LightNeedle - RJ Laser

LightNeedle 

Photon energy in the focus. 

Product and therapy description 

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LightNeedle Concept

The LightNeedle device works in 

conjunction with the Physiolaser or 

Photonic and takes advantage of all 

therapy programs and settings. Simply attach 

it to the laser outlet of the control unit 

and start the therapy. 

The LightNeedle is a modular system 

and therefore offers economic treatment 

with lowest investment costs. 

The LightNeedle has 12 outlets (3x4) 

with 12 laser diodes (50 mW/655 nm). 

Extensive optional accessories: 

Single probes 

510A 785 nm/50 mW 

511A 810 nm/500 mW 

514A 638 nm/150 mW 

512A 670 nm/200 mW 

515A 904 nm/90 W 

Cluster probes 

516A Pulse laser 

5 x 904 nm/30 Watt 

517A Standard 

4 x 785 nm/55 mW + 4 x 655 nm/40 mW + 4 x 655/5 mW 

519 derma 


519A brush 


5090B Fiber optic (0 O ) 

5090E Trolley (Physiolaser + LightNeedle) 

5090F Support for fiber optic 

Delivery contents: Main unit, 12 fiber 

optics, power supply, technical manual, 

holder, carrying case. Laser class 3B. 

Warning signs on the device: 

LightNeedle Concept 

3

The innovative way for acupuncture 

and therapy of deep tissue layers 

The LightNeedle offers precise and 

strong laser stimulation of points and deep 

tissue layers and it can be widely used for 

many therapeutic applications. 

The operation of the LightNeedle is 

optimized for daily clinical use: 

- fast and easy operation 

- channel selection in groups 

- reliable and safe photon transfer 

Patented tip 

The patented applicator offers for the first 

time a stable and secure treatment. Conventional 

systems are attached straight with 

special holders and are therefore faced with 

an unstable contact because the tip suffers 

under the weight of the fiber and tends to 

lose contact and its position. 

The patented tip of the LightNeedle 

tip is placed flat onto the skin and has a 

beam outlet of 90 o . The tip can easily placed 

on any body part, may it be small or large, 

front and back at the same time, the patient 

can get a treatment in any position. 

Easy fixation of the tip with medical 

standard tape, no special tape is 

required! 

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LightNeedle Advantages 

The main advantages 

n modular system 

n 12 outlets 

n special fiber optic (stable) 

n standard tape 

n treat 2 patients simultaneously 

n all biofrequencies 

n compact and mobile

LightNeedle Therapy 

Choose the best therapy for your 

patients 

LightNeedle system offers a large 

variety of therapeutic applications. 

It is easy to use: Select the time and attach 

the patented tip of the fiber optic to the 

body or acupuncture points. It will shut off 

automatically once the treatment time is up. 

Acupuncture 

LightNeedle acupuncture is relaxing 

and painless it offers a long lasting stimulus 

and is widely accepted by the patients*. 

It seems to be even more effective than conventional 

needle acupuncture. Because once 

the fiber is placed no further manipulation is 

required. 

LLLT - wide range of applications 

The LightNeedle therapy can be used 

for any medical laser application except on 

open wounds (multi-cluster probe or Photonic 

is required). The tip can be positioned 

perfectly and allows that the beam easily 

penetrates deeply into the body. 

n Acupuncture 

n Pain management 

n Trigger points 

n Joints 

n Tendons (e.g. carpal tunnel) 

n Muscular skeletal system 

n Nerves 

* Patients’ sensation during and after laser needle versus metal 

needle treatment”. van Amerongen KS, et al 

RESULTS: The common metal needle technique was well known 

by the patients in comparison to the laser needle method 

(p

Place the fiber tip according to the guidelines 

of the classical acupuncture instead 

of metal needles directly on the point. The 

therapy duration is 10-15 minutes. 

If required further points can be treated 

additionally with the single probe (e.g. ear 

points). 

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LightNeedle Therapy


Trigger points, painfull spots 

Muscle pain, hardness, muscle stiffness 

Improvement of the regeneration 

after excercise 

Tendons (Tendinitis, Carpal tunnel syndr.) 

Distorsion, contusion, injuries 

Edema 

Spinal cord and intervertebral discs 

Lumbal pain 

Joints (arthrits, arthrosis) 

Shoulder/arm syndrome 

Pain in the neck area 

Muscle hardness 

Please refer to: 

Effect of 655-nm Low-Level Laser Therapy on Exercise-Induced 

Skeletal Muscle Fatigue in Humans 

Ernesto Cesar Pinto Leal Junior, M.Sc.,1,2,3 Rodrigo Álvaro 

Brandão Lopes-Martins, Ph.D.,4 Francis Dalan, P.T.,5 Maurício 

Ferrari, P.T.,5 Fernando Montanari Sbabo, P.T.,5 Rafael 

Abeche Generosi, P.E.,6 Bruno Manfredini Baroni, P.T.,5 

Sócrates Calvoso Penna, Ph.D.,4 Vegard V. Iversen, Ph.D.,8 

and Jan Magnus Bjordal, Ph.D.3,7 

7

For Ischalgia and lumbal pain place the fiber 

tips at and around the nerve outlet. 

It many cases it is recommended to place 

several tips along the nerve. Treatment 

duration 15-25 minutes. 

For the successful treatment of inner joint 

disorders as e.g. arthrosis, the correct position 

of the fiber tip is crucial. The beam must 

be directed into the joint and may not be 

absorbed by the bone. 


A systematic review of low level laser therapy with location-specific 

doses for pain from joint disorders. A systematic 

review of low level laser therapy with location-specific 

doses for pain from chronic joint disorders 

Jan M Bjordal1, Christian Couppé2, Roberta T Chow3, 

Jan Tunér4 and Elisabeth Anne Ljunggren1 1University of 

Bergen, Norway 2Lund University, Sweden 3Private Medical 

Practice, Sydney 4Private Dental Practice, Stockholm, 

Sweden 

Joint distorsion and contusion shall be 

treated by placing the fiber tips directly onto 

the painful area. Treatment duration 15-30 

minutes. 

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LightNeedle Therapy


Inner organs can be reached reflectory or 

locally. For reflectory treatment the Head 

zones (Henry Head) and the common reflex 

zones are most important. 

Place the fiber tips directly on the organ 

zones. Treatment duration 10 minutes. 

Head zones 

Reflex zones 

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Because the laser beam can penetrate deeply 

into the body, it can reach inner organs 

by local irradiation. The irradiation of the 

stomach (e.g. gastritis) and the pancreas (e.g. 

diabetis) can be a promissing indication. 

Good experience was made for kidney 

disease (Schmalix). Kidney insufficiency and 

nephro sclerosis showed good reaction. 

Treat neurological disturbance, nerve 

demage, rupture, injury etc. directly at the 

most painful and affected point. 


Laser Phototherapy, a New Modality in Treatment 

of Long-Term Incomplete Peripheral Nerve Injury: 

A Randomized Double-Blind Placebo-Controlled 

Study 

Shimon Rochkind et al.

Abstracts Laser Acupuncture 

Effects on Acupuncture, Acupressure and Laserneedle acupuncture on EEG 

bispectral index and spectral edge frequency on healthy volunteers. 

G. Litscher 

University of Graz, Department of Biomedical Engineering and Researchin Anesthesia and Intensive 

Care, Graz, Austria 

Summary: Background and objective: The main purpose of this study was to investigate the effects 

of sensory (acupressure and acupuncture) and optical stimulation (Laserneedle@ acupuncture) 

on electroencephalographic bispectral index, spectral edge frequency and a verbal sedation 

score. 

Methods: Twenty-five healthy volunteers (mean age :!: SD: 25.5 :!: 4.0yr) were investigated 

during the awake state. The acupuncture point Yintang and a placebo control point were stimulated. 

The study was performed as a randomized, controlled and partly blinded cross-over trial. 

Results: Bispectral index and spectral edge frequency values both decreased significantly (P < 

0.001) during acupressureonYintang tovalues of62.9 (minimum 35) :!: 13.9 bispectral indexand 

to 13.3 (minimum 2.9) :!: 8.1 Hz (spectral edge frequency right) and 13.8 (minimum 2.7) :!: 7.3 

Hz (spectral edge frequency left), respectively. 

Bispectral index was also significantly (P < 0.05) affected by Laserneedle@ acupuncture and 

acupressure on the control point but the changes were not clinically relevant, 95.4 :!: 4 and 94.2 

:!: 4.8, respectively. All interventions significantly (Yintang: p < 0.001; control point: p < 0.012) 

reduced verbal sedation score. 

Conclusions: The study highlights the electroencephalographic similarities of acupressure induced 

sedation and general anaesthesia as assessed by bispectral index and spectral edge 

frequency. 

Biological Effects of Painless Laser Needle Acupuncture 

Gerhard Litscher, PhD Lu Wang, MD Detlef Schikora, PhD Dagmar Rachbauer, MSc Gerhard 

Schwarz, MD Andreas Sch�pfer, MD, Stefan Ropele, PhD Evamaria Huber 

Summary: Laser needle acupuncture is a new method to stimulate acupuncture points. We 

describe the technique, its first use, and its value in acupuncture research. Laser needle publications 

we included are based on 511 measurements in 231 healthy volunteers (129 female, 102 

male), with a mean (SD) age of 25 (3.5) years (range, 18-38 years). One pig experiment is also 

included. 

Results: The results of randomized, double-blind, controlled, crossover studies show that the 

methods of laser Doppler flowmetry, functional multidirectional transcranial Doppler sonography, 

functional magnetic resonance imaging, and near infrared spectroscopy are able to objectify 

and quantify peripheral and cerebral effects of laser needle acupuncture. 

Conclusion: For the first time, we were able to investigate scientifically the differences between 

needle acupuncture, which includes pain stimulation, and laser needle acupuncture, a continuous 

multichannel method of painless acupuncture stimulation. Laser needle acupuncture can 

induce specific, reproducible changes in the brain. These can be expressed by shifts in different 

parameters, such as cerebral blood flow velocity. 

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Laserneedle Acupuncture: A Critical Review and Recent Results 

Detlef Schikora, PhD 

In the last 5 years, laserneedle acupuncture has become a new category in acupuncture, with its 

own scientific basics. It combines the tradition of Chinese acupuncture with the possibilities of 

modern technology. Laserneedle acupuncture is in accordance with the aim of traditional medicine 

because it uses the most essential and most natural medium of our existence, the light, 

to heal illnesses. The painless laserneedle acupuncture is of proven medical effectiveness and 

particularly suited for the treatment of children and those patients who regard the metal needle 

insertion into the skin as unpleasant. In daily practical use, laserneedle acupuncture can 

be performed like any traditional needle acupuncture treatment. 

The diagnostic criteria of acupoint selection, the treatment duration, and treatment frequency 

are identical to the traditional Chinese acupuncture. To perform successful laserneedle acupuncture 

treatments, no additional qualification is required. 

Offering the painless laserneedle acupuncture to the patient means that the acupuncture needles 

are substituted and the risks of the metal needle are eliminated. 

Effect of New Non-invasive Laser Needles on Brain Function 

G. Litscher*, D. Schikora** 

* Department of Biomedical Eng. and Research in Anesthesia and Critical Care, 

University of Graz, Graz, Austria 

** Department of Physics and Optoelectronic, University of Paderborn, Paderborn, Germany 

This paper describes the first double-blind study in acupuncture research in 17 healthy 

volunteers using laserneedle acupuncture. Stimulation of vision related acupoints resulted 

in marked changes of mean blood flow velocity in the posterior cerebral artery measured by 

multidirectional transcranial Doppler sonography. Further studies using different laser stimulus 

intensities and wavelengths are in progress. 

Cerebral Vascular Effects of Non-invasive Laserneedles Measured by Transorbital 

and Transtemporal Doppler Sonography 

G. Litscher1 and D. Schikora2 

1Department of Biomedical Engineering and Research in Anesthesia and Critical Care, University 

of Graz, Austria; 2Department of Physics and Optoelectronic, University of Paderborn, Germany 

Laserneedles represent a new non-invasive optical stimulation method which is described for 

the first time in this paper. We investigated 27 healthy volunteers (mean ageSD: 25.154.12 

years; range: 21–38 years; 14 female, 13 male) in a randomised cross-over trial to study differences 

between laserneedle acupuncture and manual needle acupuncture in specific cerebral 

parameters. Mean blood flow velocity (vm) showed specific and significant increases in the 

ophthalmic artery during laserneedle stimulation (p=0.01) and during manual needle stimulation 

(p


Effects of laserneedle acupuncture on olfactory sensitivity of healthy human subjects: 

a placebo-controlled, double-blinded, randomized trial. 

Anzinger A, Albrecht J, Kopietz R, Kleemann AM, Schöpf V, Demmel M, Schreder T, Eichhorn I, 

Wiesmann M. 

Department of Neuroradiology, Ludwig-Maximilians-University Munich, Germany. 

The aims of the present study were to investigate the influence of laserneedle acupuncture on 

olfactory sensitivity and to examine whether the attitude towards laserneedle acupuncture affects 

the outcome. Olfaction was tested repeatedly on two days using the olfactory detection 

threshold subtest of the Sniffin’ Sticks test battery in sixty-four healthy subjects of which 32 

showed a positive attitude towards the effects of laserneedle acupuncture and 32 were sceptic 

about its effects. 

Testing was accomplished three times on day one (T1 = 0 min, T2 = 35 min, T3 = 105 min) without 

laserneedle acupuncture and on day two (T1* = 0 min, T2* = 35 min, T3* = 105 min) when 

the subjects were randomized in a non-stimulation (placebo) and a stimulation (laserneedle 

acupuncture) group. Stimulation or non-stimulation was conducted in a double-blinded design. 

Following laserneedle acupuncture a significant decrease in olfactory detection thresholds was 

observed at both, T2* and T3*, whereas no significant changes were found in the baseline or 

placebo group. 

Effects of laserneedle acupuncture on the olfactory detection threshold did not differ between 

sceptic and non-sceptic subjects. In conclusion, laserneedle acupuncture is an effective method 

to improve olfactory sensitivity after one session of stimulation for at least one hour, independently 

of the attitude of subjects towards the stimulation method. 

PMID: 19593972 [PubMed - indexed for MEDLINE 

Near-infrared spectroscopy for objectifying cerebral effects of needle and laserneedle 

acupuncture 

Gerhard Litschera* and Detlef Schikorab 

a Department of Biomedical Engineering and Research in Anesthesia and Critical 

Care, University of Graz, A-8036 Graz, Austria 

b Department of Physics and Optoelectronics, University of Paderborn, D-33095 

Paderborn, Germany 

Near infrared spectroscopy (NIRS) has been successfully used in this study to objectify cerebral 

alterations in oxyhemoglobin and desoxyhemoglobin, due to manual needle acupuncture and 

laserneedle acupuncture, in 88 healthy volunteers mean age 25.7 + 4.0 (x + SD) years (19 - 38 

years). Results from Traditional Chinese Acupuncture, Korean and Chinese hand acupuncture, 

ear acupuncture, combinations of the different acupuncture methods and placebo needling are 

presented. NIRS seems to be able to shed some light upon the functioning of the different acupuncture 

methods. 

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Patients’ sensation during and after laserneedle versus metal needle treatment. 

van Amerongen KS, Kuhn A, Mueller M. 

Department of Obstetrics and Gynaecology, Inselspital, Bern University Hospital, and University 

of Bern, Switzerland. 

OBJECTIVES: Aim of the study was to evaluate the patients’ sensations during and after laserneedle 

versus metal needle acupuncture. 

STUDY DESIGN: The prospective study was performed at the gynaecological outpatient department 

of a University Teaching Hospital of Bern, Switzerland. Thirty female patients per group 

were included in the study and randomized into laserneedle or metal needle group. All women 

visited the acupuncture out patient department because of gynaecological disorders. 

Age of the patients in the metal needle group was 38 years in median (range 18-73 years); 

mean age was 41+/-13.3. Age in the laserneedle group was 36 years in median (range 16-60 

years) and mean age was 39.1+/-12.2. I 

nterventions were laserneedle acupuncture and metal needle acupuncture. Patients answered 

a questionnaire before, after the first treatment and prior to the second treatment. The questionnaires 

asked about the patients’ knowledge of the various acupuncture methods and their 

health condition before treatment, their perception of pain, warmth, tiredness and relaxation 

during or after application of the needles or during or after the treatment. 

Statistics were performed by Graph Pad InStat 3 for windows. 

RESULTS: The common metal needle technique was well known by the patients in comparison 

to the laserneedle method (p


Laser-Needle Therapy for Spontaneous Osteonecrosis of the Knee 

Winfried Banzer, M.D., Ph.D.,1 Markus Hübscher, Ph.D.,1 and Detlef Schikora, Ph.D.2 

Objective: This case report describes the treatment of a 63-year-old patient with spontaneous 

osteonecrosis of the knee (SONK). Background Data: SONK usually appears in the elderly patient 

without the typical risk factors for osteonecrosis. It is characterized by acute and sudden pain, 

mostly occurring at the medial side of the knee joint. Symptoms usually worsen with physical 

activity and improve with rest. Besides physical therapy, limited weight-bearing and the use of 

analgesics and nonsteroidal anti-inflammatory drugs, we propose lowlevel laser therapy (LLLT) 

as a conservative treatment option. 

Methods: LLLT was carried out using laser needles emitting radiation with wavelengths of 685 

and 885 nm, and a power density of 17.8 W/cm2. Therapy sessions lasted 60 min and were 

performed daily over a period of 3 mo. The total irradiation dose emitted by 8 laser needles in 60 

min of treatment was 1008 J. 

Results: Magnetic resonance imaging revealed distinct restitution 

of the spongiosa edema 5 wk after treatment onset, and the final check-up at 35 wk demonstrated 

complete restoration of integrity. 

Conclusion: The present case report provides the first indication that laser-needle therapy may 

be a promising tool for complementary and alternative therapeutic intervention for those with 

SONK. 

Quantification of Gender Specific Thermal Sensory 

and Pain Threshold Before and After Laserneedle Stimulation 

1Abteilung für Biomedizintechnische Forschung in Anästhesie und Intensivmedizin, 

Medizinische Universität Graz, Österreich 

2Fachbereich Physik – Optoelektronik, Universität Paderborn, Deutschland 

3Klinische Abteilung für Neuro- und Gesichtschirurgische Anästhesiologie und Intensivmedizin, 

Medizinische Universität Graz, Österreich 

Quantitative thermal sensory and pain threshold testing (QST) was performed in 29 adult 

healthy volunteers (mean age 24.2 ± 2.7 years; range: 18–29 years; 20 females, 9 males) using 

the Thermal Sensory Analyser TSA-II (Medoc Advanced Medical Systems, Ramat Yishai, 

Israel, and Minneapolis, Minnesota, USA) before and after laser needle acupuncture and placebo 

stimulation, respectively. 

Significant (p 0,001; t-test) gender-specific differences were seen on cold pain threshold 

analysis. No significant changes in parameters of thermal sensory and pain thresholds were 

found before and after laser needle or placebo stimulation at acupuncture points for acute pain. 

However, a trend towards change in the median value of cold pain sensation after laser needle 

stimulation (p = 0.479; paired t-test; n.s.) was seen within the group of healthy females. 

The influence of stimulation of acupuncture points for chronic pain on the various parameters 

needs to be clarified in future studies. 

Please contact RJ-LASER in order to get the complete paper: 

contact@rj-laser.com 

15

Original Article 

G. Litscher 

European Journal of Anaesthesiology 2004; 21: 13-19 

@ 2004 European Academy of Anaesrhesiology 

ISSN 0265-0215 

University of Graz, Department of Biomedical Engineering and Research in Anesthesia and Intensive Care, Graz, Austria 

Summary 

Background and objective: The main purpose of this study was to investigate the effects of sensory (acupressure 

and acupuncture) and optical stimulation (Laserneedle@ acupuncture) on electroencephalographic bispectral 

index, spectral edge frequency and a verbal sedation score. 

Methods: Twenty-five healthy volunteers (mean age :!: SD: 25.5 :!: 4.0yr) were investigated during the 

awake state. The acupuncture point Yintang and a placebo control point were stimulated. The study was per- 

formed as a randomized, controlled and partly blinded cross-over trial. 

Results: Bispectral index and spectral edge frequency values both decreased significantly (P < 0.001) during acu- 

pressureonYintang tovalues of62.9 (minimum 35) :!: 13.9 bispectral indexand to 13.3 (minimum 2.9) :!: 8.1 Hz 

(spectral edge frequency right) and 13.8 (minimum 2.7) :!: 7.3 Hz (spectral edge frequency left), respectively. 

Bispectral index was also significantly (P < 0.05) affected by Laserneedle@ acupuncture and acupressure on the 

control point but the changes were not clinically relevant, 95.4 :!: 4 and 94.2 :!: 4.8, respectively. All interventions 

significantly (Yintang: p < 0.001; control point: p < 0.012) reduced verbal sedation score. 

Conclusions: The study highlights the electroencephalographic similarities of acupressure induced sedation 

and general anaesthesia as assessed by bispectral index and spectral edge frequency. 

Keywords: ACUPRESSURE; ACUPUNCTURE; ELECTROENCEPHALOGRAPHY, bispectral index, spectral edge 

frequency. 

Noninvasive bioelectrical neuromonitoring is gaining 

more and more attention in anaesthesia and 

critical care [1,2]. The bispectral index (BIS) and the 

spectral edge frequency (SEF) are important numerical 

descriptors of the electroencephalogram (EEG) 

and both are mainly used for assessing depth of 

anaesthesia [3]. If anaesthetists relyon BIS and SEF 

to detect awareness, then it is very important to 

Correspondence ro. Gerhard Lirscher, Departmenr of Biomedical Engineering 

and Research in Anesthesia and Intensive Care, University of Graz, 

Auenbruggerplatz 29, A-8036 Graz, Austria. E-mail: gerhard.litscher@ 

uni-grazat; Tel. +433163853907/83907; Fax. +433163853908 

Accepted for publication August 2003 EJA 1537 

exclude other influences that could give false readings. 

