Equis ISSN 2398-2977

Acupuncture: overview

Contributor(s): Marvin Cain, Tim Couzens, Mike Dale, Dietrich Graf von Schweinitz

History

  • May have originated in Tibet or India and considered to be one of the oldest therapies in the world - practised from as far back as 2000-3000 BC. Evidence in China of acupuncture dates from the middle Chou (Zhou) Period about -600 when medicine begins to emerge as a separate entity from demonology and magical correspondences. Early acupuncture instruments were made from sharpened stone, bone or bamboo. Bronze needles have been identified from the Chou period.
  • The frozen remains of a Tyrolean alpine man (Ötzi) discovered in 1991 has been dated to 5300 years old. Over 50 tattoos found have been forensically analyzed and found to lie on or within 5 mm of classical acupuncture points (acupoints) used to treat OA of the spine, hips, knees which were conditions noted on the radiologic findings. These tattoos would be covered by clothing and not likely to be of ornamental purpose. This suggests acupuncture cauterization treatments were employed in cultures outside China in prehistoric times of approximately 3300 BC.
  • The first significant text on Chinese Medicine including acupuncture practice is the Huang Di Nei Jing (The Yellow Emperors Canon of Internal Medicine) from the Han Period of approximately -200. The concepts of Yin and Yang, the Organs, 5 Phases and the practice of determining the state of the viscera by palpation of certain points on the body are described, along with the principal forms of treatment, including bloodletting, insertion of needles, and burning of herbs at specific points along the identified channels that communicated with the vessels and viscera.
  • The first references to veterinary acupuncture appear in the Tang dynasty (600-900AD) but no surviving texts exist. The first surviving veterinary text covering acupuncture is from the Therapeutic Treatise of Horses, 1608. Acupuncture points, mainly over veins and for bloodletting, were described without referring them to channels as done for humans.
  • Some critics dispute the historical evidence of acupuncture and it is clear that even defining what constitutes the practice of acupuncture becomes a hindrance to acceptance of a particular history (Ramey).
  • During the Qing period 1644-1911 acupuncture and Chinese medical traditions went into decline and during the 1800s western medical practices were increasingly adopted leaving the traditionalists operating in the more rural areas.
  • In 1600s Japan produced a famous blind acupuncturist (known as the father of acupuncture there), Sugiyama, who invented the insertion tube: a hollow tube to place the needle in which allowed much thinner needles to be inserted painlessly. He founded an acupuncture school for the blind and the practice was brought to palpation based practice which had been in decline in China where physicians progressively lost the skills of body palpation due to cultural taboos. They had become restricted to palpating the radial artery pulse with a very detailed pulse diagnosis technique and a tongue diagnostic exam. They also became restricted to use of only distal extremity acupuncture points (from the elbows and knees distally).
  • From the 1820s the Chinese government sought to ban the teaching of acupuncture and ended its inclusion at the Imperial Medical Academy. The Japanese also banned it from 1876.
  • Acupuncture references appeared in Europe from the 1600s, most significantly from a Dutch physician, Willem ten Rhinje, who learned about the medicine from his time with the Dutch East India Co. He understood the Chinese approach to channels as focused on the circulation of blood and vital air (qi).
  • The Energy-Meridian Theory was first introduced by a French diplomat stationed in China in the 1920s who published his book (L Acupuncture Chinoise) in 1939. He translated qi as energy and jing as meridian. Jingmai and jingluo refers to the large and small collateral blood vessels respectively. This mistranslation created a metaphysical concept that is not consistent with translations by other experts (P Unschuld, J Needham, D E Kendall, C Schnorrenberger).
  • Mao Zedong ordered the revival of the traditional medical practices during the Cultural Revolution in the 50s-60s which generated the present day version of Traditional Chinese Medicine (TCM).
  • The Nixon visit to China in the 1970s sparked a renewed interest in acupuncture in the West including in the veterinary community. The International Veterinary Acupuncture Society (  www.ivas.org ) was soon formed in the USA in 1976 and founded a teaching program which it has continued to run to the present. The Association of British Veterinary Acupuncturists (  www.abva.co.uk ) was formed in 1987 which runs acupuncture courses in the UK. Animal acupuncture in the UK is still restricted under the Veterinary Surgeons Act as a veterinary procedure while many other western countries have permitted non-vets to practice. 
  • The initial approach adopted in the west was predominantly influenced by the Energetics schools (energy circulation in meridians) which made acupuncture appear incompatible with modern understandings of anatomy and physiology. An increasingly scientific approach to veterinary acupuncture is progressing with research projects undertaken in a number of western veterinary colleges.
  • Traditional Chinese veterinary acupuncture differed from human acupuncture throughout its history notably developing animal acupoint charts unique to each species and quite different to the human points locations (with some exceptions). Animal acupoints were not assigned to Channels (or meridians) as in man. 
  • The ox and horse were the only 2 species in China which had early texts with acupuncture charts; the other animals only had charts developed in the last century. The Chinese equine charts show the order and location of the Organ Shu (association or communicating) points as different to humans. Acupoints were identified with their indications and were often overlying blood vessels to be treated frequently by bleeding the point, or by fire-needling (cauterized), or burning moxa (mugwort) over the point.
