1.Where did the long round needle come from?
In the 1970s, when Xue was engaged in orthopedic surgery, he used a “Keshi needle” with a sharpened edge to perform “blind surgery” to peel off soft tissue adhesions after trauma, thus treating a new attempt to treat stubborn painful diseases in the clinic. Later, after comparing the description of long needles in the Ling Shu, it was found that the ancient long needles (one of the nine types of needles) were similar to “blindsight” (“blindsight peeling”, “closed surgery”) in terms of shape and scope of application. “), thus increasing the in-depth and detailed work in this area. It has been more than 2,000 years since our Chinese ancestors invented and created the ancient nine needles, and many of us TCM practitioners have forgotten or do not use them anymore, and many of us are still immersed in the pride of using one milli-needle to cure a hundred diseases without realizing it. After consulting a large number of ancient books and documents in the library of the Chinese Academy of Traditional Chinese Medicine, Xue realized the wisdom of our ancient people and, based on many repeated trials, combined the characteristics of the nine needles in the circular needle and created the long circular needle.
2.How did our ancestors create the nine needles tool with their own wisdom?
Our ancestors were living, working and fighting with beasts, it is inevitable that injury to the flesh and muscles occurred. The emergence of disease and pain that instinctively touch, pressure to relieve pain, which began to sprout spontaneous healing activities. For acute injuries, simple treatment, relying on its ability to heal itself, may allow some of the lighter injuries to be relieved. However, the vast majority of tendon injuries, especially chronic strain disorders related to life and labor, often do not fully recover and leave sequelae. It is difficult to use hand pressure to relieve pain in tendon diseases that are deep or have formed stubborn foci.
In the struggle against disease, the search for medical tools was inevitable. The first tools used by the ancestors were “stone”, “bone needle” and “bamboo needle”. The sharp stones and bone needles could overcome the difficulties of the fingers to penetrate deep into the muscles and tendons and the “bone solution” (i.e., around the joints), especially in the areas where the tendon lesions had been formed for treatment and developed. With the gradual development of treatment for tendon injuries, the original spontaneous medical activities evolved towards medical specialization and technical treatment. In the era of the Nei Jing, a leap was made to the use of metal needles and bronze needles (microneedles) to replace the crude acupuncture stones and other primitive needles, and a major leap was made to use the “nine needles to treat a hundred diseases”. The second of the nine needles – the staff needle, “needle like an ovoid, wiping between the points” (“Ling Shu? The eighth needle – long needle, “long needle, sharp body thin, can take far paralysis” (“Ling Shu? Nine needles twelve original”), and pointed out: “eight should be wind, wind is the eight sections of the human femur also …… so for the treatment of needles, must be long its body, sharp its end, can cure deep evil far paralysis” (“Ling Shu? Nine needle theory”), it is the ancient medical doctors for the meridian injury disease special needle. It can also be inferred that in the era of Huangdi Neijing, the medical practice of meridian diseases had already reached an extremely high level.
3. Why were the long needles and round needles not widely used in the Nine Needles?
With the discovery and application of the meridian theory, especially the widespread use of the seventh of the nine needles, the “milli-needle”, people have become apprehensive about the painful needles of the “long needles”, and the painful treatment has become an insurmountable obstacle for both patients and doctors. Pain relief is one of the goals of physicians, and since the beginning of medical activities, people have been exploring in the area of analgesia. For example, an early medical text that preceded the Nei Jing, the “Fifty-two Sickness Formula”, recorded: “Make the injured person not to have pain, not to have blood come out, take the old bushy yellow mat aversion□□□□□□□□□□□□□□□□□□□□□ □□□□ ……”. “so that the gold injury no pain, take the chestnut dun (cooked) dried real, arrogant (boil) so black, treat one; Lin (art) root to remove the skin, treat two, where the two things and and, take three fingers most (handful) to the section one, alcoholic wine full a heart (cup), into the medicine, scratch drink, not, the wine half a cup (cup). Has drunk, a short time no pain. Again pain, drink medicine as many, no pain, no drink medicine ……”. It is possible that the painkiller formula is not widely spread, perhaps the painkiller effect is difficult to grasp, so far there is no record of this as the basis of anesthesia, used to relieve the pain of needles. After all, scraping the bone is a legendary thing, after all, you can not ask every patient is Guan Yu. Especially the royal palace officials, more intolerant of pain, in the official medical means will not be widely carried out. Therefore, also make the “long round needle” application and research, the collation and improvement of the theory of the tendons affected.
