1.1 MUSCULOSKELETAL PROBLEMS
(Kothbauer; Westermayer; Jeffries; Hwang; Grady-Young; Kuussaari; White)
The paravertebral Shu are helpful diagnostic points to isolate Channel lameness. Once the Channel(s) are identified, all anatomical structures under or nearest to that Channel path are considered (and palpated). For example, the LI Channel passes through or near the intermediate and 3rd carpal bone, the inside shin, the osselet under the medial digital flexor tendon, the inside splint, anterior branch of suspensory ligament, shoulder bursa etc. In tenderness of BL25 (lumbar 4-5, large intestine Shu), the lameness may lie in those structures, if it is not due to primary strain of the lumbar area, or referred from the organ. Thus BL25 may relate to anterolateral forelimb lameness above the carpus or the anteromedial forelimb below the carpus. In such cases, apart from needling the affected Shu and other key points, one should balance the paired Channel of LI (LU) by needling BL13 (LU Shu).
Check for diagonal relationships. Forelimb lameness is often accompanied by AhShi (tenderness) at contralateral lumbosacral or hindlimb points (M.J.C). Also, hindlimb lameness is sometimes associated with AhShi points on the contralateral side of the neck.
Forelimb lameness: Add the relevant Ting point, especially LI, LU.
Hindlimb lameness: Add the relevant Ting point, especially SP, KI, LV.
Search for tender points in all local problems (neck, shoulder, elbow, back, thoracolumbar, lumbosacral, hip, stifle, laminitis etc). These are the Trigger Points (TPs), Pain Points, or AhShi Points. Check especially the paraspinal area (neck and interscapular area in forelimb problems; thoracolumbar and lumbosacral area in hindlimb problems).
Ovarian or uterine irritation in mares and fillies, may cause severe sporadic lameness due to referred pain (hindquarter, hunched or rigid back and, occasionally, forelimb lameness). This may occur in cystic ovary or at the time of ovulation if there is a lot of local haemorrhage. It is essential in such cases to check for AhShi points related to the ovary and uterus (see section 1.5 below).
Experts locate the Channel imbalances and choose points according to Five Phase Theory (Sheng and Ko Cycles) and the relevant Ting and/or Shu points. If the Command Points are dangerous to needle (too distal on the limbs or in other sensitive areas), they can be treated by painless methods (Laser, LACER etc). This minimises the number of needles and sessions needed. It also gives longer lasting results than the Cookbook method.
Use AhShi points, Local points, Region points. Consider points with potent actions: BL11 (bones & joints); BL40 (hindlimb & back); LI04 (forelimb & general effects); ST36 (hindlimb & general effects); ST44 (hindlimb); TH05 (forelimb); GB34 (hindlimb, muscles, tendons, neck, shoulder & elbow); GV03 (BaiHui) (hindlimb, lumbosacral area, general effects); BL23 (lumbosacral and hindlimb, adrenal point (all stress conditions), ovary/kidney/Vitamin D/parathyroid/bone point & general effects).
Problems of the back, sacral- and gluteal- area respond better and longer and need fewer sessions if AP is combined with spinal manipulative therapy (M.J.C).
Treat for 20 minutes, 2-4 times at intervals of 1-2 days (acute) or 3-7 days (chronic). White suggests electro-AP for 20 minutes, repeated every 12-24 hours in acute cases with severe pain or paralysis. Before using electro- AP, ensure that the horse has not had adverse electrical experience in the past (electric goad etc).
1.1.1. Soreback (thoracic, lumbar and sacral area) (Fig. 1)
(Cain; Kothbauer; Kuussaari; Klide; Grady-Young; Johnson; Rogers; White)
Search the back and paravertebral muscles for AhShi (tender) points. If the tail twitches during riding, this indicates AhShi at BL23 (kidney Shu). Use all AhShi points. Add BaiHui and points from BL18 (ICS 15) to BL26 (L5-L6) and BL28,30 (foramina S2,4) or points from BL17 (ICS 14) to BL25 (L4-L5) and BL27,29 (foramina S1,3). Use the more anterior points if the pain is more anterior. Consider also GV12; BL31,34,54 and the point at the meeting of the scapula and the anterior edge of the scapular cartilage (TH15 = TCVM PoChien).
