EXAMPLES OF AP THERAPY IN HORSES

1.1.1. Soreback (thoracic, lumbar and sacral area)

(Kothbauer; Kuussaari; Klide; Grady-Young; Johnson; White)

Search the back and paravertebral muscles for TPs. If the tail twitches during riding, this indicates pain at BL23 (kidney SHU). Use all TPs. Add PAIHUI and points from BL18 (ICS 15) to BL26 (L 5 to L 6) and BL28, 30 (foramina S 2, 4) or points from BL17 (ICS 14) to BL25 (L 4 to L 5) and BL27, 29 (foramina S 1, 3). Use the more anterior points if the pain is more anterior. Consider also VG12; BL31, 34, 49 and the point at the meeting of the scapula and the anterior edge of the scapular cartilage (TH15, TCVM POCHIEN).

Treatment: injection, simple needling, electro-AP (20 seconds/needle) or LASER. Treat 1-2 times/week (usually every 5 days) for 2 - 10 times. In acute cases, with severe pain or paralysis, treat every 12 - 24 hours. Relapse within 6 months after successful treatment may be 5-50%.

A set formula, used with 87% success by Klide, is:

PAIHUI, BL19 (or 43), 22, 23, 24, 25, 26, 50 (simple needling or injection of 1 ml saline/point). Treat weekly, 7-12 times (Klide 1984, 1987). Point lasering gave a lower success rate (73%) (Martin and Klide 1987) but the difference between AP and Laser may not be significant.

Ly (1977) reported that all 5 horses treated for lumbosacral pain and sciatica recovered. They were treated at PAIHUI, WEIKEN, BL points on the lumbosacral area, GB30 and points along the course of the sciatic nerve. Electro-AP was used, twice/week for 10 sessions. The horses were rested for 3 months before being slowly returned to work.

1.1.2. Saddle-sore: (Grady-Young; Johnson)

Pain in the area of the saddle, is treated similarly. Tenderness near BL18 (liver SHU) may be associated with muddy colour of the eye mucosa -the liver controls the eye in TCVM.

Treatment: all TPs plus BL points, especially BL21, 23, 25.

: inject procaine-B12 (9 ml 1% procaine + 1ml B12 - 3000 units/ml at each point), using 19 g needle, depth 1.5'

(or): needle or electro-AP 20 minutes; 2/week; 2 - 4 times.

1.1.3. Shoulder lameness: (Kuussaari; White)

Few cases relapse after successful treatment.

The main points (Klide and Kung system) are: FL 2, 4, 12, 13, 7 with any TPs located in the neck or scapular-shoulder muscles. These points correspond with points: BL11; GB21; TH14; CO15; SI 9; LU 1 in humans -all of which are key points for shoulder lameness in people.

Treatment is: Electro-AP (10 - 20 seconds per point) or simple needling (20 - 30 minutes), 2 - 6 times (mean 3) at intervals of 3 - 7 days mean 4). White suggests 20 minutes electro-AP every day in acute cases.

1.1.5. Hip and thigh lameness:

The points most effective on the hip and thigh are:

: all TPs in the lumbo-sacral, hip-thigh and posterior thigh ms.

: local points (GB29, 30, 31, 32; BL50, 51, 52; ST31, 32, 33, 34)

: region points (PAIHUI; BL23, 49)

: additional points from GB34, 39

Treat by simple AP, electro-AP or point injection every 3 - 7 days for 1 to 3 times in recent cases and 3 to 8 times in chronic cases.

1.1.6. Stifle lameness: (Jeffries)

Point injection is excellent in 1 to 2 sessions. Walk the horse for 2 days before return to the track. Jeffries uses an American product for injection (Sarapin, containing Vitamin B12 and C). Three ml is injected below the patella, medial and lateral to the patellar tendon at the point HSIYEN (Knee Eyes = ST35) and the point postero-medial to the patellar tendon; ST36 (12 ml); KI10 (5 ml); BL54 (4 ml, 2' deep).

1.5. REPRODUCTIVE PROBLEMS:

The most important points for reproductive disorders and for the genital organs are in the lumbo-sacral area. A simple guide is to imagine the female organs (ovary to vulva) as a straight tube, with the ovaries related to AP points in the area T 18 to L 3 (points such as BL21, 22, 23, BL45, 46, 47; TIANPING; VG 5, 4) and the vulva/anus/perinaeum related to the area S 3 to the tailhead (points such as BL29, 30, 33, 34, 35, 49; VG 1, 2). The other organs (tubes, uterine horn, uterine body, cervix, vagina) are related to intermediate points.

Kothbauer recommends BL22, 23, 47; VG4 for the ovary and BL27, 28, 31; PAIHUI; VC 6 for the uterus. Johnson reports excellent results with these points in cases of uterine atony, metritis, embryonic reabsorption etc.

