Techniques of Acupuncture

and Moxibustion

 Techniques of acupuncture and

moxibustion vary a lot in clinic, but it is the
combination of various acupuncture and
moxibustion techniques on some
acupoints that brings about the curative
effectiveness. Therefore, a good
command and application of the
techniques is a basic skill for an
acupuncturist.

Main contents of Acupuncture

and Moxibustion
Techniques of acupuncture and moxibustion
vary a lot and have been innovated and
increased all the time. In ancient times, the
techniques were classified into three types:
1) to stimulate the point with acupuncture
apparatuses by inserting into the skin, which
was called acupuncture. Of course a few
apparatuses (like ancient round-point needles,
pins) are taken to press on the acupoint area to
stimulate, which are included in the this type;

 2) to fumigate the point with ignited moxa leaves

or other things, which is called moxibustion
technique. It also includes cold moxibustion
(named medicinal vesiculation in ancient times)
which is applied to the selected points with some
animals or plants medicine to cause blisters.
3) cupping which is to suck or pluck on the point
or complaint site with specially made jars like
pottery cup, bamboo jar or metal can (glass cup
nowadays).

Function of Acupunture and

Moxibustion
Both acupuncture and moxibustion aim to
regulate qi and blood, balance yin and
yang by stimulating the points and
provocating the functions of meridians.

 Traditional acupuncture theory believes

that acupuncture has two major functions
as regulating qi and concentrating shen
(vitality). Regulating qi is to regulate qi of
meridians and zang-fu viscera from
excess or deficiency to coordinated state
or healthy state, and to harmonize qi and
blood to circulate freely without meeting
any obstruction.

 The functions of moxibustion is similar to those

of acupuncture in general, but moxibustion is
used to cure diseases by means of warm and
heat stimulations, which is able to warm
meridians, dissipate cold and circulate blood for
those with blood stasis due to coagulated cold,
and to recuperate depleted yang and relieve
prostration for those with yang deficiency.
Whats more, moxibustion has the function of
disease prevention and health care since it
improves and consolidates yang qi so to
reinforce the defensive function of human body.

 There have been further studies on the

function of acupuncture and moxibustion,
and a great deal of clinical observation
and experimental research has proved
that:

 Acupuncture and moxibustion involves the

stimulating spots: puncturing acupoints is
more effective than puncturing non-point
spots, and puncturing local points more
effective than puncturing distant points.

 Acupuncture and moxibustion involves the

quality and quantity of needling methods:
the effectiveness varies with different
methods like moxibustion,
electroacupuncture or needling, with
different stimulation intensity or length of
moxibustion.

 Acupuncture and moxibustion involves

functional state of the main body: it has
little effect on healthy bodies but
significantly effect on the bodies of
dysfunction and illness.

Requirements of Acupunture and

Moxibustion
Locate precisely the position: to achieve the
effectiveness, acupuncture and moxibustion
must be applied to a certain position that refers
to two aspects: one is the correct acupoint, the
other is the depth of insertion. For example,
different positions of different depths were
mentioned in Neijing (the Inner Classic) like
puncturing the skin, the tendon, the flesh, the
channel, and the bone. In addition, different
stimulation methods have different requirements
for the positions.

 Select different manipulations: the ultimate

goal is to prevent and cure diseases with
acupuncture and moxibustion, but different
manipulations will lead to different effectiveness.
Only with proper manipulation, can satisfactory
effect be achieved. How to select proper
manipulation is also relative to the host factors.
For example, mild stimulation is applicable for
the old and the weak while painless and safe
stimulation for children.

 Command correct stimulating dose: stimulating dose

includes the intensity and the length of stimulation.
Generally speaking, the stronger or the longer, the larger
the dose is, and vice versa. The dose depends on the
patients constitution and condition. Supply large dose to
the strong, and small to the weak; large to those
unresponsive to stimulation, and small to the sensitive;
large to acute and sthenic syndromes, and small to the
chronic and deficiency syndromes. In short, nothing is
absolute, and different problems should be analyzed with
different approaches.

Prevention and management

of Possible Accidents in
Acupuncture Treatment

 Acupuncture accidents refer to accidental

injuries owing to either the practitioner or
the sufferer during acupuncture,
moxibustion or other acupoint stimulation.
Slight injuries may cause pain and severe
ones may lead to lifetime physical
disability even death. The following will be
introduced here: causes, classification,
precautions and accidents commonly seen
in clinic.

