Introduction to Acupuncture Techniques

Ancient Art to Modern Science

Comparison of East & West

East

West

Empirical Observations over Thousands of Years Art of Medicine Holistic View Circular Logic Energetic

Scientific Method & Case-Based Medicine Technology of Medicine Molecular & Organ View Linear Logic Mechanistic

Science versus Art

Over the last 10 years, there has been no change in mean life expectancy in human beings, dog or cats

There is an increase in incidence of inflammatory diseases and cancer over our ability to detect the conditions

Acupuncture: History

Sun Yang Alias Bole Veterinarian Qinmugong period 659 B.C. to 621 B.C. Bole Zhen-jing

Boles Canon of Veterinary Acupuncture

Sun Yang

659 to 621 B.C.

Bole Zhenjing

Acupuncture: History
Yuan-Hengs Therapeutic Treatise of Horses

Yuan Heng Liao Ma Ji

1608 Benyuan Yu Benheng Yu

Veterinarian Ming Dynasty 1368 to 1644

Basic Tenets of AP

Based upon the AP point selected Based upon the method of stimulation

Based upon the length of stimulation

Low-rate, twisting stimulation of GV26 leads to endorphin response, while high-frequency needling of GV26 leads to epinephrine response

Dry needles Electrical AP Aquapuncture Hemoacupuncture

Basic Acupuncture Techniques

Stone needles: 8,000 years ago Bones needles: 3,000 years ago Needles Metal needles: 2,200 years ago Gold/silver needles Bamboo needles Electro-acupuncture Embedding New Acupuncture

Fine needles
Zhen-jiu Ai-jiu (moxa): moxibustion

Injectable AP
aquapuncture & pneumo-AP

Alcohol (huo-jiu)
Moxibustion Herbal moxibustion Needle + Moxa Fire-needling

Laser therapy
Magnetic therapy Infrared therapy (TDP)

Nine needles (2,200 years ago)

Long

Sword Pressure

Fine

Arrowhead

Round

Sharp

Round/Sharp

Large

Arrowhead needle Sharp needle Sword needle Round needle sharp needle

To drain abscesses To bleed superficial vessels (TCM Surgical tools)

Round needles Pressure needles

Acupressure (Not penetrate the skin)

Fine or Filiform Long/Large needles

Penetrate the skin at known acupuncture points (commonly known acupuncture)

Dry Needle Acupuncture or Conventional Needling Techniques

Dry Needle (White Needle)- -Bai-zhen

Not intentionally bleeding Most common treatment modality in veterinary and human practice Filiform needles
Sterile needle

With tube Without tube

Can be applied in most acupoints (GV-1, LI-4) Can be used any patterns of disease

Acupuncture Needle Diameters in Gauge and Millimeters

Gauge Millimeters Application

40
38 36 34 32 30

0.15
0.16

Hand/feet Needle
Baby needle

0.20 0.22 0.25 0.30 Cats, little dogs All the Small animals (dogs/cats/birds) Horses, cattle, llamas, pigs

28

0.35

Large animals: horses, cattle, elephants

Acupuncture Needle Diameters in Gauge and Millimeters

Millimeters 7 13 Inches 0.25 (Korean Hand Needle) 0.5 Application Dogs/cats: around eyes, nose, feet, or sensitive patients Dogs/cats: head, feet, lower limbs, ear, tail, mu pts Horses: ears/eyes, feet Dogs: back-shu, neck, shoulder, limbs Horses: feet, lower limbs, head, tail Dogs: hip, shoulder Horses: back-shu, mu points, limbs

25 40

1.0 1.5

50
75 100

2.0
3.0 4.0

Dogs: hip, cervical hua-tuo-jia-ji for big dogs Horses: back-shu, limbs
Horses: hip Horses: hip

How to needle an acupoint

Preparation Needle Animal Practitioner Insertion of a needle Pressing hand Angle Depth

