Acupuntura Laser Book

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Gerhard Litscher and Detlef Schikora

(Eds.)

Laserneedle - Acupuncture

Science and Practice

PABST SCIENCE PUBLISHERSLengerich, Berlin, Bremen, Miami,

Riga, Viernheim, Wien, Zagreb


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Bibliographic information published by Die Deutsche BibliothekDie Deutsche Bibliothek lists this publication in the Deutsche Nationalbibliografie; detailed bibliographic data is available in the Internet at .

This work is subject to copyright. All rights are reserved, whether the whole or part of thematerial is concerned, specifically the rights of translation, reprinting, reuse of illustrations,recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. The use of registered names, trademarks, etc. in this publication does not imply, evenin the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use.The authors and the publisher of this volume have taken care that the information andrecommendations contained herein are accurate and compatible with the standards generallyaccepted at the time of publication. Nevertheless, it is difficult to ensure that all the

information given is entirely accurate for all circumstances. The publisher disclaims anyliability, loss, or damage incurred as a consequence, directly or indirectly, of the use andapplication of any of the contents of this volume.

Gerhard Litscher , Prof MSc PhD MDsc

Medical University of Graz

Department of Biomedical Engineering and

Research in Anesthesia and Intensive Care Medicine

Auenbruggerplatz 298036 Graz / AustriaTel. ++43 316 385-3907, -83907

Fax ++43 316 385-3908 E-mail: [email protected]

Detlef Schikora , PhD

University of Paderborn

Faculty of ScienceWarburger Straße 100

33095 Paderborn / Germany

Tel. ++49 5251 60-3566 Fax ++49 5251 60-3490 E-mail: [email protected]

© 2005 Pabst Science Publishers, 49525 Lengerich, Germany

Printing: D+L Printpartner GmbH, 46395 Bocholt, Germany

ISBN 3-89967-199-6 (Europe), ISBN 1-59326-074-1 (USA)


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Preface

This compendium of „Laserneedle-Acupuncture“ conveys scientific and first

practical results from the field of laserneedle acupuncture in an abridged andconcise form.

Just the thought of being pricked with needles is very uncomfortable formany people. Using the new, advanced laserneedle acupuncture method upto eight laserneedles are applied to the skin simultaneously, however,without puncturing the skin. Thus, painless, non-invasive acupuncture is

possible for the first time.

First public presentation of the laserneedle-system was in the year 2000 atthe Medica fair in Düsseldorf. Three years of intensive scientific researchand developmental work preceded.

The basic idea of laserneedles originated from analysis of laser acupuncture,which was developed and spread throughout Europe in the 1990´s. It wasobvious, that the technique of classic acupuncture as it had been practised forcenturies, namely the simultaneous stimulation of therapy-specific acupointcombinations, became to leave its natural course. Today and in the past,acupoints are stimulated one after another using laser light, even though no

evidence regarding identical effects achieved with Traditional ChineseMedicine has been documented in classic or modern literature. Suddenly, thesimultaneous puncturing of acupoints according to the basic scheme ofChinese acupuncture was no longer important when practicing the Westernmethod of laserpuncture.

With the development of laserneedles, the goal to maintain the fascination ofacupuncture itself was pursued: the complex diagnostic systemic approachon the one hand, and the simple manner of therapeutic application and itseffects on the other. Simultaneous procedures, simple, manual handlingduring needle acupuncture with needle-equivalent stimulation effects andstimulation characteristics were the developmental goals of our laserneedle

project.

The main part of this volume includes „Peer-Review“ studies and thus,represents a scientifically substantiated work dealing with laserneedleacupuncture in particular and acupuncture in general. Noted scientists andwell-known users have taken part in this book and reported about thescientific investigations and use of this new, advanced method in the field of

acupuncture.


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Non-invasive laserneedle stimulation can induce specific, reproducibleeffects in the brain. This is expressed by changes in different parameterssuch as cerebral blood flow velocity, which can be objectified using modernneuromonitoring methods for the first time. The results in this book showthat cerebral effects induced by the new, painless laserneedle technique liewithin similar dimensions as those evoked by manual needle acupuncture.For the first time, laserneedle acupuncture allows simultaneous opticalstimulation of individual acupoint combinations. At the same time,variations in acupuncture on the body, ear or hand, as performed in our firststudy were made possible. Based on these investigations, the cerebral effectsof laserneedle stimulation could be systematically objectified, specified andoptimized for the first time. These scientific findings do not only haveextensive consequences in laser medicine, but also build an important bridge

between traditional Eastern and innovative Western medicine.

Contact between the editors of this compendium developed in a typicalmodern way: per e-mail. Professor Litscher from the Medical University ofGraz reported his interest in performing studies with laserneedle acupunctureto the University of Paderborn. Dr. Schikora from Paderborn answered backthat he was very interested. What developed from this contact is documentedin this book. Currently studies with laserneedle acupuncture are being

performed in several University Clinics in Germany, Austria, Switzerlandand France. All of these studies will contribute to a better understanding andobjectification of effects not only for acupuncture with laserneedles but alsofor classic acupuncture and promote the use of this comprehensive, naturalmedical treatment method. Scientists agree that the 21st Century will be theCentury of Photons, like the 20th Century was the Century of Electrons. It iscertain, that exact understanding of the elementary interaction of photonswith biological molecules, will lead to new, natural medical treatmentmethods which will reach far beyond acupuncture.

January 2005

Detlef Schikora Gerhard LitscherUniversity of Paderborn Medical University of Graz


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Contents

1. Laserneedles in acupuncture ............................................................... 1

1.1 Introduction and motivation ......................................................... 1

1.2 Dose-effect relationships in acupuncture ..................................... 41.3 Laserneedle acupuncture as a placebo method............................. 71.4 Physical characteristics of laserneedles...................................... 111.5 Acknowledgements .................................................................... 161.6 References .................................................................................. 16

2. Cerebral vascular effects of noninvasive laserneedles measured

by transorbital and transtemporal Doppler sonography................ 18

2.1 Introduction ................................................................................ 182.2 Methods ...................................................................................... 20

2.2.1 Non-invasive laserneedles ............................................. 202.2.2 Multidirectional transorbital and transtemporal

Doppler sonography ...................................................... 222.2.3 Participants .................................................................... 232.2.4 Acupuncture and procedure........................................... 232.2.5 Statistical analysis ......................................................... 25

2.3 Results ....................................................................................... 252.4 Discussion .................................................................................. 272.5 Conclusion.................................................................................. 28

2.6 Acknowledgements .................................................................... 292.7 References .................................................................................. 29

3. Near-infrared spectroscopy for objectifying cerebral

effects of needle and laserneedle acupuncture ................................. 32


3.2.1 Near-infrared spectroscopy............................................ 323.2.2 Laserneedle stimulation ................................................. 333.2.3 Healthy volunteers, acupuncture,

measurement procedure ................................................. 343.2.4 Statistical analysis ......................................................... 36

3.3 Results ....................................................................................... 363.4 Discussion .................................................................................. 383.5 Acknowledgements .................................................................... 413.6 References .................................................................................. 41

4. Communication between acupoint and brain proved

by ultrasound ...................................................................................... 43

4.1 Introduction ................................................................................ 434.2 Methods and materials................................................................ 43


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4.2.1 TCD monitoring of the anterior and posteriorcerebral arteries with a new probe holder...................... 43

4.2.2 Participants .................................................................... 444.2.3 Laserneedle acupuncture ............................................... 454.2.4 Statistical analysis ......................................................... 48


5. Histological investigations regarding micromorphological

effects of laserneedle illumination. Results of an animal

experiment........................................................................................... 57

5.1 Introduction ................................................................................ 57

5.2 Methods ...................................................................................... 575.2.1 Procedure ....................................................................... 575.2.2 Laserneedle stimulation ................................................. 595.2.3 Laser Doppler flowmetry and temperature

measurement.................................................................. 595.3 Results ....................................................................................... 605.4 Discussion .................................................................................. 615.5 Acknowledgements .................................................................... 625.6 References .................................................................................. 62

6. Effects of laserneedle stimulation on microcirculation and

skin temperature................................................................................. 64

