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Objective: To confirm that acupuncture applied to patients would improve the clinical curative effect and accelerate the patient’s recovery by introducing the application of acupuncture in pre-operation, during operation, and post-operation. Data sources: Literature cited in this review was retrieved from PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) and was primarily published in English or Chinese from 2010 to 2018, with keywords of "acupuncture," "electroacupuncture," "perioperative period," "sedation," "analgesia," and "recovery." Relevant citations in the retrieved articles were also screened to include more data. Study selection: All retrieved literature was scrutinized, most typical articles related on perioperative acupuncture application in clinical study were reviewed. Results: Acupuncture could relieve anxiety and stress during the preoperative stage. It reduces the usage of narcotics and stress response, and maintains the respiratory stability and homeostasis during surgery. It also exerts a protective effect on vital organs, and during the postoperative stages, enhances the recovery while effectively alleviating the postoperative pain. This phenomenon prevents common postoperative discomforts such as nausea and vomiting. In addition, it might improve the patients’ long-term prognosis. Conclusions: The novel concept "perioperative acupuncture medicine" is to focus on the optimal treatment in the perioperative period of surgical patients. The review reveals the important role of acupuncture in enhancing rapid recovery of patients during the perioperative period. Key words: Acupuncture; Acupuncture anesthesia; Perioperative acupuncture medicine

Acupuncture anesthesia is a technique by partially or completely replacing anesthetics with acupuncture in surgery based on the traditional acupuncture analgesia mechanism. It emerged in the 1950s, went viral in the 1970s and then gradually fell into decline. In the recent years, this technique has regained attention and further research. Acupuncture anesthesia can be classified as either pure acupuncture anesthesia or acupuncture-medication combined anesthesia. To expand the application of this technique, a patient with non-ST elevation acute coronary syndrome in urgent need of percutaneous coronary intervention (PCI) received pure acupuncture anesthesia because of an allergy to lidocaine, and the operation went successfully. This is the first time that pure acupuncture anesthesia and coronary arteriography were combined, which is of great significance in further study and development of acupuncture anesthesia.

Objective To evaluate the effectiveness of acupuncture analgesia (AA) compared with combined spinal-epidural anesthesia (CSEA) for labor pain relief and labor outcomes. Methods We evaluated 131 primiparous women who received respiratory guidance during maternal uterine contractions and received either AA (n = 43), CSEA (n = 45), or no additional treatment (control, n = 43). The groups were compared regarding visual analog scale (VAS) scores for abdominal and back pain, and labor outcomes. Results The abdominal VAS scores of the AA and CSEA groups were significantly lower than that of the control group. In addition, the VAS scores of the CSEA group were significantly lower than that of the AA group at 10 and 60 min after intervention. The back pain VAS scores of the AA and CSEA groups were significantly lower than that of the control group at 5, 10, and 60 min after intervention. The duration of the active phase of labor in the CSEA group was significantly longer than that of the AA and control groups. The rates of oxytocin use (4.70%), urinary retention (4.70%), and postpartum hemorrhage (273.72 ± 53.63 mL) in the AA group were significantly lower than in the CSEA group (46.70%, 24.20%, and 320.00 ± 85.60 mL, respectively). Conclusion Both AA and CSEA were effective for labor pain relief, CSEA provided more effective pain relief, while AA was associated with a shorter duration of labor and fewer adverse effects.and each has its advantages and disadvantages.

Background Acupuncture anesthesia originated from the pain relief and pain prevention theory in acupuncture and moxibustion. This technique is a new exploration of anesthesiology and an original achievement of China, representing a landmark combination of Traditional Chinese Medicine and Western medicine. Objectives The aim of this historical vignette to introduce acupuncture anesthesia with its meaningful history, especially the use in neurosurgery to the public. Design This historical vignette introduced the development, mechanism research, awake craniotomy, in order to analyze the utility of acupuncture anesthesia, its global impact, the current situation and future of acupuncture anesthesia. Conclusion Acupuncture anesthesia was initiated in 1958, and, reflecting the historical background of China after the 1960s, the use of this technique spread widely throughout the country. Reaching other countries after 1971, acupuncture anesthesia had a significant influence, drawing attention from medical academia worldwide. Thus, acupuncture anesthesia has made a special contribution to the medical science of modern China.

The success of acupuncture anesthesia (AA) for pneumonectomy in Shanghai in 1960 was a key event for AA gaining practical clinical application. The effort was a close collaboration between the Shanghai First Tuberculosis Hospital and the Shanghai Institute of Acupuncture and Moxibustion. One of the most important factors of AA success was the great financial and political support provided by the Chinese central government and Shanghai local government. In December1965 the State Science and Technology Commission of China issued a formal document acknowledging AA as an important first-level national achievement of the integration of Chinese and Western medicine, and a collaborative effort of the whole scientific community in China. AA was an important influential factor that helped acupuncture spread across the world.

