the techniques of acupuncture and moxibustion. filiform needle manipulation
TRANSCRIPT
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The Techniques Of Acupuncture and Moxibustion
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Filiform Needle Manipulation
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Preparations Prior to Acupuncture Treatment
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Selection of the Instruments
The filiform needle is one of the nine kinds
of needles in ancient China.
Most of the filiform needles used at present
are made of stainless steel.
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A filiform needle may be divided in to five parts. Tip : the sharp point of the needle Body : the part between the handle and the tip Root: the connecting part between the body and the
handle Handle: the part behind the body, of which the hand
catches hold; Tail : the part at the end of the handle.
tip
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Filiform needles of 0.5-3.5 cun in length are commonly used in clinic.
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Selection of the Patient’s Postures
Lying postures Lying in Supine posture Lateral recumbent Prone posture
Sitting postures Sitting in supine posture Sitting in flexion Sitting in lateral posture
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Lying in supine posture
Suitable for the points on the head and face, chest, abdomen, and the upper and the lower limbs.
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Lateral recumbent
Suitable for the points on the Shaoyang Meridian on the lateral side and the upper and lower limbs.
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Prone posture
Suitable for the points on the back of the head and posterior torso.
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Sitting in supine posture
Suitable for the points on the forehead, face
and anterior part of the neck.
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Sitting in flexion
Suitable for the points
on the vertex, back of
the head, hind neck,
shoulders and back.
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Sitting in lateral posture
Suitable for the
points on the
head, arms and
shoulders.
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Selection of the Patient’s Postures
Moreover, posture in lying should be adopted as
far as possible to the new, nervous, aged or
asthenic patients, or to seriously ill persons, to
avoid fainting.
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Sterilization
Sterilization refers to sterilization of
needles and other instruments practitioners’ fingers the area on which acupuncture is applied
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Sterilization of instruments Autoclave sterilization Boiling sterilization Medicinal sterilization :Soak the needles in
75% alcohol for 1~2 hours.
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Sterilization Disinfection of the practitioners’ fingers
--- should be cleaned with water and soap or with an alcohol cotton ball.
Disinfection of the area where acupuncture is performed
---should be cleaned with a 75% alcohol cotton ball
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Needling Methods Needling Methods
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Insertion
Fingernail pressing insertion Pinch needle insertion Pinch skin insertion Stretch skin insertion
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Fingernail pressing insertion
Press the point with the nail of the thumb of the left hand.
Hold the needle with the right hand and keep the needle tip closely against the finger nail of the left hand.
insert the needle into the skin
This method is suitable for puncturing points with short needles, such as Jingming(BL1), Chengqi(ST1), etc.
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Pinch needle insertion
Hold the needle body by
the thumb and index finger of the left hand with a dry sterilized cotton ball.
Fix the needle tip on the selected point.
Hold and rotate the needle handle with the right hand and insert the needle into the skin.
The method is suitable for puncturing points with long needles, such as Huantiao(GB30), Zhibian(BL54),etc.
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Pinch skin insertion
Pinch the skin up around the point with the thumb and index finger of the left hand.
Hold the needle with the right hand, then insert the needle into the skin that is pinched up.
This method is suitable for puncturing points in areas where the muscle and skin are thin, such as Yintang(EX-HN3), Zanzhu(BL2),etc.
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Stretch skin insertion
Stretch and tighten the skin where the point is located with the thumb and index finger of the left hand
hold the needle with the right hand and insert it into the point.
This method is suitable for the points where the skin is loose, such as Tianshu(ST25), Guanyuan(RN4),etc.
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Angle and Depth of Insertion
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Angle of InsertionGenerally, there are three kinds. Perpendicular Oblique Horizontal
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Perpendicular
The needle is inserted
perpendicularly, forming an
angle of approximately
90°with the skin surface.
The method is suitable for
most points on the human
body.
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Oblique
The needle is inserted obliquely
to form an angle of
approximately 45°with the skin
surface.
The method is used for the
points where the muscle is thin,
or where is vital organ
underlying the point, or deep
and perpendicular insertion is
not suitable.
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Horizontal The needle is inserted
transversely to form an angle of
approximately 15°with the skin.
The method is suitable for the
points on thin skin or muscle, for
example, the points on the
head.