6.1 Introduction ................................................................................ 646.2 Method and volunteers ............................................................... 64

6.2.1 Laser Doppler flowmetry .............................................. 646.2.2 Volunteers and procedure .............................................. 656.2.3 Statistical analysis ......................................................... 67

6.3 Results ....................................................................................... 676.4 Discussion .................................................................................. 70

6.5 References .................................................................................. 72

7. Effects of acupressure, manual acupuncture and

laserneedle acupuncture on EEG bispectral index (BIS) and

spectral edge frequency (SEF) in healthy volunteers ...................... 73

7.1 Introduction ................................................................................ 737.2 Material and methods ................................................................. 73

7.2.1 Subjects ......................................................................... 737.2.2 Procedure and study design........................................... 747.2.3 Evaluation parameters ................................................... 767.2.4 Statistical analysis ......................................................... 77


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8. Acupuncture using laserneedles modulates brain function:

first evidence from functional transcranial Doppler

sonography (fTCD) and functional magnetic resonance

imaging (fMRI) ................................................................................... 87


8.2.1 Painless laserneedles ..................................................... 888.2.2 Functional multidirectional transcranial Doppler

sonography (fTCD) ....................................................... 88

8.2.3 Functional magnetic resonance imaging (fMRI)........... 898.2.4 Participants .................................................................... 898.2.5 Experimental design and procedure .............................. 898.2.6 Evaluated parameters..................................................... 918.2.7 Statistical analysis ......................................................... 92

8.3 Results ....................................................................................... 928.4 Discussion .................................................................................. 968.5 Conclusions ................................................................................ 988.6 Acknowledgements .................................................................... 988.7 References .................................................................................. 98

9. Quantification of gender specific thermal sensory and

pain thresholds before and after laserneedle stimulation ............. 101

9.1 Introduction .............................................................................. 1019.2 Method ..................................................................................... 101

9.2.1 Volunteers.................................................................... 1019.2.2 Measurement of thermal sensitivity and thermal

pain thresholds ............................................................. 1029.2.3 Laserneedle acupuncture and procedure...................... 103

9.2.4 Statistical analysis ....................................................... 1059.3 Results ..................................................................................... 1059.4 Discussion ................................................................................ 1099.5 Acknowledgements .................................................................. 1109.6 References ................................................................................ 110

10. Biological effects of painless laserneedle acupuncture -

a short summary of important scientific results ............................ 112

10.1 Introduction .............................................................................. 11210.2 Methods .................................................................................... 112

10.2.1 Temperature and microcirculatory monitoring ........... 112


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10.2.2 Functional multidirectional transcranial Doppler-sonography (fTCD) ..................................................... 113

10.2.3 Functional magnetic resonance imaging (fMRI)......... 11310.2.4 Near infrared spectroscopy (NIRS) ............................. 11310.2.5 Laserneedle stimulation............................................... 11310.2.6 Healthy volunteers, animal experiment and

procedures.................................................................... 11410.2.7 Statistical analysis ....................................................... 11410.2.8 Evaluation parameters ................................................. 115

10.3 Results ..................................................................................... 11510.4 Discussion ................................................................................ 12110.5 Conclusion................................................................................ 12210.6 Acknowledgements .................................................................. 12210.7 References ................................................................................ 122

11. Increases in intracranial pressure and changes in blood

flow velocity due to acupressure, needle and

laserneedle acupuncture?................................................................. 124

11.1 Introduction .............................................................................. 12411.2 Material and methods ............................................................... 124

11.2.1 Volunteers, patient, acupressure and procedure .......... 12411.2.2 Measurement techniques, evaluation parameters

and statistical analysis ................................................. 12611.3 Results ..................................................................................... 12711.4 Discussion ................................................................................ 13111.5 Acknowledgements .................................................................. 13311.6 References ................................................................................ 133

12. Laserneedle acupuncture - clinical studies..................................... 135

12.1 Introduction .............................................................................. 13512.2 Material, patients and methods................................................. 13612.3 Results ..................................................................................... 139

12.3.1 Lumbar, thoracic and cervical spine syndromes as

well as post cervical and lumbar intervertebraldisk prolapse ................................................................ 139

12.3.2 Gonarthrosis, coxarthrosis, rhizarthrosis, periarthritisin the shoulder, epicondylitis, tendinitis,Morbus Bechterew and fibromyalgia-syndrome ......... 140

12.3.3 Remaining paresis after stroke .................................... 14112.3.4 Cephalgia, migraine and trigeminal neuralgia............. 14212.3.5 Arterial obstruction disease ......................................... 14312.3.6 Gastropathy and bronchial asthma .............................. 14312.3.7 Depression, anxiety, panic attacks,

psychovegetative exhaustion ....................................... 143


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12.4 Discussion ................................................................................ 14412.5 References ................................................................................ 145

13. Pain therapy with laserneedle acupuncture ................................... 147

13.1 Introduction .............................................................................. 14713.2 Case reports .............................................................................. 14713.3 Argumentation.......................................................................... 14813.4 Discussion ................................................................................ 15013.5 References ................................................................................ 151

14. Pain therapy of osteoarthrosis / osteoarthritis-patients

using the laserneedle system in a medical practice with

emphasis on rheumatology and pain therapy ................................ 152

14.1 Introduction .............................................................................. 152

14.2 Patients and method.................................................................. 15214.3 Results ..................................................................................... 15414.4 Discussion ................................................................................ 15414.5 References ................................................................................ 155

15. Laserneedles in gynecology.............................................................. 156

15.1 Introduction .............................................................................. 15615.2 Material, test persons, technique .............................................. 15715.3 Case studies .............................................................................. 158

15.3.1 Induction of labor with laserneedles............................ 15815.3.2 Carpal tunnel syndrome............................................... 16015.3.3 Urogenital symptoms, back pain, hot flushes.............. 16115.3.4 Breast cancer with mastectomy, transmission in scars 16215.3.5 Dysmenorrhoea, lack of energy................................... 16415.3.6 Childlessness, temperature curve, cycle regulation..... 165

15.4 Results and discussion.............................................................. 16615.5 References ................................................................................ 168

16. Laserneedles in gynecology - a study with questionnaires............ 169

16.1 Introduction .............................................................................. 16916.2 Test persons.............................................................................. 16916.3 Method ..................................................................................... 17016.4 Results ..................................................................................... 17116.5 Discussion ................................................................................ 17716.6 References ................................................................................ 178

17. Laserneedle therapy in dentistry..................................................... 179

17.1 Introduction .............................................................................. 17917.2 Methods and materials.............................................................. 17917.3 Results ..................................................................................... 179


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17.3.1 Oral surgery ................................................................. 17917.3.2 Endodontology ............................................................ 18017.3.3 Crown - bridges ........................................................... 18117.3.4 Pain therapy ................................................................. 18117.3.5 Myoarthropathy ........................................................... 18117.3.6 Neuralgia ..................................................................... 18217.3.7 Sedation in case of dental phobias............................... 18217.3.8 Nausea during molding................................................ 182

17.4 Discussion ................................................................................ 18317.5 References ................................................................................ 183

18. Laserneedle stimulation as a potential additive method

for post operative pain treatment.................................................... 185

18.1 Introduction .............................................................................. 185

18.2 Method ..................................................................................... 18518.2.1 Patients and procedure................................................. 18518.2.2 Laserneedle acupuncture ............................................. 18618.2.3 Statistical analysis ....................................................... 187

18.3 Results ..................................................................................... 18718.4 Discussion ................................................................................ 18818.5 Acknowledgements .................................................................. 18918.6 References ................................................................................ 189

19. Effects of laserneedle stimulation in the external auditory

meatus on very early auditory evoked potentials .......................... 190

19.1 Introduction .............................................................................. 19019.2 Methods .................................................................................... 190

19.2.1 Laserneedle stimulation in the externalauditory meatus ........................................................... 190

19.2.2 Auditory evoked potentials of early latency................ 19119.2.3 Volunteers and procedure ............................................ 19219.2.4 Statistical analysis ....................................................... 193

19.3 Results ..................................................................................... 193

19.4 Discussion ................................................................................ 19519.5 Acknowledgements .................................................................. 19819.6 References ................................................................................ 199

