The sequence of acupuncture and massage

At present, there is no absolutely unified standard answer in clinical and practical scenarios. In most conventional conditioning scenarios, massage is given first and then acupuncture is given priority. In a few special cases and different schools, there is also an operational logic of acupuncture first and then massage. It must be flexibly adjusted according to personal physique, symptom type, conditioning purpose, and the operator’s school habits.

To be honest, I have been doing rehabilitation physiotherapy for almost 7 years, and the people I usually deal with the most are office workers with pain in their shoulders, necks, waists and legs. Eight out of ten patients are massaged first and then pricked.

For those who sit in the office and stare at the computer every day, their trapezius muscles feel as hard as old bacon that has been exposed to the sun, and the lumpy ropes feel sore when pressed. First, rub them for 15 to 20 minutes to loosen the tight muscles and loosen the deep adhesions. After the needle is opened and then inserted, the resistance of the needle is much smaller, and the soreness, numbness and swelling "deqi feeling" mentioned by the patient is also very even. It is not like when the needle is inserted directly, the muscles are so tight that it is difficult for the needle to penetrate even half an inch, and the patient still complains of pain. Leave the needle in for 20 minutes and your shoulders will become half lighter. Last time, there was a little girl who was working in operations. She had had an injection in another place before. She said that it hurt for three days after the injection. She came to me to press the needle first and then inject it. After that, she said that the injection was quite comfortable for the first time.

But it’s true that not all situations have to be this way. A while ago, I met a young man who had an acute stiff neck. When he woke up in the morning, his neck was twisted at a 45-degree angle and he couldn't touch him. As soon as I raised my hand to touch his shoulder, he howled. Isn't it scolding me for giving him a massage first in this situation? I directly pricked the stiff neck point on his hand, twisted it until he was angry, and asked him to slowly turn his neck. After turning it for five or six minutes, he said that most of the pain disappeared and he could move a little. I then gently rubbed his tense sternocleidomastoid muscle, and his neck could basically straighten when walking. If he had done it in the normal order, he would have cried in pain.

Different schools have different requirements. A few years ago, I consulted an old Chinese doctor who practices ancient acupuncture. He is used to inserting acupuncture first to adjust the ventilator of the main points in every situation. After the qi is cleared, he will do very light kneading to smooth the qi and blood. Their saying is "qi comes first, and then the form is adjusted." No. However, it is easy for the blocked air to move to other places during massage. I followed him for two months and saw that he treated elderly patients with chronic low back pain and the results were particularly good. There is nothing right or wrong at all, but the underlying logic is different.

A friend who specializes in health care told me that when I meet a client who is particularly weak in qi and blood, even when he squats down or stands up, he or she will feel dark and dizzy. They will first prick the acupuncture points that replenish qi and blood, such as Zusanli and Guanyuan, and leave the needles for 20 minutes to replenish the qi before performing gentle manipulations. Otherwise, the qi will be depleted with just one press, and the client will be exhausted after the treatment.

I met a very serious customer before. He said that he had read some popular science online and said that he could not be massaged after acupuncture, and that my operation was not standardized. I didn’t argue with him and tried both orders. The shoulder pain was 80% better when I pressed it first and then pricked it. When I pricked it first and then pressed it, he felt that his whole body was warm and he slept very well. After that, I could arrange it according to my wishes.

There is really no need to worry about a fixed order. When you go for treatment, it doesn’t matter whether the master massages or pricks first. As long as you feel comfortable and your symptoms have improved after the treatment, that is the correct order. Oh, by the way, if your skin is particularly sensitive and you are very red after the needle is inserted, just don’t ask the doctor to press the position near the eye of the needle. There is not much else to pay attention to.