Magnets applied to acupuncture points as therapy--a literature review

By: Colbert, Agatha P.,Cleaver, James,Brown, Kimberly Ann,Harling, Noelle,Hwang, Yuting,Schiffke, Heather C.,Brons, John,Qin, Youping

Abstract

Objectives To summarise the acu-magnet therapy literature and determine if the evidence justifies further investigation of acu-magnet therapy for specific clinical indications.

Methods Using various search strategies, a professional librarian searched six electronic databases (PubMed, AMED, ScienceDirect College Edition, China Academic Journals, Acubriefs, and the in-house Journal Article Index maintained by the Oregon College of Oriental Medicine Library). English and Chinese language human studies with all study designs and for all clinical indications were included. Excluded were experimental and animal studies, electroacupuncture and transcranial magnetic stimulation. Data were extracted on clinical indication, study design, number, age and gender of subjects, magnetic devices used, acu-magnet dosing regimens (acu-point site of magnet application and frequency and duration of treatment), control devices and control groups, outcomes, and adverse events.

Results Three hundred and eight citations were retrieved and 50 studies met our inclusion criteria. We were able to obtain and translate (when necessary) 42 studies. The language of 31 studies was English and 11 studies were in Chinese. The 42 studies reported on 32 different clinical conditions in 6453 patients from 1986-2007. A variety of magnetic devices, dosing regimens and control devices were used. Thirty seven of 42 studies (88%) reported therapeutic benefit. The only adverse events reported were exacerbation of hot flushes and skin irritation from adhesives.

Conclusions Based on this literature review we believe further investigation of acu-magnet therapy is warranted particularly for the management of diabetes and insomnia. The overall poor quality of the controlled trials precludes any evidence based treatment recommendations at this time.

Keywords Acu-magnet therapy, static magnetic field, dosimetry, permanent magnet, acupuncture points.

Introduction

As part of clinical practice, acupuncturists often apply magnets to acupuncture points as either an adjunct to needling or as a stand alone therapy.(1-4) Magnets (gold plated or non-plated 800 Gauss magnets) are often left on key acupuncture points after an acupuncture needle treatment with the intention of prolonging the therapeutic effect. Stronger magnets (3000 Gauss) may be used with or without an electromagnetic device as the primary treatment in lieu of needling. (5) Practitioners of magnetotherapy teach patients to apply magnets to various body parts as a self care intervention for a number of conditions. (6-8) Although site of magnet placement is presumably an important therapeutic consideration, a recent critical review of static magnetic field (SMF) dosing parameters found that the optimal site for magnet placement on the body has not been determined. (9) However, in 5 of 56 studies reviewed, when magnets were explicitly placed on tender points or trigger points, (10-14) positive outcomes were consistently reported, whereas mixed outcomes were reported in studies in which magnets were simply applied to 'where it hurts'. Like myofascial trigger points, acupuncture points are believed to be responsive to physical or electrical inputs such as needling, (15) transcutaneous electrical stimulation, (16) ultrasound and digital massage, (17) moxibustion, (19) laser treatments, '8 and other electromagnetic therapies. (19)

Paralleling the growing popular use of magnets, biological mechanisms including influences on blood flow, (20) microvascular remodelling, (21) oedema reduction" and blockade of sensory neurons (23) have been identified as providing biological plausibility for the potential therapeutic benefits of static magnetic fields. If the application of permanent magnets does exert a physiological effect, especially when applied to electromagnetically active sites such as acupuncture points or trigger points, it seems appropriate to evaluate the practice of acu-magnet therapy and begin relevant research to determine its effectiveness.

Our two goals in conducting this literature review are to summarise the acu-magnet therapy literature and determine if current evidence justifies further investigation of acu-magnet therapy for particular clinical indications. We define 'acu-magnet therapy' as stimulation of an acupuncture point with a static magnetic field (SMF) that is generated by a permanent magnet.

