INSERTION ANGLE TEACHING FOR AN ACUPUNCTURE

TRAINING SYSTEM

Ren Kanehira

Fujita Health University, Toyoake, Aichi, Japan

Weiping Yang

Aichi Shukutoku University, Nagoya, Aichi, Japan

Miyoko Tateishi, Makoto Yagihashi, Hirohisa Narita, Hideo Fujimoto

Nagoya Institute of Technology, Nagoya, Aichi, Japan

Keywords: Acupuncture, Training system, Virtual reality, Insertion angle.

Abstract: We are developing an acupuncture training system using virtual reality (VR) technology for teaching of

oriental medical techniques. In this paper, special attention was paid in the insertion angle which is one of

the most important actions in acupuncture. The training system and related teaching method were proposed

for insertion angle training. The proposed system was evaluated with experiments, and the results were

proved effective.

1 INTRODUCTION

Acupuncture among the traditional oriental medical

treatments has the merit of high efficiency with

almost no harmful side-effects. The effectiveness of

it has been re-realized in recent years, and

promotions of its use are also carried on worldwide.

(Shirota, F., 2002, Textbook executive committee,

1992, Sugiyama, I., 2003).

To carry out acupuncture treatment, it is

necessary in sequence to find the correct position

(acupoint), to put a needle on it, and to insert the

needle with proper angle. However, it has been

difficult to learn the technique because that the

acupoint was practically invisible, and in the

acupuncture teaching text the points were figured out

on a human body with only a flat 2D description

while a correct insertion require 3D information

containing the depth and insertion angle.

A training system using the advanced VR

technology has been proposed to solve the above

problems (Chen, L., 2005). The system is with a 3D

acupoint human body model upon which the

teaching of the 3D position of acu-points and a true-

false judgment of them can be done real-timely

(Kanehira, R., Shoda, A., Yagihashi, M., Narita, H.,

Fujimoto, H., 2008).

As one more advance to the training system, this

paper studied the training method for the insertion

angle upon a produced acupoint model of the human

head. The correct position and insertion angle of an

acupoint were provided so quantitative training

becomes possible. Experiments were done to

evaluate the system, and the effectiveness of the

training system for a beginner to learn acupuncture

was proved using the true-false judgment upon

quantitative information.

2 INSERTION ANGLE

Acupuncture starts from the searching for the correct

position of an acupoint and then inserting a needle.

If the insertion angle cannot be taken precisely, it is

difficult to obtain the expected healing effect even

on a correct acupoint position. That is, the insertion

angle is as important as the position itself (Mori, H.,

1971).

281

Kanehira R., Yang W., Tateishi M., Yagihashi M., Narita H. and Fujimoto H. (2009).

INSERTION ANGLE TEACHING FOR AN ACUPUNCTURE TRAINING SYSTEM.

In Proceedings of the First International Conference on Computer Supported Education, pages 281-284

DOI: 10.5220/0001846202810284

 SciTePress

Insertion angles can be roughly divided into 3

types shown in Figure 1. A plumb insertion (90°) is

used on positions with thicker muscle or fat such as

the legs or arms. An oblique insertion (45°) is used

on human body with thinner muscle such as the bent

parts or the face or spine. And a subcutaneous

insertion (15°) is used on parts with bones directly

under the skin Yamashita, M., 2003). It can be seen

that the smaller the angle is, the difficult the

insertion becomes.

Figure 1: Insertion angle.

There are many important acu-points around the

human head and neck. In this area, an oblique

insertion is required, followed by a subcutaneous

insertion to the acu-points (Mori, H., 1981).

Therefore, a human head-neck model was chosen for

this study.

Conventional training for insertion angle in

acupuncture has been carried on using such methods

as to insert on a fruit or a gauze ball, or on student’s

body of each other. In such a situation, the insertion

technique can only be learnt by sense with trial and

error while looking over the teacher’s performance.

In addition, the human body is not a flat one, and it

is difficult to measure correctly the insertion angle

on face or spine having concavo-convex.

Furthermore, a true or false judgment on student’s

trial is based on experience and personal senses with

variety. Thus, the proposed training system for

insertion angle is expected effective in practice.

3 THE TRAINING SYSTEM

3.1 Construction of the System

The system utilizes VR technology for insertion

angle training, which should be with high presence

and real timely. A human body model of acupoint

was firstly constructed on a computer. The trainee

moves the virtual needle connected with the training

device, to study the insertion angle according to

information provided on the computer. Figure 2

shows the system construction.

Figure 2: Configuration of the system.

