The Use of Laser Scalp Acupuncture in the Treatment of Canine Cerebrovascular Accidents

1. The Use of Laser Scalp Acupuncture in the Treatment of Canine Cerebrovascular Accidents Sherryl Friedman Dipl. Ac., AP, Steven D. Engle DVM, Patricia Saville B.A

2. Scalp acupuncture is a relatively modern acupuncture method. The Chinese attribute its development to Jiao ShunFa, a physician in Northern China, and it has been used in China since 1971. The principle of scalp acupuncture is very straightforward, the aim being to stimulate the diseased area of the brain in order to facilitate a return of function in that area. This method is based on elementary functional neuroanatomy and has very little to do with traditional Chinese medicine, although traditional body acupuncture is often combined with it. All scalp points are representations of the underlying functional areas of the brain. Thus, the most common use of scalp acupuncture will be in diseases in which there is brain damage, such as CVAs or severe head injuries.

3. The major areas or zones used in scalp acupuncture consist of: (1) Motor area which is located 0.5cms posterior to the midpoint of the anterior-posterior line that defines the upper limit of the of the motor area. The lower limit intersects the eyebrow-occiput line at the anterior border of the temple. The upper 1/5 represents the lower limbs and trunk, the middle 2/5 represents the upper limbs and the lower 2/5 represents the face. Used to treat contralateral motor disturbance of the appropriate area. (2) Sensory area, which is located in a line parallel to the motor area and 1.5cms behind it. The sensory input to the lower limbs and trunk is represented on the upper 1/5, the middle 2/5 represents the upper limbs and the lower 2/5 represents the face and is used to treat numbness and pain. (3) Chorea-tremor area, which is located parallel to and 1.5cms in front of the motor area, treats tremor and chorea from any cause, such as Parkinson’s disease.

4. (4) Vasomotor area, which is parallel to and 1.5cms in front of the chorea-tremor line and is used to treat cerebral edema. (5) Vertigo-auditory area, which is a 4cm horizontal line with its center located about 0.5cm above the base of the ear and used to treat vertigo and deafness. (6) Balance area, which originates 2cm lateral to the midpoint of the occipital protuberance and runs for 3cm in an anterior-posterior line in an anterior direction and is used to treat cerebellar disorders such as nystagmus.

7. Four frontal area zones are used to treat diseases that are not responding to conventional acupuncture. These are: 1) Ezhongxian, middle of the frontal area, 1 cun from GV24, straight down along the meridian and used to treat epilepsy, mental disorders, nasal diseases. 2) Epangxian, thoracic cavity area (T), 1 cun from BL3, straight down along the meridian and used to treat coronary disorders, angina pectoris, allergic asthma, bronchitis. 3) Epangxian II, stomach area (S), 1 cun from GB15, straight down along the meridian and used to treat acute and chronic gastritis, gastric ulcer, diseases of the liver and gallbladder. 4) Epangxian III, reproductive area (R), 0.75 cun medial from ST8, straight downward ad used to treat reproductive and urinary problems, lower abdominal pain.

9. There are four extra points on the top of the head, Sishencong, located 1 cun posterior, anterior and lateral to GV20, that are used to pacify wind, regulate qi and blood in the brain and calm the spirit, and are useful adjunctive points to the major zone areas.

10. Why laser acupuncture, as opposed to traditional acupuncture? • The Chinese usually insert 2- or 3-inch needles into the scalp area, running them down the subcutaneous layer. This requires a great deal of dexterity with an acupuncture needle, so some practitioners use several short consecutively connecting needles over the scalp area. • For the most positive effect, the scalp requires repeated stimulation, with recommendation that the needles be manually rotated 200 times per minute for about five minutes, then repeated two or three times during a twenty to thirty minute treatment. • Treatment is difficult for all but the most skilled practitioners and painful for the patient because of the large number of nerves and blood vessels located in the scalp. • The laser is painless and provides continuous stimulation to an acupuncture point. • Precise line location is not paramount because of the wider area of stimulation. • Frequencies can be changed to accommodate different types of physical problems such as paralysis, inflammation, organ function, etc.

11. All laser therapy was performed using a Petrolaser SL-202™, pre-programmed with the seven Nogier frequencies, using a wavelength of 810 – 890 nm, 50 to 60 mW power and a 2mm beam diameter.

12. Irradiation intensity W is expressed in mW/cm2 and specific irradiation dosage D is expressed as WT or J/cm2. For superficial acupuncture points, 0.5 to 2.5 J/cm2 is recommended and for deeper acupuncture points and myofascial trigger points, 2.5 to 5 J/cm2 is recommended. Using a laser at 50 mW power would yield a dosage of 1 J/cm2 after 20 seconds. We have observed by the animals’ reactions (licking, chewing, yawning) that acupuncture points reach a state of homeostasis in less than a minute and the next point or area can be treated.

