Sicher Nadeln

Akupunkturnadeln können in ungeübter Hand gefährlich sein. Durch unsteriles Arbeiten oder unsterile Nadeln können Krankheitserreger unter die Haut gebracht werden. Des Weiteren können durch nicht fachgerechtes Setzen der Nadeln innere Strukturen und Organe verletzt werden. Der Pneumothorax stellt hierbei das bekannteste und am häufigsten (wobei auch das selten ist) eintretende Problem dar. Die Akupunktur gehört nicht in schlecht ausgebildete Hände. In meinem folgenden Artikel erkläre ich für Studierende die Akupunkturpunkte, bei deren Verwendung man besonders sorgsam sein sollte.

Safe needling

Needling is potentially dangerous and needles applied incorrectly can cause serious damage and death. Dangerous needle points are close to organs, nerves or arteries. It is of paramount importance for acupuncturists to have a concise knowledge of anatomy and develop highly refined palpatory sensitivity.

Points close to Arteries

Ermen (SJ21), Tingong (SI19), Tinghui (GB2) (superficial temporal artery, ear), Renying (ST9) (carotid artery, neck), Chongyang (ST42) (dorsal pedal artery, foot). Jiquan (HE1) (axillary artery) should be needled towards Jianjing (GB21) to avoid the lung and not inserted deeper than 0,5-1cun.

Eyes

At the eyes we find the acupuncture points Chengqi (ST1) Just below the eye and Jingming (BL1) at the medial superior canthus of the eye. Deadman advises that these points should not be needled or manipulated without sufficient training and supervision.

Medulla Oblongata

Fengchi (GB20) should be needled towards yintang, tip of the nose or contralateral eyeball to a depth between 0,5-1cun. A slightly oblique inferior insertion allows needling between 1,0-1,5cun. Deeper needling may lead to unconsciousness or injury to the spinal cord.

Fengfu (DU16) lies directly above the spinal canal which lies at a depth of between 1,5-2cun. Therefore the point should be needled perpendicular and slightly inferiorly to a maximum depths of 0,5-1cun. Deeper needling damages the spinal cord. Yamen (DU15) lies 0,5cun below Fengfu and for Yamen count the same principles as for Fengfu.

Neck

Renying (ST9) and Tianrong (SI17) lie in close proximity to the carotid artery. Needling the artery can result in falling blood pressure and sudden loss of consciousness.

Tianding (LI17) should be needled 0,3-0,5cun deep if perpendicular insertion or 0,5-0,8cun in case of oblique insertion. Carotid artery and jugular vein sit below.

Quishe (ST11) is needled perpendicular at only 0,2-0,3cun. Deeper insertion can lead to penetrating the subclavian vessel or lung. Needling Tiantu (RN22) too deep can lead to injury of the trachea.

Lung

The lung lies about 10-20mm under the skin. The risk of puncturing the lung or the pleural cavity is increased in patients with asthma, emphysema or chronic bronchitis, smokers, cancerlung patients or people who take or have taken corticosteroids. In the above cases the lung and pleural cavity might be enlarged. With needling lung points the right depth and direction of needling are crucial. The lung extends anteriorly to the 8th intercostal space on inspiration and rises into the supra-clavicular fossa. On the mid axillary line the lung reaches the 10thintercostal space on inhalation and on the back, the lung reaches down till the 12thrip.

Most points in the area of the lung are needled in oblique direction to a maximum depths of 0,5-1cun. That counts for back and front.

In the supraclavicular area particular care needs to be taken. Jianjing (GB21) carries a substantial risk of pneumothorax. Quepen (ST12) is needled 0,2-0,3cun perpendicular along the posterior border of the clavicle otherwise the subclavian vessel or lung might get penetrated.

The signs and symptoms of pneumothorax through an acupuncture needle are sudden sharp pain, hacking cough and shortness of breath. The symptoms can occur and worsen till 24 hours after the treatment.

