Deqi sensations without cutaneous sensory input: results of an RCT

Abstract

BackgroundDeqi is defined in relation to acupuncture needling as a sensory perception of varying character. In a recently published sham laser validation study, we found that subjects in the verum and the sham laser group experienced deqi sensations. Therefore, we aim to further analyze whether the perceptions reported in the two study arms were distinguishable and whether expectancy effects exhibited considerable impact on our results.MethodsA detailed re-analysis focusing on deqi sensations was performed from data collected in a previously published placebo-controlled, double-blind, clinical cross-over trial for a sham laser evaluation. Thirty-four healthy volunteers (28 ± 10.7 years; 16 women, 18 men) received two laser acupuncture treatments at three acupuncture points LI4 (hégu), LU7 (liéque), and LR3 (táichong); once by verum laser and once using a sham device containing an inactive laser in randomized order. Outcome measures were frequency, intensity (evaluated by visual analogue scale; VAS), and quality of the subjects' sensations perceived during treatments (assessed with the "acupuncture sensation scale").ResultsBoth, verum and the sham laser acupuncture result in similar deqi sensations with regard to frequency (p-value = 0.67), intensity (p-value = 0.71) and quality (p-values between 0.15 - 0.98). In both groups the most frequently used adjectives to describe these perceptions were "spreading", "radiating", "tingling", "tugging", "pulsing", "warm", "dull", and "electric". Sensations reported were consistent with the perception of deqi as previously defined in literature. Subjects' conviction regarding the effectiveness of laser acupuncture or the history of having received acupuncture treatments before did not correlate with the frequency or intensity of sensations reported.ConclusionsSince deqi sensations, described as sensory perceptions, were elicited without any cutaneous sensory input, we assume that they are a product of non-specific effects from the overall treatment procedure. Expectancy-effects due to previous acupuncture experience and belief in laser acupuncture do not seem to play a major role in elicitation of deqi sensations. Our results give hints that deqi might be a central phenomenon of awareness and consciousness, and that its relevance should be taken into account, even in clinical trials. However, further research is required to understand mechanisms underlying deqi.

A Literature Review of de qi in clinical studies

“…Salih et al 35 conducted a study comparing de qi after real and sham-laser acupunctures and found that spreading, radiating, tingling, tugging, pulsing, warm and dull were the sensations most frequently experienced by both groups. The results also indicated that real acupuncture and sham-laser acupuncture produced de qi that was similar in terms of frequency, intensity and quality.…”

The Japanese Version of the Massachusetts General Hospital Acupuncture Sensation Scale: A Validation Study

“…An acupuncturist disinfected the subject's skin with ethanol, administered the needle using the tapping-in method to penetrate the skin, and then applied the rotation technique at LI4 (large-intestine meridian) [6, 7, 12, 14, 16, 21, 24, 25, 27, 29] on the right or left hand. After the needle was inserted 10 mm perpendicularly to the skin's surface, the acupuncturist rotated the needle handle by 180 degrees clockwise and anticlockwise at 1 Hz for 2 minutes [7] and then removed it.…”

“…Studies suggest that there are close associations between acupuncture sensations and acupoints [6–8], anatomical structures (e.g., the tissues and the nerves stimulated with needle insertion) [9, 10], depth of needle insertion [11], and methods of acupuncture [6, 12–14]. Physiological responses with de qi, including blood flow [15, 16] and brain activity (observed using electroencephalography [17] or functional magnetic resonance imaging [18–20]), have also been reported.…”

Psychophysical responses in patients receiving a mock laser within context of an acupuncture clinical trial: an interoceptive perspective

“…Other research groups further suggest that De Qi might be a central phenomenon of bodily self-awareness and consciousness [16, 34, 60]. Shifting attention to specific body sites due to induced sensory input interacting with central brain processing may cause the perception of De Qi, and at the same time modulate cognitive and affective responses in the brain [60, 61].…”