Background: The demand for improved anesthesia during off-pump coronary artery bypass grafting (OP-CABG) is continually increasing. Ensuring stable hemodynamics and balanced myocardial oxygen supply during OP-CABG are key issues that remain to be resolved. There is evidence that acupuncture anesthesia can decrease mortality after OP-CABG, while reducing the dose of anesthesia required, minimizing surgical complications, and decreasing medical costs. Acupuncture at distal-proximal acupoints in combination is the most commonly used method requiring acupoint compatibility. We hypothesize that electroacupuncture at distal-proximal and regional acupoints prior to OP-CABG will reduce the dosage of anesthesia required during OP-CABG, and minimize postoperative complications. Methods/Design: This prospective, randomized, double-blind, controlled trial will be performed at the Departments of Anesthesiology at Xijing Hospital, Fourth Military Medical University, and Tianjin Chest Hospital, China. A total of 186 patients scheduled for OP-CABG in these two hospitals will be included in the study. The patients will be divided into three groups: distal-proximal acupoints group (acupuncture at the Danzhong (CV17) and Hegu (LI4) acupoints); regional acupoints group (acupuncture at the Danzhong (CV17) and Juque (CV14) acupoints); and non-acupoint group (acupuncture at a site 2 cm lateral from the Danzhong (CV17) and Juque (CV14) acupoints). All interventions will start 30 minutes prior to anesthesia and continue until the beginning of anesthesia. The primary outcome is the dose of sufentanil used for anesthesia. Secondary outcomes are cardiac troponin I content, inotropic score, dose of propofol used for anesthesia, duration of mechanical ventilation, duration of stay in the intensive care unit, length of postoperative hospital stay, incidence of overall complications within 30 days of surgery, and incidence of overall mortality within 30 days of surgery. Adverse events will be also evaluated. Discussion: This trial protocol will determine whether acupuncture at distal-proximal or regional acupoints can reduce anesthetic dose and postoperative complications in OP-CABG surgery, with the purpose of ensuring patient safety in the perioperative phase. Trial registration: ClinicalTrals.gov identifier: NCT02443220; registered on 18 August 2014. Ethical approval: The protocol was approved by the Ethics Committee on Clinical Trials of Drugs, Xijing Hospital, and the Ethics Committee on Clinical Trials, Tianjin Chest Hospital, China. Written informed consent regarding trial procedure and treatment protocol will be obtained from each subject.

Acupuncture anesthesia was created in the 1950's in China and continues to be used there today during most major surgeries. It is widely used in China for such complex operations as brain, heart, and abdominal surgery. It is popular in China because it is economical, practical, and beneficial to the patients. With acupuncture anesthesia there is less bleeding during surgery and there is also quicker post-operative recovery.This randomized prospective study aims at comparing the effect of two acupoints (Yongquan, KI1 and Renzhong, DU26) with sham acupuncture and no acupuncture on the time to recovery of consciousness after general anesthesia by means of the Bispectral Index monitor (BIS).This is a prospective randomized controlled study. We randomly assigned 50 patients to 5 groups during recovery from surgical anesthesia. Four groups had acupuncture on KI1 (group A), DU26 (groups B), both KI1 and DU26 (group C), and sham points (group D), and one had no acupuncture (group E).Bispectral Index (BIS), time to spontaneous eye opening, time to tracheal extubation, and time to following commands were measured as the main outcome measures.Time to spontaneous eye opening differed among groups (P=0.002), as well as time to tracheal extubation (P0.000 1) and time to following commands (P=0.000 6). BIS values differed significantly among groups both 5 and 10 min after the end of anesthesia (P0.000 1 and P=0.000 4, respectively). BIS values of groups D and E were lower than those of the other groups and those of group C were higher. The same pattern was observed also 15 and 30 min after the end of anesthesia, although the difference among groups was not significant at these time points (P=0.164 and P=0.104, respectively).Acupuncture on DU26 and KI1 accelerates recovery of consciousness after general anesthesia. Moreover, a possible synergistic effect of DU26 and KI1 is suggested. This issue may play a role in the optimization of operating room management and raise interest about the usefulness of acupuncture on unconsciousness states of different nature.