Spinal and paravertebral muscle pain (cervical, thoracic, lumbar, sacral): Add the relevant Ting point, especially KI, GB, BL.
Lumbar weakness: Add the relevant Ting point, especially BL, KI, SI.
Treatment: injection, simple needling, electro-AP (20 seconds/needle) or Laser. Treat 1-2 times/week (usually every 5 days) for 2-10 times. In acute cases, with severe pain or paralysis, treat every 12-24 hours. Relapse within 6 months after successful treatment may be 5-50%.
1.1.2. Saddle-sore (Fig. 2)
(Cain; Grady-Young; Johnson; Rogers)
In all cases of "saddle-sore", check the design and fit of the saddle and the habits, skill, balance and of the usual rider. Advise on necessary correction of detected faults. Advise the use of high-quality saddle-pads (especially cellular, gel-filled saddle pads, for the first few weeks after treatment.
Pain, stiffness, rigidity in the area of the saddle, is treated as in 1.1.1, above. Tenderness near BL18 (liver Shu) may be associated with a muddy colour of the mucosa of the eye. (The liver controls the eye in TCVM).
Use AhShi points plus BL points, especially BL21,23,25. Add the relevant Ting point, especially ST, SP, GB, LV, HT, LU, as may be indicated by the findings of the AP examination.
Treatment: Inject procaine-B12 (9 ml 1% procaine + 1 ml B12; 3000 units/ml at each point), using 19g needle, depth 3-4 cm (or)
needle or electro-AP 20 minutes; 2/week; 2-4 times.
1.1.3. Shoulder lameness (Fig. 3)
(Cain; Kuussaari; Rogers; White)
Check for cervical subluxation, especially in the area C6 to T1. See the LI, SI and TH Channels (Appendix). Check TH16 (endocrine), BL22 (TH Shu, endocrine), BL27 (SI Shu), BL25 (LI Shu).
SI10, if still tender after proper Channel balancing, is diagnostic for LOCAL shoulder lameness (OCD). TH14 may be tender in shoulder lameness but true joint lameness (OCD) is rare. More often, the lameness is muscular, referred from subluxation of vertebrae C6-T1, via the brachiocephalicus m., attached to the humeroscapular joint. Painful shoulder or neck can cause spasm of that and other muscles and a choppy forward stride on the ipsilateral forelimb. If the problem is ovarian, treat BL22 (TH Shu) and the sensitivity at TH16 usually disappears. If the problem is shoulder lameness, treat TH14 and SI10, with BL22 and 27 (Shu of TH and SI). If the shoulder pain is referred from the neck, treat the neck, with vertebral adjustments, if needed (see 1.2.4).
The main points are: AhShi points located in the muscles of the neck, scapular, shoulder and paravertebral area, with points from BL11,22,27; GB21; TH05,14,15,16; LI15,17; SI09,10,13,17; LU01,01a; ST10.
Treatment: Electro-AP (10-20 seconds/point) or simple needling (20-30 minutes), 2-6 times (mean 3) at intervals of 3-7 days (mean 4). White suggests 20 minutes electro-AP every day in acute cases.
If the lameness is due to irreversible OCD, gold bead implants at ST10, LI17, SI09,10,13,17, BL22,27 can halt the progress of the condition. If done at 1-2 years of age, the result is very good: most can go on to full training and racing (M.J.C). Few cases relapse after successful treatment.
