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com

A BriefReviewof the History

of Electrotherapy
and its

Sumrnary
Key words
This is a brief revic\,,,aiLhehistoty()l -.lectrcthetapv. Dorsal Colunn Stiniulatiotl, ElectroacLtpuncture,
P,tin has been relieved by ele.triaity since ancient Elect] oia hthiotherapy, Elealrctherapy, Faraalism,
ri|les, at first bv ncans oi appl,vittgliv-. ele(tric fish Franklitlisn|],Galvanism, I nt-.rierentialslimulati()t1,
to the tenclcrpart lo aaLtsenumbness.But once IF\'s.
ii(Iional machincsw,erelouDd to produce electro
,tdtic eledticitl, (Franklirlisr,)in the nid 1qth
a-Dnturythe use of livint orianisms w;Js discan Painha\ beenrelievedby electricalstimulation
ever
tinued. By the latc lSth cenrur,v Calvani had since the discoveryof electficity.The hislorv of
rediscovered the iact tha! animals developed ' I n , r o , ' r . : , . I m , )
i!
s"ll
.
. ri pr'
,\
electri(it), spontatleously. Volta diss;v,.red a aclrplrncture
afd bolh nrelhodshavea goodclealin
chemic,tl ntc,tDsot- ptoduaitlB electricity lront the corlrmonin their ralionale.,^swe arc begir]r]inil
to
first fbm of battcty or voltaic ytile\r,ithoutrecourse realise,they ofief the practitidrerthe opponunityto
to animal tissucsar iidion;l nachtnes \,liosc slimlrlatethe felcasc oi specific pain relieving
efiiciency varied \,/ith atDrosplleri(( otlditions. l'his slrbst,rnces
\\,ithrnihc patienl'sceftfal ncrvoLrs
system.
clis(orery lcd to the medical use ()i direct currenl
When electroacupuncllrre
is practised,theset\!o
(Calvanisnt).lls abililr, to r:;::us--necrosisby elec- ancientthefapcLrli.
methodsare combinecl.
As long
trolvtic D)canswas entployed in the dcsttuctianoi agoas 1823,Sarlandi6fe
discusscd
ihe gfeatbenetits
tLtnaLtrs.CalvanisDJwas also applied to rJccdles, ior pain relief resrltirg from thc combinationof
hence thc lirst iorm of electrcacLq)un.tL1rc
electricity
and orientalneedling.
pioneercd by Berlioz ,tnd Sarlandi're.For the titst
In more reccnl times Woolf (198,1)has lvrjttef,
timc thc conbinalian oi elechathetapvand orietllal ''Theability ol a aliniciaDto reclucepain in a patient
idtas ahout needling werc brought together. by explailitlBthe patient'sawn iD-builtneurcphysio
Furthetnore thes--early expcriflentesssllow-odhaw logical mechatiistts ntust sur-oly raDk as one
stin'l]ulatioD
aI th-Dnervoussystembroughtptotount] ot' the Brc.llesl achievenents ol (otitenporary
relici fron pain.ln the earl,\,19th centLltyFara.lav's medicalscicnce".
\\ork an lhe pradLtctiaDof alte iating cunents ancl
his understandingoi electrolysisprovided nEdiaitie Animal electricily
with the ercnpe that was requircd from the dan.r;ers Jn thc an.ient world (l(ellawa),,19461, thcre
ol (;alvatrisnnl.
A variett af safcr allenjatitlland happcnedlo be n varietyof r.arineand ffeshwatcr
intcnupled.utrents(Faradisn)havcbeenemployed fish rvhoseexistencewas a source of lear and
in clcc0alherapyever since,particularlyin the iont
superstitjous
conjecture ihcy possessed
the stfante
of clectroa.upundLrre, IFNS lTranscutaneaus powcr of deliveringpainfuiand paralysinS
shock.
Lle.tri.al Stitiulati()n) and Dorsal Column Theseincludedthe totpeda tay (Tatped()tnal.,crata),
Stimulatiotl. The popularity ol electrcttherapyfell the eleciricor Nile catiish(Mak)pteturus
elcctticus)
durinB th-. -.arlvpart af the 2oth cenrury,as no one and the electfic eel lCymnotuse/ectrlcus).Njle
knew ho\jt its e/teclsnere abtained. Howevet n()w catlish were pfominentlydisplayed in Egyptian
\re know how afferent nervc fibres respoDt! kt tombs: the oldest of thcse dated from the
dillerentltequ-.nciesanclamplitudcs,electrotherapl, Vth dynasry(cir(a2750 BC).
perntils th-- maderD pftlctitiancr to stimulat-. the
Electricfish mav genefatccurrentsof up to 150
nervoussystem in a nuntber oi diilerent ways ta voits,but the average
currentis of the orderoi .10to
induae the selectivc pradu.tion ot vanaus 50 volls.Thesefishelrplov l\ro typesof trequen.y
monoamines. amino acicls and peptides in the 200H2or I KHz.
central ne!voussyste|f,,Ho\,rcvcr ntore expetiments Afistotlenoled the numbingeile(t of the torpcdo
ar""t-.quited to nake electratlrcrapvrealiseits true fay: thusthe Creekscallcdthis lish Narl<e,
rvhichis
p.t.,.tt.l tn ti,tttl"tnt
pJtpjt . uin
p . . i n the rool ot the tefm narcosis.Incleedtorpedo is
th
reIi -.vi nI su bstances.
derived irorn the Latjn Lorpereor sluggish.Both
Pline and Plutirch fefcr lcj lhe numbingcflectsof
t h i sf i s h .
A. 0| un. tur. i n i.ed i. it."

