Development and current application status of acupuncture manipulation measuring instrument and operating instrument

Acupuncture manipulation, a crucial component of acupuncture procedures, significantly influences the therapeutic outcomes. Acupuncture manipulation measuring instrument and operating instrument have been developed based on modern technology to objectively characterize manipulation parameters, and achieve standardized and normalized output of acupuncture manipulation. This paper systematically reviews the development and current application status of in vivo acupuncture manipulation measuring instrument, ex vivo acupuncture manipulation measuring instrument, and acupuncture manipulation operating instrument worldwide, and explores key issues that acupuncture manipulation operating instruments need to address for clinical applications, and provides insights into the future prospect of acupuncture robots.

[Study on the quantitative evaluation parameter system for basic acupuncture manipulations based on 3D motion tracking technology]

OBJECTIVE

To establish a quantitative evaluation parameter system for basic acupuncture manipulations based on 3D motion tracking technology, and to further analyze the characteristics of acupuncture manipulation.

METHODS

The motion tracking system Simi Motion Ver.8.5 was used to collect parameters of acupuncture manipulations, so as to establish a quantitative evaluation system mainly in spatial control parameters, time control parameters and stability parameters. Based on the evaluation parameter system, data of acupuncture manipulations (even reinforcing-reducing manipulation using lifting-thrusting technique and twirling technique) were collected from 19 teachers majored in acupuncture-moxibustion, of which the characteristics were analyzed and were compared with the results tested by traditional ATP-Ⅱ acupuncture manipulation parameter determination apparatus (ATP-Ⅱ).

RESULTS

The evaluation parameter system could quantitatively analyze the basic acupuncture manipulations in 3 aspects, i.e. space, time and stability. Acupuncture manipulations were performed by shifting the needle body in a certain range along X, Y and Z axes. The amplitude and speed of thumb movement were greater than those of index finger. The time-history of lifting was similar to thrusting, while the time-history of twirling to left was similar to twirling to right in even reinforcing-reducing manipulation. The coordinate-time curve of finger movement of the evaluation system had consistent wave pattern compared with the voltage-time curve generated by ATP-Ⅱ.

CONCLUSION

The quantitative evaluation parameter system based on 3D motion tracking technology can objectively evaluate basic acupuncture manipulations, and show the characteristics of different manipulations and the movement details of finger joints.

[Analysis on influencing factors of acupuncture curative effect based on experts' experience]

To explore the influencing factors of acupuncture curative effect in literature of experts' experience. The journal literature of experts' experience was retrieved from China National Knowledge Infrastructure (CNKI) and PubMed, starting from inception to September 4, 2020, and the influencing factors of acupuncture curative effect were extracted and analyzed. A total of 499 articles were included, involving 495 articles in Chinese and 4 articles in English. The influencing factors of acupuncture curative effect mainly include five aspects: diagnostic method, acupoint selection of acupuncture, acupuncture manipulation, regulating mind of acupuncture and acupuncture time, and provide reference for acupuncture protocol design in clinical trials.

[Exploring theory of contemporary acupuncture manipulation and its application characteristics: in the perspective of acupuncture technique in Acupuncture and Moxibustion]

Through reviewing acupuncture technique in various editions of the state-compiled teaching material of Acupuncture and Moxibustion, the hierarchical structure, definitions, and variations of acupuncture manipulation were collected, the theory of contemporary acupuncture manipulation as well as its application characteristics were explored. In the perspective of the hierarchical structure, acupuncture technique with filiform needle is predominated. It is implied in the description of the definition of acupuncture technique that the devices of acupuncture have been developed from single form to multivariant one and the stimulation regions have no longer limited to acupoints. The types of acupuncture manipulations have been enriched gradually during the development of teaching materials. But a part of acupuncture manipulation have been deleted from the knowledge hierarchy of acupuncture technique in textbooks. Acupuncture and Moxibustion is comprehensive and normative, which is important in the inheritance and application of the theory of acupuncture and moxibustion. However, it has to some extent restricted the diversified development of knowledge on acupuncture manipulation.

