The Needle

1	The Needle

As the Ling Shu, the second part of the Huang Di Nei Jing, the 2000-year old book on traditional acupuncture, posits,“If you should want to treat illness there is nothing so good as the needle” and certainly, the needle is the primary tool of treatment for the acupuncturist. Ironically though, in my experience as a teacher, I have found students to be disinterested in the specifics of the needle, such as its gauge and length, and are more interested in actually using it. This is understandable in the sense that in their passion for the medicine and compassion for the patient they are anxious to help alleviate suffering.

While I am sure that the students do learn this material in school, I also know that it is not given the pre-eminence it deserves, nor are the students held accountable for it over other topics. This relative lack of basic, fundamental training can easily be rectified if students are taught the facts with the proper attention and respect the subject deserves. As a result of my observations as an advanced needle technique instructor therefore, it would be wise to take some time to review the various parameters of the needle over the needling process. Correct understanding of the gauges and lengths of needles contributes to their correct usage and thus clinical success.

Needle Composition and Safety

According to anthropological data, ancient needles were made of bamboo, stone, and steel. Modern day needles are made out of the most refined metals such as silver, gold, copper, titanium, and mostly stainless steel. The most practical and popular disposable metal needle is made of stainless steel because it does not tarnish like silver or corrode like gold. For the most part, it is hypoallergenic. Titanium is better for the few patients who are hypersensitive even to stainless steel and this is an option open to the practitioner.

Nowadays it is more practical, safe and even required in some states of the United States, to use disposable needles to guard against the transmission transmission of infectious disease. Patients are less apprehensive about treatment, and the practitioner’s time is freed from sterilizing contaminated needles, which can be dangerous. The cost of disposable needles is not great and so not prohibitive. Used needles should be disposed of in biohazard containers and processed by a biohazard service for proper disposal.

Parts of the Needle, Lengths, and Gauges

Needle parts are important. The needle is composed of four parts—the handle, the root, the body, and the tip. The body and tip of the needle must always be sterile and never contaminated through touch or any other means, as this can contribute to the transmission of infectious disease.

An important part of the needle is the root. The root is the juncture of the handle and the body of the needle. The needle must never be inserted with less than 0.25 in of the root exposed. This allowance helps prevent a deeper penetration of the needle that might inadvertently happen if the patient moves, a muscle twitches, or the needle sinks deeper into the body due to muscle relaxation or other factors such as being touched.

Needle length is important and proper needle lengths must be selected. Most acupuncture points have a depth of insertion of 0.5 to 1.0 in, so in acupuncture practice the most common needles used are 1 in and 1.5 in. Needle length is chosen by the depth of insertion of the acupuncture point, meaning the range in which the qi resides in each acupuncture point. Figure 1.1 illustrates the parts of the needle and the proper depth of insertion on a 1 in needle and Table 1.1. summarizes the most accepted depths of insertions of all the acupuncture points of the 12 main channels.

The gauge of the needle refers to the diameter or the thickness of the needle. Gauges are selected depending on the points to be treated, for instance, the texture of the skin they are located on. For thick skin such as the scalp or the ear, use a thick needle such as a 28 g (gauge) or 30 g. When needling the delicate skin of the face, use a thin needle such as a 36 g.

Fig. 1.1 The parts of the needle.

