Beijing Tuberculosis Research Institute
From 1965 to 1978 a total of 1,048 cases of lung resections was performed under acupuncture anesthesia. This article discusses the relationship between the effect of acupuncture anesthesia and the specificity of acupuncture points, the individual variation of patients, and the regulatory effect of needling. Some of the experiments were carried out in collaboration with other institutes.
THE EFFECTIVENESS OF ACUPUNCTURE ANESTHESIA FOR LUNG RESECTION AND THE SELECTION OF ACUPUNCTURE POINTS
1. Multiple points along different channels.
When we began using acupuncture anesthesia in the lung operations, we selected a few points along each of 12 Channels. We have used more than 80 combinations of 40, 32, 20, 16 and 12 points etc. in a total of 234 cases with excellent and good results in 175 cases (74.8%).
2. Single insertion -- needling at Sanyangluo.
After many trials on ourselves and in the course of clinical practice the number of needles required was gradually reduced to only one. Lung resections were successfully carried out with needling at Sanyangluo manipulated by hand. Altogether 133 operations were performed with excellent and good results in 85.7%.
3. Selection of points on lower limbs
30 lung resections were performed with excellent and good results in only 50% of cases. Practice showed that for chest surgery points on the lower limbs provided less analgesic effect than those on the upper limbs.
Multiple points vs single insertion (Sanyangluo): X{2}=6.56, P<0.01.
Point on the upper limb (Sanyangluo) vs points on the lower limbs: X{2}=5.17, P<0.02.
THE EFFECT OF INDIVIDUAL VARIATION OF PATIENTS ON THE EFFICACY OF ACUPUNCTURE ANESTHESIA
On the basis of the analysis of the clinical data obtained from 1,048 cases of acupuncture anesthesia for lung resections, the efficacy of acupuncture anesthesia had not much to do with patients' sex, age and occupation but was related the following factors:
1. The efficacy of acupuncture anesthesia was good in patients, calm, cooperative, mentally balanced and confident of the effectiveness of the method. On the contrary, in those apprehensive, nervous, incooperative, mentally irritable and not confident of the method the efficacy was poor.
2. The efficacy of acupuncture anesthesia and the physiological parameters recorded preoperatively:
Respiration, pulse and skin galvanic potential were recorded preoperatively with polygraph RM-150 in 473 patients who underwent lung resections under acupuncture anesthesia. If these parameters were kept relatively unchanged after needling, the effect of acupuncture anesthesia would be good; otherwise the effect would be poor. The rate of agreement was 80%.
3. The efficacy of acupuncture anesthesia and the patients' tolerance to needling as well as skin sensitivity:
(1) According to clinical observation on 158 patients operated upon under acupuncture anesthesia, efficacy was good in those with a good tolerance to needling; otherwise the efficacy was poor (X{2}=10.28, P<0.0015).
(2) results based on skin sensitivity test in 106 patients, showed that the efficacy of acupuncture anesthesia was poor in hypersensitive patients and good in hyposensitive patients (X{2}=23.629, P<0.001).
4. The relationship between the efficacy of acupuncture anesthesia and respiration:
According to the observation on 100 patients, the effectiveness of acupuncture anesthesia was good in those who did abdominal breathing exercises smoothly, naturally and slowly before the operation and could still keep their respiration smooth and slow during operation after chest had been opened; otherwise the effect was poor (X{2}=323, P<0.001).
In patients operated upon under acupuncture anesthesia, after chest had been opened, the blood gas could generally be kept at normal range, except slight increase of PaCO[2]. With administration of oxygen, operation could be carried out uneventfully.
Besides the above mentioned factors, there was also relationship between surgical manipulation, management of respiration and the efficacy of acupuncture anesthesia.
REGULATORY EFFECTS AND ANALGESIA PRODUCED BY ACUPUNCTURE
1. Pain tolerance of the patients was raised after needling.
Experiment on normal subjects demonstrated that after needling at Sanyangluo the pain tolerance of the subjects was markedly increased when stimulated with MSE-40 stimulator. The results were:
(1) The occurence of severe pain decreased on the average by 67.8% (P<0.001).
(2) The occurence of severe pain and pain was reduced on the average by 38.6% (P<0.001).
