針感是在針灸過程中，感受到刺痛、脹、痠、麻、重、溫/涼、鈍痛等等複合性的感覺。它有時是一種蠻強烈的感覺，有時則是延著經絡蔓延，有時在遠離針刺部位的地方也有感覺。
There’s a combination of sensations people experience at the needle site during acupuncture, such as tingling, distention, soreness, numbness, heaviness, warmth/coolness, and dull pain. Sometimes it’s a strong feeling, sometimes it spreads along the meridian, and sometimes it triggers feelings at other parts of the body far away from the needle site.
針感不只是被針的人單方面的感覺，而是針與被針的雙方都會有的感知。最經典的描述就是《標幽賦》說針感（特別指「得氣」）為如魚吞鉤，就像魚咬住魚鉤時的瞬間透過釣魚線傳來，針下的指感會有微妙的力量改變。
It’s not just about what the patient feels, acupuncture sensation includes the feeling from both the operator and the patient. Song to Elucidate Mysteries stated that the operator can feel with fingers the subtle changes of the pulling strength under the needle tip (specifically the “Deqi” phenomenon), which would be like the piscator feels the twitching of fishing line when the fish bites the hook.
有些穴位容易觀察到得氣現象，肌纖維會瞬間輕跳一下。針灸的位置、深度和捻針方式，都會刺激到不同類型的神經纖維。徒手針灸可以活化幾乎所有類型的神經傳入纖維，而電針會透過電流刺激 Aβ 和 Aγ 纖維來發揮效果。電流的強度、波型（連續波、間斷波...）、頻率（以Hz為單位，密集 / 疏散），會決定是放鬆止痛，還是改善肢體麻痺的效果。
Some acupuncture points are relatively easy to observe Deqi, the muscle fibers will perform a sudden small twitching. The location and depth of the needle along with the twirling methods after needle insertion can trigger different types of nerve fibers. Manual acupuncture can activate almost all types of afferent fibers, and electroacupuncture excites Aβ and Aγ fibers via current. The intensity, wave type (continuous wave, intermittent…), and frequency (measured by Hz, dense / disperse wave) of the current will determine whether it is relaxation and pain relief or can make improvement to weakness of the limb. ◗ 針感之「痠」Soreness 針灸會引起「痠」感，但肌肉酸痠痛也可以透過針灸緩解。這兩種疼痛有什麼差別？
Acupuncture can cause soreness, but muscle soreness can also be relieved by acupuncture. What is the difference between these two types of soreness?
也許你還記得劇烈運動後的24-48小時，肌肉所感到的那種不適，它通常還伴隨著痛覺敏感。這種情況被稱為「延遲性肌肉痠痛（DOMS）」，是由發炎引起的。 DOMS 與肌肉中組織胺、緩激肽、嗜中性球和前列腺素等介質的增加有關。肌纖維/衛星細胞產生的神經生長因子 (NGF) 和衍生神經營養因子 (GDNF) 也會導致 DOMS。
Maybe you can recall having discomfort of muscle groups 24–48 hours after strenuous exercise, which is usually accompanied by sensitivity to pain. This condition has a name called “delayed onset muscle soreness (DOMS)” and is believed to be caused by inflammation. DOMS is associated with an increase in mediators such as histamine, bradykinin, neutrophils, and prostaglandins in the muscle. Nerve growth factor (NGF) and derived neurotrophic factor (GDNF) produced by muscle fibers/satellite cells also contribute to DOMS.
根據組織學和解剖學，人體的針灸結構可分為四層。和DOMS由發炎因子引起的不同，針灸時由於針刺到不同層次，會產生不同的感覺，而「痠」是針尖達到肌肉層所產生的。當針刺激肌肉深處的接受器時，就會透過Aδ型纖維和C型纖維傳遞到大腦中樞，活化左顳葉和顳上迴等大腦區域。
According to histology and anatomy, the acupuncture structures of the human body can be divided into four layers. Different from DOMS, which is caused by inflammatory factors, acupuncture will produce different sensations when the needle is inserted to different levels. Soreness occurs when the needle tip pierces the muscle. When receptors deep in the muscles are triggered by the needle, the stimulation is transmitted to the brain via Aδ-type fibers and C-type fibers, and activate brain regions such as the left temporal lobe and superior temporal gyrus. The superior temporal gyrus (STG) is involved in the formation of pain memories and may be associated with pain regulation.
◗ 針感之「麻」Numbness
麻與神經密切相關，主要由Aβ纖維傳導。日常生活中，當神經長時間受壓迫或血液循環障礙時就會出現這種感覺，但這種感覺大多持續很短的時間，一旦壓迫解除就會立即消失。麻很少是致命的，但如果是持續的麻感，還是會導致相當的不舒服，擾亂人的日常功能和睡眠。
Numbness is closely related to the nerves and is mainly conducted by Aβ fibers. It happens when there’s prolonged compression of nerves or blood circulation disorders, but most of this sensation lasts for a short time, and will disappear immediately when the compression is relieved. Numbness is rarely fatal, but can cause discomfort that disturb one’s daily function and sleep if it develops to a constant symptom.
