Acupuncture's Therapeutic Effect

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American Physiological Society (APS)

4-Jan-02

 

 

Old Technique May Hold the Key to Acupuncture's Therapeutic Effect

Library: MED

Keywords: ACUPUNCTURE PAIN PHYSIOLOGY ALTERNATIVE MEDICINE

Description: Needle manipulation is performed to elicit the

characteristic reaction to acupuncture needling known as " de qi. " As

a first step toward understanding the physiological and therapeutic

significance of de qi, researchers quantified needle grasp by

measuring the force necessary to pull an inserted acupuncture needle

out of the tissues (pullout force). (J. of Applied Physiology, Dec-

2001)

 

 

 

A 2,000 Year-Old Technique May Hold the Key to Acupuncture's

Therapeutic Effect

 

A new study establishes a link between needle manipulation and

biomechanical effects.

 

January 3, 2002 -- Bethesda, MD -- Western medical experts have been

inherently skeptical of acupuncture's therapeutic value for the

treatment of pain and other medical conditions. One reason is that

it seems very unlikely that the simple act of inserting fine needles

into tissue could elicit any effect at all, let alone wide-ranging

and long-lasting therapeutic effects. Acupuncture needles are of a

finer gauge than even the finest hypodermic needles (not considered

therapeutic); acupuncture rarely results in a single drop of blood

being discharged.

 

What skeptics are not aware of is that acupuncture typically

involves manual needle manipulation after needle insertion. Manual

needle manipulation consists of rapidly rotating (back-and-forth or

one direction) and/or pistoning (up-and-down motion) of the needle.

The manipulation can be brief (a few seconds), prolonged (several

minutes), or intermittent depending on the clinical situation.

Manipulation occurs even when electrical stimulation is used (a

relatively recent development in the history of acupuncture).

 

Traditionally, manipulation is performed to elicit the

characteristic reaction to acupuncture needling known as " de qi. " De

qi has a sensory component, known as " needle grasp, " which is

perceived by the patient as an ache or heaviness in the area

surrounding the needle and a simultaneously occurring biomechanical

component that can be perceived by the acupuncturist. During needle

grasp, the acupuncturist feels as if the tissue is grasping the

needle such that there is increased resistance to further motion of

the manipulated needle. This " tug " on the needle is classically

described as " like a fish biting on a fishing line. "

 

Needle grasp can range from subtle to very strong, with pulling back

on the needle resulting in visible tenting of the skin. During

acupuncture treatments, needle manipulation is used to elicit and

enhance de qi, and de qi is used as feedback to confirm that the

proper amount of needle stimulation has been used.

 

De qi is widely viewed as essential to acupuncture's therapeutic

effectiveness. Needle manipulation, de qi, and needle grasp,

therefore, are potentially important components of acupuncture's

therapeutic effect, yet the mechanisms underlying de qi and needle

grasp are unknown. As a first step toward understanding the

physiological and therapeutic significance of de qi, researchers

quantified needle grasp by measuring the force necessary to pull an

inserted acupuncture needle out of the tissues (pullout force). They

also hypothesized that:

 

* Pullout force is greater with two different types of needle

manipulation commonly used in acupuncture practice [bi-directional

(BI) and unidirectional (UNI) needle rotation] than with needle

insertion with no manipulation (NO). If proven true, this will

demonstrate that needle manipulation has measurable biomechanical

effects.

 

* These measurable effects could suggest that needle manipulation

may indeed play an important role in acupuncture therapy as de qi is

traditionally believed to be greater at " acupuncture points. "

 

* Pullout force is greater at classically defined acupuncture points

than at non-acupuncture control points.

 

To test these hypotheses, an experiment was performed in which

normal human subjects received different types of acupuncture needle

manipulation at eight acupuncture points and eight corresponding

control points.

 

The authors of the research study, " Biomechanical Response to

Acupuncture Needling In Humans, " are Helene M. Langevin, David L.

