J Appl Physiol

91: 2471–2478, 2001.

Biomechanical response to acupuncture
needling in humans

Departments of Neurology, 2Orthopaedics and Rehabilitation, 3Medical Biostatistics, and
Radiology, University of Vermont College of Medicine, Burlington, Vermont 05405
Received 23 March 2001; accepted in final form 25 July 2001

Langevin, Helene M., David L. Churchill, James R. and/or pistoning (up-and-down motion) of the needle.
Fox, Gary J. Badger, Brian S. Garra, and Martin H. Needle manipulation can be brief (a few seconds), pro-
Krag. Biomechanical response to acupuncture needling in longed (several minutes), or intermittent depending on
humans. J Appl Physiol 91: 2471–2478, 2001.—During acu- the clinical situation (33). Even when electrical stimu-
puncture treatments, acupuncture needles are manipulated
lation is used (a relatively recent development in the
to elicit the characteristic “de qi” reaction widely viewed as
essential to acupuncture’s therapeutic effect. De qi has a
history of acupuncture), a certain amount of manual
biomechanical component, “needle grasp,” which we have needle manipulation is usually performed immediately
quantified by measuring the force necessary to pull an acu- after needle insertion (6, 40).
puncture needle out of the skin (pullout force) in 60 human Traditionally, manipulation is performed to elicit the
subjects. We hypothesized that pullout force is greater with characteristic reaction to acupuncture needling known
both bidirectional needle rotation (BI) and unidirectional as “de qi.” De qi has a sensory component perceived by
rotation (UNI) than no rotation (NO). Acupuncture needles the patient as an ache or heaviness in the area sur-
were inserted, manipulated, and pulled out by using a com- rounding the needle and a simultaneously occurring
puter-controlled acupuncture needling instrument at eight biomechanical component that can be perceived by the
acupuncture points and eight control points. We found 167 acupuncturist (3, 6, 10, 16, 33). We refer to this com-
and 52% increases in mean pullout force with UNI and BI, ponent as “needle grasp.” During needle grasp, the
respectively, compared with NO (repeated-measures ANOVA,
acupuncturist feels as if the tissue is grasping the
P ⬍ 0.001). Pullout force was on average 18% greater at
acupuncture points than at control points (P ⬍ 0.001). Needle needle such that there is increased resistance to fur-
grasp is therefore a measurable biomechanical phenomenon ther motion of the manipulated needle (6, 10, 38, 40).
associated with acupuncture needle manipulation. This “tug” on the needle is classically described as “like
a fish biting on a fishing line” (48). Needle grasp can
acupuncture meridians; connective tissue range from subtle to very strong, with pulling back on
the needle resulting in visible tenting of the skin (16,
21). During acupuncture treatments, needle manipu-
ALTHOUGH ACUPUNCTURE IS INCREASINGLY USED for the lation is used to elicit and enhance de qi, and de qi is
treatment of pain and other conditions (27, 37), the used as feedback to confirm that the proper amount of
rational basis underlying its use remains unclear (2). needle stimulation has been used.
Western medical experts have been inherently skepti- De qi is widely viewed as essential to acupuncture’s
cal of acupuncture’s therapeutic value. One reason is therapeutic effectiveness (6, 10, 16, 23, 33, 40). Docu-
that it seems very unlikely that the simple act of mentation of de qi has been used as a criterion for
inserting fine needles into tissue could elicit any effect evaluating the adequacy of both manual and electrical
at all, let alone wide-ranging and long-lasting thera- acupuncture treatments in clinical trials (13, 46). Nee-
peutic effects. Hypodermic needles are routinely used dle manipulation, de qi, and needle grasp, therefore,
in Western medicine, and their insertion into the body are potentially important components of acupuncture’s
is not considered therapeutic. Acupuncture needles are therapeutic effect, yet the mechanisms underlying de
of a finer gauge than even the finest needles used for qi and needle grasp are unknown.
intradermal injections, and acupuncture rarely results As a first step toward understanding the physiolog-
in a single drop of blood being discharged. ical and therapeutic significance of de qi, we have
What is not widely appreciated by nonacupunctur- quantified needle grasp by measuring the force neces-
ists, however, is that acupuncture typically involves sary to pull an inserted acupuncture needle out of the
manual needle manipulation after needle insertion (3, tissues (pullout force). We hypothesized that pullout
6, 16, 33, 40). Manual needle manipulation consists of force is greater with two different types of needle
rapidly rotating (back-and-forth or one direction)
The costs of publication of this article were defrayed in part by the
Address for reprint requests and other correspondence: H. M. payment of page charges. The article must therefore be hereby
Langevin, Dept. of Neurology, Given C423, Univ. of Vermont College marked ‘‘advertisement’’ in accordance with 18 U.S.C. Section 1734
of Medicine, Burlington, VT 05405 (E-mail: hlangevi@zoo.uvm.edu). solely to indicate this fact.

