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ACUPUNCTURE ANALGESIA FOR

SURGERY IN ANIMALS
Part 1
Philip A.M. Rogers MRCVS
e-mail : progers@grange.teagasc.ie
1980, 1982, updated 1993, 1995
Postgraduate Course in Veterinary AP, Sydney, 1991

SUMMARY
Surgical analgesia can be produced by methods involving peripheral or central stimulation,
such as acupuncture (AP) analgesia (AA). The most common method is Electro-Acupuncture
Analgesia (EAA), using a special electrostimulator attached to needles in AP points.
The major advantages of AA or EAA are its safety in high-risk patients and excellent postoperative pain relief, freedom from complications and enhanced healing which follows
surgery under AA. The major disadvantages are the long induction period (10-40 minutes)
and variable degrees of analgesia, even in skilled hands.
Many combinations of AP points can be used to induce EAA in large and small animals and
there is no agreement on which combination is best for which operation. However, certain
points have marked analgesic effects. They are LI04,11; TH08; PC06; points along the GV
Channel; (BaiHui, WeiGan, TianPing, SanTai; ChihYi points); points between the digits
(BoKoKu, InKoTen in dogs; second interdigital space in rabbits), certain Earpoints; the Root
of the Ear; LU01; BL23,30; ST25,36,44; SP06; GB34; and X 35. Sometimes needles are
inserted parallel to (or at both ends of) the incision, together with some of those points.
The choice of point combinations depends largely on the personal preference and experience
of the operator. However, it is useful to consider the Channels in relation to the operation site
and to choose points from (a) distant points on Channels whose superficial, deep, collateral
or other branches pass through the operation site, plus (b) local points near the operation
site, plus (c) points along nerves supplying the operation site or related to the operation site
by spinal reflexes.
There is no agreement on the choice of stimulation parameters, although work by Toda et al,
Matsumoto and others show that these can be critical. Further research in this area is needed.
The mechanisms of AA involve stimulation of peripheral sensory nerves, spinal cord and
supraspinal areas (thalamus, midbrain and hypothalamus). Release of endorphin and serotonin
activates a descending pain-inhibition mechanism. ACTH release assists healing. Extra-spinal
and autonomic transmission may also be involved in AA mechanisms.
Stimulation-Produced Analgesia (SPA) and Transcutaneous Electro-Stimulation Analgesia
(TESA) are closely allied with EAA and involve endorphin release. Vaginal Stimulation

Analgesia (VSA) appears to use different mechanisms. Electro-restraint ("Stockstill") appears


to be quite a different phenomenon and may have little analgesic effect.
Electro-Narcosis, Electro-Anaesthesia and Electro-Sleep (Cerebral Electro- Therapy) differ
from the other techniques, as they cause unconsciousness during Electro-Stimulation (ES).
Combining AP and western concepts, as in combination anaesthesia, will lead to development
of safer and more reliable methods of surgical anaesthesia.
INTRODUCTION
Acupuncture (AP) can be used to obtain pain relief in clinical disorders or as an alternative or
complementary method of inducing pain control during surgical procedures.
AP analgesia (AA) is a misnomer. It should really be called AP hypoalgesia. It is a pain
inhibition phenomenon caused by stimulation of peripheral nerves via certain AP points. The
degree of pain inhibition may be complete or partial.
In vet surgery, the AA technique, if applied carefully, often is sufficient to allow surgery
without the use of other anaesthetics. Consciousness is retained throughout the operation but
many animals become slightly drowsy (as if slightly sedated) during and for a short time after
AA stimulation. All other sensations (touch, traction, pressure, tickle etc) and reflexes (to
sight or sound stimuli, fear, traction etc) are intact.
AA can be induced by simple AP (manual twirling of the needles) but it is more common to
use electrical stimulation (ES) via the needles. In this case the technique is called Electro-AP
analgesia (EAA).
In emergencies a slight degree of hypo-algesia can be obtained in humans and animals by
heavy digital pressure over the correct AP/nerve points. This method may have application
in time of war or national disasters, when anaesthetists and anaesthetics may not be available.
AA also can be induced by other stimuli, such as injection or electro-static fields applied to
the points. Since the late 1980s, research on uses of low-power (cold) Laser as an AA
stimulus is ongoing, with some positive results. However, it is too early to attempt to assess
that method.
Stimuli via the AA points are carried in the peripheral sensory nerves to the spinal cord. They
reach the midbrain via the ascending spino-thalamic tracts. In the midbrain the ascending
signals cause release of endorphin, serotonin and other neurotransmitters which activate a
"descending inhibition mechanism" and prevent the "pain signals" from the surgical area from
reaching the cerebral cortex. Thus, AA can be said to "close" various "pain gates" in the
nervous system. These gates are thought to be located in the spinal cord, thalamus and
possibly other areas. The result is that the human (and, presumably, the animal) patient can
feel the knife, the touch and traction etc but does not "feel pain".
Stimulation-Produced-Analgesia (SPA): Since the 1970s, western researchers, working
independently of the Chinese, found that various types of stimuli applied indirectly or directly
to the nervous system can reduce or abolish clinical and operative pain. Transcutaneous
Electro-Stimulation Analgesia (TESA) has been used in childbirth in the human female and
is somewhat comparable to EAA. Dorsal Column Stimulation (DCS) of the spinal cord has

been used in intractable pain in humans. ES via electrodes implanted in specific sites in
human or animal brain can induce a high degree of analgesia, usually involving the entire
body. Direct ES of human thalamic or spinal areas can abolish clinical pain. Vaginal
stimulation (electrical or mechanical) can cause potent whole-body analgesia in rats.
SPA has some similarities to AA. The main difference between these methods is that SPA
tends to cause "whole body" analgesia, whereas the area of analgesia is much more localised
in AA and is related to the site of the AA stimulation.
This paper will discuss the following topics:
1. types of operation successfully done under AA
2. equipment and methods of restraint used
3. techniques in large and small animals
4. advantages and disadvantages of AA in animals
5. mechanisms of AA
6. other methods of SPA (vaginal stimulation analgesia, electro-restraint, electro-narcosis and
electro-sleep)
1. TYPES OF OPERATIONS UNDER AA
Since the mid 1970s, major surgery has been done in animals under AA as the sole analgesic
agent in many countries in the West. These include France, Germany, Austria, Belgium, USA,
Canada and Australia. Workers in Eastern countries such as China, Japan, Taiwan etc have
used the method for many years. The animal species involved include horses, mules, donkeys,
cattle, sheep, goats, pigs, monkeys, dogs, cats, rats, cavies, guinea pigs and mice.
Types of surgery successfully done in animals include: caesarean section, ovariohysterectomy; gastric and intestinal surgery; nephrectomy; removal of mammary and skin
tumours; surgery of the eye, ear, anal and vaginal region, limbs and teats; surgery on the lip,
oesophagus, trachea, frontal sinuses; rumen; navel hernia repair; surgery on the bladder and
urethra; orthopaedic surgery (bones, joints); removal of parotid and submaxillary glands;
castration, orchidopexy, inguinal hernia. The late Dr. Westermayer's method for reposition of
the prolapsed uterus has been mentioned already, as has AP therapy for the relief of dystocia.
(See the paper on AP effects on the body's defence systems. See also the paper on the
integration of AP into routine vet practice).
Experimental surgery under AA includes: pain responses to towel clips, incision, thermal
and electrical stimuli; thoracotomy, laparotomy, limb and skin surgery.
2. EQUIPMENT AND METHODS OF RESTRAINT FOR AA
Equipment: Most AA is done using electrostimulation (ES) through needles in the correct
points (Electro-AP analgesia = EAA). The choice of points will be discussed later. Many