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ScriboniusLargus(AD 47) reportedthe case ot Electrical stimulation from non living sources
Anteros,a freedmanof Nero,who obtaineda cure Franklinism
machines
centuryelectrostatic
cominBinto contactwith in the mid eighteenth
from gout by accidentally
The
a live electricray,or torpedofish,while strollingon were usedin medicineto generatenumbness.
the beach. ScriboniusLargus advocated elec medicalpracticeof employingstaticelectricityis
troichthiotherapyfor the relief of pain in the called Franklinism. Benjamin Franklin was
following practical way that permitted the {ish to celebratedfor his couraBeousexperimentthat
survivewhile treatinSthe palienr. "For any type ot proved clouds ate charged with electricity:in
gout a live black torpedoshould, v/henpain begins, Philadelphiain 1752, he succeededin drawing
be placed undet the foot. Thepatientmust standon sparksto his hand from a key attachedto a hempen
a moist shore rrashedby the seaand he shouldstay cord, that had become a good conductor as it
Iike this until his whole foot and leg up to the knee is becamewet with rain,aftachedto a kite flying in a
numb. This takesaway the presentpain anclprevents thundercloud, the key being insulatedfrom the
groundby beingheld by a dry silk cord takenirom
painfrom comingon if it hasnot alrcadyarisen."
ClaudiusCalen(AD 131 201)wroteof his cautious his wife's wedding dressand tied to a nearby tree.
"/ While he was US ambassador
to Francehe was sent
approach to remediesbrought to his attention,
trustnone that tell of such things.until I have tried a glass cylinder that generatedsparksof static
them myself". He tried to relieve headache and electricitywhen rubbed,and treateda Sooclnumber
prolapsusani with dead torpedofish, but failedto of patients.Indeedhe inventedthe "Magic square",
to Sivepatientselectric
achievean effect.But when the {ish was applied a simpleform of condenser,
live, he found it as effectiveas any other remedy shocksfFigule 1).
that numbsthe senses.Indeedhe wrote, "Headache,
even il it is chronic and unbearable,is taken away
ancl remedied forever by a live black torpedo
placed on the spot which is in pain, until the pain
ceaies.A5 soon as the numbnesshasbeen felt, the
remedyshould be removed lestthe ability to feel be
taken from the part. Moreover sevetal torpedoes of
the samekind shoulclbe preparedbecausethe cure,
that is, the torpot \thich is a sign of beftement, is
sometimeseffectiveonly aftertwo or thtee".
The idea that prolapsusani can be treatedby
electric shock rnust be one of the first recorded
observationsthat electrical stimuli may cause
Indeeda 16th centuryJesuit
musclecontractions.
tfavellerin Ethiopianoted that an electriccatfish fi1ure 1. fn.anklin's plate ("the nasic squarc") is a waoden
newly caughtin the riversand lakesthrown on a frane containing a Elassplate with sheets of tin fail attached to
bath its sides. ]t acts as a simple fom of .:ondenser capable of
pile ol "dead" fish seeminsly caused the latter to giting
quib nron1 shocks.To charye it, one sheetof tin foil is
'l946).
cometo life (Kellaway,
placed in contact with an electostatic generatot while the tin
A 17th centurytravellerto Ethiopia,reportedhow failon the athersideis connectedto earh via a chain.
patientssufferinSthe ASue were "Bound hard to a
table, alter which the fish being applied to his joints.
Many clerics took up the method and the
causeththe most cruel pain all over his members, developmentof the Leydon jar for storing electrowhich being done the fit never returns again. A static electricity allowed them to treat their
sevete medicine which perhaps would not be parishioners
at home. Indeed Rev. John Wesley
unprclitable to those that are troubled with gout... (1759),the founder of Methodism,describedhis
Those Ethiopienswould certainly believe it who successin treatingone: "William Tyler,livin7 at the
affirm that the virtue of the fish will dispossessa Sun in Long LaneSmithfield,was on March 9th last,
manof the devil himself". it was no wonder that on about three in the morning seized with rheumatic
their return to Europe,those early travellersto pain, chiefly on his right side, so violently that he
Ethiopia, by all accounts the most exotically was helpless as an infant, and was frequently
barbarousplace on earth,found it hard to convince constftineclto shriek ou' Iike a woman in labouL I
anyoneof suchstories.
came belore nine. After the second shock he felt
However there is evidencethat electroichthio some change, after the third he was able to raise
elsewherethfouBhoutthe Middle himselfa little. A{tet tuvomore he rcse and walked
therapypersisted
i971). Indeedas late as the 16th round the room, and belorenoon he was quite easy
Ages(Schechter,
century,the haplesstorpedo was found to be and neli . We.leybelrevedelectricity\,1a\in some
