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The Importance of De-Qi in Acupuncture According to a Bioengineer Turned Acupuncturist

Updated: 6 days ago

Introduction


De-Qi (得气 in Chinese), which translates to “arrival of Qi,” is a “composite of a series of needling sensations which include but are not limited to aching, pressure, soreness, heaviness, fullness, temperature change (warmth or coolness), numbness, tingling, and dull pain” [1] experienced by patients during acupuncture needling. De-Qi is also experienced by the acupuncture practitioner as “needle grasp;” “during needle grasp, the acupuncturist feels pulling and increased resistance to further movement of the inserted needle.” [2] Traditional Chinese medicine (TCM) considers De-Qi to be critical in achieving the therapeutic effects of acupuncture. The purpose of this article is to provide Rise Acupuncture & Wellness Clinic (Rise Acupuncture) patients and the average interested reader a brief overview of De-Qi’s significance in achieving the therapeutic effects of acupuncture according to TCM classic texts and modern research, as well as an understanding of how and why we, at Rise Acupuncture, apply this important concept in clinic.


De-Qi According to TCM Classic Texts


De-Qi was first described in Huang Di Nei Jing (黄帝内经, The Yellow Emperor’s Classic of Internal Medicine), compiled during the Warring States period (475-221 B.C.E.), which is recognized as the first major compilation of TCM and is the quintessential canonical TCM and acupuncture text. Huang Di Nei Jing is divided into two books – Su Wen (素问, Plain Questions) and Ling Shu (灵枢, Spiritual Pivot). Ling Shu (chapter 9) states the following: “The acupuncturist should devote all his concentration to the needle, keep the needle on the surface, and move it gently, until the qi has arrived.” Additionally, Ling Shu (chapter 1) explains that “for acupuncture to be successful, the qi must arrive. Acupuncture’s effects come about like the clouds blown away by the wind.” Ling Shu (chapter 3) also states, “The acupuncturist must obtain the qi. If qi has arrived, fastidiously hold it and do not lose it.” [3] These excerpts show that the authors of the Huangdi Neijing viewed De-Qi as fundamental to the efficacy of acupuncture.


Biao You Fu (宝祐甫, Ode to Clear Obscurity), written in the Yuan Dynasty (1271–1368) and recorded in the Great Compendium of Acupuncture and Moxibustion (针灸大成, Zhen Jiu Da Cheng) describes De-Qi from the acupuncturist’s perspective: “The acupuncturist may feel as though the needle is being firmly grabbed and moving roughly when qi arrives, but only loosely grasped and moving smoothly if qi does not arrive. Qi arrival feels like a fish biting a hook and bobbing in the water; if qi does not arrive, the acupuncturist feels as though the needle is in a quiet empty house.” [4]


Cheng Dan An’s Chinese Acupuncture Therapy (中国针灸治疗学, Zhong Guo Zhen Jiu Zhi Liao Xue) describes the patient’s sensation of De-Qi: “While you are twisting the needle, you should ask the patient whether he feels soreness and heaviness. If he only feels pain or nothing at all, you can insert the needle deeper or lift the needle a little and twist it again. You should keep trying until the patient feels soreness or heaviness.” [5]


De-Qi Deactivates Pain Centers in the Brain


While acupuncture is used to a treat a multitude of disorders, its most well-known application is in the treatment of pain. The De-Qi needling sensations, described as pressure, numbness, heaviness, fullness, and tingling, have been shown to deactivate regions of the brain that are involved in the sensation of pain.


A 2013 study conducted by Wang, et al. and researchers at the Department of Radiology of Massachusetts General Hospital and Harvard Medical School in Charlestown, MA and the Department of Radiology of Guang An Men Hospital in Beijing, China showed “extensive deactivation” of the “limbic-paralimbic-neocortical network (LPNN), such as anterior cingulated cortex (ACC), parahippocampal gyrus (PHG), lingual gyrus (LgG), precuneus (Pcun), and cuneus,” (Figure 1) [1] all of which are implicated in acute and chronic pain [6][7][8][9][10][11][12].


Deqi acupuncture study

Figure 1. “The mean brain positive (yellow) and negative (blue) bold responses to acupuncture stimulation… Extensive deactivation… [was found in parts of the] limbic-paralimbic-neocortical network (LPNN), such as [the] anterior cingulated cortex (ACC), parahippocampal gyrus (PHG), lingual gyrus (LgG), precuneus (Pcun), and cuneus. The orbital gyrus (OrG) also showed deactivation. Left thalamus (Th) and secondary somatosensory cortex (SII) demonstrated activation.” [1]


In another study, conducted by Wu, et al. of the Department of Radiology at Kaohsiung Veterans General Hospital in Taiwan, two acupuncture points, ST-36 Zusanli and LI-4 Hegu, which are well-known for their strong De-Qi sensation and analgesic effects, were found to result “in significantly higher scores for De-Qi… Acupuncture at both acupoints resulted in activation of the hypothalamus and nucleus accumbens and deactivation of the rostral part of the anterior cingulate cortex, amygdala formation, and hippocampal complex,” while “control stimulations did not result in such activations and deactivations.” Because of this, the researchers concluded that “acupuncture at ST-36 (Figure 2) and LI-4 (Figure 3) activates structures of descending antinociceptive pathway and deactivates multiple limbic areas subserving pain association.” [13]


Acupuncture Points for health

Figure 2. ST-36 Zusanli. [14] Figure 3. Hegu. [14]


