Acupuntura Laser Book

Gerhard Litscher and Detlef Schikora (Eds.
LaserneedleAcupuncture
Science
and
Practice
PABST
III
Gerhard Litscher and Detlef Schikora

(Eds.)
Laserneedle - Acupuncture
Science and Practice
PABST SCIENCE PUBLISHERS

Lengerich, Berlin, Bremen, Miami,
Riga, Viernheim, Wien, Zagreb
IV
Bibliographic information published by Die Deutsche Bibliothek
Die Deutsche Bibliothek lists this publication in the Deutsche Nationalbibliografie; detailed
bibliographic data is available in the Internet at <http://dnb.ddb.de>.
This work is subject to copyright. All rights are reserved, whether the whole or part of the
material 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, even
in 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 and
recommendations contained herein are accurate and compatible with the standards generally
accepted 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 any
liability, loss, or damage incurred as a consequence, directly or indirectly, of the use and
application 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 29
8036 Graz / Austria
Tel. ++43 316 385-3907, -83907
Fax ++43 316 385-3908
E-mail: gerhard.litscher@meduni-graz.at
Detlef Schikora, PhD
University of Paderborn
Faculty of Science
Warburger Strae 100
33095 Paderborn / Germany
Tel. ++49 5251 60-3566
Fax ++49 5251 60-3490
E-mail: schikora@upb.de
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)
Preface
This compendium of Laserneedle-Acupuncture conveys scientific and first
practical results from the field of laserneedle acupuncture in an abridged and
concise form.
Just the thought of being pricked with needles is very uncomfortable for
many people. Using the new, advanced laserneedle acupuncture method up
to 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 at
the Medica fair in Dsseldorf. Three years of intensive scientific research
and developmental work preceded.
The basic idea of laserneedles originated from analysis of laser acupuncture,
which was developed and spread throughout Europe in the 1990s. It was
obvious, that the technique of classic acupuncture as it had been practised for
centuries, namely the simultaneous stimulation of therapy-specific acupoint
combinations, 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 Chinese
Medicine has been documented in classic or modern literature. Suddenly, the
simultaneous puncturing of acupoints according to the basic scheme of
Chinese acupuncture was no longer important when practicing the Western
method of laserpuncture.
With the development of laserneedles, the goal to maintain the fascination of
acupuncture itself was pursued: the complex diagnostic systemic approach
on the one hand, and the simple manner of therapeutic application and its
effects on the other. Simultaneous procedures, simple, manual handling
during needle acupuncture with needle-equivalent stimulation effects and
stimulation 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 laserneedle
acupuncture in particular and acupuncture in general. Noted scientists and
well-known users have taken part in this book and reported about the
scientific investigations and use of this new, advanced method in the field of
acupuncture.
VI
Non-invasive laserneedle stimulation can induce specific, reproducible
effects in the brain. This is expressed by changes in different parameters
such as cerebral blood flow velocity, which can be objectified using modern
neuromonitoring methods for the first time. The results in this book show
that cerebral effects induced by the new, painless laserneedle technique lie
within similar dimensions as those evoked by manual needle acupuncture.
For the first time, laserneedle acupuncture allows simultaneous optical
stimulation of individual acupoint combinations. At the same time,
variations in acupuncture on the body, ear or hand, as performed in our first
study were made possible. Based on these investigations, the cerebral effects
of laserneedle stimulation could be systematically objectified, specified and
optimized for the first time. These scientific findings do not only have
extensive 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 typical
modern way: per e-mail. Professor Litscher from the Medical University of
Graz reported his interest in performing studies with laserneedle acupuncture
to the University of Paderborn. Dr. Schikora from Paderborn answered back
that he was very interested. What developed from this contact is documented
in this book. Currently studies with laserneedle acupuncture are being
performed in several University Clinics in Germany, Austria, Switzerland
and France. All of these studies will contribute to a better understanding and
objectification of effects not only for acupuncture with laserneedles but also
for classic acupuncture and promote the use of this comprehensive, natural
medical treatment method. Scientists agree that the 21st Century will be the
Century of Photons, like the 20th Century was the Century of Electrons. It is
certain, that exact understanding of the elementary interaction of photons
with biological molecules, will lead to new, natural medical treatment
methods which will reach far beyond acupuncture.
January 2005
Detlef Schikora
Gerhard Litscher
VII
Contents
1.
Laserneedles in acupuncture ............................................................... 1

1.1 Introduction and motivation ......................................................... 1
1.2 Dose-effect relationships in acupuncture ..................................... 4
1.3 Laserneedle acupuncture as a placebo method............................. 7
1.4 Physical characteristics of laserneedles...................................... 11
1.5 Acknowledgements .................................................................... 16
1.6 References .................................................................................. 16
2.
Cerebral vascular effects of noninvasive laserneedles measured

by transorbital and transtemporal Doppler sonography................ 18
2.1 Introduction ................................................................................ 18
2.2 Methods...................................................................................... 20
2.2.1 Non-invasive laserneedles ............................................. 20
2.2.2 Multidirectional transorbital and transtemporal
Doppler sonography ...................................................... 22
2.2.3 Participants .................................................................... 23
2.2.4 Acupuncture and procedure........................................... 23
2.2.5 Statistical analysis ......................................................... 25
2.3 Results ....................................................................................... 25
2.4 Discussion .................................................................................. 27
2.5 Conclusion.................................................................................. 28
2.7 References .................................................................................. 29
3.
Near-infrared spectroscopy for objectifying cerebral

effects of needle and laserneedle acupuncture ................................. 32
3.1 Introduction ................................................................................ 32
3.2 Methods...................................................................................... 32
3.2.1 Near-infrared spectroscopy............................................ 32
3.2.2 Laserneedle stimulation................................................. 33
3.2.3 Healthy volunteers, acupuncture,
measurement procedure................................................. 34
3.3 Results ....................................................................................... 36
3.4 Discussion .................................................................................. 38
3.6 References .................................................................................. 41
4.
Communication between acupoint and brain proved

by ultrasound ...................................................................................... 43
4.1 Introduction ................................................................................ 43
4.2 Methods and materials................................................................ 43
VIII
4.2.1
4.3
4.4
4.5
4.6
TCD monitoring of the anterior and posterior

cerebral arteries with a new probe holder...................... 43
4.2.2 Participants .................................................................... 44
4.2.3 Laserneedle acupuncture ............................................... 45
Results ....................................................................................... 48
Discussion .................................................................................. 53
Acknowledgements .................................................................... 55
References .................................................................................. 55
5.
Histological investigations regarding micromorphological

effects of laserneedle illumination. Results of an animal
experiment........................................................................................... 57
5.1 Introduction ................................................................................ 57
5.2 Methods...................................................................................... 57
5.2.1 Procedure....................................................................... 57
5.2.2 Laserneedle stimulation................................................. 59
5.2.3 Laser Doppler flowmetry and temperature
measurement.................................................................. 59
5.3 Results ....................................................................................... 60
5.4 Discussion .................................................................................. 61
5.6 References .................................................................................. 62
6.
Effects of laserneedle stimulation on microcirculation and

skin temperature................................................................................. 64
6.1 Introduction ................................................................................ 64
6.2 Method and volunteers ............................................................... 64
6.2.1 Laser Doppler flowmetry .............................................. 64
6.2.2 Volunteers and procedure.............................................. 65
6.3 Results ....................................................................................... 67
6.4 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 ................................................................................ 73
7.2 Material and methods ................................................................. 73
7.2.1 Subjects ......................................................................... 73
7.2.2 Procedure and study design ........................................... 74
7.2.3 Evaluation parameters ................................................... 76
IX
7.3
7.4
7.5
7.6
Results ....................................................................................... 77
Discussion .................................................................................. 81
Acknowledgements .................................................................... 85
References .................................................................................. 85
8.
Acupuncture using laserneedles modulates brain function:

first evidence from functional transcranial Doppler
sonography (fTCD) and functional magnetic resonance
imaging (fMRI) ................................................................................... 87
8.1 Introduction ................................................................................ 87
8.2 Methods...................................................................................... 88
8.2.1 Painless laserneedles ..................................................... 88
8.2.2 Functional multidirectional transcranial Doppler
sonography (fTCD) ....................................................... 88
8.2.3 Functional magnetic resonance imaging (fMRI)........... 89
8.2.4 Participants .................................................................... 89
8.2.5 Experimental design and procedure .............................. 89
8.2.6 Evaluated parameters..................................................... 91
8.3 Results ....................................................................................... 92
8.4 Discussion .................................................................................. 96
8.5 Conclusions ................................................................................ 98
8.7 References .................................................................................. 98
9.
Quantification of gender specific thermal sensory and

pain thresholds before and after laserneedle stimulation ............. 101
9.1 Introduction .............................................................................. 101
9.2 Method ..................................................................................... 101
9.2.1 Volunteers.................................................................... 101
9.2.2 Measurement of thermal sensitivity and thermal
pain thresholds............................................................. 102
9.2.3 Laserneedle acupuncture and procedure...................... 103
9.2.4 Statistical analysis ....................................................... 105
9.3 Results ..................................................................................... 105
9.4 Discussion ................................................................................ 109
9.5 Acknowledgements .................................................................. 110
9.6 References ................................................................................ 110
10. Biological effects of painless laserneedle acupuncture a short summary of important scientific results ............................ 112
10.1 Introduction .............................................................................. 112
10.2 Methods.................................................................................... 112
10.2.1 Temperature and microcirculatory monitoring ........... 112
10.3
10.4
10.5
10.6
10.7
10.2.2 Functional multidirectional transcranial Dopplersonography (fTCD) ..................................................... 113

10.2.3 Functional magnetic resonance imaging (fMRI)......... 113
10.2.4 Near infrared spectroscopy (NIRS) ............................. 113
10.2.5 Laserneedle stimulation............................................... 113
10.2.6 Healthy volunteers, animal experiment and
procedures.................................................................... 114
10.2.8 Evaluation parameters ................................................. 115
Results ..................................................................................... 115
Discussion ................................................................................ 121
Conclusion................................................................................ 122
Acknowledgements .................................................................. 122
References ................................................................................ 122
11. Increases in intracranial pressure and changes in blood

flow velocity due to acupressure, needle and
laserneedle acupuncture?................................................................. 124
11.1 Introduction .............................................................................. 124
11.2 Material and methods ............................................................... 124
11.2.1 Volunteers, patient, acupressure and procedure .......... 124
11.2.2 Measurement techniques, evaluation parameters
and statistical analysis ................................................. 126
11.3 Results ..................................................................................... 127
11.4 Discussion ................................................................................ 131
11.6 References ................................................................................ 133
12. Laserneedle acupuncture - clinical studies..................................... 135
12.1 Introduction .............................................................................. 135
12.2 Material, patients and methods................................................. 136
12.3 Results ..................................................................................... 139
12.3.1 Lumbar, thoracic and cervical spine syndromes as
well as post cervical and lumbar intervertebral
disk prolapse................................................................ 139
12.3.2 Gonarthrosis, coxarthrosis, rhizarthrosis, periarthritis
in the shoulder, epicondylitis, tendinitis,
Morbus Bechterew and fibromyalgia-syndrome ......... 140
12.3.3 Remaining paresis after stroke .................................... 141
12.3.4 Cephalgia, migraine and trigeminal neuralgia............. 142
12.3.5 Arterial obstruction disease ......................................... 143
12.3.6 Gastropathy and bronchial asthma .............................. 143
12.3.7 Depression, anxiety, panic attacks,
psychovegetative exhaustion ....................................... 143
XI
12.4 Discussion ................................................................................ 144
12.5 References ................................................................................ 145
13. Pain therapy with laserneedle acupuncture ................................... 147
13.1 Introduction .............................................................................. 147
13.2 Case reports .............................................................................. 147
13.3 Argumentation.......................................................................... 148
13.4 Discussion ................................................................................ 150
13.5 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.................................................................. 152
14.3 Results ..................................................................................... 154
14.4 Discussion ................................................................................ 154
14.5 References ................................................................................ 155
15. Laserneedles in gynecology.............................................................. 156
15.1 Introduction .............................................................................. 156
15.2 Material, test persons, technique .............................................. 157
15.3 Case studies .............................................................................. 158
15.3.1 Induction of labor with laserneedles............................ 158
15.3.2 Carpal tunnel syndrome............................................... 160
15.3.3 Urogenital symptoms, back pain, hot flushes.............. 161
15.3.4 Breast cancer with mastectomy, transmission in scars 162
15.3.5 Dysmenorrhoea, lack of energy................................... 164
15.3.6 Childlessness, temperature curve, cycle regulation..... 165
15.4 Results and discussion.............................................................. 166
15.5 References ................................................................................ 168
16. Laserneedles in gynecology - a study with questionnaires ............ 169
16.1 Introduction .............................................................................. 169
16.2 Test persons.............................................................................. 169
16.3 Method ..................................................................................... 170
16.4 Results ..................................................................................... 171
16.5 Discussion ................................................................................ 177
16.6 References ................................................................................ 178
17. Laserneedle therapy in dentistry..................................................... 179
17.1 Introduction .............................................................................. 179
17.2 Methods and materials.............................................................. 179
17.3 Results ..................................................................................... 179
XII
17.3.1 Oral surgery ................................................................. 179
17.3.2 Endodontology ............................................................ 180
17.3.3 Crown - bridges ........................................................... 181
17.3.4 Pain therapy ................................................................. 181
17.3.5 Myoarthropathy ........................................................... 181
17.3.6 Neuralgia ..................................................................... 182
17.3.7 Sedation in case of dental phobias............................... 182
17.3.8 Nausea during molding................................................ 182
17.4 Discussion ................................................................................ 183
17.5 References ................................................................................ 183
18. Laserneedle stimulation as a potential additive method
for post operative pain treatment.................................................... 185
18.1 Introduction .............................................................................. 185
18.2 Method ..................................................................................... 185
18.2.1 Patients and procedure................................................. 185
18.2.2 Laserneedle acupuncture ............................................. 186
18.3 Results ..................................................................................... 187
18.4 Discussion ................................................................................ 188
18.6 References ................................................................................ 189
19. Effects of laserneedle stimulation in the external auditory
meatus on very early auditory evoked potentials .......................... 190
19.1 Introduction .............................................................................. 190
19.2 Methods.................................................................................... 190
19.2.1 Laserneedle stimulation in the external
auditory meatus ........................................................... 190
19.2.2 Auditory evoked potentials of early latency................ 191
19.2.3 Volunteers and procedure............................................ 192
19.3 Results ..................................................................................... 193
19.4 Discussion ................................................................................ 195
19.6 References ................................................................................ 199
20. List of references............................................................................... 200
21. Websites............................................................................................. 202
Addendum................................................................................................. 203
XIII
Editors (and authors):

Gerhard Litscher, Prof MSc PhD MDsc
Department of Biomedical Engineering and Research in Anesthesia and
Intensive Care Medicine, Medical University of Graz
Auenbruggerplatz 29
8036 Graz / Austria
Detlef Schikora, PhD
Faculty of Science
Warburger Strasse 100
33098 Paderborn / Germany
Authors:
Konrad B. Borer, MD
Therwilerstrasse 11
4153 Reinach BL / Switzerland
Franz Ebner, Prof MD
MR Research Unit and Clinical Department of Neuroradiology
Auenbruggerplatz 9
8036 Graz / Austria
Franz Fazekas, Prof MD
Department of Neurology, Medical University of Graz
Auenbruggerplatz 22
8036 Graz / Austria
Rudolf Helling, MD
1st Chairman of the rzte-Forum fr Akupunktur e.V.
Ostenallee 107
59071 Hamm / Germany
Evamaria Huber
Auenbruggerplatz 29
8036 Graz / Austria
XIV
Knut Kolitsch, MD
General practitioner and expert for special pain therapy
Oelzer Strae 12
98746 Katzhtte/Thringen / Germany
Wolfgang Nemetz, MD
Department of Anesthesiology for Neurosurgical and Craniofacial Surgery
and Intensive Care, Medical University of Graz
Auenbruggerplatz 29
8036 Graz / Austria
Dagmar Rachbauer, MSc MDsc
Department of Neurology, Medical University of Graz
Auenbruggerplatz 22
8036 Graz / Austria
Stefan Ropele, Prof PhD
Department of Neurology and MR Research Unit
Auenbruggerplatz 22
8036 Graz / Austria
Matthias Saraya, MD
Auenbruggerplatz 29
8036 Graz / Austria
Andreas Schpfer, MD
Auenbruggerplatz 29
8036 Graz / Austria
Gerhard Schwarz, Prof MD
Auenbruggerplatz 29
8036 Graz / Austria
XV
Josef Smolle, Prof MD
University Clinic for Dermatology, Medical University of Graz
Auenbruggerplatz 8
8036 Graz / Austria
Kirsten Sthler van Amerongen, MD
Gynecological Clinic
Inselspital Berne
University of Berne
Effingerstrasse 102
3010 Bern / Switzerland
Selman Urans, Prof MD
Department of Surgical Research, University Surgical Clinic, Medical
University of Graz
Auenbruggerplatz 29
8036 Graz / Austria
Lu Wang, MD Dipl. Acup.
Auenbruggerplatz 29
8036 Graz / Austria
Michael Weber, MD Dipl. Chem.
General practitioner, emergency medical aid, naturopathic treatment,
acupuncture
Lnsstrae 10
37697 Lauenfrde / Germany
Nai-Hua Yang, Prof MD
University Clinic for Ophthalmology, Medical University of Graz
Auenbruggerplatz 4
8036 Graz / Austria
Acknowledgements
The editors thank Mrs. Ingrid Gaischek MSc (Biomedical Engineering and
Research in Anesthesia and Intensive Care Medicine, Medical University of
Graz) for skillful preparation of the text and illustrations and Mrs. Sonya
Mendlik-Bauer for translating a major part of the manuscripts.
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 of
treatment 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. In
1998, a great advancement was made leading to the acceptance of
acupuncture in Western medicine. After a Consensus Conference, the United
States National Institute of Health concluded that acupuncture was proven
effective in cases of post operative nausea and vomiting, nausea and
vomiting accompanying chemotherapy, as well as post operative tooth pain
[1]. Acupuncture was also rated for the following indications: addictive
illnesses, menstrual pain, headaches, tennis elbow, fibromyalgia, back pain,
carpal tunnel syndrome, bronchial asthma as well as for alternative or
complementary treatment after stroke. At this conference, it was emphasized
that side effects of competently performed acupuncture are rare and
compared with conventional therapies seem to be much more favourable [2].
Even today, the acceptance of acupuncture in some fields of western
medicine is problematic particularly because no objectified proof regarding
the effects of acupuncture is available. Critics fail to see, that many excellent
scientific studies exist, particularly regarding acupoint-analgesia, which
provide a detailed picture of physiological pain reduction achieved by
acupuncture treatments. Currently, over 200 scientific publications dealing
with the elementary mechanisms of acupoint-analgesia exist. Especially the
leading 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 an
increased release of -endorphin, establish the complex picture of neurobiological basics of acupoint-analgesia [5]. A systematic overview and
critical rating of the current level of knowledge regarding neurobiological
mechanisms in acupoint-analgesia were recently documented by Irnich and
Beyer [6].
In the meantime, the acupuncture-endorphin-hypothesis could be proven in a
number of different independent animal experiments. The ability to block the
analgesic effect of acupuncture by injecting an opiate antagonist in the
2
acupoint is a strong indication that the afferent nervous system plays a role
in transmitting the effects of acupuncture. All of these scientific results
conform to the knowledge of modern pain research regarding the role of
endorphins and are described to such an extent, desirable for other wellestablished western medical methods. The fact that these scientific results
are mainly obtained from animal studies, underlines their objectivity. On the
clinical level, the situation is fundamentally different. Numerous single-case
and controlled studies have been documented, however definite evidence for
the effects could not be proven up to this day. Of course we must note that
classic needle acupuncture cannot be investigated using randomised, doubleblind study designs. Neither the patient, nor therapist can be blinded, since
the patient always feels the insertion or stimulation of the applied needle and
the therapist always must control the position, puncture depth and angle of
insertion. 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 classic
needle 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 the
requirements 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 by
German private insurance companies) was to prove or refute the efficacy of
acupuncture treatment in selected indications using clinically controlled
methods on a statistically significant level. Objectified, clinical evidence of
effects 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 1990s. It was obvious, that
the century-old technique of classic acupuncture or simultaneous stimulation
of therapy specific acupoint combinations began to leave its natural course.
Acupoints are stimulated one after the other, even though no evidence in
classic or modern literature is given, that identical effects occur. Suddenly,
the puncturing of acupoints according to the basic schemes of Chinese
acupuncture was no longer important in Western Laserpuncture. With the
development of laserneedles, we tried to maintain the fascinating aspects of
acupuncture: the complex diagnostic system on the one hand, the simple
therapeutic procedure and the effects on the other. The simultaneous
procedure, simple handling adapted to needle acupuncture, needle equivalent
stimulation effects and stimulating characteristics, were the most important
goals of laserneedle acupuncture. Thus, laserneedles should be applied noninvasively by direct contact between the light emitting source and the skin. It
was always clear, that quantitative documented proof of the postulated
equivalence between laserneedle and classical metal needles is necessary.
3
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 and
repositioned by the therapist to increase stimulation intensity resulting in the
De-Qi sensation. This effect is not easy to quantify since the intensity of
stimulation triggered by needle puncture is also not quantifiable. How the
stimulation intensity at the acupoint influences the effect of acupuncture still
remains an unanswered question in this context. If we assume that
acupuncture is not more than a specific kind of nerve stimulation, the
question arises, whether this form of acupoint stimulation correlates with the
dose-effects known from the field of bio-physiology, and underlies the
Weber-Fechner-Law. With laserneedles, the light dose applied at any desired
acupoint combination can be measured exactly. Compared to other classic
metal needles, the stimulus strength can be quantified so that determination
of dosis-effect relationships is possible. A basic assumption regarding
stimulation characteristics i.e. the timing factor of stimulus intensity has to
be made for experimental investigation of dose-effect relationships in
acupuncture. In our first approach we assumed that the nocizeptive stimulus
triggered by the classic metal needle is a continuous constant stimulation
which lasts as long as the needle is inserted. In order to be equivalent to this
stimulation mode, the laserneedles should act in the so-called continuous
wave modus. Equivalence between both needle types can only be assumed
under these circumstances. Frequency-modulated laser light is generally not
equivalent to the application procedure of the classic needle acupuncture.
The physical characteristics of laserneedles determine their physiological
influence in tissue. We have been performing theoretical studies for some
time 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 molecular
excitation and basic relaxation on molecular surroundings. However, this is
only possible when quasi elastic scattering processes between the photons
and biological molecules are the predominant interactive processes. If we
assume that elementary stimulation in acupuncture is generated on a
molecular level, molecular-dynamic calculation shows [8], that electrical and
optical stimulation show physiologically identical results and also generate
and maintain a rhythmic cascade of action potentials at the nozizeptive
structures as those produced when chemical transmitters such as substance P
and bradykinine are released after needle puncture. These results can define
the most important physical marginal requirements for the emission
characteristics of the laserneedles: the emission wave lengths should be
selected in a such a way, that quasi elastic scattering processes are dominant
and emission intensity at the distal output of the laserneedle should be so
4
high, that responses relevant for acupuncture can be triggered by optical
stimulation.
1.2
Dose-effect relationships in acupuncture
One of the fundamental biophysiological laws, the Weber-Fechners Law,

describes the relationship between strength of perception E of a sensory
stimulus and intensity of the stimulus S. As a result, the stimulus effect and
stimulus response correlate and can be described with the following
logarithm:
E ~ ln S
This proportionality does not imply more than that the doubling of stimulus
strength not automatically leads to doubling of perception or effects of the
stimulus.
If we illustrate this simple relationship graphically, two important
characteristics become visible and are shown in Figure 1.1.
5
Reizwirkung
[a.u.]
stimulus
effects [a.u.]
10
stimulus
strength
Reizstrke
[a.u.][a.u.]
Fig. 1.1: Relationship between stimulus strength and stimulus effects according to
Weber-Fechner s Law.
The curve illustrates threshold characteristics of physiological stimulation.

Sensory stimuli do not lead to any effects when stimulus intensity lies under
5
a critical threshold value. Weak external influences are filtered out by the
organism. Moreover, the curve shows the saturation characteristics of
physiological stimuli. Thus, a doubling of stimulus strength does not lead to
the doubling of effects within the organism. Finally, this is an expression for
the adaptability of the organism to external stimulation, whose intensities
can vary over many orders of magnitude.
Validity of Weber-Fechners Law has been proven for acoustic, thermal,
chemical and mechanical stimuli.
In our experiments, we investigated if this physiological law is also
applicable to acupuncture, e.g. if stimulus strength at the acupoint and the
resulting induced specific effects are correlated. For this purpose,
laserneedles with different optical power density were used. Power densities
which are effective on the skin were varied from 1.5 5 W/cm. In order to
compare the effect of laserneedles under identical circumstances, parallel
experiments using classic metal needles were also performed. The blood
flow velocity in the ophthalmic artery (OA) and its changes during
stimulation of an eye specific acupuncture scheme were studied in this
experiments. . Preliminary studies showed that the simultaneous stimulation
of acupoints Zanzhu and Yuyao, the acupoints eye and liver on the ear, as
well acupoints E2 from Korean hand acupuncture and Yan Dian from
Chinese Hand acupuncture led to significant and specific increases in blood
flow velocity (OA) when using metal needles or laserneedles [9] (compare
chapter 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 measurement
results when using this acupuncture scheme. Measurement of blood flow
velocity was performed with transorbital and transtemporal Doppler
sonography. Blood pressure was registered before, during and after
measurement. Treatment time was 10 minutes and blood flow velocity data
was monitored continuously. A randomised, cross-over study design was
used and each volunteer underwent acupuncture with laserneedles, as well as
with metal needles. The study protocol was approved by the ethics
commission of the Medical University of Graz, reasons for exclusion of
volunteers (n = 27) were treatment with medication, visual disorders, as well
as neurological and psychological deficits.
Figure 1.2 shows the detected dependency of blood flow velocity in the OA
as a function of power density from the laserneedles.
change in blood flow velocity [cm/s]
metal needle
laserneedle - power density [W/cm ]
Fig.1.2: Change in blood flow velocity in the OA in dependence on the power

density of the laserneedles during stimulation of an eye-specific acupuncture
scheme. The mean changes measured in metal needle acupuncture are marked with a
line.
Figure 1.2 clearly shows that acupuncture of the seven eye-specific

acupoints leads to a significant increase in blood flow velocity in the OA.
Metal needles yield an increase from 10 cm/s to 18 cm/s.
It is obvious that changes in blood flow velocity are dependent upon the
optical power densities applied when using laserneedle acupuncture. The
curve conveys the best analytical adaptation of measurement values. This
curve satisfies the mathematical function f (x) = c x ln (x + 0.5).
This indicates that blood flow velocity in the OA is an effective parameter
for acupuncture treatment and is logarithmically dependent on the stimulus
intensity of the laserneedles. Thus, we can conclude, that Weber-Fechners
Law is valid for the dose-effect relationship examined here. The threshold
value I* for optical power density can be calculated from the registered and
analytically determined effect curve; I* = 1.3 W/cm. This indicates that the
optical power density of the laserneedles must be greater than 1.3 W/cm in
order to activate the physiological effects of acupuncture. In addition, we can
see that the needle equivalence in optical power densities of the laserneedles
reach I t 5 W/cm. We can assume that an increase in blood flow velocity in
the OA is based on a complex cerebral reaction resulting from acupoint
7
stimulation, preceded by multi-synaptic switching of optically induced
acupuncture stimulation potentials.
It is noteworthy, that despite the physiological complexity, the logarithmic
relationship between stimulus strength I and stimulus effect is maintained.
We interpret this as obvious proof, that specific effects of acupuncture
underlie these logarithmic dose-effect relationships. The existence and
validity of dose-effect relationships in acupuncture could be proven for the
first time using the methods described here. This statement is strictly valid
only when using laserneedles which trigger continuous permanent
stimulation, thus allowing exact quantification of stimulus strength. To what
extent low or high frequency modulation of laserneedle light can modify
proven dose-effect relationships is unclear and must be investigated in
further studies. Since the postulated equivalence between metal needles and
laserneedles could be clearly shown in the examined context, we can
conclude that classical acupuncture and its effects also should be
functionally dependent on stimulus strength according to a potency rule.
1.3
Laserneedle acupuncture as a placebo method
The requirements of an adequate placebo needle and an adequate placebo

method for classical needle acupuncture are clearly to define:
The requirements of a placebo needle are:
1. The placebo needle should not generate any acupuncture effect
2. The placebo needle should be of identical shape and size compared
to the verum needle and therefore should not be distinguishable from
a verum acupuncture needle
3. The application procedure of the verum needle and the placebo
needle should be identical
4. The application procedure of the verum needle and the placebo
needle should not depend on the individual experiences of the
treating physician
5. The perception of the placebo needle and the verum needle at the
acupoint by the patient should be identical
The requirements of an acupucnture placebo method are:
1. The fundamental rules of the classic acupuncture have to be
preserved, in particular the simultaneous needling of any acupoint
combination should be possible with the placebo method
8
2. The direct contact between the treating physician and the patient has
to be minimized by the placebo method, to exclude any healing
effect by the aura of the physician
If the placebo needle and the placebo method meets all this requirements, a
double blind clinical study can be performed.
We know that needle puncture at desired skin points also leads to effects that
are similar to those resulting from stimulation of acupoints. For that reason,
this type of acupuncture is called sham-acupuncture. A further demand on
the placebo method would be to establish a clear definition between the
categories of verum-acupuncture, placebo-acupuncture and shamacupuncture.
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, but
applied to the skin at the acupoint. This non-invasive method of application
is an important characteristic of laserneedle acupuncture. Our studies with
more than 250,000 practical applications of laserneedles show that
laserneedle stimulation with distal optical power densities of about 5 W/cm
are not perceived as a stimulus sensation by the majority of patients and
volunteers. Of course the threshold of laser light stimulation is different and
variable 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 laserneedle
acupuncture were investigated systematically using multi-directional
functional Doppler sonography, near-infrared spectroscopy (NIRS) and
functional magnetic resonance imaging [10].
In other chapters of this book we show that laserneedles with power
t 5 W/cm lead to specific changes in cerebral blood flow velocity during
stimulation of visual acupoints nearly identical to those in needle
acupuncture.
In addition to these experimental studies, the effects of acupuncture
regarding changes in cerebral oxyhaemoglobin concentrations were
investigated. Here, a visual acupuncture scheme was used and in this case,
non-specific cerebral parameters could be analysed. This was done using a
randomized, cross-over design with direct comparison between metal needle
and laserneedle stimulation. Details from these experiments are described in
[11].
Measurement of cerebral concentrations of oxyhaemoglobin and
desoxyhaemoglobin were done using NIRS: Figure 1.3 shows the results of
these measurements dependent on the optical power of the laserneedles.
metal needle
laserneedle - power [mW]
Fig. 1.3: Changes in cerebral oxyhaemoglobin concentration when using a visual

acupuncture scheme with metal needles and laserneedles of different optical power.
The curve shows the best analytical adaptation to the measurement values of
laserneedle stimulation.
The experimental data in Figure 1.3 show that laserneedle stimulation with
an optical power of about 40 mW leads to changes in oxyhaemoglobin
concentration, similar to the effects when using metal needles. The
equivalency between metal needle stimulation and laserneedle stimulation
can also be proven with these cerebral effects. These experiments also yield
the best analytical adaptation of the measurement results in a logarithmic
function, i.e. cerebral oxyhaemoglobin concentration parameters also
underlie a physiological dose-effect relationship.
The definition of verum-acupuncture, placebo-acupuncture and shamacupuncture 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 experimentally
for laserneedle acupuncture. Hereby, acupoint combinations were stimulated
with laserneedles, which according to traditional Chinese medicine are
coherent with the visual or olfactory system. Figure 1.4 shows the scheme of
visual distant points used.
10
Fig. 1.4: Distant acupuncture points Hegu, Zusanli, Kunlun and Zhiyin of the visual
system (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 cerebral
artery (PCA) and anterior cerebral artery (ACA) were used for determining
the effects of acupuncture stimulation and registered with functional Doppler
sonography. In addition, changes in activity in the frontal area and olfactory
cortex were detected using functional MR-imaging. Detailed information
regarding these measurements [10] are described in chapter 8.
A randomised, controlled cross-over study design was used and can be
divided in the following test situations:
The verum situation, characterized by activated laserneedles at the selected
acupoint, the placebo-situation characterized by non-activated laserneedles
at the acupoints and the sham-situation, characterized by activated
laserneedles 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 in
specific, significant activity in the occipital and olfactory cortex visible in
MR-imaging. No significant changes in functional Doppler sonography and
in functional MR-imaging were registered in the placebo-situation or shamsituation.
From these experimental studies, we conclude that a clear differentiation
between verum-acupuncture and placebo- or sham-acupuncture is possible in
regard 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 placeboacupuncture method. Since the reproducible De-Qi sensations can be
11
triggered with laserneedle acupuncture and the proven cerebral effects do not
pose special demands regarding the positioning of the laserneedles, we
conclude that acupuncture with laserneedles fulfils all requirements of a
complete placebo experiment. We want to emphasize that the proven
physiological equivalence between metal needles and laserneedles applies to
all of the reports and scientific results achieved with laserneedles and in turn
is also valid for classic needle acupuncture. Therefore, the use of laserneedle
acupuncture, performed in randomised, double-blind studies, can be of great
advantage for clinically objectifying the effects of acupuncture.
1.4
Physical characteristics of laserneedles
The laserneedles were developed at the University of Paderborn to provide a

therapeutically and methodically equivalent, non-invasive instrument to the
classic metal needle.
Fig. 1.5: Laserneedle for acupuncture.
Figure 1.5 shows a laserneedle. You can see that laserneedles are
acupuncture needles with optical fibres that can be applied to the skin in
such a way that the distal light emitting region of optical fibre is in contact
with the surface of the skin. A major goal of these scientific studies was to
develop photonic acupuncture needles for simultaneous stimulation of
selected acupoint combinations on the body and ear which can be used in the
exact same way as metal needles, The optical power densities at the distal
laserneedle exit were set in such a way, that metal needle equivalent
stimulation effects are guaranteed.
12
Physical foundation of stimulation effects in the numerous experimental

studies is the emission of laser light with a wavelength of 685 nm (red light)
as well as the complementary emission of infrared laser light with
wavelengths of 880 950 nm. Hence, laserneedles emit bi-chromatic light
with a power density of 5 - 10 W/cm at the exit of the laserneedle.
Complementary, bi-chromatic emission is based on light conversion, i.e. red
laser light also activates the infra-red photons in the light wave conductor.
Laser light leaving the laserneedle is coherent and is routinely examined
with Michelson-Interferrometry regarding its characteristics of coherence.
Chronological and spatial coherence of emitted photons is immediately lost
when entering the skin and diffuse scattering becomes a determining factor.
The physiologically determinant power density range of 5 - 10 W/cm is
achieved 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 to
reach a maximum of power density with a minimum of laser strength.
Laser power
Laser-spot diameter
Optical power density
at the skin
50 mW
5 mm
0.25 W/cm
50 mW
0.5 mm
25.5 W/cm
50 mW
0.05 mm
2550 W/cm
Tab. 1.1: Connection between laser power, laser-spot diameter and optical power
densities.
Exemplary calculations show that a power density of 0.25 W/cm2 results

when 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 the
required physiological range of power density for the laserneedles, a 20 W
laser must be used! As illustrated in Table 1.1, reduction of the spotdiameter by the factor 10 leads to an increase in optical power densities by a
factor of 100.
The emission characteristics of laserneedles described here, in particular
regarding the optical power densities affecting the skin from 5 - 10 W/cm,
as well as the bichromatic emissions of red and infrared laser light are based
on patented technologies only realised in laser-acupuncture needles and are
available under the trade name LASERneedle [12].
13
Contact application guarantees that the applied light dose can be exactly
determined and reproduced. The next figure (Fig. 1.6) graphically illustrates
how much light energy is transferred from a laserneedle during acupuncture
treatment into the skin.
applied light energy dose per laserneedle [J]
60
50
40
30
20
10
0
10
15
20
25
duration of treatment [min]
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 during
stimulation of acupoints, the value in the graph needs only to be multiplied
with the number of laserneedles applied.
Transmitted light energy of about 320 J, equivalent to about 80 cal or that
contained in less than a half teaspoon of yogurt, resulted after a treatment
time of 20 minutes, using 8 laserneedles.
In this chapter, we have already noted, that the emission wave length of
laserneedle light should be selected in such a way, that quasi elastic
scattering processes in tissues are dominant and the adsorption of photons
can be neglected.
Figure 1.7 shows the absorption behaviour of the most important tissue
structures, dependent on the emission wave length of laser light.
14
Fig. 1.7: Absorption behaviour of important tissue structures dependent on the

emission wave length of laser light.
Figure 1.7 shows that all important tissue structures from the skin yield a
minimum in absorption coefficients ranging from 550 -1100 nm within the
electromagnetic spectrum. This is particularly true for water,
oxyhaemoglobin and melanin. In this window, the absorption of photons
and production of heat can be neglected since the scattering of photons on
tissue molecules is the dominant interactive process. Therefore, this range is
very suitable for optical stimulation at the surface of the skin. The depth
which photons can reach with diffuse, elastic scattering processes is once
again dependent on the wave length. Simple estimates show that even at a
depth of 2 - 3 cm, photon densities exist, which can trigger molecular
activity 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, so
that conduction losses in the optical fiber are practically neglectable.
Laserneedles use semi-conductor laser diodes as a light source. Figure 1.8
shows a semi-conductor laser diode schematically.
15
Fig. 1.8: Schematic illustration of a semi-conductor laser diode.
We can see that lasers consisting of mono-crystalline (Ga, Al, In) As are
about 1 x 0.5 x 0.1 mm in size, and are about as big as a salt grain. The
optically active area of a semi-conductor laser diode is once again smaller by
a factor of 1000 and is comprised of layers that are only a few nanometres
thick. The fact that the light field emitted by a laser diode doesnt have a
circular, but rather an elliptical diameter, is of decisive importance for
optical fibre laserneedles. Since the standard light wave conductors available
today have a circular diameter they lead to optical losses when an elliptical
light field is fenced in a round fibre core. These loses are relatively low and
according to technical standings, losses in a fiber are less than 10 %.
The optical power densities alone and not the primary laser strength are
responsible for the physiological stimulation effects of laserneedles at the
acupoint. The results from our studies show that metal needle equivalent
acupuncture can only be performed within a range of 5 - 10 W/cm. Today,
we attribute power densities of 10 W/cm to the field of photodynamic
therapies. The question, whether power densities in this range lead to
histologic damage is of great importance and was investigated
experimentally by our study group [13] (see chapter 5). In an animal study,
we could prove that no micromorphologic changes occurred during 20
minute application of laserneedles with about 5 W/cm. Neither microthrombosis or extravasation could be proven, nor changes in endothelial cells
of dermal blood vessels could be observed.
Thermic interaction at the acupoint was determined with infrared
thermography. As a result, a heating effect of laserneedle light can be
neglected. We measure an increase in temperature of about 1 C at the
16
immediate contact area during a 20 minute treatment period. If we discuss
the conditions during head- and ear acupuncture with laserneedles, we must
consider that light intensity in the skin decreases exponentially and is
weakened to about 50 % of the initial value when it reaches the skull. Since
the stratum corneum, epidermis and dermis have different refractive indexes
for optical light, wave transmitting effects occur in the layers of the skin
which distribute the laser light laterally over an area of about one to 2 cm.
As a result, a proportional reduction in optical power densities up to two
magnitudes 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 no
laserneedle-radiation (continuous wave modus) at the surface of the cortex
can be observed [14].
Today, the new laserneedles for acupuncture provide instruments which are
extensively characterized in medical-scientific studies. About 750,000
acupuncture treatments with laserneedles are performed worldwide in the
last two years. In particular, patients appreciate this painless but still
effective method of acupuncture.
The medical potential of this new acupuncture method is huge. At the
moment, ten University Clinics in Germany, Austria, Switzerland and
France are perfoming scientific studies. The goal of these studies is to study
and understand the basics of acupuncture and to get a step closer to the
clinical objectification of the effects of acupuncture.
1.5
Acknowledgements
The author would like to thank all of his colleagues who took part in the
development of laserneedles.
1.6
[1]
[2]
[3]
[4]
References
NIH Consensus Conference (1998) Acupuncture. JAMA 280: 15181524
Yamashita H, Tsukayama H, Hori N, Kimura T, Tanno Y (2000)
Incidence of adverse reactions associated with acupuncture. J Altern
Complement Med 6: 345-350
Pomeranz B, Chiu D (1976) Naloxone blockade of acupuncture
analgesia: endorphin implicated. Life Sci 19: 1757-1762
Mayer DJ, Price DD, Rafil A (1977) Antagonism of acupuncture
analgesia in many by the narcotic antagonist naloxone. Brain Res 2:
368-372
17
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
[13]
Pomeranz B (1998) Wissenschaftliche Grundlagen der Akupunktur.