efficaciousin the relief of chronic headache, sensethe spifit of Cod mademanifestout of such
headache
and vertigo.In the 17thCentury inanimatematerialsas glass.He was certainlynot
unilateral
'?
however the discovery of how to produce undulytimid in his diagnosis
and management:
electrostaticelectricity replaced the need for the Mr Creenfield was reported to be dying ... of the
livingorSanism.
gout in the stomach, but on obsetving the
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symptoms,I was convincedit was not the gout, but i n 1 7 9 6 :ne opposed Calvani'sview and felt that
the an]ina pectoris (well described by Dr Heberden electricity was not animal, but electrochemical
and still more accuratelyby Dr McBride of Dublin).
in origin.
I advisedhim to take no more medicinesbut to be
As often happens in
electrilied through the breast. He was so. The
the development of
violent symptomsimmediately ceasedand he fell
physics and medicine.
into a sweetsleep".
both protagonists were
At first,the fashionin medicalpracticefor this{orm
partly right and partly
of electricity (Seneratedby frictional machines,
wrong.
whosedevelopment
led to the Wimshurstmachine)
Electricity may well
arisefrom a non animal
Brewand was usedfor all mannerof ills including
what was then called paralysis,malcirculation
of
source such as the
body fluids, and irregular operations of the
Voltaic cell, where we
"principle of life". Needlessto say many of these
havea copperand a zinc
practitjoners
wereaccusedof malpractice
plaie dipped in a
anclcharlatanismfor theiroverstated
claims.
solution of sulphuric
Nevenhelessas the methods of producing
acid. When the two
electricitywere improved,electrotherapycontinued
plates are attachedby a
to form part of medical practice.
wire, a current flows;
there is a copious
Calvanism
evolutionof gas bubbles
Luigi Calvani, an obsietricianand anatomist,
at the copper plate and
concludedfrom his many yearsof experiments
on Figure 3. The fn* baftety ol the zinc plate wastes
the felation between biology and electricit, that Voltaic pile consists af a seies
animal electricity was the long sought after "vital al alternating discs of coppel
Yet it has beenproved
and zinc separated ton
fotce"and announcedthis in BolognaAcademyof other by cloth naistened each
in
modern times thai
with
Sciencein 1791. His experiments
began in 1786 brine. The supparts c,f the pile when brief electrical
when he stimulated
the nervesand musclesof frogs are venical calunns of glass. stimulation
by wiresfrom
with electricalcharges(Figure2) and arrived at the UnfonunaEly a npid deuease some external source
belief thai animals developedelectricitysponta ol curent occus '|ith use.
such as a Voltaiccell is
neously.
Many Iaboratories
repeated
his expefiments
applied to a nerve
and supportedhis theory of the "frog" current. As supplyinga muscle,this may causea currentto be
this type of electricityseemedqLlitedistinctfrom generatedby the nerve itselfthat can passa consideJectrostatic currents derived from frictional efable distancefrom the site of the electrodesto
machines,
it wascalledCalvaniccunent.
initiateniusclecontraction.
In honoufof LuiSiCalvani,whosework duringhis
Iife time on animalelectricitywas eclipsedby the
aristocraticVolta who had honours heaped upon
him by Napoleon for his work on electricity from
non-livingsubstances,
the use of direct currentin
medicineis calledCalvanism.
Calvanism was employed for the treatmentof a
remarkable
numberof illnesses,
and many striking
descriptionsare to be found in the literatureof the
time (seeFigure6). ln 1802, for example,Aldini
reported one of the earliest uses of electricity in
treatingseveredepressionand found that, although
the pain ofthe Calvanicshockswas hard to bear,the
bestsitefor producingreliefof depressionwas on the
headit.erf.pdrti.uldrlyo! pr rhe parietd| 'e8ion.
The first useof needlesin elecirothenpy
In the early 1800'ssomethingnew arrivedin the
method of applicationof Calvanic current in
Figure 2. Calvani connects the lumbar netues to the crutal
medicine.lesuitmissionaries
nuscle of a fros throuqh a bimetallic circuit of zinc (z) antl
in China had already
copper (c): the leg kicks oureards.
introducedthe practice o{ acupunctureinto France
in 1774. Betlioz, the composerand physician,
However AlessandroVolta of Padua discovered revivedthe methodin 1B11and broughtit to the
that he could generatesimilarcurrentsby chemical attention of Sarlandierewho in 1823 said, "All
meanswithoutrecoorse
to animaltissuesor paying lesions of motion shoulcl be treated by Franklinism
regard
to
weather.
any
the
Volta inventedone of the ancl all those of sensationshould be treated by
earliestforms of battery,the Voftaic pile (Figure3), Calvanism". He began to attach his apparatusto
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aclrpunctureneedlesinsteadof surfaceelectrodes connected to a platinum or steel needle insetted

