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Hongmei Li, Hongyan Li, Yifan Feng, Sarah Nalbandian, Zhonghua Fu
Introduction
In 1996, Dr. Zhonghua Fu, M.D., Ph.D. invented Fu’s subcutaneous needling (FSN). It is a type of acupuncture treatment in which singleuse specialized subcutaneous needles are used to perform procedures such as sweeping and reperfusion within the subcutaneous superficial fascia of affected muscles in areas of pain or in distal areas. For the last 27 years, FSN has been used widely for pain management, internal medicine, gynecology and the treatment of benign chronic pain. ［1］ FSN has great advantages such as wide indications, fast and precise efficacy, easy operation, and no side effects.
FSN Concepts: from FSN Medical Essentials
In October 2016, at the same time as the founding congress of the FSN Expert Committee of the World Federation of Chinese Medicine Societies, the first edition of FSN Medical Essentials was released in Nanjing by Peoples Publishing House. The first definition of FSN (TCM) is: FSN is the use of needles to perform widearea sweeping subcutaneously so as to unblock the sinews, quicken the network vessels, and stimulate the selfhealing ability of the human body, thereby achieving the goal of treatment without the use of medication. It is mainly used to treat neck, shoulder, lumbar, and leg pain as well as a number of internal medicine and gynecological conditions caused by sinew vessel blockage and blood stasis. The second definition (rehabilitation) is: FSN is a subcutaneous needling method that uses needle implements such as singleuse subcutaneous needles in the area around the affected muscle that is causing pain or on nearby limbs. Like traditional acupuncture, it is a drug free treatment method. When carrying out the treatment, it is often combined with reperfusion exercises. Compared to traditional acupuncture, treatment effects and feedback can be obtained more quickly.
In October 2021, A New Theory of Qi and Blood was released by People’s Publishing House. This is a book based on FSN medicine that integrates TCM and Western medicine. The definition of FSN in this text is: FSN uses single use subcutaneous needles to perform wide area, prolonged traction on subcutaneous tissues. By releasing the associated muscles, it promotes blood circulation, improves metabolism, and activates the human body’s selfhealing ability, thereby achieving the goal of treatment without the use of medication. It is mainly used for neck, shoulder, lumbar, and leg pain, as well as a number of internal medicine and gynecological conditions caused by tense muscles or other soft tissue, or blockage caused by blood stasis.
How does FSN differ from traditional acupuncture
The first difference is in the type of needle used. Initially, when using FSN, traditional acupuncture needles were used, i.e. filiform needles. At present, some practitioners use filiform needles to perform early tage FSN techniques, but this is not called FSN. The subcutaneous needle invented by Dr. Fu is an extension, development, and innovation based on the traditional needle. The most recent version of this needle is the fifth generation, FSN5.0.
The second difference is in the needle’s point of insertion. Traditional acupuncture points often combine the area of pathology and that of treatment, and the majority have fixed locations. For instance, the point Hegu ［LI-4］ is located at the midpoint of the radial border of the second metacarpal bone on the bulge of the muscle. By comparison, the needle insertion point in FSN is just the area of treatment and its location is not fixed. In FSN, the needle insertion point is chosen based on searching for the affected muscle in the area of pain, from which the area of treatment is determined. For instance, if there is lumbar and back pain with a bulging disc, the muscles to examine include the erector spinae, quadratus lumborum, external obliques, multifidi, biceps femoris, tensor fasciae latae, psoas major, rectus abdominis, soleus, and peroneus longus. Instead of searching for pain points, one looks for the affected muscle and procedures are performed outside of this muscle.
The third difference is in the area of needling： which is limited to the subcutaneous connective tissues. This is the key feature of FSN. FSN is a change from the norm; while conventional needling stimulates the epidermis, dermis, muscular fasciae, muscle, and even the periosteum with a perpendicular insertion, FSN is a transverse needling method in which only the subcutaneous layer of connective tissue and superficial fasciae is needled.
Needling techniques listed in chapter 7 of Ling Shu ［The Magic Pivot］, entitled “Official Needles”, such as hair needling, straight needling, surface needling, and half needling, are the theoretical origin and basis for the subcutaneous needle insertion technique of FSN.
FSN has a single target organ, the loose subcutaneous connective tissues. What it treats is the muscles, as affected muscles can cause many ailments in clinical practice. It reveals the reasoning behind the adage of treating a deeprooted illness with shallow interventions.
The fourth difference is in the needling techniques used. Techniques used with traditional filiform needles include lifting and thrusting, twirling, adjusting the direction, and supplementation and drainage. In contrast, FSN only uses the sweeping technique, including level sweeping and spiral sweeping.
