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A Brief History of Acupuncture Analgesia

The first type of acupuncture to have a large-scale impact in the West, acupuncture anesthesia (AA) is gradually gaining prominence as a viable healthcare modality in the modern world.

As a primary branch of traditional Chinese medicine, acupuncture has been practiced in China and other Asian countries for thousands of years. In the West, acupuncture is gradually gaining prominence as a viable healthcare modality in the modern world. According to the National Health Interview Survey — the largest and most comprehensive survey of complementary and alternative medicine (CAM) use by American adults to date — visits to acupuncturists were increased by 32% from 2002 to 2007[1]. According to a 2009 report released by American Hospital Association, among the hospitals surveyed, 38.7% offer medical acupuncture[2]. In the U.S. today, there are an estimated 21,000 licensed acupuncturists, of whom approximately 5,000 are physicians. 

The first type of acupuncture to have a large-scale impact in the West is acupuncture anesthesia (AA). James Reston, a member of the press covering a Ping-Pong tournament, unexpectedly became a medical pioneer when he had to have an emergency appendectomy in Beijing. His New York Times article in July of 1971[3] described how the practice had relieved his postoperative abdominal pain, but was understood by many to be an endorsement of surgical acupuncture anesthesia. The enthusiasm was further fueled by reports from John Bonica[4] and from other medical delegates from Australia, Norway, the United Kingdom, and Canada, as well as the United States, who made fact-finding trips to China to witness operations where AA was the only anesthetic[5]. The first attempt to duplicate Chinese acupuncture analgesia techniques was initiated in late 1971 in Marseilles by Dr. Nguyen Van Nghi; he and his team reported 50 major operations using the method with good results by 1973. In the United States, the technique was first used by W.C. Liu for a tonsillectomy, whose result was published on April 21, 1972[6].

Actually, acupuncture as a functional modality employed in modern surgical technique was introduced in several cities in China in 1958, the year of the Great Leap Forward, and the third year of the famous program launched by the Chinese government to train “Western doctors” in TCM. During this time, hospitals recruited traditional medical practitioners to join newly created departments, while physicians were encouraged to pursue studies in traditional methods. Within this social and political context, surgeons, acupuncturists, anesthesiologists, researchers and patients were all motivated to work together to develop this new modality[7].

Basic researchers explored the underlying physiology in order to demystify AA, studying the anatomical and histological substrate of the traditional acupoints and meridians, and searching for neurophysiological and neurochemical mechanisms. Basic AA research was informed by new theoretical developments in neuroscience, for example, the gate control model in 1965, and the identification of the endogenous opioids and opioid receptors in the 1970s.

Meanwhile, these interprofessional and patient-practitioner relationships were also re-emphasized in clinical practice. The clinical application of AA started from small-scale surgical operations, such as tonsillectomy, thyroidectomy, and appendectomy, and then expanded to major operations, such as pneumonectomy. The initial goal was the replacement of chemical anesthetic drugs with AA, or the use of anesthetics only as adjuvants, whenever possible. However, as anesthesiology developed safer and more reliable drugs, while AA remained a complicated method to use in practice, clinicians transitioned to acupuncture-assisted anesthesia (AAA), using acupuncture itself as an adjuvant, and making it possible to achieve better outcomes with fewer anesthetic drugs[8].

The topic was nested in a larger study, the Visual History Project of Integrative Medicine Development in China, which traces the development of integrative medicine in China since mid-1950s. We used snowball sampling methodology to develop three lists of subjects for interview. First, from literature searches and recommendations from the Chinese Association of Integrative Medicine (CAIM), we identified seven first generation integrative medicine experts in the field of acupuncture, including two surgeons, one acupuncturist, one anesthesiologist, and three researchers, who actively participated in acupuncture analgesia research and clinical practice from the late 1950s to the early 1970s. We interviewed these pioneers and then consulted with them to identify seven of their close colleagues and/or protégés who are still actively involved with acupuncture analgesia study and/or practice. Finally, through consultation with the first two groups, we identified three international observers, who have collaborated with these Chinese experts, for interview.

In brief, based on seventeen oral history interviews with Chinese leaders and international experts in the field conducted from October 10, 2007 to November 8, 2010, we compiled this 21-minute video, titled “Acupuncture from East to West: Scientific Research and Clinical Application.”

This summary is based on a paper titled, “Miracles that has no end: the development of acupuncture in surgical anesthesia in China, 1958-1990” by Weijun Zhang, DrPH, UCLA Center for East-West Medicine.

References

  1. Barnes, P.M., B. Bloom, and R.L. Nahin, Complementary and alternative medicine use among adults and children: United States, 2007. National health statistics reports, 2008(12): p. 1-23.
  2. Ananth, S. CAM: An Increasing Presence in U.S. Hospitals 2009; Available from: http://www.hhnmag.com/hhnmag_app/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/01JAN2009/090120HHN_Online_Ananth&domain=HHNMAG.
  3. Reston, J., Now about my operation in Peking in New York Times 1971. p. 6.
  4. Bonica, J.J., Acupuncture anesthesia in the People’s Republic of China Implications for American medicine. JAMA, 1974. 229(10): p. 1317-25.
  5. Chen, J.Y.P., Acupuncture anesthesia in the People’s Republic of China, 1973. DHEW publication ;1973, Washington: U.S. Dept. of Health, Education, and Welfare, Public Health Service, National Institutes of Health xi, 105 p.
  6. Liu, W.C., Acupuncture anesthesia. A case report. JAMA, 1972. 221(1): p. 87-8.
  7. Wang, Z.R., J.W. Li, and K.J. Chen, [Reviewing over the history of integrative medicine in China in 20th century]. Zhongguo Zhong Xi Yi Jie He Za Zhi, 2005. 25(11): p. 1033-7.
  8. Han, J.S., [Acupuncture anesthesia (AA) versus acupuncture-assisted anesthesia (AAA)][Chinese]. Zhen Ci Yan Jiu, 1997(1-2): p. 97-100.

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