order: L.I.-4 Hegu, P-6 Neiguan, Ren-11 Jianli, ST-36 Zusanli.
If an Empty condition is being treated and the patient's pulse is very Weak and Fine, a different
approach could be used whereby the needles are inserted from bottom to top. This has a
reinforcing effect on Qi and causes a rush of Qi upwards much like a container of water being
filled from the bottom. In this case, however, the needles should be inserted with a longer
interval between each other, say about 1-2 minutes. The time gap between each needle's insertion
is important as the patient might otherwise develop a headache. For example, if a patient is being
treated for a Deficiency-type Stomach condition one could insert the following points in this
order: SP-6 Sanyinjiao, ST-36 Zusanli, Ren-12 Zhongwan and L.I.-4 Hegu.
However, this is not to say that inserting needles from top to bottom has an automatic reducing
effect.
Another exception to the rule of inserting needles from top to bottom is when a distal point is
used first to clear obstructions from a channel in acute cases. This technique makes use precisely
of the above-mentioned upward rush of Qi to remove obstructions from a channel. For example,
in acute sprain of the shoulder joint, the distal point ST-38 Tiaokou is needled first and
manipulated vigorously to clear stagnation from the shoulder channels. Other points are inserted
later.
Order of Withdrawal of Needles
In general, needles are withdrawn from top to bottom, but the order of withdrawal may be
changed according to Fullness or Emptiness.
In Full conditions characterized by Qi rebelling upwards or stagnating horizontally, it is best to
withdraw needles from top to bottom: this has the effect of promoting the downward flow of Qi.
Examples of conditions characterized by Qi rebelling upwards are cough (Lung-Qi rebelling
upwards), hypochondrial pain (Liver-Qi stagnating horizontally), severe giddiness (Liver-Qi
rebelling upwards), etc.
In Empty conditions, especially those characterized by sinking of Qi, it is best to withdraw the
needles from the bottom towards the top: this has the effect of promoting the lifting of Qi.
Examples of conditions characterized by sinking Qi are prolapses and severe Qi deficiency with
a dragging-down feeling. For example, if a patient is being treated for severe exhaustion, mental
depression and a dragging-down feeling, one might select Du-20 Baihui to raise Qi, Du-26
Renzhong, P-6 Neiguan, ST-36 Zusanli and KI-3 Taixi. Needles should then be withdrawn from
the bottom starting with KI-3 and finishing with Du-20.