20. List of references............................................................................... 200

21. Websites............................................................................................. 202

Addendum................................................................................................. 203


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Editors (and authors):

Gerhard Litscher, Prof MSc PhD MDscDepartment of Biomedical Engineering and Research in Anesthesia and

Intensive Care Medicine, Medical University of GrazAuenbruggerplatz 298036 Graz / Austria

Detlef Schikora, PhDFaculty of ScienceUniversity of PaderbornWarburger Strasse 10033098 Paderborn / Germany

Authors:

Konrad B. Borer, MDTherwilerstrasse 114153 Reinach BL / Switzerland

Franz Ebner, Prof MDMR Research Unit and Clinical Department of Neuroradiology

Medical University of GrazAuenbruggerplatz 98036 Graz / Austria

Franz Fazekas, Prof MDDepartment of Neurology, Medical University of GrazAuenbruggerplatz 228036 Graz / Austria

Rudolf Helling, MD1st Chairman of the ‘Ärzte-Forum für Akupunktur e.V.’Ostenallee 10759071 Hamm / Germany

Evamaria Huber

Department of Biomedical Engineering and Research in Anesthesia andIntensive Care Medicine, Medical University of GrazAuenbruggerplatz 298036 Graz / Austria


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Knut Kolitsch, MDGeneral practitioner and expert for special pain therapyOelzer Straße 1298746 Katzhütte/Thüringen / Germany

Wolfgang Nemetz, MDDepartment of Anesthesiology for Neurosurgical and Craniofacial Surgeryand Intensive Care, Medical University of GrazAuenbruggerplatz 298036 Graz / Austria

Dagmar Rachbauer, MSc MDscDepartment of Neurology, Medical University of GrazAuenbruggerplatz 22

8036 Graz / Austria

Stefan Ropele, Prof PhDDepartment of Neurology and MR Research UnitMedical University of GrazAuenbruggerplatz 228036 Graz / Austria

Matthias Saraya, MDDepartment of Anesthesiology for Neurosurgical and Craniofacial Surgeryand Intensive Care, Medical University of GrazAuenbruggerplatz 298036 Graz / Austria

Andreas Schöpfer, MDDepartment of Anesthesiology for Neurosurgical and Craniofacial Surgeryand Intensive Care, Medical University of GrazAuenbruggerplatz 298036 Graz / Austria

Gerhard Schwarz, Prof MDDepartment of Anesthesiology for Neurosurgical and Craniofacial Surgeryand Intensive Care, Medical University of GrazAuenbruggerplatz 298036 Graz / Austria


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Josef Smolle, Prof MDUniversity Clinic for Dermatology, Medical University of GrazAuenbruggerplatz 88036 Graz / Austria

Kirsten Stähler van Amerongen, MDGynecological ClinicInselspital BerneUniversity of BerneEffingerstrasse 1023010 Bern / Switzerland

Selman Uranüs, Prof MDDepartment of Surgical Research, University Surgical Clinic, Medical

University of GrazAuenbruggerplatz 298036 Graz / Austria

Lu Wang, MD Dipl. Acup.Department of Biomedical Engineering and Research in Anesthesia andIntensive Care Medicine, Medical University of GrazAuenbruggerplatz 298036 Graz / Austria

Michael Weber, MD Dipl. Chem.General practitioner, emergency medical aid, naturopathic treatment,acupunctureLönsstraße 1037697 Lauenförde / Germany

Nai-Hua Yang, Prof MDUniversity Clinic for Ophthalmology, Medical University of GrazAuenbruggerplatz 4

8036 Graz / Austria

Acknowledgements

The editors thank Mrs. Ingrid Gaischek MSc (Biomedical Engineering andResearch in Anesthesia and Intensive Care Medicine, Medical University ofGraz) for skillful preparation of the text and illustrations and Mrs. SonyaMendlik-Bauer for translating a major part of the manuscripts.


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1. Laserneedles in acupuncture

D. Schikora

1.1 Introduction and motivation

In the past 30 years, acupuncture established itself in Europe and America.Patients perceive acupuncture as an effective, non-medicinal form oftreatment which conforms to the increasing desire of living a natural and

balanced life. Particularly in case of chronic pain, patients attested the predominantly satisfactory results of acupuncture, especially since side

effects of long term drug treatment can be ruled out with this method. In1998, a great advancement was made leading to the acceptance ofacupuncture in Western medicine. After a Consensus Conference, the UnitedStates National Institute of Health concluded that acupuncture was proveneffective in cases of post operative nausea and vomiting, nausea andvomiting accompanying chemotherapy, as well as post operative tooth pain[1]. Acupuncture was also rated for the following indications: addictiveillnesses, menstrual pain, headaches, tennis elbow, fibromyalgia, back pain,carpal tunnel syndrome, bronchial asthma as well as for alternative orcomplementary treatment after stroke. At this conference, it was emphasizedthat side effects of competently performed acupuncture are rare andcompared with conventional therapies seem to be much more favourable [2].

Even today, the acceptance of acupuncture in some fields of westernmedicine is problematic particularly because no objectified proof regardingthe effects of acupuncture is available. Critics fail to see, that many excellentscientific studies exist, particularly regarding acupoint-analgesia, which

provide a detailed picture of physiological pain reduction achieved byacupuncture treatments. Currently, over 200 scientific publications dealing

with the elementary mechanisms of acupoint-analgesia exist. Especially theleading studies by Pomeranz and Chiu [3], as well as those by Mayer et al.[4] which deal with the analgesic effect of acupuncture resulting from anincreased release of ß-endorphin, establish the complex picture of neuro-

biological basics of acupoint-analgesia [5]. A systematic overview andcritical rating of the current level of knowledge regarding neurobiologicalmechanisms in acupoint-analgesia were recently documented by Irnich andBeyer [6].In the meantime, the acupuncture-endorphin-hypothesis could be proven in anumber of different independent animal experiments. The ability to block theanalgesic effect of acupuncture by injecting an opiate antagonist in the


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acupoint is a strong indication that the afferent nervous system plays a rolein transmitting the effects of acupuncture. All of these scientific resultsconform to the knowledge of modern pain research regarding the role ofendorphins and are described to such an extent, desirable for other well-established western medical methods. The fact that these scientific resultsare mainly obtained from animal studies, underlines their objectivity. On theclinical level, the situation is fundamentally different. Numerous single-caseand controlled studies have been documented, however definite evidence forthe effects could not be proven up to this day. Of course we must note thatclassic needle acupuncture cannot be investigated using randomised, double-

blind study designs. Neither the patient, nor therapist can be blinded, sincethe patient always feels the insertion or stimulation of the applied needle andthe therapist always must control the position, puncture depth and angle ofinsertion. There is no doubt that acupuncture has to be proved in the future

by objectivized, double-blind clinical trials.However, this is only possible, when an adequate placebo method for classicneedle acupuncture is available. Such a method does not exist up to this date;the placebo needle used by Streitberger et al. [7] does not fulfil therequirements of a double-blind study design.The development of a real placebo method for classic needle acupuncture is

definitely of initial importance for further acupuncture research and

establishing acupuncture as a medical treatment method.The goal of recent extensive field studies (GERAC-Study, Model study byGerman private insurance companies) was to prove or refute the efficacy ofacupuncture treatment in selected indications using clinically controlledmethods on a statistically significant level. Objectified, clinical evidence ofeffects could not be obtained in these studies for the named reasons.The initial idea of laserneedles resulted from analysis of laser acupuncture,developed and spread throughout Europe in the 1990´s. It was obvious, thatthe century-old technique of classic acupuncture or simultaneous stimulationof therapy specific acupoint combinations began to leave its natural course.Acupoints are stimulated one after the other, even though no evidence inclassic or modern literature is given, that identical effects occur. Suddenly,

the puncturing of acupoints according to the basic schemes of Chineseacupuncture was no longer important in Western “Laserpuncture”. With thedevelopment of laserneedles, we tried to maintain the fascinating aspects ofacupuncture: the complex diagnostic system on the one hand, the simpletherapeutic procedure and the effects on the other. The simultaneous

procedure, simple handling adapted to needle acupuncture, needle equivalentstimulation effects and stimulating characteristics, were the most importantgoals of laserneedle acupuncture. Thus, laserneedles should be applied non-invasively by direct contact between the light emitting source and the skin. Itwas always clear, that quantitative documented proof of the postulatedequivalence between laserneedle and classical metal needles is necessary.


