When the needle is inserted the acupuncturist must be aware of the underlying tissues and organs. When a needle is being used on a point that is over the lung it must be inserted obliquely to avoid the danger of a pneumothorax. Common sense and a knowledge of basic anatomy should avoid any untoward accidents. The needle must also be sterilized properly so that there is no possibility of transmitting serum hepatitis.

It is important to remember that the piece of skin into which you insert the needle is relatively unimportant as long as the needle stimulates the acupuncture point. The needle for Shenmen (H 7) can be inserted in several different ways but the acupuncture point has been stimulated only if the needling sensation is felt. The actual acupuncture point is always underneath the skin, and it may be an inch or more deep to the dermis. The best method of knowing that you have stimulated an acupuncture point is to obtain deqi over that point. This means that the tip of the needle is the best point locator that the acupuncturist has at his disposal.

Stimulation of the Needle
Deqi
Deqi means needling sensation. This sensation is difficult to describe unless you have actually felt it; it is not pleasant though it is not painful. Deqi is slightly different for each point. Points on the head usually have a burning or pricking sensation, whereas points on the limbs usually have a bursting, sore, full or numb sensation when they are stimulated. The needling sensation can travel up or down the channel.

The needle is stimulated by a perpendicular and rotary movement, lifting and thrusting the needle whilst it is being rotated. The only way to become competent at obtaining deqi is to practice

Unless the acupuncturist obtains deqi over each acupuncture point used then the acupuncture point has not been stimulated, and this means that the acupuncture is of questionable value.

Electrical stimulation
It is impossible to be dogmatic about the use of electrical stimulation as so much work is being done in this area at the moment. The Chinese are not the best people to give a clear picture of the use of stimulators. In general the stimulator is used in anaesthesia and when it is used therapeutically it is used for conditions of severe pain, acute conditions, scalp acupuncture, and conditions where ordinary needling has failed. The Chinese do not use it very much for treating disease.

Manual stimulation
The reducing method is used in acute or shi diseases, and the reinforcing method is used in chronic or xu diseases. Strong stimulation is approximately equivalent to the reducing method and weak stimulation is roughly equivalent to the reinforcing method. This is all dependent on the individual as strong stimulation of a sensitive patient may be equivalent to weak stimulation of a less sensitive person. In weak stimulation the manipulation of the needle should be stopped as soon as the patient feels deqi, in strong stimulation the needle should be stimulated until the needling sensation is intense.

Reactions
If a patient is overstimulated then this may cause a temporary worsening of the condition. This is transitory and indicates a response to acupuncture. If this occurs then stimulate less forcefully next time.