Filiform Needling Techniques on Back Points

1. Introduction

Back points in this paper mainly refer to the points at the vertebral region. There are important internal organs and spinal nerves distributing at deep levels of those points. It is proved that needling them can treat diseases of various systems of the body. According to the theory of Chinese medicine, each point located on a particular site is able to treat disorders of this area and nearby organs. So the points on the trunk can cure ailments of internal organs. From the point of view of western medicine, the curative mechanism of acupuncture has close relationship with the stimulation of spinal nerves which have both functions of conduction and reflection. Because of their specific closeness with important internal organs and spinal cord, incorrect needling methods not only weaken curative effects but also result in damage of organs and nerves. Therefore, it is necessary to grasp the gist of the manipulative techniques applied on those points.

There are three lines of points at the vertebral region. The midline is Du meridian. The first lateral line is 0.5 cun lateral to the midline. The second lateral line is 1.5 cun lateral to the midline. The location of each point is on the level between two spinous processes of vertebrae. Points on the same horizontal level have the similar curative effects while at the same perpendicular have some similarities in needling methods. It looks like a net, in which the crossing points can treat the diseases of all over the body. The representative of Du meridian discussed in this paper is point Dazhui(GV14). Xinshu(BL15), Ganshu(BL18), Shenshu(BL23) and Zhibian(BL54) of Bladder meridian are presented as well. Points on the first lateral line are Extra points of Dingchuan and Huatuojiaji. Manipulative techniques frequently used on each point are explained respectively. There is also a case study presented under each point to help readers to comprehend the manipulation.

2. Filiform needling methods on back points

2.1 Dazhui(GV14)

Dazhui(GV14) is located below the Processus spinosus of the seventh cervical vertebra namely the prominent vertebra, approximately at the level of the shoulders. It is the crossing point of Governor vessel and all Yang meridians, so it is the most important point of strengthening body Yang. It functions to inspire the Yang Qi of the body, clear head and expel heat. Its indications include all consumptive diseases, febrile diseases, cough, asthma, depressive-manic disorders, epilepsy, neck rigidity, and so on.

This point may be punctured perpendicularly with the depth of 15-25mm. Rotating and lifting-thrusting methods with small amplitude may be applied to it. To activate Qi, rapid rotating method is frequently used as well. Hold the needle handle 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. Twist the needle continuously for 2-3 minutes. Patients may feel strong distension and soreness spreading around the point, or electric numbness radiating downwards or to the shoulder of both sides.

The needle can also be inserted obliquely with the tip of the needle slightly upward along the Processus spinosus. With the depth of 30-45 mm, the needle may pass through ligamenta flava and get into vertebral canal. The resistance of the needle disappears suddenly and operators will feel loose and empty beneath the hand. patients may feel electric numbness spreading toward the limbs. Withdraw the needle immediately without any manipulation of lifting and thrusting. This method is frequently used in treating epilepsy or depressive-manic disorders.

Case Study

Male 31years

Headache, dizziness and nausea for 2 hours

The patient did outdoor activities in the scorching summer sun. He felt headache, dizziness, nausea, thirst, short of breath with profuse sweating. He said he was lucky to get into clinic before collapse.

Examination: Pale red tongue, white coating. Superficial, large and rapid pulse.

Diagnosis: Sunstroke

Differentiation: Damage of body Qi and fluid due to summer heat

Point: Dazhui(GV14)

Method: Insert the needle perpendicularly with the depth of 25mm. Rotate and lift-thrust the needle with small amplitude to achieve the arrival of Qi. Twirl the needle rapidly with the speed reaching 200 times per minute or so. Retain the needle for 40 minutes and twist the needle continuously for 2 minutes every 15 minutes. The patient felt strong distension, soreness and electric numbness around the point. No sweating during retaining period. Symptoms such as headache, dizziness and nausea disappeared right after withdrawal of the needle. Ask the patient to drink more water and rest in cool place.

