Acupuncture in Small Animal Practice
INTRODUCTION
Acupuncture (AP) literally means needle (acus) puncture. In the past it referred to needling specific points of the body to assist the healing (homoeostatic) power of the human or animal patient. The word AP has a much wider meaning today. It infers diagnostic and prognostic value as well as therapeutic effects.
Many methods can be used to activate the defensive systems of the body via the AP points. These include: simple needling, injection of the AP points (with orthodox or unorthodox medicaments, non-isotonic saline, B12 or local anaesthetic solutions), insertion of surgical staples or other implants at the points, electro-needling, transcutaneous electrical stimulation, ultrasound, low level laser therapy (LLLT), application of heat (microwave; infrared; moxa; thermostatically controlled heat probes) or cold (ice massage; ethyl-chloride or other vapocoolant sprays), massage etc. As long as it is adequate, the method of stimulation is less important than the correct choice of AP points.
This paper, discusses AP in small animal (SA) practice under 6 headings:
1. AP concepts and mechanisms
2. Methods of choosing AP points for therapy
3. Diagnostic prognostic and therapeutic aspects of AP with examples in emergencies, musculoskeletal problems, disc disease and reproductive disorders
4. AP analgesia for surgery
5. Practical methods of AP stimulation, especially in Trigger Point (TP) therapy
6. Further training
1. AP CONCEPTS AND MECHANISMS
Traditional Chinese Medicine (TCM) is based on oriental philosophies of Qi, Yin-Yang, Five Phases, Perverse Causes of Disease, the Concept of Change and other concepts which western-style professionals find difficult to understand. These concepts are discussed in detail elsewhere. Those interested may read the basic human texts, listed below.
Briefly, Qi is the vital energy which comes from heaven (air), earth (food) and ancestors (genetic vitality). The Channel-Organ System (COS) is a vast network of superficial Channels (Jing), superficial and deep Collaterals (Luo, pathways connecting one Channel with a specific Phase-Mate Channel) and deep pathways which connect the exterior with the interior, the superficial Channels with their named Organs. The COS comprises an extensive 3-dimensional system of the Channels (Jing), Collaterals (Luo), superficial and deep pathways of Qi and the organs and their TCM Functions. The COS is the anatomical and functional system which controls all body organs, parts and functions and interfaces the interior to the exterior and the exterior to the external world beyond. The Jing-Luo (Channels and Collaterals) used to be called the Meridians and Qi Pathways of TCM.
Yin-Yang is the principle of opposite, yet complementary forces (female/male; hypo-/hyper-; cool/warm; chronic/acute; parasympathetic/sympathetic; diastole/systole etc).
Five Phases (Fire, Earth, Metal, Water, Wood) represented the five basic types, once called the Five Elements. Everything in existence can be categorised by analogy to Yin-Yang and Five Phases. The Sheng Cycle (anabolic, creative) and the Ko Cycle (catabolic, restraining) keeps the Five Phases in perfect harmony and balance. Each body organ and function relates to a specific Phase and disease patterns reflect the Phases. For example, in Winter (Phase = Water), the diseases to expect would be diseases of bladder and kidneys (Water), bones (Water), nervous system (Water).
In TCM, the classical Exogenous Causes of Disease (the Perverse Causes, or External Evils in TCM) are Wind, Damp, Heat, Summer Heat, Dryness and Cold. If the Wei (Defensive) Qi in the skin is weak, the External Evils can penetrate the body via the AP points and Channels. If the Qi in the Jing-Luo is not strong enough to throw off the attack, the Evil Qi can reach the viscera via the Jing-Luo and lead to fatality. Trauma, diet and internal causes are recognised also as causes of disease, as are phycological factors. In modern China, much of this philosophy is replaced by "scientific concepts" of medicine and pathology. However, many aspects of TCM still retain their full value in today's world, especially the holistic concepts of TCM and the validity (objective reality) of the AP points and their diagnostic, prognostic and therapeutic functions.
Two basic types of points are used in AP: Classical AP points and Tender Points which may or may not correspond with documented AP points
Classical AP Points: More than 2500 years ago, TCM described the functions and anatomical positions of hundreds of points on the classical human Jing-Luo System. These points have diagnostic and therapeutic properties. They occur on the head, neck, trunk and limbs. Specific sets of points relate to and/or have functional connections with each other and with the COS, its TCM Functions and Qi-COS network.
The 12 Main Jing (Channels): In TCM, there are 12 Jing (Qi pathways) which run in the long axis of the body and are bilaterally symmetrical. Each Jing has a superficial path, along which lie its Channel points (close to the skin) and a deep path through the interior of the body, to connect with its organ and other related body parts and functions. Each Jing connects also with one "upstream" and one "downstream" in the daily energy (Qi) circuit. The 12 main Jing are LU (Lung); LI (Large Intestine or Colon); ST (Stomach); SP (Spleen); HT (Heart); SI (Small Intestine); BL (Bladder); KI (Kidney); PC (Pericardium; Circulation-Sex, Heart Constrictor); TH (Triple Heater: respiratory, digestive, reproductive functions); GB (Gallbladder); LV (Liver). Each of these Jing controls both superficial and deep functions.
The Qi in three Channels flows from thorax to fingers (LU, PC, HT); in three from fingers to face (LI, TH, SI); in three from face to foot (ST, BL, GB) and in three from foot to chest (SP, KI, LV).
Diurnal Qi circulation: Qi circulates in the Jing Luo to reach every cell in the body. The Qi tide flows through the Jing-Luo in a definite direction and time sequence: LU -> LI -> ST -> SP -> HT -> SI -> BL -> KI -> PC -> TH -> GB -> LV (and back to LU). The Qi peaks in LU between 0300-0500h and peaks in the other Jing in sequence at 2-hour intervals, to begin a new energy circuit in LU at 0300h next morning. Thus the Qi of each COS has its high- and low- tide.
In TCM, blockage or imbalance in the flow and distribution of Qi is the cause of ill-health. When there is disease, the Channel Qi is disturbed and certain points along the Channel become sensitive to palpation, heat and electric current. Stimuli applied to the sensitive points can normalise the energy flow, helping the adaptive responses to remove the disease (restore ease).
Example of a Channel path: The BL Jing begins at the inner canthus of the eye, goes across the skull, then paravertebral to the sacrum, then down the posterior midline of the buttock, thigh and calf to pass between the lateral malleolus of the tibia and the Achilles tendon and thence to the lateral aspect of the little toe.
Along the course of each Channel, a specific number of points is recognised. Each of these points is said to influence the parts and functions "controlled" by the Channel. For example, there are 67 BL points and BL67 (on the little toe) could influence the eye (BL01) and BL01 could influence the little toe. Each Jing also has a deep course and is "connected" to the organ bearing its name. Thus any BL point could influence BL function.
Each Channel point has local functions also. For example, BL40 (old BL54, in the popliteal crease) is used in knee (stifle) pain, arthritis etc; BL23 (between transverse processes of L2-L3) in nephritis; BL01 in acute opthalmitis etc.
Channel points also influence the organs lying close to them. For example, BL13,14,15 (beside vertebrae T3, T4, T5) influence the lungs, pericardium and heart; CV03,4,12,17 influence the bladder, small intestine, stomach and heart respectively because of their proximity to these organs.
The Eight Mo (or Mai): These are called the Eight Extra Vessels. As well as the 12 main (bilaterally symmetrical) Jing, there are 8 special Qi reservoirs. Two of these are in the midline: the Ren Mo (Conception Vessel, CV, in the ventral midline, from perinaeum to lower lip) and the Du Mo (Governing Vessel, GV, in the dorsal midline, from the anococcygeal area to the upper lip). The CV and GV are said to be reservoirs of energy and contain many important AP points for cranial, thoracic and abdominal problems. The six other Mo (Vessels, Qi reservoirs) are the Chong Mo; Dai Mo; Yangqiao Mo; Yinqiao Mo; Yangwei Mo and Yinwei Mo. The Eight Extra Vessels link with some of the main COSs, thereby allowing one COS to influence many other COSs and other body parts.
AP diagnosis: So far, we have discussed the relationship between points and organs mainly as a one-way system (the points influencing the organs). In fact, AP has diagnostic aspects as well as therapeutic aspects. The organs influence the points and the points influence the organs. When an organ or its function is upset, reflex changes occur on the surface of the body and can be detected by careful examination of the points. The best examples of the diagnostic reflex points are the Shu (Back Association, paravertebral) and the Mu (Front Alarm, abdominal/thoracic) points. In disease of the heart, BL15 (Shu) and CV14 (Mu) are frequently tender to palpation, as are HT Channel points. In appendicitis (large intestine, LI), ST25 (Mu, McBurney's point) and BL25 (Shu, paravertebral point between L4-L5) may be tender in addition to LI Channel points.
Thus, via the Jing-Luo of TCM (or via neuroendocrine reflex/hormonal mechanisms in western physiology) AP points have a two-way relationship with the COSs. Channel or Organ pathology alters point sensitivity (diagnostic) and stimulation of the sensitive point helps to normalise the affected organ. Point sensitivity also returns to baseline as the organ or its function is normalised.
The relationships between point sensitivity and diagnostic/therapeutic aspects led to the search (in recent years) for other sensitive points in specific pathologies. This uncovered another 300 or so points not mentioned in the ancient texts. They are described in recent texts as "Extra-Channel, New or Strange Points" and their human positions are described.
In modern physiology, segmental reflexes explain many of the therapeutic and diagnostic relationships between internal organs and their related AP points; the same spinal nerves service both the area of the point and the area of the pathology. However, not all the therapeutic/diagnostic relationships can be explained by segmental reflex. For example, in acute appendicitis, a new point (LanWei: literally gut tail or appendix) on the tibialis anterior muscle (right side) is usually very tender to palpation. This point is very powerful in relieving the pain and spasm of acute appendicitis. Its effect may be explained by short inter-segmental reflexes. Other effects, for example between Earpoints and abdominal organs can be explained by supraspinal reflexes.
As well as the documented AP points, Trigger Points (TPs) are another point category of diagnostic and therapeutic value in AP. TPs often occur in pain syndromes, especially in myofascial syndromes. They have no fixed location but may appear in the musculature, where they may be palpated as "nodules" or areas of localised spasm. Heavy pressure on (or needling of) the TP causes severe pain which radiates back to the area of complaint (i.e.) it "triggers" the complaint. Other points can act as triggers, for example scar tissue is frequently a trigger for muscle or organ pain elsewhere. TPs occasionally arise near the Golgi apparatus of tendons and at motor points (where the motor nerve enters the muscle). International experts, such as Melzack (Canada), Pontinen (Finland), MacDonald (UK) and Chung (Taiwan), have done intensive research on TPs in relation to human pain syndromes and a Belgian colleague has recently described TPs in myofascial problems in dogs (Janssens 1987).
In AP, location of tender points (including TPs) is extremely important in diagnosis and stimulation of these points can give pain relief in 50-70% of cases. The quickest and easiest way to convince sceptics of the benefits of AP therapy is to persuade them to experiment with TP therapy. It needs no knowledge of AP points or of the very detailed laws of AP. The clinical success of TP therapy is usually met with disbelief at first. Later the sceptic comes to accept it. It is then be easier to persuade him/her to undertake serious study of the complete AP system. The weakness of TP therapy is that many clinical cases (including some myofascial cases) do not develop triggers. Therefore many of these cases can not be treated successfully by needling unless the practitioner knows classical AP.
AP POINT STIMULATION
AP stimulation means the application of a sufficient stimulus to the AP points to activate a desired response. There is not time in this talk to discuss mechanisms in detail. Briefly, AP effects are mediated by the peripheral and CNS, autonomic, neuroendocrine and endocrine systems.
Acupuncture (AP) literally means needle (acus) puncture. In the past it referred to needling specific points of the body to assist the healing (homoeostatic) power of the human or animal patient. The word AP has a much wider meaning today. It infers diagnostic and prognostic value as well as therapeutic effects.
Many methods can be used to activate the defensive systems of the body via the AP points. These include: simple needling, injection of the AP points (with orthodox or unorthodox medicaments, non-isotonic saline, B12 or local anaesthetic solutions), insertion of surgical staples or other implants at the points, electro-needling, transcutaneous electrical stimulation, ultrasound, low level laser therapy (LLLT), application of heat (microwave; infrared; moxa; thermostatically controlled heat probes) or cold (ice massage; ethyl-chloride or other vapocoolant sprays), massage etc. As long as it is adequate, the method of stimulation is less important than the correct choice of AP points.
This paper, discusses AP in small animal (SA) practice under 6 headings:
1. AP concepts and mechanisms
2. Methods of choosing AP points for therapy
3. Diagnostic prognostic and therapeutic aspects of AP with examples in emergencies, musculoskeletal problems, disc disease and reproductive disorders
4. AP analgesia for surgery
5. Practical methods of AP stimulation, especially in Trigger Point (TP) therapy
6. Further training
1. AP CONCEPTS AND MECHANISMS
Traditional Chinese Medicine (TCM) is based on oriental philosophies of Qi, Yin-Yang, Five Phases, Perverse Causes of Disease, the Concept of Change and other concepts which western-style professionals find difficult to understand. These concepts are discussed in detail elsewhere. Those interested may read the basic human texts, listed below.
Briefly, Qi is the vital energy which comes from heaven (air), earth (food) and ancestors (genetic vitality). The Channel-Organ System (COS) is a vast network of superficial Channels (Jing), superficial and deep Collaterals (Luo, pathways connecting one Channel with a specific Phase-Mate Channel) and deep pathways which connect the exterior with the interior, the superficial Channels with their named Organs. The COS comprises an extensive 3-dimensional system of the Channels (Jing), Collaterals (Luo), superficial and deep pathways of Qi and the organs and their TCM Functions. The COS is the anatomical and functional system which controls all body organs, parts and functions and interfaces the interior to the exterior and the exterior to the external world beyond. The Jing-Luo (Channels and Collaterals) used to be called the Meridians and Qi Pathways of TCM.
Yin-Yang is the principle of opposite, yet complementary forces (female/male; hypo-/hyper-; cool/warm; chronic/acute; parasympathetic/sympathetic; diastole/systole etc).
Five Phases (Fire, Earth, Metal, Water, Wood) represented the five basic types, once called the Five Elements. Everything in existence can be categorised by analogy to Yin-Yang and Five Phases. The Sheng Cycle (anabolic, creative) and the Ko Cycle (catabolic, restraining) keeps the Five Phases in perfect harmony and balance. Each body organ and function relates to a specific Phase and disease patterns reflect the Phases. For example, in Winter (Phase = Water), the diseases to expect would be diseases of bladder and kidneys (Water), bones (Water), nervous system (Water).
In TCM, the classical Exogenous Causes of Disease (the Perverse Causes, or External Evils in TCM) are Wind, Damp, Heat, Summer Heat, Dryness and Cold. If the Wei (Defensive) Qi in the skin is weak, the External Evils can penetrate the body via the AP points and Channels. If the Qi in the Jing-Luo is not strong enough to throw off the attack, the Evil Qi can reach the viscera via the Jing-Luo and lead to fatality. Trauma, diet and internal causes are recognised also as causes of disease, as are phycological factors. In modern China, much of this philosophy is replaced by "scientific concepts" of medicine and pathology. However, many aspects of TCM still retain their full value in today's world, especially the holistic concepts of TCM and the validity (objective reality) of the AP points and their diagnostic, prognostic and therapeutic functions.
Two basic types of points are used in AP: Classical AP points and Tender Points which may or may not correspond with documented AP points
Classical AP Points: More than 2500 years ago, TCM described the functions and anatomical positions of hundreds of points on the classical human Jing-Luo System. These points have diagnostic and therapeutic properties. They occur on the head, neck, trunk and limbs. Specific sets of points relate to and/or have functional connections with each other and with the COS, its TCM Functions and Qi-COS network.
The 12 Main Jing (Channels): In TCM, there are 12 Jing (Qi pathways) which run in the long axis of the body and are bilaterally symmetrical. Each Jing has a superficial path, along which lie its Channel points (close to the skin) and a deep path through the interior of the body, to connect with its organ and other related body parts and functions. Each Jing connects also with one "upstream" and one "downstream" in the daily energy (Qi) circuit. The 12 main Jing are LU (Lung); LI (Large Intestine or Colon); ST (Stomach); SP (Spleen); HT (Heart); SI (Small Intestine); BL (Bladder); KI (Kidney); PC (Pericardium; Circulation-Sex, Heart Constrictor); TH (Triple Heater: respiratory, digestive, reproductive functions); GB (Gallbladder); LV (Liver). Each of these Jing controls both superficial and deep functions.