1.1.4. Elbow lameness (Fig. 4)
Lameness associated with AhShi points in the muscles behind the elbow is a good indication for AP. The points used are:
AhShi points in the area (check also the scapular and neck muscles)
Local points LI10,11,12; TH10; HT03; PC03; SI08
Region points (BL11; LI15; TH14; SI09 etc)
additional points from TH05; LI05
Treat by simple AP, electro-AP or point injection every 3-7 days for 1-3 times in recent cases and 3-8 times in chronic cases.
1.1.5. Hip and thigh lameness (Fig. 5)
(Cain; Rogers)
Hip and thigh lameness may be due to local muscle strain, hip arthritis, hip dysplasia or pain referred from the thoracolumbar area. Dysplasia is very common in horses. It is often misdiagnosed as stifle or hock lameness. In severe dysplasia, BL19,48 (GB Shu), GB29,30,31 are usually tender, making it possible to diagnose dysplasia pre-purchase (as in yearlings). Tenderness at all those points indicates a poor prognosis, even if the points are implanted. In mild cases, or in other cases of hip and thigh pain, needling those points gives very good results (M.J.C). In coxofemoral lameness of horses and dogs, insertion of gold beads towards the rim of the acetabulum (using a 16 g 30 mm needle) has powerful clinical effects, even though the beads are inches away from the acetabulum in horses.
Injection of irritant substances (such as copper compounds) over the sciatic nerve may cause sciatica with hip and thigh lameness (Rogers). BL25 may be tender in sciatica.
The points most effective on the hip and thigh are:
AhShi points in the thoracolumbar, sacral, hip-thigh and posterior thigh muscles.
Local points (GB29,30,31,32; BL30,36,37,38,54; ST31,32,33,34)
Region points (BaiHui; BL23,54)
Additional points from BL18,19,25,27,47,48, GB21,25a,34,39
Add the relevant Ting point, especially GB.
Treatment: as for elbow lameness.
1.1.6. Stifle and hock lameness (Fig. 6)
(Cain; Jeffries; Rogers)
Points BL36,36a,37 are diagnostic/therapeutic for the stifle. ST25a, at the lower, posterior edge of the tuber coxae (origin of tensor fascia lata) is also important. Add BL20,21, SP10, ST10 and point anterior to the origin of the biceps femoris (near BL35).
Tenderness at BL18,20,23 (LV, SP, KI) suggests inside stifle.
Tenderness at BL19,21,28 (GB, ST, BL) suggests outside stifle.
In stifle wear, Cain injects 10 ml Hypodermin (18g needle, 3 cm) towards BL40 in the intercondyloid fossa and adds SP09, ST36, GB34. Jeffries uses Sarapin (containing Vitamin B12 and C), 3 ml injected below the patella, medial and lateral to the patellar tendon at XiYan (Knee Eyes = ST35) and the point posteromedial to the patellar tendon; ST36 (12 ml); KI10 (5 ml); BL40 (4 ml, 5 cm deep).
In stifle lameness, point injection is excellent in 1-2 sessions. Walk the horse for 2 days before return to the track.
In hock lameness, tenderness at BL18,20 (LV, SP) can help to diagnose cunean tendon problems (inside hock). Tenderness at BL19,28 (GB, BL), and BL27 (SI Shu, Son of GB) can arise in curbs. Reactive GB can cause spasm of the biceps femoris muscle, resulting in hindlimb lameness.
In hock lameness, Local points (BL60, KI03) and BL30,35,53,38,39,40, ST36 (hock-related points) are used with reactive BL points (M.J.C). In bone spavin, add the relevant Ting point, especially ST, KI.
1.1.7. Laminitis, navicular disease, foot abscess (Fig. 7)
AP is successful in 80-90% of cases of laminitis in the short and longterm (Klide; Kuussaari). Acute cases respond faster than chronic cases. The most important points are FL21 and 22 (Klide and Kung's system). They are at the back of the hoof, at the medial and lateral cartilages (FL21) and in the centre of the hollow above the hoof (FL22).