http://www.jap.org 8750-7587/01 $5.00 Copyright © 2001 the American Physiological Society 2471

1. Eight traditional acupuncture point locations were inves. neuromuscular disease. Needle-insertion depth was standardized and based on tissue measurements made by ultrasound. we carried out an experi- ment in which normal human subjects received differ- ent types of acupuncture needle manipulation at eight acupuncture points and eight corresponding control points. bones. Langevin) according to pressibility (subcutaneous tissue vs. Healthy volunteers aged 18–55 yr were invited to participate.2472 BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING manipulation commonly used in acupuncture practice [bidirectional (BI) and unidirectional (UNI) needle ro- tation] than with needle insertion with no manipula- tion (NO). subcutaneous tissue thickness measured by ultrasound at J Appl Physiol • VOL 91 • DECEMBER 2001 • www.5 cm. Testing was not scheduled during menstru. For each acupuncture/control location. a disk-shaped template was centered on the extensive scarring or dermatological abnormalities in the acupuncture point. On the side selected for acupunc- inflammatory medication. These measurable effects. Protocol summaries were mailed after used to refer to a corresponding pair of acupuncture and to volunteers for review. The control point days before testing. Ultrasound im- traditional methods. 1). or NO). a pair of corresponding tion depth was determined based on ultrasound measure- acupuncture points on the right and left sides of the body ment of subcutaneous tissue thickness. UNI. manipulation. The same needle depth (D) was eated by these landmarks. fraction of the distance linear array transducer. M. obtained on the day of the study. ture point. Within the area delin. perpendicular to the skin. A computer-controlled acupuncture needling instrument was fabricated and used to perform all needling procedures (needle insertion. and Chengshan (B57). Mountain View. a similar “dummy” procedure was performed and then disregarded. Female volunteers were excluded if they was marked on the perimeter of the disk at a 45° angle from were pregnant.org . The disk was 2 cm in radius for points areas tested. Volunteers taking anti-inflammatory or anti. The transducer was always held between wrist and elbow creases) (6). METHODS Fig. each subject was randomized into tion type (NO. and pullout) as well as measurement of pullout force. informed consent was control points. collagen for acupuncture point and control point. On the side selected vascular disease. bleeding disorder. one of three experimental groups. subjects were neither told nor able to participated in one testing session lasting 2–3 h. The term “acupuncture/control location” is here- Institutional Review Board. CA) equipped with a 7-MHz proportional measurements (e. These groups differed only Determination of Needle Insertion Depth in type of needle manipulation used (BI. For each location.” we also hypothesized that pullout force is greater at classically defined acupuncture points than at nonacu- puncture control points. tendons) and chine (Acuson.g. or UNI) was being performed. aging. this will demonstrate that needle manipulation has measurable biomechanical effects. during see or hear any indication of which side was used for each which a total of 16 points on the body received acupuncture point (acupuncture and control) and which needle manipula- needling. With ultrasound im- were identified and marked with a skin marker (16 acupunc. target needle inser- tigated (Fig. Exclusion criteria were a history of right and left sides of the body were then randomly selected diabetes. will suggest that needle manipulation may indeed play an impor- tant role in acupuncture therapy. Acupuncture points were identified by an separating two tissues of different echogenicity and com- experienced acupuncturist (H. and for control point.g.. After consenting. the nearest bone and joint. muscle). Each enrolled volunteer Throughout testing.. If proven true. and written. Each acupuncture point was therefore Study Protocol paired with a corresponding control point on the opposite side Study protocol was approved by the University of Vermont of the body. Approximate position was determined aging was performed with an Acuson 128 ultrasound ma- in relation to anatomic landmarks (e. Abbre- viations in parentheses correspond to acupuncture meridians and The study was conducted at the University of Vermont point numbers (6). The following acupuncture points were used in this study: Hoku (LI4). acute or chronic corticosteroid therapy. Quchi (LI11). To test these hypotheses. For each location. BI. the perimuscular fascia is visible as an echogenic line ture points total). Sanyinjiao (Sp6). where S was the slight depression or yielding of tissues. Zusanli (St36). Zhongdu (GB32). Qinling Study Site and Participants (Ht2). Since de qi is tradi- tionally believed to be greater at “acupuncture points. the precise position of each acu. Kongzui (Lu6). located on the forearm and lower leg and 3 cm in radius for histamine medications were asked to discontinue their use 3 points located on the upper arm and thigh. together with the historical importance of this technique.jap. General Clinical Research Center between June 2000 and December 2000. feeling for a point and was calculated as: D ⫽ S ⫹ 1. the acupuncture point’s meridian and as far as possible from ation to avoid possible discomfort due to cessation of anti. used for both acupuncture point and corresponding control puncture point was determined by palpation.