2. Changes in blood pressure during acupuncture anesthesia:
We compared patients undergoing similar types of operations under general anesthesia and under acupuncture anesthesia with 500 cases each. In the general anesthesia group the systolic pressure fell below 90 mmHg in 73 cases, accounting for 14%, but in the acupuncture group there were only 12 cases, accounting for 2.4%.
Regulatory effect was also demonstrated in animal experiments. Experimental hemorrhagic shock was induced in rabbits under acupuncture anesthesia, general anesthesia and local anesthesia, 37 in each group. The volume of blood let out was the same in all groups. Blood pressure decrease more slowly and the decrement was smaller in the acupuncture group than those in other two groups, while it rose faster and higher after the termination of bleeding.
3. Changes in certain humoral factors in peripheral blood after needling.
It was shown in normal subjects that certain humoral factors changed after needling and the changes were in positive correlation with analgesia produced by acupuncture.
(1) Blood histamine level was higher in those with poor analgesic effect; on the contrary, in those with better effect, the blood histamine level remained unchanged or even decreased slightly (P<0.025).
(2) In the control group, without needling, pain stimulation raised blood histamine level markedly (P<0.05).
According to clinical observation on 45 cases of acupuncture anesthesia, in 36 cases with excellent or good result the blood histamine level remained unchanged in 25 cases; while in 9 cases of grade III or IV, the blood histamine level rose in 6 (X{2}=6.64, P<0.01).
(3) Blood endogenous opiate-like substances (OLS) level rose after needling. In those with good analgesia blood OLS level increased markedly (P<0.01).
4. Acupuncture did not depress the immune function of the body.
Blood samples were taken before and immediately after induction and one hour after incision from patients operated upon under acupuncture anesthesia as well as general anesthesia.
(1) Acupuncture group: White blood count rose markedly. White cells retained their ability to phagocytize B. Subtilis and the phagocytic index was not decreased. Lymphocyte transformation was not inhibited markedly. There was no significant change in rosette formation test.
(2) General anesthesia group: The above-mentioned parameters were all depressed to some extent, or even to a great extent, indicating immunologic compromise.
Therefore the fact that patients operated upon under acupuncture anesthesia recovered earlier may be explained by the uncompromised immune function.
From 1965 to 1978 a total of 1,048 cases of lung resections was performed under acupuncture anesthesia. This article discusses the relationship between the effect of acupuncture anesthesia and the specificity of acupuncture points, the individual variation of patients, and the regulatory effect of needling. Some of the experiments were carried out in collaboration with other institutes.
THE EFFECTIVENESS OF ACUPUNCTURE ANESTHESIA FOR LUNG RESECTION AND THE SELECTION OF ACUPUNCTURE POINTS
1. Multiple points along different channels.
When we began using acupuncture anesthesia in the lung operations, we selected a few points along each of 12 Channels. We have used more than 80 combinations of 40, 32, 20, 16 and 12 points etc. in a total of 234 cases with excellent and good results in 175 cases (74.8%).
2. Single insertion -- needling at Sanyangluo.
After many trials on ourselves and in the course of clinical practice the number of needles required was gradually reduced to only one. Lung resections were successfully carried out with needling at Sanyangluo manipulated by hand. Altogether 133 operations were performed with excellent and good results in 85.7%.
3. Selection of points on lower limbs
30 lung resections were performed with excellent and good results in only 50% of cases. Practice showed that for chest surgery points on the lower limbs provided less analgesic effect than those on the upper limbs.
Multiple points vs single insertion (Sanyangluo): X{2}=6.56, P<0.01.
Point on the upper limb (Sanyangluo) vs points on the lower limbs: X{2}=5.17, P<0.02.
THE EFFECT OF INDIVIDUAL VARIATION OF PATIENTS ON THE EFFICACY OF ACUPUNCTURE ANESTHESIA
On the basis of the analysis of the clinical data obtained from 1,048 cases of acupuncture anesthesia for lung resections, the efficacy of acupuncture anesthesia had not much to do with patients' sex, age and occupation but was related the following factors:
1. The efficacy of acupuncture anesthesia was good in patients, calm, cooperative, mentally balanced and confident of the effectiveness of the method. On the contrary, in those apprehensive, nervous, incooperative, mentally irritable and not confident of the method the efficacy was poor.
