Acupuncture and Moxibustion Techniques PDF

Chapter 5
Acupuncture and Moxibustion Techniques
5 1 Acupuncture Techniques of Filiform needle

T he filiform needle also know n as the tiny needle is the needle most com monly used in the
clinical setting Due to its minuteness and various skills and methods the acupuncture techniques
are exquisite and thus require excellent skills Acupuncture techniques form the foundation for
using other types of needles and therefore constitute the primary technical training in acupuncture
education L ing S hu J iu Zhen S hi E r Y uan says I w ant to dredge the meridians w ith a tiny
needle make the blood and qi flo w sm oothly and harm oniously and regulate the m ovement of qi
and blood along the meridians B iao You F u Lyrics of Standard Profundities says A m ong
the manipulating techniques included with the nine needles the ones associated w ith handling the
tiny needles are the m ost exquisite they interact w ith the seven stars in the sky and control all
the acupoints
5 1 1 Structure Specifications Inspection and Storage of Filiform Needles
5 1 1 1 Structure
A M aterial Filiform needles are made of metal A lthough the m odern filiform needle
m odels follo w the example of one of the nine needles in H uang D i N ei J ing there are great
differences bet w een them in material techniques and specifications N o w adays various materials
are used to make filifor m needles T hose made of stainless steel w hich accounts for its straight
and sm ooth shape high quality of strength and tenacity for midable resistance to high
temperature rustiness and chemicals are co m m only used in the clinical settin g filifor m
needles made of gold or silver have the advantage of heat conductivity as w ell as that of
electricity but they are not as cheap thin strong or tenacious as stainless steel needles
therefore they are only used for special treat ments N or mally steel copper and iron needles
are used even less clinically because of their poor flexibility tenacity elasticity and high
inclination to rust
B T he Structure of Filifor m Needles Filifor m needles are divided into five parts the tail
handle body root and the tipFig
Chapter Acupuncture and Moxibustion Techniques
Fig The Structure of Filiform Needles
417
Fig The Shape of Filiform Needles Handle
The tip zhen mang is the sharp point of the needle also known as the key part of the needle that
is punctured through the skin The body zhen ti is the main part between the tip and the handle it is
used to determine suitable depths into the acupoints The root connects the body and the handle which
is the external sign that indicates the depth of the body punctured and the range of lifting and
thrusting The handle the end of the needle from the root to the tail is usually wrapped in a helical
style with wire this is the place where the practitioner holds and manipulates the needle as well as
location for fixing moxa The tailend of the handle is also known as zhen ding it indicates the angle
of the needle following insertions and during manipulations
Filifor m needles based on the structure and shape of the handle and tail can be classified
as follo w s coiled needles w hich are w rapped by gilded silver or oxidated wire needles with
ornamental designs on the handles needles decorated with a coiling dragon on the handle
w hich is t w isted across like a coilingdragon by t w o w ires flatbodied needles w hich are flat at
their tails and tubed needles that have metal tubelike handles Flatbodied and tube needles
are mainly used with insertion tubesFig
5 1 1 2 Specifications of Filiform Needles
T he specifications of filifor m needle are distinguished by the diameter and length of the
body see the T able
and Table
Table 5 1 Length of Filiform Needles

Inch
Lengthmm
Table 5 2 Diameter of Filiform Needles

No
Diametermm
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Part
T wo Needling and Moxibustion Techniques
T he N o m mand inch m mfilifor m needles are the most
com monly ones used in the clinic Short filifor m needles are primarily used for shallo w needling
of body and auricular points long filifor m needles are mainly used for acupoints located on
thickly muscled body parts and for horizontal needling
5 1 1 3 The Inspection of Filiform Needles
T he quality of a filifor m needle can affect the treat ment during both insertions and
manipulation We should inspect the filifor m needle before treat ments so as to enhance the
effect relieve pain and avoid undesirable incidents
T he tip should be straight shiny and clean as sharp and smooth as a pine needle T hese
qualities decrease resistance during inser tions T he body should be straight smooth and
sym metrical as w ell as tenacious and flexible T he root should be solid and without rust or
scratches T he handle wire should be w rapped around the handle evenly tightly and
continuously the length and diameter of the handle should be suitable for holding and
manipulating
5 1 1 4 Storage
With the exception of onetime use disposable filifor m needles reusable needles should be
stored properly so as to avoid damage to the tip bending rust or contamination T hey are
usually kept in a needle box needle tube or needle clip Needles should be put in a container
that corresponds to their length after they have been w ashed and dried Needle bo xes and needle
clips should be padded and covered with gauze needle tubes should be plugged with dried
cot ton ball Needles and containers should be sterilized in an autoclave
5 1 2 Needling Practice
Besides maintaining S hen technical practice mainly involves building up good finger force
and developing skillful manipulations Finger force is the strength generated by the
practitioners hand w hen handling a needle Good finger force is the basis for good techniques
w hile skillful techniques are essential in treating diseases with needles Practitioners must
practice to develop good finger force and techniques frequently until they become adept after
w hich time they will be able to s wiftly insert a needle through the skin without causing pain
and easily withdraw it as w ell as freely manipulate it to produce reinforcing or reducing effects
Other wise they will have difficulty controlling the needle T he therapeutic effects will be
dramatically diminished if insertions cause obvious pain and needle manipulations feel
aw k w ard T herefore it is imperative that beginners put forth great effort to develop good finger
force and skillful manipulations
Needling PracticeT hree Steps
5 1 2 1 Finger Force Practice
Practicing with sheets of paper Fold a soft piece of paper into a small packet about cm
cm in size and cm thick then bind the packet with gauze H old the paper packet in one
hand and the needle handle in the other Rotate the needle in and out with the thumb index and
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middle finger of your needling hand applying enough pressure for the needle to penetrate the
paper then change to another point Repeat this practice until you feel it is easy to do
Practicing needling through sheets of paper is the basic process done to develop finger force as
w ell as to practice manipulations such as t wirling methodFig
Fig Practicing with Sheets of Paper
Fig Practicing with a Cotton Cushion
5 1 2 2 Manipulation Practice
Practicing w ith a Cotton Cushion M ake a cushion about cm in diameter by
w rapping a bunch of cotton w ith cotton thread and covering it w ith a piece of cloth A s the
cotton cushion is soft various stimulating techniques such as lifting and thrusting t w irling and
rotating as w ell as insertions and w ithdraw als can be practiced w ith it W hen practicing
thrusting handle the needle like handling a pen insert it into the cushion and make lifting and
th rustin g m ovement in the same place w ith appropriate and even depths the needle body
needs to be held perpendicularly A fter that lifting and th rustin g and t w irling and rotatin g
can be practiced sim ultaneously T ry to make the lifting and th rustin g even in depth w hen
going up and do w n and the t w irlin g and rotating at angles w hen going back and forth Be
sure the frequency is alw ays the same to achieve har m ony and facility during manipulations
Fig
5 1 2 3 Needling Practice on a Body
T his practice should be done only after you have developed good finger force and skillful
manipulations from practicing on paper packets and cushions T he goal is so to gain personal
experiences of finger force needling sensations and manipulations When practicing try to
obtain painless perpendicular smooth insertions with facile lifting thrusting t wirling and
rotations using even finger force and skillful manipulations Also carefully experience the
relationship bet w een finger force insertions and manipulations to obtain qi as w ell as the
sensations of the fingers holding the needle the fingers of the pressing hand and the parts of the
body being needled
5 1 3 Preparation
5 1 3 1 Selection of the Filiform Needle
Selecting the Filifor m Needle of Suitable Material and Specifications N o w adays stainless
steel filifor m needles are widely used Before using the quality of the needle should be given
close attention to avoid unnecessary pain and accidents
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Part
T he filifor m needle specifications are based on sex age physique constitution the nature
of disease the interior or exterior location of the disease and the location of the acupoints T he
selection of an appropriate needle is not something to be taken lightly L ing S hu Guan Zhen
says that each of the nine needles long short lar ge or small has its specific usage For
example w e use longer and larger filifor m needles on male patients w ho are strong fat and
female patient w hose disease is much deeper A s far as selecting filifor m needles according to
the location of the acupoints longer thicker filifor m needles are usually used on thickly
muscled areas or places that require deep needling not on thin muscles or areas requiring
shallo w needling T he suitable filifor m needles length usually equals the depth that the
acupoint should be punctured plus cun the amount that should be visible above the skin
For example one should use a cun filifor m needle to puncture an acupoint a depth of
cun and a cun filifor m needle to puncture an acupoint a depth of cun In
conclusion it is necessary to select filifor m needles of suitable specifications to assure the

desired needling sensations and therapeutic effects
5 1 3 2 Disinfection
Strict aseptic technique must be faithfully observed throughout every treat ment to avoid
unnecessary incidents T he follo w ing things should be disinfected before doing acupuncture the
medical treat ment room needling appliances both hands of the practitioner and the patients
skin over selected acupoin ts In addition to that it is advisable to use onetime only
disposable filifor m needles for so me diseases and to assign a separate set of needles for each
patient
A Disinfection of Needling Appliances An Introduction to Common Methods of Disinfection
a A utoclave Sterilization Needles should be sterilized in an autoclave at kgcm
and for minutes to satisfy the requirements for sterilization
b Chemical Disinfection Needles should be placed into a solution of alcohol for
minutes after w hich time they should be taken out and w iped off w ith a sterile to w el or
sterile cotton ball before using Needles may also be put into a disinfectant such as Pasteurs
solutiondisinfector and processed according to the instructions on the manufacturers label

Appliances w hich come into direct contact w ith the filifor m needles such as needle trays tubes
boxes and t w eezers should be soaked in the glutaraldehyde for minutes Disinfected
needles should be put in disinfected needle trays and covered with a sterile to w el or sterile
gauze
c Boiling Needles and other instruments can be boiled in w ater for min H o w ever
it should be noted that boiling can blunt the sharp metal appliances Adding Sodium
Bicarbonate can raise the boiling point to and prevent corrosion
B Finger Disinfection Practitioners should w ash and brush their hands and fingernails
with soap and w ater before treat ments follo w ed by rubbing their hands with a cotton ball
soaked in a solution of alcohol after their hands have dried During the treat ment the
practitioner should avoid touching the body of filifor m needle directly with their fingers if some
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manipulations require direct contact a dry disinfected cotton ball should be used for
insulation
C Skin Disinfection T he skin to be needled should be w iped with a cot ton ball soaked in a
solution of alcohol or it can be wiped w ith a tincture of iodine w hich should then be
removed after a few minutes with a cotton ball soaked in a solution of alcohol When
wiping the skin one should start from the center of the skin and continue w orking out w ard
using circular motions Care should be taken to keep the disinfected areas clean and to avoid re
contamination
D Disinfection of the M edical T reat ment Room Disinfection of the medical treat ment
room includes the sheets pillo w cases blankets bolsterscushions etc those items should also
be changed and w ashed regularly It is better to use sanitized disposable sheets pillo w cases
and to w els T he medical treat ment room should also be cleaned and disinfected regularly A
filtration system can be used to clean and recirculate the air in the room
5 1 3 3 Postural Alignment and Positioning
Proper positioning of the patient is an important consideration to facilitate the accurate
location of acupoints facilitate needle insertions and manipulations increase patient comfort
during and after needling and to minimize the incidence of fainting and bentbroken needles
T he t w o primary positions most com monly used in the clinic are prone and seated
A S upine P osition aka BackL yin g T his position is suitable fo r gainin g easy access t o
the acup oin ts o n the head face chest abdo m en and so m e acupoin ts on all fou r ex trem ities
Fig
Fig Supine Position aka BackLying
B Lateral Recumbent aka SideLying T his position is suitable for accessing the acupoints
on the lateral side of the body and some acupoints on the ex tremitiesFig
Fig Lateral Recumbent aka SideLying
C Prone Posture aka BellyLying T his position is suitable w hen needling the acupoints on
the head nape uppermiddle and lumbar region of the back parasacral area buttocks the
posterior aspects of the lo w er ex tremities and some acupoints on the upper ex tremities
Fig
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Part
Fig Prone Posture aka BellyLying
D Seated in the U pright Position with the Back Leaning A gainst a Chair T his position is
suitable for accessing the acupoints on the forehead face and neckFig
Fig Seated in the Upright Position with the

Back Leaning against a Chair
Fig SideProne Sitting
E SideP rone Sitting Seated U prigh t w ith the H ead Resting to the Side on O ne
A r m T his position is suitable for accessing the acupoints on the lateral head cheeks and
ears Fig
F ProneT orso Sit ting Seated with the Back to w ards the Practitioner T his position is
suitable for accessing the acupoints on the occiput nape and backFig
In addition to the positions discussed above doctors can select different postures
positions to needle specific acupoints W hen preparing
point prescriptions basically one sh ould try their best
to select the acupoints w hich can be punctured w ithout
repositioning the patient Patient positioning should be
done w ith the patients condition in mind w henever it is
necessary to chan ge the position during the same

treat men t
To avoid fatigue or fainting during acupuncture one
should consider selecting the lying position as much as
possible for patients receiving their first treatment or for
those who are nervous old weak or seriously ill Patients
should be instructed to avoid moving or suddenly changing
positions after the needles have been inserted to maximize

the effectiveness of the treatment and minimize the incidence
Fig
ProneT orso Sitting
of bending or breaking the needles
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5 1 4 Acupuncture Techniques
Needle manipulations usually involve the use of both hands w orking in concert with each
other N an J ing Qi Shi Ba N an says T hose w ho kno w a lot about acupuncture believe in
their left hands w hile the ones w ho do not believe only in their right hands B iao You Fu
explains Press heavily with the left hand several times so as to let the qi disperse insert
slo w ly and lightly with the right hand so as to cause no pain T he coordinated movements of
both hands together are of great importance to insure successful manipulations as w ell as to
mitigate disco mfort and enhance the effects so much at tention should be paid
T he hand holding the needle is generally kno w n as the puncturing needling hand w hile
the hand that assists or presses the body part to be punctured is the pressing palpating hand
T he puncturing needling hand mainly holds the handle of
a needle w ith the thumb index finger and the middle

finger like handling a pen Fig
this hand
is
to
hold
the
T he function of
needle
and
to
perfor m
manipulations During insertions the puncturing hand
generates focused force on the tip of the needle to make it
penetrate the skin During manipulations it t w irls and

rotates lifts
and
thrusts plucks
and
vibrates
and
w ithdraw s the needle By contrast the function of the
pressing palpating hand is to fix the location of a point
Fig
The hand holding

the needle
and to grip the needle body to help the punctureneedling hand insert the needle It can support
the body of the needle keep it straight and focus the strength directly to the tip of the needle
resulting in a good insertion less pain w hile facilitating the regulation and control of the
needling sensations
5 1 4 1 Insertions
T here are various w ays of doing an insertion Generally they are classified into single
handed insertions doublehanded insertions and tube insertions depending on ho w the
puncturing and pressing hands are used
A SingleHanded Insertions T his method mainly applies to the insertion of short needles
T he body of the needle is grasped with the thumb and
index finger with the pad of the middle finger
approximately supporting the middle of the needle

body While pushing do w n with the thumb and index
finger the middle finger is flexed as you insert the
needle to the appropriate depth Fig

Fig SingleHanded Insertions
Since
this method only involves the use of three fingers it
is especially applicable for doing insertions into t w o
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Part
points simultaneously It is done with the thumb and index finger grasping the needle body
using the tip of middle finger as a prop on the point the tip of the needle is then quickly
inserted into the point T he middle finger is removed fro m the point as soon as the needle is
inserted then the fingers are free to do manipulations as needed

B DoubleHanded Insertions
a Fingernailpressing needle insertion Press the acupuncture point w ith the thumbnail or
the index finger of the pressingpalpatinghand H old the needle with the puncturingneedling
hand and keep the needle tip closely against the border of the nail of the pressing handFig
T his method is suitable for puncturing with short needles
Fig Fingernailpressing needle insertion
Fig Handholding needle insertion
b Handholding needle insertion H old a dry sterile cot ton ball around the needle tip
with the thumb and index finger of the pressingpalpatinghand and fix the needle tip directly
over the selected point T wirl the needle handle with the puncturingneedlinghand and insert it
into the point T his method is suitable for puncturing with long needlesFig
T he stick method is also in clinical use H old a dry
sterile cotton ball around the needle tip w ith the thumb and
index finger of one hand allo w the needle tip to ex tend out
beyond the finger tips f en at length Guide the needle

over the selected point and insert the needle sw iftly Fig
c Skinspreading needle insertion Put the thumb and
index fingers of the pressing palpating hand on the skin

w here the point is located and separate the t w o fingers to
tautly stretch the skin H old the needle with the puncturing
needlinghand and insert the needle into the point through

the space bet w een the t w o fingers Fig
T his
Fig Stick method
method is suitable for needling acupoints on areas w here the skin is loose
d Pinching insertion method Pinch the skin up around the point with the thumb and index
fingers of the pressingpalpatinghand H old the needle with the puncturingneedlinghand and
insert the needle into the point in pinched skin Fig
T his method is suitable for
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Fig Skinspreading needle insertion
puncturingneedling acupoints on areas w here the muscle and skin is thin such as YintangEX
H N
Fig Pinching insertion method
Fig Needle in tube insertions
T he methods listed above should be adopted in the clinical setting according to the
anatomical features of the areas w here the acupoints are located as w ell as needling depth and
manipulation requirements so as to facilitate smooth painless insertions
C Needle in T ube Insertions Put the needle into a glass plastic or metal tube note the
tube should be shorter than the needle by about f en in lengthand put them on the skin w here
the point is located Press the tube with the pressing palpating hand tap the needles tail
s wiftly with index finger of the puncturing needling hand to insert the tip of needle into the
skin Remove the tube over the needle and insert the needle into the point to the appropriate
depthFig
T his method causes less pain so it is often used w hen treating children and
those w ho are afraid of needlesneedlephobic
5 1 4 2 Angles Directions and Depths of Insertion
During the process of insertion angle direction and depth are especially important in
acupuncture Correct angles directions and depths help to induce needling sensations bring
about the desired therapeutic results and guarantee safety Accurate point locations not only
refer to correct locations on the body surface but also to integrating the proper angle direction
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Part
and depth Only then w ill the intended effect of acupuncture be w ell exerted Clinically using
different angles directions or depths of insertions even on the same points w ill lead to
needling sensations that have obviously different intensities transmission directions and
therapeutic effects T he angles directions and depths of insertions are decided accordin g to
specific acupoint locations the physical condition of a patient the nature of an illness and
needling manipulations
A A ngles of Insertion T he angle of insertion refers to the one for med by the needle and
the surface of the skin as the needle is
inserted Fig
It is decided in
consideration of both the location of the
point and the doctors purpose Generally

there are three options
a Perpendicular Insertion The needle
is inserted perpendicularly forming a

angle with the surface of the skin Most
points on the body can be needled in this

