Treatment of Backpain in the Horse and Dog by Acupuncture
Philip A.M. Rogers MRCVS
Nordic Acupuncture Congress, Oslo, Norway, September 1987
Nordic Acupuncture Congress, Oslo, Norway, September 1987
ABSTRACT
Backpain may be primary, secondary, or as part of a generalised disorder. Depending on the cause, nature and duration, 70-90% of cases in horses and dogs respond to acupuncture (AP) therapy. In practice, it is difficult to make a specific diagnosis of the cause of backpain, especially in horses, due to the difficulty of routine X-ray and myelography. The general practitioner may be satisfied with clinical remission. In hospitalised dogs, AP is successful in treating post-operative pain and complications. It can be successful also in backpain which has not responded to surgery.
AP therapy is by stimulation of relevant reflex points in the skin and muscles. Points of tenderness to palpation are important. They are equivalent to human Trigger Points (TPs) or AHSHI points. Stimulation is given to the TPs, paravertebral (SHU) points, and points related to specific areas, organs or functions, e.g. local and distant points on meridians through affected areas.
AP points are located in dogs by transposition from human AP. Those in horses are located in the same way, with some adjustment for 18 ribs, 6 lumbar vertebrae and digital anatomy, or by reference to traditional horse AP texts. The choice of points to treat backpain in horses and dogs is similar to that outlined in humans (Paper 1). In animals, the position of PAIHUI is in the lumbo-sacral space, not on the head, as in humans. The combination of TPs, PAIHUI, BL23, 26, 30, 54, 60, GB30, 34, covers most backpain below the ribs, including radiating sciatic pain. The combination of TPs, BL13, 16, 21, TH15, SI 9 covers most thoracic backpain. The combination of TPs, GB20, 21, TH15, CO17, ST38 (or GB34) covers most neck pain. Other useful points are: PAIHUI (all problems below the ribs); BL11 (joints); BL23 (bones); BL16 (spinal column); GB34 (muscles).
Simple needling (for 20 minutes every 1-3 days in acute cases or every 3-7 days in chronic cases) is the classical method. Electro-needling is also used. Point injection is effective and faster.
Most responsive cases improve after 1-3 sessions but chronic cases may need 1-10+ sessions.
Other methods of point selection (Earpoints, Hoofpoints etc) and of stimul-ation (Dermojet, staples, implants, magnets, LASER, ultrasound etc) must be regarded as experimental at this time.
INTRODUCTION
Backpain may be primary (paravertebral muscle pain, thoracolumbar disc disease, vertebral, sacroiliac or arthrotic), secondary (referred from irritation of thoracic or abdominal organs), or as part of a generalised disorder (nutritional muscular dystrophy in deficiency of Vit E-Se; myositis in azoturia).
Animals used for competitive sports (racing, jumping, polo etc) or for active work (draught animals, hunting dogs etc) need to be physically fit. For top performance, they rely heavily on the musculo-skeletal system. In particular, they need full flexion and extension of the paravertebral musc-les for maximum stride and speed and to enable them to run around corners.
Owners request acupuncture (AP) for two main reasons: (a) the animal is visibly lame or some other signs of pain or stiffness (aggression, reluctance to be saddled, mounted or handled over the back; rigidity of the back; running wide on bends etc) are present or (b) the competitive performance has fallen off gradually or suddenly. In both cases, other forms of therapy usually have been tried without much success before AP is considered.
This paper deals with the clinical assessment and AP therapy of backpain in horses and dogs. It includes some examples of limb lameness, where this is associated with irritation of the vertebral nerves. Most of the data are from named experts but some of my own cases are included.
THE BASICS OF ANIMAL ACUPUNCTURE
Irritation of the thoracic or abdominal organs can refer pain to related skin and muscle segments, especially in the paravertebral area. This can establish Trigger Points (TPs), as detailed by Travell and Simons (1984) and in the TP Therapy Symposium (1981). Long after the visceral pain has gone, the TPs can remain active. Unless TPs in the thoraco-sacral muscles are 'removed' by AP or other physiotherapy, the function of the back muscles is impaired and performance is impaired. In human AP, the AHSHI point is defined as a point, usually in muscle, which is tender on palpation. AHSHI means Ouch! or Ah Yes! There are two kinds of AHSHI points: those from which palpation elicits only local tenderness and those which radiate pain to the problem area (the area in which the patient complains of pain). The latter type is the true TP of western medicine. In animals, however, it is not possible to distinguish between real TPs and AHSHI points which are just tender locally. In practice, this distinction is unnecessary- the tender point is the most important point in AP therapy and AHSHI points are taken to be TPs.
REFERRED PAIN: Hindlimb lameness is often due to pain referred from thoraco-lumbar or lumbo-sacral nerves, as in sciatica in humans. It may arise also in pain referred from abdominal viscera, such as in a painful kidney, ovary, uterus or colon. Forelimb lameness may arise in pain referred from cervical or upper thoracic nerves or from pain in thoracic organs (lung, pericardium, heart). Thus, neck- and back-pain often manifest as lameness in the fore- or hind- limb.
In human AP, the paravertebral SHU (reflex points for all major thoracic and abdominal organs) are located on the inner line of the bladder (BL) meridian as follows:
Lung (LU), Pericardium (HC), Heart (HE), Governor Vessel (VG), Diaphragm = BL13 to 17, in area T3 to T7 respectively; Liver (LI), Gallbladder (GB), Spleen-pancreas (SP), Stomach (ST) =BL18 to 21, in area T9 to T12 respectively; Triple Heater (TH), Kidney(KI), CHIHAISHU, COLON (CO), KUANYUANSHU = BL22 to 26, in area L1 to L5 respectively; Small intestine (SI), Bladder (BL), CHUNGLUSHU, PAIHUANSHU = BL27 to 30, in area S1 to S4 respectively. These points have diagnostic value (when tender). They help to identify the affected organ. They also have therapeutic value in treating the affectedorgan and local problems near the points. However, local muscle strain or trauma can also cause SHU point tenderness. Thus, SHU point tenderness need not always indicate disorders of the related organs. The outer line of paravertebral BL points (BL36 to 49) have similar functions to the related points on the inner line.
AP points are located in dogs by transposition from human AP. Janssens (1984) has prepared an atlas of the points in dogs. The points in horses are located in the same way, with some adjustment for 18 ribs, 6 lumbar vertebrae and digital anatomy, or by reference to traditional horse AP texts. Fuller details of animal AP (points, methods of therapy) are given elsewhere (Rogers 1987a, b).
ASSESSMENT OF HORSES AND DOGS BEFORE TREATMENT
A complete history is taken, together with any findings of previous investigations. In the clinical examination, attention is paid to any lesions or signs related to all major systems or functions. One tries to identify the primary problem(s) and the location(s) of pain.
It is essential to probe or palpate the muscles from head to tail, to locate any TPs. Particular attention is paid to the paravertebral muscles and the large muscles of the neck and limbs. The joints and tendons are also palpated. Animals with signs of pain, stiffness or lameness are seldom free of TPs. Their detection is indicated by an attempt to bite, kick, or avoid the palpation or by yielding to the pressure, or by vocalising.
TPs may occur almost anywhere in muscle. Scars may also act as TPs. TPs in the paravertebral area correspond with SHU points. For example, virus infection of the respiratory tract in horses can increase the fragility of capillaries and small bloodvessels. An affected horse may rupture small vessels in the lung or upper respiratory tract at full gallop, especially in a long race. Such horses are called Bleeders. The condition is a common cause of poor racing performance and often shows up as a sudden loss of speed on the run home. The condition may last for months or years. Most bleeders are tender to palpation of the reflex areas of the lung (BL13 and the area behind the posterior edge of the scapula). They may be tender also on the Diaphragm and Liver points (BL17, 18), which are related to haemorrhage and prothrombin (Fig. 15). As the saddle sits over those areas, such horses may resent being saddled, or may be troublesome when mounted. Horses with kidney or ovary problems may be touchy in the area L1 to L3 (BL22-24). The key reflex point for the ovary and kidney is BL23.
In mares and fillies, sporadic lameness (hindquarter, hunched or rigid back and, occasionally, forelimb lameness) which may be severe can arise due to referred pain from ovarian or uterine irritation. Check for TPs related to the ovary and uterus (see section 1.5 below).
Be careful to check for DIAGONAL relationships. Cain stresses that forelimb lameness is often accompanied by tenderness at contralateral lumbo-sacral or hind-limb points. Also, hindlimb lameness is sometimes associated with TPs on the contralateral side of the neck.
Be careful to check the paravertebral SHU points in relation to the location of limb pathology, for instance BL25 (lumbar 4-5, large intestine SHU) in medial forelimb lameness and BL21 (behind last rib, stomach SHU) in antero-lateral hindlimb lameness etc.
In all local problems (neck, shoulder, elbow, back, thoraco-lumbar, lumbo- sacral, hip, stifle, laminitis etc), the TPs must be found. They are recorded and clipped (in horses) as they are located. This helps rapid reassessment of the case on later visits. It also makes it easy for the handler to locate them for heavy massage or other physiotherapy (ultraound, LASER etc) between AP sessions.
