Electric Plum-Blossom Acupuncture Therapy:An Overview from a Modern Medicine Perspective

Plum-blossom acupuncture therapy prevents and treats diseases by tapping a particular part of the body surface, acupoint, or meridian circulation route with a needle, a bundle of short needles combining multiple stainless, also known as a dermal needle [1]. Developed from ancient methods such as ‘ Semi-acupuncture ‘ and ‘ Central-square needling ‘, plum-blossom acupuncture therapy is a superficial method of acupuncture that has been used since ancient times. As one end of the needle handle is equipped with seven short needles, resembling a plum blossom shape, it is referred to as a ‘Plum-blossom needle’. Children are easy to accept because of its shallow stimulation site, less pain when tapping, and safety, hence the term’ pediatric acupuncture [2]. Plum-blossom acupuncture therapy is an important component of Traditional Chinese Medicine. The technique has been documented for over 2000 years in ‘The Yellow Emperor’s Internal Classic,’ a foundational text on acupuncture.

‘Miraculous Pivot-Guanzhen’ mentioned that ‘Semi-acupuncture, acupuncture on the superficial part of the skin due to the impediment ‘and’ Central-square needling is a needle in the middle of the acupuncture point, and then a needle is shallowly pricked on the upper and lower left and right, which is used to treat diseases where cold retention, extensive area, and shallow disease location [3]. Plain Question-Ciyaolun ‘explains: ‘ Disease has the difference between exterior and interior, and the acupuncture method has the difference between superficial and deep acupuncture. Diseases on the exterior should be superficially acupuncture, and diseases in the interior should be deeply acupuncture’. These acupuncture theories laid the foundation for developing and improving plum-blossom needles for later generations [4]. Electro-acupuncture therapy has a long history of research and application, and the first physician to apply electricity to acupuncture needles in medicine was the French physician Barry Waltz, who proposed that the electrical stimulation generated by the battery can enhance the therapeutic effect of acupuncture [5].

In the 1950s, Chinese doctor Zhu Longyu formally proposed electro-acupuncture therapy and successfully piloted the development of an electro-acupuncture therapeutic apparatus [6]. By replacing long-term needle manipulation, electro-acupuncture saves time and effort, allows objective stimulation control, improves therapeutic effect, and is easy to popularize [7]. Electric plum-blossom acupuncture has been around since the late 19th century and combines skin stimulation, meridian and acupoint, and electro-acupuncture to create a more powerful therapeutic effect. This article aims to review and summarize the mechanism of action, the method of adding electricity, clinical treatment, indications, contraindications, and adverse event reports of electric plum-blossom acupuncture to provide some new ideas for future research.

Electric plum-blossom acupuncture therapy belongs to the category of Western medicine physical therapy, and its main mechanism is as follows:
A. Electric plum-blossom acupuncture gives a certain degree of stimulation to acupoints by tapping, which causes the nerve endings or receptors of the human body to produce effects, which then transmit the stimulation signal to the central nervous system through nerve reflexes, which are integrated and analyzed by the centre, activate the nerve cells, promotes neuronal function recovery, and send signals to the motor terminals to correct the abnormal mode. The neurological function is improved by increasing neurons’ excitability and promoting their conduction speed through electrical stimulation [8].
B. By shallowly pricking the skin with plum-blossom acupuncture, the stimulation transmits acupuncture signals to the spinal cord via the thick fibres of sensory nerve endings, which prevent the noxious stimulation from entering the spinal dorsal horn by closing the sluice gates of the astrocytes, and nerve fibres are sequentially excited from the thick fibres, leading to an analgesic effect [9].
C. Electric plum-blossom acupuncture can make the lesion tissue congested and heated, improve local blood circulation and increase blood flow while improving vasodilatation, thereby improving the supply of oxygen and nutrients to the tissues, reducing edema and improving immunity, and restoring nerve function by reducing damage caused by compression [10].
D. Electric plum-blossom acupuncture therapy can enhance muscle function by increasing muscle strength and endurance through the contraction of muscle fibres by stimulation with electric current [11].
E. Based on the findings of Sun et al. [12]. plum-blossom acupuncture exerts its therapeutic effects primarily through the ‘pain reflex’. When a painful stimulus is applied to the body’s muscle surface, the nerve impulses generated by the pain receptors are connected to internal organs via afferent and autonomic nerves. In response to the stimulus, the neurohumoral system releases a series of cytokines and active substances that regulate the immune and endocrine systems (Figure 1).

Figure 1:Mechanisms of action of electric plum-blossom acupuncture therapy.

Beginning in the 1950’s

Since the 1950’s, electric plum-blossom acupuncture has been used to treat various diseases. Doctors commonly attached one pole of the output wire to the needle body of the plum-blossom acupuncture and handed the other pole, connected to a copper cylinder, to the patient to hold. The electro-acupuncture instrument was then turned on, and the plum-blossom acupuncture was tapped on a specific area to treat the disease. The electric plum-blossom acupuncture treatment with this method of adding electricity is easy to operate, eliminating the inconvenience of long-term manual operation, but it also has obvious shortcomings. In the last century, electro-acupuncture was still in the exploratory stage. It could not guarantee that the copper cylinder gripped by the patient was conducting electricity [13,14].

