SUMMARY
1. Modern concepts of AP mechanisms include mediation by the peripheral and central nervous system, the autonomic, neuroendocrine and endocrine systems. AP diagnosis may be pragmatic, using "western concepts" of the major symptoms and signs to identify the organs or parts involved. It can be assisted by reactivity at Shu, Mu, TPs and AhShi points. The importance of these reactive points in diagnosis and therapy is emphasised. In AP therapy, the stimulus is given to reactive areas linked to the affected organ, part or function. Signals are sent to the spinal cord and brain by the sensory nerves. The output response is via segmental, intersegmental and supraspinal reflexes and autonomic, neuroendocrine or endocrine mechanisms. These responses may be specific or generalised.
2. Vets can learn the human Channel system easily. Great emphasis is put on the AP points of the paravertebral (BL) Channel, the paravertebral HuaToJiaJi (X 35) points and the midline Channels, CV (ventral) and GV (dorsal). Beginners should learn the use of these points first. Methods of point selection for therapy can include "Prescription" or "Cookbook" AP. Points for various conditions in humans are listed.
3. Points in cattle can be located by subjective transposition of the human AP system. The author's transposition is given for the main points in the cow. It is left to the reader to do the exercise for the pig.
4. Although many methods of point stimulation are used, injection, stapling and simple needling of the AP points are the most practical methods. Moxa can be used in chronic cases and "cold" diseases. Electro-AP (EAP) is almost essential for good surgical hypoalgesia. Laser-AP has some enthusiastic users (especially in horses, small animals and humans). The higher power Lasers (mean output power 20-50 mW) may have a role as a substitute for needles in cattle and pigs but more research is needed on this.
INTRODUCTION
Acupuncture (AP) in large animals differs from AP in small animals, in that there are traditional AP charts and methods for large animals but none for small animals. In small animals, AP is practised by one method only, the transposition of concepts of human AP to the animal. In this method, the location, function and uses of the human AP point system are applied to the small animal, making suitable adjustments for differences in anatomy and nerve supply to the various organs.
In large animals, occidental vets, unable to obtain or decipher the oriental traditional veterinary texts, developed a similar transposition system of AP for large animals. Therefore, two systems of AP in large animals exist today: the Traditional system and the Transposition system.
In Part 1 of this seminar, four main topics will be discussed:
1.1 Modern concepts of AP (mechanisms and diagnosis)
1.2 The human system of AP and methods of choosing points
1.3 Location of some important AP points in cattle by transposition
1.4 Methods of stimulation of the AP points in cattle and pigs
1.1 MODERN CONCEPTS of AP (MECHANISMS AND DIAGNOSIS)
There are some fundamental concepts in Traditional Chinese Medicine (TCM) which are acceptable to workers trained in the "western" style also: The organism (psyche and soma) is influenced by external environment. External forces include: diet, poisons, climate, trauma, infections, extra-terrestrial forces etc.
The organism (psyche and soma) is influenced by internal environment. Internal forces include: genetics, basic resistance (vital energy, Qi, immune competence, autonomic and neuroendocrine balance, psychological balance etc), balanced blood circulation, especially microcirculation in vital organs such as brain, heart, kidney and liver.
The body, its organs and functions is one complete unit. One function or part can influence another. Disease in one part is reflected in changes in other parts.
1.1.A AP mechanisms
The body has its own adaptive-defence-healing systems. All good medicine (western or eastern) attempts to activate the homoeostatic mechanisms to keep the various organs, functions and energies in perfect balance. Imbalance = disease. Balance = health.
When an organ, part or function is imbalanced (in disorder) changes occur elsewhere via viscerocutaneous, viscerosomatic, viscerovisceral reflexes. These changes can aid diagnosis (see later). The reverse is also true. Stimuli applied to the skin, superficial muscles and the nerves related to an affected organ can induce homoeostasis in the organ. The effect is mediated by reflexes (cutaneovisceral, somatovisceral etc), as well as by autonomic, neuroendocrine and endocrine mechanisms.
Thus, diagnostic or therapeutic change at one part, reflected elsewhere, is mediated by the nervous, neuroendocrine and endocrine-humeral systems. Segmental, intersegmental and supraspinal reflexes are involved.
In many painful conditions, especially of myofascial origin (muscle pain, sprain, rheumatism, myositis etc), localised areas in muscle and fascia may act as TPs. TPs arise also in arthritis and in disorders of thoracic, abdominal and other internal organs. They often lie in the paravertebral area but may occur anywhere in the body. Reactive (tender) points on scar tissue, traumatised periosteum or infected tooth sockets can also contain TPs.
