Techniques Final

Front 1

Anatomy of a Needle:

Back 1

Tail, Handle, Root, Body (Shaft) & Tip

Front 2

Tubes vs Freehand Pros & Cons
Tubes:

Back 2

- Can use thinner needles.
- Can get below epidermis quickly, tube creates
surface tension.
- Less pain for beginning needling.
- Keep needle shaft sterile.
- Easy to learn.
- Awkward on body areas.
- Not as precise.

Front 3

Tubes vs Freehand Pros & Cons
Freehand:

Back 3

- Need to use thicker needles.
- Precise.
- More connected to sensation on the needle.
- Need good technique for painless insertion.
- Needle shaft more exposed to contamination.

Front 4

Angles of Insertion
Perpendicular:

Back 4

- 90 degree angle to the surface being needled.
- Good for most points that are not over organs or bone.

Front 5

Angles of Insertion
Oblique:

Back 5

- 45 degree angle to the surface.
- Good for thinner muscle and over organs.
- Chest and back points are often needled this way.

Front 6

Angles of Insertion
Transverse Oblique:

Back 6

- 20 degree angle to surface.
- Chest and over organs on thin bodies.

Front 7

Angles of Insertion
Horizontal, transverse or subcutaneous:

Back 7

- Thin muscles over bone. Head points and CV 17 over sternum.

Front 8

Basic Supplementation and Sedation Techniques
Supplementation

Back 8

- Gold needles,
- close point after removal,
- needle with flow of channel,
- gentle or no stimulation, shallow needling,
- needle in on exhale needle
- remove needle on inhale.
- Turn needle in clockwise direction.

Front 9

Basic Supplementation and Sedation Techniques
Sedation

Back 9

- Stainless steel needles,
- keep point open after removal,
- needle against the flow of the channel,
- deeper needling,
- more stimulation,
- needle in on inhale,
- remove needle on exhale,
- turn needle anti-clockwise.

Front 10

Cautions and Contraindications for Acupuncture:

Back 10

• Use caution when needling weak, hungry or exhausted patients. Keep an eye on facial expression & color. Use gentle technique.
• Don't treat intoxicated patients.
• Needling lower abdomen, lumbosacral area or pregnant women under 3
months is contraindicated. After 3 months the whole abdomen, LI4, SP6,
UB60, UB67 and GB21 are contraindicated.
• Don't ever needle the vertex of an infant. If needling infants, no needle
retention.
• Avoid needling into large blood vessels.
• Use caution over organs. Injuries caused by needling into organs are listed
under accident management below. Caution – bleeding disorders or
patients on Warfarin/Coumadin

Front 11

Accident Management for broken needle

Back 11

- Needles rarely break, if so, the break usually occurs at the root.
- Don't ever needle up to the root.
- If a needle breaks and enough of it is sticking out of the skin grasp it with forceps and pull it out,
- If not enough is above the skin level, press skin down on either side f the needle and then grasp with forceps and pull out.
- If below the skin level, Call 911 for emergency transport.

Front 12

Accident Management for Needle Shock

Back 12

- If dizziness or fainting occurs. First take all needles out!
- Lay patient down. Slightly elevate legs or feet. Can press on Du26, PC9, PC6, ST36 or moxa on DU20, CV4, or CV6.
- Can give warm drink or juice.
- Even though fainting can be a sign of needle shock, it can also be from other reasons.
- If fainting occurs and patient doesn't respond to the above listed protocol, call 911.

Front 13

Accident Management for stuck Needle

Back 13

- If a needle gets stuck, tap or stroke around area.
- If still stuck, can insert another needle close to the needle site.
- If you use a twisting technique, try twisting back
the other way to release the muscle fibers.
- If bent, DON'T rotate needle.

Front 14

Accident Management for Organs:
• Pneumothorax – Signs and symptoms

Back 14

- can include pain in chest, cough.
- If severe: dyspnea, pallor, cyanosis or coma can occur.
- Call 911 – can be fatal if not managed.

