Practical Application of Acupuncture Analgesia

S. B. Cheng and L. K. Ding

Editor’s Note

Around this time, the widespread use of acupuncture analgesia across China was drawing interest from the West. Here Chinese medical doctors S. B. Cheng and L. K. Ding sum up pros and cons for the use of the technique in surgery. The procedure, which is cheaper and carries fewer complications than analgesic drugs, works particularly well in patients with a confident outlook. But it fails to dull the nerves as effectively as drug analgesia, and only really works well in upper-body operations such as thyroidectomies and lung surgery. Given this, the duo suggests that acupuncture analgesia sometimes be considered an alternative but not a replacement to drug therapy. 中文

SINCE the reported success of the use of acupuncture analgesia in several hundred thousand operations in China, great interest in this type of analgesia has been aroused all over the world. In Japan, America and other nations, medical people have begun to investigate the application of acupuncture analgesia in their daily medical and clinical work. This article is an attempt to give some explanation of the technique in order to assist others who are experimenting with it. It is based on the personal experience of one of us who has used this type of analgesia in twenty-four operations—three mitral stenoses, five lobectomies, six gastrectomies and ten thyroidectomies. 中文

Acupuncture analgesia uses no anaesthetic drugs. Instead it is based on Chinese traditional medical theory, Ching-lo , which states that by applying pressure to certain specific points on the body, these points (on the meridians) will become numb. Pressure is applied by using a certain method of needling so that pain is either dulled or removed altogether. Thus, in using this technique during surgical operations, sensation in the area in which the operation is to be performed can be dulled while the patient remains entirely conscious. 中文

At present in China this technique is widely used in both urban and rural hospitals and in mobile medical clinics. It has been used for surgery on the brain, neck, chest, abdomen and limbs. In addition, it has been applied in obstetric operations and in operations on the ears, nose and throat. Acupuncture has attained a definite place in Chinese medical practice and, when it can be used appropriately, has become the first choice of anaesthetic. 中文

The use of acupuncture analgesia depends on the availability of properly trained manpower. A skilled medical team including anaesthetists is necessary. The team should be composed both of those who have expertise in the use of anaesthetic drugs and of those familiar with acupuncture analgesia. Those who have a thorough knowledge of both techniques are obviously the most valuable. Before the operation, one or two members of the team need to visit the patient to find out the patient’s mental attitude, his desire to use this kind of analgesia and the nature of his illness. For their part, the team member or members should give a complete explanation of the anaesthesia technique to the patient. 中文

In addition, the team of surgeons must be skilled, alert and capable. The doctors must be those whom the patient trusts, and they must have a thorough understanding of the patient’s illness and mental attitude. Before the operation, they must give the patient a complete explanation of the surgical procedure and teach the patient to do the appropriate exercises such as deep breathing. The doctors must work quickly, steadily and accurately and must make the incisions and do suturing in the shortest possible time. 中文

Particular Applications

To illustrate the use of this technique in surgery, we shall describe its application in a thyroidectomy, where the best results have been obtained. Two preliminary steps are necessary. First, the consent of the patient must be obtained. In addition to explaining the procedures to him, it is highly recommended that a demonstration be performed on the patient before his operation. Second, the individuals who administer the analgesia must have a thorough understanding of the procedures. We suggest that the anaesthetists practise acupuncture on their own bodies in order to discover the various methods of using the needle, the different sensations acupuncture produces and the proper depth to which the needle needs to be inserted. 中文

About a half hour before surgery, 50 mg pethidine or other sedative is given to the patient by injection. The acupuncture needles are then inserted at two points on the hand and forearm. The first point is called the hu ku and is located between the thumb and the forefinger on each hand. The needle is inserted to a depth of 0.5 inch or until the patient begins to feel sensations of aching, heaviness, fullness and numbness. The other point is the nei kuan which is located posteriorly about 2 inches above the wrist. The needle is inserted to a depth of 0.5 to 1 inch, again until similar sensations are felt. If the needles are placed in the proper position and are rotated in a circular manner for about 20 min, an analgesic effect will be induced. The ensuing surgical procedure must be light and fast. When the skin is cut, the technique of “flying knife-rapid cutting” must be used as some pain may be caused when the incision is made. 中文

Acupuncture analgesia does not completely remove pain. For this reason, electric cauterization must not be used to stop bleeding. Instead, either ligation or pressure must be used. In addition, the patient must be warned that some uncomfortable feeling may be caused when the muscle is pulled around the neck and thyroid gland. The suturing procedure may also cause some pain and must be done as quickly as possible with sharp suture needles. If the level of pain increases, then the needles may be rotated again—or if that fails to bring relief, of course, drug anaesthesia may be resorted to. The whole operation should be performed very quickly to obtain the best results. 中文

Advantages

There are many advantages to the use of acupuncture analgesia. Here we shall discuss three. First, as we have mentioned, acupuncture analgesia, unlike drug anaesthesia, dulls the nerves without causing the patient to lose consciousness; thus, it allows the patient and doctor to cooperate with each other. For example, again in a thyroidectomy, the doctor can talk with the patient at any time, and by listening to the patient’s voice can discover if any injury has been caused to the recurrent laryngeal nerve. Another example is found in cases which involve heart and lung surgery. After the opening incision has been made the doctor can direct the patient to do deep abdominal breathing in order to prevent a sudden shift in the mediastinum and to keep the lung inflated so as not to interfere with the operation and ventilation of the patient. 中文

