[Analysis on "the essence of tuina, arrival of qi ensuring curative effect"].

In reference with the systematic review of the thought of deqi (arrival of qi) put forward in Huangdi Neijing (Internal Classic of Yellow Emperor) and other classic books of traditional Chinese medicine, in view of detecting qi and identifying qi before treatment, as well as the prerequisites of deqi in tuina, meaning the accurate syndrome differentiation and manipulations, the importance of deqi in treatment with tuina is expounded. In association with clinical experience, the specific manifestations of deqi in patients during tuina are summarized, e.g. soreness, distention, pain, numbness, warm feeling and slight sweating, local changes in intestinal sound and skin color, as well as mind regulation. It is anticipated that deqi of tuina may be drawn the attention in clinical practice, and the relevant study be expanded.

Analysis on "the essence of tuina, arrival of qi ensuring curative effect" / 中国针灸

In reference with the systematic review of the thought of deqi (arrival of qi) put forward in Huangdi Neijing (Internal Classic of Yellow Emperor) and other classic books of traditional Chinese medicine, in view of detecting qi and identifying qi before treatment, as well as the prerequisites of deqi in tuina, meaning the accurate syndrome differentiation and manipulations, the importance of deqi in treatment with tuina is expounded. In association with clinical experience, the specific manifestations of deqi in patients during tuina are summarized, e.g. soreness, distention, pain, numbness, warm feeling and slight sweating, local changes in intestinal sound and skin color, as well as mind regulation. It is anticipated that deqi of tuina may be drawn the attention in clinical practice, and the relevant study be expanded.

[Criteria of "arrival of qi" of acupuncture from "reaction of spirit produces curative effect": inheriting SHI Xue-min's thoughts of treating spirit].

From "arrival of qi produces curative effect", it is considered that arrival of qi, qi reaching and acupuncture sensation cannot contain the effect attribute, location attribute and performance attribute of acupuncture at the same time, so it is necessary to find a more suitable standard to measure the arrival of qi and clinical curative effect. Inspired by "the arrival of qi should be reaction of spirit, and reaction of spirit produces curative effect", the authors propose to use the term "reaction of spirit" to summarize the numerous external manifestations of arrival of qi, and to coordinate the attributes of arrival of qi, qi reaching and acupuncture sensation. Academician SHI Xue-min guides the clinical treatment with "reaction of spirit produces curative effect", attaches importance to the spirit treatment to improve the clinical curative effect, and evaluates whether acupuncture is successful or not with "reaction of spirit".

[Relationship between acupuncture sensations of deqiand different organizational structures of acupoint area].

Acupuncture sensation, as one of the essential signs of deqi (arrival of qi), is closely associated with curative effect. With systematically reviewing the literature regarding relationship between acupuncture sensations of deqi and different organizational structures of acupoint area (skin, connective tissue, muscles, nerves and blood vessels), it is believed that acupuncture sensation of deqi is the product of various organizational structures in acupoint area, which is closely related to the nervous system. The deqi sensations sensed by the hands of acupuncturists, which is called sense of needle stagnation, maybe caused by the contraction of muscles in the acupoint area during the process of needle manipulation. By system review, this paper puts forward a new research idea to explore the role of different manipulations of needling in generating the sense of qi-generating needle based on different acupoint structure and brain function response system, which could provide some reference for clarifying the scientific mechanism and clinical application of acupuncture sensations of deqi.

Influence of the quickness and duration of De Qi on the analgesic effect of acupuncture in primary dysmenorrhea patients with a cold and dampness stagnation pattern.

