TCM Acupuncture and Massage

Chapter 31 Common Acupuncture and Moxibustion Methods (2)
([-]) Depth of acupuncture
The depth of acupuncture refers to the depth of the body piercing the acupoint.The principle is to have the feeling of getting qi under the needle without hurting tissues and organs.However, in the clinical operation, factors such as the patient's age, gender, constitution, body shape, disease location, disease nature, and acupoint locations must also be considered comprehensively.Generally speaking, deep needling is suitable for men, young adults, strong and fat people; shallow needling is suitable for women, old people, children, frail and thin people.Those with deep lesions should be pricked deeply; those with shallow lesions should be pricked shallowly.Superficial, yang, deficiency and new disease patients should be treated shallowly; internal syndrome, yin syndrome, excess syndrome and long-term patients should be deeply needled.For places with thick skin and flesh such as the limbs, buttocks and abdomen, it is advisable to do deep puncture; for places with thin skin and flesh such as the head, face, chest and back, it is advisable to do shallow puncture.

There is a close relationship between the angle, direction and depth of acupuncture.For deep thorns, use straight thorns, and for shallow thorns, use oblique or horizontal thorns.For the acupoints of the eyes, medulla oblongata, and trunk, since there are important organs in them, the angle, direction, and depth of acupuncture must be strictly controlled to avoid accidents.

[-]. Acupuncture and Deqi
Acupuncture, also known as "needle movement", refers to various acupuncture techniques performed to obtain and adjust the needling sensation after needle insertion.Deqi means that after the filiform needle is pierced into an acupoint, the needle is passed through to make the meridian qi sense at the acupuncture point, also known as the needling sensation.Acupuncture is closely related to deqi. Acupuncture is the prerequisite for deqi, and deqi is the purpose and result of acupuncture.Acupuncture techniques can be divided into basic techniques and auxiliary techniques.

([-]) Basic method

1. Lifting and insertion method The lifting and insertion method is an operation method in which the needle is inserted into the acupoint to a certain depth, and then the lifting and lowering movements are performed.

When using the lifting and inserting method, the lifting and inserting range should be uniform, generally 3 to 5 points are appropriate; the frequency should be consistent, 60 to 90 times per minute; the force should be even, not sometimes light and sometimes heavy; keep the needle vertical.It is generally believed that if the lifting range is large, the frequency is fast, the force is heavy, and the operation time is long, the stimulation volume will be large; otherwise, the stimulation volume will be small.The amount of stimulation should be flexibly controlled according to the patient's constitution, condition, acupoint location, and acupuncture purpose.

2. Twisting method Twisting method is an operation method in which the needle is inserted into the acupoint to a certain depth, and then alternately rotated forward and backward.Rotating the thumb forward and the index finger backward is called a left turn; turning the thumb backward and the index finger forward is called a right turn; left and right rotations are repeated and alternated to form a twirling method.

When using the twisting method, the twisting angle should be uniform, generally around 180°; the frequency should be consistent, about 90 times per minute; The entanglement of muscle fibers and the like causes pain and leads to needle stagnation.It is generally believed that if the twisting angle is large, the frequency is fast, the force is heavy, and the operation time is long, the stimulation amount will be large; otherwise, the stimulation amount will be small.The amount of stimulation should be flexibly controlled according to the patient's constitution, condition, acupoint location, and acupuncture purpose.

([-]) Auxiliary methods

The auxiliary technique of needling is a supplement to the basic technique, and its purpose is to promote the acquisition of needling sensation, strengthen and control the needling sensation.The commonly used auxiliary acupuncture techniques in clinical practice are as follows.

1. Xunfa Xunfa refers to the method in which the doctor follows the path of the meridians with his fingers and gently presses the upper and lower parts of the acupoints.This method can stimulate the meridian qi, promote the circulation of qi and blood, and promote the easy acquisition of qi after acupuncture.When acupuncture fails to produce qi, the method can be used to urge qi.

