Acupuncture Effects on the Body's Defence Systems and Conditions Responsive to AP
Philip A.M. Rogers MRCVS1
1980, edited 1995
Postgraduate Course in Veterinary AP, Dublin, 1996
1980, edited 1995
Postgraduate Course in Veterinary AP, Dublin, 1996
This paper was written in 1980. For an update, see "ACUPUNCTURE FOR IMMUNE-MEDIATED DISORDERS", attached.
INTRODUCTION
Acupuncture (AP) is best known for its effects in controlling pain, its value in treating alcohol and narcotic addiction and in the induction of surgical analgesia in humans and animals . It is less well known that AP has great therapeutic value in a wide variety of human and animal diseases. These effects are well established in clinical practice. Modern textbooks and journals of AP list hundreds of clinical conditions which respond (partially or completely) to AP therapy.
Some of the therapeutic effects of AP have been studied experimentally in animals and humans. In this talk we will discuss the effects of AP in stimulating the defence systems of the body. These effects are directly involved in the therapeutic value of AP in humans and animals.
THE DEFENCE SYSTEMS OF THE BODY
Defence systems have two basic components: (a) recognition of the attack, its nature, locality and extent, and (b) activation of mechanisms to counter the attack and to repair the damage which has been done. Important defence systems of the body include the following:
The autonomic nervous system (and its reflexes) controls to a large degree these defence systems in the body. The neuroendocrine system also allows the organism to adapt to changes in the internal and external environment. The PRIMITIVE SYSTEM of Becker (see the paper on Holistic concepts of health and disease) is also involved in the sensing and regeneration of damaged tissue, such as wounds, fractures, burns, etc.
Occasionally the defence systems develop defects which cause them to react to self rather than non-self. Examples of self-destruction include auto-immune diseases and auto-inflammation. Other examples are failure to recognise pain (due to congenital neurological defect or stress/excitement) with consequent risk of severe injury. One of the causal factors in cancer is uncontrolled tissue regeneration or failure of the immune system to recognise and destroy aberrant cells.
The immune system, which normally serves a useful protective function, occasionally creates problems by causing reactions to allergens which gain entry to the body by inhalation, ingestion or by skin contact.
AP IN THE TREATMENT OF INFECTIONS
AP textbooks and journals list many human infections which may be helped by AP stimulation. Treatment is aimed at the main symptoms of the infection (such as fever, headache, vomiting, diarrhoea, pain, colic, jaundice, paralysis, etc) and at the major regions involved (such as the liver, lungs, intestine, upper limbs, etc).
Clinical infections in humans which may be helped by AP include:
Clinical infections in animals: Animal AP, even in China, is much less well developed than human AP. Traditional Chinese Medicine (TCM) also relies very heavily on the use of HERBAL Medicine, especially in the treatment of animal diseases. Thus, in veterinary practice, AP as a therapy to help fight clinical infections appears to be limited (at this time) to the treatment of enteric infections (such as E. coli) in pigs and dogs, uterine infections in cows and bitches, udder infections in cows, and a few other infections.
As will be seen later, the use of AP in experimental infections and in the treatment of many clinical and experimental conditions in animals suggests that it may have wide applications in animal infections.
Experimental infections: Animals have been infected with bacillary dysentery, poliomyelitis virus, trypanosomiasis and Erlich Ascites Tumour virus. In each of these conditions AP had complete or partial effect in combatting the infection.
Further details of the antibiotic/antimicrobial effects of AP are given in Appendix 2.
AP IN THE TREATMENT OF INFLAMMATION
Inflammation is the normal defence reaction to local injury, infection, necrosis, allergy or other local irritation. Thus, inflammation is a desirable reaction and one does not try to treat inflammation per se, but to help the inflammatory response and to speed up its successful resolution. Where possible, the cause of the inflammation should be diagnosed, removed and/or treated also. In practice, many inflammations arise from non-specific or unidentified causes. In these cases, orthodox treatment consists of analgesic, anti-inflammatory, antibiotic drugs + penetrating agents and physical therapy, used in an empirical manner.
AP is a highly effective means of treating clinical inflammatory conditions in humans and animals. The needles usually are used on local points (points near the inflamed organ or area), plus some needles on distant points on meridians passing through the affected organ or area. When they arise, associated symptoms (such as fever, cough, headache, back pain, etc) are treated by needling the relevant points for these symptoms.
Human inflammatory conditions responsive to AP in clinical practice include:
Inflammatory conditions in animals which respond clinically to AP are basically similar to those in humans. However, as mentioned in the previous section, AP in animals has not been used as extensively as in humans. Veterinary AP literature mentions clinical success with inflammation in similar regions to those in humans. Examples are:
Klide and Kung's textbook and the books of Westermayer and Brunner list many more inflammatory conditions which are said to respond clinically to AP (see Appendix 1 of this paper).
The conditions listed above refer to uncontrolled clinical observation in humans and animals. It could be argued that such observations do not prove that AP has anti-inflammatory effects. However, there is direct evidence from experimental work with animals which shows that AP has powerful effects on the inflammatory response.
Experimental inflammation
These experiments were conducted by Chinese workers but other experiments in animals also confirm that AP has anti-inflammatory effects. One of the most obvious uses of AP for its anti-inflammatory effects is in surgical (operative) cases. AP analgesia or AP therapy post-surgery causes a marked reduction in the incidence of post-operative complications (wound sepsis, slow healing, intestinal atony etc). Wound healing in acupunctured animals is fast and clean. The points used are similar to those used in AP analgesia for the surgical area (see paper on AP Analgesia) but points LI04 (HoKu), LI11 (ChuChih), GV14 (TaChui) and ST36 are especially effective in controlling wound infection and fever.
AP IN THE TREATMENT OF FEVER
Clinical fever: AP is used to reduce fever in many specific and non-specific conditions in humans. For this purpose, the points most often used are LI04, LI11 and GV14. For instance, these points are used to reduce fever in influenza, poliomyelitis, malaria, typhoid, cholera etc and in post-operative sepsis. The same points are used in non-specific fevers.
Experimental fever was induced in rabbits by injection of typhoid vaccine. Needling of points ST36 and GV14 consistently reduced body temperature in the experimental rabbits but normal temperatures were not reached. However, repeated needling at these points reduced the duration of the fever as compared with the duration in control rabbits. Other Chinese experiments also confirmed the anti-febrile effects of AP in monkeys with experimental bacillary dysentery. In clinical veterinary practice, needling of points ST36; GV14; LI04; LI11 is recommended to help reduce fever in many specific and non-specific cases.
AP EFFECTS ON ANTIBODY LEVELS
Papers presented at the AP symposium at Beijing (1979) noted strong effects of AP in stimulating the immune response in humans and animals (6). Needling TienShu (ST25) and ShangChuHsu (ST37) increased immunoglobulins and specific antibody levels in blood of rabbits and monkeys experimentally infected with bacillary dysentery and in naturally-occurring cases in humans. In clinical cases of human malaria, AP increases serum complement levels.
Injection of specific antigen into many species of experimental animals (rats, guinea pigs, rabbits, monkeys) has been used to examine the antibody response to AP. The main points which enhance antibody production are LI04; HsuanChung (GB39) penetrating to San Yin Chiao (SP06); ST36. In these experiments, AP caused a faster rise in antibody level, a higher plateau and longer persistence of antibody than in the inoculated but non- acupunctured animals.
AP EFFECTS ON PHAGOCYTES, RETICULO-ENDOTHELIAL SYSTEM AND LYMPHOID TISSUE
Under experimental conditions in humans, needling LI11 caused neutrophilia (leucocytosis), whereas needling a placebo point had no effect. In clinical medicine, LI11 (sometimes with as LI04, GV14 and ST36) is frequently used in infections and in other conditions in which activation of the neutrophils and reticulo-endothelial system is required. It is hardly coincidence that these effects are stimulated by the same points which activate the antibody system and that these points are valuable in the therapy of infections in humans.
Similarly, in animals, points such as LI4, LI11, ST36 and GV14, cause leucocytosis and increase phagocytosis in experimental studies, as well as in clinical infections. For example, AP at LI11 caused leucocytosis in rabbits whereas placebo points did not produce this effect. Similarly, when plasma from rabbits needled at LI11 was injected into control rabbits, they also developed leucocytosis, whereas plasma from control rabbits injected into other controls caused a leucopenia. The release of a humoral leucocytic factor has been shown by other studies. It was also shown that this effect of AP was inhibited by nerve section above the point or by local anaesthesia of the point before needling. This demonstrates that the input signal to the hypothalamus is transmitted via the peripheral sensory nerve.
Japanese workers challenged rabbits and rats with bovine serum albumin. ST36 and PangGu (new points on the limbs) were needled. Marked histological changes occurred in the lymph nodes of the acupunctured limb (enlargement of the lymph sinuses, haemorrhage, increase in mast cells and degranulation. A rapid increase in plasma cells occurred in 48 hours). It could be argued that these changes were of an inflammatory nature rather than an immune response. However, the other data of the trial indicated definite immune enhancement of antibody production and lymphocytopenia.
AP also caused release of a humoral bactericidal factor. In experimental bacillary dysentery in rabbits and monkeys, AP at ST25 and ST37 increased the bactericidal activity of plasma by 50% after 30 minutes and by 70% after 3 hours. In these experiments, the phagocytic activity of the reticulo-endothelial system of the liver increased 46% after 6 days and 63% after 12 days of AP. The treated animals ceased to excrete the bacilli in faeces in 4-5 days, whereas control animals (untreated by AP) were still excreting bacilli after 21 days. All the symptoms (fever, abdominal pain, tenesmus, bowel frequency etc)were eliminated by AP. In 800 clinical cases of bacillary dysentery in humans, AP alone, given 1-3 times daily for 5-10 days was effective therapy in 90% of patients. The symptoms were controlled and the organisms were eliminated from the faeces.