Heart

Burong (ST19) should be needled perpendicular between 0,5-0,8cun. Deeper insertion risks injury of the heart on the left and the liver on the right iherzf the organs are enlarged.

Jiuwei (RN15) is located below the xiphoid process. Insertion is always oblique and in inferior direction. Needling towards the heart is contraindicated. In thin patients be aware of possible damage to an enlarged heart or an enlarged liver.

Symptoms of injury to the heart are severe chest pain, fainting, cyanosis, shortness of breah. The treatment must be stopped immediately and medical assistance sought.

Liver

The Liver is protected by the costal arch but it is still possible to injure the organ. The likelihood is higher via the front. With the points Juque (RN14), Jiuwei (RN15), Rugen (ST18), Burong (ST19), Riyue (GB24) and Qimen (LR14) you can injure a healthy liver. A patient with liver disease (hepatitis etc.) or a liver taxed by lifestyle (drugs, alcohol etc.) can be enlarged and thus be punctured through a much wider number of points.

leber

Zhangmen (LR13) is anterior and inferior to the end of the 11th rib and might lead to the penetration of an enlarged spleen or liver. Zhangmen gets needled along the rib or transverse, but definitely oblique. Take care at the points Juque (RN14), Jiuwei (RN15), Zhongting (RN16), Shanzhong (RN17) in case the patient is one of the 5-8% of people who have a sternal foramen, which is not palpable.

Jingmen (GB25) is at the floating end of the 12th rib. Insertion is perpendicular 0,5-1cun. Deeper insertion or the use of this point in very thin patients may lead to the penetration of the peritoneal cavity.

It is very likely that the liver is injured when the following symptoms occur: Nausea, vomiting, facial pallor, rigid abdominal muscles and pain in the stomach with rebound tenderness. Needles must be removed and the patient must be seen by an A&E.

Gallbladder

The Gallbladder is not a fixed organ in the body. It moves in relation to the posture of the patient. The Organ is relatively well protected but might be injured through deep needling of one of the following points: Burong (ST19), Chengman (ST20), Ryue (GB24), Zhangmen (LR13), Quimen (LR14).

Injury to the gallbladder results in leaking of bile. First symptoms usually occur 10 minutes to 6 hours after treatment but can take up to 2 days. Patients would complain about right upper abdominal pain that travels towards the right shoulder and/or scapula and nausea. The infection that results from the leaking bile will lead to fever, serious abdominal pain with tightness of the muscles in the region, tachycardia and fast shallow breathing.

The patient must be send to A&E.

Spleen and small intestines

Both are structures that are relatively hard to puncture with a needle.

The Spleen is on the left side of the abdomen and following points are in the region: Liangmen (ST21), Fuai (SP16), Zhangmen (LR13), Jingmen (GB25). An enlarged spleen can extent to Burong (ST19), Rugen (ST20), Daheng (SP15).

The symptoms of spleen and small intestine injury are similar and show nausea, vomiting, severe pain, a tightening and guarding by the abdominal muscles, pallor, and falling blood pressure.

Bladder

Maximal care needs to be taken with the points Qugu (RN2) and Zhongji (RN3).

The patient should always be asked to empty his bladder before treatment. In case of urinary retention the following points are also dangerous:

Guanyuan (RN4), Shuidao (ST28), Guilai (ST29), Henggu (KD11), Dahe (KD12), Qixue (KD13).

Stomach

Stomach injury is rare but possible if the stomach is full because of a big meal (stomach stretches then down to the umbilicus) or the stomach lining is weakened through ulcers or gastritis. Following points are relevant: Shangwan (RN13), Zhongwan (RN12), Jianli (RN11), Futongu (KI20), Yindu (KI19), Shiguan (KI18), Shangqu (KI17), Chengman (ST20), Liangmen (ST21), Guanmen (ST22), Taiyi (ST23), Fuai (SP16).