It is known that a number of environmental 

and physiological factors may affect BIS performance. 

Recently it has been reported that nonpharmacological 

interventions such as acupressure can also 

reduce BIS values significantly [4]. 

This study is a randomized, controlled and partly 

blinded (Laserneedle@ acupuncture; LASCO Int. 

Medical Mark. AG, Basel, Switzerland) cross-over 

trial intended to investigate the effects of three nonpharmacological 

interventions (acupressure, manual 

needle acupuncture and Laserneedle@ acupuncture) 

on two processed EEG variables (BIS and SEF) and a 

verbal sedation score (VSS) in healthy volunteers.

14 G. Litscher 

Methods 

Subjects 

The study was approved by the Ethics Committee of 

the University of Graz (13-048 ex 02/03). Written 

informed consent was obtained from each subject. 

We studied 25 healthy volunteers (mean age :!: SD: 

25.5 :!: 4.0yr, range 21-39yr; 15 fernales, 10 males; 

height173.5 :!: 9.3cm;bodyweight69.1 :!: 16.1kg). 

None of the subjects had neurological or psychological 

disorders and they were not taking any medication. 

They were partly informed about the nature of 

the investigation and were paid for their participation. 

The investigators recording EEG and sedation 

data were blinded to the intervention applied to the 

volunteers. The subjects were not informed which of 

the four interventions was effectively a placebo control 

(acupressure on a control point). 

Procedure and study design 

The study was performed as a randomized, controlled 

cross-over trial. Four EEG electrodes (F7-Fpz, 

F8-Fpz' Fz = ground) and a noninvasive blood pres- 

sure cuff were attached to the volunteers after they 

arrived at the biomedical engineering laboratory. 

Two channels of spontaneous electrical activity 

were recorded from EEG electrodes (Zipprep@ selfprepping 

electrodes; Aspect Medical Systems Inc., 

Natick, MA, USA). The skin-electrode impedance 

was

Laserneedle@ acupuncture at the acupoint Yintang 

was performed using a new method for optical stimulation. 

This method was reported by our research 

group in the scientific literature in 2002 [6,7]. The 

Laserneedle@ technique represents a new, noninvasive 

method for optical stimulation of acupuncture 

points. The laser used in this study emits red light 

in continuous-wave mode with an output power of 

30-40 rn W, which results in a radiant exposure energy 

of about 2.3 kJ cm-2 at the acupuncture point during 

a stimulation time of 10 min [6]. 

Acupressure on the control point (location: 2 cm 

from lateral end of the left eyebrow; Fig. Id) was 

performed in similar manner as on the acupoint 

Yintang (duration 10 min). 

All subjects had four conditions applied (Fig. la-d). 

The persons were in a semi-lying position with 

closed eyes. The choice of the stimulation procedure 

was randomized within a subject and the interval 

between the different sessions was at least 20 min. 

Evaluation parameters 

The main evaluation parameters were BIS and SEF90 

during the different conditions (Fig. 1) and time 

intervals (Fig. 2). Measurements were made at time 

points a-g (Fig. 2). In any one condition we recorded 

BIS and SEF values continuously but sampled the 

data for subsequent analysis at seven points. A single 

reading was taken at each point. The stimulation 

was not stopped at the time of reading. The whole 

study session lasted 2-3 h. BIS and SEF90 represent 

single numbers, which should decrease continuously 

with decreasing level of consciousness (hypnosis). 

There are several review articles for methodological 

details of signal processing of BIS and SEF [3]. 

After 5 min of stimulation (Fig. 2d) the subjects 

were asked to move their right hand to clarify that 

they were awake and not asleep. In addition, before 

and after each stimulation mode the persons were 

asked to score their stress and tension based on a VSS 

from 0 (no stress) to 10 (maximum stress) [4]. Heart 

rate (HR) and noninvasive blood pressure (BP) were 

also recorded before and after acupressure stimulation 

Figure 2. 

Stimulation procedure and different measuring points before 

(a) during (b-f) and after (g) stimulation. 

Nonpharmacological influences on BIS and SEF 15 

at Yintang (measurement points: 

and 1 min after 'g' (cf Fig. 2». 

Statistical analysis 

min before 

The BIS and SEF data were tested with analysis of 

variance (one-way repeated measures ANOVA; 

similar data were found to be normally distributed 

in previous investigations) using SigmaStat@ Oandel 

Scientific Corp., Erkrath, Germany). Dunnett's 

method was used for post hoc analysis; VSS data were 

compared using paired t-test. The results were 

graphically presented as box plots (BIS and SEF) and 

as scatter plot (VSS). Changes were considered 

significant at p < 0.05. 

Results 

All subjects completed the study. Figure 3 shows the 

decreases of BIS values during acupressure applied to 

the acupoint Yintang in all 25 healthy volunteers. 

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Figure 3. 

The trend of BIS values of 25 healthy volunteers { 1-25) before, 

during and after acupressure performed on the acupoint Yintang. 

All subjects were awake. Note the significant decrease {minimum 

BIS = 35; no.14) due to acupressure. 

24

16 

100 

80 

~ 60 

m 

N 

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I 

40 

20 

O 

35 

G. Litscher 

30 . 

25 

20 

10 

Figure 4. 

. 

. 

. 

. 

. 

SEFr 

Box plots of alterations of BIS and SEF values ( r: right; I: left) in 

25 healthy volunteers before (a), during (b-f) and after (g) acu- 

pressure (cf. Fig. 2) on the acupoint Yintang. The ends of the boxes 

define the 25%0 and 75%0, with a line at the median and error 

bars defining the 10%0 and 90%0. 

Before the subjects were stimulated, their mean 

BIS values (:tSD) were 97.4 (98-95) :t 1.0 andtheir 

mean SEF values (:tSD) were 23.9 :t 4.1 (right) and 

23.5 :t 4.9Hz (left). The BIS and SEF values both 

decreased significantly (P < 0.001) after starting acupressure. 

After 5 min acupressure at the acupoint 

Yintang, the mean BIS values were 62.9 (minimum 

35; see no.14 in Fig. 3) :t 13.9, and the mean SEF 

values were 13.3 (minimum 2.9) :t 8.1 (right) and 

13.8 (minimum 2.7) :!: 7.3 Hz (left). The release of 

acupressure caused an increase in BIS and SEF back 

to the baseline values before stimulation (cf Fig. 4). 

Figure 5 summarizes the BIS and SEF results 

obtained during manual needle acupuncture, 

Laserneedle @ acupuncture and acupressure on the 

control point. Significant (P < 0.05) changes were 

found in BIS values during Laserneedle@ acupuncture 

(measuring points d and e; cf Figs. 2 and 5) and 

during acupuncture on the control point (measuring 

points d-f). After 7.5 min Laserneedle@ acupuncture at 

acupoint Yintang, the mean BIS values (:!:SD) were 

95.4 (minimum 81; see Fig. 5, middle, upper panel) 

:!: 4.1. After 5 min acupressure at the control point, 

the mean BIS values (:!:SD) were 94.2 (minimum 77; 

see Fig. 5, right, upper panel) :!: 4.8. SEF did not show 

any significant alteration. 

The results of the analysis of the VSS are demonstrated 

in Figure 6. The VSS values were significantly 

(P < 0.001) reduced after pressure application on 

Yintang, needle acupuncture and Laserneedle@ 

acupuncture but also after pressure application on 

the control point (P = 0.012). Mean baseline VSS 

values were insignificantly lower in Laserneedle@ 

and control conditions. 

HR and BP values (mean :!: SD) before and after 

acupressure at Yintang were calculated to be 73.2 :!: 

12.4beatsmin-l, 109.8:!: 14.0mmHg (systolic) and 

69.3 :!: 10.6 mmHg (diastolic), respectively. After 

stimulation the values decreased to 63.7 :!: 

11.9beatsmin-l, 107.7:!: 8.7mmHg(systolic)and 

66.8 :!: 8.6 mmHg (diastolic), respectively. 

Discussion 

The BIS and the SEF are mainly used intraoperatively 

to monitor the hypnotic effect of anaesthetic drugs. 

There are several studies reported in the literature 

proposing target values for EEG parameters to guide 

the depth of anaesthesia. A number of authors have 

reported a low probability of recall and a high probability 

of unresponsiveness during surgery at a level 

of 60 for BIS [8,9]. BIS values

(8) (b) (c) 

120 

100 ~ ...T T T T T 

80 

(I) 

tC 60 

40 

20 

0 

30 

25 , 

n.s. 

.~ ."'(7i'ti!! ~ " 

BIS 

N 20 

:I: 

15 

. 

10 

5 n.s. 

0 I. ... ~ 

Nonpharmacological influences on BIS and SEF 17 

b c d e 9 

Figure 5. 

Box plots of changes of BIS and SEF values ( r: right; I: left) during ( a) manual needle acupuncture, ( b) Laserneedle@ acupuncture and 

( c) acupressure at the control point. Further explanations see Figure 4. 

Figure 6. 

Mean (::t:SD) values ofthe vss of25 healthy volunteers before 

(a) and after (b) different modalities of nonpharmacological stimu- 

lation (0: no stress; 10: maximum stress). 

Acupuncture has been shown to reduce medication 

use in a number of trials [12]. Acupressure has been 

studied and offered in scientific literature as a valuable 

treatment in improving the quality of sleep [13]. 

In previous studies, it has also been shown that pressure 

on acupoints can decrease postoperative pain [14] and 

that Korean hand acupressure reduces postoperative 

nausea and vomiting after gynaecologicallaparoscopic 

N 

I 

surgery [15]. Acupressure has also been used in some 

other studies for prevention of emesis [16]. There are 

a number of theories as to how acupressure or acupuncture 

works. All these hypotheses show that the brain 

plays a key role in acupuncture and acupressure research 

[17-20]. Modulation of subcortical structures may be 

an important mechanism by which acupuncture and 

acupressure exerts its complex multisystem effects 

[20]. Demonstration of regionally specific, quantifiable 

acupuncture and acupressure effects on relevant 

structures of the human brain would facilitate acceptance 

and integration of these therapeutic modalities 

into the practice of modern medicine [17-20]. 

It has been shown in several publications that different 

narcotics have different influence on BIS and 

SEF [8-11,21-26]. However, nonpharmacological 

influences such as electromyographic activity may 

contribute to the low specificity of the absolute values 

of the electrophysiological measurement data [21]. 

In the majority of the cases, the BIS is falsely elevated 

[21]. Our results appear to confirm the results 

of the study ofFassoulaki and colleagues [4] who also 

found that acupressure on Yintang resulted in a 

significant and clinically relevant reduction on BIS 

values and they concluded that BIS is therefore 

of limited clinical relevance for monitoring depth 

of anaesthesia [22-26]. However, Fassoulaki and

18 

G. Litscher 

colleagues [4] did consider the SEF, nor did they 

investigate the effects of manual needle acupuncture 

and the effects ofLaserneedle@ acupuncture. 

We have shown in this study that awake volunteers 

subjected to acupressure at Yintang can have 

similar BIS and SEF values to anaesthetized patients. 

While it is unlikely that a patient will receive acupressure 

or acupuncture during surgery, the question 

as to what causes BIS readings below 50 in awake 

subjects remains. It is unlikely to be a placebo effect 

as we have shown in several test measurements usin~ 

placebo points that BIS is not affected by Laserneedle 

stimulation per se. In the present study there were 

small statistically significant but not clinically important 

changes with needle acupuncture, Laserneedle@ 

acupuncture and acupressure at control point. These 

findings also help confirm that the BIS and SEF 

reductions induced by acupressure at Yintang are 

not a placebo effect. Reduced electromyographic 

levels could be partially responsible [21]. At the 

moment it is unclear to what degree system algorithms 

contribute to such findings. BIS is certainly 

affected by electrical activity nearby, especially 

diathermy. Therefore, there could also be a possibility 

that local movement in the region of the recording 

electrode might be responsible for the EEG effects 

observed. These are apparently less during control 

point acupuncture than during Yintang acupressure, 

where pressure is applied to a point immediately 

adjacent to the Zipprep@ electrode. Further investigations 

are necessary to clarify these questions. 

In conclusion, we found in healthy awake volunteers 

that acupressure at Yintang results in statistically 

significant and clinically relevant reductions in 

BIS and SEF while needle acupuncture, Laserneedle@ 

acupuncture and acupressure at a control point result 

in statistically significant but clinically unimportant 

reductions. Although the validity of BIS in anaesthesia 

is higher than that of SEF, BIS too has to be 

interpreted very carefully as our results show. Our 

results also highlight the EEG similarities of acupressure 

induced sedation and anaesthesia. 

Acknowledgements 

The author would like to express his thanks to Dr Lu 

Wang, Mag. Petra Petz and Evamaria Huber (Department 

of Biomedical Engineering and Research in 

Anesthesia and Intensive Care, University of Graz) 

for their valuable help. 

References 

Litscher G, Schwarz G. Noninvasive bioelectrical neuromonitoring 

in anaesthesia and critical care. Bur J Anaesthesiol 

2001; 18: 785-788. 

2. Litschet G. Editotial. The future of neuromonitoring. 

Internet J Neuromonitoring 2000; 1(1): http:/ /www.ispub.com/ 

ostia/ index. php ?xmlF ilePath = journals/ i j nm/voll n 1/ 

editorial2.xml 

3. Rampil IJ. A primer for EEG signal processing in anesthesia. 

Anesthesiology 1998; 89: 980-1002. 

4. Fassoulaki A, Paraskeva A, Patris K, Pourgiezi T, 

Kostopanagiotou G. Pressure applied on the extra 1 

acupuncture point reduces bispectral index values and 

stress in volunteers. Anesth Analg 2003; 96: 885-889. 

5. Stux G, Pomeranz B. Basics of Acupuncture. Berlin, Germany: 

Springer, 1998. 

6. Litscher G, Schikora D. Cerebral vascular effects of noninvasive 

laserneedles measured by transorbital and transtemporal 

Doppler sonography. Laser Med Sci 2002; 17: 

289-295. 

7. Litscher G, Schikora D. Near-infrared spectroscopy for 

objectifying cerebral effects of needle and laserneedle 

acupuncture. Spectroscopy 2002; 16: 335-342. 

8. Sebel PS, Lang E, Rampil IJ, et al. A multicenter study of 

bispectral electroencephalogram analysis for monitoring 

anesthetic effect. Anesth Analg 1997; 84: 891-899. 

9. LiuJ, Singh H, White PF. Electroencephalographic bispectral 

index correlates with intraoperative recall and depth of 

propofol-induced sedation. Anesth Analg 1997; 84: 185-189. 

10. HeckM, Kurnie B, BoldtJ, LangJ, Lehmann A, Saggau W. 

Electroencephalogram bispectral index predicts hemodynamic 

and arousal reactions during induction of anesthesia 

in patients undergoing cardiac surgery.J Cardiothorac Vasc 

Anesth 2000; 14: 693-697. 

11. Chan MTV, Gin T. What does the bispectral EEG index 

monitor? Eur J Anaesthesiol2000; 17: 146-148. 

12. Greif R, Laciny S, Mokhtarani M, et al. Transcutaneous 

electrical stimulation of an auricular acupuncture point 

decreases anesthetic requirement. Anesthesiology 2002; 96: 

306-312. 

13. Tsay SL, Chen ML. Acupressure and quality of sleep in 

patients with end-stage renal disease -a randomized control 

trial. Int J Nurs Stud 2003; 40: 1-7. 

14. Felhendler D, Lisander B. Pressure on acupoints decreases 

postoperative pain. ClinJ Pain 1996; 12: 326-329. 

15. Boehler M, Mitterschiffthaler G, Schlager A. Korean hand 

acupressure reduces postoperative nausea and vomiting after 

gynecologicallaparoscopic surgery. Anesth Analg 2002; 94: 

872-875. 

16. Eizember FL, Tomaszewski CA, Kerns WP. Acupressure 

for prevention of emesis in patients receiving activated 

charcoal.J Toxicol-Clin Toxicol2002; 40: 775-780. 

17. Cho ZH, Wong EK, Fallon JH. Neuro-Acupuncture. Los 

Angeles, USA: Q-Puncture, 2001. 

18. Litscher G, Cho ZH, eds. Computer Controlled Acupuncture@. 

Berlin, Germany: Pabst Science Publishers, 2000. 

19. Litscher G. High-Tech Akupunktur@. Berlin, Germany: Pabst 

Science Publishers, 2001. 

20. Hui KKS, Liu J, Makris N, et al. Acupuncture modulates 

the limbic system and subcortical gray structures of the 

human brain: evidence from fMRI studies in normal subjects. 

Hum Brain Mapp 2000; 9: 13-25. 

21. Bruhn J, Bouillon TW, Shafer SL. Electromyographic 

activiry falsely elevates the bispectral index. Anesthesiology 

2000; 92: 1485-1487.

MEDICAL ACUPUNCTURE 

Volume 20, Number 1, 2008 

© Mary Ann Liebert, Inc. 

DOI: 10.1089/acu.2007.0606 

Original Paper 

Laserneedle Acupuncture: A Critical Review and Recent Results 


ABSTRACT 

In the last 5 years, laserneedle acupuncture has become a new category in acupuncture, with its own scientific 

basics. It combines the tradition of Chinese acupuncture with the possibilities of modern technology. Laserneedle 

acupuncture is in accordance with the aim of traditional medicine because it uses the most essential and 

most natural medium of our existence, the light, to heal illnesses. The painless laserneedle acupuncture is of 

proven medical effectiveness and particularly suited for the treatment of children and those patients who regard 

the metal needle insertion into the skin as unpleasant. In daily practical use, laserneedle acupuncture can 

be performed like any traditional needle acupuncture treatment. The diagnostic criteria of acupoint selection, 

the treatment duration, and treatment frequency are identical to the traditional Chinese acupuncture. To perform 

successful laserneedle acupuncture treatments, no additional qualification is required. Offering the painless 

laserneedle acupuncture to the patient means that the acupuncture needles are substituted and the risks of 

the metal needle are eliminated. 

Key Words: Laserneedle, Acupuncture, Laser 

INTRODUCTION 

THE BASIC IDEA FOR THE DEVELOPMENT of “laserneedles” 

for acupuncture in the Biophotonic Research Group at 

Paderborn University (in Germany) originated from an 

acupuncture analysis in Europe 10 years ago. At that time, 

the first hand-held devices/”laser pens” arrived on the market, 

which were recommended as instruments to perform 

painless laser acupuncture treatments. It is obvious, however, 

that acupuncture treatments using such devices are not in accordance 

with the long tradition of Chinese acupuncture 

which is based on a simultaneous stimulation of a selected 

acupuncture point combination. Hand-held acupuncture laser 

devices allow just a serial stimulation of acupuncture points, 

i.e., 1 point after the other. The question arises: is it acupuncture 

if one sticks a needle in the first acupuncture point, takes 

University of Paderborn, Paderborn, Germany. 

37 

it out after 2 minutes, punctures the second point for 2 minutes, 

takes it out again, and stimulates the third point, and so 

forth. Every experienced acupuncturist would perhaps answer, 

“No, that is not acupuncture. I would never do that. 

The needles must remain for at least 20 minutes in the selected 

acupuncture points.” That is, the points have to be 

stimulated simultaneously. Our analysis came to the same 

conclusion; furthermore, we could not find proof in the literature 

of a serial point stimulation approach, neither for 

metal needles nor for laser pens. 

With the development of laserneedles, we have tried to 

preserve the methodical rules of the classic Chinese 

acupuncture. Several fundamental scientific and medical 

problems had to be resolved and investigated: 

1) How can visible laser light stimulate acupuncture 

points? It is known from daily experience that visible light

38 

that is shining on the skin does not create any acupuncturelike 

reaction nor does it interact with peripheral sensory 

nerves. The pleasant warmth that we feel on the skin during 

a summer day does not come from the visible light of 

the sun. How can laser light stimulate acupoints? If one 

pricks a metal needle in the skin, the patient often feels pain. 

Is that physical stimulation an essential requirement for efficient 

acupuncture? 

2) Which parameter and properties are important in laser 

acupuncture that determine the therapeutic efficacy? 

3) Is it dangerous to stimulate acupuncture points by laser 

irradiation? Are there any risks or side effects? 

4) Is laser acupuncture comparable to the traditional metal 

needle acupuncture regarding its therapeutic efficacy? 

5) What are the limits and challenges of laserneedle stimulation. 

These 5 topics are addressed in this paper. One of the 

practical outcomes of our previous research work was a new 

medical instrument, the “laserneedle.” 1 We are aware that 

the term laserneedle is somewhat misleading; it suggests that 

these instruments hurt the skin. This is not true; laserneedles 

are non-invasive instruments that do not puncture the 

skin. They are brought in contact with the skin and can be 

fixed on the skin, but do not penetrate the skin. Therefore, 

acupuncture treatments with laserneedles are of non-invasive 

character and are free of the unpleasant metal needle 

pain sensations. 

HOW DOES LASERNEEDLE 

ACUPUNCTURE WORK? 

