president’s messageveterinary acupuncture which will take place at the auditorium de sant’...
TRANSCRIPT
Inside this issue
President’s message .................... 1
A.V.A.C. Board of Directors, Regional Delegates, House of Delegates Representative for IVAS…………………………………..……...2
A.V.A.C. Ground rounds/ OVMA Conference Upcoming events ........................ 3
IVAS CONGRESS………………………4-5
Using Acupuncture and TCVM To Aid Diagnosis (by Dr LindaHamilton) ................. 6
Case Report by Dr Alix Serapiglia……………………8-14
Proceedings, Videocassettes and DVDs order form…………………15-16
Volume 16, Issue 1 Winter 2014
News and notes from the Association of Veterinary Acupuncturists of Canada
President’s message Dear AVAC members,
My best wishes for this upcoming year 2014: love, peace in your hearts and great
success with your acupuncture careers!
2014 should be an exciting and fulfilling year. Great CE events are coming
our way. It is the pulse that makes us go forward and better tune in our
acupuncture and TCM skills. The 11th Annual Canadian Oriental Medical
Symposium is coming up soon! Please reserve the following dates: March 13-16
2014, Vancouver BC. The Annual General Meeting will be held on Thursday
March 13, 2014 over lunch hour on the day of the COMS Vet talk. Also mark your
calendar for the 40th Annual International & 15th ItVAS Annual Congress on
Veterinary Acupuncture which will take place at the Auditorium de
Sant’ Appolonia, Florence Italy from September 24-27, 2014. For more
information, please visit www.ivas.org.
I would also like to congratulate our American affiliate the AAVA
(American Academy of Veterinary Acupuncture) for being admitted by the AVMA
(American Veterinary Medical Association) in the House of Delegates (HOD) as a
constituent Allied Veterinary Organization. All my respect and bravo for this great
achievement. It is a huge step for veterinary acupuncture and it gives us, other
affiliates great hope for the future.
Our website is moving along quite nicely, many thanks to Linda Hamilton
for all her help and support. Please go and visit our website at:
www.avacanada.net or www.avacanada.org and get a glimpse.
I would like to take a moment and make the following announcement:
my days as AVAC president have come to an end. It is time for me to step back
and pass on. I am pleased to announce that Dr. Linda Hamilton has gladly
accepted the position. I am convinced that she will make a solid and outstanding
president, someone in which we will trust and look up to. I am thankful to have
been part of this great journey with you all. I plan on remaining active in this
wonderful organization and give my full support to the Board.
I encourage all AVAC members to contact the office with any ideas,
suggestions or comments about continuing education, or any other aspects of
AVAC. I also strongly encourage everyone to get involved; whether it’s about
sitting on the Board of Directors, volunteering for entering a committee or help
with C.E. It is a great way to get in contact with your colleagues from all over the
country and to promote veterinary acupuncture in Canada. If you have interesting
cases you would like to share, please submit them to AVAC.
All the best to you all,
Myriam Audet dvm,cva
AVAC President
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A.V.A.C. Newsletter
PRESIDENT
Myriam AUDET, DVM
2850 St-Roch Sud
Shebrooke, Qc J1N 2T3
Tel (819) 864-6924 Fax (819) 864-7418
Email : [email protected]
PAST-PRESIDENT
Mirek HAINISH, DVM
Park Animal Hospital
1958 Burnhamthorpe Rd East
Mississauga, ON L4X 2S8
Tel work: (905) 625-5222 Fax: (905) 625-7808
Email: [email protected]
VICE-PRESIDENT
Linda HAMILTON, DVM
1438 Corydon Avenue
Winnipeg, MB R3N 0J3
Tel work: (204) 487-7738 Fax: (204) 489-7623
Email: [email protected]
