THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE

Volume 15, Number 5, 2009, pp. 495–500

ª Mary Ann Liebert, Inc.
DOI: 10.1089=acm.2008.0331

Characteristics of Electrical Skin Resistance at Acupuncture

Points in Healthy Humans

Sybille Kramer, M.D.,1 Kathrin Winterhalter, M.D.,1 Gabriel Schober, M.D.,1 Ursula Becker, Dipl.-Stat.,1
Bernhard Wiegele, Dr.-ing,2 Dieter F. Kutz, Ph.D.,3 Florian P. Kolb, Ph.D.,3 Daniela Zaps,1
Philip M. Lang, M.D.,1 and Dominik Irnich, M.D., Ph.D.1

Abstract

Objectives: The aim of this study was to evaluate the phenomenon of electrical skin resistance (ESR) changes at
different acupuncture points (APs).
Setting: This single-blinded study was performed at the hospital of the University of Munich.
Design: Six common APs were measured (TE5, PC6, LU6, ST36, SP6, GB39) in 53 subjects. Subgroups were
formed with varying time intervals for follow-ups (1 minute, 1 hour, 1 week) and a varying grade of reduction of
the stratum corneum.
Methods: Electrical skin resistance measurements (ESRMs) were taken from a skin area of 66 cm using an array
consisting of 64 (88) electrodes. The electrodes corresponding to the AP were located and the ESRM results
were compared to those of the surrounding electrodes. The methodological setting made it possible to minimize
major influence factors on electrical skin impedance measurements.
Results: A total of 631 ESRMs was evaluated: In 62.8% of the measured APs, no significant ESR difference was
found. In 234 (37.2%) of the ESRMs, the ESR at the AP was significantly different from the surrounding skin area,
with 163 (25.9%) points showing a lower and 71 (11.3%) points showing a higher ESR. Reproducibility was
extremely high after 1 minute but was low after 1 hour and 1 week.
Conclusions: This study shows that electrical skin resistance at APs can either be lower or higher compared to
the surrounding area. The phenomenon is characterized by high short-term and low long-term reproducibility.
Therefore, we conclude that APs might possess specific transient electrical properties. However, as the majority
of the measured APs did not show a changed ESR, it cannot be concluded from our data that electrical skin
resistance measurements can be used for acupuncture point localization or diagnostic=therapeutic purposes.

Introduction diagnosis-and-treatment-systems are widely used in the

clinical practice today.3,4

A widespread theory claims that meridians and acu-

puncture points (APs) possess certain properties, such as
a lower electrical resistance or impedance (and consequently
an increased electrical conductivity) compared to the sur-
rounding tissue.1,2 Furthermore, it has been assumed that the
difference in the electrical skin resistance (ESR) may reflect
upon the ability of the meridians and acupuncture points to
react to physiologic processes and pathologies in the body.
Based upon this theory, numerous AP location devices and
Many investigators have tried to show a difference be-
tween the skin impedance of an AP and the impedance of its
surrounding area.5–9 A review published earlier this year
found as many as 320 citations dealing with this topic. Only
18 studies met their evaluation criteria and were generally
described as of poor quality and limited by a small sample
size. All of them used different methods and their results
were controversial.10 Even less scientific data exist to support
the reliability of electrical skin resistance measurements

1
Multidisciplinary Pain Centre, Department of Anaesthesiology, University of Munich, Munich, Germany.
2
Fachbereich Elektrotechnik, FH Augsburg, Augsburg, Germany.
3
Department of Physiological Genomics, Institute of Physiology, University of Munich, Munich, Germany.

