Fire needling, huozhen (η«ι), heats a needle in a flame until it glows red and pushes it into the skin and straight out again. A 2021 review of fire needling for flat warts by Ying Zhang and colleagues describes it as a needle heated until it burns red and quickly stabbed into the lesion or an acupuncture point, and notes that in China it has been used to treat skin diseases. The needle stays in for a moment rather than the minutes an ordinary acupuncture needle is left, which Needling and de qi describes.
In the classical texts
The Lingshu, part of the Huangdi Neijing, names the method twice, and Wikisource transcribes both chapters. In chapter 7, Guan zhen, the ninth of nine needling methods is cui ci (η εΊ), defined as needling with a fan zhen (ηιΌ), a burning needle, to treat bi, the painful obstruction disorders. Chapter 6 in the same volume has Bo Gao tell the Yellow Emperor that cold bi is treated in commoners with fire and in nobles with a hot medicinal compress.
Chapter 13, on the channel sinews, ends the entry for nearly every sinew with the same instruction: treat with the burning needle, needled swiftly, as many times as it takes to work, at the painful spot. It closes with a limit: cui ci is for contraction from cold, and where heat has left the sinews slack the burning needle is not used. Channel sinews and divergent channels explains what the sinews are.
The Zhenjiu dacheng (Great compendium of acupuncture and moxibustion), which the Ming physician Yang Jizhou completed in 1601, as The classical texts records, gives the method its own section, which Wikisource also transcribes. Its list of nine needles ends with the fire needle, βalso called fan zhenβ, four cun long.
The section tells the practitioner to dip the needle in oil and burn it on a lamp until it is red through, warning that a needle that is not red will not remove the disease and will harm the patient; to mark the point in ink beforehand; to go neither too deep, which injures the channels, nor too shallow; to reassure the patient; and to withdraw at once and press the hole. It says the pain passes faster than the pain of moxibustion, that the needle may be used anywhere on the body except the face, and that it should not be used for jiaoqi, a swelling disorder of the legs, because it makes the swelling worse.
Needles and depth
A 2023 overview of fire needling devices by Song and colleagues, in Chinese with an English abstract, divides them into traditional designs, such as Heβs and Shiβs fire needles, and newer ones, among them the filiform fire needle and the micro fire needle, and asks for needle specifications, manufacture and technique to be unified. The 2016 knee osteoarthritis review by Yidan Wang and colleagues describes a needle with a rounded tip that withstands high temperature, inserted 0.3 to 0.5 cun and removed swiftly; Measuring in cun explains the unit. Unlike the Ming text, it says the hole is not pressed unless it bleeds.
On skin lesions the needle goes shallower. The flat warts review describes heating the needle over an alcohol lamp from root to tip until it turns red, then puncturing the centre of each wart vertically, never deeper than the base of the lesion. Over muscle it goes deeper: of the trials in a 2021 review of fire needling for spasticity after stroke by Xuan Qiu and colleagues, ten reported depths of 3 to 30 mm and one only 1 to 3 mm, with needles about 0.35 mm across and 20 to 40 mm long.
China has a national standard for the technique, GB/T 21709.12-2009, part 12 of its standardised acupuncture manipulations. Its official record lists it as a recommended standard drafted by the Beijing Acupuncture Santong Method Research Society, in force since August 2009 and confirmed as still valid on review in November 2025. The record does not carry the text, so this page does not report what the standard specifies.
