Techniques of stimulation of the acupuncture points

INTRODUCTION

Traditional Chinese Medicine (TCM) is several millennia old. Its main therapeutic procedures are Ben-cao (Herbology) and Zhen-jiu (Zhen = needle; Jiu = Fire) but other methods (massage, diet, exercise, meditation etc.) are used also.

Zhen (needle) = acupuncture (AP); it literally means needle puncture (acus = needle) but the term has a more general meaning: stimulation of specific AP points in the superficial areas of the body by many different methods. Jiu (Fire) = moxibustion (combustion of mokusa (Japanese term for burning herbs) is the direct or indirect application of heat to the AP points. These will be dealt with in detail.

Other methods of stimulating the AP points will be discussed briefly. These include point injection; "dermojet" injection; implantation; incision of the points; application of heat or cold; massage, pressure or vibration of the points; cupping or application of a vacuum to the points; electro-AP (EAP); transcutaneous electrostimulation, faradism; application of magnetic, static, electromagnetic or electrostatic fields to the points; ultrasonic stimulation and laser stimulation. Rare methods of stimulation include concentration of "psychic energy" and "hand energy" to the points without actually touching the animal.

The most important aspect of AP is not the precise method of stimulation but to apply an adequate stimulus to the correct points. Methods of choosing correct points are discussed elsewhere.

NEEDLING (ZHEN)

In traditional AP, 9 types of needles were used. Some of these were like scalpel blades or lances and must have inflicted severe pain on the animal. These are seldom if ever used in western AP today. To avoid unnecessary suffering, the finest needles possible should be used. In practice, this means using 25-32 gauge needles in small animals and 19-25 gauge needles in large animals.

The length of the needles depends on the species of animal and on the location of the points to be needled. Points over bony areas, such as the scalp, face, ears and distal limbs require the shortest needles. Those over the thorax, abdomen and lightly muscled areas require medium length needles and those over heavily muscled areas, such as the lumbar area, the hindquarter (buttock and thigh) area and the heavy muscles of the shoulder area require the longest needles.

In general, needle lengths ranging from 10-50 mm should suit all purposes in small animals and needles 10-100 mm should suit all purposes in large animals. In human surgery under AP analgesia, occasionally very long (up to 250 mm) needles are placed parallel to the incision site, one on each side of the wound. This method is seldom used in veterinary surgery.

The needles can be of two types (a) special solid, stainless steel AP needles, made of very high quality steel wire and (b) standard hypodermic needles.

a. AP needles: The cheapest needles are made in China and Taiwan but many other eastern and western countries make AP needles. They are available through APsupply houses. The cheapest source is via Hong Kong mail-order houses, such as Mayfair Medical Supplies, which accepts international credit cards and orders can be placed by Fax (852-721-2851).

Human-type needles are suitable for small animals but they are too fine for use in large animals. The problem is that muscular twitching and spasm, which frequently occurs during the needling session (especially when the needles are electrically stimulated), can twist the fine needles into bizarre shapes (L-shapes, Z-shapes and U-shapes etc), making them difficult to extract and destroying them for future use. AP needles are expensive and between 1 and 20 may be required during a session. If 6-12 needles are bent or destroyed each time, the cost in one year can be high. Therefore, the thicker needles (19-25g) are used in large animals. Even then, some of them will be bent during therapy. Chinese (Yuan Li) needles, 30 mm long and 21 gauge wide are ideal for use in large animals. Similar vet needles made by the Richter Company, Wels, Austria, are also available.

b. Standard hypodermic needles have the advantage of being very cheap and disposable but they have the disadvantage of causing more pain and they may introduce dirt or skin into the tissues because they have a lumen. They also cause more tissue damage and bleeding.

Before use, each needle should have been properly sterilised. It should be checked to ensure that it has no physical defects such as a blunted or hooked tip, bent or rusted body or loose handle. The points are clipped and cleaned with alcohol or other antiseptic solution. In my opinion, unless the skin is visibly dirty, attempts to clean it by alcohol swabbing or by aerosol spray are a public-relations exercise more than a useful hygienic procedure. Clipping makes the points easier to find on subsequent visits. Occasionally clipping is omitted, as some owners may object to their animal being clipped in up to twenty places.

Insertion of needles: The animal should be restrained adequately. Hypodermic needles can be inserted to the required depth in one swift, firm movement. In nervous or dangerous horses, it may help to have a twitch placed on the horse's upper lip, or ear, and to apply counter-pressure to the point (using, for instance, the plastic needle cover) with one hand as the needle is thrust home with the other hand.

AP needles need a different technique. They are inserted by a push-twirl technique in two stages: the first movement to penetrate the skin and the second to place the needle to the required depth in the tissues. With longer needles, it is useful to hold the needle shaft with one hand about 25 mm from the tip (using a cotton-wool bud or piece of sterile tissue) and to push-twirl the handle of the needle with the other hand. Alternatively, a stainless steel or plastic needle guide can be used. Needle guides are hollow tubes, about 10-13 mm shorter than the needle. The guide is placed firmly on the point and held with one hand. The needle is inserted into the tube and the needle-handle, protruding from the guide, is tapped firmly with the finger of the free hand to drive the needle 10-13 mm deep. The guide is then removed and the needle is advanced to the correct depth.

It is not possible to give an exact depth or direction for needle insertion: these vary between points (within species) and between points (between species). The direction of insertion depends on the body region being needled. Over muscular areas, the needle is usually inserted at 90^o to the skin, deep into the muscle. Over bony areas and on Earpoints, the needle is inserted perpendicularly until- the skin is penetrated and then is advanced subcutaneously. One should not normally needle the periosteum (except in cases where this is specifically indicated) or the ear cartilage. Accidental striking of bone can bend the tip of the needle, making it difficult to extract and destroying the tip.

Penetration of the human ear cartilage can cause a chronic auricular chondritis which can be very difficult to cure. In animals (because ear AP is less commonly used than in humans) this problem is uncommon but, it is safer to avoid penetrating the cartilage. Penetration of the thoracic or abdominal cavities is normally forbidden, except in specific cases, such as aspiration of fluid or releasing gas from the viscera etc. Therefore, when needling points over the thorax and abdomen, the needles are usually inserted at 45^o, to reduce the risk of accidental penetration into the cavity. Penetration of major arteries (such as the carotid) or of sensitive organs such as the eye is forbidden.

The depth of insertion also varies within and between species. In large animals the needles can be inserted up to 100 mm deep in certain points, such as those over heavy muscles, or when the needle is obliquely inserted in certain points on the head. However depths of 25-50 mm would be more usual. Certain points are merely pricked to a depth of 3 mm or so. The exact depth and direction of needle insertion is described for each point in the vet AP textbooks, such as those of Westermayer, Brunner, Klide and Kung etc.