Front 15

Accident Management for Organs:
Brain / Spinal Cord – Signs and symptoms

Back 15

- Convulsions, paralysis or coma. Call 911

Front 16

Accident Management for Organs:
Kidney – Signs and symptoms

Back 16

- Lumbar pain and / or blood in the urine. Call 911

Front 17

Accident Management for Organs:
Liver or Spleen – Signs and symptoms

Back 17

- Abdominal pain or rigidity on palpation.
- Can also have rebound pain upon palpation.
- Call 911

Front 18

Accident Management for:
hitting a vein

Back 18

- apply direct pressure for 0.5 to 1 minute

Front 19

Accident Management for:
hitting an artery

Back 19

- put on gloves and apply pressure for 5 minutes.
- Older people have less elasticity in their vessels so more likely to happen with them

Front 20

Hematomas are from:

Back 20

- injury of small blood vessels during needling
- or from not pressing the point on withdrawal of needle on thinner skin areas (face, neck etc)

Front 21

Moxibustion

Back 21

- Artemesia Vulgaris – Mugwort: Acrid & Bitter. - --Functions: Warm the channels, regulate qi & blood, expel cold and dampness, warm the uterus, warm the
spleen and stomach, stop bleeding, regulate menstruation.

Front 22

Moxa Classifications: Direct: Scarring and Non-Scarring

Back 22

- Moxa cones burned directly on the body.
- Use only high grade gold moxa.
- Burns cooler. 400 degrees.
Insurance sometimes won't cover direct moxa. Even if they cover it, get a waiver signed by patient.

Front 23

Moxa Classifications: Direct Scarring

Back 23

- Suppurative or festering.
- Burn cone all the way.
- Usually put garlic or onion juice on point first.
- In our scope of practice but be careful.
- ST-36 to stimulate immunity.
- Back shu points used in China in past.

Front 24

Moxa Classifications: Non-Scarring

Back 24

- Remove cone when patient feels it getting hot.
- Most effective method of moxibustion.
- Allows deeper penetration into the channels than indirect.

Front 25

Moxa Classifications: Indirect

Back 25

- Stick, Needle top, Belly bowl, Tiger Thermie Warmer, Stick-on, Insulators
- Indirect is usually done with a lower grade crude moxa. Burns hotter, about 800 degrees.

Front 26

Stick Moxa: Smoky and Smokeless

Back 26

- Use when insurance won't cover direct.
- Smokeless can sometimes use when can't use smoky.

Front 27

Needle Top Moxa:

Back 27

- Place moxa on needle handle. Spring handles are best. - Good for deep penetrating heat directly to a point being needled, cold damp, numbness, paralysis.

Front 28

Belly Bowl Moxa:

Back 28

- Good for digestive disorders. Ren-12, 8, 6, KD Yang Xu – UB-23, 52, DU-4

Front 29

Tiger Thermie Warmer:

Back 29

- Good for moxa on kids, scars, Bells Palsy.

Front 30

Stick On Moxa:

Back 30

- Can send some home with the patient.

Front 31

Moxa Insulators include:

Back 31

- Garlic
- ginger
- salt
- aconite

Front 32

Moxa Insulators
Garlic:

Back 32

- 0.5cm slice of garlic on point, poke holes in it, place moxa cone on top.
- Use for tuberculosis, poisonous insect bites, early stage skin ulcers.

Front 33

Moxa Insulators
Ginger:

Back 33

- 0.5cm slice of ginger, poke holes in it, place moxa on top.
- Use for digestive disorders, SP Yang Xu: Diarrhea, abdominal pain. Ren 6, 8 & 12.
Asthma: U B 13, 42, 43.

Front 34

Moxa Insulators
Salt:

Back 34

- Ren 8 only. Fill umbilicus with salt and place moxa cone on top of salt.
- Use for abdominal pain, vomiting, diarrhea, hernia, dysentery, yang collapse
(excessive sweating, cold limbs, undetectable pulse.)

Front 35

Moxa Insulators
Aconite:

Back 35

- F D A ban? Poke holes in it, place moxa on top. Very Hot. Use for severe K D Yang Xu: impotence, premature ejaculation.

