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Investigation of Acupuncture Sensation Patterns under Sensory Deprivation Using a Geographic Information System

  • Insula Institute for Integrative Therapy Research

Abstract and Figures

The study of acupuncture-related sensations, like deqi and propagated sensations along channels (PSCs), has a long tradition in acupuncture basic research. The phenomenon itself, however, remains poorly understood. To study the connection between PSC and classical meridians, we applied a geographic information system (GIS) to analyze sketches of acupuncture sensations from healthy volunteers after laser acupuncture. As PSC can be subtle, we aimed at reducing the confounding impact of external stimuli by carrying out the experiment in a floatation tank under restricted environmental stimulation. 82.4% of the subjects experienced PSC, that is, they had line-like or 2-dimensional sensations, although there were some doubts that these were related to the laser stimulation. Line-like sensations on the same limb were averaged to calculate sensation mean courses, which were then compared to classical meridians by measuring the mean distance between the two. Distances ranged from 0.83 cm in the case of the heart (HT) and spleen (SP) meridian to 6.27 cm in the case of the kidney (KI) meridian. Furthermore, PSC was observed to "jump" between adjacent meridians. In summary, GIS has proven to be a valuable tool to study PSC, and our results suggest a close connection between PSC and classical meridians.
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Evidence-Based Complementary and Alternative Medicine
Volume 2012, Article ID 591304, 10 pages
Research Article
Investigation of Acupuncture Sensation Patterns under
Sensory Deprivation Using a Geographic Information System
Florian Beissner1and Irene Marzolff2
1Pain & Autonomics-Integrative Research (PAIR), Department of Psychiatry and Psychotherapy, Jena University Hospital,
07743 Jena, Germany
2Institute for Physical Geography, Goethe University, 60438 Frankfurt am Main, Germany
Correspondence should be addressed to Florian Beissner,
Received 20 July 2012; Revised 30 August 2012; Accepted 3 September 2012
Academic Editor: Wolfgang Schwarz
Copyright © 2012 F. Beissner and I. Marzol. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
The study of acupuncture-related sensations, like deqi and propagated sensations along channels (PSCs), has a long tradition in
acupuncture basic research. The phenomenon itself, however, remains poorly understood. To study the connection between PSC
and classical meridians, we applied a geographic information system (GIS) to analyze sketches of acupuncture sensations from
healthy volunteers after laser acupuncture. As PSC can be subtle, we aimed at reducing the confounding impact of external stimuli
by carrying out the experiment in a floatation tank under restricted environmental stimulation. 82.4% of the subjects experienced
PSC, that is, they had line-like or 2-dimensional sensations, although there were some doubts that these were related to the laser
stimulation. Line-like sensations on the same limb were averaged to calculate sensation mean courses, which were then compared
to classical meridians by measuring the mean distance between the two. Distances ranged from 0.83cm in the case of the heart
(HT) and spleen (SP) meridian to 6.27 cm in the case of the kidney (KI) meridian. Furthermore, PSC was observed to “jump”
between adjacent meridians. In summary, GIS has proven to be a valuable tool to study PSC, and our results suggest a close
connection between PSC and classical meridians.
1. Introduction
Acupuncture is a medical intervention originating from
ancient Asia, where needles are used to stimulate certain
points on the body. Despite more than five decades of
intensive research in Asia and the West, the underlying
mechanisms of acupuncture are still largely unknown. A
phenomenon that may be of great importance for the under-
standing of these mechanisms is a specific sensation upon
stimulation of acupuncture points that is called deqi (“the
arrival of qi”, ) in Chinese medicine. Previous works
have shown that the perception of this sensation usually
described by words like “aching,” “soreness,” “pressure,” or
“tingling” [1] is similar between subjects, irrespective of
their expectation, sex, or cultural background [24]. Judging
from the adjectives that are most frequently used to describe
deqi, it is a mixed sensation with a strong component of C-
fiber-mediated pain [5]. Another important feature of deqi
is that it often spreads or radiates from the point of its
elicitation. This has led to the term “propagated sensation
along meridians” (PSM) or, more commonly, “propagated
sensation along channels” (PSC) [2].
So far, the investigation of PSC has been limited by a lack
of appropriate methods for its assessment. Questionnaires
like the MASS (MGH acupuncture sensation scale) [6]
have been developed to measure sensory qualities and
intensity of deqi. But they give only a rough estimate of
the spreading/radiation experienced by the subject. To gain
a deeper understanding of PSC, however, it is crucial to
measure its exact course and compare it between subjects.
To close this gap, we developed a new method by
combining standardized subjects’ drawings, a method often
used for pain assessment [7], with an analysis based on
a geographic information system (GIS) [8]. Geographical
information systems allow to map, visualize, and analyze the
patterns, dimensions, relationships, and changes of spatial
2 Evidence-Based Complementary and Alternative Medicine
Control room
Floating room
Fiber optic cables
Isolation tank (open) Isolation tank (closed)
Restricted environmental
No thermal input
No tactile input
No visual input
No auditory input
Figure 1: Experimental design. The subject inside the tank was stimulated with an acupuncture laser, while floating on the water surface to
reduce tactile input. Laser light was transmitted by fiber optic cables from the control room. Laser optodes were attached to the skin using
silicone adapters and adhesive tape. After the tank was closed, there was also reduced visual, auditory, and thermal input, so that subjects
could concentrate on sensations occuring during laser acupuncture. Tank images courtesy of Floataway, Norfolk, UK.
data. The spatial reference is usually a coordinate system of
the Earth such as latitudes and longitudes, metric units in a
map projection or postal codes, but any other local system
may be used as well. In health care and medical science,
spatial data analyses on local to global scales have a long
tradition, beginning with the classic study of London’s 1854
cholera epidemic by British epidemiologist John Snow [9].
GIS today plays an important role in public and private
health care, medical research and insurance for management,
planning and analysis [10,11], but few studies have so far
been conducted on the basis of body maps. Our approach
allows for the first time to map the detailed course of PSC in a
sample of subjects, compare the results between subjects, and
calculate mean courses. The results can then be compared to
the so-called meridians (chin.: “jingluo”,经络), vessel-like
structures that according to Chinese medical theory traverse
the human body circulating an immaterial substance (chin.:
“qi, ). Based on acupuncture classics as well as previous
reports, we hypothesized a strong resemblance between the
courses of certain meridians and those of PSC. Since no
anatomical correlate has been found for the concept of
meridians despite decades of research [12,13], it is very likely
that these structures were originally inspired by the line-like
appearance of PSC patterns.
