Two Chinese terms are involved here: 得氣 ‘de qi‘, obtaining the qi, and 氣至 ‘qi zhi‘, arrival of the qi.
In current Chinese TCM practice, no differentiation is made between the two. ‘De qi‘ is generally regarded as essential to effective acupuncture. Qi is ‘obtained’ when the patient or the practitioner experiences certain needling sensations. To the patient, it may be a heavy, achy, distending, spreading, or
electrical sensation under the needle. To the practitioner at the other end of the
needle, ‘de qi‘ may be similar to the ‘qi zhi‘ sensation most colorfully described in this passage from the Guide to Acupuncture Canon (1312 AD):
“Before the qi arrives, it feels light, slippery, and slack, like one is resting in a deep corner of an empty hall. When the qi arrives, the feeling is sinking, rough, and tight, as though a fish has swallowed the bait and is darting up and down in the water.” How quickly this happens has prognostic value because it’s an indication of how intact the zheng qi of the patient is : “If the qi arrives quickly, recovery will be swift; if it doesn’t, recovery will be slow.”
Ling Shu, however, has a quite different description of ‘de qi‘, obtaining the qi, vs. ‘qi zhi‘, arrival of the qi. Ch 1 says: “One must continue acupuncture until the qi arrives; when the qi arrives, one must remove the needles. The purpose of acupuncture treatment is to bring about the arrival of the qi. When the qi arrives, it’s as if the wind has blown away the clouds, exposing a bright, blue, sky. The treatment is then complete.
But what does the’ bright, blue, sky’ image mean? Ling Shu Ch 3 explains:
“Qi arriving means that that supplementing and draining maneuvers with the needles have restored qi and yin yang balance. Needles must then be removed immediately to avoid adverse effects.” ‘Qi zhi‘ therefore refers to the restoration of a state of balance and harmony, rather than sensations from the needle.
And what is ‘de qi‘ then? Ling Shu Ch 9 has this to say:
“The acupuncturist must first observe the patient’s body and qi. For instance, if the body is basically intact, but the qi is deficient and the pulse is restless, then miu ci method should be used. (Miu ci, literally, ‘wrong needling’, means contralateral needling. Needle the left side if the pathology is on the right side, and vice versa.) This will gather the scattered qi and spread the stagnated qi. Body, mind, and spirit should be quiet, focused, one, free from distractions, so that intention is concentrated on the needle. In this way lightly needle and stimulate to redirect the spirit. Immediately stop when the qi arrives, thus guarding against the invasion of bad qi, and preventing the leakage of good qi. Balancing yin yang in this way is called de qi.”
From this, we can see that Ling Shu emphasizes examination, diagnosis, choice of technique based on diagnosis, understanding the rational for the choice; then a clear, one-pointed touch of one spirit to another via the needle to restore balance and harmony, and when this is accomplished, to end treatment without delay so to consolidate the good effects. All this, Ling Shu says, is the way of de qi. Understood in this way, ‘de qi‘ is not sensations from needling; it is both the method and the goal of proper acupuncture practice.