1

SHORT TRAINING COURSE

ON

BASIC SMALL ANIMAL ACUPUNCTURE

23-24 July 2009

Department of Veterinary Clinical Sciences

College of Veterinary Medicine

University of the Philippines Los Baños

College, Laguna

TABLE OF CONTENTS

Page

Course description3

Training staff and schedule3

Role of acupuncture4

Definitions4

Status 5

Issues6

Fundamentals of acupuncture7

Principles7

Acupuncture points14

Equipment and accessories37

Methods of acupuncture40

Conventional methods of stimulation40

Non-conventional methods of stimulation41

Modern methods of stimulation43

Application of needles43

Applications of acupuncture47

Conventional medicine and acupuncture47

Acupuncture analgesia47

Acupuncture therapy52

Glossary of terms63

References65

COURSE DESCRIPTION

Rationale

The Short Training Course on Basic Small Animal Acupuncture is intended for small animal practitioners who are interested in exploring the use of acupuncture as an additional tool for diagnosis, treatment and surgery in their practice.

The course is made up of lecture presentations and laboratory sessions where participants will have hands-on opportunities to explore, experience and practice basic acupuncture in small animals.

Course Objectives

At the end of the course, the participant is expected to be able to:

  • Discuss the basic principles of acupuncture
  • Identify the location of major acupuncture points in small animals
  • Demonstrate different methods of acupuncture stimulation
  • Perform basic acupuncture procedures in small animals

TRAINING STAFF AND SCHEDULE

Training Staff

Training Coordinator:Marianne Leila S. Flores, DVM, MHA

Resource Persons

Marianne Leila S. Flores, DVM, MHA

Elaine P. Manigbas, DVM, MS

Jezie A. Acorda, DVM, MAgr, PhD

Training Schedule

23 July (Thursday) / 24 July (Friday)
8:00-8:20 AM / Registration
8:20-8:30 AM / Opening Ceremonies / Methods of acupuncture
Part II. Application
8:30-10:00 AM / Role of acupuncture
10:00-10:20 AM / Break / Break
10:20-12:00 AM / Fundamentals of acupuncture / Applications of acupuncture
12:00-1:00 PM / Lunch / Lunch
1:00-3:00 PM / Acupoints detection in dogs / Acupuncture analgesia
3:00-3:20 PM / Break / Break
3:20-4:30 PM / Methods of acupuncture
Part I: Experience / Acupuncture therapy
4:30-5:00 PM / Closing Ceremonies

ROLE OF ACUPUNCTURE

“It matters not if medicine is old or new so long as it can cure.
It matters not if theories come from East or West so long as they be true.”
Jen-Hsou Lin, Taipei

Presently, there is a world-wide trend in the use of complementary and alternative medicine, including acupuncture, in both human and veterinary medicine. Several factors have led to increase public awareness for a more natural system of animal production and medical care. These include fear of chemical residues in food, antibiotic resistance, zoonosis, and iatrogenic diseases, in addition to the high cost of conventional medicines. With contrasting claims on the efficacy of acupuncture, there is a need to know if this therapeutic modality can be of practical benefit especially to veterinary practitioners and animal owners. This training manual will expound on the basics of acupuncture and explore its possible application in small animals.

Definitions

Biomedicine has been defined by Republic Act 8423 as “that discipline of medical care advocating therapy with remedies that produce effects differing from those of the diseases treated. It is also called allopathy, western medicine, regular medicine, conventional medicine, mainstream medicine, orthodox medicine, or cosmopolitan medicine.”

Conventional medicine depends on expensive high-tech diagnostic methods, surgery and synthetic or bioengineered medicinal agents (antimicrobials, analgesics, cytotoxic chemotherapy, mood-altering drugs, tranquillizers, hormones and vaccines).

Complementary medicine, sometimes called integrative medicine, on the other hand, includes any form of physical, nutritional, mental or spiritual therapy that can address the root causes of disease, and/or substitute for, or improve, the clinical outcome of conventional medicine and/or alleviate its adverse side-effects.

The differences between the two categories of medical practice can be seen in the following comparison (Table1):

Table 1. Comparison between two broad groups of medical practice.

