Needle Sensation Research Articles

Effect of heat-producing needling technique on the local skin temperature: a clinical study

ObjectiveThis clinical study was performed to examine the influence of heat-producing acupuncture (HPA) treatment on the local skin temperature of Zúsānlĭ (足三里ST36) acupoint in healthy participants. Methods30 healthy participants received four successive sessions of heat-producing acupuncture (HPA), non-acupoint HPA (NAHPA), normal stable acupuncture (Norm) and non-invasive sham acupuncture (Sham) on the ST36 acupoint in random order. Within each treatment session, the local skin temperature of ST36 acupoint and basal body temperature of each participant were measured at 1 min before needle insertion (T1B), just after needle insertion and manipulation (T0), 5 min after needle insertion (T5) and 5 min after needle removal (T5A). Visual Analogue Scale (VAS) scores of the participants’ perceived needling and heat sensation felt during the acupuncture treatment period (T0-T5) were also recorded on a scale of 1 to 10. ResultsIntra-session group statistical analyses of the different time points in the HPA treatment session group demonstrates that ST36 local skin temperature remained relatively stable between T1B and T0, increased significantly between T0 and T5 and decreased significantly between T5 and T5A. For inter-session group statistical analysis of all treatment session groups, the increase in local skin temperature of ST36 acupoint between T0 and T5 in the HPA treatment session group was significantly higher than those of the NAHPA treatment session group (P < 0.01), Norm treatment session group (P < 0.01) and Sham treatment session group (P < 0.01). The decrease in local skin temperature of ST36 acupoint between T5 and T5A in the HPA treatment session group was also significantly more than those of NAHPA treatment session group (P < 0.05), Norm treatment session group (P < 0.01) and Sham treatment session group (P < 0.001). ConclusionOur study provides evidence that HPA treatment performed significantly better than the other three treatments in elevating the local skin temperature of ST36 acupoint temporarily. Our results also align with those of many previous clinical studies on HPA and related acupuncture manipulations.

Acute Onset Asymmetric Sensorimotor Paraparesis: Not Always Spinal!

Objective: To report an atypical case of acute onset sensorimotor paraparesis secondary to bilateral cerebral stroke. Background: Acute onset paraparesis or paraplegia is usually secondary to a spinal cord disease. Central or cerebral causes of paraparesis are rare and include parasagittal and bilateral precentral lesions. Design/Methods: Case report and literature review. Results: A 65-year-old man presented with acute onset weakness of both lower limbs, associated with pins and needle sensation. On examination, he was found to have paraparesis (grade 2/5, both legs) and an asymmetric sensory loss in both legs and thighs. Spinal magnetic resonance imaging ruled out any compressive or noncompressive etiology. Magnetic resonance imaging of the brain showed an acute infarction in the bilateral cerebral hemisphere in both the pre- and postcentral gyrus. An angiogram of the brain revealed an aplastic right ACA-A1 with left ACA-A1 feeding bilateral A2. There was distal left ACA-A1 stenosis seen, the probable cause of bilateral stroke in this patient. The patient was treated conservatively and showed symptomatic improvement during the course of stay at the hospital. Conclusion: This case of acute paraparesis secondary to bilateral cerebral infarction demonstrates the need to always look for a cerebral cause. In patients with cerebral infarction, who present early to a hospital, it may provide a window for thrombolytic or endovascular therapy.

Acupuncture for poststroke hemiplegia focusing on cerebral bilateral connections: study protocol for a randomised controlled neuroimaging trial

IntroductionAcupuncture is safe and effective for improving the motor function of poststroke hemiplegic patients, but there still exists a certain gap between clinical practice and understanding its neural mechanisms. The...

ZHANG Ren's special penetrating needling method

The clinical experience of ZHANG Ren's penetrating needling method for refractory diseases is summarized. In clinical practice, the penetrating needling method is usually divided into shallow penetrating needling method and deep penetrating needling method. The shallow penetrating method includes parallel penetrating method, cross penetrating method, relay penetrating method and multi-directional penetrating method. Deep penetrating needling method includes deep penetration at auricular area, deep penetration at back-shu points, deep penetration at buttocks and deep penetration at knees. The clinical application of penetrating needling method should be based on the symptoms and the operation essentials should be grasped, in which, the needling sensation could go to the affected area, one acupoint could be stimulated by different techniques to ensure the suppelementory effect.