EFFECTS OF AP ON TISSUE DAMAGE CAUSED BY X-RAYS
Rats exposed to X-rays developed anaemia and leucopenia. Needling at LI04, GB39 and SP06 caused the red cell count, haemoglobin level and while cell count to recover faster than in control rats which received the same dose of X-ray. AP has been used clinically in humans to assist recovery from nuclear exposure. Apart from its effects in haematology, nuclear exposure also damages the immune response in humans and animals. The immunostimulant effects of AP may be helpful to patients suffering from the effects of nuclear radiation, such as that used in cancer therapy.
AP IN THE TREATMENT OF ALLERGIES
AP in human clinical allergies: AP is used to treat many human allergies, including allergies caused by inhalation, oral intake and skin contact. These conditions include asthma, hay fever, allergic rhinitis, food allergies, diarrhoea, contact allergies, allergic conjunctivitis etc.
The most important points for treatment in asthma include FeiShu (BL13) and GV14 but other points are sometimes added, including HsinShu (BL15), KeShu (BL17), TingChuan (Asthma point) and HaiLao (a new point). In hay fever and allergic rhinitis, the main points are LI04 and YingHsiang (LI20) but other points, such as LI11 and Yin Tang (Z 03, between the eyebrows) are also used.
In treating human allergies, the selection of the points is based mainly on the location of the symptom or lesions. For instance, in asthma, the main points are chosen for their action on the lung. In rhinitis the points are chosen for their action on the nose and upper respiratory tract. Thus, in treating a food allergy in which the main symptom was nausea and vomiting, the main points would be aimed at the stomach (ChungWan (CV12); ST36, PC06). If the main symptom was biliousness and dizziness with headache, the main points would be aimed at the liver and gallbladder ((TaiChung (LV03); FengChih (GB20) with possibly ST36 added for its gastric effect).
A course of AP can often succeed in desensitising patients to their allergens, despite continued exposure to them. Examples are hay fever, migraine headache and food allergies.
AP in clinical allergies in animals: There are few reports of the use of AP in specific clinical allergies in animals. However, it might be tried in fog fever in cattle and in bronchospasm in horses (similar to asthma) and in non-specific dermatitis, and pruritus in small animals. Also many symptoms of allergies (bloat, vomiting, diarrhoea, etc) in animals are known to respond to AP, aimed at the organ, region or symptom involved.
Experimental allergy in animals: Allergic-encephalomyelitis was induced in guinea pigs by injections of an encephalogenic antigen. Needling certain points (LI11; ST36) enhanced the immune response and exaggerated the allergic response. On the other hand, needling ChihShih (BL52) prevented the allergic response. The antiallergic effect may have been due to release of ACTH and corticosteroids. BL52 has effects on the kidney and adrenal.
AP AND ENDOCRINE RESPONSES
In the paper on AP analgesia, the role of the hypothalamus and endorphin release is discussed more fully. AP stimuli are carried via the peripheral sensory nerves and sympathetic trunks to the hypothalamus. Hypothalamic activation with subsequent activation of the pituitary, may release ACTH, MSH, TSH, gondatropins, pancreatic (insulin) tropins etc depending on which nuclei in the hypothalamus have been stimulated. This, in turn, depends on which AP points have been stimulated. Release of these hormones may cause release of corticosteroids, adrenalin, thyroid hormones, oestrogen, progesterone, oxytocin, prolactin, relaxin, insulin, etc.
Clinical endocrine disorders in humans: AP is used to treat many human endocrine disorders. If there are sufficient endocrine cells which can be activated by the trophic and/or neural stimuli, the results can be very good. However, in chronic or severe cases (especially where hormone substitution therapy has been given for a long time and has suppressed the body's ability to produce its own hormones), the results are not so good.
Examples of endocrine conditions responsive to AP include: mild goitre, mild hormonal infertility (due to oestrogen-prostaglandin-progesterone imbalance), post-parturient agalactia (prolactin, oxytocin), uterine atony at parturition (oxytocin); cervical non-dilation at parturition (ringwomb); recurrent abortion; menopausal syndromes. ln early or mild cases of diabetes mellitus, AP at SP06; LV13 (ChangMen); BL20 (PiShu) can be very effective in controlling blood sugar and in treating pancreatitis. In diabetes insipidus, due to deficiency of the antidiuretic hormone, needling at BL23 (Shen Shu), BL28 (PangKuangShu); GB25 (ChingMen) can help.
Clinical endocrine disorders in animals: Similar conditions in animals have been helped (reproductive disorders; parturition disorders; agalactia; pseudopregnancy; polyuria; hormonal alopecia in castrated cats). However, as in other areas of veterinary AP, documentation of these effects in very scarce.
The evidence from clinical use in humans and animals suggests that some of the therapeutic effects of AP are mediated by the endocrine system.
OTHER CONDITIONS RESPONSIVE TO AP THERAPY
Earlier sections discussed many therapeutic effects of AP. These include leucocytosis, increased activity of the phagocytic, lymphoid and reticulo-endothelial systems, release of a leucocytotic factor and a bactericidal factor into plasma, enhanced antibody production, antifebrile, anti-inflammatory and anti-infectious effects. These effects help to explain the therapeutic value of AP in fighting infection, resolving inflammation and reducing fever in humans and animals. Increased haematological stimulation and immunostimulation also help to explain the effect of AP in damage caused by exposure to nuclear radiation. These effects are stimulated only by certain points.
Other points have immunosuppressant effects and help patients during the allergic reaction. Still others act by releasing various hormones in mild endocrine disorders.
Other applications of AP in humans and animals include: pain, poor circulation, smooth muscle dysfunction, tissue damage and bleeding, paralysis, paresis and miscellaneous.
a. PAIN
Pain due to trauma, inflammation, ischaemia, muscle spasm, arthritis and other peripheral causes, can be helped, if not fully controlled, by AP.
Pain conditions in humans which respond in varying degrees to AP are: headache, toothache, eye pain, earache, neck pain; colic; pain in gastric, duodenal or colonic ulcer; backache, sciatica; pain in the muscles and joints, phantom limb pain, angina pectoris, narcotic withdrawal pain. One of the main uses of AP in human patients is in the control of chronic peripheral pain. However, pain of central origin does not respond well.
AP is also of astonishing value in treating acute traumatic pain (fractures, dislocations, pulled muscles, contusions, abrasions, etc). For this purpose, the most important point is YangLingChuan (GB34). GB34 is usually combined with a local point for the region involved.
AP is also of great value in treating post-operative pain (and other complications, such as inappetance, nausea, ileus and urine retention) in humans. For this purpose the main points used are the same as in AP analgesia for the region (see paper on AP analgesia). Points to assist the function of the stomach, large intestine, kidney and bladder are added, as needed.
Pain conditions in animals which respond to AP include: Lameness due to muscular rheumatism, muscle spasm, myositis; arthritis; spinal trauma and mild cases of intervertebral disc protrusion; laminitis, tendinitis, periostitis and trauma; abdominal colic (gastrointestinal, hepatic, renal, cystic, uterine, etc).
Post-operative pain in animals: Although AP is seldom used specifically for this purpose in animals, those which have been operated upon under AP analgesia have far fewer complications and heal faster than those operated upon under conventional anaesthetics.
Post-operative complications in animals: after surgery, AP can be used to obtain pain relief and to help restore normal physiological function, as in humans.
b. POOR BLOOD CIRCULATION
Many human clinical conditions are caused by poor blood circulation. Coronary heart disease (CHD) and angina pectoris are greatly helped by frequent needling of PC06. Experimental reduction of coronary blood supply in dogs was used as a model of human CHD. AP at PC06 improved coronary/myocardial circulation, reduced the size of the subsequent infarct and assisted the healing of the damaged muscle.
Muscular aches and pains, "pins and needles" (peripheral paraesthesia) or ulcers, etc in humans are frequently caused by poor blood circulation. AP is effective in many of these conditions.
Human indigestion and hyperacidity may be associated with poor circulation in the gastrointestinal tract. AP is very effective in these conditions. Two important points are ST36 and PC06; others include CV12 and BL21. Under experimental conditions in laboratory animals, stimulation of ST36 and PC06 improves mesenteric and gastrointestinal circulation and delays or prevents the onset of experimental ulcers, or assists in their resolution. Similarly, gastrointestinal hyper- or hypo-motility is corrected by needling these points.
Poor circulation in the brain, such as in senile human arteriosclerosis, may cause many problems. AP of points which act on brain function helps to alleviate these problems. Under experimental conditions in animals, AP at JenChung (GV26) greatly improves brain micro-circulation. GV26 is the emergency point par excellence in shock, collapse, coma, heatstroke, convulsions and anaesthetic apnoea in humans and animals. Similarly, nausea and fainting in humans are quickly corrected by needling or massaging GV26. However, other points also help nausea + dizziness. These include PC06; ST36; GB20; CV12.
By its effect on the autonomic nervous system (see below) AP has powerful effects on blood circulation in most vascular areas. The points for specific regions are similar to those for pain or other problems of those regions.
c. SMOOTH MUSCLE DYSFUNCTION
Human conditions very often involve spasm of smooth muscle. Examples are pain in angina pectoris; biliary, renal, uterine and gastrointestinal colic; peripheral circulatory upsets; asthma etc. Factors which relieve smooth muscle spasm greatly reduce or eliminate the symptoms. AP of the correct points produces this result. Also, in obstruction of ducts (such as the bile duct and ureter), smooth muscle spasm not only causes pain but also prevents the obstruction from being expelled. AP often allows calculi to pass out of the gallbladder, bile duct, ureter or bladder by inducing relaxation of the smooth muscle and by increasing the fluid pressure proximal to the calculus. In children, ascaris worms in the bile duct often have been expelled after AP and even expulsion from the gut has been claimed. Many studies have shown that needling the correct points has marked effects on smooth muscle contractability, bile flow, peristalsis and gastrointestinal secretion.