Methods

We surveyed the journal literature to identify clinical studies involving the use of magnets applied to acupuncture points in humans. A professional librarian (NH) searched six electronic databases, including PubMed, AMED, ScienceDirect College Edition, China Academic Journals, Acubriefs, and the in-house Journal Article Index maintained by the Oregon College of Oriental Medicine Library. Each database was searched from inception. All searches occurred in December 2007, with two exceptions. Acubriefs was searched in January 2008. The China Academic Journals search was conducted in February 2006 for a closely-related study and could not be rerun in December 2007 due to loss of database access.

We employed various search strategies depending on the size and scope of the database. In one case, a simple keyword search using the term 'magnet' was sufficient to retrieve relevant articles with reasonable precision and recall. In most cases, a more sophisticated strategy involving multiple synonyms for permanent magnet--and acupuncture-related concepts, subject headings, truncation, and excluded terms was required (details available from author). The primary author examined the resulting 308 references to identify articles for analysis, screening by title, abstract when it was available, and full text where necessary.

Inclusion and exclusion criteria

We selected studies for inclusion using the following criteria. Study design--clinical trials, case series and case reports were all included because our goal was to summarise as much of the clinical literature as possible. Clinical indication--we included studies involving any clinical diagnosis or medical condition in humans. Type of magnetic field therapy--only studies involving the stimulation of acupuncture points by application of permanent magnets were included. Studies reporting on electroacupuncture and transcranial magnetic stimulation were excluded. We also excluded experimental and animal studies.

Publication type--duplicate publications were excluded. Editorials and letters were excluded because they fail to provide sufficient information with which to evaluate acu-magnet treatment parameters. Only English and Chinese language articles were included. Eighteen additional articles in Chinese met our inclusion criteria but were ultimately excluded from analysis either because the full text article could not be obtained or due to our limited resources for full and accurate translation.

Data extraction and synthesis

Six acupuncture researchers extracted data from the final 42 studies on: clinical condition, study design, number, age and gender of subjects, magnetic devices used, acu-magnet dosing regimen, control devices and/or control groups, outcomes, and adverse events. The authors summarised the extracted data. A synthesis of the controlled trials and observational studies is provided in Tables 1 and 2.

Results

Of the 42 articles reviewed, (24-65) 31 were published in English and 11 in Chinese. Thirty four studies were conducted in China, five studies in the USA and three in Finland. All studies were published between 1986 and 2007. Five of the total 34 authors contributed more than one article. Articles appeared in 12 journals, 10 of which were Chinese medicine or acupuncture journals. The remaining two were Western medical journals.

Thirty two clinical indications were evaluated in the 42 studies. Three studies were conducted on insomnia in the elderly. (52;54;55) Two studies each were conducted on diabetes, (27;46) obesity, (56;61) hypertension, (26;32) temporomandibular joint disorder, (36;39) depression, (28;64) chemotherapy induced vomiting (44;45) headache (58;59) and gallbladder disease. (42;47) Single studies were conducted on stroke, (38) facial paralysis (40) benign prostatic hyperplasia, (41) hyperlipidaemia, (65) hiccup, (31) pinworms, (62) chronic leg ulcers, (35) phantom limb pain, (57) pseudocyst, (63) magnets as an adjunct anesthetic, (33) and various psychiatric and neurological disorders, (37;43;49-51) musculoskeletal, (30;48;53) and women's health conditions. (24;25;34;60)

Study designs

We included all research study designs in this review because our intent was to provide a comprehensive summary of the available literature and generate hypotheses for further research. We identified an equal number of case series (or case reports) and controlled trials. The controlled trials were of consistently poor quality as defined by the Jadad scale. (66) The only Jadad criterion met by the studies was the use of words such as 'random', 'randomly' or 'randomised.'

Demographics

The total number of subjects reported in the 42 studies was 6453, with 3101 males, 2791 females, and 561 subjects whose gender was not described. Age of study participants varied from 7 years to greater than 82 years. The majority of the studies (30 out of 42, or 71%) involved fewer than 100 subjects: 16 studies had 50 or fewer subjects, and 14 had between 51 and 100 subjects. Only two studies (both case series) were of a large scale. Li et al reported on 1500 patients with peripheral facial paralysis, (40) and He et al (29) described the results of acumagnet needling in 808 subjects (the majority were paediatric patients) with a wide variety of conditions. Except for gender specific disorders (eg labour pain, (34) prostate disorders (41)) studies included participants of both genders.

