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Electro-Acupuncture.
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ELECTRO-ACUPUNCTURE
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon
HISTORY AND GENERAL PRINCIPLES
Electro-acupuncture, the application of a pulsating electrical current to acupuncture needles as a
means of stimulating the acupoints, was developed in China as an extension of hand manipulation of
acupuncture needles around 1934. It is described, though only briefly, in most comprehensive texts of
acupuncture (1-4). The procedure for electro-acupuncture is to insert the acupuncture needle as would
normally be done, attain the qi reaction by hand manipulation, and then attach an electrode to the
needle to provide continued stimulation.
The benefits of using electrical stimulation are:
It substitutes for prolonged hand maneuvering. This helps assure that the patient gets the amount of
stimulation needed, because the practitioner may otherwise pause due to fatigue. Electro-acupuncture
may also help reduce total treatment time by providing the continued stimulus. During electro-
acupuncture, the practitioner can attend to other patients.
It can produce a stronger stimulation, if desired, without causing tissue damage associated with
twirling and lifting and thrusting the needle. Strong stimulation may be needed for difficult cases of
neuralgia or paralysis.
It is easier to control the frequency of the stimulus and the amount of stimulus than with hand
manipulation of the needles.
The main disadvantage of electrical stimulation of acupuncture needles is the lack of direct
practitioner participation in this aspect of acupuncture therapy and the associated limited opportunity
for the practitioner to respond to changes that are taking place during treatment. However, for
practitioners who, after inserting and initially stimulating the needles, normally leave the patient to rest
undisturbed without performing prolonged needle manipulation, electro-acupuncture can provide a
significant benefit: replacing the missing stimulus that is recommended by most experienced
acupuncturists in China.
Although electro-acupuncture may be used as a component of nearly all acupuncture treatments that
require manipulation of the needles, according to the Chinese literature, especially good results are
expected from electro-acupuncture treatment of neurological diseases, including chronic
pain, spasm, and paralysis.
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In patients with serious cardiac diseases, however, the method should be used with caution. It is
generally recommended to avoid placing electrodes near the heart, as the heart can respond
adversely to electrical impulses, and the path between any two electrodes should not cross the heart
area, despite the low current that is used. Some have suggested avoiding placing electrodes to
needles on both sides of the spinal cord (e.g., for Hua Tuo or bladder meridian points), because of the
possible effect of the electrical stimulus on the nervous system. Points are generally selected in pairs
for electrical pulse stimulation, with 1-3 pairs at one time, and the pairs are usually on the same side of
the body.
THE USE OF ELECTRICAL STIMULATION DEVICES
The electro-acupuncture device is not intended to provide a significant current between the
acupuncture needles: it delivers less than a milliampere (modern devices usually have an upper level
of 0.6 milliampere), about the same as that produced by a wristwatch battery. But, it will provide a
significant voltage: 40-80 volts (with short spikes as high as 130 volts), which is the basis for the
patient response. In the commonly-used portable battery devices, this is accomplished by boosting the
voltage output of the battery, such as raising the voltage from 9 volts to 45 volts. Thus, there is virtually
no current transmitted through the body, but there is enough of a local voltage stimulus for the patient to
feel an evident reaction at the point where the needle is inserted.
Duration of standard treatment with electro-acupuncture is usually 10-20 minutes and rarely exceeds
30 minutes. The electrical pulsing stimulus is used in a few cases for an hour or more, especially for
difficult to treat neurological disorders. During the stimulation period, the patient may become adapted
to the stimulus (this will typically happen after the first minute or two), with a gradual decline in
response. The electrical output should then be adjusted in frequency and/or intensity to resume the
sensation. Variable frequency output of the electro-acupuncture device is sometimes utilized in an
attempt to circumvent this adaptation.
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Electro-acupuncture is normally administered with alternating current. Therefore, the two electrodes in
any pair are equivalent, even if they are color coded to distinguish them. Some devices allow a direct
current (non-alternating) setting, but the use of this has been discouraged, as mild adverse effects
might occur if the pulsing of the current ceases for any reason (i.e., device defect). Further, it has been
suggested, though it remains to be proven, that the adaptation to the direct current may be more rapid
than to the alternating current. When it is said in electro-acupuncture literature that "the negative
electrode is attached to what is considered the main point, while the positive electrode is attached to
a secondary point," the statement has no relevance when using an alternating current.
