2. POINTS AND METHODS USED IN THERAPY
ABSTRACT
Acupuncture (AP) therapy is based on stimulation of relevant reflex points. These are the AhShi points, paravertebral (Shu) points and other points with effects on specific organs, areas or functions. The choice of points can be made from traditional horse texts or by transposition of the human AP point system to the equine anatomy, or by combining both systems. Classical AP gives better and more long lasting results than Cookbook AP, especially in complicated cases.
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. Points and techniques used by leading international experts are described for many common conditions in horses. These include lameness, peripheral nerve paralysis, colic, windsucking, heaves, bleeders, infertility and nervousness.
The points may be stimulated by simple needling, electroneedling, point-injection or other methods. The classical method is simple needling for 20 minutes every 1-3 days in acute cases or every 4-7 days in chronic cases. Point-injection is fast, popular and effective in busy practice.
Most responsive cases show improvement after 1-4 sessions but 4-10 sessions or more may be needed in long standing serious cases.
When AP is accompanied with Herbal Medicine, success rates are higher and longer-lasting, especially in internal problems, such as gastrointestinal and respiratory disorders (bleeders etc) (M.J.C)
The locations of the AP points (APs) mentioned in the text are in an Appendix, together with 26 charts and 26 figures.
INTRODUCTION
In classical AP, the practitioner seeks to identify any imbalances in the Jing-Luo (the classical Channel and Collateral) system, now called the Channel-Organ System (COS). These imbalances are corrected by stimulating specific AP points (APs). Unpublished research with thermography in the horse (Cain 1984) suggests that activation of APs causes immediate communication of energy with other points.
It is important to make a correct AP diagnosis before AP therapy is attempted. Cookbook AP is useful for beginners and can give good or excellent results in simple cases but beginners are advised to study AP in depth to get the best results. However, simply selecting tender points (TPs, AhShi points, "sore points") and needling a few points from Cookbook recipes is inferior therapy. Cookbook AP alone, without an adequate knowledge of traditional AP principles (Channel paths, Yin-Yang pairs of Channels, Master Points, Five Phase Theory, Shu-Mu relationships to Channel function etc) gives only mediocre results, at best. For long-lasting results, especially in complicated cases, the practitioner needs to know the classical principles, in order to correct the imbalances in body energies.
Part 2 discusses points and methods used by leading exponents of equine AP. Much of the clinical material was gathered by personal contact with experts and is confirmed by extensive clinical usage. The following areas are discussed:
1.0. Classical tonification and sedation points
1.0.1. Important Shu-Channel relationships
1.0.2. Ting Points in horses
1.1 Musculoskeletal problems
1.1.1. Soreback (thoracic, lumbar and sacral area)
1.1.2. Saddle-sore
1.1.3. Shoulder lameness
1.1.4. Elbow lameness
1.1.5. Hip and thigh lameness
1.1.6. Stifle and hock lameness
1.1.7. Laminitis, navicular disease, foot abscess
1.1.8. Tendinitis, splints, curbs
1.1.9. Azoturia, tying-up syndrome
1.2. Neurological problems
1.2.1. Peripheral nerve paralysis
1.2.2. Radial paralysis
1.2.3. Facial paralysis
1.2.4. Cervical ataxia (the Wobbler Syndrome)
1.3. Gastrointestinal problems
1.3.1. Colic
1.3.2. Windsucking, crib-biting
1.3.3. Gastric ulcer, diarrhoea
1.4. Respiratory problems
1.4.1. Bronchospasm, heaves, bronchitis
1.4.2. Bleeders, lung haemorrhage, epistaxis
1.4.3. Rhinitis, sinusitis
1.5. Reproductive problems
1.5.1. Anoestrus
1.5.2. Cystic ovary
1.5.3. Repeat breeders
1.5.4. Reproductive problems in stallions
1.6. Other clinical uses
1.6.1. Anxiety, nervousness, especially in filly
1.6.2. Skin problems
1.6.3. Cracked Heels
Charts 1-23 (Appendix) show the location of the main APs used in conditions 1.1-1.6.
1.0. CLASSICAL TONIFICATION AND SEDATION POINTS
In TCM/Classical AP, the symptom picture, clinical exam, Chinese Pulses, facial and lingual colour etc may suggest energy (Qi) deficiency (hypoactive Qi = Xu) or excess (hyperactive Qi = Shi) in one or more Channels. Deficiency or excess Qi in a Channel can be corrected by many methods (herbal remedies, fasting, feeding, diuretics, bleeding, fluids, laxatives etc, as appropriate) but AP can also be used according to the Mother and Son Law of the Five Phase Cycle.