OBJECTIVE: To investigate the influence of the quickness and duration of De Qi (or Qi arrival) on the analgesic effect of acupuncture in primary dysmenorrhea patients with a cold and dampness stagnation pattern. METHODS: Sixty-eight patients were randomly assigned to the De Qi group (deep needling with thick needles and manipulation, n = 17) or the non-De Qi group (shallow needling with thin needles and no manipulation, n = 51). Both groups underwent needling at Sanyinjiao (SP 6) for 30 min. The visual analogue scale was used to measure the degree of menstrual pain, and the Acupuncture De Qi Clinical Assessment Scale was used to assess De Qi. Only data from patients who experienced actual De Qi were included in the analysis. RESULTS: Thirty-nine patients experienced actual De Qi. Patients who experienced actual De Qi in the De Qi group (n = 14) felt De Qi more rapidly (P = 0.028) and for a longer duration (P = 0.04) than patients who experienced actual De Qi in the non-De Qi group (n = 25). Both groups showed a reduction in the visual analogue scale score for pain after treatment. The analgesic effect did not significantly differ between the two groups. The occurrence time of De Qi showed a significant negative correlation with pain reduction at 20 and 30 min after needle removal (P < 0.05). There was no correlation between the duration of De Qi and the therapeutic effect. CONCLUSION: In primary dysmenorrhea patients with a cold and dampness stagnation pattern, quicker onset of De Qi when needling Sanyinjiao (SP 6) achieves a better analgesic outcome. However, a longer duration of De Qi does not affect the degree of analgesia. Compared with minimal acupuncture, active acupuncture stimulation achieves a more rapid onset and longer duration of De Qi.

Relationship between acupuncture sensations of and different organizational structures of acupoint area / 中国针灸

Acupuncture sensation, as one of the essential signs of (arrival of ), is closely associated with curative effect. With systematically reviewing the literature regarding relationship between acupuncture sensations of and different organizational structures of acupoint area (skin, connective tissue, muscles, nerves and blood vessels), it is believed that acupuncture sensation of is the product of various organizational structures in acupoint area, which is closely related to the nervous system. The sensations sensed by the hands of acupuncturists, which is called sense of needle stagnation, maybe caused by the contraction of muscles in the acupoint area during the process of needle manipulation. By system review, this paper puts forward a new research idea to explore the role of different manipulations of needling in generating the sense of -generating needle based on different acupoint structure and brain function response system, which could provide some reference for clarifying the scientific mechanism and clinical application of acupuncture sensations of .

[Progress of fMRI-based deqi research in recent 10 years].

OBJECTIVE: The research regarding the central mechanism of acupuncture deqi (arrival of qi) based on functional magnetic resonance imaging (fMRI) in recent 10 years was analyzed to summarize existing research achievements and experience. METHODS: The literature regarding fMRI-based deqi research published from January of 2007 through December of 2016 in CNKI and PubMed databases was collected. The research content and methods, including research design, inclusion criteria, acupoint selection and deqi evaluation, were analyzed. RESULTS: Totally 18 articles regarding the central mechanism of acupuncture deqi based on fMRI was included. According to research content, the literature was divided into two categories: deqi research and deqi sensation research. In deqi research, the differences of deqi and not deqi on brain functional activity were compared to summarize the central response pattern of deqi; in deqi sensation research, the differences of different sensations and intensities of deqi on central response were compared to explore the effects of different sensations and intensities of deqi on brain functional activity. In recent 10 years, the number of research gradually increased, and the type of design was various, mainly RCT and paired design. The majority of participants was healthy people, and single acupoint was the focus of researches, including Zusanli (ST 36), Waiguan (TE 5), Hegu (LI 4), etc. The evaluation of deqi was based on visual analogue scale (VAS). The research contents were mainly the effects of deqi and not deqi and different deqi sensations on brain function activities. The present studies confirmed that deqi and not deqi as well as different deqi sensations had different impacts on brain functional effects, and different acupoints had specific activated brain areas. There was a positive correlation between the degree of deqi and the intensity of the activation of brain regions. Furthermore, tingling sensation was not included to deqi sensations. CONCLUSION: The number and quality of fMRI-based deqi research need to be improved; the research content is simple, and research method is in exploratory stage. The results obtained in the literature are the phenomena of deqi in the central level, and it is imperative to summarize the essential link between deqi and the central effect through these phenomena to reveal the mechanism of deqi. The specific impact of deqi for brain function needs more clinical exploration.

