, add Yangbai (Yang White), Zan Zhu, or Shenmai (Shen Pulse), Zhaohai.
Needle Technique: For facial acupuncture points, initially use shallow and light insertion, and after one week, consider horizontal or angled insertion.
Treatment Course: Retain the needle for 20 to 30 minutes each time, once daily, totaling 10 sessions for 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 activity, widespread tenderness in the local area, and restricted movements such as external rotation, abduction, elevation, and backward rotation. In the later stages, adhesions occur in the affected tissues, gradually worsening functional impairment, leading to “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, overexertion, and chronic strain are related to the development of this condition. The diagnosis of this condition 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 Joint), Jianqian (Front of Shoulder), Ashi points, Tiaokou (Channel Mouth). Additional points based on symptoms: for upper arm pain, add Binao (Upper Arm); for scapular pain, add Quyuan (Scapula) and Tianzong (Heavenly Gathering).
Needle Technique: Direct insertion.
Treatment Course: Retain the needle for 20 to 30 minutes each time, once daily, totaling 10 sessions for 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, with difficulty bending or straightening, or pain radiating to the buttocks and legs. The occurrence of this condition is mainly related to the invasion of external pathogens, falls, or injuries. The diagnosis of this condition refers to the relevant standards in the Clinical Research Guidelines for New Chinese Medicines.
This condition is classified into three main categories: cold-damp low back pain, blood stasis low back pain, and kidney deficiency low back pain; this section mainly discusses acupuncture treatment for blood stasis low back pain.
[Treatment Principle] Unblock the meridians and collaterals, invigorate blood and resolve stasis.
[Operation Steps]
Acupuncture Points: Shenshu (Kidney Shu), Yaoyangguan (Lumbar Yang Pass), Weizhong (Middle of the Knee), Ashi points.
Needle Technique: Direct insertion.
Treatment Course: Retain the needle for 20 to 30 minutes each time, once daily, totaling 10 sessions for one treatment course.
3. Contraindications
1. Pregnant women should avoid acupuncture in the lower abdomen, lumbar region, and points such as Hegu, Sanyinjiao, and Zhiyin.
2. For children 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 when overly hungry, fatigued, or under excessive mental stress.
2. For patients with a weak constitution 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 over the chest, ribs, waist, and back.
4. When needling points around the eyes and neck (such as Fengfu, Yamen, 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 points in 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 mental tension, improper positioning, or excessive stimulation from the needle, 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 with their head elevated. Emergency points such as Shuigou, Suli, Neiguan, Hegu, Taichong, Zusanli, and Yongquan may be needled, along with other necessary measures.
2. Stuck Needle: Due to mental tension, or muscle spasms from pain after needling, or changes in patient positioning after needle insertion, muscle fibers may wrap around the needle, causing difficulty in manipulation or removal. The patient should be instructed to relax, or gentle pressing or tapping on the needle handle near the stuck point may help, or another needle may be inserted nearby.
3. Bent Needle: Due to unskilled technique, or the needle encountering hard tissue, or changes in patient positioning during needle retention, or improper management of a stuck needle, the needle handle may change direction, making manipulation and removal difficult and causing pain. Manipulation should be stopped, and the needle should be slowly withdrawn in the direction of the bend.
4. Broken Needle: Due to poor quality of the needle or excessive force during manipulation, the needle may break inside the body. The left hand should press the skin around the needle to expose the broken end, and the right hand should use tweezers to remove it; if the broken part is deeply embedded, X-ray localization and surgical removal may be necessary.
5. Hematoma: Caused by puncturing a blood vessel, leading to minor subcutaneous bleeding, resulting in local bruising or swelling, which generally resolves on its own. If local swelling and pain are severe, a method of cold compress followed by heat compress may be used.
6. Pneumothorax: Deep insertion of needles into points on the chest, back, and near the clavicle may puncture the thoracic cavity and lung tissue, leading to pneumothorax, with 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 position changes. Generally, small amounts of air may be absorbed naturally; for severe cases, timely rescue measures such as thoracentesis and slow oxygen supplementation may be required.
