.
Dr. Liu Wei, TCM practitioner, acupuncture expert, and professor of acupuncture in Minnesota, USA
Identifying qi under the needle is an understanding of the qi dynamic that an acupuncturist gains through long-term clinical practice. It is an advance that occurs through the internal process of perceiving and recognizing the patient’s qi dynamic after one has improved one’s own level of sensitivity and ability to identify qi dynamics. From this, one can understand various changes in the qi dynamic in the patient’s body, including those that occur at different physiological and pathological stages. By combining this understanding with clinical findings, one can use it as a basis for applying supplementation, drainage, or other methods. Acupuncture treatment is based on qi; all acupuncture techniques such as moving qi, regulating qi, supplementing qi, draining qi, and moving qi theory are applied after identifying different movements of the qi dynamic. It is necessary to note that acupuncturists who understand how to identify qi under the needle have the deepest understanding of acupuncture. Chapter 25 of Su Wen [Elementary Questions], entitled “On the Preservation of Life and the Body”, states: “Quietly reflect and observe properly, watching and waiting until the right time. This is called that which is unseen. No one can know its form. It is like watching a flock of crows come together; it becomes dense and abundant like millet, and then it scatters, leaving no hint of its presence. Retain the needle as if drawing a crossbow; remove the needle as if shooting an arrow. ” This passage is saying that one must be calm and focus one’s attention to observe the changes in the qi after needling. Otherwise, even though the channel qi has arrived, it will be unseen, as there is no form to be observed. One must carefully observe and experience it, and recognize its details. When qi comes to attack the needle, one will feel as if a flock of crows is gathering; when the qi is exuberant, it appears lush and flourishing like a field of millet. The coming and going of qi is like crows flying to and fro; if one is not very good at analyzing what one experiences, one will only know that the channel qi is moving, but not why it moves as it does.
Why must one identify qi under the needle? There are 5 levels of acupuncture needling: “form, qi, reflection, spirit, and emptiness” . Dry needling typically only involves skillfully carrying out familiar procedures on the “form” level, so if you just want to be a skilled laborer, is that a problem? Not at all, and you might even be able to make a good living by doing so. But is skill alone what keeps our amazing field of TCM and acupuncture alive?! Is that enough to cure deep-rooted illnesses?! As professional TCM practitioners and acupuncturists, there are some things that may never change, like our passion for our culture and the needle in our hand. There are also some things that can be changed, like the clinical techniques that we must constantly improve.
So, when using acupuncture clinically to treat disease, what is the goal of needling? It is to regulate and harmonize qi and blood, and balance yin and yang; everyone knows this. Ling Shu [The Magic Pivot] discusses how“the essence of needling is that qi arrives and then the effects appear. The reliability of these effects is like wind blowing clouds; it is as clear as seeing a blue sky. This is the way of needling” and so on. This means that it is necessary to obtain qi and perform manipulation when needling. What is the goal? To supplement vacuity and drain repletion.
The classics say that “in treating vacuity and repletion, the 9 needles are most effective; when it is time to supplement or drain, use a needle to do this” . When discussing supplementation and drainage, it is necessary to talk about manipulation. Supplementing vacuity and draining repletion are the general principles of acupuncture; this is to say that when supplementing or draining, one must clearly distinguish whether there is evil qi or upright qi under the needle. Ling Shu describes this very clearly, but what it describes are general principles: “the arrival of evil qi is tense and swift; the arrival of grain qi is slow and harmonious” . This is insufficient for clinical practice; one must differentiate the two in greater detail. In a nutshell, when needling, one must recognize and interact with qi. This interaction happens on the qi level and even on the spirit level as a type of interaction with the patient. How can we describe this in modern terms? Building on the foundation of traditional theories, methods, formulas, points, and techniques, we must grasp the qi dynamic and regulate yin and yang, thereby engaging in a multi-level patient-provider interaction and achieving unity between heaven and humankind.
So, how does one identify qi? Obtaining qi, preserving qi, and summoning qi all require the identification of qi. The so-called “listening needle” of the ancients was actually a method similar to introspection in which doctors used their keen perception to experience and become aware of the sensation under the needle. What is the sensation under the needle? It is the sensation of the patient’s qi and blood, which is also the sensation of the qi dynamic.
The process of identifying qi under the needle can be divided into several steps.
