Brief History of Veterinary Acupuncture

Dr Ulrike Wurth B.V.Sc., Dip Acup., CVA (IVAS)

(This lecture was first presented at the Australian Veterinary Association Annual Conference in Adelaide 2011)

INTRODUCTION

When any system of treatment is examined we need to ask ourselves, is the treatment safe and is it efficacious?  How does it work and when would you use it?  This paper will address these questions and provide a brief overview of acupuncture, its clinical application, recent research  and the training available for veterinarians

HISTORY

Acupuncture is an ancient form of medical treatment that has its roots in antiquity. Perhaps the earliest record of acupuncture dates to the “Ice-Man” Oetzi found in 1991 in the Oetztal Alps on the border of Italy and Austria.  Carbon dated to have lived about 5300 years ago, he was 25 -40 years old.  Oetzi had several carbon tattoos including groups of short parallel vertical lines on both sides of his lumbar spine, a cruciform mark behind the right knee and various marks around both ankles.   X Rays showed degenerative changes in his spine, including osteochondrosis, spondylitis and wear and tear of the knee and ankle joints.  On magnetic resonance imaging (MRI), the Ice-Man had an intervertebral disc herniation which would have been painful.  The tattooed marks correspond to acupuncture points that would normally be used to treat this condition.

Veterinary acupuncture has a long history that is closely associated with human acupuncture. According to legend, veterinary acupuncture was discovered when lame horses became sound after being hit by arrows in battle.  The first veterinary text was written in about 650 BC by General Sun Yang (alias Bai Le).   His book is called Bai Le Zhen Jing (Bai Le’s Canon of Veterinary Medicine).   Legend records his skill with horses. Most of the early veterinary texts related to horses, but later there were also texts and charts for cattle, pigs, camels, chickens, ducks, geese, sheep and goats.  There was little information on dogs and cats and most of our knowledge today is from transposed human texts.

There is evidence that veterinarians practised acupuncture during the Zang and Chow Dynasties around 2000 – 3000 BC.  Therefore, acupuncture has been practised for approximately 4500 years.  This makes it the oldest and most field tested system of medicine still in use today.

The text that is considered the basis of Traditional Chinese Medicine (TCM), the Huang Ti Nei Jing (Yellow Emperor’s Classic of Internal Medicine) was published between 400 and 200 BC.  It is one of the oldest known documents of (TCM). This book describes a total medical system including anatomy, physiology, pathology, diagnosis and treatment of the diseases of that time.  It lists 365 acupuncture points and describes the indications and contraindications of using these points.

Although acupuncture has a long history, this does not mean that the acupuncture practised today is the same as it was 4500 years ago.   A study of Chinese Medical history shows that theories have been altered and modified over the years.  Acupuncturists in different countries, have developed different techniques of diagnosis and treatment.  Chinese acupuncture differs from Korean and Japanese Acupuncture.  Acupuncture practiced in Europe and USA is different from that practiced in China.   Each generation and each culture has added knowledge and made new discoveries, e.g.

-ear acupuncture was developed in the 1950’s by Dr Paul Nogier in France,

-scalp acupuncture in China to treat neurological conditions,

-acupuncture point injection therapy,

-electro acupuncture,

Today in China, Western and Chinese medicine are often used together, e.g.

-Cholelithiasis (gall stones) is diagnosed with ultrasound, but treated using acupuncture.

-Acupuncture analgesia is used for surgery in conjunction with sedatives and mild analgesics.

-Acupuncture decreases the side effects of chemotherapy and radiation by reducing nausea and vomiting and oedema.

-Herbal remedies are injected into acupuncture points using hypodermic syringes.

-MRI is used as a tool for studying the effect of acupuncture on different parts of the brain.

Interest in acupuncture in the United States exploded in the 1970s following President Nixon’s historic trip to China, where demonstrations of surgical analgesia using acupuncture were made. Reportedly, one of Nixon’s aides was ill and responded almost immediately to acupuncture treatment, even though Western medicines were not working. This led to a great increase in scientific interest in acupuncture in the West, producing over 8000 scientific references to acupuncture since that time.  References to animals make up about 1/10th of the total publications.

WHAT IS ACUPUNCTURE?

Acupuncture is by definition the insertion of fine needles into specific points on the body to achieve therapy and homeostasis.  The selection of points is based on a holistic concept of diagnosis and treatment and the acknowledgement of the body’s ability to repair itself. In addition to needles, many other methods can be used to stimulate acupuncture points, e.g.  acupressure, moxibustion, electro stimulation, gold beads, aquapuncture and laser.

