Yonago Acta medica 1999;42:167–170

The Effects of Nasal Massage of the Yingxiang Acupuncture Point onNasal Airway Resistance and Sensation of Nasal Airflow in Patientswith Nasal Congestion Associated with Perennial Nasal Allergy
Hiromi Takeuchi, Satoshi Matsuo, Shigeru Higami, Yumiko Tanaka and Hisaaki
Ikoma
Department of Oto-Rhino-Laryngoloy, Faculty of Medicine, Tottori University, Yonago 6830826, JapanThe aim of the present study was to determine if nasal massage of the yingxiang acupuncture point in patients with nasal congestion associated with perennial nasal allergy
had any effect on nasal airway resistance (NAR) measured by anterior rhinomanometry
and sensation of nasal airflow on a visual analogue scale (VAS). Ten patients were recruited for this study. NAR and VAS were measured before (baseline), 2 min after and
10 min after massage. NAR had no ruled changes after massage although all patientsfelt their symptom of nasal congestion had improved. The results of this study, whentaken together, indicate that nasal massage may provide some relief mainly from thesensation of nasal congestion.
key words: acupuncture; nasal airway resistance; perennial nasal allergy; yingxiang

In oriental medicine, acupuncture has been used
to treat a variety of diseases, including nasal congestion. Nasal congestion is treated by acupuncture at the yingxiang point which lies just lateral
to the nostril (Beijing College of Traditional
Chinese Medicine, 1980). In Japan and China
the yingxiang point is often chosen as a massage
point because patients are able to easily identify
the point and perform finger massage. In nasal
allergy, nasal congestion is one of the mostbothersome symptoms. Since massage of thisacupuncture point seems to provide relief fromnasal congestion, this simple technique can be avery useful treatment without medicine and surgery. The aim of the present study was to investigate the effects of nasal massage on nasal
congestion associated with perennial nasal allergy using both objective and subjective measures for nasal congestion.

Subjects and Methods
Ten patients with perennial nasal allergy causedby house dust mites were recruited for the pres-ent study. All had at least moderately blocked
noses and therefore needed to breathe throughthe mouth at sometime during the day. Patientswere examined by clinicians and excluded fromthe study if they had: anatomical nasal obstruction or gross anatomical deformity; sufferedfrom acute upper respiratory tract infection;
started immunotherapy within the year; or,taken any prescribed medication which theclinician deemed unsuitable.
Subjective scores of nasal congestion andmeasurements of nasal airway resistance(NAR) were made before (baseline), approximately 2 min after and 10 min after treatment.
Patients scored the severity of their nasal congestion on a 100 mm visual analogue scale(VAS) with the extremes labeled “nose feelsextremely blocked” and “nose feels extremelyclear.”
NAR was measured using anterior rhinomanometry (rhinomanometer, MPR2100,Nihon Kohden Instrument, Tokyo, Japan) at aninspiratory reference pressure of 100 Pa. NAR
Abbreviations: NAR, nasal airway resistance; VAS,
visual analogue scale167

H. Takeuchi et al.

Treatment
The yingxiang acupuncture point is part of the“large intestine channel of Hand-Yangming”
and is described as point LI 20 which is an acupuncture point located in the nasolabial groove,at the level of the midpoint of the lateral borderof the ala nasi. Acupuncture of this point is recommended for the treatment of nasal obstruction, epistaxis and rhinorrhea (Beijing Collegeof Traditional Chinese Medicine, 1980). Eachpatient was instructed to massage the bilateral
yingxiang points by drawing small circles with
their index fingers at twice per second for 30 s.

(%)
115

110% Change in NAR

to airflow is calculated from the following
equation:R = ∆P/V
where R = resistance to airflow, in Pa/cm3/s; ∆P= transnasal pressure, in Pa; and V = nasalairflow, in cm3/s. Transnasal pressure can bemeasured by relating the pressure at the posterior nares to that at the entrance of the nostril.
With anterior rhinomanometry, nasal airflow
and the pressure at the entrance of the nostril aremeasured one side at a time with the pressure atthe posterior nares measured from the opposite
side. Therefore, NAR is determined separately
for each nasal passage and the total resistance isthen calculated by summing the values using
Ohm’s law for parallel resistance.