 Causes of Possible Accidents

The causes involve the practitioner and
the patient, but the former takes the main
responsibility.

 Causes concerning the practitioner:

1) incorrect points location and imperfect manipulations.
Accidents may happen because of negligence of the
knowledge of anatomy, with only deep insertion, or
inserting in a wrong direction; or inserting aimlessly or
promiscuously damaging the organs.
2) infection caused by improper sterilization of needles
or selected region for needling; bent needle due to
eroded base; or other injuries caused by over thick
needles.
3) too strong electro-acupuncture stimulation or out-ofspecification of the apparatus resulting to broken
needles.
4) absence of responsibility of the practitioner during
treatment, another important factor causing possible
accidents.

 Causes concerning the patient:

1) psychological factor, such as excessive
tension, fear or agitation;
2) physiologic factor, such as hunger, or fatigue,
which is one of the major causes to fainting
during acupuncture;
3) constitution factor, like inanition, or allergic
constitution;
4) pathologic factor, like injuries by mistake due
to internal organs pathological changes (lung,
liver, spleen in particular) causing enlargement,
rough surface or porosity of tissues structure; for
patient with hematological disease, breaking
small vessels may lead to haemophilia;

 5) others, for example, rapid postural changes

of the patient (mainly infants or mentally ill
person) may lead to needle squirm in the tissues
even needle bending; changes of respiratory
rhythm or depth may shorten the distance
between the acupoint and the internal organ and
accidents tend to happen. In general, whatever
causes are, the practitioner should take the main
responsibility for the accident.

 Classification of Acupuncture Injury

The possible accidents are seen as
follows:
Reactive injury: including fainting
reaction during acupuncture or
moxibustion, anaphylactic reaction (such
allergic hives due to moxibustion) and
hysteria reaction (sudden aphasia,
convulsion and wild laughter).

 Physical injury: mechanical injury is the

most hazardous one whose lesion position
involves internal organs, blood vessels
and nerves. The degree of the injury
depends on the specific organ. Generally,
the most serious is the injury of the brain
or the heart which tends to cause death.
Mechanical injury is the most common
one in clinic. For example, pneumothorax
by piercing is one of the most common
accidents due to acupuncture.

 Chemical injury: This may arise from the

development of acupoint injection therapy.
Injuries vary according to different injecting sites,
including: soft tissue injuries (often seen in the
forearm and the hand which may lead to hand
abnormality or functional disorder), peripheral
nerve injuries (radial nerve, ulnar nerve and
median nerve injuries, sciatic nerve injury),
vascular injury (thromboangiitis as the highest
incidence). Besides improper manipulations, the
causes are relevant to the physic liquor for
injection, including the quality, power of
hydrogen, density and dosage.

 Biological injury: this refers to secondary

infection due to incomplete sterilization,
that is, causative organism (parasites,
bacteria, or viruses) is brought into the
patients body by various apparatuses
(filiform needle, injection needle, dermal
needle, three-edged needle) causing
infection like local red swelling and
suppuration, type B viral hepatitis
spreading.

 In addition to the four injuries mentioned

above, it is worth noting some indirect
injuries. One patient was reported to have
died of cerebral hemorrhage suddenly
after acupuncture on points of the head,
which was found out later that the death
may be due to nervous tension of the
patient and the too strong stimulation
instead of acupuncture itself.

Preventions and Managements

in Acupuncture Treatment
Preventions: be cautious of selecting
acupoints, especially the points noted to
be dangerous, to follow the routine
manipulations, to sterilize strictly both
hands of the practitioner, needles and
selected points for acupuncture, and to
reinforce the sense of responsibility,
improve medical ethics, keep calm and be
serious in treating every patient.

 Managements: When accidents happen, rapid and exact

judgment must be made, including the type of injury,
injury site and degree for further treatment. It requires a
comprehensive consideration about all aspects, such as
inserting direction, depth, manipulation, and clinical
situation of the patient. Whats more, measures should be
actively taken. Managements of the accidents consists of
two kinds: one is to be managed in office, such as mild
pneumothorax, ocular hematoma, fainting during
acupuncture, anaphylaxis and common infections, which
requires a good command for practitioners. The other one
needs transition management, such as moderate or
severe pneumothorax, major visceral injury, and bent
needle that cannot be withdrawn without surgical
techniques. If the accident remains unclear about the
kind or graveness, transition management or consultation
of doctors should be needed.

