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JKM > Volume 40(3); 2019 > Article
Lee, Jo, Kim, Lee, Park, Moon, Jung, Sung, Cho, Kim, Lee, and Kim: A Review on the Characteristics of Temperature Variation in Warm Needle

Abstract

Objectives

The purpose of this study is to organize the research methods and results of studies related to the temperature of the warm needle for systematic utilization of warm needling technique.

Methods

This study used the databases of nine (Pubmed, Science Direct, Cochrane Central, 4 Korean databases, CNKI, CiNii) to analyze temperature-related studies of the warm needle from 2000 to June 2019.

Results

A total of 19 papers were included. Of these, 15 were used for mugwort, 2 for high frequency, and 1 for both mugwort and high frequency, and the other one for a ceramic heater. The maximum temperature rises as the amount of moxibustion increases. It is also affected by the density of moxa and the ignition part. There were 16 papers using stainless steel needles and 4 papers using a needle made of gold or silver to compare. In the area of the needle, the closer it is to moxibustion, the hotter it is. Compared to stainless steel needles, gold and silver needles showed almost twice the temperature. The effects of environment and radiant heat should be considered during warm needle procedures.

Conclusions

There are various experimental methods such as warm needle technique materials, methods, measuring parts, measuring instruments, etc. The results were also very diverse. When setting the heating source, ignition part, size of moxibustion, etc. of warm needles, it should be implemented in a way that takes safety and validity into account. Considerations for temperature characteristics, radiant heat, etc. of warm needles will be needed when making warm needle apparatus.

Fig. 1
Process of the Selecting Data (PRISMA Flow chart)
jkm-40-3-112f1.gif
Table 1
Summary of Moxibustion Used in Warming Needling
First authors(year) Origin Shape Weight (g) Height (mm) Diameter (mm) Ignition Distance between the Moxibustion Block and the Surface(mm)
Kim et al. (2008) Korea cone 0.2 10.4 11.4 at the apex/bottom using incense 15
0.4 15.7 22.4
0.6 20.4 25.0
0.8 23.9 28.5
1.0 25.2 33.3

Yeo. (2013) Korea cone 0.2 10.4 11.4 at the apex using incense 15
0.4 15.7 22.4
0.6 20.4 25.0
0.8 23.9 28.5
1.0 25.2 33.3

Kim et al. (2008) Korea cone 0.8 n.r. n.r. at the apex using incense 15

Lee et al. (2006) Korea ball 0.50±0.01 n.r. 20 at the upper end n.r.

Yang et al. (2017) Korea cylinder n.r. 8 7 n.r. 20

Lee et al. (2013) Taiwan cylinder 0.6 10 10 at the lateral side 35
1.0 15 13

Zhou et al. (2014) China cylinder n.r. n.r. n.r. at the upper end/bottom end 20, 30

Kim et al. (2015) Korea cylinder n.r. 15 n.r. using torch 30

Litscher et al. (2009) Austria cylinder n.r. n.r. n.r. top n.r.

Cheng et al. (2011) China n.r. 1.2 10 18 n.r. n.r.
1.5 13 18

Yuan et al. (2014) China ball 1.3 n.r. n.r. at the upper end with 1ml of 95% ethanol n.r.

Gao et al. (2012) Hong Kong cylinder 1.70±0.05 15 12 at the upper end 20, 25, 30 in anaesthetized rabbits/25, 30, 35 in human

Ahn et al. (2010) Korea cone 0.1 n.r. n.r. at the apex using incense n.r.
0.3
0.5
1.0
3.0
5.0

Cheng et al. (2007) China cone 0.5 n.r. n.r. n.r. n.r.

Wang et al. (2009) China n.r. n.r. 15 n.r. n.r. n.r.

Hong et al. (2008) Korea cone 0.5 n.r. n.r. at the apex using incense n.r.
1.0
3.0
5.0

n.r.: not reported

Table 2
Summary of Other Heating Source Used in Warm Needling
Kind of Heating Source kHz mA for Duration Distance between the Heating Source and the Surface
Hong et al. (2008) Korea high frequency warm needling device 300 1mA, 2.5mA, 5mA, 10mA, 20mA for 20minutes X
Jang et al. (2009) Korea high frequency warm needling device 300 1mA, 2.5mA, 5mA, 10mA, 20mA for 30 minutes X
Lee ea al. (2012) Korea high frequency warm needling device 150 n.r. for 20 minutes X
Chung et al. (2009) Korea ceramic heater N N 25mm