CHOICE OF POINTS IN AP THERAPY
Rogers 1987 lists the methods of choosing points for the treatment of human backpain. Similar points and reasoning are used in animals. The points depend on the organs and parts involved. The most common combination of points is: all TPs, plus 1-2 LOCAL points (near the affected organ or part), plus 1-2 DISTANT points on meridians passing through, near or related to the affected parts. If an organ is thought to be involved, its SHU point is used, whether tender or not. To this can be added the MU (abdominal alarm) point.
In low-backpain patients, GB30, 34 and BL54, 60 are useful distant points. In animals, the lumbo-sacral space is called PAIHUI. (In humans, PAIHUI (VG20) is on the top of the head).
The combination of TPs, PAIHUI, BL23, 26, 30, 54, 60, GB30, 34, covers most backpain below the ribs, including radiating sciatic pain. The combination of TPs, BL13, 16, 21, TH15, SI 9 covers most thoracic backpain. The combination of TPs, GB20, 21, TH15, CO17, ST38 (or GB34) covers most neck pain.
Other useful points are:
PAIHUI (all problems below the ribs); BL11 (joints); BL16 (spinal column); CO 4 (forelimb & general effects); BL21, ST36 (hindlimb, appetite and general effects); ST44 (hindlimb); TH 5 (forelimb); GB34 (hindlimb, muscles, tendons, neck, shoulder and elbow); BL23 (lumbo- sacral and hindlimb; adrenal point, stress conditions; ovary/kidney/Vitamin D/para-
thyroid/bone point and general effects).
However, many point combinations are possible. Examples of these are given below and the locations are shown in attached figures.
METHODS USED IN AP THERAPY
Simple needling: In horses, special AP needles or hypodermic needles 19-26 gauge, 2-6 inches long are used. In dogs, human AP needles or hypodermic needles 26-30 gauge, 0.5-2 inches long are used. Sterile needles are inserted into the points. Cleansing of the skin before insertion of the needle is a cosmetic exercise unless the skin is wet or visibly dirty. The needles are left in situ for 20 minutes. Twirling and pecking of the needle is done every few minutes. Cases are treated at intervals of 1 - 2 days in acute or 3 - 7 days in chronic cases. Acute cases may require 1 to 3+ sessions to recovery. Chronic cases may need 1 to 10+ sessions.
Electroneedling: Needles are inserted as usual. Output leads from special electrostimulators are used to deliver electrical stimuli to the needles. Session length and intervals between sessions are as for simple needling. An advantage claimed for electro-AP is that it requires fewer sessions. This, however, is doubtful. Strong, painful needle manipulation is as good as electro-AP, but electro-AP leaves the operator free to talk, take notes etc. In cases of paralysis and in severe pain, electro-AP may be better than simple needling. White suggests electro-AP treatment every 12-24 hours in acute cases with severe pain or paralysis. Electro-AP is also the usual method used to obtain AP analgesia for surgery in animals.
Point injection: This is an effective, rapid and safe method in horses and dogs. It is very useful in busy practice. In horses, 1-5 ml is injected at each point; in dogs, .5-1.5 ml. The solution may be .5-1.0% procaine in saline, saline alone, saline-B12, Impletol, homoeopathic solutions etc. Choice of solution depends on practitioner preference- all methods are used. Point injection also allows the use of drug-therapy, when needed. The Dermojet (high-pressure skin injector) is also used.
Massage: It shortens recovery time if animal handlers are shown the techniques of massage. TPs and other important AP points can be marked or clipped. Massage for 2 minutes/point every 1-2 days between AP sessions is very useful. In the horse, I demonstrate massage by fist-pounding to the horse's tolerance. In the dog, I demonstrate deep massage with the thumbs (for spinal areas) or other methods for limb muscles.
Ultrasound: Standard equipment may be used. Different probes are available for diifferent parts- body surface, orifices etc. A contact jelly is essential. Output is .25-1.0 watts. Time 15-60 seconds/point. The method is painless and non-invasive but is not as well documented as the needling or injection methods.
LASER: Low power laser (1-5 mW) and higher power (5-10 mW) has been used in horses and dogs instead of needling. Three types are common: He-Ne (632 nm wavelength), infrared (902 nm) and diode lacers (not true laser light). Laser is painless and non-invasive but its penetration is shallow. It is not possible to assess laser effectiveness at this time.
Some users report excellent results (for instance Martin and Klide 1987) in backpain in the horse but others say the laser is not as good as needling. All agree that laser is excellent for local (superficial) problems, such as septic wounds, tendonitis, granulomas, ulcers, eye problems etc. It may be useful in Earpoint AP. However, at this time, Earpoint AP is also not as well documented as classical AP and TP therapy.
Implants: Skin staples, implant of sutures, platinum-, gold- or surgical beads or wire can be used to stimulate the AP points. Klide has used implants effectively to control epilepsy in dogs. Cain has used them to control nervousness in fillies. Others have used them in backpain and other conditions. They are very effective (implants around the acetabulum) in treating hip dysplasia in dogs. However, the method needs more documentation before acceptance as a routine procedure.
Backpain may be primary, secondary, or as part of a generalised disorder. Depending on the cause, nature and duration, 70-90% of cases in horses and dogs respond to acupuncture (AP) therapy. In practice, it is difficult to make a specific diagnosis of the cause of backpain, especially in horses, due to the difficulty of routine X-ray and myelography. The general practitioner may be satisfied with clinical remission. In hospitalised dogs, AP is successful in treating post-operative pain and complications. It can be successful also in backpain which has not responded to surgery.
AP therapy is by stimulation of relevant reflex points in the skin and muscles. Points of tenderness to palpation are important. They are equivalent to human Trigger Points (TPs) or AHSHI points. Stimulation is given to the TPs, paravertebral (SHU) points, and points related to specific areas, organs or functions, e.g. local and distant points on meridians through affected areas.
AP points are located in dogs by transposition from human AP. Those in horses are located in the same way, with some adjustment for 18 ribs, 6 lumbar vertebrae and digital anatomy, or by reference to traditional horse AP texts. The choice of points to treat backpain in horses and dogs is similar to that outlined in humans (Paper 1). In animals, the position of PAIHUI is in the lumbo-sacral space, not on the head, as in humans. The combination of TPs, PAIHUI, BL23, 26, 30, 54, 60, GB30, 34, covers most backpain below the ribs, including radiating sciatic pain. The combination of TPs, BL13, 16, 21, TH15, SI 9 covers most thoracic backpain. The combination of TPs, GB20, 21, TH15, CO17, ST38 (or GB34) covers most neck pain. Other useful points are: PAIHUI (all problems below the ribs); BL11 (joints); BL23 (bones); BL16 (spinal column); GB34 (muscles).
Simple needling (for 20 minutes every 1-3 days in acute cases or every 3-7 days in chronic cases) is the classical method. Electro-needling is also used. Point injection is effective and faster.
Most responsive cases improve after 1-3 sessions but chronic cases may need 1-10+ sessions.
Other methods of point selection (Earpoints, Hoofpoints etc) and of stimul-ation (Dermojet, staples, implants, magnets, LASER, ultrasound etc) must be regarded as experimental at this time.
INTRODUCTION
Backpain may be primary (paravertebral muscle pain, thoracolumbar disc disease, vertebral, sacroiliac or arthrotic), secondary (referred from irritation of thoracic or abdominal organs), or as part of a generalised disorder (nutritional muscular dystrophy in deficiency of Vit E-Se; myositis in azoturia).
Animals used for competitive sports (racing, jumping, polo etc) or for active work (draught animals, hunting dogs etc) need to be physically fit. For top performance, they rely heavily on the musculo-skeletal system. In particular, they need full flexion and extension of the paravertebral musc-les for maximum stride and speed and to enable them to run around corners.
Owners request acupuncture (AP) for two main reasons: (a) the animal is visibly lame or some other signs of pain or stiffness (aggression, reluctance to be saddled, mounted or handled over the back; rigidity of the back; running wide on bends etc) are present or (b) the competitive performance has fallen off gradually or suddenly. In both cases, other forms of therapy usually have been tried without much success before AP is considered.
This paper deals with the clinical assessment and AP therapy of backpain in horses and dogs. It includes some examples of limb lameness, where this is associated with irritation of the vertebral nerves. Most of the data are from named experts but some of my own cases are included.
THE BASICS OF ANIMAL ACUPUNCTURE
Irritation of the thoracic or abdominal organs can refer pain to related skin and muscle segments, especially in the paravertebral area. This can establish Trigger Points (TPs), as detailed by Travell and Simons (1984) and in the TP Therapy Symposium (1981). Long after the visceral pain has gone, the TPs can remain active. Unless TPs in the thoraco-sacral muscles are 'removed' by AP or other physiotherapy, the function of the back muscles is impaired and performance is impaired. In human AP, the AHSHI point is defined as a point, usually in muscle, which is tender on palpation. AHSHI means Ouch! or Ah Yes! There are two kinds of AHSHI points: those from which palpation elicits only local tenderness and those which radiate pain to the problem area (the area in which the patient complains of pain). The latter type is the true TP of western medicine. In animals, however, it is not possible to distinguish between real TPs and AHSHI points which are just tender locally. In practice, this distinction is unnecessary- the tender point is the most important point in AP therapy and AHSHI points are taken to be TPs.