In small animals heavy muscle groups would be needled to depths 10-50 mm, depending on the amount of muscle. Pricking of certain points and shallow needling (up to 10 mm deep) of other points is applied as in the human textbooks. (The Chinese have no texts on small animals and Western vets have to approach these species by reference to similar human conditions).

In humans and in animals, the most active points are over peripheral nerves especially main nerves, such as the trigeminal, facial, radial, median, ulnar, sciatic, spinal nerves etc. Nerves running on and in the muscles are also very important. The acupuncturist deliberately inserts the (very fine) needles directly through these nerves. Nerve stimulation (by twirling the needle clockwise and anticlockwise and pecking it up and down) causes very specific sensations (De Qi) in humans. Shooting sensations (paraesthesia), numbness and heaviness must be elicited, otherwise the needle is not exactly in the correct position. Once the needle is correctly in the nerve point and De Qihas been attained, care is taken to avoid further pecking motion with the needle to avoid physical damage to the nerve. This is more important when hypodermic needles (with sharp cutting edges) are used.

When the needle is correctly placed and stimulated, a local reflex muscle spasm grips the needle tightly, "like a fish taking the bait". The response is felt both by the patient and the acupuncturist. Animals, however cannot tell the acupuncturist what they feel. Thus, vets have to seek the objective signs of strong nerve stimulation. Animal reaction to this may differ, but shivering, local muscle twitch, vocalisation, lifting of a limb, attempts to escape, bending of the back, swishing the tail, lowering of the head and defensive reaction may occur during strong stimulation. The needle should be tightly gripped by the tissue, as in humans.

Tonification and sedation techniques: Classic methods of manipulating the needle are different if the diagnosis indicates a definite excess of Qi in a meridian (SHI diseases = excess Qi) or definite deficiency of Qi in a meridian (XU diseases = deficient Qi). These topics are discussed further in the paper on "Holistic concepts of health and disease". In SHI diseases use XI (Sedation) technique. In XU diseases use BU (Tonification) technique. In both methods, the needle is manipulated until De Qiarrives (i.e.) until sensation of tingling, numbness, heaviness and gripping sensation needle occurs.

In BU (tonification) technique the needle is thrust in heavily and rapidly. It is rotated (twirled) with small amplitude and low frequency and is lifted gently and slowly before the next rapid and heavy thrust.

In XIE (sedation) technique the needle is thrust in gently and slowly. It is then twirled strongly (large amplitude) at high frequency and is lifted forcibly and rapidly before the next gentle and slow thrust. The techniques are summarised below.

Duration of needling: Needles are usually left in position for 10-30 minutes in conditions such as rheumatism, muscle pain, arthritic lameness etc. Occasionally the vet may be too busy to wait for up to 30 minutes until the needles are withdrawn. In these cases the farmer or owner may be instructed to twirl the needles for 10 seconds every 2-4 minutes, until 10-30 minutes have elapsed and to remove the needles then. (In this case, disposable needles are used). In some cases, for instance rhinitis, conjunctivitis, shock etc, duration of needling can be very short, 10-60 seconds.

Textbooks seldom indicate whether quick needling or longer duration of needling is required. In general, for paralysis and painful conditions (especially of the muscles) long duration of needling (up to 30 minutes) is indicated, whereas for most other conditions a quick needling is sufficient. Some Chinese sources claim that if De Qi is obtained, there is no advantage to be gained from leaving the needles in situ for 10-30 minutes, except in certain chronic conditions, such as peripheral nerve damage. Thus, a short, quick, strong needling may replace the longer, more gentle method in many diseases.

Needles falling out: If (having been properly planted at the beginning) a needle falls out during treatment, it is usually left out. Relaxation of the muscles around the needle is taken to indicate sufficient stimulation for that point.

Other types of needling: The textbooks describe other types of needle - the blood needle and the fire needle.

The blood needle is a thick needle or lance used to puncture points over superficial blood vessels to allow a small amount of blood to escape. A mild haematoma around the puncture would may cause longer stimulation of the point than if a fine needle were used. However this method has few adherents at best.

The fire needle is a thick needle which is heated before use by burning a swab soaked in alcohol on the needle. It is then plunged in the tissues, taking special precautions. This method is seldom used in the West.

Moxa-needle: This method is used widely, especially in muscle rheumatism and "Cold Diseases", such as chronic infertility in cattle. ln this method, standard APneedles are inserted into the points as usual. A piece of moxa about 20 mm long and 20 mm diameter is pushed aver the handle of the needle and is ignited. The moxa burns slowly for 5-10 minutes and the heat is transferred to the needle and the tissues. This method is not painful and does not usually cause noticeable tissue damage. At the end of the session the animal may be sweating profusely near the needle site and occasionally in other areas if multiple needles are used. (It is well known that heat applied to the trunk will cause reflex sweating of the face in humans).

POINT INJECTION

This method is popular in human and vet AP. It has two advantages (a) it is much quicker to use than classic needling and electro-needling and (b) it produces stimulation which lasts for up to 1 hour or more after injection.

The points are chosen in the usual manner. Standard precautions of needle sterility and skin cleanliness are taken, and sterile solutions are used. Disposable hypodermic needles, 19-25 gauge (depending on species) are inserted to the correct depth. The needles are manipulated to elicit the needle reaction (De Qi) as described above. Then a syringe is attached and 1-10 ml of solution is injected. Small volumes are used in small animals and on Earpoints. Larger volumes are used in large animals and in muscular areas.

The choice of solution is largely a matter of personal preference: aqua pro injectione; sterile saline; weak glucose saline; very dilute Lugol's iodine; 0.25-0.5% procaine or lignocaine or xylocaine solution; "Impletol" (a procaine solution manufactured by a German pharmaceutical firm, Bayer); Sarapin; P Block; dilute Vitamin B12, B1, or C solution; very dilute sodium salicylate solution; DMSO/B12 saline; placental fluid etc.

If orthodox drugs, suitable for intramuscular injection (such as antibiotics, hormone solutions, electrolyte solutions etc) or plant extracts (as in Chinese herbal medicine) are indicated, they can be diluted, as needed, before injection into the points. Alternatively, they can be given subcutaneously over the points if they are suitable for s/c injection. Some vets claim that drugs injected at the correct AP points have clinical effects at much smaller dose rates than if they were injected in random (usual) sites. This claim, however, is not proved.

