Special Issue

A new proposal for Thumbtack needle treatments● Keyword/Thumbtack needle, Three-point acupuncture needling, cervical spine deformity

Oriental Medicine Clinical Laboratory, Kuretake College of Medical arts & Sciences

Eiji Furuya
We conducted a comparative clinical study of thumbtack needle acupuncture versus sham acupuncture applied
to shoulder stiffness to investigate the effectiveness of a thumbtack needle. The result proved positive. Meanwhile, we
could not obtain sufficient effects with cases attributed to organ disorders. Therefore, we examined the clinical effects
of a thumbtack needle with a case accompanied by a disorder such as cervical spine deformity. We stimulated threeacupuncture points, which will be the corners of a triangle around the tender point and nodule after acupuncture andmoxibustion previously practiced. The symptoms already relieved by the therapies were further reduced (p < 0.05). We
also examined the needle’s clinical effects according to the differences of angle velocity based on the total amount ofisokinetic movements. As a result, the total amount of them with thumbtack needles was lower than that with shamneedles at 240 degrees. This trial suggests that appropriately specified dose of stimulation could achieve intended
clinical effects.

1. Diffusion of Thumbtack needles

Thumbtack needle, it is detached from the plate by

The Thumbtack needle was brought into Japan

peeling the tape off, so that it can be utilised directly on

as a souvenir from China in the 1970s. The needles were

the patient who is to be treated. The shape of aprovided in a small glass bottle with a cork stopper in 10

Thumbtack needle in those days was such that theor 20 needle units, and required sterilization prior toneedle tip protruded from the centre of the ring-shaped

their use in treatment. The instructions for use were notwire, which was formed by the coiling-up of a steel wire.

provided, in which there was a sequence of events that

The length of the needle shaft was over 2mm, but it

led to these being used as indwell-type acupuncture

seldom equalled the depth of the insertion itself due toneedles for Tender Point treatment or auricular

the spring action of the ring part. Moreover, the painacupuncture.

Intradermal

experienced upon needle insertion (penetrating theacupuncture needles, represented by indwell-typeepidermis) or a pricking pain experienced during needle

acupuncture needles, in Japan at that time, theinsertion could easily occur. Since then, the individual

Thumbtack needle quickly became popular. Sterilized

packaging style with one Thumbtack needle per packThumbtack needles were approved as a medical device

became the standard due to measures based on aby the Ministry of Health and Welfare (at that time) andhygienic perspective; however, the shape of thewere sold by an acupuncture needle manufacturing

Thumbtack needle was still the same as when it wascompany in 1978. They provided 10 Thumbtack needles

imported from China.

Althoughtherewereindividually attached to a plastic plate. When using theSubsequently, the ring shape of the Thumbtack needle

resembled an ice pick. In general, they were integrally

was improved and the needle shaft was formed into anconfigured with the needle handle, needle shaft, andL-shape and embedded in a plastic spindle, from which

needle tip. It seems that this needle shape was

the needle tip was slightly exposed.

transmitted to England, where the sword guard was

The unpleasant feeling accompanied withneedle insertion (penetrating the epidermis) wasattached for further innovation in order to serve as astopper to maintain a constant insertion depth.

improved and thus it became much easier to use thisSword Guard

Thumbtack needle as an insertable needle without pain.
At present, a 0.6mm main shaft length is being provided
for acupuncture treatment.
The Thumbtack needle is unique in the way that

Shape of Ice Pickthe entire length of the established needle shaft lengthis inserted making the needle insertion depth constant.

Fig. 1 Schematic Drawing of the Acupuncture Needle

It can be said that this is a new acupuncture needle

Used by J. M. Churchill.

configuration that was developed for this approach. The

The needle insertion depth is made constant due to the sword
guard attached to the acupuncture needle.
This needle can be widely accepted as the origin of the Thumbtack
needle.

Thumbtack needle has an innovative shape that isunprecedented in the long history of acupuncture
treatment. It is completely different from the fineneedle that requires a timely adjustment of theinsertion depth.
Then, what is the origin of the Thumbtack
needle? The idea that the insertion depth is madeconstant is demonstrated with an acupuncture needleof 1 to 1.5 inches, which was introduced in "A Treatiseon Acupuncturation" that was written by J. M. Churchillin 18211). The shape resembled the shape of a fencing
sword. It is particularly noteworthy that the needle isequipped with a saucer-shaped guard in between theneedle shaft and the needle handle. It is believed thatthe acupuncture treatment performed in England atthat time was strongly influenced by Japanese and/orChinese acupuncture. The acupuncture needles usedduring the early 17th century in Japan were round, sharp
needles (meridian needle and percussion needle), which