Manipulation of a needle Withdrawal of a needle

How to needle an acupoint: preparation

Needle

Sterile disposable
The tip should be smooth & sharp as a pine needle

Horse
Size

0.30-0.40 mm (#28-#30) 13 mm (1/2): in extremities (feet, tail, ear, head) 25 mm (1): in lower limbs, head 50 mm (2): in the trunk, back 75 mm (3): in shoulder, hip 100 mm (4): hip

Length

How to needle an acupoint: preparation

Needle

Cat:
Size

Small animal
generally thinner not too thin

0.25 (#32) 13 mm (1/2)

Length

Dog:
Size

0.25 (#32) 13 mm (1/2) 25 mm (1) 50mm (2): large dog

Length

How to needle an acupoint: preparation

Animal

quiet
relaxed (house call benefit) Restrained if needed (nose twisted), but not sedation/tranquilized The site of acupoints
nice and clean

How to needle an acupoint: preparation

Practitioner

Sound plan of acupuncture treatment

Considered as a surgical procedure

others

How to needle an acupoint: Insertion

Pressing

Hand

1. Thumbing 2. Pinching
1

How to needle an acupoint: Insertion

Pressing

Hand

3. Holding 4. Stretching
3

How to needle an acupoint: Insertion

How

to insert a needle

Jabbing: a quick insertion (Flying technique)

0.5 (13 mm)

#28 to 30 for horses #30 to 32 for small animals

tube guiding Twirling: a slow insertion

How to needle an acupoint: Insertion

Angle

Perpendicular insertion Angular insertion Horizontal insertion

Depth

Location De-Qi response Condition Patient

How to induce De-Qi

1. Up-down thrusting 2. Left-right twisting 3. Flicking 4. Scraping

Quantity/dose of needle stimulation

Intensity

De-Qi Response Intense Intermediate Mild

Duration

of stimulation

Short: < 5 min Long: >60 min Intermediate: 10 to 30 min

Withdrawal of a needle
Twirling

Pulling

the needle out Pressing the point after withdrawal

Pressing---tonification No pressing ---sedation

Practice needling an acupoint

Orange a

layer of paper a ball of cotton on self health animal real case

Elbow, sore throat, fever, abdominal pain, vomiting, diarrhea, hypertension, seizure, conjunctivitis

LI-11

PC-6: over the median nerve

2 cun above the wrist

Indication: nausea, vomiting, chest pain

Dry Needle Acupuncture

Manipulating

needles until "De-Qi"

response
10

to 30 min, manipulated once every 3 to 5 min

Indication:

Any diseases

Or starting technique

Electro-acupuncture techniques
History

After electro-acupuncture (EA) analgesia was found effectively to perform a surgery in China in the early 1970's, EA has been widely used in TCM practice.

Advantage:

1) More effective 2) Less treatments 3) Fewer acupoints 4) Save labor to manipulate the needles (Classically, the needles should be manipulated every 2 to 3 minutes). 5) Objective control of frequency and amplitude
Dynorphins

Amplitude (intensity of stimulation): a tolerance level Frequency:

Low level: pain ----> beta endorphin mediated Medium level: segmental ----> dynorphin mediated High level: internal medicine----> serotonin mediated

Methods: Acupuncture Points: 6 to 10 points

Frequency: 20 Hz, 80 to 120 Hz or 200 Hz Electrical intensity: gradually goes to the point the patient can tolerate

Indications:

1) Pain management a) Bi syndromes (arthritis) b) Soft tissue injuries c) Disc problems d) colic/abdominal pain 2) Peripheral nerve paralysis a) facial b) radial c) others 3) Gastrointestinal conditions: vomiting, diarrhea, constipation, indigestion 4) Muscle atrophy

Contraindications:
1)

Weak/deficient patients 2) Heart problems 3) Seizure/epilepsy 4) Tumor

How to Use the Electronic Acupunctoscope

Dial the AMPLITUDE and FREQUENCY to zero Plug the wire leads into sockets 1 to 7 and fasten the clips to the handles of needles