Acupuncture and moxibustion for the elderly patients with depression: A randomized controlled trial

ObjectiveTo identify the effects of acupuncture and moxibustion therapy by soothing liver and regulating mind on the quality of life among the elders with depression. MethodsThis was a single-blind, randomized, controlled trial of 75 elders with depression conducted in Guangdong Province, China, in January to December 2010. Eligible patients were randomly divided into three treatment groups. 22 patients received acupuncture and moxibustion treatment of soothing liver and regulating mind [group A, in acupuncture procedure: Hégǔ (合谷 LI4), Tàichōng (太冲 LR3), Bǎihuì (百会 GV20) and Yìntáng (印堂 GV29) were selected, in moxibustion procedure, bilateral Géshū(膈俞 BL17) and Dǎnshū (胆俞 BL19) were selected, the moxibustion cones was placed on the acupoints, five cones were given to each point. In intradermal needling procedure, Xīnshū(心俞 BL15), and Gānshū (肝俞 BL18) were selected]. 28 patients received acupoint shallow puncturing treatment (group B, patients received the same acupoints as in the group A, with a 2–3 mm needling depth and no needle sensation was required. A shorter duration of moxibustion and only 1–2 mm of needle body was inserted into the points when intradermal needling). 25 patients received non-acupoint shallow puncturing treatment (group C, patients received non-acupoint shallow puncturing at points 10 mm lateral to LI4 and LR3, 10 mm left side of GV20 and GV29 in acupuncture procedure; 10 mm lateral to BL17 and BL19 in moxibustion procedure; 10 mm lateral to BL15 and BL18 in intradermal needling procedure, with the same manipulation method as that in the group B). In all three groups, the treatment was given twice a week for 12 weeks. The Short Form (36) Health Survey(SF36) and TCM Symptom Scale Score as clinical efficacy and quality of life were used to quantitatively assess patients' outcomes before and after treatment. ResultsThe TCM Symptom Scale scores showed significant differences between the group A and C, and between group B and C (both P < 0.05), while there was no significant difference between group A and B (P > 0.05). An item-by-item analysis of the SF36 showed the elders in group A obtained the highest scores at each time point after treatment (all P < 0.05). Among the results, mental health and report health transition items showed no significant differences between the group A and group B at time point of after treatment (all P > 0.05). Vitality and social functioning items at a month after treatment time point, social functioning and report health transition items at 3 months after treatment time point, role emotional item at after treatment time point showed no significant differences between the group B and group C (all P > 0.05). ConclusionsThe therapeutic effect of acupuncture and moxibustion by soothing liver and regulating mind can obviously improve the quality of life of depression elders.

Progress of researches on mechanisms of needling and moxibustion sensations and their related sensation transmission

There are some records about the needling and moxibustion sensations in Chinese ancient medical literature, in which, the concept of Deqi (qi arrival) and its relationship with the production of therapeutic effects were put forward. The generation of needling or moxibustion sensations is one of the symbol for qi reaching the affected site during the manipulation and is also related to the treatment outcomes. In the present paper, we reviewed current situations about the mechanisms of acupuncture and moxibustion stimulation induced sensations and their relation to the propagated sensation (PS) published in recent 10 years from the following four aspects: 1) the patterns of manifestation of needling sensations (including general sensations, and specific sensations, as well as the practitioner's hand felt heavy, tight, hard-going senses, etc.) and moxibustion sensations (local superficial and deep warmth); 2) modern anatomical and physiological basis (skin, loose and dense connective tissue, free nerve ending, various receptors); 3) neurohumoral mechanism of acupuncture stimulation induced PS phenomenon (mechanical receptors, afferent and efferent nerve fibers, neural center, various neurotransmitters/modulators, chemical substances, etc.); 4) neurohumoral mechanism of moxibustion stimulation induced channel transmission (transient receptor potential vanilloid receptors－heat sensitive receptors, heat-shock protein, immunocytes, etc.). Additionally, the authors also put forward some suggestions about future researches on acupuncture-moxibustion sensations.

