Professional Documents
Culture Documents
Operation Guideline
For
Acupuncture by Physiotherapists
The content of this guideline was based on epidemiological and other research
evidence available in international literature and guidelines, supplemented where
necessary by the consensus opinion of the Acupuncture Working Group of PTCOC,
Hong Kong Hospital Authority.
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Composition of the Acupuncture Working Group, PTCOC:
Chairman
Mr. Eric LAW Yuen Tung SPT, POH
Secretary
Ms. Cecilia KWOK Yee Fung PTI, RHTSK
Members
Mr. Andy CHAN Chi Ming SPT, HKBH
Mr. Anthony LAU Wing Keung DM(PT), AHNH
Mr. Alex WONG Kam Wah PTI, PYNEH
Mr. Chris WONG Hiu Po PTI, TWH
Mr. Frank LAU Wai Kwong PTII, HHH
Mr. Kenny YUEN Chi Chung PTI, DTRC
Mr. Raymond TSANG Chi Chung SPT, QMH
Mr. Simon HUI Wai Chi SPT, KCH
Mr. Steward CHEUNG Ying Kit SPT, KWH
Mr. Tony CHIU Hiu Fai PTI, UCH
Introduction
Acupuncture has been embraced as one of the treatment modalities within the scope of
Physiotherapy practice in some hospitals in Hong Kong since 1980’s. According to
the Chinese Medicine Ordinance 108(3), the Hong Kong Government SAR has
legitimized the practice of acupuncture, bearing distinguishable differences from that
based on Traditional Chinese Medicine, by registered physiotherapists in Hong Kong.
To uphold the standard of local physiotherapists practicing acupuncture , there is an
accreditation procedure by our professional body – the Hong Kong Physiotherapy
Association , which has set its standards in line with the international benchmark- the
International Acupuncture Association of Physical Therapists (IAAPT).
11 接受針刺治療病人須知 p.27
8. Follow the Code of Practice issued by the Physiotherapists Board of Hong Kong.
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Formulation of Acupuncture Treatment Plan
A. Assessment
1. Subjective and objective information from patients, as well as medical
investigation, patient’s personal particulars are collected.
2. Data from the assessment should be documented as clinical records.
3. Data is analyzed.
4. Area and type of acupuncture intervention are identified.
B. Intervention Plan
1. Goal for acupuncture intervention should be set.
2. Problems, goals and intervention program (including acupuncture and other
appropriate modalities) should be discussed with patients.
3. Contra-indications and precautions for acupuncture and all intervention
modalities selected should be noted. A checklist prior to implementation of
acupuncture is advised. See Appendix I for reference.
4. Verbal consent for acupuncture treatment must be obtained from patients.
5. Intervention plan and time frame of therapy are designed.
6. Acupuncture intervention plan, as aligned with the holistic treatment plan,
is documented.
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Contra-indications and Precautions of Acupuncture
B. General Precautions
C. Special Precautions
a. Orbit of eye:
B1 ( Jingming 睛明), medial orbit
S1 ( Chengqi 承泣), mid-lower orbit
Ex-HN4 (Yuyao 魚腰), mid-eyebrow
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c. Points over lung tissues unprotected by bone or cartilage:
L 1 (Zhongfu 中府), front of upper lung
G 21 ( Jianjing 肩井), apex of lung
B 11 ( Dazhu 大杼), back of upper lung
Liv 14 ( Qimen 期門), anterior of lung
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2. Pregnant patients-Avoid acupuncture in the first trimester of pregnancy as
needling may cause a “miscarriage”, or in the last 3 months as it may cause
premature labour. Also to avoid points that are considered especially likely to
disturb a pregnancy. e.g.
a. LI 4 (Hegu 合谷)
SP 6 (Sanyinjiao 三陰交)
K 3 ( Taixi 太溪)
B 60 (Kunlun 昆侖)
B 67 (Zhiyin 至陰)
b. points over lower abdomen
c. ear points related to endocrine and genito-urinary system
d. scalp points for genital and motor sensory areas
e. strong electro-stimulation to acupuncture points.
3. Diabetics patients- Care should be taken when needling diabetic patients because
of the danger of poor peripheral circulation and the effect of some points on
blood sugar level.
4. Frail Patients- Patients with a weak constitution after prolonged chronic illness
may tolerate acupuncture poorly. Strong manipulation is not recommended.