n.r.: not reported; N: inappropriate

Table 3
Summary of Needle
Kind of Needle Size of Needle Coating handle of the needle Punctured into Acupoint Method Depth of needling(mm)
Kim et al. (2008) Korea stainless steel 0.25×40mm n.r. n.r. center of the disposable paper cup N perpendicular insertion 5mm
Yeo. (2013) Korea stainless steel/95%gold+5% white gold 0.25×40/0.53×35 mm n.r. 1.14×33mm 100% silver center of the disposable paper cup N perpendicular insertion 5mm
Kim et al. (2008) Korea stainless steel 0.25×40mm n.r. n.r. center of the disposable paper cup N perpendicular insertion 5mm
Lee et al. (2006) Korea stainless steel/95%gold+5% white gold 0.25×40mm/0.53 ×35mm silicon coated 1.14X33mm 100% silver plate N perpendicular insertion n.r.
Yang et al. (2017) Korea stainless steel 0.3×40mm/0.5×4 0mm/0.8×40mm n.r. removed fixed frame N perpendicular insertion n.r.
Lee et al. (2013) Taiwan stainless steel 1.5inch 32gauge n.r. n.r. polystyrene plastics N perpendicular insertion n.r.
Zhou et al. (2014) China stainless steel 0.35mm×40mm n.r. n.r. n.r. N perpendicular insertion n.r.
Chung et al. (2009) Korea silver 0.6×60mm none coated/Al2O3 ceramic coated(25mm length, 100μm thickness) n.r. n.r. N perpendicular insertion n.r.
Kim et al. (2015) Korea stainless steel 0.25×40mm ceramic pigment coated(15, 20, 25, 30mm length)/aluminum silicate coated(30mm length)/manicure coated(30mm length) n.r. styrofoam plate N perpendicular insertion n.r.
Litscher et al. (2009) Austria stainless steel 0.30×50mm silicone coated 25mm length metal holder made of a good thermal insulator/6 healthy volunteers CV 6 perpendicular insertion n.r.
Cheng et al. (2011) China stainless steel/75% gold/85% silver 0.35mm×40mm n.r. n.r. 10 healthy volunteers ST 36 n.r. 25mm
Yuan et al. (2014) China 80% silver+20% copper, zinc, nickel 1.1×180mm/1.1×160mm n.r. 60mm length 72 healthy volunteers medial superior part of the left buttock(7 cm below the highest point of the iliac crest and 7 cm lateral to posterior median line+ four matching points 2 cm superior, inferior, left and right ) perpendicular insertion 60mm
Gao et al. (2012) Hong Kong stainless steel 0.30×40mm/0.35 ×40 mm n.r. 1.0mm×33.6mm 3 anaesthetized rabbits/6 healthy volunteers GB 30 in animal/ST36 in human perpendicular insertion n.r.
Ahn et al. (2010) Korea stainless steel 0.30×40mm n.r. n.r. pork(2×2×7cm) N transverse insertion 0.5~1mm
Cheng et al. (2007) China stainless steel/75% gold/85% silver 0.35mm×40mm n.r. n.r. pork leg ST 36 perpendicular insertion n.r.
Wang et al. (2009) China 85% silver+15% copper, zinc, nickel 1.0mm×80mm, 100mm, 120mm, 150mm n.r. n.r. pork leg(10cm×5cm×4 cm) n.r. perpendicular insertion 15, 15, 30, 50mm respectively
Hong et al. (2008) Korea stainless steel 0.30×40mm teflon coated(36mm length, 50±00μm thickness) n.r. pork(2×2×7cm) N transverse insertion 0.5~1mm
Jang et al. (2009) Korea stainless steel 0.25×30mm/0.25 ×40mm/0.25×60 mm/0.30×40mm teflon coated(25~26mm/34~35mm length, 50±00μm thickness) n.r. gelatin plate/anaesthetized animal N perpendicular insertion n.r.
Lee ea al. (2012) Korea stainless steel 0.25×40mm n.r. n.r. 20 healthy volunteers LI11, LI9, TE5 perpendicular insertion 10~20mm

n.r.: not reported; N: inappropriate

Table 4
Summary of Experimental Environment
Space Size Temperature Humidity Ventilation
Kim et al. (2008) Korea open-fronted chamber 42×26×34cm 24±2°C 60±5% ventilation fan
Yeo. (2013) Korea open-fronted chamber 42×26×34cm 24±2°C 60±5% ventilation fan
Kim et al. (2008) Korea open-fronted chamber 42×26×34cm 24±2°C 60±5% ventilation fan
Lee et al. (2006) Korea n.r. n.r. 24±2°C n.r. n.r.
Yang et al. (2017) Korea open-fronted wooden frame 3.5×1.5×2.6cm 25±2°C 55±5% n.r.
Lee et al. (2013) Taiwan n.r. n.r. controlled to be stable controlled to be stable n.r.
Zhou et al. (2014) China n.r. n.r. 25°C n.r. n.r.
Chung et al. (2009) Korea n.r. n.r. n.r. n.r. n.r.
Kim et al. (2015) Korea indoors n.r. 26.5°C n.r. no forced air flow occurred
Litscher et al. (2009) Austria stainless steel lab bench 12×6×9cm 22°C 34% no forced air flow occurred
Cheng et al. (2011) China n.r. n.r. 23~25°C 40%~70% n.r.
Yuan et al. (2014) China n.r. n.r. 22±3°C 40%~70% smoked extraction system
Gao et al. (2012) Hong Kong n.r. n.r. 23°C n.r. n.r.
Ahn et al. (2010) Korea indoors, using 6 heat resistant plates heat resistant plate:1×30×70cm n.r. n.r. no forced air flow occurred
Cheng et al. (2007) China n.r. n.r. n.r. n.r. n.r.
Wang et al. (2009) China n.r. n.r. 23°C n.r. n.r.
Hong et al. (2008) Korea indoors, using 6 heat resistant plates heat resistant plate:1×30×70cm 19~21°C n.r. no forced air flow occurred
Jang et al. (2009) Korea indoors n.r. infrared thermometer:18±0. 5°C/digital infrared thermograpy imaging system:21–25°C digital infrared thermography imaging system: low humidity digital infrared thermography imaging system: no forced air flow occurred
Lee ea al. (2012) Korea n.r. n.r. n.r. n.r. n.r.

