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The purpose of manipulating acupuncture needles is to obtain qi. Obtaining qi* is to cause the acupuncture needle to elicit the patient's feeling of soreness, numbness, distension, heaviness, or even sensation like an electric shock around the point together with the practitioner's feeling of tenseness around the needle. These feelings of the patient are called needle sensations*, or qi arrival*. Proper and skillful manipulation often promotes qi arrival.

Twirling method* is a type of needle manipulation involving twirling the needle. Twirling is achieved by rotating the needle backward and forward with your thumb, index and middle fingers. Lifting-thrusting method* is another type of needle manipulation involving lifting and thrusting the needle.

Twirling and lifting-thrusting methods are the two basic types of needle manipulation and can be applied individually or in combination. The extent of twirling and lifting-thrusting as well as the frequency and duration depends upon the patient's constitution, pathological conditions and the acupoints being needled.

Under certain conditions, supplementary manipulations* are employed after the insertion of needles. Massage along the meridian* is a method of hastening the arrival of qi, in which the practitioner gives finger massage along the meridian after the needle is inserted. Handle-scraping method* is a type of needle manipulation involving scraping the handle of the needle with a finger nail (Fig. 14-5), an auxiliary method of promoting the needle sensation.

Handle-flicking method* involves flicking the handle of the needle with your finger nail (Fig. 14-6). Handle-waggling method* is a type of needle manipulation involving shaking the handle of the needle (Fig. 14-7) as an auxiliary method of promoting the needle sensation. If the needle is inserted obliquely or transversely, shaking the needle handle can make the needle sensation transmit toward a certain direction. Handle-twisting method* is a needle manipulation involving twisting the handle of the needle in one direction. And trembling method* is manipulation for promoting the needle sensation in which the practitioner lifts, thrusts and twists the needle at a high frequency and small amplitude* to make it tremble.

Fig. 14-5 Scraping the handle of the needle with a finger nail

Fig. 14-6 Flicking the handle of the needle with a finger nail

Fig. 14-7 Shaking the handle of the needle

In addition to the filiform needle, three-edged needle, intradermal needle* and dermal needle* are also frequently used. Three-edged needle is a thick needle with a sharp three-edged tip and the needle is typically used for blood-letting. An intradermal needle is a small needle for embedding* in the skin, such as the thumbtack needle*. A dermal needle is composed of several shot needles used for tapping the points, such as seven stay needle and plum-blossom needle*.

A supplementation method is used to treat a deficiency pattern, in order to activate and restore a decreased function to normal, while draining method is chosen for an excess pattern, to expel pathogenic factors and thus to restore hyperactivity to normal.

In the twirling supplementation and draining method*, rotating the needle gently and slowly with small amplitude after qi arrives is supplementation manipulation, while rotating the needle rapidly with large amplitude is draining manipulation.*The reinforcing effect is obtained by thrusting the needle forcefully and rapidly and lifting the needle gently and slowly, and the reducing effect is achieved by lifting the needle forcefully and rapidly and thrusting the needle gently and slowly in the lifting-thrusting supplementation and draining method*.

Inserting the needle slowly after it reaches the subcutaneous region and withdrawing the needle rapidly is supplementation, while inserting the needle rapidly and withdrawing the needle slowly is draining in the quick-slow supplementation and draining method*. Pressing the insertion hole quickly to close it after the withdrawal of the needle is reinforcing, while shaking the needle to enlarge the insertion hole is reducing, in the open-closed supplementation and draining method*. The needle tip pointing to the direction following the meridian course is reinforcement, while the needle tip pointing to the direction against the meridian course is reduction in the directional supplementation and draining method*. The reinforcement is achieved by inserting the needle when the patient is breathing out and withdrawing the needle when the patient is breathing in, and vice versa, in the respiratory supplementation and draining method*. Neutral supplementation and draining method* is a form of needle manipulation with equal reinforcement and reduction indicated in a case with combined excess and deficiency or no distinct excess or deficiency. In mother-supplementing child draining method*, the points are selected according to the rule of reinforcing the mother in deficiency conditions and reducing the child in excess conditions.