Outcomes

The majority of studies (37 out of 42, or 88%) reported positive outcomes. Only one study reported no benefit. (24) Patients in that study experienced no improvement or a worsening of hot flush symptoms associated with magnet application. The results of another study involving patients with migraine headache were inconclusive because of a high dropout rate; 7 of 13 participants dropped out because of poor outcomes or adverse reactions. (59) In three controlled trials, that studied the effects of magnets on high blood pressure, (32) temporomandibular joint disease, (39) and hyperlipidaemia, (65) improvement was observed in both the active and control groups, with no significant difference between groups.

Magnets: devices, materials, strengths, polarities and methods of application

Forty of the 42 studies provided at least partial descriptions of the magnetic devices applied, which included three types of magnets: flat rectangular or circular discs, beads or pellets, and magnetic acupuncture needles. Many studies neglected to report material composition of magnets and/or magnetic field strengths. In other studies there was ambiguity as to whether the reported strength was the manufacturer's Gauss rating (the internal core strength of the magnet) or the surface field strength. Surface field strengths of therapeutic magnets usually range between 300E to 2500E In two instances, (48;65) the magnetic intensities were reported respectively as 8000E and 5000E which we assume were the manufacturer's Gauss ratings rather than the surface field strengths.

Of 20 studies using plates or discs, 14 reported dimensions and magnetic strengths. Seven studies used circular discs ranging from 1.5 to 7mm in diameter and 1-2.5mm in thickness. Seven studies used rectangular or square plates varying between 8-50mm in length and 2-7mm in thickness. Magnetic beads or pellets were used in 12 studies, of which eight provided dimensions and six provided magnetic field strengths. Diameters ranged from 0.3-13mm and magnetic strengths ranged from 50E to 3000E Eight studies used magnetic acupuncture needles made of rare earth metals. Tip dimensions were not given but were assumed to be similar to typical Chinese acupuncture needles. Five studies reported magnetic needle strengths of 180E to 5000E

Only 7 of 42 studies mentioned which pole of the magnet faced the skin. Terms such as 'alternating pole magnets (24) or 'disparate poles (38) or 'north pole' (31;35,44;64) were used without a precise definition of terms. A commonly held belief among clinicians is that different magnetic pole applications lead to different outcomes, but this belief has not been tested in any clinical trials. Furthermore there is no established naming convention among clinicians for defining north and south poles.

Methods of magnet application were not described in 18 of 42 (43%) of studies (Table 3). When reported, discs, plates and beads or pellets were most often attached to the skin with adhesive tape. In two cases, the disc or beads were rotated above the skin without physical contact. (47;50) Magnetic acupuncture needles were either inserted 0.5-1.5 can depending on location, (31;61;65) or simply touched the skin without penetration. (30;43) In four studies, magnets were sewn into garments and worn at the desired location. (28;44;45;62) In one instance, children drank magnetised water to treat ascariasis. (62)

The sites for magnet application also varied (Table 4). Many researchers (48%) applied magnets to auricular (ear) acupuncture points. The ear acupuncture points most often used were Shenmen, Kidney, Liver, and Occiput. Body and scalp acupuncture points were also stimulated, as were local and distal points in accordance with acupuncture diagnostic theory. The choice of acupuncture points varied depending on clinical indication.

Frequency and duration of magnet application

There was no standard protocol for frequency or duration of magnet application in the studies reviewed. In the case series, durations of application varied from 1-3 minutes (30) to near continuous wear for several years. (27;49) In the controlled trials, frequency of application varied from a continuous 72 hour wear to continuous 30 day wear with removal and replacement of magnets every 2-3 days.

Control devices and control groups

The most common sham control device used in the controlled trials was a non-magnetic needle or ear seeds, applied to the same points as the magnetic needles or magnets. Non-magnetised metal objects were also used as controls as were herbs and vitamins. Magnetic devices were sometimes applied to non acupuncture sites or non-magnetised discs to non-acupuncture sites.