13. The following table is a list of the different Nogier frequencies and their use:

14. Case Study 1 • 15 year old Yorkshire Terrier exhibited sudden onset of nystagmus and left-sided hemiplegia. ◦ Head and body were bent to the left and she could only move in a circle in that direction, falling after a few steps. • Western Diagnosis made by owner’s small animal practitioner: Stroke ◦ Treatment plan: 5 mg prednisone b.i.d for 10 days and return after that period for re-evaluation or sooner if symptoms worsen. • TCM examination performed 48 hours after onset of symptoms ◦ Tongue: Dim pink and thin with clear to thin-white coating ◦ Pulse: Thin, weak and wiry, especially left guan position (Liv) • TCM Diagnosis: Blood deficiency failing to contain rising yang ◦ Treatment plan: Alleviate the hemiplegia and nystagmus, dispel interior wind and liver yang, nourish yin and blood to anchor excess yang

15. Treatment Protocol Treatment 1 ◦ Laser scalp acupuncture using Nogier frequency G on bilateral upper fifth of the motor line and balance line ◦ Needle acupuncture on LI4, LIV3, ST36 and TH5 LI4 / LIV3 “the four gates” open circulation throughout the meridians, expel exterior and interior wind from the head, invigorate blood, stop pain and have a calming effect on the mind (shen) ST36 tonifies qi, nourishes blood and yin, calms the spirit, fosters original qi TH5 expels wind and benefits the head and eyes

16. Treatment 2 performed 48 hours later Animal able to walk in a straight line, barely perceptible head tilt, occasional occurrence of nystagmus (when eating or drinking), still falling over when making a turn ◦ Laser scalp acupuncture as performed in Treatment 1 ◦ Needle acupuncture on SI3, BL62, GB20 (bilateral) and SP6 ◦ Addition of Vertigoheel® ½ tablet b.i.d for 10 days (loss of balance) SI3 / BL62 confluent pair that opens Du mai (Governing vessel) and used for spinal diseases GB20 dispels liver yang and wind, invigorates qi and blood and opens the sensory orifices SP6 calms the spirit and nourishes yin and blood to anchor excess yang

17. Final treatment performed four days later Animal exhibiting great improvement with nystagmus completely resolved, no perceptible head tilt, able to move around the house without falling over and only loss of balance when negotiating stairs Tongue is now a normal pink color with clear to thin-white coating Pulse although slightly thin, no longer had a wiry quality ◦ Laser acupuncture on bilateral vertigo line ◦ Needle acupuncture on GB34, SP6 and GB20 GB34 was used to enhance free flow of qi, subdue liver qi and wind and facilitate qi and blood flow in the tendons and channels After 3 more days of the Vertigoheel, the animal had full recovery with complete motor and balance control

18. Point Locations for LIV3 / LI4 Reprinted by permission of Are Thoresen

19. Case Study 2 • 11 year old Labrador Retriever exhibited sudden onset of hind-end paralysis which was more left-sided, with nystagmus and dilated left pupil that was unresponsive to light stimulation. • Western Diagnosis made by owner’s small animal practitioner: “Brain Event” ◦ Treatment Plan: 20 mg prednisone b.i.d for ten days and then re- evaluation. • TCM Examination performed 72 hours after onset of symptoms ◦ Tongue: Slightly reddish especially on the sides (LIV/GB area) with a sticky pale yellow coating ◦ Pulse: Rapid and wiry especially in the left guan position • TCM Diagnosis: LIV Qi stagnation generating heat and stirring up wind ◦ Treatment Plan: Alleviate the paralysis and nystagmus, clear heat, dispel wind and promote free flow of qi

20. Treatment Protocol Treatment 1 ◦ Electro-acupuncture on GV6 and Lumbosacral space (Shiqizhuixia) ◦ Acupuncture BL23 GV6 benefits the spine and alleviates lumbar spinal stiffness Shiqizhuixia tonifies the kidneys and activates the spine BL23 strengthens the lumbar region, aids in the treatment of windstroke and hemiplegia

21. Treatment 2 performed 48 hours later Animal was able to move around now with some assistance ◦ Electro-acupuncture on points performed in Treatment 1 ◦ Conventional acupuncture on LI11, ST36, SI3 and BL62 LI11 was selected because it resolves wind, damp, heat, is the he- sea point of the hand yangming channel and would also be of benefit to the animal’s arthritic elbow This point paired with ST36 (he-sea point of the foot yangming channel) has a very strong heat clearing and qi and blood tonifying affect