Objective To evaluate the effect on acne vulgaris of pricking-bloodletting cupping at Dazhui (GV 14) under acupuncture anesthesia, and establish whether providing anesthesia to the treatment area by manipulating Hegu (LI 4) and Quchi (LI 11) might have an additional therapeutic benefit. Methods Thirty-eight patients were recruited and randomized into a control group and an intervention group with a single-blind (observer-blind) method. The control group was treated by pricking-bloodletting cupping at Dazhui (GV 14) and the studied group by pricking-bloodletting cupping at Dazhui (GV 14) under acupuncture anesthesia at Hegu (LI 4) and Quchi (LI 11). Both groups were treated twice weekly for 6 weeks. The analgesic and therapeutic effects of acupuncture were evaluated on a visual analog scale (VAS) and global acne grading system (GAGS), respectively. Results There were differences in the VAS scores of pain on pricking and in the pricked area, and the duration of pain between the groups. After 12 treatments, there was a significant reduction in GAGS scores from baseline in both groups, but there was no significant difference between the groups. Conclusion Acupuncture anesthesia at Hegu (LI 4) and Quchi (LI 11) is an effective means of alleviating the pain of pricking-bloodletting cupping and reducing the duration of pain in the treatment area. Pricking-bloodletting cupping at Dazhui (GV 14) improves the skin lesions of patients with moderate acne vulgaris, but acupuncture anesthesia does not appear to have an additional therapeutic effect.

Pain is one of the most important sensations in daily life,andthe traditional Chinese medicine such as acupuncture has shown great potential in pain relief. The principle research of acupuncture anesthesia has been the focus of modern science. In this paper the noninvasive brain imaging technique fMRI (functional magnetic resonanceimaging) was used. Eight volunteers were enrolled and received pain stimulation,andthe brain response under TEAS (transcutaneous elec-trical acupoint stimulation) and manual needle stimulation were observed. The research finds pain has specific sensation region and the acupuncture anesthesia is realized through modulating the corresponding brain function region, but the manual needle has wider brain response region than TEAS.

Objective To observe the protective effect of acupuncture-drug compound anesthesia with different frequency electroacupuncture (EA) on stress reaction in patients of pneumonectomy and to explore potential mechanisms. Methods Eighty patients scheduled for pneumonectomy were randomly divided into four groups, group A, B, C and D, 20 cases in each group. General anesthesia and single lung protective mechanical ventilation were carried out in all the groups. Acupuncture was given at Houxī ( SI 3), Zhīgōu ( TE 6), Neiguān ( PC 6), and Hegŭ ( LI 4) 30 min before general anesthesia, and the acupuncture needles were connected with Han's acupoint nerve stimulator (HANS-200) in all the groups, but the acupuncture needles without needle bodies were pasted on the acupoints and EA was not given in the group A. 2 Hz continuous wave, 100 Hz continuous wave and 2 Hz/100 Hz EA were given in the group B, C and D respectively. The supplementary amount of anesthesia medicine, heart rate (HR) and mean arterial pressure (MAP) during pneumonectomy, and CD+4/CDCD+8 in venous blood before and one day after the surgery, and the contents of epinephrine (E) and Cortisol (Cor) in plasma after entering the operating room and before turning out the operating room were detected. Results During the operation, supplementary amounts of Fentanyl in the group B and C were lower than those in the group A and D (P The MAP in the four groups at tracheal intubation (T1) all were higher than those before anesthesia (T0) (all P 0.05), and the ascending extents in the group B and D were lower than that in the group A (both P CD+4/CD+8 in the group A after pneumonectomy was lower than that before the surgery (P 0.05). Contents of E and Cor after the operation were significantly increased in all the groups (all P Conclusion Acupuncture-drug compound anesthesia can attenuate the stress reaction so as to protect organs under the condition of less or same narcotic amount and can alleviate the fluctuation of MAP and HR at tracheal intubation and stabilize CD+4/CD+8 after pneumonectomy. Among them, 2 Hz and 2 Hz/100 Hz EA have better effects.

Prof. HUANG Xian-ming (1920), a famous acupuncturist at home and abroad, was appointed as the director of Shanghai Research Institute of Acupuncture and Meridian, director of WHO Shanghai International Acupuncture Training Center, chairman of shanghai Association of Acupuncture-moxibustion, vicepresident of China Association of Acupuncture and Moixbustion, Chinese side member and advisor of the organization committee of the World Federation of Acupuncture-moxibustion Societies (WFAS), editorial committee director of Shanghai Journal of acupuncture and moxibustion. In 1987, he was approved to be first group of TCM professor, tutor for master and doctoral postgraduates and leading professor of acupuncture science by the Ministry of Education of the State. In 1991, he was approved to be one of 500 famous and senior TCM doctors of the first national group jointly by the Ministry of Education, Ministry of Human Resources and Ministry of Laboring Affairs, enjoying the special expert allowance of the state council, and he has achieved plentiful scientific results in his clinical and scientific field of acupuncture and was one of the establishers of “acupuncture anesthesia” in China. In the social public duties, he used to be people’s representative of No. 2 to No. 9 session of Shanghai people’s congress, member of the central committee of No.6, 7, and 8 sessions of Chinese Democratic Promotion Society, member of No. 3 session of consultation committee, standing member of Shanghai committee of Chinese Democratic Promotion Society, and directorial member of medical and health committee. He visited over 20 countries and regions of the five continents, and participated in many international academic communication activities and working conferences and was given award by leaders of many countries.

