The Historical Development of Deqi Concept from Classics of Traditional Chinese Medicine to Modern Research: Exploitation of the Connotation of Deqi in Chinese Medicine

Abstract

Although it is difficult in fully clarifying its mechanisms and effects, Deqi still can be considered as an instant "sign" of acupuncture response of the patient and acupuncturist, which has a significant value in clinic and research. This paper aims to take a history trace to the development of Deqi theory, understand the connotation of Deqi based on Chinese medicine theory, and establish an evaluation methodology accordingly. We believe that Deqi is not only the needling sensation, but also the perception of changes of qi (') flowing of the patient elicited by needling on acupoints. The signs of Deqi include the patient's subjective perception (needling sensation), the objective physiological changes (common referred to the skin redness around the acupoints and the response of brain), and the acupuncturists' perception. Although Deqi is essential for attaining the effect, it may not be the necessary sign of the ideal efficacy. It is found that the characteristics of Deqi sensations, Deqi's intensity, time duration, and the propagation will all affect the efficacy. Thus, acupuncturists should pay attention to elicit and control Deqi state, which is also the key point in modern research on the therapeutic implications of Deqi.

Full text

Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2013, Article ID 639302, 5pages
http://dx.doi.org/10.1155/2013/639302
Review Article
The Historical Development of Deqi Concept from Classics of
Traditional Chinese Medicine to Modern Research: Exploitation
of the Connotation of Deqi in Chinese Medicine
Hong-Wen Yuan,1,2 Liang-Xiao Ma,1,3 Dan-Dan Qi,1Peng Zhang,1
Chun-Hua Li,4and Jiang Zhu1,3
1School of Acupuncture Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
2School of Traditional Chinese Medicine, Capital Medical University, Beijing 100069, China
3e Key Unit of Evaluation of Characteristic Acupuncture erapy, State Administration of Traditional Chinese Medicine,
Beijing 100029, China
4Beijing Electric Power Hospital, Capital Medical University, Beijing 100073, China
Correspondence should be addressed to Jiang Zhu; jzhjzh@263.net
Received 12 May 2013; Revised 11 September 2013; Accepted 18 September 2013
Academic Editor: Lijun Bai
Copyright © 2013 Hong-Wen Yuan et al. is 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
cited.
Although it is dicult in fully clarifying its mechanisms and eects, Deqi still can be considered as an instant “sign” of acupuncture
response of the patient and acupuncturist, which has a signicant value in clinic and research. is paper aims to take a history
trace to the development of Deqi theory, understand the connotation of Deqi based on Chinese medicine theory, and establish an
evaluation methodology accordingly. We believe that Deqi is not only the needling sensation, but also the perception of changes of
𝑞𝑖󸀠owing of the patient elicited by needling on acupoints. e signs of Deqi include the patient’s subjective perception (needling
sensation), the objective physiological changes (common referred to the skin redness around the acupoints and the response of
brain), and the acupuncturists’ perception. Although Deqi is essential for attaining the eect, it may not be the necessary sign of
the ideal ecacy. It is found that the characteristics of Deqi sensations, Deqi’s intensity, time duration, and the propagation will all
aect the ecacy. us, acupuncturists should pay attention to elicit and control Deqi state, which is also the key point in modern
research on the therapeutic implications of Deqi.
1. Introduction
ere is so far little evidence of investigating the relationship
between the therapeutic ecacy of acupuncture and the
Deqi experience. However, as the specic perception of
acupuncture stimulation, Deqi may inuence the physical
and psychological condition of the patients.
e terms of “Deqi”and“Qizhi”wererstfoundin
“Huang Di Neijing ”[1]. e sentence “acupuncture therapy
does not take eect until the arrival of energy,” which is
thought to be the basic principle to guide the clinical practice
of acupuncture. At present, most acupuncture doctors and
researchers in China [2–5]believethatDeqi is essential for
theecacyofacupunctureanditisnecessarytoinduceDeqi
sensation to a certain degree.
