Needle Sensation and Personality Factors Influence Therapeutic Effect of Acupuncture for Treating Bell＇s Palsy： A Secondary Analysis of a Multicenter Randomized Controlled Trial

Background： It has not been solved what kind of needle sensation might influence outcomes of acupuncture treatment. Effects of personality factors on the therapeutic effect of acupuncture have not been investigated. This study aimed to find the effects of the traits of personality on the objective outcome when different acupuncture techniques were used in treating patients with Bell＇s palsy. Methods： We performed a secondary analysis of a prospective multicenter randomized controlled trial of acupuncture for Bell＇s palsy. Patients were randomly assigned to the de qi and control groups, respectively. The primary outcome was facial nerve function at month 6. The intensity of each needle sensation was rated by a visual analog scale. Psychosocial thctors were assessed by the pretreatment mediator questionnaire： 16 Personality Factor Questionnaire （16PF） was used tbr assessing personality factors and digit cancellation test for assessing attention. 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）. Path analysis showed that intensity of needle sensation of fullness had direct effect on House-Brackmann （HB） score at month 6. In de qi group, the low HB score on day I （OR： 0.13, 95% （_7： 0.03-0.45） and the low Social Boldness score （OR： 0.63, 95% CI： 0.41-0.97） in 16PF were associated with better facial function. In control group, low HB score on day 1 （OR： 0.25, 95% CI： 0.13-0.50）, low Vigilance score （OR： 0.66, 95% CI： 0.50-0.88）, and high Tension score （OR： 1.41,95% CI： 1.12 1.77） in 16PF were related to better facial function. Conclusions： The needle sensation of fullness could predict better facial function and personality traits might influence outcomes of acupuncture treatment. Both of them should be considered seriously in acupuncture treatment and research.

PRELIMNARY STUDY ON THE EFFECT OF SUBSTANCE P IN THE PROCESS OF FORMATION OF NEEDLING SENSATION

Object: To study the effect of SP in the process of formation of needling sensation in the rat. Methods: The pain threshold was determined by inducing rat’s tail swing reaction when the electrical stimulation was gradually increased to a certain extent via two electrodes inserted in the bilateral sides of the tail. Right Zusanli (ST 36) was stimulated electrically for 30 min by setting the stimulating parameters as continuous waves, frequency of 20 Hz and a suitable strength (just generating slight muscular tremor). The relative SP contents of the spinal cord and the small intestine were displayed by using immunohistochemical method and evaluated using gray density value. The effect of "Zusanli" injection of SP on pain threshold was observed by injecting 25 μL of SP (5 nm) into the bilateral ST 36. In control group, normal saline (25 μL) was injected into the bilateral ST 36. Results: ① After elctroacupuncture (EA) of ST 36, both the pain threshold and SP content of the spinal dorsal horn on the EA side increased significantly (P< 0.05); and ② Both EA and injection of SP could raise the pain threshold remarkably. Conclusion: SP may play an important role in the process of formation of needling sensation in the primary nerve center.

Introduction of two novel devices for investigating the influence of non-mechanical components such as therapeutic qi in acupuncture

OBJECTIVE： Acupuncture is a complex intervention consisting of specific and non-specific components. Acupuncture studies more frequently focus on collecting data from the patients＇ perspective and response, but the acupuncturist＇s role remains relatively unclear. In order to investigate potential non-mechanical active factors originating from the acupuncturist and transmitted to the patient during treatment, two novel devices for basic research in acupuncture were designed. The Acuplicator allows the researcher to insert needles without touching the needles themselves, while the Veliusator locks the needle in its place so that no mechanical movement can be transferred. METHODS： The Acuplicator was used to insert needles at Neiguan （PC6） on the right forearm of 23 volunteers. The insertion depth was measured using a depth gauge. The transfer of mechanical movements from the handle to the tip was detected with a precision length gauge with a motoric-tactile sensor. RESULTS： The mean insertion depth was （12.3 ± 1.5） mm （range 9.5 to 15.0 mm）. Even with intense manipulation of the needle handle, no movements within ± 1 μm could be detected at the tip when the needle was locked. CONCLUSION： With these two devices it will be possible to investigate the influence of non- mechanical components such as therapeutic qi in acupuncture.