EDUCATION COMMITTEE CHAIR AND SCIENTIFIC MEETING COORDINATOR Rona SHEREBRIN, DVM
Secord Animal Hospital
3271 Yonge St.
Toronto, ON M4N 2L8
Tel work: (416) 486 1700
Email: [email protected]
MEMBERS AT LARGE
Allyson MACDONALD, DVM
MacDonald Mobile Veterinary Service
464430 Rivers Rd, RR 5
Ingersoll, ON N5C 3J8
Tel work: (519) 532-5376
Email: [email protected]
MEMBERS AT LARGE
Janet KNOWLTON, DVM
417 Ferrill Crescent
Carleton Place, ON, K7C 3V4
Tel: (613) 253-2427
Email: [email protected]
A.V
.A.C
. BO
AR
D O
F D
IREC
TO
RS
REGIONAL DELEGATE COORDINATOR AND
REGIONAL DELEGATE OF QUEBEC
Myriam AUDET, DVM
Tel (819) 864-6924 Fax (819) 864-7418
Email : [email protected]
REGIONAL DELEGATE OF BRITISH COLUMBIA
Helen KWONG, DVM
Merecroft Veterinary Clinic
Unit E1-B, 465 Merecroft Road Campbell River, BC V9W 6K6 Tel work: (250) 287-2007 Fax: (250) 287-2026
Email: [email protected]
REGIONAL DELEGATE OF ONTARIO
Rona SHEREBRIN, DVM
Tel work: (416) 486 1700
Email: [email protected]
REGIONAL DELEGATE OF THE ATLANTIC
PROVINCES
Jennifer BISHOP, DVM
61 A Portland street
Dartmouth, NS B2Y 1H1
Tel work: (902) 461-0951 Fax: (902) 461-0150
Email: [email protected]
REGIONAL DELEGATE OF THE PRAIRIES
Julie SCHELL, DVM
1186 137 Avenue SE
Calgary, AB T2J 6T6
Tel work: (403) 278-1984 Fax: (403) 206-7276
Email: [email protected]
REG
ION
AL
DEL
EGA
TES
IN CHARGE OF THE ACCOUNTING
Vicki O’LEARY, DVM
252 A – Veteran’s Drive
Cormack, NL A8A 2R3
Tel work: (709) 635-8245 Fax: (709) 635-8245
Email: [email protected]
NEWSLETTER EDITOR
Janet KNOWLTON, DVM
Tel: (613) 253-2427
Email: [email protected]
ADMINITRATIVE ASSISTANT/PUBLICATION COORDINATOR
Marie-Ève BRUNET
PO Box 32497
Vaudreuil-Dorion, QC J7V 9v2
Tel: (450) 200-0782
Email: [email protected]
AD
MIN
ISTR
ATI
VE
TASK
S
HOUSE OF DELEGATES REPRESENTATIVES FOR IVAS
Myriam AUDET, DVM, Sherbrooke, QC Tel work: (819) 864-6924 Email: [email protected]
Janice CROOK, DVM, North Vancouver, BC Tel work: (604) 990-3647 Email: [email protected]
Julie SCHELL, DVM, Calgary, AB, Tel work: (403) 278-1984, Email: [email protected]
Janet KNOWLTON, DVM, Carleton Place, ON, Tel work: (613) 253-2427 Email: [email protected]
Fernando MONCAYO, DVM, Lower Sackville, NS Tel work: (902) 865-8110 Email: [email protected]
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Volume 16, Issue I
A.VA.C. HERBAL GRAND ROUNDS
OVMA Conference, Friday, Jan 31, 7:30 - 10pm
UPCOMING EVENTS...
March 6-9 2014 AAVA Annual meeting
Scottsdale Cottonwood Resort, Scottsdale AZ www.aava.org
March 13-16 2014 11th Annual Canadian Oriental Medical Symposium
Vancouver, BC www.easterncurrents.ca
March 14 2014 (lunch time) A.V.A.C. Annual general Meeting
COMS, Vancouver BC
September 24-27 2014 40th Annual International Congress
Florence, Italy www.ivas.org
Toronto, Ontario
You are invited to join in discussion with veterinarians who have training in herbal
medicine. This meeting will not have a lecture format. It is designed for all of us to bring
our challenging herbal cases and questions and present them in a informal setting to be
discussed by veterinarians who use herbal medicine day to day in their practices. The
discussions will assume a working knowledge of TCM principles, this is not meant as an
introductory course.
Present at the head table of this meeting will be:
Michelle Kinoshita; Mountain Vista Veterinary Hospital
Debbie Boyd, Grey Bruce Animal Hospital
Allyson MacDonald; MacDonald Mobile Veterinary Service
Rona Sherebrin; Secord Animal Hospital
If you are interested in joining us please email me :
Once we have established the estimated number of attendees arrangements will be made
to rent a room in the Westin Harbour Castle. Registration in the OVMA conference is not
required. We are scheduling in this time slot to make it easy for people who are already
gathered for the larger meeting. There will be no fixed cost for this event but depending on
room cost we may ask participants to throw $10 to $20 in the pot to cover room
rental. Please bring along the history on some of your challenging cases and we will work
on them together.
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A.V.A.C. Newsletter
Dr. Linda Hamilton
When someone asks me what the
best part of attending an IVAS
Congress is, I am hard pressed to
name just one thing. Seeing old
friends and meeting new ones,
hearing informative, inspiring and
passionate speakers, advanced
learning opportunities,
networking, and seeing different
parts of the world are all THE best
part of Congress. These are all the
reasons why I make the annual
IVAS congress a “must attend”
event every year.