495
496
(ESRMs).6,11–13 Apart from deficiencies in study design and
statistical analysis, the main reason for the lack of scientific
evidence can be found in the vulnerability to various inter-
ferences of the measuring procedure itself.
Factors that can interfere with ESRMs include environ-
mental disturbances (temperature, relative air humidity),
physiologic differences (body temperature, blood circulation,
skin humidity, skin surface topography, skin thickness), or
technical issues (size, angle, pressure, and duration of elec-
trode application and measurement).6,14
Most of numerous devices for ESRM consist of one elec-
trode (of varying size) that is placed at the tip of a pen-shaped
device, which is pressed manually against the skin by the
examiner.9,13,15–17 It is known that variation of pressure,
angle, or duration of the measurement can significantly in-
fluence the results.8,9 Furthermore, repeatedly pressing the
electrode tip into the skin or scratching over the skin surface
may result in hyperemia and stratum corneum abrasions that
increase skin conductivity and lower the electrical resistance.
As the stratum corneum is claimed to form the major part of
ESR,18 small abrasions of its surface could lead to a reduced
layer and thus a reduced resistance at the damaged area. Even
though this might considerably change skin resistance values,
it has never been investigated whether this has a relevant
impact on ESRMs of APs.
Moreover, controversy exists about the reproducibility of
ESMRs delivered by the usual measuring devices.8,11 There-
fore, a comprehensive investigation of the phenomenon of
skin resistance should take into account the following:
1. Reproducible measuring process
2. Minimization of disturbing factors
3. Evaluation of the influence of the stratum corneum layer
FIG. 1. Study design: Test persons were divided into five subgroups with varying applications of tape stripping (TS) and
different time intervals for follow-up measurements for evaluation of reproducibility. Follow-up measurements were not
used for evaluation of electrical skin resistance changes. APs, acupuncture points.
KRAMER ET AL.
The objective of this trial was to determine whether and
to what degree differences in ESR at APs actually do exist.
Materials and Methods
Participants
Fifty-three (53) volunteers (18–38 years, mean age 26.3
years, 24 male, 29 female) were recruited on the campus of
the Ludwig-Maximilians University, Munich, Germany. All
volunteers signed an informed consent form before partici-
pation. The study was approved by the local Ethics Com-
mittee of the University of Munich. Inclusion criteria were
general good health, age 18–40 years, and the ability to
understand and sign an informed consent form. Exclusion
criteria were pregnancy, current medication, acute or chronic
medical problems of any kind, skin irritations, and previous
treatments with acupuncture or transcutaneous electrical
nerve stimulation.
Setting and procedures
The study was carried out in the Multidisciplinary Pain
Unit of the Ludwig-Maximilians University, Munich, Ger-
many in a standardized setting. Ambient room temperature
was 22.58C  1.38C (mean  standard deviation), outside tem-
side temperature 9.58C  8.68C ( 3.1, 23.3), relative air hu-
midity outside was 29.7%  7.6%, mean barometric pressure
was 1027.2  7.2 hPa, and body temperature was 36.28C 
0.28C. Subjects were advised to rest for 15 minutes be-
fore measurements were taken. If necessary, the skin was
shaved in the area of the APs on the evening before mea-
surements.
ELECTRICAL SKIN RESISTANCE AT ACUPUNCTURE POINTS 497

Volunteers were divided into five subgroups with 4–6 male
and 4–6 female participants in each subgroup (Fig. 1). In each
subgroup there was a variation in time intervals between
follow-ups and grade of reduction of the stratum corneum by
tape stripping (TS). Follow-up measurements were per-
formed at short (group I: 1 minute, four follow-ups), medium
(group II: 1 hour, one follow-up), and long (groups III, IV, and
V: 1 week, one follow-up) time intervals. The array was left on
the skin between ESRMs with 1-minute intervals. Measure-
ments with 1-week intervals were performed at the same time
of the day as the first measurement in order to avoid variation
due to changes in the circadian rhythm. Reduction of the
stratum corneum was done before the start of ESRMs and
varied by the number of applications of TS: groups I and III:
no TS; groups II and IV: 3TS; group V: 5TS.
Tape stripping
The stratum corneum has been shown to form the major
part of the ESR, and with its reduction the ESR is known to
decrease.18 Therefore, we wanted to ensure that our results
were not caused by irregularities in the thickness of its layer.
A common way to reduce the stratum corneum layer in
dermatological research is the procedure of tape stripping
(TS). In this study, it was performed according to the pro-
tocol described by Jacobi et al.19 An adhesive tape (‘‘tesa
film’’ 5529, 19 mm, Beiersdorf, Hamburg, Germany) was
pressed against the skin and then removed again with cor-
neocytes stuck to it. Five repetitions of TS have been shown
to lead to a removal of approximately 25% of the stratum
corneum and a near total removal of substances that had
penetrated into the horny layer.19
Instruments
An impedance meter array was specially designed for the
purpose of this study.20 It consists of a field of 64 electrodes
on a flexible plastic foil surface of 66 cm with a distance of
8 mm between the centers of each electrode (Fig. 2A).
Voltage was measured through a voltmeter between each
of the electrodes and a reference electrode, which was held in
the participants’ hands during measurements. Electrical skin
resistance was indicated in arbitrary units for each of the
measuring electrodes. All the electrodes were scanned re-
peatedly one after another (average scanning time 15 ms).
This method of fast scanning allowed an almost simultaneous
measurement of the whole array within 1 second. We used
direct current (DC, max flow 20 mA, mean voltage 4.8 V).
These technical details correspond approximately to other
commercially available devices. The array has been approved
by the German Technical Inspection Authority for security.
Skin resistance measurements
First the array was placed on the skin area in which the
acupuncture point is known to be found. A pad of medical gel
was placed upon the array to distribute fixation pressure
evenly over the whole array. Array and gel pad were then
fixed with a blood pressure cuff (pressure 10 mm Hg). The
measuring process was started and terminated after 30
seconds. The resistance values at the end were used for eval-
uation. The position of the array was marked on the skin and
the array was removed (Fig. 2A). Afterward, the acupuncture
points were localized and marked by an acupuncturist, who
was blinded regarding the results of the measurement (Fig.
2B). An array template was used to match the array electrodes

