concept from classics of in chinese medicinedownloads.hindawi.com/journals/ecam/2013/639302.pdf ·...

Hindawi Publishing CorporationEvidence-Based Complementary and Alternative MedicineVolume 2013 Article ID 639302 5 pageshttpdxdoiorg1011552013639302

Review ArticleThe Historical Development of Deqi Concept from Classics ofTraditional Chinese Medicine to Modern Research Exploitationof the Connotation of Deqi in Chinese Medicine

Hong-Wen Yuan12 Liang-Xiao Ma13 Dan-Dan Qi1 Peng Zhang1

Chun-Hua Li4 and Jiang Zhu13

1 School of Acupuncture Moxibustion and Tuina Beijing University of Chinese Medicine Beijing 100029 China2 School of Traditional Chinese Medicine Capital Medical University Beijing 100069 China3The Key Unit of Evaluation of Characteristic Acupuncture Therapy State Administration of Traditional Chinese MedicineBeijing 100029 China

4 Beijing Electric Power Hospital Capital Medical University Beijing 100073 China

Correspondence should be addressed to Jiang Zhu jzhjzh263net

Received 12 May 2013 Revised 11 September 2013 Accepted 18 September 2013

Academic Editor Lijun Bai

Copyright copy 2013 Hong-Wen Yuan et al This is an open access article distributed under the Creative Commons AttributionLicense which permits unrestricted use distribution and reproduction in any medium provided the original work is properlycited

Although it is difficult in fully clarifying its mechanisms and effectsDeqi still can be considered as an instant ldquosignrdquo of acupunctureresponse of the patient and acupuncturist which has a significant value in clinic and research This paper aims to take a historytrace to the development of Deqi theory understand the connotation of Deqi based on Chinese medicine theory and establish anevaluation methodology accordingly We believe that Deqi is not only the needling sensation but also the perception of changes of1199021198941015840

flowing of the patient elicited by needling on acupoints The signs of Deqi include the patientrsquos subjective perception (needlingsensation) the objective physiological changes (common referred to the skin redness around the acupoints and the response ofbrain) and the acupuncturistsrsquo perception Although Deqi is essential for attaining the effect it may not be the necessary sign ofthe ideal efficacy It is found that the characteristics of Deqi sensations Deqirsquos intensity time duration and the propagation will allaffect the efficacy Thus acupuncturists should pay attention to elicit and control Deqi state which is also the key point in modernresearch on the therapeutic implications of Deqi

1 Introduction

There is so far little evidence of investigating the relationshipbetween the therapeutic efficacy of acupuncture and theDeqi experience However as the specific perception ofacupuncture stimulation Deqi may influence the physicaland psychological condition of the patients

The terms of ldquoDeqirdquo and ldquoQizhirdquo were first found inldquoHuang Di Neijingrdquo [1] The sentence ldquoacupuncture therapydoes not take effect until the arrival of energyrdquo which isthought to be the basic principle to guide the clinical practiceof acupuncture At present most acupuncture doctors andresearchers in China [2ndash5] believe that Deqi is essential forthe efficacy of acupuncture and it is necessary to induce Deqisensation to a certain degree

Some clinical results confirm thatDeqi reveals some con-nection with the efficacy of acupuncture treatment [6ndash11]however others concluded that Deqi sensations did notresult in effectiveness [12 13] Learning from these studieswe found that studies conducted in China usually applieddeep needling (1 to 2 cm) with manipulations every 5minduring needle retention (30min as usual) so as to maintaincertain intensity and time duration ofDeqi sensations Whilethe studies abroad mostly insert superficially or manipulateneedle only once in the treatment

There is one sentence in Neijing that talked about DeqildquoThe qi in acupoints is delicate means that to elicit responsesof qi (Deqi) maintaining qi and watch the movementsof energy is an important step in acupuncture therapyrdquo