病理性麻木可能是由於局部供血不足（如雷諾氏症候群）或神經損傷（糖尿病會損傷Aβ神經纖維）所致。有些患者在接受順鉑等抗腫瘤藥物治療後也會出現四肢末梢麻木的情況。
Pathological numbness can result from local blood supply deficiency (such as Raynaud syndrome), or nerve injury (diabetes can damage Aβ nerve fibers). Patients also experienced numbness in their extremities after receiving antineoplastic drugs such as cisplatin.
針灸過程中，當針尖靠近神經時，就會引發麻麻的感覺，不限於特定的組織層。如果針碰到神經主幹，可能會引發電擊或滾動感。
The numbness can be triggered during acupuncture when the needle tip goes near to the nerve, not limited to specific tissue layers. If the needle hits the nerve trunks, it can trigger an electric shock or rolling sensation.
◗ 針感之「重」Heaviness
有些人認為「重」的感覺是由本體感受器所感知，本體接受器位於皮膚機械感受器旁。人體的周邊本體感受器有肌梭、高爾基腱器（位於肌肉與肌腱交界處附近的肌腱）、關節囊感受器和皮膚。
Some believed that “heaviness” is mediated by proprioceptors, which are located next to cutaneous mechanoreceptors. The peripheral proprioceptors in the human body are muscle spindles, Golgi tendon organs (located in the tendon near the myotendinous junction), the joint capsule receptors, and the skin.
針灸過程中出現的「重」感是當針尖達到深層筋膜，產生的刺激透過Aδ纖維傳遞到大腦中樞系統，如中央感覺運動區。
The “heaviness” sensation occurs during acupuncture is when the needle tip crosses the deep fascia and the stimulation is transmitted by Aδ fibers to the brain such as the central sensorimotor area.
◗ 針感之「脹」Distention
「脹」感有時類似我們測試柔軟度時肢體緊繃的感覺。臨床上很少有單獨表現的脹感，通常是混合其他感覺，如耳悶即是中耳的黏膜和鼓膜表面，神經末梢的壓力感受器以及體感覺受器異常有關。腸脹氣則是結腸擴張時扯動張力感受器時引發的感覺。
The distension sensation is sometimes similar to the feeling when the limbs are tightened when we try to check body flexibility. Clinically, distension sensation seldom occurs alone, most of which are mixed sensations, such as ear fullness. The sensation of ear stuffiness is associated with abnormal baroreceptors receptors and somatosensory fibers in the surface nerve endings of the middle ear mucosa and tympanic membrane. Flatulence results from dilation of the colon that pulls tension receptors and triggers a series of mechanical sensation.
針灸時的脹感最容易在皮下第二層，也就是疏鬆結締組織產生。當針尖到達淺筋膜時，可沿著經絡或往穴道周圍擴散。
The distension sensation during acupuncture mostly occurs in the second layer of subcutaneous (loose connective tissue). When the needle tip touches the superficial fascia, it can spread around the acupoint or along the meridian.
◗ 針感之「痛」與「癢」Pain and pruritus
有人認為痛與「得氣」的針感不一樣，也有人認為痛也是一種特殊的針感。痛和癢很有關連，因為這兩種感覺共享許多感覺受體，例如 PAR 和 TRPV1。痛通常會抑制癢的感覺，而麻醉鎮痛因為抑制了痛，可能會讓癢的感覺加重。
Some believe that there is a difference between pain and acupuncture sensation, and some believe that pain is also a special kind of acupuncture sensation. Pain and pruritus are closely related, as the two sensations share many identical receptors, such as the protease-activated receptor (PAR) and the transient receptor potential receptor vanilloid type 1 (TRPV1). Pain often exerts an inhibitory effect on pruritus, while analgesia not only reduces pain but also its inhibitory effect and might aggravate pruritus.
有趣的是，針灸引發疼痛，也可以緩解疼痛。進針可使針刺部位產生暫時的疼痛，對穴位的刺激透過上行路徑將訊號傳至大腦，誘導身體釋放天然止痛物質，並透過下行路徑強化鎮痛力。
It’s interesting that acupuncture triggers pain but also can relieve pain. The needle insertion can generate transient pain at the needle site, and the stimulation sends signals to the brain through ascending pathway. This induces the release of natural pain-relieving factors and promotes antinociceptive effect through the descending pathway.
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這篇的靈感是時不時就會被問，「針灸越有感覺越好嗎？」「會痛比較有效嗎？」「越痛表示病越嚴重嗎？」我想回答不是這樣，又覺得怎麼回答好像都不是很準確。我常常遇到問出那種大哉問的問題的人，但很多事情是無法這樣一言以蔽之的。
I get asked from time to time, "Does it mean more therapeutic effect if I get stronger feelings with acupuncture?" "Is it more effective when it hurts?" "Does it mean I have a serious illness because I feel more pain from the needling?" I want to say that, it’s not the case, but then I feel, no matter how I answer it, it just seems to be not the right answer. It is really easy for patients to ask big questions, but many things cannot be summed up in one word/sentence.
