AP Techniques

8/13/2019 AP Techniques

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Introduction to AcupunctureTechniques

Ancient Art to Modern

Science


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Comparison of East & West

Empirical

Observations overThousands of Years

Scientific Method &

Case-BasedMedicine

East West

Art of Medicine

Holistic View Circular Logic Energetic

Technology ofMedicine

Molecular & OrganView

Linear Logic

Mechanistic


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Science versus Art

Over the last 10

years, there has been

no change in mean

life expectancy inhuman beings, dog or

cats

There is an increase

in incidence of

inflammatory

diseases and cancerover our ability to

detect the conditions


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Sun YangAlias Bole

Veterinarian

Qinmugong period

659 B.C. to 621 B.C.

Bole Zhen-j ing

Acupuncture: History


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Boles Canon of Veterinary

Acupuncture

Sun Yang

659 to 621 B.C.

Bole Zhenjing


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Acupuncture: History

1608

Benyuan Yu

Benheng Yu Veterinarian

Ming Dynasty

1368 to 1644

Yuan Heng Liao Ma Ji

Yuan-Hengs Therapeutic Treatise of Horses


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Basic Tenets of AP

Based upon the AP

point selected

Based upon the

method of stimulation Dry needles

Electrical AP

Aquapuncture

Hemoacupuncture

Based upon thelength of stimulation

Low-rate, twistingstimulation of GV26 leadsto endorphin response,while high-frequencyneedling of GV26 leads to

epinephrine response


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Zhen-jiu

Needles

Moxibustion

Bones needles: 3,000 years ago

Metal needles: 2,200 years ago

Gold/silver needles

Bamboo needles

Stone needles: 8,000 years ago

Fine needles

Ai-jiu (moxa): moxibustion

Alcohol (huo-jiu)

Herbal moxibustion

Needle + Moxa

Fire-needling

New Acupuncture

Basic Acupuncture Techniques

Electro-acupuncture

Embedding

Injectable AP

Laser therapy

Magnetic therapy

Infrared therapy (TDP)

aquapuncture &

pneumo-AP


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Arrowhead needle

Sharp needle

Sword needleRound needle

sharp needle

To drain abscesses

To bleed superficial vessels(TCM Surgical tools)

Acupressure (Not penetrate the skin)Round needlesPressure needles

Fine or FiliformLong/Large needles

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


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Gauge Millimeters Application40 0.15 Hand/feet Needle

38 0.16

Baby needle36 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


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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, limbs50 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

Acupuncture Needle Diameters in Gauge

and Millimeters


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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


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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


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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)


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Animal

quiet

relaxed (house call benefit)

Restrained if needed (nose

twisted), but not

sedation/tranquilized

The site of acupoints

nice and clean


preparation


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preparation

Practitioner

Sound plan of

acupuncture treatment

Considered as a

surgical procedure

others


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Pressing Hand

1. Thumbing

2. Pinching


Insertion

1

2


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Pressing Hand

3. Holding

4. Stretching


Insertion

3

4


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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


Insertion


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Angle Perpendicular

insertion

Angular insertion

Horizontal insertion

Depth

Location

De-Qi response

Condition

Patient


Insertion


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How to induce De-Qi

1. Up-down

thrusting

2. Left-right twisting

3. Flicking

4. Scraping

1

2

3 4


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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


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Withdrawal of a needle

Twirling

Pulling the needle out

Pressing the point after withdrawal Pressing---tonification

No pressing ---sedation


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Practice needling an acupoint

Orange a layer of

paper

a ball of cotton on self

health animal

real case


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LI-11

Elbow, sore throat, fever,

abdominal pain, vomiting,

diarrhea, hypertension,

seizure, conjunctivitis


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PC-6: over the median nerve 2 cun above the wrist

Indication: nausea, vomiting,

chest pain


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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


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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.


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Advantage:

1) More effective

2) Less treatments

3) Fewer acupoints

4) Save labor to manipulate the needles (Classically, theneedles 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 ----> dynorphin mediated

High level: internal medicine----> serotonin mediated

Dynorphins


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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

Methods:

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) radialc) others

3) Gastrointestinal conditions: vomiting,

diarrhea, constipation, indigestion

4) Muscle atrophy

Indications:


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Contraindications:

1) Weak/deficient patients

2) Heart problems

3) Seizure/epilepsy 4) Tumor


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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)


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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 andF2 =120

Indications: nerve paralysis and internal

medical conditions


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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


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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.


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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


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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


points


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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 thetumor mass

Caution for seizure dogs when using EA


points


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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 notavailable 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


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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


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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

Patients own blood


1 - 15 ml each point for large animals

0.1 - 1 ml each point in small animals


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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


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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


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Hemoacupuncture

Indications: Blood Stagnation

Blood Heat

Excess Heat

Contraindications and cautions:

Weak and debilitated animals

Qior/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


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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


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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


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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


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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 withsome pores

Moxa + Needling

L A t


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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 woundhealing

cannot penetrate accurately and deeply into most acupuncturepoints 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 thinintegument

Avian: skin is generally very thin

Lie Que(Lung 7)

Jing-well points.


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Infrared Acupuncture

Radiation heat (moxibustion)

250 W infrared bulb

TDP lamps (Teding Diancipo Pu):

Heat a metal plate constructed from numerousmineral substrates

Developed in Chong-qing, China in the 1980s.

Indication Bi syndrome Wound

Caution: avoiding too hot.


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Origin: tip of ear

Human auriculotherapy

Germany 1950s China

Diagnosis

Treatment

Canine ear points

Diagnosis

Treatment

Auriculotherapy


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Other Acupuncture techniques

Cupping

Tui-na (massage and

chiropractic)

Scalp acupuncture

Microwaveacupuncture


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How to Approach AP Patient

Take history, do exam &

make pattern diagnosis

Start with Dry Needles

10-15 needles unlessstrong or weak

Treat 15-30 minutes

Follow with B-12

aguapuncture

5-8 points


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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


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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 myselfand the Universe.

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AP Techniques