The fifth difference is in the intensity and effects of stimulation: In traditional acupuncture, de qi ［obtaining qi］ is an important method and sign of clinical effectiveness, so in clinical practice, the majority of acupuncturists try to obtain qi as described in the text Biao You Fu ［Song to Elucidate Mysteries］: “The arrival of qi is like the floating and sinking of a fish swallowing a baited hook.” One of the standards for evaluating an acupuncturist’s skills is whether or not they can obtain qi. By comparison, FSN requires one to avoid making the patient feel qi sensations like soreness, distension, heaviness, and numbness. This is especially useful for acupuncturists practicing outside of China, as we often find that in clinical practice, patients complain, “I do not like de qi.”
The sixth difference is in the unique characteristics of FSN treatment: it is simple, safe, natural, non toxic, and yields quick results. Its efficacy is readily comparable to Western medicine, the procedures are 100% safe, and there are no side effects. It is also highly reproducible.
Six Unique Features
Find affected muscles instead of finding pain points and all procedures are performed outside the affected muscle. When sweeping, one must make the affected muscle move. Treating deeprooted illness with shallow interventions increases patient satisfaction. The needling is painless and harmless, and treatment outcomes are obvious and immediate.
FSN Procedures
Inserting the needle
Transporting the needle
Sweeping the needle
Retaining the needle
Removing the needle
The Thought Process Behind FSN Treatment
Definitive Diagnosis
Based on a full understanding of the etiology, pathology, condition, and duration of an illness, as well as the size of the affected area and its location, one can take into account the location, severity, and quality of pain to perform a comprehensive analysis and thereby clarify the diagnosis to determine whether or not the case is within the scope of FSN treatment. This is the first question to consider in clinical practice because it is only possible to obtain the best clinical results if the diagnosis is correct and fits the scope of FSN treatment.
Here it is necessary to emphasize that no treatment method is universally effective. FSN is not effective for treating all illnesses and pain. In clinical practice, we must sincerely evaluate and screen for indications. If we have yet not seen the patient and the relevant examinations have not been done, we must not make any promises.
1. Definitive Needle Insertion Point
The correct direction for needle insertion is the prerequisite for treatment effectiveness. The tip of the needle must be inserted from the distal to the proximal end in vertical alignment with the affected muscle. The selection of the needle insertion point is based on finding affected muscles in the area of pain and confirming the area of treatment. The principles are:
1) If the area is small and there are few affected muscles, a proximal needle entry point is best, while a distal point should be used for a large area with many affected muscles.
2) Needling should be done starting from distal locations and moving to proximal locations, e.g. most chronic lumbar pain complaints are accompanied by abnormal findings of the lower limbs, so the selection of needle entry points should start in a distal area and then move to proximal areas.
3) In most situations, it is sufficient to choose a needle insertion point above, below, or to the left or right of the affected muscle.
4) Try to avoid superficial blood vessels, so as not to cause bleeding and pain.
2. Sweeping
The sweeping procedure is a distinctive feature of of FSN. It refers to waving the body of the needle left, right, up, and down in a series of movements after the needle has been transported and before removing the needle. The sweeping motions should be large, steady, and rhythmic, not seesawing or varying in speed. One must maintain focus when performing the sweeping procedure. The practitioner must be closely aware of the sensation under the needle and the patient’s reaction.
There are two kinds of sweeping: level sweeping and spiral sweeping.
Time for sweeping a needle entry point: usually about 100 sweeps/minute for 2 minutes
Many features of FSN are clearly present in Huang Di Nei Jing; this is to say that many of the characteristics of FSN are scattered throughout the various needling techniques in Huang Di Nei Jing. In terms of true innovation, the FSN sweeping method is completely new, as well as the special needling implements used.
“Pierce the skin without touching the muscle, then sweep left and right. Natural reperfusion boosts patient satisfaction and achieves quick results.”
3. Needle Retention for 24 Hours is Preferred
When removing the needle, it is best to use a bandage and press for 1 minute to prevent bleeding.
4. Reperfusion: Resistance exercises, to be discussed in detail at a later time.
We have been implementing FSN in many cases at the hospital of CedarsSinai Medical Center (CSMC). In some cases, only FSN is used, although most patients are treated by FSN combined with traditional acupuncture. FSN has been able to help support certain pathways in the body that are associated with pain and inflammation. Several FSN case reports are provided below:
Case1: Temporomandibular Joint (TMJ) in a Pregnant Patient
The patient was a 30-ear-old American female. The initial intake was on July 3rd, 2020.
Chief complaint: Stiff, sore, and painful lower jaw muscles for 2 weeks.
History of present illness (HPI): The patient stated she was 16 weeks pregnant with her second child. Two weeks before, she started to feel stiffness, soreness, and pain in the muscle of the lower jaw, with a pain level of 9/10 as well as clicking and popping, and popping sounds in her ears. The pain made it impossible for her to sleep at night.
Past medical history: She previously came to the clinic in 2017 for lumbar pain, which was treated successfully.
Physical exam: Affected muscles were suspected to be the masseter, temporalis, and sternocleidomastoid. Palpation: Muscles were tense, stiff, hard, and slippery.