The Qi in three Channels flows from thorax to fingers (LU, PC, HT); in three from fingers to face (LI, TH, SI); in three from face to foot (ST, BL, GB) and in three from foot to chest (SP, KI, LV).
Diurnal Qi circulation: Qi circulates in the Jing Luo to reach every cell in the body. The Qi tide flows through the Jing-Luo in a definite direction and time sequence: LU -> LI -> ST -> SP -> HT -> SI -> BL -> KI -> PC -> TH -> GB -> LV (and back to LU). The Qi peaks in LU between 0300-0500h and peaks in the other Jing in sequence at 2-hour intervals, to begin a new energy circuit in LU at 0300h next morning. Thus the Qi of each COS has its high- and low- tide.
In TCM, blockage or imbalance in the flow and distribution of Qi is the cause of ill-health. When there is disease, the Channel Qi is disturbed and certain points along the Channel become sensitive to palpation, heat and electric current. Stimuli applied to the sensitive points can normalise the energy flow, helping the adaptive responses to remove the disease (restore ease).
Example of a Channel path: The BL Jing begins at the inner canthus of the eye, goes across the skull, then paravertebral to the sacrum, then down the posterior midline of the buttock, thigh and calf to pass between the lateral malleolus of the tibia and the Achilles tendon and thence to the lateral aspect of the little toe.
Along the course of each Channel, a specific number of points is recognised. Each of these points is said to influence the parts and functions "controlled" by the Channel. For example, there are 67 BL points and BL67 (on the little toe) could influence the eye (BL01) and BL01 could influence the little toe. Each Jing also has a deep course and is "connected" to the organ bearing its name. Thus any BL point could influence BL function.
Each Channel point has local functions also. For example, BL40 (old BL54, in the popliteal crease) is used in knee (stifle) pain, arthritis etc; BL23 (between transverse processes of L2-L3) in nephritis; BL01 in acute opthalmitis etc.
Channel points also influence the organs lying close to them. For example, BL13,14,15 (beside vertebrae T3, T4, T5) influence the lungs, pericardium and heart; CV03,4,12,17 influence the bladder, small intestine, stomach and heart respectively because of their proximity to these organs.
The Eight Mo (or Mai): These are called the Eight Extra Vessels. As well as the 12 main (bilaterally symmetrical) Jing, there are 8 special Qi reservoirs. Two of these are in the midline: the Ren Mo (Conception Vessel, CV, in the ventral midline, from perinaeum to lower lip) and the Du Mo (Governing Vessel, GV, in the dorsal midline, from the anococcygeal area to the upper lip). The CV and GV are said to be reservoirs of energy and contain many important AP points for cranial, thoracic and abdominal problems. The six other Mo (Vessels, Qi reservoirs) are the Chong Mo; Dai Mo; Yangqiao Mo; Yinqiao Mo; Yangwei Mo and Yinwei Mo. The Eight Extra Vessels link with some of the main COSs, thereby allowing one COS to influence many other COSs and other body parts.
AP diagnosis: So far, we have discussed the relationship between points and organs mainly as a one-way system (the points influencing the organs). In fact, AP has diagnostic aspects as well as therapeutic aspects. The organs influence the points and the points influence the organs. When an organ or its function is upset, reflex changes occur on the surface of the body and can be detected by careful examination of the points. The best examples of the diagnostic reflex points are the Shu (Back Association, paravertebral) and the Mu (Front Alarm, abdominal/thoracic) points. In disease of the heart, BL15 (Shu) and CV14 (Mu) are frequently tender to palpation, as are HT Channel points. In appendicitis (large intestine, LI), ST25 (Mu, McBurney's point) and BL25 (Shu, paravertebral point between L4-L5) may be tender in addition to LI Channel points.
Thus, via the Jing-Luo of TCM (or via neuroendocrine reflex/hormonal mechanisms in western physiology) AP points have a two-way relationship with the COSs. Channel or Organ pathology alters point sensitivity (diagnostic) and stimulation of the sensitive point helps to normalise the affected organ. Point sensitivity also returns to baseline as the organ or its function is normalised.
The relationships between point sensitivity and diagnostic/therapeutic aspects led to the search (in recent years) for other sensitive points in specific pathologies. This uncovered another 300 or so points not mentioned in the ancient texts. They are described in recent texts as "Extra-Channel, New or Strange Points" and their human positions are described.
In modern physiology, segmental reflexes explain many of the therapeutic and diagnostic relationships between internal organs and their related AP points; the same spinal nerves service both the area of the point and the area of the pathology. However, not all the therapeutic/diagnostic relationships can be explained by segmental reflex. For example, in acute appendicitis, a new point (LanWei: literally gut tail or appendix) on the tibialis anterior muscle (right side) is usually very tender to palpation. This point is very powerful in relieving the pain and spasm of acute appendicitis. Its effect may be explained by short inter-segmental reflexes. Other effects, for example between Earpoints and abdominal organs can be explained by supraspinal reflexes.
As well as the documented AP points, Trigger Points (TPs) are another point category of diagnostic and therapeutic value in AP. TPs often occur in pain syndromes, especially in myofascial syndromes. They have no fixed location but may appear in the musculature, where they may be palpated as "nodules" or areas of localised spasm. Heavy pressure on (or needling of) the TP causes severe pain which radiates back to the area of complaint (i.e.) it "triggers" the complaint. Other points can act as triggers, for example scar tissue is frequently a trigger for muscle or organ pain elsewhere. TPs occasionally arise near the Golgi apparatus of tendons and at motor points (where the motor nerve enters the muscle). International experts, such as Melzack (Canada), Pontinen (Finland), MacDonald (UK) and Chung (Taiwan), have done intensive research on TPs in relation to human pain syndromes and a Belgian colleague has recently described TPs in myofascial problems in dogs (Janssens 1987).
In AP, location of tender points (including TPs) is extremely important in diagnosis and stimulation of these points can give pain relief in 50-70% of cases. The quickest and easiest way to convince sceptics of the benefits of AP therapy is to persuade them to experiment with TP therapy. It needs no knowledge of AP points or of the very detailed laws of AP. The clinical success of TP therapy is usually met with disbelief at first. Later the sceptic comes to accept it. It is then be easier to persuade him/her to undertake serious study of the complete AP system. The weakness of TP therapy is that many clinical cases (including some myofascial cases) do not develop triggers. Therefore many of these cases can not be treated successfully by needling unless the practitioner knows classical AP.
AP POINT STIMULATION
AP stimulation means the application of a sufficient stimulus to the AP points to activate a desired response. There is not time in this talk to discuss mechanisms in detail. Briefly, AP effects are mediated by the peripheral and CNS, autonomic, neuroendocrine and endocrine systems.
Local anaesthetic block or experimental section of the neural input at (a), (b), or (c) abolishes the effect. Certain drugs active at central and peripheral sites can act as agonists or antagonists to AP effects. Therefore, correct choice of points and adequate stimulation of the points are critical to success.
For >2500 years, the points were stimulated by insertion of "needles" into them. Over the millennia the "needles" were refined from crude instruments made of bamboo, flint or porcelain, to lancets of metal and (finally) to extremely fine, solid, stainless steel needles. Today, human AP needles are made of the finest quality steel and are 28-34 gauge. Vet AP needles are usually 22-26 gauge (large animals) or 26-30 gauge (small animals).
Apart from needling, many other types of stimuli can activate the points. Modern methods of stimulation include point injection; implantation of absorbable or non-absorbable materials; TENS; faradism; magnetotherapy; ultrasound; low level laser therapy (LLLT); application of heat or cold; massage; blisters etc. Thus the term AP therapy, though originally meaning therapy by needle puncture, is now used to mean therapy using the AP points. The choice of correct reflex points is more important than the method of stimulation used. For more details, see "Techniques of stimulation of the AP points".
Up to now, we have discussed concepts of human AP. This was necessary because there are no texts on small-animal AP other than those based on the human system. Since 1974, small-animal vets around the world have been successful with transposition of the human principles to dogs and cats etc, (In, fact, even large-animal vets must learn the human system before they can hope to progress to the classical texts on large-animal AP).
We can summarise the talk so far by four points:
a. AP has diagnostic and therapeutic aspects.
b. Point sensitivity (to palpation and other stimuli) is a critical guide to the location of the diagnostic points.
c. When present, the diagnostic points are also therapeutic points.
d. Successful AP therapy depends on a knowledge of classical points and concepts when tender points are absent.
2. METHODS OF CHOOSING AP POINTS FOR THERAPY
In TCM, choice of AP points depends on the diagnosis in terms of: which Channel(s) are involved; whether the Qi is deficient or excessive in the Channel(s) and whether or not AP is appropriate. (TCM makes extensive use of herbal medicine, dietary advice, exercises (physical and mental) fasting, sweating, purgation etc as needed. AP was only a small part of TCM).
TCM has many Laws of Choosing Points. These include:
1. AhShi points (tender points, TPs; see later).
2. Local points (points near the problem area or near the affected organs).
3. Distant points, especially on Channels passing through the affected part or organ.
4. Points on the affected Channel.
5. A chain of points on an affected Channel, for example GB30,32,34,39 along the GB Channel, from the hip to the lower lateral leg in leg paralysis.
6. Points on related Channels (on the "Husband or Wife" Phase-Mate, or on Channels near the affected one.
7. Encircling the affected area.
8. "Fore and Aft" combination (points anterior and posterior to the problem organ or area).
9. Mu-Shu combination (combination of thoracoabdominal alarm points with paravertebral reflex points for the affected organ or function).
10. Yuan-Luo combination (combination of Yuan-Source point of the affected Channel with the Luo-Passage (Qi transfer) point of its Phase-Mate Channel).
11. Symptomatic Points: Certain symptoms were long known to respond to certain points, for example, GV26 (in the philtrum) in shock; PC06 (over median nerve) in nausea and vomiting etc.
12. Xi (Cleft, Accumulation) points (special points for acute diseases)
13. The use of the 5 Phase points (special points for energy transfer between Channels).
To these laws, modern medicine adds the following:
14. Needling along the affected nerve trunks relating to the affected parts or organs. Needling near the affected dorsal nerve roots. Needling the affected dermatomes.
15. Needling "Extra-Channel" points (new points discovered in recent decades), such as "Scalp", "Ear", "Face", "Nose", "Hand" or "Foot" zone points related to the affected function or area. Examples are: Scalp Zone "Lower Motor Area" in paralysis of the legs; "Hand" point "Loin and Leg" in sciatica; NX04 (TingChuan = Soothing Asthma) in asthma or bronchitis etc.
The most common prescription is a combination of AhShi points + local points + distant points on the affected Channel. This may seem to be a simple matter to resolve but a look at any standard charts shows the difficulties. (It is advisable to limit the number of needles to 6-12 in most sessions, therefore one must discriminate which local and distant points are most relevant). The textbooks (as individual texts) do not help much either. A careful study of the texts shows that there is major variation between them in their choice of points for specific conditions.
One solution to the problem is to construct a database from many textbooks and to use the computer to do a frequency ranking on the points for specific conditions. In this way, the most commonly recommended points for any specific condition can be output in seconds.
COOKBOOK AP: Cookbooks usually provide instant details of the ingredients needed to prepare the required dish. They are used mainly by cooks, who have bad memories, or have not tried to prepare the dish before. Either way, they are very useful and many an enjoyable meal was prepared in this way. Master Chefs, however, are in a class apart from cooks. They, through experience, good memory and intuition, seldom need to refer to cookbooks.
Cookbook AP is basically "prescription AP". It is suitable for statistical medicine (standardised approach to all "similar" cases). It is quite unsuitable for difficult, complicated or atypical cases, especially in humans. To treat such cases successfully by AP would require a deep study of the classical concepts. Having said that, Cookbook AP is ideal for routine and simple cases. It is the quickest, least painful way of introducing busy professionals to the AP techniques. Whether right or wrong, many busy professionals are not prepared to devote the effort and time to a deep study of AP. Without the cookbook approach, most of these would never be able to attempt AP therapy (except for the simplest type, TP therapy or AhShi therapy).
There are dozens of AP textbooks available. The main problem with the cookbook method is to decide which text to use. The best include: Anon 1974; O'Connor & Bensky 1983; Cheng et al 1987; Ellis et al 1989; Anon 1993. However, no one text lists all the conditions which can be helped by AP, and there are many differences within and between texts. Thus, the serious student is forced to either construct a personal database (as already discussed) or to purchase a commercial AP point database (such as Shenberger's card-index system). The latter, based on only a few textbooks, is good but is very incomplete. Tables 1 to 3 are examples of Cookbook AP, as compiled by computer analysis. For more details on point selection, see "Choice of AP points for particular conditions".
3. DIAGNOSTIC, PROGNOSTIC AND THERAPEUTIC ASPECTS OF AP
Diagnostic aspects of AP are based on the tenderness/sensitivity which occurs in certain points when their related organs are affected. Five types of AP points may have diagnostic value in humans: (a) Mu-Shu points; (b) Earpoints; (c) general tenderness along the Channel (d) Voll-Akabane-Ryodoraku points; (e) Trigger Points (TPs).
a. MU-FRONT ALARM AND SHU-BACK ASSOCIATION POINTS
There are 12 main COSs: LU-LI, ST-SP, HT-SI, BL-KI, PC-TH, GB-LV. Each COS has a specific point on the anterior abdomen-thorax called the Mu (Front Alarm) point and on the paravertebral area between T3 to S2, called the Shu (Back Association, or Reflex) point, corresponding with BL13-30. For example, the Mu-Shu points for stomach in humans are halfway between the navel and the xiphoid (CV12, Mu point) and 1.5 cun paravertebral to the lower edge of the spine of T12, or just caudal to the last rib (BL21, Shu point).
In disease, if there is tenderness to palpation at the Mu and Shu point of an organ, disease of that organ must be considered. However, the spinal innervation of the internal organs comes from several neighbouring spinal nerves and each spinal nerve can innervate more than one internal organ. Thus, because of this overlap of spinal innervation, the Mu-Shu points are not as specifically valuable as TCM would claim. They are, however, quite useful guides to the affected organs.
b. EAR POINTS
A French worker (Nogier) discovered that the human ear contained a somatotopic representation of the body and its organs. This has been developed by the European and Oriental schools of Auriculotherapy. Certain zones on the ear become tender to probe-pressure or to electrical current when the related organ or body part is diseased. These points have diagnostic value and therapeutic value. Blind studies at University College of Los Angeles (Oleson et al 1989), confirmed the diagnostic value of the human Ear zones. The therapeutic value of the human Earpoint system is well documented also. Workers in Europe, USA, Czechoslovakia and elsewhere have evidence to support the diagnostic and therapeutic value of Earpoints in animals also but more work is needed before strong claims can be made for the diagnostic and therapeutic value of ear points in the dog.
c. CHANNEL TENDERNESS
General tenderness along the course of a specific human Channel is diagnostic of a problem in that COS.
d. CHANGES IN POINT SENSITIVITY
Changes in sensitivity to heat or electrical current at special measurement points on the human hands and feet have diagnostic value in the Voll, Akabane and Ryodoraku systems of AP. It is claimed that diseases can be diagnosed in the very early stages (such as pre-clinical cancer) with these methods but, unfortunately, there is little written in orthodox scientific refereed journals on these claims. Little research seems to have been done with these methods in animals.
e. TRIGGER POINTS
Travell and Simons (1984) published the definitive textbooks on TPs. Part 1 deals with TPs in every muscle from the hips up. Part 2 (1985) deals with the pelvic limb. TPs arise in most cases of myofascial and musculoskeletal pain, whether of soft-tissue, arthritic or disc origin. These TPs maintain pain and dysfunction long after the original causes have disappeared.
Janssens (1984) described TP therapy for myofascial lameness in 21 dogs. Mean duration of lameness before therapy was 24 weeks. TP therapy was successful in 70% of cases in a mean time of 17 days (2.5 treatments). The relapse rate was 33% but relapse cases also responded well to therapy.
It is most important to identify TPs and eliminate them. TPs may occur in cases of disease of internal organs and they may trigger autonomic effects (vasospasm, cardiovascular effects, altered peristalsis etc), as well as effects on proprioception, muscle coordination, eye sight, hearing and taste (when muscles relating to the cranial nerves are involved).
Prognostic aspects of AP: the tenderness in the Mu-Shu, Earpoints, the course of a Channel or at the special measurement points returns to normal as the case improves. Disappearance of tenderness at these points and at TPs during the course of therapy is taken as a sign that the case is resolving satisfactorily.