In Austria, Germany and France, homeopathic remedies are widely used in human and animal medicine. Special injectable preparations are available from the homeopathic supply houses. Vets who use the system claim that the clinical results are markedly improved if the correct homeopathic drugs are injected into the correct points for the pathological condition. Walter Greiff (Memmingen) uses this method to great effect. I have witnessed two almost incredible responses to his treatment. (1) A cow with total rumen stasis, anorexia, depression and drop in milk yield was found to be very sensitive on a point in the intercostal space between ribs 9-10, left side. This point corresponds with one of Kothbauer's "Rumen Points". One needle was used to inject the point with Spasmovetsan (homeopathic: Chelidonium, Colocynth, Nux Vomica; potency 1-2; Willmar Schwabe, Karlsruhe, Laupheim, West Germany). Within three minutes the cow began to eat and I confirmed that the rumen was now active. (2) A calf in extremis with scouring, dehydration, hypothermia, limb spasticity and opisthotonos (probably E. coli enterotoxaemia) had needles placed at Jen Chung (GV26), Ya Men (GV15), Ta Chui (GV14); Feng Chih (GB20); Hsin Shu (BL15); Chi Hai (CV06). The points (except GV26) were injected with a mixture of Dysenteral (homoeopathic: Arsen alb., Rheum., Podophyllum; c. 30 preparations Waldemar- Weimer, Baden, West Germany), Laseptal (homoeopathic: Lachesis, Echinacea ang., Pyrogenium, Chlorophyll; potency 1-14; Willmar-Schwabe, Karlsruhe, Laupheim, West Germany) and 5 ml Borgal (sulphadoxin/ Trimethoprim). An electrolyte powder was left with the farmer for administration as fluid replacement therapy. Within 20 hours the calf was remarkably improved and standing. In my opinion, the Borgal and electrolyte alone by conventional routes, would not have saved that calf. These two cases were treated by Walter Greiff, Memmingen.

Injection of scar tissue: The importance of treating tender areas along scars, (especially those which cause marked twisting or distortion of tissue on a major meridian) has been discussed elsewhere. Such scars can be quickly treated, using a dental or tuberculin syringe, set to deliver 0.1-0.2 ml/point. The solution (Impletol or procaine solution) is injected intradermally at a depth of 2-5 mm, using a very fine (c. 25 gauge), short (2.5-10 mm) needle. The scar is injected at intervals of c. 4 mm along its length, (i.e.) about 11 shots along the length of a 40 mm scar. Some experts inject straight into the centre of the scar. Others inject from the periphery of the scar, towards its centre. Still others inject only the tender (sensitive) parts of the scar.

The use of Dermojet instrument (see next section) is ideal for treating scar tissue. Scars should be injected c. 3 times at intervals of 2-7 days, as part of the general APtherapy. If scars are in accessible areas, the owner is encouraged to massage the area as strongly as the animal will allow for c. 5 minutes each day during the course of APtherapy.

If one does not wish to inject scar tissue, one may still reestablish the flow of Qi through the area by a technique known as "Bridging the Scar". In his Manual on Small animal AP, Gilchrist lists a number of different methods of using needles to do this. They are summarised in the diagrams below.

The needles are left in position for up to 20 minutes and are then removed. The scar is treated 3-6 times at intervals of 2-7 days.

Intradermal point injection: Some experts use dental, tuberculin or Dermojet syringes to inject intradermally in the location of the Ear or body AP points. This method uses dilute procaine, vitamin B12 or other solutions (as in the injection method). The small blebs which are created give physical (pressure) stimulation for a short period after injection. The number of sessions and the interval between sessions is similar to "standard" AP methods.

DERMOJET INJECTION

This is a very fast and simple method of point stimulation. It uses a high-pressure (jet) spray injection technique, without the need for needles. It is very suitable for stimulating points on the limbs of horses and cats which would not accept needling of the same points. It is also ideal for the treatment of zoo animals.

The nozzle of the instrument is held 1-2 cm from the skin and the lever is depressed. The jet of spray is shot into the point, leaving a blister on the skin. Solutions which are suitable for point injection are also suitable for the dermojet technique. This technique is especially valuable in nervous or highly-strung animals. French vets claimed highly successful results in treating colic in horses by using Dermojet treatment of points such as Tsu San Li (ST36), Pi Shu (BL20), Ta Chang Shu (BL25), Kuan Yuan Shu (BL26) and Tien Shu (ST25). Dermojet is also very valuable in the treatment of cats.

Cats tolerate needling of the face and trunk very well but they resent needling of the distal parts of the limbs. Dermojet is ideal for these parts.

IMPLANTS, INCISION, NERVE MASSAGE

In human AP sterile foreign bodies are often implanted in the tissues at AP points to elicit long-term stimulation in chronic diseases, such as chronic bronchitis and asthma.

Stainless steel AP needles and other special steel implants may be used. They are anchored externally or internally so that they can be removed easily, if required.

Absorbable material such as catgut and foetal or placental tissue is also used. In this method a curved suture needle is used to introduce the material in through the active point and out through another (such as Fei Shu (BL13) and Chueh Yin Shu (BL14) in asthma). The ends are cut off at the skin and the skin is massaged to bury the material in the tissues, where it is left until it is resorbed by the body. This method is listed as a valid method in vet AP textbooks but it does not appear to be popular. It could be used in chronic conditions of the lumbo-sacral and sacroiliac region and chronic gastric and pulmonary conditions.

Other types of implant include press needles, AP staples and gold beads. Press needles and intradermal needles are made of stainless steel, usually 30-32 gauge. Press needles may be 1 or 2 mm long. Intradermal needles may be up to 10 mm long. They are inserted into the dermis and are taped in position for 1-6 weeks, depending on the condition being treated. Press needles are used especially on EarAP points. Intradermal needles (5-10 mm long) may be used on Ear or body points (but usually on the body points). They are used especially in human chronic diseases and chronic pain. For instance to counteract withdrawal symptoms when cigarette smokers let go of the habit, press needles may be put in Ear points Lung and Shenmen and left in for 2-4 weeks. In asthma, intradermal needles may be put in points PC06; NX04; CV17; BL13 and press needles in Earpoints Lung or Asthma. Intradermal needles are left in position for 1-2 days in summer and for longer periods in winter. Care must be taken to prevent local infection at the needle sites.

Gold beads 1 mm diameter, are useful implants in certain chronic conditions in animals. For instance in treating hip dysplasia in dogs, the late Grady Young of Thomasville, Georgia, inserted these beads under general anaesthesia. The hip area is shaved and prepared for surgery. Then, 5-8 hypodermic needles, c. 50 mm long and 12-14 gauge are inserted through the skin and tissue until the tip of each needle touches the rim of the acetabulum. A stilette is then used to deposit one gold bead near the rim of the acetabulum.

The technique is fast, safe and very effective. Only one session is needed. Alternatively, small double knots of orthopoedic suture wire, with the loose ends clipped off, can be used instead of gold beads. They are inserted in the same way as the beads. To prevent postoperative infection/ inflammation, penicillin is injected i/m and oral antibiotic is given for 5 days afterwards. Young used gold bead implants in >200 dogs, with no serious complications. Marked improvement in the clinical signs can be expected in >80% of cases in 1-3 days after the operation.