DOES IT HURT?

The needles used for acupuncture have a rounded point that separates the skin and muscle fibres, which is less painful than the cutting action of a hypodermic needle.  The skin is the most sensitive part and once through the skin, there is no pain in putting the needle deeper into the subcutaneous and muscle tissue.  A skilful practitioner causes only a slight pricking sensation when needling acupuncture points.  Modern acupuncture needles have a guide tube which is placed on the skin, the needle is tapped and rapidly penetrates the skin without pain.

Once inserted, the needle is stimulated and the patient feels the sensation of De Qi. This has been described as soreness, numbness, heaviness and distension around the needle. This can also be felt by the practitioner as “needle grab.”

WHAT CAN BE EXPECTED AFTER AN ACUPUNCTURE TREATMENT?

There are three possible outcomes after the first treatment:-

–           No obvious change in the symptoms, but animal may be “brighter”.

–           Symptoms improve for 24- 48 hours and then slowly return to their previous state.

–           Occasionally symptoms may be worse for 12-24 hours, then improve rapidly.

With subsequent treatments there is a gradual improvement until there is complete recovery or a plateau is reached.   For chronic conditions, subsequent treatments may be required to maintain the plateau.

The number of treatments needed and the treatment interval depends on the individual patient.   An acute condition may be resolved in 1-3 treatments and the treatments may be daily or every second day.  A chronic condition may require 4-10 treatments. Treatments are usually given weekly.  A condition that has been present for months will require fewer treatments than a condition that has been present for years.  When treating chronic conditions the patient may not return to normal but reach a plateau and then gradually deteriorate.  Repeat treatments are required to maintain their best clinical response, e.g. arthritis.

IS IT SAFE?

When used by a veterinarian that has adequate training in acupuncture techniques, side effects are rare.  Theoretically there is a danger of puncturing an organ, however acupuncture needles are much finer than commonly used biopsy needles.  Breaking a needle when an animal moves is also possible, but is rare as acupuncture needles are more likely to bend that break.

WHAT CONDITIONS CAN ACUPUNCTURE TREAT?

Acupuncture treats various conditions of the musculoskeletal system, skin, urinary tract, respiratory tract, cardiovascular system, neurological disorders, gastrointestinal disease, reproduction, eyes, ears and geriatric conditions.

WHEN IS ACUPUNCTURE CONTRAINDICATED?

–  In the absence of a differential diagnosis.

–  While using corticosterioids – these reduce the effect of acupuncture and increase the recovery time.

– During pregnancy – there are restrictions on using some points; these are listed and depend on the stage of pregnancy.

HOW DOES ACUPUNCTURE FIT INTO MODERN VETERINARY PRACTICE?

While Western Medicine and Traditional Chinese Medicine (TCM), of which acupuncture is a part,  are different in their approach to a disease, they are not mutually exclusive. The goal of both systems is to restore health and prevent disease, e.g. if you look at half a glass of water – is it half full or half empty?  Whichever way you look at it and describe it, it is still the same glass with a certain amount of water. There is however a cultural difference in the approach to disease between Western medicine and TCM.

Western cultures like to analyse (Greek for breaking into little pieces) and believe that matter is composed of discrete objects called atoms.   “Western medicine” is based on the Cartesian principles that separate the mind and the body and refers to the medicine that has been practiced for several hundred years in Europe, UK and USA . This is reflected in the western approach to medicine where the patient’s symptoms are analysed to find a specific, usually physical cause, such as an infectious agent, enzyme deficiency, toxic insult or trauma.  By understanding the physiology at a cellular level, the treatment sets out to remove or control the abnormality.

Western medicine has powerful drugs and surgery and deals well with acute diseases.  However with chronic disease, if the initiating cause is no longer present, diagnosis may be difficult.   If the patient does not improve with drugs or surgery, then they just have to live with their disease.   In addition, drug side effects may cause more problems for some patients, e.g. chronic pain may be refractory to non-steroidal anti-inflammatory drugs and cause gastric ulcers in some patients.  Often it is these patients that seek other therapies.

