Background. Development of non-deqi control is still a challenge. This study aims to set up a potential approach to non-deqi control by using lidocaine anesthesia at ST36. Methods. Forty healthy volunteers were recruited and they received two fMRI scans. One was accompanied with manual acupuncture at ST36 (DQ group), and another was associated with both local anesthesia and manual acupuncture at the same acupoint (LA group). Results. Comparing to DQ group, more than 90 percent deqi sensations were reduced by local anesthesia in LA group. The mainly activated regions in DQ group were bilateral IFG, S1, primary motor cortex, IPL, thalamus, insula, claustrum, cingulate gyrus, putamen, superior temporal gyrus, and cerebellum. Surprisingly only cerebellum showed significant activation in LA group. Compared to the two groups, bilateral S1, insula, ipsilateral IFG, IPL, claustrum, and contralateral ACC were remarkably activated. Conclusions. Local anesthesia at ST36 is able to block most of the deqi feelings and inhibit brain responses to deqi, which would be developed into a potential approach for non-deqi control. Bilateral S1, insula, ipsilateral IFG, IPL, claustrum, and contralateral ACC might be the key brain regions responding to deqi. 1. Introduction deqi, also called needle sensation, refers to the sensations of soreness, numbness, fullness, heaviness, and so forth around the acupoints of patients when the needle is inserted to a certain depth. At the same time, the operator may feel heaviness or tension around the needle. As one of the most classic and important concepts originated from Neijing (The Yellow Emperor’s Classic of Internal Medicine), deqi has drawn increasing attention of researchers recently [1–5]. The studies on deqi mainly focused on four directions: (1) identifying the relationship between deqi and acupuncture efficacy [6–10]; (2) quantifying the deqi sensations and making deqi visualization and objectification [11–13]; (3) investigating the influence factors on deqi such as insertion site, insertion depth, puncture manipulation and needle retaining time, and body position [14–19]; (4) exploring the mechanisms of deqi [20–31]. Whatever direction of investigations on deqi, it is essential to establish an appropriate non-deqi control. To date, several kinds of sham acupuncture strategies have been employed as non-deqi control, which include on-invasive placebo stimulation (Von Frey, Streitberger Needle, etc.) at the same acupuncture point or nonacupuncture point [7, 29, 31], superficial needling at the same acupuncture point or
References
[1]
J. Kong, R. Gollub, T. Huang et al., “Acupuncture deqi, from qualitative history to quantitative measurement,” Journal of Alternative and Complementary Medicine, vol. 13, no. 10, pp. 1059–1070, 2007.
[2]
K. K. Hui, E. E. Nixon, M. G. Vangel et al., “Characterization of the “deqi” response in acupuncture,” BMC Complementary and Alternative Medicine, vol. 7, p. 33, 2007.
[3]
S. Chen, S. Guo, F. Marmori et al., “Appraisal of the deqi concept among contemporary Chinese acupuncturists,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 538476, 7 pages, 2013.
[4]
X. Y. Yang, G. X. Shi, Q. Q. Li, Z. H. Zhang, Q. Xu, and C. Z. Liu, “Characterization of deqi sensation and acupuncture effect,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 319734, 7 pages, 2013.
[5]
H. W. Yuan, L. X. Ma, D. D. Qi, P. Zhang, C. H. Li, and J. Zhu, “The historical development of concept from classics of traditional Chinese medicine to modern research: exploitation of the connotation of in Chinese medicine,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 639302, 5 pages, 2013.
[6]
B. M. Berman, L. Lao, P. Langenberg, W. L. Lee, A. M. K. Gilpin, and M. C. Hochberg, “Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee. A randomized, controlled trial,” Annals of Internal Medicine, vol. 141, no. 12, pp. 901–910, 2004.
[7]
J. Xiong, F. Liu, M. Zhang, W. Wang, and G. Huang, “De-qi, not psychological factors, determines the therapeutic efficacy of acupuncture treatment for primary dysmenorrhea,” Chinese Journal of Integrative Medicine, vol. 18, no. 1, pp. 7–15, 2012.
