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Expert Introduction
Li Xuewu (Li Yaozu), born in 1940 in Ping Shan County, Hebei Province, graduated from Beijing University of Chinese Medicine in 1965. He has worked at the affiliated Dongzhimen Hospital and the Acupuncture and Tuina Department of the university. He is currently a professor at Beijing University of Chinese Medicine, head of the Acupuncture and Moxibustion Teaching and Research Office, doctoral supervisor, council member of the National Acupuncture and Moxibustion Research Association, and a renowned TCM acupuncture expert. After graduation, he has been engaged in clinical practice, teaching, and research in TCM acupuncture, with a particular focus on cerebrovascular diseases (stroke) and other neurological disorders, geriatric diseases, anti-aging, gastrointestinal diseases, and various pain syndromes, as well as ocular diseases in adolescents, accumulating over 30 years of clinical experience. He has extensive experience in the combined treatment of cerebrovascular diseases and gastrointestinal diseases using acupuncture and herbs. He has authored “Health Care Acupuncture and Massage”; as a member of the editorial board for textbooks in national higher medical institutions, he has compiled textbooks such as “Acupuncture and Moxibustion Techniques” and “Acupuncture Science” teaching reference materials, as well as “Acupuncture Health Care” and “Practical Acupuncture Dictionary”; he has published over 30 papers, including “Clinical Applications of Health Care Moxibustion”, “Initial Exploration of Deep Insertion at Fengfu and Yamen Points”, “Practical Techniques for Jingming Point”, and “Insights on Needling Zhongwan and Tianshu Points”.Summary of Li Xuewu’s Experience with Deep Needle Insertion Techniques
Professor Li Xuewu was born into a family of traditional Chinese medicine practitioners and has over 30 years of clinical, teaching, and research experience in TCM acupuncture. He has rich experience in treating cerebrovascular diseases, gastrointestinal diseases, ocular diseases, and various difficult syndromes. Professor Li’s needling techniques are skilled and insightful, often employing special angles and depths of needle insertion based on the patient’s condition, particularly excelling in deep insertion techniques to enhance needle sensation and improve efficacy. Below are the deep insertion methods for commonly used acupuncture points in Professor Li’s clinical practice.01PARTDeep Insertion at the Jiaji Points for Treating Lumbar and Leg Pain
From the 1st thoracic vertebra to the 5th lumbar vertebra, 0.5 cun lateral to the spinous processes, there are 17 points on one side, totaling 34 points on both sides.The Jiaji points include all the Jiaji points on both sides of the cervical, thoracic, lumbar, and sacral vertebrae. The depth, direction, and efficacy of needling have a significant relationship.Professor Li generally needles the Jiaji points about 20mm lateral to the Du Mai (Governing Vessel), which is both safe and relatively easy to find the desired needle sensation. If too close to the midline of the back, the needle may contact bone tissue after insertion, preventing deep insertion; if too far from the midline, there is a risk of injuring internal organs. During insertion, the needle tip should be slightly angled inward or inserted straight (in obese patients, it is often inserted straight), and should not be angled outward to avoid injuring internal organs. The Jiaji points in the cervical and thoracic regions are generally not suitable for deep insertion, while those below the lumbar region can be inserted relatively deeply, reaching 40-75mm. The patient should be positioned on their side, with the lumbar region arched and the lower limbs flexed, needling the 3rd, 4th, and 5th Jiaji points quickly, then slowly advancing the needle to 40-75mm, with the needle sensation potentially radiating to the feet. This deep insertion method increases the occurrence of numbness and electric sensation radiating to the lower limbs, which can have immediate effects in treating lumbar osteophytes, radiculitis, sciatica, and other conditions.When deep inserting at the Jiaji points, if numbness and electric sensation radiate distally, it indicates a response to the spinal nerve; at this point, the needle should be slightly lifted and retained, avoiding repeated lifting and thrusting to prevent nerve damage.02PARTDeep Insertion at the Jingming Point for Treating Retinal Diseases