FIG. 2. Electrical skin resistance measurements (ESRMs): (A) ESRM array consisting of 64 electrodes on a 66-cm square
plastic foil. (B) Localization of the acupuncture point (AP) was performed after the ESR. (C) The localization of the AP is
matched with the electrodes on the array. Ink marks are used for the exact placement of the template. (D) Screenshot of one
exemplary ESRM: ESR was indicated by colors and arbitrary units (shown here in black and white). The ink cross marks the
localization of the AP and the ink square shows the electrodes defined as AP.
498
and marked APs (Fig. 2C). A square of 33 electrodes sur-
rounding the detected electrode was assumed to correspond
to the AP. The ESR values of these nine electrodes were
compared to the other 55 electrodes of the array (Fig. 2D).
Acupuncture points
The following APs were selected: TE5, PC6, LU6, ST36, SP6,
and GB39. They were chosen for reasons of clinical relevance as
well as their location on the forearm or lower leg, which allows
fixation of the array with a steady pressure. The location of the
APs was determined according to standards of TCM.21
Statistical analysis
Microsoft Excel and SPSS were used for statistical analysis.
Correlation of follow-up measurements was estimated by
calculating the Spearman correlation coefficient. For corre-
lations, the pattern of the ESR distribution was considered to
be more important than the absolute ESR values, as the
question examined in this study was measurable changes in
ESR and their connection to the AP location. Correlation was
estimated in group I with five repeat measurements with
intervals of 1 minute, in group II with one follow-up mea-
surement after 1 hour, and in groups III, IV, and V with a
follow-up after 1 week. Correlation coefficients were calcu-
lated between each pair of successive measurements (1st and
2nd, 2nd and 3rd, 3rd and 4th, 4th and 5th) and between the
1st and 5th measurement.
For the evaluation of ESR changes at APs, only first mea-
surements of a series were used. Differences in the ESR were
evaluated employing the Wilcoxon rank sum test. This is a
nonparametric test transforming the absolute resistance
values into ranks. The resulting ranks of the pooled sample
are used for the calculation of the test statistic, which indi-
cates if the distribution of the ESR between two groups of
electrodes (AP versus surrounding) is significantly different.
We decided to define an area of 33 electrodes around the
located point as the region of interest (Fig. 2D) and compare
these 9 electrodes to the rest of the electrodes on the array.
Electrodes on the array corresponding to other close-by APs
were excluded from evaluation. ESRMs were excluded, if the
AP was located too far on the edge of the measured area, and
the lesser number of electrodes could therefore influence
validity of the evaluation. P-values of <0.05 were considered
as statistically significant. False discovery rate was used as
an adjustment for multiple testing. The significance level
between the groups with different repetitions of TS and the
different APs was determined using w2 test.
Results
The aim of this study was to measure the ESR at acu-
puncture points and to compare changes in ESR to the lo-
cation of the acupuncture point (AP). More than 1450 ESRMs
were performed in a collective of 53 healthy volunteers fol-
lowing high-quality standards regarding methodology and
statistical evaluation.
Changes in ESR
We evaluated a total of 631 measurements at six different
acupuncture points: 396 (62.8%) showed no significantly
KRAMER ET AL.
FIG. 3. Results of electrical skin resistance measurements
(ESRMs): 631 ESRMs were evaluated. One hundred and
sixty-three (163) acupuncture points (APs) showed a signif-
icantly lower and 72 APs a significantly higher ESR than the
surrounding areas.
changed ESR at the AP in comparison to the ESR of the sur-
rounding skin area. Two hundred and thirty-four (234)
(37.2%) of the measured APs showed an ESR that was sig-
nificantly different, with 163 (25.9%) APs showing a lower
and 71 (11.3%) APs showing a higher skin resistance than the
surrounding skin areas (Fig. 3). So, in contrast to the theory
that the ESR at acupuncture points is lower than the ESR of
the surrounding areas, we found that electrical skin resistance
at APs can also be significantly higher. ESR values in general
varied broadly between approximately no impedance (»high
