CONCLUSIONS
Concepts of TCM are based on a philosophy of Yin-Yang (balance of opposite forces), Five Phases (anabolic and catabolic relationships between 5 primitive types), a balance between humans and nature, the Six External Evils (causing disease by attack from the outside), the Seven Emotions (imbalance of which causes psychosomatic disease) and the Eight Principles of classifying disease (Yang-Yin; Excess/Deficient; External/Internal; Hot/Cold).
The concept of Qi (vital energy) flowing in the superficial and deep Channels in a diurnal cycle is central to AP. Imbalance of Qi (excess, deficiency or blockage) is the cause of disease. In disease, the AP points related to the affected parts show abnormal Qi, manifested by hyper- or hypo-sensitivity to palpation and electrical current. Detection of these abnormal points has diagnostic and therapeutic value. Diagnosis is further aided by the 4 traditional methods (looking, listening, smelling, touch, including the taking of the "Chinese pulses"). The aim of all methods of TCM is to restore the normal balance and/or flow of Qi, This may involve dietary, physical, medical, surgical and psychological methods. AP is a relatively small part of TCM.
Western concepts of AP mechanisms: Examples of diagnostic and therapeutic aspects of AP were discussed. The neuroendocrine system is the basis of AP mechanisms. Supraspinal, segmental and intersegmental reflexes (viscero- visceral, somatic and cutaneous; somato- visceral, somatic and cutaneous, cutaneo- visceral, somatic and cutaneous) are involved. AP has diagnostic and therapeutic value via these reflexes. Adequate stimulation of the correct AP points activates autonomic, humoral and neuroendocrine functions. The therapeutic effects of AP can occur only if the natural defence/healing systems can be activated (autonomic effects, immune response, antiinflammatory effects, endorphin release etc). If there is no possibility of natural responses (e.g. in severed spinal cord or severely fibrotic kidneys), AP can not substantially improve the situation.
Methods of choosing AP points are based on many Laws of TCM, the most important of which is the combination of local points, AhShi points and distant points on Channels passing through the affected area. In Western concepts this is translated into choosing points in the same nerve segment, TPs and points in nerve segments related by intersegmental reflex.
Today, computer databases makes frequency citation analysis possible. This allows computer ranking of points from many reference sources, so that prescriptions can be generated from the top 6 or 7 points in order of ranked scores. This is very useful to those whose study of AP is still in the early stages.
GV26 (the philtrum point) is excellent in emergencies and first aid. TPs, local points and points such as LI11 (in forelimb problems), BL23,40 (in lumbar and hindlimb problems) and GB34 (in hindlimb problems) are very useful in treating myofascial, musculoskeletal and vertebral disc problems. Points useful in obstetrics include animal GV03 (BaiHui, lumbosacral space), GV02 (WeiKen, sacrococcygeal space) and BL22-30 (paravertebral area from L2-S4). Some of those points may be combined with SP06 and one or two points from the low abdomen (such as ST29, CV04, SP13, KI01) to treat problems of the reproductive system and its functions.
It is very important to identify and treat TPs in myofascial and musculoskeletal problems and in some problems of the internal organs. Reflex tenderness of paravertebral (Shu (BL Associated)) points and thoracoabdominal (Mu (Alarm)) points has diagnostic value.
Advantages and disadvantages of AP analgesia (APA) for surgery were discussed. APA is unlikely to replace safe, fast, effective drug anaesthesia. However, in severely toxic patients and in caesarian section where the pups are very valuable, APA has a role. It also has a role in national/international disasters such as large-scale warfare, where drugs may be in short supply.
The most practical methods of AP stimulation for busy practitioners are the methods of point-injection, simple- or electro- AP, TENS and ultrasound. Although LLLT has applications as a local stimulant in local superficial problems, it can not be recommended as a complete replacement for needles at this time. The higher the power output, the more likely LLLT is to replace the needle, i.e. lasers of 20-50 mw/cm2 are more likely to be useful as needle replacements than those of 1-5 mw/cm2.
Some possibilities for further training were discussed; you are strongly recommended to join IVAS, irrespective of your degree of AP expertise. IVAS can help beginners to learn but it also wishes to learn from expert practitioners.