2 Evidence-Based Complementary and Alternative Medicine

(from Ling Shu Chapter 3 on minute needle) It confirmedthat ldquomaintaining qirdquo actually refers to the fact that maintain-ing the intensity and time duration of needling sensation isnecessary after Deqi The manipulation every 5min duringneedle retention afterDeqimay be the key to a higher efficacyin the study Some researchers also pay attention to thedose-effect relationship of acupuncture and consider thatthe efficacy of acupuncture treatment depends on complexfactors such as the number of needles depth of needlingpoint location needling retention and interval between twosessions [14] Therefore the intensity of needling in mostpresent acupuncture studies might not be enough for achiev-ing therapeutic effects It may help some confounders to havebiased findings toward a negative outcome [15 16] Theseviews support that Deqi is a key to the treatment efficacyHowever the diversity of perspectives on the relationshipbetween Deqi and effect in current studies may be caused bydifferent understanding of Deqi

The distinct difference in the understanding of Deqi canbe found in the literatures in China and other countriesAmong the Deqi related literatures published in China since1950 there are 137 articles (67) discussed on the under-standing of Deqi There are a variety of definitions of Deqiacross different textbooks

2 The Definitions of Deqi Nowadays

In the latest ldquoEleventh Five-Yearrdquo national plan textbookldquoAcupuncture and Moxibustionrdquo Zhen Jiu Xue [17] statesldquoDeqi normally calledQizhi in ancient or needling sensationin modern refers to the response of channel qi elicited byacupuncture stimulation such as lifting thrusting as wellas rotating the needle after inserting the needle into anacupointrdquo The signs of Deqi include two aspects one is thepatientsrsquo needling sensations and the other is acupunctur-istrsquos perceptions When obtaining qi the patient may feelsensations of suan (soreness) ma (numbness) zhang (full-nessdistention) and zhong (heaviness) and sometimes afeeling of heat cold pain itching muscular twitchingformication and so forth and those sensations can spread insome certain directions A fewpatientsmay show the reactionof twitching or involuntary movement of skin and musclesalong the stimulated channel or red skin rash or red or whitelines on the skin around the punctured area At the same timethe acupuncturist may feel heavy tight or vibration of theneedle If Deqi is not evoked the patient would not have anyspecial feeling or reactions and the acupuncturist may feelthe needles are loose and empty

The widely accepted definition of Deqi in English lan-guage textbooks is ldquoTraditional acupuncture involves stimu-lation with very fine needles inserted into defined sites on thebody eliciting a composite of sensations termedDeqi whichis considered to be related to clinical efficacy in traditionalChinese medicinerdquo [18]

The latest Chinese-English Dictionary of TraditionalChinese Medicine (TCM) defines Deqi as ldquoneedling sensa-tion which refers to the patientrsquos response to sore numbdistention electric shock and the doctorrsquos heavy and tightsensation coming from beneath the needlerdquo [19]

Several randomized controlled clinical trials in a largesample with a significant influence usually defined Deqi asldquoan irradiating feeling deemed to indicate effective needlingrdquo[6 20 21]

Recently the most common definition of Deqi is ldquotheneedling sensations of both patient and acupuncturistrdquo How-ever in the theory of TCM acupuncture needling sensationis the most significant manifestation of Deqi but they arenot equal on the level of connotation In addition modernfunctional brain imaging technology also demonstrated thatclassic Deqi sensation such as a sense of soreness haddifferent effect on the certain area of the brain compared withsharp pain [22] which further supports the point that Deqi isnot equal to needling sensation

3 The Origin of Deqi Theory

The theory of TCM acupuncture generated from traditionalChinese culture Therefore prior to the study of Deqi theorywe should firstly understand its background and then theconnotation of Deqi could be explained by modern researchmethods

Deqi is derived from the concept of ldquoQirdquo in ldquoHuang DiNeijingrdquo (written in AD 206sim221 [23]) ldquoQirdquo is an importantconcept inNeijing to describe the activities of human lifeTheability tomaintain a healthy state is normally called healthy qi(zheng qi) or grain qi (gu qi) while the exogenous pathogenicfactors that lead to varieties of diseases or pathologicalchanges in the body are called pathogenic qi (xie qi)