The low-frequency BOLD signal oscillation response in the insular associated to immediate analgesia of ankle acupuncture in patients with chronic low back pain.

PurposeThe present study evaluated the modulation effect of a painless acupuncture technique, ankle acupuncture (AA), on resting-state functional change in patients with chronic low back pain (CLBP).Patients and methodsFourteen participants diagnosed with CLBP received AA and underwent one brain functional image scan after tactile stimulation and another one following the insertion of the needle. The needling sensations and clinical pain intensities were evaluated after the end of each functional image scan. The significance levels of Visual Analog Scales/Scores (VASs) before and after acupuncture were determined using paired t-test. The brain areas showing differences in the amplitude of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF) between the two scans were identified. We also explored the relationship between mean ALFF values in brain areas identified and VAS scores based on Pearson correlation coefficient.ResultsA complete-case analysis was performed on 12 participants. Neither different needling sensations nor any local sensations during the two scans was found. The clinical findings indicated that the scores of VAS scores were significantly lower after AA intervention (P<0.001). Compared with those after tactile stimulation, ALFF decreased in the left insular and increased in the left precuneus and right precentral gyrus, and fALFF decreased in the left insular, during retaining of AA (corrected). Moreover, there was a positive correlation found between mean ALFF change in the left insular and that of VAS values (P<0.05).ConclusionThe present study demonstrated the low-frequency BOLD signal oscillation response in the left insular in brain activity was associated with an immediate analgesia of AA in patients with CLBP, which provides new insights into intrinsic connections between low-frequency brain signals and analgesic effects of acupuncture.

Investigating the mechanisms of acupuncture on neural excitability in healthy adults.

Acupuncture is gaining interest as a potential treatment modality for various neurological conditions. Yet, the underlying mechanisms and efficacy on brain function are not well understood. Therefore, this study investigated the previously proposed hypothesis that acupuncture suppresses motor cortex excitability using transcranial magnetic stimulation (TMS) in healthy adults. The study was randomised, sham-controlled, and double-blinded. Single and paired-pulse TMS was delivered before, during, immediately after, and 30 min after removal of the needle. Acupuncture to the right Hegu acupoint (LI-4) of the hand was delivered by an experienced acupuncturist using standardised manipulations. A disposable (0.22×30 mm, Hwato) needle was used for verum stimulation (penetrating) and a Park retractable needle for sham (nonpenetrating). The peak-to-peak amplitude of TMS-induced motor-evoked potentials was recorded from two intrinsic hand muscles. Needling sensations were quantified using the Massachusett's acupuncture sensation scale. Participant needling sensations were not different between verum or sham acupuncture (P>0.54). Corticomotor excitability, intracortical inhibition, and intracortical facilitation were not modulated by verum or sham acupuncture during, immediately after, or 30 min after, recorded from a local or distant hand muscle to the needling site (all P>0.075). Contrary to previous studies, manual acupuncture did not affect motor cortex excitability in healthy adults. Because of the increasing popularity of acupuncture therapy, further research using patient populations should be considered.

Effect of Heat-Producing Needling Technique on the Local Skin Temperature: Clinical Dataset

The heat-producing needling technique is a special compound manipulating procedure on the acupuncture needle which has been recorded to produce a warm sensation in the body in ancient TCM literature. This randomized, subject-blinded clinical study was performed to examine the effect of heat-producing acupuncture treatment on the ST36 local skin temperature. A total of 30 healthy participants received four successive sessions of heat-producing acupuncture treatment, non-acupoint heat-producing acupuncture treatment, normal stable acupuncture treatment, and non-invasive sham acupuncture treatment at the ST36 acupoint in a random sequence. Within each session, the local ST36 skin temperature and basal body temperature of each participant were measured at 1 min before needle insertion, just after needle insertion and manipulation (if any), 5 min after needle insertion with needle removal immediately after temperature taking, and 5 min after needle removal. Furthermore, the participants were also required to declare their needling and heat sensation felt during the acupuncture needling treatment period using a visual analogue scale from 1 to 10 immediately after each treatment session. This data descriptor presents all the clinical data obtained in the above mentioned study.

