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Refer to: Behrstock BB, Petrakis NL: Permanent subcutaneous


gold acupuncture needles. West J Med 121:140-142, Aug
a ffight of stairs," causing a back injury and
1974 necessitating her admission to hospital for two
weeks. She reports having had "no broken bones"
and was without noticeable discomfort within
three months. One year later the patient began
having brief attacks of mid-back pain. As a result,
Permanent Subcutaneous she saw an acupuncturist for five consecutive
treatments over a five-month period, reporting
Gold Acupuncture Needles symptomatic relief after the first therapy. There
was no pain until three years ago, when she began
BARRY B. BEIRSTOCK, MD noticing fleeting mid-back and right posterior
NICHOLAS L. PETRAKIS, MD chest pain, unrelated to exercise and relieved by
application of an electric heating pad. When the
San Francisco patient was seen for the first time in the medical
clinic with complaint of increased pain, she ex-
pressed the fear that she might have cancer. She
ACUPUNCTURE, THE ANCIENT CHINESE ART of had no history of smoking or drinking, or of
inserting thin needles into various points on the cardiac or pulmonary disease. Results of physical
body as an anesthetic or for treating various ail- examination were completely normal except for
ments, has recently attracted enormous interest in two findings: (1) first percussion tenderness over
this country and gained some degree of accept- the 6th to 8th thoracic spinous process and right
ance by Western medicine. As more people ex- costovertebral angle, and (2) a coarse, reticu-
amine this art, the complexity and variety of its lated, hyperpigmented skin change in a radicular
techniques and styles are becoming apparent. Be- pattern in the subscapular and right mid-thoracic
cause of an incidental radiological finding, an region. This coincides with the site of application
alternative form of acupuncture treatment was of the heating pad and was characteristic of ery-
brought to our attention: the permanent place- thema ab igne.
ment of acupuncture needles. This method, de- X-ray examination of the spinal column and rib
scribed and practiced by a few acupuncturists in detail films showed no evidence of a neoplastic or
the Far East, has had little or no previous de- degenerative process. An x-ray film of the chest
scription in the Western literature. showed no abnormalities except for the presence
Report of a Case of twenty-two 0.5 to 1 cm metallic densities in the
subcutaneous tissue along the entire back and
A 44-year-old Korean woman was admitted supraclavicular regions bilaterally (see Figure 1).
to the University of California, San Francisco, At the time the films were taken the nature of
Medical Comprehensive Clinic with complaint of these foreign bodies was unknown to the radiolo-
right posterior pleuritis-type chest pain of ap- gist. After two months of conservative medical
proximately three years' duration. She stated that therapy, the patient was without pain.
the pain had become noticeably more severe at the At first it was our opinion that the linear metal-
time her late husband was unexpectedly found to lic densities represented accidentally broken tips
have lung cancer, which later caused his death. of acupuncture needles. However, further ques-
Six years ago she had accidentally "rolled down tioning revealed that the patient was aware of
From the Division of Ambulatory and Community Medicine, the their presence. She said that it is common for
Department of International Health, and the G. W. Hooper Foun- Korean acupuncturists to insert gold needles for
dation, University of California, San Francisco.
Submitted November 9, 1973. people with adequate financial resources. She had
Reprint requests to: N. L. Petrakis, MD, University of Califor-
nia, San Francisco, San Francisco, CA 94143. been told that these needles would stay perma-

140 AUGUST 1974 * 121 * 2


CASE REPORTS

Figure 1.-Arrows indicate lo- !IRVW.. 4.1 ir '.


!
cations of acupuncture nee-
dles in the subcutaneous tis-
*sues above the clavicles and i
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:.
X

in the back. 04 "..


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nently in place and provide relief for 15 years. isolated acupuncture needle seen in x-ray films or
Biopsy studies to confirm their true metallic na- in tissue biopsy studies is that the needle was un-
ture were not made. intentionally broken off by the therapist, who then
was unable to retrieve it. Although only one refer-
Discussion ence to such accidental breakage can be found in
Acupuncture needles may be left in the sub- the English language literature,2 the oriental litera-
cutaneous tissue for either of two reasons. First, ture contains multiple references to "broken nee-
they may be left intentionally as a form of "longer dles."1 3 The previously mentioned Japanese text
therapy," as was done in this case. We found no translates ". . . if the broken needle cannot be
reference to this practice in the English language removed, then even if left in place there will be
literature, but did find one Japanese text that had pain the first two or three days, but no harm.
a section translated to read "On Broken Nee- Eventually they have new reactive tissue grow
dles."' This source referred to a "new form" of around them in a foreign body reaction and form
treatment called "the broken or thrown out needle a lump."' A 1955 Chinese acupuncture text ex-
treatment." The author states that the needles are plains that "naturally, many broken needles have
inserted approximately 3 cm into the skin and been left in place since the old days, with no harm
broken off in place. This is usually done "around reported. They used to be more common when the
the hips where the muscle is thick," and report- older, more brittle iron needles were used. If the
edly works as a "stressor." Also, acupuncture patient would tense up his muscles the needles
needles occasionally are left inserted intact for an would break."3
extended period. In such instances the needles The choice of gold needles for the patient in
are usually taped to the skin to prevent them from the present case also raises the question of what
entering the tissue and moving subcutaneously. determines the material of the needle. Louis Moss4
The second and more likely explanation for an states that one can use any metal that produces