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Depth of insertion
The depth of insertion refers to the length of the
needle body inserted into the skin.
The principle for depth of the insertion is the
following: constitution, age, pathological condition,
location of the point.
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Manipulation and Arrival of Qi
(Needling Sensation)
Needle manipulation refers to the various
manipulations of the acupuncture needle to
assist the sensation of the arrival of qi
The arrival of qi refers to the reaction of
meridian qi that is produced after the needle is
inserted.
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Reaction of meridian qi (Needling Sensation)
the practitioner will feel tenseness and a
dragging sensation around the needle;
the patient will feel soreness, numbness,
distention or heaviness around the point,
or a sensation traveling up and down the
meridian.
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Reaction of meridian qi
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manipulation techniques
The manipulation techniques, in general,
can be divided into two groups:
Primary manipulating techniques
Secondary manipulation techniques
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Primary manipulating techniques
Lifting and thrusting
Twirling or rotating
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Lifting and thrusting
This is a manipulation method
whereby the needle is
perpendicularly thrusted from
the superficial layer to the
deep layer, and lifted from the
deep layer to the superficial
layer in the point when the
needle is inserted to a certain
depth.
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Twirling or rotating
This is a manipulation method
whereby the needle is held by the
thumb, index and middle finger of
the right hand and twirled or rotated
forward and backward continuously
when the needle is inserted to a
certain depth.
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Secondary manipulation techniques
flicking scrapingTremblingPressingshaking
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flicking flicking
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trembling scraping
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Reinforcing and Reducing Methods
The reinforcing method refers to the method
which is able to invigorate the body’s healthy qi
and to strengthen weak physiological function.
The reducing method refers to the method which
is able to eliminated the pathogenic factors and
to harmonize hyperactive physiological function.
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Reinforcing and reducing
1) twirling and rotating the needle
2) lifting and thrusting the needle
3) rapid and slow insertion and withdrawal of the needle
4) the direction the tip of the needle pointing to
5) Breathing reinforcing and reducing
6) Open-close reinforcing and reducing
7) Even reinforcing and reducing movement
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twirling and rotating the needle
Reinforcing: rotating the needle gently and
slowly with small amplitude and at a short
duration
reducing: rotating the needle strongly and
rapidly with large amplitude and at a long
duration
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lifting and thrusting the needle
Reinforcing: thrusting the needle strongly and
lifting it gently with a small amplitude, low
frequency with a short duration of operation.
Reducing: thrusting the needle gently and
lifting it strongly with a large amplitude, high
frequency and a long duration of operation.
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rapid and slow insertion and withdrawal of the needle
Reinforcing: slow insertion, low frequency of
rotation and rapid withdrawal of the needle
Reducing: rapid insertion, high frequency of
rotation and slow withdrawal of the needle
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the direction the tip of the needle pointing to
Reinforcing: puncturing
a point following the
meridian course
Reducing: puncturing a
point against the
meridian course
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Breathing reinforcing and reducing Reinforcing: inserting the needle when the patient
breathes out and withdrawing the needle when the patient breathes.
Reducing: is achieved in the opposite way
Exhalation InhalationInhalation Exhalation
Reinforcing Reducing
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Open-close reinforcing and reducing
Reinforcing: after withdrawal
of the needle, pressing the
needle hole quickly to close
Reducing: shaking and
enlarging the hole and not
pressing the hole
immediately
Reinforcing Reducing
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Even reinforcing and reducing movement
Lift, thrust and rotate
the needle evenly, then
withdraw the needle
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Retaining and Withdrawal of the Needle
Retaining and Withdrawal of the Needle
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Retaining
Retaining refers to keeping the needle in
place after it is inserted into a point to
strengthen and maintain the needling effect.
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Withdrawing the Needle press the skin around the point with the thumb and
index finger of the left hand
rotate the needle gently and lift it slowly to the
subcutaneous level
withdraw it quickly and press the punctured point with
an alcohol cotton ball for short period to prevent
bleeding.
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Management of Possible Accidents Fainting----nervous tension, fatigue,
hunger
Stuck Needle----strong contraction of the local
muscles
Bent Needle----forceful or too rapid
manipulation
Broken Needle----poor quality of the needle
Hematoma----injury of skin ,muscle or blood
vessles
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Fainting
Manifestations: Sudden mental tiredness, dizziness and vertigo,
pallor, nausea and vomiting, profuse sweating, palpitation, or loss of consciousness.