3.2 Head Acupoint Model

As stated earlier, a human head-neck model was

chosen for training. A head acupoint model

represented was made within a computer, and its

surface was attached with skin images by texture

mapping method to get the most reality. Because the

position is changeable according to the position and

movement of a patient, the head model was also

made to be able to move freely. While the acu-points

in a conventional text can only be 2D-represented,

our model is with a 3D representation so an acupoint

can be seen even under the skin.

3.3 Teaching the Insertion Angle

A teaching method for insertion angle was proposed.

A virtual needle connecting to the training device

was produced and the acupoint was colored in red

for an easier looking. A pipe to guide the insertion

angle was then constructed. The guide pipe was put

over the skin surface with the far end to act as the

insert position called the insertion point. Figure 3

shows the relationship among the acupoint, the guide

pipe and the insertion point.

Figure 4 shows the training device. It was

equipped with a 3D sensor. When a hand is holding

and moving the device, a virtual needle (Figure. 5)

appears on screen of the computer, moved in

correspondence.

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Figure 3: Relationship among the acu-point, guide pipe

and insertion point.

Figure 4: Training device.

Figure 5: Virtual needle.

The judgment on true or false of an insertion

angle was done according to the contact relationship

among the tip of needle, the insertion point and the

acupoint model. A 2-step process is required for the

judgment. That is, a judgment on whether the virtual

needle has been inserted into the insertion point is

made first, and a blue circle is presented for a done

insertion (Figure 6). The 2nd judgment on whether

the insertion is with a correct angle is made

sequentially. A successful insertion with correct

angle is represented with double red circles (Figure

7), while an insertion with incorrect angle is with a

red crisscross (Figure 8).

Figure 6: A successful entry to the insertion point.

Figure 7: A successful entry with right angle.

Figure 8: An entry with false angle.

4 EVALUATION TO THE

SYSTEM

4.1 Experiment

Evaluation of the system, as an initial step of effect

evaluation, was done by operating/dialogizing

method by questionnaire over 6 persons (2 males

and 4 females of the 20th) on operating of plumb

insertion (90°), oblique insertion (45°), subcutaneous

insertion (15°), respectively.

4.2 Method

Experiment was done as the following.

1) Starting from plumb insertion, operating

when the guide pipe was represented.

2) Plumb insertion operating without the guide

pipe representation.

3) The same as above for oblique insertion and

subcutaneous insertion operating.

4) Questionnaire to the trainee on plumb

insertion, oblique insertion and subcutaneous

insertion, respectively.

Questionnaire questions are listed as Table 1.

Table 1: Questions for questionnaire.

No. Questions

1 Is operation easy?

2 Remember the insertion angle?

3 Keep the insertion angle?

4 An insertion with the guide map?

5 An insertion without guide map?

4.3 Evaluation

The SD method is used in evaluation (Nagamachi,

M., 1989). The SD method is one to

analyze/evaluate the psychological image using

words of sensitivity. A 7 levels of sensitivity with

INSERTION ANGLE TEACHING FOR AN ACUPUNCTURE TRAINING SYSTEM

283

words “very good”，“good”， “so-so”， “yes and

no”，“not so bad”，“bad”，“too bad” and point

from 6 to 0 were used in evaluation.

4.4 Results and Discussion

The results were summarized and compared for each

insertion angle. It is seen that higher scores were got

with plumb insertion and oblique insertion than

subcutaneous insertion, indicating the former two are

relatively easier to learn. Lower scores were

obtained for subcutaneous insertion, because the

latter is more difficult due to the very small insertion

angle.

The results are further divided according to

answers to questions 4 and 5 over 6 persons, with

and without the use of a guide pipe. The use of a

guide pipe results in higher scores in all insertion

angles (90°) (45°) and (15°). The result of the

subcutaneous insertion (15°) is shown in Figure 9.

①②③④⑤⑥

score

test subject

(a) with guide pipe

①②③④⑤⑥

score

test subject

(b) without guide pipe

Figure 9: Results of experiment (15°).

It is evident by comparing (a) and (b) in Figures

9 that higher scores are obtained with the use of

guide pipe particularly for subcutaneous insertion. It

can be said that the use of guide pipe is much helpful

for an insertion with right angle. Further, lower

scores appear for the difficult operation of

subcutaneous insertion so progress should be made

for an improvement of training effectiveness in

subcutaneous insertion.

5 CONCLUSIONS

A training system using VR technology was

presented for teaching the insertion angle in

acupuncture. A training environment having a 3D

head model with high presence and real-time

response was constructed within a computer. A

guide pipe was presented for a real-time true-false

judgment on the insertion angle. The system was

evaluated by operators using the method of

questionnaire, and the improvement on training of

insertion angle was confirmed.

ACKNOWLEDGEMENTS

This study was done partly with the finical support

from the Japan Society for the Promotion of Science

(JSPS) Grant-in-Aid for Scientific Research.

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