Treatment with abdominal acupuncture shares a conceptual framework similar to that of herbal prescriptions. Instead of using a single point for treatment, a complete abdominal point prescription may comprise up to four fundamental types of points, each serving a distinct role and significance in the therapeutic process. These points are referred to as Jun, Chen, Zuo, and Shi and are commonly known as Chief, Deputy, Assistant, and Envoy points, respectively.

Many well-known point combinations have been developed to achieve specific therapeutic effects. In some cases, only points from one or two categories (Chief, Deputy, Assistant, Envoy) may be utilized in a prescription. Some example protocols for common patient conditions are included below for your reference.

Explore Example Protocols

To perform an abdominal acupuncture treatment, in a nutshell, a practitioner first lightly taps the needles in for all the points in a prescription, takes a short break, and then returns for a second round to adjust each needle to stand upright at the proper depths to work their magic. Accuracy in locating the points and needling the correct depths are the keys to successful treatment outcomes. Read below for technical guidelines critical for an effective abdominal acupuncture treatment.

Points Are Needled in a Specific Order

Abdominal acupuncture treatment works by regulating the flow of qi through the meridians in the abdomen to address various illnesses and imbalances. Since the meridians function in an orderly manner, the regulation of the meridian energy should follow its flow for optimal effectiveness. Therefore, the abdominal needling process adheres to a specific sequence:

As a general rule of thumb, needle insertion is performed on points from the midline outward and from top to bottom. It's essential to follow this sequence when manipulating the needles for optimal results.

Needling Depth Determines the Therapeutic Effects

The depth of needling in abdominal acupuncture has a direct impact on its therapeutic effects and is crucial for achieving the desired treatment outcome. By adjusting the needle insertion depth at specific points, the same set of prescribed points can be used to treat various conditions.

Abdominal needling depth is categorized into Heaven, Man/Humanity, and Earth. These three levels map to the shallow, medium, and deep insertion depths, respectively, and the exact corresponding depths of these three levels are personalized for each patient based on their proportions and the skin thickness around their abdomen.

The Heaven Level: Shallow Needling

The Heaven level sits close to the skin's surface. It is primarily utilized for pain management and symptomatic relief.

The Heaven level is further distinguished into the top and bottom layers. Use the top layer to treat the front of the body, peripheral, acute, or painful conditions related to muscles and bones. Use the bottom layer to treat the posterior side of the body or the bones. Because different needling depths address different issues, avoiding needling deeper than needed is crucial.

The Man/Humanity Level: Medium Needling

The Man/Humanity level sits below the Heaven level, reaching the subcutaneous fat. Needling at this depth treats problems with the channels and collaterals.

The Earth Level: Deep Needling

Below the Man level sits the Earth level, reaching the muscle layer. Needling to this depth treats zang fu disorders.

Utilize Visuals on Patient Chart as Needling Depth Reminders

For beginners, it is not trivial to remember the different needling depths required for each prescribed point in a treatment. One helpful tip is using notations on the patient chart as visual reminders for each point's correct needling depths. For example, you can mark the Chief points in red and the Deputy and Assistant points in blue to indicate that these points require deep and medium needling, respectively. Similarly, you can also notate a point with "D" for deep needling at the Earth level, "M" for medium needling at the Man/Humanity level, and "S" for shallow needling at the Heaven level.

Slow and Gentle Needling to "De Qi"

"De Qi" in abdominal acupuncture is achieved through the following three stages:

Abdominal needling is applied slowly and gently, without the need for repeatedly inserting and pulling out the needle to stimulate a point, which is a typical "De Qi" practice in body acupuncture. In abdominal acupuncture, inserting needles to the appropriate depth is sufficient to activate qi without additional manipulation.

It is important to note that the strength of abdominal stimulation, just like needling depth, determines the effect of needling. Mild stimulation tonifies, while strong stimulation sedates. Therefore, it is critical to apply the correct amount of stimulation to achieve the intended effect, as overstimulation can lead to the opposite outcome. Moxibustion can also be used to the needled points to supplement the tonifying effect.

Abdominal acupuncture is indicated for many chronic disorders, and since chronic patients tend to be deficient and more likely need tonifying, mild needle stimulation is utilized much more often than strong stimulation in abdominal acupuncture.

Choosing the Needle Size

Abdominal acupuncture typically uses 32 gauge needles that are 1 to 1.5 cun in size. For safety and better control over needling, all the needles used for a particular patient should be the same size.