Stainless steel staples, shot into the skin by special surgical staple-guns, are used by American and Canadian vets. The technique is fast and easy to use, especially in large animals. The staples are left in position until they fall out. The method has been used on body points with claims of success in many conditions responsive to AP. They have also been used on Ear points. However, chondritis (which may be difficult to treat) may follow puncture of ear cartilage. (The use of such staples in the human ear has caused this problem already).

The advantage of the method is its speed and the claim that many conditions (such as muscular lameness, pain and other chronic conditions) respond to one treatmentsession because the AP stimulus continues for a long time after insertion. Some authorities would advise against the use of staples near the eyes; over bony areas; over major blood vessels and nerves and in the ears. Their use over well muscled areas would seem to be safe enough.

Incision of certain AP points, leaving a 10-25 mm wound in the skin down to the subcutaneous layer, is used in certain chronic human conditions also. An example is Yu Chi (LU10) in chronic asthma. This method does not appear to be used in vet AP in the West, although in vet AP texts it is mentioned in relation to certain points, especially in the horse and ox. The use of the wide (spear-shaped) lance needle would have identical effects.

In the West of Ireland, traditional healers (not vets !) used a method similar to incision and implantation to treat shoulder lameness and dislocation of the shoulder joint in cattle. Two twigs about 250 mm long and 10 mm diameter were cut from the willow tree. The external bark was removed to leave the moist, white inner wood. One end of each twig was sharpened with a knife. Then 4 stab-incisions were made with the knife about 70 mm above, below, cranial and caudal to the shoulder joint. One twig was inserted above and advanced downwards to emerge at the lower incision. The other twig was inserted at the cranial incision and advanced to emerge at the caudal. A piece of string was used to secure the implants in position. It was said that the lameness disappeared quickly and that dislocated joints spontaneously reset themselves. The implants were removed when the problem was corrected or within one week, whichever occurred first. I cannot vouch for the efficiency of this method but it was still used in the countryside in the 1960s.

Incision, with exposure of the nerve and blunt massage of the nerve using artery forceps is used in poliomyelitis paralysis in China. For instance incision of Chien Cheng (SI09) over the junction of the radial, median and ulnar nerves above the posterior axillary crease is used in paralysis of the upper limb or difficulty in raising the shoulder. Other points which may be treated in this way in very serious cases are Ho Ku (LI04) and Chu Chih (LI11) near branches of the radial nerve; Huan Tiao (GB30) near the superior gluteal nerve; Yang Ling Chuan (GB34) near the tibial and common peroneal nerves and ST36 near the deep peroneal nerve. This method does not appear to be used in vet AP.

MOXIBUSTION (JIU = FIRE)

One of the most ancient forms of treatment is to apply fire (Jiu) to various parts of the body. Many methods were employed, irons treated in a fire being used for centuries in human and animal medicine. In vet practice, line and point firing (using hot irons) is still used for tendon problems in some countries but many Vet Associations have banned this type of treatment on humane grounds.

Moxibustion: In China, a dried preparation of Artemisia vulgaris, rolled into cigar or cigarette shape has been used to heat the points since before the time of Christ. The preparation is called the Moxa and the process of using it is called moxibustion. It is used in human and animal medicine. When moxa is ignited, it burns slowly like a cigar. It is used in 4 ways (a) Non-scarring method, (b) moxa-needle, (c) scarring method and (d) festering method.

a. Non-scarring method: The moxa is held at a distance of about 25 mm from the skin until the patient feels pain (human) or reacts defensively. It is removed for a few seconds and the process is repeated 10-20 times. Alternatively a slice of garlic or ginger is put on the point and a small ball of moxa the size (if a pea, is put on the slice. This prevents severe burning but care must be taken that the moxa does not touch the skin.

b. Moxa-needle: Using moxa to heat the needles, has been mentioned earlier. This method is most suitable for vet use. Moxa emits an acrid irritating smoke and must not be used near the eyes.

c. Scarring method: The moxa is burned directly on the skin, causing intense pain, with second or third degree burns. This method is not acceptable in western medicine or vet practice.

d. Festering moxa: This is also a scarring method. An irritant blister paste is applied to the heated area to increase further the stimulation of the area. Alternatively, garlic juice or crushed garlic is rubbed into the points before moxa is applied. Pustules form within a few days. These are drained and dressed with antiseptic cream until they heal. Festering moxa often causes severe skin damage and is not recommended except in very difficult chronic diseases, such as human rheumatoid arthritis or psoriasis, in which GV points from GV14 to GV03 are used.

In vet AP texts, another method uses alcohol which is ignited and allowed to burn on the skin. This is also not recommended.

Thermostatically heated probes at 80^oC have been used to heat the points. They are safe if checked regularly and not applied too strongly or too long.

Other methods of heating the points include ultraviolet rays, infrared rays and microwaves. Special instruments are available for these purposes but they appear to be used in humans rather than in animals.

If heat is to be used in therapy, care should be taken to avoid burning the patient and to avoid sensitive areas such as the eyes, major blood vessels and mucous membranes. Moxibustion should not be repeated in the same area more than once unless the area is perfectly free from burns or blisters. Moxibustion can be used in "cold diseases" (chronic diseases), such as in chronic cases of muscular rheumatism, arthritis, asthma, abdominal pain, severe enteritis and vomiting, pyometra and metritis; chronic tendinitis, chronic lymphangitis and chronic pain.

COLD

Cryostimulation or stimulation of the AP points by the application of cold is effective in many pain conditions. Modern cryosurgical instruments, solid carbon dioxide and ethyl chloride spray may be used. Care is taken to avoid "burning" the skin by reducing the time of application. The idea is to induce numbness and coldness of the tissues near the AP points. It is especially useful in human acute painful conditions. In fever, cold applied to GV14 helps to reduce the fever.

A very useful first-aid treatment of acute human toothache is to massage the LI04 points in the 1st-2nd inter-metacarpal area with ice-cubes until the area seems numb. This requires about 5 minutes. The toothache usually disappears within minutes. Occasionally it may be necessary to add Chia Che (ST06). The method is ideal for treating children. For headaches try GB20, LI04 and Lieh Cheuh (LU07).

The method has not been used widely in vet medicine but applications could include acute myositis and lowback syndromes. If the vet wishes to show the owner the correct points to work on, the owner could use the ice or dry-ice method between therapy sessions, thereby making the vet's work easier.

