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Nina Malik, DVMOctober 15, 2008
Atlantic Coast Veterinary Specialists
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• History of Ac p nct re• !astern "ra#e$ork• %estern "ra#e$ork& Mec'anis# of Action• Ac p nct re Mo(alities• )n(ications for Ac p nct re• Case St (ies
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%'at %e *earnCurriculum in Veterinary MedicineGraduation Requirements
First Year Cr+ "all 5 rinciples of Morp'olo-y )./ M S 0 /io#e(ical Sciences )./ M S 'ysiolo-ical C'e#istry.//M/ 20 1 Clinical "o n(ations./ M S3V C S 4 1 Clinical )#a-in- ).VC S 41 1 Case St (y )./ M S 5 Veterinarian in Society ).V C S 11 16 Cr. Spring rinciplesof Morp'olo-y ))./ M S 1 /io#e(ical Sciences ))./ M S Ne robiolo-y./ M S 6 2Veterinary )## nolo-y.V M M 80 2 7eneral at'olo-y.V t' 2 1 Case St (y ))./ M S 1Veterinarian in Society )).V C S 12 14
Second Year Cr+ "all Veterinary arasitolo-y.V t' 6 Syste#ic at'olo-y.V t' 62 5Veterinary Microbiolo-y ).V M M 8 2 Case St (y ))).V t' 66 1 Veterinarian in Society ))).V C S1 15 Cr. Spring 7eneral 'ar#acolo-y./ M S 5 1 Anest'esiolo-y.VCS 48 VeterinaryMicrobiolo-y )).V M M 86 blic Healt'.V M M 88 rinciples of S r-ery.V C S 46 2 CaseSt (y )V.V M M 68 18
Third Year Cr+ "all Clinical at'.V t' 25 2 )nfert+ Diseases.V M M 5 Clinical Me(icine ).V C S S r-ery *aboratory.V C S 4 Dist rbances of epro( ction.V C S 503VD AM 50 'ar#acolo-y an( 'erape tics./ M S 1 Veterinarian in Society )V.V C S 1 )ntro( ction toClinics.V C S 03VD AM 0 Se#inar.V C S 85 21 Cr. Spring Special at'olo-y.V t' 22 )nfectio s Diseases an( re9enti9e Me(icine.V M M 6 5 Clinical Me(icine )).V C S 53VD AM5 Veterinary o:icolo-y.VD AM 2 2 a(iolo-y.V C S 8 1 Op't'al#olo-y.V C S 44 1
Veterinarian in Society.V C S 15 Se#inar.V C S 85 18
Fourth Year 'e fo rt' year of t'e 9eterinary #e(ical c rric l # is (esi-ne( to be fle:ible an(to pro9i(e for species e#p'asis+ St (ents # st co#plete 8 cre(its ( rin- t'eir fo rt' year+ 'ey# st take a re; ire( block an( at least one option block+ 'e re#ain(er of t'e fo rt' year cre(itsare ac; ire( by selectin- a((itional option blocks, Veterinary eac'in- Hospital clinical electi9es, off&ca#p s clinical electi9es, or ot'er electi9es+ A((itional off&ca#p s clinical electi9e cre(its can beearne( at appro9e( -o9ern#ent a-encies, researc' laboratories, 9eterinary practices, an( ot'er
)n(ications Applications Mec'anis#s of action
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o rna o e #er canVeterinary Me(ical
AssociationSepte#ber 15, 2006, Vol+ 2 1, No+ , a-es 41 &418
Abstract
!aluation o" electroacupuncturetreatment "or thoracolumbarinter!ertebral dis# disease in dogs
Ayne M rata Hayas'i, DVM, MSc, < lia Maria Matera, DVM, 'D, Ana Carolina /ran(=o (e Ca#pos"onseca into, DVM, 'D Depart#ent of S r-ery, Sc'ool of Veterinary Me(icine, >ni9ersity of S=oa lo, S=o a lo&S , /ra?il 05508&400+ @Hayas'i, Matera, (e Ca#pos "onseca into
Conclusions and Clinical Rele!ance .!lectroac p nct re co#bine( $it' stan(ar(%estern #e(ical treat#ent $as effecti9e an(res lte( in s'orter ti#e to reco9er a#b lation an(
(eep pain perception t'an (i( se of %esterntreat#ent alone in (o-s $it' si-ns of t'oracol #bar
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Ancient Healin- Art 'eories ofcirc lation an( p lsec'aracter post late(in C'ina ,000 yearsbefore %estern#e(icineVario s nations
clai#e( to befo n(ers"o n(ers ofac p nct re&Nort'ern )n(ia or
ibet @Ay r9e(ic
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H an-&(e&nei& in-"irst $ritten recor( ofac p nct re o9er2,200 years a-o inC'ina
$o books& S $en ist'e #ost fa#o sCon9ersation $it'
ello$ !#peror @ r( #illenni # /+C+'ysiolo-y, pat'olo-y,
(ia-nosis, an(pre9ention of (iseaseA t'ors'ip& ello$!#perorB
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History of Veterinary