2. The efficacy of acupuncture anesthesia and the physiological parameters recorded preoperatively:
Respiration, pulse and skin galvanic potential were recorded preoperatively with polygraph RM-150 in 473 patients who underwent lung resections under acupuncture anesthesia. If these parameters were kept relatively unchanged after needling, the effect of acupuncture anesthesia would be good; otherwise the effect would be poor. The rate of agreement was 80%.
3. The efficacy of acupuncture anesthesia and the patients' tolerance to needling as well as skin sensitivity:
(1) According to clinical observation on 158 patients operated upon under acupuncture anesthesia, efficacy was good in those with a good tolerance to needling; otherwise the efficacy was poor (X{2}=10.28, P<0.0015).
(2) results based on skin sensitivity test in 106 patients, showed that the efficacy of acupuncture anesthesia was poor in hypersensitive patients and good in hyposensitive patients (X{2}=23.629, P<0.001).
4. The relationship between the efficacy of acupuncture anesthesia and respiration:
According to the observation on 100 patients, the effectiveness of acupuncture anesthesia was good in those who did abdominal breathing exercises smoothly, naturally and slowly before the operation and could still keep their respiration smooth and slow during operation after chest had been opened; otherwise the effect was poor (X{2}=323, P<0.001).
In patients operated upon under acupuncture anesthesia, after chest had been opened, the blood gas could generally be kept at normal range, except slight increase of PaCO[2]. With administration of oxygen, operation could be carried out uneventfully.
Besides the above mentioned factors, there was also relationship between surgical manipulation, management of respiration and the efficacy of acupuncture anesthesia.
REGULATORY EFFECTS AND ANALGESIA PRODUCED BY ACUPUNCTURE
1. Pain tolerance of the patients was raised after needling.
Experiment on normal subjects demonstrated that after needling at Sanyangluo the pain tolerance of the subjects was markedly increased when stimulated with MSE-40 stimulator. The results were:
(1) The occurence of severe pain decreased on the average by 67.8% (P<0.001).
(2) The occurence of severe pain and pain was reduced on the average by 38.6% (P<0.001).
2. Changes in blood pressure during acupuncture anesthesia:
We compared patients undergoing similar types of operations under general anesthesia and under acupuncture anesthesia with 500 cases each. In the general anesthesia group the systolic pressure fell below 90 mmHg in 73 cases, accounting for 14%, but in the acupuncture group there were only 12 cases, accounting for 2.4%.
Regulatory effect was also demonstrated in animal experiments. Experimental hemorrhagic shock was induced in rabbits under acupuncture anesthesia, general anesthesia and local anesthesia, 37 in each group. The volume of blood let out was the same in all groups. Blood pressure decrease more slowly and the decrement was smaller in the acupuncture group than those in other two groups, while it rose faster and higher after the termination of bleeding.
3. Changes in certain humoral factors in peripheral blood after needling.
It was shown in normal subjects that certain humoral factors changed after needling and the changes were in positive correlation with analgesia produced by acupuncture.
(1) Blood histamine level was higher in those with poor analgesic effect; on the contrary, in those with better effect, the blood histamine level remained unchanged or even decreased slightly (P<0.025).
(2) In the control group, without needling, pain stimulation raised blood histamine level markedly (P<0.05).
According to clinical observation on 45 cases of acupuncture anesthesia, in 36 cases with excellent or good result the blood histamine level remained unchanged in 25 cases; while in 9 cases of grade III or IV, the blood histamine level rose in 6 (X{2}=6.64, P<0.01).
(3) Blood endogenous opiate-like substances (OLS) level rose after needling. In those with good analgesia blood OLS level increased markedly (P<0.01).
4. Acupuncture did not depress the immune function of the body.
Blood samples were taken before and immediately after induction and one hour after incision from patients operated upon under acupuncture anesthesia as well as general anesthesia.
(1) Acupuncture group: White blood count rose markedly. White cells retained their ability to phagocytize B. Subtilis and the phagocytic index was not decreased. Lymphocyte transformation was not inhibited markedly. There was no significant change in rosette formation test.
(2) General anesthesia group: The above-mentioned parameters were all depressed to some extent, or even to a great extent, indicating immunologic compromise.
Therefore the fact that patients operated upon under acupuncture anesthesia recovered earlier may be explained by the uncompromised immune function.
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