Front 36

Moxa: Order of Treatment

Back 36

- Yang first, then Yin,
- Back first then front,
- upper first then lower,
- body first then extremities

Front 37

Moxa Treatment:

Back 37

- Usually 3 to 7 cones sufficient to get reddening of skin. - - Treat what is presenting.
- Don't overheat patient.

Front 38

Moxa Cone size:

Back 38

- Vary from rice grain to date size.
- Larger size feels cooler for longer.

Front 39

Moxa Cautions and Contraindications:

Back 39

- High fever,
- Excess heat,
- Yin xu heat.
- No scarring moxa on face (U B 1), head and in vicinity of large blood vessels (ST 9).
- No moxa on abdominal or lumbo-sacral region of pregnant women.

Front 40

Fire Cupping
Actions

Back 40

- Warm and regulate qi & xue in the meridians
- Dispel cold dampness - Bi syndrome, around joints
- Diminish swelling and pain - Sprains, Blood stagnation.
Can combine with bleeding.
- Dispel pathogens - Wind invasion (upper back), Blood heat
- Often used for Gastro-intestinal disorders and lung disease

Front 41

Original cups

Back 41

- Horns
- Bamboo

Front 42

Modern cups

Back 42

- Bamboo
- Glass
- Plastic
- Bian stone

Front 43

Cup desinfection:

Back 43

- 1:10 Bleach (hydrochloride) solution for 1 hour
- Cidex plus for 20 minutes

Front 44

Auto claving

Back 44

- Only glass cups
- Sterilizes by using saturated steam under pressure, then has a sudden drop in pressure at the end of the cycle that breaks down all walls of resistant spores
- Pressurized Steam bath @ 250º F
- 15 # pressure
- 30 minutes
- rapid release of steam at the end

Front 45

Retention fire cupping

Back 45

- Most common
- Ignited alcohol soaked cotton ball held with hemostat quickly inserted and removed from cup and cup is quickly and firmly placed on skin.
- Retention of 10 minutes
- Good for stagnant painful areas

Front 46

Flash cupping

Back 46

- Same as fire cupping, but done repeatedly and removed quickly and vigorously.
- Good for expelling external wind pathogens (upper back)
- Some people use this on areas of cellulite

Front 47

Traveling / Moving cupping

Back 47

- Use oil or lotion on area to be cupped
- Keep moving cups around
- Gentle - like a massage
- Nice at the end of a treatment

Front 48

Cupping and bleeding

Back 48

- Prick small vein, spider nevi or stagnant area with 3 edge needle or lancet, then cup area
- Most sedating form of cupping
- Blood stagnation or heat

Front 49

Fire throwing

Back 49

- Not used much here.
- Throw ignited paper or cotton into cup, then rapidly place cup in place on skin
- Used on sides of body so burning object doesn't fall on skin

Front 50

Cupping Cautions and Contraindications

Back 50

- Blisters, warts, acne, open sores and cuts, shingles, rashes, herpes outbreaks (can cup near these areas)
- Edema
- Hemophiliacs - Severe SP Xu, so bruise easy and can bleed
- Caution in Geriatrics (loose skin, tear and bruise easily, weaker bones)
- Can cause bruising, discoloration (Can last several days or more). Get permission first
- Hairy areas - use more oils to help create suction. Traveling cupping uncomfortable on these patients

Front 51

Plum Blossom, 7 star, or Dermal Needling

Back 51

- is done with 5 to 7 short needles
inlaid evenly into the head of a small hammer about 6 to 10 inches long. This is
used as a superficial technique to tap on and prick the skin.

Front 52

Plum Blossom, 7 star, or Dermal Needling
Actions:

Back 52

- regulate free flow of Qi and Blood in the network vessels
- regulate the functions of the zang-fu organs.

Front 53

Plum Blossom, 7 star, or Dermal Needling
Indications:

Back 53

- CAM – Primarily used for nervous system disorders and skin disease.
- Can also be used for headache, dizziness, and vertigo, insomnia, GI diseases, gynecological disease, painful points and paralysis.

Front 54

Plum Blossom, 7 star, or Dermal Needling
Techniques:

Back 54

- Swab area to be treated. Hold handle between the thumb and middle finger with index finger on top of the handle and tap on the skin.
This allows for flexibility of the wrist.
- Be careful to tap evenly so that all the needles
make contact at the same time to avoid the technique being too uncomfortable.