Ac p nct re
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"irst Veterinary
Ac p nct re e:tbook
S n& an-, 50 /+C+ *yon, "rance, 16 1
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'e !astern "ra#e$ork Yin
$ Yang
• Dark• Descen(s• Cool, #oist• Anabolis#, rest• S bstance& tiss es• Ventral an( )nner aspects of bo
• *i-'t• !:pan(s o t$ar(s an( p$ar(s• Hot• Metabolis#, #o9e#ent• Hea(, /ack, O ter
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%i• !ner-y force r nnin- t'ro -' bo(y• "lo$ of Fi infl ences 'ealt' of ani#
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• )ns fficient• >nbalance(• Obstr cte(
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Meri(iansFi tra9els in#eri(ians3c'annels
Ac p nct re points&locations $'ere#eri(ians co#e tos rface3accessible
Nee(lin- pointsG#anip late Fi an(restore balanceAllo$s bo(y to 'ealitself
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7/ an( /* 5
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attern Differentiation CM (ia-nosis is base( on pattern (ifferentiation,not on (ia-nosis of a partic lar (isease as in%estern #e(icine
One (isease entity in %estern #e(icine #ay 'a9e# ltiple n(erlyin- possible CM patterns+ CM atterns are base( on a n #ber of (ifferentfactorsE
HistoryDia-nostic ests @ a(io-rap's, /loo($ork'ysical !:a#ination
on- e an( lse (ia-nosis
*ifestyle, e:ternal factors @(a#p $eat'er ,an( personality3be'a9ior
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'e "orest t'ro -' t'e
rees
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Anato#y of ac p nct re points
Mec'anis#s of Action• !ffects on t'e CNS• !n(o-eno s ain )n'ibition• Se-#ental Anal-esia• *ocal iss e !ffects• A tono#ic Ner9o s Syste#• ri--er oint 'erapy
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Anato#y of Ac p nct re
ointsNot ran(o# points on t'e bo(y
Areas of lo$er electrical skin resistanceco#pare( $it' t'e s rro n(in- skin+ Nor#alskinE 200,000&2 #illion o'#s 9s+ 50,000 o'#s
Hi-' electrical skin con( ctance
Many fo n( in palpable (epressions on t'ebo(y
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Anato#y of Ac p nct re
oints
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ri--er oints• Hyperirritable loc s$it'in a ta t ban( ofskeletal # scle or itsassociate( fascia
• Appro:i#ately 60
of ac p nct repoints correspon( totri--er points
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!ffects of Ac p nct re ont'e CNS
e-ions of CNS Acti9ate(
1+ Spinal Cor(
2+ /rainste#
+ Hypot'ala# s&pit itary
elease of N @en(o-eno s opiates
/lock ain Messa-es
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!n(o-eno s ain
)n'ibitionA (elta fibers carrypain i#p lse tola#ina ) of (orsal'ornActi9ate ne rons oft'e neospinot'ala#ictractNe rons 'a9e lon-a:ons t'at cross toopp spinal cor( an(
ascen( to t'e' ot'ala# s3 it ita
H ' l # (
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Hypot'ala# s an(it itary
Arc ate n cle s Lpit itary contain allt'e beta&en(orp'incells in t'e brain
/eta&en(orp'inrelease into bloo(an( CS"
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cti9ation of t'e /rainste#
• Sti# lates (escen(in-norepinep'rine in'ibitory
an( serotoner-icin'ibitory fibers
• ra9el in (orsolateral
tract of t'e spinal cor(• Synapse on (orsal 'orn
interne rons
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Co#bine( res ltE beta&en(orp'in, N!35&Hin'ibitory fibers
elease of enkep'alinan( (ynorp'ins fro#se-#ental interne ronsof spinal cor(
/in( opiate receptors onpain afferents
re&synaptic in'ibition ofA&(elta an( C fibers@te#p, cr (e to c',ac'in-, b rnin-, c'ronic
pain
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Nalo:one re9ersal
Nalo:one re9ersesac p nct reanal-esia
!9i(ence t'at painin'ibition is#e(iate( t'ro -'en(o-eno s opioi(ne ral loop
