Reproductive disorders of domestic animals cause significant economic loss in the animal industry. Acupuncture treatments for such conditions have shown profound results in the last decade and can be used as a good alternative therapy. In this article, we summarise the results and techniques obtained from recent literature. The basic hypotheses and practical techniques may provide a useful approach for treating common disorders including anoestrus in sows, repeat breeders in cows, antibroodiness in hens, etc.
Key words: acupuncture, reproductive disorder, pig, hen, cow, Chinese medicine
Since 1989 when he first used an acupuncture (AP) needle on a infertile sow in South Taiwan, Lin have written several scientific papers concerning the use of AP treatments on animal reproductive disorders. This paper is an overview of our results obtained during the last decade.
Though traditional Chinese medical (TCM) knowledge delineates the fields of human gynaecology and obstetrics well, animal reproduction was never considered overly important in China. Spaying and castration are the oldest known reproduction-related techniques in Chinese veterinary medicine. They obviously prevent reproduction.l,2 We find, therefore, that traditional Chinese veterinary theriogenology is not nearly as complete as its human counterpart.3-5 For this reason, the therapies discussed in this essay include a mixture of AP teachings, some borrowed from human medicine and some from the traditional veterinary school.
In TCM, human or veterinary, AP has a secondary role to that of Chinese herbal medicine in treating reproductive disorders.l,3,5,6 An explanation of herbal treatments is beyond the scope of this essay. However, at the end, we report on a herbal formula to improve reproductive performance in sows. For some reproductive problems, however, AP alone may not be effective. In such cases, we recommend AP as an adjunct to Western or Chinese medical therapies.7-12
Gonadal function and sexual behaviour are principally regulated by the hypothalamic-pituitary-gonadal axis (HPGA). The HPGA is a complex orchestration of hormonal cascades and feedback loops that originates in the hypothalamus. The hypothalamus processes visual, auditory, olfactory and tactile cues, and translates this information into the secretion of gonadotropin-releasing hormone (GnRH). GnRH is then responsible for pituitary release of luteinising hormone (LH) and follicle-stimulating hormone (FSH). These pituitary hormones cause gonadal production of steroid hormones, which affect ovulation, spermatogenesis and sexual behaviour, as well as inhibit further production of hormones by the higher brain centres.
Any imbalance of this hormone cascade results in reproductive dysfunction. As veterinarians, we must diagnose any lesions and then administer appropriate therapy to alleviate the problem. Using Western medicine, we usually treat such problems by overcompensating for an imbalance with hormone therapy or surgical removal of the gonads. Though we are often successful in restoring balance to the HPGA with large doses of reproductive hormones, in fact we are overwhelming the system without consideration for its delicate system of checks and balances. This lack of consideration risks side effects, such as further imbalances within other hormone systems and sterility. Using Chinese medicine, we can seek ways to stimulate the body to heal itself and restore hormonal balance with all of the checks and balances intact.7-l2
Physiologic Mechanisms of Acupuncture
Clinical studies indicate that AP treatment for reproductive problems is quite effective and free of side effects. Most of these reports involve treatment of infertility in animals or dysmenorrhoea and impotence in people.8-12 Unfortunately, the Western physiologic bases for these therapies have not been studied in great detail. One problem for such research is that the intricacies of the reproductive hormone system are still somewhat enigmatic. Another problem is that the myriad of environmental factors and biological variations that affect the reproductive systems of animals and people are not easily controlled. However, recent research offers two possible theories of mechanism accounting for the effectiveness of AP on reproductive dysfunction.13, 14
AP stimulation of certain points historically associated with reproductionl3-16 significantly alters plasma levels of sex hormones, such as LH, FSH, oestradiol and progesterone. For example, one study found that the short-term effect of electroacupuncture (EAP) at Baihui and Weiken (GV02) in sows lowers plasma LH levels in 1-2 hours. Also, there is a subsequent increase in the frequency and magnitude of the pulsatile release of LH and an increase in plasma progesterone levels 4-6 hours after stimulation.l4
One possible explanation for these phenomena involves an endorphin-mediated mechanism.l6-18 Endorphins can inhibit LH secretion, whereas naloxone can induce an LH surge.16-18 Many studies have shown that AP can increase endorphin levels in the brain, spinal cord and blood.15-17 Therefore, it is possible that the AP-induced decrease in LH was mediated by endorphins, and after the period of depression, the pituitary is more responsive to GnRH. If an imbalance exists in the HPGA, depression of LH release may, in effect, allow it to regain balance by breaking a vicious cycle or providing a needed rest period.14
A second hypothesis involves the possibility that AP has direct effects on gonadal paracrine and autocrine control of steroidogenesis by stimulating production and release of epinephrine, catecholoestrogens and growth factors.19,20 AP can increase epinephrine levels in boars' semen.21 Though the implications of this finding are not yet clear, epinephrine and catecholoestrogens are known to stimulate ovarian steroidogenesis. Therefore, AP may affect reproductive function by paracrine and autocrine pathways, as well as through stimulation of the HPGA endocrine system.