Smooth muscle spasm in animals: The antispasmodic effects of AP are of use in treating colics and digestive upsets. They are also of use in treating bronchospasm.
In dystocia, relative oversize of the foetus and uterine atony are often present. Kothbauer and Westermayer used AP routinely in bovine dystocia. They found that pelvic relaxation occurred within 10 minutes of AP and the birth was greatly helped by this. Westermayer treated more than 200 cases of prolapsed uterus in cows by AP of the lumbosacral region. The uterus was easily put back in position and straining by the cow seldom occurred, making the procedure simple and very fast. Also in retention of the foetal membranes or in metritis + pyometra (in which uterine atony is involved) AP may help the condition.
d. TISSUE DAMAGE AND BLEEDING
These conditions often follow trauma. Other factors also cause tissue damage, for instance liver and kidney damage in many toxic conditions; heart and brain damage in circulatory disorders; muscle damage in Vitamin E and selenium deficiency etc. The effects of AP in traumatic pain has been mentioned earlier. However, AP also assists the recovery of damaged tissue, if tissue regeneration is possible. For instance, the skin and liver have marked regenerative capacity and AP stimulates this effect, by improving local circulation and its anti-inflammatory and anti- infectious effects.
Muscular injury in humans and animals is also greatly helped by AP. The best points are the tender spots (AHSHI points, trigger points) in the damaged muscles and the AP points which control the damaged area.
Where subcutaneous or intramuscular bleeding and oedema result from trauma, AP helps in the resorption of the fluid and in the resolution of the swelling.
Where tissue damage is severe (as in extensive burns or trauma) the main approach should be to control shock, haemorrhage, fracture and infection by conventional means. AP may be used later to relieve pain and to assist tissue healing.
AP cannot stimulate tissue regeneration if the tissues are incapable of regenerating, such as in severe neural, spinal, cardiac, pulmonary or renal damage. However, many cases of severe lameness in humans and animals are (wrongly) attributed to severe lesions in joints or in the spine, including prolapsed inter-vertebral discs. Many of these patients can be greatly helped by AP, but the lesion (other than soft tissue swelling, oedema etc) remains unaffected by the treatment. This suggests that many cases of such lameness are not due to the lesion, but to reflex muscle spasm triggered initially by the lesion. The clinical effects of AP in these cases are due to their effects on pain and muscle spasm.
e. PARALYSIS, PARESIS
These conditions may arise in humans and animals from nerve damage at central, spinal or peripheral level. For example, human cerebral haemorrhage, thrombosis, encephalitis, spinal injury or peripheral nerve injury may cause paralysis of one or more regions or functions. We are taught that if the nuclei of motor neurons are damaged, the neurons cannot regenerate and that paralysis due to neural necrosis is irreversible. However, we also know (1) that many cases of paralysis occur from axon damage, (2) that functional damage to the nervous system (poor micro-circulation) may cause paralysis, and (3) that considerable plasticity exists in the nervous system, i.e. that some neural circuits can be re- programmed to adopt new functions. These facts explain a reasonably high success rate of AP in treating conditions such as central, spinal and peripheral- nerve paralysis in humans. I would strongly recommend that any of you who have friends or relatives who suffer from recent paralysis should consult with a competent medical acupuncturist. AP combined with conventional therapy can be very helpful in many of these cases.
Animals usually suffer paralysis from trauma or arthritis, involving the vertebral column or trauma to peripheral nerves. AP is very effective therapy for many of these cases but many sessions may be required and physical manipulation may also be required. (Paralysis from central causes, metabolic upsets or poisoning is not in discussion here). Paralysis associated with prolapsed intervertebral disc may also respond to AP. As in the treatment of pain, AP does not alter the physical lesion (dislocation, arthritis, spondylitis, disc prolapse etc) but function is often restored despite the persistence of the lesion. This indicates that these cases of paralysis may be functional or due to oedema or poor blood supply to the nerve tracts. The antiinflammatory, antioedematous and pro-circulatory effects of AP may explain the clinical recovery in these cases.
f. MISCELLANEOUS CONDITIONS
The list of conditions which can be helped by AP runs to hundreds. Some respond very well, others have less satisfactory results, or require many sessions. In general, AP has therapeutic effects on all the major systems of the body in humans (nervous system, the 5 senses; endocrine system; respiratory, cardiovascular, digestive, reproductive, urinary, musculoskeletal systems and skin). It also influences all the main body regions (and their parts) and organs, including the head, neck, upper limb, thorax, abdomen, spine and lower limb. Recent reports from Hospitals in Sweden and Taipei suggest that AP has powerful effects in treating spastic paralysis and cerebral palsy in children.
No one textbook of AP lists all the conditions amenable to therapy, but a study of many text-books and journals will demonstrate the wide range of clinical uses (for details, see references 1 to 7 at end).
Veterinary AP therapy is not as well developed as human AP, but a wide range of clinical conditions (involving all the main physiological systems and all the body regions, their parts and organs) may be helped. The main limiting factor is often the economic one. AP therapy generally requires more time per session and more sessions to be effective, especially in chronic cases. Time is money to a busy veterinarian and to the client. It is often decided that the cost of treatment would not be justified on economic grounds because of the relatively small cash value of the animal. However, in the case of family pets, racing animals (dogs, horses) and valuable breeding stock, the economic considerations are less important.
Appendix 1 lists miscellaneous conditions in animals which can be helped by AP. For further details on AP in the activation of the defence systems, see References 6, 10, 11, 12 at the end of this paper.
CONCLUSIONS
AP at specific points activates the defence system of humans and animals via reflex neural effects, autonomic effects, neuroendocrine, endocrine and humoral effects. Sensory input to the hypothalamus is most important in these effects. Other mechanisms, such as the Primitive Nervous System of Becker, may be involved in the slow healing processes.
In general, if activation of the defence systems of the body can affect the clinical condition or if tissue regeneration is possible, AP is indicated as a possible therapy alone or in combination with other therapies.
AP has wide therapeutic effects in infection, inflammation, fever, allergy, endocrine disorders and many other clinical conditions. AP is not a panacea; it should be seen as an aid to conventional therapy and not as a complete alternative to it.
AP may be the treatment of choice in some cases (for instance anaesthetic apnoea, muscular lameness). In other cases, AP combines well with other therapies (i.e. with antibiotics in mastitis, with glucose infusion + corticosteroids in bovine ketosis). AP is useless, or of very little use in cases in which the adaptive response is disabled (for instance in terminal malignant cancer, severe spinal damage, the later stages of liver or renal fibrosis). In these cases other therapies are required but these may be of little use also.
INTRODUCTION
Acupuncture (AP) is best known for its effects in controlling pain, its value in treating alcohol and narcotic addiction and in the induction of surgical analgesia in humans and animals . It is less well known that AP has great therapeutic value in a wide variety of human and animal diseases. These effects are well established in clinical practice. Modern textbooks and journals of AP list hundreds of clinical conditions which respond (partially or completely) to AP therapy.
Some of the therapeutic effects of AP have been studied experimentally in animals and humans. In this talk we will discuss the effects of AP in stimulating the defence systems of the body. These effects are directly involved in the therapeutic value of AP in humans and animals.
THE DEFENCE SYSTEMS OF THE BODY
Defence systems have two basic components: (a) recognition of the attack, its nature, locality and extent, and (b) activation of mechanisms to counter the attack and to repair the damage which has been done. Important defence systems of the body include the following:
- a. the immune system (specific and non-specific immunity);
b. the phagocytic system (white cells and reticulo-endothelial systems) and lymphoid tissues; c. the inflammatory reaction;
d. the thermoregulatory system;
e. the recognition and control of pain and muscle spasm;
f. the sensing of damaged tissue and its controlled regeneration.
The autonomic nervous system (and its reflexes) controls to a large degree these defence systems in the body. The neuroendocrine system also allows the organism to adapt to changes in the internal and external environment. The PRIMITIVE SYSTEM of Becker (see the paper on Holistic concepts of health and disease) is also involved in the sensing and regeneration of damaged tissue, such as wounds, fractures, burns, etc.
Occasionally the defence systems develop defects which cause them to react to self rather than non-self. Examples of self-destruction include auto-immune diseases and auto-inflammation. Other examples are failure to recognise pain (due to congenital neurological defect or stress/excitement) with consequent risk of severe injury. One of the causal factors in cancer is uncontrolled tissue regeneration or failure of the immune system to recognise and destroy aberrant cells.
The immune system, which normally serves a useful protective function, occasionally creates problems by causing reactions to allergens which gain entry to the body by inhalation, ingestion or by skin contact.
AP IN THE TREATMENT OF INFECTIONS
AP textbooks and journals list many human infections which may be helped by AP stimulation. Treatment is aimed at the main symptoms of the infection (such as fever, headache, vomiting, diarrhoea, pain, colic, jaundice, paralysis, etc) and at the major regions involved (such as the liver, lungs, intestine, upper limbs, etc).
Clinical infections in humans which may be helped by AP include:
- Bacterial (typhoid, paratyphoid, cholera, bacillary dysentery, brucellosis, venereal disease, tuberculosis).
- Viral (Virus B encephalitis, poliomyelitis, viral hepatitis, influenza, Heres Zoster).