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Anato#y of ac p nct re points
Mec'anis#s of Action• !ffects on t'e CNS• !n(o-eno s ain )n'ibition• Se-#ental Anal-esia• *ocal iss e !ffects• A tono#ic Ner9o s Syste#• ri--er oint 'erapy
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Se-#ental Anal-esiaHi-' fre; ency @100H? , lo$ intensitysti# lation!lectroac p nct re@!A*ocali?e( anal-esia,
rapi( onset, ceasesafter sti# lation 'asstoppe(/rainste# acti9ate(
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Sti# lates N! an(5H in'ibitory fibersin brain ste#
Dorsal 'orn of spinalcor(
Me(iation by 7A/Ain t'e spinal cor(
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Mec'anis#s of Action• !ffects on t'e CNS• !n(o-eno s ain )n'ibition• Se-#ental Anal-esia• *ocal iss e !ffects• A tono#ic Ner9o s Syste#• ri--er oint 'erapy
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*ocal iss e !ffects
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Hi l f A
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Histolo-y of Ac p nct reoint
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Vasoacti9e !ffects
2 #in tes&2 $eeks
15& 0 secon(s
10 secon(s&2#in tes
'(AS S
1+
2+
+
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i#e&(epen(ent 'asesVaso(ilation
)nacti9ationNocicepti9eof eaction
potentiation
iss e epairC'e#ota:is
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S # otal of *ocal iss e
!ffects)#pro9e( local tiss e perf sion
)ncrease( local i## ne responsi9eness
M scle an( tiss e rela:ation
ain reliefE increase( perf sion an( cessationof # scle spas#s
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Mec'anis#s of Action• !ffects on t'e CNS• !n(o-eno s ain )n'ibition• Se-#ental Anal-esia• *ocal iss e !ffects• A tono#ic Ner9o s Syste#• ri--er oint 'erapy
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Visceroc taneo s efle:7eneral #ec'anis#by $'ic' (isease(or-ans are able to
refer pain,sensiti9ity, or # sclecontraction to areasof skin oftencorrelatin- toac p nct re ortri--er pt 'e pain can bereferre( to areas t'atare far a$ay or
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eferre( ainMc/ rney s point&ri-'t lo$erab(o#inal ; a(rantpainf l inappen(icitisHeart attack& *eftar#, back, neck @notat c'estJ/rain free?eK& icecrea#
Diap'ra-# refers to
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C taneo9isceral efle:e9erse loop propose(7V 2 & 'e#orr'a-ics'ock in (o-sEincreases car(iaco tp t& bloo( press reincreasesC& in catsE !A
in'ibits fre; ency oftransient lo$eresop'a-eal sp'incterrela:ation
S & accelerates
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C taneo9isceral efle:Nee(le in para9ertebral # scle at #yoto#ese-#ental le9el associate( $it' # sc lar pain
So#atic ner9e en(in- of a # scle sti# late(Afferent i#p lse to (orsal 'orn
Sti# lation of contralateral anterior 'ypot'ala# s
Acti9ation of so#ato&a tono#ic refle:
C'oliner-ic 9aso(ilator ner9es acti9ate( to spastic
# scles
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Mec'anis#s of Action• !ffects on t'e CNS• !n(o-eno s ain )n'ibition• Se-#ental Anal-esia• *ocal iss e !ffects• A tono#ic Ner9o s Syste#• ri--er oint 'erapy
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a t /an(s of Skeletal
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a t /an(s of SkeletalM scle
Da#a-e to # scle
Calci # release fro# S
Actin&#yosin interact
M scle contraction
Decrease( perf sion to #+
Decrease( A locally
Calci # can not ret rn to SActin&#yosin (o not
(issociate
" # ti f i
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"or#ation of ri--eroint
ra #a to # scle3fascia3ten(on 9ia ac te in ry or c'ronic strain
elease of #e(iators @bra(ykinin, 7, 'ista#ine
latelets an( #ast cells recr ite(
M S release( into spaces bet$een # scle fibers
"ibrocytic no( les e:pan( an( stretc' s rro n(in- # scle