Meridians, Collaterals, Muscles, and Skin Areas
1. Meridians
(1) Definition of Meridians
Meridians refer to the twelve meridians, which are branches of the twelve primary meridians, distributed in the chest, abdomen, and head, connecting the exterior and interior meridians and enhancing the relationship with the internal organs. They are considered “the proper meridians that branch from the twelve meridians.”
(2) Pathways of Meridians
The pathways of the twelve meridians begin from the limbs, penetrating into the internal organs, and then ascend to the superficial areas of the head and neck, connecting the exterior and interior. The points of “departure, entry, exit, and convergence” are closely related to the pathways of the twelve meridians, but there are significant differences in the direction of flow compared to the twelve primary meridians. For example, the pathway of the hand three Yin meridians starts from the chest and goes to the hand, while the meridian branches enter the chest from the armpit and then ascend to the head, converging with the hand three Yang meridians; the pathway of the hand three Yang meridians starts from the hand and goes to the head, while the hand three Yang meridian branches enter the internal organs from the armpit and then ascend to the head; the pathway of the foot three Yin meridians starts from the foot and goes to the chest (abdomen), while the foot three Yin meridian branches go from the foot to the head; the pathway of the foot three Yang meridians starts from the head and goes to the foot, while the foot three Yang meridian branches go from the foot to the head.
The main difference between the twelve meridians and the primary meridians lies in their pathways, which exhibit the characteristics of “departure, entry, exit, and convergence.” Each meridian branch departs from its corresponding primary meridian, referred to as “departure” (branch), enters the chest and abdomen, referred to as “entry,” exits at the head and neck, referred to as “exit,” and converges with the exterior and interior meridians, referred to as “convergence.” The three Yin and three Yang meridians together form six pairs, known as “six harmonies.”
1. Foot Taiyang – Foot Shaoyin (One Convergence)
(1) Foot Taiyang Meridian Branch
Branch Entry: At the Yanzhong point, one branch goes to five cun below the buttocks, entering the anus.
Branch Pathway: Belongs to the bladder, disperses to the kidney, and connects to the heart.
Exit Convergence: Exits from the back and reaches the neck.
Converges with: Foot Taiyang.
(2) Foot Shaoyin Meridian Branch
Branch Entry: At the Yanzhong point.
Branch Pathway: One branch connects with Foot Taiyang and ascends to the kidney, linking to the fourteen vertebrae, thus connecting to the Dai Mai (Belt Vessel); the direct pathway ascends to the tongue base.
Exit Convergence: Exits from the neck.
Converges with: Foot Taiyang.
2. Foot Shaoyang – Foot Jueyin (Two Convergences)
(1) Foot Shaoyang Meridian Branch
Branch Entry: Ascends around the hip, reaching the hairline and converging with the Foot Jueyin meridian, with one branch entering between the ribs.
Branch Pathway: Circulates in the chest, belongs to the gallbladder, disperses to the liver, ascends to the heart, and goes up to the throat.
Exit Convergence: Exits from the jaw, disperses to the face, and connects to the outer corner of the eye.
Converges with: Foot Shaoyang Meridian.
(2) Foot Jueyin Meridian Branch
Branch Entry: From the back of the foot, ascends to the hairline.
Branch Pathway: Converges with the Foot Shaoyang meridian.
Converges with: Foot Shaoyang Meridian.
3. Foot Yangming – Foot Taiyin (Three Convergences)
(1) Foot Yangming Meridian Branch
Branch Entry: Ascends to the hip, penetrating into the abdomen.
Branch Pathway: Belongs to the stomach, disperses to the spleen, ascends to the heart, and circulates in the throat.
Exit Convergence: Exits from the mouth, ascends to the upper part of the nasal column and below the eye socket, and connects to the eye.
Converges with: Foot Yangming Meridian.
(2) Foot Taiyin Meridian Branch
Branch Entry: Ascends to the hip.
Branch Pathway: Converges with the Foot Yangming meridian, linking to the throat and penetrating the tongue base.
Converges with: Foot Yangming Meridian.
4. Hand Taiyang – Hand Shaoyin (Four Convergences)
(1) Hand Taiyang Meridian Branch
Branch Entry: Branches from the shoulder, entering the armpit.
