Acupuncture & moxibustion techniques

1. Acupuncture & moxibustion techniques • Acu tech • Electro-acu • Other types of needles: seven star, tacks, three edged, etc • Nine needles • Moxa tech • Cupping • Bleeding • Gua-sha( scrapping)

2. Miscellaneous • Different needling techniques in Classics • Micro-systems of the body Nose Eye • Master Tong’s points • Modern research about acupuncture

3. Filiform needles 毫针 • Materials Stones Bones Bamboo Metals: Gold, silver, stainless steel, etc.

4. Styles of the needles

5. Sizes Lengths 1--3 cun (0.5--5 cun) Wideth-Gauge 30--38#

7. Structures

10. Preparations for treatment • Environment: quiet, warm, clean, relaxing • Needles: clean, smooth, good quality short-thin long-thick • Patient: calm, appropriate position • Doctor: trustworthy, warm, gentle.

11. Needle Eroded in Body

12. Holding needle techniques • Single-handed Two fingers-short needles Three fingers-longer needles-solid Four fingers-long needles-avoid bending • Double-handed One hand holding the handle, the other hand holding the tip of the needle with cotton ball

13. Patient’s positions • Supine • Prone • One side up • Supine sitting • Prone sitting • Side prone sitting

14. Insertion of needles • Concentration, communication. • Put your qi to your fingers ,holding the needle like holding the tiger’s tail. • no any other thought while you start insert the needle , and treat the needle like a very important person to you . • Get trust from patient, so patient’s muscle will be relaxed , and easier to put the needle in , less pain.

15. Insertion techniques • Needling hand-right • Aid hand-left, should focus on both hands, not only the needling hand • Techniques Pressing Pinching Spreading Tube

16. Needling angles and depths • Angles Perpendicular Oblique Subcutaneous • Depths : 70-80% of the needle body length • Body sizes Point selection • Directions normally towards the problem area

18. Signs of De qi- arrival of qi • Doctor: heaviness, tension, like a fish on the line. • Patient: soreness, numbness, distention, heaviness, or transmission (sensation) goes up or down along the meridians. other sensations: itchiness, coldness, warmth, muscle spasm, rash, white or red colored lines, pain- • But should not be sharp pain

19. De qi’s principles • 粗守形, 上守神 • Focus on the Shen more than the hands and needles. • Shen - Internal Qi and spirit Patient’s Doctor’s • Xing - shape, posture or movement of the hand. refer to the details of the techniques.

20. Relations between De Qi and effectiveness • De Qi-good result • No De Qi-No good result • De Qi Quick-quick result Slow-slow result

21. Factors influencing De Qi • Location of the point • Insertion depth of each point Too deep, too shallow • Manipulations superior or inferior • Constitution and sensation weak & dull, strong & sharp

22. Basic manipulation techniques • lifting up & thrusting down 0.3-0.5 Cun, 60 times/min • Twirling or rotating left & right within 180 degree

23. Retaining of needles • regular:about 15-30 minutes, can be 45 minutes • Can be as short as no retaining, in and out • Can be as long as several hours or 1-2 days

24. Withdrawing needles • press the skin • rotate the needle gently • lift the needle slowly to subcutaneous level • withdraw • press the point for a while to prevent bleeding

25. Precautions & contraindications • Avoid treatment when the patient is over sweating, over eating, too hungry, too tired, too nervous • For people who are weak, qi xu, blood xu should give minor stimulations, and lying down position. • Pregnancy-under 3 months, no needing lower abdomen, over 3 months, abdomen, sacrum, low back are not allowed to be needled • Points: LI4, SP6, UB60, UB67, GB21….

26. Precautions & contraindications • Infant, vertex should not be needled. Also no retention of needles on the body • Oblique insertion is preferred on the body trunk • Eye, neck & spinal area’s points need to be cautious when needled. shallow, angle. • Try to avoid blood vessels • Patient’s with bleeding tendency needs to be cautious • No local needling on area with skin infection, ulcer, scar, tumor etc

27. The 15 Luo- Connecting pts • Lu - Lu7 LI - LI6 Sp21 • Ht - Ht5 SI - SI7 • PC - Pc6 SJ - SJ5 • SP - Sp4 ST - St40 • Kid - Kid4 UB - UB58 • Liv - Liv5 GB - GB37 • DU - Du1 Ren - Ren15

28. Promoting Techniques Help De Qi: • Pressing • Plucking • Scraping • Shaking • Flying • Trembling

29. Functions • Promoting Qi arrival to the points • Stimulating Qi to move along channels • Enhancing needling sensation • Achieving faster therapeutic effects

30. Pressing along meridian • Method: After inserting the needle at certain depth, press the needling area along the related meridian.

31. Plucking • Method: After inserting the needle, flick the needle handle gently, to let the needle body move back and forth slightly.

32. Scraping • Method: After inserting the needle, hold the needle handle by thumb and or/and third finger, scrap the needle handle up and down by index finger a few times.