In Neijing the formation of the theory of ldquoQirdquo is mainlyoriginated from ldquothe theory of qi transformation in liferdquo inTaoism In the Taoism work ldquoHuai Nan Zirdquo [24] ldquobodyrdquoldquoqirdquo and ldquomindrdquo are composed of three treasures of lifeThey are interdependent andmutually relatedThe efficacy ofacupuncture would be closely related to the patientrsquos mentalstatus and psychological factors showing correspondencebetween ldquoqirdquo and ldquomindrdquo Both the patient and acupuncturistwill perceive certain sensations after Deqi which is actuallythe interactions between ldquoqirdquo and ldquobodyrdquo Moreover TCMholds that the qi of the human body corresponds to theseasons resulting in the relationship between physiologicalchanges and the replacement of the four seasons Thus theseasons may affect the difficulty of Deqi For example theblood flows superficially in summer during which Deqi iseasier while the blood flows deeply in winter and Deqi isrelatively difficult In Neijing ldquoqirdquo can also be classified intothree categories organrsquos qi (Zangqi) channelrsquos qi (Jingqi)and vesselrsquos qi (Maiqi) These three types of qi circulate inthe body nonstoppingly Therefore stimulating acupoints onchannel can regulate the certain internal organ to cure thedisease Detecting the changes of pulse can also be applied todetermine ldquoDeqirdquo in Neijing

In summary the theory of ldquoQirdquo in Neijing is the basis ofthe traditional acupuncture theory of ldquoDeqirdquo Phenomenonand impact of Deqi are all developed on this basis TCMacupuncture emphasizes that the acupuncturist should con-centrate on the needling process and carefully perceive thesensations below the needle to judge and regulate qi of thepatient

Evidence-Based Complementary and Alternative Medicine 3

4 The Development of Connotation of Deqi

Theview that acupuncture treatment efficacy is closely relatedto Deqi originated in Neijing ldquoIf insertion of needle failsto bring about the response of energy treatment should becontinued for as long as necessary Acupuncture therapy doesnot take effect until arrival of energy (Qizhi)rdquo (from LingshuChapter 1 Nine needles and twelve original points) What ismore there is a detailed explanation of ldquoQizhirdquo in Neijingldquothe principles of needling dictate that needling should stopas soon as energy is brought into harmony due to tone up thebody energy of yin and sedate the pathogen of yang or to toneup the body energy of yang and sedate the pathogen of yin The assertion that needling takes effect so long as Qizhimeans that an excessive disease could be sedated and thedeficient energymay be complementrdquo (from LingshuChapter9 From beginning to end) It expresses that the functionof acupuncture is ldquoregulating qirdquo which can be achievedby supplementing and draining acupuncture manipulationTherefore pathogens can be eliminated deficient healthy qican be supplemented or reversed flow of qi be adjustedleading to a state of yin-yang balanceThe connotation of ldquoqirdquoin ldquoQizhirdquo refers to healthy qi or grain qi Obviously Qizhiindicates ldquoproper intensity of stimulationrdquo and also the signof removing the needle In Neijing ldquoDeqirdquo and ldquoQizhirdquo areusually considered as the same regarded as a sign of efficacy[25 26]

TheDifficult Classic (Nanjing) [27]written inAD 106sim210[28] normally has similar reputation as Neijing in ChinesemedicineThe chapter of Seventy-eight Difficult Issues statesldquoInsert a needle along the route of the channel to induceDeqifirstly Then thrusting the needle inward is a supplementarymethod while lifting the needle outward is a drainingmethodrdquo That text shows that certain needling techniquesfor supplementary or draining are applied afterDeqiNanjingdescribes Deqi as the basis and premise of acupuncturemanipulation It may indicate thatDeqi andQizhi are not thesameDeqi refers to the first period ofQizhi which is the signof ideal efficacy

The development of acupuncture can be traced to the Jinand YuanDynasty (AD 1115sim1368) clarifying that Deqi is thebase of acupuncture manipulation There is one sentence inSong to Elucidate Mysteries (Biao You Fu) written by DouHanqing starting ldquoThen the acupuncturist should perceiveqi carefully The sensation of loose and empty beneath theneedle means qi does not arrive While heaviness tightnessand fullness sensations suggest that qi has arrived When qiarrives manipulate the needle properly according to cold orheat syndromes when qi does not arrive wait for qi accordingto deficiency or excess conditionsrdquo It keeps the same pointas the Nanjing Till that time it is found that Deqi not onlyis related to the treatment efficacy but also can be used todetermine the prognosis of the disease As written in Song toelucidate mysteries ldquothe more quickly of qi arrives the easierthe disease is to cure supposing the qi does not arrive thepatient may be hard to curerdquo which means that the degree ofdifficulties of getting Deqi can predict the efficacy Of coursehere the efficacy does not refer to the real-time acupunctureeffect but to the significant treatment efficacy of the disease