n.r.: not reported; N: inappropriate

Table 5
Summary of Measurement Instrument and Methods
Measuring Instrument Measurement Time Criteria Measurement Time Interval (once per) Measurement Time Duration(sec) Number of Repetitions Dealing With Radiant Heat, Conductive Heat
Kim et al. (2008) Korea 0.08mm thermocouple (K-type-TT-40-SLE, Omega, USA) after moxa sticks were burned second 300 3 measure the heats: vertically 2cm, horizontally 1.5cm from the lower end of the handle
Yeo. (2013) Korea 0.08 mm thermocouple (K-type-TT-40-SLE, Omega, USA) after moxa sticks were burned second 0.2g moxa:300/0.4 g, 0.6g moxa:360/0.8g moxa:420/1.0g moxa:480 3 measure the heats: vertically 2cm, horizontally 1.5cm from the lower end of the handle
Kim et al. (2008) Korea 0.08mm thermocouple (K-type-TT-40-SLE, Omega, USA) after moxa sticks were burned second 300 3 n.r.
Lee et al. (2006) Korea self-production thermocouple n.r. n.r. n.r. n.r. n.r.
Yang et al. (2017) Korea infrared thermometer (TESTO 845)/infrared camera(Flir E30) before moxa sticks were burned 50seconds 150 5 block the heats: heat proof plate(thickness 8mm)
Lee et al. (2013) Taiwan raytek infrared thermometer (Raytek Corp., CA, USA) once before moxa sticks were burned/after moxa sticks were burned 30seconds 0.6g moxa:540, 1g:780 40 n.r.
Zhou et al. (2014) China infrared temperature measuring instrument n.r. n.r. n.r. 5 n.r.
Chung et al. (2009) Korea K-type thermocouple n.r. n.r. 1800 5 n.r.
Kim et al. (2015) Korea K-type/J-type thermocouple thermometer(DMpower, DT-3879F) from 1minute before moxa sticks were burned 10seconds 600 8/only for paint A: 6 n.r.
Litscher et al. (2009) Austria automatic temperature acquisition module/thermocouple(TT-K-40-SLE, K-type; Omega, Stanford, CT)/infrared camera n.r. second 600 n.r. measure the heats: 5mm away from the needle
Cheng et al. (2011) China UT-325 digital thermometer/UT-T01 K-type thermocouple n.r. 5seconds until burnout, the temperature reached 34~35°C, occur wave for 1 minute 2 n.r.
Yuan et al. (2014) China multi channel digit thermoscope/infrared camera(therma FLIR, CAMTM P30) n.r. n.r. 600 n.r. n.r.
Gao et al. (2012) Hong Kong thermal tracer(NEC, model TH9100PMV) equipped with a close-up lens(TH-386)/infrared camera n.r. n.r. n.r. n.r. block the heats: either with of without a thin piece of cardboard (50mm×50mm×0.2mm)
Ahn et al. (2010) Korea infrared thermometer (testo 845, Testo, Korea) n.r. n.r. n.r. n.r. block the heats: heat proof plate(a board, tinfoil)
Cheng et al. (2007) China infrared thermography (ThermaCAM P30) n.r. minute n.r. n.r. n.r.
Wang et al. (2009) China digital thermometer after moxa sticks were burned 5minutes 1200 n.r. n.r.
Hong et al. (2008) Korea infrared thermometer (Testo845, Testo, Korea) n.r. n.r. until the temperature reached less than the normal temperature n.r. block the heats: heat proof plate(a board, tinfoil)
Jang et al. (2009) Korea infrared thermometer (Testo845)/digital infrared thermograpy imaging system (DITI, IRIS-XP, Medicore, Korea) n.r. minute until the temperature reached the normal temperature n.r. n.r.
Lee ea al. (2012) Korea infrared camera(FLIR system Co.LTD) n.r. n.r. manual acupuncture stimulation: for 20minutes, warm acupuncture stimulation:for 20minutes at 38~40°C 1 n.r.

n.r.: not reported

Table 6
Summary of Measurement Results(1)
Measurement Criteria Measurement Part Peak Temperature (°C) Peak Time(sec) Effective Stimulus Time(sec) Mean Temperature in Effective Stimulus(°C) Conclusion
Kim et al. (2008) Korea
  1. by measurement part

  2. by position of ignition

  3. by mass of moxa(g)

  1. 1cm below the lower end of the handle

  2. 2cm below the lower end of the handle

  3. vertically 2cm, horizontally 1.5cm from the lower end of the handle

➀ apex ignition method
1) 0.2g: 46.7±4.4/0.4g: 48.5±6.1/0.6g:60.3±9.2/0.8g:58.6±3.1/1.0g:66.9 ±8.9
2) 0.2g:38.6±1.1/0.4g: 40.9±3.1/0.6g:44.0±5.0/0.8g:50.7±2.8/1.0g:61.8 ±2.2
3) 0.2g:45.2±1.5/0.4g: 48.6±1.9/0.6g:54.6±3.4/0.8g:66.6±6.5/1.0g:87.9 ±1.8
➁ bottom ignition method
1) 0.2g:63.0±8.3/0.4g: 57.5±7.9/0.6g:71.1±16. 8/0.8g:80.5±2.9/1.0g:10 7.2±31.2
2) 0.2g:53.7±1.1/0.4g: 57.4±4.5/0.6g:69.5±10. 3/0.8g:78.0±3.4/1.0g:92.7±12.0
3) 0.2g:57.1±3.0/0.4g: 63.1±5.6/0.6g:76.0±4.1/0.8g:90.5±7.4/1.0g:105. 6±15.2
➀ apex ignition method
1) 0.2g:80.7±4.5/0.4g: 107.7±15.5/0.6g:143.3± 15.0/0.8g:148.7±17.0/1. 0g:163.7±4.9
2) 0.2g:80.3±5.5/0.4g: 106.3±15.3/0.6g:138.3± 16.2/0.8g:148.7±17.5/1. 0g:160.0±1.0
➁ bottom ignition method
1) 0.2g:72.7±1.2/0.4g: 79.7±16.4/0.6g:88.3±15.0/0.8g:119.0±11.3/1.0g :106.7±8.4
2) 0.2g:82.0±4.4/0.4g: 84.0±4.4/0.6g:98.7±9.1/0.8g:119.7±20.3/1.0g:1 08.0±7.0
Criteria: Duration for temperature from rise above 34°C to fall below 34°C
➀ apex ignition method
1) 0.2g:49.0±5.6/0.4g: 73.0±15.7/0.6g:109.7± 4.0/0.8g:124.7±16.0/1. 0g:157.3±15.3
2) 0.2g:28.3±3.5/0.4g: 38.7±15.9/0.6g:57.0±1 1.4/0.8g:108.7±12.6/1. 0g:145.0±6.6
➁ bottom ignition method
1) 0.2g:129.7±13.6/0.4g:94.3±18.6/0.6g:1 37.3±17.4/0.8g:189.0± 23.5/1.0g:230.±24.8
2) 0.2g:112.3±6.8/0.4g:95.7±15.3/0.6g:1 43.3±5.1/0.8g:190.3±6.5/1.0g:224.3±15.3
➀ apex ignition method
1) 0.2g:40.3±2.1/0.4g: 40.7±2.7/0.6g:43.7±2.2/0.8g:44.4±0.7/1.0g:48.6± 2.5
2) 0.2g:36.4±0.7/0.4g: 37.0±1.0/0.6g:38.4±2.1/0.8g:41.7±1.7/1.0g:46.7± 1.1
➁ bottom ignition method
1) 0.2g:48.3±3.1/0.4g: 44.4±2.4/0.6g:50.1±6.4/0.8g:52.7±0.7/1.0g:59.7 ±9.1
2) 0.2g:43.2±0.5/0.4g: 44.0±1.0/0.6g:50.3±3.3/0.8g:51.5±0.3/1.0g:57.1± 3.3
When we measure the warm needling’s partial temperature according to the position of ignition, the bottom ignition method got the higher result on the peak temperature measured at 2cm below the head than the apex ignition method.
Yeo. (2013) Korea
  1. by measurement part