As PSC can sometimes be subtle, we aimed at reducing
the confounding impact of tactile stimuli that can hardly be
controlled under normal circumstances. Therefore, all mea-
surements were carried out in a floatation tank [14]under
restricted environmental stimulation [15]. A floatation tank
is filled with saline that is constantly kept at skin temperature
as is the surrounding air. It is soundproof and either
dark or illuminated by very dim light. The subject inside
the tank floats supine on the saline without eort, which
greatly reduces the amount of tactile, visual, and auditory
input and allows full concentration on sensations inside the
2. Methods
2.1. Study Design. All measurements were carried out at
floatbase GmbH (Frankfurt am Main, Germany). The
experimental design is shown in Figure 1. When subjects
arrived at the floatbase, they were first familiarized with
the isolation tank and its emergency facilities to reduce
anxiety. Next, subjects were shown the questionnaire with
the body schemes, which were used after the experiment to
sketch their sensations. Silicone adapters for the laser optodes
were attached to the following points of the body using
adhesive tape: (1) Little toe of the left foot, acupuncture
point Bladder 67 (BL-67), (2) Big toe of the right foot,
acupuncture point Spleen 1 (SP-1), (3) Index finger of the
left hand, acupuncture point Large Intestine 1 (LI-1), (4)
Little finger of the right hand, acupuncture point Small
Intestine 1 (SI-1). For the exact localization of the points, see
Supplementary Figure 1 in Supplementary Material available
online at doi:10.1155/2012/591304. Subjects were instructed
how to enter the tank, take a comfortable position, insert the
laser optodes into the silicone adapters, and close the tank
from the inside. They were also informed about the timing
of the experiment, which is described in detail below. The
investigator then left the room so that subjects could undress
and enter the tank.
The closing of the tank was indicated to the investigator
by a signal light and marked the ocial beginning of the
experiment. In a first period, lasting 10 minutes, subjects
did not receive any stimulation, so they could adapt to the
new environment. In the second period, lasting 16 minutes,
a randomly chosen set of three of the four points were
stimulated one after another with the laser in a randomized
order. Each stimulation lasted three minutes followed by
one minute without stimulation. For the point that was not
stimulated, the laser was simply left switched oduring the
entire four (3 + 1) minutes. The end of the stimulation
Evidence-Based Complementary and Alternative Medicine 3
paradigm was indicated to the subjects by a special sound
(sea rushing). From this point, subjects had four minutes to
prepare themselves to leave the tank. After this time, the tank
opened automatically.
After taking a shower to remove excess saline from the
body, subjects were handed out the questionnaire, which they
were asked to fill out immediately.
2.2. Subjects. 20 healthy subjects (10 male/10 female) took
part in the study. The mean age was 28.8±4.1(S.D.)
years. Prior to the measurement, subjects were screened
for any acute diseases or contraindications for using the
floatation tank (skin diseases, epilepsy, claustrophobia, and
pregnancy). All subjects were healthy on the day of the
measurement. None of them had any history of neurological
disease or took any kind of medication on a regular basis.
The intake of analgesics as rescue medication was prohibited
during the five days before the measurement. None of the
subjects had any prior knowledge of acupuncture theory as a
student or practitioner.
After the measurement, three subjects (1 male, 2 female)
were excluded. Two mentioned the intake of antihistaminic
drugs not until after the measurement, and one developed
severe vertigo and nausea inside the tank.
2.3. Laser Stimulation Device. Low-level laser stimulation
was administered using a Laserneedle (Laserneedle EG
GmbH, Wehrden, Germany) emitting a combination of
655 nm (red) and 785 nm (infrared) laser light with an
irradiation power of about 15 W/cm2at the distal output.
Laser optodes were applied in contact mode using silicone
adapters, which were attached to the skin using adhesive tape.
The laser power at the distal output of each optode was about
40 mW. Reflection losses could be neglected due to the direct
contact of the optode with the skin. Acupuncture Lasers like
this have been used before in a number of studies [16,17].
2.4. Isolation Tank. All measurements were performed using
the same isolation tank (floataway, Norfolk, UK) at floatbase.
The size of the tank was 2.20 m ×1.50 m with a water depth
of 25 cm. The water inside the tank was loaded with 300 kg
magnesium sulfate to achieve the floatation eect, that is,
make subjects float on its surface. The water temperature was
kept at a constant 34C to minimize temperature sensations.
The tank and the surrounding room were soundproof and
subjects were asked to keep their eyes shut throughout the
whole experiment, thus minimizing auditory and visual
sensations. A dim red light illuminated the tank during the
whole experiment to prevent subjects from noticing changes
in ambient light due to switching of the laser.
2.5. Body Schemes and Questionnaires. To assess and com-
pare bodily sensations experienced by the subjects, body
schemes were developed based on the illustrations in [18]
(see Supplementary Figure 1). When these body schemes
were first shown to the subjects before the measurements,
the following instructions were given: “Please pay attention
to any sensation that you believe is an eect of the laser stim-
ulation. You will later be asked to sketch your sensations on
these body schemes. You will also be asked about the quality
and intensity of the sensations.” Directly after the end of the
measurements, subjects were given the body schemes as well
as the German version of the McGill pain questionnaire [19,
20] with its 77 descriptors (sensory, aective, and evaluative)
and an additional visual analogue scale. The order of the
descriptors was randomized for each subject. The following
instructions were read aloud to the subjects: “Please describe
any sensation that you believe was an eect of the laser
stimulation. Sketch the localization of these sensations on
the body schemes using the following three signs: A dot for
every point-like sensation, a line for every line-like sensation
and hachures for every two-dimensional sensation. Please
choose any number of descriptors from the questionnaire
that describe the sensations you have experienced. Please
rate the overall intensity of these sensations on the vertical
line between 0 (no sensation) and 100 (maximally tolerable
sensation). Finally, please indicate, which of the points you
of stimulation was.
2.6. Analysis of Psychophysical Data. Descriptors chosen by
the subjects to describe their sensations were ranked by their
absolute frequency (see Table 1). Only those descriptors that
were chosen five times or more were taken into account.