MASSAGE, PRESSURE, VIBRATION

Massage is a form of self-help and first-aid in minor human conditions. It is widely used in the East by the ordinary people to treat their ordinary day-to-day aches and pains. Massage is sometimes combined with rubbing adrenalin cream, alcohol or rubifacient agents (menthol, eucalyptus etc) into the points. It is of great benefit in minor human headaches, muscle aches, toothaches, earaches, nausea, upset stomach, insomnia, etc. The same AP points as would be needled (for the specific condition) are massaged firmly and deeply.

There are many types of Chinese massage, including slapping, pinching, rubbing, kneading and deep pressure. The type used depends on the area to be massaged. AP points over muscle masses can be heavily kneaded and deep finger pressure and slapping is used also. Points over bony areas are pinched, rubbed or slapped. For human first-aid use, especially useful in children, the following are suggested.

Nausea and upset stomach: ST36, CV12, PC06, BL21.

Earache: GB20, LI04, points around the ears; TH05.

Toothache: LI04 and ST06 with hard pressure on the Earlobes.

Muscle ache: seek out the tender points in the muscles and add main points for the affected region.

Headache: GB20; heavy massage of the Trapezius muscles, especially GB21 + LI04; LU07; Yin Tang (Z 03, between the eyebrows); Tai Yang (Z 09, in the hollow of the temple lateral to the eye).

One of the most useful applications of massage in first-aid is in the treatment of humanfainting, shock, collapse etc. For this purpose, the main point is JenChung (GV26) + YungChuan (KI01). Strong pressure and vibration is applied to GV26 (in the philtrum) using the thumbnail. In many cases, especially if the patient's head is kept lowered, consciousness returns in 30-60 seconds. GV26 is the shock point par excellence and can be used anywhere, anytime in emergencies when other therapies may not be available. If nausea or angina pectoris is also present point PC06 is added, pending medical attention.

Spooning is a variation of massage used in humans. The edge of a large soup-spoon is rubbed repeatedly over the area (for instance BL13-16 (FeiShu to TuShu) and BL42-45 (PoHu to YiHai) in asthma and bronchitis) until the whole area is bright red. It helps if oil is spread over the area first to make it easier to move the spoon.

Mechanical vibrators are also useful, especially for muscle massage in rheumatism. Physiotherapists who use these machines could greatly improve their results by adding the main AP points for the region as well as applying local vibration and using the AHSHI (tender) points.

Fisting: Massage techniques are not used commonly by vets in large animals because of the large body areas and the time involved. However, key points, especially the AHSHI points over heavily muscled areas, can be clipped and owners or handlers can be shown how to "fist" the points. Fisting to the animal's tolerance for 4-6 minutes/day between AP sessions can shorten the recovery time. Fisting should not be used over the spine or over bony tissues. It is especially useful in horses with paraspinal AHSHI points.

Vibrators: Some practitioners use vibration techniques in racehorses and dogs for muscular problems and other minor lameness but in general these techniques are not popular in busy practices.

CUPPING, VACUUM

Application of reduced pressure to points (+ the use of needles or moxa) is used occasionally in humans. Special instruments (glass or bamboo cups) are used. A lighted swab, soaked in alcohol, is put into) the cup, which is then applied firmly to the point. Reduced pressure causes suction on the skin, causing congestion to the area. Mechanical devices (similar to vacuum cleaners, or based on a syringe and plunger principle) could cause the same effect. Although it is mentioned in some vet texts, it is rarely used in animals the west.

ELECTROSTIMULATION (ES)

Stimulation of the points by the application of electric impulses is one of the most common methods used in western medical AP. The stimuli can be applied via electrodes attached to AP needles or via simple (non-invasive) skin electrodes, such as those used in ECG measurements. The stimulators are battery operated, easily portable and are available from AP supply houses. Waveform can be single pulses, adjustable from 1-50 Hz or more; dense-disperse forms (a train of high followed by a train of lower frequency pulses). Other waveforms are also used but the common one is single pulses (triangular, square or bipolar) in the range 1-10 Hz. For most purposes a 3 Hz wave is adequate but individual practitioners and patients have their own preferences. Output voltage is fully controllable from 1-160 volts or more. The current is very small, being measured in mA.

Modern stimulators use bipolar pulses to avoid the necessity of altering the polarity of the electrodes. (This was necessary with earlier stimulators which had positive and negative electrodes and which could cause electrolytic lesions if used more than a few minutes without reversing polarity).

Before the electrodes are attached, the needles should be checked to ensure that they are in the correct points i.e. that they can elicit the De Qi sensation (the needle reaction). Julian Kenyon, Liverpool, has evidence that simple needling for a short time is as effective as electro-needling for 10-30 minutes in most conditions responsive toAP, provided that De Qi is obtained when needling. De Qi is most important in effective ap therapy. It is claimed, however, that exact positioning of the needles is not so important with electro-AP as with manual AP because the electrical stimulus diffuses for quite a distance from the needle.

Electrodes are attached to the needles in pairs. The output control for each pair of needles is slowly advanced until the needles begin to twitch strongly (due to muscle twitch) at the same frequency as the frequency setting. (Care is taken that each member of the pair is on the same side of the body for needles inserted in the thorax. Electrical stimuli which cross the spinal area in the thorax may cause cardiac fibrillation). Normally, 10-30 minutes per session is allowed. At the end of the session the output voltage is turned to zero and the power is switched off. The electrodes are disconnected and the needles are removed.

Modern (Western) electrostimulators (such as those used in transcutaneous electrical nerve stimulation (TENS), transcutaneous electro-stimulation (TES) or Faradic stimulation) can be used without needles. The skin (contact) electrodes are coated with electrode jelly and are applied to the points using adhesive plaster. Otherwise they are used in the same way as the AP stimulators. Both types of stimulators can be obtained in mini- versions which fit in an inside pocket. Human patients or owners whose animals who require frequent stimulation may purchase their own and use them at any time via contact electrodes left semi-permanently in position.

ES is most often used in the relief of human chronic pain syndromes, in the relief of past-operative pain and in the treatment of withdrawal symptoms in narcotic/alcoholic detoxification clinics. ES can be used in ANY disease in which AP is indicated. In APanalgesia for surgery, stimulators are regarded as essential equipment. (Although APanalgesia can be produced by manipulation of the needles and other methods, most operations under AP analgesia use the stimulators).

In the treatment of addictions, special ear-clips are used to keep metal ball electrodes in contact with Earpoint LUNG (in the concha of the ears). Alternatively, ECG electrodes can be used to stimulate the area of the mastoid processes. Portable stimulators deliver mild, pleasant electrical stimuli to the ears. Detoxification (without withdrawal symptoms and without substitution therapy) is complete in 6-10 days in 90% of patients.

TES is also useful in childbirth and dental surgery as a method of analgesia and in the relief of cancer pain.