For Xu (deficiency) use Bu (tonification) needling: To stimulate (tonify) a weak Channel, one can needle its "Mother Point", manipulating the needle in Bu-style ("Tonification Mode", thrusting heavily and rapidly but lifting gently and slowly, while rotating the needle with small amplitude and low frequency).
For Shi (excess) use Xie (sedation) needling: To pacify (sedate) a hyperactive Channel, one can needle its "Son Point", manipulating the needle in Xie-style ("Sedation Mode", thrusting gently and slowly but lifting forcefully and rapidly, while rotating the needle with large amplitude and high frequency).
TONIFICATION AND SEDATION POINTS
| PHASE | METAL | EARTH | WATER | WOOD | ||
| Mother | Earth | Fire | Wood | Metal | Wood | Water |
| Son | Water | Metal | Earth | Wood | Earth | Fire |
| PHASE | METAL | EARTH | WATER | WOOD | ||||||||
| Channel | LU | LI | ST | SP | HT | SI | BL | KI | PC | TH | GB | LV |
| To Tonify: | 09 | 11 | 41 | 02 | 09 | 03 | 67 | 07 | 09 | 03 | 43 | 08 |
| To Sedate: | 05 | 02 | 45 | 05 | 07 | 08 | 65 | 01 | 07 | 10 | 38 | 02 |
For example, in acute bacterial enteritis, with excess Qi in LI and SI Channels (Metal and Fire), one could sedate LI at the Son (Water) point of LI (LI02) and sedate SI at the Son (Earth) point of SI (SI08), needling in Xie-style ("Sedation Mode"). One could also use fluids, demulcents, intestinal sedatives, antibacterials etc, as needed. In chronic bronchitis, with deficient Qi in the LU (Metal) Channel, one could tonify LU at its Mother (Earth) point (LU09), needling in Xu-style ("Tonification Mode"). These principles are explained in more detail in The Essentials of Chinese AP (Beijing 1993).
1.0.1. IMPORTANT SHU-CHANNEL RELATIONSHIPS
The AhShi points and sensitivity at the Shu points (BL points in the paravertebral area) are most important in the selection of APs in horses. Shu point sensitivity often gives diagnostic information on the location of Channel problems and helps in the choice of APs for therapy.
If the Shu of one Channel is tender, the Shu of its paired Channel may be used also. The pairs are: Fire (HT-SI/PC-TH); Earth (SP-ST); Metal (LU-LI); Water (KI-BL); Wood (LV-GB). Thus, in hindlimb lameness, if BL23 (kidney Shu) is tender, one can add BL28 (bladder Shu) to the prescription.
The Sheng (Mother-Son) relationship is:
FIRE -> EARTH -> METAL -> WATER -> WOOD
Yin Channels: HT, PC -> SP -> LU -> KI -> LV
(HT, PC nurtures SP; LV is nurtured by KI etc)
Yang Channels: SI, TH -> ST -> LI -> BL -> GB
(SI, TH nurtures ST; GB is nurtured by BL etc).
The Sheng (Mother-Son) relationship can be used clinically via the back Shu (Paravertebral BL) points:
The Mother point of HT is BL18 (LV) and of SI is BL19 (GB).
The Son point of HT is BL20 (SP) and of SI is BL21 (ST).
The Mother point of SP is BL15,14 (HT, PC) and of ST is BL27,22 (SI, TH).
The Son point of SP is BL13 (LU) and of ST IS BL25 (LI).
The Mother point of LU is BL20 (SP) and of LI is BL21 (ST).
The Son point of LU is BL23 (KI) and of LI is BL28 (BL).
The Mother point of KI is BL13 (LU) and of BL is BL25 (LI).
The Son point of KI is BL18 (LV) and of BL is BL19 (GB).
The Mother point of LV is BL23 (KI) and of GB is BL28 (BL).
The Son point of LV is BL15 (HT) and of GB is BL27 (SI).
The Mother point of PC is BL18 (LV) and of TH is BL19 (GB).
The Son point of PC is BL20 (SP) and of TH is BL21 (ST).
