To be or not to be: the needling sensation (de qi) in acupuncture Thomas Lundeberg Correspondence to Dr Thomas Lundeberg, Foundation for Acupuncture and Alternative Biological Treatment Methods, Sabbatsbergs Hospital, Stockholm, 113 82, Sweden; thomas.lundeberg@me.com Received 22 April 2013 Accepted 25 April 2013 ▸ http://dx.doi.org/10.1136/ acupmed-2012-010280 ▸ http://dx.doi.org/10.1136/ acupmed-2012-010279 To cite: Lundeberg T. Acupunct Med 2013;31:129–131. Needling sensation has been considered by many acupuncturists to be an import- ant component of acupuncture since the early classical texts. From a traditional Chinese medicine perspective, needling sensation, de qi, is a composite of unique sensations interpreted as the flow of Qi or ‘the arrival of vital energy’. Based on the theory of traditional Chinese medi- cine, acupuncture is successful only when de qi is experienced. From a medical acupuncture perspec- tive, needling sensation is a sensation mediated by sensory afferent nerves. Although the perception of needling sen- sation may vary in individuals and with manual technique, this distinct sensation is generally characterised by soreness, numbness, heaviness, distension and aching in the deep tissues surrounding the inserted needle. 1–3 Thus, the needling sensation is not a single but a composite sensation that is generated from the acti- vation of various sensory receptors and their afferent fibres in acupuncture sites— in particular, small fibre-innervated noci- ceptors and myelinated fibre-innervated mechanoreceptors. 4 It has recently been hypothesised that numbness, heaviness and distension are elicited when manual manipulation is performed at acupuncture sites rich in muscle spindles and tendon organs, whereas the sensation evoked in sites rich in receptors is characterised by aching and soreness. 5 Studies by Hui and coworkers have shown that acupuncture stimulation indu- ces deactivation of a limbic–paralimbic– neocortical network (LPNN) and activation of somatosensory brain regions. On the other hand, when acupuncture induced sharp pain, there was an activation of LPNN. Tactile stimulation induced greater activation of the somatosensory regions but less extensive deactivation of the LPNN. These results imply that acupuncture mobi- lises the anticorrelated functional networks of the brain to mediate its actions. 6 PSYCHOPHYSICAL EXPERIENCE OF NEEDLING The process of eliciting Qi with needles is experienced by both patient and acu- puncturist. Patients experience de qi as multiple unique sensations at the needle site itself and around the site of needle manipulation. Simultaneously, acupunc- turists feel a change in the mechanical behaviour of the tissues surrounding the needle (needle grasp). This change is described as tense, tight and full, like ‘a fish biting onto the bait’. 7 Needle grasp is a biomechanical phenomenon of de qi, which was characterised by an increase in the force necessary to pull the needle out of the tissue (pullout force). 8 Langevin’s trial supports connective tissue winding as the mechanism responsible for the increase in pullout force induced by needle rotation. 9–11 The sensory component of de qi is dif- ficult to study because of its subjective nature and because it is influenced by many factors, such as the constitution of a patient, severity of the illness, location of the acupuncture points and the need- ling techniques. There appears to be a limit to the number of sensations that can be discriminated by each individual patient. A number of researchers have sought to establish a credible rating scale for de qi. In the linked review, Park and coauthors 12 reviewed de qi questionnaires and tried to evaluate the relationship between de qi and acupuncture points, acupuncture stimulation and treatment effects. They reported that in several questionnaires developed to evaluate de qi, the most frequent sensation reported was ‘heavy’ and ‘numb’. Although a few studies showed specificity to acupuncture points, information was lacking to allow any conclusion about the relationship between de qi and acupuncture points. In most studies ‘real’ acupuncture was reported to induce greater de qi than sham acupuncture. Editorial Lundeberg T. Acupunct Med 2013;31:129–131. doi:10.1136/acupmed-2013-010384 129 group.bmj.com on September 12, 2016 - Published by http://aim.bmj.com/ Downloaded from