The ancient needles were not as fine as modern needles, and the sterility of the treatment area and needles could not be guaranteed before and after the treatment, and infections often occurred after the treatment, which also hindered the treatment effect in different degrees.
After the Nei Jing, famous medical writings of the past generations have recorded the treatise “Ling Shu? The eighth needle (long needle), which is used to treat painful meridian tendon paralysis, has rarely been studied and applied. Some physicians, based on their experience of applying the milli-needle, have interpreted strongly, or even misinterpreted, the contents of the various chapters of the Nei Jing on the meridian tendon, and as a result, have hindered the collation and application of research on the theory of the meridian tendon and the long circular needle.
These three aspects have led to the fading out of the treatment methods of medical practitioners after the Neijing.
4.What are the characteristics of long circular needling?
Ling Shu? Official Needle” chapter pointed out: “nine needles of the appropriate, each for the size of the length of each, each have to apply.” It can be seen that the ancient doctors created nine needles are each its own shape and use range (not only with milli needles).
The eighth of the nine needles is the long needle, “long needle, sharp body thin, can take far paralysis” (“the nine needles of the Ling Shu twelve original”), at the same time, in the “Ling Shu? Nine Needle Theory” chapter also explains the scope of its application, mechanism and shape. “Eight should be wind, the wind is the eight sections of the human femur and humerus also …… eight wind injuries, contained within the bone solution, waist and spine section, between the couples, for deep paralysis also, so for the treatment of needles, must be long its body, sharp its end”. The “A B Jing” also repeated the description of the “Ling Shu” on the long needle, and pointed out the characteristics of the thin body: “long needle, take the method of the Qi needle, seven inches long, its body thin and sharp its end, so that you can take deep evil far paralysis”. From these documents can be seen: long needle is not the previous understanding of “long needle is the extension of the milli-needle, later called the ring jump needle, the modern application of the mango needle, that is, the evolution of the long needle” (Shanghai College of Traditional Chinese Medicine “Acupuncture”). It is not only seven inches long, but also has a “sharp body thin”, that is, the end of the needle has the characteristics of the edge. To sharp body thin, its needle body must be thick and straight, otherwise it can not be “sharp body thin” processing. In fact, in ancient times, due to the metal material and processing technology limitations, the needle body is originally thick collar, in 1968 in Hebei Mancheng Western Han Dynasty Liu Sheng tomb unearthed four gold needles and five silver needles, its shape again verified the above characteristics of the long needle.
Liu Sheng was King Jing of Zhongshan in the Western Han Dynasty, reigning from 154 to 113 B.C. The creation of gold and silver needles for his burial may have been in this era, which was just a little later than the era of the compilation of the Ling Shu Jing. The shape of the gold and silver needles is more in line with the shape described in the Ling Shu Jing. The five silver needles, due to the age, the material corrosion resistance is poor, the end of the needle, the end of the needle has rust and fracture, but the residual body of the needle can also generally reflect the “body thin” characteristics. One of the silver needles for flat, the needle body cross-diameter width of 0.3 cm, while the thickness of 0.1 cm, due to corrosion can not see the shape of the end of the needle is sharp, but “body thin” is exact, and the closer the end the thinner. Another four gold needles, the needle shank needle body a total of 7 cm long, but three of the needle shank are 5.5 cm, the needle body 1.5 cm, for the body short and shank long; and the other one is the needle shank 2.7 cm long, the needle body 4.3 cm, was long and shank short, obviously from the length of the analysis it is long needle. Ling Shu? Nine needles twelve original” and so on, the ancient nine needles length were one inch six minutes to four inches ranging, only the long needle for seven inches, obviously longer than other needles. The gold needles in the body of the needle long and the needle handle short of this gold needle, fully consistent with the characteristics of the long needle. It is worth pointing out: the end of this long needle needle has a sharp edge. Comprehensive above measurements and comparative control can be analyzed, this gold needle should be the original form of the ancient long needle. Its needle diameter is 1.5 mm, the body of the needle is 4.3 cm long, the end of the needle has an edge. And the thin shape of the body of the silver needle, again with physical evidence of the long needle “sharp body thin” characteristics.
