Zhang Guangzheng, Yie Qiang, Xiang Limin, Wu Chuande, Zhu Meimei, Gu Yanqing, Xue Lunxian (Shu Guang Hospital, Shanghai College of Traditional Chinese Medicine)
Zhou Shaoci, Wong Enqi (Department of Biology, Shanghai Normal University)
Zhang Meili, Ke Xuefan, Mao Liang, Yang Zhen (Faculty of Basic Medical Science, Shanghai College of Traditional Chinese Medicine)
The abdominal operation required a well relaxed abdominal muscles. In order to research into the feature of acupuncture anesthesia of abdominal operation, since 1964 we have synthesized in gastrectomy cases the data of patients' appeal, expression, blood pressure, pulse rate, sweating, internal organ's reaction, relaxation or tension of abdominal wall and the doses of auxiliary drugs to estimate the effect of acupuncture anesthesia. 1,100 cases were grouped under four grades, namely, excellent, good, fairly good and failure. 184 cases (16.7%) belonged to excellent and 45 (4.9%) to failure group.
The patients who should be operated for gastric and duodenal ulcers, were selected for observation except those with anxiety, complex focus and fat abdominal wall. Before the operation, they were given scopolamine 0.3 mg and meperidine 50 mg intramuscularly. Then the points were acupunctured and stimulated continuously for 20 minutes.
Analysing the factors which influenced the effect of acupuncture anesthesia, we discovered that the effect was independent of the type of operation and the age of patients. The acupuncture points were relatively specific. Among 31 pointrecipes, we selected the following one as the best for analgesia of abdominal wall: Zusanli and Shangjuxu. Among the methods of stimulation, the maneuver instrument was considered the best, the hand maneuver the next and the electric anesthetic instrument the worse. The patients, with sufficient mental preparation for the operation of acupuncture anesthesia and with an acupuncture sensation of soreness, distension and heaviness always gave a better effect. When the doctor performed an operation steadily, exactly, gently and promptly, to reduce the operation stimulus to minimum, the patient obtained a better effect. A better result was also seen in the patients with simple ulcerous focus, lack of circumferential adhesions, thin abdominal wall and that of gastroptosis etc.. Moreover, the individual variance of patients had a greater influence upon the effect of acupuncture anesthesia.
In order to evaluate the effect of acupuncture anethesia of gastrectomy objectively the electromyography of rectus abdominalis was studied during the operation. Among 72 cases observed, 11 cases were excellent, 31 good and 24 fairly good. Their mean value of eletromyointe gratinggram area was 196 m.m.{3} 443.9 m.m.{3}, and 661.5 m.m.{3} respectively. The amount of discharge was large during the exploration, the detachment of duodenum and the recheck, but was small during the incision and the gastrojejunostomy. This result was contrasted with electomyography under epidural anesthesia. In general there was no electromyographic discharge in epidural anesthesia. It was shown that there was a corresponding relation between the amount of electromyographic discharge and the effect of acupuncture anesthesia, so that the effect of acupuncture anesthesia was not better than that of epidural anesthesia. Nevertheless the patients of excellent grade effect of acupuncture anesthesia had small drawing reaction of internal organs, less pain and also less difficulties during the operation, and these patients took part in activities ahead of time and their relieving wind came earlier than those with epidural anesthesia postoperatively. Therefore it might be considered that acupuncture anesthesia had certain clinical values.
The individual variance of the patient could exert an influence on the clinical effect of acupuncture anesthesia. According to the dialectic diagnosis of eight principles in the traditional Chinese medicine, we observed and grouped this difference.
The patients with Yang deficiency appeared pale and weary, liked warm and feared of cold. Their extremities were cold, their urine clear and much, their stools thin, their saliva much and dilute, their tongues pale with a white and moist coating and their pulses deep, soft and slow. Hypernatremia and hypokaliemia were assayed from blood electrolytic analysis. During the stimulation with a certain intensity of pain, the amplitude of the finger pulse wave diminished not markedly, while after the acupuncture it enlarged in most cases. During the operation, the mean values of systolic blood pressure and pulse rate were less than those of the patients with Yin deficiency. The duration of their surgical fever was also shorter. All the above meant that there would be a tendency of sympathetic hypotonus in the patients with Yang deficiency, which could easily be inhibited by acupuncture on Zusanli and Shangjuxu. Therefore the effect of acupuncture anesthetia was efficient.
The patients with Yin deficiency were anxious, vexed, sleepless, night sweating and fond of cold drinking with their palms and soles hot, their throats dry, their faces reddish and their bowels constipated. The tongue was red in color, somewhat swollen with prominent papillae and a thin yellow and dry coating. The pulse was slender-rapid or string-rapid. The physio-chemical reaction was contrary to that of the patients with Yang deficincy, indicating a sympathetic hypertonus. The excited reaction to hurtful stimulus was stronger. The inhibitory effect of acupuncturing Zusanli and Shangjuxu, was insufficient, so that the effect of acupuncture anesthesia was less.
Among the 116 patients of acupuncture anesthesia with Yang deficiency and Yin deficiency the excellent and good rate of patients with Yang deficiency was 83.3% and that of Yin deficiency was 39.1% (X{2} test P<0.005). Concerning to the individual variance, this showed that the effect of acupuncture anesthesia of the patients with Yang deficiency was better than that of the patients with Yin deficiency.