The device to be used for electro-acupuncture (see Figure 1 for modern example) must have good
control over its voltage output to avoid excessive electrical stimulation, namely an unexpected higher
voltage pulse that causes pain or muscular contraction, and to assure that the frequency and intensity
is maintained as set by the practitioner. Informal testing of devices has showed that some are erratic
in their output, so older devices, and those not produced with adequate quality control measures, are
to be avoided. A device commonly used in China is the G6805 or G6805-2 electric stimulator.
The device should not be turned on until after the acupuncture needles are in place and the electrodes
connected. All changes in the electrical stimulus should be carried out gradually. It is normal for the
patient to experience responses such as rhythmic spasm or weak twitching of the muscle (frequently
visible to the practitioner), as well as the usual "deqi" reactions of acupuncture therapy: sensation of
numbness, distention, and/or heaviness. The stimulus intensity, set by a voltage-adjusting knob on the
device, should be in the range between the minimum amount needed for the patient to sense its effect
and the minimum amount that produces an uncomfortable reaction; care should be taken to limit the
muscle twitching to a mild response. Areas that are particularly sensitive to electrical stimulation are
the face and regions below the elbow and knee. These areas should be treated initially with a very low
intensity voltage. Patients who have not had acupuncture previously should receive standard
acupuncture first to assure that they tolerate the treatment well, before moving on to electro-
acupuncture, which may yield a stronger sensation.
The wave form (squared off or sharp; dense, sparse, mixed dense and sparse, or interrupted; see
Figure 2 for sample outputs) can provide slightly different responses and must be tried for each patient
to evaluate their suitability. Claims that one form is tonifying and another is dispersing may not be
justified due to lack of adequate testing to support such differentiation of effects. A continuous wave
(frequency doesn't change over time) is most similar to what acupuncturists in China attempt to
administer by the manual method. The overall frequency of stimulus (either by continuous wave or
pulses of dense waves) should be set similar to the frequency that would be used in manual
stimulation by twirling or lifting/thrusting. Frequencies as high as 200 pulses per minute have been
recommended for scalp acupuncture, with low frequencies being more commonly mentioned for body
acupuncture (e.g., 50 or less). Different authors writing about electro-acupuncture present differing
opinions on the ideal frequency for various desired effects. All the wave forms and frequencies are
claimed to be of value in promoting circulation of qi and blood and alleviating various symptoms,
particularly pain.
Although some theories have been developed regarding the mechanism of action of electro-
acupuncture, there are no conclusive tests. The main function of electro-acupuncture, as evidenced by
the discussions in several clinical reports in the Chinese medical literature, appears to be no more
than pulsation by voltage spikes serving as stimulus replacing a rhythmic physical movement as
stimulus at the site.
MEDICAL REPORTS FROM CHINA
The majority of journal articles from China on electro-acupuncture are devoted to laboratory animal
studies, mainly with mice or rabbits. Those studies have limited relevance to humans because of
difficulties matching points on these animals with those on humans, and the possible unique effects of
electricity in small animals because of the close proximity of points, which can make the effect of the
electric voltage, current, and associated electromagnetic fields more evident than would be the case
in humans. It is rarely indicated by these animal studies that the effects are different from standard
acupuncture manipulation, though it would be difficult to carry out prolonged manual manipulation on
small animals. Thus, electro-acupuncture animal studies mainly provide a means of using an animal
model to study acupuncture therapy in general.
An extensive review of the Chinese acupuncture literature shows that most clinical work with
acupuncture is carried out with manual stimulus despite the ready availability of electro-acupuncture
devices. In clinical trials where electro-acupuncture is used, there are few details, if any, reported
about the technique, other than the duration of stimulus and the frequency of the electrical output. In
one study of treatment of depression in which some explanation was given (5), the authors stated that
"The intensity of stimulation was optimal when slight muscle twitching was visible, yet the patient was
comfortable and the stimulus tolerable. The frequency of stimulus chosen was about 80-90 beats per
minute. The duration of treatment was 1 hour each time, once a day (except Sundays) for 5 weeks,
altogether 30 needlings." The authors expressed the belief, based on animal studies of electro-
acupuncture, that the treatment would promote production of neurotransmitters that would alleviate the
brain dysfunction. The same kind of biochemical response has been suggested as the mechanism for
standard (non-electric stimulated) acupuncture.
Zheng Qiwei, an acupuncturist at the China Academy of Traditional Chinese Medicine wrote an article
on point selection for electro-acupuncture (6). He first mentioned that electro-acupuncture is used the
same as standard acupuncture but that electro-acupuncture therapy "has certain peculiarities and
limitations because electro-acupuncture apparatus cannot be connected with all the acupoints...."