way
Fig Angles of insertion
b Oblique Insertion T he needle is inserted obliquely to form an angle of approximately
w ith the skins surface T his is suitable for acupoints w here there isnt much underlying
tissue w here internal organs are close to the surface of the body or w here perpendicular or deep
insertions are inadvisable
c H orizontal Inser tion T ransverse or subcutaneous insertion T he needle is inserted
h orizontally to for m a or even smaller an gle w ith the skin T his meth od is suitable for
points w here there is little underlying tissue andor bone for instance the points on the head
B Direction of Insertion T he direction of insertion refers to the direction of the needle tip
during acupuncture Generally it is decided according to the direction in w hich the meridians
and blood vessels flo w the location of a point and the desired therapeutic requirements of an
illness
a In Accordance w ith the M eridian Flo w By virtue of the direction of the needle tip
needling a point by going in the direction of the nor mal flo w of the course of its meridian or
against its meridian course w ill yield reinforcing or reducing effects
b In Accordance w ith the Location of the Acupoint Deciding the direction of insertions
according to the location of acupoints ensures safety w hen needling F or instance the needle
should be inserted slo w ly w ith the tip pointing in the direction of the mandible w hen
puncturing Y am en G V h o w ever to w ards the spinal colu m n w hen puncturing acupoints

on the back
c According to the therapeutic requirements of a disease In order to make the needling
sensation transmit to the diseased region or to promote the movement of the meridian qi to
reach the diseased area so as to achieve a better therapeutic effect the direction the needle tip
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is pointed in can be adjusted to correspond to the affected area and the related qimoving and
qihastening manipulations can be done at the same time For example w hen t reating nose
diseases with needles insertingyamen G V the needle tip should point to the root of the
nose
C Depth of Insertion Depth of Inser tion refers to ho w deep the needle body is pushed into
the skin Generally each acupoint has its definitive needling depthsee Acupoints Clinically
the depth of insertion is also deter mined by the constitution of the patient their pathological
condition and the location of the points
a A ge Elderly patients often suffer from qi and blood deficiencies and infants have
delicate constitutions deep insertions are inadvisable w here they are concerned H o w ever
young and middleaged patients are usually ablebodied therefore appropriate deep insertions
may be practiced on them
b T he Location of the Points Points on the head and face chest and belly and areas
w here the skin and muscles are thin should be punctured superficially w hile deep insertions are
appropriate for points on the four ex tremities the abdomen and thick bulky areas
c T he Constitution of the Patient Relatively shallo w insertions should be done on lean
andor w eak patients and deep insertions on strong robust patients
d T he Pathological Condition Yang syndromes and acute diseases should be treated with
shallo w insertions w hile Y in syndro mes and chronic illnesses with deep insertions
T he angle of insertion relates closely to the depth of insertion Generally speaking deep
insertions often go w ith perpendicular insertions w hile shallo w insertions go hand in hand w ith
oblique or horizontal insertions T he an gle and dep th of inser tion m ust be w ell mastered w hen
needling points such as T iantu C V F eng f u G V and Y amen G V and points on
the areas around the eyes on the back and points close to internal organs T he depth of the
insertion is also influenced by seasonal factors T herefore w e should think it m uch

m ore
5 1 5 Manipulations and the Arrival of Qi Needling Sensation
5 1 5 1 Manipulation Techniques
Manipulations also kno w n as needling transmissions are maneuvers done follo wing
insertions designed to produce needling sensations regulate the intensity of needling
sensations or to transmit needling sensations in specific directions Generally manipulation

techniques can be divided into t w o categories Fundamental and A uxiliary
A T he Fundamental M anipulation T echniques T he fundamental manipulations refer to
the basic maneuvers done in acupuncture that involve the technique of lifting and th rustin g
and the technique of t w irlin g and rotating both of w hich are co m m only used in the clinical
set tin g T hese t w o basic techniques can either be used separately or in conjunction w ith each
other
a Lifting and T hrusting T his is a method w hereby the needle body is lifted and thrusted
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Part
perpendicularly into the point after the needle has been inserted to a certain depth T hrusting
involves inserting the needle from the superficial layer do w n to the deep layer By contrast
lifting involves withdraw al of the needle from the deep layer up to the superficial layer
Essentially the lifting and thrusting technique incorporates the action of moving the needle up
and do w n alternately and repeatedlyFig
Fig Lifting and thrusting
Fig T wirling and rotating
T he ex tent of moving up and do w n changes within the levels of tissue beneath the skin
frequency and time of this manipulation should be deter mined according to the constitution of
the patient the pathological condition the location of the points and the intended purpose for
acupuncture Finger force should be even during this manipulation T he extent of movement up
and do w n should be moderate about f en in depth the frequency should also be moderate
at about times per minute Care should be taken to keep the needle straight to avoid
changing its angle and direction Generally large fast movements lead to heavy stimulation
w hile contrarily small short ones result in to light stimulation
b T wirling and Rotating T his is a method that involves t wirling or rotating the needle
body continuously back w ard and for w ard after it has reached its desired depth in other w ords
the t wirling and rotating technique involves moving the needle back and forth alternately and
repeatedlyFig T he amplitude frequency and duration of these manipulations depend on
the constitution of the patient the pathological condition the location of the points and the
intended purpose for doing acupuncture Finger force should be even during this manipulation
and the amplitude should be moderate at about T wirling should not be done in only
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one direction to avoid getting the needle stuck as a result of tissue entanglement Generally
large angles and high frequencies lead to strong stimulation w hile small angles and lo w
frequencies yield gentle stimulation
B A uxiliary T echniques T he auxiliary techniques are supplements to the fundamental
ones for the purpose of promoting the arrival and movement of meridian qi and enhancing
needling sensation T he ones that are com monly used in the clinical setting are as follo w s
a Pressing Pressing involves pushing and sliding along the path w ay of a meridian w hile
lightly press the skin up and do w n along the course of the meridian w ith the fingers Fig
Zhen J iu D a Cheng points out Whenever the meridian qi does not arrival after insertion
press the skin up and do w n along the course of the meridian with fingers to make the qi and
blood flo w smoothly By doing so consequentially the meridian qi will arrive and bring about
heavy and tight sensations that can be felt by the doctor in the fingers holding the needle So
this method is employed to invigorate the qi and thereby promote the circulation of qi and
blood by means of mechanical pushing M oreover pressing will accelerate the movement of the
qi through the meridian after it has arrived
Fig Pressing
Fig Plucking
b Plucking T his technique involves plucking the needles tail or handle slightly with the
fingers causing it to gently vibrate Fig
It strengthens the needling sensation and
facilitates the movement of meridian qi Zhen J iu W en D ui says If the meridian qi does not
move pluck the needle slightly and hasten the movement of the meridian qi T hat is to say
plucking has the function of stimulating and invigorating qi
c Scraping A fter the needle has been inserted to a specific depth support the tail of the
needle with the pads of the index finger and thumb w hile scraping the handle of the needle
frequently fro m top to botto m up and do w n w ith the nail of the thumb index finger or middle
finger Fig
If the needle sensation does not arrive it can be stimulated using this
technique if the needle sensation has already arrived it will transmit and diffuse it with more
intensity
d Shaking A fter the needle has been inserted to a specific depth hold the handle and
shake it gentlyFig
T here are t w o w ays of shaking One is to shake the needle w ith it
standing up straight to intensify the needling sensation or shake the needle during withdraw al
to enlar ge the opening as a means of facilitating the dispersal of pathological qi T he other
option is to shake the needle w hile its lying obliquely or transversely so as to transmit the
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Part
Fig Scraping
needle sensation in a specific direction
e Flying Grasp the needle handle bet w een thumb and index finger and t wirl it slightly
several times Nex t release the thumb and index finger w hile
t wirling Repeat this action several times T his method is
ter med flyin g because the t w o fingers separate fro m the
needle just like bird spreading its w in gs and flying Fig
Y i X ue R u M en Elementary C ourse for M edicine
says Flyin g is the separation of the thu m b and index finger
fro m the needle w hile continuing to t w irling just like
vibratin g the hand T his method has the function of
stim ulating and invigoratin g the qi as w ell as enhancin g the

needle sensation
f T rembling A fter the needle has been inserted to a
certain depth hold the needle with the fingers of the right
Fig Shaking
hand and apply quick lifting and thrusting or t w irling and rotating movements in small
amplitudes to create gentle vibrationsFig T his promotes the arrival of qi or intensifies

the needling sensation
Fig Flying
that
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Lifting and thrusting and t wirling and rotating are fundamental manipulation techniques
are
supplemented
techniques in accordance
with
corresponding
auxiliary
with clinical situations For
example scraping and plucking can be applied to acupoints

w here t wirling with large angles is inadvisable Flying is
suitable for needling points on areas w here the muscles
tissues are thick or dense Shaking and trembling can be

adopted w hen needling points on areas w here the skin and
underlying tissue is
thin Fundamental and auxiliary
techniques are primarily employed to promote the arrival of

meridian qi and to intensify the needling sensation
Fig T rembling
5 1 5 2 The Arrival of Qi
T he arrival of qi kno w n in ancient times as qi z hi and recently ter med needling
sensation refers to the responses produced in the meridian qi after a needle has been inserted
into an acupoint to a certain depth and then manipulated T here are t w o w ays of deter mining
w hether the qi has arrived or not judging by the reaction of the patient and judging by the
feelings transmitted through the needle to the puncturing needling hand of the practitioner
When the qi arrives the patient will have one or more of the follo wing sensations around the
point of insertion soreness distension numbness or heaviness So metimes they may feel
w ar mth coolness itching tingling t witching or craw ling sensations T hese feelings may radiate
in a specific direction or to a specific place a phenomenon w hich is kno w n as meridian
transmission another sign of the arrival of qi Some patients might even feel a vibration or thrill
along the meridian path w ay or in some cases develop a rash along the meridian One might even
witness the phenomenon of the appearance of a red and w hite line follo wing the meridian path
A s the patient beco mes aw are of the sensation the practitioner may also feel a tension or
dragging sensation around the needle or the needle might begin to shake Sometimes the patient
will have no corresponding feeling or reaction and you might feel an emptiness or loose
slippery sensation around the needle Dou Hanqing stated in B iao You Fu if you feel a loose
slo w slippery sensation around the needle qi has not yet arrived if you feel a tight sinking
taut sensation around the needle qi has arrived w hen qi arrives you feel like a fish has
s w allo w ed your bait or else you just feel as still as standing by a lake T his is a vivid
description of the arrival of qi
Whether the arrival of qi can be obtained or not and the speed at w hich it occurs directly
influences the therapeutic effect of acupuncture it is also the basis for deter mining the patients
prognosis L ing S hu J iu z hen S hi E r Yuan says T he key to acupunctures therapeutic effect
is the arrival of qi J in Zhen Fu T he Golden Needle Odesays T he rapid arrival of qi suggests
good effects during a treat ment the slo w arrival of qi is an indication of retarded effects in a
treat ment T he t w o texts quoted above emphasize that the key to acupuncture is associated
with the arrival of qi U sually the faster qi arrives the bet ter the therapeutic effect will be if qi
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does not arrive it is possible that there will be no beneficial effect T herefore if the qi does not
arrive in your clinical practice you must analyze and discover the reason s w hether
inaccurately acupoint location improper needle manipulation or incorrect angles andor
needling depths may be at the root of the problem Once any of these problems has been
rectified the qi will usually be obtained If not you may w ait for the qi or accelerate the flo w of
qi
It must be pointed out that w e should not overly pursue stimulating the arrival of qi
because the strength of the arrival of qi differs from patient to patient and disease to disease
With the enervated w e ought to let qi arrive gently w ith the vital w e ought to let it arrive
strongly as such bi syndrome should be treated w ith strong needling sensations w hile only
mild needle sensations are necessary t o treat facial spasms
5 1 5 3 Waiting for Qi Arrival Promoting Qi Arrival Maintaining Needle Sensations and
Activating Qi Flow
A Waiting for the Arrival of Qi Zhen J iu Da Chen says Waiting for qi arrival is a priority
in all techniques of acupuncture Waiting for qi arrival means that w hen the qi does not arrive
w hen needling one should allo w the needle to stay in the acupoint for a longer period of time
you can also manipulate it at intervals to w ait for the arrival of qi T he for mer method is called
quietly w aiting for qi the latter is called actively w aiting for qi Be patient w hen retaining the
needle and w aiting for qi and do not hurry
B Pro moting the A rrival of Qi T his involves accelerating the arrival of qi by using various
types of manipulation S hen Ying J ing T he Classic of Shen Y ing says H old the needle with
the puncturingneedlinghands thumb and index finger slightly shake lift and thrust or rotate
the needle so that it trembles T his is called pro moting the arrival of qi M oreover scratching
the handle vibrating and shaking the body or pressing and kneading can also promoting the
arrival of qi
C Maintaining the Needling Sensation T his method is designed to maintain and promote
the arrival of qi Once the qi has been obtained and the patient is co mfortable the practitioner
should use so me supplementary techniques to maintain the needling sensations In chapter of
Su W en it says M aintain the meridian qi w hen it has arrived L ing Shu X iao Zhen J ie
S p i ritual Pivot T he E xplanation of the S mall Needle says Conserving the needle qi can
help conserve the vital qi Maintain the qi carefully and do not lose the qi w hen it has arrived
A s long as you maintain qi around the needle you can apply different techniques and regulate
the qi
D Activating or Stimulating the Flo w of Qi T his method accelerates the transmission of
needling sensations along the meridians to reach the affected site by utilizing corresponding
techniques Pressing vibrating scraping shaking and t wisting all have certain effects related to
activating the flo w of qi Our clinical observations demonstrate that needling sensations
generated on the affected site for certain distances and in specific directions can enhance the
therapeutic effects
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5 1 6 The Reinforcing Tonification and Reducing Dispersal Methods of

Acupuncture
L ing S hu J ing M ai points out that Deficiency syndromes should be reinforced
tonified w hile excessive syndro mes should be reduced dispersed T his established the
principle of tonifying deficiencies and reducing excesses w hen perfor ming acupuncture
manipulations L ing S hu J iu Zhen S hi E r Y uan points out that T he nine needles are m ost
effective in regulating deficiencies and excesses Just by using the needles to reinforce or
reduce T he pathological mechanism of disease progression and development is due to hyper
activity or hypoactivity in the viscera the meridians and collaterals y in and yang and qi and
blood caused by various diseases T he reinforcing and reducing methods of acupuncture is
intended to stim ulate acupoints w hile adopting feasible manipulations in order to restore the
normal functions of the viscera supplements the right z heng qi to balance y in and yang by
regulating the meridian qi that helps strengthening the w eakened physiological function and
eliminates pathogenic factors T herefore reinforcing and reducing in acupuncture is of great
importance in treating diseases w ith acupuncture and is one of the essential parts of acupuncture
techniques
Since the reinforcing and reducing methods of acupuncture were created and sum marized
by various doctors from past dynasties some of the ones most co mmonly used in the clinical
set ting are introduced as follo w s
5 1 6 1 Single Methods
A Basic Reinforcing and Reducing M ethods
a T wirling and Rotating N ian Zhuan A fter the needle has been inserted to a given
depth and the qi has arrived rotate the needle slo w ly and gently with small amplitudes for a
relatively short duration When manipulating rotate the needle relatively more forcefully with
the thumb moving for w ard the index finger moving back w ard and the finger strength directed
do w n w ard T his is called reinforcing Conversely reduction is done by rotating the needle
strongly and rapidly w ith large amplitudes for a relatively long duration When turning
back w ard rotate the needle relatively more forcefully w ith the thumb moving back w ard the
index finger moving for w ard and the finger force directed upw ard
b Lifting and T hrusting T i Cha Follo wing the insertion of a needle to a given depth
and after obtaining the needling sensation reinforcing is achieved by lifting the needle slo w ly
and gently w hile thrusting the needle rapidly and st rongly Reducing is achieved by lifting the
needle rapidly and forcefully w hile thrusting the needle slo w ly and gently Comparatively
speaking reinforcing takes less time than reducing
B O ther Reinforcing and Reducing M ethods
a Rapid and Slo w Insertions and Withdraw als X u J i T his method of reinforcing and
reducing is distinguished by the speed of insertion and w ithdraw al of the needle During
manipulations reinforcement is achieved by inserting the needle superficially and pushing it
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Part
slo w ly do w n to a certain depth as soon as the qi arrives from L ing Shu J iu Zhen S hi E r
Yuan then lifting it rapidly to the layer just beneath the skin It s like sticking your hand in
hot w ater and quickly withdra wing it Reduction is perfor med by inserting the needle rapidly to
a deep position then lifting it slo w ly to the layer just beneath the skin from L ing S hu J iu
Zhen S hi E r Yuan T his is like lingering around and being reluctant to go
b Directing the Needle Tip Ying S ui Pointing the tip of the needle during an insertion
in the same direction of the nor mal flo w or course of the meridian path w ay is kno w n as
reinforcing Conversely w hen the needle tip is pointing in the opposite direction going against
the nor mal course of the meridian path w ay it is considered reducing T his method should
coincide with other reinforcing and reducing methods
c BreathingRespirations H u X i With this method reinforcing is achieved by inserting
the needle w hen the patient breathes in and withdrawing the needle w hen the patient breathes
out T he reducing is achieved in an opposite w ay T his method should also coincide with other
reinforcing and reducing methods
d OpenClose M ethod K ai H e Covering and pressing the needle hole to quickly close it
upon withdraw al is called reinforcing shaking the needle to enlarge the hole prior to
withdra wing it and not covering and pressing the hole is kno w n as reducing T his method
should coincide w ith other reinforcing and reducing methods
e Even Method P ing B u P ing X ie W hen the needle is inserted into the point and the
needle sensation is achieved lift thrust and rotate the needle evenly then withdra w the needle
T his method is suitable for treating inconspicuously deficient or excessive syndromes or
syndromes with both deficiency and excess
5 1 6 2 Comprehensive Reinforcing and Reducing Methods
A Setting the M ountain On Fire S hao Shan H uo Divide the needling depth into three
equal portions the upper heaven middle human and lo w er earth A fter the
needle has been inserted push it to the upperheaven portion employ the reinforcing method by
lifting and thrusting or t wirling and rotating after the qi arrives then strongly insert the needle
to the middlehumanportion using the reinforcing method by lifting and thrusting or t wirling
and rotating after the qi arrives finally strongly insert the needle to the earth por tion use the
reinforcing method by lifting and thrusting or t wirling and rotating after the qi arrives
follo wing that lift the needle slo w ly back to the middle human portion and one operation is
finished Repeat the abovementioned process times and thrust the needle to the lo w er
earthportion and retain it there T his process can be done in conjunction with reinforcing by
means of respiration and by covering and pressing the hole upon the withdraw al of the needle
T his method is suitable for treating paralysis and numbness due to cold syndromes and Yang
deficiency
B PenetratingHeavens Coolness T ou T ian L iang Divide the puncturing depth into
three equal portions the upper heaven middle human and lo w er earth seg ments A fter the
needle has been inserted push it directly do w n to the lo w er earth portion use the reducing
435
method by lifting and thrusting or t wirling and rotating after the qi arrives Next strongly lift
the needle to the middlehuman portion employ the reducing method by lifting and thrusting
or t wirling and rotating after the qi arrives Finally strongly lift the needle to the upper
heaven portion adopt the reducing method by lifting and thrusting or t wirling and rotating
after the qi arrives Follo w ing that insert the needle slo w ly back to the earth portion and one
operation is finished Repeat the process mentioned above times and lift the needle to the
upperheaven portion and retain it there Reducing by means of respiration and by the open
methodnot covering and pressing the holecan be done in conjunction w ith this process T his
method is suitable for treating excessive heat syndromes like paralysis and numbness caused by
heat and acute carbuncles
5 1 6 3 Factors that can Influence the Therapeutic Effects of Reinforcing and Reducing
Accurate differentiation and proper manipulations are the basic principles that will
guarantee getting the desired effects from reinforcing and reducing While the condition of the
body accurate location of the acupoints and reasonable application of needle appliances and
manipulation are all closely related to achieving the desired results careful at tention should be
paid to manipulations
A Physical and Mental Status T he mental and physical conditions of the doctor and
patient and the struggle bet w een the vital qi and evil pathogenic factors are significant and will
influence the therapeutic effects of reinforcing and reducing
Maintaining the Shen spiritis indispensable during manipulations the practitioner needs
to be able to feel the needling sensation have a good sense of timing modify the mental status
of the patient and establish clear effective com munication with the patient Essentially
carefully monitoring the mental status of both practitioner and patient can enhance the
therapeutic effect involved with reinforcing and reducing
One can regulate the different therapeutic effects of acupuncture by using the reinforcing
or reducing method according to the patients pathologic condition When the body is w eak and
deficient acupuncture can strengthen the right z heng qi on the other hand w hen there are
exuberant pathogens such as with excess heat acupuncture can clear heat dredge the
obstruction expel pathogens and reduce the excess In the case of cramps due to gastrointestinal
hyperactivity acupuncture can alleviate the cramps and pain by reinforcing the function of the
digestive tract If the peristaltic action of the patients intestines is retarded acupuncture can
promote peristalsis and digestive function eliminate abdominal distension and increase the
appetite A great deal of practical experience confir ms that the condition of the body has a
strong relationship to the therapeutic effect of reinforcing or reducing
B T he Relative Specificity of Acupoints T he indications of acupoints not only have
universality but also relative specificity Relative specificity is also kno w n as the points
properties Some acupoints such as Guany uan C V Qihai C V M ingmen G V