[Development and initial evaluation of deqi sensation scale of heat-sensitive moxibustion].

Based on heat-sensitive moxibustion (HSM) theory, a widely applicable scale was developed to reflect the deqi (arrival of qi) sensation of HSM. By documentary method and interviewing method, the items of describing deqi sensation of HSM were collected to establish the pool of candidate items. With expert questionnaire, patient questionnaire and core expert discussion, the items were screened and quantified by method of subjective evaluation to develop the initial draft of the scale. A total of 121 patients were pre-surveyed with the initial draft, and the structural validity of the scale was examined by exploratory factor analysis (principal component) and its internal consistency was assessed by Cronbach's coefficient. As a result, the items in the scale was reduced from 36 to 9; 110 effective questionnaires were reclaimed for statistical analysis. Finally, the scale (Version 1.0) contained 9 items and 4 dimensions, of which, 3 items highlighted the comfort emotional experience, 3 items highlighted autonomic response, 2 items highlighted heat sensation, and 1 item highlighted non-heat sensation. In conclusion, the deqi sensation scale of HSM containes 9 items, which has fair content and structure validity. It is in line with the current clinical understanding of deqi sensation of HSM and has strong clinical operability and wide adaptability.

A review of the methods used for subjective evaluation of De Qi.

De Qi refers to a series of sensations experienced when acupuncture is performed at acupoints. De Qi comprises needling sensations felt by the patient, and the sensations perceived by the acupuncturist. Classical Traditional Chinese Medicine theory states that De Qi is closely related to curative effect. In modern studies, the main index that researchers have used to evaluate De Qi was the needling sensation reported by the patient. Between 1st Aug and 31st Oct 2014, we conducted an electronic database search of all fields in Chinese and English to select literature assessing acupuncture needle sensations. We then reviewed the methods used within these studies to evaluate De Qi. The methods included simple evaluation, and the use of a De Qi scale/questionnaire. The simple evaluation, a qualitative evaluation, was judged by typical sensations felt by the patient after needling at acupoints, such as soreness, numbness, fullness, and heaviness. This method was easy and practicable, and had been adopted widely by Chinese researchers. In contrast, the De Qi scale/questionnaire, a quantitative evaluation, had multiple compiling methods available for evaluating the intensity of De Qi. The standardization and objectification of the De Qi scale/questionnaire effectively improved the quality of studies on De Qi, thereby these scales/questionnaires have been acknowledged and applied by most researchers. The present review analyzed and compared the scales/questionnaires used to evaluate De Qi; furthermore, we provided suggestions for the development and improvement of these questionnaires through integration with classical De Qi theory.

Development and initial evaluation of sensation scale of heat-sensitive moxibustion / 中国针灸

Based on heat-sensitive moxibustion (HSM) theory, a widely applicable scale was developed to reflect the (arrival of ) sensation of HSM. By documentary method and interviewing method, the items of describing sensation of HSM were collected to establish the pool of candidate items. With expert questionnaire, patient questionnaire and core expert discussion, the items were screened and quantified by method of subjective evaluation to develop the initial draft of the scale. A total of 121 patients were pre-surveyed with the initial draft, and the structural validity of the scale was examined by exploratory factor analysis (principal component) and its internal consistency was assessed by Cronbach's coefficient. As a result, the items in the scale was reduced from 36 to 9; 110 effective questionnaires were reclaimed for statistical analysis. Finally, the scale (Version 1.0) contained 9 items and 4 dimensions, of which, 3 items highlighted the comfort emotional experience, 3 items highlighted autonomic response, 2 items highlighted heat sensation, and 1 item highlighted non-heat sensation. In conclusion, the sensation scale of HSM containes 9 items, which has fair content and structure validity. It is in line with the current clinical understanding of sensation of HSM and has strong clinical operability and wide adaptability.