different types of electrostimulator are on the market. Some are made in China, others in
Japan, USA, Canada, Europe and Australia etc.
The equipment should be strong, portable and battery-operated. It should have outputs for at
least 8 electrodes. There is little standardization of equipment. Newer models for human use
would be adequate for EAA in animals. It is safer to use models which deliver a bipolar
waveform, (+) and (-), at each electrode. This prevents the development of serious electrolytic
lesions which could arise if a monopolar waveform was used for long periods, as in prolonged
surgery.
The Model 71-3 General Purpose Electro-AP Apparatus is suitable for AA as well as AP
therapy. I had 8 teeth extracted and 8 teeth filled under EAA with the Model 71-3. I used
mainly ChiaChe (ST06) plus Earlobe "Dental Analgesia Point" on the affected side. Needles
were inserted 12-20 mm in the points. Voltage was increased slowly to maximum tolerance
(anaesthesia mode, dense-disperse waveform). Occasionally adjustable waveform at 5-10 Hz
was used. After 30 minutes of induction, the output was usually at a setting of 4-5 on a 10
point scale. When heavy needle-probing of the gum caused no pain, dentistry could begin.
Dental fillings under EAA were uneventful except in deep root fillings. If "nerve pain" arose,
turning up the voltage usually controlled it. Extraction was painless or caused minimal pain
in 5/8 cases but 3/8 extractions caused moderate to severe pain but were completed without
the use of drug analgesia. An impacted wisdom-tooth required 10 minutes of very strong
rocking to remove it from its socket. There was rather severe pressure-pain with that attempt
but I was able to tolerate it without asking for another anaesthetic. My dentist told me that
most patients could not have had the tooth removed unless they had general anaesthesia.
In human patients, Caesarean section has been done in Japan using electro-static or
electromagnetic fields around the hands and feet. The apparatus used does not appear to have
been tested in Europe or America. Childbirth has been helped in 60-80% of women treated by
transcutaneous ES analgesia (TESA) of the thoraco-lumbo-sacral region. The apparatus used
was the Travisens, available from Dan Sjo Elektronik AB, Box 144-17224, Sundbyberg,
Sweden. TESA does not appear to have been tested in animals.
Restraint for AA in animals: Surgery under AA requires adequate restraint because
consciousness and all sensations and reflexes (except those of pain) are retained.
In large animals, operations under AA may be performed with the animal in the standing
position or in dorsal, lateral or ventral recumbency, depending on the type of operation and
whether or not the animal is quiet. Horses and nervous cattle should be knocked by ropes or a
short-acting knock-down anaesthetic. Nervous animals may be given a tranquilliser i/v.
Recumbent animals should be roped securely and an attendant should ensure that the head is
kept down. A blindfold over the animal's eyes helps to avoid fright by visual stimuli.
Unnecessary noise, movement and fuss should be kept to a minimum.
The standing position may be used for surgery in quiet cattle. An attendant may hold the nose
and the animal should be restrained in a suitable cattle crate, or ropes may be used through
rings in the wall to keep the animal in one position. Kicking may be prevented by the usual
methods as applied in operations under local anaesthesia.
Small animals are normally operated on in lateral, dorsal or ventral recumbency. If a special
operation-harness is not available they are restrained by tying bandages from the hocks and

elbows to suitable anchor-points on the operating table. Dogs are excellent subjects for AA
but it is advisable to tie a tape bandage around the jaws to prevent biting. It helps if the owner
or an attendant talks to the dog and comforts the animal from time to time during surgery.
Cats are difficult animals to handle and some vets who have tried AA in cats have ceased to
use the technique in this species.
3. AA TECHNIQUES IN LARGE AND SMALL ANIMALS
Electro-AP analgesia (EAA) is the most common method used. When the animal is properly
restrained, AP needles are placed to the correct depth in the AA points related to the operation
site. The stimulator is checked to ensure that the power switch is off. The output leads are then
connected to the needles. Do not connect the leads from one output across the thoracic or
posterior cervical region. This is especially advisable if the instrument uses (+) and (-)
electrodes. In this case the correct connection would be as in the diagram on the next page. An
output circuit placed across the thorax may interfere with cardiac function and may, on rare
occasions, cause cardiac arrest.
Tape or suture the needles firmly in position. Otherwise, they are liable to become
dislodged by muscle twitches induced by the stimulation, or by struggling in nervous animals.
When the needles are in position, the output controls are checked to ensure they are set at
zero. Attach the leads and turn on the power switch. Turn up the output controls slowly until
the needles begin to twitch in time with the frequency of the stimulator. Increase the output
voltage from each control to the maximum tolerance of the patient. At that point, the animal
indicates a degree of discomfort or pain (restlessness, defensive reaction, struggling,
vocalisation etc). Reduce the output to a "strong but acceptable level" (that which can be
tolerated without obvious discomfort). Excessive stimulation reduces the EAA effect and to
weak a stimulus may induce little or no analgesia.
Note: A needle can not twitch unless it is embedded in reactive muscle. As long as one of a
pair is twitching, the paired needle is also receiving a similar stimulus. Needles may not
twitch in points such as GV26. If output voltage is too high at such points, the animal will
indicate discomfort. In that case, reduce the output to the tolerance of the patient.
Every 5 minutes or so, after switch-on, the operation site is tested for analgesia using rattooth forceps, towel clip, clamp or pin prick. Initially, full sensitivity to pain is present, as
indicated by local muscle twitch or guarding, vocalisation or defence reactions/struggling.
After 5-10 minutes, the response to pain stimulus decreases. After 20-40 minutes, in
successful cases, the animal makes no response to strong pain stimuli in and around the
operation site. The operation may then commence.
Pain stimuli may exceed the hypoalgesia (thereby inducing pain response by the animal) at
certain stages of the operation, especially during incision and suturing of the skin, serosa
(peritoneum, pleura etc) and incision of periosteum and nerves. During these stages of the
operation the frequency or output voltage should be increased. This is normally sufficient to
counteract the pain. Occasionally (in those animals which respond poorly to AA) it may be
necessary to use small volumes of local anaesthetic injection or spray at these stages.
In the first few minutes after stimulation begins it is usual for the animal to show a mild
stress reaction (dilated pupils, increased blood pressure, faster respiration and heart rate).
These quickly return to normal or near normal levels, and should remain at this level during