6. Confused Patients- Great care must be taken with patients who are unable to
understand the acupuncture procedure.
8. Bleeding disorders:-
a. naturally occurring haemorrhagic diseases like haemophilia, Von
Willebrands
b. drug-induced bleeding, like warfarin
c. apply pressure on each point on removing needles
9. Drugs- Patients receiving drug treatment for certain diseases may suffer
complications due to over-correcting of that condition by the homeostatic action
acupuncture eg. patients with high blood pressure or diabetes.
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10. When Sensation of acupuncture cannot be obtained at a conservative needle
depth, let the needle rest and allow Sensation of acupuncture to come to the
needle over time.
10
Warnings Given to Patients Prior to Acupuncture
Treatment
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Acupuncture Infection Control Procedure
A. Practitioner Preparation
1. Practitioners should wash hands with liquid soap and water, and thoroughly
pat dry hands before and after acupuncture application to patients.
1. The patient’s skin should be clean and free from cut, wound and infection.
2. The patients’skin should be inspected for dirt and grease. If skin is dirty, oily or
sweaty, it should be washed with warm water and liquid soap, rinsed and dried
before a skin disinfectant is applied. Dirty skin may inactivate the skin
disinfectant.
[Note: all practitioners must check for iodine allergy if using disinfectant
containing iodine.]
5. Disinfectant should be left on the patient’s skin for acupuncture for at least 1
minutes and then allowed to dry, before commencing acupuncture. The
patient’s skin should not be touched after skin disinfection.
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B.2 For patients with deficiency in immune system or when needling into a
joint space
5. For patients who have a deficiency in their immune systems, or when needling
into a joint space, a disinfectant such as povidone iodine or 0.5-1.0 % w/v
chlorhexidine in alcohol should be used. The disinfectant should be left on the
skin for a minimum time of 1 minute and then allowed to dry.
[Note: all practitioners must check for iodine allergy. For those patients
allergic to iodine, chlorhexidine in alcohol is suitable as a substitute.]
C. Needle Insertion
2. Ensure the portion of the needle to penetrate the skin does not come into
contact with the bare fingers of the practitioner, or any non-sterile surface.
D. Needle Manipulation
1. Manipulate needle using the handle of the needle. Avoid touching the shaft of
the needle.
2. In the case of long needles, a sterile glove may be used to grasp the top of the
needle shafts for insertion and/or manipulation.
E. Needle Removal
1. Practitioners must wash their hands with liquid soap and water and dry hands.
Use of approved disinfectant hand-rub is an alternative for hand hygiene if the
hands are not soiled and are clean.
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3. Used needles and swab/cotton wool balls must be disposed into an approved
sharps disposal container immediately.
5. Therapists should thoroughly wash their hands with liquid soap and water or
rub their hands in approved disinfectant hand-rub at the end of the treatment as
a routine infection control procedure to reduce the risk of cross-infection.
F. The Environment
1. The treatment area should be clean and with washing facilities near at hand.
3. Linen contaminated with blood and other body fluids should be treated with
hypochlorite solution before laundering.
1. Care must be taken to avoid contact with patients’ blood and body fluid.
Should bleeding occur, a dry cotton wool ball should be used to absorb it. The
used cotton wool ball should be put into an appropriate container marked
‘Contaminated Material’ and disposed of according to the Hospital Authority
policy and guideline.
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Prevention of needle accidents & adverse reactions
Possible Needle
Accidents or Adverse Possible causes Recommended Preventive Measures
Reactions
2. Pain during needle Blunt, hooked or Check needle before needle insertion
insertion thick needles Use quality needles
Highly sensitive Use needle of appropriate size
patients Full explanation and assurance to
patient prior to treatment
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Possible Needle
Accidents & Adverse Possible Causes Recommended Preventive Measures
Reactions
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Possible Needle
Accidents or Adverse Possible causes Recommended Preventive Measures
Reactions
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Possible Needle
Accidents or Adverse Possible Causes Recommended Preventive Measures
Reactions
11. Needle stick` Improper Use needle guide to facilitate
Injury management of needle insertion
needle Count number of needles after insertion
and on removal of needles
Use a gloved hand to hold the cotton
ball or use a cotton bud to assist to
remove the needles
All used needles should be
directly discarded in a sharps
container clearly marked
"danger- contaminated needles"
Locate sharps containers in close
proximity to treatment table, and
secure them to a wall or
horizontal surface.