One of the characteristics of the long needle is “sharp body thin”. With a slight modification of the needle end and body, it can be used in surgical procedures. Among the indications for Chinese medicine surgery, carbuncles and sores are an important category of diseases. When pus has formed, it should be incised and drained. The tool used at that time was a needle with a blade. In the Su Wen? It is written in the book “Long Stabbing Section” that “those who treat decay and swelling stab on the decay, depending on the size and depth of the carbuncle, …… must end inside the needle for the reason to stop”. It can be seen that the “Nei Jing” era, surgical instruments are used “needle” to carry out. The sharp edge of the end of the long needle is formed by the thinning of the end of the needle, and its cross-section is very small. Although it can penetrate deep into the interior, but also because of its sharp edge is too short, for cutting and expanding the wound is still difficult. With the expansion of the scope of surgical treatment and treatment needs, the needle-shaped blade must be made wider, in order to facilitate the “cut skin and muscle”, “router through the back and abdomen, extraction and cutting accumulation”. The emergence of the end of the broadening, the edge of the knife like the shape of the “size of the thin mouth knife”, “size of the open knife” “large and small needle knife”, etc., so that the ancient nine needles in the edge of the needle tool to the field of surgery.
The ancient nine needles the second needle for the member needle, “member needle, needle such as ovoid, wipe and moisten between the points, shall not hurt the muscle, in order to diarrhea points gas” (“Ling Shu? Nine needles twelve original”). Member, pictogram, looking down on the tripod shape. That is, the tripod is seen inside the straight wall round. Therefore, the member is also through the round. Its needle end rounded blunt, although not cutting tissue, but can be deep pressure flesh, squeezed in the flesh coup gap, up and down wipe, so that the flesh between the “cross-loop” (adhesions and scarring) to get part of the loosening. Its operation method is similar to the surgical “blunt separation” operation.
5.What kind of diseases are the indications for long circular needles?
The “Ling Shu Nine Needles Twelve Principles”: “Long needles are sharp and thin, and can be used for distant paralysis”.
The “Ling Shu nine needle theory” further explained that “eight wind injuries, contained in the bone solution, waist and spine joints, between the couples, for deep paralysis, so for the treatment of needles, must be long its body, sharp its end, can take deep evil far paralysis ……, take the method in the compilation needle, seven inches long, the main take deep evil far paralysis also “. It can be seen that the Nei Jing repeatedly emphasizes that long needles can treat stubborn paralysis that resides deep between the tendons and bones.
Deep and distant both refer to the deep level of the disease location in the human body. The surface of the human body is the skin, the next is the flesh, then deeper is the tendon, and to the deepest is the bone. In this sense, paralysis between tendons and bones is “deep evil and distant paralysis”. Deep and distant also mean long and long-term. The evil is deep and difficult to treat, and the course of the disease must be long. The Su Wen? This is another commentary on deep and distant paralysis. In the past, textbooks have inferred that long needles must be “long in body” based on the fact that deep and distant means that the disease is deeply hidden. But from the “Ling Shu? The eight should be wind, the wind, the eight sections of the human femur also”, obviously its deeper, more distant can only be depending on the thickness of the eight sections of the femur. Ma Maki note: “human hands and feet, each femur and humerus joints count eight, so called eight sections.” Chinese medicine believes that the eight joints when referring to the wrist, elbow, ankle, knee, left and right a total of eight, called the eight joints. These eight joints are the junction of the tendons, and their tissue structure is mainly tendons. Tendons are located under the skin, its attachment to the bone joint, no muscle coverage, little fat filling, to touch the hand, from the skin to the bone near the minute. It can be seen in the treatment of the needle tool used, the body of the needle does not need to be seven inches long. It can also be inferred that the primary characteristic of long needles should be “sharp body thin”, that is, the end of the needle has a knife edge, the second characteristic is the needle length of more than seven inches. In this passage, the deeper meaning of long is to suggest the principle of treatment of needles to the location of the disease.