Traditional Chinese Principles
According to TCM theory, female reproductive function depends on the complex, co-operative functions of the internal organs, the Qi-Xue (Qi and Blood), the Channels and the reproductive organs. The internal organs and their Channels, especially the kidney (KI), spleen (SP), liver (LV) and heart (HT), supply the foetus, placenta and uterus with Qi-Xue. They are also responsible for postpartum milk production. Qi-Xue provides the essential materials for foetal development. The Channels are the conduits that carry the Qi-Xue from the organs to the developing foetus. The main Mai (Extraordinary Vessels) involved in reproduction are the Chongmai (Penetrating Vessel), Renmai (Conception Vessel, CV) and Dumai (Governing Vessel, GV). Finally, the ovaries and uterus are the developmental sites of the ovum, embryo and foetus. Therefore, according to TCM theory, lesions on malfunction of the internal organs, the Qi-Xue, the Channels, Extraordinary Vessels, or reproductive organs can cause reproductive dysfunction.l,3,5
The main acupoints used for treatment of reproductive disorders involve the KI, SP, LV, Urinary Bladder (BL), and Stomach (ST), and the Extraordinary Vessels - CV, GV and Chongmai, as well as some Extra-Channel points.
The techniques used include manual needle stimulation (AP), EAP, moxibustion, injection-AP (liquid needle technique, aquapuncture), suture embedding and laser stimulation. We recommend injection of vitamin B12 or B-complex for the injection-AP technique, but many other liquid media may be used. Further, we generally do not use injection-AP or suture-embedding techniques along the GV, except at Baihui. Suture embedding is very useful for prolonged stimulation of a point for up to 14 days. We recommend 2-0 catgut or synthetic absorbable suture.
Though treatment of disease is vital to medical practice, even the most ancient Chinese medical texts regard preventive medicine as the most important aspect of patient care. The general principles of prevention are high-quality nutrition (including mineral- and vitamin- nutrition), good management, proper housing and adequate exercise. These principles are especially important for breeding animals to ensure good conception rates, normal births and healthy offspring.
For pregnant animals, Chinese medical practice recommends the following rules as extra precautions against poor foetal development, abortion, dystocia and postpartum disease:
Treatment of Specific Reproductive Disorders
We do not intend that every point listed be used during a single treatment for a given condition, nor are our point lists exhaustive. Our lists should be used as a guide to formulating prescriptions. We encourage everyone to be innovative in the practice of veterinary AP. If you find something that works, try it again; if you encounter an impasse, creativity is needed to find another approach.
Behavioural anoestrus is defined as the inability of the female to show oestrus during the breeding season. Of course, there are many reasons for anoestrus, and if anoestrus is not caused by congenital dysfunction, then nutritional, environmental and management problems should be considered.
The main acupoints used for treatment of anoestrus are Baihui, Weiken (GV02), GV01, BL23, BL25 and Yanchi (Goose Wing). Yanchi is an Extra-Channel point located two-thirds of the way along a straight line from the midline to the highest point of the tuber coxae (the goose wing bone). Associate points include GV04 and CV04. As long as the animal is in good health, anoestrus can be successfully treated with EAP at Baihui and Weiken, or injection-AP therapy at BL23 and BL25.11,22~24
AP techniques include tonification of these points with simple needling, EAP, moxibustion, suture embedding or injection-AP stimulation. Needling may be repeated twice/week if the initial treatment is not successful, or suture embedding may be used for prolonged stimulation.
Cystic Ovaries, Retained or Cystic Corpus Luteum, Silent Heat, Pseudopregnancy
These problems are related in that they involve imbalances of oestrogen or progesterone. Injection-AP therapy at BL23 and BL25 with chorionic gonadotropin therapy added for cystic ovaries, or prostaglandin therapy for retained or cystic corpus luteum has been recommended for cows. This same protocol may be used in other species with similar disorders. Alternatively, EAP between Baihui and GV01 or CV01 may help. SP06 is another very powerful point associated with reproductive problems. However, its location (behind the posterior edge of the tibia, 3 body units above the medial malleolus) may make it less useful in conjunction with BL22 or BL23 for treatment of silent heat and pseudopregnancy in large animals. For each of these protocols, one treatment is usually sufficient to induce a new reproductive cycle or end a false pregnancy.