Located on the face, slightly above the inner canthus of the eye.The Jingming point is a primary point for treating various eye diseases in both ancient and modern medicine. The depth of needling at this point varies significantly in acupuncture literature, ranging from 2 to 40mm. Professor Li often inserts the needle straight into the Jingming point to a depth of 30-45mm for treating retinal diseases such as optic neuritis, optic atrophy, retinitis, retinal detachment, and amblyopia. For some patients with myopia, hyperopia, or strabismus, when shallow needling is ineffective, deep insertion is often employed. During the procedure, a needle with a diameter of 0.25-0.32mm and a length of 40-50mm is selected.The patient is instructed to close their eyes, with the left hand gently pushing the eyeball outward for stabilization, while the right hand holds the needle 2mm above the inner canthus and then inserts it subcutaneously 2mm outward, slowly advancing along the edge of the eye socket. When significant resistance is felt under the needle, or if the patient experiences pain, do not forcefully rotate the needle; instead, slightly withdraw the needle, adjust the direction, and continue advancing to a depth of 30-45mm. When the patient feels local soreness and the needle sensation radiates to the back of the eyeball or the entire eyeball, the insertion should be stopped. For adolescents, the insertion depth is generally between 25-40mm. The needle should be retained for 20-30 minutes, and when withdrawing, the needle should be removed slowly, applying pressure with a disinfected cotton ball at the needle hole for 1-2 minutes to prevent bleeding.When using deep insertion techniques, the point should be located in the depression above the outer canthus of the eye, where insertion can reach depths of over 40mm, which is effective for treating retinal diseases. If the needle is inserted too close to the nasal bone for fear of injuring the eyeball, it is easy to contact the nasal bone, preventing deeper insertion, resulting in only pain without the desired sensation, thus failing to achieve the purpose of deep insertion. To avoid injuring the eyeball or causing subcutaneous bleeding, the eyeball should be stabilized with the hand, and a finer needle should be used, advancing slowly without lifting or rotating the needle.03PARTDeep Insertion at the Tianshu and Zhongwan Points for Treating Acute Gastroenteritis
Located in the middle of the abdomen, 2 cun from the umbilicus.
Located in the upper abdomen, on the anterior midline, 4 cun above the umbilicus.Ancient texts such as “Zhenjiu Dacheng” mention that abdominal points can be deeply needled, as noted in the “Zhabing Xuefa Ge” stating, “For cholera, Zhongwan can be deeply needled.” Professor Li often uses conventional needling techniques at the Tianshu and Zhongwan points for chronic diseases, inserting to a depth of 20-40mm without entering the abdominal cavity. However, for certain acute conditions, such as acute gastric pain and acute diarrhea, deep insertion techniques are often employed. For example, in patients with acute gastric pain (gastric spasm), when conventional needling at Zhongwan and Zusanli points does not provide immediate relief, deep insertion methods can be used. Generally, a needle of 75-100mm in length and 0.30-0.32mm in diameter (depending on the patient’s body type) is selected, inserting straight into the Zhongwan point. When the needle tip penetrates the abdominal wall and reaches the abdominal cavity, a sensation of emptiness is felt under the hand, indicating sudden loss of resistance. Continuing to insert the needle will encounter a hard yet elastic resistance, indicating contact with the gastric wall, at which point insertion should be stopped. For moderately sized patients, insertion of about 65-75mm typically reaches the stomach, and the patient often experiences significant soreness or distension. After slightly withdrawing the needle, it should be rotated for 0.5 minutes, with 2-3 small thrusts before withdrawal. If pain is not relieved, the needle can be retained at a depth of 25-45mm outside the abdominal cavity, and after about 10 minutes, deep insertion can be repeated, and this can be done 2-3 times until pain is alleviated. Professor Li has treated around 120 cases of acute diarrhea in children around 1 year old, using the method of needling Zhongwan, Tianshu, and Zusanli points with a 0.30mm diameter, 40mm long needle, inserting about 35mm (equivalent to 2.5-3 cun), rotating each point for about 0.5 minutes, and performing 2-3 small thrusts before withdrawal. The treatment results showed that except for 3 cases that improved after one treatment but did not return for further treatment, all others were cured after 1-3 treatments.Due to the potential risk of damaging abdominal organs during deep needling at abdominal points, it is essential to be clear about the