還是學生的時候，針灸課就是跟同學互針（針得到的部位也可以針自己），然後有學習單可以把感受到的感覺打勾勾，通常在溫／涼那格大部份人是溫或熱，但我一直都是涼感。上課也有聽到針感是涼的偏氣虛，但如果其他氣虛症狀我沒有的話，光是針感涼掉，就代表我是氣虛嗎？所以我覺得單從某幾個徵兆就要去論斷一個人就是這樣，好像缺了很多環節。而且一個現象可能隨時間變化，需要觀察一段時間，才能知道是否有意義，有多大的意義，又是對誰、對什麼有意義。
When I was a student, the acupuncture class required classmates to perform acupuncture on each other (you could also acupuncture yourself, it’s easy to do so in the area where you can reach by yourself), and then there was a worksheet to tick off the sensations you felt. Most of my classmates got the “warm” feeling, but I always feel a current of coolness at the needle site. I also learned in the class that people who feel “coolness” at the needle site were indicative of qi deficiency. But if I don’t have other symptoms of qi deficiency, does it mean that I’m qi deficient? So I feel like there are a lot of missing pieces when it comes to judging a person from just a few signs. Moreover, a phenomenon may change over time, and only by observation for a period of time can we know whether it is meaningful, how significant it is, and to whom and what it is meaningful.
就個人經驗來說，肌肉量多、腠理結實、氣足的人針感較強烈，因此壯男容易暈針是真的。緊張和疲勞時，人的肌肉不自覺繃緊、疼痛閾值降低，針灸也會感覺比較痛。久病臥床、肉質鬆垮（都是脂肪，肌肉很少或不結實的）、過度消瘦的人，針灸能調度的氣和力道都有限，所以遠端取穴效果可能和近端取穴差很多，最好選擇針在還有肉的部位和針感較強的穴，療效比較明確，也比較不會掉針（肉含不住針）。
From personal experience, people with a lot of muscles, a strong constitution, and sufficient qi will feel stronger acupuncture sensations, so it is true that strong men are prone to fainting during acupuncture treatments. When people are nervous or/and fatigued, their muscles are tightened and the pain threshold will be lowered, so it feels more painful when receiving acupuncture. For people who have been bedridden for a long time, have loose flesh (more fat tissue, little or no muscle), or are too thin, the energy and strength that acupuncture can regulate are limited, so the effect of distal acupoint may be much weaker than that of proximal acupoint. So I think it’s best to choose to needle at body areas that are still muscles, and acupoints that trigger a strong feelings. The curative effect will be clearer and the needle will be less likely to drop (cuz the flesh cannot hold the needle).
額外一提，有人說針灸能引發「愉悅感」 (?!)
By the way, some people believe that acupuncture also generates “Pleasant sensation” (?!)
前面提到的針灸刺激肌肉深處的接受器引發的痠感，會透過Aδ型纖維和C型纖維傳遞到大腦，活化左顳葉和顳上迴等大腦區域。雖然左顳葉最為人所知的，就是聽覺皮層和語言中樞，不過，顳上迴也參與大腦的疼痛記憶編碼。顳上迴功能異常可能會因情緒的感知而形成誇大的痛覺記憶，這意味著顳上迴可能與調節疼痛的情感記憶有關。
The superior temporal gyrus (STG) is involved in the formation of pain memories, STG is involved in pain encoding. Disorders in STG may cause exaggeration of pain memories, which suggests that the STG plays a role in regulating the affective memory of pain.
顳上迴下方的顳上溝(Superior temporal sulcus)，也與人腦的社交能力緊密相關，包括理解他人的語言、動作和表情等。
The superior temporal sulcus (which is below the superior temporal gyrus) is also closely related to the human brain's social abilities, including understanding other people's language, movements, and expressions.
情緒調節不只與針灸刺激神經與內分泌反應有關，針灸的「過程」可能也有不小的影響力。中醫師在針灸治療過程中，經常需要觸摸患者進行檢查、進行徒手治療，或在進針前確認穴位，這些都被認為能提高針灸的療效。這種溫和的觸摸會激發慢傳導的無髓鞘C型神經纖維，並活化腦島區，從而發揮情緒調節作用。
Emotional regulation is not only related to the stimulation of nerve and endocrine responses by acupuncture, but the "process" of acupuncture may also have a considerable impact. TCM physicians often have to touch the patient for examination, perform manual management, or check the acupoints before treating them during acupuncture, which is thought to help increase the effectiveness of the acupuncture. This affinity contact is mediated by slow-conducting unmyelinated C-fibers and activates insula areas, which exert a mood-regulating effect.
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