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.