If there is weakness (deficiency) in a Channel, the Shu of the Mother Channel can help. If there is hyperactivity (excess energy) in a Channel, the Shu of the Son Channel can help. Thus, in weakness of KI, one could use the LU Shu (BL13) with other points; in weakness of LI, one could add the ST Shu (BL21). In excess of HT, one could add BL20 (SP Shu). In excess of ST, one could add BL25 (LI Shu). (See section 1.0. (above) for the more classical method).
Injury to Shu points, or to key APs, can have effects far more serious than "local injury" in a western sense. It may induce signs and symptoms in the associated organ or Channel and in related Channels. Injury to the paravertebral area from the withers to the tail, whether due to incompetent riding, badly fitting saddle etc must be identified and treated as quickly as possible.
Those who have not used AP in horses should study the references and, if possible, attend professional veterinary AP teaching seminars before trying to use the method. The information which follows is aimed at colleagues who know the basics of AP rather than at complete novices of the technique.
APs seem to have properties like magnetic vortices: they can receive and transmit electromagnetic signals. A point which is too deep to reach by the needle (such as KI24,25,26 on the chest wall medial to the shoulder muscles, or ST29,30 and SP12 in the abdominal muscles medial to the thigh muscles) can be acted upon by inserting a needle pointed towards the point, although the needle may not reach the point (M.J.C). The vortex theory is supported by the powerful effect of superficial implants in lameness of deep tissues or joints in horses and dogs. The implants (gold beads, orthopaedic suture wire etc) are dropped at whatever depth DeQi arrives (usually less than 1.5 inches (M.J.C). (See hip lameness, 1.1.5 below).
See Appendix 1 for details of the points and Channels (figures 1 to 26).
1.0.2. TING POINTS IN HORSES
The Ting Zones, located 1-2 cm above the hoof-hair junction, are the most distal points on each Channel. Are Thoresen (Norway) pioneered their diagnostic and therapeutic use in horses. He found that stimulation of a distant reactive body AP point on the affected Channel caused complete disappearance of the pitting in the reactive Ting Zone, within seconds. This effect was visible from several metres away. The speed of this reaction indicates that the reactivity at the Ting Zone is functional and it confirms the connection between the Ting Zone and the Channel concept of TCM.
Stimulation of the correct Ting Zones causes a biological response in the microcirculation and in the affected organ(s), part(s) or function(s) and can influence all other reactive Zones on the affected Channel, especially the Shu points, as well as the parts traversed by the Channel. Thoresen found (and we have confirmed) that needling the appropriate (usually reactive) Ting Zones can sedate ("satisfy", "cool" or obliterate reactivity from) reactive Shu points, or AhShi points elsewhere on the body within 2-15 minutes (and sometimes within 10 seconds).
Where more than 1 reactive Ting Zone is present, needling of the primary one (according to Five Phase Theory) is often followed by disappearance of the secondary Ting Zones within seconds.
Location of Ting Zones in horses
Zones 1 and 7 medial side of the fore and hind hoof respectively, 1-2 cm anterior to a line with the posterior edge of the coronet.
Zones 2 and 8 medial side of the fore and hind hoof respectively, about 1/2 of the distance between Zones 1 and 3 or 7 and 9 respectively.
Zones 3 and 9 anterior midline of the fore and hind hoof respectively.
Zones 4 and 10 lateral side of the fore and hind hoof respectively, about 1/2 of the distance between Zones 3 and 5 or 9 and 11 respectively.
Zones 5 and 11 lateral side of the fore and hind hoof respectively, 1-2 cm anterior to a line with the posterior edge of the coronet.
Zones 6 and 12 in the hollow of the heel of the fore and hind foot respectively, on a line joining the highest point of the horn on the medial and lateral side of the hoof.
Zone 1 (HT09) (forelimb, posterolateral zone) relates to the Heart Channel. The horse often pulls up towards the end of the race for no apparent reason, especially in very hot or very cold weather. There can be lameness in different joints, which may alternate from time to time. Although the HT Channel relates to the forelimb, the lameness may also affect a hindlimb. Zone 1 is often reactive in overexertion. (See Zone 5). It may be reactive in bruised sole/soft horn, laminitis and flexor tendon strain.
Zone 2 (SI01) (forelimb, mid lateral zone) relates to the Small Intestine Channel and arteries, especially the larger vessels. The symptoms may be similar to those of Zone 1 but are less obvious or less severe. There are often intestinal problems, especially jejunal (colic, pain) and these often arise with change in feeding or a new supply of hay. This Zone often reacts in forelimb deep flexor tendon problems. It is often reactive together with Zones 10 and 11 (see below).