The mechanism of acupuncture analgesia has been studied 

extensively in the past 2 decades in Western countries. 2 

Studies using biomedical instruments have demonstrated the 

key role of the brain in acupuncture. 3–11 It was also found 

that the insertion of a metal needle into an acupuncture point 

leads to a release of different chemical substances like histamine, 

bradykinin, substance P, and ATP in the tissue at the 

acupuncture point. Due to the increased concentration of 

these substances, the peripheral nociceptors, which exist in 

great numbers at acupoints, seem to become depolarized. As 

SCHIKORA 

a consequence, rhythmic discharges occur in nociceptors and 

a cascade of electrical signals (action potentials) is generated 

and transmitted via afferent nerve fibres to the brain. Specific 

cortical areas like the pain-related cores of the hypothalamus 

and areas of the limbic system become activated. 3,12 

The following effect transduction from the central nervous 

system to the periphery, accompanied by a release of �-endorphins 

and other opiogen or non-opiogen neurotransmitters, 

uses efferent signal paths. This rather short description of the 

basic mechanism of acupuncture analgesia shall illustrate the 

essential point. That means that acupuncture effects are based 

on rhythmic discharges of nociceptors and are not based on 

the needle pain. As a consequence, painless acupuncture 

should be possible, provided that the rhythmic discharges of 

nociceptors can be induced in a non-invasive, non-traumatic 

way. In this context, the question arises: can we use laser irradiation 

for the induction of discharges in peripheral nociceptors? 

The answer is not as simple as it seems. Visible light 

does not interact with peripheral nerves; we do not feel pain 

during light illumination of the skin. How can nociceptors 

discharges be generated by light if there is no interaction? To 

investigate this problem, we did cell research studies, using 

mast cells selected from human connective tissue. 13 Single 

mast cells were isolated by a patch-clamp technique and illuminated 

with the red radiation of a laserneedle. Figure 1 

demonstrates the effect of the laserneedle-radiation. 

A few minutes after laserneedle illumination, the mast 

cell degranulates, releasing histamine. Conversly, a mast cell 

that is not illuminated does not show any effects under the 

same experimental conditions. This suggests that the irradiation 

of red laser light, emitted by a laserneedle, leads to a 

release of histamine in the connective tissue at the acupoint. 

When the histamine concentration increases, the nociceptors 

again become depolarized and rhythmic discharges may initiate. 

This may be the basic mechanism of laser acupuncture 

and it suggests the important role of connective tissue 

in acupuncture. The stimulation is of indirect character; the 

light does not directly influence the peripheral nociceptors, 

but probably influences indirectly the alteration of the histamine 

concentration in the surrounding connective tissue. 

We have found that the release of histamine from the connective 

tissue mast cells occurs only when a critical value 

FIG. 1. Degranulation of a single human mast cell of connective tissue, irradiated 60 s by a laserneedle, in-vitro isolated by a patchclamp 

technique (a: before irradiation; b: after 10 minutes; c: after 25 minutes).

LASERNEEDLE ACUPUNCTURE 39 

Transmitted light intensity, � W 

10 5 

10 4 

1000 

100 

10 

0 

Skin fold 

5 10 15 20 25 

Laserneedle 

Photodetector 

Tissue penetration depth, mm 

30 35 40 

FIG. 2. Experimentally-determined tissue penetration depth of 

laserneedle radiation of 685 nm wavelength. The intensity of the 

transmitted laser radiation is reduced by 1 magnitude of order after 

penetration of a 35 mm skin fold. The effective penetration 

depth of 685 nm laserneedle radiation in human tissue, therefore, 

is in the order of 35 mm. 

of laser irradiation (light power per area) is exceeded. The 

laserneedles had an irradiance of 20 W/cm 2 , a value able to 

induce needle-equivalent acupuncture effects. 4–11 The conclusion 

may be that there is basically no difference in the 

stimulation of an acupoint by insertion of a metal needle 

compared to the stimulation or laser radiation. Both approaches 

generate the same rhythmic discharges and action 

potentials in peripheral nociceptors and activate analogous 

afferent and efferent signal transduction paths and therefore, 

similar acupuncture effects. Invasive needle acupuncture 

and non-invasive laserneedle acupuncture probably only differ 

in the specific way of inducing changes in the chemical 

composition of the connective tissue around the acupointnociceptors. 

What Determines the Therapeutic Efficacy of 

Laser Acupuncture? 

The most important laser acupuncture parameter is power 

per area of the laser beam. This parameter was optimized 

by our mast cell experiments. The degranulation of connective 

tissue mast cells requires an irradiation of about 

20 W/cm 2 . For laserneedles, which emit 40 mW at their distal 

output, this critical value is exceeded. Only laserneedles 

of 35–40 mW distal light power induce the histamine release 

and, therefore, the acupuncture effects. When the distal 

light power is not sufficient, either none or weak, 

acupuncture effects are not generated. 

The second important laser acupuncture parameter is the 

wavelength of the laser light. The laser wavelength determines 

the absorption of the photons in the tissue and therefore, 

the “penetration depth” of the light. For needle 

acupuncture treatments, the insertion depth varies because 

traditional Chinese acupuncture assumes that acupuncture 

points are located in different depths in the tissue. Photon 

penetration into tissue is inversely proportional to its absorption. 

To achieve a substantial penetration depth, we have 

to use laser wavelength which exhibits the lowest absorption 

in human skin, muscle, and fat tissue. It is believed that 

infrared light penetrates deeper in human tissue than red 

light, but is controversial. It has been recently demonstrated 

in experimental measurements 14 that the dispersion of the 

absorption coefficients in complex human tissue shows 2 

distinct absorption minima: the lowest absorption exists at 

about 700 nm, i.e., red light of 700 nm exhibits the deepest 

penetration in human tissue. Therefore, the best choice for 

the wavelength of laser acupuncture devices is red light near 

700 nm. There exists a second absorption minimum at 

820 nm (infrared radiation) which is the second best choice. 

A bichromatic combination or mixture of red and infrared 

radiation would probably be the optimum for an efficient 

stimulation of acupuncture points. In conclusion, the most 

important laserneedle parameters that directly influence the 

therapeutic efficacy are laser irradiance (laser power per 

FIG. 3. Laserneedle treatment of a 6-year-old asthma patient 

(courtesy of R. Klowersa, MD, Berlin, Germany).

40 

FIG. 4. Laserneedle treatment of cervical syndrome. Acupuncture 

point combination: SI 3 (Hou Xi), BL 62 (Shen Mai), BL 60 

(Kun Lun), LI 4 (He Gu), LR 3 (Tai Chong). Treatment duration, 

20 minutes; treatment frequency, 8 treatments, 3 times a week. 

area) and absorption. In this context, the laser irradiance is 

physiologically equivalent to the stimulation strength of the 

laserneedle at the acupoint; the wavelength is equivalent to 

the “penetration depth” of a laserneedle. 

At 40 mW distal laser power, which corresponds to an 

irradiation of 20 W/cm 2 and an emission wavelength of 

about 685–690 nm, we found that the stimulation effects at 

the acupoints are comparable to the stimulation effects of 

metal needles (Figure 2), although the patients did not feel 

any pain from the activated laserneedles. Further proof for 

that observation could be the fact that De Qi sensations are 

sometimes felt and reported by the patients during laserneedle 

acupuncture analgesia treatments. 

In comparison to the large stimulation strength (large irradiance) 

which is necessary to induce the specific acupuncture 

mechanism, the energy that is transferred into the body 

during a laserneedle acupuncture treatment is rather moderate. 

Assuming a treatment duration of 1000 s (�17 min) using 

10 laserneedles of 40 mJ distal energy, the total energy 

that is transferred into the tissue during the treatment is about 

4 J. For better understanding and simplification and expressed 

in more familiar quantities, 4 J correspond to an energy 

transfer into the body of about 17 cal during a normal 

laserneedle treatment. This is much less than a teaspoon of 

yogurt. Due to the moderate dosage and its painless stimulation 

character, the laserneedle acupuncture is particularly 

suited for acupuncture treatments of children (Figure 3). 

Is It Dangerous to Stimulate Acupuncture Points 

by Laser Light? 

We have studied this important question carefully in the 

past. To determine the temperature effects of activated 

laserneedles, we have performed animal experiments as well 

as experiments with healthy volunteers. In this context, we 

SCHIKORA 

used different biomedical methods: laser Doppler flowmetry 

and laser Doppler imaging, for registration of changes 

in microcirculation and different temperature measurement 

equipments. 15 The main result of these studies was that the 

temperature increased about 1°C in the tissue by laserneedle 

activation. This increase is negligible and of no critical 

relevance. The temperature-increase of about 1°C is accompanied 

by an increase of the peripheral microcirculation 

in the acupoint area during laserneedle stimulation. 14 

To investigate micromorphological changes in the skin 

during and after laserneedle stimulation, we performed animal 

experimental studies. 16 We studied in particular the 

possible influence of laserneedle radiation on a necrosis of 

the epidermis, alterations of endothelia cells, blood vessels, 

and occurrence of microthrombosis using histological preparations 

of the skin. In all these investigations, we could not 

detect any micromorphological alterations of the animal (sus 

scrofa domesticus) skin. 

From the results of these experimental studies, we can, 

therefore, conclude that laserneedle stimulation using these 

specific technical parameters does not induce measurable 

micromorphological changes in the illuminated skin. 15,16 

Is Laserneedle Acupuncture Therapeutically 

Equivalent to Traditional Metal 

Needle Acupuncture? 

This question must be discussed under 2 different aspects. 

The first aspect regards the physiological equivalency that can 

be determined exactly by modern spectroscopic methods. The 

second aspect regards the clinical equivalency, which can only 

be assessed by a statistically significant number of therapeutic 

reports and clinical studies. Regarding the physiological 

equivalency, a larger number of scientific studies exist for the 

peripheral physiological effects as well as for the central physiological 

effects in the brain (summarized in reference 15). 

FIG. 5. Laserneedle regeneration therapy of a retropatellar chondropathy. 

Treatment time, 30 minutes; treatment frequency, 3 times 

a week; duration, 8 weeks.

LASERNEEDLE ACUPUNCTURE 41 

An important result was obtained by studying the alterations 

of the blood flow velocity in the ophthalmic artery during 

acupuncture of a visual acupuncture scheme. Combining 3 

different acupuncture microsystems: the Traditional Chinese 

Medicine body acupuncture (acupoints Zanzhu/ BL 2 and 

Yuyao/Ex. 3), ear acupuncture (points Eye and Liver), and 

Korean Hand Acupuncture (point E 2). Eighty-eight healthy 

volunteers were investigated in the study using metal needles 

and laserneedles. This scheme is known as particularly successful 

for the treatment of eye diseases. For the stimulation 

with metal needles, a significant increase (factor: 1.9) of the 

cerebral blood flow velocity in the ophthalmic artery was detected. 

The increase was observed only in the ophthalmic 

artery. In comparison, stimulation of the same acupuncture 

points using laserneedles resulted in an increase (factor: 1.6) 

of the blood flow velocity in the ophthalmic artery. Also, the 

oxygen metabolism in the brain, measured by near-infrared 

spectroscopic parameters, 17 was increased during the stimulation 

by a factor of 1.6 for metal needles and a factor of 1.8 

for laserneedle stimulation. These results demonstrate that 

laserneedle stimulation may be nearly equivalent to the traditional 

metal needle stimulation. 

The clinical equivalency between traditional metal needle 

acupuncture and laserneedle acupuncture can be assessed 

on the basis of 1.4 million laserneedle treatments worldwide. 

No side effects of laserneedle treatments have been reported. 

The clinical reports and studies confirmed that laserneedle 

acupuncture is comparable to traditional needle acupuncture 

also from the clinical point of view. Laserneedle 

acupuncture has been employed to treat allergic diseases like 

rhinitis allergica, asthma bronchiale, neurodermatitis; neurological 

diseases like migraine, trigeminusneuralgia, herpes 

zoster neuralgia, hemiparese, phantom pain, paresis after 

stroke; orthopedic diseases like cervical syndromes 

(Figure 4), gonarthritis, rhizarthritis, epicondylitis, tendonitis, 

fibromyalgia, polyarthritis, spine syndromes; and 

pediatric diseases like bronchitis, asthma bronchiale, otitis 

media, bladder inflammations, enuresis, etc. Practitioners 

report better clinical efficacy of laserneedle treatments compared 

to metal needle treatments. We explain that by the 

“double effect” of laser needles: they stimulate specifically 

the acupuncture points as metal needles do, and, in addition, 

they stimulate the surrounding tissue by laser light, resulting 

in typical laser therapy effects like enhanced microcirculation, 

increased ATP-synthesis in the mitochondria, and 

improved anti-inflammatory effects. Laserneedles, combine, 

always and during each treatment, the laser acupuncture with 

the laser therapy. This is, perhaps, a remarkable difference 

to metal needles. 

New Therapeutic Possibilities of 

Laserneedle Stimulation 

Recent cell research studies with laserneedles demonstrate 

other therapeutic possibilities. 18 It was found that in- 

vitro studies of human osteoblast cells metabolism could be 

increased by a factor of 9.1 by laserneedle irradiation. A 

shift of the osteoblast-osteoclast-activity equilibrium to the 

bone regeneration side can be induced and maintained by 

the laserneedle therapy. Successful clinical treatments of osteoarthritic 

illnesses (Figure 5) like chondropathy and osteonecrotic 

illnesses, like morbus Ahlbäck, morbus Osgood- 

Schlatter, and morbus Perthes have been reported. In all 

these reports, the regeneration effects were achieved without 

any accompanying medication. 

ACKNOWLEDGEMENTS 

The author thanks Professor Ch. Kasperk, Dr V. Haxsen 

(University Hospital. Heidelberg, Germany), and Professor 

W. Schwarz and Ms Zhang Di (Max Planck Institute for 

Biophysics, Frankfurt/Main, Germany) for the cell research 

collaboration. 

REFERENCES 

1. Schikora D. European Patent EP 1 298:337. 

2. Irnich D, Beyer A. Neurobiologic mechanisms of acupuncture 

analgesia. Schmerz. 2002;16:93–102. 

3. Cho ZH, Wong EK, Fallon J. Neuro-Acupuncture. Los Angeles, 

CA: Q-Puncture Inc; 2001. 

4. Litscher G. Bioengineering assessment of acupuncture. part 1: 

thermography. Crit Rev Biomed Eng. 2006;34(1):1–22. 


monitoring of microcirculation. Crit Rev Biomed Eng. 

2006;34(4):273–294. 


ultrasound. Crit Rev Biomed Eng. 2006;34(4):295–326. 


functional magnetic resonance imaging. Crit Rev Biomed Eng. 

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cerebral near-infrared spectroscopy. Crit Rev Biomed Eng. 

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monitoring—neurophysiology. Crit Rev Biomed Eng. 2007; 

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heart rate variability. Crit Rev Biomed Eng. In press. 

11. Litscher G, Wang L, Schikora D, et al. Biological effects of 

painless laserneedle acupuncture. Medical Acupuncture. 

2004;16(1):24–29. 

12. Siedentopf C, Haala I, Koppelstätter F, et al. Placebo laser controlled, 

computer controlled double blind study—a new attempt 

at basic research. D Zeit Akupunktur. 2005;48(1):18–23. 

13. Zhang D, Schwarz W, Schikora D. Proceedings of the 2 nd International 

Workshop on TCM, held at University Hospital 

Heidelberg. October 14, 2007. 

14. Walter H. Photobiological basics of low level laser irradiation. 

Helbo-Medizintechnik GmbH. 2001. 

15. Litscher G, Schikora D. Laserneedle Acupuncture. Science and 

Practice. Lengerich, Pabst Science Publishers; 2004.

42 

16. Litscher G, Nemetz W, Smolle J, Schwarz G, Schikora D, 

Uranüs S. Histological investigation of the micromorphological 

effects of the application of a laserneedle—results of an 

animal experiment. Biomed Tech. 2004;49(1–2):2–5. 

17. Litscher G, Schikora D. Near-infrared spectroscopy for objectifying 

cerebral effects of needle and laserneedle acupuncture. 

Spectroscopy. 2002;16:335–342. 

18. Haxsen V, Schikora D, Sommer U, Remppis A, Greten J, 

Kasperk C. Relevance of laser irradiance threshold in the induction 

of alkaline phophatase of human osteoblast cultures. 

Lasers Med Sci. In press. 

SCHIKORA 

Address correspondence to: 


University of Paderborn 

Faculty of Science 

Warburger Street 100 

33098 Paderborn, Germany 

E-mail: detlefschikora@tiscali.de

EFFECTS OF NEW NONINVASIVE LASERNEEDLES 

ON BRAIN FUNCTION 


* Department of Biomedical Engineering and Research in Anesthesia and Critical Care, 



Abstract: This paper describes the first double-blind 

study in acupuncture research in 17 healthy volunteers 

using laserneedle acupuncture. Stimulation of 

vision related acupoints resulted in marked changes 

of mean blood flow velocity in the posterior cerebral 

artery measured by multidirectional transcranial 

Doppler sonography. Further studies using different 

laser stimulus intensities and wavelengths are in 

progress. 

Keywords: laser, laserneedle, acupuncture, brain 

function, blood flow velocity 

Introduction 

A new noninvasive laserneedle system has been developed 

and used for the first time in acupuncture research 

[1,2]. This new optical stimulation technique has 

the advantage that the stimulation cannot be felt by the 

patient. The operator may also be unaware of whether 

the laserneedle system is active and therefore for the 

first time true double blind studies in acupuncture research 

can be performed. 

Materials and Methods 

The laser radiation is coupled into eight optical fibres 

and the laserneedles are arranged at the distal ends 

of the optical fibres. Due to the direct contact of the 

laserneedles and the skin, no loss of intensity occurs and 

the laser power, which affects the acupoints, can be 

exactly determined [1,2]. 

Simultaneous and continuous transtemporal Doppler 

sonographic examinations of the posterior cerebral artery 

(PCA) and the middle cerebral artery (MCA) were 

performed to objectify alterations of cerebral blood flow 

velocity. Seventeen healthy volunteers with a mean age 

of 25.1 + 4.1 years (⎺x + SD) were examined. Eight 

vision related distal acupoints (Hegu, Zusanli, Kunlun, 

Zhiyin) on both sides and 8 placebo points were tested 

using two schemes, each in one session in a randomized 

double-blind cross-over study design. The data before 

(a), during (b - d), and after (e) laserneedle acupuncture 

(Fig.1) were tested with Kruskal-Wallis one way 

ANOVA on ranks (SigmaStat, Jandel Scientific Corp., 

Erkrath, Germany). 

Fig. 1: Measurement profile. 

Results 

The results of the alterations of mean blood flow velocities 

in the PCA and MCA before (a), during (b - d), 

and after (e) laserneedle and placebo acupuncture are 

summarized in Table 1. 

Tab. 1: Changes in mean blood flow velocity (vm; 

⎺x + SE) in 17 healthy volunteers during laserneedle 

(A) and placebo (B) acupuncture. Note the 

increase of vm at the conditions b - d (* n.s.) during 

A. 

v m (cm/s) A: PCA B: PCA A: MCA B: MCA 

a 42.2 ± 2.5 42.9 ± 2.6 48.0 ± 3.1 47.5 ± 3.2 

b 44.7 ± 2.7 * 41.6 ± 2.7 48.0 ± 3.2 45.9 ± 3.1 

c 43.9 ± 2.6 41.6 ± 2.7 47.6 ± 3.2 45.7 ± 3.1 

d 44.1 ± 2.6 41.9 ± 2.4 48.6 ± 3.1 45.9 ± 3.0 

e 42.3 ± 2.4 42.1 ± 2.8 46.8 ± 3.2 46.2 ± 3.1 

Discussion 

Recent scientific and technological progress has 

truly revolutionized acupuncture. The usage of advanced 

exploratory tools, such as laser Doppler flowmetry, 

laser Doppler imaging, ultrasound or magnetic 

resonance imaging, provides revealing insights and 

attempt to shine scientific light upon the most spectacular 

of the eastern medical procedures [3-9]. 

Similar like in animal studies we have found recently 

that the brain is the key to acupuncture’s and 

laserpuncture’s effects. New experimental constructions 

to measure ultrasound, light and bioelectrical processes 

can reproducibly demonstrate effects of stimulation of 

acupoints in the brain [1,3-9]. 

Streitberger and Kleinhenz [10] have reported that 

the stimulus strength at the acupuncture points are of

decisive importance for the therapeutic efficiency of 

acupuncture treatments. Using placebo-needles in 

comparison with metal needles, it was found that the 

efficiency of acupuncture treatments decreases 

significantly, if placebo needles were used. 

Our studies show that the new high optical 

stimulation with laserneedles can elicit reproducible 

cerebral effects which are in the same order (half 

dimension) with respect to the maximum amplitude of 

the mean blood flow velocity as compared to needle 

acupuncture [1]. 

Conclusions 

The new laserneedle system is able to induce specific, 

marked alterations in cerebral blood flow velocity 

of the PCA after stimulation of vision-related acupoints 

on the foot and hand. At the same time blood flow velocity 

in the MCA did show minor changes. Further 

studies using different laser stimulus intensities and 

wavelengths are in progress. 


We are especially indebted to Dr. Lu Wang, 

Evamaria Huber and Mag. Petra Petz (all Department of 

Biomedical Engineering and Research in Anesthesia 

and Critical Care, University of Graz, Austria) for their 

support to this study. We thank Petra Thöne, Tanja 

Prohaska, Marianne Hubbert and Jörg Reitemeyer from 

Laserneedle ® Systems GmbH (Germany) for technical 

support. 

The present report is a pilot study to the presumtive 

FWF project P16020. 

REFERENCES 

[1] G. Litscher and D. Schikora, “Cerebral vascular 

effects of non invasive laserneedles measured by 

transorbital and transtemporal Doppler sonography”, 

Lasers Med. Sci., vol. 17, 2002, in press. 

[2] D. Schikora, European Patent Nr. PCT/EP 

01/08504. 

[3] Litscher G and Z.H. Cho, Eds., “Computer- 

Controlled Acupuncture ® ”, Lengerich Berlin Rom 

Riga Wien Zagreb: Pabst Science Publishers, 

2000. 