Additional Local points are FL19 (two points on medial and lateral digital veins, dorsocaudal to fetlock) and FL20 (4-8 fen lateral to anterior of the coronet at the hoof-hair junction) (Klide).
Kuussaari also adds a point for the forelimb (behind the humerus in fossa between long and lateral heads of the triceps m. and the posterior edge of the deltoid m.).
Johnson also searches the paravertebral area. In laminitis and navicular disease, BL18 (liver Shu) and BL23 (kidney Shu) are often tender. Johnson adds these AhShi points and SI08 (forelimb) or BL40 (hindlimb). The veins (FL19) are bled only if there is heat in the coronary band. He may add BL11,12,13 as Region points in forelimb cases.
Cain punctures PC09 several times with a 16 gauge needle until the blood changes from tarry and dark to cherry red and normal viscosity. He adds puncture of medial and lateral digital veins or other terminal points (LU11, LI01, ST45, SP01, HT09, SI01, BL67, KI01, PC09, TH01, GB44, LV01) with 18 or 20g needles. These points are at the coronary band. It is helpful to puncture the medial and lateral digital veins with 18 or 20g needle also.
Add the relevant Ting point, especially HT, SI.
Treatment: simple AP or electro-AP, 1-4 times (mean of 3 times) every 2-4 days (mean of 3 days) in recent cases (Kuussaari) or 1-12 times (mean of 6 times) every 3-7 days in chronic cases (Klide, Johnson). Use corrective shoeing, silicone pads and foot care to put pressure on the frog supplements the AP effect.
Laser on LI04; LU07 (10 seconds/session) may help AP treatment (Johnson).
Navicular disease is treated with similar points but success in navicular is not as well documented as in laminitis. One theory of navicular disease is that of poor blood supply to the area. Vasodilators and anticoagulants have been used in attempts to alleviate this. Vasodilation can follow AP at Local points but Region points, can help also:
Forelimb: LI11,15; TH05,14; SI09; BL11 etc
Hindlimb: GB30,34; ST36; BL40; BL23; BaiHui
Johnson claims excellent results in navicular disease. Treatment is to a maximum of 6 times in 3 weeks (some need less than this). He uses electro- AP, with 7-8 cm 26g needles. No twitch is necessary in most cases. Laser at LI04 and LU07 helps.
Foot abscess is treated as for laminitis or navicular disease (Johnson).
Hoof-bend bleeders, heelcracks, heel haemorrhage/sores: Add the relevant Ting point, especially TH (Thoresen).
1.1.8. Tendinitis, splints, curbs
(Cain)
Tendinitis and sheath inflammation may be helped by application of local Laser. Many veterinarians find that Laser is better than standard AP. Plum Blossom Needling has helped in problems of the superficial flexor tendons. Many cases of injury to the tendon sheath are misdiagnosed as tendon tears. Sheath injuries respond well to stimulation of Local and Channel points. Local circulation is enhanced. Intradermal or dermal needle implants, left in place for several days, help.
Magnets (500 gauss) with gold bead centres (CORIMAGS) may be glued on with Superglue. They are remarkably beneficial if used with Laser or AP.
Splints (especially inside) respond very well when the affected Channels are balanced. Inside splints are usually related to the ipsilateral stifle. The Channels LU, SP are those primarily involved, with LI and ST as secondary.
Curbs respond well to local therapy when the affected Channels (GB, LV) are balanced.
1.1.9. Azoturia, tying-up syndrome
(Cain)
Azoturia often accompanies the tying-up syndrome. CPK, SGOT levels usually are elevated in blood. The syndrome occurs especially in spring (season of Wood, GB-LV). It is a common racetrack problem and responds very well if GB-LV, SP-ST, KI-BL can be balanced. These are Wood, Earth, Water in the Five Phase Cycle. See the Sheng and Ko Cycles in classical AP. See section 1.0 and the Appendix.
