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Characterization of the "deqi" response in acupuncture.

Hui KK, Nixon EE, Vangel MG, Liu J, Marina O, Napadow V, Hodge SM, Rosen BR, Makris N, Kennedy DN - BMC Complement Altern Med (2007)

Bottom Line: The deqi response was elicited in 71% of the acupuncture procedures compared with 24% for tactile stimulation when thresholded at a minimum total score of 3 for all the sensations.The findings are clinically relevant and consistent with modern concepts in neurophysiology.They can provide a foundation for future studies on the deqi phenomenon.

View Article: PubMed Central - HTML - PubMed

Affiliation: Athinoula A, Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. hui@nmr.mgh.harvard.edu

ABSTRACT

Background: Acupuncture stimulation elicits deqi, a composite of unique sensations that is essential for clinical efficacy according to traditional Chinese medicine (TCM). There is lack of adequate experimental data to indicate what sensations comprise deqi, their prevalence and intensity, their relationship to acupoints, how they compare with conventional somatosensory or noxious response. The objective of this study is to provide scientific evidence on these issues and to characterize the nature of the deqi phenomenon in terms of the prevalence of sensations as well as the uniqueness of the sensations underlying the deqi experience.

Methods: Manual acupuncture was performed at LI4, ST36 and LV3 on the extremities in randomized order during fMRI in 42 acupuncture naïve healthy adult volunteers. Non-invasive tactile stimulation was delivered to the acupoints by gentle tapping with a von Frey monofilament prior to acupuncture to serve as a sensory control. At the end of each procedure, the subject was asked if each of the sensations listed in a questionnaire or any other sensations occurred during stimulation, and if present to rate its intensity on a numerical scale of 1-10. Statistical analysis including paired t-test, analysis of variance, Spearman's correlation and Fisher's exact test were performed to compare responses between acupuncture and sensory stimulation.

Results: The deqi response was elicited in 71% of the acupuncture procedures compared with 24% for tactile stimulation when thresholded at a minimum total score of 3 for all the sensations. The frequency and intensity of individual sensations were significantly higher in acupuncture. Among the sensations typically associated with deqi, aching, soreness and pressure were most common, followed by tingling, numbness, dull pain, heaviness, warmth, fullness and coolness. Sharp pain of brief duration that occurred in occasional subjects was regarded as inadvertent noxious stimulation. The most significant differences in the deqi sensations between acupuncture and tactile stimulation control were observed with aching, soreness, pressure and dull pain. Consistent with its prominent role in TCM, LI4 showed the most prominent response, the largest number of sensations as well as the most marked difference in the frequency and intensity of aching, soreness and dull pain between acupuncture and tactile stimulation control. Interestingly, the dull pain generally preceded or occurred in the absence of sharp pain in contrast to reports in the pain literature. An approach to summarize a sensation profile, called the deqi composite, is proposed and applied to explain differences in deqi among acupoints.

Conclusion: The complex pattern of sensations in the deqi response suggests involvement of a wide spectrum of myelinated and unmyelinated nerve fibers, particularly the slower conducting fibers in the tendinomuscular layers. The study provides scientific data on the characteristics of the 'deqi' response in acupuncture and its association with distinct nerve fibers. The findings are clinically relevant and consistent with modern concepts in neurophysiology. They can provide a foundation for future studies on the deqi phenomenon.

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Experimental paradigm. Manual acupuncture was administered to LI4, LV3 and ST36 on the right. The subject's sensitivity to needling was pre-tested and adjusted to tolerance prior to scanning. After remaining in place for 2 min (R1), the needle was rotated forward and backward with even motion for 2 min at the rate of 60 times per minute with a amplitude of approximately 180° in each direction (M1). After a rest period of 3 min (R2), needle manipulation was repeated in like manner (M2). The needle was withdrawn 1 minute after completion of acupuncture. For tactile stimulation control, the acupoint was tapped with a size 5.88 von Frey monofilament using a matched paradigm.
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Figure 1: Experimental paradigm. Manual acupuncture was administered to LI4, LV3 and ST36 on the right. The subject's sensitivity to needling was pre-tested and adjusted to tolerance prior to scanning. After remaining in place for 2 min (R1), the needle was rotated forward and backward with even motion for 2 min at the rate of 60 times per minute with a amplitude of approximately 180° in each direction (M1). After a rest period of 3 min (R2), needle manipulation was repeated in like manner (M2). The needle was withdrawn 1 minute after completion of acupuncture. For tactile stimulation control, the acupoint was tapped with a size 5.88 von Frey monofilament using a matched paradigm.

