The aim of the present study was to determine if nasal massage of the yingxiang acupuncture point in patients with nasal congestion associated with perennial nasal allergy had any effect on nasal airway resistance (NAR) measured by anterior rhinomanometry and sensation of nasal airflow on a visual analogue scale (VAS). Ten patients were recruited for this study. NAR and VAS were measured before (baseline), 2 min after and 10 min after massage. NAR had no ruled changes after massage although all patients felt their symptom of nasal congestion had improved. The results of this study, when taken together, indicate that nasal massage may provide some relief mainly from the sensation of nasal congestion

Higami, Shigeru

Ikoma, Hisaaki

Matsuo, Satoshi

Takeuchi, Hiromi

Tanaka, Yumiko

Yonago Acta Medica

Tottori University Research Result Repository

167Yonago Acta medica 1999;42:167–170The Effects of Nasal Massage of the Yingxiang Acupuncture Point onNasal Airway Resistance and Sensation of Nasal Airflow in Patientswith Nasal Congestion Associated with Perennial Nasal AllergyHiromi Takeuchi, Satoshi Matsuo, Shigeru Higami, Yumiko Tanaka and HisaakiIkomaDepartment of Oto-Rhino-Laryngoloy, Faculty of Medicine, Tottori University, Yonago 683-0826, JapanThe aim of the present study was to determine if nasal massage of the yingxiang acu-puncture point in patients with nasal congestion associated with perennial nasal allergyhad any effect on nasal airway resistance (NAR) measured by anterior rhinomanometryand sensation of nasal airflow on a visual analogue scale (VAS).  Ten patients were re-cruited for this study.  NAR and VAS were measured before (baseline), 2 min after and10 min after massage.  NAR had no ruled changes after massage although all patientsfelt their symptom of nasal congestion had improved.  The results of this study, whentaken together, indicate that nasal massage may provide some relief mainly from thesensation of nasal congestion.key words:  acupuncture; nasal airway resistance; perennial nasal allergy; yingxiangAbbreviations:  NAR, nasal airway resistance; VAS,visual analogue scaleIn oriental medicine, acupuncture has been usedto treat a variety of diseases, including nasal con-gestion.  Nasal congestion is treated by acupunc-ture at the yingxiang point which lies just lateralto the nostril (Beijing College of TraditionalChinese Medicine, 1980).  In Japan and Chinathe yingxiang point is often chosen as a massagepoint because patients are able to easily identifythe point and perform finger massage.  In nasalallergy, nasal congestion is one of the mostbothersome symptoms.  Since massage of thisacupuncture point seems to provide relief fromnasal congestion, this simple technique can be avery useful treatment without medicine and sur-gery.  The aim of the present study was to in-vestigate the effects of nasal massage on nasalcongestion associated with perennial nasal al-lergy using both objective and subjective mea-sures for nasal congestion.Subjects and MethodsTen patients with perennial nasal allergy causedby house dust mites were recruited for the pres-ent study.  All had at least moderately blockednoses and therefore needed to breathe throughthe mouth at sometime during the day.  Patientswere examined by clinicians and excluded fromthe study if they had:  anatomical nasal obstruc-tion or gross anatomical deformity; sufferedfrom acute upper respiratory tract infection;started immunotherapy within the year; or,taken any prescribed medication which theclinician deemed unsuitable.Subjective scores of nasal congestion andmeasurements of nasal airway resistance(NAR) were made before (baseline), approx-imately 2 min after and 10 min after treatment.Patients scored the severity of their nasal con-gestion on a 100 mm visual analogue scale(VAS) with the extremes labeled “nose feelsextremely blocked” and “nose feels extremelyclear.”NAR was measured using anterior rhino-manometry (rhinomanometer, MPR2100,Nihon Kohden Instrument, Tokyo, Japan) at aninspiratory reference pressure of 100 Pa.  