What Is Acupuncture?

Two types of acupuncture predominate within the veterinary profession: (1) medical (or scientific) acupuncture and (2) traditional Chinese veterinary medicine (TCVM). Medical acupuncture requires extensive familiarity with neuroanatomy. TCVM, on the other hand, relies on metaphorical and metaphysical constructs, together with the primitive, folkloric, and unvalidated assessments of tongue and pulse diagnosis.

It would be wrong to assume that either style of acupuncture practiced in North America resembles that of early China during the time some claim veterinary acupuncture began, in the tenth century, BCE.2,3 Early acupuncture embodied a system of bloodletting and involved large, cutting instruments. Other arcane Chinese methods of cauterizing the skin with branding irons or burning it with smoldering herbs (direct moxibustion) have no home outside of China because they risk unnecessary tissue trauma, discomfort, and nerve injury.⁴

Although similar techniques are practiced in China still today, Western sensibilities and medical advances have created a gentler, less invasive repertoire of stimulation methods. Today, acupuncturists in the West typically treat their patients with fine, filiform needles specially designed to minimize pain and cellular disruption. Electroacupuncture, that is, a method of passing low amplitude electric current between acupuncture needles in the tissue has become a popular means of augmenting treatment effects. It is generally safe if delivered in accordance with electroacupuncture guidelines.

Early Recognition of the Neural Basis of Acupuncture

Although the ancient Chinese described the effects of acupuncture in metaphoric, agrarian terminology, they were often referring to the somatovisceral and somato-somatic reflexes they witnessed. Even in China, however, the realization that acupuncture worked because the needles influenced nerves started to surface in the middle of the twentieth century. Finally, in the 1970s, reports began filtering into Western journals showing that acupuncture works via the nervous system.5–20 In 1972, the Peking Acupuncture Anesthesia Coordinating Group reported that “about half of the known acupuncture points are located right over various nerves, and the rest are within half a centimeter of one or another nerve. From this, the conclusion was drawn that acupuncture acts, in fact, on the nervous system, and it is through a nerve that the stimulus produced by needling or applying a mild electric current is transmitted to a certain part or organ of the body where it effects a cure or brings about a state of analgesia.”²¹

At about that time, articles linking acupuncture and the autonomic nervous system reached the veterinary medical literature.¹⁵ Over the ensuing decade, recognition of the interrelationship between acupuncture and the nervous system strengthened further.¹⁶ In 2004, Kothbauer clearly outlined the relationship between acupuncture points and nerves in his review of steps toward anatomic verification of point locations in cattle.⁸

Kothbauer understood that neurologic connections in the thoracolumbar spinal cord adjoin nerves feeding acupuncture points on the body wall and sympathetic pathways. This insight explains how one might influence internal organ function by stimulating paraspinal points such as the Back Shu points along the Bladder channel. However, because incoming signals from the viscera diverge to numerous adjacent spinal cord segments, several authors have advocated treating several spinal segments at one time. This translates, in acupuncture terminology, to selecting multiple Bladder points along the back that cover two, three, or four vertebral segments. Furthermore, because anatomic differences exist in vertebral formulas between humans and quadrupeds, the exact placement of points on the human back to points on the camelid requires further study.

How Acupuncture Works: From Somatic Afferent Fibers to the Brain

In very simple terms, acupuncture begins as an afferent signal initiated near the needling site that travels centripetally into the central nervous system (CNS). Propagated neural information courses along the neurovascular routes comprising the acupuncture channels. These action potentials converge on spinal cord and brainstem centers within the CNS.¹¹ Some impulses arriving at the cord may (1) send efferent signals back out to the periphery (leading to antidromic activation of free nerve endings at the site of needling), (2) loop into related visceral neural networks and alter internal organ function in a spinal segmental manner, (3) foster endogenous opioid release in the dorsal horn of the spinal cord to reduce spinal facilitation, or “wind-up,” and block pain, or (4) proceed to higher centers in the brain, altering neuroendocrine activities, limbic system functions, and the conscious recognition of pain.