  • Since the 1950s the Chinese have moved to a predominantly electro-acupuncture practice and their veterinary practice continues to use their traditional animal points (different for each species).
  • Other forms of acupuncture stimulation include aquapuncture the injection of agents ranging from local anesthetics, vitamin B12, homeopathic solutions, and irritant solutions; laser stimulation; and implantation with materials such as catgut and gold beads.
  • Western veterinary acupuncturists in the 1970s were frustrated by the lack of translations of the traditional Chinese veterinary acupuncture texts and also more impressed by the system employed by their human counterparts. The founders of IVAS subsequently developed transpositional acupuncture, ie copying the human acupoints and channels onto animals along with the human paradigms and indications for their use. This style of acupuncture is presented as TCM acupuncture and presupposes that the animal responses to the transposed points are equivalent to the human.
  • There is little explanation why human and animal acupuncture charts evolved so differently in China, especially with regard to assigning the points to a particular channel-organ system in humans vs the equine having only 1 acupoint assigned to each channel-organ and these were predominantly hemoacupuncture points, ie a bleeding point over obvious large veins. One reason given in an ancient text was that the horse was generally inclined to an excess of blood in pathology terms (therefore drain blood) unlike the human who was inclined to excess Qi and deficient blood patterns. Kendall explains (Dao of Chinese Medicine) that reports of propagated sensation in acupunctured humans describes commonly experienced paths of sensation from the needled point. These are about 1-2 cm wide along the extremities and about 10 cm wide along the trunk, and spread at speeds of 1-20 cm/sec, far slower than any nerve conduction. These reports likely led to the concepts of superficial channels with a flow of Qi linking chains of acupoints. Animals cannot report propagated sensation from acupuncture stimulation so there was no equivalent phenomena to describe animal channels. The exception is the observation on some acupunctured horses of a Pilomotor Response along the Bladder Channel and demonstrates a linear chain of acupoints along the thoracolumbar spine   Acupuncture: pilomotor response 01    Acupuncture: pilomotor response 02  . The classical acupoints (channel associated) in man number 365 while the horse had only 173 described in 1608 which are still used in China today.
  • The traditional or Chinese equine acupoints were named to denote their special aspects either in anatomic location or by their function, eg each organ had a Shu (Association) point. There are only a small proportion of the traditional equine points which correlate in location and purported function to the transposed human points   Acupuncture: meridian / channel points 01    Acupuncture: meridian / channel points 02  . As the transposed points system provided Western veterinarians with positive results it reinforced the trend and made it easier to adopt the human TCM acupuncture teachings readily available in English translations while in the early 70s there was no available translated Chinese veterinary acupuncture text. Over time and through collaboration with Chinese veterinary acupuncture researchers, there has been some mixing of the 2 systems and a recent Chinese author (Xie) who resides in the USA has published a text which incorporates a substantial number of the human transposed points into charts containing otherwise traditional points. In addition to the mixing of the traditional and transpositional systems there have been many other novel approaches developed by various Western equine veterinary acupuncturists which produces very different acupuncture treatments for any given disease.
  • Debates exist in accurate locations for the transposed points due to anatomical variations, particularly in the equine compared to man where many important points are on digits the horse doesnt possess. Todays animal acupuncture in the west is a practice developed by westerners since the 1970s and is significantly different to the Chinese practice past and present.
  • Scientific advances in neuro-endocrinology have improved the understanding of acupuncture effects and made it a more credible therapy in medical minds; and it has sharpened the debate between traditionalists and medical acupuncturists. Many questions remain over the specificity of points and many other matters pertaining to the practice. Much research is needed to meet evidence based medicine criteria, but there have been recent studies meeting scientific demands and providing stimulus for further investigation.
  • Veterinary acupuncture demand has grown steadily in the UK as elsewhere in the world. The ABVA has had approximately 80 veterinary surgeons per year taking its introductory level course. Many western countries have a veterinary acupuncture society. As yet, no external validation or accreditation exists for any veterinary acupuncture education or certification.
  • Equine acupuncture is mainly carried out for chronic pain or poor performance issues, where conventional treatments have had little to no benefit, or in horses competing under rules prohibiting medications. Other conditions amenable to acupuncture include chronic respiratory, digestive, ophthalmologic, dermatologic, neurologic and reproductive diseases.
  • Acupuncture is a very safe procedure if carried out with due care. The use of single use disposable sterile needles, use of appropriate needle size and technique, knowledge of anatomy, avoidance of needling infected or neoplastic tissue, care with fractious animals and late stage pregnancy, clotting disorders and applying caution as with other similar interventions makes complications extremely rare.
  • Risks include stuck needles due to bending from muscular contraction, needle breakage (extremely rare), puncture of viscera, eye, or intrasynovial space, infection, ingestion of needle, loss of needle in long hair or fur, and forgotten needle.
Print off the Owner factsheet on Complementary therapies to give to your clients.