Progress of fMRI-based research in recent 10 years / 中国针灸

<p><b>OBJECTIVE</b>The research regarding the central mechanism of acupuncture (arrival of ) based on functional magnetic resonance imaging (fMRI) in recent 10 years was analyzed to summarize existing research achievements and experience.</p><p><b>METHODS</b>The literature regarding fMRI-based research published from January of 2007 through December of 2016 in CNKI and PubMed databases was collected. The research content and methods, including research design, inclusion criteria, acupoint selection and evaluation, were analyzed.</p><p><b>RESULTS</b>Totally 18 articles regarding the central mechanism of acupuncture based on fMRI was included. According to research content, the literature was divided into two categories: research and sensation research. In research, the differences of and not on brain functional activity were compared to summarize the central response pattern of ; in sensation research, the differences of different sensations and intensities of on central response were compared to explore the effects of different sensations and intensities of on brain functional activity. In recent 10 years, the number of research gradually increased, and the type of design was various, mainly RCT and paired design. The majority of participants was healthy people, and single acupoint was the focus of researches, including Zusanli (ST 36), Waiguan (TE 5), Hegu (LI 4), etc. The evaluation of was based on visual analogue scale (VAS). The research contents were mainly the effects of and not and different sensations on brain function activities. The present studies confirmed that and not as well as different sensations had different impacts on brain functional effects, and different acupoints had specific activated brain areas. There was a positive correlation between the degree of and the intensity of the activation of brain regions. Furthermore, tingling sensation was not included to sensations.</p><p><b>CONCLUSION</b>The number and quality of fMRI-based research need to be improved; the research content is simple, and research method is in exploratory stage. The results obtained in the literature are the phenomena of in the central level, and it is imperative to summarize the essential link between and the central effect through these phenomena to reveal the mechanism of . The specific impact of for brain function needs more clinical exploration.</p>

Research Progress of the Modern Evaluation Methods of De Qi Sensation in Acupuncture and Moxibustion / 上海针灸杂志

Objective To introduce the research progress of the modern methods in evaluating de qi sensation in acupuncture and moxibustion, and to analyze the current research situation and major problems. Method The objective evaluation methods majorly used to estimate qi sensation were summarized. Result The currently used evaluation methods basically include scales and cerebral function imaging, while the rest methods are still in the beginning stage. Conclusion As a subjective feeling, de qi sensation is difficult to determine and quantify objectively, and there lacks an objective standard. The study on the mechanism of de qi sensation is relatively insufficient and superficial.

Effect of Acupuncture at Neiguan (PC 6) with Different Inserting Methods on Short-form McGill Pain Questionnaire and Cardiovascular Function / 上海针灸杂志

Objective To observe the changes of cardiovascular function after acupuncture at Neiguan (PC 6) respectively with slowly twirling needling and tube needling in healthy subjects, and to objectively evaluate the pain intensity of the two needling methods.Method A hundred healthy young subjects were randomized into group A and group B, 50 cases in each group. Neiguan (PC 6) point was selected for acupuncture in both groups. In the first stage, group A received acupuncture by slowly twirling needling, while group B received acupuncture with tube needling; in the second stage (a week later), group A received acupuncture with tube needling, while group B by slowly twirling needling. The Short-form McGill Pain Questionnaire (SF-MPQ) was observed after acupuncture for each subject, and ZXG-E automatic cardiovascular function detector was adopted to evaluate the cardiovascular function before puncturing, 5 min after puncturing, and 30 min after puncturing.Result The Sensory Pain Rating Index (S-PRI) and total SF-MPQ scores of slowly twirling needling were significantly different from that of tube needling (P<0.01). The Affective Pain Rating Index (A-PRI), Visual Analogue Scale (VAS), and Present Pain Intensity (PPI) of slowly twirling needling method were significantly different from that of tube needling (P<0.01). At 5 min after needle insertion, the FEK and VER values of twirling needling were significantly different from that of tube needling (P<0.01).Conclusion The pain produced by slowly twirling needling is more variant and stronger than that by tube needling, and this pain variation can produce a positive effect on cardiovascular function.