REFERRED PAIN: Hindlimb lameness is often due to pain referred from thoraco-lumbar or lumbo-sacral nerves, as in sciatica in humans. It may arise also in pain referred from abdominal viscera, such as in a painful kidney, ovary, uterus or colon. Forelimb lameness may arise in pain referred from cervical or upper thoracic nerves or from pain in thoracic organs (lung, pericardium, heart). Thus, neck- and back-pain often manifest as lameness in the fore- or hind- limb.
In human AP, the paravertebral SHU (reflex points for all major thoracic and abdominal organs) are located on the inner line of the bladder (BL) meridian as follows:
Lung (LU), Pericardium (HC), Heart (HE), Governor Vessel (VG), Diaphragm = BL13 to 17, in area T3 to T7 respectively; Liver (LI), Gallbladder (GB), Spleen-pancreas (SP), Stomach (ST) =BL18 to 21, in area T9 to T12 respectively; Triple Heater (TH), Kidney(KI), CHIHAISHU, COLON (CO), KUANYUANSHU = BL22 to 26, in area L1 to L5 respectively; Small intestine (SI), Bladder (BL), CHUNGLUSHU, PAIHUANSHU = BL27 to 30, in area S1 to S4 respectively. These points have diagnostic value (when tender). They help to identify the affected organ. They also have therapeutic value in treating the affectedorgan and local problems near the points. However, local muscle strain or trauma can also cause SHU point tenderness. Thus, SHU point tenderness need not always indicate disorders of the related organs. The outer line of paravertebral BL points (BL36 to 49) have similar functions to the related points on the inner line.
AP points are located in dogs by transposition from human AP. Janssens (1984) has prepared an atlas of the points in dogs. The points in horses are located in the same way, with some adjustment for 18 ribs, 6 lumbar vertebrae and digital anatomy, or by reference to traditional horse AP texts. Fuller details of animal AP (points, methods of therapy) are given elsewhere (Rogers 1987a, b).
ASSESSMENT OF HORSES AND DOGS BEFORE TREATMENT
A complete history is taken, together with any findings of previous investigations. In the clinical examination, attention is paid to any lesions or signs related to all major systems or functions. One tries to identify the primary problem(s) and the location(s) of pain.
It is essential to probe or palpate the muscles from head to tail, to locate any TPs. Particular attention is paid to the paravertebral muscles and the large muscles of the neck and limbs. The joints and tendons are also palpated. Animals with signs of pain, stiffness or lameness are seldom free of TPs. Their detection is indicated by an attempt to bite, kick, or avoid the palpation or by yielding to the pressure, or by vocalising.
TPs may occur almost anywhere in muscle. Scars may also act as TPs. TPs in the paravertebral area correspond with SHU points. For example, virus infection of the respiratory tract in horses can increase the fragility of capillaries and small bloodvessels. An affected horse may rupture small vessels in the lung or upper respiratory tract at full gallop, especially in a long race. Such horses are called Bleeders. The condition is a common cause of poor racing performance and often shows up as a sudden loss of speed on the run home. The condition may last for months or years. Most bleeders are tender to palpation of the reflex areas of the lung (BL13 and the area behind the posterior edge of the scapula). They may be tender also on the Diaphragm and Liver points (BL17, 18), which are related to haemorrhage and prothrombin (Fig. 15). As the saddle sits over those areas, such horses may resent being saddled, or may be troublesome when mounted. Horses with kidney or ovary problems may be touchy in the area L1 to L3 (BL22-24). The key reflex point for the ovary and kidney is BL23.
In mares and fillies, sporadic lameness (hindquarter, hunched or rigid back and, occasionally, forelimb lameness) which may be severe can arise due to referred pain from ovarian or uterine irritation. Check for TPs related to the ovary and uterus (see section 1.5 below).
Be careful to check for DIAGONAL relationships. Cain stresses that forelimb lameness is often accompanied by tenderness at contralateral lumbo-sacral or hind-limb points. Also, hindlimb lameness is sometimes associated with TPs on the contralateral side of the neck.
Be careful to check the paravertebral SHU points in relation to the location of limb pathology, for instance BL25 (lumbar 4-5, large intestine SHU) in medial forelimb lameness and BL21 (behind last rib, stomach SHU) in antero-lateral hindlimb lameness etc.
In all local problems (neck, shoulder, elbow, back, thoraco-lumbar, lumbo- sacral, hip, stifle, laminitis etc), the TPs must be found. They are recorded and clipped (in horses) as they are located. This helps rapid reassessment of the case on later visits. It also makes it easy for the handler to locate them for heavy massage or other physiotherapy (ultraound, LASER etc) between AP sessions.
CHOICE OF POINTS IN AP THERAPY
Rogers 1987 lists the methods of choosing points for the treatment of human backpain. Similar points and reasoning are used in animals. The points depend on the organs and parts involved. The most common combination of points is: all TPs, plus 1-2 LOCAL points (near the affected organ or part), plus 1-2 DISTANT points on meridians passing through, near or related to the affected parts. If an organ is thought to be involved, its SHU point is used, whether tender or not. To this can be added the MU (abdominal alarm) point.
In low-backpain patients, GB30, 34 and BL54, 60 are useful distant points. In animals, the lumbo-sacral space is called PAIHUI. (In humans, PAIHUI (VG20) is on the top of the head).
The combination of TPs, PAIHUI, BL23, 26, 30, 54, 60, GB30, 34, covers most backpain below the ribs, including radiating sciatic pain. The combination of TPs, BL13, 16, 21, TH15, SI 9 covers most thoracic backpain. The combination of TPs, GB20, 21, TH15, CO17, ST38 (or GB34) covers most neck pain.
Other useful points are:
PAIHUI (all problems below the ribs); BL11 (joints); BL16 (spinal column); CO 4 (forelimb & general effects); BL21, ST36 (hindlimb, appetite and general effects); ST44 (hindlimb); TH 5 (forelimb); GB34 (hindlimb, muscles, tendons, neck, shoulder and elbow); BL23 (lumbo- sacral and hindlimb; adrenal point, stress conditions; ovary/kidney/Vitamin D/para-
thyroid/bone point and general effects).
However, many point combinations are possible. Examples of these are given below and the locations are shown in attached figures.
METHODS USED IN AP THERAPY
Simple needling: In horses, special AP needles or hypodermic needles 19-26 gauge, 2-6 inches long are used. In dogs, human AP needles or hypodermic needles 26-30 gauge, 0.5-2 inches long are used. Sterile needles are inserted into the points. Cleansing of the skin before insertion of the needle is a cosmetic exercise unless the skin is wet or visibly dirty. The needles are left in situ for 20 minutes. Twirling and pecking of the needle is done every few minutes. Cases are treated at intervals of 1 - 2 days in acute or 3 - 7 days in chronic cases. Acute cases may require 1 to 3+ sessions to recovery. Chronic cases may need 1 to 10+ sessions.
Electroneedling: Needles are inserted as usual. Output leads from special electrostimulators are used to deliver electrical stimuli to the needles. Session length and intervals between sessions are as for simple needling. An advantage claimed for electro-AP is that it requires fewer sessions. This, however, is doubtful. Strong, painful needle manipulation is as good as electro-AP, but electro-AP leaves the operator free to talk, take notes etc. In cases of paralysis and in severe pain, electro-AP may be better than simple needling. White suggests electro-AP treatment every 12-24 hours in acute cases with severe pain or paralysis. Electro-AP is also the usual method used to obtain AP analgesia for surgery in animals.
Point injection: This is an effective, rapid and safe method in horses and dogs. It is very useful in busy practice. In horses, 1-5 ml is injected at each point; in dogs, .5-1.5 ml. The solution may be .5-1.0% procaine in saline, saline alone, saline-B12, Impletol, homoeopathic solutions etc. Choice of solution depends on practitioner preference- all methods are used. Point injection also allows the use of drug-therapy, when needed. The Dermojet (high-pressure skin injector) is also used.
Massage: It shortens recovery time if animal handlers are shown the techniques of massage. TPs and other important AP points can be marked or clipped. Massage for 2 minutes/point every 1-2 days between AP sessions is very useful. In the horse, I demonstrate massage by fist-pounding to the horse's tolerance. In the dog, I demonstrate deep massage with the thumbs (for spinal areas) or other methods for limb muscles.
Ultrasound: Standard equipment may be used. Different probes are available for diifferent parts- body surface, orifices etc. A contact jelly is essential. Output is .25-1.0 watts. Time 15-60 seconds/point. The method is painless and non-invasive but is not as well documented as the needling or injection methods.