33. Shaking • Method: After insert the needle, hold the handle, shack it left and right or back and forth gently. The needle angle can be perpendicular or oblique.

34. Flying • Method: Hold the needle handle by two or three fingers, rotate it by moving thumb forward, then backward and suddenly release it. A flying bird.

35. Trembling • Method: Hold the needle handle by three fingers, hand and wrist and forearm shake slightly to cause the needle to vibrate slightly.

36. Accident management • Fainting • Bent needles • Stuck needles • Broken needles • Hematoma • After effect • Injure the internal organs

37. Fainting • Causes: weak, hungry, tired, nervous, inappropriate position or too strong stimulations. • Signs: dizziness, vertigo, palpitation, short of breath, nausea, cold sweat, weak pulse. drop of BP, cold extremities, loss consciousness. • Management: stop and pull out all of the needles quickly, lay down, warm and sugar water, wait for a while. needle or press DU26, DU25, P6, P9,or moxa DU20, REN4,6. if it is necessary call emergency.

38. Stuck needles • Causes: nervousness, inappropriate techniques, too much single direction rotations, too long retaining. • Signs: hard to rotate, lift & thrust, hard to get it out, patient feels sharp pain when pull out. • Management: relax, wait for a while, twirl to opposite direction, massage local area, insert another needle next to the stuck needle.

39. Bent needle • Causes: improper technique, too forceful or fast manipulations, needle striking the hard tissues, position change after inserting the needle, or due to stuck needle management. • Signs: difficult to lift &thrust or rotate the needle, pain • Management: remove slowly by the bent angle, let patient change back his position, then relax the muscle, slowly withdraw.

40. Broken needle • Causes: poor quality of the needle, too strong manipulations, strong muscle spasm, position change or bad result due to bent needle. • Signs: handle or body is broken. • Management: stay calm. prevent the broken needle from going deeper into the body. if needle body above the skin, take it out. same level of the skin, press skin, then take it out by using forceps. under the skin, call emergency or send them to the hospital.

41. Edema due to bleeding Hematoma • Causes: injury of the blood vessels during insertion, or lack of pressing after withdraw the needle. • Signs: local bleeding, swelling, distention. • Management: press the point after withdrawal of the needle, cold pad 5-15 minutes, heat after 1-2days, light massage, moxa.

42. After-effect • Causes: unskilled manipulation, forceful stimulation. Needle the nerve cause the mild nerve damage. • Signs: after withdraw the needles, the soreness, painful or numbness feeling can persist for longer time. • Management: gentle massage, local moxa, vitamin B intake.

43. Injure the internal organs • Lung • Liver, Spleen, • Kidney • Stomach, Colon, Gallbladder, Urinary Bladder

44. Injure the kidney • Kidney location: left is 1-2 cm higher than right. Left is in between the lower border of T11 to in the space between L2-3. Right kidney is in between upper border of T12 to upper border of L3. The upper border of the kidney is 3.8 cm away from the midline while the lower border of the kidney is 7.2 cm away from the midline. • Symptoms: Low back Pain, especially when taping, bloody urination. • Management: not too deep, gentle stimulation

45. Injure the liver, spleen • Cause: needle too deep on the front or back of the body trunk, or don’t notice of the enlarged liver under the rib cage. • Symptoms: organ bleeding cause the liver or spleen area pain, sometimes radiate to the back. It also can cause abdominal pain, distention or pain when press. Severe case can cause dropping of blood pressure, lose consciousness • Management: mild case: take rest, if bleeding,use stop bleeding medicine, local cold pad, watch out the blood pressure. Severe case: send to the emergency.

46. Injure the lung • Cause : needle too deep on the chest, upper back, especially around the clavicle bone. It can cause the air that goes into the Lung press the Lung so that it shrinks. • Symptoms: Chest congestion, chest pain,cough, difficulty breath, purple lips, sweat, even faint, drop of blood pressure. Sometimes the symptoms may occur several hours after the treatment. • Management: mild: keep the sitting position until the patient is better, give cough medicine if needed, the air may be absorbed by the Lung itself. Severe:send to the hospital

47. Injure the ST, Co,GB or UB • Cause: needle too deep or too strong lifting and thrusting • Symptoms:local pain or infection • Management: avoid infection

48. Yuan － source points • Lung - Lu9 LI - LI4 • Ht - Ht7 SI - SI4 • Pc - P7 SJ - SJ4 • Sp - Sp3 St - St 42 • Liv - Liv3 GB - GB40 • Kid - Kid3 UB - UB64

49. Reinforcing & reducing (tonifying & sedating) techniques Basic techniques Comprehensive techniques

50. Basic techniques • Lifting & thrusting the needle • Twirling & rotating the needle • Insertion & withdraw the needle • Leaving the needle hole open or close • Observing breaths • Direction of needle tip • Even technique