Based on subjects’ estimation concerning the point
selection, that is, the three stimulated points out of four
points with attached optodes, results were sorted into four
standard categories for every point: hits, misses, correct
rejects, and false positives (see Table 2). The sum over
all subjects was calculated for each category. A one-tailed
Fisher’s exact test was used to analyze a possible connection
between stimulation and perception. A Pvalue of <0.05 was
considered significant.
Finally, the perceived order of stimulation was compared
to the actual order.
2.7. Analysis of the Sketched Sensations. In order to compare
the localization and extent of the sensations between sub-
jects, a GIS body-map template (front and back) was created
in ESRI ArcGIS 10.0 by digitizing the body scheme used in
the questionnaire and scaling it to the mean body height
transferred into the GIS database, and georeferenced to
the body-map template. The database was then populated
with the subjects’ mapped sensations in point, polyline,
and polygon format by digitizing them on-screen from the
scanned sketches, and attributing each feature with a key ID
and the subject code. For point-like sensations, the radius
as drawn in the sketch was added to the attribute table and
for line-like and two-dimensional sensations, the line lengths
or polygon area, respectively, were calculated in the GIS (see
Supplementary Table 1). In the case of multiple objects of
the same kind for one subject (e.g., two line-like sensations),
these objects were given dierent roman numbers as indices.
Note that GIS calculations in this case were based on a 2D
4 Evidence-Based Complementary and Alternative Medicine
Tab le 1: The most frequently used descriptors chosen by the subjects to describe their sensations during laser acupuncture. Only descriptors
that were chosen by at least five subjects are shown.
Subjects Descriptors
Tingling Radiating Spreading Hot Dull Pulsing Throbbing Pricking Stinging Tender Pinching
2X X X X
8X X
10 X
11 X X
12 X X X X
13 X X X X X
14 X X X X X X X
15 X X X X X
16 X X X X X X X X
17 X X X X X X X
Sum 11 10 9 8 7 7 7 7 5 5 5
representation of the body, not taking account of the actual
3D surface of the body.
To be able to overlay all sensations in one plot (see
Figure 2), lines representing the line-like sensations were
converted to polygons by a buering algorithm in the GIS,
resulting in 1.5 cm wide swaths. Point-like sensations were
converted to circles using the radius drawn in the sketches
by the subjects. All sensations were then overlaid and
intersected, resulting in a dataset of overlapping sensation
polygons. The choice of 1.5 cm width for the line-like sen-
sations was based on previous literature reports on PSC [21].
2.8. Calculation of Sensation Mean Courses and Comparison
to Classical Meridians. Depending on the subject’s sensa-
tion and way of sketching, the line-like sensations were
represented by single or multiple line features, sometimes
arranged in parallel or radially. In order to analyze their
general direction and compare them to classical meridians,
mean courses of all lines related to a certain body part (e.g.,
lower right leg) were calculated as follows: each line was
subdivided into 10 parts of equal length that were numbered
1 to 10 and attributed with their length. For all lines
belonging to the same body part, the length-weighted mean
center point of each group of sublines with the same part
number was then calculated. Finally, the resulting 10 center
points were converted back to a polyline, thus representing
a mean course and length of the mapped sensations within
a given body part. Only sensation mean courses longer than
5 cm were further considered.
To be able to compare sensation mean courses to classical
meridians, an approach was needed to incorporate the
variability of dierent literature sources concerning the exact
course of meridians. We decided to include two well-known
reference works [22,23]aswellasdrawingsfromtwo
specialists, each with more than 10 years of experience in
application and teaching of traditional chinese medicine.
While the latter two drew their sketches directly on the body
scheme, meridian courses from the reference works were
transferred to the schemes by one of the authors (FB). After
scanning and georeferencing the sketches, the four versions
of all meridians were digitized and added to the GIS database.
For each of the four versions, distance maps in the form
of raster datasets with 1 cm resolution were computed by
calculating the Euclidean distance for each raster cell to the
meridian. The four versions were then averaged using Map
Algebra, yielding a map of mean distance to each meridian
(see Supplementary Figure 2). Using a GIS tool originally
developed to extract 3D properties such as mean elevations
for features located on a terrain surface, the minimum,
maximum, and mean distance for each sensation mean
course recorded by the subjects could then be calculated
(Table 3 , Figures 3and 4).
3. Results
3.1. Psychophysical Data. The mean intensity of subjects’
sensations had a VAS score of 26.47 ±20.09 (SD) (see
Supplementary Table 2).
Subjects chose 7.76 ±5.23 (mean ±SD) descriptors for
their sensations. Eleven descriptors were chosen by five or
more subjects (see Table 1). These were tingling, radiating,
spreading, hot, dull, pulsing, throbbing, pricking, stinging,
tender, and pinching. It should be mentioned that some
subjects, while filling out the questionnaire, mentioned the
Evidence-Based Complementary and Alternative Medicine 5
Tab le 2: Comparison of subjects’ perceived and actually exerted stimulation. Fisher’s exact test was calculated independently for each of the four stimulatedpointsaswellasfortheoverall
Left little toe (BL-67) Right big toe (SP-1) Left index finger (LI-1) Right little finger (SI-1) All points
Hits Misses Correct
positives Hits Misses Correct
positives Hits Misses Correct
positives Hits Misses Correct
positives Hits Misses Correct
1XXX X1210
2X XX X 3001
3X X X X 3010
5X X X X 3010
6X X X X 3010
7X X X X3001
9X X X X 2110
10 X X X X 2 1 1 0
11 X X X X 1 2 0 1
12 X X X 1 1 1 0
13 X X X X 2 1 1 0
14 X X X X 3 0 0 1
15 X X X X 1 2 0 1
16 X X X X 3 0 1 0
17 X X X X 3 0 1 0
Sum 1221 2842 31024 1843 1381210 7
Fisher’s exact
test P=0.46 P=1.00 P=0.03 P=0.26 P=0.02
6 Evidence-Based Complementary and Alternative Medicine
Tab le 3: Distances of sensation mean courses to meridians at the same limb.
