2Dep. of Acupuncture & Moxibustion Medicine, Dongguk University Bundang Oriental Hospital
3Dep. of Acupuncture & Moxibustion Medicine, Dongguk University Ilsan Oriental Hospital
4Dept. of Sasang Constitutional Medicine, Dongguk University Bundang Oriental Hospital
5Dep. of Korean Rehabilitation Medicine, Dongguk University Bundang Oriental Hospital
6Institute of Oriental Medicine, College of Korean Medicine, Dongguk University
7Dept. of Medical Classics and History, College of Korean Medicine, Dongguk University
8Dongje Medical Co., Ltd
Correspondence to: Eun-Jung Kim, Department of Acupuncture & Moxibustion Medicine, Dongguk University Bundang Oriental Hospital 268, Buljeong-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-865, Republic of Korea, Tel: +82-31-710-3751, E-mail: hanijjung@naver.com
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.
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 )
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
by measurement part
by kind of needle
by mass of moxa(g)
1cm below the lower end of the handle
2cm below the lower end of the handle
vertically 2cm, horizontally 1.5cm from the lower end of the handle
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.
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
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.
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.
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
by measurement part
with or without coating
tip of the needle body
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.
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
7mm below the bottom of the needle handle
5mm below the needle
reference
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.
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
by measurement part
by acupuncture size(mm)
3mm above the tip of the needles
33mm above the tip of the needles
63mm above the tip of the needles
66mm above the tip of the needles
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
by measurement part
by subject: anaesthetized rabbits, human
by distance between moxa and skin(mm)
with or without cardboard
skin surface directly under the ignited moxa block
10mm below the burning moxa block
15mm below the burning moxa block
20mm below the burning moxa block
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.
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.
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.
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
by measurement part
by heating source: by mass of moxa(g)/by quantity of electricity(mA)
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
by measurement part
by with or without heat proof plate
by thickness of needle(mm)
by time
1cm from bottom-end of moxa stick
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
by subjects: gelatin(by electrolytes), anaesthetized animals
by acupuncture size(mm)
depending on the degree of exposure of the tip of the needle
by quantity of electricity(mA)
tip of the needle body
divide the upper and lower sides into nine zones at 5mm intervals around the tip of the needle body
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
참고문헌
1. Korean Acupuncture & Moxibustion Medicine Society. Acupuncture Medicine. Seoul. Hanmibook Co;(2016). p. 152-3.
2. 元植 洪. 精校黃帝內經素問. 서울. 동양의학연구원출판사;(1985.
3. Kim, YH, Lee, SH, Yeo, SJ, Choi, IH, Kim, YK, & Lim, S. Study on Ignition Position-related changes in Warm Needle Temperature. Korean Journal of Acupuncture, (2008). 25(1), 247-57.
4. Li, C, Jiang, Z, & Li, Y. Therapeutic effect of needle warming through moxibustion at twelve shu points on rheumatoid arthritis. J Tradit Chin Med, (1999). 19(1), 22-26.
5. Li, X, Han, Y, Cui, J, Yuan, P, Di, Z, & Li, L. Efficacy of warm needle moxibustion on lumbar disc herniation: a meta-analysis. Journal of evidence-based complementary & alternative medicine, (2016). 21(4), 311-319.
6. Kim, H, Shim, I, Yi, SH, Lee, H, Lim, HS, & Hahm, DH. Warm needle acupuncture at Pungsi (GB31) has an enhanced analgesic effect on formalin-induced pain in rats. Brain research bulletin, (2009). 78(4–5), 164-169.
7. Yang, L, Tan, JY, Ma, H, Zhao, H, Lai, J, Chen, JX, & Suen, LK. Warm-needle moxibustion for spasticity after stroke: a systematic review of randomized controlled trials. International journal of nursing studies, (2018). 82, 129-138.
8. Lim, S. Effects of On-Chim on immune response induced by irradiation. The Journal of Korean Acupuncture & Moxibustion Society, (1995). 11(2), 191-206.
9. Cheng, K, Ding, YW, Shen, XY, & Ding, GH. Study of heat conduction of warming acupuncture. Shanghai Journal of Acupuncture and Moxibustion, (2007). 26(8), 32-36.
10. Hao YF, Ma LX; Nursing Science of Traditional Chinese Medicine. Bilingual Versions. Beijing. People’s Medical Publishing House;(2015). p. 251-252.
11. Yang XM. Clinical research on needle warming moxibustion treatment ofupper extremity spastic paralysis after stroke. China:M.Sc. Thesis. Guangzhou ACCEPTED MANUSCRIPT University of Chinese Medicine;2013.
12. Kim, JW, Lee, HJ, Ahn, CB, & Yi, SH. Study of the thermal properties of warm needle and the development of warm needle apparatus. Journal of Acupuncture Research, (2011). 28(1), 15-28.
13. Kim, YH, Lee, SH, Yeo, SJ, Choi, IH, Kim, YK, & Lim, SBN. Study on ignition position-related changes in warm needle temperature. Korean Journal of Acupuncture, (2008). 25(1), 247-257.
14. Kim, YH, Lee, SH, Yeo, SJ, Choi, IH, Kim, YK, & Lim, SBN. Study on Moxa density-related Changes in Warm Needle Temperature. The Journal of Korean Medicine, (2008). 29(3), 11-20.
15. Kim, YJ, Shin, KM, Kim, EJ, Kim, KH, Kim, KS, & Lee, SD. A comparative study on heat transfer characteristics in tissue model with application of heating or cooling therapeutic modalities. Journal of Korean Acupuncture & Moxibustion Society, (2013). 30(4), 125-138.
16. Yeo, S. The Study on Temperature Measurement of Warm Needling Using Stainless Steel Needle and Gold Needle. Korean Journal of Acupuncture, (2013). 30(3), 178-84.
17. Yang, SB, Park, SJ, Lee, JG, Jung, JC, & Kim, JH. Experimental Interpretation of Heat Transmits Pattern on Warm Needling. Korean Journal of Acupuncture, (2017). 34(3), 109-115.
18. Choi, GM, & Eom, TS. Effect of the quality of acupuncture on variation of temperature in the warm needle. The Journal of Korean Acupuncture & Moxibustion Society, (1992). 9(1), 143-51.
19. Kim, JWR, Lee, HJ, & Yi, SH. Study of air flow effects on heat characteristics of warm needle acupuncture. Korean Journal of Acupuncture, (2010). 27(4), 35-47.
20. Gao XY, Chong CY, Zhang SP, Cheng KWE, Zhu B. Temperature and safety profiles of needle-warming techniques in acupuncture and moxibustion. Evidence-based complementary and alternative medicine. (2012.
21. Kim, J, & Lee, JS. Thermal distribution in living tissue during warm needling therapy. Journal of Korean Medicine Rehabilitation, (2014). 24(3), 111-119.
22. Cheng, W, Wei, J, & Shen, X. Temperature Characteristic of Moxibustion with Warming Needles Made of Different Materials. Chinese Journal of Chinese Chinese Medicine, (2011.
23. Lee, SH. Study on Thermal Changes and Biological Safety of Thermo Needles. Graduate School KyungHee University, (2006.
, Hyo Rim Jo2
PDF Links
Full text via DOI
PubReader
Download Citation 
Print 