Decrease( O2 to # scle
*ocal Aci(ity
Sensiti?e( # scle nociceptors an( con9erte( to tri--er points
i A ti9 ti f i
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ain Acti9ation of ri--eroints
ra #a to # scle3fascia3ten(on 9ia ac te in ry orc'ronic strain
elease of #e(iators @bra(ykinin, 7, 'ista#ine, etc
Sensiti?e C&"ibers Sensiti?e A&(elta fibers
Slo$ trans#ission to "ast trans#ission toli#bic syste# parietal lobe
"rontal lobeS'arp, s'ort ( ration
painAfter s'ort (elayE
ersistent, ( ll ac'in- pain,Near or (istant to acti9ate( tri--er point
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ypes of ri--er ointsActi9e& ca ses pain$it'o t #anip lation*atent& not ob9io slypainf l to patient+ Maybe painf l onpalpation+ May ca serestriction of
#o9e#ent an(e9ent al $eakness+Often refer pain tospecific area(epen(in- on locationof tri er oint+ @7/
Str ct res Affecte(ESkeletal # scles
en(ons3*i-a#ents <oint caps leserioste #Skin @esp+ scar&associate(
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• History of Ac p nct re• !astern "ra#e$ork• %estern "ra#e$ork& Mec'anis# of Action• Ac p nct re Mo(alities• )n(ications for Ac p nct re•
Case St (ies
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Ac p nct re Mo(alities
)ry *eedlesC'ina or <apanSin-le& se, sterile,(isposable15&25 -a -e6& 0 ##Seirin <E 0+20 : 0 ##Seirin DE 0+1 &0+20 :15 ##7 i(e t be or $it'o t
Metal 'an(lesE
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A; ap nct re
Fluid ""ect+1+C'an-es pH2+Displaces tiss e to pro( ce press re+C'an-es electrical potential+ rolon-e( effect
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!lectroac p nct re @!ASe-#entalAnal-esia @100H?
assin- ofelectrical ener-yt'ro -'ac p nct repoints
Attac' Acc al tonee(les in lace
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!lectroac p nct reAd!antages+
1+A9oi( #an al#anip lation of
nee(les
2+A#o nt an( ; ality ofsti# lation to nee(lesEacc rate an( nifor#
+ Hi-'er an( #orecontin o s le9el ofsti# lation t'an
#an al
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!lectroac p nct re o tp tsI eac' $it' 2nee(le clip lea(s
AC& alternatesbet$een positi9e an(ne-ati9e polarity @(eeptiss e penetration
A#plit (e a( st#ent
"re; ency @H? E p lsesper secon( @'i-' 15 Ese(ate pain 9s+@lo$P15 E # scleatrop'y
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!lectroac p nct re Mo(esE
1+ Contin o s& stablefre; encyI contin o ssti# lation @tolerance
2+ Dense Disperse& contin o ssti# lation $it' alternatin-'i-' an( lo$ fre; encyb rsts @a9oi(s tolerance
+ )nter#ittent& stablefre; encyI sti# lationp lse( $it' rest perio(s@a9oi(s tolerance
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Mo:ib stionHeatin- ofac p nct re points Artemesia vulgaris
@# -$ortI relate(c'rysant'e# #fa#ily00Q "
)n(icationsEJCol(K con(itions
CM
ainf l
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)ND) !C MORA
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reca tions1+Vicinity of ## orsensory or-ans
2+Ca (al back3ab( inpre-nant ani#als
+ "ebrile con(itions
+ / rn " r
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)nfrare( *i-'t 'erapyAnot'er #eans ofsin- 'eat to sti# lateac p nct re pointsCan se on in(i9i( alac p nct re points or-enerali?e( areasMitoc'on(ria absorbli-'t & co9ert to A &f els cell lar processes
release of NO&9aso(ilation@re( ce infla##ation,i#pro9e localcirc lation, cellreplication an( repair
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)nfrare( *i-'t 'erapy"DA appro9e( forspecific in(ications in' #ans
H #an t'erapyECarpal t nnelsyn(ro#e, art'ritis,
M<
Veterinary Me(icineE• Sti# lation of
ac p nct re point• Nee(le p'obic
patients• Har( to reac'
ac p nct re points• Corneal lcers, Non&
'ealin- skin $o n(s,S perficialpenetration
•
epetiti9e Strain