Conventional medicine / Nonconventional medicine
Western medicine / Eastern medicine
Orthodox medicine / Unorthodox medicine
Mainstream medicine / Alternative medicine
Regular medicine / Complementary medicine
Cosmopolitan medicine / Traditional medicine
Biomedicine / Natural medicine
Modern medicine / Ethnomedicine

Complementary medicine involves therapies used to supplement conventional medical treatments. Alternative medicine, on the other hand, is used in place or as a replacement of conventional medicine or therapies. Practitioners of both conventional and complementary and alternative veterinary medicine (CAVM) often refer to themselves as holistic practitioners because the approach to diagnosis and therapy involves a careful look at the animal's whole mental and physical well-being.

Status

A survey by the American Association of Equine Practitioners revealed that 22% use physical therapy, 17% acupuncture; 8% chiropractic; 7% massage; 6% homeopathy and 6% employ herbs for treatment.

Although the practice of acupuncture originally has been confined mainly to East Asia, it has spread through different areas of the world in the last 50 years. The percentage of veterinarians using acupuncture in different countries throughout the world is shown in Table 2.

Table 2. Percentage of veterinarians using acupuncture.*

Country / Percentage / Country / Percentage
Australia / 1.0-2.5 / Ireland / 1.0
Austria / <1.0 / Japan / <2.5
Belgium / 10-20 / Mexico / 1.0
Canada / <0.5 / Netherlands / <0.2
Czechoslovakia / <0.4 / Norway / <0.1
Denmark / <1.0 / South Africa / 3.0
Finland / 10.0 / Switzerland / <0.5
France / <3.0 / Taiwan / 10.0
Germany / 1.0-5.0 / United Kingdom / <0.5
Germany / 1.0-5.0 / USA / <0.5

*From Rogers (1988).

Veterinary schools in Austria, Belgium, Czechoslovakia, France, Germany and Switzerland and in the University of the Philippines have accepted theses or dissertations on acupuncture. National or State Veterinary Associations in Taiwan, Japan, Austria, Finland, Germany, Belgium, Canada, Australia, United Kingdom and the United States have accepted acupuncture as a valid modality.

The most current guidelines approved by the American Veterinary Medical Association House of Delegates in 1996 state that: “…Veterinary acupuncture and acutherapy are now considered an integral part of veterinary medicine.”

The International Veterinary Acupuncture Society (IVAS), now the biggest organization for veterinary acupuncture outside the East, with members or informal contacts in 38 countries, was established in 1974. Its aims include working for the full integration of acupuncture into veterinary science and the standardization of training internationally.

Currently, nearly 1 million veterinary practitioners are trained in acupuncture. In addition, there are more than 100 worldwide publications devoted to disseminating results of studies and researches on acupuncture.

Issues

Although acupuncture is being used by some veterinary practitioners in various countries throughout the world, there are still problems regarding its full integration into mainstream medicine. It has been criticized in the past for things such as poor quality research, reliance on the placebo effect, misdiagnoses, and the fact that many of the conditions studied are self-limiting. The main political and ethical arguments against the use of acupuncture by veterinarians are as follows:

Acupuncture challenges the concept of standards of care.

Acupuncture challenges the notion that the health care of animals is the sole purview of veterinarians.

Acupuncture may not be veterinary medicine and, as such, may be outside the regulatory domain of veterinary state boards.

Veterinarians have an obligation to provide effective treatments; therefore, it is unethical to provide treatments that lack systematic research studies.

It is insufficient for veterinarians to claim knowledge of effect or a therapeutic mechanism only on personal experience.

It is unethical to charge for any service or product beyond that which has been proven.

Although many practitioners of mainstream or conventional medicine criticize the use of acupuncture by some practitioners, there are certain issues which must considered regarding the value of acupuncture for use as therapies in animals. These include the following:

Science has social and political obligations to actively investigate alternative theories in the interest of society.

Although veterinarians tend to believe that most of their therapeutic interventions are proven, evidence-based assessments of typical veterinary practices suggest otherwise. Only about 37% of medical interventions are supported by randomized controlled trials while CAVM studies show that 76% of interventions are supported by some form of compelling evidence.

A search of MEDLINE reveals over 5,600 articles on acupuncture (over 1,000 on animals), thousands of which are controlled trials.

A carefully selected panel of nonfederal, nonadvocate researchers and independent experts appointed by the National Institutes of Health (NIH) reviewed the voluminous literature on acupuncture and concluded unequivocally that acupuncture worked for a variety of conditions.