anatomical positions of various abdominal organs, master needling techniques, and be able to perceive the sensations under the needle when it reaches the abdominal wall, abdominal cavity, and gastric wall before attempting deep insertion. The needle should preferably be a 0.30mm diameter needle, not too thick; the patient should be in a supine position with a relaxed abdominal wall; insertion should be slow, as the intestinal wall often automatically avoids stimulation, making it less likely to be punctured; during needling, the technique should focus on rotation rather than large thrusts; and no retention of the needle is advised. Patients with pathological changes such as liver enlargement, spleen enlargement, kidney hydronephrosis, intestinal obstruction, or intestinal tumors should not undergo deep needling.04PARTDeep Insertion at the Yamen and Fengfu Points for Treating Epilepsy and ManiaFengfu is located at the nape, 1 cun directly above the midpoint of the posterior hairline, in the depression between the trapezius muscles. Yamen is located at the nape, 0.5 cun directly above the midpoint of the posterior hairline, below the first cervical vertebra.The deep structures of Fengfu and Yamen points include the medulla oblongata and spinal cord, and needling carries certain risks. Ancient texts state that these two points should only be needled to a depth of 7-10mm. Clinical reports have indicated that deep needling at these points can be effective for treating mental disorders, but there have also been incidents. To ensure safe and effective clinical application, Professor Li conducted in-depth anatomical observations and research on the needling depth. He summarized that needling at Fengfu passes through the skin → subcutaneous tissue → nuchal ligament → origin of the trapezius muscle → posterior atlanto-occipital membrane; needling at Yamen passes through the skin → subcutaneous tissue → nuchal ligament → interspinous ligament → yellow ligament (which contains a rich venous plexus) → dura mater. When deep needling at Fengfu and Yamen, there are generally two sensations of resistance: the first is the nuchal ligament, followed by a sensation of emptiness; the second resistance is the dura mater, so the needle tip must not penetrate the dura mater and should avoid upward insertion towards the foramen magnum to prevent damage to the medulla oblongata and blood vessels. If deep insertion occurs and the patient experiences an electric sensation, the needle should be immediately withdrawn, avoiding any thrusting.The specific needling method involves instructing the patient to sit upright with their head slightly forward and neck muscles relaxed, then slowly inserting the needle with the tip directed towards the lower jaw (or mouth). If a firm yet elastic resistance is encountered, it indicates the nuchal ligament, interspinous ligament, or posterior atlanto-occipital membrane. Continuing to insert the needle will lead to a sensation of emptiness under the needle, indicating that the tip has entered the epidural space; if a soft resistance is felt, it indicates contact with the dura mater. When needling Yamen to a depth of 40mm, there is a possibility of reaching the dura mater; when needling Fengfu to a depth of 40mm, there is a possibility of reaching the cerebellomedullary cistern. Generally, needling should not exceed this depth; if the patient experiences electric or numb sensations radiating to the head, upper limbs, or lower limbs, the desired sensation has been achieved, and the needle should be immediately withdrawn, avoiding repeated thrusting and rotation.If the patient experiences headache or dizziness after needling, it should be considered whether there has been a subarachnoid hemorrhage, and immediate emergency measures should be taken.Professor Li often uses this method to treat epilepsy, seizures, and other neuropsychiatric disorders, achieving better results than conventional needling techniques. However, deep needling at Fengfu and Yamen does carry certain risks, as stated in the “Xihong Fu”: “Fengfu is the most difficult point to needle, yet requires skill in controlling depth.” Needling must be performed with a thorough understanding of the local anatomy of the points; proficient needling techniques; correct control of the direction of needling (the needle tip should be directed towards the mouth or lower jaw, not towards the foramen magnum); strict control of needling depth and strength; stabilization of the patient’s position; close monitoring of the patient’s reactions; and selection of appropriate needles.Further Reading:
What are the similarities and differences in the treatment of Fengchi, Fengfu, Fengmen, and Fengshi points?