22. Treatment 3 performed 4 days later Animal is now able to move around on his own, with only occasional stumbling, but still exhibiting some nystagmus and dilated left pupil Tongue is now a normal pink color with clear to thin white coating Pulse is slightly wiry ◦ Laser scalp acupuncture using Nogier frequency G on GV20, sishencong, upper fifth of the motor line (bilateral) and balance line (bilateral) ◦ Needle acupuncture on LI4, LIV3, GB20, SI3, BL62 and TH5 ◦ GV20 expels wind, calms the brain, calms the spirit, subdues yang and benefits the sea of marrow Even though the animal was responding well to conventional acupuncture, we opted to incorporate the scalp points because of the remaining nystagmus and dilated left pupil

23. Final treatment performed five days later ◦ Needle acupuncture on GV20, BL10, LI11, ST36, SI3 and BL62 BL10 was added to open the orifices, clear wind and facilitate qi flow in the muscles The animal was completely stabilized after the last treatment and was moving and running normally with no signs of nystagmus. One week after this treatment, the pupil returned to normal with full responsiveness to light stimulation

24. Case Study 3 • 6 to 7 year old Collie mix suffered from constant full body tremors, head-shaking, nystagmus, heavy labored breathing, possible vertigo and hind end paralysis (mostly right sided) • Western diagnosis made by neurologist: aneurism, brain tumor or problem with middle/inner ear (no CAT scan performed due to cost constraints) ◦ Animal taken home to see if he would recover on his own • TCM Examination performed after three months (with no improvement) ◦ Tongue: Crimson tongue with purple spots, more so on the tip and sides, with a dry yellow tongue coating and crimson gums ◦ Pulse: Rapid, large and wiry • TCM Diagnosis: Heat toxicity in the xue (blood) level (heat in the liver damaging yin and creating internal wind) ◦ Treatment Plan: Clear heat, regulate lung qi, dispel wind, support yin, alleviate the paralysis and nystagmus

25. Treatment Protocol Treatment 1 ◦ Laser scalp acupuncture using Nogier frequency G on GV20, sishencong, balance line, chorea tremor line, vertigo line and GV16 ◦ Needle acupuncture on LI11, ST36, GV14, BL13 (bilateral), LI4, LIV3, GB20, SI3 and BL62 GV16 dispels all forms of wind, clears the brain, opens the sensory orifices, strengthens the sea of marrow (sea of marrow points effect mental functioning and energy levels) GV14, LI11 and ST36 were selected to clear heat and wind BL13 tonifies and descends lung qi, clears heat from the lung

26. Treatment 2 performed 72 hours later Tongue and gums were now a pink color, breathing was slower and quieter and the nystagmus was almost imperceptible occurring only when eating or drinking. The full body spasms had disappeared and he could move around with some assistance ◦ Same points used for this treatment with addition of upper fifth of the motor line ◦ Placed on milk thistle (silybum marianum), 3 capsules b.i.d to protect the liver from damage due to chemicals, assist regeneration of liver tissue and detoxify the blood

27. Treatment 3 and 4 performed one week apart Animal could now get up and down and move on his own, but would lose balance after several steps and fall ◦ Needle acupuncture on LIV2, BL18, LIV14, BL20, ST36 and GB34 to clear liver fire, promote free-flow of liver qi and nourish yin to anchor yang

28. Treatments 5 through 7 performed one week apart Animal was now able to sit and lay like a normal animal, eat and drink on his own without assistance, but would exhibit some uncontrolled neural firing response to strong stimulation (excitement) Since this response resembled strychnine or strychnine-like poisoning, he was placed on two homeopathic remedies, Arsuraneel® containing strychninum nitricum and Valerianaheel™ for a sedative effect, 2 tablets and 8 drops b.i.d respectively (recommended by PJ Broadfoot, DVM) Since poisoning of this type affects the brain stem and spinal cord, the treatments consisted of: ◦ Laser scalp acupuncture using Nogier frequency E on the upper 1/5 of the motor line, balance line and GV26 (regulates Du mai and expels internal wind) ◦ Needle acupuncture on the huato jia ji points along the spine from L1 to S4 as well as similar location from C4 to C8

29. Two weeks after the addition of the remedies and these treatments, the animal exhibited much improved motor skills and was starting to move at a jog without falling over (improvement went from 60 to 85%) The animal was kept on the homeopathic remedies for two more weeks and acupuncture was performed on an as needed basis thereafter as he was showing good recovery

30. Conclusion The indication from the above three cases is that scalp acupuncture used in conjunction with body acupuncture can shorten recovery time from cerebrovascular events in canines compared with conventional approaches alone (several weeks to several months depending on the severity)