A 44-year-old male patient had had severe emphysema and rheumatoid heart disease for 5 years. Within the 2 months before hospital admission, severe cough with large volume of sputum and some blood had developed. The patient requested acupuncture treatment. Examination: The patient's temperature was 36.2 ° C; pulse rate was 108/minute. Shortness of breath, atrophic left side of the chest, and enlarged right side of the chest (compensatory) were noted.

Needling treatment: Paravertebral points UB13 (T3 to T4), UB43 (T4 to T5), UB46 (T6 to T7), and UB47 (T7 to T8) were needled to a depth of 1.0 to 1.7 cm. Patient felt pain after insertion and asked for removal of the needles 6 minutes after insertion. The patient experienced very difficult respiration and sweating, and his lips became dark purple. Epinephrine (Adrenalin) was injected immediately, but the patient's heartbeat stopped in 10 minutes. Autopsy: Findings were as follows: (1) right pneumothorax, needle holes in right inferior lobe, fibroid pleuritis and hemorrhage, and emphysema; (2) left severe fibroid tubercular pleuritis, pus in the thoracic cavity, shrunken lung lobes, emphysema, mild lobar pneumonia, and chronic bronchitis; and (3) chronic rheumatoid heart valve diseases (bicuspid, tricuspid, and aortic valves), interstitial connective tissue of the heart muscle, and fresh needle holes in right ventricle of the apex. Analysis: The depth of needling was normal and within safety range, but both heart and lung were punctured as a result of deformation and enlargement and because the chest wall was thin. Chest and back ARPs should be avoided when such patients are treated.

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