Manipulations and Arrival of Qi ( Needling Reaction )

Manipulations : Needle manipulations may induce needling reaction, for which several methods should be applied. The arrival of qi refers to soreness, numbness or a distending feeling around the point after the needle is inserted to a certain depth. At the same time the operator may feel tenseness around the needle.

The fundamental manipulation techniques

• Lifting and thrusting. After the needle tip penetrating the skin surface, the needle body is perpendicularly lifted and thrust in the point. This, known as lifting and thrusting, is applied only when the needle is inserted to a certain depth. But it is not appropriate to lift and thrust too much, otherwise, local pain or damage of the local tissues may take place.
• Twirling or rotating. After the needle has reached its desired depth, twirl and rotate the needle backward and forward continuously. Generally, the needle is rotated with an amplitude from 180 ' to 360 ' . Rotating clockwise or counterclockwise alone may twine the muscle fibers and produce pain.

Waiting for and promoting qi. If qi fails to arrive after manipulation, some measures have to be taken, such as temporarily retaining the needle and then rotating again until qi is obtained. This is called " waiting for qi. " If, after the insertion and manipulation of the needle, the patient does not feel or only has little needling sensation, the method of promoting qi should be used. The six auxiliary manipulations are seen below.

• Pressing : Slightly press the skin along the course of the meridian. It is described in Compendium of Acupuncture and Moxibustion that " the related meridian is pushed up and down to promote the circulation of qi and blood " . The main purpose of this method is to encourage the movement of qi through the related meridian and facilitate its sensation at the point. It is used in patients whose needing sensation is delayed.
• Plucking : Pluck the handle of the needle lightly, causing it to tremble and strengthening the stimulation to obtain qi. In Compendium of Acupuncture and Moxibustion, it says : " First, pluck the handle of the needle, after the arrival of qi, insert the needle a bit deeper. This is the reinforcing method. " It is also pointed out in Questions and Answers on Acupuncture and Moxibustion that : " If qi does not flow smoothly, pluck the needle lightly and make qi travel faster. " The plucking method used to promote qi flow is for patients with retarded qi sensation due to qi deficiency.
• Scraping : When the needle is retained the thumb and index finger of the left hand support the body of the needle where it enters the skin, while the thumb of the right hand is placed on the tail end to hold the needle steady, then scrap the handle with the nail of the index or middle finger of the right hand upward from downward or vice versa. Scraping is used to spread the needling sensation.
• Shaking : Shaking of the needle can strengthen the needling sensation. In the book Questions and Answers on Acupuncture and Moxibustion, it is said that " shaking is an aid for qi flow. " Moreover, shaking the needle may be used as an auxiliary method for reducing, i.e. before withdrawal of the needle, shake the needle to drive the pathogenic factors out. In Compendium of Acupuncture and Moxibustion, it says, " First, shake the handle of the needle to cause arrival of qi. When qi arrives, withdraw the needle a little, which is known as the reducing method. "
• Flying : In the book Introduction to Medicine, it says : " Twirling the needle quickly for three times is known as ' flying ' . " Twirl the needle and separate the thumb and index finger from it for several times until the needling sensation is strengthened.
• Trembling : Hold the needle with the fingers of the right hand and apply quick lift - thrust movement in small amplitude to cause vibration. It is stated in Classic of Divine Resonance that " hold the needle with the thumb and index finger of the right hand, lift and thrust it rapidly and lightly in a trembling way to promote qi. " Therefore it is applied to strengthen the needling sensation and activate the flow of qi and blood.

Arrival of qi. In the process of acupuncture, no matter what manipulation it is, the arrival of qi must be achieved. In the first chapter of Miraculous Pivot, it is described that " acupuncture therapy does not take effect until the arrival of qi. " In Ode of Golden Needle it is said : " Quick arrival of qi suggests good effects in treatment ; slow arrival of qi shows retarded effects in treatment. " It indicates that the arrival of qi is especially important in acupuncture treatment.

Signs of the arrival of qi : When the patient feels soreness, numbness, heaviness and distension around the point, or their transmission upward and downward along the meridians, it is a sign of the arrival of qi. Meanwhile, the operator should feel tenseness around the needle. Lyrics of Standard Profundities says : " It seems a fish bites on fishing pulling the line downward. " This is a vivid description to whether the arrival of qi is obtained or not.

Factors influencing the arrival of qi :

• Inaccurate location of the points : It is very important to locate points correctly in acupuncture treatment. In case of inaccurate location, the required needling sensation will be affected.
• Improper depth of the needle insertion : A given depth of insertion to each point is required. Either too deep or too shallow affects the arrival of qi.
• Imperfect manipulation : The needle manipulation is requisite for the arrival of qi. The operator should practice it perfectly, otherwise, the expected effects can not be achieved. iv ) Weak constitution and dull sensation : In chapter 67 of Miraculous Pivot it describes, " An individual with abundant yang qi may have a quick needling sensation ; a healthy person responds with a normal rate to acupuncture, neither quick nor slow ; and a man with excessive yin and deficient yang, ( i.e. delicate constitution and dull sensation ) may have a slow needling sensation. "

For severe cases there may not appear the needling sensation, and the therapeutic results are bad.

Acupuncturists in the past dynasties attached importance not only to the arrival of qi, but also to the activity of the " spirit qi " in the meridians. In Compendium of Acupuncture and Moxibustion it is said, " In case of arrival of the spirit qi, a tense feeling appears under the needle. " The first chapter of Miraculous Pivot says, " A point is the place where the spirit qi enters and flows out. " The function of acupuncture is to regulate the meridian qi. The arrival of qi is a manifestation of the normal activity of the spirit qi. Therefore, it is important in observation of the therapeutic effects.