The order of acupuncture and massage is

There is no absolute standard answer for the order of acupuncture and massage. In more than 80% of routine conditioning scenarios in clinical practice, massage is performed first and acupuncture is performed later. For a few specific diseases and special schools, acupuncture is performed first, or even the two are interspersed.

Last week, I met an old client, Aunt Zhang, who had stiff shoulders and neck for almost three weeks. She was worried about the pain when she came here for the first time, so she insisted on inserting the needle first and then massaging it. She said, "It won't hurt anymore after the numbness is applied." However, when the needle was inserted that day, she winced in pain. The second time I came, I didn't follow her. I first used the rolling method to loosen her trapezius muscles for ten minutes, and kneaded most of the two knots on her upper back that were as hard as pebbles. When the needle was inserted, she only said, "I feel so sore and swollen."

In fact, the principle is simple. The main focus of massage is to "loosen the surface and open channels." Whether it is rolling, kneading or dialing, the tight superficial muscles and fascia are first kneaded to let the local stagnant Qi and blood move first. At this time, the first thing to do when inserting the needle is that the needle can be inserted smoothly, the patient will feel less pain, and the needle will not get stuck in the hard muscle bundle. ； The second is that the induction of "deqi" can more easily penetrate deep-seated lesions. Massage has already led the qi and blood to the local area. The effect of acupuncture is equivalent to adding a handful of firewood to the burning fire, which disperses it faster and more thoroughly. Moreover, after the massage, the pores are slightly opened, and the evil energy from the pinholes can more easily dissipate after the needles are pulled out, making it less likely to cause local soreness and swelling for several days after the needle is applied.

But this is not an iron-clad rule, and the differences between different schools of thought are quite large. For example, a doctor I know who practices Jingjin style will never massage a patient with an acute sprain or contusion. For example, if the waist has been injured within 24 hours, and the local area is so swollen that it is hard to touch, he will never massage it first. Instead, he will prick the pain point on his hand first. , the foot is in the center, and the patient is asked to slowly move the waist after pinning it. When the pain is reduced by 50 to 60% and the local muscles are less spasm, then use very light kneading to loosen the adhesions. It is said that pressing first at this time will aggravate the inflammatory exudation, and the more you press it, the more swollen it will be. There are also some old doctors who practice the ancient method of Qi-regulating acupuncture, and they pay more attention to "regulating Qi first and then adjusting the body." For patients who have whole-body conditioning, such as insomnia, poor spleen and stomach, and waist and leg pain, they will first prick the Qi-regulating acupuncture points on the abdomen and limbs, leaving the needles for 20 minutes to straighten the whole body's Qi mechanism, and then do a full-body massage to loosen the muscles and bones. They say that if the muscles and bones are loosened first and then the acupuncture is inserted, it will easily disperse the Qi that has just been introduced, and the effect will be compromised.

When I do it myself, I don’t get stuck in the order. Sometimes when I encounter a little girl who is afraid of needles, I first relax her head and neck for five minutes, and then I press her until she is dazed before inserting the needle. Basically, she won’t complain of pain.； If I deal with a client who has a heavy body and heavy moisture, I will first prick acupuncture points such as Zusanli and Yinlingquan that drain away moisture. I will press the arms and legs while retaining the needles. After removing the needles, I will relax the shoulders and back for a while. The client will feel several pounds lighter when he wakes up.

Of course, there are some red lines that should not be touched. For example, if there is localized skin damage, herpes, or fungal infection, you must not massage it first, otherwise it will easily rub the damaged area and cause infection. You must first use acupuncture to avoid the damaged area, and then massage it after the skin has healed.； For the elderly who are particularly weak and patients who have been ill and weak for a long time, try to prick the analgesic and tonic acupuncture points first, and then massage them with light techniques when their tolerance is up, so as to avoid feeling tired and exhausted after the massage.

To put it bluntly, there is actually no need to worry about the order. The core is to follow the patient's tolerance and the stage of the disease. The order that can solve the problem is the right order.