2. Efficacy of the Thumbtack Needle forUpper Back Muscle Stiffness
Treatment using the Thumbtack needle involves
application at the points that are identified by theevocation of pain when pressed, which is to say, the"tender points". The tender point treatment method
has its origin in “The Meridians” of “”Huang Di Nei Jing
Ling Shu”, which states that “the painful location shallbe the treatment point,” describing a treatment for thereaction points identified on the 12 Tender-muscle
Energy Channels. Since the Tender-muscle Energy
Channels go around the muscles and joints, where theMeridians go, as well as manage the functions, themodern interpretation regards them as the generalterm for locomotor systems. “Performing treatment on
the areas causing pain” is effective for the symptoms
appearing in the motor systems. The authors conductedthe study3) on the effects of the Thumbtack needle

compared to a sham needle on upper back muscle

manual test findings, and the so-called upper backstiffness, which is one of the symptoms that ismuscle stiffness left undiagnosed or with no positive

characteristic of Japanese people, to verify the effects

findings investigated in a manual test for cervicobrachialof Thumbtack needle treatment. The Thumbtack needle

pain, we examined the visual analogue scale (VAS)

that was used for this tender point treatment was a 0.6

values before, immediately after, and 3 days after themm-long Pyonex acupuncture needle (made by Seirin

application of Thumbtack needles. As a result, the so-Co., Ltd.). The treatment was conducted on thecalled upper back muscle stiffness demonstrated thatpressure painful point regardless of whether it was a

the VAS value decreased (p<0.01) 3 days after

meridian point location or not. The Tender Point wasapplication; whereas, the upper back muscle stiffness

detected at four or fewer locations per individual whothat was caused by organic disease did not demonstrate

were complaining of subjective upper back muscle

asufficient effect.

stiffness. The sham needles provided were packed in apackage and attached to a tape in the same way as thereal ones, although their tips were cut off. Thus, thestudy allowed us to verify the acupuncture treatment
effect while ruling out the placebo effect.

3. The efficacy of the Thumbtack needle"Three-point acupuncture needling" on theupper back muscle stiffness was attributed
to organic disease.

In order to investigate the subjective symptomsof the stiffness, we used one of the question items:“Positive stiffness in upper back muscle”, which wasincluded in questionnaire III: “Physical disintegration”
proposed by the Industrial Fatigue Research Committeeof the Japan Society of Industrial Health. TheThumbtack needles and sham needles were randomly
assigned to the subjects, in which the subjective upperback muscle stiffness was compared after 3 days. As aresult, 12 of the 28 subjects in the Thumbtack needle
group had subjective upper back muscle stiffness, whileFig.2 Three-Point Needling by Means of the Thumbtack

it was 23 of the 25 subjects in the sham needle group.

NeedleThese changes in the Thumbtack needle group and thesham needle group were statistically significant (p<0.01).
In a comparison of the levels of upper back muscle
stiffness, which was attributed to organic diseases
diagnosed as cervical disc hernia, cervical spondylosis,or thoracic outlet syndrome suspected according toThree Thumbtack needles were inserted in turn forming a triangularshape in order to cover the induration. This was called Three-point
needling. The needle tip is inserted so that it does not touch the tapethat anchors the Thumbtack needle. The length of one side of thetriangle formed by the needle tips of the Thumbtack needles
corresponds to the size of the induration, in which it was decidedfrom there that the edge of the tape would slightly cover the spin top(Photograph and Schematic drawing a) to the extent that the edgesof the needle- attached tapes are slightly overlapped (Schematicdiagram b).

"Three-point needling"4) was devised as an application

stimulation. It is believed that this is the result of

method of the Thumbtack needle for upper back muscle

facilitation, which is one of the interactions between

stiffness that is caused by organ disease. In this method,

excitation and sedation in the synaptic transmission of

three Thumbtack needles are used to surround thethe central nervous system. This characteristic oftender induration that is detected by palpation. Here,synaptic transmission, which is also recognised in thethe "Three-point needling" conducted immediately

autonomic nerve ganglion, impacts the local vessels,

after acupuncture and moxibustion treatment shall be

sweat

elucidated as a clinical application. The change in thesympathetic innervation, and is believed to contribute