1.2. NEUROLOGICAL PROBLEMS
1.2.1. Peripheral nerve paralysis (Fig. 8)
AP is of no real use in paralysis due to spinal transection, motor neuron
degeneration (German Shepherd syndrome) or severe damage to motor centres in the brain. It can accelerate recovery in paralysis with radiculopathy due to soft tissue inflammation or in CVA cases where paralysis is due mainly to vasospastic ischaemia of the motor centres. It helps to establish a cross-spinal reflex arc, which can be important in the salvage of a horse with traumatic "Wobbler Syndrome".
Peripheral nerve paralysis, especially that following trauma, also can be
helped by AP. The points are usually along the course of the affected nerve but points are often stimulated on the normal side also.
In brain or spinal paralysis in humans (such as arm paralysis after cerebrovascular accident or leg paralysis after polio), a chain of points along the nerve is used. For example, sciatic nerve:BL31,35,36,36a,37,38,40,57,60; GB30,31,34,39. Add BL19 (GB) and BL28 (BL) to balance Channels if GB and BL points are used. Add ST10 and BL21 if ST points are used.
In paralysis, electro-AP is better than simple needling but great care is needed to avoid electrical burns or electrolytic lesions in areas with sensory paralysis. Alternatively, inject the points with homoeopathic acid substances (ascorbic acid or HCl 9c). If definite improvement is not seen by 10 sessions, further AP is unlikely to be helpful.
1.2.2. Radial paralysis (Fig. 8)
(Cain; Hwang; Grady-Young; White)
Expect 90% success if recent case; 50-70% if paralysis is more than 2 weeks old. Use local AhShi points. Add points from LI04,10,11,15; LU01,01a, SI08,10; TH10,14 bilateral. Add BL27,22,13,25 respectively to balance the Channels if SI, TH, LU, LI points are used (M.J.C).
White suggests electro-AP for 30 minutes every day in acute cases. Others would treat every 3-7 days in chronic cases.
1.2.3. Facial paralysis (Fig. 8)
Points such as ST02-06; CV24; GV26; LI20 are used, depending on the nerve affected. In TCVM, the classic points are: SouKou; KaiGuan; BaoSai; FuTu. HouMen and HouYu on the neck (see White 1985) may be added to these. Add BL21 and BL25 to balance ST and LI points, if these are used (M.J.C).
1.2.4. Cervical ataxia (the Wobbler Syndrome) (Fig. 9)
(Cain; Jeffries; Rogers)
Early cases of ataxia in young horses can be helped or cured completely by AP. It is one of the most rewarding applications of AP therapy. Wobblers respond better and longer and need fewer sessions if AP is combined with spinal manipulative therapy (M.J.C). Adjustment of the neck vertebrae must accompany AP therapy for good success. Using adjustment and AP, Cain has restored to normal competitive ability many horses which had been sanctioned by insurance companies to be destroyed. In some cases, especially congenital and OCD cases, the ataxia was not fully cured but 90% of these were suitable for breeding, provided there was no history of genetic transmission. Jeffries has had similar success. Longstanding cases, with severe articular damage, have a poor prognosis.
Clinical experience in hundreds of cases suggests that 80% of cases are due to mechanical causes. A further 10-15% are genetically programmed. Gradual onset may be due to nutritional disorders, but these are rare.
The condition usually arises suddenly (overnight), due to trauma (a fall; being pulled up roughly by the training-rope; tie chains; being cast in the box). The earlier the case is treated, the better the success rate. Cure is impossible if the motor neurons are degenerated.
The signs include ataxia (especially of the hindlimbs), inability to turn sharply or to back-up properly (the horse may fall over if forced to do these movements). Some cases show obvious restriction of neck movement. The limbs (especially hind) may be placed heavily, as if the horse does not know when they should make contact with the ground. In milder cases or in cases of spontaneous improvement (rare !), the only signs may be slight awkwardness or restricted ability to turn sharply, (excessive abduction of the hindlimb on turning), toeing of the ground at the walk or turn and heavy placement of the hindlimbs.
