Clinical experiences with Acupuncture: failures and successes
Philip A.M. Rogers MRCVS
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IVAS Congress, The Netherlands 1990
SUMMARY
1. Winter follows spring. All creatures die. In life, many suffer dis-ease through failure/inability to adapt to external or internal challenges or stressors.
2. Accurate diagnosis is needed for optimum results to any form of therapy. The cause, nature, location and extent/severity of the dis-ease/lesion/disorder should be known. First-degree therapy aims to remove/alleviate the cause, to enhance the adaptive response and to provide supportive/symptomatic relief during recovery.
3. The adaptive response is the key to all healing. Acupuncture (AP) activates the adaptive responses, which depend mainly on functional neuro-endocrine transmission. Physical or chemical interruption of transmission or functional inability of the target-organs to respond abolish or reduce the AP effect.
4. Clinical failures may be due to professional error (faulty diagnosis, incorrect choice of points, inadequate stimulation, failure to use other supportive therapies, premature withdrawal of therapy); patient/owner error (non-compliance with advice given); coincidental disordersand inability of target organs to respond. Some patients may be "non-responders".
5. Clinical success may be due to spontaneous remission or toactivation of adaptive responses (even in cases wrongly diagnosed, or in cases assessed initially as "difficult" or "unlikely to respond"). Some patients may be powerful "responders".
6. Examples of the author's failures and successes in cases of muscular lameness or paresis, cervical ataxia, chronic pain, are given. Some failures and successes are difficult to explain.
INTRODUCTION
Definition of therapeutic success: This is complex, as illustrated by the old joke: ... the operation was successful but the patient died...
Many definitions are possible. Three are given here, the one chosen for discussion in this paper being definition (c):
Definition (a), in humans, is the complete and permanent elimination of all present and past symptoms and signs, with full return of integrated functions of the spirit/mind/body.
By definition (a), most attempts at therapy must be classed as partial or complete failures (non-attainment of success). Permanent restoration of health is not possible: at best, death knocks and enters uninvited at some future time.
Definition (b) substitutes "medium-term" (months or years) for "permanent" in definition (a).
Acupuncture (AP), electro-AP (EA) or transcutaneous electrostimulation (TES), at points such as Earpoint Lung or the mastoid process, can give complete and dramatic success within 10 days in the elimination of withdrawal signs and symptoms in the detoxification of alcohol- or heroin- dependent patients. If combined with naloxone therapy, EA can induce symptom-free detoxification within 4-6 days.
However, by definition (b), that detoxification success would be classed as ultimate failure in most cases if therapy did not include adequate rehabil-itation. This entails rebuilding the self-respect of the patient and providing the possibility of change of internal and external environment to allow his/her growth as a full human being. Without rehabilitation, most detoxified patients who are returned to the environment which spawned the dependence, return to the habit within weeks.
Definition (b) is too severe to be applied to individual clinicians, who may have little control over internal or external environments, (their own or their patients').
Definition (c) is less severe than (b). It also can be applied to animals.
It is the medium-term elimination of most of the severe signs and symptoms, with restoration of body-mind functions to the extent possible under prevailing circumstances.
The "prevailing circumstances" include the possibility or otherwise to activate the body/mind adaptive responses, the physiological/pathological circumstances of the patient (wear-and-tear on organs/joints, senile changes, adjustment of human "purposes" for the animal patient etc).
Definition (c) allows for relapses (due to irreparable damage or weakness of organs/joints etc or due to inability to rectify adverse internal or external environmental factors). It also allows for coincidental disorders, for future unrelated disorders and for re-evaluation of the goals and purposes of the patient in the context of the realistic possibilities.
In limb paralysis due to vaso-spastic or oedematous hypoxia of the motor centres post-Cerebro-vascular accident, AP may give marked (yet incomplete) functional and physical improvement. For some affected patients, partial success may seem "miraculous" but would be unsatisfactory if the patient's goal was to be a professional pianist or Olympic athlete.
In cervical ataxia in a pet dog, AP may restore limb function sufficiently to be most acceptable to the owner but the same degree of success in a racing greyhound could be unacceptable and could lead to a request for euthanasia.
In human arthritis, even with marked radiological signs and crepitation, AP can give marked clinical improvement (pain relief and partial or complete restoration of joint function), even though no change may be evident on radiological re-assessment. Sceptical surgeons and radiologists may attribute the improvement to psycho-somatic temporary remission. However, similar improvements following AP in canine hip dysplasia or animal arthritis can hardly be explained as due to patient suggestibility.