2. The method of playing the needle is to lightly flick the needle tail or the handle of the needle with the finger to make the needle body vibrate slightly during the process of retaining the needle after pricking.This method has the function of invigorating and promoting qi.

3. Scraping method Scraping means that after the needle has penetrated to a certain depth and the meridian has not arrived, use the thumb or index finger to hold the end of the needle, and use the thumb, index finger or middle finger to scrape frequently from bottom to top or from top to bottom The needle handle method.This method can stimulate the meridian qi when acupuncture is not enough. If the qi is already obtained, it can strengthen the conduction and diffusion of the acupuncture sensation.

4. Shaking method Shaking method refers to the method of gently shaking the needle with the handle of the needle after the needle has penetrated to a certain depth.There are two methods: one is to shake the needle upright to enhance the induction of De-qi; the other is to shake the needle lying down to make the meridian qi flow in a certain direction.

5. For those who feel uncomfortable after flying acupuncture, use the right thumb and index finger to hold the needle handle and rub it several times, then spread the two fingers, rub and release, repeat several times, the shape is like a bird spreading its wings, so it is called "Flying Method" ".This method can promote qi, promote qi, and enhance the needling sensation. It is suitable to perform the operation on the thick muscles.

6. Tremor method After the pointer is penetrated to a certain depth, the method of lifting, inserting and twisting with small amplitude and fast frequency is used to make the needle body tremble slightly.This method can promote Qi under the needle and enhance the needle sensation.

([-]) get angry

Deqi, known as "Qizhi" in ancient times and "needle sensation" in recent times, refers to the sensation of meridian qi at the acupuncture point after the needle is inserted to a certain depth and then lifted or twisted.

1. Performance of deqi Deqi can be analyzed and judged from two aspects, one is the patient's response to the acupuncture, and the other is the doctor's response to pricking the finger.When needling the acupoints to get qi, the patient will experience sensations of soreness, numbness, swelling, heaviness, etc. at the acupuncture point, and sometimes heat, coolness, itching, pain, convulsions, ants crawling, etc. The direction and location of pity conduction and diffusion.A small number of sensitive people may also have skin twitches and tremors along the meridians, or rash belts along the meridians, red and white lines.At the same time as the patient feels the sensation, the doctor can also experience the sensation of the needle sinking, tightness, astringency, stagnation, or needle vibration.If no qi is obtained after acupuncture, the patient will not have any special feeling or reaction, and the doctor will also feel empty and slippery under the needle when pricking his hand.Just as "Biao You Fu" said: "Slow and slow, the future is coming, and it is tight and astringent... The arrival of the breath is like the ups and downs of a fish swallowing the bait; the breath has not yet arrived, like the depth of a quiet hall in a leisurely place."

2. The meaning of getting qi Whether you get qi or not and the speed of qi arrival are not only related to the curative effect of acupuncture, but also can be used to infer the ups and downs of righteous qi, the prognosis and outcome of diseases. "Lingshu·Nine Needles and Twelve Origins" says: "The essential point of needling is the arrival of qi and it will be effective." "Golden Needle Fu" points out: "Qi is quick and effective, and qi is slow and late." Generally speaking, getting qi quickly and curative effect It is better; if you get qi slowly, the curative effect is poor; if you don't get qi, it is difficult to get the effect.Clinically, if the menstrual qi still does not arrive after repeated application of various climatic and qi-inducing techniques, it is mostly due to the failure of righteous qi, and the prognosis is extremely poor; Afterwards, starting to get qi or getting qi faster means that the patient's righteousness has recovered and the prognosis is good.

3. The method of promoting De-Qi. During acupuncture, if the patient does not get Qi or gets slow-moving, after analyzing the reasons, methods such as adjusting and correcting, climate-relieving, invigorating and replenishing Qi should be adopted to promote De-Qi.

