Transcript AP_Techniques.ppt

Introduction to Acupuncture
Techniques
Ancient Art to Modern
Science
Comparison of East & West
East

•
•
•
•
Empirical
Observations over
Thousands of Years
Art of Medicine
Holistic View
Circular Logic
Energetic
West

•
•
•
•
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
Bole’s Canon of Veterinary
Acupuncture

Sun Yang

659 to 621 B.C.

Bole Zhenjing
Acupuncture: History
Yuan-Heng’s 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




Dry needles
Electrical AP
Aquapuncture
Hemoacupuncture

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
Basic Acupuncture Techniques
Stone needles: 8,000 years ago
Bones needles: 3,000 years ago
Needles
New Acupuncture
Metal needles: 2,200 years ago
Gold/silver needles
Electro-acupuncture
Bamboo needles
Embedding
Fine needles
Injectable AP
aquapuncture &
pneumo-AP
Zhen-jiu
Ai-jiu (moxa): moxibustion
Moxibustion
Alcohol (huo-jiu)
Laser therapy
Herbal moxibustion
Magnetic therapy
Needle + Moxa
Infrared therapy (TDP)
Fire-needling
Long
Nine needles (2,200 years ago)
Sword
Fine
Pressure
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
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
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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
0.15
Hand/feet Needle
38
0.16
“Baby” needle
36
0.20
34
0.22
Cats, little dogs
32
0.25
All the Small animals (dogs/cats/birds)
30
0.30
Horses, cattle, llamas, pigs
28
0.35
Large animals: horses, cattle, elephants
Acupuncture Needle Diameters in Gauge
and Millimeters
Millimeters
Inches
Application
7
0.25 (Korean
Hand Needle)
Dogs/cats: around eyes, nose, feet, or sensitive
patients
13
0.5
Dogs/cats: head, feet, lower limbs, ear, tail, mu pts
Horses: ears/eyes, feet
25
1.0
Dogs: back-shu, neck, shoulder, limbs
Horses: feet, lower limbs, head, tail
40
1.5
Dogs: hip, shoulder
Horses: back-shu, mu points, limbs
50
2.0
Dogs: hip, cervical hua-tuo-jia-ji for big dogs
Horses: back-shu, limbs
75
3.0
Horses: hip
100
4.0
Horses: hip
How to needle an acupoint
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Preparation
 Needle
 Animal
 Practitioner
Insertion of a needle
 Pressing hand
 Angle
 Depth
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Manipulation of a needle

Withdrawal of a needle
How to needle an acupoint:
preparation
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Needle

Sterile disposable
• The tip should be smooth & sharp as a
pine needle
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Horse
• Size

0.30-0.40 mm (#28-#30)
• Length
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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
How to needle an acupoint: preparation
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Needle

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Small animal
• generally thinner
• not too thin
Cat:
• Size

• Length

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Dog:
• Size
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0.25 (#32)
• Length
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13 mm (1/2’)
25 mm (1’)
50mm (2’): large dog
0.25 (#32)
13 mm (1/2’)
How to needle an acupoint:
preparation
 Animal

quiet

relaxed (house call benefit)

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Restrained if needed (nose
twisted), but not
sedation/tranquilized
The site of acupoints
• nice and clean
How to needle an acupoint:
preparation
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Practitioner


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Sound plan of
acupuncture treatment
Considered as a
surgical procedure
others
How to needle an acupoint:
Insertion
 Pressing
Hand
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1. Thumbing

2. Pinching
1
2
How to needle an acupoint:
Insertion
 Pressing
Hand

3. Holding

4. Stretching
3
4
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


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Location
De-Qi response
Condition
Patient
How to induce De-Qi

1. Up-down
thrusting
 2. Left-right twisting
 3. Flicking
 4. Scraping
1
2
3
4
Quantity/dose of needle stimulation
 Intensity


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De-Qi Response
Intense
Intermediate
Mild
 Duration
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
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
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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:
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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
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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
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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
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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 α and A β

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
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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
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Bilateral connection
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Same Channel connection.
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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
Local connection
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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
TH-14 + LI-15 on the same side for shoulder pain
GB-34 + ST-35 on the same side for stifle pain
Same energetic connection


ST-36 + GB-34 on the same side for vomiting, rear weakness
ST-36 + BL-20 on the same side for SP Qi deficiency
Electro-acupuncture: how to pair the
points
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From the top to bottoms for paralysis
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Cover large areas

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BL-54 + KID-1 for rear limb paralysis
PC-8 + GV-14 for front limb paralysis
GB-21 + HT-3 for front limb paralysis
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
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But, we must pay attention to the following:

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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:


Herbal medication for pigs:
very challenge

• Injectable herbal liquid
(Angelica Dang Gui)


Patient own blood for
chronic eye blood
Fire Constitution of Animals
• Will not remain still

Some of points not
available with dry-needling
or EA
Points:


Acupoints: except for
hemo-acupoints
A-shi Point
Needle:


Dogs/cats: 25-27 ga
Horses: 20 to 22 ga
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)

Medications
• Sterile water
• 5-10% dextrose
• 0.25-0.5% procaine
• Vitamin B1, B12, or B
complexion
• Antibiotics
• Anesthetics, sedatives
or anti-rheumatics
• Biological products:


Antitetanolysin
Vaccine
• Homeopathic remedies
• Patient’s 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:




Contraindications and cautions:






Blood Stagnation
Blood Heat
Excess Heat
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

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

Moxa + Needling
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):



Indication



Heat a metal plate constructed from numerous
mineral substrates
Developed in Chong-qing, China in the 1980’s.
Bi syndrome
Wound
Caution: avoiding too hot.
Auriculotherapy
 Origin:
tip of ear
 Human


auriculotherapy
Germany 1950’s
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



EA




10-15 needles unless strong
or weak
Treat 15-30 minutes
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.