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An important, but not yet investigated question concerns the connection between stimulation strength and the effects of acupuncture.We know that an inserted acupuncture needle must be moved andrepositioned by the therapist to increase stimulation intensity resulting in theDe-Qi sensation. This effect is not easy to quantify since the intensity ofstimulation triggered by needle puncture is also not quantifiable. How thestimulation intensity at the acupoint influences the effect of acupuncture stillremains an unanswered question in this context. If we assume thatacupuncture is not more than a specific kind of nerve stimulation, thequestion arises, whether this form of acupoint stimulation correlates with thedose-effects known from the field of bio-physiology, and underlies theWeber-Fechner-Law. With laserneedles, the light dose applied at any desiredacupoint combination can be measured exactly. Compared to other classicmetal needles, the stimulus strength can be quantified so that determination

of dosis-effect relationships is possible. A basic assumption regardingstimulation characteristics i.e. the timing factor of stimulus intensity has to

be made for experimental investigation of dose-effect relationships inacupuncture. In our first approach we assumed that the nocizeptive stimulustriggered by the classic metal needle is a continuous constant stimulationwhich lasts as long as the needle is inserted. In order to be equivalent to thisstimulation mode, the laserneedles should act in the so-called continuouswave modus. Equivalence between both needle types can only be assumedunder these circumstances. Frequency-modulated laser light is generally notequivalent to the application procedure of the classic needle acupuncture.The physical characteristics of laserneedles determine their physiologicalinfluence in tissue. We have been performing theoretical studies for sometime dealing with the elementary interaction between photons and complex,

biological molecules. Using molecular-dynamical methods of theoretical physics, we are able to calculate and predict the interaction of electrons or photons with complex molecules, as well as the effects of molecularexcitation and basic relaxation on molecular surroundings. However, this isonly possible when quasi elastic scattering processes between the photonsand biological molecules are the predominant interactive processes. If we

assume that elementary stimulation in acupuncture is generated on amolecular level, molecular-dynamic calculation shows [8], that electrical andoptical stimulation show physiologically identical results and also generateand maintain a rhythmic cascade of action potentials at the nozizeptivestructures as those produced when chemical transmitters such as substance Pand bradykinine are released after needle puncture. These results can definethe most important physical marginal requirements for the emissioncharacteristics of the laserneedles: the emission wave lengths should beselected in a such a way, that quasi elastic scattering processes are dominantand emission intensity at the distal output of the laserneedle should be so


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high, that responses relevant for acupuncture can be triggered by opticalstimulation.

1.2 Dose-effect relationships in acupunctureOne of the fundamental biophysiological laws, the Weber-Fechner´s Law,describes the relationship between strength of perception E of a sensorystimulus and intensity of the stimulus S. As a result, the stimulus effect andstimulus response correlate and can be described with the followinglogarithm:

E ~ ln S

This proportionality does not imply more than that the doubling of stimulusstrength not automatically leads to doubling of perception or effects of thestimulus.If we illustrate this simple relationship graphically, two importantcharacteristics become visible and are shown in Figure 1.1.

Fig. 1.1: Relationship between stimulus strength and stimulus effects according toWeber-Fechner ´s Law.

The curve illustrates threshold characteristics of physiological stimulation.Sensory stimuli do not lead to any effects when stimulus intensity lies under

0

1

2

3

4

5

0 2 4 6 8 10

R e i z w i r k u n g [ a . u . ]

Reizstärke [a.u.]stimulus strength [a.u.]

s t

i m u l u s e f f e c t s [ a . u . ]


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a critical threshold value. Weak external influences are filtered out by theorganism. Moreover, the curve shows the saturation characteristics of

physiological stimuli. Thus, a doubling of stimulus strength does not lead tothe doubling of effects within the organism. Finally, this is an expression forthe adaptability of the organism to external stimulation, whose intensitiescan vary over many orders of magnitude.Validity of Weber-Fechner´s Law has been proven for acoustic, thermal,chemical and mechanical stimuli.In our experiments, we investigated if this physiological law is alsoapplicable to acupuncture, e.g. if stimulus strength at the acupoint and theresulting induced specific effects are correlated. For this purpose,laserneedles with different optical power density were used. Power densitieswhich are effective on the skin were varied from 1.5 – 5 W/cm². In order tocompare the effect of laserneedles under identical circumstances, parallel

experiments using classic metal needles were also performed. The bloodflow velocity in the ophthalmic artery (OA) and its changes duringstimulation of an eye specific acupuncture scheme were studied in thisexperiments. . Preliminary studies showed that the simultaneous stimulationof acupoints Zanzhu and Yuyao, the acupoints eye and liver on the ear, aswell acupoints E2 from Korean hand acupuncture and Yan Dian fromChinese Hand acupuncture led to significant and specific increases in bloodflow velocity (OA) when using metal needles or laserneedles [9] (comparechapter 2). The specific effect on the visual system could be proven by the

parallel measurement of blood flow velocity in the middle cerebral artery,which remained constant i.e. did not show any changes in measurementresults when using this acupuncture scheme. Measurement of blood flowvelocity was performed with transorbital and transtemporal Dopplersonography. Blood pressure was registered before, during and aftermeasurement. Treatment time was 10 minutes and blood flow velocity datawas monitored continuously. A randomised, cross-over study design wasused and each volunteer underwent acupuncture with laserneedles, as well aswith metal needles. The study protocol was approved by the ethicscommission of the Medical University of Graz, reasons for exclusion of

volunteers (n = 27) were treatment with medication, visual disorders, as wellas neurological and psychological deficits.Figure 1.2 shows the detected dependency of blood flow velocity in the OAas a function of power density from the laserneedles.


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2. The direct contact between the treating physician and the patient hasto be minimized by the placebo method, to exclude any healingeffect by the aura of the physician

If the placebo needle and the placebo method meets all this requirements, adouble blind clinical study can be performed.We know that needle puncture at desired skin points also leads to effects thatare similar to those resulting from stimulation of acupoints. For that reason,this type of acupuncture is called sham-acupuncture. A further demand onthe placebo method would be to establish a clear definition between thecategories of verum-acupuncture, placebo-acupuncture and sham-acupuncture.Based on these criteria the applicability of laserneedle acupuncture as a

placebo method for classic needle acupuncture can be analyzed precisely.We already mentioned that laserneedles are not inserted into the skin, butapplied to the skin at the acupoint. This non-invasive method of applicationis an important characteristic of laserneedle acupuncture. Our studies withmore than 250,000 practical applications of laserneedles show thatlaserneedle stimulation with distal optical power densities of about 5 W/cm²are not perceived as a stimulus sensation by the majority of patients andvolunteers. Of course the threshold of laser light stimulation is different andvariable from person to person, however, laserneedle stimulation with a

primary emission wavelength of 685 nm at acupoints on the body is not perceivable for most patients. The cerebral effects generated by laserneedleacupuncture were investigated systematically using multi-directionalfunctional Doppler sonography, near-infrared spectroscopy (NIRS) andfunctional magnetic resonance imaging [10].In other chapters of this book we show that laserneedles with power

5 W/cm² lead to specific changes in cerebral blood flow velocity duringstimulation of visual acupoints nearly identical to those in needleacupuncture.In addition to these experimental studies, the effects of acupuncture

regarding changes in cerebral oxyhaemoglobin concentrations wereinvestigated. Here, a visual acupuncture scheme was used and in this case,non-specific cerebral parameters could be analysed. This was done using arandomized, cross-over design with direct comparison between metal needleand laserneedle stimulation. Details from these experiments are described in[11].Measurement of cerebral concentrations of oxyhaemoglobin anddesoxyhaemoglobin were done using NIRS: Figure 1.3 shows the results ofthese measurements dependent on the optical power of the laserneedles.


