Introduction to Acupuncture Techniques Ancient Art to Modern

Introduction to Acupuncture Techniques Ancient Art to Modern Science

Comparison of East & West East Ø • • West Empirical Ø Scientific Method & Observations over Case-Based Thousands of Years Medicine • Technology of Art of Medicine Holistic View • Molecular & Organ Circular Logic View Energetic • Linear Logic • Mechanistic

Science versus Art Ø Over the last 10 years, there has been no change in mean life expectancy in human beings, dog or cats Ø There is an increase in incidence of inflammatory diseases and cancer over our ability to detect the conditions

Acupuncture: History Sun Yang Alias Bole Veterinarian Qinmugong period 659 B. C. to 621 B. C. Bole Zhen-jing Z

Bole’s Canon of Veterinary Acupuncture Ø Sun Yang Ø 659 to 621 B. C. Ø Bole Zhenjing

Acupuncture: History Yuan-Heng’s Therapeutic Treatise of Horses Yuan Heng Liao Ma Ji l l l 1608 Benyuan Yu Benheng Yu Veterinarian Ø Ming Dynasty Ø 1368 to 1644 Ø

Basic Tenets of AP Based upon the AP point selected Ø Based upon the method of stimulation Ø l l Dry needles Electrical AP Aquapuncture Hemoacupuncture Ø Based upon the length of stimulation Ø Low-rate, twisting stimulation of GV 26 leads to endorphin response, while high-frequency needling of GV 26 leads to epinephrine response

Basic Acupuncture Techniques Stone needles: 8, 000 years ago Bones needles: 3, 000 years ago Needles Metal needles: 2, 200 years ago Gold/silver needles Electro-acupuncture Bamboo needles Embedding Fine needles Injectable AP Zhen-jiu Ai-jiu (moxa): moxibustion Moxibustion New Acupuncture aquapuncture & pneumo-AP Alcohol (huo-jiu) Laser therapy Herbal moxibustion Magnetic therapy Needle + Moxa Infrared therapy (TDP) Fire-needling

Long Nine needles (2, 200 years ago) Sword Fine Pressure Arrowhead Round Sharp Round/Sharp Large

Arrowhead needle Sharp needle Sword needle Round needle sharp needle To drain abscesses To bleed superficial vessels (TCM Surgical tools) Round needles Pressure needles Acupressure (Not penetrate the skin) Fine or Filiform Long/Large needles Penetrate the skin at known acupuncture points (commonly known acupuncture)

Dry Needle Acupuncture or Conventional Needling Techniques Ø Dry Needle (White Needle)- -Bai-zhen l l l Not intentionally bleeding Most common treatment modality in veterinary and human practice Filiform needles • Sterile needle l l With tube Without tube l Can be applied in most acupoints (GV-1, LI-4) l Can be used any patterns of disease

Acupuncture Needle Diameters in Gauge and Millimeters Gauge Millimeters Application 40 0. 15 38 0. 16 Hand/feet Needle “Baby” needle 36 0. 20 34 0. 22 Cats, little dogs 32 0. 25 All the Small animals (dogs/cats/birds) 30 0. 30 Horses, cattle, llamas, pigs 28 0. 35 Large animals: horses, cattle, elephants

Acupuncture Needle Diameters in Gauge and Millimeters Inches Application 7 0. 25 (Korean Dogs/cats: around eyes, nose, feet, or sensitive Hand Needle) patients 13 0. 5 Dogs/cats: head, feet, lower limbs, ear, tail, mu pts Horses: ears/eyes, feet 25 1. 0 Dogs: back-shu, neck, shoulder, limbs Horses: feet, lower limbs, head, tail 40 1. 5 Dogs: hip, shoulder Horses: back-shu, mu points, limbs 50 2. 0 Dogs: hip, cervical hua-tuo-jia-ji for big dogs Horses: back-shu, limbs 75 3. 0 Horses: hip 100 4. 0 Horses: hip

How to needle an acupoint Ø Ø Preparation l Needle l Animal l Practitioner Insertion of a needle l Pressing hand l Angle l Depth Ø Manipulation of a needle Ø Withdrawal of a needle

