Auricular & Scalp /Needle Technique Review • ACR class 13
General requirements • 1.1. Not for patients who are over-hungry, overeaten, over fatigued, too nervous, or very weak. • 1.2. Contraindicated to puncture points on the lower abdomen and lumbosacral region for pregnant women less than 3 months. After 3 months, it is contraindicated to needle the points on the abdomen and lumbosacral region. • 1.3. Points on the vertex of infants should not be needled when the fontanel is not closed.
1.4. Don’t put needles on the areas of infection, ulcer, scar, or tumor. • 1.5. Pay attention to the points where there are important organs and tissues. • ex: GB34 - Deep needling may injure the peroneal nerve • ex: ST13 - Deep or perpendicular insertion may injure the subclavian vessel • 1.6. Be cautious with patients with spontaneous bleeding. • 1.7. Needling should avoid the blood vessels to prevent bleeding.
2.1 Acupuncture syncope (needling fainting) • Manifestations: dizziness, vertigo, palpitation, short breath, fidgets, nausea, pallor, cold sweating, weak pulse. In severe cases, cold extremities, drop of blood pressure, and loss of consciousness • Cause: nervous tension, delicate constitution, fatigue, improper position, too forceful manipulations
2.1 Acupuncture syncope (needling fainting) • Management: • Stop needling immediately and withdraw all needles, • Help the patient to lie down, offer the warm water, • In severe cases, in addition to the above management, press DU26, PC9, DU25, PC6, ST36, or moxa DU20, REN6, REN4, if no response, call 911 • Prevention: Treat patients lying down if they are weak, tired, fasting, or in nervous state, manipulations should be gentle. Observe the facial expression and color of these patients at all the time.
2.2 Stuck needles • Manifestations: After the needle is inserted, it may be difficult or impossible to rotate, lift and thrust, or withdraw • Cause: spasm of the muscle or overly wide amplitude of rotation of the needle, leading to fibrous tissue becoming tangled around the shaft of the needle • Management: Ask the patient to relax, then massage or tap the skin around the point, if the needle still can be removable, needle nearby the point to relax the muscle, if needle still entangled in fibrous tissue, turn it slightly in the opposite direction until it becomes loose, then withdraw it • Prevention: Ask patient to relax, avoid the muscle tendons during insertion, avoid twirling with too large amplitude or in one direction.
2.3 Bent needle • Manifestations: The angle and direction of the handle of the needle changed. The needle may be difficult or impossible to rotate, lift and thrust, or withdraw, the patient feels pain • Cause: unskillful manipulation or too forceful manipulation, so the needle striking the hard tissue. Or the patient changed the position during retaining the needle. Or the handle of the needle impacted or pressed by an external force
Management: When the needle is bent, manipulations can not be applied. The needle may be removed slowly and withdrawn by following the direction of bend. In case the bent needle is caused by the change of the patient’s position, move him to his original position, relax the local muscle and then remove the needle. Never try to withdraw the needle with force. • Prevention: perfect insertion and gentle manipulation are required. The patient should have a proper and comfortable position. During the retaining period, change of the position is not allowed. The needle area shall in no case be impacted or pressed by external force.
2.4 Broken needle • Manifestations: the needle body is broken during manipulation and the broken part is below the skin. • Cause: poor quality of the needle or eroded base of the needle, from too strong manipulation of the needle, from strong muscle spasm or a sudden movement of the patient when the needle is in place, or from withdrawing stuck needle.
Management: Ask the patient to keep calm to prevent the broken needle from going deeper into the body. If the broken part protrudes from the skin, remove it with forceps or fingers, it the broken part is at the same level of the skin, press the tissue around the site until the broken end is exposed, and then remove it with forceps, it is completely under the skin, seek medical help immediately. Do not cut the flesh to get access to the needle • Prevention: careful inspection of the quality of the needle should be made prior to the treatment; the needle body should not be inserted into the body completely. If the needle is bent, the needle should be withdrawn immediately. Never try to insert a needle with too much force.