Stimulated point Front/back Length of sensation mean course/cm Meridian Distance to meridian/cm
Min Mean Max
Right big toe (SP-1) f 25.00 SP 0.46 0.83 1.28
Right big toe (SP-1) f 25.00 LR 0.61 1.07 2.03
Right little finger (SI-1) f 27.07 HT 0.06 1.39 2.53
Left little toe (BL-67) f 11.71 KI 4.05 6.27 10.08
Left little toe (BL-67) b 20.28 (lower line) BL 1.06 3.38 4.53
Left little toe (BL-67) b 16.18 (upper line) BL 1.22 1.30 1.37
Left index finger (LI-1) b 30.35 LI 0.02 0.83 2.53
Right little finger (SI-1) b 27.88 SI 0.38 1.30 1.82
Figure 2: Exploratory GIS analysis of subjects’ sensations experi-
enced during laser acupuncture. The grey level of the superimposed
polygons indicates the number of subjects who experienced a point-
like, line-like or 2-dimensional sensation in this area.
lack of the descriptor warm that seemed to describe their
sensations. As no further explanations by the experimenter
were allowed, most of them decided to use the descriptor hot
Five subjects correctly identified the three out of four
points that had been stimulated (see Table 2). Nine subjects
missed one or more points, and seven subjects had false
positives, that is, one of the points they chose had not been
stimulated. Fisher’s exact test over all points (pooled data)
was significant (P<0.02) showing a connection between
stimulation and perception. For the single points, however,
only LI-1 at the left index finger showed a significant result
Interestingly, the order of stimulation of the points was
not estimated correctly by a single subject.
3.2. Sketched Sensations. 13 subjects experienced point-like,
12 line-like, and 13 2-dimensional sensations during laser
acupuncture. 10 subjects experienced all three kinds of
sensations. The detailed results of the GIS analysis can be
found in Supplementary Table 1. While the majority of
subjects (10) reported all three kinds of sensations, two
subjects drew only points, and one returned an empty
body scheme. Excluding the latter three subjects, we can,
thus, say that 14 out of 17 subjects (82.4%) experienced
PSC. The mean radius of the point-like sensations was
1.67 ±1.35 cm. Line-like sensations had a mean length of
13.81 ±11.81 cm, while the average length per subject of all
summed up single lines was 38.19 ±40.50 cm. 2-dimensional
sensations had a mean area of 67.31 ±94.72 cm2or 201.94 ±
222.87 cm2,ifsummeduppersubject.Figure 2 shows an
overlay of all sensations with dots represented by circles
and lines represented by swaths. The majority of sensations
were reported from the limbs, while relatively few subjects
sketched sensations on the trunk. Point-like sensations were
mostly restricted to the stimulation loci. One eye-catching
exception was a point experienced by one subject bilaterally
at the location of acupuncture point BL-36, directly below
the buttock. Furthermore, for the SI Meridian, there was a
single subject showing line-like sensations almost along the
whole course (see lines in the back shoulder region in the
upper right of Figure 3).
3.3. Comparison of Sensation Mean Courses to Classical
Meridians. There were eight subregions on the limbs were
sensation mean courses could be calculated. These are shown
in Figure 3 (for the upper half of the body) and Figure 4 (for
the lower half of the body). Three of the mean courses were
on the front (inner side of the right arm, inner and outer
side of the left arm), and five lines on the back side of the
body scheme (inner side of the right leg, sole of the right foot,
dorsum of the left foot, and posterior thigh area). The mean
length of the sensation mean courses was 12.33 ±7.32 cm.
The assessment of distances between sensation mean
courses and classical meridians (see Tabl e 3 ) showed an
overall good agreement between the two. The smallest mean
deviation of the sensation mean from the meridian course
was 0.83 cm, seen on the right leg (inner side), where SP-1
had been stimulated, and on the left arm (back side), where
LI-1 had been stimulated. For the sole of the foot, no distance
Evidence-Based Complementary and Alternative Medicine 7
Right little finger
Left index finger
d=0.83 cm
Meridian versions
Practitioner 2
Practitioner 1
Overlap Line-like
mean course
Figure 3: Comparison of subjects’ sensations and the courses of meridians on the upper body. In each frame, the left image depicts all
sensations in the respective quadrant of the body (see also Figure 2). The middle image shows all line-like sensations as well as sensation
mean courses. The right image depicts the course of the meridian taking into account dierences from the literature. The mean distance of
the sensation mean course from the respective meridian as calculated with the GIS is given and denoted with a small d (for explanation see
Supplementary Figure 2). For the minimum and maximum distance, the reader is referred to Tab l e 3 .
calculation was possible, as neither SP nor LR Meridians
traverse this part of the body. On the inner side of the right
leg (SP-1), agreement with the sensation mean course was
better for the SP Meridian (d=0.83 cm) than for the LR
Meridian (d=1.07 cm). However, this clear connection
between stimulated point and associated meridian was not
always found. For example, sensations on the right arm that
should be related to stimulation of the point SI-1, showed
good agreement with, both, the SI Meridian (d=1.30 cm)
and the HT Meridian (d=1.39 cm). A general observation
was the low variance of the distance: Maximum distances
of sensation mean courses and meridians were as low as
1.28 cm (for SP-1 and the SP meridian) and 1.37 cm (for
BL-67 and the BL meridian), meaning that the sensation
never deviated more than this value from the meridian.
Minimum distances showed points, where sensation mean
courses virtually intersected with meridians (0.02 cm for LI-
1 and the LI meridian, 0.06 cm for SI-1 and the HT meridian,
and 0.38 cm for SI-1 and the SI meridian). Interestingly,
due to our calculation method, such small values also imply
a negligible variability in meridian courses. These points,
where all lines come very close to each other, were all located
on the distal part of the extremities (see Figure 3).
4. Discussion
In this paper, we have demonstrated the general feasibility
of two experimental concepts: firstly, we have shown that
propagated sensations along channels (PSC) can be studied
under sensory deprivation in a single-blinded design, when
using laser acupuncture. Secondly, we applied for the first
time a geographic information system (GIS) to the study of
PSC phenomena.
We used sensory deprivation in an isolation tank to
reduce environmental stimuli (visual, auditory, tactile, and
temperature), to allow subjects to fully concentrate on
sensations occurring during laser acupuncture stimulation.
