If administered correctly, acupuncture should not injure any organ. However, if injury does occur, it may be serious.
There are a great many acupuncture points, some which carry little or no risk and others where the potential of serious injury always exists, particularly in unskilled or inexperienced hands.
As training programmes in acupuncture are intended for different levels of personnel, it follows that they should be adapted to the knowledge, abilities and experience of those concerned. At elementary levels, the selection of acupuncture points should be limited. At professional levels, the range can be expanded but, even so, the use of certain points and manipulations should still be restricted to those with great experience.
The following passages present examples of points which carry particular potential risk. As in all forms of treatment, it is important to measure risk against expected benefit.
5.1 Areas not to be punctured
Certain areas should not be punctured, for example: the fontanelle in babies, the external genitalia, nipples, the umbilicus and the eyeball.
5.2 Precautions to be taken
Special care should be taken in needling points in proximity to vital organs or sensitive areas. Because of the characteristics of the needles used, the particular sites for needling, the depth of needle insertion, the manipulation techniques used, and the stimulation given, accidents may occur during treatment. In most instances they can be avoided if adequate precautions are taken. If they do occur, the acupuncturist should know how to manage them effectively and avoid any additional harm. Accidental injury to an important organ requires urgent medical or surgical help.
Chest, back and abdomen
Points on the chest, back and abdomen should be needled cautiously, preferably obliquely or horizontally, so as to avoid injury to vital organs. Attention should be paid to the direction and depth of insertion of needles.
Lung and pleura
Injury to the lung and pleura caused by too deep insertion of a needle into points on the chest, back or supraclavicular fossa may cause traumatic pneumothorax. Cough, chest pain and dyspnoea are the usual symptoms and occur abruptly during the manipulation, especially if there is severe laceration of the lung by the needle. Alternatively, symptoms may develop gradually over several hours after the acupuncture treatment.
Liver, spleen and kidney
Puncture of the liver or spleen may cause a tear with bleeding, local pain and tenderness, and rigidity of the abdominal muscles. Puncturing the kidney may cause pain in the lumbar region and haematuria. If the damage is minor the bleeding will stop spontaneously but, if the bleeding is serious, shock may follow with a drop of blood pressure.
Central nervous system
Inappropriate manipulation at points between or beside the upper cervical vertebrae, such as GV 15 yamen and GV 16 fengfu may puncture the medulla oblongata, causing headache, nausea, vomiting, sudden slowing of respiration and disorientation, followed by convulsions, paralysis or coma. Between other vertebrae above the first lumbar, too deep needling may puncture the spinal cord, causing lightning pain felt in the extremities or on the trunk below the level of puncture.
Other points which are potentially dangerous and which therefore require special skill and experience in their use include:
BL 1 jingming and ST 1 chengqi, located close to the eyeball;
CV 22 tiantu, in front of the trachea;
ST 9 renying, near the carotid artery;
SP 11 jimen and SP 12 chongmen, near the femoral artery; and
LU 9 taiyuan on the radial artery.
Care should be taken in needling areas of poor circulation (e.g. varicose veins) where there is a risk of infection, and to avoid accidental puncture of arteries (sometimes aberrant) which may cause bleeding, haematoma, arterial spasm or more serious complications when pathological change is present (e.g. aneurysm, atherosclerosis). Generally, bleeding due to puncture of a superficial blood vessel may be stopped by direct pressure.