Veterinary Acupuncture Book From Philip Rogers

HOLISTIC CONCEPTS OF HEALTH AND DISEASE

SUMMARY In Western holistic concepts, disease seldom arises from a single cause. Three or more factors in combination may be needed for the dis-ease to become manifest. These factors upset the balance between the external and internal environments and overload the capacity of the adaptive mechanisms. In Chinese concepts, dis-ease occurs when the balance of the vital energy (Qi) in the acupuncture (AP) Channels2 is disturbed. This arises as a result of external or internal insults overcoming the body's defences. Chinese and unorthodox concepts recognise many more forces which can cause dis-ease (and many more ways of controlling dis-ease) than are recognised by orthodox science. There is considerable agreement between progressive, holistic Western concepts and ancient Chinese concepts of dis-ease. In both philosophies, any dietary, medical, physical, psychological or other treatment which restores the balance of Qi or the balance between the external and internal environments will automatically restore health. The exception is in cases where irreparable damage has occurred, for instance, death of nerve cells, inoperable malignant cancer, extensive fibrosis of the liver or kidneys etc, or where physical damage renders self-healing impossible (for instance in tuberculous spinal injury, severe dislocation of joints etc). Theorem: the BODY HEALS ITSELF by its own defence/adaptation mechanisms. Medicines, surgery, acupuncture etc do not cure disease! Implications: a. Orthodox and unorthodox medicine may help the organism to heal itself and to adapt to its new reality. (This is the best therapy). b. Orthodox and unorthodox medicine may suppress the symptoms/remove dis-eased organs or functions. (This is inferior therapy). c. Orthodox and unorthodox medicine may fail to help the patient, due to incorrect understanding of the case or because the defence mechanisms can not be activated sufficiently. (This is useless "therapy"). INTRODUCTION A dictionary-definition of holism is: "A philosophical theory according to which a fundamental feature of nature is the existence of wholes which are more than the composite assembly of the parts and which always tend to become more highly developed and complex". A transcendant element is inferred, i.e. something greater than the sum of the parts. A poet's definition of mysticism is: "Man's dialogue with God, Man-in-the-world-and-why" (Brendan Kennelly 1983).

By definition, a holistic concepts involve all possible component parts, how they interact (fit together), how they fit into the larger plan of Nature and (in the end) an artistic-intuitive search for aspects of the transcendant immaterial blueprint which religious people call God or atheistic physicists see as the infinite interchange of matter and energy. Holism and holistic concepts of health, disease and medicine contain elements of scientific medicine, art, poetry and mysticism. Mechanistic materialistic medicine has blind spots. It tends to label "Man-who-dialogueswith-God" as duped, irrational or mad. It tends to look on "Man-in-the-World" through halfblind eyes. It does not recognise transcendant "Whys". Ancient Chinese medical philosophy states that "Man stands between Heaven and Earth." In modern concepts, this can be translated as: "The organism is the product of (embodies the characteristics of) Heaven (spirit, mind, non-material forces) and Earth (food, physical environment, material forces)." This can also be translated as: "The organism is influenced by spiritual, psychic arid non-earthly forces (cosmic, solar, lunar forces) as well as forces in its immediate environment (nutrition, climate, electro- magnetic and geophysical forces)". Other factors which influence the organism include hereditary influences and the internal environment (emotions, neuroendocrine system). Health in man and animal may be defined as harmony within the internal environment and with the external environment. The organism has adapted successfully to stimuli from its internal and external environment and can carry on its natural functions in a variable (changing) world. Thus, health is not an absolute state. It is a relative state which depends on the environment. For instance, it might not be healthy (normal) for men to have a heart rate of 84 and a PCV of 57 in Holland, but for men living high up in the Andes or in Mexico City these could be normal, healthy values. Dis-ease arises when there is disharmony or imbalance/maladaptation between the internal and external environment, or within the internal environment. Dis-ease seldom arises from a single cause. A combination of three or more factors may be needed for the dis-ease to become manifest. The combination overloads the body's adaptive (homeostatic) mechanisms. It follows that dis-ease may be treated by removing the causes singly or in combination and/or by enhancing the adaptive/homeostatic mechanisms. Holistic medicine, including acupuncture (AP) and homoeopathy, must be seen against this holistic (unified) theory of health and dis-ease. AP is only one modality among many which can be used to help the adaptive mechanisms. Other forms of therapy which work in the same direction will usually complement the effects of AP. Whatever can be done to remove the causes or to neutralise them will increase the probability of cure. The concepts which will be discussed now are based mainly on concepts of human health and dis-ease but many of them apply also to animals. YIN-YANG, DUALITY, RELATIVITY Thousands of years before the Bible spoke of Good and Evil, the Chinese developed the concepts of duality and relativity. To them, nothing was absolute, but was a mixture of opposing forces, Yin (the passive or negative force) and Yang (the active or positive force).

"Yin and Yang are the source of creation and the cause of destruction of all things": Chinese concepts of Yin and Yang were essential, fundamental parts of this world view. The YinYang principle referred to opposites. Everything in creation has its opposite. Yin-Yang referred to female-male, below-above, earth-heaven, passive-active, front-back, dark-bright, etc. The totally balanced system has equal amounts or Yin and Yang. Neither could exist in isolation, (i.e.) there is always some Yin in Yang and some Yang in Yin. Each was necessary for the other (interdependence) yet each opposed the other (inter-opposition). Balance or equilibrium was maintained by the mutual antagonism, yet mutual dependence of opposing forces. For example, for life to exist (as we know it on our planet) we need a balance of sunlight and darkness. If there was perpetual sunlight or perpetual darkness, life on the planet would cease. Similarly, in the family there must be Yin and Yang. If both husband and wife are Yang (active, bossy) there are family arguments, and if both are Yin (passive, inactive the marriage will be dull, apathetic and uncreative. Either way, the lack of balance (antagonism between Yin and Yang) leads to poor family life. On the other hand, the male (Yang) may have some Yin characteristics (gentleness, laziness) and the female (Yin) may have some Yang characteristics (strong-mindedness, creativity). If the Yin-Yang balance is maintained, the marriage (unity) can be very stable. This concept of Yin-Yang was applied to everything in Chinese life - art, politics, philosophy, medicine, architecture, etc. In medicine, Yin-Yang referred to hypo-hyper states, solid organshollow organs, female genitalia-male genitalia etc. Chronic dis-eases were Yin, acute diseases were Yang, etc. Table 1 shows some other examples of Yin-Yang. Table 1. Examples of Yin and Yang (states of relative opposition) Yin Water Ice Cold Female Passive Dark Material Solid Yang Fire Steam Hot Male Active Bright Immaterial Gas Yin Slow Centripetal Precipitation Winter Night Downwards Inner Yang Fast Centrifugal Evaporation Summer Day Upwards Outer Yin Solid organs LU SP HT KI PC LV CV Below waist Dorsal Medial lower Yang Hollow organs LI ST SI BL TH GB GV Above waist Ventral Lateral upper Yin Inhibition Relaxation Hypo- (deficient) Chronic Cold Moon Yang Excitation Contraction Hyper- (excess) Acute Hot Sun Yin Parasympathetic Diastole Flaccid Yang Sympathetic Systole Erect CHANGE, RHYTHMS, CYCLES The concept of CHANGE is fundamental to Chinese thought. Everything in existence must change in a ceaseless cycle of anabolism (building up) and catabolism (breaking down). Nothing is permanent. All great civilizations were aware of the rhythms and cycles in nature:

a. the seasonal cycle b. the lunar and tidal cycle c. the mating-birth-growth-death cycle (d) the sexual (menstrual and male) cycles. We have the activity-rest, the day-night cycles, sunspot cycles, political cycles. Internal (diurnal) cycles include the cardiac cycle (systole-diastole), respiratory cycle, hormone secretion cycle etc. All of life and nature follows cyclic patterns. Yin-Yang concepts imply continuous transformation, change and movement. Nothing is static. Day must become night. Winter must become Summer, (i.e.) Yin reaches a limit and transforms into Yang. Yang reaches a limit and transforms into Yin. Substance (Yin) transforms into function (Yang) and function transforms into substance. The Monad or wheel symbolises the cycle: endless and beginningless revolution. Within the Monad, we see the Yin-Yang symbol also. Yin changes to Yang and Yang changes to Yin in a changing, yet changeless cycle. Thus, mountains become flat land and flat land becomes mountains. Rock becomes sand and sand becomes rock. Thus, tears and laughter are opposite yet essential parts of the same whole. RELATIVITY: Yin and Yang are seen as relative states. Summer is Yang relative to winter (Yin) but a cold, wet summer is Yin relative to a normal summer and a warm, dry winter is Yang relative to a normal winter. The head is Yang relative to the chest (Yin), but the chest is Yang relative to the feet (Yin). In the male (Yang) childhood, adulthood and old age are relatively Yin, Yang and Yin respectively. In the female (Yin) childhood, adulthood and old age are relatively Yang, Yin and Yang respectively. BALANCE AND TRANSFORMATION: Yin or Yang can not exist in isolation. They need each other and they change into each other. The circle is complete, without beginning, middle or end. If there is no day, there is no night. If there is no excitation, there is no inhibition. The balance of Yin-Yang is a dynamic, changing state. There is seldom exact balance, with equal amounts of Yin and Yang. For instance in Summer, daylight exceeds darkness (Yang is predominant) but in Winter, darkness exceeds daylight (Yin is predominant). Equal amounts of Yin and Yang (night and day) occurs only at the equinoxes (March 2lst and September 23rd). The limits of Yin and Yang are seen, for example at the Winter solstice (December 2lst) when Yin is maximal (relative to Yang) and Summer solstice (June 2lst) when Yang is maximal. This transformation of Yin to Yang and Yang to Yin is a natural, universal phenomenon. It is natural for Yin to predominate at certain times and Yang to predominate at other times, in dynamic cycles. WESTERN EXAMPLES OF DUALITY: In modern medical and scientific concepts, the idea of duality and relativity is accepted easily. We know that homeostasis in the body is maintained by mutually antagonistic yet mutually dependent systems. For instance, health requires the balance (harmony) of Yin-Yang : sleep-wakefulness; flexor muscles-extensor muscles; parasympathetic-sympathetic systems; feedback-feedforward systems; inhibitoractivator; relaxation-contraction; sensory-motor systems; corpus luteum-follicle; calcitoninparathyroid hormone; receptor-ligand etc. We also know that an excess or deficiency of any one of these can lead to imbalance in the system. In time, this may lead to dis-ease.

Thus, the Chinese concept of Yin-Yang is not as incomprehensible as it may seem at first glance. It is similar to western ideas of duality-relativity. But it preceded our concept and use of binary theory (the idea of on-off, as used in modern computers) by thousands of years. Indeed, those who appreciate the beautiful symmetry of Chinese Yin-Yang philosophy have no difficulty in accepting the probability of advanced concepts in physics and astronomy etc such as ; gravity-antigravity; matter-antimatter; expanding space-black holes; time-negative time. INTERDEPENDENCE, INTERACTIONS IN THE BODY There was a story about the relative importance of the organs. They were arguing among themselves: "I am the most important", said the brain. "I do all the thinking, make all the decisions and control the lot of you!". "Not at all", said the heart. "I am more important because I keep you alive by pumping blood, oxygen and glucose up to you and I take away all your waste for disposal!". "Hold on!" said the liver. "I am the most important. I am responsible for glucogenesis and detoxification. Without me, both of you would be in trouble!". "Bull-shit!", growled the stomach. "Without me, you three would starve to death!". The argument grew fierce. The spleen, lungs, gallbladder, bones, muscles et al all had their spake. Meanwhile, the anus (which had not said a word) got fed up with all the arguing and ballyhoo. Muttering "I'll show them who is boss!", it seized up tight and said nothing (kept its mouth shut). After a few days of severe constipation, colic and toxaemia set in. The stomach lost its appetite, the liver was unable to cope with the toxins, the heart went into failure and the brain began to grow faint. At the last moment, the brain screamed to the anus: "All right, you win!". The anus relaxed and all was well3 . Although moral of the original joke was: "Don't underestimate an Ass-Hole!", there is an obvious moral for clinicians also. There is interdependence and interaction between the organs, functions, and emotions of the body. We saw earlier that the Chinese regarded man as a unity of Yin-Yang in body-spirit. Psychosomatic medicine also sees man as a unity of mind (spirit) and soma. Thus, interactions between these components of the organism influence the health (balance) of the organism. Psyche influences Soma and Soma influences Psyche. Those who ignore this reality have a very incomplete view of factors influencing health. In vet medicine, it would appear that the animal psyche plays a less important role in dis-ease than the psyche in human medicine. Nevertheless, the animal psyche is important and can be harnessed in many practical ways, as any experienced animal handler knows. The psyche (and psychic energy) of the therapist can (and should) be focused to help/love and beam compassion into the psyche of the willing patient, animal or human. The Chinese were aware of the unity of the psyche-soma and of the interdependence of the organs and emotions. Disorders of the heart may influence the kidneys and lungs, and viceversa. Disorder of the liver-gallbladder may influence the stomach. Chinese medical philosophy developed a complete schema of interdependence between the organs in the Five Phase Cycle. The Five Phase Theory and its uses in medicine are discussed in another paper, to which the reader is referred.

INTERACTIONS WITH EXTERNAL ENVIRONMENT The organism does not exist in isolation. All living organisms survive by a process of adaptation to their external (and internal) environments. Those who can not adapt successfully must suffer as a result. The organism acts upon and is influenced by natural forces in its external environment. Environmental factors are not often considered but are very important nonetheless. They include Cosmic, Solar and Lunar forces, climatic changes, electromagnetic fields, geographical conditions and geophysical fields. (In a later section, we will examine other external factors). The effects of cosmic and solar forces on animal health are poorly defined. Effects of the moon on health include a tendency to haemorrhage during new and full moon. Surgical complications are less likely to arise if major surgery is avoided for a few days before and after new and full moon. Many years ago, Harold Burr, USA, recorded the electrical potentials of trees, day after day for many years. He found a cyclical change in potentials related to moon phase, day v night and sunspot activity. Maximum DC electrical potentials occurred at new and full moon; in daytime; and at peak sunspot activity. Minimum potentials occurred at quarter and threequarter moon phase; at night and at minimum sunspot activity. He found similar changes in electrical potentials in humans. Robert Becker (Veterans Administration Hospital, Syracuse, New York) and others have reported that people are more irritable at new and full moon and that violent crimes (rape, murder, assault, suicide) and admissions to psychiatric hospitals are more common at these times. The English word lunatic is derived from the Latin luna (Moon) and tic (fit, convulsion). Epileptic fits, convulsions and hallucinations are more likely to arise at these times also. I am unaware of published work on the effects of the full and new moon on animal dis-ease, but I suspect that neuromuscular disorders such as convulsions in dogs and grass (hypomagnesaemic) tetany in cows may be more common at these times also. Geophysical forces: For thousands of years, in all civilisations, certain people claimed to be able to find water under the ground, using instruments like Y sticks (divining rods) pendulums, etc. When the diviner passes across underground streams, an involuntary muscular contraction causes the instrument to react. The diviner tries to locate exactly the course of the stream. He then tries to find the place where one or more other streams intersect (usually at different depths). The hole for the well is sunk at this point. Diviners explain this phenomenon by claiming that the water, running in fissures in the underground rocks, creates a distortion in the magnetic field above the fissure. The body of the diviner reacts as a biosensor to this alteration by an involuntary muscular contraction. (See the paper on psychic methods of diagnosis and therapy in AP and homoeopathy). Diviners in Europe, Australia, Africa and America have reported that many dis-eases in man and animals are associated with strong reactive points over these streams. Insomnia, arthritis rheumatism, asthma and cancer have been associated with these places. Where cattle or other animals are confined to a stall or pen directly over these geophysical reaction points, chronic disorders can arise, such as poor growth, chronic ketosis and infertility. Orthodox treatment is often unsuccessful in these cases. If, however, the animals are moved to a stall/pen which is free of reactive points, the condition usually disappears quickly.