Repeat breeding of dairy cattle cause a great economic loss. Recently, many reports have used gonadotropin-releasing hormone as a treatment for the problem and indicated that GnRH could increase the conception rate of affected cows. However, in our experience, GnRH (100 mg, Fertagyl) given at artificial insemination only slightly improved fertility when compared with that of control animals. In our recent study, 18 repeat breeders (2 heifers and 16 cows with failure to conceive after 3-9 services and unresponsive to GnRH treatment) were treated with injection-AP. A 50 % glucose solution was injected, 10 ml at Baihui and 5 ml at Shenpeng (Kidney Shelf, the depression between transverse processes of lumbar vertebrae 5 and 6) bilaterally using a 21G, 1.5 inch hypodermic needle. The overall pregnancy rate within 14 days after one treatment was 66.7% (12/18) suggesting the technique is a simple and effective method for treating repeat breeding in cattle.25
Impotence and Penile Paralysis
These problems are usually caused by overuse of the male breeding animal. Sexual desire disappears, and the penis may not return to the prepuce. The KI Channel, Chongmai, CV and GV are all involved. Animals with such afflictions should be rested for 5-10 days and treated with AP.
Typically, one treatment at Baihui and Weiken with the moxa-needle technique is sufficient for impotence problems. For treatment of penile paralysis, BL31, BL32, BL33, BL34, Baihui, Weiken, GV01, GV04 and CV01 are most useful. Tonification of these points using manual stimulation or EAP is indicated. The moxa-needle technique may be used on BL31, BL32, BL33, BL34, Baihui, Weiken and GV04. One useful prescription is moxa-needle of the bladder points with EAP between Baihui and GV01.
Penile paralysis may require several AP treatments to produce a response. The penis may be manually replaced in the prepuce and held in place with interrupted stay sutures through the sheath. Corrective surgery should be considered if the penis still shows a degree of paralysis after several days.
Inflammation of the Reproductive System
This category includes endometritis, vaginitis and orchitis. AP should be used in conjunction with antibiotic therapy for any infectious disease. Injectable antibiotics can be used as the injection-AP media.
Although LI04, LI11, ST36, GV14, LV03, GB39, BL43, BL20 and others are key immunostimulation- and antiinflammatory points in humans, BL20 and ST36 are the most commonly used acupoints for general inflammatory disease in animals. Acupoints BL23, BL25 and CV01 may be used specifically for inflammation of the reproductive organs. These points may be stimulated with EAP or by injection-AP.
Without question, ovariohysterectomy is the best treatment for severe pyometra. Nevertheless, clients sometimes wish to try to salvage an animal's reproductive function. In such cases, along with antibiotic therapy, one may try EAP at BL31, BL32, BL33 and BL34 using strong stimulation for 15-30 minutes to dilate the cervix and contract the uterus. Associated points include LI04, SP04, SP06, CV02, CV03, CV04, CV05, KI11, KI12, KI13, KI14, Baihui and Weiken (see sections on Abortion, Dystocia and Retained Placenta). One can expect the uterus to empty within 12-24 hours after treatment (usually overnight). If the treatment produces no response, it may be repeated with discretion. This technique may also prove useful in non-emergency surgical pyometra cases to remove some of the exudate from the uterus before surgery.
Abortion and Dystocia
Abortion has many causal factors, including infection, mineral-vitamin imbalances, toxicity, fatigue and trauma. Though unwanted abortion usually is considered a loss, induced abortion after mismating is beneficial. Induced parturition is sometimes necessary in cases of dystocia or when delivery is overdue. Abortion and parturition may be successfully induced in large animals with prostaglandins. However, prostaglandin therapy in small animals may produce side effects, such as diarrhoea, emesis, tachycardia, hyperpnoea and hypothermia.
AP may be used to induce abortion or parturition with little risk of side effects. Strong manual or electrical stimulation of acupoints LI04, SP04, SP06, CV02, CV03, CV04, CV05, KI11, KI12, KI13 and KI14 for 5-10 minutes usually induces abortion or parturition within 24 hours. However, it is important to remember that AP may fail before the latter half of the second trimester, and great care must be taken not to overstimulate debilitated animals. In 1996, an elephant was dying from dystocia in the Taipei Zoo. No veterinarians could help her and eventually I was called as a last resort. I tried to induce abortion by injecting 50% glucose solution 10 ml each at the low back points (BL31, BL32, BL33 and BL34) bilaterally. About 8 hours later, the young mother delivered a dead calf naturally, but she survived.