the operation. Studies of EEG patterns in animals under AA indicate that brain waves are in
the alpha range (8-13 cycle per second) i.e., similar to those of drowsiness or light sleep.
However, the animals are still conscious and can eat or drink and (in dogs) wag the tail if
petted by someone they know. Because sight and hearing are unaffected (pupil reflex is also
intact), unnecessary noise should be avoided and a blindfold may be desirable. Pupillary
dilation and salivation occurs in some animals. If salivation is excessive or retching/vomiting
occurs, this usually indicates that excessive traction on mesentery/internal organs is the cause.
This may be partly counteracted by increase in frequency or output of the AA stimuli.
The choice of points for AA depends on the species of animal, the operation site and
personal preference/experience. Many different combinations are effective and there is no one
combination which is agreed by all authors. In general, points are chosen according to
Channel theory of human AP.
Classic AP teaches that the Channels have a superficial course (Jing, from the first to the
last point on the Channel), a deep course (going to the organ of the Channel and possibly
linking to other organs and deep regions), a collateral course (Luo, which links up with its
Mate Channel) and other connections linking to every part of the body, interior and exterior.
For instance, the LV Channel (big toe to chest, under the nipple) also sends a branch to the
eye. (Discussion of the deep, collateral and other connections is not included in this seminar.
These concepts are covered in certain classic texts, such as those of Van Nghi and Mann).
Thus in eye operations, a LV point might be included; in tongue operations a HT point
might be included; in ear and bone operations a KI point might be included. In man, AA
sometimes uses Earpoints for the organ or region being incised, i.e. for lung operations,
Earpoint LU; for appendectomy, Earpoint LI, or Appendix etc.
The general rule is to use Local Points (near the operation site). As will be seen from some
point prescriptions below, this rule is not always obeyed. Other workers pay particular
attention to the points or nerves supplying the operation site, or related to it. In human
EAA, same workers add two needles, one on each side of the incision. The diagram shows 2
needles, 25 cm long, buried parallel to the incision:
.........................
_ _ _ _ _ _ _ _ _ _ _ _ _
needle 2 (25 cm) .........................

needle 1 (25 cm)


25 cm incision

Some workers prefer to use AP stimulation at a low frequency and to increase the frequency
gradually during the induction period. For instance, Ishizaki recommended a frequency of 10
Hz, increasing to 30-50 Hz at the start of operation in dogs. Other operators prefer faster or
slower frequencies. For instance, Matsumoto found that frequencies of less than 200 or
greater than 10000 Hz were less satisfactory in rabbits than frequencies within this range.
Points used in AA in animals: Many different workers have used many different
combinations of points in various animal species. Examples of point combinations are given
later. The following table lists the points by authors whose work is discussed later. These
points are similar in position to points of the same name and code in HUMAN AP.

Other points used in AA in animals are:


1. On the GV Channel:
BaiHui: In the dorsal midline of the lumbo-sacral space, depth 3-5 cm in horse/ox, to react
the dura mater. There is no direct equivalent in human AP.
WeiGan: In the dorsal midline between coccygeal vertebrae 2-3. Depth 1-1.5 cm in horse/ox.
There is no direct equivalent in human AP.
TianPing : In the dorsal midline, in the thoraco-lumbar space. Depth 2-4 cm in horse/ox, at
90 degrees to the surface). There is no direct equivalent in human AP.
SanTai: In the dorsal midline, between the spines of thoracic vertebrae 4-5 (some texts say
T5-6). Depth 6-8 cm antero-ventrally in horse/ox. SanTai is equivalent to GV11 (Shen Tao).
2. HuaToChiaChi Points (X 35 in my coding system). These points are located on the
paravertebral line from the first cervical to the last sacral vertebra, between the GV and inner
line of the BL Channel. One pair of points is located beside each vertebra. X 35 points lying
nearest to spinal nerves which supply the operation site may be added as secondary points.
3. ChihYi Points are on the course of the GV Channel but are not classic GV points. They
have been described recently in relation to human AA. The main ones used in vet AA are over
the dorsal spines of vertebrae: Dorsal 3,5,6,11 and Lumbar 1.
4. Para-incisional points are not often used in vet AA, as the needles may impede access to
the site.
5. ChiehKou points. These are also described in recent human texts. They are local points at
each end of the incision.
Points
UNDERLINED:

used

in

AA

or

EAA:

The

most

commonly

used

Point

Point name

Point

Point name

Point

Point name

LU01

CHUNGFU

SP03

TaiPai

TH03

ChungChu

LU02

YunMen

SP04

KungSun

TH05

WaiKuan

LU03

TienFu

SP06

SANYINCHIAO

TH08

SANYANGLO

LU05

ChihTse

HT03

ShaoHai

TH13

NaoHui

LU06

KungTsui

HT05

TungLi

TH14

ChienLiao

LU10

YuChi

BL22

SanChiaoShu

TH17

YiFeng

LI04

HOKU

BL23

SHENSHU

TH23

SsuChuKuan

points

are

LI10

SanLi

BL40

YiHsi

GB01

TungTzuLiao

LI11

ChuChih

BL49

ChihPien

GB30

HuanTiao

LI14

PiNao

BL54

WeiChung

GB34

YangLingChuan

LI15

ChienYu

BL57

ChengShan

GB36

WaiChiu

LI17

TienTing

BL59

FuYang

GB38

YangFu

LI18

FuTu

BL60

KunLun

GB39

HsuanChung

ST06

ChiaChe

KI03

TaiHsi

GB40

ChiuHsu

ST25

TienShu

PC04

HsiMen

GB43

HsiaHsi

ST36

TSUSANLl

PC04.5

YIEYEN

LV14

ChiMen

ST40

FengLung

PC05

ChienShih

GV03a

BAIHUI

ST44

NeiTing

PC06

NEIKUAN

GV26

JenChung

6. Points described by Japanese workers also include: InKoTen (between metacarpal bones 3
and 4 in small animals); BoKoKu (between metatarsal bones 3 and 4 in small animals);
GeiKo (on the lateral margin of the naso-labial fold in mice and rats); unnamed point (in the
second interdigital space in rabbits on the hindlimb (this may correspond with ST44
(NeiTing)). The Japanese points do not appear to have equivalents in Chinese human or vet
texts.
EXAMPLES OF POINT SELECTION IN LARGE ANIMALS: Points used for AA in
horses and cattle.
a. Horse: LU01 (ChungFu) with TH08 (SanYangLo penetrating to YieYen) was one of the
first combinations used in large animals ln China (Niboyet). It was used especially in thoracic
and abdominal surgery. A needle is inserted to a depth of 3-5 cm in LU01 (behind the
shoulder in the second intercostal space). A second needle is inserted at TH08 (about 1
handsbreadth below the elbow, on the lateral side). It is driven medially and downwards
behind the radius/ulna to reach YieYen (PC04.5), just under the skin above the "chestnut".
The needles are inserted on the uppermost limb (horse in lateral recumbency).
b. Horse: In navel hernia operation, Humphries used 4 needles: Set 1: LU01 (positive) with
TH08 penetrating to PC04.5 (negative). Set 2: SP06 (positive) with ST36 (negative). The
frequency was 200 Hz, square wave, altered to spike wave during surgery. This horse was
very ill and was a high anaesthetic risk, yet the operation went perfectly and no signs of pain
were detected at any stage in the operation, which lasted 4 hours.
c. Horse or ox: Sun et al used traditional Chinese vet AP points on hundreds of large animals
(horses and cattle).