Channel	Depth of insertion (in)
Lung
LU-1	0.5–0.8 obliquely towards the lateral aspect
LU-2	0.5–0.8 obliquely towards the lateral aspect
LU-3	0.5–1 ppd.* moxa as a Window to the Sky point
LU-4	0.5–1 ppd
LU-5	0.5–1 ppd. No moxa, may shorten the tendon
LU-6	0.5–1 ppd
LU-7	0.3–0.5 obliquely
LU-8	0.1–0.3 ppd. No moxa, as the point is on the course of the radial artery
LU-9	0.2–0.3 Shallow insertion on course of the radial artery
LU-10	0.5–0.8 ppd
LU-11	0.1 or obliquely upward prick to bleed. No moxa, as it is a point to release hea
Large intestine
LI-1	0.1 or obliquely upward prick to bleed
LI-2	0.2–0.3 ppd
LI-3	0.5–0.8 ppd
LI-4	0.5–1 ppd. Forbidden in Pregnancy: no moxa and needle
LI-5	0.3–0.5 ppd
LI-6	0.5–0.8 obliquely
LI-7	0.5–1 ppd
LI-8	0.5–1 ppd
LI-9	0.5–1 ppd
LI-10	0.8–1.2 ppd
LI-11	1–1.5 ppd
LI-12	0.5–1 ppd
LI-13	0.5–1 ppd. Forbidden to needle due to location on the course of the radial collateral artery andvein
LI-14	0.8–1.5 ppd or obliquely upward
LI-15	0.8–1.5 ppd or obliquely
LI-16	0.5–0.7 ppd
LI-17	0.3–0.5 ppd
LI-18	0.3–0.5 ppd
LI-19	0.2–0.3 obliquely
LI-20	0.3–0.5 obliquely or subcutaneously
Stomach
ST-1	0.5–1 ppd. Push eye up to needle. No manipulation. No moxa
ST-2	0.2–0.3 ppd
ST-3	0.3–0.5 ppd
ST-4	1–1.5 subcutaneously to ST-6
ST-5	0.3–0.5 obliquely, posteriorly. Avoid the facial artery
ST-6	0.3–0.5 ppd or subcutaneously towards ST-4
ST-7	0.3–0.5 ppd
ST-8	0.5–1 subcutaneously
ST-9	0.3–0.5 ppd. Caution as the point is on the bifurcation of the carotid artery. No moxa
ST-10	0.3–0.5 ppd
ST-11	0.3–0.5 ppd
ST-12	0.3–0.5 ppd Watch depth
ST-13	0.3–0.5 lateral obliquely. Caution as the point is over the lungs
ST-14	0.3–0.5 obliquely
ST-15	0.3–0.5 obliquely
ST-16	0.3–0.5 obliquely
ST-17	Forbidden point, the nipple, no needle, no moxa
ST-18	0.3–0.5 obliquely
ST-19	0.5–0.8 ppd. Careful of the liver
ST-20	0.5–1 ppd
ST-21	0.8–1 ppd. Careful of the liver
ST-22	0.8–1 ppd.
ST-23	0.7–1 ppd
ST-24	0.7–1 ppd
ST-25	0.7–1.2 ppd
ST-26	0.7–1.2 ppd
ST-27	0.7–1.2 ppd
ST-28	0.7–1.2 ppd
ST-29	0.7–1.2 ppd
ST-30	0.5–1 ppd
ST-31	1–1.5 ppd
ST-32	1–1.5 ppd
ST-33	0.7–1 ppd
ST-34	0.5–1 ppd
ST-35	0.7–1 ppd
ST-36	0.5–1.2 ppd
ST-37	0.5–1.2 ppd
ST-38	0.5–1 ppd
ST-39	0.5–1 ppd
ST-40	0.5–1 ppd
ST-41	0.5–0.7 ppd
ST-42	0.3–0.5 ppd. Avoid the dorsal artery
ST-43	0.3–0.5 ppd
ST-44	0.3–0.5 ppd
ST-45	0.1 obliquely
Spleen
SP-1	0.1 obliquely
SP-2	0.1–0.3 ppd
SP-3	0.3–0.5 ppd
SP-4	0.5–0.8 ppd
SP-5	0.2–0.3 ppd
SP-6	0.5–1 ppd. Forbidden point in pregnancy: no moxa, no needle
SP-7	0.5–1 ppd
SP-8	0.5–1 ppd
SP-9	0.5–1 ppd
SP-10	0.5–1.2 ppd
SP-11	0.5–1 ppd
SP-12	0.5–1 ppd. Avoid the femoral artery