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laserneedle - power [mW]

metal needle

Fig. 1.3: Changes in cerebral oxyhaemoglobin concentration when using a visualacupuncture scheme with metal needles and laserneedles of different optical power.The curve shows the best analytical adaptation to the measurement values oflaserneedle stimulation.

The experimental data in Figure 1.3 show that laserneedle stimulation withan optical power of about 40 mW leads to changes in oxyhaemoglobinconcentration, similar to the effects when using metal needles. Theequivalency between metal needle stimulation and laserneedle stimulationcan also be proven with these cerebral effects. These experiments also yieldthe best analytical adaptation of the measurement results in a logarithmicfunction, i.e. cerebral oxyhaemoglobin concentration parameters alsounderlie a physiological dose-effect relationship.

The definition of verum-acupuncture, placebo-acupuncture and sham-acupuncture presents a fundamentally unsolved and principally unsolvable

problem for classic acupuncture with metal needles. We examined the possibilities to differentiate and define these three modalities experimentallyfor laserneedle acupuncture. Hereby, acupoint combinations were stimulatedwith laserneedles, which according to traditional Chinese medicine arecoherent with the visual or olfactory system. Figure 1.4 shows the scheme ofvisual distant points used.


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Fig. 1.4: Distant acupuncture points Hegu, Zusanli, Kunlun and Zhiyin of the visualsystem (left) and the selected sham-points (right).

Stimulation of the olfactory system was done with acupoints Yinxiang,Pianli and Hegu. Changes in blood flow velocity in the posterior cerebralartery (PCA) and anterior cerebral artery (ACA) were used for determiningthe effects of acupuncture stimulation and registered with functional Dopplersonography. In addition, changes in activity in the frontal area and olfactory

cortex were detected using functional MR-imaging. Detailed informationregarding these measurements [10] are described in chapter 8.

A randomised, controlled cross-over study design was used and can bedivided in the following test situations:The verum situation, characterized by activated laserneedles at the selectedacupoint, the placebo-situation characterized by non-activated laserneedlesat the acupoints and the sham-situation, characterized by activatedlaserneedles at the selected sham-points.The verum-situation showed a specific, significant increase in blood flow

velocity in the PCA and ACA in our volunteers (n = 41), resulting inspecific, significant activity in the occipital and olfactory cortex visible inMR-imaging. No significant changes in functional Doppler sonography andin functional MR-imaging were registered in the placebo-situation or sham-situation.From these experimental studies, we conclude that a clear differentiation

between verum-acupuncture and placebo- or sham-acupuncture is possible inregard to laserneedle acupuncture. In this context, the basic difference

between acupuncture with laserneedles and with metal needles becomes

obvious and fulfils and important criterion for an adequate placebo-acupuncture method. Since the reproducible De-Qi sensations can be


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triggered with laserneedle acupuncture and the proven cerebral effects do not pose special demands regarding the positioning of the laserneedles, weconclude that acupuncture with laserneedles fulfils all requirements of acomplete placebo experiment. We want to emphasize that the proven

physiological equivalence between metal needles and laserneedles applies toall of the reports and scientific results achieved with laserneedles and in turnis also valid for classic needle acupuncture. Therefore, the use of laserneedleacupuncture, performed in randomised, double-blind studies, can be of greatadvantage for clinically objectifying the effects of acupuncture.

1.4 Physical characteristics of laserneedles

The laserneedles were developed at the University of Paderborn to provide atherapeutically and methodically equivalent, non-invasive instrument to theclassic metal needle.

Fig. 1.5: Laserneedle for acupuncture.

Figure 1.5 shows a laserneedle. You can see that laserneedles areacupuncture needles with optical fibres that can be applied to the skin insuch a way that the distal light emitting region of optical fibre is in contactwith the surface of the skin. A major goal of these scientific studies was todevelop photonic acupuncture needles for simultaneous stimulation ofselected acupoint combinations on the body and ear which can be used in theexact same way as metal needles, The optical power densities at the distallaserneedle exit were set in such a way, that metal needle equivalentstimulation effects are guaranteed.


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Physical foundation of stimulation effects in the numerous experimentalstudies is the emission of laser light with a wavelength of 685 nm (red light)as well as the complementary emission of infrared laser light withwavelengths of 880 – 950 nm. Hence, laserneedles emit “bi-chromatic“ lightwith a power density of 5 - 10 W/cm² at the exit of the laserneedle.Complementary, bi-chromatic emission is based on light conversion, i.e. redlaser light also activates the infra-red photons in the light wave conductor.Laser light leaving the laserneedle is coherent and is routinely examinedwith Michelson-Interferrometry regarding its characteristics of coherence.Chronological and spatial coherence of emitted photons is immediately lostwhen entering the skin and diffuse scattering becomes a determining factor.The physiologically determinant power density range of 5 - 10 W/cm² isachieved by a specially developed method of optical tailoring of the fibre

core.In Table 1.1 we can see that this method is very effective, when we want toreach a maximum of power density with a minimum of laser strength.

Laser power Laser-spot diameter

at the skin

Optical power density

50 mW 5 mm 0.25 W/cm²

50 mW 0.5 mm 25.5 W/cm²

50 mW 0.05 mm 2550 W/cm²

Tab. 1.1: Connection between laser power, laser-spot diameter and optical powerdensities.

Exemplary calculations show that a power density of 0.25 W/cm2 resultswhen laser power of 50 mW and spot-diameter of 5 mm at the skin,commonly used in one-hand, laser-pens is applied. In order to reach therequired physiological range of power density for the laserneedles, a 20 Wlaser must be used! As illustrated in Table 1.1, reduction of the spot-diameter by the factor 10 leads to an increase in optical power densities by afactor of 100.The emission characteristics of laserneedles described here, in particularregarding the optical power densities affecting the skin from 5 - 10 W/cm²,as well as the bichromatic emissions of red and infrared laser light are basedon patented technologies only realised in laser-acupuncture needles and areavailable under the trade name LASERneedle® [12].


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Contact application guarantees that the applied light dose can be exactlydetermined and reproduced. The next figure (Fig. 1.6) graphically illustrateshow much light energy is transferred from a laserneedle during acupuncturetreatment into the skin.

0

10

20

30

40

50

60

0 5 10 15 20 25

duration of treatment [min]

a p p l i e d l i g h t e n e r g y

d o s e p e r l a s e r n e e d l e [ J ]

Fig. 1.6: Light dose of a laserneedle dependent on the duration of treatment.

In order to determine the entire optical power transferred into tissue duringstimulation of acupoints, the value in the graph needs only to be multipliedwith the number of laserneedles applied.Transmitted light energy of about 320 J, equivalent to about 80 cal or thatcontained in less than a half teaspoon of yogurt, resulted after a treatmenttime of 20 minutes, using 8 laserneedles.In this chapter, we have already noted, that the emission wave length oflaserneedle light should be selected in such a way, that quasi elasticscattering processes in tissues are dominant and the adsorption of photonscan be neglected.

Figure 1.7 shows the absorption behaviour of the most important tissuestructures, dependent on the emission wave length of laser light.


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Fig. 1.7: Absorption behaviour of important tissue structures dependent on theemission wave length of laser light.

Figure 1.7 shows that all important tissue structures from the skin yield aminimum in absorption coefficients ranging from 550 -1100 nm within theelectromagnetic spectrum. This is particularly true for water,

oxyhaemoglobin and melanin. In this “window”, the absorption of photonsand production of heat can be neglected since the scattering of photons ontissue molecules is the dominant interactive process. Therefore, this range isvery suitable for optical stimulation at the surface of the skin. The depthwhich photons can reach with diffuse, elastic scattering processes is onceagain dependent on the wave length. Simple estimates show that even at adepth of 2 - 3 cm, photon densities exist, which can trigger molecularactivity at nocizeptive structures.Light wave conductors available today are made of plastic (PMMA), quartz

or sapphire and have comparably little absorption in the „window“ area, sothat conduction losses in the optical fiber are practically neglectable.

Laserneedles use semi-conductor laser diodes as a light source. Figure 1.8shows a semi-conductor laser diode schematically.