@@ Acupuncture anesthesia is a great breakthrough in the development history of acupuncture science in China. It has promoted the development of acupuncture science, promoted the study on acupuncture from multiple subjects of modem natural sciences and has become an important component part in the studies of modem life science[1].

Acupuncture anesthesia has been practiced in China since about 1960. In Japan, Hyodo reported 30 cases of acupuncture anesthesia in 1972. However, from around 1980, the direction of acupuncture investigations turned from anesthesia to analgesia. Acupuncture analgesia is presently considered a way to activate the body's endogenous analgesic system. Recently, with the rise of acupuncture as one of the most well known CAM therapies, acupuncture or moxibustion treatment has been reported for both acute and chronic pain. Even so, few clinical reports and original articles have been reported in Japan. This review illustrates how acupuncture is being used in Japan for acute pain such as surgical operations, post- operative pain (POP), neuropathic pain, pain associated with teeth extractions and after the extraction of impacted wisdom teeth.

Background Acupuncture anesthesia was used instead of intubation anesthesia in the 1970s and 1980s in West Germany and West Berlin. In East Germany acupuncture played no decisive role. Sources Different articles and papers in journals, in daily press, statements of contemporary witnesses, films, records in archives. Results As in other Western countries, acupuncture was hugely popular in the Federal Republic of Germany in the 1970s. Chief triggers were the state visits to China of the American President Richard Nixon in 1972 and shortly thereafter of West German Foreign Minister Walter Scheel and his wife Mildred, an x-ray technician. During that period observation of an operation under acupuncture anesthesia was an obligatory element in the agenda of a foreign delegation. Following this showcasing, acupuncture was widely adopted in Western surgery as an alternative to the previously exclusive employment of intubation anesthesia. While the alternative method was soon abandoned in the frontline city of West Berlin, it continued to prevail in other West German cities, e.g. Giesen and Munich. Following the Chinese example, the acupuncture effect was normally enhanced electrically. In accordance with the animosity between the USSR and the People’s Republic of China, exchange between the German Democratic Republic and China was very restricted through the late 1980s. This made it easier for East German acupuncture sceptics to reject the procedure and brand it as unscientific. Those who advocated it were in a precarious position. Conclusions Acupuncture was lauded in the West as ancient savvy destined to complement science-oriented medicine. However, the cultural transfer which accompanied the spread of acupuncture was flawed by misunderstanding and misguidance. Acupuncture anesthesia instead of intubation was not practiced in the GDR. Acceptance of acupuncture in East German medicine failed to make any headway until the last few years of the country’s existence.

Objective To observe the anesthesia effect of ear acupuncture for in vitro fertilization-embryo transfer (IVF-ET) egg retrieval.

Fig. 1. A child, fully awake and comfortable, undergoing open heart surgery for repair of a congenital ventricular septal defect under acupuncture anesthesia in a hospital in Shanghai, photographed by the author during his 1972 visit to China. The word acupuncture combines the Latin acus (needle) and punctum (a prick) [1,2]. From the historical record of Huangdi Neijin (the Yellow Emperor's Classic), acupuncture has been used in China as a therapeutic tool for at least 2000 years [3]. Soldiers noted, after being wounded by arrows, that their pain often eased for quite a while. Therefore, a cause-and-effect relationship was assumed between the arrow wound and the unexpected diminution of pain. However, it has been little known in theWestern world until the early 1970s following U.S. President Nixon's historic visit to China in 1972 [4]. Acupuncture becomes one of the most popular treatments in alternative medicine and accounts for more than 10 million treatments given annually in the United States [5]. Much interest was further engendered by tales by subsequent visitors to China who witnessed surgical operations being successfully performed on conscious patients under acupuncture anesthesia [6–15]. Skeptics who deny that acupuncture anesthesia can work have suggested that acupuncture is nothing more than an effective use of hypnosis or autosuggestion. I was also a skeptic until I witnessed with myowneyes several operative procedures performedonpatients under acupuncture anesthesia including those with congenital (Fig. 1) and acquired valvular (Fig. 2) heart diseases. Being a native-born Chinese, I was able to communicate directly with the patients, without going through any interpreters, to find out what discomfort and if any pain they actually might experience during the procedures. Of course, I was not the only physician who was impressed by cardiac surgery under acupuncture anesthesia. Other well-known surgeons around theworld, such as DeBakey from the United States [16], Hollinger et al. [17] from Germany, and Caracausi from Italy [18] were too.

