Acupuncture for the Western practitioner (Proceedings)

Acupuncture is the insertion of needles into specific points on the body (acupoints) to cause a desired healing effect. The word acupuncture comes from the Greek words acus needle, and pungare to pierce. Traditional Chinese Medicine (TCM) is comprised of five distinct branches: acupuncture, Chinese herbal medicine, Chinese food therapy, Tui-na and Tai-chi/Qi-gong. TCM is believed to have been in use for about 3000 years in humans and 2600 years in horses. The first known written record of the basic theories of TCM is in Huang Di Nei Jing (The Yellow Emperor's Classic of Internal Medicine) which was written during the Warring States Period (475-221 B.C.). Acupuncture is the most utilized and accepted branch of Traditional Chinese Medicine (TCM). The 2002 National Health Interview Survey conducted by the National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes of Heath, and the National Center for Health Statistics (part of the Centers for Disease Control and Prevention) revealed that 8.2 million American adults had utilized acupuncture.

Most Americans were first exposed to acupuncture when New York Times reporter and member of President Nixon's press corps in China, James Reston, wrote about his emergency appendectomy and post-operative pain management with acupuncture while visiting Peking in 1971. Soon after, Western physicians began to travel to China to observe the procedure.

Scientific Basis of Acupuncture

The National Institutes of Health (NIH) conducted a consensus on acupuncture in 1997 and found compelling evidence that acupuncture was useful for adult postoperative and chemotherapy associated nausea and vomiting, postoperative dental pain, addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma.

The basic tenets that acupuncture is based upon (point selection, method of stimulation, and duration of stimulation) have been proven using fMRI. Specific changes in specific areas of the central nervous system were observed when different acupuncture points were stimulated. When electroacupuncture was added to these points, the changes were more pronounced.1

At the twenty-fourth and twenty-fifth congresses of the International Veterinary Acupuncture Society, abstracts from previously untranslated studies from Brazil, Korea, China and Taiwan were presented. Among the studies were the successful treatment of neurological disturbances due to distemper in dogs with acupuncture, increased lymphocyte count in dogs 21 days after concurrent rabies immunization and treatment with acupuncture, increased gastrointestinal motility following electroacupuncture in dogs and horses, antipyretic effect following electroacupuncture in six febrile equine cases, and the regulation of reproductive functions in cows. To date, there are 13,695 Pubmed citations on acupuncture and at least 219 of these are double-blind studies. A new journal, The American Journal of Traditional Chinese Veterinary Medicine, was established in 2006 to promote the publication of evidence-based research on the efficacy of Traditional Chinese Veterinary Medicine.

Acupuncture Techniques

Acupuncture needles are made from surgical stainless steel and vary in gauge, length, and the presence or lack of silicon coating. They come sterilized and sealed in packages (individually and are intended for single-use only.

Dry Needle Bai-zhen (white needle)

Insertion of a needle without the intention of bleeding or injecting any substances. Conventional needling technique and most commonly utilized.

• Electroacupuncture:

Transmission of electrical energy through acupuncture points via the attachment of electronic devices (leads connected to an electroacupuncture machine) to acupuncture needles that are already in place. Continuous and uniform stimulation is created and maintained for a prescribed amount of time. Among the advantages of electroacupuncture are increased effectiveness of treatment, fewer treatments required, and decreased labor (fewer needles, no manual stimulation of needles). Frequency can be adjusted to mediate the release of β-endorphin or serotonin and dynorphins. β-endorphin is 10-100 times more potent than morphine and circulates in the body for several hours. Acupuncture analgesia is associated with increased levels of β-endorphin in the CSF however there is debate on how pituitary β-endorphin reaches the brain to cause analgesia. There is also strong evidence that acupuncture analgesia is mediated by serotonin. 5-HT concentrations have been shown to increase 30-40% in the systemic circulation post-acupuncture treatment. Dynorphins are 200 times more potent than morphine and are released within the spinal cord in response to high frequency electroacupuncture providing segmental pain relief. Electroacupuncture is commonly utilized for pain relief, nerve stimulation (bladder atony, laryngeal hemiplegia, etc.), internal medicine disorders and paresis/paralysis. See lecture notes "Veterinary Acupuncture and Chinese Herbs: Clinical Applications and Contraindications" for contraindications of electroacupuncture use.

Aquapuncture

The injection of liquids into specific acupoints. This technique is utilized to reinforce points already needled, for points where full needle insertion is contraindicated (e.g., ventral abdominal points), or for animals that are very active and will not stay still for regular needling. Fluids commonly utilized include sterile saline, Vit B-12, B-complex, Adequan, homeopathic remedies, antibiotics, acepromazine, and the patient's own blood. For cats, 27 gauge needles are utilized; for dogs 25-27 gauge needles, and for horses 20-22 gauge needles.