For >2500 years, the points were stimulated by insertion of "needles" into them. Over the millennia the "needles" were refined from crude instruments made of bamboo, flint or porcelain, to lancets of metal and (finally) to extremely fine, solid, stainless steel needles. Today, human AP needles are made of the finest quality steel and are 28-34 gauge. Vet AP needles are usually 22-26 gauge (large animals) or 26-30 gauge (small animals).
Apart from needling, many other types of stimuli can activate the points. Modern methods of stimulation include point injection; implantation of absorbable or non-absorbable materials; TENS; faradism; magnetotherapy; ultrasound; low level laser therapy (LLLT); application of heat or cold; massage; blisters etc. Thus the term AP therapy, though originally meaning therapy by needle puncture, is now used to mean therapy using the AP points. The choice of correct reflex points is more important than the method of stimulation used. For more details, see "Techniques of stimulation of the AP points".
Up to now, we have discussed concepts of human AP. This was necessary because there are no texts on small-animal AP other than those based on the human system. Since 1974, small-animal vets around the world have been successful with transposition of the human principles to dogs and cats etc, (In, fact, even large-animal vets must learn the human system before they can hope to progress to the classical texts on large-animal AP).
We can summarise the talk so far by four points:
a. AP has diagnostic and therapeutic aspects.
b. Point sensitivity (to palpation and other stimuli) is a critical guide to the location of the diagnostic points.
c. When present, the diagnostic points are also therapeutic points.
d. Successful AP therapy depends on a knowledge of classical points and concepts when tender points are absent.
2. METHODS OF CHOOSING AP POINTS FOR THERAPY
In TCM, choice of AP points depends on the diagnosis in terms of: which Channel(s) are involved; whether the Qi is deficient or excessive in the Channel(s) and whether or not AP is appropriate. (TCM makes extensive use of herbal medicine, dietary advice, exercises (physical and mental) fasting, sweating, purgation etc as needed. AP was only a small part of TCM).
TCM has many Laws of Choosing Points. These include:
1. AhShi points (tender points, TPs; see later).
2. Local points (points near the problem area or near the affected organs).
3. Distant points, especially on Channels passing through the affected part or organ.
4. Points on the affected Channel.
5. A chain of points on an affected Channel, for example GB30,32,34,39 along the GB Channel, from the hip to the lower lateral leg in leg paralysis.
6. Points on related Channels (on the "Husband or Wife" Phase-Mate, or on Channels near the affected one.
7. Encircling the affected area.
8. "Fore and Aft" combination (points anterior and posterior to the problem organ or area).
9. Mu-Shu combination (combination of thoracoabdominal alarm points with paravertebral reflex points for the affected organ or function).
10. Yuan-Luo combination (combination of Yuan-Source point of the affected Channel with the Luo-Passage (Qi transfer) point of its Phase-Mate Channel).
11. Symptomatic Points: Certain symptoms were long known to respond to certain points, for example, GV26 (in the philtrum) in shock; PC06 (over median nerve) in nausea and vomiting etc.
12. Xi (Cleft, Accumulation) points (special points for acute diseases)
13. The use of the 5 Phase points (special points for energy transfer between Channels).
To these laws, modern medicine adds the following:
14. Needling along the affected nerve trunks relating to the affected parts or organs. Needling near the affected dorsal nerve roots. Needling the affected dermatomes.
15. Needling "Extra-Channel" points (new points discovered in recent decades), such as "Scalp", "Ear", "Face", "Nose", "Hand" or "Foot" zone points related to the affected function or area. Examples are: Scalp Zone "Lower Motor Area" in paralysis of the legs; "Hand" point "Loin and Leg" in sciatica; NX04 (TingChuan = Soothing Asthma) in asthma or bronchitis etc.
The most common prescription is a combination of AhShi points + local points + distant points on the affected Channel. This may seem to be a simple matter to resolve but a look at any standard charts shows the difficulties. (It is advisable to limit the number of needles to 6-12 in most sessions, therefore one must discriminate which local and distant points are most relevant). The textbooks (as individual texts) do not help much either. A careful study of the texts shows that there is major variation between them in their choice of points for specific conditions.
One solution to the problem is to construct a database from many textbooks and to use the computer to do a frequency ranking on the points for specific conditions. In this way, the most commonly recommended points for any specific condition can be output in seconds.
COOKBOOK AP: Cookbooks usually provide instant details of the ingredients needed to prepare the required dish. They are used mainly by cooks, who have bad memories, or have not tried to prepare the dish before. Either way, they are very useful and many an enjoyable meal was prepared in this way. Master Chefs, however, are in a class apart from cooks. They, through experience, good memory and intuition, seldom need to refer to cookbooks.
Cookbook AP is basically "prescription AP". It is suitable for statistical medicine (standardised approach to all "similar" cases). It is quite unsuitable for difficult, complicated or atypical cases, especially in humans. To treat such cases successfully by AP would require a deep study of the classical concepts. Having said that, Cookbook AP is ideal for routine and simple cases. It is the quickest, least painful way of introducing busy professionals to the AP techniques. Whether right or wrong, many busy professionals are not prepared to devote the effort and time to a deep study of AP. Without the cookbook approach, most of these would never be able to attempt AP therapy (except for the simplest type, TP therapy or AhShi therapy).
There are dozens of AP textbooks available. The main problem with the cookbook method is to decide which text to use. The best include: Anon 1974; O'Connor & Bensky 1983; Cheng et al 1987; Ellis et al 1989; Anon 1993. However, no one text lists all the conditions which can be helped by AP, and there are many differences within and between texts. Thus, the serious student is forced to either construct a personal database (as already discussed) or to purchase a commercial AP point database (such as Shenberger's card-index system). The latter, based on only a few textbooks, is good but is very incomplete. Tables 1 to 3 are examples of Cookbook AP, as compiled by computer analysis. For more details on point selection, see "Choice of AP points for particular conditions".
3. DIAGNOSTIC, PROGNOSTIC AND THERAPEUTIC ASPECTS OF AP
Diagnostic aspects of AP are based on the tenderness/sensitivity which occurs in certain points when their related organs are affected. Five types of AP points may have diagnostic value in humans: (a) Mu-Shu points; (b) Earpoints; (c) general tenderness along the Channel (d) Voll-Akabane-Ryodoraku points; (e) Trigger Points (TPs).
a. MU-FRONT ALARM AND SHU-BACK ASSOCIATION POINTS
There are 12 main COSs: LU-LI, ST-SP, HT-SI, BL-KI, PC-TH, GB-LV. Each COS has a specific point on the anterior abdomen-thorax called the Mu (Front Alarm) point and on the paravertebral area between T3 to S2, called the Shu (Back Association, or Reflex) point, corresponding with BL13-30. For example, the Mu-Shu points for stomach in humans are halfway between the navel and the xiphoid (CV12, Mu point) and 1.5 cun paravertebral to the lower edge of the spine of T12, or just caudal to the last rib (BL21, Shu point).
In disease, if there is tenderness to palpation at the Mu and Shu point of an organ, disease of that organ must be considered. However, the spinal innervation of the internal organs comes from several neighbouring spinal nerves and each spinal nerve can innervate more than one internal organ. Thus, because of this overlap of spinal innervation, the Mu-Shu points are not as specifically valuable as TCM would claim. They are, however, quite useful guides to the affected organs.
b. EAR POINTS
A French worker (Nogier) discovered that the human ear contained a somatotopic representation of the body and its organs. This has been developed by the European and Oriental schools of Auriculotherapy. Certain zones on the ear become tender to probe-pressure or to electrical current when the related organ or body part is diseased. These points have diagnostic value and therapeutic value. Blind studies at University College of Los Angeles (Oleson et al 1989), confirmed the diagnostic value of the human Ear zones. The therapeutic value of the human Earpoint system is well documented also. Workers in Europe, USA, Czechoslovakia and elsewhere have evidence to support the diagnostic and therapeutic value of Earpoints in animals also but more work is needed before strong claims can be made for the diagnostic and therapeutic value of ear points in the dog.
c. CHANNEL TENDERNESS
General tenderness along the course of a specific human Channel is diagnostic of a problem in that COS.
d. CHANGES IN POINT SENSITIVITY
Changes in sensitivity to heat or electrical current at special measurement points on the human hands and feet have diagnostic value in the Voll, Akabane and Ryodoraku systems of AP. It is claimed that diseases can be diagnosed in the very early stages (such as pre-clinical cancer) with these methods but, unfortunately, there is little written in orthodox scientific refereed journals on these claims. Little research seems to have been done with these methods in animals.
e. TRIGGER POINTS
Travell and Simons (1984) published the definitive textbooks on TPs. Part 1 deals with TPs in every muscle from the hips up. Part 2 (1985) deals with the pelvic limb. TPs arise in most cases of myofascial and musculoskeletal pain, whether of soft-tissue, arthritic or disc origin. These TPs maintain pain and dysfunction long after the original causes have disappeared.
Janssens (1984) described TP therapy for myofascial lameness in 21 dogs. Mean duration of lameness before therapy was 24 weeks. TP therapy was successful in 70% of cases in a mean time of 17 days (2.5 treatments). The relapse rate was 33% but relapse cases also responded well to therapy.
It is most important to identify TPs and eliminate them. TPs may occur in cases of disease of internal organs and they may trigger autonomic effects (vasospasm, cardiovascular effects, altered peristalsis etc), as well as effects on proprioception, muscle coordination, eye sight, hearing and taste (when muscles relating to the cranial nerves are involved).
Prognostic aspects of AP: the tenderness in the Mu-Shu, Earpoints, the course of a Channel or at the special measurement points returns to normal as the case improves. Disappearance of tenderness at these points and at TPs during the course of therapy is taken as a sign that the case is resolving satisfactorily.
EXAMPLES OF AP THERAPY IN SA PRACTICE
AP is effective in a very wide range of human and animal conditions. For example, a database from >55 textbooks and clinical articles lists frequency-ranked prescriptions for >1100 human clinical conditions. Only a very small number of prime indications are discussed here. The text books listed in the references give more details on points for other areas.
Tables 1, 2 and 3 show examples of AP point selection for specific body regions, specific organs and some common conditions. These tables are based on the human system; the point coding used is similar to that used by IVAS, where BL41-54-40 for the outer line of the BL Channel between T2 to S4 to the popliteal crease; older texts put BL36 at T2-3, BL49 at S4 and BL54 at the popliteal crease.
In all the examples below, the depth of needling is given a minimum and maximum range depending on the size of the patient.
1. EMERGENCIES
Common emergencies include respiratory and/or cardiac arrest under general anaesthesia, haemorrhagic or traumatic shock. Resuscitation points include:
GV26 (in the midline of the nasal philtrum, level with the lower canthi of the nostrils; depth 0.5-1.5 cm towards the nasal septum)
KI01 (between metatarsal bones 3-4, approached from the anterior or posterior edge of the plantar pad; depth 0.5-1.5 cm)
Tip of the tail (needle the last coccygeal vertebra from the free end of the tail; depth 0.3-1.0 cm)
Ting (Terminal) points on the digits, beside or behind each nailbed.
GV26 is the most important of these points for its effect on the respiratory centre. It has a marked effect as a sympathicomimetic and in improving cerebral circulation. In respiratory arrest without cardiac arrest, needling for 10-30 seconds is usually sufficient (Rogers, 1977; Janssens et al 1979).
In other forms of shock (trauma, haemorrhage) the needles are left in situ for 10-40 minutes, twirling strongly every 5 minutes. Emergencies with cardiac arrest require strong needling for 5-15 minutes and points with cardiac effects should be added, such as:
PC06 (on the medial aspect of the forearm between radius and ulna, about 1/5 distance from carpus to elbow; depth 1-3 cm)
BL15 (1.5-3.0 cm paramedian to the dorsal midline behind the spine of 5th thoracic vertebra; depth 1-4 cm)
CV14 (midline, behind the tip of the xiphoid cartilage; depth 1-3 cm at 45 degree angle anteriorly)
PC06 is the most important of these three points for cardiac conditions. PC06 is also effective in conditions of the lung, diaphragm and stomach.
2. PAIN SYNDROMES
AP is excellent in treating myofascial pain; pain and stiffness in arthropathy; hip dysplasia; spinal pain (root "disc" syndromes); acute traumatic pain (Chan et al 1996). It also helps to relieve pain from smooth muscle spasm (various types of colic and bronchospasm etc).
MYOFASCIAL SYNDROMES: Muscle lameness (strain, rheumatism, claudication "myositis" etc) is very common in greyhounds and is a major cause of poor racing performance. The dog may not be visibly lame (although in many cases is lame). The common feature of myofascial syndromes is the presence of exquisitely tender areas ("nodules", TPs, AhShi points) in the muscles or fascia. They can be found in any muscles but are more common in the neck and shoulder muscles, paravertebral area and thigh muscles. There is often a history of good racing performance coming to an abrupt end. There need not be a history of known injury. Undoubtedly, most of these begin as minor muscle tears, but chilling or draughts may also precipitate "muscle rheumatism" or myositis. (In horses, there is often a history of virus infection in the stable in the previous 2-18 months). It is possible that there may be nutritional causes also but I have no experience of this. AP is a highly effective therapy. Recent cases usually respond in 1-4 sessions at 1-3 day intervals. Chronic cases need 1-8 sessions at intervals of 3-7 days.
The most important part of the examination is to determine the location of the affected parts of the muscles and the TPs in nearby (and occasionally distant) muscles. This is done by careful palpation using the thumb or index finger. Where possible the muscles should be palpated with a pincer grip (between thumb and index finger), for example, the triceps, forearm, leg and thigh muscles, TPs are often found in the paravertebral areas from neck to tail. They may be uni- or bi-lateral.
Diagonal relationships often exist in musculoskeletal problems; muscle pain in the left neck is often associated with some tenderness in the right lumbosacral area and vice-versa.
Having carefully recorded the affected area(s) and the TPs, a few classical AP points known to influence the affected area are chosen (see Table 1). All TPs are treated also. In searching for these areas, one should check the major joints systematically.
a. Neck mobility: The neck is turned to the left, gently but firmly, in an attempt to make the nose touch the left flank. This is repeated to the right side. Normal dogs do not whine or resist this test. Vertical and rotation movement is also checked. If the dog resists or whines, the tender points usually are found on careful (inch by inch) palpation.
b. Shoulder and elbow joints and muscles are checked by full extension, flexion and abduction of the limb. This is followed by careful deep palpation of the muscles and joints.
c. The spine and paravertebral area is checked by running the thumbs down the spinal processes and also along the muscles on 2 or 3 lines (1, 2 and 3" from the mid-line), applying firm pressure, first left, then right, from the first thoracic to the base of the tail.
d. The hip and stifle are also checked by full extension, flexion and abduction, followed by joint and muscle palpation.
If tender points are found, they are noted and rechecked later (some nervous or fidgety dogs may give occasional "false positive" reactions to finger pressure but the recheck differentiates the true from the false reaction). The true TP usually elicits a strong yelp and the dog usually turns the head towards the pain and may try to bite.
The response to treatment of muscle lameness can be dramatic. If the case is not well improved by 4-6 sessions (with marked loss of TP sensitivity) the prognosis for AP therapy is poor. In general, if AP is to be successful, effective results should be seen by 3-6 sessions. Improvement may occur within 20 minutes and is usual by session 2 or 3. Full improvement however may require more sessions. Racing dogs should be given mild to moderate exercise during the course of therapy but racing should be postponed until they are fully sound and all TPs are absent.
ARTHROPATHY: AP is very effective as a therapy in trauma (sprain), arthritis and rheumatism of joints (especially in older dogs). Much of the pain and stiffness in arthropathy comes from the muscles and soft tissues around the joint rather than from the joint itself. The original pain signals may have come from the joint but they usually set up reflex "guarding" of the joint, with secondary triggers in the muscles and soft tissues above or below the joint. The secondary triggers may become the main foci of pain signals long after the irritation in the joint has eased.
AP can not alter the bone lesions in an arthritic joint but it can have antiinflammatory effects and can be very effective in treating the soft tissue foci of irritation. The net result after successful AP is greatly improved locomotion (less stiffness, less pain on movement). The approach to arthropathy is to tackle the causes if known. AP can be of value, even if little can be done to treat or alleviate the causes. It is important to locate AhShi points if present, as in myofascial syndromes. AhShi points are needled for about 20 minutes, together with local and distant points for the specific joint (see Table 1). Arthropathy usually is treated every 3-7 days. If results are poor by 6 sessions, AP is unlikely to be of value.