and pullout-force measurement) were After the instrument has been properly positioned and performed by a computer-controlled acupuncture needling oriented but just before the needling procedure has been system. side view. 12. Taring the system needling instrument contains two miniature servomotors. Just enough force is applied acupuncture points from seven different acupuncture text. grip (which are mounted to the loadcell’s live side) is signif- a personal computer fitted with a servomotor controller. The second motor Once the instrument has been positioned and the loadcell generates needle rotation (manipulation).org . J Appl Physiol • VOL 91 • DECEMBER 2001 • www. through a hole in the instrument’s skin-contacting foot (Fig. BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING 2473 the acupuncture point. needling procedure is initiated. 2). needle depth determination sure. In at each acupuncture point in all subjects. 6. the loadcell reading is tared. All needling procedures (insertion. and custom-written control and data acquisition software. and within this range no Needling system.jap. evaluation tests. To perform a pullout test. rotated to perform manipulation (if called for). inset). 2. This is necessary eliminated many potential sources of investigator bias. ma. In loadcell readings are not affected by pressure against the a pilot study of subcutaneous tissue measurements in 16 skin by the foot of the instrument. 47) and averaging the suggested ically isolated from the skin-contacting foot. and. Fig. This formula for needle depth was against a subject’s skin in the appropriate location and ori- based on compiling needle depth guidelines for the listed ented perpendicular to the skin. Under the computer’s strain-gauge loadcell measures all axial forces exerted by the control. A: design schematic of acupuncture needling instrument. A 500-g capacity tared. pulled out of the tissue. significant tissue compression artifact was found. can compress the underlying tissue and could using the above formula fell within the recommended ranges potentially influence how the tissue responds to needling. The icant compared with typical pullout force. The loadcell is phys- books (1. the needle is robotically advanced into the tissue tissue on the needle. with the instrument in its final orientation compensates for both of which are controlled by the computer. cutaway view with needle retracted. Applying too much pres- subjects (8 men and 8 women). The investigator holds the instrument after a 10-s delay. we found that the investigator could easily Acupuncture Needling maintain skin contact without causing visible skin compres- sion throughout a pullout test. This because the weight of the needle rotation motor and needle system consists of a hand-held needling instrument (Fig. From left to right: cutaway view with needle extended. motion (needle insertion and pullout). 39. Inset shows needle in extended position. 3. however. following manner. the system operates in the 2. 33. This ensured consistent experimental conditions and initiated. nipulation. pullout. B: needling instrument in use. to maintain light contact with the skin. The first motor this gravity-induced loadcell signal such that only those is coupled to a ball leadscrew and generates linear needle forces exerted by the tissue on the needle are recorded. and therefore upper and lower limits of the listed ranges for each point.