(Sarlandiare,1825). Eventually he abandoned into, saya fibroid tumourof the uterus,or applied to
Franklinismand performedmost of his work wrth any mucous surface,and a current of 15-250mA
Calvanism.He claimed his method "lntroduces passed, tissue in coniact with the electrodes will be
shock into the very place l wish and this is able to decomposed.Owing to the extent af lhe external
modily pain, motion or capillary circulation...As l electrodeand small densityof lhe current,the result
have said, even the lightest dischargesupon the will be inappreciable,but it is very obvious at the
needle intrcduced into our tissue will cause a intenal one. Thus, if the internal electrode is
feeling of vibntion all through the sufferingpaft. lf positive, the products of decomposition will be
thispart is a muscle,one can feel, and even see,the stronBlyacid in rcaction(tuning Iitmusred),and the
contraction through the skin. Heavy discharges tissueround the electrode will be condensed,and
resull in a sort of convulsion and, by its beint contractarcund it. If the electrodeis naw negative,
suddenlyshaken in this way the netvous t'unctions the products of decomposition will be strongly
of a sufferingpartare modifiedand pain is relieved". alkaline in rcaction, and the tissuewill be rapidly
He went on to say (StiIlings,1975) that these brokenup, a loosefrcthy materialescapinghom the
experiences
reinforcedhis judsementthat the old- electrotJe,which will move freely in a sinusformed
fashionedidea that rheumatismis caused by a by electrolysis.The negativepole while liberating
humour that ought to be activelyexpelJedwas a alkalineproducts has much more marked disinte
beliefthat shouldbe releSated
to the i8norant.He BratinBinfluencethan the positive".
In order to study the electrolytic effects of a
took the rnodernview that rheumatismresidedin
some affJictionof the nervoussystem.He believed continuousdirector Calvaniccurrentemployedin
Ryo-dou-raku
alJ effectivemethodsfor the relief of rheumatism: Japanese
electroacupunctufe
devices,
"Set up other sensations,othet stimuli, which, as Solomons(1984), of the CumberlandInfirmary
of MedicaJPhysics,
demonstrated
what
they arc communicatedto the netvoussystemal the Department
when a l0 volt directcurrentwas applied
alfecledpart, act so as to alter the mode of iftitation, happened
de,ttot ng ,he p"in rfut \"rd\ .onttu tcd:
to two steel 30 gauge 1" acupunctureneedles
FranqoisMaSendie,a seJfconfessed"ngpicket in suspendedin a bath of normal saline:gas forms
science"tried io keep his observations
simpleand round both needlesat a similaf rate;the cathode
free of speculation.Not only did he clrscover
the (negativepoie) remained intact; but the anode
and
functionsof ventraland dorsalnerveroots,but he is (positivepoJe)developeda reddishprecipitare
also credited with founding the discipline of dissolvedwithin 10 minutes-Therwas a distinct
pharmacology.He too perforrnedelectroacupunc smellof chlorineabovethe bath.His interpretation
ture in the early 19th century. he mentions of the eventswere as follows: eventsat the cathoderemarkablecures, but never his farlures and both sodium and hydrogenanions are attractedto
accidents,while he boldly plungedplatinumand th cathode,but as sodiumis r.ore eJectro-positive
steelneedlesinto muscles,nervesand eventhrough than hydrogenil remainsionisedand the hydrogen
the eye-ballinto the optic nerve,and connected bubblesoff as gas; eventsal the anode - both
1826).ThisearJywofk hydroxyland chlorinecationsare attractedto the
them to a battery(Magendie,
of insertingneedlesinto the body not only laid the anode chJoridecationsare more electro-negative
for beingableto stimuiate
specificbody than hydroxylcations,but for some inexplicable
foundations
for recording
rhe electrical reasonit is the chlorideionsthat bubbleoff as Bas,
sites,but also,eventualiy,
changesin the bodt eitheroccurringspontaneouslyn c \ e n h e J c ) \t h p c h l o ' i d e . o n s d o e r a r a r r
itself.
sufficientquantityto attackthe iron in the needle
or afterstimulation
and form the reddishprecipitateof ferric (or ferrous)
chloride.
Dangercof Galvanism
Thus if we wish to stimuJatethe nervoussystemfor
But Calvanism,or the use of directcurrent,has 'ts
dangers.The dfarnaticchan8esthat occur in the any lengthof timewe mustnot useCalvanism,
as the
battery,or Voltaiccell, tend to be mirroredin the electrolytic
effectsinducedby the directcurrentwill
for destroythe tissues.Insteadwe may use Faradism,an
tissuesif the currentis maintainedcontinuousiy
any appreciable
lengthof ti.ne.Thesechangesin the interrupted
or alternating
currenralable/).
tissuesdufingthe passa:le
of directcLrrrent
are electrophoreticin ofigin:for exampleNiemeyer(1859)
describeshow continuousdirect currentproduces:
"A stronq erythemaand an increasein volume ol
= electrostatic
FRANKLINISM
subcutaneousareas,but in addition,especiallyat the
CALVANISM = directcufrent
(interrupted)
negativepole, weals and patchesof rash develop, FARADISM = altefnating
current
the surface of which is covered with a slough".
Theseirreversible
necroticchangespfoducedby
in Victorian Fandism
Calvanismwere employeddeliberately
limes to destroy tumours: 1l a broad surface- Michael Faraday11791-1867)
employeda Voltaic
electrode be applied to any part of the body and pile, composedof sevenhal{pence,
sevendiscsof
connected to one pole, and the othet pole sheetzinc and six pieceso{ papermoistenedin salt
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IT SHOULD
BE IN EVERY IIoME
water. This source of electricai power was
invaluable
to him for his experiments.
Faradaydiscovefedthat the flow of electricity
could be induced intermittentlyin alternate
directionsin anothercircuitnot actuallyattachedto
t l _ "r o l t a r ,p . l e .H F , o r n F 't p d d n i ' 1 r e ' o rp r i - d y
coil of wire to his VoJtaicpile, and as soon as the
circLritwas switchedon eJectricity
flowed in one
directionthroughan outeror secondary
coil of wire
(not connectedto the first).This effectbecamemore
noticeableif the primarycoiJwas wound roundan
iron core.When the primarycurrentwas switched
off the cunent in the secondary
coil flowed In the
oppositedirection.Again, if the primarycoil was FiBurc 5. Lindstron's Elect.o Medi.al Appatatuswas widely
suddenlyremovedfrom the secondary,
a flow of use.litl thc mklwestUSAarcunri 189.1.
currentoccurred;but when the primarycoil was
relurnedto its originalposition,the flow of current In I857 an Americanphysician,
Professor
Oliverof
occurredagain in the secondarycoil but if the Buffalo,employedan inductioncoil in this manner:
opposite direction. Currents could be induced in order to form an electrode, he insertedtwenty
whenevertherewas relativemovementof a circuit loops of continuousuninsulatedwire into a wet
and a magneticfield. Furthermore
the differencein three inch bandage;he applied two bandage
currentstrength
one 3" aboveand the other3" belowthe
betweenthe innerand outercrrcurts electrodes,
could be determinedby the numbersof turns of regionof a leg that he wishedto operateupon. He
\,\,ire:if therewere many more turnsof wire in the setthe levelof currentto producea gentJyquivering
outer circuit as comparedwith the inner,then a movementof the patientt musclesfor a periodof
Breatercurrent would arise in the outer crrcuit five minutes,at the end of whjch time the professor
wheneverthere was any rnovementbetweenthe could cut roundthe edgeof the ulcerthat he was
two coils.
attempting
to removeand when it bled he was able
By this meansFaraday
established
the possibility
of to use scaldingwater which would have caused
inducingpowerfulcurrenLsof alternatingpolarity severepain, but was not felt at all. Although
using a felativelyweak direcl currentsouTce.For analgesia
to cuttingand heatwas producedin this
medicalpurposesthe Du Bois Raymondinduction way, Oliver repofted that it did not completeJy
coil offeredthe meansby which the distancemoved abolishtemperature
sensation.
In 185B Francis(a little known physicianfrom
by the outef coii in relationto the innercoil could
performed164 toothextractions,
be controlled,so that the strenBth
of the alternating Philadelphia)
with
electricalimpulsescould be carefullyregulatedThe the patienthoJdingone poleof the secondary
circuit
medicaluse oI such machinesis called Faradism and the extracting forceps attached to the otherl
(Figures4 and 5), and the stimulationemployed is patientscornplainedof a good deal lesspain than
anotherBroupattachedin a similarwa, but with
calledFaradic.
the prirl-lary
circuit not switchedon. Althoughhis
results could not be
repeated by the local
committee of dental
surgeons,his techniqLre
spreadfar and wide and
variousmodificationsof
the oriSinalapparatus
are
stillemployedtoday.