2.2 Dingchuan (Extra point)

The meaning of Dingchuan is eliminating dyspnea. This point is named so because it has amazing effects in treating asthma and cough under suitable manipulation. It is located 0.5 cun lateral to Dazhui(GV14) which is below the Processus spinosus of the seventh cervical vertebra.

The suggested needling method recorded in most text books is puncturing perpendicularly 15-20mm. Actually it is safe to insert the needle perpendicularly 25-35mm, with the tip of the needle touching the vertebral body. In practice, insert the needle slowly until the tip of it meets the bone. Withdraw a little. Rotate or/and lift-thrust the needle with large amplitude to apply strong stimulation to this point after the arrival of Qi. Patients feel strong distension and soreness around the point or even the upper back.

In addition, stuck needling technique is frequently used at this point to strengthen the needling sensation. Rotate the needle in one direction with the angle of 360 degrees, causing muscle fibers to bind around the body of the needle tightly. Hold the needle with the thumb and index finger. Lift and thrust the needle slowly 3 to 5 times to drag the muscle fibers. Or combine vibrating with stuck needling technique at this time. Rotate and lift-thrust the needle quickly with very small amplitude and high frequency like the hand trembling. Patients may feel strong heaviness or dragging pain on the chest.

For excess syndromes, on withdrawing the needle, shake the needle in different directions, up, down, left and right when pull it from deep level to shallow level slowly. Enlarge the hole and allow the pathogenic factor going out of the body with the needle. Keep the hole open to fulfil the reducing method.

Case Study

Female 48 years

Asthma for 21 years and recur for 2 weeks

Fail to lie in horizontal position, rapid and shallow breathing, cough with thick yellow sputum, dry mouth, pain and tight chest, using asthma spray for temporary remission of wheezing.

Examination: red tongue with sticky yellow coat. Slippery pulse.

Diagnosis: Asthma

Differentiation: phlegm heat blocking the lung

Points: Dingchuan(Extra point) Chize(LU5) Fenglong(ST40)

Method: Ask the patient to sit in flexion and locate the point Dingchuan(Extra point). Keep inserting the needle perpendicularly until the tip of it reach the bone with the depth of around 30mm. Withdraw a little. Lift-thrust and rotate the needle quickly with large amplitude to get Qi sensation. Rotate the needle backward with the angle of 360 degrees. Lift it 3 times with the thumb and index finger after the needle stuck. Ask the patient to breathe deeply during the manipulation. The patient felt strong soreness and dragging pain at the upper back and was able to have deep breathing. Twirl the needle forward to loose it. Shake the needle to enlarge the hole on withdrawing it slowly. The patient felt very easy and clear at the chest and then was able to lie down horizontally. At last, reduce Chize(LU5) and Fenglong(ST40) by lifting-thrusting the needle. The patient kept taking western medication but at the same time accepted acupuncture treatment twice a week. She said that the recurrence of asthma was shorter in course and less painful.

2.3 Huatuojiaji (Extra point)

Huatuojiaji (Extra point) is a group of 34 points on both sides of the spinal column, 0.5 cun lateral to the lower border of each spinous process from the first thoracic vertebra to the fifth lumbar vertebra. This group of points has wide range of indications. Points at upper thoracic vertebrae can treat ailments of lung, heart and upper limbs. Points at lower thoracic vertebrae function to treat disorders of stomach and intestines. Points at the lumber region are frequently adopted for diseases of loin, pelvic cavity and lower limbs.

Huatuojiaji points may be punctured perpendicularly with the depth of 15-25mm. Vibrating is one of the most appropriate technique applied to this group of points. Hold the needle with the thumb and index finger. Rotate the needle forward and backward and at the same time move it up and down with very small amplitude and high frequency like the hand trembling. Patients may have such needling sensation as local soreness or/and distension. This superficial needling method is suitable for most cases especially for patients of insomnia or clients who are sensitive to needling stimulation.