FAILURES IN AP PRACTICE
Idealists may reject definition (c) as too soft, a cop-out for charlatans and incompetent clinicians. I suggest that it is a realistic recognition of the frailty of human endeavour and of the final and inevitable degeneration of human and animal life. In spite of decades of study of conventional and complementary diagnostic and therapeutic methods, the most skilled, sensitive, loving and intuitive of clinicians will still have failures, even under definition (c).
If we define success as in (c) above (medium-term elimination of most of the severe signs and symptoms, with restoration of body-mind functions to the extent possible under prevailing circumstances), clinical failures may be due to professional error; patient/owner error (non-compliance with advice given); coincidental disorders and inability of target organs to respond. Some patients may be "non-responders".
PROFESSIONAL ERROR
There are five main sources of professional error: (1) faulty diagnosis, (2) incorrect choice of points, (3) inadequate stimulation, (4) failure to use supportive therapies, (5) premature withdrawal of therapy.
1. Faulty diagnosis
Accurate diagnosis is needed for optimum results to any form of therapy. The cause, nature, location and extent/severity of the dis-ease/lesion/dis-order should be known. First-degree therapy aims to remove/alleviate the cause, to enhance the adaptive response and to provide supportive/symptom-atic relief during recovery.
In practice, many of us have not the training, skill or equipment to make a precise and detailed diagnosis in a conventional sense. Even if we have back-up services, we may put undue emphasis on laboratory or radiological findings. For instance non-clinicalmineral deficiency and non-clinical radiological lesions are commonplace and their correction will not improve the health/productivity of the "patient".
I am a Vet who has worked in nutritional/metabolic research (herd or flock disorders) for over 32 years. I think that I am very good at this ! My greatest weakness as a clinician is in the area of diagnosis of individual cases and my failure to keep abreast of developments over the past decades in practice general diagnostics, medicine and pharmacology.
My AP practice is extra-mural (after-hours, weekends). Most of my animal patients are horses (plus a few dogs), usually presented with pain or lameness. About 30% are referred by a colleague and 70% are referred by owners/trainers. Many of my equine cases are not clinically lame but have a history of poor limb action, reduced stride at the gallop, "hanging" to one side or poor racing performance. Most of these would have been seen by one or more colleagues who had made no specific diagnosis. As a result, unless there are visible or palpable lesions, my diagnosis is doubtful in many cases. If the patient has been referred by a colleague who has made a specific diagnosis (based on X-ray, nerve block etc), I usually accept that diagnosis. However, most of my cases have some abnormality of the muscular system (with 1-8 TPs present). Some have bone, joint, periosteal or tendinous problems. Less than 10% have definite muscle atrophy (poor prognosis; see below).
Some of my clinical failures (due to faulty diagnosis on my part) were: in carpitis(carpal chips missed); in septic tendinitis (sesamoideal chips missed); in canine posterior ataxia (degenerative myelopathy missed); in equine cervical ataxia(irreparable myelopathy missed); in equine severe hindlimb lameness (sacroiliac subluxation missed).
Carpitis (carpal chips missed): A gelding was treated successfully for sacro-iliac lameness by injection of AP points in February 1989. In late February, chip-fractures of the both carpi developed. A colleague used arthroscopy on both carpi to remove the chips. The horse was rested until August, when training recommenced. By early September he was in full training and was working well. Suddenly his action became poor and tenderness in the left lumbar area was noted.
Hoof marks on the wall of his box suggested that he had been cast in his box before the lumbar injury. Point injection of TPs and AP points for lumbar lameness between 5/10 and 17/10 had little effect. On 17/10, laser was used on the points, plus the arthroscopy scars. Marked and visible relaxation of the back muscles occurred within 5 minutes. On 18 and 19/10, his hind action was improved but his front action was short and he was hanging on the rein. Further sessions between 20/10 and 4/11 eliminated all TPs but, meanwhile, the carpal area became swollen and hot. X-rays were not taken at the time. Between 4/11 and 11/11, laser (local points plus Ting points) did not help the carpitis. Advised carpal X-ray and Animalintex plaster. On 18/11, X-ray by colleague showed carpal chips. Colleague operated to remove chips. Prognosis poor (second time surgery done).
Septic tendinitis (sesamoideal chips missed): On 11/11, horse with severe lameness due to tendinitis, with marked infection and oedematous swelling of the lower part was presented. The condition had been treated by poulticing and parenteral ampicillin and other antibiotics over three weeks. Laser was applied for 12 seconds to many points over the tendon (medial, posterior and lateral) and to ST36, LI11, LI 4, VG14 and SI, HC and LU Ting points. Five sessions of laser between 14/11 and 18/11 gave a definite decrease in soft tissue swelling but the infection persisted. On 23/11, X-rays showed bone sequestra in the sesamoid area. They were removed surgically. On 9/12/89, the referring vet reported that the prognosis was poor and euthanasia was being considered. Laser gave initial success in reducing soft tissue swelling in < 9 days (6 sessions) but necrotic bone sequestra required surgical operation and laser was discontinued.