[8]
S. B. Xu, B. Huang, C. Y. Zhang et al., et al., “Effectiveness of strengthened stimulation during acupuncture for the treatment of Bell palsy: a randomized controlled trial,” Canadian Medical Association Journal, vol. 185, no. 6, pp. 473–479, 2013.
[9]
C. Witt, B. Brinkhaus, S. Jena et al., “Acupuncture in patients with osteoarthritis of the knee: a randomised trial,” The Lancet, vol. 366, no. 9480, pp. 136–143, 2005.
[10]
R. B. Spaeth, S. Camhi, J. A. Hashmi et al., “A longitudinal study of the reliability of acupuncture deqi sensations in knee osteoarthritis,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 204259, 12 pages, 2013.
[11]
P. White, F. Bishop, H. Hardy et al., “Southampton needle sensation questionnaire: development and validation of a measure to gauge acupuncture needle sensation,” Journal of Alternative and Complementary Medicine, vol. 14, no. 4, pp. 373–379, 2008.
[12]
D. Pach, C. Hohmann, R. Lüdtke, F. Zimmermann-Viehoff, C. M. Witt, and C. Thiele, “German translation of the southampton needle sensation questionnaire: use in an experimental acupuncture study,” Forschende Komplementarmedizin, vol. 18, no. 6, pp. 321–326, 2011.
[13]
Y. Kim, J. Park, H. Lee, H. Bang, and H. Park, “Content validity of an acupuncture sensation questionnaire,” Journal of Alternative and Complementary Medicine, vol. 14, no. 8, pp. 957–963, 2008.
[14]
K. Zhou, J. Fang, X. Wang et al., “Characterization of de qi with electroacupuncture at acupoints with different properties,” Journal of Alternative and Complementary Medicine, vol. 17, no. 11, pp. 1007–1013, 2011.
[15]
A. Benham, G. Phillips, and M. I. Johnson, “An experimental study on the self-report of acupuncture needle sensation during deep needling with bi-directional rotation,” Acupuncture in Medicine, vol. 28, no. 1, pp. 16–20, 2010.
[16]
K. Itoh, Y. Minakawa, and H. Kitakoji, “Effect of acupuncture depth on muscle pain,” Chinese Medicine, vol. 6, no. 1, p. 24, 2011.
[17]
B. Y. Loyeung and D. M. Cobbin, “Investigating the effects of three needling parameters (manipulation, retention time, and insertion site) on needling sensation and pain profiles: a study of eight deep needling interventions,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 136763, 12 pages, 2013.
[18]
J. J. Park, M. Akazawa, J. Ahn et al., “Acupuncture sensation during ultrasound guided acupuncture needling,” Acupuncture in Medicine, vol. 29, no. 4, pp. 257–265, 2011.
[19]
X. Z. Chen, Y. K. Yang, J. Yang et al., “Acupuncture deqi intensity and propagated sensation along channels may, respectively, differ due to different body positions of subjects,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 897048, 6 pages, 2013.
[20]
T. Kuo, C. Lin, and F. Ho, “The soreness and numbness effect of acupuncture on skin blood flow,” American Journal of Chinese Medicine, vol. 32, no. 1, pp. 117–129, 2004.
[21]
K. Takamoto, E. Hori, S. Urakawa et al., “Cerebral hemodynamic responses induced by specific acupuncture sensations during needling at trigger points: a near-infrared spectroscopic study,” Brain Topography, vol. 23, no. 3, pp. 279–291, 2010.
[22]
C. S. Yin, H. Park, S. Kim et al., “Electroencephalogram changes according to the subjective acupuncture sensation,” Neurological Research, vol. 32, supplement 1, pp. S31–S36, 2010.
[23]
S. Huang, G. Chen, H. Lo, J. Lin, Y. Lee, and C. Kuo, “Increase in the vagal modulation by acupuncture at Neiguan point in the healthy subjects,” American Journal of Chinese Medicine, vol. 33, no. 1, pp. 157–164, 2005.
[24]
J. Fang, X. Wang, H. Liu et al., “The limbic-prefrontal network modulated by electroacupuncture at CV4 and CV12,” Evidence-based Complementary and Alternative Medicine, vol. 2012, Article ID 515893, 11 pages, 2012.