FUNDAMENTALS OF acupuncture

The term acupuncture is from the Latin, “acus” meaning ‘needle’ and “punctura” meaning ‘to prick’. Acupuncture, in its simplest sense, is the treatment of conditions or symptoms by the insertion of very fine needles into specific points on the body in order to produce a response. It is a therapy first developed by the Ancient Chinese about 3,000 years ago that consists of stimulating designated and precise points on the surface of the body by the insertion of fine solid needles, by application of heat or by a variety of techniques including electrical stimulation, implantation of substances, and stimulation through microwave, ultrasound or low power laser. Acupuncture therapy is used to relieve pain, induce surgical anesthesia, correct dysfunction, prevent diseases and treat disorders.

The basic principle of acupuncture is to restore balance.

  • If a disease is due to an excess, that excess must be drained.
  • If it is due to a deficiency, that deficiency should be tonified.
  • If the problem is due to heat, that heat should be cooled.
  • If the problem is due to cold, that cold should be warmed.
  • If it is due to dryness, that dryness should be moistened.
  • And, if it is due to dampness, that dampness should be dried.

Principles

The theoretical bases of acupuncture include the Ying-Yang theory, Five Elements theory, Qi, Blood, Essence and Body Fluids, the Meridians, Eight Principles and the Zang-Fu theory.

Yin-Yang theory

Health can be defined as a state of harmony between the body and its internal and external environment. Disease arises where there is an imbalance within the internal environment or between the internal and external environment. The early Chinese explained this relationship as the Yin-Yang theory, which is based on the philosophic principle of two polar complements of Qi or Ch’i (pronounced chee). All phenomena in the universe may be placed in either the Yin or the Yang category. Balance or equilibrium is maintained by the mutual antagonism, as well as mutual dependence, of opposing forces. Yin exists by virtue of Yang and Yang exists by virtue of Yin. Yin refers to night time, cold, quiet, cloudy, overcast, passive, dark, downward-seeking; Yang refers to daytime, warm, active, sunny, bright, light, upward-seeking. The Yang (heat or warm) energy is designed to treat coldness (Yin diseases such as ascites). The Yin (cool or cold) energy is used to treat heat (Yang diseases such as inflammations and infections).

Five elements theory

The five elements theory consists of two normal cycles (generating or promoting sequence and controlling sequence) and two abnormal cycles (over-acting sequence and insulting sequence) of five elements - wood, fire, earth, metal and water (Fig. 1). Earth is linked to digestion. It is comprised of the spleen/pancreas and the stomach. Metal is linked to respiration and elimination. It is comprised of the lungs and large intestine. Water is linked to the plumbing. It is comprised of the kidneys and urinary bladder. Wood is linked to the tree of toxic processing. It is comprised of the liver and gall bladder. Fire is linked to the circulation of blood, hormones and food. It is comprised of the heart and small intestines.

The similarities between the rhythm of events taking place in the physical world and those taking place in the physical body resemble a circle. This circular rhythm became known as the creation cycle. Fire burned, creating the earth (soil). The earth gave rise to mountains, which contain metal ores. The metal separated, making way for the water. The water flowed and nourished the wood of the trees. And the trees, vulnerable to burning kindled the fire. Check and balances also give rise to the control cycle. Fire melts metal, metal axes chop wood. As the wooden tree falls, it blocks the earth. As the earth’s soil builds up, it dams water. As the water floods, it douses the fire.

Fig. 1. Theory of five elements.

Qi, blood, fluids and vital essences

Qi is the force or energy that controls harmony in the human body, the “vital force” or “life energy” that activates and maintains the life process. This energy is derived from our environment through such processes as nutrition and respiration, is converted into an absorbable form by certain organs, and is stored in the body and distributed throughout the system by other organs. Its functions include promotion, protection, transformation, retention, warming and nourishment.

Qi includes two aspects, the refined nutritious substances such as Food-Qi which form animal body and maintain activity of life and the physiological functions of the internal organs and tissues such as Qi of the Yang (Fu) and Ying (Zang) organs and Qi of the meridians, etc. Blood is the red fluid with abundant nutrition that circulates in the blood vessels. Essence or Jing has three forms: a) pre-heaven essence (blending of sexual energies of male and female and female animals; b) post-heaven essence (essence which is refined and extracted from food and fluids by the stomach and spleen after birth; and c) kidney-essence (more specific kind of energy which plays an extremely important role in animal physiology derived from both the pre-heaven and post-heaven essence.