Differential diagnosis: Facial spasm, trigeminal neuralgia
Initial diagnosis: Acute mandibular arthritis
Treatment process: With the patient supine, the masseter and sternocleidomastoid were chosen for FSN treatment. The needle tip was aimed at the affected muscles and inserted, then slowly transported. Level sweeping and spiral sweeping procedures were used. The treatment was divided into two parts, each of which involved sweeping 100 times/minute, for a total of about 200 sweeps in 2 minutes. The whole treatment process lasted 60 minutes.
Immediate effects: After one session of FSN , the patient reported that her pain had decreased by 90% and she felt much more relaxed. She cheered: “It’s a miracle!”
Medical advice: The patient was advised to come back soon for a followup. She was advised to avoid using cold water to wash her face, and use warm or hot water instead. She was also advised to enhance her diet by eating foods high in protein and vitamins.
Follow up: After a week, the patient called to report that the pain was under control and the sounds were gone. At the time of follow up 1 year later, the patient’s TMJ complaints had not recurred.
Case Analysis and Discussion:
1. Temporomandibular joint disorders can cause pain in the mandibular joint and the muscles that control the mandible. The target tissue of FSN treatment is the muscles, so FSN is indicated in this case. Therefore, the diagnosis has been clarified. (TMJ disorders will often cause difficulty chewing and talking, so although these illnesses are not fatal, they will influence a person’s quality of life. If they are not brought under control, symptoms will often worsen and cause chronic issues.)
2. In comparison to traditional acupuncture treatment for TMJ disorders, FSN’s immediate effects are unparalleled. One FSN treatment can fully resolve the pain.
3. At present, FSN’s analgesic mechanism is unclear. Sweeping stimulates the sternocleidomastoid, so it may indirectly block the transmission of neurotransmitters or directly block the nerve roots from transmitting pain signals to the brain, thereby obstructing the feeling of pain. Could it have the same effect as a nerve blocking anesthetic? This would cause the patient to feel the pain has decreased or disappeared.
4. Using FSN to treat TMJ will definitely yield results. It may enable the patient to avoid invasive treatments like surgery. In the majority of cases, the pain and discomfort associated with temporomandibular joint disorders is temporary, and can be mitigated with selfcare and nonsurgical measures. Although surgery is often a last resort after conservative measures have failed, a few patients with temporomandibular joint disorders may benefit from it.
Figure 1: Pregnant woman with TMJ symptoms treated by FSN
Case 2 Cervical Pain
The patient was a 30-year-old American female. The initial intake was on June 15th, 2021.
Chief complaint: Rightsided neck pain for 1.5 years.
HPI: The patient was a 30-year-old female who was referred to FSN by her Western medical provider for right sided neck pain. The pain level was 6/10. In October 2019, after the patient was involved in a car accident, she felt sharp pain in her neck that radiated to the right shoulder. She had difficulty turning her head left and right, and felt pain while doing so. She did not go to the emergency room at that time. Later, she sought Western medical treatment, took pain medication, and had two cortisone shots, while also undergoing physical therapy. Unfortunately, while her pain had improved after nearly 2 years of treatment, there was no noticeable effect.
Past medical history: No other history of injury.
Physical exam: Right neck and shoulder tension with pressurepain. Limited range of motion.
Muscle exam: Trapezius, levator scapulae, splenius capitis, splenius cervicis, sternocleidomastoid, scalenes, supraspinatus, infraspinatus; at times even the deltoid, brachialis, and brachioradialis are involved.
MRI diagnosis: Cervical spondylosis
Treatment process: The patient was seated with the head facing left. The muscles chosen for FSN treatment were the sternocleidomastoid, trapezius, levator scapulae, supraspinatus, and infraspinatus. The needle point was aimed at the affected muscles, slowly inserted, and swept. The treatment was divided into 2 parts, each of which consisted of 100 sweeps/minute, for a total of 2 minutes. The whole treatment process lasted 60 minutes.
Immediate effects: After treatment, the patient reported that the pain had decreased by 70%. She said that out of all her treatments, FSN was the most effective treatment method, so every time she came, she would mention wanting to “fire the gun”, i.e. she wanted to get FSN treatment.
Treatment outcomes: After 5 FSN treatments, the patient’s pain level decreased to 1/10.
Medical advice: 1) Avoid carrying or lifting heavy objects. 2) Keep the neck area warm and avoid exposure to cold. 3) Exercise as appropriate.
Case Analysis and Discussion:
The method used here was: bombarding distal areas, starting from distal areas and moving to proximal ones. The FSN treatment started with the deltoid, supraspinatus, and sternocleidomastoid, and finally reached the levator scapulae. The cervical nerve and carotid vein and artery run through the neck area. Because FSN sweeps the subcutaneous loose connective tissues, it may increase the blood flow to the neck muscles, thereby also increasing the blood supply to the face. It may also be that the mechanical stimulus functions to block the cervical nerve roots from sending pain signals to the brain, thus decreasing the patient’s pain.
Case 3: Bulging Lumbar Discs with Lower Back Pain and Urinary Incontinence
The patient was a 32-year-old American male hospital inpatient.