Janssens (1984) described AP therapy in 61 dogs with arthrosis. The mean duration before treatment was 36 weeks. AP was most successful in shoulder and stifle (80 and 72%), less so in hips (55%) and lease successful in elbow, carpus and tarsus (33%). Recovery averaged 24 days (3.5 sessions/case); 48% relapsed but with original success rates on re-treatment. Schoen (1984) reported good or excellent results in 63% of dogs with arthrosis. There were 24 dogs in the series. Patients treated successfully for arthrosis/arthritis may relapse in 6-12 months. They usually respond well and rapidly to further courses of AP, as required (Janssens 1984; Schoen 1984).
Purulent arthritis is unsuitable for AP as a sole therapy. If specific pathogens are involved, specific anti-microbial drugs are indicated but AP may be added for its immunostimulant effect.
HIP DYSPLASIA often manifests with muscle pain and lameness. Much of the pain and stiffness is due to excess joint mobility, with consequent strain on ligaments and soft tissues. Hip dysplasia is a very good indication for AP. Although AP does not alter the X-ray lesion, abnormal joint mobility can be curtailed if the muscle tonus around the joint can be improved.
The main points for hip dysplasia are AhShi points (if present) plus local points (in the vicinity of GB30) together with GB34 (between the upper head of the fibula and the tibia, from the lateral side). Three needles may be placed near the hip joint, one in GB30 and the other 2 about 2.5-3.5 cm on either side of it, angled towards the acetabulum. The needles are placed deep enough so that they almost touch the acetabulum. Sessions are about 7 days apart. Usually 3-4 sessions give excellent results. Relapses may occur and require further AP treatment. AP can be combined with homoeopathic remedies such as Arnica (soft tissue bruising), Hypericum (deep pain), Ruta (joint pain) or Rhus toxicodendron ("rheumatism").
An alternative approach is to implant 5-7 gold beads (1 mm diameter) around the rim of the acetabulum in one single session. The technique is inexpensive, safe, simple and fast. If gold beads are difficult to obtain, orthopaedic suture wire or 18 gauge, 18 carat gold wire, tied in tiny knots (with the ends clipped off) may be used instead. The implants are inserted using aseptic techniques under general anaesthesia, using a wide-bore (14-16 gauge) needle and a stilet to deposit each implant. The first implant is deposited at the uppermost edge of the acetabulum ("12 o'clock"). The remaining 4-6 implants are deposited between "9-12" and "12-3 o'clock".
It is not uncommon for the dog to jump up on its hindlimbs within 2 days after implantation. Although it is not essential, antibiotic cover is advisable in the post-operative period. Long-term success rates of more than 80% are claimed by some workers (Grady-Young, 1979).
DISC DISEASE, VERTEBRAL ARTHROSIS: As mentioned in relation to arthritis and hip dysplasia, the presence of lesions on X-ray need not cause pain or lameness and successful outcome to AP therapy often occurs in spite of persistence of the lesion. The pain and lameness in vertebral problems usually are due to muscle spasm and irritation of nerve roots and meninges. Vertebral arthrosis is treated similarly to disc disease.
Prognosis in disc disease: Before attempting to treat spinal disc syndromes, it is important to assess the degree of neurological damage. The prognosis is excellent in Grade 1 and 2 disc disease (mild to moderate damage, i.e. (pain only to pain + some paresis)). The prognosis is still very good in Grade 3 disc disease (severe, i.e. motor paralysis but with deep pain sensation intact), but additional nursing and care is always needed. In Grade 4 disc disease (where damage is very severe, with paralysis and total loss of superficial and deep pain reflexes), the prognosis in cases presented more than 48 hours after onset is about 33%. Grade 4 cases require a lot of care, work and nursing. Time to recovery in Grade 4 is >> Grade 3 >> Grade 2 >> Grade 1.
The approach to AP treatment of disc cases is to localise the affected area by finger palpation and other methods. One to two points are used (bilaterally) above and below the problem disc, together with Tender and Distant points as indicated in Table 1. Treat acute cases every 1-2 days, chronic cases every 3-7 days. If there are other symptoms (faecal/urinary retention etc), these must be treated also, usually by western methods.
In a series of 75 dogs with thoracolumbar disc disease, AP gave success rates of 97,95,85 and 33% in Grades 1, 2, 3 and 4 respectively. Mean time to complete recovery was 13, 24, 32, 76 days respectively, requiring a mean of 2, 3.4, 4.8 and 9 sessions respectively (Janssens 1983, 1984). In a series of 32 dogs with cervical disc disease, 70% had full recovery after 2.5 sessions (mean recovery time 14 days). 37% relapsed with similar results on re-treatment (Janssens 1984).
To ensure the best outcome, Janssens recommends good nursing (catheterisation of the bladder; treatment of cystitis; enemas or digital rectal evacuation; frequent turning to avoid pressure-sores etc, if required). He also advises confinement in a playpen to prevent any exaggeration of clinical Grade from further trauma to, or bleeding into, the nerve roots or spinal cord etc. However, Chan et al (1996) found that controlled mild exercise (supervised walking on a lead) shortened the recovery time and improved the success rate of AP in disk disease.
ACUTE TRAUMATIC PAIN: The human pain-point par excellence is GB34 (between the upper head of fibula and the tibia, needled from the lateral side). One or two local points are added (ipsilateral). However, if the tissues are badly mangled or are covered by a cast, points on the contralateral limb may help. Treat daily for 2-3 days. If the animal is in shock, GV26 + KI01 help to control shock (+ western therapy).
SMOOTH MUSCLE SPASM: Human colic can arise from spasm of smooth muscle in the coronary arteries, bileduct, gastrointestinal tract, urinary and female reproductive systems. These types of colic can be relieved (often in minutes) by AP. The main points for disorders of the internal organs are given in Table 2. In small animal practice, gastrointestinal colic is very rare, but is a good indication for AP, once surgical emergencies have been eliminated from the diagnosis. In acute cases treatment is given every 8-24 hours; in chronic cases every 1-2 days.
GASTRIC TORSION, with bloat and pain in dogs can be relieved in minutes by AP. The main points are PC06, ST36, CV12, BL21. The stomach tube can be passed easily after the torsion is relieved (Blakely, 1985). Megaoesophagus and "choke" can sometimes be helped by PC06, ST36, CV12,17,22, BL13,17,21.
FUNCTIONAL DISORDERS: AP is successful in many functional disorders such as vomiting, diarrhoea, autonomic upsets, shock etc. Table 3 lists AP points which may be used in many common conditions.
MINOR HORMONAL DISORDERS: AP can activate hypothalamus-pituitary and the endocrine system, if the target cells are capable of responding. It is of use in mild human disorders of the thyroid, adrenal, pancreas and gonads.
AP has been used to treat hormonal infertility, pseudopregnancy and skin conditions associated with hormonal upsets in small animals. It could be tried in mild cases of diabetes mellitus also. Table 3 includes points used in female and male infertility. In pseudo-pregnancy, points active on the ovary/tubes/uterus (Table 2) should be added. The success rate in oligospermia is not as high as in female hormonal infertility but it is worth trying in valuable stud dogs.
OBSTETRICS: AP can be very useful in inducing birth (oxytocin-effect) and in treating dystocia in women. It is also useful in dystocia in other species. The most important points in obstetrics (dystocia etc) are points active on the pelvic ligaments, cervix/vagina and uterus: animal-BaiHui (GV03 = lumbosacral space) or human GV03 (one space anterior to lumbosacral); GV04 and BL23 (near L2-L3); points from BL25-34 and points on the outer BL line in the lumbosacral area.
Needling points on the lumbosacral area (especially animal-Baihui (GV03)) helps cervical dilation. The other points help relaxation of the pelvic ligaments and uterine contraction. The net result is more room in the pelvis and better contractions. Needling should be continued for 10-15 minutes before further obstetrical intervention.
4. AP ANALGESIA FOR SURGERY
Electro-AP can induce hypoalgesia sufficient for surgery. Dogs are good subjects for AP analgesia. Cats are very poor subjects. Indications include: cases in which general anaesthetic poses a high risk (severely shocked, debilitated or toxic cases; subjects with severe disease of the lung, heart, liver or kidney etc). AP analgesia is also suitable for caesarian section, as it has no depressive effects on the foetus.
Advantages include: (a) can be used in "cocktail anaesthesia", or to reduce greatly the dose of anaesthetic or sedative needed; (b) suitable in high-risk cases (c) suitable in Caesarian section (d) suitable in prolonged surgery (up to 10 hours) (e) autonomic functions remain stable (f) faster post-operative recovery of appetite, gut and bladder function etc; faster post-operative healing and less infection; reduced post-operative pain (g) simple and inexpensive; can be used in national disasters etc, using manual needling alone.
Disadvantages include: (a) operative success without the need for chemical anaesthetics or sedatives etc varies from 50-95%, depending on the skill of the operator and the tolerance of the patient to prolonged restraint; (b) very good restraint is necessary; all sensory inputs except pain are registered and full motor power is retained; (c) light, deft surgery is needed, not for ham-fisted surgeons; (d) prolonged manipulation of viscera/organs or traction on mesentery can induce nausea/vomiting; (e) poor relaxation of abdominal muscles can cause "ballooning" of viscera; (f) an induction period of 10-20+ minutes is necessary; (g) it is not suitable for intra-thoracic operations in animals.
POINTS USED FOR AP ANALGESIA IN DOGS: Point combinations vary with the operative site and between operators.
a. BL23 (bilateral): suitable for most operations in dogs (Kitazawa)
b. SP06 (bilateral): suitable for most operations in dogs but Electro-AP (EA) of SP06 may cause convulsions in some dogs (Kitazawa).
c. LI04; ST36; InKoTen (between metacarpals 3 and 4) and BoKoKu (between metatarsals 3 and 4). All bilateral (8 points). Suitable for most operations (Kitazawa) but BL23 (bilateral) is better (Kitazawa).
d. PC06, TH08 (bilateral). Suitable for thorax, neck, head and thoracic limb (Ishizaki). Local points may be added (Ishizaki).
e. ST36, SP06 (bilateral). Suitable for abdominal, perineal and pelvic limb (Ishizaki). For anal surgery, needles left and right of anus are added (Ishizaki).
f. SP06, ST25,36 (bilateral) + periincisional needles was very successful in ovariohysterectomy in toxic pyometra (Arambarri et al 1975).
g. SP06 and GB34 were successful in caesarian section (Janssens).
Other point combinations, including ear points, are possible. Jan Still (Vet School, Medunsa, South Africa) has published a number of successful studies on AA in dogs and cats.
APA procedure: The animal is restrained in a special harness or by tying the limbs to the corners of the operating table. The needles are inserted deeply into the points. Limb points, such as ST36, SP06, TH08, PC06, are transfixed (i.e.) needle is pushed out through the skin on the opposite surface of the limb. The needles are taped or sutured in position to prevent dislodgement. The needles are connected in pairs to the electro-stimulator. Frequency is 2-15 Hz, square or spike, biphasic wave. Voltage is increased slowly to the tolerance of the animal. Voltage and frequency may be increased gradually every few minutes. After 15 minutes, pinprick, towel clamp or scalpel prick tests are applied every 5 minutes in the vicinity of the operative site. When pain reaction to test is negative, surgery can begin (usually 10-20 minutes after onset of stimulation). An indwelling intravenous catheter is advisable for routine use, in case short-acting barbiturates are needed for intubation (for gaseous anaesthesia) in the event of failure or severe vomiting. If pain reaction occurs during incision of skin or serosa or at the closure stage, small amounts of local anaesthetic may be injected. Alternatively, the voltage and frequency of the stimulator may be increased to tolerance. The stimulator is switched off at the end of the operation. For further details contact the author. A detailed review with references is available.
AP IN POST-OPERATIVE COMPLICATIONS
Post-operative complications include pain, inappetance, nausea/vomiting, retention of urine or faeces, wound infection and delayed healing. Even if it is not used during surgery as a means of inducing hypoalgesia, AP can be used post-operatively to speed the restoration of normal function and to improve wound-healing. The selection of AP points depends on the clinical signs and/or the target organs or functions to be helped.
Tables 1, 2 and 3 list points for various body regions, organs and conditions. For example, dogs after abdominal incision may require treatment for abdominal pain and constipation. Points can be selected from Tables 2 and 3 for these conditions. Treatment would be for 10-20 minutes twice daily for the first 2-3 days; then daily for 3-4 days.
In retention of urine, catheterisation time can be reduced greatly by needling points active on the bladder and micturition centres. These points include BL28, CV03 (bladder Shu and Mu points); BL31-34 (active on urinary-genital function) and SP06 or KI03 (active on lower abdominal functions).
To assist wound healing, local points (near the incision) can be used, or TENS may be used across the incision-site. In cases where wound healing is unsatisfactory, points from the immunostimulation list could be added to points for the affected area.
5. PRACTICAL METHODS OF AP POINT STIMULATION
1. AP Point injection (0.5-1.5 ml/point) is safe and fast; it requires only a few seconds/point but can be painful where many points need treatment. The injection-solution may be distilled deionised water, saline, procaine saline (0.5-1.0%), vitamin B12 solution, isotonic saline, Impletol, homoeopathic solutions, or combinations etc.
AP point-injection is ideal in dogs which need medication which is suitable for intramuscular or subcutaneous use. In those cases, the dose can be diluted and distributed via the AP or TPs. Injection of TPs with Impletol is the classic method of TP therapy.
The method also is suitable if AP is indicated but the practitioner believes that the client may be unreceptive to the idea. In that case, sterile saline, glucose-saline, dilute procaine or vitamin B12 solution etc can be injected into the correct points. A variation of this technique is to use the Dermojet (high-pressure spray penetration of the epidermis). This may be painful and animals learn to fear it after a few sessions. The Dermojet is very useful in cats.
2. Simple needling: Having located the tender points and/or the classic points relevant to the case, sterile, stainless-steel needles 26-30 gauge/ 2.5-7.5 cm long are inserted 1-4 cm deep. Depth and direction of needling vary with the points. The finest and shortest needles possible are used but in fractious animals, thicker needles may be used to facilitate insertion and removal of the needles.
Aim to induce DeQi (Teh Ch'i): Classical AP recommends pecking and twirling of the needles for 15-30 seconds after needle insertion. The needles are "pecked" (up and down) and "twirled" (rotated in opposite directions, 90o left, then 180o right then 180o left etc, to avoid twisting the tissues around the needle; the latter causes unnecessary pain). In humans, needle twirling in the correct position induces a strong paraesthesia radiating along the course of the nerve or Channel. This is called DeQi (the arrival of the energy), or the Propagated Channel Sensation (PCS). If this sensation is not obtained, the needle is not at the correct position and/or depth and the results are poor. In that case, the needle is withdrawn slightly, redirected, pushed in and twirled again, until DeQi is obtained.
Animals may react to needle twirling by trembling, or defensive action, but often they give no clear sign of DeQi. After attempting to induce DeQi, the needles are retained in position for 15-20 minutes; every 5 minutes, or so, the needles are twirled for a few seconds. Just before removal, the needles are twirled for a few seconds again. Some experts claim that leaving the needles in situ for 20 minutes without twirling is adequate.
One should not needle major arteries, body cavities, bone or joint spaces, nipples or vital organs etc. It is permitted (indeed mandatory in many cases) to keep soft tissue and nerve trauma to a minimum.
3. Electro-AP (EA): This is most valuable in the induction of AP analgesia for surgery but EA can be used routinely in AP therapy also. The needles are inserted to the correct depth and are connected in pairs to the output sockets of an AP electro-stimulator. To avoid the possibility of cardiac fibrillation, any one pair of leads should not cross the spine between vertebrae C2 and T10, i.e. each pair of electrodes should be on the same side of the spinal cord in these areas. Crossing the midline in the lumbosacral area is accepted.
For surgical AP analgesia the needles are taped firmly in position to prevent their being dislodged during the operation. The power is turned on and the output controls advanced from zero to tolerance. The needles usually beat to the frequency of the stimulator (at frequencies of 2-15 Hz). At higher frequencies, the muscle goes into local spasm, i.e. the needle vibration is not obvious. The best wave form for AP analgesia (APA) is square wave or spike wave biphasic. In electro AP therapy, the output voltage is set lower than in APA. In therapy, the stimulation is maintained for 5-20 minutes. In APA, it is maintained until near the final closure stage. Although EA looks impressive to the owner of the animal it has little if anything to offer (above simple needling) for most AP indications. Exceptions are: peripheral and central nerve paralysis and in APA for surgery. EA is preferable in these cases.