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immediate contact area during a 20 minute treatment period. If we discussthe conditions during head- and ear acupuncture with laserneedles, we mustconsider that light intensity in the skin decreases exponentially and isweakened to about 50 % of the initial value when it reaches the skull. Sincethe stratum corneum, epidermis and dermis have different refractive indexesfor optical light, wave transmitting effects occur in the layers of the skinwhich distribute the laser light laterally over an area of about one to 2 cm².As a result, a proportional reduction in optical power densities up to twomagnitudes of order and the power density of laserneedle light is reduced to

physiologically unimportant values after transmission through the skin.Transmitted part of the radiation of the laserneedles is completely absorbed

by the skull. Using animal experiments, we could also show that nolaserneedle-radiation (continuous wave modus) at the surface of the cortexcan be observed [14].

Today, the new laserneedles for acupuncture provide instruments which areextensively characterized in medical-scientific studies. About 750,000acupuncture treatments with laserneedles are performed worldwide in thelast two years. In particular, patients appreciate this painless but stilleffective method of acupuncture.The medical potential of this new acupuncture method is huge. At themoment, ten University Clinics in Germany, Austria, Switzerland andFrance are perfoming scientific studies. The goal of these studies is to studyand understand the basics of acupuncture and to get a step closer to theclinical objectification of the effects of acupuncture.

1.5 Acknowledgements

The author would like to thank all of his colleagues who took part in thedevelopment of laserneedles.

1.6 References

[1] NIH Consensus Conference (1998) Acupuncture. JAMA 280: 1518-1524

[2] Yamashita H, Tsukayama H, Hori N, Kimura T, Tanno Y (2000)Incidence of adverse reactions associated with acupuncture. J AlternComplement Med 6: 345-350

[3] Pomeranz B, Chiu D (1976) Naloxone blockade of acupunctureanalgesia: endorphin implicated. Life Sci 19: 1757-1762

[4] Mayer DJ, Price DD, Rafil A (1977) Antagonism of acupunctureanalgesia in many by the narcotic antagonist naloxone. Brain Res 2:368-372


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2. Cerebral vascular effects of non invasive

laserneedles measured by transorbital and

transtemporal Doppler sonography

G. Litscher, D. Schikora

2.1 Introduction

The term "acupuncture" is used to refer to the insertion of needles into the body, at special chosen sites, for the treatment or prevention of symptoms

and conditions.“Laserpuncture” is known as a method to stimulate sequentially acupoints bylow level laser radiation. In contrast to that "laserneedles" allow to stimulateappropriate acupoint combinations simultaneously and with higher radiationdoses and therefore represent a new non invasive optical stimulation whichis described in this book. The laserneedles used in this study emit red light incw-mode with an output power of 30 - 40 mW per laserneedle, which resultsin a radiant exposure energy of about 2.3 kJ/cm² at each acupuncture pointduring a treatment time of about 10 min. Due to the well defined contactapplication and the possibility to stimulate simultaneously up to eightacupoints, the laserneedles allow to attribute the resulting cerebral vasculareffects unambiguous and exactly to the total laser radiation dose exposed atthe acupuncture point combination selected. This opens the new scientific

possibility to describe the input stimulus strength of complex acupuncturetreatments with well established physical parameters. The aim of this studywas to provide a possible first selective evidence of specific effects oflaserneedle acupuncture and needle acupuncture on brain and eye using acombination of vision related acupoints of traditional Chinese medicine,Korean hand acupuncture and ear acupuncture. Quantification of differences

in cerebral effects [1] between laserneedle acupuncture and needleacupuncture was performed using a randomized cross-over study design.


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CC omputeromputer--

CC ontrolledontrolled

AA cupuncturecupuncture®®

CC omputeromputer--

CC ontrolledontrolled

LL aserpunctureaserpuncture

Fig. 2.1: Computer-Controlled Acupuncture® (CCA®) [1] and Computer-ControlledLaserpuncture (CCL) with multidirectional ultrasound probe holder devices in the biomedical engineering lab of the Medical University of Graz. Details concerningthe method can be found on the website http://litscher.info.


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M ED-U N I G R AZ

CC omputeromputer--CC ontrolledontrolledLL aserpunctureaserpuncture

LaserneedlesLaserneedles

Fig. 2.2: The laserneedle system is a class 3B laser system, therefore it iscompulsory to wear specific laser protection glasses.

2.2 Methods

2.2.1 Non invasive laserneedles

The non invasive laserneedles were constructed to fulfil two essentialrequirements of acupuncture [2]:(i) They allow the simultaneous stimulation of up to eight acupuncture

points in any different combinations on the body, the head, the hands

and the ears.(ii) The emitted laser intensity is so adjusted that a stimulus can be

induced without destroying the surrounding tissue.

The laser radiation of eight 55 mW - laserdiodes was coupled into eightoptical fibres and the laserneedles are arranged at the distal ends of theoptical fibres. Due to coupling losses the output power of each laserneedlewas reduced to 30 - 40 mW. The fibre core diameter used in the study was ofabout 500 µm. For our experiments seven vision related acupuncture points

were chosen and irradiated simultaneously. The average time of irradiationwas of about 10 min resulting in an energy density of about 2.3 kJ/cm² at


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each acupoint and a total sum of 16.1 kJ/cm² for seven acupoints. Tomaintain the fundamental advantage of non invasiveness, the laserneedleswere fixed onto the skin but not pricked into the skin. Fig. 2.3 depicts themeasured intensity profile across the optical fibre output. The insert shows a

photograph of the distal laserneedle end. Due to the direct contact of thelaserneedles and the skin, no loss of intensity occurs and the laser power,which affects the acupuncture points, can by exactly determined byintegration of the intensity curve shown in Fig. 2.3. Actually, the outputintensity of each laserneedle was determined in such a way, resulting in anaverage irradiance intensity at one acupoint of about 3.8 W/cm².

Fig. 2.3: Emission characteristics of a tailored laserneedle used in the present study(a.u. = arbitrary units). The coherence of the laser radiation at the distal output of theoptical fibre was examined by Michelson-Interferometry. The inset shows a photograph of the distal end of a laserneedle.

Due to the fact that the contact area exposed to laser rays is constant and the

beam divergence can be neglected, the effective laser radiation dose at theacupoints was determined directly from the output intensity of thelaserneedles and the treatment duration.

optical fibre diameter [ a.u.]

i n t e

n s

i t y

[ a . u . ]

1 21

1

-2 -1

emission wavelength:

685 nm

total output power at distal end:30 mW

laser-needle emission-

characteristics

optical cladding

fibre core


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Fig 2.4: Energy density at the laser-needle contact area in dependence on thetreatment time. Due to the contact type application, as well the exposed area as thelaser intensity are constant and the laser radiation dose at the acupuncture point can be determined with high accuracy from treatment time.

2.2.2 Multidirectional transorbital and transtemporal Doppler

sonography

Transorbital and transtemporal Doppler sonographic examinations were performed with a Multi-Dop T unit (DWL Electronic Systems GmbH,Sipplingen, Germany). A 4 MHz and a 2 MHz probe were used in amultidirectional ultrasound probe holder construction. The monitoringarrangement for simultaneous recording of Doppler sonographic signals inthe ophthalmic artery (OA) and the middle cerebral artery (MCA) wasstationary at the circumference of the head. Blood flow profiles in the OAwere measured transorbitally with the smallest power value able to detectsignals (max. 20 mW/cm²). Under acoustic control, the angle and position ofthe probes were adjusted until the greatest possible signal amplitude wasreached. Alterations in the blood flow velocities of both arteries wereregistered continuously and simultaneously. In addition blood pressure wasmeasured non invasively before, during and after stimulation (Cardiocap®CC-104, Datex Medical Electronics, Hoevelaken, The Netherlands).

0

500

1000

1500

2000

2500

3000

3500

0 200 400 600 800 1000 1200 1400

l a s e r e n e r g y

d e n s

i t y

[ J

/ c m

² ]

time [s]


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2.2.3 Participants

The study protocol was approved by the institutional ethics committee of theMedical University of Graz (11-017 ex 00/01) and all 27 participants gave

written informed consent. Fourteen female and 13 male aged 21 - 38 years(mean age 25.15 + 4.12 ( x + SD) years) were examined. None of thesubjects was under the influence of centrally active medication and hadvisual deficits. All persons were free of neurological or psychologicaldisorders. They were paid for their participation.