With the congress hotel located
right in the heart of New Orleans
French Quarter it was easy to
enjoy and explore the
architecture, music, food and of
course famous Bourbon Street.
Other tourist attractions included
a tour on a Mississippi
Paddlewheel Steamboat, a
relaxing stroll through the garden
district and a Bayou boat ride on
the hunt (photos only!) for gators.
Here is a very brief overview of
just a few of the speakers at
New Orleans:
Dr. Maria Glinski: “Small Animal Rehabilitation” Reviewed by Dr. Allyson Belyea
Dr. Beebe gave a very interesting presentation on food and TCVM
therapy. She explained how different food can be use to amplify the
effect and the duration of our acupuncture treatments. It is
important to consider our TCM diagnostic when choosing the
ingredients that will be in our patient’s diet. One thing to consider is
that raw diet is not always the better choice. For example in a
condition that is Yin or Cold, it could be contraindicated. She
suggested using slow and low temperature cooking in a slow cooker
when recommending a cooked diet. Dr. Beebe helped create a “Food
Chart” which explains the effects of some of the ingredients that
were presented in the conference. Food therapy would be a great
tool for any TCVM practitioner.
Dr. Maria Glinski from the CARE Center in Aiken, South Carolina, gave a four-hours presentation on small animal rehabilitation. It was a great lecture for those of us who have not been specifically trained in animal rehab, yet find ourselves often working with musculoskeletal issues and geriatric pets with limited mobility. She outlined and educated us on the various therapeutic modalities used by rehabilitators (such as therapeutic ultrasound, electrical stimulation, laser therapy and manual techniques). Her slides on post-operative ACL massage and
rehabilitation were particularly helpful. A significant amount of time was spent on therapeutic exercise. Dr. Glinski is very involved in canine agility on the national level, and had wonderful slides and videos demonstrating particular exercises and techniques to rehabilitate injured dogs and prevent re-injury. These exercises promote strength training, flexibility, endurance and balance/proprioception. An excellent, effective core strengthener is the “beg “-- a good rationalization at mealtime!
IVAS CONGRESS
NEW ORLEANS—MAY 2013
Dr. Signe Beebe: “Traditional Chinese Veterinary Medicine (TCVM) Food Therapy” Reviewed by Dr. Valerie Trudel
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Dr. Bonnie Wright delivered a thought provoking series of talks at the opening of the IVAS conference in New Orleans. Her main thrust was to look at acupuncture from the perspective of Evidence Based Medicine: where does acupuncture fit in? Dr. Wright discussed the 5 different levels of scientific vigor with a discussion of where veterinary medicine currently stands. She also introduced the concept of Patient Outcomes assessment in veterinary medicine whereby the rituals all medical practitioners utilize may have neurobiological effects and activate healing. Dr. Wright then discussed the
mechanisms and effect of acupuncture in GI and renal disease, immune modulatory effects of acupuncture, ending with controversies surrounding surgical and non surgical approaches to back pain, paraplegia and cruciate disease in animals and human medicine. She again brought in the concept of the 5 tiers of scientific proof of validity. This lecture series provoked a lot of discussion and thought, as Dr. Wright successfully married the concept of scientific validity/proof, with pathophysiological effects and neurophysiological changes.
Dr. Schultz gave a fascinating lecture on myofascial lines and how they can relate to acupuncture meridians. Fascia is not just to be dissected, discarded and forgotten. It is deeply involved in the functional part of the locomotion system and has many molecular and architectural variations. She showed how the fascia is a continuum and does not end on each muscle, but instead is anchored at different bony attachments and then continues as a connective web to other parts of the body. Dr. Schultz also explained the term “Tensegrity”, coined by R. Buckminster Fuller. The word is a composition of “tension integrity” meaning a structure can hold its shape by a combination of tension and compression forces in balance. By using this term (sometimes referred to as Biotensegrity”) she describes how an injury to one area of the body spreads due to
tensional forces through the whole body and symptoms can show up at the body’s weakest link. Put into a TCVM concept the injury is an external excess (pain) and the weak link is an area of deficiency. She goes on to describe the different kinetic lines in horses and shows how closely related they are to the acupuncture meridians that we are familiar with. This may be one more excellent way to show our skeptical veterinary colleagues how acupuncture can work, from an anatomical point of view. Dr. Schultz continues to do research in this emerging field and it will be very exciting to hear more from her in the near future. For more information on this check out: www.fasciaresearchsociety.org (YouTube “Strolling under the Skin”)
www.anatomytrains.com (Textbook: “Anatomy Trains” by Thomas Myers)
Dr. Bonnie Wright: “Current Status of Research and Evidence as Applied to Acupuncture” “Acupuncture for Gastro-intestinal and Renal Disease” “Acupuncture for Immune Modulaiton” “Controversies in Veterinary Medicine – Surgical Vs Non-surgical Approaches” Reviewed by Dr. Jim Berry
Dr. Rikke Mark Schultz (Denmark): “Can Myofascial Kinetic Lines be an Anatomical Foundation for Acupuncture Meridians?” Reviewed by Dr. Linda Hamilton
Dr. Steve Marsden: “Pulse Diagnosis Made
Easier” (Wet Lab) Reviewed by
Dr. Julie Beaubien
Dr. Steve Marsden gave a remarkable wet-lab on pulse diagnosis. He explained his way of using the pulse as a guideline to choose points, and as a confirmation of the diagnoses and treatment. He also showed us how to use heat detection (with instruments or hands) to choose points. His way of working is simple and clear, and it will help us a lot using acupuncture easily.