GaohuangBL and Zusanli S T can invigorate the right z heng qi and strengthen the
body making them suitable to treat deficiency syndromes Some other acupoints such as
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Ren z hongG V W ei z hongBL S hi er j ingthe Well points and S hi x uanEXU E
dispel pathogens and restrain hyperactive functioning in the body therefore they are good for
patients w ith conditions associated with pathogenic excesses When practitioners manipulate
needles using the reinforcing and reducing technique the therapeutic effects of acupuncture will
be elevated w hen it is combined with the relative specificity of acupoints Besides it is noted
that the combination of pointspoint prescriptionalso has an influence on the effect
C Needles and the Force of Manipulation Needles can also influence the therapeutic effect
of acupuncture in many w ays such as the material the specifications and so on Whether the
manipulation is correct or not directly influences the therapeutic effects of acupuncture
adequate attention should be given to each
5 1 7 The Retention and Withdrawal of Needles
5 1 7 1 Needle Retention
T he purpose of retaining the needles in the acupoints is to strengthen the effect by

prolonging the needling sensation and facilitate further manipulation In general the reinforcing
or reducing method is applied after obtaining the needle sensation then the needles are
withdra w n or retained for to minutes after they have been inserted and manipulated
When treating certain diseases such as acute abdominal pain cold sy mptoms persistent pain or
spastic cases retention time may be prolonged to minutes or even several hours during
w hich time inter mittent manipulations should be done to strengthen the therapeutic effects If
the qi does not arrive passive retention of the needle is appropriate until the arrival of
the qi
5 1 7 2 Withdrawal
Withdra w al refers to taking out or removing a needle Follo wing the insertion
manipulation and retention the needle can be withdraw n or removed
T o do so the skin around the acupoint should be pressed with a piece of cotton held
bet w een the thumb and index finger of the pressingholding hand then slo w ly and gently
rotated and lifted up to the subcutaneous layer follo w ed by a brief pause prior to withdrawing
the needle Various methods of withdraw al may be utilized here based on the need to reinforce
or reduce
With the exception of special treat ments upon w ithdraw al every acupoint needled should
be momentarily pressed w ith a sterilized cot ton ball to prevent bleeding andor pain Prolonged
pressure should be applied to acupoints on the headscalp as these areas have a tendency to
bleed A fter the needles have been w ithdraw n it is appropriate to ask the patient ho w they are
feeling check for bleeding at the insertion sites count the number of needles w hich w ere used
and observe the patient for any signs that might indicate a delayed reaction associated with
fainting
5 1 8 Management and Prevention of Accidents

Acupuncture accidents can be the result of carelessness violation or neglect of the rules
437
inappropriately strong manipulations or inadequate kno w ledge of human anatomy If they are
not w ellhandled the patients situation may w orsen causing undue pain andor suffering One
should be thoroughly acquainted with co m mon acupuncture accidents in order to manage them
appropriately in the event that they occur
5 1 8 1 Fainting During the Acupuncture Treatment
Fainting during the acupuncture treat ment refers to the s w oon w hich patients have in the
process of the acupuncture treat ment
Causes Weak constitutions nervous tension fatigue hunger severe diarrhea needling
done after profuse s w eating or bleeding improper positioningposture fear of needlesneedle

phobiaor overlyforceful manipulations done by the practitioner
Sy mptoms Dizziness blurred vision lassitude pallor nausea and possibly vo miting
profuse sw eating cold extremities sudden drop in blood pressure a deep thin pulse mental
disorientation cyanotic lips andor nails or sudden loss of consciousness fecal and urinary
incontinence and acrotism
Management T he treat ment should be stopped im mediately and all needles quickly
withdra w n A ssist the patient to lie flat or if they are seated have them hold their head do w n
and bet w een their legs keep him or her w ar m In mild cases the patient will recover after lying
flat for a few minutes and drinking w ar m or dex trose w ater In a severe cases you can needle
Ren z hong G V S uliao G V N ei guan PC Zusanli S T mild manipulations are
strongly suggested or moxibustion can be done at BaihuiG V Guany uanC V and Qihai
C V If the condition gets w orse or the patient is unresponsive its suggested to call for help
andor perfor m emergency first aid
Prevention Fainting associated w ith acupuncture treat ments is avoidable if the follo wing
rules are observed During the initial visit for firsttime patients give a detailed explanation of
the process of acupuncture w hat it is ho w it w orks and w hat patients usually experience or can
expect during a treat ment in an effort to dispel their fears It should be noted that there is a
higher incidence of fainting with patients w ho are nervous or w eak A comfortable position
should be selected many times the prone position is preferred A minimal number of acupoints
should be selected to needle firsttimers using slo w and gentle manipulations T he patient
should be treated w hen he or she is not hunger thirsty or fatigued During the treat ment close
at tention should be paid to the patients facial expressions body language and verbal feedback
T here should be an im mediate response to any preliminary signs or sy mptoms precluding
syncope i e dizziness and in the event that there is an incident it should be managed quickly
and with a sense of urgency to nip it in the bud

5 1 8 2 Stuck Needles
If it is difficult to manipulate or withdraw a needle after it has been inserted or the patient
has intense pain its a sign that the needle is stuck
Causes T he patients nervous tension can cause the local muscles to contract tightly
around a needle follo wing an insertion If the intensity of the manipulations is too strong they
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can induce local muscular contractions as can rotations of the needle in only one direction so
much so that the muscular tissues unduly w rap around the body of the needle Also prolonged
retention of a needle or undue movement by the patient can cause them to beco me stuck
Manifestations When this happens it is difficult for the practitioner to rotate lift or
thrust the needle during manipulations
Management One or more of the follo wing manipulations can be done to reduce excessive
nervous tension in the local treat ment areas of the body that results in overly contracted
muscles Allo w the inserted needle to be retained a little longer massage around the affected
area of the body or tap the handle of the stuck needle or insert another needle near the problem
area If the stuck needle w as caused by rotating the needle in only one direction t w irl it back in
the opposite direction w hile scraping and tapping the needle handle to facilitate loosening and
un winding the t wisted muscle fibers
Prevention Nervous patients should be encouraged to relax and reassured that w orrying
is unnecessary Care should be taken during manipulations to avoid rotating the needle in only
one direction If rotating the needle in one direction is necessary it should be done in
conjunction with lifting and thrusting the needle

5 1 8 3 Bent Needles
Bent needles occur during the unusual situations w here the angle of the body of the needle
changes w hile or after it has been inserted into an acupoint
Causes U nfamiliarity with the anatomical st ructures associated with the acupoints
inappropriate use of force needle insertions into hard body tissues and changes in the patients
body position during inser tions or w hile the needles are being retained can result in bent
needles Other causes may include external forces accidentally forcefully pressing or pushing
the handles of the needles w hile being retained
Manifestations T he desired direction and angle of the needles handle follo wing insertion
and retention is thus changed making it difficult to lift thrust rotate or withdraw without
causing intense pain to the patient
Management When a needle is bent manipulations like lifting thrusting and rotating etc
should no longer be done If the handle of the needle is only slightly bent it can be slo w ly
withdra w n H o w ever if the needle has been dramatically bent it should be slo w ly withdraw n
follo wing the course of the bend If a bend is caused by the patient changing body position
assist them to assume their for mer position and then slo w ly withdraw the needle w hen the
surrounding muscles have fully relaxed It should be noted that it is inappropriate to forcibly
withdra w a needle to avoid breaking it w hich w ould leave remnants of the needle in the body
and possibly belo w the skin
Prevention Skillful manipulations are required of all practitioners w hich include the
steady application of finger force instead of sudden rapid thrusting and familiarity w ith the
associated anatomical structures Appropriate body positions should be selected prior to
treat ments and patients should be instructed not to change them after the needles have been
439
inserted Also all areas being treated should be protected so that the handle of the needles
w ouldnt be accidentally pressed or pushed deeper than desired by ex ternal forces
5 1 8 4 Broken Needles
T his means an inserted needle is accidentally broken during acupuncture and the remnant
of the needle is left in the body possibly above or belo w the surface of the skin
Causes Broken needles can be the result of the following circumstancesconditions poor needle
qualityintegrity that can lead to erosion in the body or at the base of the needle failure to carefully
examine needles prior to insertions inserting the entire body of the needle below the surface of the
skin inappropriately lifting thrusting or twirling the needles too strongly during manipulations causing
intense muscular contractions sudden changes in the patients body position during retention and
inappropriate management of bent or stuck needles
Manifestation T he needle body is broken during a manipulation with a remnant partially
left in the body above or belo w the skin
Management Both the practitioners and the patient should remain calm w hen dealing with
this situation T he patient should be requested to remain in the same body position to avoid the
remnant from sinking deeper into the body If the broken end is still protruding fro m the skin
it should be withdraw n with the fingers or a pair of forceps H o w ever if it is already beneath
the skin but still visible press the area of the body surrounding the acupoint perpendicularly
with thumb and index finger of one hand to expose the broken end and withdra w it w ith a pair
of forceps using other hand In the event that of the broken needle is deeply submerged it
should be surgically removed after locating its position with an Xray
Prevention Accidents can be prevented by carefully inspecting needles for quality and
disposing of those that are substandard Needle manipulations should be done gently with
careful attention paid to avoid using inappropriately strong manipulations andor rapid force
T he patient should be instructed and reminded before and during the course of the treat ment
not to change hisher position after the needles have been inserted Also it should be noted that
the needle body should not be completely inser ted belo w the surface of the skin part of it
should be left outside In the event of a bent needle the insertion or manipulation should be
discontinued and the needle withdraw n im mediately Stuck and bent needles should be properly
managed and never forcibly withdraw n
5 1 8 5 Hematomas
A hematoma is a bruise with sw elling and pain produced by bleeding beneath the surface
of the skin after a needle has been removed
Causes T his may arise from injuries to the skin or underlying tissue especially if the tip of
the needle is bent or hooked or from puncturing blood vessels during insertions
Manifestation Local s w elling distension and pain after the withdraw al of a needle
follo w ed by the skin around the acupoint punctured turning blue and purplish
Management A slight hematoma caused by subcutaneous bleeding will generally
disappear on its o w n If the local sw elling distension and pain is severe or the blue and purplish
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areabruising is lar ge enough to restrict or impair motor function andor movement

management is required First a cold compress should be applied to stop the bleeding follo w ed
by a hot compress or light kneading and massage to the local area to facilitate the dissipation of
blood stasis
Prevention Needles should be carefully inspected before use and practitioners should be
thoroughly familiar with the human anatomy Pressured should be applied to the needled area with a
sterilized cotton ball as soon as the needle is withdrawn to prevent bleeding beneath the skin
5 1 8 6 Traumatic Pneumothorax
A pneumothorax is caused by injury to the lung s resulting in puncturing w hich allo w s
air to escape into the thoraxchest cavity
Causes Deep needling in the points of the thorax and back
Manifestations Chest pain and oppression palpitations shortness of breath shallo w
breathing and possibly dyspnea tachycardia cyanotic lips sw eating and a drop in blood
pressure Physical examination of the injured aspect of the lung presents a co mparatively w ide
intercostal space the lung is resonant to percussion the breath sounds are obviously reduced or
imperceptible in severe cases the trachea is even deviated A chest xray indicates the presence
of air in the thorax and a collapsed lung A diagnosis is made accordingly
Management Needling should be discontinued and all needles withdraw n T he patient
should be placed in the lateral recumbent position Patients with small amounts of air in the
thorax can recover on their o w n ho w ever a close eye should be kept on them and preparations
should be made to deal w ith sy mptoms such as medication to stop coughing or antipyrotic
drugs used to prevent enlargement of the injured area in the lung due to coughing deterioration
of leakage and infection In severe cases emergency measures should be taken im mediately such
as a thoracocentesis the insertion of a needle into the chest to aspirate air and reduce the
pressure or a slo w steady supply of oxygen
Prevention When needling practitioners should be focused and properly positioned to
deter mine and control the appropriate needling angles direction and depths For acupoints on
the chest back or supraclavicular fossae oblique horizontal and superficial needling is
preferable It is inadvisable to do deep perpendicular insertions or large lifting and thrusting

movements w ith the needle Also prolonged retention time is contraindicated
5 1 9 Acupuncture Treatment Precautions
A t tention should be paid to the follo wing precautions to ensure acupuncture safety and
avoid accidents
A It is inadvisable to give acupuncture to patients w ho are either hungry full intoxicated
or exhausted For patients with w eak constitutions or those with severe or chronic illnesses and
deficiencies of qi and blood strong needle manipulations should be avoided and it is preferable
if the patient is treated in the supine position
B It is contraindicated to needle the points on the abdomen of w o men w ho are up to three
441
months pregnant For those w ho have been pregnant for more than three months acupuncture
on points of the abdomen or the lumbosacral area is contraindicated Acupuncture is also
contraindicated on the follo wing acupoints since they have the property of promoting blood
circulation and dredging the meridians during pregnancy Sany in j iao SP H egu LI
K unlunBLand Zhi y inBL
C Points on the vertex of the head of infants should not be needled w hen the fontanels are
not closed
D Patients w ith the tendency to bleed spontaneously or w ho have blood clotting problems
should not receive acupuncture
E It is contraindicated to do acupuncture on body areas that have infections ulcers and
scars
F It is inappropriate to do deep needling on the acupoints of the chest ribs lumbar region
or upper back especially for patients with sw elling and enlargement of the liver or spleen If
deep needling is done on the chest back axilla ribs and supraclavicular fossae it is possible to
injure the lungs causing a traumatic pneumothorax
G T o avoid serious injury to the internal or gans practitioners ought to be careful of the
angles direction and depths of needling w hen needling points around the eyes and along the
spine or Feng f uG Vand Yamen G V at the base of the skull Large amplitudes lifting
and thrusting t wirling and rotating or prolonged needle retention is illadvised
H T o prevent accidentally puncturing the urinary bladder the direction angles and depths
of needle insertions should be carefully controlled w hen needling patients with urine retention
5 2 Moxibustion
M oxibustion therapy j iu f a literally means the burning of m oxa It is a therapy that can
prevent and treat diseases with heat stimulation on acupoints or related parts of the body Y i X ue
R u M en Zhen J iu T he chapter on Acupuncture and M oxibustion in Elementary M edicine said
that w hen drugs and acupuncture are inapplicable m oxibustion must be applied It suggests that
m oxibustion is a supplementary alternative to acupuncture w ith its o w n special benefits in clinical
practice
T hough there are quite a few materials used for m oxibustion m oxa the leaf of A rtemisia
A rgyi from the compositae family a perennial herbaceous plant remains the chief ingredient
M oxa is produced in all parts of China yet the name of J in M oxa co mes from the J in Zhou
area w here it is m ost fam ous Due to its special aroma bitter and pungent flavor and w ar m
nature as w ell as its flam mability and moderate heat m oxa surely is an ideal option just as
both B en Cao Gang M u T he Co mpendium of M ateria M edica and M ing Y i B ie L u T he G reat

Physicians A dditional Records mentioned M oxibustion can be applied in various diseases
With dry moxa leaves pounded and purified fine soft m o xa w ool is thus made and after
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bein g dried in the sun it is stored for future use T he reason for using old dry m o xa w ool
instead of fresh new w ool is that the latter contains so m uch volatile oil that w hen burned it
gives off too m uch heat So the best choice is m oxa that has been dried for an ex tended period
of time
5 2 1 The Functions of Moxibustion
5 2 1 1 Warm the Meridians to Dispel Cold
S u W en Y i Fa Fang Yi L un suggested that distension of the z ang organs caused by high
altitude and the cold w eather of the north should be treated with moxibustion From this w e
could see that indeed moxibustion can w ar m the meridians to dispel cold Clinically it is
indicated for all diseases caused by cold obstruction blood stagnation and blockages of the
meridians such as colddamp biathralgia dysmenorrhea amenorrhea stomachache epigastric
pain and cold herniation shan
5 2 1 2 Supporting Yang to Strengthen the Original Qi
It is said in B ian Que X in Shu Bian Ques H ear t y W or ds that sickness is caused by the
deficiency of qi the loss of w hich can result in death and moxibustion is first in line to keep it
sufficient M oreover mo xibustion could be used to treat diarrhea coldness of the ex tremities
and acrotism as w ritten in a chapter of S hang H an L un B ian J ue Y in B ing Mai Zhen B ing Zhi
T he Differentiation of J uey in Syndrome in T reatise on Febrile Diseases In all it has been
widely applied to many serious diseases due to insufficiency sinking or depletion of y ang qi
A mong them are enuresis rectocele prolapse of the genitalia menorrhagia leukorrhea and
chronic diarrhea just to name a few
5 2 1 3 Remove Blood Stasis and Dissipate Pathological Accumulation
L ing Shu Ci J ie Zhen X ie suggests that T he blood in vessels can be solidificated and the
stasis in the blood vessels can only be treated with heat T his is because qi is the com mander of
blood and blood is the m other of qi here com mander means governor and m other means
source and foundation So heat stimulation facilitates the normal flo w of qi the normal
circulation of blood is ensured M oxibustion with its heat has the effect of keeping the actions
of Y in qi and W ei qi in balance and in turn it dispels blood stasis and dissipates pathological
accumulation In the clinical setting it is com m only used to treat diseases related to qi and blood
stagnation such as the early stages of acute mastitis scrofula and goiter
5 2 1 4 Prevent Disease and Maintain Health
A s is recorded in Z hu B ing Y uan H ou L un X iao E r Za B ing Z hu J i T he earth of H e
L uo is predominantly cold so local kids are m ore likely to suffer fro m convulsions
T raditionally new born babies receive m o xibustion for th ree days after delivery to prevent
them and trism us is also averted w ith m o xibustion on the cheeks In Qian J in Y ao F ang
V aluable Prescriptions A cupuncture and M o xibustion it says T he tourists in the coun try
of W u and S hu should select t w o or three points for scarring m o xibustion and keep the post
m o xibustion sores unhealed In this w ay the to xic qi like miasma pestilence and malaria
443
w ill not gain access in to the hu man body B ian Que X in S hu tells us M oxibustion on
G uan y uan C V Q ihai C V M ing m en G V and Z hong w an C V w ould be beneficial
to us at any time w hen man is free fro m illnesses A lthou gh it cannot make us live forever it
w ill guarantee us over one hundred years of age its said in Y i S huo M edical T heories
A cupuncture and M o xibustion If one w ants to stay health y scar m o xibustion on Z usanli
S T should be continuously applied It indicates that m o xibustion on Z usanli S T or
other points has the function of preventin g diseases and maintaining health It w as called
reverse m oxibustion in ancient C hina w hile no w adays it is kno w n as healthy m o xibustion

w hich means maintaining the habit by doin g m oxibustion even though one enjoys g ood
health T his meth od can invigorate health y qi and streng then the im m unity to keep one full of
vitality and increase longevity
5 2 2 Classification Manipulation and Application of Moxibustion

