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Medical History
Journal of Integrative Medicine: Volume 14, 2016   Issue 4
The history of acupuncture anesthesia for pneumonectomy in Shanghai during the 1960s
1. Li-gong Liu (Department of Literature Research, Shanghai Research Center of Acupuncture and Meridian, Shanghai 200030, China )
2. Arthur Yin Fan (McLean Center for Complementary and Alternative Medicine, PLC., Vienna, VA 22182, USA )
3. Hong Zhou (Department of Acupuncture Anesthesia Clinical Research, Shanghai Pulmonary Hospital, Shanghai 200433, China )
4. Jun Hu (Acu-Herbs Healing, Citrus Heights, CA 95610, USA )

ABSTRACT

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.

Citation: Liu LG, Fan AY, Zhou H, Hu J. The history of acupuncture anesthesia for pneumonectomy in Shanghai during the 1960s. J Integr Med. 2016; 14(4): 285–290.

  

In the 1960s, successful use of acupuncture anesthesia (AA) for pneumonectomy, a major surgical procedure, was a big news in both China and the larger global medical community. The authors try to record every aspect of the story in order to provide a whole picture of this AA history, because the outside world may not otherwise have the opportunity to know the details due to the political environment of that time. The miraculous stories of AA in major surgeries are one of the triggering factors for reintroducing acupuncture into Western countries, especially into the United Sates (U.S.) after President Nixon’s visit to China in 1972[1–3].

1 AA for major surgeries caused a global sensation

AA originated in 1958 in Shanghai and Xi’an respectively, where it was used only for minor surgeries such as a tonsillectomy[4,5]. On March 30, 1959, in the midst of the “Great Leap Forward”, based on the protocol provided by the Beijing Tuberculosis Hospital (BTH, currently the Beijing Chest Hospital affiliated to the Capital Medical University), Dr. Yong-bo Gao (高永波), a surgeon of the Liuzhou Tuberculosis Hospital (currently the Longtan Hospital) in Guangxi Zhuang Autonomous Region, successfully applied AA to a surgery in which the chest was opened to remove the upper portion of the right lung in a tuberculosis patient (formerly known as pulmonary lobectomy). After that operation, he successfully repeated the procedure more than 12 times. Subsequently, however, Dr. Gao did not continue due to technical problems among other reasons[6]. In June of 1960, at the China National Tuberculosis Conference held in Qingdao, Dr. De-mao Qiu
(裘德懋), the director of the Surgery Department of Shanghai First Tuberculosis Hospital (SFTH, currently the Shanghai Pulmonary Hospital), received the report from Dr. Gao’s surgeries with AA and was very excited. He immediately repeated Dr. Gao’s surgery after he flew back to Shanghai, but his first attempt with the use of AA for surgery failed.
So Dr. Qiu sent a representative to the Shanghai Institute of Acupuncture and Moxibustion (SIAM, it is now the Shanghai Research Institute of Acupuncture and Meridian), seeking possible collaborations. Mr. Bao-xi Sun (孙宝玺), the head of the SIAM and the deputy director of the outpatient department, met him and immediately called senior acupuncture experts Dr. Bo-ping Dang (党波平), Dr. Song-yan Tang (汤颂延), Dr. De-zun Chen (陈德尊, Figure 1) and Dr. Shu-bai Jin (金舒白), to have a collective brain storm. All the doctors agreed that this was something worth pursuing, and an AA protocol was designed. Mr. Sun then decided to send a team with Dr. Song-yan Tang as a leader to the SFTH to work with them. The reason to choose Dr. Tang as a leader was his extensive Western medical training as well as communication skills with the surgeons. On July 5, 1960, Dr. Tang worked with the surgeons Dr. Xue-xi Xu (徐学僖) and Dr. Zhen-pu Zhao (赵振普) in a pneumonectomy removing the upper lobe of the right lung at the SFTH, successfully using AA induced by filiform needle stimulation as a substitute for medication anesthesia. The patient was Mr. Lü-ping Chen (陈履平), a 54 years old factory worker. The operation lasted three and a half hours, and used more than 100 acupuncture points (acu-point, in short), partially adopting the experience of Dr. Gao in Guangxi Zhuang Autonomous Region. The patient was awake and conscious, and able to chat during the operation. There was no obvious postoperative pain recorded. It was also reported that the patient slept well the night after his operation.
The next day, Dr. Tang and Dr. Dang worked with the surgeons Dr. Ting-huai Xie (谢庭槐) and Dr. Tao Long (龙涛) in a pneumonectomy, successfully using AA for a second patient, Mr. Guo-liang Zhou (周国良), a 23 years old college student. The surgery was successful, with no observable pain; after the chest-opening, experts from the Soviet Union visited and observed twice. The patient stayed calm, conscious, and was able to answer questions. In this way, the door of AA for thoracic surgery was opened. Researchers were excited and went to the Shanghai Municipal Health Bureau (Heath Bureau, in short) to report on their findings. The leaders of the SIAM and the SFTH decided to further strengthen the collaboration and deepen the AA study. On August 14, 1961, Mr. Da-gong Du (杜大公), deputy director of the Health Bureau, visited the SFTH, observed the No. 41 case of AA pneumonectomy, and listened to the report by the AA pneumonectomy research team, after which he gave encouragement and affirmation of the use of AA. From then through September, 1961, there were 42 cases of pneumonectomy completed under AA, of which 37 (88.1%) were completed successfully with the use of AA. Only 5 cases (11.9%) failed in AA.
In September 1961 at the National Forum on Small- Dose Acu-point Drug Injection and Acupuncture Anesthesia in Shanghai, the SFTH and the SIAM jointly published a report entitled Acupuncture Anesthesia Applied to the Chest Surgery: A Clinical Analysis of 42 Cases. The report emphasized an AA operation was characterized by “dry needling” (simply a needling manipulation) without anesthesia medication. Its advantages include: simplicity of the tools used, no common side effects that are induced by and present from medication anesthesia, patients are awake during the operation, more convenient postoperative care, faster physical recovery, patients can cough to eliminate the sputum, and no need for intubation. The report caused a sensation. After this report at the meeting, the delegates visited the SFTH and observed AA for pneumonectomy (Figure 2).

