Introduction of Acupuncture Flashcards
History of acupuncture
Oldest evidence of acupuncture practice is from the Neolithic period in China, approximately 8000 years ago
-Stone needles unearthed in inner Mongolia
More sophisticated and varied instruments dating from the Shang Dynasty (1600-1100 BCE)
First complete description of veterinary acupuncture included in Si Mu An Ji Ji (simus collection of equine medicine) written by Li Shi during the Tang Dynasty (618 to 907 CE)
History of acupuncture
The veterinary acupuncture text copied into Si Mu An Ji Ji was written by.. Bo Le (Sun Yang) prior to 300 CE
Includes the loci and indication of 77 acupoints in horses.
Western interest in acupuncture increased dramatically after…
President Nixons visit to china during the 1970s
Acupuncture for companion animals is a relatively recent development
Both traditional and evidence based approaches are taught in the US.
Current practice of acupuncture..
In most states and provinces, vet acupuncture is restricted to licensed vets or must be performed under the supervision of a licensed veterinarian..
Three main programs in US, Colorado, IVAS, and Chi institute.
NIH consensus statement on acupuncture..
Promising results have emerged, showing efficacy of acupuncture in adult post op and chemotherapy nausea and vomiting and in post op dental pain.
Adjunct treatment or an acceptable alternative included in a comprehensive management plan. Further research is likely to uncover additional areas..
Guiding principles of acupuncture..
Foundational skills
Evidence based analysis
Life long learning techniques.
Arguments against acupuncture..
Lack of evidence for effectiveness..
May be real or perceived
25 to 75% of conventional tx in human medicine have solid evidence supporting their use
Potential placebo effect (shown by the owner) animals do not demonstrate.
Poor understanding of the mechanisms by which acupuncture works.
What is an acupoint?
Shu Xue = communicating holes
Superficial points under the skin with higher densities of free nerve endings, blood, lymphatic vessels and mast cells.
Lower electrical resistance and higher electrical conductivity at these points.
Four anatomic acupoint types?
Type 1: motor point
Type 2: dorsal & ventral midline
Type 3: superficial nerves and nerve plexus
Type 4: muscle- tendon junctions
Type 1 motor point
67% of all acupoints
Located at the point where a nerve enters the muscle.
Effect: maximal contraction with minimal intensity of stimulation.
Type II acupoint
Dorsal and ventral midline.
Superficial nerves in the sagittal plane.
Type III acupoint
superficial nerves and nerve plexus
PC-6 over the median nerve, GB-34, over the common peroneal nerve
Type IV acupoint
Muscle tendon junctions
-BL-57 at the tendon of the gastrocnemius m.
Acupuncture MOA
Gate theory
Melzack and Wall
Acupuncture activates specific receptors that block transmission of painful stimuli
-Heavily myelinated A-beta fibers quickly conduct signals to the SPC before signals from slower C fibers can arrive.
-Results in pre-synaptic inhibition of information carried by the C fibers (pain)
Local response to needling or stimulation of an acupoint
Acupuncture
Tissue microtrauma from a needle…
Tissue microtrauma > mast cell degranulation > release of histamine > heparin > proteases and bradykinin > increased lymph and blood flow to an area. Increased local immune responsiveness. Relaxation of muscles and fascia.
Acupucture stimulation results in..
release of neuroactive molecules which modulate pain response, including B-endorphin, dynophin and encephalin.
- Increase in endogenous opioids in the CSF and serum
- Increase in B-endorphins
- Electroacupuncture stimulates release of opioids (lower frequency) and serotonin (higher frequency).
Drugs or treatments that alter or block the response to acupuncture..
Naloxone: blocks or reverses opioids
Dexamethasone- decreases B- endorphin levels
Procaine/LA: block signal transmission
Adrenalectomy: increases B-endorphin levels, increases AP analgesia**
Hypophysectomy: completely eliminates AP analgesia
What is a positive treatment that increases AP analgesia and increases B-endorphin levels?
