Acupuncture: Technique

The arrival of qi

得氣 dé qì

It is not pain. It is a dull sensation of heaviness, cramping or distension that the patient feels around the needle and that the therapist senses as a soft resistance. Without it, needling is just a prick.

What the patient feels

heaviness, tingling, distension

What the therapist feels

the needle «grabs»

What it must not be

sharp or electric pain

If it does not arrive

check depth, angle and location

Common mistake: Insisting with strong manipulation to chase the sensation. If it will not come, the point is almost always misplaced.

Angle and depth are decided by anatomy

There is no standard depth: what lies underneath decides it. Over the chest and upper back you always needle obliquely or transversely, because the lung is below.

Perpendicular

areas with muscle mass: buttock, thigh, lower abdomen

Oblique

near organs or bone

Transverse

skull, face, thin-skinned areas

Fixed rule

over the chest, never perpendicular and deep

Common mistake: Applying the textbook depth without adjusting it to the build of the patient in front of you.

Tonifying and draining

The same needle does opposite things depending on how it is handled. The differences are subtle and what matters is sustained intention: gentle and brief against strong and longer.

Tonify

gentle stimulus, few manipulations, slow withdrawal

Drain

stronger, repeated stimulus, quick withdrawal

With the breath

inserting on exhalation tonifies; on inhalation drains

Duration

less time in deficiency, more in excess

Common mistake: Stimulating a very weakened patient strongly. Draining where something is missing exhausts further.

Tonify or drain?

• Pale patient, weak voice, tires while talkingTonifyDrain
• Acute low back pain since yesterday that refuses pressureTonifyDrain
• Years of poor digestion with loose stoolsTonifyDrain
• Intense headache with red eyes and a wiry pulseTonifyDrain
• Constipation with distension and a thick yellow coatingTonifyDrain
• Chronic coldness with clear night urinationTonifyDrain

When does adding moxa make sense and when not?

1. Always: heat relaxes and is never excessive
2. Only in winter
3. In cold and in deficiency yes; in heat or yin-deficiency pictures, no

Order a session, first step to last.

1. Confirm the pattern and rule out red flags↑↓
2. Choose the combination and decide tonify or drain↑↓
3. Position the patient and locate the points↑↓
4. Needle, seek the arrival of qi and let it rest↑↓
5. Withdraw, count the needles and see how they stand up↑↓