Judging from the ratio of occurrence of PSC (82.4%) in
our experiment, we can say that this strategy seems to be a
successful one, as other studies have reported much lower
ratios: the larges cohort that has so far been investigated,
8 Evidence-Based Complementary and Alternative Medicine
Right big toe
d=0.83 cm
d=1.07 cm
Left little toe
d1=3.38 cm
Meridian versions
Practitioner 2
Practitioner 1
Overlap Line-like
mean course
Figure 4: Comparison of subjects’ sensations and the courses of meridians on the lower body. In each frame, the left image depicts all
sensations in the respective quadrant of the body (see also Figure 2). The middle image shows all line-like sensations as well as sensation
mean courses. The right image depicts the course of the meridian taking into account dierences from the literature. The mean distance of
the sensation mean course from the respective meridian as calculated with the GIS is given and denoted with a small d(for explanation see
Supplementary Figure 2). For the minimum and maximum distance, the reader is referred to Tab l e 3 . Note, that for the right big toe, none
of the relevant meridians (SP/LR) runs on the backside of the leg.
comprised incredible 63,228 individuals in more than 20 dis-
tricts in China in the late 1970s [24]. The authors reached the
conclusion that PSC occurs in 20.7% of subjects, although
these studies used needles instead of an acupuncture laser.
Thus, the use of an isolation tank to study PSC in detail
can be recommended despite the increased eort of such an
Using laser instead of conventional needle acupuncture
produced very similar sensations to those usually reported
in studies on the acupuncture sensation deqi.Tingling,
radiating, spreading, hot (warm), dull, and throbbing are
descriptors that have often been reported in this context
[1,3,25]. However, also sham laser acupuncture has
previously been reported to induce such sensations [26,
27]. This reminds us of our own observations of false-
positive results, when subjects were asked, which points
they believed had been stimulated. Only one of the single
points (LI-1) showed a significant correlation of stimulation
and sensation. Even more strangely, none of the subjects
estimated the stimulation order correctly. Contemplating
these results in conjunction with our rather small sample
size, we must not neglect the possibility that the actual laser
stimulation (i.e., laser on or o)maynotbeofcentral
importance for the elicitation of deqi and PSC. In other
words, the phenomenon of PSC may be unrelated to actual
laser stimulation taking place. This should be tested in
further experiments.
Within the GIS framework, we have introduced a new
approach to calculate mean courses of line-like sensations,
which now allows group analysis of spatial PSC patterns.
This method can be used to compare PSC lines (i.e.,
sensation mean courses) to any other data, whose spatial
pattern can be mapped on a body scheme similar to
that used in our study (Supplementary Figure 1), which
constitutes an important step forward in the study of the still
unknown physiological basis of PSC and its relation to other
acupuncture eects. In our study, PSC lines were compared
to classical meridians, as this connection has been reported
Evidence-Based Complementary and Alternative Medicine 9
numerous times before [28]. Despite the purely descriptive
character of our analysis, we believe that an average distance
between sensation mean courses and meridians of around
1 cm, as observed in our study, clearly points towards a close
connection of the two entities. We also sought to include
possible variability of meridian courses between dierent
literature sources [29] and, thus, developed an approach
to incorporate this variability in the distance measurement
by means of Euclidean distance fields. An interesting side
observation was that variability seemed to be larger for some
meridians than for others. Meridians with a rather smooth
course, like HT, LI, KI, and SP showed less variability than
those with sharp edges, like SI and BL. Although not the
focus of this study, GIS may in general provide a means for
further investigation of meridian variability. This should be
of importance for the study of the underlying mechanism of
PSC as well as acupuncture in general. We speculate that the
paradigmatic concept of meridians as small-diameter, line-
like vessels with clear anatomical courses cannot withstand
closer investigation.
Although this study was more like a proof-of-concept,
some limitations need to be addressed:
Firstly, the small sample size precludes a detailed inter-
pretation especially of the results concerning the connection
of stimulated and sensed points. Furthermore, a design
where only two of the four points had been stimulated,
would have probably made the results clearer in the sense
that it would have been easier to achieve significant results
in Fisher’s exact test. One could also argue, that we have not
tested, how well the participants of the study were able to
remember the sensations after each single laser stimulation.
So they may given unreliable answers after receiving three
stimulations in a row.
From the GIS-methodological point of view, the use
of body schemes as a base map within the GIS is not
quite correct, as the complex 3-dimensional shape of the
human body is transferred into 2D by a simple orthogonal
projection. In cartography, the shape of the Earth is described
by 3D bodies such as spheres (for small scales), ellipsoids
(usually locally optimized), or the geophysical Geoid model
(for highest precision) and transferred to the plane by a
map projection. The wide choice of possible projections
allows preserving selected metric properties such as areas
or local angles. Both 3D models for representing the shape
of the Earth and map projection methods are integrated
into GIS software, but there is, so far, no “standard human
body” model implemented in these systems. In our case,
the body maps do not precisely preserve areas or distances,
resulting in distortions mainly around the edges of the body
maps. Therefore, small dierences in calculated distances,
for example between meridians running along the middle
of the body trunk and along the sides of the body must be
interpreted with caution.
Furthermore, our choice of meridians for distance cal-
culation might be criticized, as we did not restrict ourselves
to the meridian connected to the stimulated point (e.g., the
SP meridian for the point SP-1), but also included other
meridians with a known connection to the stimulated finger
or toe. This was done, after first results showed that many
subjects experienced PSC following the course of the HT
meridian, despite SI-1 being the stimulation locus. Such
“jumping” of PSC from one meridian to an adjacent one
has been reported from the very beginning of PSC research
in China [24] and we believe that despite the obvious
connection between PSC and meridians, the latter may be the
result of some oversystematization of early PSC observations
during the last two millennia.
For the future, it would be desirable to make the
transition from descriptive to predictive PSC analyses using
GIS. This could be accomplished by including null data
for comparison. Such null data may either be generated
by some model or by changing the position and shape of
existing objects with Monte-Carlo-like methods. Once this
is accomplished, Pvalues could be calculated expressing
the likelihood of findings, like those presented here, thus
paving the way to finally understand the physiological
underpinnings of deqi, PSC, and acupuncture in general.
The authors thank floatbase GmbH, Frankfurt (Gunnar
Ehrke, Stefan Eckhardt, Mark Neuberger) for their generous
and friendly support in carrying out the experiments. F.
Beissner thanks Mark Neuberger, Anna Kristina Beissner,
and Professor Hans-Georg Schaible for helpful discussions.
F. Beissner was supported by Horst G¨
ortz Foundation.