- Protozoal (Malaria, schistosomiasis, filariasis, amoebic dysentery).
- Fungal (Tinea pedis).
- Post-operative infection.
Clinical infections in animals: Animal AP, even in China, is much less well developed than human AP. Traditional Chinese Medicine (TCM) also relies very heavily on the use of HERBAL Medicine, especially in the treatment of animal diseases. Thus, in veterinary practice, AP as a therapy to help fight clinical infections appears to be limited (at this time) to the treatment of enteric infections (such as E. coli) in pigs and dogs, uterine infections in cows and bitches, udder infections in cows, and a few other infections.
As will be seen later, the use of AP in experimental infections and in the treatment of many clinical and experimental conditions in animals suggests that it may have wide applications in animal infections.
Experimental infections: Animals have been infected with bacillary dysentery, poliomyelitis virus, trypanosomiasis and Erlich Ascites Tumour virus. In each of these conditions AP had complete or partial effect in combatting the infection.
Further details of the antibiotic/antimicrobial effects of AP are given in Appendix 2.
AP IN THE TREATMENT OF INFLAMMATION
Inflammation is the normal defence reaction to local injury, infection, necrosis, allergy or other local irritation. Thus, inflammation is a desirable reaction and one does not try to treat inflammation per se, but to help the inflammatory response and to speed up its successful resolution. Where possible, the cause of the inflammation should be diagnosed, removed and/or treated also. In practice, many inflammations arise from non-specific or unidentified causes. In these cases, orthodox treatment consists of analgesic, anti-inflammatory, antibiotic drugs + penetrating agents and physical therapy, used in an empirical manner.
AP is a highly effective means of treating clinical inflammatory conditions in humans and animals. The needles usually are used on local points (points near the inflamed organ or area), plus some needles on distant points on meridians passing through the affected organ or area. When they arise, associated symptoms (such as fever, cough, headache, back pain, etc) are treated by needling the relevant points for these symptoms.
Human inflammatory conditions responsive to AP in clinical practice include:
- Ear, nose, throat, eye, mouth (otitis, rhinitis, sinusitis, tonsillitis, pharyngitis, opthalmitis, conjunctivitis, stomatitis, gingivitis, glossitis
- Respiratory tract (tracheitis, bronchitis, pneumonia)
- Gastrointestinal tract (gastritis, duodenitis, gastroduodenal ulcer, enteritis, appendicitis, colitis, proctitis)
- Liver, gallbladder, pancreas, peritoneum (inflammation,pain, colic etc)
- Urinary tract (nephritis, cystitis, urethritis)
- Genital tract (oophoritis, salpingitis, metritis, cervicitis, and cervical erosion, vaginitis, orchitis, prostatitis)
- Muscle-skeletal (myositis, bursitis, tenosynovitis, arthritis) Cardiovascular (thromboangiitis, varicose ulcers, myocardial infarct and myositis)
- Lymphatic (lymphadenitis, lymphangitis)
- Skin and subcutaneous tissue (eczema, dermatitis, acne, furunculosis)
- Nervous tissue (neuritis, encephalitis)
Inflammatory conditions in animals which respond clinically to AP are basically similar to those in humans. However, as mentioned in the previous section, AP in animals has not been used as extensively as in humans. Veterinary AP literature mentions clinical success with inflammation in similar regions to those in humans. Examples are:
- gingivitis, stomatitis, rhinitis
- bronchitis, pneumonia
- gastritis, enteritis,
- hepatitis, cholecystitis, pancreatitis, peritonitis
- nephritis, cystitis, metritis, pyometra
- myositis, tenosynovitis, arthritis, laminitis
- eczema, lick granuloma
- mastitis, encephalitis
Klide and Kung's textbook and the books of Westermayer and Brunner list many more inflammatory conditions which are said to respond clinically to AP (see Appendix 1 of this paper).
The conditions listed above refer to uncontrolled clinical observation in humans and animals. It could be argued that such observations do not prove that AP has anti-inflammatory effects. However, there is direct evidence from experimental work with animals which shows that AP has powerful effects on the inflammatory response.
Experimental inflammation
- Bacterial peritonitis was produced in rabbits and other laboratory animals. AP greatly reduced the volume of inflammatory exudate produced and the exudate became (bacteriologically) sterile in a much shorter time in treated animals than in the control animals.
- Inflammatory granuloma was produced on the skin of the back in rats. After 8 days of treatment by AP or moxa at ST36 (TsuSanLi), treated rats produced 3.5 ml effusate, as compared with 7.0 ml in control rats.
- Turpentine injection in rabbits caused severe inflammation. AP treatment increased local circulation and lymph drainage and had strong effects in resolving the inflammation.
- Perforated gastric or duodenal ulcers were produced in rabbits. AP enhanced peritoneal activity (speed of adhesion and speed of resorption of effusate) and was effective in alleviating the clinical signs.
- Myocardial infarct, necrosis and cardiopathy was produced in dogs and rabbits by arterial ligation. AP at PC06 (NeiKuan) improved coronary circulation, reduced the size of the infarct and the subsequent necrosis.
These experiments were conducted by Chinese workers but other experiments in animals also confirm that AP has anti-inflammatory effects. One of the most obvious uses of AP for its anti-inflammatory effects is in surgical (operative) cases. AP analgesia or AP therapy post-surgery causes a marked reduction in the incidence of post-operative complications (wound sepsis, slow healing, intestinal atony etc). Wound healing in acupunctured animals is fast and clean. The points used are similar to those used in AP analgesia for the surgical area (see paper on AP Analgesia) but points LI04 (HoKu), LI11 (ChuChih), GV14 (TaChui) and ST36 are especially effective in controlling wound infection and fever.
AP IN THE TREATMENT OF FEVER
Clinical fever: AP is used to reduce fever in many specific and non-specific conditions in humans. For this purpose, the points most often used are LI04, LI11 and GV14. For instance, these points are used to reduce fever in influenza, poliomyelitis, malaria, typhoid, cholera etc and in post-operative sepsis. The same points are used in non-specific fevers.
Experimental fever was induced in rabbits by injection of typhoid vaccine. Needling of points ST36 and GV14 consistently reduced body temperature in the experimental rabbits but normal temperatures were not reached. However, repeated needling at these points reduced the duration of the fever as compared with the duration in control rabbits. Other Chinese experiments also confirmed the anti-febrile effects of AP in monkeys with experimental bacillary dysentery. In clinical veterinary practice, needling of points ST36; GV14; LI04; LI11 is recommended to help reduce fever in many specific and non-specific cases.
AP EFFECTS ON ANTIBODY LEVELS
Papers presented at the AP symposium at Beijing (1979) noted strong effects of AP in stimulating the immune response in humans and animals (6). Needling TienShu (ST25) and ShangChuHsu (ST37) increased immunoglobulins and specific antibody levels in blood of rabbits and monkeys experimentally infected with bacillary dysentery and in naturally-occurring cases in humans. In clinical cases of human malaria, AP increases serum complement levels.
Injection of specific antigen into many species of experimental animals (rats, guinea pigs, rabbits, monkeys) has been used to examine the antibody response to AP. The main points which enhance antibody production are LI04; HsuanChung (GB39) penetrating to San Yin Chiao (SP06); ST36. In these experiments, AP caused a faster rise in antibody level, a higher plateau and longer persistence of antibody than in the inoculated but non- acupunctured animals.
AP EFFECTS ON PHAGOCYTES, RETICULO-ENDOTHELIAL SYSTEM AND LYMPHOID TISSUE
Under experimental conditions in humans, needling LI11 caused neutrophilia (leucocytosis), whereas needling a placebo point had no effect. In clinical medicine, LI11 (sometimes with as LI04, GV14 and ST36) is frequently used in infections and in other conditions in which activation of the neutrophils and reticulo-endothelial system is required. It is hardly coincidence that these effects are stimulated by the same points which activate the antibody system and that these points are valuable in the therapy of infections in humans.
Similarly, in animals, points such as LI4, LI11, ST36 and GV14, cause leucocytosis and increase phagocytosis in experimental studies, as well as in clinical infections. For example, AP at LI11 caused leucocytosis in rabbits whereas placebo points did not produce this effect. Similarly, when plasma from rabbits needled at LI11 was injected into control rabbits, they also developed leucocytosis, whereas plasma from control rabbits injected into other controls caused a leucopenia. The release of a humoral leucocytic factor has been shown by other studies. It was also shown that this effect of AP was inhibited by nerve section above the point or by local anaesthesia of the point before needling. This demonstrates that the input signal to the hypothalamus is transmitted via the peripheral sensory nerve.
Japanese workers challenged rabbits and rats with bovine serum albumin. ST36 and PangGu (new points on the limbs) were needled. Marked histological changes occurred in the lymph nodes of the acupunctured limb (enlargement of the lymph sinuses, haemorrhage, increase in mast cells and degranulation. A rapid increase in plasma cells occurred in 48 hours). It could be argued that these changes were of an inflammatory nature rather than an immune response. However, the other data of the trial indicated definite immune enhancement of antibody production and lymphocytopenia.
AP also caused release of a humoral bactericidal factor. In experimental bacillary dysentery in rabbits and monkeys, AP at ST25 and ST37 increased the bactericidal activity of plasma by 50% after 30 minutes and by 70% after 3 hours. In these experiments, the phagocytic activity of the reticulo-endothelial system of the liver increased 46% after 6 days and 63% after 12 days of AP. The treated animals ceased to excrete the bacilli in faeces in 4-5 days, whereas control animals (untreated by AP) were still excreting bacilli after 21 days. All the symptoms (fever, abdominal pain, tenesmus, bowel frequency etc)were eliminated by AP. In 800 clinical cases of bacillary dysentery in humans, AP alone, given 1-3 times daily for 5-10 days was effective therapy in 90% of patients. The symptoms were controlled and the organisms were eliminated from the faeces.