Teaching method of the basic ability of acupuncture in training the manipulation skills in Techniques of Acupuncture and Moxibustion

Through checking the ancient books and the articles at the modern times and combining the disciplinary characteristics of techniques of acupuncture and moxibustion, the training of manipulation skills was discussed. It is proposed that during the teaching of the techniques of acupuncture and moxibustion, the most basic ability of needling technique should be trained in the first place. This ability includes the ability of spiritual cultivation, the ability of tactile perception and the specific training for the needling techniques. The ability of spiritual cultivation refers to the consciousness concentration to the patient when providing acupuncture, which may promotes deqi and conducts qi to the affected area. The ability of tactile perception refers to the different feelings of different tissues under the hands before and after acupuncture, the perception to the different needling sensations corresponding to the chief complains of patients as well as the different body responses after acupuncture. In order to ensure the better learning results, the specific manipulations of needling techniques should be provided accordingly on the base of these basic training skills of acupuncture.

LUO Caigui's manipulations in the treatment of tendon bi syndrome

The manipulation characteristic and experience in the treatment of tendon bi syndrome, by LUO Caigui, the veteran TCM physician, were introduced in the article. The tendon bi syndrome is treated on the base of syndrome differentiation for the acupoint selection in the guidance of the theory on the tendon region of meridian in Huangdi Neijing (Yellow Emperor's Inner Canon) and in accordance with the etiology and clinical characteristics of tendon bi syndrome. Focusing on the palpation and the responses under the fingers, as well as the application of warming method, the acupuncture (rubbing and twisting) and tuina (relaxing, separating, warming and regulating) manipulations are adopted in combination on the positive points and the intermuscular spaces. This compound manipulation results in the rapid deqi, prolonged needling sensation and obvious warming effects. With this therapeuticmethods, the clinical effects are achieved significantly, the symptoms and physical signs improved and the duration of sickness shortened.

Would a Placebo Acupuncture Needle be Able to Induce Deqi?

The aim of this study was to evaluate Deqi in patients under treatment with acupuncture and sham acupuncture. Forty (40) volunteers of all genders with temporomandibular dysfunction (TMD) were randomized into two study groups: Acupuncture and Sham Acupuncture (non-penetrating device). The patients answered the Southampton Needle Sensation Questionnaire (SNSQ) at the initial and final sessions of acupuncture treatment. The questionnaire was composed of two parts: the first one, consisting of 17 Deqi descriptors and a Likert scale in order to evaluate the intensity of each sensation; and the second one, consisting of a visual analog scale (VAS) to evaluate how painful the acupuncture treatment was. At the initial session, LI4 was the most cited acupuncture point in both groups, being responsible for a ‘Slight Intensity’ needling sensation of electric shock in the acupuncture group at initial (10%) and final (15%) sessions. The most common related needling sensations at different acupuncture points was “Pricking” and “Sharp” in both groups. The acupuncture group showed higher VAS than the Sham Acupuncture either in the initial (3.87 × 2.43) and final (2.04 × 2.14) sessions. Deqi response to acupuncture stimulation was verified either in the both groups.

Improvement of Upper Limb and Hand Functions of Stroke Patients by Balancing Acupuncture Combined with Motor Relearning Training