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Supplementary resource (1)

... Common therapies that elicit therapeutic sensations include acupuncture [8,[10][11][12][13], acupressure [14,15], moxibustion [16], cupping [17] and other related techniques. However, they also occur in various other interventions, such as massage [18], cryotherapy [19], pulsed ultrasound [20], trigger point therapy [21], body-oriented psychotherapy [9,22], transcutaneous electrical nerve stimulation [23], low-level laser stimulation [24,25], auriculotherapy [26], hypnotherapy [27], osteopathy [28], Reiki [29], therapeutic touch [5,30], charismatic healing [31], meditation [6,32,33], and somatic bodywork methods [34]. ...
... Furthermore, a growing body of evidence shows that therapeutic sensations are elicited by placebo stimulation as reported for placebo laser stimulation [24,25,35], placebo TENS [36], and the topical application of placebos [37]. Finally, several studies have reported sham acupuncture to elicit therapeutic sensations [38,39]. ...
... The systematic literature search for graphical representations of therapeutic sensations (see Suppl. Methods) yielded six articles reporting sensations related to acupuncture [69][70][71][72], tactile stimulation [71], low-level laser stimulation [25], and several forms of placebo stimulation [37]. ...
Full-text available
Physical sensations of tingling, warmth, dull pain, and heaviness are a common phenomenon in mind-body interventions, such as acupuncture, hypnotherapy, osteopathy, qigong, meditation, and progressive muscle relaxation. Even though there are striking parallels between sensations produced by many different interventions, no attempt has yet been made to understand them from a unifying perspective that combines information from different therapies and practices. Therefore, this narrative systematic review introduces the concept of therapeutic sensations and summarizes studies of their sensory quality, bodily topography, and the meaning that patients attach to them. Furthermore, it highlights the essential role of therapeutic sensations in the development of vital energy concepts, such as qi, prana, pneuma, and orgone, in various traditional medicine systems, body-oriented psychotherapy, and so-called energy medicine. Finally, the assessment of therapeutic sensations may help to gain a deeper understanding of such concepts, finding a common language between scientists, patients and practitioners, and bridging the wide gap between materialistic and vitalistic views.
... nach [3]; mit freundl. Genehmigung von Elsevier) [2,4,5,11]. Dabei wird deutlich, dass die körperlichen Muster sowohl flächige als auch linienförmige Anteile besitzen und innerhalb der einzelnen Studienkollektive eine hohe Ähnlichkeit aufweisen. ...
... Jedoch enthält keine der wenigen in Englisch erschienenen Arbeiten eine Behandlung der Ausbreitungsmuster, deren Methodik aus heutiger Sicht überzeugen kann. In einer eigenen Arbeit habe ich daher die Thematik zusammen mit der Geografin Irene Marzolff wieder aufgenommen [2]. Wie wir zeigen konnten, berichteten 82 % der gesunden Probanden, die unter sensorischer Deprivation mit einem Akupunkturlaser stimuliert wurden, über sich ausbreitende Empfin-dungen. ...
... Die statistische Analyse ihres mittleren Verlaufs zeigte, dass die Empfindungen mit unerwarteter Genauigkeit dem Verlauf der jeweils stimulierten Leitbahn folgten. Der mittlere Abstand zwischen Empfindung und Leitbahn betrug an den Armen 1,2 ± 0,3 cm und an den Beinen 2,6 ± 2,3 cm, wobei sich der erste Wert im Bereich der Ungenauigkeit bewegt, mit der wir den Leitbahnverlauf angeben können [2]. ...
Ungewöhnliche Empfindungen, wie Wärme, Kribbeln, Schwere oder Druckgefühl, die während therapeutischer Interventionen oder Übungen auftreten, sind ein häufiges Phänomen von Mind-Body-Therapien. Trotz der Bedeutung, die ihnen sowohl Therapeuten als auch Patienten beimessen, sind sie bisher nicht systemübergreifend untersucht worden. Durch eine Literaturübersicht der Forschungsergebnisse der vergangenen Jahre soll eine erste systemübergreifende Analyse dieser therapeutischen Empfindungen durchgeführt werden. Literaturrecherche und Metaanalyse. Die Analyse der sensorischen Qualität zeigt zwei unterschiedliche Typen von therapeutischen Empfindungen (schmerzhafte und nichtschmerzhafte), für die unterschiedliche Entstehungs- bzw. Wirkmechanismen anzunehmen sind. Bei der Bedeutungsdimension zeigt sich eine häufige Assoziation mit dem Gefühl der Heilung sowie mit emotionalen und energetischen Konzepten. Die körperlichen Ausbreitungsmuster lassen systemübergreifende Ähnlichkeiten erkennen und weisen zudem Übereinstimmungen mit den klassischen Leitbahnen der Chinesischen Medizin auf. Die Erforschung therapeutischer Empfindungen kann einen wichtigen Beitrag zum Verständnis von Mind-Body-Therapien leisten und eröffnet insbesondere einen wissenschaftlichen Zugang zu Konzepten, wie Leitbahnen und lebensenergetischen Vorstellungen.
... De qi sensations include a combination of various sensations, such as heaviness, numbness, soreness, distention, and even a spreading sensation far from the stimulus site (MacPherson and Asghar, 2006). Recently, spatial patterns of acupuncture-induced sensations, including sensations propagated along the acupuncture meridians, have been demonstrated based on a geographic information system using a bodily sensation map (BSM) (Beissner and Marzolff, 2012;Jung et al., 2016). The BSM, one of a digital pen-and-paper platform, is useful to measure location and intensity of the bodily sensation (Jung et al., 2017a,c). ...
... In this experiment, the participants expected that they would receive acupuncture treatment at various angles. Interestingly, propagated sensations induced by acupuncture have been reported along perpendicular and horizontal lines on the body (Beissner and Marzolff, 2012;Jung et al., 2016). Since diagonal spatial patterns of de qi sensations are unusual, the participants may have had weaker expectations of diagonally elongated-shaped response perception patterns. ...
