Laserterapia

1. Gerhard Litscher and Detlef Schikora (Eds.)
Science
and
Practice
PABST
Laserneedle-
Acupuncture
Laserneedle-
Acupuncture
Gerhard Litscher and Detlef Schikora (Eds.)

3. III
Gerhard Litscher and Detlef Schikora
(Eds.)
Laserneedle - Acupuncture
Science and Practice
PABST SCIENCE PUBLISHERS
Lengerich, Berlin, Bremen, Miami,
Riga, Viernheim, Wien, Zagreb

4. IV
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The authors and the publisher of this volume have taken care that the information and
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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 Straße 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)

5. V
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 Düsseldorf. 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 1990´s. 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.

6. 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
University of Paderborn Medical University of Graz

7. 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
2.6 Acknowledgements .................................................................... 29
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
3.2.4 Statistical analysis ......................................................... 36
3.3 Results ....................................................................................... 36
3.4 Discussion .................................................................................. 38
3.5 Acknowledgements .................................................................... 41
3.6 References .................................................................................. 41
4. Communication between acupoint and brain proved
by ultrasound ...................................................................................... 43
4.1 Introduction ................................................................................ 43
4.2 Methods and materials................................................................ 43

8. VIII
4.2.1 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
4.2.4 Statistical analysis ......................................................... 48
4.3 Results ....................................................................................... 48
4.4 Discussion .................................................................................. 53
4.5 Acknowledgements .................................................................... 55
4.6 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
5.5 Acknowledgements .................................................................... 62
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
6.2.3 Statistical analysis ......................................................... 67
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
7.2.4 Statistical analysis ......................................................... 77

9. IX
7.3 Results ....................................................................................... 77
7.4 Discussion .................................................................................. 81
7.5 Acknowledgements .................................................................... 85
7.6 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
8.2.7 Statistical analysis ......................................................... 92
8.3 Results ....................................................................................... 92
8.4 Discussion .................................................................................. 96
8.5 Conclusions ................................................................................ 98
8.6 Acknowledgements .................................................................... 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. X
10.2.2 Functional multidirectional transcranial Doppler-
sonography (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
10.2.7 Statistical analysis ....................................................... 114
10.2.8 Evaluation parameters ................................................. 115
10.3 Results ..................................................................................... 115
10.4 Discussion ................................................................................ 121
10.5 Conclusion................................................................................ 122
10.6 Acknowledgements .................................................................. 122
10.7 References ................................................................................ 122
11. Increases in intracranial pressure and changes in blood
flow velocity due to acupressure, needle and
laserneedle acupuncture?................................................................. 124
11.1 Introduction .............................................................................. 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
11.5 Acknowledgements .................................................................. 133
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

11. 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

12. 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
18.2.3 Statistical analysis ....................................................... 187
18.3 Results ..................................................................................... 187
18.4 Discussion ................................................................................ 188
18.5 Acknowledgements .................................................................. 189
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
19.2.4 Statistical analysis ....................................................... 193
19.3 Results ..................................................................................... 193
19.4 Discussion ................................................................................ 195
19.5 Acknowledgements .................................................................. 198
19.6 References ................................................................................ 199
20. List of references............................................................................... 200
21. Websites............................................................................................. 202
Addendum................................................................................................. 203

13. 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
University of Paderborn
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
Medical University of Graz
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 ‘Ärzte-Forum für Akupunktur e.V.’
Ostenallee 107
59071 Hamm / Germany
Evamaria Huber
Department of Biomedical Engineering and Research in Anesthesia and
Intensive Care Medicine, Medical University of Graz
Auenbruggerplatz 29
8036 Graz / Austria

14. XIV
Knut Kolitsch, MD
General practitioner and expert for special pain therapy
Oelzer Straße 12
98746 Katzhütte/Thüringen / 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
Medical University of Graz
Auenbruggerplatz 22
8036 Graz / Austria
Matthias Saraya, MD
Department of Anesthesiology for Neurosurgical and Craniofacial Surgery
and Intensive Care, Medical University of Graz
Auenbruggerplatz 29
8036 Graz / Austria
Andreas Schöpfer, MD
Department of Anesthesiology for Neurosurgical and Craniofacial Surgery
and Intensive Care, Medical University of Graz
Auenbruggerplatz 29
8036 Graz / Austria
Gerhard Schwarz, Prof MD
Department of Anesthesiology for Neurosurgical and Craniofacial Surgery
and Intensive Care, Medical University of Graz
Auenbruggerplatz 29
8036 Graz / Austria