LASER: Low power laser (1-5 mW) and higher power (5-10 mW) has been used in horses and dogs instead of needling. Three types are common: He-Ne (632 nm wavelength), infrared (902 nm) and diode lacers (not true laser light). Laser is painless and non-invasive but its penetration is shallow. It is not possible to assess laser effectiveness at this time.
Some users report excellent results (for instance Martin and Klide 1987) in backpain in the horse but others say the laser is not as good as needling. All agree that laser is excellent for local (superficial) problems, such as septic wounds, tendonitis, granulomas, ulcers, eye problems etc. It may be useful in Earpoint AP. However, at this time, Earpoint AP is also not as well documented as classical AP and TP therapy.
Implants: Skin staples, implant of sutures, platinum-, gold- or surgical beads or wire can be used to stimulate the AP points. Klide has used implants effectively to control epilepsy in dogs. Cain has used them to control nervousness in fillies. Others have used them in backpain and other conditions. They are very effective (implants around the acetabulum) in treating hip dysplasia in dogs. However, the method needs more documentation before acceptance as a routine procedure.
EXAMPLES OF AP THERAPY IN HORSES
1.1.1. Soreback (thoracic, lumbar and sacral area)
(Kothbauer; Kuussaari; Klide; Grady-Young; Johnson; White)
Search the back and paravertebral muscles for TPs. If the tail twitches during riding, this indicates pain at BL23 (kidney SHU). Use all TPs. Add PAIHUI and points from BL18 (ICS 15) to BL26 (L 5 to L 6) and BL28, 30 (foramina S 2, 4) or points from BL17 (ICS 14) to BL25 (L 4 to L 5) and BL27, 29 (foramina S 1, 3). Use the more anterior points if the pain is more anterior. Consider also VG12; BL31, 34, 49 and the point at the meeting of the scapula and the anterior edge of the scapular cartilage (TH15, TCVM POCHIEN).
Treatment: injection, simple needling, electro-AP (20 seconds/needle) or LASER. Treat 1-2 times/week (usually every 5 days) for 2 - 10 times. In acute cases, with severe pain or paralysis, treat every 12 - 24 hours. Relapse within 6 months after successful treatment may be 5-50%.
A set formula, used with 87% success by Klide, is:
PAIHUI, BL19 (or 43), 22, 23, 24, 25, 26, 50 (simple needling or injection of 1 ml saline/point). Treat weekly, 7-12 times (Klide 1984, 1987). Point lasering gave a lower success rate (73%) (Martin and Klide 1987) but the difference between AP and Laser may not be significant.
Ly (1977) reported that all 5 horses treated for lumbosacral pain and sciatica recovered. They were treated at PAIHUI, WEIKEN, BL points on the lumbosacral area, GB30 and points along the course of the sciatic nerve. Electro-AP was used, twice/week for 10 sessions. The horses were rested for 3 months before being slowly returned to work.
1.1.2. Saddle-sore: (Grady-Young; Johnson)
Pain in the area of the saddle, is treated similarly. Tenderness near BL18 (liver SHU) may be associated with muddy colour of the eye mucosa -the liver controls the eye in TCVM.
Treatment: all TPs plus BL points, especially BL21, 23, 25.
: inject procaine-B12 (9 ml 1% procaine + 1ml B12 - 3000 units/ml at each point), using 19 g needle, depth 1.5'
(or): needle or electro-AP 20 minutes; 2/week; 2 - 4 times.
1.1.3. Shoulder lameness: (Kuussaari; White)
Few cases relapse after successful treatment.
The main points (Klide and Kung system) are: FL 2, 4, 12, 13, 7 with any TPs located in the neck or scapular-shoulder muscles. These points correspond with points: BL11; GB21; TH14; CO15; SI 9; LU 1 in humans -all of which are key points for shoulder lameness in people.
Treatment is: Electro-AP (10 - 20 seconds per point) or simple needling (20 - 30 minutes), 2 - 6 times (mean 3) at intervals of 3 - 7 days mean 4). White suggests 20 minutes electro-AP every day in acute cases.
1.1.5. Hip and thigh lameness:
The points most effective on the hip and thigh are:
: all TPs in the lumbo-sacral, hip-thigh and posterior thigh ms.
: local points (GB29, 30, 31, 32; BL50, 51, 52; ST31, 32, 33, 34)
: region points (PAIHUI; BL23, 49)
: additional points from GB34, 39
Treat by simple AP, electro-AP or point injection every 3 - 7 days for 1 to 3 times in recent cases and 3 to 8 times in chronic cases.
1.1.6. Stifle lameness: (Jeffries)
Point injection is excellent in 1 to 2 sessions. Walk the horse for 2 days before return to the track. Jeffries uses an American product for injection (Sarapin, containing Vitamin B12 and C). Three ml is injected below the patella, medial and lateral to the patellar tendon at the point HSIYEN (Knee Eyes = ST35) and the point postero-medial to the patellar tendon; ST36 (12 ml); KI10 (5 ml); BL54 (4 ml, 2' deep).
1.5. REPRODUCTIVE PROBLEMS:
The most important points for reproductive disorders and for the genital organs are in the lumbo-sacral area. A simple guide is to imagine the female organs (ovary to vulva) as a straight tube, with the ovaries related to AP points in the area T 18 to L 3 (points such as BL21, 22, 23, BL45, 46, 47; TIANPING; VG 5, 4) and the vulva/anus/perinaeum related to the area S 3 to the tailhead (points such as BL29, 30, 33, 34, 35, 49; VG 1, 2). The other organs (tubes, uterine horn, uterine body, cervix, vagina) are related to intermediate points.
Kothbauer recommends BL22, 23, 47; VG4 for the ovary and BL27, 28, 31; PAIHUI; VC 6 for the uterus. Johnson reports excellent results with these points in cases of uterine atony, metritis, embryonic reabsorption etc.
If one had to remember just 3 points for reproductive/genital disorders, they should be: PAIHUI; BL26 (between transverse wings of L 5 - L 6); BL28 (lateral to sacral foramen 2). There are other points (Fig. 18).
The abdominal meridians include ST, SP, BL, KI, GB, LI, VC, VG. Local points (points nearest the target organs) on ANY of these meridians influence the organs. Although most importance is attached to the VG and BL points (lumbo-sacral area), GB 26 to 28 in the paralumbar fossa and under the external angle of the ilium are sometimes tender in mares with ovarian problems, especially cysts. Points over the iliac wing (between the tuber coxae and the iliac crest) may also be tender in uterine disorders.
In disorders of the reproductive system and genitalia, (as in all other clinical uses of AP), TREAT THE TPs (AHSHI POINTS). A few points (whether tender or not) for the affected organ may be added and VC 2, 3, 4; BL49; LI 2 may be considered as additional points. SP 6 is regarded as a point with special action on the inguinal area, genitalia and reproductive function of males and females.
Westermayer suggests treatment for 20 - 30 minutes for 2 to 4 times (mean of 3), at intervals of 5 days.
1.5.2. Cystic ovary: (Jeffries; Grady-Young; Johnson)
Luteal cysts often are associated with metritis or pyometra. They may be expressed manually (per rectum) in many cases (Grady-Young).Follicular cysts are usually associated with nymphomania.
Points in the area L 2 to S 1 (BL22 - 27, 46, 47; VG 4) and in the paralumbar fossa and under the tuber coxae (GB26, 27, 28) are examined for TPs. All TPs are used. Other points are chosen from:
BL22 to 29; SP 6, 15; LI14; GB25; ST36; PAIHUI; YANCHI
Jeffries and Johnson also inject 10 ml of 2% procaine solution into the broad ligament on each side of the cervix, using a special 50-60 cm needle. This method was successfully used in cows by Kothbauer and Greiff for many years. It is called paracervical injection or neural therapy.
Treatment: simple AP; injection of NaOH solution (concentration of 10 to the power of minus 9) + Vitamin B12 and Ascorbic acid; LASER. The choice is individual preference.
Jeffries: injection method plus paracervical injection, 2 times. Success is 5-15% better in luteal cysts than in follicular cysts.
Grady-Young: LASER (20 minutes total to do all points) 3 to 5 times at interval of 3-4 days. Skip 3 oestrus periods before breeding.
Johnson: needle + moxa (20 minutes) on 10 cm, 20 guage needles. Inject BL54 and LASER SP 6; ST36 and (sometimes) BL11.
EXAMPLES FROM MY FILES
Case 1. Sciatica. Severe left hind lameness in mare following injection of a copper compound i/m over the sciatic nerve area. Duration > 6 mths.
17/6 Sacro-trochanteric sweat track and area of hair regrowth noted, running in postero-ventral direction from suspect injection site. Five TPs located and clipped along the track. TPs in left and rightneck. Electro-AP, 20 minutes, at rump TPs, plus BL23, 25, GB30, 34, PAIHUI. Simple AP at neck TPs (probably not important) plus BL11. Handler to massage all TPs.
22/6 Little change. Treated as before.