Canine posterior ataxia (degenerative myelopathy missed): A German Shepherd was referred in 1986 by a colleague for gold-bead implant treatment of hip dysplasia. (There was pain on compression of the hip area). I assumed that the diagnosis was correct and did not conduct a full clinical/neurological examination. Gold bead (1 mm diameter) implants were inserted "between 9 and 3 o'clock" around the acetabulum, under general anaesthesia. (In hip dysplasia, the response to this treatment is usually marked in the days following implants). In this case, there was no improvement and the dog's ataxia deteriorated in the next few weeks. On re-examination, a diagnosis of degenerative myelopathy was made and euthanasia was advised.
Equine cervical ataxia (irreparable myelopathy missed): In my early days of equine AP, I attempted to treat cervical ataxia (wobbler syndrome) in horses. Diagnosis of the degree of pathology was not attempted. Treatment consisted of needling (usually with electro-stimulation) of TPs, neck points (including GB20, 21, TH and SI points) plus distant points (including SI 3, BL23, VG 3, GB34). In foals with recent signs, the outcome was good to excellent. However, in cases with long-standing clinical signs (> 3 months duration) in older animals, the outcome (in spite of initial and stable improvement, which would have been most welcome if the case was a human or family pet) was unsatisfactory. Most cases were shot eventually. If race-horses cannot race their future is grim, unless they are very well-bred mares. I attribute failure in older horses/chronic cases to irreparable myelopathy.
Equine severe hindlimb lameness (sacroiliac subluxation missed): In 1988, a horse with recent severe bilateral hindlimb lameness following a race and transport in a horse-box was found to have marked tenderness over both sacro-iliac joints. I diagnosed muscular strain in the sacro-iliac area. (In the previous months, I had treated successfully 2-3 similar clinical cases by point injection (5 ml of 0.5% procaine-saline) at 3-4 points over both sacro-iliac joints, plus all TPs, plus BL23, VG 3, GB30). 2-3 sessions of point injection was not successful in this case. I changed the diagnosis to sacro-iliac subluxation and recommended manipulation of both joints. Within days of one session of manipulation (by a human "bone-setter"), the horse became sound. (In April 1990, I met another case. I treated it with laser on presentation, in an attempt to provide some temporary analgesia, but recommended immediate manipulation. The result was dramatic improvement within days).
Now, in cases of sacro-iliac pain, if the height of the sacro-iliac area is the same on both sides (as the horse stands square), I diagnose the case as muscle-strain (likely to respond to AP). If the height is not the same, I diagnose sacro-iliac subluxation(poor prognosis to AP) and I suggest manipulation as the best option.
2. Incorrect choice of points
Failure to locate AHSHI/Trigger points: Experienced clinicians search carefully for TPs at each session. Even experienced clinicians miss them occasionally. It is not uncommon to find TPs on the second or third session which were not present (or were missed) in the first examination. Failure to treat and eliminate TPs can mean that the clinical signs persist in spite of correct use of other (regional and general) AP points.
In patients located far away from base, the cost of time/travel may allow only one visit from the vet acupuncturist, who must rely on the local vet to continue treatment. At the first session, every attempt is made to diagnose the case and to select the best points, as indicated by the first examination. The local vet is advised as to how to treat the points (for instance by point injection) in 2-5 subsequent sessions at intervals of 3-7 days. This may not be very satisfactory, as it is usually impossible for the local vet to re-assess the case (from an AP viewpoint) each time. Therefore, he/she is unable to find/use the most appropriate AP points (especially new TPs) as the case develops.
In difficult cases, AP must be adapted to the individual needs of the patient. Experienced clinicians modify Cookbook prescriptions or include Classical methods in their selection of points in later sessions if the clinical result is not satisfactory after session 2 or 3. Practitioners who rely too rigidly on Cookbook prescriptions (because they have not grasped the basics of Classical AP) often use incorrect or less effective AP points.
3. Inadequate stimulation
A good response to AP needs an adequate stimulus applied to the correct AP points.
Needling: In human AP, failure to place the needle in the correct position, at the correct depth and angle, and failure to obtain DeQi may produce poor clinical results. DeQi is the classical "Needle sensation" (para-esthesia, "pins and needles", numbness, heaviness, sensations running proximally or distally along the course of the meridian; occasionally the sensation may spread to the related organ or body part). In human practice, those who overstimulate in order to ensure strong DeQi may cause more "needle shock" (fainting, nausea etc). Shock may be induced easily in some patients. This may frighten them and they may discontinue therapy.
