Laser Acupuncture Therapy(LAT)
bySteve Liu, L.Ac.
CSOMA 2001 Summer Expo
San Francisco, California
August 5, 2001


Part A - LLLT vs. LAT: An Overview

LLLT - Low-Level Laser Therapy refers to biostimulation with lasers that are painless, noninvasive, and DO NOT burn tissue.
These lasers are considered "investigational", class IIIb laser device by the Food and Drug Administration (FDA) - no medical claims of cures are permitted in the U.S.

Laser output powers used in LLLT are between 5 and 500 mW - Class IIIb.
First laser was developed in 1960 by Theodore Maiman, of Howard Hughes Aircraft Laboratories.

The late Endre Mester, M.D. of Budapest, Hungary is the founder of LLLT.

Synonymous Terms used in LLLT: photobiostimulation, photoradiation, biostimulation, or photobiomodulation - modulate and normalize.

Extensive researches on LLLT since 60s in, to name a few, China, Russia, Spain, and Germany.

Common LLLT applications : non-healing wounds, acute and chronic pain conditions.

The general mechanism underlying the therapeutic effect of LLLT is not fully understood (i.e. how photobiomodulation works).

It is believed the LLLT promotes increased production of adenosine triphosphate (ATP) by the mitochondria, thus improving cellular respiration and function. Other effects of LLLT include synthesis and repair of DNA and RNA, and increased collagen production.

In 1998 WALT (World Association for Laser Therapy Meeting) in Kansas City a paper reviewed the safety of LLLT and found that with more than 30 years of application and study in both humans and animals, no permanent or long-term side effects have been reported. More than 100 research papers on LLLT were presented at the meeting.

When LLLT is applied on acupuncture points - LAT (Laser acupuncture Therapy) and its researches and treatments mainly were found in China, Spain, Germany, Austria, Czech Republic, Hungary, Russia, and Finland, to name a few. In these countries, laser acupuncture is used to treat various disorders including mild-moderate paralysis in adult stroke patients, spasticity and paralysis in babies and children (cerebral palsy), carpal tunnel syndrome, and Parkinsonõs.

In U.S. Dr. Margaret Naeser, Ph.D., Lic.Ac., Dipl.Ac., a research professor of Neurology, Boston University School of Medicine, and a licensed acupuncturist in Massachusetts, who has been doing research since 1984 and has published a textbook and many papers on the related topics. She has developed a LAT protocol for hand ailments: carpal tunnel, mild hand paresis, "fisted hand" in flexion, Raynaud's, peripheral neuropathy, R.A. or O.A. and a LAT protocol for foot ailments: peripheral neuropathy, poor circulation to the feet, "foot drop".

With the primary LAT and microamps treatment protocol in a private clinic in Massachusetts, 33 out of 36 cases were successfully treated.

Controlled LAT research is possible because it produces no sensation in the patient.

Part B - Introduction to terminology, laser, and device


In this lecture Laser refers to (all synonymous terms):
low-level Laser
low-energy laser
cold laser
diode laser
semiconductor laser

L.A.S.E.R. is an acronym for Light Amplification by Stimulated Emission of Radiation

Stimulated Emission - Emission in the form of a photon (a quantum of electromagnetic energy - generally regarded as a discrete particle having zero mass, no electric charge, and an indefinitely long life time) is generated when an electron makes a transition from an upper to a lower energy level (state). The electrons are stimulated to produce additional photons in a laser because the photons are partially "trapped" in a optical cavity to build the optical wave through positive feedback. In a laser light the radiation is considered to be coherent since all the emitted photons are in phase both in temporal and spatial planes, just like a perfectly synchronized dance troop. Hence, the laser light is monochromatic or one color.

Radiation - refers to the emission of photons. The type of radiation emitted from low-energy lasers in the red or infrared wavelength range is non-ionizing radiation, not known for cancer-causing. The photons emitted with very short wavelength, such as gamma rays, x-rays, or ultraviolet rays in the sunlight, are cancer causing.

3 must-know parameters: power, wavelength, and energy density

1) Power - refers to emission power. A laser emits more or fewer photons according to its emission power; the more energy per second, or photons, it emits, the more powerful it is (and more $ it costs).