As the acupuncture developed in the Ming and Qingdynasties (1368sim1911) there is a further illustration of therelationship between the acupuncturistrsquos perception of theneedle and efficacy One of the most influenced publicationsat that time The Complete Compendium of Acupunctureand Moxibustion (Zhen Jiu Da Cheng) [29] states ldquoHowto remove the needle depends on the acupuncturistrsquos per-ception on the needle Extremely tense and firm sensationbeneath the needle indicates the needle is being grabbed bypathogens not by the healthy qi therefore the needle cannotbe removed If the needle was removed at this momentthe disease might be palindromia Instead needling tech-niques for supplementary and draining should be appliedand retain the needle for a certain period Only when alooser sensation beneath the needle is felt the needle canbe removedrdquo According to these texts acupuncturist shouldclarify the sensations beneath the needle afterDeqi It is calledldquodistinguishing qirdquo

Originating from Nanjing the connotation of ldquoDeqirdquo andldquoQizhirdquo are different ldquoQizhirdquo is obtaining the effect of thefinal state through the returning of qi in human body bynormal acupuncture treatment while ldquoDeqirdquo is the early partof ldquoQizhirdquo which means that the qi has been elicited to theneedle After realizingDeqi it is still needed to distinguish thecharacter of qi and apply the related manipulation or retainthe needle so as to reach the ldquoQizhirdquo state [30ndash33]

5 The Evaluation Method of Deqi Based onIts TCM Connotation

51 Both Notice the Perception of Patient and AcupuncturistEvaluation of Deqi in ancient Chinese medicine mainlyfocused on the acupuncturistrsquos perceptions rather than thepatientrsquos needling sensation during an acupuncture treat-ment Ancient Chinese acupuncturists believe that duringacupuncture the acupuncturist should concentrate on thechanges of qi after the needle being inserted so as to knowthe situation of patient and disease then give appropriateneedling manipulations to regulate qi Moreover the abilityof ldquoeliciting qirdquo ldquodistinguishing qirdquo and ldquoregulating qirdquo reflectsthe level of healing skill of the acupuncturist Inmodern timeDeqi is defined as the needling sensation so the quantitativeevaluations ofDeqi aremainly based on the patientrsquos needlingsensations [34ndash37] Although the needling sensations of thepatient are more direct and sensitive we suggest that theperceptions of the acupuncturist should be noticed as wellwhich is the key of ldquoregulating qi with the needlerdquo

52 Distinguish the Sensation of Penetrating Skin from DeqiIn TCM Deqi is the sign of the change of qi so it should beelicited when the needle is inserted into the acupoint Parket al [38] also find a strong connection between acupunc-ture sensation and tissue depth the frequency of prinkingand sharp sensation was significantly greater in shallowertissue levels and the frequency of sensations described astraditionalDeqi sensation such as dull heavy and spreadingwas significantly greater in deeper tissue levels Thereforethe pain or other sensations which could be felt when


the needle penetrated skin is not Deqi sensation In recentneedle sensation questionnairescale the item ldquosharp painrdquoldquoprickingrdquo and ldquopenetratingrdquo may evaluate the sensation ofpenetrating skin but notDeqi It would be better to design aninstrument for calling attention to the patient to distinguishthe sensation of needling penetrating from Deqi

53 Evaluating Deqi More Comprehensively Than Existenceand Intensity Deqi is closely related to the treatment efficacyin Neijing however the formation of Deqi is only the firststep of achieving the ideal efficacy in traditional theoryThrough diagnosing based on qi after Deqi retaining theneedle skills further improve the acupuncture efficacy Afterimmediately finishing the treatment after Deqi the patientcondition would deteriorate as the doss of stimulation isnot enough It was also stated that ldquoQi extending affectedtreatment partiallyrdquo as mentioned in Zhen Jiu Da Chengwhich means that the correct direction and a certain distanceof Deqi spreading can enhance the efficacy Therefore theevaluation of Deqi existence and intensity is only two aspectsin evaluating the relationship between the Deqi and thetreatment efficacy The nature of qi intensity duration andthe spreading should be recorded comprehensively by Deqievaluation instrument which may influence the efficacy inclinical trials