If one had to remember just 3 points for reproductive/genital disorders, they should be: PAIHUI; BL26 (between transverse wings of L 5 - L 6); BL28 (lateral to sacral foramen 2). There are other points (Fig. 18).

The abdominal meridians include ST, SP, BL, KI, GB, LI, VC, VG. Local points (points nearest the target organs) on ANY of these meridians influence the organs. Although most importance is attached to the VG and BL points (lumbo-sacral area), GB 26 to 28 in the paralumbar fossa and under the external angle of the ilium are sometimes tender in mares with ovarian problems, especially cysts. Points over the iliac wing (between the tuber coxae and the iliac crest) may also be tender in uterine disorders.

In disorders of the reproductive system and genitalia, (as in all other clinical uses of AP), TREAT THE TPs (AHSHI POINTS). A few points (whether tender or not) for the affected organ may be added and VC 2, 3, 4; BL49; LI 2 may be considered as additional points. SP 6 is regarded as a point with special action on the inguinal area, genitalia and reproductive function of males and females.

Westermayer suggests treatment for 20 - 30 minutes for 2 to 4 times (mean of 3), at intervals of 5 days.

1.5.2. Cystic ovary: (Jeffries; Grady-Young; Johnson)

Luteal cysts often are associated with metritis or pyometra. They may be expressed manually (per rectum) in many cases (Grady-Young).Follicular cysts are usually associated with nymphomania.

Points in the area L 2 to S 1 (BL22 - 27, 46, 47; VG 4) and in the paralumbar fossa and under the tuber coxae (GB26, 27, 28) are examined for TPs. All TPs are used. Other points are chosen from:

BL22 to 29; SP 6, 15; LI14; GB25; ST36; PAIHUI; YANCHI

Jeffries and Johnson also inject 10 ml of 2% procaine solution into the broad ligament on each side of the cervix, using a special 50-60 cm needle. This method was successfully used in cows by Kothbauer and Greiff for many years. It is called paracervical injection or neural therapy.

Treatment: simple AP; injection of NaOH solution (concentration of 10 to the power of minus 9) + Vitamin B12 and Ascorbic acid; LASER. The choice is individual preference.

Jeffries: injection method plus paracervical injection, 2 times. Success is 5-15% better in luteal cysts than in follicular cysts.

Grady-Young: LASER (20 minutes total to do all points) 3 to 5 times at interval of 3-4 days. Skip 3 oestrus periods before breeding.

Johnson: needle + moxa (20 minutes) on 10 cm, 20 guage needles. Inject BL54 and LASER SP 6; ST36 and (sometimes) BL11.

EXAMPLES FROM MY FILES

Case 1. Sciatica. Severe left hind lameness in mare following injection of a copper compound i/m over the sciatic nerve area. Duration > 6 mths.

17/6 Sacro-trochanteric sweat track and area of hair regrowth noted, running in postero-ventral direction from suspect injection site. Five TPs located and clipped along the track. TPs in left and rightneck. Electro-AP, 20 minutes, at rump TPs, plus BL23, 25, GB30, 34, PAIHUI. Simple AP at neck TPs (probably not important) plus BL11. Handler to massage all TPs.

22/6 Little change. Treated as before.

29/6 Marked improvement. All TPs gone. Mare sound. Treated as before.

Riding to begin in early July.

18/7 All TPs still gone. Hair more normal along original track. Mare riding sound. Working up to full race training.

20/8 Came 4th in high-class race. Still sound.

Case 2. Ovarian backpain. 18/5 Severe left lumbar pain and left hind lameness in filly. Humped back and lumbar m. spasm clearly visible. Duration > 10 months. She had ovulated 2 days before and left ovary area was very sore on rectal examination by colleague. History of not showing clear signs of oestrus. TPs in left lumbar area and under external angle of ilium (ovary areas). Electro-AP, 20 minutes on all TPs, plus BL23, PAIHUI and uterus point (midway between external angle of ilium and iliac crest).

21/5 Some improvement but TPs still tender. New TP on right rump near uterus point. Treatment as before, plus GB34 (both).

25/5 definite improvement on walk but hunched up on turning. All left TPs gone but right one still tender. Treated as before.

30/5 Normal on walk, trot and on turning. Right TP still tender and new TPs found on left and right neck and over last right rib. Treated all TPs including original ones, plus PAIHUI.

4/6 Normal walk and turn. TPs gone except right neck. All TPs treated, plus PAIHUI, BL23 (both).

9/6 Sound. All TPs gone. Walking exercise to be increased. No treatment except massage by handler.

16/6 Going well in walk and canter on soft ground.

