Part 1
Philip A.M. Rogers MRCVS
e-mail :
IVAS Congress, The Netherlands 1990


1. Winter follows spring. All creatures die. In life, many suffer dis-ease through failure/inability to adapt to external or internal challenges or stressors.

2. Accurate diagnosis is needed for optimum results to any form of therapy. The cause, nature, location and extent/severity of the dis-ease/lesion/disorder should be known. First-degree therapy aims to remove/alleviate the cause, to enhance the adaptive response and to provide supportive/symptomatic relief during recovery.

3. The adaptive response is the key to all healing. Acupuncture (AP) activates the adaptive responses, which depend mainly on functional neuro-endocrine transmission. Physical or chemical interruption of transmission or functional inability of the target-organs to respond abolish or reduce the AP effect.

4. Clinical failures may be due to professional error (faulty diagnosis, incorrect choice of points, inadequate stimulation, failure to use other supportive therapies, premature withdrawal of therapy); patient/owner error (non-compliance with advice given); coincidental disorders and inability of target organs to respond. Some patients may be "non-responders".

5. Clinical success may be due to spontaneous remission or to activation of adaptive responses (even in cases wrongly diagnosed, or in cases assessed initially as "difficult" or "unlikely to respond"). Some patients may be powerful "responders".

6. Examples of the author's failures and successes in cases of muscular lameness or paresis, cervical ataxia, chronic pain, are given. Some failures and successes are difficult to explain.


Definition of therapeutic success: This is complex, as illustrated by the old joke: ... the operation was successful but the patient died...

Many definitions are possible. Three are given here, the one chosen for discussion in this paper being definition (c):

Definition (a), in humans, is the complete and permanent elimination of all present and past symptoms and signs, with full return of integrated functions of the spirit/mind/body.

By definition (a), most attempts at therapy must be classed as partial or complete failures (non-attainment of success). Permanent restoration of health is not possible: at best, death knocks and enters uninvited at some future time.

Definition (b) substitutes "medium-term" (months or years) for "permanent" in definition (a).

Acupuncture (AP), electro-AP (EA) or transcutaneous electrostimulation (TES), at points such as Earpoint Lung or the mastoid process, can give complete and dramatic success within 10 days in the elimination of withdrawal signs and symptoms in the detoxification of alcohol- or heroin- dependent patients. If combined with naloxone therapy, EA can induce symptom-free detoxification within 4-6 days.

However, by definition (b), that detoxification success would be classed as ultimate failure in most cases if therapy did not include adequate rehabil-itation. This entails rebuilding the self-respect of the patient and providing the possibility of change of internal and external environment to allow his/her growth as a full human being. Without rehabilitation, most detoxified patients who are returned to the environment which spawned the dependence, return to the habit within weeks.

Definition (b) is too severe to be applied to individual clinicians, who may have little control over internal or external environments, (their own or their patients').

Definition (c) is less severe than (b). It also can be applied to animals.

It is the medium-term elimination of most of the severe signs and symptoms, with restoration of body-mind functions to the extent possible under prevailing circumstances.

The "prevailing circumstances" include the possibility or otherwise to activate the body/mind adaptive responses, the physiological/pathological circumstances of the patient (wear-and-tear on organs/joints, senile changes, adjustment of human "purposes" for the animal patient etc).

Definition (c) allows for relapses (due to irreparable damage or weakness of organs/joints etc or due to inability to rectify adverse internal or external environmental factors). It also allows for coincidental disorders, for future unrelated disorders and for re-evaluation of the goals and purposes of the patient in the context of the realistic possibilities.

In limb paralysis due to vaso-spastic or oedematous hypoxia of the motor centres post-Cerebro-vascular accident, AP may give marked (yet incomplete) functional and physical improvement. For some affected patients, partial success may seem "miraculous" but would be unsatisfactory if the patient's goal was to be a professional pianist or Olympic athlete.

In cervical ataxia in a pet dog, AP may restore limb function sufficiently to be most acceptable to the owner but the same degree of success in a racing greyhound could be unacceptable and could lead to a request for euthanasia.

In human arthritis, even with marked radiological signs and crepitation, AP can give marked clinical improvement (pain relief and partial or complete restoration of joint function), even though no change may be evident on radiological re-assessment. Sceptical surgeons and radiologists may attribute the improvement to psycho-somatic temporary remission. However, similar improvements following AP in canine hip dysplasia or animal arthritis can hardly be explained as due to patient suggestibility.