A TP is a local focus of irritation which maintains the clinical pain (and sometimes autonomic disorders) elsewhere long after the original cause has disappeared or resolved. As long as the TPs remain, the clinical condition will not resolve fully. It is vital to locate and neutralise the TPs. This requires a careful, inch-by-inch search of the body, as the patient is usually unaware of the TPs until they are probed or needled. They are very painful when probed or electrically stimulated and they refer pain to the area of clinical complaint, which may be near the TP, but often is quite far away.
The concept of the AhShi point is most important in TCM. AhShi means "Ah Yes!" or "Ouch !", the exclamation of the human patient when the point is probed or needled. The AhShi is a point that is reactive (tender) to palpation pressure. However, there are two types of reactive point: local tenderness only and local tenderness plus referral of pain elsewhere (TP). Thus, all TPs are AhShi points but AhShi points are not all TPs. Among the AhShi points, the TP is the most important diagnostically and therapeutically.
TPs are of use in diagnosis because they arise in predictable locations in relation to areas of subjective pain in humans. The most comprehensive text on human TPs is by Travell and Simons (1984, 1985) but other articles on TPs are given in the references at the end of part 2.
TPs are poorly researched and documented in animals and Janssens (1984) is one of the first vets to document TPs in dogs although all vets using AP will have used TPs (possibly classed as AhShi points) routinely. Much more work is needed to document animal TPs to the extent that Travell and Simons have done for humans.
In humans and dogs, the location of TPs often corresponds with that of documented AP points on the Channels. This is especially seen in the Shu (paravertebral Reflex) and Mu (Alarm) points in humans (see later).
TP therapy is a physical therapy similar to simple AP. Dry needling, ultrasound, injection of procaine or non-isotonic B12/saline solution or other agents at the TPs frequently results in instantaneous relief of pain and the associated functional disorder (e.g. tremor or autonomic disorder). TP therapy alone, without any knowledge of AP, can give 60-70% success in suitable cases of human or animal disease.
The abdominal and thoracic organs are innervated by branches from spinal nerves as well as branches from the cervicolumbar sympathetic and craniosacral parasympathetic nerves. According to the principle of reflex action, stimulation of any point in an area whose nerve supply is common to that of an affected organ should influence that organ and any irritation of the organ should be reflected in changes in reactivity at the body segments innervated by the common supply.
Thus, in diagnostic and therapeutic AP, relationships between an affected organ and its AP points, TPs and AhShi points are mediated by the peripheral and central system and their reflexes (Mann 1977). However, there are many examples which show that points NOT in the same or nearby spinal segments can have powerful therapeutic effect also. For example, in acute spasm of neck muscles in humans, immediate relief may follow needling of points GB39 or ST38 on the lateral side of the lower tibial area. Also, the schools of AP which use Earpoints in humans claim that needling the reactive earpoints which correspond to the affected organ or joint etc can have very good therapeutic effect. Diagnostic or therapeutic action at points distant from the problem can be explained by intersegmental or supraspinal nerve reflexes.
Earpoint AP is not sufficiently developed in animals to be a reliable alternative to body point AP at this time. However, there is increasing evidence in many species (horse, ox, dog, rabbit) that the animal ear contains reflex points for major organs and parts, as is the case for man (Oleson et al 1980). No practical details of ear AP in cattle or pigs can be given in this seminar.
1.1.B AP diagnosis
In TCM, disease is classified in many ways: the Eight Types; the Channel involved; the effects of the Perverse Climatic Evils etc. Diagnostic tests included reading the Chinese Pulses, looking, listening, feeling and smelling.
This type of diagnosis would be meaningless to those not trained in TCM. For those fully trained in TCM, however, the traditional diagnostic descriptors and methods indicated the AP points necessary to correct the imbalance of vital energy.
In recent textbooks from China and in AP (as practised, for instance in the Veterans Hospital Taipei), little attention is given to esoteric aspects of diagnosis and choice of points for therapy. Instead, diagnosis is by "western" methods and choice of points is by pragmatic "Cookbook" prescription. However, the Shu and Mu points are regarded as very important in diagnosis of human problems.
When a major internal organ is imbalanced, predictable areas along the spine (the Shu or Reflex points along the bladder Channel) and on the anterior or lateral side of the thorax or abdomen (the Mu or Alarm points) often become reactive (tender) to pressure palpation. Tables 1 and 2 and figures 1 and 2 show the location of the Shu and Mu points in humans. The combination of Shu and Mu point (or points near them) is also very helpful in treating abnormal function of an affected organ.
In Traditional Chinese Vet Medicine (TCVM), the Channel system is poorly developed and pulse diagnosis is rarely used in animals. Therefore, in TCVM, diagnosis depended mainly on local knowledge, knowledge of seasonal diseases and especially on searching for the reactive points and identification of the major signs and symptoms.