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)nfrare( *i-'t 'erapyDisa(9anta-esE
Si?e of (io(e cl sterD rationS perficialpenetration>nit cost
esearc'& !; ine3Co#panion ani#alopti#al settin-s
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• History of Ac p nct re•
!astern "ra#e$ork• %estern "ra#e$ork& Mec'anis# of Action• Ac p nct re Mo(alities• )n(ications for Ac p nct re•
Case St (ies
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• !n(o-eno s ain )n'ibition
• Se-#ental Anal-esia
• *ocal iss e !ffects
•
A tono#ic Ner9o s Syste#
• ri--er oint 'erapy
ain Control
M sc loskeletal DiseaseNe rolo-ic Disease
ain ControlM sc loskeletal DiseaseNe rolo-ic DiseaseDer#atolo-ic Disor(ers
7astrointestinal Disor(ers
Car(io9asc lar Diseaseespiratory Disease>ro-enital Disor(ers
ain Control
M sc loskeletal Disease
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)n(icationsM sc loskeletal
Diseaseost&operati9e
ort'ope(ic s r-eryOsteoart'ritis
ri--er oint 'erapy
<oint (ysplasia
Pain, Range ofMotion, ImproveCirculation, Promote
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)n(ications
7astrointestinalDisor(ersNa sea
Vo#itin-Diarr'eaConstipationAb(o#inal ain
PC 6 – Inhibitingfrequency of lo eresophageal sphincterrela!ation cats
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)n(icationsDer#atolo-ic
Disor(ersAller-ic Der#atitisC'ronic Skin DiseaseOtitis !:ternaNon&'ealin- skin
$o n(s @infrare(
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)n(icationsCar(io9asc lar3 espirat
ory'initisSin sitis/ronc'itisC'ronic co -'in-
Circ latory Disor(ersAst'#a
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)n(ications>ro-enital Disor(ers
>rinary incontinence>rinary tract infectionsC'ronic ki(ney (isease
)## ne Sti# lation&)ncrease in absol tely#p'ocyte n #ber
@21 (
/e'a9ioral roble#s
Oncolo-y atients
'e "orest t'ro ' t'e
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'e "orest t'ro -' t'e
rees
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Co rse of 'erapy
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isks of 'erapyOne of t'e safest t'erapies a9ailableSi(e effects are rareatient #ay be transiently sleepy or sore for
1&2 (ays!:pectationsE ( ration of treat#ent 3in(ications
Disclose cancerO9er se of in re( li#bS$allo$e( nee(les!ye in ry, pne #ot'ora:, infectio s art'ritis
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Case St (iesAc p nct re
reat#entArt'ritis in s'o l(ersan( 'ips ri--er points in *+triceps an(; a(riceps>n(erlyin- CMpatterns contrib tin-to o9erall con(itionan( H* # scleatrop'y
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Case St (ies
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Case St (y 22 year ol(, MN, /asset
Ho n(Dia-nose( $it' )VDD *1&
*2 an( *2&*S r-ical Deco#pression
resentation 1 #ont'
ost&op1+Se9erely paretic in H*2+C (eficits H*+ No (eep pain H*
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Case St (y 2Ac p nct re
reat#entCo#bination of (rynee(les an( !A
* #bar back an((istal le- pointstreate(
' s farE 2 (ry
nee(le an( 2 !A
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Case St (y 2ro-ressAfter first co ple of t:
Able to stan( p ono$n an( 'ol( $it'o tfallin- o9er
After t'ese fo r t:/etter #otor H*Deep pain
Case St (ies& Ot'er
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(Species
2 year ol(, "S, DSH• )nitial presentation&se9ere -in-i9itis
• Dental an( #e(ical#ana-e#ent
• 2 ac p nct re t:, 1
#ont' apart
Case St (ies& Ot'er
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(Species
6 year ol(, MC, Mini*op• C'ronic 'ea( tilt,(ecrease( appetite,(ecrease( acti9itysince a paste rellaear infection aco ple of years a-o• /ein- treate( $it'ac p nct re#ont'ly for past 18#ont's• Acti9ity i#pro9e(,Appetite i#pro9e(,Hea( tilt i#pro9e(b t #il( one present
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