Acupuncture for Osteoarthritis and Pain Management
World Small Animal Veterinary Association World Congress Proceedings, 2015
S.H. Xie, DVM, PhD, MS
Chi Institute, Reddick, FL, USA

The most common conditions that can be treated effectively with acupuncture include osteoarthritis (OA), degenerative joint disease (DJD) and pain.1-6 In Traditional Chinese Veterinary Medicine (TCVM), OA, DJD and painful clinical conditions are considered as Bi syndrome (stiffness and pain). It can be divided into 6 types: Wind Bi, Cold Bi, Damp Bi, Heat Bi, Kidney Yang Deficiency Bone Bi and Kidney Yin/Qi Deficiency Bone Bi. This presentation will focus on how to select acupuncture points and techniques for treatment of these 6 types of osteoarthritis in dogs and cats.7-10

I. Wind Bi Syndrome

Also called wandering Bi (Xing Bi)

Etiology and Signs

 Wind-Cold-Damp (but Wind dominant) invasion into the exterior

 Wind obstructs Qi-Blood flow in muscle, bone and meridian

 Rapid onset, pain in meridian and joints

 Changing from one place to another ("pain wanders")

 Pain worsens when exposed to Wind

 Tongue: slightly thin and pale coating

 Pulse: superficial (floating)

Treatment Strategy

 Eliminate Wind and invigorate the channels

 Eliminate Cold and disperse Damp

Acupuncture Points

 GB-20: Pond of Wind. Eliminate Wind and clear the exterior

 Bl-17: Influential point of Blood. Invigorate and activate Blood

 Sp-10: Sea of Blood. Invigorate and activate Blood

 LIV: Invigorate Qi in order to eliminate stagnation and eliminate Wind

 Local points or A-shi points: Move local Qi and resolve stagnation and pain

Herbal Formula: Fang Feng Tang (Siler Powder)

II. Cold Bi Syndrome

Also called Painful Bi (Tong Bi)

Etiology and Signs

 Wind-Cold-Damp (but Cold dominant) invasion into joints

 Coldness obstructs Qi and Blood flow

 Pain in joints, difficulty in movement (acute)

 Pain relieves when exposed to heat

 Pain exacerbates when exposed to Cold

 Tongue: purple with a pale coating

 Pulse: Tight and wiry

Treatment Strategy

 Warm the Channel and eliminate Cold

 Eliminate Wind-Damp

Acupuncture Treatment

Using moxibustion or electro-acupuncture

 Shen-shu and BL-23: kidney association point, and Warm Yang and eliminate Cold

 Bai-hui: Warm Yang and strengthen kidney

 GV-4: Warm Yang and eliminate Cold

 Combined with local points or A-shi points: Move local Qi and resolve stagnation and pain

Herbal Formula One: Dok's Formula (Du Huo Ji Sheng Tang)

III. Damp Bi Syndrome

Also called Fixed Bi (Zuo Bi)

Etiology and Signs

 Wind-Cold-Damp (but Damp dominant) invasion into joints

 Damp obstruct Qi and Blood flow

 Difficulty in movement (chronic); more stiffness than pain

 Pain relieves when exposed to heat and dryness

 Pain exacerbates when exposed to Cold-Damp (weather changed)

 Tongue: greasy with a pale coating

 Pulse: soft and slow

Treatment Strategy

 Resolve Damp and activate channel

 Eliminate Wind-Cold

Acupuncture Treatment

 SP-6: Strengthen spleen and resolve Damp

 SP-9: Strengthen spleen and resolve Damp

 ST-36: Strengthen spleen and resolve Damp

 Local points or A-shi points: Move local Qi and resolve stagnation and pain

Herbal Formula: Coix Formula (Yi Yi Ren Tang)

IV. Heat Bi Syndrome

Also called Febrile Bi (Re Bi)

Etiology and Signs

 Wind-Damp-Heat (but Heat dominant) invasion into joints, muscles and meridians

 Pain, redness, swelling and heat of joints, infectious arthritis

 Acute onset; fever or thirst

 Tongue: red with yellow coating

 Pulse: strong and fast

Treatment Strategy

 Clear Heat and activate Channels

 Eliminate Wind-Damp

Acupuncture Treatment

 GV-14: clear Heat and eliminate Wind, invigorate Yang, Qi-Blood

 LI-11: clear Wind-Heat and resolve swelling

 LI-4: clear Wind-Heat

 ST-44: clear Heat

 Local points or A-shi points: Move local Qi and resolve stagnation and pain

Herbal Formula: Bai Hu Si Miao Tang

V. Kidney Yang Deficiency Bone Bi Syndrome

Also called bony Bi (gu bi). Including hip dysplasia.

Etiology and Signs

 Kidney Yang Deficiency fails to support bone, back and knees

 Difficulty in getting up, walking

 Coldness in back and extremities, or soft stool

 Lameness worse in Cold/Damp; heat-seeking

 Tongue: pale and wet

 Pulse: deep and weak

Treatment Strategy

 Tonify Kidney Yang

 Eliminate Wind-Cold-Damp

Acupuncture Treatment

 Bai-hui: warm Kidney Yang and strengthen back

 Jian-jiao (#124): Hip dysplasia point in dog

 BL-23: Tonify Kidney

 BL 11: Influential point of bones and strengthens bones

 BL 40: Strengthen lower back and hind limbs

 BL 60: Aspirin point and disperse Wind and relaxes muscles

 GB-34: Influential point for tendons, ligaments and bones

 GB-39: Influential point for bone marrow

Herbal Formula One: Loranthus Powder (Sang-ji-sheng)