Listed belo w T able
are some of the various methods of doing moxibustion

Table 5 3 Classification of Moxibustion
Moxibustion
with Moxa
Cones
Direct
Moxibustion
Indirect
Moxibustion
Nonscarring Moxibustion
Scarring Moxibustion
Ginger Moxibustion
Garlic Moxibustion
Salt Moxibustion
Monkshood cake Moxibustion
Moxibustion
with moxa
Moxibustion
with Moxa
Stick
Moxibustion
Suspended
Moxibustion
Pressing
Moxibustion
Mild Moxibustion
Pecking Moxibustion
Revolving Moxibustion
ThunderFire Miraculous needle

Taiyi Moxa Stick
Moxibustion with Warming Needle
in common
Moxibustion with Moxa Burner
use
Scorching
Other ways of
Moxibustion
Moxibustion
Natural
Moxibustion
Rush Burning Moxibustion

Match Moxibustion
Jossstick Moxibustion
Mustard Seed Moxibustion
Garlicmash Moxibustion
Cantharides Moxibustion
5 2 2 1 Moxibustion with Moxa
A M o xibustion w ith M o xa C ones Z huang s M o xacones refer to burn m o xa w ool that
has been shaped into small cones and placed on various parts of the body to treat illnesses
M o xibustion can be done w ith m oxa cones made of m oxa w ool on various parts of the body
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Part
M aking m o xacones is fairly easy pure m o xa w ool is lain on a table w here it is shaped and
for med into different sizes small ones the size of a grain of w heat mediu msized ones about
half the size of a jujube date and large ones that are about the size of an olive Fig
m o xa cone is also kno w n as a z huang M o xibustion w ith m o xacones z huang s is sub
divided into direct and indirect
Fig MoxaCones Zhuang
Fig Direct Moxibustion
a Direct M oxibustion Zhi J ie J iu When a moxa cone is placed directly on an acupoint
area and ignited it is called direct mo xibustion Fig
It is subdivided into scarring
mo xibustion and nonescarring moxibustion T he for mer leaves a festering burn that later
scars w hile the lat ter w hich does not produce such a strong stimulation usually leaves no
scars
Scarring M oxibustion Ban H en J iu also kno w n asfestering moxibustion Prior to doing
mo xibustion a small amount of garlic juice is applied to the treat ment site to facilitate the
adhesion and stimulation of the moxa cones on the skin A n appropriate sized cone is then
positioned and ignited until it burns completely A fter removing the ash this procedure is
repeated for each subsequent cone z huang as needed Clinically moxibustion done in this
manner is effective in treating chronic and refractory diseases such as asth ma tuberculosis and
scrofula
T he pain produced follo w ing direct m oxibustion can be reduced by gently tapping the skin
around the treat ment area N ormally one w eek after moxibustion the treat ment site w ill blister
and postm oxibustion sores w ill appear Five to six w eeks later the sores heal and scars for m
w hen the crust falls aw ay Due to the pain the blister and scar that follo w s it is highly advisable
to get the patients permission and cooperation prior to using this method
N onescarring M o xibustion W u B an H en J iu T o facilitate the adhesion of the m o xa
cone to the skin durin g m oxibustion vaseline should be applied to the acupointarea prior to
placing and igniting an appropriate sized cone on the site selected W hen about or of
445
the cone has been burnt or the patient feels an uncom fortable burning pain it should be
replaced w ith another cone and the procedure repeated until the required nu m ber of cones
have been burnt T his process is repeated until the site
is red and flushed but no blisters are for med

therefore after the treat men t it w ill not fester or leave
scars T his method is often used for disorders associated

w ith cold deficiencies
b Indirect M oxibustion J ian J ie J iu T his
method also kno w n as moxibustion
w ith material
insulation involves so me form of insulation bet w een the
cone and the skin so that there is no direct contact
Fig
Various materials are used for insulation
ho w ever those m ost co m m on medicinal substances used
are gin ger salt garlic and m onksh ood cake
Fig
Indirect M oxibustion
Ginger M oxibustion Ge J iang J iu Fresh ginger is cut into slices each about cm
wide and cm thick Several needle holes are then punched into the slices that are then
placed on the acupointsareas selected T he mo xa cone is then placed on top of the ginger slice
w here it is ignited and burned When the cone has burned completely and the ash is removed it
is replaced w ith another one and the procedure is repeated until all the cones required are
finished U sually the local skin in the area being treated will become flushed w hich is the
desired effect T his method can w ar m the spleen and stomach to stop vomiting and disperse cold
to relieve pain T hus it is indicated for sy mptoms related to cold such as vomiting abdominal
pain joint pain etc
Garlic Moxibustion Ge Suan Jiu Garlic cloves are cut into slices each about to cm
thick then holes are punched into themNote garlicmash may also be used The garlic is then placed
on the acupointsareas selected and moxa cones are ignited and burned on top of them as described
above This method effectively eliminates heat and toxins and it is also useful for killing parasites so it
is often used to treat scrofula tuberculosis and the early stages of skin ulcers and local swellings It can
clear away the heat evil or detoxify and has a pesticidal function
Salt M oxibustion Ge Yan J iu T his method is also kno w n as Shenque C V
mo xibustion as it is usually done on the umbilicus First the umbilicus is filled with salt to the
level of the skin follo w ed by placing a largesized moxa cone on top of the salt or a slice of
ginger it is then ignited and burnt When consumed the ash is removed and it is replaced with
another until all the cones required have been consumed Since this method is effect for
restoring Yang collapse it is used for treating y incold disorders vomiting and diarrhea and
flaccid type windstroke For example w hen treating flaccid type w indstroke continuous
mo xibustion is applied until the patients vital signs are steady that is hisher pulse can be
palpated and the extremities have become w ar m
M onkshood Cake M oxibustion Fu Zi B ing J iu A cake of M onkshood is approximately
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Part
cm in diameter and cm in thickness and it is made of M onkshood po w der mixed with
alcohol It is punched with several holes and placed on the affected area w here mo xa cones are
placed on top of it to be ignited and burnt T his method is useful for w ar ming and strengthening
the kidneyYang and thus it is adopted to treat impotence sper matorrhea premature
ejaculation infertility and ruptured abscesses resistant to healing
B M oxibustion w ith M oxa Sticks A i T iao M oxibustion with moxa sticks refer to make
the moxa sticklike and applied on certain parts
M oxa sticks are made in the follo wing manner Tightly roll grams of soft pure argyi
w ool with a sheet of soft thin paper cm by cm Roll it into a column approximately
inches in diameter and then w rap it w ith soft tough mulberry paper Apure moxa stick has
thus been made after sealing each end with glue A medicinal herbal moxa stick is made by
combining grams each of the follo w ing special ingredients and pounding them into a po w der
Rou Gui Cor tex Cinnamom Gan J iang R hi z oma Zingiber is D ing X iang F los Car yo p hy lli
D u H uo Radi x A ngelicae P ubescebtis X i X in H erba A sar i Bai Zhi Rad i x A ngelicae
Dahur icae X iong H uang Real gar Cang Zhu R hi z oma A t ract y lodis Mo Yao M yrrha R u
X iang Olibanum and Chuan J iao P er icar p ium Zantho x y li
M oxibustion with moxa sticks includes t w o kinds suspended and pressing moxibustion
a Suspended M oxibustion X uan Qi J iu T his method is done by holding the moxa stick
over the acupointareaduring the treat ment N ote T he end of the moxa stick should not make
contact with the skin It is subdivided into mildw ar ming sparro wpecking and w aving
mo xibustion
Mild M o xibustion W en H e J iu One end of a moxa stick is ignited and held over an
acupointarea T he distance bet w een the end of the stick and the skin should be about or
centimetersFig
T he intention here is to bring w ar mth to the treat ment area so the
patient should not feel any burning sensations T he practitioner should place their index and
middle fingers on the sides of the affected area to feel the heat so that they can deter mine and
adjust the appropriate distance bet w een the end of the stick and the patients skin to avoid
burning for patients in a co ma or w ho have delayedimpaired sensory perception
Fig Mild Moxibustion
Fig Pecking Moxibustion
Pecking M oxibustion Que Zhou J iu With this method the distance bet w een the ignited
end of a mo xa stick and the patients skin is not fixed Instead as its name indicates it is moved
up and do w n over the pointarea like a pecking birdFig

Waving Painting M oxibustion H ui X uan
447
J iu When using this method though the end
of the moxa stick is kept or centimeters
above the skin it is moved back and forth or
circularlyFig
b Pressing M oxibustion Shi A n J iu T his
method of moxibustion is done by pressing the
burning end of a moxa stick partitioned off by
several layers of cloth or cotton paper on the
acupoints to allo w the heat to penetrate the skin
Fig WavingPaintingMoxibustion
and muscle A fter the fire is extinguished it should be ignited again and repeated T he third
chapter of S hou Yu S hen Fang T he M agic Prescriptionnot only recorded this method but also
mentioned that it is usefed for treating patients until they feel w ar mth in the abdomen with
s w eating then the patients will be healed T aiyi mo xa stick and T hunderFire M oxibustion is
com monly used
T ai y i moxa stick T ai Yi Zhen J iu Ingredients Ren S hen Radi x Ginseng g
Chuan S han J ia Squama M anitis g Shan Yang X uethe blood of a goat g Qian N ian
J ian R hi z oma H omalomenae g Zuan D i Feng g Rou Gui Cor tex Cinnamomi g
X iao H ui X iang F r uctus Foeniculi g Cang Zhu Rhi z oma A tracty lodis g Gan Cao
Radi x Gl ycy r r hi z ae g Fang Feng Radi x L edebour iella g and a little musk
Grind them all into a fine po w der then mix grams of the po w der with grams of pure fine
argyi w ool Tightly roll the mix ture into a stick with a piece of mulberry paper cm by
cm shaped like a fire cracker Finally paint the outside with so me egg w hite and dry the
sticks in a cool ventilated place
To use ignite one end of the stick and wrap the ignited end with several layers of cloth then
immediately press it on the acupointarea to be treated When the spark goes out and the temperature
of the treated area cools reignite it and repeat the same procedure for seven to ten times If the patient
cannot bear the intensity of the heat at any time during the treatment the practitioner should lift the
stick up long enough to allow the temperature to decrease and apply it later
T here is another option for doing this kind of moxibustion cover the parts of the body to
be treated with several layers of cot ton paper or cloth and quickly press the ignited end of a
mo xa stick and lift it up rapidly T his is repeated several times and w hen the heat decreases
another moxa stick is used for the same procedure Generally it is done times for each
acupoint until the area treated is flushed the penetrating heat is sustained Practitioners should
be aw are of anything that might catch fire during this procedure It is effective for treating
wind cold damp B i syndromes intractable numbness of the body atrophy and hemiplegia
T hunderFire M oxibustion T he method of making moxa sticks is the same as that of the
T ai y i moxa stick moxibustion except that the ingredients are different A rgyi Wool g
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Part
Chen X iang L i gnum A quilar iae R esinatum g Ru X iang Resina Olibani g Qiang H uo
R hi z oma seu Radi x N oto p ter gii g M u X iang Radi x A ucklandiae g Y in Chen H erba
A rtemisiae Sco p ar iae g Gan J iang R hi z oma Zingiber is g Chuan S han J ia Squama
M anitis g and a little musk
T he procedure is also similar to that of the T ai y i moxa stick moxibustion and it is
indicated in A Complete Collection of Acupuncture and M oxibustion for sprains contusions and
pains caused by cold dampness or qi disorders In clinic it can be used to threat the diseases
mentioned above besides other indications are similar to the T ai y i moxa stick
C War mNeedle M oxibustion W en Zhen J iu War mNeedle moxibustion is actually a
combination of acupuncture and moxibustion During
the manipulation after the arrival of qi w hile the
needle is still retained in the point affix a small
section of moxa stick about cm long on the

needles handle and then ignite the moxa stick from
its bottom When the moxa stick burns out remove

the ash and take out the needle Fig
T his
method is used w hen both retaining needles and

mo xibustion is indicated
D M oxibustion with a M oxa Burner W en J iu
Qi J iu T he mildmoxibustioner is a special
Fig WarmNeedle Moxibustion
instrument used for moxibustion T here are t w o kinds the box and the canisterFig Fig
Both are co m monly used in clinical practice T o use place put some argyi w ool either
alone or together with the special ingredients previously mentioned into the box or canister
Ignite the argyi w ool and make sure its lid is properly secured T hen place it on the acupoints
or affected area of the body to be treated T he desired effect is to make the local skin w ar m and
flushed T his method of doing moxibustion is especially useful for children and other individuals
w ho are afraid of being burnt by an open flame
Fig
Fig Moxibustion with a Moxa Burner
5 2 2 2 Other Moxibustion Methods
A BurningRush M oxibustion D eng H uo J iu We can also call this method medical
M edulla Junci Effusi moxibustion oilsoaked moxibustion Yuan X iaofire on thirteen and
449
burning fumigation T his is a simple method of moxibustion that has been used by folks for a
long time T his method involves soaking a stick of Medulla Junci in the Faecula Sesami or other
vegetable oil and moving it slo w ly and pausing above the location to be treated w ait there until
the fire flares up then quickly allo w the burning end to touch the selected treat ment area
vertically Remove it w hen a ba sound is heard If there is no sound repeat the procedure Its
function can dispel wind to relieve ex terior syndrome invigorate qi to resolve phleg m and clear
heat to alleviate convulsions It is primarily used for mumps neonatal tetanus stomachache
abdominal pain eruptive distension and numbness of the four ex tremities
B Natural M oxibustion T ian J iu T his method is also kno w n as medicinal or
vesiculating moxibustion A skin irritant is applied to the acupoint or the affected area to
stimulate local congestion and vesiculation w hich resembles a postmo xibustion sore T hats
w hy w e call it automoxibustion If the treat ment is carried out on the day of SanFuthe hottest
day of the year it can be referred to as SanFu moxibustion T he medicine applied can be a
single Chinese herb as w ell as a complex prescription A mong those most com monly used are
Semen Sinapis GarlicM ud and M ylabris moxibustion
a White M ustard Seed M oxibustion Bai J ie Zi J iu White M ustard Seed is ground into
a fine po w der and mixed with w ater to make a paste or cream It is then applied to an acupoint
or affected region w here its strong stimulative action will for m blisters on the skin T he
treat ment duration should be about t w o to four hours or until the local skin becomes
congested reddish and blisters generally it is used for treating Bisyndrome of the joints and
facial deviations It can also be combined with other medicines to treat asth ma
b GarlicM ud M oxibustion S uan N in J iu Garlic cloves are smashed until they become
muddy after w hich three to five grams are applied to an acupointarea It is keep there for one to
three hours until the local skin becomes flushed begins to itch and turns red GarlicMud moxibustion
can be applied to Yongquan KI for hemoptysis and hemorrhage of the five senses H egu LI for
tonsillitis Yu j i Lu for throat obstructions and on areas affected by neural dermatitis
c M ylabis M oxibustion Ban M ao J iu T his method is done by smashing w hole M ylabris
into ashes then mixing it with vinegar glycerine or alcohol Prior to application a piece of
adhesive plaster with a beansized hole in the centre is placed over a selected point T he
intention is to expose the point w hile protecting the adjacent area Once that is done a small
amount of M ylabris po w der is placed in the hole and covered with a piece of adhesive plaster
w here it is retained until the skin blisters T his is a useful treat ment for itching due to
ring w or ms neural der matitis and joint pain
5 2 3 Precautions
5 2 3 1 Order of Moxibustion
On this subject explicit dissertations w ere given by the ancestors Qian J in Yao Fang
Zhen J iu Invaluable Prescriptions for E mer gencies Acupuncture and moxibustion recorded
mo xibustion ought to be conducted on the yang aspect first follo w ed by the y in and the upper
450
Part
area first then the lo w er M ing T ang J iu J ing Mo x ibustion Canon o f the B r i ght H all also
points out M oxibustion should be applied to the points on the upper portion before that on the
lo w er the number of moxa cones should be small first and second larger Clinically w e should
start moxibustion from the upper part of the body to the lo w er par t first the yang aspect then
the y in aspect of the body Initially a small number of moxa cones should be applied with
additional treat ment over a period of time lar ger ones can be used H o w ever in special
circumstances these rules can be modified to coincide w ith the patients condition
5 2 3 2 Reinforcing and Reducing With Moxibustion
In Ling Shu Bei Shu it says For reinforcement do not assist combustion by blowing let the
moxa burn naturally till it burns out for reduction blow air to it time after time to make the
combustion vigorous That is the detail record for reinforcement and reduction with moxibustion from
ancient peoples Besides in Zhen Jiu Bu X ie chapter of Zhen Jiu Da Cheng it adds the rule of
pressing on points for reinforcement and no pressing for reduction In practice moxibustion can be
conducted according to the patients condition and the properties of the acupoints
5 2 3 3 Moxibustion Contraindications
A In principle patients with excess heat syndro mes or with fevers due to y in deficiency
are contraindicated for moxibustion
B Scarring moxibustion is prohibited on the face and head and areas close to large blood
vessels
C M oxibustion is prohibited on the abdomen and lumbosacral areas during pregnancy
D Precautions should be taken w ith patients suffering from skin allergies or ulcers
5 2 3 4 Moxibustion Disposal
Follo wing moxibustion the local skin area will appear red or flushed accompanied by a
scorching hot sensation this is a nor mal phenomenon and no management is required
H o w ever blisters will appear if moxibustion is excessive or prolonged if not ruptured they will
be absorbed naturally Large blisters can be lanced and drained or the fluid inside the blisters
can be aspirated with a hypoder mic needle follo w ed by the application of a topical antiseptic
and a bandage When scarringfestering mo xibustion is done during the suppurative stage of
the sores patients should be infor med about the importance of proper rest good nutrition and
keeping the affected area clean and dressed to protect the sores and prevent infection until it is
healed In the event that the resulting sores are not properly at tended to they may ooze pus and
blood w hich can be treated by the practitioners with antiinflam matory oint ments or Rubin
oint ment Whenever doing moxibustion practitioners should take precautions to prevent the fire
from the moxa to burn the skin or clothes
5 3 Cupping Therapy Ba Guan Liao Fa
Cupping T herapy is a treat ment in w hich a cup guanis at tached to the skin with suction
451
to cause local stimulation for disease treat ment and prevention T he secret is the negative
pressure created by consuming the air inside the cup with fire or other methods
Cupping therapy also kno w n as Jar Suction T herapy X i T ong L iao Fa or the H orn
M ethod J iao Fa in ancient China w as recorded as early as in T he W u S hi E r B ing Fang
FiftyT w o Prescriptions a silk book unearthed in E mperor M as tomb during the Han
Dynasty Also a discussion about it can be found in the T C M literature of other dynasties
Cupping w as primarily used to drain stagnant blood and pus from carbuncles and ulcers during
sur gery H o w ever with medical progress not only have the materials and methods of cupping
therapy improved but the scope of its indications has also greatly increased Clinically it often
employed in conjunction with of acupuncture and moxibustion
5 3 1 Types of Cups
Cups are made from a wide variety of materials ho w ever three types are most com mon
usedFig
5 3 1 1 Bamboo Cups Zhu Guan
A section of fir m bamboo cm in
diameter and cm in length is cut to
for m a short cylinder One end is used as
the base the other as the opening at the
top T he rim of the cup should be made
smooth with a piece of sandpaper Bamboo
cups are easily made with handy raw
materials they are light economical break
resistant and suitable for boiling T hese are
their good points but the draw back is that
they are prone to crack from dryness w hich
Fig T ypes of Cups
causes air leakages that w eaken their suctioning force

