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John A. Amaro L.Ac., Dipl.Ac.(NCCAOM), DC

Even though acupuncture has been practiced throughout Asia for more than 4,000 years, acupuncture analgesia for surgical procedures was only developed and first used in 1958. This was a meaningful interaction between traditional acupuncture procedures and modern Western theories of neurophysiology and neuroanatomy.
The first reported surgery employing acupuncture as the analgesia was a tonsillectomy utilizing the acupoint He Gu (LI4). By as early as 1980 as much as 25 percent of all surgery in the major hospitals of China employed acupuncture analgesia as either an adjunct or as the sole analgesia.

Acupuncture analgesia offers a safe and simple alternative to chemical analgesia which Western surgeons and anesthesiologists use exclusively, despite the many adverse effects which may be encountered. Acupuncture analgesia is easy to perform and requires no elaborate equipment. The patient is conscious during the procedure and can cooperate with the surgeon. It is safe to use in the debilitated, elderly or seriously ill patient. Postoperative complications are rare and convalescence is quickened. The patient is historically ambulatory much quicker than with conventional anesthesia. They are able to eat and drink earlier following surgery and very seldom require extended intravenous feeding. Cardiorespiratory, pulmonary and electrolyte complications are seldom reported compared to patients having received general chemical analgesia.

Apprehensive, tense, anxious patients are much less likely to be candidates for acupuncture analgesia. This procedure produces "analgesia", not "anesthesia." In other words, with acupuncture, the patient's pain threshold is diminished, but they can still experience and feel pulling, tugging, pressure and various other paraesthesias, just not intense pain from the surgery. Obviously the proper selection of the patient makes all the difference in the world for the success of this procedure.

In selecting patients for acupuncture analgesia, it is recommended the patient be described the actual surgical procedure to avoid suddenly developed apprehensions. Acupuncture points used in surgery are primarily based on three factors:

• previous experience, such as Tsu San Li (ST 36) for gastrointestinal and abdominal surgery and Nei Guan (P 6) for thoracic surgery;

• anatomical region by utilizing local points in the area of the surgery.

• according to meridian theory, meaning the selection of powerful points on the meridian(s) which course through where the surgery is being performed, which may be far removed from the actual surgery site. According to tradition, "Wherever the Ching mo pathway passes, there lies places amenable to treatment."

Once the proper point is selected, the needle can be either manually or electrically stimulated. In manual stimulation, the needle is inserted until the Teh Chi sensation is obtained. The needle is then rotated and twirled with a frequency of 120-150 twirls per minute. An up/down motion is also used varying between 0.5 and 1.0 tsun (human inch). Induction of the analgesia depends on the individual patient and varies considerably, but as a general rule it can expect to take place in 15-20 minutes from the time needling begins to the time of the initial incision.
In electrical application to the needle, the intensity varies from patient to patient according to the comfort level of the patient and is continued throughout the surgical procedure. Generally, the electrical current is a biphasic spike wave with a frequency in the endorphin-producing range of 2-5 pulses/second.

One of the most significant rewards of reading this article is that the formulae which follow are classic formulae which are used in surgical interventions. But bear in mind, if these points can alleviate the pain of surgery, what do you think they can potentially do as just a treatment approach to pain?

Even though there are other formulae, these are some of the most classic. The majority of people reading this article are not going to employ these in surgical interventions, but they are always good to know or use for painful afflictions.

Tooth extraction:
        LI4 -- Tai Yang -- ST7
        Ear Points: tooth extraction points

Thyroidectomy:
        LI4 -- P6 -- GB20 -- ST6
        Ear points: Shen Men, lung,

subcortex Nasal polypectomy:
        LI4 -- LI20 -- SI3
        Ear Points: nose, apex of tragus,

lung, sympathetic Tonsillectomy:  
        LI4 -- P6 -- TH6
        Ear Points: throat, tonsil, Shen Men, sympathetic  

Laryngectomy:
        LI4 -- TH6
        Ear Points: adrenal to throat, Shen Men to sympathetic lung, kidney   

Splenectomy:   
        ST36 -- LI3 -- SP6  
        Ear Points: spleen, lung Shen Men,   

CV15 -- LI13  sympathetic       

Caesarean section:
        STE6 -- GB26 -- SP6  
        Ear Points: uterus, abdomen, Shen Men, sympathetic, lung   

Nephrectomy:
        GB38 -- SP6 -- BL60
        Ear Points: kidney, Shen Men,     

LI3 -- SP3 -- TH5 sympathetic, spleen, liver, bladder,       

LI4 -- P4  abdomen, lung       

Hysterectomy:
        CV2 -- CV4 -- ST36  
        Ear Points: uterus, Shen Men     

SP6 -- GB26
Appendectomy:
        ST36 -- GB26  
        Ear Points: appendix, abdomen, Shen Men   

Gastrectomy:
        ST36 -- ST37 -- TH17
        Ear Points: Shen Men, sympathetic,  stomach   

Ligation of hemorrhoids:  
        BL3O   
        Ear Points: lung, lower rectum   

Internal fixation of  
        ST36 -- BL59 -- ST40
        Ear Points: hip, ankle, Shen Men

Knee:  ST36 -- SP12 -- ST31       
Leg (posterior): ST36 -- BL57 -- BL54 -- ST40       
Leg (anterior): ST36 -- LI5 -- LI3       
Ankle: ST36 -- KI3 -- SP6 -- GB39       
Sole of foot: BL60 -- SP4 -- KI3       
Dorsum of foot: ST36 -- ST41 -- BL6O -- GB39       
First three toes: ST36 -- ST41 -- SP6 -- SP4 -- LI3       
Fourth & fifth toes:  ST36 -- BL54       
Thigh (anterior): ST36 -- GB29 -- SP12       
Thigh (anterior): BL51 -- BL54       
Buttock: BL51 -- Huo To Chia Chi -- GB30       
Inguinal region: ST36 -- SP4       
Small finger: LI4 -- SI3 -- HT5       
Ring finger: LI4 -- TH3 -- HT5       
Thumb, index, middle  LI4 -- LU10 -- LI10 -- P6 -- TH9       

finger:
Neck: LI4 -- SI3 -- P6 -- GB20
Shoulder: LI4 -- LI15 -- TH5
Spine: ST36 -- LI4 -- Hou To Chia Chi -- BL57 -- GB38 -- TH5 -- P6
Elbow: LI4 -- LI11
Lip: LI4 -- ST6 -- ST4
Ear: LI4 -- TH5  
Face: LI4 -- ST6 -- ST4 -- SI18 -- ST2 -- ST7
Frontal sinus: GB14 -- BL2 -- ST2 -- TH6 -- LI4
Eye: LI4 -- SI3 -- TH6 -- TH5
Eyebrow: LI4 -- GB14 -- Yu Yao -- Tai Yang  
Forehead: LI4 -- GB14 -- Yu Yao -- Tai Yang -- BL2  
Occiput: LI4 -- GB20 -- P6

John A. Amaro L.Ac., Dipl.Ac.(NCCAOM), DC
Carefree, Arizona
DrAmaro@IAMA.edu