Clinical Application

Table of contents
  1.  Preparation
  2. Acupuncture Methods
  3. Moxibustion Methods
  4. Cupping Methods


Before an acupuncture treatment method such as needling, moxibustion, or cupping is applied, the practitioner has to ensure that the procedure can be performed in a safe and comfortable way. This means that the treatment area is clean, the materials are inspected, and the patient is positioned so that a skillful procedure is possible while the patient can maintain a comfortable position for the duration of the treatment.

Treatment Area

The treatment area needs to be clean and organized before the start of the treatment. Treatment tables and surfaces should be disinfected after every use. All the materials that are needed should be organized within easy reach of the practitioner.


In most jurisdictions, only pre-sterilized disposable acupuncture needles are approved for use. This greatly reduces the chance of error and cross-infections without significantly increasing the cost of needles. Other materials, such as tweezers, forceps, and trays, should be disinfected or autoclaved, depending on their classification as critical, semi-critical, or non-critical items.

For Cupping Therapy

Glass cups have the advantage over bamboo cups of easier disinfection. Cups need to be cleaned and disinfected after every use.

Acupuncture Methods

Traditional and Modern

(1) Conditions for effective needling:
  • Correct point location.
  • Correct technique and needle manipulation.
  • Correct depth.
(2) Inspect the needle prior to insertion for defects.
(3) Position: The patient should be asked to assume a comfortable position that allows easy needling of the selected points. This can be supine lying, prone lying, lateral recumbent lying, or sitting. It is recommended to have the patient lying down at least for the first few treatments, to reduce the occurrence of needle sickness and fainting.
(4) Disinfection: After the practitioner has washed his/her hands, the selected point can be wiped with a cotton ball saturated with 75% alcohol or betadine solution.
(5) Needling methods: Needling is performed with or without the use of a guide tube. One hand will be used to insert and manipulate the needle, while the other hand, referred to as the pressing hand, will stimulate the Qi flow and support the tissue around the needle insertion.
(i) Straight insertion using a guide tube:
(a) The use of needles, individually packaged with guide tubes, has become very popular.
(b) Press the guide tube on the skin with moderate pressure after swabbing the insertion site.
(c) Tap the exposed part of the handle and tail firmly once (or twice) without affecting the pressure on the guide tube. Keep the tapping finger resting on the tube for a few seconds to allow the needle to penetrate the skin. Certain skin types or oversensitive patients may require a more light repetitive tapping action.
(d) Set the needle at the correct, required depth in a smooth motion. If resistance of the softer muscle tissues or fascia is felt (causing the shaft of the needle to bend), use a gentle twirling (clockwise and counterclockwise) rotating manipulation with the tip of the index finger and thumb. While positioning the needle at the correct depth, the fingers of the other hand should be used to support the skin and tissues around the insertion site.
(ii) Straight insertion using a “free hand” technique:
(a) This technique is being used less, as it requires much more skill and the risk of contaminating the shaft is much higher.
(b) This technique is easier with shorter needles (☂ −1 cun) or stiffer (thicker gauge) needles.
(c) When one is using this technique with longer needles, it is acceptable to guide the shaft with a sterile cotton ball or gauze, to reduce the chance of contaminating the shaft.
(d) In this needling technique, the practitioner holds the handle of the needle with two or three fingers and supports the shaft of the needle with some of the other fingers of the needling hand. This technique is not permitted in some jurisdictions where it is not allowed to touch the shaft of the needle. An alternative way to needle without a guide tube, using two hands, is to hold the handle of the needle with the fingers of one hand while supporting and guiding the shaft during insertion with the fingers of the other hand. This should be done with a sterile gauze or cotton ball between the needle shaft and the fingers to avoid compromising the sterility of the needle shaft.
(6) Needle manipulations:
Acupuncture needles are manipulated after insertion to obtain “arrival of Qi,” to direct a sensation to the diseases area, or to reinforce, reduce, or disperse meridian Qi.