5 3 1 2 Glass Cups Bo Li Guan
T hese cups are shaped like a ball with smooth open mouth T here are three different sizes
large medium and small T hey can also be substituted with w idemouthed cans T he glass cup
is transparent therefore the skin in the cup can be visualized to help deter mine the appropriate
treat ment time H o w ever one disadvantage of glass cups is that they can shatter and are easily
broken
5 3 1 3 Suction Cups Chou Qi Guan
Presently suction cups for the most part are made of plastic Each cup has a fitting on the
cro w n w here a suctioning device is attached to remove the air Sometimes different sized
rubberbag suction cups are also used Suction cups are convenient breakresistant safe and the
suction force can be easily regulated with very simple adjust ments N o w adays due to these
advantages they are widely used
452
Part
5 3 2 Methods of Creating Suction Inside the Cup

T he follo wing are popular w ays of creating the negative pressure required for a cup to fix
itself to a specific treat ment area as the result of suction

5 3 2 1 Fire Cupping Method Huo Xi Fa
With this method negative pressure is created by introducing an ignited material inside the
cup to consume the air thereby making the cup suck itself onto the skin T he follo wing details
pertain to different w ays of creating suction using fire
A FireT winkling Method S han H uo Fa Light an alcohol soaked cot ton ball held with
a clamp or forceps or use a strip of paper place it inside the cup quickly turn it around in one to
three circles and take it out immediately and press the cup on the selected area the cup will
at tached itself to the skin Fig
Presently this is the most com mon used method and
since no fire is retained in the cup it is relatively safe H o w ever caution should be taken to avoid
scalds or burns by overheating the mouth of the cup
Fig FireT winkling Method
Fig FireThrowing Method
B FireT hro wing Method T ou H uo Fa A n alcohol soaked cotton ball or piece of paper
is ignited and placed into the cup A fter a short time the cup is rapidly placed fir mly against the
skin on the desired location Since there is burning material inside the cup w hich is apt to drop
do w n and burn the skin it is often applied to the lateral side of the bodyFig
C AlcoholFiring Method D i J iu Fa Place one to three drops of alcohol into a cuponly
a small amount should be used to prevent it from dripping out of the cup and burning the
skin turn the cup to distribute the alcohol evenly on the surface of the w alls Promptly place
the cup on the area to be treated after igniting the alcohol for a few seconds
D CottonSticking M ethod T ie M ian Fa Stick an appropriatesized alcohol soaked
cot ton ball on the inner w all of the cup ignite the cotton ball and quickly place the cup on the
453
area to be treated With this method the cotton ball should not be soaked with too much
alcohol other wise the skin w ould be burned w hen the burning alcohol drops do w n
5 3 2 2 Water Suction Method Shui Xi Fa
With this method the negative pressure is created w hen boiling w ater draw s the air out of
the cup so that it can attach to the skin Generally a bamboo cup is chosen to put in the boiling
w ater or herbal liquid for several minutes then the cup is grasped with clamped with the mouth
facing do w n w ards T he cup is im mediately placed on the selected location and attached to the
body surface
5 3 2 3 Suction Cup Method Chou Qi Xi Fa
A suction cup is placed fir mly on the chosen area w here a device is used to withdraw the
air When a sufficient amount of negative pressure is produced the cup w ill attach itself to the
skin T he negative pressure can be adjusted according to the quantity of air withdraw n to
regulate the suction force
5 3 3 Application of Cupping
5 3 3 1 The CupRetention Method Liu Guan Fa
T his could also be called the cupw aiting method as it involves keeping the cup on the
selected location for minutes before removal T his method is com monly used in clinic to
treat general diseases
5 3 3 2 MobileMoving Cupping Zou Guan
T his is also kno w n assliding cupping A lubricant should be applied to the skin over the
treat ment area prior to using this method Once suction has been created the cup is held and slid
across the skin until it becomes rosy and congested or even blood stagnation is seenFig
Its
suitable for treating large thicklymuscled areas such as the back lumbar region and the thighs
Fig Moving Cupping
5 3 3 3 FlashKissCupping Shang Guan
T his method is done by rapidly placing and removing the cup repeatedly over the same
place Its extensively used to treat a variety of diseases especially in situations w here it is
inadvisable to use retention cupping such as with kids and on the cheeks of young ladies
5 3 3 4 Pricking and Cupping Therapy Ci Xue Ba Guan
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Part
T his is also referred to as collateralpricking and cupping A fter disinfecting the treat ment
area it is punctured w ith a threeedged needle to cause bleeding or tapped it with a plum
blossom needle the cup is then applied to induce more bleeding T his method may be used to
treat all kinds of illness Generally speaking the cup is retained for to minutes
5 3 3 5 NeedleRetention Cupping Liu Zhen Ba Guan
Sometimes referred to as needle cupping for short this method is done by applying a cup
over the center of the site w here a needle has been
inserted T he cup is removed w hen the skin turns

rosy congested and blood stagnation appears T his
method combines cupping w ith acupuncture Fig
5 3 3 6 Medicinal CuppingYao Guan
Fig NeedleRetention Cupping
There are actually two methods involved here One is to boil a bamboo cup in an herbal decoction
for to minutes and place it on the affected area the other is to put the herbal decoction in the
suction cup and apply it to the affected location The prescription is made according to the illness for
example herbal medicinals with the properties of dispelling wind and promoting blood circulation such
as Qiang H uo Rhi zoma et Radix Notopter ygii Du H uo Radix Angelicae Pubesecentis Dang Gui
Radix Angelicae Sinensis Hong H ua Flos Carthami Ma H uang H erba E phedrae Ai Ye

Folium A rtemisiae A rgyi Chuan Jiao Pericar pium Zanthox yli Mu Gua Fructus Chaenomelis
Chuan Wu Radix Aconit and Cao Wu Radix Aconiti K usnezof f ii can be selected for treating
windcolddamp bisyndrome
5 3 4 The Actions and Indications for Cupping

Cupping therapy has the action of w ar ming the meridians invigorating qi and blood
circulation relieving blood stagnation alleviating pain and sw elling and dispelling damp and
cold With this extensive range of indications its commonly applied for w ind colddamp bi
syndrome lumbar pain shoulder and back pain aching lo w ex tremities soft tissue sprains and
contusions com mon colds headaches cough asth ma

stomachaches abdominal pain and dysmenorrhea
5 3 5 Cup Removal and Precautions
5 3 5 1 Cup Removal Qi Guan
When removing a cup it should be held in one hand
w hile the index finger and thumb of the opposite hand
presses the skin around the mouth of the cup to break

the seal created by the suction In this w ay the air is let
in and the cup is released Fig
Cup Removal If
the strength of suction is too strong it should not be
pulled forcibly to avoid injuring the skin
Fig Cup Removal
5 3 5 2 Precautions
455
A Generally large thickly muscled areas are selected Patients should be comfortably
positioned It should be noted that cups are prone to drop off bone edges and hairy areas T o
avoid the loss of suction w hich will result in the cups falling off patients should remain still
w hen manipulating the cups
B U sing cups of different sizes is deter mined by the cupping location Flash cupping
should be used on areas that are difficult for cups to stick
C Precautions should be taken to avoid scalding the skin Prolonged retention and
overheating of the mouth of the cup may cause blisters to arise In the event that this occurs
small blisters should be covered with sterile gauze to avoid scraping bigger ones should be
aspirated with a sterile syringe follo w ed by the application of a disinfectant or sterile gauze If
there is purple or even black agglomeration left the w ar m to w el can be used or w e can press
the local area in order to promote the blood circulation and relieve the sy mptom
D Cupping is contraindicated on patients with skin allergies ulcers or edema as w ell as
on the precordium and places supplied with large blood vessels It is also contraindicated for
those that have high fevers accompanied by convulsions and on the abdo minal and sacral areas
of pregnant w omen
5 4 Therapies for ThreeEdged Skin and Intradermal

Needles Electroacupuncture and Point Injection
5 4 1 ThreeEdged Needling Therapy San Leng Zhen Fa
T his therapy involves pricking certain areas of the skin to discharge blood or serous fluid
with a stainless steel threeedged needle about cm long with a thick round handle a
triangular body three sharp edges and a sharp tip
The threeedged needle was known as the shar p needle in ancient times In Ling Shu Jiu
ZhenSpiritual Pirot Nine needle It is stated thatthe sharp needle served for heat elimination and
bloodletting The therapeutic principleBlood stasis should be moved by bleeding is stated in Ling
Shu In addition the methods ofcollateral needling luo ci repeated shallow needling zan ci and
leopardspot needling bao wen ci are recorded indicating that threeedged needle therapy was one
of the important common therapies at that time
5 4 1 1 Manipulation Methods
T here are four manipulation methods
A Spot Pricking Method D ian Ci Fa T his method is done by creating a slight w ound
with quick vertical superficial pricking with a needle Prior to pricking the area to be
punctured should be massaged with the thumb of the pressing hand to create local hyperemia
blood congestion the skin should be disinfected with a cot ton ball saturated with a Tincture
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Part
of Iodine follo w ed by one saturated in a solution of alcohol During the operation pinch
the spot to be pricked with the thumb index and middle fingers of the pressing hand hold the
handle of needle with the thumb and index fingers of needling hand the pad of the middle finger
should support distal ex tremity of the needle leaving approximately m m of the tip
exposed T he needle tip is then directed over the sterilized point and s wiftly pricked about
m m deep into the spot and im mediately withdraw n A fter pricking squeeze the puncture hole
gently to allo w for a little bloodletting drops then press the punctured hole with a dry
cot ton ball until the bleeding stops T his method is usually applied to acupoints on the tips of
fingers or toes such as S hi x uan EXU E and t w elve Well S hi E r J ing X ue E r j ian EX
H N S hang x ingG Vand T ai yangEXH N etc
B Scattered Pricking M ethod San Ci Fa T his method is used to slightly prick a small
area around an affected par t with a threeedged needle Depending on the size of the affected
area to needle pricks can be made in the for m of a ring around the outer margin to the
center of affected part to dissipate s w elling and blood stagnation T he function of this method is
to eliminate stagnation reduce s w elling dispel blood stasis facilitate healing and remove
blockages in the meridians T his method is usually used for local blood stagnation edema styes
and nodules
C Collateral Pricking M ethod Ci L uo Fa Prior to using this method one should massage
the area to be punctured back and forth with the pressing hand or bind the superior part
proximal partof the area to be punctured with belt or rubber band A fter sterilization press
the inferior part of the punctured area with the thumb of the pressing hand hold the handle of
needle w ith the needling hand prick the acupoint or collateral on the area to be punctured about
m m deep shallo w for collaterals and deep for acupoints and w ithdraw the needle
im mediately to let out sufficient blood A fter bleeding stops press the puncture hole w ith a dry
cot ton ball During bleeding you may press the superior ext remity of the vain gently to help
expel the stagnant blood and reducing the har mful pathogenic factors T his method is usually
used on acupoints such as Qu z ePCand W ei z hongBLfor the treat ment of acute vomiting
and diarrhea sunstroke and fever
D Open Picking T iao Ci Fa A fter routine sterilization press both sides of the punctured
area or pinch it and hold the skin up with the pressing hand hold the handle of the needle with
the needling hand and s wiftly prick the skin about m m deep Im mediately tilt the body of
needle to discharge a small amount of blood or serous fluid Another method is to prick it about
m m deep then tilt the body of the needle and tease the tip of the needle to rupture the
subcutaneous fibers then withdraw the needle the area is then covered with a dressing T his
method is com monly used to treat periarthritis of the shoulder sto machache cervical
syndrome inso mnia bronchial asth ma and neurovascular headache

5 4 1 2 Indications
T h reeedged needle therapy san leng z hen liao f a is m ostly used for rem ovin g
blockages in the m eridians opening the orifices clearing heat and dissipatin g s w ellings and
457
nodules Its ex tensive indications include excess syndro mes heat syndro mes blood stasis and
various pain syndro mes A lso include are syncope high fever sunst roke styes acne apoplex y
w ith spasticity s w elling and pain of throat red s w elling and pain of the eyes mam m ary
abscesses ring w or m earlystage carbuncles or fu runcles sp rains o r b ruises m alnu t rition

hem o r rh oids obstinate B isy ndr o m e headaches er y sipelas and nu m bness o f fin ger s o r
t oes
5 4 1 3 Precautions
A Since threeedged needle therapy could cause damage so it is necessary to infor m
patients about it in advance
B Strict disinfection must be applied to the area to be pricked to prevent infection
C For spot pricking the operation should be light steady exact and rapid Deep insertions
and excessive use of force should be avoided to prevent unnecessary pain trauma and collateral
tissue damage T he quantity of bleeding depends on the patients condition generally no more
than ml is necessary Care should be taken to avoid injuring arteries
D Pricking should never be done on patients with w eak constitutions on pregnant w omen
or individuals w ho are susceptible to bleeding Patients should be placed in a co mfortable
position to prevent faint during this procedure
E T reat ments are given once a day or every other day to treat ments co mprise
course
5 4 2 Skin Needling Therapy Pi Fu Zhen Fa

T his therapy is done by tapping the body with skin needle w hich is used for facilitating
meridian function and regulating the flo w of qi and blood in the z ang f u organs to prevent and
treat diseases Skin needling therapy originated from Half Needling Ban Ci Skin Needling
M ao Ci and CentroSquare Needling Yang Ci in ancient times It is recorded in L ing

S hu Guan Zhen thathalf needling Ban Ciis a shallo w insertion with the pro mpt removal of
a needle without hurting inside but like taking the hair aw ay to regulate the function of qi in
the skin Centrosquare needling is the method of inserting one needle at the center of the
affected area and another four superficially around it in a square shape indicated for cases
caused by widespread cold pathogenic qi Finally skin needling is the method of inserting
superficially into the affected area to treat hypoesthesia and numbness of the skin All above
methods belong to superficial needling on the skin In S u W en P i B u L un Plain Q uestions

T he Cutaneous Region it says T he cutaneous regions are the parts of the t w elve meridians
w hich are located in the superficial layer of the body So various diseases originate from the
skin and hair In other w ords the t w elve cutaneous regions are closely related to the meridians
and the z ang f u organs Cutaneous needling is used for preventing and treating diseases by
tapping on the cutaneous regions to promote the smooth flo w of qi in the meridians and regulate
the functions of the z ang f u organs
T he pinhead of the cutaneous needle p i f u z henis like a small ham mer T he length of its
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Part
handle is about cm One of its ends is assembled with a lotus podshaped base on w hich
stainless steel needles are embedded T he names are given according to different numbers of
needles inlaid e g plumblosso m needle needles sevenstar needle needles or arhat
needle needles T he tips of needles should not be too sharp but as sharp as a pine needle
T he handle of the needle should be strong and flexible All the needles should be even w ell
arranged and free from any bias hooks rust or defects T he Roller needle w hich has a cylinder
shaped and is made of steel needles is one of the skin needles that w ere developed in modern
times T he advantages of using it are convenient manipulation it provides an ex tensive
stimulation area along with a w elldistributed stimulation strength and simple application
A T apping Locations In general there are different tapping locations tapping along the
meridians on the acupoints and on local areas
a Tapping Along the Meridians X un J ing K ou Ci Tapping along the meridians is
mostly used on the G V and bladder meridians of foot tai yang w hich are located from the nape
of the neck to the lumbosacral area T he G V meridian is the sea of all the y ang meridians
w hich regulates the yangqi in the entire body All the backshu points of the z ang f u organs
are distributed along the bladder meridian of foot tai yang they are used extensively for many
diseases T his method is also used on meridians belo w the elbo w or knee joints on w hich the
y uanprimarysourcepoints luoconnectingpoints x icleftpoints and other specific points
are dispersed So diseases of the meridians and z ang f u organs can be treated by tapping on
corresponding areas
b T apping on the Acupoints X ue W ei K ou Ci U sing this method appropriate acupoints
are selected for tapping based on their indications T he most com monly used acupoints consist
of various specific points H ua tuo j ia j ispinal points and A shi points
c Tapping on Local A reas J u B u K ou Ci T his method is used for tapping on the
affected area For example treating local stasis and pain after sprains and styes
B T he Intensity of Stimulation and Course of T reat ment Stimulation intensity depends on
the tapping areas location the patients constitution and their pathological condition Generally
it is classified into the follo wing categories
a Gentle Tapping Qing Ci Light tapping is done until the skin beco mes flush and
congested this is used on head and face and is advisable for elderly w eak or female patients as
w ell as patients with deficiency syndromes or those with requiring ex tensive treat ments
b Heavy T apping Zhong Ci H eavy tapping is done until the skin becomes apparently
flush and is slightly bleeding T his method is com monly applied to tender points on the back
and buttocks area of strong young patients and those excessive syndromes or acute outbreaks
c M oderate Tapping Zhong Ci M ediumstrength tapping is done somew here bet w een
light and heavy stimulation until the skin becomes relatively flush but not bleeding w hich is
advisable for general locations
In general treat ments with tapping are done once a day or every other day treat ments
459
constitute a complete course with an interval of days bet w een each course
C Manipulation
a T apping M ethod K ou Ci A fter the routine sterilization on needles and the tapping
area with a solution of alcohol hold the handle with the thumb middle and ring fingers of
needling hand at the end of handle near the posterior portion of palm ex tend the index finger to
apply pressure to the middle section of handle and place the head of needle directly over the
skin Tap the skin with needle tips with a loose flexible movement of the w rist then rebound
up im mediately and continue repeatedly tapping in this manner W hile tapping the needle tips
should be held perpendicularly over the skin the location should be exact and the strength
should be even Different locations and strength may be used according to different treat ment
requirements
b Roller Pricking Gun Ci A fter sterilization with a solution of alcohol use the
speciallymade roller needle hold the handle of the roller and roll back and forth over the skin
of the affected area creating a long and narro w surface of stimulation or an ex tensive area as
needed
5 4 2 2 Indications
T here is a very w ide range of applications for cutaneous needling to include myopia optic
nerve atrophy acute tonsillitis com mon cold cough chronic gastrointestinal disease
constipation headache insomnia lumbago enuresis cutaneous

