ACUPUNCTURE IN ROUTINE VETERINARY PRACTICE

Part 1Philip A.M. Rogers MRCVSe-mail : progers@grange.teagasc.ie Updated 1991, 1993, 1995 Postgraduate Course in Veterinary AP, Dublin, 1996

ABSTRACTAcupuncture (AP) is a reflex phenomenon with diagnostic and therapeutic value. AP points (APs) and Channels (AP meridians) have many applications in routine veterinary practice. AP has diagnostic and therapeutic value.

Irritated organs/functions cause reflex changes in sensitivity (usually hypersensitivity to pressure, heat and electrical current) at specific zones (the AP points (APs)) on the body's surface (diagnostic effect). Adequate stimuli (needling, injection etc) applied to the APs can influence the pathophysiology of the affected organs/functions (therapeutic effect).

Most of you are Vets whose main source of income comes from private practice. If you hope to integrate AP into your day-to-day practice, you must keep certain considerations in mind:

1. You must study AP in reasonable detail. A few weekend seminars may be enough to get you started but are only the beginning of mastery of AP.

2. The AP technique which you use routinely should require a maximum of 10-20 minutes/session, otherwise the number of cases which you can treat/week will fall. Unless your fee for treatment includes a cost for the time involved, your income will fall in proportion to the fall in cases/week. Point injection is the fastest method and gives good results.

3. Having studied AP, you should present it in a scientific way to your clients and your colleagues. This is essential if you wish to preserve your reputation as a vet and a scientist.

This paper discusses AP point injection; methods of adapting ultrasonic, faradic, laser and other physical therapies along AP principles; some of the best indications for AP therapy in large and small animals and possible uses of AP analgesia in surgery. It also discusses options for AP training; continuing study and development of intuitive powers in relation to an Holistic "total view" of health and disease and some of the methods of fostering public awareness of AP.

ACUPUNCTURE (AP): REFLEX AND ENERGETIC CONCEPTSAP has diagnostic and therapeutic value. It has many applications in routine veterinary practice (1,2,11,12,13,14).

In its simplest form, AP is a reflex phenomenon: irritated organs/functions cause reflex changes in sensitivity (usually hypersensitivity to pressure, heat and electrical current) at specific zones (the APs) on the body's surface (diagnostic effect). Adequate stimuli (needling, injection etc) applied to the APs cause reflex responses in the pathophysiology of the affected organs/functions (therapeutic effect). The reflex (neurally-mediated) mechanism is easily demonstrated by experimental chemical or surgical interference with neural transmission in the peripheral nerves, spinal cord or midbrain or by sympathectomy.

In its purest form, AP involves a concept of interacting external and internal energy fields (5,6,7,8). It involves an holistic concept of the organism in relation to its internal and external environments. It involves the manipulation of Vital Energies (Qi), some of which are known (defence reactions) and some of which are only hinted at in occult or esoteric literature (the Aura, the Etheric body, Kundalini, Prana etc). Western science has much to learn about the Energies of Life! We are far behind Soviet and Eastern Block science in this research. They are already well advanced in research on "Bioplasma", mitogenic cell radiation, weak electrical and EMF radiation etc.

AP: NOMENCLATURE AND POINT SELECTIONEach AP point has a Chinese name, an alpha-numeric code and an anatomical location. For example TsuSanLi (ST36) means FootThreeMiles, is the 36th point on the ST (stomach) Channel and is situated 3 cun (body inches) below the patella, 1.5 cun lateral to the tibial crest in adult humans. Details of the point nomenclature and points for particular conditions are given elsewhere (3,4,9). AhShi points and Trigger Points (TPs) are discussed elsewhere (3,4,12,14,17).

Novices should note that many different nomenclatures are used for the APs. Before using the point combinations listed below, novices should consult those references and cross-compare the codes with those in their standard reference textbooks.

The AP-based applications (below) use some or all of the Laws of Choosing Points for therapy. Let us recall some of these Laws:

* Sensitive points (AhShi points/TPs, Motor points etc)

* TianYing points (centre of the swelling) and sensitive area

* Local points

* Distant points along affected Channels* Combination of Local and Distant points

* Points along affected Channels* Points on related affected Channels* Selection according to symptoms

* Selection according to nerve supply

* "Fore and Aft" points

* Master Points: Mu-Shu (Alarm-Association); Yuan-Luo (Source-Passage); Xi (Cleft) points etc

* Ear Points and APs not on the main ChannelsThese laws and methods of selecting APs for therapy are discussed elsewhere (8,9,11,12,13,14).

