An examination of acupuncture psychophysical response (De Qi) parameters, scales and implications for clinical practice

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According to the theory of traditional Chinese acupuncture, acupuncture psychophysical responses (De-Qi) is a fundamental characteristic of acupuncture and believed to be indicative of a successful therapeutic acupuncture treatment. The phenomenon is understood to represent a constellation of subjective unique psychophysical responses of varying characteristics during the administration of acupuncture. Certain sensory responses are also thought to serve as an indicator for the dose of acupuncture needling. Qualities or characteristics of these sensory responses are often utilised to perform quantitative evaluation of acupuncture dosage. Hence, to ascertain the acupuncture-specific effects in an optimal way, it is essential to investigate this complex phenomenon into its constituent components. Furthermore, preliminary investigations indicate interoception to be reflective of De-Qi. Studies have reported that exposure of individuals to an unfamiliar situation or experimental study may cause anxiety, which is likely to influence sympathetic nervous system activity. It is also proposed that environmental or interoceptive signals are linked with a perceived sense of threat in anxious individuals which in turn may affect the perception of De-Qi in clinical settings. Recently several measures have been developed to quantify the potency and characteristics of the De Qi, as it is often reported that one of the major criticisms of acupuncture remains the lack of scientifically acceptable data and measurable efficacy. With this in mind, this dissertation examines the psychophysical responses experienced during acupuncture within the context of an acupuncture randomised clinical trial. At the same time, the thesis highlights the importance of understanding interoception and in particular the role of self-awareness, which may contribute to the placebo effect, and psychophysical responses that are often observed in clinical studies. Additionally, the role of pre-operative or situational anxiety in the elicitation of the acupuncture psychophysical responses was investigated. The study also investigates the influence of culture on individuals’ perception of acupuncture sensory responses and provocation of negatively valanced emotions such as situational anxiety. Finally, the thesis systematically and critically appraises all the existing scales developed to quantify acupuncture psychophysical responses by adhering to published guidelines such as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) quality criteria guidelines.
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