1. INDICATIONS AND CONTRAINDICATIONS

ABSTRACT

Acupuncture (AP) has major effects on the autonomic, nervous and endocrine systems. It has immunostimulant, immunosuppressive, analgesic and antiinflammatory effects. It can influence the physiological processes of all major systems. It has therapeutic value when the affected organ or function is capable of responding through the normal response mechanisms. AP is physiotherapy at its most powerful.

 

The main indications for AP therapy are functional disorders of the musculoskeletal, nervous (central or peripheral), gastrointestinal, reproductive, urinary and respiratory systems. Certain conditions of the skin and eye can be helped. The most important indication is in muscular lameness (neck, back, limb muscles) and in poor athletic performance due to soft tissue involvement. Milder or more acute problems usually respond faster and better than chronic problems. However, many chronic diseases, (including chronic laminitis and navicular disease) and certain serious acute diseases (including severe non-obstructive colic) can respond.

 

The main contraindications are severe organic disease in which irreversible change has occurred already (calcification, fracture chips, cancer, necrosis, fibrosis, degeneration, degenerative myelopathies). Although AP may help to control symptoms in toxic, infectious, nutritional and neoplastic diseases, its use as a primary therapy in such cases is contraindicated but it could be combined with chemotherapy, other therapies and dietary supplementation.

 

The cost factor may be an important contraindication. A prolonged course of AP might not be justified on economic grounds in horses of low cash value, whereas it might be justified in horses of great cash- or sentimental- value.

 

INTRODUCTION

Specific areas (Trigger Points (TPs) and the AP points (APs), usually in muscle and skin) often become tender in response to pathogenic irritation of organs or body parts. Segmental, intersegmental, supraspinal and autonomic reflexes mediate this response. Tenderness or increased sensitivity of the TPs and APs may be found by firm palpation or by the response to constant thermal or electrical stimuli applied to the points. Alternatively, electrical resistance-, impedance- or conductance- meters may be used to detect the increased permeability of the skin points. As these points related via the nervous system to the affected parts, stimulation of the points by , TENS, needling, point-injection and other methods can evoke a reflex therapeutic response in the affected organ or part. The diagnostic and therapeutic efficacy of the organ-point relationship is possible only if the nervous system is functional and if the affected part is capable of the desired physiological response.

 

AP influences all physiological systems, including the nervous (central, autonomic and peripheral), endocrine, musculoskeletal, gastrointestinal, urogenital, respiratory and skin. It has analgesic, antiinflammatory, immunostimulant and immunosuppressive effects. It has antispasmodic effects on striated and smooth muscle. It has marked effect on blood micro-circulation, cell metabolism and glandular secretion in organs related to the APs being stimulated.

 

AP is a most powerful physiotherapy. Its therapeutic effects are mediated by the reflex system and by activation of spinal and central neuroendocrine and systemic responses. Its therapeutic value lies in its ability to induce homoeostasis. For example, needling ST36 (TsuSanLi) can control gastric spasm in one case and gastric atony in another. The same point can have diametrically opposite physiological effects, depending on the homoeostatic needs of the body at that time.

 

Therapeutic effects of AP are possible only when the normal physiological mechanisms of the body are capable of response. For example, AP can have little or no effect on paralysis due to spinal transection, motor neuron degeneration (German Shepherd syndrome) or severe damage to motor centres in the brain. However, AP can accelerate recovery in paralysis due to peripheral nerve trauma or radiculopathy due to soft tissue inflammation or in CVA cases where paralysis is due mainly to vasospastic ischaemia of the motor centres. AP may be useless in severe fibrosis of the liver or kidney but it can help in early hepatitis or nephritis, before the pathological changes have become severe or irreversible. In humans and animals, AP can be very helpful in bronchospasm but may be of little use in emphysema, in which severe rupture of the alveolar sacs has occurred.

 

The prognosis for full recovery is very good in paralysis due to cervical radiculopathy, if the symptoms are due to soft tissue swelling with very minor damage to the motor neurons or tracts but the prognosis is very poor if neuronal degeneration is severe.

 

The contraindications include neoplasia and severe organic disease. Although some claims are made for effectiveness of AP in tendinitis, many experts got poor results in these cases. Tendinitis responds poorly to AP of Local points over the tendon but Laser or "Plum Blossom Needling" may give a better response.