Chief complaint: Lower back pain for 2.5 years
The patient was a 32-year-old male. He was admitted as a hospital inpatient for lower back pain, bulging lumbar discs, and unintentional weight loss. The patient presented with worsening lower back pain and acute urinary incontinence. Upon admittance to the hospital, he was given oral analgesic medication, 1 epidural injection, and a ketamine IV drip, which reduced his pain.
At the time of intake, the patient was seen lying down on the bed, with his wife at the bedside. The patient reported lumbar pain that radiated towards his legs, with a pain level of 8/10, and frequent urination, about 14 times/day. He also reported positional headaches.
Physical exam: Pressurepain, limited range of motion.
MRI (Magnetic Resonance Imaging): Mild cervical spondylitis, bilateral L5-S1 has severe foraminal narrowing.
MRI cervical, thoracic, and lumber myelogram: Small upper thoracic perineural sleeve cysts.
Treatment Process: Because the patient’s condition was relatively complicated, he was treated using Jiao’s scalp acupuncture and FSN.
1. For Jiao’s scalp acupuncture, the foot motor sensory area and psychoaffective area were selected.
2. FSN: Suspected muscles examined: erector spinae, quadratus lumborum, external obliques, multifidi, biceps femoris, tensor fasciae latae, psoas major, rectus abdominis, soleus, and peroneus longus.
Diagnosis: Bulging lumbar discs
The point of the needle was aimed at the affected muscles, namely the erector spinae, quadratus lumborum, external obliques, rectus abdominis, soleus, and peroneus longus. The needle was slowly inserted and then swept. The treatment was divided into 2 parts, each of which consisted of 100 sweeps/minute, for a total of 2 minutes. The whole treatment process lasted 60 minutes.
Immediate results: After the first FSN treatment, the patient reported that the pain had noticeably decreased by 70% and the headache was under control. He could get up from the bed and stand up, and he was able to take a shower unassisted the same day.
Treatment #2: The patient’s main complaint was lumbar pain, 2-3/10, which had improved greatly. However, he experienced urinary incontinence about 14 times a day. He requested FSN treatment.
Treatment outcomes: After receiving 2 FSN treatments, the patient’s pain level decreased to 3/10. Urinary frequency decreased to about 7 times a day.
Treatment #3: The patient’s main complaint was lumbar pain, 2/10, with a noticeable improvement in the pain. The urinary incontinence was already controlled and returned to normal.
Treatment outcomes: After receiving 3 FSN treatments, the pain level had decreased to 3/10. Urinary frequency had returned to normal.
Medical advice: 1) Avoid carrying or lifting heavy objects. 2) Keep the back warm and avoid exposure to cold. 3) Exercise as appropriate. 4) Eat a diet high in protein and vitamins to gain weight. 5) After discharge, continue acupuncture treatments 2 times a week. Follow up in 2-3 weeks.
Case Analysis and Discussion:
1. This case was relatively complicated, so the patient was treated using Jiao’s scalp acupuncture and Fu’s FSN simultaneously. As he was a hospital inpatient, we provided acupuncture treatments in our capacity as TCM practitioners, while Western medical practitioners provided medication. This integration of TCM and Western medicine allowed the patient to receive the best physical and mental care possible.
2. FSN treatment mainly focused on the lumbar and back pain, as well as the urinary incontinence.
1) Low back pain: The majority of scholars believe that possible mechanisms by which bulging discs cause lumbar and leg pain include: A. mechanical pressure, i.e. the bulging vertebral pulp places acute pressure on the nerve roots, causing symptoms of lumbar and leg pain, with the size of the bulge directly affecting the level of pain; B. inflammatory response, i.e. the bulging vertebral pulp is a biochemical and immunological irritant that causes an inflammatory response in the surrounding tissues and nerve roots.
We used FSN to treat bulging vertebral discs that caused lumbar and leg pain with swift results. In this case, 3 treatments achieved clear effects. The mechanism behind this may be that the widearea sweeping of subcutaneous connective tissue in FSN improved the blood supply to the affected muscles and reduced muscle shrinkage, causing the bulging vertebral discs to retract and thereby relieving the pain by eliminating the pressure on the nerve roots.
Most lumbar pain is caused by the lower erector spinae or quadratus lumborum. Typically, the “remote bombardment” method is used, proceeding from the distal to the proximal, mostly on the peroneus longus or the lower portion of the gastrocnemius. The needle is inserted from bottom to top, and reperfusion exercises are done against resistance.
2) Urinary incontinence: This is usually due to the pelvic floor muscles and vesicourethral sphincter not functioning normally. It manifests most visibly when there is increased abdominal pressure, e.g. when coughing, sneezing, laughing, or doing physical activity, which causes urine to be discharged from the urethra. In severe cases, this may happen when walking or standing up. In this case, the bulging lumbar discs and affected muscles increased the abdominal pressure, causing urine to flow out.
The main suspected muscles include: the lower rectus abdominis, thigh adductor group, medial head of the quadriceps, and the soleus.