EFFECTS OF AP ON TISSUE DAMAGE CAUSED BY X-RAYS
Rats exposed to X-rays developed anaemia and leucopenia. Needling at LI04, GB39 and SP06 caused the red cell count, haemoglobin level and while cell count to recover faster than in control rats which received the same dose of X-ray. AP has been used clinically in humans to assist recovery from nuclear exposure. Apart from its effects in haematology, nuclear exposure also damages the immune response in humans and animals. The immunostimulant effects of AP may be helpful to patients suffering from the effects of nuclear radiation, such as that used in cancer therapy.
AP IN THE TREATMENT OF ALLERGIES
AP in human clinical allergies: AP is used to treat many human allergies, including allergies caused by inhalation, oral intake and skin contact. These conditions include asthma, hay fever, allergic rhinitis, food allergies, diarrhoea, contact allergies, allergic conjunctivitis etc.
The most important points for treatment in asthma include FeiShu (BL13) and GV14 but other points are sometimes added, including HsinShu (BL15), KeShu (BL17), TingChuan (Asthma point) and HaiLao (a new point). In hay fever and allergic rhinitis, the main points are LI04 and YingHsiang (LI20) but other points, such as LI11 and Yin Tang (Z 03, between the eyebrows) are also used.
In treating human allergies, the selection of the points is based mainly on the location of the symptom or lesions. For instance, in asthma, the main points are chosen for their action on the lung. In rhinitis the points are chosen for their action on the nose and upper respiratory tract. Thus, in treating a food allergy in which the main symptom was nausea and vomiting, the main points would be aimed at the stomach (ChungWan (CV12); ST36, PC06). If the main symptom was biliousness and dizziness with headache, the main points would be aimed at the liver and gallbladder ((TaiChung (LV03); FengChih (GB20) with possibly ST36 added for its gastric effect).
A course of AP can often succeed in desensitising patients to their allergens, despite continued exposure to them. Examples are hay fever, migraine headache and food allergies.
AP in clinical allergies in animals: There are few reports of the use of AP in specific clinical allergies in animals. However, it might be tried in fog fever in cattle and in bronchospasm in horses (similar to asthma) and in non-specific dermatitis, and pruritus in small animals. Also many symptoms of allergies (bloat, vomiting, diarrhoea, etc) in animals are known to respond to AP, aimed at the organ, region or symptom involved.
Experimental allergy in animals: Allergic-encephalomyelitis was induced in guinea pigs by injections of an encephalogenic antigen. Needling certain points (LI11; ST36) enhanced the immune response and exaggerated the allergic response. On the other hand, needling ChihShih (BL52) prevented the allergic response. The antiallergic effect may have been due to release of ACTH and corticosteroids. BL52 has effects on the kidney and adrenal.
AP AND ENDOCRINE RESPONSES
In the paper on AP analgesia, the role of the hypothalamus and endorphin release is discussed more fully. AP stimuli are carried via the peripheral sensory nerves and sympathetic trunks to the hypothalamus. Hypothalamic activation with subsequent activation of the pituitary, may release ACTH, MSH, TSH, gondatropins, pancreatic (insulin) tropins etc depending on which nuclei in the hypothalamus have been stimulated. This, in turn, depends on which AP points have been stimulated. Release of these hormones may cause release of corticosteroids, adrenalin, thyroid hormones, oestrogen, progesterone, oxytocin, prolactin, relaxin, insulin, etc.
Clinical endocrine disorders in humans: AP is used to treat many human endocrine disorders. If there are sufficient endocrine cells which can be activated by the trophic and/or neural stimuli, the results can be very good. However, in chronic or severe cases (especially where hormone substitution therapy has been given for a long time and has suppressed the body's ability to produce its own hormones), the results are not so good.
Examples of endocrine conditions responsive to AP include: mild goitre, mild hormonal infertility (due to oestrogen-prostaglandin-progesterone imbalance), post-parturient agalactia (prolactin, oxytocin), uterine atony at parturition (oxytocin); cervical non-dilation at parturition (ringwomb); recurrent abortion; menopausal syndromes. ln early or mild cases of diabetes mellitus, AP at SP06; LV13 (ChangMen); BL20 (PiShu) can be very effective in controlling blood sugar and in treating pancreatitis. In diabetes insipidus, due to deficiency of the antidiuretic hormone, needling at BL23 (Shen Shu), BL28 (PangKuangShu); GB25 (ChingMen) can help.
Clinical endocrine disorders in animals: Similar conditions in animals have been helped (reproductive disorders; parturition disorders; agalactia; pseudopregnancy; polyuria; hormonal alopecia in castrated cats). However, as in other areas of veterinary AP, documentation of these effects in very scarce.
The evidence from clinical use in humans and animals suggests that some of the therapeutic effects of AP are mediated by the endocrine system.
OTHER CONDITIONS RESPONSIVE TO AP THERAPY
Earlier sections discussed many therapeutic effects of AP. These include leucocytosis, increased activity of the phagocytic, lymphoid and reticulo-endothelial systems, release of a leucocytotic factor and a bactericidal factor into plasma, enhanced antibody production, antifebrile, anti-inflammatory and anti-infectious effects. These effects help to explain the therapeutic value of AP in fighting infection, resolving inflammation and reducing fever in humans and animals. Increased haematological stimulation and immunostimulation also help to explain the effect of AP in damage caused by exposure to nuclear radiation. These effects are stimulated only by certain points.
Other points have immunosuppressant effects and help patients during the allergic reaction. Still others act by releasing various hormones in mild endocrine disorders.
Other applications of AP in humans and animals include: pain, poor circulation, smooth muscle dysfunction, tissue damage and bleeding, paralysis, paresis and miscellaneous.
a. PAIN
Pain due to trauma, inflammation, ischaemia, muscle spasm, arthritis and other peripheral causes, can be helped, if not fully controlled, by AP.
Pain conditions in humans which respond in varying degrees to AP are: headache, toothache, eye pain, earache, neck pain; colic; pain in gastric, duodenal or colonic ulcer; backache, sciatica; pain in the muscles and joints, phantom limb pain, angina pectoris, narcotic withdrawal pain. One of the main uses of AP in human patients is in the control of chronic peripheral pain. However, pain of central origin does not respond well.
AP is also of astonishing value in treating acute traumatic pain (fractures, dislocations, pulled muscles, contusions, abrasions, etc). For this purpose, the most important point is YangLingChuan (GB34). GB34 is usually combined with a local point for the region involved.
AP is also of great value in treating post-operative pain (and other complications, such as inappetance, nausea, ileus and urine retention) in humans. For this purpose the main points used are the same as in AP analgesia for the region (see paper on AP analgesia). Points to assist the function of the stomach, large intestine, kidney and bladder are added, as needed.
Pain conditions in animals which respond to AP include: Lameness due to muscular rheumatism, muscle spasm, myositis; arthritis; spinal trauma and mild cases of intervertebral disc protrusion; laminitis, tendinitis, periostitis and trauma; abdominal colic (gastrointestinal, hepatic, renal, cystic, uterine, etc).
Post-operative pain in animals: Although AP is seldom used specifically for this purpose in animals, those which have been operated upon under AP analgesia have far fewer complications and heal faster than those operated upon under conventional anaesthetics.
Post-operative complications in animals: after surgery, AP can be used to obtain pain relief and to help restore normal physiological function, as in humans.
b. POOR BLOOD CIRCULATION
Many human clinical conditions are caused by poor blood circulation. Coronary heart disease (CHD) and angina pectoris are greatly helped by frequent needling of PC06. Experimental reduction of coronary blood supply in dogs was used as a model of human CHD. AP at PC06 improved coronary/myocardial circulation, reduced the size of the subsequent infarct and assisted the healing of the damaged muscle.
Muscular aches and pains, "pins and needles" (peripheral paraesthesia) or ulcers, etc in humans are frequently caused by poor blood circulation. AP is effective in many of these conditions.
Human indigestion and hyperacidity may be associated with poor circulation in the gastrointestinal tract. AP is very effective in these conditions. Two important points are ST36 and PC06; others include CV12 and BL21. Under experimental conditions in laboratory animals, stimulation of ST36 and PC06 improves mesenteric and gastrointestinal circulation and delays or prevents the onset of experimental ulcers, or assists in their resolution. Similarly, gastrointestinal hyper- or hypo-motility is corrected by needling these points.
Poor circulation in the brain, such as in senile human arteriosclerosis, may cause many problems. AP of points which act on brain function helps to alleviate these problems. Under experimental conditions in animals, AP at JenChung (GV26) greatly improves brain micro-circulation. GV26 is the emergency point par excellence in shock, collapse, coma, heatstroke, convulsions and anaesthetic apnoea in humans and animals. Similarly, nausea and fainting in humans are quickly corrected by needling or massaging GV26. However, other points also help nausea + dizziness. These include PC06; ST36; GB20; CV12.
By its effect on the autonomic nervous system (see below) AP has powerful effects on blood circulation in most vascular areas. The points for specific regions are similar to those for pain or other problems of those regions.
c. SMOOTH MUSCLE DYSFUNCTION
Human conditions very often involve spasm of smooth muscle. Examples are pain in angina pectoris; biliary, renal, uterine and gastrointestinal colic; peripheral circulatory upsets; asthma etc. Factors which relieve smooth muscle spasm greatly reduce or eliminate the symptoms. AP of the correct points produces this result. Also, in obstruction of ducts (such as the bile duct and ureter), smooth muscle spasm not only causes pain but also prevents the obstruction from being expelled. AP often allows calculi to pass out of the gallbladder, bile duct, ureter or bladder by inducing relaxation of the smooth muscle and by increasing the fluid pressure proximal to the calculus. In children, ascaris worms in the bile duct often have been expelled after AP and even expulsion from the gut has been claimed. Many studies have shown that needling the correct points has marked effects on smooth muscle contractability, bile flow, peristalsis and gastrointestinal secretion.
