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Qistr; :General
" Englishfcnly
"Akupunkturkurse in Peking - Klinische Praxis & Theorie', Büro Deutschland: Andreas
Rinnößel - D-78713 Schramberg - Tel.: 07422 /21665 ­ Fax: 07422 / 21699
viNi/chiatcde - Diese VVHO Guidelines Wurden heruntergeladen ¿von der l-lornepagewmîyff»î '

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Section I: Basic training in acupuncture
This would bring under Control the situation, current in certain industr'

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Section I: Basic training in acupuncture
0 Alphanumeric codes and names, classifications of points, direction
and depth of insertion of needles, actions and indications of the
Commonly Used Points selected for Basic Training.
3. Applications of acupuncture in modern Western medicine
0 Principal clinical conditions in which acupuncture has been shown to
be beneficial.
° Selection of patients and evaluation of progress / benefit.
¢ Planning of treatment, selection of points and methods of needle
manipulation, and use of medication or other forms of therapy
concurrently with acupuncture.
4. Guidelines on safety in acupuncture
5. Treatment techniques
0 General principles.
° Specific clinical conditions.
On completion of the course and after passing an official examination,
participants should be able to integrate acupuncture into their clinical
work or speciality.
7.2 Special courses
Some physicians or dental surgeons might wish to acquire proficiency in certain
specific applications of acupuncture (for example, pain relief, or dental or
Obstetric analgesia) and for them flexibility would be needed in designing special
courses adapted to their particular areas of interest.
7.3 Advanced training
Physicians or other health personnel who have satisfactorily completed a "short"
course of basic training might wish to pursue their training at an advanced level,
in which case suitable courses would have to be "tailor-made" to meet their

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Guidelines on basic training and safety in acupuncture
8. Limited training in acupuncture for
primary health care personnel
The introduction of "acupuncture" into primary health care at community level
would require the training of a considerable number of personnel over a short
period, if it is to have a demonstrable effect. This would probably strain the
teaching and supervision resources of the country concerned.
It would seem wiser, in such cases, to train such personnel in acupressure (Zhi-ya)
rather than in acupuncture itself. Training in acupressure would make no great
demands, could be incorporated into the general training of primary health care
personnel, and would carry no risk to the patient. The use of acupressure in
primary health care would have to be evaluated after a suitable trial period.
Some personnel who show particular aptitude might be chosen for basic training
in acupuncture, a training programme being arranged according to the
applications envisaged.
9. Selected acupuncture points for basic
Participants at the WHO Consultation on Acupuncture at Cervia, Italy in 1996
drew up a list of Commonly Used Points suitable for inclusion in basic training
courses. rIhese were selected from the document A Proposed Standard International
Acupuncture Nomenclature: Report of a WHO Scientific Group (WHO, Geneva, 1991).
As may be seen from the table below, the selection includes 187 of the 361
classical points, and 14 of the 48 extra points. Thus, the basic training courses for
the categories of personnel described lay emphasis on the use of only 201 of a
total of 409 points.
The guidelines on safety, which follow, mention certain points as being
potentially dangerous and requiring special skill and experience in their use.
Some of these are included in the selection of Commonly Used Points, and
attention is drawn to this fact.

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Section I: Basic training in acupuncture
10. Selected points for basic training in
ac u p u nctu re
Meridians, vessels Standard international2 Selected points3
and eXtra POÍIIÍS acupuncture nomenclature for basic training
Lung 11 6
Large intestine 20 12
Stomach 45 25
Spleen 21 11
Heart 9 5
Small intestine 19 13
Bladder 67 34
Kidney 27 8
Pericardíum 9 7
Triple energizer 23 12
Gallbladder 44 20
Liver 14 8
Governor vessel 28 13
Conception vessel 24 13
Sub-total 361 187
Extra points 48 14
Total points 409 201
Standard International Acupuncture Nomenclature, Report of a WHO Scientific Group
(WHO, Geneva, 1991).
3 Selected by participants at the WHO Consultation on Acupuncture, Cervia, Italy, 1996.