Some clinical results conrm that Deqi reveals some con-
nection with the ecacy of acupuncture treatment [6–11];
however, others concluded that Deqi sensations did not
result in eectiveness [12,13]. Learning from these studies,
we found that studies conducted in China usually applied
deep needling (1 to 2 cm) with manipulations every 5 min
during needle retention (30 min as usual), so as to maintain
certain intensity and time duration of Deqi sensations. While
the studies abroad mostly insert supercially or manipulate
needle only once in the treatment.
ere is one sentence in Neijing that talked about Deqi:
“e qi in acupoints is delicate, means that to elicit responses
of qi (Deqi), maintaining qi, and watch the movements
of energy is an important step in acupuncture therapy”

2 Evidence-Based Complementary and Alternative Medicine
(from Ling Shu Chapter 3 on minute needle). It conrmed
that “maintaining qi” actually refers to the fact that maintain-
ing the intensity and time duration of needling sensation is
necessary aer Deqi. e manipulation every 5 min during
needle retention aer Deqi may be the key to a higher ecacy
in the study. Some researchers also pay attention to the
dose-eect relationship of acupuncture and consider that
the ecacy of acupuncture treatment depends on complex
factors, such as the number of needles, depth of needling,
point location, needling retention, and interval between two
sessions [14]. erefore, the intensity of needling in most
present acupuncture studies might not be enough for achiev-
ing therapeutic eects. It may help some confounders to have
biased ndings toward a negative outcome [15,16]. ese
views support that Deqi is a key to the treatment ecacy.
However, the diversity of perspectives on the relationship
between Deqi and eect in current studies may be caused by
dierent understanding of Deqi.
e distinct dierence in the understanding of Deqi can
be found in the literatures in China and other countries.
Among the Deqi related literatures published in China since
1950, there are 137 articles (67%) discussed on the under-
standing of Deqi. ere are a variety of denitions of Deqi
across dierent textbooks.
2. The Definitions of Deqi Nowadays
In the latest “Eleventh Five-Year” national plan textbook
“A c u p u n c t u r e a n d M o x i b u s t i o n ,” Zhen Jiu Xue [17]states:
“Deqi,normallycalledQizhi in ancient, or needling sensation
in modern, refers to the response of channel qi elicited by
acupuncture stimulation such as liing, thrusting, as well
as rotating the needle aer inserting the needle into an
acupoint.” e signs of Deqi include two aspects, one is the
patients’ needling sensations, and the other is acupunctur-
ist’s perceptions. When obtaining qi,thepatientmayfeel
sensations of suan (soreness), ma (numbness), zhang (full-
ness/distention), and zhong (heaviness) and sometimes a
feeling of heat, cold, pain, itching, muscular twitching,
formication, and so forth, and those sensations can spread in
some certain directions. A few patients may show the reaction
of twitching or involuntary movement of skin and muscles
along the stimulated channel, or red skin rash, or red or white
lines on the skin around the punctured area. At the same time,
the acupuncturist may feel heavy, tight, or vibration of the
needle. If Deqi is not evoked, the patient would not have any
special feeling or reactions, and the acupuncturist may feel
the needles are loose and empty.
e widely accepted denition of Deqi in English lan-
guage textbooks is: “Traditional acupuncture involves stimu-
lation with very ne needles inserted into dened sites on the
body, eliciting a composite of sensations, termed Deqi,which
is considered to be related to clinical ecacy in traditional
Chinese medicine” [18].
e latest Chinese-English Dictionary of Traditional
Chinese Medicine (TCM) denes Deqi as “needling sensa-
tion, which refers to the patient’s response to sore, numb,
distention, electric shock and the doctor’s heavy and tight
sensation coming from beneath the needle” [19].
Several randomized controlled clinical trials in a large
sample with a signicant inuence usually dened Deqi as
“an irradiating feeling deemed to indicate eective needling”
[6,20,21].
Recently, the most common denition of Deqi is “the
needling sensations of both patient and acupuncturist.” How-
ever, in the theory of TCM acupuncture, needling sensation
isthemostsignicantmanifestationofDeqi,buttheyare
not equal on the level of connotation. In addition, modern
functional brain imaging technology also demonstrated that
classic Deqi sensation, such as a sense of soreness, had
dierent eect on the certain area of the brain compared with
sharp pain [22] which further supports the point that Deqi is
not equal to needling sensation.