  2. by kind of needle

  3. by mass of moxa(g)

  1. 1cm below the lower end of the handle

  2. 2cm below the lower end of the handle

  3. vertically 2cm, horizontally 1.5cm from the lower end of the handle

➀ stainless steel needle
1) 0.2g:46.7±4.4/0.4g: 48.5±6.1/0.6g:60.3±9.2/0.8g:58.6±3.1/1.0g:66.9 ±8.9
2) 0.2g:38.6±1.1/0.4g: 40.9±3.1/0.6g:44.0±5.0/0.8g:50.7±2.8/1.0g:61.8 ±2.2
3) 0.2g:45.2±1.5/0.4g: 48.6±1.9/0.6g:54.6±3.4/0.8g:66.6±6.5/1.0g:87.9 ±1.8
➁ gold needle
1) 0.2g:83.0±4.5/0.4g: 95.1±9.2/0.6g:95.1±1.2/0.8g:115.7±3.0/1.0g:122.3±26.5
2) 0.2g:50.2±0.3/0.4g: 66.1±1.0/0.6g:73.6±1.8/0.8g:86.1±3.7/1.0g:87.0 ±6.0
3) 0.2g:42.1±1.2/0.4g: 57.4±3.6/0.6g:61.0±2.2/0.8g:66.9±1.2/1.0g:71.1 ±1.8
➀ stainless steel needle
1) 0.2g:80.7±4.5/0.4g: 107.7±15.5/0.6g:143.3± 15.0/0.8g:148.7±17.0/1. 0g:163.7±4.9
2) 0.2g:80.3± 5.5/0.4g: 106.3±15.3/0.6g:138.3± 16.2/0.8g:148.7±17.5/1.0g:160.0±1.0
➁ gold needle
1) 0.2g:107.0±6.0/0.4g: 129.7±7.0/0.6g:146.3±6.4/0.8g:161.0±5.3/1.0g: 170.3±11.1
2) 0.2g:107.7±10.1/0.4g:134.7±5.1/0.6g:14 3.3±6.5/0.8g:159.7±2.1/1.0g:173.0±5.6
Criteria: Duration for temperature from rise above 34°C to fall below 34°C
➀ stainless steel needle
1) 0.2g:49.0±5.6/0.4g: 73.0±15.7/0.6g:109.7± 4.0/0.8g:124.7±16.0/1.0g:157.3±15.3
2) 0.2g:28.3±3.5/0.4g: 38.7±15.9/0.6g:57.0±1 1.4/0.8g:108.7±12.6/1.0g:145.0±6.6 ➁ gold needle
1) 0.2g:152.0±7.8/0.4g:194.0±5.6/0.6g:2 34.3±12.5/0.8g:257.7± 7.0/1.0g:281.3±3.8
2) 0.2g:110.7±5.5/0.4g:162.0±12.2/0.6g: 222.7±22.8/0.8g:246.7 ±5.8/1.0g:270.3±13.6
➀ stainless steel needle
1) 0.2g:40.3±2.1/0.4g: 40.7±2.7/0.6g:43.7±2.2/0.8g:44.4±0.7/1.0g:48.6± 2.5
2) 0.2g:36.4±0.7/0.4g: 37.0±1.0/0.6g:38.4±2.1/0.8g:41.7±1.7/1.0g:46.7± 1.1
➁ gold needle
1) 0.2g:60.0±2.0/0.4g: 66.0±6.4/0.6g:65.9±1.3/0.8g:76.5±0.8/1.0g:77.7± 9.7
2) 0.2g:44.1±0.2/0.4g: 51.7±0.1/0.6g:53.6±0.5/0.8g:58.9±0.5/1.0g:60.0± 2.2
When we measured the warm needling’s partial temperature, temperature measured at 1 and 2 cm below the head, according to the kind of needle, gold needle got the higher result on the peak than SS304 stainless steel needle. In the case of combustion of the moxa cones, cones weighing 0.4 g and 0.8 g, respectively, and the apex ignition method with gold needle showed the higher result than the apex ignition method with stainless steel needle, when we measured the effective stimulus time at 2 cm below the head and the mean temperature during the effective stimulus time. Although more research to standardize the characteristics of the warm needling technique will be needed, we suggest, according to these results, that warm needling of gold needle combined with moxa cone of 0.4 or 0.8 g is effective.
Kim et al. (2008) Korea
  1. by measurement part

  2. by density of moxa(g/cm3)

