Is De Qi Essential To A Therapeutic Effect From Acupuncture?

There are many studies to show that acupuncture can be used effectively in orthopedics cases and for pain management. As students of acupuncture and Oriental medicine, we are eventually faced with a dilemma in our training. Some schools of thought state that "De Qi," or the arrival of qi at the acupuncture point must be obtained in order to have a therapeutic effect. Systems such as Traditional Chinese Medicine-style of acupuncture posit that it is essential and others such as Kiiko Matsumoto's style of Japanese acupuncture claim that it is not necessary. How can there be so much difference in opinion and whose school of thought can be believed?

The concept of "De Qi" is taught in acupuncture schools throughout California. In his book The Art of Acupuncture Techniques (a book on the list of required texts for the California Acupuncture Licensing Exam), Robert Johns discusses "De Qi" as follows, "Needling response (de qi) is typified by increased feeling of tightness or heaviness around the needle. It is described as a fish hooked on a line, jumping up and down, floating and deep. The patient's response to the arrival of qi may be light or very slow in coming. When the qi comes late or takes a long time to arrive, it indicates that the patient is weak and that overall response to treatment will be slow.

The strong patient experiences a quick arrival of qi. When the qi comes quickly the therapeutic results also are quick. Slow arrival of qi or a weak response can also indicate incorrect depth of needling or wrong placement of the needle. The importance of the arrival of qi cannot be overstated: in order to apply the desired technique there must first be arrival of qi, or needling response."1 It is generally accepted that the action of a given acupuncture point is assured only when needling is accompanied by "De Qi."

I recently came across a study that caused my eyebrows to rise a bit. It is regarding whether or not "De Qi" is necessary in treatment response to acupuncture in pain treatments.2 I am specializing in the treatment of chronic pain conditions and am concerned for the comfort of my patients so I became very interested to read this study. The aforementioned study comes out of the University of Southampton School of Health Sciences, Southampton, UK. The object of this study was to assess the importance of the strength of "De Qi" on the outcome of acupuncture treatments for patients with osteoarthritis of the knee and hip. The interventions used in this study included real acupuncture, Streitberger needle and mock electrical stimulation on 140 patients.

The relevant outcomes were pain reduction (they used a visual analog scale to assess) and the Park needling sensation questionnaire. The results showed that a) there was no significant correlation between the strength of "De Qi" and improvement of pain and b) that there was no significant difference in pain relief from those who felt "De Qi" and those who did not. The study concludes, "These data suggest that the presence and intensity of de qi has no effect on the pain relief obtained for patients with OA [osteoarthritis]. This result may have implications for both acupuncture treatment and for future trial methodology."

This eye-opening experience has caused me to focus more on my patient's comfort level than that of obtaining "De Qi" to ensure therapeutic effect with acupuncture treatment.