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Seduced
By De Qi
Peter A. S. Johnstone, MD
KEY WORDS
Acupuncture, Alternative and Complementary Therapies, Auricular Therapy
POINT
The radiation oncology community experienced an upheaval in the late
1950s, when researchers discovered that hypoxic cells in culture were
more resistant to radiation therapy than their oxygenated counterparts.1
This is considered to be due to the relative lack of intra-cellular
oxygen which, when present, amplifies the damage caused by radiation-induced
free radicals.2 This revelation sparked decades of research and millions
of dollars' investment in interventions to (a) determine and (b) reduce
the amount of hypoxia in tumors, since those cells could theoretically
contribute to treatment failure after
radiotherapy.
For many years, this primacy of oxygen had been a mantra among segments
of the community, accepted as an integral aspect of the practice. In
1988, Finkelstein and Glatstein3 published their commentary "Seduced
by Oxygen." While it did not single-handedly debunk the importance
of oxygen in clinical radiotherapy (many years of negative results in
clinical trials have rendered it less central), it was important in
that it revealed a small fraction of the crowd who could tell the Emperor
that he had no clothes.
It must be understood that this paper did not remove the hypoxic effect
from cell culture, and did not change oxygen's role as a free radical
modifier. It served most importantly as a parry to conventional wisdom,
to remove blinders that the community at large had been wearing, and
to allow critical thought outside a box which we ourselves had constructed.
Acupuncture as a community is relatively immune to such restrictions.
It is polyparadigmatic; practitioners must have open minds regarding
techniques and mechanisms of effect. Still, there is a central construct
to our discipline that bears deeper investigation: that of the primacy
of de Qi. We are taught early in our acupuncture experience that the
sensation described as de Qi is integral to acupuncture effect and treatment
outcome. Specifically stated is the precept:
•"Unless
the acupuncturist obtains de Qi over each point used, then the acupuncture
point has not been stimulated, and this means the acupuncture is of
questionable value."4
•"If there is no response, i.e., no needle sensation, it is
doubtful if the treatment will be effective."5
•"In the process of acupuncture, no matter what manipulation
it is, the arrival of Qi must be achieved."6
However, I am in disagreement with this. Recognizing that my intent
is not to foster or promote poor technique for those treatments for
which de Qi is critical (for instance, Four Gates), my contention is
that it is not required all the time. While the Qi response is necessary
for many treatments, it is clearly not mandatory; concentrating on de
Qi over clinical effect ignores effect for technique. The following
data are pertinent:
1. It has been
shown that sham points may provide significant relief both
in the pain7 and xerostomia8,9 literature. True sham points should not
manifest de Qi.
2. In our clinic, success with percutaneous electrical nerve stimulation
technique does not require de Qi prior to electrical stimulation to
achieve good results.
3. We,10 and others,11 have documented efficacy of non-traditional points
in acupuncture regimens. Since non-traditional points need not have
the physiologic and microanatomic structure of traditional points, de
Qi should not be expected.
4. Auricular acupuncture does not require de Qi. It may be argued that
these points are not anatomically similar to body acupuncture points,
but their physioelectric properties are sufficiently similar in that
electrical point detectors "find" points the same way either
on the trunk or the ear.
CONCLUSION
Thus, de Qi is not a necessary or integral aspect of many acupuncture
techniques. This "heresy" is borne out in several aspects
of practice. While important in many cases, it is not always required.
REFERENCES
1. Thomlinson RH, Gray LH. Br J Cancer. 1955; 9:539-549.
2. Hall EJ. Radiobiology for the Radiologist. 5th Ed. Philadelphia,
Pa: Lippincott Williams & Wilkins; 2000:91-111.
3. Finkelstein E, Glatstein E. Seduced by oxygen. Int J Radiat Oncol
Biol Phys. 1988;14:205-207.
4. Lewith GT, Lewith NR. Modern Chinese Acupuncture: A Review of Acupuncture
Techniques as Practiced in China Today. 2nd ed. Wellingborough, Northamptonshire:
Thorsons Publishers;1983:58-59.
5. O'Connor J, Bensky D. Acupuncture: A Comprehensive Text. Shanghai
College of Traditional Medicine. Seattle, Wash: Eastland Press; 1981:411.
6. Xinnong C. Chinese Acupuncture and Moxibustion. Beijing: Foreign
Language Press; 1981:326.
7. Gaw AC, Chang LW, Shaw L-C. Efficacy of acupuncture on osteoarthritic
pain: a controlled, double-blind study. N Engl J Med. 1975;293: 375-378.
8. Blom M, Dawidson I, Fernberg JO, et al. Acupuncture treatment of
patients with radiation-induced xerostomia. Eur J Cancer B Oral Oncol.
1996;32B:182-190.
9. Blom M, Lundeberg T. Long-term follow-up of patients treated with
acupuncture for xerostomia and the influence of additional treatment.
Oral Dis. 2000; 6:15-24.
10. Johnstone PAS, Peng YP, May BC, Inouye WS, Niemtzow RC. Acupuncture
for pilocarpine-resistant xerostomia following radiotherapy for head
and neck malignancies. Int J Radiat Oncol Biol Phys. 2001;50:353-357.
11. Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians.
Berkeley, Calif: Medical Acupuncture Publishers; 1995.
AUTHOR INFORMATION
Dr Peter A. S. Johnstone, MD, MA is a Commander in the United States
Navy, and is Chief of Radiation Oncology at the Naval Medical Center,
San Diego, California.
CDR Peter A. S. Johnstone, MC, USN*
Naval Medical Center San Diego
Radiation Oncology Division
34800 Bob Wilson Drive, Suite 14
San Diego, CA 92134-1014
Phone: 619-532-7274 o Fax: 619-532-8178
E-mail: pajohnstone@nmcsd.med.navy.mil
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