Points for abdominal, vaginal and hindlimb operations were : BaiHui (main point) plus
WeiGan (secondary point) plus TianPing (minor point). In chest operations, they used
SanTai. To each of these points they added points on or near the spinal nerves supplying the
operation site + points from the attached charts nearest the incision site.
d. Cattle: Kothbauer did many Caesarian sections in cows using EAA. In his first 2 cases he
used LV14 (8th intercostal space, at a level with the shoulder joint) with BL30, both points on
the left side. EAA was given at 40 Hz, output causing marked muscle twitch. Induction time
was 20 minutes.
e. Ox, pig: In Japan, the Akita Veterinary AP Research Unit tested many point combinations
(including the classic LU01 with TH08 penetrating to PC04.5). They concluded that the best
effective points in cattle and pigs were Tenpei (TianPing) and Hyahai (BaiHui). These points
are located in the midline at the thoraco-lumbar space and the lumbo-sacral space, as in
combinations (c) above. The depth of needle insertion would be similar to that in combination
(c) above (the Chinese combination), i.e. penetrating almost to the dura mater. They used 30
Hz. Voltage (output) was increased if the animals were recumbent.
EXAMPLES OF POINT SELECTION IN SMALL ANIMALS
Dog:
a. Kitazawa (Gifu Veterinary Faculty, Japan) did dozens of operations in which he compared
the efficiency of various point combinations. The best combination for surgery in all areas
was BL23 bilateral. Equally good was SP06 bilateral, but EAA of this point occasionally
caused convulsions.
The next best combination was 8 needles, one in each point on each limb: LI11 plus InKoTen
(Japanese point, between metacarpals 3 and 4) plus ST36 plus BoKoKu (Japanese point,
between metatarsals 3 and 4); 4 points, bilateral = 8 needles.
He also examined other combinations but his preference was for 2 needles in BL23 (left and
right). This point is paravertebral between the transverse processes of lumbar vertebrae 2-3.
b. The late Dr. Ishizaki (Japan) did over 50 major operations in dogs with 95% success.
Unfortunately, he had no simple combination of points, as he chose points according to
Channel Theory and also points near the operation site. However, in general, for operations
on the head, neck, thorax and upper limb he used points PC06 and TH08 bilateral, with the
needles penetrating completely through the limb (in one side, out the other) behind the radius
and ulna. For operations on the abdomen and hindlimbs, he used SP06 (penetrating
completely through the limb) and ST36. For anal surgery he added points lateral to the anus.
c. In a large series of toxic pyometra cases, Arambarri and Cazieux in the Toulouse Vet School
used AA at points SP06; ST36,25; plus para-incisional needles for ovariohysterectomy. Not
one case died and all recovered uneventfully. EAA was given at 2.5 Hz, rising to 3.5-4.5 Hz
during operation. Manual AA was also successful.
d. Ralston reported uneventful removal of bladder calculi and Caesarean section in high-risk
dogs using needles bilaterally in LI04 and ST36 (positive poles) and SP06, LI11 (negative
poles).

e. O'Boyle and Vajda used SP06 and ST36 (bilateral) in 15 dogs. The operations (all of which
were done successfully without other anaesthetics) included Caesarean section, removal of
abscessed mammary tumour, splenectomy, gastric and intestinal surgery and
ovariohysterectomy. They used 125 Hz, square wave, 2 seconds on/2 seconds off.
Monkeys:
Many combinations can be used in monkeys. The ones listed below are only a few of the
combinations listed in texts on human EAA.
Vierck applied an electrical pain stimulus to the gastrocnemius area of monkeys. Bilateral
electrostimulation of ST36 gave marked hypo-algesic effects. He used 200 Hz monophasic
square wave, 0.5 msec. Monkeys respond similarly to man in many aspects of AP. Thus one
should expect the following points to be effective:
Dental surgery: LI04 plus ST06 or Ear Root (Dental) point plus ST06
Oral plus lip surgery: ST44 plus LI04 (Jacobs: 15 minutes at 100 Hz gave excellent results).
Thoracic surgery: TH08 penetrating to PC04.5 +/- PC06 (or) TH05 penetrating to PC06
(or) LI14; TH14 (or) LI04; PC06 (or) LI10; TH17
Abdominal surgery: SP06; ST36 (or) ChihYi points (main point in midline at vertebra T6
plus secondary point at T3. Upper abdominal surgery: add point at T5; lower abdomen: add
point at T11).
Upper limb surgery: Choose points from LI04,11,15,17,18; LU02,5,10; TH03,4,13;
PC04,6; HT03, depending on site of surgery, Channels near the operation site and the nerve
supply.
Lower limb surgery: Choose points from SP03,4,6; GB30,34,36,38,39,40,43;
LV02,03,05,06; KI03; ST36,40,44; BL40,49,54,57,59,60; ChihYi points (main point in
midline over the 6th thoracic vertebra and secondary point over 1st lumbar vertebra; X 35 in
region lumbar 1 to sacrum 2, depending on site of surgery, Channels near site and nerve
supply.
Dorso-lumbar surgery: LI04; TH05 plus ChiehKou (local points at each end of the
incision); ChihYi points.
Cats:
The cat is difficult to work with and resents needles placed in the feet. Lambardt used EAA at
2.5 Hz on 4 cats (3 ovariohysterectomies, 1 Caesarean section). His points were: ST36; BL49;
LU01; TH08 (bilateral). The results were not satisfactory and he noted much struggling.
Three assistants were needed to restrain the animals! He concluded that cats are not the best
subjects for EAA.
Other workers have used cats very successfully in experimental work on EAA (confirmation
that the limbic and cortical potentials elicited by pain stimuli were suppressed by EAA) and
Still (1987) claimed very good surgical analgesia in cats, using EAA at pre- and post-