Developing in the 1980’s

After the 1980’s, many doctors began to explore different methods of adding electricity to the electric plum-blossom acupuncture treatment, making it more effective. Bai et al. [15] drilled a small hole above the plum-blossom acupuncture, unscrewed the needle plate, removed a small lead skin, and penetrated the wire from the spot. One wire was on the lead skin with a soldering iron, and the other was welded on the power plug. Then put the lead skin back in place to screw the needle plate on. Thus, it is more efficient, provides constant strength, and is easier to operate. Zhang et al. [16] connected two output wires of an electro-acupuncture instrument, one to the plum-blossom acupuncture and the other to an electrode on the affected limb’s Yanglingquan point (GB34). The affected area and needles were sterilized, and the electro-acupuncture instrument was activated, producing dilatational wave frequencies of 16-300 times/min. This electric plum-blossom acupuncture treatment is easy and safe to operate, with strong effects.

Maturing in the 21^st century

A new digital electric plum-blossom acupuncture combines micro-pulses of electricity with plum-blossom acupuncture, with adjustable therapeutic parameters to realize automatic tapping instead of manual tapping, was developed by Xu et al. [17]. It drives the needle to vibrate up and down using an alternating current, producing a tapping action and a micro-pulse current that acts on the treatment site. With this new technology, the intensity and frequency of plum-blossom acupuncture movement can be accurately adjusted for different diseases, enhancing the curative effect by forming a circulation circuit in the patient’s skin. This instrument is not limited to clinical treatment but can also be used for family health care.

Electric plum-blossom acupuncture treatment has been used to prevent and treat diseases for many years. It is beneficial to many diseases, among which skin diseases include acne vulgaris, [18] alopecia areata, [19-22] alopecia, [23] urticaria, [24] vitiligo, [25] pruritus skin disease, [14] and cutaneous neuritis of the lateral thigh [16]. In treating acne vulgaris, Zhang et al. [18] used the electric plum-blossom acupuncture treatment to make a homemade metal head plum-blossom acupuncture with a cannula welded to the acupuncture head, which was connected to the output of the electro-acupuncture instrument through an electrode clip. After wiping the patient’s palm with 75% medical alcohol, the patient was asked to hold the metal cannula at the other end of the output electrode, turn on the power switch, use a continuous wave, and rotate the output potentiometer clockwise until the patient felt the appropriate intensity of the electric pulse. Use the plum-blossom acupuncture to gently tap around the acne-dense area of the face and back, as well as the first lateral line of the Governor’s pulse and Bladder meridians, the Lung and Large intestinal meridians on the forearm, and the Stomach meridian on the lower extremities. Use the electric plum-blossom acupuncture to tap along the meridians 3-5 times, with each key acupoint tapped for 30 seconds to 1 minute. Electric plum-blossom acupuncture is tapped vertically on the skin surface at a frequency of 70 to 90 times/min to the extent that the skin is flushed. The control group was treated by applying vitamin A cream. The results showed that the short-term efficacy of the electric plum-blossom acupuncture for treating acne vulgaris was precise, without side effects, and readily accepted by patients.

Eye disorders include oculomotor paralysis, [26] juvenile myopia, [27-32] children amblyopia, [33-35] xerophthalmia, [36] and concomitant strabismus [37]. Among them, juvenile myopia is one of the most commonly treated disorders with electric plum-blossom acupuncture. Li et al. [27] used the plum-blossom acupuncture mode of the acupuncture and massage instrument to apply a pair of electrodes on one side of the corresponding acupoints (Bilateral Neiguan point (PC6)) on the wrist and another pair of electrodes on the related acupoints on the face (in the order of Jinming point (BL1), Chengqi point (ST1), Taiyang point (Ex-HN05), each pair tapped for 5 minutes) and then activated the treatment instrument to tap evenly for 15 minutes, once a daypatient tolerance as the degree. The patients in the drug group were instructed to use eye drops every night before going to bed, with 1-2 drops per use, ten times as a course of treatment. Continuous treatment of 2 courses, five days of rest between the course of treatment. The results showed that the electric plum-blossom acupuncture group was significantly better than the drug group in reducing the lens and ciliary body thickness in myopic eyes under regulation and relieving ciliary muscle spasms (P<0.05). Electric plum-blossom acupuncture treatment effectively improves visual acuity, corrects refractive errors, and delays myopia development in myopic eyes. Electric plum-blossom acupuncture can also be applied to sensory diseases (functional sensory abnormalities, [38] limb numbness [39,40], nasal disorders (paranasal sinusitis [41]), head disorders (headaches [42]), nocturnal enuresis, [43] and gynecological disorders [13].