The deep evil far paralysis is the so-called tendon paralysis and bone paralysis in Chinese medicine. Su Wen? Long prick section theory: “disease in the tendons, tendon contracture joint pain, can not walk, called tendon paralysis, prick the tendons for the reason”. Su Wen? The theory of paralysis: “In the tendon is flexion but not extension …… paralysis is in the bone is heavy”. The “Ling Shu? The actual evil of the stabbing section: “The evil in the middle of the people also, sprinkling Xi moving form, starting hair and hair coup. It is deeper, the internal fight in the bone, then the bone paralysis”. Therefore, all tendon contracture joint pain of tendon paralysis, bone contracture of bone paralysis are caused by injury to the tendons or the tendons are not comfortable. When taking long round needles, stabbing tendons for the reason, to close the stab, resume stabbing, lose stabbing, short stabbing method, etc., to untie the knot to slow down the emergency and can loosen the pain.
6, long round needle how to enter the needle treatment?
Take the long circular needle of corresponding length, thickness and blade type, and enter the needle along the direction of the safe entry of the local anesthetic needle probe. In order to prevent the eventuality and increase the safety, it should also be noted that the direction of the long circular needle blade line should be consistent with the direction of the surrounding important tissues, in order to avoid possible medical source of injury. In the surrounding important tissues, especially the nerve trunk, large blood vessels, tendons, muscle fibers as important. That is, the nerve trunk along the nerve trunk; no nerve trunk, should be along the direction of the large blood vessels or along the tendon, muscle fiber direction to correct the direction of the blade.
Hold the needle with the pen method, and slowly and gradually apply pressure vertically with finger and wrist force. At this time, because of anesthesia without pain sensation, you can try to slowly press, so that the skin forms a deep groove, so that the surrounding tissues, especially important tissues due to slow pressure, and crowding to avoid the long circular needle entry, thereby reducing the possibility of injury. Because the skin is thicker and tougher, the greatest resistance, into the needle, should master the needle into the direction and strength, not fierce waves of sudden entry, otherwise it will lead to the inability to control the depth and direction, resulting in the needle tip to the location and level of unclear, and affect safety. To avoid this, the wrist can be pressed against the patient’s body surface, as a fulcrum, which can make the finger wrist easier to grasp the proportion and force.
During the operation, when the knotted tendon point cannot be reached for various reasons, attention should be paid to the probing depth, and care should be taken so that no possible danger occurs. That is, the back of the chest should not cross the shallow surface of the ribs; the root of the neck should not cross the shallow surface of the clavicle, the deep surface of the sternocleidomastoid muscle; the lumbar region should not cross the transverse process of the lumbar vertebrae; the kidney region should not straight stab across the erector spinae muscle; the abdominal wall should not cross the abdominal white line, the surface of the lateral semilunar line of the rectus abdominis muscle; the joints should not be stabbed into the joint cavity.
7.Long circular needle operation method
(1)Guan stab method
Ling Shu? Guan acupuncture”: “Guan acupuncture, straight stabbing left and right, all tendons on, in order to take tendon paralysis”.
The end of the tendon, Zhang Jinyue explained: “the joint also”. It should be the end of the tendon, that is, the end of the tendon.
The key is the meaning and interpretation of “straight stabbing left and right”. Zhang Jinyue explained: “left and right, the limbs are also”, which is a general statement. Some people comma this sentence as “straight stab, left and right to the end of the tendon”, that is, the needle stabbing the tendon ends on both sides of the tendon. Seems to make sense, but the operation of the technique does not help. Others interpret it as “straight stabbing left and right”, that is, the application of the milli-needle first straight stabbing, lifting to the subcutaneous and then stabbing to the left once, and lifting to the right once, forming a chicken claw stabbing method. However, this article has: “hegu stabbing, left and right chicken feet, needles in between the flesh, to take the muscle paralysis”, it is repeated. Some people also say: Guan stabbing for deep stabbing, penetrating stabbing acupuncture points around the joints. Xue Lao believes that “straight stabbing left and right” is the operation method of long needles. The “exhausted tendon” is the tendon end tissue of the muscle. Around the tendon stopping point is a special area where tendon foci are likely to appear, and most of the tendons are near the joints, so “all tendons belong to the joints.” Guan stab is a method of treating superficial paralysis and pain around the joints with long needles. The direct stabbing is from the surface to the inside, directly to the surface of the foci around the tendons. Its left and right is to scrape and peel the superficial layer of the knotted tendon lesion (such as tendon with deep fascia, superficial fascia, ligament, lipid membrane and other tissues that have adhesions and cause pain), it is to scrape and peel the superficial layer of the knotted tendon lesion in the left and right transversely to loosen the superficial adhesions, so it is a kind of unknotting needle method for superficial adhesions.