This group of points can also be punctured subcutaneously from the top down with the depth of 50-70mm. Rotate the needle gently and slowly in small amplitude. Or apply scraping technique to the needle to promote the Qi flow. Place the index finger on the end of the needle to hold it steady. Scrape the handle with the nail of the thumb of the same hand from top to bottom or vice versa. Patients may feel itching and numbness at the back. The key of this method is stimulating more than one point and one spinal nerve with only one needle. For example, puncturing the needle into Jiaji points of the first, sixth thoracic vertebrae and first lumbar vertebra of both sides horizontally with the depth of 60mm means stimulate almost all the Huatuojiaji points and all spinal nerves. This horizontal needling method is an effective accessory treatment for some refractory diseases of central nervous system such as paralysis agitans, myelitis, motor neuron disease, and so on.

Needles may also be inserted perpendicularly much deeper at Jiaji points. In most cases, the tip of the needle will meet the vertebrae. Withdraw the needle a little and then lift and thrust it. Sometimes patients may feel electric numbness moving along the vertebral column or spreading over the back. For example, to treat hemiplegia, lumbar radiculitis, hyperosteogeny, protrusion of intervertebral disc and so on, deep needling technique need to be applied to Jiaji points of lumbar vertebrae. To get the desirable sensation, patients are required to have lateral recumbent posture with the loin in the shape of an arch and legs flexed. Insert the needle slowly with the depth of 45-70mm. The needling sensation of electric numbness may go down to the feet. Retain the needle after withdrawing it a little without strong lifting and thrusting. Generally, the tip of the needle will arrive at a spinal nerve at the depth of 50 to 65 mm for most people.

Case study

Male 50 years

Low back pain for 3 days

The patient felt rigidity and severe pain at the lower back which was fixed in the central area after getting up in the morning three days ago. Then pain radiated downwards to the buttocks and lower limbs. Limitation of extension and flexion of the back. Pain aggravated by pressure and by turning the body.

Examination: MRI showed the bulging of intervertebral disc between the third and fourth vertebrae. Tension of back muscles. Tenderness at third and fourth vertebrae. Red tongue with thin white coating. Wiry pulse.

Diagnosis: low back pain

Differentiation: low back pain due to blood stasis

Points: Jiaji point of the third lumbar vertebrae of both sides, Weizhong(BL40)

Method: Ask the patient to lie on one side with legs flexed. Insert the needle perpendicularly at the Jiaji point. The patient felt strong aching and distension after inserting the needle about 40mm. Ask the patient to take it easy and relax the lumbar region. After a few second, keep going the needle until there is electric numbness radiating downward to the feet. It is about 60mm in depth. Lift the needle 3-5 mm and then retain the needle for 40 minutes. Reduce Weizhong(BL40) by lifting and thrusting method. Pain was alleviated by one section. He got treatment every other day and all symptoms disappeared after ten sections.

2.4 Xinshu(BL15)

Xinshu(BL15) is the Back-Shu point of the heart on the back, where the Qi of heart meridian is infused. The location of this point is 1.5 cun lateral to Shendao (GV11), at the level of the lower border of the spinous process of the fifth thoracic vertebra. It is widely used to prevent and cure such diseases of cardiovascular and nerve systems as cardiac pain, panic, palpitation, loss of memory, nocturnal emission, night sweating, insomnia, mania, epilepsy and so on.

