Preventing Kidney Injuries in Acupuncture

The risks of potential kidney injuries associated with acupuncture have been highlighted as far back as ancient medical texts, such as the "Neijing." These texts state: "If the needle hits the kidney, death may follow within six days." In modern medical literature, there are also numerous case reports of improper acupuncture procedures that have led to kidney injuries, whether due to needle punctures or the administration of injectable substances. Some of these cases were treated with conservative therapy, while others led to kidney surgeries, such as nephrectomies, which posed significant stress on patients. To avoid such complications, it is crucial for acupuncturists to possess thorough anatomical knowledge, pay attention to detail, and exercise precision.

Causes of Kidney Injury

There are three main causes of kidney injuries related to acupuncture: improper point selection, incorrect technique, and improper drug injection.

1. Improper Selection of Acupuncture Points

The kidneys are paired organs located on either side of the spine, at the level of the 11th-12th thoracic vertebrae, near the posterior abdominal wall. Since the kidneys are hidden deep within the body, the acupuncturist must be well-versed in their precise anatomical location. Certain acupuncture points, such as "Yíshě," "Wèicāng," and "Zhìshì," are very close to the kidneys, and incorrect needle depth can easily cause kidney injury. In the case of nephroptosis (floating kidney), even points like "Dachangshu" or "Guanyuanshu" could lead to damage. To prevent such cases, the acupuncturist must thoroughly understand the patient's anatomical variations and adapt accordingly.

2. Incorrect Technical Execution

Incorrect needle direction and depth can lead to serious damage. When working with points near the kidneys, if the needle direction points outward or upward, it can potentially reach the kidney. Poor technique, particularly during sudden patient movements or forceful coughing, can exacerbate kidney damage. Therefore, the acupuncturist must ensure safe needle technique and prevent sudden patient movements during treatment to avoid further injury.

3. Use of Injectable Substances

Injecting substances at acupuncture points can also be risky. High concentrations or highly irritating drugs, if injected into the renal parenchyma, can lead to kidney injury or even tissue necrosis. Proper selection of drug type and concentration is essential, and it must be verified that the needle does not reach kidney tissue during injection. Knowledge of treatment methods and precise technical execution are crucial to minimize the risk of kidney injury.

Clinical Symptoms

The symptoms of kidney injury vary depending on the extent of the damage. Prompt and accurate diagnosis and early intervention are essential for improving the patient's condition.

1. Mild Kidney Injury

Mild kidney injuries typically involve damage to the connective tissue surrounding the kidney or the outer layer of the kidney. This can cause minor bleeding and localized pain, though symptoms are often subtle, and red blood cells may only be detectable in the urine through microscopic examination. In some cases, secondary bleeding may occur two to three weeks post-puncture, requiring immediate attention and further medical examination. Early diagnosis can help avoid more serious complications and promote faster recovery.

2. Severe Kidney Injury

Severe kidney injuries involve significant damage to the renal parenchyma, resulting in intense pain, often radiating to the shoulder. This can cause palpable swelling and muscle tightness in the lower back area. In cases of substantial bleeding, the patient may go into shock due to massive blood loss, which necessitates immediate emergency care. Symptoms may also include fever and chills, indicating possible infection. Rapid diagnosis of such conditions includes urine and blood tests, as well as imaging techniques like ultrasound or CT, to provide a clear picture of the kidney's condition. Fast diagnosis and targeted treatment are critical for preserving the patient's life and kidney function.

Prevention

1. Proper Needling Technique

For acupuncture points located over the projection of the kidneys (e.g., "Zhishi"), it is crucial that the needle depth does not exceed 1.5 cun. When puncturing areas near the back muscles, the needle should be angled at 45 degrees towards the spine. Points such as "Shenshu" require extra care to avoid the kidneys. Acupuncturists must have an in-depth understanding of the precise location of these points and the anatomical characteristics of the area to minimize potential errors. Individual patient characteristics, such as body type, age, and medical history, should also be considered, as they can influence kidney positioning.

2. Cautious Technique

During acupuncture treatment, special attention must be paid to signs that indicate excessive needle depth. If the needle penetrates the connective tissue of the muscles behind the spine and a sudden "empty" sensation is felt, it is likely that the needle has entered the renal capsule. In such cases, the needle must immediately be stopped to avoid further damage. Proper patient education is also important so they understand the potential risks of treatment and can provide accurate information about their condition to the acupuncturist.

3. Use of Injectable Substances

For acupuncture points involving injections, it is recommended to use low-concentration, less irritating substances. Before administering an injection, withdrawing the needle slightly can confirm whether it has reached a blood vessel, which helps to prevent tissue damage. The acupuncturist must be knowledgeable about the effects and side effects of various medications to minimize treatment risks.

Treatment Approaches

1. Treating Mild Kidney Injury

Mild kidney injuries are generally managed conservatively. Complete bed rest, analgesics, and antibiotics (if needed) are recommended for 3-4 weeks. During recovery, regular urine tests should be conducted to monitor kidney function. Adequate hydration is crucial, as fluid intake supports kidney recovery. Anti-inflammatory foods, such as antioxidant-rich vegetables and fruits, should be included in the diet to support the healing process.

2. Treating Severe Kidney Injury

In more severe cases, surgical intervention may be necessary, especially if the patient goes into shock or bleeding does not cease within 24-48 hours. During surgery, the damaged kidney may either be repaired or, if needed, removed. Postoperative rehabilitation requires regular medical follow-ups and a gradual reintroduction of physical activity. Psychological support for the patient is also important, as severe kidney injuries can be both physically and mentally challenging.

Acupuncture can offer numerous benefits to patients, but it is essential for practitioners to focus on the proper technique, anatomical knowledge, and caution. Proper training and practical experience are crucial when applying such delicate treatment methods and can be life-saving in preventing complications.