To observe the therapeutic effect of balance acupuncture combined with motor relearning training for upper limb and hand functions of stroke patients. Sixty-two stroke patients were randomly divided into balance acupuncture group (n＝31) and routine acupuncture group (n＝31). For patients of the balance acupuncture group, Piantan, Jiantong and Wantong points on the healthy side were used. When Jiantong point taken, the acupuncture needle was removed after the patient experienced an electric shock-like spreading needling sensation. When Wantong point employed, the needle was removed after the patient experienced a local, intensified or spreading needling sensation. When Piantan point used, the needle was retained after the patient experienced an electric shock-like needling sensation, then, the motor relearning training was conducted, and the needle was removed immediately after the training. For patients of the routine acupuncture group, Jianyu(LI 15), Jianzhen (SI 9), Quchi (LI 11), etc. were needled with the needles retained for 30 min after getting needling sensations. The motor relearning training was also carried out after removal of the needle. The treatment in both groups was performed once daily, 6 days a week, and lasted for 8 weeks. The Fugl-Meyer score and motor function scale (MAS) of the upper limb, and the fine performance score and motor function score of the hand were assessed before and after the treatment. Following treatment, the Fugl-Meyer score and MAS of the upper limbs, and the motor function score and fine performance score of the hand were significantly increased in both groups compared with pre-treatment in each group (P<0.05 ), suggesting a functional improvement of both upper limb and hand. The therapeutic effect of the balance acupuncture was obviously superior to that of routine acupuncture in improving functions of both the upper limb and hand (P<0.05)．. Balance acupuncture combined with motor relearning training is helpful to improve the comprehensive function of the upper limb and hand in stroke patients.

Relationship between needling layers and needling sensations in acupuncture

Based on the sancai (literally three talents referring to "earth", "human" and "heaven") and wuti (literally five organs referring to skin, muscle, vessel, tendon and bone, which correspond to five internal organs: lungs, spleen, heart, liver and kidney respectively) in Neijing (Internal Classic), as well as the tissue structure theory of modern anatomy, and in combination with the clinical practice of acupuncture by the author in the past over 30 years, it is proposed that four layers are divided in needling depth of acupuncture. The different needling sensations are induced at different layers. The first layer is the skin. When the needle is inserted into the skin, the main sensation is "pain". The second layer is the subcutaneous layer (superficial fascia). The needle tip at this layer generates a strong "swelling" sensation, which radiates along a certain direction. The third layer is the deep fascia and muscle layer. If the needle tip touches the deep fascia, there is a "heavy" feeling. If the needle tip goes into the muscle, an "acid" sensation will occur. The fourth layer is the periosteum and bone layer, which produces a strong sensation of "pain" when touched by the needle tip. In addition, each layer has blood vessels and nerve distribution. When the needle tip touches the blood vessels, a sense of "pain" happens. If the needle tip touches the nerve, there will be a sensation of numbness, which spreads along the direction of nerve conduction. On the contrary, through the patient's needling sensations, we can roughly know which layer and direction the needle tip goes. Better understanding of the relationship between the needling layers and needling sensations contributes to the further study of needling techniques, therapeutic effects of acupuncture and patient's sensations. It is significant for the regulations of needling sensations in patients.

Acupuncture points can be identified as cutaneous neurogenic inflammatory spots

Acupuncture, a traditional medical procedure practised for over 2000 years in Asia, stimulates specific but poorly defined sites called acupoints. To date, no unique anatomical acupoint structures have been found. However, noxious sensory signals from visceral organs produce hypersensitive spots on the skin (neurogenic spots), caused by cutaneous neurogenic inflammation, in the dermatome that overlaps with visceral afferent innervations. Here, we show that an acupoint is one form of neurogenic inflammation on the skin. Various studies have demonstrated that acupoints show mechanical hypersensitivity and have high electrical conductance. Stimulation of acupoints produces needling sensations caused by the activation of small diameter afferent nerve fibres and therapeutic effects on the associated visceral organs, which is likely due to the release of endogenous opioids. The present study provides experimental evidence that neurogenic spots exhibit all the characteristics of the acupoints listed above. In addition, the stimulation of neurogenic spots by electrical, mechanical, or chemical means alleviated pathological conditions in rat colitis and hypertension models via the endogenous opioid system. Our results suggest that acupoints associated with internal organs may be identical to neurogenic inflammatory spots on the skin, which are produced by activation of somatic afferents in abnormal conditions of visceral organs.