Note that if acupuncture worked by moving energy and not by nerves as so many unfortunately still believe, its effects would continue regardless of neural health or integrity. However, partial neurologic injuries cause the needling effects to diminish or disappear, depending on the locus of the lesion.²² Acupuncture has no effect in the face of complete denervation.

In fact, the neural basis of acupuncture is so clear that some authors have replaced the conventional alphanumeric naming system of acupuncture points and channels with names referencing the relevant nerves, not remote and possibly irrelevant organs.²³ As early as 1974, Dr. Patrick Wall, the co-developer of the gate control theory, felt that a new classification system based on acupuncture points and nerves was overdue.²⁴

Structural Facts about Acupuncture Point Anatomy

Medical acupuncturists understand that acupuncture points are merely locations along nerve pathways. When stimulated, these regions inspire neurophysiologic changes within the patient leading to functional restoration, homeostatic regulation, and pain relief. These normalizing influences caused by acupuncture are called “neuromodulation.”

The process of selecting points for treatment depends on the patient’s problem and avenues that invoke effective neuromodulation. For example, needling points around a painful joint augment regional circulation, venous drainage, muscle relaxation, and analgesia. Adding points along associated spinal nerve routes (i.e., along the Bladder channel) and peripheral nerve pathways associated with sensation, autonomic control, and motor function further dampens pain transmission. Nonspecific, homeostatic points such as Stomach 36 (ST36) squelch pain and counter inflammation predominantly through autonomic neuromodulation and opioidergic effects.²⁵

A general grouping of points with similar structure–function relationships and clinical properties are listed in Box 54-1.

Physiologic Influences of Acupuncture Stimulation

Acupuncture needles inserted into tissue and twisted tug on somatic and autonomic nerve afferent fibers housed within the connective tissue. Electrotherapy applied to the needles enhances the neurophysiologic responses and often augments treatment benefits.

Physiologic consequences (including changes in blood flow) from acupuncture stimulation depend on the types of somatic afferent fibers involved.²⁶ The frequency of stimulation, whether delivered manually or electrically, may also differentially excite various groups of somatic afferents, resulting in different outcomes in autonomic reflex responses.²⁶ Insufficient afferent stimulation fails to deliver the desired effect.²⁷

In addition to treating pain and neuromusculoskeletal impairments, acupuncture may influence visceral function via spinal segmental interneuronal activation. As indicated previously, points located longitudinally in paraspinal regions (along the Bladder channel) stimulate the dorsal primary rami of the spinal nerve roots, which then affect spinal cord segments that are simultaneously overseeing visceral sympathetic drive. Because somatic and visceral inputs converge via common interneurons, stimulation of these loci influence and transmit feedback pertaining to internal organ function.²⁸ This explains how nonsurgical colic or ileus responds to acupuncture along the back. Points on the pelvic limb are important to regulate intestinal motility also, as explored next.

Additional Opportunities for Somatoautonomic Regulation via Acupuncture

A key pathway involved in regulating gastrointestinal (GI) motility and supervising other organs’ neural activities is the nucleus tractus solitarius (NTS). The NTS, a major visceral sensory nucleus in the brainstem, receives input from both somatic and visceral sources, including the heart, lungs, digestive tract, baroreceptors, and chemoreceptors. General and special visceral afferent fibers arising from cranial nerves III, VII, and X also converge onto the NTS.

The NTS integrates the myriad incoming signals and responds with efferent volleys sent to numerous end organs, including the gut. The NTS alters gastric function by modulating output from the dorsal motor nucleus of the vagus (DMNV), which, together with the NTS, comprises the dorsal vagal complex (DVC). The plasticity of responses generated by intimate neuronal communications between the NTS and the DMNV allow the body to closely regulate digestive and other processes through their control over widespread autonomic activities. Why acupuncture points for colic and other GI problems occur on the face and the pelvic limb (ST36) becomes clear if the linkages between the trigeminal nerve and the DVC as well as the peroneal nerve and the DVC are considered.

By accurately defining nerves and nerve characteristics typical of human acupuncture points, researchers in veterinary acupuncture anatomy are well armed to move forward with a systematic reexamination of the entire veterinary acupuncture transpositional point system to improve needling accuracy and treatment outcomes.