54 Notice the Influence of Deqi in ldquoMindrdquo The traditionaltheory of Deqi does not merely refer to the needle feelingbut also includes the reaction of ldquoqirdquo in the human bodyAccording to TCM theory this phenomenon can affect con-stituting the other two significant elements of the humanbody the ldquobodyrdquo and ldquomindrdquo manifested in ldquobodyrdquo is theneedle feeling while that manifested in ldquomindrdquo referred tothe change of the state of brain function which are the twomost important factors in evaluating the Deqi

The study of brain central mechanisms of acupuncturecarried out recently is combined with a large number ofbrain imaging technology (PET SPECT fMRI etc) whichprovides a scientific method in investigating the Deqi effectResearchers hope to define a model ofDeqi brain function byapplying the brain functional imaging technology throughwhich the cases fit this model can be defined as Deqi soit may become easy to distinguish whether to get Deqi ornot [39] Kong et al [40] have confirmed that the signals offMRI can correctly reflect the specificity Deqi state betweenthe different individuals which provides a reliable method toevaluate Deqi

6 Conclusion

Acupuncture is one of the important methods to realizeldquomediating meridians regulating the qi and bloodrdquo in TCMin which Deqi plays an important role in the process ofacupuncture Neijing lays the theoretical basis of the theoryof Deqi Deqi does not only refer to needling sensations butalso involves the changes of qi induced by needle insertioninto the acupoint The signs of Deqi include the patientrsquos sen-sations (needling sensations) objective physiological changes

(commonly refer to the skin redness around the acupointas well as the response of brain) and the acupuncturistrsquosperceptions Deqi is closely related to the treatment efficacyhowever it is not a necessary sign for the most ideal efficacyThe characteristics ofDeqi including what kind of sensationsof both patient and acupuncturist their prevalence intensitytime duration and the propagated sensation along channelwill all affect the treatment efficacy So acupuncturists shouldpay attention to elicit Deqi and control its state which isalso the key point in modern research on the therapeuticimplications of Deqi

Authorsrsquo Contribution

Hong-Wen Yuan and Liang-Xiao Ma contributed equally tothis work

Acknowledgments

The authors sincerely acknowledge the National BasicResearch Program of China (973 Program) (nos2012CB518506 and 2006CB504503) the National NaturalScience Foundation of China (no 30973793) and the Doc-toral Program of Higher Education of Ministry of Educationof China (no 20090013110005) for funding this study

References

[1] BWangHuangDi Nei Jing TCMAncient Books Press BeijingChina 2003

[2] Y W Zhu ldquoAcademic strong points and clinical experienceof veteran TCM doctor Luo Shirongrdquo Chinese Acupuncture ampMoxibustion vol 23 no 3 pp 37ndash39 2003

[3] Y Q Yuan ldquoXie Guorongrsquos experience on needling methodsrdquoChinese Acupuncture amp Moxibustion vol 23 no 11 pp 44ndash462003

[4] X-YGao S-J Shao S-X Shao andQ-LMa ldquoStudy on profes-sor Shao Jing-Mingrsquos academic thoughtrdquo Chinese Acupunctureamp Moxibustion vol 27 no 5 pp 362ndash364 2007

[5] Q Wang R Hu X-Y Zhong and G-Q Zhu ldquoProfessorHUANG Xuan-Weirsquos clinical experience in acupuncture andmoxibustionrdquo Chinese Acupuncture amp Moxibustion vol 28 no6 pp 445ndash447 2008

[6] C Witt B Brinkhaus S Jena et al ldquoAcupuncture in patientswith osteoarthritis of the knee a randomised trialrdquoThe Lancetvol 366 no 9480 pp 136ndash143 2005

[7] W Takeda and JWessel ldquoAcupuncture for the treatment of painof osteoarthritic kneesrdquo Arthritis Care and Research vol 7 no3 pp 118ndash122 1994

[8] J Vas E Perea-Milla C Mendez et al ldquoEfficacy and safetyof acupuncture for chronic uncomplicated neck pain a ran-domised controlled studyrdquo Pain vol 126 no 1ndash3 pp 245ndash2552006

[9] X Q Huang ldquoThe study of relationship between acupunctureeffect and Deqi phenomenonrdquo Chinese Acupuncture amp Moxi-bustion vol 19 no 1 pp 19ndash21 1999