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A.V.A.C. Newsletter
A TCVM evaluation was done with the following unusual findings: Tongue: darker red, thin tip, crack to very tip Pulses: HT pulse significantly weaker AP active points: -BL 13-15 very warm(Back-shu points for LU, PC and HT) -CV 14 sensitive on gentle palpation (Alarm point for HT) -HT 7 very warm to touch (HT source point) With these findings, I had a discussion with the owners regarding potential early heart disease and available non-invasive diagnostic tests (ultrasound, ECG) that could be offered locally. They were keen to have a diagnostic ultrasound of their pet’s heart and an appointment was made. At the ultrasound appointment, the referral veterinarian actually tried to dissuade the owners from having the test done because the dog was not exhibiting any classic heart disease symptoms, and the heart sounded normal on auscultation. The owners did want to continue
with the evaluation and they were prepared for any results. If no heart disease was detected, then normal findings would give them “piece of mind”. Ultrasound evaluation revealed an enlarged heart with a leaky heart valve. The primary care vet and the ultrasound vet did not think these findings warranted any pharmaceutical medications at this time. After consulting with me, their dog is now on oral Co-Enzyme Q-10 and has regular acupuncture and chiropractic “tune-ups” every few months. They report the dog is “back to normal”, does not have any foot dragging, is active, bright and has the bounce back in her step. The owners are absolutely delighted.
‘’ This is a reminder that TCVM tongue and pulse as well as acupuncture points can be used to aid in diagnosing difficult or “mystery” cases.’’
Using Acupuncture & TCVM to Aid with Diagnosis Dr. Linda Hamilton
Natural Healing Vet Care, Winnipeg, Manitoba
A 12 year old F/S Wheaton Terrier was presented for “slowing down”, dragging hind toes occasionally and “just not quite herself”. She continued to go for 1.5 hour walks twice daily but was losing the “bounce” in her step. The primary care DVM was unable to determine a diagnosis after a very thorough physical exam and complete blood work and urinalysis; DVM suspected either “old age” or a possible neurologic disease of the lumbar spinal cord. An MRI of the spinal cord was recommended however the owners did not want to have their pet anesthetized. Also, the nearest MRI machine was an 8 hour drive from their home.
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A.V.A.C. Newsletter
Case Report
2011-2012 AVAC Course Toronto, Ontario, Canada
Acupuncture used to control Equine Chronic
Recurrent Uveitis (moonblindness) in an
Appaloosa mare.
Alix Serapiglia, dvm [email protected]
At the time of the first acupuncture treatment, Chloe was asymptomatic, 2 weeks post flare-up. The right eye was smaller and presented permanent miosis from synechiae. There was presence of a small cataract. Vision in the right eye was present but diminished. There were no signs of pain or active uveitis. The left eye was enucleated. Chloe was slightly overweight with a body score of
7/9. She appeared to be generally in good health with no other abnormalities on physical exam. Chloe seemed well adapted to the loss of vision in the left eye and the owner still rides her regularly including small jumps.
Acupuncture therapy was used to successfully control the occurrence of uveitis flare ups in an Appaloosa mare following disappointing re-sults using conventional treatments alone. Success of treatment was measured by the decrease in frequency and severity of uveitis
flare ups (ocular discharge, blepharospasm, and photophobia). After three acupuncture treatments, the asymptomatic period was increased from 70 days to 120 days. Uveitis flare ups were also shorter in duration and less severe.