The needling method of this point is inserting the needle obliquely toward vertebral column to form an angle of approximately 60 degrees with the skin surface. The suitable depth of insertion is from 20 to 35mm. The tip of the needle may get into the muscle of longissimus, so there will be some resistance due to contraction of the muscle. It is not advisable to insert the needle perpendicularly because the deep level of this point is the lung. For some patients of slim figure, acupuncture may cause pneumatothorax with the depth of only 30 mm under perpendicular insertion. As we know, the lung is not sensitive to the stimulation of the needle. Patients may not have abnormal feeling even if their lungs are hurting. Generally, symptoms such as chest distress, pain, cough, etc. of pneumatothorax occur a few hours after wrong needling. Therefore, it seems quite important for operators to realize the feelings of a needle in different tissues. If all resistance disappears when insert the needle, or loose and empty sensation are felt under the needle, it may passing through pulmonary alveoli. Withdraw the needle immediately without any manipulation. Deep insertion or inserting the needle obliquely outward is never allowed at this point.

After inserting the needle, rotating the needle quickly with small amplitude may be applied to get the arrival of Qi. If the Qi sensation is not felt or not strong enough, flying technique is frequently employed to promote Qi flow and strengthen stimulation. Hold the handle of the needle with the thumb and index finger of the right hand to rotate for 1-3 times and then free it quickly with fingers separating. This procedure may be continued for several times just like the flying of a bird.

Case study

Female 32 years

Insomnia for 2 months

Difficulty in falling asleep and dream disturbed sleep after prolonged overwork. Accompanied by poor memory and palpitation

Examination: pale complexion and pale lips. Pale tongue, thin white coating. Thin pulse.

Diagnosis: insomnia

Differentiation: deficiency of heart blood

Points: Xinshu(BL15), Pishu(BL20)

Xinshu(BL15): Insert the needle obliquely toward middle line with the depth of 25mm. The angle between the needle and skin is about 60 degrees. Rotate the needle for 2 minutes. The patient had dull needling sensation due to weak constitution. Apply flying technique to strengthen the stimulation. Hold the needle with the thumb and index finger. Twirl the handle of the needle gently 3 times and then release it quickly. Separate the fingers just like a bird spreading its wings. The needle was left slightly quivering on the point. After the patient got obvious feeling of distension, apply reinforcing method by lifting the needle gently while thrusting the needle heavily. Retain the needle for half an hour.

It is easier for Pishu(BL20) to get the arrival of Qi than Xinshu(BL15). Reinforce Pishu(BL20) by lifting and thrusting the needle. The patient accepted the treatment once a day and recovered to normal sleep after five sections. All the other symptoms disappeared as well.

2.5 Ganshu(BL18)

Ganshu(BL18) is the Back-Shu point of the Liver on the back, where the Qi of liver meridian is infused. The location of this point is 1.5 cun lateral to Jinsuo(GV8), at the level of the lower border of the spinous process of the nine thoracic vertebra. This point can prevent and cure ailments of liver and gallbladder, eyes, blood and nerve system. Its indications include jaundice, pain in the hypochondriac region, redness of the eye, blurring of vision, night blindness, mental disorders, epilepsy, backache, spitting of blood, epistaxis, insomnia, irregular menstruation and so on.

At this point, needles need to be inserted obliquely with the tip of it toward vertebral column. The angle between the needle and the skin is around 60 degrees. The suggested depth of insertion is 25-35 mm. Rotating, lifting and thrusting the needle with small amplitude may be applied to the needle. Flying technique is also frequently used to promote the circulation of Qi and strengthen the needling sensation. Patients may have local soreness and distension. Sometimes their transmission may spread over the intercostals space.

The needle can also be inserted subcutaneously from Ganshu(BL18) to Pishu(BL20) with the depth of 30-45mm. Rotate the needle to get the Qi sensation. Stuck needling technique performed by rotating the needle unidirectionally to twine muscle fibers around the body of the needle tightly and then lift-thrusting the needle gently 3 to 5 times is often used to strengthen the stimulation. This method is suitable for all the symptoms caused by disharmony between the liver and spleen.

Case study

Male 16 years

Recurrent stye for 1 year.

The patient suffered from stye 6 times in the recent year. Red, itch, pain and edema of eyelids, accompanied with irritability, bitter taste in the mouth, constipation.

