244
Acupuncture
to
Relieve
Facial
and
Dental
Pain
Anesth
Prog
36:242-248
1989
of
this
technique
on
a
pregnant
woman
is
highly
unlikely
to
cause
harm.
(3)
Children
under
seven
years
of
age.
Children
do
not
have
the
psychic
defenses
or
the
emotional
armoring
of
adults.
Use
of
the
electrode
stimulator
may
pro-
duce
unnecessarily
profound
relaxation.
This
could
alarm
parents.
Normally,
just
using
the
ear-ring
electrode,
with
no
connection
to
the
stimulator,
helps
young
children
be
more
calm.
The
electrode
stimulator
used
in
this
study
provides
alternating
current.
That
is
why
two
acupuncture
points
are
required.
The
principal
point
in
this
technique
is
ear
shenmen.
The
hand
point,
hegu,
is
used
to
provide
a
second
skin
contact.
But
the
point
hegu
(colon
4)
has
effects
such
as
promoting
healing
in
the
face
and
jaws.
Interestingly,
in
over
three
years
of
using
this
technique
on
all
patients
requiring
tooth
extractions,
my
partner
and
I
have
had
only
one
case
each
of
dry
socket.
Most
electric
stimulators
have
two
main
controls:
an
on-off
switch
that
also
controls
intensity
of
stimulation;
and
a
frequency
control.
Usually
less
than
twenty
cycles
per
second
is
used.
Care
must
be
taken
with
the
on-off
switch.
The
stimulator
must
be
connected
to
the
acupuncture
points
before
being
switched
on.
Once
the
apparatus
is
on,
the
intensity
is
increased
slowly
until
the
patient
just
perceives
the
pulses.
The
patient
does
not
have
to
be
aware
of
the
pulse,
but
most
people
like
to
know
that
something
is
happening.
If
the
stimulator
is
on
when
the
connection
is
made
to
the
patient
and
the
intensity
is
too
high,
it
may
startle
the
patient.
Finally,
some
patients
have
reported
actually
enjoying
dental
treatment,
especially
when
this
technique
is
used
in
conjunction
with
suitable
music
supplied
by
a
cassette
player.
Acupuncture
for
te
Relief
of
Pain
of
Facial
and
Dental
Origin
Srilal
A.
Silva
R
esults
reported
here
reflect
the
use
of
acupuncture
largely
to
induce
analgesia;
patients
were
treated
at
the
Acupuncture
Institute,
Kalabowila.
Acupuncture
has
been
used
at
our
institution
for
surgical
procedures
(extractions,
incision
of
abscesses,
excision
of
tumors,
and
insertion
of
radium
needles)
and
for
symptomatic
relief
of
pain
(simple
toothache,
postextraction
pain,
and
trigeminal
neuralgia).
RESULTS
Surgical
Tooth
Extraction
Of
the
94
patients
who
underwent
normal
tooth
extrac-
tions,
81
reported
no
pain
after
acupuncture,
ten
re-
ported
slight
pain,
and
three
reported
no
relief
of
pain
from
acupuncture.
Electrical
pulse
stimulators
that
pro-
vide
stimulation
in
continuous
intermittent
or
dense
wave
form
are
also
used.
Frequency
is
increased
from
very
low
to
as
high
as
2000
Hz.
Analgesia
obtained
after
a
20-minute
induction
time
is
usually
sufficient
for
such
surgery.
Received
March
1,
1989;
accepted
for
publication
August
8,
1989
Address
correspondence
to
Sililal
A.
Silva,
127
Galle
Road,
Colombo
6,
Sri
Lanka.
C
1989
by
S.S.
Silva
Relief
from
Toothache
Table
1
indicates
results
among
46
subjects
treated
with
low-frequency
electrostimulation
acupuncture
for
relief
of
simple
toothache.
Postextraction
Pain
Of
the
12
patients
treated
for
postextraction
pain,
ten
reported
complete
relief,
one
reported
partial
relief,
and
one
reported
no
relief.
Trigeminal
Neuralgia
Forty-two
trigeminal
neuralgia
patients
were
given
a
course
of
daily
low-frequency
electroacupuncture
treat-
ments
for
10
days.
The
treatments
were
repeated
three
times,
with
a
week
intervening
between
treatments.
Thirty-six
patients
experienced
complete
relief,
four
ex-
perienced
partial
relief,
and
the
treatment
failed
in
two
subjects.
Two
patients
returned
for
another
course
of
treatment
a
year
later.
Table
1.
Acupuncture
in
Surgical
Procedures
No.
of
Patients
No
Pain
Slight
Pain
No
pain
relief
96
81
(86.2%)
18
(10.6%)
3
(3.1%)
Anesth
Prog
36:242-248
1989
ACUPUNCTURE
POINTS
USED
The
Baihui
point
(Du
20)
(meeting
place
of
100
points),
or
governing
point,
is
always
used
in
acupuncture.
