NON COMPLIANCE OF OWNER/HANDLER
Failure to use supportive methods: In large stables, owners and trainers frequently have little to do with individual horses. They delegate day-to-day responsibility for the care and management of patients to a groom/ handler who may be over-worked, under-paid, incompetent, apathetic, or (rarely) malevolent. It often happens that handlers are changed frequently, i.e. different handlers may be responsible for the patient from day to day or week to week. Instructions given to one handler may not be passed on (or carried out) by other handlers. As in orthodox vet practice, even when only one handler is involved, instructions to administer specific supportive treatment (medical, homoeopathic or physical), or to exercise the patient in a specific way, may not be carried out.
Failure to give physiotherapy between AP sessions: If other physiotherapy (for instance TENS) is not available, I usually ask that TPs in muscle be fisted (thumped gently but firmly with the closed fist) for 4-6 minutes each day between AP sessions. In my experience, when this is done, fewer AP sessions are needed and clinical recovery is faster. I attribute most of my failures in simple TP cases to non-compliance with that request or to the owner/trainer refusing to have further sessions of AP if 2 or 3 sessions had not been able to restore locomotor function on its own.
Failure to accept advice re use of "Allweather" tracks: A famous trainer was advised by three different vets not to use the "Allweather" track for speed-work for a potentially great colt. (Each time the colt was galloped on the "Allweather", he came in lame). AP at TPs and regional points successfully treated a long-standing back muscular lameness in 2 sessions, after which the colt won an Irish Classic race. One week after the win, the trainer insisted in using the "Allweather" and the horse came in acutely lame again, this time with TPs in the scapular muscles. (The colt was to run in an English Classic within 14 days). Four days after the injury, one session of AP at the TPs and regional points restored locomotor function in 36 hours. The manager was instructed to examine the colt daily for TP tenderness at the clipped points and to inform me within 3-4 days if tenderness persisted there. The training speed was so good that the trainer instructed that AP was not necessary, even though the TPs were still tender and his manager had told him of my advice. On the day before the second race, the TPs were still present. The colt ran a poor last in that race.
Failure to rest horses with strained tendons: In treating horses with tendinitis/bowed/strained flexor tendons, rest is very important when the tendon is "hot" or painful. In all my cases in which laser treatment for simple tendinitis failed, the owner/trainer refused to rest the patients and to re-introduce them gradually to full work, as I had instructed.
OTHER REASONS FOR FAILURE
Coincidental disorders
Ideally, AP therapy aims to normalise all the functions of patient, not just the presenting signs. In practise, however, this ideal may not be attainable. Coincidental problems may be present at presentation, or may arise during the course of successful AP therapy for a specific complaint. These coincidental problems may (or may not) be helped by further sessions of AP.
For example, a human patient may present with acute sciatica (in which AP could be highly successful) but may have a coincidental history of Parkinson's disease, chronic cardiac insufficiency or diabetic neuropathy (in which AP might have little to offer). In practise, one might treat the sciatica but advise the patient to seek specialist help for the other disorders.
Early in 1990, a horse was presented with a history of poor hind action since purchase some months before. The horse had been rested, except for walking and cantering exercise. On examination, TPs were found in the sacral area. Laser and needling of TPs and points such as BL23, VG 3, GB34,44 eliminated the TPs by the 3rd session. During therapy, mild exercise continued and the horse developed abrasions on both hind fetlocks. Acute inflammation of the fetlocks ensued. It was treated with antibiotics. Exercise was stopped and the horse was sent home to allow the inflammation to subside.
Inability of target organs to respond
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. Loss of function due to severe fibrosis of lung, liver, kidney can not be reversed by AP. Paralysis due to large-scale cerebral or spinal motor-neuron necrosis or due to section of the spinal cord can not be reversed.
Muscle atrophy in human patients usually has a poor prognosis if associated with motor-neuronal pathology. In spite of intensive physiotherapy 3-5 times/week for 6-12 months, many patients do not respond.
My experience of muscular atrophy in animals is limited mainly to horses showing atrophy of the sacral or rump area in association with myofascial syndrome or a history of lumbar or sacral injury and to dogs with German Shepherd syndrome. The prognosis to AP in such cases is poor, even if it can eliminate muscular pain and TPs. AP therapy usually fails to resolve the muscle atrophy and to restore full function and proper placement of the affected limb. This may be a minor drawback in pets or non-athletic animals but can eliminate any possibility of success as regards top competitive performance (racing, show-jumping, competitive dog shows etc).
