The Techniques Of Acupuncture and Moxibustion

Filiform Needle Manipulation

Preparations Prior to Acupuncture Treatment

Selection of the Instruments

The filiform needle is one of the nine kinds

of needles in ancient China.

Most of the filiform needles used at present

are made of stainless steel.

A filiform needle may be divided in to five parts. Tip : the sharp point of the needle Body : the part between the handle and the tip Root: the connecting part between the body and the

handle Handle: the part behind the body, of which the hand

catches hold; Tail : the part at the end of the handle.

tip

Filiform needles of 0.5-3.5 cun in length are commonly used in clinic.

Selection of the Patient’s Postures

Lying postures Lying in Supine posture Lateral recumbent Prone posture

Sitting postures Sitting in supine posture Sitting in flexion Sitting in lateral posture

Lying in supine posture

Suitable for the points on the head and face, chest, abdomen, and the upper and the lower limbs.

Lateral recumbent

Suitable for the points on the Shaoyang Meridian on the lateral side and the upper and lower limbs.

Prone posture

Suitable for the points on the back of the head and posterior torso.

Sitting in supine posture

Suitable for the points on the forehead, face

and anterior part of the neck.

Sitting in flexion

Suitable for the points

on the vertex, back of

the head, hind neck,

shoulders and back.

Sitting in lateral posture

Suitable for the

points on the

head, arms and

shoulders.

Selection of the Patient’s Postures

Moreover, posture in lying should be adopted as

far as possible to the new, nervous, aged or

asthenic patients, or to seriously ill persons, to

avoid fainting.

Sterilization

Sterilization refers to sterilization of

needles and other instruments practitioners’ fingers the area on which acupuncture is applied

Sterilization of instruments Autoclave sterilization Boiling sterilization Medicinal sterilization :Soak the needles in

75% alcohol for 1~2 hours.

Sterilization Disinfection of the practitioners’ fingers

--- should be cleaned with water and soap or with an alcohol cotton ball.

Disinfection of the area where acupuncture is performed

---should be cleaned with a 75% alcohol cotton ball

Needling Methods Needling Methods

Insertion

Fingernail pressing insertion Pinch needle insertion Pinch skin insertion Stretch skin insertion

Fingernail pressing insertion

Press the point with the nail of the thumb of the left hand.

Hold the needle with the right hand and keep the needle tip closely against the finger nail of the left hand.

insert the needle into the skin

This method is suitable for puncturing points with short needles, such as Jingming(BL1), Chengqi(ST1), etc.

Pinch needle insertion

Hold the needle body by

the thumb and index finger of the left hand with a dry sterilized cotton ball.

Fix the needle tip on the selected point.

Hold and rotate the needle handle with the right hand and insert the needle into the skin.

The method is suitable for puncturing points with long needles, such as Huantiao(GB30), Zhibian(BL54),etc.

Pinch skin insertion

Pinch the skin up around the point with the thumb and index finger of the left hand.

Hold the needle with the right hand, then insert the needle into the skin that is pinched up.

This method is suitable for puncturing points in areas where the muscle and skin are thin, such as Yintang(EX-HN3), Zanzhu(BL2),etc.

Stretch skin insertion

Stretch and tighten the skin where the point is located with the thumb and index finger of the left hand

hold the needle with the right hand and insert it into the point.

This method is suitable for the points where the skin is loose, such as Tianshu(ST25), Guanyuan(RN4),etc.

Angle and Depth of Insertion

Angle of InsertionGenerally, there are three kinds. Perpendicular Oblique Horizontal

Perpendicular

The needle is inserted

perpendicularly, forming an

angle of approximately

90°with the skin surface.

The method is suitable for

most points on the human

body.

Oblique

The needle is inserted obliquely

to form an angle of

approximately 45°with the skin

surface.

The method is used for the

points where the muscle is thin,

or where is vital organ

underlying the point, or deep

and perpendicular insertion is

not suitable.

Horizontal The needle is inserted

transversely to form an angle of

approximately 15°with the skin.

The method is suitable for the

points on thin skin or muscle, for

example, the points on the

head.

Depth of insertion

The depth of insertion refers to the length of the

needle body inserted into the skin.

