1. Even method; 2. Setting the mountain on fire ; 3. Penetrating-heaven coldness; 7. Facing reinforcement ; 8. Against reduction; 13. TR reinforcement; 14. TR reduction; 21. Moxibustion with ginger ; 43. Cupping therapy ; 52. 3edged Needle spot pricking; 55. Electrotherapy with CW; 59. Point Injection; 60. Manipulation of the Dermal Needle; 61. Manipulation of Intradermal Needle;
Even reinforcing and reducing: After the needle is inserted and the needling sensation appears, lift, thrust and rotate the needle evenly, then withdraw the needle at moderate speed. This is known as even reinforcing and reducing.
Setting the mountain on fire: First of all, determine the depth of point to be punctured, then divide the depth into three equal portions, the superficial, medium and deep. After the needle is inserted slowly beneath the skin, the needle is heavily thrusted and slightly lifted for nine bouts at the upper 1/3 (superficial portion) of the depth. Then the needle is inserted to the middle 1/3 (medium portion) of the depth and is heavily thrusted and slightly lified for another nine. Finally insert the needle to the lower 1/3 (deep portion) of the depth and thrust and lift for nine again. After that lift the needle up to the upper 1/3 of the depth (directly from the deep portion to superficial portion), and repeat the process mentioned above. Thrusting thrice according to the superficial, medium and deep portions and lifting once is called one operation. Repeated operations can be conducted for several times until a warm feeling is got. Quickly withdraw the needle and press the hole. The operation may also be performed in combination with the reinforcing by inserting the needle when the patient breathes out and by withdrawing it when the patient breathes in.
Penetrating-heaven coldness: Insert the needle into the point to the lower third (deep portion) of a required depth. Lift quickly and thrust slowly the needle for six times. After that the needle is lifted to the middle third (medium portion) and given the same performance. Then the needle is further lifted to the upper third (superficial portion) of the depth and given the same performance too. Lifting the needle thrice according to the deep, medium and superficial sequence and thrusting it once is called one operation. Repeated operations can be conducted for several times until a cool feeling is got. On withdrawal of the needle, shake it to enlarge the hole. The operation is also performed in combination with the reducing by inserting the needle when the patient breathes in and by withdrawing it when the patient breathes out.
The reinforcing and reducing achieved by the direction the needle tip points to: Puncturing a point following its channel course is known as reinforcing method, and against its channel course is known as reducing method. For example, in puncturing the points of the three yin channels of hand, because the three channels run from the chest to the hand, the needle tip pointing to the hand is the reinforcing method, the opposite direction of the needle tip is the reducing metbod, after the channel qi is obtained.
The reinforcing and reducing achieved by the direction the needle tip points to: Puncturing a point following its channel course is known as reinforcing method, and against its channel course is known as reducing method. For example, in puncturing the points of the three yin channels of hand, because the three channels run from the chest to the hand, the needle tip pointing to the hand is the reinforcing method, the opposite direction of the needle tip is the reducing metbod, after the channel qi is obtained.
Reinforcing and reducing by twirling and rotating the needle: The left rotation of the needle with the thumb forward and the index finger backward means the reinforcing method, the right rotation of the needle with the thumb backward and the index finger forward is the reducing method.
Reinforcing and reducing by twirling and rotating the needle: The left rotation of the needle with the thumb forward and the index finger backward means the reinforcing method, the right rotation of the needle with the thumb backward and the index finger forward is the reducing method.
Moxibustion with Ginger: The moxibustion in which ginger is used as the media is called moxibustion with ginger. First, cut a thin slice of fresh ginger about 0.2-0.3cm thick, puneh several holes on it with a needle and place it on the point selected and then put a moxa cone on the ginger, and ignite the moxa cone until the local skin becomes congested. In general, each treatment needs 5-10 units of moxa cones and this type of moxibustion may be repeated many times according to the pathological condition. The method is indicated in abdominal pain due to cold, diarrhea due to cold, arthralgia syndrome due to wind-cold, etc.
