The Taiwan Report

4. Needle Manipulation

All operators were very careful to cleanse the skin (alcohol swab), use sterile needles (disposable in VGH) and to touch only the handle (not the body) when inserting the needle.

Styles of inserting the needle varied between operators. In general, staff at VGH inserted the needle while twirling vigorously clockwise and anticlockwise until the skin was penetrated, and then the needle was advanced with less twirling. "Sparrow pecking" (up and down movement) was fast and strong, often combined with some twirling.

Vigorous needle twirling and pecking was continued for 5-30 seconds until definite "DeQi" was reported by the patient and the visible signs were observed by the operator.

In contrast, Dr. R.T. Chiang (CMC) inserted the needle through the skin with one, deft half-twirl and push. He then advanced the needle with minimal, if any, twirling to its correct depth. His sparrow-pecking and subsequent twirling was slower and more deliberate than in VGH. He also scratched the handle vigorously and "went around the clock" (moved needle handle like the hands of a clock through 360 degrees) once or twice, to get DeQi. He told me that the classic (traditional) methods of needle manipulation ("tonification" and "sedation" manipulation) are very important in difficult cases. (Staff at VGH do not appear to put importance on the classical needle manipulations used to tonify or sedate Qi).

In both hospitals, needles usually were left in position for 15-30 minutes (estimated average 20 minutes). In VGH, some twirling and pecking was repeated just before needle removal. This was mainly to ensure that the needle was not "caught" in the tissues and to avoid rough removal of a "caught" needle. In contrast, at CMC, a quick check that the needle was "free" was followed by gentle removal of the needle.

At VGH, a cotton-bud was used to apply pressure at the point for a few seconds after removal, to prevent local pinpoint bleeding.

4.1. Needling AhShi/TP points: This was one exception to the 20-minute needling time. Chung twirled the needle and pecked very strongly for 15-60 seconds. The patient often had very strong reaction to this (grunts, slight groans, facial grimaces etc). In many cases, the needle was removed within the 15-60 seconds. To my amazement (and that of other observers) the pain or stiffness which the patient had reported before needling seemed to have disappeared (as judged by the consternation or smile on the patient's face and/or visible and marked improvement in neck/shoulder/lumbar/knee movement)!!

The immediate responses seen after AhShi needling in some patients at VGH were hard to believe but I witnessed them many times (see case notes later). This is certainly similar to the Huneke "Sekunden phanomen" (instantaneous phenomenon) and is a typical reaction to TP therapy (Melzack, Pontinen, Macdonald, Lewit ). See Section 9. I was told that similar responses are not uncommon at CMC but I did not witness any there, probably, because the total number of cases I observed there were much less than in the VGH, due to shortage of time to stay at CMC.

5. DeQi

All experts agreed that it is essential to get DeQi if the best results are to be obtained in needle therapy. In Chinese medical experience, DeQi is known to have subjective (patient), subjective (operator) and objective characteristics.

5.1. Patient's sensations: The patient reports strong sensations running, proximally, or distally from the needle. Sometimes the sensation is said to travelproximally and distally. The sensations are described as: "sore", "heavy", "tingling," "electric shock-like", "running", "aching" (but not painful). The observable reactions of the patient at this time included grunts, groans, flinching of the limb or part being needled, explosive intake or expulsion of breath, facial grimaces and occasionally (in strong reactors) sudden jerks involving all or part of the body, and occasional expletives.

During the Symposium, I was needled at left LI10 by a Master. This man claimed that with really expert needle use, the PCS sensation should be felt not only along the needled Channel (LI Channel goes from index finger to nose) but also into its following Channel (ST follows LI, goes from eye to second toe via nipple and anterolateral knee). I felt the classic DeQi sensations and reacted as a typical strong reactor, as described above and in 5.3 below. However, the sensation travelled a maximum of 6" upwards, whereas it travelled distally to the dorsum of the hand and was most marked in the 6" below the point. After 3-4 minutes, the palm of my left hand became very cold and sweaty. My right palm was (normally) warm and was sweating less than the left. I had no queasiness, nausea or other signs of needle shock. The dull ache (6" above, to 6" below LI10) persisted about 2 hours afterwards. The point was slightly sensitive to local pressure for 2 days afterwards. I have needled many APpoints on my body, obtained DeQi most times but without such a strong PCS reaction.

5.2 Operator's sensations: The operator usually has the sensation that the needle is being gripped by the tissue, i.e. especially on withdrawal of the needle, (when a definite "nipple" seems to form at the skin surface) or on twirling of the needle (when the needle seems to "lock" at the end of each twirl).

5.3 Objective signs of DeQi are the "nipple" and the patient's reaction. After a few minutes, a definite zone of hyperaemia (1-3 cm diameter) may appear around the needle in some patients.

5.4 Propagated Channel Sensation (PCS): When needled correctly, certain ("sensitive") patients claim to feel the sensation (PCS) radiating along most or all of the Channel. Some also report sensations radiating to the organ controlled by theChannel! Chung stresses that correct needling of the AhShi point almost always sends strong sensations to the problem area, muscle or organ.

5.5 Over-stimulation of points such as LI04, ST36, etc can cause "needle shock" (weakness, dizziness, nausea, vomiting, fainting, syncope, etc).