Set the desirable frequencies and wave forms

low frequency F1 = 20-30 Hz

Indication: pain conditions Endorphin release
C fiber is sensitive to less than 10 Hz of electrical stimulations 20 to 120 Hz stimulates A and A

moderate frequency F1 = 80-120 Hz

Enkalphalin release Indications: internal medical conditions (diarrhea etc)

How to Use the Electronic Acupunctoscope

Wave Form: depends on how F1 and F2 is set up

Continuing Wave: F1=20-200 and F2=0

Indications: pain conditions

Intermittent wave: F1=0 and F2=>0

Indications: muscular atrophy

Dense and Disperse (DD) wave: F1=80 and F2 =120

Indications: nerve paralysis and internal medical conditions

How to Use the Electronic Acupunctoscope

Turn on the power 3 Gradually increase AMPLITUDE buttons until the patient can tolerate

Can increase amplitude a little bit every 5 minutes.

Turn off power to terminate the acupuncture treatment

How to Use the Electronic Acupunctoscope

The output socket between 4 and 5 is only used for the needleless technique, which acupuncture points are stimulated using the needleless electrode. Fill the cup of electrode with absorbent cotton soaked with saline. Tape the electrode onto the acupuncture points.

Electro-acupuncture: how to pair the points

Bilateral connection

Pair BL-54 on left side to right BL54 for hip dysplasia; Hua-tuo-jia-ji on the left to right side for disk diseases BL-21 on the left to right BL-21 for vomiting KID-1 on the left to right KID-1 for rear weakness GV-14 + Bai-hui for disk disease, vestibular dx LI-10 + LI-15 on the same side for shoulder pain Tip of tail + GV-20 for vestibular dx, disk disease TH-14 + LI-15 on the same side for shoulder pain GB-34 + ST-35 on the same side for stifle pain ST-36 + GB-34 on the same side for vomiting, rear weakness ST-36 + BL-20 on the same side for SP Qi deficiency

Same Channel connection.

Local connection

Same energetic connection

Electro-acupuncture: how to pair the points

From the top to bottoms for paralysis

BL-54 + KID-1 for rear limb paralysis PC-8 + GV-14 for front limb paralysis GB-21 + HT-3 for front limb paralysis

Cover large areas

BL-20 on the left + right BL28 for T-L-S IVDD

Normal area to sick area

BL-21 to KID-1 for no deep pain caudal to BL-22 ST-5 left to right for right facial paralysis

Electro-acupuncture: how to pair the points

But, we must pay attention to the following:

The wire (lead) should NOT be connected around the abdominal areas for pregnant moms

The wire (lead) should NOT be connected through the chest if the patient has a pacemaker
The wire (lead) should NOT be connected through the tumor mass Caution for seizure dogs when using EA

Aquapuncture (point injection)

History:

Points:

Herbal medication for pigs: very challenge

Injectable herbal liquid (Angelica Dang Gui)

Acupoints: except for hemo-acupoints A-shi Point

Patient own blood for chronic eye blood Fire Constitution of Animals
Will not remain still

Needle:

Dogs/cats: 25-27 ga Horses: 20 to 22 ga

Some of points not available with dry-needling or EA

Aquapuncture (point injection)

Technique:

Insert needle After "De-Qi" occurs, the injection is given 1-8 points per treatment Once every 3-7 days, for 3 to 5 times t

Aquapuncture (point injection)

Injectable agents

Herbal liquids
Angelica sinesis (Dang-gui) Carthamus tinctorius (Hong-hua) Coptis chinensis (Huang-lian) Andrographis paniculata (Chuan-xin-lian)

5-10% dextrose 0.25-0.5% procaine Vitamin B1, B12, or B complexion Antibiotics Anesthetics, sedatives or anti-rheumatics Biological products:

Antitetanolysin Vaccine

Medications
Sterile water

Homeopathic remedies Patients own blood

1 - 15 ml each point for large animals 0.1 - 1 ml each point in small animals

Acupuncture point embedding (Implantation)

Point injection of a solid substances

Thread/catgut/suture Magnetic beads or pellets Gold bead/wire Biodegradable plastics