Electromagnetic Fields (EMF): It is known that many species are extremely sensitive to weak EMFs. Some cases of chronic dis-ease may be associated with these EMFs such as those created by high-voltage cables , electric cables underground, electrical equipment (electric blankets, TV and VDU screens etc. Other electro-magnetic and gravitational influences include eclipses, planetary alignments, thunder-storms etc. Effects of climate: Exposure to cold, damp weather when animals are turned out to pasture in the Spring are often associated with outbreaks of grass tetany and muscular degeneration (white muscle dis-ease, associated with selenium deficiency). There is evidence that cattle can sometimes eat large amounts of ergot (Claviceps purpurea) with no effects if they are warm and dry. If, however, the weather is very cold and the lower limbs are wet or freezing (as in cold, damp cow-sheds in winter) severe outbreaks of ergotism (gangrene of the limbs etc) can follow. Effects of diet and food-sensitivity/intolerance: The diet is one of most obvious environmental factors affecting animal health. Deficiencies or imbalances in total intake of dry matter, its energy, protein, mineral and vitamin status, are well studied and need no further comment. The diet may also influence health if it contains plant, organic or inorganic poisons. In man, the role of masked (hidden) allergies to common feedstuffs, drugs, contact and inhalant-allergens has been recognised only in recent years. Many chronic dis-eases are associated with a hypersensitivity or intolerance, hidden allergy to common foods etc (Randolph; Mackarness; Coca; Breneman). Diagnosis of masked allergy is based on systematic elimination of specific items from the diet or the environment of the patient for a period of 8-14 days or so. Then the patient is challenged orally, sublingually or nasally with each suspect food, etc in single tests. If a violent reaction occurs within 0-2 hours after challenge, the food etc is eliminated completely from the diet. Following this, the health of the patient improves dramatically. The role of these masked allergies in animal dis-ease is not yet as well established as in human dis-eases. INTERACTIONS BETWEEN EXTERNAL AND INTERNAL ENVIRONMENT Signals or stimuli from the external environment are transmitted to the internal environment in many ways. The sensory nervous system transmits stimuli of touch, taste, smell, sight and hearing. These signals are transmitted to the spinal cord and, via the ascending tracts, to the brain and higher centres. Sensory input may activate segmental, intersegmental and supraspinal reflexes. It may also activate the autonomic nervous system and the hypothalamus-pituitary etc. The role of the nervous system and the endocrine system in adaptation responses is well discussed by other authors (4, 14). External stimuli and internal sensory stimuli may reach the internal environment by another route, the PRIMITIVE NERVOUS SYSTEM of Becker and his colleagues in New York. They postulated the existence of two systems which can transmit information in the body : (a) the neuroendocrine system as already described, and (b) a slow acting non-nervous system analogous to the primitive nervous system of plants and lower animals. This Primitive Nervous System acts by sensing alterations in the electrical potentials at the skin5 and in damaged organs and tissues. The DC current of injury is transmitted along planes of low electrical impedance (the AP Channels) and is boosted (amplified) at the AP points. This system switches on when injury grossly alters the normal electrical potential. When healing occurs, the electrical potentials return to normal and switch off the system.

The ancients, mystics and many moderns accept that humans and animals have a psychic (sixth) sense. By Yin-Yang philosophy that sense implies a psychic transmission force also. These are the bases of telepathy, divination, telekinesis, kinaesthesia, prayer-healing, spells, incantations, symbolic healing rituals, magic (black- and white-) etc. In spite of the ridicule of many scientists, telepathy, telepathic diagnosis and telepathic healing or injury (voodoo, black-magic) are realities for many people (see the paper on Psychic Methods of Diagnosis and Treatment in AP and homoeopathy). The Chinese name for the AP point (Xue) means "hole". The Chinese have claimed for centuries that influences such as heat, damp, cold, dryness, wind and physical injury can gain direct access to the body via the "body holes" (the AP points). Electro-magnetic forces may gain entry through the "leaky holes" in the same way, as the AP points are characterised as zones of high DC potential/low electrical resistance. We know that lightning tends to strike in certain places which have low electrical resistance. (Diviners claim that all lightning strikes at strong geophysical reactive points, low-resistance "holes" in the earth). AP points may attract EMF and external signals in the same way as a lightning conductor attracts lightning. The skin and mucous membranes are the interfaces between the external and internal environment; the AP points are the "leaky places" on the skin, which connect the external and internal environments. The AP system is also said to connect all the organs and body parts with each other, via planes of higher electrical permeability/lower impedance. CHINESE CONCEPTS OF HEALTH AND DISEASE The Chinese concept of Qi represents the vital life force. All living things contain Qi. Balance of Qi in the body maintains health. Imbalance of Qi (excess Yin or excess Yang, deficient Yin or deficient Yang) causes ill-health. Absence of Qi occurs at death. Qi is obtained from the lungs (oxygen, air) and the food (nutrients). It circulates to every cell in the body, via the Channel-Organ System (COS) and blood stream. Qi interacts with genetic influences, immunity to infections and non- specific resistance to trauma, poisons and dis-ease, autonomic balance and hormone balance. If the degree of insult disturbs the balance of Qi, dis-ease results. See diagram: DISEASE (+) HEALTH (-) DISEASE External insults: Trauma, dietary imbalance, allergies, infection, parasitism, poisons, pollution, stresses, cosmic, solar, lunar, EMF, geophysical- forces, climatic changes. Internal insults: Genetic susceptibility, uncontrolled emotions; auto-immune diseases, autonomic and hormonal disturbance, reflex effects of injury. The life energy (Qi) has its Yin and Yang aspects, seen as the typical energy in the Yin and Yang Channels. Dis-ease arises when the Qi is disturbed by any deficiency, excess or blockage of Yin or Yang energy in the Channel-Organ System (COS). Abnormality is a relative state caused by a poor adaptation to internal or external changes, associated with an abnormal excess or deficiency of energy in one or more Channels. a. Excess Yin will consume (weaken) Yang. Deficient Yang will allow a relative excess of Yin. In both cases, there is a relative net excess of Yin. This causes Yin (Cold) Syndromes. b. Excess Yang will consume (weaken) Yin. Deficient

Yin will allow a relative excess of Yang. In both cases there is a relative net excess of Yang. This causes Yang (Hot) Syndromes. c. Excess of Yin or excess of Yang causes conditions known as Shi (excess) Syndromes. d. Deficiency of Yin or deficiency of Yang causes conditions known as Xu (deficiency) Syndromes. Chinese combinations allow 4 main Syndromes Cold Shi, Cold Xu, Hot Shi and Hot Xu Syndromes. In Shi (excess) Syndromes, the body resistance (anti-pathogenic defence systems) are relatively normal and the cause of dis-ease is usually external. In Xu (deficiency) Syndromes, body resistance is relatively weak, and the dis-ease has usually gained the interior and is more serious. AP therapy is different for Shi and Xu Syndromes. In the Shi (excess) Syndromes, a sedation technique (Xie) is used (In Shi, use Xie). In the Xu (deficiency) Syndromes, a tonification technique (Bu) is used (In Xu, use Bu). These are discussed in other papers (Five Phase Theory and its Use in Medicine and Techniques of Stimulation of the AP Points) to which the reader is referred. WESTERN CONCEPTS OF HEALTH AND DISEASE In a given case, the cause of dis-ease (the insult) may appear to be simple. For instance, a herd of cattle may show depigmentation of the coat, enteritis, abortion/stillbirth /neonatal deaths and infertility. Blood tests may show severe copper deficiency. One may be tempted to assume that copper deficiency is the main cause, or the only cause. However, further examination may show that infection and parasitism are involved also and the role of these may not be appreciated fully. If very detailed investigation were done, other factors (for instance excess of iron, molybdenum, lead or zinc and stress factors) may also be present. In practice, herd supplementation with copper salts could restore health and fertility. If, however, the other factors were corrected singly or together, the same good result could be obtained even without copper supplementation. Similarly, outbreaks of infectious dis-ease in young calves (enteritis, pneumonia, septicaemia, oomphalitis, etc) may suggest very heavy bacterial challenge as the main cause. On further examination, however, it may be found that the herd is deficient in trace-minerals (Cu, Co, Se, Zn) which are essential to herd immunity. Control of the "infectious disease" in these cases may be achieved by adequate supplementation of the calves with the correct traceelements. Prevention, in subsequent years, is based on supplementation of the pregnant cows, so that the calves are born with adequate trace-mineral status and the dams' colostrum is adequate in antibody. Of course, improvement in the housing and hygiene on the farm will also help. CONCLUSION The best chance for healing or cure depends on:  

a. recognition that the organism is influenced by many more forces than orthodox concepts consider; b. removing or alleviating as many causal factors as possible and/or



c. stimulating the defence systems or homeostatic- adaptive systems of the body.

It follows that many conditions respond to a wide variety of treatments, singly or in combination. These treatments include orthodox medical or surgical methods, physiotherapy, desensitisation to allergens, alteration of diet or lifestyle, relaxation therapy, hypnosis, psychiatric care etc. AP is extremely valuable in stimulating the adaptive mechanisms. This will be discussed in another paper (AP for immunomediated disorders). Unorthodox therapies, such as homeopathy, cytotherapy, chiropractic, osteopathy, "neutralising" geophysical forces, radiaesthesia, laying on of hands etc may also be effective in man and animals but the absence of controlled studies has limited their acceptance and their use. FURTHER READING MATERIAL 1. Becker, R.O. (Veteran's Administration Hospital, Upstate Medical Centre, Syracuse, New York 13210, USA). Over 100 scientific publications on tissue regeneration, electrical potentials, the primitive nervous system, AP and geo- physical effects on health. 2. Breneman, J.C. (1978) The basics of food allergy. Charles C. Thomas, Springfield, Illinois. 3. Burr, H.S. (1972) Blueprint for immortality: the electric patterns of life. Neville Spearman Ltd., London. (or) Burr, H.S. (1973). The Fields of Life: our links with the universe. Ballantyne Books Inc., New York. 4. Buxton-Hopkin, D.S, (1976) James Reilly and the autonomic nervous system: a prophet unheeded: Annals of Royal College of Surgeons of England, 60, 108-116. 5. Coca,A.F. (1978). The pulse test: easy allergen detection. Arco Books, c/o Thorson's Books, Wellingborough, Northants, England. 6. Graves,T. (1977) Dowsing techniques and applications. Penguin Books, Harmondsworth, UK. 7. Journal of the British Society of Dowsers. Quarterly journal from: The Secretary B.S.D., Sycamore Cottage, Hastingleigh, Ashford, Kent, UK. 8. Mackarness,R. (1976) Not all in the mind. Pan Books, London. 9. Ostrander,S. and Schroeder,L. (1977) Psychic discoveries behind the iron curtain. Abacus Books (Sphere Books), London. 10. Randolph,T.G. (1951) Food allergy. Charles C. Thomas, Springfield, Illinois, U.S.A. 11. Randolph,T.G. (1965) Ecologic orientation in medicine: comprehensive environmental control in diagnosis and therapy. Annals of Allergy, 23, 7-22. 12. Russell,E.W. (1971) Design for destiny. Neville Spearman Ltd., London. 13. Russell, Edward W. (1973) Report on radionics: science of the future. Neville Spearman Ltd., London. 14. Selye,H. (1976) Stress in health and disease. Butterworths, London. 15. Watson,L. (1973) Supernature. Hodder and Stoughton, London. 16. Watson,L. (1979) Lifetide. Hodder and Stoughton, London. 17. Mann,F. (1973) AP Cure of many Diseases. Heinemann Medical Books, London. 18. Austin,M. (1974) AP Therapy. Turnstone Books, London. 19. Connolly,D. (1979) The Law of the Five Elements. Centre for Traditional AP, American City Building, Columbia, Maryland 21044, USA. HOMOEOPATHY AND AP

AP and homoeopathy make an excellent therapeutic partnership. Homoeopathic remedies may be given orally or by injection into the AP points chosen to fit the case. Austrian, German and French Vets are using this method successfully. The British Vet Homoeopathic Society was founded in the UK in 1987. Contact the British Vet Association, 7 Mansfield St., London W1M 0AT for details. Further information on U.K. Supply Houses and Homoeopathic Materia Medica (by Allen or Boericke or Boenninghausen or Clarke or Kent) from: Royal Homoeopathic Hospital, Great Ormond St., London; Nelson's Pharmacy, 73, Duke Street, London; Ainsworth's Pharmacy, London TEXTBOOKS ON HOMOEOPATHIC THEORY AND PRACTICE McLeod,G. (1978) Treatment of horses by Homoeopathy. Health Science Press, Holsworthy, Devon, UK. Roberts,H.A. (1976) Principles and Art of Cure by Homoeopathy. Health Science Press, Holsworthy, Devon, UK. ESSENTIAL READING, EXCELLENT BACKGROUND Tyler,M.L. (1975) Homoeopathic Drug Pictures. Health Science Press, Holsworthy, Devon, UK. 1

1 Esker Lawns, Lucan, Dublin, IRELAND. Fax: 353-46-25187; Tel: 353-46-25214 (lab); 353-1-6281-222 (home) 2 Throughout this text, the following convention is used for the codes for the Channel-Organ System (COS): LU=Lung; LI=Large Intestine; ST=Stomach; SP=Spleen-Pancreas; HT=Heart; SI=Small Intestine; BL=Bladder, with BL40=WeiZhong; KI=Kidney; PC=Pericardium, Heart Constrictor, or Circulation-Sex; TH=Triple Heater/Endocrine; GB=Gall Bladder; LV=Liver; CV=Conception Vessel (ventral midline); GV=Governor Vessel (dorsal midline). Other authors may use different conventions. 3 Joking aside, the miracle of life outside the womb begins with the first breath and ends with the last. LU function is the most important of all vital Qi functions. All the other organs and functions die within minutes if starved of oxygen (part of the Qi of air). Body energies at their lowest ebb, the Qi cycle ends in LV at 0100-0300h (0300 is known as the dead hour of night). The new Qi cycle begins in LU at 0300-0500h. 4 Swedish research, published in 1992, has suggested a causal link between EMFs from high voltage transmission lines and leukaemia/brain tumours in people. 5 The skin is a more important organ than generally is realised. It is a powerful organ of elimination. It also acts as the terminal for viscerocutaneous and cutaneovisceral reflexes and similar reflexes, which are the basis of AP effects.