Zhou Shaoci, Wong Enqi (Department of Biology, Shanghai Normal University)
Zhang Meili, Ke Xuefan, Mao Liang, Yang Zhen (Faculty of Basic Medical Science, Shanghai College of Traditional Chinese Medicine)
The abdominal operation required a well relaxed abdominal muscles. In order to research into the feature of acupuncture anesthesia of abdominal operation, since 1964 we have synthesized in gastrectomy cases the data of patients' appeal, expression, blood pressure, pulse rate, sweating, internal organ's reaction, relaxation or tension of abdominal wall and the doses of auxiliary drugs to estimate the effect of acupuncture anesthesia. 1,100 cases were grouped under four grades, namely, excellent, good, fairly good and failure. 184 cases (16.7%) belonged to excellent and 45 (4.9%) to failure group.
The patients who should be operated for gastric and duodenal ulcers, were selected for observation except those with anxiety, complex focus and fat abdominal wall. Before the operation, they were given scopolamine 0.3 mg and meperidine 50 mg intramuscularly. Then the points were acupunctured and stimulated continuously for 20 minutes.
Analysing the factors which influenced the effect of acupuncture anesthesia, we discovered that the effect was independent of the type of operation and the age of patients. The acupuncture points were relatively specific. Among 31 pointrecipes, we selected the following one as the best for analgesia of abdominal wall: Zusanli and Shangjuxu. Among the methods of stimulation, the maneuver instrument was considered the best, the hand maneuver the next and the electric anesthetic instrument the worse. The patients, with sufficient mental preparation for the operation of acupuncture anesthesia and with an acupuncture sensation of soreness, distension and heaviness always gave a better effect. When the doctor performed an operation steadily, exactly, gently and promptly, to reduce the operation stimulus to minimum, the patient obtained a better effect. A better result was also seen in the patients with simple ulcerous focus, lack of circumferential adhesions, thin abdominal wall and that of gastroptosis etc.. Moreover, the individual variance of patients had a greater influence upon the effect of acupuncture anesthesia.
In order to evaluate the effect of acupuncture anethesia of gastrectomy objectively the electromyography of rectus abdominalis was studied during the operation. Among 72 cases observed, 11 cases were excellent, 31 good and 24 fairly good. Their mean value of eletromyointe gratinggram area was 196 m.m.{3} 443.9 m.m.{3}, and 661.5 m.m.{3} respectively. The amount of discharge was large during the exploration, the detachment of duodenum and the recheck, but was small during the incision and the gastrojejunostomy. This result was contrasted with electomyography under epidural anesthesia. In general there was no electromyographic discharge in epidural anesthesia. It was shown that there was a corresponding relation between the amount of electromyographic discharge and the effect of acupuncture anesthesia, so that the effect of acupuncture anesthesia was not better than that of epidural anesthesia. Nevertheless the patients of excellent grade effect of acupuncture anesthesia had small drawing reaction of internal organs, less pain and also less difficulties during the operation, and these patients took part in activities ahead of time and their relieving wind came earlier than those with epidural anesthesia postoperatively. Therefore it might be considered that acupuncture anesthesia had certain clinical values.
The individual variance of the patient could exert an influence on the clinical effect of acupuncture anesthesia. According to the dialectic diagnosis of eight principles in the traditional Chinese medicine, we observed and grouped this difference.
The patients with Yang deficiency appeared pale and weary, liked warm and feared of cold. Their extremities were cold, their urine clear and much, their stools thin, their saliva much and dilute, their tongues pale with a white and moist coating and their pulses deep, soft and slow. Hypernatremia and hypokaliemia were assayed from blood electrolytic analysis. During the stimulation with a certain intensity of pain, the amplitude of the finger pulse wave diminished not markedly, while after the acupuncture it enlarged in most cases. During the operation, the mean values of systolic blood pressure and pulse rate were less than those of the patients with Yin deficiency. The duration of their surgical fever was also shorter. All the above meant that there would be a tendency of sympathetic hypotonus in the patients with Yang deficiency, which could easily be inhibited by acupuncture on Zusanli and Shangjuxu. Therefore the effect of acupuncture anesthetia was efficient.
The patients with Yin deficiency were anxious, vexed, sleepless, night sweating and fond of cold drinking with their palms and soles hot, their throats dry, their faces reddish and their bowels constipated. The tongue was red in color, somewhat swollen with prominent papillae and a thin yellow and dry coating. The pulse was slender-rapid or string-rapid. The physio-chemical reaction was contrary to that of the patients with Yang deficincy, indicating a sympathetic hypertonus. The excited reaction to hurtful stimulus was stronger. The inhibitory effect of acupuncturing Zusanli and Shangjuxu, was insufficient, so that the effect of acupuncture anesthesia was less.
Among the 116 patients of acupuncture anesthesia with Yang deficiency and Yin deficiency the excellent and good rate of patients with Yang deficiency was 83.3% and that of Yin deficiency was 39.1% (X{2} test P<0.005). Concerning to the individual variance, this showed that the effect of acupuncture anesthesia of the patients with Yang deficiency was better than that of the patients with Yin deficiency.
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