Among
the
distal
points
also
used
are
those
related
spe-
cifically
to
pain:
Hegu
(L.I.
4)
and
Neiting
(St.
44).
Two
points
in
the
ear
are
used
in
conjunction
with
surgical
procedures;
area
1
(lobe)
is
the
anesthetic
point
for
ex-
tractions
in
the
maxilla
and
area
4
for
the
extractions
in
the
mandible.
Focal
points
also
exist
on
the
face.
For
the
maxilla,
these
are
Renzong
Du
26,
Yingxiang
Li
10,
and
Quanliao
SI
18;
for
the
mandible,
they
are
Chengjian
Ren
24
and
Jiache
St.
6.
Only
the
distal
points
on
the
hands
and
feet
were
used
in
the
present
series,
for
patients
requiring
analgesia
for
tooth
extractions.
Local
points
on
the
hand,
foot,
and
face
were
stimu-
lated
for
relief
from
the
pain
of
trigeminal
neuralgia.
These
included,
for
the
ophthalmic
branch,
Yangbai
(G.B.
14),
Taiyang
(Extra
2),
and
Zanzhu
(U.B.
2)
and
ear
points
Shenmen,
forehead,
subcortex,
and
sympa-
thetic;
local
points
Sibai
(St.
2),
Juliao
(St.
3),
Rhenzong
(Du.
26),
Xiaguan
(St.
7),
Quanliao
(S.I.
10),
and
Yingxian
(L.I.
20);
and
ear
points
Shenmen,
facio-man-
dibular
area,
subcortex,
and
sympathetic.
For
the
man-
dibular
branch,
the
local
points
used
were
Yifeng
(S.J.
17),
Jiachenjiang
(Extra
S),
Dicang,
(St.
4),
Jiache
(St.
6),
and
the
facio-mandibular
area
ear
point.
Needling
is
often
not
possible
on
the
affected
region
of
the
face.
In
that
case,
the
opposite
side
is
used.
One
starts
with
a
low
frequency,
but
up
to
20
Hz
may
be
necessary.
The
treatment
is
given
for
10
days,
and
the
course
is
repeated
three
times
with
intervals
of
1
week
between
treatments.
THE
THEORY
OF
CHANNELS
AND
COLLATERALS
(JING
LUNG
THEORY)
Acupuncture's
effects
are
explained
on
the
basis
of
a
flow
of
energy
(qi).
Energy
is
held
to
flow
in
a
defined
sequence
along
a
system
of
channels:
there
are
14
vertical
channels
(jing),
consisting
of
12
paired
organ
channels
and
two
unpaired
midline
channels.
A
number
of
interconnecting
horizontal
collaterals
(Luo)
are
postu-
lated.
The
system
can
be
altered
and
imbalances
cor-
rected
by
needling.
ZANG-FU
THEORY
The
12
paired
channels
are
deemed
to
originate
from
internal
organs.
The
solid
organs
(Zang)
(lung,
heart,
spleen,
kidney,
pericardium,
and
liver)
are
negative
(Yin).
The
six
other
organs
(Fu)
are
hollow
(large
intestine,
small
intestine,
stomach,
urinary
bladder,
body
cavity
[Sanjiao],
and
gall
bladder)
and
positive
(Yang).
MODERN
THEORIES
The
gate-control
theory
of
Melzack
and
Wall
holds
that
the
perception
of
pain
is
modulated
by
a
system
of
gates
within
the
central
nervous
system.
The
effect
of
acupuncture
is
explained
in
this
system
by
postulating
that
needling
sends
impulses
along
the
large
fibers,
resulting
in
overcrowding
or
jamming
of
the
gate,
causing
it
to
close.
Acupuncture
can
also
be
explained
by
the
other
important
current
theory
of
pain
control,
which
states
that
a
specific
peptide,
substance
P,
is
involved
in
pain
transmission
along
the
small
afferent
nerves.
Other
neu-
ropeptides,
the
endorphins
and
the
enkephalins,
inhibit
the
sensation
of
pain.
It
is
assumed
that
needling
excites
the
system
to
secrete
these
pain
inhibitors.
Acupuncture
is
preferable
to
drug
therapy
in
the
management
of
pain
because
of
the
various
side
effects
of
many
of
the
drugs
used.
However,
much
remains
to
be
learned
about
such
factors
as
infection,
age,
sex,
and
degree
of
pain,
and
to
what
extent
acupuncture
can
be
deemed
reliable
with
variations
in
these
factors.
Silva
245