APPENDIX Holistic concepts integrate those of advanced physics with traditions of the shaman/ witchdoctor/ priest-priestess healer of many ancient cultures. They involve a belief that

everything in creation is linked in a universal, if intangible, energy field (E = mc2); that each cell of the body has an electromagnetic field which reflects the state of the cell; that the healthy organism is a bioelectric entity, with a balanced, integrated set of fields; that a very wide range of stimuli (external, internal and genetic) can modulate (beneficially or adversely) the bioelectric fields in the organism; that focused thought can interact with the universal and personal energy field; that there is no past and no future, merely a continuous present; that field effects interact with cellular metabolism etc. In the definition of the dictionary, many aspects of Holistic Concepts of Health and Disease are arcane or occult (something which is restricted to the fraternity/sorority; secret, hidden). Holistic (transcendent) medicine recognises many more causes and therapies of dis-ease than does mechanistic (scientific) medicine. Many scientifically-trained professionals have a religious belief, in which the healing arts (medical or veterinary) are human expressions of a divine vocation, similar to priesthood or humanitarian service. In human frailty, they attempt to realise the "will of God" (as revealed by the Christ, the founders of other great religions and the mystics) "to love one another" and "to heal the sick". They believe that the mind/soul is often involved in dis-ease and that healing of the disturbed mind/soul can often be more important than mechanical correction of physical lesions. They believe that the mind of the patient (and of those who know the patient) can influence the outcome of psycho-somatic disease. An inherent part of holistic medicine is the desire to understand when, where, how and why the patient is ill (diagnosis) and what to do about it i.e. what methods of therapy may help the patient most. When diagnosing, many holistic practitioners positively seek the help of our Creator. They also seek the patient's help by an internal (mental) dialogue: if I am to help you most effectively, you must please show me where and what is your main problem! When treating, they will/visualise/ project healing to the patient as a routine part of what they do: I open myself to the healing energy of the Creator, who heals all pain and suffering. I transmit to you the healing energies with my love and with the love of our Creator. Many holistic practitioners believe that a drug administered with love and compassion is of more benefit to a patient that the same drug administered mechanically or dispassionately. Great healers (believing that they act as channels for a benevolent Creator/Universal Life Force) can dispense with the drug altogether. Fragments of my unpublished prose and verse follow. They may give some slants on this student's impressions of some of these concepts. PATRICK KAVANAGH'S WORLDS: MINE AND NOT MINE (Extracts from an unpublished work by P.A.M. Rogers). Patrick Kavanagh (K) was a great poet, one of the greatest in the English language since W.B. Yeats. You may wonder what on earth a dead Irish poet has to do with Holistic Concepts of Health and Disease! I choose to discuss K's life and work, as they illustrate the paradoxical (Yin-Yang, positive and negative) nature of humanity, the power of mind to be creative or destructive, the struggle between rationalism and blind belief. Most of all, they allow

discussion of materialistic-atheistic versus mystical-transcendent values. For poets and many holistic practitioners mysticism is the foundation of their work and their search for "why". K was born on a small farm in Inniskeen, on the borders of Monaghan, Armagh and Louth (Ireland) on October 21, 1904. He died in a Dublin Nursing Home on November 30, 1967 after suffering years of cancer and alcoholism. Though his body, bones and brain are long since dead and decomposed, K's warrior-spirit is alive and thriving! In his poetry, he is a warrior, a Christ-like champion of the poor and oppressed. His verses scream out human dis-ease (loneliness, pain, injustice, poverty and ignorance). They also sing out one recipe for optimal human health, the desire of the human soul to transcend the weakness and imperfection of this life. They acknowledge the joy and beauty of life (the only life that we really know) and the fearful wondering if there can be anything waiting on the other side of the Veil. My comments on Kavanagh and his worlds are my impressions of his work. References and page numbers are shown as (CP5), where 5 is the page number in his COMPLETE POEMS. References from his novel the GREEN FOOL are coded (GF). LAPPED FURROWS and SACRED KEEPER (by his brother, Peter) are coded (LF) and (SK) respectively. He was aware of the human condition: frailty, loneliness, frustration, the isolation of the artist and the need for love, the false friendship of the bottle, the transience of life and the battle to survive. K was a paradox, an Irish version of a Zen riddle:... some said a great artist, others, ambiguously, a fiddle... (CP300). He was:... the representative of those/ clay-faced sucklers of spade handles,/ bleak peasants for whom Apollo blows... (CP30). KAVANAGH THE POET : K wanted to find his own truths. Mysticism, Man's dialogue with God, Man-in-the-world-and-why was the foundation stone of his work: At the foot of a Cross is the Utterness/ of humanity/ every atom of clay,/ every worn stone/ becomes your wish for beauty/ the world cannot own... (SK8). K had held fast to reason as the guiding principles for most of his life. But human actions and their expression are a mixture of reason and instinct (unreason). Alcoholism is "unreasonable", as is faith. In the end of his life, he wrote: The day I walked out on reasonthat old plodder/ (but you didn't)/ was the best day of my life... (CP351) K was a beggar but rich in spirituality, a dour loner and a black comedian. He was said to have been a plagiarist but he was also a creative genius. He meditated constantly on the place of humanity in nature and on the conflict and similarities between the pagan and Christian ways. He was a visionary/mystic, a Catholic/pagan. The paradoxical riddles in K's life and work, his dualism (love/hate, joy/despair) and his undoubted consciousness of these suggest leanings towards the spirit of Zen Buddhism. He throws out a mighty challenge and no challenge: "my purpose in life is to have no purpose". Again, he said: Philosophy's graveyard- only dead men analyse/ the reason for existence./... The world began this morning, God-dreamt and full of birds.../ O come all ye youthful poets and try to be more human (CP225)

Humanity is a mixture of good and evil, gentleness and brutality. The conflict and tension between opposites has always been part of poetry and of life. K was a very astute observer of nature- light, wind, landscape, animal- and humanbehaviour. His readers, especially those from rural backgrounds, can feel the textures, see the pictures, hear the sounds of his ideas: A dog lying on a torn jacket under a heeled-up cart,/ a horse nosing along the posied headland, trailing/ a rusty plough..../ October playing a symphony on a slack wire paling (CP80) SELF-EXAMINATION: I go from you as a snail/ into my twisted habitation./... I know the shallow ways/ of self (CP63). If it is to be of universal import, poetry must contain a high degree of self-examination. It must examine and question accepted conventions and all the so-called basic dogmas and truths: birth/death, growth/senility, immaturity/maturity. It must also address human reaction to more abstract values and emotions- love/hate, God/Devil, good/evil, subjective/objective realities randomness/meaning of existence, etc. Am I merely an amalgamation of things, bits and pieces strung together? Am I my profession, an ethical reality? Am I my feet, my penis, hands, one hand clapping in a Zen temple, the other severed in the surgeon's bin? Am I the sin of my ancestors, the mind-creation of my children, wife? Shall I pay the price for them? (Rogers). FIERCE HONESTY AND LOVE OF TRUTH: K knew that nothing can be known fully and that people who assume that it can commit a crime against wonder: ...The poet wrote it down as best he knew/ as integral and completed as the emotion/ of men and women cloaking a burning emotion/ in the rags of the commonplace, will permit him (CP124) Science, psychology and literary assessment rely on analysis, the breaking down and tearing apart of complex things and ideas into their components in an attempt to understand how they all fit together in the complete picture. This attempt, unless done with sensitivity and wonder, is of itself an act of destruction, a desecration:... we shall not ask for reason's payment/... nor analyse God's breath in common statement (CP125) The dissected flower, butterfly, mind (or writer's work!) is a sad sight. K's comic vision sensed the vulgarity of such analysis. He was also sceptical of "objective" science. K was convinced that rational thought and scientific exploration are but one aspect of human search for subjective truth: Now I have to sit down and think/ a world into existence; you cannot borrow/ anyone else's... (CP296) Objective truth depends on at least one observer. The more observers who agree, the more objective the truth is for them, in other words objective truth is arrived at by a consensus of subjective truth and ... Truth's insanity/ is a spell that all men must hold to; when they wake/ not even dust is left for all their striving (CP182) TRUTH VERSUS FANTASY: ... If truth is certainty and our world uncertain, our world is fantasy. The main certainty for us is death, the main uncertainty what then? My truth/reality may be your fantasy/nightmare. Our interpretation of the world is imperfect and subjective. It depends on our senses, our training and, to some extent, on instinct/intuition

to fill in missing pieces of the image. Reason can be defective, a fact well known to those who work with psychiatric patients. Dream-trance/hypnosis: In occult traditions thought (dream, conception, will) precedes action (foundation, construction, reality). The Spirit(s) breathe(s) the dream/idea, which may strike a number of people at the same time. Nothing is more powerful than an idea which has reached its time. If enough people want something to be (to happen), it will, at least for them. The dream precedes the blueprint, which precedes the Taj Mahal. Directed or controlled visualisation (daydream) is a powerful tool. Truth/reality is primarily opposite in trend to dream/fantasy but the seeds of one lie in the other and the opposites of each lie in each. One can lead to the other. Dreams or fantasy can have a basis in truth/reality and can develop into it, as in precognitive dreams or medical diagnosis/healing using the inner (sixth) sense. Truth/reality can have a basis in dream/ fantasy and can develop into it, as in human endeavour in the First World to solve the problems of the Third World. One fingerless hand claps, as in most aspects of nature. TRAGI-COMEDY: "tragedy is underdeveloped comedy" (SK106) and "some crucial/ documents of sad evil... may yet/... fuel the fires of comedy" (CP296) PAGANISM, NATURE WORSHIP AND ATHEISM: New life, new day./ A half-pilgrim saw it as a rabbiter/ poaching in wood sees/ primeval magic among the trees (CP113). Prayer, worship and meditation were directed towards the spirits, or towards the material manifestation of their power- hence sun and moon worship; sacrifices to the sea and the forest; festivals of spring, summer, harvest etc: And you who have not prayed/ the blackbird's evening prayer/ will kneel all night dismayed/ upon a frozen stair (CP64) Many of the places of Christian pilgrimage were originally sacred, or "places of power", in earlier pagan cultures. Many Irish "Holy Wells" flowed healing water long before the Christian era. As is the case with all thinkers, K often questioned if life had any meaning which can be discerned by human mind: Mind is a poor scholar/ O blind mind/ when is spun your chilly firmament/ souls nothing find (CP12) The occult is based on dualism (white- black, good- evil). Adepts choose the left or right path, both of which are powerful. They pray/meditate in the belief that concentrated thought is concentra-ted energy and can cause the desired effect to happen, if only by bolster-ing their own self-confidence and resolve. Benevolent or malign human thought can be potentiated by calling in the heavies- benevolent or malign entities. Apart from powers vested in the spirit world, occult traditions recognised special powers in certain natural phenomena. These forces could be harnessed by people for good or evil. One could draw healing power from a tree, an underground stream, the wind etc: It is there! Earth force! Life force!... Feel it flow: pins and needles tingling, Kundalini spreading. Scalp, neck, back, arms, trunk, loins, legs electric. Feel the Power and hold it within! (Rogers) "They who live by the sword shall die by the sword". "As you sow, so shall you reap". Occult traditions teach, as does the Judaeo-Christian:... Thought and Word are straining hounds./ Once unleashed, they track and course/ the distance of the universe./ They nurture

life or inflict savage wounds./ By day they turn their master's chosen game./ At night fall, they return/ (often matted in dried mud, torn,/ bloody, thorned, panting, lame)/ home to their lair. They paw and gnaw/ on parboiled heads and other gory chow./ They gorge as hungry hounds know how,/ then circle down to rest in the tangled straw/ synapses of their slipper's demon mind/ or wag their tails and nose his godly hand (Rogers) Positive thoughts produce positive effects, as in healing prayer/Lourdes, telepathic healing. Negative thoughts produce negative effects, hence the use of curses, spells, voodoo etc in occult, pagan and satanic rituals. But the thoughts, or their clones, return to the sender. ORIENTAL CONCEPTS AND ZEN: loser of the self to others is, through others, finder of the self. Oriental philosophy is based on duality, the interplay of opposite forces. It holds that all created things depend on interplay of Yin-Yang energies or Qi- the vital or life force: Chained by a leathery navel cord to sweet-and-sour earth and pulled towards the celestial by fierce magnetic force, must our soft centres rip apart on that cosmic rack? Between the foolish and the wise, man lies. Between the glowing stars and groaning ice, man lies. Between laughter and tears, man lies. God-Satan fights in him. Hope-despair lurches his heart. Love-hatred savages his mind. Nun-Harlots turn his head and in a vital world many living souls are dead (Rogers). The symbol of Yin-Yang Qi is the Monad, a circle divided in halves by a wavy line, so that it resembles two fish, head to tail. How many city-dwellers have seen the sharp line of demarcation between the north- and south- faces of a Toblerone of milled peat on a frosty January morning? The north face (Yin) is white with frost and the south face (Yang) is brown and the dividing line between the two runs along the top of the Toblerone. It is an amazing sight when seen for the first time but is shrugged at, as something absolutely natural, by those who know the bogs. It is one of the best examples of the oriental concept of Yin-Yang for visual display. K was aware of nature's laws. In describing the North-facing side of hills, he wrote: My hills hoard the bright shillings of March/ while the sun searches in every pocket (CP13) Yin (material, solid) and Yang (immaterial, ethereal) are merely different forms or states of energy. These realities, depend for their definition on each other. Yin (passive) and Yang (active) can not exist without each other. Yin and Yang transform (change) into each other and return to the original state (Yin to Yin, passivity to activity to passivity). Good and evil, antagonistic yet complementary fundamental energies must find expression. Night and day, winter and summer, ice and fire, death and birth are common realities. In Zen they are neither evil nor good. They just are. Good and evil are only words. It is the personal choice and direction of action or inaction which matters to the Zen Master. The concept of natural rhythms and change is central to Yin-Yang theory: See Master Sun, sail in at dawn, dip away at dusk. See Mistress Moon, slip in at dusk, pale away at dawn. But in the night the sun is there and in the day the moon, there and not there at the same time, like Santa Claus and God (Rogers)

Conception, birth, puberty, parenthood, menopause, death (reincarnation?) are all part of the seasons of life. There is a time for activity and a time for rest. All action/interaction involves input or output of energy, creation and destruction, and transformation, i.e. involves dynamic, inevitable change. Yet, the whole system stays in balance, with nothing added and nothing taken away. All of nature consists of change and no change. Yin-Yang theory predated Einstein's relativity theory by over 5000 years: The Newgrange sign is clear and penetrates the soul.... The whorls and spirals,... deeply etched in granite cry aloud: "The reality of life and death is change! The reality of change is death and life! Listen and act if you dare!". The eagle understood. He saw his death and rebirth, found great inner peace (Rogers) Zen Buddhism is rooted in concepts of Tao (the Way), the paradox, the way of change and no change, the way of Yin to Yin and Yang to Yang. It is the way of reason and unreason (intuition). An exercise of Zen meditation is to wrestle with a riddle to which there can be no reasonable answer- the paradoxical KOAN. A typical piece of Zen verse depicts a crag (Yang), valley (Yin), each merging into the other (change). K was a great, if unwitting, poet of the oriental Zen Yin-Yang tradition: ... the boortree that has a curse but also a blessing (CP155). "Suddenly I remember something that makes me sad and, curiously enough, I am happy then" (SK122). "... people are hated because they are loved" (SK320). But now I will hate till my hate/ comes out the other side of the world as love,/ love in Australia (CP218). K's statements that "to be willing to be nothing is one of the best ways of being something" (SK222), that "his purpose was to have no purpose", that "tragedy is underdeveloped comedy" in the most profound sense (SK106) and that "the right way is wrong" (CP347) are characteristic of the Zen KOAN. The comic poet and the Zen Master have a lot in common. Evil does not faze the Zen Master. He/she accepts evil with the same serene detachment as good. Both are equally valid realities:... praise, praise praise/ the way it happened and the way it is (CP322). Evil does not subdue or even arrest the comic poet because his/hers is the superb sanity of knowing what really matters (Kennelly). In typical Zen riddles, K confounds thinkers and poets who take themselves too seriously in seeking to explore the unexplorable:... There are no answers/ to any real question (CP237, 238)/... no answer, no message from experience won,/ advice forever explores the banal/ so let us walk along the banks of the canal... (CP279) or to those writers who try to explain the unexplainable: The only true teaching/ subsists in watching/ things moving or just colour/ without comment from the scholar (CP287) CHRISTIAN FAITH: The way I see it, all that went before is gone, work, rest, good, sin, but sparrows still find grain. Today is incarnation, birth, death and resurrection, wheel, spoke and axle, hub and rim of universe (Rogers). Child there is light somewhere/ under a star,/ sometime it will be for you/ a window that looks inward to God (CP7). I saw Christ today/ at a street corner stand,/ in the rags of a beggar he stood/ he held ballads in his hand (CP27) For faith to have value, believers must wrestle constantly with unbelief. K had many doubts. Talking to himself, he said: you... take up religion bitterly/ which you laughed at in your youth,/ well not actually laughed/ but it wasn't your kind of truth (CP223) but he wanted to

accept the idea of a personal God: Only God thinks of the dying sparrow/ in the middle of a war (CP115). But the concept posed problems for him in later life, as it does to many who want to say (and believe) "Amen!". If the personal Ear of God listens to the millions who pray for specific, selfish, intentions, poor God must be weary, if not downright confused. K touches on this: A secret lover/ is saying Three Hail Marys.../ that... will bring/ Cathleen O'Hara... home to him./... Cathleen herself is saying/ (three more)... to bring/ somebody else home to her.../ What is the Virgin Mary now to do? (CP176) K's idea of prayer was one of worship, praise and wonder at the beauty of creation (nature), a sense of oneness with the Creator and all things created, rather than a plea to supernatural beings for special treatment of the self: ... You plough, you sow, you reap, you buy and sell/ and sing and eat and sleep. All is well/ done/ in the name of the Holy One (CP181). For him, the search for truth and its expression in poetry was real prayer, the praise and worship of the Spirit in mortal flesh, the childlike affirmation of the utter dependence of humanity on the benevolence of the Energy behind nature. The Circle is the Father/ Diameter His Son/ Spirit the mathematical centre/ thus truth is known/ in all turning wheels/ in all tumbling clowns/ as in the firmament deep/ where the Prophet drowns (CP67) But, as in other things, K was paradoxical: The poet's task is not to solve the riddle/ of Man and God but buckleap on a door/ and grab his screeching female by the middle/ to the music of a melodeon (preferably), roar/... up lads and thrash the beetles (CP248) HUMANISM, ATHEISM, SCIENCE: (Knowledge said... ): This is the only way/ of truth ./ And the fool in me/ buried God's lantern in dark clay/ that an angel might not see (CP41) K had difficulty in resolving the conflict between intelligence/rationality and blind or reluctant obedience to religious dogma and practice. The self-reliance and pride of atheistic humanism is exemplified in the "scientific" search for truth. Many scienti-sts and thinkers believe that natural phenomena can be reduced ultimately to physical/chemical reactions governed by a complex set of equations. By reducing nature to equations, they remove all the wonder and mystery. Analysis may quantify the elements in the beetle's iridescent wing but can it reconstruct the beetle's ash to fly again? Can Science weigh the human soul or take the pulse of God? Atheistic scientists would not be:... afraid when the sun opened a flower,/... never astonished/ at a stick carried down a stream/ or at the undying difference in the corner of a field (CP180) No scientist has seen a quark but the reality of quarks is inferred from effects which can be explained by their existence. No scientist has yet seen God through his/her telescope. Ergo, God does not exist- God is not given the status of the quark: Way out among the distant stars, or hidden in a quark,/ or in the pure song of the lark, or in the deeds of dark,/ or in the thunder and the rain, or in the desert dry,/ or in the fission of the bomb, or in the human cry,/ or in the slowly rotting leaf that births a giant tree,/ or in the plastic micro-chip, or in the depths of me,/ mc squared equals E! I kneel and adore THE E:/ at one with the Universe! (Rogers)