In this case, FSN treatment was performed on the soleus and lower rectus abdominis, yielding excellent results.
3. FSN treatment played a crucial role in this case. It yielded good realtime results with a high level of efficiency and safety, and had no side effects.
4. FSN increased the hospital bed turnover rate and decreased the duration of inpatient stays.
Figure 2: Inpatient with lower back pain and urinary incontinence
About the Author:
Hongmei Li Senior acupuncturist Cedars-Sinai Medical Center ，Los Angeles, CA.
Hongyan Li Senior acupuncturist Cedars-Sinai Medical Center，Los Angeles,CA.
Yifan Fang Acupuncturist Alternative Medical Center,Los Angeles,CA.
Sarah Nalbandian, Student at University of California, Los Angeles, CA.
Zhonghua Fu Clinical Medical College of Acupuncture & Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine
The Institute of Fu’s Subcutaneous Needling, Beijing University of Chinese Medicine.
References
1. Zhonghu Fu, the foundation of Fu’s Subcutaneous needling, People’s Medical Publishing House(PMPH), ISBN 978-7-117-23380-4/R·23381
2. Zhonghua Fu, Ryan Shepherd . Fu’s Subcutaneous Needling, a modern style of ancient acupuncture. J. Acupuncture in modern medicine. 2013; 06(3) DOI: 10.5772/53970
3. Zhonghua Fu, YuehLing Hsieh, ChangZern Hong, MuJung Kao, JaungGeng Lin, LiWei Chou, Evid Based Complement Alternat Med. 2012; 2012: 353916. Published online 2012 Dec 25. doi: 10.1155/2012/353916PMCID: PMC3544156
4. Ching Hsuan Huang, Lung Hung Tsai, Mao Feng Sun, Zhonghua Fu, Jian Sun, Li Wei Chou, Rapid Improvement in Neck Disability, Mobility, and Sleep Quality with Chronic Neck Pain Treated by Fu’s Subcutaneous Needling: A Randomized Control Study, Pain Res Manag. 2022; 2022: 7592873. Published online 2022 Sep 30. doi: 10.1155/2022/7592873 PMCID: PMC9553660
5. Yaping Li, Xianghui Gao, Hailiang Huang, Xiyan Zhou, Yunhua Zang, LiWei Chou, Effects of Fu’s subcutaneous needling on mitochondrial structure and function in rats with sciaticaMol Pain. 2022; 18: 17448069221108717. Published online 2022 Jun16. doi: 10.1177/17448069221108717 PMCID: PMC9210095
6. Jiangxia Yang, Chen Yang, Yajie Wang, Ning Li, Xingzhang Yao, Bowen Yang, Xia Xu, Xingyong Li,Effect of subcutaneous needling on visual analogue scale, IgG and IgM in patients with lumbar disc herniation. Medicine (Baltimore) 2020 Feb; 99(9): e19280. Published online 2020 Feb 28. doi: 10.1097/MD.0000000000019280 PMCID: PMC7478818
浮針治療臨床疑難病例研究(一)
李紅梅 李紅艷 馮一帆 符仲華 薩拉·納爾班迪安
導言
“浮針療法” 是1996年，符仲華教授發明的。它是用一次性的浮針專屬針具在病痛的周圍或者遠處搜尋患肌，在皮下淺筋膜層進行掃散及再灌注等活動的針刺療法。浮針療法具有適應症廣、療效快捷確切、可與西醫打封閉療效相媲美、操作方便、沒有副作用等巨大優點。該法適用於臨床各科，特別是對疼痛科和內科、婦科良性慢性病痛的治療療效尤為卓著。尤其是臨床同類疾病治療效果，更是超越古今!