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Guidelines on basic training and safety in acupuncture
Selected from:
A Proposed Standard International Acupuncture Nomenclature
Report of a WHO Scientific Group
(WHO, Geneva, 1991).
Lung meridian (LU)
LU 1 zhongŕu LU 7 kongzui LU 10 yuji
LU 5 chíze LU_9 taiyuan LU 11 shaoshang
Large intestine meridian (LI)
LI 1 shangyang LI 7 Wenliu LI 14 binao
LI 3 sanjian LI 6 pianli LI 15 jianyu
LI 4 hegu LI 10 shousanli LI 18 ŕutu
LI 5 yangxi LI 11 quchi LI 20 yingxiang
Stomach meridian (ST)
ST_1 Chengqi ST 21 liangmen ST 36 zusanli
ST 2 sibai ST 25 tianshu ST 37 shmgjuxu
ST 3 juliao ST 27 daju ST 38 tiaokou
ST 4 dicang » ST 29 guilai ST 40 fenglong
ST 5 daying ST 31 biguan ST 41 jiexie
ST 6 jiache ST 32 futu ST 42 chongyang
ST 7 xiaguan ST 34 liangqiu ST 44 neiting
ST 8 touwei ST 35 dubi ST 45 lidui
ST 18 rugen
Spleen meridian (SP)
SP 1 yinbai SP 5 shangqiu SP 10 xuehai
SP 2 dadu SP 6 sanyinjiao SL11 jimen
SP 3 taibai SP 8 diji SP 15 daheng
SP 4 gongsun SP 9 yinljngquan
Heart meridian (HT)
HT 3 shaohai HT 7 shenmen HT 9 shaochong
HT 5 tongli HT 8 shaofu
Small intestine meridian (SI)
SI 1 shaoze SI 9 jianzhen SI 17 tianrong
SI 3 houxi SI 10 naoshu SI 18 quanliao
SI 4 wangu SI 11 tianzong SI 19 tinggong
SI 5 yanggu SI 12 bingfeng
SI 6 yanglao SI 14 jianwaishu
NOTE: Alphanumeric codes which are in bold and underlined are mentioned in the
Guidelines on Safety as being potentially dangerous and requiring special skill and
experience in their use: LUS, SI_1, SIlll, ELL GBUS, Qlló, CÄLZZ

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Section I: Basic training in acupuncture
Bladder meridian (BL)
BL_1 jingming BL 21 weishu
BL 2 cuanzhu BL 22 sanjiaoshu
BL 7 tongtian BL 23 shenshu
BL 10 tianzhu BL 25 dachangshu
BL 11 dazhu BL 28 pangguangshu
BL 12 fengmen BL 31 shangliao
BL 13 feishu BL 32 ciliao
BL 15 xinshu BL 33 zhongliao
BL 17 geshu .BL 34 Xialiao
BL 18 ganshu BL 36 chengfu
BL 19 danshu BL 40 Weiyang
BL 20 pishu BL 43 gaohuang
Kidney meridian (KI)
KI 1 yongquan KI 5 shuiquan
KI 2 rangu KI 6 zhaohai
KI 3 taixi Kl 7 fuliu
Pericardium meridian (PC)
PC 3 quze PC 6 neiguan
PC 4 ximen PC 7 daling
PC 5 PC 8 laogong
Triple energizer meridian (TE)
TE 1 guanchong TE 5 waiguan
TE 2 yemen TE 6 zhigou
TE 3 zhongzhu TE 9 sidu
TE 4 yangchi TE 13 naohui
Gall bladder meridian (GB)
GB 1 tongziliao GB 24 riyue
GB 2 tinghui GB 25 jingmen
GB 8 shuaigu GB 29 juliao
GB 12 wangu GB 30 huantiao
GB 14 yangbai GB 31 fengshi
GB 20 fengchi GB 33 xíyangguan
GB 21 jianjing GB 34 yanglingquan
Liver meridian (LR)
LR 1 dadun LR 4 zhongfeng
LR 2 xingjian LR 5 ligou
LR 3 taichong LR 8 ququan
BL 52
BL 58
BL 60
BL 62
BL 65
BL 67
KI 9
LI 10
TE 14
TE 17
GB 37
GB 39
GB 4()
GB 41
GB 43
GB 44
LR 13
LR 14