litdsfEo-g*

Fiqurc 4. This nedicai nduction coil was used for pain relief in
Englandin the mid nineteenth.entury. lt prcvided a rapid,
continuoustrah of snall electri.al pukes, similat ta a modenl
trcnsculaneous eIectr i caI nerve stitn uIatoI

Diff i cultie s faci ng the

ea y pioneers of
fi\ure 6. Ihis early electticaj Faftdism
tteatment for toothache was In ofder to employthese
The advantageof this method is that provided the used in Pais by PN Bertholan. techniques, the early
pulsewidth of each impulseis lessthan lmsec,
pjoneershad to controJ
there is insufficienttime for the tissuedestructive the intensity and frequency of the firing
electrolytic effects to develop, and when the of theirinductioncoilsmostcarefullyto producethe
directionof the currentof eachimpulseis alteredon desiredanaestheticeffects.
eachoccasionthe electrolyticeffectsare in any case We now know thatthereare a remarkable
number
feversed.
So stimuJation
may be continuedindefi of intensity and {requency dependent systemsior
nitely without any ilJ effects produced by relievjngpain. Fof example:Chung er a/. (1984)
etectrorysrshave shown that at low frequency (2Hz), if XmA
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to obtain good
intensityis requiredto exciteA/l fibres,2xmA will must have been very considerable
begin to recruit Ab fibres, and l020XmA is results.So the usesand advantaSesof electroanalat gesia had to be "re-discovered"many tirnes in the
requiredto fire AB, Ab and C fibres.Stimulation
high {requency (80-100H2),just sufficient to nexthundredyearsor so.
In 1870,for example/Arayaworkingin Chile not
firesAB fibres;as
produces-.nsation
only,selectively
Ab fibres are unable to respondto frequencies only discovered anaesthetic effects of induced
sleepinducingeffects
but alsoinvestigated
h;gher than 50 BoHz. AB fibres fire at all currents,
placed
when
the
electrodes
were
on the neck or
the
hrghc.tbeingapprorr.eqJen,ipqlorl ard h eh
i.nately800H2);while the highestrateof firinSof Ao crantum_
was re50-B0Hz,and C fibresare unable The sleepinducingeffectof electrotherapy
is approximately
(1902):
Stephane
Leduc
he
usually
periods
of time at explored by
to fire except for very brief
a
current
interrupted
at
a
frequency
of
frequencieshiSherthan 2-'loHz. As we will see, employed
(Figure
per
second
7).
When
the
produce
100 cycles
of stimulationmay
varyingthe parameters
were placedoverthe craniumin rabbits
electrodes
a numberof differentanalgesiceffects.
pioneers,
whcr and dogs, not only was sleep induced but
But this was not knownto the early
in the body as well. Howeverthis forr.
the intensityto try and anaesthesia
might well have increased
was not entirely ffee of side
at a frequencylow of electronarcosis
obtainmoreefectiveanaesthesia
The
method
itselfwas painful,and apnoea,
pain
by firing A3 or even C effects.
enoughto produce
arrest
and
convulsions
were common. In
fibres, or they may have employed so high a cardiac
"nightmare"
hLrrnan
a
state
was reported,
subjects
frequencythat even AB fibres were unable to
pain
where
the
subject
was
aware
of
withoLrtbeing
respond.
to
react
to
it.
able
Scepticism
Thus there were rnany scepticswho had not
of stimulattonlor
employedthe ideal pafameters
their patients. Indeed in 1B5B there was an
interestingmeeting between a sceptical physician
who demandeda demonstration
called Richardson
Althaus
by Althaus,a prominentelectrothefapisl.
E
ulnar netveat the erDowilt
stimuJated
Richardson's
(!)
ol the rnuscles c
a high frequencyuntil contractions
graduallyaccommo
wete "animated";Richardson
dated to the stimulusand the intensitycould be
stfonBflexionof the
increased,
eventuallyproducinS
was
3rd and 4th fingers-At intervalsRichardson
testedwith electricshocksalongthe courseof the figure 7. Thecurcntfom usedby Leduc.
to a
ulnarnerveand graduallyhe becameinsensible
at High fiequency penetntion of tissue
shockthat would have been quite unendutable
also The idea of inducing sleep by transcutaneous
the beginninBof the experiment.Richarclson
at the tips of the cranialstimulationwas continuedby the Russians
mentioneda feelingof numbness
to
3rd and 4th fin8ersand that he did not feel the (Anan'evet a/. 1960).Howevertheyendeavoured
"interference"
means
stirnulate
the
btain
by
of
board on which his fingersrested.Therefotethe two
doctors concluded that the direct reduction in currentsgeneratedby tlvo oscillators(Figure8), one
of the ulnar nervehad beenachievedby at a frequencyof 4200H2and the otherat 4000H2,
sensitivity
in the skinwas not producinga beat frequencyof 20OHz li.e. 4200
but thatthe numbness
electricity,
ot
of supplyo{ the minus4000).The ideaof usinghigh frequencies
cor.pleteas therewas overlapping
penetration
current
this
kind
was
to
obtain
deeper
of
radialand mediannerves.
from the surfaceelectrcdes(Kuzinet al.. 1963).
The humanorganism's
impedanceto the passage
waxing and waning of fashion for electrctherapy
an
alternatinB
cunent
is largely capacitive.
of
The initial {avourabletide of electrotherapywaned,
proportional
lmpedance
is
inversely
to frequency
probablyas a resultof the followingfactorstno one
(where
Xc is the
to
the
formula
Xc=1/2nfc
according
at that time couldexplainhow the methodworked;
frequency
and C is
impedance,
f
is
body's
capacitive
the difficultiesand cost in producing reliable
Thus
high
in
Farads).
the
body's
capacitance
the lackof knowledge
machineswere considerable;
penetrate
the
body
better
frequency
currents
of the ideal stimulusparametershas been conected
only in the pasttwo decadesby neurophysiologicallnan row.
"interferential
experimentsboth on man and animals;and even This concept is employed in
now in clinicalwork, the ideal locationor size of clevices" used in physiotherapy (Laycock et a/.
electrodeshas not been established.Bearingin l98B). Here two paifs of surfaceelectrodesare
mind all these deficienciesof knowledge,the employed.Eachpair is placedon oppositesidesof a
areattached
to locationson the
amount of time taken to experimentwith each Iimb.Theelectrodes
of
a
horizontal
section
of
the limb,with the
surface
patientto discoverthe ideal methodof stimulation
Acupuncturein Medicinc

Nav 1993 Val 11 No.2

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and possiblyC fibres,one could readilyperform

deepelectroacupuncture
in this way without needles.
Anotherhigh frequencymethodrequiresonly one
s;gnalsource.Stinuset a/. (1990)describes
the use
ot AimC Limoge's intermittenthigh frequency
current designedto penetratethe brain from two
surfaceelectrodes(Figure9). Herc a high frequency
of 166KHzis appliedin 4msecburstsat a repetition
rate of 100H2.This form of stimulationis painful
however,and is usually applied during general
anaesthesiato potentiatethe effects of opiates to
relievepostoperativepain.

Figute8. Kuzin'slnteiercncecu ents(Kuzinetal.1963).

a.lnteferencecurrentforn employedby Kuzin'sGam.
b. Schematic representation af Kuzin's high ftequency cuffents
praducin\ a 2A0Hz frcquency inteierence current in the brain

RegionaI eI ectroanaI gesia

Howeverone does not haveto Bo to such elaborate
lenBthsto provide currentsthat penetratetissue to
produceperipheral
pain relie{.In 1892 the Thomas
producedequipmentfor inducing
EdisonIaboratory
peripherallyduring painfuloperations.
anaesthesia
(1906),useda 100H2
A lady surgeon,Robinovitch
curfentwith a wide pulsewidth of l0msecsand 40
volts to produce sufficient anaesthesiator several
-aior lower le8 amputdiions
\^hen the ele.trodc*
were placedon the appropriatenervesto the leg.
Thompsonand Inman(1933)usedthe electrically
induced anaesthesiaphenomenon to explore the
distributionof cutaneousne|Ves.They appliedthe
electrodesto particularcutaneousbranchesot
peripheralnervesin the forearmand mappedthe
areasof insensitivity.
Followingthis work, Parafin
1948 reportedsuccessful
therapyin 127 patients
suffering
suchconditionsas sciatica,lumbago,postherpeticneuralgia
and tic doloureux.