METHODS OF STIMULATING THE AP POINTS (APs)There are many different methods of stimulating the APs to activate the AP response. These are discussed elsewhere (10).

AP POINT INJECTION: The injection of APs can be tried by all practitioners. It is the fastest and most practical method. It requires no sophisticated equipment, stimulators etc. It is fast and takes little more time/session than the routine vet treatment requires. The technique is described in detail elsewhere (10).

If the client can accept the fact that AP is applicable in vet medicine, the practitioner inserts a hypodermic needle in a correct point, stimulates the needle manually (by pecking and twirling for 10-15 seconds before the syringe is attached), attaches the syringe and injects the point, manipulates the needle again and removes it. Then he/she proceeds to the next point, and so on.

If the client is very conservative and would not accept AP treatment for his/her animals, the needles are not manipulated by pecking or twirling. If the client asks why so many points are being injected, he/she can be told that the results are better when many points are injected. Alternatively, he/she can be told that different compounds are being used. (For this purpose the practitioner should have a number of bottles with 0.9% saline, 0.5% procaine (or xylocaine or lignocaine) solution in 0.9% saline, B12, Sarapin, homoeopathic solutions or other injection material. Preferably non-toxic, non-irritant colouring agents can be incorporated in the solutions).

Point injection is ideal in those cases in which the practitioner considers intramuscular injection of therapeutic agents to be desirable. If the therapeutic dose is calculated as 20 ml of drug solution and the vet needs to inject 8 points with 10 ml each (large animals), the 20 ml drug solution can be diluted to 80 ml by adding 60 ml sterile water or saline.

In emergencies (such as anaesthetic collapse, coma which has not responded to orthodox therapy etc) the GV26 + KI01 combination may be needled or electro-stimulated. In cattle and horses, KI01 is not transposable but the interdigital cleft (cattle) or the hollow at the back of the hoof (horses) may be tried instead. If the owner asks why the animal is being stimulated in the nose/foot he/she can be told that: "It is a new resuscitation technique which I have read about and it is worth a try".

ULTRASOUND, FARADISM, TENS, LASER AND OTHER PHYSICAL THERAPIESVets whose clients already accept these types of therapy have a few problems adapting these methods to treat the many conditions responsive to AP. The main differences between the "orthodox" and AP-based application of these methods are:

a. orthodox uses are limited to a few conditions whereas AP based applications have a much wider scope and

b. orthodox use of these methods is usually confined to the problem area (muscle, joint, etc).

If the vet wishes, the client need not know that the animal is being treated by AP principles. For example, in low-back syndrome, the electrode of the transcutaneous stimulator can be moved first over the problem area. Then the other sensitive points are identified in the lumbosacral (and possibly low-thoracic) area, the heavy muscles of the thigh and gastrocnemius and their locations are noted for future reference. They are stimulated for a few minutes. Electro-stimulators with multiple outputs allow faster therapy during a session, as multiple points can be stimulated together. Finally, a few classic points for the low-back region (BL23, GV03, GB34) are stimulated. If the owner asks why so many points (and especially distant points) are being stimulated, he/she can be told: "They are nerve zones with beneficial reflex effects on the back".

SOME PRIME INDICATIONS FOR AP THERAPYThe following conditions are suggested as prime indications for beginners. The points suggested are taken from the transposition method (anatomical transposition from human to animal models). APs may also be taken from the traditional vet texts (3,4,9).

In all cases, search the patient carefully for points which are tender/hypersensitive to palpation or electric current (AhShi points, TPs (17)). Animals can not tell us where they "feel" referred pain when a tender point is pressed. Therefore, it is usually not possible to distinguish locally sensitive AhShi points from genuine TPs (which refer pain elsewhere) with certainty in animals. I assume that the most painful AhShi points are TPs. For the purposes of this paper, I use the term AhShi point to include both types of points, causing local and referred pain. If AhShi points are found, mark their position and use them.

1. Cows: dystocia, especially due to relative oversize of the foetus: The method was used by Kothbauer the late Erwin Westermayer. Their main points are: GV02,03,04, (sacrococcygeal space, L4-L5 space and L2-L3 space) and BL32,53. Any AhShi points among BL23,24,26,31,33,34,54 are added. AP at these points helps to relax the pelvic ligaments, helps uterine contraction and cervical relaxation. It greatly facilitates parturition.

On arrival, the vet inserts the needles and instructs the farmer as in (2) below. Electro-stimulation is not essential. Having prepared him/herself, the instruments and the cow, the vet proceeds with the delivery. This method is recommended strongly.

