Pneumothorax due to improper needling is one of the most common needling accidents, and it has the highest incidence among physical injuries. Pneumothorax often causes serious consequences if the injury is severe or improperly handled. Since the first report of pneumothorax accidents due to needlestick in China in 1954, more than one hundred cases have been reported so far, and the actual number of occurrences is much more than that. Western countries and Japan, etc., also continue to appear this type of accident. Although mild pneumothorax is common after acupuncture, a considerable number of moderate to severe pneumothorax, including hemopneumothorax, which may cause life-threatening injuries, should be given great attention by acupuncture practitioners and readers. The following is a brief introduction to the general reader on knowledge related to pneumothorax after acupuncture. The pneumothorax caused by acupuncture accident is traumatic pneumothorax. Its pathological process is that the milli-needle acupuncture is too deep to pierce or cut the lung tissue, stabbing the lung to cause large lacerations, so that the lung layer pleura and alveoli damage, gas from the breach into the pleural cavity, the lung tissue at the breach can form a live valve, inhalation, the air into the pleural cavity; exhalation, the air can not be discharged, resulting in the accumulation of air in the cavity, the pleural cavity negative pressure disappeared, the lung that is according to its retraction force atrophy, the formation of pneumothorax. As a result, the intrathoracic pressure increases rapidly and the lung is atrophied by the pressure. The pneumothorax caused by acupuncture accident is generally divided into two categories: closed and tensional, depending on the severity of the injury and the original lesion. If the fissure is not large and the lung tissue is healthy, it is mostly closed pneumothorax; if the injury is heavy, or the original emphysema and other diseases, the fissure forms a unidirectional live flap, and tension pneumothorax can appear. If punctured blood vessels can form a hemopneumothorax. A few can also form a severe open pneumothorax. Pneumothorax is mostly caused by beginners who lack knowledge of acupuncture and anatomy. The specific reasons are the following: (a) the reason of acupuncture points: according to anatomy, in the back above the tenth thoracic vertebra, lateral thorax above the ninth rib, anterior thorax above the seventh rib, as well as the supraclavicular fossa, the upper edge of the sternal notch points, can cause pneumothorax due to improper acupuncture. Therefore, the ancients had the saying “the back of the chest is as thin as a cake”, cautioning against deep stabbing. (B) pathological reasons: the lungs are in a pathological state, mainly in the occurrence of emphysema, the lung volume increases, alveolar tension increases, not only easy to cause pneumothorax, the consequences are often serious. (C) operational reasons, which is the most important reason, mainly include: 1. Needle stab too deep: Where the tenth thoracic vertebra in the back, the lateral thorax in the ninth rib, the anterior thorax above the seventh rib, as well as the supraclavicular fossa, the upper edge of the sternotomy point (including the shoulder well), if the needle is too deep or incorrect direction, there is the possibility of stabbing the lung. Especially for some old and thin, with emphysema and other chronic chest and lung disease patients, in the needling chest back should be particularly careful. Secondly, failure to master the direction of the needle is also one of the causes of pneumothorax. Acupuncture points in the chest and back are generally suitable for oblique or flat pricking. In order to obtain satisfactory needle sensation and therapeutic effect, it is difficult to control the proper depth with straight stabs. Finally, when the needle is inserted with the hand, the muscle layer becomes thinner due to pressure and the stabbing channel becomes shorter accordingly. In addition, the back of the chest application of warm needles, may also be due to the needles on the addition of moxa cones, not enough proficiency, only pay attention to the finger end force, but ignore this action can also drive the needle body to the deep, resulting in pneumothorax. 2. Needles too thick, too heavy: with thick needles acupuncture acupuncture points inappropriate chest, can aggravate the symptoms of pneumothorax, resulting in extensive subcutaneous emphysema and mediastinal emphysema. The original depth of the needle is appropriate, but because the needle in the line of substantial twisting and turning more than the depth, the same can increase the chance of lung injury, the occurrence of pneumothorax. 