Also, he mentioned that electro-acupuncture is particularly relied upon for treatment of pain, flaccidity
syndromes, paralysis due to stroke, and facial paralysis of various causes. These disorders often
require extensive manipulation of the needles, for which electro-acupuncture serves as a useful
substitute.
As to the treatment of pain, Zheng suggests that the following points can be chosen (included, in some
cases, is the "ashi" point, or point that is tender to the touch, and not necessarily a meridian point
location as listed below):
trigeminal neuralgia: zanzhu (BL-2) and yangbai (GB-14) for the first nerve branch; sibai (ST-2) with
xiaguan (ST-7) or quanliao (SI-18) for the second branch; chengjiang (CV-24) and xiaguan (ST-7) for
the third branch.
sciatica: points are selected from huantiao (GB-30), zhibian (BL-54), yanglingquan (GB-34),
xuanzhong (GB-39), yinmen (BL-37), and weizhong (BL-40).
pain of greater occipital nerve: fengchi (GB-20) and an ashi point.
migraine: fengchi (GB-20) and shuaigu (GB-8).
periarthritis of the shoulder: select from jianyu (LI-15), jianliao (TB-14), jianzhen (SI-9), naohui (TB-13),
binao (LI-14) and quchi (LI-11).
injury of the knee joint ligaments: liangqiu (ST-34) and dubi (ST-35).
tennis elbow: quchi (LI-11) and ashi point.
kidney pain: jingmen (GB-25) and ashi point.
abdominal pain: bilateral tianshu (ST-25).
intestinal adhesion pain: local points on both ends of the operation scar.
bone fracture: use points at the center of the fracture and at the ends of the fracture zone (e.g., for
humerus fracture, jianyu (LI-15) and quchi (LI-11) represent the ends of the fracture zone; for femoral
fracture, xuehai (SP-10) and biguan (ST-31) are the ends).
For flaccidity (wei) syndromes, he mentions the following points (note: when large numbers of points
are offered, he recommends to select either 2 or 4 of the points to needle with electrical stimulus; the
sets of points needled can vary from day to day, alternating from one set to the other and back again):
paraplegia: select from biguan (ST-31), futu (ST-32), zusanli (ST-36), and jiexi (ST-41) as one group;
a second group is zhibian (BL-54), chengfu (BL-36), yinmen (BL-37), weizhong (BL-40), chengshan
(BL-57), and kunlun (BL-60).
hemiplegia: jugu (LI-16), jianyu (LI-15), jianliao (TB-14), binao (LI-14), quchi (LI-11), waiguan (TB-5),
shousanli (LI-10), and hegu (LI-4) are used for upper extremity paralysis; huantiao (GB-30), biguan (ST-
31), zusanli (ST-36), yanglingquan (GB-34), sanyinjiao (SP-6), and jiexi (ST-41) for paralysis of the
lower extremities.
facial paralysis: do not use electro-acupuncture in the initial phase, as it may cause spasm. It can be
used at the later stage, for example: taiyang (extra point) and zanzhu (BL-2) or sibai (ST-2) for
incomplete closing of the eye; yingxiang (LI-20 and quanliao (SI-18 or xiaguan (ST-7) for difficulty
sniffing; either dicang (ST-4) and jiache (ST-6) or xiaguan (ST-7 and dicang (ST-4) for difficulty in
blowing out the cheeks; and heliao (LI-19) and dicang (ST-4) for deviation of the philtrum.
In addition to treatment of local points for pain or paralysis or other disorders, distal points may also
be selected along the course of the meridians that flow through the area to be treated. In cases of one-
sided ailments, such as arthritis in one shoulder, tennis elbow, or trigeminal neuralgia, Zheng
considers it acceptable to select points on the opposite side of the body for treatment in cases where
the patient may not tolerate local treatment or where local treatment might cause spasms.
Gu Yuehua, at the Nanjing College of Traditional Chinese Medicine described the use of electro-
acupuncture for treatment of acute abdomen (7). This is a severe abdominal pain that can be due to
several causes including renal or gallbladder colic associated with stones, acute appendicitis,
dysmenorrhea (especially that due to endometriosis), and gastric spasms. Gu reported on several
recommended sets of points for electroacupuncture, as follows:
Gastric spasm: zhongwan (CV-12), juque (CV-14), and zusanli (ST-36); this point set could be
modified for cold syndrome-add liangmen (ST-21)-or hot syndrome-add quchi (LI-11); for distending
pain in the hypochondriac region, add taizhong (LV-3). Points were treated bilaterally where that
applies.