3. The Origin of Deqi Theory
e theory of TCM acupuncture generated from traditional
Chinese culture. erefore, prior to the study of Deqi theory,
we should rstly understand its background, and then the
connotation of Deqi could be explained by modern research
methods.
Deqi is derived from the concept of “Qi”in“Huang Di
Neijing”(writteninAD206∼221 [23]). “Qi”isanimportant
concept in Neijing to describe the activities of human life. e
ability to maintain a healthy state is normally called healthyqi
(zheng qi) or grain qi (gu qi), while the exogenous pathogenic
factors that lead to varieties of diseases or pathological
changesinthebodyarecalledpathogenicqi (xie qi).
In Neijing, the formation of the theory of “Qi”ismainly
originated from “the theory of qi transformation in life” in
Taoism. In t h e Ta o i s m w o r k “Huai Nan Zi”[24], “body”,
“qi”, and “mind” are composed of three treasures of life.
ey are interdependent and mutually related. e ecacy of
acupuncture would be closely related to the patient’s mental
status and psychological factors, showing correspondence
between “qi” and “mind”. Both the patient and acupuncturist
will perceive certain sensations aer Deqi,whichisactually
the interactions between “qi”and“body”.Moreover,TCM
holds that the qi of the human body corresponds to the
seasons, resulting in the relationship between physiological
changesandthereplacementofthefourseasons.us,the
seasons may aect the diculty of Deqi. For example, the
blood ows supercially in summer, during which Deqi is
easier, while the blood ows deeply in winter and Deqi is
relatively dicult. In Neijing,“qi” can also be classied into
three categories: organ’s qi (Zangqi), channel’s qi (Jingqi),
and vessel’s qi (Maiqi). ese three types of qi circulate in
the body nonstoppingly. erefore, stimulating acupoints on
channel can regulate the certain internal organ to cure the
disease. Detecting the changes of pulse can also be applied to
determine “Deqi”inNeijing.
In summary, the theory of “Qi”inNeijing is the basis of
the traditional acupuncture theory of “Deqi.” Phenomenon
and impact of Deqi arealldevelopedonthisbasis.TCM
acupuncture emphasizes that the acupuncturist should con-
centrate on the needling process and carefully perceive the
sensations below the needle to judge and regulate qi of the
patient.

Evidence-Based Complementary and Alternative Medicine 3
4. The Development of Connotation of Deqi
e view that acupuncture treatment ecacy is closely related
to Deqi originated in Neijing. “If insertion of needle fails
to bring about the response of energy, treatment should be
continued for as long as necessary. Acupuncture therapy does
nottakeeectuntilarrivalofenergy(Qizhi).” (from Lingshu
Chapter 1 Nine needles and twelve original points). What is
more, there is a detailed explanation of “Qizhi”inNeijing,
“the principles of needling dictate that needling should stop
as soon as energy is brought into harmony, due to tone up the
body energy of yin and sedate the pathogen of yang,ortotone
upthebodyenergyofyang and sedate the pathogen of yin.
...e assertion that needling takes eect so long as Qizhi
means that an excessive disease could be sedated and the
decient energy may be complement.” (from Lingshu Chapter
9 From beginning to end). It expresses that the function
of acupuncture is “regulating qi,” w h i c h c a n b e a c h i e v e d
by supplementing and draining acupuncture manipulation.
erefore, pathogens can be eliminated, decient healthy qi
canbesupplemented,orreversedowofqi be adjusted,
leading to a state of yin-yang balance. e connotation of “qi”
in “Qizhi” refers to healthy qi or grain qi.Obviously,Qizhi
indicates “proper intensity of stimulation” and also the sign
of removing the needle. In Neijing,“Deqi”and“Qizhi”are
usually considered as the same, regarded as a sign of ecacy
[25,26].
e Dicult Classic (Nanjing) [27]writteninAD106∼210
[28]normallyhassimilarreputationasNeijing in Chinese
medicine. e chapter of Seventy-eight Dicult Issues states,
“Insert a needle along the route of the channel to induce Deqi
rstly. en thrusting the needle inward is a supplementary
method, while liing the needle outward is a draining
method.” at text shows that certain needling techniques
for supplementary or draining are applied aer Deqi.Nanjing
describes Deqi as the basis and premise of acupuncture
manipulation. It may indicate that Deqi and Qizhi are not the
same. Deqi refers to the rst period of Qizhi,whichisthesign
of ideal ecacy.