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Guidelines on basic training and safety in acupuncture
13. Governor vessel (GV)
GV 1 changqiang GV 13 taodao
GV 3 yaoyangguan GV 14 dazhuí
GV 4 mingmen GÃLIE yamen
GV 9 zhiyang GV 16 fengfu
GV 12 shenzhu
14. Conception vessel (CV)
CV 3' zhongji CV 10 xiawan
CV 4 guanyuan CV 12 zhongwan
CV 6 qihaí CV 13 shangwan
CV 8 Shenque CV 14 juque
CV 9 shuifenÍ
15. Extra points EX-HN 1 sishencong EX­I­1N4 yuyao
EX-HNß yintang EX-HNS taíyang
EX-UE 7 yaotongdian EX-LE 4 neixiyan
EX-UE 9 baxie EX-LE 6 dannang
EX-UE 10 sifeng EX-LE 7 1anWei
EX-UE 11 shixuan EX-LE 10 bafeng
GV 23
GV 25
GV 26
CV 17
CV 23
CV 24
EX-B 1
EX-B 2
* HN Head and neck; B Back; UE Upper extremities; LE Lower extremities.

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Section II: Safety in acupuncture
Section II:
Safety in acupuncture
In competent hands, acupuncture is generally a safe procedure with few
contraindications or complications. Its most commonly used form involves
needle penetration of the skin and may be compared to a subcutaneous or
intramuscular injection. Nevertheless, there is always a potential risk, however
slight, of transmitting infection from one patient to another (eg. HIV or hepatitis)
or of introducing pathogenic organisms. Safety in acupuncture therefore requires
constant vigilance in maintaining high standards of cleanliness, sterilization and
aseptic technique.
There are, in addition, other risks which may not be foreseen or prevented but for
which the acupuncturist must be prepared. These include: broken needles,
untoward reactions, pain or discomfort, inadvertent injury to important organs
and, of course, certain risks associated with the other forms of therapy5 classified
under the heading of "acupuncture".
Finally, there are the risks due to inadequate training of the acupuncturist. These
include inappropriate selection of patients, errors of technique, and failure to
recognize contraindications and complications, or to deal With emergencies when
they arise.
1. Prevention of infection
As with any subcutaneous or intramuscular injection, avoidance of infection in
acupuncture requires:
0 a clean working environment;
° clean hands of the practitioner;
0 preparation of the needling sites;
° sterile needles and equipment, and their proper storage;
~ aseptic technique; and
° careful management and disposal of used needles and swabs.
Acupunture treatment is not limited to needling, but may also include: acupressure,
electro-acupunture, laser acupuncture, moxibustion, cupping, scraping and