Idealists may reject definition (c) as too soft, a cop-out for charlatans and incompetent clinicians. I suggest that it is a realistic recognition of the frailty of human endeavour and of the final and inevitable degeneration of human and animal life. In spite of decades of study of conventional and complementary diagnostic and therapeutic methods, the most skilled, sensitive, loving and intuitive of clinicians will still have failures, even under definition (c).

If we define success as in (c) above (medium-term elimination of most of the severe signs and symptoms, with restoration of body-mind functions to the extent possible under prevailing circumstances), clinical failures may be due to professional error; patient/owner error (non-compliance with advice given); coincidental disorders and inability of target organs to respond. Some patients may be "non-responders".


There are five main sources of professional error: (1) faulty diagnosis, (2) incorrect choice of points, (3) inadequate stimulation, (4) failure to use supportive therapies, (5) premature withdrawal of therapy.

1. Faulty diagnosis

Accurate diagnosis is needed for optimum results to any form of therapy. The cause, nature, location and extent/severity of the dis-ease/lesion/dis-order should be known. First-degree therapy aims to remove/alleviate the cause, to enhance the adaptive response and to provide supportive/symptom-atic relief during recovery.

In practice, many of us have not the training, skill or equipment to make a precise and detailed diagnosis in a conventional sense. Even if we have back-up services, we may put undue emphasis on laboratory or radiological findings. For instance non-clinical mineral deficiency and non-clinical radiological lesions are commonplace and their correction will not improve the health/productivity of the "patient".

I am a Vet who has worked in nutritional/metabolic research (herd or flock disorders) for over 32 years. I think that I am very good at this ! My greatest weakness as a clinician is in the area of diagnosis of individual cases and my failure to keep abreast of developments over the past decades in practice general diagnostics, medicine and pharmacology.

My AP practice is extra-mural (after-hours, weekends). Most of my animal patients are horses (plus a few dogs), usually presented with pain or lameness. About 30% are referred by a colleague and 70% are referred by owners/trainers. Many of my equine cases are not clinically lame but have a history of poor limb action, reduced stride at the gallop, "hanging" to one side or poor racing performance. Most of these would have been seen by one or more colleagues who had made no specific diagnosis. As a result, unless there are visible or palpable lesions, my diagnosis is doubtful in many cases. If the patient has been referred by a colleague who has made a specific diagnosis (based on X-ray, nerve block etc), I usually accept that diagnosis. However, most of my cases have some abnormality of the muscular system (with 1-8 TPs present). Some have bone, joint, periosteal or tendinous problems. Less than 10% have definite muscle atrophy (poor prognosis; see below).

Some of my clinical failures (due to faulty diagnosis on my part) were: in carpitis (carpal chips missed); in septic tendinitis (sesamoideal chips missed); in canine posterior ataxia (degenerative myelopathy missed); in equine cervical ataxia (irreparable myelopathy missed); in equine severe hindlimb lameness (sacroiliac subluxation missed).

Carpitis (carpal chips missed): A gelding was treated successfully for sacro-iliac lameness by injection of AP points in February 1989. In late February, chip-fractures of the both carpi developed. A colleague used arthroscopy on both carpi to remove the chips. The horse was rested until August, when training recommenced. By early September he was in full training and was working well. Suddenly his action became poor and tenderness in the left lumbar area was noted.

Hoof marks on the wall of his box suggested that he had been cast in his box before the lumbar injury. Point injection of TPs and AP points for lumbar lameness between 5/10 and 17/10 had little effect. On 17/10, laser was used on the points, plus the arthroscopy scars. Marked and visible relaxation of the back muscles occurred within 5 minutes. On 18 and 19/10, his hind action was improved but his front action was short and he was hanging on the rein. Further sessions between 20/10 and 4/11 eliminated all TPs but, meanwhile, the carpal area became swollen and hot. X-rays were not taken at the time. Between 4/11 and 11/11, laser (local points plus Ting points) did not help the carpitis. Advised carpal X-ray and Animalintex plaster. On 18/11, X-ray by colleague showed carpal chips. Colleague operated to remove chips. Prognosis poor (second time surgery done).

