The significance of needle placement site in acupuncture

doi:10.1016/0022-3999(89)90010-X

Journal of Psychosomatic Research

Volume 33, Issue 4, 1989, Pages 489-496

https://doi.org/10.1016/0022-3999(89)90010-X Get rights and content

Abstract

Traditional acupuncturists claim that correct needling of classical acupuncture loci is associated with a characteristic set of sensations usually referred to as ‘Teh Chi’. The studies reported here examine this claim. In the first a multiple adjective sensation rating scale was developed and administered to 125 patients receiving acupuncture treatment. The results were subjected to principal components analysis and the first factor to emerge provide some support for the constellation of sensations corresponding to Teh Chi. In the second study the scale was used in a randomised controlled mixed single/double blind experiment in which 65 volunteers were stimulated at three classical and three non-classical (sham) needling sites by either a trained acupuncturist (single blind) or an anaesthetist (double blind). The results of the second study did not support the contention that the sensations of Teh Chi occur more frequently at classical acupuncture needling sites. The implications of the results for the practice of acupuncture are discussed.

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Cited by (99)

Historical perspectives on using sham acupuncture in acupuncture clinical trials
2022, Integrative Medicine Research
Trials of acupuncture in the West began before textbooks about acupuncture were generally available. This placed trials at risk of possible faulty assumptions about the practice of acupuncture and adoption of problematic research assumptions and methods. Further, this lack of information has had an influence on the theories of developing a valid and reliable sham control treatment in clinical trials of acupuncture. This commentary explores these issues.
Literature review focussing on the time line of developments in the field, developments of sham interventions and use thereof and knowledge of physiological effects of needling.
Early trials demonstrated a lack of knowledge about acupuncture. As the methodology of trials improved, new sham treatment methods were developed and adopted; however, the sham treatment methods were implemented without physiological studies exploring their potential physiological effects and without examining the broader practice of acupuncture internationally.
Mistaken assumptions about the practice of acupuncture reinforced by paucity of physiological investigations are factors that led to use of inappropriate sham interventions for acupuncture trials. These not only lead to confusing or misleading trial results, they, as far as we can see underestimate the effects of acupuncture leading to bias against acupuncture. There are significant problems with sham interventions and how they are applied in trials of acupuncture. Further research is needed to explore the effects of this both for future trials and for interpreting existing evidence.
The therapeutic encounter between being-in-pain and acupuncture: An interpretative phenomenological analysis
2021, European Journal of Integrative Medicine
Citation Excerpt :
Attempts have been made to classify de qi and to differentiate it from adverse needling pain [44,45]. Many English language de qi descriptors began by borrowing from the McGill Pain Questionnaire (MPQ) [46–49] following a seminal study by Vincent et al. [50]. The MPQ attempts to provide a standardised means of describing and measuring pain in a way that is meaningful for patients and clinicians, however it is questionable if such language is adequate for describing de qi experiences.
Chronic pain is a widespread problem and predicted to rise, yet remains poorly understood. Acupuncture is a frequently used intervention for pain. Acupuncture can be understood as a complex intervention involving ‘specific’ and ‘non-specific’ effects. Given the complexity of acupuncture therapy, and the inherently subjective and multidimensional nature of pain, acupuncture might interact with pain at a multidimensional level, with implications for the therapeutic encounter and how this influences experiences of pain. The aim of this research was to re-examine and thus enhance understandings of how lived experiences of being-in-pain is encountered in acupuncture therapy.