Replace sharps containers when they
are more than 2/3 full.
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Management of Possible Complications
1. Pain caused by needle inserted deep Adjust the depth and direction of needle
into tissues and hitting pain receptor insertion
nerve fibers
2. Pain caused by needle entwined with Gently rotate the needle back and forth
fibrous tissue during manipulation until the fiber is released
3. Pain caused by curved needle after the Resume the original position , then
patient moved withdraw the needle carefully
4. Pain caused by unskilled manipulation Massage the affected area gently with clean
or excessive stimulation gauze for a while after withdrawal of
needle
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Possible complications Suggested Management
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Possible complications Suggested Management
13. Needle Stick Injury Encourage bleeding and wash wound well.
Blood test for Hepatitis, HIV status for both
therapist and patient.
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Application of Electro-acupuncture (EA)
A. Equipment
1. You must use a biphasic stimulator, designed for EA. Direct current
must be avoided in order to prevent polarization of the needle due to
electrolysis.
2. Do not use needles with a plastic handle.
B. Application Procedure
1. Place each pair of needles in acupuncture points according to:
a. type of stimulation
b. area of pain
c. distal points
d. meridians
2. Select needles to be paired up for EA.
3. Do not apply electrodes circuiting across the heart.
4. Minimum distance between two needles in a pair should be 3-5cm
while maximum distance be 20-30cm.
5. Insert needles to the selected acupuncture points till acupuncture
sensations are achieved.
6. Connect the wires to the handles.
7. Turn on the device and raise the intensity slowly till muscle
contraction (for use with Low Frequency) or paraesthesia (for use
with high frequency) is reported from the patient.
8. Set Treatment time e.g. 20-30 minutes.
9. Turn down intensity and switch off the device before disconnect from
the patient.
C. Choice of Parameters
1. Low Frequency(LF), 2-10Hz: stimulate the A-delta fibres, give
release of endogenous opioids, endorphins and produce muscle
contraction.
2. High Frequency(HF), 80-100Hz: stimulate the A-beta fibres, block
pain on segmental level through “pain gate mechanism”, it produces
paraesthesia.
3. Combination of LF and HF, e.g.2/15Hz (a continuous 2 Hz frequency
along with intervening but intermittent pulse trains of 15 Hz):
stimulate A-delta fibres, give release of maximum endogenous
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opioids, endorphins and enkaphelins.
4. Distal points: often LF (2/4Hz), the main issue for using distal points
is to prolong the treatment effect by activating central descending
inhibitory pathways.
5. HF in area where no muscle-contractions are possible, e.g. around
joints.
6. HF in patient with spasicity.
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Application of
Auricular Acupuncture Press Needle and Bead
A. Auricular Acupuncture
1. Select the acupuncture points and mark with pressure, or detect the most tender sites
with the point finder.
2. Clean the skin with warm water and liquid soap to remove the natural oil and dirt
from skin and dry well.
3. The needling site must be disinfected prior to acupuncture using disinfectant such as
70-80% ethanol, 60-70% isopropanol, 0.5-1.0% w/v chlorhexidine in alcohol or
povidone-iodine.
4. The disinfectant should be left on the skin for at least 1 minute and then allowed to
dry.
5. If acupuncture needles are inserted into the cartilage of the ear, the skin should be
prepared by using disinfectant such as povidone-iodine or 0.5-1.0% w/v
chlorhexidine in alcohol.
6. The disinfectant should be left on skin for at least 1 minute and then allowed to dry.
[Note: all practitioners must check for iodine allergy if using disinfectant containing
iodine. For those patient allergic to iodine, chlorhexidine in alcohol is suitable as a
substitute.]
7. Use small sterile disposable needles with 1/2 to 1 inch, either ipsilaterally or
bilaterally.
11. Use light weight clips to connect to needles in pair. Tape it if necessary.
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B. Semi-permanent Press Needle
(It is about 1.5mm long small needle with a head like a thumbtack)
1. Clean the skin with warm water and liquid soap to remove the natural oil and dirt
from skin and dry well.
2. The needling site must be disinfected prior to acupuncture using disinfectant such as
70-80% ethanol, 60-70% isopropanol, 0.5-1.0% w/v chlorhexidine or
povidone-iodine.
3. The disinfectant should be left on the skin for at least 1 minute and then allowed to
dry.