conductance) and approximately no conductance at all (»high
impedance), even within one array measurement.
Acupuncture points
Not every acupuncture point (TE5, PC6, LU6, ST36, SP6,
GB39) showed the same percentage of measurements, with
higher and lower ESR within-acupuncture-point-analysis
showing a distribution of 7.7%–15.0% with a significantly
higher skin ESR and 19.6%–31.8% of points with a signifi-
cantly lower ESR (Table 1).
Reproducibility
Reproducibility of measurements was tested using the
Spearman correlation coefficient (see Statistical analysis sec-
tion above). In group I (5 repeated measurements, intervals 1
minute), out of 583 correlation coefficients only 34 (5.8%)
were <0.85 and 236 (40.5%) were >0.95, indicating highly
repeatable results. After 1 hour (group II) and after 1 week
(groups III, IV, and V), there was no clear correlation be-
tween first and second measurement, with only 1 of 106
correlation coefficients >0.85, 36 (33%)<0.2, and 17 (15.6%)
showing negative correlation in group II and only one of 340
correlation coefficients >0.85, 154 <0.2 and 72 showing a
negative correlation in group III, IV and V. These results
indicate that there is a high short-term reliability and a low
reliability of the measurements with medium- and long-term
follow-up.
Influence of stratum corneum
To examine the influence of the reduction of the stratum
corneum layer on ESRMs, we measured ESRMs after zero,
three, and five TS: In groups I and III (no tape stripping) 273
ESRMs were evaluated: 60 APs (21.9%) showed a significantly
ELECTRICAL SKIN RESISTANCE AT ACUPUNCTURE POINTS
Table 1. Within-Acupuncture-Point-Analysis of Electrical Skin Resistance Measurements (ESRMs)
Acupuncture
Point
ESR
Properties TE5 GB39
ESRMs (total) 107 108
ESR $ 21 (19.6%)* 28 (25.9%)
ESR # 16 (15.0%) 11 (10.2%)
The acupuncture point (AP) LU6 showed the highest percentage (31.8%) and the TE5 showed the lowest percentage of ESRMs with
significantly lower ESR. This difference was statistically significant (*p < 0.05). The highest percentage (15%) of APs with significantly higher
ESR was found in TE5. Three hundred and ninety-seven (397) APs showed no significant differences in ESR.
lower ESR, whereas 38 APs (13.9%) had a higher resistance. In
group V (5TS) 24 (20.7%) acupuncture points of 116 showed
lower and 14 (12.1%) higher skin impedance. The percentage
of APs with significantly lower ESR was highest in groups II
and IV (3TS) with 32.6%. In the same group, the percentage
of APs with higher ESR was lowest (7.9%).
Discussion
In this study, we performed ESRMs on six common acu-
puncture points in 53 subjects with a multi-electrode device.
Because the absolute skin resistance values can vary strongly
inter- and intra-individually, we evaluated each ESRM
individually in respect to the ESR of the skin area at the AP
compared to the ESR of the surrounding skin area. Then the
results were summarized and the percentage of APs with
ESR changes was calculated: In a total sample size of 631, we
found 62.8% of the tested AP to have no significantly chan-
ged skin resistance. A significantly changed ESR at the AP
was shown in 32.7% (26.9% decreasing, 11.3% increasing
ESR). These results are partly in line with previous high-
quality studies, most of which seem to show a trend for
negative results to this topic (review article10,22), but it still
must be admitted that there is some evidence for a physio-
logic basis of the phenomenon of ESR changes at an AP. One
example for this is the study by Pearson et al.22 While their
overall results showed no statistically different skin imped-
ance at AP compared to control points, several of their hy-
pothesis tests did. Thus, perhaps the theory of electrical skin
resistance changes at APs is nothing to be generally proved
or rejected, but something that can be measured at certain
points in certain persons at a certain time. Nevertheless, we
can only agree with Pearson et al. in their conclusion that
caution is warranted in using and interpreting results from
electrodermal screening devices.
Technical issues
ESRMs are technically complex.14 We believe that we
overcame most disturbances in skin impedance testing by
our evaluation: The array was constructed to ensure equal
technical conditions for all electrodes. It was completely
measured within 1 second. Within this time interval, it is
unlikely that environmental conditions had changed. At any