A group of German physicians was invited to accompany an acupuncture anesthesia in Beijing Guang’anmen Hospital. This case report presents the observations of this group during a bilateral turbinat outfracture operation of the nose with acupuncture assisted local anesthesia in a 38-year-old patient.

As a part of acupuncture system, acupuncture anesthesia can promote the development of acupuncture theory. Muscle region is also a part of acupuncture system and plays a guiding role in clinical application of acupuncture anesthesia. The correlation between the distribution of muscle regions and nerves acts as the substantial foundation of the guiding role. At the same time, acupuncture anesthesia has been promoting the continuous development of muscle region theory. The cyclic development relation between the two (practice-theory- practice) is consistent with the dialectical development view.

Since a journalist covering Richard Nixon's historic trip to China in the early 1970s reported on his incredible experience of having an emergency appendectomy performed under acupuncture anesthesia, acupuncture gradually increased in popularity and sophistication in the United States. Although most noted for its effects on pain, acupuncture has been studied extensively and found to be effective in a variety of medical conditions, including skin disorders such as atopic dermatitis, acne, and psoriasis.1-8 The term acupuncture is derived from the Latin words acus (needle) and punctura (puncture)—or using a needle to puncture the body. A more modern and expansive definition of acupuncture is the stimulation of specific points on the body with needles and/or other stimuli (eg, moxibustion, heat, massage, and electricity), which are discussed subsequently in this article. To understand how stimulating points on the body with any modality could lead to physiologic changes that might be beneficial, one must first remember that human beings are composed of matter and energy and that energy condenses into matter and matter can become energy. A fundamental tenet of all energetic medicine is that the goal of therapy is to eliminate energetic dysfunction before it condenses into material or physiologic disturbances. Initially, energetic dysfunction manifests itself as symptoms and symptom complexes that lead to reversible alterations in matter that

Objective: To investigate the regulation of acupuncture on γ-interferon (INF-γ) and tumor necrosis factor (TNF) of lung cancer-operative cases.Methods: to determine the INF-γ and TNF contents in the blood serum of lung cancer patients by double antibody sandwich immuno-enzymatic method (ELISA); to measure the INF-γ and TNF contents of 30 lung cancer patients in the acupuncture anesthesia group and 30 lung cancer patients in general anesthesia group before the operation and at the 8th days, the 12th day after the operation respectively and make comparison between the two groups.Results: The pre-operation INF-γ contents of the two groups showed no significant difference (P>0.05); the post-operation INF-γ contents of the two groups showed significant difference at 8th day and 12th day after the operation (P 0.05) and the post-operation TNF contents of the two groups showed significant difference at the 8th day and 12th day after the operation (P

Perioperative myocardial ischemia–reperfusion, pulmonary interstitial edema, and postoperative central nervous system complications are the main risk factors that affect the postoperative rehabilitation of patients who have undergone cardiac surgery. Based on the principle of “where there is a meridian acupoint, there is the indication,” we have selected two points of pericardium meridian of hand-Jue Yin [Neiguan (PC-6)] and lung meridian of hand-Tai Yin [Yunmen (LU-2), Lieque (lU-7)] to strengthen prevention and protection of perioperative myocardial ischemia, reduce perioperative risk factors effectively, and improve patient’s postoperative rehabilitation through regulation of body’s internal environment. The regulation mechanisms of circulatory function by acupuncture include (1) cardiac autoresuscitation rate, incidence of myocardial ischemia, vasoactive drug dosage, incidence of postoperative complications, ICU, and hospital stay days for cardiac surgery patients to whom the acupuncture anesthesia were significantly better than patients with endotracheal intubation anesthesia. (2) The studies show that the acupuncture anesthesia for cardiac surgery has reduced operative risk and improved surgical safety. Its main mechanisms include (a) regulation of β-EP, ACTH, cortisol, and plasma dopamine by electroacupuncture stimulation that improve impact of surgery on internal environment; (b) increase HSP70 expression by myocardial cells; (c) reduce mitochondrial membrane permeability; (d) inhibit cell adhesion process so as to reduce myocardial cell injury. (3) According to the principle of “where there is a meridian acupoint, there is the indication,” we find that double points selection of lung meridian of hand-Tai Yin [Yunmen (LU-2), Lieque (lU-7)] has apparent effect on myocardial protection, suggesting local and remote synergy of acupoints along meridians. Acupuncture anesthesia is a combined technique, including acupuncture combined with hypothermic anesthesia, and acupuncture anesthesia combined drugs (salvia, nicardipine, l-arginine) which have a synergistic effect on circulation regulation.