  1. 1cm from the lower end of the handle

  2. 2cm from the lower end of the handle

1) 0.11g/cm3:59.7±1.5/0.16g/cm3:58.6±3.1/0.24g/cm3:42.8±2.6
2) 0.11g/cm3:54.8±1.6/0.16g/cm3:50.7±2.8/0.24g/cm3:41.2±3.5
1) 0.11g/cm3:141.0± 7.0/0.16g/cm3:148.7± 17.0/0.24g/cm3:187.7± 20.6
2) 0.11g/cm3:141.0± 7.2/0.16g/cm3:148.7± 17.5/0.24g/cm3:190.3± 20.5
Criteria: Duration for temperature from rise above 34°C to fall below 34°C
1) 0.11g/cm3:109.3± 10.2/0.16g/cm3:124.7 ±16.0/0.24g/cm3: 85.0±34.7
2) 0.11g/cm3:107.3± 1.2/0.16g/cm3:108.7± 12.6/0.24g/cm3:63.7± 31.1
1) 0.11g/cm3:45.2±1.2/0.16g/cm3:44.4±0.7/0.24g/cm3:38.4±1.6
2) 0.11g/cm3:44.5±0.7/0.16g/cm3:41.7±1.7/0.24g/cm3:37.8±1.9
Examination of the warm-needle’s partial temperature in relation to the cone density of the 0.8g moxa specimen suggests that a lower density of the moxa cone corresponds to a higher peak temperature and but with a shorter duration. During the effective stimulus time, the lower the density of the moxa cone, the shorter the duration of the effective stimulus time and the higher the mean temperature. Conversely, the higher the density of the moxa cone, the longer the effective stimulus time and lower the mean temperature.
Lee et al. (2006) Korea
  1. by measurement part

  2. by kind of needle

  1. 1cm below the lower end of the handle

  2. 2cm below the lower end of the handle

➀ stainless steel needle
1) 68.8
2) 35.3
➁ gold needle
1) 111
2) 68.8
➀ stainless steel needle
1) 140
2) 120
➁ gold needle
1) 120
2) 140
n.r. n.r. Warm needles are a safe therapeutic measures.
Lee et al. (2013) Taiwan
  1. by measurement part

  2. by mass of moxa(g)

  1. upper end of the handle

  2. lower end of the handle

  3. the needle body above the polystyrene plastics 4) tip of the needle body

1) 0.6g:344/1.0g:375
2) 0.6g:320/1.0g:306
3) 0.6g:66.4/1.0g:111.8
4) 0.6g:26.6/1.0g:29.1
1) 0.6g:270/1.0g:510
2) 0.6g:330/1.0g:510
3) 0.6g:270/1.0g:390
4) 0.6g:270/1.0g:450
n.r. n.r. The larger the size of moxa cone is, the longer is the burning time. Based on the observations we suggest that when 0.6 g moxa is used, the physicians should better pick out the needles around 9 min after ignition; however, while using the 1 g moxa, it might be safer to pick out the needles around 13 min after ignition.
Zhou et al. (2014) China
  1. by measurement part

  2. by position of ignition

  1. 2cm below bottom-end of moxa stick

  2. 3cm below bottom-end of moxa stick

➀ upper-end ignition method
1) 47.7
2) 40.2
➁ bottom-end ignition method
1) 40.6
2) 36.4
➀ upper-end ignition method
1) 985
2) 960
➁ bottom-end ignition method
1) 284
2) 239
Criteria: Duration for temperature from 30°C to 35°C
➀ upper-end ignition method
1) 447
2) 285
➁ bottom-end ignition method
1) 890
2) 678
Criteria: Duration for temperature above 35°C
➀ upper-end ignition method
1) 375
2) 147
➁ bottom-end ignition method
1) 383
2) 145
n.r. With any identical ignition method, the maintenance time of moxibustion temperature 2cm away from bottom-end of moxa stick was longer by 3 min compared with that from 3cm, for bottom-end ignition and upper-end ignition, in the case of 30°C to 35°C, more ignition time could be kept from bottom-end ignition; in the case of more than 35°C, the maximum temperature of needle body by upper-end ignition was higher by 5°C than that by bottom-end ignition. The bottom-end ignition could achieve earlier effective initial time of moxibustion temperature. From the curves, bottom-end ignition was characterized by left-shift peak while upper-end ignition was characterized by right-shift peak. The ignition location of warming needling seems to be reasonable if moxa stick is ignited form botto-end which is 2 to 3 cm away from skin.
Chung et al. (2009) Korea
  1. by measurement part

  2. with or without coating

  1. tip of the needle body

  2. skin contact point

1. without coating
1) 43.8
2) 48.37
2. with coating
1) 40.26
2) 39.18
n.r. n.r. n.r. The results showed that the surface temperature of needle decreased as the needle was coated with Al2O3. The surface temperature of uncoated needle was about 48°C, while that of needle coated with Al2O3 was about 39°C.
Kim et al. (2015) Korea
  1. by measurement part

  2. by coating

  1. 3cm below bottom-end of moxa stick

  2. 2.5cm below bottom-end of moxa stick

  3. 2cm below bottom-end of moxa stick

  4. 1.5cm below bottom-end of moxa stick

➀ stainless steel needle
1) 35.2±1.49
➁ ceramic pigment coated
1) 41.31±1.95
2) 45.1±3.24
3) 56.28±2.29
4) 63.5±5.40
➂ aluminum silicate coated
1) 38.70±1.36
➃ manicure coated
2) 39.24±1.27
n.r. n.r. n.r. Silver needle and traditional needle showed high thermal conductivity while marked heat loss was seen in stainless steel needles. Coating of insulation paint in stainless steel needle prevented the heat loss during warm needle acupuncture techniques.
Litscher et al. (2009) Austria by measurement part
  1. 7mm below the bottom of the needle handle

  2. 5mm below the needle

  3. reference

  4. surface directly next to the needling point

➀ holder
1) 52.74
2) 39.0
3) 22도
➁ human
4) 37.6
n.r. Criteria: Duration for temperature above 35°C
1) 266
n.r. Temperature distributions were registered. The dimensions of local and temporal effects of heat stimulation could be visualized objectively. Effects of the new moxibustion method can be quantified reliably by modern measuring equipment. Using this system, moxibustion under standardized conditions can be performed with high degree of safety.
Cheng et al. (2011) China
  1. by kind of needle