29/6 Marked improvement. All TPs gone. Mare sound. Treated as before.
Riding to begin in early July.
18/7 All TPs still gone. Hair more normal along original track. Mare riding sound. Working up to full race training.
20/8 Came 4th in high-class race. Still sound.
Case 2. Ovarian backpain. 18/5 Severe left lumbar pain and left hind lameness in filly. Humped back and lumbar m. spasm clearly visible. Duration > 10 months. She had ovulated 2 days before and left ovary area was very sore on rectal examination by colleague. History of not showing clear signs of oestrus. TPs in left lumbar area and under external angle of ilium (ovary areas). Electro-AP, 20 minutes on all TPs, plus BL23, PAIHUI and uterus point (midway between external angle of ilium and iliac crest).
21/5 Some improvement but TPs still tender. New TP on right rump near uterus point. Treatment as before, plus GB34 (both).
25/5 definite improvement on walk but hunched up on turning. All left TPs gone but right one still tender. Treated as before.
30/5 Normal on walk, trot and on turning. Right TP still tender and new TPs found on left and right neck and over last right rib. Treated all TPs including original ones, plus PAIHUI.
4/6 Normal walk and turn. TPs gone except right neck. All TPs treated, plus PAIHUI, BL23 (both).
9/6 Sound. All TPs gone. Walking exercise to be increased. No treatment except massage by handler.
16/6 Going well in walk and canter on soft ground.
19/6 (32 days after initial exam, 34 days after painful ovulation): Was sent for jog on hard surface. Came back crippled, worse than ever. Left lumbar TPs very tender.
c. 22/6 colleague found left ovary area very sore on rectal exam. (This case is classed as a failure. Despite initial success, she relapsed. She was sent to the Veterinary College for specialist examination and treatment. They found nothing and suggested resting her for 6-8 months.)
Case 3. Stiff back. Gelding, had won races earlier. Back rigidity and stiffness had prevented him from racing for the past 2 years.
4/4 TPs over the last few ribs on both sides. Rhinitis (mild). Electro-AP 20 minutes, at TPs plus PAIHUI, BL23, GB30 (both).
10/4 Not possible to assess improvement, as he had not been ridden since. TPs still tender. Treated as before, plus BL13 (both) for the rhinitis.
16/4 Rhinitis gone. Vast improvement in back flexibility and stride was noted by riders who did NOT KNOW he had been treated. Put back on full training schedule. No treatment.
26/4 Owner reported him fully sound and going very well. One year later, he was still sound.
EXAMPLES OF AP THERAPY IN DOGS
MYOFASCIAL LAMENESS:
TPs are frequently found in dogs in the paravertebral, neck, shoulder, triceps and thigh muscles.
Janssens (1984) reported 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 sessions). The relapse rate was 33% but response to treatment of relapse cases was similar to that in new cases. He described TPs in the Triceps, Peroneus longus, Gluteus medius, Iliocostarum lumborum, and the thigh Adductor ms.
ARTHROPATHY
Joint trauma, rheumatism and arthritic pain can be helped by AP. Much of the pain and stiffness in arthropathy is due to muscle spasm (guarding) and TPs in the muscles above or below the affected joint.Arthropathy can affect the vertebrae also and is treated as in disc disease (see below).
Janssens (1986) reported AP therapy in 61 dogs with arthritis. The mean duration before treatment was 36 weeks. AP was most successful in pain of the shoulder and stifle (80 and 72% respectively), less so in hip pain (55%) and was least successful in pain of the elbow, carpus and tarsus (33%). Recovery time averaged 24 days (5.2 sessions). Relapses occurred in 48%. Retreatment had the same success in them as in new cases. Schoen (1984) reported good or excellent results in 63% of 24 dogs treated by AP for arthrosis.
CERVICAL (CDD) AND THORACOLUMBAR (TLDD) DISC DISEASE
As in arthrosis, much of the pain in disc disease is due to spasm and guarding of the muscles near the lesion. Irritation of the vertebral nerve root and oedema of the spinal cord add to the pain signals.
In treating disc disease, it is important to assess the degree of nerve damage. If one uses a 4-grade system (1 = pain only; 2 = pain+paresis; 3 = pain+paralysis; 4 = paralysis and loss of deep pain sensation), the prognosis in grade 1 and 2 is excellent, in grade 3 is very good and in grade 4 is poor. Grade 4 cases need a lot of care (nursing, turning, catheterisation, manual emptying of rectum in faecal retention etc) and many owners are unwilling to give it.
The approach to AP treatment in disc disease is to localise the affected area by finger palpation and other methods (including X-ray). One or two points are used bilaterally above and below the problem disc(s), with TPs and distant points.
For TLDD, distant points include GB30, 34, BL54, 60. For CDD, they include CO11, SI 3, GB34. The local points in CDD include GB20, TH15. Treatment is every 5-7 days but in acute pain every 2-4 days.) Additional therapy (conventional, playpen rest etc) is used as needed.
Ly (1977) reported that 79% of 19 dogs with paresis recovered following electro-AP and point injection (.5 ml/point) with B12 solution. He treated every 2-3 days for 8-10 sessions and most cases improved within the first 5 sessions.
Janssens (1983) reported results of AP therapy in 78 chronic TLDD cases. The average duration of signs before AP was 21, 23, 31 and 18 days in Grades 1 to 4 respectively. Recovery rates to were 97% in Grade 1 in a mean of 13 days (2 sessions); 95% in Grade 2 in a mean of 24 days (3.4 sessions); 85% in Grade 3 in a mean of 32 days (4.8 sessions); 33% in Grade 4 in a mean of 76 days (9 sessions).
In another study (Still 1987), 63 dogs with acute TLDD (mean duration 4.4 days) were treated with AP every 1-3 days. In contrast to chronic cases, 100% of acute cases of Grade 1+2 had pain control within 4 sessions; 63-71% within 24 hours. Full cure (all signs gone) was seen in 83%. In Grades 3+4, 62% had pain control within 4 sessions; 39% within 24 hours. However, full recovery (all signs) in Grades 3+4 occurred in only 11%, with improvement in another 46% (43% remained unchanged in sensory-motor function). Essential improvement of motor and other sensory functions occurred within 24-36 hours after the first treatment in Grade 2 and within 3-21 days (mean 10.9) after first treatment in Grades 3+4. Occasional autonomic upsets (constipation, diarrhoea, urinary retention) resolved within 1-3 days of first treatment in Grades 1+2 and 7-14 days in Grades 3+4.
These recovery rates and times compared very well with published values for conventional methods, including surgery.
In CDD, Janssens (1984) reported 80% recovery in Grade 1 in a mean of 11 days (2.8 sessions). In Grades 2 and 3, 67% recovered in a mean of 21 days (3.5 sessions). There were no Grade 4 cases in the seris.
Relapses in cured TLDD and CDD cases occur in 20-40% but response to treatment in relapse cases is similar to that in new cases.
POSTOPERATIVE PAIN
Janssens (personal communication) reported that AP has controlled pain in dogs which did not respond to surgery for disc disease. He has also used AP successfully to control pain and other complications arising after abdominal and other surgery.
EXAMPLE FROM MY FILES
Case 1. Cramp. Greyhound with history of race cramp, 5 months duration. He had won as a pup. Examination showed TPs near BL23 (kidney) and near the femoral artery on the upper, inner thighs. Three sessions of electro-AP at weekly intervals (TPs, GB20, 34) gave marked improvement. All TPs disappeared and normal urination (he had been a 'dribbler') was restored. The dog was beaten by a nose in his next race (I lost my bet!) but he won the following race and was exported at a good price.
CONCLUSIONS
In practice, it is difficult to make a specific diagnosis of the cause of backpain, especially in horses, due to the difficulty of routine X-ray and myelography. The general practitioner may be satisfied with clinical remission.
Palpation of the muscles, to locate TPs is an essential part of the clinical examination.
Point selection for local problems includes some from TPs, local points, distant points for the region, points with special or generalised action and (most of all) the paravertebral SHU point(s) for affected organ(s) or function(s). This includes the use of SHU points in superficial problems which may not have direct organic involvement. For instance, BL13 and 25 (SHU points for the LU and CO meridians) would be indicated as part of a prescription to help resolve pain of an inside-forelimb splint (in the meridian area of LU and CO). Similarly, BL23, 28 (SHU of KI and BL) would be indicated in capped hock (meridian area of KI and BL). One or two distant points on a meridian passing through the problem area, or a chain of points along an affected nerve are also helpful.
Certain key points are: ST36, BL21 stomach and appetite; BL13, 38 lung; BL18, VG 9 liver; GB34, TH15 muscles; BL23, PAIHUI adrenal, uro-genital, hindquarter; TH15, GB21 forequarter; GB20, 21 neck; BL25, PAIHUI hindgut; BL11, 23 bones, joints; CO11, VG14, ST36 immunostimulation.
Simple needling for 20 minutes, electroneedling or point injection are the main methods used in horses and dogs.