Aging is of critical interest in the medical, health, and social domains, especially in developed countries and newly industrializing countries. Because muscle atrophy in elderly individuals can cause falls, its prevention is important. Moreover, prevention of agingrelated reduced skeletal muscle mass may allow a higher quality of life in the elderly, because reduced muscle function is linked to the occurrence of several chronic diseases (Handschin & Spiegelman, 2008). High-intensity resistance training effectively maintains muscle mass and strength, but rigorous training is difficult for elderly people (Seynnes et al., 2007). Acupuncture is a well-known traditional technique in eastern Asia that is used to maintain health and cure many diseases. Major acupuncture techniques utilize penetration of the skin by thin, solid metallic needles, which are manipulated manually or are stimulated electrically. This electrical needle stimulation is called electroacupuncture (EA) (Klein & Trachtenberg, 1997). EA is effective not only for pain but also for muscle problems, such as stiffness, exhaustion, and atrophy, in many patients including elderly people (Zhang, 2003). Acupuncture studies have reported the nerve routes of acupuncture signal transmission, effects via the spinal reflex, and reactions in the brain (Cho et al., 1998; Murase & Kawakita, 2000; Uchida et al., 2000). Figure 1 is a schematic diagram showing the routes of EA stimuli between treated points and organs. In a previous investigation on acupuncture, only a neural mechanism of pain reduction was clear; endogenous opioid (beta endorphin and enkephalin) is induced under the acupuncture anesthesia (Chung & Dickenson, 1980). However, the molecular mechanisms of other effects of acupuncture were as yet not defined (Acupuncture, 1997). Scientific evidence of efficacy is an important as for the CAM research, as for research in Western medicine. The enhancement of blood flow in target organs of acupuncture treatment, which is a major reason for the effectiveness of acupuncture (Niimi & Yuwono, 2000), cannot sufficiently explain the recovery of muscle from exhaustion because it is not clear how the supplied oxygen and nutrients would be used during the cellular recovery process. Many cellular and physiological processes are regulated at the transcription level of gene expression. The identification of genes specifically modulated during the process of acupuncture would provide an initial step toward elucidation of the underlying mechanisms of this technique.

Although the use of acupuncture anesthesia for open heart surgery, which was introduced in China four decades ago, has declined in recent years, there is a renewed interest in it in contemporary China due to the escalating medical costs associated with open heart surgery. This study was aimed to determine whether a combined acupuncture-medicine anesthesia (CAMA) strategy reduces early postoperative morbidity and medical costs in patients undergoing open heart operation under cardiopulmonary bypass.From July 2006 to October 2010, CAMA was applied in 100 patients undergoing open heart surgery in comparison with another 100 patients under the conventional general anesthesia (GA). For all the CAMA patients, an abdominal breathing training program was practiced for the 3 consecutive days prior to operation. About 15 to 20 min prior to surgical incision, acupuncture needles were inserted into the bilateral points ZhongFu, LieQue, and XiMen. During operation, patients were kept on spontaneous breathing. Endotracheal intubation was not employed but only prepared as a standby. The narcotic drugs, fentanyl and midazolam, were intravenously injected but in very low doses as compared to GA. Open heart procedures were performed routinely in both groups.Compared with the GA patients, the CAMA patients had a less usage of narcotic drugs (p0.001), less postoperative pulmonary infection (p0.05), shorter stay in intensive care unit (p0.05), and a lower medical cost (P0.05).A combined acupuncture-medicine anesthesia strategy reduces the postoperative morbidity and medical costs in patients undergoing open heart surgery under cardiopulmonary bypass.

According to previous reports, there are few side effects and it is easy to perform in acupuncture administration for anesthesia or pain relief Acupuncture anesthesia as an alternative method to conventional premdication in panendoscopy was inziestigated in tzvo hundred outpatients who were divided into a conventional anesthesia group and an acupuncture anesthesia group by their own choice. Sentype two pairs of patients were selected from these two groups of patients using the casecontrol matching method. The conventional group way premedicated with an intramuscular injection of 0.6 mg trospium chloride (an anticholinergic) and a local spray of 0.3 cc 8% Xylocaine to the orophurynx. The acupunctrrro group was premedicated by needling the left Hogu and Neigun- Yaiguan points. All patients in both, groups tolerated the endoscopy procedure and the efficacy of these two methods were analyzed. There were no statistical differences (p>0.05) in terms of the patients’discomfort, cooperation, gastric peristalsis during the procedure, the mean pulse rute before examination, and the patients’willingness to undergo another panendoscopy, between the two groups. Only belching during examination was noted to be more seviere in the acupuncture group (p=0.022). Acceleration of pulse rate after examination was found to hc more significant in the conventional group (p