In vet medicine the uses of these techniques are similar to those in humans but the two main uses would be (a) in the treatment of pain, lameness and nerve paralysis and (b) to induce analgesia fur surgery. In spite of its effectiveness, ES is not used often as a therapy in farm animals or pets because of the relatively long time (10-30 minutes) required for each session. For most purposes in human and animal patients, once De Qi is obtained, simple AP can elicit results as good as EAP. In valuable animals, such as stud animals, racehorses and greyhounds, however, EAP is used more widely, but more as a "hi-tech" public relations exercise than as an essential method of stimulation.

MAGNETIC AND STATIC STIMULATION

It is possible to elicit analgesic and therapeutic effects in humans by stimulating the APpoints by magnetic, static, electro- magnetic and electrostatic fields without actually touching the body. These claims are made in the American Journal of AP. Japanese workers have claimed to have done Caesarean section on women whose hands and feet were encased in an ES- field. Under experimental conditions in humans, static and electrostatic fields applied to the hands cause analgesia in areas identical to`those which respond to simple needling of LI04. The Chinese make portable stimulators which work on the EM and ES principle.

These methods are rarely used at present (in humans or animals) but they should be mentioned as possible methods for the future. They also set an objective precedent for a physiological effect induced by an intangible field (see the paper on "Holistic concepts of health and disease" and the section below on psychic healing).

Special magnetic beads or discs, for instance "Corimags", can be taped or super-glued onto the points for long-term stimulation.

ULTRASONIC STIMULATION (US)

US has many adherents in human and vet medicine, especially in treating soft tissue injury (muscle spasm, muscular rheumatism, tendinitis etc). In orthodox use, the US head is applied mainly to the area of pain or inflammation. In the Veterinary Record (1980, 106, 427-431), Lang reported treating 53 horses, and 143 dogs and cats with US. The conditions included sacroiliac, thoracolumbar, cervical, lumbosacral and coccygeal spinal lesions (50/67 successes); limb joint lesions (luxation, trauma, synovitis) (35/45 successes), trauma, lumbar spasm, paresis, swelling etc (29/33 successes); bone and joint lesions in horses (5/10 successes); soft tissue trauma in horses (22/25 successes). The average number of treatments was 2.7 per case. Rapid, complete recovery occurred in 64%.

The overall results are summarised below. Unfortunately these results were uncontrolled and it is not known what percentage of these cases would have recovered without treatment.

	                       Success
+++      ++       +       Nil     Total
(n)         127      31       9       31        198
(%)         64.1     15.7     4.5     15.7      100

US, as a method of stimulating the AP points is used by medical more than by vet acupuncturists. It is used for many conditions other than soft tissue injury - US merely replaces the needle - and many of the conditions amenable to treatment by needling are also responsive to US. As with all other types of AP stimulation attention is paid not only to the local area of pain/inflammation but also to the AHSHI points and other APpoints which are active in treating the affected area. One of the advantages of US is that it is a fast method of therapy. American medical acupuncturists recommend 10-30 seconds/point. The manufacturer's instructions on maximum output and duration of treatment should be followed. A contact jelly must be used if the area to be treated can not be immersed in water.

Those of you who already use US in your practice will further increase your success rate and widen the scope for treatment of other conditions if you combine US with APtheory. It is also useful in treating local infection such as in the ears, vagina, nose etc. US therapy is especially good using the AP points on the human ear. In animals, however, we have much to learn about the potential of this method of treatment. As animal Earpoints are not fully documented, it is not possible to use earpoint therapy to the same extent as in humans.

LASER STIMULATION

Laser light (monochromatic, polarised and coherent) is another type of electromagnetic energy but the wavelength frequency is in the light range. The most common type of cold laser (power <50 mW/cm²) is the visible (red) light from He-Nelasers. Red light (ruby laser) is also used. Infra-red (I-R) lasers emit invisible lightbut the clinical effects are marked.

The power of cold lasers varies widely, from 1-50 mW/sq cm. Lasers emitting <10 mW/cm² are not powerful enough to reach deep trigger points. For large animals, lasers emitting 30-50 mW/cm² are recommended.

Most He-Ne and I-R lasers, even those emitting <5 mW/cm², are effective in treating superficial disorders (cuts, bruises, granuloma, ulcers, wounds).

Rapid interruption of the light beam at fixed intervals is called pulsing. Pulsed lasers (especially those interrupted 2000-10000 times/second (Hz) penetrate deeper than unpulsed lasers.

Laser stimulators are available as robust, portable instruments. They are operated by batteries or by mains electricity. The laser probe is held within 0-5 cm from the skin and the laser light is directed to the point. Treatment time depends on emission power. With 30-50 mW lasers, dose time is very short, 10-60 seconds per point. There is no pain or noxious sensation. The method is ideal (if it works !) for treatment of Earpoints (when documented properly !) and all points on nervous or difficult animals, such as the points below the carpus and tarsus of horses. Cats tolerate the laser very well.

The commercial claims are for excellent results. Russian and German workers have used cold laser stimulation of the human AP points for some years now. Since 1984, there are many papers on the method in humans. (See "AP for immune-mediated disorders", Rogers 1990).

The use of cold laser in conventional veterinary practice (as a therapy for tissue trauma, wounds, granuloma, myositis, tendinitis etc) is growing rapidly. Laser is also be used in vet AP (instead of needles) to stimulate the AP points in animals but there are few published studies to date. The author (PAMR) has used a 30 mW I-R laser with similar results to those of EAP or point injection in horses since October 1989. However, there are reports that the lower power lasers (especially those <10 mW/cm²) are not as effective as AP.

Further work is needed to document the uses and limitations of laser, the effects of power, wavelength, different pulse frequencies, different exposure dosage etc. In the next few years, I believe that we will see much more use of electromagnetic types of therapy, including ultrasound, microwave and laser stimulation in medical and vet therapy.

TREATMENT OF CATS AND ZOO ANIMALS

Cats and zoo animals present special problems to vets who wish to use AP therapy. For effective needling, proper restraint is necessary. Cats resent needling on the extremities of the limbs and on the medial aspects of the limbs. Because of their sharp teeth and claws, needling points on the ventral abdomen can also be dangerous for the operator. Also, the duration of needling must be short.

Some vets find it useful to sedate these animals lightly before AP. Methods of choice in these species include painless techniques, such as laser, ultrasound and EM or ES fields. (Sedation is usually not necessary in domesticated species, other than cats, with these methods). Alternative, quick methods are point injection, Dermojet injection and quick needling, all of which may require sedation.