Springer, Berlin-Heidelberg-New York-London-Paris-Tokio-Hongkong
Irnich D, Beyer A (2002) Neurobiologische Grundlagen der
Akupunkturanalgesie. Schmerz 16: 93-102
Streitberger K, Kleinhenz J (1998) Introducing a placebo needle into
acupuncture research. Lancet 352: 364-365
Frauenheim T, Schikora D (2003) J Med Phys, subm.
Litscher G, Schikora D (2002) Cerebral vascular effects of noninvasive laserneedles measured by transorbital and transtemporal
Doppler sonography. Lasers Med Sci 17: 289-295
Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D (2004) Die
schmerzfreie Lasernadelakupunktur moduliert die Gehirnaktivitt:
Erste Nachweise mit funktioneller transkranieller Dopplersonographie
(fTCD) und funktionellem Magnetresonanzimaging (fMRI). Schmerz &
Akupunktur 1: 4-11
Litscher G, Schikora D (2002) Near-infrared spectroscopy for
objectifying cerebral effects of needle and laserneedle acupuncture.
Spectroscopy 16: 335-342
Schikora D. Europisches Patent EP01/08504
Litscher G, Nemetz W, Smolle J, Schwarz G, Schikora D, Urans S
(2004) Histologische Untersuchungen zu mikromorphologischen
Einflssen
von
Lasernadelstrahlung
Ergebnisse
einer
tierexperimentellen Untersuchung. Biomed Tech 49: 2-5
18
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 by
low level laser radiation. In contrast to that "laserneedles" allow to stimulate
appropriate acupoint combinations simultaneously and with higher radiation
doses and therefore represent a new non invasive optical stimulation which
is described in this book. The laserneedles used in this study emit red light in
cw-mode with an output power of 30 - 40 mW per laserneedle, which results
in a radiant exposure energy of about 2.3 kJ/cm at each acupuncture point
during a treatment time of about 10 min. Due to the well defined contact
application and the possibility to stimulate simultaneously up to eight
acupoints, the laserneedles allow to attribute the resulting cerebral vascular
effects unambiguous and exactly to the total laser radiation dose exposed at
the acupuncture point combination selected. This opens the new scientific
possibility to describe the input stimulus strength of complex acupuncture
treatments with well established physical parameters. The aim of this study
was to provide a possible first selective evidence of specific effects of
laserneedle acupuncture and needle acupuncture on brain and eye using a
combination 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 needle
acupuncture was performed using a randomized cross-over study design.
19
C omputerC ontrolled
A cupuncture
L aserpuncture
Fig. 2.1: Computer-Controlled Acupuncture (CCA) [1] and Computer-Controlled

Laserpuncture (CCL) with multidirectional ultrasound probe holder devices in the
biomedical engineering lab of the Medical University of Graz. Details concerning
the method can be found on the website http://litscher.info.
20
L aserpuncture
MED-UNI GR
AZ
Laserneedles
Fig. 2.2: The laserneedle system is a class 3B laser system, therefore it is

compulsory to wear specific laser protection glasses.
2.2
2.2.1
Methods
Non invasive laserneedles
The non invasive laserneedles were constructed to fulfil two essential

requirements 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 eight
optical fibres and the laserneedles are arranged at the distal ends of the
optical fibres. Due to coupling losses the output power of each laserneedle
was reduced to 30 - 40 mW. The fibre core diameter used in the study was of
about 500 m. For our experiments seven vision related acupuncture points
were chosen and irradiated simultaneously. The average time of irradiation
was of about 10 min resulting in an energy density of about 2.3 kJ/cm at
21
each acupoint and a total sum of 16.1 kJ/cm for seven acupoints. To
maintain the fundamental advantage of non invasiveness, the laserneedles
were fixed onto the skin but not pricked into the skin. Fig. 2.3 depicts the
measured intensity profile across the optical fibre output. The insert shows a
photograph of the distal laserneedle end. Due to the direct contact of the
laserneedles and the skin, no loss of intensity occurs and the laser power,
which affects the acupuncture points, can by exactly determined by
integration of the intensity curve shown in Fig. 2.3. Actually, the output
intensity of each laserneedle was determined in such a way, resulting in an
average irradiance intensity at one acupoint of about 3.8 W/cm.
1
intensity [a.u.]
emission wavelength:
685 nm
laser-needle emissioncharacteristics
total output power

at distal end:
30 mW
optical cladding
fibre core
-2
-1
optical fibre diameter [ a.u.]
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 the
optical 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 the
acupoints was determined directly from the output intensity of the
laserneedles and the treatment duration.
22
laser energy density [ J/cm]
3500
3000
2500
2000
1500
1000
500
0
200
400
600
800 1000 1200 1400
time [s]
Fig 2.4: Energy density at the laser-needle contact area in dependence on the
treatment time. Due to the contact type application, as well the exposed area as the
laser 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 a
multidirectional ultrasound probe holder construction. The monitoring
arrangement for simultaneous recording of Doppler sonographic signals in
the ophthalmic artery (OA) and the middle cerebral artery (MCA) was
stationary at the circumference of the head. Blood flow profiles in the OA
were measured transorbitally with the smallest power value able to detect
signals (max. 20 mW/cm). Under acoustic control, the angle and position of
the probes were adjusted until the greatest possible signal amplitude was
reached. Alterations in the blood flow velocities of both arteries were
registered continuously and simultaneously. In addition blood pressure was
measured non invasively before, during and after stimulation (Cardiocap
CC-104, Datex Medical Electronics, Hoevelaken, The Netherlands).
23
2.2.3
Participants
The study protocol was approved by the institutional ethics committee of the
Medical 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 (Cx + SD) years) were examined. None of the
subjects was under the influence of centrally active medication and had
visual deficits. All persons were free of neurological or psychological
disorders. 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 acupuncture
scheme consisted of two traditional Chinese acupoints: UB.2 Zanzhu
(location: in the depression of the medial end of the eyebrow. Needling
method: puncture transversely 0.5 - 0.8 cun) and Ex.3 Yuyao (location: at
the 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-related
acupoints 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 distal
to the first metacarpal bone. Needling method: puncture perpendicular 0.2
cun) were used [3-5]. Three different acupuncture systems were used
together because the combination shows an enhanced effect of the
parameters measured in the study [5].
24
Yuyao Zanzhu
Liver
Eye
E2
Yan Dian
Fig. 2.5: Vision related acupuncture points used in this study. Traditional Chinese
Medicine: 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 local
disinfection of the skin. We used three different types of needles (body: 0.25
x 25 mm, Huan Qiu, Suzhou, China; ear: 0.2 x 13 mm, European Marco
Polo Comp., Albi, France; hand: 0.1 x 8 mm, Sooji-Chim, Korea). Needle
stimulation was achieved by rotating with lifting and thrusting of the
needles.
25
In case of laserneedle acupuncture the acupoints were cleaned with alcohol,
the laserneedles were put in contact to the skin and stable fixed by plaster
stripes. 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 acupuncture
needles were applied. The choice for the initial stimulation was randomized.
The mean blood flow velocity (vm) in the OA and the MCA were evaluated
simultaneously and continuously [1]. Each person was studied with
laserneedle acupuncture and needle acupuncture. The choice of the
measuring procedure was randomized and the interval between the
experiments was 20 to 30 minutes.
2.2.5
Statistical Analysis
The data were tested with Kruskal-Wallis ANOVA on ranks using the
computer program SigmaStat (Jandel Scientific Corp., Erkrath, Germany).
The results of the conditions before (a), during (b) and after (c) acupuncture
were given as means (Cx) + 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 the
measurements of mean blood flow velocity in the OA and MCA are
summarized in Fig. 2.6.
26
Participants n=27
14 female, 13 male, mean age 25.15 + 4.12 (SD), range 21 38 years
Randomized, cross-over design
R
Non invasive Laserneedles
Manual Needle Acupuncture
Ophthalmic artery (OA)

vm (cm/s)
20
15
SE
p=0.01*
10
20
15
p<0.001*
10
Middle cerebral artery (MCA)
c
a
60
60
50
before (a)
during (b)
after (c)
Mean blood
Laserpuncture
flow velocity
Cx+ SE
Ophthalmic
10.33+0.88 14.67+1.15
11.33+0.96
artery (cm/s)
Middle cerebral 54.93+3.28 54.56+3.26
55.07+3.50
artery (cm/s)
40
before (a)
during (b)
after (c)
Mean blood
Acupuncture
flow velocity
Cx+SE
Ophthalmic
10.22+0.83 19.15+1.20
12.22+0.94
artery (cm/s)
Middle cerebral 53.93+3.33 56.04+3.44
55.04+3.47
artery (cm/s)
*Kruskal-Wallis ANOVA on Ranks
Fig. 2.6: Subjects, acupoints, and graphical (means + standard error (SE)) as well as
numeric data of the mean blood flow velocity of the ophthalmic artery (OA) and the
middle cerebral artery (MCA) before (a), during (b), and after (c) stimulating with
laserneedles or needling vision related acupoints in 27 healthy volunteers in a
crossover design.
The results showed significant increases of vm in the OA during (b)

laserneedle acupuncture (p = 0.01) and needle acupuncture (p < 0.001). At
27
the same time only minor, insignificant changes in vm were seen in the
MCA. The mean arterial blood pressure (before laserneedle acupuncture:
79.2 + 6.6 (SD) mmHg; before needle acupuncture: 77.5 + 6.6 mmHg) was
not 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 sec
after the initial stimulus by the laserneedles.
2.4
Discussion
Important factors have led to the expanding use of laser technology in

medicine. These factors are the increasing understanding of the wave-length
selective interaction and associated effects of ultraviolet-infrared radiation
with biologic tissues, including those of acute damage and long-term
healing, the rapidly increasing availability of lasers emitting at those
wavelengths that are strongly absorbed by molecular species within tissues,
and the availability of both optical fiber and lens technologies [6]. Fusion of
these factors has led to the development of the new laserneedle system
which is described for the first time in scientific literature by our research
group.
Acupuncture using laserneedles has the advantage that the stimulation can
hardly be felt by the patient. The operator may also be unaware of whether
the laserneedle system is active, and therefore true double-blind studies can
be performed, which was almost impossible up to now in acupuncture
research. The new system has the added advantage that it can be used at all
standard acupuncture points [32].
The effectiveness of unconventional complementary medical methods, such
as 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 revolutionized
acupuncture. The usage of advanced exploratory tools, such as laser Doppler
flowmetry [17], laser Doppler imaging [18], ultrasound [1,5,19,20] or
magnetic resonance imaging [1,21], provides revealing insights and attempt
to 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 brain
is the key to acupunctures and laserpunctures effects. New experimental
28
constructions to measure ultrasound, light and bioelectrical processes can
reproducibly 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 showed
that acupuncture can increase significantly and specifically the blood flow
velocity in different cerebral arteries and increase the oxygen supply to the
brain [1,5,19,20,24,25,27,28]. Laserpuncture and manual needle acupuncture
can also lead to an increase in oxygenated hemoglobin in the tissue oxygen
index [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 by
Pntinen et al. [30]. Nonetheless, the changes of cerebral function elicited
with commercially available low level lasers were in average one magnitude
of order less pronounced than those elicited with conventional needle
acupuncture [1,19,20,29].
Streitberger et al. [31] have reported that the stimulus strength at the
acupuncture points are of decisive importance for the therapeutic efficiency
of acupuncture treatments. Using placebo-needles in comparison with metal
needles, it was found that the efficiency of acupuncture treatments decreases
significantly, if placebo needles were used.
Our present study shows that the new high optical stimulation with
laserneedles can elicit reproducible cerebral effects which are in the same
order (half dimension) with respect to the maximum amplitude of the mean
blood flow velocity (vm) as compared to needle acupuncture. As it is shown
in Fig. 2.3 the maximum blood flow velocity rate ratio
'vm (needle) / 'vm (laserneedle) for the acupuncture scheme selected is of
about 2. Regarding the stimulus dynamics we found that the delay time
between the initial stimulus and the occurrence of the maximum amplitude
of vm is in the order of 10 - 60 sec for both methods. This allows to conclude
that obviously the basic mechanism of signal activation and transmission are
comparable for both acupuncture methods. Interestingly, the maximum flow
rate for laserneedles was obtained after exposing a total (sum of seven
acupoints) laser ray dose of about 1.6 kJ/cm.
2.5
Conclusion
In conclusion, the results of the laserneedle applications for acupuncture

demonstrate specific, significant alterations in blood flow velocity of the
ophthalmic artery after stimulating vision-related acupoints on the body, ear
29
and hand. At the same time blood flow velocity in the middle cerebral artery
did not change significantly. For needle acupuncture qualitatively the same
behavior was observed. The cerebral effects of the laserneedles were
comparable to the alterations of the needle acupuncture, they differ
absolutely by a factor of ~ 2. This is a significant improvement compared to
the common low-level-handylaser (LLLT) acupuncture (cerebral effects
factor ~ 10 lower as for needle acupuncture).
Further studies using different laser stimulus intensities and wavelengths are
in progress, to optimize the adjustment of the new noninvasive laserneedles
and to clarify the elementary excitations at the acupoints.
2.6
Acknowledgements
The present report is the product of many co-workers. We are especially

indebted to Ms. Lu Wang MD, Evamaria Huber, Ms. Petra Petz MSc and
Ms. Ingrid Gaischek MSc (all Biomedical Engineering and Research in
Anesthesia and Intensive Care Medicine, Medical University of Graz /
Austria) for their support to this study. We would also express our thanks to
Dr. Leopold Dorfer, President of the Austrian Society for Controlled
Acupuncture and to Dr. Michael Weber, Member of the EGFAA for their
help. We thank Petra Thne, Tanja Prohaska, Marianne Hubbert and Jrg
Reitemeyer for technical support.
2.7
[1]
[2]
[3]
[4]
[5]
[6]
[7]
References
Litscher G, Cho ZH (Eds) (2000) Computer-Controlled Acupuncture.
Pabst Science Publishers, Lengerich-Berlin-Rom-Riga-Wien-Zagreb
Schikora D. European Patent Nr. PCT/EP 01/08504
Knig G, Wancura I (1989) Neue Chinesische Akupunktur. Lehrbuch
und Atlas der Akupunkturpunkte. Wilhelm Maudrich, Wien-MnchenBern
Yoo TW (2001) Koryo hand therapy - Korean hand acupuncture. Eum
Yang Mek Jin Publishing Co, Seoul
Litscher G (2002) Computer-based quantification of traditional
Chinese-, ear- and Korean hand acupuncture: Needle-induced
changes of regional cerebral blood flow velocity. Neurol Res 24: 377380
Judy MM (1995) Biomedical lasers. In: Bronzino JD. (Ed) The
Biomedical Engineering Handbook. CRC Press, IEEE Press, Boca
Raton (USA), pp. 1333-1345
Fargas-Babjak A (2001) Acupuncture, transcutaneous electrical nerve
stimulation, an laser therapy in chronic pain. Clin J Pain 17 (4. Suppl):
105-113
30
[8]
[9]
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
Radmayr C, Schlager A, Studen M, Bartsch G (2001) Prospective

randomized trial using laser acupuncture versus desmopressin in the
treatment of nocturnal enuresis. Euro Urol 40(2): 201-205
Naeser MA (1997) Neurological rehabilitation: acupuncture and laser
acupuncture to treat paralysis in stroke, other paralytic conditions, and
pain in carpal tunnel syndrome. J Altern Complement Med 3(4): 425 428
Read A, Beaty P, Corner J, Sommerville Ville C (1996) Reducing
naltrexone-resistant hyperphagia using laser acupuncture to increase
endogenous opiates. Brain Inj 10(12): 911-919
Troshin OV (1994) A clinico-neurophysiological analysis of the single
action of laser puncture. Lik Sprava 5-6: 148-153
Qin JN (1987) Laser acupuncture anaesthesia and therapy in People's
Republic of China. Ann Acad Med Singapore 16(2): 261-263
Nikolaev NA (1986) Therapeutic efficacy of laser and electropuncture
reflexotherapy in correcting the initial manifestations of cerebral
circulatory insufficiency. Zh Nevropathol Psikhiatr Im S S Korsakova
86(1): 60-64
Omura Y (1983) Non-invasive circulatory evaluation and electroacupuncture & TES treatment of diseases difficult to treat in Western
medicine. Acupunct Electrother Res 8(3-4): 177-256
Schlager A, Oehler K, Huebner KU, Schmuth M, Spoetl L (2000)
Healing of burns after treatment with 670-nanometer low-power laser
light. Plast Reconstr Surg 105(5): 1635-1639
Schlager A, Offer T, Baldissera I (1998) Laser stimulation of
acupuncture point P6 reduces postoperative vomiting in children
undergoing strabismus surgery. Br J Anaesth 81(4): 529-532
Sandner-Kiesling A, Litscher G, Voit-Augustin H, James RL, Schwarz
G (2001) Laser Doppler flowmetry in combined needle acupuncture
and moxibustion: a pilot study in healthy adults. Lasers Med Sci 16(3):
184-191
Litscher G, Wang L, Huber E, Nilsson G (2002) Changed skin blood
perfusion in the fingertip following acupuncture needle introduction as
evaluated by laser Doppler perfusion imaging. Lasers Med Sci 17: 1925
Litscher G, Wang L, Wiesner-Zechmeister M (2000) Specific effects of
laserpuncture on the cerebral circulation. Lasers Med Sci 15: 57-62
Litscher G (2001) High-Tech Akupunktur. Pabst Science Publishers,
Lengerich-Berlin-Rom-Riga-Wien-Zagreb
Cho ZH, Wong EK, Fallon J (Eds) (2001) Neuro-Acupuncture I.
Neuroscience Basics. Q-Puncture Inc, Los Angeles
Ji G, Zhao L, Shi R, Liu Y, Wang S, Wu F (1996) Effects of electrical
acupuncture on the cerebral blood flow and the pial microcirculatory
blood flow in dogs. Zhen Ci Yan Jiu 21(2): 43-46
Uchida S, Kagitani F, Suzuki A, Aikawa Y (2000) Effect of
acupuncture-like stimulation on cortical cerebral blood flow in
anesthetized rats. Jpn J Physiol 50(5): 495-507
31
[24]
[25]
[26]
[27]
[28]
[29]
[30]
[31]
[32]
Litscher G, Wang L, Yang NH, Schwarz G (1999) Computer-controlled

acupuncture. Quantification and separation of specific effects. Neurol
Res 21(6): 530-534
Litscher G, Wang L, Yang NH, Schwarz G (1999) Ultrasoundmonitored effects of acupuncture on brain and eye. Neurol Res 21(4):
373-377
Litscher G, Yang NH, Schwarz G, Wang L (1999) Computer-controlled
acupuncture. A new construction for simultaneous measurement of
blood flow velocity of the supratrochlear and middle cerebral arteries.
Biomed Techn 44(3): 58-63.
Litscher G, Schwarz G, Sandner-Kiesling A, Hadolt I (1998) Robotic
transcranial Doppler sonography probes and acupuncture. Int J
Neurosci 95(1-2): 1-15
Litscher G, Schwarz G, Sandner-Kiesling A, Hadolt I, Eger E (1998)
Effects of acupuncture on the oxygenation of cerebral tissue. Neurol
Res 20 Suppl 1: 28-32
Litscher G, Wang L (2000) Cerebral near infrared spectroscopy and
acupuncture - results of a pilot study. Biomed Technik 45(7-8): 215218
Pntinen PJ, Pothmann R (1998) Laser in der Akupunktur.
Hippokrates, Stuttgart
Streitberger K, Kleinhenz J (1998) Introducing a placebo needle into
acupuncture research. Lancet 352: 364-365
Litscher G, Schikora D (2002) Effects of new noninvasive
laserneedles on brain function. IFMBE Proceedings, 2nd European
Medical and Biological Conference (EMBEC) 4. - 8.12.2002 Vienna,
pp. 996-997
32
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 reaction
at another area of the body is still unclear. However, it has been proven that
when particular acupuncture points are stimulated with needles or laser light,
specific effects in the brain can be objectivized and quantified with modern
cerebral monitoring methods [1-3].
In this present study, we objectivized the systematic changes of oxygenation
in the brain [4] using cerebral near-infrared spectroscopy (NIRS), after
stimulating acupuncture points according to traditional Chinese medicine
(TCM), Korean and Chinese hand acupuncture, ear acupuncture and
combinations of these different methods.
We analyzed a total of 328 recordings after manual needle and laserneedle
stimulation 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 oxygenation

through 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 instrument
in this field of research. Parameters such as changes in oxyhemoglobin
('O2Hb) and desoxyhemoglobin ('HHb) are determined by Lambert-Beers
principle [4]. The system can measure the absolute value (mol) of changes
in parameters, but not the level (absolute concentration) at which these
changes occur (in positive or negative direction). The measurement value is
zero, 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 a
color LCD-display and color printer.
33
In addition to the spectroscopic method, non-invasive, standard monitoring

parameters such as blood pressure (Cardiocap CC-104, Datex Medical
Electronics, Hoevelaken, Netherlands) were determined before, during and
after different manners of stimulation.
3.2.2
Laserneedle stimulation
The laserneedle-technique represents a new, non-invasive method for optic

stimulation of acupuncture points and was first described in literature in
2002 [5,6,11,12]. Laserneedle (Schikora D.: European Patent Nr. PCT/EP
01/08504) acupuncture allows the simultaneous stimulation of individual
acupuncture point combinations. Variations and combinations of
acupuncture at different areas of the body, ear or hand, as performed
particularly in this study are possible (compare Fig. 3.1). Details regarding
this 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 of

the brain were continuously registered and analyzed.
34
3.2.3
Healthy volunteers, acupuncture, measurement procedure
In this study, a total of 328 measurements on 88 healthy volunteers (50

female, 38 male) mean age 25.7 + 4.0 (Cx + SD) years (19 - 38 years) were
performed. The study protocol was approved by the ethics committee of the
Medical University of Graz (11-017) and all test persons gave their written
consent. None of the volunteers had visual, neurological or psychological
deficits or were under the influence of central nervous system effective
drugs.
A maximum of 7 acupuncture points in different measurement series (needle
acupuncture and laserneedle acupuncture) were investigated. The
acupuncture scheme included two acupuncture points from TCM: Zanzhu
(localization: at the medial end of the eyebrow, perpendicular to and above
the inner corner of the eye, at the foramina of the supraorbital nerve;
needling: perpendicular 0.5 - 0.8 cun) and Yuyao (localization: at the middle
of the eyebrow, perpendicular and above the pupil; needling: inclined 0.3 0.5 cun). In addition, 2 ear acupuncture points (eye and liver: localization see
Fig. 3.2; needling: inclined 0.3 cun) and 2 eye acupuncture points from
Korean hand acupuncture (E2: localization see Fig. 3.2; needling:
perpendicular 0.1 0.2 cun) and one acupuncture point from Chinese hand
acupuncture (Yan Dian: localization: on the ulnar side of the middle phalanx
of the thumb; needling: inclined 0.2 cun) were included in the study [11-13].
In addition, possible responses in NIRS parameters after needling and
stimulating of a placebo point (localization: lateral from the radius 6 cun
above the horizontal fold of the wrist exactly on the radial ledge, lateral from
the pulmonary meridian) were tested.
The different acupuncture schemes were applied alone and in combination,
since preliminary studies indicated that the selection of different
combinations also result in different effects in the cerebral parameters to be
measured (e.g. bloodflow velocity in the ophthalmic artery) [11-13] (Fig.
3.2).
35
liver
Yuyao Zanzhu
eye
E2
Yan Dian
Fig. 3.2: Acupuncture schemes used in this study.
Acupuncture points were needled with single-use needles after local

disinfection of the skin. We used three different types of needles (body: 0.25
x 25 mm, Huan Qiu, Suzhou, China; ear: 0.2 x 13 mm, European Marco
Polo Comp., Albi, France; hand: 0.1 x 8 mm, Sooji-Chim, Korea).
Stimulation was performed with simultaneous rotating, pulling and thrusting
movements of medium intensity.
In the case of laserneedle acupuncture, the skin at the acupuncture point was
cleaned with alcohol, the laserneedle was positioned at the surface of the
skin and then fixated with special adhesive tape. We used the same
acupuncture schemes as in the combined measurements using needle
acupuncture.
During the experimental phase, the test persons were positioned in a relaxed
manner on a lounge. After applying the near-infrared spectroscopic sensors
in the frontal area of the skull, a 10 minute resting period was observed.
Then, either laserneedle stimulation was activated or the acupuncture
needles were inserted and stimulated for 10 seconds. Thereafter, the laser
was activated for 10 minutes or the needles were left alone. The maximum
amplitude of 'O2Hb and 'HHb (phase during acupuncture) was analyzed
during this period of time. Randomized selection of which technique should
be started with, as well as selection of sequence of the particular type of
36
stimulation (body, ear, hand, combination) was done. The resting period
between each investigation was at least 30 minutes.
3.2.4
Statistical analysis
Data was analyzed with the computer program SigmaStat (Jandel Scientific
Corp., Erkrath, Germany). Results from the phases before (=zeropoint
calibration), during and 5 minutes after needle acupuncture or of laserneedle
acupuncture are shown in the diagrams as mean values, respectively.
3.3
Results
At the left side of Figure 3.3, the hypothetical functional curve of stimulus
intensity dependent upon the treatment time is shown. This diagram gains in
importance due to the actually measured, specific cerebral data in regard to
changes in O2Hb and HHb shown at the right. During manual, metal needle
stimulation a nearly exponential maximum increase in O2Hb and an
exponential decrease to a higher level than initially, occurred, whereas the
trend of O2Hb during laserneedle NIRS response remains plateau-like.
Stimulus intensity SI [a.u.]
Stimulus intensity - cerebral NIRS response

O2Hb
metal needle
HHb
O2Hb
laserneedle
HHb
b
time [s]
10 min
B.J., 22y, f
Fig. 3.3: Left: Stimulus intensity (SI f(t)) as a function of time (hypothesis).
Right: Real measured cerebral responses of NIRS-parameters O2Hb
(oxyhemoglobin) and HHb (desoxyhemoglobin) on manual, brief (20 seconds)
acupuncture needle stimulation (a) and laserneedle stimulation (b) in 22-year-old
female test person. The arrows indicate the beginning of stimulation.
37
Figures 3.4 and 3.5 show the mean values of maximum change in O2Hb
(Fig. 3.4) and HHb (Fig. 3.5) parameters during and 5 minutes after manual
needle acupuncture or laserneedle acupuncture.
Fig. 3.4: Changes in mol of oxyhemoglobin (O2Hb) during needling of a placebo

point, 3 hand acupuncture points, 2 ear acupuncture points, 2 acupuncture points
from TCM, a combination of hand, ear and body acupuncture as well as laserneedle
stimulation and an intensity-increased (+ 30 %) laserneedle acupuncture (from left
to right) during and 5 minutes after acupuncture.
38
Fig. 3.5: Cerebral changes (generally decreases) in desoxyhemoglobin (HHb). For

further descriptions see Fig. 3.4.
It is obvious that needling and stimulation of the placebo point does not lead
to marked changes in cerebral NIRS parameters during and 5 minutes after
acupuncture. Manual needling and laserneedle stimulation leads to a marked
increase in O2Hb (compare Fig. 3.4) and simultaneous decrease in HHb
(compare Fig. 3.5) when using the combined Korean hand acupuncture (E2)
and Chinese hand acupuncture (Yan Dian), as well as TCM-body (Zhanzu
and Yuyao) acupuncture, as well as combined body, ear, and hand
acupuncture. This effect is still present 5 minutes after removing the needles
or deactivating laserneedle stimulation. An almost negligible, but contrary
behavior of O2Hb and HHb occurs when both ear points (eye and liver) are
needled or stimulated with laser.
None of the acupuncture stimulation methods or combinations resulted in
significant changes in standard monitoring parameters (blood pressure).
3.4
Discussion
One of the main advantages of the laserneedle technique is its noninvasiveness. It is possible to apply the laser in such a manner, that the test
39
person cannot feel optical stimulation of the acupuncture point. In addition,
the acupuncturer does not need to know if the system is activated or
deactivated. Thus, double-blind studies using this new method are possible
in acupuncture research for the first time. This method of study was already
performed by our research group [14] and included simultaneous and
continuous monitoring of blood flow velocity in the posterior cerebral artery
and the middle cerebral artery in 17 healthy volunteers. This study showed
that laserneedle stimulation of distant acupuncture points at hands and feet
(Hegu, Zusanli, Kunlun, Zhiyin) is able to achieve marked and specific
changes in cerebral blood flow velocity [12,14].
Even though laser puncture using Low-Level-Laser stimulation devices is an
established method, measurable cerebral effects lie far below conventional
needle acupuncture [15]. The results from the first studies [11,12,14] using
the laserneedle system revealed significant changes in cerebral parameters
(blood flow velocities), which were otherwise only achieved by manual
needle acupuncture. The proportion of maximum change in blood flow
velocity (needle/laserneedle) is approximately factor 2.
Since Chinese medicine and acupuncture are considered an integrative part
of TCM based on energetic processes, the registration of changes in the
cerebral metabolism could express energetic processes in the brain and
obviously plays a key role in investigating the effects of acupuncture. To
date, it has not been possible to obtain non-invasive and continuous results
regarding regional cerebral oxygenation. Near-infrared spectroscopy can
register changes in oxygenation in the cerebral vascular region very
sensitively. The advantages of transcranial oximetry are its noninvasiveness, low risks and continuity, as well as its easy and time-saving
application. A wide range of indications are the result for the potential use of
this spectroscopic method [4].
A number of factors which can influence adequate interpretation of data
must be considered. Contamination with surrounding light, mechanical
irritations, intracerebral hematoma, misplacement of optodes or other user
errors are just some possibilities which should be noted [4].
A number of studies which deal with NIRS conclude that NIRS can exactly
determine extremely small changes in cerebral hemodynamics, as a response
to different functional stimulations.
In this study [5,6], 328 systematic NIRS registrations on healthy volunteers
during manual and laserneedle acupuncture stimulation were performed for
the first time. The results from two preceding publications [8,9] were the
reference points for this study.
40
The first study regarding acupuncture and NIRS [8] indicated that the
changes in the occipital region after acupuncture stimulation in 3 healthy
volunteers, was measurable and reproducible in each of the test persons. In
the second study [9], NIRS-changes were measurable and reproducible at the
central region after acupuncture stimulation at the Hegu point. This study
showed, that reproducible changes in frontally monitored NIRS parameters
could be determined, after stimulation of specific eye acupuncture points.
In general, changes in NIRS parameters are unspecific and we do not know
if an isolated decrease in saturation is caused by an increase in cerebral
oxygenation consumption or results from a decrease in cerebral blood flow.
Therefore, not only the extent of oxygenation is shown, but the interaction
between oxygenation and desoxygenation is reflected. This is possible since
the measurement zone is mainly dominated by the venous part of the
cerebral vascular bed (~ 75 %). The arterial part (~ 20 %) or the capillary
(~ 5 %) flow region is respectively smaller [4].
For these reasons, we were able to determine changes, which for example
occur due to an increase in oxygenation. Which ruling mechanisms are
present is still unclear. Increased desoxygenation by stimulus-induced
neuronal activation, i.e. caused by changes in membrane potentials or release
of neurotransmitters could be possibilities [16]. For whatever reason,
acupuncture obviously influences the oxygen metabolism of the brain in
healthy test persons.
Similar to this study using ear acupuncture, a paradox contra-directional
change in blood flow velocity (increase) and regional cerebral O2-saturation
(decrease) occurred in a vascular based case of dementia, when an
individually adapted acupuncture scheme was used [16]. The described case
report showed that acupuncture could improve the clinical status of vascular
dementia. Using NIRS and transcranial Doppler sonography, we were able
to register the effects on cerebral blood flow velocity and the O2-metabolism.
In combination with clinical findings, an inverse decrease in regional
cerebral O2-saturation during simultaneous increase in cerebral blood flow
velocity during acupuncture could be interpreted, as a sign of increased
cerebral oxygenation. A decrease in regional cerebral O2-saturation does not
necessarily indicate a poor condition of the O2-metabolism in the sense of
reduced oxygen supply, however could also document the beneficial effects
of regionally increased oxygenation, activated by acupuncture [16]. In a
similar manner, the minor contradirectional regional changes in NIRS
parameters using ear acupuncture could be interpreted, since the monitoring
method conveys the balance between oxygenation and desoxygenation.
41
Further studies are necessary to investigate the importance of these
phenomena on acupuncture, since not only the influence in general and in
detail of laser acupuncture, but also the influence of combined ear and body
acupuncture, are still discussed controversially. Spectroscopic methods
probably are useful tools for this investigations.
3.5
Acknowledgements
The authors thank Ms. Lu Wang MD for performing the acupuncture, Ms.
Evamaria Huber for help in data recording and Ms. Petra Petz MSc for her
valuable support in data analysis (all Department of Biomedical Engineering
and Research in Anesthesia and Intensive Care Medicine, Medical
University of Graz).
3.6
References