Effect of acupuncture Zusanli on brain functional magnetic resonance imaging

Objective To study the effect of acupuncture Zusanli on brain functional magnetic resonance imaging. Methods 96 healthy volunteers were randomly divided into acupoint group and non-acupoint group.The acupoint group received acupuncture Zusanli, and the non-acupoint group received manipulation, acupuncture and sham acupuncture.The functional brain imaging was determined by MRI, the brain functional images were compared between two groups. Results All subjects were matched with the end of the experiment, the acupoint group received acupoint stimulation, had obvious needling sensation, the non-acupoint group had mild needling sensation.The acupoint group activated 13 brain regions, non-acupoint group in 10 brain regions, the thalamus, pons, supramarginal gyrus in non-acupoint group without the activation.In the basal ganglia(28 cases vs.5cases) and temporal lobe(38cases vs.21cases) between the two groups were activated, the difference was statistically significant(χ2=36.250, P 0.05). Conclusion The research of acupuncture by brain functional magnetic resonance imaging showed that Zusanli acupoint can activate the brain function area through brain regulation and treatment of body organs, so as to prove the existence of its own and meridian sensing characteristics. Key words: Manual acupuncture; Zusanli; Magnetic resonance imaging; Function

Investigation of the Phenomenon of Propagated Sensation along the Channels in the Upper Limb Following Administration of Acupuncture and Mock Laser

BackgroundSimilar to De Qi psychophysical responses, propagated sensation along the channels (PSC) is considered an important phenomenon in traditional Chinese acupuncture. In acupuncture clinical trials, different acupuncture manipulation techniques are used to enhance the propagation of sensation along the channels to facilitate an optimum therapeutic result. AimTo examine and compare the PSC reported by participants in a clinical trial following the administration of acupuncture and inactive mock laser. MethodsThe study was embedded in a two-arm parallel design multicenter, randomized clinical trial, the Tennis Elbow Acupuncture—International Study—China, Hong Kong, Australia, Italy (TEA IS CHAI). Needle sensations were measured using a validated instrument, the Massachusetts General Hospital Acupuncture Sensation Spreading Scale. Ninety-six participants with lateral elbow pain were randomly allocated into two groups in a 1:1 ratio; the acupuncture treatment group (n = 47) and the mock laser control group (n = 49). Participants in both groups received the intervention at two acupoints, LI10 and LI11, consisting of 2 minutes of either standardized needle manipulation or mock laser at each acupoint with a rest period between each intervention period. Data were collected immediately following the interventions at the first and the ninth session within the clinical trial. ResultsAlthough participants in both groups perceived PSC radiating to similar sites along the upper limb, the frequency of the reported radiation sites among the two intervention groups for both radiation up the limb (p < 0.05) and radiation down the limb (p < 0.001) were statistically significantly different. Among the radiating sensation sites recorded within the two study groups, the sensations were reported as radiating a greater distance down the forearm to the wrist compared to up the arm. Evaluation of PSC across the four study sites revealed a statistically significant difference in frequency of the reported radiation down the limb sites in each study group and radiation up the limb sites only in control group only (p < 0.001). ConclusionThe findings of the study demonstrated that the PSC phenomenon is not just associated with needling but can be perceived when using a mock laser. Trial registrationAustralian and New Zealand Clinical Trial Registry reference: ACTRN12613001138774 on 11th of October 2013.

Effects of three needling manipulations of the right-side Zusanli (ST 36) on brain using functional magnetic resonance imaging