Caution & Contraindications

While applying abdominal acupuncture, it is essential to avoid puncturing deep into the abdomen, vessels, or organs. In addition, abdominal acupuncture is contraindicated for the following patients:

• Patients with acute abdominal disorders or cancer
• Patients with acute peritonitis, splenomegaly, or hepatomegaly with visible veins (for patients with hepato- or splenomegaly, shallow needling around the rib area is recommended instead)
• Extremely deficient patients or post-surgical patients
• Pregnant women

Before performing an abdominal acupuncture treatment, practitioners should comprehensively observe and evaluate a patient's abdomen to rule out any contraindicated conditions. This assessment can also help the practitioner to locate the acupoints in a prescription better and fine-tune the point combinations and the required depth of needle insertion for each point.

Step 1: Needle the Primary Points

A prescription typically contains 1 to 4 of the following as the primary (Chief) points. As the first step in abdominal acupuncture treatment, tap the needles into position at all the prescribed primary points, starting from points on top and working towards the bottom. In Step 4, you will return to adjust the depths of these needles.

• Zhongwan (CV 12) - Tonify the Sp/St
• Xiawan (CV 10) - Tonify the Sp/St
• Qihai (CV 6) - Tonify the Kd
• Guanyuan (CV 4) - Tonify the Kd

Different combinations of these points are used to achieve diverse effects:

• Zhongwan (CV 12) + Guanyuan (CV 4): effectively tonify the Spleen and the Kidney
• Xiawan (CV 10) + Guanyuan (CV 4): harmonizing the Stomach and reinforcing the Spleen
• Zhongwan (CV 12) + Xiawan (CV 10): can address a broader range of gastrointestinal disorderswith better effectiveness than using either point alone

Step 2: Needle the Secondary Points

Tap the needles into position at all the prescribed secondary (Deputy and Assistant) points. For points on the same vertical line, start needling from the top and work towards the bottom. For points on the same horizontal line, start needling from the midline and move outward. In Step 4, you will return to adjust the depths of these needles.

The following points are often included in a prescription as the Deputy or Assistant points to serve different therapeutic functions:

• Tianshu (ST 25) - Add this point if a patient also has digestive disorders.
• Daheng (SP 15) - Add this point to address disorders involving muscles or to enhance the harmonization of the Middle jiao, ease pain, and eliminate dampness.
• Huaroumen (ST 24) & Wailing (ST 26) bilaterally - add this combination (a.k.a. " the Abdominal 4 Gates") to move more qi and blood.
• Qixue (KI 13) - Add this point on the healthy side to move qi in the lower jiao to treat lower body problems.
• Shangqu (KI 17) - Add this point on the healthy side to move qi in the upper jiao to treat upper body problems.

Step 3: Needle the Supporting Points

To locate the supporting (Envoy) points, palpate the abdomen in the area that images the patient's problem to identify any nodes, grain-like sensations, bubbles, or ashi points, then tap the needles in. Use up to three needles for a specific location if needed. In Step 4, you will return to adjust the depth of these needles.

When treating pain, the following can be used as an Envoy point to open channels and collaterals to relieve bi zheng (painful obstruction syndrome):

• AB 1 Elbow (Upper Rheumatism point)
• AB 4 Knee (Lower Rheumatism point)

Step 4: Adjust Needle Depths

After all needles are in position, take a short break of 3-5 minutes for the qi to arrive at the insertion sites (Stage I: Waiting for Qi / "Hou Qi"). Then, in the same order as the insertions, adjust each needle to stand upright from the abdomen at the appropriate depths (Stage II: Activating Qi / "Xing Qi").

Refer to each point in the prescription for the recommended insertion depth(s) for treating different conditions. The table below summarizes a general guideline for the needling depths by point type. The exact depths of the Heaven, Man, and Earth levels are scaled based on each patient's height and weight.

The process described above applies a mild stimulation for tonification at the inserted points. Moxibustion can be added to supplement the tonifying effect. To apply a stronger stimulation for sedation, add gentle stimulation in clockwise and counterclockwise rotations, maintaining the insertion depths and the upright standing of the needles.

Step 5: Remove the Needles

Let the needles stay in and work for 20-30 minutes before removing them. Typically, this duration is shorter for chronic or weaker patients and longer for acute conditions or patients with more robust constitutions.

Slowly remove the needles in the same order as the insertions. Do not stimulate the point again or insert the needle further during this process. Apply a dry cotton ball to add pressure to a point after needle removal.

Below are some examples of abdominal point prescriptions. Click on a condition below to expand the tab and view the abdominal points prescribed for the treatment.