Eastern cultures look at the world as a whole and are more interested in understanding the object’s relationship context rather than focusing on it in isolation.   This is reflected in TCM where the practitioner looks at the whole body as a single system and observes its relationship to the environment.  TCM describes disease as an imbalance.  This imbalance produces a pattern of disease and while the causative factor is understood, it is only one of a number of aspects , including environment, diet, constitution, age and emotions to name a few.  The practitioner recognises the pattern and uses acupuncture to restore the balance and therefore the health of the patient.

Both systems have their strengths and weaknesses.   Ideally they can be used together, so that the strengths of one will compensate for the weaknesses in the other.   Integrating both systems of medicine for the benefit of the patient is the goal of the Australian College of  Veterinary Acupuncture.

When making a diagnosis, both systems require a detailed medical history and a physical examination.  Western medicine has access to an amazing array of diagnostic tests, e.g. blood tests, radiographs, CAT scans and MRI.  Its treatment of trauma and acute disease using these diagnostic tools, surgery and pharmaceuticals is unparalleled.   The TCM practitioner examines pulses and specific points on the body that relate to organs, as well as taking into account environmental influences, the emotions, the patient’s general constitution and treats according to the patient’s current needs using acupuncture, herbs and nutrition to help the body regain homeostasis.  The treatment may change as the patient improves.

Learning the theories of acupuncture requires a shift in perspective and an open mind to learn these different concepts and terminology.  However once you understand the theory, it is often surprising how well it correlates with clinical observations and experience and can explain what is happening in some clinical cases, for which there is no real western diagnosis.

YIN AND YANG IN MEDICINE

The use of metaphors is a common way of describing the unfamiliar in terms of something that is familiar.  Like shorthand, it conveys a picture immediately e.g. He is a lion in battle rather than he is like a lion in battle.   In TCM metaphors are frequently used to explain aspects of health and disease and to a western trained physician these often sound very odd.  However once the meaning of these metaphors is understood, their clinical application is logical.

Using metaphors the concepts of Yin and Yang are easily understood.  Yin is matter and Yang is energy.  Yin has a tendency to sink, contract and solidify, Yang has a tendency to rise and expand and move outwards.  To exist, they must be present in approximately equal proportions although they fluctuate with the diurnal rhythms and the seasons.

In western terms, this can be expressed as a continuum of energy and matter as it is now understood in modern physics.  When energy vibrates at a high frequency, it is pure energy (Yang). When it vibrates at a lower energy, it forms matter (Yin).  The total sum of all the energy remains constant (certainly within our time frame) and the energy alternates between these vibrations.

In the body Yang represents vitality, movement and metabolism, Yin represents body tissues, fluids, rest and anabolism.  Health is a balance between Yin and Yang.  When Yin and Yang interact they produce Qi.

QI

Another metaphor is the concept of Qi.  As the basis of ancient acupuncture, Shen Nung theorized that Qi circulated in the body and consisted of all essential life activities which include the spiritual, emotional, mental and the physical aspects of life. A person’s health was influenced by the flow of Qi in the body, in combination with the universal forces of Yin and Yang. If the flow of Qi is insufficient, unbalanced or interrupted, Yin and Yang become unbalanced, and illness occurred.

Qi has been defined as the primary motivating force behind all life or the vital energy. The Qi or vital force can be thought of as the life force that maintains and sustains our very existence, every cell is dependent on this force.  This energy is the difference between life and death.  Qi is derived from our ancestors (genetics), from the air we breathe (oxygen) and the food we eat (nourishment).

MERIDIANS

Qi is described as moving throughout the body along “Meridians” or special pathways.  In total there are 104 meridians in the body.   These meridians unify all parts of the body, connecting the internal body with the external body and maintaining equilibrium or homeostasis.  There are fourteen main meridians running vertically up and down the surface of the body. Twelve of these are paired and named after the organ to which they have an internal connection. The other two are midline, one on the front and one on back of the body. The meridians influence the structures in their pathway and are predictable in the symptoms they produce.

These fourteen meridians are the most important ones in terms of diagnosis and treatment and lie just below the surface of the skin. The meridians are named for the organs that they relate to:-

LUNG (LU) – LARGE INTESTINE (LI )

STOMACH (ST) – SPLEEN (SP), 

HEART (HT) – SMALL INTESTINE (SI), 

BLADDER (BL) – KIDNEY (KI)  

PERICARDIUM (PC) – TRIPLE HEATER (TH)

GALL BLADDER (GB) – LIVER (LIV) 

CONCEPTION VESSEL (CV) – GOVERNING VESSEL (GV)

In the body the meridian pathways follow the course of major blood vessels and nerve pathways.  If meridians are thought of as a metaphor for arteries, veins, lymphatics and nerve pathways and Qi as including nerve impulses and blood that carries the oxygen and nutrients, then the concept makes sense to the western practitioner.