19/6 (32 days after initial exam, 34 days after painful ovulation): Was sent for jog on hard surface. Came back crippled, worse than ever. Left lumbar TPs very tender.

c. 22/6 colleague found left ovary area very sore on rectal exam. (This case is classed as a failure. Despite initial success, she relapsed. She was sent to the Veterinary College for specialist examination and treatment. They found nothing and suggested resting her for 6-8 months.)

Case 3. Stiff back. Gelding, had won races earlier. Back rigidity and stiffness had prevented him from racing for the past 2 years.

4/4 TPs over the last few ribs on both sides. Rhinitis (mild). Electro-AP 20 minutes, at TPs plus PAIHUI, BL23, GB30 (both).

10/4 Not possible to assess improvement, as he had not been ridden since. TPs still tender. Treated as before, plus BL13 (both) for the rhinitis.

16/4 Rhinitis gone. Vast improvement in back flexibility and stride was noted by riders who did NOT KNOW he had been treated. Put back on full training schedule. No treatment.

26/4 Owner reported him fully sound and going very well. One year later, he was still sound.

EXAMPLES OF AP THERAPY IN DOGS

MYOFASCIAL LAMENESS:

TPs are frequently found in dogs in the paravertebral, neck, shoulder, triceps and thigh muscles.

Janssens (1984) reported TP therapy for myofascial lameness in 21 dogs. Mean duration of lameness before therapy was 24 weeks. TP therapy was successful in 70% of cases, in a mean time of 17 days (2.5 sessions). The relapse rate was 33% but response to treatment of relapse cases was similar to that in new cases. He described TPs in the Triceps, Peroneus longus, Gluteus medius, Iliocostarum lumborum, and the thigh Adductor ms.

ARTHROPATHY

Joint trauma, rheumatism and arthritic pain can be helped by AP. Much of the pain and stiffness in arthropathy is due to muscle spasm (guarding) and TPs in the muscles above or below the affected joint.Arthropathy can affect the vertebrae also and is treated as in disc disease (see below).

Janssens (1986) reported AP therapy in 61 dogs with arthritis. The mean duration before treatment was 36 weeks. AP was most successful in pain of the shoulder and stifle (80 and 72% respectively), less so in hip pain (55%) and was least successful in pain of the elbow, carpus and tarsus (33%). Recovery time averaged 24 days (5.2 sessions). Relapses occurred in 48%. Retreatment had the same success in them as in new cases. Schoen (1984) reported good or excellent results in 63% of 24 dogs treated by AP for arthrosis.

CERVICAL (CDD) AND THORACOLUMBAR (TLDD) DISC DISEASE

As in arthrosis, much of the pain in disc disease is due to spasm and guarding of the muscles near the lesion. Irritation of the vertebral nerve root and oedema of the spinal cord add to the pain signals.

In treating disc disease, it is important to assess the degree of nerve damage. If one uses a 4-grade system (1 = pain only; 2 = pain+paresis; 3 = pain+paralysis; 4 = paralysis and loss of deep pain sensation), the prognosis in grade 1 and 2 is excellent, in grade 3 is very good and in grade 4 is poor. Grade 4 cases need a lot of care (nursing, turning, catheterisation, manual emptying of rectum in faecal retention etc) and many owners are unwilling to give it.

The approach to AP treatment in disc disease is to localise the affected area by finger palpation and other methods (including X-ray). One or two points are used bilaterally above and below the problem disc(s), with TPs and distant points.

For TLDD, distant points include GB30, 34, BL54, 60. For CDD, they include CO11, SI 3, GB34. The local points in CDD include GB20, TH15. Treatment is every 5-7 days but in acute pain every 2-4 days.) Additional therapy (conventional, playpen rest etc) is used as needed.

Ly (1977) reported that 79% of 19 dogs with paresis recovered following electro-AP and point injection (.5 ml/point) with B12 solution. He treated every 2-3 days for 8-10 sessions and most cases improved within the first 5 sessions.

Janssens (1983) reported results of AP therapy in 78 chronic TLDD cases. The average duration of signs before AP was 21, 23, 31 and 18 days in Grades 1 to 4 respectively. Recovery rates to were 97% in Grade 1 in a mean of 13 days (2 sessions); 95% in Grade 2 in a mean of 24 days (3.4 sessions); 85% in Grade 3 in a mean of 32 days (4.8 sessions); 33% in Grade 4 in a mean of 76 days (9 sessions).

