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To be or not to be: the needling sensation (de qi) in acupuncture
  1. Thomas Lundeberg
  1. Correspondence to Dr Thomas Lundeberg, Foundation for Acupuncture and Alternative Biological Treatment Methods, Sabbatsbergs Hospital, Stockholm, 113 82, Sweden; thomas.lundeberg{at}

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Needling sensation has been considered by many acupuncturists to be an important component of acupuncture since the early classical texts. From a traditional Chinese medicine perspective, needling sensation, de qi, is a composite of unique sensations interpreted as the flow of Qi or ‘the arrival of vital energy’. Based on the theory of traditional Chinese medicine, acupuncture is successful only when de qi is experienced.

From a medical acupuncture perspective, needling sensation is a sensation mediated by sensory afferent nerves. Although the perception of needling sensation may vary in individuals and with manual technique, this distinct sensation is generally characterised by soreness, numbness, heaviness, distension and aching in the deep tissues surrounding the inserted needle.1–3 Thus, the needling sensation is not a single but a composite sensation that is generated from the activation of various sensory receptors and their afferent fibres in acupuncture sites—in particular, small fibre-innervated nociceptors and myelinated fibre-innervated mechanoreceptors.4 It has recently been hypothesised that numbness, heaviness and distension are elicited when manual manipulation is performed at acupuncture sites rich in muscle spindles and tendon organs, whereas the sensation evoked in sites rich in receptors is characterised by aching and soreness.5

Studies by Hui and coworkers have shown that acupuncture stimulation induces deactivation of a limbic–paralimbic–neocortical network (LPNN) and activation of somatosensory brain regions. On the other hand, when acupuncture induced sharp pain, there was an activation of LPNN. Tactile stimulation induced greater activation of the somatosensory regions but less extensive deactivation of the LPNN. These results imply that acupuncture mobilises the anticorrelated functional networks of the brain to mediate its actions.6

Psychophysical experience of needling

The process of eliciting Qi with needles is experienced by both patient and acupuncturist. Patients experience de qi as multiple unique sensations at the needle site itself and around the …

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