VI. Kidney Yin and Qi Deficiency (Bone Steaming)

Etiology and Signs

 Kidney Yin Deficiency leads to bone steaming

 Arthritis, weak in back and limbs

 Infections in discs, spondylitis

 Difficulty in getting up, walking

 Tongue: pink or pale

 Pulse: weak and deep

Treatment Strategy

 Tonify Kidney Yin and Yang

 Eliminate Wind-Damp

Acupuncture Treatment

 KID-3: Nourish Kidney and strengthen lower back

 LIV-3: Break up stagnation, nourish liver

 SP-9: Strengthens spleen, resolve Damp

 SP-6: Nourish kidney, spleen and liver

 LI-10/11: Dispels the Surface, tonification of Qi and Blood

 ST-36: Tonification of Qi and Blood

Herbal Formula: Di Gu Pi

Combination with the Local Acupoints

1.  Neck area: Jing-jia-ji, SI-16, LI-16

2.  Shoulder area: LI-14/15, SI-9, TH-14

3.  Elbow area: Zhou-shu, LI-10/11, TH-10, LU-5

4.  Carpus area: LI-4, SI-3, TH-5

5.  Vertebral column: Hua-tuo-jia-ji at the lesion areas, BL-11, GV-14, Bai-hui, Wei-jian

6.  Pelvic limb/hind ends: Jian-jiao, Er-yan, BL-54, BL-35, BL-36

7.  Coxofemoral area: GB-29/30, BL-54, Hou-tiao/hou/zhong

8.  Stifle area: BL-39/40, ST-35a/b, ST-36/34, GB-34/33/32

Conclusion

TCVM therapy including acupuncture and herbal medicine is highly effective for pain management of arthritis patients. Proper exercise and daily massage can enhance the results of acupuncture and herbal medicine.

Table 1. Acupuncture and herbal medicine for treatment of common patterns of arthritis

Pattern

Clinical signs

Acupuncture points
Herbal medicine

Painful (Cold) Bi

Joint pain, difficult movement, Heat relieves pain
Dislikes being massaged; Cold exacerbates pain
Tongue: purple or normal; slightly pale coating
Pulse: Tight and wiry pulse

GV-3/4, Bai-hui, BL-10/26, CV-4, + Local points Dok's Formula

Fixed (Damp) Bi

Difficult movement, more stiffness than pain
Heat and dryness relieves pain
Cold-damp (weather changes) exacerbates pain
Tongue: Greasy/pale coating
Pulse: Soft and slow

BL-20/21/22, SP-6/9, ST-40/36, + local points Coix Formula

Kidney Qi/Yang Deficiency Bi Syndrome

Difficulty getting up and/or walking
Coldness of back and extremities or soft stool
Lameness is worse in cold/damp or winter
Heat seeking, likes to be massaged
Tongue: Pale, wet
Pulse: Deep and weak

GV-3/4, Bai-hui,CV-4/6 (moxa), + local points Loranthus Powder

Kidney Yin and Qi/Yang Deficiency Bi Syndrome

Dry skin, thirsty
Lameness is worse in summer or hot conditions
Cool-seeking
Difficulty in getting up, lethargy
Tongue: Pale or red
Pulse: Thready and weak

BL-23, SP-6, KID-3/6/7/10Di Gu Pi

  

References

1.  Cantwell SL. Traditional Chinese veterinary medicine: the mechanism and management of acupuncture for chronic pain. Topics in Companion Animal Medicine. 2010;25(1):53–58.

2.  Suarez-Almazor ME, Looney C, Liu Y, Cox V, Pietz K, Marcus DM, Street RL Jr. A randomized controlled trial of acupuncture for osteoarthritis of the knee: effects of patient-provider communication. Arthritis Care & Research (Hoboken). 2010;62(9):1229–1236.

3.  Zhang QR, Fu WB. Osteoarthritis of knee joint treated with acupuncture and moxibustion. Zhongguo Zhen Jiu. 2010;30(5):375–378 [article in Chinese].

4.  Molsberger AF, Schneider T, Gotthardt H, Drabik A. German randomized acupuncture trial for chronic shoulder pain (GRASP) - a pragmatic, controlled, patient-blinded, multi-centre trial in an outpatient care environment. Pain. 2010;151(1):146–154.

5.  Kenney JD, McCormick WH. Manual therapy, acupuncture, and Chinese herbal medicine in the geriatric equine. In: Equine Geriatric Medicine and Surgery. 2006:79–114.

6.  Xie H, Ortiz-Umpierre C. What acupuncture can and cannot treat. Journal of the American Animal Hospital Association. 2006;42(4):244–248.

7.  McCauley L, Glinski MH. Acupuncture for veterinary rehabilitation. In: Millis DL, Levine D, Taylor RA, eds. Canine Rehabilitation & Physical Therapy. 2004:337–354.

8.  Rychel JK. Diagnosis and treatment of osteoarthritis. Topics in Companion Animal Medicine. 2010;25(1):20–25.

9.  Xie H, Preast V. Xie's Veterinary Acupuncture. Ames, IA: Blackwell Publishing; 2007:247–266.

10. Schoen AM. Veterinary Acupuncture Ancient Art to Modern Medicine. 2nd ed. St. Louis, MO: Mosby; 2001:161–178.

  

Speaker Information
(click the speaker's name to view other papers and abstracts submitted by this speaker)

S.H. Xie, DVM, PhD, MS
Chi Institute
Reddick, FL, USA


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