2. Filiform needle techniques Lecturer: Qu Hongyan

3. Acupuncture or needling, is a type of therapy that stimulates certain locations or points of the body, by manipulating needles or other similar instruments.

4. Development of needles Bian-stone needles Bone needles Stainless steel filiform needles

5. Structure and Gauge of a Filiform Needle A filiform needle used today is made of stainless steel which has high intensity and elasticity, is non- corrosive and inexpensive. It can be divided into 5 parts

6.  Length of the filiform needle  Diameter of the filiform needle The gauge of a needle is determined by its length and diameter. Old gauge 0.511.5 22.5 3 44.5 5 6 length 152540506575100115125150 Size 262728 2930 31 3233 34 35 diameter 0.450.420.380.340.320.300.280.26 0.240.22 Structure and Gauge of a Filiform Needle

7. Practicing Needling Skills  Practicing finger force  Practicing common manipulations practicing quick puncturing practicing twirling-rotating manipulation practicing lifting-thrusting manipulation  Self-needling test

8. This is to train the finger force and manipulation of twirling and rotating.

9. It is to train the manipulation of lifting and trusting, twirling and rotating, insertion and withdrawal of the needles.

10. Preparations Prior to Treatment  Explanation to the patient prior to treatment  Selection of needles (patient constitution, age, point location and the condition to be treated)  Posture selection of the patient  Sterilization

11. The commonly used posture in acupuncture treatment  Supine posture  Lateral recumbent posture  Prone posture  Sitting in supine posture  Sitting in flexion  Sitting in lateral posture

12. Lying posture Supine posture Supine posture Suitable for points on the head, face, neck, chest, abdomen and limbs Suitable for points on the head, face, neck, chest, abdomen and limbs

13. Lying posture Prone posture Suitable for points on the head, neck, shoulder, back, lumbar and buttock regions and posterior region of the lower limbs.

14. Lateral recumbent posture Suitable for points on the lateral side of the chest, abdomen, arms and legs. Lying posture

15. Sitting posture Sitting in supine posture Suitable for points on the head, face, neck, upper chest and upper limbs.

16. Sitting in flexion Suitable for the top of the head, back of the head, neck, shoulders and back Sitting posture

17. Sitting in lateral posture Suitable for the lateral sides of the head and neck.

18. Methods of Needle insertion (1)  Puncturing hand ： The right hand is usually applied to hold the needle handle to puncture the skin. The correct method is to hold the needle handle with the thumb, index and middle fingers with the pulp of the thumb against the pulps of the index and middle fingers as if holding a traditional Chinese writing brush.  Functions ： Hold the needle Administrate the needling manipulations

19. Methods of Needle insertion(2)  Pressing hand ： The left hand is usually applied to press down the skin around the point to support the insertion of the needle.  Function ： Fix the location of the point; support the puncturing hand when inserting the needle vertically and quickly in order to reduce pain caused by needling; help to moderate some of the needle manipulations

20. The commonly used needle insertion methods 1. Inserting the needle with one hand 2. Inserting the needle with both hands  Inserting the needle with the aid of the fingers of the pressing hand  Gripping and inserting the needle  Inserting the needle by stretching the skin  Inserting the needle by pinching the skin

21. Inserting the needle with one hand Hold the needle handle with the thumb and index finger. The pulp tip of the middle finger touches the skin close to the point gently and supports the lower part of the needle at the same time. The needle can be inserted quickly by exerting finger force from the thumb and index finger meanwhile bending the middle finger simultaneously.

22. Inserting the Needle with Both Hands Press on the point with the nail of the thumb of the pressing hand, hold the needle with the right hand and insert it into the skin close to the edge of the nail of the finger of the left hand. Inserting the needle with the aid of the finger of the pressing hand

23. Gripping and inserting the needle Grip the lower portion of the needle body with the thumb and index finger of the left hand with a dry sterilized cotton ball. Hold the handle of the needle with the right hand, then quickly insert the needle into the skin with pressure exerted downward with the two hands simultaneously. Inserting the Needle with Both Hands

24. Put the thumb and index finger, or index and middle fingers on the skin where the point is located. Separate the two fingers to stretch the skin tightly, then insert the needle with the right hand. Inserting the needle by stretching the skin

25. Inserting the Needle with Both Hands Pinch the skin upwards around the point with the thumb and index fingers of the left hand. Hold the needle with the right hand and insert the needle into the pinched skin. Inserting the needle by pinching the skin

26. In acupuncture clinic, in order to reduce pain caused by needling we should select the appropriate needling method from what we learned above according to the location of acupoints, depth of needling and different manipulations.

27. Direction, Angle and Depth of Needle In the process of acupuncture, correct direction, angle and depth of the needle are very important aspects for inducing the needling sensation, bringing about the desired therapeutic results and avoid accidents. For the same point, different direction, angle or depth may cause different results.