dwell time. plot) and acupuncture and control points (subplot) random- tween marking and needling. force were log transformed before analysis to satisfy the Skin at each point was disinfected with alcohol. pullout speed was 5 mm/s.. Fig. Statistical analyses were performed using SAS statisti- disinfected by submerging in isopropyl alcohol for 30 s. continuously recorded the needle force detected by the load- tions/s. and body needle manipulations corresponding to “moderate” practice mass index (BMI) by using ANOVA. ranging from almost no manipu. Because across the three needle-manipulation types. all motion parameters (e. Wallis tests. These automatically identified and saved as the pullout-force out- parameters were determined by observing and simulating come measure (Fig. Approximate (verified by an observer). Top: programmed linear insertion/retrac- tion (dashed line) and rotary manipula- tion (solid line) motion of acupuncture needle for the three experimental groups. These differed only in the needle manipu- lation used. no nee- dle manipulation. insertion contact with the subject or the needle were steam sterilized. insertion speed. Because the needling instrument is tween subjects. ized to right or left side for each acupuncture/control location dled before control points within each acupuncture/control within subjects. The needling normality and homogeneity of variance assumptions associ- instrument was then held by hand against the skin using just ated with ANOVA (5). the appropriate insertion depth for each acupunc. rotation speed. In this study. J Appl Physiol • VOL 91 • DECEMBER 2001 • www. bidirectional rota- tion. types were compared with respect to age. a new sterile disposable needle appropriate. Between puted based on the method described by Kendall and Stuart test points within the same subject. used to assess differences in mean pullout force and needle- formed. gender.25 cant difference (LSD) test. direction of rota- tion. 3. rotation speed was 8 revolu. depth. Repeated-measures ANOVA was Needling protocol. BI. After ultrasound imaging was per. all parts of the instrument that came in computer controlled. the instrument was (18).jap. M. Graphical descriptions of needling procedure types and examples of corre- sponding pullout force measurements.org . NO. Outcome Measure pendently set. which correspond to the antilog of the avoid any visible compression of skin by the instrument arithmetic means of the log-transformed data. Peak force detected during needle pullout was taken as the pullout force. Pairwise comparisons among means. Pullout- rotations each for BI. acupuncture points were nee. Bottom: examples of the re- sulting axial force on the needle. cal software. Data corresponding to pullout mm in diameter was mounted in the needling instrument. The peak force occurring during the pullout phase was 10 s after manipulation. Needle-motion parameters are listed in text. Experimental needle insertion depth at each control point was set according design was treated similar to a split-plot with subjects ran- to ultrasound measurements at the corresponding acupunc. needle manipulations performed by an acupuncturist trained in a variety of different acupuncture needling techniques Statistical Methods (H. the data acquisition system insertion speed was 10 mm/s. respectively. when location. Langevin). amount of rotation. Japan) 30. UNI. ␹2-tests. For each point. All means presented for pullout force enough pressure to maintain light contact with the skin to are geometric means. 3). 40. 3): needle the entire needling procedure. Be. In this study. and Kruskal- were chosen for BI and UNI. or 50 mm in length and 0. needle dwell time was 2 s before manipulation and cell. insertion depth between acupuncture and control points and ture/control location was entered into the computer. Activation of a push-button switch standard errors associated with geometric means were com- initiated the needling procedure as described above. All other needling parameters with the force outcome measure quantifies the force required to over- exception of needle insertion depth (see above) were held come the attractive forces between needle and tissue. Needle-manipulation techniques vary widely in clinical practice.g. were performed by using Fishers least signifi- (Seirin. the number of needle rotations for needle manipulation was 16 clockwise for UNI and 16 The needle-grasp component of de qi is an increase in the alternating clockwise and counterclockwise cycles of four gripping of the acupuncture needle by local tissues. Subjects randomized to the three needle-manipulation lation to rapid and forceful needle movements. During constant across all points and all subjects (Fig.2474 BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING Needling parameters. unidirectional rotation. pullout speed) can be inde. domized to one of the three needle-manipulation types (whole ture point and to minimize repositioning of the subject be. Shimizu.