Einstein's Law of Relativity states that energy is neither created nor destroyed; it merely changes form. Mass and energy are interchangeable. Yet, the whole system stays in balance, with nothing added and nothing taken away. All of nature consists of change and no change. Ancient Yin/Yang and Zen theory predated these concepts by over 5000 years. K saw science as a game for creatures of limited consciousness. FOR EMINENT PHYSICISTS is one of his best religious poems, in which he implies that faith in God wins him rather than reliance on science. The poem is so good that it said it all in less words that this commentary: God must be glad to see them play/ like kittens in the sun/ delighted with the wisps of hay/ blown from His haggard on a breezy day.../ Time's kittens, have your fun (CP147) REPENTANCE: We have sinned.../ Let us lie down again/ deep in anonymous humility and God/ may find us worthy material for His hand (CP256) Sin, guilt and repentance mean different things to different people. The human reality is that we are human. To be human is to err. Some belief systems call this sin and demand a personal and social expression of guilt (confession) and sorrow for it (repentance). Where possible, recompense is expected. Honest people admit to having made some serious mistakes, or having failed to hit the desired ethical target. This recognition of human frailty, with a sense of praise, worship and total dependence on God/Nature is the basis for all healing of mind and body. O divine Baby in the cradle/ all that is joy in me/ is that I have saved from the ruin/ of my soul your Infancy (CP71) K admitted failure in the end and threw himself in God's hands, even though doubts about the existence of life after death had recurred again (1965): ... heaven if there is such/ a place which I doubt very much (CP344). One wonders if those lines flashed through his mind at his last conscious moment, or if he died composing some new and violently beautiful poem to the Creator or a poem simply praising human ability to defy poverty, pain, darkness and silence. CONCLUSIONS: We are all conditioned in our beliefs, morality and behaviour by family, school and immediate society. Most parents try to pass on their sense of values to their children. Parents would resent the charge that they try to "condition the children to the same taboos and fears which make a mess of their own emotional, mental, spiritual and sexual lives" but, in many cases, this is what the system (home + school + church + society) really does: She held the strings of her children's Punch and Judy,/ and when a mouth opened/ it was her truth that the dolls would have spoken/ if they hadn't been made of wood and tin (CP99) Professionals are conditioned by teachers, drug companies, peer-pressure and our own clinical experience. While much of our conditioning is very useful, much is unhelpful- it does not solve our clinical problems. It is possible to delete obsolete or faulty software/ideas from our brains' storage area/memory and to reprogramme with worthwhile or experimental software/ideas by interfacing with holistic practitioners, artists, mystics and poets. I urge you to try it. If the new software is unhelpful, that can be scrubbed also!

Life is for loving and living, for growth and decay, for experimentation and failure. It is not for futile talk or unfelt prayer: He saw the sunlight and begrudged no man/ his share of what the miserly soil and soul/ gives in season to the ploughman (CP96) Teaching depends on the knowledge, instinct and communication skills of the teacher and on the ability and willingness of the student to learn. The great teacher may have many students or only one. But one is enough because that one may teach many. K believed that the great poets... never teach us anything... they... provide us with an orgy of sensation and nothing else or more (SK220). I believe that K was wrong. He undervalued the priesthood of the great poets and the sermons on love, hate, hope and despair in his own life and work. In 1957 he said that malice is only another name for mediocrity. People need not be mediocrities if they accept themselves as God made them. God only makes geniuses (SK326). What a teaching if there are students to listen! REFERENCES TO KAVANAGH'S LIFE AND WORK  Kavanagh, Patrick. Ploughman and other Poems. 1936. Macmillan, London.  Kavanagh, Patrick. The Green Fool. 1938, 1987. Penguin Modern Classics.  Kavanagh, Patrick. Tarry Flynn. 1948, 1975. Penguin Modern Classics.  Kavanagh, Patrick. The Complete Poems (Collected, arranged and edited by Peter Kavanagh). 1972, 1984, 1987. Goldsmith Press, Newbridge, Ireland.  Kavanagh, Peter. Lapped Furrows. 1969. The Peter Kavanagh Hand Press, New York.  Kavanagh, Peter. Sacred Keeper. A biography of Patrick Kavanagh. 1979. The Goldsmith Press, The Curragh, Ireland.  Kennelly, B. Irish Poets in English. 1973. Editor Sean Lucy, The Mercier Press, Cork and Dublin.  O'Brien, D. Patrick Kavanagh. Bucknell University Press, U.S.A.  O'Loughlin, M. After Kavanagh. 1985. The Raven Arts Press, Finglas, Dublin.  Warner, A. Clay is the Word. 1973. Dolmen Press.  Warner, A. A Guide to Anglo-Irish Literature. 1981. Chapter 9: Patrick  Kavanagh. Gill and Macmillan, New York. CONCEPTS OF UNITY Unpublished verse by P.A.M. Rogers MUNDANE ARCANE Long and slender/ needles of fine steel/ are symbols of another way./ One Master inserts two tips/ through the eye of a third.../ voila, a Chinese dowsing-rod/ to find the leaking point./ Another reads the pulses,/ with sorcerer's intent,/ or reads the tongue/ to find the locus/ of the block. A third simply feels/ above the horse's hooves/ for watery holes. He nods/ when his finger drowns/ in Sandefjord. In her sanctum/ an adept gazes/ at crystal fire./ The prayer dream/ grows, water-cries/ and claws for birth./ In the next village,/ the cripple, laughing madly,/ walks. REVOLT AND GOVERNMEN

THE CIRCLE (Yin-Yang) Two fish fill the circle./ Lovers circle and clinch/ and fall into the circle./ A tireless snake/ swallows its tail./ Where is the rattle, the venom ?/ Hidden away as potential energy/ to please the child or put/ the demented out of misery ? Atoms and universes show/ the power of revolution/ and Einstein proclaimed/ ex cathedra the dogma/ of the unity of matter and energy./ So to infinity are the Word, the Flesh/ and the Light interchangeable./ Nothing is lost, nothing gained/ in the endless cosmic dance./ Hexagrams from ancient yarrow sticks/ or from random number generators/ point the ultimate reality :/ change is the source and end of all/ change is revolution !/ Wheels roll on ; all is change/ and nothing changes anyway. THE STAR (THE FIVE PHASES) The inner calm, the balance/ between atoms and the universe,/ the hidden seabed and the clouded peak,/ the human states, the blues, the joys,/ lie in the circle around the star. The tips of the Five Point Star/ sow seeds of revolt and government./ As fire begets the ash of earth,/ Earth-mother births her shining/ and so around the clockwise wheel/ the change brings life and growth/ and death. The wheel and pentagram roll on,/ Government and revolution live in harmony./ As water controls fire,/ fear controls desire but if water overheats,/ fire rebels, attacks,/ turning it to steam/ and desire flares, then flickers out./ So are all the elemental attributes controlled/ in flux. Creation and destruction/ vie as equals in the turning wheel./ Nuclei disintegrate. Nuclei fuse./ Seal-pups clubbed to death ; a V of swans in flight./ Did Einstein get his calculations right ... ? BRUSH STROKES ON A CANVAS Jagged crag, what is your need ?/ To lose my stoneness in beauty,/ avalanche, granite-chipped, myriad shaped,/ mica glistened, marble streaked,/ thunder down into the shrouded valley. Empty valley, what is your need ?/ To be seeded with sound, colour, form,/ swell the senses, mind to consciousness,/ flood my fullness up my fertile slopes,/ overflow to other empty craters. Crag and valley fuse, explode,/ disintegrate, reform to emptiness and stone again./ The canvas satisfies the painter's eye/ and palette, brushes, paint/ sleep the easel sleep of waiting. UNIVERSES REFLECTE FLOW Two lifeless planets, coldly orbiting,/ attracted and repelled in silent dance/ around two lonely suns, hurtle onward with their suns through nothingness,/ collide with a sixteen-pointed star,/ cruising too hungrily to enter Eden. Blueprinted by a thirsty Architect,/ eighteen sparkling planets realign./ We have ignition ! H2O is formed.

The flow is fierce, the tides are strong./ The Artist claps in glee/ as the seething sea pounds puffing holes. From its heavings, from its froth,/ live erupts unstoppable. EBB Sea-sculpted from Easky shale,/ pools at the high-tide mark/ swirl, dart- twisted by stranded fish,/ their water of life break-dancing to elemental rhythms. Salty source/ and final leveller of seer and fool,/ sea-fields grassed with bubble-weed and wrack,/ sliding ruin of the careless foot. Mines of gold and silver flashes,/ crab and shrimp, joy of urchins/ dangling threads for treasures/ and the treasures released unharmed. Winkles, algae, plankton/ teem in landlocked space-time./ Birth-grunts of dinosaurs imprint/ on cliffs and human stains dissolve in salt-spray. Water-born lifetimes/ of centuries, years, seconds,/ riff the surface, sink/ like skipping-stones/ but mirrors reflect the user/ and images of glory reappear. ON THE 37th ANNIVERSARY OF THE FOUNDING OF THE PEOPLE'S REPUBLIC OF CHINA Ming Ming and Ping Ping were gone/ but over the well-trimmed Embassy lawn,/ echoed the crunching of bamboo on skulls./ Kaleidoscopes of bamboo-shoots, green and tender/ and dissident shoots, scarlet and brutalised/ floated in the air against a sea of blood/ and righteous bullets./ Feudal lords, sated/ and peasants ground to poverty and blank despair/ whispered from the Ballsbridge trees./ Sweat dripped from heat-struck oxen./ Terrible diseases fought each other/ to be first in the land./ A rapist laughed as he buttoned up/ but his mouth became a giant O/ as his severed head was shown to the crowd./ More warriors clashed among the flowers/ before they petrified. The unlucky ones/ lost their arms in a Dublin hospital/ but the arm of Wu Song-Fook,/ severed by an unguarded band-saw,/ was replanted to his living trunk/ by a macro-team of microsurgeons/ in a Shanghai hospital./ Opium the religion of the people no more./ The opiate receptors, deep in the brain,/ now explain the potency/ of tiny needles in the skin./ Miracles of ancient sciences,/ the needles, moxa, herbs,/ help the hopeless cases./ The soldier, paralysed by a stroke,/ drives again the army truck./ The polio child walks without her braces,/ which recycle endlessly./ The dumb speak./ Miracles of our science/ irrigate the fields, yield four crops/ of living rice. And paddyfields yield/ fish and ducks and not a Paddy poacher to be seen./ We try to understand but fail,/ our superior politeness wearing thin./ Chinese fiddles and strings/ create their weird cacophonies,/ background to the high-pitched and bass/ voices of the Beijing Opera./ The artists move as if on strings themselves./ Are they mindless marionettes/ or experts far beyond our dreams ?/ We strain to catch the meanings/ where there are none for us./ Twirling his fourth glass of wine,/ a shrewd observer mutters/ that it is all above him./ Good on you mate-/ there are others less perceptive!/ The gulf of comprehension narrows/ slightly when we realise/ the discipline and method/ behind the sounds and movements./ Control, control ! A game of mastery/ with different rules

and codes from ours./ The dawning as the black eyes smile/ into the puzzled blue :/ THEY are Chinese. They are CHINESE./ This is their way, perfect in its form/ and execution. More images mirage on the lawn./ Slender women run on unbound feet,/ free and equal with their men ;/ laughing children point at the bearded ones ;/ workers meditating at the factory lathe ;/ Tai Ch'i in the streets,/ control of mind and body,/ bees in the hive where there is no queen ;/ one thousand million on the march to peace ;/ a flawless pearl, sand-itched from the Yellow River -/ love, respect, morality and strength,/ a fearsome combination, backed by boundless hope./ To the next thirty-seven years/ and their kaleidoscopic clones,/ Kampe ! Kampe, Ambassador !/ Between our heres and there 's a bridge is built/ but treat your rebels without guilt ! RIVER SCENE The ferryman spent his days/ poling people to and fro./ Monks and merchants, poor and rich/ passed their hurried way,/ missing the ferryman's wink/ and the banyan tree. Content in the banyan shade,/ sat a hardened Buddhist monk/ remembering his debauched youth,/ a youth of silk and softness,/ perfumes, musk and wine./ All his urgent needs were met./ Nothing needed now/ but the river's confidence/ and its womb-like murmuring. River, your questions ?/ What sought you of the burning eyes, excited face ?/ To know the unknown./ What sought you of the burnt-out eyes and ashen face ?/ To unknow the known./ What is the time between your coming and your going ?/ A wasted lifetime./ Return to the watery peace from whence you came ! The monk caught the ferryman's wink -/ they knew the river's age and of its wisdom./ What is the answer, river ?/ Monk and ferryman, hear me well !/ You must choose your heaven and hell./ Now is the time to live or die./ Now is the time to laugh or cry,/ fast or eat, wake or sleep./ Now is the time of knowing. Virgin to the bed of shame,/ foetus on the draining-board,/ soldier in the sights,/ death of a loved child -/ there is no going back./ Unknowing is the dark finality./ Be, my friends ! Just be/ or choose and be done with questions. VIVE LA DIFFERENCE US He wears last-year's baggy pants,/ discordant jacket, any shirt./ She disapproves in her aesthetic agony./ She sees herself a queen in seamless silk./ He sees the price in coolie's sweat. She sees red flowers, pearled with dew./ He sees the thorns, the horse manure./ She is pricked as she captures her dream./ He ignores the perfume/ as he digs their common grave/ in the shadow of the unseen rose. She of the spirit, he of the flesh/ at the middle time of life/ live a charade/ unless they understand the wheel/ and compromise.