Cupping Therapy Cupping is a therapy in which a jar is attached to the skin surface to cause local congestion through the removal of the air in the jar created by introducing heat in the form of an ignited material. This method has the function of warming and promoting the free flow of qi and blood in the channels, diminishing swellings and pains, dispelling cold and dampness. l) Types of Jars There are a great variety ofjars, but the commonly used are as follows. Bamboo jar: Cut down a section of bamboo 3-5 cm in diameter and 6-8 or 8-10 cm in length, forming a pipe. One end is used as the bottom, and the other as the opening. The middle part of the jar is a little thicker. And the rim of the jar should be made smooth by a piece of sand paper. The bamboo jar is light, economical and uneasy to break, but easy to crack with dryness to cause air leakage. Pottery jar: It is made from pottery clay by means of baking. The mouth of the jar is smooth with both ends smaller and the middle part extended slightly. The jar is shaped as a waist drum. The pottery jar is characterized by a big force of suction, but easy to break. Glass cup: Glass cup is made of glass. The mouth of the cup is smooth and small, but the body of the cup is large, and the rim of the mouth everted externally. The cup is transparent, so the congestion of the local skin in the cup can be seen so as to control the time of the treatment. but glass cup is also easy to break. 2) Manipulations Fire throwing method: Throw a ignited alcohol cotton ball or a piece of ignited paper into the cup, then rapidly place the mouth of the cup firmly against the selected site. Fire twinkling method: Clamp a ignited alcohol cotton ball with the forceps, move it round the inner wall of the cup, and immediately take it out and rapidly place the cup on the selected site. 3) Withdrawing the Cup After cupping, generally, the cup is sucked in place for 10 minutes or so. When the local skin becomes congested with violet coloured blood stasis formation, the cup is withdrawn. On withdrawing the cup, hold the cup with the right hand, and press the skin around the rim of the cup with thumb and index finger of the left hand to let air in, and take the cup away. 4) Indications The cupping method is mainly used to treat arthralgiasyndrome due to wind-dampness, various nervous paralyses. the diseases in gastrointestinal region and the region of the lung. 5) Precautions (l) It is not advisable to apply cupping to the patient with skin ulcer, high fever and convulsion, skin allergy or edema, and to the abdominal and sacral regions of the pregnant women. (2) The uneven site around joints and the areas with very loose skin are not selected for cupping. (3) After cupping the local area becomes flushed or bruises. This is a normal condition. If the local blood stasis is severe, further cupping on this area is not advisable. Small blisters occurring on the skin are not necessary to manage. If the blisters are large, puncture them with a sterile needle, apply gentian violet and cover them with sterilized gause to prevent infection.
The Three-edged Needle The three-edged needle, known as the ensiform needle in the ancient times, is shaped in a thick and round handle, a triangular body and a sharp tip. Generally, it is used in superficial-blood-vessel pricking to cause bleeding. 1. Manipulation l) Spot pricking: This method is used to treat fever, sore throat, heat stroke, apoplexy, etc. During the operation, pinch up the selected area tightly with the thumb, index and middle fingers of the left hand, hold a three-edged needle with the right hand, prick swiftly 0.05-0.1 cun deep at the area and withdraw the needle immediately, then squeeze and press the local area for blood letting. 2) Clumpy pricking: This method is indicated in carbuncles,arthralgia-syndrome, erysipelas, etc, Apply the routine sterilization around a reddened swelling, prick it around the lesion for several times or several dozen times with a three- edged needle, then squeeze and press the swelling gently with both hands or cup it to make the decayed blood escape completely, in order to diminish swelling and pain. 3) Pricking. The method is suitable for the hands, chest, back, head and face, and for areas with thin muscles. During the operation, point to the local reactive spot, pinch up the muscles around the area, prick the area with a three-edged nedle held in the right hand to make bleeding. 2. Indications The three-edged nedle is mostly used for blood letting and promoting the smooth flow of qi and blood in channels. It is advisable to treat blockage of the channels, blood stasis, pathogenic excess and blockage of both yin-qi and yang-qi. 3. Precautions Strict sterilization must be applied to the area to be pricked. The operation should be slight, superficial and quick. Bleeding should not be excessive. Avoid injuring the deep large arteries. Pricking shall in no case be applied for those with weak constitution or anemia, for pregnant women, parturients and those susceptible to bleedliig.
Electrotherapy with continuous wave. Electrotherapy Electrotherapy is a therapy which combines needling and electrical stimulation by sending a small amount of electric current to the needle after insertion of the needle and arrival of qi to treat diseases. The instrument used in the electrotherapy is composed of two parts: the filiform needle and the electric stimulator. There are many types of electric stimulators. According to its different power supply, the electric stimulator is classified as AC or DC electric stimulator, according to its structures and natures, it is classified as the low-frequency scillating, high-frequency oscillating, intermittent induced impulse curent, buzzer-type, electronic tube or semiconductor electric stmulator. I. Manipulations After insertion of the needles and arrival of qi, adjust the output potentiometer to "0", then connect the two outlets to the handles or bodies of the two needles respectively, turn on the power supply and selecte the required waveform and frequency. Then, adjust the output current from small to large until the patient feels comfortable and tolerates it. If the patient adapts the situation after 1-2 minutes, the current may be increased properly. Generally, the time of making-current lasts 10-20 minutes for each treatment. The time may also be prolonged properly according to the requirement of the pathological condition. When the required time is up, first adjust the output potentiometer back to "0",then turn off the power supply and disconnect the outlets from the needles. After that, withdraw the needles according to the common withdrawal of the needle. 2. Indications All the diseases which respond to the filiform needling therapy can be treated by the electric therapy. Clinically, this method is most used to treat painful diseases, epilepsy, flacciditysyndrome and arthralgia-syndrome, neuroasthenia, hypertension, etc., and also used in acupuncture anesthesia. 3. Precautions 1) During adjustment of the electric current, it should be increased gradually, not suddenly, in order to prevent the intense muscular contraction and result in bent or broken needle. 2) For the electric stimulator with the maximum output voltage over 40V, its maximum output current should be limited within 1 mA in order to avoid getting an electric shock. 3) For the patients with heart disease, avoid the clectric current passing through the heart. For the patients with weak constitution or nervousness, too much electric current is not advisable because it may cause the patients' fainting. 4) After the needle is used in moxiubstion with warming. needle, the needle handle may be burnt, and its surface is oxidized and loses electric conductivity. In this case, it is not advisable to use the needle in the electrotherapy. If used, the needle should be clipped at its body by an outlet clip.