[10] M H Sui C YWang andW Z Ma ldquoEffect of arrival of Qi andthemethod of reinforcing-reducing by twirling and rotating theneedle by acupuncturing quchi(LI 11) on the blood pressure


of essential hypertension patientsrdquo Information on TraditionalChinese Medicine vol 29 no 3 pp 87ndash90 2012

[11] J Xiong F Liu M-M Zhang W Wang and G-Y HuangldquoDe-qi not psychological factors determines the therapeuticefficacy of acupuncture treatment for primary dysmenorrheardquoChinese Journal of Integrative Medicine vol 18 no 1 pp 7ndash152012

[12] P White P Prescott and G Lewith ldquoDoes needling sensation(de qi) affect treatment outcome in pain Analysis of data froma larger single-blind randomised controlled trialrdquo Acupuncturein Medicine vol 28 no 3 pp 120ndash125 2010

[13] A Enblom A Johnsson M Hammar E Onelov G Stei-neck and S Borjeson ldquoAcupuncture compared with placeboacupuncture in radiotherapy-induced nauseamdasha randomizedcontrolled studyrdquo Annals of Oncology vol 23 no 5 pp 1353ndash1361 2012

[14] X B Chang X N Fan S Wang et al ldquoThe origin of lsquoacu-puncture quantificationrsquo studyrdquo Journal of Traditional ChineseMedicine vol 52 no 5 pp 363ndash366 2011

[15] A Benham andM I Johnson ldquoCould acupuncture needle sen-sation be a predictor of analgesic responserdquo Acupuncture inMedicine vol 27 no 2 pp 65ndash67 2009

[16] A White M Cummings P Barlas et al ldquoDefining an adequatedose of acupuncture using a neurophysiological approachmdashanarrative review of the literaturerdquoAcupuncture inMedicine vol26 no 2 pp 111ndash120 2008

[17] X M Shi Acupuncture and Moxibustion (Zhen Jiu Xue) ChinaTraditional Medicine Press Beijing China 2007

[18] X Cheng Chinese Acupuncture amp Moxibustion Foreign Lan-guages Press Beijing China 1987

[19] Y X Yuan J Ren L Huang et al Chinese-English Dictionary ofTraditional Chinese Medicine RenminWeisheng Press BeijingChina 1997

[20] K Linde A Streng S Jurgens et al ldquoAcupuncture for patientswith migraine a randomized controlled trialrdquo Journal of theAmerican Medical Association vol 293 no 17 pp 2118ndash21252005

[21] D Melchart A Streng A Hoppe et al ldquoAcupuncture inpatients with tension-type headache randomised controlledtrialrdquo British Medical Journal vol 331 no 7513 pp 376ndash3792005

[22] K K S Hui E E Nixon M G Vangel et al ldquoCharacterizationof the ldquoDeqirdquo response in acupuncturerdquo BMC Complementaryand Alternative Medicine vol 7 article 33 2007

[23] X J Xia J G Xie and S Q Zhang ldquoA test on composing timeof Huang Di Nei Jingrdquo Gansu Journal of Traditional ChineseMedicine vol 22 no 5 pp 4ndash5 2009

[24] G Z Chen Huai Nan Zi Zhonghua Book Company BeijingChina 2012

[25] M Feng and T S Hou ldquoA rough vision for Qizhi in Huang DiNei Jingrdquo Jiangsu Journal of Traditional Chinese Medicine vol42 no 12 pp 66ndash67 2010

[26] C Z Liu and S Z Gao ldquoDiscussion on arrival of Qi in themiraculous pivotrdquo Liaoning Journal of Traditional ChineseMedicine vol 30 no 3 pp 173ndash174 2003

[27] Nanjing College of Traditional Chinese Medicine Collationand Annotation of Nanjing Peoplersquos Medical Publishing PressBeijing China 2009

[28] J Y Li ldquoA test on composing time ofNanjingrdquo Journal of HenanUniversity of Traditional ChineseMedicine no 4 pp 12ndash14 1979

[29] J Z YangZhen JiuDaCheng PeoplersquosMedical PublishingPressBeijing China 2006

[30] C YWangM Xue Q G Liu et al ldquoThe difference understand-ing about ldquoDeqirdquo and ldquoQizhirdquo between Neijing and NanjingrdquoJournal of BeijingUniversity of Traditional ChineseMedicine vol14 no 3 pp 28ndash29 2007