If more needles are used than can be stimulated simultaneously, the leads are alternated between needles as required.
4. Ultrasound: Standard equipment may be used. A contact medium (jelly or solution, or water) should be used between the probe and the points. Some instruments have a range of probes of different diameters for various parts of the body (including probes for use in the rectum, vagina, ears and nose for local infections etc in these orifices). Output is set at 0.25-1.0 W. Time of application is 15-60 seconds/point. The technique is painless, non-invasive and very often effective. Long hair may make contact difficult or impossible.
If results are disappointing after the first few sessions, point injection or simple AP should be tried.
5. LLLT-AP: Three types of low-power laser are used: Helium-Neon (He-Ne, red light); infrared (invisible); diode lacers (not true lasers but emitting light varying from visible to invisible frequencies). It is not possible to give critical assessment of which type of laser (visible v invisible; pulsed v unpulsed) is best, as comparative trials need to be done.
Low-power lasers usually produce no sensation of pain. Thus, they are ideal for treating animals like cats (which are not good subjects for multiple needling) and when treating points in painful areas of the body such as the ears and digits.
Wavelengths vary from 632 (visible red) to 1100 (invisible infrared) nM. The laser light is emitted via a fibre-optic cable or other outlet. The power output is low in most lasers (0-10 mW/cm2). Higher power lasers (10-50 mW/cm2) are also available.
Penetration of most lasers is superficial (1-2 cm). Thus, they are especially useful for superficial conditions such as: skin wounds; trauma; abrasions; ulcers; granulomas; mucosal ulcers; corneal ulcers (LASER should not be beamed at the retina). It is also useful in tendinitis and myositis of superficial muscles. The higher wavelengths, higher power outputs and pulsed lasers may penetrate deeper into the tissues, especially in large animals.
When used on local lesions (such as an infected wound), LLLT (<5 mW/cm2) is applied in grid movement (moving all the time) to the wound for 5-15 minutes. Higher power lasers (20-50 mW/cm2) need much less time. Those claiming LLLT success via AP points claim a great advantage in the short time of application, 5-30 seconds/point. However, exposure time depends on mean output power (MOP, in mW). It is essential to deliver sufficient power density (J/cm2) to the irradiated area. Calculation of optimal laser dose is discussed in the paper on LLLT.
A survey by IVAS (1984) on LLLT in AP suggested that the local use of LLLT was the main application. Although there were claims that LLLT could activate AP points (especially those close to the surface and in the ears), there was not agreement on that claim. In spite of some claims to the contrary from China and other countries (see "AP for immune-mediated disorders" by Rogers (1991)), LLLT, according to other users, had failed to influence organic diseases and deep-seated muscles in many attempts. Also, many respondents found that AP gave better results than LLLT at that time. However, most of the older lasers emitted <10 mW/cm2 and their penetration depth was limited. Since than, more powerful lasers (10-50 mW/cm2, with beam interruption (pulsing) at 2000-10000 Hz, are available. These lasers (especially pulsed Infra-Red lasers) can be used as a substitute for needles in AP, also in large animals. However, more research is needed on the benefits and limitations of LLLT as full substitutes for other types of AP stimulation.
LLLT is not thought to be suitable for routine AP analgesia, although Zhou (1984) claimed good success with 2.8-6 mW He-Ne laser in density and orofacial surgery.
6. FURTHER TRAINING
Possibilities for further training in AP include:
a. Home-study of human and vet AP texts, such as those listed in the references, is essential.
b. Formal study of human AP at specialist AP schools, colleges or seminars is advisable. As mentioned, transposition of human principles to small-animal patients is relatively easy and is very successful. Many medical AP societies and study-groups welcome vets as members.
c. Formal study of vet AP is advisable. Courses are given by national vet AP societies or by the International Vet AP Society (IVAS).
IVAS runs a training course in the USA. It has run the course in Europe and Australia in recent years. If there is demand for the course and national groups can carry the costs, IVAS may be able to run the course elsewhere. The total course time is 120 hours, divided into 4 sessions/year.
Each candidate is expected to attend the full course, study the recommended texts, pass a 3-hour written examination and submit 5 fully documented case reports. Having fulfilled these requirements, the candidate receives IVAS accreditation. IVAS also acts as a clearing-house for clinical and research information on AP and produces a quarterly Newsletter. Contact: IVAS, c/o David Jagger, 5139 Sugarloaf Rd., Boulder, CO 80302-9217, USA (Fax: 1-303-449-8312).
AP is effective in a very wide range of human and animal conditions. For example, a database from >55 textbooks and clinical articles lists frequency-ranked prescriptions for >1100 human clinical conditions. Only a very small number of prime indications are discussed here. The text books listed in the references give more details on points for other areas.
Tables 1, 2 and 3 show examples of AP point selection for specific body regions, specific organs and some common conditions. These tables are based on the human system; the point coding used is similar to that used by IVAS, where BL41-54-40 for the outer line of the BL Channel between T2 to S4 to the popliteal crease; older texts put BL36 at T2-3, BL49 at S4 and BL54 at the popliteal crease.
In all the examples below, the depth of needling is given a minimum and maximum range depending on the size of the patient.
1. EMERGENCIES
Common emergencies include respiratory and/or cardiac arrest under general anaesthesia, haemorrhagic or traumatic shock. Resuscitation points include:
GV26 (in the midline of the nasal philtrum, level with the lower canthi of the nostrils; depth 0.5-1.5 cm towards the nasal septum)
KI01 (between metatarsal bones 3-4, approached from the anterior or posterior edge of the plantar pad; depth 0.5-1.5 cm)
Tip of the tail (needle the last coccygeal vertebra from the free end of the tail; depth 0.3-1.0 cm)
Ting (Terminal) points on the digits, beside or behind each nailbed.
GV26 is the most important of these points for its effect on the respiratory centre. It has a marked effect as a sympathicomimetic and in improving cerebral circulation. In respiratory arrest without cardiac arrest, needling for 10-30 seconds is usually sufficient (Rogers, 1977; Janssens et al 1979).
In other forms of shock (trauma, haemorrhage) the needles are left in situ for 10-40 minutes, twirling strongly every 5 minutes. Emergencies with cardiac arrest require strong needling for 5-15 minutes and points with cardiac effects should be added, such as:
PC06 (on the medial aspect of the forearm between radius and ulna, about 1/5 distance from carpus to elbow; depth 1-3 cm)
BL15 (1.5-3.0 cm paramedian to the dorsal midline behind the spine of 5th thoracic vertebra; depth 1-4 cm)
CV14 (midline, behind the tip of the xiphoid cartilage; depth 1-3 cm at 45 degree angle anteriorly)
PC06 is the most important of these three points for cardiac conditions. PC06 is also effective in conditions of the lung, diaphragm and stomach.
2. PAIN SYNDROMES
AP is excellent in treating myofascial pain; pain and stiffness in arthropathy; hip dysplasia; spinal pain (root "disc" syndromes); acute traumatic pain (Chan et al 1996). It also helps to relieve pain from smooth muscle spasm (various types of colic and bronchospasm etc).
MYOFASCIAL SYNDROMES: Muscle lameness (strain, rheumatism, claudication "myositis" etc) is very common in greyhounds and is a major cause of poor racing performance. The dog may not be visibly lame (although in many cases is lame). The common feature of myofascial syndromes is the presence of exquisitely tender areas ("nodules", TPs, AhShi points) in the muscles or fascia. They can be found in any muscles but are more common in the neck and shoulder muscles, paravertebral area and thigh muscles. There is often a history of good racing performance coming to an abrupt end. There need not be a history of known injury. Undoubtedly, most of these begin as minor muscle tears, but chilling or draughts may also precipitate "muscle rheumatism" or myositis. (In horses, there is often a history of virus infection in the stable in the previous 2-18 months). It is possible that there may be nutritional causes also but I have no experience of this. AP is a highly effective therapy. Recent cases usually respond in 1-4 sessions at 1-3 day intervals. Chronic cases need 1-8 sessions at intervals of 3-7 days.
The most important part of the examination is to determine the location of the affected parts of the muscles and the TPs in nearby (and occasionally distant) muscles. This is done by careful palpation using the thumb or index finger. Where possible the muscles should be palpated with a pincer grip (between thumb and index finger), for example, the triceps, forearm, leg and thigh muscles, TPs are often found in the paravertebral areas from neck to tail. They may be uni- or bi-lateral.
Diagonal relationships often exist in musculoskeletal problems; muscle pain in the left neck is often associated with some tenderness in the right lumbosacral area and vice-versa.
Having carefully recorded the affected area(s) and the TPs, a few classical AP points known to influence the affected area are chosen (see Table 1). All TPs are treated also. In searching for these areas, one should check the major joints systematically.
a. Neck mobility: The neck is turned to the left, gently but firmly, in an attempt to make the nose touch the left flank. This is repeated to the right side. Normal dogs do not whine or resist this test. Vertical and rotation movement is also checked. If the dog resists or whines, the tender points usually are found on careful (inch by inch) palpation.
b. Shoulder and elbow joints and muscles are checked by full extension, flexion and abduction of the limb. This is followed by careful deep palpation of the muscles and joints.
c. The spine and paravertebral area is checked by running the thumbs down the spinal processes and also along the muscles on 2 or 3 lines (1, 2 and 3" from the mid-line), applying firm pressure, first left, then right, from the first thoracic to the base of the tail.
d. The hip and stifle are also checked by full extension, flexion and abduction, followed by joint and muscle palpation.
If tender points are found, they are noted and rechecked later (some nervous or fidgety dogs may give occasional "false positive" reactions to finger pressure but the recheck differentiates the true from the false reaction). The true TP usually elicits a strong yelp and the dog usually turns the head towards the pain and may try to bite.
The response to treatment of muscle lameness can be dramatic. If the case is not well improved by 4-6 sessions (with marked loss of TP sensitivity) the prognosis for AP therapy is poor. In general, if AP is to be successful, effective results should be seen by 3-6 sessions. Improvement may occur within 20 minutes and is usual by session 2 or 3. Full improvement however may require more sessions. Racing dogs should be given mild to moderate exercise during the course of therapy but racing should be postponed until they are fully sound and all TPs are absent.
ARTHROPATHY: AP is very effective as a therapy in trauma (sprain), arthritis and rheumatism of joints (especially in older dogs). Much of the pain and stiffness in arthropathy comes from the muscles and soft tissues around the joint rather than from the joint itself. The original pain signals may have come from the joint but they usually set up reflex "guarding" of the joint, with secondary triggers in the muscles and soft tissues above or below the joint. The secondary triggers may become the main foci of pain signals long after the irritation in the joint has eased.
AP can not alter the bone lesions in an arthritic joint but it can have antiinflammatory effects and can be very effective in treating the soft tissue foci of irritation. The net result after successful AP is greatly improved locomotion (less stiffness, less pain on movement). The approach to arthropathy is to tackle the causes if known. AP can be of value, even if little can be done to treat or alleviate the causes. It is important to locate AhShi points if present, as in myofascial syndromes. AhShi points are needled for about 20 minutes, together with local and distant points for the specific joint (see Table 1). Arthropathy usually is treated every 3-7 days. If results are poor by 6 sessions, AP is unlikely to be of value.
Janssens (1984) described AP therapy in 61 dogs with arthrosis. The mean duration before treatment was 36 weeks. AP was most successful in shoulder and stifle (80 and 72%), less so in hips (55%) and lease successful in elbow, carpus and tarsus (33%). Recovery averaged 24 days (3.5 sessions/case); 48% relapsed but with original success rates on re-treatment. Schoen (1984) reported good or excellent results in 63% of dogs with arthrosis. There were 24 dogs in the series. Patients treated successfully for arthrosis/arthritis may relapse in 6-12 months. They usually respond well and rapidly to further courses of AP, as required (Janssens 1984; Schoen 1984).
Purulent arthritis is unsuitable for AP as a sole therapy. If specific pathogens are involved, specific anti-microbial drugs are indicated but AP may be added for its immunostimulant effect.
HIP DYSPLASIA often manifests with muscle pain and lameness. Much of the pain and stiffness is due to excess joint mobility, with consequent strain on ligaments and soft tissues. Hip dysplasia is a very good indication for AP. Although AP does not alter the X-ray lesion, abnormal joint mobility can be curtailed if the muscle tonus around the joint can be improved.
The main points for hip dysplasia are AhShi points (if present) plus local points (in the vicinity of GB30) together with GB34 (between the upper head of the fibula and the tibia, from the lateral side). Three needles may be placed near the hip joint, one in GB30 and the other 2 about 2.5-3.5 cm on either side of it, angled towards the acetabulum. The needles are placed deep enough so that they almost touch the acetabulum. Sessions are about 7 days apart. Usually 3-4 sessions give excellent results. Relapses may occur and require further AP treatment. AP can be combined with homoeopathic remedies such as Arnica (soft tissue bruising), Hypericum (deep pain), Ruta (joint pain) or Rhus toxicodendron ("rheumatism").
An alternative approach is to implant 5-7 gold beads (1 mm diameter) around the rim of the acetabulum in one single session. The technique is inexpensive, safe, simple and fast. If gold beads are difficult to obtain, orthopaedic suture wire or 18 gauge, 18 carat gold wire, tied in tiny knots (with the ends clipped off) may be used instead. The implants are inserted using aseptic techniques under general anaesthesia, using a wide-bore (14-16 gauge) needle and a stilet to deposit each implant. The first implant is deposited at the uppermost edge of the acetabulum ("12 o'clock"). The remaining 4-6 implants are deposited between "9-12" and "12-3 o'clock".
It is not uncommon for the dog to jump up on its hindlimbs within 2 days after implantation. Although it is not essential, antibiotic cover is advisable in the post-operative period. Long-term success rates of more than 80% are claimed by some workers (Grady-Young, 1979).
DISC DISEASE, VERTEBRAL ARTHROSIS: As mentioned in relation to arthritis and hip dysplasia, the presence of lesions on X-ray need not cause pain or lameness and successful outcome to AP therapy often occurs in spite of persistence of the lesion. The pain and lameness in vertebral problems usually are due to muscle spasm and irritation of nerve roots and meninges. Vertebral arthrosis is treated similarly to disc disease.
Prognosis in disc disease: Before attempting to treat spinal disc syndromes, it is important to assess the degree of neurological damage. The prognosis is excellent in Grade 1 and 2 disc disease (mild to moderate damage, i.e. (pain only to pain + some paresis)). The prognosis is still very good in Grade 3 disc disease (severe, i.e. motor paralysis but with deep pain sensation intact), but additional nursing and care is always needed. In Grade 4 disc disease (where damage is very severe, with paralysis and total loss of superficial and deep pain reflexes), the prognosis in cases presented more than 48 hours after onset is about 33%. Grade 4 cases require a lot of care, work and nursing. Time to recovery in Grade 4 is >> Grade 3 >> Grade 2 >> Grade 1.
The approach to AP treatment of disc cases is to localise the affected area by finger palpation and other methods. One to two points are used (bilaterally) above and below the problem disc, together with Tender and Distant points as indicated in Table 1. Treat acute cases every 1-2 days, chronic cases every 3-7 days. If there are other symptoms (faecal/urinary retention etc), these must be treated also, usually by western methods.
In a series of 75 dogs with thoracolumbar disc disease, AP gave success rates of 97,95,85 and 33% in Grades 1, 2, 3 and 4 respectively. Mean time to complete recovery was 13, 24, 32, 76 days respectively, requiring a mean of 2, 3.4, 4.8 and 9 sessions respectively (Janssens 1983, 1984). In a series of 32 dogs with cervical disc disease, 70% had full recovery after 2.5 sessions (mean recovery time 14 days). 37% relapsed with similar results on re-treatment (Janssens 1984).
To ensure the best outcome, Janssens recommends good nursing (catheterisation of the bladder; treatment of cystitis; enemas or digital rectal evacuation; frequent turning to avoid pressure-sores etc, if required). He also advises confinement in a playpen to prevent any exaggeration of clinical Grade from further trauma to, or bleeding into, the nerve roots or spinal cord etc. However, Chan et al (1996) found that controlled mild exercise (supervised walking on a lead) shortened the recovery time and improved the success rate of AP in disk disease.
ACUTE TRAUMATIC PAIN: The human pain-point par excellence is GB34 (between the upper head of fibula and the tibia, needled from the lateral side). One or two local points are added (ipsilateral). However, if the tissues are badly mangled or are covered by a cast, points on the contralateral limb may help. Treat daily for 2-3 days. If the animal is in shock, GV26 + KI01 help to control shock (+ western therapy).