(i) The most common manipulation techniques are “lifting and thrusting” and “twirling,” or a combination of the two.
(ii) Other techniques to obtain arrival of Qi are to wiggle the needle, to scrape the handle of the needle with the fingernail, or other ways to move or vibrate the needle.
(iii) Twirling insertion: After the needle is inserted and put in place at the correct angle and depth, it is rotated clockwise and counterclockwise with the thumb, index finger, and/or middle finger.
(iv) Flying needle technique (rapid twirling insertion): This technique is usually done with short needles (☂ − or 1-cun needles) and involves the rapid insertion of the needle while giving it a quick twirl with the thumb and index finger. A steady hand, good finger strength, accuracy, and coordination in moving the fingers and wrist together, with an optimal timing of inserting the needle, are important for a good flying needle technique.
(v) Reinforcing and reducing techniques: Reinforcing (supplementing or tonifying) manipulations of the needle are done in the case of deficiency patterns. Reducing (draining and dispersing) manipulations are done in the case of excess patterns.
   The even method is a combination of reinforcing and reducing, and is used in complex cases where deficiency patterns are mixed with excess patterns — for example, when an excess pattern like stasis of blood is the result of a deficiency of Qi.
(vi) Twirling and thrusting: Twirling and/or thrusting the needles nine times every time the needle is manipulated is considered a reinforcing technique, while twirling and/or twisting the needles six times is considered reducing.
(vii) Rotating the needle: Gentle, minimal rotation of the needle is considered reinforcing, while a more vigorous rotation with a bigger angle is considered reducing.
(viii) Direction of the needling: Needling with the flow of Qi in the meridian is considered reinforcing; needling against the flow of the meridians is considered reducing.
(ix) Respiration and needle insertion: Inserting the needle during exhalation and withdrawing the needle during inhalation is considered a reinforcing method, while inserting the needle during inhalation and withdrawing the needle during exhalation is considered reducing.
(x) Insertion of the needle: Slow insertion, and swift withdrawal with covering of the insertion site with a cotton ball immediately after withdrawal is considered reinforcing. Rapid insertion with slow withdrawal while not applying pressure on the insertion site after withdrawal of the needle is considered reducing.
(xi) Lifting and thrusting: Forceful thrusting and gentle lifting of the needle is reinforcing. Gentle thrusting and forceful lifting is reducing.
(xii) Maximal/minimal times — five elements theory — five shu points:
Reinforcing and reducing can be achieved by making use of several basic principles of TCM.
(xiii) Additional methods for reinforcing and reducing.
Burning mountain fire method: Use a reinforcing thrusting and lifting technique nine times at the heaven (upper third of the normal needle depth), then human (middle third of the normal needle depth), and then earth level (lower one-third of the normal needle depth). Finally, withdraw the needle slowly to the heaven level, which produces a warm feeling.
Penetrating heaven cooling method: Insert the needle directly to the earth level. Perform a reducing thrusting and lifting technique six times and repeat this at the human and heaven level 5.
(7) Duration of the treatment: Leaving the needles in place for a long duration is considered reducing, while leaving the needles in place for a short duration is considered reinforcing.
   It is impossible to define an exact time for “long duration” and “short duration,” as this depends on a lot of factors, such as age, constitution, needle gauge, and other methods used for reinforcing or reducing. In a lot of cases, less than 20 min is considered relatively short (from a few seconds to 20 min), while over 20 min (sometimes up to several hours) is considered long. Twenty minutes is often considered neither reinforcing nor reducing, or both reinforcing and reducing, and is referred to as the “Even method.”

Moxibustion Methods

Application of heat to a specific area or acupuncture point for the purpose of treating disharmony or disease. Usually, Artemisia Vulgaris (Mugwort, ☂) is used as a heat source alone or in combination with other herbs.

Effects of Moxa

  • Warm the Meridians and tonify Yang.
  • Prevents Yang from collapsing (and a deficiency of both Yin and Yang).
  • Promotes the flow of Qi and Blood.
  • Expels Cold and Dampness.
  • Prevents (external) diseases.
  • Opens the 12 Primary Channels.
  • Regulates Qi and Blood.