Magnets as adjunct to standard care

Although not always specifically described as such, in more than half the studies, magnets appear to have been used as an adjunct to standard care. In some cases magnets were applied in addition to acupuncture needling, moxibustion or Chinese herbs. Magnets on acupuncture points served as an adjunct to standard care for diabetes management, (27;46) antihypertensive therapy, (26) antiemetic therapy (44;45) and antipsychotic therapy. (51) In studies of insomnia in the elderly, magnets served as a stand alone therapy. (52;54)

Adverse events

Adverse events included an exacerbation of hot flushes (24) and skin irritation due to the adhesives that held the magnets to the body. (52)

Discussion

Our goals in conducting this literature review were: 1) to summarise the outcomes and techniques of various acu-magnet intervention studies that have been published to date, primarily in English; and 2) to identify clinical conditions with positive outcomes, and assess whether a rigorous investigation of acu-magnet therapy for specific conditions is warranted. The most striking observation from this review was the overwhelmingly positive outcomes reported. A note of caution is that 34 of the 42 studies evaluated were conducted in China where there is a significant bias toward publishing positive trials." In addition, the studies were either case series or poor quality controlled trials, so no claims for the efficacy of acu-magnet therapy can be made at this time. Nonetheless, the large number of subjects (a total of 6453) in these studies suggests that many patients are treated with acu-magnet therapy in clinical practice, particularly in China, and report meaningful clinical improvement.

The single N of 1 study warrants special comment. (27) When evaluating clinical benefit for an individual patient, the N of 1 randomised controlled trial ranks highest in terms of evidence based hierarchy for that individual. An N of 1 controlled trial, involves the use of a crossover design to treat a single patient. In random order, the patient receives one period of active therapy and one period of placebo. The patient is kept blind to allocation, and treatment outcomes are monitored. In her N of 1 study, Chen used ear acu-magnet therapy, as an adjunct to standard care, to treat a patient with long standing diabetes mellitus. (27) The study looked at fasting blood glucose levels as the primary outcome measure. For seven days placebo discs were applied to the pancreas point of the left ear and the thalamus points of both ears. Then after a three day washout period, 2500G magnetic discs were applied to those same auricular acupuncture points. Results of this trial showed that fasting blood glucose during the placebo week was 194[+ or -]15mg/dL. During the active magnet week, fasting glucose dropped to 136[+ or -]10mg/dL. Having determined that auricular magnets applied to this patient using this dosing regimen were effective, the clinician researcher then used magnetic ear clips for ongoing treatment as an adjunct to standard diabetes management. At four year follow up, evaluation of this patient showed a persistent decrease in fasting blood glucose and HbAIC with no further progression of the patient's diabetic neuropathy.

We believe that the preliminary evidence for two conditions, insomnia in elderly patients (52;54) and glucose control in diabetics, (27) justify further clinical trials to evaluate the effectiveness of acu-magnet therapy. The studies of Suen et al (52;54) and Chen 21 should be replicated as the first step in this program of research on acu-magnet therapy.

Information gained from this review will help to guide protocol development for future studies. Of particular relevance to future trials is the fact that adverse reactions associated with acu-magnet therapy were reported in only two studies. In one study, high intensity magnets (surface field strength ~2000G) were left on six clinically 'powerful' acupuncture points for 72 hours, to treat hot flushes. (24) Participants in this study had an exacerbation of their hot flush symptoms. An important lesson learned is that dosing parameters such as number of acupuncture points to treat simultaneously, the strength of the magnet and duration of magnet application should be tested and optimised prior to conducting a clinical trial. Skin irritation associated with the adhesive securing the tape may need to be considered when adverse reactions are encountered.

