ABSTRACT
Acupuncture (AP) is a reflex phenomenon with diagnostic and therapeutic value. AP points (APs) and Channels (AP meridians) have many applications in routine veterinary practice. AP has diagnostic and therapeutic value.
Irritated organs/functions cause reflex changes in sensitivity (usually hypersensitivity to pressure, heat and electrical current) at specific zones (the AP points (APs)) on the body's surface (diagnostic effect). Adequate stimuli (needling, injection etc) applied to the APs can influence the pathophysiology of the affected organs/functions (therapeutic effect).
Most of you are Vets whose main source of income comes from private practice. If you hope to integrate AP into your day-to-day practice, you must keep certain considerations in mind:
1. You must study AP in reasonable detail. A few weekend seminars may be enough to get you started but are only the beginning of mastery of AP.
2. The AP technique which you use routinely should require a maximum of 10-20 minutes/session, otherwise the number of cases which you can treat/week will fall. Unless your fee for treatment includes a cost for the time involved, your income will fall in proportion to the fall in cases/week. Point injection is the fastest method and gives good results.
3. Having studied AP, you should present it in a scientific way to your clients and your colleagues. This is essential if you wish to preserve your reputation as a vet and a scientist.
This paper discusses AP point injection; methods of adapting ultrasonic, faradic, laser and other physical therapies along AP principles; some of the best indications for AP therapy in large and small animals and possible uses of AP analgesia in surgery. It also discusses options for AP training; continuing study and development of intuitive powers in relation to an Holistic "total view" of health and disease and some of the methods of fostering public awareness of AP.
ACUPUNCTURE (AP): REFLEX AND ENERGETIC CONCEPTS
AP has diagnostic and therapeutic value. It has many applications in routine veterinary practice (1,2,11,12,13,14).
In its simplest form, AP is a reflex phenomenon: irritated organs/functions cause reflex changes in sensitivity (usually hypersensitivity to pressure, heat and electrical current) at specific zones (the APs) on the body's surface (diagnostic effect). Adequate stimuli (needling, injection etc) applied to the APs cause reflex responses in the pathophysiology of the affected organs/functions (therapeutic effect). The reflex (neurally-mediated) mechanism is easily demonstrated by experimental chemical or surgical interference with neural transmission in the peripheral nerves, spinal cord or midbrain or by sympathectomy.
In its purest form, AP involves a concept of interacting external and internal energy fields (5,6,7,8). It involves an holistic concept of the organism in relation to its internal and external environments. It involves the manipulation of Vital Energies (Qi), some of which are known (defence reactions) and some of which are only hinted at in occult or esoteric literature (the Aura, the Etheric body, Kundalini, Prana etc). Western science has much to learn about the Energies of Life! We are far behind Soviet and Eastern Block science in this research. They are already well advanced in research on "Bioplasma", mitogenic cell radiation, weak electrical and EMF radiation etc.
AP: NOMENCLATURE AND POINT SELECTION
Each AP point has a Chinese name, an alpha-numeric code and an anatomical location. For example TsuSanLi (ST36) means FootThreeMiles, is the 36th point on the ST (stomach) Channel and is situated 3 cun (body inches) below the patella, 1.5 cun lateral to the tibial crest in adult humans. Details of the point nomenclature and points for particular conditions are given elsewhere (3,4,9). AhShi points and Trigger Points (TPs) are discussed elsewhere (3,4,12,14,17).
Novices should note that many different nomenclatures are used for the APs. Before using the point combinations listed below, novices should consult those references and cross-compare the codes with those in their standard reference textbooks.
The AP-based applications (below) use some or all of the Laws of Choosing Points for therapy. Let us recall some of these Laws:
* Sensitive points (AhShi points/TPs, Motor points etc)
* TianYing points (centre of the swelling) and sensitive area
* Local points
* Distant points along affected Channels
* Combination of Local and Distant points
* Points along affected Channels
* Points on related affected Channels
* Selection according to symptoms
* Selection according to nerve supply
* "Fore and Aft" points
* Master Points: Mu-Shu (Alarm-Association); Yuan-Luo (Source-Passage); Xi (Cleft) points etc
* Ear Points and APs not on the main Channels
These laws and methods of selecting APs for therapy are discussed elsewhere (8,9,11,12,13,14).
METHODS OF STIMULATING THE AP POINTS (APs)
There are many different methods of stimulating the APs to activate the AP response. These are discussed elsewhere (10).
AP POINT INJECTION: The injection of APs can be tried by all practitioners. It is the fastest and most practical method. It requires no sophisticated equipment, stimulators etc. It is fast and takes little more time/session than the routine vet treatment requires. The technique is described in detail elsewhere (10).
