Editor's Note: Part one of this article was published in the Jan 2019 issue.
While classic sages have said a lot on this topic, I will share my own experience with the sensations under the needle with you. You, in turn, will also need to gain your own understanding of them through daily clinical observation, thinking, and practice. The sensations under the needle can be divided into eight types:
1. Empty Qi: a sensation of emptiness under the needle as if sticking needles into the air or a tofu block. This is one of the most common clinical manifestations, especially in patients with chronic illness. The most common area to feel this emptiness is in the abdomen. When Empty Qi is detected, it is more difficult to achieve De Qi. Empty Qi indicates that there is not enough Qi, which means we need to do something to fill the emptiness. By applying the Chou Tian method (draw and fill) needling technique, you can gather Qi in the affected area and achieve De Qi. Apply additional needling techniques such as Burning Mountain Technique to fill the emptiness.
2. Excess Qi: This feels like sticking a needle into mud, or in more serious cases, into putty. The Excess Qi sensation can be seen at any level, deep or shallow. Excess Qi indicates excess conditions. When Deficient Qi is detected, fill or tonify the Healthy Qi; when there is Excess Qi, give the evil a way out. This is a clinical principle we must follow. There are two ways of purging the excess:
a. Treat at the far end, guiding the Qi and giving the evil Qi a way out.
b. When the excess is as severe enough that it feels like sticking the needle into putty, and a knot can be found at the local region, the method of treating the far end is not sufficient. In this case, dig it out like an excavator, or even to exaggerate, blow it up with dynamite.
3. Floating Qi: This is generally felt in the superficial layer and occasionally in a deeper layer, which is important to keep in mind. The sensation of Floating Qi is like being lifted up by the buoyant force when swimming. Another example of how Floating Qi will feel is like putting a cork in water. It floats in the water and if you push it down gently, there will be a feeling of resistance.
4. Sinking Qi: This is the opposite end of Floating Qi. Sinking Qi feels similar to suction, or something dragging the needle down. In my opinion, this is the feeling described in the classic: "like fish swallowing the bait." The appearance of Floating Qi or Sinking Qi helps us determine the location of the pathogen and the prognosis of the disease.
5. Slippery Qi: This is a feeling that is commonly found in a newly occurring disease or in the Yang meridians. I liken the sensation of Slippery Qi to the feeling of catching a loach. It is slippery, hard to grasp, and it often escapes, or you may experience it as a feeling of repetitive collision. It feels like you are almost catching it but having it run off again.
6. Sticky Qi: This is the opposite of Slippery Qi. True to its name, Sticky Qi feels sticky and very uncomfortable, similar to having honey, caramelized sugar, or sticky rice sticking to your hands. It is most often found in patients with dampness or chronic disease with dampness and is commonly found when needling the Yin Meridians. Conditions associated with Sticky Qi will be more difficult to treat. It is not simply a case of using only tonifying or dispersing techniques to remedy it. To treat Sticky Qi successfully, you may need to select a combination of points from different meridians based on syndrome differentiation.
7. Tight Qi: This sensation is relatively easy to understand. It is similar to when something is tangled and resists your movement mildly. The resistance is subtler than feeling like a game of tug-of-war. Tight Qi can occur at different levels. For example, when the needle tip just penetrates the skin surface, you may see goose bumps and may find that the needle resists going in any further. The same sensation can be experienced when the needle goes into the muscle level. Generally, Tight Qi is more commonly found in people who have an acute pain condition.
8. Micro Qi: This refers to a feeling of feebleness and being unrooted. It is not as strong and consistent as Healthy Qi and not as empty as Deficiency Qi in that, although it is feeble, it is detectable under the needle. It is as if someone shook hands with you for a quick second then walked away. Micro Qi is most often found in people with chronic disease.
Mastering the 8 Basic Sensations
There are additional needle sensations (e.g. cold, heat, clear, harmony, etc.) which will not be discussed in this article. Mastering finding these eight basic sensations found under the needle will be sufficient for most of your clinical needs. Each of these sensations have clinical significance upon which your needling techniques and treatment plan should be based.
This has been a rather in-depth beginning discussion of these sensations. The above concepts are essential for you to incorporate into your clinical practice. I urge you to practice patience with your progress and learn to overcome challenges as you transform these concepts into skills. They will not be mastered immediately. In Buddhism, there is a concept of "lamrim" which means stages of the path and in Ruism/Confucianism, there is a rule of gradual advancement. These apply in learning these sensations.
Our professional practice of acupuncture cannot tolerate any laziness or fraud. We have a depth and breadth in what we offer, which differentiates us from simply practicing one type of needling theory. Performing our acupuncture competently and practically, built on a solid foundation of mastering needling techniques and discovering the beauty of each point will allow us to differentiate our profession. We need to aim to become adept at consistently practicing in this way and be able to articulate this difference when speaking of our professional skills. We should not simply settle for pursuing the miracle, one-needle-technique type of treatment. It is not what we are called to do and be in this profession.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Laser therapy has emerged as a powerful tool in the realm of traditional Chinese medicine (TCM). This new modality fits beautifully into the toolbox of the modern acupuncturist, as it can be used as a hybrid form of stimulation to acupuncture points, meridians, organs, nerves, and symptomatic areas in a new way that blends both moxa and energetic needle-like responses.