Examination: Red tongue with yellow coat. Wiry pulse

Differentiation: preponderance of fire in the liver

Point: Ganshu(BL18)

Method: Insert the needle obliquely toward middle line with the depth of 30mm. Perform reducing method by lifting the needle heavily while thrusting the needle gently for 3 minutes after the arrival of Qi. The patient felt strong aching and distension at local area. Shake the needle by swinging it upward and downward, from the left to the right in the withdrawal of the needle to enlarge the needling hole and induce the leakage of Qi. Treat the patient once a week in a five weeks’ course of treatment. There was no recurrence in the follow-up survey of half a year.

2.6 Shenshu(BL23)

Shenshu(BL23) is the Back-Shu point of the Kidney on the back, where the Qi of kidney meridian is infused. The location of this point is 1.5 cun lateral to Mingmen(GV4), at the level of the lower border of the spinous process of the second lumbar vertebra. This point has the effect of reinforcing kidney Qi, strengthening loin and knee, protecting brain and building up health. Its indications include all the symptoms of kidney deficiency such as nocturnal emission, impotence, enuresis, irregular menstruation, leucorrhea, low back pain, weakness of the knee, dizziness, tinnitus, deafness, edema, asthma, diarrhea and so on.

This point can be punctured slightly toward vertebral column with the depth of 15-60mm. Too deep insertion or inserting the needle obliquely outward may hurt the kidney. Rotating and lifting-thrusting methods could be applied to Shenshu(BL23) to get Qi sensation. Needling sensations include local soreness, distension, and electric numbness going down to the buttock and lower limbs. Different feeling is required according to the disease. For example, soreness and distension around point are enough for treating lumbago. As for weakness of lower limbs or edema, the needling sensation needs to reach the leg. Seeking technique which is performed by thrusting the needle in different levels and directions, up and down, left and right, could be employed to promote Qi flow and seek for the required feeling.

Pyretic strengthening method at this point is suitable for warming the kidney and strengthening the body. Press the acupoint with the thumb or index finger of the left hand and insert the needle with right hand. After the Qi arrives, the left hand reinforces the pressure and the right hand rotates the needle forward for 3-5 times with power of the thumb exerted downward until there are heavy and sunken sensation felt beneath the needle. Thrust the needle heavily and lift it lightly for 3-5 times with the tip of it against the acu-esthesia. The thumb rotates the needle forward for another 3-5 times to keep the heavy and sunken sensation and wait for a feeling of warmth. Press the acupoint quickly after the withdrawal of the needle.

Case study

Female, 52 years

Edema on the legs for 3 months

Edema on the anterior crural region surface for 3 months, accompanied by aversion to cold, cold limbs, soreness of the loin and knees, tinnitus sometimes.

Examination: normal routine urine examination. Pale tongue with white coating. Deep and thin pulse

Diagnosis: edema

Differentiation: kidney yang deficiency

Points: shenshu(BL23), Taixi(KI3)

Method: Shenshu(BL23): Press the acupoint with the index finger of the left hand. Insert the needle slightly toward vertebral column with the depth of 40mm. Lift and thrust the needle until the patient felt distention around the point. Press the point heavily with the left index finger. Twirl the needle with the power of the right thumb forward and downward for several times until there are heavy and sunken sensation felt beneath the needle. Stick the acu-esthesia on the tip of the needle. Thrust it heavily and lift it lightly 5 times. Repeat the above manipulation until the patient felt warm around the point.

Half an hour later, there is no feeling left at the point. Thrust the needle in different directions gently and slowly until the patient felt electric shock going downward to the ankle. Press the acupoint quickly after the withdrawal of the needle.

Apply reinforcing method of rotation at Taixi(KI3). The patient accepted treatment every other day. Edema disappeared after 10 sections.

2.7 Zhibian(BL54)

Zhibian(BL54) is on the level of the fourth posterior sacral foramen, 3 cun lateral to the median sacral crest. Apart from pain in the lumbosacral region and motor impairment of the lower extremities, this point can also prevent and treat diseases of urogenital system and anus such as dysuria, pain and swelling around external genitalia, hemorrhoids, constipation, and so on.