THEM "Vive la difference !" some say,/ as if the fact is static./ But I wonder about wheels and rhythms,/ cycles turning. The adult male is hard,/ his softness locked away/ by the evidence of his witnesses/ until, at sixty-five or so,/ the witnesses withdraw the evidence,/ springing softness from its prison./ The ripe female is soft,/ her hardness camouflaged by egg-stuff/ until the ova yield to menopause./ Hormonal brake released, she grows a beard/ and talks bass tones. Testosterone and oestrogen, the fighting twins,/ secreted from the same cells in the embryo,/ compete for sexual expression/ in body and in mind./ The different responses are statistically significant,/ programmed parts of our humanity./ Brutality responds to nature's nudge/ but all things pass in time./ C'est la vie ! JACK AND MARY SPRATT For fifty years they shared a home/ whose solid walls absorbed/ the joy and hate, laughter/ and the sound of grinding teeth./ Their bioclocks were three hours out of phase -/ best times for both were rare./ Although they died three years apart,/ their coffins touch. Her life was spotless,/ regulated by strict rules./ Her dream was changelessness,/ defying seething tides of change./ He lived undisciplined,/ driven by escapist dreams/ to change the world,/ yet sure that nothing changes./ She was rooted in the earth and things,/ but sometimes soared./ He hawked the air on flimsy wings/ and plummeted to earth for meat./ They orbited between the earth and stars/ and nodded in greeting/ when their orbits crossed. Neighbours heard their squabbles/ frequently./ The travelling woman called on Saturdays/ religiously./ They ate the bread of life together/ occasionally,/ made calm-eyed children/ accidentally/ and nurtured them/ instinctively./ At night, together but apart/ they dreamed and sighed. When clay was thrown down on them/ and the old priest intoned for them/ great crowds wept for them/ knowing/ how much they loved each other/unknowingly. LET THE STUDENT BEWARE TRUTH I show you nature through my eyes/ but you must cast away my truths,/ unless your own experience/ should drift with mine/ as grappled boats, lost/ in the ghostly fog/ which scientists call truth. You must reach and trap the fog/ in baby's hands. Call it your truth./ But, if you dare to chink your hands,/ be quick to look ! Some truths/ can last no longer than the dew at noon/ nor than the lightning bolt/ that streaks to earth in June. The thought of truth as absolute/ provokes me to irate invective !/ The nearest thing to objective truth/ is the death of the unconceived./ The fool who knows she is a fool is not./ The sage who thinks he is a sage is not. BEWARE Like digging moles, your eager minds/ probed for slugs of knowledge hidden/ in the humus of half truths./ Your search is tonic to our jaded souls./ You drank my rehashed notes/ as if your

thirst could not be slaked/ and bolted my cliched words,/ then licked with relish from my fingertips/ small crumbs of my truths./ You stomached them in your spring-bound books,/ to ruminate on, quietly/ pelleting your truth. I loved you then for I'm a student too !/ Beware ! THEN WHAT? It starts in the heart, seeps to the groin, the awful need to be oneone with wife, with friends, with life, the simple need to be just one, a unity, completeness, the opposite of lonely zero. In the head the cynic jeers, at the idiot's need. Soul-lost in a lover's core, at the precious moment of surrender, or the farewells of a party, or the climax of hard work, he whispers the devil's anthem: Is that all? I must return to my dark now, to myself. Then what? QUESTIONS 1. One of the following statements is not correct. Indicate the incorrect statement: (a) Yang relates to the hollow organs/Channels (LI, ST, SI, BL, TH, GB) (b) Yin relates to dorsal, external, superior and facial areas (c) In male development, it is normal to pass through Yin to Yang to Yin phases (d) Perfect balance of Yin and Yang exists at the equinoxes (March and September). (e) Maximum Yin exists at the winter solstice 2. One of the following statements is not correct. Indicate the incorrect statement: (a) Sleeping over "the cross-point" of underground streams can cause chronic disease. (b) The surface electrical potentials of plants and animals increase at full moon and at peak sunspot activity. (c) The vital energy (Qi) in a human is determined at birth and can not be increased after that.

(d) In Xu (deficiency) Syndromes, body resistance is relatively weak, and the dis-ease has usually gained the interior and is more serious. (e) In Shi (excess) Syndromes, body resistance (anti-pathogenic defence systems) are relatively normal and the cause of dis-ease is usually external. 3. One of the following statements is not correct. Indicate the incorrect statement: (a) AP can be used alone, or with other therapies, to enhance the adaptive responses (b) Einstein's equation (E = m.c squared) has an analogy: Yang (function, energy) and Yin (mass, substance) are interchangeable (c) Human emotions rarely cause physical/organic disease (d) The health and function of the organs are interdependent (e) Chronic disease seldom arises from a single cause 4. One of the following statements is not correct. Indicate the incorrect statement: (a) The least important cause for high mortality with E. Coli/Salmonella may be underlying deficiency of trace-elements (Cu, Se, I). (b) Climatic changes can cause disease (c) Qi interacts with genetic influences and non-specific resistance to trauma, poisons and disease. (d) Excess Yang weakens Yin. Deficient Yin allows excess of Yang. In both cases there is a relative net excess of Yang ("Hot" Syndrome). (e) Excess Yin weakens Yang. Deficient Yang allows excess of Yin. In both cases, there is a relative net excess of Yin ("Cold" Syndrome). 5. One of the following is more Yang than Yin. Indicate the Yang one: (a) cold (b) above (c) winter (d) female (e) ventral 6. Geopathological effects on the body are due to (indicate the correct one): (a) mineraldeficiency (b) sun-spots (c) moon-phase (d) atmospheric-electricity (e) distortions in earth magnetic field 7. Which came first: the hen or the egg ? Indicate the most likely Chinese answer: (a) the hen (b) the egg (c) it does not matter because each is an aspect of the other (d) springtime (e) the nest

1=b

2=c

3=c

4=a

5=b

6=e

7=c

ACUPUNCTURE EFFECTS ON THE BODY'S DEFENCE SYSTEMS AND CONDITIONS RESPONSIVE TO ACUPUNCTURE This paper was written in 1980. For an update, see "ACUPUNCTURE FOR IMMUNEMEDIATED DISORDERS", attached. INTRODUCTION Acupuncture (AP) is best known for its effects in controlling pain, its value in treating alcohol and narcotic addiction and in the induction of surgical analgesia in humans and animals . It is less well known that AP has great therapeutic value in a wide variety of human and animal diseases. These effects are well established in clinical practice. Modern textbooks and journals of AP list hundreds of clinical conditions which respond (partially or completely) to AP therapy. Some of the therapeutic effects of AP have been studied experimentally in animals and humans. In this talk we will discuss the effects of AP in stimulating the defence systems of the body. These effects are directly involved in the therapeutic value of AP in humans and animals. THE DEFENCE SYSTEMS OF THE BODY Defence systems have two basic components: (a) recognition of the attack, its nature, locality and extent, and (b) activation of mechanisms to counter the attack and to repair the damage which has been done. Important defence systems of the body include the following: a. the immune system (specific and non-specific immunity); b. the phagocytic system (white cells and reticulo-endothelial systems) and lymphoid tissues; c. the inflammatory reaction; d. the thermoregulatory system; e. the recognition and control of pain and muscle spasm; f. the sensing of damaged tissue and its controlled regeneration. The autonomic nervous system (and its reflexes) controls to a large degree these defence systems in the body. The neuroendocrine system also allows the organism to adapt to changes in the internal and external environment. The PRIMITIVE SYSTEM of Becker (see the paper on Holistic concepts of health and disease) is also involved in the sensing and regeneration of damaged tissue, such as wounds, fractures, burns, etc. Occasionally the defence systems develop defects which cause them to react to self rather than non-self. Examples of self-destruction include auto-immune diseases and autoinflammation. Other examples are failure to recognise pain (due to congenital neurological defect or stress/excitement) with consequent risk of severe injury. One of the causal factors in cancer is uncontrolled tissue regeneration or failure of the immune system to recognise and destroy aberrant cells. The immune system, which normally serves a useful protective function, occasionally creates problems by causing reactions to allergens which gain entry to the body by inhalation, ingestion or by skin contact.

AP IN THE TREATMENT OF INFECTIONS AP textbooks and journals list many human infections which may be helped by AP stimulation. Treatment is aimed at the main symptoms of the infection (such as fever, headache, vomiting, diarrhoea, pain, colic, jaundice, paralysis, etc) and at the major regions involved (such as the liver, lungs, intestine, upper limbs, etc). Clinical infections in humans which may be helped by AP include:     

Bacterial (typhoid, paratyphoid, cholera, bacillary dysentery, brucellosis, venereal disease, tuberculosis). Viral (Virus B encephalitis, poliomyelitis, viral hepatitis, influenza, Heres Zoster). Protozoal (Malaria, schistosomiasis, filariasis, amoebic dysentery). Fungal (Tinea pedis). Post-operative infection.

Clinical infections in animals: Animal AP, even in China, is much less well developed than human AP. Traditional Chinese Medicine (TCM) also relies very heavily on the use of HERBAL Medicine, especially in the treatment of animal diseases. Thus, in veterinary practice, AP as a therapy to help fight clinical infections appears to be limited (at this time) to the treatment of enteric infections (such as E. coli) in pigs and dogs, uterine infections in cows and bitches, udder infections in cows, and a few other infections. As will be seen later, the use of AP in experimental infections and in the treatment of many clinical and experimental conditions in animals suggests that it may have wide applications in animal infections. Experimental infections: Animals have been infected with bacillary dysentery, poliomyelitis virus, trypanosomiasis and Erlich Ascites Tumour virus. In each of these conditions AP had complete or partial effect in combatting the infection. Further details of the antibiotic/antimicrobial effects of AP are given in Appendix 2. AP IN THE TREATMENT OF INFLAMMATION Inflammation is the normal defence reaction to local injury, infection, necrosis, allergy or other local irritation. Thus, inflammation is a desirable reaction and one does not try to treat inflammation per se, but to help the inflammatory response and to speed up its successful resolution. Where possible, the cause of the inflammation should be diagnosed, removed and/or treated also. In practice, many inflammations arise from non-specific or unidentified causes. In these cases, orthodox treatment consists of analgesic, anti-inflammatory, antibiotic drugs + penetrating agents and physical therapy, used in an empirical manner. AP is a highly effective means of treating clinical inflammatory conditions in humans and animals. The needles usually are used on local points (points near the inflamed organ or area), plus some needles on distant points on meridians passing through the affected organ or area. When they arise, associated symptoms (such as fever, cough, headache, back pain, etc) are treated by needling the relevant points for these symptoms. Human inflammatory conditions responsive to AP in clinical practice include:

         

Ear, nose, throat, eye, mouth (otitis, rhinitis, sinusitis, tonsillitis, pharyngitis, opthalmitis, conjunctivitis, stomatitis, gingivitis, glossitis Respiratory tract (tracheitis, bronchitis, pneumonia) Gastrointestinal tract (gastritis, duodenitis, gastroduodenal ulcer, enteritis, appendicitis, colitis, proctitis) Liver, gallbladder, pancreas, peritoneum (inflammation,pain, colic etc) Urinary tract (nephritis, cystitis, urethritis) Genital tract (oophoritis, salpingitis, metritis, cervicitis, and cervical erosion, vaginitis, orchitis, prostatitis) Muscle-skeletal (myositis, bursitis, tenosynovitis, arthritis) Cardiovascular (thromboangiitis, varicose ulcers, myocardial infarct and myositis) Lymphatic (lymphadenitis, lymphangitis) Skin and subcutaneous tissue (eczema, dermatitis, acne, furunculosis) Nervous tissue (neuritis, encephalitis)

Inflammatory conditions in animals which respond clinically to AP are basically similar to those in humans. However, as mentioned in the previous section, AP in animals has not been used as extensively as in humans. Veterinary AP literature mentions clinical success with inflammation in similar regions to those in humans. Examples are:        

gingivitis, stomatitis, rhinitis bronchitis, pneumonia gastritis, enteritis, hepatitis, cholecystitis, pancreatitis, peritonitis nephritis, cystitis, metritis, pyometra myositis, tenosynovitis, arthritis, laminitis eczema, lick granuloma mastitis, encephalitis

Klide and Kung's textbook and the books of Westermayer and Brunner list many more inflammatory conditions which are said to respond clinically to AP (see Appendix 1 of this paper). The conditions listed above refer to uncontrolled clinical observation in humans and animals. It could be argued that such observations do not prove that AP has anti-inflammatory effects. However, there is direct evidence from experimental work with animals which shows that AP has powerful effects on the inflammatory response. Experimental inflammation 





Bacterial peritonitis was produced in rabbits and other laboratory animals. AP greatly reduced the volume of inflammatory exudate produced and the exudate became (bacteriologically) sterile in a much shorter time in treated animals than in the control animals. Inflammatory granuloma was produced on the skin of the back in rats. After 8 days of treatment by AP or moxa at ST36 (TsuSanLi), treated rats produced 3.5 ml effusate, as compared with 7.0 ml in control rats. Turpentine injection in rabbits caused severe inflammation. AP treatment increased local circulation and lymph drainage and had strong effects in resolving the inflammation.





Perforated gastric or duodenal ulcers were produced in rabbits. AP enhanced peritoneal activity (speed of adhesion and speed of resorption of effusate) and was effective in alleviating the clinical signs. Myocardial infarct, necrosis and cardiopathy was produced in dogs and rabbits by arterial ligation. AP at PC06 (NeiKuan) improved coronary circulation, reduced the size of the infarct and the subsequent necrosis.

These experiments were conducted by Chinese workers but other experiments in animals also confirm that AP has anti-inflammatory effects. One of the most obvious uses of AP for its anti-inflammatory effects is in surgical (operative) cases. AP analgesia or AP therapy postsurgery causes a marked reduction in the incidence of post-operative complications (wound sepsis, slow healing, intestinal atony etc). Wound healing in acupunctured animals is fast and clean. The points used are similar to those used in AP analgesia for the surgical area (see paper on AP Analgesia) but points LI04 (HoKu), LI11 (ChuChih), GV14 (TaChui) and ST36 are especially effective in controlling wound infection and fever. AP IN THE TREATMENT OF FEVER Clinical fever: AP is used to reduce fever in many specific and non-specific conditions in humans. For this purpose, the points most often used are LI04, LI11 and GV14. For instance, these points are used to reduce fever in influenza, poliomyelitis, malaria, typhoid, cholera etc and in post-operative sepsis. The same points are used in non-specific fevers. Experimental fever was induced in rabbits by injection of typhoid vaccine. Needling of points ST36 and GV14 consistently reduced body temperature in the experimental rabbits but normal temperatures were not reached. However, repeated needling at these points reduced the duration of the fever as compared with the duration in control rabbits. Other Chinese experiments also confirmed the anti-febrile effects of AP in monkeys with experimental bacillary dysentery. In clinical veterinary practice, needling of points ST36; GV14; LI04; LI11 is recommended to help reduce fever in many specific and non-specific cases. AP EFFECTS ON ANTIBODY LEVELS Papers presented at the AP symposium at Beijing (1979) noted strong effects of AP in stimulating the immune response in humans and animals (6). Needling TienShu (ST25) and ShangChuHsu (ST37) increased immunoglobulins and specific antibody levels in blood of rabbits and monkeys experimentally infected with bacillary dysentery and in naturallyoccurring cases in humans. In clinical cases of human malaria, AP increases serum complement levels. Injection of specific antigen into many species of experimental animals (rats, guinea pigs, rabbits, monkeys) has been used to examine the antibody response to AP. The main points which enhance antibody production are LI04; HsuanChung (GB39) penetrating to San Yin Chiao (SP06); ST36. In these experiments, AP caused a faster rise in antibody level, a higher plateau and longer persistence of antibody than in the inoculated but non- acupunctured animals. AP EFFECTS ON PHAGOCYTES, RETICULO-ENDOTHELIAL SYSTEM AND LYMPHOID TISSUE

