---
title: "Fire needling"
url: "https://acuiq.com/wiki/techniques/fire-needling"
updated: 2026-10-12
last_verified: 2026-10-12
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "techniques"
basis: "Classical and modern"
audience: "Anyone"
published: "2026-10-12"
reading_minutes: 9
sources: 15
---

# Fire needling

_A needle heated red in a flame and pushed in and straight out: the Lingshu and Ming sources, the needles and depths used, what reviews of skin, joint and stroke trials report, and its risks._

Fire needling, _huozhen_ (火针), 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](/wiki/techniques/needling-and-deqi) 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_ (焠刺), defined as needling with a _fan zhen_ (燔鍼), 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](/wiki/theory/the-classical-texts) records, gives the method its own section, which Wikisource also transcribes. Its list of nine needles ends with the fire needle, “also called fan zhen”, 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](https://pubmed.ncbi.nlm.nih.gov/36633250/) by Song and colleagues, in Chinese with an English abstract, divides them into traditional designs, such as He’s and Shi’s 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](https://doi.org/10.1155/2016/1392627) 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](/wiki/nomenclature/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](https://pubmed.ncbi.nlm.nih.gov/31532139/) | Shingles pain: 25 trials, 2,024 people, treatment based mainly on fire needling against Western medicine | Lower pain scores (weighted mean difference −0.96) 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](https://doi.org/10.1016/j.ctim.2019.04.009) | 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](https://doi.org/10.1155/2020/8492097) | 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](https://doi.org/10.1155/2021/9513762) | 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](https://doi.org/10.1155/2016/1392627) | 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](https://doi.org/10.1371/journal.pone.0249313) | 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](https://doi.org/10.3389/fmed.2025.1639713) | 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](https://doi.org/10.1093/qjmed/hcaf275) | 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`](/points/li11) (Quchi) and [`LI10`](/points/li10) (Shousanli), each in 9 trials, and [`LI04`](/points/li04) (Hegu), in 7. [Herpes zoster and postherpetic neuralgia](/wiki/evidence/herpes-zoster) and [Knee osteoarthritis](/wiki/evidence/knee-osteoarthritis) set these results beside the wider acupuncture evidence, and AcuiQ’s pages on [shingles](/symptoms/herpes-zoster) and [acne](/symptoms/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](https://pubmed.ncbi.nlm.nih.gov/24298774/) 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](/wiki/safety/burns-from-moxibustion-and-cupping) and [Infection and clean needles](/wiki/safety/infection-and-clean-needles) cover those two risks, and [Moxibustion](/wiki/techniques/moxibustion) and [Bloodletting](/wiki/techniques/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](/wiki/method/reading-a-protocol) explains each field.

### Sources

1. Huangdi Neijing Lingshu, volume 2 (chapters 5 to 9, including Shou yao gang rou and Guan zhen), Chinese text on Wikisource — https://zh.wikisource.org/wiki/%E9%BB%83%E5%B8%9D%E5%85%A7%E7%B6%93/%E9%9D%88%E6%A8%9E%E7%AC%AC%E4%BA%8C%E5%8D%B7
2. Huangdi Neijing Lingshu, volume 4 (chapters 13 to 19, including Jing jin, the channel sinews), Chinese text on Wikisource — https://zh.wikisource.org/wiki/%E9%BB%83%E5%B8%9D%E5%85%A7%E7%B6%93/%E9%9D%88%E6%A8%9E%E7%AC%AC%E5%9B%9B%E5%8D%B7
3. Yang Jizhou, Zhenjiu dacheng, the volume containing the nine needles and the section on fire needling, Chinese text on Wikisource — https://zh.wikisource.org/wiki/%E9%87%9D%E7%81%B8%E5%A4%A7%E6%88%90/%E5%8D%B7%E4%BA%94
4. Song YQ, Fu YB, Li B, et al, Overview on the modern development of fire needling device: from tradition to innovation, Zhongguo Zhen Jiu 2023 (Chinese, English abstract) — https://pubmed.ncbi.nlm.nih.gov/36633250/
5. State Administration for Market Regulation, national standard record: GB/T 21709.12-2009, Standardized manipulations of acupuncture and moxibustion, part 12: fire needle — https://std.samr.gov.cn/gb/search/gbDetailed?id=71F772D7FA70D3A7E05397BE0A0AB82A
6. Wang JX, Zhao WX, Zeng JC, et al, Systematic review and sequential analysis on treatment of herpes zoster pain mainly by fire needle therapy, Zhen Ci Yan Jiu 2019 (Chinese, English abstract) — https://pubmed.ncbi.nlm.nih.gov/31532139/
7. Xing M, Yan X, Sun X, et al, Fire needle therapy for moderate-severe acne: a PRISMA systematic review and meta-analysis of randomized controlled trials, Complementary Therapies in Medicine 2019 — https://doi.org/10.1016/j.ctim.2019.04.009
8. Luo Y, Qian W, Dai T, et al, A new therapy for vitiligo using fire needles: a systematic review of evidence from 3618 subjects, Evidence-Based Complementary and Alternative Medicine 2020 — https://doi.org/10.1155/2020/8492097
9. Zhang Y, Jiang JS, Kuai L, et al, Efficacy and safety of fire needle therapy for flat warts: evidence from 29 randomized controlled trials, Evidence-Based Complementary and Alternative Medicine 2021 — https://doi.org/10.1155/2021/9513762
10. Wang Y, Xie X, Zhu X, et al, Fire-needle moxibustion for the treatment of knee osteoarthritis: a meta-analysis, Evidence-Based Complementary and Alternative Medicine 2016 — https://doi.org/10.1155/2016/1392627
11. Qiu X, Gao Y, Zhang Z, Cheng S, Zhang S, Fire acupuncture versus conventional acupuncture to treat spasticity after stroke: a systematic review and meta-analysis, PLoS One 2021 — https://doi.org/10.1371/journal.pone.0249313
12. Qiu X, Hu X, Jia R, Ding Y, Wang Y, Fire needling therapy for neurodermatitis: a systematic review and meta-analysis of randomized controlled trials, Frontiers in Medicine 2025 — https://doi.org/10.3389/fmed.2025.1639713
13. Liu L, Sun XY, Zhao YD, et al, Efficacy and safety of fire needle therapy for plaque psoriasis: a randomized, single-blind, multicenter clinical trial, QJM 2026 — https://doi.org/10.1093/qjmed/hcaf275
14. Liu L, Lu Y, Yan XN, et al, Efficacy and safety of fire needle therapy for blood stasis syndrome of plaque psoriasis: protocol for a randomized, single-blind, multicenter clinical trial, Trials 2020 — https://doi.org/10.1186/s13063-020-04691-7
15. Dai S, Analysis on two cases of clinical infection caused by fire needle therapy, Zhongguo Zhen Jiu 2013 (Chinese) — https://pubmed.ncbi.nlm.nih.gov/24298774/