auricular points, plus GV06b, BL23,23a,24, lumbo-sacral space (GV03a) and SP06. The
choice of points and frequency of stimulation are important to good success, especially in
cats.
Rabbits:
Matsumoto reported the best analgesia from ES of a single needle placed to a depth of 3 cm in
the second interdigital space. The negative electrode was a needle placed in the thigh muscles
or at the vertex of the head. This technique at 200-10000 Hz sine wave gave powerful
analgesia of ventral aspects of the neck, upper limb, thorax, abdomen and thigh. The
analgesic effect crossed the midline, i.e. a left needle gave left and right analgesia. Chinese
workers have also used AA on Earpoints alone for abdominal surgery in rabbits.
Rats:
Toda et al have done many years of research with EAA in rats to study the mechanisms of
EAA in the treatment of dental pain and as a preparation for dental surgery. They tested
various points and concluded that the most effective points for dental analgesia were LI04
(bilateral) or needle cathode at GeiKo (Japanese points on the lateral margin of the nasolabial fold) and a 3 x 4 cm silver plate anode placed on the centre of the abdomen. The GeiKo
point was stimulated at 45 Hz, 5 msec, until the nose twitched in frequency with the
stimulator. Analgesia occurred on both sides of the mouth from stimulation of GeiKo on one
side but was better on the side opposite to the needle.
In the experiments with LI04, they did extensive trials to examine various frequencies (0.5,
1,10,30,45,100,150,300,500,1000 Hz). They found that some analgesia occurred at all
frequencies from 0.5 to 500 Hz but the best analgesia was given by frequencies between 30
and 150 Hz. 1000 Hz was unsatisfactory. Induction was about 15 minutes. They also tested
stimulation patterns using pulse durations between 0.1-5.0 msec. The pulse duration had little
effect on efficiency of analgesia.
Mice:
EAA at LI04, square wave, 4 Hz, 0.1 msec, for 20 minutes. Output level was adjusted until
muscular contraction occurred and was increased to just below the level which caused the
mice to vocalise (squeak). Under experimental conditions this had analgesic effects on the
nose. The effects were reversed by opiate antagonists (levo-naloxone, naltrexone, cyclazine,
diprenorphine) but not by dextro-naloxone (which has little opiate- antagonist effect) (Cheng
& Pomeranz 1980).
Dogs, cats, monkeys, cavies and rats:
Lynd in the San Antonio Medical School, Texas, experimented with a "standard surgical
incision and suturing" applied to the upper lateral abdomen. A lateral incision through skin
and muscle layers was used in all animals. He used only simple insertion of needles (no ES)
in the following points GB01; TH23; HT05; BL23,22; KI06. All points were needled
bilaterally and the needles were left in position. When the animal lost its reaction to pinprick
etc, the incision was made and was then sutured. He reported excellent analgesia but gave no
statistics.

4. ADVANTAGES AND DISADVANTAGES OF AA


ADVANTAGES OF AA
AA is a simple, cheap and effective preparation for surgery, especially if combined with
tranquilliser or drug anaesthesia. It may be the only method of surgical analgesia which might
be available in wartime, national disasters and other emergency situations.
Combination anaesthesia: In humans, a combination of EAA and tranquilliser or anaesthetic
drugs is used in thoracic or abdominal surgery, especially in allergic or high-risk patients
(circulation, heart, lung, kidney or liver disease). Results were compared with control patients
operated under drug anaesthesia alone. They confirmed that the amounts of narcotic and
barbiturate drugs needed to maintain adequate anaesthesia were reduced. The EAA-drug
group had less deviations from the baseline in heart rate, BP, EEG and body heat loss than the
controls during surgery. Blood levels of ACTH, cortisol and aldosterone during surgery did
not differ between groups. Recovery of consciousness in the EA-drug group was associated
with more alpha- and less beta- activity in the EEG and with less time-space-disorientation on
waking up than in the control group. The AP-drug anaesthesia was associated with minimal
depression of vital functions and maintained good adaptive reactions (Ponomarenko 1987).
EAA combined with diazepam was successful in surgery for fracture of the femoral head in
elderly high-risk patients (Glennie-Smith 1986).
Some vet acupuncturists combine EAA with drug analgesia. The dogs are given a
tranquillizer (i/v) and small doses of general anaesthetic (much smaller than would be
successful without EAA), together with EAA. The results are very good and post-operative
recovery is faster and less troublesome than after surgery under conventional anaesthesia.
a. Per-operative benefits: AA can be used in high-risk patients, who might NOT tolerate
general or local anaesthesia. These cases include shock (post trauma, haemorrhage), severe
debilitation (after chronic disease, malnut-rition or cruelty), toxaemia (renal, hepatic,
pulmonary or cardiac cases, toxic pyometra etc); obstetric surgery (Caesarean section etc). It
can also be used on very young and very old animals, and in operations lasting up to 10 hours.
The effect of AA on the autonomic nervous system prevents shock during the operation so
that deaths during or immediately after operation under AA are extremely rare. Operative
haemorrhage is also decreased.
b. Post-operative benefits: Because consciousness and reflexes (other than pain response)
are retained under EAA, the animal can walk unaided to the recovery area immediately
after surgery. There is no risk of self-injury due to ataxia, struggling or falling, as may occur
under general anaesthesia or spinal block.
Many authors, operating on animals as well as human patients, report far fewer postoperative complications after AA (less ileus, less urine retention, faster return to normal
appetite, less nausea etc). Defecation and urination occur very quickly after EAA and the
animal will eat and drink immediately after operation (if it is hungry or thirsty). It is common
practice to offer cattle some hay or concentrates during operations and many dogs will
placidly accept bits of meat during major surgery.
Post-operative pain and discomfort are almost totally absent. If they occur, AP at the AA
sites or at other points for the pain site can control the pain quickly. It is well known that AA

effects last for up to 20- 60 minutes after stimulation is ended. An extraordinary finding in
monkeys is that peaks of powerful analgesia (interspersed with periods of normal pain
sensitivity) can continue for up to 70 hours afterwards (Vierck). This finding demands
further research.
After AA, surgical incisions heal much faster, with less oedema, less wound infection and
less wound breakdown.
DISADVANTAGES OF AA
a. Analgesia is inadequate in some patients. In animals, expert technique can obtain a
success rate of 90-100% between different operators but the success rate has 3 categories:
Excellent results are defined as no indications of pain at any stage in the operation (struggling
and vocalising because of physical discomfort, restraint, fear etc must be distinguished from
pain reaction). The operation proceeds smoothly at all stages and no other anaesthetic method
is required. Slight muscle tremor or local guarding may occur.
Good is defined as short intervals of restlessness or mild struggling during traction of internal
organs, suturing of sensitive structures etc. Local muscle tremor or guarding is noted at
intervals but the operation can proceed without other anaesthetics.
Fair some pain reactions are noted at intervals during the operation and frequent, intermittent
struggling may arise. Marked local tremor and guarding may arise. The operation can still
proceed. Some of the effects can be relieved by increasing the frequency or voltage or by
relocating the needles.
Failure is defined as pain reactions (fierce struggling, vocalisation, muscle tremor, strong
reaction and impossible to proceed with the operation without some other form of anaesthesia.
Skilled operators may have excellent, good and fair rates of about 78, 19 and 3% respectively,
with failure rates of zero. However, these success rates are seldom obtained by Western
operators in the first year or two of their use of the technique, and many western operators,
despite much experience in general AP therapy have not had such good success with AA.
Failure: Western vets can expect a failure rate of 20-50% in the beginning. This is due mainly
to incorrect choice of points, incorrect location of points, incorrect needle depth, direction,
incorrect or inadequate methods of stimulation, animal factors and surgical technique.
b. Animal factors which may reduce the success rate:
Regional variation in EAA: Certain body regions are more difficult to render insensitive to
pain than other regions. Vets who specialise in limb surgery might not get success rates as
high as those who specialise in intestinal surgery. Success rates for surgery on the frontal
sinus, oesophagus, intestine or bladder may be less than for other body regions. Sex and
breed effects may interfere: female cattle respond slightly better than male cattle and
domestic cattle may respond better than buffaloes. Species differences: among farm animals
cattle and sheep are the best reactors, followed by pigs and horses. Dogs are very good
reactors but cats are difficult subjects to handle and their intolerance of morphine may be
related to their poor response to AA. Temperament differences: nervous, excitable animals