NARH. Takeuchi et al.168to airflow is calculated from the followingequation:R = D P/Vwhere R = resistance to airflow, in Pa/cm3/s; D P= transnasal pressure, in Pa; and V = nasalairflow, in cm3/s.  Transnasal pressure can bemeasured by relating the pressure at the poste-rior nares to that at the entrance of the nostril.With anterior rhinomanometry, nasal airflowand the pressure at the entrance of the nostril aremeasured one side at a time with the pressure atthe posterior nares measured from the oppositeside.  Therefore, NAR is determined separatelyfor each nasal passage and the total resistance isthen calculated by summing the values usingOhm’s law for parallel resistance.TreatmentThe yingxiang acupuncture point is part of the“large intestine channel of Hand-Yangming”and is described as point LI 20 which is an acu-puncture point located in the nasolabial groove,at the level of the midpoint of the lateral borderof the ala nasi.  Acupuncture of this point is re-commended for the treatment of nasal obstruc-tion, epistaxis and rhinorrhea (Beijing Collegeof Traditional Chinese Medicine, 1980).  Eachpatient was instructed to massage the bilateralyingxiang points by drawing small circles withtheir index fingers at twice per second for 30 s.Statistical analysisThe results are given as the mean percentagechange from baseline with SE.  A paired t-testwas used for the comparison of NAR and VASvalues.  A P value of < 0.05 was considered sig-nificant.  NAR values are given as median (in-terquartile range).ResultsThe 10 patients with nasal congestion associ-ated with perennial nasal allergy consisted of 7males and 3 females, aged between 9 and 38years (mean 19.1), with a baseline total NAR of0.27 Pa/cm3/s (0.14).Figure 1 illustrates the percentage changesin total NAR from baseline.  There was no sig-nificant difference in percentage changes intotal NAR at any time point during the study.Figure 2 illustrates the percentage changesin VAS score from baseline.  There were signifi-cant changes in VAS scores between baselineand the 2 min or 10 min time point (P < 0.05).0 2 4 6 8 10 12Time   Massage11010090807060% Change in VAS(%)(min)Fig. 2.  Mean percent changes in nasal sensation ofairflow (and SE bars) in 10 patients treated with na-sal massage.  The arrow represents the time oftreatment.  Nasal sensation of airflow was scored ona 100 mm visual analogue scale with the extremeslabeled “nose feels extremely clear” and “nose feelsextremely blocked.”  VAS, visual analogue scale.0 2 4 6 8 10 12Time   Massage1151101051009590% Change in NAR(%)(min)Fig. 1.  Mean percentage changes in total nasalairway resistance (and SE bars) in 10 patients treatedwith nasal massage.  The arrow represents the timeof treatment.  NAR, nasal airway resistance.The effects of nasal massage of the yingxiang point169DiscussionThe aim of the present study was to determine ifnasal massage of the yingxiang acupuncturepoint had any effect on NAR or sensation ofnasal airflow in patients with nasal congestionassociated with perennial nasal allergy.The measurement of sensation has proved adifficult task in many fields of human research,and nasal physiology is no exception.  The 100mm VAS which was used in this study was firstintroduced into medicine by Aitken who usedthe scale to investigate mood changes in airlinepilots and the degree of asphyxia in volunteersbreathing through mouth pieces of differentresistance (Aitken, 1964).  The VAS was intro-duced as an instrument to measure nasal sensa-tion of airflow in 1988 in a study on the effectsof D and L isomers of menthol on nasal sensa-tion of airflow (Eccles et al., 1988).  The VAS hassince been used in many similar experimentsand has become a standard measure of nasalsensation of airflow (Jones et al., 1989; Fairleyet al., 1993; Roithmann et al., 1994; Simola andMalmberg, 1997).The results for NAR show that there was nosignificant difference between pre- and post-massage.  However, the sensation of nasalairflow measured using VAS improved post-massage in all patients.  