2.2.4 Acupuncture and procedure

Seven vision related acupoints were tested in two sessions (laserneedle

acupuncture and needle acupuncture) in the same persons. The acupuncturescheme consisted of two traditional Chinese acupoints: UB.2 Zanzhu(location: in the depression of the medial end of the eyebrow. Needlingmethod: puncture transversely 0.5 - 0.8 cun) and Ex.3 Yuyao (location: atthe midpoint of the eyebrow. Needling method: puncture transversely 0.3 -0.5 cun). In addition two ear acupoints (eye and liver: locations see Fig. 2.5.

Needling method: puncture perpendicular 0.3 cun) and two vision-relatedacupoints from Korean hand acupuncture (E2: location see Fig. 2.5.

Needling method: puncture transversely 0.1 – 0.2 cun) and one from Chinese

hand acupuncture (Yan Dian: location: on the ulnar side of the thumb distalto the first metacarpal bone. Needling method: puncture perpendicular 0.2cun) were used [3-5]. Three different acupuncture systems were usedtogether because the combination shows an enhanced effect of the

parameters measured in the study [5].


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Yan Dian

Eye

Liver

E2

ZanzhuYuyao

Fig. 2.5: Vision related acupuncture points used in this study. Traditional ChineseMedicine: Zanzhu and Yuyao. Ear acupuncture: eye and liver. Korean hand

acupuncture: E2. Chinese hand acupuncture: Yan Dian.

The acupoints were punctured with sterile, single-use needles after localdisinfection of the skin. We used three different types of needles (body: 0.25x 25 mm, Huan Qiu, Suzhou, China; ear: 0.2 x 13 mm, European MarcoPolo Comp., Albi, France; hand: 0.1 x 8 mm, Sooji-Chim, Korea). Needlestimulation was achieved by rotating with lifting and thrusting of theneedles.


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In case of laserneedle acupuncture the acupoints were cleaned with alcohol,the laserneedles were put in contact to the skin and stable fixed by plasterstripes. The acupoint scheme was the same as described above.

During the experiments the subjects were in a relaxed and comfortable position on a bed in our laboratory. Then the monitoring equipment was positioned. After a 10-minute resting period the laserneedles or acupunctureneedles were applied. The choice for the initial stimulation was randomized.

The mean blood flow velocity (vm) in the OA and the MCA were evaluatedsimultaneously and continuously [1]. Each person was studied withlaserneedle acupuncture and needle acupuncture. The choice of themeasuring procedure was randomized and the interval between theexperiments was 20 to 30 minutes.

2.2.5 Statistical Analysis

The data were tested with Kruskal-Wallis ANOVA on ranks using thecomputer program SigmaStat (Jandel Scientific Corp., Erkrath, Germany).The results of the conditions before (a), during (b) and after (c) acupuncturewere given as means ( x) + standard deviation (SD) or standard error (SE).The criterion for significance was defined as p < 0.05.

2.3 Results

The demographic data, the laser- and acupuncture schemes and themeasurements of mean blood flow velocity in the OA and MCA aresummarized in Fig. 2.6.


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Participants n=27

14 female, 13 male, mean age 25.15 + 4.12 (SD), range 21 – 38 years

Randomized, cross-over design

40

60

50

60

Ophthalmic artery (OA)

Middle cerebral artery (MCA)

Ophthalmic artery (OA)

Middle cerebral artery (MCA)

before (a) during (b) after (c)Mean bloodflow velocity

Laserpuncturex+ SE

Ophthalmic

artery (cm/s)

10.33+0.88 14.67+1.15 11.33+0.96

Middle cerebralartery (cm/s)

54.93+3.28 54.56+3.26 55.07+3.50

before (a) during (b) after (c)Mean bloodflow velocity

Acupuncturex+SE

Ophthalmic

artery (cm/s)

10.22+0.83 19.15+1.20 12.22+0.94

Middle cerebralartery (cm/s)

53.93+3.33 56.04+3.44 55.04+3.47

R

Non invasive Laserneedles Manual Needle Acupuncture

10

15

20

10

15

20vm (cm/s)

a

a

a

a

b b

b

b

c

c

SE

c

c

p=0.01*

p


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the same time only minor, insignificant changes in vm were seen in theMCA. The mean arterial blood pressure (before laserneedle acupuncture:79.2 + 6.6 (SD) mmHg; before needle acupuncture: 77.5 + 6.6 mmHg) wasnot significantly changed during laserneedle acupuncture (78.4 + 6.4 mmHg)or needle acupuncture (79.1 + 6.5 mmHg).The maximum amplitude of vm in the OA was detected with a delay of 10 -30 sec after the initial stimulus by the needles and with a delay of 20 - 60 secafter the initial stimulus by the laserneedles.

2.4 Discussion

Important factors have led to the expanding use of laser technology inmedicine. These factors are the increasing understanding of the wave-length

selective interaction and associated effects of ultraviolet-infrared radiationwith biologic tissues, including those of acute damage and long-termhealing, the rapidly increasing availability of lasers emitting at thosewavelengths that are strongly absorbed by molecular species within tissues,and the availability of both optical fiber and lens technologies [6]. Fusion ofthese factors has led to the development of the new laserneedle systemwhich is described for the first time in scientific literature by our researchgroup.

Acupuncture using laserneedles has the advantage that the stimulation canhardly be felt by the patient. The operator may also be unaware of whetherthe laserneedle system is active, and therefore true double-blind studies can

be performed, which was almost impossible up to now in acupunctureresearch. The new system has the added advantage that it can be used at allstandard acupuncture points [32].

The effectiveness of unconventional complementary medical methods, suchas laserpuncture, have previously been documented mainly as single cases.There are only few theoretical and clinical studies concerning laserpuncture

in scientific literature [7-16].

Recent scientific and technological progress has truly revolutionizedacupuncture. The usage of advanced exploratory tools, such as laser Dopplerflowmetry [17], laser Doppler imaging [18], ultrasound [1,5,19,20] ormagnetic resonance imaging [1,21], provides revealing insights and attemptto shine scientific light upon the most spectacular of the eastern medical

procedures.

Similar like in animal studies [22,23] we have found recently that the brainis the key to acupuncture’s and laserpuncture’s effects. New experimental


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constructions to measure ultrasound, light and bioelectrical processes canreproducibly demonstrate effects of stimulation of acupoints in the brain[1,5,19,20,24-28].

Studies with biosensors and probes in a specially designed helmet showedthat acupuncture can increase significantly and specifically the blood flowvelocity in different cerebral arteries and increase the oxygen supply to the

brain [1,5,19,20,24,25,27,28]. Laserpuncture and manual needle acupuncturecan also lead to an increase in oxygenated hemoglobin in the tissue oxygenindex [20,29]. However, laserpuncture and needling at placebo points did not

produce the same effects on cerebral oxygenation.

Laserpuncture has been established for many years and was reviewed byPöntinen et al. [30]. Nonetheless, the changes of cerebral function elicited

with commercially available low level lasers were in average one magnitudeof order less pronounced than those elicited with conventional needleacupuncture [1,19,20,29].

Streitberger et al. [31] have reported that the stimulus strength at theacupuncture points are of decisive importance for the therapeutic efficiencyof acupuncture treatments. Using placebo-needles in comparison with metalneedles, it was found that the efficiency of acupuncture treatments decreasessignificantly, if placebo needles were used.

Our present study shows that the new high optical stimulation withlaserneedles can elicit reproducible cerebral effects which are in the sameorder (half dimension) with respect to the maximum amplitude of the mean

blood flow velocity (vm) as compared to needle acupuncture. As it is shownin Fig. 2.3 the maximum blood flow velocity rate ratio

vm (needle) / vm (laserneedle) for the acupuncture scheme selected is ofabout 2. Regarding the stimulus dynamics we found that the delay time

between the initial stimulus and the occurrence of the maximum amplitudeof vm is in the order of 10 - 60 sec for both methods. This allows to concludethat obviously the basic mechanism of signal activation and transmission arecomparable for both acupuncture methods. Interestingly, the maximum flowrate for laserneedles was obtained after exposing a total (sum of sevenacupoints) laser ray dose of about 1.6 kJ/cm².