SMOOTH MUSCLE SPASM: Human colic can arise from spasm of smooth muscle in the coronary arteries, bileduct, gastrointestinal tract, urinary and female reproductive systems. These types of colic can be relieved (often in minutes) by AP. The main points for disorders of the internal organs are given in Table 2. In small animal practice, gastrointestinal colic is very rare, but is a good indication for AP, once surgical emergencies have been eliminated from the diagnosis. In acute cases treatment is given every 8-24 hours; in chronic cases every 1-2 days.
GASTRIC TORSION, with bloat and pain in dogs can be relieved in minutes by AP. The main points are PC06, ST36, CV12, BL21. The stomach tube can be passed easily after the torsion is relieved (Blakely, 1985). Megaoesophagus and "choke" can sometimes be helped by PC06, ST36, CV12,17,22, BL13,17,21.
FUNCTIONAL DISORDERS: AP is successful in many functional disorders such as vomiting, diarrhoea, autonomic upsets, shock etc. Table 3 lists AP points which may be used in many common conditions.
MINOR HORMONAL DISORDERS: AP can activate hypothalamus-pituitary and the endocrine system, if the target cells are capable of responding. It is of use in mild human disorders of the thyroid, adrenal, pancreas and gonads.
AP has been used to treat hormonal infertility, pseudopregnancy and skin conditions associated with hormonal upsets in small animals. It could be tried in mild cases of diabetes mellitus also. Table 3 includes points used in female and male infertility. In pseudo-pregnancy, points active on the ovary/tubes/uterus (Table 2) should be added. The success rate in oligospermia is not as high as in female hormonal infertility but it is worth trying in valuable stud dogs.
OBSTETRICS: AP can be very useful in inducing birth (oxytocin-effect) and in treating dystocia in women. It is also useful in dystocia in other species. The most important points in obstetrics (dystocia etc) are points active on the pelvic ligaments, cervix/vagina and uterus: animal-BaiHui (GV03 = lumbosacral space) or human GV03 (one space anterior to lumbosacral); GV04 and BL23 (near L2-L3); points from BL25-34 and points on the outer BL line in the lumbosacral area.
Needling points on the lumbosacral area (especially animal-Baihui (GV03)) helps cervical dilation. The other points help relaxation of the pelvic ligaments and uterine contraction. The net result is more room in the pelvis and better contractions. Needling should be continued for 10-15 minutes before further obstetrical intervention.
4. AP ANALGESIA FOR SURGERY
Electro-AP can induce hypoalgesia sufficient for surgery. Dogs are good subjects for AP analgesia. Cats are very poor subjects. Indications include: cases in which general anaesthetic poses a high risk (severely shocked, debilitated or toxic cases; subjects with severe disease of the lung, heart, liver or kidney etc). AP analgesia is also suitable for caesarian section, as it has no depressive effects on the foetus.
Advantages include: (a) can be used in "cocktail anaesthesia", or to reduce greatly the dose of anaesthetic or sedative needed; (b) suitable in high-risk cases (c) suitable in Caesarian section (d) suitable in prolonged surgery (up to 10 hours) (e) autonomic functions remain stable (f) faster post-operative recovery of appetite, gut and bladder function etc; faster post-operative healing and less infection; reduced post-operative pain (g) simple and inexpensive; can be used in national disasters etc, using manual needling alone.
Disadvantages include: (a) operative success without the need for chemical anaesthetics or sedatives etc varies from 50-95%, depending on the skill of the operator and the tolerance of the patient to prolonged restraint; (b) very good restraint is necessary; all sensory inputs except pain are registered and full motor power is retained; (c) light, deft surgery is needed, not for ham-fisted surgeons; (d) prolonged manipulation of viscera/organs or traction on mesentery can induce nausea/vomiting; (e) poor relaxation of abdominal muscles can cause "ballooning" of viscera; (f) an induction period of 10-20+ minutes is necessary; (g) it is not suitable for intra-thoracic operations in animals.
POINTS USED FOR AP ANALGESIA IN DOGS: Point combinations vary with the operative site and between operators.
a. BL23 (bilateral): suitable for most operations in dogs (Kitazawa)
b. SP06 (bilateral): suitable for most operations in dogs but Electro-AP (EA) of SP06 may cause convulsions in some dogs (Kitazawa).
c. LI04; ST36; InKoTen (between metacarpals 3 and 4) and BoKoKu (between metatarsals 3 and 4). All bilateral (8 points). Suitable for most operations (Kitazawa) but BL23 (bilateral) is better (Kitazawa).
d. PC06, TH08 (bilateral). Suitable for thorax, neck, head and thoracic limb (Ishizaki). Local points may be added (Ishizaki).
e. ST36, SP06 (bilateral). Suitable for abdominal, perineal and pelvic limb (Ishizaki). For anal surgery, needles left and right of anus are added (Ishizaki).
f. SP06, ST25,36 (bilateral) + periincisional needles was very successful in ovariohysterectomy in toxic pyometra (Arambarri et al 1975).
g. SP06 and GB34 were successful in caesarian section (Janssens).
Other point combinations, including ear points, are possible. Jan Still (Vet School, Medunsa, South Africa) has published a number of successful studies on AA in dogs and cats.
APA procedure: The animal is restrained in a special harness or by tying the limbs to the corners of the operating table. The needles are inserted deeply into the points. Limb points, such as ST36, SP06, TH08, PC06, are transfixed (i.e.) needle is pushed out through the skin on the opposite surface of the limb. The needles are taped or sutured in position to prevent dislodgement. The needles are connected in pairs to the electro-stimulator. Frequency is 2-15 Hz, square or spike, biphasic wave. Voltage is increased slowly to the tolerance of the animal. Voltage and frequency may be increased gradually every few minutes. After 15 minutes, pinprick, towel clamp or scalpel prick tests are applied every 5 minutes in the vicinity of the operative site. When pain reaction to test is negative, surgery can begin (usually 10-20 minutes after onset of stimulation). An indwelling intravenous catheter is advisable for routine use, in case short-acting barbiturates are needed for intubation (for gaseous anaesthesia) in the event of failure or severe vomiting. If pain reaction occurs during incision of skin or serosa or at the closure stage, small amounts of local anaesthetic may be injected. Alternatively, the voltage and frequency of the stimulator may be increased to tolerance. The stimulator is switched off at the end of the operation. For further details contact the author. A detailed review with references is available.
AP IN POST-OPERATIVE COMPLICATIONS
Post-operative complications include pain, inappetance, nausea/vomiting, retention of urine or faeces, wound infection and delayed healing. Even if it is not used during surgery as a means of inducing hypoalgesia, AP can be used post-operatively to speed the restoration of normal function and to improve wound-healing. The selection of AP points depends on the clinical signs and/or the target organs or functions to be helped.
Tables 1, 2 and 3 list points for various body regions, organs and conditions. For example, dogs after abdominal incision may require treatment for abdominal pain and constipation. Points can be selected from Tables 2 and 3 for these conditions. Treatment would be for 10-20 minutes twice daily for the first 2-3 days; then daily for 3-4 days.
In retention of urine, catheterisation time can be reduced greatly by needling points active on the bladder and micturition centres. These points include BL28, CV03 (bladder Shu and Mu points); BL31-34 (active on urinary-genital function) and SP06 or KI03 (active on lower abdominal functions).
To assist wound healing, local points (near the incision) can be used, or TENS may be used across the incision-site. In cases where wound healing is unsatisfactory, points from the immunostimulation list could be added to points for the affected area.
5. PRACTICAL METHODS OF AP POINT STIMULATION
1. AP Point injection (0.5-1.5 ml/point) is safe and fast; it requires only a few seconds/point but can be painful where many points need treatment. The injection-solution may be distilled deionised water, saline, procaine saline (0.5-1.0%), vitamin B12 solution, isotonic saline, Impletol, homoeopathic solutions, or combinations etc.
AP point-injection is ideal in dogs which need medication which is suitable for intramuscular or subcutaneous use. In those cases, the dose can be diluted and distributed via the AP or TPs. Injection of TPs with Impletol is the classic method of TP therapy.
The method also is suitable if AP is indicated but the practitioner believes that the client may be unreceptive to the idea. In that case, sterile saline, glucose-saline, dilute procaine or vitamin B12 solution etc can be injected into the correct points. A variation of this technique is to use the Dermojet (high-pressure spray penetration of the epidermis). This may be painful and animals learn to fear it after a few sessions. The Dermojet is very useful in cats.
2. Simple needling: Having located the tender points and/or the classic points relevant to the case, sterile, stainless-steel needles 26-30 gauge/ 2.5-7.5 cm long are inserted 1-4 cm deep. Depth and direction of needling vary with the points. The finest and shortest needles possible are used but in fractious animals, thicker needles may be used to facilitate insertion and removal of the needles.
Aim to induce DeQi (Teh Ch'i): Classical AP recommends pecking and twirling of the needles for 15-30 seconds after needle insertion. The needles are "pecked" (up and down) and "twirled" (rotated in opposite directions, 90o left, then 180o right then 180o left etc, to avoid twisting the tissues around the needle; the latter causes unnecessary pain). In humans, needle twirling in the correct position induces a strong paraesthesia radiating along the course of the nerve or Channel. This is called DeQi (the arrival of the energy), or the Propagated Channel Sensation (PCS). If this sensation is not obtained, the needle is not at the correct position and/or depth and the results are poor. In that case, the needle is withdrawn slightly, redirected, pushed in and twirled again, until DeQi is obtained.
Animals may react to needle twirling by trembling, or defensive action, but often they give no clear sign of DeQi. After attempting to induce DeQi, the needles are retained in position for 15-20 minutes; every 5 minutes, or so, the needles are twirled for a few seconds. Just before removal, the needles are twirled for a few seconds again. Some experts claim that leaving the needles in situ for 20 minutes without twirling is adequate.
One should not needle major arteries, body cavities, bone or joint spaces, nipples or vital organs etc. It is permitted (indeed mandatory in many cases) to keep soft tissue and nerve trauma to a minimum.
3. Electro-AP (EA): This is most valuable in the induction of AP analgesia for surgery but EA can be used routinely in AP therapy also. The needles are inserted to the correct depth and are connected in pairs to the output sockets of an AP electro-stimulator. To avoid the possibility of cardiac fibrillation, any one pair of leads should not cross the spine between vertebrae C2 and T10, i.e. each pair of electrodes should be on the same side of the spinal cord in these areas. Crossing the midline in the lumbosacral area is accepted.
For surgical AP analgesia the needles are taped firmly in position to prevent their being dislodged during the operation. The power is turned on and the output controls advanced from zero to tolerance. The needles usually beat to the frequency of the stimulator (at frequencies of 2-15 Hz). At higher frequencies, the muscle goes into local spasm, i.e. the needle vibration is not obvious. The best wave form for AP analgesia (APA) is square wave or spike wave biphasic. In electro AP therapy, the output voltage is set lower than in APA. In therapy, the stimulation is maintained for 5-20 minutes. In APA, it is maintained until near the final closure stage. Although EA looks impressive to the owner of the animal it has little if anything to offer (above simple needling) for most AP indications. Exceptions are: peripheral and central nerve paralysis and in APA for surgery. EA is preferable in these cases.
If more needles are used than can be stimulated simultaneously, the leads are alternated between needles as required.
4. Ultrasound: Standard equipment may be used. A contact medium (jelly or solution, or water) should be used between the probe and the points. Some instruments have a range of probes of different diameters for various parts of the body (including probes for use in the rectum, vagina, ears and nose for local infections etc in these orifices). Output is set at 0.25-1.0 W. Time of application is 15-60 seconds/point. The technique is painless, non-invasive and very often effective. Long hair may make contact difficult or impossible.
If results are disappointing after the first few sessions, point injection or simple AP should be tried.
5. LLLT-AP: Three types of low-power laser are used: Helium-Neon (He-Ne, red light); infrared (invisible); diode lacers (not true lasers but emitting light varying from visible to invisible frequencies). It is not possible to give critical assessment of which type of laser (visible v invisible; pulsed v unpulsed) is best, as comparative trials need to be done.
Low-power lasers usually produce no sensation of pain. Thus, they are ideal for treating animals like cats (which are not good subjects for multiple needling) and when treating points in painful areas of the body such as the ears and digits.
Wavelengths vary from 632 (visible red) to 1100 (invisible infrared) nM. The laser light is emitted via a fibre-optic cable or other outlet. The power output is low in most lasers (0-10 mW/cm2). Higher power lasers (10-50 mW/cm2) are also available.
Penetration of most lasers is superficial (1-2 cm). Thus, they are especially useful for superficial conditions such as: skin wounds; trauma; abrasions; ulcers; granulomas; mucosal ulcers; corneal ulcers (LASER should not be beamed at the retina). It is also useful in tendinitis and myositis of superficial muscles. The higher wavelengths, higher power outputs and pulsed lasers may penetrate deeper into the tissues, especially in large animals.
When used on local lesions (such as an infected wound), LLLT (<5 mW/cm2) is applied in grid movement (moving all the time) to the wound for 5-15 minutes. Higher power lasers (20-50 mW/cm2) need much less time. Those claiming LLLT success via AP points claim a great advantage in the short time of application, 5-30 seconds/point. However, exposure time depends on mean output power (MOP, in mW). It is essential to deliver sufficient power density (J/cm2) to the irradiated area. Calculation of optimal laser dose is discussed in the paper on LLLT.
A survey by IVAS (1984) on LLLT in AP suggested that the local use of LLLT was the main application. Although there were claims that LLLT could activate AP points (especially those close to the surface and in the ears), there was not agreement on that claim. In spite of some claims to the contrary from China and other countries (see "AP for immune-mediated disorders" by Rogers (1991)), LLLT, according to other users, had failed to influence organic diseases and deep-seated muscles in many attempts. Also, many respondents found that AP gave better results than LLLT at that time. However, most of the older lasers emitted <10 mW/cm2 and their penetration depth was limited. Since than, more powerful lasers (10-50 mW/cm2, with beam interruption (pulsing) at 2000-10000 Hz, are available. These lasers (especially pulsed Infra-Red lasers) can be used as a substitute for needles in AP, also in large animals. However, more research is needed on the benefits and limitations of LLLT as full substitutes for other types of AP stimulation.
LLLT is not thought to be suitable for routine AP analgesia, although Zhou (1984) claimed good success with 2.8-6 mW He-Ne laser in density and orofacial surgery.
6. FURTHER TRAINING
Possibilities for further training in AP include:
a. Home-study of human and vet AP texts, such as those listed in the references, is essential.
b. Formal study of human AP at specialist AP schools, colleges or seminars is advisable. As mentioned, transposition of human principles to small-animal patients is relatively easy and is very successful. Many medical AP societies and study-groups welcome vets as members.
c. Formal study of vet AP is advisable. Courses are given by national vet AP societies or by the International Vet AP Society (IVAS).
IVAS runs a training course in the USA. It has run the course in Europe and Australia in recent years. If there is demand for the course and national groups can carry the costs, IVAS may be able to run the course elsewhere. The total course time is 120 hours, divided into 4 sessions/year.
Each candidate is expected to attend the full course, study the recommended texts, pass a 3-hour written examination and submit 5 fully documented case reports. Having fulfilled these requirements, the candidate receives IVAS accreditation. IVAS also acts as a clearing-house for clinical and research information on AP and produces a quarterly Newsletter. Contact: IVAS, c/o David Jagger, 5139 Sugarloaf Rd., Boulder, CO 80302-9217, USA (Fax: 1-303-449-8312).
CONCLUSIONS
Concepts of TCM are based on a philosophy of Yin-Yang (balance of opposite forces), Five Phases (anabolic and catabolic relationships between 5 primitive types), a balance between humans and nature, the Six External Evils (causing disease by attack from the outside), the Seven Emotions (imbalance of which causes psychosomatic disease) and the Eight Principles of classifying disease (Yang-Yin; Excess/Deficient; External/Internal; Hot/Cold).
The concept of Qi (vital energy) flowing in the superficial and deep Channels in a diurnal cycle is central to AP. Imbalance of Qi (excess, deficiency or blockage) is the cause of disease. In disease, the AP points related to the affected parts show abnormal Qi, manifested by hyper- or hypo-sensitivity to palpation and electrical current. Detection of these abnormal points has diagnostic and therapeutic value. Diagnosis is further aided by the 4 traditional methods (looking, listening, smelling, touch, including the taking of the "Chinese pulses"). The aim of all methods of TCM is to restore the normal balance and/or flow of Qi, This may involve dietary, physical, medical, surgical and psychological methods. AP is a relatively small part of TCM.