In Vet AP, it may be very difficult to recognise whether or not DeQi is obtained. In treating difficult animals (especially dangerous horses or dogs), clinicians may not place as many needles as they would wish. They may not be able to place the needles deep enough, may not maintain stimulation long enough, or may not replace needles which fall out before the session is over.
Electro-AP (EA): Some horses react violently to EA. (In those cases, point injection or manual needling/pecking/twirling can often elicit good clinical results).
Laser (especially lower power, used for too short time) may not be as effective as classical needling, EA or point injection. For maximum effect the light beam should be almost parallel and the light-spot should be small (concentrated). Lasers of less than 10 mW/cm sq have little penetrative power and may not reach AP points or TPs in deeper tissue. For large-animal work, output in the range 30-50 mW/cm sq is recommended. Unpulsed lasers do not penetrate as deeply as lasers pulsed at 2000-5000 Hz or more. Dirt on the glass at the probe-tip may limit output. This may not be noticed if the beam is invisible (infra-red). Infra-red lasers with an in-built optical sensor to monitor output power are preferable to those without a sensor.
Faulty lasers may not emit at the stated power or may have too wide an angle of irradiation. Some "laser" instruments are not real lasers and offer little more therapeutic power than a domestic flashlamp !
4. Failure to use primary or supportive therapies
AP can help to control pain and other signs and symptoms in life-threatening disorders, such as acute surgical conditions, acute pneumonia, toxaemia, septicaemia, poisoning etc. But in such conditions, it should be used as a secondary treatment, in combination with primary and supportive treatments.
AP may need to be supplemented by conventional therapy also in less severe conditions, in which there is no immediate threat to life. Two examples are given: infected tendon and incontinence/urinary-faecal retention in disc disease.
In treating an infected tendon, in which there is pus or sesamoideal bone sequestra, antibiotic therapy, drainage and/or surgery may be indicated as primary therapies and AP as a secondary therapy once the infection is controlled and the bone/pus removed.
In disc disease, with paresis/paralysis and urinary-faecal retention, enemas or manual evacuation of the rectum or catheterisation of the bladder may be necessary until rectal/bladder control is established. In cases with faecal-urinary incontinence, general nursing (to try to keep the body/hair-coat dry) helps to prevent excoriation and secondary infection of skin. Reliance on AP alone in such cases may give poor results.
5. Premature withdrawal of therapy
The number of AP sessions needed to elicit the optimal therapeutic response depends on the condition being treated and the ability of the adaptive mechanisms to respond. In acute simple cases, such as myofascial syndromes, 1 to 3 sessions may suffice. In chronic cases, 3 to 10 sessions may be needed. In severe chronic human cases, such as limb paralysis in poliomyelitis, post-CVA etc, therapy may continue for 10-60+ sessions.
A good response to AP may be gradual (i.e. continuous improvement after each session) or sudden (i.e. no change for the first few sessions, then a marked response after (say) the 5th session. Occasionally, little change may be seen until after AP has been discontinued.
Following the first 1-3 AP sessions, there may be one of three responses: no change,improvement in signs, or exaggeration of signs. Exaggeration is usually due to over-stimulation of points. In my opinion, exaggeration is a better response than no change. It suggests that therapy is activating some response and that alteration of the points or a lesser degree of AP stimulus is indicated.
Because the cost of AP therapy must be weighed against the financial value of animal patients, AP may not be attempted in cases with a difficult prognosis. Premature withdrawal of therapy occurs more commonly in Vet AP than in human AP, if acceptable clinical responses are not seen after 2 to 5 sessions in cases which could possibly respond to further sessions.
NON COMPLIANCE OF OWNER/HANDLER
Failure to use supportive methods: In large stables, owners and trainers frequently have little to do with individual horses. They delegate day-to-day responsibility for the care and management of patients to a groom/ handler who may be over-worked, under-paid, incompetent, apathetic, or (rarely) malevolent. It often happens that handlers are changed frequently, i.e. different handlers may be responsible for the patient from day to day or week to week. Instructions given to one handler may not be passed on (or carried out) by other handlers. As in orthodox vet practice, even when only one handler is involved, instructions to administer specific supportive treatment (medical, homoeopathic or physical), or to exercise the patient in a specific way, may not be carried out.
Failure to give physiotherapy between AP sessions: If other physiotherapy (for instance TENS) is not available, I usually ask that TPs in muscle be fisted (thumped gently but firmly with the closed fist) for 4-6 minutes each day between AP sessions. In my experience, when this is done, fewer AP sessions are needed and clinical recovery is faster. I attribute most of my failures in simple TP cases to non-compliance with that request or to the owner/trainer refusing to have further sessions of AP if 2 or 3 sessions had not been able to restore locomotor function on its own.