Mentions: Acupuncture and tactile stimulation control was delivered to LI4 on the hand, LV3 on the foot and ST36 on the lower leg on the right in randomized order by an acupuncturist with over 25 years of clinical experience (JL). The individual's sensitivity to needle manipulation was pretested, aiming to elicit deqi sensations without noxious pain. The stimulation paradigm is depicted in Figure 1. The needle was rotated approximately 180° in each direction with even motion at the rate of 60 times/min for 2 min during M1 and M2. The needle remained in place during the rest periods R1, R2 and R3. Each procedure lasted a total of ten minutes. In order to avoid excess discomfort, the subject was instructed to raise one finger if any sensation reached the intensity of 7–8 on a scale of 1–10 and 2 fingers in case of any sharp pain. When so signalled, the acupuncturist would adjust the force of stimulation so that the sharp pain would disappear within a few seconds. The acupuncture stimulation procedure was performed twice for each acupoint. Sterile, one-time use only stainless steel needles were used for LV3 (0.20 mm diameter) and ST36 (0.22 mm diameter) (KINGLI Medical Appliance Co. Wuxi, China). Silver needles (0.23 mm diameter) were used for LI4 (Matsuka, Tokyo, Japan). Superficial tactile stimulation was performed by gentle tapping with a size 5.88 von Frey monofilament, a standard method of sensory stimulation, prior to acupuncture with needling. The purpose of this design was to explore how acupuncture sensations might differ from the sensations elicited by the conventional sensory stimulus of touch. At the end of each tactile stimulation or acupuncture procedure, the subject was questioned by another researcher in the team if each of the deqi sensations (aching, pressure, soreness, heaviness, fullness, warmth, cooling, numbness, tingling, dull pain), sharp pain or any other sensations occurred during the stimulation, and to rate its intensity on the scale of 1–10 (1–3 mild, 4–6 moderate, 7–9 strong, 10 unbearable).


Characterization of the "deqi" response in acupuncture.

Hui KK, Nixon EE, Vangel MG, Liu J, Marina O, Napadow V, Hodge SM, Rosen BR, Makris N, Kennedy DN - BMC Complement Altern Med (2007)

Experimental paradigm. Manual acupuncture was administered to LI4, LV3 and ST36 on the right. The subject's sensitivity to needling was pre-tested and adjusted to tolerance prior to scanning. After remaining in place for 2 min (R1), the needle was rotated forward and backward with even motion for 2 min at the rate of 60 times per minute with a amplitude of approximately 180° in each direction (M1). After a rest period of 3 min (R2), needle manipulation was repeated in like manner (M2). The needle was withdrawn 1 minute after completion of acupuncture. For tactile stimulation control, the acupoint was tapped with a size 5.88 von Frey monofilament using a matched paradigm.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2200650&req=5

Figure 1: Experimental paradigm. Manual acupuncture was administered to LI4, LV3 and ST36 on the right. The subject's sensitivity to needling was pre-tested and adjusted to tolerance prior to scanning. After remaining in place for 2 min (R1), the needle was rotated forward and backward with even motion for 2 min at the rate of 60 times per minute with a amplitude of approximately 180° in each direction (M1). After a rest period of 3 min (R2), needle manipulation was repeated in like manner (M2). The needle was withdrawn 1 minute after completion of acupuncture. For tactile stimulation control, the acupoint was tapped with a size 5.88 von Frey monofilament using a matched paradigm.
Mentions: Acupuncture and tactile stimulation control was delivered to LI4 on the hand, LV3 on the foot and ST36 on the lower leg on the right in randomized order by an acupuncturist with over 25 years of clinical experience (JL). The individual's sensitivity to needle manipulation was pretested, aiming to elicit deqi sensations without noxious pain. The stimulation paradigm is depicted in Figure 1. The needle was rotated approximately 180° in each direction with even motion at the rate of 60 times/min for 2 min during M1 and M2. The needle remained in place during the rest periods R1, R2 and R3. Each procedure lasted a total of ten minutes. In order to avoid excess discomfort, the subject was instructed to raise one finger if any sensation reached the intensity of 7–8 on a scale of 1–10 and 2 fingers in case of any sharp pain. When so signalled, the acupuncturist would adjust the force of stimulation so that the sharp pain would disappear within a few seconds. The acupuncture stimulation procedure was performed twice for each acupoint. Sterile, one-time use only stainless steel needles were used for LV3 (0.20 mm diameter) and ST36 (0.22 mm diameter) (KINGLI Medical Appliance Co. Wuxi, China). Silver needles (0.23 mm diameter) were used for LI4 (Matsuka, Tokyo, Japan). Superficial tactile stimulation was performed by gentle tapping with a size 5.88 von Frey monofilament, a standard method of sensory stimulation, prior to acupuncture with needling. The purpose of this design was to explore how acupuncture sensations might differ from the sensations elicited by the conventional sensory stimulus of touch. At the end of each tactile stimulation or acupuncture procedure, the subject was questioned by another researcher in the team if each of the deqi sensations (aching, pressure, soreness, heaviness, fullness, warmth, cooling, numbness, tingling, dull pain), sharp pain or any other sensations occurred during the stimulation, and to rate its intensity on the scale of 1–10 (1–3 mild, 4–6 moderate, 7–9 strong, 10 unbearable).