may be good responders to AA but are easily frightened by noise, smell, sight stimuli and
may be hard to restrain, despite good analgesia. Dull, depressed animals may appear to be
easy to handle but their reaction to AA may be sluggish and not of a high degree.
Recumbency: Large animals in the recumbent position need a more expert AA technique
than those which are standing. Voltage should be increased in recumbency. External and
other stimuli: Animals with an elevated pain threshold under AA can still react to disturbance
by environmental stimuli (smell of blood, noise, excitement, fearful sights, proprioceptive
stimuli/physical discomfort, clumsy surgical technique etc). These may lower pain threshold
and reduce the success rate.
c. Muscle relaxation may be inadequate if the EAA technique is not expert. This may cause
ballooning of intestines through abdominal incisions.
d. Induction time (10-40 minutes) may be inconvenient for some surgeons, who may also
complain about "electric wires all over the place".
e. Needle dislodgement: Occasionally one or more needles become dislodged, especially if
they had not been taped or sutured securely in position. Dislodgement may occur (despite
good restraint of the animal) due to strong muscle twitch induced by EAA. If needles fall out,
they must be replaced or the analgesia may be poor or absent. When reconnecting a replaced
needle, the output voltage should be set to zero and then restored gradually after reconnection.
f. Restraint must be good: This usually needs the presence of at least one assistant at all
times after the start of induction. Restraint of small animals, by tying them in dorsal or dorsolateral recumbency, may cause them some discomfort. Struggling against discomfort needs to
be distinguished from possible pain reactions to the surgery. The special EAA harnesses tend
to reduce this problem in small animals.
g. EAA demands skilled surgery. Surgical technique must be deft, light, fast and
unhesitating. Prolonged probing or manipulation of organs and slow uncertain incision reduce
the success rate. Traction on mesentery or ligaments should be kept to a minimum, as should
handling of organs and viscera. Although AA has anti-shock effects, heavy traction during
EAA can cause autonomic (vagal) reflexes (nausea, vomiting, shock, collapse etc). Where
possible, use the hands, rather than surgical retractors, clamps, forceps, probes etc. The hands
usually are more sensitive than instruments and are less likely to cause unnecessary
trauma/stimulation during surgery.
5. MECHANISMS OF AA
EAA is not hypnosis: In humans, hypnosis or self-hypnosis (deep relaxation) can induce
surgical analgesia in sensitive subjects and can be used to treat certain disorders associated
with stress. "Animal hypnosis" (the Still Reaction) is not fully analogous to human hypnosis.
It is a reversible and involuntary "Tonic Immobility" (TI), induced in many species as a
defensive reaction to sudden fright or pain. TI is disrupted easily by noise, movement or
touch. In TI, animals may tolerate mildly painful stimuli (pinprick, sound, electric shock)
without somatic (muscular) reaction. This is due to descending motor inhibition, not sensory
inhibition. They feel the stimulus (as assessed by neuronal discharges in the cerebral cortex)
but do not appear to react. There are marked differences between the physiological effects and
mechanisms of human and animal hypnosis and those of EAA. Appendix 1 compares and
contrasts TI and AA.

Sensory inhibition in EAA: Modern theories attribute the effects of EAA to inhibition of the
ascending (sensory) pain signals at three levels: peripheral, spinal and central. Some recent
research findings which support this theory are as follows:
1. Many of the most active AA points are directly over, or very close to, main nerve trunks
and branches of peripheral nerves.
2. Interruption of the sensory nerve supply proximal to the AA needle site abolishes the EAA
effect. This has been demonstrated in many species (including humans) by local anaesthesia
(procaine infiltration etc) of the AA point, by nerve block above the point and by spinal block
above the entry point of the nerve into the spinal cord. In animals, direct EAA of the isolated
nerve gives the same analgesic effect as EAA of the AP point. If the nerve is transected,
stimulation of the proximal cut end produces AA but stimulation of the distal cut end
produces no effect.
3. In monkeys, cats, rabbits, rats and other laboratory animals, pain stimuli applied at distant
regions (for example, the hind limbs) evoke electrical activity in cortical and thalamic
neurons. This activity can be monitored by electrodes placed directly into specific neuronal
centres of the brain or by surface electrodes at specific regions of the head. EAA at points
which cause analgesia of the pain zone suppress or abolish completely the evoked potentials
in the brain. (There is also experimental evidence that transmission of pain signals is inhibited
by AA at peripheral and spinal levels.
4. Experimental electrolytic lesions placed around the 3rd ventricle (midbrain) or surgical
hypophysectomy completely abolish AA effects. The midbrain and hypothalamic areas are
rich in opiate receptors. (Certain strains of mice, which have no opiate receptors because of a
genetic abnormality can not respond to AA). Levo-naloxone, naltrexone and other opiate
antagonists prevent and abolish much of the analgesic effect of AP in humans and animals.
Thus far, these facts indicate that the signals generated by needling or
ES of the AA points are transmitted via the peripheral sensory nerves to the spinal cord and
that they activate a descending brain-based pain-inhibition mechanism, especially the
midbrain and hypothalamus. There are also "pain inhibition gates" in the spinal cord. Thus,
the "ascending pain signals" are blocked at spinal and midbrain level and fail to reach the
cerebral cortex.
There is very strong evidence that the pain inhibition mechanism involves activation of
opiate and serotonin (5HT) receptors in the brain and, probably, other sites also. This
evidence is strengthened by the following observations:
AA stimulation causes release of endorphins, enkephalins (endogenous morphine compounds)
and ACTH. This has been confirmed by chemical analysis of tissues.
AP stimulation of certain points (especially Earpoint "Lung"; LI04; ST36; GB34 etc) relieves
the symptoms of narcotic and alcohol withdrawal within 10-30 minutes in human addicts and
in laboratory animals addicted experimentally to morphine or heroin. These points have major
AA effects (Patterson).