Deep needling at Fengfu with direct moxibustion, clinical experience of Xie Xiliang
Clinical experiences of needling Yamen point
05PARTMultidirectional Deep Insertion Techniques at the Xiaguan Point
Located in front of the ear, in the depression formed by the zygomatic arch and the mandible notch.Professor Li has summarized through years of clinical practice that conventional straight needling at the Xiaguan point to a depth of 15-40mm is suitable for most diseases. However, for certain specific diseases, using modern anatomical knowledge to employ deep insertion techniques in specific directions often yields better results. For example, for backward and upward oblique insertion: inserting vertically to a depth of 40-50mm until bone tissue (the lateral plate of the sphenoid wing) is touched, then lifting the needle slightly and inserting it backward and upward (towards the opposite mastoid foramen), advancing about 40-60mm can reach the foramen ovale, where the third branch of the trigeminal nerve (mandibular nerve) may be stimulated, resulting in numbness or pain radiating to the mandible, lower teeth, gums, or tongue. This method can be used to treat trigeminal neuralgia (third branch), lower tooth pain, and facial nerve paralysis. When treating hearing loss and other ear diseases, the needle tip should be slightly angled backward during insertion, reaching a depth of about 40mm, which can produce local soreness or pain radiating to the ear area, yielding good results.For forward and upward oblique insertion: after entering the subcutaneous layer, the needle tip should be inserted at an angle of 15-30 degrees forward and upward to a depth of about 50-60mm, reaching the pterygopalatine fossa and the exit of the maxillary nerve (trigeminal nerve second branch). The sensation is local soreness, and if the maxillary nerve is stimulated, numbness or pain may occur in the upper teeth or face. This is used to treat trigeminal neuralgia (second branch), upper tooth pain, allergic rhinitis, chronic rhinitis, and sinusitis. When treating nasal diseases, the needle can also be inserted about 1-1.5cm forward from the midpoint below the zygomatic arch, penetrating forward and upward between the zygomatic and mandible bones to a depth of about 60mm, sometimes reaching the pterygopalatine ganglion, which can produce ipsilateral facial numbness or a sensation of running water in the nasal cavity, immediately relieving nasal congestion, yielding good results for allergic rhinitis.For downward oblique insertion: the needle body should be at a 30-45 degree angle downward and slightly backward towards the Qiangzheng point (located 1cm in front of the earlobe, level with the midpoint of the earlobe), penetrating to a depth of 40-50mm, which can reach the branches of the facial nerve, with local soreness radiating to the cheek area, and sometimes a sensation of muscle twitching on the same side of the face. This is used to treat facial nerve paralysis. When treating jaw muscle spasms causing trismus, the needle tip should be directed straight down towards the Jaw Point, penetrating to a depth of 40-50mm.The above special needling techniques require deeper insertion and often aim to reach the corresponding nerve trunk or ganglion, so familiarity with the local anatomy of the points and proficiency in needling techniques are essential. When performing forward and upward oblique insertion, to avoid excessive depth, it is advisable to first insert straight until the needle reaches the lateral plate of the sphenoid wing, noting the depth, then withdrawing the needle to the subcutaneous layer and changing to forward and upward oblique insertion, which can be about 1cm deeper than the previous depth. If there is no numbness sensation indicating nerve stimulation, the direction of needling can be adjusted without further deepening the insertion. When treating nasal diseases by stimulating the pterygopalatine ganglion, some patients may have little space between the zygomatic and mandible bones, making it difficult to insert the needle; Professor Li has found that about half of the patients achieve the desired effect. Generally, insertion should not exceed 5-6cm, as excessive depth may penetrate the nasal cavity, causing nasal bleeding. For treating trigeminal neuralgia, it is best to achieve needle sensation in the pain area for optimal analgesic effect; if the sensation does not correspond to the pain area, the needling direction should be slightly adjusted to align the needle sensation with the pain area.06PARTDeep Insertion Techniques at the Taiyang Point
Located in front of the ear, on both sides of the forehead, above the extended line of the outer canthus of the eye, in the depression behind the tips of the eyebrows.The Taiyang point is one of the most commonly used extraordinary points in clinical practice, with common techniques including shallow needling, flat needling, and bloodletting. Professor Li has often used the downward oblique deep insertion technique at the Taiyang point over decades of clinical practice, achieving special efficacy in treating certain stubborn diseases. For example, when treating long-standing tooth pain at the Taiyang point, the needle body should be inserted at a 40-45 degree angle downward, penetrating through the inner side of the zygomatic arch to a depth of about 50-65mm, resulting in a strong sensation of soreness or numbness in the upper gum area, often leading to immediate cessation or significant reduction of tooth pain. Some have used this method for tooth extraction, inserting the needle to about 65mm, at which point a sensation of numbness or electric sensation may occur in half of the cheek, indicating readiness for extraction. Continuous needling during the procedure maintains the sensation until the extraction is complete, with clinical observations of 200 cases showing excellent results.Additionally, for treating long-standing conditions of the first and second branches of the trigeminal nerve, facial paralysis, and temporomandibular joint disorders, the Taiyang point can be needled towards the Xiaguan point, with the needle at a 50-degree angle, penetrating along the inner