Acupuncture sensation during ultrasound guided acupuncture needling

Department of Physical Medicine and Rehabilitation, UNC-Chapel Hill, School of Medicine, 1st Floor, North Wing, UNC Hospitals, Campus Box #7200, Chapel Hill, NC 27599, USA.
Acupuncture in Medicine (Impact Factor: 1.5). 06/2011; 29(4):257-65. DOI: 10.1136/aim.2010.003616
Source: PubMed


Although acupuncture sensation (also known as de qi) is a cornerstone of traditional acupuncture therapy, most research has accepted the traditional method of defining acupuncture sensation only through subjective patient reports rather than on any quantifiable physiological basis.
To preliminarily investigate the frequency of key sensations experienced while needling to specific, quantifiable tissue levels (TLs) guided by ultrasound (US) imaging.
Five participants received needling at two acupuncture points and two control points at four TLs. US scans were used to determine when each TL was reached. Each volunteer completed 32 sets of modified Southampton Needle Sensation Questionnaires. Part one of the study tested sensations experienced at each TL and part two compared the effect of oscillation alone versus oscillation+rotation.
In all volunteers, the frequency of pricking, sharp sensations was significantly greater in shallower TLs than deeper (p=0.007); the frequency of sensations described as deep, dull and heavy, as spreading, and as electric shocks was significantly greater in deeper TLs than shallower (p=0.002). Sensations experienced did not significantly differ between real and control points within each of three TLs (p>0.05) except TL 4 (p=0.006). The introduction of needle rotation significantly increased deep, dull, heavy sensations, but not pricking and sharp sensations; within each level, the spectrum of sensation experienced during both oscillation+rotation and oscillation alone did not significantly differ between acupuncture and control points.
The preliminary study indicates a strong connection between acupuncture sensation and both tissue depth and needle rotation. Furthermore, the new methodology has been proven feasible. A further study with an objective measurement is warranted.

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Available from: Robert T Davis, Nov 06, 2015
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    • "Researchers using functional magnetic resonance (fMRI) to test mild cognitive impairment found that deep muscle insertion of acupuncture is necessary to achieve appreciable clinical effects [1–3]. Others have used ultrasound scans to guide the specific depth for achieving acupuncture sensation [4]. Such findings correspond to the Layer Analysis as described in the Yellow Emperor's Inner Classic [5]. "
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    • "Interestingly, only for TRPV1, a very thin layer at the margin of the muscle beneath the epimysium which exhibited even higher expression was discovered (Figure 4A). This is rather interesting because acupuncture sensation (de-qi) is stronger just after the needle tip enters the perimuscular fascia (epimysium) [42]. "
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    • "So needling on the tendon layer may induce more sensations of aching, soreness, distention, and warmth [5]. Related research demonstrated that stabbing pain and sharp pain were more obvious on the shallow layer while dull, heaviness, radiating, and electric sensation were much easier to be induced on the deeper layer than the shallow layer, which elucidated that the deeper layer could excite more Deqi sensation [6]. Based on these researches, length of the needle and the insertion depth were considered as stimulation factors. "
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