[31] Z G Li and S K Liu ldquoDiscussion on the ldquoarrival of Qirdquo inmed-ical classic lsquothe yellow emperorrsquos internal classicrsquordquo AcupunctureResearch vol 30 no 4 pp 246ndash248 2005

[32] P-Q Wang ldquoDeqi and application and manipulation of DeqirdquoChinese Acupuncture ampMoxibustion vol 27 no 5 pp 349ndash3512007

[33] F Zhang and H D Wang ldquoDiscussion on needling sensationarrival of qi and needling response (Deqi)rdquo Chinese Acupunc-ture amp Moxibustion vol 32 no 12 pp 1132ndash1134 2012

[34] C A Vincent P H Richardson J J Black andC E Pither ldquoThesignificance of needle placement site in acupuncturerdquo Journal ofPsychosomatic Research vol 33 no 4 pp 489ndash496 1989

[35] H Park J Park H Lee and H Lee ldquoDoes Deqi (needle sen-sation) existrdquo American Journal of Chinese Medicine vol 30no 1 pp 45ndash50 2002

[36] J Kong R Gollub T Huang et al ldquoAcupuncture Deqi fromqualitative history to quantitative measurementrdquo Journal ofAlternative and Complementary Medicine vol 13 no 10 pp1059ndash1070 2007

[37] P White F Bishop H Hardy et al ldquoSouthampton needle sen-sation questionnaire development and validation of a measureto gauge acupuncture needle sensationrdquo Journal of Alternativeand Complementary Medicine vol 14 no 4 pp 373ndash379 2008

[38] J J Park M Akazawa J Ahn et al ldquoAcupuncture sensationduring ultrasound guided acupuncture needlingrdquo Acupuncturein Medicine vol 29 no 4 pp 257ndash265 2011

[39] X-S Lai and Y Huang ldquoA cerebral functional definition on thespecificity of acupoints needling sensation and association ofacupoints based on the lsquoacupoints-brain relation hypothesisrsquordquoChinese AcupunctureampMoxibustion vol 27 no 10 pp 777ndash7802007

[40] J Kong R L Gollub J M Webb J-T Kong M G Vangel andK Kwong ldquoTest-retest study of fMRI signal change evoked byelectroacupuncture stimulationrdquoNeuroImage vol 34 no 3 pp1171ndash1181 2007

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Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom


(from Ling Shu Chapter 3 on minute needle) It confirmedthat ldquomaintaining qirdquo actually refers to the fact that maintain-ing the intensity and time duration of needling sensation isnecessary after Deqi The manipulation every 5min duringneedle retention afterDeqimay be the key to a higher efficacyin the study Some researchers also pay attention to thedose-effect relationship of acupuncture and consider thatthe efficacy of acupuncture treatment depends on complexfactors such as the number of needles depth of needlingpoint location needling retention and interval between twosessions [14] Therefore the intensity of needling in mostpresent acupuncture studies might not be enough for achiev-ing therapeutic effects It may help some confounders to havebiased findings toward a negative outcome [15 16] Theseviews support that Deqi is a key to the treatment efficacyHowever the diversity of perspectives on the relationshipbetween Deqi and effect in current studies may be caused bydifferent understanding of Deqi

The distinct difference in the understanding of Deqi canbe found in the literatures in China and other countriesAmong the Deqi related literatures published in China since1950 there are 137 articles (67) discussed on the under-standing of Deqi There are a variety of definitions of Deqiacross different textbooks

2 The Definitions of Deqi Nowadays

In the latest ldquoEleventh Five-Yearrdquo national plan textbookldquoAcupuncture and Moxibustionrdquo Zhen Jiu Xue [17] statesldquoDeqi normally calledQizhi in ancient or needling sensationin modern refers to the response of channel qi elicited byacupuncture stimulation such as lifting thrusting as wellas rotating the needle after inserting the needle into anacupointrdquo The signs of Deqi include two aspects one is thepatientsrsquo needling sensations and the other is acupunctur-istrsquos perceptions When obtaining qi the patient may feelsensations of suan (soreness) ma (numbness) zhang (full-nessdistention) and zhong (heaviness) and sometimes afeeling of heat cold pain itching muscular twitchingformication and so forth and those sensations can spread insome certain directions A fewpatientsmay show the reactionof twitching or involuntary movement of skin and musclesalong the stimulated channel or red skin rash or red or whitelines on the skin around the punctured area At the same timethe acupuncturist may feel heavy tight or vibration of theneedle If Deqi is not evoked the patient would not have anyspecial feeling or reactions and the acupuncturist may feelthe needles are loose and empty