SP-13	0.5–1 ppd
SP-14	0.5–1 ppd
SP-15	0.7–1.2 ppd
SP-16	0.5–1 ppd
SP-17	0.3–0.5 obliquely
SP-18	0.3–0.5 obliquely
SP-19	0.3–0.5 obliquely
SP-20	0.3–0.5 obliquely
SP-21	0.3–0.5 obliquely
Heart
HT-1	0.5–1 ppd. Avoid the axillary arteryy
HT-2	0.3–0.5 ppd
HT-3	0.5–1 ppd
HT-4	0.3–0.5 ppd
HT-5	0.3–0.5 ppd
HT-6	0.3–0.5 ppd
HT-7	0.3–0.5 ppd
HT-8	0.3–0.5 ppd
HT-9	0.1 subcutaneously or prick
Small intestine
SI-1	0.1 subcutaneously or prick
SI-2	0.3–0.5 ppd
SI-3	0.5–0.7 ppd
SI-4	0.3–0.5 ppd
SI-5	0.3–0.5 ppd
SI-6	0.3–0.5 ppd
SI-7	0.5–0.8 ppd
SI-9	0.5–1 ppd
SI-10	0.5–1 ppd
SI-11	0.5–1 ppd or obliquely
SI-12	0.5–1 ppd
SI-13	0.3–0.5 ppd
SI-14	0.3–0.7 obliquely
SI-15	0.3–0.6 obliquely
SI-16	0.3–0.7 ppd
SI-17	0.5–0.7 ppd
SI-18	0.5–0.8 ppd
SI-19	0.3–1 ppd with the mouth open
Bladder
BL-1	0.3–0.7 ppd
BL-2	0.3–0.5 subcutaneously
BL-3	0.3–0.5 subcutaneously
BL-4	0.3–0.5 subcutaneously
BL-5	0.3–0.5 subcutaneously
BL-6	0.3–0.5 subcutaneously
BL-7	0.3–0.5 subcutaneously
BL-8	0.3–0.5 subcutaneously
BL-9	0.3–0.5 subcutaneously
BL-10	0.5–0.8 ppd
BL-11	0.5–0.7 obliquely
BL-12	0.5–0.7 obliquely
BL-13	0.5–0.7 obliquely
BL-14	0.5–0.7 obliquely
BL-15	0.5–0.7 obliquely
BL-16	0.5–0.7 obliquely
BL-17	0.5–0.7 obliquely
BL-18	0.5–0.7 obliquely
BL-19	0.5–0.8 obliquely
BL-20	0.5–0.7 obliquely
BL-21	0.5–0.8 obliquely
BL-22	0.5–1 ppd
BL-23	1–1.2 ppd
BL-24	0.8–1.2 ppd
BL-25	0.8–1.2 ppd
BL-26	0.8–1.2 ppd
BL-27	0.8–1.2 ppd
BL-28	0.8–1.2 ppd
BL-29	0.8–1.2 ppd
BL-30	0.8–1.2 ppd
BL-31	0.8–1.2 ppd
BL-32	0.8–1.2 ppd
BL-33	0.8–1.2 ppd
BL-34	0.8–1.2 ppd
BL-35	0.8–1.2 ppd
BL-36	1–1.5 ppd
BL-37	1–2 ppd
BL-38	0.5–1 ppd
BL-39	0.5–1 ppd
BL-40	0.5–1 ppd. No moxa, may shorten the tendon
BL-41	0.3–0.5 ppd
BL-42	0.3–0.5 obliquely
BL-43	0.3–0.5 obliquely
BL-44	0.3–0.5 obliquely
BL-45	0.3–0.5 obliquely
BL-46	0.3–0.5 obliquely
BL-47	0.3–0.5 obliquely
BL-48	0.3–0.5 obliquely
BL-49	0.3–0.5 obliquely
BL-50	0.3–0.5 obliquely
BL-51	0.3–0.5 obliquely
BL-52	0.5–1 ppd
BL-53	0.8–1.2 ppd
BL-54	1.5–2 ppd
BL-55	0.7–1 ppdd
BL-56	0.8–1.2 ppd
BL-57	0.8–1.2 ppd
BL-58	0.7–1 ppd
BL-59	0.5–1 ppd
BL-60	0.5–1 ppd. No needle in pregnancy
BL-61	0.3–0.5 ppd
BL-62	0.3–0.5 ppd
BL-63	0.3–0.5 ppd
BL-64	0.3–0.5 ppd
BL-65	0.3–0.5 ppd
BL-66	0.2–0.3 ppd
BL-67	0.1
Kidney
KI-1	0.3–0.5 ppd
KI-2	0.3–0.5 ppd
KI-3	0.3–0.5 ppd
KI-4	0.3–0.5 ppd
KI-5	0.3–0.5 ppd
KI-6	0.3–0.5 ppd or horizontally posteriorly
KI-7	0.5–0.7 ppd
KI-8	0.5–0.7 ppd
KI-9	0.5–0.7 ppd
KI-10	0.8–1 ppd
KI-11	0.5–1 ppd
KI-12	0.5–1 ppd
KI-13	0.5–1 ppd
KI-14	0.5–1 ppd
KI-15	0.5–1 ppd
KI-16	0.5–1 ppd
KI-17	0.5–1 ppd
KI-18	0.5–1 ppd
KI-19	0.5–1 ppd
KI-20	0.5–1 ppd