Western concepts of AP mechanisms: Examples of diagnostic and therapeutic aspects of AP were discussed. The neuroendocrine system is the basis of AP mechanisms. Supraspinal, segmental and intersegmental reflexes (viscero- visceral, somatic and cutaneous; somato- visceral, somatic and cutaneous, cutaneo- visceral, somatic and cutaneous) are involved. AP has diagnostic and therapeutic value via these reflexes. Adequate stimulation of the correct AP points activates autonomic, humoral and neuroendocrine functions. The therapeutic effects of AP can occur only if the natural defence/healing systems can be activated (autonomic effects, immune response, antiinflammatory effects, endorphin release etc). If there is no possibility of natural responses (e.g. in severed spinal cord or severely fibrotic kidneys), AP can not substantially improve the situation.
Methods of choosing AP points are based on many Laws of TCM, the most important of which is the combination of local points, AhShi points and distant points on Channels passing through the affected area. In Western concepts this is translated into choosing points in the same nerve segment, TPs and points in nerve segments related by intersegmental reflex.
Today, computer databases makes frequency citation analysis possible. This allows computer ranking of points from many reference sources, so that prescriptions can be generated from the top 6 or 7 points in order of ranked scores. This is very useful to those whose study of AP is still in the early stages.
GV26 (the philtrum point) is excellent in emergencies and first aid. TPs, local points and points such as LI11 (in forelimb problems), BL23,40 (in lumbar and hindlimb problems) and GB34 (in hindlimb problems) are very useful in treating myofascial, musculoskeletal and vertebral disc problems. Points useful in obstetrics include animal GV03 (BaiHui, lumbosacral space), GV02 (WeiKen, sacrococcygeal space) and BL22-30 (paravertebral area from L2-S4). Some of those points may be combined with SP06 and one or two points from the low abdomen (such as ST29, CV04, SP13, KI01) to treat problems of the reproductive system and its functions.
It is very important to identify and treat TPs in myofascial and musculoskeletal problems and in some problems of the internal organs. Reflex tenderness of paravertebral (Shu (BL Associated)) points and thoracoabdominal (Mu (Alarm)) points has diagnostic value.
Advantages and disadvantages of AP analgesia (APA) for surgery were discussed. APA is unlikely to replace safe, fast, effective drug anaesthesia. However, in severely toxic patients and in caesarian section where the pups are very valuable, APA has a role. It also has a role in national/international disasters such as large-scale warfare, where drugs may be in short supply.
The most practical methods of AP stimulation for busy practitioners are the methods of point-injection, simple- or electro- AP, TENS and ultrasound. Although LLLT has applications as a local stimulant in local superficial problems, it can not be recommended as a complete replacement for needles at this time. The higher the power output, the more likely LLLT is to replace the needle, i.e. lasers of 20-50 mw/cm2 are more likely to be useful as needle replacements than those of 1-5 mw/cm2.
Some possibilities for further training were discussed; you are strongly recommended to join IVAS, irrespective of your degree of AP expertise. IVAS can help beginners to learn but it also wishes to learn from expert practitioners.
For those with the motivation to study the traditional methods, the rewards are great: new insights into philosophy, especially the philosophy of health and healing; a special bond of friendship with like-minded colleagues; a superior success rate in the use of AP in clinical practice or research.
However, many vets in busy practice and who have families, mortgages and heavy social commitments may be unable to spend the time, energy, and money needed to study AP in depth along strictly traditional lines. It is possible for such people to obtain good to excellent results with AP without an in-depth study of the method, provided certain minima are observed:
1. Reasonable study of the more important AP points and laws;;
2. Study of the use of TPs;
3. Use of a very comprehensive AP cookbook or access to a computerised database;
4. Restriction to single-symptom conditions.
Though beginners can expect good results in many simple conditions, practitioners who have not studied AP in depth can not expect good results in multi-symptom conditions. Inadequately trained practitioners may bring themselves and the AP system into disrepute if they attempt to use AP as the sole therapy in complex cases.
ACKNOWLEDGEMENTS
I thank Shelly Altman (North Hollywood, CA, USA), David Jagger (Boulder, CO, USA), Luc Janssens (Wilryk, Belgium) and Jen-Hsou Lin (Taipei, Taiwan) for their comments and corrections of an early draft of this paper and colleagues in many countries, especially those named in the text for sharing their experiences of AP with me.
REFERENCES
BASIC HUMAN TEXTS
Anon (1993) Essentials of Chinese AP. (Coll. Trad. Chin. Med., Beijing, Shanghai, Nanking) Foreign Languages Press, Beijing. 432pp.
Anon (1974) The Barefoot Doctor's Manual. Running Press, Philadelphia. 948pp.
Anon (1975) Newest illustrations of the AP points (Charts and Booklet). Medicine and Health Publishers, Hongkong.
Anon (1977) Basic AP: a scientific interpretation and application. Chinese Acup. Res. Foundation, Box 84-223, Taipei, Taiwan.
Austin,M. (1974) AP therapy. Turnstone Books, London, 290pp.
Chan,W.W., Lin,J.H. & Rogers,P.A.M. (1996) A review of AP therapy of canine paralysis and lameness. Veterinary Bulletin, In Press.
Cheng Xinnong et al (1987) Chinese AP and Moxibustion. Foreign Languages Press, Beijing. 432pp.
Chung,C. (1983) The AH SHIH Point. Illustrated guide to clinical AP (Chen Kwan Books, 5-2, 1F, Chung Ching South Road, Section 3, Taipei, Taiwan), 212pp.
Connolly,D. (1979) Traditional AP: The Law of the Five Elements. Centre for Trad. AP. American City Bldg. Columbia, Maryland 21044, 197pp.
Ellis,A., Wiseman,N. & Ross,K. (1989) Grasping the Wind. Paradigm Publications, Brookline, Massachusetts, 462 pp.
Lee,J.F. & Cheung,C.S. (1978) Current AP Therapy. Med. Interflow Publ. House, Hong Kong, 408pp.
O'Connor,J. & Bensky,D. (1983) AP: A Comprehensive Text. Shanghai College of Trad. Med. (Eastland Press, Chicago), 750pp.
Oleson,T.D., Kroening,R.J. & Bressler,D. (1980) An experimental evaluation of auricular diagnosis. Pain, 8, 217-.
Overview. Proceedings of the 1979 Symposia on AP and Moxibustion, Peking. Abstracts of 534 papers. 517pp. Available (in English) from East Asia Books, 103 Camden High Street., London.
Pontinen,P. (1982) AP Seminar for Swedish Physicians (contact: AP and Pain Research Department, University of Tampere, Finland).
Ulett,G. (1982) Principles and practice of physiological AP. (Warren Green Inc., 8356 Olive Blvd., Missouri 63132), 220pp.
Wu Wei Ping (1973) Chinese AP. Health Science Press, Wellingborough, Northants, UK, 181pp.
TEXTS ON VET AP
Altman,S. (1981) AP for animals (c/o 5647 Wilkinson Ave., North Hollywood, CA 91607, USA, 281pp.
Blakely,C.S. (1985) AP in gastric torsion in dogs. Vet AP Newsletter, 11, January-March, p. 34.
Brunner,F. (1980) AP der klein Tiere (German). (WBV Biologisch Med. Verlag, Ipweg 5, D4070 Schorndorf, Germany, 320pp.
Gilchrist,D. (1981) Manual of AP for small animals. Also: Greyhound AP (1984) Published privately, c/o 219 Byrnes Street, Mareeba, Australia, 4880.
Janssens,L., Altman,S. & Rogers,P.A,M. (1979) Respiratory and cardiac arrest under general anaesthesia: treatment by AP of the nasal philtrum. Vet. Rec., 105, 273-.
Janssens,L. (1984) Atlas of the AP points and Channels in the dog (c/o Oudestraat 37, Wilrijk 2610, Antwerp, Belgium).
Janssens,L. (1984) Treatment of disc disease and arthritis in dogs. Also trigger points and myofascial syndromes in dogs. AP Training Seminar, Vet School, Gent (Antwerp) Belgium, 289pp and 1983 VMSAC, October, 1580-.
Janssens,L.A.A. (1987) Myofascial pain syndromes in dogs: the treatment of TPs. In: Some aspects of small animal AP the clinical scientific approach. (Chapter 13 of the Belgian Vet AP Society Manual).
Klide,A. & Kung,S. (1977) Vet AP (Univ Pennsylvania Press, Philadelphia), 297pp.
Kothbauer,0. (1983) AP in the ox, horse and pig (in German). (WBV Biologisch Verlag, Ipweg 5, Schorndorf D4070, Germany).
Lin,J.H. & Rogers,P.A.M. (1980) AP Effects on the Body's Defence Systems: A Vet Review. Vet. Bulletin, 50, 633-.
Proceedings of IVAS Congresses and Seminars. Contact: IVAS, c/o David Jagger, 5139 Sugarloaf Rd., Boulder, CO 80302-9217, USA (Fax: 1-303-449-8312).
Rogers,P.A.M. (1977) Revival in collapse, shock, respiratory failure and narcotic overdose. Vet. Rec., 101, 215.
Rogers,P.A.M., White, S.S. & Ottaway, C.W. (1977) Stimulation of AP Points re. Analgesia & Therapy of Clinical Disorders in Animals. Vet. Annual, 17, 258-.
Rogers,P.A.M. & Bossy, J. (1981) Activation of the Defence systems in Animals and Man by AP and Moxibustion. Acup. Res. Quarterly (Taiwan), 5, 47-.
Rogers,P.A.M. (1991) AP for immune mediated disorders. In: AP in Animals, Proceedings 167, Postgraduate Committee in Veterinary Science, University of Sydney. pp 124-142.
Rubin,M. (1976) Manuel d'AP Veterinaire pratique moderne. Maloine Publishers, Paris, 85pp (in French).
Schoen,A.M. (1984) Re: treatment of arthrosis in dogs. Vet. AP. Congress, Gent, Antwerp, 289pp.
Westermayer,E. (1980) Treatment of Horses by AP. Health Science Press, Holsworthy. Devon, UK, 90pp.
Westermayer,E. (1978) Atlas of AP for cattle. WBV Biologisch Verlag, Ipweg 5, Schorndorf, Germany, 60pp.
White,S.S. (1984) Electro-AP in Vet. Med. Chinese Materials Centre, San Francisco. 122 pages.
Grady-Young,H. (1979) Personal communication on gold bead implantation in hip dysplasia.
TEXTS ON AP ANALGESIA IN SMALL ANIMALS
Anon (1974) The Principles and practical use of AA. Medicine and Health Publishing Co., Hong Kong, 325pp.
Arambarri,R. et al (1975) EAA in vet surgery. Revue Med. Vet. 126, 1231-1236.
Ishizaki,S. et al (1977) EAA in high risk dogs. Jap. J. vet. Anaesth., No 8. 21-28 and World APCongress, Paris Summer, 1978.
Kadono,H., et al. (1977) EEG during EAA in the dog. Jap. J. Vet. Sci., 39, 539-547.
Kitazawa,K., et al. (1975) Experimental studies on EAA in the dog. Proc. 20th World Vet Congress,
Thessaloniki, 1657-1658 and (1975) Studies on EAA in the dog; confirmation of the effect. Jap. J. vet. Anaesth., No. 6, 7-14.
Klide,A.M. & Kung,A.H. (1977) Vet AP. University of Pennsylvania Press, Philadelphia.
Lambardt,A. (1975) AA versuche bei katzen. Der Prakt, Tierarzt, 1/1975, 33-36.
Lynd,F.T. (1975) AP analgesia investigations in animals. Internal report, Department of Laboratory Animal Medicine, Medical School, University of Texas, San Antonio, Texas 78283. 5 pages.
Niboyet,J.E.H. et al. (1973) L'anaesthesie par l'AP. Maisonneuve, 433pp.
O'Boyle,M.A. & Vajda,G.K. (1975) AA for abdominal surgery. Mod. Vet. Pract., 56, 705-707.
Ralston,N.C. & Ralston,B.L. (1978) AA for cystotomy surgery in a dog. Amer. J. Acup., 6, 75-76.
Zhou,Y.C. (1984) (Re lasers as an analgesic in oro-facial surgery and dentistry). Lasers in surgery and medicine, 4, 297-
TEXTS ON TP AND SCAR THERAPY
Chung,C. (1983) The AH SHIH Point. (Chen Kwan Books, 5-2, 1F, Chung Ching South Road, Section 3, Taipei, Taiwan), 212pp.
Dorrigo,B. et al (1979) Fibrositic myofascial pain in intermittent claudication. Effect of anaesthetic block of TPs on exercise tolerance. Pain, 6, 183-.
Fox,W.W. (1975) Arthritis and allied conditions: a new and successful approach. Ranelagh Press, South Hill Park, London.
Huneke,F. (1961) Das sekunden phanomen (the instantaneous phenomenon). Karl F. Haug Verlag, Ulm, Germany (in German).
Kajdos,V. (1974) Neural therapy: its possibilities in everyday practice. Amer. J. Acup. 2, 113.
Kellgren,J.H. (1939-42) On the distribution of pain arising from deep somatic structures with charts of segmental pain areas. Clinical Science, 4, 35-.
Khoe,W.H. (1979) Scar injection in AP. Amer. J. Acup., 7, 15.
Lewit,Karel (1979) The needle effect in relief of myofascial pain. Pain, 6, 83-.
Malzack,R. et al (1977) TPs and AP points for pain: correlations and implications. Pain, 3, 3-.
MacDonald,A. (1983) Trigger mechanisms and myofascial pain. III Nordic Congress on AP, May 1983.
Also: Annals Roy. Coll. Surg. Eng. (1983), 65, 44-.
Moss,L. (1972) AP and you. Paul Elek Books, London.
Pontinen,P. (1982) AP Seminar for Swedish Physicians (contact: AP and Pain Research Dept., Tampere University, Finland).
Rogers,C. (1982) AP therapy for post-operative scars. Amer. J. Acup., 10, 201-.
Symposium on Myofascial Trigger Points. (Simons/Travell/Rubin/Melzack/Reynolds). Archives of Rehabil. Med., 1981. March Issue, 97-117.
Travell,J. & Simons,M. (1984) Myofascial pain and dysfunction - the Trigger Point Manual. Part 1. (Williams & Wilkins, Baltimore & London), 713pp.
Travell,J. & Simons,M. (1985) Myofascial pain and dysfunction - the Trigger Point Manual. Part 2. (Williams & Wilkins, Baltimore & London).
JOURNALS ON AP AND ALLIED FIELDS
AP and Electrotherapeutics Research (Pergamon Press, Oxford, UK).
AP in Medicine (British Medical AP Society, Newton Lane, Lower Whitley, Warrington, Cheshire WA4 4JA
AP Research Quarterly (C.A.R.F. Box 84-223, Taipei, Taiwan).
American J. Acup. (1400 Lost Acre Drive, Felton, California, USA).
American J. Chinese Medicine (Box 555 Garden City, New York, USA).
Bulletin de l'Association Veterinaires Acupuncteurs de France (3 rue Letellier, Paris 75015, France)
Chinese Medical J (English). Guozi Shudian, Box 399 Peking, China.
Internat. J. Chin. Med., 5266 Pomona Blvd., Los Angeles CA 90022, USA.
Lasers in Surgery and Medicine
Scandinavian Journal of AP and Electrotherapy, c/o AP and Pain Research Department, University of
Tampere, Finland. (No longer in print)
AP SUPPLY HOUSES (NEEDLES, BOOKS, EQUIPMENT ETC)
Acumedic, 101-103 Camden High St., London NW1 7JN, UK
John Scarborough & Partners, Orchard Hse, West Bradley, nr Glastonbury, Somerset BA6 8PB, UK
Mayfair Medical Supplies, Rm 501-3, 5/F, Far East Consortium Bldg., 204-206 Nathan Rd., Kowloon, Hong Kong (Fax 852-3-721-2851)
Concepts of TCM are based on a philosophy of Yin-Yang (balance of opposite forces), Five Phases (anabolic and catabolic relationships between 5 primitive types), a balance between humans and nature, the Six External Evils (causing disease by attack from the outside), the Seven Emotions (imbalance of which causes psychosomatic disease) and the Eight Principles of classifying disease (Yang-Yin; Excess/Deficient; External/Internal; Hot/Cold).
