Superior Medicine

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

hand shaoyin meridian

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.

Ling Shu Ch 15 delineates the warp and woof of heaven, earth, and humanity:

The 28 constellations correspond to the 28 primary meridians. The total length of the 28 meridians is 1,620 cun. Ying qi travels 6 cun in the meridians per respiration. Therefore, it travels one complete cycle in 270 breaths. During that same period of time, the earth  travels 1/50 of the distance of its circuit around the 28 constellations. In one day and night, the earth completes one cycle around the 28 constellations, while ying qi completes 50 cycles through the 28 meridians.

While the ancient astronomy here may be abstruse, the intention is clear. It is a total integration of heaven, earth, and humanity. Events in these different realms correspond with each other. They occur together in a tightly woven matrix. With every breath we express the quality of this integration .

Since ying qi circulates through the meridians 50 times a day, each cycle takes 28 minutes and 48 seconds. It makes sense to allow for  a complete qi cycle in an acupuncture treatment. So, we can retain needles for about 30 minutes. Indeed, many acupuncturists, including Master Tung of the ‘Miraculous Points’ fame, use this as a guide for needle retention time. But that’s just one approach.

foot taiyin meridian

Ling Shu Ch 12 specifies different needling depths and needle retention times for each of the 6 foot channels. Points of foot-yangming, for example, should be needled 6 fen deep and retained for 10 breaths; points of foot-jueyin should be needled one fen deep and retained for 2 breaths. Prescriptions for the other four channels fall in between. Points of all hand channels should be needled no deeper than two fen and retained for only one breath. Furthermore, these prescriptions should be modified to fit each person’s condition such as size, height, and age, as well as the nature of the imbalance or disease.

So how long should the needles stay in? The question deserves consideration on an individual basis. Everything in an acupuncture treatment matters: it can make the treatment more effective, or it can make the treatment less effective. In any case, since the purpose of adjusting needling depth and retention time is to elicit the ‘arrival of the qi’, we can say that when the qi has arrived, the acupuncture treatment is done. But that is another story.