Lengerich Berlin Dsseldorf
[2] Litscher G, Cho ZH (Eds.) (2000) Computer-Controlled Acupuncture.
Pabst Science Publishers, Lengerich Berlin Dsseldorf Riga Scottsdale
Wien Zagreb
[3] Cho ZH, Wong EK, Fallon J (2001) Neuro-Acupuncture. Q-puncture,
Los Angeles
[4] Litscher G, Schwarz G (Eds.) (1997) Transcranial cerebral oximetry.
Pabst Science Publishers, Lengerich Berlin Dsseldorf Riga Scottsdale
Wien Zagreb
[5] Litscher G, Schikora D (2002) Nahinfrarot-spektroskopische
Untersuchungen zur Nadel- und Lasernadelakupunktur. AKU
Akupunktur Theorie und Praxis 3: 140-146
[6] Litscher G, Schikora D (2002) Near-infrared spectroscopy for
[7] Litscher G, Schwarz G, Sandner-Kiesling A, Hadolt I, Eger E (1998)
Res 20/S1: 28-32
[8] Litscher G, Wang L (2000) Zerebrale Nahinfrarot-Spektroskopie und
Akupunktur Ergebnisse einer Pilotstudie. Biomed Technik 45: 215218
[9] Litscher G, Wang L, Huber E (2002) Vernderungen zerebraler
nahinfrarot-spektroskopischer Parameter whrend manueller
Akupunkturnadelstimulation. Biomed Technik 47: 76-79
[10] Litscher G, Wang L (2002) Computergesttzte Objektivierung der
Grenzen der Akupunktur. AKU Akupunktur Theorie und Praxis 30/1: 1319
[1]
42
[11] Litscher G, Schikora D (2002) Cerebral effects of noninvasive
laserneedles measured by transorbital and transtemporal Doppler
sonography. Lasers Med Sci 17: 289-295
[12] Litscher G, Schikora D (2002) Neue Konzepte in der experimentellen
Akupunkturforschung - Computerkontrollierte Laserpunktur (CCL) mit
der Laserneedle Technik. Der Akupunkturarzt / Aurikulotherapeut
28(3): 18-28
[13] Litscher G (2002) Computer-based objectivation of traditional Chinese-,
ear- and Korean hand acupuncture, Needle-induced changes of
regional cerebral blood flow velocity. Neurol Res 24: 377-380
[14] Litscher G, Schikora D (2002) Effects of new noninvasive laserneedles
on brain function. IFMBE Proceedings, 2nd European Medical &
Biological Engineering Conference (EMBEC), Vienna, December 2002:
996-997
[15] Litscher G, Wang L, Wiesner-Zechmeister M (2000) Specific effects of
[16] Litscher G, Schwarz G, Wang L, Sandner-Kiesling A (2002) Akupunktur
bei vaskulr bedingtem dementiellem Abbau. Jahrestagung der
sterreichischen Alzheimer-Gesellschaft. 14. Klagenfurter
Arbeitstagung fr Neurologie. 24. - 25. Mai 2002, Klagenfurt / Austria
43
4.
Communication between acupoint and brain

proved by ultrasound
G. Litscher, L. Wang, N.H. Yang
4.1
Introduction
Transcranial Doppler ultrasonography (TCD) provides a noninvasive, rapid

and continuous assessment of blood flow velocity in cerebral arteries. Using
new probe holder constructions, it is possible to record blood flow patterns
in various cerebral arteries simultaneously and continuously [1-4].
Acupuncture has been used as a therapeutic medical technique in China for
thousands of years and is indicated for a wide variety of conditions [5,6].
However, evidence of quantitative measurable effects of acupuncture is still
rare in the scientific literature. We have reported a number of quantifiable
effects of acupuncture on cerebral perfusion and cerebral oxygenation [14,7-16].
In the present study we investigated the specific effects of laserneedle
acupuncture of two acupuncture schemes on the mean blood flow velocity in
the anterior (ACA) and posterior (PCA) cerebral arteries in a cross-over
study design.
4.2
4.2.1
Methods and materials

TCD monitoring of the anterior and posterior cerebral
arteries with a new probe holder
Doppler sonographic signals were recorded simultaneously in the left ACA

and the right PCA with a Multi-Dop T system (DWL Electronic Systems
GmbH, Sipplingen, Germany). Two 2-MHz probes were used in a
multidirectional ultrasound probe holder.
44
ACA - Acupuncture
Ying Xiang (LI.20)
Fig. 4.1: Monitoring of the blood flow profiles in the anterior cerebral artery (ACA)
and the posterior cerebral artery (PCA) and localization of the acupuncture point
Ying Xiang.
The A1 segment of the ACA was assessed in its entirety at depths between
58 and 88 mm. The direction of flow in the ACA was away from the
ipsilaterally placed probe. The PCA was found by aligning the transducer
slightly posteriorly and inferiorly from the bifurcation of the internal carotid
artery. Between a depth of 60 to 78 mm, its P1 segment was found and
showed a direction of flow toward the transducer.
The mean blood flow velocity (vm) is an important parameter [1,8], because
it describes the most intense mean values of Doppler frequency at every
interval of the spectrum [17]. Forty vm values were averaged in each patient
in five phases (a: 5 minutes before acupuncture; b - d: during laserneedle
acupuncture and e: 2 minutes after stimulation). The averaged values of the
five measured phases were compared for each subject.
4.2.2
Participants
Blood flow profiles in the ACA and PCA were measured before, during and
after the acupuncture sessions in 22 adults (mean age 24.4 + 2.6 years; range
21 29 years). None of the subjects was under the influence of centrally
active medication. They were fully informed about the nature of the
45
investigation and gave informed consent. During the experiments the
subjects were in a relaxed and comfortable positon on a bed in our
laboratory. Then the TCD monitoring equipment was positioned. After a 10minute resting period the laserneedle stimulation was activated for a duration
of 20 minutes.
4.2.3
Laserneedle acupuncture
Two acupuncture schemes were tested in two sessions in the same persons.
One scheme (including Yingxiang) was chosen to influence the olfactory
system (Figs. 4.2 - 4.4) and one (including Zhiyin) to stimulate the optical
system.
PCA
ACA
NIRS - sensor
Fig. 4.2: Healthy volunteer during laserneedle stimulation and TCD-registration.

Additionally a sensor was placed frontally for the registration of near infraredspectroscopic signals (NIRS).
Yingxiang (LI.20)
Location: Between ala nasi and nasolabial groove.
Indication: Rhinitis, blocked nose, common cold, nose bleeding, facial
paralysis, trigeminal neuralgia, toothache.
Hegu (LI.4)
Location: At the highest point of the m. adductor pollicis with the thumb
and index finger adducted.
Indication: The most important analgesic point; stimulation of this point
relieves pain in all parts of the body. The specific effect on the
46
head, especially in headache has been verified by clinical
research.
Pianli (LI.6)
Location: 3 cun proximal to Yangxi (LI.5) on the line connecting Yangxi
with Quchi (LI.11).
Indication: Dry throat, rhinitis, throat pain, redness of the eye, tinnitus,
deafness, sore throat, edema.
Guangming (GB.37)
Location: On the anterior side of the fibula, 5 cun proximal to the
malleolus lateralis.
Indication: Eye disorders, headache, mental disorders.
Taichong (Liv.3)
Location: Between the first and second metatarsal bones, 2 cun proximal
to the margin of the web.
Indication: Distal point for eye disorders, pain and tension of the head and
chest, urogenital, endocrine and metabolic disorders.
47
olfactory epithelium
Fig. 4.3: Schematic presentation of the olfactory epithelium (modified according to

JW Karapelou, Spektrum der Wissenschaft Spezial, 4/1999).
48
Fig. 4.4: Functional magnetic resonance imaging: activation during chemical

stimulation
(modified
according
to
DH
Zald
et
al.
1997;
http://james.psych.umn.edu/olfactory.html). Note the dominance on the left.
4.2.4
Statistical Analysis
The data were tested with analysis of variance (one-way repeated-measure

ANOVA) with SigmaStat software (Jandel Scientific Corp., Erkrath,
Germany). The results were expressed as means + standard error (Cx + SE).
The criterion for significance was p < 0.05.
4.3
Results
Figure 4.5 shows an example of increased vm in the ACA during laserneedle

acupuncture. Stimulation of acupoint Yingxiang was repeated and the
changes in vm were reproducible.
49
Laserneedle - specific effects

ACA - PCA
vm (cm/s)
before
during
laserneedle-acupuncture
time
1 min
Fig. 4.5: Trend of the mean blood flow velocity vm in cm/s in the left anterior
cerebral artery (ACA) and the right posterior cerebral artery (PCA) before and
during laserneedle acupuncture in a 24-year-old volunteer. The arrow marks the
beginning of stimulation.
Figure 4.6 (middle and lower panel) summarizes the results in all 22 subjects
for both acupoint schemes. The values of vm in the ACA increased
significantly (p<0.001) using acupuncture scheme A (b - d) and were higher
at the end of the investigation (e) than before acupuncture (a). Insignificant
changes (n.s.) in vm were seen in the PCA. However, with the vision-related
acupoint scheme B the same subjects showed a significant increase of vm in
the PCA without significant changes in the ACA.
50
Healthy volunteers n=22
12 female, 10 male, 21 - 29 years ( 24.4 + 2.6 years; x + SD )
R
laserpuncture scheme A
laserpuncture scheme B
Anterior cerebral artery (ACA)
50
52
51
49
*)
48
50
47
49
46
48
45
n.s.
47
*) p < 0.001
Posterior cerebral artery (PCA)

47
45
46
44
45
43
*)
44
42
n.s.
41
43
42
40
a
*) p < 0.002
Fig. 4.6: Healthy volunteers, acupuncture points and graphic presentation (means) of
the results of the mean blood flow velocity of the anterior cerebral artery (ACA) and
the posterior cerebral artery (PCA) before (a), during (b - d) and after (e) laserneedle
stimulation. The arrows mark the relative maximum changes during laserneedle
stimulation referring to the basic value.
51
vm
(cm/s)
50
Specific cerebral effects of

p = 0.001*
48
46
ACA
PCA
44
42
n = 22
40
38
One Way Repeated Measures Analysis of Variance (Tukey Test)
Fig. 4.7: Absolute changes in vm during laserneedle acupuncture.
'vm
(cm/s)
p = 0.001*
2,5
2
1,5
ACA
PCA
0,5
n = 22
0
-0,5
-1
a
One Way Repeated Measures Analysis of Variance (Tukey Test)
Fig. 4.8: Relative changes in vm during laserneedle acupuncture.
52
Specific cerebral effects of

vm
(cm/s)
50
n.s.
48
46
44
ACA
PCA
42
n = 22
40
38
a
Fig. 4.9: Absolute changes in vm during laserneedle acupuncture.
'vm
(cm/s) 3
n.s.
2,5
2
1,5
1
ACA
0,5
PCA
n = 22
-0,5
-1
a
Fig. 4.10: Relative changes in vm during laserneedle acupuncture.
53
4.4
Discussion
Transcranial Doppler ultrasonography measures blood flow profiles in

cerebral arteries. The technique is used to detect stenoses, emboli and
malformations of intracranial arteries, assess cerebral collateral circulation
before surgery, monitor cerebral vasospasm, and document cerebral
circulatory arrest, as well as for intraoperative monitoring.
Acupuncture is a form of traditional Chinese medicine (TCM) that has
developed over thousands of years. Until now, modern Western medicine
has used acupuncture mostly for complementary or supportive purposes.
There are hundreds of acupoints on the human body. These are points at
which according to TCM the flow of the vital force Qi can be stimulated
[5,6]. In this study we used laserneedles, a new way to stimulate these
points.
In previous studies we have found that the brain is the key to understanding
acupunctures effects [1-4,7-14]. New experimental constructions to measure
ultrasound, light and bioelectrical processes can reproducibly demonstrate
effects of acupuncture in the brain. We have shown that acupuncture with
needles can increase overall cerebral blood flow. Studies with biosensors and
probes in a specially designed helmet showed that acupuncture can increase
the blood flow velocity in the middle cerebral artery and increase the oxygen
supply to the brain.
The present study is a further step to objectify the effects of acupuncture. In
22 participants we found that laserneedle acupuncture of specific acupoints
increases blood flow in specific regions of the brain.
An acupuncture scheme including two points in the face (Yingxiang) which
TCM places in connection with the olfactory system increased mean blood
flow velocity in the ACA significantly (p < 0.001). The ACA supplies most
of the frontal and medial mass of the cerebrum including part of the
olfactory cortex. At the same time, blood flow in the PCA stayed nearly
unchanged.
In contrast, an acupuncture scheme including a point on the foot (Zhiyin)
which is in connection with the optic system increased blood flow in the
PCA significantly (p = 0.002). Simultaneously blood flow in the ACA
stayed nearly unchanged.
Cho et al. [16] have described similar effects in the brain by stimulating
vision-related acupoint Zhiyin with functional magnetic resonance imaging
54
and after light stimulation. Control studies with stimulation of other points
on the foot did not produce specific activation in the visual cortex.
Acupuncture - fMRI
Vis. Ref.
Acup.
Acup.
(light)
light)
(Zhiyin)
Fig. 4.11: Functional magnetic resonance imaging (fMRI) at the Medical University
of Graz (fMRI-results: Cho et al. [2]).
In our study we measured the blood flow profiles in the left ACA and the
right PCA. This procedure was chosen for technical reasons and due to
previous reports in the literature. Zald et al. [17] found that olfactory stimuli
increased regional cerebral blood flow exactly in the left lateral orbitofrontal
cortex. Cerebral blood flow in this study was measured with a slow bolus O15 water technique and positron emission tomography.
We are convinced that sophisticated biomedical technology, particularly
noninvasive ultrasound techniques, can objectify some effects of traditional
Chinese medicine. In acupuncture the brain likely plays a key intermediate
role. However, brain activity in and of itself does not explain anything about
the healing power of acupuncture.
55
4.5
Acknowledgements
The authors thank Ms. Ingrid Gaischek MSc (Biomedical Engineering and
Research in Anesthesia and Intensive Care Medicine, Medical University of
Graz) for her valuable help.
4.6
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
References
transcranial Doppler sonography probes and acupuncture. Intern J
Neurosci 95: 1-15
Litscher G, Yang NH, Schwarz G (1999) Computerkontrollierte
Akupunktur: Eine neue Konstruktion zur simultanen und
kontinuierlichen Erfassung der Blutflugeschwindigkeit in der A.
supratrochlearis und A. cerebri media. Biomed Technik 44: 58-63
Litscher G, Wang L, Yang NH (1999) Ultrasound-monitored effects of
acupuncture on brain and eye. Neurol Res 21: 373-377
Litscher G, Yang NH, Wang L (1998) Quantitative Separation
spezifischer Akupunktureffekte von Gehirn und Auge mittels
bidirektionaler Ultraschallmekonstruktion. AKU 26(4): 212-217
Engin I: Chinese acupuncture and moxibustion. Shanghai China,
Publishing House of Shanghai College of Traditional Chinese
Medicine, 1990
Mao-Liang Q (1996) Chinese acupuncture and moxibustion. Churchill
Livingstone, London
Litscher G, Schwarz G, Sandner-Kiesling A, Hadolt I (1997)
Transkranielle Doppler-Sonographie - Robotergesteuerte Sonden zur
Quantifizierung des Einflusses der Akupunktur. Biomed Technik 42:
116-122
Effects of acupuncuture on the oxygenation of cerebral tissue. Neurol
Res 20(1): 28-32
Litscher G, Schwarz G, Sandner-Kiesling A (1997) Transcranial near
infrared spectroscopy and transcranial Doppler sonography during
acupuncture. In Litscher G, Schwarz G (Eds) (1997) Transcranial
Cerebral Oximetry. Pabst Science Publishers, Lengerich, pp. 184-198
Litscher
G,
Schwarz
G,
Sandner-Kiesling
A
(1998)
Computerkontrollierte Akupunktur. Akupunktur Theorie und Praxis
26(3): 133-142
acupuncture Quantification and separation of specific effects. Neurol
Res 21:530-534
56
[13]
[14]
[15]
[16]
[17]
[18]
Litscher G, Yang NH, Wang L (1998) Ultrasound-controlled

acupuncture. Internet J Anesthesiology 2/4:
http://www.ispub.com/journals/IJA/Vol2N4/acu.htm
Litscher G, Yang NH, Wang L (1999) Acupuntura controlada por
ultrasonidos.
http://www.tmed.uam.es/dpto/anesne...tas/ijae/vol2n4e/articulos/acu.h
tm
Litscher G, Wang L (1999) Visualisierung von peripheren
Durchblutungsnderungen
whrend
der
Akupunktur
mittels
Thermographie. Biomed Technik 44: 129, 1999
Cho ZH, Chung SC, Park JP, Park HJ, Lee HJ, Wong EK, Min BI
(1998) New findings of the correlation between acupoints and
corresponding brain cortices using functional MRI. Proc Natl Acad Sci
95: 2670-2673
McCartney JP, Thomas-Lukes KM, Gomez CR (1997) Handbook of
Transcranial Doppler. Springer, New York
Zald DH, Pardo PJ, Pardo JV et al (1997) Left orbitofrontal activation
during aversive chemical stimulation.
http://james.psych.umn.edu/olfactory.html
57
5.
Histological investigations regarding

micromorphological effects of laserneedle
illumination. Results of an animal
experiment
G. Litscher, W. Nemetz, J. Smolle, G. Schwarz,
D. Schikora, S. Urans
5.1
Introduction
For the first time, laserneedle stimulation allows simultaneous and

continuous laser illumination of individual acupuncture points [3,4]. Due to
the contact of the laserneedle with the skin, the illuminated area at the
acupuncture point remains constant and the relevant doses can be varied
exactly by altering the duration of illumination.
Goal of this animal experiment was to investigate the influence of
laserneedle illumination on micro morphological structures of the skin and
obtain objectified information regarding the effects of characteristic densities
and illumination doses for laserneedles.
5.2
5.2.1
Methods
Procedure
In this animal study, we performed experiments regarding the

microcirculation in the skin and surface skin temperature, before, during and
after laserneedle stimulation. We used a sus scrofa domesticus, which was
put under general anaesthesia in the animal surgical unit, at the Department
of Surgical Research, University Clinic of Surgery (Figure 5.1). The study
was performed according to the rules of the ethical commission (animal
study approval number GZ 66.010/10-BRGT/2003).
58
Fig. 5.1: Animal experimental investigation with laserneedle stimulation.

Illumination of the skin using 8 laserneedles (circular positioning scheme).
The microcirculation and temperature sensor is located in the middle of the
positioning scheme.
Pre-medication was done in two steps on the day of intervention:
a) Orally: Diazepam (Gewacalm) 10 mg, Ketamin (Ketanest S) 250 mg,
Azaperom (Stresnil) 80 mg.
b) 20 min after oral pre-medication, intramuscular: Atropin 0.5 mg,
Diazepam (Gewacalm) 20 mg, Ketamin (Ketanest S) 50 mg,
Azaperom (Stresnil) 80 mg.
Anaesthesia was started 20 minutes after pre-medication: Etomidate-Lipuro
40 mg, Fentanyl 0.5 mg i.v. Intubation was done during spontaneous
respiration and muscle relaxation with Pancuroniumbromid (Pavulon)
4 mg.
Maintenance of anaesthesia was performed with: Thiopental 4 g, Fentanyl
1.5 g, Pancuroniumbromid (Pavulon) 20 mg/500 NaCl 0.9 % as continuous
instillation. Ventilation was performed instrumentally according to
characteristic biometric data.
At the time of excision, hemodynamic parameters (blood pressure
130/70 mmHg; heart rate 80/min; central venous pressure 5 mmHg), as well
as oxygenation (SaO2 99 %) and ventilation (etCO2 38 mm) were all in the
normal range.
Data registration of the measurement parameter Flux (= product of mean
flow velocity and concentration of red blood cells), surface skin temperature
and room temperature were measured during anaesthesia. A total of five
measurement values were analyzed (a = 2 min before; b = 2 min, c = 10 min,
d = 18 min after beginning stimulation and e = 2 min after deactivating
laserneedle stimulation; compare Figure 5.3).
59
After completing the experiment, four histological samples from the shaved
cutis at the thoracic-abdominal transition were investigated, two had been
illuminated with laser the other two were used as negative controls.
5.2.2
Laserneedle stimulation is new optic method, which is used for stimulating

acupuncture points. Illumination of different variations and combinations on
the body, ear, or hand are possible. Figure 5.2 shows the characteristic
emission of a fitted laserneedle, which was used in this study. The coherence
of laser illumination at the distal exit point was measured with Michelsoninterferrometry. The laserneedles used (wavelength: 685 nm) emitted red
light in a continuous wave mode with an output of 30 - 40 mW per
laserneedle, resulting in a power density of 4.6 W/cm or an energy density
of ~ 4.6 kJ/cm. The transmitted energy into the skin is 55 J per laserneedle
during a treatment period of 20 minutes.
1
intensity [a.u.]
emission wavelength:
685 nm
laser-needle emissioncharacteristics
total output power

at distal end:
30 mW
optical cladding
fibre core
-2
-1
optical fibre diameter [ a.u.]

Fig. 5.2: Emission characteristics of a laserneedle (a.u. = arbitrary units).
5.2.3
Laser Doppler flowmetry and temperature measurement
Laser Doppler signals were registered with a Laser Doppler device (DRT4),
by Moor Instruments Ltd. (Devon, England). Probe output is defined as 1
mW. Laser wavelength was 780 nm, the raw signal was filtered with a
digital filter from 20 Hz to 22.5 kHz. A DPITprobe (diameter 8 mm, length
60
7 mm) was used for registration. An additional unit for measuring
temperature (accuracy 0.1 C) was integrated.
5.3
Results
Figure 5.3 shows the results from the three measurement parameters at
different measurement times before (a), during (b - d) and after (e)
laserneedle activation. Skin surface temperature and room temperature
parameters did not show marked changes, whereas the Flux value increased
significantly 2 minutes after activation (b) and reached a maximum at the
end of laserneedle stimulation at measurement point (d). Thereafter, this
value was reduced to its initial level.
Temp.
(C) 45
Temp.
R.-Temp.
Flux 40
(a.u.)
Flux
35
30
25
20
a
20 min
Fig. 5.3: Surface body temperature (Temp.), room temperature (R.-Temp.) and Flux
(= product of mean flow velocity and concentration of erythrocytes) in a.u. (arbitrary
units) before (a), during (b - d) and after (e) 20-minute laserneedle stimulation. Note
the increase in the Flux parameter during illumination.
The examination of the four histological samples revealed the following:

The hematoxylin-eosin samples of the illuminated cutis did not reveal any
changes in comparison with the control biopsies. In particular, no necroses
of the epidermis or single keratinocytes was evident, nor were changes in the
endothelial cells of the dermal blood vessels visible. No micro thrombosis or
extravasation could be detected (Figure 5.4).
61
Fig. 5.4: Histological results of the illuminated (a) and not illuminated (b) cutis. No
micro morphological differences are evident.
5.4
Discussion
Laser has become a term for future technology, precision, rapidity, and
achievement. Although the discovery of laser dates back to Einstein, who
founded the theory of stimulated emission in 1917, the history of laser in
acupuncture is still young [8].
Questions regarding tissue damage caused by certain laser power densities
arise repeatedly. Border values have been determined, however are currently
being discussed very differently [2,8]. Goal of this animal experimental
study was to objectify whether the illumination of the cutis with a new laser
system (laserneedle stimulation) leads to tissue damage when used in
acupuncture. We illuminated the cutis of a sus scrofa domesticus with 8
laserneedles and simultaneously registered microcirculatory parameters and
temperature values with a laser Doppler flowmetry monitor. This technique
allows the objectifying of circulation in the micro-capillary region, without
influencing tissue structures. It is based on the Doppler-shifting of light
when it hits moving parts (erythrocytes). This technique is mainly used in
pharmacology for comparing measures which influence circulation, for
controlling transplants and flaps in plastic surgery and for objectifying and
classifying disease stages in angiological and dermatological research, as
well as in occupational medicine [1,7,9]. It can also be applied for research
in the fields of anaesthesiology, intensive medicine and neurosurgery [5,6].
Even though the microcirculation parameters indicate an increase in skin
circulation after an illumination time of 20 minutes, histological
62
examinations did not show any signs of alterations in the examined layers of
skin tissue.
We assume that this results from the minimal absorption of the most
important tissue parts such as water, haemoglobin, and melatonin, which is
comparatively small at the emission wavelength of 685 nm of the
laserneedles. This indicates that photons entering the tissue are scattered at
the tissue molecules, however do not thermically counteract, as in processes
of adsorption. The skin is more or less, transparent for laser at a wavelength
of 685 nm, thus thermically induced tissue changes such as coagulation,
ablation and carbonisation can not take place and were not provable in our
experiments.
Laser illumination of 685 nm used in the laserneedles and applied in a
contact mode, with power densities between 1- 5 W/cm, did not induce
measurable micro morphological changes in the illuminated skin [10]. The
definition of relevant critical values, in particular, determination of
wavelength dependent power densities which lead to micro-morphological
tissue changes, will be clarified in further studies.
5.5
Acknowledgements
The authors thank cand. med. Evamaria Huber from the Department of
Biomedical Engineering and Research in Anaesthesia and Intensive Care
Medicine, Medical University of Graz, for her assistance in data registration.
5.6
[1]
[2]
[3]
[4]
[5]
[6]
References
Fagrell B (1994) Problems using laser Doppler on the skin in clinical
practice. In: Belcaro GV, Hoffmann U, Bollinger A, Nicolaides N
(1994) Laser Doppler. Med-Orion Publishing Company, London Los
Angeles Nicosia, 49-54
Kert J, Rose L (1989) Clinical Laser Therapy. Scandinavian Medical
Laser Technology, p. 13
Litscher G, Schwarz G, Dalageorgos K, Neger J, Kehl G (1996) LaserDoppler-Flowmetrie - Erfahrungen aus der Intensivmedizin. Biomed
Technik 41: 166-169
Litscher G, Mller KO, Stollberger R, Schwarz G, Fuchs G,
Baumgartner A, Leber K, Koop T, Ascher PW (1997) Laser-Doppler-
63
[7]
[8]
[9]
[10]
Datenanalyse whrend interstitieller Laserthermotherapie unter

Magnetresonanz-Kontrolle im Rahmen einer tierexperimentellen
Studie. Biomed Technik 42: 93-96
berg P (1990) Laser-Doppler flowmetry. Crit Rev Biomed Eng 18:
125-163
Pntinen PJ, Pothmann R (1998) Laser in der Akupunktur.
Grundlagen, Indikation und Technik fr die AkupunkturSchwerpunktpraxis. Hippokrates, Stuttgart
Tenland T, Salerud EG, Nilsson GE, berg PA (1983) Spatial and
temporal variations in human skin blood flow. Int J Microcirc: Clin Exp
2: 81-90
Einflssen
von
Lasernadelstrahlung.
Ergebnisse
einer
tierexperimentellen Untersuchung. Biomed Technik 49: 2-5
64
6.
Effects of laserneedle stimulation on

microcirculation and skin temperature
G. Litscher, L. Wang, E. Huber
6.1
Introduction
Laser Doppler flowmetry (LDF) is a technique particularly used in the field

of pharmacology for comparing measures which influence circulation, for
controlling transplants and flaps in plastic surgery and for objectifying and
classifying disease stages in angiological and dermatological research and in
anesthesiology and intensive care medicine [1-6]. Flux (product of mean
flow velocity and the concentration of red blood cells), for example, and the
concentration of moving particles (erythrocytes) in the measurement volume
are calculated.
Recently, some reports in literature documented, that this method can also be
applied in the field of acupuncture for scientific investigations [7, 8]. In this
chapter, the use of laserneedle stimulation under real circumstances is
examined, based on LDF- monitoring results.
6.2 Method and volunteers

6.2.1
Laser Doppler flowmetry
A laser Doppler monitor DRT4 (Moor Instruments, Millwey, Axminster,

England) was used to determine Flux and temperature.
Probe output was defined with 1 mW. Edge frequencies were 20 Hz and
22.5 kHz. The temperature unit (5 C to 50 C) had a resolution of 0.2 C
and accuracy of 0.5 C. In addition to an RS-232 interface, this instrument
disposes of analogous signals (0 10 V) as an output voltage. The
instrument has the following dimensions: 280 x 160 x 360 mm and weighs
8 kg.
Several measurement probes are available for the DRT4 monitor. The results
documented in this study were obtained with the DPIT probe (diameter
8 mm, length 7 mm) (Fig. 6.1).
65
Fig. 6.1: Laser Doppler probe.
6.2.2
Volunteers and procedure
Twenty-two healthy volunteers (12 female, 10 male), with a mean age of

24.4 + 2.6 years (21 - 29 years) were examined. At the time of measurement,
none of the volunteers were under the influence of drugs. They were
informed about the procedure and gave their consent. Approval of this study
was obtained from the Ethical Commission of the Medical University of
Graz (Laserneedle-Stimulation; 13-048 ex 02/03).
Continuous measurement of microcirculation parameters and temperature
was started, after a resting period of 10 minutes. After reaching the steadystate, the following acupuncture points on the right hand were stimulated
with a laserneedle (compare Fig. 6.2):
Hegu (LI.4)
Localization: At the highest point of the M. adductor pollicis, when the
thumb lies against the index finger.
Indication: Hegu is the most important analgesic point. Pain conditions;
particularly massive manual stimulation relieves pain in the
entire body. Specific cerebral effects of this distant point
could be proven in clinical studies.
66
Laserneedle temperature / Flux
Fig. 6.2: Laser Doppler perfusion and temperature monitor DRT4 (Moor
Instruments, Millwey, Axminster, England) and laserneedle stimulation.
The laserneedle was fixed to the skin at the acupuncture point with adhesive
tape, after previous cleaning of the skin with alcohol. A semi-conductor laser
with an emission wavelength of 685 nm was used as the light source. Laser
intensity was 60 mW. Details regarding the stimulation method can be found
in the previous chapters.
The Laser Doppler probe (compare Fig. 6.1) was applied at a distance of
1 cm from the laserneedle. This distance was selected based on the given
geometric dimensions of the probe holder (compare Fig. 6.1) and a supposed
optic depth in the infrared range of 1 cm. Temperature at the measurement
point and room temperature were determined for comparison.
Figure 6.3 shows the different measurement times schematically (a - e)
before, during and after laserneedle stimulation.
67
b
1 min
d
1 min
10 min
e
20 min
2 min
2 min
laserstimulation active
Fig. 6.3: Measurement profile and measurement times (a - e).
6.2.3
Data were analyzed using Friedman Repeated Measures ANOVA on

Ranks with the computer program SigmaStat (Jandel Scientific Corp.,
Erkrath, Germany). The Tukey test was used for post hoc analysis. Results
from the conditions before (a), during (b - d) and after (e) laserneedle
acupuncture were noted as mean values (Cx + standard error SE). The level
of significance was defined as p < 0.05.
6.3
Results
Figure 6.4 summarizes the results of the three parameters; Flux, hand and
room temperature at the different measurement times (compare Fig. 6.3).
68
Laserneedle temperature and Flux

p = 0.005*
p = 0.002*
Temp.
(C)
Flux
(a.u.)
34
32
30
28
Temp.
R.-Temp.
Flux
26
24
n = 22
22
20
20 min
*
Friedman Repeated Measures

Analysis of Variance on Ranks
(Tukey Test)
Fig. 6.4: Changes in Flux (= product of concentration and velocity of erythrocytes),

skin (Temp.) and room temperature (R.-Temp.) parameters before (a), during (b - d)
and after (e) laserneedle stimulation at acupuncture point Hegu.
Observe the highly significant changes in Flux (p = 0.005) as well as the

increase in temperature at the measurement site (p = 0.002). Even 2 minutes
after deactivating laser stimulation (measurement time e), Flux was no
longer significant but still markedly higher.
Temperature at the stimulation point (distance 1 cm) also showed an obvious
increase, which reached its maximum at measuring time d. The nearly
constant room temperature was simultaneously registered as a comparative
parameter.
69
Laserneedle - microcirculation
left hand
right hand
Fig. 6.5: Eight deactivated laserneedles before starting the examination.
left hand
right hand
B.A., 25y, f
Fig. 6.6: Activated laserneedles during examination procedure.
70
10 min
30 min
10 min
B.A., 25y, f
Fig. 6.7: Changes in parameters regarding concentration of erythrocytes (c1, c2) and
temperature (t1, t2) at the left, or right hand in the phases before (10 min), during
(30 min) and after (10 min) laserneedle stimulation.
6.4
Discussion
The Laser Doppler technique is a suitable method for measuring the

concentration and velocity of moving blood cells in surface vessels.
Penetration depth is confined to about 1 mm. Laser light is usually guided to
the output point via light conductors. Due to the Doppler effect, frequency
shifts of scattered light take place and can be determined by measuring flow
velocity. Possible advantages of this technique particularly in acupuncture
research are currently being evaluated [7-13].
Negative factors regarding this method per se are the failing standardization
combined with difficult interpretation of clinical data and high purchasing
costs of the LDF equipment. Advantages of this method are its time-saving
aspect, non-invasiveness, continuous monitoring ability and user
friendliness.
71
The results from this study indicate that the energy dose emitted by a
laserneedle in 20 minutes, is high enough to increase local skin temperature
and subcutaneous tissue temperature (mean of 0.7 C ; p = 0.02). Thus, the
modality of periphery stimulation with laserneedles is not only optical but
also thermal.
Light dispersion on the skin was measured using a new device (O2C Oxygen
to see, LEA Medizintechnik, Giessen, Germany). Figure 6.8 shows that even
at a distance of 4 cm the laser light from the laserneedle (685 nm) can be
detected.
4 cm
3 cm
2 cm
1 cm
1 cm
2 cm
3 cm
4 cm
Fig. 6.8: Light dispersion on the skin. Note the peak in the spectrum at 685 nm.
In addition it is very interesting that especially Flux is significantly increased

(p = 0.005) only 2 minutes after beginning laserneedle stimulation. In other
words, an improvement in local, peripheral microcirculation at the
stimulation point takes place. This fact could prove to be useful in
dermatologic indications.
The results from this study should induce further investigations regarding the
evaluation of temporal and spatial (laser Doppler imaging) changes in
microcirculation parameters, during and after laserneedle stimulation.
Possible artifacts, as described in literature should be reduced further [4].
72
6.5
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
[13]
References
Fagrell B (1994) Problems using laser Doppler on the skin in clinical
practice. In: Belcaro GV, Hoffmann U, Bollinger A, Nicolaides AN
(1994) Laser Doppler. Med-Orion Publishing Company, London-Los
Angeles-Nicosia, 49-54
berg P (1990) Laser-Doppler flowmetry. Crit Rev Biomed Eng 18:
125-163
Litscher G, Schwarz G, Boggett D (1995) Laser Doppler flowmetry
Peripheral microcirculation during cessation of cerebral and
cardiocirculatory function. Biomed Technik 40: 195-199
Litscher G, Schwarz G, Dalageorgos K, Neger J, Kehl G. (1996)
Laser-Doppler-Flowmetrie Erfahrungen aus der Intensivmedizin.
Biomed Technik 41: 166-169
Litscher G, Mller KO, Ratzenhofer-Komenda B, Schwarz G, Koop T,
Kovac H (1997) Laser Doppler flowmetry in the hyperbaric
environment. Lasers Med Sci 12: 342-346
Litscher G, Mller KO, Stollberger R, Schwarz G, Fuchs G,
Baumgartner A, Leber K, Koop T, Ascher PW (1997) Laser-DopplerDatenanalyse whrend interstitieller Laserthermotherapie unter
Magnetresonanz-Kontrolle im Rahmen einer tierexperimentellen
Studie. Biomed Technik 42: 93-96
and moxibustion: A pilot study in healthy adults. Lasers Med Sci 16:
184-191
flow perfusion in the fingertip following acupuncture needle
introduction as evaluated by laser Doppler perfusion imaging. Lasers
Med Sci 17: 19-25
Litscher G, Wang L, Nilsson G (2001) Laser Doppler Imaging und
Kryoglobulinmie. Biomed Technik 46: 154-157
Sprott H, Jeschonnneck M, Grohmann G, Hein G (2000)
Microcirculatory changes over the tender points in fibromyalgia
patients after acupuncture therapy (measured with laser-Doppler
flowmetry). Wien Klin Wochenschr 112(13): 580-586
Suter B, Kistler A (1994) Does acupuncture modify skin circulation via
the autonomic nervous system? Schweiz Med Wochenschr 62: 36-38
Blom M, Lundeberg T, Dawidson I, Angmar-Mansson B (1993) Effects
on local blood flux of acupuncture stimulation used to treat xerostomia
in patients suffering from Sjogrens syndrome. J Oral Rehabil 20(5):
541-548
Cramp AF, Noble JG, Lowe AS, Walsh DM (2001) Transcutaneous
electrical nerve stimulation (TENS): the effect of electrode placement
upon cutaneous blood flow and skin temperature. Acupunct
Electrother Res 26(1-2): 25-37
73
7.
Effects of acupressure, manual acupuncture

and laserneedle acupuncture on EEG
bispectral index (BIS) and spectral edge
frequency (SEF) in healthy volunteers
G. Litscher
7.1
Introduction
Noninvasive bioelectrical neuromonitoring is gaining more and more

attention in anesthesia and critical care [1,2]. The bispectral index (BIS) and
the spectral edge frequency (SEF) are important numerical descriptors of the
EEG and both are mainly used for assessing depth of anesthesia [3]. If
anesthetists rely on BIS and SEF to detect awareness, then it is very
important to exclude other influences that could give false readings. It is
known that a number of environmental and physiologic factors may affect
BIS performance. Recently it has been reported that also
nonpharmacological interventions such as acupressure can reduce BIS
values significantly [4].
This study is a randomized, controlled partly blinded (laserneedle
acupuncture) cross-over trial intended to investigate the effects of three
nonpharmacological interventions (acupressure, manual needle acupuncture
and laserneedle acupuncture) on two processed EEG variables (BIS, SEF)
and a verbal stress score in healthy volunteers.
7.2
7.2.1
Material and methods