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Guidelines on basic training and safety in acupuncture
1.1 Clean Working environment
The treatment room should be free from dirt and dust, and should have a special
working area, such as a table covered with a sterile towel, on which sterile
equipment should be placed. This equipment (including trays of needles, cotton
wool balls and sticks, and 70% alcohol) should be covered with a sterile towel
until needed for use. Adequate light and ventilation should be provided
throughout the treatment rooms.
1.2 Clean hands
Practitioners should always wash their hands before treating a patient. Washing
the hands again immediately before the acupuncture procedure is particularly
important in preventing infection, and should include thorough lathering with
soap, scrubbing the hands and fingernails, rinsing under running water for 15
seconds, and careful drying on a clean paper towel.
Many acupuncturists palpate the acupuncture point after the needling site has
been prepared. In such cases, their fingertips should again be cleaned with an
alcohol swab. The use of sterile surgical gloves, or individual finger stalls, is
recommended for the protection of the patient and the practitioner, especially if
the latter has cuts or abrasions. Those with infected lesions on the hands should
not practise until they are healed.
1.3 Preparation of the needling sites
The needling sites should be clean, free from cuts, wounds or infections. The
point to be needled should be swabbed with 70% ethyl or isopropyl alcohol, from
the centre to the surrounding area using a rotary scrubbing motion, and the
alcohol allowed to dry.
1.4 Sterilization and storage of needles and equipment
Sterilization is required for all needles (filiforrn, plum-blossom, seven-star,
subcutaneous, round~head subcutaneous), cups and other equipment used
(storage trays, forceps, guide tubes for needles, cotton wool balls and sticks, etc.).
Disposable sterile acupuncture needles and guide tubes are strongly
recommended in all instances. However, the use of disposable needles should
not slacken the practitioner's vigilance in adopting aseptic techniques in other
aspects of clinical practice. All disposable needles should be discarded
immediately after use and placed in a special container.
Each sterile filiform needle should be used for puncturing once, and once only.
Plum-blossom or seven-star needles may be used repeatedly on one and the
same patient, but must be sterilized before being used for another patient, or else
disposable plum-blossom heads should be used.

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Section II: Safety in acupuncture
Sterilization procedures should conform to those described in the Appendix. The
therapist is responsible for ensuring that these standards are maintained.
Immediately after use, reusable needles and other contaminated equipment
should be immersed in an effective chemical disinfectant, then soaked in water,
with or without detergent and, after careful cleaning, thoroughly rinsed in water
before being packaged for resterilization.
The sterilized package should be stored in a safe and clean area, well ventilated
and free from excessive humidity, to preclude any possibility of condensation
and mould growth. The maximum safe storage time varies with the type of
packaging. Needles should be placed in a test tube which should then be plugged
with cotton wool, and clearly labelled with an expiry date not more than seven
days after the date of sterilization. Improper storage conditions may, however,
cause equipment to lose sterility long before the expiry date. rIhe integrity of the
package should be inspected before use. Sterile needles stored in needle trays
should be resterilized at the end of the day because the trays may become
contaminated during use in treatment.
1.5 Aseptic technique
The needle shaft must be maintained in a sterile state prior to insertion. Needles
should be manipulated in such a way that the practitioner's fingers do not touch
the shaft. If there is difficulty in inserting a long needle, such as that used in
puncturing GB 30 huantiao or BL 54 zhibian by just grasping its handle, the shaft
should be held in place with a sterile cotton wool ball or swab. The use of
disposable sterile surgical gloves or finger stalls makes it easy to manipulate
needles without contamination.
0n withdrawing a needle, a sterile cotton wool ball should be used to press the
skin at the insertion site, thus protecting the patient's broken skin surface from
contact with potential pathogens, and the practitioner from exposure to the used
needle shaft and the patient's body fluid. All compresses or cotton wool balls
contaminated by blood or body fluids must be discarded in a special container
for infectious waste.
2. Contraindications
In view of the "regulatory action" of acupuncture, it is difficult to stipulate
absolute contraindications for this form of therapy. However, for reasons of
safety, it should be avoided in the following conditions.
2.1 Pregnancy
Acupuncture may induce labour and, therefore, should not be performed in
pregnancy, unless needed for other therapeutic purposes and then only with
great caution.

