Acupuncture Point Ozone Injection Protocol

Microdose volume, concentration and technique for ozone injected into acupuncture points, with the safety reports on the facial route.

Quick answer: Ozone acupuncture point injection is a microdose technique. Madrid lists 0.1–0.3 mL per point at 6–9 µg/mL, with a maximum of 1 mL per point. A case series gave sessions weekly, then spaced out. The sheet covers safety reports on the facial route.

Ozone-oxygen doses from the Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), section 12 and Table 1BTechnique from a published case series

Warning

Requires hands-on training from an experienced physician

Acupuncture point ozone injection should only be performed by a practitioner trained in it by an experienced physician.

Practitioner-only procedure. Injecting ozone into acupuncture points is done by trained, licensed clinicians. This sheet is a reference for them. It is not a self-treatment guide and not medical advice. Strict sterile technique is required every time.

Concentration (Madrid)6–⁠9 µg/mL

Volume per point (Madrid)0.1–⁠0.3 mL

Maximum per point (Madrid)1 mL

Frequency (case series)Weeklythen spaced out

What are the basics of ozone acupuncture point injection?

Acupuncture point (and reflexology area) injection puts a very small amount of ozone-oxygen gas into the skin at chosen points. Madrid files it with trigger points under "microdosing", but the procedure differs, so MediSkill gives it its own sheet.
The difference: acupuncture points are intradermal (Table 1B also allows subcutaneous), 0.1 to 0.3 mL a point and 1 mL at most. Trigger points are deep in the muscle and take 3 to 5 mL. See the trigger point sheet.
Madrid's Table 1B lists 6, 7 or 9 µg/mL, which works out to 0.6 to 1.8, 0.7 to 2.1 and 0.9 to 2.7 µg per point. The section 12 text says concentrations "below 6 to 9". This sheet treats 9 µg/mL as the ceiling.
The ISCO3 method sheet (MET/00/18) gives a larger volume: 0.3 to 1.0 mL per acupuncture point, intradermal or subcutaneous, at 6 to 9 µg/mL, repeated per acupuncture practice.
Madrid names no points, no conditions, no number of points per session and no schedule for this method. Choosing the points is a matter of your acupuncture training, and this sheet lists none.
A 67-person case series (people with pain) used 8 to 15 µg/mL, which is above Madrid's range. It is shown below as a study, not as Madrid dosing.

Sources: Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), section 12 and Table 1B; trials and case series in the study list below. Paraphrased.

What dose and technique are used for ozone acupuncture point injection?

Madrid's microdose is shown next to what the case series and the one randomized trial used.

	Madrid	What the studies used
Depth	Intradermal (section 12). Table 1B: intradermal or subcutaneous.	Acute cases: subcutaneous. Chronic cases: an intradermal papule (a small raised wheal).
Concentration	6, 7 or 9 µg/mL.	8 to 15 µg/mL (case series). 30 µg/mL (randomized low back pain trial).
Volume per point	0.1 to 0.3 mL, up to 1 mL at most (ISCO3 method sheet: 0.3 to 1.0 mL).	Acute: 1 mL per point. Chronic: 0.2 to 0.5 mL per papule. The randomized trial's abstract gives no volume.
Dose per point	0.6 to 2.7 µg (Table 1B).	Not given in the sources.
Needle	Not stated.	30G, 4 mm for papules; 30G, ½ inch for subcutaneous points. Needle tilted 10 to 15 degrees.
Schedule	Not stated.	Weekly, then every 10 days, then every 2 weeks as symptoms settled. About 4 sessions per patient on average.

Points per session are not stated by Madrid or by the sources used here. Madrid's titration rule applies: start low and increase gradually.

What are the best tips when using ozone acupuncture point injection?

Madrid's microdose is the safest place to start. The case series used about double Madrid's concentration, so treat anything above 9 µg/mL as outside Madrid.
For chronic pain, raise a small papule with a short 30G needle held at a shallow angle (10 to 15 degrees).
In the case series, the side effects were brief burning at the injection site for 1 to 3 minutes and mild redness.
In the randomized low back pain trial, the points were three low back points on the bladder meridian (Qihaishu, Dachangshu and Guanyuanshu) plus local tender (Ashi) points.
Keep volumes small. The microdose idea depends on a tiny amount of gas at each point.

What are the precautions for ozone acupuncture point injection, and who should avoid it?