e development of acupuncture can be traced to the Jin
and Yuan Dynasty (AD 1115∼1368), clarifying that Deqi is the
base of acupuncture manipulation. ere is one sentence in
Song to Elucidate Mysteries (Biao You Fu)writtenbyDou
Hanqing starting, “en the acupuncturist should perceive
qi carefully. e sensation of loose and empty beneath the
needle means qi does not arrive. While heaviness, tightness
and fullness sensations suggest that qi has arrived. When qi
arrives, manipulate the needle properly according to cold or
heat syndromes; when qi does not arrive, wait for qi according
to deciency or excess conditions.” It keeps the same point
as the Nanjing. Till that time, it is found that Deqi not only
isrelatedtothetreatmentecacy,butalsocanbeusedto
determine the prognosis of the disease. As written in Song to
elucidate mysteries, “the more quickly of qi arrives, the easier
the disease is to cure; supposing the qi does not arrive, the
patient may be hard to cure,” which means that the degree of
diculties of getting Deqi can predict the ecacy. Of course,
here, the ecacy does not refer to the real-time acupuncture
eect but to the signicant treatment ecacy of the disease.
AstheacupuncturedevelopedintheMing and Qing
dynasties (1368∼1911), there is a further illustration of the
relationship between the acupuncturist’s perception of the
needle and ecacy. One of the most inuenced publications
at that time, e Complete Compendium of Acupuncture
and Moxibustion (Zhen Jiu Da Cheng)[29], states, “How
to remove the needle depends on the acupuncturist’s per-
ception on the needle. Extremely tense and rm sensation
beneath the needle indicates the needle is being grabbed by
pathogens, not by the healthy qi, therefore, the needle cannot
be removed. If the needle was removed at this moment,
the disease might be palindromia. Instead, needling tech-
niques for supplementary and draining should be applied
and retain the needle for a certain period. Only when a
looser sensation beneath the needle is felt, the needle can
be removed.” According to these texts, acupuncturist should
clarify the sensations beneath the needle aer Deqi. It is called
“dist in g u i s h i n g qi.”
Originating from Nanjing,theconnotationof“Deqi”and
“Qizhi” are dierent; “Qizhi” is obtaining the eect of the
nal state through the returning of qi in human body by
normal acupuncture treatment, while “Deqi”istheearlypart
of “Qizhi,” which means that the qi hasbeenelicitedtothe
needle. Aer realizing Deqi, it is still needed to distinguish the
character of qi and apply the related manipulation or retain
the needle, so as to reach the “Qizhi”state[30–33].
5. The Evaluation Method of Deqi Based on
Its TCM Connotation
5.1. Both Notice the Perception of Patient and Acupuncturist.
Evaluation of Deqi in ancient Chinese medicine mainly
focusedontheacupuncturist’sperceptions,ratherthanthe
patient’s needling sensation during an acupuncture treat-
ment. Ancient Chinese acupuncturists believe that during
acupuncture, the acupuncturist should concentrate on the
changes of qi aer the needle being inserted, so as to know
the situation of patient and disease, then give appropriate
needling manipulations to regulate qi.Moreover,theability
of “eliciting qi,” “d i s t i n g u i s h i n g qi,”and“regulatingqi”reects
thelevelofhealingskilloftheacupuncturist.Inmoderntime,
Deqi is dened as the needling sensation, so the quantitative
evaluations of Deqi are mainly based on the patient’s needling
sensations [34–37]. Although the needling sensations of the
patient are more direct and sensitive, we suggest that the
perceptions of the acupuncturist should be noticed as well,
which is the key of “regulating qi with the needle.”