The principle for depth of the insertion is the

following: constitution, age, pathological condition,

location of the point.

Manipulation and Arrival of Qi

(Needling Sensation)

Needle manipulation refers to the various

manipulations of the acupuncture needle to

assist the sensation of the arrival of qi

The arrival of qi refers to the reaction of

meridian qi that is produced after the needle is

inserted.

Reaction of meridian qi (Needling Sensation)

the practitioner will feel tenseness and a

dragging sensation around the needle;

the patient will feel soreness, numbness,

distention or heaviness around the point,

or a sensation traveling up and down the

meridian.

Reaction of meridian qi

manipulation techniques

The manipulation techniques, in general,

can be divided into two groups:

Primary manipulating techniques

Secondary manipulation techniques

Primary manipulating techniques

Lifting and thrusting

Twirling or rotating

Lifting and thrusting

This is a manipulation method

whereby the needle is

perpendicularly thrusted from

the superficial layer to the

deep layer, and lifted from the

deep layer to the superficial

layer in the point when the

needle is inserted to a certain

depth.

Twirling or rotating

This is a manipulation method

whereby the needle is held by the

thumb, index and middle finger of

the right hand and twirled or rotated

forward and backward continuously

when the needle is inserted to a

certain depth.

Secondary manipulation techniques

flicking scrapingTremblingPressingshaking

flicking flicking

trembling scraping

Reinforcing and Reducing Methods

The reinforcing method refers to the method

which is able to invigorate the body’s healthy qi

and to strengthen weak physiological function.

The reducing method refers to the method which

is able to eliminated the pathogenic factors and

to harmonize hyperactive physiological function.

Reinforcing and reducing

1) twirling and rotating the needle

2) lifting and thrusting the needle

3) rapid and slow insertion and withdrawal of the needle

4) the direction the tip of the needle pointing to

5) Breathing reinforcing and reducing

6) Open-close reinforcing and reducing

7) Even reinforcing and reducing movement

twirling and rotating the needle

Reinforcing: rotating the needle gently and

slowly with small amplitude and at a short

duration

reducing: rotating the needle strongly and

rapidly with large amplitude and at a long

duration

lifting and thrusting the needle

Reinforcing: thrusting the needle strongly and

lifting it gently with a small amplitude, low

frequency with a short duration of operation.

Reducing: thrusting the needle gently and

lifting it strongly with a large amplitude, high

frequency and a long duration of operation.

rapid and slow insertion and withdrawal of the needle

Reinforcing: slow insertion, low frequency of

rotation and rapid withdrawal of the needle

Reducing: rapid insertion, high frequency of

rotation and slow withdrawal of the needle

the direction the tip of the needle pointing to

Reinforcing: puncturing

a point following the

meridian course

Reducing: puncturing a

point against the

meridian course

Breathing reinforcing and reducing Reinforcing: inserting the needle when the patient

breathes out and withdrawing the needle when the patient breathes.

Reducing: is achieved in the opposite way

Exhalation InhalationInhalation Exhalation

Reinforcing Reducing

Open-close reinforcing and reducing

Reinforcing: after withdrawal

of the needle, pressing the

needle hole quickly to close

Reducing: shaking and

enlarging the hole and not

pressing the hole

immediately

Reinforcing Reducing

Even reinforcing and reducing movement

Lift, thrust and rotate

the needle evenly, then

withdraw the needle

Retaining and Withdrawal of the Needle

Retaining and Withdrawal of the Needle

Retaining

Retaining refers to keeping the needle in

place after it is inserted into a point to

strengthen and maintain the needling effect.

Withdrawing the Needle press the skin around the point with the thumb and

index finger of the left hand

rotate the needle gently and lift it slowly to the

subcutaneous level

withdraw it quickly and press the punctured point with

an alcohol cotton ball for short period to prevent

bleeding.

Management of Possible Accidents Fainting----nervous tension, fatigue,

hunger

Stuck Needle----strong contraction of the local

muscles

Bent Needle----forceful or too rapid

manipulation

Broken Needle----poor quality of the needle

Hematoma----injury of skin ,muscle or blood

vessles

Fainting

Manifestations: Sudden mental tiredness, dizziness and vertigo,

pallor, nausea and vomiting, profuse sweating, palpitation, or loss of consciousness.