The concept of Qi (vital energy) flowing in the superficial and deep Channels in a diurnal cycle is central to AP. Imbalance of Qi (excess, deficiency or blockage) is the cause of disease. In disease, the AP points related to the affected parts show abnormal Qi, manifested by hyper- or hypo-sensitivity to palpation and electrical current. Detection of these abnormal points has diagnostic and therapeutic value. Diagnosis is further aided by the 4 traditional methods (looking, listening, smelling, touch, including the taking of the "Chinese pulses"). The aim of all methods of TCM is to restore the normal balance and/or flow of Qi, This may involve dietary, physical, medical, surgical and psychological methods. AP is a relatively small part of TCM.
Western concepts of AP mechanisms: Examples of diagnostic and therapeutic aspects of AP were discussed. The neuroendocrine system is the basis of AP mechanisms. Supraspinal, segmental and intersegmental reflexes (viscero- visceral, somatic and cutaneous; somato- visceral, somatic and cutaneous, cutaneo- visceral, somatic and cutaneous) are involved. AP has diagnostic and therapeutic value via these reflexes. Adequate stimulation of the correct AP points activates autonomic, humoral and neuroendocrine functions. The therapeutic effects of AP can occur only if the natural defence/healing systems can be activated (autonomic effects, immune response, antiinflammatory effects, endorphin release etc). If there is no possibility of natural responses (e.g. in severed spinal cord or severely fibrotic kidneys), AP can not substantially improve the situation.
Methods of choosing AP points are based on many Laws of TCM, the most important of which is the combination of local points, AhShi points and distant points on Channels passing through the affected area. In Western concepts this is translated into choosing points in the same nerve segment, TPs and points in nerve segments related by intersegmental reflex.
Today, computer databases makes frequency citation analysis possible. This allows computer ranking of points from many reference sources, so that prescriptions can be generated from the top 6 or 7 points in order of ranked scores. This is very useful to those whose study of AP is still in the early stages.
GV26 (the philtrum point) is excellent in emergencies and first aid. TPs, local points and points such as LI11 (in forelimb problems), BL23,40 (in lumbar and hindlimb problems) and GB34 (in hindlimb problems) are very useful in treating myofascial, musculoskeletal and vertebral disc problems. Points useful in obstetrics include animal GV03 (BaiHui, lumbosacral space), GV02 (WeiKen, sacrococcygeal space) and BL22-30 (paravertebral area from L2-S4). Some of those points may be combined with SP06 and one or two points from the low abdomen (such as ST29, CV04, SP13, KI01) to treat problems of the reproductive system and its functions.
It is very important to identify and treat TPs in myofascial and musculoskeletal problems and in some problems of the internal organs. Reflex tenderness of paravertebral (Shu (BL Associated)) points and thoracoabdominal (Mu (Alarm)) points has diagnostic value.
Advantages and disadvantages of AP analgesia (APA) for surgery were discussed. APA is unlikely to replace safe, fast, effective drug anaesthesia. However, in severely toxic patients and in caesarian section where the pups are very valuable, APA has a role. It also has a role in national/international disasters such as large-scale warfare, where drugs may be in short supply.
The most practical methods of AP stimulation for busy practitioners are the methods of point-injection, simple- or electro- AP, TENS and ultrasound. Although LLLT has applications as a local stimulant in local superficial problems, it can not be recommended as a complete replacement for needles at this time. The higher the power output, the more likely LLLT is to replace the needle, i.e. lasers of 20-50 mw/cm2 are more likely to be useful as needle replacements than those of 1-5 mw/cm2.
Some possibilities for further training were discussed; you are strongly recommended to join IVAS, irrespective of your degree of AP expertise. IVAS can help beginners to learn but it also wishes to learn from expert practitioners.
For those with the motivation to study the traditional methods, the rewards are great: new insights into philosophy, especially the philosophy of health and healing; a special bond of friendship with like-minded colleagues; a superior success rate in the use of AP in clinical practice or research.
However, many vets in busy practice and who have families, mortgages and heavy social commitments may be unable to spend the time, energy, and money needed to study AP in depth along strictly traditional lines. It is possible for such people to obtain good to excellent results with AP without an in-depth study of the method, provided certain minima are observed:
1. Reasonable study of the more important AP points and laws;;
2. Study of the use of TPs;
3. Use of a very comprehensive AP cookbook or access to a computerised database;
4. Restriction to single-symptom conditions.
Though beginners can expect good results in many simple conditions, practitioners who have not studied AP in depth can not expect good results in multi-symptom conditions. Inadequately trained practitioners may bring themselves and the AP system into disrepute if they attempt to use AP as the sole therapy in complex cases.
ACKNOWLEDGEMENTS
I thank Shelly Altman (North Hollywood, CA, USA), David Jagger (Boulder, CO, USA), Luc Janssens (Wilryk, Belgium) and Jen-Hsou Lin (Taipei, Taiwan) for their comments and corrections of an early draft of this paper and colleagues in many countries, especially those named in the text for sharing their experiences of AP with me.
REFERENCES
BASIC HUMAN TEXTS
Anon (1993) Essentials of Chinese AP. (Coll. Trad. Chin. Med., Beijing, Shanghai, Nanking) Foreign Languages Press, Beijing. 432pp.
Anon (1974) The Barefoot Doctor's Manual. Running Press, Philadelphia. 948pp.
Anon (1975) Newest illustrations of the AP points (Charts and Booklet). Medicine and Health Publishers, Hongkong.
Anon (1977) Basic AP: a scientific interpretation and application. Chinese Acup. Res. Foundation, Box 84-223, Taipei, Taiwan.
Austin,M. (1974) AP therapy. Turnstone Books, London, 290pp.
Chan,W.W., Lin,J.H. & Rogers,P.A.M. (1996) A review of AP therapy of canine paralysis and lameness. Veterinary Bulletin, In Press.
Cheng Xinnong et al (1987) Chinese AP and Moxibustion. Foreign Languages Press, Beijing. 432pp.
Chung,C. (1983) The AH SHIH Point. Illustrated guide to clinical AP (Chen Kwan Books, 5-2, 1F, Chung Ching South Road, Section 3, Taipei, Taiwan), 212pp.
Connolly,D. (1979) Traditional AP: The Law of the Five Elements. Centre for Trad. AP. American City Bldg. Columbia, Maryland 21044, 197pp.
Ellis,A., Wiseman,N. & Ross,K. (1989) Grasping the Wind. Paradigm Publications, Brookline, Massachusetts, 462 pp.
Lee,J.F. & Cheung,C.S. (1978) Current AP Therapy. Med. Interflow Publ. House, Hong Kong, 408pp.
O'Connor,J. & Bensky,D. (1983) AP: A Comprehensive Text. Shanghai College of Trad. Med. (Eastland Press, Chicago), 750pp.
Oleson,T.D., Kroening,R.J. & Bressler,D. (1980) An experimental evaluation of auricular diagnosis. Pain, 8, 217-.
Overview. Proceedings of the 1979 Symposia on AP and Moxibustion, Peking. Abstracts of 534 papers. 517pp. Available (in English) from East Asia Books, 103 Camden High Street., London.
Pontinen,P. (1982) AP Seminar for Swedish Physicians (contact: AP and Pain Research Department, University of Tampere, Finland).
Ulett,G. (1982) Principles and practice of physiological AP. (Warren Green Inc., 8356 Olive Blvd., Missouri 63132), 220pp.
Wu Wei Ping (1973) Chinese AP. Health Science Press, Wellingborough, Northants, UK, 181pp.
TEXTS ON VET AP
Altman,S. (1981) AP for animals (c/o 5647 Wilkinson Ave., North Hollywood, CA 91607, USA, 281pp.
Blakely,C.S. (1985) AP in gastric torsion in dogs. Vet AP Newsletter, 11, January-March, p. 34.
Brunner,F. (1980) AP der klein Tiere (German). (WBV Biologisch Med. Verlag, Ipweg 5, D4070 Schorndorf, Germany, 320pp.
Gilchrist,D. (1981) Manual of AP for small animals. Also: Greyhound AP (1984) Published privately, c/o 219 Byrnes Street, Mareeba, Australia, 4880.
Janssens,L., Altman,S. & Rogers,P.A,M. (1979) Respiratory and cardiac arrest under general anaesthesia: treatment by AP of the nasal philtrum. Vet. Rec., 105, 273-.
Janssens,L. (1984) Atlas of the AP points and Channels in the dog (c/o Oudestraat 37, Wilrijk 2610, Antwerp, Belgium).
Janssens,L. (1984) Treatment of disc disease and arthritis in dogs. Also trigger points and myofascial syndromes in dogs. AP Training Seminar, Vet School, Gent (Antwerp) Belgium, 289pp and 1983 VMSAC, October, 1580-.
Janssens,L.A.A. (1987) Myofascial pain syndromes in dogs: the treatment of TPs. In: Some aspects of small animal AP the clinical scientific approach. (Chapter 13 of the Belgian Vet AP Society Manual).
Klide,A. & Kung,S. (1977) Vet AP (Univ Pennsylvania Press, Philadelphia), 297pp.
Kothbauer,0. (1983) AP in the ox, horse and pig (in German). (WBV Biologisch Verlag, Ipweg 5, Schorndorf D4070, Germany).
Lin,J.H. & Rogers,P.A.M. (1980) AP Effects on the Body's Defence Systems: A Vet Review. Vet. Bulletin, 50, 633-.
Proceedings of IVAS Congresses and Seminars. Contact: IVAS, c/o David Jagger, 5139 Sugarloaf Rd., Boulder, CO 80302-9217, USA (Fax: 1-303-449-8312).
Rogers,P.A.M. (1977) Revival in collapse, shock, respiratory failure and narcotic overdose. Vet. Rec., 101, 215.
Rogers,P.A.M., White, S.S. & Ottaway, C.W. (1977) Stimulation of AP Points re. Analgesia & Therapy of Clinical Disorders in Animals. Vet. Annual, 17, 258-.
Rogers,P.A.M. & Bossy, J. (1981) Activation of the Defence systems in Animals and Man by AP and Moxibustion. Acup. Res. Quarterly (Taiwan), 5, 47-.
Rogers,P.A.M. (1991) AP for immune mediated disorders. In: AP in Animals, Proceedings 167, Postgraduate Committee in Veterinary Science, University of Sydney. pp 124-142.
Rubin,M. (1976) Manuel d'AP Veterinaire pratique moderne. Maloine Publishers, Paris, 85pp (in French).
Schoen,A.M. (1984) Re: treatment of arthrosis in dogs. Vet. AP. Congress, Gent, Antwerp, 289pp.
Westermayer,E. (1980) Treatment of Horses by AP. Health Science Press, Holsworthy. Devon, UK, 90pp.
Westermayer,E. (1978) Atlas of AP for cattle. WBV Biologisch Verlag, Ipweg 5, Schorndorf, Germany, 60pp.
White,S.S. (1984) Electro-AP in Vet. Med. Chinese Materials Centre, San Francisco. 122 pages.
Grady-Young,H. (1979) Personal communication on gold bead implantation in hip dysplasia.
TEXTS ON AP ANALGESIA IN SMALL ANIMALS
Anon (1974) The Principles and practical use of AA. Medicine and Health Publishing Co., Hong Kong, 325pp.
Arambarri,R. et al (1975) EAA in vet surgery. Revue Med. Vet. 126, 1231-1236.
Ishizaki,S. et al (1977) EAA in high risk dogs. Jap. J. vet. Anaesth., No 8. 21-28 and World APCongress, Paris Summer, 1978.
Kadono,H., et al. (1977) EEG during EAA in the dog. Jap. J. Vet. Sci., 39, 539-547.
Kitazawa,K., et al. (1975) Experimental studies on EAA in the dog. Proc. 20th World Vet Congress,
Thessaloniki, 1657-1658 and (1975) Studies on EAA in the dog; confirmation of the effect. Jap. J. vet. Anaesth., No. 6, 7-14.
Klide,A.M. & Kung,A.H. (1977) Vet AP. University of Pennsylvania Press, Philadelphia.
Lambardt,A. (1975) AA versuche bei katzen. Der Prakt, Tierarzt, 1/1975, 33-36.
Lynd,F.T. (1975) AP analgesia investigations in animals. Internal report, Department of Laboratory Animal Medicine, Medical School, University of Texas, San Antonio, Texas 78283. 5 pages.
Niboyet,J.E.H. et al. (1973) L'anaesthesie par l'AP. Maisonneuve, 433pp.
O'Boyle,M.A. & Vajda,G.K. (1975) AA for abdominal surgery. Mod. Vet. Pract., 56, 705-707.
Ralston,N.C. & Ralston,B.L. (1978) AA for cystotomy surgery in a dog. Amer. J. Acup., 6, 75-76.
Zhou,Y.C. (1984) (Re lasers as an analgesic in oro-facial surgery and dentistry). Lasers in surgery and medicine, 4, 297-
TEXTS ON TP AND SCAR THERAPY
Chung,C. (1983) The AH SHIH Point. (Chen Kwan Books, 5-2, 1F, Chung Ching South Road, Section 3, Taipei, Taiwan), 212pp.
Dorrigo,B. et al (1979) Fibrositic myofascial pain in intermittent claudication. Effect of anaesthetic block of TPs on exercise tolerance. Pain, 6, 183-.
Fox,W.W. (1975) Arthritis and allied conditions: a new and successful approach. Ranelagh Press, South Hill Park, London.
Huneke,F. (1961) Das sekunden phanomen (the instantaneous phenomenon). Karl F. Haug Verlag, Ulm, Germany (in German).
Kajdos,V. (1974) Neural therapy: its possibilities in everyday practice. Amer. J. Acup. 2, 113.
Kellgren,J.H. (1939-42) On the distribution of pain arising from deep somatic structures with charts of segmental pain areas. Clinical Science, 4, 35-.
Khoe,W.H. (1979) Scar injection in AP. Amer. J. Acup., 7, 15.
Lewit,Karel (1979) The needle effect in relief of myofascial pain. Pain, 6, 83-.
Malzack,R. et al (1977) TPs and AP points for pain: correlations and implications. Pain, 3, 3-.
MacDonald,A. (1983) Trigger mechanisms and myofascial pain. III Nordic Congress on AP, May 1983.
Also: Annals Roy. Coll. Surg. Eng. (1983), 65, 44-.
Moss,L. (1972) AP and you. Paul Elek Books, London.
Pontinen,P. (1982) AP Seminar for Swedish Physicians (contact: AP and Pain Research Dept., Tampere University, Finland).
Rogers,C. (1982) AP therapy for post-operative scars. Amer. J. Acup., 10, 201-.
Symposium on Myofascial Trigger Points. (Simons/Travell/Rubin/Melzack/Reynolds). Archives of Rehabil. Med., 1981. March Issue, 97-117.
Travell,J. & Simons,M. (1984) Myofascial pain and dysfunction - the Trigger Point Manual. Part 1. (Williams & Wilkins, Baltimore & London), 713pp.
Travell,J. & Simons,M. (1985) Myofascial pain and dysfunction - the Trigger Point Manual. Part 2. (Williams & Wilkins, Baltimore & London).
JOURNALS ON AP AND ALLIED FIELDS
AP and Electrotherapeutics Research (Pergamon Press, Oxford, UK).
AP in Medicine (British Medical AP Society, Newton Lane, Lower Whitley, Warrington, Cheshire WA4 4JA
AP Research Quarterly (C.A.R.F. Box 84-223, Taipei, Taiwan).
American J. Acup. (1400 Lost Acre Drive, Felton, California, USA).
American J. Chinese Medicine (Box 555 Garden City, New York, USA).
Bulletin de l'Association Veterinaires Acupuncteurs de France (3 rue Letellier, Paris 75015, France)
Chinese Medical J (English). Guozi Shudian, Box 399 Peking, China.
Internat. J. Chin. Med., 5266 Pomona Blvd., Los Angeles CA 90022, USA.
Lasers in Surgery and Medicine
Scandinavian Journal of AP and Electrotherapy, c/o AP and Pain Research Department, University of
Tampere, Finland. (No longer in print)
AP SUPPLY HOUSES (NEEDLES, BOOKS, EQUIPMENT ETC)
Acumedic, 101-103 Camden High St., London NW1 7JN, UK
John Scarborough & Partners, Orchard Hse, West Bradley, nr Glastonbury, Somerset BA6 8PB, UK
Mayfair Medical Supplies, Rm 501-3, 5/F, Far East Consortium Bldg., 204-206 Nathan Rd., Kowloon, Hong Kong (Fax 852-3-721-2851)
All material © New York Complementary & Alternative Veterinary Medical Association 2026.