2 ⫾ 0. control bars represent SE.039].9 ⫾ 2.3 ⫾ 8. St36. differences in pullout force between acu- puncture and control points not were dependent on the type of needle manipulation. P ⫽ 0. LI11. LI4. UNI: average pullout force was observed at acupuncture 22.001. a greater types [NO: 21.07. Fig.4 g. P ⬍ 0.05).7 ⫾ 1.jap. insertion depth across the three needle-manipulation trol locations was not the aim of our study. There were no significant differences with respect to these subject characteristics between the groups of subjects randomized to the three needle-manipulation types. Significant differences in pullout force were observed across the three needle- manipulation types [F(2. Pairwise compari. and UNI (C). P ⬍ BI. with three (Ht2. Means are significantly 0. control. F(1. 4. and Sp6) achieving statis.4 g. points than at control points in seven out of the eight DISCUSSION locations tested (Ht2.19) ⫽ 9. 0.3 kg/m2. Means and SD for age and BMI of participants that completed the study were 37. control point: 87. P ⬍ acupuncture points and control points (B).57) ⫽ 49.7 ⫾ control points and acupuncture points (C).0. P ⫽ 0.41 mm. BI: ⫾ 5. Acupuncture and control points also differed different across the three needle-manipulation types within both significantly within NO [acupuncture point: 38..9 ⫾ 0.0 g at control points.05).57) ⫽ 75.001]. Lu6. significant differences were found among the manipulation types [F(2.8.001) different between needle-manipulation types (A) and between icantly different from the others (Fishers LSD. Fig. 4C).2 ⫾ 7.37 mm. Means are significantly (P ⬍ sons indicated that each manipulation type was signif.19) ⫽ 26.8 g) (Fishers LSD.1 g. Mean pullout force at acupuncture points was 63. Sp6.001 for acupuncture points and F(2.2 g. 4A].7 g).8 ⫾ 2. P ⫽ 0. Secondary analyses were performed comparing pull- out force within needle-manipulation types and within point types (acupuncture vs. P ⫽ 0.5 ⫾ 2.0 g. Pullout force measurements.5 g) was significantly greater than that for BI (55. Height of bars represents geometric means. Error 0.5 ⫾ 2. point: 51.57) ⫽ 18.05).5.7 ⫾ 1. Pullout-Force Measurements Pullout force. There was no significant difference in mean needle- Although the testing of individual acupuncture/con. and B57).35]. acupuncture vs.57) ⫽ 62. F(1. the primary outcome measure.1 ⫾ 10.57) ⫽ 0.0. quantification of needle grasp.e. F(1. BI [acupuncture point: 60. 4.57) ⫽ 1.007] and UNI [acupuncture point: 109. P ⬍ 0. completed the testing protocol.6 ⫾ 0. BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING 2475 RESULTS Study Participants Sixty-one volunteers were enrolled in the study. consisting of 38 women and 22 men. F(2.48 for needle manipulation by point-type interaction]. 4B].001. The remaining 60. control point: 34. P ⬍ 0. Within acupuncture and control points.50 mm.73. Fig. Fig.001 for control points].2 yr and 26. One female participant withdrew during testing because of discomfort associated with the testing procedure.19) ⫽ 4. and the latter was significantly greater than that for NO (36. is graphically displayed in Fig.9. P ⬍ 0.5 ⫾ 5.3 g. Our measurements of pullout force are the first tical significance (P ⬍ 0. a biomechanical aspect J Appl Physiol • VOL 91 • DECEMBER 2001 • www. Mean pullout force (⫾SE) for UNI (97. 1. There was no evidence that differences between nee- dle-manipulation types were dependent on point type (i. control) [F(2. Means are also signifi- cantly different between acupuncture and control points with NO. LI11.5 ⫾ 0. P ⬍ 0.org . Conversely.3 g compared with 53. respectively. Mean pullout force was also significantly greater at acupuncture points than at corresponding control points [F(1.