Septic tendinitis (sesamoideal chips missed): On 11/11, horse with severe lameness due to tendinitis, with marked infection and oedematous swelling of the lower part was presented. The condition had been treated by poulticing and parenteral ampicillin and other antibiotics over three weeks. Laser was applied for 12 seconds to many points over the tendon (medial, posterior and lateral) and to ST36, LI11, LI 4, VG14 and SI, HC and LU Ting points. Five sessions of laser between 14/11 and 18/11 gave a definite decrease in soft tissue swelling but the infection persisted. On 23/11, X-rays showed bone sequestra in the sesamoid area. They were removed surgically. On 9/12/89, the referring vet reported that the prognosis was poor and euthanasia was being considered. Laser gave initial success in reducing soft tissue swelling in < 9 days (6 sessions) but necrotic bone sequestra required surgical operation and laser was discontinued.

Canine posterior ataxia (degenerative myelopathy missed): A German Shepherd was referred in 1986 by a colleague for gold-bead implant treatment of hip dysplasia. (There was pain on compression of the hip area). I assumed that the diagnosis was correct and did not conduct a full clinical/neurological examination. Gold bead (1 mm diameter) implants were inserted "between 9 and 3 o'clock" around the acetabulum, under general anaesthesia. (In hip dysplasia, the response to this treatment is usually marked in the days following implants). In this case, there was no improvement and the dog's ataxia deteriorated in the next few weeks. On re-examination, a diagnosis of degenerative myelopathy was made and euthanasia was advised.

Equine cervical ataxia (irreparable myelopathy missed): In my early days of equine AP, I attempted to treat cervical ataxia (wobbler syndrome) in horses. Diagnosis of the degree of pathology was not attempted. Treatment consisted of needling (usually with electro-stimulation) of TPs, neck points (including GB20, 21, TH and SI points) plus distant points (including SI 3, BL23, VG 3, GB34). In foals with recent signs, the outcome was good to excellent. However, in cases with long-standing clinical signs (> 3 months duration) in older animals, the outcome (in spite of initial and stable improvement, which would have been most welcome if the case was a human or family pet) was unsatisfactory. Most cases were shot eventually. If race-horses cannot race their future is grim, unless they are very well-bred mares. I attribute failure in older horses/chronic cases to irreparable myelopathy.

Equine severe hindlimb lameness (sacroiliac subluxation missed): In 1988, a horse with recent severe bilateral hindlimb lameness following a race and transport in a horse-box was found to have marked tenderness over both sacro-iliac joints. I diagnosed muscular strain in the sacro-iliac area. (In the previous months, I had treated successfully 2-3 similar clinical cases by point injection (5 ml of 0.5% procaine-saline) at 3-4 points over both sacro-iliac joints, plus all TPs, plus BL23, VG 3, GB30). 2-3 sessions of point injection was not successful in this case. I changed the diagnosis to sacro-iliac subluxation and recommended manipulation of both joints. Within days of one session of manipulation (by a human "bone-setter"), the horse became sound. (In April 1990, I met another case. I treated it with laser on presentation, in an attempt to provide some temporary analgesia, but recommended immediate manipulation. The result was dramatic improvement within days).

Now, in cases of sacro-iliac pain, if the height of the sacro-iliac area is the same on both sides (as the horse stands square), I diagnose the case as muscle-strain (likely to respond to AP). If the height is not the same, I diagnose sacro-iliac subluxation (poor prognosis to AP) and I suggest manipulation as the best option.

2. Incorrect choice of points

Failure to locate AHSHI/Trigger points: Experienced clinicians search carefully for TPs at each session. Even experienced clinicians miss them occasionally. It is not uncommon to find TPs on the second or third session which were not present (or were missed) in the first examination. Failure to treat and eliminate TPs can mean that the clinical signs persist in spite of correct use of other (regional and general) AP points.

In patients located far away from base, the cost of time/travel may allow only one visit from the vet acupuncturist, who must rely on the local vet to continue treatment. At the first session, every attempt is made to diagnose the case and to select the best points, as indicated by the first examination. The local vet is advised as to how to treat the points (for instance by point injection) in 2-5 subsequent sessions at intervals of 3-7 days. This may not be very satisfactory, as it is usually impossible for the local vet to re-assess the case (from an AP viewpoint) each time. Therefore, he/she is unable to find/use the most appropriate AP points (especially new TPs) as the case develops.

In difficult cases, AP must be adapted to the individual needs of the patient. Experienced clinicians modify Cookbook prescriptions or include Classical methods in their selection of points in later sessions if the clinical result is not satisfactory after session 2 or 3. Practitioners who rely too rigidly on Cookbook prescriptions (because they have not grasped the basics of Classical AP) often use incorrect or less effective AP points.

