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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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Comparison of the frequency of different categories of psychophysical responses between acupuncture and tactile stimulation control. When thresholded at a score of 3, the pooled data (N = 45) from the three acupoints showed a deqi frequency of 71% for acupuncture compared with 24% for tactile stimulation control (p < 0.0001). Standard error bars are based on a 95% Confidence Interval. Fisher's exact test. **p < 0.01, ****p < 0.0001. For more details on data refer to Table 1.
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Figure 2: Comparison of the frequency of different categories of psychophysical responses between acupuncture and tactile stimulation control. When thresholded at a score of 3, the pooled data (N = 45) from the three acupoints showed a deqi frequency of 71% for acupuncture compared with 24% for tactile stimulation control (p < 0.0001). Standard error bars are based on a 95% Confidence Interval. Fisher's exact test. **p < 0.01, ****p < 0.0001. For more details on data refer to Table 1.

Mentions: For the pooled data from all acupoints, the three categories of overall response demonstrated significant differences between acupuncture and tactile stimulation at both thresholds used for the definition of deqi (Figure 2, Table 1). Of the two thresholds, the minimal score of 1 may be too lenient a criterion for designating a response as deqi. When thresholded at T = 3, the pooled data showed a deqi frequency of 71% for acupuncture compared with 24% for tactile stimulation control (p < 0.0001). The frequency was slightly higher at LI4 and ST36 (76%) than at LV3 (61%). The deqi sensations were accompanied by brief occurrences of mild to moderate sharp pain in 27% of all acupuncture procedures. In tactile stimulation control, gentle tapping with a nylon filament caused pain in only 2% of subjects. The most striking contrast between tactile stimulation and acupuncture was the frequent failure to elicit any deqi sensations in tactile stimulation (73%) compared with acupuncture (2%).


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)

Comparison of the frequency of different categories of psychophysical responses between acupuncture and tactile stimulation control. When thresholded at a score of 3, the pooled data (N = 45) from the three acupoints showed a deqi frequency of 71% for acupuncture compared with 24% for tactile stimulation control (p < 0.0001). Standard error bars are based on a 95% Confidence Interval. Fisher's exact test. **p < 0.01, ****p < 0.0001. For more details on data refer to Table 1.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Comparison of the frequency of different categories of psychophysical responses between acupuncture and tactile stimulation control. When thresholded at a score of 3, the pooled data (N = 45) from the three acupoints showed a deqi frequency of 71% for acupuncture compared with 24% for tactile stimulation control (p < 0.0001). Standard error bars are based on a 95% Confidence Interval. Fisher's exact test. **p < 0.01, ****p < 0.0001. For more details on data refer to Table 1.
Mentions: For the pooled data from all acupoints, the three categories of overall response demonstrated significant differences between acupuncture and tactile stimulation at both thresholds used for the definition of deqi (Figure 2, Table 1). Of the two thresholds, the minimal score of 1 may be too lenient a criterion for designating a response as deqi. When thresholded at T = 3, the pooled data showed a deqi frequency of 71% for acupuncture compared with 24% for tactile stimulation control (p < 0.0001). The frequency was slightly higher at LI4 and ST36 (76%) than at LV3 (61%). The deqi sensations were accompanied by brief occurrences of mild to moderate sharp pain in 27% of all acupuncture procedures. In tactile stimulation control, gentle tapping with a nylon filament caused pain in only 2% of subjects. The most striking contrast between tactile stimulation and acupuncture was the frequent failure to elicit any deqi sensations in tactile stimulation (73%) compared with acupuncture (2%).

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