Second, by comparison with the use of anaesthetic drugs, there are fewer physiological and psychological complications. During operations using acupuncture, we have observed that the blood pressure, pulse and breathing remain regular. This is often not the case with drugs. After an operation with acupuncture analgesia, there are no side effects nor evidence of the complications which may follow operations done with drug anaesthesia. Moreover, because there are few physiological reactions, the patient recovers his normal physical and mental state very quickly. In addition, the patient is more psychologically fit after an operation using acupuncture analgesia. According to our observations, the patient has been aware of and understood the entire surgical process as he has been conscious during the operation; therefore, when the operation is finished, he feels the surgery has gone smoothly and has been quite safe. He is very happy with the results. Often, he immediately wants to get off the operating table, walk around and eat. 中文

Third, acupuncture analgesia is more convenient and comparatively cheaper than other known techniques. 中文

Sometimes Inappropriate

One should not assume, however, that acupuncture analgesia is appropriate for all operations or a complete substitute for drug anaesthesia. Again according to our observations, the following factors impose limits on the use of this technique. First, acupuncture analgesia produces different results on different parts of the body. Our past experience has indicated that the results are better if the parts of the body involved are in the chest cavity and above. At present acupuncture analgesia is used in operations involving the head, neck and chest. As mentioned above, the best results have been achieved in thyroidectomies, so this type of surgery is being used for demonstration purposes. Other types of operation in which acupuncture analgesia has achieved good results are lung operations. In surgery on the abdomen and limbs, however, the results have been disappointing. 中文

Second, the surgical cases must be selected carefully. When choosing a patient to undergo surgery with acupuncture analgesia, his illness must be considered. For example, in operations such as gastrectomies for gastric ulcers and pyloric stenosis, only if the operating time is short is it appropriate to use acupuncture analgesia. But for gastrectomies for stomach cancer in which a rather wide and long investigation is necessary, it is not wise to use acupuncture analgesia. For simple chest surgery such as localized pulmonary tuberculosis, acupuncture analgesia can be used. For exploratory surgery which takes time and in operations for widespread adhesions, it is, however, not advisable to use this technique. In conclusion, at the present time, cases should be chosen in which the nature of the disease is not too complicated and in which the operating time is 1 to 2 h. 中文

Third, the emotional state of the patient must be considered. Because the success of the use of acupuncture analgesia depends on the willingness and understanding of the patient, this is a decisive factor. Before it is used, the entire procedure must be explained to the patient and his active cooperation must be enlisted. Thus, we select those who are emotionally stable, who have a high degree of confidence in the advantages of using acupuncture analgesia, and who are able to follow the doctor’s requests and carry out his instructions. This kind of person is usually strong, energetic and young. Unsuitable types of patient include children under 10, who cannot cooperate with the doctor, and highly nervous individuals. In China, because thought preparation is thorough and deep, there are many people who have great faith in the doctors and nurses, and therefore many now volunteer for and even request acupuncture analgesia. 中文

Problems

Acupuncture analgesia in clinical use is still in the initial stages of development. Our experience indicates that several problems have arisen in its application. 中文

Acupuncture analgesia does not dull the nerves as completely and effectively as drugs. Thus, it is not suitable for every operation. On some occasions when the first incision is made, when suturing commences and/or when the procedure is long, the pain threshold may be decreased so as to render the analgesic effect relatively ineffective. It is therefore necessary to have drug anaesthesia available in case it must be used to complete the operative procedure. 中文

Acupuncture analgesia does not cause complete relaxation of the muscles. For example, in abdominal surgery, during the operation the stomach and intestines might be disturbed which could result in a nervous reflex tightening the muscles and hence pain to the patient. If this condition does arise, drug anaesthesia may have to be used. 中文

The theoretical investigation of the effects and uses of acupuncture analgesia is still in the early stages. The results of the use of this technique are only being brought to light through continued experience and experiments. Thus, at present, there is a method of systematic investigation to provide a firm basis for our work. We are now attempting to investigate the relationships between drugs and acupuncture analgesia. Although we believe acupuncture analgesia can be used widely, we feel it is misleading to say that it can and will replace the use of drug anaesthesia. At this stage we can only say that in certain cases acupuncture analgesia is better than drugs. Acupuncture analgesia is only a new anaesthetic technique, and in some contexts at least it may prove to be a better kind of anaesthetic skill. We believe that both acupuncture analgesia and drugs should be used in surgical work in order to further our understanding of the use of this new technique. We admit that it is a radical step to say it is possible merely to insert a needle, in the absence of drugs, to relieve pain. But at a time when the medical field is changing rapidly and new ideas are ever present, the importance of this development must not be neglected. 中文

( 242 , 559-560; 1973)

S. B. Cheng and L. K. Ding

Chinese Medical Research Centre, 566-568 Nathan Road, Kowloon, Hong Kong FvH08MYFldZLGj90/ui7FhuvWmPBLyt8M49lcJeADgdAtacSn+eylHU654KLx+JM