[4] G Litscher, “Computer-based quantification of 

traditional Chinese-, ear- and Korean hand acupuncture: 

Needle-induced changes of regional 

cerebral blood flow velocity”, Neurol. Res., vol 24, 

2002, in press. 

[5] G. Litscher, L. Wang and M. Wiesner- 

Zechmeister, “Specific effects of laserpuncture on 

the cerebral circulation”, Lasers Med. Sci., vol 15, 

pp 57-62, 2000. 

[6] G. Litscher, “High-Tech Akupunktur ® ”, Lengerich 

Berlin Rom Riga Wien Zagreb: Pabst Science Publishers, 

2001. 

[7] Z.H. Cho, E.K. Wong and J. Fallon, Eds., “Neuro- 

Acupuncture I. Neuroscience Basics”, Los Angeles: 

Q-Puncture Inc, 2001. 

[8] G. Litscher, L. Wang, N.H. Yang NH and G. 

Schwarz, “Computer-controlled acupuncture. 

Quantification and separation of specific effects”, 

Neurol. Res., vol. 21(6), pp 530-534, 1999. 


Schwarz, “Ultrasound-monitored effects of acupuncture 

on brain and eye”, Neurol. Res., vol 

21(4), pp 373-377, 1999. 

[10] K. Streitberger and J. Kleinhenz, “Introducing a 

placebo needle into acupuncture research, Lancet, 

vol. 352, pp 364-365, 1998. 

Information 

gerhard.litscher@uni-graz.at 

www.litscher.info

Biological Effects Of Painless Laser Needle Acupuncture 

Gerhard Litscher, PhD 

Lu Wang, MD 


Dagmar Rachbauer, MSc 

Gerhard Schwarz, MD 

Andreas Sch�pfer, MD 

Stefan Ropele, PhD 

Evamaria Huber 

ABSTRACT 

Laser needle acupuncture is a new method to stimulate acupuncture points. We describe the 

technique, its first use, and its value in acupuncture research. Laser needle publications we included 

are based on 511 measurements in 231 healthy volunteers (129 female, 102 male), with a mean (SD) 

age of 25 (3.5) years (range, 18-38 years). One pig experiment is also included. 

The results of randomized, double-blind, controlled, crossover studies show that the methods of laser 

Doppler flowmetry, functional multidirectional transcranial Doppler sonography, functional magnetic 

resonance imaging, and near infrared spectroscopy are able to objectify and quantify peripheral and 

cerebral effects of laser needle acupuncture. 

For the first time, we were able to investigate scientifically the differences between needle 

acupuncture, which includes pain stimulation, and laser needle acupuncture, a continuous 

multichannel method of painless acupuncture stimulation. Laser needle acupuncture can induce 

specific, reproducible changes in the brain. These can be expressed by shifts in different parameters, 

such as cerebral blood flow velocity. 

KEY WORDS 

Laser Needle Acupuncture, Acupuncture, Laser, Laser Doppler Flowmetry, Transcranial Doppler 

Sonography, Functional Magnetic Resonance Imaging (fMRI), Near Infrared Spectroscopy 

INTRODUCTION 

The stimulation of acupuncture points with laser light can evoke specific effects in the periphery and in 

the brain. These effects can be objectified and quantified using modern biomedical engineering 

techniques. Laser needle acupuncture represents a new, painless method for primary optical 

stimulation of acupuncture points.1-14 Laser needles are not inserted in the skin; they are simply 

applied to the acupuncture point. This method allows the simultaneous stimulation of individually 

combined points. 

This study gives a current summary regarding scientific proof and innovative aspects of laser needle 

acupuncture. We discuss studies of the peripheral effects using registration of temperature and laser 

Doppler flowmetry8,9,13 as well as publications regarding the objectification of cerebral effects of laser 

needle acupuncture aided by functional multidirectional transcranial Doppler sonography,1-3,8,9,11,12 

functional magnetic resonance imaging (fMRI),11,12 and near infrared spectroscopy.2,4-6,8,9 

METHODS 

Temperature and Microcirculatory Monitoring 

The surface temperature of the skin and the measurement parameter Flux (= product of concentration 

and velocity of erythrocytes) were measured with the Laser-Doppler-Flowmetry Monitor DRT 4 (Moor 

Instruments, Millway, Axminster, England). A DPIT-probe (diameter, 8 mm; length, 7 mm) with a 

power of 1 mW was used. The edge frequencies were 20 Hz and 22.5 kHz.8,9,13 

Functional Multidirectional Transcranial Doppler Sonography 

The Multi-Dop T System (DWL Electronic Systems GmbH, Sipplin-gen, Germany) was used to 

measure the mean blood flow velocity in different cerebral arteries. A 4-MHz (ophthalmic artery), as 

well as 2-MHz probes (posterior cerebral artery, anterior cerebral artery , middle cerebral artery) were 

applied with a specially developed ultrasound probe-holding construction. 

Functional Magnetic Resonance Imaging (fMRI) The fMRI investigations were performed using a 1.5-T 

total body system (Intera, Philips Medical Systems, Best, Netherlands). The blood oxygen leveldependent 

contrast sensitive images were acquired with a T2-weighted gradient echo sequence 

(single shot planar readout, flip angle 90�, TE 50 ms, FOV 250 mm, matrix 96 x 96 interpolated at 

128 x 128, layer number 30, layer thickness 4 mm). A total of 144 volume images were registered 

continuously in succession, with a repetition time of 5 seconds.

The fMRI-study was based on a block design with alternating resting conditions for 1 minute and 1 

minute of laser needle activation. A total of 6 resting and 6 activation intervals were registered. Each 

fMRI data registration required 12 minutes.11,12 

Near Infrared Spectroscopy 

Near infrared spectroscopic investigations for monitoring laser needle acupuncture were done with the 

NIRO 300 Monitor (Hamamatsu Photonics, Japan). Measurement values and changes such as in 

oxyhemoglobin and desoxyhemoglobin were determined using the Lambert-Beer principle. Alterations 

in parameters could be measured absolutely with this system, but not the level (absolute 

concentration) at which these changes (in a positive or negative direction) occur. As long as no 

change in concentration was given, the measurement value was zero. The fixating of the sensor 

(emitter and near infrared detectors) on the head was done with a silicone holder. 

Laser Needle Stimulation 

As mentioned, laser needle acupuncture (D. Schikora: European Patent PCT/EP 01/08504) allows the 

simultaneous stimulation of individual point combinations. Variation and combination of acupuncture 

points on the body are possible according to Traditional Chinese Medicine (TCM), or at the ear and 

hand using Korean (KHA) or Chinese(CHA) Hand Acupuncture. The laser needle method is based on 

a multichannel system with 8 separate semiconductor laser diodes and emission wavelengths of 685 

and 785 nm. The system consists of flexible optical light fibers, which conduct the laser light without 

loss to the laser needle. Thus, a high optical density at the distal end of the laser needle is achievable. 

The intensity of the laser needles is optimized in such a way so that the patient does not feel the 

activation of the needle (30-40 mW per needle; diameter 500 mm; duration 10 min; power density 2.3 

kJ/cm2 per acupuncture point). More details regarding this method are described in previous 

studies.1,6 

Volunteers, Animal Experiments, and Procedures 

This summarizing study presents a total of 511 measurements in 231 healthy volunteers (129 females, 

102 males) with a mean (SD) age of 25 (3.5) years (range, 18-38 years). Protocols were approved by 

the local ethics committee, Medical University of Graz, and all volunteers gave their written consent. 

None of the volunteers had obvious visual, neurological, olfactory, or mental deficits, or were under the 

influence of drugs acting on the central nervous system. A maximum of 7 acupuncture points were 

investigated simultaneously in different measurement 

series. 

Figure 1. Pig (top) and human 

experimental (bottom) studies using laser 

needle stimulation. Flux (product of 

concentration and velocity of 

erythrocytes), surface skin temperature, 

and room (R) temperature before (a), 

during (b-d), and after (e) laser needle 

activation. 

Animal Experiment (sus scrofa 

domesticus), n=1 

Modified from: Biomed. Technik, 

2004;49:2-5[13]

In addition, an animal study (pig) was included in this 

report. The pigs were put under general anesthesia in the 

animal surgical suite of the Department of Surgical 

Research at the Medical University of Graz. This study was 

performed in accordance with the rules defined by the 

ethics committee (animal study approval number GZ 

66.010/10-BRGT/2003). 

Statistical Analysis 

Data were analyzed with 1-way repeated measure analysis 

of variance using the computer program SigmaStat (Jandel 

Scientific Corp, Erkrath, Germany). The tests described in 

single publications were used for post hoc analyses. The 

level of significance was defined as P

Figures 2 and 3 document specific changes in cerebral blood flow velocities in different arteries. Using 

the laser acupuncture scheme (TCM: Zanzhu and Yuyao; ear: eye and liver; KHA: E2; CHA: Yan 

Dian), the blood flow velocity in the ophthalmic artery using a wavelength of 685 nm increased 

significantly (P = .01). However, a 30% increase in stimulation intensity only increased vm in the 

ophthalmic artery to a mean value of 11%. Simultaneously, no significant changes in vm occurred in 

the middle cerebral artery. Using laser needle acupuncture with a wavelength of 785 nm, a marked but 

nonsignificant (P = .55) increase in vm in the ophthalmic artery during stimulus application occurred. 

Brief stimulation (20 seconds each) of the single points with a hand-held low-level laser (19 mW) did 

not reveal any significant (P = .94) differences in vm in the ophthalmic artery concerning the conditions 

before and after stimulation. 

Figure 3 

Figure 3 shows the changes in vm in the anterior and posterior cerebral arteries when applying 

different laser acupuncture schemes. When using laser acupuncture scheme A, vm increased during 

stimulation significantly in the anterior cerebral artery (P

The first fMRI results using laser needle acupuncture are summarized in Figure 4. Significant (P

Figure 6 (at the left) shows the hypothetically assumed course of stimulus intensity, in random units of 

a metal and laser needle, as a function of time. At the right, real time signals registered with near 

infrared spectroscopy and bioelectric methods are illustrated. 

DISCUSSION 

Innovation and laser are nearly synonymous. In 1917, Albert Einstein already formulated the physical 

foundation for so-called light intensification with stimulated emission. In the field of medicine, laser not 

only allows careful treatment for patients but also, a manifold of selective therapies in nearly all special 

fields. Laser has become an important instrument in acupuncture for the treatment of small children or 

patients with needlephobia. 

Our goal was to give a summary about previous clinical experimental studies dealing with this new 

method of optical acupuncture stimulation. Since the volunteer or patient does not feel the 

intervention, the different acupuncture points can be stimulated continuously and simultaneously. The 

double-blind, randomized, controlled, crossover studies indicated that cerebral effects of this manner 

of stimulation are nearly equivalent to that of needles. In addition to complex multidirectional 

sonography, it was also possible to provide proof regarding cerebral functional changes after laser 

needle stimulation using fMRI for the first time. At the same time, points "near the head" could be 

stimulated during fMRI examination, which has not been possible with acupuncture needles and handheld 

laser instruments. 

These findings may be of great importance, not only for the field of laser medicine but also for 

acupuncture research in general. 

CONCLUSION 

We report that laser needle acupuncture allows simultaneous optical stimulation of individual 

acupuncture point combinations. Variations in acupuncture on the body, ear, or hand, as performed 

and described in these studies, are also possible. The studies were able to objectify and specify the 

cerebral effects of laser needle stimulation for the first time. The cerebral effects triggered by this new, 

painless laser needle technique were of similar dimension to those evoked by manual needle 

acupuncture. 

Painless laser needle acupuncture can induce specific, reproducible changes in the brain. These can 

be expressed by shifts in different parameters, such as cerebral blood flow velocity. 

ACKNOWLEDGEMENT 

We would like to thank Ingrid Gaischek, MS (Biomedical Research in Anesthesia and Critical Care, 

Medical University Graz) for her valuable support in this study.

REFERENCES 

1. Litscher G, Schikora D. Cerebral effects of non-invasive laserneedles measured by 

transorbital and transtemporal Doppler sonography. Lasers Med Sci. 2002;17:289-295. 

2. Litscher G, Schikora D. Neue Konzepte in der experimentellen Akupunkturforschung � 

Computerkontrollierte Laserpunktur (CCL) mit der Laserneedle Technik. Der Akupunkturarzt 

Aurikulotherapeut. 2002;28:18-28. 

3. Litscher G, Schikora D. Effects of New Non-invasive Laserneedles on Brain Function. EMBEC 

2002. Proceedings of the 2nd European Medical & Biological Engineering Conference. 

December 4-8, 2002; Vienna, Austria. Graz, Austria: Verlag der Technischen Universit�t 

Graz; 996-997. 

4. Litscher G, Schikora D. Nahinfrarot-spektroskopische Untersuchungen zur Nadel und 

Laserakupunktur. AKU. 2002;30:140-146. 

5. Litscher G, Schikora D. Near-infrared spectroscopy for objectifying cerebral effects of needle 

and laserneedle acupuncture. Internet J Neuromonitoring. 2003;3(2). Link: 

http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijnm/vol3n1/nirs.xml. Accessibility 

verified June 27, 2004. 

6. Litscher G, Schikora D. Near-infrared spectroscopy for objectifying cerebral effects of needle 

and laserneedle acupuncture. Spectroscopy. 2002;16: 335-342. 

7. Litscher G. Lasernadelakupunktur Eine neue nicht-invasive optische 

Akupunkturstimulationsmethode. Dtsch Z Akupunktur. 2003;1:News. 

8. Litscher G. Laserneedle-Akupunktur auf dem Pr�fstand der Wissenschaft. Schweizerische Z 

Ganzheitsmedizin. 2003;15:253-259. 

9. Litscher G. Cerebral and peripheral effects of laserneedle stimulation. Neurol Res. 

2003;25:722-728. 

10. Litscher G. Effects of acupressure, manual acupuncture and Laserneedle acupuncture on 

EEG bispectral index (BIS) and spectral edge frequency (SEF) in healthy volunteers. Eur J 

Anaesthesiol. 2004;21:13-19. 

11. Litscher G, Rachbauer D, Ropele S, et al. Acupuncture using laserneedles modulates brain 

function: first evidence from functional transcranial Doppler sonography (fTCD) and functional 

magnetic resonance imaging (fMRI). Lasers Med Sci. 2004;19(1):6-11. 

12. Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D. Die schmerzfreie 

Lasernadelakupunktur moduliert die Gehirnaktivit�t: Erste Nachweise mit funktioneller 

transkranieller Dopplersonographie (fTCD) und funktionellem Magnetresonanzimaging (fMRI). 

Schmerz Akupunktur. 2004; 1:4-11. 

13. Litscher G, Nemetz W, Smolle J, Schwarz G, Schikora D, Uran�s S. Histologische 

Untersuchungen zu mikromorphologischen Einfl�ssen von Lasernadelstrahlung. Ergebnisse 

einer tierexperimentellen Untersuchung. Biomed Technik. 2004;49:2-5. 

14. Litscher G, Schikora D. Laserneedle-Akupunktur: Wissenschaft und Praxis. Berlin, Germany: 

Pabst Science Publishers; 2004. 

AUTHORS' INFORMATION 

Dr Gerhard Litscher is Doctor of Technical Sciences and Doctor of Medical Sciences, and is Head of 

the Department of Biomedical Engineering and Research in Anesthesia and Intensive Care at the 

Medical University of Graz, Austria. Dr Litscher's special interests are Neuromonitoring and 

Acupuncture Research. 

Gerhard Litscher, MSc, PhD, MDsc* 

Dept of Biomedical Engineering and Research in Anesthesia and Intensive Care, Medical University of 

Graz 

Auenbruggerplatz 29 

A-8036 Graz/Austria 

Phone: ++43 316 385-3907, -83907 � Fax: ++43 316 385-3908 

E-mail: gerhard.litscher@meduni-graz.at

Dr Lu Wang is a Doctor of Western and Traditional Chinese Medicine, and is a Research Assistant in 

the Department of Biomedical Engineering and Research in Anesthesia and Intensive Care at the 

Medical University of Graz, Austria. 

Lu Wang, MD 

Biomedical Engineering and Research in Anesthesia and Intensive Care 

Medical University of Graz 



Phone: ++43 316 385-3907 � Fax: ++43 316 385-3908 

E-mail: probanden@gmx.at 

Detlef Schikora, PhD, is Associate Professor of Physics and Head of the Bio-photonics Group at the 

University of Paderborn in Paderborn, Germany. 


Faculty of Science 

University of Paderborn 

Warburger Strasse 100 

D-33098 Paderborn/Germany 

Phone: ++49 5251 60-3566 � Fax: ++49 5251 60-3490 

E-mail: schikora@upb.de 

Dagmar Rachbauer, MSc, is a Research Associate and PhD student (2004) at the Department of 

Neurology, Medical University of Graz, Austria. She is working with functional Magnetic Resonance 

Imaging (fMRI) and multiple sclerosis patients, and is interested in acupuncture and Chinese herbal 

therapy from a scientific point of view. 

Dagmar Rachbeuer, MSc 

Dept of Neurology 




Phone: ++43 316 385-3691 � Fax: ++43 316 385-6808 

E-mail: dagmar.rachbauer@meduni-graz.at; drachbauer@gmx.at 

Dr Gerhard Schwarz is Head of the Department of Anesthesiology for Neurosurgical and Craniofacial 

Surgery and Intensive Care at the Medical University of Graz, Austria. Dr Schwarz's specialties are 

Neuroanesthesia and Neurointensive Care. 

Gerhard Schwarz, MD Prof 

Dept of Anesthesiology for Neurosurgical and Craniofacial Surgery and Intensive Care 



A-8036 Graz 

Phone: ++43 316 385-3911 � Fax: ++43 316 385-3491 

E-mail: gerhard.schwarz@meduni-graz.at 

Dr Andreas Schoepfer is a Neuroanesthesiologist in the Department of Anesthesiology for 

Neurosurgical and Craniofacial Surgery and Intensive Care at Medical University of Graz, Austria. Dr 

Scheopfer's specialties are Neuroanesthesia and Pain Therapy. 

Andreas Schoepfer, MD 

Dept of Anesthesiology for Neurosurgical and Craniofacial Surgery and Intensive Care 



A-8036 Graz 

Phone: ++43 316 385-80436 � Fax: ++43 316 385-3491 

E-mail: andreas.schoepfer@meduni-graz.at

Stefan Ropele, PhD, is a senior MR-Physicist, Department of Neurology and MR Research Unit, 

Medical University of Graz, Austria. 

Stefan, Ropele, PhD Prof 

MR Research Unit 



8036 Graz/Austria 

Phone: ++43 316 385-3529 � Fax: ++43 316 385-3164 

E-mail: stefan.ropele@meduni-graz.at 

Evamaria Huber is a student of Medicine at Medical University of Graz, and a Research Assistant at 

the Department of Biomedical Engineering and Research in Anesthesia and Intensive Care. 

Evamaria Huber 

Biomedical Engineering and Research in Anesthesia and Intensive Care 




Phone: ++43 316 385-3907 � Fax: ++ 316 385-3908 

E-mail: evamaria.huber@stud.meduni-graz.at 

*Correspondence and reprint requests

Gerhard Litscher 

Department 0( Biomedical Engineering and Research in Anesthesia and Critical Care, University 0( Graz, Austria 

This study comprises scientific-theoretic fundamental investi~ations of laserneedle@ technology, a new 

and painless method of acupuncture stimulation. Laserneedlesfß> are not inserted in the skin, but are merely 

placed on the surface of the acupuncture point. The study documents the significant changes in peripheral 

microcirculation (p = 0.005) and surface temperature of the skin (p = 0.02) induced by laser, in 22 healthy 

volunteers (mean age 24.4:1: 2.6 years). In addition, a randomised cross-over study to characterise the 

specific changes in cerebral blood flow velocity with laserneedleil;) acupuncture (p < 0.001) is presented. 

These results provide important information for characterising the effects of laserneedleil;) acupuncture. 

[Neurol Res 2003; 25: 000-000] 2003, in press 

Keywords: Laserneedlelgl acupuncture; High-Tech Acupuncturelgl; computer-controlled laserpuncture; 

transcranial Doppler sonography; near-infrared spectroscopy; laser Doppler flowmetry 

INTRODUCTION 

By stimulating acupuncture points with laserbeam and/ 

or needles, specific effects can be achieved at the 

periphery and in the brain. For the first time, these effects 

can be characterised and quantified with modern 

biomedical equipment and cerebral monitoring 

methods 1-37. 

Laserneedle@-acupuncture represents a new, painless 

method for primary optic stimulation of acupuncture 

points, whose effects were first described in international 

scientific literature in the year 20023,31-34,36,37. The goal 

of this stud~ is to convey current knowledge regarding 

laserneedle acupuncture from a theoretic-experimental 

point of view, based on the scientific studies 

mentioned above. 

METHODS 

The multi-parameter monitoring methods described in 

our study comprise investigations with laserneedle@ 

acupuncture in regard to peripheral effects (temperature 

and microcirculation), as weil as central effects (blood 

flow velocity and regional cerebral oxygenation). 

Laserneedle@.acupuncture 

Für the first time, laserneedle@ acupuncture allows 

the simultaneaus stimulation of individual acupuncture 

point combinations. Thus, variations and combinations 

of acupuncture points are possible on the body, ear or 

hand (Figure 1). More details regarding this method and 

its technical realisation can be found in previously 

publ ished stud iesJl-J4,J6,J7 . 

-- 

Correspondence and reprint requests to: Prof. Dr G. Litscher, 

Departrnent of Biomedical Engineering and Research in Anesthesia 

and Critical Care, University of Graz, Auenbruggerplatz 29, A-8036 

Graz, Austria. [gerhard.litscher@uni-graz.at] Accepted for publication 

June2003. 

