Measurement of acupuncture needle grasp at acupuncture points and control points

March 18, 2004

Measurement of acupuncture needle grasp at acupuncture points and control

points

Helene M. Langevin†, David L. Churchill† , James R. Fox‡ , Gary J. Badger*

and Martin H. Krag‡

Depts of Neurology†, Orthopaedics & Rehabilitation‡ and Medical

Biostatistics*, Univ of Vermont, Burlington, VT

One of the most controversial aspects of acupuncture is whether the location

of acupuncture needling sites is important, ie: does the needling of

classically defined acupuncture points have an enhanced therapeutic effect

as compared with the needling of any other set of points on the body.

Resolving this issue is of fundamental importance, since the specificity of

acupuncture points is implied in some of the most basic principles

underlying the traditional practice of acupuncture.

These principles are:

a reaction termed " de qi " occurs when an acupuncture point is correctly

identified and needled;

eliciting de qi is essential to acupuncture’s therapeutic effect.

During de qi, the patient feels a characteristic needling sensation.

Simultaneously, the acupuncturist feels a change in the mechanical behavior

of the tissues surrounding the needle. This change is described as a

tightening, pulling or grasping of the needle by the tissues, and is

intensified by manual manipulation of the needle. Ancient Chinese texts have

likened this sensation to that of " a fish biting on a fishing line " . The

term " needle grasp " will be used here to describe this phenomenon. The

nature of the phenomenon causing needle grasp is unknown. A commonly

expressed opinion is that needle grasp is due to contraction of skeletal

muscle when needled at a motor point or neurovascular hilus, but so far no

published data have conclusively supported this model.

The sensory component of de qi, (what the patient feels during needling) is

difficult to study because of its subjective nature. In contrast, needle

grasp is an observable phenomenon consisting of a change in the mechanical

interaction between the needle and surrounding tissue. Needle grasp can be

objectively quantified by measuring the amount of force required to pull an

acupuncture needle out of the skin (pullout force). Pullout force

measurements can therefore be used to address our primary research question:

does needle grasp occur everywhere, or is it specific to acupuncture points?

Since needle grasp is an integral component of de qi, measuring pullout

force may be an important step to understanding the role, if any, played by

classically defined acupuncture points in acupuncture therapy.

We are currently performing a study in which we are measuring pullout force

at 8 acupuncture points and 8 corresponding contralateral control points in

80 normal human subjects. A novel and important aspect of this study is that

all acupuncture needles are inserted, manipulated and pulled out using a

computer-controlled mechanical instrument. Pullout force is measured

automatically by the instrument as the needle is pulled out of the skin.

This ensures controlled experimental conditions and eliminates sources of

investigator bias. The needle movement parameters (insertion speed, rotation

speed, rotation angle, pullout speed) were chosen to be consistent with

acupuncture practice. At each point, needle insertion depth is set in

proportion to subcutaneous tissue thickness as determined by ultrasound. The

same depth is used for corresponding acupuncture and control points.

A secondary research question addressed in our study is whether the method

of needle manipulation influences needle grasp. Subjects are randomized to

one of three manipulation types: Needle insertion only with no manipulation

(NO), and Needle insertion followed by either Bi-directional rotation (BI),

or Uni-directional rotation (UNI).

The acupuncture vs. control comparison is made within subjects, with

acupuncture and control points randomized to right and left sides of the

body. Control points are located within a 2 or 3 cm radius (depending on

location) of the contralateral acupuncture point. Subjects are blind to both

procedure type and acupuncture vs. control variables.

Results from the first 33 subjects show that pullout force at acupuncture

points is 22% higher than at corresponding control points (57.5g vs. 47.1g)

(Fig. 1). This difference is statistically significant (repeated measures

ANOVA, p<0.001). There is also a significant difference in pullout force

between the three needling procedure types (p<0.001) (Fig. 2). This

difference is significant both at acupuncture points and at control points.

These results provide objective evidence that acupuncture points have

different biomechanical behavior than control points. Whether this is due to

anatomical and/or physiological differences between acupuncture points and

surrounding tissues, and what these differences are, remains unknown. Our

results also show that needle manipulation strongly influences needle grasp,

and does so at control points as well as at acupuncture points. We are

planning to use the results of this study as a first step to understand the

mechanisms underlying needle grasp, and the therapeutic significance of both

de qi and acupuncture points.

Acknowledgement: Funded by the NIH Center for Complementary and Alternative

Medicine, Grant #1 RO1AT00133.

Physiological effects of superficial acupuncture: A technique focusing on

patients’ respiratory rhythm

Tim H. Tanaka1,2, Kazushi Nishijo2

1The Pacific Wellness Institute, Canada

2Acupuncture, Department, Tsukuba College of Technology, Japan

As a result of the growing number of research activities in the field of

acupuncture over the past decade, an understanding of acupuncture and its’

mechanisms has been substantially advanced. However, the acupuncture

technique used in most previous studies was deep needle insertion with

strong manual or electrical stimulation. Very little study has been

conducted using a gentle, superficial acupuncture technique.

The series of our experiments indicated that superficial acupuncture

stimulation (stimulating skin and subcutaneous tissue only) causes a

significant autonomic reaction, which in turn induces various physiological

reactions. However, the degree of autonomic response significantly varies

depending on the subject’s " biological state " (e.g., respiratory status)

during acupuncture needling. The result indicated that acupuncture

stimulation must be in synchronization with the patient’s exhalation phase

of respiration in order to elicit a consistent parasympathetic excitation

response.

Our controlled study using the superficial acupuncture technique on

chronic-tension-type-headache patients indicated that integrated

electromyographic activity and the subject’s self-reported pain

significantly decreased following the application of superficial needling on

the SJ. 5 point. However, significant response only occurred when the point

was stimulated during the patient’s exhalation.

The study suggested that acupuncture’s positive effect does not depend on

the selection of acupuncture points and depth alone but also of significant

importance is the knowledge of a patient’s physiological state during

needling.

The presentation also covers a clinical study on neck pain patients, and

discusses the immediate and prolonged effect of superficial and deep

acupuncture needling techniques.

Centro de Medicina Oriental

Acupunctura,Laserterapia,Shiatsu,

Drenagem Linfatica,El-Terapia.

Dr.H.Peter Nussbaumer

351 269 827272 +351 967 044284

medoriental

Santiago do Cacém / Portugal

March 18, 2004