Electric plum-blossom acupuncture is prohibited for the following diseases:
A. Acute and acute phases: Acute infectious diseases or acute inflammation should not be used alone.
B. Severe lesions: Severe organic diseases, a high degree of anemia, serious heart disease, and advanced cancer should not be used.
C. Bleeding-prone diseases: Diseases that tend to cause bleeding after tapping, such as hemophilia, thrombocytopenic purpura, and allergic purpura, should be banned. Visceral bleeding, such as hemoptysis, vomiting blood, spitting blood, bloody urine, bloody stools, and traumatic hemorrhagic disease should avoid tapping the bleeding site to prevent aggravated bleeding after tapping.
D. Various kinds of fracture: Avoid tapping on the affected area when the callus is not formed before or after reduction and fixation.
E. Pregnancy: Pregnant women should be used with caution, especially pregnant women with a history of habitual abortion (Table 1).

Table 1:RCT, randomized controlled trial.

F. Various skin diseases: swelling, sores, should avoid tapping on the affected area to prevent spreading the disease [44].

Electric plum-blossom acupuncture current has been proven to be a safe and effective method of treating numerous ailments. Adverse Events (AEs) have been reported rarely, and most AEs are mild to moderate. The most common AEs associated with electric plum-blossom acupuncture are bleeding and hematoma caused by tapping. Other possible AEs include fainting during acupuncture, skin infection, unbearable tingling, nausea, vomiting, palpitation, dizziness, headache, abscess formation, insomnia, and hyperpigmentation. We classify these AEs into preventable adverse events and non-preventable adverse events (Table 2).

Table 2:Classification of adverse events.

Preventing or avoiding preventable adverse events through some previous measures is possible. The cause of bleeding and hematoma was bleeding caused by stabbing a large blood vessel. It is necessary to avoid heavy stimulation manipulation at the treatment site with blood vessels and use sterile cotton balls to press the treatment site promptly after tapping. It has been shown that prolonging the pressing time can reduce bleeding [45]. A small amount of subcutaneous bleeding or slight local bruising, generally not treated, can subside independently. The bruised area can be treated with cold compresses if swelling and pain are severe, and the injured area is more extensive. Then the patient is instructed to apply hot compresses 24-48 hours later to promote local hematoma dissipation and absorption.

The main reason for skin infection is lax sterilization. Doctors should disinfect their hands and treatment sites and use disposable needles to prevent skin infections. The treatment site should avoid the use of heavy stimulation manipulation. If local skin infections related to this study occur, treatment must be given according to the condition. Symptoms that are mild, tolerable, and do not interfere with daily study or life do not require treatment. If the pain is obvious and there is a slight inflammatory reaction, which affects daily life and research, suspend the treatment and rest, reduce the activity, do not squeeze the affected area, apply anti-inflammatory and analgesic drugs properly, and continue treatment after the symptoms disappear. Treatment should be stopped immediately if local ulceration or general discomfort occurs due to the infection, and symptomatic and supportive therapy such as pus drainage, anti-inflammatory and analgesic should be given.

To summarize, some diseases have been treated very effectively with electric plum-blossom acupuncture therapy, which combines skin stimulation, meridians, and acupoints. This article reviews and summarizes the electric plum-blossom acupuncture treatment mechanism, the method of adding electricity, clinical treatment, indications, contraindications, and adverse event reports, offering insight for future research. This article suggested that electric plumblossom acupuncture activates nerve cells, promotes neuronal function, improves neurological function, produces analgesic effects, increases local blood circulation, eliminates edema rapidly, improves local immunity, and strengthens muscle strength and endurance by contracting muscle fibres. In this article, the method of adding electricity to the electric plum-blossom acupuncture is divided into three stages: beginning in the 1950s, developing in the 1980s, and maturing in the 21st century. Various conditions can be treated with electric plum-blossom acupuncture, including skin, eye, sensory, nasal, head, nocturnal enuresis, gynecological, etc. However, these pieces of literature are all Chinese, and most are case series studies. Therefore, more high-quality randomized controlled trials are needed to verify the effectiveness of electric plum blossom needles in treating diseases. The plum-blossom electric acupuncture is part of the traditional Chinese medicine approach. Among its characteristics is the ability to provide customized treatment. For example, the choice of acupoints, the size of stimulation, the frequency of treatment, etc., all need us to formulate specific treatment plans according to the patient’s condition. Plum-blossom acupuncture therapy has received less attention recently, resulting in a limited application for varied conditions. Even in China, awareness of this treatment method could be higher. To increase its effectiveness, we should promote plum-blossom acupuncture therapy through more literature and broaden its application to various ailments, thus providing new treatment ideas and methods.

All authors contributed to the study’s conception and design. The research and the analysis of the articles found in the China National Knowledge Infrastructure (CNKI) and other databases were performed by WY and YY. WY wrote the first draft of the manuscript in consultation with LK. TY supervised the project. All authors read and approved the final manuscript.

The datasets during and analysed during the current study available from the corresponding author on reasonable request.

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