28. Direction of Insertion It refers to the direction where the needle tip faces. the direction of the channel points condition of the disease

29. Angle of Insertion It refers to the angle formed by the needle and the skin surface.  perpendicular insertion  oblique insertion  horizontal insertion

30. Perpendicular insertion Keep the angle between the needle and the skin surface at 90°and insert the needle perpendicularly

31. Oblique insertion Keep the angle between the needle and the skin surface at 45°and insert the needle obliquely.

32. Horizontal insertion Keep the angle between the needle and the skin surface at 15°and insert the needle transversely

33. Depth of needle insertion It refers to the depth of the needle inserted into the human body. We should choose the correct depth according to the following factors: Age Constitution Disease condition Location of acupoints

34. Needle manipulations Needle manipulations refer to maneuvers conducted on an inserted needle to promote or regulate the needling sensation, or to fufil a reinforcing or reducing formula.

35. Basic manipulations The essential methods of needling and can be divided into two aspects

36. Lifting and trusting  Lifting means to move the needle from the deep level to the superficial level  Thrusting means to move the needle from the superficial level to the deep level

37. Twirling and rotating The manipulations that twist the handle of the needle using the thumb and the index and middle fingers forward and backward alternately

38. The above listed two basic manipulations can be used independently or jointly in clinic.

39. Assistant manipulations  Channel pushing method  Needle-scraping method  Needle-flicking method  Needle-shaking method  Wing-spreading method  Needle-vibrating method

40. The needling sensation may be evaluated from two aspects: The arrival of Qi Soreness, numbness, distension and heaviness and so on around the point Tightness around the needle The patient The operator

41.  Simple reinforcing-reducing manipulations  Comprehensive manipulations Reinforcing and Reducing Manipulations of the Filiform Needle

42.  Reinforcing-reducing by twirling and rotating the needle  Reinforcing-reducing by lifting and thrusting the needle Basic Manipulations The result of the reinforcing or reducing is determined by the amplitude, frequency, duration, and so on

43.  Setting the Mountain on Fire Method  Heaven-Penetrating Cooling Method Comprehensive Manipulations Stubborn numbness, cold arthralgia and diseases with deficient-cold patterns. hot Bi-syndrome, acute abscesses and swelling from excessive heat patterns

44. Setting the mountain on fire method Insert the needle into the heaven level, perform the reinforcing method using lifting-thrusting manipulation for nine times when the needling sensation occurs; then insert the needle to the human being level and perform the reinforcing method again; insert the needle to the earth level for the reinforcing method again. Finally, lift the needle back to the heaven level for the second and third time.

45. Insert the needle into the earth level, perform the reducing method using lifting-thrusting manipulation for six times when the needling sensation occurs; then lift the needle to the human being level and perform the reducing method again; lift the needle to the heaven level for the reducing method again. Finally, insert the needle back to the earth level for the second and third time. Heaven-penetrating cooling method

46.  the functional conditions of the patient Acupuncture may result in various effects if the pathological state is different.  characteristics of points Some of the points are good for tonifying deficiencies, while some are good at reducing evils.  skills of the manipulation The reinforcing-reducing manipulation is one of the chief components during the acupuncture treatment in order to obtain reinforcing or reducing effects. Factors related to the effect of reinforcing-reducing manipulations

47. Retaining and Withdrawing the needle Retaining the needle means to hold the needle in place after it is inserted up to a given depth in the point and manipulated. Withdrawing of the needle means to take out the needle when the manipulation is completed.

48. Acupuncture syncope It refers to the patient fainting during the course of acupuncture treatment.  Manifestations: the patient suddenly presents symptoms of fainting, mental fatigue, vertigo, dizziness, pale complexion, nausea, profuse sweating, cold limbs, decreased blood pressure, etc.

49. How to deal with Acupuncture syncope in clinic?  Stop the needling immediately, and withdraw all the needles out of the body  Have the patient lie on his or her back and keep the patient’s body warm  In minor cases, ask the patient to have a rest, and give him or her some warm water or sugar water to drink.  For severe cases, patient rescue can be obtained by pinching or puncturing certain points such as Renzhong ( GV 26 ), Suliao ( GV 25 ), Neiguan ( PC 6 ), and Zusanli( ST36 ), or administering moxibustion on the Baihui ( GV20 ), Qihai ( CV 6 ), and Guanyuan ( CV4 )  Other first aid methods should be used as deemed necessary.

50. Hematoma  Manifestations: A localized, distended and painful bruise with a black purplish color that usually appears after the needle is withdrawn.  Management: Cold compresses early on to stop the bleeding, and applying hot compresses or mildly massaging the area to dissipate the stagnated blood

51. Precautions and contraindications of acupuncture  Do not do acupuncture immediately when a patient is famished, tired, or nervous  Do not choose points in the lower abdominal region for pregnant women in the first trimester  Do not provide acupuncture for patients who suffer from autogenous hemorrhage  Do not insert the needle vertically and deeply to points on the chest, hypochondriac regions and back where vital zang-fu organs are located.