General Indications

  • Qi and Yang deficiency conditions.
  • Immune deficiencies.
  • Bi syndromes.
  • Excess Cold conditions; Interior Excess Cold.
  • Yang deficiency conditions resulting in asthma, arthritis, GI weaknesses, impotence, enuresis, etc.

General Rules for Moxibustion Treatments

  • Treat the upper body first, then the lower body.
  • First the back, then the front.
  • First the head/or body, then the extremities.


(1) According to the materials used:
  • Moxa cones.
  • Moxa stick.
  • Moxa Box.
  • Warming needle.
  • Heated needle.
(2) According to the technique used:
(a) Direct moxibustion:
  • Cones placed directly on the skin.
  • Scarring moxibustion (for chronic persistent diseases).
  • Non-scarring moxibustion (cones in “mountain” or “grain” size).
(b) Indirect moxibustion:
  • The moxa is not touching the skin.
  • With ginger — cone placed on a thin ginger slice with tiny holes (Spleen Yang Xu or Yang Xu).
  • With garlic — Full garlic cone (Chronic paralysis, scrofula).
  • With aconite (Kidney Yang Xu, Yin abscesses, Bi syndromes).
  • With clay (clay cakes) for skin disorders.
  • On salt (e.g. umbilicus), for abdominal pain, vomiting, extreme coldness of the extremities, and general deficiency.
  • Indirect moxa with a moxa stick.
  • Stick held at a fixed level.
  • Rotating the moxa stick above a small area.
  • Pecking method (“Sparrow pecking method”).
  • Heated needle, warm needle.
  • Moxa box (often on the lower abdomen or lower back).

Quantity and Duration

  • 8 cones per point.
  • 15 min per point when using the moxa stick.
  • Take age, general constitution, site, and pathological condition into consideration.

Precautions and Side Effects

  • Fire hazard.
  • Be aware of legal complications resulting from blisters or scars, and avoid “scarring moxibustion.”
  • Extreme caution is required for patients with a decreased sensitivity to heat.
  • Contraindicated for pregnant women in the lower abdomen or lumbosacral area.
  • Contraindicated over main arteries, organs, and eyes.

Do not Use Over Points Such as Ren 14, 15, or Du 24

Cupping Methods

In a cupping technique, local congestion results from a partial vacuum in jars, placed on the skin.


Headaches, dizziness, cough, asthma, Wind-Damp conditions, musculoskeletal conditions (Rheumatic conditions), acute sprains, epigastric pain, vomiting, diarrhea, indigestion, common cold, menstrual disorders, Bi syndromes.


The most commonly used technique is to thrust a pair of forceps with a lighted cotton ball (pre-soaked in 90% alcohol) in a cup, followed by swiftly placing the cup on the skin. There are several kinds of “mechanical” cup sets on the market.

(1) Cupping methods:
  • Retention cupping: The cup is left in place for 5–15 min. The retention time depends on the patient’s condition; a shorter retention is indicated in the summer or on delicate skin.
  • Multiple cuppings (several cups at once). Indications: Injuries to muscle groups or Bi stagnation in certain organs.
  • Flash cupping: The cup is applied and pulled off repeatedly. Indications: Deficiency conditions, numbness or declining function.
  • Sliding cup.
(2) Contraindications:
  • Special caution is required in the thoracic and abdominal areas.
  • Skin ulcers, skin lesions.
  • High fever.
  • Over large blood vessels (i.e. groin area).
  • Bleeding disorders, very thin blood vessels.
  • Semiconscious patients.
  • Edema.
  • Convulsions.
  • Abdominal and sacral regions in pregnant women.
  • Severe allergic skin, dermatitis.


  • Red–purple skin coloration after cupping is normal and should disappear within a few days or a week.
  • Cupping can be combined with regular acupuncture.
  • Cupping is sometimes applied to facilitate a bleeding technique.
  • Use small cups around joints. Do not place cups too close together. Avoid bony prominences when sliding the cups.