2.5 Hematoma • Manifestations: local swelling, distension and pain after withdrawal of the needle • Cause: injury of the blood vessels during insertion, or from absent pressing of the point after withdrawing the needle • Management: A mild hematoma will disappear by itself, if the local swelling and pain are serious; apply local pressing, or light massage, or warming moxibustion to help disperse the hematoma • Prevention: avoid injuring the blood vessels
2.6 Residual sensation • Manifestations: after withdrawal of the needle, there may remain an uncomfortable feeling of soreness and pain, which may persist for long period. • Cause: unskilled manipulation and forceful stimulation • Management: For mild cases, press the local area, for severe cases, in addition to pressing, moxibustion is applied to the local area • Prevention: avoid forceful manipulations
2.7 Traumatic pneumothorax • Manifestations: oppression of the chest, chest pain, cough, short of breath, palpitation, in severe cases, dyspnea, pallor, cold sweating, cyanosis, scared feeling, lowered blood pressure, shock. • Cause: the needle is thrust too deeply or in an incorrect direction into the points of the chest, back or supraclavicular fossa • Management: Carefully withdraw the needle immediately. The worst damage is tearing of tissue caused by breathing coughing with the needle still in • Encourage the patient to lie calmly • The patient should be take to the hospital, if the symptoms are severe, call for emergency help • Prevention: needle at correct depth or in correct direction into the points of the chest, back or supraclavicular fossa
2.8 Puncture of viscera • Manifestations: • Liver and spleen: interior bleeding, abdominal pain, rigidity of the abdominal muscles, and or rebound pain upon pressure • Kidney: pain in the lumbar region, tenderness and pain upon percussion around the kidney region, and bloody urine • Heart: stabbing pain in the chest, shock • Stomach, gallbladder, intestines, urinary bladder: pain, rigidity of the abdominal muscles or rebound pain upon pressure
Cause: poor knowledge of anatomy and point location, incorrect depth and angle • Management: • Take the patient to the hospital and emergency medical help be called • Prevention: study anatomy and point location, when examining patient rule out organ enlargement
2.9 Puncture of the brain and spinal cord • Manifestations: convulsions, paralysis, and coma. • Cause: needling too deeply, or inappropriate manipulation in such points as DU15 or DU16 • Management: • Emergency medical help be called for immediately • Prevention: use correct manipulation, not too deep in such points as DU15 or DU16
Functions of moxibustion • Warm meridians and expel cold • Induce the smooth flow of qi and blood • Strengthen yang from collapse. • Prevent disease and keep healthy.
Classification of moxibustion • 1. Direct moxibustion • a. Scarring moxibustion • b. Non-scarring moxibustion • This type of moxibustion is subdivided into scarring moxibustion and nonscarring moxibustion according to whether the local scar is formed or not after moxibustion.
2. Indirect moxibustion • The ignited moxa cone does not rest on the skin directly but is insulated from the skin by some materials. • a. Moxibustion with ginger • This method is also indicated in symptoms caused by exterior or yang deficiency such as cold, cough, diarrhea, abdominal pain, and vomiting, nocturnal emission due to deficiency of spleen, stomach and kidney. • b. Moxibustion with garlic • It is mainly used for lung-deficiency tuberculosis, mass in the abdomen, pyogenic infection and abscess which have not festered.
c. Moxibustion with salt • This method is effective in case of abdominal pain, vomiting and diarrhea, pain around the umbilicus, prolonged dysentery, pain caused by hernia, etc. in addition, moxibustion with salt has the function to restore (rescue) yang from collapse, such as symptoms of excessive sweating, cold limbs, undetectable pulse. • d. Moxibustion with monkshood (fuzi) cake • This method can tonify kidney yang.
3. Moxibustion with moxa stick • It can be divided into Moxa stick moxibustion and drug-moxa stick moxibustion in which the material is mixed with aiye and some herbal powders. • a. Mild-warming moxibustion • Ignite one end of the moxa stick, hold the stick and keep the ignited end 15-30 mm above the selected acupoint without moving, and heat the area for 5-10 minutes each time until the local area is red.
b. Sparrow-pecking moxibustion • Holding a moxa stick with its ignited end directly above the acupoint moving up and down, like a bird pecking food. • c. Circling/ rounding mxibustion • Keeping the ignited moxa stick above the selected acupoint and moving the stick in a circular fashion horizontally and repeatedly. • d. Moxibustion along the meridians • Hold and move the moxa stick with its ignited end close to and along the meridians slowly and repeatedly.
Contraindications • 1 Excess heat syndrome. • 2 Scarring moxibustion should not be applied to the face and head, and the area in the vicinity of the large blood vessels. • 3 The lower abdominal region and lumbosacral region of the pregnant woman are not allowed to use moxibustion.
Acupuncture with the Three-edged Needle • Introduction • The three-edged needle is commonly used in blood-letting therapy, which is pricking a certain acupoint or superficial blood vessels in the body of a patient to cause bleeding.
Manipulation and procedure • Spot-pricking method • Before needling, pushing and pressing the area around the point to cause blood stagnation. Sterilize the skin to be punctured. Pinch the needling part tightly. Insert the lancet perpendicularly into the sterilized the point 2-3mm then withdraw it instantly. Slightly squeeze or press the periphery of the needle hole with the left hand until a little blood flows out. Then cover the hole with a sterilized cotton ball and press slightly.
Scattering pricking method • First sterilize the affected area and the acupoint to be punctured. Then prick from the boundary of the affected area. According to the size of the location of the disease, 10-20 needles may be used to puncture along the outer margin of the location of the disease to the center, appearing like a circle.
Clinical application • It is applicable to the treatment of emergent syndrome, heat syndrome, excess syndrome, stagnant syndrome and pain syndrome.
Precautions • Care must be taken to sterilize properly to prevent infections • When spot pricking and scattering pricking are conducted, the manipulation must be gentle, soft, shallow and quick. Be careful not to let out too much blood and never injure the deep big artery when the blood-letting method is used. • In case of deficiency syndrome, postpartum, spontaneous hemorrhage and hemophilias this kind of three-edged needle puncture can’t be used.