15. XV
Josef Smolle, Prof MD
University Clinic for Dermatology, Medical University of Graz
Auenbruggerplatz 8
8036 Graz / Austria
Kirsten Stähler van Amerongen, MD
Gynecological Clinic
Inselspital Berne
University of Berne
Effingerstrasse 102
3010 Bern / Switzerland
Selman Uranüs, Prof MD
Department of Surgical Research, University Surgical Clinic, Medical
University of Graz
Auenbruggerplatz 29
8036 Graz / Austria
Lu Wang, MD Dipl. Acup.
Department of Biomedical Engineering and Research in Anesthesia and
Intensive Care Medicine, Medical University of Graz
Auenbruggerplatz 29
8036 Graz / Austria
Michael Weber, MD Dipl. Chem.
General practitioner, emergency medical aid, naturopathic treatment,
acupuncture
Lönsstraße 10
37697 Lauenförde / 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.

17. 1
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 ß-endorphin, establish the complex picture of neuro-
biological 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

18. 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 well-
established 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, double-
blind 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 1990´s. 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 non-
invasively 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.

19. 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

20. 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-Fechner´s 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.
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
0
1
2
3
4
5
0 2 4 6 8 10
Reizwirkung[a.u.]
Reizstärke [a.u.]stimulus strength [a.u.]
stimuluseffects[a.u.]

21. 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-Fechner´s 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/cm². 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.

22. 6
laserneedle - power density [W/cm
2
]
changeinbloodflowvelocity[cm/s]
metal needle
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-Fechner´s
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/cm². This indicates that the
optical power density of the laserneedles must be greater than 1.3 W/cm² 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 5 W/cm². We can assume that an increase in blood flow velocity in
the OA is based on a complex cerebral reaction resulting from acupoint

23. 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

24. 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 sham-
acupuncture.
Based on these criteria the applicability of laserneedle acupuncture as a
placebo method for classic needle acupuncture can be analyzed precisely.
We already mentioned that laserneedles are not inserted into the skin, 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/cm²
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
5 W/cm² 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.

25. 9
laserneedle - power [mW]
metal needle
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 sham-
acupuncture presents a fundamentally unsolved and principally unsolvable
problem for classic acupuncture with metal needles. We examined the
possibilities to differentiate and define these three modalities 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.

26. 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 sham-
situation.
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 placebo-
acupuncture method. Since the reproducible De-Qi sensations can be

27. 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.

28. 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/cm² 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/cm² 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
at the skin
Optical power density
50 mW 5 mm 0.25 W/cm²
50 mW 0.5 mm 25.5 W/cm²
50 mW 0.05 mm 2550 W/cm²
Tab. 1.1: Connection between laser power, laser-spot diameter and optical 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 spot-
diameter 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/cm²,
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].

29. 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.
0
10
20
30
40
50
60
0 5 10 15 20 25
duration of treatment [min]
appliedlightenergydoseperlaserneedle[J]
Fig. 1.6: Light dose of a laserneedle dependent on the duration of treatment.
In order to determine the entire optical power transferred into tissue 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.

30. 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.

31. 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 doesn’t 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/cm². Today,
we attribute power densities of 10 W/cm² 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/cm². Neither micro-
thrombosis 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

32. 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 cm².
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 References
[1] NIH Consensus Conference (1998) Acupuncture. JAMA 280: 1518-
1524
[2] Yamashita H, Tsukayama H, Hori N, Kimura T, Tanno Y (2000)
Incidence of adverse reactions associated with acupuncture. J Altern
Complement Med 6: 345-350
[3] Pomeranz B, Chiu D (1976) Naloxone blockade of acupuncture
analgesia: endorphin implicated. Life Sci 19: 1757-1762
[4] Mayer DJ, Price DD, Rafil A (1977) Antagonism of acupuncture
analgesia in many by the narcotic antagonist naloxone. Brain Res 2:
368-372