2. Cows: reposition of prolapsed uterus: The main points are: GV02,03,04; BL23,26,31,53. Occasionally, BL24,32,33,34,54 might be substituted for the other BL points (Westermayer).

First thing on arrival, before other preparations, AP needles or hypodermic needles 5 cm long and 19 to 23 gauge are placed to a depth of about 3 cm in GV02,03,04 and to a depth of 4-5 cm in the BL points, bilaterally. The farmer or an assistant is shown how to twirl and manipulate the needles and is instructed to continue twirling them in sequence for 10-15 seconds each. Two needles can be twirled together. Alternatively, an electro-AP stimulator is attached to the needles and the frequency is set for about 5 Hz. The output voltage is increased until the needles are pulsating in rhythm with the outputs.

The vet then proceeds to reposition the uterus and to ensure that it is fully back. A uterine pessary may be inserted. The vaginal lips are sutured as usual and a special harness to apply perivulval pressure is applied for a few days. Normally the whole procedure takes only 15-20 minutes and there is seldom any straining or re-expulsion of the uterus by the cow. Spinal anaesthesia is seldom necessary. The late Erwin Westermayer (Germany) made a superb video-film showing this method in eight random cases.

3. Cows: hormonal infertility/functional pituitary, ovarian, uterine pathology: Infertility in cows is often associated with anoestrus, persistent corpus luteum, pyometra and cystic ovary. Main points are traditional points YungQi (near BL26, bilateral), 9-10 cm from the midline between the transverse processes of 5th & 6th lumbar vertebrae. Any AhShi points in the lumbosacral area (in the area BL23-34 and BL52-53) are added. AP can be by point injection, manual needling + electro-stimulation for 10-15 minutes, repeated every few days until the cow comes into oestrus.

Alternatively, point injection with 5-10 ml solution of 0.25-0.50% procaine, vitamin B12, homeopathic agents etc can be used. Anoestrus usually responds to 1-2 treatments, cows coming into oestrus within 3 weeks. Cystic ovaries may need up to 4 sessions, with the formation of a corpus luteum by the 10th day and the appearance of oestrus by 3-5 weeks after the last treatment.

Some vets apply moxa to the needle handles (when the needles are inserted) and allow the moxa to burn itself out. Kothbauer also uses paracervical injection, via a very long needle.

4. Small animals: conjunctivitis, rhinitis: Main APs for these disorders are: Conjunctivitis: LI04: BL01; GB01 / + / GB20: ST01,02; LV03; TH23. Rhinitis: LI04,20; Z 03,14; GB20; GV23,25. The animals may be needled with fine human AP needles, 10 mm long and 30-32 gauge. The needles are inserted to a depth of 2-3 mm on the face points; 12-25 mm on GB20 and 12 mm on LI04. In acute cases, quick needling (a few seconds/point) is sufficient. Repeat daily for 2-3 days. In chronic cases, sessions should last 10-20 minutes, repeated once every 3-7 days for 4-6 sessions.

Alternatively, APs may be injected with 0.1 to 0.5 ml of solution using a dental syringe and a very fine needle. In severe conjunctivitis, if the animal is quiet, pricking the everted eyelid in 3-6 places is recommended in large animals, or injection of 0.1 ml 0.25-0.50% local anaesthetic into a few subconjunctival areas. One may also try laser or ultrasound using the same APs, but avoid irradiating the eye.

In chronic cases of conjunctivitis, warn the owner not to allow the dog to poke its head out of the car window while the car is moving.

5. Small animals: gastrointestinal disorders: Main points for vomiting, inappetance, gastritis etc are PC06, ST36, CV12, BL21. For enteritis, gastroenteritis, diarrhoea, constipation, colic etc, add points from TH06, BL25,27, CV04,06, ST25. Other points are listed in the Appendix to the paper on the "Choice of Points for Therapy" (9).

Acute gastrointestinal conditions are treated every 12-24 hours and should respond in 1-2 days. Chronic conditions are treated every 1-7 days, depending on their severity. They may require up to 4-5 sessions. Point injection, needling + moxa, electro-AP, ultrasonic or transcutaneous electro-stimulation methods may be tried in these cases.

6. All species: hip lameness: This may be associated with arthritis, muscular injury, trauma, metabolic diseases, hip dysplasia, low-back syndrome + etc. If dislocation of the hip is involved, this must be corrected. If metabolic causes are involved, appropriate adjustments to the diet and adequate mineral supplements are required. Once fracture is excluded, the AP treatment is similar, irrespective of the cause.