(C) 2003 Forefront Publishing Group 

0161-6412!03/00000{}-ü7 

Thermography 

The thermography system used in our study to 

determine surface temperature of the hand includes a 

Therma CAMTM P60 infrared camera (Flir Systems Inc., 

Portland, OR, USA) in connection with a computeraided 

warmth visualisation system for real time video 

recording and analysis (Tracer Plus, Flir Systems Inc.). 

The infrared camera (distance to the measuring point 

on the hand 0.5 rn) was connected to a notebook via 

interface. For these investigations, a total of 20 min per 

volunteer with a resolution time of 3 min were registered 

and analysed. The registered temperatures were shown 

color-coded on a display which yielded color pictures of 

the color distribution. 

Laser Doppler flowmetry (LDF) 

A laser Doppler monitor DRT4 (Moor Instruments, 

Millwey, Axminster, England) was used to determine 

flux (product of concentration and velocity of erythrocytes) 

and temperature (selective measurement). 

Specified performance of the probe was 1 mW. Cutoff 

frequencies were 20 Hz and 22.5 kHz. The temperature 

measurement unit (5°C to sa°C) had a resolution of 

0.2°C. Several measurement probes are available for the 

DRT4 monitor. Derivatives documented in this study 

were performed with a DPIT probe (diameter 8 mm, 

length 7 mm). 

Mu'tidirectional transcrania' Doppler-sonography 

(TCD) 

In this study, Doppler sonographic signals were 

simultaneously registered in the left anterior cerebral 

artery (ACA) and the right posterior cerebral artery (PCA) 

with a Multi-Dop T System (DWL Elektronische Systeme 

GmbH, Sipplingen, Germany). Two 2-MHz probes were 

applied with a multi-functional construction2,11. Seg- 

Neurological Research, 2003, Volume 25,

ment A 1 of the ACA was exposed to ultrasonic waves at 

a depth of 58 to 88 mm. The flow direction in the ACA 

was opposite from the ipsilaterally applied probe. The 

PCA was exposed to ultrasonic waves between 60 and 

78 mm and the flow direction in segment Pl was 

directed towards the probe. 

Near-infrared spectroscopy (NIRS) 

The NIRS method allows the monitaring of changes in 

cerebral oxygenation through the intact skull, and is 

gaining importance in acupuncture research because of 

its non i nvasiveness2,6, 17,28=-30,34,36,37. 

One equipment für this fjeld of research is the NIRO 

300 Monitor (Hamamatsu Photonics, Japan). Measurement 

values such as changes in oxyhemoglobin 

(AO2Hb) and desoxyhemoglobin (AHHb) are determined 

by Lambert-Beer's Principle3,37. With this system, 

changes in parameters can be measured absolutely 

(Jlmolar), however, the niveau (absolute concentration) 

at which these changes (in positive ar negative direction) 

occur cannot be determined. As lang as no change in 

concentration takes place, the measurement value is 

zero. Using a silicone holder, the application of the 

probe (emitter and near-infrared detectors) on the head 

is simple. Data reproduction of AO2Hb and AHHb was 

düne with a color LCD-display and color printer. 

2 Neurological Research, 2003, Volume 25, 

Volunteers and procedure 

Twenty-two healthy volunteers, mean age 24.4 :f: 2.6 

years (21-29 years) were examined with LDF and 

temperature monitoring. At the time of measurement, 

the volunteers were informed about the procedure, were 

not under influence of medication and gave their written 

consent. In addition, thermography imaging was performed 

on two volunteers. This study was approved by 

the Ethics Committee of the University of Graz, Austria 

(Laserneedle@-Stimulation; 13-048 ex 02/03). 

Continuous measurement of microcirculation parameters 

and temperature at the right hand were initiated, 

after a resting period of 10 min. When the 'steady-state' 

condition was reached, acupuncture point Hegu (Li.4) 

on the right hand was stimulated with a laserneedle@. 

After cleaning the skin with alcohol, the laserneedle@ 

was fixed at the acupuncture point with special adhesive 

tape. A semi-conductor with an emitting wavelength of 

680 nm was used as light source. Laser intensity was 

rv60 mW. 

The LDF-tem~erature probe was applied 1 cm from 

the laserneedle .This distance was selected in the 

infrared range of 1 cm, based on the given geometric 

dimensions of the probe holder and the supposed optic 

penetration depth. In addition, temperature at the 

measurement point as weil as room temperature were 

determined for comparison.

a 

+-+ 

2 min 

b c 

miR 

10 min 

20 min 

lasemeedle@-stimulation activ 

Effects of laserneedle@-stimulation: Gerhard Litscher 

d 

'..e 

I min 

e 

-.-+ 2 min 

Figure 2: Measurement profile and measuring times (a-e) before, during and after laserneedle\n1-acupuncture 

Figure 2a-e shows the different measurement times 

before, during and after laserneedle@ stimulation. 

In a further study series, flow profiles from the ACA 

and P CA, before, during and after acupuncture were 

registered continuously in the same 22 adult volunteers3. 

Two laserpuncture schemes were tested during two 

different measurements on each test person. The first 

scheme (Yingxiang, Hegu and Pianli, stimulated 

bilaterally) was used to influence the olfactory system 

according to the expectations of traditional Chinese 

medicine, the second scheme (Guangming, Taichong 

and Zhiyin, bilateral stimulation of all three points) to 

activate the optic system3, has already been documented 

in preliminary studies 1-3. 


LDF-data were analysed with 'Friedman repeated 

measures ANOV A on ranks' using SigmaStat Oandel 

Scientific Corp., Erkrath, Germany). The Tukey test was 

used for post hoc analysis. Mean values before (a), 

during (b-d) and after (e) laserneedle@ acupuncture are 

shown graphically. Statistical significance was estab- 

lished at p< 0.05. 

Mean blood flow velocity (vm) in the left ACA as weil 

as Vm in the PCA were referred to as evaluative 

parameters for TCD-measurements. This data was 

analysed with 'one-way repeated measure ANOVA'. 

RESULTS 

Figure 3 shows the summary of results from the three 

parameters flux, as weil as hand and room temperature 

at different measurement times. 

Note the significant changes in flux (p= 0.005) as weil 

as the increase in temperature at the measuring point 

(p= 0.02). Even 2 min after discontinuing laser stimulation 

(measurement time e), the flux was no longer 

significant, however markedly higher compared to the 

initial value. 

Temperature at the stimulation point (distance "",1 cm) 

showed an obvious increase, which reached its maximum 

at measurement time d. The nearly constant room 

temperature was registered simultaneously as a com- 

parative parameter. 

Figure 4 shows a typical example of Vm jncrease in the 

ACA during laserneedle@-stjmulation. 

Figure 5 (middle and lower sectjons) summarizes the 

TCD-results from all 22 volunteers and both laserpuncture 

schemes. When usjng laserpuncture scheme 

A, Vm increases significantly (p < 0.001) during stimulatjon 

(b-d) in the ACA and at the end of the test (e) is stjll 

higher than before laserneedle@-acupuncture (a). At the 

same time, no significant changes jn Vm in the PCA 

occurred. However, durjng optjc stjmulation of the 

acupuncture points jn scheme B, a signjfjcant 

(p< 0.002) increase in Vm in the PCA without signjficant 

simultaneous changes jn the ACA, took place. 

A frontal derivation of near-jnfrared spectroscopic 

parameters js shown jn Figure 6. 

DISCUSSION 

Laser Doppler technology js a suitable method for 

determinjng concentratjon and velocjty of moving blood 

cells in surface vessels. Penetratjon depth is Ijmjted to 

about 1 mm. Laser Ijght js usually transferred to the 

derivation point via optical fibres. Due to the Doppler 

effect, a frequency change in scattered Ijght occurs, 

whjch enables determination of e.g. flow velocjty. 

Currently, the possible advantages of this method jn 

acupuncture research are being investjgated2.3,21-23,26. 

Based on the results in this study, we see that the 

energy dose emjtted from a laserneedle@ jn 20 min at a 

distance of 1 cm, was able to warm local skin and 

subcutaneous tissues about 0.7°C (p= 0.02). Thus, 

stimulation wjth laserneedles@ is not only optical, but 

also thermic. 

It is interestjng that flux is signjficantly ~= 0.005) 

increased, 2 mjn after begjnnjng laserneedle stimulation. 

Laserneedle@ acupuncture leads to an jmprovement 

in local, peripheral microcirculation at the area 

where stjmulus applicatjon was done. This fact could be 

useful in case of dermatologic indications (p=0.005). 

The additional use of TCD enables continuous, 

noninvasjve monitorjng of blood flow in different 

cerebral vessels. The results presented in this study 

document a further important factor for characterising 

cerebral effects of laserneedle@ acupuncture. laserneedle@ 

stimulatjon of particular acupuncture points 

Neurological Research, 2003, Volume 2

Effects of laserneedle@-stimulation: Gerhard Litscher 

c.e Bi;- 

-T~~"S.- 

~;~,L;J 

I" ..,5 

- 07 ~ " 

