A JAVMA Article Review Kristen Mitchell and Janna Muccio

1. Evaluation of a radiographic caudolateral curvilinear osteophyte on the femoral neck and its relationship to DJD and distraction index in a dog A JAVMA Article Review Kristen Mitchell and Janna Muccio

3. Veterinary Acupuncture, an introduction

5. Presentation Outline • History of acupuncture • Traditional Chinese Medicine theories • Acupuncture points • Mechanisms of action • Where can you look for more info?

6. Eastern and Western Medicine • Western Medicine • New techniques • Historical understanding? • Eastern Medicine • Theories 1000s of years old • Historical understanding necessary

7. How long ago? • Some texts of acupuncture-- 200 BCE • Confucianism and Taoist views • Physiology and nature are tied

8. Health --A state of harmony existing between internal and external environments Balance

9. BALANCE • Central core of the Yin/Yang theory • Neither can exist in isolation

10. Yin Water Passive Slow Night Moon Winter Dark Yang Fire Active Fast Day Sun Summer Bright Natural World

11. Physiology • Yin Organs-- Liver Spleen/Pancreas Kidney Heart Lungs Pericardium • Yang Organs-- Stomach Lg/Sm Intestine Gall Bladder Urinary Bladder Triple Heater

12. Classification of Energy • Remember Physics? • Potential Energy • Kinetic Energy • Qi

13. When the balance is lost… Illness– an imbalance in the homeostatic mechanisms of the body Disorders of Qi Deficient Qi Stagnant Qi Rebellious Qi

14. Meridian Concept • Pathways • 1 meridian associated with each organ • Total= 14 used mainly in veterinary acupuncture today

15. The 5 Phases

17. The 8 Principles

18. Diagnosis • History • Physical Exam– all senses • Five Phases • Eight Principles

20. How is it performed? • Thin, flexible, sterile needles • Pierce and stimulation specific acupuncture points (“acupoints”) • Stimulation causes a complex cascade of body responses

21. Acupoints • Over 1,000 have been located and mapped • Found mostly in depressions located along cleavages between muscles, tendons, and bones • Foci of increased electrical conductivity (lower skin resistance)

22. Lower Skin Resistance (LRS) • Caused by… • Local increase in capillary permeability • A sympathetic reflex • ??? • Observed at many, but not all, acupoints • In dogs, 79% correlation • Zones or narrow bands of LRS resembling meridians extending along the long axis of limbs

23. Structural Basis • High density of nerve fibers and vascular networks in the subcutaneous tissue at or near acupoints • Specific structures… • Free nerve endings • Muscle spindles • Golgi tendon organs

24. Free Nerve Endings • Free nerve endings tend to converge in bundles with vascular structures beneath acupoints • Perforate superficial fascia • Enter skin

25. Form unique cylindrical structures surrounded by a sheath of loose connective tissue

26. Trigger Points (Travell and Rinzler, 1952) • Skin location that, when stimulated, produces pain in an adjacent or distant location • Suggested that this response was caused by blood vessels or nerves lying close to skin’s surface

27. Trigger Points, continued • Applied dry needling technique to trigger points to produce pain relief • 71% correlation between trigger points and acupoints

28. Examples of Locations • Superficial nerves or plexuses • Midline points where superficial nerves meet on the dorsal or ventral midline • Motor points (where nerves enter target muscle) • Muscle-tendon junctions (where Golgi tendon organs are abundant) • Sites where nerves exit bony foramina (supraorbital, infraorbital)

29. Mechanisms of Action • Neural Opiate Theory • Humoral Mechanism Theory • Local Mechanism Theory • Bioelectric Theory

30. Neural Opiate Theory • Acupuncture causes release of endogenous opioids into the CNS • Enkephalins • β Endorphins • Etc. • These opioids alter the integration and perception of pain

31. Humoral Mechanism Theory • Acupuncture causes release of a variety of humoral factors from the brain and other organs • Cortisol • Serotonin • Prolactin • Luteinizing hormone • Etc.

32. Local Mechanism Theory • Needle stimulation is associated w/ a local defense reaction • Muscle contraction around needle • Coagulation cascade • Activation of complement cascade • Vasodilation and increased vascular permeability • Mast cells degranulate

33. Bioelectric Theory • Meridians are conduits for sodium ions • Acupuncture induces the flow of sodium ions to deficient areas • Reducing cell lysis • Reducing pain

34. Pain management Oncology Immune mediated dz Dermatologic dz Neurologic dz Renal dz Cardiovascular dz Respiratory dz Applications

35. “It matters not whether medicine is old or new, so long as it brings about a cure. It matters not whether theories are Eastern or Western, so long as they prove to be true” Dr. Jen-Hsou Lin DVM, PhD

36. Where to get additional information: • International Veterinary Acupuncture Society • www.ivas.org/main.cfm • American Association of Veterinary Acupuncture • www.aava.org • American Holistic Veterinary Medicine Association • www.ahvma.org/ • www.altvetmed.com/associat.html • “Veterinary Acupuncture: Ancient Art to Modern Medicine”, by Alan M. Schoen • “Four Paws, Five Directions”, by Cheryl Schwartz • “The Web That Has No Weaver”, by T. Kaptchuk

37. References • Schoen, A.M.“Veterinary Acupuncture: Ancient Art to Modern Medicine”, Mosby, Inc., St. Louis, MO, 2001. • Schwartz, C. “Four Paws Five Directions: A Guide to Chinese Medicine for Cats and Dogs”, Celestial Arts, Berkley, CA, 1996. • Mitchell, D. “Introduction to Veterinary Acupuncture”, Proceedings of the 2000 Annual Conference of the American Holistic Veterinary Medical Associations, 2000. • Dr. Debbie Wilson • Dr. Mary Lindamood • Dr. Susan Drapek

38. Questions?