VAS values was used as the parameter for evaluating

to improving local symptoms through autonomic

the extent of the subjective upper back muscle stiffness,

nerves.5)

glands,anderector

pilimuscles

underin which an evaluation was conducted before
acupunctureandmoxibustion

treatment,aftertreatment, and after "three point needling". The 11
examined cases diagnosed as organ disease by a
medical institution included 9 cases of cervicalspondylosis, 1 case of cervical hernia, and 1 case ofthoracic outlet syndrome. The subjects consisted of 4
males and 7 females, with an average age of 56.5 ± 9.5
years. The location for applying the "Three-point

Fig.3 Efficacy of Three-point Acupuncture Needlingneedling" was the single most sensitive Tender Point

The ordinate shows the VAS in mm, and the abscissa shows thestages of the treatment process: before and immediately after
acupuncture and moxibustion treatment, and after Three-point
acupuncture needling during the process of treatment. The VAS
values, demonstrating the level of upper back muscle stiffness,decreased from 62.6±19.7mm (before acupuncture and moxibustion)
to 25.2 ±9.1mm (after acupuncture and moxibustion) and further to9.5± 6.5mm (after three-point acupuncture needling). The one-way
analysis of variance showed that the levels were significantly
different (※p<0.01), whereupon a multiple comparison was also
conducted, in which the decrease was recognised in the VAS values(♯p <0.05) between post acupuncture and “Three-point
acupuncture needling.”

where subjective symptoms had remained following
acupuncture and moxibustion treatment. As a result,
the VAS values decreased between post-acupuncture
and moxibustion treatment and post-Three-point
needling (p<0.05). It was proved that the effects ofacupuncture and moxibustion on upper back muscle
stiffness that was caused by organ disease were moreenhanced by the “Three point needling.” "Three-pointneedling" is the method of surrounding an induration
with three acupuncture needles.

additiveeffects

NeedleI am hereby introducing the effects of theThumbtack needle on motor function. I have reported

Even if the Thumbtack needle is a minutestimulation,

4.
EffectsofThumbtack
Stimulationon Isometric Exercise

generatedthat a Thumbtack needle stimulation 1 cm lateral to thebyspinous processes of the cervical vertebra, C5 ～ Th1,

simultaneously stimulating multiple points create anon the posterior cervical regions, which are on the same

area of stimulation, which is not the case with one-pointside as the upper extremity being exercised, will recoverfrom the declined muscle output.6). In this discussion,of Thumbtack needle stimulation varies depending on

we are introducing a comparison of the effects of thethe type of movement.

total amount of knee joint flexion and extension
exercise work at angular velocities of 60° and 240° with
the Thumbtack needle and the sham needle duringisometric exercise using the Biodex system 3.
It was decided that the stimulus area for theThumbtack needle or sham needle would be BL23 to BL
32, on the same side of the lumbar region as the lower
extremity movement, from the L2 to S1 area innervatedby the posterior branch of the cutaneous branch at thesame spinal nerve level as the sciatic nerve that controls
the movement of the lower extremities. Thumbtack
needle stimulation was performed in advance, and thestimulation was continued during the entire cycle ofmovement. As a result, there was no difference
between the Thumbtack needle group and the shamneedle group in the angular velocity of the knee joint
extension exercise.
There wasn't a difference in the total amount ofwork during the flexion movement between the groups

Fig. 4 Effects of Thumbtack Needle on the Total
Amount of Work
The ordinate shows W (Watts) of the total amount of work, and theabscissa shows the number of sets of the exercise load. In the entire
process of knee joint flexion movement, although a two-way analysisof the variance testing resulted in there not being any difference
between the Thumbtack needle group and the sham needle group at
an angular velocity of 60° (n=12), a difference was recognised
between the Thumbtack needle group and the sham needle group at
an angular velocity of 240° (p<0.05), whereupon the Thumbtack
needle group reduced the total amount of work in contrast to thesham needle group.

5. Adverse Event Caused by the Thumbtack
NeedleThe occurrence of adverse events due to theat an angular velocity of 60°, but the Thumbtack needle
Thumbtack needle was discussed in a study entitledgroup decreased more than the sham needle group did“The Effects of Thumbtack Needle on Upper Backat an angular velocity of 240° (p<0.05). Thumbtack
Muscle Stiffness.” According to the study, 4 subjects
needle stimulation demonstrated different results
experienced “itchiness” and 1 subject was “annoyed byaccording to the type of exercise (speed and power),
the inserted needle” in 28 subjects of the Thumbtack
such as the angular velocity of 60° (slow type exercise)needle group; 3 subjects had “itchiness” and 1 subject
and the angular velocity of 240° (fast type exercise).
More specifically, although these were particularconditions of isometric exercise, it was supposed thatexperienced a “sense of discomfort” in 25 subjects ofthe sham needle group during the continuous