浮針療法的概念：參照《浮針醫學綱要》
2016年10月，世界中醫藥學會聯合會浮針專業委員會成立大會之時，人民衛生出版社的《浮針醫學綱要》在南京首發。定義一（中醫）：浮針療法是在皮下使用針具，大面積掃散，以通筋活絡，激發人體自愈能力，從而達到不藥而愈的目的，主要用於治療筋脈不舒、血滯不通所導致的頸肩腰腿疼痛和一些內科婦科雜病；定義二（康復）：浮針療法是使用一次性浮針等針具在引起病痛的患肌周圍或鄰近四肢進行的皮下針刺法，和傳統針灸一樣，是一種非藥物治療方法。操作時，通常還配合再灌注活動。相對於傳統針刺方法而言，療效反饋速度快。
2021年10月，人民衛生出版社的《氣血新論》橫空問世，這是一本基於浮針醫學的中西醫匯通。定義：浮針療法是用一次性使用浮針在皮下大面積持久牽拉皮下組織，通過松解相應肌肉，促進血液循環，改善新陳代謝，激發人體自愈能力，從而達到不藥而愈的目的。主要用於治療肌肉等軟組織緊張不舒、血滯不通所導致的頸肩腰腿疼痛和一些內科婦科雜病。
浮針和傳統針灸有什麼不同
首先是針具，開始釆用浮針療法時，使用的是傳統針灸針具—毫針，現在有些人用毫針作為針具，用浮針早期的操作方法，不過不叫浮針療法。符教授發明浮針是在傳統針基礎上的繼承、發展和創新。到目前為止，已經有最新的第五代浮針FSN5.0問世。
其次是進針點，傳統穴位常常是病理部位和治療部位的合二為一，位置多數是固定的，例如合谷穴在第二掌骨中央橈側肌肉豐厚處，而浮針療法的進針點僅僅是治療點，位置不固定。浮針療法對進針點的選擇是根據病痛部位尋找相應的患肌進而確定治療部位。比如腰背疼痛，腰椎間盤突出症，嫌疑肌查找：豎脊肌，腰方肌，腹外斜肌，多裂肌，股二頭肌，闊筋膜張肌，腰大肌，腹直肌，比目魚肌，腓骨長肌等，不找痛點找患肌，操作只在患肌外。
針刺部位：僅限皮下結締組織，這是浮針的主要特點。浮針療法一改常態，將通常的針刺激表皮、真皮、肌筋膜、肌肉乃至骨膜的垂直刺法改為僅刺皮下，結締組織和淺筋膜的平行刺法。
《靈樞·官針》中毛刺、直刺、浮刺、半刺等刺法是浮針療法皮下進針的理論來源和依據。
FSN靶器官單一，僅僅為皮下疏松結締組織，治療的是肌肉，患肌可以導致臨床很多病痛。揭示了病深治淺的道理。
針刺手法：傳統毫針有提插捻轉迎隨，補瀉等手法；而浮針療法只有掃散，包括平掃和旋掃。
刺激強度與效應:傳統針灸學認為，得氣是臨床取效的一個重要手段和標誌，所以在臨床上大多數針灸醫生都追求得氣。如《標幽賦》所述的“氣之至也，如魚吞鈎餌之浮沉”。針灸醫生高明與否的評價標准之一，就是能否得氣。而浮針療法要求避免患者有酸脹重麻沉等得氣感。這對在我們國外行醫的針灸師來講，尤其實用。因為我們在臨床治療病人時往往會聽見病人的抱怨： “I do not like de qi”。
療效特點：簡便、安全、綠色、無毒，效果快。可與西醫打封閉療效比美，操作百分之百安全，沒有副作用。重複性強。
六大怪
不找痛點找患肌，操作只在患肌外。
掃散還要患肌動，病深刺淺患者愛。
打針不痛無傷害，立竿見影療效快。
浮針操作
進針
運針
掃散
留管
出針
浮針療法治療思路
明確診斷
在全面瞭解病因，病理，病情，病程長短，病變範圍大小，病變位置等情況的基礎上，對病痛的部位、程度性質等加以綜合分析，從而明確診斷，確定是否屬於浮針療法的治療範圍，這是在臨床中首先要考慮的問題。因為只有診斷正確，並屬於浮針療法的範圍，才能夠得到最好的治療效果。
這裡要強調，任何一種治療方法都不是萬能的，浮針療法，也並非對所有的疾病病痛都有良好的效果。在臨床上，我們必須認真評估篩選適應症，在沒有見到患者，沒有做出相關檢查之前，不要隨意作出承諾。
1.明確進針點
針刺的方向正確是保證療效的前提，針尖必須由遠而近的直對患肌。進針點的選取是根據病痛部位，尋找相應患肌，確定治療部位。原則是：
1)範圍小，少患肌進針點宜近；大範圍多患肌宜遠，
2)從遠到近，例如慢性腰部病痛多伴有下肢的異常，進針點的選取要從遠到近，
3)多數情況下，進針點選取在患肌周邊上下左右都可以，
4)儘量避開淺表血管，以免引起出血和刺痛。
2.掃散
掃散動作是浮針療法的鮮明特色。是指運針完畢，到抽出針芯前，針身左右上下搖擺的系列動作。掃散動作要做到大幅度，平穩有節律。不要忽上忽下，忽快忽慢。掃散時神情專注。醫者要細心體會針下的感覺和患者的反應。