Using the Dermojet method, at a distance of 5 cm from the skin, Demontoy has treated many cats without sedation, using limited numbers of points. Cases which gave excellent responses included vomiting, diarrhoea, (gastritis, enteritis, gastroenteritis), constipation, urolithiasis- cystitis-urethritis; urine retention; induction of parturition in overdue females; hormonal alopecia; coryza (rhinitis, conjunctivitis, gingivitis); cough (tracheitis, bronchitis, pneumonia); shock and anaesthetic emergencies. For details, see: Demontoy, Revue d'AP Veterinaire (1981), No.8, p.17-21 (published by Assoc. des Vet. Acupuncteurs de France, 3 Rue Letellier, Paris 75015, France).

Qi Gong, PSYCHIC AND TOUCH HEALING

This paper has concentrated on the more physical methods of stimulating the APpoints. It would not be complete, however, without a brief mention of paraphysical methods. Modern Chinese Communists do not believe in a soul (a personal energy/memory independent of the body) that survives death. However, recent (unconfirmed) reports from China indicate that research in Qi Gong is producing exciting results. Mental and physical focusing/ control of body Qi is possible. It can belearned and used for many purposes, including diagnosis and healing. Acupuncturists who are Masters of Qi Gong can often "sense" the location of disturbedQi in the patient and, without touching the patient, can treat the disorder by directing their own Qi to the correct AP points.

The whole area of "paranormal" diagnosis and healing is difficult to assess in terms of our scientific methods. Little or no thorough research has been done in the area. Many confidence-tricksters make large sums of money from the public by claiming (falsely) to have these abilities. Nevertheless, the phenomena, although rare and unpredictable, are real.

There are people who are gifted with natural ability to diagnose disease and to heal in strange ways. Some of the diagnostic and therapeutic aspects of psychic methods have been discussed briefly in another paper (see "Psychic methods of diagnosis and treatment in AP and homeopathy" by Rogers, Belgian Veterinary AP Society Seminar 1982). Psychic healers often have no training in biology and medicine. Some of these people believe that God acts through them; others may not believe in a God, but they use some type of meditation /trance or "thought projection" to help the patient. The healer may be near or far distant from the patient. Some vets and doctors have these gifts to a greater or lesser degree. They may not realise that they have the ability and they may attribute their diagnostic skills and clinical success to "luck" or good fortune as well as good medicine. I would ask you to keep an open mind on these questions. If some of you recognise these abilities in yourselves, please read as much as you can of the literature on the paranormal. You will find that your clinical success will improve when you combine these techniques with scientific medicine.

a. Psychic diagnosis: There are people who can sense, by "paranormal" means, the nature and location of human and animal disease. Some do this in the presence of the patient. Others do it from a long distance, using the dowsing (divining) facility or by other psychic means.

The late Erwin Westermayer (Bellamont), a great healer, did not have to see the animal patient or to have a detailed history of the case. He relaxed into a type of trance and within a minute or so, sensed in his own body the site of pain or other lesion which he saw when he later examined his patient clinically.

b. Therapeutic energy emission: The healer's hands are held near or on the patient. Many of these healers have a strange phenomenon associated with their hands - if they hold an earthworm in their hand, the worm dies within a minute or two. If they go fishing, they need to have a friend with them to put worms on the hook for them.

c. Thought projection: There are people who can heal animals or humans by psychic means with or without the conscious knowledge of the patient. They do not have to be near the patient - they simply pray for or visualise or concentrate/ meditate on the patient and "project healing energy / Qi / Prana" to the diseased area, Chakra or AP points.

How does this relate to AP ? Firstly, the seers of the East and West have claimed that all living things have an Aura, or Energy Field. This aura reflects the mental and physical state of the organism. It responds to the internal environment of the organism and also to its external environment (terrestrial and extra-terrestrial forces). It is the interface between the external and internal environments.

The AP points are the areas where the Energy Field is strongest. In disease, the energy pattern at the AP points changes. These changes can be sensed (by paranormal sight or touch) by psychic people. With some experience, the nature and location of disease can be diagnosed by the changes in the Energy Field. (By telepathic means, trance, clairvoyance or other paranormal means, these changes can be sensed at great distances by trained psychics).

Secondly, healing can be stimulated by altering the Energy Field of the patient so that normal patterns of energy are re-established. Transfer of energy from the healer to the patient causes this to occur.

Those who are trained in the AP method can concentrate more specifically on sensing and altering the Energy Field at those AP points which are most affected. I have given much consideration as to whether or not I should discuss this section on psychic healing with a scientifically trained audience of vet colleagues. There is a danger that my discussion of this section may undermine the credibility of the whole paper, if not my entire credibility as a qualified lecturer ! However, whether we like it or not, there is a growing consciousness of these topics in the West. It is time that scientists discuss the "paranormal" even if we do not accept its validity.

If you are scandalised, please, forget this section and try some of the other techniques mentioned earlier. AP can be explained satisfactorily by orthodox physical concepts without the necessity of invoking the "paranormal". To those of us who have first-hand experience of psychic methods, they merely add another dimension to a fascinating tapestry that is total reality.

CONCLUSIONS

It can not be stressed often enough that successful AP is based on the choice of the correct points. These points may be on the body, limbs, ears etc. (See other papers on this). Methods of stimulating the points are of secondary importance.

Many different methods of point stimulation are possible but care and common-sense should be used to avoid damaging the tissues (Rogers 1981).

The methods used by vets are mainly a matter of personal preference and experience. Although the needle and moxa have the longest history of use, they are likely to be replaced in Western AP by electronic, non-invasive methods, such as laser, TES/TENS, US and microwave. Until then, it is likely that point injection, simple AP, EAP and moxa will remain the most commonly used methods of AP therapy in vet medicine.

FURTHER READING ON PSI-ESP

1. Lethbridge, T.C. (1974) ESP-beyond space and time. Sidgwick & Jackson Ltd., London. Paperback. ISBN 0-283-98378-0.

2. Stelter, A. (1976) PSI healing. (Bantam Books, USA) ISBN 0-553-02505-8.

3. Wilson, C. (1973) PSI healing. (Hazell Watson & Viney Ltd., Aylesbury, Bucks, UK). Paperback (Abacus).

4. Parkes, M.W. (1974) Healing and the wholeness of man. (Regency Press, London). Hardcover.

5. Shealy, N. & Freese, A.S. (1975) Occult medicine can save your life. (Dial Press, New York). Hardcover. ISBN 0-8037-8816-9.

6. Koestler, A. (1975) The act of creation. (Pan-Picador Books). Paperback. ISBN 0-330-24447-7.

7. Schumaker, E.F. (1977) A guide for the perplexed. (Jonathan Cope Ltd., London. Hardcover. ISBN 0-224-01496-X.

8. Castaneda, C. (1974-77) The techniques of Don Juan (Penguin).

(1976) Tales of Power (Penguin) ISBN 0-1400-4144.

(1975) Separate Reality (Penguin) ISBN 0-1400-3558-3.