Point Injection Point injection is a therapy combining medicines with acupuncture, that is to say, using the syringe to inject liquid medicine into the acupuncture point or the positive sensitive spot to treat the disease. 1. Manipulations Take the syringes to draw in the selected liquid medicine according to different diseases, sterilize the local skin routinely, fix the selected point or positive sensitive spot with the left hand and then insert the needle into the point quickly with the right hand. When the needle tip reaches a certain depth at which the patient feels the needling sensation of soreness, distention or irradiation, and there is no blood in the syringe after being drawn, push the liquid medicine into the point. For patients with acute diseases and good constitution, it is advisable to push liquid medicine into the point quickly, for those with chronic diseases and weak constitution, slowly. 2 The Injection Dosage and Course of Treatment On the four limbs and lumbar regions with the abundant and thick muscles, 1-2 ml liquid medicine may be injected into each point or each positive sensitive spot; on the head, face and regions of the ears, 0.3-0.5 ml in general. If antibiotics or others are used, 1/5-2/5 of the usual dosage is recommended. For patients with acute diseases, 1-2 times of injection per day is advisable, for those with chronic diseases, one time per day or every other day, in general. A course of treatment consists of 6-8 times of injection. 3. Indications This method can be used in all diseases which are suitable for acupuncture treatment. The point injection is indicated mostly in pain of the lower back and the leg, the pain of the joints, and some chronic diseases. 4. Precautions Before treatment, let the patient know the characteristics and the normal reactions of this therapy in order to dispel their misgivings. Pay attention to the natures, incompatibilities, side effects and allergic reactions of the medicine to be used. The hypersensitive tests should be done before the medicines which may possibly produce allergic reactions are used. Avoid by all means injecting the liquid medicine into the articular cavities. The method should be used with great care for the elderly individuals, young children, pregnant women and the individuals with weak constitution.
Manipulation of the Dermal Needle Also known as the "plum-blossom needle" and the "seven-star needle", the dermal needle is made with a bundle of stainless steel needles (five to seven) fixed vertically at the end of a handle. Belonging to superficial acupuncture, the dermal needle therapy is developed from different needle manipulations prevailing in ancient China. It can clear the meridian passage, and regulate the flow of qi and blood by tapping the skin surface. 1. Manipulation Before use, the dermal needle should be sterilized in 75% alcohol solution for 30 minutes. To start treatment, hold the handle with the right hand, with the ring and little fingers gripping the end of the handle. Meanwhile, hold the handle with the thumb and middle fingers, and fix the needle body by putting the index finger on the stalk. Tap the acupoint with the needle, using wrist strength. Make sure that the needle is tapped perpendicularly and lifted immediately, because oblique insertion and lifting will add pain to the patient. The frequency of tapping is 70 to 90 times per minute and the distance between two taps is about 1.0 to 1.5 cm. The tapping intensity may be classified as gentle, moderate and forceful. Gentle tap makes the skin to become red, using slight wrist strength; forceful tap causes local congestion or even slight bleeding, using full wrist strength; and moderate tap causes local congestion without bleeding. There are three types of tapping: Along the meridian; on the local area or selecting relevant points; on the whole body. These methods can either be used separately or in combination. The tapping order of each part is as follows: Head: Along the Du Meridian, the Bladder Meridian and the Gallbladder Meridian, from the anterior hairline to Naohu (DU 17), Yuzhen (BL 9) and Fengchi (GB 20) near the posterior hairline. The tapping on both sides of temples should proceed from the upper part to the lower one. Neck: First, tap the posterior border of sternocleidomastoid muscle; second, tap downward from the anterior border of the sternocleidomastoid muscle; third, tap forward from the posterior side of the mandible angle. Nape: Tap from Naohu (DU 17) to Dazhui (DU 14), and from Fengchi (GB 20) and Tianzhu(BL 10) to both sides of the spinous process of the sixth cervical vertebra. Scapula: First, tap downward from the medial border of the scapula; second, tap outward from the upper border of scapular spine; third, tap outward from the lower border of scapular spine. If the arms are difficult to raise, the