Research design and analysis was carried out using Interpretative Phenomenological Analysis (IPA). Phenomenology has been widely applied in pain research, yet there is a relative paucity of acupuncture phenomenological studies. An opportunity thus exists to re-examine the complexity of the therapeutic encounter from this perspective. In depth, semi-structured interviews were carried out with a purposive sample of three participants recruited from a private acupuncture clinic.
Three superordinate themes explicated the encounter: (1) A journey of becoming a person-in-pain and arriving at acupuncture, (2) The embodied encounter with acupuncture, and (3) Acupuncture as an intersubjective encounter of evolving meanings.
Applying a phenomenological perspective revealed self-identity, temporally and socially-constituted meanings, and relationship dynamics as integral to the encounter. Deqi (therapeutic needling) was a complex, temporal, meaningful construct that went beyond established sensory descriptors. Pain alleviation was important but validation and the alleviation of personal suffering often took priority.
Anxiety related to De Qi psychophysical responses as measured by MASS: A sub-study embedded in a multisite randomised clinical trial
2018, Complementary Therapies in Medicine
Citation Excerpt :
The importance given to De Qi stems often from its purported clinical significance,22–27 needling is effective when one obtains De Qi (Ling Shu, chapter3),28 a belief held by practitioners’ traditional and conservative viewpoints throughout the many dynasties of ancient China, and which still influence today’s clinical practice.29 Acupuncture needling often evokes complex somatosensory sensations30 (literally De Qi), which are often characterised as a conglomerate of unique somatosensory responses.31–38 The term ‘De Qi’ is frequently acknowledged as ‘obtaining Qi’,22,23,34,39,40 and to be perceived by patients as a unique response41,42 and/or by the practitioner as needle grasp.41,42
Acupuncture has been broadly applied in the management of many diseases and conditions; however, its mechanism of action has been partially elucidated. Additionally, assessment of psychophysical responses in the acupuncture therapy is not common regarding anxiety disorder studies. Taken together, the therapeutic effect of acupuncture appears when De Qi psychophysical response is experienced following stimulation of the afferent sensory nerves.
The present study investigates the level of anxiety perceived at different occasions in acupuncture and mock laser group. Furthermore, it examines the relationship between perceived De Qi psychophysical response and the level of anxiety experienced during administration of each intervention.
The study was embedded in a two-arm parallel design multi-center, randomized clinical trial, the Tennis Elbow Acupuncture-International Study-China, Hong Kong, Australia, Italy. Participants’ level of anxiety was measured using a validated instrument, the Massachusetts General Hospital Acupuncture Sensation Mood Scale. Ninety-six participants with Lateral Elbow Pain were randomly allocated into two groups; the acupuncture treatment group (n = 47) and the inactive mock laser control group (n = 49). Data were collected immediately following the interventions at the first and the ninth session within the clinical trial.
Acupuncture with De Qi did not induce higher level of anxiety compared to prior administration of acupuncture. In fact, participants were more relaxed after receiving acupuncture than those who received mock laser. There was also a weak association between participants’ perception of anxiety during acupuncture and the MASS De Qi Index in session nine only (p < 0.01). Further investigation of the result revealed weak positive correlation between anxiety perceived during administration of acupuncture and the following De Qi characteristics; ‘soreness’ (p < 0.01), ‘Deep pressure’ (p < 0.05), ‘Heaviness’ (p < 0.05), and ‘Fullness/distension’ (p < 0.05).
Acupuncture can be regarded as a potential therapy for preoperative anxiety through its possible regulatory function of emotion. While culture may not alter the expectation of the individual regarding anxiety, symptomology associated with anxiety should be understood within the context of the cultural background.
Investigation of the Phenomenon of Propagated Sensation along the Channels in the Upper Limb Following Administration of Acupuncture and Mock Laser
2017, JAMS Journal of Acupuncture and Meridian Studies
Citation Excerpt :