  2. by mass of moxa(g)

skin contact point ➀ gold needle
1.5g:46.56±3.65
➁ silver needle
1.2g:52.56±5.53/1.5g:55.54±6.33
➀ gold needle
1.5g:355
➁ silver needle
1.2g:365/1.5g:405
Criteria: Duration for temperature above 42°C
➀ gold needle
1.5g:325.2
➁ silver needle
1.2g:409.8/1.5g:525
n.r. Moxibustion with silver needle(moxa of 1.5g) produced the warmest and the longest stimulation. Next to silver needle(moxa of 1.5g) is in turn moxibustion with silver needle(moxa of 1.2g), gold needle(moxa of 1.5g) and stainless steel needle (moxa of 1.5g). Moxibustion with silver needle(moxa of low dose) could produce enough warm stimulation.
Yuan et al. (2014) China
  1. by measurement part

  2. by acupuncture size(mm)

  1. 3mm above the tip of the needles

  2. 33mm above the tip of the needles

  3. 63mm above the tip of the needles

  4. 66mm above the tip of the needles

  5. the center of four needles

➀ single needle of 1.1×180 mm
1) 41.12±1.80
2) 41.21±1,94
3) 41.45±1,98
4) 41.57±2.01
➁ single needle of 1.1×160 mm
1) 44.26±3.39
2) 44.33±3.45
3) 44.96±3.61
4) 45.22±3.60
➂ several needles of 1.1×180 mm
1) 43.02±2.52
2) 43.17±2.62
3) 43.51±2.80
4) 43.72±2.84
➃ several needles of 1.1×180 mm
1) 45.16±2.52
2) 45.26±2.58
3) 45.94±2.8
4) 46.18±2.75
n.r. n.r. n.r. There were statistically significant differences in the highest temperatures at 3, 33, 63 and 66 mm above the tip of the temperature measuring silver needle between group of single needle of 1.1×180 mm and group of single needle of 1.1×160 mm or several needles of 1.1×180 mm(P<0.01, P<0.05) and between groups several needles of 1.1×180 mm and several needles of 1.1×180 mm(P<0.05). There were no statistically significant differences in the highest temperatures at 3, 33, 63 and 66 mm above the tip of the temperature measuring silver needle between groups of single needle of 1.1×160 mm and several needles of 1.1×180 mm(P>0.05). The highest temperatures of the needle tips and bodies in warm needling moxibustion with two sizes of silver needles reach over 41 in single needle placement and °C over 43°C in several needles placement. Under the same heating source and needle insertion depth, the highest temperature of a silver needle in human body is influenced by silver needle length and the needling mode. The shorter the silver needle, the higher the maximum temperature. The maximum temperature is higher in several needles placement than in single needle placement.
Gao et al. (2012) Hong Kong
  1. by measurement part

  2. by subject: anaesthetized rabbits, human

  3. by distance between moxa and skin(mm)

  4. with or without cardboard

  1. skin surface directly under the ignited moxa block

  2. 10mm below the burning moxa block

  3. 15mm below the burning moxa block

  4. 20mm below the burning moxa block

  5. 25mm below the burning moxa block

➀ anaesthetized rabbits
1) 30mm:39.1±1.2/25mm:40.0±2.3/20mm: 42.6±2.0/15mm:exceed ed 46 C(the moxa block was quickly removed)
➁ human - with cardboard
1) 35mm:36.21±1/30mm:37.8±0.6/25mm: 39.1±0.9
2) 90*
3) 40*
4) 35*
5) 48* - without cardboard
1) 35mm:38.4±1.3/30mm:40.8±0.9/25mm: (not tested, as it might cause severe pain and even skin burn injuries)
2) 75*
3) 40*
4) 35*
5) 30*
n.r. *That is, the duration of skin temperature above 40 C during burning of these moxa cylinders was less than 30 seconds when the cylinder was at 10mm above the skin. *effective heating period (i.e., >37 C) lasted only 2–3 minutes n.r. Our results show that during needle-warming moxibustion there is little heat being conducted into deep tissue via the shaft of the needle, and that the effective heating time to the acupoint is rather short compared to the period of moxibustion. These findings suggest that the needle-warming technique is an inefficient way of acupoint thermal stimulation and should be modified and improved using new technologies.
Ahn et al. (2010) Korea
  1. by measurment part

  2. by mass of moxa(g)

  1. tip of the needle body

  2. 1cm above the tip of the needle body

  3. 2cm above the tip of the needle body

1) 0.1g, 0.3g, 0.5g:n.t.c./1.0g: 22.40/3.0g:24.8/5.0g:25.5
2) 0.1g, 0.3g, 0.5g:n.t.c./1.0g:22.40/3.0g:24.70/5. 0g:25.46
3) 0.1g, 0.3g:n.t.c./0.5g: 22.4/1.0g:23.5/3.0g:26.5/5.0g:28.3
n.r. n.r. n.r. The thermal conduction through acupuncture needle from the moxa-corn was relative to the weight of moxa-corn and was inversely relative to the distance of the moxa-corn and acupuncture needle length. And the value of thermal conduction to the apex of the acupuncture needle from the moxa-corn was about 3~5°C. The above results suggest that the present study may be useful in finding the mechanism and effects of the warming needling technique.
Cheng et al. (2007) China by kind of needle n.r. (K)
➀ silver: 320*
➁ gold: 300*
➂ stainless steel: 290*
➀ silver: 620*
➁ gold: 740*
➂ stainless steel: 580*
n.r. n.r. A numerical analysis provided the distribution of temperature and the vectorgram of thermal flow in tissues during warming acupuncture. The experiment observed that the curve of temperature distribution and the result of numerical simulation tallied. The investigation found that if the other conditions were the same, a silver needle conducted heat most rapidly and its maximum value was several times as large as those of gold and stainless steel needles during warming acupuncture. Heat passes rapidly mainly along the needle body during warming acupuncture. A silver needle conducts heat most rapidly, raises tissue temperature to a highest degree and transmits heat in a largest range, which prove that warming acupuncture with silver needles produces a best curative effect clinically. In this article, infrared thermography and numerical modeling were used to investigate the process of heat conduction during warming acupuncture and make a quantitative analysis, providing a theoretical and experimental basis for clinical application of different kinds of moxibustion.
Wang et al. (2009) China
  1. by measurement part