4. If acupuncture needles are inserted into the cartilage of the ear, the skin should be
prepared by using disinfectant such as povidone-iodine or 0.5-1.0% w/v
chlorhexidine in alcohol.
5. The disinfectant should be left on the skin for at least 1 minute and then allowed to
dry.
[Note: all practitioners must check for iodine allergy if using disinfectant containing
iodine. For those patients allergic to iodine, chlorhexidine in alcohol is suitable as a
substitute.]
7. Cover and hold the needle in place with plastic skin (flexible collodion)
9. If there are signs and symptoms of infection of the needling site(s), prompt medical
advice and treatment should be sought.
C. Semi-permeable Bead
Instead of using the press needles, small ballbearing –like objects can be used. They are
stuck over the site with an adhesive tape patch. Patients can apply pressure over the
beads to stimulate the points.
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Patient Information for Acupuncture
1. Please inform your physiotherapist if you have any of the following conditions:
pregnancy
menstruation
on Warfarin or other similar medications
haemophilia
diabetes mellitus
hypertension
epilepsy
pulmonary tuberculosis
hepatitis
infectious diseases
cardiac pacemaker
deep brain stimulator
other electronic implants
2. Please keep the body parts for treatment clean and free of any ointment before
acupuncture.
3. Avoid being hungry, thirsty and unduly tired before acupuncture.
4. Avoid wearing tight outfits and metal accessories over the body parts for
acupuncture.
5. During acupuncture, please relaxed and do not change position or move.
6. Please empty your bladder before acupuncture. This is especially important if
acupuncture is applied to the lower abdominal region.
7. Do not touch the needles or other acupuncture equipment.
8. Do not fall asleep during acupuncture.
9. During acupuncture, you may have one or more of the following sensations:
soreness, heaviness, fullness, local or radiating paraesthesia, and warmth. These
sensations are normal. Such sensations may last for a period of time after
treatment.
10. After acupuncture, there may be mild bruising over the treatment area, it will subside
gradually.
11. If you have any discomfort during acupuncture, please inform your
physiotherapist immediately.
12. Please consult your physiotherapist for any queries.
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接受針刺治療病人
病人須知
接受針刺治療病人須知
1. 病人如有任何以下疾病或情況,請立刻通知物理治療師:
˙ 懷孕
˙ 月經
˙ 正服食薄血丸或同類抗凝血藥物
˙ 血友病
˙ 糖尿病
˙ 高血壓
˙ 羊癇症
˙ 肺結核
˙ 肝炎
˙ 傳染病
˙ 裝有心臟起搏器
˙ 裝有腦部深層刺激儀器
˙ 裝有其他電子植入儀器
2. 每次應診前,請保持身體清潔,及避免在針刺治療部位塗上任何
藥膏。
3. 接受針刺治療前,應避免過飢、口渴或過累。
4. 請勿穿著緊身衣服或於治療部位配帶任何金屬物件。
5. 針刺治療時,請放鬆,切勿轉換姿勢或移動針刺部位。
6. 請於治療前如廁,這對於下腹部位的針刺治療尤其重要。
7. 切勿觸摸針或針刺用品及儀器。
8. 針刺治療時請保持清醒,切勿睡著。
9. 針刺治療時,可能會感到:酸 / 重 / 脹 / 麻 / 微溫。這是正常
針感,可能會於治療後持續一段時間。
10. 針刺治療後,針刺部位可能會有微瘀,一般會於數天後消失。
11. 於針刺治療時如感到不適,請立即通知物理治療師。
12. 如有任何疑問,可向物理治療師查詢。
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_______________________ Hospital
Physiotherapist Signature
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Reference
29
12 International Acupuncture Association of Physical Therapist 1997. Standards of
Practice of Acupuncture by Physiotherapist.
13 Kailin D.C. et al. 1997. Acupuncture Risk Management. The Essential Practise
Standards & Regulatory Compliance Reference. CMS Press 1st edition
ISBN-10:1891426001.
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24 The World Health Organisation 1996. Guidelines on Basic Training and Safety
in Acupuncture.
27 Woo Patrick C.Y., Leung K.W., Wong Samson S.Y. et al. 2002. Relatively
Alcohol-resistant Mycobacteria Are Emerging Pathogens in Patients Receiving
Acupuncture Treatment. Journal of Clinical Microbiology. 40:1219-1224.
29 Yang J. 1998. The way to locate acupoints. Foreign Languages Press, Beijing.
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