Alternative or complimentary medicine is becoming increasingly more accepted, available and in some cases sought after.  Examples include acupuncture, chiropractics, herbal medicine, and homeopathy.

Whether you describe these therapies as alternative or complimentary may depend on your point of view of their use. One way to look at it is if you use them in conjunction with Western veterinary medicine (WVM) then you might consider them complimentary. If you use them in place of WVM then they may be alternative.

There are obvious shortcomings to both WVM and complimentary/alternative medicine. A complimentary approach, using the two together, rather than excluding one or the other is preferable in my opinion. My clinical experience with these therapies is limited to acupuncture and chiropractics. This article will focus on acupuncture. 

History

Acupuncture has been used in human and veterinary medicine for thousands of years in China. An exact date or how the practice initiated is not known. Sharpened stone artifacts, known as Bian shi, that date to the Neolithic or even the Stone Age have been found in China, which may have been used in early acupuncture or bloodletting.1 One interesting explanation as to the origin of acupuncture was from soldiers wounded by arrows who were believed to be cured of chronic ailments that had been unresponsive to treatment. 

The practice of acupuncture spread to other countries in the region and there is also evidence of its use in Europe, possibly as ancient as its use in China. “Otzi the Iceman,” a 5,000-year-old mummified body found along the border between Austria and Italy, had groupings of tattoos that some believed were depicting acupoints.

The first major exposure of acupuncture to the United States came in the early 1970’s, specifically following President Nixon’s visit to China. As early as 1973, the Internal Revenue Service allowed acupuncture as a deductible medical expense.

The use of acupuncture in horses dates back to around 2,000-3,000 BC.4   Equine medicine and the use of acupuncture and moxibustion was the focus of one of the first veterinary texts ever written—Bai-le’s Canon of Veterinary Medicine that dates to around 650 BC.

Historically, traditional Chinese veterinary medicine (TCVM) did not use the meridian system on animals. Instead, they used a collection of 173 named points for horses. The points were later correlated to the meridian system, especially here in the West.

Theory 

The question as to how acupuncture works will most likely continue for quite some time. According to  TCVM all living things have qi. “Qi gives life to the world.”   An over-simplified way to describe qi is to think of it as energy or life force. Maintaining the balance (homeostasis)  and flow of qi is the foundation of the practice. There are several forms of qi, the two primary being yin and yang. Yin and yang are essentially opposites, but I would hesitate to describe them as positive and negative.

Pathology results from the disruptions/imbalances in the normal flow of qi, or the presence of Xie qi (pathogenic qi). By inserting needles at acupoints one may influence and restore the normal flow and balance of qi. Acupoints are loci on the body that are related to and may influence the flow of qi through the body and along meridians. Meridians, pathways through which qi flows, not only course near the surface but also run deep into the body through the specific organs for which they are named.

From a Western standpoint, the idea of a mystical energy called qi is difficult to comprehend. The notion that stimulating a subcutaneous area can influence organ function may seem a bit far-fetched. It is also difficult to perform research testing the effectiveness of  acupuncture in a manner accepted by the standards of Western scientific research. One of the major challenges is appropriately designing a negative control, or placebo group. Often times sham acupuncture ,randomly placed needles,  is employed as the negative control. However, poorly placed or misplaced needles often times still end up in or near an acupoint and may elicit some type of response. Furthermore, it is difficult to objectively assess the response. Some feel that due to the semi-invasive nature of acupuncture that the placebo effect is maximized. There are some skeptics that believe there is little, if any, scientific evidence for the use of acupuncture and that positive results are mostly from placebo effect.

Western medicine does offer up some explanation as to the pain-modifying effects of acupuncture. Acupuncture may induce a biochemical response that results in increased release of endorphins, serotonin, norepinephrine, or gamma-aminobutyric acid (the body’s own pain killers). Electroacupuncture—the use of acupuncture with a low level electrical current, has been shown to increase beta-endorphin levels while simultaneously decreasing lameness scores in experimentally induced lameness in horses.

Applications

How, when and why acupuncture may be applied depends on many things. First and foremost is the diagnosis. Without an accurate diagnosis treatment of any type will have limited results. Depending on the practitioner, and the potential diagnosis, acupuncture may be used as an adjunctive treatment to WVM or as a primary treatment. 

Acupuncture has some distinct advantages over WVM. For example, some drugs have the potential for adverse reactions, side effects, and toxicity. With acupuncture, you have the potential option of treating a condition without drugs. Also, when examining a patient for acupuncture treatment it allows one to look at a problem from a different perspective. A patient may have an unremarkable physical exam, normal biochemistry and complete blood count, yet still be apparently ill. The same patient may have evidence of pathology from a TCVM exam.

Here are some examples of  conditions where acupuncture is utilized:
- Musculoskeletal/lameness- back pain (primary or secondary), arthritis, navicular, laminitis, and various soft tissue injuries
- Gastrointestinal- non surgical colic, chronic diarrhea, post op pain and ileus, gastritis
- Reproductive- both mare and stallion issues
- Respiratory- especially immune mediated conditions but also infectious
- Neurologic- especially radial or facial nerve paralysis
- Ophthalmic- especially anterior uveitis
- Anhydrosis
- Chronic pain
- Shock

Often when I utilize acupuncture in my practice it is as an adjunctive treatment, but there are cases when I will use it as the first line of treatment. The most frequent of these being primary back pain. Back pain in the horse, both primary or secondary, is by no means rare. Using acupuncture to treat back pain that may be secondary in origin is often quite unrewarding if the concurrent limb lameness is not addressed. Therefore, before focusing therapy on the back, lameness originating in the limbs, especially the hind limb, needs to be investigated. A common source of secondary back pain originates in the hocks or stifles. Patterns of sensitivity in the horses back may also aid in the diagnosis. Despite being secondary, back pain may not be alleviated even once the primary cause of the lameness is addressed.
 