  2. by length of needle(mm)

  1. tip of the needle body

  2. 1cm above the tip of the needles

  3. 2cm above the tip of the needles

  4. 3cm above the tip of the needles

  5. 4cm above the tip of the needles

  6. skin contact point

➀ 1.0mm×80mm
1) 24.2±0.38
2) 26.8±1.18
6) 28.6±1.18
➁ 1.0mm×100mm
1) 23.3±0.43
2) 23.7±1.04
6) 24.9±1.13
➂ 1.0mm×120mm
1) 22.5±0.66
2) 23.2±0.52
3) 23.2±1.01
6) 24.1±0.95
➃ 1.0mm×150mm
1) 21.9±0.14
2) 22.0±0
3) 22.6±0.80
4) 22.7±0.58
5) 23.3±0,25
6) 24.0±0.25
all: 600 Temperature of the needle body ascended first and descended later. Temperatures on the tenth minute were the highest among the five points measured. Temperatures of the tips of 8cm and 10cm silver needles elevated(P<0.05). Temperatures of the spot on muscle surface of all needles raised(P<0.05). Temperature of 8cm silver needles raised highest among them. Temperature fluctuation of silver needle in pig’s isolated skeletal muscles are obvious. Temperatures of the needle body in tissue are influenced by length of the whole needle and length of the part outside.
Hong et al. (2008) Korea
  1. by measurement part

  2. by heating source: by mass of moxa(g)/by quantity of electricity(mA)

  1. tip of the needle body

  2. 1cm above the tip of the needles

  3. 2cm above the tip of the needles

➀ moxa
1) 0.5g:n.t.c./1g:21.26/3g:22.09/5g:23.06°C
2) 0.5g:n.t.c./1g:22.40/3g:24.77/5g:25.46
3) 1g:23.5/3g:26.5/5g: 28.3
➁ high frequency warm needling device
1) 1mA:n.t.c./2.5mA :20.5*/5mA:22*/10mA:31*
2) 1mA:n.t.c./2.5mA: n.t.c./5mA:22.1/10mA:23.7
3) 1mA:n.t.c./2.5mA: n.t.c./5mA:n.t.c./10mA:21.2*
1) 0.5g:n.t.c./1g:700/3g: 750/5g:800
2) 0.5g:n.t.c./1g:550/3g: 650/5g:850
3) 1g:650/3g:1000/5g: 1500
The thermal conduction mount via acupuncture from the moxibustion was relative to the weight of moxibustion and was inverse relative to the distance of the moxibustion and acupuncture length. The thermal conductant mount transferring to the apex of the acupuncture needle from the moxibustion was about 3~5°C. The generation mount of heat used by a high-frequency warming needling device was relative to the quantity of electricity. The thermal transfer location was limited within the apex of insulated acupuncture in the high-frequency warming needling device. As the above results suggest, the present study may be vuseful in finding the mechanism and effects of the warming needling technique.

n.r.: not reported;

* approximate figures on a graph; n.t.c.: no temperature changes

Table 7
Summary of Measurement Results(2)
Measurement Criteria Measurement Part Δ Temperature of Warm Needle(°C) Interpretation of Infrared Thermal Image Conclusion
Yang et al. (2017) Korea
  1. by measurement part

  2. by with or without heat proof plate

  3. by thickness of needle(mm)

  4. by time

  1. 1cm from bottom-end of moxa stick

  2. 2.5cm from bottom-end of moxa stick

➀ without heat proof plate
1) 0.3mm:0.5±0.1~2.4±0.3/0.5mm: 0.6±0.1~3.6±0.7/0.8mm:1.4±0.2~ 11.8±2.6
2) 0.3mm:0.2±0.1~1.4±0.1/0.5mm: 0.2~1.0±0.2/0.8mm:0.3±0.1~2.5±0.3
- Δ Temperature of 1) and 2) (50, 100, 150sec)
0.3mm:0.3, 0.76, 1.04/0.5mm:0.36, 1.22, 2.6/0.8mm:1.14, 3.1, 9.34
➁ with heat proof plate(50, 100, 150 sec)
1) 0.3mm: −0.1±0.1, 0.1±0.1, 0.3±0.2/0.5mm:0.1±0.1, 0.6±0.2, 1.6±0.3/0.8mm:0.2±0.1, 1,3±0.4, 3.4±0.9
2) 0.3mm, 0.5mm:n.t.c./0.8mm: 0.3±0.1(100sec), 0.8±0.2(150sec)
- Δ Temperature of 1) and 2) (50, 100, 150sec)
0.3mm:0.1, 0.28, 0.5/0.5mm:0.24, 0.74, 1.64/0.8mm:0.22, 0.98, 2.66
➀ without heat proof plate Combustion heat of moxa is transmitted to the shaft of the needle and thermal imaging is observed in the tip of needle inserted frame. The thicker the shaft of the needle, the clearer the thermal imaging of the frame.
➁ with heat proof plate The thicker the shaft of the needle, the clearer the thermal imaging of the frame. But, the change is very slight compared to conditions without heat proof plate. Thermal imaging isn’t observed in the tip of needle inserted frame.
In the normal condition, heat transmit of needle shaft increased at spots 10 mm and 25 mm below the moxa stick. The amount of heat transmit increased with the diameter of needle shaft. However, when the heat shield was installed to exclude radiant heat from the moxa stick, heat transfer was less at 10 mm below the moxa stick and no temperature change was observed at 25 mm below the moxa stick. Heat transfer by warm needling does not reach the end of needle shaft even in ø 0.8 mm needle. It is suggested that the radiant heat of moxa stick results in the heat transmit of acupuncture needle shaft. Thus, radiant heat transmit must be considered as one of the heat transfer characteristics of the warm needling.
Cheng et al. (2007) China already mentioned in the table6 already mentioned in the table6 already mentioned in the table6 Heat transfer velocity: silver is the fastest, followed by gold and stainless steel. The heat is concentrated mainly on the inserted needle, and the heat is quickly transferred along the needle, showing a noticeable V shape. It seems photographic that the heat of the silver needle is transmitted most deeply. The heat of stainless steel needles was delivered only to relatively shallow tissues. already mentioned in the table6
Jang et al. (2009) Korea
  1. by subjects: gelatin(by electrolytes), anaesthetized animals