105

10095900246810Time

Massage12(min)Fig. 1. Mean percentage changes in total nasal
airway resistance (and SE bars) in 10 patients treatedwith nasal massage. The arrow represents the timeof treatment. NAR, nasal airway resistance.

Figure 1 illustrates the percentage changes
in total NAR from baseline. There was no significant difference in percentage changes intotal NAR at any time point during the study.
Figure 2 illustrates the percentage changes
in VAS score from baseline. There were significant changes in VAS scores between baseline
and the 2 min or 10 min time point (P < 0.05).
(%)
110% Change in VAS

100Statistical analysis
The results are given as the mean percentagechange from baseline with SE. A paired t-test
was used for the comparison of NAR and VASvalues. A P value of < 0.05 was considered significant. NAR values are given as median (interquartile range).

9080

70

600Results

2Massage

The 10 patients with nasal congestion associated with perennial nasal allergy consisted of 7males and 3 females, aged between 9 and 38years (mean 19.1), with a baseline total NAR of0.27 Pa/cm3/s (0.14).

46Time81012(min)Fig. 2. Mean percent changes in nasal sensation ofairflow (and SE bars) in 10 patients treated with nasal massage. The arrow represents the time oftreatment. Nasal sensation of airflow was scored on
a 100 mm visual analogue scale with the extremes
labeled “nose feels extremely clear” and “nose feels
extremely blocked.” VAS, visual analogue scale.

168

The effects of nasal massage of the yingxiang point

Discussion
The aim of the present study was to determine if
nasal massage of the yingxiang acupuncture
point had any effect on NAR or sensation ofnasal airflow in patients with nasal congestion
associated with perennial nasal allergy.
The measurement of sensation has proved adifficult task in many fields of human research,and nasal physiology is no exception. The 100mm VAS which was used in this study was first
introduced into medicine by Aitken who used
the scale to investigate mood changes in airline
pilots and the degree of asphyxia in volunteers
breathing through mouth pieces of different
resistance (Aitken, 1964). The VAS was introduced as an instrument to measure nasal sensation of airflow in 1988 in a study on the effectsof D and L isomers of menthol on nasal sensation of airflow (Eccles et al., 1988). The VAS has
since been used in many similar experiments
and has become a standard measure of nasal
sensation of airflow (Jones et al., 1989; Fairley
et al., 1993; Roithmann et al., 1994; Simola andMalmberg, 1997).
The results for NAR show that there was no
significant difference between pre- and postmassage. However, the sensation of nasal
airflow measured using VAS improved postmassage in all patients. These findings, whentaken together, indicate that nasal massage may
provide some relief from nasal congestion. Nasal massage could provide relief from nasal
congestion by stimulation of the branches of thetrigeminal nerve which supply the massage
area. The infra-orbital branches of the trigeminal nerve have been implicated in serving thesensation of nasal airflow and the control ofsneezing (Davies and Eccles, 1985; Hensel etal., 1974; Wallois et al., 1991) so there is areasonable basis for hypothesizing that mechanical stimulation of the branches of theinfra-orbital nerve could provide some relief
from nasal congestion.
The present study demonstrates that there is
no relationship between the changes in objective and subjective measures of nasal conges-tion used in the study. This supports otherstudies which have found no correlation between objective and subjective measures ofnasal congestion (Eccles et al., 1987; Naito etal., 1988; Sipila et al., 1995; Takeuchi et al.,1999).
The results of this study when taken together, indicate that nasal massage of the acupuncture point may provide some relief fromnasal congestion and that further studies involving a larger patient population are warranted toinvestigate the efficacy of nasal massage in thetreatment of nasal disease.
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(Received April 20, Accepted May 10, 1999)

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