Qizhi to Deqi: The Living Sequence That Animates Acupuncture

In the art of acupuncture, two concepts – qizhi (qi arrival) and deqi (obtaining qi) – form the clinical foundation of effective needling. Though often used interchangeably, they describe distinct and sequential phases of therapeutic engagement. To truly feel and guide qi, a practitioner must learn to embody this classical sequence, recognizing qizhi as the current that is initiated and deqi as the resonance that is confirmed.

Qizhi: The Arrival and Movement of Qi

First, there is qizhi. I define this as a dynamic, functional process – the arrival and directional movement of qi at a targeted site. Through skillful, guided stimulation, qi is not merely activated; it is conducted with intention toward its therapeutic endpoint. This is the moment your treatment becomes kinetic; a tangible flow you can perceive through a confluence of patient sensation and your own tactile feedback.

• Your Patient's Experience: They may report a traveling, radiating or wave-like sensation; a feeling of warmth or pressure moving along a defined pathway.
• Your Tactile Observation: You will feel an elastic tension under the needle, a shifting tissue tone, or the subtle “pull” or “grasp” that signals movement.

“When the qi arrives, the effect becomes evident. Its impact is as certain as the wind that scatters clouds, as clear as the blue sky that follows.” — Huangdi Neijing Lingshu, Chapter 3

Qizhi is the energetic current – the vital signal that the therapeutic process has begun.

Deqi: The Confirmation of Shared Awareness

Following qizhi, you seek deqi. I define this as the clinical confirmation that qi has not only arrived, but also has been successfully received, anchored, and acknowledged. More than just a sensation, deqi is a relational event – a mutual awareness between practitioner and patient that a therapeutic threshold has been crossed.

This shared moment of recognition is often marked by unmistakable cues:

• From Your Patient: A spontaneous deep sigh, an emotional release, a visible softening of their facial expression, or a felt sense of resolution and inner stillness.
• From Your Hands: A palpable softening of the local tissues, a subtle vibration that replaces tension, or a clear harmonization of the patient's breath and radial pulse.
• Deqi marks the moment the body affirms the connection: “Yes, the qi is here, and I am responding.”

Case Vignette

A 42-year-old patient presents with chronic neck and shoulder tension. After the practitioner needles SI 15 and GB 21 with breath-guided insertion, the patient reports a wave of warmth spreading down the arm – a classic presentation of qizhi. Moments later, you observe her exhale deeply and smile without prompting. . Simultaneously, you sense a distinct softening of the trapezius muscle and feel a smoother, more harmonious quality in her radial pulse. With these cues, you have confirmed deqi.

Mapping the Sequence

In this sequence, qizhi is the current you initiate; deqi is the resonance you confirm.

The Five Gates Model

This clinical sequence finds its structured home within the Five Gates needling model I teach:

1. Perceiving qi (chaqi): Your initial sensory awareness and observation
2. Guiding qi (daoqi): Your intentional direction of qi with breath and touch
3. Moving qi (xingqi): Your responsive stimulation to initiate flow
4. Obtaining qi (deqi ): Your confirmation of arrival and resonance
5. Stabilizing qi (shouqi): Your final anchoring and integration of the effect

At gate four, you consciously shift from doing to listening. It is here that your technique becomes a relationship. Your needle, no longer a mechanical tool, becomes an instrument of awareness, shaped by your intention and spirit.

Bridging Ancient Wisdom and Modern Science

This clinical sequence of flow and confirmation is not merely a poetic construct; it is directly reflected in distinct physiological events now being mapped by modern science. While classical texts like the Huangdi Neijing Lingshu established the importance of these phenomena,¹ contemporary research provides a modern blueprint for the biological processes that underpin them.

• The Neurosensory Current of Qizhi: The traveling and radiating sensations of qizhi correlate directly with the activation of specific Aδ and C-nerve fibers. Psychophysical studies confirm that this subjective experience generates a complex signal engaging both spinal and central pathways, providing a neurological explanation for the "flow" felt by the patient.²
• The Biomechanics of Needle Grasp (Qizhi): The practitioner's tactile sensation of "needle grasp" has a clear biomechanical origin. Research shows that rotating a needle causes subcutaneous connective tissue and fascial planes to wind around it. This mechanical coupling initiates a cellular signaling cascade known as mechanotransduction, which can propagate along meridians and explains the practitioner's tangible perception of qizhi.³
• The Systemic Confirmation of Deqi: The state of deqi – marked by a deep sigh, emotional release, and a sense of resolution – is mirrored by profound changes in the central nervous system. Functional MRI studies reveal that acupuncture modulates the limbic system, the brain's hub for emotion and memory. This provides a clear neurological basis for the autonomic shift and inner stillness that confirm the therapeutic connection has been made.⁴

From Needle Insertion to Therapeutic Resonance

Too often, acupuncture is reduced to protocols and point prescriptions. The deeper work, however, begins when we shift our focus from treating symptoms to engaging systems; from targeting points to connecting with the person.

• Qizhi flows.
• Deqi confirms.
• Together, they initiate transformation.

Before your next needle insertion, pause and ask: Have I truly sensed the movement of qi? Has the patient affirmed its arrival, verbally or non-verbally? Has resonance replaced resistance in the tissue?

These are not procedural checkboxes; they are gateways into the therapeutic dialogue. When you approach acupuncture as a conversation, rather than a directive, your technique is elevated by mindfulness, and healing unfolds not just from a needle, but through connection.

References

1. Unschuld PU, Tessenow H. (Trans.) Huang Di Nei Jing Ling Shu: The Ancient Classic on Needle Therapy. University of California Press, 2011.
2. Kong J, Gollub RL, Fufa DT, et al. Brain activity associated with the acupuncture sensation of déqì: A psychophysical study. Human Brain Mapping, 2005;24(3):189-199.
3. Langevin HM, Churchill DL, Wu J, et al. Subcutaneous tissue fibroblast cytoskeletal remodeling induced by acupuncture: evidence for a mechanotransduction-based mechanism. J Cell Physiol, 2002;191(3):321-327.
4. Hui KKS, Liu J, Makris N, et al. Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies. Human Brain Mapping, 2000;9(1):13-25.