Plum-blossom needling taps the skin with a small hammer whose head carries a cluster of short needles. The US Council of Colleges of Acupuncture and Herbal Medicine’s Clean Needle Technique Manual (seventh edition, last revised May 2026) describes a hammer-like device whose needle projections strike a much broader area of skin than a single acupuncture needle, often called a seven-star hammer after the number of its points, and says it generally does not reach below the skin but stimulates the superficial, or cutaneous, channels. A 2026 review of alopecia trials by Ji Hee Jun and colleagues gives the head as 5 or 7 needle tips. The Chinese names translate directly: meihua zhen, plum-blossom needle, and qixing zhen, seven-star needle.
How it is done
The Clean Needle Technique Manual has the hammer held 1 to 2 inches above the skin and tapped rapidly along the area being treated, stopping once the skin turns red. It advises against raising the hand too high or tapping hard enough to puncture the skin, and against flinging the hammer, which can spray blood. China’s national standard on acupuncture manipulation gives the technique its own part under the name skin needle (pifu zhen); a 2011 commentary on it by Wang Hua and colleagues says the standard fixes the stimulation intensity, where to tap, the length of a course and the interval between treatments.
Trial protocols show the range of intensity in use. A 2015 protocol for a Tourette syndrome trial, by Yu Jinna and colleagues, taps each point perpendicularly, driven from the wrist and lifted straight off, for 30 seconds, 6 minutes a session, gently enough to cause only a little pain, and stops when the skin flushes but before it bleeds. A 2026 trial in diabetic nerve damage by Zhang Yongwen and colleagues tapped the numb and painful areas at moderate intensity for 15 minutes, until the skin flushed and showed pinpoint bleeding. Other trials tap along channels, over a patch of hair loss or over a skin lesion, as the table below shows.
With cupping
Plum-blossom tapping is one way to break the skin before wet cupping, in which a cup then draws blood out; the Clean Needle Technique Manual lists it with lancets and three-edged needles for that step. In a 2024 review of wet cupping for neurodermatitis (thickened, itchy patches of skin), Zhai Yan and colleagues counted 12 of 19 trials that used plum-blossom needles for it. A 2025 review of bloodletting for shingles by Wu and colleagues found one such trial among 16: 56 people given cutaneous needle bleeding and cupping for 14 days, against antiviral drugs. Cupping and Bloodletting cover both methods.
What reviews and trials report
| Source | What it covered | What it found |
|---|---|---|
| Jun and colleagues, 2026 | Alopecia areata (patchy, autoimmune hair loss): 11 trials, 1,144 people, searched to December 2024; in 7 trials, 756 people, tapping was added to drugs and compared with the drugs alone | More people rated improved with tapping added (risk ratio 1.09, 95% CI 1.03 to 1.16), low certainty; every trial was run in China, and none described concealed allocation or blinding |
| Dai, Song and Li, 2021 | Alopecia areata: 11 trials, 1,192 people, tapping added to conventional treatment | More people with any regrowth (risk ratio 1.22, 95% CI 1.11 to 1.34) and with complete regrowth (1.33, 1.10 to 1.61); trial quality medium or relatively low; no clear rise in adverse events |
| Zhai and colleagues, 2024 | Neurodermatitis: 19 trials, 1,505 people, wet cupping alone or added to other treatment | No clear difference between wet cupping alone and strong steroid creams (risk ratio 1.13, 95% CI 0.90 to 1.41); better response when added to drugs; evidence graded low overall |
| Li and colleagues, 2026 | A map of 40 reviews of acupuncture for postherpetic neuralgia, the nerve pain that can follow shingles | Includes a 2023 Chinese review of 11 plum-blossom trials, 898 people, against drugs or acupuncture, which reported benefit; the map rated 34 of the 40 reviews critically low in quality and the other 6 low |
| Wang and colleagues, 2024 | Tension-type headache: network meta-analysis of 42 trials, 4,103 people, 21 treatments | Tapping beat drugs on the share of people who responded (odds ratio 3.76, 95% CI 1.04 to 13.65), from a network holding one trial of tapping alone and one of tapping with acupuncture |
| Zhang and colleagues, 2026 | Diabetic peripheral neuropathy: 225 people, press needles plus tapping, against sham needles with blunted tips or no needling, all on standard drugs for 6 months | Better nerve conduction and symptom scores than either control; the effect cannot be split between the two needles, and of 320 people enrolled, 43 were excluded because they could not tolerate the needles |
| Wang and colleagues, 2023 | Actinic keratosis (sun-damaged, scaly skin): 142 people at several centres, lesions tapped before photodynamic therapy or wiped with saline | More lesions cleared after the first session (57.9% against 48.0%); no difference in pain |
Most comparisons in the table are against drugs or usual care; only the neuropathy trial used a sham plum-blossom needle, and there it was combined with press needles, which Press needles describes. For myopia in children, the one trial found for this page is a 2020 protocol by Chen and colleagues for a crossover trial against tropicamide eye drops, which reports no result. AcuiQ’s pages on alopecia areata and shingles list the protocols individual studies prescribed, each with its citation.
Plum-blossom needles and microneedling
In dermatology the tool is used, as a microneedle device is, to help a drug spread on afterwards pass through the skin. A 2026 international expert consensus on transdermal drug delivery, by Zhu Jinjin and colleagues, recommends microneedles for delivering the photosensitising drug in photodynamic therapy of actinic keratosis, on moderate evidence, and cites the plum-blossom trial above under the same statement. The consensus does not compare the two devices’ depth or design.
Infection and single-use heads
The Clean Needle Technique Manual found no adverse events from plum-blossom tapping reported in the literature, most of which is in Chinese, but notes that the needles can break the skin over a broad area, carry organisms from one area to another and bring blood to the surface. Its critical rules are gloves throughout, skin that is clean and free of lesions, single-use sterile needles or a handle with single-use removable heads, a reusable handle sterilised before each new head, and disposal straight into a sharps container; it recommends eye protection.
The World Health Organization’s 1999 guidelines on safety in acupuncture allow a plum-blossom or seven-star needle to be reused on the same patient, provided it is sterilised before use on another, or else disposable heads, and names HIV and hepatitis among the infections needling can pass between patients. The Tourette protocol followed the WHO rule, with detachable heads kept for one patient and sterilised under pressure after each use. The 2026 alopecia review reported folliculitis, redness and itching among the side effects in the acupuncture groups of its trials, and no serious events. Infection and clean needles covers infection risk across techniques.
What the sources cannot tell you
The reviews pool small trials, nearly all from China, most adding tapping to drugs rather than testing it against a sham, and most report response as the share of cases each trial rated effective. Where a review graded certainty, it was low. How hard to tap, how often and for how long varies from one trial to the next. The Clean Needle Technique Manual found few studies that reported adverse events at all, so how often harm occurs is not known. A protocol entry on AcuiQ names the modality the study used; Reading a protocol explains each field.