Introducing Watt (power unit) and Joule (energy unit):

The Formula: 1 Watt (P) = 1 joule (E) / second (t) P = E / t or E = P x t

The low-energy laser in this lecture refers to lasers which are 5 to 20 milliwatts (mW) in emission power. One milliwatt is one-thousandth of a watt. When a 5 to 20 mW laser beam is shown onto the skin, it produces no heat, no cold, no pain. A laser will begin to burn the skin when it is 500 mW and it produces pain. The cutting lasers used in surgery are often above 300 watts; some vaporize the tissue away. Again, in laser acupuncture therapy we use emission power between 5 and 20 mW or 0.005 to 0.02 watts.

2) Wavelength - When a periodic variation is considered with respect to distance, one cycle includes the wavelength, which is the length of one complete wave or cycle. The visible lights (i.e. red, orange, yellow etc.) that our eyes can see are between 400 nanometer (nm) and 800 nm. Ultraviolet is below 400 nm and infrared above 800 nm. Most wavelengths of low-energy lasers used in the LAT are in the 600 - 1000 nm range, or red to infrared. The wavelengths in the visible spectrum do not cause cancer.
Introducing nanometer (nm): 1 nm = 1 billionth of a meter and 1 meter = 39.37 inches

3) Energy Density - Often a "dosage" of a particular LAT is expressed in the terms of energy density, or energy ( in joules) / area (in cm2) or E/A or
(P x t)/ A where the area (A) is the beam spot size of the laser. Usually the
area can be approximated by the laser probe tip aperture (ie. The opening of the tip)

The formula for the calculation of the area A = 3.14 x r2 where r is the radius of the laser beam

The following formula is used to calculate the necessary time to produce 1 joule/cm2:
(Output Power in Watts x Seconds)/Beam Area in cm = 1 joule/cm2
or (P x t )/ A = 1 J/ cm2

With a 5 mW Laser (0.005 Watts), P = 0.005
with a 5 mm( about 2 tenth of an inch) diameter aperture on the probe tip, the Beam Spot Size is 0.196 cm2 (use formula A = 3.14 x r2 )

The necessary time to emit 1 Joule per cm2 (Energy Density) is computed as follows:
(0.005 Watts) x (X Seconds) / 0.196 cm2 = 1 Joule/cm2 0.005 X = 0.196 cm2
X = 0.196 / 0.005
X = 39.2 Seconds

It means it takes about 40 seconds of treatment time to obtain one joule of energy using a 5 mW laser with a 5 mm diameter of probe tip opening !
Thus, if a specific dosage for a treatment calls for 4 joules/cm2 and still use the laser probe from above, the treatment time then will be about 160 seconds (4 x 40 seconds)

*Remember for a given power density and aperture, if you double the laser power, you halve the treatment time! And for a given laser power and aperture, if twice the energy density is needed, the treatment time then is doubled!

Time for a quiz:
If you purchase a 10 mW, 780 nm wavelength laser and assuming the aperture is the same as above. The treatment protocol calls for 8 joules/ cm2 energy density for a particular acupuncture point.
Question 1) What is the color of your laser? ______________________
Question 2) What is your treatment time? _______________________

Based on a Spain study the following dosages are recommended as a starting point for general LLLT therapy:

Analgesic effect:
Muscular pain ---------------- 2 to 4 joules/ cm2
Joint pain ----------------------- 4 to 8 joules/ cm2

Anti-inflammatory effect:
Acute ------------------ 1 to 6 joules/ cm2
Chronic --------------- 4 to 8 joules/ cm2

Circulatory effect: ------------------------ 1 to 3 joules/ cm2

Three more issues you need to know:
* LAT wavelengths are between 600 nm and 1000 nm because least energy absorption by the hemoglobin and water occurred inside of this range. Hence the light penetration is the deepest in the range.

* Red beam (670 nm) generally has a penetration depth of 1-2 millimeters (<0.1 inches) - best for Jing-Well points and ear points. Infrared (780 nm) can have penetration up to 50 millimeters or 2 inches - thus best for arm, leg, back-shu and ahshi points.