Under experimental conditions in humans, needling LI11 caused neutrophilia (leucocytosis), whereas needling a placebo point had no effect. In clinical medicine, LI11 (sometimes with as LI04, GV14 and ST36) is frequently used in infections and in other conditions in which activation of the neutrophils and reticulo-endothelial system is required. It is hardly coincidence that these effects are stimulated by the same points which activate the antibody system and that these points are valuable in the therapy of infections in humans. Similarly, in animals, points such as LI4, LI11, ST36 and GV14, cause leucocytosis and increase phagocytosis in experimental studies, as well as in clinical infections. For example, AP at LI11 caused leucocytosis in rabbits whereas placebo points did not produce this effect. Similarly, when plasma from rabbits needled at LI11 was injected into control rabbits, they also developed leucocytosis, whereas plasma from control rabbits injected into other controls caused a leucopenia. The release of a humoral leucocytic factor has been shown by other studies. It was also shown that this effect of AP was inhibited by nerve section above the point or by local anaesthesia of the point before needling. This demonstrates that the input signal to the hypothalamus is transmitted via the peripheral sensory nerve. Japanese workers challenged rabbits and rats with bovine serum albumin. ST36 and PangGu (new points on the limbs) were needled. Marked histological changes occurred in the lymph nodes of the acupunctured limb (enlargement of the lymph sinuses, haemorrhage, increase in mast cells and degranulation. A rapid increase in plasma cells occurred in 48 hours). It could be argued that these changes were of an inflammatory nature rather than an immune response. However, the other data of the trial indicated definite immune enhancement of antibody production and lymphocytopenia. AP also caused release of a humoral bactericidal factor. In experimental bacillary dysentery in rabbits and monkeys, AP at ST25 and ST37 increased the bactericidal activity of plasma by 50% after 30 minutes and by 70% after 3 hours. In these experiments, the phagocytic activity of the reticulo-endothelial system of the liver increased 46% after 6 days and 63% after 12 days of AP. The treated animals ceased to excrete the bacilli in faeces in 4-5 days, whereas control animals (untreated by AP) were still excreting bacilli after 21 days. All the symptoms (fever, abdominal pain, tenesmus, bowel frequency etc)were eliminated by AP. In 800 clinical cases of bacillary dysentery in humans, AP alone, given 1-3 times daily for 5-10 days was effective therapy in 90% of patients. The symptoms were controlled and the organisms were eliminated from the faeces. EFFECTS OF AP ON TISSUE DAMAGE CAUSED BY X-RAYS Rats exposed to X-rays developed anaemia and leucopenia. Needling at LI04, GB39 and SP06 caused the red cell count, haemoglobin level and while cell count to recover faster than in control rats which received the same dose of X-ray. AP has been used clinically in humans to assist recovery from nuclear exposure. Apart from its effects in haematology, nuclear exposure also damages the immune response in humans and animals. The immunostimulant effects of AP may be helpful to patients suffering from the effects of nuclear radiation, such as that used in cancer therapy. AP IN THE TREATMENT OF ALLERGIES

AP in human clinical allergies: AP is used to treat many human allergies, including allergies caused by inhalation, oral intake and skin contact. These conditions include asthma, hay fever, allergic rhinitis, food allergies, diarrhoea, contact allergies, allergic conjunctivitis etc. The most important points for treatment in asthma include FeiShu (BL13) and GV14 but other points are sometimes added, including HsinShu (BL15), KeShu (BL17), TingChuan (Asthma point) and HaiLao (a new point). In hay fever and allergic rhinitis, the main points are LI04 and YingHsiang (LI20) but other points, such as LI11 and Yin Tang (Z 03, between the eyebrows) are also used. In treating human allergies, the selection of the points is based mainly on the location of the symptom or lesions. For instance, in asthma, the main points are chosen for their action on the lung. In rhinitis the points are chosen for their action on the nose and upper respiratory tract. Thus, in treating a food allergy in which the main symptom was nausea and vomiting, the main points would be aimed at the stomach (ChungWan (CV12); ST36, PC06). If the main symptom was biliousness and dizziness with headache, the main points would be aimed at the liver and gallbladder ((TaiChung (LV03); FengChih (GB20) with possibly ST36 added for its gastric effect). A course of AP can often succeed in desensitising patients to their allergens, despite continued exposure to them. Examples are hay fever, migraine headache and food allergies. AP in clinical allergies in animals: There are few reports of the use of AP in specific clinical allergies in animals. However, it might be tried in fog fever in cattle and in bronchospasm in horses (similar to asthma) and in non-specific dermatitis, and pruritus in small animals. Also many symptoms of allergies (bloat, vomiting, diarrhoea, etc) in animals are known to respond to AP, aimed at the organ, region or symptom involved. Experimental allergy in animals: Allergic-encephalomyelitis was induced in guinea pigs by injections of an encephalogenic antigen. Needling certain points (LI11; ST36) enhanced the immune response and exaggerated the allergic response. On the other hand, needling ChihShih (BL52) prevented the allergic response. The antiallergic effect may have been due to release of ACTH and corticosteroids. BL52 has effects on the kidney and adrenal. AP AND ENDOCRINE RESPONSES In the paper on AP analgesia, the role of the hypothalamus and endorphin release is discussed more fully. AP stimuli are carried via the peripheral sensory nerves and sympathetic trunks to the hypothalamus. Hypothalamic activation with subsequent activation of the pituitary, may release ACTH, MSH, TSH, gondatropins, pancreatic (insulin) tropins etc depending on which nuclei in the hypothalamus have been stimulated. This, in turn, depends on which AP points have been stimulated. Release of these hormones may cause release of corticosteroids, adrenalin, thyroid hormones, oestrogen, progesterone, oxytocin, prolactin, relaxin, insulin, etc. Clinical endocrine disorders in humans: AP is used to treat many human endocrine disorders. If there are sufficient endocrine cells which can be activated by the trophic and/or neural stimuli, the results can be very good. However, in chronic or severe cases (especially where hormone substitution therapy has been given for a long time and has suppressed the body's ability to produce its own hormones), the results are not so good.

Examples of endocrine conditions responsive to AP include: mild goitre, mild hormonal infertility (due to oestrogen-prostaglandin-progesterone imbalance), post-parturient agalactia (prolactin, oxytocin), uterine atony at parturition (oxytocin); cervical non-dilation at parturition (ringwomb); recurrent abortion; menopausal syndromes. ln early or mild cases of diabetes mellitus, AP at SP06; LV13 (ChangMen); BL20 (PiShu) can be very effective in controlling blood sugar and in treating pancreatitis. In diabetes insipidus, due to deficiency of the antidiuretic hormone, needling at BL23 (Shen Shu), BL28 (PangKuangShu); GB25 (ChingMen) can help. Clinical endocrine disorders in animals: Similar conditions in animals have been helped (reproductive disorders; parturition disorders; agalactia; pseudopregnancy; polyuria; hormonal alopecia in castrated cats). However, as in other areas of veterinary AP, documentation of these effects in very scarce. The evidence from clinical use in humans and animals suggests that some of the therapeutic effects of AP are mediated by the endocrine system. OTHER CONDITIONS RESPONSIVE TO AP THERAPY Earlier sections discussed many therapeutic effects of AP. These include leucocytosis, increased activity of the phagocytic, lymphoid and reticulo-endothelial systems, release of a leucocytotic factor and a bactericidal factor into plasma, enhanced antibody production, antifebrile, anti-inflammatory and anti-infectious effects. These effects help to explain the therapeutic value of AP in fighting infection, resolving inflammation and reducing fever in humans and animals. Increased haematological stimulation and immunostimulation also help to explain the effect of AP in damage caused by exposure to nuclear radiation. These effects are stimulated only by certain points. Other points have immunosuppressant effects and help patients during the allergic reaction. Still others act by releasing various hormones in mild endocrine disorders. Other applications of AP in humans and animals include: pain, poor circulation, smooth muscle dysfunction, tissue damage and bleeding, paralysis, paresis and miscellaneous. a. PAIN Pain due to trauma, inflammation, ischaemia, muscle spasm, arthritis and other peripheral causes, can be helped, if not fully controlled, by AP. Pain conditions in humans which respond in varying degrees to AP are: headache, toothache, eye pain, earache, neck pain; colic; pain in gastric, duodenal or colonic ulcer; backache, sciatica; pain in the muscles and joints, phantom limb pain, angina pectoris, narcotic withdrawal pain. One of the main uses of AP in human patients is in the control of chronic peripheral pain. However, pain of central origin does not respond well. AP is also of astonishing value in treating acute traumatic pain (fractures, dislocations, pulled muscles, contusions, abrasions, etc). For this purpose, the most important point is YangLingChuan (GB34). GB34 is usually combined with a local point for the region involved.

AP is also of great value in treating post-operative pain (and other complications, such as inappetance, nausea, ileus and urine retention) in humans. For this purpose the main points used are the same as in AP analgesia for the region (see paper on AP analgesia). Points to assist the function of the stomach, large intestine, kidney and bladder are added, as needed. Pain conditions in animals which respond to AP include: Lameness due to muscular rheumatism, muscle spasm, myositis; arthritis; spinal trauma and mild cases of intervertebral disc protrusion; laminitis, tendinitis, periostitis and trauma; abdominal colic (gastrointestinal, hepatic, renal, cystic, uterine, etc). Post-operative pain in animals: Although AP is seldom used specifically for this purpose in animals, those which have been operated upon under AP analgesia have far fewer complications and heal faster than those operated upon under conventional anaesthetics. Post-operative complications in animals: after surgery, AP can be used to obtain pain relief and to help restore normal physiological function, as in humans. b. POOR BLOOD CIRCULATION Many human clinical conditions are caused by poor blood circulation. Coronary heart disease (CHD) and angina pectoris are greatly helped by frequent needling of PC06. Experimental reduction of coronary blood supply in dogs was used as a model of human CHD. AP at PC06 improved coronary/myocardial circulation, reduced the size of the subsequent infarct and assisted the healing of the damaged muscle. Muscular aches and pains, "pins and needles" (peripheral paraesthesia) or ulcers, etc in humans are frequently caused by poor blood circulation. AP is effective in many of these conditions. Human indigestion and hyperacidity may be associated with poor circulation in the gastrointestinal tract. AP is very effective in these conditions. Two important points are ST36 and PC06; others include CV12 and BL21. Under experimental conditions in laboratory animals, stimulation of ST36 and PC06 improves mesenteric and gastrointestinal circulation and delays or prevents the onset of experimental ulcers, or assists in their resolution. Similarly, gastrointestinal hyper- or hypo-motility is corrected by needling these points. Poor circulation in the brain, such as in senile human arteriosclerosis, may cause many problems. AP of points which act on brain function helps to alleviate these problems. Under experimental conditions in animals, AP at JenChung (GV26) greatly improves brain microcirculation. GV26 is the emergency point par excellence in shock, collapse, coma, heatstroke, convulsions and anaesthetic apnoea in humans and animals. Similarly, nausea and fainting in humans are quickly corrected by needling or massaging GV26. However, other points also help nausea + dizziness. These include PC06; ST36; GB20; CV12. By its effect on the autonomic nervous system (see below) AP has powerful effects on blood circulation in most vascular areas. The points for specific regions are similar to those for pain or other problems of those regions. c. SMOOTH MUSCLE DYSFUNCTION

Human conditions very often involve spasm of smooth muscle. Examples are pain in angina pectoris; biliary, renal, uterine and gastrointestinal colic; peripheral circulatory upsets; asthma etc. Factors which relieve smooth muscle spasm greatly reduce or eliminate the symptoms. AP of the correct points produces this result. Also, in obstruction of ducts (such as the bile duct and ureter), smooth muscle spasm not only causes pain but also prevents the obstruction from being expelled. AP often allows calculi to pass out of the gallbladder, bile duct, ureter or bladder by inducing relaxation of the smooth muscle and by increasing the fluid pressure proximal to the calculus. In children, ascaris worms in the bile duct often have been expelled after AP and even expulsion from the gut has been claimed. Many studies have shown that needling the correct points has marked effects on smooth muscle contractability, bile flow, peristalsis and gastrointestinal secretion. Smooth muscle spasm in animals: The antispasmodic effects of AP are of use in treating colics and digestive upsets. They are also of use in treating bronchospasm. In dystocia, relative oversize of the foetus and uterine atony are often present. Kothbauer and Westermayer used AP routinely in bovine dystocia. They found that pelvic relaxation occurred within 10 minutes of AP and the birth was greatly helped by this. Westermayer treated more than 200 cases of prolapsed uterus in cows by AP of the lumbosacral region. The uterus was easily put back in position and straining by the cow seldom occurred, making the procedure simple and very fast. Also in retention of the foetal membranes or in metritis + pyometra (in which uterine atony is involved) AP may help the condition. d. TISSUE DAMAGE AND BLEEDING These conditions often follow trauma. Other factors also cause tissue damage, for instance liver and kidney damage in many toxic conditions; heart and brain damage in circulatory disorders; muscle damage in Vitamin E and selenium deficiency etc. The effects of AP in traumatic pain has been mentioned earlier. However, AP also assists the recovery of damaged tissue, if tissue regeneration is possible. For instance, the skin and liver have marked regenerative capacity and AP stimulates this effect, by improving local circulation and its antiinflammatory and anti- infectious effects. Muscular injury in humans and animals is also greatly helped by AP. The best points are the tender spots (AHSHI points, trigger points) in the damaged muscles and the AP points which control the damaged area. Where subcutaneous or intramuscular bleeding and oedema result from trauma, AP helps in the resorption of the fluid and in the resolution of the swelling. Where tissue damage is severe (as in extensive burns or trauma) the main approach should be to control shock, haemorrhage, fracture and infection by conventional means. AP may be used later to relieve pain and to assist tissue healing. AP cannot stimulate tissue regeneration if the tissues are incapable of regenerating, such as in severe neural, spinal, cardiac, pulmonary or renal damage. However, many cases of severe lameness in humans and animals are (wrongly) attributed to severe lesions in joints or in the spine, including prolapsed inter-vertebral discs. Many of these patients can be greatly helped by AP, but the lesion (other than soft tissue swelling, oedema etc) remains unaffected by the treatment. This suggests that many cases of such lameness are not due to the lesion, but to

reflex muscle spasm triggered initially by the lesion. The clinical effects of AP in these cases are due to their effects on pain and muscle spasm. e. PARALYSIS, PARESIS These conditions may arise in humans and animals from nerve damage at central, spinal or peripheral level. For example, human cerebral haemorrhage, thrombosis, encephalitis, spinal injury or peripheral nerve injury may cause paralysis of one or more regions or functions. We are taught that if the nuclei of motor neurons are damaged, the neurons cannot regenerate and that paralysis due to neural necrosis is irreversible. However, we also know (1) that many cases of paralysis occur from axon damage, (2) that functional damage to the nervous system (poor micro-circulation) may cause paralysis, and (3) that considerable plasticity exists in the nervous system, i.e. that some neural circuits can be re- programmed to adopt new functions. These facts explain a reasonably high success rate of AP in treating conditions such as central, spinal and peripheral- nerve paralysis in humans. I would strongly recommend that any of you who have friends or relatives who suffer from recent paralysis should consult with a competent medical acupuncturist. AP combined with conventional therapy can be very helpful in many of these cases. Animals usually suffer paralysis from trauma or arthritis, involving the vertebral column or trauma to peripheral nerves. AP is very effective therapy for many of these cases but many sessions may be required and physical manipulation may also be required. (Paralysis from central causes, metabolic upsets or poisoning is not in discussion here). Paralysis associated with prolapsed intervertebral disc may also respond to AP. As in the treatment of pain, AP does not alter the physical lesion (dislocation, arthritis, spondylitis, disc prolapse etc) but function is often restored despite the persistence of the lesion. This indicates that these cases of paralysis may be functional or due to oedema or poor blood supply to the nerve tracts. The antiinflammatory, antioedematous and pro-circulatory effects of AP may explain the clinical recovery in these cases. f. MISCELLANEOUS CONDITIONS The list of conditions which can be helped by AP runs to hundreds. Some respond very well, others have less satisfactory results, or require many sessions. In general, AP has therapeutic effects on all the major systems of the body in humans (nervous system, the 5 senses; endocrine system; respiratory, cardiovascular, digestive, reproductive, urinary, musculoskeletal systems and skin). It also influences all the main body regions (and their parts) and organs, including the head, neck, upper limb, thorax, abdomen, spine and lower limb. Recent reports from Hospitals in Sweden and Taipei suggest that AP has powerful effects in treating spastic paralysis and cerebral palsy in children. No one textbook of AP lists all the conditions amenable to therapy, but a study of many textbooks and journals will demonstrate the wide range of clinical uses (for details, see references 1 to 7 at end). Veterinary AP therapy is not as well developed as human AP, but a wide range of clinical conditions (involving all the main physiological systems and all the body regions, their parts and organs) may be helped. The main limiting factor is often the economic one. AP therapy generally requires more time per session and more sessions to be effective, especially in chronic cases. Time is money to a busy veterinarian and to the client. It is often decided that