Gate Control theory of pain

Meanwhile in recent times, the effects of
electroanalgesiaor anaesthesiawere reported by
axisof one pair beingplacedat a rightangleto the Wall and Sweet (1967) and Wall (1982).While
otherTwo oscillators
delivercurrentsof trequencies mowing a lawn with a large motor mower, Wall
highefthananythinSthe nervoussystemcan follow, noticedhis handshad becomenumb to pin prick.
for example2000 and 1900H2.Where the t\,vo He surmisedthat the vibrationhad fired his ,48
currentsmeet deep in the tissues,the discrepancy fibresand that this had somehowraisedhis pain
(i.e.2000 minus1900) threshold.Wall and Sweei(1967)insertedneedles
the tlvo frequencies
betlveen
causesa 100H2 "beat" or interferencefrequency. into a patienfssupratrochlear
nerveand stimulated
Thisbeatfrequencyis usuallyintendedto stimulate it at 100H2,which would exclusivelyfire the AG
AB fibres lyinB in the deep tissues.Howeverby fibres. This indeed produced anaesthesia.
Work of
reducingthe discrepancybetween the frequencies this kind Baveriseto the CateControltheoryof pain,
the amplitudeto recruit46 whereactivityin C fibresopensthe pain gatein the
to 2Hz and increasing
spinalcord,and activiiyin theAB fibresshutsit.

4m sec

6m sec

Figue 9. ln Linoge's tanscranial stinulation, 4msec hiqh

lrcquency bursts af t66kHz arc applied at a rcpetition ."te of
IOAHZvia two electrades(Stinuset al.1990).

Nov1993val 1t No.2

IfNS
To avoidthe inconvenience
and possiblecomplications of inseftingneedles into nerves, surface
electrodes were employed - hence the term
(Electrical)
Transcutaneous
Nerve Stimulation(TNS
or TENS).The optimum size for the electrodesis
currentlythoughtto be 4 x 4 cm. Anythingsmaller
was thoughtto run the risk of increasingcurrent
densityand producingburns.Anythinglargerwould
exhaustthe batteries,as it was very quickly found
that mostpatientsceasedto derivepain reliefwhen
the stimulator was switched off. Thus probably a
Acupuncture i n Medi cine

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in thisfashion. Dorsal CoIumn StimuIati on

few hundredA/Jfibresarestimulated
the numberof Af fibresbeing
The usualTENSmachinedevelopsa monophasic In orderto increase
Shealyet al. (.1967)insertedelectrodes
pulse,whosewidth can be variedfrom stimulated,
rectangular
employinga currentwhoseamplrtude into the spinal canaJ to stimulatethe dorsal
0.1-0.5msec,
be
increased
from 0-50mA, and whose columns-Thesearetractsin the spinalcordthrough
can
which all AB and many Aa fibres pass-Thus the
frequencyis generallyB0 or 100H2(Woolf,l9B4).
To maintainclosecontactbelweenan electrodeof bare tips of otherwiseinsuJatdwires stimulate
of A/Jfibres.This is called Dorsal
4 x 4 cm on vafious pafts oi the body, the material many thousands
and has becomean accepted
chosen for the electrodeshould be sufficiently ColumnStimulation,
past 25 years
malleableto confirr. well with a whole varietyof method of pain relief
_loover the
(Krainick
et
a/.
I989).
irnplant
the
wiresrequrres
stimuJation
has
to
be
contours.
As
the
body
maintainedfor long periodsof time (on average40 rnajor surgery:the neurosurgeonoften having to
haveto remainin situ femovelhe spinal laminaeto ensurethe corfect
hoursa week),the electrodes
patient
moves
about.The modern locationof the tip of the wire;and the patientrunsa
when
the
even
electrodeis made of siliconerubber impreSnated long term risl<of sepsis in the fegion of the
with carbon particles. This substancehas a implantedwire and inductioncoil or stimulator.
Nevertheless
th;s techniquedoes produce more
resistivity
of 10 ohn-rskm.
to eifectivereliefthan TENS,as many more ,46 fibres
The vexed questionof siling TENSelectrodes
obtain the optimum effect has not yet been settled are firedIn a reviewof the effec- lndeedthe dorsalcolumn stimulationmethod is
for the majorityof patients.
tiveness
of TENS(woolf, 198,i),the mostconvincing beingemployednot only for sornaticpainwherethe
pain relief occurred in patientsonly when the nervoussystemis intact,suchas severeback pain,
sourceof the pain was clearJyknown, /.e. in the but also for neurogenicpain,wherethe centralor
nervoussystemitselfhasbeendama:led.
pain and otherforans peripheral
management
of post-operalive
peripheral vascular disease is
In
pain,
addition,
some
specific
muscuacute
trauma,
labour
of
by thisform of stimulation.
Not only is
loskeletaldisordersand variousnerve injurjes.In ameliorated
ulcer relieved,but healing
these casesthe eiectrodescould be placedwith lhe pain of a cutaneous
some confidenceover the correctneryesupplyto takes place more rapidly.Visceralpain such as
anginahasalsobeenmanagedjn thisway; hereit is
the sourceof the pain.
Bul in the rnajorityof patienlssufferingchronic believedihal nol only is the pain relieved,but the
pain,for exa..ple,no one is sufeof the exactorigin coronary perfusion is also improved by such
of the pain: in many casesthe tenderregiontound stirnulation.
palpationdoesnot even share Dorsal Colur.n Stirnulationwould be practised
by the practitionef's
nerve
supply
as the areaof refenedpain. much morereadilyif it did not requireneurosurgical
the same
rhe
disappo;ntingly
low successrateof the techniques.
Indeed
^
.
p
t
h
o
d
t
r
e
i
n
r
e
l
i - f 6 f , h l q nr p a i r i s
ILN\
practitioners
many
to be due in large M odem electroa cupu nctu r e
believedby
the
inaccurate
location
of the electrodes. Unknown to the West, the Chinese were
measure
io
patientsderive investigating
ln I965 Professor
electroanaJgesia.
show
that
only
40%
of
Most studies
used
rather
simpledevice
Han
in
Beijing
a
kind
relief
from
the
method.
any
of
iisheng
(at
plugged
frequency
patients
relief
into
the
mains
a
of 50Hz),at
study
of
who
do
derive
A lon8term
palients
higher
than
his pain
intensities
considerably
that
only
37olo
of
these
from TENSshowed
(johnson
his
left
thumb,
to
inducea
1991).
threshold
in
the
region
of
more
relief
er
a/derive 60% or
generalised
The
analgesia
all
over
the
body.
Chinese
was
rapid
in
onset:
75%
of
responders
Pain relief
at
low
frequency
95%
workers
found
that
stimulation
analgesia
wjthin
30
minutes,
and
developed
had reliefwithin 60 minutes,howeverpain tended (ideally 2Hz) and high intensity(close to pain
stimulated
not only ,46and ,44 but alsoC
was discontinued. tolerance)
to returnrapidlyafterstirnulation
painful
post-TENS
fibres.
This
stimulus
appears
to raisethe pain
lasted
less
than
30
Indeed
analgesia
two
threshold
ovef
wide
regions
of
the
body
to produce
an
hour
in
337o
and
over
minutesin 5lo/o,over
patients
Lrndergo
reliet
the
enough
analgesia
for
11%
of
to
To
achieve
a
continuity
of
hoursin 20%.
lorms
40
surgery
in
the
conscious
state,
altholrgh
other
was
applied
on
average
TENS rnethod
including
of
support
were
ernployed
as
well,
opiares
hoursa week.
Although the TENS method is painless and drd .o,rl dnde.r'le\idKJadaet a/. ,l-4t.
reasonablywell acceptedby patients.lts main The mechanismof acupunctureanalgesia is
are that it tendsto producea short- different from the Western approach to elecdisadvantages
- rarely lastinilmore than 5 hours troanaesthesia.
Acupunctureanalgesiatends to
lived analgesia
produce
generaiised
a
risein painthresholdall over
is
discontinued;
fufther.nore
the
afterthe stimulation
the
bodyi
this
effect
takes
20-40 minutesto develop
is
to
the
stianulated
area of analgesia confined
lasG
minutes.
Acupuncture
analgesia
may be
patients
have
many
tender
fe8ions
and
90
region,so
who
pain
by
naloxone,
which
implies
that
the
they
have
several
blocked
are unable to benefit unless
inhibitory
effects
of
the
centfal
nervous
system
stimulators.
in thismanneremployopioid neurotransstirnulated
A.upuncturc in Medicine

