Allen M. Schoen, MS, DVM
Clinical Associate Professor, Tufts University College of Veterinary Medicine, Grafton, MA, USA; Affiliate Faculty, Colorado State University College of Veterinary Medicine, Ft. Collins, CO, USA; Director, VITA, Sherman, CT, USA
There has been a great increase in interest in veterinary acupuncture recently, both by the public and the veterinary medical community. With this increased awareness, there has been an increase in research and thus a better understanding of its physiologic basis and its clinical applications.
Acupuncture (AP) may be defined as the stimulation of specific predetermined points on the body to achieve a therapeutic or homeostatic effect. Acupuncture points are areas on the skin of decreased electrical resistance or increased electrical conductivity Acupuncture points correspond to four known neural structures. Type I acupoints which makeup 67% of all acupoints, are considered motor points. The motor point is the point in a muscle which when electrical stimulation is applied, will produce a maximal contraction with minimal intensity of stimulation. Motor points are located near the point where the nerve enters the muscle. Type II points are located on the superficial nerves in the sagittal plane on the midline dorsally and ventrally. Type III acupoints are located at high density foci of superficial nerves and nerve plexi. For instance acupoint GB-34 is located at the point where the common peroneal nerve divides into the deep and superficial branches. Type IV acupoints are located at the muscle tendon junctions where the golgi tendon organ is located (1). Recently, histologic studies have revealed that small microtubules consisting of free nerve endings, arterioles and venules penetrate through the fascia at acupuncture points. Based on this histologic evidence they have also been called neurovascular nodes (2).
Acupuncture has many varied physiologic effects on all systems throughout the body. No one mechanism can explain all the physiologic effects observed. The traditional Chinese medical theories have explained these effects for four thousands years based upon empirical observations and descriptions of naturally occurring phenomena. The traditional Chinese medical theories include: the five element theory and the theory of eight principles. Scientific research has been able to document many of these effects. The western medical theories include the gate and multiple gate theories, autonomic theories, humeral mechanisms as well as the bioelectric theories. The neural non-opiate or gate theory attempts to explain the analgesic effects of acupuncture. It involves the interaction of inhibitory interneurons on pain transmitting neurons. Recent reviews of the latest research on the neurophysiologic effects of acupuncture are available (2,3)
The neural opiate theory is based on evidence that acupuncture stimulates the release of endogenous opiates, endorphins and encephalins. This mechanism acts at several levels in the central nervous system to inhibit pain perception in higher centers and to inhibit pain transmission from the spinal cord via descending inhibition. The hormonal opiate theory involves the interaction of neurons with the subsequent release of humoral factors from the hypothalamic-pituitary axis. Acupuncture facilitates the function of the neuroendocrine system and has been found to have effects on ovarian, testicular, thyroid, parathyroid and pancreatic function (4). Through its effects on the neuroendocrine system and its homeostatic regulatory functions it has been found to effect blood pressure, pulse, respiration, gastrointestinal motility, hormone secretion, leukocyte production and accelerate the healing process (4).
Many of our somatovisceral reflexes may be explained through the autonomic theories of acupuncture. Cutaneous needle stimulation is transmitted to the internal viscera through the somatovisceral neuronal synapses in Laminae I & V of the spinal cord. Essentially, acupuncture stimulates various sensory receptors (pain, thermal, pressure, touch) which stimulates sensory afferent nerves which transmit the signal through the central nervous system to the hypothalamic-pituitary system. Various neurotransmitters and neurohormones are then released and have their subsequent effects throughout the body. A detailed description of the physiologic basis of acupuncture is reviewed by Steiss (5).
TECHNIQUES AND INSTRUMENTATION
There are numerous techniques to stimulate acupuncture points. The following modes of stimulation are commonly used in veterinary acupuncture: dry needle stimulation, electroacupuncture, aquapuncture, moxibustion, laser stimulation, gold implants and acupressure. Each method has its indications and limitations. Details of these techniques are described by Altman (6).
