Jin Shubai, Chen Dezun (Shanghai Institute of Traditional Chinese Medicine)
Cooperating with First Tuberculosis Hospital of Shanghai in 1960, we successfully applied acupuncture anesthesia in the operation of pulmonary lobectomy. Under the guidance of the "Viscera-Channels" theory of Chinese traditional medicine, the pain was reduced by using points along the "Yang Channels", and the mediastinal-flutter was controlled by using the points along the "Yin Channels" of heart, lung and kidney etc. Out of 163 cases of pulmonary lobectomy. 72 cases were operated successfully without any anesthetic drug, with good results of 91.7% of cases. Furthermore on this basis, cooperating with Chest Hospital and Hua-Shan Hospital, we tried applying acupuncture anesthesia on heart and brain operations with the method of "points-selection according to the course of the channels" and "manipulation of acupuncture", and the results were also satisfactory. Owing to the existence of the "three troubles" of the acupuncture anesthesia in abdominal operations, we continued our investigation of acupuncture anesthesia on gastrectomy with the principle of "giving treatment following dialectical diagnosis recognized" of the Chinese traditional medicine in Lung Hua Hospital in recent years. Out of the clinical results of acupuncture anesthesia of 105 cases of gastrectomy, 93.4% was successful and 81.0% satisfactory. Following are some our clinical experiences:
(1) "Transformation" before operation
Good cooperation of the patients is necessary because the patients under acupuncture anesthesia are still in a status of consciousness. Much explanation must be given to patients so as to reduce the mental stress and fear of them. However, the patients must be told that discomfortable feelings would be present during the process and to give them preparations in mind is required. In view with the results of acupuncture anesthesia of 105 gastrectomy cases, the relations between the cooperation of the patients and the satisfactory results of acupuncture anesthesia is extremly significant (X{2}=23.15, P<0.005).
Besides, Chinese traditional drugs and acupuncture moxibustion treatments were sometimes given too. For examples, the patients with "Yin deficiency and fire burning intensely" were given Ghizoma Coptidis, Rhizoma Pinelliae and so on, and the points "Neiguan" "Zusanli" "Taichong" were acupunctured for digestion and sedation, using the point "Fuliu" for over perspiration, and the point "Hegu" for constipation and so on. After these preparations, the effectiveness of acupuncture anesthesia on the patients with the "Yin deficiency" was improved.
(2) Point selection and manipulation of the acupuncture
According to the "Viscera-Channels" theory, "Zusanli" "Gongsun" "Taichong" on the three Meridians of Stomach, Spleen and Liver were selected as main points in gastrectomy and "twisting" and "lifting-inserting" were the basic manipulation used. In different stages of the surgical operation processes, various points and manipulations were used. Different points were used according to the degree of the surgical operational stimulation and the patients' reaction. Needling reaction must be gained when needles were inserted. During the inducing periods, needles were twisted in each point 5 minutes before incision, the points "Zusanli" "Gongsun" were acupunctured and needling was hasted and strengthened. At the just moment of incision of skin, manipulation and strong stimulation must be done quickly chiefly by "lifting-inserting". During hemostatic periods, manipulation was done slowly and lightly. During incision of the peritomeum, the points "Taichong" "Gongsun" were acupunctured with quick and light manipulation. When the operation went into abdominal cavity, then the point "Gongsun" was mainly used in order to release abdominal muscular tension. When patients' reaction was heavy in drawing the viscera, we heavily used the points "Taichong" "Zusanli" to reduce the reaction. In general light lifting and slow twisting were suitable. If the patient was calm during visceral suturing, the acupuncture manipulation may be stopped and the needles retained in sites. But before the reexamination and closing of abdomen, twisting of the needles must be applied before every heavy surgical manoeuvre.
(3) Other factors affected the results of acupuncture anesthesia
The surgical operation whether light or heavy, the patients' body-style whether thin or fat, their constitution whether strong or weak as well as the complicacy of focus, all these would objectively affected the results of acupuncture anesthesia, so it is important for an experienced acupuncture anesthetist to be able to master these things.
