I can answer this questions two ways – one for the exam, and my personal preference as it’s important to distinguish the two!
***For the exam***
It’s important to remember what the CAM (Chinese Acupuncture and Moxibustion) book says:
1. Heavy pressing of the needle to a deep region is known as reinforcing, while forceful lifting of the needle to the superficial region is known as reducing. Basically, to reinforce, after the needle is at its correct depth, the needle is lifted gently and slowly and then thrusted heavily back to its correct depth. To reduce, the needle is lifted quickly and forcefully, and then placed back to its correct depth gently and slowly.
2. Rotating the needle gently and slowly is reinforcing, while rotating rapidly is reducing.
3. The counter-clockwise and clockwise method is a very confusing passage. If you are partaking in a station and have to demonstrate two reinforcing/reducing techniques, I suggest not picking this one. Pick thrusting and angling (the direction of the needle tip) as they can’t be disputed.
4. Inserting a needle slowly and withdrawing rapidly is reinforcing. Inserting a needle rapidly and withdrawing slowly is reducing.
5. On withdrawing of the needle, shake it to enlarge the hole and allow the pathogenic factor to come out – this is reducing. Pressing the hole quickly to close it is reinforcing.
6. When needling against the meridian/channel course, this is reducing. When needling in the direction of the meridian/channel, this is reinforcing.
7. When the patient breathes out when inserting the needle, and breathes in when the needle is withdrawn, this is reinforcing. When the patient breathes in when inserting a needle, and breathes out when the needle is withdrawn, this is reducing.
Even method is achieved when there is no specific and repeated heavy lifting, thrusting or rotating – instead everything is nice and even!
I don’t use any reinforcing and reducing techniques when I give a patient a treatment – regardless of the problem or area. I am more concerned with slowly relaxing the tissue until I reach the correct depth. If you made me pick for Back Shu’s, I’d say ‘the direction of the needle tip’ because it’s very safe. A lot of lifting and trusting when we’re trying to keep the angle and depth correct over the pleura of the lungs can be tricky.