Common Possible Accidents and

managements
Pneumothorax: the commonly seen accident in
clinic. It happens owing to lack of the knowledge
of acupuncture and anatomy. Generally
speaking, pneumothorax may be caused by too
deep puncturing on the acupoints of the chest
and the back above the 10th dorsal vertebra, the
9th lateral rib, and the 7th rib of the prothorax.
And pneumothorax may affect the patient with
emphysema even with deep needling on the
acupoints of the superior belly or upper lumbar,
or routine acupuncture for its over distension of
the lung and muscle atrophy.

 The clinical manifestations of pneumothorax fall

into three types: mild, moderate and severe.
Mild pneumothorax presents itself with
oppression in chest, cough and dragging pain
with movement; moderate and severe
pneumothorax with stabbing pain of costa
sternales, dyspnea, severe cough, even cold
limbs or unconsciousness. The former needs a
rest of 3-5 days without special management,
and medicinal of relieving cough or pain may be
applied according to symptoms; the latter must
be sent to surgery for treatment.

 To avoid pneumothorax, the beginner should

take Jiaji (EX-B 2) or distant points instead of
acupoints of the back or the chest, especially for
the patient with emphysema. If necessary, do as
follows: at 1 cm lateral to the selected back-shu
point, insert the needle at an angle of 65toward
the vertebral column until it touches the bone,
and then lift the needle a little with retention,
which is both safe and highly effective in clinic.

 Fainting: This is often due to nervous tension, delicate

constitution, hunger, fatigue, too strong stimulation (too
forceful manipulation, too long retention), stale air or
noisiness in the office. Manifestations are dizziness,
vertigo, palpitation, short breath, fidgets, nausea, pallor,
cold sweating, weak pulse. In severe cases, there may
be loss of consciousness, fainting on the floor, great
dripping sweat, urinary and fecal incontinence, even
convulsion. Fainting often occurs during acupuncture or
minutes after the withdrawal. Fainting during cupping or
moxibustion has the similar manifestations.

 Management: for mild cases, withdraw all

the needles or cups, or stop moxibustion
immediately. Then help the patient to lie
down with good ventilation, legs slightly
up. The symptoms will disappear after a
short rest. If not, offer the patient some
warm water. In severe cases, in addition to
the above management, apply warm
moxibustion on Baihui (DU 20), or needle
Shuigou (Du 26), Yongquan (KI 1).

 Ocular hematoma: This is also a

commonly seen accident in clinic with
manifestations as cyanosed ecchymosis
on the point area or around the eye that is
so-called panda eyes that will make otiose
distress to patients for it does affect the
looks.

 The main causes of hematoma are too thick

needles or too forceful manipulation. To prevent
it, try to avoid selecting Jingming (BL 1) and
Chengqi (ST 1) for they are easy to bleed. Even
if it has to do, the beginners should take shallow
needling. No. 32-34 filiform needles must be
employed with slow insertion. Never try to lift
and thrust or twirl the needles with a large
amplitude. Withdraw the needle slowly and
press the point for a moment with dry cotton
balls.

 For mild cases, no management is needed or applying

hot soaks is to remove the ecchymosis. Severe cases
often result from injury of the blood vessels or relatively
important artery or vein of the eyes causing a large
volume of blood. During bleeding, cold compress should
be applied to the local area with distilled water or cold
boiled water for 20 minutes. Then ask the patient to
apply hot compress with a hot towel two or three times a
day, 20 minutes each time, which may be changed to
once daily after the swelling and distension disappear.
Generally it takes 1-3 weeks to remove ecchymosis.

Moxibustion

 Moxibustion is a traditional therapy with a

long history in China, referring to the
therapeutic technique with heat stimulation
of applying ignited mugwort or other
medical herbs to a certain part of the body.
It falls into two types as follows:

 Moxibustion with Moxa Wool

Moxibustion with moxa wool is divided into
moxibution with moxa cone, moxibustion
with moxa stick and moxibustion with
apparatus. The former two will be
introduced in detail for they are most
commonly used in clinic.

 Moxibustion with Moxa Cone: It refers to a method of

moxibution applied with moxa cones which is tapered
with the tip of the cone at the top and the flat at the
bottom made of moxa wool. According to the needs of
moxibustion, moxa cones vary in size --- large, medium
and small. The smallest is as big as a grain of wheat; the
medium size is as a soybean, and the largest is the size
of a vicia faba. Generally speaking, patients with a
strong constitution and catching diseases in the early
stage should be applied with the large cones; patients
with a weak constitution and chronic diseases applied
with small ones. Moxibustion with moxa cones is divided
further into direct and indirect moxibustion.