HISTORY
ABSTRACT
Chloe, an eight year old dark bay Appaloosa mare, developed chronic recurrent uveitis in both eyes three years ago. Flare-ups were characterised by abundant clear ocular discharge, miosis, blepharospasm and photophobia. The flare-ups were initially controlled with topical dexamethasone and atropine and oral banamine followed by oral phenylbutazone. Chloe was also on long-term low dose daily oral aspirin (1/2 aspirin bolus once daily). The owner made changes to her upkeep, Chloe wore a fly net when turned out and care was taken to minimise exposure to the elements (wind, rain, snow, dust and strong sun) at which time she was kept inside. Eighteen months later, the left eye progressively worsened and the flare ups increased in severity and frequency. Uveitis flare ups
happened on average every 2 ½ months (70 days). The left eye eventually developed a cataract and Chloe lost vision from that eye. At this point Chloe was referred to the University Equine Teaching Hospital where the left eye was enucleated and a cyclosporine Implant was placed in the right eye hoping to prevent further flare-ups. The cyclosporine implant did not have the results hoped for with no change in frequency of flare ups in the right eye. Chloe had a flare up 2 weeks post surgery and on a regular basis thereafter. At this point the owner was very discouraged and frustrated with the outcome of conventional treatments and decided to consult in acupuncture 7 months ago.
CLINICAL SIGNS AND DIAGNOSIS – Conventional (Western)
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Chloe displayed a predominantly Earth constitution (calm, bombproof and loves to eat according to the owner’s description). She was generally calm and quiet during the exam however she also occasionally displayed some signs of irritability and impatience during the acupuncture sessions (Wood/Liver unbalance). She has a very good appetite and water intake, manure and urination are all normal. Occasionally right before a uveitis flare up Chloe appears to be more lethargic (laying down more often) and may have some loss of appetite which resembles small colic episodes. These episodes resolve with minimal treatment. She does not have any temperature preferences and prefers to be outside. The owner reported that the flare-ups usually happen when Chloe has been out in the wind or if it has been very dry and dusty outside. They are also more frequent during the spring and fall. Tongue and Pulse diagnosis was not done. There were no apparent acupoint sensitivities during the exam. The Liver has its specific body opening in the eyes and through its role in the movement of Qi and Blood is the organ most directly involved in maintaining normal eye health(1). A diagnosis of
Liver Qi stagnation (2) with Liver Fire flaring up toward the eyes(3), was made based on the history of inflammatory eye disease and occasional irritability. According to the owner Wind and Heat climatic factors seem to aggravate symptoms supporting the theory of invasion of exogenous Wind Heat and upward disturbance of Heat in the Liver(4). Spring is the season associated with the Liver which also appeared to worsen the patient’s condition. A secondary diagnosis of Liver Spleen disharmony demonstrated by the mild colics, was also made.
CLINICAL SIGNS AND DIAGNOSIS – TCM (EASTERN)
TCM (EATERN) TREATMENT
The TCM treatment principles involved regulating the movement of Qi to resolve Liver stagnation as well as clearing Heat and expelling Wind to relieve ocular inflammation. Acupuncture treatment also focused on supporting the Spleen in order to maintain Liver-Spleen harmony and tempering the immune system since chronic uveitis may also have an autoimmune component. Points used to invigorate the flow of Qi and Blood as well as Fire/Heat and Wind dispelling points were chosen. A dry needle acupuncture technique was utilized using 0.30mm x 50mm Tewa non coated sterile acupuncture needles for back shu points and 0.25mm x 15mm seirin sterile acupuncture needles for points on the limbs and around the eye. An even needling technique was used at all points for 20 min. The depth of needling varied with the point being treated and the patient’s tolerance. Two sessions two weeks apart were done and a third treatment was done 2 months later.
Session 1
At the initial visit, the patient received dry needling at Baihui to relax her and help with general body pain. LI 4 and LIV 3 were used together as the Four Gates to enhance the Wind expelling action on the eyes. LI 4 was also chosen as the Master point for the Head and Face for pain in the eye, and LIV 3 for its role in promoting the flow of Liver Qi and clearing Liver Fire(5-6). Next I needled the Back Shu points bilaterally, BL 18 and BL 19 to support Liver function, BL 20 to support Spleen function and help with digestion. ST 36 was chosen as Master point for the abdomen and gastrointestinal tract and to benefit the Spleen. Local points for the right eye consisted of ST 1, BL 2, TH 23 and GB 1. LI 11 was used bilaterally to dispel Wind and Heat and for its immune properties. GB 20 was needled to dispel Wind and Heat from the eyes. Chloe tolerated the acupuncture needles well.
CONVENTIONAL (WESTERN)
TREATMENT
No new therapies were instituted during the course of the acupuncture treatment. The original treatment plan in case of uveitis flare-ups was maintained, topical dexamethasone and oral banamine 250mg SID for 3-5 days followed by oral phenylbutazone 1g BID for 7 days followed by 1g SID for 7 days. Daily oral aspirin was also continued.