KI-21	0.3–0.7 ppd. Caution close to the liver
KI-22	0.3–0.5 obliquely
KI-23	0.3–0.5 obliquely
KI-24	0.3–0.5 obliquely
KI-25	0.3–0.5 obliquely
KI-26	0.3–0.5 obliquely
KI-27	0.3–0.5 obliquely
Pericardium
PC-1	0.2–0.4 obliquely
PC-2	0.5–0.7 ppd
PC-3	0.5–0.7 ppd or bleed
PC-4	0.5–1 ppd
PC-5	0.5–1 ppd
PC-6	0.5–0.8 ppd
PC-7	0.3–0.5 ppd
PC-8	0.3–0.5 ppd
PC-9	0.1 ppd
Triple burner
TB-1	0.1 ppd or prick
TB-2	0.3–0.5 obliquely toward the metacarpal bones
TB-3	0.3–0.5 ppd
TB-4	0.3–0.5 ppd
TB-5	0.5–1 ppd
TB-6	0.8–1.2 ppd
TB-7	0.5–1 ppd
TB-8	0.5–1 ppd. Classically forbidden to needle as the group luo of the threearm yang
TB-9	0.5–1 ppd
TB-10	0.3–0.5 ppd
TB-11	0.3–0.5 ppd
TB-12	0.5–0.7 ppd
TB-13	0.5–0.8 ppd
TB-14	0.7–1 ppd
TB-15	0.3–0.5 ppd
TB-16	0.3–0.5 ppd
TB-17	0.5–1 ppd
TB-18	0.3–0.5 subcutaneously or bleed
TB-19	0.3–0.5 obliquely
TB-20	0.3–0.5 subcutaneously
TB-21	0.3–0.5 ppd with the mouth open
TB-22	0.1–0.3 obliquely
TB-23	0.3–0.5 subcutaneously. No moxa due to proximity to the eye
Gall bladder
GB-1	0.3–0.5 subcutaneously. No moxa due to proximity to the eye
GB-2	0.5–0.7 ppd
GB-3	0.3–0.5 ppd
GB-4	0.3–0.5 subcutaneously
GB-5	0.3–0.5 subcutaneously
GB-6	0.3–0.5 subcutaneously
GB-7	0.3–0.5 subcutaneously
GB-8	0.3–0.5 subcutaneously
GB-9	0.3–0.5 subcutaneously. No moxa on this point within the hairline
GB-10	0.3–0.5 subcutaneously
GB-11	0.3–0.5 subcutaneously
GB-12	0.3–0.5 obliquely
GB-13	0.3–0.5 subcutaneously
GB-14	0.3–0.5 subcutaneously
GB-15	0.3–0.5 subcutaneously
GB-16	0.3–0.5 subcutaneously
GB-17	0.3–0.5 subcutaneously
GB-18	0.3–0.5 subcutaneously
GB-19	0.3–0.5 subcutaneously
GB-20	0.5–0.8 towards the tip of the nose
GB-21	0.3–0.5 ppd
GB-22	0.3–0.5 obliquely
GB-23	0.3–0.5 obliquely
GB-24	0.3–0.5 obliquely
GB-25	0.3–0.5 ppd
GB-26	0.5–0.8 ppd
GB-27	0.5–1 ppd
GB-28	0.5–1 ppd
GB-29	0.5–1 ppd
GB-30	1.5–2.5 ppd
GB-31	0.7–1.2 ppd
GB-32	0.7–1 ppd
GB-33	0.5–1 ppd
GB-34	0.8–1.2 ppd
GB-35	0.5–0.8 ppd
GB-36	0.5–0.8 ppd
GB-37	0.7–1 ppd
GB-38	0.5–0.7 ppd
GB-39	0.3–0.5 ppd
GB-40	0.5–0.8 ppd
GB-41	0.3–0.5 ppd
GB-42	0.3–0.5 ppd. No moxa due to dorsal artery and venous network
GB-43	0.3–0.5 ppd
GB-44	0.1 subcutaneously
Liver
LR-1	0.1–0.2 obliquely
LR-2	0.3–0.5 obliquely
LR-3	0.3–0.5 ppd
LR-4	0.3–0.5 ppd
LR-5	0.3–0.5 subcutaneously posteriorly horizontally
LR-6	0.5–0.8 subcutaneously horizontally
LR-7	0.5–1 ppd (0.4–0.6 range)
LR-8	0.5–0.8 ppd
LR-9	0.5–0.7 ppd
LR-10	0.5–1 ppd
LR-11	0.5–1 ppd
LR-12	Moxa, no needle due to the femoral artery and vein
LR-13	0.5–0.8 ppd. Moxa three to five minutes
LR-14	0.5–0.8 obliquely towards the lateral aspect
Conception vessel
CV-1	0.5–1 ppd
CV-2	0.5–1 ppd
CV-3	0.5–1 ppd