If the client can accept the fact that AP is applicable in vet medicine, the practitioner inserts a hypodermic needle in a correct point, stimulates the needle manually (by pecking and twirling for 10-15 seconds before the syringe is attached), attaches the syringe and injects the point, manipulates the needle again and removes it. Then he/she proceeds to the next point, and so on.
If the client is very conservative and would not accept AP treatment for his/her animals, the needles are not manipulated by pecking or twirling. If the client asks why so many points are being injected, he/she can be told that the results are better when many points are injected. Alternatively, he/she can be told that different compounds are being used. (For this purpose the practitioner should have a number of bottles with 0.9% saline, 0.5% procaine (or xylocaine or lignocaine) solution in 0.9% saline, B12, Sarapin, homoeopathic solutions or other injection material. Preferably non-toxic, non-irritant colouring agents can be incorporated in the solutions).
Point injection is ideal in those cases in which the practitioner considers intramuscular injection of therapeutic agents to be desirable. If the therapeutic dose is calculated as 20 ml of drug solution and the vet needs to inject 8 points with 10 ml each (large animals), the 20 ml drug solution can be diluted to 80 ml by adding 60 ml sterile water or saline.
In emergencies (such as anaesthetic collapse, coma which has not responded to orthodox therapy etc) the GV26 + KI01 combination may be needled or electro-stimulated. In cattle and horses, KI01 is not transposable but the interdigital cleft (cattle) or the hollow at the back of the hoof (horses) may be tried instead. If the owner asks why the animal is being stimulated in the nose/foot he/she can be told that: "It is a new resuscitation technique which I have read about and it is worth a try".
ULTRASOUND, FARADISM, TENS, LASER AND OTHER PHYSICAL THERAPIES
Vets whose clients already accept these types of therapy have a few problems adapting these methods to treat the many conditions responsive to AP. The main differences between the "orthodox" and AP-based application of these methods are:
a. orthodox uses are limited to a few conditions whereas AP based applications have a much wider scope and
b. orthodox use of these methods is usually confined to the problem area (muscle, joint, etc).
If the vet wishes, the client need not know that the animal is being treated by AP principles. For example, in low-back syndrome, the electrode of the transcutaneous stimulator can be moved first over the problem area. Then the other sensitive points are identified in the lumbosacral (and possibly low-thoracic) area, the heavy muscles of the thigh and gastrocnemius and their locations are noted for future reference. They are stimulated for a few minutes. Electro-stimulators with multiple outputs allow faster therapy during a session, as multiple points can be stimulated together. Finally, a few classic points for the low-back region (BL23, GV03, GB34) are stimulated. If the owner asks why so many points (and especially distant points) are being stimulated, he/she can be told: "They are nerve zones with beneficial reflex effects on the back".
SOME PRIME INDICATIONS FOR AP THERAPY
The following conditions are suggested as prime indications for beginners. The points suggested are taken from the transposition method (anatomical transposition from human to animal models). APs may also be taken from the traditional vet texts (3,4,9).
In all cases, search the patient carefully for points which are tender/hypersensitive to palpation or electric current (AhShi points, TPs (17)). Animals can not tell us where they "feel" referred pain when a tender point is pressed. Therefore, it is usually not possible to distinguish locally sensitive AhShi points from genuine TPs (which refer pain elsewhere) with certainty in animals. I assume that the most painful AhShi points are TPs. For the purposes of this paper, I use the term AhShi point to include both types of points, causing local and referred pain. If AhShi points are found, mark their position and use them.
1. Cows: dystocia, especially due to relative oversize of the foetus: The method was used by Kothbauer the late Erwin Westermayer. Their main points are: GV02,03,04, (sacrococcygeal space, L4-L5 space and L2-L3 space) and BL32,53. Any AhShi points among BL23,24,26,31,33,34,54 are added. AP at these points helps to relax the pelvic ligaments, helps uterine contraction and cervical relaxation. It greatly facilitates parturition.
On arrival, the vet inserts the needles and instructs the farmer as in (2) below. Electro-stimulation is not essential. Having prepared him/herself, the instruments and the cow, the vet proceeds with the delivery. This method is recommended strongly.
2. Cows: reposition of prolapsed uterus: The main points are: GV02,03,04; BL23,26,31,53. Occasionally, BL24,32,33,34,54 might be substituted for the other BL points (Westermayer).
First thing on arrival, before other preparations, AP needles or hypodermic needles 5 cm long and 19 to 23 gauge are placed to a depth of about 3 cm in GV02,03,04 and to a depth of 4-5 cm in the BL points, bilaterally. The farmer or an assistant is shown how to twirl and manipulate the needles and is instructed to continue twirling them in sequence for 10-15 seconds each. Two needles can be twirled together. Alternatively, an electro-AP stimulator is attached to the needles and the frequency is set for about 5 Hz. The output voltage is increased until the needles are pulsating in rhythm with the outputs.
