Guo Bangfu, Yao Zhiying, Zhang Qingcai, Shen Lei, Wang Liuqiang (Shanghai Institute of Traumatology and Orthopaedics, Department of Traumatology and Orthopaedics of Ruijin Hospital, Shanghai Second Medical College)
Lateral meniscectomy is an intra-articular operation, it requires a very strict effect of anaesthesia in eliminating the painful sensation of the skin and the capsule, the dragging sensation during the detachment of the posterior horn of the meniscus and the ischemic pain due to the use of a tourniquet. If all these problems could be solved by acupuncture anaesthesia, we believe that it would be meaningful.
Since 1964 we have adopted two sets of point selections in accordance with the course of channels. Prior to 1969 we used the points of Zusanli, Yanglingquan, Yinlingquan, Fenglong, Juegu, and Taichong bilaterally with a total amount of twelve points, all of which were picked up according to the principle of distal selection of points. After 1969 we shifted to proximal selection, using Qihaishu, Dachangshu, Yinmen and Fengshi on the affected side amounting to only four points. From the analgesic effects obtained in 385 cases of lateral meniscectomy, it is apparent that proximal selection is preferable to distal selection, as the acceptable rate of the former was 83 per cent and latter 93 per cent (P<0.005).
The requirement of analgesia in lateral meniscectomy is not only over the incisional line, but also along the entire lateral half of the knee joint. We found that the analgesic result could not be improved by simply selecting points on the channels of Gall Bladder, Stomach and Kidney, and in accordance with the theory of Traditional Chinese Medicine, which stated that "the effect of needling is to see where the 'Qi' (vital energy) is reaching" "so long as the effect of needling reaches, it can cure the disease and alleviate the pain", we therefore selected Qihaishu, Dachangshu and Yinmen on the Urinary Bladder Channel and Fengshi on the Gall Bladder Channel and indeed, the analgesic result was significantly improved as mentioned above.
Anatomically, the points of Qihaishu and Dachangshu are located at the vicinity of intervertebral foramina of L[3-4] and L[4-5] emerge. The point of Fengshi is located at the region of the lateral femoral cutaneous nerve dermatome. The femoral nerve and lateral femoral cutaneous nerve originate from L[2] and L[3] roots, the anterior branch of the latter supplies mainly the antero-lateral aspect of the thigh down to the knee to form a patellar plexus. The point of Yinmen is located at the region of the posterior femoral cutaneous nerve which is a sensory branch of the popliteal space. Consequently, the activation of these points gives analgesic effect physiologically over the anterior, lateral and posterior regions of the knee.
The analgesic effects of acupuncture are accomplished by mechanical activation of points and the impulse is transmitted to the spinal cord and cerebral cortex. The activation of points gives not only 'central analgesia', but also 'segmental analgesia' by mediating the action of the posterior horn of the spinal cord. With the activation of receptors in the points, the impulse is transmitted to the brain with the production of intermediate substances, such as 5-HT, morphine-like substance, etc. to elevate the pain threshold by blocking the impulse. Therefore, we postulate that the meridian line and the nervous system might be identical.
Lateral meniscectomy is an intra-articular operation, it requires a very strict effect of anaesthesia in eliminating the painful sensation of the skin and the capsule, the dragging sensation during the detachment of the posterior horn of the meniscus and the ischemic pain due to the use of a tourniquet. If all these problems could be solved by acupuncture anaesthesia, we believe that it would be meaningful.
Since 1964 we have adopted two sets of point selections in accordance with the course of channels. Prior to 1969 we used the points of Zusanli, Yanglingquan, Yinlingquan, Fenglong, Juegu, and Taichong bilaterally with a total amount of twelve points, all of which were picked up according to the principle of distal selection of points. After 1969 we shifted to proximal selection, using Qihaishu, Dachangshu, Yinmen and Fengshi on the affected side amounting to only four points. From the analgesic effects obtained in 385 cases of lateral meniscectomy, it is apparent that proximal selection is preferable to distal selection, as the acceptable rate of the former was 83 per cent and latter 93 per cent (P<0.005).
The requirement of analgesia in lateral meniscectomy is not only over the incisional line, but also along the entire lateral half of the knee joint. We found that the analgesic result could not be improved by simply selecting points on the channels of Gall Bladder, Stomach and Kidney, and in accordance with the theory of Traditional Chinese Medicine, which stated that "the effect of needling is to see where the 'Qi' (vital energy) is reaching" "so long as the effect of needling reaches, it can cure the disease and alleviate the pain", we therefore selected Qihaishu, Dachangshu and Yinmen on the Urinary Bladder Channel and Fengshi on the Gall Bladder Channel and indeed, the analgesic result was significantly improved as mentioned above.
Anatomically, the points of Qihaishu and Dachangshu are located at the vicinity of intervertebral foramina of L[3-4] and L[4-5] emerge. The point of Fengshi is located at the region of the lateral femoral cutaneous nerve dermatome. The femoral nerve and lateral femoral cutaneous nerve originate from L[2] and L[3] roots, the anterior branch of the latter supplies mainly the antero-lateral aspect of the thigh down to the knee to form a patellar plexus. The point of Yinmen is located at the region of the posterior femoral cutaneous nerve which is a sensory branch of the popliteal space. Consequently, the activation of these points gives analgesic effect physiologically over the anterior, lateral and posterior regions of the knee.
The analgesic effects of acupuncture are accomplished by mechanical activation of points and the impulse is transmitted to the spinal cord and cerebral cortex. The activation of points gives not only 'central analgesia', but also 'segmental analgesia' by mediating the action of the posterior horn of the spinal cord. With the activation of receptors in the points, the impulse is transmitted to the brain with the production of intermediate substances, such as 5-HT, morphine-like substance, etc. to elevate the pain threshold by blocking the impulse. Therefore, we postulate that the meridian line and the nervous system might be identical.
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