NCCAOM Acupuncture cheat sheet

Yin-Yang qualities: Yin is cold, still, interior, descending, and deficient; Yang is heat, movement, exterior, ascending, and excess; the two are relative and mutually transforming.

Five Elements generating cycle: Wood generates Fire, Fire generates Earth, Earth generates Metal, Metal generates Water, Water generates Wood.

Five Elements controlling cycle: Wood controls Earth, Earth controls Water, Water controls Fire, Fire controls Metal, Metal controls Wood.

Zang organs are Yin and store vital substances: Heart, Liver, Spleen, Lung, Kidney; Fu organs are Yang and transport/transform: Gallbladder, Stomach, Small Intestine, Large Intestine, Bladder, San Jiao.

Qi functions include transforming, transporting, holding, raising, defending, and warming; failure of each function produces distinct deficiency signs such as fatigue, bleeding, prolapse, or poor defense.

Qi and Blood relationship: Qi is the commander of Blood and moves it; Blood is the mother of Qi and nourishes it; Qi deficiency can lead to Blood stasis, and Blood deficiency can lead to Qi weakness.

Eight Principles: Yin/Yang, Interior/Exterior, Cold/Heat, Deficiency/Excess; interior patterns involve organs, exterior patterns involve skin and muscles.

Six Excesses: Wind moves and changes, Cold contracts and stagnates, Damp is heavy and turbid, Heat/Fire consumes fluids, Dryness injures the Lung, Summerheat combines heat and damp.

Four Levels: Wei is exterior defense, Qi is high fever and thirst, Ying is nutritive heat with night fever, Xue is blood heat with bleeding or rash.

Cun measurements: thumb interphalangeal joint width = 1 cun; four-finger breadth = 3 cun; umbilicus to pubic symphysis = 5 cun; elbow crease to wrist crease = 12 cun.

Five Shu transport points from distal to proximal are Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea; they treat conditions along the channel and corresponding organ.

Front-Mu points are on the chest or abdomen and diagnose/treat their corresponding Zang-Fu organs; examples include CV12 for Stomach and CV17 for Pericardium.

Back-Shu points are paravertebral Bladder-channel points that correspond to Zang-Fu organs; examples include BL13 for Lung, BL18 for Liver, BL20 for Spleen, and BL23 for Kidney.

Yuan-source points are where original Qi surfaces and are used to tonify or regulate the channel/organ; examples include LI4, LU9, HT7, PC7, SP3, LR3, and KI3.

Luo-connecting points branch to the paired channel and treat disorders of both channels; examples include LU7, HT5, PC6, SP4, LR5, KI4, ST40, and GB37.

Xi-cleft points accumulate Qi and Blood and are used for acute pain or acute flare-ups; examples include LU6, HT6, PC4, SP8, LR6, KI5, ST34, and GB36.

Needling depth and angle vary by point: thin chest-wall points require shallow oblique needling, while thick gluteal or thigh points may permit deeper perpendicular needling.

Normal adult vital signs: heart rate 60-100/min, respiratory rate 12-20/min, blood pressure <120/80 mmHg, oral temperature 36.5-37.5°C.

Stroke recognition uses FAST: Face droop, Arm weakness, Speech difficulty, Time to call emergency services; any positive sign is an emergency.

Diabetes diagnostic thresholds: fasting glucose ≥126 mg/dL, HbA1c ≥6.5%, random glucose ≥200 mg/dL with symptoms, or 2-hour OGTT ≥200 mg/dL.

Hypertensive emergency is BP ≥180/120 mmHg with new end-organ damage such as chest pain, dyspnea, neurologic deficit, or visual change.

Myocardial infarction often presents with substernal chest pressure radiating to arm or jaw, diaphoresis, nausea, or dyspnea; atypical presentations occur in women, elderly, and diabetics.

Anaphylaxis signs include urticaria, angioedema, wheezing, hypotension, and gastrointestinal symptoms; intramuscular epinephrine is first-line emergency treatment.

Common lab tests include CBC, BMP, LFTs, HbA1c, and TSH; abnormal values guide referral but do not replace medical evaluation.

Red flags for headache include sudden thunderclap onset, fever with stiff neck, new neurologic deficit, age over 50 with new headache, and immunosuppression or cancer history.

Pneumothorax risk is highest at thin chest-wall points over the lungs; use shallow oblique needling and monitor for pleuritic chest pain, dyspnea, cough, or reduced breath sounds.

Do not needle over open wounds, cellulitis, abscesses, burns, varicose veins, or malignant lesions because of infection, bleeding, and spread risk.

Pregnancy precautions: avoid strong stimulation of lower abdominal and lumbosacral points and points such as LI4, SP6, GB21, and BL60 unless clinically justified.

Needling syncope management: stop treatment, remove needles, lie patient supine with legs elevated, monitor airway and pulse, and call emergency services if no rapid recovery.

Bleeding management: apply direct pressure after needle removal; use caution in coagulopathy, thrombocytopenia, and anticoagulant therapy.

Emergency referral is required for chest pain, stroke symptoms, anaphylaxis, severe asthma, suicidal ideation, or loss of consciousness.

Cupping and gua sha can cause ecchymosis; avoid over broken skin, acute inflammation, or in patients with severe bleeding disorders.

Needle retention time and stimulation intensity should be reduced in frail, elderly, pregnant, or highly anxious patients to lower adverse-event risk.

Hand hygiene is performed before and after every patient contact and after glove removal, using soap and water or alcohol-based rub.

Acupuncture needles must be sterile, single-use, and within expiration; inspect packaging and discard damaged or contaminated needles.

Skin antisepsis: swab the insertion site with alcohol in a circular motion from center outward, allow to dry, and do not touch the site afterward.

Gloves are required when contact with blood, body fluids, non-intact skin, or mucous membranes is anticipated; masks and eye protection are added for splash risk.

Used needles are never recapped, bent, or broken; they go immediately into a puncture-resistant sharps container that is replaced when three-quarters full.

Needlestick injury: wash with soap and water, report immediately, follow post-exposure evaluation, and start HIV prophylaxis promptly when indicated.

Clean field technique keeps sterile needle shafts from contacting non-sterile surfaces; contaminated needles are discarded, not reused.

Adverse events such as pneumothorax, infection, or needlestick exposure are documented and reported according to clinic and public-health requirements.

Informed consent includes diagnosis, proposed treatment, material risks and benefits, alternatives, and the right to refuse; document the patient's voluntary agreement.

Confidentiality: protected health information is disclosed only with written authorization or as required by law, such as mandatory reporting or imminent danger.

Scope of practice is defined by state licensure and training; conditions requiring medical, surgical, or emergency care are referred to appropriate providers.

SOAP documentation records Subjective, Objective, Assessment, and Plan; acupuncture notes also include points, technique, response, and adverse events.

Mandatory reporting includes suspected child abuse, elder abuse, and certain communicable diseases as specified by state law.

Professional boundaries prohibit sexual relationships with current patients and require avoiding dual relationships that could impair judgment.

Advertising must be truthful, not misleading, and must not claim guaranteed cures; state licensure and credentials are accurately represented.

Billing requires accurate service codes and documentation; submitting claims for services not rendered is fraud.