How to needle an acupoint: preparation Ø Needle l Sterile disposable • The tip should be smooth & sharp as a pine needle l Horse • Size l 0. 30 -0. 40 mm (#28 -#30) • Length l l l 13 mm (1/2’): in extremities (feet, tail, ear, head) 25 mm (1’): in lower limbs, head 50 mm (2’): in the trunk, back 75 mm (3’): in shoulder, hip 100 mm (4’): hip

How to needle an acupoint: preparation Ø Needle l l Small animal • generally thinner • not too thin l Dog: • Size l 0. 25 (#32) • Length l l l 13 mm (1/2’) 25 mm (1’) 50 mm (2’): large dog Cat: • Size l 0. 25 (#32) • Length l 13 mm (1/2’)

How to needle an acupoint: preparation Ø Animal l quiet l relaxed (house call benefit) l l Restrained if needed (nose twisted), but not sedation/tranquilized The site of acupoints • nice and clean

How to needle an acupoint: preparation Ø Practitioner l l l Sound plan of acupuncture treatment Considered as a surgical procedure others

How to needle an acupoint: Insertion Ø Pressing Hand l 1. Thumbing l 2. Pinching 1 2

How to needle an acupoint: Insertion Ø Pressing Hand l 3. Holding l 4. Stretching 3 4

How to needle an acupoint: Insertion Ø How to insert a needle l Jabbing: a quick insertion (Flying technique) • 0. 5’ (13 mm) l l #28 to 30 for horses #30 to 32 for small animals l tube guiding l Twirling: a slow insertion

How to needle an acupoint: Insertion Ø Angle l l l Perpendicular insertion Angular insertion Horizontal insertion Ø Depth l l Location De-Qi response Condition Patient

How to induce De-Qi 1. Up-down thrusting Ø 2. Left-right twisting Ø 3. Flicking Ø 4. Scraping Ø 2 3 1 4

Quantity/dose of needle stimulation Ø Intensity l l De-Qi Response Intermediate Mild Ø Duration of stimulation l l l Short: < 5 min Long: >60 min Intermediate: 10 to 30 min

Withdrawal of a needle Ø Twirling Ø Pulling the needle out Ø Pressing the point after withdrawal l l Pressing---tonification No pressing ---sedation

Practice needling an acupoint Ø Orange Ø a layer of paper Ø a ball of cotton Ø on self Ø health animal Ø real case

Elbow, sore throat, fever, abdominal pain, vomiting, diarrhea, hypertension, seizure, conjunctivitis LI-11

l PC-6: over the median nerve • 2 cun above the wrist Indication: nausea, vomiting, chest pain

Dry Needle Acupuncture Ø Manipulating needles until "De‑Qi" response Ø 10 to 30 min, manipulated once every 3 to 5 min Ø Indication: Any diseases l Or starting technique

Electro-acupuncture techniques History Ø After electro-acupuncture (EA) analgesia was found effectively to perform a surgery in China in the early 1970's, EA has been widely used in TCM practice.

Advantage: Ø Ø Ø 1) More effective 2) Less treatments 3) Fewer acupoints 4) Save labor to manipulate the needles (Classically, the needles should be manipulated every 2 to 3 minutes). 5) Objective control of frequency and amplitude l l Amplitude (intensity of stimulation): a tolerance level Frequency: • Low level: pain ----> beta endorphin mediated • Medium level: segmental ----> enkephalin mediated • High level: internal medicine----> serotonin mediated

Methods: Acupuncture Points: 6 to 10 points Frequency: 20 Hz, 80 to 120 Hz or 200 Hz Electrical intensity: gradually goes to the point the patient can tolerate Indications: 1) Pain management a) Bi syndromes (arthritis) b) Soft tissue injuries c) Disc problems d) colic/abdominal pain 2) Peripheral nerve paralysis a) facial b) radial c) others 3) Gastrointestinal conditions: vomiting, diarrhea, constipation, indigestion 4) Muscle atrophy

Contraindications: Ø 1) Weak/deficient patients Ø 2) Heart problems Ø 3) Seizure/epilepsy Ø 4) Tumor

How to Use the Electronic Acupunctoscope Ø Dial the AMPLITUDE and FREQUENCY to zero Ø Plug the wire leads into sockets 1 to 7 and fasten the clips to the handles of needles Ø Set the desirable frequencies and wave forms l low frequency F 1 = 20 -30 Hz • Indication: pain conditions • Endorphin release • C fiber is sensitive to less than 10 Hz of electrical stimulations • 20 to 120 Hz stimulates A α and A β l moderate frequency F 1 = 80 -120 Hz • Enkalphalin release • Indications: internal medical conditions (diarrhea etc)