Smooth muscle spasm in animals: The antispasmodic effects of AP are of use in treating colics and digestive upsets. They are also of use in treating bronchospasm.
In dystocia, relative oversize of the foetus and uterine atony are often present. Kothbauer and Westermayer used AP routinely in bovine dystocia. They found that pelvic relaxation occurred within 10 minutes of AP and the birth was greatly helped by this. Westermayer treated more than 200 cases of prolapsed uterus in cows by AP of the lumbosacral region. The uterus was easily put back in position and straining by the cow seldom occurred, making the procedure simple and very fast. Also in retention of the foetal membranes or in metritis + pyometra (in which uterine atony is involved) AP may help the condition.
d. TISSUE DAMAGE AND BLEEDING
These conditions often follow trauma. Other factors also cause tissue damage, for instance liver and kidney damage in many toxic conditions; heart and brain damage in circulatory disorders; muscle damage in Vitamin E and selenium deficiency etc. The effects of AP in traumatic pain has been mentioned earlier. However, AP also assists the recovery of damaged tissue, if tissue regeneration is possible. For instance, the skin and liver have marked regenerative capacity and AP stimulates this effect, by improving local circulation and its anti-inflammatory and anti- infectious effects.
Muscular injury in humans and animals is also greatly helped by AP. The best points are the tender spots (AHSHI points, trigger points) in the damaged muscles and the AP points which control the damaged area.
Where subcutaneous or intramuscular bleeding and oedema result from trauma, AP helps in the resorption of the fluid and in the resolution of the swelling.
Where tissue damage is severe (as in extensive burns or trauma) the main approach should be to control shock, haemorrhage, fracture and infection by conventional means. AP may be used later to relieve pain and to assist tissue healing.
AP cannot stimulate tissue regeneration if the tissues are incapable of regenerating, such as in severe neural, spinal, cardiac, pulmonary or renal damage. However, many cases of severe lameness in humans and animals are (wrongly) attributed to severe lesions in joints or in the spine, including prolapsed inter-vertebral discs. Many of these patients can be greatly helped by AP, but the lesion (other than soft tissue swelling, oedema etc) remains unaffected by the treatment. This suggests that many cases of such lameness are not due to the lesion, but to reflex muscle spasm triggered initially by the lesion. The clinical effects of AP in these cases are due to their effects on pain and muscle spasm.
e. PARALYSIS, PARESIS
These conditions may arise in humans and animals from nerve damage at central, spinal or peripheral level. For example, human cerebral haemorrhage, thrombosis, encephalitis, spinal injury or peripheral nerve injury may cause paralysis of one or more regions or functions. We are taught that if the nuclei of motor neurons are damaged, the neurons cannot regenerate and that paralysis due to neural necrosis is irreversible. However, we also know (1) that many cases of paralysis occur from axon damage, (2) that functional damage to the nervous system (poor micro-circulation) may cause paralysis, and (3) that considerable plasticity exists in the nervous system, i.e. that some neural circuits can be re- programmed to adopt new functions. These facts explain a reasonably high success rate of AP in treating conditions such as central, spinal and peripheral- nerve paralysis in humans. I would strongly recommend that any of you who have friends or relatives who suffer from recent paralysis should consult with a competent medical acupuncturist. AP combined with conventional therapy can be very helpful in many of these cases.
Animals usually suffer paralysis from trauma or arthritis, involving the vertebral column or trauma to peripheral nerves. AP is very effective therapy for many of these cases but many sessions may be required and physical manipulation may also be required. (Paralysis from central causes, metabolic upsets or poisoning is not in discussion here). Paralysis associated with prolapsed intervertebral disc may also respond to AP. As in the treatment of pain, AP does not alter the physical lesion (dislocation, arthritis, spondylitis, disc prolapse etc) but function is often restored despite the persistence of the lesion. This indicates that these cases of paralysis may be functional or due to oedema or poor blood supply to the nerve tracts. The antiinflammatory, antioedematous and pro-circulatory effects of AP may explain the clinical recovery in these cases.
f. MISCELLANEOUS CONDITIONS
The list of conditions which can be helped by AP runs to hundreds. Some respond very well, others have less satisfactory results, or require many sessions. In general, AP has therapeutic effects on all the major systems of the body in humans (nervous system, the 5 senses; endocrine system; respiratory, cardiovascular, digestive, reproductive, urinary, musculoskeletal systems and skin). It also influences all the main body regions (and their parts) and organs, including the head, neck, upper limb, thorax, abdomen, spine and lower limb. Recent reports from Hospitals in Sweden and Taipei suggest that AP has powerful effects in treating spastic paralysis and cerebral palsy in children.
No one textbook of AP lists all the conditions amenable to therapy, but a study of many text-books and journals will demonstrate the wide range of clinical uses (for details, see references 1 to 7 at end).
Veterinary AP therapy is not as well developed as human AP, but a wide range of clinical conditions (involving all the main physiological systems and all the body regions, their parts and organs) may be helped. The main limiting factor is often the economic one. AP therapy generally requires more time per session and more sessions to be effective, especially in chronic cases. Time is money to a busy veterinarian and to the client. It is often decided that the cost of treatment would not be justified on economic grounds because of the relatively small cash value of the animal. However, in the case of family pets, racing animals (dogs, horses) and valuable breeding stock, the economic considerations are less important.
Appendix 1 lists miscellaneous conditions in animals which can be helped by AP. For further details on AP in the activation of the defence systems, see References 6, 10, 11, 12 at the end of this paper.
CONCLUSIONS
AP at specific points activates the defence system of humans and animals via reflex neural effects, autonomic effects, neuroendocrine, endocrine and humoral effects. Sensory input to the hypothalamus is most important in these effects. Other mechanisms, such as the Primitive Nervous System of Becker, may be involved in the slow healing processes.
In general, if activation of the defence systems of the body can affect the clinical condition or if tissue regeneration is possible, AP is indicated as a possible therapy alone or in combination with other therapies.
AP has wide therapeutic effects in infection, inflammation, fever, allergy, endocrine disorders and many other clinical conditions. AP is not a panacea; it should be seen as an aid to conventional therapy and not as a complete alternative to it.
AP may be the treatment of choice in some cases (for instance anaesthetic apnoea, muscular lameness). In other cases, AP combines well with other therapies (i.e. with antibiotics in mastitis, with glucose infusion + corticosteroids in bovine ketosis). AP is useless, or of very little use in cases in which the adaptive response is disabled (for instance in terminal malignant cancer, severe spinal damage, the later stages of liver or renal fibrosis). In these cases other therapies are required but these may be of little use also.
APPENDIX 1
EXAMPLES OF ANIMAL DISORDERS WHICH MAY BE HELPED BY AP
This list is not complete. It is extracted from the veterinary AP textbooks by Brunner, Gilchrist, Klide and Kung and Westermayer. (See references).
GENERAL CONDITIONS: Emergencies, poisoning, intoxication, toxaemia, hog cholera, distemper in dogs; agalactia, mastitis, udder oedema; fevers, chills; general weakness, lack of energy; exhaustion, over-exertion, dullness; polyhidrosis, insect bites; tranquillizer effect; to calm after a race; to tonify before a race; haemorrhage after uterine contraction; pain; to stimulate immunity; allergy; stress.
MUSCULOSKELETAL DISORDERS: Lameness, pain, sprain, trauma to muscles, joints, bones, tendons; muscle pain, trauma, atrophy, rheumatism, tired muscles, "tying-up", myositis, myotonia, muscle spasms; arthropathy, arthritis, joint pain, strain, trauma, luxation; bone trauma, periostitis, osteomalacia, rickets; ring-bone, sidebone; tendon disorders, pain; bowed tendons; tendonitis, tenosynovitis; tendovaginitis; bursitis.
DISORDERS OF HEAD REGION: Nervous system: encephalitis, encephalomyelitis, encephaloedema; cerebral accidents, cerebral anaemia, cerebral hyperaemia; stroke; mental disorders; convulsions, epilepsy, chorea, ataxia, dizziness, unconsciousness; paralysis, wobblers, tetanus. Eyes: cataract, keratitis, pannus, ophthalmia; ocular microfilariasis; excess tears; conjunctivitis, eyelids swollen. Ears: certain types of deafness; ear paralysis. Face: facial swelling; trigeminal neuralgia; facial paralysis.
DISORDERS OF THE NECK: pain, sprain, rheumatism, muscle spasm, arthritis, subluxation, myositis of m. sternobrachiocephalicus.
DISORDERS OF FORELIMBS: General: pain, sprain, rheumatism, trauma, arthritis, lameness, paralysis, weakness and oedema of the forelimbs. Shoulder: pain, sprain, luxation, trauma, rheumatism, arthritis, lameness; shoulder m. atrophy; scapular and suprascapular n. Paralysis. Arm: pain, rheumatism; biceps brachii m. strained; muscle pain. Elbow: pain, sprain, trauma, luxation, rheumatism, arthritis. Forearm: radial, ulnar and medial m. paralysis; muscle pain, rheumatism. Carpus: pain, sprain, luxation, arthritis, trauma, swelling, synovitis. Metacarpus: pain etc; flexor and extensor tendon disorders; bucked shins. Fetlock: arthritis, luxation, trauma, contusion, oedema; unable to flex fetlock. Digit: pain etc. Hoof: disorders laminitis, bulb of heel pain and inflammation; navicular disease.