Impacts of the different tissue specificities of the acupoints on electroacupuncture sensations

Objective To evaluate the influence of the tissue specificity of the acupoints （different meridians, tissues and nerve segments） on the frequency, intensity and current flow output in association with electroacupuncture （EA） sensations. Methods Twenty one volunteers received EA. According to the tissue specificities of acupoints, 5 acupoint pairs were selected, named Zúsānlǐ （足三里 ST 36） vs Yánglíngquán （阳陵泉 GB 34, different meridians）, Nèiguān （内关 PC 6） vs Dàlíng （大陵 PC 7, different tissues）, Zúsānlǐ （足三里 ST 36） vs Shuǐdào （水道 ST 28, different nerve segments）, Guānyuán （关元 CV 4） vs Zhōngwǎn （中脘 CV 12, different nerve segments）, and Zúsānlǐ （足三里 ST 36） vs Guānyuán （关元 CV 4, different meridians, tissues and nerve segments）. The electric frequency was 15 Hz. The electric current was under the subject’s tolerance without sharp pain induced. EA lasted 90 s with 3 discontinuities. The sensations, such as soreness, numbness, fullness/distention, heaviness, tingling, pressure, dull pain, hotness and coldness were recorded as well as the current flow output in association with the needling sensations. The differences in the frequency, intensity and current flow output relevant with the needling sensations were compared among the different acupoint pairs. Results There were no significant differences in the frequency of the needling sensations among the different acupoint pairs （all P〉0.05）. Of 9 different sensations of EA, fullness/distention, numbness and soreness presented the most commonly and remarkably; heaviness, pressure and tingling were on the second top; dull pain, hotness and coldness occurred at the lower frequency. There were the differences in the intensity of some needling sensations among the acupoint pairs, in which, the intensity of soreness, fullness/distention and heaviness was stronger at Zúsānlǐ （足三里 ST 36） vs Shuǐdào （水道 ST 28） （all P〈0.05）; the intensity of fullness / distention, and numbness was stronger at Zúsānlǐ （足三里 ST 36） vs Guānyuán （关元 CV 4） （P〈0.01）; the intensity of fullness/distention was stronger at Guānyuán （关元 CV 4） vs Zhōngwǎn （中脘 CV 12） （P〈0.05）. The current flow output of EA was similar among the acupoint pairs （all P〉0.05）. Conclusion In the situation that there is no obvious difference in the current flow output associated with EA sensations, the frequency of EA sensations does not relevant apparently with the different tissues. The difference in the intensity of the needling sensations among the different acupoints is probably relevant with the nerve segments at the acupoint locations. The frequency and the intensity of the different needling sensations at the same acupoint are relatively stable at the different times of EA.

Effects of Three Needling Manipulations of Zusanli(ST 36) on Deqi Sensations and Surface Myoelectricity in Healthy Participants

Objective:To investigate the effects of different acupuncture manipulations on Deqi sensations and surface myoelectricity,and explore the correlation between Deqi sensations and needling manipulations.Methods:Forty-five healthy participants accepted twirling,lifting-thrusting,and twirling plus lifting-thrusting manipulanions at right Zusanli(ST 36),respectively.The acupuncturist’s and participants’Deqi sensations were collected by MGH Acupuncture Sensation Scale(MASS).The intensity and occurrence rate of soreness,dull pain,pressure,heaviness,fullness,numbness,sharp pain,warmth,coolness,and throbbing feelings of participants,and tightness,smooth,and tangle feelings of acupuncturist were measured.The correlation between the acupuncturist’s and participant’s Deqi sensations was analyzed.Surface electromyogram(EMG)was recorded before,during and after needling in 30 participants.The integrated EMG(iEMG),mean power frequency(MPF)and media frequency(MF)were analyzed.Result:Both fullness and soreness of participants and tightness of acupuncturist were the most frequently occurred ones.A positive correlation between participants’fullness and acupuncturist’s tightness was observed during the three aforementioned needling manipulations(P<0.05,OR>1).Almost all the needling sensations measured in the present study could be induced by the three needling manipulations.However,strength of Deqi sensations was exhibited as lifting-thrusting>twirling plus lifting-thrusting>twirling according to MASS index.The i EMG values were increased and MPF,MF values were decreased during needling compaired to those before needling,especially during lifting-thrusting(P<0.01).Conclusions:The intensity and occurrence rate of the different Deqi sensations induced by different needling manipulations were basically similar.The fullness and soreness were both the most frequently induced Deqi sensations.The strongest Deqi sensation could be induced by lifting-thrusting manipulation.There is a positive correlation between participants’fullness and acupuncturist’s tightness during the three needling manipulations.The myoelectricity around the acupoint is related to Deqi responses.(Registration No.AMCTR-IOR-20000314).

Modern and ancient knowledge about “deqi ” and analysis on the researches in recent 10 years

Objective With the development of science of acupuncture and moxibustion, people have, in the knowledge of ＂deqi＂, developed from subjective level to the quantitative level, and discovered many factors influencing the ＂deqi＂ of acupuncture. In this report, the relationship between ＂deqi＂ and these factors was explored in terms of different acupuncture methods and quantity and depth of stimulus. Methods Ancient literature about ＂deqi＂, as well as related literature for clinical and basic research on ＂deqi＂ in recent 10 years were systematically collected. Results （1） Cerebral functional imaging technology and the scale of ＂deqi＂ were the most common quantitative indexes for ＂deqi＂ in recent 10 years. （2） There were many factors influencing ＂deqi＂ in acupuncture, which involved personal physiological status, nature of disease, anatomical features under the acupoint, different acupuncture methods, quantity and depth of stimulus, etc. Different acupuncture methods, quantity and depth of stimulus would bring different influences on and mechanisms of ＂deqi＂. Conclusion （1） ＂Deqi＂ is not equal to needling sensation; （2） recessive needling sensation should be re-recognized; （3） the sensation of doctor should be paid attention; （4） The meaning of ＂deqi＂ should be re-defined and re-understood.