The first step is greeting the point. It is as if we are going from door to door, knocking on each one and greeting the residents. Here one must address the issues of pressing and palpating points, and then by lifting, thrusting, and rotating the needle, find the same and different levels of qi and blood, as well as the sensation under the needle.
The second step is crossing the border. I call it “crossing the border” because when one perceives it, one must enter a kind of selfless state: your spirit is still present, but it feels as if you are spiritless. At the same time, maintain a synchronized breathing rhythm.
The third step is contemplation. “Contemplation” here means a closely interrelated and deep reflective and meditative state.
The fourth step is conducting qi. This is not part of the process of identifying qi under the needle. It refers to using manipulation and some heart-methods to achieve the effect of conducting and regulating qi.
The fifth step is spiritual unity. There is a Buddhist theory that humans have 6 roots, namely the eyes, ears, mouth, nose, body, and mind, and the mind is the leader. This is to say that we must use our mind to guide the sensation at the bodily level.
Regarding levels of needling, I have my own theory, which is the 5 levels of form, qi, reflection, spirit, and emptiness. When our awareness is concentrated in a state of simultaneous complete spiritual focus and emptiness, when we have this kind of conscious focus and relaxation as well as imagination, we can strive to achieve unity between our spiritual awareness and the needle. At this time, we will become unusually sensitive to what is under our hands and we will be able to experience the sensation under the needle. This sensation is that of the needle entering the interstices; it is intricate and nuanced. At this time, we must make sure to act naturally and follow our hearts, and we must be extremely attentive without being deliberate.
Sensations under the needle have been discussed in the classics and by our predecessors. I will take a moment to discuss my own experience. Sensations under the needle can be divided into a few types. Everyone can take time to ponder these sensations and experiment with them in clinical practice.
The first is qi vacuity. What does qi vacuity mean? It feels like, after the needle has been inserted, there is empty space under the needle, like needling into air or a piece of tofu. This is actually a relatively common sensation in clinical practice, especially with patients who have long-term chronic diseases; this sensation is commonly felt when needling the abdomen. In this kind of situation, it is actually difficult to obtain qi, so one must supplement the vacuity using manipulations such as the pumping [or repeated lifting and pressing] method. Use this method to summon qi to the local area; after qi has been obtained by summoning, perform additional manipulations. One can also use the burning mountain fire method. After all, the space is empty, right? So one should strive to fill it up.
The second sensation is qi repletion. What does qi repletion mean? Qi repletion is when the sensation under the needle is like sinking into sludge or possibly even as extreme as stabbing into putty. This can be observed at multiple levels; it may be found at both the deep and superficial levels. Qi repletion is a repletion pattern, so one should drain it.
There are two manipulation techniques to use in treatment. One is summoning qi at a distal point to give the evil qi an escape route. However, if the sensation of qi repletion has reached the point of being like putty, this means that sinew binds have already formed in the local area, so there may not be enough force to summon qi distally. In this situation, one must dig around in the local area to empty it out like an excavator digging in the dirt or, to use a more exaggerated metaphor, toss in a bag of dynamite and blow it up. For the previous situation of qi vacuity, one should supplement the upright qi, while for qi repletion, one should give the evil qi a way out; these are principles that must be applied in clinical practice.
The third sensation is qi floating. What is meant by qi floating? Generally, in the majority of cases this sensation is encountered at the superficial level and occasionally at the deep level. In fact, it is related to both the deep and superficial levels, but not particularly so. It is not only confined to the superficial level, so everyone should keep this in mind. Qi floating is like when you are swimming and the buoyancy of the water is pushing you upwards, or to use another example of this sensation, it is as if you put a cork stopper in water, like the cork stoppers that were used in thermos bottles. These may not exist anymore; when I was little, the thermos bottles we used were sealed with this kind of cork stopper. If you placed it in water and lightly pressed it down, it would feel as if it was being pushed up. This is qi floating.
The fourth sensation is qi sinking. If there is qi floating, then there must be qi sinking. Qi sinking is when, after the needle is inserted, it feels like there is suction or something pulling the needle in. Do not be afraid if you encounter this phenomenon; it’s not a demon dragging you away. My personal understanding of the so-called “fish swallowing the hook” is the phenomenon of qi floating and qi sinking. It can help us to determine the location of disease in the viscera and bowels, as well as its direction.