", 

;. 

~~~.?~.~ 

:~ 

-. 

B '! B ,; ' b c"" 

, " " . 

-0 "": c 9 . : 

" """ 5 min 

+ 

.i4,~4.J 

SJ.. 28),', f, 11..02..03 

Figure 6: Near infrared spectroscopy parameters from a 28-year-old healthy male volunteer during laserneedlelß)stimulation 

with scheme A in Figure 5. Observe the relative increase ( + 1.5 p.mol) in oxyhemoglobin (O2Hb) and the 

simultaneous decrease (-0.9 p.mol) in desoxyhemoglobin (HHb) correlated to the initial value 

showed specific changes in blood flow velocity and 

regional cerebral oxygenation in our 22 healthy 

volunteers. 

Laserneedle@ stimulation of points Yingxiang, Hegu 

and Pianli, which are connected to the olfactory system 

according to traditional Chinese medicine, lead to a 

significant change in blood flow velocity in the ACA. 

The ACA supplies major regions of the frontal and 

median area of the brain, including the olfactory cortex. 

At the same time, blood flow in the PCA remained 

nearly unchanged. In comparison, laserneedle@ stimulation 

of points Guangming, Taichong and Zhiyin, 

which are supposed to be connected to the optic 

system, showed a significant increase in blood flow 

velocity in the PCA, whereas flow in the ACA only 

changed irrelevantly3. 

Modern biomedical techniques such as multidirectional 

transcranial Doppler sonography, near-infrared 

spectroscopy or laser Doppler flowmetry combined with 

thermography are able to quantify the effects of 

laserneedle@ acupuncture objectively. 

ACKNOWlEDGEMENTS 

The author thanks the members of the Department of Biomedical 

Engineering and Research in Anesthesia and Critical Care, Lu Wang, 

MD, for performing laserneedleal> acupuncture, Evamaria Huber for her 

support in data recording and Mag. Petra Petz for her help in data 

analysis. We also thank PD Dr Detief Schikora (University Paderborn, 

Department of Physics-OptoelectronicsJ for his valuable help a:ld 

technical support in connection with the laserneedleal>-system. These 

investigations were partially supported by LASCO Int. Medical 

Marketing AG, Basel, Switzerland. 

Neuroloj!ical Research, 2003, Volume 25 

-"ii;; ;; " 

REFERENCES 

1 Litscher G, Cho ZH, eds. Computer-Control'ed AcupuncturelK> 

(CCA), Lengerich: Pabst Science Publishers, 2000 

2 Litscher G. High-Tech Akupunktu~, Lengerich: Pabst Science 

Publishers, 2001 

3 Litscher G, Schikora D (Hrsg.). LASERneedlelK>-Akupunktur. Wissenschaft 

und Praxis, Lengerich: Pabst Science Publishers, 2003, in 

press 

4 Litscher G, Schwarz G, Sandner-Kiesling A, Hadolt I. Transkranielle 

Doppler-Sonographie -Robotergesteuerte Sonden zur Quantifizierung 

des Einflusses der Akupunktur. Biomed Technik 1997; 42: 

116-122 

5 Litscher G, Schwarz G, Sandner-Kiesling A, Hadolt I, Eger E, 

Lenhard H. Transcranial near infrared spectroscopy and transcranial 

Doppler sonography during acupuncture. In: Litscher G, 

Schwarz G, eds. Transcranial Cerebral Oximetry, Lengerich: Pabst 

Science Publishers, 1997: pp. 184-198 

6 Litscher G, Schwarz G, Sandner-Kiesling A, Hadolt I, Eger E. Effects 

of acupuncture on the oxygenation of cerebral tissue. Neurol Res 

1998; 20: 28-32 

7 Litscher G, Schwarz G, Sandner-Kiesling A, Hadolt I. Robotic 

transcranial Doppler sonography probes and acupuncture. Int J 

Neurosci 1998; 95: 1-15 

8 Litscher G, Schwarz G, Sandner-Kiesling A. Computerkontrollierte 

AkupunkturlK> .Akupunktur Theorie und Praxis 1998; 26: 133-142 

9 Litscher G, Yang NH, Wang L. Ultrasound-controlled acupuncture. 

Internet J Anesthesiology 1998; 2/4: http://www.ispub.com/ 

jou rnals/IJA/V 012 N4/acu .htm 

10 Litscher G, Yang NH, Wang L, Schwarz G. Quantitative Separation 

spezifischer Akupunktureffekte von Gehim und Auge mittels 

bidirektionaler Ultraschallmeßkonstruktion. AKU 1998i 26: 

212-217 

11 Litscher G, Yang NH, Schwarz G, Wang L. Computerkontrollierte 

AkupunkturlB>: Eine neue Konstruktion zur simultanen und kontinuierlichen 

Erfassung der Blutflußgeschwindigkeit in der A. 

supratrochlearis und A. cerebri media. Biomed Technik 1999; 

44: 58-63 

12 Litscher G, Wang L, Yang NH, Schwarz G. Ultrasound-monitored 

effects of acupuncture on brain and eye. Neurol Res 1999; 21 : 

373-377

13 Litscher G, Wang L. Visualisierung von peripheren Durchblutungsänderungen 

während der Akupunktur mittels Thermographic. 

Biomed Technik 1999; 44: 129-134 

14 Litscher G, Wang L, Yang NH, Schwarz G. Computer-controlled 

acupuncture(ß). Quantification and separation of specific effects. 

Neurol Res 1999; 21: 530-534 

15 Litscher G, Wang L, Wiesner-Zechmeister M. Specific effects of 

laserpuncture on the cerebral circulation. Lasers Med Sci 2000; 15: 

57-62 

16 Litscher G, Wang L, Lehmann R. Computerkontrollierte Akupunktur(ß) 

-Einfluß der Körperakupunktur auf die Blutflußgeschwindigkeit 

von intra- und extrakraniellen Arterian. Europ Z Akup 

Der Akupunkturarzt/Aurikulotherapeut 2000; 1: 4-19 

17 Litscher G. Wang L. Zerebrale Nahinfrarot-Spektroskopie und 

Akupunktur- Ergebnisse einer Pilotstudie. Biomed Technik 2000; 

45: 215-218 

18 Litscher G, Wang L, Niederwieser G. Computer-aided 

neuromonitoring techniques to objectify the effects of 

acupuncture in the treatment of migraine. Intemet J Neuro- 

monitoring 2000; 1/1: http://www.ispub.com/joumals/IJNM/ 

Voll N1/compaide.html 

19 Litscher G, Wang L, Yang N, Hanselmayer R. Transorbital Doppler 

assessment of blood flow velocity during stimulation of acupoints 

Yuyao and Zanzhu. Internet J Neuromonitoring 2000; 1/1 : http:// 

www.ispub.com/journals/IJNM/VoI1 N1/transorbit.html 

20 Litscher G, Wenzel G, Niederwieser G, Schwarz G. Effects of Qi 

Gong on brain function. Neurol Res 2001; 23: 501-505 

21 Litscher G, Wang L, Huber E, Nilsson G. Laser Doppler Imaging - 

Objektivierung und Quantifizierung primärer peripherer Mikrozirkulationsänderungen 

durch Akupunktur. Europ Z Akup Der 

Akupunkturarzt/Aurikulotherapeut 2001; 3: 7-17 

22 Litscher G, Wang L, Nilsson G. Laser Doppler Imaging und 

Kryoglobulinämie. Biomed Technik 2001; 46: 154-157 

23 Sandner-Kiesling A, Litscher G, Voit-Augustin H, James RL, 

Schwarz G. Laser Doppler flowmetry in combined needle 

acupuncture and moxibustion: A pilot study in healthy adults. 

Lasers Med Sci 2001; 16: 184-191 

24 Litscher G, Wang L, Huber E. High-frequency brain oscillations 

(600 Hz) in human somatosensory evoked potentials -quantification 

of effects after needling and stimulating large intestine 4 using 

new EEG-electrodes. Internet J Neuromonitoring 2001; 1: http:// 

www.ispub.com/journals/IJNM/VoI1 N2/sep.html 

25 Litscher G. Visual evoked potentials and acupuncture. Intemet J 

Neuromonitoring 2001; 2: http://www.ispub.com/journals/ijnrn/ 

voI2n2/visual.html 

Effects of laserneedlelß)-stimulation: Gerhard Litschel 

26 Litscher G, Wang L, Huber E, Nilsson G. Changed skin blood 

perfusion in the fingertip following acupuncture needle introduction 

as evaluated by laser Doppler imaging. Lasers Med Sci 2002; 

17: 19-25 

27 Litscher G. Computer-based objectivation of traditional Chinese-, 

ear-, and Korean hand acupuncture: Needle-induced changes of 

regional cerebra! blood flow velocity. Neurol Res 2002; 24: 

377-380 

28 Litscher G, Wang L. Computergestützte Objektivierung der 

Grenzen der Akupunktur. AKU Akupunktur Theorie und Praxis 

2002; 1: 13-19 

29 Litscher G, Wang L, Huber E. Veränderungen zerebraler nahinfrarot-spektroskopischer 

Parameter während manueller Akupunkturnadelstimulation. 

Biorned Technik 2002; 47: 76-79 

30 Litscher G. Quantifizierung zerebraler Effekte der Ohrakupunktur 

durch innovative computergestützte Verfahren -Vergleich mit der 

Traditionellen Chinesischen Körperakupunktur und der Koreanischen 

Handakupunktur. Europ Z Akup Der Akupunkturarzt/ 

Aurikulotherapeut 2002; 4: 4-13 

31 Litscher G, Schikora D. Cerebral effects of noninvasive laserneedles 

measured by transorbital and transtemporal Doppler 

sonography. Lasers Med Sci 2002; 17: 289-295 

32 Litscher G, Schikora D. Neue Konzepte in der Experimentellen 

Akupunkturforschunl! -Computerkontrollierte Laserpunktur (C CL) 

mit der Laserneedle Technik. Der Akupunkturarzt/Aurikulotherapeut 

2002; 28: 18-28 

33 Litscher G, 5chikora D. Effects of new noninvasive !aserneedles on 

brain function. EMBEC 2002. 2nd European Medical & Biological 

Engineering Conference, Vienna, Decernber 2002. Proc Int Fed 

Med Biol Engng 2002; 996-997 

34 Litscher G, Schikora D. Near-infrared spectroscopy for 

objectifying cerebral effects of needle and laserneedle 

acupuncture. Internet J Neurornonitoring 2003; 3: http:// 

www .ispub.com/ostia/i ndex.pholxml Fi lePath=journal s/i j nm/ 

voI3nl/nirs.xml 

35 Litscher G. High-Tech Acupuncture(ß) -A scientific interdisciplinary 

website. Internet J Alternative Medicine 2002; 1 : 

httpj /www .i spub.com/osti a/i ndex.phplxm I F i lePath=jou rna Is/i jam/ 

voll nl/acuweb.xml 

36 Litscher G, Schikora D. Nahinfrarot-spektroskopische Untersuchungen 

zur Nadel- und Lasernadelakupunktur. AKU 2002; 

30: 136-141 

37 Litscher G, Schikora D. Near-infrared spectroscopy for objectifying 

cerebral effects of needle and laserneedle acupuncture. Spectro- 

SCOpy 2002; 16: 335-342 

Neurological Research, 2003, Volume 25,

Effects of laserneedle acupuncture on olfactory sensitivity of healthy human subjects: a 

placebo-controlled, double-blinded, randomized trial. 

Anzinger A, Albrecht J, Kopietz R, Kleemann AM, Schöpf V, Demmel M, Schreder 

T, Eichhorn I, Wiesmann M. 

Department of Neuroradiology, Ludwig-Maximilians-University Munich, Germany. 

The aims of the present study were to investigate the influence of laserneedle 

acupuncture on olfactory sensitivity and to examine whether the attitude towards 

laserneedle acupuncture affects the outcome. Olfaction was tested repeatedly on two 

days using the olfactory detection threshold subtest of the Sniffin' Sticks test battery in 

sixty-four healthy subjects of which 32 showed a positive attitude towards the effects of 

laserneedle acupuncture and 32 were sceptic about its effects. Testing was accomplished 

three times on day one (T1 = 0 min, T2 = 35 min, T3 = 105 min) without laserneedle 

acupuncture and on day two (T1* = 0 min, T2* = 35 min, T3* = 105 min) when the 

subjects were randomized in a non-stimulation (placebo) and a stimulation (laserneedle 

acupuncture) group. Stimulation or non-stimulation was conducted in a double-blinded 

design. Following laserneedle acupuncture a significant decrease in olfactory detection 

thresholds was observed at both, T2* and T3*, whereas no significant changes were 

found in the baseline or placebo group. Effects of laserneedle acupuncture on the 

olfactory detection threshold did not differ between sceptic and non-sceptic subjects. In 

conclusion, laserneedle acupuncture is an effective method to improve olfactory 

sensitivity after one session of stimulation for at least one hour, independently of the 

attitude of subjects towards the stimulation method. 

PMID: 19593972 [PubMed - indexed for MEDLINE 

Patients' sensation during and after laserneedle versus metal needle treatment. 

van Amerongen KS, Kuhn A, Mueller M. 

Department of Obstetrics and Gynaecology, Inselspital, Bern University Hospital, and University of 

Bern, Switzerland. k.staehler@spin.ch 

OBJECTIVES: Aim of the study was to evaluate the patients' sensations during and after 

laserneedle versus metal needle acupuncture. STUDY DESIGN: The prospective study 

was performed at the gynaecological outpatient department of a University Teaching 

Hospital of Bern, Switzerland. Thirty female patients per group were included in the 

study and randomized into laserneedle or metal needle group. All women visited the 

acupuncture out patient department because of gynaecological disorders. Age of the 

patients in the metal needle group was 38 years in median (range 18-73 years); mean 

age was 41+/-13.3. Age in the laserneedle group was 36 years in median (range 16-60 

years) and mean age was 39.1+/-12.2. Interventions were laserneedle acupuncture and 

metal needle acupuncture. Patients answered a questionnaire before, after the first 

treatment and prior to the second treatment. The questionnaires asked about the 

patients' knowledge of the various acupuncture methods and their health condition 

before treatment, their perception of pain, warmth, tiredness and relaxation during or

after application of the needles or during or after the treatment. Statistics were 

performed by Graph Pad InStat 3 for windows. RESULTS: The common metal needle 

technique was well known by the patients in comparison to the laserneedle method 

(p

Cerebral and peripheral effects of laser needle-stimulation. 

Litscher G. 

Department of Biomedical Engineering and Research in Anesthesia and Critical Care, University of 

Graz, Auenbruggerplatz 29, A-8036 Graz, Austria. gerhard.litscher@uni-graz.at 

This study comprises scientific-theoretic fundamental investigations of laserneedle 

technology, a new and painless method of acupuncture stimulation. Laserneedles are not 

inserted in the skin, but are merely placed on the surface of the acupuncture point. The 

study documents the significant changes in peripheral microcirculation (p = 0.005) and 

surface temperature of the skin (p = 0.02) induced by laser, in 22 healthy volunteers 

(mean age 24.4 +/- 2.6 years). In addition, a randomised cross-over study to 

characterise the specific changes in cerebral blood flow velocity with laserneedle 

acupuncture (p < 0.001) is presented. These results provide important information for 

characterising the effects of laserneedle acupuncture. 

PMID: 14579790 [PubMed - indexed for MEDLINE]

EFFECTS OF NEW NONINVASIVE LASERNEEDLES 

ON BRAIN FUNCTION 


* Department of Biomedical Engineering and Research in Anesthesia and Critical Care, 



Abstract: This paper describes the first double-blind 

study in acupuncture research in 17 healthy volunteers 

using laserneedle acupuncture. Stimulation of 

vision related acupoints resulted in marked changes 

of mean blood flow velocity in the posterior cerebral 

artery measured by multidirectional transcranial 

Doppler sonography. Further studies using different 

laser stimulus intensities and wavelengths are in 

progress. 

Keywords: laser, laserneedle, acupuncture, brain 

function, blood flow velocity 

Introduction 

A new noninvasive laserneedle system has been developed 

and used for the first time in acupuncture research 

[1,2]. This new optical stimulation technique has 

the advantage that the stimulation cannot be felt by the 

patient. The operator may also be unaware of whether 

the laserneedle system is active and therefore for the 

first time true double blind studies in acupuncture research 

can be performed. 

Materials and Methods 

The laser radiation is coupled into eight optical fibres 

and the laserneedles are arranged at the distal ends 

of the optical fibres. Due to the direct contact of the 

laserneedles and the skin, no loss of intensity occurs and 

the laser power, which affects the acupoints, can be 

exactly determined [1,2]. 

Simultaneous and continuous transtemporal Doppler 

sonographic examinations of the posterior cerebral artery 

(PCA) and the middle cerebral artery (MCA) were 

performed to objectify alterations of cerebral blood flow 

velocity. Seventeen healthy volunteers with a mean age 

of 25.1 + 4.1 years (⎺x + SD) were examined. Eight 

vision related distal acupoints (Hegu, Zusanli, Kunlun, 

Zhiyin) on both sides and 8 placebo points were tested 

using two schemes, each in one session in a randomized 

double-blind cross-over study design. The data before 

(a), during (b - d), and after (e) laserneedle acupuncture 

(Fig.1) were tested with Kruskal-Wallis one way 

ANOVA on ranks (SigmaStat, Jandel Scientific Corp., 

Erkrath, Germany). 

Fig. 1: Measurement profile. 

Results 

The results of the alterations of mean blood flow velocities 

in the PCA and MCA before (a), during (b - d), 

and after (e) laserneedle and placebo acupuncture are 

summarized in Table 1. 

Tab. 1: Changes in mean blood flow velocity (vm; 

⎺x + SE) in 17 healthy volunteers during laserneedle 

(A) and placebo (B) acupuncture. Note the 

increase of vm at the conditions b - d (* n.s.) during 

A. 

v m (cm/s) A: PCA B: PCA A: MCA B: MCA 

a 42.2 ± 2.5 42.9 ± 2.6 48.0 ± 3.1 47.5 ± 3.2 

b 44.7 ± 2.7 * 41.6 ± 2.7 48.0 ± 3.2 45.9 ± 3.1 

c 43.9 ± 2.6 41.6 ± 2.7 47.6 ± 3.2 45.7 ± 3.1 

d 44.1 ± 2.6 41.9 ± 2.4 48.6 ± 3.1 45.9 ± 3.0 

e 42.3 ± 2.4 42.1 ± 2.8 46.8 ± 3.2 46.2 ± 3.1 

Discussion 

Recent scientific and technological progress has 

truly revolutionized acupuncture. The usage of advanced 

exploratory tools, such as laser Doppler flowmetry, 

laser Doppler imaging, ultrasound or magnetic 

resonance imaging, provides revealing insights and 

attempt to shine scientific light upon the most spectacular 

of the eastern medical procedures [3-9]. 

Similar like in animal studies we have found recently 

that the brain is the key to acupuncture’s and 

laserpuncture’s effects. New experimental constructions 

to measure ultrasound, light and bioelectrical processes 

can reproducibly demonstrate effects of stimulation of 

acupoints in the brain [1,3-9]. 

Streitberger and Kleinhenz [10] have reported that 

the stimulus strength at the acupuncture points are of

decisive importance for the therapeutic efficiency of 

acupuncture treatments. Using placebo-needles in 

comparison with metal needles, it was found that the 

efficiency of acupuncture treatments decreases 

significantly, if placebo needles were used. 

Our studies show that the new high optical 

stimulation with laserneedles can elicit reproducible 

cerebral effects which are in the same order (half 

dimension) with respect to the maximum amplitude of 

the mean blood flow velocity as compared to needle 

acupuncture [1]. 

Conclusions 

The new laserneedle system is able to induce specific, 

marked alterations in cerebral blood flow velocity 

of the PCA after stimulation of vision-related acupoints 

on the foot and hand. At the same time blood flow velocity 

in the MCA did show minor changes. Further 

studies using different laser stimulus intensities and 

wavelengths are in progress. 


We are especially indebted to Dr. Lu Wang, 

Evamaria Huber and Mag. Petra Petz (all Department of 

Biomedical Engineering and Research in Anesthesia 

and Critical Care, University of Graz, Austria) for their 

support to this study. We thank Petra Thöne, Tanja 

Prohaska, Marianne Hubbert and Jörg Reitemeyer from 

Laserneedle ® Systems GmbH (Germany) for technical 

support. 

The present report is a pilot study to the presumtive 

FWF project P16020. 

REFERENCES 

[1] G. Litscher and D. Schikora, “Cerebral vascular 

effects of non invasive laserneedles measured by 

transorbital and transtemporal Doppler sonography”, 

Lasers Med. Sci., vol. 17, 2002, in press. 

[2] D. Schikora, European Patent Nr. PCT/EP 

01/08504. 

[3] Litscher G and Z.H. Cho, Eds., “Computer- 

Controlled Acupuncture ® ”, Lengerich Berlin Rom 

Riga Wien Zagreb: Pabst Science Publishers, 

2000. 

[4] G Litscher, “Computer-based quantification of 

traditional Chinese-, ear- and Korean hand acupuncture: 

Needle-induced changes of regional 

cerebral blood flow velocity”, Neurol. Res., vol 24, 

2002, in press. 

[5] G. Litscher, L. Wang and M. Wiesner- 

Zechmeister, “Specific effects of laserpuncture on 

the cerebral circulation”, Lasers Med. Sci., vol 15, 

pp 57-62, 2000. 

[6] G. Litscher, “High-Tech Akupunktur ® ”, Lengerich 

Berlin Rom Riga Wien Zagreb: Pabst Science Publishers, 

2001. 

[7] Z.H. Cho, E.K. Wong and J. Fallon, Eds., “Neuro- 

Acupuncture I. Neuroscience Basics”, Los Angeles: 

Q-Puncture Inc, 2001. 


Schwarz, “Computer-controlled acupuncture. 

Quantification and separation of specific effects”, 

Neurol. Res., vol. 21(6), pp 530-534, 1999. 


Schwarz, “Ultrasound-monitored effects of acupuncture 

on brain and eye”, Neurol. Res., vol 

21(4), pp 373-377, 1999. 

[10] K. Streitberger and J. Kleinhenz, “Introducing a 

placebo needle into acupuncture research, Lancet, 

vol. 352, pp 364-365, 1998. 

Information 

gerhard.litscher@uni-graz.at 

www.litscher.info

Spectroscopy 16 (2002) 335-342 

lOS Press 

Gerhard Litscher a,* and DetIef Schikora b 

Reprinted from 

An International Journal 

a Department of Biomedical Engineering and Research in Anesthesia and Critical Care, University of 

Graz, Auenbruggerplatz 29, A-8036 Graz, Austria 

b Department of Physics and Optoelectronics, University of Paderborn, D-33095 Paderborn, Germany 

lOS Press 

Amsterdam, Washington DC, Tokyo

SPECTRQSCOPY: An International Journal 

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Sciences 

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Tokushima 770. Japan 

Tel.: +81 886229611 

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E-mail: asakawatlph.bunri-u.ac.jp 

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DBCM- Centre d'Etudes de Saclay 

Gif.sur- Yvette, Fmnce 

Atta-ur-Rahman 

Universily of Kamchi, Pakistan 

J.M.R. Belanger 

Environment Canada, Ottawa, ON 

Canada 

J.H. Bowie 

University of Adelaide 

SA, Australia 

H. Budzlklewicz 

Universität Köln, Germany 

P. Cozzone 

CRMBM, Marsei"e, France 

E. Dlaz Torres 

Univ. Aut6noma de Mexico, Mexico 

J. Elguero 

Inst. de Quimica Medica 

Madrid, Spain 

P. Joseph-Nathan 

Centro de Investigaci6n y Estudios 

Avanzados delIPN, Mexico 

M. Kainosho 

Tokyo Metropolitan University 

Japan 

s. Kaplan 

Xerox Corp. Webster Research 

Webster, N~ USA 

A.M. Lawson 

Clinjcal Mass Spectrometry 

Harrow Middlesex, UK 

G. Lhoest 

UCL. Ecole de Pharmacie, Brussels 

Belgium 

H.H. Mantsch 

Natl. Research Council Canada 

Winnipeg, MB, Canada 

A.J. Marsaioli 

Universidade Estadual de Campinas 

SP; Brazil 

A. Nikiforov 

Universität Wien, Austria 

J.-C. Prome 

Centre de Biochimie, Toulouse, France 

J.D. Roberts 

California Institute of Technology 

Pasadena, CA, USA 

J. Roboz 

Mount Sinai Medical Center, New York 

USA 

Co Sandcrfy 

University cf Mcntreal, Canada 

J.-C. Tabel 

Univ. P. et M. Curie, Paris, France 

M. Tori 

Tokushima Bunri University, Japan 

A. Trka 

Czech Academy of Sciences. Prague 

Czech Republic 

B.J. van der Veken 

Rijksuniv. Ctr. Antwerpen. Antwerp 

Belgium 

L. Vereczkey 

Institute tor Drug Research Berlini 

Budapest, Hungary 

F. van de Voort 

McGi11 University, Bellevue, ac, Canada 

M. Witanowski 

Polish Academy of Sciences, Warszaw 

Poland 

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Spectroscopy 16 (2002) 335-342 

lOS Press 

Gerhard Litscher a.* and Detlef Schikora b 

a Department of Biomedical Engineering and Research in Anesthesia and Critical Care, Universit.v (~f 

Graz, Auenbruggerplatz 29, A-8036 Graz, Austri(/ 

b Department of Physics and Optoelectronics, University of Paderborn, D-33095 Paderborn, Germ(/ny 

Abstract. Near infrared spectroscopy (NIRS) has been successfully used in this study to objectify cerebral alterations in oxYhemoglobin 

and desoxyhemoglobin, due to manual needle acupuncture and laserneedle acupuncture. in 88 healthy volunteers 

mean age 25.7 ::I: 4.0 (x ::I: SD) yeal.s (19-38 years). Results from Traditional Chinese Acupuncture, Korean and Chinese hand 

acupuncture, ear acupuncture, combinations of the different acupuncture methods and placebo needling are prcsented. NIRS 

seems to bc able to shed somc light upon the functioning of the ditIcrcnt acupuncturc methods. 

Keywords; Near-infrarcd spectl.oscopy, necdle acupuncturc, lasernecdlc@ acupuncture, High-Tech Acupul1cture

336 G. Lit.\'cher l/lld f). Schikur rvellr-itifrared spectrO.\'L'opy lmd UL'UpU/Ic(1 

Fig. 1. Test person during laserneedle slimulation and simultaneous registration of NIRS paramereT~. Righr botrom single active 

laserneedle and application device. 

The NIRO 300 Monitor (Hamamatsu Photonics, Japan) is a new instrument in this field 01: research. 

Parameters such as changes in oxyhemoglobin (1102Hb) and desoxyhemoglobin (I1HHb) are determined 

by Lambert-Beer's principle [4]. The system can measure the absolute value (/tmol) of changes ill parameters, 

but not the level (absolute concentration) at which these changes occur (in positive or Ilegative 

direction). The measurement value is zero, as long as no change ill concentration occurs. Placement of the 

sensor (emitter and near-int'rared detectors) on the head witll a silicone holder is easy and rcproducibll' 

Data output of 1102Hb and L\HHb were presented on a color LCD-display and color printer. 

In addition to the spectroscopic method, non-invasive, standard monitoring parameters such as blood 

pressure (Cardiocap@ CC-]04, Datex Medical Electronics, Hoevelaken, The Netherlands) were determined 

before, during and after dift.erent manners of stimulation. 

2.2. Laserneedle@ ~1imulation 

The Lasemeedle@ -technique represents a new, non-invasive method für üptic stimulation üf acupuncture 

points and was first dcscribed in literature in 2002 [9,10]. Laserneedle@ (Schikora D.: EurOpeUlJ 

Patent Nr. PCT/EP 01/08504) acupuncture allüws the simultaneous stimulation of individual a

E2 

G. Litscher und D. Schikoru / Neu r.infrured spectroscopy und ucupuncture 

Fig. 2. Acupuncture schemes used in this study. 

committee of the University of Graz (11-017) and all test persons gave their written consent. None of 

the volunteers had visual, neurologjcal or psychological deficits or were under the influence of central 

nervous system effective drugs. 

A maxjmum of 7 acupuncture points jn difterent measurement series (needle acupuncture and 

Laserneedle@ acupuncture) were investigated. The acupuncture scheme included two acupuncture points 

from TCM: Zanzhu (localization: at the medjal end of the eyebrow, perpendicular to and above the inner 