Front 55

Plum Blossom, 7 star, or Dermal Needling
Tonifying (Reinforcing) Technique:

Back 55

- tap lightly until reddening of area occurs.
Tap heavily until slight bleeding appears.
This is a good technique to use on children. Use gentle technique on them.

Front 56

Plum Blossom, 7 star, or Dermal Needling
Sedating (Reducing) Technique:

Back 56

- Tap heavily until slight bleeding appears.

Front 57

Plum Blossom, 7 star, or Dermal Needling
Where to Tap:

Back 57

- Tap along the vessel pathways for channel disorders, on specific points,
- along the affected area or on either side of the spine - along the inner shu line of the UB or the Hua Tuo Jia Ji (HTJJ) points.
- The back shu points are the most important
areas to treat the zang-fu organs. Tap parallel lines from top to bottom.

Front 58

Plum Blossom, 7 star, or Dermal Needling
Back Areas of Treatment:

Back 58

T1 to T4 – Upper limbs, respiratory disease, shoulder and back, cardiovascular
disease
T3 to T5 – Cold fever, CV disease, asthma
T5 to T8 – Stomach, CV disease, intercostal neuralgia, hicups
T7 to T10 – Liver, Gall Bladder disease, hypertension, CV disease
T11 to T12 – Gastro-intestinal disease, urogenital disease

Front 59

Plum Blossom, 7 star, or Dermal Needling
Caution and Contraindications:

Back 59

- Needles should hit skin at a 90 degree angle to the surface.
- Don't drag the needle across the patient's skin.
- If doing heavy technique, swab with alcohol again when finished to prevent infection.
- Don't tap directly on skin ulcers.
Be careful on local trauma.
Acupuncture cautions apply for pregnant women.

Front 60

Bleeding
Actions:

Back 60

- Eliminate heat,
- dispel blood stasis,
- promote smooth flow of Qi and Blood in the vessels.

Front 61

Bleeding
Indications:

Back 61

- High fever,
- extreme heat, seizures,
- loss of consciousness,
- pain along Tendinomuscle channels,
- blood stagnation.

Front 62

Bleeding
Techniques:

Back 62

- Always wear gloves!
- Use a lancet or 3 edge needle to pierce the
skin.
- If on a Jing well point, milk the area to be bled first to bring more blood to the area. Squeeze out 10 drops of blood, swabbing with an alcohol wet cottonball
between drops.

Front 63

Bleeding
Jingwell points:

Back 63

- Used to treat extreme heat
- or unconsciousness
- or to openTendinomuscle channels.

Front 64

Bleeding
UB40

Back 64

- Clear summer heat, prick vein in the middle of the popiteal fossa.
- Can also use for lumbar pain due to blood stagnation.

Front 65

Bleeding
LU11

Back 65

- sore throat

Front 66

Bleeding
Apex of the ear

Back 66

- High fever

Front 67

Bleeding
Spider nevi

Back 67

- can prick smaller spider nevi on the legs.

Front 68

Bleeding
Cautions & Contraindications

Back 68

- Very deficient patients.
- Bleeding disorders
- Avoid arteries.
- Pregnancy

Front 69

Electro-Acupuncture
Amperage

Back 69

- Measurement of current. Volume, intensity, magnitude.

Front 70

Electro-Acupuncture
Intensity

Back 70

- Low Intensity is more supplementing
- High Intensity is more dispersing.

Front 71

Electro-Acupuncture
Milliamps

Back 71

- stronger stimulation
- 1000 Milliamps = 1 Amp

Front 72

Electro-Acupuncture
Microamps

Back 72

- milder than Milliamps thus more supplementing
- 1000 Microamps= 1 Milliamp

Front 73

Electro-Acupuncture
Hertz (Hz)

Back 73

- Frequency of a cycle, rate.
- 1 Hz = 1 cycle per second

Front 74

Electro-Acupuncture
Low Frequency

Back 74

- Low Frequency = 2 to 25 HZ,
- thought of as being more supplementing and used for chronic pain
- If frequency that is to low will irritate acute pain.