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mitters,i.e. 8-endorphinand Met-enkephalin,

that
With this in mind, we should continueexperiact on p and d receptofsrespctiveJy.
r.entingwith furtherstepsforward in the fieJdof
In conlrast,
as we haveseen,the low iftensity,high eJectroanalgesia,
particulafJy
in developingmethods
frequency Western TENS method applied to that can be conveniently
practised
by the patientat
peripheralnervestendsto producea much more honre,not only to augmentthe effectsor exrsLrng
localisedanalgesiceffect which tends not to be analEesics,
but also to producelastingrelief in its
blocked by naloxone.A non opioid neurotrans own right.
m i l r . r i r d l $ o r k h ' r e . o r o b a b ' 1g a m m aa r i n o
In Faraday's
words in lB3l, experimenters
in this
butyricacid,CABA(Duggsnel a/. I985; Thompson, difficuk field are recommended to: "Pursue the
19BB).
inquiry zealously yet cautiouslv combining
Howeverthe two systemsof pain inhibitionare experitnent with analo?y, suspicious ot' theil
weJl integraiedwithin the centralnervoussystem preconceivednotions,paying more respectto a fact
and it is quite possibleto imagine methodsby thana theoty,not tao hastyto generalize,and above
which one could stirnulate both systems all thnb' A;ltinB dt a\e!t Jcp ,o , ro:,-errmine
simultaneousJy.
their own opinions, both by reasonin7 and
For example,by increasinS
the amplitudeof high experiment,no branchof knowledgecan aflord so
irequencyl00Hz stimuJationso that it becomes fine and ready a field for discovery as this".
painful, Han et al. 1.1992)
have shown that high
dosesof naloronecan blockthe analgesia
produced
Alexander Macdonald MB BS DLO
in this way.Theyshowedthatthe reasons
why high
2 3 Chatles Place
dose naloxone is required is that this form of
BristolBSB4QW
stimuJationreleasesdynofphin, which acts on
l< receptorsthat are relativelyJesssensitiveto
nalorone blockade than the p and d receptors.
Han's meLhod,employing3 secondsof low (2Hz)
foilowed by a 3 secondcycle of high frequency I A n a . e v M C , C o u b e v al W C l r o v a E V K a s c h e v s k aLi aA ,
L e v i t s k a iLaA , K h l d y i Y ! B ( 1 9 6 0 )P r e l i m i n a rdya t ao n e l e c
1100H2)srimulation,has been incorporatedin a
t.onarcosis iduced with apparatls of scienrifc research
commercially available device called HANS
lnsiitutcot experimentals!rgica apparatusand instr!merG.
\Therapy+ PIusLtd, PO. Box6, Heaton, Newcastle
upon-TyneNE6 lHU). fhis device stimulatesthe 2 C h u n g j M , L e e K H , H o r i Y E n d o K , W i l l l s W D ( 1 9 8 4 )
F a c t o bi n f u e n c i n gp e r i p h e r an c N e s rm ! l r r i o n p r o d ! c e d
produciionof rnetenkephalinand dynorphin in
i n h i b t i o n o f p r i m a t es p n o L h a n r i c r r a d . e l l s . p a t r . / 9 :
manyseBments
of the spinalcord.
2 7 79 )
Akhoughthe acupuncture
analgesiamethoddoes 3 . D ! 8 E a n A W F o o n g F W ( 1 9 8 5 ) B i c u c u l l n ea n d
spindl
produce more widespread analgesia, lasting
i n h l b i t l o np r o d L r c ebdy D o r s a lC o l u n r nS t i m u l a t i o inn t h e
somewhat longer than TENS, its applicationis
.at. Pain.22: 249-59
painful in a way that n ost Westernpatientsfind 4 . H a nJ s , W a n sQ ( 1 9 9 2 )M o b i l i z a t i oonf s p e c i f i cf e l r o p e p tides by priphera nimulation of identified frequen.iet.
ratherdifficuitto accepl.
Newsin Physlalo1i.alS.iences.7: 176 ao
5. Johnson
M l , A s h t o nC H , T h o m s p o lnW ( 1 9 9 1 ) A ni n d e p t h
study of long'term usen of transcutirneous
n i m u l a t i o n{ T E N S )l.m p l i c a t i o nlso r c l i n i c a l! s e o f T E N S .