 1) Direct Moxibustion: It is to place a

moxa cone directly on the skin and ignite
it.

 2) Indirect Moxibustion: It refers to the

moxibustion performed with some material
placed between the smoldering moxa cone
and the skin, so it is also termed separated
moxibustion or insulated moxibustion
which can serve as both of treatment with
moxibustion and treatment with drug at the
same time. The material used for
separation is usually Chinese drugs in
forms of slices, cakes or powder.

 Moxibustion with ginger

Moxibustion with garlic
Moxibustion with salt

 Moxibustion with Moxa sticks: It is also

known as moxibustion with moxa rolls,
applied as early as in Ming Dynasty. Moxa
sticks are made by rolling moxa wool
(other herbal medicine may be mixed in)
into the shape of a cigar, using paper
made of mulberry bark.

 Indications
Moxibustion functions to warm meridians and expel cold,
mainly applicable for cold syndrome, yang-deficiency
syndrome, and all chronic diseases. In addition,
moxibustion is used for health care. It will be introduced
in the following chapters.
Among the moxibustion methods, moxibustion with moxa
stick is most frequently used, direct moxibustion with
moxa cone (especially scarring moxibustion) is
inadvisable to be applied to the face, portions with
obvious vessels or joints. Patients with high fever, loss of
consciousness and wind-stroke block syndrome should
not be treated with moxibustion.

Cupping

 Cupping is a therapeutic method in which a jar

or a cup is attached to the skin surface to cause
local congestion through the negative pressure
created by introducing heat in the form of an
ignited material. Cupping, also known as sucking
tube method, was named horn cupping in
ancient times that was used in Jin Dynasty.
Various kinds of cupping apparatuses are
available such as bamboo jar, pottery jar, metal
(copper, iron) cup, glass cup and sucking cup.
Nowadays glass cups and sucking cups are the
most widely used in clinic.

Cupping Methods
1) Fire Cupping: a traditional cupping
method which is applied by burning fire in
the cup, driving away the air to create a
negative pressure inside, thus producing
suction of the cup to the skin.

 2) Cupping by Extracting Air: a modern cupping

method, it consists of two parts: the aspirator and the
plastic jar with a piston of various types. When it is
applied, place the jar on the desired area, connect the
piston to the air aspirator, and extract the air to form a
negative pressure inside, making the cup absorbent on
the skin. Pull up the plastic core when it is time to
withdraw the jar. By using mechanical force instead of
fire, accidents like scalding will not happen and the
suction can be regulated according to the patients
constitution, condition and sucking part. It is worth
generalizing.

Cupping manipulations
1) Retaining Cupping: After a jar is sucked on the skin
of the selected area, retain it there for 5-20 minutes
before removing it. The retaining time may be shortened
on the face or other tenellous area and lengthened on
the area with thick muscle. Generally dont remove the
jar until the local skin becomes reddish or has
ecchymosis. But sometimes too long retaining may
cause blisters on the cupping area, then apply gentian
violet and bind it up if necessary. Most of the cases will
be absorbed to form a scab without scar. Retaining
cupping is applicable for most of the diseases which can
be treated with cupping.

 2) Quick Cupping: also known as

successive flash cupping, it is applied by
placing the cup on the affected area and
removing it at once. Do the same thing
many times over the same area until the
skin becomes hyperemic red. It is mostly
used for local skin numbness and
miopragia of deficiency type.

 3) Moving Cupping: also termed pushing cupping. This

method is suitable for cupping to the area with abundant
muscle. In its operation, smear vaseline or vegetable fat
over the selected area skin, make a jar sucked on the
area. Then, press the skin above the jar to stretch tense,
hold the jar with the right hand and draw it to slide
downwards for a certain distance. Then, forcefully press
the skin below the jar with the left hand and push it with
right hand to slide upwards. Repeat this course several
times until the skin becomes red. This method is mainly
used in treating muscle strain of the lumbus and the
back.

 4) Pricking-cupping Bloodletting: also

termed bloodletting cupping, it refers to
bloodletting with a three-edged or
cutaneous needle, followed by cupping,
and retain the jar there 10-15 minutes.
Wipe the blood after withdrawing the jar.
This method is mainly used to treat all
kinds of sprains and contusions, and
muscle pain.

 Indications: Cupping is applicable for

rheumatalgia, sprains and contusions,
cold, stomachache, abdominal pain,
headache, sore and carbuncle, but not for
high fever, convulsions and spasm, or
area with thin muscle, hair or cobbly
bones.