Front 75

Electro-Acupuncture
High frequency

Back 75

- High frequency = 50 to 200 Hz
- more sedating and used for acute pain.
- Feels smoother.

Front 76

Electro-Acupuncture
Wave Forms
Continuous, constant, same frequency

Back 76

- Body accommodates this to quickly
- have to adjust often

Front 77

Electro-Acupuncture
Wave Forms
Discontinuous, intermittent

Back 77

- one frequency off and on at regular intervals.
- Helps overcome accommodation.
- Use if machine doesn't have mixed wave option.

Front 78

Electro-Acupuncture
Wave Forms
Mixed Wave Two different frequencies alternating. Overcomes accommodation and is easier for
the body to handle.

Back 78

- Two different frequencies alternating.
- Overcomes accommodation and is easier for
the body to handle.

Front 79

Electro-Acupuncture
Actions

Back 79

Moves Qi and Blood

Front 80

Electro-Acupuncture
Indications:

Back 80

- Improve blood circulation and relieve pain,
- surgical anesthesia,
- labor induction,
- stimulate tissue and scar repair.

Front 81

Electro-Acupuncture
Contraindicated:

Back 81

- Pacemakers, open wounds, hypertension, directly into scar, tumor, cancer, on chest area, and with heart arrhythmias.
- Don't cross spine.
- Don't use in last trimester except when inducing
labor.

Front 82

Electro-Acupuncture
Cautions:

Back 82

- weak, elderly, tired/hungry, hypersensitive patients.
- Caution during pregnancy.
- Caution with shallow needle insertion.

Front 83

Electro-Acupuncture
Polarity
Milli

Back 83

- Black (negative)
- Red (positive).
- Generally, place black on affected area to bring energy from there to the distal area (red).

Most E-stim machines have alternating current to alleviate needle breakage so positive and negative are
moot.

Front 84

Electro-Acupuncture
Polarity
Micro

Back 84

- Black (positive)
- Red (negative).
- note that it is opposite of milli.

Most E-stim machines have alternating current to alleviate needle breakage so positive and negative are
moot.

Front 85

Vital Signs: Blood Pressure

Back 85

Blood pressure is the pressure exerted on the wall of the artery or vein as blood is pumped through the
body. Blood does not flow readily, it surges along with each beat of the heart. The walls of the arteries are
thicker than the veins and as such much more force is generated allowing us to record that pressure.
As the blood is pumped through the vessels a turbulence is heard. These sounds are created by
turbulence as the blood begins to flow through the arteries after the blood pressure cuff has temporarily
stopped the flow by the pressure exerted as it was inflated. When the sound is first heard, this is the
systolic pressure; and when the sound ceases as the turbulence ends, the diastolic pressure is
determined.

Front 86

Vital Signs: Blood Pressure
Systolic and Diastolic pressure

Back 86

As blood is pumped through the body it exerts pressure on the veins and arteries. The systolic pressure
is the pressure as the heart contracts and pumps the blood. The diastolic pressure is the pressure in
the vessels when the heart is at rest between beats.

Front 87

Vital Signs: Blood Pressure
Systolic pressure:

Back 87

- top number

Front 88

Vital Signs: Blood Pressure
Diastolic pressure:

Back 88

- bottom number.

Front 89

Vital Signs: Blood Pressure
Influencing Factors:

Back 89

- proper cuff size for the size of the arm,
- activity,
- emotions,
- posture,
- medications,
- alcohol consumption,
- temperature
- diet.

Front 90

Vital Signs: Blood Pressure
What Should Your BP Be?

Back 90

- In general, optimal blood pressure is considered less than 120 systolic and 60 to 70 diastolic
- According to the American Heart Association, a blood pressure of less than 120 over 80 is optimal .
- Blood pressure of more than 140 systolic or 80 diastolic is considered to be high and should be
evaluated by your health care provider.

Front 91

Vital Signs: Blood Pressure
Some Precautions

Back 91

Never take a blood pressure in an arm with:
• an IV line or heplock in place
• a dialysis or other fistula or shunt
• on the same side as a mastectomy.