First, search the muscles of the lumbosacral area, buttocks, hip, thigh and gastrocnemius to identify AhShi points. (Note: In humans, pain may be referred to the hip/gluteal area by TPs in the paravertebral muscles as far away as the posterior edge of the scapula). Clip the points, or note their position carefully. Choose as main points from the following: AhShi points; GB30,31,34; BL23,40; LV08,11. Point injection, needling + moxa, electro-AP, electro-stimulation, ultrasonic, injection, laser etc may be tried. If needling is chosen, peck the periosteum of the femoral neck when GB30 is needled.

Treat acute cases every 1-2 days. Expect results by 2-4 sessions. Treat chronic cases every 3-9 days. Expect results by 2-8 sessions.

AP can help greatly the lameness in hip dysplasia in dogs. (The implantation technique is especially good, especially in dogs which respond well to AP or electro-AP in a preliminary test-session (10, 14). Advise the owner not to breed from affected dogs/bitches.

7. All species: shoulder lameness: This is tackled in a similar manner to hip lameness. Identify, clip or note all AhShi points in the neck, upper limb and upper thoracic area. Choose as main points from the following: AhShi points; LI11,15; TH14; SI09,11 / + / TH05,15; LI04,16; BL11; GB21; SI10,12,13,14.

8. All species: low-back syndrome (lumbosacral lameness; "disc syndrome", arthritis, spondylitis etc in lumbosacral area; rheumatism, myositis, myalgia in the area). This is tackled in a similar way to hip lameness, as above. Identify, clip or note all AhShi points from the lumbosacral area to the hock (tarsus) and note their positions carefully. Choose as main points from the following: AhShi points; X 35 (HuaToJiaJi, paravertebral points) in region first lumbar to last sacral vertebrae; BL23,25,27,31,52,40,60; GB30,38; GV02,03,04. The choice of points is discussed elsewhere (9,12,14,18).

9. All species: muscle cramp, soft tissue lameness: Where causal factors are known (trauma, exposure to cold and damp, metabolic upsets and mineral vitamin deficiencies etc) correct them. AP treatment consists of careful palpation to reveal all AhShi points. If the problem is in the forelimb, search from the knee (carpus) to the shoulder, neck and upper thorax. If the problem is paravertebral, search the whole paravertebral and intercostal area. If the problem is in the hindlimb, search the lumbosacral area and the hindlimb to the hock (tarsus). If the problem is in the flexor tendons, search these areas and the area behind the scapula (BL13,14,15 = LU, PC, HT Shu points) and the lumbosacral area (BL22,25,27 = TH, LI, SI Shu points) also. Note carefully and treat all sensitive areas.

In therapy, choose main points from: AhShi points plus main points for the affected regions (9,12,14,18). Treat acute cases every 3-7 days for up to 8 sessions. Expect results by the third session in acute cases and by the 4th-5th session in chronic cases.

In tendinitis, local APs along the affected tendons are added. In bursitis, local points and TianYing points (penetration of the bursa or cyst) are added. (I have had poor or no results with AP in tendinitis until I used a 30 mW pulsed infrared Laser, applied to many points over the medial, posterior and lateral edge of the tendon, with other APs). Laser gives better results than AP in tendinitis but the longterm benefit in seriously trained/torn tendons is questionable, unless the owner/trainer lays the horse off work for 10 months.

10. All species: anaesthetic emergencies (apnoea, respiratory arrest, cardiac arrest). The main point is GV26, in the midline at the lower extremity of the nostrils. Occasionally, KI01 is added in small animals.

Immediately the emergency is noted, insert a needle, 19-30 gauge (depending on species), into GV26, directing the needle towards the nasal septum. Stimulate the point by strong twirling, rotation and pecking of the needle. (Some colleagues who were disappointed with AP at GV26 in emergencies did not stimulate the needle adequately. Strong stimulation is needed). In apnoea and respiratory arrest, expect a response in 10-60 seconds. Remove the needles when breathing recommences. If there is no response in 60 seconds try artificial respiration for a few minutes and needle again. The response in apnoea and respiratory arrest is almost 100% if the heart continues to beat.

In cardiac arrest however, the response may be as low as 40% and stimulation of the point must continue for up to 10 minutes. The method is very good in neonatal asphyxia, coma, shock, traumatic shock and haemorrhagic shock. Remember GV26 + KI01 in shock, collapse, coma, emergencies. Remember PC06 for cardiac cases, thorax, lung disorders, nausea.

