Characterization of the "deqi" response in acupuncture.
Characterization of the "deqi" response in acupuncture.
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DOI：
10.1186/1472-6882-7-33
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发表时间：
2007-10-31
影响因子：
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通讯作者：
Kennedy, David N
中科院分区：
文献类型：
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作者：
Hui, Kathleen K S;Nixon, Erika E;Kennedy, David N
背景：针刺刺激引起德气，这是一种独特的感觉组合，对中医的临床疗效至关重要。缺乏足够的实验数据来表明什么感觉构成了德气，它们的普遍性和强度，它们与穴位的关系，它们与传统的体感或有害反应的比较。本研究的目的是为这些问题提供科学证据，并根据感觉的普遍性和德气体验背后感觉的独特性来描述德气现象的本质。方法：42例未接受针灸治疗的健康成人志愿者，在功能磁共振成像（fMRI）期间，按随机顺序在肢体LI4、ST36和LV3处进行手工针刺。在针刺前用von Frey单丝轻拍穴位进行非侵入性触觉刺激，作为感觉控制。在每个过程结束时，受试者被问及在刺激过程中是否出现问卷中列出的每一种感觉或任何其他感觉，并以1-10的数值等级对其强度进行评分。采用配对t检验、方差分析、Spearman相关检验、Fisher精确检验等统计学方法比较针刺与感觉刺激的反应。结果：当所有感觉的最低总分为3分时，71%的针刺过程引发了deqi反应，而触觉刺激的这一比例为24%。针刺组个体感觉的频率和强度明显更高。在与德气相关的感觉中，最常见的是疼痛、酸痛和压力，其次是刺痛、麻木、钝痛、沉重、温暖、充实和凉爽。偶尔发生的短暂剧烈疼痛被认为是无意的有害刺激。针刺与触觉刺激控制组的德气感觉差异以疼痛、酸痛、压痛和钝痛最为显著。与中医中LI4的突出作用一致，针刺与触觉刺激控制的LI4反应最突出，感觉最多，疼痛、酸痛、钝痛的频率和强度差异最显著。有趣的是，与疼痛文献的报道相反，钝痛通常先于或发生在没有尖锐疼痛的情况下。提出了一种称为德气复合的感觉概要的方法，并应用于解释穴位之间德气的差异。结论：deqi反应中复杂的感觉模式表明涉及广泛的有髓神经纤维和无髓神经纤维，特别是腱肌层中传导较慢的纤维。这项研究为针灸中“得气”反应的特征及其与不同神经纤维的关联提供了科学数据。这些发现具有临床相关性，与神经生理学的现代概念一致。为进一步研究德气现象奠定了基础。
BACKGROUND: Acupuncture stimulation elicits deqi, a composite of unique sensations that is essential for clinical efficacy according to traditional Chinese medicine (TCM). There is lack of adequate experimental data to indicate what sensations comprise deqi, their prevalence and intensity, their relationship to acupoints, how they compare with conventional somatosensory or noxious response. The objective of this study is to provide scientific evidence on these issues and to characterize the nature of the deqi phenomenon in terms of the prevalence of sensations as well as the uniqueness of the sensations underlying the deqi experience.METHODS: Manual acupuncture was performed at LI4, ST36 and LV3 on the extremities in randomized order during fMRI in 42 acupuncture naive healthy adult volunteers. Non-invasive tactile stimulation was delivered to the acupoints by gentle tapping with a von Frey monofilament prior to acupuncture to serve as a sensory control. At the end of each procedure, the subject was asked if each of the sensations listed in a questionnaire or any other sensations occurred during stimulation, and if present to rate its intensity on a numerical scale of 1-10. Statistical analysis including paired t-test, analysis of variance, Spearman's correlation and Fisher's exact test were performed to compare responses between acupuncture and sensory stimulation.RESULTS: The deqi response was elicited in 71% of the acupuncture procedures compared with 24% for tactile stimulation when thresholded at a minimum total score of 3 for all the sensations. The frequency and intensity of individual sensations were significantly higher in acupuncture. Among the sensations typically associated with deqi, aching, soreness and pressure were most common, followed by tingling, numbness, dull pain, heaviness, warmth, fullness and coolness. Sharp pain of brief duration that occurred in occasional subjects was regarded as inadvertent noxious stimulation. The most significant differences in the deqi sensations between acupuncture and tactile stimulation control were observed with aching, soreness, pressure and dull pain. Consistent with its prominent role in TCM, LI4 showed the most prominent response, the largest number of sensations as well as the most marked difference in the frequency and intensity of aching, soreness and dull pain between acupuncture and tactile stimulation control. Interestingly, the dull pain generally preceded or occurred in the absence of sharp pain in contrast to reports in the pain literature. An approach to summarize a sensation profile, called the deqi composite, is proposed and applied to explain differences in deqi among acupoints.CONCLUSION: The complex pattern of sensations in the deqi response suggests involvement of a wide spectrum of myelinated and unmyelinated nerve fibers, particularly the slower conducting fibers in the tendinomuscular layers. The study provides scientific data on the characteristics of the 'deqi' response in acupuncture and its association with distinct nerve fibers. The findings are clinically relevant and consistent with modern concepts in neurophysiology. They can provide a foundation for future studies on the deqi phenomenon.