ADRENALECTOMY
Acupuncture
These processes combine to create the bodies response to acupuncture stimulation.
Some recent publications demonstrate additional effects, but the mechanism is still unclear.
Scientific resources are available.
Acupuncture stands for..
Acus (needle) pungare (to pierce)
Traditional definition of acupuncture:
manipulation of the body energy through the regulation of Qi
How does disease result according to acupuncture?
Disturbance or imbalance in the flow of Qi
The effects of acupuncture result from a combination of..
The AP point selected
The method of stimulation
Duration of stimulation
The AP point selected..
12 regular channels
8 extraordinary channels
Classical points
Methods of stimulation..
Dry needle technique Aquapuncture Electroacupuncture Hemoacupuncture Moxibustion Pneumoacupuncture
Acupuncture is one of the four branches of TCVM:
Acupuncture Herbal medicine Food therapy Tui-na (medical manipulation) TCM has one additional branch: Tai chi
TCVM Basics
Yin and Yang
Yin: female, dim, dark, night, cooling, interior, descent, stillness, rest, posterior, tail
Yang: male, bright, light, day, warming, exterior, ascent, movement, activity, anterior, head.
*Its all relative, it depends. There is no Yin that does not have Yang. No yang without Yin.
Properties of a given situation can depend upon the alternative.
The five element theory:
Everything in the universe can be divided into one of five elements..
Wood, fire, earth, metal, water.
Each element is part of repeating cycles
-promoting (mother/child), restraining (grandparent, grandchild) or overwhelming.
Relationships between the five elements describe the relationships between the organ systems, the body and environment.
Fire element:
Season: summer
Stage of life: maturity (adolescence)
Attributes; joy, communication, love
Body: heart and circulation
Earth element
Season: harvest
Stage of life: fruition (maturity
Attributes: nourishment- food and ideas
Body: spleen and stomach
Metal element
Season autum
Stage of life letting go, retirement
Attributes: inspiration, enrichment
Body: lung and colon
Water element:
Season: winter
Stage of life: gestation (senescence)
Attributes: potency, reserves
Body: kidney and bladder
Wood element
Stage: spring
Stage of life: birth (youth)
Attributes: vision, self assertion
Body: liver and gallbladder
Meridians
12 regular channels
Paired channels named after Zang-fu organ systems
Connect transpositional points
Meridians
8 extraordinary channels
Coordinate and balance blood and Qi along the regular channels they link
Most do not have their own points.
Meridians
Classical points
Traditional points developed on animals
horse and ox
Zang-Fu organ systems
Each organ system is associated with a particular element, energetic level and polarity (yin/yang)
-the 6 zang organs are paired with the 6 fun organs as husband and wife
Zang organs..
Interior, yin, wife, solid organs manufacture and store essential substances
-Lungs, spleen, heart, liver, kidney, pancreas.
Originate or end at the chest
Fu organs..
Exterior, yang, husband, hollow organ’s that receive or transport food and waste..
-Liver, stomach, small intestines, gall bladder, bladder, thyroid
Originate or end on the head.