3. Inadequate stimulation

A good response to AP needs an adequate stimulus applied to the correct AP points.

Needling: In human AP, failure to place the needle in the correct position, at the correct depth and angle, and failure to obtain DeQi may produce poor clinical results. DeQi is the classical "Needle sensation" (para-esthesia, "pins and needles", numbness, heaviness, sensations running proximally or distally along the course of the meridian; occasionally the sensation may spread to the related organ or body part). In human practice, those who overstimulate in order to ensure strong DeQi may cause more "needle shock" (fainting, nausea etc). Shock may be induced easily in some patients. This may frighten them and they may discontinue therapy.

In Vet AP, it may be very difficult to recognise whether or not DeQi is obtained. In treating difficult animals (especially dangerous horses or dogs), clinicians may not place as many needles as they would wish. They may not be able to place the needles deep enough, may not maintain stimulation long enough, or may not replace needles which fall out before the session is over.

Electro-AP (EA): Some horses react violently to EA. (In those cases, point injection or manual needling/pecking/twirling can often elicit good clinical results).

Laser (especially lower power, used for too short time) may not be as effective as classical needling, EA or point injection. For maximum effect the light beam should be almost parallel and the light-spot should be small (concentrated). Lasers of less than 10 mW/cm sq have little penetrative power and may not reach AP points or TPs in deeper tissue. For large-animal work, output in the range 30-50 mW/cm sq is recommended. Unpulsed lasers do not penetrate as deeply as lasers pulsed at 2000-5000 Hz or more. Dirt on the glass at the probe-tip may limit output. This may not be noticed if the beam is invisible (infra-red). Infra-red lasers with an in-built optical sensor to monitor output power are preferable to those without a sensor.

Faulty lasers may not emit at the stated power or may have too wide an angle of irradiation. Some "laser" instruments are not real lasers and offer little more therapeutic power than a domestic flashlamp !

4. Failure to use primary or supportive therapies

AP can help to control pain and other signs and symptoms in life-threatening disorders, such as acute surgical conditions, acute pneumonia, toxaemia, septicaemia, poisoning etc. But in such conditions, it should be used as a secondary treatment, in combination with primary and supportive treatments.

AP may need to be supplemented by conventional therapy also in less severe conditions, in which there is no immediate threat to life. Two examples are given: infected tendon and incontinence/urinary-faecal retention in disc disease.

In treating an infected tendon, in which there is pus or sesamoideal bone sequestra, antibiotic therapy, drainage and/or surgery may be indicated as primary therapies and AP as a secondary therapy once the infection is controlled and the bone/pus removed.

In disc disease, with paresis/paralysis and urinary-faecal retention, enemas or manual evacuation of the rectum or catheterisation of the bladder may be necessary until rectal/bladder control is established. In cases with faecal-urinary incontinence, general nursing (to try to keep the body/hair-coat dry) helps to prevent excoriation and secondary infection of skin. Reliance on AP alone in such cases may give poor results.

5. Premature withdrawal of therapy

The number of AP sessions needed to elicit the optimal therapeutic response depends on the condition being treated and the ability of the adaptive mechanisms to respond. In acute simple cases, such as myofascial syndromes, 1 to 3 sessions may suffice. In chronic cases, 3 to 10 sessions may be needed. In severe chronic human cases, such as limb paralysis in poliomyelitis, post-CVA etc, therapy may continue for 10-60+ sessions.

A good response to AP may be gradual (i.e. continuous improvement after each session) or sudden (i.e. no change for the first few sessions, then a marked response after (say) the 5th session. Occasionally, little change may be seen until after AP has been discontinued.

Following the first 1-3 AP sessions, there may be one of three responses: no change, improvement in signs, or exaggeration of signs. Exaggeration is usually due to over-stimulation of points. In my opinion, exaggeration is a better response than no change. It suggests that therapy is activating some response and that alteration of the points or a lesser degree of AP stimulus is indicated.

Because the cost of AP therapy must be weighed against the financial value of animal patients, AP may not be attempted in cases with a difficult prognosis. Premature withdrawal of therapy occurs more commonly in Vet AP than in human AP, if acceptable clinical responses are not seen after 2 to 5 sessions in cases which could possibly respond to further sessions.