Twitch-eliciting acupuncture (Zhatiao) has not only gained increasing clinical attention but also provided a new perspective for comprehensively understanding the traditional concept of“Deqi” (Qi arrival) . Based on a systematic review of relevant literature over the past three decades and the author’s 60 years of clinical acupuncture experience, this paper proposes that the generalized local twitch response (gLTR) induced by Zhatiao, together with changes in muscle tone, are the primary objective manifestations of Deqi beyond subjective needle sensations. gLTR can be elicited by stimulating three types of intramuscular physiological targets: muscle spindles, motor point areas and neurovascular entrance points (NV-EP) into the muscle. The forms and mechanisms of gLTR induced by these targets differ significantly. Stimulation of muscle spindles evokes moderate gLTR and muscle tension via spinal reflexes, accompanied by marked sensations of soreness, distension, heaviness or numbness. Stimulation of motor points (neuromuscular junctions) directly triggers endplate potentials, which can induce prominent gLTR but are often associated with no obvious needle sensation. Stimulation of NV-EP usually produces intense needle sensations, sometimes accompanied by gLTR. Under pathological conditions, specific acu-reflex points (ARP), characterized by sensitized muscle spindles or hyperreactive motor endplates (e.g., myofascial trigger points, MTrP), may develop. Stimulation of MTrP/ARP can elicit more pronounced gLTR, with significant radiating sensations to distant or affected regions. This paper also introduces the common acupoints corresponding to these targets, the author’s four frequently used Zhatiao techniques (claw-like needling, longitudinal/transverse needling, slow-traction needling, and electrically assisted needle repositioning), and analyzes the clinical importance of Zhatiao in analgesia, anti-inflammation and motor rehabilitation—especially the advantages of muscle spindle-targeted Zhatiao for central motor tone disorders. This study provides a theoretical foundation and feasible paradigm for fully understanding the connotation and significance of Deqi, as well as for the clinical application and promotion of Zhatiao techniques.

twitch-eliciting acupuncture (Zhatiao)  /  Deqi  /  generalized local twitch response (gLTR)  /  muscle spindle  /  motor point  /  neurovascular entrance point (NV-EP)  /  myofascial trigger point (MTrP)  /  acu-reflex point (ARP)  /  acupuncture therapy