Subjects
We studied 25 healthy volunteers (mean age r SD: 25.5 + 4.0 years, range
21 - 39 years; 15 women, 10 men; body weight 69.1 r 16.1 kg; height 173.5
r 9.3 cm). None of the subjects had neurological or psychological disorders
and they were not taking any medication. They were partly informed about
the nature of the investigation and were paid for their participation. The
investigators recording EEG and sedation data were blinded to the
intervention applied to the volunteers. The subjects were not informed which
of the four interventions was effectively a control (acupressure on a control
74
point). The study was approved by the Ethics Committee of the Medical
University of Graz (13-048 ex 02/03). Written informed consent was
obtained from each subject.
7.2.2
Procedure and study design
The study was performed as a randomized, controlled cross-over trial. Four

EEG electrodes (F7-Fpz, F8-Fpz, Fz = ground) and a noninvasive blood
pressure cuff were attached to the volunteers after they arrived at the
biomedical engineering laboratory.
Two channels of spontaneous electrical activity were recorded from
electroencephalographic electrodes (Zipprep self-prepping electrodes;
Aspect Medical Systems Inc., Natick, MA, USA). The skin-electrode
impedance was < 2 kOhm. Low cutoff frequency was 2 Hz and high cutoff
frequency was 30 Hz. The EEG was measured continuously using an Aspect
A-1000 system (Aspect Medical Systems Inc., version 3.12, Natick, MA,
USA).
A period of 5 min was allowed for each subject to obtain steady state BIS
and SEF values. Thereafter with one of the four conditions - acupressure at
the acupoint Yintang, manual needle acupuncture at Yintang, laserneedle
acupuncture at Yintang or acupressure at a control point was started (Fig.
7.1). There were three treatments and additionally to investigate a possible
placebo effect, we also used acupressure at a control point.
The acupoint Yintang (Ex.1) is located midway between the medical ends of
the two eyebrows at the root of the nose (see Fig. 7.1, a - c). To assess the
reliability and validity of acupressure and manual needle acupuncture,
pressure on the acupoint and the control point was applied by the same
chinese medical doctor experienced in Traditional Chinese Medicine. The
thumb pressure was estimated to be about 3 x 105 Pa (mean force measured
~ 30 N / 1 cm; Pascal (Pa) = N/m; 30/0.0001=3x105).
75
Fig. 7.1: Different conditions of the cross-over study design: (a) acupressure at the
acupoint Yintang, (b) manual needle acupuncture at Yintang, (c) laserneedle
acupuncture at Yintang, and (d) acupressure at a control point in a 25-year-old
healthy female (with permission by the volunteer E.H.).
Manual needle acupuncture was performed using sterile single use needles
0.30 x 30 mm (Huan Qiu; Suzhou, China). After local disinfections of the
skin the needling method was oblique, in caudal direction (0.5 cm) [5].
Stimulation for a duration of 20 sec in intervals of 2 minutes consisted of a
combination of rotating and thrusting movements using a special manual
acupuncture stimulation technique (sedation method). The needle was
removed after 10 minutes.
Laserneedle acupuncture at the acupoint Yintang was performed using a new
method for optical stimulation. This method was reported by our research
group in the scientific literature in 2002 [6,7]. The laserneedle-technique
represents a new, noninvasive method for optical stimulation of acupuncture
points. The laser used in this study emits red light in continuous-wave mode
with an output power of 30 - 40 mW, which results in a radiant exposure
energy of about 2.3 kJ/cm at the acupuncture point during a stimulation
time of 10 min [6].
76
Acupressure on the control point (location: 2 cm from lateral end of the left
eyebrow; Fig. 1, d) was performed in similar manner as on the acupoint
Yintang (duration 10 min).
All subjects had four conditions applied (Fig. 1, a - d). The persons were in a
semi-lying position with closed eyes. The choice of the stimulation
procedure was randomized within a subject and the interval between the
different sessions was at least 20 min.
7.2.3
Evaluation parameters
The main evaluation parameters were BIS and SEF90 during different
conditions (Fig. 7.1) and time intervals (Fig. 7.2). Measurements were made
at time points a - g (see Fig. 7.2). In any one condition we recorded BIS and
SEF values continuously but sampled the data for subsequent analysis at 7
points. A single reading was taken at each point. The stimulation was not
stopped at the time of reading. The whole study session lasted 2 3 hours.
BIS and SEF90 represent single numbers, which should decrease
continuously with decreasing level of consciousness (hypnosis). There are
several review articles for methodological details of signal processing of BIS
and SEF [3].
1 min
5 min
1 min
2.5 min
2.5 min
5 min
5 min
2 min
2 min
10 min
Fig. 7.2: Stimulation procedure and different measuring points (a=before, b f=during, g=after stimulation).
After five minutes of stimulation (Fig. 7.2, d) the subjects were asked to
move their right hand to clarify that they were awake and not asleep. In
addition before and after each stimulation mode the persons were asked to
score the stress and tension that they had based on a verbal stress scale
(VSS) from 0 (no stress) to 10 (maximum stress) [4]. Heart rate (HR) and
noninvasive blood pressure (BP) were also recorded before and after
77
acupressure stimulation at Yintang (measurement points: 1 min before a
and 1 min after g (comp. Fig. 7.2)).
7.2.4
The BIS and SEF data were tested with analysis of variance (one-way
repeated measures ANOVA; similar data were found to be normally
distributed in previous investigations) using SigmaStat (Jandel Scientific
Corp., Erkrath, Germany). Dunnetts method was used for post hoc analysis.
VSS data were compared using paired t-test. The results were graphically
presented as box plots (BIS and SEF) and as scatter plot (VSS). Changes
were considered significant at a p-value < 0.05.
7.3
Results
All subjects completed the study. Figure 7.3 shows the decreases of BIS
values during acupressure applied to the acupoint Yintang in all 25 healthy
volunteers.
78
10
11
12
13
14
15
16
17
21
18
22
19
23
20
24
25
Yintang
n=25
10 min
Fig. 7.3: The trend of BIS values of 25 healthy volunteers (1 25) before, during
and after acupressure performed on the acupoint Yintang. All subjects were awake.
Note the significant decrease (min. BIS = 35; no. 14) due to acupressure.
Before the subjects were stimulated, their mean BIS values (r SD) were 97.4
(98 - 95) r 1.0 and their mean SEF values (r SD) were 23.9 r 4.1 Hz (right)
and 23.5 r 4.9 Hz (left). The BIS and SEF values both decreased
significantly (p < 0.001) after starting acupressure. After 5 minutes
acupressure at the acupoint Yintang the mean BIS values were 62.9
(minimum 35; see no. 14 in Fig. 7.3) r 13.9, and the mean SEF values were
13.3 (minimum 2.9) r 8.1 Hz (right) and 13.8 (minimum 2.7) r 7.3 Hz (left).
The release of acupressure caused an increase in BIS and SEF back to the
baseline values before stimulation (compare Fig. 7.4).
79
120
100
BIS
80
60
40
p < 0.001 (b-f vs. a)
20
One Way Repeated Measures ANOVA (Dunnetts Method)
BIS
0
35
30
25
Hz
20
15
10
5
SEF r
p < 0.001 (b-f vs. a)
0
35
30
25
Hz
20
15
10
5
0
p < 0.001 (b-f vs. a)
SEF l
Fig. 7.4: Box plots of alterations of BIS and SEF values (r right, l left) in 25 healthy
volunteers before (a), during (b - f), and after (g) acupressure (compare Fig. 7.2) on
the acupoint Yintang. The ends of the boxes define the twenty-fifth and seventy-fifth
percentiles, with a line at the median and error bars defining the tenth and ninetieth
percentiles.
80
Figure 7.5 summarizes the BIS and SEF results obtained during manual
needle acupuncture, laserneedle acupuncture and acupressure on the control
point. Significant (p < 0.05) changes were found in BIS values during
laserneedle acupuncture (measuring points d and e; compare Figs. 7.2 and
7.5) and during acupuncture on the control point (measuring points d - f).
After 7.5 minutes laserneedle acupuncture at acupoint Yintang the mean BIS
values (r SD) were 95.4 (minimum 81; see Fig. 7.5, middle, upper panel) r
4.1. After 5 minutes acupressure at the control point the mean BIS values (r
SD) were 94.2 (minimum 77; see Fig. 7.5, right, upper panel) r 4.8. SEF did
not show any significant alteration.
Acupressure - Control
120
120
120
100
100
100
80
80
60
n.s.
20
BIS
20
One Way Repeated Measures ANOVA

(Dunnetts Method)
BIS
35
35
35
30
30
30
25
25
25
20
20
20
15
15
10
10
n.s.
SEF r
10
n.s.
SEF r
35
35
35
30
30
30
25
25
25
20
20
20
Hz
15
15
10
10
5
n.s.
SEF l
n.s.
SEF r
Hz
BIS
15
Hz
One Way Repeated Measures ANOVA

(Dunnetts Method)
Hz
Hz
Hz
p < 0.05
(d-f vs. a)
60
40
40
40
20
80
p < 0.05
(d,e vs. a)
60
BIS
BIS
BIS
Needle - Acupuncture
15
10
5
n.s.
SEF l
n.s.
SEF l
Fig. 7.5: Box plots of changes of BIS and SEF values (r right, l left) during manual
needle acupuncture, laserneedle acupuncture and acupressure at the control point.
Further explanations see Fig. 7.4.
The results of the analysis of the VSS are demonstrated in Fig. 7.6.
81
10
VSS
Acupuncture
Yintang
NeedleAcupuncture
Laserneedle
Acupuncture
Acupressure
Control
a
2
b
b
p < 0.001
b
paired t-test
b
(n.s. p < 0.012)
Fig. 7.6: Mean (+ SD) values of the verbal stress score (VSS) of 25 healthy
volunteers before (a) and after (b) different modalities of nonpharmacological
stimulation (0 = no stress; 10 = maximum stress).
The VSS values were significantly (p < 0.001) reduced after pressure
application on Yintang, needle acupuncture and laserneedle acupuncture but
also after pressure application on the control point (p = 0.012). Mean
baseline VSS values were insignificant lower in laserneedle and control
conditions.
HR and BP values (mean r SD) before and after acupressure at Yintang
were calculated to be 73.2 r 12.4 1/min, 109.8 r 14.0 mmHg (systolic) and
69.3 r 10.6 mmHg (diastolic). After stimulation the values decreased to 63.7
r 11.9 1/min, 107.7 r 8.7 mmHg (systolic), and 66.8 r 8.6 mmHg
(diastolic), respectively.
7.4
Discussion
The bispectral index and the spectral edge frequency are mainly used
intraoperatively to monitor the hypnotic effect of anesthetic drugs. There are
several studies reported in the literature proposing target values for EEG
parameters to guide the depth of anesthesia. A number of authors have
reported a low probability of recall and a high probability of
unresponsiveness during surgery at a level of 60 for BIS [8,9]. BIS values
< 50 are described as suppressing hemodynamic responses during intubation
82
[10]. In an editorial of the European Journal of Anaesthesiology Chan and
Gin reported recently that statistically it would be extremely unlikely for a
patient to be aware when BIS is less than 50 and, in fact, there has not been a
single case of frank awareness at this level [11]. In that context our results
showed that 10 of 25 awake healthy volunteers (40 %) have Yintang
acupressure induced BIS values below 50 and 21 of 25 subjects (84 %)
below 60.
Acupressure, acupuncture, meditation, hypnosis or relaxation techniques are
all considered to be forms of complementary and alternative medicine.
Acupuncture has been shown to reduce medication use in a number of trials
[12]. Acupressure has been studied and offered in scientific literature as a
valuable treatment in improving the quality of sleep [13]. In previous studies
it has also been shown that pressure on acupoints can decrease postoperative
pain [14] and that Korean hand acupressure reduces postoperative nausea
and vomiting after gynecological laparoscopic surgery [15]. Acupressure has
also been used in some other studies for prevention of emesis [16]. There are
a number of theories as to how acupressure or acupuncture works. All these
hypotheses show, that the brain plays a key role in acupuncture and
acupressure research [17-20]. Modulation of subcortical structures may be
an important mechanism by which acupuncture and acupressure exerts its
complex multisystem effects [20]. Demonstration of regionally specific,
quantifiable acupuncture and acupressure effects on relevant structures of the
human brain would facilitate acceptance and integration of these therapeutic
modalities into the practice of modern medicine [17-20].
It has been shown in several publications that different narcotics have
different influence on BIS and SEF [8-11, 21-26]. However,
nonpharmacologic influences such as electromyographic activity may
contribute to the low specificity of the absolute values of the
electrophysiological measurement data [21]. In the majority of the cases the
BIS is falsely elevated [21]. Our results appear to confirm the results of the
study of Fassoulaki et al. [4] who also found that acupressure on Yintang
resulted in a significant and clinically relevant reduction on BIS values and
they concluded that BIS and SEF are therefore of limited clinical relevance
for monitoring depth of anesthesia [22-26]. However, Fassoulaki et al. [4]
did not look at the SEF, nor did they investigate the effects of manual needle
acupuncture and the effects of laserneedle acupuncture (Fig. 7.7).
We have shown in this study that awake volunteers subjected to acupressure
at Yintang can have similar BIS and SEF values to anaesthetized patients.
While it is unlikely that a patient will receive acupressure or acupuncture
during surgery, the question as to what causes BIS readings below 50 in
awake subjects remains. It is unlikely to be a placebo effect as we have
83
shown in several test measurements using placebo points that BIS is not
affected by laserneedle stimulation per se. In the present study there were
small statistically significant but not clinically important changes with
needle acupuncture, laserneedle acupuncture and acupressure at control
point. These findings also help confirm that the BIS and SEF reductions
induced by acupressure at Yintang are not a placebo effect. Reduced
electromyographic levels could be partially responsible [21] (Fig. 7.8).
Fig. 7.7: Laserneedle stimulation at Yintang (CSA = coulor spectral array; CFM =
mean EEG-parameter; BIS = bispectral index; HR = heart rate; HRV = heart rate
variability). Note the decrease of the BIS values during laserneedle activation.
84
EEG EMG - HR
EMG
EEG - DELTA
LaserneedleLaserneedle-Stimulation Yintang (10 min)
Fig. 7.8: Electromyographic (EMG) and electroencephalographic Delta (EEG Delta) activities during laserneedle stimulation at Yintang.
At the moment it is also unclear to what degree system algorithms contribute

to such findings. BIS is certainly affected by electrical activity nearby,
especially diathermy. Therefore there could also be a possibility that local
movement in the region of the recording electrode might be responsible for
the EEG effects observed. These are apparently less during control point
acupuncture than during Yintang acupressure, where pressure is applied to a
point immediately adjacent to the Zipprep electrode. Further investigations
are necessary to clarify these questions.
In conclusion, we found in healthy awake volunteers that acupressure at
Yintang results in statistically significant and clinically relevant reductions
in BIS and SEF while needle acupuncture, laserneedle acupuncture and
acupressure at a control point result in statistically significant but clinically
unimportant reductions. Although the validity of BIS in anesthesia is higher
than that of SEF, BIS too has to be interpreted very carefully as our results
show. Our results also highlight the electroencephalographic similarities of
acupressure induced sedation and anesthesia [27].
85
7.5
Acknowledgements
The author would like to express his thanks to Ms. Lu Wang MD, Ms. Petra
Petz MSc and Evamaria Huber (all Biomedical Engineering and Research in
Anesthesia and Intensive Care Medicine, Medical University of Graz) for
their valuable help.
7.6
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
References
Litscher G, Schwarz G (2001) Editorial. Noninvasive bioelectrical
neuromonitoring in anaesthesia and critical care. Eur J Anaesthesiol
18: 785-788
Litscher G (2000) Editorial. The future of neuromonitoring. Internet J
Neuromonitoring 1(1):
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijnm/vol1n
1/editorial2.xml
Rampil IJ (1998) A primer for EEG signal processing in anesthesia.
Anesthesiology 89: 980-1002
Fassoulaki A, Paraskeva A, Patris K, Pourgiezi T, Kostopanagiotou G
(2003) Pressure applied on the extra 1 acupuncture point reduces
bispectral index values and stress in volunteers. Anesth Analg 96:
885-889
Stux G, Pomeranz B (1998) Basics of acupuncture. Springer; Berlin
Heidelberg New York
Sebel PS, Lang E, Rampil IJ, White PF, Cork R, Jopling M, Smith NT,
Glas PS, Manberg P (1997) A multicenter study of bispectral
electroencephalogram analysis for monitoring anesthetic effect.
Anesth Analg 84: 891-899
Liu J, Singh H, White PF (1997) Electroencephalographic bispectral
index correlates with intraoperative recall and depth of propofolinduced sedation. Anesth Analg 84: 185-189
Heck M, Kumle B, Boldt J, Lang J, Lehmann A, Saggau W (2000)
Electroencephalogram bispectral index predicts hemodynamic and
arousal reactions during induction of anesthesia in patients
undergoing cardiac surgery. J Cardiothorac Vasc Anesth 14: 693-697
Chan MTV, Gin T (2000) Editorial. What does the bispectral EEG
index monitor? Eur J Anaesthesiol 17: 146-148
Greif R, Laciny S, Mokhtarani M, Doufas AG, Bakhshandeh M, Dorfer
L, Sessler DI (2002) Transcutaneous electrical stimulation of an
86
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
[26]
[27]
auricular acupuncture point decreases anesthetic requirement.

Tsay SL, Chen ML (2003) Acupressure and quality of sleep in patients
with end-stage renal disease - a randomized control trial. Intern J
Nursing Studies 40: 1-7.
Felhendler D, Lisander B (1996) Pressure on acupoints decreases
postoperative pain. Clin J Pain 12: 326-329
Boehler M, Mitterschiffthaler G, Schlager A (2002) Korean hand
acupressure reduces postoperative nausea and vomiting after
gynecological laparaoscopic surgery. Anesth Analg 94: 872-875
Eizember FL, Tomaszewski CA, Kerns WP (2002) Acupressure for
prevention of emesis in patients receiving activated charcoal. J
Toxicol Clin Toxicol 40: 775-780
Cho ZH, Wong EK, Fallon JH (2000) Neuro-Acupuncture. Q-Puncture,
Los Angeles
Litscher G, Cho ZH (Eds.) (2000). Computer Controlled Acupuncture.
Pabst Science Publishers, Lengerich Berlin Dsseldorf Riga
Scottsdale Wien Zagreb
Lengerich Berlin Dsseldorf
Hui KKS, Liu J, Makris N, Gollub RL, Chen AJ, Moore CI, Kennedy
DN, Rosen BR, Kwong KK (2000) Acupuncture modulates the limbic
system and subcortical gray structures of the human brain: evidence
from fMRI studies in normal subjects. Human Brain Mapping 9: 13-25
Bruhn J, Bouillon TW, Shafer SL (2000) Electromyographic activity
falsely elevates the bispectral index. Anesthesiology 92: 1485-1487
Riess ML, Graefe UA, Goeters C, Van Aken H, Bone HG (2002)
Sedation assessment in critically ill patients with bispectral index. Eur
J Anaesthesiol 19: 18-22
Drummond JC (2000) Monitoring depth of anesthesia. With emphasis
on the application of the bispectral index and the middle latency
auditory evoked response to the prevention of recall. Anesthesiology
93: 876-882
Nieuwenhuijs D, Coleman EL, Douglas NJ, Drummond GB, Dahan A
(2002) Bispectral index values and spectral edge frequency at
different stages of physiologic sleep. Anesth Analg 94: 125 - 129
Kalkman CJ, Drummond JC (2002) Monitors of depth of anesthesia,
quo vadis? Anesthesiology 96(4): 784-787
Bruhn J, Bouillon TW, Radulescu L, Hoeft A, Bertaccini E, Shafer SL
(2003) Correlation of approximate entropy, bispectral index, and
spectral edge frequency 95 (SEF95) with clinical signs of anesthetic
depth during coadministration of propofol and remifentanil.
Litscher G (2004) Effects of acupressure, manual acupuncture and
Laserneedle acupuncture on EEG bispectral index and spectral edge
frequency in healthy volunteers. Eur J Anaesthesiol 21: 13-19
87
8.
Acupuncture using laserneedles modulates

brain function: first evidence from functional
transcranial Doppler sonography (fTCD) and
functional magnetic resonance imaging
(fMRI)
G. Litscher, D. Rachbauer, S. Ropele, L. Wang,
D. Schikora, F. Fazekas, F. Ebner
8.1
Introduction
A new noninvasive laserneedle system has been developed and used for the
first time in acupuncture research recently [1,2]. This new optical
stimulation technique has the advantage that the stimulation is absolutely
painless. Moreover laserneedle acupuncture allows to stimulate appropriate
acupoint combinations simultaneously and with higher radiation doses than
commercially available low level hand held laser equipment.
The laser radiation of eight laser diodes is coupled into eight optical fibers
and the laserneedles are arranged at the distal ends of the optical fibers. Due
to the direct contact of the laserneedles and the skin, no loss of intensity
occurs and the laser power, which affects the acupoints, can be exactly
determined [1,2].
The aim of this study was to provide evidence of specific effects of
laserneedle acupuncture by stimulating a combination of vision related
acupoints of traditional Chinese medicine (TCM). Quantification of cerebral
effects of stimulation was performed using functional multidirectional
transcranial Doppler sonographic (fTCD) in a randomized controlled doubleblind cross-over study design (fTCD). We also performed functional
magnetic resonance imaging (fMRI) measurements in one volunteer using a
block design.
The dynamics of the metabolic mechanism that regulates cerebral blood flow
has already been studied in normal human subjects using fTCD [3,4]. Blood
flow velocity in the posterior cerebral artery (PCA), supplying the visual
cortex, increased by 16.4 % in response to light stimulation of the retina.
88
The method of fTCD has also been used in previous studies in acupuncture
and laserneedle research to investigate specific changes in blood flow
velocities of different cerebral arteries [1]. Functional magnetic resonance is
sensitive to subtle regional changes in the blood oxygenation level from
increased neuronal activity during a specific task or stimulation. It has been
successfully used to map the sites of brain activations during needle and low
level laser acupuncture [5-9]. These studies report increase (positive
activation) and decrease (negative activation) of the BOLD (blood
oxygenation level dependent) signal. However, fMRI has not been used up
to now during laserneedle stimulation.
8.2
8.2.1
Methods
Painless laserneedles
For our experiments eight acupuncture points were chosen and irradiated
simultaneously. The laserneedles used in this study emit red light in cwmode with an output power of 30 - 40 mW per laserneedle (wavelength:
685 nm). The fiber core diameter used in this study was about 500 m. The
time of irradiation was 20 min (fTCD measurements) resulting in an energy
density of about 4.6 kJ/cm at each acupoint and a total sum of 36.8 kJ/cm
for all acupoints. The laserneedles were fixed onto the skin using plaster
stripes but not pricked into the skin.
8.2.2
Functional
multidirectional
sonography (fTCD)
transcranial
Doppler
Transtemporal Doppler sonographic examinations of the PCA and the

middle cerebral artery (MCA) were performed simultaneously and
continuously to determine alterations of cerebral blood flow velocities [4]. A
Multi-Dop T unit (DWL Electronic Systems GmbH, Sipplingen, Germany)
including two 2 MHz probes were used in a multidirectional ultrasound
probe holder construction. Under acoustic control, the angle and position of
the probes were adjusted until the greatest possible signal amplitude was
reached. Alterations in the blood flow velocities of both arteries were
registered continuously and simultaneously. In addition blood pressure was
measured non invasively before and after stimulation (Cardiocap CC-104,
Datex Medical Electronics, Hoevelaken, The Netherlands).
89
8.2.3
Functional magnetic resonance imaging (fMRI)
Functional magnetic resonance imaging was performed using a 1.5 Tesla

whole body system (Intera, Philips Medical Systems, Best, The
Netherlands). Functional images sensitive to blood oxygen dependent
contrast were acquired with a T2* weighted gradient echo with single shot
echo planar readout (flip angle 90, TE 50 ms, FOV 250 mm, matrix 96 x 96
interpolated to 128 x 128). Thirty axial slices with a slice thickness of 4 mm
were imaged.
A total of 144 volume images was obtained continuously with a repetition
time of 5 seconds per volume.
8.2.4
Participants
We investigated 18 healthy volunteers (mean age r SD: 25.4 r 4.3 years;

range: 21 - 30 years; 11 female, 7 male) using fTCD (n=17) and one
volunteer using fMRI (27 y, female).
The study protocol was approved by the institutional ethics committee of the
Medical University of Graz (11-017 ex 00/01) and all 18 participants gave
written informed consent. None of the subjects was under the influence of
centrally active medication. All persons were free of neurological or
psychological disorders including the absence of visual deficits. A
honorarium was given for participation.
8.2.5
Experimental design and procedure
Eight vision related distal acupoints (Hegu, Zusanli, Kunlun, Zhiyin)

[6,7,10] on both sides and 8 placebo points were tested using two schemes
(fTCD measurements), each in one session in a randomized controlled
double-blind cross-over study design (Fig. 8.1). The same acupoints were
used for the fMRI investigation. The acupuncture scheme was selected by an
expert in TCM. In addition we have seen in several test measurements that
needle stimulation of this acupuncture scheme led to alterations of blood
flow velocity in the PCA.
90
Vision Related Acupoints
Placebo Points
Fig. 8.1: Vision related acupuncture points and placebo points used in this study. All
acupoints (left panel, from bottom to top and from right to left: Hegu, Zusanli,
Kunlun, Zhiyin) and all placebo points (right panel) were stimulated bilaterally.
The acupoints were cleaned with alcohol. Then the laserneedles were put in
contact with the skin and fixed by plaster stripes. During the experiments the
subjects were in a relaxed and comfortable position on a bed in our
laboratory (fTCD measurements) or lying in the scanner (fMRI
investigation). For the fTCD investigations we started randomly with either
acupoint or placebo stimulation.
Acupoints
Hegu (LI.4):
Location:
On the dorsum of the hand, between the 1st and 2nd metacarpal
bones, in the middle of the 2nd metacarpal bone on the radial
side.
Indications: Headache, redness, swelling and pain of the eye.
Zusanli (Sp.36):
Location:
3 cun below Dubi (S 35), one finger-breadth from the anterior
crest of the tibia.
Indications: Gastric pain, abdominal distension, vomiting, diarrhea,
dysentery, has tonification effect.
Kunlun (UB.60):
Location:
In the depression between the tip of the external malleolus and
tendo calcaneus.
Indications: Headache, neck rigidity, dizziness.
91
Zhiyin (UB.67):
Location:
On the lateral side of the small toe, about 0.1 cun lateral to the
corner of the nail.
Indications: Headache, pain in the eye, nasal obstruction, epistaxis,
malposition of fetus.
8.2.6
Evaluated parameters
The mean blood flow velocity (vm) in the PCA and the MCA were evaluated
simultaneously and continuously at different measurement points (a - e in
Fig. 8.2A) [10]. Each person was studied performing stimulation on vision
related acupoints and placebo points. The interval between the fTCDexperiments was 20 to 30 minutes and the subjects were instructed to keep
their eyes closed during the whole fTCD experiments.
Similarly, during fMRI investigations the subject could not see whether the
laser was off or on. The fMRI study used a block design with alternating one
minute resting condition (R) and one minute activation condition (A)
(Fig. 8.2B). The experiment started with R followed by the laserneedle
acupuncture condition (A). A total of 6 R and 6 A intervals was
registered. Altogether the fMRI data acquisition took 12 minutes.
b
d
1 min
1 min
10 min
20 min Laserneedle Stimulation

2 min
2 min
Stimulation OFF
Stimulation ON
A
R
A
R
A
R
A
R
A
R
1 min
12 min
Fig. 8.2: Measurement profiles for fTCD (A) and fMRI (B) measurements.
92
8.2.7
The fTCD data before (a), during (b - d), and after (e) laserneedle
acupuncture (comp. Fig. 8.2A) were tested with Kruskal-Wallis one way
ANOVA on ranks (SigmaStat, Jandel Scientific Corp., Erkrath, Germany).
The criterion for significance was p < 0.05.
The fMRI data were analysed using SPM 99 (SPM 99, Department of
Imaging Neuroscience, London, UK). All volumes from the subject were
realigned using the first volume as a reference and resliced using sincinterpolation. The functional images were spatially normalized to a standard
echo planar template in Tailarach space.
Functional data were spatially smoothed with a 6 mm full width at half
maximum isotropic kernel. A boxcar waveform convolved with a synthetic
hemodynamic response function was used as the reference waveform.
A t-test was performed to identify regions showing significantly higher
activation during the activation condition versus the resting condition. For
significantly activated regions, a statistical threshold p < 0.05, corrected at
the cluster level for multiple comparisons, was used.
8.3
Results
The results of the alterations of mean blood flow velocities in the PCA and
MCA before, during, and after laserneedle and placebo acupuncture are
summarized in Figure 8.3.
93
vm [cm/s]
PCA
Vision related acupoints (A)
50
+ 2.5 cm/s
40
SE
MCA
50
40
vm [cm/s]
Placebo points (B)
PCA
50
40
SE
MCA
50
40
Fig. 8.3: Mean blood flow velocity (vm) of the posterior cerebral artery (PCA) and
the middle cerebral artery (MCA) before (a), during (b - d), and after (e) stimulating
vision related acupoints (A) and placebo points (B) with laserneedles in 17 healthy
volunteers. Note the trend towards an increase (+ 2.5 cm/s) in vm in the PCA during
acupoint stimulation.
The results showed a trend towards an increase of vm (insignificant changes)

in the PCA during (b - d) laserneedle acupuncture at vision related acupoints
(Fig. 8.3A, upper panel). At the same time only minor changes in vm were
seen in the MCA (Fig. 8.3A, lower panel). The maximum amplitude of vm in
the PCA was detected with a delay of 20 - 60 sec after the initial stimulus by
94
the laserneedles (vm; Cx r SE, acupoint stimulation, PCA: 42.2 r 2.5 before
(a), 44.2 r 2.6 during (b - d), 42.3 r 2.4 cm/s after (e)). Stimulation at
placebo points did not increase vm of the PCA and of the MCA (Fig. 8.3B),
rather there was a trend towards a small decrease of mean values of the mean
vm in both arteries (vm, Cx r SE, placebo point stimulation, PCA: 42.9 r 2.6
before (a), 41.7 r 2.6 during (b - d), 42.1 r 2.8 cm/s after (e)).
The mean arterial blood pressure before and after laserneedle acupuncture
was almost identical (76.7 r 7.6 (SD) vs. 75.8 r 6.8 mmHg).
The results of the fMRI investigation are shown in Figures 8.4 and 8.5 and
Table 8.1. Significant changes in brain activation were found in the occipital
lobe and in the frontal lobe.
right
left
Fig. 8.4: First evidence of significant effects of changes in brain activation during
laserneedle stimulation of vision related acupoints in the occipital and frontal areas
in a 27-year-old healthy female using fMRI investigation.
95
Signal Change Visual Cortex [a.u.]
A
3
2
1
0
-1
-2
-3
12 min
Time [min]
Fig. 8.5: The time course of signal change correlated with the experimental fMRI
paradigm. Note the signal increases during active laserneedle acupoint stimulation
(A) and the signal decreases during resting condition (R).
Brain Areas
Occipital
Left superior
occipital gyrus
Frontal
Right inferior
frontal gyrus
Right precentral
gyrus
Left middle
frontal gyrus
Left superior
frontal gyrus
Brodmann
Area
19
Coordinates in Tailarach
Cluster size
space (x,y,z)
Z-value
(mm)
-38
-84
28
5.80
32
54
34
12
5.23
64
20
-28
64
5.43
32
-20
60
20
5.59
32
-18
56
16
5.23
32
Tab. 8.1: Regions of significant activation (occipital and frontal areas) due to
laserneedle stimulation of vision related acupoints. The p-values are corrected (p <
0.05) at the cluster level for multiple comparisons. Compare Fig. 8.4.
96
8.4
Discussion
Recent scientific and technological progress especially regarding the

application of modern brain function monitoring systems has truly
revolutionized acupuncture research. The usage of advanced exploratory
tools, such as functional multidirectional transcranial ultrasound Doppler
sonography or functional magnetic resonance imaging, provides insights and
attempt to shine scientific light upon the most spectacular of the eastern
medical procedures [3,4]. Recently it has been attracted interest that the
brain is the key to acupunctures and laser punctures effects. New
experimental constructions to measure ultrasound, light and bioelectrical
processes can reproducibly demonstrate effects of stimulation of acupoints in
the brain [1,2,5-21].
The new laserneedle system has been described for the first time in scientific
literature recently [1]. In addition previous studies from our group show that
the new optical stimulation with laserneedles can elicit reproducible cerebral
effects which are in the same order with respect to the maximum amplitude
of the mean blood flow velocity as compared to needle acupuncture [1]. The
stimulation performed within this study could not be felt by the patient. The
operator was also unaware of whether the stimulation was active, and
therefore a true double-blind study was performed. Moreover laserneedle is
the first laser system commercially available that could be used at eight or
more standard acupuncture points simultaneously.
The effectiveness of unconventional complementary medical methods, such
as laserpuncture, has previously been documented mainly as single cases.
There are many theoretical and clinical studies concerning laserpuncture in
scientific literature. For a short review see [1]. To our knowledge, laseracupuncture has not been studied in cases where more than one acupoint at
time were stimulated. In our experiment, we tested four acupoints (four on
both sides of the body) with laserneedle acupuncture, and measured the
alterations of brain activations using fTDC and fMRI.
In this study, we were not able to separate significant specific cerebral
effects of blood flow velocity during laserneedle acupuncture using fTCD.
However, there was a trend of an increase in vm during laserneedle
stimulation of visual acupoints in the PCA. Similar significant effects have
been reported after manual needle acupuncture [11,13-16]. Previous results
also show that different modes of manual acupuncture stimulation
differentially modulate cerebral blood flow velocity [20].
97
In addition to fTCD we used for the first time fMRI in a healthy volunteer
during laserneedle stimulation of the same vision related acupoints as used
for the fTCD measurements. Bilateral stimulation of the acupoints produced
bilateral positive activation over the frontal cortex. A time-logged increase
of the BOLD signal was also seen at the left superior occipital gyrus
(Brodmann Area 19). Apparently the stimulation of vision-implicated
acupoints (Kunlun, UB.60 and Zhiyin, UB.67) activated the visual cortex.
These findings are in accordance with other fMRI acupuncture studies. Cho
et al. [7] reported that needling of acupoints (UB.60, 65, 66 and 67) on the
foot created activation in the visual cortex similar to actual visual stimuli.
Needling of non-acupoints on the foot 2 to 5 cm away from the vision
related acupoints as control caused no activation in the occipital lobes [7].
In traditional needle acupuncture treatment points are located at different
depths and hence needle insertion is different. This is of particular
importance with the points we selected because Zhiyin requires a very
shallow needle insertion versus Zusanli. With the laserneedle stimulation the
acupoints will receive different energy doses because of their different
depths. It is possible that the effects seen with fTCD and fMRI could be due
to stimulation of one of the points. Further investigation on this topic is
necessary.
Li et al. [6] recently also found that the application of conventional or
electro-acupuncture over four vision-implicated acupoints on the right foot
can modulate the activity of specific brain sites. Negative and positive
activations were seen using fMRI during conventional acupuncture while
positive activations, similar to our results of laserneedle stimulation, only
were observed during optical stimulation and electro-acupuncture. The
authors also found bilateral activations in frontal cortices [6].
It has been demonstrated using fMRI that needle acupuncture [7] and laser
puncture [9] of the vision-related acupoint Zhiyin (UB.67) activates the
visual cortex of the human brain. As a further study on the effect of this
acupoint stimulation on the visual cortex, Lee et al. [22] examined c-Fos
expression in binocularly deprived rat pups. Interestingly, acupuncture
stimulation of UB.67 resulted in a significant increase in the number of cFos-positive cells in the primary visual cortex, while acupuncture
stimulation of other points less important for visual function had no
significant effect on c-Fos expression in the primary cortex.
Other studies have shown effects of acupuncture needle manipulation of LI.4
(we also used this acupoint (Hegu) in our scheme as a general point of
activation) on a network of cortical and subcortical limbic and paralimbic
structures [5]. We did not find the same significant effects in our fMRI
98
experiment. In this context it is important to mention that laserneedle
acupuncture allows for the first time a totally painless acupuncture
stimulation. Therefore differences between electro acupuncture [23] and
needle acupuncture, which often includes pain stimulation, and a painless
acupuncture stimulation technique can be examined.
8.5
(a)
(b)
(c)
8.6
Conclusions
Using the new laserneedle acupuncture method we were able to
stimulate multiple vision-associated acupuncture points at the same
time. The results showed insignificant increases in cerebral blood flow
velocity of the PCA after stimulation of vision-related acupoints on the
foot. At the same time blood flow velocity in the MCA showed minor
changes. Stimulation at placebo points did not show increases in blood
flow velocity in both arteries.
The fMRI results of a healthy volunteer after laserneedle stimulation
of the same acupoints showed significant changes in occipital and
frontal brain areas.
Both techniques, fTCD and fMRI, can be used to study cerebral effects
of laserneedle acupuncture in a complementary way [24].
Acknowledgements
The authors thank Evamaria Huber (Biomedical Engineering and Research