33. 17
[5] Pomeranz B (1998) Wissenschaftliche Grundlagen der Akupunktur.
Springer, Berlin-Heidelberg-New York-London-Paris-Tokio-Hongkong
[6] Irnich D, Beyer A (2002) Neurobiologische Grundlagen der
Akupunkturanalgesie. Schmerz 16: 93-102
[7] Streitberger K, Kleinhenz J (1998) Introducing a placebo needle into
acupuncture research. Lancet 352: 364-365
[8] Frauenheim T, Schikora D (2003) J Med Phys, subm.
[9] 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
[10] Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D (2004) Die
schmerzfreie Lasernadelakupunktur moduliert die Gehirnaktivität:
Erste Nachweise mit funktioneller transkranieller Dopplersonographie
(fTCD) und funktionellem Magnetresonanzimaging (fMRI). Schmerz &
Akupunktur 1: 4-11
[11] Litscher G, Schikora D (2002) Near-infrared spectroscopy for
objectifying cerebral effects of needle and laserneedle acupuncture.
Spectroscopy 16: 335-342
[12] Schikora D. Europäisches Patent EP01/08504
[13] Litscher G, Nemetz W, Smolle J, Schwarz G, Schikora D, Uranüs S
(2004) Histologische Untersuchungen zu mikromorphologischen
Einflüssen von Lasernadelstrahlung - Ergebnisse einer
tierexperimentellen Untersuchung. Biomed Tech 49: 2-5

34. 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/cm² 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.

35. 19
CC omputeromputer--
CC ontrolledontrolled
AA cupuncturecupuncture®®
CC omputeromputer--
CC ontrolledontrolled
LL aserpunctureaserpuncture
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.

36. 20
MED-UNI GRAZ
CC omputeromputer--
CC ontrolledontrolled
LL aserpunctureaserpuncture
LaserneedlesLaserneedles
Fig. 2.2: The laserneedle system is a class 3B laser system, therefore it is
compulsory to wear specific laser protection glasses.
2.2 Methods
2.2.1 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 µm. 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/cm² at

37. 21
each acupoint and a total sum of 16.1 kJ/cm² 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/cm².
Fig. 2.3: Emission characteristics of a tailored laserneedle used in the present study
(a.u. = arbitrary units). The coherence of the laser radiation at the distal output of 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.
optical fibre diameter [ a.u.]
intensity[a.u.]
1 21
1
-2 -1
emission wavelength:
685 nm
total output power
at distal end:
30 mW
laser-needle emission-
characteristics
optical cladding
fibre core

38. 22
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/cm²). 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).
0
500
1000
1500
2000
2500
3000
3500
0 200 400 600 800 1000 1200 1400
laserenergydensity[J/cm²]
time [s]

39. 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 ( x + 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].

40. 24
Yan Dian
Eye
Liver
E2
ZanzhuYuyao
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.

41. 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 ( x) + standard deviation (SD) or standard error (SE).
The criterion for significance was defined as p < 0.05.
2.3 Results
The demographic data, the laser- and acupuncture schemes and the
measurements of mean blood flow velocity in the OA and MCA are
summarized in Fig. 2.6.

42. 26
Participants n=27
14 female, 13 male, mean age 25.15 + 4.12 (SD), range 21 – 38 years
Randomized, cross-over design
40
60
50
60
Ophthalmic artery (OA)
Middle cerebral artery (MCA)
Ophthalmic artery (OA)
Middle cerebral artery (MCA)
before (a) during (b) after (c)
Mean blood
flow velocity
Laserpuncture
x+ SE
Ophthalmic
artery (cm/s)
10.33+0.88 14.67+1.15 11.33+0.96
Middle cerebral
artery (cm/s)
54.93+3.28 54.56+3.26 55.07+3.50
before (a) during (b) after (c)
Mean blood
flow velocity
Acupuncture
x+SE
Ophthalmic
artery (cm/s)
10.22+0.83 19.15+1.20 12.22+0.94
Middle cerebral
artery (cm/s)
53.93+3.33 56.04+3.44 55.04+3.47
R
Non invasive Laserneedles Manual Needle Acupuncture
10
15
20
10
15
20
vm (cm/s)
a
a
a
a
b b
b
b
c
c
SE
c
c
p=0.01*
p<0.001*
*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

43. 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 acupuncture’s and laserpuncture’s effects. New experimental

44. 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
Pöntinen 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/cm².
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