the cost of treatment would not be justified on economic grounds because of the relatively small cash value of the animal. However, in the case of family pets, racing animals (dogs, horses) and valuable breeding stock, the economic considerations are less important. Appendix 1 lists miscellaneous conditions in animals which can be helped by AP. For further details on AP in the activation of the defence systems, see References 6, 10, 11, 12 at the end of this paper. CONCLUSIONS AP at specific points activates the defence system of humans and animals via reflex neural effects, autonomic effects, neuroendocrine, endocrine and humoral effects. Sensory input to the hypothalamus is most important in these effects. Other mechanisms, such as the Primitive Nervous System of Becker, may be involved in the slow healing processes. In general, if activation of the defence systems of the body can affect the clinical condition or if tissue regeneration is possible, AP is indicated as a possible therapy alone or in combination with other therapies. AP has wide therapeutic effects in infection, inflammation, fever, allergy, endocrine disorders and many other clinical conditions. AP is not a panacea; it should be seen as an aid to conventional therapy and not as a complete alternative to it. AP may be the treatment of choice in some cases (for instance anaesthetic apnoea, muscular lameness). In other cases, AP combines well with other therapies (i.e. with antibiotics in mastitis, with glucose infusion + corticosteroids in bovine ketosis). AP is useless, or of very little use in cases in which the adaptive response is disabled (for instance in terminal malignant cancer, severe spinal damage, the later stages of liver or renal fibrosis). In these cases other therapies are required but these may be of little use also. APPENDIX 1 EXAMPLES OF ANIMAL DISORDERS WHICH MAY BE HELPED BY AP This list is not complete. It is extracted from the veterinary AP textbooks by Brunner, Gilchrist, Klide and Kung and Westermayer. (See references). GENERAL CONDITIONS: Emergencies, poisoning, intoxication, toxaemia, hog cholera, distemper in dogs; agalactia, mastitis, udder oedema; fevers, chills; general weakness, lack of energy; exhaustion, over-exertion, dullness; polyhidrosis, insect bites; tranquillizer effect; to calm after a race; to tonify before a race; haemorrhage after uterine contraction; pain; to stimulate immunity; allergy; stress. MUSCULOSKELETAL DISORDERS: Lameness, pain, sprain, trauma to muscles, joints, bones, tendons; muscle pain, trauma, atrophy, rheumatism, tired muscles, "tying-up", myositis, myotonia, muscle spasms; arthropathy, arthritis, joint pain, strain, trauma, luxation; bone trauma, periostitis, osteomalacia, rickets; ring-bone, sidebone; tendon disorders, pain; bowed tendons; tendonitis, tenosynovitis; tendovaginitis; bursitis.

DISORDERS OF HEAD REGION: Nervous system: encephalitis, encephalomyelitis, encephaloedema; cerebral accidents, cerebral anaemia, cerebral hyperaemia; stroke; mental disorders; convulsions, epilepsy, chorea, ataxia, dizziness, unconsciousness; paralysis, wobblers, tetanus. Eyes: cataract, keratitis, pannus, ophthalmia; ocular microfilariasis; excess tears; conjunctivitis, eyelids swollen. Ears: certain types of deafness; ear paralysis. Face: facial swelling; trigeminal neuralgia; facial paralysis. DISORDERS OF THE NECK: pain, sprain, rheumatism, muscle spasm, arthritis, subluxation, myositis of m. sternobrachiocephalicus. DISORDERS OF FORELIMBS: General: pain, sprain, rheumatism, trauma, arthritis, lameness, paralysis, weakness and oedema of the forelimbs. Shoulder: pain, sprain, luxation, trauma, rheumatism, arthritis, lameness; shoulder m. atrophy; scapular and suprascapular n. Paralysis. Arm: pain, rheumatism; biceps brachii m. strained; muscle pain. Elbow: pain, sprain, trauma, luxation, rheumatism, arthritis. Forearm: radial, ulnar and medial m. paralysis; muscle pain, rheumatism. Carpus: pain, sprain, luxation, arthritis, trauma, swelling, synovitis. Metacarpus: pain etc; flexor and extensor tendon disorders; bucked shins. Fetlock: arthritis, luxation, trauma, contusion, oedema; unable to flex fetlock. Digit: pain etc. Hoof: disorders laminitis, bulb of heel pain and inflammation; navicular disease. DISORDERS OF THORAX: General: pain, spasm, colic, oedema, pleuritis, diaphragmspasm. Cardiovascular and haematological: heart disorders, arrythmia; circulatory disorders; arterial and blood pressure disorder; anaemia; leucopenia; ascites, oedema; shock, collapse, syncope, heatstroke. Respiratory: nose disorders, rhinitis, rhinorrhoea, purulent sinusitis, epistaxis; pharyngitis, laryngitis, tracheitis; lung disorders; bronchitis, pneumonia, lung oedema, congestion; lung haemorrhage; emphysema; allergies; coughs, colds, 'flu, asthma, wheezing, not enough wind; respiratory viruses; pleuritis. DISORDERS OF BACK AND ABDOMEN: General: pain, spasm, colic, oedema, ascites; abdominal disorders; peritonitis, adnexitis; liver diseases, hepatitis, cholecystitis, icterus; ketosis and fatty liver, diabetes mellitus, pancreatitis. Mouth and digestive system: stomatitis, salivation, glossitis, tongue ulcer, swelling, lips swollen, trismus, masseter spasm; disorders of the jaws; chewing difficulty; pharyngitis, parotitis, pharyngeal paralysis, oesophageal paralysis; inappetance, anorexia. Gastric: dilation, atony, bloat, gastritis, vomiting, hyperacidity. Intestinal: enteritis, colitis, spasm, colic. Gastrointestinal: bloat, allergies; spasm, colic, gastroenteritis, diarrhoea, dysentery, blood in faeces, constipation, hog cholera. Rectum: paralysis, prolapse. Reproductive tract: infertility, sterility, nymphomania, prolonged oestrus, anoestrus, pseudopregnancy, dysmenorrhoea; ovarian dysfunction, oophoritis, cystic ovary; salpingitis; metritis, pyometra, dystocia (to relax pelvis and assist birth); uterine prolapse (to assist reposition); vaginal prolapse, vaginitis; male impotence, depressed libido, penile paralysis; orchitis, scrotal oedema. Urinary tract: incontinence, dysuria, difficult urination, anuria, urine retention, haematuria. Kidney, ureter, bladder and urethra: nephritis; ureter spasm; cystitis, bladder retention spasm; urethritis. Pelvic area: sacroiliac strain, luxation; to relax pelvis in obstetrics. Lumbosacral area: pain, rheumatism, stiffness, myositis, spondylosis, arthritis, nerve paralysis, paresis, posterior paralysis. SPINAL DISORDERS: Pain, spasm, rheumatism, stiffness, myositis, lameness, etc in the spinal or paravertebral area from neck to tail. Vertebral disorders: arthritis, luxation, mild disc prolapse; spinal trauma; spinal paresis and paralysis, torticollis, wobbler syndrome.

HIND LIMB DISORDERS: Hindquarter: rheumatism, pain, spasm of rump muscles; paralysis of the tail and hindquarters; Hindlimb: rheumatism, myositis, pain, spasm, lameness, arthritis, motor malfunction, weakness, paralysis; hind limb oedema. Hip: pain, rheumatism, spasm, lameness, arthritis, dysplasia; sciatic nerve paralysis, femoral nerve paralysis, myositis of semimembranosus and biceps femoris m. Stifle (Knee): pain, rheumatism, arthritis; patellar luxation; stifle locked; pain in region of tibia, fibula; tibial, fibular m. paralysis. Hock (tarsus): swelling, pain, hypertrophy, spavin, arthritis; pain, inflammation and swelling of Achilles' tendon. Metatarsus: pain, bucked shins, arthritis, flexor tendon disorders. Fetlock: oedema, pain, arthritis, luxation, trauma, inability to flex. Digit and hoof: pain, laminitis, panaritium, phlegmon, pododermatitis, heel and bulb of heel pain. SKIN DISORDERS: allergy, urticaria, pruritus, trauma, eczema, dermatitis. APPENDIX 2 EXPERIMENTAL TRYPANOSOMIASIS: Mice were infected experimentally with Trypanosoma evasi. Some of the mice received water injections at GV14, ST36 + AiKen (a point behind the second metatarsophalyngeal joint, at the inner side of the plantar surface). Others remained as infected, untreated controls. AP significantly prolonged survival time of infected mice. All control mice died. Some of the treated mice lived (Lin et al 1976, Chinese Med. J. (Taiwan), 23, 152-157). EXPERIMENTAL ERLICH ASCITES TUMOUR was induced in mice by inoculation with tumour cells. Some of the mice were needled at the same points as above. AP significantly prolonged the survival time of treated mice as compared with controls but all mice died eventually (Lee and Lin, 1975. Chinese Medical J. (Taiwan) 22, 167-171). EXPERIMENTAL POLIOMYELITIS was induced by virus injection in rhesus monkeys. Ligation of certain points enhanced nerve fibre regeneration and the formation of neuromuscular plaques in paralysed muscle. It also increased cholinesterase in the large motor neurons in the ventral horn or the spinal cord, increased the number of dendrites and synapses in the segment, increased the conduction velocity in motor nerves and increased metatarsal perspiration (Anon 1979 a, p. 517). CLINICAL HUMAN POLIOMYELITIS: AP or injection of the relevant points gave valuable therapeutic results in 360 cases. In patients treated in the acute (febrile) phase, improvement occurred in 88% and 52% recovered. In patients treated in the first month of illness, the response rate was 48%, as compared with 31% and 18% respectively in those treated within 6 months and after 6 months of onset respectively (Anon 1979a, p.76). CLINICAL VIRAL HEPATITIS was treated in 280 cases by manual or electro-AP of relevant points. Treatment was effective in 90% of cases in eliminating the symptoms (fever, jaundice, gastrointestinal upset, pain etc) and in restoring health in less than 3 weeks. (Anon 1979a, p. 41 and 43). CLINICAL BACTERIAL ENTERITIS IN PIGLETS: E. coli enteritis in piglets was treated by needling certain points or by spiramycin. Some scouring piglets were left as untreated controls. AP once daily gave a highly effective clinical response in 2-5 days, as good as, or better than, the response to spiramycin (Anon 1977a, p265-). The results are summarised below.

Trial 1 Treatment

No. % cured 5th day

Points used

Acupuncture

18

88

GV03, GV01, YuTang, ShanKen

Spiramycin

18

83

none

Control

18

44

none Trial 2

Treatment

No.

% cured 5th day

Points used

Acupuncture

20

85

GV01, GV03, YuTang

Control

20

0

none

Acupuncture

20

95

GV01, BL20, ST36

Control

20

0

none

Acupuncture

20

100

BL20, ShanKen, TiMen

Spiramycin

20

100

none

YuTang : 0.5 tsun on either side of midline of hard palate, 1 tsun behind incisors ShanKen: midline, just above snout (GV25) TiMen : just above bulb of heels INFERTILITY IN COWS: AP at YungChi gave excellent results. YungChi is 5 fingerwidths on either side of the spine, between lumbar vertebrae 5-6. FURTHER READING MATERIAL AP textbooks and Symposium Proceedings are available from Acumedic, 103 Camden High Street, London, UK.  1. American Journal of AP (1973-), Quarterly Journal.  2. Scandinavian Journal of AP and Electrotherapy, from Pekka Pontinen, 4-B-77 Pikkusaarenkuja, Tampere, Finland.  3. Anonymous (1993) Academy of Traditional Medicine, Beijing. Essentials of Chinese AP. English version. Foreign Languages Press, Beijing 432pp.  4. Anonymous (1977a) United States Dept. Health translation of official Chinese (1970) manual. A barefoot doctor's manual. Running Press, 38 South 19th St., Philadelphia, Pennsylvania, USA 948pp.  5. Anonymous (l977b) Basic AP: a scientific interpretation and application. English version. Chinese AP Research Foundation, Box 84-223, Taipei, Taiwan, Republic of China 313pp.  6. Anonymous (1979b) AP, Moxibustion and AP anaesthesia. Proceedings of the Beijing 1979 Symposium, parts 1-5. Foreign Languages Press, Beijing. 534 abstracts, 517pp.  7. Anonymous (1979b) The treatment of 100 common diseases by new AP. Medicine and Health Publishing Co., Hong Kong 89pp.  8. Brunner, F. (l980) Akupunktur der Kleintiere. WBV Biologisch Med. Verlag, Ipweg 5, D7060 Schorndorf, Germany 309pp.

 8a. Gilchrist, D. (1981) Manual of AP for small animals. PO Box 303, Redcliffe, Queensland 4020, Australia 79pp.  9. Klide, A.M. and Kung, S.H. (1977). Veterinary AP. University of Pennsylvania Press, Philadelphia, Pennsylvania USA 297pp.  10. Lin, J.H. and Rogers, P.A.M. (1980). AP effects on the body's defence system: a veterinary review. Veterinary Bulletin (August issue), 50, 633-640.  11. O'Connor, J. and Bensky, D. (1975) Summary of research on the effects of AP. American Journal of Chinese Medicine, 3, 377-394.  12. Rogers, P.A.M. and Bossy, J. (1981) Activation of the defence systems of the body in animals and man by AP and moxibustion: additional evidence from the Peking (1979) Symposium: AP Research Quarterly (Taiwan), 5, 47-54.  13. Westermayer, E. (1978) AP in horses. Health Science Press, Devon, UK and WBV Biologisch Med. Verlag, D7060 Schorndorf, Germany 90pp.  14. Westermayer, E. (1978) Atlas of AP for cattle. WBV Biologisch Med. Verlag, D7060 Schorndorf, Germany 60pp.  15. Rogers, P.A.M. (1990) AP for immune-mediated disorders. Chapter 14 of text on Veterinary AP. Lippincott Publishers, USA, in press.

