title: Effectiveness of strengthened stimulation during acupuncture for the treatment of Bell palsy: a randomized controlled trial.
abstract: BACKGROUND
  The traditional Chinese theory of acupuncture emphasizes that the intensity of acupuncture must reach a threshold to generate de qi, which is necessary to achieve the best therapeutic effect. De qi is an internal compound sensation of soreness, tingling, fullness, aching, cool, warmth and heaviness, and a radiating sensation at and around the acupoints. However, the notion that de qi must be achieved for maximum benefit has not been confirmed by modern scientific evidence.
  
  
  METHODS
  We performed a prospective multicentre randomized controlled trial involving patients with Bell palsy. Patients were randomly assigned to the de qi (n = 167) or control (n = 171) group. Both groups received acupuncture: in the de qi group, the needles were manipulated manually until de qi was reached, whereas in the control group, the needles were inserted without any manipulation. All patients received prednisone as a basic treatment. The primary outcome was facial nerve function at month 6. We also assessed disability and quality of life 6 months after randomization.
  
  
  RESULTS
  After 6 months, patients in the de qi group had better facial function (adjusted odds ratio [OR] 4.16, 95% confidence interval [CI] 2.23-7.78), better disability assessment (differences of least squares means 9.80, 95% CI 6.29-13.30) and better quality of life (differences of least squares means 29.86, 95% CI 22.33-37.38). Logistic regression analysis showed a positive effect of the de qi score on facial-nerve function (adjusted OR 1.07, 95% CI 1.04-1.09).
  
  
  CONCLUSIONS
  Among patients with Bell palsy, acupuncture with strong stimulation that elicited de qi had a greater therapeutic effect, and stronger intensity of de qi was associated with the better therapeutic effects.
  
  
  BACKGROUND
  Clinicaltrials.gov no. NCT00685789.
authors: Department of Neurology, Key Laboratory of Neurological Diseases of Chinese Ministry of Education, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
authors: Sha-bei
authors: SB
authors: Xu
authors: Bo
authors: B
authors: Huang
authors: Chen-yan
authors: CY
authors: Zhang
authors: Peng
authors: P
authors: Du
authors: Qi
authors: Q
authors: Yuan
authors: Gui-juan
authors: GJ
authors: Bi
authors: Gui-bin
authors: GB
authors: Zhang
authors: Min-jie
authors: MJ
authors: Xie
authors: Xiang
authors: X
authors: Luo
authors: Guang-ying
authors: GY
authors: Huang
authors: Wei
authors: W
authors: Wang
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D000328:Adult; D020330:Bell Palsy / Q000503:physiopathology / Q000628:therapy*; D005154:Facial Nerve / Q000503:physiopathology; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D016896:Treatment Outcome; D055815:Young Adult