A combination of life force components makes up the substance and function of the body and mind. The substances provide the fluid, blood, energy and spirit that allow us to exist, either happily or unhappily. These three vital essences or treasures are the Jing (basic essence), Qi (vitality or life force) and Shen (spirit and mind). Jing essence is the substinative essence we are born with, similar to Western understanding of the genes, DNA and heredity. Qi is vitality, it is not a palpable entity but a function. It has three main components: the hereditary Qi which is from the Jing; the nutritive Qi that is derived from the food we eat; and the cosmic Qi that is from the air we breathe via the lungs. Shen is a metaphysical or psychologic term. It is the spirt and the psyche of the body. It encompasses our emotional well-being, thoughts and beliefs.

Meridian theory

Meridians form the basis of acupuncture, as they are the pathways by which Qi and blood circulate throughout the body. The meridian system unifies all parts of the organism, connecting the internal organs with the external body, and maintaining harmony and equilibrium. A meridian is a channel of energy that courses beneath the skin’s surface. Each meridian pathway follows aspects of the circulatory, lymphatic, muscular and nervous systems. Each pathway has exit points with greatly increase electrical conductivity called acupuncture points. There are 14 major meridian systems:

  1. Lung (LU) meridian of the hand (Tai Yin)
  2. Heart (HT) meridian of the hand (Shao Yin)
  3. Pericardium (PC) meridian of the hand (Jue Yin)
  4. Large Intestine (LI) meridian of the hand (Yang Ming)
  5. Small Intestine (SI) meridian of the hand (Tain Yang)
  6. Triple Heater (TH) meridian of the hand (Shao Yang)
  7. Stomach (ST) meridian of the foot (Yang Ming)
  8. Urinary Bladder (BL) meridian of the foot (Tia Yang)
  9. Gallbladder (GB) meridian of the foot (Shao Yang)
  10. Spleen (SP) meridian of the foot (Tai Yin)
  11. Kidney (KI) meridian of the foot (Shao Yin)
  12. Liver (LIV) meridian of the foot (Jue Yin)
  13. Governing Vessels (GV) meridian (back midline)
  14. Conception Vessels (CV) meridian (abdominal midline)

The meridians pertain to the Zang-Fu organs internally and extend over the body externally. The channels which constitute the main trunks run longitudinally and internally within the body while the collaterals which represent branches of the channels run transversely and superficially. The functions of the meridians include:

  1. transporting Qi and blood and regulating Yin and Yang.
  2. resisting pathogens and reflecting symptoms and signs
  3. transmitting needling sensation and regulating deficiency and excess conditions

Eight principles

This system is based upon the quality, quantity and location of a problem. The eight principles include the categories and concepts of:

Yin and Yang

Interior and exterior

Cold and hot

Deficiency and excess

The quality of the system refers to whether the disease pattern or its response has Yin or Yang or cold or hot tendencies. The quantity refers to the deficiency or excess aspect of the condition, and the location depends upon interior or exterior aspects.

Yin is related to fluids in the body, which includes all water and blood. Yang is related to the metabolism of the body. Yin is like water with a tendency to be cold and heavy. Yin moistens both the surface and the interior of the body, helping fluids to flow and cool us. Yang is like fire with its heating and circulating capabilities. If the heat is too great, it can consume the Yin of the body and cause fever, inflammation and dryness.

Cold is similar to Yin, though not as encompassing. It is the water that contracts and stagnates inside of the body, causing sluggishness. Hot is similar to Yang, but not as pervasive. Hot individuals cannot tolerate much heat and summer and can be nervous, restless and agitated.

The principle of exterior has to do with the location of the condition. In upper respiratory condition a mild virus attacks the outside or surface of the body. Exterior conditions are usually acute, of short duration and leave no long-lasting detrimental effects. The principle of interior denotes that a problem is deep below the surface, affecting an internal organ. Interior problems are serious and may cause death.

Excess means too much of something, e.g. too much heat can cause inflammation of the skin while too much water can cause fluid buildup in the thorax or abdomen. Deficiency means too little of something, e.g. a deficiency of energy can cause fatigue or lethargy, not enough water in the intestines can cause constipation.