Branch Pathway: Connects to the heart, linking to the small intestine.
Converges with: Hand Taiyang Meridian.
(2) Hand Shaoyin Meridian Branch
Branch Entry: Between the two tendons in the armpit.
Branch Pathway: Belongs to the heart, ascending to the throat.
Exit Convergence: Exits from the face, connecting to the inner canthus of the eye.
Converges with: Hand Taiyang Meridian.
5. Hand Shaoyang – Hand Jueyin (Five Convergences)
(1) Hand Shaoyang Meridian Branch
Branch Entry: Branches from the top of the head, entering the chest.
Branch Pathway: Descends to the Sanjiao, disperses in the chest.
Converges with: Hand Shaoyang Meridian.
(2) Hand Jueyin Meridian Branch
Branch Entry: Branches from three cun below the armpit.
Branch Pathway: Enters the chest, linking to the Sanjiao.
Exit Convergence: Along the throat, exits behind the ear, and reaches the base of the skull.
Converges with: Hand Shaoyang Meridian.
6. Hand Yangming – Hand Taiyin (Six Harmonies)
(1) Hand Yangming Meridian Branch
Branch Entry: Ascends from the hand, circulating between the chest and breast, branching at the shoulder joint, entering the Tianzhu bone.
Branch Pathway: Descends into the large intestine, ascends to connect with the lung, and then goes up along the throat.
Exit Convergence: Exits from the Tianzhu.
Converges with: Hand Yangming Meridian.
(2) Hand Taiyin Meridian Branch
Branch Entry: Branches from the armpit, entering before the Hand Shaoyin Meridian.
Branch Pathway: Enters the lung, disperses to the large intestine.
Exit Convergence: Exits from the Tianzhu, circulating along the throat.
Converges with: Hand Yangming Meridian.
(3) Physiological Functions of Meridians
The six Yang meridians among the twelve meridians all pass through their corresponding interior organs, such as “the branch of Foot Shaoyang disperses to the liver,” “the branch of Foot Yangming disperses to the spleen,” and “the branch of Foot Taiyang disperses to the kidney.” The six Yin meridians also pass through their respective organs. This not only indicates that the twelve meridians are connected to the internal organs, playing a nourishing role, but also highlights the mutual relationship between Yin and Yang meridians. Their distribution and interrelationship are more intricate than the communication of the exterior and interior tissues by the collaterals.
The twelve meridians assist the twelve primary meridians in connecting the internal organs and the body surface, reflecting the “departure, entry, exit, and convergence” of the three Yin and three Yang meridians and their mutual infusion, forming a system of Qi and blood circulation. Since each meridian has its own branches, the therapeutic range of a specific meridian point is not limited to the pathway of the meridian, which specifically illustrates the function of the meridian branches.
The twelve meridian branches are not recorded in the “Neijing” for specific diseases. However, the branches significantly influence the therapeutic properties of certain acupuncture points, as the symptoms that each meridian point can treat may not be reached by the primary meridian but can be accessed by the meridian branches. Treating with the corresponding meridian points often yields significant therapeutic effects. For example, the Chengshan (Mountain of Acceptance), Chengjin (Mountain of Acceptance), and Huyang (Convergence of Yang) points of the Foot Taiyang Bladder Meridian can treat hemorrhoids, but the pathway of the bladder meridian does not reach the anus, while the pathway of the meridian branch is “five cun below the buttocks, entering the anus.”
2. Collaterals
(1) Definition of Collaterals
Collaterals are branches that branch off from the primary meridians, also known as “branch collaterals,” mainly consisting of fifteen collaterals. The fifteen collaterals are composed of the branch collaterals of the twelve primary meridians and the Ren and Du meridians, as well as the great collateral of the spleen.
Smaller branches that branch off from the collaterals are called “sun collaterals.” The collaterals distributed on the surface of the skin are called “floating collaterals.” The collaterals can interconnect with each other, “reconverging in the skin, with all connections visible externally” (from “Lingshu: Meridians”). The collaterals branch from large to small, forming countless fine branches that permeate the body, allowing Qi and blood to nourish all parts and tissues of the body, thus enabling the Qi and blood flowing in the meridians to circulate smoothly.