Full-text available
Objective: Humans interpret sensory inputs based on actual stimuli and expectations of the stimuli. We investigated whether manipulating information related to the physiological response could change the somatosensory experience of acupuncture. Methods: Twenty-four participants received tactile stimulations with a von Frey filament on the left arm. Participants were informed that they would receive acupuncture stimulations at different angles while they were presented with changes in their peripheral blood flow (PBF) measured with Laser Doppler perfusion imaging. However, in reality, they were observing premade pseudo-biosignal images (six sessions: one circular, two rectangular elongated, two diagonally elongated, and one cross-fixation [control] shape). After each session, the participants reported the intensity and location of the de qi sensations perceived on their arm using a bodily sensation mapping tool. The spatial patterns of the somatic sensations were visualized using statistical parametric mapping. The F1 score was calculated to measure the similarity between the presented pseudo-biosignals and reported de qi response images. Results: The spatial configurations of the presented pseudo-biosignal images and de qi response images were similar. The rectangular elongated pseudo-biosignal shape had a significantly higher F1 score compared to the control. All tactile stimulations produced similar levels of enhanced PBF regardless of the pseudo-biosignal shape. Conclusion: The spatial configurations of somatic sensations changed according to the presented pseudo-biosignal shape, suggesting that expectations of the physiological response to acupuncture stimulation can influence the perceived somatic sensation.
... By far, the biological characteristics of meridians has been investigated. Over the last few decades, results from many studies have suggested distinctive biophysical features of the meridians, such as high electrical conductance, [18][19][20] nitric oxide levels, [21,22] high transcutaneous CO 2 emissions, [23] acupuncture sensation patterns, [24] and possible relationships with connective tissue. [25,26] Nevertheless, the scientific evidence on the microcirculatory characteristics of meridians still needs further explosion by using modern scientific techniques. ...
Full-text available
Introduction: The aim of the present study is to compare the microcirculatory difference of different meridians by using laser doppler flowmetry and investigate the specificity for the meridian-visceral association and site-to-site association between 2 specific meridians. Methods and analysis: The Lung and Heart meridians are chosen as 2 specific studied meridians. 120 participants will be enrolled and divided into the healthy control group, chronic stable angina pectoris group and healthy intervention group. Laser doppler flowmetry will be used to assess the blood perfusion of the Heart and Lung meridians. The specificity for the meridian-visceral association will be investigated by comparing the microcirculatory difference between the Heart and Lung meridians in the healthy control group and chronic stable angina pectoris group. Besides, participants in the healthy intervention group will receive 2 sessions of moxibustion in the Heart meridian and Lung meridian, respectively, to explore the specificity for the site-to-site association on the body surface. Primary outcomes will be blood flow curve and blood perfusion units of relevant sites along the Heart and Lung meridians. Statistical analysis will be conducted by third party statisticians. Ethics and dissemination: Ethics approval (approval No: ZSLL-KY-2019-001A-01) has been obtained from the Ethics Committee of the Third Affiliated Hospital of Zhejiang Chinese Medical University. The study findings will be disseminated through presentation at peer-reviewed medical journals. Trial registration: NCT04244812.
... At this time, there is no dominant template or method, and this will contribute to a lack of standardization. Furthermore, PDs can be used to assess more than just pain, for example, discomfort drawings [40], general symptom drawings [80] or sensation drawings as evidenced by the recent application of PDs in studies on emotions [81][82][83], the placebo effect [84], or acupuncture [85,86]. This means the encoding of sensations may continue to develop in this area as the applicability of PDs expands. ...
Full-text available
Background: In a pain drawing (PD), the patient shades or marks painful areas on an illustration of the human body. This simple yet powerful tool captures essential aspects of the subjective pain experience, such as localization, intensity, and distribution of pain, and enables the extraction of meaningful information, such as pain area, widespreadness, and segmental pattern. Starting as a simple pen-on-paper tool, PDs are now sophisticated digital health applications paving the way for many new and exciting basic translational and clinical applications. Objective: Grasping the full potential of digital PDs and laying the groundwork for future medical PD apps requires an understanding of the methodological developments that have shaped our current understanding of uses and design. This review presents methodological milestones in the development of both pen-on-paper and digital PDs, thereby offering insight into future possibilities created by the transition from paper to digital. Methods: We conducted a systematic literature search covering PD acquisition, conception of PDs, PD analysis, and PD visualization. Results: The literature search yielded 435 potentially relevant papers, from which 53 methodological milestones were identified. These milestones include, for example, the grid method to quantify pain area, the pain-frequency maps, and the use of artificial neural networks to facilitate diagnosis. Conclusions: Digital technologies have had a significant influence on the evolution of PDs, whereas their versatility is leading to ever new applications in the field of medical apps and beyond. In this process, however, there is a clear need for better standardization and a re-evaluation of methodological and technical limitations that no longer apply today.
... Deqi is usually described as a sensation of a deep pain with an involvement of sensations such as aching, soreness, tingling, numbness, throbbing, involuntary movements of the limbs, and sometimes stabbing pain, and felt by the acupuncturists grasping needles as tense, tight, and full. Deqi, on the other hand, is not only recognized as a prerequisite for the best clinical effects because it tells that whether or not the Qi and Blood in the meridians are activated, but also an important judgment criterion of the exuberance and decline of the meridian Qi and the prognosis of disease, and may be one of great important factors to understand the acupuncture mechanisms[5,6].Since deqi sensation in TCM and acupuncture is believed to be closely related to clinical efficacy, TCM doctors and acupuncturists elicits deqi sensations with intention in patients and sees deqi as the sign of treatment efficacy with correct manipulation and retaining the needle to strengthen the deqi sensation and improve clinical efficacy to their expectations. The observation in 2014 of a total of 32 patients with primary hyperuricemia, to whom acupuncture was performed on the Five Shu acupoints on the Spleen meridian each morning with the needles retained for 30 minutes when deqi occurred, highlights the importance of deqi in the treatment and ...
Notions of a life energy form the basis of many traditional systems of medicine. At the same time, they represent one of the main reasons for their rejection by modern natural sciences. In this article, using historical passages and modern experimental findings, I show that life energy concepts are closely related to so-called therapeutic sensations, as they regularly occur in Chinese medicine but also in other mind-body therapies. A differentiated language that clearly separates sensations (“flowing”, “streaming”) from their interpretations (“energy”) can make an important contribution to interdisciplinary understanding.