In another study (Still 1987), 63 dogs with acute TLDD (mean duration 4.4 days) were treated with AP every 1-3 days. In contrast to chronic cases, 100% of acute cases of Grade 1+2 had pain control within 4 sessions; 63-71% within 24 hours. Full cure (all signs gone) was seen in 83%. In Grades 3+4, 62% had pain control within 4 sessions; 39% within 24 hours. However, full recovery (all signs) in Grades 3+4 occurred in only 11%, with improvement in another 46% (43% remained unchanged in sensory-motor function). Essential improvement of motor and other sensory functions occurred within 24-36 hours after the first treatment in Grade 2 and within 3-21 days (mean 10.9) after first treatment in Grades 3+4. Occasional autonomic upsets (constipation, diarrhoea, urinary retention) resolved within 1-3 days of first treatment in Grades 1+2 and 7-14 days in Grades 3+4.

These recovery rates and times compared very well with published values for conventional methods, including surgery.

In CDD, Janssens (1984) reported 80% recovery in Grade 1 in a mean of 11 days (2.8 sessions). In Grades 2 and 3, 67% recovered in a mean of 21 days (3.5 sessions). There were no Grade 4 cases in the seris.

Relapses in cured TLDD and CDD cases occur in 20-40% but response to treatment in relapse cases is similar to that in new cases.

POSTOPERATIVE PAIN

Janssens (personal communication) reported that AP has controlled pain in dogs which did not respond to surgery for disc disease. He has also used AP successfully to control pain and other complications arising after abdominal and other surgery.

EXAMPLE FROM MY FILES

Case 1. Cramp. Greyhound with history of race cramp, 5 months duration. He had won as a pup. Examination showed TPs near BL23 (kidney) and near the femoral artery on the upper, inner thighs. Three sessions of electro-AP at weekly intervals (TPs, GB20, 34) gave marked improvement. All TPs disappeared and normal urination (he had been a 'dribbler') was restored. The dog was beaten by a nose in his next race (I lost my bet!) but he won the following race and was exported at a good price.

CONCLUSIONS

In practice, it is difficult to make a specific diagnosis of the cause of backpain, especially in horses, due to the difficulty of routine X-ray and myelography. The general practitioner may be satisfied with clinical remission.

Palpation of the muscles, to locate TPs is an essential part of the clinical examination.

Point selection for local problems includes some from TPs, local points, distant points for the region, points with special or generalised action and (most of all) the paravertebral SHU point(s) for affected organ(s) or function(s). This includes the use of SHU points in superficial problems which may not have direct organic involvement. For instance, BL13 and 25 (SHU points for the LU and CO meridians) would be indicated as part of a prescription to help resolve pain of an inside-forelimb splint (in the meridian area of LU and CO). Similarly, BL23, 28 (SHU of KI and BL) would be indicated in capped hock (meridian area of KI and BL). One or two distant points on a meridian passing through the problem area, or a chain of points along an affected nerve are also helpful.

Certain key points are: ST36, BL21 stomach and appetite; BL13, 38 lung; BL18, VG 9 liver; GB34, TH15 muscles; BL23, PAIHUI adrenal, uro-genital, hindquarter; TH15, GB21 forequarter; GB20, 21 neck; BL25, PAIHUI hindgut; BL11, 23 bones, joints; CO11, VG14, ST36 immunostimulation.

Simple needling for 20 minutes, electroneedling or point injection are the main methods used in horses and dogs.

A clinical success rate of 70-90% can be attained in 1-3 sessions at 1-3 day intervals (recent or acute cases), or in 1-10 sessions at 3-7 day intervals in longstanding or chronic cases. However, beginners should study the principles of AP before attempting to use it. They should advise the use of other physiotherapies (massage, ultrasound, LASER etc) on the points (between sessions) to ensure high success rates.

There are other methods of point selection (earpoints, hoof points etc) and of point stimulation (magnets, staples, implants, Dermojet, LASER etc) but these methods must be regarded as experimental until adequate documentation and comparative clinical trials are available.

ACKNOWLEDGEMENTS

Basic texts on animal acupuncture are scarce. The authors of texts on the horse kindly presented me with copies and explained their methods to me. They are:

Colleagues Alan Klide, Philadelphia; Oswald Kothbauer, Austria; Jen Hsou Lin, Taiwan; Erwin Westermayer, Germany; Sheila White, Australia.

The following gave details of their approach to equine AP, either in formal or informal meetings, discussions or correspondence:

Marvin Cain, Cincinnati; Yann Ching Hwang, Alabama; Dick Jeffries, Ohio;

Ralph Johnson, Minnesota; Jukka Kuussaari, Finland; Grady Young, Georgia.

Colleagues Shelly Altman, Los Angeles; Luc Janssens, Belgium; Jacques Milin, France; Jan Still, Belgium have been most helpful in my study of small-animal AP.

To them and to many others unnamed, who have taught me to listen to the body (my own as well as the patient's), I give my sincere thanks.

I also thank Dr. Pekka Pontinen, Tampere, Finland and the organisers of the Nordic Acupuncture Congress for financing my trip to the Congress.

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