34. Needle technique
Chapter Contents
The art and the mechanics of needle technique264
The mechanics of needle technique265
The art of needle technique270
If you should want to heal disease there is nothing so good as the needle! Its skill lies in the mystery of its working – one’s labour exposes its sacred principles.
(Da Cheng; Bertschinger, 1991, p. 81)
The art and the mechanics of needle technique
‘Tonification’ and ‘sedation’ are the two needle techniques used by practitioners of Five Element Constitutional Acupuncture. This chapter will describe these techniques taking into account both the ‘mechanics’ and the ‘art’ of needle technique.
The section on the ‘mechanics’ of needle technique will outline how each needle technique is carried out. The section on the ‘art’ of needling discusses how the practitioner can develop internally so that treatment can be aimed at healing a person at the level of body, mind and spirit. A great concert pianist must have impeccable technique but also needs to integrate that expertise by accessing her or his inner expression. A practitioner with experience (jingyan) and virtuosity (linghuo) is capable of similar levels of excellence.
When to use each technique
The predominant needle technique used in Five Element Constitutional Acupuncture is tonification. There are occasions when the qi of an Organ appears full, in which case sedation is used. Pulse diagnosis is the main method used to decide which technique to use (see Chapter 28, this volume, for more on pulse diagnosis). In some cases because of the difficulty in establishing a ‘norm’, this can require experience on the part of the practitioner.
Because Five Element Constitutional Acupuncture is treating a person’s underlying constitutional imbalance, it is not surprising that tonification is used more often than sedation. Occasionally at the start of treatment a pulse feels full and later becomes deficient. When the pulses begin to change, a different needle technique becomes appropriate.
Less commonly, a sedation needle technique needs to be carried out for a longer period, although an underlying deficiency may still emerge later on.
Needle technique for physical versus spirit level
The needle gauge, number of points used, retention time and amount of needle sensation vary according to the level of treatment a patient requires. In general, the subtler spirit levels are reflected by more refined and subtle needle techniques. Table 34.1 summarises the use of needle technique when treating the physical level versus a more spirit level.
| Physical level | Spirit level | |
|---|---|---|
| Needle gauge | Thicker | Finer |
| Number of points | More points | Fewer points |
| Retention time | Longer retention | Less or no retention |
| Obtaining deqi | More sensation | Less sensation |
The mechanics of needle technique
Tonification technique
Tonification is used to strengthen a patient’s qi when it is deficient. This technique involves inserting a needle to contact the patient’s qi, then immediately removing it. The whole technique usually lasts for only 2–3 seconds. (The equivalent technique used by practitioners of TCM is different. It is usually called ‘reinforcing’ and the needle is left in place for up to 20 minutes.) The Ling ShuChapter 1 states:
Once qi has arrived there is no further need to retain the needle in the patient’s body as the aim of the manipulation has now been achieved.
(Auteroche et al., 1992, p. 47)
In the Ling ShuChapter 3 it states:
A good physician withdraws the needle as soon as qi has arrived.
(Auteroche et al., 1992, p. 47)
A practitioner of Five Element Constitutional Acupuncture who finds that a patient’s pulses are deficient uses this needle technique. For example, if the Metal Element is deficient, the practitioner may choose to use any of the points on the Lung and Large Intestine channels. In this case the needle action will be tonification.
The procedure for tonification needle technique
The following instructions assume that the reader is already trained in appropriate sterile procedure.
• Hold the needle angled 10° off the perpendicular and towards the flow of qi.
• Needle the left side of the body first then the right.
• Insert the needle slowly to the required depth, as the patient breathes out.
• Contact the patient’s qi (deqi).
• Turn the needle 180° clockwise.
• Remove the needle immediately.
• Close the hole by pressing a clean swab over the point.
Tonification is the most common needle technique used by practitioners of Five Element Constitutional Acupuncture. This is because it is primarily concerned with strengthening long-standing deficiencies in the Organs and Elements.