Cooperating with First Tuberculosis Hospital of Shanghai in 1960, we successfully applied acupuncture anesthesia in the operation of pulmonary lobectomy. Under the guidance of the "Viscera-Channels" theory of Chinese traditional medicine, the pain was reduced by using points along the "Yang Channels", and the mediastinal-flutter was controlled by using the points along the "Yin Channels" of heart, lung and kidney etc. Out of 163 cases of pulmonary lobectomy. 72 cases were operated successfully without any anesthetic drug, with good results of 91.7% of cases. Furthermore on this basis, cooperating with Chest Hospital and Hua-Shan Hospital, we tried applying acupuncture anesthesia on heart and brain operations with the method of "points-selection according to the course of the channels" and "manipulation of acupuncture", and the results were also satisfactory. Owing to the existence of the "three troubles" of the acupuncture anesthesia in abdominal operations, we continued our investigation of acupuncture anesthesia on gastrectomy with the principle of "giving treatment following dialectical diagnosis recognized" of the Chinese traditional medicine in Lung Hua Hospital in recent years. Out of the clinical results of acupuncture anesthesia of 105 cases of gastrectomy, 93.4% was successful and 81.0% satisfactory. Following are some our clinical experiences:
(1) "Transformation" before operation
Good cooperation of the patients is necessary because the patients under acupuncture anesthesia are still in a status of consciousness. Much explanation must be given to patients so as to reduce the mental stress and fear of them. However, the patients must be told that discomfortable feelings would be present during the process and to give them preparations in mind is required. In view with the results of acupuncture anesthesia of 105 gastrectomy cases, the relations between the cooperation of the patients and the satisfactory results of acupuncture anesthesia is extremly significant (X{2}=23.15, P<0.005).
Besides, Chinese traditional drugs and acupuncture moxibustion treatments were sometimes given too. For examples, the patients with "Yin deficiency and fire burning intensely" were given Ghizoma Coptidis, Rhizoma Pinelliae and so on, and the points "Neiguan" "Zusanli" "Taichong" were acupunctured for digestion and sedation, using the point "Fuliu" for over perspiration, and the point "Hegu" for constipation and so on. After these preparations, the effectiveness of acupuncture anesthesia on the patients with the "Yin deficiency" was improved.
(2) Point selection and manipulation of the acupuncture
According to the "Viscera-Channels" theory, "Zusanli" "Gongsun" "Taichong" on the three Meridians of Stomach, Spleen and Liver were selected as main points in gastrectomy and "twisting" and "lifting-inserting" were the basic manipulation used. In different stages of the surgical operation processes, various points and manipulations were used. Different points were used according to the degree of the surgical operational stimulation and the patients' reaction. Needling reaction must be gained when needles were inserted. During the inducing periods, needles were twisted in each point 5 minutes before incision, the points "Zusanli" "Gongsun" were acupunctured and needling was hasted and strengthened. At the just moment of incision of skin, manipulation and strong stimulation must be done quickly chiefly by "lifting-inserting". During hemostatic periods, manipulation was done slowly and lightly. During incision of the peritomeum, the points "Taichong" "Gongsun" were acupunctured with quick and light manipulation. When the operation went into abdominal cavity, then the point "Gongsun" was mainly used in order to release abdominal muscular tension. When patients' reaction was heavy in drawing the viscera, we heavily used the points "Taichong" "Zusanli" to reduce the reaction. In general light lifting and slow twisting were suitable. If the patient was calm during visceral suturing, the acupuncture manipulation may be stopped and the needles retained in sites. But before the reexamination and closing of abdomen, twisting of the needles must be applied before every heavy surgical manoeuvre.
(3) Other factors affected the results of acupuncture anesthesia
The surgical operation whether light or heavy, the patients' body-style whether thin or fat, their constitution whether strong or weak as well as the complicacy of focus, all these would objectively affected the results of acupuncture anesthesia, so it is important for an experienced acupuncture anesthetist to be able to master these things.
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