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Acupuncture De Qi, from Qualitative History to Quantitative Measuremen

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THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINEVolume 13, Number 9, 2007, pp. 000–000© Mary Ann Liebert, Inc.DOI: 10.1089/acm.2007.0524Acupuncture De Qi, from Qualitative History to Quantitative MeasurementJIAN KONG, M.D., M.S.,1RANDY GOLLUB, M.D., Ph.D.,1TAO HUANG, M.D., Ph.D.,2GINGER POLICH, B.A.,1VITALY NAPADOW, Ph.D.,3KATHLEEN HUI, M.D.,3MARK VANGEL, Ph.D.,3BRUCE ROSEN, M.D., Ph.D.,3and TED J. KAPTCHUK4ABSTRACTDe qi is an important traditional acupuncture term used to describe the connection between acupuncture nee-dles and the energy pathways of the body. The concept is discussed in the earliest Chinese medical texts, butdetails of de qi phenomenon, which may include the acupuncturist’s and/or the patient’s experiences, were onlyfully described in the recent hundred years. In this paper, we will trace de qi historically as an evolving con-cept, and review the literature assessing acupuncture needle sensations, and the relationship between acupunc-ture-induced de qi and therapeutic effect. Thereafter, we will introduce the MGH Acupuncture Sensation Scale(MASS), a rubric designed to measure sensations evoked by acupuncture stimulation as perceived by the pa-tient alone, and discuss some alternative statistical methods for analyzing the results of this questionnaire. Webelieve widespread use of this scale, or others like it, and investigations of the correlations between de qi andtherapeutic effect will lead to greater precision in acupuncture research and enhance our understanding ofacupuncture treatment.1INTRODUCTION‘De qi” is the traditional acupuncture term used to de-scribe the connection between acupuncture needlesand the energy pathways of the body. It is a central conceptin Traditional Chinese Acupuncture.1The de component ofthe word compound means “obtain,” and the qi componentis an untranslatable word signifying the potential of a phe-nomenon to transform from 1 state to another state and/orretain its identity. (For convenience, qi is often translated as“vital energy”2). Traditionally, other terms have been usedfor the same phenomenon including qizhi, which indicates“arrival” of qi. Both concepts originated from the Neijing,or Yellow Emperor’s Inner Classic of Internal Medicine, acanonical book that will be subsequently described.Historical debates dispute the range of sensations en-compassed by de qi. Some posit that de qi refers only to thesensations of the patient receiving acupuncture,3while oth-ers argue that sensations of both the patient and the admin-istering acupuncturist comprise de qi.4,5In recent years, re-searchers have put more weight on the patient’s rather thanthe acupuncturist’s experience during needling.6–11Thismay be due in part to the rising popularity of new acupunc-ture modalities such as electroacupuncture. In elec-troacupuncture, the acupuncturist is prevented from per-ceiving de qi because stimulation is not delivered manually,but by means of an automated current passing through a nee-dle. (Routinely, the acupuncturists should first evoke de qibefore the electricity is applied. Despite this fact, it is gen-erally believed that stimulation parameters such as fre-quency and intensity are more important than the acupunc-turist’s subtle perceptions.121Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA.2Institute of Acupuncture, China Academy of Traditional Chinese Medicine, Beijing, People’s Republic of China.3Martinos Center for Biomedical Imaging, Charlestown, MA.4Osher Institute, Harvard Medical School, Boston, MA.“De qi, particularly the sensations evoked by acupuncturestimulation on patients/subjects, has recently drawn the at-tention of many scientific researchers.6–11,13These investi-gators have attempted to assess the phenomenon through dif-ferent scales,6–11and most importantly, begun to investigatede qi’s relationship to therapeutic effects.9,14,15Such stud-ies are helping to clarify our understanding of the de qi phe-nomenon.This paper is designed to expand our current under-standing of acupuncture de qi in four ways. Section 1 willtrace the historical perspective of de qi as an evolving con-cept through time. Section 2 will briefly review the currentclinical perspective regarding investigations of the relation-ship between de qi and acupuncture therapeutic effect. Sec-tion 3 will present a novel de qi scale designed to quantita-tively measure sensations derived from acupuncture needlestimulation. Finally, we will discuss future directions of thisfield.HISTORICAL PERSPECTIVE OF DE QIDe qi and needling sensationTraditionally, de qi refers to the excitation of qi throughthe acupuncture channels/meridians by means of needlestimulation, moxibustion, massage, or other procedures. Ac-cording to Traditional Chinese Medicine (TCM), both theadministering acupuncturist and the patient may be able todetect signs of de qi.4,5,16Typically, the acupuncturist wouldperceive de qi as heaviness or tenseness about the needle heor she is stimulating, and in response to being punctured,the patient would perceive de qi as soreness, numbness,heaviness, and distention at the site of needle placement,though these sensations may spread to other parts of thebody as well.De qi’s fundamental role in TCM acupuncture cannot beoverstated. Its significance was first mentioned circa 100B.C., in the Neijing (The Yellow Emperor’s Classic of In-ternal Medicine). (This ancient text is recognized as the firstmajor compilation of Chinese Medicine and continues toserve as the canonical acupuncture text to the present time.The Neijing is divided into two books: Su wen (Plain Ques-tions), which mainly describes Chinese medical theory andLing shu (Spiritual Pivot), which focuses on acupuncturemore specifically). Much can be revealed about the histori-cal roots of acupuncture and de qi by consulting this text.For example, in Ling Shu (chapter 9)17it is advised that:“The acupuncturist should devote all his/her concentrationto the needle, keep the needle on the surface and move itgently, until the qi has arrived (qizhi).” A more famous say-ing from this text Ling Shu (chapter 1) reads, “For acupunc-ture to be successful, the qi must arrive (qizhi). Acupunc-ture’s effects come about like the clouds blown away by


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