Can Heat and Cold be Parametrized? Clinical Data of a Preliminary Study

Doenitz C, Anjos, A, Efferth T, Greten T, Greten HJ. JCIM 2012; 10(5):532-7


The aim of this study was to demonstrate whether it is possible to objectively assess the effects of acupuncture by microcirculation-related parameters in the given clinical scenario, to evaluate the significance of the status of capillary perfusion prior to acupuncture for the treatment of a clinical cold pattern, and to evaluate the possible role of microcirculation-related parameters for the future parameterization of the traditional Chinese medicine (TCM) diagnosis.

This prospective, uncontrolled, unblinded preliminary clinical trial included 32 elderly patients after surgical treatment for femoral fractures. For acupuncture treatment the patients received acupuncture with the „leopard spot technique“ an the stomach meridian (Liangqiu, S34/ST34). Measurements of microcirculation-related parameters (velocity, blood flow, haemoglobin, oxygen saturation) by white light spectroscopy and laser Doppler were performed prior to and after acupuncture treatment.
Two subgroups of patients after femur fracture could be identified: a low- and a high-perfusion group. Capillary flow velocity and blood flow were significantly augmented by acupuncture in the low-perfusion group only. In the high-perfusion group, there was no significant change of perfusion after acupuncture. The statistical analysis of all patients regardless of their pre-acupuncture perfusion status revealed no statistically significant alteration after acupuncture. The acupuncture effect may have been masked by the inhomogeneity of the overall group.
Microcirculation-related parameters may be valuable to measure acupuncture effects objectively and to characterize the vegetative functions prior to acupuncture so as to homogenize the comparison groups in clinical trials. In our example, a local cold pattern (low capillary perfusion of the leg) could be treated successfully by a point which enhances qi and blood flow, whereas in heat pattern (high capillary perfusion) this Intervention had no such effect. Future studies may be directed to correlate the vegetative status as measurable by TCM vegetative parameters with the key symptoms of TCM diagnosis.

Assessment of Qigong-Related effects by Infrared Thermography: A Case Study

Matos LC, Gonçalves M, Machado J, Greten HJ. JCIM 2012; 10(6):663-666

A contemporary understanding of traditional Chinese medicine (Heidelberg Model of TCM) considers TCM to be a traditional model of system biology.This model focuses on the fact that the core technical terms of TCM such as yin, yang and the phases or elements may be understood as terms of vegetative regulation. Hence TCM diagnosis is understood as a comprehensive description of the vegetative functional state of a patient.

Learn more:
Qigong is a therapeutic method of TCM and combines slow and soft movements with breath control and a specific mental state of „awareness“ and imagination. The traditional explanation of Qigong-related effects is that qi flow and homeostasis (balance of yin and yang) are promoted. Many findings on the physiological basis of Qigong-related effects remain contradictory or have not been reproduced on a sufficient scale. From a Western standpoint these exercises may be understood as traditional vegetative feedback exercises. This was the reason why the authors are searching for consistent vegetative functional changes during Qigong exercise.

As the authors were experimenting with a special kind of Qigong, the „White Ball“ system, consistent changes of skin temperature by infrared thermography were observed, which were shared with other researchers so as to objectify vegetative Qigong-related effects in the future. Unlike other qi exercises, the „White Ball“ system only takes some 5 to 6 min to perform, but apparently has some clinical value. A subjective qi sensation is evoked relatively easily and quickly.

Effects of qigong on performance-related anxiety and physiological stress functions in transverse flute music schoolchildren

–  A Feasibility Study –

Sousa  CM, Gonçalves M, Machado J, Efferth T, Greten T, Froeschen P, Greten HJ. JCIM 2012; 10(8):858-65


Based on individual cases of treatment, we were interested in whether the effects of a special kind of qigong, the „White Ball“ exercises, can be objectified by physically measurable parameters and psychological scores.

We performed a preliminary prospective controlled interventional study with the waiting list design. In the qigong group eight children were included. They received specific qigong lessons of the „White Ball“ qigong over seven weeks, twice a week, for 30 min with a waiting list design and instructions to perform the same exercises at home daily. In the control group eight children were included in a waiting list design with no qigong instruction. Subjective perception of anxiety was measured by the Portuguese version of the Depression, Anxiety and Stress Scale adapted for children. In addition, salivary cortisol, heart rate variability, blood pressure, surface electromyography of the trapezius muscle and reaction time were measured at the beginning and the end of the study prior to the regular public auditions.
In comparison to the changes in the control group, the qigong group scored significantly lower in heart rate. Otherwise the groups did not differ significantly; however, the effect size was large for salivary cortisol, surface electromyography of the trapezius muscle and blood pressure. There were relevant reductions of subjective perception of anxiety, salivary cortisol levels and heart rate.
The heart rate of performing schoolchildren can be potentially reduced by „White Ball“ exercises. Based on a sample of 8/8, positive tendencies were also observed for anxiety and blood pressure. The next steps of objectifying possible qigong effects are toincrease the sample size, to study young people in other situations arousing anxiety, to develop an appropriate control Intervention, to solve the problem of blinding and double blinding, to find additional parameters that may be influenced by the „White Ball“ qigong, and to compare the qigong effects with other methods reducing anxiety such as more traditional biofeedback or systematic desensitization.