Failure to accept advice re use of "Allweather" tracks: A famous trainer was advised by three different vets not to use the "Allweather" track for speed-work for a potentially great colt. (Each time the colt was galloped on the "Allweather", he came in lame). AP at TPs and regional points successfully treated a long-standing back muscular lameness in 2 sessions, after which the colt won an Irish Classic race. One week after the win, the trainer insisted in using the "Allweather" and the horse came in acutely lame again, this time with TPs in the scapular muscles. (The colt was to run in an English Classic within 14 days). Four days after the injury, one session of AP at the TPs and regional points restored locomotor function in 36 hours. The manager was instructed to examine the colt daily for TP tenderness at the clipped points and to inform me within 3-4 days if tenderness persisted there. The training speed was so good that the trainer instructed that AP was not necessary, even though the TPs were still tender and his manager had told him of my advice. On the day before the second race, the TPs were still present. The colt ran a poor last in that race.
Failure to rest horses with strained tendons: In treating horses with tendinitis/bowed/strained flexor tendons, rest is very important when the tendon is "hot" or painful. In all my cases in which laser treatment for simple tendinitis failed, the owner/trainer refused to rest the patients and to re-introduce them gradually to full work, as I had instructed.
OTHER REASONS FOR FAILURE
Coincidental disorders
Ideally, AP therapy aims to normalise all the functions of patient, not just the presenting signs. In practise, however, this ideal may not be attainable. Coincidental problems may be present at presentation, or may arise during the course of successful AP therapy for a specific complaint. These coincidental problems may (or may not) be helped by further sessions of AP.
For example, a human patient may present with acute sciatica (in which AP could be highly successful) but may have a coincidental history of Parkinson's disease, chronic cardiac insufficiency or diabetic neuropathy (in which AP might have little to offer). In practise, one might treat the sciatica but advise the patient to seek specialist help for the other disorders.
Early in 1990, a horse was presented with a history of poor hind action since purchase some months before. The horse had been rested, except for walking and cantering exercise. On examination, TPs were found in the sacral area. Laser and needling of TPs and points such as BL23, VG 3, GB34,44 eliminated the TPs by the 3rd session. During therapy, mild exercise continued and the horse developed abrasions on both hind fetlocks. Acute inflammation of the fetlocks ensued. It was treated with antibiotics. Exercise was stopped and the horse was sent home to allow the inflammation to subside.
Inability of target organs to respond
The adaptive response is the key to all healing. Acupuncture (AP) activates the adaptive responses, which depend mainly on functional neuro-endocrine transmission. Physical or chemical interruption of transmission or functional inability of the target-organs to respond abolish or reduce the AP effect. Loss of function due to severe fibrosis of lung, liver, kidney can not be reversed by AP. Paralysis due to large-scale cerebral or spinal motor-neuron necrosis or due to section of the spinal cord can not be reversed.
Muscle atrophy in human patients usually has a poor prognosis if associated with motor-neuronal pathology. In spite of intensive physiotherapy 3-5 times/week for 6-12 months, many patients do not respond.
My experience of muscular atrophy in animals is limited mainly to horses showing atrophy of the sacral or rump area in association with myofascial syndrome or a history of lumbar or sacral injury and to dogs with German Shepherd syndrome. The prognosis to AP in such cases is poor, even if it can eliminate muscular pain and TPs. AP therapy usually fails to resolve the muscle atrophy and to restore full function and proper placement of the affected limb. This may be a minor drawback in pets or non-athletic animals but can eliminate any possibility of success as regards top competitive performance (racing, show-jumping, competitive dog shows etc).
Infertility due to blocked oviducts: In some cases of female sterility, the cause may be bilateral oviductal occlusion due to previous inflammation or adhesions. AP may not restore patency of occluded ducts.
Ovarian pain: I have treated a few fillies with recurrent hind-limb lameness arising within 10 days pre- to 10 days post- ovulation. In all cases, TPs were present in the area L2 - L4 (and occasionally in other reflex areas for the ovary-uterus), usually ipsilateral to the affected limb. In some cases, a colleague had found severe pain on ovarian palpation on the same side as the TPs. I diagnosed hind-limb pain referred from the ovary in association with ovulation pressure-pain/haemorrhage. AP at TPs and ovary-uterus points eliminated the TPs and gave good short-term clinical response but the condition (and TPs) recurred at the next ovulation. I would be reluctant to attempt AP in such cases in future.
Psycho-somatic dependence in humans
"Miraculous cures" in terminal or hopeless cases are well known in human medicine. They are attributed usually to inexplicable spontaneous remission. A positive attitude, a deep religious belief, the "will to live" or a "fighting spirit" are often involved. In other cases, with relatively minor pathology, patients may deteriorate rapidly and may die. Such cases are often associated with negative attitudes, pessimism or depression. Medical hypnosis is used successfully to treat organic as well as functional problems. Thus, the psyche may modulate the pathogenesis and resolution of many human somatic disorders.