Study of acupuncture in inducing body responses of Swiss patients

Objective To observe Europeans’ different responses to acupuncture,to analyze body tolerance,and to provide objective basis for clinical intervention temporal frequency of acupuncture-moxibustion in Europe.Methods The information of 168 patients（Swiss original residents） who visited doctor for the first time from December,2013 to June,2015（MediQi AG Die Zentrenfur TCM）was collected,the duration and property of responses to acupuncture were analyzed,and SPSS 18.0 software was adopted to analyze the study result.Results Responses to acupuncture were observed in 65 patients（28 males and 37 females） with an incidence rate of 38.69%（65/168）.According to Chisquared test,the difference was not statistically significant（P〉0.05）.Among the patients with response,49 patients felt fatigue（19 males and 30 females）,12 cases felt sore and swelling pain（7 males and 5 females）,conduction along meridian occurred in 2 patients（1 males and 1 females）,and 1 patient suffered from spasm（male）.Based on statistical analysis,the differences were not statistically significant（all P〉0.05）.The duration of responseis（13.00 ± 12.51）h for male,and（32.81 ± 25.59） h for female,according to t-test,the difference was statistically significant（P〈0.001）.Conclusion The incidence rate and property of responses to acupuncture has nothing to do with gender;the duration of responses to acupuncture is closely related with gender,and the duration of responses to acupuncture is longer in females.

Immediate analgesic effect of needling acupoints(bilateral De Qi vs unilateral De Qi)on primary dysmenorrhea:a multi-center,randomized,controlled trail

OBJECTIVE: To analyze the effect of needling acupoints(bilateral vs unilateral) with De Qi using data collected from 501 primary dysmenorrhea(PD) patients participating in multi-center, randomized,controlled trail.METHODS: De Qi was defined as at least one of the feelings in soreness, numbness, fullness or heaviness at the acupoints when stimulated with needles. The 501 patients were grouped in 3 groups in terms of De Qi or not De Qi in one side(unilateral)or both sides(bilateral) of the body: bilateral De Qi group, unilateral De Qi group, and non-De Qi group. The abdominal pains were measured using visual analog scale(VAS).RESULTS: In 501 patients, 472 acquired De Qi at unilateral acupoints, 24 De Qi at bilateral acupoint,and 5 had no De Qi at any acupoint. The data of non-De Qi group was excluded as the sample was less than 5% of that in the bilateral De Qi group.There was significant difference in the VAS before and after treatment between unilateral and bilateral De Qi group(P < 0.01). After stratified by acupoints, for the patients needled at Sanyinjiao(SP 6)and Xuanzhong(GB 39), VAS scores in the bilateral De Qi group were larger than those in the unilateral De Qi group(P < 0.05).CONCLUSION: Bilateral De Qi was possibly superior to unilateral De Qi in enhancing the immediate analgesic effect of needling the acupoints, but no statistical significance was observed on the pa-tients of needling at non acupoint, which preliminarily suggested this immediate analgesic effect was perhaps along meridians.

A review of the methods used for subjective evaluation of De Qi

De Qi refers to a series of sensations experienced when acupuncture is performed at acupoints. De Qi comprises needling sensations felt by the patient, and the sensations perceived by the acupuncturist. Classical Traditional Chinese Medicine theory states that De Qi is closely related to curative effect.In modern studies, the main index that researchers have used to evaluate De Qi was the needling sensation reported by the patient. Between 1 st Aug and 31 st Oct 2014, we conducted an electronic database search of all fields in Chinese and English to select literature assessing acupuncture needle sensations. We then reviewed the methods used within these studies to evaluate De Qi. The methods included simple evaluation, and the use of a De Qi scale/questionnaire. The simple evaluation, a qualitative evaluation, was judged by typical sensations felt by the patient after needling at acupoints, such as soreness, numbness, fullness, and heaviness.This method was easy and practicable, and had been adopted widely by Chinese researchers. In contrast, the De Qi scale/questionnaire, a quantitative evaluation, had multiple compiling methods available for evaluating the intensity of De Qi. The standardization and objectification of the De Qi scale/questionnaire effectively improved the quality of studies on De Qi, thereby these scales/questionnaires have been acknowledged and applied by most researchers. The present review analyzed and compared the scales/questionnaires used to evaluate De Qi; furthermore, we provided suggestions for the development and improvement of these questionnaires through integration with classical De Qi theory.