ACUPUNCTURE POINTS

Acupuncture points are specific locations on the meridians where the energy in the meridian can be influenced by acupuncture.  In healthy animals, this energy flows smoothly.  In diseased animals, the energy cannot flow smoothly, causing pain and disease. When a needle is inserted into a point on a specific meridian, it regulates the flow of Qi within the meridian, affects the related organ and thereby restores health and relieves pain.

A simple analogy is electricity.  Imagine you have a network of power lines (meridians) carrying electricity (Qi) to various parts of the body.  Along the power lines there are amplifiers (acupuncture points), which can be used to increase or decrease the amount of electricity (Qi) passing through the network.

While there are several thousand acupuncture points on the body, about 365 are commonly used and their function is described in detail. There are also specific points on the body called “Alarm Points” (AP’s) and ‘Associated Effect Points’ (AEP’s) that become painful when an organ or a meridian is diseased.  These points can be checked for pain and used for diagnosis, as well as treatment.

DOES ACUPUNCTURE WORK?

Initially dismissed as just placebo, the analgesic effect of acupuncture allowing surgery to be performed on conscious patients excited western scientists and much of the early research was concentrated in this area.   Even today many people believe that all acupuncture can do is to relieve pain.   Research using animals and people has shown that stimulating acupuncture points affects all the major systems of the body.  Controlled studies under laboratory conditions indicate that acupuncture can stimulate physiological changes, e.g. uterine contractions, gastrointestinal tract motility, cardiovascular changes, changes in haemograms and immune responses.  It also has an anti-inflammatory and analgesic effect locally and systemically.

Clinical studies and experimental reports indicate that acupuncture is a safe and effective treatment modality if used properly and competently.  The World Health Organisation (WHO) currently lists 40 human diseases for which there are clinical studies to indicate that acupuncture is an effective treatment.

ACUPUNCTURE RESEARCH

In TCM the successful application of acupuncture depends on three important factors, selection of the appropriate acupuncture point, the method of stimulation and the response observed. Acupuncture is known to have many varied physiological effects on all systems throughout the body.  The question is how are all these effects stimulated and through which pathways.  Currently there are a number of theories to explain some of effects of acupuncture. However, there is currently no single theory able to explain all its affects.

From a scientific point of view1 we know that:-

– The body is surrounded by a subtle energy field.

– Acupuncture points have a lower electrical resistance than the surrounding skin.

– Acupuncture points differ histologically from the surrounding skin.

– Meridians behave differently from surrounding tissue.

– Nerves, blood vessels and lymphatics need to be intact for acupuncture to work.

– Needling acupuncture points produces a local effect as indicated by the immediate area becoming red

– A systemic effect is also produced, e.g. changes in white cell counts and hydrocortisone occur approximately 20 minutes after needling.

– Acupuncture points can affect internal organs.

– Acupuncture is blocked by local anaesthesia.

– Naloxone can block some of the humeral acupuncture mechanisms.

 Anatomically acupuncture points occur where nerves penetrate tissue planes or where the nerves divide.  Researchers(2) have divided these into four major groups:-

Type I – points where nerves penetrate muscles, these are the most common points. Type II – points where nerves intersect the dorsal and ventral midlines of the body.

Type III – points where superficial nerves branch.

Type IV – points where nerves penetrate tendons (Golgi tendon organ).

Meridians can be measured electrically and by patient sensation.  When an acupuncture point is needled, the sensation is propagated along the meridian in both directions.  It is reduced if there is mechanical pressure on the skin or low skin temperatures.  It is abolished by the injection of local anaesthetic, major nerve or spinal cord transection.

SCIENTIFIC THEORIES AND MECHANISMS OF ACTION

The act of inserting a needle into an acupuncture point appears to be a simple procedure, however it stimulates a process that is very complex and the subject of most of the current research into how acupuncture works.  There are currently four main theories(3), the gate theory, the neurohumeral hypothesis, the connective tissue theory and more recently the concept of limbic deactivation.

The gate control theory was developed in neuroscience independently of acupuncture. In this theory, pain is controlled by various inhibitory actions on the pain pathway by physiological, pharmacological and psychological means.  It was later proposed as the possible mechanism as to how acupuncture modulates pain.