The following quote from Schoen summarizes a common situation for the use of acupuncture in my practice.
 “For instance, one may have a primary hock problem and it may be treated with an intra-articular injection. However, it may not completely resolve the entire complaint the owner has. The horse may still “not be right: or be “off.” There often times is a secondary compensation and subsequent patterns of trigger points in the back or neck that remain unresolved. Acupuncture therapy may then be used to treat the secondary sequelae of the primary hock problem quite successfully. Hence, you may then get 100% resolution of the lameness and increased client satisfaction.” 

Generally speaking acupuncture is considered quite safe with minimal side effects or complications when proper technique and sterile needles are used. Pain or irritation at the needle site is uncommon but generally short lived and resolves once the needle is removed or shortly after. Infection at the insertion site is rare. Most acupuncture needles are filiform (thin solid needles)- instead of cutting the tissue as they pass through it they squeeze in between them. Filiform needles tend to be less traumatic than hypodermic needles and drag less debris into the body. As with any type of medicine a thorough exam and history need to be taken into consideration before initiating treatment. The patient may present with a history or diagnosis that may increase the risk of complications from acupuncture.

There are cases where one should be very cautious about using acupuncture:
- In the case of a potential neoplasm or tumor acupuncture may inadvertently cause the tumor to grow or spread more rapidly.
- Areas of dermatitis or potentially infected tissue should be avoided.
- There may be an increased risk of local infection if needling is performed adjacent to a joint that has recently been injected with corticosteroids.
- A number of acupoints are in close proximity to synovial structures. Infections of synovial structures in horses can be potentially life threatening due to the severe lameness that may accompany them.
- Certain acupoints should not be used during pregnancy.
- Large/long needles- Always need to be cognizant of where the end of the needle winds up
- Extremely fractious horses-  Obvious safety risk to the practitioner but also to the patient. Theoretically tranquilizer, especially opioids, may decrease the response to acupuncture but the tradeoff is likely worth it.

There are some disadvantages to acupuncture. Acupuncture may require multiple or continued treatment for some conditions to achieve a similar end result when compared to WVM. In the case of a surgical colic or severe infection acupuncture alone is likely inadequate. 

Conditions in which treating with acupuncture alone may be contraindicated:
- Moderate to severe soft tissue injuries- tendons and ligaments have very slow turnover rate  which is a large part of the reason they heal very slowly- may be combine with regenerative medicine for better outcome
- Surgical colic- have not had a problem with acupuncture “covering up” a surgical colic
- Injuries where surgery is indicated
- Corneal ulcers
- Shock
- Infections requiring antimicrobial therapy

Expense

The cost to have your horse examined and treated with acupuncture is going to be dependent in large part on the individual performing the service. In my practice the average exam and treatment runs between $50 and $150. Time spent and whether aquapuncture or electroacupuncture are used figure on this cost. Whether acupuncture treatment is more or less expensive than WVM will be heavily influenced by the condition you are treating. Ideally the increase in cost will be offset by a better response and shorter down time.

Regulations

Performing acupuncture is considered practicing veterinary medicine in most states and may therefore only be performed by a veterinarian or under the supervision of a veterinarian. You should check with your provincial veterinary board to verify regulations. In Texas, a written statement is required stating that the owner is aware that acupuncture is considered an alternative practice and they have been informed of all other treatment options.9

I often hear people say “acupuncture has been around for thousands of years so it must work.” But if acupuncture was the answer to all medical problems western medicine would likely not have come into practice. And if Western medicine had all the answers then we would not be looking to acupuncture. The goal of any treatment, whether it be from Western medicine or traditional Chinese medicine, is to diagnose and treat the problem. Acupuncture can be safely and effectively incorporated into the treatment of most ailments affecting horses. Seldom is it necessary to exclude one or the other.

References
1. Jaggar D.  History and concepts of veterinary acupuncture. In:  Schoen AM. Ed Veterinary Acupuncture, ancient art to modern medicine, Goleta, CA:   American Veterinary Publishing Inc., 1994;5—18.
2. e.g. White, A; Ernst E (1999) Acupuncture: a Scientific Appraisal.  Elsevier Health Sciences. Pp 1.
3. Dorfer,L; Moser, M; Bahr, F; Spindler, K; Egartervigl, E; Guillen, S; Dohr, G; Kenner, T (1999). A       Medical Report from the Stone Age, The Lancet p 354
4. Schoen, A Equine Acupuncture: Incorporation into Lameness Diagnosis and Treatment Proceedings of the Annual Convention of the AAEP  2000;40:80-83
5. Hwang, Y.; Yu, C. Traditional Equine Acupuncture Atlas. In Schoen AM. Ed Veterinary Acupuncture, ancient art to modern medicine Second Ed, St. Louis, MO: Mosby Publishing, 2001;363-391
6. Xie H, Preast V, Traditional Chinese Veterinary Medicine Volume 1 Fundamental Principles, Beijing China: Jing Tang 2005, p 70
7. Ramey,D.  Acupuncture and ‘traditional Chinese medicine’ in the horse. Part 2: A scientific overview. Equine Veterinary Education April 2005 136-144
8. Xie H, Ott E.A., Colahan P, et al.   Influence of Acupuncture on Experimental Lameness in Horses. Proceedings of the Annual Convention of the AAEP 2001;41:347-357
9. Rules Pertaining to the Practice of Veterinary Medicine, Texas Administrative Code Title 22, Part 24, Rule 573.16


 

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