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Introduction to Acupuncture Techniques

Introduction to Acupuncture Techniques. Ancient Art to Modern Science. Comparison of East & West. Empirical Observations over Thousands of Years. Scientific Method & Case-Based Medicine. East. West. Technology of Medicine. Art of Medicine. Holistic View. Molecular & Organ View.

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Introduction to Acupuncture Techniques

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  1. Introduction to Acupuncture Techniques Ancient Art to Modern Science

  2. Comparison of East & West • Empirical Observations over Thousands of Years • Scientific Method & Case-Based Medicine East West • Technology of Medicine • Art of Medicine • Holistic View • Molecular & Organ View • Circular Logic • Energetic • Linear Logic • Mechanistic

  3. 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

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

  5. Bole’s Canon of Veterinary Acupuncture • Sun Yang • 659 to 621 B.C. • Bole Zhenjing

  6. Acupuncture: History Yuan-Heng’s Therapeutic Treatise of Horses • 1608 • Benyuan Yu • Benheng Yu • Veterinarian • Ming Dynasty • 1368 to 1644 Yuan Heng Liao Ma Ji

  7. 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

  8. Basic Acupuncture Techniques Stone needles: 8,000 years ago New Acupuncture Bones needles: 3,000 years ago Metal needles: 2,200 years ago Needles Gold/silver needles Electro-acupuncture Embedding Injectable AP Bamboo needles Fine needles aquapuncture & pneumo-AP Zhen-jiu Ai-jiu (moxa): moxibustion Alcohol (huo-jiu) Herbal moxibustion Needle + Moxa Fire-needling Laser therapy Magnetic therapy Infrared therapy (TDP) Moxibustion

  9. Long Nine needles (2,200 years ago) Sword Fine Pressure Arrowhead Round Sharp Round/Sharp Large

  10. 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)

  11. 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

  12. Acupuncture Needle Diameters in Gauge and Millimeters

  13. Acupuncture Needle Diameters in Gauge and Millimeters

  14. 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

  15. 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) • Length • 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

  16. How to needle an acupoint: preparation • Needle • Small animal • generally thinner • not too thin • Dog: • Size • 0.25 (#32) • Length • 13 mm (1/2’) • 25 mm (1’) • 50mm (2’): large dog • Cat: • Size • 0.25 (#32) • Length • 13 mm (1/2’)

  17. 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

  18. How to needle an acupoint: preparation • Practitioner • Sound plan of acupuncture treatment • Considered as a surgical procedure • others

  19. How to needle an acupoint: Insertion • Pressing Hand • 1. Thumbing • 2. Pinching 1 2

  20. How to needle an acupoint: Insertion • Pressing Hand • 3. Holding • 4. Stretching 3 4

  21. 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

  22. How to needle an acupoint: Insertion • Angle • Perpendicular insertion • Angular insertion • Horizontal insertion • Depth • Location • De-Qi response • Condition • Patient

  23. How to induce De-Qi • 1. Up-down thrusting • 2. Left-right twisting • 3. Flicking • 4. Scraping 1 2 4 3

  24. 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

  25. Withdrawal of a needle • Twirling • Pulling the needle out • Pressing the point after withdrawal • Pressing---tonification • No pressing ---sedation

  26. Practice needling an acupoint • Orange • a layer of paper • a ball of cotton • on self • health animal • real case

  27. Elbow, sore throat, fever, abdominal pain, vomiting, diarrhea, hypertension, seizure, conjunctivitis LI-11

  28. PC-6: over the median nerve • 2 cun above the wrist Indication: nausea, vomiting, chest pain

  29. 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

  30. 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.

  31. 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 Amplitude (intensity of stimulation): a tolerance level Frequency: Low level: pain ----> beta endorphin mediated Medium level: segmental ----> enkephalin mediated High level: internal medicine----> serotonin mediated Advantage:

  32. 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: • 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

  33. Contraindications: • 1) Weak/deficient patients • 2) Heart problems • 3) Seizure/epilepsy • 4) Tumor

  34. How to Use the Electronic Acupunctoscope • Dial the AMPLITUDEand FREQUENCYto 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 α and A β • moderate frequency F1 = 80-120 Hz • Enkalphalin release • Indications: internal medical conditions (diarrhea etc)

  35. 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

  36. 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

  37. 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.

  38. 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 • Same Channel connection. • 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 • 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

  39. 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

  40. 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

  41. 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

  42. 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

  43. 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

  44. 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

  45. 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

  46. 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

  47. 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

  48. 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

  49. 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

  50. 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

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