Correspondence

Images in Clinical Medicine: Acupuncture-Needle Fragments

N Engl J Med 1995; 332:1792-1794June 29, 1995

Article

To the Editor:

Chiu and Austin (Feb. 2 issue)1 provide radiographic evidence of multiple, fine, metallic densities in the soft tissue of the back of a Japanese man, representing permanently placed acupuncture needles. We disagree, however, with the statement that the needles remain in the subcutaneous tissue permanently.

This form of acupuncture, known as Hari acupuncture, is undertaken to improve one's general health and specifically to treat pain, paralysis, and skin diseases. The skin is initially prepared with alcohol, and a spring-loaded syringe is used to inject the 1-cm needles along predefined meridians. In a typical session lasting one to two hours, dozens of needles may be placed. Made of gold, silver, or stainless steel, the needles may be placed anywhere in the body.

We studied three Korean patients who had undergone extensive Hari acupuncture in New York City. Ultrasound and computed tomographic (CT) scans were obtained to determine the exact positions of these needles. In one patient the needles had migrated from their initial subcutaneous positions. CT images showed that multiple needles had penetrated the peritoneal cavity, impinging on the anterior aspect of the stomach, the left lobe of the liver, and the transverse colon. Other needles had become embedded in the wall of the urinary bladder.2 Though this patient has had no ill effects from the acupuncture treatments to date, long-term follow-up is required to determine whether there are sequelae of acupuncture-needle migration.

An unusual radiographic appearance of this sort, usually found incidentally, should alert the clinician to the presence of Hari acupuncture needles and the possible complications that accompany other, more traditional types of acupuncture, such as local infection and transmission of viral hepatitis.3 Problems associated with permanent subcutaneous placement of needles in Hari acupuncture, such as the migration of the needles from the soft tissue to more distant sites, should always be kept in mind.

Perry S. Gerard, M.D.
Eric Wilck, M.D.
Maimonides Medical Center, Brooklyn, NY 11219

Thomas Schiano, M.D.
Temple University Hospital, Philadelphia, PA 19140

3 References

1. 1

   Chiu ES, Austin JHM. Acupuncture-needle fragments. N Engl J Med 1995;332:304-304
   Full Text | Web of Science | Medline

2. 2

   Gerard PS, Wilck E, Schiano T. Imaging implications in the evaluation of permanent needle acupuncture. Clin Imaging 1993;17:36-40
   CrossRef | Web of Science | Medline

3. 3

   Carron H, Epstein BS, Grand B. Complications of acupuncture. JAMA 1974;228:1552-1554
   CrossRef | Web of Science | Medline