One possible reason is that there is little emphasis on PSC compared to obtaining De Qi, as part of achieving treatment efficacy. This could be because in the acupuncture literature, PSC is prevalently considered to be another feature of the De Qi psychophysical response [6,27,32,33] frequently described as a spreading or radiation sensation [23,34–37]. In several studies, De Qi is often characterized as a composite of unique psychophysical responses described as “Suan (aching/soreness), Ma (tingling/numbness), Zhang (fullness/distension pressure) and Zhong (heaviness)” [32,41,65–70].
Similar to De Qi psychophysical responses, propagated sensation along the channels (PSC) is considered an important phenomenon in traditional Chinese acupuncture. In acupuncture clinical trials, different acupuncture manipulation techniques are used to enhance the propagation of sensation along the channels to facilitate an optimum therapeutic result.
To examine and compare the PSC reported by participants in a clinical trial following the administration of acupuncture and inactive mock laser.
The study was embedded in a two-arm parallel design multicenter, randomized clinical trial, the Tennis Elbow Acupuncture—International Study—China, Hong Kong, Australia, Italy (TEA IS CHAI). Needle sensations were measured using a validated instrument, the Massachusetts General Hospital Acupuncture Sensation Spreading Scale. Ninety-six participants with lateral elbow pain were randomly allocated into two groups in a 1:1 ratio; the acupuncture treatment group (n = 47) and the mock laser control group (n = 49). Participants in both groups received the intervention at two acupoints, LI10 and LI11, consisting of 2 minutes of either standardized needle manipulation or mock laser at each acupoint with a rest period between each intervention period. Data were collected immediately following the interventions at the first and the ninth session within the clinical trial.
Although participants in both groups perceived PSC radiating to similar sites along the upper limb, the frequency of the reported radiation sites among the two intervention groups for both radiation up the limb (p < 0.05) and radiation down the limb (p < 0.001) were statistically significantly different. Among the radiating sensation sites recorded within the two study groups, the sensations were reported as radiating a greater distance down the forearm to the wrist compared to up the arm. Evaluation of PSC across the four study sites revealed a statistically significant difference in frequency of the reported radiation down the limb sites in each study group and radiation up the limb sites only in control group only (p < 0.001).
The findings of the study demonstrated that the PSC phenomenon is not just associated with needling but can be perceived when using a mock laser.
Australian and New Zealand Clinical Trial Registry reference: ACTRN12613001138774 on 11th of October 2013.
Expectation and experience of 'nonspecific' (whole person) feelings elicited by acupuncture: Content validity of a set of questionnaires
2014, Deutsche Zeitschrift fur Akupunktur
Two 32-item questionnaires designed to assess expectation and experience of the relatively nonspecific feelings (whether bodily, emotional or mental) that may arise in response to acupuncture-type interventions have been developed and tested on acupuncture and other complementary health practitioners and students (N = 204).
To conduct a survey to assess content validity (CV) for the questionnaires, following two methods popularised by Lawshe and Lynn, and to compare the results. A secondary objective was to reduce questionnaire length from 32 to 20 items.
Two surveys (Phase 1, 48 items; Phase 2, 18 items) were conducted among 20 experienced acupuncture practitioners and researchers, who scored items as either ‘essential’, ‘useful but not essential’, or ‘not necessary’. Lawshe's and Lynn's methods were applied to the returned data, the former using Wilson's recent modification, the latter with ‘useful but not essential’ rescored as either ‘essential’ or ‘not necessary’. Some subgroup analysis was carried out. In addition, Randolph's multi-rater kappa was used to assess inter-rater reliability as a further measure of content validity.
There were 17 usable responses in Phase 1, 13 in Phase 2. In both surveys, women considered more items as ‘essential’ than men, but fewer as ‘not necessary’, and vice versa (p < 0.001). Lawshe's content validity ratio (CVR) was significant for only 3 items, and the resulting content validity index (CVI) therefore meaningless. When ‘useful’ was rescored as ‘essential’ and Lynn's Scale CVI (S-CVI) calculated as the average of the CVI only for those items considered appropriate for retention (S-CVI_AV-UA), acceptable values were found for subsets of the full list of items, although only for the women respondents. Inter-rater reliability was low for most items, but on the basis of the content validity analysis, together with respondent reservations about particular items and analysis of actual questionnaire usage, a 20-item list was created and circulated to the survey respondents for further feedback.