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A.V.A.C. Newsletter
Session 2, two weeks later
Chloe was still asymptomatic and had had no uveitis flare up since the previous session. The own-er did not notice anything new since the first acupuncture treatment. On physical examina-tion, all was nor-mal and there were no new find-ings. The same
prescription plan as session one was used. I also de-cided to add two Ting points on the right hind foot, BL 67 to help clear Wind in the eyes and GB 44 to benefit the Liver. We planned to do another treatment in 2 months, hoping this would be just in time to prevent the usual 2 ½ month flare up. Session 3, two months after session 2
Chloe was still asymptomatic and had had no uveitis flare up since the previous session. However, the
owner noted that she felt Chloe had lost more vision from the right eye. On physical examination Chloe could still distinguish light/dark and the menace re-flex was present in the right eye. There were no signs of active uveitis, however the cataract had pro-gressed a little. The owner reported Chloe was happy and still enjoyed being ridden. She had had no colic episodes in the last 2 months, for this reason I did not use ST 36 or BL 20 at this session. The rest of the pre-scription plan remained the same as session 2. We planned another treatment session in 75 – 90 days in order to prevent another flare up. Follow-up Chloe had a small uveitis flare up (ocular discharge and blepharospasm) 1 month after the third session, which was 4 months (120 days) since her last flare up (2 weeks before the start of acupuncture treatment). This latest flare up was in the spring and there had been a lot of wind. The owner immediately started regular uveitis treatments (topical dexamethasone and oral banamine). The flare up responded very well to conventional treatment and only lasted 24h. There were no colic episodes either. The plan is to treat Chloe every 3 months with acu-puncture the goal being to maintain the time be-tween flare ups to at least every 4 months.
Table 1: Point prescription at each acupuncture session
Session 1 Baihui, LI 4, LIV 3, GB 20, BL 18, BL 19, BL 20, ST 1 right, BL 2 right, TH 23 right, GB 1 right, LI 11, ST 36
Session 2 Baihui, LI 4, LIV 3, GB 20, BL 18, BL 19, BL 20, ST 1 right, BL 2 right, TH 23 right, GB 1 right, LI 11, ST 36, BL 67, GB 44
Session 3 Baihui, LI 4, LIV 3, GB 20, BL 18, BL 19, ST 1 right, BL 2 right, TH 23 right, GB 1 right, LI 11, BL 67, GB 44
Table 1 summarizes the point prescription for each acupuncture session and Table 2 details all the acupuncture points utilized during the course of treatment.
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Volume 16, Issue I
Table 2: Point selection, location and indication for use (7)
IVAS Name Point location Nature of point Indications for use
LI4 Hegu
On the medial side of the forelimb, in the depression just palmar to the 2nd metacarpal bone and distal to its base. This would be at the level between the proximal and middle thirds of the 3rd metacarpal (cannon bone)
Masterpoint for Face and Mouth
Clears Wind and Heat When combined with LIV 3 (Four Gates) has a much more profound effect on expelling Wind from the face.
LI 11 Quchi
In the transverse cubital crease, in the depression just cranial to the lateral epicondyle of the humerus, between the extensor carpi radialis and common digital extensor mm.
Earth, Tonification and He-Sea point
Dispels Wind and Heat Immune suppression
ST 1 Cheng Qi
Superficial location is in the depression at the intersection of the medial and middle thirds of the lower eyelid, with the deeper location between the infraorbital ridge and the globe
Local point eye Expels Wind from the eye
ST 36 Zusanli
In the depression just lateral to the tibial crest, in the muscular groove between the tibialis cranialis and the long digital extensor mm., 2 cun distal to the proximal edge of the tibial crest. The direction of needl e insertion is craniolateral to caudomedial
Master point for the abdomen and gastrointestinal tract Earth, He Sea, Horary point
Benefits the Spleen function of transformation and transportation Expels Wind Enhances whole body Qi
BL 2 Zan Shu
In the depression on the supraorbital ridge, about 1/3 of the distance from the medial to the lateral canthus of the eye.
Local point eye Expels Wind Soothes the effects of Liver dysfunction on the eye
BL 18 Gan Shu
3 cun lateral to the dorsal midline, this point has 2 locations: in the 13th and 14th intercostal spaces, in the mus-cular groove between the longissimus thoracis and ili-ocostalis thoracis mm.
Back Shu point Liver
Benefits the Liver function of patency of flow of Qi. Brightens the eye
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A.V.A.C. Newsletter
IVAS Name Point location Nature of point Indications for use
BL 19 Dan Shu
3 cun lateral to the dorsal midline, in the 15th intercostal space, in the muscular groove between the longissimus thoracis and iliocostalis thoracis mm.
Back Shu point Gallbladder
Benefits the Liver function of patency of flow of Qi
BL 20 Pi Shu
3 cun lateral to the dorsal midline, in the 17th intercostal space, in the muscular groove between the longissimus thoracis and iliocostalis thoracis mm.