11. All species, nephritis, cystitis: Nephritis: BL22,23,58; GV03,04; SP06,09; ST25; GB25; KI03 / + / BL24,25,27,28,31,32; ST28; TH09; SP14; LV08; KI07; CV06. Cystitis: BL28,38,58; CV03,04; KI02,03; ST28 / + / BL23,25,26,31,32,33,54; GB26,29; SP06,09; CV02; ST27. Main points for treatment are drawn from these lists, depending on the symptoms and diagnosis. Also check for AhShi points in the lumbosacral and low abdominal area and include these points.

Treat acute cases daily for 4-6 sessions, expecting a response by third session. Treat chronic cases once/week. (Chronic nephritis, with marked fibrosis may have a low success-rate). If vomiting or other signs are major signs, include points according to the symptoms (9). Point injection, needling + moxa; electro-AP; electro-stimulation or ultrasound techniques may be used.

AP ANALGESIA FOR SURGERYBefore AP analgesia is attempted, the practitioner should have a good AP electro-stimulator. You are advised not to use AP analgesia in the presence of your clients until you have tried the technique many times (to your satisfaction) in the privacy of your surgery. Even then, the disadvantages of AP analgesia may prevent its use in routine surgery. However, it is worth consideration in highly toxic, debilitated or weak patients which present a high risk of intolerance of general anaesthetic, or in Caesarian sections (all species) and in routine dystocia and prolapsed uterus in cows. (The latter two cases do not require a stimulator). It is ideal for use with reduced doses of local or general anaesthetic.

The client should be informed (in those cases which are operated on in his/her presence) that AP analgesia is being used and that supplementary local anaesthesia may be required in 10-30 % of cases. For this purpose, an indwelling i/v catheter is placed before surgery is attempted. The points for use in AP analgesia are discussed elsewhere (9,11).

VETERINARY AP TRAININGVets who want to study AP have 3 main options: (a) self-study of good human and veterinary AP texts; (b) formal, long courses in human AP, followed by shorter study of veterinary AP abroad (UK, USA, Europe, Far East etc) or (c) formal, short veterinary courses, such as those organised by IVAS (International Veterinary AP Society) or national groups in Europe (especially Belgium and Denmark), combined with guided reading. Short courses are also available in UK. However, because of our isolation from mainland Europe, it is difficult for Irish vets to study AP. There are no formal training courses here and a lot of time and expense is needed to follow courses abroad.

It takes more than a few weekend seminars to transform a novice into a master. You must study for at least 60 hours of formal lectures and >400 hours of guided reading in the next year or two if you hope to become a really competent acupuncturist. Even then, your skill and success rate will improve with further study and practice of the technique, especially if you combine it with other methods of healing.

The student of AP is advised to concentrate on a few clinical conditions, rather than attempt to treat dozens of clinical conditions in the beginning. When the approach to a few responsive conditions has been mastered and the vet is satisfied with the results, he/she may study the approach to other conditions.

If you study it seriously for a year or two, it is relatively easy to learn the mechanical approach to AP (the Cookbook method plus the Classic Laws of choosing points). Those of you who regard medicine as a mechanical or physical therapy will get good results with "mechanical AP". Your results will improve further when you combine different therapies (including AP), as each new case indicates.

THE HOLISTIC APPROACH TO DIAGNOSIS AND THERAPYThe aim of all medicine should be to heal by the best methods available or, if these are impracticable, by any method which gives the desired result with minimal side-effects.

The bases of effective healing are:

a. accurate diagnosis of the causes of the diseases and their removal, if possible and

b. enhancing the defence systems of the body to cope with the various challenges that the organism meets.

a. Orthodox medicine has a very limited view of the causes of disease. Therefore, its diagnoses are equally limited.

The concepts of holistic medicine have been discussed more fully elsewhere (5,6,7,8). The holistic approach tries to assess how the external or internal environment may be changed to help the health of the patient. Harmful electromagnetic fields may be neutralised or eliminated; scars "obstructing the Channels" can be mobilised etc; diet can be altered or supplemented; management errors in animal handling can be corrected etc.

b. By its nature AP is holistic, especially if practised in the more classical method, using the laws of Choosing Points or the laws of Energetic AP (Pulse Diagnosis, Five-Phase Theory, the Eight Principles etc (5,6,7,8).

AP works not only on the affected region, organ or symptom, but on the defence system of the whole organism. It can not be compared validly with suppressive or symptomatic therapy (aspirin/ analgesics/tranquillizer), nor with the diabetes-insulin dependence approach. In mild diabetes, AP (at the correct points) helps to counteract any infection or mild inflammatory changes in the pancreas, assists pancreatic function and helps the body to produce its own insulin. The outcome of a successful course of AP in this case would be a patient who is kept reasonably healthy by its own defence response. The patient is not dependent on exogenous drugs or further AP ad infinitum to keep it healthy.

