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How to manipulate an acupuncture needle

How to manipulate acupuncture needles according to traditional theory? The most known is the lifting and thrusting with the needle, but many more are described and developed throughout time. These are the main characteristics of insertion and manipulationĀ±

Angle of insertion
AngleMethodPoints
PerpendicularThe needle is inserted perpendicularly, forming a 90 degree angle with the skin surface.Most points
ObliqueUsed for points close to important viscerae or where muscles are thinner. A angle of 45 degrees with the skin surface is formed while puncturing.Points as
Lieque (L7)
Jiuwei ( Ren 15)
Qimen (Liv 14)
points on the back
HorizontalThere where muscle is thin.Points such as
Baihui (Du20)
Touwei (S8)
Zanzhu (B2)
Yangbai ( B14)
Tanzhong ( Ren 17)
Methods of insertion
Insertion generalInserting the needle aided by the pressure of the finger of the pressing hand.Inserting the needle with the help of the puncturing and pressing handsInserting the needle with the fingers stretching the skin.Inserting the needle by pinching the skin.
The needle should be inserted coordinately with the help of both hands. The posture for insertion should be correct so that the manipulation can be smoothly done. Generally the needle should be held with the right hand known as the puncturing hand. The left hand known as the pressing hand pushes firmly against the area close to the point.Press beside the acupuncture point with the nail of the thumb or the index finger of the left hand, hold the needle with the right hand and keep the needle tip closely against the nail, and then insert the needle into the point. .Hold the needle tip with the thumb and the index finger of the left hand, leaving 0.2-0.3 cm. of its tip exposed and hold the needle handle with the thumb and index finger of the right hand. As the needle tip is directly over the selected point, insert the needle swiftly into the skin with the left hand, meanwhile the right hand presses the needle downward to the required depth. Stretch 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 rapidly to a required depth.pinch the skin up around the point with the thumb and index finger of the left hand, insert the needle rapidly into the point with the right hand.
PointsThis method is suitable for puncturing with short needles such as for needling Neiguan (P6), Zhaohai (K6). etcThis method is suitable for puncturing with long neeldes, such as those used in needling Huantiao (G30), Zhibian (B54) etc.This method is suitable for the points on the sbodomen where the skin is loose, such as Tianshu (S25), Guanyuan,(Ren4) etc.This method is suitable for puncturing the points on the head and face, where muscle and skin are thin, such as Zanzhu (B2), Dicang(S4), Yintang (extra),
Depth of insertion
DepthStructures 
SuperficialCutaneous, subcutaneous, superficial muscles
Deepdeep muscles, bones
Needle manipulations
Manipulation techniquesReinforcing/tonificationReducing/sedation
Lifting and thrustingQuick and heavy thrusting; gently and slowly liftingthrusting gently and slowly; lifting forcefully and quick
Rotating and twirlingrotating gently and slowly with small amplitude.rotating quick with large amplitude.
InsertionSlowQuick
WithdrawalQuickSlow
Action after withdrawalPress the point to close the holeShake it to enlarge the hole
Direction of needle tipFollow the running course of meridianAgainst the flow of meridian
RespirationInsert needle when patient breathes in.Insert needle when patient breathes out.
Retention of needle20-25 min. arrival of Qi once20-25 min. Arrival of Qi three times.