Traditional concepts (in brief)

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Scientific explanations of acupuncture

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Hui K K, Marina O et al (2010) Acupuncture, the limbic system, and the anticorrelated networks of the brain. Auton Neurosci 157 (1-2), 81-90 PubMed.
  • Wang J et al (2010) Three-dimensional reconstruction of the meridians with MRI picture in the upper limb of human. Zhongguo Zhen Jiu 30 (2), 125-128 PubMed.
  • Zhang J H, Li J et al (2009) Can electroacupuncture affect the sympathetic activity, estimated by skin temperature measurement? A functional MRI study on the effect of needling at GB 34 and GB 39 on patients with pain in the lower extremity. Acupunct Electrother Res 34 (3-4), 151-164 PubMed.
  • Jing Yuan, Nithima Purepong et al (2008) Effectiveness of acupuncture for low back pain: A systematic review. Spine 33 (23) E887-900 PubMed.
  • Lin J G & Chen W L (2008) Acupuncture analgesia: A review of its mechanisms of actions. Am J Chin Med 36 (4), 635-645 PubMed.
  • Sun Y, Gan T J et al (2008) Acupuncture and related techniques for postoperative pain: A systematic review of randomized controlled trials. Br J Anaesthesia 101 (2), 151-160 PubMed.
  • Zhao Z Q (2008) Neural mechanism underlying acupuncture analgesia. Prog Neurobiol 85 (4), 355-375 PubMed.
  • Ezzo J, Streitberger K & Schneider A (2006) Cochrane systematic reviews examine P6 acupuncture-point stimulation for nausea and vomiting. J Altern Complement Med 12 (5), 489-495 PubMed.
  • Habacher G, Pittler M H & Ernst E (2006) Effectiveness of acupuncture in veterinary medicine: systematic review. J Vet Intern Med 20 (3), 480-488 PubMed
  • Macgregor J & Graf von Schweinitz D (2006) Needle electromyographic studies at myofascial trigger points and control sites in equine cleidobrachialis muscle. Acupunct Med 24 (2), 61-70 PubMed.
  • Xie H & Ortiz-Umpierre C (2006) What acupuncture can and cannot treat. J Am Anim Hosp Assoc 42 (4), 244-248 PubMed.
  • Manheimer E, White A, Berman B, Forys K & Ernst E (2005) Meta-analysis: acupuncture for low back pain. Ann Intern Med 142 (8), 651-663 PubMed.
  • Ramey D W (2005) Acupuncture and 'traditional Chinese medicine' in the horse. Part 2: A scientific review. Equine Vet Educ 17 (2), 106-112. 
  • Xie H, Colahan P & Ott E A (2005) Evaluation of electroacupuncture treatment of horses with signs of chronic thoracolumbar pain. JAVMA 227 (2), 281-286 PubMed.
  • Ramey D & Buell P D (2004) A true history of acupuncture. Focus Altern Complement Ther 9, 269-273.
  • Boldt E Jr (2002) Use of complementary veterinary medicine in the geriatric horse. Vet Clin North Am Equine Pract 18 (3), 631-636 PubMed.
  • Langevin H M, Churchill D L et al (2002) Evidence of connective tissue involvement in acupuncture. FASEB 16 (8), 872-874 PubMed.
  • Skarda R T, Tejwani G A & Muir W W 3rd (2002) Cutaneous analgesia, hemodynamic and respiratory effects, and beta-endorphin concentration in spinal fluid and plasma of horses after acupuncture and electroacupuncture. Am J Vet Res 63 (10), 1435-1442 PubMed.
  • MacPherson H, Thomas K et al (2001) A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists. Acupunct Med 19 (2), 93-102 PubMed.
  • Scott S (2001) Developments in veterinary acupuncture. Acupunct Med 19 (1), 27-31 PubMed.
  • Dorfer L et al (2000) A medical report from the stone age? Lancet 354 (9183), 1023-1025 PubMed.
  • Gaynor J S (2000) Acupuncture for management of pain. Vet Clin North Am Small Anim Pract 30 (4), 875-884 PubMed.
  • Mittleman E & Gaynor J S (2000) A brief overview of the analgesic and immunologic effects of acupuncture in domestic animals. JAVMA 217 (8), 1201-1205 PubMed