Churchill, James R. Fox, Gary J. Badger, Brian S. Garra, and Martin

H. Krag, all from the University of Vermont College of Medicine,

Burlington, VT. Their findings are published in the December 2001

edition of the Journal of Applied Physiology.

 

Methodology

Healthy volunteers, ages 18-55, were invited to participate.

Exclusion criteria were a history of diabetes, neuromuscular

disease, bleeding disorder, collagen vascular disease, acute or

chronic corticosteroid therapy, and extensive scarring or

dermatological abnormalities in the areas tested. Volunteers taking

anti-inflammatory or antihistamine medications were asked to

discontinue their use three days before testing. Female volunteers

were excluded if they were pregnant. Testing was not scheduled

during menstruation to avoid possible discomfort due to cessation of

anti-inflammatory medication.

 

Thirty-eight women and 22 men completed the testing protocol. The

mean age and body mass index of the participants was 37.1 +- 10.2

years and 26.5 +- 5.3 kg/m2, respectively. There were no significant

differences with respect to these subject characteristics between

the groups of subjects randomized to the three needle-manipulation

types.

 

Eight traditional acupuncture point locations were investigated. For

each location, pairs of corresponding acupuncture points on the

right and left sides of the body were identified and marked with a

skin marker (16 acupuncture points total). Acupuncture points were

identified according to traditional methods. Approximate position

was determined in relation to anatomic landmarks (e.g., bones,

tendons) and proportional measurements (e.g., fraction of the

distance between wrist and elbow creases). Palpation, feeling for a

slight depression or yielding of tissues determined the precise

position of each acupuncture point. For each location, right and

left sides of the body were then randomly selected for acupuncture

point and control point. On the side selected for control point, a

disk-shaped template was centered on the acupuncture point.

 

Throughout testing, subjects were neither told nor able to see or

hear any indication of which side was used for each point

(acupuncture and control) and which needle manipulation type (NO,

BI, or UNI) was being performed. All needling procedures (insertion,

manipulation, pullout, and pullout-force measurement) were performed

by a computer-controlled acupuncture needling system. This ensured

consistent experimental conditions and eliminated many potential

sources of investigator bias.

 

Results

The measurements of pullout force are the first quantification of

needle grasp, a biomechanical aspect of the characteristic de qi

reaction widely viewed as essential to the therapeutic effect of

acupuncture. The research found 167 and 52 percent increases in

pullout force with UNI and BI, respectively, compared with NO.

Needle manipulation increased pullout force at both acupuncture

points and control points. Although 18 percent difference in mean

pullout force between acupuncture points and control points existed,

the magnitude of this difference was much smaller than the

difference caused by manipulation of the needle. Together, these

results indicate that needle grasp is strongly influenced by needle

manipulation and that this effect is not unique to acupuncture

points.

 

Conclusions

Needle grasp has been described in acupuncture textbooks for over

2,000 years. This study constitutes a first step toward determining

the biological and clinical significance of this phenomenon. For the

first time, a link has been demonstrated between acupuncture needle

manipulation and biomechanical events in the tissue. These

biomechanical events are potentially associated with long-lasting

cellular and extracellular effects. Developing an understanding of

these effects in future studies may eventually lead to insights into

acupuncture's therapeutic mechanisms. In the shorter term, these

same effects may also provide important biological markers that can

be used in clinical trials of acupuncture.

 

Source

December 2001 edition of the Journal of Applied Physiology.

 

-end-

 

The American Physiological Society (APS) was founded in 1887 to

foster basic and applied science, much of it relating to human

health.

 

The Bethesda, MD-based Society has more than 10,000 members and

publishes 3,800 articles in its 14 peer-reviewed journals every

year.

 

***

 

Editor's Note: To set up an interview with a member of the research

team, please contact Donna Krupa at 703.527.7357 (direct dial),

703.967.2751 (cell) or djkrupa1.