Infertility due to blocked oviducts: In some cases of female sterility, the cause may be bilateral oviductal occlusion due to previous inflammation or adhesions. AP may not restore patency of occluded ducts.
Ovarian pain: I have treated a few fillies with recurrent hind-limb lameness arising within 10 days pre- to 10 days post- ovulation. In all cases, TPs were present in the area L2 - L4 (and occasionally in other reflex areas for the ovary-uterus), usually ipsilateral to the affected limb. In some cases, a colleague had found severe pain on ovarian palpation on the same side as the TPs. I diagnosed hind-limb pain referred from the ovary in association with ovulation pressure-pain/haemorrhage. AP at TPs and ovary-uterus points eliminated the TPs and gave good short-term clinical response but the condition (and TPs) recurred at the next ovulation. I would be reluctant to attempt AP in such cases in future.
Psycho-somatic dependence in humans
"Miraculous cures" in terminal or hopeless cases are well known in human medicine. They are attributed usually to inexplicable spontaneous remission. A positive attitude, a deep religious belief, the "will to live" or a "fighting spirit" are often involved. In other cases, with relatively minor pathology, patients may deteriorate rapidly and may die. Such cases are often associated with negative attitudes, pessimism or depression. Medical hypnosis is used successfully to treat organic as well as functional problems. Thus, the psyche may modulate the pathogenesis and resolution of many human somatic disorders.
The psyche is also important in human social interactions. Patients may use their illness" to attract attention" from loved-ones, to excuse their failure in family or work activities etc. For such patients, AP alone may be of little help, as they may not "want" their illness to be cured. Cure in such cases would need psycho-therapy/counselling etc to help the patient face up to (and defeat) the reasons for their psycho-somatic dependence on their clinical disorders.
Failure due to unknown causes (in spite of AHSHI points)
In many clinical cases, it is possible to make only a partial diagnosis. For example, hindlimb lameness in a horse may be attributed to muscular pain referred from clinically detected TPs in the lumbo-sacral area. But the precise cause of the TPs may remain unanswered. (Are they due to primary muscle strain, or are they recruited as secondary TPs to primary TPs elsewhere, or to pathology elsewhere (referred from spinal nerve pressure/entrapment, or referred from irritation of associated organs etc ?)). AP (including TP therapy) in such cases may lead to some failures, even though the TPs may disappear during therapy.
Carpal oedema: On 24/11/89, a foal was presented with marked oedema of the left carpus. No pain or heat was obvious. The foal had been bought about 2 weeks before that and the swelling had been present for some weeks before purchase. The cause was thought to be traumatic. X-rays were negative. Poultices had been applied without success. The foal was due for resale in 14 days. Between 24/11 and 6/12, 6 sessions of laser (local points plus points for the region) gave dramatic results. Daily massage was used to try to disperse the skin folds left after the oedema disappeared. On 7/12, the left carpus looked fine but on 8/12 it had swollen up as bad as before. The cause of the relapse is unknown.
Some patients may be "non-responders"
Genetic or acquired damage to neural circuitry may produce "non-responders" to AP therapy. Apart from the ability of target-organs to respond, the clinical response to AP depends on intact transmission of stimuli from the periphery, to the ascending tracts of the spinal cord, to the CNS, to the descending spinal tracts. Synaptic transmission of stimuli depends at each level on neuro-transmitters and their receptors.
Defective synthesis of neuro-transmitter or reduction in the number of receptors can block transmission. Certain strains of mice (CKBX) are genetically deficient in opiate receptors. These mice respond poorly or not at all to opiate analgesics or AP analgesia.
Karma ?
The concept of Karma teaches that the main events of our lives are pre-destined, as part of an overall Divine plan for our (and human) personal growth and maturity. In this concept, we must all suffer pain, loneliness, hunger etc as well as pleasure, companionship and plenty.
In the concept of Karma, one's disease may be part of the growth process and will not be cured until the reason for the lesson is learnt. In the end, we all die, in spite of every human physical and intellectual effort to save us.
The concept of Karma is scorned by most westerners. But those who scorn are not always correct.