Qigong Therapy in Physiotherapists in Burnout – A Preliminary Study

Saganha JP,  Doenitz CA, Greten T, Efferth T, Greten HJ, 2012, JCIM 2012; 10(11): 1233-9


The study was carried out in order to evaluate the prevalence of burnout in physiotherapists, and to assess whether „White Ball“ Qigong exercises may be effective in burnout. This was aimed to provide preliminary data for the preparation and development of a larger study.

Physiotherapists completed a demographic questionnaire and the Maslach Burnout Inventory (MBI) questionnaire. For the intervention and the control groups, the authors selected those physiotherapists with the highest levels of burnout on the most important subscale. The intervention group (eight physiotherapists) performed a specific qigong intervention as developed by the Heidelberg School of Chinese Medicine; the control group consisted of eight physiotherapists on a waiting list. At the end of a three-week period of treatment or waiting list, both groups repeated the MBI for the comparison of results.
Of 106 physiotherapists (36 males and 70 females) assessed by the MBI, Emotional Exhaustion subscale was seen in 52 (49.1%), Depersonalization subscale in 36 (33.9%), and Burnout in the Personal Accomplishment subscale in 33 (31.2%), of whom 4 (3.8%) suffered to a severe degree and 29 (27.4%) moderately. Within the study group qigong lowered the mean values of Emotional Exhaustion subscale from 38.0 to 31.4, whereas in the control group the values rose from 33.9 to 37.9. The differences between the two groups were statistically significant (P=0.023). Qigong lowered the mean value of Depersonalization subscale from 10.8 to 6.8. In controls the value rose from 7.3 to 10.6. The difference between the two groups was statistically significant (P=0.013). The mean values of Personal Accomplishment subscale decreased in both groups: from 35.4 to 33.9 in the intervention group, and from 37.5 to 37.1 in the control group. The difference between the two groups was not statistically significant.
The effects of „White Ball“ Qigong on burnout symptoms are measurable by the MBI. The results are compatible with the thesis that this type of qigong is an effective tool for the self-management of burnout. It is easy to integrate into a daily routine as it takes only 2×5 min per day. On the basis of this evaluation, a study design can now be developed on a larger scale with appropriate blinding, follow-up testing and adequate controls.

TCM diagnosis and objective pain assessment may be useful to demonstrate specific effects of acupuncture in low back pain

A Prospective, Randomized, Controlled and Single-Blinded Pre- Study

Seca S, Paula Capelo P, Efferth T, Doenitz CA, Schroeder S, Anjos A, Machado J, Greten HJ (submitted to JAcuTuinaSci)


It has been claimed that studies on appr. 20.000 individuals failed to prove specific effects of acupuncture on chronic pain. We speculated that the potential specific effectiveness of acupuncture could be better shown in more properly designed studies. Therefore, we used diagnoses of both Western medicine and traditional Chinese medicine (TCM) as inclusion criteria to allocate acupoints more precisely to the complaints of the patients. Secondly, we chose objectively measurable parameters of pain relief in addition to usual Visual Analogue Scale (VAS) to quantify the effects of acupuncture.

The study was prospective, randomised, controlled and single-blinded. Eighteen patients with chronic back pain and TCM diagnosis of a greater yang/yang major syndrome received one single session of acupuncture chosen according to TCM diagnosis or acupuncture on points outside the conduit (meridian) system (controls). We evaluated pain via VAS and increased mobility via inclinometry of the back.
Although the sample size was low, there was a statistically significant improvement in pain and mobility in the verum group (n=13), but not in the control group (n=5). The calculated sample size adequate power was lower for inclinometry than for VAS, indicating that VAS is less probable to discriminate acupuncture effects.
Objectively measurable physical parameters such as the angle of flexion before and after acupuncture (inclinometry) may be more suitable to measure pain relief than subjective assessment by VAS in acupuncture studies. TCM diagnosis may be a helpful inclusion criterion in studies on acupuncture, so as to potentially allocate interventions better to the complaints of patients.