For those with the motivation to study the traditional methods, the rewards are great: new insights into philosophy, especially the philosophy of health and healing; a special bond of friendship with like-minded colleagues; a superior success rate in the use of AP in clinical practice or research.
However, many vets in busy practice and who have families, mortgages and heavy social commitments may be unable to spend the time, energy, and money needed to study AP in depth along strictly traditional lines. It is possible for such people to obtain good to excellent results with AP without an in-depth study of the method, provided certain minima are observed:
1. Reasonable study of the more important AP points and laws;;
2. Study of the use of TPs;
3. Use of a very comprehensive AP cookbook or access to a computerised database;
4. Restriction to single-symptom conditions.
Though beginners can expect good results in many simple conditions, practitioners who have not studied AP in depth can not expect good results in multi-symptom conditions. Inadequately trained practitioners may bring themselves and the AP system into disrepute if they attempt to use AP as the sole therapy in complex cases.
ACKNOWLEDGEMENTS
I thank Shelly Altman (North Hollywood, CA, USA), David Jagger (Boulder, CO, USA), Luc Janssens (Wilryk, Belgium) and Jen-Hsou Lin (Taipei, Taiwan) for their comments and corrections of an early draft of this paper and colleagues in many countries, especially those named in the text for sharing their experiences of AP with me.
REFERENCES
BASIC HUMAN TEXTS
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TEXTS ON VET AP
Altman,S. (1981) AP for animals (c/o 5647 Wilkinson Ave., North Hollywood, CA 91607, USA, 281pp.
Blakely,C.S. (1985) AP in gastric torsion in dogs. Vet AP Newsletter, 11, January-March, p. 34.
Brunner,F. (1980) AP der klein Tiere (German). (WBV Biologisch Med. Verlag, Ipweg 5, D4070 Schorndorf, Germany, 320pp.
Gilchrist,D. (1981) Manual of AP for small animals. Also: Greyhound AP (1984) Published privately, c/o 219 Byrnes Street, Mareeba, Australia, 4880.
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Janssens,L. (1984) Atlas of the AP points and Channels in the dog (c/o Oudestraat 37, Wilrijk 2610, Antwerp, Belgium).
Janssens,L. (1984) Treatment of disc disease and arthritis in dogs. Also trigger points and myofascial syndromes in dogs. AP Training Seminar, Vet School, Gent (Antwerp) Belgium, 289pp and 1983 VMSAC, October, 1580-.
Janssens,L.A.A. (1987) Myofascial pain syndromes in dogs: the treatment of TPs. In: Some aspects of small animal AP the clinical scientific approach. (Chapter 13 of the Belgian Vet AP Society Manual).
Klide,A. & Kung,S. (1977) Vet AP (Univ Pennsylvania Press, Philadelphia), 297pp.
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Schoen,A.M. (1984) Re: treatment of arthrosis in dogs. Vet. AP. Congress, Gent, Antwerp, 289pp.
Westermayer,E. (1980) Treatment of Horses by AP. Health Science Press, Holsworthy. Devon, UK, 90pp.
Westermayer,E. (1978) Atlas of AP for cattle. WBV Biologisch Verlag, Ipweg 5, Schorndorf, Germany, 60pp.
White,S.S. (1984) Electro-AP in Vet. Med. Chinese Materials Centre, San Francisco. 122 pages.
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TEXTS ON AP ANALGESIA IN SMALL ANIMALS
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Kitazawa,K., et al. (1975) Experimental studies on EAA in the dog. Proc. 20th World Vet Congress,
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Klide,A.M. & Kung,A.H. (1977) Vet AP. University of Pennsylvania Press, Philadelphia.
Lambardt,A. (1975) AA versuche bei katzen. Der Prakt, Tierarzt, 1/1975, 33-36.
Lynd,F.T. (1975) AP analgesia investigations in animals. Internal report, Department of Laboratory Animal Medicine, Medical School, University of Texas, San Antonio, Texas 78283. 5 pages.