Zone 3 (TH01) (forelimb, anterior zone) relates to the Triple Heater Channel, skin microcirculation and especially to mucosae and joint cavities. There tends to be a recurrent sinusitis and the serous fluid in the joints is often too thin. The history often mentions frequent injections of hyaluronic acid. Zone 3 is often reactive in sore heels/heel haemorrhage, cracked heels and hoof-bend bleeders. The lesion in these cases is near Zones 6 and 12.
Zone 4 (LI01) (forelimb, mid medial zone) relates to the Large Intestine (Colon) Channel and to muscles of the forelimb and shoulder area. Faeces may smell sour and their consistency may vary widely. The case often shows purulent nasal discharges. Very often the horse pulls to one side in training or racing and does not want to lead, but prefers to run with a follower group. Trotters (which should not gallop) tend to gallop in the bends and may show signs of pain in the shoulder. Its therapeutic uses include neck problems, (reactive LI16-18, BL25), sinusitis, ankle (forelimb fetlock) problems and inside forelimb splint problems (M.J.C).
Zone 5 (LU11) (forelimb, posteromedial zone) relates to the Lung Channel. This Zone reacts often when the horse is forced to breathe dusty, stale or polluted air, or has been raced in cold weather. Zone 5 indicates whether left or right lung is affected. (The ipsilateral Zone is reactive). Zone 5 is nearly always reactive in overexertion (see Zone 1), in lung disorders and in poor quality horn (soft, easily cracked or too thin), bruised sole. Its therapeutic uses include respiratory problems, respiratory bleeders (reactive BL13, 13a, 41-47), inside forelimb splint problems, infection (M.J.C).
Zone 6 (PC09) (forelimb, between and above heel bulbs) relates to the Pericardium (Circulation-Sex) Channel, which influences the psyche and sexual hormones. The symptoms include changes in sexual behaviour, sweating, nervousness, forelimb superficial flexor tendon problems. Zone 6 is not a diagnostic Zone for beginners, as outlined below. It does not react in ways that can be detected manually by novices. It is included here to complete the systematic AP schema and because it is a valuable therapeutic Zone. Its choice is dictated by the history and symptoms.
Zone 7 (BL67) (hindlimb, posterolateral zone) relates to the Bladder Channel and the paravertebral muscles from neck to tail, in the area from the midline to 20-30 cm laterally. It relates to the hindlimb flexor tendons, especially the superficial flexors. In humans, the BL Channel is often related to headaches. Horses which are seen nodding, headpressing or headbanging often respond immediately to one treatment at Zone 7 and the response is longlasting.
Zone 8 (GB44) (hindlimb, mid lateral zone). The horse has no gallbladder but functions of the Gallbladder Channel in man are similar in the horse. Zone 8 relates to the GB Channel which relates to the back and head lateral to Zone 7, i.e. paravertebral in an area 30-60 cm lateral to the midline. It is strongly related to the hip joint and to the area of insertion of the Longissimus dorsi muscle to the tuber coxae. Marked pain sensitivity in the hip or tuber coxae area is usually associated with reactivity of Zone 8. The horse does not race well and pulls to one side. Trotters may gallop in the straight as well as on bends (see Zone 4). There may be recurrent colic (see Zone 2), especially at night. (Midnight is the hour of the GB energy in TCM).
Zone 9 (ST45) (hindlimb, anterior zone) relates to the Stomach Channel. This Channel relates to appetite, stomach function, mastitis and stamina in humans. Zone 9 is very important in cattle (mastitis) but horses rarely show reactivity at this Zone. It may be reactive in thoracic stiffness and in bone spavin. Its therapeutic uses include stifle problems, (reactive BL21, ST10, 25a, stifle points in the muscle groove below the tuber ischii), colic, toothache (M.J.C).
Zone 10 (LV01) (hindlimb, mid medial zone) relates to the Liver Channel, digestion, food allergies, detoxification, eye diseases, problems of the medial hindleg muscles, also to general musculature and fitness. It is one of the most common to be found reactive in the horse. Its value in therapy is enormous. It is reactive in hindlimb lameness, generalised muscle cramp (azoturia, tying-up syndrome, Monday morning disease, Easter disease, muscular dystrophy etc). Because of the importance of optimum muscle fitness in the horse, the importance of Zone 10 in diagnosis and therapy is obvious. It is also reactive in allergies (urticaria, food allergy etc) but not in dust allergy (see Zone 5). Zone 10 is often reactive together with Zones 2 and 11 (see).