  • Ridgway K (1999) Acupuncture as a treatment modality for back problems. Vet Clin North Am Equine Pract 15 (1), 211-221 PubMed
  • Sumano Lopez H, Hoyas Sepulveda M L & Brumbaugh G W (1999) Pharmacologic and alternative therapies for the horse with chronic laminitis. Vet Clin North Am Equine Pract 15 (2), 495-516 PubMed
  • Knight D P (1998) The acupuncture system and the liquid crystalline collagen fibers of the connective tissues. Am J Chin Med 26 (3-4), 251-263 PubMed
  • Bossut D F (1996) Veterinary clinical applications of acupuncture. J Altern Complement Med (1), 65-69 PubMed.
  • Schnorrenberger C C (1996) Morphological foundations of acupuncture: An anatomical nomenclature of acupuncture structures. Acupunct Med 14 (2), 89-103.
  • Vickers A J (1996) Can acupuncture have specific effects on health? A systematic review of acupuncture antiemesis trials. J R Soc Med 89 (6), 303-311 PubMed.
  • Yu C, Zhang K, Lu G, Xu J, Xie H, Lui Z, Wang Y & Zhu J (1994) Characteristics of acupuncture meridians and acupoints in animals. Rev Sci Tech 13 (3), 927-933 PubMed.
  • Hubbard D R & Berkoff G M (1993) Myofascial trigger points show spontaneous needle EMG activity. Spine 18 (13), 1803-1807 PubMed.
  • Janssens L A (1993) The role of acupuncture in analgesia. Tijdschr Diergeneeskd 118 (Suppl 1) PubMed.
  • Altman S (1992) Techniques and instrumentation. Probl Vet Med (1), 66-87 PubMed
  • Dill S G (1992) Acupuncture for gastrointestinal disorders. Probl Vet Med (1), 144-154 PubMed
  • Hwang Y C (1992) Anatomy and classification of acupoints. Probl Vet Med (1), 12-15 PubMed
  • Jaggar D (1992) History and basic introduction to veterinary acupuncture. Probl Vet Med (1), 1-11 PubMed
  • Janssens L A (1992) Acupuncture for the treatment of thoracolumbar and cervical disk disease in the dog. Probl Vet Med (1), 107-116 PubMed
  • Janssens L A (1992) Trigger point therapy. Probl Vet Med (1), 117-124 PubMed
  • Klide A M (1992) Acupuncture analgesia. Vet Clin North Am Small Anim Pract 22 (2), 374-379 PubMed
  • Limehouse J B (1992) Oriental concepts of acupunctureProbl Vet Med (1), 53-65 PubMed
  • Lin J H & Panzer R (1992) Acupuncture for reproductive disorders. Probl Vet Med (1), 155-161 PubMed
  • Rogers P A, Schoen A M & Limehouse J (1992) Acupuncture for immune-mediated disorders. Literature review and clinical applications. Probl Vet Med (1), 162-193 PubMed
  • Schoen A M (1992)Acupuncture for musculoskeletal disorders. Probl Vet Med4(1), 88-97PubMed
  • Schwartz C (1992) Chronic respiratory conditions and acupuncture therapy. Probl Vet Med (1) 136-143 PubMed
  • Smith F W jr (1992) Acupuncture for cardiovascular disorders. Probl Vet Med (1), 125-131 PubMed
  • Smith F W jr (1992) Neurophysiologic basis of acupuncture. Probl Vet Med (1), 34-52 PubMed.
  • Janssens L A (1991) Acupuncture in thoracolumbar disk disease. J S Afr Vet Assoc 62 (1), 2.
  • Janssens L A, Altman S & Rogers P A (1979) Respiratory and cardiac arrest under general anaesthesia - treatment by acupuncture of the nasal philtrum. Vet Rec 105 (12), 273-276 PubMed.
  • Rogers P A (1978)Veterinary acupuncture. Vet Rec102(17), 387PubMed.
  • Altman S (1977) Acupuncture - taking a closer look. Mod Vet Pract 58 (12), 1003-1006 PubMed.
  • Melzack R, Stillwell D M & Fox E J (1977) Trigger points and acupuncture points for pain: correlation and implications. Pain 3, 3-23 PubMed.
  • Freeman A (1974) Veterinary acupuncture. JAVMA 164 (5), 446-448 PubMed.
  • Chiang C Y et al (1973) Peripheral afferent pathway for acupuncture analgesia. Scientia Sinica 16, 210-217.