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Guidelines on basic training and safety in acupuncture
Iust the act of needling with a certain mode of manipulation at certain
acupuncture points may cause strong uterine contractions and induce abortion.
However, this may have a use in pregnancy for the purpose of inducing labour
or shortening its duration.
Traditionally, acupunture, and moxibustion are contraindicated for puncture
points on the lower abdomen and lumbosacral region during the first trimester.
After the third month, points on the upper abdomen and lumbosacral region,
and points which cause strong sensations should be avoided, together with ear
acupuncture points that may also induce labour.
2.2 Medical emergencies and surgical conditions
Acupuncture is contraindicated in emergencies. In such cases, first aid should be
applied and transport to a medical emergency centre arranged.
Acupuncture should not be used to replace a necessary surgical intervention.
2.3 Malignant tumours
Acupuncture should not be used for the treatment of malignant tumours. In
particular, needling at the tumour site should be prohibited. However,
acupuncture may be used as a complementary measure, in combination with
other treatments, for the relief of pain or other symptoms, to alleviate side-effects
of chemotherapy and radiotherapy, and thus to improve the quality of life.
2.4 Bleeding disorders
Needling should be avoided in patients with bleeding and clotting disorders, or
who are on anticoagulant therapy or taking drugs with an anticoagulant effect.
3. Accidents and untoward reactions
3.1 Needle quality
Stainless steel is the material of choice for acupuncture needles. Each should be
carefully checked before use. If it is bent, the shaft eroded, or the tip hooked or
blunt, the needle is defective and should be discarded.
It is recommended that the quality of manufacture of acupuncture needles be
controlled by the national health authority.

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Section II: Safety in acupuncture
3.2 Position of patient
The patient should assume a comfortable posture before needling and be
requested to remain still and not to change position abruptly during treatment.
3.3 Painting
During acupuncture treatment, the patient may feel faint. The needling
procedure and the sensations it may cause should therefore be carefully
explained before starting. For those about to receive acupuncture for the first
time, treatment in a lying position with gentle manipulation is preferred. The
complexion should be closely watched and the pulse frequently checked to detect
any untoward reactions as early as possible. Particular care should be taken
when needling points that may cause hypotension, e.g. LR 3 taichong.
Symptoms of impending faintness include feeling unwell, a sensation. of
giddiness, movement or swaying of surrounding objects, and weakness. An
oppressive feeling in the chest, palpitations, nausea and sometimes vomiting
may ensue. The complexion usually turns pale and the pulse is weak. In severe
cases, there may be coldness of the extremities, cold sweats, a fall in blood
pressure, and loss of consciousness. Such reactions are often due to nervousness,
hunger, fatigue, extreme weakness of the patient, an unsuitable position, or too
forceful manipulation.
If warning symptoms appear, remove the needles immediately and make the
patient lie flat with the head down and the legs raised, as the symptoms are
probably due to a transient, insufficient blood supply to the brain. Offer warm
sweet drinks. The symptoms usually disappear after a short rest. In severe cases,
first aid should be given and, when the patient is medically stable, the most
appropriate of the following treatments may be applied:
° press GV 26 shuigou with the fingernail or puncture GV 26 shuigou, PC 9
zhongchong, GV 25 suliao, PC 6 neiguan and ST 36 zusanli; or
¢ apply moxibustion to GV 20 baihui, CV 6 qihai and CV 4 guanyuan.
The patient will usually respond rapidly to these measures, but if the symptoms
persist, emergency medical assistance will be necessary.
3.4 Convulsions
All patients about to receive acupuncture should be asked if they have a history
of convulsions. Patients who do have such a history should be carefully observed
during treatment. If convulsions do occur, the practitioner should remove all
needles and render first aid. If the condition does not stabilize rapidly or if
convulsions continue, the patient should be transferred to a medical emergency