Zone 11 (SP01) (hindlimb, posterolateral zone) relates to the Spleen-Pancreas Channel. In humans, this relates to digestion, reproduction, the muscles and the psyche. In horses, is diffuse. It is often reactive with Zones 2 and 10 (see). It may be used in prognosis with Zone 10 in muscle problems. If both Zones 10 and 11 are reactive together, the prognosis is bad and recovery may take several months. Even in cases where is reactive on its own, the prognosis is bad. The signs often are confined to the hindquarter, especially during racing. A change of diet (especially hay) can shorten the recovery time when is reactive. Homoeopathic Arsenicum album D12 and Plumbum metallicum D30 (3 pillules each/day) also help to shorten recovery time by about 1 month in these cases.
Zone 12 (KI01) (hindlimb, between and above heel bulbs) relates to the Kidney Channel. The symptoms include stiffness or weakness of the lumbar area, stifle problems, bone problems (tendency to weakening, fracture, bone spavin etc), tendency to abortion and a very unreliable (dangerous) psyche. Nearly all horses with those symptoms benefit from treatment at Zone 12 and most horses between 1 to 2 years of age can also benefit from it. Zone 12 is not a diagnostic Zone for novices, as outlined below, as it does not react in ways that can easily be detected manually. It is included here to complete the systematic AP schema and because it is a valuable therapeutic Zone. Its choice is dictated by the history and symptoms.
Most details on the use of Ting Zones are from Thoresen's paper on the subject. We (Cain & Rogers), Peggy Fleming, Dominique Giniaux, Emiel van den Bosch and others, have confirmed the value of Ting Zone therapy in horses.
Clinical uses of Ting Points in horses
Ting points can be used in organic syndromes as well as in functional disorders. Thoreson has treated more than 10 cases of bone spavin. Zones 9 and 12 (ST and KI) were usually reactive. Treatment at these Zones, plus 2 Dermojet treatments of the reactive (pain) point on the ear, gave improvement in all cases and about 90% were clinically cured and remained sound for more than 1 year.
Abortion: Add the relevant Ting point, especially KI
Bone spavin: Add the relevant Ting point, especially ST, KI
Bronchitis/cough/lung disorders: Add the relevant Ting point, especially LU
Colic, acute: Add the relevant Ting point, especially LI, SI, KI, GB
Cracked heels arise when Channel blockage is present over a period. Use of Ting Points predictably cures cracked heels in 5-7 days, even in severe long-lasting cases, especially if LU or LI are involved (M.J.C).
Diarrhoea: Add the relevant Ting point, especially LI, SI, LV, SP, ST
Dust allergy: Add the relevant Ting point, especially LU, LI, TH
Flexor tendon strain: reactive Ting Zones especially from LI, PC, TH, KI, BL, HT, SI. The usual interval to clinical success was 1-35 days, (mean of 2 weeks) and most could resume full training in 3-6 weeks. In acute cases of tendovaginitis, training may be resumed in 1-2 weeks. Tendovaginitis: Add the relevant Ting point, especially TH, LI, SI
Food allergy: Add the relevant Ting point, especially LV
Headache (headpressing, headbanging, nodders): Add the relevant Ting point, especially GB, BL
Joint pain, arthritis, uncomplicated strains: all reactive Ting Zones
Lung bleeders: Add the relevant Ting point, especially LU
Male viciousness, hitter, biter: Add the relevant Ting point, especially SP, PC, KI
Overexertion: Add the relevant Ting point, especially HT, SI, LU
Polyarthritic shifting lameness: Add the relevant Ting point, especially HT, SI, TH
Pulls to one side (check atlas !): Add the relevant Ting point, especially LV, GB
Sexual/reproductive/Female infertility/Nymphomania: Add the relevant Ting point, especially HT, TH, KI, LV, PC
Skin: Add the relevant Ting point, especially LU, TH, SP, LV
Sole haemorrhage/trauma, soft horn: Add the relevant Ting point, especially LU, HT, SI
Tracheitis: Add the relevant Ting point, especially LI, LU
Tying-up syndrome: Add the relevant Ting point, especially LV, SP
Urticaria: Add the relevant Ting point, especially LV, LU