DISORDERS OF THORAX: General: pain, spasm, colic, oedema, pleuritis, diaphragm-spasm. Cardiovascular and haematological: heart disorders, arrythmia; circulatory disorders; arterial and blood pressure disorder; anaemia; leucopenia; ascites, oedema; shock, collapse, syncope, heatstroke. Respiratory: nose disorders, rhinitis, rhinorrhoea, purulent sinusitis, epistaxis; pharyngitis, laryngitis, tracheitis; lung disorders; bronchitis, pneumonia, lung oedema, congestion; lung haemorrhage; emphysema; allergies; coughs, colds, 'flu, asthma, wheezing, not enough wind; respiratory viruses; pleuritis.
DISORDERS OF BACK AND ABDOMEN: General: pain, spasm, colic, oedema, ascites; abdominal disorders; peritonitis, adnexitis; liver diseases, hepatitis, cholecystitis, icterus; ketosis and fatty liver, diabetes mellitus, pancreatitis. Mouth and digestive system: stomatitis, salivation, glossitis, tongue ulcer, swelling, lips swollen, trismus, masseter spasm; disorders of the jaws; chewing difficulty; pharyngitis, parotitis, pharyngeal paralysis, oesophageal paralysis; inappetance, anorexia. Gastric: dilation, atony, bloat, gastritis, vomiting, hyperacidity. Intestinal: enteritis, colitis, spasm, colic. Gastrointestinal: bloat, allergies; spasm, colic, gastroenteritis, diarrhoea, dysentery, blood in faeces, constipation, hog cholera. Rectum: paralysis, prolapse. Reproductive tract: infertility, sterility, nymphomania, prolonged oestrus, anoestrus, pseudopregnancy, dysmenorrhoea; ovarian dysfunction, oophoritis, cystic ovary; salpingitis; metritis, pyometra, dystocia (to relax pelvis and assist birth); uterine prolapse (to assist reposition); vaginal prolapse, vaginitis; male impotence, depressed libido, penile paralysis; orchitis, scrotal oedema. Urinary tract: incontinence, dysuria, difficult urination, anuria, urine retention, haematuria. Kidney, ureter, bladder and urethra: nephritis; ureter spasm; cystitis, bladder retention spasm; urethritis. Pelvic area: sacroiliac strain, luxation; to relax pelvis in obstetrics. Lumbosacral area: pain, rheumatism, stiffness, myositis, spondylosis, arthritis, nerve paralysis, paresis, posterior paralysis.
SPINAL DISORDERS: Pain, spasm, rheumatism, stiffness, myositis, lameness, etc in the spinal or paravertebral area from neck to tail. Vertebral disorders: arthritis, luxation, mild disc prolapse; spinal trauma; spinal paresis and paralysis, torticollis, wobbler syndrome.
HIND LIMB DISORDERS: Hindquarter: rheumatism, pain, spasm of rump muscles; paralysis of the tail and hindquarters; Hindlimb: rheumatism, myositis, pain, spasm, lameness, arthritis, motor malfunction, weakness, paralysis; hind limb oedema. Hip: pain, rheumatism, spasm, lameness, arthritis, dysplasia; sciatic nerve paralysis, femoral nerve paralysis, myositis of semimembranosus and biceps femoris m. Stifle (Knee): pain, rheumatism, arthritis; patellar luxation; stifle locked; pain in region of tibia, fibula; tibial, fibular m. paralysis. Hock (tarsus): swelling, pain, hypertrophy, spavin, arthritis; pain, inflammation and swelling of Achilles' tendon. Metatarsus: pain, bucked shins, arthritis, flexor tendon disorders. Fetlock: oedema, pain, arthritis, luxation, trauma, inability to flex. Digit and hoof: pain, laminitis, panaritium, phlegmon, pododermatitis, heel and bulb of heel pain.
SKIN DISORDERS: allergy, urticaria, pruritus, trauma, eczema, dermatitis.
APPENDIX 2
EXPERIMENTAL TRYPANOSOMIASIS: Mice were infected experimentally with Trypanosoma evasi. Some of the mice received water injections at GV14, ST36 + AiKen (a point behind the second metatarsophalyngeal joint, at the inner side of the plantar surface). Others remained as infected, untreated controls. AP significantly prolonged survival time of infected mice. All control mice died. Some of the treated mice lived (Lin et al 1976, Chinese Med. J. (Taiwan), 23, 152-157).
EXPERIMENTAL ERLICH ASCITES TUMOUR was induced in mice by inoculation with tumour cells. Some of the mice were needled at the same points as above. AP significantly prolonged the survival time of treated mice as compared with controls but all mice died eventually (Lee and Lin, 1975. Chinese Medical J. (Taiwan) 22, 167-171).
EXPERIMENTAL POLIOMYELITIS was induced by virus injection in rhesus monkeys. Ligation of certain points enhanced nerve fibre regeneration and the formation of neuromuscular plaques in paralysed muscle. It also increased cholinesterase in the large motor neurons in the ventral horn or the spinal cord, increased the number of dendrites and synapses in the segment, increased the conduction velocity in motor nerves and increased metatarsal perspiration (Anon 1979 a, p. 517).
CLINICAL HUMAN POLIOMYELITIS: AP or injection of the relevant points gave valuable therapeutic results in 360 cases. In patients treated in the acute (febrile) phase, improvement occurred in 88% and 52% recovered. In patients treated in the first month of illness, the response rate was 48%, as compared with 31% and 18% respectively in those treated within 6 months and after 6 months of onset respectively (Anon 1979a, p.76).
CLINICAL VIRAL HEPATITIS was treated in 280 cases by manual or electro-AP of relevant points. Treatment was effective in 90% of cases in eliminating the symptoms (fever, jaundice, gastrointestinal upset, pain etc) and in restoring health in less than 3 weeks. (Anon 1979a, p. 41 and 43).
CLINICAL BACTERIAL ENTERITIS IN PIGLETS: E. coli enteritis in piglets was treated by needling certain points or by spiramycin. Some scouring piglets were left as untreated controls. AP once daily gave a highly effective clinical response in 2-5 days, as good as, or better than, the response to spiramycin (Anon 1977a, p265-). The results are summarised below.
EXAMPLES OF ANIMAL DISORDERS WHICH MAY BE HELPED BY AP
This list is not complete. It is extracted from the veterinary AP textbooks by Brunner, Gilchrist, Klide and Kung and Westermayer. (See references).
GENERAL CONDITIONS: Emergencies, poisoning, intoxication, toxaemia, hog cholera, distemper in dogs; agalactia, mastitis, udder oedema; fevers, chills; general weakness, lack of energy; exhaustion, over-exertion, dullness; polyhidrosis, insect bites; tranquillizer effect; to calm after a race; to tonify before a race; haemorrhage after uterine contraction; pain; to stimulate immunity; allergy; stress.
MUSCULOSKELETAL DISORDERS: Lameness, pain, sprain, trauma to muscles, joints, bones, tendons; muscle pain, trauma, atrophy, rheumatism, tired muscles, "tying-up", myositis, myotonia, muscle spasms; arthropathy, arthritis, joint pain, strain, trauma, luxation; bone trauma, periostitis, osteomalacia, rickets; ring-bone, sidebone; tendon disorders, pain; bowed tendons; tendonitis, tenosynovitis; tendovaginitis; bursitis.
DISORDERS OF HEAD REGION: Nervous system: encephalitis, encephalomyelitis, encephaloedema; cerebral accidents, cerebral anaemia, cerebral hyperaemia; stroke; mental disorders; convulsions, epilepsy, chorea, ataxia, dizziness, unconsciousness; paralysis, wobblers, tetanus. Eyes: cataract, keratitis, pannus, ophthalmia; ocular microfilariasis; excess tears; conjunctivitis, eyelids swollen. Ears: certain types of deafness; ear paralysis. Face: facial swelling; trigeminal neuralgia; facial paralysis.
DISORDERS OF THE NECK: pain, sprain, rheumatism, muscle spasm, arthritis, subluxation, myositis of m. sternobrachiocephalicus.
DISORDERS OF FORELIMBS: General: pain, sprain, rheumatism, trauma, arthritis, lameness, paralysis, weakness and oedema of the forelimbs. Shoulder: pain, sprain, luxation, trauma, rheumatism, arthritis, lameness; shoulder m. atrophy; scapular and suprascapular n. Paralysis. Arm: pain, rheumatism; biceps brachii m. strained; muscle pain. Elbow: pain, sprain, trauma, luxation, rheumatism, arthritis. Forearm: radial, ulnar and medial m. paralysis; muscle pain, rheumatism. Carpus: pain, sprain, luxation, arthritis, trauma, swelling, synovitis. Metacarpus: pain etc; flexor and extensor tendon disorders; bucked shins. Fetlock: arthritis, luxation, trauma, contusion, oedema; unable to flex fetlock. Digit: pain etc. Hoof: disorders laminitis, bulb of heel pain and inflammation; navicular disease.
DISORDERS OF THORAX: General: pain, spasm, colic, oedema, pleuritis, diaphragm-spasm. Cardiovascular and haematological: heart disorders, arrythmia; circulatory disorders; arterial and blood pressure disorder; anaemia; leucopenia; ascites, oedema; shock, collapse, syncope, heatstroke. Respiratory: nose disorders, rhinitis, rhinorrhoea, purulent sinusitis, epistaxis; pharyngitis, laryngitis, tracheitis; lung disorders; bronchitis, pneumonia, lung oedema, congestion; lung haemorrhage; emphysema; allergies; coughs, colds, 'flu, asthma, wheezing, not enough wind; respiratory viruses; pleuritis.