Niboyet,J.E.H. et al. (1973) L'anaesthesie par l'AP. Maisonneuve, 433pp.
O'Boyle,M.A. & Vajda,G.K. (1975) AA for abdominal surgery. Mod. Vet. Pract., 56, 705-707.
Ralston,N.C. & Ralston,B.L. (1978) AA for cystotomy surgery in a dog. Amer. J. Acup., 6, 75-76.
Zhou,Y.C. (1984) (Re lasers as an analgesic in oro-facial surgery and dentistry). Lasers in surgery and medicine, 4, 297-
TEXTS ON TP AND SCAR THERAPY
Chung,C. (1983) The AH SHIH Point. (Chen Kwan Books, 5-2, 1F, Chung Ching South Road, Section 3, Taipei, Taiwan), 212pp.
Dorrigo,B. et al (1979) Fibrositic myofascial pain in intermittent claudication. Effect of anaesthetic block of TPs on exercise tolerance. Pain, 6, 183-.
Fox,W.W. (1975) Arthritis and allied conditions: a new and successful approach. Ranelagh Press, South Hill Park, London.
Huneke,F. (1961) Das sekunden phanomen (the instantaneous phenomenon). Karl F. Haug Verlag, Ulm, Germany (in German).
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Kellgren,J.H. (1939-42) On the distribution of pain arising from deep somatic structures with charts of segmental pain areas. Clinical Science, 4, 35-.
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Lewit,Karel (1979) The needle effect in relief of myofascial pain. Pain, 6, 83-.
Malzack,R. et al (1977) TPs and AP points for pain: correlations and implications. Pain, 3, 3-.
MacDonald,A. (1983) Trigger mechanisms and myofascial pain. III Nordic Congress on AP, May 1983.
Also: Annals Roy. Coll. Surg. Eng. (1983), 65, 44-.
Moss,L. (1972) AP and you. Paul Elek Books, London.
Pontinen,P. (1982) AP Seminar for Swedish Physicians (contact: AP and Pain Research Dept., Tampere University, Finland).
Rogers,C. (1982) AP therapy for post-operative scars. Amer. J. Acup., 10, 201-.
Symposium on Myofascial Trigger Points. (Simons/Travell/Rubin/Melzack/Reynolds). Archives of Rehabil. Med., 1981. March Issue, 97-117.
Travell,J. & Simons,M. (1984) Myofascial pain and dysfunction - the Trigger Point Manual. Part 1. (Williams & Wilkins, Baltimore & London), 713pp.
Travell,J. & Simons,M. (1985) Myofascial pain and dysfunction - the Trigger Point Manual. Part 2. (Williams & Wilkins, Baltimore & London).
JOURNALS ON AP AND ALLIED FIELDS
AP and Electrotherapeutics Research (Pergamon Press, Oxford, UK).
AP in Medicine (British Medical AP Society, Newton Lane, Lower Whitley, Warrington, Cheshire WA4 4JA
AP Research Quarterly (C.A.R.F. Box 84-223, Taipei, Taiwan).
American J. Acup. (1400 Lost Acre Drive, Felton, California, USA).
American J. Chinese Medicine (Box 555 Garden City, New York, USA).
Bulletin de l'Association Veterinaires Acupuncteurs de France (3 rue Letellier, Paris 75015, France)
Chinese Medical J (English). Guozi Shudian, Box 399 Peking, China.
Internat. J. Chin. Med., 5266 Pomona Blvd., Los Angeles CA 90022, USA.
Lasers in Surgery and Medicine
Scandinavian Journal of AP and Electrotherapy, c/o AP and Pain Research Department, University of
Tampere, Finland. (No longer in print)
AP SUPPLY HOUSES (NEEDLES, BOOKS, EQUIPMENT ETC)
Acumedic, 101-103 Camden High St., London NW1 7JN, UK
John Scarborough & Partners, Orchard Hse, West Bradley, nr Glastonbury, Somerset BA6 8PB, UK
Mayfair Medical Supplies, Rm 501-3, 5/F, Far East Consortium Bldg., 204-206 Nathan Rd., Kowloon, Hong Kong (Fax 852-3-721-2851)