CC BY-NC-ND 4.0 · Revista Fisioterapia Invasiva / Journal of Invasive Techniques in Physical Therapy 2020; 03(01): 007-012
DOI: 10.1055/s-0040-1713821
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Acupuncture points and perforating cutaneous vessels identified in the upper limb using infrared thermography

Article in several languages: English | español
F. Soares-Parreira
1   Clínica Fisioefe (Fisioterapia e Bem Estar), Espargo, Portugal
D. Álvarez-Prats
2   Clínica Fisioterapia Océano, Madrid, Spain
5   Department of Physiotherapy, CEU San Pablo University, Madrid, Spain
O. Carvajal-Fernández
2   Clínica Fisioterapia Océano, Madrid, Spain
M. Barbosa-Pereira
4   MVClinic Institute, Madrid, Spain
F. Valera-Garrido
4   MVClinic Institute, Madrid, Spain
5   Department of Physiotherapy, CEU San Pablo University, Madrid, Spain
› Author Affiliations
Further Information

Publication History

02 May 2020

22 May 2020

Publication Date:
30 June 2020 (online)


Objective To verify the presence of perforating cutaneous vessels (PCV) among different acupuncture points (AP) of the upper limb by means of infrared thermography (IT).

Material and Methods An analytical observational cross-sectional study examining the upper limb of volunteer subjects (n = 7). A total of 91 AP were analyzed, as well as 91 control points (CP), one for each AP. In each subject, first, the AP and their corresponding CP were marked and, second, the thermographic images were taken. The images were then processed using the Physio Thermal Imaging (PTI) software, observing the presence or absence of these PCV on the AP and corresponding CP.

Results PCV were identified in 68.1% of the total 91 AP examined. However, despite the strong trend in the presence of PCV in the studied AP, certain AP did not display significant differences with their corresponding CP.

Conclusions This study shows a certain correlation between the PCV and the AP chosen in this sample, due to the high presence of PCV in the AP. IT is a useful tool during physical therapy treatment procedures using acupuncture.

Ethical Approval

CEU San Pablo University.