Acupoints Application

 It is a therapy for treatment of diseases by applying

medicinals to certain acupoints. Some stimulating
medicinals, such as Maogen (buttercup), Banmao
(Mylabris) and Baijiezi (Semen Sinapis), amy be
pounded or ground into powder and applied to desired
points to induce blisters or suppuration in local area like
moxibustions sores, which is termed natural
moxibustion. If the medicinals are applied to Shenque
(RN 8) to treat diseases by being absorbed through the
umbilical region or stimulating the umbilical region, such
method is called umbilical compress therapy.

1) Common medicinals for

application:
applicators include: Bing Pian (Borneolum Syntheticum),
Shexiang (Moschus), Dingxiang (Flos Caryophylli),
Huajiao (Pericarpium Zanthoxyli), ginger, green onion,
Rougui (Cortex Cinnamomi), Xixin (Radix et Rhizoma
Asari), Baizhi (Radix Angelicae Dahuricae), Zaojiao
(Fructus Gleditsiae) which are to dredge channels and
activate collaterals, as well as Sheng Nanxing ( raw
Rhizoma arisaematis), Sheng Banxia ( raw Rhizoma
Pinelliae), Chuanwu (Radix Aconiti), Caowu (Radix Aconiti
Kusnezoffii) Badou (Fructus Crotonis), Fuzi (Radix Aconiti
Lateralis Praeparata), Daji (Radix Euphorbiae Pekinensis)
which have strong smell and potency. Common solvents
(or excipients) are: water, distillate spirit or yellow wine,
vinegar, ginger pop, honey, albumen, and vaseline.
Besides, drugs infusion may also be available.

2) Dosage forms:
Pills: Grind medicinals into fine powder,
mix and stir it even with water , honey or
medicine liquor to make pills of various
sizes.
Pulvis: Grind medicinals into fine powder
and stuff it onto the umbilical region for
treatment.

 Pastes: Grind medicinals into fine powder,

make it into paste with water, vinegar,
alcohol, albumen or ginger pop and apply
it to the desired acupoint covered with
gauze and fixed with the adhesive tape.
Unguentum: make the selected medicinals
into emplastrum or ointment for
application.

 Cake: Grind medicinals into fine powder,

stir it even with appropriate amount of
water to make medicine cake of various
sizes, apply the cake to the affected area
of acupoint covered with gauze and fixed
with the adhesive tape. Or pound rhizome
or leaves of fresh plants to make into
medicine cakes heated for application.

Manipulation:
1) Point selection: the points for
application is selected less but qualified,
generally involving acupoints of the
affected area, Ashi point or experienced
points, among which Shenque (RN 8) and
Yongquan (KI 1) are more frequently
employed.

2) Application method: according to the selected acupoints, adopt

the proper posture suitable for better application. Prior to operate, fix
the point, clean the skin around the point with warm water or alcohol
cotton balls. To avoid moving or dropping, whatever the medicinal
forms are must be fixed with the adhesive tape or by covering it with
gauze or oil paper before fixing it with the adhesive tape. At present,
there are specially-made dressings for application, convenient and
simple to operate or fix. If replacement is needed, wet dry sterilized
cotton balls in warm water or plant oil of any kind, or paraffin oil to
wipe out the medicinal on the skin surface and perform the
application again. Generally, medicinals with mild stimulation are
replaced once every 1-3 days; those without solvent may be
replaced once every 5-7 days; those with strong stimulation may be
replaced from several minutes to hours according to the patients
reaction or the effervesce degree. Another application should not be
made until the local skin returns to normal.

Indications:
It is applicable for many kinds of diseases
involving departments of internal medicine,
surgery, gynecology, pediatrics and
ophthalmology & otorhinolaryngology. In clinic, it
is mainly used to treat cold, chronic bronchitis,
bronchial asthma, coronary artery disease,
diarrhea, facial paralysis, insomnia,
hypertension, cervical osteoarthritis,
menstruation disorder, uterine prolapse, infantile
diarrhea, enuresis, adolescent myopia, allergic
coryza and toothache.

 ration, select the area for application with

less movements. Medicinals with strong
stimulation should not be retained for long.
If blister appears, smear gentian violet to it.
If skin allergy occurs, determine the
causes. Change to another one if due to
medicine, and change to gauze if due to
the adhesive tape. Avoid applying
medicinals with strong stimulation or
toxicity to pregnant women or infants.