In this chapter, the clinical and experimental studies on acupuncture-drug balanced anesthesia will be reviewed. The history of acupuncture anesthesia in China started in 1958. After two decades of clinical practice and experimental investigation, the combination of acupuncture (usually electro-acupuncture, EA) with drugs has been successfully used to improve anesthesia for surgical operations and pain treatment since the 1980s, and this technique is now known as the acupuncture-drug balanced anesthesia in China. It is more advantageous to use acupuncture combined with selected drugs to produce anesthesia, because acupuncture could regulate the functions of multiple organs of the body in addition to analgesia. Moreover, the underlying mechanism has been elucidated by investigating the potentiation effects of some commonly used drugs on acupuncture analgesia, in various animal models. Substantial evidence has shown that the combination of acupuncture with these drugs promotes the release of endogenous opioid peptides (EOP). In addition, these drugs potentiate EA-induced expression of EOP gene. Furthermore, several lines of evidence show that EA induces an increase in both binding affinity and density of the opioid receptors, while the combined use of acupuncture with drugs can further enhance the EA effect. Currently, clinical and bench studies on acupuncture-drug balanced anesthesia are still in progress to improve the clinical efficacy and to better understand the working mechanisms. We expect that new discoveries through the translational research will bring more benefits to patients.

D-phenylalanine (DPA) is known to block the activity of carboxypeptidase, an enzyme which degrades enkephalins, endogenous morphine-like substances. Therefore, it is considered that DPA administered as an inhibiting drug of this degrading enzyme might prolong analgesia induced by acupuncture. 1) Thirty patients suffering from chronic low back pain were treated with acupuncture 30 minutes after the oral administration of 4.0 grams of DPA. The results were: excellent in 7 cases, good in 11, fair in 6 and poor in 6. Cases graded excellent and good were then compared with a placebo group. The effect was increased 26% in the DPA-acupuncture group, which shows no statistically significant difference (P less than 0.1). 2) In 56 patients, tooth extraction was performed under acupuncture anesthesia: 18 had received 4.0 gram of DPA (P.O.) 30 minutes earlier. The results were excellent in 8, good in 6, fair in 3, and poor in 1. The excellent and good cases were compared with 38 placebo group cases. The effect in the DPA-acupuncture anesthesia group was significantly increased by 35% (P less than 0.01). 3) In order to determine the optimum time for the administration of DPA, two schedules of administration were compared. [1] DPA was given on the previous day in three 0.5 gram doses (26 cases). [2] A single 4 gram dose was administered 30 minutes before treatment (30 cases). The results from the "excellent", "good" and "fair" cases showed a 16% increase in effectiveness when DPA was administered the day before, not a statistically significant difference (P less than 0.1), but a clear tendency to increase was observed. The above findings show that DPA has an enhancing effect on acupuncture analgesia and anesthesia in clinical practice.

Objective: To find out whether high resection rate and low incidence of disability can be obtained from operations for tumors on cerebral functional areas by applying “combined acupuncture-drug anesthesia”Methods: According to the route of entry of operations, two different groups of acupoints for body acupuncture combined with ear acupuncture therapy were applied.Results: Among the 80 patients operated on, 20 were suffering from tumors in the speech center, 60 in the sensorimotor center. Good result was obtained from all the operations. Grade 1 effective rate of acupuncture anesthesia reached 100%. None of the patients experienced aggravation of dysphasia or dysfunction. Five patients showed aggravation of myasthenia and dysesthesia, but all of them recovered within 2-4 weeks.Conclusions: High resection rate and low incidence of disability may result from operations performed with “combined acupuncture-drug anesthesia;” so this kind of anesthesia can be used as a routine anesthetic method for operations.

Acupuncture therapy is one of the original innovations in traditional Chinese medicine. The study of acupuncture has gradually advanced towards the world since 1970s. In these years the most important events might be the influence of acupuncture anesthesia, the attention of the World Health Organization, the establishment and development of the World Federation of Acupuncture and Moxibustion Societies, and the consensus development conference on acupuncture held by the National Institutes of Health in America, and so on. The reasons why acupuncture is accepted by the world are both the convinced curative effects and the scientific foundations, due to the great efforts of medical stuff in China guided by the principle of integration of traditional Chinese and western medicine. This article poses several proposals about further extending the influence of acupuncture. In brief, acupuncture research is one of the few fields that authentically impact the western scientific technology. It is of very important responsibility in the new century to impulse the acupuncture study to further progress and expand the international influence of acupuncture.