Acu-magnet therapy research shares many of the methodological challenges faced by acupuncture research in general. At a minimum, a rationale for acu-point selection and style of acupuncture used, need to be justified. Acupuncture points might be selected for a number of reasons including: following traditional Chinese medicine theory or Japanese style acupuncture or treatment of ah shi or trigger points, or using one of the acupuncture microsystems such as Korean hand acupuncture, scalp acupuncture or auriculotherapy. The acupuncture points should be described with the standard nomenclature of the World Health Organisation. (68)

Specifics of treatment, including the magnetic device itself (material composition, strength, dimensions and polarity) and the SMF dosing regimen should be detailed. The exact dosing regimen should include the site and method of magnet application, and frequency and duration of application. The dosing regimen should be pretested, optimised and precisely documented. We discovered in this review that the most lasting beneficial effects were associated with long term magnet use. (27;28;49;55) When magnets are applied for a prolonged time period or when patients self-apply magnets, the small magnetic discs may be secured to the skin via earrings or clips (in the case of auricular points) or sewn into a garment to be worn over the acu-point. If, on the other hand, high intensity magnets are applied during an in-office treatment, the method of application may be a needle, a stronger magnet or perhaps an electromagnetic device.

Polar configuration of the magnet(s) used is a special concern in the acupuncture paradigm as acupuncturists may use north and south poles on a pair of acupuncture points to either 'tonify' or 'disperse'. Terminology used to describe the poles of magnets is confusing in the literature. The term bionorth is used by some clinicians to describe what physicists denote the south pole of a magnet, ie the side of the magnet that attracts the south seeking needle of a compass. For clarity of meaning and consistency of reporting, we recommend that authors state which pole faced the skin and then define that pole with reference to a compass and/or a geographic pole. For example, one might report 'we applied the 'north' pole of the magnet to the skin and we define the 'north pole' as that side of the magnet that attracts the north seeking compass needle.' Or researchers might also report, 'When suspended by a string, the side of the magnet that faced the skin orients itself to face the earth's geographic south pole'.

Blinding subjects in acu-magnet therapy trials is problematic because magnetic properties are readily detected, making it easy for trial participants to deliberately or unintentionally discover whether their device is magnetised or not. We may not be able to use low strength magnets as sham controls because we still do not know the minimal effective dose of SMF therapy. Effects have been reported with magnets having field strengths as low as 66G. (55) Another potential control device used in some studies is semen vaccariae, a small seed which the investigators assumed to have no therapeutic effect as long as no pressure was applied to it, semen vaccariae, however, is considered a significant blood 'vitaliser' by Chinese herbalists, which may preclude its use as a sham control. Non-acupuncture sites may also be used as sham controls; however, many so-called 'sham points' have a physiological effect when stimulated with a needle. It is unclear whether or not a SMF placed anywhere on the skin might also have an effect.

Strengths and limitations of this review

The primary strength of our literature review is that it organises and summarises the available literature on acu-magnet therapy. No previous reviews of the acu-magnet literature have been conducted. Another strength is our sampling of related Chinese language literature. The limitations pertain to being unable to access other language literature, especially Japanese. Acu-magnet therapy is commonly practised in Japan. We also acknowledge the limitation of having no access to EMBASE, an electronic database where much of the European literature is found. We consider this project a first step toward developing a more rigorous program of research into acu-magnet therapy.

Future directions

This review has generated a number of questions to be answered in future clinical trials. These questions are summarised in Table 6. We recently initiated a small pilot study in an attempt to replicate Chen's findings of improved glucose control in diabetic patients with the use of ear acu-magnets (27) Our study intends to evaluate the use of non-magnetized pellets as sham controls. We will assess a dosing regimen of between 3-5 magnets (800G surface field strength, north pole facing the skin) applied for a one week period. If our findings show promise we will move forward with a full scale randomised controlled trial using magnets and sham controls to assess the efficacy of acu-magnet therapy as an adjunct to standard care for Type 2 diabetes mellitus. If our findings are negative we will conduct another pilot study using an alternate SMF dosing regimen.

Conclusions

In the absence of any consistent terminology we coined the term acu-magnet therapy to describe the application of magnets on acupuncture points as a distinct modality. We believe that further investigation of acu-magnet therapy as an adjunctive treatment for diabetes and for insomnia in the elderly is warranted based on findings from this review. Future trials should be rigorously conducted according to STRICTA (69) and CONSORT (70) guidelines, while paying special attention to the unique methodological and dosimetry issues associated with static magnetic field therapy. (9) The overall poor quality of the studies in this review precludes any evidence based treatment recommendations at this time.