Sedation technique
Sedation needle technique is used to calm a person’s qi when there is an excess or full condition. This technique involves contacting the patient’s qi then leaving the needle in place for 20–30 minutes until the pulses have changed sufficiently.
A practitioner who finds that a patient’s pulses are hyperactive may decide to soothe an Organ using this needle technique. For example, if the Wood Element is hyper-functioning this may be reflected in the patient’s pulses feeling full or agitated. In this situation the practitioner may choose to use Liver and Gall Bladder points such as the source points (Liv 3 and GB 40) or the sedation points (Liv 2 and GB 38) with a needle action of sedation technique. (Sedation is most similar to the technique known to practitioners of TCM as ‘even’ technique rather than ‘reducing’ technique.)
The analogy about sedation given below has been used by J. R. Worsley (1990, p. 190):
If we imagine a swollen river threatening to flood, there are several ways in which its flow returns to normal. Water can be drawn away or barriers impeding its course can be removed. This is how we should visualise sedation.
The procedure for sedation needle technique
• Hold the needle angled 10° against the flow of the qi.
• Needle the right side of the body first then the left.
• Insert the needle quickly, to the required depth, as the patient breathes in.
• Turn the needle 360° anticlockwise.
• Contact with the patient’s qi (deqi) is usually made while turning the needle.
• Retain the needle for between 5 and 30 minutes, until the desired pulse change has occurred.
• Remove the needle slowly.
• When removing the needle, do not close the hole.
Breakdown of stages of needle technique (Table 34.2)
1. Needle angles
| Tonification | Sedation | |
|---|---|---|
| Angle | 10 degree angle towards the flow | 10 degree angle against the flow |
| Needle order | Needle left side first, then right | Needle right side first, then left |
| Insertion | Insert slowly as patient breathes out | Insert quickly as patient breathes in |
| Needle manipulation | Turn the needle 180 degrees clockwise | Turn needle 360 degrees anti-clockwise |
| Length of retention | Do not retain needle | Retain needles until desired pulse change has occurred (from 5 to 30 minutes) |
| Removal | Immediately remove needle. Remove needle quickly | Remove needle slowly |
| Closing hole | Close hole using clean swab on removal | Do not close hole on removal |
The method is quick to grasp and clear – simply understand facing up or following on and you can work.
(Da Cheng; Bertschinger, 1991, p. 85)
The above quotation describes the need to angle the needle with or away from the flow of qi when either strengthening a deficient Organ or calming an Organ that is hyper-functioning (see Figure 34.1). In general, the needle is angled towards or against the flow of qi but only a few degrees away from the perpendicular. Large angles are rarely used unless the point is situated on a bone, for example LI 6. In this case it is necessary to use a more oblique angle in order to insert it to the required depth.
 |
| Figure 34.1 • |
2. Depth of insertion of needles
Five Element Constitutional Acupuncturists do not use extremely deep needle insertions. The depth of insertion varies according to which point is being used but 0.5 cun is common on an arm or leg. In this case a one-inch long needle is most often used (approximately 2.5cm). Half-inch needles are used for nail points when the insertion is very shallow. Needles one-and-a-half inches long are used for deeper insertions such as Ren points on the lower abdomen. (This is in contrast to practitioners primarily trained in TCM, who may use longer needles.) For a list of the most common depths, see the individual needle depths in the chapters on the different points in Section 6.
3. Needle manipulation
A practitioner usually inserts a needle to the required depth, then gently turns it in order to make contact with the patient’s qi. As the turn is slight – 180° for tonification and 360° for sedation – this requires a continuous movement and clear intention on the part of the practitioner.
4. Needle sensation
The patient usually experiences the qi by feeling a dull ache, soreness, heaviness, a pulling sensation, heat or numbness. This sensation should not be extreme. At the same time the practitioner will usually feel a pulling sensation. This feels as if the needle is being held firmly by someone’s fingers or it is described as like ‘catching a fish’.
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