Bottom Line: The deqi response was elicited in 71% of the acupuncture procedures compared with 24% for tactile stimulation when thresholded at a minimum total score of 3 for all the sensations.The findings are clinically relevant and consistent with modern concepts in neurophysiology.They can provide a foundation for future studies on the deqi phenomenon.

View Article: PubMed Central - HTML - PubMed

Affiliation: Athinoula A, Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. hui@nmr.mgh.harvard.edu

ABSTRACT

Background: Acupuncture stimulation elicits deqi, a composite of unique sensations that is essential for clinical efficacy according to traditional Chinese medicine (TCM). There is lack of adequate experimental data to indicate what sensations comprise deqi, their prevalence and intensity, their relationship to acupoints, how they compare with conventional somatosensory or noxious response. The objective of this study is to provide scientific evidence on these issues and to characterize the nature of the deqi phenomenon in terms of the prevalence of sensations as well as the uniqueness of the sensations underlying the deqi experience.

Methods: Manual acupuncture was performed at LI4, ST36 and LV3 on the extremities in randomized order during fMRI in 42 acupuncture naïve healthy adult volunteers. Non-invasive tactile stimulation was delivered to the acupoints by gentle tapping with a von Frey monofilament prior to acupuncture to serve as a sensory control. At the end of each procedure, the subject was asked if each of the sensations listed in a questionnaire or any other sensations occurred during stimulation, and if present to rate its intensity on a numerical scale of 1-10. Statistical analysis including paired t-test, analysis of variance, Spearman's correlation and Fisher's exact test were performed to compare responses between acupuncture and sensory stimulation.

Results: The deqi response was elicited in 71% of the acupuncture procedures compared with 24% for tactile stimulation when thresholded at a minimum total score of 3 for all the sensations. The frequency and intensity of individual sensations were significantly higher in acupuncture. Among the sensations typically associated with deqi, aching, soreness and pressure were most common, followed by tingling, numbness, dull pain, heaviness, warmth, fullness and coolness. Sharp pain of brief duration that occurred in occasional subjects was regarded as inadvertent noxious stimulation. The most significant differences in the deqi sensations between acupuncture and tactile stimulation control were observed with aching, soreness, pressure and dull pain. Consistent with its prominent role in TCM, LI4 showed the most prominent response, the largest number of sensations as well as the most marked difference in the frequency and intensity of aching, soreness and dull pain between acupuncture and tactile stimulation control. Interestingly, the dull pain generally preceded or occurred in the absence of sharp pain in contrast to reports in the pain literature. An approach to summarize a sensation profile, called the deqi composite, is proposed and applied to explain differences in deqi among acupoints.

Conclusion: The complex pattern of sensations in the deqi response suggests involvement of a wide spectrum of myelinated and unmyelinated nerve fibers, particularly the slower conducting fibers in the tendinomuscular layers. The study provides scientific data on the characteristics of the 'deqi' response in acupuncture and its association with distinct nerve fibers. The findings are clinically relevant and consistent with modern concepts in neurophysiology. They can provide a foundation for future studies on the deqi phenomenon.

Show MeSH
Related in: MedlinePlus