Symptoms of a punctured stomach occur 10-20 minutes after treatment. The patient will have very strong abdominal pain, vomiting and contracted abdominal muscles.

Kidney

The kidney is reached the easiest via the back. Dangerous points that lie above are: Sanjiaoshu (BL22), Shenshu (BL23) and Huangmen (BL51), Zhishi (BL52).

Pain on touch radiating up to the scapula and blood in the urine visible to the naked eye are the symptoms in case of injury. Patient must be sent to A&E.

Contraindications Pregnancy

Jianjing (GB21) and Quepen (ST12) are contraindicated for pregnancy.

Only needle Sanyinjiao (SP6), Hegu (LI4) and Kunlun (BL60) to induce labour. Zhiyin (BL67) should only be used in pregnancy after the 32nd week to turn a breach baby. The lower back and the lower abdomen of a pregnant woman must not be needled. Electroacupuncture should not be used in the first trimester of pregnancy. (Mayor, 2007, p.333).

Contraindications Electroacupuncture

Electrical stimulation is dangerous on points around lung because of the weight of the electrical connector. Electroacupuncture should not be applied around the heart or used on people with pacemakers. Not on the lower belly or back of a pregnant woman. Not around the carotid sinus, or close to the trachea. EA should not be used in undiagnosed sprain and possible fracture. EA should be avoided in people with high blood pressure, epilepsy, spinal cord injury above T8, unexplained pain or swelling and lymphectomy. Some sources say all forms of acupuncture shouldn’t be applied after lymph node removal.

Contraindications Moxabustion

Yamen (DU15) (Gate of muteness) is contraindicated for moxabustion.

Moxibustion is not to be used on patients that show signs of heat or patients with febrile disease. It should not be use around the upper and lower orifices, on the lower back or belly of a pregnant woman, not around mayor joints, the breasts and big blood vessels and take care with unconscious patients.

Contraindications Cupping

Cupping should not be used on broken or inflamed skin, scars, varicose veins and patients that show in general signs of heat or empty heat. Patients with inherited bleeding disorders, severe oedema, malignant tumours, and diseases of heart or liver or tuberculosis patients should not be treated with cupping. The points that should not be needled on a pregnant woman should also not be cupped on a pregnant woman. Extreme thin, weak or hairy patients should not be cupped as well as the areas with unflexible skin.

Needle shock

Needle shock is a syndrome that results in the patient feeling general malaise, nausea, vomiting, cold sweats, anxiety and may lead to fainting. Some practitioners consider it to be a big shift of energy and a positive sign in the treatment process. The general recommendation is to remove all needles, bring the patient into a stable position, stimulate Renzhong (RN26) if patient is unconscious, talk him or her down and make the patient comfortable.

Safe practice guidelines
  • Palpate for arteries.
  • Be aware of the presence of foramen when needling bony structures.
  • Check the patients build and apply the right cun measures.
  • Check the abdominal fat of the patient through the pinching test and do not insert needles deeper than half the thickness.
  • Do not treat patients that are hungry, have over eaten or are very weak.
  • Be always aware of the risk of puncturing an organ if it is enlarged.

 

References:

Grant, A. Prof. Bo-Ying Ma. (2003) The Safe Use of Difficult and Dangerous Acupuncture Points. Journal of Chinese Medicine. 72 (6).

Deadman, P. Al-Khafaji, M. Baker, K. (2002) A Manual of Acupuncture.

Journal of Chinese Medicine Publications. Opened on the 14.1.13: http://www.chinesemedicinetimes.com/free%20files/Running%20a%20Safe%20and%20Successful%20Acupuncture%20Clinic.pdf

Mayor, D. (2007) Electroacupuncture. A practical manual and resource. Philadelphia: Churchill Livingstone.

Greenwood, M. (2005) Needle Shock: Adverse Effect Or Transformational Signal. Paradox publishing. Available at: https://www.paradoxpublishing.com/assets/files/publications/articles/aama/vol-16-1-needle-shock.pdf

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