If the acupoints are selected inaccurately, or the angle, direction, and depth of acupuncture are inappropriate even though the acupoints are selected accurately, you can obtain qi by selecting accurate acupoints or adjusting the angle, direction, and depth of acupuncture.

When the needle is not filled with gas, it is necessary to wait for the gas to arrive by retaining the needle to wait for the gas to arrive. During the process of retaining the needle, it is also possible to use intermittent needle movement, such as lifting and inserting, twisting, etc., to wait for the gas to arrive.

In addition, auxiliary methods such as following the method, playing the method, and scraping method discussed above can also be used to stimulate Qi.

For those who are weak in constitution and lack of righteousness and are not easy to get qi from acupuncture, the following methods can be used according to the specific situation: one is to choose more strong acupoints with tonic effects, such as Zusanli, Qihai, Guanyuan, etc.; The third is to add appropriate tonics, such as Sijun Decoction, Siwu Decoction, etc.Prompt the body to gradually restore the body's righteousness, enrich the meridian qi and easily get qi.

When you get the breath from the needle, you should also pay attention to keeping the breath, so as to keep the needle feeling lasting and not to disperse.Auxiliary techniques such as scraping and tremoring, or pressing and crossbow techniques can be used to keep the Qi in order to continuously exert the therapeutic effect of acupuncture.

4. The choice of the strength of Deqi The strength of Deqi should vary from person to person and from disease to disease.Generally speaking, if the Qi is strong for acute pain, arthralgia syndrome, flaccidity syndrome, hemiplegia and other diseases, the effect will be better; for insomnia, palpitations, hemifacial spasm and other diseases, the effect will be significant if the Qi is weak.People with weak Qi and blood, long-term illnesses and elderly people should have weak Qi; people with strong Qi and blood, strong body and young body should have strong Qi.In short, the strength of Deqi should be based on the principles of patient comfort and significant curative effect.

[-]. Acupuncture for reinforcing and reducing

Tonifying method generally refers to the acupuncture method that can stimulate righteousness and restore low functions to normal; reducing method generally refers to acupuncture methods that can dredge evil qi and restore hyperactive functions to normal.

([-]) Commonly used reinforcing and reducing methods

1. The method of twirling tonifying and reducing is divided into the direction of force when twirling, or the angle, frequency, strength, and time of twirling.After needling to get qi, turn the thumb forward at the point of qi with heavy force and fast speed, and turn the thumb back to the right with light force and slow speed, which is the tonic method; , The speed is fast, when the thumb is turned forward and left, the force is light, and the speed is slow.Or after the needle is pressed to get qi, the method with small twisting angle, slow frequency, light force and short time is the tonic method; on the contrary, the method with large twisting angle, fast frequency, heavy force and long time is the reducing method.

2. Lifting, inserting, supplementing and reducing methods are divided into reinforcing and reducing methods according to the direction, strength, and frequency of force during lifting and inserting.After needling to get qi, insert heavily and lightly lift at the place where you get qi, use heavy force and fast speed when you go down, and use light force and slow speed when you lift up. Heavy, fast speed, light force and slow speed when inserting downwards is the purging method.

3. Xu Ji Reinforcing and Reducing Method is to master the technique of needle insertion, needle withdrawal, and speed of acupuncture.When inserting the needle slowly, twisting less, and withdrawing the needle quickly is the tonic method; inserting the needle rapidly, twisting more, and withdrawing the needle slowly is the reducing method.

4. Yingsui Reinforcing and Reducing Method The method of reinforcing and reducing is divided according to whether the acupuncture direction is consistent with the meridian circulation direction.The needle point pierces the practitioner along the direction of the meridian, which is the tonifying method, and the needle point pierces the practitioner against the direction of the meridian, which is the purging method.

5. Respiratory Reinforcing and Reducing Method Combining acupuncture manipulation with the patient's breathing is divided into reinforcing and reducing methods.The needle is inserted and rotated when the patient is exhaling, and the needle is withdrawn and withdrawn when the patient is inhaling.