45. 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 Thöne, Tanja Prohaska, Marianne Hubbert and Jörg
Reitemeyer for technical support.
2.7 References
[1] Litscher G, Cho ZH (Eds) (2000) Computer-Controlled Acupuncture®
.
Pabst Science Publishers, Lengerich-Berlin-Rom-Riga-Wien-Zagreb
[2] Schikora D. European Patent Nr. PCT/EP 01/08504
[3] König G, Wancura I (1989) Neue Chinesische Akupunktur. Lehrbuch
und Atlas der Akupunkturpunkte. Wilhelm Maudrich, Wien-München-
Bern
[4] Yoo TW (2001) Koryo hand therapy - Korean hand acupuncture. Eum
Yang Mek Jin Publishing Co, Seoul
[5] 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: 377-
380
[6] Judy MM (1995) Biomedical lasers. In: Bronzino JD. (Ed) The
Biomedical Engineering Handbook. CRC Press, IEEE Press, Boca
Raton (USA), pp. 1333-1345
[7] Fargas-Babjak A (2001) Acupuncture, transcutaneous electrical nerve
stimulation, an laser therapy in chronic pain. Clin J Pain 17 (4. Suppl):
105-113

46. 30
[8] 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
[9] 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
[10] 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
[11] Troshin OV (1994) A clinico-neurophysiological analysis of the single
action of laser puncture. Lik Sprava 5-6: 148-153
[12] Qin JN (1987) Laser acupuncture anaesthesia and therapy in People's
Republic of China. Ann Acad Med Singapore 16(2): 261-263
[13] Nikolaev NA (1986) Therapeutic efficacy of laser and electropuncture
reflexotherapy in correcting the initial manifestations of cerebral
circulatory insufficiency. Zh Nevropathol Psikhiatr Im S S Korsakova
86(1): 60-64
[14] Omura Y (1983) Non-invasive circulatory evaluation and electro-
acupuncture & TES treatment of diseases difficult to treat in Western
medicine. Acupunct Electrother Res 8(3-4): 177-256
[15] Schlager A, Oehler K, Huebner KU, Schmuth M, Spoetl L (2000)
Healing of burns after treatment with 670-nanometer low-power laser
light. Plast Reconstr Surg 105(5): 1635-1639
[16] 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
[17] 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
[18] 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: 19-
25
[19] Litscher G, Wang L, Wiesner-Zechmeister M (2000) Specific effects of
laserpuncture on the cerebral circulation. Lasers Med Sci 15: 57-62
[20] Litscher G (2001) High-Tech Akupunktur®
. Pabst Science Publishers,
Lengerich-Berlin-Rom-Riga-Wien-Zagreb
[21] Cho ZH, Wong EK, Fallon J (Eds) (2001) Neuro-Acupuncture I.
Neuroscience Basics. Q-Puncture Inc, Los Angeles
[22] 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
[23] 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

47. 31
[24] Litscher G, Wang L, Yang NH, Schwarz G (1999) Computer-controlled
acupuncture. Quantification and separation of specific effects. Neurol
Res 21(6): 530-534
[25] Litscher G, Wang L, Yang NH, Schwarz G (1999) Ultrasound-
monitored effects of acupuncture on brain and eye. Neurol Res 21(4):
373-377
[26] 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.
[27] 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
[28] 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
[29] Litscher G, Wang L (2000) Cerebral near infrared spectroscopy and
acupuncture - results of a pilot study. Biomed Technik 45(7-8): 215-
218
[30] Pöntinen PJ, Pothmann R (1998) Laser in der Akupunktur.
Hippokrates, Stuttgart
[31] Streitberger K, Kleinhenz J (1998) Introducing a placebo needle into
acupuncture research. Lancet 352: 364-365
[32] 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

48. 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-Beer´s
principle [4]. The system can measure the absolute value (µmol) 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.

49. 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.

50. 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 ( x + 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).

51. 35
Yan DianYan Dian
eyeeye
liverliver
E2E2
ZanzhuZanzhuYuyaoYuyao
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

52. 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.
10 min10 min
laserneedlelaserneedle
metalmetal needleneedle
StimulusStimulusintensityintensitySI[a.u.]SI[a.u.]
time [s]time [s]
OO22HbHb
OO22HbHb
HHbHHb
HHbHHb
StimulusStimulus intensityintensity -- cerebral NIRScerebral NIRS responseresponse
B.J., 22y, f
aa
bb
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.

53. 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 µmol 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.

54. 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 non-
invasiveness. It is possible to apply the laser in such a manner, that the test

55. 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 non-
invasiveness, 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.