During acupuncture treatment, “keeping vitality" and “keeping qi" are two important factors for achieving a better therapeutic effect. But not every acupuncturist can accomplish this in clinic. 

In China, the ancient acupuncture doctors were very concerned about “keeping vitality". In some chapters of the classical medical book Ling Shu (Miraculous Pivot), it is recorded that the needling method must be based on the patient's vitality first; the key point for acupuncture is not neglecting the vitality; a careless acupuncturist merely pays attention to keeping formality when needling, while a qualified acupuncturist pays more attention to keeping vitality. Thus, vitality is very important in acupuncture treatment of disease. As to keeping the vitality during acupuncture, the following four aspects should be noted.  

1. Inspecting Vitality (spirit)
During fighting between the vital energy of the body and the pathogenic factors, the vitality is referred to the vital qi. Blood and qi are the basis for generation of vital qi. Thus Su Wen (Plain Questions) says that blood and qi are the vitality of human body and must be kept flourishing carefully and continuously. So, vitality is the sublimation of qi and blood and the general reflection of the life phenomenon. It can give us the impression to the prosperity or decline of the functions of the internal organs, qi and blood.  As recorded in book Miraculous Pivot that “patients with spiritedness will survive while those with spiritlessness will die". Vitality distributes in the whole body, its higher function means mental activity. Therefore, inspecting the state of patient's spirit is the first important step for determining the reinforcing or reducing needling manipulation. It is thus that a chapter of Plain Questions says that when giving acupuncture treatment, the acupuncturist needs to understand the existence o r death of spirit, spiritedness and spiritlessness by inspecting patient's conditions of spirit. 

2. Stabilizing Spirit
Nearly everyone is afraid of needling, particularly those who accept acupuncture treatment for the first time. The frightened psychological factor may lead t o muscular tension of the whole body, which brings the doctor with some difficulties in operation for searching and controlling needling sensations. Hence, helping patient to get rid of frightened psychological factor and to set up confidence for triumphing over disease is the prerequisite to the smooth operation of acupuncture needle. Thus, it is recorded in book Jin Zhen Mei Hua Shi Cao (Duplicated Mume Flower Poems of Golden Needle) that if the patient's spirit is normal,  his or her worries are few, the qi and blood will keep smooth. If the patient believes acupuncture and the doctor firmly, the treatment will work well, and the doctor will get twice the result with half the effort. In addition, operating filiform needle is different from other methods. The environment needs being quiet. During acupuncture, the patient should also pay attention to the needling sensation. Just as some remarks in book Zhen Jing Biao You Fu (Canon of Acupuncture in Verse) that..., when patient gets calm, acupuncture is given to the patient immediately. If the patient is restless, puncturing is not suitable at that moment. In this way, the needling sensation propagating phenomenon is easier to appear. In some acupuncture clinic, there were quite a few sick beds in one room, and more than ten patients, doctors and nurses crowded together, they had a chat there. Such a noisy environment is definitely unfavorable to patient's mental relief.  

3. Regulating Vitality
When giving acupuncture treatment, some acupoints need to be selected. The acupoint is the place of activity of vitality and qi. Acupuncture treatment needs performing reinforcing or reducing manipulation upon acupoints while reinforcing or reducing is aimed at regulating vitality and qi. Whether the reinforcing or reducing manipulation is proper or not, it is closely related to the state of vitality. If reducing manipulation is adopted incorrectly for treatment of deficiency syndrome or the reinforcing manipulation used to treat excess syndrome, the  vitality will fall into derangement, and the wrong manipulation will help the pathogenic factors injure the vital energy of the body. On the contrary, if reinforcing method is used to treat deficiency syndrome and reducing method used to treat excess syndrome, the vitality will function normally. If so, the doctor is sure to be considered as a qualified doctor. Therefore, performing correct reinforcing or reducing manipulation can regulate patient's vitality by suppressing its hyperactivity and supplementing its insufficiency, making the patient full of  vim and vigor. The treatment will succeed.    