CV-4	0.8–1.2 ppd
CV-5	0.5–1 ppd
CV-6	0.8–1.2 ppd
CV-7	0.8–1.2 ppd
CV-8	Umbilicus, forbidden to needle, moxa fine
CV-9	0.5–1 ppd
CV-10	0.5–1.2 ppd
CV-11	0.5–1.2 ppd
CV-12	0.5–1.2 ppd
CV-13	0.5–1.2 ppd
CV-14	0.3–0.8 ppd
CV-15	0.4–0.6 obliquely or horizontally
CV-16	0.3–0.5 subcutaneously
CV-17	0.3–0.5 subcutaneously upwards
CV-18	0.3–0.5 subcutaneously
CV-19	0.3–0.5 subcutaneously
CV-20	0.3–0.5 subcutaneously
CV-21	0.3–0.5 subcutaneously
CV-22	0.2 subcutaneously (then 0.5–1 downward)
CV-23	0.2–0.3 obliquely upward towards the tongue root
CV-24	0.2–0.3 obliquely upward
Governing vessel
GV-1	0.5–1 ppd
GV-2	0.5–1 obliquely upward
GV-3	0.5–1 ppd
GV-4	0.5–1 ppd
GV-5	0.5–1 ppd
GV-6	0.5–1 ppd. No moxa, may move the spine
GV-7	0.5–1 ppd. No moxa, may move the spine
GV-8	0.5–1 ppd
GV-9	0.5–1 obliquely upward
GV-10	0.5–1 obliquely. Classically forbidden to needle due to connection with the heart
GV-11	0.5–1 obliquely upward
GV-12	0.5–1 obliquely upward
GV-13	0.5–1 obliquely upward
GV-14	0.5–1 obliquely upward
GV-15	0.5–0.8 ppd. No moxa on this point at the nape
GV-16	0.5–0.8 ppd, not deep. No moxa, as a Window to the Sky point
GV-17	0.3–0.5 subcutaneously
GV-18	0.3–0.5 subcutaneously
GV-19	0.3–0.5 subcutaneously
GV-20	0.3–0.5 subcutaneously
GV-21	0.3–0.5 subcutaneously
GV-22	0.3–0.5 subcutaneously
GV-23	0.3–0.5 subcutaneously or bleed
GV-24	0.3–0.5 subcutaneously or bleed
GV-25	0.2–0.3 ppd or bleed. No moxa, due to proximity to nose and connection to brain
GV-26	0.3–0.5 obliquely upward. No moxa, due to proximity to nose and connection to brain
GV-27	0.2–0.3 ppd
GV-28	0.1–0.2 obliquely upward or bleed

*ppd = perpendicularly.

Table 1.1 Depths of insertion of the points of the 12 main channels

Careful attention to needle length and gauge helps to achieve the desired therapeutic result. See the next section below for a summary of the selection criteria for needle length and gauge (see also Fig. 1.2) and a conversion table of Chinese and Japanese needle measurements (Table. 1.2), as Chinese and Japanese measurement systems are different.

Selecting a Needle

When selecting a needle to treat a particular acupuncture point there are always two parameters to consider:

The depth of insertion of the qi of the channel suggests the length of the needle.
The tissues to be needled, such as delicate face points or thick muscles or cartilage, require thin or thicker gauge or thicker needles respectively. For example, a shallow face point would be needled best with a short, thin needle, and a deep muscular point should be needled with a long, relatively thicker needle.