Cerebral hemodynamic responses induced by specific acupuncture sensations during needling at trigger points: a near-infrared spectroscopic study.
ABSTRACT Acupuncture stimulation at specific points, or trigger points (TPs), elicits sensations called "de-qi". De-qi sensations relate to the clinical efficacy of the treatment. However, it is neither clear whether de-qi sensations are associated with TPs, nor clear whether acupuncture effects on brain activity are associated with TPs or de-qi. We recorded cerebral hemodynamic responses during acupuncture stimulation at TPs and non-TPs by functional near-infrared spectroscopy. The acupuncture needle was inserted into both TPs and non-TPs within the right extensor muscle in the forearm. Typical acupuncture needle manipulation was conducted eight times for 15 s. The subjects pressed a button if they felt a de-qi sensation. We investigated how hemodynamic responses related to de-qi sensations induced at TPs and non-TPs. We observed that acupuncture stimulations producing de-qi sensations significantly decreased the Oxy-Hb concentration in the supplementary motor area (SMA), pre-supplementary motor area, and anterior dorsomedial prefrontal cortex regardless of the point stimulated. The hemodynamic responses were statistically analyzed using a general linear model and a boxcar function approximating the hemodynamic response. We observed that hemodynamic responses best fit the boxcar function when an onset delay was introduced into the analyses, and that the latency of de-qi sensations correlated with the onset delay of the best-fit function applied to the SMA. Our findings suggest that de-qi sensations favorably predict acupuncture effects on cerebral hemodynamics regardless of the type of site stimulated. Also, the effect of acupuncture stimulation in producing de-qi sensation was partly mediated by the central nervous system including the SMA.
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ABSTRACT: Objective. Despite the systematic literature review of the current evidence, we aim to answer the question " is Deqi an indicator of clinical effects in acupuncture treatment?" Methods. We systematically searched CNKI, VIP, Wanfang Data, PubMed, Embase, and the CENTRAL for three types of study: (1) empirical research probing into the role of Deqi in acupuncture; (2) mechanism studies examining the effect of Deqi on physiological parameters in animal models and human subjects; (3) clinical studies that compared the outcome of acupuncture with Deqi with that of acupuncture without Deqi. Two reviewers independently extracted data, undertook qualitative or quantitative analysis, and summarized findings. Results. The ancient Chinese acupuncturists valued the role of Deqi as a diagnostic tool, a prognosis predictor, and a necessary part of the therapeutic procedure. Findings from modern experimental research provided preliminary evidence for the physiological mechanism that produced Deqi. Few clinical studies generated conflicting evidence of the comparative effectiveness of acupuncture with Deqi versus acupuncture without Deqi for a variety of conditions. Conclusion. The current evidence base is not solid enough to draw any conclusion regarding the predicative value of natural Deqi for clinical efficacy or the therapeutic value of manipulation-facilitated Deqi.Evidence-based Complementary and Alternative Medicine 01/2013; 2013:750140. · 1.72 Impact Factor
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ABSTRACT: BACKGROUND:The traditional Chinese theory of acupuncture emphasizes that the intensity of acupuncture must reach a threshold to generate de qi, which is necessary to acheive the best therapeutic effect. De qi is an internal compound sensation of soreness, tingling, fullness, aching, cool, warmth and heaviness, and a radiating sensation at and around the acupoints. However, the notion that de qi must be acheived for maximum benefit has not been confirmed by modern scientific evidence. METHODS:We performed a prospective multicentre randomized controlled trial involving patients with Bell palsy. Patients were randomly assigned to the de qi (n = 167) or control (n = 171) group. Both groups received acupuncture: in the de qi group, the needles were manipulated manually until de qi was reached, whereas in the control group, the needles were inserted without any manipulation. All patients recevied prednisone as a basic treatment. The primary outcome was facial nerve function at month 6. We also assessed disability and quality of life 6 months after randomization. RESULTS:After 6 months, patients in the de qi group had better facial function (adjusted odds ratio [OR] 4.16, 95% confidence interval [CI] 2.23-7.78), better disability assessment (differences of least squares means 9.80, 95% CI 6.29-13.30) and better quality of life (differences of least squares means 29.86, 95% CI 22.33-37.38). Logistic regression analysis showed a positive effect of the de qi score on facial-nerve function (adjusted OR 1.07, 95% CI 1.04-1.09). INTERPRETATION:Among patients with Bell palsy, acupuncture with strong stimulation that elicited de qi had a greater therapeutic effect, and stronger intensity of de qi was associated with the better therapeutic effects. Trial registration: Clinicaltrials.gov no. NCT00685789.Canadian Medical Association Journal 02/2013; · 6.47 Impact Factor
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ABSTRACT: Background. Development of non-deqi control is still a challenge. This study aims to set up a potential approach to non-deqi control by using lidocaine anesthesia at ST36. Methods. Forty healthy volunteers were recruited and they received two fMRI scans. One was accompanied with manual acupuncture at ST36 (DQ group), and another was associated with both local anesthesia and manual acupuncture at the same acupoint (LA group). Results. Comparing to DQ group, more than 90 percent deqi sensations were reduced by local anesthesia in LA group. The mainly activated regions in DQ group were bilateral IFG, S1, primary motor cortex, IPL, thalamus, insula, claustrum, cingulate gyrus, putamen, superior temporal gyrus, and cerebellum. Surprisingly only cerebellum showed significant activation in LA group. Compared to the two groups, bilateral S1, insula, ipsilateral IFG, IPL, claustrum, and contralateral ACC were remarkably activated. Conclusions. Local anesthesia at ST36 is able to block most of the deqi feelings and inhibit brain responses to deqi, which would be developed into a potential approach for non-deqi control. Bilateral S1, insula, ipsilateral IFG, IPL, claustrum, and contralateral ACC might be the key brain regions responding to deqi.Evidence-based Complementary and Alternative Medicine 01/2014; 2014:987365. · 1.72 Impact Factor