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Medical Qi Gong

By David Twicken, DOM, LAc

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Needle Sequencing: Something I Wish I'd Known Sooner

The pathways in Chinese medicine are first presented in the Mawangdui medical texts that date to the warring states, a period of the Zhou dynasty (403 BC-221 BC). Hundreds of years later a more comprehensive and precise pathway system is presented in the Han Dynasty medical classics: the Ling Shu and the Su Wen.

What Makes Acupuncture Work?

In the early Chinese medical classics it is clear the acupuncture pathways are the main medium for how acupuncture works. However, this clear and simple reason has become very vague and ambiguous in the mainstream medical community.

Modern researchers and practitioners seek to find how and why acupuncture works from a biomedical way, but this model has not yet revealed a definitive reason. The tools of modern medicine identify that acupuncture has an effect, for example, a PET scan can show how inflammation decreases with acupuncture treatment.

As practitioners of acupuncture we have direct experience of what is clinically effective. It is my experience as a practitioner, teacher and supervisor of interns at acupuncture schools that the main reason why acupuncture works is the function of the pathways of the acupuncture channels.

Function of the Pathways

acupuncture needles - Copyright – Stock Photo / Register Mark In the study of acupuncture the student learns the pathways of the channels, which includes internal pathways and external pathways (where the acupuncture points are located). The internal pathways can flow deep within the body and the pathways where the acupuncture points exist are located at the more superficial layers.

Each of the 12 primary channel pathways connects to their own organ and then to a yin-yang paired organ. Understanding these pathways is the key to understanding how a practitioner can influence everything along the channels, including the internal organs.

One of the guiding principles in the practice of acupuncture is to know the location of the disease. This means the specific anatomical areas, and the channels where the condition is located. Selecting channels that are connected to, or influence these areas is key to the success of treatment.

Point Combinations

The Nei Jing presents two main ways to influence an acupuncture channel and its related areas; those methods are, reinforcing and reducing. Reinforcing means to guide qi (or other vital substances) to an area or location. Reducing means to guide pathogens away from an area.

These two methods seem simple, but are quite profound; in my experience, applying them in a wider way than is commonly practiced is the key to more effective acupuncture treatments. Creating point combinations by stimulating the entire channel is the goal, and this often requires more than one point on a channel.

The Importance of Needle Sequencing

The common way acupuncture is presented is learning the functions of each acupuncture point. It's common for the student to think each point can treat all the conditions and syndromes listed.

When acupuncture is presented in this way the function of the points can become detached from its relationship to the channels and the effect of treating multiple points on a channel.

One of the most important aspects in clinical practice is the sequence or order the points are needled. There is very little guidance in acupuncture texts in Chinese medical schools in the West on this critical aspect of acupuncture. A standard text in the U.S. is Acupuncture and Moxibustion. In Chapter 17, Internal Diseases, the text includes western medical conditions and their corresponding Chinese medical syndrome or condition.

They list points that can treat the condition. They do not present which points are needled first, second, third, etc. They do not present any kind of order, for example, ascending or descending. They do not even group points by areas of the body or by channel, they list points on the back of the body with points on the front of the body in a random order. There is no guidance on a clear plan of how to combine and perform a treatment.

Connecting the Dots

Making the connection between the internal pathways, anatomical areas, internal organs and the acupuncture points is the first step in applying a Chinese medical understanding for how acupuncture works. For example, if a patient is spleen qi deficient and your treatment plan is to reinforce (tonify) the spleen, the goal is to pick points on the spleen (and related channels) to reinforce the spleen. The question is how does this happen?

The spleen pathway flows from the well point, spleen 1, up the channel to connect to the spleen. The objective is to stimulate the spleen channel to move the qi up the channel into the spleen. This stimulation is the key. I use the term "therapeutic effect" for the type of stimulation necessary to accomplish the goal. In a way it can be viewed as the dosage. The key is to view the treatment as influencing the channel and the targeted area; determining how many points it takes to get the therapeutic effect is a key in treatment.

This is not a point driven approach; it is a channel driven approach. It is the ability to stimulate the channel to get the desired therapeutic effect. It is common to select spleen 3, the source point to reinforce the spleen. The practitioner needles spleen 3, preferably with a reinforcing technique. The hope is needling spleen 3 will cause the qi in the spleen channel to move into the spleen.

My experience is that using a single point is often not effective enough. If spleen 9 is added there is a stronger force than one point; hopefully, the two points and their collective influence moves enough qi within the channel to fill the spleen with qi to restore it to its normal function. Two is better than one in most cases. The order is important. If the goal is to reinforce the spleen and move the qi up the channel into the spleen, the two points on the spleen channel create a vibration or stimulation causing a stronger flow of qi than needling one point.

It is much more effective beginning at the most distal area and then move closer to the area the qi is to be directed. In this case, needling spleen 3 and then stomach 36 is more effective. Additionally, it is generally more effective to needle up one side of the channel to create a stronger influence than going right then left and breaking the momentum up the channel.

The better method would be to needle left spleen 6 and left stomach 36 and then right spleen 6 and then right stomach 36. This ipsilateral order is essential in creating a stronger therapeutic effect within its channel, resulting in a stronger flow of qi into the spleen.


  • Harper D. "Early Chinese Medical Literature: The Mawangdui Medical Manuscripts." London: Kegan Paul International, 2007.
  • Wu J. "Ling Shu or The Spiritual Pivot." Hawaii: University of Hawaii Press, 2002.
  • Twicken D. "Eight Extraordinary Channels—Qi Jing Ba Mai: A Handbook for Clinical Practice and Nei Dan Inner Meditation." London: Singing Dragon, 2013.

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