The psyche is also important in human social interactions. Patients may use their illness" to attract attention" from loved-ones, to excuse their failure in family or work activities etc. For such patients, AP alone may be of little help, as they may not "want" their illness to be cured. Cure in such cases would need psycho-therapy/counselling etc to help the patient face up to (and defeat) the reasons for their psycho-somatic dependence on their clinical disorders.
Failure due to unknown causes (in spite of AHSHI points)
In many clinical cases, it is possible to make only a partial diagnosis. For example, hindlimb lameness in a horse may be attributed to muscular pain referred from clinically detected TPs in the lumbo-sacral area. But the precise cause of the TPs may remain unanswered. (Are they due to primary muscle strain, or are they recruited as secondary TPs to primary TPs elsewhere, or to pathology elsewhere (referred from spinal nerve pressure/entrapment, or referred from irritation of associated organs etc ?)). AP (including TP therapy) in such cases may lead to some failures, even though the TPs may disappear during therapy.
Carpal oedema: On 24/11/89, a foal was presented with marked oedema of the left carpus. No pain or heat was obvious. The foal had been bought about 2 weeks before that and the swelling had been present for some weeks before purchase. The cause was thought to be traumatic. X-rays were negative. Poultices had been applied without success. The foal was due for resale in 14 days. Between 24/11 and 6/12, 6 sessions of laser (local points plus points for the region) gave dramatic results. Daily massage was used to try to disperse the skin folds left after the oedema disappeared. On 7/12, the left carpus looked fine but on 8/12 it had swollen up as bad as before. The cause of the relapse is unknown.
Some patients may be "non-responders"
Genetic or acquired damage to neural circuitry may produce "non-responders" to AP therapy. Apart from the ability of target-organs to respond, the clinical response to AP depends on intact transmission of stimuli from the periphery, to the ascending tracts of the spinal cord, to the CNS, to the descending spinal tracts. Synaptic transmission of stimuli depends at each level on neuro-transmitters and their receptors.
Defective synthesis of neuro-transmitter or reduction in the number of receptors can block transmission. Certain strains of mice (CKBX) are genetically deficient in opiate receptors. These mice respond poorly or not at all to opiate analgesics or AP analgesia.
Karma ?
The concept of Karma teaches that the main events of our lives are pre-destined, as part of an overall Divine plan for our (and human) personal growth and maturity. In this concept, we must all suffer pain, loneliness, hunger etc as well as pleasure, companionship and plenty.
In the concept of Karma, one's disease may be part of the growth process and will not be cured until the reason for the lesson is learnt. In the end, we all die, in spite of every human physical and intellectual effort to save us.
The concept of Karma is scorned by most westerners. But those who scorn are not always correct.
SUCCESSES IN AP PRACTICE
AP successes (even in cases undiagnosed, wrongly diagnosed, or assessed initially as "difficult" or "unlikely to respond") may be explained by (a) spontaneous remissionor (b) activation of adaptive responses.
a. Spontaneous remission: Some AP "successes" may be due to spontaneous remission (Vix Naturae) rather than to AP therapy. Temporary or cyclical remissions are common, for instance in human multiple sclerosis. Many clinical problems may appear to respond initially to therapy, only to recur later. For instance, "back lameness" in humans, dogs and horses can recur.
Clinicians may attribute relapses to an inherent weakness in the patient. Congenital or acquired deformities of the vertebrae (misalignment, disc disease, spondylosis etc) or limbs (toeing in or out, "back at the knee", sickle or straight hocks etc) may throw abnormal strain on limb or back muscles, predisposing to relapse following apparent successful therapy. In humans, incorrect lifting (using the bent back rather than the knees and hips) or incorrect sitting posture etc is thought to justify the phrase: Once a back, always a back"!
Inadequate "follow-up" after apparently successful therapy would miss the recurrence of the disorder and a temporary remission could be erroneously classed as a "successful clinical response".
In the absence of controlled trials, it is not possible to quantify these spontaneous remissions. However, in clinical trials published by other workers, the "Placebo Effect" (apparent remission in the negative control group) can run from 10 to 60%. In human trials, a common Placebo Effect is of the order of 30-35%. However, remission rate depends on the disorder being examined. Spontaneous remission in motor neuron disease, for instance, would not be as high as in Grade 3 disc disease (motor paralysis with intact deep pain sensation). Spontaneous remission in typhoid would not be as high as in E. coli enteritis.
b. Activation of adaptive responses: The basic tenet of Holistic Medicine is thatthe body heals itself and that all effective therapies enhance the adaptive/homoeostatic/self-healing responses.