Conflict of interest

The authors report no conflict of interest with any of the material presented in this manuscript.

Sources of Support

This study was funded in part by the National Center for Complementary and Alternative Medicine, National Institutes of Health (R21 AT003293).

Summary box
Many practitioners apply magnets to acupuncture points as
therapy

This study systematically reviewed all the available clinical
trials

37 out of 42 studies reported therapeutic benefit of
magnets

The quality of the evidence is not sufficient to make
treatment recommendations

The positive findings are sufficiently interesting to justify
further research

Reference list

(1.) Matsumoto K, Birch S. Hara Diagnosis: Reflections on the Sea. Brookline: Paradigm Press; 1988.

(2.) Manaka Y, Itaya K, Birch S. Chasing the Dragon's Tail. Brookline: Paradigm Press, 1995.

(3.) Loo M. Pediatric acupuncture modalities and treatment protocols. Pediatric Acupuncture. London: Churchill Livingstone; 2002. p. 102-106.

(4.) Owen L. Magnets and Acupuncture. Pain Free with Magnet Therapy. Roseville, CA: Prima Health; 2000. p. 154-174.

(5.) Matsumoto K, Enter D. Magnets. Kiiko Matsumoto's Clinical Strategies in the Spirit of Master Nagano. Natick, MA: Kiiko Matsumoto International; 2002. p. 451-453.

(6.) Hannemann H. Magnet Therapy: Balancing Your Body's Energy Flow for Self-Healing. New York: Sterling Publishing Co Inc; 1990.

(7.) Kahn S. Healing Magnets: a Guide for Pain Relief, Speeding Recovery; and Restoring Balance. New York: Three Rivers Press; 2000. p. 103-106.

(8.) Rose P. The Practical Guide to Magnet Therapy. New York: Sterling Publishing; 2001.

(9.) Colbert A, Wahbeh H, Harking N, Connelly E, Schiffke H, Forsten C, et al. Static magnetic field therapy: a critical review of treatment parameters. Evidence-based Complementary and Alternative Medicine 2007; doi: 10.1093/ecam/nem131.

(10.) Vallbona C, Hazlewood CF, Jurida G Response of pain to static magnetic fields in postpoho patients: a double-blind pilot study. Arch Phys Med Rehabil 1997;78(11):1200-3.

(11.) Holcomb RR, Worthington WB, McCullough BA, McLean MI. Static magnetic field therapy for pain in the abdomen and genitals. PediatrNeurol 2000;23(3):261-4.

(12.) Brown CS, Ling FW, Wan JY, Pilla AA. Efficacy of static magnetic field therapy in chronic pelvic pain: a double-blind pilot study. Am J Obstet Gynecol 2002;187(6): 1581-7.

(13.) Kanai S, Taniguchi N, Kawamoto M, Endo H, Higashino H. Effect of static magnetic field on pain associated with frozen shoulder. The Pain Clinic 2004;16(2):173-9.

(14.) Panagos A, Jensen M, Cardenas DD. Treatment of myofascial shoulder pain in the spinal cord injured population using static magnetic fields: a case series. J Spinal Cord Med 2004;27(2):138-42.

(15.) Baldry P. Acupuncture, trigger points and musculoskeletal pain. 2nd ed. London: Churchill Livingstone; 1993.

(16.) Chee EK, Watson H. Treatment of trigger points with microamperage transcutaneous electrical nerve stimulation (TENS)-(the Electro-Acuscope 80). J Manipulative Physiol Ther 1986;9(2):131-4.

(17.) Lavelle ED, Lavelle W Smith HS. Myofascial trigger points. Med Clin North Am 2007;91(2):229-39.

(18.) Whittaker P. Laser acupuncture: past, present, and future. Lasers Med Sci 2004;19(2):69-80.

(19.) Kroeling P, Gross AR, Goldsmith CH. Cervical Overview Group. A Cochrane review of electrotherapy for mechanical neck disorders. Spine 2005;30(21):E641-8.

