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Surgery => Anasthesia => Acupuncture
Acupuncture
INTRODUCTION
Acupuncture, ancient Chinese medical procedure involving insertion and manipulation of needles at any of more than 360 points in the human body. Applied to relieve pain during surgery or in rheumatic conditions, and to treat many other illnesses, acupuncture is used today in most hospitals in China and by some private practitioners in Japan and elsewhere, including the United States.
Acupressure, a variant in which the practitioner uses manipulation rather than penetration to alleviate pain or other symptoms, is in widespread use in Japan and has begun to find adherents in the U.S. Also known as shiatsu, acupressure is administered by pressing with the fingertips-and sometimes the elbows or knees-along a complex network of trigger points (see below) in the patient's body.
HISTORY
Acupuncture needles dating from 4,000 years ago have been found in China. The first needles were stone; later, bronze, gold, or silver were used, and today needles are usually made of steel. Initially, needles were used only to prick boils and ulcers. Acupuncture was developed in response to the theory that there are special meridian points on the body connected to the internal organs and that vital energy flows along the meridian lines. According to this theory, diseases are caused by interrupted energy flow, and inserting and twirling needles restores normal flow.
TREATMENT
The primary use of acupuncture in China today is for surgical analgesia. Chinese surgeons estimate that 30 percent of surgical patients obtain adequate analgesia with acupuncture, which is now performed by sending electrical current through the needles rather than by twirling them. American physicians who have observed surgery performed while the patient is under acupuncture have verified that it is effective in some patients, but put the figure closer to 10 percent. Brain surgery is especially amenable to this form of analgesia. Chinese surgeons claim that acupuncture is superior to Western, drug-induced analgesia in that it does not disturb normal body physiology and therefore does not make the patient vulnerable to shock.
Chinese doctors also treat some forms of heart disease with acupuncture. As part of an attempt to put the practice on a more scientific basis, one Chinese study tested the effects of acupuncture treatment on more than 600 people with chest pain caused by reduced blood flow to the heart. Results showed that almost all the patients greatly reduced their use of medicine and that most were able to resume work. Other physiological conditions treated with acupuncture are ulcer, hypertension (high blood pressure), appendicitis, and asthma.
In the United States, scientists have begun to investigate the use of acupuncture to treat a variety of medical conditions. In 1998 a National Institutes of Health (NIH) panel reviewed scientific studies of acupuncture and concluded that the technique effectively relieves nausea and vomiting caused by chemotherapy and surgical anesthesia. Good evidence also suggests that acupuncture relieves nausea during pregnancy and pain after dental surgery. Controlled studies of acupuncture for other medical conditions have not yet produced conclusive results.
How acupuncture works remains uncertain. Both Western and Eastern scientists have shown, by producing acupuncture analgesia in rabbits, that the effects are not simply a matter of suggestion. After the discovery in 1975 of enkephalins and endorphins (natural pain inhibitors in the body), some neurophysiologists suggested that the needles may trigger the release of one or more of these substances, which inhibit pain signals by blocking their pathway through the spinal cord. This view is supported by both American and Chinese studies showing that placing acupuncture needles in certain parts of the brain of dogs causes a rise in the level of endorphins in the spinal fluid. Scientists in the U.S. have also shown that acupuncture analgesia is at least partly reversible by naloxone, a drug that blocks the action of morphine and morphinelike chemicals such as endorphins.
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