6. The method of opening and closing the reinforcing and reducing method is divided into reinforcing and reducing methods according to whether the needle hole is pressed or not when the needle is withdrawn.Quickly press the pinhole when withdrawing the needle is the tonic method; shake the pinhole when withdrawing the needle, and do not press the needle hole is the purging method.

7. The method of flattening, flattening and purging, after the needle is inserted to obtain qi, is evenly twisted, lifted and inserted, which is suitable for diseases with no obvious deficiency or excess or mixed deficiency and excess.

([-]) Factors Affecting the Reinforcing and Reducing Effect of Acupuncture
1. The functional state of the body The functional state of the body is the basis for the reinforcing and reducing effect of acupuncture.Under different pathological conditions of the body, acupuncture can produce different adjustment effects and present different reinforcing and reducing effects.When the body is in a state of exhaustion and shows deficiency syndrome, acupuncture can play the role of strengthening the body and nourishing the deficiency; Acupuncture can clear heat, open and close, eliminate pathogenic factors and relieve excess when there is evidence of excessive heat and pathogenic closure.For example, when the gastrointestinal function is hyperactive and there is spasm and pain, acupuncture can relieve spasm and relieve pain; when the gastrointestinal function is inhibited and peristalsis is slow, abdominal distension and loss of appetite, acupuncture can strengthen gastrointestinal peristalsis, improve digestive function, eliminate abdominal distension, and increase appetite.A large number of clinical practice and experimental studies have shown that the functional state of the body is the main factor that produces the reinforcing and reducing effect of acupuncture.

2. The relative specificity of acupoint action The relative specificity of acupoint action is an important condition for the reinforcing and reducing effect of acupuncture.Some acupoints can inspire the body's righteousness, promote vigorous function, have a strong effect, and are suitable for tonifying deficiency and benefiting damage, such as Qihai, Guanyuan, Mingmen, Gaohuang, Zusanli, Baihui, Shenque, Zhongwan, Beishu, The original hole and so on.Some acupoints have the function of dredging pathogenic factors and inhibiting hyperactivity, and have the function of eliminating pathogenic factors and reducing excess, and are suitable for excess syndrome, such as Renzhong, Weizhong, Shixuan, Bafeng, Baxie, Jing, Xing, and Qi.When implementing acupuncture for reinforcing and reducing, it should be combined with the relative specificity of the acupoints in order to obtain a better effect of acupuncture for reinforcing and reducing.

3. Acupuncture tonifying and reducing techniques According to the different states of deficiency and excess of the body, the key to obtain the effect of tonifying deficiency and reducing excess is to adopt corresponding acupuncture and reinforcing and reducing techniques.The results of clinical observation and experimental research show that when the acupuncture-reinforcing-reinforcing-reducing technique acts on the body, it can produce the unique regular effects of "reinforcing" and "reducing", and is the main means to produce the effect of reinforcing and reducing, and to promote the transformation of the internal factors of the body.The above-mentioned single and compound reinforcing and reducing techniques were created and summarized by ancient and modern acupuncturists in their long-term medical practice.Therefore, in order to obtain a satisfactory effect of tonifying and reducing, the operation technique is very important and must be applied properly.

[-]. Needle retention and needle removal
([-]) Needle retention method
After the needle is inserted into the acupoint and the manipulation is performed, the needle is left in the acupoint, which is called retaining the needle.There are two methods of needle retention: static needle retention and dynamic needle retention.The method of static needle retention means that the needle is no longer used during the needle retention process; the dynamic needle retention method means that the needle must be performed intermittently during the needle retention process, and it is mostly used for patients with dull needle sensation.Clinically, whether to retain the needle or not and the length of the needle retention time should be determined according to the specific situation. For general diseases, the needle can be left for 15-30 minutes after the operation, and the needle can be appropriately increased for chronic, intractable, painful, and spastic diseases. Needle retention time, such as acute abdominal pain, trigeminal neuralgia, dysmenorrhea, tetanus, opisthotonus, etc., the needle retention time can reach several hours.Generally, no or less needles are reserved in children, and it is not advisable to retain needles for a long time in the acupuncture points of the back of the head, eye area, throat, chest and back.