 

Although AP may help to control symptoms in neoplastic, toxic, infectious and nutritional diseases, its use as a primary therapy in such cases is contraindicated but it could be combined with chemotherapy, other therapies and dietary supplementation.

 

Table 1 summarises the more important indications for AP in horses but it is not a complete list. For example, AP can help in splints (especially inside splints), curbs, tying-up (azoturia) and skin problems (M.J.C).

 

CONCLUSIONS

AP has many applications in equine practice. The conditions covered in this paper are only some of those which can be helped by AP. The success rate in many conditions is above 70%, especially in many lamenesses, functional diseases and infertility. Success often can be attained in 1-3 sessions at intervals of 1-3 days (acute cases) or in 1-10 sessions at intervals of 4-7 days (chronic cases).

 

The value of thoroughbred stock, stabling and training costs, the value of a foal in infertility cases are considerable. The AP technique is very safe if it is used properly (Rogers 1981). Therefore, AP must be deemed to be a valuable therapy for use on its own or in combination with other methods in thoroughbred practice.

 

Part 2 of this paper deals with the points and methods used in many common disorders of the horse. These are good indications for AP in horses but must not be interpreted as an exhaustive list. AP is a very versatile technique and offers much to the busy practitioner, the client and the patient.

Table 1. Some of the more important indications for AP in horses.

Condition	Author	% Success rate	Sessions	days between sessions
				Acute	Chronic
MUSCULOSKELETAL		20-100	1-12	0,5-4	3-7
Soreback (thoracic, lumbar, sacral)	Ca Jo Kl Ko Ku Ro Wh Y	75-85 (short term) 20-80 (long term)	2-10	0.5-1	5-7
Saddle-sore	Ca Jo Ro Y	80-100	2-4	1-3	3-4
Shoulder lame (acute, chronic)	Ca Ku Ro Wh	80-90 (v. few relapse)	2-6	1-3	3-7
Elbow lame	Ca Ro We	70-80 (?)	1-3 recent 3-8 chron.	1-3	3-7
Hip, thigh lame	Ca Ro	70-80 (?)	same	same	same
Stifle lame	Ca Je	> 90	1-2	2-4	3-7
Laminitis	Ca Kl Ku	80-90 80-90	1-4 (3) 1-12 (6) 3-7	2-4	3-7
Navicular	Ca Jo	>80 (?)	6		3-4
Foot abscess	Jo	>80 (?)	?	?	?
PERIPHERAL N. PARALYSIS
Radial n. paralysis	Ca Hw Wh Y	90 (recent) 50-70 (> 2 weeks)	1-4 1-10	1	3-7
Facial n. paralysis	Ca Wh	?	1-10	1	3-7
Wobbler, cervical ataxia	Ca Je Ro	50-80 recent 0-40 chronic	1-10 4-30	1-3	4-7 4-7
GASTROINTESTINAL
Colic (sand, gas, bloat)	Ca Ko Ku Wh	80-100	1-2	0.5	1-3
Windsucking	Ku	67		2-6 (3)	2-5 (4)
Cribbing	Ku	29		2-6 (3)	2-5 (4)
Gastric ulcer	Ro	100 (2 cases)	2	-	7
Chronic diarrhoea	Ro	33 (3 cases)	3-5	-	7
RESPIRATORY	Ko Ku	Poor	1-6	1-3	3-7
Heaves (no emphysema)	We Y	50-85	4-8	1-3	3-7
Bleeders	Ca Je Ro	75-90	1	-	-
Rhinitis	Y	> 90	3-5		3-4
REPRODUCTIVE	We Ca	60-70	2-4	5
Anoestrus	Hw Jo Ku Wh Y	50-100	1-10(4)	1-5 (3)
Cystic ovary (better in luteal cysts)	Je Jo Ro Y	75-90	2-5 (3)	3-4
Repeaters	Ca Je Jo Ro Wh Y	70-95	1-8 (3)	3-4
Stallion problems	Jo	good	?	?	?
NERVOUS esp. female	Ca	good	1 (implant)	-	-

 

Ca=Cain Hw=Hwang Je=Jeffries Jo=Johnson Kl=Klide Ko=Kothbauer Ku=Kuussaari

Ro=Rogers We=Westermayer Wh=White Y=Grady-Young

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