Stimulation of AA points on one side of the body may have analgesic effects on the opposite
side. In most species of animal, the stronger analgesia is usually on the same side as the
needles. However, Toda et al found a stronger effect on the opposite side when the GeiKo
point was used in rodents.
Although ES of single points such as ST06; LI04; TH08 etc may cause analgesia over a wide
area, there is some specificity between the anatomical location of the point and the area of
analgesia. For instance point PC06 or TH08 will give better analgesia of the arm and thorax
than of the leg, whereas SP06 or ST36 will give better analgesia of the leg and abdomen than
of the arm. Also, needling of "false points" usually fails to produce AA, even though the false
points can be quite near the correct points.
A certain degree of side-to-side and region-to-region specificity exists between the AA
point and "target zone of analgesia". This suggests that the AA signals are going to specific
sites in the brain. It is known already that the brain contains 3-dimensional projection areas
(both sensory and motor) for all body regions. It appears that endorphin release in these
specific areas is the main mechanism of AA.
Many years before the endorphins were discovered, the Chinese had evidence
that a morphine-like analgesic factor was released into the blood and cerebro-spinal fluid
by AA (Niboyet et al). Cross-perfusion studies were conducted in rats, dogs, rabbits and
monkeys in China. AA or EAA was established in experimental animals and cerebro-spinal
fluid, whole blood or serum was perfused directly or indirectly into animals (of the same
species) which had received no AP. Analgesia developed in the recipients but was not as
marked as in the donor animals. An extraordinary finding was that if the donor had a localised
analgesia (specific to one side or one region), the recipient also developed analgesia on the
same side and in the same region as the donor. This suggests that humoral factors are
released by EAA and that they activate specific receptors (now known to be opiate receptors)
in specific regions of the brain and spinal cord of both donor and recipient animal. Many
neurophysiologists find it difficult to accept that such specificity can exist. In the past few
years, Chinese and Western workers have confirmed that release of endorphin is involved in
AA.
As well as releasing endorphins, EAA also releases ACTH, which increases the cortisol levels
in blood. This was proved in horses by Cheng et al (1980). In these experiments, EAA was
given at 4-5 points to above the threshold of muscle twitching; biphasic pulses, 5 Hz, .25
msec duration for 30 minutes. The points were chosen from points effective in treating limb
pain in horses, BL13,65; GB26; PC09; KI01,02. The needles were 10 cm long and were
inserted to a depth of 3-5 cm. Cortisol levels before and after AP were measured. A control
group of horses received "false" AP, by the same method but at non-points 5 cm below
GB30,39; BL13,18,47 and the needles were inserted subcutaneously only (not to the deeper
levels as in the active points). EAA increased cortisol by 40% above pretrial values but "false
EAA" had little effect. (Note: If "false points" above or below the "real points" are used, some
hypoalgesia may occur because the same nerve trunk may be stimulated. If the "false points"
are lateral or medial to the "real points" (i.e. not over the nerve trunk), needling the "false
points" is usually not effective). The difference between real and false EAA was highly
significant. Recent research has also shows that serotonin (5HT) is involved in EAA and that
oral administration of 5HT precursors, such as d-phenyl alanine, greatly enhances AA and can
turn "non-responders" into "responders".

Frost reported 3 cases of human AA following needling of points below a traumatic


transection of the spinal cord in the region cervical vertebrae 1-6. Analgesia occurred
above the transection.
Terral repeated the Chinese cross-perfusion EAA studies in rabbits. He confirmed that EAA
released a humoral analgesic factor in rabbits even when the spinal cord was severed
behind the medulla oblongata.
The mechanisms of AA can be summarised as follows: Signals caused by stimulation of
AA points are carried in the peripheral sensory nerves to the spinal cord. At this level they
may activate local (spinal) pain inhibition gates. Spinal signals are also transmitted to specific
sites in the thalamus, hypothalamus and midbrain, via the ascending tracts (spino-thalamic
tracts, ventro-lateral funiculi). These signals stimulate the local (and systemic) release of
endorphin, serotonin (5HT) and other neurotransmitters not discussed in this paper. The
endorphin activates the opiate receptors, which "switch on" the pain inhibition mechanism
specific for those areas related to the needle site and its projections at brain level.
Simultaneous ACTH release from hypothalamic areas induces cortisol secretion by the
adrenal, thus preparing the animal to withstand the surgical stress and to assist (antiinflammatory effect) in wound healing.
Release of ACTH by EAA could be important in treating allergies, arthritis, inflammation and
shock. Some AA signals can reach the pain inhibition centres by routes outside of the spinal
cord, possibly by (a) cell-to-cell transmission through the skin and soft tissues (as in a beecolony); (b) by the autonomic nervous system and (c) by release of some (yet unknown)
substances from the needle-site into the bloodstream.
6. OTHER METHODS OF STIMULATION-PRODUCED ANALGESIA (SPA)
SPA originally referred to analgesia produced by direct stimulation of specific brain sites,
especially the area around the 3rd ventricle, the periaquaductal grey matter (PAG). In
humans and animals, this produces powerful analgesia over the whole body. It has many
parallels with EAA. SPA is abolished by opiate antagonists (naloxone etc). It involves
endorphin release but over a wider area of the brain than EAA. This probably explains the
more localised analgesia of EAA. Direct stimulation of the thalamus or dorsal spinal cord
roots also produces potent analgesia and ES of permanently implanted electrodes in these
sites has been used in treating severe intractable pain in humans.
Long-term direct stimulation of brain or cord sites involves some risks (possible electrolytic
lesions in brain/nerve tissue, risk of infection etc). Because direct methods were effective but
risky, researchers began to examine the possibility of indirect stimulation of the nervous
tissue, via peripheral nerves. This led to the development of various forms of transcutaneous
ES analgesia (TESA), transcutaneous nerve stimulation (TNS), transcutaneous electro-neural
stimulation (TENS) etc. These methods are widely used internationally in physiotherapy and
for personal use by outpatients of pain clinics. Workers familiar with the AP system found
that TESA, TENS etc were more effective if the electrodes were applied to the affected local
areas plus (AP points, Trigger Points, organ reflex points etc). TESA mechanisms are not
fully researched yet but there is strong evidence that they are similar to those of EAA.
Under experimental conditions, surgical intervention has been done in animals under SPA but
the main use of SPA and TESA has been in the control of clinical pain.

Other types of SPA include vaginal stimulation analgesia, electro-restraint electroanaesthesia/electro-narcosis and electro-sleep.
Vaginal Stimulation Analgesia (VSA): Mechanical (glass probe) or electrical stimulation of
the vagina in rats produces a powerful analgesia over the whole body but the mechanism does
not involve the opiate receptors in the brain because opiate antagonists (naloxone etc) do not
interfere with the analgesia. Thus, VSA is mediated by mechanisms different from SPA,
TESA and EAA.
Electro-restraint: Reports from Poland claimed that positive clamp electrodes fastened to the
ear and a negative tongs electrode fastened to the nose gives excellent restraint in cows. Using
this technique in 58 cows, the author (Szczerbac) was able to pare the hooves with no
difficulty and no defence reaction from the cows. The frequency of stimulation was 160-200
Hz and the current was 4-16 mA. Details of induction time are not available in the English
summary of the article but I believe that induction was probably very short. The Ear roots and
the nose (especially GV25 and 26) are used as EAA points in some Chinese prescriptions for
humans and animals. However, I suspect that the Polish instrument is used as a method of
restraint rather than a true analgesia. It is also interesting that stimulation of the nasal area
(the simple tongs or fingers in cattle; the rope "twitch" in horses) and of the ear-root (in both
cattle and horses) has been used internationally for many centuries as a method of restraint in
large animals. Since the Polish report, a similar instrument has been available commercially in
Australia and the USA. Its tradename is STOCKSTILL. It applies a strong electrical stimulus
to the cheek/mouth/nose and the base of the tail or other area, as required, i.e. opposite ends of
the spinal cord. To knock the animal, current is applied to the cheek and lumbar area. The
animal falls to the ground immediately and simple surgery can be done with great ease.
However, the British Veterinary Association has not accepted that this technique is humane
and painless. It seems that this method of electro-restraint has little analgesic power but
rather that it acts by a type of spinal shock which induces spastic paralysis of the motor nerves
from the spinal cord. More research is required on this method but it appears to have little or
no similarity in its effects or mechanisms of action to EAA or SPA.
Electro-narcosis and electro-anaesthesia are terms used for another type of electrically
induced anaesthesia which uses indirect electrical stimulation of the thalamus to produce
unconsciousness and total anaesthesia. The induction period in humans and animals is very
short, usually 1-5 minutes. Unconsciousness and anaesthesia can be maintained for long
periods while stimulation continues. Consciousness returns immediately stimulation ceases. In
early trials, needle electrodes were used in various sites on the head: temples, vertex, occipital
area, mastoid area, forehead etc. Contact electrodes, such as sponges soaked in saline or metal
disc electrodes were used later. Kano et al have done many experiments with the method in
monkeys. They found that needle electrodes could produce third degree burns, stretching
between the electrodes but that contact electrodes did not produce tissue damage. Their
suggestion for best results was to use high frequency current passed between B-C and B1-D,
where electrodes B and B1 are over the greater occipital nerves and C and D are over the
greater auricular nerves.
They proved that the stimuli are transmitted to the brain by these nerves by a local ring-block
around the scalp, using 0.25% lidocaine. The local anaesthetic blocked the phenomenon.
Anaesthesia produced by these techniques is sufficient for major surgery in man and animals.
In her book on AP in the treatment of drug addicts, Margaret Patterson traces the history of

