Needling Technique on Chest Points

1.     Introduction

Chest is the part of the body between the neck and the abdomen, enclosed by the ribs and the breastbone. Two of the most important organs, the heart and lung, situate in it. It is also called Upper Jiao in Chinese medicine that controls respiration and activates the flow of Qi, blood and body fluid. It disperses pectoral Qi accumulated in the chest to all parts of the body just as fog and dew moisten the earth.

 

The meridians of lung, stomach, kidney, conception, etc. travel at the chest. Most points at this area function to treat disorders of the lung and heart such as dyspnoea, coughing, wheezing, oppressive full sensation of the chest, palpitation, and so on. In addition, some of them are also able to cure ailments of breast and ribs, for example breast abscess, scanty lactation, intercostals neuralgia, etc.  

 

On the other hand, the high risk of acupuncture accidents of pneumothorax or heart trauma draws great attention of operators to the needling methods on chest points. In this paper, the filiform puncture techniques for some points will be discussed respectively. Points mentioned in this paper include Zhongfu(LU1), the Front-Mu point of the lung; Tiantu(CV22), which is recognized as an important point to treat the lung disorders; Tanzhong(CV17), both the hui-meeting point of Qi and the front-Mu point of the Pericardium; Rugen (ST18), a principle local point for treating disorders of the breast; Quepen(ST12), where many channels pass in and out the chest; and Jingbi(Extra), an extra point frequently used in clinic. The case studies of each point will be presented as well.  

 

2.     Filiform needling methods for chest points

2.1  Zhongfu(LU1)

Zhongfu(LU1), the Front-Mu point of the lung, is located at the level of the first intercostals space, 6 cun lateral to the anterior midline. It functions to prevent and cure disorders of the chest and lung. Indications of this point include cough, asthma, pain in the chest, shoulder and back, fullness of the chest, and so on.

 

The needling method of Zhongfu(LU1) is puncturing obliquely 15-30mm towards the lateral aspect of the chest. The tip of the needle may get into deltoid muscle or pectoralis major. Rotating or/and lifting-thrusting technique with small amplitude may be applied to it. Flying technique is frequently adopted to strengthen and spread the needling sensation. Hold the needle with the thumb and index finger. Twirl the handle of the needle gently for 1 to 3 times and then release it quickly. Separate the fingers just like a bird spreading its wings. The needle might be left slightly quivering on the point. There will be needling sensations such as distension, soreness or their transmission toward the chest or homolateral upper limb. To keep and strengthen the needling sensation, flicking the handle of the needle may be applied during retaining period. Cross the middle and index finger with the middle finger ahead, or cross the thumb and index finger with the thumb ahead. Flick the handle of the needle lightly with the index finger to make it trembling.

 

The needle might pass through intercostals space and hurt the lung causing traumatic pneumothorax provided that it is inserted deeply toward the medial aspect. Therefore, deep intilted insertion is not allowed at this point.

 

Case study

Male 48years

Simple chronic bronchitis for 4 years

The patient coughed and expectorated profuse, white and sticky sputum in winters of 4 continuous years. Those symptoms lasted at least for 3 months on every recurrence. He also had symptoms such as aversion to cold, spontaneous sweating, stuffiness in the chest and susceptible to common cold even in remission stage. It was October when he came to the clinic asking for preventive treatment.

Examination: Pale tongue with thin white coat, thin pulse

Diagnosis: Simple chronic bronchitis (remission stage)

Differentiation: Deficiency of the Lung Qi

Points: Zhongfu(LU1)  Zusanli(ST36)

Methods: Zhongfu(LU1): insert the needle obliquely towards the lateral aspect of the chest with the depth of 30mm. Lift and thrust the needle to promote the arrival of Qi. Hold the needle with the thumb and index finger to rotate it 3 times and then free it quickly with fingers separating. Continue this procedure for 5 times just like the flying of a bird. The patient felt distension spreading on the chest. Retain the needle for half an hour before the withdrawal of it. Flick the tail of the needle for 5 times to shake it and keep acu-esthesia during the retention of the needle.

 

Zusanli(ST36): Reinforce Zusanli(ST36) by lifting the needle gently while thrusting it heavily. Treat the patient twice per week in a three months’ course of treatment. There was no recurrence in the follow-up survey of one year.

 

2.2  Tiantu(CV22)

Tiantu(CV22) is in the centre of the suprasternal fossa. Generally it is located 0.5 cun above the midpoint of the superior border of manubrium sterni. This point can treat asthma, cough, sore throat, hiccup, sudden hoarseness of the voice, difficulty in swallowing, goiter, Laryngopharyngeal paresthesia, and so on.