  2. by acupuncture size(mm)

  3. depending on the degree of exposure of the tip of the needle

  4. by quantity of electricity(mA)

  1. tip of the needle body

  2. divide the upper and lower sides into nine zones at 5mm intervals around the tip of the needle body

1)
➀ 0.9% saline, 0.25mm thickness
- 1mA/2.5mA:n.t.c.
- 5mA:30mm length 3.03±0.47/60mm n.t.c.
- 10mA:30mm length 8.4±1.23/60mm 6.9±1.67
- 20mA:30mm length 7.63±0.97/60mm 6.9±0.17
➁ 0.4% saline, 0.25mm thickness
- 1mA:n.t.c.
- 2.5mA:30mm length 0.7, 60mm length n.t.c.
- 5mA:30mm length 2.5, 60mm length 1
- 10mA:30mm length 6.53±0.2, 60mm length 6.5±0.8
- 20mA:30mm length 7.9±0.62, 60mm length 10
➂ distilled water
- 1mA:n.t.c.
- 2.5mA:n.t.c.
- 5mA:2.5~2.8
- 10mA:30mm length 7.8±1.42, 60mm length 7.7±1.36
- 20mA:30mm length 8.2±1.02, 60mm length 9.8±0.7
➃ 0.9% saline, 40mm length
- 1mA/2.5mA:n.t.c.
- 5mA:0.6
- 10mA:0.25mm length 1.8, 0.30mm length 1.6
- 20mA:0.25mm length 4.9±0.9, 0.30mm length 4.2±0.38
➄ 0.4% saline, 40mm length
- 1mA:n.t.c.
- 2.5mA:0.30mm thickness 0.3
- 5mA:0.25mm thickness 0.6/0.30mm thickness 1
- 10mA:0.25mm thickness 3.4, 0.30mm thickness 3.1
- 20mA:0.25mm thickness 6, 0.30mm thickness 10
➅ distilled water, 40mm length
- 1mA:n.t.c.
- 2.5mA: 0.25mm thickness 0.5, 0.30mm thickness 0.9
- 5mA: 0.25mm thickness 1.4, 0.30mm thickness 3.3
- 10mA: 0.25mm thickness 3.2, 0.30mm thickness 8.5
- 20mA: 0.25mm thickness 6, 0.30mm thickness 11.5
➆ 1mm exposure(0.30×40mm)
- 10mA: 2.7±0.12
➇ 2mm exposure(0.30×40mm)
- 10mA: 2.0±0.2
1. at gelatin (0.3×40 mm): The most pronounced temperature changes are observed in the area where the tips of needle are located. It is observed that thermal conductivity occurs in the form of an oval in the form of water droplets from top to bottom around the tip of the needle.
2) Δ Temperature of peatk temperature(°C)/peak time(minute) (A~I)*
➀ 0.9% saline, 20mA
A:0.8/30, B:1.2/30, C:0.8/30
D:1.5/30, E:3/20, F:1.2/30
G:0.6/25, H:1.2/20, I:1/30
➁ 0.4% saline, 20mA
A:0.8/30, B:1.2/30, C:0.5/25
D:1.3/30, E:3.8/30, F:1.2/30
G:0.9/25, H:1.5/25, I:0.9/30
➂ distilled water, 20mA
A:2/15, B:3.5/30, C:2/20
D:2.8/25, E:6.5/30, F:2.5/20
G:1.5/25, H:3/20, I:1.5/20
2. at anaesthetized animals (0.30X40mm)
At a high frequency of 5mA, thermal phenomena through subcutaneous surface are observed at 50s. A high frequency of 10mA shows a distinct warming effect at 40s. A rapid temperature increase is observed immediately after the 20mA high frequency stimulation. A very pronounced thermal effect is observed on the body surface at the time of 10s.
The heat generation of the warm needle tip was proportionated in the intensity of the electrical currents. The lower electrolytes resulted in the higher temperature in the warm needle. The heat generation of high frequency warm needling device(HF-WN) was inversely proportional in exposure length of the needle tip, and there was not direct relationship to heat generation degree in the length and diameter of warm needle. In compliance with the high frequency the temperature increased from warm needle tip and it was diffused far away about 5–10mm in shape of a waterdrop. The more electric currents HF-WN flow, the more temperature changing rates it increased in the warm needle. As the above results, it suggests that the kind and condition of warm needle influences in the heat generation feature and tempo-spatial temperature changes of HF-WN and may be useful in understanding the mechanism and effects of the warming needling technique.
Lee ea al. (2012) Korea manual acupuncture stimulation(MAS) or warm acupuncture stimulation(WAS) n.r. ➀ MAS:0.375±0.224
➁ WAS:0.645±0.281
n.r. Temperature of acupuncture needle increased up to 60°C. In the result for clinical significance of system, in case of manual acupuncture stimulation(MAS), body temperature change was 0.373°C ±0.224(p<0.05). In case of warm acupuncture stimulation(WAS), body temperature change was 0.645°C±0.281(p<0.05). We confirm that the system is able to be applied clinically to various warm acupuncture needle therapy in the area of oriental medicine.

n.r.: not reported;

* approximate figures on a graph; n.t.c.: no temperature changes

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