A clinical success rate of 70-90% can be attained in 1-3 sessions at 1-3 day intervals (recent or acute cases), or in 1-10 sessions at 3-7 day intervals in longstanding or chronic cases. However, beginners should study the principles of AP before attempting to use it. They should advise the use of other physiotherapies (massage, ultrasound, LASER etc) on the points (between sessions) to ensure high success rates.
There are other methods of point selection (earpoints, hoof points etc) and of point stimulation (magnets, staples, implants, Dermojet, LASER etc) but these methods must be regarded as experimental until adequate documentation and comparative clinical trials are available.
ACKNOWLEDGEMENTS
Basic texts on animal acupuncture are scarce. The authors of texts on the horse kindly presented me with copies and explained their methods to me. They are:
Colleagues Alan Klide, Philadelphia; Oswald Kothbauer, Austria; Jen Hsou Lin, Taiwan; Erwin Westermayer, Germany; Sheila White, Australia.
The following gave details of their approach to equine AP, either in formal or informal meetings, discussions or correspondence:
Marvin Cain, Cincinnati; Yann Ching Hwang, Alabama; Dick Jeffries, Ohio;
Ralph Johnson, Minnesota; Jukka Kuussaari, Finland; Grady Young, Georgia.
Colleagues Shelly Altman, Los Angeles; Luc Janssens, Belgium; Jacques Milin, France; Jan Still, Belgium have been most helpful in my study of small-animal AP.
To them and to many others unnamed, who have taught me to listen to the body (my own as well as the patient's), I give my sincere thanks.
I also thank Dr. Pekka Pontinen, Tampere, Finland and the organisers of the Nordic Acupuncture Congress for financing my trip to the Congress.
REFERENCES
JANSSENS, L.A.A. (1983) AP treatment of canine thoraco-lumbar disc protrus-ions: a review of 78 cases. Vet. Med. Small Anim. Clinician, October, 1580-1585.
JANSSENS, L.A.A. (1984) Atlas of the AP points and meridians in the dog. Oudestraat 37, Wilryk, Belgium.
JANSSENS, L.A.A. (1984) Treatment of canine cervical disc disease by AP: a review of 32 cases. Veterinary AP Training Seminar, Veterinary School, Gent, Belgium. 289 pp.
JANSSENS, L.A.A. (1984) Myofascial pain syndromes in dogs: TP therapy of 21 cases. Veterinary AP Training Seminar, Veterinary School, Gent, Belgium. 289 pp.
JANSSENS, L.A.A. (1986) Observations on AP therapy of chronic osteo-arthri-tis in dogs: a review of 61 cases. J. Small Anim. Pract.27, 825-837.
KLIDE, A. & KUNG, S. (1977) Veterinary AP. University of Pennsylvania Press Philadelphia, PA, USA. 297pp.
KLIDE, A.M. (1984) AP treatment of chronic backpain in the horse. AP and Electrotherapeutics Research. Int. J. 9, 57-70.
KLIDE, A.M. (1987) Use of AP for the treatment of chronic backpain in horses: stimulation of AP points with saline solution injections. J. of the American Veterinary Medical Association 190, 1177-1080.
KOTHBAUER, O. & MENG, A. (1983) Veterinary AP: cattle, pigs and horses (in German) Verlag Welsermuhl, Wels, Austria. 334pp.
LIN, J.H. and ROGERS, P.A.M. (1980) Acupuncture effects on the body's defense systems. A veterinary review. Vet. Bulletin 50, 633-640.
LIN, J.H. (1985) AP in the ox, pig, horse, goat & dog. (in Chinese). Write c/o Dept. Animal Husbandry, National Taiwan University, TAIPEI, TAIWAN, R.O.C.
LY, J.P. (1977) Veterinary AP. Proc. 54th Ann. Conf. Austral. Vet. Assoc., pp 69-71.
MARTIN, B.B. and KLIDE, A.M. (1987) Laser AP for the treatment of chronic backpain in horses: stimulation of the AP points with a low-power laser. Veterinary Surgery 16, 106-110.
ROGERS, P.A.M. and OTTAWAY, C.W. (1974) Success claimed for acupuncture in domestic animals. A veterinary news item. Irish Vet. J., 28, 182-191.
ROGERS, P.A.M. WHITE, S.S. and OTTAWAY, C.W. (1977) Stimulation of the AP points in relation to analgesia and therapy of clinical disord-ers in animals. Vet. Annual (Wright Scitechnica, Bristol) 17, 258-279.
ROGERS, P.A.M. (1979) Acupuncture in equine practice: a brief review. Irish Vet. J., 33, 19-25.
ROGERS, P.A.M. (1981) Serious complications of AP ... or AP abuses ? Amer. J. Acup., 9, 347-350.
ROGERS, P.A.M. and BOSSY, J. (1981) Activation of the defence systems of the body in animals and man by acupuncture and moxibustion. Acup. Res. Quarterly (Taiwan) 5, 47-54.
ROGERS, P.A.M. (1984) Choice of points for particular conditions. Proc. Veterinary AP Seminar, Veterinary School, Gent, Belgium and Proc. 10th IVAS Congress, Austin, Texas.
ROGERS, P.A.M. (1987) The choice of AP points for the treatment of human backpain. Nordic Acupuncture Congress, Oslo, Norway, September 1987.
ROGERS, P.A.M. (1987a) Clinical AP in the horse: points and methods used in therapy. 13th Annual Congress of the International Veterinary AP Association, Antwerp. September 9-12.
ROGERS, P.A.M. (1987b) AP in small-animal practice. Ibid.
RUBIN, M. (1976) Manuel d'AP pratique moderne. Maloine Publishers, Paris. 85 pp.
SCHOEN, A.M. (1984) AP therapy in chronic arthropathy in dogs. A review of 24 cases. Veterinary AP Training Seminar, Veterinary School, Gent, Belgium. 289 pp.
STILL, J. (1987) AP treatment of thoracolumbar disc disease in dogs: a review of 63 cases. Paper in preparation.
TRAVELL, J.G. & SIMONS, D.G. (1984) Myofascial pain & dysfunction: the TP manual. Part 1. Williams & Wilkins, London & Baltimore, 713pp.
TRIGGER POINT THERAPY: Symposium on myofascial TPs (1981) Arch. Rehabilitation Med., March, 97-117; Dorrigo et al (1979) Pain, 6, 183-; Kajdos (1974) Amer. J. Acup., 2, 113-.; Kellgren (1939-42) Clinical Sci., 4, 35-; Khoe (1979) Amer. J. Acup., 7, 15-; Lewit (1979) Pain, 6, 83-.; Melzack et al (1977) Pain, 3, 3-.; Macdonald (1983) Annals of Royal Coll. Surg. Eng., 65, 44-,; Rogers, C. (1982) Amer. J. Acup., 10, 201-.
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. 60 pp.
WHITE, S.S., HERBERT, P.A. & HWANG, T. (1985) Electro-AP in veterinary medicine. Chinese Materials Centre Publications, San Francisco. 122pp.
1.1.1. Soreback (thoracic, lumbar and sacral area)
(Kothbauer; Kuussaari; Klide; Grady-Young; Johnson; White)
Search the back and paravertebral muscles for TPs. If the tail twitches during riding, this indicates pain at BL23 (kidney SHU). Use all TPs. Add PAIHUI and points from BL18 (ICS 15) to BL26 (L 5 to L 6) and BL28, 30 (foramina S 2, 4) or points from BL17 (ICS 14) to BL25 (L 4 to L 5) and BL27, 29 (foramina S 1, 3). Use the more anterior points if the pain is more anterior. Consider also VG12; BL31, 34, 49 and the point at the meeting of the scapula and the anterior edge of the scapular cartilage (TH15, TCVM POCHIEN).
Treatment: injection, simple needling, electro-AP (20 seconds/needle) or LASER. Treat 1-2 times/week (usually every 5 days) for 2 - 10 times. In acute cases, with severe pain or paralysis, treat every 12 - 24 hours. Relapse within 6 months after successful treatment may be 5-50%.
A set formula, used with 87% success by Klide, is:
PAIHUI, BL19 (or 43), 22, 23, 24, 25, 26, 50 (simple needling or injection of 1 ml saline/point). Treat weekly, 7-12 times (Klide 1984, 1987). Point lasering gave a lower success rate (73%) (Martin and Klide 1987) but the difference between AP and Laser may not be significant.
Ly (1977) reported that all 5 horses treated for lumbosacral pain and sciatica recovered. They were treated at PAIHUI, WEIKEN, BL points on the lumbosacral area, GB30 and points along the course of the sciatic nerve. Electro-AP was used, twice/week for 10 sessions. The horses were rested for 3 months before being slowly returned to work.
1.1.2. Saddle-sore: (Grady-Young; Johnson)
Pain in the area of the saddle, is treated similarly. Tenderness near BL18 (liver SHU) may be associated with muddy colour of the eye mucosa -the liver controls the eye in TCVM.
Treatment: all TPs plus BL points, especially BL21, 23, 25.