* CW - Continuous Wavelength refers to non-pulsing, continuous power operating mode of a laser.


Part C - CTS LAT clinical protocol
(Adapted from Naeser Laser Home Treatment Program for the Hand - An Alternative Treatment for Carpal Tunnel Syndrome and Repetitive Strain Injury and Dr. Naeser's paper presented in WALT )

Two devices are used in this protocol:
1) a red-beam, 670 nm, 5 mW, CW diode laser pen (ITO LP-5F1)
2) a microamps TENS device (MicroStim 100 TENS)

Warnings, Contraindications and Disclaimers:
1) Do not stare into the laser beam source.
2) Do not use the laser beam on pregnant women (Except during the last few weeks of pregnancy on BL 67 to help correct the "breach position" of a fetus)
3) Do not shine the laser beam onto a cancerous tumor.
4) Do not shine the laser beam onto the unclosed fontanelles of babies and children.
5) Do not use the TENS on persons with a pacemaker.
6) Do not use the TENS near carotid sinus (neck region) or transcerebrally (through the head)
7) Do not use the TENS on pregnant women.
8) No medical claims are made for this treatment protocol.

Three steps are used in this protocol:
1) The tip of the laser pen was physically placed onto the skin at PC 7 for approximately 21 minutes (6-7 J; 30-35 J/cm2)
2) The microamps TENS device electrodes were placed on PC 7 and SJ 4. The power was gradually increased until a tingling sensation was felt at either electrode site, then it was immediately turned down until there were no sensation at all. The ideal setting is usually around 200 to 500 microamps. A modulated frequency of 292 Hz (F1 setting of the TENS unit) was used for the first 2 minutes, followed by a lower frequency of 9.25 Hz (F2) or 0.3 Hz (F1) for the next 18 minutes.
3) While the TENS device was in place at the wrist, the laser pen was applied to the following acupuncture points on the affected hand for 3 minutes per point (approximately 1 J; or 4.6 J/cm2 per point): LU 11, LI 1, PC 9, SJ 1, H 9, SI 1, Ba Xie, SJ 5, LI 4, PC8, H 7 and 8, and LU 9 and 10.

In addition to the primary LAT, secondary Traditional Chinese Medicine (TCM) therapies were used on an individual case-by-case basis, including Chinese herbal medicine, supplements, moxibustion, and stimulation of deeper acupuncture points on the posterior neck, shoulder, and elbow area with infrared-beam laser and/or needle acupuncture, as necessary.


Part D: FDA guidelines on LLLT or LAT in general

For acupuncturists who wish to do laser acupuncture please note (based on 1986 and 1989 published guidelines):
On the Federal level:

Low-energy lasers are considered to be "Investigational," for medical use in the U.S.

You should obtain local "Institutional Review Board (IRB) Approval" for your proposed laser acupuncture research protocols, before you use the laser on patients.

You can set up your own independent IRB - at lest 5 members who meet at regular intervals to review applications from acupuncturists who wish to obtain approvals for the use of low-energy laser acupuncture.

An Informed Consent must be obtained from each patient.

The acupuncturist may not make any medical claims for low-energy laser acupuncture.

The acupuncturist must be able to show a patient the acupuncturist's "Approval Letter for Low-energy Laser Use" from an IRB, if the patient requests to see this.

On the State level:
State of Massachusetts (Dr. Naeser's home State), among others, have inclusion of "Laser Acupuncture" within the "Scope of Acupuncture Practice".

State of California (where over 40% of American acupuncturists call it home) do not have the inclusion. July 2000 SB466 Bill was vetoed by Governor Davis because of his concerns over the safety of low-energy lasers.

So what if one likes to practice LAT?
In California, it is critical to pass the "Scope of Practice" Bill that includes low-energy lasers.

Try to document as complete as possible about LAT in a private practice. Stick to the well-studied protocols such as Dr. Naeser's CTS treatments.

Follow FDA's guidelines mentioned above if one decides to do a larger scale laser acupuncture research.

Take Dr. Naeser laser acupuncture workshop and AAOM keeps a list of all acupuncturists who practice Dr. Naeser's LAT protocols.

Visit AAOM Web Site

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