  

2 The enthusiasm of AA cooled down

At that time, the political environment of China was criticizing “exaggeration”. There were different comments submitted to the AA joint-report from the medical community. Some were supportive and interested, some were oppositional, and some expressed doubts, such as “AA only has theoretical significance, there is no clinical value”, “AA has no theoretical basis”, “acupuncturists doing anesthesia is worthless”, “since we have medications, why not use them”, “AA surgery is merely a patient endurance”, “AA is using needling pain to overcome surgery pain”, and so on. Many hospitals originally interested in AA discontinued AA trials after some of the responses to the report came out. At the moment, there happened to be an AA pneumonectomy patient who, after lung surgery, having a panic attack. The news reached the Chinese Medical Association, and caused negative comments by some experts, in which some believed that the panic attack was caused by AA, which put great pressure on the researchers. Meanwhile, the researchers also encountered some difficulties in techniques. Such conditions made it difficult to recruit new patients for AA surgery. There was a significant reduction in the number of AA surgeries, to the point that the AA clinical trial almost stopped. In fact, there were no patients that could be recruited for AA for a full nine months. During that difficult time, Dr. Dang, Dr. Shu and Dr. Chen still carried forward with an indomitable spirit, going to the SFTH early in the morning from downtown, three days a week to “sit on the cold bench” to wait for possible candidates for AA.