The vet then proceeds to reposition the uterus and to ensure that it is fully back. A uterine pessary may be inserted. The vaginal lips are sutured as usual and a special harness to apply perivulval pressure is applied for a few days. Normally the whole procedure takes only 15-20 minutes and there is seldom any straining or re-expulsion of the uterus by the cow. Spinal anaesthesia is seldom necessary. The late Erwin Westermayer (Germany) made a superb video-film showing this method in eight random cases.
3. Cows: hormonal infertility/functional pituitary, ovarian, uterine pathology: Infertility in cows is often associated with anoestrus, persistent corpus luteum, pyometra and cystic ovary. Main points are traditional points YungQi (near BL26, bilateral), 9-10 cm from the midline between the transverse processes of 5th & 6th lumbar vertebrae. Any AhShi points in the lumbosacral area (in the area BL23-34 and BL52-53) are added. AP can be by point injection, manual needling + electro-stimulation for 10-15 minutes, repeated every few days until the cow comes into oestrus.
Alternatively, point injection with 5-10 ml solution of 0.25-0.50% procaine, vitamin B12, homeopathic agents etc can be used. Anoestrus usually responds to 1-2 treatments, cows coming into oestrus within 3 weeks. Cystic ovaries may need up to 4 sessions, with the formation of a corpus luteum by the 10th day and the appearance of oestrus by 3-5 weeks after the last treatment.
Some vets apply moxa to the needle handles (when the needles are inserted) and allow the moxa to burn itself out. Kothbauer also uses paracervical injection, via a very long needle.
4. Small animals: conjunctivitis, rhinitis: Main APs for these disorders are: Conjunctivitis: LI04: BL01; GB01 / + / GB20: ST01,02; LV03; TH23. Rhinitis: LI04,20; Z 03,14; GB20; GV23,25. The animals may be needled with fine human AP needles, 10 mm long and 30-32 gauge. The needles are inserted to a depth of 2-3 mm on the face points; 12-25 mm on GB20 and 12 mm on LI04. In acute cases, quick needling (a few seconds/point) is sufficient. Repeat daily for 2-3 days. In chronic cases, sessions should last 10-20 minutes, repeated once every 3-7 days for 4-6 sessions.
Alternatively, APs may be injected with 0.1 to 0.5 ml of solution using a dental syringe and a very fine needle. In severe conjunctivitis, if the animal is quiet, pricking the everted eyelid in 3-6 places is recommended in large animals, or injection of 0.1 ml 0.25-0.50% local anaesthetic into a few subconjunctival areas. One may also try laser or ultrasound using the same APs, but avoid irradiating the eye.
In chronic cases of conjunctivitis, warn the owner not to allow the dog to poke its head out of the car window while the car is moving.
5. Small animals: gastrointestinal disorders: Main points for vomiting, inappetance, gastritis etc are PC06, ST36, CV12, BL21. For enteritis, gastroenteritis, diarrhoea, constipation, colic etc, add points from TH06, BL25,27, CV04,06, ST25. Other points are listed in the Appendix to the paper on the "Choice of Points for Therapy" (9).
Acute gastrointestinal conditions are treated every 12-24 hours and should respond in 1-2 days. Chronic conditions are treated every 1-7 days, depending on their severity. They may require up to 4-5 sessions. Point injection, needling + moxa, electro-AP, ultrasonic or transcutaneous electro-stimulation methods may be tried in these cases.
6. All species: hip lameness: This may be associated with arthritis, muscular injury, trauma, metabolic diseases, hip dysplasia, low-back syndrome + etc. If dislocation of the hip is involved, this must be corrected. If metabolic causes are involved, appropriate adjustments to the diet and adequate mineral supplements are required. Once fracture is excluded, the AP treatment is similar, irrespective of the cause.
First, search the muscles of the lumbosacral area, buttocks, hip, thigh and gastrocnemius to identify AhShi points. (Note: In humans, pain may be referred to the hip/gluteal area by TPs in the paravertebral muscles as far away as the posterior edge of the scapula). Clip the points, or note their position carefully. Choose as main points from the following: AhShi points; GB30,31,34; BL23,40; LV08,11. Point injection, needling + moxa, electro-AP, electro-stimulation, ultrasonic, injection, laser etc may be tried. If needling is chosen, peck the periosteum of the femoral neck when GB30 is needled.
Treat acute cases every 1-2 days. Expect results by 2-4 sessions. Treat chronic cases every 3-9 days. Expect results by 2-8 sessions.