The widely accepted definition of Deqi in English lan-guage textbooks is ldquoTraditional acupuncture involves stimu-lation with very fine needles inserted into defined sites on thebody eliciting a composite of sensations termedDeqi whichis considered to be related to clinical efficacy in traditionalChinese medicinerdquo [18]

The latest Chinese-English Dictionary of TraditionalChinese Medicine (TCM) defines Deqi as ldquoneedling sensa-tion which refers to the patientrsquos response to sore numbdistention electric shock and the doctorrsquos heavy and tightsensation coming from beneath the needlerdquo [19]

Several randomized controlled clinical trials in a largesample with a significant influence usually defined Deqi asldquoan irradiating feeling deemed to indicate effective needlingrdquo[6 20 21]

Recently the most common definition of Deqi is ldquotheneedling sensations of both patient and acupuncturistrdquo How-ever in the theory of TCM acupuncture needling sensationis the most significant manifestation of Deqi but they arenot equal on the level of connotation In addition modernfunctional brain imaging technology also demonstrated thatclassic Deqi sensation such as a sense of soreness haddifferent effect on the certain area of the brain compared withsharp pain [22] which further supports the point that Deqi isnot equal to needling sensation

3 The Origin of Deqi Theory

The theory of TCM acupuncture generated from traditionalChinese culture Therefore prior to the study of Deqi theorywe should firstly understand its background and then theconnotation of Deqi could be explained by modern researchmethods

Deqi is derived from the concept of ldquoQirdquo in ldquoHuang DiNeijingrdquo (written in AD 206sim221 [23]) ldquoQirdquo is an importantconcept inNeijing to describe the activities of human lifeTheability tomaintain a healthy state is normally called healthy qi(zheng qi) or grain qi (gu qi) while the exogenous pathogenicfactors that lead to varieties of diseases or pathologicalchanges in the body are called pathogenic qi (xie qi)

In Neijing the formation of the theory of ldquoQirdquo is mainlyoriginated from ldquothe theory of qi transformation in liferdquo inTaoism In the Taoism work ldquoHuai Nan Zirdquo [24] ldquobodyrdquoldquoqirdquo and ldquomindrdquo are composed of three treasures of lifeThey are interdependent andmutually relatedThe efficacy ofacupuncture would be closely related to the patientrsquos mentalstatus and psychological factors showing correspondencebetween ldquoqirdquo and ldquomindrdquo Both the patient and acupuncturistwill perceive certain sensations after Deqi which is actuallythe interactions between ldquoqirdquo and ldquobodyrdquo Moreover TCMholds that the qi of the human body corresponds to theseasons resulting in the relationship between physiologicalchanges and the replacement of the four seasons Thus theseasons may affect the difficulty of Deqi For example theblood flows superficially in summer during which Deqi iseasier while the blood flows deeply in winter and Deqi isrelatively difficult In Neijing ldquoqirdquo can also be classified intothree categories organrsquos qi (Zangqi) channelrsquos qi (Jingqi)and vesselrsquos qi (Maiqi) These three types of qi circulate inthe body nonstoppingly Therefore stimulating acupoints onchannel can regulate the certain internal organ to cure thedisease Detecting the changes of pulse can also be applied todetermine ldquoDeqirdquo in Neijing

In summary the theory of ldquoQirdquo in Neijing is the basis ofthe traditional acupuncture theory of ldquoDeqirdquo Phenomenonand impact of Deqi are all developed on this basis TCMacupuncture emphasizes that the acupuncturist should con-centrate on the needling process and carefully perceive thesensations below the needle to judge and regulate qi of thepatient
















6 Conclusion





Acknowledgments


References
















































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of































6 Conclusion





Acknowledgments


References
















































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of





















































of






Disease Markers



OncologyJournal of





PPAR Research



Journal of

ObesityJournal of
















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