 

Superficial insertion at this point applies in children and those patients who are nervous of needling sensation. Insert the needle with the depth of 5-10mm. The tip of the needle will reach the Linea alba of neck mixed by deep cervical fascia where it meets soft resistance. Passing through the Linea alba, it gets into the space before the trachea where the resistance disappears and operators feel empty under the needle. Stop deep-going at once with the depth of 8-15mm in total. Rotate the handle of the needle gently with small amplitude to facilitate the arrival of Qi. Patients may feel tight at the throat. Deep perpendicular insertion is never allowed at this point. If the depth of insertion exceeds 15mm, the tip of the needle may touch the cartilagines tracheales which is very hard. Withdraw the needle a little and then retain it. There is no side effect for treatment. However, the tip of the needle may possibly puncture into ligamenta annularia at this level of insertion and then hurt mucosa of the trachea. Patients may feel itching at throat and burst out coughing.

 

Generally, deep insertion method at this point has better effects for most ailments. Puncture the needle perpendicularly 8-10mm with the tip of it reaching the space before the trachea. Then Change the direction of insertion by thrusting the needle downward. The needle goes along the midline and is close to the posterior aspect of the sternum with the depth of 30-45mm. Operators feel empty under the hand while patients has strong tightness at the throat. To strengthen and spread the needling sensation, scraping technique is often applied to the needle. Place the thumb on the end of the needle to hold it steady. Scrape the handle with the nail of the index or middle finger of the same hand from top to bottom or vice versa. Or hold the handle of the needle with the thumb and middle finger. Scrape the handle with the nail of the index finger. Too deep or oblique insertion to the left or right behind the sternum may hurt such arteries as Arcus aortae, brachiocephalic trunk, or A. carotis communis. The needle looks throbbing provided that the arteries are pricked. As for patients of pulmonary emphysema, too deep insertion may result in pneumatothorax.   

 

Case study

Female, 42 years

Discomfort at throat for 2 weeks

The patient had been depressed for the loss of her job for a few months. She had malaise in laryngeal part of pharynx from two weeks ago and got worse gradually. She felt like a stone blocking up at the throat which fails to be spit out or swallowed down. She also has sensation of oppression in the chest, irritability and preference for sighing. Diagnosis of western medicine is laryngopharyngeal paresthesia.  

Examination: Red tongue with white coating. Wiry pulse

Diagnosis: Globus hystericus in the throat

Differentiation: Stagnancy of the Liver-Qi

Points: Tiantu(CV22), Taichong(LI3)

Method: Tiantu(CV22): First puncture perpendicularly 10mm and then insert the needle downward along the midline of the posterior aspect of the sternum with the depth of 40mm. The patient had tight feeling around the throat when insert the needle. The belly of the thumb leans against the tail of the needle and the nail of the index finger scrape the handle of the needle frequently from the lower to the upper to promote the transmission and dissipation of acu-esthesia. Sometimes the patient felt Qi moving up and down along the trachea. Retain the needle for 20 minutes and then withdraw it gently. The patient felt clear and relaxed in the gullet after the withdrawal of the needle. 

 

Reduce Taichong(LI3) by lifting the needle heavily while thrusting it gently. Treat the patient every other day and all symptoms disappeared after three sections.

 

2.3  Tanzhong(CV17)

Tanzhong(CV17) locates on the anterior midline, at the level with the fourth intercostals space. It is the Front-Mu point of the pericardium. It is also the influential point of Qi, at which Zongqi stores. Therefore, it is the key point of regulating Qi in clinic that functions to treat all disorders caused by disharmony of body Qi. For example, it can cure cough and asthma due to the failure of descending lung Qi, difficulty in swallowing and hiccup due to rebellion of stomach Qi, palpitation and pain in the chest due to stagnation of heart Qi, insufficient lactation and mastosis due to obstruction of Qi in the chest.

 

This point may be punctured subcutaneously or obliquely upward 10-15mm with the tip of the needle reaching the periosteum. Apply sparrow pecking technique to the needle to promote the circulation of Qi. Lift and thrust the needle continuously in small amplitude but with high frequency like a sparrow pecking at the corn. The wrist joint moves slightly up and down in the operation. The range of frequency is between 150 to 300 times per minute. The needle should be kept at the same depth ultimately. This technique relies on the perpendicular movement of wrist joint, which brings about stronger stimulation to the point.