The fifth sensation is qi slipping. What is qi slipping? Generally, in cases with a new onset of illness or when needling yang channels, one frequently encounters the sensation of qi slipping. Perhaps you never experienced this; when I was little, I would go catch loaches [or mudfish] and this is how it felt: slippery and impossible to hold, slimy and fleeting, repeatedly colliding, possible to grasp, but then it escapes. This kind of sensation is called qi slipping.
The sixth is qi astringing. Since there is qi slipping, there must be qi astringing. Qi astringing is a sort of viscous sensation, a rather unpleasant feeling. Generally, if there is dampness, then this sensation will be present. Dampness arises from chronic illness or if the illness is damp in nature. It is like the sensation of eating honey or Chinese yam covered with hot toffee, or like eating glutinous rice balls
or zongzi [traditional rice dumplings] that stick to your hands. This kind of sensation is often found in the yin channels. This issue of qi astringing is difficult to treat; it is no longer a mat- ter of simply using a few supplementation and drainage manipulations, but rather may require combinations of points on different channels and vessels. It truly requires making a point prescription that matches the point’s pattern.
The seventh sensation is qi tension. Qi tension is easy to understand; after inserting the needle, you can feel a kind of entwining sensation fighting against you. Of course, it doesn’t have much strength, not as much as in a tug-of-war. The kind of evil qi that creates qi tension can occur on multiple levels. For example, when the tip of the needle has just entered the skin, it may be impossible to insert deeper and on the skin surface you may notice that lots of goosebumps have appeared. You will feel as if the needle won’t go in. When the needle has been inserted into muscle, there is also a feeling of tension. This kind of sensation is relatively common in cases with acute pain symptoms.
The eighth sensation is qi faintness, in which the qi is faint, fine, and forceless. Remember that this is faint, fine, forceless qi. The feeling it gives us differs from upright qi in that it is faint, fine, and forceless, and it feels rootless. It is not the emptiness of qi vacuity; although it is vacuous, weak, and forceless, it does have its own feeling, as if it is shaking hands with you, sometimes present and sometimes not, possibly coming and going. It is usually seen in chronic illnesses. Basically, mastering the identification of these 8 types of qi under the needle is sufficient. Aside from these, there are also sensations of cold, heat, clarity, harmony, and so on, but I will not discuss them here; I hope to share more ideas with everyone in the future.
All of these sensations under the needle have extremely important clinical significance. Based on these sensations, we can determine the corresponding manipulations and treatment plans.
About the Author: Dr. Liu Wei, PhD is a TCM practitioner in Minnesota, USA and a doctoral supervisor at OCOM. Dr. Liu is among the first group of distinguished professors at the Chi-na-US Institute for Acupuncture and Rehabilitation and a member of its expert committee. He is a visiting professor at Guangzhou University of Chinese Medicine and New Zealand College of Chinese Medicine. He is among the first group of 10 TCM experts outside of China to enter the “100 Talents 100 Projects” program for overseas Chinese in TCM. Dr. Liu is executive director of the World Chinese Medicine Forum and director of the World Federation of Chinese Youth Associations. He was also recognized as a treasured expert in the 11th “TCM Treasure Hunt” held by the Guangdong Provincial Hospital of Chinese Medicine.