There is ample research evidence that AP activates the adaptive responses via segmental, inter-segmental and suraspinal reflexes, activation of autonomic, neuroendocrine, endocrine and immune responses (Rogers et al 1977, Lin & Rogers 1980, Rogers & Bossy 1981; Rogers 1990).
TP successes: Many chronic pain-disorders are associated with TPs in humans and animals, as discussed. TP elimination can eliminate pain and other disorders rapidly.
Most of the horses treated successfully for myofascial lameness had 1 to 7 TPs present in the affected muscles. Simple or electro-AP, point-injection or Laser (plus "fisting" or TENS between sessions) at the TPs and main AP points for the region usually eliminated the TPs and restored function within 1 to 7 sessions (usually 2-4 sessions).
Very chronic cases can respond. One such case was an 83 year-old woman with severe pain in her lateral thorax for more than 12 years. All previous assessments had failed to locate the cause of the pain and all previous attempts at treatment had failed. I located a single TP in an intercostal space on the mid-axillary line. Pressure on the TP caused her to scream. One needle in the TP and one in GB34 (same side) eliminated the pain in 2 sessions. She remained free of the pain until she died 7 years later.
Success in strained flexor tendons in the horse: I have had very good success with Laser therapy (30-50 mW pulsed infra-red laser) if the horse is rested for 1-2 weeks, followed by 1 month walking, 1 month trotting and 1 month cantering before return to full training (as advised by Emiel Van Den Bosch, Belgium).
In chronic cases, with visible "bowed tendons", laser was used 1-2 times/ week for 3-5 sessions. In some of these cases, the owner used a "blister paste" over the tendon and waited until all heat and pain had disappeared before requesting laser therapy. The horse was rested in the box, or let out to grass, until the the bow disappeared. Gradual return to training is advised, as in acute cases (above).
Powerful "responders": Some patients are powerful responders, i.e. respond symptomatically to 1-2 sessions of AP and remain well for weeks or months afterwards. When they present later (with recurrence or with a new problem), they usually respond rapidly to ssubsequent treatment. This can be dramatic, as in rapid response in some dogs with hip dysplasia or chronic hip osteoarthritis.
Success in spite of severe lesions: Moderate to severe vertebral or joint lesions may exist in elderly human and animal populations, many of whom have little or no history of pain or lameness associated with the lesion.
AP can produce marked clinical results in spite of severe lesions, such as severely dysplastic or arthritic hips. One example was a man who had broken both knees in a motor-cycle accident some years before. He developed severe osteoarthtitis, with pain, stiffness and "locking" of both knees. Knee movement produced crepitation which could be heard 4 metres away. Two sessions of AP restored limb function. Six months later, he phoned for another appointment: he had to hop down a ladder on one leg, as the other knee had locked again! Further AP gave relief within days.
Similarly, AP can be helpful in some cases of rheumatoid arthritis. An airport technician with severe RA came for AP. He had prosthetic hips and was on crutches. He said that the surgeons were thinking of recommending surgery on his elbows. He was in constant pain and could work only 1-2 days/fortnight. After 6-8 AP sessions he missed work about 1-2 days/fortnight. However, I was unable to help him enough with AP, so I referred him to a physician (Dr. Liz Ogden, Dublin). She prescribed a strict diet and homoeopathic remedies. Eighteen months later, I heard my name called as I walked accross the lobby in Kennedy Airport, New York. It was "my patient". He strode accross the lobby, hale and hearty without the crutches to thank me for referring him to Dr. Ogden!
Unexplained success in the absence of specific diagnosis: Occasionally, one may attempt to treat symptomatically a condition for which there is no specific diagnosis.
One such case was a very valuable thoroughbred filly with a history of lameness for some months in the fore-limbs. The lameness was intermittent, lasting 4-10 days, and shifted between the left and right limbs. Top-class equine vets had examined her before I was called. Clinical and other tests failed to locate the location or cause of the lameness. Pressure on the cervical nerve roots was suspected. I found nothing on examination, but was told she had been typically lame the day before. I needled the main points for neck and forelimb, once/week on three occasions. She was not seen lame after the first session of AP and was sold to France within 2 months.
CONCLUSIONS
Causes of clinical failure include: professional error (faulty diagnosis; faulty AP knowledge (incorrect choice of points, inadequate stimulation, failure to use primary or supportive therapies, premature withdrawal of therapy); non-compliance of owner or handler (failure to use supportive methods, failure to give physiotherapy between AP sessions, failure to accept advice re use of "Allweather" tracks, failure to rest horses with strained tendons etc). Other reasons include: coincidental disorders; inability of target organs to respond; psycho-somatic dependence in humans; failure in apparently straight-forward cases, in spite of AHSHI points; some patients may be "non-responders"; Karma ?