Billiary colic: riyue (GB-24), burong (ST-19), juque (CV-14), dannang (extra-35), and zusanli (ST-36).
These points were all on the right side only.
Renal colic: shenshu (BL-23), jingmen (GB-25), sanyinjiao (SP-6), and fujie (SP-14) all on the side
affected; and yanglingquan (GB-34) bilaterally.
Dysmenorrhea: guanyuan (CV-4) and bilateral guilai (ST-29) and sanyinjiao (SP-6); with obvious
stagnation of qi and blood, add bilateral taichong (LV-3) and diji (SP-8).
He noted that most points were punctured perpendicularly, but that riyue (GB-24) and burong (ST-19)
were punctured obliquely. The initial stimulus by hand was with the reducing method, with swift lifting,
slow thrusting, and large amplitude rotation. After the needle sensation was felt and radiated to the
affected area, electro-stimulation was added. He used a dense-disperse wave (alternating high
frequency with low frequency output), with a frequency of 18 per minute (this is the frequency of dense
wave outputs). The electrical stimulation was given for 30-60 minutes, with an intensity that depended
on the patient's tolerance. The time required to get pain relief varied from an average of 11 minutes for
"functional pain" (as, for example, with gastric spasms), to an average of 32 minutes for "organic pain"
(as, for example, with renal stones). Up to 60 minutes treatment might be needed in cases where pain
relief at the original site was attained, but there was still tenderness and radiating pain with pressure.
A report of using electro-acupuncture plus moxibustion for sports injury was made by Yang Jun of the
Department of Acupuncture at the Anhui College of Traditional Chinese Medicine (8). Femoral
adductor syndrome (pain in the pubic and medial femoral regions, exacerbated by walking or
squatting) was treated with the main points yinlingquan (SP-9), qugu (CV-2), yinlian (LV-11), and an
ashi point. Auxiliary points for the treatment included chengfu (BL-36), ciliao (BL-32), fengshi (GB-31),
and wuli (LV-10); all of the main points and one or two auxiliary points were used for each treatment.
After the needling sensation was attained, electric stimulation was applied for 15 minutes. After
removing the needles, moxibustion was applied using cones on the main points for 10-15 minutes.
This treatment was given once every other day, with 10 sessions one course of treatment (hence,
three weeks treatment time). Yang differentiated the role of electro-acupuncture, which he said treated
the subjective symptoms by promoting the flow of qi and blood and relieving pain, from that of
moxibustion, which he said treated the root cause, by additionally warming the channels and removing
blood stasis.
For treatment of chronic shoulder-arm pain and numbness of various causes, Liu Hongyan and Zhang
Caihong claimed use of electro-acupuncture at bingfeng (SI-12) was a useful treatment (9). As
auxiliary points, hegu (LI-4) would be added if the pain and numbness extended to the thumb and
index fingers; zhongzhu (TB-3) was used if it extended to the ring and small fingers; and sanyinjiao
(SP-6) was used when there had been a prolonged pain syndrome and muscular atrophy as a result.
After getting the needle sensation, the electro-stimulation with dense wave was administered for 20
minutes once per day, with 10 days treatment constituting a course of therapy. Although improvements
could be noted after just one or four treatments for many patients, some had to undergo one to two
course of therapy or more to get adequate relief.
In a report of acupuncture therapy for post-herpetic neuralgia (10), two groups of points were selected:
the Hua Tuo jiaji that corresponded to the painful area to be treated by electric stimulation, and limb
points selected on the basis of syndrome differentiation to be treated by manual stimulation. Thus,
patients with diagnosis of qi stagnation and blood stasis were manually treated at zhigou (TB-6),
yanglingquan (GB-34), xuehai (SP-10), and sanyinjiao (SP-6); patients with deficiency of yin were
treated at laogong (PC-8), taixi (KI-3), and fuliu (KI-7); while patents with stagnation of damp-heat were
treated at quchi (LI-11), yinlingquan (SP-9), and sanyinjiao (SP-6). For the Hua Tuo points, needling
was first performed unilaterally on the painful side, using 3-5 needles with about 1 cun space between
needles, using slight oblique insertion towards the spine. After arrival of qi attained with lifting and
thrusting, the needles were connected to the electric stimulator device with continuous wave, with 40-
50 minutes stimulus. The limb points were then needled and stimulated every few minutes over the
same time period. Ten daily treatments constituted a course of therapy, which could be repeated after
a three day interval.