Inserting an acupuncture needle primarily stimulates the A delta and C fibres which transmit the signal via the spinal cord to the central nervous system, which then alters the processing and output.  Acupuncture works by modulating the activity in the central, peripheral and autonomic nervous system.

The neurohumeral hypothesis suggests that the analgesic effect of acupuncture is associated with the release of endogenous endorphins in the brain.   A large number of neurotransmitters act within this pain circuit and vary from changes in potassium and hydrogen ions, proteins (lymphokines), peptides (substance P, kinin, calcitonin, endorphins) and monoamines (glycine, noradrenaline, gamma amino butyric acid GABA).  Generally these different groups of neurotransmitters occur peripherally and centrally. These effects can be reversed or blocked by naloxone.

It has been shown that needling an acupuncture point releases nitrous oxide and calcitonin gene related peptide, both strong vasodilators, which increase the nutritive blood flow and because of the effect on the arterio-venous shunt improve temperature control.  The connective tissue releases nerve growth factor (NGF) stimulating nerve growth into the affected area and stimulating wound healing.

Viscero-somatic relationships have been described in animals as well as people. Dr.Oswald Kothbauer(4) in 1956 in a series of experiments to prove the relationship of the AEP’s and internal organs infused irritant solutions into the uterus and other abdominal organs of dairy cows. He found that points along the Bladder meridian were consistently painful, depending on which organ was infused and therefore these points could be used as diagnostic tools.   His map of diagnostic points is widely used in cattle practice today, helping practitioners make a differential diagnosis of internal conditions in cattle.

A-delta fibres are found in viscera and have a similar distribution in the dorsal gray matter and tract of Lissauer in dorsolateral funiculus. Visceral and somatic sensory afferents can cause activation of each other, therefore somatic pain may cause visceral disease and visceral disease may cause referred somatic pain. Studies have shown that afferents from these points and organs overlap in the dorsal horn grey matter.

The visceral nociceptors terminate in the sympathetic chain and enter the spinal cord at T2 – L 2.  (The Back Shu points of all the organs, apart from the small intestine and kidney are in this area).  Bladder and genital receptors enter the spinal cord at S2 – S4.  The Vagus nerve also contains a large portion of C fibres.

The Associated Effect Points (AEP’S) that lie lateral to the spine above the segmental nerves (on the Bladder meridian) seem the logical points that would affect organs. However other acupuncture points located on the limbs can also affect organ function.  Some examples are:

– GV 26 on the philtrum of the nose that is used for shock and apnea.  This point has been shown to increase adrenaline levels in the blood(5).

– PC 6 on the forearm that affects the heart.  It slows the heart rate, increases the cardiac output and reduces arrhythmias.

– ST 36 on the lower leg that regulates acid secretion and motility of the stomach and digestive system and reduces hypertension.

The connective tissue theory was developed by Langevin(6) et al because in TCM the De Qi sensation is considered to be very important for a therapeutic response. The De Qi sensation has a sensory component that is felt by the patient as a sharp sensation, an ache or heaviness around the needle.  It also has a biomechanical component, the “needle grasp” that is felt by the practitioner, making the needle difficult to remove. These researchers, through a number of experiments, concluded that during the De Qi sensation, the connective tissue and elastin fibres tightened around the needle, causing the needle grasp.  The mechanical changes as the tissue fibres were stretched altered the intracellular actin polymerisation as well as the extracellular matrix.  These changes were communicated from one cell to another sending a wave of connective tissue contraction and cell activation through the connective tissue.  The researchers postulated that this may explain how the feeling of De Qi signal moves along an acupuncture meridian. By inserting acupuncture needles into cadavers and dissecting them to observe the position of the needles, Langevin(7) et al found that 80% of acupuncture points and 50% of meridian intersections on the arms coincided with intermuscular or intramuscular connective tissue planes.

The use of MRI’s to observe changes in the brain during acupuncture have added another dimension to acupuncture research. Changes have been shown to occur in the limbic system (amygdala and hippocampus), hypothalamus, sensory cortex and the frontal and prefrontal cortex.   Overall acupuncture acts on the limbic system by activating pain inhibition, activating the inhibition of stress and decreasing brain activity while awake and asleep.

In a study by Hui(8) et al,  these researches compared superficial needling with no De Qi and deep needling with De Qi with the following results:-

Subjects that experienced De Qi with soreness and numbness showed deactivation of the limbic system, particularly the amygdala and the hypothalamus, activation of the sensory cortex and no change in the frontal cortex.