Different direction of insertion may be adopted according to the curative purpose at this point. To treat pain of lower limbs or sciatica, the needle may be inserted perpendicularly with the depth of 60-100mm. Lift and thrust it gently until there are local distention, soreness and electric shock radiating to the legs and feet.

As for ailments of urogenital system, the needle may be inserted obliquely with the tip of it toward vulva. The angle between the needle and the skin is 60-80 degrees and the depth of insertion is 60-90 mm. Patients may feel local distention and soreness and their transmission around pudendum.

The needle can also be inserted obliquely with the tip of it toward the anus. The angle between the needle and the skin is about 50 degrees. The depth of insertion is between 60 to 90mm. patients may feel soreness and distension spreading around the anus. This method is suitable for hemorrhoid and proctoptosis.

To strengthen and spread the needling sensation, technique of Green Tortoise Probing Cave may be applied to the needle. Thrust the needle to various directions up, down, left and right in the shallow, middle and deep levels. In every direction, the needle is thrust three times from the shallow level to the deep level slowly and forcefully while lifted once from the deep level to the shallow level gently. This method is also effective to tonify the weakness.

Case study

Female, 31 years

Frequent micturition for 2 months

Frequency and urgency of urination, exacerbated after overwork, dull pain at lower abdomen, weakness of the loin.

Examination: positive reaction of bacteruria. Pale tongue white coating. Weak pulse.

Diagnosis: Urination disturbance (cystitis)

Differentiation: Qi deficiency of urinary bladder

Point: Zhibian(BL54)

Insert the needle slowly with the tip of it toward vulva. Both the operator and patient focused all their attention on the needle. At the depth of around 70mm, there was distension and soreness around the point. Lift the needle once from the deep level to the shallow level gently and then thrust three times from the shallow level to the deep level slowly and forcefully. Repeat the same operation for 3 times. The patient felt distension radiating to the perineum. She accepted treatment every other day and recovered after five sections.

3. Conclusion

We discussed three lines of points at the vertebral region. Analogy learning method is supportive to grasp the needling methods of them. As for points of Du meridian, the direction of insertion is perpendicular or slightly upward according to the angle of Processus spinosus. Generally, needles need to be inserted into interspinal ligaments between two Processus spinosus with the depth of 15-35 mm at thoracic vertebrae and 30-45mm at lumbar vertebrae. For some special curative purposes, the needle may go deeper passing through ligmenta flava and get into vertebral canal. Operators will feel the resistance disappeared suddenly and loose and empty beneath the needle. There is electric numbness radiating to the limbs of patients. Withdraw the needle without any manipulation.

Back-Shu points that on the line 1.5 cun lateral to the midline are belong to Bladder meridian. They are the specific points on the back where the Qi of the respective zang-fu organs is infused and often used for disorders of the internal organs. Situated close to their respectively related zang-fu organs, it is not advisable to insert the needle over deeply or obliquely outward. Points on this line need to be punctured slightly toward vertebral column with the angle of 60-80 degrees between the needle and skin. Needles may get into sacrospinal muscle with resistance beneath them. The depth of insertion could be gradually deeper from the top to bottom.

Compared to Back-shu points, Hutuojiaji (Extra) points are much safer and have similar curative effects. In many cases, Hutuojiaji points are able to substitute for the Back-shu points at the same horizontal level. For most adults, the length between the middle line and lateral side of corpus vertebrae is from 12 to 20mm. It means that needles will meet vertebrae under deep perpendicular insertion at those points instead of getting into thoracic or abdominal cavities.

Only a few of those points are discussed representatively in this paper because the depth and direction of insertion and manipulative techniques of points at the same segment of each vertical line are quite similar. Readers may draw inferences from the instances provided here.