In our therapy, we must be ready to use whichever system or combination of systems which we feel are necessary. In many instances, we will use the well-tried and usually successful orthodox methods first. Only if they fail would the unorthodox methods be considered. In other cases, where we know from past experiences that orthodox methods give unsatisfactory results, we should be ready to try the unorthodox. AP is indicated in many of these cases.

One may decide to combine AP with medical therapy, say in acute infections. For example, in acute pneumonia with fever, diluted antibiotic solutions may be injected at APs for the lung (BL13; PC06; CV17; NX04; LU01 or 05 or 06) and at AP points for fever (GV14) and immune response (LI04 or 11; ST36), so that the total dose of antibiotic is correct but many active APs are also treated.

In the beginning, it is safer to use this combination method until one is reasonably advanced in one's AP study. (From a research viewpoint, the combination method is not so satisfactory as is makes it difficult to assess the value of AP in relation to the orthodox therapy). Later one can use AP alone in suitable cases.

Drugs which may antagonise or reduce the effects of AP include: large doses of narcotics, methadone, analgesics, corticosteroids, opiate antagonists (naloxone, naltrexone etc), alcohol, tranquillizers or sedatives.

These drugs may antagonise or reduce the neural effects of AP at the level of the specific and non-specific receptors in the brain, spinal cord and other target areas. Where possible, a period of 24-28 hours abstinence from these drugs is advisable before AP treatment. Patients on corticosteroid therapy should be weaned off steroids for some weeks before AP. Care should be taken not to terminate steroid therapy too abruptly.

In certain circumstances, it may be necessary to administer sedatives or tranquillizers to facilitate AP, for example in difficult patients (such as cats, vicious dogs or horses). The alpha-2 agonist (opiate substitute) detomidine or medetomidine (Pharmos, Finland) is said to enhance AP effects in horses and dogs. Administration of D-phenyl alanine (DPA) for some days before AP analgesia in humans is said to enhance the depth of analgesia and to turn "non-responders" into "responders".

Similarly, in AP analgesia, intravenous sedatives (diazepam etc) can be very useful supplementary drugs. Also, small doses of general anaesthetic can be used with AP analgesia (doses which would not adequate for good anaesthesia if AP was not given also).

In the treatment of withdrawal from cigarette smoking, a Dublin physician (Tom Elliott) combined a mild dose of tranquillizer (Ativan, 1 mg/day) with press needles in the Earpoints LU and ShenMen. His results were >80% successful at 4-5 weeks after commencement) as compared with 45-65% success by other acupuncturists using the same points but no tranquilliser.

In the treatment of human narcotic addiction, electro-stimulation of Earpoint "Lung" or the mastoid processes has been very successful in detoxification without withdrawal symptoms, but detoxification requires 4-8 days before urine tests are "negative" for the drug. A new development (pioneered by H.L. Wen, Hong Kong) is to combine AP stimulation with repeated i/v injection of naloxone. This reduces the detoxification period to about 10 hours. (Naloxone displaces the drug very rapidly from the opiate receptors and AP prevents the withdrawal symptoms by stimulating the release of endorphin, which had been inhibited by the exogenous drug).

DEVELOPMENT OF INTUITIVE DIAGNOSIS AND HEALINGAs I wrote the first version of this paper (1980), I was on holidays with my family in Fethard, a fishing village on the South East coast of Ireland. A 7-year-old boy was drowned in a large river a few miles away. The river is tidal and the drowning occurred while the tide was rising.

Dozens of fishermen with nets, grappling hooks, fishing lines etc dragged the river for 5 days. They had the assistance of a diver also. The body was not recovered. A friend of the boy's father knew of my unorthodox interests. He asked if I could suggest a diviner who might locate the body. Next day, I brought the boy's father and his friend to Sgt. Neil Boyle, an instructor in the Garda Training School, Templemore. This man is one of the most famous diviners in Ireland. He does most of his divining in his own house by divining over a map!Within minutes of our arrival, and working over an accurate navigation chart of the river, the diviner got a reaction some 75 metres west of a fixed marker-buoy in the river. He said that the body would be found there. The boy's father then exclaimed that the boy's teacher had dreamed that the body was near there but the search party had not acted on this dream!