Other sources of information

  • Langevin H M, Wayne P M et al (2011) Progress in Acupuncture Research: Strategies for Moving Forward. Evid Based Complement Alternat Med 180805.
  • Linde K, Allais G et al (2009) Acupuncture for Migraine Prophylaxis. Cochrane Database Syst Rev (1) CD001218.
  • Xie H & Preast V (2007) Xies Veterinary Acupuncture. Blackwell Publishing.
  • Lindley S & Cummings M (2006) Essentials of Western Veterinary Acupuncture. Blackwell Publishing.
  • Unschuld P U (2003) Huang Di nei jing su wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. University of California Press, Ltd.
  • Gwei-Djen L & Needham J (2002) Celestial Lancets A History and Rationale of Acupuncture and Moxa. Routledge Curzon.
  • Kendall DE (2002) Dao of Chinese Medicine. Oxford University Press.
  • Schoen A (2001) Veterinary Acupuncture. Ancient Art to Modern Medicine. 2nd edn. Mosby.
  • Birch S J & Felt R L (1999) Understanding Acupuncture. Churchill Livingstone.
  • Ernst E & White A (1999) Eds. Acupuncture A Scientific Appraisal. Butterworth.
  • Simons D, Travell J & Simons L (1999) General Overview. Myofascial Pain and Dysfunction. In: The Trigger Point Manual Vol 1. Williams & Wilkins. pp 13-93.
  • Filshie J & White A (1998) Eds. Medical Acupuncture A Western Scientific Approach. Churchill Livingstone.
  • Schoen & Wynn (1997) Complementary and Alternative Veterinary Medicine. Mosby.
  • Chuan Y (1995) Traditional Chinese Veterinary Acupuncture and Moxibustion. China Agricultural Press.
  • Mann F (1992) Reinventing Acupuncture. Butterworth-Heinemann.
  • Maciocia G (1989) The Foundations of Chinese Medicine. Churchill Livingstone.
  • Kaputchuk T J (1983) Chinese Medicine - The Web That Has No Weaver. Rider.
  • Travell J G & Simons D G (1983 & 1992) Myofascial Pain and Dysfunction. In: The Trigger Point Manual - Vol 1 & 2. Williams &Wilkins, Baltimore.

Organization(s)

  • The American Academy of Veterinary Acupuncture (AAVA), 100 Roscommon Drive, Suite 320, Middletown, CT 06457, USA. Website: www.aava.org.
  • The Association of British Veterinary Acupuncturists (ABVA), ABVA Admin, British Medical Acupuncture Society, BMAS House, 3 Winnington Court, Northwich CW8 1AQ, UK. Email: admin@medical-acupuncture.org.uk; Website: www.abva.co.uk.
  • The International Veterinary Acupuncture Society (IVAS), PO Box 271395, Ft Collins, CO 80527-1395, USA. Email: ivasoffice@aol.com; Website: www.ivas.org.


ADDED