(1973) Journey to Ixtlan (Bodley Head, London). Hardcover. ISBN 0-370-10482-X.

 

9. Monroe, R.A. (1974) Journeys out of the body. Corgi paperback. ISBN 0-552-09531-1.

10. Heywood, R. (1971) The infinitive hive. (Pen paperback) ISBN 0-330-23102-3

11. Randell, J.L. (1975) Parapsychology and the nature of man. Abacus. Paperback. ISBN 0-349-12926-6.

12. Rogers, P.A.M. (1981) Serious complications of AP ... or AP abuses? Am. J. Acup., 9, 347-351 (added as an Appendix to this paper).

13. Yu Chuan & Hwang Yann-Ching (1990) Handbook on Chinese Veterinary AP and Moxibustion. FAO Regional Office for Asia and the Pacific, Bangkok. 193pp.

QUESTIONS

1. One of the following statements is not correct. Indicate the incorrect statement:

(a) Human-type AP needles 28-32 gauge are suitable for small animals

 

(b) Thicker AP needles (19-25 gauge) are preferable in large animals, as the muscular twitching and spasm which frequently occurs during the needling session can twist fine needles into bizarre shapes, making them difficult to extract and destroying them for future use.

 

(c) Standard hypodermic needles have the advantage of being cheap and disposable but they have the disadvantage of causing more pain and they may introduce dirt or skin into the tissues because they have a lumen. They also cause more tissue damage and bleeding.

 

(d) In most cases, it is not necessary to attempt to sterilise the skin but each needle should be sterile

 

(e) Standard hypodermic needles should be inserted slowly and carefully by the push-twirl method

 

 

2. One of the following statements is not correct. Indicate the incorrect statement:

(a) It is not possible to give an exact depth or direction for needle insertion: these vary between points (within species) and between points (between species)

 

(b) The direction of insertion depends on the body region being needled Over muscular areas, the needle is usually inserted at 90^oto the skin, deep into the muscle. Over bony areas and on Earpoints, the needle is inserted perpendicularly until the skin is penetrated and then is advanced subcutaneously

 

(c) One should never needle periosteum

 

(d) Penetration of the human ear cartilage can cause a chronic auricular chondritis which can be very difficult to cure

 

(e) Penetration of the thoracic or abdominal cavities is forbidden, except in specific cases, such as aspiration of fluid or releasing gas from the viscera etc. Therefore, over the thorax and abdomen, the needles are usually inserted at 45^o

 

 

3. One of the following statements is not correct. Indicate the incorrect statement:

(a) In large animals the needles can be inserted up to 100 mm deep in certain points, such as those over heavy muscles. However depths of 25-50 mm would be more usual.

 

(b) In small animals heavy muscle groups would be needled to depths 10-50 mm, depending on the amount of muscle.

 

(c) The most active AP points are never over peripheral nerves especially main nerves (trigeminal, facial, radial, median, ulnar, sciatic, spinal nerves etc).

 

(d) When the needle is correctly placed and stimulated, a local reflex muscle spasm grips the needle tightly, "like a fish taking the bait".

 

(e)De Qi in animals is indicated by shivering, local muscle twitch, vocalisation, lifting of a limb, attempts to escape, bending of the back, swishing the tail, lowering of the head and defensive reaction. The needle should be tightly gripped by the tissue, as in humans.

 

 

4. One of the following statements is not correct. Indicate the incorrect statement:

(a) Needles are usually left in position for 10-30 minutes in conditions such as rheumatism, muscle pain, arthritic lameness etc. In some cases, for instance rhinitis, conjunctivitis, shock etc, duration of needling can be very short, 10-60 seconds.

 

(b) For paralysis and painful conditions (especially of the muscles) long duration of needling (up to 30 minutes) is indicated, whereas for most other conditions a quick needling is sufficient.

 

(c) Some Chinese sources claim that if De Qi is obtained, there is no advantage to be gained from leaving the needles in situ for 10-30 minutes, except in certain chronic conditions, such as peripheral nerve damage. Thus, a short, quick, strong needling may replace the longer, more gentle method in many diseases.

 

(d) If needles fall out after 10 minutes of treatment, they must be re-inserted immediately

 

(e) Blood needles and fire needles are used in large-animal AP in China

 

 

5. One of the following statements is not correct. Indicate the incorrect statement:

(a) In AP point injection, the choice of solution is largely a matter of personal preference

 

(b) Scars, especially the tender areas, can be treated, using a dental or tuberculin syringe, set to deliver 0.1-0.2 ml/point. The solution is injected intradermally at a depth of 2-5 mm, using a very fine (c. 25 gauge), short (2.5-10 mm) needle

 

(c) Intradermal point injection, using dental, tuberculin or Dermojet syringes is used on scars or on Ear AP points

 

(d) Dermojet injection is very suitable for stimulating points on the limbs of horses and cats which would not accept needling of the same points. It is also ideal for the treatment of restrained zoo animals

 

(e) Implantation (gold beads, orthopoedic suture wire etc) of animal AP points is not safe and is not advisable

 

 

6. One of the following statements is not correct. Indicate the incorrect statement:

(a) Moxibustion is used mainly in "Hot diseases", such as in acute cases of muscular rheumatism, arthritis; acute asthma and bronchitis; acute abdominal pain, enteritis and vomiting; acute pyometra and metritis; acute tendinitis, lymphangitis and pain.

 

(b) Thermostatically heated probes at 80^oC have been used to heat the points. They are safe if checked regularly and not applied too strongly or too long

 

(c) Other methods of heating the points include ultraviolet rays, infrared rays and microwaves

 

(d) Moxibustion is used in 4 ways: Non-scarring method; moxa-needle; scarring method; festering method. The latter two methods are not acceptable in western-style practise

 

(e) Moxibustion by burning alcohol on the moistened skin is not acceptable in western vet practise

 

 

7. One of the following statements is not correct. Indicate the incorrect statement:

(a) Cold laser (power <50 mW/cm²) in the red visible range (He-Ne lasers and ruby laser) or in the invisible range (infra-red) can be a useful means of stimulating superficial AP points.

 

(b) Lasers emitting <10 mW/cm² are powerful enough to reach deep trigger points in large animals

 

(c) Most He-Ne and I-R lasers, even those emitting <5 mW/cm², are effective in treating superficial disorders (cuts, bruises, granuloma, ulcers, wounds).

 

(d) Pulsed lasers (especially those interrupted 2000-10000 times/second (Hz) penetrate deeper than unpulsed lasers.

 

(e) Treatment time depends on emission power. With 30-50 mW lasers, dose time is very short, 10-60 seconds per point.

 

(f) The use of cold laser in conventional veterinary practice (as a therapy for tissue trauma, wounds, granuloma, myositis, tendinitis etc) is growing rapidly.

 

Answers