(20.) McKay JC, Praco FS, Thomas AW. A literature review: the effects of magnetic field exposure on blood flow and blood vessels in the microvasculature. Bioelectromagnetics 2007;28(2):81-98.

(21.) Morris CE, Skalak TC. Chronic static magnetic field exposure alters microvessel enlargement resulting from surgical intervention. J Appl Physiol 2007;103(2):629-36.

(22.) Morris CE, Skalak TC. Acute exposure to a moderate strength magnetic field reduces edema formation in rats. Am J Physiol Heart Circ Physiol 2008;294(1):H50-7.

(23.) McLean MJ, Holcomb RR, Ward AW, Pickett JD, Cavopol AV. Blockade of sensory neuron action potentials by a static magnetic field in the 10 mT range. Bioelectromagnetics 1995;16(1):20-32.

(24.) Carpenter JS, Wells N, Lambert B, Watson P, Slayton T, Chak B, et al. A pilot study of magnetic therapy for hot flashes after breast cancer. Cancer Nursing 2002;25(2):104-9.

(25.) Chen M. Treatment of urinary retention with auriculomagnefc therapy. Int J Clin Acupunct 1994;5(4): 501-502.

(26.) Chen X, Li M, Liao X. Analysis of magnetic treatment to ear points in 121 cases of hypertension. The Voice of Acupuncture 1994;1(3):13-14.

(27.) Chen Y. Magnets on ears helped diabetics. Am J Chin Med 2002;30(1):183-5.

(28.) Colbert A. Magnets on Sishencong and GV20 to treat depression: clinical observations in 10 patients. Medical Acupuncture 2000;12(1):20-24.

(29.) He J. Clinical application of rare-earth magnetic needle: a report of its use in 808 patients. Int J Clin Acupunct 1993;4(2):117-122.

(30.) Hou S, Meng M, Cao H. The rapid and remarkable therapeutic effect of adjustable magnetic blunt-tip needles on periarthritis. Int J Clin Acupunct 1990;1(3):305-306.

(31.) Huang W, Xing H. Magnetic needle in treatment of hiccup: an observation of 56 cases. Int J Clin Acupunct. 1997;9(2):175-177.

(32.) Jiang X. Effects of magnetic needle acupuncture on blood pressure and plasma ET -1 level in the patient of hypertension. J Tradit Chin Med 2003;23(4):290-1.

(33.) Jiang J. [Clinical study and application of auricular magnet anesthesia for the operation of the thyroid]. Zhen Ci Yon Jiu 1995;20(3):4-8.

(34.) Jin Y, Wu L, Xia Y. [Clinical study on painless labor under drugs combined with acupuncture analgesia]. Zhen Ci Yan Jiu 1996;21(3):9-17.

(35.) Liang Y. Observation on histopathology. Zhonghua Li Liao Za Zhi 1994:24-25.

(36.) Li J, Li Y. Observation on magnetic therapy on temporomandibular disorder, 66 cases. Chin Acupunct Moxibust 2003;23(2).

(37.) Li Z, Jiao K, Chen M, Wang C. Effect of magnitopuncture on sympathetic and parasympathetic nerve activities in healthy drivers--assessment by power spectrum analysis of heart rate variability. Eur J Appl Physiol 2003;88 (4-5):404-10.

(38.) Lian H, Kong L, HuWei S, Zhou Y, Zhan C43. Li Z, Jiao K, Chen M, Wang C. Reducing the effects of driving fatigue with magnitopuncture stimulation. Acrid Anal Prev 2004;36(4):501-5.

(44.) Liu S, Wang Z, Chen Z, Hou J, Zhang X. Magnetotherapy of neiguan in preventing vomiting induced by cisplatin. Int J ClinAcupunct 1997;8(1):39-41.

(45.) Liu S, Chen Z, Hou J, Wang J, Wang J, Zhang X. Magnetic disk applied on Neiguan point for prevention and treatment of cisplatin-induced nausea and vomiting. J Tradit Chin Med 1991;11(3):181-3

46.) Ma R, Wei Z. The analysis of 30 patients with diabetes mellitus examples assistant remedied with magnetic-therapy. Chin J Convalescent Med 1999;8(3):9-10.