 

To strengthen the needling sensation, hold the handle of the needle with the palmar surface of the thumb and radial surface of the index or middle finger. Twist the needle with the help of the bending and stretching movement of the metacarpophalangeal joint of the index or middle finger. Rotate the needle handle rapidly with the twisting speed reaching 200 times per minute or so. Patients may feel strong soreness, distension or/and aching at the local area.

 

As for such disorders as intercostals neuralgia, insufficient lactation of parturient or mastosis, the needle may be inserted horizontally 10-15mm to the direction of Ruzhong(ST17) with an angle of 15 degrees beneath the skin. Rotating, lifting and thrusting methods with small amplitude should be applied to the needle till acu-esthesia is felt. The main needling sensation includes distension, soreness or heaviness on the chest.  

   

Case study

Male, 48years

Hiccup for 2 days

Continuous hiccup caused by violent rage. Can not eat, drink and sleep. Myalgia at upper abdomen. Acupuncture of Neiguan(PC6) and Zusnali(ST36) got no effects.

Examination: Red tongue with white coating, wiry pulse

Diagnosis: hiccup

Differentiation: rebellion of stomach Qi caused by violation of Liver Qi

Point: Tanzhong(CV17)

Method: Insert the needle obliquely upward 15mm with the tip of it reaching the bone. Lift and thrust the needle rapidly in the fixed depth like a sparrow pecking the bone. Continue the operation for one minute. The patient felt local distending pain and then hiccup stopped. Retain the needle for one hour before the withdrawal of it.

  

2.4  Rugen (ST18)

Rugen(ST18) is on the chest, directly below the nipple, in the 5th intercostal space, 4 cun lateral to the anterior midline. Indications of this point include pain in the chest, cough, mastitis, insufficient lactation, intercostals neuralgia, and so on.

 

To treat intercostal neuralgia, the needle may be inserted obliquely outward with the depth of 15-25 mm. For the promotion of lactation, the needle need to be punctured obliquely upward to the direction of Ruzhong(ST17). The angle between the handle of the needle and the skin is no more than 30 degrees in any direction because the deep level of this point is the lung. There is high risk of injuring the lung under perpendicular or deep oblique insertion.

 

Rotating method is more frequently used at this point than lifting and thrusting. To promote or reinforce acu-esthesia, the handle of the needle may be scraped by the fingers. Lean against the tail of the needle by the belly of the thumb and scrape the handle of the needle frequently from the lower to the upper or vice versa by the nails of the index or middle finger with even strength. This technique can facilitate the flow of meridian Qi and promote the transmission and dissipation of needling sensation. Patients may feel soreness and distension at chest or electric numbness spreading along the intercostal place.   

 

Case study

Female, 29 years

Swelling and pain in the breast for one week

There are small lumps in the left breast accompanied by swelling, distension, pain and obstruction of lactation in lactation period after delivery. No local redness, chills and fever.

Examination: pale red tongue with white coating, wiry pulse

Diagnosis: Breast abscess

Differentiation: Liver Qi stagnation

Point: Rugen (ST18) of left side

Method: insert the needle obliquely upward into Rugen (ST18) with an angle of 25 degrees 25mm to the direction of Ruzhong(ST17). Rotate the needle with small amplitude to get Qi sensation. After the arrival of Qi, Place the thumb on the end of the needle to hold it steady. Scrape the handle with the nail of the middle finger of the same hand from the bottom to top. The patient felt distension around the breast. She accepted the treatment once a day. No pain and difficulty in lactation after one section. All lumps were removed three days later.

 

2.5  Quepen(ST12)

Quepen(ST12) is in the center of the supraclavicular fossa, 4 cun lateral to the midline. This point is able to treat rebellion of Lung Qi manifesting as cough, dyspnoea, and fullness of the chest. It is also indicated for pain of the supraclavicular fossa, pain of the shoulder that radiates to the neck, and so on.  

 

The needling method of this point is puncturing perpendicularly with the depth of 10-14mm. Deep perpendicular insertion may injure the subclavian artery. Deep downward insertion is never allowed at Quepen(ST12), because it is easy for the tip of the needle to pass through pleural cavity and then hurt the lung, causing pneumothorax. Rotate the needle repeatedly forward and backward in the acupoint to promote the arrival of Qi. Patients may feel distension and soreness at preater supraclavicular fossa. To strengthen and keep the needling sensation, flicking technique is often employed. Cross the middle and index finger with the middle finger ahead, or cross the thumb and index finger with the thumb ahead. Flick the handle of the needle lightly with the index finger causing it to tremble. This technique is usually used for 5 to 10 times during the retaining period.

