Is this a kind of Japanese acupressure method or la jing (stretching tendons)?

Good tips for locating Zhangmen.

“Never inferior to the umbilicus and never posterior to the mid-axillary line.”

Acupuncture syncope. That simply means fainting during an acupuncture session. Can a couple of fine needles make a big, grown man faint? You bet. The vast majority of fainting cases are not because of improper technique. The masters frequently encounter them. This novice already had 2 encounters. They were both healthy looking young men in their 30s. Both were having their first experience with acupuncture.

The first case was managed by my mentor. I remember he only had a couple of needles when he complained of giddiness. All needles were immediately removed, the patient was brought from a sitting to a supine position on the bed. A pillow was placed under his feet. He never lost consciousness and a hot drink was given to him.

Second case was managed by me. I started the patient off with bilateral Quchi and Yuji. Before I could start on his first Lieque, his wife, who was observing from a distance, commented that he looked pale. Indeed, he looked a bit pale. Even though he showed no signs of fainting yet, my mentor took no chances. All needles were pulled out immediately and the patient was asked to lie down. This mentor instructed me to do moxibustion on his Baihui and Qihai.

Colour returned to the patient’s lips very quickly. Even though both patients didn’t actually collapse, it is safer to remove all needles and abort the treatment the moment the patient shows signs of pallor.

The Meridian Theory in TCM distinguishes the pathway or “origin” of a headache by its location. The beauty of this system lies in the fact that you can treat an illness at one part of the body using a distal or “remote” point, the safest and most convenient of which are located on the limbs.

When the headache is felt at the back of the head, it is believed to associated with the taiyang meridians. Examples of taiyang meridians are the Bladder and the Small Intestine meridians. The Governor vessel is also located on the back of the head. The small intestine point Houxi (SI3) seems well suited to treat this sort of headaches. Apart from being on the hand taiyang meridian, Houxi is also a connecting point to the Governor vessel. Pain relieve is almost instant.

Frontal headache is very common and often treated with the well-known Hegu (LI4)point on the Large Intestine meridian. This is a favourite point for many acupuncturists for the treatment of a variety of ailments including toothache, fever and various ENT problems. It sounds funny, but a frontal headache can be called a Large Intestine headache.

The Gallbladder meridian runs on the lateral or temporal aspect of the head. So if you’ve got a headache on the side of your head (sometimes diagnosed as migraine), it could be the Gallbladder meridian that is bothering you, especially if this pain is accompanied by dizziness. Treatment along this meridian would involve points on the scalp. There is another meridian that runs around this region and that’s the Sanjiao meridian which virtually covers the entire body. This meridian can also be used to treat temporal headache. It has a very easily located point on the forearm. Many acupuncturists prefer this “remote” approach.

The points on the Liver meridian end somewhere on the chest, but it has an inner pathway that goes all the way to the vertex of the head. Hence, pain at the vertex of the head is related to the Liver meridian. Another easy and convenient point to needle is Xingjian (LR2) between the big toe and the second toe. Yes, pain at the top of the head, needle the toe. That’s TCM.

We all know that acupuncture does not work when the area to be treated is anaesthetised. Hence, it sort of rules out the option of doing acupuncture for patients who can’t stand needle sensation.

But I just discovered something interesting. Acupuncture works with sedation. A patient sedated with intravenous Dormicum responded to acupuncture treatment like any patient.

This is an exciting discovery for me as it opens the option of acupuncture to really nervous patients who may not tolerate needle sensation.

Is infection a possible complication of acupuncture? Recently, the mother-in-law of a friend of mine went for acupuncture at a reputable institution in Singapore. She complained of knee pain and received a few needles in her knee. A few days later, she developed severe pain and swelling in her knee joint. An infection has set in.

So what happened? I can never be sure about this case, but let’s take a look at acupuncture technique. The first step is always sterilisation and I can’t imagine anyone not using sterile, single use needles. The acupuncturist must first wash his hands, then disinfect them with 75% alcohol. Next, the skin over the area to be punctured must be disinfected with alcohol. This is usually done by swabbing the skin with a piece of cotton soaked in alcohol.

This step will certainly remove practically all pathogenic bacteria from the surface of smooth, tight skin. But what if the skin is not smooth and tight? What if it’s a piece of loose, thickened skin around the joints? Can an alcohol swab effectively disinfect the whole area? I’m not so sure.

What about hair-covered areas like the scalp? This is another area where I’ve raised my doubts. I believe very vigorous rubbing with a piece of cotton very well-soaked in alcohol is required in this area to make sure that the alcohol reaches the scalp. If the patient has dandruff or other skin diseases, then needles must not be inserted as the infection can get pushed further into the tissues.

Next, we look at needle insertion technique. Acupuncture needles are normally made of stainless steel. They are very fine, often not more than 0.3mm in diameter. This means they are extremely flexible. Short needles are OK. They don’t bend when you insert them with a single hand, holding the handle with fingers away from the body of the needle.

The problem arises when you insert with long needles 40mm or longer. In school, we were taught a “proper” 2-hand technique. The puncturing hand holds the needle at the handle. The supporting hand (fingers) grasp a small piece of dry cotton to guide the body of the needle so it doesn’t bend when the needle is inserted. Safe? I’m not sure because the dry piece of cotton is not not more sterile than the acupuncturist’s washed fingers.

There are alternative ways of inserting long needles. One which I’be tried and practised quite a lot on myself is a slow one-hand technique. No touching of the body of the needle at all, but the insertion would be slower and more painful. Another way is to hold the body of the needle near the point with a piece of cotton soaked in alcohol. Holding it so close to the point, the needle will be stiff enough not to bend during insertion. After skin penetration, the rest of the needle can be pushed in with a slow one-hand technique without much pain.

The rationale of using dry cotton is that alcohol smarts. But I thinking enduring a bit of smarting is well worth it. I’ll go to the exam with what I’ve been taught. Once graduated, I owe it to my patients to practice as safely and effectively as I know how.

Lieque, Lung Meridian treats sore throat.