Cause: This may be due to the patient’s delicate constitution, nervous
tension or fatigue, hunger.
Management: Stop needling immediately and withdraw all the
needles. Help the patient lie down and keep the body warm. In severe cases, press hard with a fingernail or needle Renzhong (DU26), Neiguan(PC6), Zusanli(ST36).
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Stuck Needle
Manifestations: After the needle is inserted, it is difficult or impossible to rotate,
lift and thrust the needles; the patient feels intolerable pain if the needle is rotated, lifted and thrusted reluctantly.
Cause: Nervous tension of the patient, strong contraction of the local muscles
after the needle is inserted into the point; or improper manipulation causing the muscle tissues to bind around the needle body.
Management: If the needle is stuck due to a strong local muscular contraction,
retain the needle for a long period of time, or insert another needle nearby. If it is caused by rotation of the needle in one direction, rotate the needle in the opposite direction.
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Bent Needle Manifestations: The direction and angle of the needle handle is
changed. It is difficult to lift, thrust, rotate or withdraw the needle. The patient feels pain..
Cause: Unskillful manipulation, forceful or too rapid manipulation; needle
striking hard tissue or organs; change of the patient’s posture after insertion.
Management: If it is slightly bent, the needle may be removed slowly. If
the needle is bent severely, the needle should be withdraw by follow the course of the bent. In the case of a bent needle being caused by the change of the patient’s posture, restore him/her to the original position. After the muscle around the needle is relaxed, remove the needle slowly.
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Broken Needle Manifestations: The needle body is broken during manipulation or
after withdrawal of the needle. The broken part may be exposed above the skin or buried inside the body.
Cause: Poor quality of the needle, erosion of the needle root; too
strong lift and thrust or rotation of the needle.
Management: If the broken part exposes above the skin, remove it
with fingers or forceps. If the broken part is completely merged in the skin or deep in the muscles, surgery should be used after the location by X-ray.
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Hematoma Manifestations: Swelling, distention and pain, bruising of skin follows in
the needling area after withdrawing the needle.
Cause: Injury of the skin and muscle or blood vessels during insertion.
Absence of pressure on the point after withdrawing the needle.
Management: A mild hematoma caused by a small subcutaneous
hemorrhage, in general, will disappear by itself. If local swelling and pain are severe, first apply a cold compress to the area of the hematoma to stop bleeding. Secondly apply a warm compress, or local pressing or light massage, to help disperse and absorb the local stasis of blood.
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MoxibustionMoxibustion
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Moxibustion
Moxibustion is a therapy in which
burning moxa is used to produce a
heat stimulation to human body.
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The Classification of Moxibustion
Moxbustion with Moxa cones
Moxbustion with Moxa sticks
Moxbustion with Warming needle
Moxbustion with instruments
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moxa cones
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Moxibustion with moxa cones
Direct moxibustion----
place a moxa cone of
appropriate size directly
on the point and ignite
it.
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Moxibustion with moxa cones
Indirect moxibustion ----the
ignited moxa is insulated
from the skin by a cake of
medicinal substance:
ginger insulation,
garlic insulation ,
salt insulation,
monkshood cake insulation
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Moxibustion with Moxa Sticks
Mid-warm moxibustion----light
one end of a moxa stick and put it
over the point about 2-3 cun
away from the skin .
“Sparrow-pecking”moxibustion
----peck up and down rapidly over
the point like a sparrow pecking
rice
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Moxibustion with Warming Needle
Moxibustion with warming
needle is a method of
acupuncture combined with
moxibustion.
The manipulation is as following:
After the arrival of qi, a moxa
stick of approx. 2cm in length or
moxa wool is fixed on the handle
of the needle and ignited.
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Moxibustion with Instruments
Place some moxa wool into
a round moxibustion
instrument, ignite it and put
the cap on, and place it on
the required point or
affected area until the local
skin sets reddish.
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Other therapies
Ear acupuncture therapy Three –edged needle therapy The cutaneous needle therapy Scalp acupuncture therapy Electric acupuncture therapy Point injection therapy
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Three –edged needle
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cutaneous needle
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Distribution of auricular points
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Key Points
Primary manipulating techniques Reinforcing and Reducing Methods