: inject procaine-B12 (9 ml 1% procaine + 1ml B12 - 3000 units/ml at each point), using 19 g needle, depth 1.5'
(or): needle or electro-AP 20 minutes; 2/week; 2 - 4 times.
1.1.3. Shoulder lameness: (Kuussaari; White)
Few cases relapse after successful treatment.
The main points (Klide and Kung system) are: FL 2, 4, 12, 13, 7 with any TPs located in the neck or scapular-shoulder muscles. These points correspond with points: BL11; GB21; TH14; CO15; SI 9; LU 1 in humans -all of which are key points for shoulder lameness in people.
Treatment is: Electro-AP (10 - 20 seconds per point) or simple needling (20 - 30 minutes), 2 - 6 times (mean 3) at intervals of 3 - 7 days mean 4). White suggests 20 minutes electro-AP every day in acute cases.
1.1.5. Hip and thigh lameness:
The points most effective on the hip and thigh are:
: all TPs in the lumbo-sacral, hip-thigh and posterior thigh ms.
: local points (GB29, 30, 31, 32; BL50, 51, 52; ST31, 32, 33, 34)
: region points (PAIHUI; BL23, 49)
: additional points from GB34, 39
Treat by simple AP, electro-AP or point injection every 3 - 7 days for 1 to 3 times in recent cases and 3 to 8 times in chronic cases.
1.1.6. Stifle lameness: (Jeffries)
Point injection is excellent in 1 to 2 sessions. Walk the horse for 2 days before return to the track. Jeffries uses an American product for injection (Sarapin, containing Vitamin B12 and C). Three ml is injected below the patella, medial and lateral to the patellar tendon at the point HSIYEN (Knee Eyes = ST35) and the point postero-medial to the patellar tendon; ST36 (12 ml); KI10 (5 ml); BL54 (4 ml, 2' deep).
1.5. REPRODUCTIVE PROBLEMS:
The most important points for reproductive disorders and for the genital organs are in the lumbo-sacral area. A simple guide is to imagine the female organs (ovary to vulva) as a straight tube, with the ovaries related to AP points in the area T 18 to L 3 (points such as BL21, 22, 23, BL45, 46, 47; TIANPING; VG 5, 4) and the vulva/anus/perinaeum related to the area S 3 to the tailhead (points such as BL29, 30, 33, 34, 35, 49; VG 1, 2). The other organs (tubes, uterine horn, uterine body, cervix, vagina) are related to intermediate points.
Kothbauer recommends BL22, 23, 47; VG4 for the ovary and BL27, 28, 31; PAIHUI; VC 6 for the uterus. Johnson reports excellent results with these points in cases of uterine atony, metritis, embryonic reabsorption etc.
If one had to remember just 3 points for reproductive/genital disorders, they should be: PAIHUI; BL26 (between transverse wings of L 5 - L 6); BL28 (lateral to sacral foramen 2). There are other points (Fig. 18).
The abdominal meridians include ST, SP, BL, KI, GB, LI, VC, VG. Local points (points nearest the target organs) on ANY of these meridians influence the organs. Although most importance is attached to the VG and BL points (lumbo-sacral area), GB 26 to 28 in the paralumbar fossa and under the external angle of the ilium are sometimes tender in mares with ovarian problems, especially cysts. Points over the iliac wing (between the tuber coxae and the iliac crest) may also be tender in uterine disorders.
In disorders of the reproductive system and genitalia, (as in all other clinical uses of AP), TREAT THE TPs (AHSHI POINTS). A few points (whether tender or not) for the affected organ may be added and VC 2, 3, 4; BL49; LI 2 may be considered as additional points. SP 6 is regarded as a point with special action on the inguinal area, genitalia and reproductive function of males and females.
Westermayer suggests treatment for 20 - 30 minutes for 2 to 4 times (mean of 3), at intervals of 5 days.
1.5.2. Cystic ovary: (Jeffries; Grady-Young; Johnson)
Luteal cysts often are associated with metritis or pyometra. They may be expressed manually (per rectum) in many cases (Grady-Young).Follicular cysts are usually associated with nymphomania.
Points in the area L 2 to S 1 (BL22 - 27, 46, 47; VG 4) and in the paralumbar fossa and under the tuber coxae (GB26, 27, 28) are examined for TPs. All TPs are used. Other points are chosen from:
BL22 to 29; SP 6, 15; LI14; GB25; ST36; PAIHUI; YANCHI
Jeffries and Johnson also inject 10 ml of 2% procaine solution into the broad ligament on each side of the cervix, using a special 50-60 cm needle. This method was successfully used in cows by Kothbauer and Greiff for many years. It is called paracervical injection or neural therapy.
Treatment: simple AP; injection of NaOH solution (concentration of 10 to the power of minus 9) + Vitamin B12 and Ascorbic acid; LASER. The choice is individual preference.
Jeffries: injection method plus paracervical injection, 2 times. Success is 5-15% better in luteal cysts than in follicular cysts.
Grady-Young: LASER (20 minutes total to do all points) 3 to 5 times at interval of 3-4 days. Skip 3 oestrus periods before breeding.
Johnson: needle + moxa (20 minutes) on 10 cm, 20 guage needles. Inject BL54 and LASER SP 6; ST36 and (sometimes) BL11.
EXAMPLES FROM MY FILES
Case 1. Sciatica. Severe left hind lameness in mare following injection of a copper compound i/m over the sciatic nerve area. Duration > 6 mths.
17/6 Sacro-trochanteric sweat track and area of hair regrowth noted, running in postero-ventral direction from suspect injection site. Five TPs located and clipped along the track. TPs in left and rightneck. Electro-AP, 20 minutes, at rump TPs, plus BL23, 25, GB30, 34, PAIHUI. Simple AP at neck TPs (probably not important) plus BL11. Handler to massage all TPs.
22/6 Little change. Treated as before.
29/6 Marked improvement. All TPs gone. Mare sound. Treated as before.
Riding to begin in early July.
18/7 All TPs still gone. Hair more normal along original track. Mare riding sound. Working up to full race training.
20/8 Came 4th in high-class race. Still sound.
Case 2. Ovarian backpain. 18/5 Severe left lumbar pain and left hind lameness in filly. Humped back and lumbar m. spasm clearly visible. Duration > 10 months. She had ovulated 2 days before and left ovary area was very sore on rectal examination by colleague. History of not showing clear signs of oestrus. TPs in left lumbar area and under external angle of ilium (ovary areas). Electro-AP, 20 minutes on all TPs, plus BL23, PAIHUI and uterus point (midway between external angle of ilium and iliac crest).
21/5 Some improvement but TPs still tender. New TP on right rump near uterus point. Treatment as before, plus GB34 (both).
25/5 definite improvement on walk but hunched up on turning. All left TPs gone but right one still tender. Treated as before.
30/5 Normal on walk, trot and on turning. Right TP still tender and new TPs found on left and right neck and over last right rib. Treated all TPs including original ones, plus PAIHUI.
4/6 Normal walk and turn. TPs gone except right neck. All TPs treated, plus PAIHUI, BL23 (both).
9/6 Sound. All TPs gone. Walking exercise to be increased. No treatment except massage by handler.
16/6 Going well in walk and canter on soft ground.
19/6 (32 days after initial exam, 34 days after painful ovulation): Was sent for jog on hard surface. Came back crippled, worse than ever. Left lumbar TPs very tender.
c. 22/6 colleague found left ovary area very sore on rectal exam. (This case is classed as a failure. Despite initial success, she relapsed. She was sent to the Veterinary College for specialist examination and treatment. They found nothing and suggested resting her for 6-8 months.)
Case 3. Stiff back. Gelding, had won races earlier. Back rigidity and stiffness had prevented him from racing for the past 2 years.
4/4 TPs over the last few ribs on both sides. Rhinitis (mild). Electro-AP 20 minutes, at TPs plus PAIHUI, BL23, GB30 (both).
10/4 Not possible to assess improvement, as he had not been ridden since. TPs still tender. Treated as before, plus BL13 (both) for the rhinitis.
16/4 Rhinitis gone. Vast improvement in back flexibility and stride was noted by riders who did NOT KNOW he had been treated. Put back on full training schedule. No treatment.
26/4 Owner reported him fully sound and going very well. One year later, he was still sound.
EXAMPLES OF AP THERAPY IN DOGS
MYOFASCIAL LAMENESS:
TPs are frequently found in dogs in the paravertebral, neck, shoulder, triceps and thigh muscles.
Janssens (1984) reported 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 sessions). The relapse rate was 33% but response to treatment of relapse cases was similar to that in new cases. He described TPs in the Triceps, Peroneus longus, Gluteus medius, Iliocostarum lumborum, and the thigh Adductor ms.
ARTHROPATHY
Joint trauma, rheumatism and arthritic pain can be helped by AP. Much of the pain and stiffness in arthropathy is due to muscle spasm (guarding) and TPs in the muscles above or below the affected joint.Arthropathy can affect the vertebrae also and is treated as in disc disease (see below).