Hemoacupuncture (red needle)

Controlled, intentional bleeding of specific, proven acupoints for excess conditions such as Heat (e.g., fever). Contraindicated in animals that are weak/debilitated, pregnant, Qi/Blood deficient, dehydrated, severe Yin Deficient, or that have possible blood-borne pathogens.

Pneumoacupuncture

Controlled injection of air into specific acupoints. Used for muscle atrophy. Contraindicated on the head.

Implantation

Injection of a solid substance in an acupoint. Gold bead/wire, magnetic bead or pellet and suture material are all commonly utilized. This provides permanent stimulation of acupoints. If gold is utilized, subsequent MRI is contraindicated.

Moxibustion

Burning of Artemesia argyi (Ai-ye) leaves to warm meridians, expel Cold and Wind, revive Yang, and alleviate stagnation. Artemsia leaves are crushed and rolled into a cylinder which is lit and either held over the skin or applied directly to an acupuncture needle that has already been inserted.

Laser Acupuncture

Use of lasers to stimulate acupoints. Two types are typically utilized, red light emitters (wave length 632-650 nm, helium-neon) or infrared light emitters (wave length 902 nm, gallium-arsenite diode). Red light emitters reach a depth of 0.8-15mm in tissue while infrared light penetrates up to 10mm-5cm in tissue. Some feel that the animal's haircoat prevents the penetration of light.

Specific AP Points

Acupoint selection and needle placement requires training however, there are a few acupoints that a veterinarian without training in acupuncture may utilize in their practice.

GV-26: In the philtrum at the level of the ventral aspect of the nostrils. For resuscitation, insert a 27-25 gauge needle and "hen peck" the area. Do not leave the needle in without stimulating the point as the reverse response (relaxation, CV depression) may result.

Wei-jian: Tip of the tail. If no acupuncture needles are available, insert a small gauge needle (25-27 gauge) into the tip of the tail (perpendicular insertion so the needle appears to extend the length of the tail). Expect some bleeding, especially in febrile cases.

Jian-jiao: Dorsolateral aspect of the hip, in the depression just ventral to the craniodorsal aspect of the iliac wing. Aquapuncture at this acupoint often provides lasting pain relief in patients with coxofemoral joint pain. If a client requests Adequan injections, up to 0.5cc/point can be injected at this acupoint in a large dog.

• Resuscitation, circulatory shock, respiratory depression or arrest, unconsciousness: GV-26, Kid-1, PC-6 to TH-5

• Behavior problems, calming: An-shen, GV-20, HT-7, PC-6, BL-14/15/43/44

• Seizures: GB-20, Da-feng-men, GV-20, An-shen, BL-18, LIV-3

• IVDD: Electroacupuncture at Hua-tuo-jia-ji (thoracic, lumbar), Jing-jia-ji (cervical ), Wei-jian

• Wobblers: Electroacupuncture at Jing-jia-ji (cervical )

• Inappetance: Shen-gen (small animal), Tong Guan (equine)

• Diarrhea, constipation: GV-1. ST-25/36

• Urinary Incontinence – BL-28/39/40, CV-3

• Hind end Weakness: BL-23/40/54, Kid-1, ST-36

• Hip Arthritis: Jian-jiao, BL-54, GB-29/30, Liv-3

• Shoulder Pain: LI-15, TH-14, Bo-Lan

• Pelvic Limb Paresis/Paralysis: Kid-1, Wei-jian, ST-41, Liu-feng

• Fever, Heat: Wei Jian, Er Jian, GV-14, LI-4/11, ST-44

• Otitis – TH21, SI-19, GB-2 (often one treatment of aquapuncture at one site only will be curative)

• Lick granuloma – "Circle the Dragon" in conjunction with PC-6, HT-7, BL-15/44

• Scar Therapy – "Circle the Dragon" using procaine

Acupuncture Training

Chi Institute of Traditional Chinese Veterinary Medicine

9700 West Highway 318

Reddick, FL 32686

1-800-891-1986

Also offers courses in Chinese herbal medication, Chinese Food Therapy, Tui-Na and TCVM for veterinary technicians.

www.tcvm.com

Colorado State University/Colorado Veterinary Medical Association

303-318-0447 Ellen Henningsen

www.aavma.org

International Veterinary Acupuncture Society (IVAS)

PO Box 271395

Fort Collins, CO 80527

970-266-0666

www.ivas.org

References

Chiu, JH, Cheng HC, Tai, Hsieh JC, Yeh TC, Cheng H, Lin JG, and Ho LT. Electroacupuncture-induced neural activation detected by use of manganese-enhanced functional magnetic resonance imaging in rabbits. Am J Vet Res. 2001 62(2): 178-82.