Vet AP, as practised in the west, is only a small part of a total (holistic) approach to health care. AP is sometimes used alone, sometimes with other therapies. In most cases, it is NOT used at all. When it is used, diagnosis is based mainly on western concepts of pathophysiology, with identification of the major signs, symptoms and organs involved and the reactive points. In vet AP, treatment can be pragmatic also. Reactive points and points for the affected organ or part with points for the major symptoms are needled, with useful results.
Diagnosis by AP methods can complement diagnosis by western methods. For example, a western diagnosis may be impossible in some cases of a "downer cows" i.e. cows recumbent after calving, despite injections of Ca, Mg, P salts and despite elimination of all the common causes of recumbency. In this case, "downer cow" is not a diagnosis. It is merely a descriptor. The vet might suspect weakness of the liver (fatty liver) and lumbosacral strain as being the most important causes of the recumbency. Treatment might be non-specific liver tonics (Parenterovite or Flor de Piedra (homoeopathic) together with AP at points from vertebra T10-L3 (for its effect on liver, kidney and adrenals) and point BaiHui (lumbosacral space) with Zu San Li (3 body inches (tsun) below the patella and lateral to the tibial crest) for their effect in hindquarter weakness and general vitality.
In other cases no attempt is made to make an AP diagnosis. For instance, in acute purulent interdigital inflammation in cattle the western diagnosis of "foul-in-the-foot" due to B.necrosis and C.pyogenes would be treated usually by antibiotic or sulphonamide injection, with (maybe) footbaths of 5% copper- or zinc- sulphate.
1.2 THE HUMAN SYSTEM OF AP AND WAYS TO CHOOSE POINTS
1.2.A The human AP system
In TCM, the Vital Energy (Qi) was thought to circulate in pathways through-out the body. Each pathway (Channel) had a superficial and deep course. The superficial course ran in the skin and muscles and had linking branches to other superficial Channels. The deep course penetrated to the interior of the body to link with its organ and with other Channels.
Thus, the body with all its parts, organs and functions was seen as a unit, bathed in a sea of Vital Energy (Qi), which flowed through the superficial and deep course of the Channels. Along the superficial course were specific zones or points where the Energy was concentrated. These were the AP points: points where energy could enter or leave the body under the normal adaptive conditions and where the body could be harmed (by trauma, as in the martial arts) or helped (as in AP) by stimuli applied to them.
The AP points had diagnostic value: reactivity to palpation along a Channel suggested disease of that Channel or its organ. They also had therapeutic value: AP stimuli to the points of the affected Channel and other related points could restore normal function in the affected organ-Channel system.
TCM describes 12 bilaterally symmetrical Channels. AP points on each one reflect and control the metabolic and TCM functions of the same organ, the anatomical structures traversed by the Channel and the organs which are near the Channel. For instance, the stomach (upper abdomen) lies under the CV, KI, ST, SP, LV, GB, BL and GV Channels. Points on any of these Channels, especially points in areas innervated by spinal nerves T8-T12, can influence stomach function.
Each point on a Channel influences the same basic functions as its Channel but especially the local structures and functions. Some points have special, wide-ranging functions. These special points included the 60 POINTS OF COMMAND (the Five Element points: 12 x 5 = 60) which were used in Energetic AP and which will not be discussed further. They also included special points, such as SOURCE (Yuan), PASSAGE (Luo), ACCUMULATION (Xi), TONIFICATION and SEDATION points.
As well as the 12 pairs of Channels, two other Channels were described: the RenMo (CV) and the DuMo (GV) (table 3). They run in the ventral and dorsal midline respectively and have powerful effects on the internal organs, especially those which lie close to or posterior to the CV or GV points.
The points of the paravertebral (BL) Channel, the HuaToJiaJi points (see later) and those of the CV and GV Channels are most important in AP. AP students should learn the uses of these points at the start of their studies. They can study other points and Channels later.
Details of the human Channel system and the AP points are in standard texts (Anon 1980a; Lee and Cheung 1978; O'Connor and Bensky 1983).
1.2.B Methods of choosing AP points in humans
A diagnosis is necessary before selecting points for therapy. The diagnostic methods of TCM are very strange and are unacceptable to many western-trained professionals. Those interested in the methods may wish to read Connolly (1979), Porkert (1983), Austin (1972) Wu Wei P'ing (1973) and Anon (1980a).
A much more simple method of choosing points is based on determining the main signs and symptoms and the organs, parts or nerves affected. Then points are chosen by the application of about 13 Ancient Laws and two modern laws, or Cookbook AP is used. This method is discussed in the paper "Choice of points for particular conditions" which is attached and which you are invited to read before going on to the next section (1.3).
*** PLEASE READ "Choice of points for particular conditions" NOW ***
*** PLEASE READ "Choice of points for particular conditions" NOW ***