How Camelid Acupuncture Differs from That in Other Species

The route to reproducible and effective neuromodulation (or acupuncture treatment) is selection and stimulation of the appropriate nerves (or acupuncture points) that produce the intended healing effect.13,29–33 Thus, the variability in veterinary acupuncture point locations throughout recorded history leads to confusion and uneven treatment outcomes. Much more information has become available for equine acupuncture as opposed to that for camelids, which raises even more questions about their truly transpositional locations. As Ramey wrote, “Animal acupuncture points have been derived from Chinese point drawings as well as from transposing one or more systems of human acupuncture points onto animal anatomy. Published charts of supposed traditional and transpositional points in horses have failed to agree on a single point of association.”³⁴

Little has been written about camelid acupuncture, in particular, and as a result, veterinary acupuncturists extrapolate needling techniques from other more commonly treated species such as the horse. Diagrams illustrating acupuncture points and channels on camelids are difficult to find and often out of date, originating long before the veterinary profession took to transposing the elaborate point system from humans to nonhuman anatomy.³⁵ Performing acupuncture on camelids differs from treating other species not only because of the unique behaviors of camelids but also because of the thickness of their skin, which means that clinicians need to make modifications in their needling technique.

Acupuncture in the Camelid

Since the mechanisms of acupuncture have been discussed previously, this portion of the text will deal with specific situations in which acupuncture, aided by manual therapy and other conventional therapies, may be beneficial. Camelids, in general, are excellent acupuncture patients, as they are “good responders.” They tolerate needling well, except in the legs, usually below the carpus and tarsus. They seem to be very sensitive to needling, so I prefer the silicone coated smaller needles (0.3 millimeters [mm] ×30 mm and smaller). Longer needles are often used only to aid in locating them in the fiber. When needling camelids, it is best to use moderate restraint, only controlling their movement but not forcefully holding them. Electroacupuncture and aquapuncture have not shown consistently to be of any further benefit than dry needling in the camelid. (Electroacupuncture is most beneficial in dealing with neurologic disorders such as facial paralysis or spinal cord injury). Length of time of each needling session is, as in any other species, dependent on the animal’s tolerance and the objective of the therapy. Stimulation of the needles may be done throughout the session by gently spinning them periodically, wrapping the underlying tissue around the needle shaft, stimulating the myofascial planes. The needles should be spun in both directions to prevent the tissue from being wrapped tightly around the needle, resulting in a stuck needle. All this depends on the animal’s tolerance of the needles and needle stimulation. The acupuncture session should be a relaxed and quiet period, not a battle. Frequency of needling is not unlike other species and will vary from once or twice a week to three times the first 2 weeks then monthly as needed to maintain the effect.

Acupuncture and manual therapy may be used in many situations in camelid practice. Some of the most common utilizations of these modalities include musculoskeletal issues and subluxation (for the most part with good success), including degenerative joint disease (DJD), nerve injury or paralysis, back pain, muscle pain, trigger point therapy, lameness, and tendon injuries; gastrointestinal issues, including (variable results, most good depending on etiology) diarrhea, ileus, nonsurgical colic, chronic colic, and inflammatory bowel disease. One of the most upcoming uses of complementary therapies is their use in reproductive performance.

Other areas in which acupuncture has been used in the camelid include, but are not limited to, skin disease, atopy or allergies, hives, wound healing, and indurated wounds; reproductive issues such as irregular heat cycles, uterine fluid retention, ovulation, cystic corpus luteum, poor libido, poor semen quality; urinary disease; renal disease; and some respiratory issues.

