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Safety & Practice

Adverse events, contraindications, depth limits, consent, and regulation — the responsibilities of needling.

Acupuncture is low-risk when performed by a trained practitioner using sterile single-use needles. Serious adverse events are rare.

Potential Adverse Events

Mild bleeding / bruisingCommon (~2–3%)Pressure; self-limiting.
Needle pain / discomfortCommonAdjust or remove needle.
Dizziness / fainting (vasovagal)Uncommon, first sessionsLie down; reassure; monitor.
Forgotten needlesRareCount needles in and out.
PneumothoraxVery rare, seriousAvoid deep/perpendicular over chest/upper back; oblique only. Refer if breathless.
InfectionVery rare with sterile techniqueAseptic single-use needles; avoid broken skin.
Nerve injuryRareAvoid needling into nerves; stop on sharp radiating pain.
Organ punctureVery rareDepth and angle limits; especially chest/neck/abdomen.

Contraindications & Cautions

  • Pregnancy: avoid LI4, SP6, BL60, BL67, lower-abdomen and sacral points; moxa on certain points.
  • Bleeding disorders / anticoagulants: use caution; superficial needling; avoid deep points.
  • Compromised immunity: sterile technique essential.
  • Lymphoedema / limb with nodes removed: avoid needling that limb.
  • Open wounds, ulcers, infection, tumors at the site: do not needle.
  • Seizure risk or severe needle phobia: caution; consider alternatives.
  • Infants: very shallow, few points.

Depth Cautions by Region

Skull/face (non-orbital) — 0.3–0.5 cun transverse

Avoid vessels and nerve trunks.

Orbit — ≤0.5 cun along orbital wall

Angle away from globe; press after.

Neck — 0.3–0.5 cun

Avoid carotid, jugular, brachial plexus.

Chest (anterior/posterior above T11) — 0.3–0.5 cun oblique

Pneumothorax risk — never perpendicular deep.

Abdomen — 0.5–1.5 cun

Empty bladder; pregnancy caution lower abdomen.

Back below diaphragm — 0.5–1 cun

Kidney at L1–L2 — avoid excessive depth.

Upper/lower limb muscle bellies — 0.5–2.5 cun

Avoid major nerves/arteries; stop on radiating pain.

Hands/feet — 0.1–0.5 cun

Prick to bleed well points.

Informed Consent

Explain the procedure, expected sensation (de qi), possible minor adverse events, and that serious events are rare. Obtain informed consent each course. Encourage patients to report discomfort immediately.

Regulation & Scope

Standards vary by country. Practice only within your licensed scope; use sterile single-use needles, clear hygiene, and accurate point location. Continuing education and clean-needle technique are standard expectations.