再談針下辨氣
劉偉 醫學博士，美國明州執業中醫師，中醫針灸專家和針灸教授
針下辨氣是針灸醫生通過長期的臨床實踐後對氣機的感悟。是在提高了自己的靈敏的感覺和對氣機的辨識度後，通過內在對病人氣機的感知、認知後的昇華。從而懂得患者機體內各種包括生理和病理時期出現的不同氣機變化，並結合臨床表現，使其作為實行補瀉等手法的依據。針灸療法是以氣為根本，所有的行氣、調 氣、補氣、瀉氣、運氣方法都是在辨別不同的氣機運動的以後應用的。必須說明，懂得針下辨氣的針灸醫生才是對針灸理解最深刻的。《素問。保命全形論》：“靜意視義，觀適之變，是謂冥冥，莫知其形，見其烏烏，見其稷稷，從見其飛，不知其誰，伏如橫弩，起如發機”。這就是說要很安靜地、聚精會神地來觀察施針後的形氣變易，不然雖經氣到來，也是冥冥然無形可察的；要細心觀察體驗，詳加辨識，在氣來襲針時，就會覺得好像烏鴉的聚集，氣盛的時候，好似稷禾欣欣向榮的一片茂盛之象；氣的往來，又像是烏鴉的飛來飛去；如果是不很好的判辨體會，只知經氣的飛騰，卻不知其何故。
針下辨氣，為什麼要辨？針刺有“形、氣、 意、神、空”這五個層次。幹針的操作一般只是在形這個層面做熟練的操作，那你做一個熟練工有問題嗎？沒問題，甚至也能過很 好的生活。但是我們大美的中醫，大美的針 灸只是靠熟練就能傳承嗎？！就能起沈痾大 病嗎？！做為職業的中醫人、針灸人，有些 東西其實是可以是一直不變的，那就是對國粹、對手中這根針的熱愛；有些東西是可以改變的，也就是我們需要不斷提高的臨床技術。
那麼臨床針灸治病，針刺的目的是什麼？就是調和氣血，平衡陰陽，這個大家都知道， 《靈樞》裡早就談過，“刺之要，氣至而有效”，“效之信，若風之吹雲，明乎若見蒼天，刺之道畢矣”等等。這是說針刺的時候需要得氣，需要做手法。目的是什麼那？補虛瀉實。
經典裡講過“虛實之要,九針最妙,補瀉之時, 以針為之。”談到了補瀉，就一定要講手 法。補虛瀉實是針灸治療的總則，就是說補瀉的時候，一定要分清楚針下是邪氣還是正氣。《靈樞》裡面已經描述得很清楚，但是描述的是總則，“邪氣來也緊而疾，穀氣來也徐而和”，這在臨床中是不夠的，還要往細處分。概括地講，就是針刺的時候對氣的認知和交流，這個交流是在氣的層面上， 甚至是在神的層面上和病人進行的一種交 流。用現代語言如何描述呢？就是在傳統的理、法、方、穴、術的基礎上，要抓住氣機，去調理陰陽，從而做到醫者與病人之間的不同層面的交流，做到天人合一。
那麼怎麼辨氣呢？得氣、守氣、導氣都需要辨氣，古人所謂的“聽針”，它實際上是一 種類似內觀的方法，就是醫生用敏知去體察覺悟針下的感覺。針下什麼感覺？對病人氣血的感覺，也就是對氣機的感覺。
針下辨氣分為幾步。
第一步問穴，就是我們去串門，敲門和主人問好一樣，這裡有押手、揣穴的問題，然後 通過提插捻轉找同一層次和不同層次的氣血、針下的感覺。
第二步入境。我把它叫“入境”，就是在感知的時候，要進入一種忘我的狀態，即你的神還在，但是類似於失神的感覺，同時保持呼吸節律的同步。
第三步觀想。所謂“觀想”，就是意合禪定的意思。
第四步引氣。這個不屬於針下辨氣的內容了，就是通過手法和一些心法達到引氣、調 氣的作用。
第五步神合。佛家有個說法，人有六根，眼 耳口鼻身意，以意領之。就是說需要用我們 的意去領身體層面的感覺。
針刺的層次，我有個原創說法，就是形、氣、意、神、空，當我們意識凝聚，在全神貫注又放空的狀態下，有這種有意識的凝聚和放鬆以及想像力的時候，爭取可以做到神識和針合為一體，這個時候手下就會變得異常靈敏，就會體會到針下氣的感覺。這種感覺就是針入腠理的感覺，它是細緻入微的， 這個時候我們要做到自然隨心，要非常的注意，但是卻不刻意。
針下的感覺經典裡面講過，我們的先賢也講過。我談一下自己的體會。針下的感覺分為 幾種，大家可以仔細體會一下這幾種感覺， 然後在臨床中去揣摩。