in Anesthesia and Intensive Care Medicine, Medical University of Graz,
Austria) and Martin Kronbichler (Department of Psychology, University of
Salzburg, Austria) for their support to this study.
8.7
[1]
[2]
[3]
References
Aaslid R (1987) Visually evoked dynamic blood flow response of the
human cerebral circulation. Stroke 18(4): 771-775
99
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
Sturzenegger M, Newell DW, Aaslid R (1996) Visually evoked blood

flow response assessed by simultaneous two-channel transcranial
Doppler using flow velocity averaging. Stroke 27(12): 2256-2261
Hui KKS, Liu J, Makris N, Gollub RL, Chen AJW, Moore CI, Kennedy
DN, Rosen BR, Kwong KK (2000) Acupuncture modulates the limbic
system and subcortical gray structures of the human brain: evidence
from fMRI studies in normal subjects. Hum Brain Map 9: 13-25
Li G, Cheung RTF, Ma QY, Yang ES (2003) Visual cortical activations
on fMRI upon stimulation of the vision-implicated acupoints.
NeuroReport 14: 669-673
Cho ZH, Chung SC, Jones JP, Park JB, Park HJ, Lee HJ, Wong EK,
Min BI (1998) New findings of the correlation between acupoints and
corresponding brain cortices using functional MRI. Proc Natl Acad Sci
USA 95: 2670-2673
Cho ZH, Oleson TD, Alimi D, Niemtzow RC (2002) Acupuncture: the
search for biologic evidence with functional magnetic resonance
imaging and positron emission tomography techniques. Editorial. J
Altern Compl Med 8: 399-401
Siedentopf CM, Golaszewski SM, Mottaghy FM, Ruff CC, Felber S,
Schlager A (2002) Functional magnetic resonance imaging detects
activation of the visual association cortex during laser acupuncture of
the foot in humans. Neurosci Lett 327: 53-56
laserneedles on brain function. Proceedings of the International
Federation for Medical and Biological Engineering 2: 996-997
Litscher G (2002) Computer-based quantification of traditional
Chinese-, ear- and Korean hand acupuncture: Needle-induced
changes of regional cerebral blood flow velocity. Neurol Res 24: 377380
Lengerich Berlin Rom Riga Wien Zagreb
acupuncture. Quantification and separation of specific effects. Neurol
Res 21(6): 530-534
Litscher G, Wang L, Yang NH, Schwarz G (1999) Ultrasoundmonitored effects of acupuncture on brain and eye. Neurol Res 21(4):
373-377
Litscher G, Yang NH, Schwarz G, Wang L (1999) Computer-controlled
acupuncture. A new construction for simultaneous measurement of
blood flow velocity of the supratrochlear and middle cerebral arteries.
Biomed Techn 44(3): 58-63
transcranial Doppler sonography probes and acupuncture. Int J
Neurosci 95(1-2): 1-15
Res 20 Suppl 1: 28-32
100
[19]
[20]
[21]
[22]
[23]
[24]
Litscher G, Wang L (2000) Cerebral near infrared spectroscopy and

acupuncture - results of a pilot study. Biomed Techn 45(7-8): 215-218
Bcker M, Hammes MG, Valet M, Deppe M, Conrad B, Tlle TR,
Dobos G (2002) Different modes of manual acupuncture stimulation
differentially modulate cerebral blood flow velocity, arterial blood
pressure and heart rate in human subjects. Neurosci Lett 333: 203206
Litscher G (2003) Cerebral and peripheral effects of laserneedlestimulation. Neurol Res 25: 722-728
Lee H, Park HJ, Kim SA, Lee HJ, Kim MJ, Kim CJ, Chung JH, Lee H
(2002) Acupuncture stimulation of the vision-related acupoint (Bl-67)
increases c-Fos expression in the visual cortex of binocularly deprived
rat pups. Am J Chin Med 30: 379-385
Napadow V, Makris N, Liu J, Kettner NW, Kwong KK, Hui KKS (2005)
Effects of electroacupuncture versus manual acupuncture on the
human brain as measured by fMRI. Hum Brain Mapp 24: 193-205
Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F,
Ebner F (2004) Acupuncture using laser needles modulates brain
function: first evidence from functional transcranial Doppler
sonography and functional magnetic resonance imaging. Las Med Sci
19: 6-11
101
9.
Quantification of gender specific thermal

sensory and pain thresholds before and after
laserneedle stimulation
G. Litscher, L. Wang, E. Huber, D. Schikora,
G. Schwarz
9.1
Introduction
The quantitative determination of border values for thermal sensory and pain
threshold testing has been clinically used for several years and is of great
importance in the fields of neurology, psychiatry, and neurophysiology [6].
Several guidelines regarding the correct application of Quantitative sensory
testing (QST) were published in scientific literature [4].
QST-systems can generally be divided into instruments, which allow the
application of physical-thermal, chemical or vibration specific stimuli. In
addition, the general equipment required for generating electric stimulation
with different frequencies and intensities can be included here. Thermal
stimulation in this study was performed with a thermode (Peltiers Principle)
applied at the right palmer base of the thumb, in healthy adult volunteers.
Goal of this study was to determine normal values and objectify possible
gender specific differences. For the first time, QST was used, in combination
with scientific tests using the new laserneedle stimulation technique, to
quantify possible alterations before and after painless acupuncture with
laserneedles.
9.2
9.2.1
Method
Volunteers
Twenty-nine healthy adult volunteers, mean age (Cx r SD) was 24.2 r 2.7
(range from 18 to 29 years) were included in the study. Twenty volunteers
were female (mean age: 23.9 r 2.7 years) and 9 were male (mean age: 24.9 r
2.8 years). The ethical committee of the Medical University of Graz
(laserneedle stimulation; 13-048 ex 02/03) approved the tests and all
102
volunteers gave their written consent. None of the volunteers had
neurological or psychological deficits or was under the influence of drugs.
9.2.2
Measurement of thermal sensitivity and thermal pain

thresholds
A computer-controlled system was used for quantitative evaluation of small

calibre nerve fibres (A-Delta and C-nerve fibres) using temperature tests
(Thermal Sensory Analyser TSA-II, Medoc Advanced Medical Systems,
Ramat Yishai, Israel, and Minneapolis, Minnesota, USA). The system
consists of a basic unit with connection to an external notebook, a thermode
with an active contact area of 30 x 30 mm (Peltier element) and a control
device for input of patient reaction data. The thermode was placed on the
inner side of the volunteers hand and can either cool or warm the skin.
Adaptation temperature between 30 and 32 C is achievable within a few
seconds after skin contact, thus, the volunteer is unable to feel cold or hot
sensations. The software runs with Windows, controls the system, and
includes the different test methods. All parameters can be set individually. In
addition to thermal sensory measurement, pain thresholds (cold pain, heat
pain: 0 - 52 C) were examined (Fig. 9.1). Cold sensation (a) and warm
sensation (b) thresholds were determined first. Then, cold pain (c) and heat
pain (d) thresholds were determined (compare Fig. 9.4). A resting period of
at least 5 minutes was held between the single measurements.
103
2
1
3
Fig. 9.1: Set-up in the lab of the Dept. of Biomedical Research in Anaesthesia and
Intensive Medicine, Medical University Graz. Thermal Sensory Analyser TSA-II (1)
with Notebook-Data analysis (2) and laserneedle stimulation device (3). With
generous consent from the volunteer.
9.2.3
Laserneedle acupuncture and procedure
Laserneedles are special light conductors which are placed vertically at the
skin, and trigger painless stimulation at the acupoint. They offer high optical
output densities regarding measurable cerebral effects compared with
acupuncture needles [9 ,10], and for the first time, allow simultaneous
optical activation of up to eight acupoints according to Traditional Chinese
Medicine (TCM).
The laserneedles used emit light with a wavelength of 685 nm in a
continuous or frequency modulated wave mode. The output per laserneedle
is 30 - 40 mW. Further information regarding the method and the periphery
and cerebral effects of laserneedle acupuncture can be found in previous
publications [8-10].
Acupuncture was performed at the acupoints shown in Figure 9.2. First, the
skin was disinfected with alcohol at the acupoint, and then the laserneedles
are applied and fixed to the skin with special adhesive tape. During testing,
the volunteers were positioned relaxed on a bed (compare Fig. 9.1). In two
104
different tests, the laserneedles were once applied and activated for 10
minutes, or remained deactivated in an identical procedure (placebo). Which
test procedure was performed first was selected at random. Each volunteer
was tested with activated as well as deactivated laserneedles, whereby the
volunteers were not informed about and could not perceive the respective
mode being used. The resting period between both tests was at least 20
minutes.
Following acupoints were used [16]:
Hegu (LI.4):
Localisation:
Indication:
Needling:
At the highest point of M. adductor pollicis, when the thumb

lies against the index finger.
Hegu is the most important analgesic point. Pain conditions;
particularly strong manual stimulation relieves pain in the
entire body.
Vertical, 1 - 2 cm deep in direction Pe.8 Laogong.
Taiyuan (Lu.9):
Localisation: On the radial side of the bending fold at the wrist joint,
lateral from A. radialis.
Indication:
Pain in the wrist region, polyneuropathy at the upper
extremity.
Needling:
Vertical or inclined, 0.3 - 1 cm deep.
Quchi (LI.11):
Localisation: At the lateral end of the bending fold of the elbow during
right-angled bending of the lower arm.
Indication:
Homeostatic and immuno-stimulating point.
Needling:
Vertical, 2 - 3 cm deep.
Shenmen (Ear point 55):
Localisation: In the fossa triangularis.
Indication:
General sedative and analgesic point.
Ear point 67:
Localisation:
Indication:
Between helix and anthelix in the so-called scapha.

Pain, hand, wrist.
105
1
2
4
5
2
1
Fig. 9.2: Laserneedle stimulation at the acupoints Hegu (1), Taiyuan (2), Quchi (3),
Shenmen Ear point 55 (4) and Ear point 67 (5).
9.2.4
A t-testfor the conditions before (I) and after (II) laserneedle stimulation
and a paired t-test for the placebo test, were used to determine gender
specific differences. Significance was defined with p < 0.05. The results are
shown graphically with box-plot illustrations (Statistical program SigmaStat;
Jandel Scientific Corp., Erkrath, Germany).
9.3
Results
Figure 9.3 shows a sample test report. In addition to a marker at the

derivation, or stimulation region (C6 right hand palmar thumb), the
measurement results (mean value of 3 tests) and differences () before and
after intervention (laserneedle stimulation or placebo test) of the respective
testing mode are shown graphically in this protocol.
106
Fig. 9.3: Quantitative Somatosensory Test Report from an 18-year-old volunteer.

Above: laserneedle stimulation; below: placebo test.
Figure 9.4 summarizes the results from all 29 volunteers, without

considering gender. No significant differences between the single tests
before and after laserneedle stimulation or placebo stimulation were evident.
107
Temp.
[C]
60
I
placebo
I
II
II
50
I
I
40
I
II
II
II
I
I
30
II
II
II
20
10
n=29
0
10 11 12 13 14 15 16 17 18
Fig. 9.4: Box-plot illustration of n = 29 healthy volunteers. Cold sensation- (a) and
warm sensation thresholds (b) and cold pain- (c) and heat pain thresholds (d) before
(I) and after (II) laserneedle stimulation (left) and placebo (right). The horizontal
line in the box indicates the position of the median. The ends of the box define the
25th and 75th percentile; the error bars mark the 10th and 90th percentiles.
Separation of the results according to gender is illustrated in Figure 9.5.

Significant (p < 0.034) gender specific differences are seen in cold pain and
heat pain thresholds. The border values of painful cold sensation also differs
significantly between males and females (p < 0.001) as those of painful heat
sensation (p = 0.009 and p = 0.034 respectively). During placebo
stimulation, no obvious differences in median values are evident. However,
it should be mentioned that the median tolerance of cold pain sensation after
laserneedle acupuncture in females, although insignificant (p = 0.479), lies
higher than before laserneedle treatment (* in Fig. 9.5A).
108
Temp.
[C]60
I
50
I
40
I
placebo
I
II
II
II
30
II
II
II
II
II
women
*)
20
10
p = 0,034
p < 0,001
p = 0,009
p < 0,001
t-test
p = 0,026
n=20
Temp.
[C]
I
II
I
I
I
II
II
II
II
II
II
I
II
men
n=9
a
Fig. 9.5: Gender specific analysis (female (A), male (B)). In addition to the
significant gender specific differences in pain sensation, note the difference (*) in
median values during cold pain threshold determination before (I) and after (II)
laserneedle stimulation. Further information see Fig. 9.4.
109
9.4
Discussion
There are numerous publications concerning QST reproducibility [20], the

different biological effects on thermal sensor, vibration specific and pain
thresholds and the gender specific differences and influence of age and body
size [19]. Clinical indications for QST described in this study are the
determination of sensory and pain thresholds in chronic pain disorders [17],
diabetic neuropathy [3] and use in patients with multiple sclerosis [7,18].
The method for quantitative determination of different thermal thresholds
used in this study has also been used in different publications in combination
with other measurement techniques. For example, the comparison and
correlation of somatosensory evoked potentials [14] and the supplementary
or combined use with functional magnetic resonance imaging [2,5] should be
mentioned.
In this study, we could document significant gender specific differences in
temperature sensation. A difference in gender specific thermal sensory
thresholds could be proven in numerous studies [20]. In addition to these
results, QST shows that cold sensations change during the female menstrual
cycle dependent upon the oestrogen secretion [1].
An interesting aspect of this study design is that acupuncture subjectively
relieves pain in females better than in males. This is one of the first,
unpublished intermediate results of the worldwide largest controlled
acupuncture study being currently performed in Germany. In a
representative random sample, 1096 patients treated with acupuncture
against lumbar or knee pain were questioned. Two thirds of the women, but
only half of the men were satisfied with the effect of needle therapy. Sixtyone percent of the questioned persons evaluated the effect as very good or
good. In contrast, 92 percent of the treating physicians were certain that this
treatment was a success. Even when nine of ten patients were not satisfied
with the treatment, the respective physician supposed treatment was
successful. This documents the physicians subjectivity towards the patients
pain sensitivity and indicates the necessity of qualitative evaluation of
acupuncture to objectify the potential therapy effect individually.
The effects of acupuncture and laserneedle acupuncture on parameters of
peripheral circulation could be scientifically proven in several studies [1113]. In many cases, moxibustion (burning of the flowering plant mugwort)
intensifies the effect [15]. Measurement data determined in our study, before
and after laserneedle acupuncture and placebo laserneedle acupuncture,
showed no significant differences when using an acupoint scheme for acute
pain. However, cold pain sensation could be reduced in women with
laserneedle acupuncture. To what extent acupuncture schemes for treating
110
chronic pain with laserneedle acupuncture can lead to provable effects in the
described measurement parameters should be investigated in further studies.
9.5
Acknowledgements
The authors thank Mr. Michael Magometschnigg and Mr. Ing. Stefan Wger
(both from INTEC Medizintechnik GmbH, Vienna, Austria) for their
organisational and technical support with Thermal Sensory Analyser TSA-II.
We also thank Ms. Ingrid Gaischek MSc. (Biomedical Engineering and
Research in Anaesthesia and Intensive Care Medicine, Medical University
Graz) for her valuable support in data analysis and writing the manuscript.
9.6
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
References
Bajaj P, Arendt-Nielsen L, Bajaj P, Madsen H (2001) Sensory
changes during the ovulatory phase of the menstrual cycle in healthy
women. Eur J Pain 5: 135-144
Becerra LR, Breiter HC, Stojanovic M, Fishman S, Edwards A, Comite
AR, Gonzalez RG, Borsook D (1999) Human brain activation under
controlled thermal stimulation and habituation to noxious heat: an
fMRI study. Magn Reson Med 41: 1044-1057
Bravenboer B, van Dam PS, Hop J, Steenhoven Jvd, Erkelens DW
(1992) Thermal threshold testing for the assessment of small fibre
dysfunction: normal values and reproducibility. Diabet Med 9: 546-549
Consensus report (1993) Quantitative sensory testing: a consensus
report from the Peripheral Neuropathy Association. Neurology 43:
1050-1052
Davis KD, Kwan CL, Crawley AP, Mikulis DJ (1998) Functional MRI
study of thalamic and cortical activations evoked by cutaneous heat,
cold, and tactile stimuli. J Neurophysiol 80: 1533-1546
Fruhstorfer H, Lindblom U, Schmidt WC (1976) Method for
quantitative estimation of thermal thresholds in patients. J Neurol
Neurosurg Psychiatry 39: 1071-1075
Heijenbrok MW, Anema JR, Faes TJ, Bertelsmann FW, Heimans JJ,
Polman CH (1992) Quantitative measurement of vibratory sense and
temperature sense in patients with multiple sclerosis. Electromyogr
Clin Neurophysiol 32: 385-388
Litscher G (2003) Cerebral and peripheral effects of laser needlestimulation. Neurol Res 25: 722-728
111
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]

perfusion in the fingertip following acupuncture needle introduction as
evaluated by laser Doppler perfusion imaging. Lasers Med Sci 17: 1925
Litscher G, Wang L, Huber E, Nilsson G (2001) Laser Doppler Imaging
Objektivierung und Quantifizierung primrer peripherer Mikrozirkulationsnderungen durch Akupunktur. Europische Zeitschrift fr
Akupunktur, Der Akupunkturarzt / Aurikulotherapeut 3: 7-17
Litscher G, Wang L, Nilsson G (2001) Laser Doppler Imaging und
Kryoglobulinmie. Biomed Technik 46: 154-157
Meh D, Denislic M (2000) Correlation between temperature and
vibration thresholds and somatosensory evoked potentials.
Electromyogr Clin Neurophysiol 40: 131-134
and moxibustion: a pilot study in healthy adults. Lasers Med Sci 16:
184-191
Stux G, Stiller N, Pomeranz B (1999) Akupunktur. Lehrbuch und Atlas.
Springer, Berlin Heidelberg New York
Thimineur M, Sood P, Kravitz E, Gudin J, Kitaj M (1998) Central
nervous system abnormalities in complex regional pain syndrome
(CRPS): clinical and quantitative evidence of medullary dysfunction.
Clin J Pain 14: 256-257
Treede RD, Hansen C, Hopf HC (1995) Paradoxical warm-sensation
is a common symptom in patients with multiple sclerosis.
Electroencephalogr Clin Neurophysiol 97: 125
Wiles PG, Pearce SM, Rice PF, Mitchell JM (1991) Vibration
perception threshold: Influence of age, height, sex, and smoking, and
calculation of accurate centile values. Diabet Med 8: 157-161
Yarnitsky D, Sprecher E, Zaslansky R, Hemli JA (1995) Heat pain
thresholds: normative data and repeatability. Pain 60: 329-332
Litscher G, Wang L, Huber E, Schikora D, Schwarz G (2004)
Quantitative Bestimmung geschlechtsspezifischer thermischer
Empfindungsund
Schmerzschwellen
vor
und
nach
Lasernadelstimulation. Biomed Technik 49: 106-110
112
10. Biological effects of painless laserneedle

acupuncture - a short summary of important
scientific results
G. Litscher, L. Wang, D. Schikora, D. Rachbauer,
G. Schwarz, A. Schpfer, S. Ropele, E. Huber
10.1 Introduction
The stimulation of acupuncture points with laser light can evoke specific
effects in the periphery and in the brain. For the first time, these effects, can
be objectified and quantified using modern biomedical engineering
techniques. Laserneedle acupuncture represents a new, painless method for
primary optical stimulation of acupuncture points [1-15]. Laserneedles, are
not inserted in the skin, however, simply applied to the acupuncture point.
This method allows the simultaneous stimulation of individually combined
points for the first time.
This study gives a current summary regarding scientific proof and innovative
aspects of painless laserneedle acupuncture. We introduce studies which
prove the peripheral effects using registration of temperature and laser
Doppler flowmetry [8,9,13], as well as publications regarding the
objectification of cerebral effects of laserneedle acupuncture aided by
functional multi-directional transcranial Doppler sonography (fTCD) [13,8,9,11,12], functional magnetic resonance imaging (fMRI) [11,12] and
near infrared spectroscopy (NIRS) [2,4-6,8,9].
10.2 Methods
10.2.1
Temperature and microcirculatory monitoring
The surface temperature of the skin and the measurement parameter Flux (=
product of concentration and velocity of erythrocytes) were performed with
the Laser-Doppler-Flowmetry Monitor DRT 4 (Moor Instruments, Millway,
Axminster, England). A DPIT-probe (diameter 8 mm, length 7 mm) with a
power of 1 mW was used (compare Fig. 10.1, above). The edge frequencies
were 20 Hz and 22.5 kHz [8,9,13].
113
10.2.2
Functional
multi-directional
sonography (fTCD)
transcranial
Doppler-
The Multi-Dop T System (DWL Electronic Systems GmbH, Sipplingen,

Germany), was used to measure the mean blood flow velocity in different
cerebral arteries. A 4-MHz- (ophthalmic artery (OA)), as well as 2-MHz
probes (posterior cerebral artery (PCA), anterior cerebral artery (ACA),
middle cerebral artery (MCA)) were applied with a specially developed
ultrasound probe holding construction (compare Fig. 10.2, right below).
10.2.3
Functional magnetic resonance imaging (fMRI)
The fMRI-investigations were performed using a 1.5 Tesla total body system
(Intera, Philips Medical Systems, Best, Netherlands) (compare Fig. 10.4,
above). The BOLD (blood oxygen level dependent) contrast sensitive
images were acquired with a T2* weighted gradient echo sequence (single
shot planar readout, flip angle 90, TE 50 ms, FOV 250 mm, matrix 96 x 96
interpolated at 128 x 128, layer number 30, layer thickness 4 mm). A total of
144 volume images, were registered continuously in succession, with a
repetition time of 5 seconds.
The fMRI-study is based on a block design with alternating resting
conditions (R) for one minute and one minute of laserneedle activation
(A). This experiment starts with R, followed by the laserneedle
condition A. A total of six R and six A intervals were registered. Each
fMRI data registration required 12 minutes [11, 12].
10.2.4
Near infrared spectroscopy (NIRS)
Near infrared spectroscopic investigations for monitoring laserneedle

acupuncture, were done with the NIRO 300 Monitor (Hamamatsu Photonics,
Japan). Measurement values, and such as changes in oxyhaemoglobin
(O2Hb) and desoxyhaemoglobin (HHb) were determined using LambertBeers principle. Alterations in parameters could be measured absolutely
(molar) with this system, but not the level (absolute concentration) at which
these changes (in a positive or negative direction) occur. As long as no
change in concentration is given, the measurement value is zero. Using a
silicone holder, the fixating of the sensor (emitter and near infrared
detectors) on the head is easy.
10.2.5
As mentioned earlier, laserneedle acupuncture (Schikora, D.: European

Patent Nr. PCT/EP 01/08504) allows the simultaneous stimulation of
114
individual point combinations. Variation and combination of acupuncture
points on the body are possible according to Traditional Chinese Medicine
(TCM), or at the ear and hand using Korean (KHA) or Chinese (CHA) hand
acupuncture. The laserneedle method is based on a multi-channel system
with 8 separate semi-conductor laser diodes and emission wavelengths of
685 nm and 785 nm. The system consists of flexible optical light fibres,
which conduct the laser light without loss to the laserneedle. Thus, a high
optical density at the distal end of the laserneedle is achievable. The intensity
of the laserneedles are optimized in such a way, so that the patient does not
feel the activation of the needle (30 - 40 mW per needle; diameter 500 m;
duration 10 min; power density 2.3 kJ/cm per acupuncture point). More
details regarding this method are described in previous studies [1,6].
10.2.6
Healthy volunteers, animal experiment and procedures
This summarizing study presents a total of 511 measurements in 231 healthy

test persons (129 females, 102 males) with a mean age of 25.2 r 3.5 (Cx r
SD) years (18 to 38 years). Protocols were approved by the local ethic
committee, Medical University of Graz (11-017 ex 00/01: Computercontrolled acupuncture; and 13-048 ex 02/03: Laserneedle-stimulation), and
all test persons gave their written consent. None of the test persons had
obvious visual, neurological, olfactory, or mental deficits or stood under
influence of CNS active drugs. A maximum of seven acupuncture points
were investigated simultaneously in different measurement series.
In addition, an animal study was included in this report. The animal used
was a sus scrofa domesticus, which was put under general anaesthesia in the
animal surgical suite of the Department of Surgical Research at the Medical
University of Graz (compare Fig. 10.1, left). This study was performed in
accordance with the rules defined by the ethic committee (animal study
approval number GZ 66.010/10-BRGT/2003).
10.2.7
Data was analysed with One-way repeated measure ANOVA , using the
computer program SigmaStat (Jandel Scientific Corp., Erkrath, Germany).
The tests described in single publications were used for post hoc-analyses.
The level of significance was defined as p < 0.05 when no other value was
explicitly given.
The fMRI-data was analysed and evaluated with SPM 99 (Statistical
parametric mapping) - Software (SPM 99, Department of Imaging
Neuroscience, London, England). All images of the test persons were newly
115
organized and the first picture was used as reference, whereby sincinterpolation was used.
Functional data were spatially smoothed with a 6 mm full width at half
maximum isotropic kernel. A boxcar waveform convolved with a synthetic
haemodynamic response function was used as the reference waveform. A ttest was performed to identify regions showing significantly higher
activation during the activation condition versus the resting condition. For
significantly activated regions, a statistical threshold p < 0,05, corrected at
the cluster level for multiple comparisons, was used. The activated regions
were located with help of the Tailairach-space.
10.2.8
Evaluation parameters
Temperature (surface skin temperature and room temperature), Flux,

partially simultaneous and continuous measurement of mean blood flow
velocity (vm) in the OA, MCA, PCA and ACA at different measurement
times (a - e) were determined. A number of test persons underwent testing
using different acupuncture schemes. The interval between the single
experiments was 30 minutes to one day, and the test persons were instructed
to keep their eyes closed during the entire active examination phase. In a
similar manner to fMRI-examination, the test persons were unable to
determine whether the laserneedles had been activated or deactivated.
10.3 Results
Figure 10.1 shows in summary the results of an animal study [13] and a nontherapeutic biomedical engineering study with test persons [8,9] regarding
the periphery effects of laserneedle acupuncture. The Flux, hand and room
temperature parameters were summarized at different measurement points.
The significant (p = 0.005) increase of Flux in the test persons during 20
minutes of laserneedle stimulation (b - d) must be considered. The results of
the animal study show that laserneedle stimulation (wavelength: 685 nm;
power density: 4.6 kJ/cm per point; duration 20 min) can cause alterations
in microcirculatory parameters of the skin, in the sense of increased
circulation, however, the laser quality and intensity did not induce any
micro-morphological changes in the skin [13].
116
Scientific studies - laserneedle acupuncture
Peripheral effects: temperature and laser Doppler flowmetry
Animal experiment
(sus scrofa domesticus)
Healthy volunteers:
mean age + SD: 24.4 + 2.6 yrs;
12 f, 10 m
n=1
n = 22
p = 0.005
p = 0.02
45
34
Temp.
32
(C)
40
Temp.
(C) 35
Flux
(a.u.)
30
Temp.
R.-Temp.
Flux
30
Flux 28
(a.u.)
Temp.
R.-Temp.
Flux
26
24
25
22
20
n=1
20 min
modified from: Biomed. Technik, 2004, 49: 2-5 [13]
20
n = 22
20 min
modified from: Neurol. Res., 2003, 25: 722-728 [9]
Fig. 10.1: Animal (left side) and human experimental (right side) studies using
laserneedle stimulation. Flux (product of concentration and velocity of
erythrocytes), surface skin temperature (Temp.) and room temperature (R.-Temp)
before (a), during (b d) and after (e) laserneedle activation.
Figures 10.2 and 10.3 document specific changes in cerebral blood flow
velocities in different arteries. Using the laser acupuncture scheme (TCM:
Zanzhu and Yuyao; ear: eye and liver; KHA: E2; CHA: Yan Dian) the blood
flow velocity in the OA using a wavelength of 685 nm increases
significantly (p = 0.01). However, a 30 % increase in stimulation intensity
only increases vm in the OA to a mean value of 11 %. Simultaneously, no
significant changes in vm occurred in the MCA. Using laserneedle
acupuncture with a wavelength of 785 nm, a marked, but insignificant (p =
0.546) increase in vm in the OA during stimulus application occurred. Brief
stimulation (20 sec each) of the single points with a hand-held low level
laser (19 mW), did not reveal any significant (p = 0.939) differences in vm in
the OA, concerning the conditions before and after stimulation.
117
Cerebral effects: fTCD / OA - MCA
Volunteers: n = 27; mean age + SD:
25.2 + 4.1 yrs, 21 - 38 yrs
14 f, 13 m

24.5 + 3.8 yrs, 18 - 34 yrs
14 f, 11 m
intensity +30 %

20
15
15
SE
10
p<0.01*
p=0.939
15
SE
p=0.01*
60
20
p=0.546
15
10
20
685 nm
vm (cm/s)
Low Level Laser
785 nm
685 nm
685 nm
20

24.8 + 3.3 yrs, 18 - 35 yrs
9 f, 9 m
10
b
a
SE
SE
10
60
50
40
Fig. 10.2: Specific changes in mean blood flow velocity (vm) under laserneedle
acupuncture (from left to right: 685 nm, 685 nm with increased intensity (+ 30 %),
785 nm and 685 nm (19 mW)). Mean values and standard error (SE) before (a),
during (b) and after (c) stimulation are shown.
Figure 10.3 shows the changes in vm in the ACA and PCA when applying
different laser puncture schemes (A, B). When using laser puncture scheme
A, vm increased during stimulation (b - d) significantly in the ACA
(p < 0.001) and is still higher at the end of the experiment (e) than before
laser puncture (a). At the same time, insignificant changes in vm occurred in
the PCA. During optical stimulation of the acupuncture points in scheme B,
a significant increase (p < 0.002) in vm in the PCA took place although
simultaneously insignificant changes in the ACA were observed.
118
Volunteers n=22
12 female, 10 male, 21 - 29 years ( 24.4 + 2.6 years; x + SD )
R
Laser puncture scheme A
Laser puncture scheme B

vm (cm/s)

vm (cm/s)
50
52
49
51
*)
48
50
47
49
46
48
45
47
a
n.s.
*) p < 0.001

45

vm (cm/s)
vm (cm/s)
47
46
44
45
43
*)
44
42
n.s.
41
43
42
40
a
*) p < 0.002
Fig. 10.3: Laserneedle acupuncture study in a double-blinded randomised, crossover design. Changes in blood flow vm before (a), during (b - d) and after (e)
activation of laserneedles according to the specific laser puncture scheme (A or B).
119
The first fMRI-results using laserneedle acupuncture are summarized in
Figure 10.4. Significant (p < 0.05) changes in brain activity were registered
in the occipital and frontal regions during stimulation of distant, visual
acupuncture points and near the olfactory cortex during the activation of
acupuncture points, which according to Traditional Chinese Medicine, have
a connection to the sense of smell. Further, significant (p < 0.001) activation
after stimulating the Yintang point in the fronto-parieto-temporal region,
with massive EEG-alterations (appearance of frontal Delta-activity) occurred
[10].
Cerebral effects: fMRI
Vision related acupoints
H.B., 27 y, f
modified from:
Las. Med. Sci., 2004; 19: 6-11 [11]
Olfactory system related acupoints
L.A., 28 y, f
modified from:
Schmerz & Akupunktur, 2004; 1: 4-11 [12]
Yintang
E.S., 28 y, f
E.M., 29 y, m
p < 0.001 (correction for multiple comparisons)
Fig. 10.4: Functional magnetic resonance images illustrating activated cerebral

regions after laserneedle stimulation. Specific cerebral activation patterns are shown
according to the selected acupuncture schemes.
Figure 10.5 shows, in summary, frontal and non-invasively registered

changes in O2Hb during and after needle or laserneedle acupuncture (same
scheme as in Fig. 10.2). Whereas nearly no changes during acupuncture of
placebo points take place, increases during laserneedle acupuncture are
obvious.
120
Cerebral effects: NIRS
Fig. 10.5: Cerebral changes in near infrared spectroscopy in mol of

oxyhaemoglobin (O2Hb) during needling of a placebo point, 3 hand acupuncture
points, 2 ear acupuncture points, 2 body acupuncture points according to TCM, a
combination of hand, ear and body acupuncture points, as well as laserneedle
stimulation, and increased (+ 30 %) laserneedle stimulation (from left to right),
during and 5 minutes after acupuncture. Modified according to [6].
Figure 10.6 at the left, shows the hypothetically assumed course of stimulus
intensity, in random units of a metal and laserneedle as a function of time. At
the middle and at the right, real time signals registered with NIRS and
bioelectric methods (EEG - BIS) are illustrated.
121
metal
needle
hypothesis
NIRS-response
EEG-BIS-response
O2Hb
100
metal needle
90
HHb
10 min
10 min
laserneedle
time [min]
O2Hb
laserneedle
100
90
HHb
time [min]
10 min
10 min
B.J., 22y, f
modified from:
Spectroscopy 2002; 16: 335-342 [6]
modified from:
Spectroscopy 2002; 16: 335-342 [6]
H.E., 25y, f
modified from:
Europ. J. Anaesthesiol. 2004; 21: 13-19 [10]
Fig. 10.6: Stimulus intensity (SI) as a function of time. From left to right:
hypothesis, real measured cerebral reactions of near infrared spectroscopy
measurement parameters O2Hb (Oxyhaemoglobin) and HHb (Desoxyhaemoglobin),
as well as the bioelectric response (BIS = Bispectral index). Modified according to
[4,6,10].
10.4 Discussion
The term laser is very fascinating for many people today. Innovation and
laser are nearly synonymous. Albert Einstein, already formulated the
physical foundation for so-called light intensification with stimulated
emission, in 1917. In the field of medicine, laser not only allows careful
treatment for patients, but also a manifold of selective therapies in nearly all
special fields. Laser has developed to be an important instrument in
acupuncture when considering the treatment of small children, or patients
with a phobia against needles.
One goal of this study is to give a summary about previous clinical
experimental studies dealing with this new method of optical acupuncture
stimulation. Since the test person or patient does not feel the intervention,
furthermore, the different acupuncture points can be stimulated continuously
and simultaneously, it was possible to perform these double-blind
randomised, controlled, cross-over studies for the first time. The studies
indicate that cerebral effects of this manner of stimulation are nearly
equivalent to that in needles. In addition to complex multi-directional
sonography, it was also possible to provide proof regarding cerebral
functional changes after laserneedle stimulation using functional magnetic
122
resonance imaging for the first time. At the same time, points near the
head could be stimulated during fMRI examination, which was not possible
thus far with acupuncture needles and hand-held laser instruments.
The new scientific results may be of great importance, not only for the field
of laser medicine, but also for acupuncture research in general.
10.5 Conclusion
For the first time, laserneedle acupuncture allows simultaneous optical
stimulation of individual puncture point combinations. Variations in
acupuncture on the body, ear or hand, as performed and described in these
studies are also possible. The studies were able to objectify and specify the
cerebral effects of laserneedle stimulation for the first time. The cerebral
effects triggered by this new, painless laserneedle technique are of similar
dimension to those evoked by manual needle acupuncture.
Painless laserneedle acupuncture can induce specific, reproducible changes
in the brain. These can be expressed by shifts in different parameters, such as
cerebral blood flow velocity [15].
10.6 Acknowledgements
The authors would like to thank Ingrid Gaischek MSc (Biomedical
Engineering and Research in Anaesthesia and Intensive Care Medicine,
Medical University of Graz) for her valuable support in this study.
10.7 References
[1]
[2]
[3]
Litscher G, Schikora D (2002) Cerebral effects of noninvasive