Uses

Diarrhea in young animals Hip dysplasia Epilepsy Lameness Eye infection

Hemoacupuncture

Also called Red Needle

Intentionally puncture a blood vessel to draw blood

Needle:

a sharp traditional needle (three edged needle, or wide needle) hypodermic needle
#27, 25 for small animals #25, 23, 20 for large animals

Only used for specific points that have a history of hemoacupuncture in TCVM such as Er-jian, Wei-jian, Tai-yang, Xiong-tang

Hemoacupuncture

Indications:

Blood Stagnation Blood Heat Excess Heat

Contraindications and cautions:

Weak and debilitated animals Qi or/and Blood Deficiency Dehydrated or severely Yin-deficient patients Pregnant animals Patients with potentially zoonotic blood-borne pathogens

Hemoacupuncture can not repeat the same point for a week

Pneumo-acupuncture

Inject fresh air into an acupoint Subcutaneous tissues Local ash Point (the worst atrophied spot) Equine: Gong-zi for shoulder atrophy Canine: 5 to 50 cc of air Indication

Shoulder atrophy Hip atrophy

Avoid the head

Moxibustion

Using burning herbs to stimulate acupoints

Originates from the Japanese "mogusa

moxa" or "moxibustion

Crushed dried leaves of Artemisia argyi (Ai-ye)

Therapeutic effects:

dredging meridians dispelling cold and wind reviving Yang for resuscitation promoting functional activities

Moxa sticks: 20 cm in length and 1.5 cm in diameter

Moxibustion

Mild moxibustion:

1 to 2 cm distance against the acupoint 5 to 10 min. for each point

Circling moxibustion:

With a circulating motion For larger area of rheumatism

Pecking moxibustion:

With a pecking motion touches the skin 2 to 5 min For chronic diseases which need stronger stimulation

Moxibustion

Moxa cone Moxibustion

Moxa + Needling

Direct Moxibustion
up to 5 zhuangs

Indirect Moxibustion
a slice of ginger or garlic placed b/w the burning cone and the acupoint. The ginger or garlic slice is about 3 mm thick with some pores

Laser Acupuncture

History

Later 1970, Laser acupuncture for diarrhea in goats and sheep in Inner Mongolia using CO2 laser at GV-1
CO2: no light Can be very dangerous

5-30 mW Helium-Neon (He-Ne laser): or cold laser

infertility, anti-inflammatory, analgesic, and promotes wound healing cannot penetrate accurately and deeply into most acupuncture points because the light is refracted in the first 1-15 mm of tissue Almost no effect if less than 5 mW.

Treating superficial acupuncture points in areas of thin integument

Avian: skin is generally very thin Lie Que (Lung 7) Jing-well points.

Infrared Acupuncture

Radiation heat (moxibustion)

250 W infrared bulb

TDP lamps (Teding Diancipo Pu):

Heat a metal plate constructed from numerous mineral substrates Developed in Chong-qing, China in the 1980s. Bi syndrome Wound

Indication

Caution: avoiding too hot.

Auriculotherapy
Origin:

tip of ear auriculotherapy

Human

Germany 1950s China

Diagnosis Treatment

Canine

ear points

Diagnosis Treatment

Other Acupuncture techniques

Cupping Tui-na (massage and chiropractic) Scalp acupuncture Microwave acupuncture

How to Approach AP Patient

Take history, do exam & make pattern diagnosis Start with Dry Needles

10-15 needles unless strong or weak Treat 15-30 minutes

Follow with B-12 aguapuncture

5-8 points

How to Approach AP Patient

Re-assess pattern diagnosis Start with Dry Needles

10-15 needles unless strong or weak Treat 15-30 minutes

EA

10 minutes @ 20 Hz 10 minutes DD 80-120 Hz 5-10 minutes 20 Hz

Follow with B-12 aguapuncture

5-8 points

TCM Prayer

Just for today, I will let go of my anger.

Just for today, I will let joy in my heart.

I will not worry or be sad.

Just for today, I will embrace life.

I will live without fear, in harmony with myself and the Universe.