eligible patients were those who referred to the xi jing hospital ( xi'an , china ) between october 2005 and february 2006 . patients taking anxiolytic herbs , having history of psychiatric illness or prior acupuncture experience were excluded . all patients participating in this trial were asked to sign a committee - approved consent form confirming that they understood the goals , risks , and potential benefits of the study and their rights to withdraw from the study at any time . subjects in this group received ear acupuncture in the point named shenmen , which is at the superior aspect to the bifurcating point between superior antihelix crus and inferior antihelix crus . subjects in this group received acupuncture in the points of baihui , four god 's cleverness , great rush and zu san li . baihui is located in the midpoint of connecting line between top of two ears on the head . four god 's cleverness has four points and each one is one inch apart from baihui . great rush is located in the back of foot and the valley of first metatarsal , and ophryon is located in the middle of two eyebrows ( figure 2 ) . 2a is baihui point and four god 's cleverness ( marked by black triangle ) , 2b is ophryon point , 2c is great rush point , and 2 d is zu san li point . anxiety symptoms were assessed using a translated and validated version of the zung self - rating anxiety scale ( sas ) . the scale is a well - known self - rating scale used worldwide for the measurement of anxiety . a subject with a sas score below 50 is considered normal , while a score of 50 or more is considered to be indicative of existence of anxiety . the scale has been verified as valid and sensitive measurement for clinical severity and research instrument . before recruitment , all patients completed sas and those who scored above 50 were selected for being acupunctured . of the ear acupuncture group , 11 were women and seven were men , and the mean age was 41.2  10.1 years ; of the body acupuncture group , nine were women and eight were men , and the mean age was 47.3  8.9 years . thus after the acupuncture treatment and before surgery , 32 patients of the two groups completed the sas for a second time . in the acupuncture treatment , patients were needled with 25 - 40 mm long needles which were 0.25 - 0.30 mm in diameter . for each subject of the two groups , duration of acupuncture therapy was four weeks ( two sessions per week , eight sessions in total ) . during treatment , among the auricular acupuncture subjects , the needles were inserted into the shenmen point , which is located in superior lateral wall of the triangular fossa , and the depth of insertion was about 0.2 cm . for the body acupuncture group , the needles were inserted into above mentioned points and the insertion depth was nearly 0.5 cm . the matched pair t - test was used to assess the statistical significance differences in the pre- and post - treatment scores . eligible patients were those who referred to the xi jing hospital ( xi'an , china ) between october 2005 and february 2006 . patients taking anxiolytic herbs , having history of psychiatric illness or prior acupuncture experience were excluded . all patients participating in this trial were asked to sign a committee - approved consent form confirming that they understood the goals , risks , and potential benefits of the study and their rights to withdraw from the study at any time . subjects in this group received ear acupuncture in the point named shenmen , which is at the superior aspect to the bifurcating point between superior antihelix crus and inferior antihelix crus . subjects in this group received acupuncture in the points of baihui , four god 's cleverness , great rush and zu san li . baihui is located in the midpoint of connecting line between top of two ears on the head . four god 's cleverness has four points and each one is one inch apart from baihui . great rush is located in the back of foot and the valley of first metatarsal , and ophryon is located in the middle of two eyebrows ( figure 2 ) . 2a is baihui point and four god 's cleverness ( marked by black triangle ) , 2b is ophryon point , 2c is great rush point , and 2 d is zu san li point . anxiety symptoms were assessed using a translated and validated version of the zung self - rating anxiety scale ( sas ) . the scale is a well - known self - rating scale used worldwide for the measurement of anxiety . sas consists of 20 items covering affective , psychological , and somatic symptoms . a subject with a sas score below 50 is considered normal , while a score of 50 or more is considered to be indicative of existence of anxiety . the scale has been verified as valid and sensitive measurement for clinical severity and research instrument . before recruitment , all patients completed sas and those who scored above 50 were selected for being acupunctured . of the ear acupuncture group , 11 were women and seven were men , and the mean age was 41.2  10.1 years ; of the body acupuncture group , nine were women and eight were men , and the mean age was 47.3  8.9 years . thus after the acupuncture treatment and before surgery , 32 patients of the two groups completed the sas for a second time . in the acupuncture treatment , patients were needled with 25 - 40 mm long needles which were 0.25 - 0.30 mm in diameter . for each subject of the two groups , duration of acupuncture therapy was four weeks ( two sessions per week , eight sessions in total ) . during treatment , among the auricular acupuncture subjects , the needles were inserted into the shenmen point , which is located in superior lateral wall of the triangular fossa , and the depth of insertion was about 0.2 cm . for the body acupuncture group , the needles were inserted into above mentioned points and the insertion depth was nearly 0.5 cm . the matched pair t - test was used to assess the statistical significance differences in the pre- and post - treatment scores . the sas score changes before and after acupuncture treatment of two groups are showed in table 1 . for the auricular acupuncture group , the mean score of sas was 57.57  8.22 before the intervention and 46.32  6.37 after - ward . for the body acupuncture group , the sas score was 55.39  5.41 and 44.82  6.76 before and after the intervention , respectively . for both groups , the difference between pre - and post - treatment scores reached the significant level ( p = 0.00 ) . however , the reduction of scores of the two groups was not significant ( p = 0.24 ) . acupuncture is one of the effective chinese medical treatments and has been used widely for treating anxiety disorder ; in some studies preoperative patients reported significantly lower levels of anxiety after receiving acupuncture.1517 although the mechanism of treating anxiety with acupuncture is not clear till now , more and more evidences have suggested the effect of acupuncture in anxiety treatment . from chinese medicine view of body acupuncture , bihui is also named  three yang and five gather  , and using the acupuncture on this point is for increasing lucid yang qing and tranquilizing by nourishing the heart ; hegu is meridian of hand - yang ming and using acupuncture on this is useful for waking up a patient from unconsciousness . inner pass and four god 's cleverness are useful for calming the nerves , and food three li is effective in brooding chest and regulating qi . so acupuncture on these points can relieve the anxiety and reduce the syndrome to some extent . results showed that both of the acupuncture treatment methods had effect on decreasing anxiety in preoperative patients . at the same time , the difference of reducing anxiety level in the two position acupuncture did not reach statistically significant level . such results might suggest that both of the acupuncture treatments can be chosen equally when needed . however , compared with the body acupuncture , the auricular acupuncture can be mastered easily by acupuncturists and may be more acceptable for patients . sw and jl carried out the design , coordinated the study , and wrote the manuscript . xz provided assistance in writing the paper . dm provided suggestions for the design and writing of the article .
background : preoperative anxiety has become more frequent in preoperative patients and can bring negative impact on operation outcomes . 
 many studies have reported the effect of body acupuncture in reducing anxiety syndromes . 
 the aim of this study is to compare the treatment effect of body acupuncture and auricular acupuncture in preoperative patients with preoperative anxiety.methods:thirty five elective ambulatory surgery patients were selected in the randomized and blinded trial . 
 subjects were randomly categorized in two intervention groups , the body acupuncture group who received acupuncture in the special points of body , and the auricular acupuncture group who received ear acupuncture . 
 zung self - rating anxiety scale ( sas ) was used before and after the study.results:for the auricular acupuncture group , the mean score of sas was 57.57  8.22 before the intervention and 46.32  6.37 afterward . for the body acupuncture group , 
 the sas score was 55.39  5.41 and 44.82  6.76 before and after the intervention , respectively . 
 for both groups , the difference between pre- and post - treatment scores reached the significant level ( p = 0.00).conclusions : both auricular and body acupuncture treatment methods were effective in decreasing anxiety in preoperative patients .