[Essence of SUN Shen-tian's clinical features on acupuncture and moxibustion]

To summarize SUN Shen-tian's treatment ideas and clinical features. SUN applies meridian syndrome differentiation to the diagnosis and treatment of diseases; advocates that prevention and treatment of diseases should be regulated mind firstly; applies transcranial repetitive acupuncture combined modern cerebral cortex function positioning; emphasizes the application of multiple acupuncture methods and manipulation, and includes the meridian penetrating needling method, the flat needling and penetrating needling method, and the stagnant needle lifting method, pays attention to the importance of achieving qi and manipulation for the effect.

[Unity and separation of lifting-thrusting and twirling reinforcing-reducing manipulation]

To analyze the collaborative use and separation reasons of lifting-thrusting and twirling reinforcing and reducing manipulation. Lifting-thrusting manipulation and twirling manipulation are two important contents of acupuncture methods. In traditional acupuncture and moxibustion, the two methods were used in reinforcing and reducing concert, which was mainly related to the therapeutic thought guided by the qi-blood theory and the influence of the human body structure on the technique manipulation. After the Republic of China, the separation of lifting-thrusting manipulation and twirling manipulation gradually appeared. It was related to the widespread use of "scientific acupuncture method" in later generations and the integration of neuroscience into the acupuncture treatment system.

[Professor YANG Jun's experience in treatment of refractory facial paralysis based on acupuncture manipulation]

To summarize professor YANG Jun's experience in treatment of refractory facial paralysis by different acupuncture manipulation. Professor YANG Jun believes that refractory facial paralysis has prolonged course, qi and blood deficiency and collaterals injury after a long illness, and it is difficult to obtain obvious curative effect with routine acupuncture. Aimed at the etiology, pathogenesis and characteristics of disease, professor YANG Jun adopts 3 kinds of acupuncture manipulations, such as "penetration needling with long needle" "pulling technique exert after needle stuck" "contralateral-balance needling on the healthy side", to relieve deviation.

[Summary and core technique on the origin and evolution of reinforcing-reducing manipulation achieved by lifting and thrusting the needle]

By analyzing the evolution of reinforcing-reducing manipulation achieved by lifting and thrusting the needle recorded in ancient literature of traditional Chinese medicine, it is found that the main contents of reinforcing-reducing manipulation by lifting and thrusting the needle include manipulating speed change, manual amplitude, insertion layer, gender, the direction to the acupuncture receiver, forenoon and afternoon and relevant quantity. Among them, gender, the direction to the acupuncture receiver, forenoon and afternoon and relevant quantity are the unnecessary parameters, while the manipulating speed change, manual amplitude and insertion layer are the indispensable parameters. The manipulating speed change is the core of the necessary parameters for the reinforcing-reducing manipulation achieved by lifting and thrusting the needle. Combined with the manual amplitude, the manipulating speed of needle determines the volume of needling stimulation. The insertion layer is decided on the base of the clinical demand. In the core technique of reinforcing-reducing manipulation by lifting and thrusting the needle, the reinforcing is achieved by thrusting the needle forcefully and quickly and then lifting the needle body slowly and evenly back to the original layer. The reducing is achieved by lifting the needle forcefully and quickly and then thrusting the needle body slowly and evenly back to the original layer. The manipulating speed and manual amplitude of needling are the parameters to quantize acupuncture manipulation. In association with the acupuncture effects in human body, these parameters contribute to the interpretation of the dose-effect relationship of acupuncture and the improvement of clinical effects.

[A brief analysis of "the key of using acupuncture therapy to treat disease lies in the regulation of qi"]

The ancients emphasized "the key of using acupuncture therapy to treat disease lies in the regulation of qi ", which means that the key point in acupuncture treatment is to regulate qi. Regulating qi is not limited to the needle stage, but run through the entire acupuncture process and has different meanings and modes of operation in each step of the needle. Hand-pressing skills is crucial to adjust qi when inserting needle, while it is critical to adjust the movements of qi when processing needle. The key is the self-adjustment in the needle-retaining period. The distinction of qi is the most important in needle-withdrawing process. Therefore, this paper discusses the connotation of regulating qi from four steps of acupuncture treatment, that is insertion, manipulation, retention and withdrawal of the needle.

