| I | General Approaches to Treatment |
1 The Needle
2 Thoughts on Needling within the Clinical Encounter
3 Treating the Spirit—Treating the Blood with Oriental Medicine
As the Ling Shu, the second part of the Huang Di Nei Jing, the 2000-year old book on traditional acupuncture, posits,“If you should want to treat illness there is nothing so good as the needle” and certainly, the needle is the primary tool of treatment for the acupuncturist. Ironically though, in my experience as a teacher, I have found students to be disinterested in the specifics of the needle, such as its gauge and length, and are more interested in actually using it. This is understandable in the sense that in their passion for the medicine and compassion for the patient they are anxious to help alleviate suffering.
While I am sure that the students do learn this material in school, I also know that it is not given the pre-eminence it deserves, nor are the students held accountable for it over other topics. This relative lack of basic, fundamental training can easily be rectified if students are taught the facts with the proper attention and respect the subject deserves. As a result of my observations as an advanced needle technique instructor therefore, it would be wise to take some time to review the various parameters of the needle over the needling process. Correct understanding of the gauges and lengths of needles contributes to their correct usage and thus clinical success.
Needle Composition and Safety
According to anthropological data, ancient needles were made of bamboo, stone, and steel. Modern day needles are made out of the most refined metals such as silver, gold, copper, titanium, and mostly stainless steel. The most practical and popular disposable metal needle is made of stainless steel because it does not tarnish like silver or corrode like gold. For the most part, it is hypoallergenic. Titanium is better for the few patients who are hypersensitive even to stainless steel and this is an option open to the practitioner.
Nowadays it is more practical, safe and even required in some states of the United States, to use disposable needles to guard against the transmission transmission of infectious disease. Patients are less apprehensive about treatment, and the practitioner's time is freed from sterilizing contaminated needles, which can be dangerous. The cost of disposable needles is not great and so not prohibitive. Used needles should be disposed of in biohazard containers and processed by a biohazard service for proper disposal.
Parts of the Needle, Lengths, and Gauges
Needle parts are important. The needle is composed of four parts—the handle, the root, the body, and the tip. The body and tip of the needle must always be sterile and never contaminated through touch or any other means, as this can contribute to the transmission of infectious disease.
An important part of the needle is the root. The root is the juncture of the handle and the body of the needle. The needle must never be inserted with less than 0.25 in of the root exposed. This allowance helps prevent a deeper penetration of the needle that might inadvertently happen if the patient moves, a muscle twitches, or the needle sinks deeper into the body due to muscle relaxation or other factors such as being touched.
Needle length is important and proper needle lengths must be selected. Most acupuncture points have a depth of insertion of 0.5 to 1.0 in, so in acupuncture practice the most common needles used are 1 in and 1.5 in. Needle length is chosen by the depth of insertion of the acupuncture point, meaning the range in which the qi resides in each acupuncture point. Figure 1.1 illustrates the parts of the needle and the proper depth of insertion on a 1 in needle and Table 1.1. summarizes the most accepted depths of insertions of all the acupuncture points of the 12 main channels.
The gauge of the needle refers to the diameter or the thickness of the needle. Gauges are selected depending on the points to be treated, for instance, the texture of the skin they are located on. For thick skin such as the scalp or the ear, use a thick needle such as a 28 g (gauge) or 30 g. When needling the delicate skin of the face, use a thin needle such as a 36 g.
Fig. 1.1 The parts of the needle.
| Channel | Depth of insertion (in) |
| LU-1 | 0.5–0.8 obliquely towards the lateral aspect |
| LU-2 | 0.5–0.8 obliquely towards the lateral aspect |
| LU-3 | 0.5–1 ppd.* moxa as a Window to the Sky point |
| LU-5 | 0.5–1 ppd. No moxa, may shorten the tendon |
| LU-8 | 0.1–0.3 ppd. No moxa, as the point is on the course of the radial artery |
| LU-9 | 0.2–0.3 Shallow insertion on course of the radial artery |
| LU-11 | 0.1 or obliquely upward prick to bleed. No moxa, as it is a point to release hea |
| LI-1 | 0.1 or obliquely upward prick to bleed |
| LI-4 | 0.5–1 ppd. Forbidden in Pregnancy: no moxa and needle |
| LI-13 | 0.5–1 ppd. Forbidden to needle due to location on the course of the radial collateral artery andvein |
| LI-14 | 0.8–1.5 ppd or obliquely upward |
| LI-15 | 0.8–1.5 ppd or obliquely |
| LI-20 | 0.3–0.5 obliquely or subcutaneously |
| ST-1 | 0.5–1 ppd. Push eye up to needle. No manipulation. No moxa |
| ST-4 | 1–1.5 subcutaneously to ST-6 |
| ST-5 | 0.3–0.5 obliquely, posteriorly. Avoid the facial artery |
| ST-6 | 0.3–0.5 ppd or subcutaneously towards ST-4 |
| ST-8 | 0.5–1 subcutaneously |
| ST-9 | 0.3–0.5 ppd. Caution as the point is on the bifurcation of the carotid artery. No moxa |
| ST-12 | 0.3–0.5 ppd Watch depth |
| ST-13 | 0.3–0.5 lateral obliquely. Caution as the point is over the lungs |
| ST-17 | Forbidden point, the nipple, no needle, no moxa |
| ST-19 | 0.5–0.8 ppd. Careful of the liver |
| ST-21 | 0.8–1 ppd. Careful of the liver |