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Guidelines on basic training and safety in acupuncture
3.5 Pain
During needle insertion
Pain during insertion is usually due to clumsy technique, or to blunt, hooked or
thick needles. lt may also occur in highly sensitive patients. In most patients,
skilful and rapid penetration of the needle through the skin is painless. The
correct technique and optimum degree of force to use must be learned through
practice. A few devices may facilitate smooth and fast penetration, such as the
use of needle guide tubes (which hold the needle steady over the point While it is
tapped into place), and the "flicking-in" technique (a method of inserting the
needle by flicking the upper end of its handle with the middle or index finger of
one hand while the handle of the needle is loosely held by the index and middle
fingers of the other hand, with the tip of the needle lightly touching the
acupuncture point). The "acupuncture sensation" of soreness, tingling and
heaviness indicating the arrival of qi (deqi) at the point should be distinguished
from painful reactions.
After insertion
Pain occurring when the needle is inserted deep into the tissues may be due to
hitting pain receptor nerve fibres, in which case, the needle should be lifted until
it is just beneath skin and carefully inserted again in another direction.
Pain occurring when the needle is rotated with too Wide an amplitude, or is lifted
and thrust, is often due to it becoming entwined with fibrous tissue. To relieve
the pain, gently rotate the needle back and forth until the fibre is released.
Pain occurring While the needle is in place is usually caused by it curving when
the patient moves, and is relieved by resuming the original position.
After withdrawal
This is usually due to unskilled manipulation or excessive stimulation. For mild
cases, press the affected area; for severe cases, moxibustion may be applied in
addition to pressure.
3.6 Stuck needle
After insertion, one may find it difficult or impossible to rotate, lift and thrust, or
even to withdraw the needle. This is due to muscle spasm, rotation of the needle
with too Wide an amplitude, rotation in only one direction causing muscle fibres
to tangle around the shaft, or to movement by the patient.
The patient should be asked to relax. lf the cause is excessive rotation in one
direction, the condition will be relieved when the needle is rotated in the
opposite direction. If the stuck needle is due to muscle spasm, it should be left in
place for a while, then Withdrawn by rotating, or massaging around the point, or
another needle inserted nearby to divert the patient's attention. lf the stuck
needle is caused by the patient having changed position, the original posture
should be resumed and the needle withdrawn.

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Section II: Safety in acupuncture
3.7 Broken needle
Breaks may arise from poor quality manufacture, erosion between the shaft and
the handle, strong muscle spasm or sudden movement of the patient, incorrect
withdrawal of a stuck or bent needle, or prolonged use of galvanic current.
lf, during insertion, a needle becomes bent, it should be withdrawn and replaced
by another. Too much force should not be used when manipulating needles,
particularly during lifting and thrusting. The junction between the handle and
the shaft is the part that is apt to break. Therefore, in inserting the needle, one­
quarter to one-third of the shaft should always be kept above the skin.
If a needle breaks, the patient should be told to keep calm and not to move, so as
to prevent the broken part of the needle from going deeper into the tissues. If a
part of the broken needle is still above the skin, remove it with forceps. lf it is at
the same level as the skin, press around the site gently until the broken end is
exposed, and then remove it with forceps. lf it is completely under the skin, ask
the patient to resume his /her previous position and the end of the needle shaft
will often be exposed. lf this is unsuccessful, surgical intervention will be needed.
3.8 Local infection
Negligence in using strict aseptic techniques may cause local infection, especially
in ear acupuncture therapy. When such infection is found, appropriate measures
must be taken immediately, or the patient referred for medical treatment.
Needling should be avoided in treating areas of lymphoedema.
3.9 Burning during moxibustion
Burning of the skin should be prevented in indirect moxibustion. Although
scarring moxibustion is performed by means of burning the skin so as to result in
non-bacterial suppuration, this technique should only be used with the full
knowledge and prior consent of the patient. It is a special therapeutic technique
only performed at specific points.
Direct moxibustion should not be applied to points on the face, or at sites where
tendons or large blood vessels are located. Moxibustion with non-bacterial
suppuration near a joint is also inappropriate because the joint movement may
make healing difficult. Special care should be taken in patients with reduced
levels of consciousness, sensory disturbance, psychotic disorders, purulent
dermatitis, or in areas of impaired circulation.