There is usually, if not always, vertebral misalignment with consequent pressure on cervical nerves or compression of the spinal cord. The primary sites are at C5, C6, C7, T1, atlas, C2, C3. Rear ataxia relates to an autonomic reflex arc from the C6 sympathetic ganglion. This affects the whole sympathetic chain to the lumbar plexus. Vertebral adjustments must be made to ensure integrity of the cord and nerves. A successful adjustment is confirmed when the horse gives a good "wet dog shake". If this does not occur, the adjustment is not successful. In long-lasting cases, AP must be done first to release the spasticity of the intervertebral muscles and ligaments.
Wobblers are treated similarly to cases of cervical syndrome in humans, with symptomatic treatment for hindlimb problems in the later stages. The initial results can be very dramatic, with marked improvement after 1-3 sessions. However, full cure (full coordination and total elimination of all signs) may take up to 30 sessions. Thus, treatment of wobblers may be impractical on economic grounds except for valuable bloodstock or loved pets.
GB20 and 21 are essential in treating wobblers and neck pain. GB20 can be injured easily by bad riders and by tie-chains in stalls. This can cause subluxation of the atlas, requiring chiropractic adjustment. AP alone, in such cases, gives poor or only temporary relief.
Cervical problems involve one or more of the Yang Channels of the forelimb (LI, TH, SI) or hindlimb (ST, GB, BL) or the GV Channel (see the Appendix below). Check the Shu points of all the Yang Channels and check for AhShi on the GV line. As most of the Yang Channels are involved, careful Five Phase balancing is necessary for full athletic recovery (see section 1.0 above and the Appendix).
A careful search is made for AhShi points (neck, paravertebral, especially thoracolumbar and sacral area). All AhShi points are used. They are often absent in Wobblers.
Points for Neck and Forelimb weakness:
JiuWei; GB20,21; TH14,16; BL11; LI16,17; ST10; GV10,11,12 (withers)
emergence points of dorsal cervical nerves;
emergence of 2nd cervical nerve (SI17);
emergence of spinal accessory nerve;
Additional points: BL13,19,21,22,23,25,27,28; GV00 (tip of the tail), GV03 (BaiHui),04,
Points for Hindlimb weakness: BL29 (or 30); GB30,31,32,34,39; BL40
These points relate to the deep musculature of the neck, nuchal ligament, supraspinous ligament, lumbosacral plexus and sacral plexus.
In horses under 3 years old, AP and adjustment is combined with Adequan i/m (2 vials initially, 2 at 5 days and 2 at 2 weeks later). If used before 3 years of age, this helps to promote healing of any cartilaginous damage.
Treatment: Simple AP (20 minutes) or electro-AP (20 minutes) every 3-7 days for 4-30 times, as needed. Advise exercise on short and long rope (left and right turning), backing exercise, neck exercise (using carrot to persuade horse to do lateral and vertical movements).
If improvement is noted, allow 3-4 weeks between courses of 3-5 sessions of AP. Full cure may take up to 12 months.
Cain and Jeffries use point injection of the AhShi points plus points on the BL, GB, LV, ST, SP Channels (the hindlimb Channels), as indicated by tenderness at the Shu points for these Channels. Once improvement occurs, point stapling can be used for longterm stimulation (up to 12 months) and to reduce the number of visits needed (Jeffries). Cain usually injects the points with homoeopathic NaOH 10c and uses LACER (light stimulation) in horses over 3 years old.
Rogers' experience with wobblers (4 cases, AP but no adjustment) was that two were destroyed within 18 months. AP did not help sufficiently to ensure the jockey's safety in competitive racing, although it did improve the coordination markedly (Case 1) and completely but with relapse in Case 2. Case 3 was a foal which responded very well. Case 4 was a yearling which responded well to two sessions but was not presented for further treatment, owing to the death of the owner. One year later, the horse was OK.