Clinical experiences with Acupuncture: failures and successes

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.