The search was switched to that area at 1900h on Friday night but was disrupted 3 times by ships passing up the river. At about 2300h, one of the fishermen hooked a submerged object but lost it. Early next morning, the body was seen floating on the surface of the river within 10 metres of the mark as indicated on the map by a man about 120 km distant from the spot! The search was over. Was the diviner's mark a coincidence? Definitely not! This man has located dozens of missing persons, alive or dead, using this technique. He usually knows immediately if the missing person is dead. He has located them in lakes, rivers, the sea and on land.

Development of intuitive diagnosis and healing was discussed in more detail elsewhere (7). Those of you who already have some ability in this area (or who may be interested) will find it very helpful to join groups or societies of professional colleagues (medical and vet) who discuss these topics. Discussions with colleagues who know this reality can accelerate your own growth in the area. AP is only one system! There are many others and combinations are possible.

One such group is the Scientific and Medical Network, c/o: David Lorimer, Lesser Halings, Tilehouse Lane, Denham, Uxbridge, Msex UB9 5DG, UK. (Fax: +44-1985-835818; Email: Scientific and Medical Network @smnet.demon.co.uk, or, 100114.1637@compuserve.com)

If one wishes to grow in skill as a healer, one must continue to study many different methods. Study must be a routine part of one's profession, despite the great difficulties that this poses to private practitioners (and their partners and families!). What to study? There is so much in orthodox literature that one could study specialist journals in one small area and never get to the end! I would urge you, however, to read some unorthodox concepts, such as those on osteopathy/chiropractic, homeopathy, food allergy, psychic phenomena, radiaesthesia. Even if you can not yet accept their scientific validity, you will find them highly entertaining! Some of you will know by "gut reaction" that their main claims are valid and you may be stimulated to continue this aspect of your study in greater depth.

Special Interest Groups (SIGs) on Email and WWW: Those who want to explore the more esoteric aspects of the psyche in healing can subscribe to SIGs on Email Lists (such as CAM&VM, Holistic, INDHN etc; details on request), or visit specialist Home Pages on the Internet (WWW), such as AltMed, AltVetMed, Dowsing Pages etc.

If one can improve one's intuitive or divining ability, it can be of great value in reaching a detailed and accurate diagnosis as to the causes and nature of the problem. This gift alone would be of great value. However, if one can also develop ones psychic (transmitting) healing power, the healer and the patient are doubly blessed. There are a few who have these gifts. If they are latent in you, please do not waste them. If (like me) you have mediocre talent in the intuitive/psychic field, don't worry! The more rational pragmatic methods may be slower in day-to-day use but they also give good results.

FOSTERING PUBLIC AWARENESS OF APTV and press coverage in recent years have informed most people that AP therapy and analgesia for human surgery have definite roles in medical science. However, few people know that AP is equally applicable in vet science. Research in humans and animals has shown that AP is a powerful physiotherapy which involves reflex effects, humoral and neuroendocrine effects (1,2,5,11).

While vets are learning the system and trying to integrate it into their approach to animal diseases, they may not wish to enter into much discussion on the topic. Later, as they grow in experience, they should gradually let their clients know that AP is just one more modality in the fight against pain and illness. The mystique and magical image of AP, so often exaggerated in the public press, should be dispelled. In its place, the concept of reflex therapy (activation of the normal defence and healing systems of the body by the stimulation of reflex points) should be fostered. If used properly, AP is the most powerful form of physiotherapy. In incompetent hands, AP may give poor results and in the wrong hands, may spread viral diseases (AIDS, hepatitis etc in humans; swine fever etc in animals).

Practitioners new to AP should replace the temptation to be over-enthusiastic with a more pragmatic approach ("let us try it in this case"). Over-enthusiasm can lead to great disappointment when failures occur.

AP, like every other attempt to fight disease, has its failures (2,15). It also can be a costly system in terms of professional time. With orthodox vet medicine, many cases can be treated by one or two visits, leaving appropriate medicines to the owner to administer when the vet has diagnosed the case. This is not applicable with AP therapy, unless the owner has a TENS instrument or Laser and is instructed in their use, or unless he/she is shown which points to massage between sessions. In chronic cases, AP therapy often requires repeated therapy sessions and these cost money. The owner should be warned of this, as some people expect miraculous cures after one or two sessions!

In many western countries, physicians and vets, especially those in the academic life, have a strong scepticism towards AP. Some are definitely prejudiced against AP. This is largely due to lack of knowledge on the types of conditions which respond to AP and to the mechanisms involved. We should discuss these topics with our colleagues when suitable opportunities arise and we should be prepared to assist them in their search for factual data and research information, should they require this.

