1. The Techniques Of Acupuncture and Moxibustion

2. Filiform Needle Manipulation

3. Preparations Prior to Acupuncture Treatment

4. 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.

5. 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.

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

7. 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

8. Lying in supine posture
Suitable for the points on the head and face, chest, abdomen, and the upper and the lower limbs.

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

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

11. Sitting in supine posture
Suitable for the points on the forehead, face and anterior part of the neck.

12. Sitting in flexion
Suitable for the points on the vertex, back of the head, hind neck, shoulders and back.

13. Sitting in lateral posture
Suitable for the points on the head, arms and shoulders.

14. 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.

15. Sterilization Sterilization refers to sterilization of
needles and other instruments
practitioners’ fingers
the area on which acupuncture is applied

16. Sterilization of instruments
Autoclave sterilization
Boiling sterilization
Medicinal sterilization :Soak the needles in 75% alcohol for 1~2 hours.

17. 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

18. Needling Methods

19. Insertion Fingernail pressing insertion Pinch needle insertion
Pinch skin insertion
Stretch skin insertion

20. 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.

21. 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.

22. 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.

23. 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.

24. Angle and Depth of Insertion

25. Angle of Insertion Generally, there are three kinds. Perpendicular
Oblique
Horizontal

26. 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.

27. 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.

28. 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.

29. 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.

30. 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.

31. 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.

32. Reaction of meridian qi

33. manipulation techniques
The manipulation techniques, in general, can be divided into two groups:
Primary manipulating techniques
Secondary manipulation techniques

34. Primary manipulating techniques
Lifting and thrusting
Twirling or rotating

35. 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.

36. 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.

37. Secondary manipulation techniques
flicking
scraping
Trembling
Pressing
shaking

38. flicking
flicking

39. trembling
scraping

40. 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.

41. 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

42. 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

43. 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.

44. 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

45. 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

46. 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

47. 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

48. Even reinforcing and reducing movement
Lift, thrust and rotate the needle evenly, then withdraw the needle

49. Retaining and Withdrawal of the Needle

50. Retaining
Retaining refers to keeping the needle in place after it is inserted into a point to strengthen and maintain the needling effect.

51. 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.

52. 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

53. 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).

54. 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.

55. 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.

56. 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.

57. 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.

58. Moxibustion

59. Moxibustion
Moxibustion is a therapy in which burning moxa is used to produce a heat stimulation to human body.

60. The Classification of Moxibustion
Moxbustion with Moxa cones
Moxbustion with Moxa sticks
Moxbustion with Warming needle
Moxbustion with instruments

61. moxa cones

62. Moxibustion with moxa cones
Direct moxibustion----place a moxa cone of appropriate size directly on the point and ignite it.

63. 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

64. 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

65. 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.

66. 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.

67. Other therapies Ear acupuncture therapy Three –edged needle therapy
The cutaneous needle therapy
Scalp acupuncture therapy
Electric acupuncture therapy
Point injection therapy

68. Three –edged needle

69. cutaneous needle

70. Distribution of auricular points

71. Key Points Primary manipulating techniques
Reinforcing and Reducing Methods