第一是氣虛。氣虛是什麼意思？就是感覺針下去之後，針下是空空如也，就像在空氣裡扎針或者是 紮到豆腐塊的感覺一樣。這個實際上是臨床比較常見的 一個感覺，尤其是一些有長期的慢性病的病人，在腹部下針時常常會有這種感覺。這種情況實際上是不易得氣，就需要虛而補之，做手法裡面的抽添法，用抽添法 引氣到局部，通過引氣，得氣之後再做手法。還有可以做燒山火的手法，這裡不是空麼？就爭取給他填滿。
第二是氣實。氣實是什麼意思呢？氣實就是針下如陷入淤泥的感覺，或者就是像扎到橡皮泥上的感覺，有可能是嚴重到這種程度。這個在不同的層次都可以見到，深 層、淺層都會見到這種情況。氣實，是實證，實而瀉之，有兩種辦法可以治療，一個是可以在遠端引氣，給邪以出路。但是這種氣實時的感覺，如果是已經到了像 橡皮泥感覺的時候，就是說局部已經有筋結，那麼遠端 引氣可能力量是不夠的，這個時候就需要在局部像挖土 機挖土一樣把它給挖空，甚至說的再誇張一點，放個炸 藥包把它給炸掉。前面氣虛，就補正氣，氣實就給邪以出路，這都是臨床中必須要用到的原則。
第三是氣浮。氣浮是什麼意思呢？一般多數是在淺層會 見到這種感覺，偶見深層，實際上它和深層淺層有關係，但是不是特別大，不是唯一在淺層，這個大家要注意。氣浮就像游泳時，有水的浮力向上去頂著你往上走，這叫氣浮，這種感覺再換一個例子，你在水裏放一 個軟木塞子，就是暖水瓶的軟木塞子，現在可能都沒有了，小時候我們用的都是暖水瓶，都塞的這種軟木塞。 軟木塞子放水裏，你輕輕的往下壓的時候，就有往上頂 的感覺，這就是氣浮。
第四是氣沉。有氣浮的話，就有氣沉。氣沉就是針下去之後，感覺像是有吸力，或者是有什麼東西，拽著針往裡走，這種現像大家不要害怕，不是什麼惡魔，把你給掠走。我個人理解所謂的“如魚吞餌”，就是一個氣浮和氣沉的現象，可幫助我們判定疾病的臟腑位置和走向 問題。
第五是氣滑。氣滑是什麼？一般在新病或者是陽經上容易見到氣滑的感覺。你們可能都沒經歷過，小時候我去 抓泥鰍，就是這種感覺，滑不留手，滑而易逃，反复衝撞的這種感覺，有可能抓住又跑掉，這種感覺就叫氣滑。
第六是氣澀。有了氣滑，就會有氣澀。氣澀就是一種粘滯的感覺，挺不舒服的感覺，一般有濕就會有這種感覺，久病有濕，濕性的疾病。就像吃蜂蜜、 拔絲山藥的感覺，或者吃糯米糰、吃粽子粘手上的感覺。這種感覺多見於陰經。這種氣澀的問題，治療就比較棘手，它已經不是簡簡單單需要用一些補 瀉手法的問題，而可能是需要有不同經脈穴位的組穴，真正的配合，穴證的配合。
第七是氣緊。氣緊就好理解，下針之後就感覺一種纏繞感跟你較勁，當然這個勁不是這麼大，不像拔河的力氣這麼大。氣緊，這種邪氣可以在不同層面發生。舉例來說，針尖剛進皮膚的時候，有可能就進不去，在皮膚表面，可看到起了一堆雞皮疙瘩， 你感覺這針感覺進不去了，針到肌肉裡也是一種緊的感覺。這種的感覺一般在急性的痛症比較常見。
第八是氣微，氣微細無力。記住它是氣微細無力， 它給我們感覺，和正氣不一樣的地方，它是微細無力，沒有根的感覺，它不是氣虛的空空如也，它雖 然虛弱無力，但是術者是有感覺的，就好像跟你握 手似有似無，可能是一會來一會走，一般在慢性病 會見到它。基本上針下辨氣這八種能掌握好就差不 多了，此外還有針下寒熱清和等等，就不在這個地方討論了，以後有時間再和大家分享交流。
所有這些針下感覺，有非常重大的臨床意義，我們可以根據這些針下的感覺，確定相應的手法和治療方案。
作者介紹: 劉偉 醫學博士，美國明州執業中醫師，美國OCOM博士班導師，中美針灸康復研究所的第一批特聘教授和專家委員會成員，廣州中醫藥大學、新西蘭中醫學院等學校客座教授。海外華僑華人中醫藥 “百人百項”工程10名首批入圍的海外中 醫藥專家之一，世界中醫論壇常務理事，世界中聯青中會理事，廣東省中醫院第十一屆“杏林尋寶”獻寶專家之一。