Anatomic Considerations in Camelid Acupuncture

Prior to providing any type of complementary care, including acupuncture and manual therapy in the camelid, it is important to understand that some important anatomic differences exist in this species, making them unique and confusing with point transposition and placement. The most common issue often making acupuncture difficult in this species is the presence of the thick fiber that covers the entire body sparing only the ventrum. The fiber is 3 to 8 inches thick, making it difficult to perform palpation for exact identification of points and placement of needles at specific sites. The fiber not only serves as a protective barrier against predators and environmental issues but also protects the skin from easy access to acupuncture sites, making palpation and location of points difficult. The fiber in its length and density often serves as a site of lost or misplaced needles, which is always a concern when acupuncturing this species. Another obstacle in acupuncturing camelids is their skin. It is thick and dense, and often calluslike areas exist, as on the carpus, lateral stifles, and ventral thorax, making needle placement and insertion difficult. Deep needle placement is rarely required in the camelid. Even though the skin is thick and dense, underlying tissues are thin, giving rise to organ injury if deep needling is done. Knowing the anatomy of this species is very important prior to needling areas over organs such as the Bladder channel and points that are located around the thorax. Deep needle placement may result in organ injury or penetration of the thorax, both of which are contraindicated.

Once the fiber is separated and the skin is identified, evaluated, and palpated, the acupuncturist must remember the anatomic vertebral pattern. The vertebral pattern in the llama and the alpaca is C7, T12, L7, S5, Ca16-20, with the spinal cord ending at the level of S2. Transposition of acupuncture points in the camelid is challenging, since their anatomic make-up is similar to that of dogs, cats, ruminates, and humans, all mixed together. Anatomic characteristics of each of the above species can be recognized in the anatomy of the camelid, making consistency in transposition of points difficult. It should again be stressed that much work still needs to be done to clearly identify the acupuncture points in the camelid. The points described in this text have been successful in many situations in camelid practice. In most situations, when evaluating and acupuncturing the vertebral points, the classic method is to transpose the canine points and adding to that, the classic points related to the ruminant described primarily by Kothbauer.

The forelimb in the alpaca and llama is very similar to that in other ungulates in which the ulna is fused to the radius. The carpal bones are anatomically identified as a proximal row and a distal row, as they are in other species, with the proximal row containing accessory, radial, intermediate, and ulnar carpal bones. The distal row contains the second, third, and fourth carpal bones. Metacarpal bones three and four are fused most commonly proximately in the adult. The phalanges of the toes are one, two, and three of digits three and four.

The pelvic region is the same as in other species, consisting of the lumbosacral junction, sacroiliac joints, the ileum, the ischium, and the sacrum. The rear legs are similar to other species in the femur, tibia, fibula, and patella. The patella contains a single patellar ligament transposing points as in the canine. The tarsal bones consist of a proximal row with tibial tarsal (talus) and fibular tarsal (calcaneus) bones, and a middle row with central tarsal bone, and a distal row with the first, second, third, and fourth tarsal bones. Metatarsal bones three and four are fused proximally. The phalanges of the rear limb are the same as those of the forelimb. The anatomy of the distal foot of the forelimb and hindlimb are very challenging for needle placement and tranpositional points. Two digits are present on each foot. A soft cornified pad is present on the palmar and plantar aspects of the foot. The angulation of the distal digits P1and P2 is 45degrees, with P1 essentially horizontal to the ground being the walking surface. The toe nails or claws are most commonly not a weight-bearing surface and are similar to the nail in the canine.

As this anatomic review stresses, transposition of acupuncture points in the camelid is difficult. The use of command points, the points below the carpus and the tarsus, is very difficult for not only this reason but also explains the difficulty in needling the points in the legs of the camelid. The camelid’s legs are very sensitive, so the camelid is protective of this area, making needling them in the nonsedated or neurologically sound camelid difficult at best. Often lower limb points are best used in those paralyzed or paretic animals. Ting points have not truly been identified as yet, and points used around P3 and the nail can best be explained as local points stimulating the distal nerves of the limb.