([-]) Needle-exiting method
The method of pulling out the needle after performing the acupuncture technique and retaining the needle to meet the treatment requirements is called needle removal.

[-]. Handling and prevention of abnormal situations

Although acupuncture treatment is relatively safe, if there is a lack of comprehensive understanding of the anatomical parts of the human body, careless operation, negligence, or violation of the ban on acupuncture, or improper acupuncture techniques, sometimes there will be some undue abnormalities, which will cause serious damage to the body. Patients bring unnecessary pain and even life-threatening.Therefore, it must be dealt with in time and prevented.Common acupuncture abnormalities are described below:

([-]) Faint needle

Faint acupuncture refers to the syncope that occurs during acupuncture.

1. Patients suddenly appear mental fatigue, dizziness, pale complexion, nausea, vomiting, cold sweat, palpitation, cold limbs, deep and weak pulse; in severe cases, coma, cold limbs, bruised lips and nails, and fecal incontinence , blood pressure drops, pulse faint.

2. Causes This phenomenon occurs during acupuncture due to weak constitution, mental stress, fatigue, hunger, profuse sweating, profuse diarrhea, hemorrhage, or improper posture, or the doctor's technique is too heavy.More common in newly diagnosed.

3. Treatment Immediately stop acupuncture and pull out all the needles.Support the patient to lie on the back, lower the head, loosen the belt, keep warm, drink warm boiled water or sugar water, and the light one can recover.In severe cases, on the basis of the above treatment, finger pinching or acupuncture at Shuigou, Suriao, Neiguan, Hegu, Taichong, Zusanli, Yongquan and other emergency points, or moxibustion at Baihui, Qihai, Guanyuan, Shenque, etc. Strong point, you can recover.For those who have not yet recovered, modern first aid measures may be considered.

4. Prevention Take precautions according to the cause of fainting.For those who receive acupuncture treatment for the first time and who are mentally stressed, they should do a good job of explaining to eliminate their worries.The selection of acupoints should be few and the techniques should be light.Choose a natural and comfortable position that can retain needles for a long time, and try to use a lying position.For those who are hungry or tired, acupuncture should be performed after they have eaten and recovered their physical strength.During the acupuncture process, the doctor should be focused, closely observe the changes in the patient's demeanor, ask about his feelings, and deal with it in time if there are signs of acupuncture fainting such as discomfort.

([-]) Stuck needle

Stuck needle refers to the phenomenon of stagnation and astringency under the needle and difficulty in moving the needle during needle pricking.

1. When the needle is performed or after the needle is retained, the doctor feels that the needle is stagnant, the twisting does not move, and it is difficult to lift and insert the needle, and the patient feels pain when the needle is twisted and lifted.

2. The reason is that the patient is nervous, and the local muscles contract strongly after the needle is inserted; or the doctor performs the needle improperly, and continues to twist in one direction, so that the muscle fibers wrap around the needle body and cause the needle to stagnate; or the needle is kept for too long, and the patient moves due to body position. ; or caused by muscle spasms due to illness.

3. To deal with patients who are caused by the patient’s nervousness and strong local muscle contraction, ask them not to be tense and relax the local muscles; the doctor can press on the local area, or flick the needle handle, or puncture another needle nearby to relax the local muscles The needle can then be removed.If it is caused by one-way twisting, twist the needle back in the opposite direction.

4. To prevent mental stress, do a good job of explaining before the needle to eliminate the patient's concerns.The tendon should be avoided when inserting the needle, and the technique should be light and gentle, and the twisting angle should not be too large, or one-way twisting.If the rubbing method is used, attention should be paid to cooperate with the lifting and inserting method to avoid needle stagnation due to muscle fibers winding around the needle body.

(End of this chapter)