Janssens (1986) reported AP therapy in 61 dogs with arthritis. The mean duration before treatment was 36 weeks. AP was most successful in pain of the shoulder and stifle (80 and 72% respectively), less so in hip pain (55%) and was least successful in pain of the elbow, carpus and tarsus (33%). Recovery time averaged 24 days (5.2 sessions). Relapses occurred in 48%. Retreatment had the same success in them as in new cases. Schoen (1984) reported good or excellent results in 63% of 24 dogs treated by AP for arthrosis.
CERVICAL (CDD) AND THORACOLUMBAR (TLDD) DISC DISEASE
As in arthrosis, much of the pain in disc disease is due to spasm and guarding of the muscles near the lesion. Irritation of the vertebral nerve root and oedema of the spinal cord add to the pain signals.
In treating disc disease, it is important to assess the degree of nerve damage. If one uses a 4-grade system (1 = pain only; 2 = pain+paresis; 3 = pain+paralysis; 4 = paralysis and loss of deep pain sensation), the prognosis in grade 1 and 2 is excellent, in grade 3 is very good and in grade 4 is poor. Grade 4 cases need a lot of care (nursing, turning, catheterisation, manual emptying of rectum in faecal retention etc) and many owners are unwilling to give it.
The approach to AP treatment in disc disease is to localise the affected area by finger palpation and other methods (including X-ray). One or two points are used bilaterally above and below the problem disc(s), with TPs and distant points.
For TLDD, distant points include GB30, 34, BL54, 60. For CDD, they include CO11, SI 3, GB34. The local points in CDD include GB20, TH15. Treatment is every 5-7 days but in acute pain every 2-4 days.) Additional therapy (conventional, playpen rest etc) is used as needed.
Ly (1977) reported that 79% of 19 dogs with paresis recovered following electro-AP and point injection (.5 ml/point) with B12 solution. He treated every 2-3 days for 8-10 sessions and most cases improved within the first 5 sessions.
Janssens (1983) reported results of AP therapy in 78 chronic TLDD cases. The average duration of signs before AP was 21, 23, 31 and 18 days in Grades 1 to 4 respectively. Recovery rates to were 97% in Grade 1 in a mean of 13 days (2 sessions); 95% in Grade 2 in a mean of 24 days (3.4 sessions); 85% in Grade 3 in a mean of 32 days (4.8 sessions); 33% in Grade 4 in a mean of 76 days (9 sessions).
In another study (Still 1987), 63 dogs with acute TLDD (mean duration 4.4 days) were treated with AP every 1-3 days. In contrast to chronic cases, 100% of acute cases of Grade 1+2 had pain control within 4 sessions; 63-71% within 24 hours. Full cure (all signs gone) was seen in 83%. In Grades 3+4, 62% had pain control within 4 sessions; 39% within 24 hours. However, full recovery (all signs) in Grades 3+4 occurred in only 11%, with improvement in another 46% (43% remained unchanged in sensory-motor function). Essential improvement of motor and other sensory functions occurred within 24-36 hours after the first treatment in Grade 2 and within 3-21 days (mean 10.9) after first treatment in Grades 3+4. Occasional autonomic upsets (constipation, diarrhoea, urinary retention) resolved within 1-3 days of first treatment in Grades 1+2 and 7-14 days in Grades 3+4.
These recovery rates and times compared very well with published values for conventional methods, including surgery.
In CDD, Janssens (1984) reported 80% recovery in Grade 1 in a mean of 11 days (2.8 sessions). In Grades 2 and 3, 67% recovered in a mean of 21 days (3.5 sessions). There were no Grade 4 cases in the seris.
Relapses in cured TLDD and CDD cases occur in 20-40% but response to treatment in relapse cases is similar to that in new cases.
POSTOPERATIVE PAIN
Janssens (personal communication) reported that AP has controlled pain in dogs which did not respond to surgery for disc disease. He has also used AP successfully to control pain and other complications arising after abdominal and other surgery.
EXAMPLE FROM MY FILES
Case 1. Cramp. Greyhound with history of race cramp, 5 months duration. He had won as a pup. Examination showed TPs near BL23 (kidney) and near the femoral artery on the upper, inner thighs. Three sessions of electro-AP at weekly intervals (TPs, GB20, 34) gave marked improvement. All TPs disappeared and normal urination (he had been a 'dribbler') was restored. The dog was beaten by a nose in his next race (I lost my bet!) but he won the following race and was exported at a good price.
CONCLUSIONS
In practice, it is difficult to make a specific diagnosis of the cause of backpain, especially in horses, due to the difficulty of routine X-ray and myelography. The general practitioner may be satisfied with clinical remission.
Palpation of the muscles, to locate TPs is an essential part of the clinical examination.
Point selection for local problems includes some from TPs, local points, distant points for the region, points with special or generalised action and (most of all) the paravertebral SHU point(s) for affected organ(s) or function(s). This includes the use of SHU points in superficial problems which may not have direct organic involvement. For instance, BL13 and 25 (SHU points for the LU and CO meridians) would be indicated as part of a prescription to help resolve pain of an inside-forelimb splint (in the meridian area of LU and CO). Similarly, BL23, 28 (SHU of KI and BL) would be indicated in capped hock (meridian area of KI and BL). One or two distant points on a meridian passing through the problem area, or a chain of points along an affected nerve are also helpful.
Certain key points are: ST36, BL21 stomach and appetite; BL13, 38 lung; BL18, VG 9 liver; GB34, TH15 muscles; BL23, PAIHUI adrenal, uro-genital, hindquarter; TH15, GB21 forequarter; GB20, 21 neck; BL25, PAIHUI hindgut; BL11, 23 bones, joints; CO11, VG14, ST36 immunostimulation.
Simple needling for 20 minutes, electroneedling or point injection are the main methods used in horses and dogs.
A clinical success rate of 70-90% can be attained in 1-3 sessions at 1-3 day intervals (recent or acute cases), or in 1-10 sessions at 3-7 day intervals in longstanding or chronic cases. However, beginners should study the principles of AP before attempting to use it. They should advise the use of other physiotherapies (massage, ultrasound, LASER etc) on the points (between sessions) to ensure high success rates.
There are other methods of point selection (earpoints, hoof points etc) and of point stimulation (magnets, staples, implants, Dermojet, LASER etc) but these methods must be regarded as experimental until adequate documentation and comparative clinical trials are available.
ACKNOWLEDGEMENTS
Basic texts on animal acupuncture are scarce. The authors of texts on the horse kindly presented me with copies and explained their methods to me. They are:
Colleagues Alan Klide, Philadelphia; Oswald Kothbauer, Austria; Jen Hsou Lin, Taiwan; Erwin Westermayer, Germany; Sheila White, Australia.
The following gave details of their approach to equine AP, either in formal or informal meetings, discussions or correspondence:
Marvin Cain, Cincinnati; Yann Ching Hwang, Alabama; Dick Jeffries, Ohio;
Ralph Johnson, Minnesota; Jukka Kuussaari, Finland; Grady Young, Georgia.
Colleagues Shelly Altman, Los Angeles; Luc Janssens, Belgium; Jacques Milin, France; Jan Still, Belgium have been most helpful in my study of small-animal AP.
To them and to many others unnamed, who have taught me to listen to the body (my own as well as the patient's), I give my sincere thanks.
I also thank Dr. Pekka Pontinen, Tampere, Finland and the organisers of the Nordic Acupuncture Congress for financing my trip to the Congress.
REFERENCES
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JANSSENS, L.A.A. (1984) Atlas of the AP points and meridians in the dog. Oudestraat 37, Wilryk, Belgium.
JANSSENS, L.A.A. (1984) Treatment of canine cervical disc disease by AP: a review of 32 cases. Veterinary AP Training Seminar, Veterinary School, Gent, Belgium. 289 pp.
JANSSENS, L.A.A. (1984) Myofascial pain syndromes in dogs: TP therapy of 21 cases. Veterinary AP Training Seminar, Veterinary School, Gent, Belgium. 289 pp.
JANSSENS, L.A.A. (1986) Observations on AP therapy of chronic osteo-arthri-tis in dogs: a review of 61 cases. J. Small Anim. Pract.27, 825-837.
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ROGERS, P.A.M. (1984) Choice of points for particular conditions. Proc. Veterinary AP Seminar, Veterinary School, Gent, Belgium and Proc. 10th IVAS Congress, Austin, Texas.
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ROGERS, P.A.M. (1987b) AP in small-animal practice. Ibid.
RUBIN, M. (1976) Manuel d'AP pratique moderne. Maloine Publishers, Paris. 85 pp.
SCHOEN, A.M. (1984) AP therapy in chronic arthropathy in dogs. A review of 24 cases. Veterinary AP Training Seminar, Veterinary School, Gent, Belgium. 289 pp.
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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. 60 pp.
WHITE, S.S., HERBERT, P.A. & HWANG, T. (1985) Electro-AP in veterinary medicine. Chinese Materials Centre Publications, San Francisco. 122pp.
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