Subjects that experience De Qi and pain from excessive stimulation showed an activation of the limbic system, sensory and frontal cortex.

Subjects that had “placebo acupuncture” i.e. superficial needling with no De Qi sensation showed a deactivation of the limbic system only.

Subjects receiving massage also showed a deactivation of the limbic system only.

The results of these MRI studies indicate that anything that touches the skin will affect the brain, but acupuncture affects different parts of the brain.  Acupuncture induces the deactivation of the limbic regions and moderate activation of the somatosensory regions, which show virtual identity with the activation and deactivation networks of the resting brain.

In the normal brain there is a task negative network or default mode network (DMN) which is active during rest and deactivated when there are cognitive and conceptual tasks to be done. There is also a task positive network that is activated during active goal directed tasks.  When one network is active the other is resting.

Hui et al hypothesised that acupuncture may mediate its diverse regulatory effects by promoting deactivation of the DMN and that additional limbic regions important to emotional processing may participate more often in acupuncture than in normal cognition and conventional sensory stimulation. Using MRI there was a close correlation to the appearance of the DMN at rest and in patients receiving acupuncture on the points studied.  This seemed to correlate with the experience of De Qi.

The role of the DMN is to be prepared and alert and the integrity of this and the task positive network may be central to the balance of brain functions and maintenance of health.  Its role in health and disease has recently become a subject of intense research interest.  Its clinical relevance is indicated by the growing number of reports of  its involvement in cognitive and behavioural disorders e.g. Alzheimer’s Disease, autism, schizophrenia, attention deficit hyperactivity disorder, Parkinson’s disease and Multiple Sclerosis.  These studies have shown that alterations in the general activity and functional connectivity of the DMN in these patients.

SCIENTIFIC RESEARCH INTO ACUPUNCTURE EFFICACY

In the past 10 – 15 years there have been a large number of clinical trials as to the efficacy of acupuncture.  Double blind trials are the accepted gold standard for drug trials, but since acupuncture is a procedure and not a pill, it is difficult to design studies where both the patient and the practitioner are blinded.  In trying to quantify the placebo effect of acupuncture, researchers have used “sham acupuncture” where a needle is inserted into a non-acupuncture point usually several centimetres from the real acupuncture point on the assumption that it was an inert treatment.  The results from many of these trials indicate that there was little difference in the clinical outcome between real and sham acupuncture although there is a difference in the effects in the brain (Hui et al).

The largest clinical study to date in people was done in Germany in 2007 with 454,920 treated by 8727 certified acupuncturists all with medical qualifications. The project was initiated by 10 private health funds and treatment was restricted to one of three conditions, low back pain 45%, headache 36% and osteoarthritis 12% (Other 7%).  The aim of the study was to assess the effectiveness, safety and cost of acupuncture for these patients over a period of 2 years. The criteria for inclusion were that:-

–          the disease had been present for at least 6 months

–          the patient had been treated for the disease but not with acupuncture

–          being insured

–          the patient could stop treatment at any time, but the reason had to be documented

The results showed 22% had a marked improvement, 54% moderate improvement,16% minimal improvement, 4% poor.  8% patients reported mild side effects and 0.003% had severe side effects.  The results confirmed that acupuncture in the hands of qualified therapists is safe. The demand for acupuncture was high and patients benefited from the treatment.

Another randomly controlled trial also treated these conditions and the results of the randomly controlled trial and the above clinical study are compared by Witt(10) et al.  Their findings showed that acupuncture was more effective than conventional standard treatment (drugs), treatment without acupuncture or a waiting list control.  A significant difference between acupuncture and sham acupuncture was only seen for arthritis of the knee, otherwise both showed similar effects, but both better than conventional therapy. Whether the effects of acupuncture are due primarily to specific or unspecific mechanisms appears to depend on the diagnosis and should be investigated in further studies.

CONCLUSION

The effects of acupuncture cannot be explained by a single mechanism. What starts as a local event spreads by way of the nervous system to affect most of the body.  Ultimately the nervous system effects create changes in the endocrine system and the immune system. While the knowledge and theory behind the application of acupuncture in a clinical setting may be derived from antiquity, it has been modified and improved over the years. Much like modern Western medicine, acupuncture has evolved and its understanding developed with the passing years. Science is beginning to catch up and develop modern explanations for this ancient medical art.  While there are likely to remain areas of traditional Chinese medicine appear to presently not have been proven scientifically, it may only be that we have not yet developed the means to evaluate them. Wisdom comes slowly in science.