Even with the anatomic variations and concerns with regard to transposition of points in the camelid, complementary care, specifically acupuncture and manual therapy (chiropractic, osteopathy, physical therapy, myofascial work) are becoming important therapeutic modalities in the care of these animals, especially in the area of pain, reproduction, GI ileus, and nerve dysfunction as seen in facial and peripheral paralysis. These modalities are already being used extensively in treating many situations in equine, avian, and small animal medicine and surgery. Acupuncture and manual therapy techniques are often being utilized as part of a routine examination of camelids, especially in cases that are difficult to diagnose. The examination is being utilized for the purpose of diagnostics as well as therapeutics. The examination utilizes soft tissue palpation and joint manipulation in an attempt to isolate pain and the lack of normal function that may lead to loss of performance, pain, or reproductive status. Acupuncture, manual therapy techniques, or both are then applied to the animal in an attempt to regain normal neurologic function aiding overall body and joint health.

As in all veterinary patients, acupuncture and manual therapy techniques are best utilized as complementary care modalities used in conjunction with conventional therapies. Their popularity and use are increasing as a secondary, adjunctive therapy, especially in complicated medical or surgical cases, in economically challenging situations, or in chronic nonresponsive conventional patients as in those with chronic arthritic pain. The most common tranpositional points in the camelid similar to those of other species are listed in Box 54-2.

Diagnostic Acupuncture (Myofascial or Manual Therapy) Examination in the Camelid

DAPE is a method to isolate trigger points and specific regions of pain or loss of motion, which often helps identify areas of referred pain or pathology in the veterinary patient. DAPE is a palpation technique derived from a Japanese approach to acupuncture, which emphasizes palpation of tissue to diagnose organ, joint, or muscle loss of function that often results in inflammation and pain. It also functions to identify local tissue swelling, pain, changes in texture, heat, and lack of motion. These types of findings are often associated with and identified as segmental dysfunction (SDF). SDF is a chiropractic term used to refer to a possible subluxation and pathology of a vertebral segment affecting motion of the vertebral segment and thus function. This type of vertebral body, articular, pathology or lack of normal motion may result in local pain as well as referred pain to muscle, skin, myofascial planes, and organs and may result in overwhelming sympathetic input leading to wind-up (activation of N-methyl-D-aspartate [NMDA] receptors). DAPE utilizes pressure, palpation, and touch of over 200 diagnostic acupuncture points for reactivity. This examination, which is an accumulation of input from many veterinary acupuncturists throughout the acupuncture community, often reveals a problem elsewhere in the body that may lead to further in-depth conventional workups. An example of this would be cervical radiography to evaluate SDF or loss of motion in the facets. It is important when utilizing this examination not to diagnose issues from one reactive point. It is important to put together the entire clinical picture, including history, presenting complaint, physical findings, lameness examination, and an accumulation of reactive diagnostic acupuncture points. The advantages of utilizing this type of examination, in addition to an in-depth conventional examination, are its ease of performance; ability to do complete body palpation, evaluation, and identification of trigger points; diagnosis of SDF; motion palpation; and low cost. DAPE is safe and quick and provides possible further insight into the camelid’s condition.

DAPE is being utilized in camelid practice to aid in the diagnosis of disease or is used to identify regions of pain. These painful regions identified may be secondary to pain elsewhere in the body, that is, it may be referred pain. As an example, if BL-13, is a painful or sensitive (Ah Shi) point, which is located between the longissimus and iliocostalis muscles bilaterally at the third intercostal space in the camelid, it may be painful for numerous reasons. These reasons include local trauma to the area, pain associated with wither issues (T-1-T6), ipsilateral hock issues, lung disease, rib bruising, and local trigger points. Another example is the identification of a trigger point that is in or near the deltoid region. This point is between the long and lateral head of the triceps at or near an acupuncture point SI-9. This may indicate local shoulder pain or pathology associated with lumbosacral pain, sacroiliac pain, coxofemoral dysfunction or pain, or pelvic or sacral pain. This point is very commonly reactive and pathologic in camelids with osteoarthritis in the coxofemoral, sacroiliac, or lumbosacral joint. Without treatment of this trigger point, the camelid may never respond to conventional medical approaches as expected. These are classically the patients that continue to be in pain or are nonresponders to nonsteroidal medications. By putting together a puzzle of painful regions, with DAPE, often it is possible to focus on more subtle issues of pain or loss of motion and correct these issues via conventional therapies or acupuncture and manual therapy. This chapter includes examples of DAPE points and examination protocols. Much investigative work still needs to be done in the camelid to further evaluate the neurology involved in many of these points. The points listed in this chapter are those extrapolated from other species and are derived from the work of many other veterinarians. The success of DAPE in the camelid is based on a good conventional workup and serves as a guideline for pinpointing other or related pathologies.