side of the zygomatic arch towards the Xiaguan point, reaching a depth of about 50mm, resulting in strong soreness or numbness sensations, often yielding good results. For treating facial paralysis and trigeminal neuralgia, the Taiyang point can also be needled towards the Qiangliao point, inserting from the Taiyang point at a 50-degree angle through the inner side of the zygomatic arch towards the Qiangliao point, reaching a depth of about 50-65mm, with the sensation radiating to the same side of the jaw, yielding good results. (Further reading: [Needling Techniques] Clinical Applications of Through-Needling Techniques)The Taiyang point is typically located in the depression 1 cun behind the line between the tip of the eyebrow and the outer canthus of the eye, and the key to deep insertion techniques is to insert the needle slightly above the original point; if the point is taken too low, it may be difficult to achieve the required depth. The angle of insertion should ideally be 45-50 degrees; if the angle is too small, the needle may not penetrate deeply enough and may contact the zygomatic arch, while if the angle is too large, it may contact the temporal bone during insertion, preventing the desired depth.The Taiyang point has a rich vascular supply, so care should be taken to avoid blood vessels during insertion, and repeated lifting and thrusting of the needle should be avoided to prevent deep bleeding and hematoma formation.07PARTClinical Insights“Ling Shu: Nine Needles and Twelve Origins” states: “The key to needling is to achieve qi and effectiveness.” Achieving qi is the key to therapeutic efficacy. Therefore, practitioners throughout history have employed various methods to enhance needle sensation and promote qi to the disease location. Professor Li believes that when needling at the disease site, the needle tip should be directed towards the disease location and inserted as deeply as possible, even reaching the pathological tissue, as this is most conducive to achieving qi and enhancing the needle sensation. Clinically, Professor Li often combines distant point selection with deep needling at local points to achieve an organic combination of reaching the disease site and qi reaching the disease location.Professor Li consciously applies deep needling techniques, stimulating nearby nerves or ganglia, which requires a solid understanding of modern anatomical knowledge to ensure safety and improve efficacy.For example,when needling abdominal points, it is essential to be clear about the anatomical positions of important abdominal organs.When patients have pathological changes such as liver enlargement, spleen enlargement, or kidney hydronephrosis, deep needling at the corresponding points is not advisable, as organs like the liver, spleen, and kidneys do not have the same contraction ability as the stomach and intestines, making them more susceptible to injury under pathological conditions, thus increasing the risk of deep needling.Needling must be performed with a thorough understanding of the local anatomical structures of the points, clarifying the distribution of surrounding bones, nerves, and blood vessels.This ensures accurate stimulation of the corresponding nerves and ganglia to achieve the desired needle sensation. Additionally, practitioners should be sensitive to the different sensations felt under the needle when needling different tissues.For instance, when encountering adipose tissue, the sensation under the needle is relatively loose, while the muscle layer feels tighter; the sensation of emptiness when the needle tip enters the epidural space, and the soft resistance when it reaches the dura mater; the sudden loss of resistance when penetrating the abdominal cavity, and the hard yet elastic sensation when contacting the gastric wall, etc. Therefore, only by being familiar with human anatomical structures and the sensations under the needle can one accurately determine when to insert deeply or shallowly, maintaining a clear understanding.Furthermore, during treatment, the selection of point locations, choice of needles, angle of insertion, and depth of needling should be determined based on the patient’s body type, disease, and the clinician’s experience, as these details directly affect the safety and effectiveness of the treatment, requiring utmost care and flexibility beyond rigid adherence to textbooks to truly achieve individualized treatment based on the person and the disease.In his decades of clinical practice, Professor Li has diligently researched and carefully experienced various needling techniques, mastering them with ease; he has also refined the needling methods for certain special points. The deep needling techniques described above are challenging, with few clinical reports, yet Professor Li can “apply them skillfully, relying on his heart.” We, the learners, must practice the fundamentals diligently and master needling techniques to emulate Professor Li’s deep needling methods.Further Reading
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Gao Zhen’s Five Needle Moxibustion for Wind Twelve Effective Points and Case Examples
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[Essentials of Acupuncture] Lü Jingshan: Synchronization Needling Techniques and Clinical Experiences of 19 Points (with Video)
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[Essentials of Acupuncture] He Purin: Detailed Explanation of the Warming and Circulating Method of the Three Passes
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[Essentials of Acupuncture] Wang Xuetai: Correspondence of Acupuncture Techniques and Syndromes, Selecting Points According to Their Rules
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Note: This article is organized by Peiyi Education (www.tcmedu.com), published in the Journal of Beijing University of Chinese Medicine, 2002, Issue 03, authors: Han Zhai, Wang Lei, guidance: Li Xuewu. The various prescriptions and formulas mentioned are for reference and learning purposes only and should not be used as prescriptions. Please do not use them blindly; this platform does not bear any responsibility for any consequences arising from this!