How to Use the Electronic Acupunctoscope Ø Wave Form: depends on how F 1 and F 2 is set up l Continuing Wave: F 1=20 -200 and F 2=0 • Indications: pain conditions l Intermittent wave: F 1=0 and F 2=>0 • Indications: muscular atrophy l Dense and Disperse (DD) wave: F 1=80 and F 2 =120 • Indications: nerve paralysis and internal medical conditions

How to Use the Electronic Acupunctoscope Ø Turn on the power 3 Ø Gradually increase AMPLITUDE buttons until the patient can tolerate l Ø Can increase amplitude a little bit every 5 minutes. Turn off power to terminate the acupuncture treatment

How to Use the Electronic Acupunctoscope Ø The output socket between 4 and 5 is only used for the needleless technique, which acupuncture points are stimulated using the needleless electrode. Fill the cup of electrode with absorbent cotton soaked with saline. Tape the electrode onto the acupuncture points.

Electro‑acupuncture: how to pair the points Ø Bilateral connection l l Ø Same Channel connection. l l l Ø GV-14 + Bai-hui for disk disease, vestibular dx LI-10 + LI-15 on the same side for shoulder pain Tip of tail + GV-20 for vestibular dx, disk disease Local connection l l Ø Pair BL-54 on left side to right BL 54 for hip dysplasia; Hua-tuo-jia-ji on the left to right side for disk diseases BL-21 on the left to right BL-21 for vomiting KID-1 on the left to right KID-1 for rear weakness TH-14 + LI-15 on the same side for shoulder pain GB-34 + ST-35 on the same side for stifle pain Same energetic connection l l ST-36 + GB-34 on the same side for vomiting, rear weakness ST-36 + BL-20 on the same side for SP Qi deficiency

Electro‑acupuncture: how to pair the points Ø From the top to bottoms for paralysis l l l Ø Cover large areas l Ø BL-54 + KID-1 for rear limb paralysis PC-8 + GV-14 for front limb paralysis GB-21 + HT-3 for front limb paralysis BL-20 on the left + right BL 28 for T-L-S IVDD Normal area to sick area l l BL-21 to KID-1 for no deep pain caudal to BL-22 ST-5 left to right for right facial paralysis

Electro‑acupuncture: how to pair the points Ø But, we must pay attention to the following: l l The wire (lead) should NOT be connected around the abdominal areas for pregnant moms The wire (lead) should NOT be connected through the chest if the patient has a pacemaker The wire (lead) should NOT be connected through the tumor mass Caution for seizure dogs when using EA

Aquapuncture (point injection) Ø History: l Ø Herbal medication for pigs: very challenge l • Injectable herbal liquid (Angelica Dang Gui) l l Patient own blood for chronic eye blood Fire Constitution of Animals • Will not remain still l Some of points not available with dry-needling or EA Points: l Ø Acupoints: except for hemo -acupoints A‑shi Point Needle: l l Dogs/cats: 25 -27 ga Horses: 20 to 22 ga

Aquapuncture (point injection) Ø Technique: l l Insert needle After "De‑Qi" occurs, the injection is given 1 -8 points per treatment Once every 3 -7 days, for 3 to 5 times t

Aquapuncture (point injection) Ø Injectable agents l Herbal liquids • Angelica sinesis (Dang‑gui) • Carthamus tinctorius (Hong‑hua) • Coptis chinensis (Huang‑lian) • Andrographis paniculata (Chuan‑xin‑lian) l Medications • Sterile water • • • 5‑ 10% dextrose 0. 25‑ 0. 5% procaine Vitamin B 1, B 12, or B complexion • Antibiotics • Anesthetics, sedatives or anti‑rheumatics • Biological products: l l Antitetanolysin Vaccine • Homeopathic remedies • Patient’s own blood 1 - 15 ml each point for large animals 0. 1 - 1 ml each point in small animals

Acupuncture point embedding (Implantation) Ø Point injection of a solid substances l l Ø Thread/catgut/suture Magnetic beads or pellets Gold bead/wire Biodegradable plastics Uses l l l Diarrhea in young animals Hip dysplasia Epilepsy Lameness Eye infection

