In the past, Chinese acupuncturists had a larger arsenal of needles or small knives since they regularly had to perform small surgeries, open abscesses, bleed, etc. An old medical treatise, the Huang Di Nei Jing Su Wen, mentions nine needles of different sizes and lengths. Among these, the Hao Zhen needle (the fine needle) is the main tool of acupuncturists today. Modern needles are very thin: barely three times the size of a human hair and much thinner than a syringe needle, for example.

Acupuncture needles are made up of five parts: the tip, the body, the root, the sleeve and the tail. They are approximately 5 cm in length.

Needles can be made from different metals: gold, silver, iron, zinc, copper, molybdenum, and cobalt, but the vast majority these days are made of stainless steel. In Quebec, for example, members of the Order of Acupuncturists are required to use only needles of this type. They are sterile and disposable, which eliminates any risk of disease transmission. Stainless steel is ideal for the acupuncturist because it is a tough, flexible metal that does not rust. Many needles have a stainless steel body and a copper alloy sleeve.

Usually, the acupuncturist inserts the needles into the surface of the skin with a quick, quick gesture. However, to reduce, or even eliminate, any sensation of pain, some acupuncturists use a mandrel. This is a tube in which the practitioner inserts the needle, which he then penetrates with the tip of his finger, before removing the mandrel; the patient then feels the sting much less. 

In addition to determining which points need to be stimulated, the acupuncturist must insert and manipulate the needle very precisely. Two parameters are taken into account at the time of puncture: the angle and the insertion depth. They vary depending on the problem to be solved, the age of the patient, his constitution and the location of the acupuncture point. For example, the Jia Che point (6E), located on the jaw, will be punctured downwards for a toothache of the lower jaw, towards the mouth in the case of facial paralysis with difficulty in chewing or with deviation of the mouth upwards for trigeminal pain and perpendicular to the skin for arthritis of the jaw.

Once the needle is inserted correctly, the acupuncturist may leave it in place or manipulate it to enhance certain therapeutic effects. Handling needles is a sophisticated art that requires great dexterity. Three basic techniques are commonly used:

• Liu Zhen Fa: leave the needle in place. The needle remains in the epidermis for 10 to 30 minutes depending on the desired effect.
• Ti Cha: pull and push the needle. After inserting the needle, the acupuncturist performs a small vertical back-and-forth motion.
• Nian Zhuan: turn the needle. When the needle is at the correct depth, the acupuncturist rolls it through the sleeve between his thumb and forefinger. If he wants to tone Qi, he will perform small rotational movements from 45o to 90o; if he wants to disperse the Qi instead, the rotation will be wider, from 180o to 360o.

Handling the needles usually causes the patient to feel the arrival of Energy (DeQi) or the sensation of Qi (ZhenGan). These sensations can take many forms: itching, numbness, stiffness, feeling of swelling, heaviness, tightness around the needle, hot, cold, muscle twitch, or small electric shock. Sometimes slightly unpleasant, these sensations are not very intense and usually last only a moment. They often indicate that the treatment has achieved its goal. The acupuncturist can then choose to remove the needle or leave it in place for a few more minutes. In general, patients feel relaxed after receiving acupuncture treatment.