Resumen Existen diferentes interpretaciones sobre el deqi descrito en los textos de la Medicina Tradicional China, lo que ha generado controversia en cuanto a lo que es o debería constituir el deqi. Con base en el estudio de los caracteres tradicionales y de las evidencias experimentales recientes, el presente artículo propone un concepto integrador del deqi, como la suma de las respuestas psiconeurofisiológicas desencadenadas durante la intervención acupuntural y que pueden ser percibidas por el paciente y el acupunturista. Tales respuestas tienen una base anatómica, funcional y emergente que se integran en un biocircuito conformado por receptores, vías aferentes, centros de procesamiento, vías eferentes y efectores, los cuales son retroalimentados entre el paciente y el acupunturista.
The chapter discusses three interventions that are often accompanied by pleasant body sensations: placebo treatment, complementary and alternative medicine, and mind–body techniques, such as yoga, tai chi chuan, and mediation. Following these interventions, subjective well-being usually improves due to the increase of positive affect and happiness and/or decrease of negative affect. Although this effect is positive and desirable, it is not without pitfalls. As we cannot directly sense the majority of (patho)physiological changes taking place in the body, higher level of well-being biases our overall appraisal of our actual health condition; in other words, feeling better often means feeling cured. This might lead to worse adherence to effective conventional treatments and even delays in the treatment, which can lead to fatal consequences in degenerative diseases with rapid progression. Overall, the perceived condition of the body should not be used as an indicator of actual health state.
The practice of acupuncture guided by the meridian theory is first mentioned in the Yellow Emperor’s Classic of Internal Medicine. The basic theories and techniques of acupuncture were established in the Eastern Han Dynasty. The first book to combine the theories and practices of acupuncture was the Systemic Classic of Acupuncture and Moxibustion, written by Huangfu Mi. In the Song Dynasty, Wang Wei-Yi designed two life-size male bronze statues, which are recognized as the earliest bronze acupuncture models to be used for teaching purposes. During the Ming Dynasty, The Great Compendium of Acupuncture and Moxibustion by Yang Ji-Zhou had a huge influence on the development of modern acupuncture. In the early twentieth century, the development of acupuncture fell into neglect. However, much research subsequently explored acupuncture using modern scientific techniques and methods. From the 1950s to the 1980s, acupuncture gained new life through exploration of traditional theories and modern research. Scientific techniques explored the essence of meridians, acupuncture analgesia and anesthesia, the characteristics of de qi, and the phenomenon of propagated sensations along channels. At the same time, the launch of academic conferences greatly advanced the quality of experimental acupuncturology studies. The period from 1980 until now marks an important stage of development in experimental acupuncturology. Since the introduction of acupuncture in other countries including Japan, Korea, France, and the U.S.A., acupuncture has become more popular, developed rapidly, and has undergone systematic research.
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Meridian theory is a major part of Chinese medicine and has guided acupuncture and clinical practice for thousands of years. Meridian theory describes many important concepts about the rules of human body function and regulation, but has comparatively huge differences with the basic concepts of modern medicine. These differences have caused deep concern and attracted attention from scholars, both inside and outside of China. The interest in meridian theory lies in determining the structural nature of meridians. Not only is this information still unclear, it is very difficult to achieve clear results in a short period of time. Despite this, the phenomena of meridians can be used as the entry point for meridian studies. After many years of effort, although the physical structure of meridians has not been found, the existence of the meridian phenomena has been fully confirmed. Although there is a lack of morphological evidence for the existence of the meridian, concluding non-existence may be incorrect as morphology techniques develop and structures previously not determined are being found. Since the phenomenon of meridians exists, some biological basis behind its occurrence must be present. This implies that research on meridians needs to continue as research techniques advance and may eventually reveal the biological basis of the meridian phenomenon. In the present review, we analyze the history of meridian studies in China.
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As Chinese medicine is going global, it is simultaneously adapting swiftly to local patterns of perception and interpretation, thereby being shaped into hitherto unknown forms. The globalization of Chinese medicine produces multiple localized visions of a healing system whose trademark is an "innate heterodoxy". Barnes described the "psychologizing" of Chinese medicine in the USA (Barnes Cult Med Psychiatry 22(4):413-443, 1998). In Germany, however, biomedical instead of "holistic" patterns of perception and interpretation and a tendency to "physiologize" prevail among patients and Chinese Medical therapists. Here the recent German Acupuncture trials, and Acupuncture Randomized Trials (ART) and Cochrane data base metaanalysis (Linde et al., 2009a) shall serve as a prominent example of how German research centers around physiological phenomena and how these studies have triggered an international debate concerning the point-specific nature of acupuncture interventions. In order to evaluate the specific effect of acupuncture in randomized controlled trials, verum acupuncture, defined as acupuncture at "classical" acupuncture points, and sham acupuncture, defined as acupuncture at "non-acupuncture points", are frequently compared. The anatomically exact location and specificity of acupuncture points are basic assumptions underlying this concept. But how clearly divisible are verum and sham acupuncture points if acupuncture physiology itself is a historical construct? To more adequately evaluate acupuncture's effectiveness future clinical studies will have to tailor their methodology to the reality of the acupuncture encounter.
By combining electrical impulse stimuli with mechanical ones, we are able to trace out a new line of feeling, coincident with the classical channel course. Impulse stimulation was carried out at the Jing point of the Large Intestine or Stomach channel, namely Shangyan or Lidui. With a small rubber nipple, light taps were applied on the skin along the lines perpendicular to the channel and crossing over the acupuncture points; a specific propagational numb feeling at the points of the channel could be found. By linking up these points of specific feeling, an imaginary line which is exactly the classical Large Intestine or Stomach channel can be traced out. This line is called the "latent propagational sensation line along the channels" because, unless through tapping, no prominent sensation of propagation could be felt. Employing an impulsive electrical generator and an all-wave commutating circuit linked to a micro-ammeter, the skin conductance was measured over the latent PSC of the Large Intestine channel lying between the wrist and 5 cm above the elbow joint. Results were compared to those locations of 1 cm apart from the channel course, i.e. the control sites devoid of acupuncture points or channels. At most acupuncture points or any site of the channel course on all of the 10 subjects under examination, there was greater electrical conductance maxima than there was at control sites. This fact indicates that not only acupuncture points, but the entire course of latent PSC are also of higher electrical conductance.
Paul A. Longley, Michael F. Goodchild, David. J. Maguire, and David W. Rhind. New York: John Wiley and Sons, 2001. 454 pp., maps, diags., tables, color figs., refs., and index. $125.00 cloth (ISBN 0-471-49521-2), $50.00 paper (ISBN 0-471-89275-0).