AP can help greatly the lameness in hip dysplasia in dogs. (The implantation technique is especially good, especially in dogs which respond well to AP or electro-AP in a preliminary test-session (10, 14). Advise the owner not to breed from affected dogs/bitches.
7. All species: shoulder lameness: This is tackled in a similar manner to hip lameness. Identify, clip or note all AhShi points in the neck, upper limb and upper thoracic area. Choose as main points from the following: AhShi points; LI11,15; TH14; SI09,11 / + / TH05,15; LI04,16; BL11; GB21; SI10,12,13,14.
8. All species: low-back syndrome (lumbosacral lameness; "disc syndrome", arthritis, spondylitis etc in lumbosacral area; rheumatism, myositis, myalgia in the area). This is tackled in a similar way to hip lameness, as above. Identify, clip or note all AhShi points from the lumbosacral area to the hock (tarsus) and note their positions carefully. Choose as main points from the following: AhShi points; X 35 (HuaToJiaJi, paravertebral points) in region first lumbar to last sacral vertebrae; BL23,25,27,31,52,40,60; GB30,38; GV02,03,04. The choice of points is discussed elsewhere (9,12,14,18).
9. All species: muscle cramp, soft tissue lameness: Where causal factors are known (trauma, exposure to cold and damp, metabolic upsets and mineral vitamin deficiencies etc) correct them. AP treatment consists of careful palpation to reveal all AhShi points. If the problem is in the forelimb, search from the knee (carpus) to the shoulder, neck and upper thorax. If the problem is paravertebral, search the whole paravertebral and intercostal area. If the problem is in the hindlimb, search the lumbosacral area and the hindlimb to the hock (tarsus). If the problem is in the flexor tendons, search these areas and the area behind the scapula (BL13,14,15 = LU, PC, HT Shu points) and the lumbosacral area (BL22,25,27 = TH, LI, SI Shu points) also. Note carefully and treat all sensitive areas.
In therapy, choose main points from: AhShi points plus main points for the affected regions (9,12,14,18). Treat acute cases every 3-7 days for up to 8 sessions. Expect results by the third session in acute cases and by the 4th-5th session in chronic cases.
In tendinitis, local APs along the affected tendons are added. In bursitis, local points and TianYing points (penetration of the bursa or cyst) are added. (I have had poor or no results with AP in tendinitis until I used a 30 mW pulsed infrared Laser, applied to many points over the medial, posterior and lateral edge of the tendon, with other APs). Laser gives better results than AP in tendinitis but the longterm benefit in seriously trained/torn tendons is questionable, unless the owner/trainer lays the horse off work for 10 months.
10. All species: anaesthetic emergencies (apnoea, respiratory arrest, cardiac arrest). The main point is GV26, in the midline at the lower extremity of the nostrils. Occasionally, KI01 is added in small animals.
Immediately the emergency is noted, insert a needle, 19-30 gauge (depending on species), into GV26, directing the needle towards the nasal septum. Stimulate the point by strong twirling, rotation and pecking of the needle. (Some colleagues who were disappointed with AP at GV26 in emergencies did not stimulate the needle adequately. Strong stimulation is needed). In apnoea and respiratory arrest, expect a response in 10-60 seconds. Remove the needles when breathing recommences. If there is no response in 60 seconds try artificial respiration for a few minutes and needle again. The response in apnoea and respiratory arrest is almost 100% if the heart continues to beat.
In cardiac arrest however, the response may be as low as 40% and stimulation of the point must continue for up to 10 minutes. The method is very good in neonatal asphyxia, coma, shock, traumatic shock and haemorrhagic shock. Remember GV26 + KI01 in shock, collapse, coma, emergencies. Remember PC06 for cardiac cases, thorax, lung disorders, nausea.
11. All species, nephritis, cystitis: Nephritis: BL22,23,58; GV03,04; SP06,09; ST25; GB25; KI03 / + / BL24,25,27,28,31,32; ST28; TH09; SP14; LV08; KI07; CV06. Cystitis: BL28,38,58; CV03,04; KI02,03; ST28 / + / BL23,25,26,31,32,33,54; GB26,29; SP06,09; CV02; ST27. Main points for treatment are drawn from these lists, depending on the symptoms and diagnosis. Also check for AhShi points in the lumbosacral and low abdominal area and include these points.
Treat acute cases daily for 4-6 sessions, expecting a response by third session. Treat chronic cases once/week. (Chronic nephritis, with marked fibrosis may have a low success-rate). If vomiting or other signs are major signs, include points according to the symptoms (9). Point injection, needling + moxa; electro-AP; electro-stimulation or ultrasound techniques may be used.