DAPE is based on identifying painful or reactive points or regions of the body via palpation, and this leads the examiner to further diagnostics or treatment protocols. The etiology behind the reactive acupuncture point is multifactorial. Joint subluxation or restricted motion may lead to inflammation, pain, or loss of muscle strength and efficiency. Loss of muscle strength around the joint may lead to joint instability that often results in a progressive, chronic, or recurring injury and pain. Trigger points may be associated with joint instability but, on many occasions, may be a separate entity not related to joint instability or altered function. Because of this, if trigger points are not addressed, they may lead to treatment failure. Trigger points and trigger point therapy are being utilized more commonly in the camelid with pain and are becoming part of a routine diagnostic and therapeutic modality. Trigger points are best recognized by palpation of a hard band or bump in the muscle belly. A trigger point is defined as a “hyperactive point within a taut band or bump in a muscle belly or fascia that is painful on compression and that can give rise to a characteristic referred pain, tenderness, motor dysfunction, and autonomic phenomena.” The etiology of a trigger point is not completely understood but is thought to be associated with excess release of acetylcholine from dysfunctional motor end plates, abnormally contracting regions of the motor end plate or muscle tissue, and spontaneous electrical activity of the muscle with uncontrollable muscle shortening. Some of the most common locations of trigger points in the camelid are triceps brachii, infra- and supraspinatus deltoids, extensor carpi radialis, trapezius, brachiocephalicus, gluteus medius, iliocostalis lumborum, longissimus, multifidus, quadriceps femoris, semitendinosus-membranosus, psoas major, iliacus, iliopsoas, and biceps femoris. The most common joints affected by loss or restricted motion include cervical vertebra, T1-T6, T12-L7, SI joints, L-S, scapula, and sacrum.

It is rare to make a diagnosis from one reactive point. All the sensitive points of DAPE must be put together to focus on areas of concern. A reactive or diagnostic point is defined as an acupuncture point that is reactive or painful, with no more than 3 pounds (lb) of pressure resulting in the painful or reactive response. The exception to this is a trigger point that can be located within any muscle, not particularly at an acupuncture point. Trigger points are often extremely painful, sensitive, and need to be evaluated and treated along with other findings. A reactive point must be repeatable with a sliding motion as well as direct pressure. A reactive point has the characteristics of a muscle spasm or fasciculation at the point of pressure. It may also be observed as a behavioral change such as tail swishing, spitting, kicking, rearing, and collapse or minor changes in standing such as walking away. It is, however, important not to confuse this with a normal panniculus response. A panniculus response is most commonly noted as a muscle, skin fasciculation cranial from the point of pressure and does not appear to be painful. The examination is best done in the camelid by using hands and fingers. In other species, a blunt object such as a needle hub is often used. In the camelid, these objects often give rise to hard-to-interpret results and are not advised. Smooth, uniform, sweeping pressure is first applied, followed by direct pressure as needed. A pressure algometer can record the amount of pressure applied to a 1 cm × 1 cm point. By using an algometer and recording this measurable reading of pressure required to create sensitivity, a quantitative means of evaluating with DAPE is achieved. It also gives the evaluator the ability to perform recheck examinations and evaluate possible improvement of a reactive point. The instrument is used mostly in human chiropractic medicine, but some veterinarians are using it routinely in their examinations on the equine. I prefer to use this instrument, whenever possible, for a quantitative form of record keeping.

The ultimate goal of DAPE is to identify areas of pathology in the body and then to apply appropriate therapy in an attempt to restore normal motion in a joint or muscle or restore the normal function of an organ. Therapy may involve means of repeated motion palpation, acupuncture, and osteopathic or chiropractic manipulation. Trigger points must be identified, isolated, and treated by direct pressure over the sensitive area or by needling the trigger point itself. This must be done with care, as they are often very painful and the patient may react in an unfavorable manner to either modality of treatment. When approaching a hyperactive trigger point, it is advisable to place needles around the point a minimum of 3 cm away from the lesion before placing a needle into the point. The needles around the point should be allowed to be in place for 5 to 10 minutes before continuing therapy.