  • References

  • 1 Berman BM, Langevin HM, Witt CM, Dubner R. Acupuncture for chronic low back pain. N Engl J Med 2010; 363 (05) 454-461
  • 2 White A, Foster NE, Cummings M, Barlas P. Acupuncture treatment for chronic knee pain: a systematic review. Rheumatology (Oxford) 2007; 46 (03) 384-390
  • 3 Haker E, Egekvist H, Bjerring P. Effect of sensory stimulation (acupuncture) on sympathetic and parasympathetic activities in healthy subjects. J Auton Nerv Syst 2000; 79 (01) 52-59
  • 4 Svedberg L, Nordahl G, Lundeberg T. Effects of acupuncture on skin temperature in children with neurological disorders and cold feet. Dev Med Child Neurol 2001; 43 (05) 358-360
  • 5 Dhond RP, Yeh C, Park K, Kettner N, Napadow V. Acupuncture modulates resting state connectivity in default and sensorimotor brain networks. Pain 2008; 136 (03) 407-418
  • 6 Hui KK, Liu J, Marina O. , et al. The integrated response of the human cerebro-cerebellar and limbic systems to acupuncture stimulation at ST 36 as evidenced by fMRI. Neuroimage 2005; 27 (03) 479-496
  • 7 Agarwal-Kozlowski K, Lange AC, Beck H. Contact-free infrared thermography for assessing effects during acupuncture: a randomized, single-blinded, placebo-controlled crossover clinical trial. Anesthesiology 2009; 111 (03) 632-639
  • 8 Zhi Wei D, Yu S, Yongqiang Z. Perforators, the Underlying Anatomy of Acupuncture Points. Altern Ther Health Med 2016; 22 (03) 25-30
  • 9 Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40 (02) 113-141
  • 10 Blondeel PN, Van Landuyt KH, Monstrey SJ. , et al. The “Gent” consensus on perforator flap terminology: preliminary definitions. Plast Reconstr Surg 2003; 112 (05) 1378-1383 , quiz 1383, 1516, discussion 1384–1387
  • 11 Smit JM, Klein S, Werker PM. An overview of methods for vascular mapping in the planning of free flaps. J Plast Reconstr Aesthet Surg 2010; 63 (09) e674-e682
  • 12 Tenorio X, Mahajan AL, Elias B. , et al. Locating perforator vessels by dynamic infrared imaging and flow Doppler with no thermal cold challenge. Ann Plast Surg 2011; 67 (02) 143-146
  • 13 Moreira D, Nohama P. Mapeamento Térmico nos pontos de acupuntura. Três Corações 2016; 14 (02) 1034-1043
  • 14 Álvarez Prats D, Carvajal Fernández Ó. Termografía en fisioterapia. En: Valera Garrido F, Minaya Muñoz F. (editores). Fisioterapia Invasiva 2ª Ed. Barcelona: Elsevier España, S. L.; 2016
  • 15 Merla A, Mattei PA, Di Donato L, Romani GL. Thermal imaging of cutaneous temperature modifications in runners during graded exercise. Ann Biomed Eng 2010; 38 (01) 158-163
  • 16 Ring EF, Ammer K. Infrared thermal imaging in medicine. Physiol Meas 2012; 33 (03) R33-R46
  • 17 Acupuntura SD. teoria y práctica. Buenos Aires: 2000
  • 18 Focks C. Atlas of acupuncture. China: Elsevier Churchilll Livingstone; 2006
  • 19 Hildebrandt C, Raschner C, Ammer K. An overview of recent application of medical infrared thermography in sports medicine in Austria. Sensors (Basel) 2010; 10 (05) 4700-4715
  • 20 Garagiola U, Giani E. Use of telethermography in the management of sports injuries. Sports Med 1990; 10 (04) 267-272
  • 21 Estanol-Vidal B, Gutierrez-Manjarrez F, Martinez-Memije R. , et al. [The two faces of veno-arteriolar reflex: cutaneous vasodilatation and vasoconstriction to raise and to lower the arm]. Rev Neurol 2016; 62 (09) 403-407
  • 22 Álvarez-Prats D, Carvajal-Fernández O, Valera Garrido F. , et al. Acupuncture Points and perforating cutaneous vessels identified using infrared thermography: A cross-sectional study. Evid Based Complement Alternat Med 2019; 2019: 7126439
  • 23 Yang HQ, Xie SS, Hu XL, Chen L, Li H. Appearance of human meridian-like structure and acupoints and its time correlation by infrared thermal imaging. Am J Chin Med 2007; 35 (02) 231-240
  • 24 Mei J, Morris SF, Ji W, Li H, Zhou R, Tang M. An anatomic study of the dorsal forearm perforator flaps. Surg Radiol Anat 2013; 35 (08) 695-700
  • 25 Hekner DD, Roeling TA, Van Cann EM. Perforator anatomy of the radial forearm free flap versus the ulnar forearm free flap for head and neck reconstruction. Int J Oral Maxillofac Surg 2016; 45 (08) 955-959
  • 26 Itoh Y, Arai K. Use of recovery-enhanced thermography to localize cutaneous perforators. Ann Plast Surg 1995; 34 (05) 507-511
  • 27 de Weerd L, Weum S, Mercer JB. The value of dynamic infrared thermography (DIRT) in perforatorselection and planning of free DIEP flaps. Ann Plast Surg 2009; 63 (03) 274-279
  • 28 Kimura T, Ebisudani S, Osugi I, Inagawa K. Anatomical Analysis of Cutaneous Perforator Distribution in the Forearm. Plast Reconstr Surg Glob Open 2017; 5 (10) e1550
  • 29 Chubb DP, Taylor GI, Ashton MW. True and ‘choke’ anastomoses between perforator angiosomes: part II. dynamic thermographic identification. Plast Reconstr Surg 2013; 132 (06) 1457-1464
  • 30 Aoki S, Tanuma K, Iwakiri I. , et al. Clinical and vascular anatomical study of distally based sural flap. Ann Plast Surg 2008; 61 (01) 73-78