Theneed for a more convenientmethoclof

obtaini ng electaanalges i a
Althoughgreatstepsforward have been macteIn the
reliefof many painfulconditionsby meansot elec- 6. Kaada 8, Hoel E, LsethK, Nygaard,Ostby8, setekleivJ,
) c ! p u i c t u r e a n a l g e s i ai n t h e P e o p l c t
S l o v n e rJ ( 1 9 7 , 1A
trotherapyover the pasttwo centuries,
we stili do
R-"publicof China. Tidsskriftfor Den NarskeLaegeforeninB.
not have a convenientlyapplied,painlessmethod
91:117-42
giving long lasting relief for patientswho have 7. Kc laway P {1946) The part playd by e ectric fish in rhe
eary history of bioelectrlcityand eleclrotherapy.Aul/ H6r
sevelal large areas of pain caused by such
commonlyoccurringconditionssuchas generalised M e d .2 A : 1 1 2) 7
8 . K r a i n i c kI U , T h o d e nU { 1 9 8 9 )S p l n a .l o r d n i m l l a r i o n .I n :
osteo or rheumatoid
arthritis.
wal PD, Mlzack R, edt. Ihe Iextbook ofPain. Chlrchi I
At pfesentdrug regimensare usuallythe only
Livingstone,Edinburghi920-4
practicalanswerfor patientswho haveseveralpain 9 . K u z i nM l , Z h u k o v s k iVy D , S a . h k o vV ( 1 9 6 3 )T h e l s e o f
i n t e d e r e n cce! t r e n t s n t h e c o m b l n e dp r i n e l l m i n a t o ni f
sites;unlessthey are able to find or afford the
s!r8ical
operations.Exp.Chit. Ansthesiol.5: 57 61
pfactitioners
physical
services
of
skilledin
medicine
li). Laycock l, Creen Rj (1988) Interferenrialrherapy jn the
techniques that affect the nervous system in a
rreatmentot incontnence.Physiothezpy.71: 161 I
varjety of long-lastinBways such as steroid 1 1 .L e d l c S ( 1 9 0 2 )P f o d l c r i o no f s l e e pa n d g e i e r a ta n d o c a l
injection,
manipulation,
massage
and acupunctuTe.
anaestheslaby intermittentc!rrent of low vo lage. A..h.
cl'Ele.tti. Me.l. 10:617 21
As far as drugtherapyis concerned,
manypatients
l2.Limoge
A 11975) An intadu.tian to electrcanalgesia
provide
find simple analgesics
inadequaterelief.
UniversityParkPre$, Ba timore
Althoughdoubtlessthey would derive adequate l l . M a g e n d i eF ( 1 8 2 6 1
O n e r l v a n l s mw, i r h o b s e r v a r o t o
r sn / r ,
relief from morphlne, few patientsor practltioners
chemicalprcpeftiesand medialefficacy in chrcnic disease.
are keen on ils Lrsein benign conditions.Many
patientsdevelop serious side eftects to the non- 1,1.Niemeyer P (1l859) Uber die electrjsche Behandtuns
If ara.l isatio n). Lebziu
anti infJammatory
groupof drugs.
steroidal,
No\ t99) Wl 1l Na.)

Acupu nctute in Medicine

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15. RobinoviichLG {1906)SommeilE/eclriqre.Nantes

l6.Sarlandiere JB 1182s) Mdnaircs sLtr l'Hectrcpuncturc
ConsidereecommeMayen Nouveaude Taitet EllicaceneDt
la Goulte, les Rhunlatisnes ei /es Affectlots Nerueoses.
New vo.k
I T.SchechterDC (1971) Origins ot Eleclrolherapy.
statelounal of Medicine-71:1ao2-B
lS.ScriboniusLarSus(.U) De CanpositianesMedicae
1 9 . s h e a l y C N , M o r t i n r e rj T , R e s w i c ki ( 1 9 6 7 ) E l e c t r i c a l
i n h i b i t l o no i p a i n b y s t i m ! l a t i o no f t h e d o t s a l c o u m n :
prellminarycl nical reports.Araesthesi,ard Analaesia.16i
149-91
2 0 .S o l o m o n(, l 9 8 4 )p e r o n a lc o n r m u n i c a t i o n
2 l . S t i l i n g s D ( 1 9 7 5 )A s u r v e yo l t h e h i s t o r yo f e l e c t r c a l
srimuiationfor pain to 1900. Medical lnnrumentation.9:
2 5 59
2 2 . S t i n l sL , A u r i a c o m b eM , T i g n o lJ , L l n r o g eA , L e M o a M
( 1 9 9 0 ) T r a n s c r a n i ael l e c t r i c a l s l i m u l a t i o n w i t h h i S h
potentrates
opraletrequencyintmlttent curre.l (LimoSe's)
inducedanal8esia:blind studies.PaiD.12: 3s1-63
2 l . T h o m p s o nl M , l n m a n V I ( 1 9 1 1 )A m e t h o do f o u t l i n i n g
cutaneousnervearea5.S.leDce.77:216 7
2 4 . T h o m p s o nl W ( 1 9 8 8 ) P h a m a c o l o g yo i t r a n s c l t a n e o ! s
electrica nervestimulation(TENS)./rrra.rable Prnr Socieiy.
7:33-40
sclrica
y f t r a n s c u t a n e oeu e
2 5 . W a l l P D ( 1 9 8 7 )T h e d i s c o v e r o
nervestimulation.l. Ordropaedic Medicine.3 : 26-a
W H ( 1 9 6 7 )T e m p o . a rayb o l i t i o no f p a i n n
2 6 . W a l lP D , S w e e L
m a n .s . i e r c e . / 5 5 r 1 0 8 9
27.Wesey J (l759) The Desideratum:ar, electri.ity nade Plain
and uselul,by a lover of mi\nkindand of connon sense.
28.Woolf Cl (1984) Transculaneo!sand imp anted nerve
srimulation.ln: Wall PD, Melzack R, eds. The lextbaok ol
P a i n c. h ! r c h i l l L i v i n g s t o n E
e ,d i n b ! r g h6: 7 9 - 9 0

H. A. N. S.
Han's Acupoint & Nerve Stimulator
modelLY257

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'causeyou can
smell when it's
leaking."

Acupun cturc i n Me.li ci n e

Downloaded from http://aim.bmj.com/ on August 26, 2016 - Published by group.bmj.com

A brief review of the history of electrotherapy

and its union with acupuncture
Alexander J R Macdonald
Acupunct Med 1993 11: 66-75

doi: 10.1136/aim.11.2.66
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http://aim.bmj.com/content/11/2/66

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