Channels and Zang-Fu…
LU-(lung)
LU-(lung)
Zang (yin) metal, thoracic limb, highest energy level
Respiratory tract, nose, skin, body, hair
11 points
Wife of LI
Very sensitive to dryness
Channels of Zang-Fu
LI: Large intestine
Fu (yang), metal, thoracic limb, highest energy level
Lower GIT, elimination of solid waste, 20 points, husband of LU
Channels of Zang-Fu
SP: spleen
Zang (ying) earth pelvic limb highest energy level
Spleen, digestion, most of the GIT, lips, movement of body fluid
21 points
wife of ST
center of the body, point of balance, very sensitive to damp
Channels of Zang-Fu
ST-Stomach
Fu (yang), earth, pelvic limb, highest energy level
Stomach
45 points
Husband of SP
Channels of Zang-Fu
HT- heart
Yang (yin) fire thoracic limb, medium energy level
heart, cv system, house of mind (mentation and disposition)
9 points
wife of si
most important of the zang organs
Channels of Zang-Fu
SI- small intestine
Fu (yang) fire thoracic limb, medium energy level
small intestine
19 points
husband of Heart
Channels of Zang-Fu
Kidney
Zang (yin) water pelvic limb medium energy level
urinary system, reproductive system, bones, teeth, marrow, spinal cord, hind limbs and congenital jig
27 points
wife of bladder
Channels of Zang-Fu
Bladder
BL-bladder Fu(yang) water pelvic limb, medium energy level bladder, elimination of liquid waste 67 points husband of the kidney
Pericardium
Channels of Zang-Fu
PC- pericardium
Zang (yin) fire thoracic limb lowest energy level
Pericardium supports the heart and its function and protects the heart
9 points
wife of the triple heater (SJ)
Channels of Zang-Fu
TH- triple heater also called san jiao
Fu (yang) fire thoracic limb, lowest energy level
NO corresponding anatomical structure**
Distributes Qi to the channels
23 points
husband to the paricardium
Channels of Zang-Fu
LIV
Liver
Zang (yin) wood pelvic limb, lowest energy level
liver, ligaments, tendons, feet, nails, endurance, regulates circulation
14 points
wife of the gallbladder
very sensitive to stress
Channels of Zang-Fu
GB
gall bladder
fu (yang) wood pelvic limb lowest energy level
gall bladder synthesis and secretion of bile
44 points
husband of liver
Channels
Conception and governing vessels:
2 of the 8 extraordinary channels are commonly used:
CV: conception vessel (ren)
-runs along ventral midline, from caudal to cranial (24 points)
GV: governing vessel (DU)
-runs along dorsal midline, from crainal to caudal
-28 points
Transpositional points
12 channels- sequences of Transpositional points
-transpostional points are named according to their channel name (ZF organ name) and the number (the order) in which they occur along the channel.
Classical points are those developed or discovered specifically for that species (have a pin-yin Chinese name not number!)
ID An Shen point
Classical points are those developed or discovered specifically for that species (have a pin-yin Chinese name not number!)
Slide 39
Horse image
Classical points
Slide 40
Cat dog image
Classical points
slide 40
Point selection
Every point has multiple actions or properties
- local therapeutic effect
- treat the local lesion or region of the body - distant therapeutic effect
- channel effect - special properties
- certain points have unique properties
Permission points
Introductory points for calming
Local points
Use points close to the area of interest (if specific lesion or injury)
Balance points
distal or channel points
Pattern points
special points relevant to the TCVM diagnosis
Methods of stimulation..
dry needling (what we traditionally think of acupuncture) Stainless steel needles inserted into acupoints or ah shi points Needles can be twirled, plucked, or just left alone without further manipulation
Aquapuncture
Dilute vitamin B12 is injected into an acupoint
-warn owners the urine may become red!
provides longer stimulation in a point then dry needling alone.
Methods of stimulation
Electroacupuncture
Electrical stimulation of acupoints
Both high and low frequency current
Provides stronger stimulation then just dry needling alone
Especially helpful for paralysis
Hemopuncture
Blood letting
Quick way to clear stagnation remove excess heat
Recommended for heat stress, laminitis
Moxibustion
Sticks of mugwort are burned near a point or touched to a needle to stimulate the point or region
Used to berak up stagnation, clear cold, warm the region or channel
Smokeless moxa can be used if the patient (or practitioner) is sensitive.
Contraindications for acupuncture..
Pregnancy
Severe or debilitating illness
Very old patient
Seizure disorders especially with Electroacupuncture.
Limitations of acupuncture..
should not be used alone or as a primary response to emergent or dynamic situations (hemorrhage, dystocia)
effects are cumulative and may take a while to see improvement
evidence to support its use for internal med cases is lacking
research difficult due to individual nature of each case, no protocols..
Best medicine is..
combination of eastern and western, not just by itself!
consider acupuncture and TCVM
start with a full western physical exam and then perform a TCVM exam
combine your findings to reach a tcvm diagnosis and select points accordingly.