Never breathe ozone gas. Keep the room ventilated.
Sterile technique every time. Madrid says most serious side effects trace back to malpractice, including technique, asepsis and antisepsis. Its reported serious events include septic arthritis of the knee after intra-articular infiltration and abscess after paravertebral injection. It also reports one death from sepsis after a paravertebral infiltration done without proper asepsis (Madrid Declaration on Ozone Therapy, 4th edition (ISCO3, 2025), section 2.5).
Clean the skin with an antiseptic and let it dry before the needle goes through. Use sterile, single-use needles and syringes, and ozone-resistant syringes for the gas.
Check with your licensing board that this procedure, and anything you inject along with the ozone, is within your scope of practice.
Never inject ozone gas into a vein or an artery. Madrid strongly discourages both because of the risk of air embolism, and lists embolic events after paravertebral and intradiscal injections among its serious adverse events.
Face and neck. A 2025 case report describes a 55-year-old man who became confused, unsteady and had uncontrolled arm movements about 10 minutes after a subcutaneous ozone injection at facial acupuncture points. He needed a ventilator for 48 hours and recovered fully. The authors call this route not recommended for any medical indication.
An earlier case describes visual loss, limb weakness and a brief seizure after subcutaneous ozone injections in the neck and upper trunk (given for atopic dermatitis). The brain changes cleared on MRI within 4 months (Kamiyama 2005, a Japanese journal).
Madrid's facial section tells you not to inject the glabella (between the eyebrows), because it can close the tear duct and risks double vision or blindness.
Madrid's rule "never inject below the knee" is written for cellulite-sized volumes (2 to 3 mL per point). It gives no rule for microdoses at lower-leg or foot points, so stay intradermal, use the smallest volume and avoid the lower leg and foot.

Contraindications

The Madrid Declaration lists these contraindications for systemic ozone:

Direct inhalation of ozone gas. The fluid lining the lungs has no antioxidants to buffer it, so inhaled ozone is toxic.
Glucose-6-phosphate dehydrogenase (G6PD) deficiency (favism, acute hemolytic anemia). Madrid lists it as a contraindication and recommends testing, but whether it is absolute is debated. MediSkill protocols start low and go slow; see the contraindications article.
Toxic hyperthyroidism (severe Graves' disease)
Thrombocytopenia (platelets under 50,000) and severe coagulation disorders
Severe cardiovascular instability
Acute alcohol intoxication
Recent acute myocardial infarction
Acute massive hemorrhage
Convulsive states
Hemochromatosis
Patients receiving intravenous copper or iron therapy

Pregnancy. Madrid advises avoiding ozone therapy in the first trimester (weeks 0 to 13) and reserves its use in pregnancy for specialists in gynecology and obstetrics.

More detail

Steps

Choose and mark the points according to your acupuncture training.
Clean the skin with an antiseptic and let it dry.
Set the generator to 9 µg/mL or less and draw 1 mL or less into a small ozone-resistant syringe.
Insert a 30G needle at a shallow angle (10 to 15 degrees in the case series).
Inject 0.1 to 0.3 mL at each point (0.2 to 0.5 mL if you follow the case series for chronic pain), raising a small papule.
Remove the needle and repeat at the next point. Record the points and volumes.

Equipment

Ozone generator with an ozone-resistant gas path (quartz glass, titanium, silicone)
Medical oxygen tank and regulator
Small ozone-resistant syringes (1 to 5 mL)
30G needles, 4 mm to ½ inch
Antiseptic and sterile supplies

What the studies used

Study doses are listed as printed in each paper and are not Madrid dosing.

In 67 adults with pain, ozone microdoses (8 to 15 µg/mL, 0.2 to 1 mL a point, about 4 sessions) at trigger points, acupuncture points and a 3 cm grid over the painful segment lowered pain scores significantly. There was no control group (Alvarado Güémez 2016).
In a randomized trial of 120 people with low back pain, ozone at 30 µg/mL injected at low back acupuncture points and tender points worked better than electroacupuncture or a herbal (Danggui) acupoint injection (p<0.01 or p<0.05) (Zhang 2007).
Safety: encephalopathy after a subcutaneous ozone injection at facial acupuncture points, with full recovery (Gante 2025).

Evidence is thin: one case series without a control group, and one randomized trial of which only the abstract was available, with no volume or schedule given.

Learn more

Background, benefits and research on injections: Ozone injections, full article. Related: side effects of ozone therapy.

Other injection protocols

Trigger point injection Subcutaneous injection PRP and ozone injection Knee injection Hip injection Shoulder injection Elbow injection Ankle injection Neck injection Back injection

For licensed practitioners. Educational reference only, not medical advice. Follow your scope of practice and local regulations.