dysmenorrhea
neuritis alopecia and
5 4 2 3 Precautions
A T he needles should be frequently inspected T he tips of the needles should be even and
free from hooks Roller needles should be flexible
B T apping manipulations should be s wift and gentle Needle tips should descend
perpendicularly avoiding oblique angles clawing or teasing w hich will cause more pain
C Tapping should never be applied to areas with ulcers or traumatized tissue
D T he local skin surface should be cleaned and sterilized to prevent infection after heavy
tapping on local areas or acupoints that result in bleeding
E Roller needling is inadvisable on bony prominences to avoid pain or bleeding
5 4 3 Intradermal Needling Therapy Pi Nei Zhen Fa
Intrader mal needling involves a specially made small needle that is embedded into or
beneath the skin for a relatively long period of time It is also kno w n as needle embedding
therapy M ai Zhen Fa T he implanted needle can generate continuous stimulation on
acupoints and regulate the function of the meridians and z ang f u organs to prevent and treat
diseases
T here are t w o types of intrader mal needles One is the granular K e L i type also kno w n
as w heat grainlike M ai L i Zhen It is cm long w ith a handle like a grain of w heat the
body of the needle is parallel to the handle T he other type is the thumbtack T u or Qin D ing
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Part
about cm long with a ringlike handle T he body of needle is perpendicular to the

handle
Intrader mal needles forceps and the local area to be embedded should be appropriately
sterilized before insertions
A Granular T ype K e L i X ingIntrader mal Needles Clamp the handle of the needle with
forceps prick the needle directly into the acupoints until the body of needle is embedded
cm beneath the skin leaving its handle outside the skin fix it in place w ith a piece of
adhesive tape
B T humbtack T ype Qin D ing X ing Intrader mal Needles Clamp the handle with
forceps press the needle directly into the acupoint and fix it in place with a piece of adhesive
tape or adhere the handle to the adhesive tape hold the tape and press the needle into the point
T he embedding duration of depends on different pathological conditions generally
days one w eek at most During hot seasons the needles should not be allo w ed to be retained for
extended periods generally for days to avoid infection While embedded the needle should
be pressed times a day for minutes to strengthen the stimulation and enhance the
therapeutic effect
5 4 3 2 Indications
Intrader mal needle therapy is com monly used for chronic persistent and stubborn diseases
or illnesses w ith recurring pain w hich require prolonged retention of the needle s E xamples
are neurotic headaches facial palsy biliary tract pain lumbago bisyndrome neurasthenia
hypertension asthma enuresis dysmenorrhea uterine contractions and postpartum pain
5 4 3 3 Precautions
A T ry to avoid embedding the intrader mal needle at the joints to prevent pain with
motion E mbedding needles on the chest or abdo men are inadvisable since these areas move
during respiration
B If the patients feel pain or has restricted motion follo w ing needle implantation the
needle should be removed and another acupoint selected
C T he area around the needle should be kept dry to prevent infection during the sum mer
and the needles should stay embedded for a shor ter period of time
5 4 4 ElectroAcupuncture Therapy Dian Zhen Fa
Electrotherapy co mbines needling and electrical stimulation by sending a small electric
current through the needle after insertion and arrival of qi to prevent and treat diseases Its
benefits are that it is a substitute for the periodic manipulations that w ould nor mally be done by
the practitioner as w ell as an objective control and regulator of the stimulation intensity
T here are many types of instruments used in electrotherapy though all of them are
assembled with an oscillation generator T he output is a lo wfrequency impulse current that
approximates the bioelectricity nor mally generated by the human body T his instrument can be
461
used not only for electrotherapy but also for treat ment by put ting point or plate electrodes on
the acupoints or affected areas T his therapy is used ex tensively in clinical settings as it provides
of high stimulation intensity yet it uses very little electricity and it is compact and portable
A Point Prescriptions T he selection and organization of acupoints for electrotherapy is
the same as filifor m needling therapy T he principal acupoints are generally selected and
combined with corresponding ancillary points for electrotherapy It is advisable to select

pairs of acupoints on the same side
B Electrotherapy M anipulations A fter inserting the needles and the arrival of qi adjust
the output potentiometer to then connect the cathode outlet to the principal acupoint and
the anode to the assistant point A n option is without differentiation bet w een cathode and
anode just connect the t w o outlets to the handles of t w o needles respectively T he same pair of
outputs elect rodes are com monly connected to the same side of the body S witch the po w er
supply on and select the required w avelength then adjust the output current slo w ly from small
to large until you have a suitable size Generally the current time is minutes for each
treat ment In cases of pain the time usually lasts minutes If the patient feels that the
stimulation is too w eak the current may be either increased appropriately or stopped for
minutes before being s witched on again When the required time is up first adjust the output
potentiometer back to then turn off the po w er supply and disconnect the outlets from the
needles A fter that the needles are withdra w n as per usual
C Electrical Current Stimulation Intensity When the current is adjusted to certain
intensity the patient w ould have the sensation of numbness soreness or pain T he current
intensity is called the T hreshold of Sensation If the current intensity becomes larger the
patient may suddenly feel a tingling sensation If the current intensity is painful its called the
T hreshold of Pain Different thresholds of sensation and pain depend on different people and
or different pathological conditions Generally the current intensity bet w een the threshold of
sensation and threshold of pain is the optimal one but its range is so narro w that careful
adjust ment is necessary Since the patient does not w ant the current intensity to go beyond the
threshold of pain it is advisable to set the current intensity within a range that is tolerable
Sometimes the patients tolerance range to the electrical stimulation increases so the current
may need to be periodically adjusted during treat ment
5 4 4 2 Actions and Indications
T he actions and indications of electrotherapy are as ex tensive as those of filifor m needling
therapy Almost all the diseases that respond to filifor m needling therapy can be treated with
electrotherapy Especially w ith acupuncture anesthesia for w hich electrotherapy is primarily

used
T he impulse current is produced by the sudden change in voltage or current taking place in
an extremely short period of time In other w ords the elect rical impulse is composed of the
sudden change in electric capacity Generally the basic w avefor m output fro m an electric
462
Part
stimulator is an alternating impulse current and it usually consists of a biphasic spike pulse or
biphasic rectangular pulse T he com monly used output w avefor ms are sparsedense w aves
inter mittent and continuous w aves
A SparseDense Waves S hu M i Bo T his w avefor m automatically alternates from sparse
to dense w aves each one lasting about seconds respectively T he single w avefor m is
susceptible to adaptation this defect could be retrieved by sparsedense w avefor ms Its main
therapeutic effect is excitation w hich promotes metabolism circulation of qi and blood
improves the nut rient supply to tissues and acts on eliminating inflam matory edema It is
com monly used for bleeding sprains or strains periarthritis impair ment circulation of qi and
blood sciatica facial palsy muscular atrophy and frostbite
B Inter mittent Waves D uan X u Bo T hese are sparse w aves that are automatically and
regularly interrupted continuous impulses N o impulse is generated for seconds during
interruptions w hile during continuous phase dense w aves last for seconds T his w avefor m
is also free from adaptive tendencies and its motive po w er is strong to enhance the excitation of
muscle tissue It is usually used t o treat paralysis
C Continuous Waves L ian X u Bo T hese are also kno w n as adjustable w aves they are
composed of a combination of single impulses moving in different w ays Its frequency differs
from a few decades per minute to a few hundreds per second T he w aves with high frequencies
generally bet w een timessec are called dense w aves or high frequency continuous
w aves and the lo w frequency w aves timessec are sparse w aves or lo w frequency
continuous w aves T he frequencies of sparse or dense w aves can be adjusted by frequency
knob High frequency continuous w aves tend to inhibit sensory and motor nerves so it is
com monly used for pain relief sedation and the remit tance of spasms in muscles or vessels
Lo w frequency continuous w aves excite muscles with shortter m usage but inhibit sensory and
motor nerves during longter m usage so it is usually applied for paralysis various impair ments
of muscles joints or tendons as w ell as chronic pain

5 4 4 3 Precautions
A Since electrical stimulation is relatively strong needle fainting should be prevented
especially patients w ho are nervous or have w eak constitutions strong intensities are
inadvisable
B When adjusting the electric current sudden increases should be avoided to prevent
sudden andor intense muscular contractions w hich could result in bent or broken needles Since
sparsedense and inter mit tent w aves fluctuate patients alw ays feel that the stimulation
suddenly becomes stronger so it is advisable to adjust the output slo w ly w hen the frequency
lamp indicator blinks or sho w s a high frequency w ave
C For the electric stimulator w ith more than V of maximum output voltage the
maximum output current should be limited to w ithin m A in order to avoid getting an electric
shock
D A fter w ar ming needle moxibustion the needle handle may be burnt and its surface
463
oxidized w hich will cause it to lose electrical conductivity T herefore it is inadvisable to use
these needles w hen doing electrotherapy
E A void passing the electric current through the heart for patients with heart disease
Further more electrotherapy is contraindicated for patients with cardiac pacemakers When
electrotherapy is used near the medulla oblongata or spinal cord the electric current should
have small w avelengths with lo w intensities to prevent accidents Precautions should be taken
with pregnant w omen w hen using electrotherapy
F A t tention should be paid to the pheno menon kno w n as need ling tolerance during
electrotherapy w hich occurs after long ter m or repeated application tolerance to electrical
stimulation may result in w eakening the therapeutic effect
G Before usage the electric stimulator should be examined carefully if the electric current
output is inter mittent check the conductivity of the outlets If should only be used after
examination or repair When the battery is lo w the current output beco mes w eak so the
batteries should be replaced
5 4 5 Point Injection Therapy Xue Wei Zhu She Fa

T his therapy involves using a syringe to inject liquid medication into the acupoints to
prevent and treat disease in other w ords incorporated the comprehensive effect of treating
disease by co mbining the actions of medicine with acupuncture

A Needle Apparatus Sterilize disposable syringes and needles are selected and used
according to different requirements
B Acupoint Selection T he principles associated with acupoint selection are the same as
that of filifor m needling therapy H o w ever with this therapy local positive sensitive spots
trigger pointsare usually chosen by palpation on the meridians or acupoints Tenderness and
bandlike tubercles nodes bulges hollo w s or changes in the skin color may be present on
specific points on the back chest abdo men or the ex tremities Since the selection of too many
points go against this essentially simple principle only points are generally selected for
each treat ment
C Injection Dosages Dosages should not exceed those given in the instructions and
suggested by the manufacturer U sually smaller dosages of the usual dosage are
reco m mended In addition the location of the acupoints should be taken into account In the
ears ml of liquid medication is suitable for injection for the head and face ml in
the four extremities ml in the chest and back regions ml and in the lumbar and
but tock regions ml or approximately ml of a solution of glucose
D Manipulation First help the patient assume an appropriate comfortable position Select
a suitable syringe and needle to draw the selected liquid medication sterilize the local area of
skin fix the selected point or positive sensitive spot with one hand hold the syringe and quickly
insert the needle into the point with the other hand Slo w ly depress the needle until the tip
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Part
reaches the proper depth w hen the patient feels the needling sensation and there is no blood in
the syringe after being draw n inject the liquid medicine into the point When the medicine is
being injected either push it fro m the deep to superficial level as the needle is withdraw n or
inject medicine in various directions
E Course of T reat ment For patients with acute diseases times for those with
chronic diseases once a day or every other day generally For those with strong reactions
injections can be done once every t w o or three days Injections can be alternated in acupoints on
the left and right side A course of treat ments consists of injections with an interval of
days bet w een each course

5 4 5 2 Indications
T his therapy can be used in all diseases that are suitable for acupuncture treat ment but it
is mostly indicated for bisyndrome and pain in the lo w er back and the leg
5 4 5 3 Commonly Used Medicinals
Generally the appropriate medicine is selected according to the pathological condition and
the medicinal properties
All liquid medicines used for intramuscular injections can be used for point injection
Chinese medicinals co m monly used as parenteral solutions consists of the follo wing Dang Gui
A ngelica root H uang Qi A stragalus root Dang S hen Sal via root H ong H ua
Sa ff lo w er Ban L an Gen I satis roo X u Chang Qing P aniculate S w allow w ort root Deng
Zhan H ua H erba E r i gerontis Bu Gu Zhi P soraleae f r uits Chai H u B u p leurum root Y u
X ing Cao H ear tlea f H outtuy nia H erb and Chuan X iong Rad i x L i gustici Western
medicinals include magnesium sulfate vitamin B B C K procaine
hydrochloride at ropine apoplon adrenosem ephedrine antibiotics aprednisolon
physiologic saline
and
5 4 5 4 Precautions
A Before treat ments patients should be infor med about the nor mal reactions of this
therapy in order to dispel any apprehensions they might have Soreness or a distending
sensation may be present in the local area after an injection there may be some slight
discomfort in the local area after hours or longer but nor mally no more than day
B Strict aseptic technique should be observed to prevent infection If the skin is red and
s w ollen or if there is heat in the local area after injections it should be dealt w ith im mediately
C Attention should be paid to the natures pharmacological actions dosages incompatibilities
side effects and allergic reactions of all the medicines to be used In addition all medicines
should be checked for expiration dates and any evidence of sedimentation or fluid degeneration
D H ypersensitivity tests are necessary before medicines w hich might possibly produce
allergic reactions are used T o avoid accidents fluid medicines should not be injected into the
articular cavities spinal canal or vessels In addition injections into nerve stems should be
avoided to prevent injuries to nerves
E Pregnant w omen are at risk of aborting if the injections w ere received in the lo w er
465
abdomen or lumbosacral area and points such as Sany in j iaoSPand H egu LI Also fluid
dosages should be decreased and few er acupoints selected for elderly individuals and individuals
with w eak constitutions
5 5 Scalp Acupuncture Tou Zhen

Scalp acupuncture therapy involves needling specific stimulation areas of the scalp for the
prevention and treat ment of disease It originated from t w o theories the theory of traditional
z ang f u organs and meridians and the projection area of cortical functional localization on the
scalp Corresponding scalp lines w ere then defined based on these theories
Scalp acupuncture has been developed on the basis of traditional acupuncture theory It is
stated in S u W en M ai Yao J ing W ei that T he head is T he house of intelligence Since all the
yang meridians traverse the head and face the head is the confluence of all the y ang meridians
A mong the six y in meridians only the hand shaoy in and foot j uey in meridians go through the
head and face directly but the other y in meridians go to the head and face indirectly by the
convergence of diver gent parts of the y in meridians with yang meridians T here is an abundance
of records that refer to the treat ment of diseases using the acupoints on the head in literary
texts such as Zhen J iu J ia Yi J ing and Zhen J iu D a Cheng
Scalp acupuncture is universally employed in clinics at present A fter years of practice and
more experience related to the location of its points and lines the indications and manipulation
methods abound It is no w beco ming one of the most frequently used therapeutic methods
employed by clinical doctors in many countries In order to adapt to the international spread and
exchange of infor mation on scalp acupuncture therapy and to facilitate its development a book
Standard Scalp Acupuncture N omenclature w as for mulated by the Chinese Acupuncture
Academy on the principles of selecting points on the meridians deter mined by their locations on
various regions of the head in conjunction w ith the classical methods of throughneedling
threadingneedling from one point to reach one or more other points T his nomenclature w as
for mally approved at the W H Os Western Pacific Regional Consultation Meeting in T okyo in
T he description of the standard nomenclature of scalp acupuncture and the basic lines for
the locations of acupuncture points in the present book are based on the contents of Standard
Scalp Acupuncture N omenclature
5 5 1 Standard Scalp Acupuncture Locations and Indications

A ll the standard basic lines of scalp acupuncture are located on the scalp T here are
areas corresponding to their anato mic nam es on the skull frontal parietal tem poral and
occipital and basic lines on each hemisphere plus the midline lines in all co m prise the
left side righ t side and the center T heir no menclature locations and indications are as
follo w ing
466
Part
5 5 1 1 Frontal MidLineMS1
Location Forehead area cun in length from S henting G V st raight do w n along the
meridianFig
Indications Epilepsy mental disorder rhinopathy
Fig In Anterior View
5 5 1 2 Frontal Lateral Line 1MS2
Location Forehead area cun in length from MeichongBLstraight down along the meridian
Fig
Indications Coronary heart disease bronchial asthma bronchitis insomnia nasal disorders
5 5 1 3 Frontal Lateral Line 2 of the ForeheadMS3
Location Forehead area cun in length from T oulinqi GB straight do w n along the
meridianFig
Indications Acute and chronic gastritis gastric and duodenal ulcers liver and gallbladder
diseases
5 5 1 4 Frontal Lateral Line 3MS4
Location Forehead area cun in length from the point cun medial to T ou w ei S T
straight do w nFig
Indications Dysfunctional uterine bleeding impotence seminal emission uterine prolapse
urinary frequency and ur gency
5 5 1 5 Vertex MidLine MS5
Location Vertex area from Baihui G V to Qianding G V along the midline of the
headFig
Indications Disorders of the lo w er back legs and feet e g paralysis pain or paraesthesia
cortical hyperdiuresis anal prolapse enuresis hypertension vertex pain
467
Fig In Vertex View
5 5 1 6 Anterior VertexTemporal Oblique LineMS6
Location Vertex area and cephalic region From Qianshencong one of the acupoints of
SishencongE XH N cun anterior to Baihui G V obliquely to X uanli GB Fig
Indications T his entire line is divided into equal parts T he upper is used for
treating paralysis on the contralateral lo w er limb and trunk the middle are for paralysis of
the upper limb the lo w er are for central facial palsy ataxic aphasia salivation cerebral
atherosclerosis
5 5 1 7 Posterior VertexTemporal LineMS7
L ocation V ertex area and cephalic region cun posterior and parallel to the anterior
oblique line of vertextem poral F ro m B aihui G V obliquely to Qubin G B Fig
Indications T his entire line is divided into equal parts T he upper is used to treat
paraesthesia in the contralateral lo w er limb and trunk the middle are for paraesthesia in the
upper limb and the lo w er are for paraesthesia on the head and face
5 5 1 8 Lateral Vertex Line 1MS8
Location Vertex area cun lateral to G V cun in length posterior from T ongtian
BLalong the meridianFig
Indications Disorders of the lo w er back and legs e g paralysis paraesthesia and pain
5 5 1 9 Lateral Vertex Line 2MS9
Location Vertex area cun lateral to G V cun in length posterior from Zheng y ing
GBto Cheng lingGBFig
Indications Impairment of the shoulders arms and hands such as paralysis numbness or pain
5 5 1 10 Anterior Temporal LineMS10
Location T emporal area fro m H anyanGBto X uanliGBFig
Indications Migraines ataxic aphasia peripheral facial palsy oral diseases
468
Part
Fig In Lateral View
5 5 1 11 Posterior Temporal LineMS11
Location T emporal area fro m S huai guGBto QubinGBFig
Indications Migraines tinnitus deafness vertigo
5 5 1 12 Upper Occipital MidLineMS12
469
Location Occipital area from Qiang j ianG Vto N aohuG V cun in lengthFig
Indications Eye diseases foot ring w or m
5 5 1 13 Upper Occipital Lateral LineMS13
Location Occipital area cun lateral and parallel to the uppermidline of the occiput
Fig
Indications Cortical visual disorders cataracts myopia
5 5 1 14 Lower Occipital Lateral Line MS14
Location Occipital area cun in length from Yu z henBLstraight do w nFig
Indications Balance disturbances resulting from diseases of the cerebellum occipital pain
Fig In Posterior View
5 5 2 Indications for Scalp Acupuncture Therapy

