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ABSTRACT The mechanism of action of acupunc- forming an integrated system, acupuncture points are
ture remains largely unknown. The reaction to acupunc- thought to represent discrete locations on the body
ture needling known as ‘de qi’, widely viewed as essen- where manual or electrical stimulation can activate
tial to the therapeutic effect of acupuncture, may be a appropriate neural pathways (8, 9). A fundamental
key to understanding its mechanism of action. De qi distinction therefore currently exists between tradi-
includes a characteristic needling sensation, perceived tional and scientific views of acupuncture. A mechanis-
by the patient, and ‘needle grasp’ perceived by the tic explanation incorporating both classic acupuncture
acupuncturist. During needle grasp, the acupuncturist theory and available scientific evidence would therefore
feels pulling and increased resistance to further move- be a major unifying step in the field.
ment of the inserted needle. We hypothesize that 1) An important key to such a mechanism may be the
needle grasp is due to mechanical coupling between the characteristic reaction to acupuncture needling
needle and connective tissue with winding of tissue known as ‘de qi’ (1, 6, 7, 10, 11). De qi is elicited by
around the needle during needle rotation and 2) needle
brief manual manipulation (e.g., rotation, up-and-
manipulation transmits a mechanical signal to connec-
down motion) of the inserted acupuncture needle.
tive tissue cells via mechanotransduction. Such a mech-
This method is used to elicit de qi whether or not
anism may explain local and remote, as well as long-
term effects of acupuncture.—Langevin, H. M., electrical stimulation is subsequently applied (1, 7).
Churchill, D. L., Cipolla, M. J. Mechanical signaling De qi has a sensory component perceived by the
through connective tissue: a mechanism for the thera- patient as an ache or heaviness in the area surround-
peutic effect of acupuncture. FASEB J. 15, 2275–2282 ing the needle and a simultaneous biomechanical
(2001) component, needle grasp, perceived by the acupunc-
turist. During needle grasp, the acupuncturist feels as
Key Words: collagen 䡠 mechanotransduction 䡠 meridian though the tissue is grasping the needle, such that
there is increased resistance to further motion of the
manipulated needle (1, 7, 10). This ‘tug’ on the
Acupuncture, a complex therapeutic system used in needle is classically described as “like a fish biting on
China for more than 2000 years (1), has become a fishing line” (12). Needle grasp has been described
increasingly popular in the West as a therapy for pain in traditional acupuncture texts for more than 2000
and a wide variety of mostly chronic disorders difficult years (13) and is still widely considered essential to
to manage with conventional treatment (2). Although acupuncture’s therapeutic effect (1, 6, 7, 10, 11), yet
considerable research has been directed toward eluci- its underlying mechanism is unknown.
dating the mechanism underlying acupuncture, several We hypothesize that, during de qi, the needle is
fundamental aspects of acupuncture treatments remain being grasped by connective tissue as a result of
poorly understood (3). Gaining knowledge of thera- collagen and elastic fibers winding and tightening
peutic mechanisms is essential to validating therapies around the needle during needle rotation. In this
such as acupuncture that are difficult to test under manner, a mechanical coupling is developed be-
double-blind, placebo-controlled conditions (4, 5). Per- tween needle and tissue. We further hypothesize that
haps more important, understanding the mechanism
needle manipulation transmits a mechanical signal
of acupuncture may provide insight into unexplored
into connective tissue via this needle/tissue cou-
physiological phenomena (3).
According to traditional Chinese theory, the nee- pling. The subsequent transduction of this mechan-
dling of ‘acupuncture points’ has specific therapeutic ical signal to a cellular response may underlie some
effects believed to occur either locally or at a distance of the therapeutic effects of acupuncture both locally
via the system of acupuncture ‘meridians’ (6). Mecha- and at remote locations.
nistic models of acupuncture based on laboratory ex-
periments performed over the past 30 years have mostly
abandoned these traditional concepts in favor of view- 1
Correspondence: Department of Neurology, Given C423,
ing the effects of acupuncture as taking place essen- University of Vermont College of Medicine, Burlington VT
tially through the nervous system (7). Rather than 05405, USA. E-mail: hlangevi@zoo.uvm.edu