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 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.

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

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 Insertion Generally, 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 scraping Trembling Pressing shaking

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 Inhalation Exhalation Inhalation 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 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.

Moxibustion

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