rate, by comparing the electrodes of each measurement to
themselves, most disturbance factors should be eliminated
by statistical analysis.
One limitation might be that in the negative cases we
simply failed to measure the AP itself due to the distance of
499
LU6 ST36 SP6 PC6
107 103 101 104
34 (31.8%)* 29 (28.2%) 21 (20.8%) 32 (30.8%)
9 (8.4%) 13 (12.6%) 12 (11.9%) 8 (7.7%)
8 mm between the centers of the electrodes. This is a possi-
bility we cannot exclude. It raises general questions in
measuring ESR: How big is an AP and the skin area in which
we can expect ESR changes due to the acupuncture point?
The location and the size of an AP in the literature can differ
up to more than 1 cm2. We hypothesized that ESR changes at
AP may not strictly be limited to an area too small to be
registered by our array. An array with smaller electrodes and
a smaller distance between the electrodes would provide a
higher resolution of the measured area, but would also
necessarily lead to a smaller screening area. We decided to
start with a larger screening area even if this meant that the
resolution of our array was lower.
ESR changes in the course of time
Our reproducibility testing shows a high reproducibility
for short time intervals between the measurements. Follow-
ups had a low reproducibility. These findings are in ac-
cordance with those of other investigators.6,17 One simple
explanation might be a change of environmental conditions.
However, especially for the reproducibility testing after 1
hour, we cannot exclude artifacts caused by the procedure of
TS. However, the reproducibility after 1 week was low in
every group irrespective of whether TS was performed be-
fore. The observation that the values of skin impedance
measurements can shift and vary widely inter- and intra-
individually has also been described before.6,8,15,17 So in our
opinion, the likeliest explanation is that electrical skin im-
pedance shifts physiologically like transepidermal water loss
or skin hydration.23
Increase or decrease in ESR
A few studies reported increasing ESR at AP24 or a general
increase of skin impedance.22 We found a certain percentage
of measurements of each AP to have a significantly higher
skin resistance. To our knowledge, we are the first ones to
describe this finding. If ESR shifts in the course of time, there
is no reason why it should not be increased at certain points
and certain locations.
Stratum corneum
Former investigators described that the major component
of ESR is generated by the stratum corneum layer.16,18,25
We therefore hypothesized that changes in the thickness
(e.g., small abrasions) could significantly influence ESRMs.
Our results show that the group with a medium reduction of
500
the stratum corneum layer showed the highest percentage of
APs with significantly lower ESR. There is no study with
a similar objective to compare to our results. Thus, one
explanation might be artifacts caused by the procedure of TS,
or maybe the medium grade of stratum corneum reduction
achieved by threefold TS provides the best balance of a
smooth surface with minimum damage to the layer. How-
ever, as it is well known that the electrode size influences the
depth of the tissue layer that is being measured (the smaller
the deeper14), future trials should conduct some pilot
measurements to find out the optimum number of TS for the
electrode size used.
Conclusions
This study shows that ESR at APs can either be lower or—
in contrast to common belief—higher compared to the
surrounding area and that this phenomenon shows a high
short-term and a low long-term reproducibility. Therefore,
we conclude that APs might possess specific transient elec-
trical properties. However, as the majority of the measured
APs did not show a changed ESR and taking into account
that reproducibility was given only in the short term, it
cannot be concluded from our data that ESR measurements
can be used for localization of acupuncture points or diag-
nosis or therapy.
Acknowledgments
This study was supported by the German Medical Acu-
puncture Association (DÄGfA).
Disclosure Statement
No competing financial interests exist.
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Address reprint requests to:
Dominik Irnich, M.D., Ph.D.
Interdisziplinäre Schmerzambulanz Innenstadt der LMU
Pettenkoferstr. 8a
80336 Munich
Germany
E-mail: dominik.irnich@med.uni-muenchen.de