Acupuncture: When not to needle

What is never needled

There are situations with no debate and no nuance. Knowing them by heart is part of the technique, just as much as knowing how to measure in cun.

Over infected or broken skin

find another area

Over a tumour or an unidentified lesion

do not needle, refer

Over an open fontanelle

never

In an unstable patient

the emergency comes first

Common mistake: Hunting for «the equivalent point» over an area that must not be touched. There is almost always a distal alternative.

Pregnancy

Always ask, and ask before locating anything. It is not enough for the patient to mention it: you must ask, because many do not say so in the first weeks.

Low lumbosacral area

avoided

Lower abdomen

avoided

Strongly mobilising points

contraindicated

What can be done

gentle distal points for nausea and sleep

Common mistake: Asking at the end, when the patient is already lying down and the points are chosen.

The three serious anatomical risks

They are rare and highly avoidable, and all are avoided by the angle. None is avoided by generic caution: it is avoided by knowing what lies below.

Pneumothorax

chest and upper back: never deep perpendicular

Vascular puncture

groin, armpit, neck: palpate first

Nerve injury

if there is an electric shock, withdraw

Red flag after the session

breathlessness or chest pain: emergency care

Common mistake: Reassuring a patient who reports difficulty breathing after chest needling. That is referred, not reassured.

What do you do in each situation?

• An anticoagulated patient with neck painNeedle with precautionsDo not needle that areaRefer before treating
• A mole that has changed shape right where the point would goNeedle with precautionsDo not needle that areaRefer before treating
• Crushing chest pain that appears on walking fastNeedle with precautionsDo not needle that areaRefer before treating
• A very nervous patient who has not eaten todayNeedle with precautionsDo not needle that areaRefer before treating
• An area with active eczema and cracked skinNeedle with precautionsDo not needle that areaRefer before treating
• A new, brutal, sudden-onset headacheNeedle with precautionsDo not needle that areaRefer before treating

Mid-session the patient turns pale, breaks into a cold sweat and says they feel faint. What do you do first?

1. Ask about symptoms to refine the diagnosis
2. Withdraw all needles at once and lay them down with the legs raised
3. Add a point to raise the blood pressure

Order the check before any session.

1. Ask about pregnancy, anticoagulation and pacemakers↑↓
2. Rule out red flags that require referral↑↓
3. Check the skin of the areas you will use↑↓
4. Decide the posture and explain what they will feel↑↓
5. Count the needles before starting and at the end↑↓