2.5 Conclusion

In conclusion, the results of the laserneedle applications for acupuncture

demonstrate specific, significant alterations in blood flow velocity of theophthalmic artery after stimulating vision-related acupoints on the body, ear


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and hand. At the same time blood flow velocity in the middle cerebral arterydid not change significantly. For needle acupuncture qualitatively the same

behavior was observed. The cerebral effects of the laserneedles werecomparable to the alterations of the needle acupuncture, they differabsolutely by a factor of ~ 2. This is a significant improvement compared tothe common low-level-handylaser (LLLT) acupuncture (cerebral effectsfactor ~ 10 lower as for needle acupuncture).Further studies using different laser stimulus intensities and wavelengths arein progress, to optimize the adjustment of the new noninvasive laserneedlesand to clarify the elementary excitations at the acupoints.

2.6 Acknowledgements

The present report is the product of many co-workers. We are especiallyindebted to Ms. Lu Wang MD, Evamaria Huber, Ms. Petra Petz MSc andMs. Ingrid Gaischek MSc (all Biomedical Engineering and Research inAnesthesia and Intensive Care Medicine, Medical University of Graz /Austria) for their support to this study. We would also express our thanks toDr. Leopold Dorfer, President of the Austrian Society for ControlledAcupuncture and to Dr. Michael Weber, Member of the EGFAA for theirhelp. We thank Petra Thöne, Tanja Prohaska, Marianne Hubbert and JörgReitemeyer for technical support.

2.7 References

[1] Litscher G, Cho ZH (Eds) (2000) Computer-Controlled Acupuncture®.Pabst Science Publishers, Lengerich-Berlin-Rom-Riga-Wien-Zagreb

[2] Schikora D. European Patent Nr. PCT/EP 01/08504[3] König G, Wancura I (1989) Neue Chinesische Akupunktur. Lehrbuch

und Atlas der Akupunkturpunkte. Wilhelm Maudrich, Wien-München-Bern

[4] Yoo TW (2001) Koryo hand therapy - Korean hand acupuncture. EumYang Mek Jin Publishing Co, Seoul

[5] Litscher G (2002) Computer-based quantification of traditionalChinese-, ear- and Korean hand acupuncture: Needle-inducedchanges of regional cerebral blood flow velocity. Neurol Res 24: 377-380

[6] Judy MM (1995) Biomedical lasers. In: Bronzino JD. (Ed) TheBiomedical Engineering Handbook. CRC Press, IEEE Press, BocaRaton (USA), pp. 1333-1345

[7] Fargas-Babjak A (2001) Acupuncture, transcutaneous electrical nervestimulation, an laser therapy in chronic pain. Clin J Pain 17 (4. Suppl):105-113


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[8] Radmayr C, Schlager A, Studen M, Bartsch G (2001) Prospectiverandomized trial using laser acupuncture versus desmopressin in thetreatment of nocturnal enuresis. Euro Urol 40(2): 201-205

[9] Naeser MA (1997) Neurological rehabilitation: acupuncture and laseracupuncture to treat paralysis in stroke, other paralytic conditions, and

pain in carpal tunnel syndrome. J Altern Complement Med 3(4): 425 -428

[10] Read A, Beaty P, Corner J, Sommerville Ville C (1996) Reducingnaltrexone-resistant hyperphagia using laser acupuncture to increaseendogenous opiates. Brain Inj 10(12): 911-919

[11] Troshin OV (1994) A clinico-neurophysiological analysis of the singleaction of laser puncture. Lik Sprava 5-6: 148-153

[12] Qin JN (1987) Laser acupuncture anaesthesia and therapy in People'sRepublic of China. Ann Acad Med Singapore 16(2): 261-263

[13] Nikolaev NA (1986) Therapeutic efficacy of laser and electropuncture

reflexotherapy in correcting the initial manifestations of cerebralcirculatory insufficiency. Zh Nevropathol Psikhiatr Im S S Korsakova86(1): 60-64

[14] Omura Y (1983) Non-invasive circulatory evaluation and electro-acupuncture & TES treatment of diseases difficult to treat in Westernmedicine. Acupunct Electrother Res 8(3-4): 177-256

[15] Schlager A, Oehler K, Huebner KU, Schmuth M, Spoetl L (2000)Healing of burns after treatment with 670-nanometer low-power laserlight. Plast Reconstr Surg 105(5): 1635-1639

[16] Schlager A, Offer T, Baldissera I (1998) Laser stimulation ofacupuncture point P6 reduces postoperative vomiting in children

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laserpuncture on the cerebral circulation. Lasers Med Sci 15: 57-62[20] Litscher G (2001) High-Tech Akupunktur ®. Pabst Science Publishers,Lengerich-Berlin-Rom-Riga-Wien-Zagreb

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pp. 996-997


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3. Near-infrared spectroscopy for objectifying

cerebral effects of needle and laserneedle

acupuncture

G. Litscher, D. Schikora

3.1 Introduction

The connection between puncturing the body with a needle and the reactionat another area of the body is still unclear. However, it has been proven thatwhen particular acupuncture points are stimulated with needles or laser light,

specific effects in the brain can be objectivized and quantified with moderncerebral monitoring methods [1-3].

In this present study, we objectivized the systematic changes of oxygenationin the brain [4] using cerebral near-infrared spectroscopy (NIRS), afterstimulating acupuncture points according to traditional Chinese medicine(TCM), Korean and Chinese hand acupuncture, ear acupuncture andcombinations of these different methods.

We analyzed a total of 328 recordings after manual needle and laserneedlestimulation from 88 healthy volunteers [5,6].

3.2 Methods

3.2.1 Near-infrared spectroscopy

The NIRS method allows the evaluation of changes in cerebral oxygenationthrough the intact skull and is also gaining importance in acupuncture

research because of its non-invasive approach [6-10].The NIRO 300 Monitor (Hamamatsu Photonics, Japan) is a new instrumentin this field of research. Parameters such as changes in oxyhemoglobin( O2Hb) and desoxyhemoglobin ( HHb) are determined by Lambert-Beer´s

principle [4]. The system can measure the absolute value (µmol) of changesin parameters, but not the level (absolute concentration) at which thesechanges occur (in positive or negative direction). The measurement value iszero, as long as no change in concentration occurs. Placement of the sensor(emitter and near-infrared detectors) on the head with a silicone holder is

easy and reproducible. Data output of O2Hb and HHb were presented on acolor LCD-display and color printer.


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In addition to the spectroscopic method, non-invasive, standard monitoring parameters such as blood pressure (Cardiocap® CC-104, Datex MedicalElectronics, Hoevelaken, Netherlands) were determined before, during andafter different manners of stimulation.

3.2.2 Laserneedle stimulation

The laserneedle-technique represents a new, non-invasive method for opticstimulation of acupuncture points and was first described in literature in2002 [5,6,11,12]. Laserneedle® (Schikora D.: European Patent Nr. PCT/EP01/08504) acupuncture allows the simultaneous stimulation of individualacupuncture point combinations. Variations and combinations ofacupuncture at different areas of the body, ear or hand, as performed

particularly in this study are possible (compare Fig. 3.1). Details regardingthis method can also be found in preceding studies [5,6,11,12].

Fig. 3.1: Test person during laserneedle stimulation and simultaneous registration of NIRS parameters. Right bottom: single active laserneedle and application device.

Changes in near-infrared spectroscopic parameters in the frontal region ofthe brain were continuously registered and analyzed.


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3.2.3 Healthy volunteers, acupuncture, measurement procedure

In this study, a total of 328 measurements on 88 healthy volunteers (50female, 38 male) mean age 25.7 + 4.0 ( x + SD) years (19 - 38 years) were

performed. The study protocol was approved by the ethics committee of theMedical University of Graz (11-017) and all test persons gave their writtenconsent. None of the volunteers had visual, neurological or psychologicaldeficits or were under the influence of central nervous system effectivedrugs.

A maximum of

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