[Evolution of filiform needle insertion methods in multi-edition of Acupuncture and Moxibustion]

This paper reviewed the filiform needle insertionmethods in multi-edition of Acupuncture and Moxibustion, explored its evolution and reasons, and analyzed its development trend. By referring multi-edition of Acupuncture and Moxibustion and related literature regarding acupuncture manipulation published after 1940s, combined with acupuncture manipulation characteristics of modern and contemporary acupuncture masters, it was found that the definition of needle insertion methods needed to be improved after several changes. The classification of needle insertion methods was stable over development. The thrusting method of needle insertion was previously included, and then disappeared. The description of needle insertion methods was improving. These evolutions were mainly influenced by the academic and clinical background, the academic thought of writers and acupuncture masters, the internationalization and standardization of acupuncture and so on. The twist-inserting method and some other needle-inserting instrument meet the safe, sterile, painless and convenient development trend, which might be included in Acupuncture and Moxibustion in the future.

[TIE's flying acupuncture for acute cerebral infarction hemiplegia: a randomized controlled trial]

OBJECTIVE

To compare the efficacy difference between TIE 's flying acupuncture combined with conventional treatment and conventional treatment alone on acute cerebral infarction hemiplegia.

METHODS

A total of 120 patients were randomly divided into an observation group and a control group, 60 cases in each one. The control group was treated with conventional treatment, including anti-platelet aggregation, lipid-lowering, formula of traditional Chinese medicine which could promote circulation and remove stasis, neurotrophic medication and symptomatic treatment; mannitol was used for cerebral infarction with large area or increased intracranial pressure. Based on the conventional treatment applied in the control group, the observation group was treated with flying acupuncture at the affected Jianyu (LI 15), Quchi (LI 11), Shousanli (LI 10), Waiguan (TE 5), Hegu (LI 4), Huantiao (GB 30), Biguan (ST 31), Futu (ST 32), Zusanli (ST 36), etc. The treatment was given once a day, six days per week, for totally 2 weeks. The simplified Fugl-Meyer score, National Institute of Health Stroke Scale (NIHSS) and ADL-Bathel index (BI) score were evaluated before and after treatment in the two groups.

RESULTS

After the treatment, the simplified Fugl-Meyer and BI were significantly increased in both groups (all P<0.05), which was significantly higher in the observation group (both P<0.05); after the treatment, the NIHSS was significantly lowered in both groups (both P<0.05), which was significantly lower in the observation group (P<0.05).

CONCLUSION

TIE 's flying acupuncture combined with conventional treatment were effective for acute cerebral infarction hemiplegia, which have better efficacy than conventional treatment on improving motor function, neurological deficit and daily living ability, and the pain is mild.

[Role of pressing hand in the clinical practice of acupuncture]

The importance of pressing hand in clinical practice of acupuncture was explored in this paper. Through literature review and clinical experience, the role of pressing hand before, during and after acupuncture was summarized and analyzed. Before acupuncture, the pressing hand helped to diagnose diseases, examine pulse and locate acupoints; during acupuncture, it participated in needle insertion and reinforcing-reducing manipulation; after acupuncture, it played a role in needle withdrawal and regulate human body. It is indicated the pressing hand is a key role not only during acupuncture or reinforcing-reducing manipulation, but also participates in the overall process of acupuncture, which has great significance in guiding clinical treatment and enhancing practice level.