3. improper body position: in the standing position or other unsustainable body position into the needle, easy to occur pneumothorax. This is due to the position is difficult to fix, piercing the tissue of the needle body in the muscle pull contraction also followed by activity, injury and lung. 4. after the needle plus can: such as needle has been injured lung, at this time cupping, often rapidly aggravate the condition. (D) patients are fat, thin, old and young, needling, such as no distinction, with the same depth, is also an important reason for the occurrence of pneumothorax. Such as the elderly, the chest muscles are not developed, especially the thin elderly, their trapezius muscle, shoulder lifting muscle and rhomboid muscle are different degrees of atrophy. In such cases, the lungs can also be injured if they are routinely deep. Most of the pneumothorax after acupuncture can be seen during or after the acupuncture process. There are also episodes within half an hour to several hours after needling, and there are even those that begin to produce typical pneumothorax symptoms 24 hours or more after needling, which are worth noting. Mild pneumothorax: generally no obvious conscious symptoms, or chest tightness and suffocation, irritating cough, pulling-like pain in the chest when moving. Moderate pneumothorax: stabbing pain in the chest and ribs, chest distension and discomfort, difficulty in breathing, persistent and violent cough, palpitation and restlessness, and inability to lie down. There are also corresponding dull pain in the back of shoulder and upper limbs and limitation of activities. Severe pneumothorax: strong stabbing pain in the chest and back on the side of the needle, the pain may radiate to the ipsilateral shoulder and arm or to the upper abdomen, and there is extreme difficulty in breathing, cold extremities, irritability and sweating, and mental coma. In case of hemopneumothorax, there are even more critical symptoms such as shallow breathing, pale face, thin and rapid pulse, and decreased blood pressure. In mild pneumothorax, the signs are not obvious. In moderate or severe pneumothorax, the respiratory rate is accelerated, the heart rate is increased, and there may be nasal flapping. The trachea and apical pulsation are shifted to the healthy side, the rib space on the affected side is full, the respiratory mobility and fibrillation are reduced or disappeared, and some patients have subcutaneous air accumulation in the chest wall. In some patients, there is subcutaneous pneumonia in the chest wall. The percussion sounds are hyperclear or turbid drums, and the breath sounds on auscultation are diminished or absent, while the breath sounds on the healthy side are enhanced. Severe cases may also show telangiectatic breathing and cyanosis. Pneumothorax after acupuncture is usually examined by X-ray, the pneumothorax part has increased translucency, no lung pattern, the lung is contracted toward the hilum and becomes a transparent mass, and the dirty layer of pleura with hairline shadow is visible at its edge. The degree of lung atrophy can vary from 10-90%, and in the case of hemopneumothorax, the fluid plane is visible. Pneumothorax patients need to rest quietly after acupuncture, oxygen, according to the severity of their pneumothorax to the corresponding treatment: 1, mild pneumothorax if the patient does not have obvious shortness of breath, cyanosis after acupuncture only the injured side of mild chest discomfort, shortness of breath after activity, by X-ray diagnosis of lung atrophy within 30%, and no pulmonary lesions such as emphysema, and no prevent the natural absorption of pneumothorax of the original disease, general bed rest 5-7 days. Cough suppressants and analgesics are given according to the symptoms. In order to prevent infection, appropriate injection of antibiotics can be considered. Generally, the gas can be absorbed and healed by itself, but it is necessary to pay attention to observation or review at any time to prevent sudden aggravation of symptoms. 2, pneumothorax patients with lung atrophy of more than 30%, or with emphysema and other conditions, the patient should be made to rest in bed and keep quiet. Use the second intercostal space in the midclavicular line or the 4th to 5th intercostal space in the anterior axillary line on the affected side, after routine disinfection, puncture and suction or perform closed chest drainage for early exhaustion to promote reopening of the compressed lung. If the chest X-ray shows that the lung has reopened and the respiratory sound of the injured side of the lung disease has been restored, the drainage tube should be closed and observed for 24h before removing the drainage tube. 3, blood, liquid pneumothorax in the use of the above treatment measures on the basis of, such as the emergence of shock symptoms, should be combined with blood transfusion, anti- shock treatment. In case of persistent active bleeding, timely surgery should be performed to stop the bleeding. It should be emphasized that severe and more serious pneumothorax is a clinical emergency. Pneumothorax due to improper acupuncture is often the main contradiction that the primary disease does not improve, but instead highlights the manifestation of pneumothorax. In this case, some family members and patients, because of panic, or some medical personnel lack of basic treatment knowledge, often send patients from rural areas to urban hospitals. This increases the patient’s suffering on the way, and even life threatening. Because most patients are simple pneumothorax, local treatment should be the main focus. For patients with severe pneumothorax who must be transferred to a hospital, the necessary chest venting should be performed before or during the transfer process. In case of emergency, a finger sleeve can be tied to the end of the general puncture needle, sterilized and pierced into the chest cavity, fixed on the chest wall with adhesive tape, and then a small hole of 2-3 mm will be cut at the top of the finger sleeve to solve emergency exhaustion and prevent accidents due to tension pneumothorax on the way.