What reviews and trials report
| Source | What it covered | What it found |
|---|---|---|
| Wang and colleagues, Zhen Ci Yan Jiu, 2019 | Shingles pain: 25 trials, 2,024 people, treatment based mainly on fire needling against Western medicine | Lower pain scores (weighted mean difference β0.96) and fewer cases of lasting nerve pain afterwards (risk ratio 0.16, 95% CI 0.09 to 0.30); no included trial reported on adverse events |
| Xing and colleagues, Complementary Therapies in Medicine, 2019 | Moderate to severe acne: 10 trials, 904 people, against drugs | More patients rated effectively treated with fire needling alone (risk ratio 2.32, 95% CI 1.77 to 3.03); no difference in relapse |
| Luo and colleagues, eCAM, 2020 | Vitiligo: 47 trials, 3,618 people, fire needling added to standard treatments against those treatments alone | Higher response (risk ratio 1.55, 95% CI 1.46 to 1.65); the gain was in patches on the limbs, not on the head, neck or trunk; no difference in adverse effects |
| Zhang and colleagues, eCAM, 2021 | Flat warts: 29 trials, 2,666 people, against immune-modulating drugs, tretinoin and other treatments | Higher response with fire needling alone than tretinoin (risk ratio 1.39, 95% CI 1.25 to 1.55); evidence for fire needling alone graded level C |
| Wang and colleagues, eCAM, 2016 | Knee osteoarthritis: 13 trials, 1,179 people, against ordinary or warm needling | Higher recovery rates; GRADE quality of evidence relatively low for every outcome |
| Qiu and colleagues, PLoS One, 2021 | Spasticity after stroke: 16 trials, 1,118 people, against ordinary acupuncture or electroacupuncture | Better response rates and function scores; no difference on the modified Ashworth scale of muscle tone where the leg was treated, the needle went deeper than 15 mm or the stroke was more than 6 months old; most trials had some concerns over bias |
| Qiu and colleagues, Frontiers in Medicine, 2025 | Neurodermatitis: 10 trials, 868 people, all run in China and published in Chinese | Fire needling alone no better than standard treatment (risk ratio 1.04, 95% CI 0.90 to 1.20); added to it, more patients reached 90% improvement (risk ratio 2.04, 95% CI 1.61 to 2.59); certainty low |
| Liu and colleagues, QJM, 2026 | Plaque psoriasis: 78 adults at 5 Chinese hospitals, single-blind, 4 weeks of treatment and 4 of follow-up | More patients reached a 75% fall in the Psoriasis Area and Severity Index (57% against 21%); no adverse reactions reported |
Every review in the table compared fire needling with drugs, standard care or ordinary needling. The
psoriasis trial is the exception: its 2020
protocol gives the control group the same needling without heating the needle, with patients
wearing eye masks, so it isolates the heat. In the spasticity review the most used points were
LI11 (Quchi) and LI10
(Shousanli), each in 9 trials, and LI04 (Hegu), in 7.
Herpes zoster and postherpetic neuralgia and
Knee osteoarthritis set these results beside the wider
acupuncture evidence, and AcuiQβs pages on shingles and
acne list the protocols
individual studies prescribed, each with its citation.
Burns, marks and infection
The knee osteoarthritis review lists the adverse events reported in the fire needling literature as allergy, burns, infection, difficulty moving and intolerance of cold, though only 2 of its 13 trials reported adverse events at all. In the flat warts review, fire needling alone left fewer blisters and less redness than the drugs it was compared with but more darkened skin. The acne review recorded burning and tingling that passed. In the neurodermatitis review, 3 trials reported redness, a burning feeling, bleeding and peeling in the fire needling groups, and none reported a serious event.
A 2013 report in Zhongguo Zhen Jiu analysed two cases of infection caused by fire needling. The psoriasis protocol tells patients that redness, warmth, mild pain and itching at the sites are expected, and to keep the sites clean and dry on the day of treatment. The limits the classical texts set, no use where heat has slackened the sinews, on the face or for leg swelling, are stated above; no review in the table tested them. Burns from moxibustion and cupping and Infection and clean needles cover those two risks, and Moxibustion and Bloodletting cover the other techniques that use heat or break the skin.
What the sources cannot tell you
Where a review states where its trials were run, as the neurodermatitis review does, all were in China, and every comparison in the table but one was with drugs or with other needling. Patients and practitioners know who received a red-hot needle: the vitiligo review found that none of its 47 trials could blind them and only 2 blinded the person assessing the result. The shingles review found no trial that reported on harms, so how often burns or infections follow fire needling is not known. The one trial found for this page that compared a heated needle with an unheated one enrolled 78 people. A protocol entry on AcuiQ names the modality the study used; Reading a protocol explains each field.