Kimura et al.2476 BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING of the characteristic de qi reaction widely viewed as insertion. compared with NO. 5A) and BI (Fig. Increased tissue turgidity. In a study using rat tissue and BI. Together. resulting from extravasa- tion of protein-rich fluid. resulting in a gradual build up of torque in wrist) and on palms and soles where there are no the tissue (Fig. occurring over seconds to min- utes and involving polymerization of soluble actin and formation of actin stress fibers. Figure 5 shows the amount of torque nonquantitative evaluation of electromyographic activ. 5B). The continuously increasing was subjectively rated by the acupuncturist (34). with UNI. final torque at the end of each rotation cycle progres- ever. It is therefore likely that. once the needle has involving these tissues include increased turgidity. 16). Contraction of connective tissue has not been studied in relation to acupuncture but is a potentially impor- tant component of the needle-grasp phenomenon. Possible mechanisms importance of this effect is that. muscle contraction is not the primary mech. essential to the therapeutic effect of acupuncture. tion procedures. the ear- liest evidence of arteriolar dilation leading to protein extravasation during the triple response occurs 10–15 min after injury (9. contraction. several hundred grams represent substantial loads although contraction of muscle may occur during nee. is well documented in vitro (20). is likely to occur as a compo- nent of the triple inflammatory response to the injury created by the acupuncture needle. J Appl Physiol • VOL 91 • DECEMBER 2001 • www. the only published study supporting this view is a sively increased. 45). the grasp is caused by a muscle contraction (15. Needle grasp can be observed at locations winding alternates with unwinding. Tenting of skin observed A mechanism involving winding of tissue is attrac- during needle grasp when the needle is pulled back tive because this would greatly amplify the friction also suggests that layers superficial to muscle are force between tissue and needle (17). Increased tissue turgidity because of the triple inflammatory response is therefore unlikely to be the mechanism underlying needle grasp. arrector pili smooth muscles. cause of its self-amplifying nature. How. With BI. these An estimate of needle torque could be obtained in our results indicate that needle grasp is strongly influ.org . the magnitude of this winding of connective tissue is consistent with our difference was much smaller than the difference finding of greater pullout force with UNI than with BI. developing at the needle-tissue interface during UNI ity during acupuncture needling. we observed a pronounced increase in the nipulation increased pullout force at both acupuncture thickness of subcutaneous tissue surrounding the nee- points and control points. 5A). 5. A frequently stated opinion is that needle continuously as needle rotation proceeds. We (19) observed elastic and collagen fibers that were found 167 and 52% increases in pullout force with UNI entwined around the needle. 40). whereas needle grasp is ob- served within seconds of inserting and manipulating the needle. Whether such rapid cytoskeletal changes in connective tissue fibroblasts can themselves result in measurable contractile forces at the tissue level is at the present unknown. Tissues likely volving winding quickly can result in strong mechani- involved in needle grasp are therefore the skin and/or cal coupling between needle and tissue. Be- dle grasp. in which needle grasp (Fig. 5B). human subjects by measuring the electrical current enced by needle manipulation and that this effect is not delivered to the motor during the different manipula- unique to acupuncture points. with visible winding of colla- 18% difference in mean pullout force between acupunc. We torque during UNI is consistent with tissue winding believe that muscle contraction is not the source of around the needle (Fig. However. Needle ma.jap. we propose that needle grasp. and winding of tissue around the needle during needle rotation. given the small diameter (250 ␮m) of the needle. In an electron microscopy Fig. but unwinding is where no skeletal muscle is present (such as at the incomplete. Winding of connective tissue around the needle dur- ing needle rotation is another possible mechanism con- tributing to needle grasp. We typically observed that. Con- traction of fibroblasts. manipulation. Example of the amount of torque developing at the needle- study of debris found on acupuncture needles after tissue interface during UNI (A) and BI (B) in a human volunteer. a mechanism in- anism responsible for this phenomenon. respectively. The potential subcutaneous connective tissues. A mechanism involving ture points and control points. Pullout forces of grasping the needle (21. The mechanism underlying needle grasp is currently the torque required to rotate the needle increased unknown. Although we also found an dle after needle rotation. and removal. gen around the needle (21). With BI. explants. caused by manipulation of the needle.