[Efficacy of filiform needle manipulation on primary dysmenorrhea:a systematic review]

The paper is a systematic review on the efficacy of acupuncture manipulation on primary dysmenorrhea. Ten medical literatures database at home and abroad were retrieved, including CNKI, VIP, CBM, WANFANG, MEDLINE, Cochrane, CENTRAL, CINAHL PLUS, EMBASE, AMED and PsycINFO, as well as 6 clinical trial registration platforms. All of randomized controlled trials (RCTs) on primary dysmenorrhea treated with different acupuncture manipulations were collected. The data were extracted by two persons. Finally, RevMa 5.3 software was used for statistical analysis. Totally, 5 148 pieces of literature were retrieved and 8 pieces on RCTs were screened with 644 cases included. According to the results of statistical analysis on the total effective rate and other indicators of pain degree, it was showed that the effects of the manipulation with filiform needle, deep puncture with strong stimulation, and specific reinforcing and reducing needling technique were better than those without manipulation applied or with shallow puncture and weak stimulation and even needling technique in the treatment of primary dysmenorrhea. It is believed initially that acupuncture manipulation contributes to the improvement of the therapeutic effects of primary dysmenorrheal, but much higher quality studies are required for the further confirmation. Protocol registration number:PROSPERO:CRD42016038515.

[Exploration on "three eye-needling" technique of acupuncture]

The "three eye-needling" technique is one of the important component of Jin's three needling therapy, mainly used for the treatment of eye disorders such as optic atrophy, macular pigment degeneration, myopia, hyperopia, strabismus, amblyopia, diplopia, glaucoma, cataract, etc. In the paper, Jin's "three eye-needling" technique is explored, including the keys of manipulation, operation procedure and basic skills. This technique is particularly for "mind regulation", focusing on tranquilizing, observing and concentrating the mind. The precise selection of point is the basic requirement, the technique for fixing, pressing and pricking are the most important link. The needle insertion with one hand is adopted with gentle rotation manipulation. Mind regulation, point selection and specific operation are coordinated with each other to bring the function of "three eye-needling" technique into play and achieve better therapeutic effects.

[Effects of acupuncture manipulations for acupoints impedance under the skin-clinical report of 60 healthy volunteers]

OBJECTIVE

To explore the effects of acupuncture manipulations for acupoints by their impedance under the skin.

METHODS

The retaining,reinforcing and reducing of acupuncture were implemented on 60 healthy volunteers, and the needles were retained for 20 min. Data analysis system for the electrical characteristics of single point was used, with insulation coating needles as the probes. The effects of acupuncture manipulations before, in the middle of and after intervention were observed through the real time dynamic detection for Zusanli (ST 36).

RESULTS

①The impedance during the reducing process was apparently higher than that during the reinforcing (P<0.05), and the reinforcing was obviously higher than that of retaining (P<0.05), namely R_reducing > R_reinforcing > R_retaining. ②After intervention,the three manipulations can decrease the impedance of acupoints than before (all P<0.01). The retaining method reduced about 11.44 kΩ; reinforcing, 11.15 kΩ; reducing,11.12 kΩ.

CONCLUSIONS

Acupuncture manipulations can variously and apparently change the impedance of acupoints.

[Origin and exploration of "white tiger shaking the head" technique]

White tiger shaking head technique is one of the four techniques for meridian qi conduction. It is a very complicated technique and has many controversies by medical scholars of dynasties, which results in the difficulties in the normalization of manipulation in teaching and clinical practice. In the paper, in terms of the origins and the statements of medical scholars in different dynasties, it is attempted to explain the original technique, to explore the existing questions in practice and also propose the understanding on this technique.

Is sham acupuncture as effective as traditional Chinese acupuncture? It's too early to say

Many clinical trials and experimental studies claim that sham acupuncture is as effective as traditional Chinese acupuncture. However, these studies have no standard sham acupuncture control and many other factors can affect the clinical effect. These factors include needle retention time, treatment frequency, and the total number of treatments needed for satisfactory results, and all can change the clinical effect. The majority of existing acupuncture treatment studies do not consider these factors and lack standard dosage criteria. Therefore, it is still too early to conclude that sham acupuncture is as effective as traditional Chinese acupuncture. This article investigates the factors that influence the curative effect of acupuncture as to help set a standard for acupuncture studies in the future.