Point selection for acupuncture anaesthesia follows exactly the same rules as acupuncture therapy. When selecting body points for a thyroidectomy use Hegu (LI 4) and Neiguan (P 6) as distal points, and Neck-Futu (LI 18) as a local point. The ear points for this operation would be Throat, Neck, Shenmen and Subcortex; Throat and Neck are local points and Shenmen and Subcortex are sedative points. It is obvious, therefore, that the principles of point selection follow the principles of point selection for therapy, i.e., when using body acupuncture select local and distal points and when using ear acupuncture select local representative points and add in sedative points.
Acupuncture anaesthesia is a fascinating application of acupuncture; perhaps, in the West, it could be used for postoperative analgesia rather than anaesthesia.
Some Ideas on the Physiological Basis of Acupuncture
At present there is no unified theory that explains the complex mechanism of acupuncture, but there are many well substantiated physiological changes that do occur when this technique is applied. The Chinese are investing a large amount of research resources in the investigation of the physiology of acupuncture; they are not limited to the traditional approach but they do see that this is empirically useful and gives better results than simply needling tender areas. Contradictions can co-exist easily in the Chinese mind and so there is no real conflict between the traditional and the more scientific approach to acupuncture, and furthermore they see this combined approach as mutually beneficial.
Acupuncture points are well known to us in the West, studies by Melzack show that acupuncture points correlate very closely with trigger points1 and that the use of these trigger points, particularly for injection therapy, is a well recognized technique within Western medicine. These tender areas (acupuncture points) are frequently to be found on or near neuromuscular junctions. Further work by Becker also strongly suggests that acupuncture points have special electrical properties, and that the skin over acupuncture points is able to pass electrical current more easily than the surrounding areas of normal skin.2 As yet, however, there is no good anatomical or physiological basis for the theory of the channels; although a considerable amount of physiological investigation has been directed at attempting to prove the existence of channels.3
The fact that acupuncture works as an analgesic is quite clear; surgical analgesia in animals and in man follows the needling of specific acupuncture points, and sham needling of non-specific points does not produce analgesia.4 Furthermore, using the human model of dental pain, acupuncture can also be shown to be a specific and relatively powerful analgesic.5 However, there has been a distinct lack of good clinical trials on the effect of acupuncture as a therapy for chronic pain problems; the author has reviewed the studies that are available and suggested models that can be used for the clinical evaluation of acupuncture.6 Such clinical trials are essential if acupuncture is to progress as a therapeutic technique within the context of Western medicine.