Scalp acupuncture therapy is often used clinically to treat cerebral diseases e g hemiplegia
as a sequelae of apoplexy numbness of the extremities aphasia cortical hyperdiuresis vertigo

tinnitus chorea epilepsy cerebral palsy mental retardation agitans paralysis and supranuclear
paralysis O ther com mon or frequently occurring diseases such as headaches trichomadesis
spinal paraplegia hypertensive disease neuropsychosis insomnia oculopathy rhinopathy peri
arthritis of the shoulder posterior leg pain and a variety of painful diseases can also be treated
with scalp acupuncture therapy
5 5 3 Manipulations Methods
5 5 3 1 Positions
With the patients cooperation allo w them to assume seated or lying position Scalp points
should be selected according to the diagnosis and the acupoints disinfected as per usual
470
Part
5 5 3 2 Insertions
Generally No cun filiform needles are used along the subcutis of the scalp at a
angle insert the needle quickly into the skin until the tip of needle extends beneath the epicranial
aponeurosis or the force of the resistance felt by the manipulating fingers diminishes Hold the needle
parallel to the scalp and continue to twirl it until it reaches an appropriate depth according to the point
sselected
5 5 3 3 Manipulation
Generally the needle handle is held with the thumb pad and the radial aspect of the index
finger T wist the needle by rapidly and continuously flexing and extending the metacarpo
phalangeal joint of the index finger T he t wisting speed should be approximately times
minute T wist the needle continuously for minutes after the needle has been inser ted and
retain the needle for minutes Repeat this manipulation times then withdraw the
needle T he needle retention time may be extended depending on the pathological condition
Allo w patients with hemiplegia to move their ex tremities passiveassisted movements should
be done for patients with severe hemiplegiain order to enhance the therapeutic effects Some
patients will generally feel heat sensations numbness distension or vibrations in andor on the
affected areasafter minutes of stimulation

5 5 3 4 Needle Withdrawals Qi Zhen
Press the scalp around the point with the palpating hand hold the needle handle and rotate
it gently and slo w ly as you w ithdraw it with the needling hand Pressure should be applied to
the insertion hole momentarily to prevent bleeding follo wing the withdra w al
5 5 4 Precautions
A Due to the presence of hair on the scalp appropriate aseptic technique should be
employed to prevent infection
B Due to the duration and strong stimulation of scalp acupuncture practitioners should be
cognizant of the patients facial expressions in an at tempt to decrease the incidence of needle
fainting
C Scalp acupuncture therapy inadvisable for infants w hen their fontanels have not yet
closed
D Scalp acupuncture is inadvisable for patients during the acute stages of a hemorrhagic stroke
when they are in coma or their blood pressure is too high Once these conditions have stabilized
treatment with scalp acupuncture can begin However scalp acupuncture should be used as early as
possible for patients with hemiplegia due to cerebral infarctionischemic strokes Scalp acupuncture
should be used cautiously in cases where patients have complications such as high fevers acute
inflammations or heart failure
E T here is a high incidence of bleeding w hen doing scalp acupuncture due to the
abundance of blood vessels in the scalp T herefore it is important to remember that appropriate
pressure should be applied to the insertion hole with a dry cotton ball for minutes
follo wing the withdraw al of the needles
471
F O ther therapeutic modalities may be done in conjunction with stimulation w ith filifor m
needles on scalp points to include electrotherapy moxibustion or palpation
5 6 Ear Acupuncture Therapy Er Zhen Liao Fa
Ear acupuncture therapy treats and prevents diseases by stimulating certain points on the
auricles w ith needles or other methods T his therapy incorporates a widerange of indications
and its a simple technique It is also used as a diagnostic indicator for disease
A uricular diagnostic and therapeutic methods w ere first documented in N ei J ing It is
recorded in L ing S hu W u X ie Spiritual Pivot T he Five Evils that w hen pathogenic factors
at tack the liver it will cause pain in the hypochondria needle the blue vessels around the ear
to relieve the dragging pain In the L ing S hu J ue B ing Spiritual Pivot Syncopeit says
for the deaf w ho cant hear needle the center of the ear It is also recorded in Qian J in Yao
Fang that needling pointcenteris an appropriate treat ment for jaundice diseases due to cold
sum merheat or epidemic pathogenic factors In other classic medical literary tex ts there are
descriptions of stimulating the ears and certain auricular areas with needles moxibustion
massage and herbal suppositories to treat and prevent diseases as w ell as inspecting and
palpating the auricles to assist in disease diagnoses T hese methods are still used as folk
remedies w hich demonstrate that auricular therapy has a very long history associated with the
diagnosis and treat ment of diseases in China In order to facilitate international research and
com munication T he Chinese Acupuncture and M oxibustion A ssociation for mulated T he

National Standard of N o menclature and Location of A uricular Points
5 6 1 The Relationship between the Ears Meridians and the ZangFu Organs
The ears are closely correlated to the meridians Information aboutear channels was recorded as
early as years ago in silk scrolls known Yin Yang Shi Yi Mai Jiu Jing More extensive
information is found in H uang Di Nei Jing about the relationship between the ears meridians
divergent channels and muscle regions e g meridians and how their divergences hand taiyang hand
and foot shaoyang and hand yangming go into the ear the meridians of foot yangming and foot
taiyang are anterior and superior to the ear respectively All the yin meridians dont go into the ear
directly but they are indirectly connected to the ear through their divergent channels which converge
with the corresponding yang meridians In short all the twelve meridians either go directly or
indirectly to the ear Among the eight extra meridians the yin heel vessel and yang heel vessel
meridians are distributed over the posterior area to the root of the ear the Yin link vessel meridian
passes through the head and subsequently enters the ear In chapter of Ling Shu it says thatthe ear
is the confluent place of all the meridians
T here is also a close relationship bet w een the z ang f u organs and the ears T he
472
Part
physiological correlations bet w een the ear the five z angorgans are recorded in N ei J ing as w ell
as in N an J ing in L ing Shu J ing Mai it saysthe qi of the kidney connects the ear making the
ear hear various kinds of sounds It is also stated in the chapter of N an J ing thatthe lung
do minates sound making the ear hear the sound Later doctors discussed the relationship
bet w een the ears and the z ang f u organs in more detail In Zheng Zhi Zhun Sheng T he
Standards of Diagnosis and T reat ment it says thatthe kidney is the master of the ear and the
heart is its guest It is recorded in L i Zheng A n Mo Yao S hu T he Revised Synopsis of

M assagethat the tragus pertains to the kidney the helix to the spleen the supraauricular
helix to the heart the skin and flesh of the ear to the lung and the bony prominence on the
dorsal surface of the ear per tains to the liver T he auricle is divided into five parts corresponding
to the five z ang f u organs w hich further indicates that the ear is closely related to the z ang f u
organs in physiological function
When diseases or disorders are present in the internal organs or tissues of the body positive signs
and characteristic changes in the electrical resistance of the skin may occur on corresponding areas of
the auricles These signs and changes not only provide reliable evidence for diagnosing diseases but
also for determining the selection of auricular points to be used in its treatment
5 6 2 Auricular Surface Anatomy
T he auricle is classified into the concave part of the anterior ear and the convex part of the
posterior aspect of the ear T he follo wing is a list of their anatomical nomenclatureFig
Fig Anatomical Structure of the Auricle
Helix T he portion of the auricular border that bends in w ard
Helix T ubercle T he nodular process on the posterosuperior portion of the auricle
473
Helix Cauda T he inferior part of the helix at the junction of the helix and the lobule
Helix Crus T he portion of the helix w hich ex tends into the auricular concha
A ntihelix T he Yshaped prominence opposite to the helix w hich co mposes the principal
part of antihelix and the superior inferior crus of the antihelix
T he Principal Part of A ntihelix T he inferior section of antihelix parallel to the helix
Superior A ntihelix Crus T he superior branch of the upper portion of the antihelix
Inferior Antihelix Crus The inferioanterior branch of the upper portion of the antihelix
T riangular Fossa T he triangular depression bet w een the t w o branches superior &
inferiorof the antihelix crus
Scapha T he groove bet w een the helix and the antihelix
T ragus T he cartilaginous projection or rounded flap in front of the auricle anterior to the
ear opening
Supratragic N otch T he depression bet w een the upper tragus and the helix crus
A ntitragus T he projection superior to the lobe and opposite t o the tragus
Intertragic N otch T he depression bet w een the tragus and antitragus

Helix N otch T he depression bet w een the antitragus and antihelix
Lobe T he lo w est portion of the auricle w here there is no cartilage
Concha T he depression bet w een part of the helix antihelix antitragus tragus and orifice
of the external auditory foramen w hich consists of cy mba concha and cavum concha
Cavum Concha T he cavumcavityinferior to the helix crus
Cymba Concha The cavumcavitysuperior to
the helix crus
Orifice of the E x ternal A uditory M eatus
T he opening in the cavum concha
5 6 3 Auricular Point Distribution

Auricular points are specific areas distributed
on the auricle in a specific pattern The distribution
of auricular points and areas resemble the shape

of an upsidedo w n fetusFig
T he rule is
as follo w s Points located on the lobe are related
to the head and facial region T hose on the
scapha to the upper ex tremities T hose on the
antihelix and its t w o crura to the trunk and

lo w er ex tremities T hose in the cavum and
cymba concha to the internal organs

5 6
Fig Distribution of the Ear Points
4 Auricular Point Locations and Indications
In order to measure the points exactly according to its anatomy the auricle is divided into
474
Part
zones in every portion in T he National Standard of N omenclature and Locations of A uricular

Points T here are points in allFig
Fig Schematic Diagram of Distribution of Auricular Points
5 6 4 1 Points on the Helix
T he helix is divided into zones T he helix crus is Zone T he area from the notch of the
helix crus to the upper border of inferior antihelix crus is divided into equal portions T hey
are fro m bottom to top Zones and T he portion of the helix from the upper border of the
475
inferior antihelix crus to anterior border of superior antihelix crus is Zone Zone of helix is
from the anterior border of the superior antihelix crus to the apex of ear T he upper border of
helix tubercle is Zone and from the upper to the lo w er border of the helix tubercle is Zone
T here are equal portions from the lo w er border of the helix tubercle to the notch bet w een the
helix and the lobe they are from top to bottom Zones and
T he locations and indications of the points on the helix are sho w n in Table
Table 5 4 Helix Point Locations and Indications

Name of Point
Center of the Ear
Rectum
Urethra
External Genitals
Anus
Ear Apex
Tubercle
Helix
Location
The helix crus
Zone
Hiccups urticaria hives pruritus of the
skin enuresis hemoptysis and other bleeding
disorders
Anterior & superior to the ridge of the Constipation diarrhea anal prolapse hemor
helix crus
rhoids
Superior to the rectum
Frequent painful dribbling urination reten
Zone
Zone
Anterior to the inferior antihelix crus
Zone
tion of urine
Testitis epididymitis pruritus vulvae
Anterior to the triangular fossa
Hemorrhoids anal fissures
Tip of the auricle superior to the helix
Fever hypertension acute conjunctivitis
Zone
when folded towards the tragus
hordeolum toothache insomnia
On the helix tubercle
Dizziness headache hypertension
Inferior to the helix tubercle
Fever tonsillitis upper respiratory tract in
The junction of Zone and
Zone
Zone
fection
Zone
fection
Zone
fection
Zone
fection
Helix
Inferior to helix
Helix
Superior to helix
Helix
Indications
Inferior to helix
5 6 4 2 Points on the Scapha
T he scapha is separated into equal sections w hich are listed in descending order as Zones
and Table
476
Part

Table 5 5 Scapha Point Locations and Indications
Name of Point
Fingers
Wrist
Wind Stream
Feng X i
Elbow
Shoulder
Clavicle
Location
Indications
The upper section of the scapha
Paronychia pain and numbness of the fingers
Inferior to the Fingers
Wrist pain
Zone
Zone
Between the fingers and wrist in front of
Urticariahives pruritus of the skin allergic
the helix tubercle
rhinitis
Inferior to the wrist
External humeral epicondylitis elbow pain
Inferior to the elbow
Periarthritis of the shoulder shoulder pain
Inferior to the shoulder
Periarthritis of the shoulder
Zone
Zone
Zone and
Zone
5 6 4 3 Points on the Antihelix
T he antihelix is separated into sections
T he superior crus of the antihelix is separated into equal sections T he lo w er third is
Zone the middle Zone and the upper is divided into equal sections T he inferior section is
Zone of antihelix T he superior section is separated into t w o equal parts T he posterior half is
Zone and the anterior half is Zone
T he inferior crus of the antihelix is also separated into equal sections T he middle and
anterior are Zone and the posterior third is Zone
T he body of antihelix the area bet w een the trunk of the t w o crura and helix notch is
separated into equal sections then divided into t w o seg ments along the concha border an
anterior and a posterior T he anteriorsuperior is Zone the posteriorsuperior
is Zone the anteriormiddle is Zone the posteriormiddle is Zone anterior

inferior section is Zone and the posteriorinferior section is Zone T able
Table 5 6 Antihelix Point Locations and Indications
Name of Point
Heel
Toes
Location
Anteriosuperior section of the superior
crus
Zone
Posteriosuperior section of the superior
crus inferior to the apex

Zone
Indications
Heel pain
Paronychia pain in the toes

Name of Point
Ankle
Knee
Hip
Location
Inferior to the toes and heel
Ankle sprains
Middle third of the superior crus
Pain of the knee joint sciatica
Zone
Zone
Lower third of the superior crus
Sciatic Nerve
Sympathetic
Buttocks
Abdomen
Zone
Anterior of the inferior crus
Zone
Junction between the terminus of the inferior
crus and the inner border of the helix

The anterior end of Zone
The posterior of the inferior crus
Zone
Superior of the anterior part of the
antihelix body
Zone
LumboSacral Ver Posterior to the Abdomen
tebrae
Chest
Thoracic vertebrae
Neck
Cervical Vertebrae
Indications
Zone
477
Continued
Pain of the hip joint sciatica pain of lumbo
sacral area paralysis of the lower extremities

Sciatica paralysis of the lower extremities
Gastrointestinal spasms angina pectoris bili
ary colic ureterolithiasis functional disturb
ances of the automatic nervous system

Sciatica gluteal fasciitis
Abdominal pain or distension diarrhea acute
lumbar strain dysmenorrhea afterpains

Pain in the lumbosacral region
The middle of the anterior part of the Chest and hypochondriac pain intercostals
antihelix body
neuralgia chest distress mastitis
Posterior to the chest
Chest pain premenstrual swelling and pain of
Zone
Zone
the breasts mastitis insufficient lactation af
ter childbirth
Inferior of the anterior part of the an Stiff neck neck pain
tihelix body
Zone
Posterior to the neck
Zone
Stiff neck cervical syndrome
5 6 4 4 Points on the Triangular Fossa
T he triangular fossa ex tends fro m the inner border of the helix to the crotch of the t w o
crura of the antihelix it is separated into three equal sections T he middle is Zone T he
anterior is divided into three equal parts superior middle and inferior the superior is
Zone and the middle and inferior are Zone T he posterior has t w o equal sections
T he superior is Zone and the inferior is Zone Table
478
Part

Table 5 7 Triangular Fossa Point Locations and Indications
Name of Point
Location
Superior T riangu Superior anterior of the triangular
lar Fossa
Internal Genitalia
fossa
Zone
The inferior part of the anterior of
the triangular fossa
Zone
Middle T riangular
Fossa
Ear Shenmen
Pelvis
The middle of the triangular fossa
Zone
Indications
Hypertension
Dysmenorrhea irregular menstruation leu
korrhagia dysfunctional uterine bleeding im
potence seminal emissions premature ejacu
lations
Asthma
The superior part of the posterior of
Insomnia excessive dreaming withdrawal
Zone
nia
The inferior part of the posterior of
syndrome epilepsy hypertension neurasthe

Pelvic inflammation appendagitis
Zone
5 6 4 5 Points on the Tragus
T he tragus is separated into zones T he lateral surface is separated into equal parts
T he superior par t is Zone of the tragus and the inferior part is Zone of the tragus T he same
separation is done on the medial surface of the tragus T he superior and inferior parts are Zone
and respectively T able
Table 5 8 Tragus Point Locations and Indications

Name of Point
Superior T ragus
Inferior T ragus
External Ear
Apex of T ragus
External Nose
Adrenal Gland
Location
Indications
Superior of the lateral surface
Pharyngitis rhinitis
Inferior of the lateral surface
Rhinitis nasal obstructions
Supratragic notch close to the helix
External otitis tympanitis tinnitus
T op of the upper eminence of the tragus
Fever toothaches anopsia
Center of the lateral surface of tragus
Nasal vestibulitis rhinitis
T op of the lower eminence of the tragus
Hypotension rheumatic arthritis mumps
Zone
Zone
Superior border of Zone
Posterior border of Zone
Between Zones and
Posterior border of Zone
streptomycin poisoning vertigo asthma cir
culatory collapse

Name of Point
Throat
Location
Upper half of the medial surface
Zone
Internal Nose
Lower half of the medial surface
Anterior T ragus
Zone
Indications
479
Continued
Hoarseness pharyngitis tonsillitis aphasia
asthma
Rhinitis maxillary sinusitis epistaxis
Lowest part of the tragus anterior to the Pharyngitis oral inflammation
intertragic notch
5 6 4 6 Points on the Antitragus
T he antitragus is separated into zones From the apex of the antitragus and the midpoint
bet w een the antitragus and the helix notch vertical lines are draw n to the upper line of the ear
lobe separating the lateral surface of the antitragus and its posterior aspect into parts T he
anterior part is Zone the middle Zone and the posterior part is Zone T he medial surface
of the antitragus is Zone Table
Table 5 9 Antitragus Point Locations and Indications

Name of Point
Forehead
tragic notch
Middle portion of the lateral surface of antitragus
Posterior portion of the lateral surface of antitragus
of
the
Migraine dizziness
Dizziness headaches epilepsy asth
Zone
ma neurasthenia
Zone
pseudomyopia insomnia
Intersection of Zones and
neurodermatitis
helix notch
sipidus functional uterine bleeding
Helix notch between the antitragus and the anti
Vertigo occipital pain pseudomyopia
Medial surface of the antitragus
Apex of the Anti
Brainstem
Frontal sinusitis
Zone of antitragus
Subcortex
Rim
Anteroinferior part of the tragus posterior to
Lower border of Zone
Occiput
Midpoint
Migraines dizziness
the intertragic notch
Temple
Indications
Anterior part of the lateral surface
Zone
Posterior inter
tragus
Location
Top of the antitragus
Pain tertian malaria neurasthenia