(2) Resumption of acupuncture method
Ling Shu? The official acupuncture: “resuscitation of acupuncture, straight acupuncture near the, lifting before and after, resuscitation of tendons urgent, in order to cure tendon paralysis also”. The previous commentators also mostly understand it from the perspective of applying milli-needle needling. That is, first straight stab, lift the needle to the subcutaneous, and then to the front oblique stab. The description is also similar to the longitudinal “chicken claw stab”. In addition, some people explain it as a method of first stabbing straight, then stabbing obliquely, and then asking the patient to lift the affected limb and move the muscles so that the muscle contracture can be relieved. According to Xue, this method is still the operation method of long needles. It is used for the treatment of tendon lesions around the joints that are complicated by adhesions around the tendon ends. The injury is usually heavy, and the adhesions, scarring and painful pathological changes must be extensive, because the pathological changes are no longer limited to the surface layer of the tendon end, so the treatment of this tendon paralysis must take into account the painful adhesions around the cross-loop. The “straight stabbing” is a direct stabbing to reach the surface of the lesion. The aim is to reach the painful cross-loop areas around the tendon without damaging the normal tendon tissue. “Before and after lifting” is a provocative operation on the adhesions. Lifting is the upward force from below, here, it is obvious that the long needle is stabbed straight along the tendon side to the deep part, then poked forward and then poked backward. Thus, the sharp edge of the end of the long needle is used to pick and cut on the adhesions, which has the effect of separating the lateral collateral cross-loop adhesions. When the adhesions on both sides of the tendon are untied, the pathological basis of the tendon is eliminated, and the protective spasm of the muscle is naturally relieved, thus achieving the effect of “restoring tendon urgency” to treat tendon paralysis.
(3) Short stabbing method and infusion stabbing method
Ling Shu? The short stabbing method treats bone paralysis by slightly shaking and deepening the needle to the bone, which is also used to move the bone up and down. “The infusion pricker, straight into the straight out, deep inside to the bone, in order to take the bone paralysis.”
Zhang Jinyue: “short stab, into the gradual also.” Gradually penetrate deeper and deeper to the bone, but it does not explain “up and down the bone”. The original text clearly requires that “up and down the bone”, Mo for the meaning of friction, the needle is thin and soft, can not do the operation of rubbing the periosteum, can only be point stabbing and carry on. However, the application of long circular needles can be completely “up and down the bone” kind of operation. In patients with bone paralysis, the long-term pulling of the tendon ends can cause damage to the tendon ends at the periosteal attachments. When the periosteum is pulled, there will be fluid and bleeding under the periosteum, which can cause periosteal reaction and stubborn pain. Therefore, long needles must be used to achieve subperiosteal decompression with their firmness and strength, which can have a frictional cutting effect on the bone surface, thus treating stubborn tendon paralysis and bone paralysis.
The short stab method is also useful for bone paralysis, for hard lump-like lesions on the bone surface, calcified focal points of knotted tendons, and ossifying myositis. Bone is characterized by hardness, and the ancients had no X-ray method, so pathological tissues that are deeper and harder to the touch are often treated according to tendons and bones. Some muscle ossification, close to the bones of the end of the tendon foci hard knot, which in ancient times is difficult to distinguish, may also be classified as bone paralysis. In the treatment, the ancients often use the “short stab” method. The short stab mainly refers to the needle into the short and gradual, into the needle into the gradual is to keep the needle body straight, vertical deep stab, which is similar to the infusion method “straight into the straight out, deep inside to the bone, to take the bone paralysis” operation and meaning. However, the reason why the ancients had to establish two methods, there must be a difference and different meaning. The short stabbing method is a gradual process, in which the patient is touched by hard, bone-like tissues, and the short stabbing method can be performed on the surface of the tissues, while the infusion stabbing method is a deep stabbing to the bone, and the hard lesions on the bone surface can be peeled off and decompressed. For example, in some stenosing tenosynovitis, the tendon sheath is thickened and deformed, and some bony fibrous tubules are like bone when touched. For the treatment of these tendon sheaths, bony fiber canal, can also be used “up and down the bone” kind of operation, with a long circular needle will tendon sheath and ligament cut open, to achieve the purpose of relaxation of narrow tendon sheath or fiber canal, this can also be said to be the short stab method of alternative applications, this kind of cutting operation for bone-like hard knots, also has clinical application value.