  

3 Encouragement from Beijing

In the fall of 1963, Mr. Ye Tian (田野), the director of the Achievement Bureau of the State Science and Technology Commission (the Commission, for short), went to Shanghai for inspections. The Health Bureau reported to him the AA research situation, which caused him to pay particularly close attention. He immediately reported this to the leaders of the Commission after he returned to Beijing. In early 1964, Mr. Guang-yuan Yu (于光远), deputy director of the Commission, visited Shanghai to further understand the AA situation. After hearing the report, Mr. Yu said: “This (AA) is a very important (research field), we have sent reports to Chairman Mao and Premier Zhou. You should summarize the information… strengthen the leadership, provide support, and consider moving forward.”
Mr. Yu shared the Shanghai’s AA information with Dr. Xin-zhong Qian (钱信忠), the Minister of the State Department of Health of China (Figure 3). Dr. Qian sent Dr. Qi-zhen Shen (沈其震), a well-known physiologist and the director of the China Academy of Medical Science, to Shanghai to inspect AA. Dr. Shen said, “I did not believe AA at all, now (that I have seen it) I believe it is true.” Dr. Qian also sent another 10-person team, led by Dr. Yu-ling Xin (辛育龄), the head of the BTH, to Shanghai, including three surgeons, three anesthesiologists, three acupuncturists, and a surgical nurse. They stayed in the SFTH, and were trained in AA pneumonectomy for three months. Before leaving, Dr. Xin exclaimed: “You formed a systematic approach, applying different AA strategies to each step of the surgery; this is the key to the success—I am convinced. We had been engaged in AA in 1958, but without this set of methods, so it had been a failure.” In fact, the idea of Guangxi’s AA pneumonectomy was derived from the BTH. Back in Beijing, Dr. Xin’s team repeated AA pneumonectomy successfully.
Thereafter, Dr. Qian, the Minister of the State Department of Health, personally visited and inspected AA in the SFTH three times between 1964 and 1965. He said: “I am delighted that you are working so well… the technique could be simplified, and the number of acu-points could be gradually reduced… could something else be used as a substitute for the manual administration of acupuncture stimulation, such as the use of an electrical device (a mechanized device mimics the manual stimulation)?” In June 30, 1964, the Shanghai Municipal Office of Education and Health issued Education and Health Situation, in which the AA research work was commended. In addition to personally inspecting AA in the SFTH many times, Shanghai municipal leader Mr. Xi-guan Yang (杨西光) opened a second AA research center in the Huashan Hospital.
On January 2, 1965, Mr. Guang-yuan Yu spent a whole day in the SFTH as starting his work for the New Year, witnessed another successful case of AA surgery. He said: “Acupuncture anesthesia is a very important area of research… We should support AA—if the project needs people, we give people; if it needs money, we give money… [We] should design a beautiful operating room, convenient for foreign visitors’ observation… that our acupuncture anesthesia research is in advance of the international level, is already beyond reproach, and now we should leave our opponents even farther behind… Last year, at the Science Center Symposium, I reported to Chairman Mao, acupuncture anesthesia as a product of the Great Leap Forward should be encouraged. Chairman Mao said: ‘Yes, we should encourage it!’; Chairman Mao also added, ‘Chinese people should have good ambitions. Japanese Shoichi Sakata (坂田昌一) found elementary particle, we Chinese people should have our own contribution (to the world)’”. (毛主席说:“是呀,要鼓励鼓励!”主席还说:“好!中国人应该有志气,日本人坂田昌一发现基本粒子,我们中国人也要有自己的贡献。”).