corner of the eye, at the foramina of the supraorbjtal nerve; need]ing: perpendjcu]ar 0.5-0.8 cun) and 

Yuyao (localization: at the middle of the eyebrow, perpendicular .and above the pupil; need]ing: inclined 

0.3-0.5 cun). In additjon, 2 ear acupuncture points (eye and liver: localization see Fig. 2; need]ing: in- 

clined 0.3 cun) and 2 eye acupuncture points from Korean hand acupuncture (E2: loca]ization see Fig. 2; 

needling: perpendjcu]ar 0.1-0.2 cun) and one acupuncture point from Chinese hand acupuncture (Yan 

Dian: localization: on the ulnar side of the mjddle phalanx of the thumb; needling: inclined 0.2 cun) were 

included in the study [9-11] . 

In addjtion, possible responses in NIRS parameters after needling and stjmulating of a placebo point 

(localizatjon: lateral from the radjus 6 cun above the horizontal fo]d of the wrist exactly on the radial 

ledge, lateral from the pulmonary meridian) were tested. 

The different acupuncture schemes were applied alone and in combination, since preliminary stud- 

ies indicated that the selection of different combinations also result in different effects in the cerebral 

parameters to be measured (e.g., bloodflow velocity in the ophthalmic artery) [9-11] (Fig. 2). 

Acupuncture pojnts were needled wjth single-use needles after local desinfection of the skin. We used 

three different types of needles (body: 0.25 x 25 mm, Huan Qiu, Suzhou, China; ear: 0.2 x 13 mm. 

337

338 G. Lit.l'cher and D. Schikora / Near-infrared spectroscopy and acupuncture 

0 2 4 6 8 10 

a 

1 .OzHb 

~ ~ ~V.,j} /~ 

b ",,".. ~ ..WI ,... # 

10 min 

';;.:.: Illlb 

B.J., 22y, f, 2002 

Fig. 3. Left: Stimulus intensity (SI f(t» as a function of time (hypothesis). Right: Real measured cerebral responses o 

NIRS-parameters 02Hb (oxyhernoglobin) and HHb (desoxyhernoglobin) on manual, brief (20 seconds) acupuncture needl, 

stimulation (a) and lasemeedle stimulation (b) in 22-year-old fernale test person. The arrows indicate the beginning of stimula 

tion. 

European Marco Polo Comp., Albi, France; hand: 0.1 x 8 mm, Sooji-Chim, Korea). Stimulation was 

performed with simultaneous rotating, pulling and thrusting movements of medium intensity. 

In the case of lasemeedle acupuncture, the skin at the acupuncture point was cleaned with alcohol, the 

lasemeedle was positioned at the surface of the skin and then fixated with special adhesive tape. We used 

the same acupuncture schemes as in the combined measurements using needle acupuncture. 

During the experimental phase, the test persons were positioned in a relaxed manner on a lounge. 

After applying the near-infrared spectroscopic sensors in the frontal area of the skull, a 10 minute resting 

period was observed. Then, either lasemeedle stimulation was activated or the acupuncture needles were 

inserted and stimulated for 10 seconds. Thereafter, the laser was activated for 10 minutes or the needles 

were left alone. The maximum amplitude of ~O2Hb and ~HHb (phase during acupuncture) was analyzed 

during this period of time. Randornized selection of which technique should be started with, as well as 

selection of sequence of the particular type of stimu.!~tion (body, ear, hand, combination) was done. The 

resting period between each investigation was at least 30 minutes. 

2.4. Statistical analysis 

Data was analyzed with the computer program SigmaStat (Jandel Scientific Corp., Erkrath, Germany). 

Results from the phases before (= zeropoint calibration), during and 5 minutes after needle acllpllnctllrc 

or of laserneedle acupuncture are shown in the diagrams as mean values, respectively. 

3. Results 

At the left side of Fig. 3, the hypothetical functional curve of stimulus intensity dependent upon thc 

treatment time is shown. This diagram gains in importance due to the actually measured, specific cerebral

L\ ~mol 

G. Lit.l'cher and D. Schikoru / Near-itifrured spectroscopy und ucupuncture 

NIRS-t1°2Hb 

Fig. 4. Changes in Jl,mol of oxyhemoglobin (O2Hb) during needling of a placebo point, 3 hand acupuncture points, 2 ear 

acupuncture points, 2 acupuncture points from TCM, a combination of hand, ear and body acupuncture as weil as lasemeedle 

stimulation and an intensity-increased ( +30% ) lasemeedle acupuncture (from left to right) during and 5 minutes after acupul1cture. 

data in regard to changes in 02Hb and HHb shown at the right. During manual, metal needle stimulation a 

nearly exponential maximum increase in 02Hb and a exponential decrease to a higher level than initially, 

occurred, whereas the trend of 02Hb during lasemeedle NIRS r8sponse remains plateau-like. 

Figures 4 and 5 show the mean values of maximum ch{{nge in 02Hb (Fig. 4) and HHb (Fig. 5) para- 

meters during and 5 minutes after manual needle acupuncture or lasemeedle acupuncture. 

It is obvious that needling and stimulation of the placebo point does not lead to marked changes in 

cerebral NIRS parameters during and 5 minutes after acupuncture. Manual needling and lasemeedle 

stimulation leads to a marked increase in 02Hb (compare Fig. 4) and simultaneous decrease in HHb 

(compare Fig. 5) when using the combined Korean hand acupuncture (E2) and Chinese hand acupuncture 

(Yan Dian), as well as TCM-body (Zhanzu and Yuyao) acupuncture, as well as combined body, ear, 

and hand acupuncture. This effect is still present 5 minutes after removing the needles or deactivating 

lasemeedle stimulation. An almost negligible, but contrary behavior of 02Hb and HHb occurs when both 

ear points (eye and liver) are needled or stimulated with laser. 

None of the acupuncture stimuiation methods or combinations resulted in significant changes in stan- 

dard monitoring parameters (blood pressure). 

339

340 G. Litscher and D. Schikora / Near-infrared spectroscopy and acupuncture 

il .umol 

NIRS -L\HHb 

Fig. 5. Cerebral changes (generally decreases) in desüxyhemüglübin (HHb). Für further descriptiüns see Fig. 4. 

4. Discussion 

One of the main advantages of the Lasemeedle@-technique is its non-invasiveness. It is possible to 

apply the laser in such a manner, that the test person cannot feel optical stimulation of the acupuncture 

point. In addition, the acupuncturer does not need to know if the system is activated or deactivated. 

Thus, double-blind studies using this new method are possible in acupuncture research for the first time. 

This method of study was already performed by our research group [12] and included simultaneous and 

continuous monitoring of blood flow velocity in the P9,sterior cerebral artery and the middle cerebral 

artery in 17 healthy volunteers. This study showed that Lasemeedle@ stimulation of distant acupuncture 

points at hands and feet (Hegu, Zusanli, Kunlun, Zhiyin) is able to achieve marked and specific changes 

in cerebral blood flow velocity [10,12]. 

Even though laser puncture using low-Ievel-laser stimulation devices is an established method, measurable 

cerebral effects lie far below conventional needle acupuncture [13]. The results from the first 

studies [9,10,12] using the Lasemeedle@ system revealed significant changes in cerebral parameters 

(blood flow velocities), which were otherwise only achieved by manual needle acupuncture. The propor- 

tion of maximum change in blood flow velocity (needle/lasemeedle) is approximately factor 2. 

Since Chinese medicine and acupuncture are considered an integrative part of TCM based on energetic 

processes, the registration of changes in the cerebral metabolism could express energetic processes in the 

brain and obviously plays a key role in investigating the effects of acupuncture. To date, it has not been 

possible to obtain non-invasive and continuous results regarding regional cerebral oxygenation. Nearinfrared 

spectroscopy can register changes in oxygenation in the cerebral vascular region very sensitively.

G. Litscher and D. .S.chiktJra / Near-infrared spectroscopy and acupuncture 

The advantages of transcranial oximetry are its non-invasiveness, low risks and continuity, as weIl as its 

easy and time-saving application. A wide range of indications are the result for the potential use of this 

spectroscopic method [4]. 

A number of factors which can influence adequate interpretation of data must be considered. Contam- 

ination with surrounding light, mechanical irritations, intracerebral hematoma, misplacement of optodes 

or other user errors are just some possibilities which should be noted [4] . 

A number of studies which deal with NIRS conclude that NIRS can exactly determine extremely small 

changes in cerebral hemodynamics, as a response to different functional stimulations. 

In this study, 328 systematic NIRS registrations on healthy volunteers during manual and laserneedie 

acupuncture stimulation were performed for the first time. The results trom two preceding publications 

[6,7] were the reference points for this study. 

The first study regarding acupuncture and NIRS [6] indicated that the changes in the occipital region 

after acupuncture stimulation in 3 healthy volunteers, was measurable and reproducible in each of the 

test persons. In the second study [7], NIRS-changes were measurable and reproducible at the central 

region after acupuncture stimulation at the Hegu point. This study showed, that reproducible changes in 

frontally monitored NIRS parameters could be determined, after stimulation of specific eye acupuncture 

points. 

In general, changes in NIRS parameters are unspecific and we do not know if an isolated decrease in 

saturation is caused by an increase in cerebral oxygenation consumption or results from a decrease in 

cerebral blood flow. Therefore, not only the extent of oxygenation is shown, but the interaction between 

oxygenation and desoxygenation is reflected. This is possible since the measurement zone is mainly 

dominated by the venous part of the cerebral vascular bed ( "" 75% ). The arterial part ( ",,20% ) or the 

capillary (",,5%) flow region is respectively smaller [4]. 

For these reasons, we were able to determine changes, which for example, occur due to an increase 

in oxygenation. Which ruling mechanisms are present is still unclear. Increased desoxygenation by 

stimulus-induced neuronal activation, i.e., caused by changes in membrane potentials or release of neu- 

rotransmitters could be possibilities [14]. For whatever reason, acupuncture obviously inftuences the 

oxygen metabolism of the brain in healthy test persons. 

Similar to this study using ear acupuncture, a paradox contra-directional change in blood flow velocity 

(increase) and regional cerebral 02-saturation (decrease) occurred in a vascular based case of dementia, 

when an individually adapted acupuncture scheme was used [14]. The described case report showed that 

acupuncture could improve the clinical status of vascular dementia:Using NIRS and transcranial Doppler 

sonography, we were able to register the effects on cerebralblood ftow velocity and the 02-metabolism. 

In combination with clinical findings, an inverse decrease in regional cerebral 02-saturation during si- 

multaneous increase in cerebral blood flow velocity during acupuncture could be interpreted, as a sign of 

increased cerebral oxygenation. A decrease in regional cerebral 02-saturation does not necessarily indicate 

a poor condition of the 02-metabolism in the sense of reduced oxygen supply, however could also 

document the beneficial effects of regionally increased oxygenation, activated by acupuncture [ 14]. In 

a similar manner, the minor contradirectional regional changes in NIRS parameters using ear acupunc- 

ture could be interpreted, since the monitoring method conveys the balance between oxygenation and 

desoxygenation. 

Further studies are necessary to investigate the importance of these phenomena on acupuncture, since 

not only the influence in general and in detail of laser acupuncture, but also the inftuence of combined 

ear and body acupuncture, are still discussed controversially. Spectroscopic methods probably are useful 

tools for this investigations.

342 G. Lit.5cher and D. Schikora / Near-infrared spectroscopy and acupunctul'(' 


The authors thank Dr. med. Lu Wang for performing the acupuncture, Ms. Evamaria Huber for help in 

data recording and Mag. Petra Petz for her valuable support in data analysis (all Department of Biomed- 

ical Engineering and Research in Anesthesia and Critical Care Graz). 

The present report is a pilot study to the presumptive FWF project P16020. 

Rererences 

[1] G. Litscher, High-Tech Akupunktur@, Pabst Science Publishers, Lengerich, Berlin, Düsseldorf, 2001. 

[2] G. Litscher and Z.H. Cho, eds, Computer-Contralled Acupuncture@ , Pabst Science Publishers, Lengerich, Berlin, Düsseidorf, 

Riga, Scottsdale, Wien, Zagreb, 2000. 

[3] Z.H. Cho, E.K. Wong and I. Fallon, Neura-Acupuncture, Q-puncture, Los Angeles, 2001. 

[4] G. Litscher and G. Schwarz, eds, Transcranial Cerebral Oximetry, Pabst Science Publishers, Lengerich, Berlin, Düsseldorf, 

Riga, Scottsdale, Wien, Zagreb, 1997. 

[5] G. Litscher, G. Schwarz, A. Sandner-Kiesling, I. Hadolt and E. Eger, Effects of acupuncture on the oxygenation of cerebral 

tissue, Neurol. Res. 20(Sl) (1998), 28-32, 

[6] G. Litscher and L. Wang, Zerebrale Nahinfrarot-Spektroskopie und Akupunktur -Ergebnisse einer Pilotstudie, Biomed. 

Technik 45 (2000), 215-218. 

[7] G. Litscher, L. Wang and E. Huber, Veränderungen zerebraler nahinfrarot-spektroskopischer Parameter währl:nd 

manueller Akupunkturnadelstimulation, Biamed. Technik. 47 (2002),76-79. 

[8] G. Litscher and L. Wang, Computergestützte Objektivierung der Grenzen der Akupunktur, AKU Akupunktur Theorie ulld 

Pra.\"is 30(1) (2002), 13-19. 

[9] G. Litscher and D. Schikora, Cerebral effects of noninvasive laserneedles measured by transorbital alld trallstemporal 

Doppler sonography, Lasers Med. Sci. 17 (2002), in press. 

[10] G. Litscher and D. Schikora, Neue Konzepte in der experimentellen Akupunkturforschung -Computerkontrollierte Laserpunktur 

(C CL) mit der Laserneedle@ Technik, Der Akupunkturarzt/Aurikulatherapeut 3 (2002), 18-28. 

[11] Litscher G., Computer-based objectivation of traditional Chinese-, ear- and Korean hand acupuncture, needle-induced 

changes of regional cerebral blood fiow velocity, Neural. Res. 24 (2002), 377-380. 

[12] G. Litscher and D. Schikora, Effects of new noninvasive laserneedles on brain function, EMBEC 2002, 2nd EurOpelll1 

Medical & Bialagical Engineering Canference, Vienna, December 2002, in press. 

[13] G. Litscher, L. Wang and M. Wiesner-Zechmeister, Specific effects of laserpuncture on the cerl:bral circulation, La.I.er.v 

Med. Sci. 15 (2000), 57-62. 

[14] G. Litscher, G. Schwarz, L. Wang and A. Sandner-Kiesling, Akupunktur bei vaskulär bedingtem dementiellen Abbau. 

Iahrestagung der Österreichischen Alzheimer-Gesellschaft. 14. Klagenfurter Arbeitstagung für Neurologie, 24-25 Mai 

2002, K1a~enfurt, Austria.

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Internet Journal of Neuromonitoring, 2002, in press 

Near-infrared spectroscopy for objectifying cerebral effects 

of needle and laserneedle acupuncture 

Gerhard Litscher a* and Detlef Schikora b 

a Department of Biomedical Engineering and Research in Anesthesia and Critical 

Care, University of Graz, A-8036 Graz, Austria 

b Department of Physics and Optoelectronics, University of Paderborn, D-33095 

Paderborn, Germany 

Correspondence to: 

Prof. G. Litscher, Ph.D. 

Department of Biomedical Engineering and Research in Anesthesia and Critical Care Graz 

University of Graz 


A-8036 Graz 

Austria 

Tel.: +43 316 385-3907; -83907 

Fax: +43 316 385-3908 

E-mail: gerhard.litscher@uni-graz.at 

www.litscher.info 

www.litscher.at 

www.neuromonitoring.org 

Abstract 

Near infrared spectroscopy (NIRS) has been successfully used in this study to 

objectify cerebral alterations in oxyhemoglobin and desoxyhemoglobin, due to 

manual needle acupuncture and laserneedle acupuncture, in 88 healthy volunteers 

mean age 25.7 + 4.0 (⎺x + SD) years (19 - 38 years). Results from Traditional 

Chinese Acupuncture, Korean and Chinese hand acupuncture, ear acupuncture, 

combinations of the different acupuncture methods and placebo needling are

presented. NIRS seems to be able to shed some light upon the functioning of the 

different acupuncture methods. 

Key words: near-infrared spectroscopy, needle acupuncture, laserneedle ® 

acupuncture, High-Tech Acupuncture ® , brain function, Computer-Controlled 

Acupuncture ® (CCA ® ), Computer-Controlled Laserpuncture (CCL) 

Introduction 

The connection between puncturing the body with a needle and the reaction at 

another area of the body is still unclear. However, it has been proven that when 

particular acupuncture points are stimulated with needles or laser light, specific 

effects in the brain can be objectivized and quantified with modern cerebral 

monitoring methods [1-3]. 

In this present study, we objectivized the systematic changes of oxygenation in the 

brain [4] using cerebral near-infrared spectroscopy (NIRS), after stimulating 

acupuncture points according to Traditional Chinese Medicine (TCM), Korean and 

Chinese hand acupuncture, ear acupuncture and combinations of these different 

methods. 

We analyzed a total of 328 recordings after manual needle and laser needle 

stimulation from 88 healthy volunteers. 

2

Methods 

Near-infrared spectroscopy 

The NIRS method allows the evaluation of changes in cerebral oxygenation through 

the intact skull and is also gaining importance in acupuncture research because of 

its non-invasive approach [4-8]. 

The NIRO 300 Monitor (Hamamatsu Photonics, Japan) is a new instrument in this 

field of research. Parameters such as changes in oxyhemoglobin ( O 2Hb) and 

desoxyhemoglobin ( HHb) are determined by Lambert-Beer´s principle [4]. The 

system can measure the absolute value (µmol) of changes in parameters, but not 

the level (absolute concentration) at which these changes occur (in positive or 

negative direction). The measurement value is zero, as long as no change in 

concentration occurs. Placement of the sensor (emitter and near-infrared detectors) 

on the head with a silicone holder is easy and reproducible. Data output of O 2Hb 

and HHb were presented on a color LCD-Display and color printer. 

In addition to the spectroscopic method, non-invasive, standard monitoring 

parameters such as blood pressure (Cardiocap ® CC-104, Datex Medical Electronics, 

Hoevelaken, Netherlands) were determined before, during and after different 

manners of stimulation. 

Laserneedle ® stimulation 

The Laserneedle ® -technique represents a new, non-invasive method for optic 

stimulation of acupuncture points and was first described in literature in 2002 [9,10]. 

Laserneedle ® (Schikora D.: European Patent Nr. PCT/EP 01/08504) acupuncture 

allows the simultaneous stimulation of individual acupuncture point combinations 

[9,10]. Variations and combinations of acupuncture at different areas of the body, 

ear or hand, as performed particularly in this study are possible (compare Fig. 1). 

Details regarding this method can be found in preceding studies [9,10]. 

3

Fig. 1: Test person during laserneedle stimulation and simultaneous registration of 

NIRS parameters. Right bottom: single active laserneedle and application device. 

Changes in near-infrared spectroscopic parameters in the frontal region of the brain 

were continuously registered and analyzed. 

Healthy volunteers, acupuncture, measurement procedure 

In this study, a total of 328 measurements on 88 healthy volunteers (50 female, 38 

male) mean age 25.7 + 4.0 (⎺x + SD) years (19 - 38 years) were performed. The 

study protocol was approved by the ethics committee of the University of Graz (11- 

017) and all test persons gave their written consent. None of the volunteers had 

4

visual, neurological or psychological deficits or were under the influence of central 

nervous system effective drugs. 

A maximum of 7 acupuncture points in different measurement series (needle 

acupuncture and Laserneedle ® acupuncture) were investigated. The acupuncture 

scheme included two acupuncture points from TCM: Zanzhu (localization: at the 

medial end of the eyebrow, perpendicular to and above the inner corner of the eye, 

at the foramina of the supraorbital nerve; needling: perpendicular 0.5 - 0.8 cun) and 

Yuyao (localization: at the middle of the eyebrow, perpendicular and above the 

pupil; needling: inclined 0.3 - 0.5 cun). In addition, 2 ear acupuncture points (eye 

and liver: localization see Fig. 2; needling: inclined 0.3 cun) and 2 eye acupuncture 

points from Korean hand acupuncture (E2: localization see Fig. 2; needling: 

perpendicular 0.1 – 0.2 cun) and one acupuncture point from Chinese hand 

acupuncture (Yan Dian: localization: on the ulnar side of the middle phalanx of the 

thumb; needling: inclined 0.2 cun) were included in the study [9-11]. 

In addition, possible responses in NIRS parameters after needling and stimulating of 

a placebo point (localization: lateral from the radius 6 cun above the horizontal fold 

of the wrist exactly on the radial ledge, lateral from the pulmonary meridian) were 

tested. 

The different acupuncture schemes were applied alone and in combination, since 

preliminary studies indicated that the selection of different combinations also result 

in different effects in the cerebral parameters to be measured (e.g. bloodflow velocity 

in the ophthalmic artery) [9-11] (Fig. 2). 

Fig. 2: Acupuncture schemes used in this study. 

5

Acupuncture points were needled with single-use needles after local desinfection of 

the skin. We used three different types of needles (body: 0.25 x 25 mm, Huan Qiu, 

Suzhou, China; ear: 0.2 x 13 mm, European Marco Polo Comp., Albi, France; hand: 

0.1 x 8 mm, Sooji-Chim, Korea). Stimulation was performed with simultaneous 

rotating, pulling and thrusting movements of medium intensity. 

In the case of laserneedle acupuncture, the skin at the acupuncture point was 

cleaned with alcohol, the laserneedle was positioned at the surface of the skin and 

then fixated with special adhesive tape. We used the same acupuncture schemes as 

in the combined measurements using needle acupuncture. 

During the experimental phase, the test persons were positioned in a relaxed 

manner on a lounge. After applying the near-infrared spectroscopic sensors in the 

frontal area of the skull, a 10 minute resting period was observed. Then, either 

laserneedle stimulation was activated or the acupuncture needles were inserted and 

6

stimulated for 10 seconds. Thereafter, the laser was activated for 10 minutes or the 

needles were left alone. The maximum amplitude of O 2Hb and HHb (phase during 

acupuncture) was analyzed during this period of time. Randomized selection of 

which technique should be started with, as well as selection of sequence of the 

particular type of stimulation (body, ear, hand, combination) was done. The resting 

period between each investigation was at least 30 minutes. 


Data was analyzed with the computer program SigmaStat (Jandel Scientific Corp., 

Erkrath, Germany). Results from the phases before (=zeropoint calibration), during 

and 5 minutes after needle acupuncture or of laserneedle acupuncture are shown in 

the diagrams as mean values, respectively. 

Results 

At the left side of Figure 3, the hypothetical functional curve of stimulus intensity 

dependent upon the treatment time is shown. This diagram gains in importance due 

to the actually measured, specific cerebral data in regard to changes in O 2Hb and 

HHb shown at the right. During manual, metal needle stimulation a nearly 

exponential maximum increase in O 2Hb and a exponential decrease to a higher 

level than initially, occurred, whereas the trend of O 2Hb during laserneedle NIRS 

response remains plateau-like. 

Fig. 3: Left: Stimulus intensity (SI f(t)) as a function of time (hypothesis). Right: Real 

measured cerebral responses of NIRS-parameters O2Hb (oxyhemoglobin) and HHb 

(desoxyhemoglobin) on manual, brief (20 seconds) acupuncture needle stimulation 

(a) and laserneedle stimulation (b) in 22-year-old female test person. The arrows 

indicate the beginning of stimulation. 

7

Figures 4 and 5 show the mean values of maximum change in O 2Hb (Fig. 4) and 

HHb (Fig. 5) parameters during and 5 minutes after manual needle acupuncture or 

laserneedle acupuncture. 

8

Fig. 4: Changes in µmol of oxyhemoglobin (O2Hb) during needling of a placebo 

point, 3 hand acupuncture points, 2 ear acupuncture points, 2 acupuncture points 

from TCM, a combination of hand, ear and body acupuncture as well as laserneedle 

stimulation and an intensity-increased (+ 30 %) laserneedle acupuncture (from left 

to right) during and 5 minutes after acupuncture. 

9

Fig. 5: Cerebral changes (generally decreases) in desoxyhemoglobin (HHb). For 

further descriptions see Fig. 4. 

It is obvious that needling and stimulation of the placebo point does not lead to 

marked changes in cerebral NIRS parameters during and 5 minutes after 

acupuncture. Manual needling and laserneedle stimulation leads to a marked 

increase in O 2Hb (compare Fig. 4) and simultaneous decrease in HHb (compare 

Fig. 5) when using the combined Korean hand acupuncture (E2) and Chinese hand 

acupuncture (Yan Dian), as well as TCM-body (Zhanzu and Yuyao) acupuncture, as 

well as combined body, ear, and hand acupuncture. This effect is still present 5 

minutes after removing the needles or deactivating laserneedle stimulation. An 

almost negligible, but contrary behavior of O 2Hb and HHb occurs when both ear 

points (eye and liver) are needled or stimulated with laser. 

None of the acupuncture stimulation methods or combinations resulted in significant 

changes in standard monitoring parameters (blood pressure). 

10

Discussion 