[25]
J. Fang, Z. Jin, Y. Wang et al., “The salient characteristics of the central effects of acupuncture needling: limbic-paralimbic-neocortical network modulation,” Human Brain Mapping, vol. 30, no. 4, pp. 1196–1206, 2009.
[26]
K. K. Hui, J. Liu, N. Makris et al., “Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects,” Human Brain Mapping, vol. 9, no. 1, pp. 13–25, 2000.
[27]
K. K. Hui, J. Liu, O. Marina et al., “The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI,” NeuroImage, vol. 27, no. 3, pp. 479–496, 2005.
[28]
X. Wang, S. T. Chan, J. Fang et al., “Neural encoding of acupuncture needling sensations: evidence from a FMRI study,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 483105, 15 pages, 2013.
[29]
V. Napadow, R. P. Dhond, J. Kim et al., “Brain encoding of acupuncture sensation—coupling on-line rating with fMRI,” NeuroImage, vol. 47, no. 3, pp. 1055–1065, 2009.
[30]
J. Sun, Y. Zhu, L. Jin et al., “Partly separated activations in the spatial distribution between de-qi and sharp pain during acupuncture stimulation: an fMRI-based study,” Evidence-Based Complementary and Alternative Medicine, vol. 2012, Article ID 934085, 11 pages, 2012.
[31]
J. R. Chen, G. L. Li, G. F. Zhang, Y. Huang, S. X. Wang, and N. Lu, “Brain areas involved in acupuncture needling sensation of deqi: a single-photon emission computed tomography (SPECT) study,” Acupuncture in Medicine, vol. 30, no. 4, pp. 316–323, 2012.
[32]
B. Brinkhaus, M. Ortiz, C. M. Witt et al., “Acupuncture in patients with seasonal allergic rhinitis: a randomized trial,” Annals of Internal Medicine, vol. 158, no. 4, pp. 225–234, 2013.
[33]
W. Huang, D. Pach, V. Napadow et al., “Characterizing acupuncture stimuli using brain imaging with fMRI—a systematic review and meta-analysis of the literature,” PLoS ONE, vol. 7, no. 4, Article ID e32960, 2012.
[34]
A. J. Vickers, A. M. Cronin, A. C. Maschino et al., “Acupuncture for chronic pain: individual patient data meta-analysis,” Archives of Internal Medicine, vol. 172, no. 19, pp. 1444–1453, 2012.
[35]
H. Chu, C. Chang, X. L. Khu, and L. F. Yang, “Peripheral afferent pathway for acupuncture analgesia,” Science in China Series A-Mathematics, vol. 1973, no. 2, pp. 210–217, 1973.
[36]
J. W. Dundee and G. Ghaly, “Local anesthesia blocks the antiemetic action of P6 acupuncture,” Clinical Pharmacology and Therapeutics, vol. 50, no. 1, pp. 78–80, 1991.
[37]
S. Wang, R. T. Constable, F. S. Tokoglu, D. A. Weiss, D. Freyle, and Z. N. Kain, “Acupuncture-induced blood oxygenation level-dependent signals in awake and anesthetized volunteers: a pilot study,” Anesthesia and Analgesia, vol. 105, no. 2, pp. 499–506, 2007.
[38]
L. Schlünzen, M. S. Vafaee, and G. E. Cold, “Acupuncture of LI-4 in anesthetized healthy humans decreases cerebral blood flow in the putamen measured with positron emission tomography,” Anesthesia and Analgesia, vol. 104, no. 2, pp. 308–311, 2007.
[39]
F. Beissner, “Functional magnetic resonance imaging studies of acupuncture mechanisms: a critique,” Focus on Alternative and Complementary Therapies, vol. 16, no. 1, pp. 3–11, 2011.
[40]
Y. Chae, D. S. Chang, S. H. Lee et al., “Inserting needles into the body: a meta-analysis of brain activity associated with acupuncture needle stimulation,” Journal of Pain, vol. 14, no. 3, pp. 215–222, 2013.