8.Yin and Yang properties of long circular needles
Yin and Yang are a pair of categories of ancient Chinese philosophy. The initial meaning of yin and yang is very simple, indicating the sunlight backward and forward, sunward for the sun, backward for the yin, later derived for the climate of the cold and warm, orientation of the up and down, left and right, inside and outside, movement state of agitation and quiet, etc.. The ancient Chinese philosophers then realized that all phenomena in nature have a relationship of mutual opposition and interaction, and used the concept of yin and yang to explain the two opposing and mutually consuming material forces in nature, and believed that the opposition and consuming of yin and yang are inherent in things themselves, and then considered the opposition and consuming of yin and yang as the basic law of the universe.
According to the doctrine of Yin and Yang, the world is a material whole, and everything in nature consists of two opposing aspects of Yin and Yang, while the opposing sides are unified with each other. The unified movement of yin and yang is the fundamental cause of the occurrence, development, change and extinction of all things in nature. As in the Suwen? Yin and Yang are the way of heaven and earth, the outline of all things, the parent of change, and the origin of life and death”. Therefore, the contradiction and unity of movement of yin and yang is the inherent law of movement and change of all things in nature, and the world itself is the result of the unity of movement of yin and yang.
Anything can be divided by the properties of yin and yang, but only when it is a pair of interrelated things, or two aspects of a thing, does this division have practical significance. If the two things being analyzed are not related to each other, or are not two opposing aspects of a unity, they cannot be distinguished by yin and yang in terms of their relative properties and their interrelationship.
Long round needles combine the dual characteristics of long needles and round needles. Long needles are sharp and thin, with an edge at the end of the blade, which allows for sharp manipulation, cutting and transection of the “cross-loop”, and is suitable for sharp separation within the adhesions and scarring, a characteristic of Yang. The round needle is the end of the needle blade, shaped like an egg, rounded and blunt without an edge, which can be operated bluntly, and can also be poked along the gap between the fractures to separate the “cross-loop” between the fractures, without damaging the fractures, and is suitable for blunt separation of adhesions, scar edges and normal tissue connection areas, which is a yin characteristic.
The long round needle is a combination of the two, so that the end of the flat-bladed needle, one end remains sharp and one end remains round and blunt. So that a needle has both sharp and blunt end shapes. The masculine nature of the sharp end of the needle is conducive to penetrating the skin, so that the end of the needle reaches the point of the tendon lesion, and can perform sharp separation in the adhesions or scars, i.e., “before and after lifting” (forward or backward poking), “up and down the bone” (cutting the periosteum). At the edge of the tendon lesion close to the normal tissue, the rounded blunt end is used to perform blunt separation.
Through medical practice, the needle tool is continuously improved to combine the sharp and blunt edges, so that the yin and yang become one, i.e., the long round needles currently used. Make the sharpness of the long needle combined with the roundness of the staff needle, made needle end sharp but unfavorable, round but not blunt shape. This way its cutting separation effect although blunt but still has a cutting effect. When picking and cutting, because it is not very sharp, also will not cause important tissue cutting injury, so the safety is greatly increased.
The innovation of the long round needle is to carry forward the inheritance. Under the guidance of Chinese medicine meridian theory, it has its own Chinese medicine characteristics for the current chronic bone and joint pain diseases. It emphasizes the overall dialectical treatment of meridians and tendons, the physiological and anatomical analysis of more than 300 tendon nodes throughout the body, and the application of modern medical aseptic concept and anesthesia technology in treatment, which not only maintains the characteristics of Chinese medicine, but also combines the treatment technology of modern medicine to reduce the patient’s pain in treatment, and better demonstrates the characteristics of Chinese medicine in treating diseases and seeking the root, which is a rare characteristic Chinese medical method in the new era of Chinese medicine to the world.