THE WESTERN JOURNAL OF MEDICINE 141


CASE REPORTS
needles meeting certain criteria: very fine, flexible, Refer to: Emmons RW, Brewster FM. Nelson BC: Tick-bite in
Oregon: Paralysis in California. West J Med 121:142-
well-polished, and, most of all, not breakable. In 143, Aug 1974
the past, non-metallic substances such as bamboo
have also been used for needles. Felix Mann, in
his recent book on acupuncture,5 states that silver
alloys have the advantage of having some self-ster- Tick-Bite in Oregon:
ilizing properties but that for very thin needles
they are too soft, and stainless steel must be used. Paralysis in California
However, Manaka6 states that some ancient Chi-
nese masters attribute particular qualities to the RICHARD W. EMMONS, MD
color of the metal: Yellow (gold) is used for Berkeley
"stimulating or tonifying depleted energy," white
(silver) for "depressing excess energy." He also F. MICHAEL BREWSTER, MD
refers to some recent investigations by Western Concord
researchers where the impedance at various elec-
tric terminal points is affected by the type of metal BERNARD C. NELSON, PhD
used to make the needle. Other authors relate the Berkeley
choice of metal to the Chinese principles of Yin
and Yang, feminine and masculine forces in na-
ture: Gold, the metal of Yang, should be used for TICK-BITE PARALYSIS is well-known in the United
diseases of Yin, and silver for diseases of Yang. States and Canada, and case reports are too nu-
But with the general acceptance of the principles merous to permit reference to all. However, de-
of asepsis it was found that stainless steel needles spite the abundance of Dermacentor andersoni
were the most practical because they could be and Dermacentor variabilis ticks (the most com-
most easily sterilized.7 mon carriers of the disease) and reports of cases
in deer, cattle, horses and other animals asso-
Summary ciated with Dermacentor occidentalis in Califor-
nia,1-3 no reports of human cases acquired in Cali-
Subcutaneous linear metallic densities were fornia have been published, so far as we are
seen in x-ray films of the back of a 44-year-old aware. There is only one previous report of a case
Korean woman. Acupuncture needles had been in California with out-of-state acquisition-that of
permanently placed in that position six years be- a three-year-old girl with tick-bite in Oregon, diag-
fore as treatment for acute back pain. These gold nosed in Oakland, California, in June, 1960.4 We
needles bring to our attention two facts. First, wish to record a second case, that of a three-and-a-
acupuncture needles may be found in subcutane- half-year-old girl who was bitten by a tick in La
ous tissue either as a result of their intentional Grande, Oregon (a well-known endemic area for
placement there or because of accidental break- tick-bite paralysis), but who became ill in Contra
age. Second, the material of which the needles is Costa County, California.
made is felt by some therapists to have special The patient is an otherwise healthy child with
significance. normal growth and development and no signifi-
cant antecedent illnesses. On the evening of June
ACKNOWLEDGMENT
26, 1972, she was noted to have some difficulty
We thank Mrs. A. Mnami, Oriental Collection Librarian at
UCSF, for translating passages from references 1 and 3. getting out of the car just after arriving home from
a trip to Oregon. The following morning she had
REFERENCES great difficulty in standing, sitting or walking.
1. Serizawa K: Shinkyu Kagaku [The Science of Acupuncture].
Vol. 2 (in Japanese). Tokyo, Ishiyaku Shuppan Co., Ltd., 1965, When seen by one of us (F.M.B.), she was alert,
p 238
2. Veith I: Acupuncture therapy-past and present-Verity or cooperative, and afebrile. Results of physical ex-
delusion. JAMA 180:478-484, 1962
3. Chu L: Hsin Chen Chiu Hsiueh [New Acupuncture Study] (in
amination were normal except for weakness and
Chinese). Tokyo, Jen Min Wei Sheng Publishing Co., 1955, p 63 From the Viral and Rickettsial Disease Laboratory and the
4. Moss L: Acupuncture and You. 1st American Ed. New York, Vector Control Section, California State Department of Health,
Citadel Press, 1964, p 39 Berkeley.
5. Mann F: Acupuncture-The Ancient Chinese Art of Healing, Submitted February 4, 1974.
2nd Ed. London, Heinemann Medical, 1971, pp 191-194
6. Manaku Y, Urquhart IA: The Layman's Guide to Acupunc- Reprint requests to: R. W. Emmons, MD, Public Health Medi-
ture. New York, Weatherhill, 1972 cal Officer, Viral and Rickettsial Disease Laboratory, California
State Department of Health, 2151 Berkeley Way, Berkeley, CA
7. Veith I: Personal communication, 1973 94704.

142 AUGUST 1974 * 121 * 2