  

4 The achievement is from the integration of Chinese and Western medicine, and the collaboration of the whole scientific community in China”

Soon after, the State Ministry of Health allocated 600 000 Yuan (RMB; at that time, one yuan equaled to one US dollar) to the SFTH to build a three-storey, 2 000 m2 building for AA research, and ordered a cutting-edge eight-channel physiology recorder and an arterial blood gas analyzer which was the first set in Shanghai, as well as English journals, especially in the thoracic surgery field from abroad. And there was also an AA documentary movie made by the Shanghai Science & Education Film Studio. AA clinical trials, mechanism studies and the work in other related fields had developed and flourished together in China, especially in the Shanghai area.
In the clinical study, the researchers summed up AA surgical experience, such as “ten fixed procedures” (ten acupuncture strategies in AA for ten different surgical procedures, one specific acupuncture procedure corresponding to one specific surgical procedure), “five requirements” (strict, quick, light, quiet and strong), and “20-word requirements” (in Chinese, meaning—attentively doing acupuncture stimulation following the knife direction, acupuncture stimulating stronger when cutting, acupuncture stimulating lighter when doing other surgical procedure, changing in acupuncture strategy following the surgical procedures). In addition, the researchers found that patients who practiced qigong (a mind-body exercise, focusing meditation) would get better results from AA during the surgeries[7].
With AA success in clinical studies, AA mechanism research also started. In 1963, Dr. Hsiang-Tung Chang (张香桐, the Father of neuroscience in China) and Dr. Feng-yan Xu (徐丰彦), two leading neurophysiologists, and Dr. Ji-nan Hu (胡寄南), a psychologist, visited the SFTH and viewed the AA procedure for the surgery. During their visit, to test AA’s efficacy, Dr. Chang actually tried it himself. He had an acupuncturist perform AA needling procedures on him (although he did not need surgery) for the duration of an hour, and he said he did feel the difference in body sensation before and after needling. After the visit, Dr. Chang asked, “How much time twisting the needles before the incision?” Dr. Qiu replied, “30–60 minutes.” Dr. Chang said, “Acupuncture anesthesia is not only the neurophysiological effects, there may be neurobiochemical effects too. Some chemicals (neurotransmitters) related to pain were already synthesized abroad. Does acupuncture produce such substances? For if we can find such substances, they can be used as research targets. We should let neurochemistry experts become involved in this.” Soon, Dr. Chang, Dr. Xu and Dr. Liang Li (李亮, a neurochemist), brought their students, Dr. E Shen (沈谔), Dr. Xiao-ding Cao (曹小定), and Dr. Tian-jue Gu (顾天爵) to the SFTH to observe AA during the surgery. Then they set up relevant research projects. Among them, Dr. Gu, Dr. Yi-tao Zeng (曾益涛) and Dr. Han-zheng Wang (王寒贞) from the SFTH engaged in “cerebrospinal fluid cross perfusion” experiments in rabbits, and observed the component changes of patients’ body fluids before and after AA, which provided some of the ideas for discovering enkephalins later.
With the support of the Health Bureau, the SFTH and the SIAM co-authored Clinical Research Report on Acupuncture Anesthesia Applying Meridian Acu-points in Thoracic (Lung) Surgery, in which 186 cases of AA for pneumonectomy were summarized[10], and reported to the State Science and Technology Commission. In December 1965 the Commission issued a formal document, internally publishing this report, acknowledging AA as a first-level achievement of national importance[8].
In March 1966, at the “Work Forum on Acupuncture Anesthesia and Limb Replantation” held in the Shanghai Science Hall, Mr. Guang-yuan Yu said AA achievements “make us rejoice… [and] have significance not only in practical, but also in theoretical [aspects]”. Dr. Xin-zhong Qian praised the SFTH and the SIAM at the meeting, “(You) have continued to try and explore, sum up and get experience, persevere, and finally succeed. (You) have played an important role in promoting the work of acupuncture anesthesia in the country… Acupuncture anesthesia is a major medical invention. It is an important achievement, from the integration of Chinese and Western medicine and the collaboration of the whole scientific community in China, under the country’s policy guidelines.” In fact by the end of 1979, there was a dramatic increase from the 0.4 million cases of AA in 1971 to a total of 2 million cases of AA in all kind of surgeries throughout all of China alone[10].