It is very helpful to the practitioner and to those colleagues who may require clinical information to keep accurate records of all cases treated by AP. These records should contain details of the clinical examination, the diagnosis, the AP method and the APs used, any other medication used, the dates of treatment and the outcome of the case. If 20-40 vets in each country kept notes of their cases, very valuable information could be made available to their AP society as well as to their State Vet Schools after 1-2 years. I strongly urge you to organise such a study as a group.

CONCLUSIONSIntegration of AP into your practice will take time and patience. You will need to study AP well and to foster public awareness of its value and mechanisms. Explanation of AP mechanisms in terms of reflex action via the neuroendocrine system is more acceptable to academic colleagues than those based on theories of intangible, undefined Life Forces (Qi).

In your early attempts at AP, it is advisable to choose just a few conditions which interest you. Learn the approach to these in depth before you attempt to treat new conditions.

If you do not wish your clients and colleagues to know that you are attempting AP methods, you can adapt ultrasound, electrostimulation and laser therapy with little difficulty. You can also use point injection with good success. As you grow in experience, it will be better for you (and for the acceptance of AP as a valid system) if you let your clients and colleagues know that you are using the Chinese system.

Integration of AP analgesia as a routine preparation for surgery is not likely to become popular in the West. However, it may be considered in high-risk patients, shock victims and Caesarian section. The analgesia and obstetric effects of lumbosacral points in bovine dystocia and bovine prolapsed uterus require no electro-stimulation and could become routine.

A Chinese parable says: "What can a frog in a well know of the outside world?". There is a mighty universe around us! Can we see it all? Can we feel it, taste it , touch it and smell it all? Can we "weigh" (measure) the Energy of Life? I don't believe it! I believe that there are other ways of knowing reality. To grow in knowledge and skill requires study and practice. I urge you to study unorthodox as well as orthodox concepts. In particular, I urge you to read on psychic methods of diagnosis and healing and to experiment with these systems together with your orthodox methods and other therapeutic systems.

Therefore, I urge you to continue your studies, especially in areas of unorthodox concepts. Study and experiment with the area of psychic phenomena such as dowsing or divining in relation to healing. These methods are as applicable to animals as they are to humans. Some of you may possess ability in these areas. I believe that the best therapy will consist of a sound mechanical approach plus the extra benefits of the psychic approach.REFERENCESFurther details of AP are in other lectures by the author. These and other manuscripts are based on material presented in 1980 to the teaching seminar at the Veterinary College in Helsinki, organised by Jukka Kuussaari. Most have been updated since 1990.

AP is a highly integrated system whose concepts and philosophies are strange to Westerners at first. Thus, Western students of AP should read and re-read these concepts until they become familiar with them.

The lectures, listed below, cover many traditional (classical) and modern (scientific) aspects of AP and related topics. This set of lectures will help students of AP to get the "feel" for subject. They complement lectures given at IVAS, BVAS and other organised training courses on AP.

Vet or Medical colleagues are most welcome to use this material for study or teaching purposes but the author reserves copyright and does not wish others to use this material for commercial publications. All the papers starred (*) are in one publication (Acupuncture in Animals, Proc 167, 548 pp) available from The Postgraduate Committee in Veterinary Science, University of Sydney, 280 Pitt St., Sydney South, NSW, Australia 2000. Those not starred are available from the author:

1*. A brief History of AP and the Status of veterinary AP outside mainland China

2*. Effects of AP on the Defence Systems and conditions responsive to AP (1980) and AP for immune-mediated disorders (1991).

3*. The Study of AP: Points and Channels in Animals.

4*. The Study of AP: Sources and Study Techniques.

5*. Traditional versus modern AP.

6*. Holistic Concepts of Health and Disease.

7. Psychic methods of Diagnosis and Treatment in AP and Homeopathy

8*. The Theory of the Five Phases and its uses in medicine.

9*. The Choice of Points for AP Therapy (1980) and the Choice of AP Points for Particular Conditions (1984).

10*. Techniques of stimulation of the AP Points.

11*. AP analgesia for surgery in animals.

12*. Clinical AP in the horse (2 papers + appendix).

13*. AP in Cattle and Pigs.

14. AP in Small Animal Practice.

15*. Clinical Experiences with AP: Failures and Successes.

16. Physiotherapy, Homeopathy and AP in the Treatment and Prevention of Lameness and the Maintenance of peak Fitness in Horses

17*. Advances and instrumentation in the diagnosis and treatment of trigger points in human myofascial pain: veterinary implications

18. Treatment of Back Pain in the Horse and Dog by AP19*. Computer Applications in the Study and clinical Use of AP20*. Serious complications of AP... or AP abuses?

21. Clinical use of low level Laser therapy.