(47.) Mao R, Li N. Treatment of cholelithiasis by stimulating gallbladder area with rotary magnetic field: a report of 491 cases. IntJ ClinAcupunct 1996; 7(3):273-280.

(48.) Mao R, Li N. Treatment of soft tissue injury with a magnetic blade. Int J ClinAcupunct 1996;7(3):279-280.

(49.) Petterson E. Earring auriculotherapy for congenital nystagmus. Medical Acupuncture 2004;16(1):43-45.

(50.) Shan L. Magnetic acupuncture therapy for treatment of neurasthenia. Am J Acupunct 1986;14(1):51-53.

(51.) Smith M, Mortenson M. Use of magnetic beads in treating serious childhood psychiatric disorders. J Complement Altern Med 2004:10(1):220.

(52.) Suen L, Wong T, Leung A. Auricular therapy using magnetic pearls on sleep: a standardized protocol for the elderly with insomnia. Clin Acupunct Orient Med 2002;3:39-50.

(53.) Suen LK, Wong TK, Cheng JW Yip VY. Auriculotherapy on low back pain in the elderly. Complement Ther Clin Pract 2007;13(1):63-9.

(54.) Suen LK, Wong TK, Leung AW Effectiveness of auricular therapy on sleep promotion in the elderly. Am J Chin Med 2002;30(4):429-49.

(55.) Suen LK, Wong TK, Leung AW, lp WC. The long-term effects of auricular therapy using magnetic pearls on elderly with insomnia. Complement Ther Med 2003;11(2):85-92.

(56.) Tong S, Zang J, Zang M. Treatment of obesity by integrating needling, cupping and magnetic therapy: a report of 356 cases. Int J Clin Acupunct 1994;5(3):337-339.

(57.) Toysa T. Phantom limb pain responds to distant skin magnets: support for the functional existence of acupuncture meridians. Acupunct Med 1998;16(2):106-10.

(58.) Toysa T. The treatment of migraine by skin magnets to acupoints on the legs. Acupunct Med 1995;13(1):51-3.

(59.) Toysa T. Headache treated with magnets on the peroneal zone of the legs. Acupunct Med 1997;15(2):112-3.

(60.) Wang Z, Wang X, Wang S. Correction of pelvic presentation by magnetic bead attached to ear points a clinical report of 45 cases. IntJ ClinAcupunct 1997;9(2):221-223.

(61.) Wang B, Lei F, Cheng G Acupuncture treatment of obesity with magnetic needles--a report of 100 cases. J Tradit Chin Med 2007;27(1):26-7.

(62.) Wu J. Further observations on the therapeutic effect of magnets and magnetized water against ascariasis in children-analysis of 114 cases. J Tradit Chin Med 1989;9(2):111-2.

(63.) Zhao H, Gu Y. Investigation on effect of treatment of auricle pseudocyst with flat-thin magnet. Bull Science Technol 2002;18(5):17-18.

(64.) Zhang G, Ruan J. Treatment of mental depression due to fiver-qi stagnancy with herbal decoction and by magnetic therapy at the acupoints--a report of 45 cases. J Tradit Chin Med 2004;24(1):20-1.

(65.) Zhang L, Sheng L. Research on the therapeutic effect of magnetic needle therapy on hyperlipidemia. Int J Clin Acupunct 2006;15(4):227-231.

(66.) Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 1996;17(1):1-12.

(67.) Vickers A, Goyal N, Harland R, Rees R. Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials 1998;19(2):159-66.

(68.) World Health Organisation. Standard Acupuncture Nomenclature. 2nd ed. Manila: World Health Organization; 1993.

(69.) MacPherson H, White A, Cummings M, Jobst K, Rose K, Niemtzow R. Standards for reporting interventions in controlled trials of acupuncture: The STRICTA recommendations. Acupunct Med 2002;20(1):22-5.

(70.) Altman DG, Schulz KF, Moher D, Egger M, Davidoff F, Elbourne D, et al. The revised CONSORT statement for reporting randomized trials: explanation and elaboration. Ann Intern Med 2001;134(8):663-94.