Back Shu point Spleen
Benefits the Spleen function of transformation and transportation
BL 67 Zhi Yin
On the plantarolateral aspect of the rear hoof, in the depression just proximal to the coronary band, approximately 2/3 the distance from the dorsal midline of the coronary band to the plantar border of the lateral bulb of the heel.
Ting point Eliminates Wind Clears the eyes
TH 23 Si Zhu Kong
On the supraorbital ridge, in the depression approximately 2/3 of the distance from the medial to lateral canthus of the eye.
Local point eye Expels Wind Benefits the eyes
GB 1 Tong Zi Liad
Just caudal to the lateral canthus of the eye, in the depression just lateral to the bony orbit overlying the orbicularis oculi m. and the zygomatic process of the temporal bone.
Local point eye Benefits the eye Expels Wind Heat Clears Fire
GB 20 Feng Chi
In the depression just cranial to the wing of the atlas, dorsomedial to the combined tendons of the cleidomastoideus and longissimus capitis m, and caudal to the cervicoauricularis medius m.
Local point Dispels Wind and Heat Subdues Liver Yang Improves eyesight (2)
GB 44
On the dorsolateral aspect of the rear hoof, in the depression just proximal to the coronary band, approximately 1/3 the distance from the dorsal midline of the coronary band to the plantar border of the lateral bulb of the heel.
Ting point Benefits the eyes Subdues Liver Yang
LIV 3 Tai Chong
On the medial aspect of the hindlimb, in the depression just plantar to the 2nd metatarsal bone and distal to its base. This would be at the level between the proximal and middle thirds of the metatarsal (cannon) bone.
Source point Expels Wind Clears Liver Fire Promotes flow of Liver Qi. When combined with LI 4 (Four Gates) has a much more profound effect on expelling Wind from the face.
Baihui In the depression on the dorsal midline in the lumbosacral space
Calming Wind pattern (8)
Table 2: Point selection, location and indication for use (7)
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Volume 16, Issue I
DISCUSSION
The patient in this report, an eight year old Appaloosa mare, was presented with chronic recurrent uveitis in the right eye minimally responsive to conventional treatment (cyclosporine implant and control of uveitis flare ups with topical dexamethasone and oral anti-inflammatories). The patient was diagnosed three years ago and has since lost the left eye from an enucleation and the uveitis in the right eye is still regularly active. The owners were disappointed with the outcome of the cysclosporine implant in the right eye which had no change on the frequency or severity of uveitis flare ups. At the time of acupuncture consultation, the patient was asymptomatic and had no signs of active uveitis. The owner also reported that the patient was prone to mild colic symptoms especially before flare-ups. From a TCM point of view, based on the history and clinical findings, the patient was diagnosed with Liver Qi and Blood stagnation allowing Liver Fire to rise in the eyes. Eye health is directly associated with Liver Blood and the Liver is particularly sensitive to Fire/Heat and Wind invasion. Inflammation of the eye is viewed in TCM theory as invasion of exogenous Wind Heat and upward disturbance of Heat in the Liver. Stagnation of Qi and Blood then occurs in the Liver(4). The fact that the episodes are worse in the spring, the season of Wood and Liver, also supports the fact that this is a Liver function issue. Recurrent Uveitis is a painful condition characterized by excessive inflammation and an exaggerated immune response. These are symptoms of Liver Fire.(2) There were no exterior signs of Fire at the time of examination since the patient was asymptomatic. Fire/Heat and Wind pathogenic factors injure the Liver, drying up the Blood and causing Blood deficiency leading to Liver stagnation. The Liver is unable to provide the cornea with ample amounts of blood resulting in uveitis. Liver Heat accumulates and rises up to escape through the Liver’s opening, the eyes. The role of the Liver is to store Blood and govern the flowing and spreading of Qi (controls the movement of Qi). When Liver function is impaired, the Spleen is the first to feel the stagnation through the control (ko) cycle (Wood - (LIV and GB) controls Earth – (SP and ST)). When the Liver is no longer able to move the Qi smoothly, the Spleen’s ability to transform food into
Fundamental Substances becomes compromised since the movement of Qi is the engine of transformation. As a result, less Blood is produced by the Spleen and the Liver stagnates even more(1). This is called Liver Spleen Disharmony and can be seen in our patient by the occasional irritability and the mild colic episodes. Chloe is also of Earth constitution making it all the more easy for the Wood element to invade the Earth element. The goal of acupuncture treatment was first to eliminate Fire/Heat and relieve Liver stagnation by moving Qi and secondly restore harmony between Liver and Spleen by tonifying the Spleen, nourishing Blood and moving Qi. Baihui was the first point needled in all sessions and was used to relax the patient at the start of acupuncture and was also useful for general Wind patterns in the body(2). LI 4 and LIV 3 were used together as the Four Gates to expel Wind from the face and to resolve Liver Qi stagnation. Together these four points enhance the circulation of Qi and Blood in the body which is what is needed to relieve the stagnation in the Liver. LI 4 was also used as the Master Point for the face and mouth to help with the uveitis in the right eye. LIV 3 is the Source point for the Liver and is used to clear Heat from the Liver and soothe Liver Qi. ST 1, BL 2, TH23, and GB1 were used as local points to dispel Heat and Wind from the right eye. I chose Back Shu points as these points are important to influence the organ function in chronic cases(9). They are especially valuable to transport energy to their respective associated Zang-Fu Organs and therefore help balance and regulate the flow of Qi throughout the body(10). In the patient’s case, Liver and Spleen Back Shu points were indicated; BL 18 for eye problems and to move stagnant Qi and BL 20 for the digestive upsets (colic). By tonifying these two organs I was also looking to harmonize the two. I added BL 19, Back Shu for the Gallbladder for its role in supporting the Liver. LI 11 and GB 20 are both important points to dispel Wind and Heat. LI 11 was also chosen for its role in immunosuppression(7). Chronic Uveitis cases are usually aggravated by the body’s exaggerated autoimmune response.