De-Qi Initiates Mechanical Signaling Through Connective Tissue


A 2001 paper by Langevin, et al. proposed that De-Qi is essential to the therapeutic effect of acupuncture because “needle grasp is due to mechanical coupling between the needle and connective tissue with winding of tissue around the needle during needle rotation” (Figure 4) and “needle manipulation transmits a mechanical signal to connective tissue cells via mechanotransduction.” “Downstream effects of this mechanical signal may include cell secretion, modification of extracellular matrix, amplification and propagation of the signal along connective tissue planes, and modulation of afferent sensory input via changes in the connective tissue milieu.” “Such a mechanism may explain local and remote, as well as long-term effects of acupuncture.” [2]


Acupuncture winding mechanism

Figure 4. “Extracellular and intracellular effects of acupuncture needle rotation compared with needle insertion without rotation in rat tissue explants. Rat abdominal wall explants were obtained and needled... The needle was either rotated (b, d, f) or not rotated (a, c, e). After 1 min, tissues were immersion-fixed in 10% formalin (a, b) or 3.5%formalin (c-f). S.c. connective tissue was dissected apart from adjacent muscles. Samples a and b were processed for histology, sectioned (6 μm thickness) parallel to the s.c. connective tissue plane, and stained with hematoxylin and eosin. In samples c-f, whole tissue mounts (~200 μm thick) were examined with confocal microscopy. Samples c and d were stained with Texas red-phalloidin (a specific stain for polymerized F-actin), and Oregon green-DNase1 (a specific stain for soluble G-actin). Samples e and f were stained with phalloidin only. Scale bars are labeled in microns. g) Illustrated insertion of an acupuncture needle into connective tissue. h) Rotation of the needle pulls on collagen fibers (arrows); the mechanical signal generated by needle rotation is transduced into local fibroblasts. Yellow lines represent collagen bundles; pink lines inside fibroblasts represent actin cytoskeleton; green dots represent focal adhesion complexes.” [2]


Rise Acupuncture Needling Technique


Rise acupuncture’s unique needling techniques were developed specifically to maximize De-Qi sensation and “needle grasp.” These techniques involve special sequences of rotation, pistoning, and other manipulations, and are used in conjunction with specifically developed needle-sensitivity; they are the culmination of eight generations of medical experience and modern research. Using these techniques, we have achieved exceptional results in treating our patients’ conditions, ranging from acute and chronic pain to stress- and anxiety-related disorders. For more information about our unique treatment methods, please contact us.



References


[1] Wang, Xiaoling, Suk-Tak Chan, Jiliang Fang, Erika E. Nixon, Jing Liu, Kenneth K. Kwong, Bruce R. Rosen, and Kathleen K. S. Hui. 2013. Neural Encoding of Acupuncture Needling Sensations: Evidence from a fMRI Study. Evidence-based Complementary and Alternative Medicine: eCAM 2013 (1): 483105. doi:10.1155/2013/483105. http://dx.doi.org/10.1155/2013/483105.


[2] Langevin, H.M., Churchill, D.L. and Cipolla, M.J. (2001), Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. The FASEB Journal, 15: 2275-2282. https://doi.org/10.1096/fj.01-0015hyp.


[3] Spiritual Pivot (Ling shu). Beijing: People’s Health Publishing, 1963.


[4] Yang JZ. Great Compendium of Acupuncture and Moxibustion (Zhen Jiu Da Cheng). Beijing: People’s Health Publishing, 1963.


[5] Cheng DA. Chinese Acupuncture Therapy (Zhong Guo Zhen Jiu Zhi Liao Xue). Suzhou: Chinese Acupuncture Research Society, 1931


[6] Fuchs, Perry N, et al. The anterior cingulate cortex and pain processing. Frontiers in integrative neuroscience vol. 8 35. 5 May. 2014, doi:10.3389/fnint.2014.00035


[7] Smallwood, Rachel F, et al. Structural brain anomalies and chronic pain: a quantitative meta-analysis of gray matter volume. The journal of pain vol. 14,7 (2013): 663-75. doi:10.1016/j.jpain.2013.03.001


[8] Shimo, Kazuhiro, et al. Visualization of painful experiences believed to trigger the activation of affective and emotional brain regions in subjects with low back pain. PloS one vol. 6,11 (2011): e26681. doi:10.1371/journal.pone.0026681


[9] Casey KL. Forebrain mechanisms of nociception and pain: analysis through imaging. Proc Natl Acad Sci U S A. 1999;96:7668–7674.


[10] Derbyshire SW, Jones AK, Gyulai F, Clark S, Townsend D, Firestone LL. Pain processing during three levels of noxious stimulation produces differential patterns of central activity. Pain. 1997;73:431–445.


[11] Andersson JL, Lilja A, Hartvig P, Langstrom B, Gordh T, Handwerker H, Torebjork E. Somatotopic organization along the central sulcus, for pain localization in humans, as revealed by positron emission tomography. Exp Brain Res. 1997;117:192–199.


[12] Peyron R, Laurent B, Garcia-Larrea L. Functional imaging of brain responses to pain. A review and meta-analysis. (2000) Neurophysiol Clin. 2000;30:263–288.


[13] Wu MT, Hsieh JC, Xiong J, Yang CF, Pan HB, Chen YC, Tsai G, Rosen BR, Kwong KK. Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain--preliminary experience. Radiology. 1999 Jul;212(1):133-41. doi: 10.1148/radiology.212.1.r99jl04133. PMID: 10405732.


[14] Deadman, Peter, Mazin Al-Khafaji, and Kevin Baker. A Manual of Acupuncture. Hove: Journal of Chinese Medicine Publications, 2009. Print.




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