What is the difference between the order of acupuncture and massage?

For ordinary strain and daily conditioning needs, in more than 90% of cases, massage first and then acupuncture will have better results.； However, for acute pain and some medical conditioning needs, many schools of traditional Chinese medicine will choose to insert acupuncture first and then perform relaxation techniques. There is no absolute right or wrong. The core depends on the conditioning goals and the patient's tolerance.

I met many people struggling with this problem when I was at a community free clinic. Last time, there was an aunt in her fifties. Her shoulders and neck were stiff for almost half a month, and she had difficulty combing her hair. The daughter who brought her here had had acupuncture and then massage elsewhere before, and she felt the effect was quick, so she urged us to give the acupuncture first. I touched her trapezius muscle. It was as hard as a dried loofah. The induration was almost as big as an egg. If the needle was inserted directly, the needle sensation would definitely be suppressed on the surface. It would be so painful that it would be useless.

First, the apprentice used rolling techniques to loosen her shoulders and back for 10 minutes. Most of the hard knots were rubbed away. The aunt sighed and said, "I haven't felt this comfortable for a long time." Then she inserted a needle into the cervical splenius muscle and shoulder well. When the needle was retained, she added a warming moxibustion box to bake it. After removing the needle, she raised her arm and tried it. She said on the spot that it was almost 70% loose. If the needle was inserted right up, her muscles would be tight and the needle would stagnate even when it was inserted. She might have to stay sore and swollen for three or four days, which would make her suffer.

To put it bluntly, it is universal to press first and then prick. The logic is actually very simple: massage opens the way for acupuncture. Nowadays, people sit in the office every day in front of the computer, or lower their heads to browse their mobile phones. The superficial muscles and fascia are stretched all year round, and they are blocked like water pipes stuffed with cement. Direct injection cannot effectively stimulate the deep strain points, and the beard is completely amputated by the tight superficial muscles. The patient grimaces in pain, and the effect is half the effect. Moreover, after doing it for ten minutes to relax, your whole state will be relaxed first, your fear of needles will be reduced, and the probability of needle fainting will be greatly reduced.

However, this is not a certainty. I communicated with an old acupuncturist from Guangdong in the past two years, and I saw the completely opposite operation logic. For acute pain, they like to insert acupuncture first and then perform manipulation.

His reasoning is also very practical: for example, when an acute lumbar sprain or stiff neck occurs, the patient's muscles are so painful that they become stiff and stiff, and he will hide when you touch him. If you press hard, you may strain the edematous soft tissue. At this time, the corresponding acupuncture points at the far end are first inserted, such as Hegu and Houxi, or Weizhong and Renzhong for acute lumbar sprains. When twisting the needles, let the patient slowly move the affected area to reduce the pain first, and the muscles will naturally relax. At this time, reset and relax techniques are performed. The patient will not resist, and the effect will be better.

I was dubious before, until I met a young man in his 20s last year. When he suffered from stiff neck, his head was tilted 45 degrees, and he hissed and sucked in cold air when his neck was touched. I tried pricking the Zhongzhu point on his hand first, and asked him to slowly turn his neck while twisting the needle. In two minutes, he could turn to 80% of the normal angle. At this time, I rubbed his tense scalene muscles. He didn't hide at all. He was basically fine when he returned the same day. The recovery speed was much faster than my previous case of massaging first and then pricking the needle.

There are also people with special physiques, and the order must also be adjusted. For example, if a patient with extremely weak qi and blood usually gets out of breath after taking only two steps and sweats frequently, if you apply massage for half an hour first, the patient will become soft and will easily faint when the needle is inserted. In this case, we usually insert the Zusanli and Qihai acupuncture points that replenish qi and blood. When retaining the needle, gently rub the limbs and push along the meridians. No need to use force. The tonic effect is much better than doing it alone.

Don’t believe the nonsense that some health centers say that “you have to get acupuncture first and then massage to detoxify.” I have met several patients who had pain for three or four days after acupuncture and then massage outside. They thought it was a reaction to detoxification. In fact, the needle was inserted when the muscles were tense. When the muscles were massaged afterwards, the muscles around the needle holes were stretched, and they would be sore and swollen for several days. It has nothing to do with detoxification.

In fact, you really don’t have to worry too much about a fixed sequence. Reliable practitioners will flexibly adjust it according to your situation. After all, whether it is acupuncture or massage, the core is to help you dredge your qi and blood and solve problems. How can there be any hard and fast rules? The order that suits you is the best.