E

XERCISE

-I

NDUCED

P

ULMONARY

H

AEMORRHAGE IN

H

ORSE

: A

CUPUNTURE

T

REATMENT AND

P

REVENTION

• • •

Barbara Bellomo, DVM, ItVAS Alessandra Vigliani, DVM, Horse Clinic “Scuderia dei Vet” Milan (Italy) Francesco Longo, DVM, Repr. Spec. ItVAS – ItVAC Bologna (Italy)

It occurs in horses: Race at high speeds

EIPH

thoroughbred standardbred Many horses with poor performance have cytologic evidences

•

Microscopic examination of tracheobronchial aspirates or bronchoalveolar lavage fluid

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Tracheobronchial tree performed 30-90 minutes after exercise or racing

Causes of EIPH:

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Rupture of alveolar capillary membranes

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Subsequent haemorrage into airways and interstitium

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Cause inflammation of both airways and interstitium

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Development of fibrosis and alteration of tissue compliance

Structural abnormalities + pulmonary hypertension + large intrathoracic force associated with respiration during strenous exercise

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repetitive damage of the tissue Causes

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haemorrhage and inflammation

Predisposing factors:

•

R A C E

•

AG E

•

BAC T E R I A L I N F EC T I O N S ( O F T E N U N D E R EST I M AT E D )

•

etc

The most common diagnosis:

Bacteriological examination Cytological exam Differential Diagnosis Guttural punch Mycosis Ethmoid haematoma Rhinitis

Allopathic therapy is based on

antibiotics vitamin C aerosol with hyaluronic acid

According TCM

the Spleen produces the Blood (Xue) The Lung allows the descent of the Qi and the fluid it settles the water passage both these Zang constitute the Tai Yin energetic level

The Qi empty of Lung determines

•

Xue and fluid stasis with conseguent fullness of the thorax

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Insufficient blood circulation in the thorax

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Dyspnoea

• • •

Tachycardia Purple tongue Rapid and superficial pulse

The Chinese classical formulas derive from three books and they point out the rebalance of Tai Yin level by different points:

•

Ling Shu

•

Nan Jing

•

Yu Xue Rou Men CV 12 – SP 1 SP 3 – LU 7 LU 9 – SP 4 SP 3 – SP 4 – TH 5 LU 9 – LU 7 – BL 58

Acupuncture therapy was based on

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Rebalancing Tai Yin level

•

Toning Lung Qi Treatment acupoints are selected according to their traditional energetic indications considering experimental and clinical evidences In respect of the individual needs of the treated subject

The authors standardize these acupuncture protocol for 2 specific conditions:

•

After race in horse affected by pulmonary haemorrhage

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Previous race preventive medicine BL 14 Jueyinshu BL 43 Gaohuang KI 27 Shufu PC 4 Ximen CV 15 Jiuwei

Fei Pan

Qi Hai – Bi Guan SP 21 Dabao BL 42 Pohu GV 12 Shenzu CV 17 Shanzhong

The authors standardize these acupuncture protocol for 2 specific condition:

•

After race in horse affected by pulmonary haemorrhage BL 14 Jueyinshu BL 43 Gaohuang KI 27 Shufu PC 4 Ximen CV 15 Jiuwei

Fei Pan

Qi Hai – Bi Guan

1) AFTER race in horses affected by pulmonary haemorrage

* In this group were enclosed horses with contingent episode of EIPH. The acupuncture treatment was performed after the race 1) Western Medical Diagnosis 2) 3) Clinical procedure was in five steps: TCM Medical Diagnosis Acupuncture therapy 4) Collecting the clinical data after Acupuncture Session 5) Results (*) The authors have treated 12 horses (2012 – 2014)

Western Medical Diagnosis:

•

Medical examination

• •

Tracheal lavage Cytological exame

TCM

Medical Diagnosis:

•

Diagnostic acupoints testing

• •

Tongue exame Pulse exame

Acupuncture therapy:

•

Only Chinese needles were employed

•

In all of horses were performed one acupuncture session within one hour after race

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The moxa was applied on needles putting in BL14 and to warm Qi Hai – Bi Guan

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BL 14 Jueyinshu It is Back Shu Point of Pericardium

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BL 14 Jueyinshu In ancient acupuncture charts BL14 is considered the Back Shu of the LU It is involved in supporting cardio pulmonary activity

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BL 43 Gaohuang Huang (membranae) point; it renforces SP, ST and Qi and Yin of the Lung.

Increase in 24 hours the number of red blood cells

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KI 27 Shufu It replaces LU 1 (Zhongfu) in the Shu – Mu technique to treat respiratory diseases in summer

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KI 27 Shufu We use this point in summer time because of it bring the Yin of KI directly to the thorax.

