Needle insertion method is the technique of inserting the needle through the skin, while needle retention refers to retaining the needle in the point for a period of time to maintain and prolong the needling effect.

Clinically, most acupuncturists like to use both hands to insert acupuncture needles, which is called double-handed needle insertion. The practitioner's hand that inserts the needle is known as the needling hand. The practitioner's hand that presses the puncturing area is known as the pressing hand.

Fingernail-pressing needle insertion* is a two-handed needle insertion technique involving the application of pressure with a single nail. Press the skin close to the acupoint with the nail of the thumb or the index finger of the left hand, hold the needle with the right hand and keep the needle tip close against the nail. Then insert the needle into the acupoint, as illustrated in Fig. 14-1.

Hand-holding needle insertion* is another two-handed needle insertion technique whereby the thumb and index finger of the pressing hand hold a sterilized cotton ball with which the shaft of the needle is wrapped. Keep the needle tip on the skin surface of the acupoint and then insert the needle into the skin with both hands (Fig. 14-2). This method is more practical for puncturing with long needles.

Skin-spreading needle insertion* is a needle insertion technique whereby the skin is stretched to facilitate needle insertion. Where the acupoint is located, stretch the skin with the thumb and the index finger of the left hand, hold the needle with the right hand and then insert it into the area between the two fingers. This method is appropriate for puncturing the acupoints located on regions with loose skin.

Pinching needle insertion* means to insert the needle with the right hand while the left hand pinches and lifts the flesh. This method is suitable for puncturing acupoints where the muscles are thin.

Most of the time, both hands are used for inserting a needle into the body. Occasionally, acupuncturists only use one hand to insert a needle, which is called single-handed needle insertion*.

Some acupuncturists in many countries other than China like to use a fine tube as a guide when they insert needles (Fig. 14-3).

Needle insertion has an angle, and using the proper angle ensures the best treatment effect. The angle of needle insertion refers to the angle formed between the shaft of the needle and where the skin is punctured (Fig. 14-4). Needle insertion at a 90° angel to the skin is called perpendicular; needle insertion at a 15° angle to the skin is named transverse insertion; and needle insertion at a 45° angle to the skin is known as oblique insertion.*

Needle retention* can strengthen needling effect. Needles are usually retained in the body for about 10-20 minutes. During this time, manipulating the needles at intervals can promote the therapeutic effects.

All needles have to be withdrawn when the therapeutic effect has been achieved. Press the skin around the acupoint slightly with a sterilized* dry swab*, rotate the needle handle gently and lift it slowly to the subcutaneous* level, then withdraw the needle quickly and press the needle hole with a sterilized dry swab to prevent bleeding.