| |
|
|
The
Necessity Of
Qi Sensation (De Qi)
Alev Inez Wilk, MD
COUNTERPOINT
The necessity of Qi sensation or de Qi during acupuncture therapy has
been supported by millennia of clinical practice in Asian countries
and is now of questionable necessity since its introduction to Western
medicine. It is argued here that Qi sensation is not only necessary
for accurate acupuncture point-finding, but also for successful point
stimulation and optimal acupuncture effectiveness. This can be indirectly
supported by the physical characteristics of acupuncture points, de
Qi's anatomical relationship to energy channels and meridians, as well
as to myofascial trigger points.
Biopsies of acupuncture points in living subjects (humans and animals)
reveal a statistically higher percentage of neurovascular structures
when compared to non-acupuncture points.1 Acupuncture points demonstrate
low electrical skin resistance when measured by a galvanometer and therefore,
electrical conduction at these points appears to be different from the
immediate environment.2 Successful excitation of acupuncture points
is not only thought to provoke Qi sensa-
tion, but also a physiologic response through the modulation of biochemical
and neurological processes. Though a subjective sensation, de Qi is
often described as an ache, fullness, or warmth, and is felt to propagate
along an acupuncture channel. In Chinese literature, the sensation has
been determined to propagate at a predictable rate of 10 cm/second in
a zone that is 1-2 cm broad overlying the pathway of a classic acupuncture
channel.3 French scientists have attempted to visualize and document
these channels by injecting technetium-99 into classic acupuncture points
and into non-acupuncture points. The dispersion pattern of the technetium-99
was documented by scintiphotography. At acupuncture points, photographs
demonstrated a linear diffusion of the isotope that topographically
corresponded to clas-
sically-described acupuncture channels in traditional Chinese texts
and graphs.4
Further support for the de Qi involves the relationship of acupuncture
points to myofascial trigger points. The similarities between myofascial
trigger points and acupuncture points include their location and distribution,
pain and referred pain, as well as local twitch response. Specific studies
analyzing acupuncture points and trigger points document a moderately
high degree of correspondence between points; every trigger point has
a corresponding acupuncture point within 3 cm.5,6 Brief, intense stimulation
of points by needling can produce prolonged relief of pain. I would
argue that intense stimulation is de Qi; therefore, more often than
not, necessary to elicit during therapy.
CONCLUSION
The sensation of de Qi is the communication between patient and acupuncturist
that not only is necessary in establishing immediate accuracy of point-finding,
but also the successful stimulation of acupuncture points and thereby,
optimal therapy. Reichmanis and colleagues reported that not all acupuncture
points tested for local skin conductance could be found on all subjects
they studied. Of 100 measured areas containing acupuncture points, 76
exhibited significant differences in skin conductance compared to anatomically
similar control sites.2,7 Failure to find proof for all acupuncture
points may be the result of the empirical derivation of acupuncture
points, or that some acupuncture points have less well-defined electrical
properties dependent on the physiologic and/or pathophysiologic processes
of individuals. Perhaps, the elicitation of de Qi confirms electrically-active
acupuncture points and thereby, ensures the acupuncturist of better
success and therapy effectiveness.
In Western society, acupuncture is under close scrutiny, and patients
expect immediate results from any form of therapy received. Therefore,
optimizing therapy and obtaining de Qi is desirable. And though sham
acupuncture points can provide some degree of effective therapy,8 I
would argue that it is not optimal acupuncture therapy. Acupuncture
without de Qi may devalue the quality of treatment and the measurable
therapeutic results attempted during the research of acupuncture.
REFERENCES
1. Heine H. The morphological basis of the acupuncture points. Acupuncture.
1990;1:1-6.
2. Reichmanis M, Marino AA, Becker RO. D.C. skin conductance variation
at acupuncture loci. Am J Chin Med. 1976;4:69-72.
3. Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians.
Berkeley, Calif: Medical Acupuncture Publishers; 1995.
4. Darras JC, de Vernejoul P, Albarede P, et al. Nuclear medicine investigation
of transmission of acupuncture information. Acupuncture Med. 1993; 11:22-28.
5. Melzack R, Stillwell DM, Fox EJ. Trigger points and acupuncture points
for pain correlations and implications. Pain. 1977;3:3-23.
6. Melzack R. Myofascial trigger points: relation to acupuncture and
mechanisms of pain. Arch Phys Med Rehabil. 1981;62:114-117.
7. Becker RO, Reichmanis M, Marino AA, Spadaro JA. Electrophysiological
correlates of acupuncture points and meridians. Psychoenergetic Systems.
1976;1:105-112.
8. Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture
effective for the treatment of chronic pain? a systematic review. Pain.
2000;86:217-225.
AUTHOR INFORMATION
Dr Alev Wilk is Assistant Professor of Internal Medicine, practicing
General Medicine and Medical Acupuncture, at the University of Wisconsin
Hospital and Clinics, Madison, Wisconsin. Dr Wilk's special interests
are Pain Management, Substance Abuse, and Mental Health.
Alev Inez Wilk, MD*
UW Health-East Clinic
5249 East Terrace Drive, Suite 9952
Madison, WI 53718
Phone: 608-265-1200 o Fax: 608-265-1207
E-mail: aiw@medicine.wisc.edu
*Correspondence
and reprint requests to: Dr Alev Inez Wilk, UW Health-East Clinic, 5249
East Terrace Drive, Suite 9952, Madison, WI 53718. Phone: 608-265-1200;
Fax: 608/265-1207; E-mail: aiw@medicine.wisc.edu
|
|
|
|