A less obvious and highly controversial factor is the mental state and "Energy Status" of the therapist. Many schools of Complementary Medicine teach that, to obtain the best clinical results, the therapist should be in good health and at peace with the self.
Modern Chinese Communists do not believe in a soul (a personal energy/ memory that exists independent of the body) that survives death. However, recent (unconfirmed) reports from China indicate that research in CH'I KUNG is producing exciting results. Mental and physical focusing/control of body Qi is possible. It can be learned and used for many purposes, including healing. Acupuncturists who are Masters of Qi Gong can often "sense" the location of disturbed Qi in the patient and can treat the disorder, without touching the patient, by directing their own Qi to the correct AP points.
Imbalanced Qi in the therapist may reduce clinical success. Focused intention (compassion, Tender Loving Care ?) has therapeutic value. Some clinicians with great knowledge (but little love) may prove inferior to those with great love (but little knowledge). And all of us have "down time", which may last days, weeks or longer.
In my opinion, top clinical success depends on the correct application of deeptheoretical and intuitive knowledge, compliance of the patient/owner, ability of the defence systems to respond and the will of God that we (and our animals) be healed. In most cases, God is willing but we are weak !
REFERENCES
- Lin,J.H. & Rogers,P.A.M. (1980) AP effects on the body's defence systems: a veterinary review. Veterinary Bulletin, 50, 633-640.
- Rogers,P.A.M., White,S.S. & Ottaway,C.W. (1977) Stimulation of the AP points in relation to analgesia and therapy of clinical disorders in animals. Veterinary Annual, 17, 258-279. Wright Scitechnica, Bristol.
- Rogers,P.A.M. & Bossy,J. (1981) Activation of the defence systems of the body in animals and man by AP and moxibustion. ARQ, 5, 47-54.
- Rogers,P.A.M. (1990) Activation of the body's adaptive responses by peripheral stimulation. IVAS Annual Congress, Netherlands.
QUESTIONS
In these questions, we define clinical success as medium-term elimination of most of the severe signs and symptoms, with restoration of body-mind functions to the extent possible under prevailing circumstances.
1. One of the following statements is not correct. Indicate the incorrect statement:
Clinical failures may be due to:
(a) professional error
(b) patient/owner error (non-compliance with advice given)
(c) coincidental disorders
(d) inability of target organs to respond
(e) refusal of an animal patient to allow acupuncture treatment
2. One of the following statements is not correct. Indicate the incorrect statement:
There are five main sources of professional error in AP therapy:
(a) faulty diagnosis
(b) incorrect choice of points
(c) inadequate point stimulation
(d) the use of supportive conventional therapies
(e) premature withdrawal of therapy
3. One of the following statements is not correct. Indicate the incorrect statement:
One can expect poor clinical success to AP in:
(a) equine carpitis (with carpal chips)
(b) equine septic tendinitis (with sesamoideal chips)
(c) canine posterior ataxia (with degenerative myelopathy)
(d) equine cervical ataxia (in older horses/chronic cases)
(e) equine hindlimb lameness (with sacroiliac muscular pain but sacro-iliac height similar on both sides when the horse is stood square)
4. One of the following statements is not correct. Indicate the incorrect statement:
(a) Experienced clinicians search carefully for Trigger Points at each session
(b) Even experienced clinicians miss TPs occasionally. It is common to find TPs on the second or third session which were absent (or were missed) in the first examination
(c) Failure to treat and eliminate TPs can mean that the clinical signs persist in spite of correct use of other (regional and general) AP points
(d) It may be necessary to rely on a colleague (who may not know AP) to continue treatment after the first session. The colleague is advised (at the first consultation) as to which points to use, and how to treat them in 2-5 subsequent sessions at intervals of 3-7 days
(e) In all cases, the colleague should be able to get the same therapeutic results as the acupuncturist if he/she uses the points discussed in the first consultation
5. One of the following statements is not correct. Indicate the incorrect statement:
(a) In Vet AP, it may be very difficult to recognise whether or not DeQi is obtained
(b) In treating difficult animals (especially dangerous horses or dogs), clinicians may not place needles as they would wish
(c)All horses accept Electro-AP (EA) calmly
(d)Laser (especially lower power, used for too short time) may not be as effective as classical needling, EA or point injection
(e) For large-animal work, pulsed lasers with output in the range 30-50 mW/cm sq are recommended
(f) Some "laser" instruments are not real lasers and offer little more therapeutic power than a domestic flashlamp
Answers
| 1 = e | 2 = d | 3 = e | 4 = e | 5 = c |