This shorter scale is now being tested on electroacupuncture training courses, and may be useful in determining whether different feelings are elicited by different types of acupuncture, other CAM modalities, or even other, unrelated activities.
A modified content validity assessment method was found to give more usable results than conventional methods. With this new approach, 32-item questionnaires on expectation and experience of nonspecific feelings were shortened to more manageable 20-item instruments. In general, CV was greater among women than among men.
Es wurden zwei 32 Items umfassende Fragebögen entwickelt und getestet, um Erwartungshaltung und Erleben relativ unspezifischer Empfindungen (sei es körperlich, emotional oder mental) zu erheben, die in Reaktion auf akupunkturartige Interventionen auftreten können. Als Testpersonen hatten sich Praktizierende und Studenten der Akupunktur und anderer komplementärer Verfahren bereitgefunden (N = 204).
Das erste Ziel war, mittels einer Erhebung die inhaltliche Validität der Fragebögen zu überprüfen, wobei die von Lawshe und Lynn eingeführten Methoden angewandt wurden, und die Ergebnisse zu vergleichen. Zweites Ziel war die Verkürzung der Fragebögen von 32 auf 20 Items.
Es wurden zwei Untersuchungen (Phase 1: 48 Items, Phase 2: 18 Items) unter Mitwirkung von 20 erfahrenen Praktizierenden und Forschern im Bereich Akupunktur durchgeführt. Sie bewerteten die einzelnen Items als „wesentlich”, „nützlich, aber nicht wesentlich” oder „unnötig”. Die erzielten Daten wurden mit den Methoden von Lawshe und Lynn analysiert. Ersterem folgend wurde die jüngste Modifikation von Wilson benutzt, nach Letzterem wurde „nützlich, aber nicht wesentlich” entweder als „wesentlich” oder als „unnötig” gewertet. Es wurde eine Analyse einiger Untergruppen vorgenommen. Zusätzlich wurde Randolphs Multi-Rater kappa eingesetzt, um die Interraterreliabilität als ein weiteres Maß für inhaltliche Validität zu bestimmen.
Es gab 17 verwertbare Antworten in Phase 1 und 13 in Phase 2. In beiden Untersuchungen stuften Frauen mehr Items als „wesentlich” ein als Männer, jedoch weniger als „unnötig” – und umgekehrt (p < 0,001). Der Lawshe Quotient für inhaltliche Validität (CVR – content validity ratio) war nur für drei Items signifikant und der resultierende Index für inhaltliche Validität (content validity index – CVI) folglich bedeutungslos. Wenn „nützlich” als „wesentlich” neu eingestuft und Lynns Skalen-CVI (S-CVI) als Durchschnittswert des CVI nur für solche Items berechnet wurde, die als geeignet für die Beibehaltung betrachtet wurden (S-CVI_AV-UA), ergaben sich akzeptable Werte für Teilmengen der Gesamtliste, jedoch nur für die weiblichen Befragten. Die Interraterreliabilität war für die meisten Items gering. Basierend auf der Analyse der inhaltlichen Validität und unter Berücksichtigung der Vorbehalte der Befragten gegenüber einigen Items sowie der Analyse der derzeitigen Anwendung von Fragebögen wurde eine 20 Items umfassende Liste aufgestellt, an die Befragten verteilt und diese um Feedback gebeten.
Die kürzere Liste wird jetzt in Ausbildungskursen für Elektroakupunktur getestet. Sie könnte helfen zu bestimmen, ob unterschiedliche Akupunkturverfahren, andere CAM-Verfahren oder sogar völlig andere Aktivitäten unterschiedliche Empfindungen auslösen.
Anhand einer modifizierten Bewertungsmethode für inhaltliche Validität wurden Fragebögen mit 32 Items zu Erwartungshaltung und Erleben von nicht-spezifischen Gefühlsreaktionen auf leichter handhabbare Instrumente mit 20 Items gekürzt. Insgesamt war die CV bei Frauen höher als bei Männern.
Brain Activities Responding to Acupuncture at ST36 (zusanli) in Healthy Subjects: A Systematic Review and Meta-Analysis of Task-Based fMRI Studies
2022, Frontiers in Neurology

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The significance of needle placement site in acupuncture

Abstract

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Ann R Coll Surg

Acupuncture for some common disorders: a review of evaluative research

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Naloxone fails to reverse pain thresholds elevated by acupuncture: acupuncture analgesia reconsidered

Pain