掃散有兩種：平掃和旋掃。
一個進針點的掃散時間：一般掃100次/分左右，2分鐘。
浮針的很多特點，在《黃帝內經》已經有很多顯現，也就是說，浮針刺法諸多特徵已經散見在黃帝內經各種針法裡了。真正有發明的話，浮針掃散動作是前無古人的，當然還有特殊的針具。
“刺皮不及肉，任君掃左右。綠色再灌注，超愛療效快。”
3. 留針24小時為宜
出針最好用創可貼並按壓1分鐘，以免出血。
4. 再灌注：抗阻運動，有機會詳細討論。
在臨床上大膽實用的針灸針，在許多情況下在雪松西奈醫療中心（CSMC）的醫院實施FSN或現代針灸。在某些情況下，遵循程序FSN:插入，運輸，掃描，保留和移除僅治療患者，大多數患者應用傳統針灸結合現代針灸方法，已經證實可以減輕疼痛和炎症。今天獲得的FSN病例數報告如下：
病例一 孕婦患顳下頜關節紊亂（TMJ）
患者，女性，30歲，美國人。初診2020年7月3日。
主訴：下頜關節肌肉僵硬酸痛2週。
現病史：患者稱妊娠16週，第二胎。兩週前開始覺得下頜關節肌肉僵硬酸痛，疼痛指標9/10，下巴卡他作響，耳邊響起啪啪聲。夜間疼痛無法睡眠。
既往病史：2017年因腰背痛到本診所就診痊愈。
體檢：主要嫌疑肌為咬肌，顳肌和胸鎖乳突肌。
觸診：緊僵硬滑
鑑別診斷：面肌痙攣，三叉神經痛
初步診斷：急性下頜關節炎
治療過程：仰臥位，選取咬肌及胸鎖乳突肌進行浮針治療。針尖對準患肌進針，緩慢運針，掃散釆取平掃和旋掃。治療分上半場和下半場。分別掃散100次/分。共約200次/2分鐘。治療全程60分鐘。
即時療效：患者自述疼痛明顯減輕90%輕松多了。浮針很神奇！
醫囑：建議近期復查一次。避免用涼水洗臉，建議用溫熱水洗臉。加強營養：高蛋白質，高維生素飲食。
隨訪：一週後打電話，病人報告疼痛已控制，摩擦響聲消失。一年復查病人的TMJ沒有反復。
病例分析及討論：
1. 顳下頜關節紊亂-可引起下頜關節和控制下頜運動的肌肉疼痛。而浮針療法治療的靶組織就是肌肉。所以是浮針療法治療的適應症。因此，診斷是明確的。（TMJ通常會導致咀嚼和說話困難。因此，雖然這些疾病不是致命的，但它們會影響一個人的生活質量。如果不加以控制，症狀往往會惡化並導致慢性問題。）
2. 對比傳統針療法治療下頜關節紊亂，浮針的即時效果超越古今。一次浮針治療解決疼痛。
3. 浮針療法止痛機理尚不清楚。掃散刺激胸鎖乳突肌，有可能間接阻斷神經遞質的傳送，或者是直接阻斷神經根將痛症的信號傳到大腦，從而阻止疼痛感覺的傳出。是不是有相當於神經阻滯麻醉劑的作用？這樣病人就會感覺疼痛減輕或消失。
4. 浮針治療TMJ，療效肯定。可讓病患者避免手術創傷治療。在大多數情況下，與顳下頜關節紊亂相關的疼痛和不適是暫時的，可以通過自我管理護理或非手術治療來緩解。手術通常是保守措施失敗後的最後手段，但一些顳下頜關節紊亂患者可能受益於手術治療。
圖1：孕婦患顳下頜關節紊亂，接受浮針治療
病例二：頸椎痛
美國女性，30歲，初診2021年6月15日。
主訴：右頸部疼痛一年半。
現病史：患者是一位30歲的女性。因右側頸痛由西醫介紹而來尋求浮針治療。疼痛指標6/10。2019年10月，該病人介入一起車禍，當時她感覺頸部刺痛，並向右側肩部放射。頭部向左向右轉頭困難，有疼痛。當時沒有進急診室治療，後來就找西醫治療，服止痛藥，並接受可的松注射兩次，同時也進行物理治療。遺憾的是治療快兩年，疼痛有改善，但沒有顯著療效。
過去史：沒有任何受傷病史。
體檢：右側頸肩部緊張，有壓痛。活動受限。
嫌疑肌查找：斜方肌，肩胛提肌，頭夾肌，頸夾肌，胸鎖乳突肌，斜角肌，岡上肌，岡下肌甚至有時涉及三角肌，肱肌，肱饒肌等。
MRI診斷：頸椎病
治療過程：坐位，頭偏向手邊。選取胸鎖乳突肌，斜方肌，肩胛提肌，岡上肌，岡下肌進行浮針治療。針尖對準患肌，緩慢進針，掃散，治療分上半場，下半場。分別掃散100/分。共2分鐘。全程治療60分鐘。
即時效果：病人治療後訴疼痛明顯減輕70%，她說在所有治療中，浮針是最有效的治療方法。所以她每次來，都提出要“打槍”，要浮針治療。
治療結果：患者接受5次FSN治療後，疼痛指標降為1/10。
醫囑：1）避免提起或舉起重物。2）保持頸部溫暖，避免受涼。3）適當運動。