Effect of Acupuncture at Sanyinjiao (SP6) on the Infrared Temperature of Guanyuan (CV4) and Sanyinjiao in Dysmenorrhea Patients / 上海针灸杂志

Objective By using infrared thermal imager (Flir-SC620), to observe the effect of needling Sanyinjiao (SP6) on the skin temperature at Guanyuan (CV4) and Sanyinjiao in patients with primary dysmenorrhea (PD) of cold and dampness stagnation pattern, and to explore the probability of using infrared thermal imaging for diagnosis and as an objective index for evaluating the action and needling qi of acupuncture. Method Thirty-six subjects were recruited and divided into four group, a health control group (group A), a control group of PD of cold and dampness stagnation pattern (group B), a needling-qi-expected group (group C) and a needling-qi-unexpected group (group D). Group A and B were not given acupuncture treatment, while group C and D were treated with acupuncture at bilateral Sanyinjiao with needles retained for 30 min, and the needling sensations were recorded. The infrared thermal imager was used to detect the skin temperature at Guanyuan and bilateral Sanyinjiao for 40 min for each group, and the temperature was recorded every 10 min. The temperature during different periods of time, 0-10 min, 20-20 min, 20-30 min, 30-40 min, 0-30 min, and 0-40 min were then calculated. In group C, those obtained the needling qi sensation were further grouped into C-1 and those didn’t obtain the sensation were into C-2; in group D, those obtained needling qi sensation were further grouped into D-1 and those didn’t obtain the sensation were into D-2. SPSS 17.0 was adopted for data processing, and the data were analyzed by using MANOVA of repeated measuring. Result Compared to group A (6 cases), the temperature at Guanyuan in group B (6 cases) was significantly decreased during 0-30 min and 0-40 min (P<0.05), the temperature at the left Sanyinjiao during 0-40 min in group B was significantly decreased (P<0.05), and the temperatures at bilateral Sanyinjiao during 30-40 min in group B significantly dropped (P<0.05). Compared to group B, the temperatures at Guanyuan during 0-30 min and 0-40 min in group C1 (12 cases) and group D1 (11 cases) were significantly increased (P<0.05), the temperature at left Sanyinjiao during 0-40 min in group D1 was significantly increased (P<0.05), and the temperatures at bilateral Sanyinjiao during 30-40 min in group D1 were significantly increased (P<0.05). There was no case in group C2 and only 1 case in group D2, hence, the data were not enough for analysis. Conclusion Decrease of the infrared temperature at Guanyuan and Sanyinjiao can be taken as one of the diagnostic criteria for dysmenorrhea of cold stagnation pattern. Increase of the infrared temperature at Guanyuan can be regarded as one of the objective evidences for the along-meridian transmission characteristic in needling Sanyinjiao.

Analysis of Mind-control and Qi-regulation:Tracing the Arrival of Qi Recorded by Nei Jing and Nan Jing / 上海针灸杂志

Objective To discuss the relationships between qi-arrival and mind-control, qi-arrival and qi-regulation, and to define qi-arrival by tracing the relevant records in Nei Jing (Classic of Internal Medicine) and Nan Jing (Classic of Difficult Issues). Method Thirty-seven relevant ancient books of the two classics were reviewed and the notes by WANG Bing, MA Shi, and YANG Shang-shan were referred. Result Mind-control requires the spirits of the practitioner, patient and environment, as well as observing and waiting for the arrival of qi. Regarding qi-regulation, theories involve that qi-arrival achieves same reinforcing and reducing effect as qi-regulation, qi-regulation is elucidated from the correct location of acupoint, proper needling depth and direction, and to regulate qi by observing the arrival of qi. Besides, the changes of internal and external environments also influence qi-arrival via qi-regulation and mind-control. Conclusion Qi-arrival is closely related to mind-control and qi-regulation in obtaining, differentiation, and adjustment. Mind-control and qi-regulation assist each other through the whole acupuncture process, which is the core of qi-arrival.