Cause: This may be due to the patient’s delicate constitution, nervous

tension or fatigue, hunger.

Management: Stop needling immediately and withdraw all the

needles. Help the patient lie down and keep the body warm. In severe cases, press hard with a fingernail or needle Renzhong (DU26), Neiguan(PC6), Zusanli(ST36).

Stuck Needle

Manifestations: After the needle is inserted, it is difficult or impossible to rotate,

lift and thrust the needles; the patient feels intolerable pain if the needle is rotated, lifted and thrusted reluctantly.

Cause: Nervous tension of the patient, strong contraction of the local muscles

after the needle is inserted into the point; or improper manipulation causing the muscle tissues to bind around the needle body.

Management: If the needle is stuck due to a strong local muscular contraction,

retain the needle for a long period of time, or insert another needle nearby. If it is caused by rotation of the needle in one direction, rotate the needle in the opposite direction.

Bent Needle Manifestations: The direction and angle of the needle handle is

changed. It is difficult to lift, thrust, rotate or withdraw the needle. The patient feels pain..

Cause: Unskillful manipulation, forceful or too rapid manipulation; needle

striking hard tissue or organs; change of the patient’s posture after insertion.

Management: If it is slightly bent, the needle may be removed slowly. If

the needle is bent severely, the needle should be withdraw by follow the course of the bent. In the case of a bent needle being caused by the change of the patient’s posture, restore him/her to the original position. After the muscle around the needle is relaxed, remove the needle slowly.

Broken Needle Manifestations: The needle body is broken during manipulation or

after withdrawal of the needle. The broken part may be exposed above the skin or buried inside the body.

Cause: Poor quality of the needle, erosion of the needle root; too

strong lift and thrust or rotation of the needle.

Management: If the broken part exposes above the skin, remove it

with fingers or forceps. If the broken part is completely merged in the skin or deep in the muscles, surgery should be used after the location by X-ray.

Hematoma Manifestations: Swelling, distention and pain, bruising of skin follows in

the needling area after withdrawing the needle.

Cause: Injury of the skin and muscle or blood vessels during insertion.

Absence of pressure on the point after withdrawing the needle.

Management: A mild hematoma caused by a small subcutaneous

hemorrhage, in general, will disappear by itself. If local swelling and pain are severe, first apply a cold compress to the area of the hematoma to stop bleeding. Secondly apply a warm compress, or local pressing or light massage, to help disperse and absorb the local stasis of blood.

MoxibustionMoxibustion

Moxibustion

Moxibustion is a therapy in which

burning moxa is used to produce a

heat stimulation to human body.

The Classification of Moxibustion

Moxbustion with Moxa cones

Moxbustion with Moxa sticks

Moxbustion with Warming needle

Moxbustion with instruments

moxa cones

Moxibustion with moxa cones

Direct moxibustion----

place a moxa cone of

appropriate size directly

on the point and ignite

it.

Moxibustion with moxa cones

Indirect moxibustion ----the

ignited moxa is insulated

from the skin by a cake of

medicinal substance:

ginger insulation,

garlic insulation ,

salt insulation,

monkshood cake insulation

Moxibustion with Moxa Sticks

Mid-warm moxibustion----light

one end of a moxa stick and put it

over the point about 2-3 cun

away from the skin .

“Sparrow-pecking”moxibustion

----peck up and down rapidly over

the point like a sparrow pecking

rice

Moxibustion with Warming Needle

Moxibustion with warming

needle is a method of

acupuncture combined with

moxibustion.

The manipulation is as following:

After the arrival of qi, a moxa

stick of approx. 2cm in length or

moxa wool is fixed on the handle

of the needle and ignited.

Moxibustion with Instruments

Place some moxa wool into

a round moxibustion

instrument, ignite it and put

the cap on, and place it on

the required point or

affected area until the local

skin sets reddish.

Other therapies

Ear acupuncture therapy Three –edged needle therapy The cutaneous needle therapy Scalp acupuncture therapy Electric acupuncture therapy Point injection therapy

Three –edged needle

cutaneous needle

Distribution of auricular points

Key Points

Primary manipulating techniques Reinforcing and Reducing Methods