Litscher G, Schikora D (2002) Neue Konzepte in der experimentellen
Akupunkturforschung - Computerkontrollierte Laserpunktur (CCL) mit
der Laserneedle Technik. Der Akupunkturarzt / Aurikulotherapeut 28:
18-28
laserneedles on brain function. In: Hutten H, Krsl K, editors. EMBEC
2002. Proceedings of the 2nd European Medical & Biological
Engineering Conference; 2002 Dec 4-8; Vienna, Austria. Graz; Verlag
der Technischen Universitt Graz, 996-997
123
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
[13]
[14]
[15]
Litscher G, Schikora D (2002) Nahinfrarot-spektroskopische

Untersuchungen zur Nadel und Laserakupunktur. AKU 30: 140-146
Internet J Neuromonitoring 3(2). URL:
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijnm/vol3n
1/nirs.xml
Litscher G (2003) Lasernadelakupunktur - Eine neue nicht-invasive
optische Akupunkturstimulationsmethode. Dt. Ztschr. f. Akupunktur 1:
News
Litscher G (2003) Laserneedle-Akupunktur auf dem Prfstand der
Wissenschaft. Schweizerische Z f Ganzheitsmedizin 15: 253-259
Litscher G (2004) Effects of acupressure, manual acupuncture and
Laserneedle acupuncture on EEG bispectral index (BIS) and spectral
edge frequency (SEF) in healthy volunteers. Europ J Anaesthesiol 21:
13-19
Ebner F (2004) Acupuncture using laserneedles modulates brain
function: First evidence from functional transcranial Doppler
sonography (fTCD) and functional magnetic resonance imaging
(fMRI). Lasers Med Sci 19: 6-11
Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D (2004) Die
schmerzfreie Lasernadelakupunktur moduliert die Gehirnaktivitt:
Erste Nachweise mit funktioneller transkranieller Dopplersonographie
(fTCD) und funktionellem Magnetresonanzimaging (fMRI). Schmerz &
Akupunktur 1: 4-11
Einflssen
von
Ergebnisse
einer
tierexperimentellen Untersuchung. Biomed Technik 49: 2-5
Litscher G, Schikora D (2004) Lasernadel-Akupunktur. Wissenschaft
und Praxis. Pabst Science Publishers, Lengerich Berlin Riga Rom
Viernheim Wien Zagreb
Litscher G, Wang L, Schikora D, Rachbauer D, Schwarz G, Schpfer
A, Ropele S, Huber E (2004) Biological effects of painless laserneedle
acupuncture. Medical Acupuncture 16(1): 24-29
124
11. Increases in intracranial pressure and

changes in blood flow velocity due to
acupressure, needle and laserneedle
acupuncture?
G. Litscher, L. Wang, G. Schwarz, D. Schikora
11.1 Introduction
Acupressure of points St.7 and SJ.22 can lead to significant, reversible ICPincreases in intensive care patients with a priori elevated intracranial
pressure (ICP) [1]. Our study group already documented this in 1988. These
increases in intracranial pressure due to acupressure can reach a threatening
extent in isolated cases.
Goal of this study was to evaluate whether stimulation of the acupoints
mentioned above using different stimulation techniques, also leads to
changes in cerebral parameters combined with alterations in ICP, in healthy
volunteers.
11.2 Material and methods

11.2.1
Volunteers, patient, acupressure and procedure
We investigated a total of 34 healthy volunteers (24 females, 10 males) and a

15-year-old intensive care patient after severe head injury. The mean age of
the volunteers (Cx r SD) was 25.2 r 3.4 years (range: 20 - 35 years). The test
persons were informed about the study procedure and gave their written
consent. A ten minute resting period on a bed prior to investigation was
observed. During this time, the measurement device was applied. The study
was approved by the local Ethical Committee at the Medical University in
Graz.
The following acupoints [2,3] were tested on each person, during three
partial unilateral (right) measurements (Fig. 11.1):
125
St.7 (Xia Guan)
Localisation: In front of the articular process of the mandible, below the
zygomatic arch, in a depression, it can be located when the
mouth is closed.
Needling:
Vertical, 5 fen - 1 cun.
SJ.22 (He Liao)
Localisation: Ventral and cranial from SJ.23, at the beginning of the
auricle, at the back edge of the temporal hairline (behind the
pulse point of the temporal superficial artery).
Needling:
Slanted, 2 - 3 fen.
St.7
SJ.22
Fig. 11.1: Laserneedle stimulation in a volunteer during simultaneous monitoring of

blood flow velocity in the right and left middle cerebral artery and frontal near
infrared spectroscopy parameters (acupuncture scheme according [3]).
We used acupressure, manual needle acupuncture and laserneedle

acupuncture for stimulation in all of our test persons.
In order to guarantee reliability and reproducibility of acupressure and
acupuncture, the stimulation in all of our volunteers, was performed by the
same Chinese expert for Traditional Chinese Medicine (TCM). The thumb
pressure applied to the acupoints was ~ 3 x 10.5 Pa (force ~ 30 N)
determined by force and area, whereby both points were stimulated
intermittently during a total time of 5 minutes.
126
Manual needle acupuncture was performed with sterile one-use needles 30 x
30 mm (Huan Qiu; Suzhou; China). Needle stimulation was done in 2
minute intervals for 20 s and included a combination of rotating, pressing
and thrusting motions. After a total of 5 minutes, the needles were removed.
Laserneedle stimulation is based on a multi-channel system with 8 separate
semi-conductor laser diodes and emissive wavelengths from 685 to 785 nm.
The system consists of flexible optic fibres, which conduct laser light to the
laserneedle without loss. Thereby, a high optical density at the distal
laserneedle end is achieved. The intensity of the laserneedles is optimized in
such a way, that the volunteer does not feel the activation of the needle (30 40 mW per needle; diameter 500 m; time 5 min; energy density 1.2 kJ/cm
per acupoint). For more details regarding this method, see the previous
studies [4-8].
The measurement procedure scheme is illustrated in Figure 11.2 and applies
to all stimulation techniques. The time between the particular stimulation
techniques was at least 10 minutes and the sequence of application was
performed at random.
3 min
5 min
b
1 min
a
1 min
Fig. 11.2: Measurement profile of the volunteer study. The measurement points were
determined before (b), during (d) and after (a) stimulation. The plateau increase
indicates the active time of acupressure, needle- and laserneedle acupuncture.
11.2.2
Measurement techniques,
statistical analysis
evaluation
parameters
and
A Multi-Dop T System (DWL Electronic Systems GmbH, Sipplingen,

Germany) combined with functional multi-directional transcranial Doppler
sonography (TCD) were used for measuring mean blood flow velocities.
127
Two 2-MHz-probes (A. cerebri media (MCA)) were used in an ultrasound
probe-holding construction (compare Fig. 11.1).
We evaluated the mean blood flow velocities (vm) in the right and left MCA
as well as the pulsatility index (PI = (systolic maximum value end diastolic
maximum value)/mean value) in both cerebral vessels, before, during and
after the different stimulation techniques.
In addition, near infrared spectroscopy (NIRS) with an INVOS 5100 cerebral
oximeter (Somanetics, Troy, USA) at the frontal left as well as right, and
registration of blood pressure (Cardiocap, Datex, Hoevelaken, Netherlands)
were performed.
Measurement values were graphically presented as box-plots and were
analysed with the paired t-test (level of significance p < 0.05). The computer
programs SigmaStat and SigmaPlot (Jandel Scientific Corp., Erkrath,
Germany) were used.
11.3 Results
Figure 11.3 exemplarily shows the registration of ICP and blood pressure (A.
radialis) during bilateral as well as unilateral acupressure in a 15-year-old
patient with severe head injury. During acupressure, significant and steep
increases in ICP occur, which first subside after terminating stimulation.
128
mmHg
50
kPa
6.7
ICP
40
5.3
150
20
80
11
BP
10 min
Fig. 11.3: Time course of intracranial pressure (ICP) and blood pressure (BP) during
acupressure of points St.7 and SJ.22 in a 15-year-old patient after severe head injury.
Direction of recordings from right to left (arrow). Observe the ICP increase during
bilateral (b) and left (l) or right (r) acupressure.
Figures 11.4 and 11.5 summarize the results of transcranial Doppler

sonography in healthy volunteers. The results show that significant increases
in blood flow velocity in both MCAs occur during acupressure (Fig. 11.4a).
These effects remain present after completing acupressure. Inverse
behaviour is shown in the pulsatility index (compare Fig. 11.5a).
To a certain extent, significant and similar in trend, but somewhat damped
amplitudes in the response pattern can be observed in manual needle (Fig.
11.4b, 11.5b) and laserneedle acupuncture (Fig. 11.4c, 11.5c).
129
p = 0.006
vm (cm/s)
100
p = 0.003
p < 0.001
p < 0.001
80
60
40
20
left
right
n=34
paired t-test
before
during
after
before
Acupressure
during
after
vm (cm/s)
120
p = 0.231 (n.s.)
p < 0.001
100
p = 0.003
p < 0.001
80
60
40
20
left
right
n=34
paired t-test
before
vm (cm/s)
during
after
before
during
Needle Acupuncture
p = 0.026
100
p = 0.061 (n.s.)
after
p = 0.015
p = 0.717 (n.s.)
80
60
40
20
left
right
n=34
before
paired t-test
during
after
before
during
Laserneedle Acupuncture
after
Fig. 11.4: Box plot illustration of changes in mean blood flow velocity in the right
and left middle cerebral artery (MCA) in 34 healthy volunteers, before, during and
after acupressure (a), needle acupuncture (b) and laserneedle acupuncture (c). The
horizontal line in the box gives the position of the median. The end of the box
defines the 25th and 75th percentile; the error bars mark the 10th and 90th percentile.
130
p = 0.147 (n.s.)
PI
p = 0.007
1,8
p = 0.162 (n.s.)
1,6
p = 0.007
1,4
1,2
1,0
0,8
0,6
0,4
left
right
0,2
0,0
paired t-test
n=34
before
PI
during
after
before
Acupressure
during
after
p = 0.374 (n.s.)
1,6
p = 0.044
1,4
p = 0.231 (n.s.)
1,2
p = 0.003
1,0
0,8
0,6
0,4
left
right
0,2
0,0
n=34
paired t-test
before
during
after
before
during
Needle Acupuncture
after
PI
1,6
p = 0.924 (n.s.)
p = 0.498 (n.s.)
1,4
p = 0.219 (n.s.)
p = 0.012
1,2
1,0
0,8
0,6
0,4
left
right
0,2
0,0
n=34
before
paired t-test
during
after
before
during
Laserneedle Acupuncture
after
Fig. 11.5: Box plot illustration of changes in pulsatility index (PI) in the right and
left middle cerebral artery before, during and after acupressure (a), needle
acupuncture (b) and laserneedle acupuncture (c). For further description see Fig.
11.4.
131
Regional cerebral oxygen saturation and blood pressure did not show any
significant stimulation-related changes (compare Tab. 11.1).
Tab. 11.1: Regional cerebral oxygen saturation (rSO2) and blood pressure (BP sys =
systolic, BP dia = diastolic and MAP = mean arterial pressure). Mean values (Cx)
and standard deviation (SD) under different test circumstances are noted.
11.4 Discussion
Intracranial pressure is defined as the pressure which the brain within the
skull (including the subarachnoid cavities), exerts on the surrounding dura
mater. This is particularly important under pathological circumstances, since
it influences cerebral perfusion as well as the oxygen and nutrient supply. An
increasing ICP consecutively leads to a decrease in cerebral perfusion. If
brain injury or damage by bleeding occurs, ICP can increase, however the
surrounding bones cannot give way. This finally can lead to further damage
of the brain reaching to transtentorial herniation or in extreme cases to brain
death.
Investigations using auditory evoked brainstem potentials in intensive care
patients with increased intracranial pressure showed that the application of
headphones alone, without activating acoustic stimulation can lead to
significant, and upon removal, reversible ICP-increases [1,9]. The use of
acupressure with similar pressing action, could also achieve these effects
(compare Fig. 11.3).
We assumed that the mechanical transmission of pressure from the
headphones, or finger pressure on the end cranium as a result of loss of bone
stability after skull fractures or after bi-temporal osteoclastic bone
trepanation could be hypothetical potential causes. Further hypothesis were
the triggering of reflex mechanisms during application of the headphone
holder or finger pressure above the structures in the retro-mandible region or
as a result of impaired venous blood flow [9].
132
An additive hypothetical approach which suggests a possible stimulation of
local acupoints was also systematically investigated in this study using TCD.
The effects of the individual stimulation techniques on regional cerebral
oxygen saturation could not be proven with continuous NIRS monitoring.
Non-invasive, intermittent blood pressure measurement on volunteers differs
methodically from continuous invasive blood pressure registration in
intensive care patients regarding reproducibility and time. The missing
correlation between stimulation and blood pressure cannot exclude a
possible accompanying brief systemic hemodynamic reaction resulting from
the measurement window of the discontinuous measurement method.
TCD has its origin in the year 1842 with the discovery and description of the
Doppler effect by the Austrian physicist Christian Doppler. In the 80s of the
past century, Aaslid et al. [10] used the temporal acoustic window to
overcome the barrier of cranial bones. As a result, TCD has become a noninvasive method for evaluating blood flow velocity in intracranial vessels.
Cerebral blood flow parameters can either be determined mathematically
from the blood or cerebral pressure (cerebral perfusion pressure
corresponds to the difference resulting from the mean arterial blood pressure
and transcranial pressure) or with TCD (blood flow velocity).
The close correlation between TCD parameters and intracranial pressure are
discussed and proven in several studies. In this manner, systemic-theoretical
approaches with simultaneous analysis of blood flow velocity and arterial
blood pressure enable transformation to the cerebral pressure curve with a
Dirac-impulse [11]. Clinical use of this non-invasive monitoring method is
being currently discussed.
The systemic-theoretical combination of the parameters described above is
the foundation of our studies on healthy volunteers using TCD. It allows the
direct and indirect connection of measurement data with transcranial
pressure measurements, in intensive care patients. Hypothetically, we must
consider the following components in our explanatory models: It is possible
that acupressure, acupuncture and laserneedle acupuncture at the acupoints
St.7 and SJ.22 induce changes in cerebral parameters, which can increase
already elevated intracranial pressure in intensive care patients. They can
also induce cerebral effects in healthy volunteers which are explainable by
similar mechanisms.
Thus, the attributes gentle, alternative and free of side effects, which are
associated with TCM are not weakened inconsiderably. As the results from
this study show, there are some signs of possible connections to side effects
133
which can occur under particular patho-physiological pre-conditions. In
other words, it is obvious that also methods of TCM require exact
diagnostics, determination of indication and selection of methods.
The authors thank Ms. Ingrid Gaischek MSc for her valuable help and for
writing the manuscript.
11.6 References
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
Schwarz G, Pfurtscheller G, Tritthart H, List WF (1988)

Hirndruckanstieg
beim
Monitoring
akustisch
evozierter
Hirnstammpotentiale mittels Kopfhrer. Neurochirurgia (Stuttg) 31:
216-218
Knig G, Wancura I (1989) Neue chinesische Akupunktur. Lehrbuch
und Atlas der Akupunktur-Punkte, 5. Auflage. Verlag Wilhelm
Maudrich, Wien-Mnchen-Bern
Hecker U, Steveling A, Peuker E, Kastner J (2001) Lehrbuch und
Repetitorium Akupunktur. Hippokrates, Stuttgart
Litscher G, Schikora D (2002) Cerebral effects of non-invasive
Spectroscopy 16/3-4: 335-342
Litscher G, Schikora D (Hrsg.) (2004) Lasernadel-Akupunktur.
Wissenschaft und Praxis. Pabst Science Publishers, Lengerich Berlin
Bremen
Litscher G, Wang L, Schikora D, Rachbauer D, Schwarz G, Schpfer
A, Ropele S, Huber E (2004) Biological effects of painless laserneedle
acupuncture. Medical Acupuncture 16(1): 24-29
Schwarz G (1990) Dissoziierter Hirntod. Computergesttzte Verfahren
in Diagnostik und Dokumentation. Springer, Berlin Heidelberg New
York
Aaslid R, Markwalder TM, Nornes H (1982) Non-invasive transcranial
Doppler ultrasound recording of flow velocity in basal cerebral
arteries. J Neurosurg 57: 769-774
Schmidt B (2003) Nichtinvasive Erfassung des Hirndrucks mittels des
transkraniellen Dopplersignals und der Blutdruckkurve unter
134
Verwendung systemtheoretischer Methoden. Dissertation, Technische
Universitt Chemnitz
135
12. Laserneedle acupuncture - clinical studies

M. Weber
12.1 Introduction
For the first time, laserneedles using a high optical energy output were
applied at multiple points allowing painless and simultaneous 8-point
treatment in accordance with traditional Chinese acupuncture. The
laserneedles were developed by the German company Laserneedle systems
[1] and were first introduced at the Medica-fair 2000 in Germany (Fig. 12.1).
Fig. 12.1: Front view of the laserneedle instrument with 8 optical energy outputs.
The basis of laserneedle therapy combines the positive biological stimulation

of tissues with laser rays, for analgesia, muscle relaxation, promotion of
microcirculation and the stimulation of the immune system, with the
traditional methods of classic acupuncture. In other words, simultaneous
needling using an 8 point combination is performed. During the period of
study 73 patients with various illnesses were treated. A prerequisite for
taking part in this study was that all other forms of conventional treatment
had been tried out, including medication, physiotherapy etc. without
satisfaction or cure of the patient. To assess the success-rate, two scales
136
ranging from 0 - 100 were used. First the patients noted their level of
contentment and secondly their individual pain-level.
12.2 Material, patients and methods

Research was performed between January and May 2001 in a general
practitioners office; the physician was certified in both body- and ear
acupuncture. The patients treated were aged between 21 and 91 years. The
majority of the patients treated had chronic or a strong tendency towards
chronic illnesses, partly with acute or subacute symptoms. Approximately
70 % of the patients were female, 30 % male.
For body acupuncture (Fig. 12.2), 8 exactly positioned laserneedles were
used simultaneously. Optimum duration of treatment was 15 minutes. For
ear- and skull-acupuncture (Fig. 12.3, Fig. 12.4), the laserneedles were
exactly positioned by using a special headgear for fixation. The optimum
duration of treatment in these cases was 5 minutes. The acupoints were
located with common methods, such as the RAC-feeler and location with a 3
Volt-hammer by Bahr, or by applying simple pressure on pain sensitive
areas. Corresponding points at the ear were also determined using the RACmethod or with a pointselect apparatus. In general we note that the triggering
of a distinct, acupuncture-specific De-Qi sensation is an absolute must for
effective acupuncture therapy [2-4].
Fig. 12.2: Typical examples of body acupuncture with activated laserneedles.
137
Fig. 12.3: Application of a laserneedle for ear acupuncture using a special headgear
for fixation.
Fig. 12.4: Typical ear acupuncture treatment after activating the laserneedle device.
138
We could show that laserneedles invoked the characteristically pleasant DeQi sensation in 450 treatments (over 90 % of all cases treated) which was
described as a gentle tingling and flowing of warmth into the extremities.
After treatment, the patients felt pleasantly relaxed and slightly tired. In
comparison to the classic metal needles, which we have been using for
acupuncture in our office for the past 10 years, the frequency of De-Qi
events was significantly higher. The De-Qi feeling was achieved in all
patients regardless of their illness, it was more intensive in acute cases than
in chronic cases. Often, the De-Qi feeling intensified during the course of
treatment, indicating an increased sensitivity towards laserneedle therapy. It
is interesting to note that De-Qi events were often reached in each patient
according to a defined time schedule, for example after 10 minutes in body
and 1 minute in ear acupuncture. In all of the cases treated no side effects
were registered. Normal complications in conjunction with traditional metal
needle acupuncture such as needle collapse, bleeding, hematoma, pain,
infections etc. can be completely ruled out with laserneedle therapy. In
particular the following illnesses from various fields of medicine were
treated (Tab. 12.1):
Orthopaedics
spinal syndromes
herniated vertebral disk
gonarthrosis
coxarthrosis
rhizarthrosis
periarthritis of the
shoulder
epicondylitis humeri
radialis
tendinitis
fibromyalgia syndrome
and polyarthritis
Morbus Bechterew
Neurology/Psych.
paresis after stroke
migraine/headache
syndrome
trigeminal nerve
neuralgia
tinnitus
depression
psychovegetative
exhaustion
Internal medicine
gastropathy
AVD
bronchial asthma
Tab. 12.1: Summary of the treated illness in the different medical fields.
139
12.3 Results
12.3.1
Lumbar, thoracic and cervical spine syndromes as well as

post cervical and lumbar intervertebral disk prolapse
We treated local pain trigger points as well as the corresponding near points
(i.e. UB.10, 11 and 13 for cervical spine syndrome, or 50, 51 and 52 for
lumbar spine syndrome) and the distant acupuncture points such as UB.60
and 62, in addition, the over regional pain trigger points such as SI.3, LI.4,
SJ.5 and GB.41. In case of superimposed psychic symptoms, we also used
compensating points such as St.36 and Ki.6 and in stress symptoms often
Liv.3.
Compared with metal needle acupuncture, pain relief set in immediately
after the first treatment and could be increased in each following session by
means of the booster effect. Therefore, pain syndromes could be completely
relieved after about 5 sessions. With simultaneous treatment of musclerelaxing and calming down points it was evident that a quick sedative, frightand stress-relieving reaction in patients was achieved. In a usual series of 10
treatment sessions, the results can be described as being exceptionally good.
A large number of patients were completely free of pain or their pain was
reduced to such an extent that their original quality of life returned. We
could note that significant improvements in all therapy-resistant and
therapied patients, particularly in those with chronic spinal problems took
place. Older people achieved a higher mobility in the affected joints and
enjoyed far less pain. Apparently the simultaneous effect of laser rays used
in combination with the rules of classic acupuncture were responsible for
this success. In most cases, analgesic and antirheumatic medication, such as
ibuprofen, diclofenac or tramadol and even morphine pain killers could be
either greatly reduced or completely terminated.
Case example
A 58-year-old female patient suffered a severe prolapse of the L5/S1 disks in
December 2000 and was treated in a hospital for 4 weeks. She was
discharged with therapy resistant acute pain, even after CT guided local
injections and being placed on a maximum of pain medication. Further
ambulatory treatment was ineffective.
She was treated with laserneedles using the following point combination:
UB.34, 36, 37, 40, 60 and 62 as well as St.36 and Du 2. After a few minutes,
an intensive De-Qi sensation was built up during each session, and was
described as a pleasant, warm tingling feeling flowing into the entire leg.
After the 15-minute treatment period, pain was significantly reduced and
140
improvement in leg mobility was achieved. After 3 further sessions, the
patient was able to go to parties and dance again. After 10 more sessions,
only 10 % of the initial symptoms remained so that she went on holiday.
Throughout treatment all pain relieving medication was gradually reduced
and at the end of the therapy stopped. After 4 months this magnificent result
remained unchanged. The individual pain score after the end of treatment
was 20 %; the patients subjective satisfaction was 95 %.
12.3.2
Gonarthrosis, coxarthrosis, rhizarthrosis, periarthritis in the

shoulder, epicondylitis, tendinitis, Morbus Bechterew and
fibromyalgia-syndrome
Significant results were achieved after only 3 - 5 treatment sessions in the

disorders mentioned above. Remarkable was the very high success rate for
chronic epicondylitis during the initial phase of treatment. This illness is
widespread in the general population and difficult to treat. After only a few
sessions using local pain trigger points and further typical points such as
SJ.5, LI.4, 11 and 12 and often additional treatment of neck rigidity with
SJ.15 and cervical vertebrate points such as UB.10, the patients were able to
go about their normal activities, take part in sports and other hobbies.
Even chronic and impairing rhizarthrosis, which is intermittently treated
with crystal-steroids, responded very well to lasering. We frequently
included the corresponding local regional, local and distant trigger points
(among others LI.1, 4, 5, Lu.9 and 10 as well as Pe.7). These types of
disorders were also treated by the so-called TMM system (tendomuscular
meridians), by additional needling of the ting- and tonus points and the
equivalent reunion zones. This proved to be very useful and provides further
evidence regarding the benefits of laserneedling.
It is also interesting to note, that severe disorders like Morbus Bechterew and
fibromyalgia, as well as chronic polyarthritis responded exceptionally well
to treatment with laserneedles. In cases of year long impairment, great
importance was attributed to the additional treatment of relaxing, sedating,
stress relieving and energy stabilizing trigger points such as St.36, Ki.6, Ren
17, UB.60 and 62, SJ.5, GB.41, Lu.7, Liv.3 or Du 20, to compensate the
psychological and depressive symptoms.
We could prove that it is more effective to treat multiple points than to
stimulate only single local pain points. This is particularly difficult in cases
of fibromyalgia, where pain occurs throughout the entire body and
constantly changes its location. The psychological background, especially in
141
fibromyalgia as well as polyarthritis is widely acknowledged and proven,
thus, we have an initial point for a stabilizing treatment.
In periarthritis of the shoulder, a long and impairing illness, the success rate
of treatment was significant and effects were of long duration.
Case example
A 54-year-old male patient, suffering from Morbus Bechterew for over 20
years with partial stiffness of the lumbar vertebrae was treated with the
following point combination: UB.31, 32 and 62, Du 2, Ki.6, St.36, Sp.6 and
SI.3.
During treatment a repeated intensive De-Qi occurred in the lumbar region
and after about 10 minutes a pleasant feeling in both legs took place
immediately after the first and each successive treatment. The patient was
able to tie his shoelaces for the first time in years. Apparently due to
relaxation of the painful muscle, the toe touching distance had improved by
about 20 cm.
The extreme pain described before treatment disappeared immediately,
however recurred after some time, but not to the same extent as originally.
The psychological condition and depressed mood as well as the sleeping
disorders were greatly improved. After an observation period of 3 months
the patient was without pain and could go about his hobbies and carefully
increase his physical condition. The individual pain score at the end of
treatment was 10 % and 100 % for the patients subjective well being.
12.3.3
Remaining paresis after stroke
Three patients who had suffered strokes with remaining paresis were treated
in the regions of the affected extremities. A blood-flow increasing and
muscle relaxing point combination was used with energy stabilizing points.
In all 3 cases, a significant increase in mobility was achieved by reducing
spasticity and improving the fine motor ability.
Case example
A 78-year-old female patient with painful, remaining paresis in her left arm
was treated using the following point combination: LI.4 and 11, SI.3, Pe.6,
SJ.5 and 15, Du 20 and St.36.
142
The elevation of her arm could be improved from 90 to 120 degrees after
only 5 sessions. The patient was able to pull a dress over her head for the
first time in 5 years. Pain reduction was achieved and fine motor ability was
greatly improved. The subjective patient satisfaction was 90 %.
12.3.4
Cephalgia, migraine and trigeminal neuralgia
The necessary requirement prior to treating chronic headaches includes

extensive neurological and radiological patient examination. In these
indications we used local and distant trigger points. Migraine attacks could
be rapidly reduced and after due course of treatment, stopped completely.
Tension headaches could be treated quickly.
Three patients suffering from tinnitus were treated. The results here were not
as impressive as in other disorders; often the tone/noise symptoms could be
reduced and sometimes stopped completely for a short time. Further longterm studies still need to be evaluated.
Long-standing trigeminal nerve neuralgias were successfully treated after
only 5 sessions and have not recurred to date. Employing laserneedles to the
head proved to be absolutely easy, considering the location and application
required.
Case example
A 53-year-old male patient suffering from right branch trigeminal neuralgia
for over 20 years was treated with 400 mg of carbamazepin, then
laserneedled with the following point combination: LI.4, SI.3, St.4, 5, 6, 36
and 44 including Ren 24. After the first session, a significant improvement
was felt in the extremely painful right mouth-lip-area. After 3 further
sessions no pain could be registered and carbamazepin was gradually
reduced.
In the following 2-month observation period, the patient remained free of
pain for the first time in a decade. The pain score was rated with 0 - 5 %.
The subjective patient satisfaction was 100 % in this case.
143
12.3.5
Arterial obstruction disease
Case example
A patient with a persisting 10-year obstruction of the pelvis and a circulatory
bypass could not be operated due to cardiac problems. After only 5 treatment
sessions, his walking distance could be increased from 100 m to over
2000 m and he was free of pain. The following point combination was used:
UB.40, 58 and 60, St.36 and 41, Liv.3, Ki.6, Sp.6.
Obviously treatment led to an improvement in microcirculation and
additional muscle relaxing effects. The subjective satisfaction was given at
95 %.
12.3.6
Gastropathy and bronchial asthma
In most cases, we are dealing with psychovegetative and other disorders,

thus, a combination of organ related trigger points with sedating and stress
relieving effects were of importance. In both diseases the patients health
greatly improved after the first session.
Case example
A patient with a long-standing case history and diagnosis of nervous
stomach was treated with the following combination of points: Pe.6, Sp.4,
SI.3, Liv.3, St.36, Yintang, Ren 12 and UB.21. After a few sessions, nausea,
vomiting, feeling bloated and nervous restlessness and dizziness vanished
completely.
The subjective satisfaction of the patient was 100 % and a 95 % symptom
reduction was achieved.
12.3.7
Depression,
exhaustion
anxiety,
panic
attacks,
psychovegetative
Spectacular results were achieved with laserneedles in the treatment of

psychic and psychosomatic illnesses. The general practitioners experience
shows that a large number of somatic related disorders are linked to
depression. In these cases, treatment is extremely difficult and often leads to
the prescription of addicting medication or psychotropic drugs. Especially
younger patients frequently refuse these drugs.
144
Disorders such as burnout and exhaustion syndromes in conjunction with
anxiety and panic attacks and depressive tendencies are extremely well
treatable and show quick results. In general, psychotropic drugs could be
stopped after only a few sessions. The same was true for pain relieving drugs
in orthopaedic disorders.
Patients who had been treated with sedating and anti depressive points were
able to sleep better after only a few sessions. Their family life improved
greatly. Laserneedle acupuncture considerably reduced illness-related
absence from work.
Case example
A 35-year-old manager of a big company with stress-related exhaustion
syndromes introduced herself to the practice. She suffered from anxiety,
restlessness, sleep disturbances, headaches and sometimes vertigo.
She was treated with the following combination: He.9 and 7, Lu.7, UB.62,
Yintang, Liv.3, Du 20 and Ki.6. During the first session a soothing warmth
flowing through the whole body was sensed, she felt very relaxed and deeply
tired, which in turn led to a good nights sleep. After only 3 sessions the
patient was able to resume her high-pressure job. The patients subjective
satisfaction was 100 %; the symptoms could be reduced by 90 %.
12.4 Discussion
In this report, more than 500 acupuncture treatments were performed with
the newly developed laserneedles. Limitations were reduced by using up to 8
stimulation points simultaneously on the body or ear so that all the principle
point combinations, either local, loco-regional and distant acupuncture
points could be activated with the laserneedles.
Treatment did not have any side effects, was extremely patient orientated,
pleasant and highly effective in all indications. During the study, the number
of patients asking for laserneedle treatment increased considerably. Because
treatment is more pleasant for the patient, no needle pricking is necessary,
and better results are achieved with laserneedles, acceptance is greater. Our
experience showed large groups of patients are willing to use the laserneedle
method. The advantages of laserneedle treatment in pediatrics are also
obvious: painlessness and the higher rate of achieved De-Qi sensations.
When we consider the economical point of view, treatment costs were
considerably lower due to the reduction of required treatments, thus,
145
expensive pain therapies, psychotherapy and physiotherapy became obsolete.
Patients being incapable of working due to orthopaedic, psychiatric and
psychosomatic disorders could also be significantly reduced. We would like
to note the frequency of chronic spinal problems, which lead to great
financial losses in our economy each year. Using this new laserneedle
acupuncture technology, we could reduce therapy resistant complaints,
especially in older patients, so that prescription of non-steroid antirheumatics
could be reduced respectively. Therefore unwanted side effects such as
ulcers, gastrointestinal bleeding, liver and kidney damage do not occur.
The special effects laserneedle treatment has on psychiatric and
psychosomatic disorders in connection with anxiety and panic disturbances
should not be neglected and is also of considerable importance. These
disturbances always lead to difficulties for the general practitioner because
they often become chronic, are very time consuming to treat, medication
therapy may be restricted and all in all are extremely difficult to treat.
Patients who experience difficult phases in their lives - adolescence, mid-life
crisis, senile depression, psychological exhaustion and burnout syndrome can be treated easily and successfully. These patients, who often have
consulted many specialists in their ordeal, accepted laserneedle treatment
exceptionally well. By presenting a new strategy they feel that their
problems are being taken seriously.
Naturally we suggest that acupuncture with the new laserneedle technology
can only be part of a treatment concept. Before treatment is done, thorough
examination and diagnosis of each patient must take place.
In conclusion, acupuncture treatment with the new laserneedle technology in
the general practitioners office is superior to the classic metal needle
acupuncture methods. We must consider the therapeutical results and effects,
the duration and effectiveness after treatment and the frequency of treatment.
Lastly we would like to mention that remarkable results were achieved with
laserneedles in fields beyond normal usage of acupuncture. Dermatological
illnesses, such as crucial ulcers, chronic eczema and acute inflammation of
the skin and mucous membranes etc. were treated with great success. We
will report on these findings at a later date.
12.5 References
[1]
Laserneedle systems GmbH (2001) Benutzerhandbuch

Akupunkturtherapie mit Lasernadeln. http://www.laserneedle.de
zur
146
[2]
[3]
[4]
Kersken T (1993) Einschtzung der handwerklichen Qualitt

durchgefhrter Akupunkturtherapie in 86 Studien. In: Bhring M,
Kemper F (Eds.) (1993) Naturheilverfahren. Springer, Berlin
Stux G, Stiller N, Pomeranz B (1993) Akupunktur. Lehrbuch und Atlas.
Springer, Berlin
Ter Riet G, Kleijnen J, Knipschild P (1990) Acupuncture and chronic
pain: a criteria-based meta-analysis. J Clin Epidemiol 43/11: 11911199
147
13. Pain therapy with laserneedle acupuncture

R. Helling
13.1 Introduction
The cases described in this chapter do not have the same value of an actual
study, however, clearly show the therapeutic effects of non-invasive
laserneedle acupuncture. The cases described, were solely treated with
laserneedle acupuncture.
13.2 Case reports