In a study of electro-acupuncture therapy given to cancer patients after chemotherapy (11), needles
were applied to zusanli (ST-36), sanyinjiao (SP-6), zhongwan (CV-12), and neiguan (PC-6). The
method of therapy was described as follows:
The patient was asked to take the supine position. After needling sensation was attained, the needles
were connected to the G-6805 electro-acupuncture apparatus with disperse-tense wave at an intensity
tolerable to the patient. The treatment was given for 30 minutes once daily, five daily sessions
constituting one course of treatment, with an interval of 2 days between courses.
Four courses of therapy (four weeks, with 5 days therapy followed by 2 days off each week) were
administered to evaluate the effects, which were claimed to be beneficial and involved an average 5-
10% increase in subsets of T-cells and a 15% increase in natural killer cell activity (however, there was
not control group for comparison). It was also claimed to improve appetite and sleep, relieve tumor
pain, and alleviate the gastro-intestinal reactions to chemotherapy.
SUMMARY
Electro-acupuncture is a convenient stimulation technique to be utilized with the same acupuncture
points and the same number of treatments as with manual acupuncture. For busy practitioners and
those who do not normally provide prolonged manual needle stimulation, even when it is normally
called for according to Chinese literature, electro-acupuncture may improve the clinical situation. In
cases where intensive, high frequency, and prolonged treatments might be deemed essential, as with
certain stubborn neurological disorders, electro-acupuncture may be the only means to provide
effective daily treatments. Practitioners should consult literature accompanying the device they
purchase regarding contraindications for electro-acupuncture and recommendations for using different
pulse forms and frequencies, but should also be aware that there may be very limited basis for some
of the statements that are made.
REFERENCES
Chinese Academy of Traditional Chinese Medicine, An Outline of Chinese Acupuncture, 1975
Foreign Languages Press, Beijing.
O'Connor J and Bensky D (translators), Acupuncture: A Comprehensive Text, 198 Eastland Press,
Seattle, WA.
Zhang Enquin (editor in chief), Chinese Acupuncture and Moxibustion, 1990 Publishing House of
Shanghai College of Traditional Chinese Medicine, Shanghai.
Dang Yi (chief editor, English), Acupuncture and Moxibustion, 1999 Academy Press, Beijing.
Luo Hechun, Jia Yunkui, and Zhanli, Electro-acupuncture vs. amitriptyline in the treatment of
depressive states, Journal of Traditional Chinese Medicine 1985; 5(1): 3-8.
Zheng Qiwei, Experience in the point selection for electro-acupuncture, Journal of Traditional Chinese
Medicine 1998; 18(4): 277-281.
Gu Yuehua, Treatment of acute abdomen by electro-acupuncture, Journal of Traditional Chinese
Medicine 1992; 12(2): 110-113.
Yang Jun, 32 cases of femoral adductor syndrome treated by electro-acupuncture and moxibustion,
Journal of Traditional Chinese Medicine 1998; 18(4): 263-264.
Liu Hongyan and Zhang Caihong, 60 cases of shoulder-arm syndrome treated by electro-acupuncture
at bingfeng (SI-12), Journal of Traditional Chinese Medicine 1998; 18(4): 256-258.
Wu Jianhui and Guo Zhili, 23 cases of postherpetic neuralgia treated by acupuncture, Journal of
Traditional Chinese Medicine 2000; 20(1): 36-37.
Ye Fang, Chen Shaozong, and Liu Weiming, Effects of electro-acupuncture on immune function after
chemotherapy in 28 cases, Journal of Traditional Chinese Medicine 2002; 22(1): 21-23.
NOTE: In this article, the term electro-acupuncture refers solely to stimulation of acupuncture needles
by a pulsed electric voltage for the purpose of providing a stimulus similar to that obtained by manual
needle manipulation. This is the definition and application of electro-acupuncture as described in
literature from China.
Unfortunately, the term electro-acupuncture has been used by Vohl and others who apply it to describe
diagnostic methods that are not permitted in the acupuncturist scope of practice, and for which there is
no viable evidence that either the diagnostic or the associated treatment methods accomplish what is
claimed.
In addition, the term electro-acupuncture has been used to describe the TENS device and its use in
treatment with microcurrent applied (usually without acupuncture needles) to a segment of the skin or
muscles, which is not addressed in this article.
Many of the electro-acupuncture devices made in the U.S. are designed for use in both electro-
acupuncture and TENS treatment.
Click here to schedule an appointment
or call now "Feel Good" at 646-327-7267 .
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