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A.V.A.C. Newsletter
REFERENCES 1. Marsden S, Overview of Chinese Medical Physiology and Pathology, AVAC Course Notes 2011-2012, Module 1, p. 58-59
2. Xie H, Preast V, Xie’s Veterinary Acupuncture, Blackwell Publishing, 2007 First Edition, 312-313
3. Schoen A, Veterinary Acupuncture, Ancient Art to Modern Medicine, Mosby 2001, p.487
4. Crisman M, The Application of Acupuncture in Equine Internal Medical Disorders, AVAC Course Notes 2011-2012, Module 3, p.72-74
5. Glinski M, Acupuncture Points, Image, Location, Function and Indications, AVAC Course Notes 2011-2012, p. 165
6. May K, Equine Acupuncture Acupuncture Points and Meridian, AVAC Course Notes 2011-2012, Module 1, p 270
7. May K, Equine Acupuncture Acupuncture Points and Meridian, AVAC Course Notes 2011-2012, Module 1, p 235-279
8. Xie H, Preast V, Xie’s Veterinary Acupuncture, Blackwell Publishing, 2007 First Edition, p. 101
9. Bierman N, Immunology, AVAC Course Notes 2011-2012, Module 3, p.193
10. Zidonis N, Snow A, Soderberg M, Equine Acupressure A Working Manual, Tallgrass Publishers, 1999, p. 56
11. Smith M, TCM Diagnosis and Patterns, AVAC Course Notes 2011-2012, Module 2, p.41
12. Zidonis N, Snow A, Soderberg M, Equine Acupressure A Working Manual, Tallgrass Publishers, 1999, p.72
13. Zidonis N, Snow A, Soderberg M, Equine Acupressure A Working Manual, Tallgrass Publishers, 1999, p.148
The mild colic episodes were addressed as a symptom of Liver-Spleen disharmony, Liver stagnation flowing back injuring the Spleen and causing digestive issues. To treat this I used ST 36 as Master point for the abdo-men and gastrointestinal tract. Stimulation of this point benefits digestion and also helps to rebalance the immune system. ST 36 is also a general Qi tonic(11). Once the digestive tract appeared to have regained its normal balanced state after Session 2, ST 36 and BL 20 were discontinued. Two Ting points were added at the second session, BL 67, a good distal point to clear Wind from the eyes and GB 44 used to subdue Liver Yang and benefit the eyes. Ting points are very powerful treatment points in horses(12). They are the Jing Well points on the meridians and in the case of BL 67 and GB 44, they are the last points of the meridian. The patient responded well to acupuncture and the treatment was considered a success by the fact that
acupuncture therapy was able to almost double the asymptomatic period between uveitis flare-ups (from 70 days to 120 days), as well as decrease the severity and duration of each flare up. It also harmonized the patient’s digestive system. The owner is extremely satisfied with the results obtained with acupuncture. The patient is still being treated with acupuncture every 3 months, with flare ups every 4 months, and it is my hope we can increase the time between treatments at least to every 4 months and gradually increase the asymptomatic period. Given the poor response to aggressive conventional treatment (cysclosporine implant and topical and oral anti-inflammatories) in this case, I believe acupuncture can be successfully utilized as an adjunctive treatment modality in controlling Equine Recurrent Uveitis alongside conventional therapy.
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Volume 16, Issue I
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