the Thumbtack needle does in fact show an inhibitory

application for 3 days. The rate of occurrence was:response to fast type exercise. The comparison has"Itchiness" 13.2%; "Uneasy about the Needle Being

shown rather impressive results that, according to an

Inserted" 1.9%; and "Sense of Discomfort" 1.9%. In theobjective, the detailed settings such as the amount andstudy7) on the effects of the Thumbtack needle in aarea of stimulation are necessary because the suitabilitytriathlon race: 1 out of 79 subjects in the Thumbtack

needle group responded "Felt Uneasy about thewithout Qi perception” is too simplistic of an approach,Needles", and 1 subject out of 70 subjects in the shamwhich should be changed in daily clinical activities andneedle group responded "Felt Uneasy about theamong researchers.

Needles during the Race". The rate of occurrence wasThe Thumbtack needle can obtain high

1.3%. Each phenomenon was promptly improved byevaluation marks because its needle insertion depth iswithdrawing the Thumbtack needle and removing theextremely shallow, and continuous indwelling for theadhesive tape. Thus, the problem due to the continuous

long-term is possible. Moreover, it contributes todwelling of Thumbtack needles is “itchiness” that was

relieving pain and improving motor function withoutcaused by the gluing agent of the adhesive tape. In daily

affecting physical activities. The clinical application ofclinical practice, however, the Thumbtack needles with

the Thumbtack needle should gain a solid position as awhich patients are allowed to return home aremeans of acupuncture treatment in the future. Needle

generally left attached until their following treatment.

stimulation will be applied to the improvement of

Although the Thumbtack needle is an indwelling type,competitive ability in sporting activities and to exercise

its placement period as a medical device is limited to 24

therapy in rehabilitation. We have just begun to review

hours. It is important that practitioners should pay

the methods of treatment and stimulation for thefurther attention to this important point. Excluding thisThumbtack needle, in which further research should beparticular issue, the continuous application of theconducted with enthusiasm in order to keep this effort

Thumbtack needle can be said to be a comparatively

moving forward.

safe method, which does not relate to the restriction ofphysical movement.

References
1) Lu Gwei-Djen, Joseph Needham: Celestial Lancets,

6. The Future of the Thumbtack Needle
Treatment Method
Overseas, they are trying to verify the effects of298, Cambridge University Press, 1980.
2) Satoshi Nagano: Japanese Acupuncture Needles
during the 16th to 17th Century (First Part) -acupuncture by inserting a needle into the muscle toAcupunctureMoxibustion

relatedvocabulary

provide stimulus. Papers on seeking “Qi perception” aredescribed in the "Vocabulário da Língua do Japãofound here and there. The sham needling for the(Japanese Portuguese Dictionary)"-, Acupuncture andcontrol group for comparison is required not toMoxibustion OSAKA, 67, 101-109, 2002.

perceive Qi with a shallow insertion such as Penetration

3) Eiji Furuya, et al.: The Effects of Thumbtack Needlingin the epidermis. It has become clear that theon Upper Back Muscle Stiffness, Journal of Japan

Thumbtack needle can obtain such effects as aSociety of Acupuncture and Moxibustion, 52 (5): 553-

therapeutic action or an enhancing action of a biological561, 2002.

function with stimulation, even though the needle

4) Eiji Furuya: Thumbtack Needle and Tender Point

insertion depth is shallow. That “there is no effectTreatment, Ido MOOK Series 001, Tender Point andClinical Acupuncture and Moxibustion, 90-94, IDONO-NIPPON SHA INC., Yokosuka, 2002.
5) Yuko Sato, et al.: Transmission of Excitation,
Physiology, Edited by Japan College Association ofOriental Medicine, 166-172, Ishiyaku Publishers, Inc.,Tokyo, 2003.
6) Kazutoshi Miyamoto, et al.: Study of SportsAcupuncture and Moxibustion, Journal of Japan
Society of Acupuncture and Moxibustion, 58 (2): 66178, 2008.
7) Yasuhisa Kaneko, et al: The Effects of Press Tack
Needle Treatment on Muscle Soreness after
Triathlon Races - Comparative Study Using Placebo-,
Journal of Japan Society of Acupuncture andMoxibustion, 56 (2): 158-165, 2006.
8) Eiji Furuya: Thumbtack Needle Treatment Method for
Elbow Disorders, IDO-NO-NIPPON, 763, 38-41, 2008.

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