These findings, whentaken together, indicate that nasal massage mayprovide some relief from nasal congestion.  Na-sal massage could provide relief from nasalcongestion by stimulation of the branches of thetrigeminal nerve which supply the massagearea.  The infra-orbital branches of the trigemi-nal nerve have been implicated in serving thesensation of nasal airflow and the control ofsneezing (Davies and Eccles, 1985; Hensel etal., 1974; Wallois et al., 1991) so there is areasonable basis for hypothesizing that me-chanical stimulation of the branches of theinfra-orbital nerve could provide some relieffrom nasal congestion.The present study demonstrates that there isno relationship between the changes in objec-tive and subjective measures of nasal conges-tion used in the study.  This supports otherstudies which have found no correlation be-tween objective and subjective measures ofnasal congestion (Eccles et al., 1987; Naito etal., 1988; Sipila et al., 1995; Takeuchi et al.,1999).The results of this study when taken to-gether, indicate that nasal massage of the acu-puncture point may provide some relief fromnasal congestion and that further studies involv-ing a larger patient population are warranted toinvestigate the efficacy of nasal massage in thetreatment of nasal disease.References 1 Aitken RCB.  Measurement of feelings using vis-ual analogue scales.  Proc Royal Soc Med 1964;62:989–993. 2 Beijing College of Traditional Chinese Medicine.Essentials of Chinese acupuncture.  1st ed.Beijing: Foreign Language Press; 1980. 3 Davies AM, Eccles R.  The effects of nasal air-flow and menthol on the electromyographic ac-tivity of the anaesthetised cat.  J Physiol 1985;85:254. 4 Eccles R, Griffiths DH, Newton CG, Tolley NS.The effects of D and L isomers of menthol uponnasal sensation of airflow.  J Laryngol 1988;102:506–508. 5 Eccles R, Lancashire B, Tolley MS.  Experimen-tal studies on nasal sensation of airflow.  ActaOtolaryngol (Stockh) 1987;103:303–306. 6 Fairley JW, Durham LH, Ell SR.  Correlation ofsubjective sensation of nasal patency with nasalinspiratory peak flow-rate.  Clin Otolaryngol1993;18:19–22. 7 Hensel H, Andres KH, During MV.  Structureand function of cold receptors.  Pflugers Arch1974;352:1–10. 8 Jones AS, Willatt DJ, Durham LM.  Nasal air-flow: resistance and sensation.  J Laryngol Otol1989;103:909–911. 9 Naito K, Cole P, Chaban R, Oprysk D.  Nasal re-sistance, sensation of obstruction, and rhino-scopic findings compared.  Am J Rhinol 1988;2:65–69.10 Roithmann R, Cole P, Chapnik J, Barreto SM,Szalai JP, Zamel N.  Acoustic rhinometry, rhino-manometry, and the sensation of nasal patency:  acorrelative study.  J Otolaryngol 1994;23:454–458.11 Simola M, Malmberg H.  Sensation of nasalairflow compared with nasal airway resistance inpatients with rhinitis.  Clin Otolaryngol 1997;22:H. Takeuchi et al.170260–262.12 Sipila J, Suonpaa J, Silvoniemi P, Laippala P.Correlations between subjective sensation ofnasal patency and rhinomanometry in both uni-lateral and total nasal assessment.  ORL J Oto-rhinolaryngol Relat Spec 1995;57:260–263.13 Takeuchi H, Jawad M, Eccles R.  The effects ofnasal massage of the “yingxiang” acupuncture(Received April 20, Accepted May 10, 1999)point on nasal airway resistance and sensation ofnasal airflow in patients with nasal congestion as-sociated with acute upper respiratory tract infec-tion.  Am J Rhinol.  1999;13:77–79.14 Wallois F, Macron J M, Jounieaux V, Duron B.Trigeminal afferences implied in the triggering orinhibition of sneezing in cats.  Neurosci Lett1991;122:145–147.

The Effects of Nasal Massage of the Yingxiang Acupuncture Point on Nasal Airway Resistance and Sensation of Nasal Airflow in Patients with Nasal Congestion Associated with Perennial Nasal Allergy

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The Effects of Nasal Massage of the Yingxiang Acupuncture Point on Nasal Airway Resistance and Sensation of Nasal Airflow in Patients with Nasal Congestion Associated with Perennial Nasal Allergy

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