5.2. Distinguish the Sensation of Penetrating Skin from Deqi.
In TCM, Deqi is the sign of the change of qi,soitshouldbe
elicited when the needle is inserted into the acupoint. Park
et al. [38] also nd a strong connection between acupunc-
ture sensation and tissue depth; the frequency of prinking
and sharp sensation was signicantly greater in shallower
tissue levels, and the frequency of sensations described as
traditional Deqi sensation,suchasdull,heavy,andspreading,
was signicantly greater in deeper tissue levels. erefore,
the pain or other sensations which could be felt when

4 Evidence-Based Complementary and Alternative Medicine
the needle penetrated skin is not Deqi sensation. In recent
needle sensation questionnaire/scale, the item “sharp pain,”
“pricking,” and “penetrating” may evaluate the sensation of
penetrating skin but not Deqi. It would be better to design an
instrument for calling attention to the patient to distinguish
the sensation of needling penetrating from Deqi.
5.3. Evaluating Deqi More Comprehensively an Existence
and Intensity. Deqi is closely related to the treatment ecacy
in Neijing;however,theformationofDeqi is only the rst
step of achieving the ideal ecacy in traditional theory.
rough diagnosing based on qi aer Deqi,retainingthe
needle skills further improve the acupuncture ecacy. Aer
immediately nishing the treatment aer Deqi,thepatient
condition would deteriorate as the doss of stimulation is
not enough. It was also stated that “Qi extending aected
treatment partially” as mentioned in Zhen Jiu Da Cheng,
which means that the correct direction and a certain distance
of Deqi spreading can enhance the ecacy. erefore, the
evaluation of Deqi existence and intensity is only two aspects
in evaluating the relationship between the Deqi and the
treatment ecacy. e nature of qi,intensity,duration,and
the spreading should be recorded comprehensively by Deqi
evaluation instrument, which may inuence the ecacy in
clinical trials.
5.4. Notice the Inuence of Deqi in “Mind”. e traditional
theory of Deqi does not merely refer to the needle feeling,
butalsoincludesthereactionof“qi”inthehumanbody.
According to TCM theory, this phenomenon can aect con-
stituting the other two signicant elements of the human
body: the “body” and “mind;” manifested in “body” is the
needle feeling, while that manifested in “mind” referred to
thechangeofthestateofbrainfunction,whicharethetwo
most important factors in evaluating the Deqi.
e study of brain central mechanisms of acupuncture
carried out recently is combined with a large number of
brain imaging technology (PET, SPECT, fMRI, etc.), which
provides a scientic method in investigating the Deqi eect.
Researchers hope to dene a model of Deqi brain function by
applying the brain functional imaging technology, through
which the cases t this model can be dened as Deqi,so
itmaybecomeeasytodistinguishwhethertogetDeqi or
not [39]. Kong et al. [40] have conrmed that the signals of
fMRI can correctly reect the specicity Deqi state between
the dierent individuals, which provides a reliable method to
evaluate Deqi.
6. Conclusion
Acupuncture is one of the important methods to realize
“mediating meridians, regulating the qi and blood” in TCM,
in which Deqi plays an important role in the process of
acupuncture. Neijing lays the theoretical basis of the theory
of Deqi.Deqi does not only refer to needling sensations, but
also involves the changes of qi induced by needle insertion
into the acupoint. e signs of Deqi include the patient’s sen-
sations (needling sensations), objective physiological changes
(commonly refer to the skin redness around the acupoint
aswellastheresponseofbrain),andtheacupuncturist’s
perceptions. Deqi is closely related to the treatment ecacy;
however, it is not a necessary sign for the most ideal ecacy.
e characteristics of Deqi, including what kind of sensations
of both patient and acupuncturist, their prevalence, intensity,
time duration, and the propagated sensation along channel
will all aect the treatment ecacy. So acupuncturists should
pay attention to elicit Deqi and control its state, which is
also the key point in modern research on the therapeutic
implications of Deqi.
Authors’ Contribution
Hong-Wen Yuan and Liang-Xiao Ma contributed equally to
this work.
Acknowledgments
e authors sincerely acknowledge the National Basic
Research Program of China (973 Program) (nos.
2012CB518506 and 2006CB504503), the National Natural
Science Foundation of China (no. 30973793), and the Doc-
toral Program of Higher Education of Ministry of Education
of China (no. 20090013110005) for funding this study.
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