 

Case study

Male, 40 years

Neck pain for 3 days

The patient felt stiffness and pain at the right lateral side of the neck after waking up in the morning. The pain got worse when turning the face to the left and radiated to the acromial end of the clavicle. It aggravated by exposure to wind and cold.

Examination: Tenderness at the point of Quepen(ST12), rigidity of sternocleidomastoideus, limited movement of cervical part. Pale tongue with thin white coating. Tight pulse.

Diagnosis: Neck pain

Differentiation: Qi stagnation by invasion of pathogenic cold

Points: Quepen(ST12) and Fengchi(GB20) of right side  

Method: Quepen(ST12): insert the needle perpendicularly with the depth of around 12mm. then rotate it quickly with the even strength of the thumb and index finger of the right hand till the arrival of Qi. The patient felt strong distension around the point and its transmission moving up to the posterior auricular area. Flick the handle of the needle frequently to slightly shake it during the retention of it.

 

Perform reducing technique at the point of Fengchi(GB20) by less thrusting and more lifting. Ask the patient to move his neck gently after withdrawal of the needle. He felt much more comfortable after only one section. Treat him once a day and no malaise was left after three days.  

 

2.6  Jingbi(Ex.)

The location of Jingbi(Ex.) is one cun above the superior border of the clavicle and one third distance between the extremitas sternalis and extrexitas acromialis of the clavicle, posterior to the sternocleidomastoid. Indications of this point include numbness of hands or arms and paralysis of upper limbs.

 

Ask the patient to turn the face to the opposite side of the selected point in order to make the sternocleidomastoid more prominent. Insert the needle perpendicularly backward with the depth of 15-30mm. Avoid the subcutaneous external jugular vein when locating this point and insert the needle very slowly. The patient will feel electric numbness radiating to the homolateral arm and hand provided that the tip of the needle touch the brachial plexus nerve. Withdraw the needle without any strong stimulation. If the desired sensation fails to arrive, lift the needle to the subcutaneous level and then change the direction slightly to the left or right. Incorrect angle of downward insertion will injure the lung and result in pneumothorax. Strong lifting and thrusting manipulation with large amplitude is not advisable at this point.   

 

Case study

Female, 64 years

Numbness of left hand for 3 months

The patient had numbness of fingers of the left hand 3 months ago. The feeling of numbness extended to the whole palm gradually. Generally, cold hands and feet. Susceptible to colds. Acupuncture of point Hegu(LI4) and Baxie(Ex.) had no help.

Examination: Normal blood pressure, no abnormal was found in the X-ray examination of cervical vertebrae. Pale tongue with thin white coating. Thin pulse

Diagnosis: Skin Bi

Differentiation: Deficiency of Qi and Blood

Points: JingBi(Ex.) of the left hand

Method: Ask the patient to sit straightly and turn the head to the right. The needle was inserted slowly and perpendicular to the sternocleidomastoid. At the insertion depth of 25mm, the patient felt electric numbness radiating from the point to the tip of the fingers. Withdraw the needle without any manipulation. Press the needled acupoint and rub it with the belly of the middle finger to disperse Qi and blood. The numbness was largely alleviated after two sections.

 

3.     Conclusion

The deep level of most chest points is the lung and heart. To avoid injuring the important internal organs, it is vital to master the needling technique of those points. The depth of perpendicular insertion of points at the root of the neck is no more than 15mm, such as Tiantu(CV22) and Quepen(ST12). It is wise to control the angle of insertion of the points at intercostals space within 30 degrees. Lifting and thrusting method with large amplitude is not advisable for chest points. Incorrect depth or angle of insertion or unskilled manipulation is easy to cause accidents or even endanger patients’ life. Points on the sternum, on the other hand, may be strongly stimulated by rapid rotating technique or sparrow pecking technique deep to the bone.  

 

Pneumothorax is one of the most common accidents of needling chest points. The lung is not sensitive to the stimulation of the needle. Patients may not have abnormal feeling even if their lungs are hurting. But the operator will feel loose, empty and lack of resistance under the tip of the needle. Pneumatothorax may occur if patients have such symptoms as chest pain, cough, and progressive dyspnea a few hours after inappropriate needling. X-ray examination will provide the evidence of the diagnosis. Ask the patient to have bed rest. Symptoms of most patients will remit spontaneously.