@@ The patient was female, 29 years old, Han Nationality and married. Chief complaints: An over 20 years' history of congenital heart disease. She was admitted to a hospital for brain abscess operation in April 2006.During the hospitalization, color echocardiography showed a pulmonary transvalvar gradient of 134 mmHg, suggesting pulmonary valve stenosis. The patient was admitted to the department of cardiothoracic surgery in the present hospital for treatment on August 8, 2006.

Acupuncture was commonly performed in China to achieve pain relief before it attracted special interest in the late 1950s as a result of its use for anesthetic purposes in surgical operations. In the excitement aroused by this unexpected new application of the ancient healing technique, numerous scientists were recruited to undertake scientific exploration of its basic mechanisms. At the first “All-China Conference on Acupuncture Anesthesia” held in Shanghai in 1965 more than 100 papers were presented; due consideration was given to the basic phenomenon of acupuncture analgesia (AA) in humans (Research Group of AA, Peking Medical College 1973), attention being drawn to its slow onset (an induction period of 20–30min) and slow decay (half-life of 16min).

Current views on acupuncture mechanisms are represented by Pomeranz (1987) in his recently published book and emphasize the role of spinal, brainstem, midbrain, and hypothalamic mechanisms, but no one in the West has emphasized the role of cerebral cortex in acupuncture analgesia (AA).

Sheng-Xing Ma. Departments of Obstetrics and Gynecology, Harbor–UCLA Medical Center, David Geffen School of Medicine at University of California at Los Angeles, Torrance, CA, USA. eCAM 2004; 1:41–97, http://www.ecam.oupjournals.org/cgi/content/full/1/1/41 It has long been accepted that acupuncture, puncturing and scraping needles at certain points on the body, can have analgesic and anesthetic effects, as well as therapeutic effects in the treatment of various diseases. This therapy, including acupuncture anesthesia, has drawn the attention of many investigators and become a research subject of international interest around the world. Numerous studies have demonstrated that the nervous system, neurotransmitters, endogenous substances and Jingluo (meridians) may respond to needling stimulation and electrical acupuncture. An abundance of information has now accumulated concerning the neurobiological mechanisms of acupuncture, in relation to both neural pathways and neurotransmitters/hormonal factors that mediate autonomic regulation, pain relief and other therapeutics. Early studies demonstrated that the analgesic effects of electroacupuncture (EA) are mediated by opioid peptides in the periaqueductal gray. Recent evidence shows that nitric oxide plays an important role in mediating the cardiovascular responses to EA stimulation through the gracile nucleus-thalamic pathway. Other substances, including serotonin, catecholamines, inorganic chemicals and amino acids such as glutamate and -aminobutyric acid (GABA), are proposed to mediate certain cardiovascular and analgesic effects of acupuncture, but at present their role is poorly understood. The increased interest in acupuncture health care has led to an ever-growing number of investigators pursuing research in the processes of the sense of needling touch, transduction of needling stimulation signals, stimulation parameters and placebos. In this Review, the evidence and understanding of the neurobiological processes of acupuncture research have been summarized with an emphasis on recent developments of nitric oxide mediating acupuncture signals through the dorsal medulla-thalamic pathways.

Four volunteers judged eight levels of thermal stimuli induced by a Hardy dolorimeter, varying in intensity from extremely painful to a low level seldom even perceived. Half of the 406 stimuli were applied during acupuncture and half either before insertion or after removal of the needles. The experimental design minimized or eliminated factors other than the needles themselves, i.e., no medication was given, the subjects were scientists accustomed to objectivity and, on a preceding day or days, all had become experienced in assigning numbers (individually chosen) to the sensations produced by the different stimuli. Galvanic skin resistance was also tested. The results did not show any influence of acupuncture on perception of pain or on galvanic skin resistance.

A new theory is proposed to explain various pain phenomena hitherto unexplainable. It is hypothesized that neurons in the thalamic region are responsible for the generation of most pain, particularly in chronic pain states. It is also hypothesized that the thalamic neurons are organized according to a master scheme representing a homunculus in the fetal position. Various painful conditions and the treatments of them including the trigger points phenomena, neurosurgical techniques, acupuncture and acupuncture anesthesia can be explained on this basis.

From November 1965 to December 1978, about 10,635 cranio-cerebral operations were performed under acupuncture anesthesia in 24 neurosurgical departments in China. The extensive clinical practices have proved that acupuncture surely has analgesic effect. So far most researches upon the mechanism for analgesia by acupuncture were based on animal experiments, but not confirmed or evidenced in human beings. For this reason, a series of clinical studies upon the neurophysiological and biochemical basis for acupuncture analgesia has been made utilizing the facilities of neurologic clinic provided that the patient's condition is not adversely affected and therapeutic efficiency is enhanced. The results are summarized as follows.