  

5 AA makes acupuncture spread to the rest of the world

When AA was in full swing, the Cultural Revolution broke out in 1966, which caused the interruption of the AA research collaboration. Until 1970, Premier Zhou Enlai met Dr. Xiao-ding Cao and other AA researchers, and he said: “(You should) engage in extensive cooperation; the mechanism of acupuncture anesthesia has to be found out… Any new stuff always has shortcomings, we should pay attention to it!”
In order to welcome President Nixon’s visit to China, on July 18, 1971, the People’s Daily officially announced the Chinese AA research to the world. In February, 1972, during President Nixon’s visit, a delegation which included three dozen U.S. officials and media reporters, led by General Alexander M. Haig Jr., the White House Chief of Staff, visited Shanghai and watched an AA pneumonectomy. They expressed surprise and great interest[9]. There were many reports and interviews in U.S. newspapers and television shows regarding AA following this visit[1–3,10]. Thus, AA went beyond China, triggering the interest of the Western medical community in acupuncture around the world.
The experiments of “cerebrospinal fluid cross perfusion” in rabbits conducted by Dr. Gu, Dr. Zeng and Dr. Wang could not continue further because of the Cultural Revolution, but their initial findings were published. Swedish scientists successfully repeated this experiment, and found enkephalins. In 1975, Dr. Gang Zou (邹岗) from the Institute of Materia Medica, Chinese Academy of Sciences visited Sweden and got the news, and he successfully repeated the experiment after he came back to China. Meanwhile, Dr. Xiao-ding Cao’s team from the Shanghai University of Medical Science extracted substances from human cerebrospinal fluid in an AA brain surgery and also found morphine-like substances. In 1997, the U.S. National Institutes of Health held a Consensus Conference and confirmed acupuncture’s analgesic effects, which helped acupuncture gain more acceptances in the U.S. and other Western countries. Acupuncture was introduced into the U.S. in the early 1970s, mostly due to the success of AA in China especially in Shanghai[1,2]. It also spread to the entire world, and promoted traditional Chinese medicine globally.

6 Acknowledgements

All authors contributed equally in the planning and writing of this paper, therefore all served as the primary author. The first draft in Chinese was written by Dr. Liu LG and Dr. Zhou H[11], and the final manuscript in English was completed by Dr. Fan AY and Dr. Hu J. Dr. Liu also provided several historical photos. Most of the information in this article was from the internal records of the SIAM the and Shanghai University of Traditional Chinese Medicine, involving the interview records of doctors involved in AA during the 1960s in Shanghai area. Authors appreciate Ms. Sarah Faggert and Mr. John Romano for editing support.

7 Competing interests

The authors declare that they have no competing interests. Due to the limitation of the authors’ personal experience and perspective, this article is not a full piece of the AA history that time and there may be some omissions and errors; comments or corrections are welcomed and appreciated.

  

Figure 1 Acupuncture anesthesia group in the operating room

Dr. De-zun Chen (left one) was performing acupuncture anesthesia in a patient before the surgery. Photo provided by Li-gong Liu.



Figure 2 Discussion of the progress in acupuncture anesthesia in the Shanghai Institute of Acupuncture and Moxibustion

The talking person is Dr. Mai-ling Sun who was the leader in charge of acupuncture anesthesia group in the Shanghai Institute of Acupuncture and Moxibustion (rear left No. 3), and the person taking notes is Dr. Li-gong Liu (left No. 2). Photo provided by Li-gong Liu.



Figure 3 The Minister of the State Department of Health, Dr. Xin-zhong Qian visited Shanghai and inspected acupuncture anesthesia on June 16, 1964

From front left: Da-gong Du, Bo-ping Dang, Xin-zhong Qian, De-mao Qiu, Jin-xiang Qin, Hai Lin, Shu-min Li; From rear right: Yan Shang, You-min Zhao, Shi Wang, Mai-ling Sun, and an unrecognized person. Photo provided by Li-gong Liu.



 

  
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