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Guidelines on basic training and safety in acupuncture
4. Electrical stimulation and laser
Electrical stimulation is potentially harmful. Itis contraindicated: in pregnancy; if
the patient has a pace-maker; if there is lack of skin sensation; and in cases of
impaired circulation, severe arterial disease, undiagnosed fever or severe skin
Careful monitoring of the electrical stimulation is recommended to prevent
neural Galvanic current should be used for only a very short period of
Low energy laser therapy may harm the eyes and both patient and operator
should wear protective glasses.
5. Injury to important organs
If administered correctly, acupuncture should not injure any organ. However, if
injury does occur, it may be serious.
There are a great many acupuncture points, some which carry little or no risk
and others where the potential of serious injury always exists, particularly in
unskilled or inexperienced hands.
As training programmes in acupuncture are intended for different levels of
personnel, it follows that they should be adapted to the knowledge, abilities and
experience of those concerned. At elementary levels, the selection of acupuncture
points should be limited. At professional levels, the range can be expanded but,
even so, the use of certain points and manipulations should still be restricted to
those with great experience.
The following passages present examples of points which carry particular
potential risk. As in all forms of treatment, it is important to measure risk against
expected benefit.
5.1 Areas not to be punctured
Certain areas should not be punctured, for example: the fontanelle in babies, the
external genitalia, nipples, the umbilicus and the eyeball.

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Section II: Safety in acupuncture
5.2 Precautions to be taken
Special care should be taken in needling points in proximity to vital organs or
sensitive areas. Because of the characteristics of the needles used, the particular-
sites for needling, the depth of needle insertion, the manipulation techniques
used, and the stimulation given, accidents may occur during treatment. In most
instances they can be avoided if adequate precautions are taken. If they do occur,
the acupuncturist should know how to manage them effectively and avoid any
additional harm. Accidental injury to an important organ requires urgent
medical or surgical help.
Chest, back and abdomen
Points on the chest, back and abdomen should be needled cautiously, preferably
obliquely or horizontally, so as to avoid injury to vital organs. Attention should
be paid to the direction and depth of insertion of needles.
Lung and pleura
Injury to the lung and pleura caused by too deep insertion of a needle into points
on the chest, back or supraclavicular fossa may cause traumatic pneumothorax.
Cough, chest pain and dyspnoea are the usual symptoms and occur abruptly
during the manipulation, especially if there is severe laceration of the lung by the
needle. Alternatively, symptoms may develop gradually over several hours after
the acupuncture treatment.
Liver, spleen and kidney
Puncture of the liver or spleen may cause a tear with bleeding, local pain and
tenderness, and rigidity of the abdominal muscles. Puncturing the kidney may
cause pain in the lumbar region and haematuria. If the damage is minor the
bleeding will stop spontaneously but, if the bleeding is serious, shock may follow
with a drop of blood pressure.
Central nervous system
Inappropriate manipulation at points between or beside the upper cervical
vertebrae, such as GV 15 yamen and GV 16 fengfu may puncture the medulla
oblongata, causing headache, nausea, vomiting, sudden slowing of respiration
and disorientation, followed by convulsions, paralysis or coma. Between other
vertebrae above the first lumbar, too deep needling may puncture the spinal
cord, causing lightning pain felt in the extremities or on the trunk below the level
of puncture.
Other points
Other points which are potentially dangerous and which therefore require
special skill and experience in their use include:
0 BL 1 jingming and ST 1 chengqi, located close to the eyeball;
0 CV 22 tiantu, in front of the trachea;
° ST 9 renying, near the carotid artery;

Page 18
Guidelines on basic training and safety in acupuncture
0 SP 11 jimen and" SP 12 chongmen, near the femoral artery; and
° LU 9 taiyuan on the radial artery.
Circulatory system
Care should be taken in needling areas of poor circulation (eg. varicose veins)
where there is a risk of infection, and to avoid accidental puncture of arteries
(sometimes aberrant) which may cause bleeding, haematoma, arterial spasm or
more serious complications when pathological change is present (eg. aneurysm,
atherosclerosis). Generally, bleeding due to puncture of a superficial blood vessel
may be stopped by direct pressure. '
6. Patient records
Patient records should contain full details of the medical history, clinical
findings, diagnostic data, treatment plan and the response to treatment. They
should be regarded as confidential.