Hemoacupuncture Ø Also called Red Needle l Ø Intentionally puncture a blood vessel to draw blood Needle: l l a sharp traditional needle (three edged needle, or wide needle) hypodermic needle • #27, 25 for small animals • #25, 23, 20 for large animals Ø Only used for specific points that have a history of hemoacupuncture in TCVM such as Er-jian, Wei-jian, Tai -yang, Xiong-tang

Hemoacupuncture Ø Indications: l l l Ø Contraindications and cautions: l l l Ø Blood Stagnation Blood Heat Excess Heat Weak and debilitated animals Qi or/and Blood Deficiency Dehydrated or severely Yin-deficient patients Pregnant animals Patients with potentially zoonotic blood-borne pathogens Hemoacupuncture can not repeat the same point for a week

Pneumo-acupuncture Inject fresh air into an acupoint Ø Subcutaneous tissues Ø Local ash Point (the worst atrophied spot) Ø Equine: Gong-zi for shoulder atrophy Ø Canine: 5 to 50 cc of air Ø Indication Ø l l Ø Shoulder atrophy Hip atrophy Avoid the head

Moxibustion Ø Using burning herbs to stimulate acupoints l Originates from the Japanese "mogusa“ • “moxa" or "moxibustion“ Ø Crushed dried leaves of Artemisia argyi (Ai-ye) Ø Therapeutic effects: l l Ø dredging meridians dispelling cold and wind reviving Yang for resuscitation promoting functional activities Moxa sticks: 20 cm in length and 1. 5 cm in diameter

Moxibustion Ø Mild moxibustion: l l Ø 1 to 2 cm distance against the acupoint 5 to 10 min. for each point Circling moxibustion: l l With a circulating motion For larger area of rheumatism • Ø Pecking moxibustion: l l With a pecking motion touches the skin 2 to 5 min For chronic diseases which need stronger stimulation

Moxibustion Ø Moxa cone Moxibustion l Direct Moxibustion • up to 5 zhuangs l Indirect Moxibustion • a slice of ginger or garlic placed b/w the burning cone and the acupoint. • The ginger or garlic slice is about 3 mm thick with some pores Ø Moxa + Needling

Laser Acupuncture Ø History l Later 1970, Laser acupuncture for diarrhea in goats and sheep in Inner Mongolia using CO 2 laser at GV-1 • CO 2: no light • Can be very dangerous Ø 5 -30 m. W Helium-Neon (He-Ne laser): or cold laser l l l Ø infertility, anti-inflammatory, analgesic, and promotes wound healing cannot penetrate accurately and deeply into most acupuncture points because the light is refracted in the first 1 -15 mm of tissue Almost no effect if less than 5 m. W. Treating superficial acupuncture points in areas of thin integument l l l Avian: skin is generally very thin Lie Que (Lung 7) Jing-well points.

Infrared Acupuncture Ø Radiation heat (moxibustion) Ø 250 W infrared bulb Ø TDP lamps (Teding Diancipo Pu): l l Ø Indication l l Ø Heat a metal plate constructed from numerous mineral substrates Developed in Chong-qing, China in the 1980’s. Bi syndrome Wound Caution: avoiding too hot.

Auriculotherapy Ø Origin: tip of ear Ø Human auriculotherapy l l Germany 1950’s China • • Diagnosis Treatment Ø Canine ear points l l Diagnosis Treatment

Other Acupuncture techniques Ø Cupping Ø Tui-na (massage and chiropractic) Ø Scalp acupuncture Ø Microwave acupuncture

How to Approach AP Patient Ø Take history, do exam & make pattern diagnosis Ø Start with Dry Needles l l Ø 10 -15 needles unless strong or weak Treat 15 -30 minutes Follow with B-12 aguapuncture l 5 -8 points

How to Approach AP Patient Ø Re-assess pattern diagnosis Ø Start with Dry Needles l l Ø EA l l l Ø 10 -15 needles unless strong or weak Treat 15 -30 minutes 10 minutes @ 20 Hz 10 minutes DD 80 -120 Hz 5 -10 minutes 20 Hz Follow with B-12 aguapuncture l 5 -8 points

TCM Prayer Ø Just for today, I will let go of my anger. Ø Just for today, I will let joy in my heart. Ø I will not worry or be sad. Ø Just for today, I will embrace life. Ø I will live without fear, in harmony with myself and the Universe.