AP may also prove useful in preventing abortion and treating recurrent abortion. Acupoints ST36, SP06, PC06, HT07, BL23, BL47 and Baihui may be stimulated weekly with mild manual stimulation, EAP or moxibustion for 1 month before breeding and during the first half of gestation. As a general rule, one should not use AP on an animal during the second half of gestation because of the possibility of inducing abortion.
Though it is most common in cows, placental retention may occur in any species. By dilating the cervix, and increasing the coordination of uterine contractions, AP can help to expel the placenta and lochia. Strong EAP stimulation at BL31, BL32, BL33 and BL34 for 15-30 minutes should cause the cervix to dilate sufficiently for manual removal of the placenta and placement of intrauterine antibiotics. Points for the uterus and cervix include Yanchi and Baihui. Associated points include Weiken and SP06.
Although it is most common in sows and dairy cows, uterine prolapse may occur in any species. Occurrence is sporadic and the cause is unclear. However, trauma, dystocia and hypocalcaemia have been proposed as contributory factors.
Before replacement of the uterus, AP can help in healing and prevention of recurrence. The main points used in treating uterine prolapse include CV01, Yintuo (Yinti, clitoris), BL20 and Baihui. Yintuo is an Extra-Channel point located bilaterally on a horizontal line drawn across the centre of the vulva, where the vaginal mucosa meets the skin. These 4 points should be stimulated with EAP or moxibustion at least weekly for 5-6 weeks. Associated points include GB27, GB28, SP06, KI11, KI12, KI13, CV02, CV03 and CV04.
Ovariohysterectomy, Castration and Caesarean Section
AP analgesia is used quite extensively in mainland China for routine castration and caesarean section in large animals, particularly cattle. However, we do not recommend the use of AP analgesia for any surgery in small animals no matter how routine, because it provides an inconsistent effect in dogs and cats. We hope that methods will be developed to combine AP with conventional anaesthesia, such that smaller doses of chemical agents may be used. Such techniques would be particularly useful for surgery in debilitated animals and for caesarean sections.
Postoperative and postparturient haemorrhage can sometimes be a problem in any species. For horses, cattle and dogs, there is a traditional point called Duanxue (Stop Bleeding); it is also called Tianping (Heavenly Balance). It is located on the dorsal midline (Dumai, GV) between the dorsal spinous processes of the last thoracic and first lumbar vertebrae. Amongst other indications, Duanxue / Tianping is used to stop haemorrhage; it also has analgesic effects oon the abdomen / testicle, and helps in abdominal and gastrointestinal disorders. For horses, there are 2 assistant points located between T17-T18 and L1-L2. Duanxue should be strongly stimulated with a manual technique until bleeding stops. For internal haemorrhage related to trauma, strong stimulation for 10-15 minutes should suffice.
Broodiness causes considerable economic loss in some native strains of domestic fowl. For thousands of years, Chinese have used AP to block the behaviour and increase income. In our study, a hand-made feather needle, named Yu-Jane, was made from a safety-pin attached with some plastic threads at one end of the pin. It was inserted through acupoints Pikao, located between the nostrils, and left in situ for 2 days. When compared with the control group, the results indicated that the needle at Pikao inhibited broodiness, usually within 1-2 days after treatment, and egg production increased slightly during the observation period increased slightly.26
Postpartum syndrome in sows by using Sheng-Hua-Tang
In the hot season, the two big problems in postpartum sows are post-weaning anoestrus and poor lactation. TCM has a long history in maintaining human and animal health, especially in obstetrics and gynaecology. Sheng-Hua-Tang (SHT) is a well-known formula for treating postpartum and aborted women. It is used to activate blood circulation and contraction of the uterus, to reduce abdominal pain, and to expel lochia. In the following study, we evaluated the feasibility of SHT to improve reproductive performance of postpartum sows. Results suggested that SHT could overcome the postpartum syndrome of sows by reducing the oestrus return intervals and increasing the body weight gain of the new borns.27
Though AP for reproductive disorders in domestic animals can have rewarding results, it does not always work. If one is having difficulty treating a reproductive problem with AP alone, it is best to combine AP with Western drugs / hormones, or Chinese herbal remedies. As more information on the physiological basis of AP becomes available through research, we shall have a greater understanding of its limitations and usefulness in treatment of animal reproductive disorders.
We thank Philip A.M. Rogers MRCVS, Dublin, Ireland for editorial help in the final preparation of this text.