病例分析討論：
採用的方法是：遠處轟炸，由遠及近，先從三角肌，岡上肌，胸鎖乳突肌，最後到肩胛提肌進行浮針治療。在頸部有頸神經和頸動、靜脈出入。由於浮針在皮下疏松結締組織中掃散，可能是增加了頸部肌肉的血流量，繼而也增加了面部的血供；也可能是由於機械的刺激作用，阻斷了頸神經根將疼痛的信號傳至大腦，從而減輕了病人的疼痛。
病例三 腰椎間盤突出症
美國男性，32歲，住院病人。
主訴：腰背痛2年半
現病史：患者是一位32歲的男性。因下背部疼痛，腰椎間盤突出，和不明原因的體重減輕而入院。患者表現為下背部疼痛加重和急性尿失禁。入院後給予止痛藥口服，硬膜外注射1次，並用Ketamine靜脈點滴，疼痛有所緩解。
會診時，病人躺在床上，妻子坐在床旁邊。患者訴下腰背疼疼痛，指數為8/10，並向腿部放射。尿頻，14次/天左右。並伴有體位性頭痛。
體檢：有壓痛。活動受限。
MRI（核磁共震成像察看）：輕度頸椎炎，L5-S1有嚴重的椎弓型行狹窄
MRI頸椎、胸椎、腰椎脊髓造影察看：小的上胸神經周圍袖囊腫
治療過程：因病人病情較複雜，給患者用焦氏頭針和符氏浮針治療。
1. 焦氏頭針選取足運感區，精神情感區
2. 符氏浮針：嫌疑肌查找：豎脊肌，腰方肌，腹外斜肌，多列肌，股二頭肌，闊筋膜張肌，腰大肌，腹直肌，比目魚肌，腓骨長肌等
診斷：腰椎間盤突出症
針尖對準患肌，豎脊肌，腰方肌，腹外斜肌，腹直肌，比目魚肌，腓骨長肌。緩慢進針，掃散，治療分上半場，下半場。分別掃散100/分。共2分鐘。全程治療60分鐘。
即時效果：第一次針灸治療後，病人訴後背疼痛明顯減輕70%，頭痛已基本得到控制。他能夠從床上起床，並站立當天並可自己洗澡。
二診：病人主訴腰背疼痛2-3/10，疼痛好多了。但尿失禁，每天14次左右。要求用浮針治療。
治療結果：患者接受2次FSN治療後，疼痛指標降為3/10。排尿次數減至每天7次左右。
三診：病人主訴腰背疼痛2/10，疼痛顯著改善。尿失禁已被控制，恢復正常。
治療結果：患者接受3次FSN治療後，疼痛指標降為3/10。排尿次數恢復正常。
醫囑：1）避免提起或舉起重物。2）保持背部溫暖，避免受涼。3）適當運動。4）高蛋白，維生素飲食，以增加體重。5）出院後繼續針灸治療，每週兩次。2-3週後復查。
病例分析討論：
1. 本病例病情較複雜，所以給患者提供焦氏頭針和符氏浮針同時治療。因為是住院病人，所以我們中醫提供針灸治療；西醫提供藥物治療。中西結合，使病人達到最好的身心照顧。
2. 浮針主要是針對腰背部疼痛和尿失禁的問題。
1）下腰背疼痛：多數學者認為，關於椎間盤突出產生腰腿痛的可能機制有：A.機械型壓迫，突出的髓核的急性壓迫神經跟產生腰腿痛症狀，突出大小，直接影響疼痛程度。B.炎性反應，突出的髓核作為生物化學和免疫學刺激物，引起周圍組織及神經根的炎症反應。
我們用浮針治療腰椎間盤突出症，腰腿痛，效果迅速。本病例治療3次都有明顯效果。其機制可能是浮針在皮下結締組織中大面積掃散，使患肌的血供改善，減輕了肌肉的收縮，使突出的椎間盤回縮，從而解除神經根的受壓而減輕疼痛。
腰部疼痛多為下段豎脊肌或腰方肌，一般使用“遠程轟炸“的方法，由遠及近多數在腓骨長肌，或者腓腸肌的下方，由下向上進針，用力抗阻做再灌注活動。
2）尿失禁：多因盆底肌肉和膀胱尿道括約肌不能夠正常工作所致，最明顯表現為當腹壓明顯增大，如咳嗽、打噴嚏大笑或運動時，即有從尿液從尿道排出。嚴重者行走、起立時即可發生。本病例因為有腰椎間盤突出症，有患肌，腹部壓力增高，導致尿液流出。
主要嫌疑肌有：腹直肌下段，大腿內收肌群，股四頭肌內側頭，比目魚肌等。
本例浮針治療比目魚肌和腹直肌下段，取得良好療效。
3. 浮針治療起到了定海神針的作用。即時效果好，高效，安全，無副作用。
4. 增加了醫院的床位週轉率；減少了病人住院天數。
圖2：住院病人患腰椎間盤突出症、尿失禁
未完，下期繼續
作者簡介:
李紅梅，資深針灸師，美國洛杉磯西奈山醫學中心。
李紅艷，資深針灸師，美國洛杉磯西奈山醫學中心。
馮一帆，針灸師，美國洛杉磯替代醫學醫療中心。
薩拉·納爾班迪安，加州洛杉磯分校學生。
符仲華，教授， 廣州中醫藥大學針灸與康復臨床醫學院，北京中醫藥大學浮針研。究所。
