Manipulations: Needle manipulation may induce needling effect, for which several methods can be used. The arrival of qi refers to the sensation of aching, numbness, heaviness or distension around the acupoint after the needle is inserted. At the same time the acupuncturist may feel heaviness and tension beneath the needle.
The arrival of qi is directly related to the therapeutic effect. Generally speaking, obvious and quick arrival of qi suggests good therapeutic effects, while unclear and slow arrival of qi shows poor therapeutic effects. Many factors may influence the arrival of qi, such as the constitution of the patient, pathological conditions, the acupoints selected, and the needling method used. Clinically the patient with abundant yang-qi may experience quick needling sensation, while the patient with abundant yin-qi may feel slow arrival of qi. Accurate location of acupoints on thick muscles is easy to induce needling sensation while inaccurate location of acupoints on these areas is difficult to in-duce the arrival of qi. Proper and skillful manipulation promotes the arrival of qi. Therefore, correct manipulations are prerequisite to better therapeutic effects.
Manipulations can be divided into basic manipulation techniques and supplementary ones:
(1) Basic Manipulation Techniques
Twirling-rotating: After the needle is inserted to the desired depth, the needle is twirled and rotated backward and forward with the thumb, index and middle fingers of the right hand.
Lifting-thrusting: After the needle is inserted to a certain depth, the needle is lifted and thrusted perpendicularly and continuously.
Twirling-rotating and lifting-thrusting are the two basic manipulations and can be used individually or in combination. The amplitude of twirling and the scope of lifting-thrusting as well as the frequency and duration of manipulation depend upon the patient's constitution, pathological conditions and the acupoints to be needled.
(2) The Supplementary Manipulation Techniques
Under certain conditions, the supplementary manipulations are employed after insertion. The following are the commonly used techniques:
Pressing: Slightly rub, knead and press the skin a-long the route of the meridian or around the acupoint to promote the flow of qi and blood. This method is used to promote the arrival of qi.
Scraping: Scrap the needle handle with the nail of the thumb, or the index or middle finger downward and upward, or vice versa. This method can be used to strengthen the needling sensation.
Plucking: Pluck the needle handle lightly to make the needle body shake slightly. It is often used to strengthen the stimulation in order to obtain qi.
Shaking: Shaking the needle handle slightly with the hand can strengthen the needling sensation. If the needle is inserted obliquely or horizontally, shaking the needle handle can make the needling sensation transmit toward a certain direction.