Acupuncture point selection is based on locating points on the body where stimulation will produce a beneficial change in the central nervous system by modulating ongoing physiologic activity. The number of treatments required depends upon the condition treated and the chronicity of the problem. The length of treatment varies from 5 to 30 minutes.
Acupuncture has been found to be beneficial therapeutically in the treatment of various musculoskeletal, gastrointestinal, neurological, reproductive and respiratory conditions in veterinary practice. Musculoskeletal conditions that may benefit from AP include chronic degenerative joint disease, nonsurgical cervical and thoracolumbar disc disease, immune-mediated myopathies, trigger point patterns and soft tissue injuries (7). Neurological conditions treatable with AP include nerve paralysis, epilepsy, coma, cerebrovascular accidents, various neuropathies, neuritis and neurogenic deafness (8). AP may be beneficial in the treatment of most immune-mediated conditions via its immunomodulatory effects, both stimulating or suppressing immune responses (9). Cardiovascular conditions such as cardiac and respiratory depression and arrest, shock, arrhythmias and congestive heart failure may benefit form AP as an adjunctive therapy (10). AP has a normoregulatory effect on GI motility, thereby being an excellent adjunct to the treatment of any vomiting or diarrhea (11). It also can be of benefit in the treatment of pancreatitis and various hepatopathies. AP can help with various reproductive disorders through its neurohormonal regulatory effects (12). AP is also being used as an excellent perioperative and postoperative analgesic therapy (13). Acupuncture does not just relieve the pain and mask a problem but actually may accelerate the healing process, restore homeostasis and resolve many conditions through its normoregulatory effects.
Acupuncture is an exciting new (yet ancient) diagnostic and therapeutic technique that one can incorporate into a conventional veterinary practice. It offers an additional approach to diagnostic and therapeutic dilemmas that may not have adequate answers based on conventional western medicine. It may also be of benefit when conventional medicine and surgery are not available. Further research will continue to explain the physiologic basis of acupuncture.
Acupuncture will continue to be incorporated into veterinary practice as an additional complementary therapy and as an adjunct to our therapeutic armamentarium as we develop a further understanding of its mechanisms of action. The latest textbook on veterinary acupuncture offers comprehensive descriptions and references on all aspects of veterinary acupuncture.
1. Hwang Y., Egerbacher, M., Anatomy and Classification of Acupoints. In: Schoen A M, Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, St Louis, MO., 2001. 19-26.
2. Kendall, D., Dao of Chinese Medicine, Oxford University Press, N.Y., 2002. 256-285.
3. Steiss, J., The Neurophysiologic Basis of Acupuncture, in Schoen, A., 2ed. Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, St Louis, MO., 2001.
4. Ulett G. Principles and Practice of Physiologic Acupuncture, St Louis: Warren Green Inc.,1982.
5. Altman, S., Techniques and Instrumentation. In: Schoen, A.M., Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, St Louis, MO., 2001.
6. Schoen, AM, Acupuncture for Musculoskeletal Disorders. In: Schoen, A.M., Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, St Louis, MO., 2001. 161-170.
7. Kline, K, Caplan, E, Joseph, R., Acupuncture for Neurologic Disorders. In: Schoen, A.M., Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, St Louis, MO., 2001. 179-192.
8. Bierman, N., Thompson, C, Acupuncture for Immunologic Disorders. In: Schoen, A.M., Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, St Louis, MO., 2001. 269-280.
9. Smith, F., Acupuncture for Cardiovascular Disorders. In: Schoen, A.M., Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, St Louis, MO., 2001. 212-216.
10. Dill, S., Bierman, N., Acupuncture for Gastrointestinal Disorders. . In: Schoen, A.M., Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, St Louis, MO., 2001. 239-260.
11. Lin, JH, Chan, W, Wu, L., Acupuncture for Reproductive Disorders. In: Schoen, A.M., Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, St Louis, MO., 2001. 261-268.
12. Klide, A., Gaynor, J., Acupuncture for Surgical Analgesia and Postoperative Analgesia. In: Schoen, A.M., Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby, St Louis, MO., 2001. 295-302.