Acupuncture has reached an all-time high for popularity and acceptance, but there is still a long way to go in defining how to integrate acupuncture with modern Western medicine. While they can exist together for the mutual benefit of the patient, some Western drugs can alter the responses to acupuncture and vice versa. Traditional Chinese medical theory and pattern recognition must evolve and be characterized in terms of Western medical theory so that a unified theory can evolve.  At the same time, the individualized patient care provided by TCM approaches should be preserved as acupuncture becomes part of mainstream Western medical care.

Recognising our current limits to understanding how the central nervous system works is probably all that is required to realise why we do not fully understand acupuncture.   Recent research advances in understanding brain function and the use of MRIs have also helped with understanding some of the acupuncture mechanisms.  The discovery of mirror neurones which are scattered in pockets all over the brain that help us feel the pain and joy of others, the discovery that thoughts can alter the function of the brain, that one person’s thoughts can alter another’s, how things that you have learned to do changes the way your brain responds to a particular situation.  If thoughts can alter brain function then the insertion of a needle may have an even more powerful effect on the brain and thereby cause healing and restoration of health.

ACUPUNCTURE TRAINING

Veterinarians who wish to practice acupuncture should undergo a training program.  Currently the majority of certified veterinary acupuncturists in Australia and the Pacific Region have studied the International Veterinary Acupuncture Society’s basic acupuncture training program which requires a minimum of 150 hours of lectures and practical sessions plus assignments, case reports and a final theory and practical examination.

The Australian IVAS Veterinary Acupuncture Course is organised by the Australian Veterinary Acupuncture College Ltd. as Trustee for ACVA Foundation.  This course which takes 18 months to complete, combines on line lectures with face to face workshops and as endorsed by the Australian Veterinary Acupuncture Group (AVAG).

Most veterinary acupuncturists integrate acupuncture into their daily practice, although there are some that use acupuncture alone or in combination with other complementary therapies.

REFERENCES:

1. Bensoussan Alan (1991)  The Vital Meridian. Churchill Livingstone.

2. Gunn C.C. (1976) Acupuncture Loci – a proposal for their classification according to their relationship to known neural structures.  Am J Clin Med 4:183-95.

3. Lundeberg Thomas (2010) Acupuncture a Western Perspective.  36th International Congress on Veterinary Acupuncture Aalborg.  37-44.

4.         Kothbauer Oswald ( 1991),  Veterinary Acupuncture for Cattle, Pigs and Horses. ZweimuhlenVerlag.

5.         Still Jan (1991) Research in Veterinary Acupuncture. Belgium Veterinary Acupuncture Society.

6.         Langevin H.M., Churchill D.L. and Cipolla M.J.  (2001) Mechanical signalling through connective tissue:- a mechanism for the therapeutic effect of acupuncture. FASEB J. 15, 2275 -2282.

7.         Langevin H.M., Churchill D.L.,Wu J., Badger G.J.,, Yandow J.A.,  Fox J.R.,   and Krag M.H.(2002) Evidence of Connective Tissue Involvement in Acupuncture FASEB J.  16 872 -874.

8.         Hui KK, Liu J, Makris N, Gollub RL, Chen AJ, Moore CI, Kennedy DN, Rosen BR, Kwong KK. (2009) Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Hum Brain Mapp. (1):13-25.

9.           Weidenhammer W., Streng A., Linde K., Hoppe A., Melchart D. (2007) Acupuncture for chronic within the research program of 10 German Health Insurance Funds – Basic results from an observational study.  Complementary Therapies in Medicine (15) 238-246.

10.       Witt C.M., Brinkhaus B., Willich S. N. (2006) Akupunktur  Clinical Studies of benefits in patients with chronic pain.(article in German)  Bundesgesundheitsbl-Gesunheitsforsch-Gesundheitzschutz.  (49) 736-742.

GENERAL READING

Kendall, Donald E, (2002) Dao of Chinese Medicine – Understanding an Ancient Healing ArtOxford University Press.

Schoen, Allen M,  (2001)  Veterinary Acupuncture – Ancient Art to Modern Medicine, Moseby.

Xie Huisheng, Priest Vanessa (2007).  Xie’s Veterinary Acupuncture, Blackwell Publishing.