One of the main advantages of the Laserneedle ® -technique is its non-invasiveness. It 

is possible to apply the laser in such a manner, that the test person cannot feel 

optical stimulation of the acupuncture point. In addition, the acupuncturer does not 

need to know if the system is activated or deactivated. Thus, double-blind studies 

using this new method are possible in acupuncture research for the first time. This 

method of study was already performed by our research group [12] and included 

simultaneous and continuous monitoring of blood flow velocity in the posterior 

cerebral artery and the middle cerebral artery in 17 healthy volunteers. This study 

showed that Laserneedle ® stimulation of distant acupuncture points at hands and 

feet (Hegu, Zusanli, Kunlun, Zhiyin) is able to achieve marked and specific changes 

in cerebral blood flow velocity [10,12]. 

Even though laser puncture using Low-Level-Laser stimulation devices is an 

established method, measurable cerebral effects lie far below conventional needle 

acupuncture [13]. The results from the first studies [9,10,12] using the Laserneedle ® 

system revealed significant changes in cerebral parameters (blood flow velocities), 

which were otherwise only achieved by manual needle acupuncture. The proportion 

of maximum change in blood flow velocity. (needle/laserneedle) is approximately 

factor 2. 

Since Chinese medicine and acupuncture are considered an integrative part of TCM 

based on energetic processes, the registration of changes in the cerebral 

metabolism could express energetic processes in the brain and obviously plays a 

key role in investigating the effects of acupuncture. To date, it has not been possible 

to obtain non-invasive and continuous results regarding regional cerebral 

oxygenation. Near-infrared spectroscopy can register changes in oxygenation in the 

cerebral vascular region very sensitively. The advantages of transcranial oximetry 

are its non-invasiveness, low risks and continuity, as well as its easy and time-saving 

application. A wide range of indications are the result for the potential use of this 

spectroscopic method [4]. 

11

A number of factors which can influence adequate interpretation of data must be 

considered. Contamination with surrounding light, mechanical irritations, 

intracerebral hematoma, misplacement of optodes or other user errors are just some 

possibilities which should be noted [4]. 

A number of studies which deal with NIRS conclude that NIRS can exactly determine 

extremely small changes in cerebral hemodynamics, as a response to different 

functional stimulations. 

In this study, 328 systematic NIRS registrations on healthy volunteers during manual 

and laserneedle acupuncture stimulation were performed for the first time. The 

results from two preceding publications [6,7] were the reference points for this 

study. 

The first study regarding acupuncture and NIRS [6] indicated that the changes in the 

occipital region after acupuncture stimulation in 3 healthy volunteers, was 

measurable and reproducible in each of the test persons. In the second study [7], 

NIRS-changes were measurable and reproducible at the central region after 

acupuncture stimulation at the Hegu point. This study showed, that reproducible 

changes in frontally monitored NIRS parameters could be determined, after 

stimulation of specific eye acupuncture points. 

In general, changes in NIRS parameters are unspecific and we do not know if an 

isolated decrease in saturation is caused by an increase in cerebral oxygenation 

consumption or results from a decrease in cerebral blood flow. Therefore, not only 

the extent of oxygenation is shown, but the interaction between oxygenation and 

desoxygenation is reflected. This is possible since the measurement zone is mainly 

dominated by the venous part of the cerebral vascular bed (~ 75 %). The arterial 

part (~20 %) or the capillary (~5 %) flow region is respectively smaller [4]. 

For these reasons, we were able to determine changes, which for example, occur 

due to an increase in oxygenation. Which ruling mechanisms are present is still 

12

unclear. Increased desoxygenation by stimulus-induced neuronal activation, i.e. 

caused by changes in membrane potentials or release of neurotransmitters could be 

possibilities [14]. For whatever reason, acupuncture obviously influences the oxygen 

metabolism of the brain in healthy test persons. 

Similar to this study using ear acupuncture, a paradox contra-directional change in 

blood flow velocity (increase) and regional cerebral O 2-saturation (decrease) 

occurred in a vascular based case of dementia, when an individually adapted 

acupuncture scheme was used [14]. The described case report showed that 

acupuncture could improve the clinical status of vascular dementia. Using NIRS and 

transcranial Doppler sonography, we were able to register the effects on cerebral 

blood flow velocity and the O 2-metabolism. In combination with clinical findings, an 

inverse decrease in regional cerebral O 2-saturation during simultaneous increase in 

cerebral blood flow velocity during acupuncture could be interpreted, as a sign of 

increased cerebral oxygenation. A decrease in regional cerebral O 2-saturation does 

not necessarily indicate a poor condition of the O 2-metabolism in the sense of 

reduced oxygen supply, however could also document the beneficial effects of 

regionally increased oxygenation, activated by acupuncture [14]. In a similar 

manner, the minor contradirectional regional changes in NIRS parameters using ear 

acupuncture could be interpreted, since the monitoring method conveys the balance 

between oxygenation and desoxygenation. 

Further studies are necessary to investigate the importance of these phenomena on 

acupuncture, since not only the influence in general and in detail of laser 

acupuncture, but also the influence of combined ear and body acupuncture, are still 

discussed controversially. Spectroscopic methods probably are useful tools for this 

investigations. 


The authors thank Dr. med. Lu Wang for performing the acupuncture, Ms. Evamaria 

Huber for help in data recording and Mag. Petra Petz for her valuable support in 

13

data analysis (all Department of Biomedical Engineering and Research in 

Anesthesia and Critical Care Graz). 

The present report is a pilot study to the presumptive FWF project P16020. 

References 

[1] G. Litscher, High-Tech Akupunktur ® , Pabst Science Publishers, Lengerich Berlin 

Düsseldorf, 2001. 

[2] G. Litscher and Z.H. Cho, eds., Computer-Controlled Acupuncture ® , Pabst 

Science Publishers, Lengerich Berlin Düsseldorf Riga Scottsdale Wien Zagreb, 

2000. 

[3] Z.H. Cho, E.K. Wong and J. Fallon, Neuro-Acupuncture, Q-puncture, Los 

Angeles, 2001. 

[4] G. Litscher and G. Schwarz, eds., Transcranial cerebral oximetry, Pabst Science 

Publishers, Lengerich Berlin Düsseldorf Riga Scottsdale Wien Zagreb, 1997. 

[5] G. Litscher, G. Schwarz, A. Sandner-Kiesling, I. Hadolt and E. Eger, Effects of 

acupuncture on the oxygenation of cerebral tissue, Neurol. Res. 20/S1 (1998), 

28-32. 

[6] G. Litscher and L. Wang, Zerebrale Nahinfrarot-Spektroskopie und Akupunktur – 

Ergebnisse einer Pilotstudie, Biomed. Technik 45 (2000), 215-218. 

[7] G. Litscher, L. Wang and E. Huber, Veränderungen zerebraler nahinfrarot- 

spektroskopischer Parameter während manueller Akupunkturnadelstimulation, 

Biomed. Technik. 47 (2002), 76-79. 

[8] G. Litscher and L. Wang, Computergestützte Objektivierung der Grenzen der 

Akupunktur, AKU Akupunktur Theorie und Praxis 30/1 (2002), 13-19. 

[9] G. Litscher and D. Schikora, Cerebral effects of noninvasive laserneedles 

measured by transorbital and transtemporal Doppler sonography, Lasers Med. 

Sci. 17 (2002), in press. 

[10] G. Litscher, D. Schikora, Neue Konzepte in der experimentellen 

Akupunkturforschung - Computerkontrollierte Laserpunktur (CCL) mit der 

Laserneedle ® Technik, Der Akupunkturarzt / Aurikulotherapeut (2002), in press. 

14

[11] Litscher G., Computer-based objectivation of traditional Chinese-, ear- and 

Korean hand acupuncture, Needle-induced changes of regional cerebral blood 

flow velocity. Neurol. Res. 24 (2002), 377-380. 

[12] G. Litscher and D. Schikora, Effects of new noninvasive laserneedles on brain 

function. EMBEC 2002. 2 nd European Medical & Biological Engineering 

Conference, Vienna, December 2002, in press. 

[13] G. Litscher, L. Wang and M. Wiesner-Zechmeister, Specific effects of 

laserpuncture on the cerebral circulation, Lasers Med. Sci. 15 (2000), 57-62. 

[14] G. Litscher, G. Schwarz, L. Wang and A. Sandner-Kiesling, Akupunktur bei 

vaskulär bedingtem dementiellem Abbau. Jahrestagung der Österreichischen 

Alzheimer-Gesellschaft. 14. Klagenfurter Arbeitstagung für Neurologie. 24. - 25. 

Mai 2002, Klagenfurt / Austria. 

15

Photomedicine and Laser Surgery 

Volume 26, Number 4, 2008 

© Mary Ann Liebert, Inc. 

Pp. 301–306 

DOI: 10.1089/pho.2007.2188 

Abstract 

Laser-Needle Therapy 

for Spontaneous Osteonecrosis of the Knee 

Winfried Banzer, M.D., Ph.D., 1 Markus Hübscher, Ph.D., 1 and Detlef Schikora, Ph.D. 2 

Objective: This case report describes the treatment of a 63-year-old patient with spontaneous osteonecrosis of 

the knee (SONK). Background Data: SONK usually appears in the elderly patient without the typical risk factors 

for osteonecrosis. It is characterized by acute and sudden pain, mostly occurring at the medial side of the 

knee joint. Symptoms usually worsen with physical activity and improve with rest. Besides physical therapy, 

limited weight-bearing and the use of analgesics and nonsteroidal anti-inflammatory drugs, we propose lowlevel 

laser therapy (LLLT) as a conservative treatment option. Methods: LLLT was carried out using laser needles 

emitting radiation with wavelengths of 685 and 885 nm, and a power density of 17.8 W/cm 2 . Therapy sessions 

lasted 60 min and were performed daily over a period of 3 mo. The total irradiation dose emitted by 8 

laser needles in 60 min of treatment was 1008 J. Results: Magnetic resonance imaging revealed distinct restitution 

of the spongiosa edema 5 wk after treatment onset, and the final check-up at 35 wk demonstrated complete 

restoration of integrity. Conclusion: The present case report provides the first indication that laser-needle 

therapy may be a promising tool for complementary and alternative therapeutic intervention for those with 

SONK. 

Introduction 

STEONECROSIS OF THE KNEE was first described by Ahlbäck 

Oand 

colleagues in 1968, and has been classified into two 

distinct types: (1) spontaneous or idiopathic osteonecrosis, 

and (2) secondary osteonecrosis associated with various risk 

factors such as steroid therapy, renal transplantation, systemic 

lupus erythematosus (SLE), alcohol abuse, caisson decompression 

sickness, Gaucher’s disease, and hemoglobinopathies. 

1,2 Spontaneous osteonecrosis of the knee 

(SONK) usually appears in the elderly patient over 55 years 

of age without the typical risk factors for osteonecrosis, with 

an age-related prevalence between 3.4% and 9.4%. 3 Women 

are three times more often affected than men. SONK is characterized 

by acute and sudden pain, mostly occurring at the 

medial side of the knee joint. Symptoms usually worsen with 

physical activity and improve with rest. Also, nocturnal pain 

is frequently observed, and clinical examination shows local 

hypersensitivity to pressure. 4 Even though the precise etiology 

still remains unclear, two major theories have been proposed. 

5 The traumatic theory suggests that repeated microtraumata 

in porotic bone cause stress fractures and 

301 

successive necrosis. 6 According to the vascular theory, occlusion 

of the blood supply at the arterial and venous side 

may lead to decreased bone microcirculation with subsequent 

edema formation. Edema increases bone marrow pressure, 

further diminishing the blood supply and resulting in 

osseus ischemia and necrosis. 4 Furthermore, elevated bone 

marrow pressure due to increased fat cell size and fat microemboli 

has been suggested to impair intraosseus microcirculation. 

7 Established treatment options comprise physical 

therapy, limited weight-bearing, and the use of analgesics 

and nonsteroidal anti-inflammatory drugs. These conservative 

approaches are recommended, usually in the early 

stages of disease. But even in such cases, progression can not 

always be successfully hindered, and patients with severe 

necrotic changes may require surgical intervention (e.g., high 

tibial osteotomy or total knee replacement). 2,8–10 In this context 

and in consideration of the basic research on the biostimulatory 

effects of low-level laser therapy (LLLT) on microcirculation 

and vascularization as well as on osteogenesis, 

and its clinical effectiveness in bone and joint diseases such 

as osteoarthritis and rheumatoid arthritis, we propose LLLT 

as a promising therapeutic option for patients with 

1 Department of Sports Medicine, Goethe-University Frankfurt/Main, and 2 Department of Physics and Optoelectronic, University of 

Paderborn, Germany.

302 

SONK. 11–16 However, clinical data on its effectiveness are 

currently lacking. For the first time, we describe the treatment 

of a 63-year-old patient with SONK using low-level 

laser irradiation. 

Case Report 

A 63-year-old man presented to sports medicine consultation 

with pain in the right medial femur radiating to the 

medial joint cavity. The complaints had first developed a 

year before, were aggravated by exercise, ceased spontaneously, 

then recurred during exercise on the treadmill 3 wk 

earlier. Up to that point the patient had worked out 1–2 h 

daily. In recent months, however, exercising was possible 

only with limitations. This otherwise healthy patient denied 

preceding trauma and had no history of diabetes mellitus or 

other metabolic disorders. 

On clinical examination the medial distal femur of the 

knee joint was sensitive to pressure. The circumference measurement 

at the joint cavity revealed a left-to-right proportion 

of 36.5 cm to 35 cm. No other side discrepancies, 

swelling, or hyperthermia were apparent. All relevant functional 

tests of the knee were normal. With the exception of 

increased homocysteine values, all relevant laboratory values, 

including the rheumatoid factors, were unremarkable. 

Furthermore, predisposing factors associated with secondary 

osteonecrosis, such as long-term glucocorticoid therapy, 

renal transplantation, SLE, alcohol abuse, caisson 

decompression sickness, Gaucher’s disease, and hemoglobinopathies 

could be excluded. 

The magnetic resonance imaging (MRI) examination of the 

right knee joint performed 2 d later (on March 16, 2005) revealed 

Morbus Ahlbäck (spontaneous osteonecrosis of the 

knee, stage III) at the coronary fat-suppressed PD TSE se- 

A 

BANZER ET AL. 

quence (Fig. 1). There was a linearly demarcated subcortical 

focus at the medial femur condyle with adjacent spongiosa 

edema (necrotic zone) reaching deep into the bone marrow. 

There was no osteochondritis dissecans. Furthermore, chondral 

irregularities were present at the medial femur condyle, 

with a lesion consisting of less than 50% of the normal cartilage 

thickness, in accordance with grade II chondropathy. 

The frontal view showed centrally and along the medial 

condyle a retropatellar cartilage lesion also in accordance 

with grade III chondropathy. Irritation at the lower portion 

of the medial retinaculum was also revealed. 

We explained to our patient the various therapeutic alternatives, 

in particular the conservative options, and recommended 

no or only very minor surgical intervention. The patient 

decided on a conservative course of laser therapy. The 

therapy was conducted with the commercially available 

Laserneedle ® System (Germany). 

The device consists of eight laser needles, each attached 

to the end of an optical fiber. Laser diodes were used for the 

light source, and they emit red light at a wavelength of 685 

nm and infrared light at a wavelength of 885 nm (bichromatic 

emission) in continuous-wave mode with an output 

power of 35 mW per laser needle. The fiber core diameter 

was 0.5 mm, resulting in a power density of 17.8 W/cm 2 per 

laser needle. The use of two wavelengths with different scattering 

properties has the advantage that the tissue light absorbance 

is more homogeneous, which is critical to achieve 

the optimal therapeutic effect. The laser needles were not inserted 

into the skin, but were taped to the skin along the distal 

part of the femur in the region of the medial condyle and 

joint cavity with the patient lying relaxed on his back. Therapy 

sessions lasted 60 min and were performed daily over a 

period of 3 mo. The total irradiation dose emitted by the eight 

laser needles in each 60-min treatment session was 1008 J. 

FIG. 1. These MRI images, made March 16, 2005, are a coronary fat-suppressed PD TSE sequence. (A) Axial and (B) frontal 

images, showing a linearly subcortical focus at the medial femur condyle with adjacent spongiosa edema (necrotic zone) 

reaching deep into the bone marrow. 

B

LASER-NEEDLE THERAPY IN SONK 303 

The treatment parameters were deduced from our experimental 

data on human osteoblast cultures, which demonstrated 

a significant increase in osteoanabolic activity. 17 The 

treatment duration and frequency of sessions were chosen 

and adapted according to the patient’s functional status and 

level of pain. 

No additional treatment was administered during the 

LLLT therapy period. The patient quit jogging and kept fit 

only by weight training once a week, daily exercising on a 

cycling ergometer for 30 min, and playing golf occasionally. 

We agreed with our patient to assess therapeutic progress 

regularly with MRI. The first check-up on April 25, 2005, revealed 

distinct regression of the spongiosa edema at the medial 

femur condyle, as well as a decrease in size of the subcortical 

focus (Fig. 2). The cartilage lesion grade II at the 

medial inner femur condyle did not at that point show any 

change. The signal intensity of the linearly demarcated subcortical 

focus lay under that of the joint cavity, implying no 

communication between the lesion and the joint cavity. The 

check-up revealed as secondary findings small synovial cysts 

in Hoffa’s fat pad. Clinically marked pain reduction and virtually 

complete resolution of the patient’s complaints had 

also taken place. The patient experienced pain only when 

briskly walking. Since he was satisfied with therapy results 

up to that point, we agreed to continue it. 

The next check-up on June 16, 2005, 3 mo after treatment 

onset, revealed nearly complete restitution of the spongiosa 

edema (Fig. 3). A faintly visible subcortical demarcation continued 

to show on the images. The depth of the cartilage ulceration 

at the femoral condyle had receded to less than 50% 

of the total cartilage thickness, in accordance with grade II 

A 

chondropathy. Our patient was clinically entirely pain-free, 

even when training vigorously on the bicycle. 

During the follow-up period, the patient also did not take 

any medication. The final check-up on December 5, 2005, 

confirmed the findings of June 16: full recovery had taken 

place (Fig. 4). The initially diagnosed Morbus Ahlbäck could 

no longer be seen, and 35 wk after treatment onset the chondropathy 

at the medial femur condyle showed complete 

restitution. Any remaining pathology was at this point minor, 

in accordance with grade I chondropathy. The cartilage 

at the femoral condyle also showed marked improvement. 

There were slight alterations seen in the chondral surface, 

consisting only of a solitary, flat lesion, in accordance with 

grade I–II chondropathy. 

Discussion 

MRI has proven to be the most sensitive method to detect 

SONK at an early stage, 18 to enhance visualization of bone 

marrow, and to distinguish necrotic tissue from viable tissue 

with a high level of specificity. 2 This method is currently 

considered the gold standard and was therefore used for diagnosis 

and therapeutic evaluation in the present case. 

Based on MRI findings, SONK can be categorized into four 

stages. 19 In stage I, bone marrow edema is present in the 

load-bearing zone of the femoral condyle. This initial stage 

is reversible. In stage II, early subchondral fracturing with 

flattening of the affected weight-bearing portion of the 

femoral condyle is observed. Further progression leads to osteochondral 

fracturing in stage III, and consequently to secondary 

osteoarthritis in stage IV. 

FIG. 2. These MRI images, made on April 25, 2005, are a coronary fat-suppressed PD TSE sequence. (A) Axial and (B) 

frontal images, demonstrating distinct regression of the spongiosa edema at the medial femur, as well as a decrease in size 

of the subcortical focus. 

B

304 

A 

Derived from the MRI data showing SONK stage III and 

in accordance with our patient’s request, we decided to 

treat nonsurgically. With regard to the basic evidence of 

laser-induced biostimulation, 11–14 clinical research demonstrates 

the potential positive effects of LLLT in osteoarthritis 

and rheumatoid arthritis, 15,16 and with our own clinical 

experience we considered this treatment option to be appropriate 

in the present case. Laser-needle stimulation using 

the parameters described above demonstrated succes- 

BANZER ET AL. 

FIG. 3. These MRI images, made on June 16, 2005, are a coronary fat-suppressed PD TSE sequence. (A) Axial and (B) 

frontal images, showing almost complete restitution of the spongiosa edema. 

A 

sive restitution over the course of the therapy. Distinct restitution 

of the spongiosa edema took place 5 wk after treatment 

onset, and the final check-up of December 5, 2005 revealed 

complete restoration of joint integrity. These findings 

may be explained by the above-mentioned evidence suggesting 

the biostimulatory effects of LLLT on biological 

processes. Laser-induced vascular relaxation and increased 

microcirculation have been demonstrated in animals 20,21 

and in humans. 11,22 Data from the study of Bayat et al. in- 

FIG. 4. These MRI images, made on December 5, 2005, are a coronary fat-suppressed PD TSE sequence. (A) Axial and (B) 

frontal images, demonstrating complete restoration of joint integrity. 

B 

B

LASER-NEEDLE THERAPY IN SONK 305 

dicated that laser irradiation of random skin flaps without 

recognizable blood vessels in rats reduced vasospasm, produced 

vasodilation, and significantly reduced necrosis. 23 In 

addition, recent research has identified laser-induced regenerative 

processes in surgically-damaged rat tibia. Garavello 

et al. demonstrated that laser therapy applied transcutaneously 

accelerated the deposition of bone matrix, and 

histological characteristics showing active recovery of the 

injured tissue. 12 Using biochemical and radioactive labeling 

methods, Yaakobi et al. found a significant increase in 

osteoblastic activity at the injured site, as reflected by increased 

alkaline phosphatase activity. 13 The laser treatment 

also evoked a twofold increase in the rate of bone repair, 

as evidenced by the rate and extent of calcification. Likewise, 

morphometrical and histological analyses by Garavello-Freitas 

et al. showed that daily laser irradiation stimulated 

the growth of the trabecular area, and improved 

parallel organization of bone matrix collagen fibers within 

the first week, probably related to the activation of osteoblasts 

to produce bone matrix. 14 In the second week, the 

effects of laser irradiation changed from stimulatory action 

on bone growth to an inhibitory action, indicating increased 

activity of osteoclasts to promote bone resorption and remodeling. 

The authors therefore concluded that a two-stage 

mechanism might be involved in the interaction of the laser 

and the bone repair process. Since an adequate blood supply 

or neovascularization is crucial for regenerative and 

proliferative processes, it was suggested that laser irradiation 

also promotes angioneogenesis. This assumption may 

be verified by light microscopic examination of histological 

sections that reveal new formation of blood vessels over 

the course of low-level laser stimulation. 12 

Conclusion 

The present case report provides the first indication that 

laser-needle stimulation with the parameters described here 

may be a promising tool for complementary and alternative 

therapeutic intervention for spontaneous osteonecrosis of the 

knee. It is likely that laser-needle therapy stimulated neovascularization 

and osteogenesis. Further research in the form of 

randomized, controlled trials should be done to assess the clinical 

effectiveness of laser-needle therapy and compare it to current 

standard treatments for SONK. 

Acknowledgments 

The authors acknowledge the help of Dr. Dominik Weber 

for providing the MRT recordings and assisting on the 

diagnositc process. They also acknowledge Eszter Füzeki 

for help with correcting syntax. 

References 

1. Ahlbäck, S., Bauer, G.C., and Bohne, W.H. (1968). Spontaneous 

osteonecrosis of the knee. Arthritis Rheum. 11, 

705–733. 

2. Patel, D.V., Breazeale, N.M., Behr, C.T., Warren, R.F., Wickiewicz, 

T.L., and O’Brien S.J. (1998). Osteonecrosis of the 

knee: current clinical concepts. Knee Surg. Sports Traumatol. 

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Address reprint requests to: 

Prof. Winfried Banzer, M.D., Ph.D. 

Department of Sports Medicine 

Goethe-University Frankfurt/Main 

Ginnheimer Landstrasse 39 

60487 Frankfurt am Main 

Frankfurt/Main, Germany 

E-mail: banzer@sport.uni-frankfurt.de

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