tapping can be centered around the shoulder joint. Back: First, tap the first line of the Bladder Meridian on both sides of the spinal column, then tap its second line. Sacral region: Tap outward and upward from both sides of the coccyx tip, three times on each side. Upper limbs: Tap along the routes of the three yin and three yang meridians of hand. Circling tap can be applied to the joints. Face: Local tap. Around the eyes: First, tap along the eyebrow from the medial end to the outer end; second, passing the upper eyelids, tap from the inner canthus to Tongziliao (GB 1); third, passing the infraorbital ridge, tap from the inner canthus to Tongziliao. Nose: The tapping is centered around the columella on both sides of the nose. Ear: Tap the areas behind the lobe and in front of the ear. 2. Indications This method is mainly used for insomnia, headache, pain in the hypochondriac region, alopecia areata, protracted skin diseases, hypertension and neurodermatitis. To treat insomnia, tap both sides of the spine, Xinshu (BL 15), Feishu (BL 13), the Heart Meridian of Hand-Shaoyin and the Pericardium Meridian of Hand-Jueyin; for dreaminess and palpitation, tap Fengchi (GB 20) and Sanyinjiao(SP 6). together with both sides of the spine, Xinshu (BL 15), Feishu (BL 13), the Heart Meridian Hand-Shaoyin and the Pericardium Meridian of Hand-Jueyin; for headache, tap the nape, head£¬areas with pain, and remote sensitive region along the related meridians; for migraine, tap the nape, areas with pain, and sensitive region along the related meridians; for pain in the chest and hypochondrium, tap both sides of thoracic vertebrae on the back, especially Geshu (BL 17) and Ganshu (BL 18); for chest pain, tap the affected area and along the ribs; for hypochondriac pain, tap Zhigou (SJ 6) and Taichong (LR 3); for numbness and pain in the upper limbs, tap both sides of thoracic vertebrae, shoulder and elbow joints; for pain in the lower limbs, tap both sides of lumbar vertebrae and the affected area. For treatment of other diseases, please refer to relevant chapters in the third part of this book. 3. Points for Attention 1) Check the dermal needles regularly to make sure that all the tips are in good shape, When tapping, the needles should be kept vertically towards the skin surface so as to alleviate pain. 2) The needle and the skin should be sterilized carefully before tapping. After a forceful tapping, the skin surface should be sterilized to avoid infection. 3) Tapping is contraindicated if there is wound or ulcer on the skin.
Manipulation of Intradermal Needle The intradermal needle is made of stainless steel wire in shapes like a thumbtack or wheat. It is embedded subcutaneously to give out a continuous stimulus to the acupoint, and therefore is also called "needle-embedding therapy." 1. Manipulation Since the needle is embedded subcutaneously for a long time, the needle and the skin should be sterilized to prevent infection. The thumbtack-shape needle, also known as the "pressing needle", is mainly used for the ear region. The manipulation is as follows: Hold the annular handle with forceps and insert the needle proper into the acupoint after the skin is sterilized and then fix it with a piece of adhesive plaster. Or put the annular handle of the needle on a piece of adhesive plaster . Or put the annular handle of the needle on a piece of adhesive plaster first, then hold the plaster with a forceps and insert the needle body into the acupoint, leaving the annular handle on the skin. Then use an adhesive plaster to fix the handle. Usually the needle is kept under skin from three to seven days, during which the needle must be pressed several times a day to add stimulus. The wheat-shaped needle can be used for most of the acupoints. The manipulation is as follows: Hold the handle with a forceps and insert the needle into the sterilized acupoint about 0.5 to 1.0 cm deep. Take care that the inserting direction does not influence the free movement of the local area. Then fix the remaining needle body and handle on the skin with an adhesive plaster and cover it with a piece of gauze. 2.Indications The intradermal needle treatment is suitable for chronic or painful diseases which need continuous stimulus given by needle retention, such as headache, stomachache, asthma, insomnia, enuresis, menoxenia and dysmenorrhea. 3. Points for Attention 1) The intradermal needle treatment is not suitable for body area with purulent inflammation or ulcer. 2) The area for needle embedment should be easy to fix, and causes no inconvenience to body movement. Usually, needle embedment is not applied to areas around the joints for fear of causing pain or influencing movement 3) During the needle retention period, the area should be kept clean. In summer, the duration of needle embedment should be shorter so as to prevent infection.