Keep up to date with the latest news and articles from BMC Complementary and Alternative Medicine and BioMed Central.
Kathleen KS Hui*, Erika E Nixon, Mark G Vangel, Jing Liu, Ovidiu Marina, Vitaly Napadow, Steven M Hodge, Bruce R Rosen, Nikos Makris and David N Kennedy
Corresponding author: Kathleen KS Hui firstname.lastname@example.org
BMC Complementary and Alternative Medicine 2007, 7:33 doi:10.1186/1472-6882-7-33
(2008-01-11 17:05) University of Life
Howard Moffet makes several misleading comments.
His first, regarding the necessity, or otherwise, of obtaining a de qi response is
covered by the authors in the Background information when they clearly state in the
first sentence that 'Acupuncture stimulation elicits deqi, a composite of unique sensations
that is essential for clinical efficacy according to traditional Chinese medicine
(TCM).' They do not indicate their intention to study other non-invasive forms of
acupuncture, or indeed any methods which do not rely upon obtaining a de qi response
such as Japanese acupuncture, merely TCM acupuncture.
The use of an experienced acupuncturist was clearly important for the study and 25
years of clinical experience of acupuncture would, I suggest, equip him to elicit
the appropriate de qi response and at the appropriate depth of needling for the selected
The purpose of the exercise was not to specify how deeply the needles were inserted
but that a de qi response was obtained. It would have been of interest to know the
depth (although the information can be readily obtained elsewhere) but not essential.
The study aim was to characterise de qi phenomena so it is unsurprising that the investigators
wanted to elicit such a response. It seems surprising that this can be misconstrued
as predetermining the outcome.
The tapping of points with a monofilament prior to needling provided a control and
also introduced another element into the equation, which is that even gently touching
an acupuncture point will elicit a response.
As to the final comment, ANY competent acupuncturist can perform acupuncture without
eliciting a de qi response - tapping a needle into a point through a guide tube and
then leaving it should fulfil the criteria. However, Mr Moffett still misses the
point of the study. It is not whether achieving de qi is necessary when carrying
out an acupuncture treatment, or even whether it is possible to perform acupuncture
without achieving de qi. It is characterising the de qi response.
(2007-12-10 11:28) Kaiser Permanente Division of Research
Hui et al reported on their investigation into sensations elicited by acupuncture
needling which are known as deqi. The authors have previously made significant contributions
to our understanding of how the brain responds to acupuncture stimulation.
The present study of deqi is motivated by the premise that “this state [sic]
is essential for clinical efficacy,” but two years ago, they professed merely
that deqi is “related to clinical efficacy.” In fact, there is little
evidence for the necessity of deqi, in part because “there is lack of adequate
experimental data to indicate what sensations comprise deqi.” Non-invasive
forms of acupuncture point stimulation, including acupressure, moxibustion and Toyo
Hari acupuncture, are not known to depend on deqi. While deqi may reflect relevant
nervous system input, the belief that deqi is necessary for clinical effectiveness
The study investigators enlisted an acupuncturist whose “sensitivity to needle
manipulation was pretested, aiming to reliably elicit deqi sensations.”
Unfortunately, the authors fail to state how or by what criteria the acupuncturist
was pretested. The study aim was to characterize deqi phenomenon, but the intervention
was chosen for its ability to reliably produce the outcome they sought to study.
Thus they reported that the predetermined outcome has reliable characteristics! Clinical
investigations are more informative when they are less tautological.
The authors described the needling technique, but failed to mention the depth of needle
insertions (0.5-1.0” are minimum depths typically prescribed for these points).
For the control, “superficial tactile stimulation was performed by gentle tapping
with a size 5.88 von Frey monofilament;” that is, with no insertion. The
subjects reported that the “frequency and intensity of individual sensations
were significantly higher in acupuncture” than in superficial tactile stimulation.
That subcutaneous needling feels more intense than superficial stimulation is neither
surprising nor informative.
The authors claim that they “have provided experimental evidence to support
the occurrence of a unique composition of sensations termed deqi,” but they
determined only that the sensations are different from those produced by one type
of superficial tactile stimulation and have failed to demonstrate uniqueness. Patients
naturally experience diverse sensations depending on the needling technique and their
own health status. Moreover, needling sensations experienced by healthy volunteers,
even if consistent, may have little or no relevance to those in ill patients.
If we grant that the investigators have demonstrated that one acupuncturist can reliably
elicit deqi, can this (or any) acupuncturist perform acupuncture which reliably does
not elicit deqi? That is, can the acupuncturist choose to elicit deqi or not? Deqi
may simply be an artifact of needling and not essential for clinical effectiveness.
1. Hui KK, Nixon EE, Vangel MG, Liu J, Marina O, Napadow V et al.: Characterization
of the "Deqi" Response in Acupuncture. BMC Complement Altern Med 2007, 7: 33.
2. Hui KK, Liu J, Marina O, Napadow V, Haselgrove C, Kwong KK et al.: The integrated
response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation
at ST 36 as evidenced by fMRI. Neuroimage 2005, 27: 479-496.
3. O'Connor J, Bensky D: Acupuncture, a comprehensive text. Chicago: Eastland Press;
BioMed Central Ltd unless otherwise stated. Part of Springer Science+Business Media.