A 48-year old female with idiopathic trigeminal neuralgia of the left second
branch was treated. A specialist ruled out differential diagnostically
important causes such as cranio-mandibular dysfunction, maxillary sinusitis,
or post zoster neuralgia. No odontogenous disturbances were evident.
Drug therapy with Carbamacepin and Baclofen led to insignificant pain
reduction, therapeutic and local anaesthetic blocks of the pterygopalatine
ganglion, as well as stellate blocks only achieved pain reduction for about 2
days. Despite massive pain, the patient was not willing to undergo surgical
treatment with micro vascular decompression according to Janettas method.
Laserneedle acupuncture was performed according to standard rules of
acupuncture (see Fig. 13.1).
The following acupuncture points were used:
contra lateral St.2 St.4 SJ.21
bilateral LI.4
ipsilateral St.44 and Liv.3
148
Fig. 13.1: Acupuncture points used (modified from [1]).
13.3 Argumentation
In case of highly painful local processes, local points on contra lateral sides
are usually selected (St.2 St.4 SJ.21 ), in addition to distal points ipsi- or
bilateral:
LI.4: LI.4 is the so-called reference point for the large intestine meridian.
This is the most important distant acupuncture point for pain in the facial
149
region. According to studies by Heine, somato-sensory afferents of LI.4 at
the segment level of C4/C5 to Th1/2 are switched synaptically to the sensory
neurons of the dorsal horns of the spinal cord. Thus, LI.4 has control action
on all afferents and efferents running through the spinal cord. Because of the
unique relationship of point LI.4 to the spinal cord, acupuncture of this point
not only switches the afferents at the dorsal horns cord to the bulbo-spinal
and spino-thalamic tracts, but connects the spinal nucleus of the trigeminal
nerve and sympathetic cilio-spinal center via interneurons in the spinal cord.
Both nuclear zones reach from rostral to the lower brain stem. Here, the
connection to the principle nucleus of the trigeminal nerve takes place.
According to Traditional Chinese Medicine (TCM) LI.4 frees the surface
from external pathogenic factors (such as wind). TCM considers trigeminal
neuralgia and facial paresis to be wind diseases.
Liv.3: is the reference point of the liver meridian. Combined with LI.4, this
point drives the wind out of the face [2,3].
St.44 as second to last point of the stomach meridian excellently influences
the other end of the meridian, which begins at the face. St.44 is often used
for pain in the face, which according to TCM is triggered by climatic factors.
Because of severe pain, therapy with laserneedle acupuncture was performed
daily for 20 minutes during the first week. In the second week, three
acupuncture sessions (each lasting 20 minutes) were performed, in the third
week only 2 sessions were made.
According to the patient, pain reduction of about 50 % was achieved after
the third therapy session. After the eighth session, the patient was free of
pain; the last two points were only performed to stabilize the therapeutic
effect. During the last 2 sessions, only the distant points LI.4 Liv.3 St.44
were still treated with laserneedle - acupuncture, the contralateral points at
the face (St.2 St.4 SJ.21 ) were no longer treated. During the following
observation period of 8 weeks, the patient was completely free of symptoms.
This is particularly notable, since the patient only had one pain free interval
for two to three days in the past seven years.
A 35-year-old female patient with intercostal neuralgia, underwent
unexplainable left-sided rhizotomy of the sensory and motory root from Th7
to Th11 (malpractice process is currently running). Rhizotomy did not lead
to lindering pain; instead, permanent pain resulted, including the zone where
surgery was performed and extending under the left thorax to the left
pectoral region. Only high doses of Tramal and Novalgin led to pain
150
reduction of about 30 %. Opiates did not show any effects, local anaesthetic,
paravertebral blocks caused additional pain.
In the paravertebral surgical region, treatment with laserneedle acupuncture
at six highly tender points, in the region of the surgical scar, was performed.
The therapy zones were not selected according to the localisation of known
acupuncture points, but based on so-called A-Shi- points (tenderpoints).
According to TCM all points were located along the so-called Hua Tuo
Line (one transverse finger paravertebral).
Treatment was performed once a week for 20 minutes. The weekly therapy
interval exists since 4 months and is still being performed currently. After
being completely free of pain for one week, massive pain of the previous
intensity builds up within 24 hours. Since all therapeutic methods performed
by several specialists were unable to achieve the effect of laserneedle
acupuncture, the patient has decided to buy her own therapy device.
According to the patient, she can achieve pain free intervals lasting one
week, with this painless therapy method and can live well this way.
13.4 Discussion
The two cases described here do not fulfil the criteria of a study. However,
they impressively show the effectiveness of laserneedle acupuncture in two
therapy resistant pain disorders.
Independent from the effectiveness of laserneedle acupuncture, the author
finds it very important to select the acupuncture points according to the
following three criteria, especially when treating pain disorders:
1. The so-called intrinsic value of the acupuncture point must correspond
with the demands.
2. The combination of acupuncture points must be additive regarding their
effect.
3. The effect of acupuncture points must reach the localisation of pain
(goal area) [3].
151
13.5 References
[1]
[2]
[3]
Jiangping L, Yanliang C, Renhua S (1990) Chinese acupuncture and

moxibustion. Publishing House of Shanghai College of Traditional
Chinese Medicine, Shanghai
Deadman P (1998) Groes Handbuch der Akupunktur. Verlag fr
Ganzheitliche Medizin, Ktzting
Maciocia G (1994) Die Grundlagen der Chinesischen Medizin. Verlag
fr Traditionelle Chinesische Medizin, Ktzting
152
14. Pain therapy of osteoarthrosis /

osteoarthritis-patients using the laserneedle
system in a medical practice with emphasis
on rheumatology and pain therapy
K. Kolitsch
14.1 Introduction
The largest joint of the body is the knee joint. Practically no other joint has
to endure greater daily stress. Complex rolling and sliding movements
guarantee high flexibility as well as stability. The required flexible
connection between different bones is guaranteed by the perfect cooperation
of muscles, tendons and ligaments. The knee joint consists of the articular
condyle and articular cavity, and is surrounded by the synovial capsule
these establish the mobile connection between the upper and lower leg.
Stabilisation of the joint is secured on the side with ligaments, the meniscus
acts as shock absorbers. The synovioum, combined with synovial fluid and
articular cartilage provide optimum slidability. In case of arthrosis, the
articular cartilage is worn down, and in advanced stages, severe pain occurs,
due to friction between the bones.
14.2 Patients and method

Wear and tear of the knee joint reduces the quality of life for those who are
affected. Especially these patients can be found in a medical practice with
emphasis on rheumatology and pain therapy. The number of patients
suffering from osteoarthritis of inflammatory, as well as generative genesis
shows increasing tendency. The knee joint is the clinically the most often
affected joint. The changed structure of aging in the population is
responsible for this phenomenon. Today we assume that every arthrosis
causes accompanying symptoms of arthritis. On the other hand, arthritis
leads to the triggering of arthrosis. Due to severe pain resulting from
advanced loss of articular cartilage, affected patients are nearly immobile.
Only few therapies seem to be promising regarding stopping or slowing the
further degeneration of articular cartilage. Exactly these patients clients
develop chronified pain symptoms or a chronic pain illness.
153
Practical studies show that a dramatic deficit in caring for patients with
chronic pain exists. 75 % of osteoarthrosis/osteoarthritis patients are treated
by a general practitioner. About 60 % do not receive adequate pain therapy.
Effective pain treatment is still a foreign word for many older osteoarthrosis/
osteoarthritis patients. An untenable condition which risks the development
of a pain career. Frequent change in physicians, alternative methods without
competency and irregular medication are the result. In particular, modern
pain therapy methods offer a multi-modal pain therapy concept for patients
with chronic pain diseases. The qualified combination of drug and non-drug
treatment, in connection with psychotherapeutic strategies, leads to an
optimum of therapeutic results. Most important goal of treatment is the
mobilisation of patients with chronic pain diseases. Goal is a variety of
physical straining of the affected knee joint without repeated, one-sided
movement. Stressing of the knee joint should be avoided which doesnt
follow the natural movement patters of this joint. In particular, torsional
movements should be regarded as dangerous for the knee joint. Modern pain
therapy offers patients a number of options within the multimodal treatment
concept.
Animated by the effectiveness of laserneedle therapy compared to needle
acupuncture, we performed a laser therapy on 150 patients with
osteoarthrosis/osteoarthritis. Drug or pain therapy remained unchanged. The
patient collective included patients with osteoarthrosis/osteoarthritis stage I
and II. The technical and scientific basis of the laserneedle system were
thoroughly described by Litscher and Schikora [1-3].
Within observational use of the laserneedle system in pain therapy,
prescription laser acupuncture was used. The following acupuncture and
extra points were applied on 150 osteoarthrosis/osteoarthritis patients:
Extra points:
Nu Xi Jan
Xiyan (Ex.32)
Heding (Ex.31)
Acupuncture points:
St.34
GB.43
Sp.10
St.35
Sp.9
Figure 14.1 shows a patient undergoing laserneedle treatment.
154
Fig. 14.1: Laserneedle treatment in Dr. Kolitschs medical practice
Duration of laserneedle therapy was 20 minutes. All patients wrote a pain

diary from STK (Schmerztherapeutisches Kolloquium) as pain therapy
control.
The first follow-up was made after completing therapy, the second, 4 weeks
later.
14.3 Results
Evaluation of the treatment data after completing therapy showed pain
reduction of three graduation marks on the VAS (visual analog scale) in
65 % of the osteoarthrosis/osteoarthritis patients. After follow-up 4 weeks
after completing therapy the result improved to 70 %.
70 % of the patients registered a reduction pain of 3 graduation marks on the
VAS. 15 % of the osteoarthrosis/osteoarthritis patients showed a decrease in
pain of 2 graduation marks on the VAS.
14.4 Discussion
Evidence regarding efficiency is provided by the drug-free treatment with
the laserneedle system within a multimodal pain therapy concept under
remaining basis and or pain treatment (WHO graduated scheme). As a
result of reduced pain intensity, an increase in mobility in chronic pain
patients was achieved with laserneedle therapy. Thereby this therapeutic
option achieves measurable improvement in the quality of life. Long-term
observations regarding the long-time effects of laserneedle therapy will
provide further effective data regarding the efficiency of this therapy.
155
14.5 References
[1]
[2]
[3]
156
15. Laserneedles in gynecology

K. Staehler van Amerongen
15.1 Introduction
The laserneedle technique is a new, non-invasive method to stimulate
specific acupuncture points with laser light. The method and clinical effects
are described in more recent scientific literature >1@.
Unlike metal needles used in common acupuncture which are inserted into
the skin, Laserneedles are adhered to the desired acupoints points using
small adapters and a special adhesive technique.
Fig. 15.1: Laserneedles.
After activating the device, continuous, visible red laser light with a
wavelength of 685 nm is applied via an optic fiber, directly to the acupoint
with the laserneedle. Intensity of the laserneedle is optimized in such a way,
that the patient barely feels the activation, however still builds up vegetative
stimulation at the acupuncture point. It has been documented, that
laserneedles at the acupoint trigger particular stimuli that is identical to the
Qi sensation of metal needles. The device has 8 exits with corresponding
cables. Therefore, laserneedle acupuncture makes the simultaneous
stimulation of individual point combinations possible. As a result, all
combinations of body, head, and ear acupuncture application are possible.
Laserneedles can be applied alone or in combination with additional
traditional acupuncture needles.
The acupoint is stimulated by the continuous photon flow from the
laserneedle. After subtraction of scattering losses, about 40 mW optic output
is achieved at the distal end of the laserneedle. The actual dose per
laserneedle at the skin during acupuncture treatment is 40 60 J >5@. The
157
power density of a laserneedle increases with the duration of treatment >2@.
Absorption in tissue is minimal at this wavelength; therefore, no warming or
burning of tissue as by surgical lasers occurs. The power of the laser light
leads to triggering of action potentials >4@. Continuous stimulation generates
a cascade of action potentials at the acupoint.
15.2 Material, test persons, technique

The investigations took place during the time period between March and
October 2003. Three-hundred women between 30 and 56 years were
evaluated. All patients were treated during the acupuncture consultation
hours at the University gynecological clinic. Different clinical pictures from
the fields of gynecology and obstetrics were treated. In most cases, single
body laserneedle treatment was performed. In 40 patients, additional
application of laserneedles in the ear region was done.
The clinical pictures treated included 265 gynecological patients and 35
obstetric patients. The gynecological clinical pictures included menstrual
problems, cycle regulation, dysmenorrheal problems, hypothalamic
amenorrhea, premenstrual bleeding, premenstrual and menstrual migraine
headaches, back pain during menstruation, exhaustion, burn-out, hot flushes
and flush during menopause, sterility and childlessness, bladder disorders,
dysuria, uro-genital symptoms, and in the oncologic field, shoulder tension
after breast surgery, tension and decreased arm mobility after breast surgery.
Obstetric indications were induction of labor, carpal tunnel syndrome, hyper
emesis and laser application during childbirth process. Selection of acupoints
on the body was done using the common traditional Chinese medicine
technique and according to the pressure sensitivity of the acupoints. Ear
points were partially determined with RAC-touching or with the electric
Pointselector. Laserneedles were activated at the acupoints for an average of
30 minutes.
Since this method is still quite new, no well-founded results can be presented
due to the small number of case studies.
158
15.3 Case studies

15.3.1
Induction of labor with laserneedles
A 23-year-old patient in the 40th week of gestation, after normal course of

pregnancy came to the ambulant consultation hour for acupuncture to induce
labor. It was her second pregnancy. The first child was a spontaneous
delivery on the awaited date of birth, 2 years earlier. Now the belly was quiet
and no signs of labor were present. The child was also quiet at the beginning
of treatment. The vaginal examination showed an immature finding with
closed sacral mouth of the uterus. The cervix was maintained and scirrhous.
The patient wanted a natural induction of labor without medication. Up
until this time, no measures to induce labor had been performed. After
comprehensive explanation of the different possibilities, the patient decided
to induce labor with laserneedles at the usual acupoints. For her, the fact that
laserneedles did not cause pain was significant since she knew that
acupuncture with metal needles causes some pain during insertion.
At the beginning of treatment, she was positioned in a relaxed, comfortable
manner on the left side. Laserneedles were applied at points LI.4, St.36,
GB.34 and Liv.3 with special adhesive tape.
Fig. 15.2: Induction of labor at points LI.4, St.36, GB.34 and Liv.3.
These are the common acupoints for inducing labor. Especially LI.4 (Fig.
15.3) is an important point to stimulate labor.
159
Fig. 15.3: Laserneedle-stimulation at LI.4.
Laser emission was activated simultaneously and continuously for 30

minutes at these 8 acupoints. During treatment, the patient could feel an
increase in fetal movements and a minor cramping in the belly. Towards the
end of treatment, her belly was hard four times. At point LI.4 she felt the
most tingling. All in all, she felt well and relaxed. After completing laser
application, the cramping in the belly stopped for the time being. She
returned home on that afternoon. During the night she had to go to the
hospital due to beginning labor. The first stage of labor in which the mouth
of the uterus opens only lasted 3 hours. The second phase only lasted 20
minutes and 4 bearing-down pains. The entire birth took 3 hours which
was very fast. In addition, she said she felt very well and was very relaxed.
She had enough energy to bear the child and said she perceived delivery as a
very nice experience.
In this case, the patient delivered quickly and comfortably. Remarkable was
the short first phase of labor lasting only 3 hours.
The literature describes that emotional and physical stress for mother and
child has a clear influence on the length of childbirth. An allowable
duration of childbirth in plurpara patients is usually 8 hours during the first
phase, 1 hour during the second phase and half an hour for bearing down.
Altogether childbirth takes 9 hours >3@.
In our patient, childbirth only took 3 hours. If this was due to the influence
of the laserneedles or if she would have delivered so well without this
measure remains a speculation. Noteworthy is the quick begin of labor after
laserneedle treatment, the brief first phase of childbirth and the subjectively
good feeling of having enough energy to achieve childbirth easily.
160
15.3.2
Carpal tunnel syndrome
A 22-year-old mother with a 2-year-old child came to my consultation hour

in the 28th week of pregnancy. I knew her from her first pregnancy as she
had severe pain and edema in both hands and I treated her for carpal tunnel
syndrome with acupuncture. The current pregnancy was a twin pregnancy
and she had the same symptoms with tingling in the hands especially at
night. She complained about severe pain and weakness in the fingers so that
she could barely pick up a cup from the table. Her hands were severely
edematous. The severity of the symptoms was worse in this pregnancy than
in the last.
In the last pregnancy, she was treated with acupuncture needles at the
acupoints Pe.6 and Pe.7.
Fig. 15.4: Needle acupuncture at points Pe.6 and Pe.7.
At that time, the symptoms increased after the first treatment, but improved
distinctly after the third treatment. Eight sittings using common acupuncture
with metal needles were performed, first 3 times a week, then once a week.
The patient experienced slight pain during needling.
After appropriate explanation, the patient wanted to try acupuncture with
laserneedles. Again the same two acupoints Pe.6 and Pe.7 at the inside of the
wrist were selected. The laserneedles were applied at these points and
illuminated with laser light for 30 minutes. Coincidently, 8 sittings were
161
necessary again. After the first treatment, again, an increase in symptoms
occurred. First the pain increased however after the second treatment she
could feel an obvious improvement in her symptoms. It was a positive effect
for her that the fixing of the needles with adhesive tape did not cause pain,
contrary to the insertion of common acupuncture needles. During laserneedle
acupuncture, she felt a warming sensation. She described this as comfortable
and felt better being able to move her hands slightly during treatment
without moving the needles. This small freedom of movement compared to
common acupuncture was positive for her. The children were quite quiet
during treatment. There were no signs of labor. Cardiotocogram (CTG)
registration, twice during and twice immediately after treatment, showed
normal heart action in both children and no signs of labor. The carpal tunnel
syndrome symptoms improved distinctly. In the 35th week of pregnancy
childbirth was performed with Caesarean section.
15.3.3
Urogenital symptoms, back pain, hot flushes
A 52-year-old patient was treated with common acupuncture against her

year-long symptoms. She reported a constant feeling of pressure on the
bladder coming from the bladder region. Because of nycturia she had to get
out of bed 2 to 3 times per night, and during the day she had to go to the
toilet every hour. She could hold her urine and did not have episodes of
incontinence. She experienced the constant back pain in the lumbar region as
the worst symptom and had to take 2 - 4 Voltaren 50 mg per day. Walking
was strenuous and she could not carry much. Despite physiotherapy and
bladder training, no success could be achieved. Blood pressure was stable
with medication at 120/85 mmHg. Before treatment, the patient rated her
pain with 8 on a 10 point pain scale.
After extensive diagnostics, the patient was treated with common
acupuncture using metal needles and combined body and ear acupuncture.
The acupoints UB.28, 29, 30, 40 as well as Du 20 and Ren 3 on the body and
the acupoints lumbar spine, hip and bladder at the ear were selected for
acupuncture. The needles remained in place for 30 minutes without
stimulation. After 9 treatments with common metal needles her condition
improved distinctly. She rated her pain with 3 on the pain scale and did not
require any pain medication. Her blood pressure was still stable and she felt
subjectively better than before acupuncture.
As she heard about the new laserneedle device, she wanted to try it out. The
laserneedles were applied at UB.28, 29, 30, 40 on both sides for 30 minutes.
After a few minutes, the typical Qi sensation occurred during the two sittings
we performed. She said that she felt a comfortable tingling sensation, which
spread throughout the entire body. She rated the back trouble with 1 - 2 on
the pain scale. After laserneedle treatment, she felt a direct and distinct
162
improvement in her back pain. However, her blood pressure showed
diastolic peaks of 95 to 100 mmHg and she complained about extreme hot
flushes.
This case was mentioned in particular to attract attention to possible
disadvantages of this method. I can only speculate, whether these circulatory
disturbances have a direct connection to the laserneedles. My observances
have indicated that the use of laserneedles in diseases with too much fullness
or conditions, which are strongly influenced by the sympathicus require
more caution. In particular, I noticed that hot flushes increased. I also
observed this phenomenon in patients during the menopause or in oncologic
patients treated with Zoladex. It is conceivable that the additional energy
input, which is achieved with the laser method, can bring a system that is
too full to boil over. Further controlled studies are definitely necessary
to confirm this statement.
15.3.4
Breast cancer with mastectomy, transmission in scars
A 40-year-old patient had breast cancer surgery on the left two years earlier.
Because of the tumor stage, a radical mastectomy and axillary
lymphadenectomy had to be performed. Histology showed an invasive
ductal breast cancer stage with neoplastic angiolysis and metastases in
lymph nodes, estrogen and progesterone receptor positive. Thereafter, she
had 6 cycles of chemotherapy as well as a anti-estrogen therapy with
Tamoxifen and Zoladex.
Her problem was a frozen shoulder on the left which severely restricted the
mobility of her arm. The skeletal scintigraphy and CT did not reveal any
metastasis. Arm movement was restricted and only sideward movement to
< 45 and towards the front to < 90 was possible. Shoulder pain caused by
tense muscles was rated with 7 on a 10 point pain scale. She had achieved
little improvement with physical therapy exercises.
In a sitting position, the patient was treated with laserneedles on both sides at
the body acupoints LI.14, SJ.15, GB.21, SI.11.
163
Fig. 15.5: Laserneedle treatment at acupoints LI.14, SJ.15, GB.21 and SI.11.
The acupoints were illuminated continuously with 30 mW laser light for 30

minutes. Eight 8 sittings at 1 - 2 week intervals were performed. After this
treatment interval, an obvious improvement in arm movement to < 150 to
the front and < 110 sideward was achieved. She could also reach the back
of her left shoulder with her left arm, a movement that was impossible
before. She described her emotional and physical condition as much better
and stable since laserneedle treatment. She also had more energy and was
not as tired. Solely the heat sensation within the body and sweating had
increased somewhat.
Interestingly she describes the transmission of the laser energy directly to the
scars. The needles were adhered on the back and rear shoulder region. About
5 minutes after activating the device, she felt a tingling sensation at the
mastectomy scar and axillary scar. After two further minutes, she described a
strange sensation in all scars on her body, even at the scar on her right knee
from an old injury.
The scar on the knee was located somewhat lateral from the stomach
meridian. As we know, the stomach meridian runs directly over the breast.
Interestingly, the scar on the knee was on the right side, the mastectomy scar
on the left side of the body.
Whether energy from laserneedles flows further and is stopped at scars and
how far scars can be influenced with laserneedles should be discussed.
According to the interference field theory, scars are very important focuses
were energy is disturbed. Further studies to this topic should follow.
164
15.3.5
Dysmenorrhoea, lack of energy
A 45-year-old patient came to the consultation hour and suffered from severe
pain in the lower abdomen during menstruation. Endometriosis AFS III was
documented in her medical records and she had several operations because
of endometriosis in the past. Dysmenorrhea was so severe, that she had to go
to the hospital for treatment with strong painkillers. Menstrual blood was
always clumpy and sluggish and dark in color. In addition, she had severe
back pain. She also complained about changing moods, loss of libido and
lack of energy.
Nine sittings with laserneedles were performed once a week. Different
acupoints on the body and ear were stimulated with laser light.
The time of treatment was selected in such a way, that it was briefly before
the beginning of menstruation.
During the nine treatments, the acupoints were stimulated with laser light.
After the treatment with laserneedles, the patient said that she hadnt felt so
well in the last 2 years and that she was also emotionally better balanced.
She had much more energy and felt strong. Major changes had taken place
with positive effects on her body and emotional condition. She was
impressed. The changes in mood had also improved distinctly. Pain in the
lower abdomen was almost gone and she only needed a hot-water bottle on
the first day of menstruation. The color of menstrual blood was much lighter
and without clumps. As she was treated one day before the awaited
menstruation she reported that she already menstruated on the same day as
she was treated and that she didnt experience any pain. The blood flow was
now much thinner and she didnt experience clumpy or sluggish blood.
As the acupoint Yintang (comp. Chapter 7), a point on the forehead between
the eyebrows (Fig. 15.6) was treated, she described a pleasurable sensation
from the acupoint over the forehead, over the eyebrows, around the eyes and
to the nose.
165
Fig. 15.6: Stimulation of acupoint Yintang.
It was a relaxing feeling. She had her eyes closed during the treatment.
Nevertheless, she reported feeling lightness within. After treatment, she was
full of energy and felt very well.
15.3.6
Childlessness, temperature curve, cycle regulation
A 34-year-old patient with a strong wish for having children came to my

acupuncture consultation hour with the question regarding alternative
methods for treating sterility. She already had 2 miscarriages in the 5th and
6th week of pregnancy. She also had a consultation in the department of
endocrinology. She didnt want to take any hormones. She didnt take
contraceptives because she wanted to get pregnant. Her menstrual cycle was
somewhat prolonged with 32 days. At the beginning, the menstrual blood
was sluggish, clumpy, dark in color and painful. During the first days of
menstruation, she always had heavy, dark red bleeding. Every morning
before getting up from bed, she measured her body temperature and recorded
these values on a curve. The temperature curves over 5 months, showed a
zigzag picture. The values were between 36.7 and 37.5 C. It was not a
typical two-phase course with sudden increase in temperature and following
higher level favorable for pregnancy. We performed 10 sittings, 4 times once
a week and then 6 times every 2 weeks.
Combined treatment with laserneedles on the body, and metal needles and
laserneedles on the ear were performed. On the body, acupoint combinations
Sp.6, Liv.3 and St.36 and Yintang were selected. First, 7 metal needles were
166
applied on the ear at the acupoints ovary, TSH, Gonadotropin. Illumination
of the endocrine regions at the intertragic notch was performed 3 times.
Here, the laserneedles were fastened to a head-holding device (Fig. 15.7) and
the endocrine region of the ear was illuminated.
Fig. 15.7: Head-holding device for laserneedle treatment at the ear.
On the evening of the first treatment, she was very tired. Menstruation began
on the very next day. She reported that the blood flow wasnt quite so
sluggish. The color of menstrual blood was still dark. During the course of
treatment, the color and consistence of blood changed. It was lighter red, not
as clumpy and more flowing. The menstrual cycle regulated itself to about
29 days. Pain in the lower abdomen was more tolerable. Remarkable is the
nearly picture-book like temperature curve with the typical increase at the
point of ovulation and the following plateau during the second cycle phase.
One day she came to my consultation hour and reported her positive
pregnancy test. The result was confirmed.
If she would have become pregnant without laser treatment is questionable.
Noteworthy is the change in the temperature curve from the initial zigzag
course to the two phase course, as well as the change in color and
consistency of menstrual blood.
15.4 Results and discussion

This method seems to be trend setting for the future because of high patient
acceptance, comfortable treatment, and good results. The special advantage
compared to acupuncture with metal needles, is that insertion into the skin is
167
not necessary. Therefore, no side effects such as bleeding, haematomas,
infection, or pain during insertion into the skin occur. The mothers fear of
vegetative reactions from needle insertion is eliminated. There is no
additional stress for mother and child with this method. Thus, she can
enjoy this method of treatment more.
Furthermore, more mobility during treatment is possible. The patients do not
have to remain completely still as by common acupuncture. Since the
needles are not inserted into the muscle no pain occurs during slight
movement. Especially in the field of obstetrics, it is desirable that the woman
is relatively mobile. During childbirth, women usually make fists during
labor pains. Since acupoint LI.4 at the ball of the thumb is often used to
regulate labor, this can be somewhat painful. With laserneedles, stimulation
of this acupoint is easily possible.
At several acupoints, patients also perceive the typical Qi sensation as when
using classical needle acupuncture. However, the range of sensitivity
differed. When using common acupuncture, differences in sensitivity on
both sides of the body were described. The Qi sensation was described as a
tingling and warming feeling. Several patients reported feelings of
comfortable relaxation and tiredness. The transmission of sensations along
the meridians was often mentioned.
In the case study with carpal tunnel syndrome, the patient reported an initial
increase in symptoms after the first treatment with laserneedles, identical to
that when using common acupuncture needles. This seems to indicate that
the laserneedle method has similar effects as traditional acupuncture.
We could observe positive results in treating gynecologic and obstetric
indications with laserneedles. Cycle regulation with lighter, improved
menstrual bloodflow was observed. Temperature curves also showed better
results. In the field of oncology, arm mobility and reduced muscular tension
could be achieved after breast cancer surgery. In case of bladder problems,
dysuria was improved and an improvement in bladder capacity could be
reported. After laserneedle therapy, pain was rated with better scores on the
pain scale. Exhaustion and lack of energy could also be improved. In the
field of obstetrics, faster phases of labor and more energy for the mother
could be noted. Labor could be successfully induced by stimulating acupoint
LI.4. During treatment of carpal tunnel syndrome a decrease in pain and
tingling in the hands during the night could be registered. Hyper emesis with
less nausea and vomiting was also achieved.
The observation regarding the transmission of laser energy to the different
scars on the body is noteworthy. This could further explain the transmission
to the meridians. A flow of energy is perceived. This flow will probably be
altered on interfering fields / scars, which very sensitive patients can
perceive.
168
Scientific studies have shown that an increase in ATP takes place when
using the laserneedle method. I think that this ATP is very useful during
childbearing. Childbearing requires much energy from the mother and the
main supplier is definitely ATP.
In particular, the energy aspect is one major difference to common
acupuncture. In the approx. 300 patients we have treated with laser therapy,
nearly 80 % had the impression that they gained more energy through the
treatment.
Caution should be taken when treating patients with too much fullness or
heat. Even though the laserneedle method does not lead to an increase in
body temperature, one could observe that this method wasnt appropriate for
such patients as described in the case study with hot flushes. One would be
cautious in patients with an already increased sympathicus. This also seems
logical. You should not give a person with too much fullness additional
energy.
It should be clearly stated that these are reports from experience in personal
treatment of patients. Further controlled studies to evaluate the effect of
laserneedles are necessary.
15.5 References
>1@
>2@
>3@
>4@
>5@
Litscher G, Schikora D (2002) Cerebral vascular effects of non

invasive laserneedles measured by transorbital and transtemporal
Doppler Sonography. Lasers Med Sci 17: 289-295
Litscher G, Schikora D (2002) Neue Konzepte in der experimentellen
Akupunkturforschung Computerkontrollierte Laserpunktur (CCL) mit
der Laserneedle Technik. Der Akupunkturarzt / Aurikulotherapeut 28:
18-28
Martius G, Rath W (1998) Geburtshilfe und Perinatologie. Thieme
Verlag, Praxis der Frauenheilkunde Band II, 1998, S. 383-384
Schikora D.: European Patent Nr. PCT/EP 01/08504
Schikora D.: Physikalische und physiologische Eigenschaften der
Lasernadeln fr Akupunktur, personal communication
169
16. Laserneedles in gynecology - a study with

questionnaires
K. Staehler van Amerongen
16.1 Introduction
In the meantime, different descriptions regarding the use and effects of
laserneedle acupuncture can be found in literature [1]. Goal of this study was
to evaluate what patients experienced during and after treatment with
laserneedles and what they knew about the technique before treatment.
Using questionnaires, this current study compares the laserneedleacupuncture method with the common metal needle acupuncture method
based on the patients perception during and after treatment.
16.2 Test persons

Thirty female patients per group were questioned. All of these patients
visited the acupuncture consultation hour at the University Gynecological
Clinic in Bern. They were treated for gynecological disorders and came to
the consultation hours with the following symptoms: Carpal tunnel
syndrome, premenstrual pain, urogenital symptoms, pruritus gravis,
mastodynia, chronic abdominal pain in endometriosis, induction of labor,
hyper emesis gravidarum, dysmenorrhoea, breast cancer with decreased
mobility of the arm, sacra-iliac joint pain during pregnancy, smoking
withdrawal during pregnancy, primary sterility and preparation for
childbirth.
The mean age of patients in the metal needle group was 38 years (range from
18 to 73 years) and the mean age in the laserneedle group was 36 years
(range from 16 to 60 years). Assignment to the laserneedle or metal needle
treatment groups was done at random. Each patient took a random number
from 1 - 60. The patients with even numbers were treated with metal needle
acupuncture; those with uneven numbers were treated with laserneedle
acupuncture.
170
16.3 Method
The patients obtained questionnaires part 1 before the first treatment, part 2
after the first treatment and part 3 prior to the second treatment. The patients
filled out the questionnaires voluntarily and independently. In part 1, the
question Do you know the method (metal needle acupuncture or laserneedle
acupuncture)? was asked. Two answers were possible: either yes or no. The
second question was Have you already been treated with acupuncture?
Here also the answers yes and no could be selected. The third question was
How would you evaluate your personal state of health at the moment? The
following answers were possible: very good, good, satisfactory, poor and
very poor. The fourth question was How strongly does your illness or
symptoms influence you in daily life? Here, 5 answers were possible as
follows: extremely, strongly, moderately, a little, not at all. The
questionnaires were given back for evaluation. Treatment was then
performed according to assignment either with metal needle or laserneedle
acupuncture.
Immediately after the first treatment, the patients filled out part 2 of the
questionnaire for evaluation. Again, the patients filled the questionnaire out
independently and without influence from others. In the second part of the
questionnaire, the patients were questioned regarding their perception during
treatment. The following questions were to be answered: Did you
experience pain when the needle was applied? - Did you experience pain
during treatment? - Did you experience a feeling of warmth in the body
during treatment? - Did you experience an electrical tingling sensation
during treatment? - Did you feel something at the needle itself during
treatment? - Did you experience a sensation in the entire body during
treatment? - Did you experience tiredness during treatment? - Did you
feel relaxed, comfortable during the treatment? The following answers were
possible for the questions above: extremely, strongly, moderately, a little,
none.
The third part of the questionnaire was filled out by the patients prior to the
second treatment. Questions regarding perception after treatment were
asked. The following questions were evaluated: Did you experience pain
after the treatment? - Were you tired after treatment? - Did you feel
relaxed after treatment? - Did your symptoms improve after treatment? Did you feel well physically after treatment? - Did you feel well
emotionally after treatment? - Did your symptom improve with
treatment? Again, several answers were possible: extremely, strongly,
moderately, a little, and none.
171
16.4 Results
After evaluating the question: Do you know the method? Thirty patients
answered no regarding the laserneedle method and 29 yes regarding the
acupuncture method. This shows that treatment with common metal needle
acupuncture is well known among the patients; however, they have not yet
been informed about laserneedle acupuncture. Already 13 of 30 patients
were treated with metal needle acupuncture whereas all 30 patients in the
laserneedle group had not yet been treated with this technique. The majority
of patients in both groups noted their current health condition as being good
to satisfactory (n=27 in the metal needle group and n=26 in the laserneedle
group) (Fig. 16.1). The symptoms they had influenced them very strongly to
moderately (Fig. 16.2).
In the laserneedle group (n=30) 29 patients experienced no pain and 1 a little
pain during application, however in the metal needle group (n=30) 3 patients
experienced extreme, 3 strong, 9 moderate, 12 a little and only 3 no pain
during needle insertion (Fig. 16.3). The great advantage of painless
laserneedle-acupuncture should be noted here. In addition, none of the 30
patients experienced any pain during laserneedle acupuncture, whereas 2
patients experienced strong, 3 moderate, 4 a little and 21 no pain during
metal needle acupuncture (Fig. 16.4).
The question whether they felt warmth during treatment was answered by 7
patients with extremely, 17 with strongly, 5 with moderately, 1 with little
and 0 with none in the laserneedle group (n=30). In the metal needle group
(n=30) only 1 patient answered with extremely, 4 with strongly, 7 with
moderately, 8 with a little and 10 with none (Fig. 16.5). In the laserneedle
group (n=30), the question regarding tiredness during treatment was
answered by 2 patients with extreme, 9 strong, 10 moderate, 6 a little and 3
none at all. In the metal needle group (n=30) 2 patients answered with
extremely, 12 strongly, 8 moderately, 2 a little and 6 with none at all (Fig.
16.6). In the laserneedle group no one answered the question regarding
tiredness after treatment with extreme, 1 with strong, 2 with moderate, 13
with a little and 14 with none. In the metal needle group, 4 patients were
extremely tired, 8 strongly, 4 moderately, 6 a little and 8 not at all (Fig.
16.7).
In the laserneedle group 2 patients said they were extremely relaxed during
treatment, 13 experienced strong relaxation. Six patients experienced
moderate, 6 little and 3 no relaxation. In the metal needle group, 4 noted
extreme, 17 strong, 5 moderate 4 little and 0 no relaxation (Fig. 16.8). The
question regarding relaxation after treatment showed similar results. In the
laserneedle group 8 answered with extreme, 14 with strong, 7 with moderate,
172
1 with little and no one with none and in the metal needle group 4 answered
with extreme, 18 with strong, 6 with moderate, 2 with little and no one with
none (Fig. 16.9). In both groups, the patients experienced a strong feeling of
relaxation during and after treatment.
In both groups, most of the patients experienced a great improvement in their
symptoms and felt well after treatment (Fig. 16.10 and 16.11).
number of patients (n=30) per group
How would you evaluate your personal state of health at the

moment?
20
16
15
15
11
11
10
5
3
0
0
very good
good
satisfactory
metal needle acupuncture
poor
very poor
laserneedle acupuncture
Fig. 16.1: How would you evaluate your personal state of health at the moment?
How strongly does your illness or symptoms influence you in

daily life?
16
14
12
10
8
6
4
2
0
15
12
10
7
1
extremely
strongly
moderately
a little
not at all
Fig. 16.2: How strongly does your illness or symptoms influence you in daily life?
173
Did you experience pain when the needle was

applied?
35
30
25
20
15
10
5
0
29
12
9
3
extreme
strong
0
moderate
a little
3
none
Fig. 16.3: Did you experience pain when the needle was applied?
Did you experience pain during treatment?

35
30
30
25
21
20
15
10
5
0
extreme
strong
4
0
moderate
a little
none
Fig. 16.4: Did you experience pain during treatment?
174
Warmth during treatment

18
16
14
12
10
8
6
4
2
0
17
10
8
4
1
extreme
strong
moderate
little
0
none
Fig. 16.5: Warmth during treatment
Tiredness during treatment

14
12
12
10
8
10
8
6
6
4
2
6
3
0
extreme
strong
moderate
Fig. 16.6: Tiredness during treatment
little
none
175
Tiredness after treatment

16
14
12
10
8
6
4
2
0
14
13
8
8
6
extrem e
strong
m oderate
little
none
Fig. 16.7: Tiredness after treatment
Relaxation during treatment

17
18
16
13
14
12
10
8
6
4
2
6
4
2
0
0
extreme
strong
moderate
Fig. 16.8: Relaxation during treatment
little
none
176
Relaxation after treatment
20
18
18
16
14
14
12
10
8
6
4
4
2
0
extrem e
strong
m oderate
little
none
Fig. 16.9: Relaxation after treatment
Improvement of symptoms after treatment

20
18
15
15
10
5
7
4
2
0
0
extremely
strongly
moderately
a little
not at all
Fig. 16.10: Improvement of symptoms after treatment
177
How do you feel after treatment?

25
20
20
18
15
10
5
5
1
0
very good
good
satisfactory
poor
very poor
Fig. 16.11: How do you feel after treatment?
16.5 Discussion
Our study shows that metal needle acupuncture is well known among
patients but that laserneedle acupuncture requires further explanation
regarding the method and possibilities of use.
With the exception of one patient, no one experienced any pain during
application of the needle or during treatment. The painless laserneedle
method has a clear advantage compared to common metal needle
acupuncture.
Obvious differences in both groups regarding warming sensations can be
reported. Laserneedle therapy is definitely a method in which warmth is
experienced by the patient during treatment. According to temperature
measurements, the body and tissue temperature does not increase during
laserneedle acupuncture; however our studies show that the majority of
patients perceive a warming sensation in the body. Further temperature
measurements should follow.
The tendency that metal needle acupuncture leads to stronger tiredness
during and after treatment is obvious. On the other hand, patients treated
with laserneedles were more energetic after treatment. Maybe laserneedles
have a positive influence on less energetic persons? On the other hand,
persons in our patient collective experienced a strong feeling of relaxation
178
during and after treatment. Both methods seem to be good in achieving
relaxation.
Most patients in both groups experienced a great improvement in their
symptoms and felt well after treatment.
When we view this questioning in its entirety, laserneedle acupuncture
seems to be a method which according to the patients perception has a
positive influence on symptoms and is a painless, energetic and relaxing
method which leads to a warming sensation during treatment.
16.6 References
[1]
Litscher G, Schikora D (Hrsg) (2004) Lasernadel-Akupunktur.