these techniques. Electro-anaesthesia has a long history in western medicine dating back to
1902 (long before the development of EAA, SPA, TESA etc). It was discovered by Francois
Luduc in 1902. The first human operations using the method were in 1972 in the Necker
Hospital, Paris. Since then, more than 400 operations (including arterial grafting, kidney
transplants, urological and intestinal surgery) have been done using that method in the
hospital. Other hospitals in France are also using the method. The electrode placement is: 2
electrodes (anodes) behind the mastoids (one each) and one cathode between the eyebrows;
unidirectional high frequency current (See Patterson for details). Post-operative analgesia is
marked, lasting 6-48 hours, as in EAA. Post-operative infection, abscesses etc are rare (3%)
as compared with operations under general anaesthesia (17% abscesses) in the same hospital.
This also parallels the EAA effect but loss of consciousness during electro-anaesthesia
indicates that the mechanisms differ from those in EAA.
Electro-Sleep or Cerebral Electro-therapy (CET) has some parallels with
electroanaesthesia but it differs in other respects. It is used in therapy of various diseases with
underlying disturbances of cortical regulation of somatic function and in all disorders with
psycho-autonomic manifestations. It was widely used in the old USSR and in Austria but
there is no agreement on the mechanism of the effects or on the stimulation parameters used
to induce electrosleep. One Russian worker (Sergeer - see Patterson for other details) used
rectangular pulse, constant polarity, pulse duration 0.2-0.3 msec, current intensity 15-20 mA,
80-100 Hz, for 30-120 minutes per day. A course of treatment lasted 20-25 sessions.

APPENDIX
ANIMAL HYPNOSIS AND AA EFFECTS
Definition: "Animal hypnosis" is also called the "Still Reaction", "Death Feint", "Tonic
Immobility (TI)" or the "Immobility Reflex". In this discussion it is called TI. It is a specific
tonic immobility, with involuntary but reversible inhibition of spinal reflexes. It involves the
selective loss of placing, righting and supporting reflexes. The animal may be alert or drowsy,
depending on the nature of the induction of TI and the sensory stimulation during the trance.
Induction of TI: Strong emotions, such as intense fear can trigger TI spontaneously. (The
chicken/rabbit "freezes" at the sight of the hawk/weasel). Experimental induction involves
one or more of four main techniques: (a) repetitive stimulation; (b) pressure on parts of the
body; (c) inversion; (d) forcible restraint until struggling ceases. Tactile and proprioceptive
stimuli are the most important inducers but other stimuli, such as visual and auditory inputs,
enhance the effect. Visual stimuli are most important in chickens. Enhancement and duration
of TI in rabbits 2-4 kg weight is most marked if they are restrained for 5 seconds on their
backs in a holder with inside measurements: base 18" X 3.25" X 4.5" high. The effect is
enhanced by inserting a block to press slightly against the head. Using this method, duration
of TI was 15-60+ minutes, as compared with 0.2-8.0 minutes induced by restraint on a table.
TI can be enhanced greatly in duration and depth by low-level ES of certain subcortical brain
sites, or of electrodes placed across the head.
Reversibility: TI is easily disrupted by stimuli and care must be taken to avoid disruption of
the trance by stimuli , such as loud noise, sudden moves or accidental blows to the animal's
legs or body.

Human hypnosis can induce surgical analgesia in some subjects. Animals in TI are less
responsive than when awake to mild stimuli, such as sound, pinprick, electric shock. Arousal
responses are elicited readily and cerebral-evoked potentials to applied pain stimuli are intact,
indicating that sensory information is received. The lack of response to mild stimuli is due to
motor inhibition and not to sensory inhibition (analgesia).
TI mechanisms: TI is associated with sympathetic arousal. Motor centres in the brain are
inhibited but sensory cortical centres are fully active.
Young rats (up to 3 weeks of age) are good subjects but TI is difficult or impossible to induce
in adult rats. Removal of the cerebral cortex in adult rats makes them very susceptible to TI.
The difference in susceptibility between intact and decorticated adult rats suggests that, in
that species, there is a cortical centre which inhibits a hypnogenic centre elsewhere and that
the cortical centre may be underdeveloped in young rats.
Decerebration does not inhibit TI in guinea pigs and rabbits. In TI of rabbits and frogs, the
loci of descending inhibition on spinal motor neurons are located in the medullary reticular
formation (MRF), brainstem and cerebellum.
Opiate antagonists (naloxone etc) do not inhibit the lack of motor response to mild painful
stimuli in TI. In contrast, AA is inhibited by opiate antagonists.
TI and AA activate clearly different responses, use different neurotrans-mission mechanisms,
controlled by different parts of the nervous system.
Similarities between "Animal Hypnosis" (TI) and Acupuncture Analgesia (AA)
TI
premedication,
meperidine

tranquillisers

AA
tranqs,

atropine

scopolamine,

enhance depth &


duration of TI

enhance AA

mild electrical stimulation

enhances

enhances

motor reaction to mild pain


applied anywhere on the body

absent

absent if AA points
with wide analgesic
effect are used

drowsiness

sometimes

often

noise, sudden movement,


strong pain stimuli

disrupt TI, cause


motor response

may disrupt AA, cause


motor response

autonomic effect

sympathetic

mild sympathetic to
neutral

Differences between "Animal Hypnosis" (TI) and Acupuncture Analgesia (AA)


physiological response
inhibition

TI
AA
motor inhibition;
sensory inhibition;
no sensory inhibition no
motor

analgesia sufficient for


major surgery

generalised response

10% of selected cases


in humans;
< 20% of selected cases
in animals
yes

local

80-90% of selected
cases in humans and
animals
only if points with
generalised response
used; mainly
response

induction time

5-30 seconds

10-40 minutes

duration of effect

usually < 3 minutes;


up to 60 minutes in
optimal conditions

as long as needed,
up to 10+ hours

post-effect analgesia

no

yes

naloxone

no effect

inhibits/abolishes AA