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1 BEFORE WE BEGIN: NOTES FOR MODULES I & II A REMINDER ON BASIC NEEDLING SENSATIONS Please remind yourself and review the Eight Basic Sensations we are looking for when needling: 1. A sensation of awareness or awakening at a location other than where the patient is being needled: the practitioner and patient are often pleased or surprised at the magic of acupuncture when this happens, particularly if the location of the sensation is unexpected, far away from the injury, and apparently unrelated to it. While this certainly occurs during ashi treatment, and is often felt in the area perceived to be injured, be aware that this can give false information. A distal sensation can be due to proper awakening of the channel and tendochannel, but it can also be the patient involuntarily tensing, shifting or holding themselves in awkward ways, causing them to be aware of other areas of their body. 2. A spiderweb sensation from the epicenter of the ashi point outwards in all directions: this is useful, especially when treating the upper back, shoulders, scapula or anywhere else where there are a large number of tendo-muscles connecting, overlapping or intertwining. In this way, successfully needling an ashi point can awaken and reinvigorate the qi and blood throughout a number of lesser ashi points, particularly those that are small but very painful or hard upon palpation. 3. A sensation of electricity up or down a specific pathway can be very important in certain situations. Not only does this fully awaken the qi along the pathway, but it is also the most important tool in chasing secondary stagnation i.e. cold or damp blockage, wei or bi syndromes that happen opportunistically due to the injury - out of the pathway. However, an electric sensation by itself without also creating throbbing, achiness or fasciculation is unlikely to cure the problem and may only provide temporary relief that then disappears after a few days. 4. Throbbing at the point means that the flow of blood has been increased in the area. This can be very important in large muscles and thicker parts of the tendomuscular channels, or when the ashi point is a small lump within a specific layer of a tendo-muscle, but is not

2 affecting all of its layers. This needle sensation is often then retained for a few minutes by further stimulation in order to maximise circulation in the area. 5. A sensation of fullness is always a good sign, and often the best strategy when dealing with patients who require gentle treatment. However, with stronger patients or when treating serious injuries, eliciting a sensation of fullness is rarely successful by itself. 6. A sensation of heaviness, like fullness, is always a good sign but again is rarely enough with stronger patients or with serious injuries. The most important result of heaviness is that it means that the area is no longer stuck in a holding pattern of tension and resistance, but has relaxed to a place where healthy qi and blood flow is possible. 7. Achiness, like fullness and heaviness, indicates a low level of qi and blood flow that is important in terms of healing weaker patients, but rarely enough for stronger ones. The greatest function of achiness is that it forces the body and mind to acknowledge a particular area, and thus begin repairs. 8. Fasciculation is frequently the most important treatment method in ashi work. The twitch and spasm of the muscle literally pushes and courses the qi and blood through the point and pathway. While it is tempting for the practitioner to see fasciculation as a validation of correct needling, I again caution against the belief that it is necessary to achieve at every insertion and with every patient. In a situation where bi or wei have settled in, fasciculating the ashi point without also producing a traveling sensation (warmth, movement, electricity, for example) down the pathway to create flow, from and through the injury often produces a painful treatment with low success. Acupuncture is Chinese medicine, and in Chinese medicine qi leads the blood. Fasciculation primarily addresses the blood aspect of an injury and physically lengthens the pathway to release the tension vectors involved, but does not necessarily address the numerous secondary problems that happen as a result of qi no longer flowing smoothly through the pathway. This illustrates the point that ashi needling must be included in the context of a correct Chinese medical diagnosis in order for treatment to be truly successful.

3 BASIC PATIENT REACTIONS TO NEEDLING SENSATIONS 1. Warmth 2. Coolness 3. Strong Heat or Burning 4. Cold or Freezing 5. Feeling energized and invigorated 6. Feeling energized but tired 7. Feeling purged but energized from the clearing 8. Feeling purged and sedated from the clearing 9. Feeling relaxed, meditative, or transported to an internal state 10. Feeling agitated, aggressive or transported to an external state

4 TERMS I WILL BE USING There will be terms I will be using frequently, so I want to review what they mean and what I am referring to. My learning of these terms was done in an internship framework over years and years, not in a textbook course with set definitions that end up falling short in the clinic. Thus, these terms are being used 'relatively' and have broad meanings and applications like the term Qi, for instance. Traction This will most likely be one of the most common things we are doing with our hands. Most of the time it is the creating of space by the lengthening of the skeletal system. That is, we are holding the skeletal system at a specific location and lengthening our contact so that we are 'pulling' through the length of the bones and the joints they pass through in a continuous connection. This does have the Yin within Yang aspect, thus sometimes traction is done by compacting the skeletal system to create connection through the bones and joints. Traction is critical to creating connected pathways at the Earth or Skeletal layer so that Opening, Dispersing, Raising or Lowering, Entering or Exiting can happen. Creating Space This is a term we will be using frequently when addressing joints and compactions creating pain or loss or ROM. Traction creates space, but Space is often created in specific areas instead of lengths. Creating Space is sometimes also referring to relaxing tension and unintentional contraction in the patient's chest or lower back/pelvis to encourage flow and return of good Qi. Without Space, bad Qi created at the site of injury cannot Exit, nor can good Qi Enter. Thus, it is not Open, but the Closing is such that things are closed out instead of closed in. With Space, Opening, Closing, Gathering, Dispersing, Raising, Lowering, Entering & Exiting can happen. Note that Space is not the same thing as Flaccidity, which is Tuo in Chinese. Gathering This may become confusing occasionally, as it is both a Function of Qi and a term used somewhat akin to Filling. Gathering is a very tonifying and enlivening technique done gently

5 ALWAYS ASK OR TAKE INTO ACCOUNT On top of our intake using the Four Diagnostic Techniques, when treating physical injuries we always doubly focus on the following: 1. Age, vitality and strength of Qi of the patient overall 2. Strength of Qi at the moment of treatment 3. Condition of the Shen overall and at the moment of treatment 4. Pulse for any unsuspecting You Yu or Bu Zu 5. Tongue to assess Yin Damage and/or Weakness of spleen 6. If Female, be clear if they are near, on or just finishing their menses 7. Women are more Blood, thus are more prone to stasis of Blood post treatment 8. Men are more Qi, thus are more prone to scattering of Qi during treatment 9. If expecting a strong treatment, check what their afternoon is and/or how they are leaving your clinic 10 If expecting a deep treatment, check how they are leaving your clinic ALSO Patient Education before treatment on what to expect Patient Education post treatment on what to expect

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