Manual therapy is a term that is used to include chiropractic, osteopathy, massage, and physical therapy. It is a means of manipulating and stimulating receptors in the body and a means of identifying areas or sites of pain or body dysfunction. Most joint injuries are secondary to a failure of the soft tissue of the supporting structures. These supporting structures are most commonly the muscles surrounding a joint. For optimal muscle health, the muscle must have motion through active neurostimulation, glucose, and oxygen. Manual therapy is a means of maintaining good joint and muscle health through stimulation of the mechanoreceptors as well as muscle spindle cells. Efficiency of a joint is dependent on the efficiency of the muscles that support it. The health or efficiency of the muscle is dependent on the frequency of firing of the motor neuron supply to that muscle. The frequency of firing of the motor neurons is dependent on the summation of neural influences in a multimodal system. This summation of neural influences is then dependent on the spinal cord reflexes, brain, and integration of sensory input from the environment. Receptors that both acupuncture and manual therapy target are nociceptors (A-δ, C-fibers). A-delta fibers are very small, slow, slightly myelinated nerves that carry sharp pain. A-δ fibers are responsible for the “De Qi,” a term used in Chinese medicine, which means muscle myofascial contraction or fasciculation upon stimulation via a needle or manipulation. Mechanoreceptors are those receptors that transduce the somatic sensation regarding touch, joint position, and vibratory sensation to the CNS. These sensations are carried to the dorsal horn of the spinal column through large-diameter myelinated fibers 1A and 1B, which are very fast fibers, which is the basis for the gate control theory of pain control. The gate control theory states that by eliciting stimulation of the very fast myelinated 1A and 1B neurons as well as the α-motor neuron, their arrival at the spinal segment, before the slower, harder-to-stimulate nociceptors A-δ and C-fibers do, may dampen the perception of pain. In summary, it is the summation of all excitatory and inhibitory influences on the motor neuron that will determine its frequency of firing and thus its strength.

Motion palpation is the main means of identifying lack of normality or presence of pathology in the acupuncture and manual therapy examination. It is a means of diagnosing pathology as well as treating dysfunction. It is important that we, as complementary and alternative veterinary caregivers, understand the importance of palpation of subtle changes in motion of a joint and surrounding tissue as well as changes in texture or temperature and palpation of small focal regions of pain. Without understanding the neurology involved, evaluation of DAPE can be misleading at best. Gentle palpation of the camelid’s entire body allows for the location of specifically described acupuncture points, allowing treatment of the problem via acupuncture, manual therapy, or both. Often the camelid or other species may not present for acute or chronic lameness or undetermined pain but may just be “off” or have a drop in attitude, “just not itself.” This is when the art of palpation must be used.

Prognosis in alternative therapies is often difficult to determine. The entire clinical picture has to be put together: severity of the pathology, acute versus chronic bony involvement, and DJD lesions. The prognosis in alternative therapies is much like that of conventional medicine. With soft tissue involvement, restricted motion through partial subluxation of a joint, and loss of strength of the surrounding soft tissue, the prognosis is usually good. This may be evaluated often in a few weeks. If no significant change or improvement is observed after three treatments, prognosis or response to treatment has to be guarded, and reevaluation of the patient, both with the conventional medical approach and the alternative approach, is important. Often reevaluation of the patient is best achieved by repeating DAPE and comparing results.

Box 54-3 lists a few of the diagnostic acupuncture points being utilized in the camelid. Those in bold print type are those points that have good repeatability and tend to be more reliable.

Box 54-3   Diagnostic Acupuncture Points in the Camelid

Cardiac disease: (pericarditis, endocarditis, myocardial dysfunction)

• Sensitive points include: BL-13, BL-14, BL-15, ST-10, 11, PC-1, CV-14, and CV-17.

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