4. Concentrating Attention (on acupuncture)   
Even in ancient times, Chinese practitioners always stressed devoting the mind to needling during acupuncture treatment. For example, in one chapter of Plain Questions, it is recorded that when giving acupuncture treatment to the patient, the clinician should not take care of any other affairs except for acupuncture, as if he is standing beside the abyss or holding a tiger with hands. Miraculous Pivot says that during acupuncture, the clinician has to concentrate his or her attention to the needle. Zhen Jing Biao You Fu also stresses that during acupuncture, the doctor should not watch other things, as if he is holding a tiger or very carefully serving a distinguished guest. These all stress that the doctor should devote his or her mind to inspect the feeling beneath the needle tip and patient's reaction when conducting acupuncture treatment. Nowadays, we sometimes see that during acupuncture, one or two clinicians are observant and alert to other things rather than acupuncture operation, they carelessly manipulate the needles, talking and laughing incessantly. If no needling sensations are gained, they lift, thrust and twirl the needle violently or aimlessly give penetration puncture from point to point or perform deep insertion of the needle. As a result, some sequelae as stiffness of the limbs (in light cases), even visceral hemorrhage, pneumatothroax, shock, etc. (in severe cases) may occur.   

For this reason, during acupuncture, the doctor should pay close attention to  “keeping vitality" including both the patient's spirit and doctor's own mind from beginning to the end of the treatment. In ancient China, practitioners always required to stop all interference from different sources during acupuncture treatment in order to get a good exchange between the doctor and patient. As is mentioned in Miraculous Pivot that the doors and windows should be closed during acupuncture treatment of patients, which is not a bad idea even today. 

In the process of acupuncture, the doctor should not only pay attention to “keeping vitality" but also to “keeping qi". The so-called qi is referred to puncture induced reaction in the local area. Only “Deqi" (achieving needling sensations), can a satisfied result be obtained. Thus, Miraculous Pivot says that the key point for acupuncture is “Deqi", if qi comes, the treatment will work well,  as if the wind blows away the clouds in the sky, ... . Zhen Jing Biao You Fu also says that if qi comes quickly, the therapeutic effect will be gained rapidly; if qi comes slowly, the therapeutic effect will be poor. All of these indicate the correlation between “Deqi"and the therapeutic effect. “Keeping qi" means that after achieving needling sensations, keeping them and don't let them go away. This point is very important in acupuncture treatment. Zhen Jiu Da Cheng (Com pendium of Acupuncture and Moxibustion) says that it would rather miss the opportunity than lost qi, showing the importance of keeping qi. But in acupuncture circle, there is always a saying that Deqi is easier than keeping qi. If the acupuncturist is careless during operation, even qi has come already, it will disappear very soon. Like this, needling manipulation is making a futile effort. This situation is frequently seen in clinicians with poor experience. Miraculous Pivot points out that the practitioner knowing to grasp the opportunity of treatment, also knows keeping qi, ..., after achieving qi, pay attention to it and don't l et it go. That is to say that for keeping qi, the doctor must identify the condition of “Deqi" carefully, if qi reaches, don't change the direction and depth of the acupuncture needle, and keep holding the needle still continuously, or apply treating  vitality to control qi method, making the operator's qi run through  his finger to maintain acupuncture manipulation induced qi. On the other hand, the practitioner applies gentle and even manipulation to promote meridian qi to come around the needle tip slowly and continuously. For keeping qi, the acupuncture doctor has to give all of his or her attention to acupuncture, carefully experience and watch activities of meridian qi, including impulsive feeling, heavy and tight feelings, the attracting force when twirling the acupuncture body, muscular beating in acupoint area or in the distal part from the stimulated acupoint, etc.. When needing retaining the needle to maintain qi, twirl the needle body forwards for a few times to wait for arriving of heavy and tight sensations beneath the needle tip. It is all right if the acupuncture doctor feels stagnant beneath the needle tip and the patient experiences heavy and tight sensations. Such kind of “keeping qi" not only generates an apparent needling sensation during retaining of needle, but also lasts a stronger reaction for a several hours or even a longer period of time after removing the needle. As a result, a good therapeutic effect will be sure to be obtained.  

In conclusion, keeping vitality and keeping qi are two inseparable and indispensable aspects for achieving a better therapeutic effect. Keeping vitality is the premise for generating therapeutic effect while keeping qi is the key for gaining a better therapeutic effect. If the acupuncture doctor can pay close attention to the both simultaneously, the treatment will work very well.   

By Zeng Yonglei, Wang Jing