Bremen
179
17. Laserneedle therapy in dentistry

K. Borer
17.1 Introduction
In addition to toothache and neuralgia, patients in dental practices often also
suffer from anxiety and needle phobia. Experienced dentists can achieve fast
relief with acupuncture therapy [1-4]. Laserneedle-technology allows new,
painless acupuncture stimulation.
This study is a report about the use of laserneedle acupuncture in daily
routine dentistry.
17.2 Methods and materials

Prerequisite for laser acupuncture treatment was the diagnostic exclusion of
all obvious dental causes.
For example, bite problems were treated first in the occlusion; root treatment
was performed in case of gangrenous dental pulp.
The positioning of the diodes was done differently according to indication: 1
2 diodes for direct treatment of the tooth and respective wound region,
dermatologic hammer for extensive treatment (mandibular joint), application
of diodes at acupuncture points according to body and ear acupuncture. Main
emphasis during testing of the device was the local treatment of the problem
areas.
17.3 Results
17.3.1
Oral surgery
Post operative pain with lockjaw after surgical removal of wisdom tooth:
Daily treatment was done locally using the dermatologic hammer (Fig. 17.1)
with eight diodes for three sittings. After the first treatment, only minor pain
was present and after the third sitting, the patient could open his mouth
normally.
180
Fig. 17.1: Dermatologic hammer for the treatment of jaw problems.
Massive symptoms after paradontal surgery:

Local treatment with three diodes, every three days, resulted in immediate
painlessness after the first sitting, thereafter, to very rapid healing (gingiva
without necrotic coating, rapid resolution of the haematoma).
17.3.2
Endodontology
Toothache with new porcelain inlay:

The affected tooth was treated daily, with two diodes, from the dental neck
to the apex. The patient was free of pain after two sittings with positive
vitality testing.
Routine treatment during direct capping of open dental nerves:
The corresponding area of the dental nerves were treated locally with one
diode, for one minute, thereafter, a dental wound bandage was applied. In
this manner, the possible death of dental nerves may be reduced.
181
17.3.3
Crown - bridges
Routine treatment of prepared pillar teeth:

The prepared teeth were treated with a diode for 2 minutes. As a result, later
death of the treated teeth may be avoided.
17.3.4
Pain therapy
Bite problems, sensitivity of teeth to temperature:

The dental neck to the apex was treated locally with 1 2 diodes for about
10 minutes, every 2 3 days (Fig. 17.2). The reaction time until pain ceased
was variable; usually 2 to 3 sittings were required.
Fig. 17.2: Treatment of the dental neck.
17.3.5
Myoarthropathy
Due to increasing stress in the population, an increase in central pressing,

grinding and severely indurated jaw and neck muscles with jaw problems
occur. As a result, contraction of the jaw, neck and back muscles with
corresponding pain symptoms occur.
Treatment was performed using the dermatologic hammer (Fig. 17.3) above
the affected jaw muscles, above the cervical vertebra C0/1 and C7.
Thereafter, the patients felt relaxation and a light warming sensation.
182
Fig. 17.3: Dermatologic hammer for the treatment of myoarthropathy and jaw
problems.
17.3.6
Neuralgia
Based on the affected areas of the head, diodes were applied at the classic
acupuncture points of the head and rest of the body. For example, Du 20 as
local point, and LI.4 and Liv.3 as distant points.
17.3.7
Sedation in case of dental phobias
Acupuncture was performed 30 minutes before dental treatment. Excellent

relaxation to the patient was achieved with points Ki.6, LI.1-1, Ren 17 and
Ren 24.
17.3.8
Nausea during molding
Acupuncture was performed 30 minutes before taking moulds, above the

acupuncture points Ren 24 (Fig. 17.4), Ki.6, LI.1-1 and Pe.6. As a result,
even extremely difficult models could be made without problems.
183
Fig. 17.4: Acupuncture point Ren 24 for treatment of nausea.
17.4 Discussion
Laserneedle-technology can be very well integrated into the routine dental
practice. The instrument is simple to handle and can be easily delegated. A
sterilizable dental adapter which survives repeated sterilization would be
desirable.
Laser acupuncture represents an excellent initial therapy due to its positive
effects on microcirculation and relaxation. Further studies should confirm
the reproducibility of these positive effects under consideration of possible
relapses.
Overall, the application of this technology leads to a higher efficiency in
treatment. On the one hand, local therapy with good initial effects can be
achieved; on the other hand, causal therapy can be performed using body
acupuncture. This improves and widens the possibilities in dental medicine.
17.5 References
[1]
[2]
Rosted P (2000) Introduction to acupuncture in dentistry. Br Dent J

189: 136-140
Lu DP, LU GP (2003) Anatomical relevance of some acupuncture
points in the head and neck region that dictate medical or dental
application depending on depth of needle insertion. Acupunct
Electrother Res 28: 145-156
184
[3]
[4]
Thayer T (2001) Acupuncture in dentistry. SAAD Dig 18: 3-8

Lu DP, Lu GP, Reed JF 3rd (2000) Acupuncture/acupressure to treat
gagging dental patients: a clinical study of anti-gagging effects. Gen
Dent 48: 446-452
185
18. Laserneedle stimulation as a potential

additive method for post operative pain
treatment
G. Litscher, G. Schwarz, A. Schpfer, L. Wang,
M. Saraya, D. Schikora
18.1 Introduction
The influence of post operative pain on the entire course of treatment was
underestimated for a very long time. The inadequate suppression of acute
postoperative pain has a negative influence on the subjective feeling,
compromises vegetative regulatory and control cycles and also plays an
important role in the risk of chronification. Innovative technical
developments such as laserneedle acupuncture (LNA) [1-4], provide the
foundation for new, potentially additive techniques in pain treatment. At the
Medical University Graz, initial indications for neuro-modulated effects of
LNA could be determined on healthy volunteers using non-invasive
neuromonitoring techniques and modern imaging modalities [1-4]. Goal of
these preliminary examinations was to document a possible influence of the
new laserneedle stimulation method on the subjective, individual need of
analgesics during post-operatively controlled analgesia, within a doubleblind, randomized study.
18.2 Method
18.2.1
Patients and procedure
A total of 25 patients (13 f, 12 m) with a mean age (r SD) of 45.2 r 11.9

years, were treated with activated laserneedle stimulation. The control group
comprised 19 patients (mean age (r SD): 47.3 r 11.0 years; 8 f, 11 m) and
was treated with deactivated laserneedles. All patients gave their written
consent and the study was approved by the local Ethical Committee at the
Medical University Graz.
The patients who had flavotomies (mean duration of surgery: 129.3 r 19.7
min; 104 - 161 min), were treated with laserneedle acupuncture immediately
before and after surgery and during consciousness for 10 minutes. The
following acupoints according to Chinese ear and body acupuncture (Fig.
18.1.) were selected on both sides: ear 55 (Shenmen), ear 40 (Lumbar spine),
186
LI.4 (Hegu) and UB.60 (Kunlun). A blind pain scale (VAS 0 - 10; 0 = free of
pain - 10 = maximum pain) was used for evaluation.
Fig. 18.1: Laserneedle acupuncture as a possible additive method in

postoperative pain treatment. The following acupoints were stimulated: ear
point 55 (Shenmen), ear point 40 (Lumbar spine), LI.4 (Hegu), UB.60
(Kunlun) (from above to below).
After intervention, the effects of pain treatment within a pre-defined
observation time of 90 minutes were evaluated. At a VAS > 3, the pain
therapeutic regime included intravenous bolus administration of 3 mg
Piritramid (Dipidolor) at a body weight (BW) of > 50 kg; 1.5 mg at a BW
< 50. The maximum dosage of analgesics was limited according to BWs to a
total of 15 mg, or 7.5 mg/h respectively. After the final administration of the
opiate, the patients were observed for at least 30 more minutes. Criteria for
exclusion from this study were an age > 70 years, liver and kidney diseases
as well as neurological disorders.
18.2.2
After cleaning the skin with alcohol, eight laserneedles were applied to the
acupoints with a special adhesive. A semi-conductor laser with an emitting
wave length of 680 nm was used as the light source. Output was 30 - 40 mW
per laserneedle. Duration of stimulation was 20 minutes, resulting in an
energy density ~ 4.6 kJ/cm at each single acupoint, and an average total
187
value 36.8 kJ/cm for all. Further details regarding the method can be found
in previous studies [1-4].
18.2.3
The determined data was presented graphically with box plots (SigmaStat,
Jandel Scientific Corp., Erkrath, Germany). The t-test was used for statistical
analysis. The level of significance was determined with p < 0.05.
18.3 Results
The results of the investigations are shown in Figure 18.2. The pilot study
indicated insignificant changes in the rating of subjective pain based on the
VAS before and after laserneedle acupuncture. It is noteworthy, that the use
of analgesics during postoperative observation was higher in the group
without activated laser stimulation (t-test; p = 0.09, n.s.). Clinical side effects
were not observed in any of the patients.
use of
analgesics (O)
VAS
12
10
10
p = 0.09 (n.s.)
p=0.619
SE
Boli
8.0 + 1.1
8
n=19
SE
6.6 + 0.7
2
n=25
0
before
after
before
after
n=25
1
PE
2before OP
3
4 after OP
5
6
O
1 7POPD 8
5
with
without
Fig. 18.2: Box plots of changes in the values on the pain scale (VAS) at the
preliminary examination (PE), before and after surgery (OP), during postoperative
observation (O) and on the first post operative day (1 POPD).
188
18.4 Discussion
Adequate postoperative pain treatment fitted to the patients risks and needs
by the anesthesiologist, is an absolute necessity. Corresponding immediate
post and perioperative pain treatment not only helps the patient by relieving
pain, but also supports the stabilization of neuro-vegetative functions and
can also avoid the chronification of the pain process [5].
Dependent upon the extent and localization of surgery, postoperative pain is
expected in the majority of patients. However, the difference in individual
pain perception and the extent of side effects differs greatly from patient to
patient. Advances in pharmacological treatment have led to treatment
strategies which reduce postoperative pain to a minimum and in the best
case, avoid pain altogether. In addition to oral (tablets, drops) and
intramuscular administration of analgesic substances, other methods of pain
treatment should be mentioned, whereby drugs with analgesic potency
(opiates, local anesthetics) are applied via inserted special catheters (lumbar
or thoracic epidural catheters, arm plexus catheter etc.) or with long term
venous canules. These substances act either regionally or on the central
nervous system. Patient-controlled analgesia can be realized with
microprocessor controlled electronic perfusion and infusion devices.
Transcutaneous electrical nerve stimulation is another possibility for
suppressing post operative pain [6]. Moreover, scientific literature describes
the use of acupuncture for perioperative pain treatment in different types of
surgical interventions [7,8].
For the first time, this study applies the new laserneedle acupuncture method
as a possible additive method to pharmacologic pain treatment. The use of
laserneedles seems to achieve a subjective, additive suppression of pain and
leads to changes in the required pain medication within a 90 minute
postoperative observation period. Criterion for the required analgesics was
based on the patients rating of pain intensity on a visual pain analogue scale.
Non-invasive laserneedle stimulation can induce specific, reproducible
changes in the brain. This leads to changes in different parameters such as
cerebral blood flow velocity, and for the first time can be objectified with the
newest neuromonitoring methods [1-4]. This new method of painless
acupuncture has not yet been used experimentally or clinically in the field of
postoperative pain treatment.
Further investigations with a larger patient collective are necessary to
evaluate and optimize this method before laserneedle acupuncture can be
considered as an additive in routine, postoperative pain treatment.
189
The authors thank Ingrid Gaischek MSc for her valuable support in data
analysis and preparing the manuscript (Biomedical Engineering and
Research in Anaesthesia and Intensive Care Medicine, Medical University
Graz).
18.6 References
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
Litscher G, Schikora D (Eds) (2004) Lasernadel-Akupunktur.
Bremen
Jage J (1997) Schmerz nach Operationen. Wissenschaftliche
Verlagsgesellschaft, Stuttgart
Bjordal JM, Johnson MI, Ljunggreen AE (2003) Transcutaneous
electrical nerve stimulation (TENS) can reduce postoperative
analgesic consumption. A meta-analysis with assessment of optimal
treatment parameters for postoperative pain. Eur J Pain 7(2): 181-188
Usichenko TI, Lysenyuk VP, Groth MH, Pavlovic D (2003) Detection of
ear acupuncture points by measuring the electrical skin resistance in
patients before, during and after orthopedic surgery performed under
general anesthesia. Acupunct Electrother Res 28(3-4): 167-173
Stener-Victorin E, Kowalski J, Lundeberg T (2002) A new highly
reliable instrument for the assessment of pre- and postoperative
gynecological pain. Anesth Analg 95(1): 151-157
190
19. Effects of laserneedle stimulation in the

external auditory meatus on very early
auditory evoked potentials
G. Litscher
19.1 Introduction
In the past years, several new, technical advancements in laser acupuncture
have triggered an innovative jump in this field of study. In addition,
scientific studies have proven that laserneedle acupuncture can achieve
needle-equivalent, reproducible changes in cerebral parameters, that can be
registered with modern neuromonitoring techniques [1-5].
Laser light stimulation in the external auditory canal and its effects on early
(BAEP; latency: 1 - 10 ms) and very early auditory evoked potentials
(SAEP; latencies: < 1 ms) have not yet been scientifically investigated. In
this study, laserneedle-induced changes in biological factors of SAEP, could
be determined and registered for the first time in 23 healthy volunteers using
this measurement technique.
19.2 Methods
19.2.1
Laserneedle stimulation in the external auditory meatus
For application of laser stimulation in the right external auditory meatus, an

adapter was developed which is similar to a spectacle construction and is
fixed at the ear (see Fig. 19.1 and Fig. 19.2). A total of 4 optical fibers were
conducted into the external auditory meatus using a rotating, round holder
allowing different distances. These laserneedles deliver continuous or
frequency-modulated laser light with a wavelength of 685 nm and an output
of 30 - 40 mW per laserneedle. Duration of stimulation was 10 minutes
resulting in a power density of 2.3 kJ/cm at each laserneedle and an average
total of 9.2 kJ/cm [1-5].
In addition to laser light stimulation, a sound tube for acoustic stimulation of
evoked potentials was integrated in the adapter. The entire adapter does not
include any metal parts; only plastic components were used.
191
Fig. 19.1: Stimulation adapter for optical laser stimulation in the area of the external
acoustic meatus. A sound tube for acoustic stimulation between the 4 laserneedles is
implemented in the construction.
19.2.2
Auditory evoked potentials of early latency
Acoustic stimulation was performed with clicks of 200 s duration and

alternating polarity with a frequency of 11.1 Hz. Stimulus intensity was 105
dB nHL (normal hearing level). The contra-lateral ear was not masked.
Miniature earphones (Nicolet 464-656, Nicolet Instrument Corp., Madison,
WI, USA) which were connected to a sound tube were used for stimulation.
Gold cup electrodes (Grass E6GH) between the vertex (Cz) and right ipsilateral mastoid (Cb2) were used on the volunteers. The ground electrode was
located at the position Fz. Skin-electrode impedance was < 3 kOhm. The cup
electrodes were directly connected to active electrodes for amplifying the
signals in the head region enabling the registration of bioelectric cerebral
activities with a minimum of artifacts [6] (compare Fig. 19.2). In each
investigation, at least 2000 single clicks were averaged and each
measurement was reproduced one time. A PC-based neuromonitoring system
(Viking IV, Nicolet Instrument Corp., Madison, WI, USA) was used for data
analysis.
192
Fig. 19.2: Experimental set-up of laser stimulation at the laboratory of Biomedical

Engineering and Research in Anaesthesia and Intensive Care Medicine at the
Medical University of Graz.
19.2.3
Volunteers and procedure
SAEP and BAEP were investigated in a total of 23 healthy volunteers, mean

age (r SD) from 26.5 r 3.6 years (range 20 to 36 years old; 15 f, 8 m). The
volunteers were informed about the procedure and gave their written
consent. The study was approved by the ethical committee at the Medical
University of Graz. None of the volunteers took central nervous system
active medication during the study period and the neurological, mental and
otological status was normal in all test persons.
In addition to the amplitudes of wave I and those of the IV/V-complex in
brainstem auditory evoked potentials, the amplitudes of very early AEPresponses including so-called stimulation artifacts were evaluated. Further,
the tympanic temperature using a ThermoScan pro LT (Thermoscan Inc.,
San Diego, CA, USA) was investigated before and after the three
examination phases (a) resting phase (steady state), (b) continuous
laserneedle stimulation and (c) frequency-modulated (2 Hz) laserneedle
stimulation.
193
19.2.4
Analysis of measurement data and graphic presentation was performed with

the computer programs SigmaStat and SigmaPlot (Jandel Scientific Corp.,
Erkrath, Germany). The paired t-test was used for statistical evaluation and
graphic illustration was done with box-plot illustrations. Criterion for
significance was determined by p < 0.05.
19.3 Results
The first five components of BAEP could be isolated and reproduced in all
test persons and corresponded with conventional standards [7]. One example
is shown in Fig. 19.3.
resting condition without stimulation
continuous laserstimulation
frequency-modulated laserstimulation (2 Hz)
Fig. 19.3: Early auditory evoked potentials without (a), during continuous (b) and
during frequency-modulated (c) laser stimulation in a 24-year-old volunteer. Note
the occurrence of very early stimulus responses and the increase in stimulation
artefacts (see arrows) despite alternating stimulation modes during laser stimulation.
The tables show the absolute latencies of components I, III and V in milliseconds
(ms) as well as the interpeak latencies I-III, III-V and I-V in ms and the amplitude
relationships (I-I)/(V-V).
194
The mean amplitudes of SAEP, of wave I (Ia) and of the IV/V-complex

(IV/V)a during resting conditions (without stimulation; steady state), after
continuous laserneedle stimulation and after frequency-modulated (2 Hz)
laserneedle stimulation in all volunteers can be found in Figure 19.4.
SAEP
V
0,4
Ia
(IV/V)a
p = 0.014 (s.)
n=23
p = 0.019 (s.)
0,3
n.s.
n.s.
0,2
0,1
0,0
cw
S1
LN
LN
cw
S1
LN
LN
cw
S1
LN
LN
Fig. 19.4: Box-plot illustrations of very early auditory evoked potentials (SAEP),
amplitudes of the wave I (Ia) and amplitude of the IV/V-wave complex (IV/V)a in
V under condition R (= resting, steady state, control measurement), cw LN
(continuous laserneedle stimulation) and S1 LN (2 Hz frequency-modulated
laserneedle stimulation). Note the significant increase in SAEP during laser
stimulation. The horizontal line in the box shows were the median is situated. The
ends of the box define the 25th and 75th percentile; error bars show the 10th and
90th percentile.
Whereas the amplitudes of wave I and those of the IV/V-complex did not
reveal significant changes during laser stimulation, the mean amplitude of
the stimulation artifact under continuous (p = 0.019), as well as during 2 Hzmodulated stimulation (p = 0.014) show a significant increase.
The tympanic temperatures measured immediately after each phase of
investigation are shown in Figure 19.5.
195
C
38,0
normal range for ear temperature

(11 - 65 years)
37,5
37,0
36,5
36,0
p < 0.001 (s.)
35,5
p < 0.001 (s.)
35,0
cw
LN
S1
LN
Fig. 19.5: Laser stimulation related changes in temperature at the external auditory
meatus. The normal range for ear temperature given by the manufacturer is shown
on the right (R = resting, without stimulation; cw LN = continuous laser stimulation;
S1 LN = frequency-modulated laser stimulation). For further details, see Fig. 19.4.
19.4 Discussion
Laser has gained a permanent position in the field of acupuncture.
Corresponding to the desired solutions, the quality of different laser systems
must be applied. Future developments in laser technology will be based on
the new application of laser in the field of medicine in general, and its
specific use in acupuncture. Factors such as the better understanding of
working mechanisms, availability of technically perfected laser
constructions and the development of flexible optical transmitting systems
and optical fibers all lead to technically simpler systems and will play an
increasing role in the future [8].
Whereas laser technology is increasingly used in the fields of surgery,
ophthalmology or gynecology, comparatively few scientific studies dealing
with this topic can be found in the field of ear, nose and throat medicine.
In this study, we tried to objectify peripheral and possible cerebral effects of
this stimulus modality using computer-aided, bioelectric stimulus responses
after performing laserneedle stimulation in the external auditory meatus.
196
Therefore auditory evoked potentials of very early latency were used. Socalled clicks (= rectangular impulses) with a duration of 200 s were used
as stimulus impulses. Effects on latency, amplitudes and waveforms of early
auditory evoked potentials dependent on the polarity of electrical
stimulation, were investigated and described in detail in the literature [9-11].
If these stimuli are presented alternately, i.e. alternating once positive and
once negative, stimulus-related artifacts which occur during stimulus
presentation of one polarity are averaged in the signal response.
In the same manner, electro-cochleographic potentials originating in the presynaptic region in the hair cells and their support structures, cochlear
microphonics and the summating potential are normally eliminated by
alternating the polarity of the stimulus.
Small blood vessels transport oxygen and nutrition and supply the sensory
cells responsible for hearing. In case of hypo-perfusion, cells are damaged
and their function is disturbed. Goal of standard medical treatment is to
avoid potential sudden deafness and improve the flowing characteristics of
blood. Other methods of blood cleansing or the so-called hyperbaric oxygen
therapy are further possibilities. Latter leads to an increase in oxygen in
blood and tissues which should result in an improved clinical picture.
The treatment with laserneedles could provide a further option e.g. as
tinnitus therapy. It is very interesting that changes in SAEP triggered by
laser stimulation could be registered in this study. In this latency range,
microphonic potentials, summating potentials and subsequently, summating
active potentials of the auditory nerve could be recorded (Fig. 19.6).
197
10 V
10 V
CM
c
0,1 V
CM
N1
d
0,1 V
AP
1 ms
Fig. 19.6: Very early auditory evoked potentials (SAEP) in a 20-year-old volunteer
after performing positive (a) and negative (b) clicks; (c) shows microphonic
potentials (CM) and (d) the summating action potential (AP = N1).
The main component, the post synaptic wave N1 (compare Fig. 19.6),
represents a summating action potential of the auditory nerve and doesnt
actually originate in the cochlea [12]. However, microphonic potentials
(CM) are considered as a cochlear event but do not play a major role in
clinical diagnostics [12].
Our results obtained from earlier studies showed an interesting phenomenon,
that definitely biologically-related changes in stimulus artifacts, despite
unchanged stimulus and monitoring parameters in coma depasse occur
[13,14]. During our present study, measurements with laser stimulation
showed a change in SAEP in the sense of a positive increase in these
components, whereas results from previous studies on comatose patients, or
in the extreme case of coma depasse, indicated a contrary negative increase
in activity [13,14].
Similar results, namely different early AEP-stimulation responses (wave I to
V) to positive and negative auditory stimulation in healthy persons as well as
198
in pathological cases, have already been discussed in the literature [13,14]. A
solution for this problem, probably lies in the mechanics of the inner ear, but
is not yet in sight. More specific information regarding the actual pressure
conditions within the ear would be necessary. This is difficult to determine
because the insertion of a microprobe additionally alters the course of sound
pressure within the ear [13,14].
A second hypothesis is based on the assumption that extra cerebral changes
in functional impedance occur. Already back in 1973 [15], scientists
reported irreversible functional disturbances in the brain after ischemia and
after anoxia resulting in a reduction of cortical impedance compared to the
initial value, whereas an increase in impedance occurred in the reticular
formation.
A further hypothesis can be supposed for the arising changes in SAEP under
laser stimulation, which indicates that these stimulus-related depolarization
processes in extra cerebral areas of the auditory system underlie altered
conditions of impedance.
In order to get more exact results in the future, we could use a transtympanic or extra tympanic technique to register the changes resulting from
laser stimulation instead of registering induced bioelectrical activity from the
mastoid, as performed in this study. The trans-tympanic technique requires
the application of a thin metal needle through the ear and eardrum to the
nearest area of the inner ear; the less invasive extra tympanic technique
allows the registration of changes in potential by applying a needle electrode
behind the ear and advancing it near the eardrum.
Further investigations such as exact analysis of accompanying temperature
effects are necessary before final statements regarding this topic can be
made.
The author thanks Ms. Ingrid Gaischek MSc and Ms. Lu Wang MD (both
Biomedical Engineering and Research in Anaesthesia and Intensive Care
Medicine, Medical University of Graz) for their valuable support in data
registration and data analysis. The author thanks Dr. Detlef Schikora
(University of Paderborn) for the development of the ear adapter prototype.
199
19.6 References
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
[13]
[14]
[15]
Litscher G, Schikora D (Eds.) (2004) Lasernadel-Akupunktur.
Bremen
Litscher G (1998) A mulitifunctional helmet for noninvasive
neuromonitoring. J Neurosurg Anesthesiol 10(2): 116-119
Litscher G (1995) Continuous brainstem auditory evoked potential
monitoring during nocturnal sleep. Int J Neurosci 82(1-2): 135-142
Albrecht H, Rohde E, Zgoda F, Mller G (2002) Lasersysteme. In:
Kramme R. (Ed.) (2002) Medizintechnik. Springer, Berlin Heidelberg
New York, pp. 296-318
Maurer K, Schfer E, Leitner H (1980) The effect of varying stimulus
polarity (rarefaction vs. condensation) on early auditory evoked
potentials (EAEPs). Electroenceph Clin Neurophysiol 50: 332-334
Stockard JJ, Stockard JE, Sharbrough FW (1978) Non-pathologic
factors influencing brainstem auditory evoked potentials. Am J EEG
Technol 18: 177-209
Stockard JE, Stockard JJ, Westmoreland BF, Corfits JL (1979)
Brainstem auditory-evoked responses. Normal variation as a function
of stimulus and subject characteristics. Arch Neurol 39: 823-831
Maurer K, Lowitzsch K, Sthr M (1990) Evozierte Potentiale. AEP VEP - SEP. Atlas mit Einfhrungen. Ferdinand Enke Verlag, Stuttgart
Litscher G, Schwarz G, Kleinert R (1995) Brain-stem auditory evoked
potential monitoring. Variations of stimulus artifact in brain death.
Electroenceph Clin Neurophysiol 96: 413-419
Litscher G, Schwarz G, Jobstmann R, Kehl G, Kleinert R (1996) Brainstem auditory evoked potential monitoring. The increase of the
stimulus artifact in the development of brain death: a biological
phenomenon? Int J Neurosci 91(1-2): 95-103
Lechner H, Ott E (1973) Impedanzuntersuchungen bei reversiblen
und irreversiblen Funktionsverlust des Gehirns. In: Krsl W, Scherzer
E (Eds.) (1973) Die Bestimmung des Todeszeitpunktes. Maudrich,
Wien, pp. 163-170
200
20. List of references

Chapter 2: Litscher G, Schikora D (2002) Cerebral vascular effects of
noninvasive laserneedles measured by transorbital and transtemporal
Doppler sonography. Lasers Med Sci 17: 289-295.
Chapter 3: Litscher G, Schikora D (2002) Near-infrared spectroscopy
for objectifying cerebral effects of needle and laserneedle
acupuncture. Spectroscopy 16/3-4: 335-342.
Chapter 5: Litscher G, Nemetz W, Smolle J, Schwarz G, Schikora D,
Urans
S
(2004)
Histologische
Untersuchungen
zu
mikromorphologischen
Einflssen
von
Ergebnisse einer tierexperimentellen Untersuchung. Biomed Technik
49: 2-5.
Chapter 6: Litscher G (2003) Laserneedle-Akupunktur auf dem
Prfstand der Wissenschaft. Schweizerische Z f Ganzheitsmedizin 15:
253-259.
Chapter 7: Litscher G (2004) Effects of acupressure, manual
acupuncture and Laserneedle acupuncture on EEG bispectral index
(BIS) and spectral edge frequency (SEF) in healthy volunteers. Europ
J Anaesthesiol 21: 13-19.
Chapter 8: Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D,
Fazekas F, Ebner F (2004) Acupuncture using laserneedles modulates
brain function: First evidence from functional transcranial Doppler
(fMRI). Lasers Med Sci 19: 6-11.
Chapter 9: Litscher G, Wang L, Huber E, Schikora D, Schwarz G
(2004) Quantitative Bestimmung geschlechtsspezifischer thermischer
Empfindungsund
Schmerzschwellen
vor
und
nach
Lasernadelstimulation. Biomed Technik 49(5): 106-110.
Chapter 10: Litscher G, Wang L, Schikora D, Rachbauer D, Schwarz
G, Schpfer A, Ropele S, Huber E (2004) Biological effects of
painless laserneedle acupuncture. Medical Acupuncture 16(1): 24-29.
201
Chapter 11: Litscher G, Wang L, Schwarz G, Schikora D (2005)
Intrakranieller
Druckanstieg
nach
zerebralen
Blutflussgeschwindigkeitsnderungen
durch
Akupressur,
Nadelakupunktur
und
Lasernadelakupunktur?
Forschende
Komplementrmedizin und Klassische Naturheilkunde, subm.
Chapter 18: Litscher G, Schwarz G, Schpfer A, Wang L, Saraya M,
Schikora D (2005) Laser-Nadel-Stimulation als potenzielle additive
Methode zur postoperativen Schmerztherapie. Schmerz & Akupunktur
4: 2-5.
202
21. Websites
http://www.laserneedle.ch
http://www.laserneedle.de
http://www.laserneedle.at
http://litscher.info
High-Tech Acupuncture
http://litscher.at
Biomedical Engineering and

Research in Anesthesia and
Intensive Care Medicine,
203
Addendum
204
Biomedical Engineering and Research

in Anesthesia and Intensive Care Medicine
Laserneedle - Stimulation
205
ComputerComputer-based Quantification
LaserneedleLaserneedle-Acupuncture
Peripheral
Effects
Thermography
(surface temperature)
Laser Doppler
Flowmetry
(microcirculation)
Laser Doppler
Imaging
+ Standard parameters
NeedleNeedle-Acupuncture
Central
Effects
Multidirectional
Transcranial UltrasoundDoppler Sonography
(blood flow velocity)
Cerebral Near-infrared
Spectroscopy (changes of
cerebral oxygen metabolism)
f MRI
Bioelectrical Methods
(EEG, BIS, EP)
Laserneedle Animal Experiments
206
Laserneedle - Thermography
Laserneedle - Thermography
10:40
10:42
10:44
10:46
207
Laser Doppler Perfusion Imaging
Laser Doppler Perfusion Imaging
before
immediately
after
after
208
Laserneedle - Stimulation
ComputerComputer-based Quantification
Cerebral Effects
209
Laserneedle Acupuncture Research
Ophthalmic Artery
(OA)
210
Laserneedle Acupuncture - fMRI
211
Laserneedle Stimulation
Neuromonitoring
212
Laserneedle - Acupuncture - Yintang
213
as a potential additive method for post operative
pain treatment
University Clinic for Anesthesiology and Intensive Care Medicine Graz
214
LASERneedle - History:
First Generation (1998)
Second Generation
(2000)
The Laserneedle
Laserneedles were developed at the University of Paderborn (1997-1999)
[ Dr. D. Schikora, Dr. M. Bartels, R. Winterberg ]
Laserneedles are:
fiberoptic acupuncture needles
with non-invasive contact application
Goals of the development were:

needle equivalent stimulation effects
needle equivalent functioning
(simultaneous stimulation of various acupuncture
point combinations)
215
LASERneedle-medical
the most effective laser acupuncture system of our time

with 8 painless, bichromatic laserneedles,
completely sufficiently for each experienced acupuncturist
and each indication
LASERneedle-frequency
Diagnostics according to BAHR and NOGIER

Special analgesic frequencies to increase
endorphins and non-endorphinerg
transmitters
216
LASERneedle - applicators
comfortable, rapid fixation of laserneedles

on acupoints using self-adhesive
non-reusable applicators
Dermatology: Laser surface illumination

using LASERneedle
Acute and chronic eczema

Neurodermatitis
Chronic ulcer and phlebitis
Psoriasis
Lichen ruber planus
Verruca
Alopecia areata
Herpes
I = 20
I = 0
4
x / [mm]
2
0
-2
=
=
=
=
=
d0
0.9996
0.9992
0.9990
0.9986
*
*
*
*
d0
d0
d0
d0
4
x (B)
2
0
-4
-6
-6
-4
-2
y / [mm]
x (A)
-2
-4
-6
d
d
d
d
d
x / [mm]
d
d
d
d
d
x (C)
-6
-4
-2
y / [mm]
= 1.02 *
= 1.01 *
= d0
= 0.99 *
= 0.98 *
d0
d0
d0
d0
217
LASERneedle-dental
Parodontolology
Aphthae, wounds, postoperative pain therapy,

pulpalgia, inflammation of the gingivae
complementary: nausea-acupuncture
Endodontology
LASERneedle - optical technologies
Laserneedlesurface-polishing procedure
Computer-controlled laser fiber coupling
The ability to heal illnesses and relieve pain with light is a fascinating vision.
Scientists agree that the 21st Century will be the century of photons,
as the past 20th Century was that of the electrons.
The laserneedles described in this compendium are characteristic
for modern advancements.
For the first time, they allow painless and highly effective acupuncture treatment according to traditional rules. Why this is possible is
discussed in this book.
Laserneedles are products from interdisciplinary and international
research. Their effects open up new therapeutic dimensions beyond
acupuncture whose medical-technological foundations are
described here by authors from Austria, China, Germany and
Switzerland.
ISBN 3-89967-199-6 (Europe)

ISBN 1-59326-074-1 (USA)
www.pabst-publishers.com

Acupuntura Laser Book

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Acupuntura Laser Book

Uploaded by

Copyright:

Available Formats

Gerhard Litscher and Detlef Schikora (Eds.

Gerhard Litscher and Detlef Schikora

PABST SCIENCE PUBLISHERS

Gerhard Litscher, Prof MSc PhD MDsc

2005 Pabst Science Publishers, 49525 Lengerich, Germany

Medical University of Graz

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

Cerebral vascular effects of noninvasive laserneedles measured

Near-infrared spectroscopy for objectifying cerebral

Communication between acupoint and brain proved

TCD monitoring of the anterior and posterior

Histological investigations regarding micromorphological

Effects of laserneedle stimulation on microcirculation and

Effects of acupressure, manual acupuncture and

Acupuncture using laserneedles modulates brain function:

Quantification of gender specific thermal sensory and

10.2.2 Functional multidirectional transcranial Dopplersonography (fTCD) ..................................................... 113

11. Increases in intracranial pressure and changes in blood

Editors (and authors):

Introduction and motivation

In the past 30 years, acupuncture established itself in Europe and America.

Dose-effect relationships in acupuncture

One of the fundamental biophysiological laws, the Weber-Fechners Law,

The curve illustrates threshold characteristics of physiological stimulation.

change in blood flow velocity [cm/s]

laserneedle - power density [W/cm ]

Fig.1.2: Change in blood flow velocity in the OA in dependence on the power

Figure 1.2 clearly shows that acupuncture of the seven eye-specific

Laserneedle acupuncture as a placebo method

The requirements of an adequate placebo needle and an adequate placebo

laserneedle - power [mW]

Fig. 1.3: Changes in cerebral oxyhaemoglobin concentration when using a visual

Stimulation of the olfactory system was done with acupoints Yinxiang,

Physical characteristics of laserneedles

The laserneedles were developed at the University of Paderborn to provide a

Fig. 1.5: Laserneedle for acupuncture.

Physical foundation of stimulation effects in the numerous experimental

Optical power density

Exemplary calculations show that a power density of 0.25 W/cm2 results

applied light energy dose per laserneedle [J]

duration of treatment [min]

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

Fig. 1.7: Absorption behaviour of important tissue structures dependent on the

Fig. 1.8: Schematic illustration of a semi-conductor laser diode.

Pomeranz B (1998) Wissenschaftliche Grundlagen der Akupunktur.

Cerebral vascular effects of non invasive

Fig. 2.1: Computer-Controlled Acupuncture (CCA) [1] and Computer-Controlled

Fig. 2.2: The laserneedle system is a class 3B laser system, therefore it is

The non invasive laserneedles were constructed to fulfil two essential

total output power

optical fibre diameter [ a.u.]

laser energy density [ J/cm]

800 1000 1200 1400

Multidirectional transorbital and transtemporal Doppler

Transorbital and transtemporal Doppler sonographic examinations were

Acupuncture and procedure

Seven vision related acupoints were tested in two sessions (laserneedle

Non invasive Laserneedles

Manual Needle Acupuncture

Ophthalmic artery (OA)

Ophthalmic artery (OA)

Middle cerebral artery (MCA)

Middle cerebral artery (MCA)

*Kruskal-Wallis ANOVA on Ranks