DISORDERS OF BACK AND ABDOMEN: General: pain, spasm, colic, oedema, ascites; abdominal disorders; peritonitis, adnexitis; liver diseases, hepatitis, cholecystitis, icterus; ketosis and fatty liver, diabetes mellitus, pancreatitis. Mouth and digestive system: stomatitis, salivation, glossitis, tongue ulcer, swelling, lips swollen, trismus, masseter spasm; disorders of the jaws; chewing difficulty; pharyngitis, parotitis, pharyngeal paralysis, oesophageal paralysis; inappetance, anorexia. Gastric: dilation, atony, bloat, gastritis, vomiting, hyperacidity. Intestinal: enteritis, colitis, spasm, colic. Gastrointestinal: bloat, allergies; spasm, colic, gastroenteritis, diarrhoea, dysentery, blood in faeces, constipation, hog cholera. Rectum: paralysis, prolapse. Reproductive tract: infertility, sterility, nymphomania, prolonged oestrus, anoestrus, pseudopregnancy, dysmenorrhoea; ovarian dysfunction, oophoritis, cystic ovary; salpingitis; metritis, pyometra, dystocia (to relax pelvis and assist birth); uterine prolapse (to assist reposition); vaginal prolapse, vaginitis; male impotence, depressed libido, penile paralysis; orchitis, scrotal oedema. Urinary tract: incontinence, dysuria, difficult urination, anuria, urine retention, haematuria. Kidney, ureter, bladder and urethra: nephritis; ureter spasm; cystitis, bladder retention spasm; urethritis. Pelvic area: sacroiliac strain, luxation; to relax pelvis in obstetrics. Lumbosacral area: pain, rheumatism, stiffness, myositis, spondylosis, arthritis, nerve paralysis, paresis, posterior paralysis.
SPINAL DISORDERS: Pain, spasm, rheumatism, stiffness, myositis, lameness, etc in the spinal or paravertebral area from neck to tail. Vertebral disorders: arthritis, luxation, mild disc prolapse; spinal trauma; spinal paresis and paralysis, torticollis, wobbler syndrome.
HIND LIMB DISORDERS: Hindquarter: rheumatism, pain, spasm of rump muscles; paralysis of the tail and hindquarters; Hindlimb: rheumatism, myositis, pain, spasm, lameness, arthritis, motor malfunction, weakness, paralysis; hind limb oedema. Hip: pain, rheumatism, spasm, lameness, arthritis, dysplasia; sciatic nerve paralysis, femoral nerve paralysis, myositis of semimembranosus and biceps femoris m. Stifle (Knee): pain, rheumatism, arthritis; patellar luxation; stifle locked; pain in region of tibia, fibula; tibial, fibular m. paralysis. Hock (tarsus): swelling, pain, hypertrophy, spavin, arthritis; pain, inflammation and swelling of Achilles' tendon. Metatarsus: pain, bucked shins, arthritis, flexor tendon disorders. Fetlock: oedema, pain, arthritis, luxation, trauma, inability to flex. Digit and hoof: pain, laminitis, panaritium, phlegmon, pododermatitis, heel and bulb of heel pain.
SKIN DISORDERS: allergy, urticaria, pruritus, trauma, eczema, dermatitis.
APPENDIX 2
EXPERIMENTAL TRYPANOSOMIASIS: Mice were infected experimentally with Trypanosoma evasi. Some of the mice received water injections at GV14, ST36 + AiKen (a point behind the second metatarsophalyngeal joint, at the inner side of the plantar surface). Others remained as infected, untreated controls. AP significantly prolonged survival time of infected mice. All control mice died. Some of the treated mice lived (Lin et al 1976, Chinese Med. J. (Taiwan), 23, 152-157).
EXPERIMENTAL ERLICH ASCITES TUMOUR was induced in mice by inoculation with tumour cells. Some of the mice were needled at the same points as above. AP significantly prolonged the survival time of treated mice as compared with controls but all mice died eventually (Lee and Lin, 1975. Chinese Medical J. (Taiwan) 22, 167-171).
EXPERIMENTAL POLIOMYELITIS was induced by virus injection in rhesus monkeys. Ligation of certain points enhanced nerve fibre regeneration and the formation of neuromuscular plaques in paralysed muscle. It also increased cholinesterase in the large motor neurons in the ventral horn or the spinal cord, increased the number of dendrites and synapses in the segment, increased the conduction velocity in motor nerves and increased metatarsal perspiration (Anon 1979 a, p. 517).
CLINICAL HUMAN POLIOMYELITIS: AP or injection of the relevant points gave valuable therapeutic results in 360 cases. In patients treated in the acute (febrile) phase, improvement occurred in 88% and 52% recovered. In patients treated in the first month of illness, the response rate was 48%, as compared with 31% and 18% respectively in those treated within 6 months and after 6 months of onset respectively (Anon 1979a, p.76).
CLINICAL VIRAL HEPATITIS was treated in 280 cases by manual or electro-AP of relevant points. Treatment was effective in 90% of cases in eliminating the symptoms (fever, jaundice, gastrointestinal upset, pain etc) and in restoring health in less than 3 weeks. (Anon 1979a, p. 41 and 43).
CLINICAL BACTERIAL ENTERITIS IN PIGLETS: E. coli enteritis in piglets was treated by needling certain points or by spiramycin. Some scouring piglets were left as untreated controls. AP once daily gave a highly effective clinical response in 2-5 days, as good as, or better than, the response to spiramycin (Anon 1977a, p265-). The results are summarised below.
Trial 1
|
Treatment
Acupuncture Spiramycin Control |
No.
18 18 18 |
% cured 5th day
88 83 44 |
Points used
GV03, GV01, YuTang, ShanKen none none |
Trial 2
|
Treatment
Acupuncture Control Acupuncture Control Acupuncture Spiramycin |
No.
20 20 20 20 20 20 |
% cured 5th day
85 0 95 0 100 100 |
Points used
GV01, GV03, YuTang none GV01, BL20, ST36 none BL20, ShanKen, TiMen none |
YuTang : 0.5 tsun on either side of midline of hard palate, 1 tsun behind incisors
ShanKen: midline, just above snout (GV25)
TiMen : just above bulb of heels
INFERTILITY IN COWS: AP at YungChi gave excellent results. YungChi is 5 finger-widths on either side of the spine, between lumbar vertebrae 5-6.
FURTHER READING MATERIAL
AP textbooks and Symposium Proceedings are available from Acumedic, 103 Camden High Street, London, UK.
ShanKen: midline, just above snout (GV25)
TiMen : just above bulb of heels
INFERTILITY IN COWS: AP at YungChi gave excellent results. YungChi is 5 finger-widths on either side of the spine, between lumbar vertebrae 5-6.
FURTHER READING MATERIAL
AP textbooks and Symposium Proceedings are available from Acumedic, 103 Camden High Street, London, UK.
- 1. American Journal of AP (1973-), Quarterly Journal.
- 2. Scandinavian Journal of AP and Electrotherapy, from Pekka Pontinen, 4-B-77 Pikkusaarenkuja, Tampere, Finland.
- 3. Anonymous (1993) Academy of Traditional Medicine, Beijing. Essentials of Chinese AP. English version. Foreign Languages Press, Beijing 432pp.
- 4. Anonymous (1977a) United States Dept. Health translation of official Chinese (1970) manual. A barefoot doctor's manual. Running Press, 38 South 19th St., Philadelphia, Pennsylvania, USA 948pp.
- 5. Anonymous (l977b) Basic AP: a scientific interpretation and application. English version. Chinese AP Research Foundation, Box 84-223, Taipei, Taiwan, Republic of China 313pp.
- 6. Anonymous (1979b) AP, Moxibustion and AP anaesthesia. Proceedings of the Beijing 1979 Symposium, parts 1-5. Foreign Languages Press, Beijing. 534 abstracts, 517pp.
- 7. Anonymous (1979b) The treatment of 100 common diseases by new AP. Medicine and Health Publishing Co., Hong Kong 89pp.
- 8. Brunner, F. (l980) Akupunktur der Kleintiere. WBV Biologisch Med. Verlag, Ipweg 5, D7060 Schorndorf, Germany 309pp.
- 8a. Gilchrist, D. (1981) Manual of AP for small animals. PO Box 303, Redcliffe, Queensland 4020, Australia 79pp.
- 9. Klide, A.M. and Kung, S.H. (1977). Veterinary AP. University of Pennsylvania Press, Philadelphia, Pennsylvania USA 297pp.
- 10. Lin, J.H. and Rogers, P.A.M. (1980). AP effects on the body's defence system: a veterinary review. Veterinary Bulletin (August issue), 50, 633-640.
- 11. O'Connor, J. and Bensky, D. (1975) Summary of research on the effects of AP. American Journal of Chinese Medicine, 3, 377-394.
- 12. Rogers, P.A.M. and Bossy, J. (1981) Activation of the defence systems of the body in animals and man by AP and moxibustion: additional evidence from the Peking (1979) Symposium: AP Research Quarterly (Taiwan), 5, 47-54.
- 13. Westermayer, E. (1978) AP in horses. Health Science Press, Devon, UK and WBV Biologisch Med. Verlag, D7060 Schorndorf, Germany 90pp.
- 14. Westermayer, E. (1978) Atlas of AP for cattle. WBV Biologisch Med. Verlag, D7060 Schorndorf, Germany 60pp.
- 15. Rogers, P.A.M. (1990) AP for immune-mediated disorders. Chapter 14 of text on Veterinary AP. Lippincott Publishers, USA, in press.
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