Page 19
1. Sterilization of acupuncture needles and equipment
Sterilization is defined as the destruction of all microbes, including bacterial
spores (Bacillus subtilis, Clostridium tetani, etc.). High-level disinfection is defined
as the destruction of all microbes, but spores may survive if initially present in
large numbers.
2. Methods of sterilization
Steam sterilization is the most widely used method for acupuncture needles and
other instruments made of metal. Itis nontoxic, inexpensive, sporicidal and rapid
if used in accordance with the manufacturer's instructions (eg. time,
temperature, pressure, wraps, load size and load placement). Steam sterilization
is only fully effective when free from air, ideally at 100% saturated steam.
Pressure itself has no influence on sterilization, but serves as a means of
obtaining the high temperatures required.
Dry heat can also be used for sterilizing needles and particularly for sterilizing
materials that might be damaged by moist heat, but it may cause the needle to
become brittle. It requires higher temperatures and longer sterilization times.
Recommended sterilizing temperatures and times for steam under pressure, and
for dry heat, are shown in the table below.
Recommended methods of sterilization
* Steam under pressure (eg. autoclave, pressure cooker)
Required pressure: => 15 pounds per square inch (101 kilopascals)
Temperature Time
l 15°C 30 minutes
121°C 15 minutes
126°C 10 minutes
134°C 3 minutes
* Dry heat (eg. electric oven)
Temperature Time
160°C 120 minutes
170°C 60 minutes
180°C 30 minutes
(Source: WHO - GPA/TCO/HCS/95/16 p.15.)
Instruments made of rubber or plastic which are unable to stand the high
temperature of an autoclave can be sterilized chemically, at appropriate
concentrations and ensuring adequate immersion times (eg. 6% stabilized
hydrogen peroxide for six hours).

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Guidelines on basic training and safety in acupuncture
For cupping, it is recommended that glass rather than rubber or plastic cups
should be used since glass can withstand the higher temperatures required for
It should be noted that boiling needles in water is not sufficient for sterilization,
nor is soaking in alcohol, since these methods do not destroy resistant bacterial
spores or certain viruses.
3. Disinfection
A high level of disinfection is achieved when instruments are boiled for 20
minutes. This is the simplest and most reliable method of inactivating most
pathogenic microbes, including HIV, when sterilization equipment is not
available. Boiling should be used only when sterilization by steam of dry heat is
not available. Hepatitis B virus is inactivated by boiling for several minutes; HIV,
which is very sensitive to heat, is also inactivated by boiling for several minutes.
However, in order to be sure, boiling should be continued for 20 minutes.
Chemical disinfection is used for heat-sensitive equipment that may be damaged
by high temperatures. Most disinfectants are effective against a limited range of
microorganisms only and vary in the rate at which they destroy microorganisms.
Items must be dismantled and fully immersed in the disinfectant. Care must be
taken to rinse disinfected items with clean water so that they do not become
recontaminated. Chemical disinfectants are unstable and chemical breakdown
can occur. They may also be corrosive and irritating to skin. Protective clothing
may be required. Chemical disinfection is not as reliable as boiling or
sterilization. The agents include:
° chlorine-based agents, eg., bleach
0 aqueous solution of 2% glutaraldehyde
° 70% ethyl or isopropyl alcohol.
(Source: WHO - GPA/TCO/HSC/95/16 plö und WHO AIDS Series 2, 2nd edition, p.3, 1989.)
4. Maintenance
All sterilizers should be checked periodically. r[he sterilizer should be loaded in
accordance with the manufacturer's instructions, with enough air space between
packages to permit the proper circulation and penetration of steam or hot air. The
effectiveness of sterilization should be regularly checked with biological
indicators, autoclave control indicators or such other tests as may be devised to
ensure that the contents of the load have been subjected to sterilization
Use of a new pattern of sterilizing box to contain needles is recommended. The
box is made of a special kind of metal sensitive t0 heat, with air holes that open
automatically under high temperature, and close when the temperature falls
below 75°C.