ObjectiveTo investigate the effects on the brain using three needling manipulations (twirling, lifting-thrusting, and twirling plus lifting-thrusting) when the right-side Zusanli (ST 36) acupoint was stimulated with needles. MethodsSeventeen healthy subjects accepted three needling manipulations stimulating the right Zusanli (ST 36) over separate days. Functional magnetic resonance imaging was used to detect changes in the brain during the manipulations, and then the needling sensations were recorded using the MGH acupuncture sensation scale (MASS) after each scan. fMRI data were processed using Statistical Parametric Mapping 8 to analyze the positive and negative activation in the brain induced by different acupuncture manipulations. ResultsThe individual needling sensations showed no statistically significant differences among the three manipulations. However, the MASS index showed that lifting-thrusting > twirling plus lifting-thrusting > twirling. Lifting-thrusting activated left premotor cortex, left postcentral, right middle frontal gyrus, left inferior frontal gyrus, right lingual gyrus, left insula, right putamen, bilateral cingulate gyrus and right cerebellum; and deactivated bilateral hippocampus and left caudate. Twirling activated bilateral orbital middle frontal gyrus, left opercular and triangular inferior frontal gyrus, and right middle occipital gyrus; and deactivated bilateral precuneus, right amygdala, left anterior cingulate gyrus, right inferior temporal gyrus, right middle frontal gyrus, right supplementary motor gyrus, and left postcentral. Twirling plus lifting-thrusting activated bilateral postcentral, left inferior occipital gyrus, left insula, left thalamus, left cingulate gyrus, and right putamen; and deactivated right superior frontal gyrus, right superior parietal gyrus, right temporal gyrus, right middle occipital gyrus, right insula, and left lingual gyrus. Pairwise comparisons of the three manipulations showed that signals induced by lifting-thrusting were the strongest, especially in the limbic system, followed by twirling plus lifting-thrusting; twirling alone was the weakest. ConclusionThree methods of needling manipulations similarly activated areas associated with the somatosensory system, vision, cognition, and emotional regulation. This may have significant implications for acupuncture in clinical practice.

Exploration of acupoint combination and needling techniques in the reinforcing and reducing manipulation at different acupoints

The reinforcing and reducing manipulation at different acupoints is a kind of acupuncture manipulations and has satisfactory clinical therapeutic effects, combined with a proper needling techniques. The reinforcing needling method is used in the upper and the reducing one in the lower, the distal acupoints are combined with the nearby acupoints. The local acupoints or adjcant acupoints of the affected area are regarded as the nearby acupoints, e.g. the acupoints in the upper. The distant acupoints and the acupoints on the hand and foot are named as distal acupoints, e.g. the acupoint in the lower. In the reinforcing manipulation, the needle is inserted shallowly along the running direction of meridian. In the reducing manipulation, the needle is inserted deeply and against the running direction of meridian. The yin-yang couple needling technique is used with the combination of the front-mu and back-shu points. In the first option, the reinforcing and reducing needling method with rotating technique is predominated at the front-mu points, while that with lifting and thrusting technique is at the back-shu points. In the second option, when needling the back-shu points, the needling sensation is transmitted along the transverse segment and far to the chest and abdomen. These two kinds of integration of acupoint combination and needling techniques display a certain clinical significance in improving the therapeutic effects of acupuncture.

Evoked Pressure Pain Sensitivity Is Associated with Differential Analgesic Response to Verum and Sham Acupuncture in Fibromyalgia.

Fibromyalgia is a chronic pain condition with few effective treatments. Many fibromyalgia patients seek acupuncture for analgesia; however, its efficacy is limited and not fully understood. This may be due to heterogeneous pathologies among participants in acupuncture clinical trials. We hypothesized that pressure pain tenderness would differentially classify treatment response to verum and sham acupuncture in fibromyalgia patients. Baseline pressure pain sensitivity at the thumbnail at baseline was used in linear mixed models as a modifier of differential treatment response to sham versus verum acupuncture. Similarly, needle-induced sensation was also analyzed to determine its differential effect of treatment on clinical pain. A cohort of 114 fibromyalgia patients received baseline pressure pain testing and were randomized to either verum (N = 59) or sham (N = 55) acupuncture. Participants received treatments from once a week to three times a week, increasing in three-week blocks for a total of 18 treatments. Clinical pain was measured on a 101-point visual analog scale, and needle sensation was measured by questionnaire throughout the trial. Participants who had higher pain pressure thresholds had greater reduction in clinical pain following verum acupuncture while participants who had lower pain pressure thresholds showed better analgesic response to sham acupuncture. Moreover, patients with lower pressure pain thresholds had exacerbated clinical pain following verum acupuncture. Similar relationships were observed for sensitivity to acupuncture needling. These findings suggest that acupuncture efficacy in fibromyalgia may be underestimated and a more personalized treatment for fibromyalgia may also be possible.