needle placement (acupuncture vs. a grasp has been described in acupuncture textbooks credible sham procedure but did not aim to test for for over 2. acupuncture points.000 years (27a). events in the tissue. 33). 35) have been reported at This study was funded by the National Institutes of Health (NIH) Center for Complementary and Alternative Medicine Grant no. 47). the therapeutic effects lasting days to weeks and even same amount of needle grasp may have more power- permanently.jap. the impact of the insertion and manipulation of needles. Riesner and Richard A. J Appl Physiol • VOL 91 • DECEMBER 2001 • www. Winding underlying condition. and Adam D. stimulation of these structures by the mechanical ulation on pullout force dominates over the effect of matrix deformation caused by tissue winding. The technique of practice. Doran for assistance Various histological structures such as neurovascu. first step toward determining the biological and clin- ture points and nonacupuncture points. those points. endings (7. The difference in the magnitude of these effects form all acupuncture needling procedures is an impor- may correspond to the difference between the impact of tant and novel aspect of our study. and sensa- of connective tissue in response to needle rotation tions obtained during the needling itself (6. 44). acupuncture points and meridians are formation may be transduced into local cells present frequently located along connective tissue planes within connective tissue with a wide variety of down. dling techniques are used (22). 31) but not in others (28. NIH Center for Research Resources Grant M01RR-00109. the therapeutic effect of needling An important limitation of this study is that a nonacupuncture points appeared either equal to that of cause and effect relationship between pullout force acupuncture points or intermediate between that of and therapeutic effect has not been established. sistent with available evidence from clinical trials. with a mechanism involving tissue winding. Gale A. Hamill is also lar bundles (4. Apparent therapeutic effects acupuncture needle manipulation and biomechanical observed at control points were attributed to the “non. This is con- potheses objectively but might. in a clinical setting.Weld for recruitment of vol- meridians so far have been mostly unconvincing. Elim- would be expected to occur wherever connective tissue ination of feedback-driven adjustments in needling is present but may also vary depending on local qual- technique was necessary in our study to test our hy- itative or quantitative tissue differences. Needle trials showed the effectiveness of acupuncture vs. a wide variety of nee- effect. A remove an important therapeutic component. 42. 26. Yandow for assistance in conducting the study physiological properties of acupuncture points and and preparing the manuscript. subsequent Skin electrical conductance has been found to be needle manipulation (either rotation or pistoning) may lower at acupuncture points than at control points in pull on collagen fibers. Substrate ture. on the other hand. 36). Compar- number of early clinical trials of acupuncture com- ison of clinical outcomes obtained with acupuncture pared clinical outcomes with needling of acupuncture needling performed by our instrument vs. Reviews of these studies concluded that. Some differences nevertheless necessarily ex- needle manipulation appears to have pronounced ef. and acupuncturists The difference between these two levels of effects fits modify these techniques according to the patient’s age. W. Recent well. appears to be more subtle. unteers. This study constitutes a differences in therapeutic response between acupunc. Attempts to identify unique anatomical and/or We thank Jason A. secretion of paracrine or autocrine factors. In the shorter term. these same effects may needling or minimal needle insertion without manipu. These clinical be used in clinical trials of acupuncture. resulting in deformation of some studies (8. also provide important biological markers that can lation at nonacupuncture points (24. other hand. 25. The ongoing support of Dr. These biomechanical events are specific physiological effect of needling. This needling acupuncture points and that of nonneedle study for the first time demonstrates a link between placebos (2. since neurovascular bun- plexing claim that acupuncture treatments can have dles are located along connective tissue planes. Needle grasp may therefore be pression.” or to the gen. BIOMECHANICAL RESPONSE TO ACUPUNCTURE NEEDLING 2477 become mechanically coupled to the tissue. 39. potentially associated with long-lasting cellular and eralized effect of noxious stimulation (“diffuse noxious extracellular effects. 32) and various types of nerve gratefully acknowledged. However. ist between our study protocol and clinical acupunc- fects no matter where the needle is placed. 30. Developing an understanding inhibitory controls or DNIC”) (42. poorly controlled. In addition. 43). manual acu- vs. allowing controlled a technique (needle manipulation) vs. slightly greater at acupuncture points because more and neuromodulation of afferent sensory input (21). of these effects in future studies may eventually lead controlled clinical trials have compared the needling of to insights into acupuncture’s therapeutic mecha- acupuncture points with sham procedures using no nisms.org . (between muscles or between muscle and bone or stream effects ranging from cell contraction. palpation of tissues. This matrix de. nonacupuncture The use of a computer-controlled instrument to per- point). gene ex. no histological study RO1AT-00133 and conducted at the University of Vermont General so far has compared acupuncture points with control Clinical Research Center at Fletcher Allen Health Care supported by points by using quantitative morphometric methods. tendon) (6. In the clinical situation. ical significance of this phenomenon. 29). We chose our substrate on which this technique is applied (the tissue needling parameters to be consistent with acupuncture into which the needle is inserted). On the extracellular connective tissue matrix. 11. ful downstream effects at acupuncture points via Our results indicate that the effect of needle manip. although many of these trials were puncture would be valuable in future studies. connective tissue can wind around the needle at These effects may be prolonged and explain the per. with illustrations. 14. R. nonacupuncture points.

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