It’s possible to stimulate the acupuncture point also with Tuina

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PC 4 Ximen Xi – cleft point; It is employed in acute chest problems It has great antihaemorrhagic effect

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CV 15 Jiuwei It is Luo point of Renmai; It is Yuan point of Gao (fat organic substance)

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Fei Pan It is an ancient point very effective in chronic respiratory diseases like COPD It treats cough, pneumonia, Heat in the Lung

Foto •

Qi Hai – Bi Guan They are stimulated by moxibustion to eliminate Tan from the respiratory tract.

These are local points very usefull in treating respiratory conditions.

Collecting the clinical data after race:

Endoscopy was performed 1-2 hours after race

TCM diagnosis was made

The same collection of data was performed 6 months after the last acupuncture treatment (at the end of races season)

Results

:

• •

All of horses treated by acupuncture were in good clinical conditions after 1 – 12 – 24 hours after treatment

•

All of horses have shown an almost normal endoscopic picture The Collection of data after 24 hours prove the effectiveness of Acupuncture in treating acute EIPH

The authors standardize these acupuncture protocol for 2 specific condition:

•

Previous race preventive medicine SP 21 Dabao BL 42 Pohu GV 12 Shenzu CV 17 Shanzhong

2) PREVIOUS RACE – PREVENTIVE MEDICINE

* In this group were enclosed horses with medical history (in 6 – 12 months before) of at least one episode of EIPH. The acupuncture treatment was performed before three races; the race were a fifteen day interval Clinical procedure was in five steps: 1) Western medical diagnosis 2) TCM medical diagnosis 3) Acupuncture therapy 4) Collecting the clinical data after race 5) Results (*) The authors have treated 20 horses (2012 – 2014)

Western Medical Diagnosis:

•

Medical examination

• •

Tracheal lavage Cytological exam

TCM Medical Diagnosis:

• • •

Diagnostic acupoints testing Tongue exam Pulse exam

Acupuncture therapy:

•

Only Chinese needles were employed

•

In all of horses were performed one acupuncture session 24-48 hours before every race

•

The moxa was applied on needles putting in BL 42

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Tuina e manual medicine technique were employed

The authors assessed the effectiveness of some acupoints for respiratory clinical conditions:

•

SP 21 Dabao It is the Great Luo of Spleen.

It treats dyspnoea, respiratory diseases, wei syndrome.

This is a junction of all Luo vessels .

We can use needles or Tuina

•

SP 21 Dabao It ‘s starting point for the Spleen divergent meridian,in this way in possible to rebelance the energy of the SP involving in Tai Yin level; moreover from SP21 starts an inner branch to heart: it’s very important tonifying this organ before race We can apply fists massage: At begin gently and then stronger clockwise to activate circulation of collateral vessels.

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BL 42 Poshu It treats bronchitis, pleuritis, it allows the downword movement of the Lung Qi

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BL 42 Poshu It is located on the external branch of the BL meridian.

All of points on this branch have action on psycological aspect of zang organs and they are related to a specific shen or soul that have seated in those It is named Po Ho = Door of the Po Po = vegetative soul that has seated in LU It is very effective in treating many behavioural troubles link to Po, like sandness, excess or deficency of sensitiveness Other important function of the points located on external branch of the BL is carrying Yang and Wei Qi to the corrispondent organ.

BL42 send Yang and Wei Qi to the LU, in this way it is possible strenghten this organ before the race effort

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GV 12 Shenzu It improves therapies for bronchitis and asthma; It is Middle Gate of GV according to Taoist Acupuncture It regulates Lung Qi and it disperses the Wind-Heat There is a tecnique named “

Trasverse Reinforcement

” that involves BL42 BL13 GV12 BL13 BL42 The same points on both sides

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CV 17 Shanzhong It is Mu point of PC and Influencial Point of Upper Burner

Collecting the Clinical Data after Acupuncture Session:

It was performed endoscopy 24 hours after acupuncture session

TCM diagnosis was made

In 5 horses the tracheal lavage has shown the presence of bacteria It was made a specific antibiotic therapy based on antibiogram exam

Results:

•

All of horses treated by acupuncture have shown abnormal endoscopic picture

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The collection of data after 6 months prove the effectiveness of Acupuncture in preventing EIPH

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17 horses have completed the races season

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3 horses were withdrawn for orthopaedic problems

Acupuncture for the horses treated AFTER race

:

has a relevant anti-inflammatory action and effect on biological functions of the organism assures the complete wellbeing of the horse and it acts on specific problem and on global energy of the body resulting “naturally” effective

Acupuncture for the horses treated PREVIOUS race

:

It is very effective in controlling the acute onset and restoring the Qi flow in the horses It is very effective in normalizing the respiratory tract as shown by endoscopy has proven to be particularly effective as a

preventive medicine