Asthma mumps testitis epididymitis
Midpoint between apex of the antitragus and the Enuresis auditory vertigo diabetes in
Intersection of Zone and

helix
Portion between Zone and
5 6 4 7 Points on the Concha
T he concha is separated in to zones by labeling points and lines given that the junction
480
Part
of the middle and upper of the inner mar gin bet w een the helix crus notch and the inferior
crus of the antihelix is point A W ithin the concha a horizontal line is dra w n posteriorly fro m
the end of the helix crus to the antihelix w hose intersection at the concha margin of the
antihelix is point D T he junction of the middle and posterior of the above line fro m the
end of the helix crus to point D is point B T he junction of the upper and the lo w er
of the posterior edge of the ex ternal audit ory canal opening is point C A curve w hich arc is
similar to the edge of the cy m ba concha on the antihelix is dra w n fro m point A to B T hen
another curve w h ose arc is similar to the inferior border of the helix crus is dra w n fro m point
B to C
Bet w een the anterior seg ment of line BC and the inferior border the helix crus is separated
into three equal portions the anterior is Zone of the concha the middle Zone and
the posterior is Zone T he portion at the end of the helix crus anterior to line ABC is
Zone T he area within the anterior seg ment of line AB the superior border of the helix crus
and the inner border of the helix is separated into equal portions the posterior is Zone
the middle Zone and the anterior is Zone
T he junction of the anterior and middle of the inferior border of the inferior antihelix
crus connects w ith point A to become a line T he area on the cy mba concha anterior to that line
is Zone T he par t behind the anterior seg ment of line AB and Zone is divided into equal
anterior and posterior portions that for m Zones and respectively Within the cymba
concha above the posterior seg ment of line AB the area bet w een the posterior border of Zone
and line BD is separated into t w o equal portions the upper is Zone and the lo w er is
Zone T he helix notch is connected with point B to become a line T he area on the cavum
concha posterior to and belo w line BD is Zone Given that the center of the cavum concha is
the center of a circle dra w a circle w ith the diameter equal to the distance bet w een that center
and line BC the circle is Zone T w o tangent lines crossing the apogee and perigee of Zone
are draw n respectively to the posterior w all of the external auditory foramen T he area bet w een
the t w o tangent lines is Zone T he area around Zone and is Zone Connect the
perigee of the external auditory foramen with the midpoint of the concha border of the antihelix
to for m a line then separate the area on the cavum concha belo w that line into t w o equal
portions the upper half is Zone the lo w er Zone T able
Table 5 10 Concha Point Locations and Indications

Name of Point
Mouth
Esophagus
Location
Indications
Anterior third of the area inferior to the Facial paralysis stomatitis cholecystitis cho
helix crus
lelithiasis withdrawal syndrome parodonti
Zone
tis glossitis
Middle of the area inferior to the he Esophagitis esophagospasms

lix crus
Zone

Name of Point
Cardia of the
Stomach
Stomach
Duodenum
Small Intestines
Large Intestines
Appendix
Angle of the Cym
ba concha
Bladder
Kidney
Ureter
Location
Liver
Middle of the
Cymba Concha
Spleen
Continued
Posterior of the area inferior to the Cardiospasm nervous vomiting
helix crus
Zone
End of the helix crus
Zone
Posterior of the area within the helix
Gastrospasms gastritis gastric ulcers indi
gestion nausea and vomiting frontal head
aches toothaches insomnia
Duodenal ulcers cholecystitis cholelithia
crus part of the helix and line AB
sis pylorospasms abdominal distension
Middle of the area within the helix

Indigestion bellyaches abdominal distension

tachycardia
Zone
Zone
Anterior of the area within the helix
diarrhea bellyaches
Diarrhea constipation cough toothaches
acne
Between the small and large intestines
Simple appendicitis diarrhea
Anterior area above the superior antihelix
Prostatitis urethritis
Zone
Junction of Zones and

crus
Zone
Middle area superior to the superior anti Cystitis enuresis urine retention lumbago
helix crus
sciatica occipital headaches
Zone
Posterior area superior to superior antihe Lumbago tinnitus neurasthenia nephropyeli
lix crus
Zone
Between the kidney and bladder

Juncture of Zones and
Pancreas & Gall Posteriosuperior area of the cymba concha
bladder
Indications
481
Zone
Posterioinferior area of cymba concha
Zone
Between the small intestines and kidney

Junction of Zones and
tis enuresis seminal emissions premature

ejaculations asthma irregular menstruation
Ureteral colic due to calculi
Cholecystitis cholelithiasis ascariasis of the
biliary tract migraines herpes zoster tympa

nitis tinnitus acute pancreatitis
Hypochondriac pain vertigo premenstrual
syndrome irregular menstruation menopaus
al syndrome hypertension myopia simple

glaucoma
Bellyaches abdominal distention ascariasis of

the biliary tract
Posteriosuperior area of the cavum con Abdominal distention diarrhea constipation
cha below line BD

Zone
poor appetite functional uterine bleeding

leukorrhagia Menieres disease
482
Part
Name of Point
Heart
T rachea
Lung
T riple energizer
Endocrine
Location
Central depression of the cavum concha
Zone
Indications
Continued
Tachycardia arrhythmias angina pectoris
pulselessness disease acrotism neurasthe
nia hysteria stomatoglossitis
Between the heart and the external audi Asthma bronchitis

tory foramen
Zone
Peripheral to the heart and T rachea

Zone
Cough chest distress hoarseness pruritus

urticaria hives constipation withdrawal
syndrome
Between the lung and endocrine area poste Constipation abdominal distension pain on
rioinferior to the external auditory foramen the lateral sides of the upper extremities
Zone
Anterioinferior area of the cavum concha Dysmenorrhea irregular menstruation meno
medial to the intertragic notch

Zone
pausal syndrome acne tertian malaria hy

perhypothyroidism
5 6 4 8 Points on Ear Lobe
T he ear lobe is separated into zones From the upper line to the perigee of the lo w er
border of the lobe three equidistant horizontal and t w o equidistant vertical lines are draw n
dividing the area is vertically and equally into zones T hese zones are numbered anterior to
posterior and from top to bottom Zone and of the lobe are located in the upper area Zone
and in the middle and Zone and in the lo w er area T able
Table 5 11 Ear Lobe Point Locations and Indications

Name of Point
Teeth
T ongue
Jaw
Anterior Lobe
Eye
Location
Anteriosuperior area of the frontal sur
face
Indications
Toothaches paradontitis hypotension
Zone
Middlesuperior area of the frontal sur Glossitis stomatitis
face
Zone
Posteriosuperior area of the frontal sur
Toothaches dysfunctia of the temporoman
face
dibular joint T MJ
Anteriomedial area of the frontal surface
Neurasthenia toothaches
Zone
Zone
Center of the frontal surface
Zone
Acute conjunctivitis flash ophthalmia horde
olum myopia

Name of Point
Internal Ear
Cheek
Tonsil
Location
Posteriomedial area of the frontal surface
Indications
Continued
Auditory vertigo tinnitis amblyacusia tym
Zone
panitis
Junctions of Zones and
verruca plana facial spasms mumps
Between the Eye and Internal ear

Inferior area of the frontal surface
Zone and
483
Facial paralysis trigeminal neuralgia acne

Tonsillitis pharyngitis
5 6 4 9 Points on the Dorsal Surface of the Ear
The dorsal surface of ear is separated into zones Two horizontal lines are drawn through the
locations on the dorsal surface corresponding to the beginning of the trunk of the two branches of the
helix and the helix notch respectively which divide the dorsal surface of ear into parts the upper area
is Zone the lower area Zone and the middle area is separated into equal portions the medial
is Zone the central is Zone and the lateral is Zone Table
Table 5 12 Dorsal Ear Surface Point Locations and Indications
Name of Point
Heart
Lung
Spleen
Liver
Kidney
Groove
Location
Indications
Upper area of the dorsal surface
Palpitations insomnia excessive dreaming
InnerMiddle area
Asthma pruritus
Center
Gastragia indigestion poor appetite
Midouter area
Cholecystitis cholelithiasis hypochondriac
Lower area
Headaches dizziness neurasthenia
Zone
Zone
Zone
Zone of dorsal surface

Zone
The groove formed by the two branches
of the antihelix
pain
Hypertension pruritus
5 6 4 10 Points on the Ear Root
T he locations and indications of the points on the ear root are sho w n in Table
Table 5 13 Ear Root Point Locations and Indications

Name of Point
Upper
Root of Ear Vagus
Location
Highest portion of ear root
Indications
Epistaxis
Junction of the dorsal surface of the auri Cholecystitis cholelithiasis ascariasis of the
cle and mastoid process
biliary tract bellyaches diarrhea nasal ob
structions tachycardia
484
Part
Name of Point
Lower
Location
Lowest portion of the ear root
Indications
Continued
Hypotension lower limb paralysis sequelae
to infantile paralysis
5 6 5 Clinical Applications of Auricular Points

5 6 5 1 Indications for Ear Acupuncture
A Pain Diseases Various sprains and bruises headaches neuropathic pain
B Inflammatory and Infectious Diseases For example acute and chronic colitis parodontitis
pharyngolaryngitis tonsillitis cholecystitis flu whooping cough bacillary dysentery mumps
C Dysfunctional Diseases Functional disturbances of the gastrointestinal tract cardiac
neurosis arrhyth mia hypertension vertigo polyhidrosis irregular menstruation enuresis

neurasthenia hysteria
D H ypersensitivity and Aller gies U rticaria hives asth ma allergic rhinitis allergic
colitis allergic purpura
E Endocrine Diseases and M etabolic Disorders H yperthyroidism andor hypothyroidism
diabetes mellitus menopausal syndrome
F Miscellaneous A uricular acupuncture is effective for inducing lactation and labor and
for preventing and treating transfusion and infusion reactions In addition it is also widely used
for cosmetology smoke cessation drug withdraw al age retardation and for the prevention of
diseases and health care maintenance
5 6 5 2 Auricular Point Selection Principles
A Point Selection According to the A ffected A rea When patients are ill there are specific
points on the corresponding area of the auricle that will be pressure sensitive this is the basis
for the selection of points to be treated such as the Stomach point for gastric pain etc
B Point Selection According to the Differentiation of Syndromes Based on the T heory of
the ZangFu Organs Corresponding auricular points are selected on their physiological
functions and pathological reactions E xamples Points Kidney for cavities Lung and Large
Intestines for skin disease etc
C Point Selection According to Differentiation of Syndro mes Based on Meridian T heory
Points are selected according to the routes and manifestations of the t w elve meridians
E xamples T he Bladder Pancreas and Gallbladder points for sciatica the Large Intestines point
for toothaches etc
D Point Selection According to Western M edical T heory Some auricular points are
named according to the theories of Western medicine E xamples Points Sy mpathetic Adrenal
Gland Endocrine etc T heir functions coincide with Western medical theory so the points can
be selected based on their functions E xample Point Adrenal gland for inflam matory diseases
E Point Selection According to Clinical E xperience Some points have been identified in
clinic to be useful for treating other diseases besides local disorders E xample Point E xternal
Genitalia for posterior leg pain
485
T here are various methods used to stimulate auricular points So me of the com monly used
techniques are
A Filifor m Needling It refers to use the filifor m needle to insert in the auricular points
It is a com mon w ay to treat the diseases T he follo wing procedures are observed w hen needling
the auricular points with filifor m needles
a Point Selection and Sterilization Follo wing the selection of auricular points for needling
include the sensitive spots detected by a needle probe or auricular point detector Strict
disinfection should be done before acupuncture w ith a iodine tincture follo w ed by
removing the iodine w ith a solution of alcohol Manipulations should begin after the
alcohol on the auricle dries
b Body Position and Insertions Generally patients are allowed to sit however but the elderly
and weak or those who have severe conditions or mental distress it is advisable to let them lie down
Select No cun needles made of stainless steel Stabilize the auricle with the thumb
and index fingers and hold the dorsal surface of the ear with the middle finger of one hand to control
the depth of insertion and relieve pain Then hold the needle with the thumb and index fingers of the
other hand insert the needle into the points either with the swift thrust or the slow twisting method
The insertion depth will depend on the thickness of the auricle which will vary from patient to patient
Generally penetrate the cartilage cun deep enough for the needle to stand erect without
hanging Symptoms will frequently be relieved if the patient feels a strong sensation after the insertion
of a needle in the affected area If no sensation is felt the direction depth or angle of the needle should
be adjusted Stimulation intensity and manipulation methods are applied according to the patients
condition constitution syndrome and tolerance
c Retention and Removal of Needles Needles are usually retained for minutes but
in cases with chronic seizures or pain diseases needles may be retained for longer periods While
the needles are retained it is advisable to manipulate them at minute intervals Removal of
the needles is the last manipulation of a treat ment H old the auricle with one hand withdraw
the needle quickly and perpendicularly then im mediately press the insertion hole w ith a
sterilized dry cotton ball to avoid bleeding
B Electrotherapy D ian Zhen Fa A fter the needling sensation is obtained connect the
t w o electrodes to the handles of the needles in accordance with the electrotherapy technique
T he current time is usually minutes T his method is advisable for diseases of the
nervous system spasms of the internal organs and asth ma
C Needle Embedding Therapy Mai Zhen Fa Treating auricular points by embedding
intradermal needles is suitable for chronic and pain diseases The therapeutic effect of the continuous
stimulation consolidates the treatment which can prevent relapses First stabilize the ear with one
hand after routine disinfection clamp the handle of an intradermal needle with forceps in the other
hand gently insert the needle into the selected point and stabilize it with adhesive tape In general the
486
Part
needle is embedded in the auricle on the same side as the affected area or both if necessary Each point
should be pressed times each day by the patient The needles should be retained for days after
each treatment A therapeutic course consists of treatments
D A uricular Seed Pressing T herapy Ya W an Fa T his therapy incorporates pressing and
adhering seeds onto the auricles to stimulate the points continuously Since this method is safe
painless and without sideeffects it is widely used in clinic T he materials for seed pressing
therapy could be obtained locally Seeds such as vaccaria and cole millet green gram and w hite
mustard seed can be used Presently vaccaria seeds are com monly used in clinic due to their
smooth surface suitable size and hardness Prior to usage seeds should be boiling for minutes
and allo w ed to air dry before bot tled
When applying first put the vaccaria seeds on a piece of adhesive tape cm cm
clamp it with forceps and tape it over the selected point instruct the patient to press the seeds
seconds times a day T he adhesive tape should be replaced every days Both
ears can be used alternately T he stimulation intensity depends on the patients condition In
general slight stimulation is advisable for children pregnant w o men and elderly patients or
those with w eaknesses or neurasthenia strong stimulation is advisable for acute pain
E Point Injection T herapy X ue W ei Zhu She Fa T his therapy involves the injection of
microamounts of medication into the auricular points A tuberculin T B syringe with a N o
needle is usually selected T he appropriate medication is draw n according to the patients
condition T he auricle is stabilized with one hand follo wing the administration of a routine skin
test the opposite hand slo w ly injects ml of medication into the auricular points
creating a small hillock Possible reactions might include pain distension redness and the
sensation of heat A fter the injection the puncture hole is gently pressed with a sterilized dry
cot ton ball T his therapy may be administered once every other day
5 6 5 4 Precautions
A Since the auricles are exposed and they are special structures with uneven surfaces
strict disinfection measures should be employed before doing acupuncture Needling is
contraindicated on areas w here trauma or inflam mation is present If redness or sw elling on a

puncture hole is present after acupuncture a
im mediately to avoid suppurative perichondritis
iodine tincture should be applied
B When treating sprains and motor disabilities ask patients to move their affected
extremities after insertions to enhance the therapeutic effects
C Needling is contraindicated with pregnant w omen and those with a history of multiple
abortions
D Auricular acupuncture is inadvisable for cases with severe structural disease or serious
anemia Also strong stimulation is not suitable for those with severe cardiac disease or
hypertension
E Precautions should be taken to prevent needle fainting during auricular acupuncture
treat ments A s per usual appropriate measures should be taken in the event that it does occur

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Chapter 5

Acupuncture and Moxibustion Techniques

5 1 Acupuncture Techniques of Filiform needle

5 1 1 Structure Specifications Inspection and Storage of Filiform Needles

handle body root and the tipFig

Chapter Acupuncture and Moxibustion Techniques

Fig The Structure of Filiform Needles

Fig The Shape of Filiform Needles Handle

are mainly used with insertion tubesFig

5 1 1 2 Specifications of Filiform Needles

body see the T able

Table 5 1 Length of Filiform Needles

Table 5 2 Diameter of Filiform Needles

T wo Needling and Moxibustion Techniques

T he N o m mand inch m mfilifor m needles are the most

effect relieve pain and avoid undesirable incidents

cot ton ball Needles and containers should be sterilized in an autoclave

Needling PracticeT hree Steps

5 1 2 1 Finger Force Practice

Chapter Acupuncture and Moxibustion Techniques

Fig Practicing with Sheets of Paper

Fig Practicing with a Cotton Cushion

Practicing w ith a Cotton Cushion M ake a cushion about cm in diameter by

5 1 2 3 Needling Practice on a Body

5 1 3 1 Selection of the Filiform Needle

close attention to avoid unnecessary pain and accidents

T wo Needling and Moxibustion Techniques

cun and a cun filifor m needle to puncture an acupoint a depth of cun In

conclusion it is necessary to select filifor m needles of suitable specifications to assure the

A Disinfection of Needling Appliances An Introduction to Common Methods of Disinfection

a A utoclave Sterilization Needles should be sterilized in an autoclave at kgcm

and for minutes to satisfy the requirements for sterilization

b Chemical Disinfection Needles should be placed into a solution of alcohol for

solutiondisinfector and processed according to the instructions on the manufacturers label

Chapter Acupuncture and Moxibustion Techniques

Proper positioning of the patient is an important consideration to facilitate the accurate

Fig Supine Position aka BackLying

Fig Lateral Recumbent aka SideLying

T wo Needling and Moxibustion Techniques

Fig Prone Posture aka BellyLying

Fig Seated in the Upright Position with the

Fig SideProne Sitting

positions to needle specific acupoints W hen preparing

point prescriptions basically one sh ould try their best

to select the acupoints w hich can be punctured w ithout

repositioning the patient Patient positioning should be

done w ith the patients condition in mind w henever it is

necessary to chan ge the position during the same

To avoid fatigue or fainting during acupuncture one

should consider selecting the lying position as much as

possible for patients receiving their first treatment or for

those who are nervous old weak or seriously ill Patients

should be instructed to avoid moving or suddenly changing

positions after the needles have been inserted to maximize

ProneT orso Sitting

Chapter Acupuncture and Moxibustion Techniques

of bending or breaking the needles

a needle w ith the thumb index finger and the middle

manipulations During insertions the puncturing hand

generates focused force on the tip of the needle to make it

penetrate the skin During manipulations it t w irls and

w ithdraw s the needle By contrast the function of the