ACUPUNCTURE FOR IMMUNE-MEDIATED DISORDERS

See also the earlier review "Acupuncture effects on the body's defence systems and conditions responsive to acupuncture" (Rogers 1980) SUMMARY Acupuncture (AP) activates the defence systems . It influences specific and nonspecific cellular and humoral immunity; activates cell division, including blood-, reticulo-endothelialand traumatised- cells; activates leucocytosis, microbicidal activity, antibodies, globulin, complement and interferon. It modulates hypothalamic-pituitary control of the autonomic and neuroendocrine systems, especially microcirculation, response of smooth and striated muscle and local and general thermoregulation. Applications of AP include inflammation; trauma; tissue healing; burns; ulcers; indolent wounds; ischaemia; necrosis; gangrene; infections; post-infection sequelae; fever; autoimmune disease; allergy; anaphylaxis and shock; treatment or prevention of side effects from or sequelae to cerebrovascular disease (CVD), coronary heart disease (CHD), general anaesthetics, parturition, surgery, cytotoxic chemotherapy and ionizing radiation. AP may inhibit neoplastic cells. Immunostimulant points include LI04,11; ST36; GB39; SP06; GV14; BL11,20,23-28; CV12. Some, such as BL52 are immunosuppressive. Antifebrile points include GV14 and ST36. Reactive reflex SHU, MU and Earpoints are useful in organic diseases. In immunomediated diseases, some or all of those points can be used with other points, especially local points and points for the major symptoms and/or points for the affected body part, area, function or organ. INTRODUCTION "Control of infectious diseases has depended on the use of vaccines and antibiotics, isolation and embargo, test and slaughter programmes. These strategies have failed to eradicate the major infectious diseases of livestock" (1). "Bacterial infections of the mare's uterus have the same incidence as they had before penicillin was discovered and the economic importance of endometritis is increasing with the increase in value of horses" (2). Micro-organisms and other pests preceded the evolution of higher species and will exist long after their extinction. For optimum chance of survival, higher forms must learn to co-exist with lower. Adaptation is the key. Acupuncture (AP) has antiinflammatory, antibacterial, antiviral effects. It enhances humoral and cellular immunity and has antiallergic effects. Earlier papers on the effects of AP on immunity were reviewed (3-9). Trelles et al (10) reviewed low power laser therapy (LLLT). The stimulus elicited analgesia, vasodilation, antiinflammatory and antioedematous effects, biostimulatory effects, cell proliferation, cicatrisation and tissue regeneration (wounds, burns, ulcers of skin and portio uteri, herpes lesions, urethritis, haemorrhoids, sinusitis, bone

fractures and osteomyelitis, arthritis, muscle injury, neuralgia, alopecia areata) and local immune responses. This Chapter summarises papers published mainly since 1980. The papers were published in medical journals, or in journals not usually read by orthodox health professionals. Most of the abstracts are from the American Journal of AP and the Scandinavian Journal of AP and Electrotherapy. Most of the reviews listed above are excluded. Readers are referred to those reviews. EFFECTS OF AP ON THE IMMUNE SYSTEM AND CLINICAL USES AP, Electro-AP (EAP) or moxa enhanced the recovery of red and white cell counts (RCC and WCC) to normal or near-normal values in many conditions (11), including experimental radiation sickness (13-17), experimental Vibrio cholerae sensitivity (18). AP post-op in humans enhanced WCC, neutrophil phagocytosis, lymphocyte counts, and bactericidal activity (19). Low Level Laser Therapy (LLLT) increased phagocytosis in chronic wounds in horses (20), improved immune functions and remedied anaemia in children (21). Homoeostatic effects of AP are more obvious when abnormalities exist first (14). AP in patients on long-term cortisone therapy for spastic bronchitis, restored granulocyte migration to almost normal values (22). LLLT decreased the numbers and caused marked degranulation of mast cells in irradiated tissues (23). EAP or moxa enhanced the activity of the reticuloendothelial system (24,25) but if used too often, adaptation reduced the effect (26-28). Narcotic medication inhibits local immune response (29). AP or moxa enhanced cellular immunity (29-31), increased lymphocyte proliferation/count (30,32), lymphocyte transformation (LT) (31,33-35), T-cell numbers (36), serum globulins (34), T-cell staining by alpha naphthyl acetate esterase (ANAE) (37,38) and E-rosette formation (29,31,38). AP increased Natural Killer (NK) -cell activity (32). AP increased suppressor/cytotoxic Tcells, E-rosette positive T-cells and Leu 7+NK cells. Leu 11+NK cells decreased (39). SPECIFIC AND NON-SPECIFIC ANTIBODIES, GLOBULIN, COMPLEMENT, INTERFERON Globulins and antibodies: AP, LLLT or moxa increased SIgA in the small intestine in mice sensitised against Vibrio cholerae (18), Igs, specific antibodies and faecal IgA in bacillary dysentery (40), plasma IgM in chronic pelvic inflammation (41), beta and gamma globulins and A/G ratio in dogs with g/i helminthiasis (42) and antibody formation in wounded horses (20). AP improved non-specific immunity and regulated hyperactivity of the non-specific immune system in asthmatic and normal subjects (43). AP, LLLT and moxa improved immune parameters in systemic lupus erythematosus (44). Plasma cAMP was low in early malaria, indicating that metabolites of Plasmodia inhibit immune responses. As AP may cure malaria, its actions are thought to involve activation of the immune system and its symptomatic effects (45). AP or moxa increased complement in acute bacillary dysentery (40) and in scleroderma and asthma (46). Moxa increased complement in rabbits (47). AP increased circulating interferon in humans. Stimulation of interferon production may have clinical uses in viral infections and in other diseases (48). PRE-, PER- AND POST- OPERATIVE INDICATIONS FOR AP: General anaesthesia suppresses antibody response (49) and other immune functions. It markedly reduces lymphocyte blastogenesis, which is not influenced by AP analgesia (50). Reflex analgesia by AP, EAP or TENS enhances immune response (see above) and leaves autonomic functions,

including those of the foetus, intact (51,52). Effective methods of pre-, per- and post- op management, if they have immunostimulant effects, would be in the best interests of the patient and would reduce the need for potent drugs (opiates, barbiturates, diazepam, epidurals, gastric sedatives etc) and depress vital functions less (53,54). Shock, anxiety, anorexia, nausea, vomiting etc are common pre-op. Some patients are hypersensitive to drugs. Pain, shock, abdominal spasm, anxiety, anorexia, wound infection, adhesions, scar TPs, intestinal adhesion, ileus, nausea, vomiting, apnoea, dyspnoea, retention of sputum, laryngitis, decreased renal filtration rate, urinary retention, peripheral ischaemia, pressure ischaemia etc are common post-op. AP pre- and/or post- op can prevent or treat most of those complications. Combination of per- and post-op EAP reduces the demand for post-op analgesic drugs and patients become self-caring more quickly (55,56). In particular, Patterson (53) cited data which showed that the incidence of post-op sepsis was 3% in patients under AP analgesia or electro-analgesia, as compared with 17% under general anaesthetics. AP, EAP or acupressure at PC06 was more effective in preventing pre- or post- op nausea and vomiting than cyclazine and metoclopramide in patients undergoing surgery (57-59). When given during operation under drug anaesthesia, EAP (5 minutes at 10 Hz) was not effective (60). Nausea and vomiting due to passing a laryngoscope can be prevented in 80% of patients by heavy acupressure on LI04 (61,62). Atropine or conventional anticholinergic agents produce side effects, including dry mouth, blurred vision, dizziness and tachycardia. AP can replace anticholinergics, with few or no side effects, to facilitate gastroscopy or a barium meal (63-67). AP, EAP or LLLT are useful per-operative analgesics in: high-risk patients (68); coordination of uterine contraction in labour (69,70); Caesarian section (71); gynaecological operations (31) and in hysterectomy. Post-op analgesia persists for 3-4 hours (54). EAP combined with epidural (55), local or general anaesthesia for surgery reduces the amount of anaesthetic drugs needed (71) and confers neurovegetative protection from the effects of surgical trauma (72). Post-op recovery of spontaneous breathing, consciousness (56), and autonomic function is faster and the immune system is less depressed after combined anaesthesia than after drug anaesthesia without AP (68,73,74). Similar analgesic and neurovegetative effects occur with post-op use of EAP and TENS (75). AP or EAP post-op stimulates fast recovery of liver function (69) and reduces hallucinations on emerging from ketamine anaesthesia (76). EAP and TENS post-op gave better analgesia than i/v meperidine but EAP analgesia lasted longer than TENS analgesia and increased with repetition of treatment (77). EAP post-op halved the use of pethidine (78). In post-op wound infection, blood vessels near the HuatoJiaJi points become engorged, usually in the scapular or inter-scapular area in the case of infected wounds of the upper limbs or face and in the lumbar area in the case of the lower limbs. One paravertebral needling, to release a few drops of blood from engorged vessels on the back, cured most cases (79). AP was better than laser-AP or narcotic management of post-op infected wounds as regards analgesia, speed of healing and hospital stay (29). EAP reduced post-op intestinal adhesions (80). EAP or AP rapidly cured urinary retention post-op and in paraparetic cases (81-83) or retention postpartum or post-obstetrical surgery (84). AP restored urinary function in 100% of cases of retention or incontinence due to laceration and spondylosis of sacral vertebrae (85).

AP was effective in 96% of ileus/obstipation cases. Most cases emptied the bowel within 1 hour (86). TRAUMA, TISSUE HEALING, BURNS, ULCERS, FISTULAS, INDOLENT WOUNDS: The success and use of plastic surgery, tissue replantation can be improved by increasing local blood circulation, phagocytosis and inflammatory reaction and/or preventing arterial spasm, thrombosis, blood sludging or clotting. Topical leeches (87), nitroglycerin, AP, EAP and LLLT enhance flap/graft survival (88-90). Time to obtain pain relief and to resolve swelling in bone fracture and time to eliminate other symptoms and to heal the fracture was less than usual with EAP (91). EAP, Electrostimulation (ES) or LLLT greatly enhanced the rate of healing and strength of repair of wounds (92-94) and infected wounds and burns (95) and local antibiotics did not improve the success (96). Brown et al (11) stated that AP stimulation gave a longer rise in ipsilateral skin temperature (vasodilation) than stimulation of "non-points". AP or EAP via needles around the edge of trophic ulcers, including post-phlebitis ulcers, cured 100% (97). AP cured thromboangitis obliterans (98). AP, with anticoagulant therapy (heparin), cured thrombophlebitis (99). LLLT cured chronic wounds in horses (20). TENS or LLLT cured wounds, fistulas and peripheral circulatory disorders including ischaemia, ulcers, gangrene (10,100-103); chronic leprous ulcers (104). The healing rate was the same as in TENS treatment of other types of ulcer (neuropathy, atherosclerosis, varicose veins, thrombophlebitis, decubitus etc). Marked, prolonged vasodilation follows non-segmental TENS, probably due to release of vasoactive intestinal polypeptide (VIP), endorphin and serotonin (104). AP cured 92% of anal fissures. Pain and bleeding improved or stopped after the first session in 82% (105). Moxa needle (warming effect) was better than EAP or simple AP in re-establishing peripheral circulation in frostbite of the fingers (106). INFLAMMATION, LOCALISED AND ORGANIC INFECTION: EAP inhibited experimental inflammation. EAP into the site gave the greatest antiinflammatory effect (107-109). AP suppressed histamine-mediated increase in vascular permeability and reduced exudation in burns (110). AP or LLLT cured and prevented acute conjunctivitis (111), cured maxillary sinusitis (112,113). The results were better than with antibiotics. EAP is a first-choice method of preventing repeated attacks of chronic tonsillitis with fever (114). Earpoint AP was effective in treating tracheitis in infants (115) and was as good as medication in pyogenic otitis media (116). LLLT cured most acute cases (117). Fire needling, with a medicinal fuse, cured 100% of tubercular cervical lymphadenitis (118). AP cured 80% of Tinea capitis cases (119). EAP cured 46% and improved 42% of Tinea pedis cases. Fungal culture from the site was negative after AP (120). AP cured or markedly improved 46% and improved 50% of Scrofula cases (121). AP needling to bleed viral warts cured 97% within 3 months (122). GASTROINTESTINAL DISORDERS: Stomach: AP at ST36 increased gastric motility (123) and amplitude, decreased the frequency of gastric contraction (124), increased serum gastrin (125) and decreased basal and vagally-mediated gastric acid secretion (126,127). EAP at BL20 increased the frequency and amplitude of contraction. Naloxone did not abolish the effect but vagotomy or atropine did (128). AP or EAP at ST36, BL21, PC06 increased gastric secretion of bicarbonate and sodium in dogs. Gastric acidity decreased (129,130). The AP effect was blocked by local anaesthesia of the AP points or by use of atropine. The AP effect is mediated by somatovisceral reflexes, via blockade of histamine H2- or cholinergic-

receptors in gastric mucosa (126,128-130). AP-injection at BL18, BL21, ST36 was effective in atrophic gastritis (131). AP or EAP was effective in treating experimental gastric ulcer in rats (132,133), peptic ulceration in foals (134) and in clinical gastroduodenal ulcer in humans (126,135,136), even those which had relapsed after completion of conventional therapies (137). AP, moxa, magnetic-, electro-magnetic- or laser-AP were effective in 1-3 days in infantile enteritis, often in cases which had failed to respond to medication (138-142) and AP was effective in diarrhoea in diabetic neuropathy (143). AP was as good as antibiotic therapy in treating piglet diarrhoea usually associated with E. coli and coronavirus (144146). LLLT at GV01 was effective in lamb dysentery (403). AP or AP + moxa was effective in dysentery (34,147), which had not responded to medication (37), increased intestinal microcirculation in 15 minutes and reduced hyperperistalsis and borborygmus after 15-30 minutes (148). AP or LLLT was effective in acute appendicitis (149,150). AP at GV01, BL35, BL57, GV20 cured 100 % of types 1 and 2 and 77 % of type 3 prolapsed rectum in children (151). AP, EAP, moxa and herbs are effective in curing hepatopathy (152) and hepatitis, including acute viral icteric hepatitis (153,154,155,156,157,158,159). AP and EAP aided normalisation of the pathological increase of 5-HT metabolism and decrease of DA content of the brain in CCl4 toxicity (160) and helped to prevent and cure pathology in CCl4 toxicity. The AP effect was mediated by endogenous opiates (161,162). AP at GB-related points increases intra-GB pressure up to 26 times. This helps expulsion of stones or ascarides from the bile duct (163). AP, EAP, acupressure are effective in cholecystitis, cholelithiasis and biliary ascariasis (136,163-176). REPRODUCTIVE DISORDERS: AP-type stimuli influence reproductive organs and functions, including release of LH, FSH, progesterone and oestradiol (177-179). It can activate or inhibit uterine and cervical contraction in humans and animals and can increase local microcirculation and immunity. AP can be used to prevent threatened abortion (180); to correct foetal malposition (181,182); to induce labour in women; to cure morning sickness (183,184); vaginitis/leucorrhea (185); dysmenorrhoea (186-190). AP cured vulvar ulceration (191), vulvar leukoplakia (192) and hysteromyoma without the need for surgery (193). It cured female infertility/sterility (amenorrhoea, anovulation, polycystic ovarian disease (POCD), functional metrorrhagia) (178,179,194,195); pelvic inflammatory disease (PID) (41,196-198). The results were better than in similar cases treated by antibiotics (199). Endometritis always follows mating in mares but healthy mares clear the uterus within 48-72 hours. Poor contractility, imbalance of lymphatic/ circulatory/uterine secretion (build-up of secretions) and inability to clear the debris through the cervix are important in the aetiology uterine infection (200). AP was effective in repeat-breeder mares (201). Laser on the clitoris was effective in anoestrus in cows (404). Others claim success with AP in treating infertility (anoestrus, cystic ovary, and repeat breeder) in other species (cows, bitches, sows). AP can treat impotence, poor libido, infertility and prostatitis in men (143,202-209). Similar claims are made for stud animals. MAMMARY DISORDERS: AP, moxa, point bleeding and massage was effective within a few days in acute mastitis, breast abscess and breast carbuncle in women (210-214). AP cured mammary fibrocystic disease in women within 3 weeks and can be used in the differential diagnosis of fibrocystic disease from mammary carcinoma (215). AP was effective in mammary hyperplasia (216-217); proliferative mastosis (painful breast tumour, not specified if inflammatory or neoplastic) (218); primary agalactia and hypogalactia (219221). There are claims that AP is effective in mastitis and agalactia in animals. Because of

different anatomy/nerve supply, points for mammary disorders in animals are different to those in women. URINARY DISORDERS: AP is effective in nephritis, cystitis, urethritis, urolithiasis and disorders of diuresis and micturition. BL23, GB25 and KI01 are especially effective for kidney function. AP at KI01 in dogs reduced diuresis (KI function). AP at BL23 blocks the effect of KI01 and adjusts diuresis (222). AP at BL23 markedly increased diuresis (urine, Na and Cl excretion) in men (223). AP was effective in limiting proteinuria and curing nephritis in HgCl2 toxicity in mice (162). AP was effective in renal colic, urolithiasis. Pain is controlled in minutes and stones are often passed in hours or days (136,224-229). The effects of AP on renal function and ureteral peristalsis can be seen with intravenous pyelography (230). BL28,32; CV03 and SP06 are very effective for bladder function and irritable bladder. The effects of AP on bladder function involve supra-spinal reflexes (83,231,232). AP is effective in cystitis, dysuria, urgency, frequency (233). In monkeys with unstable bladder, AP at SP06 had similar effects to atropine - it reduced or eliminated inappropriate bladder contractions but left normal voiding sequences intact. AP gave fast relief of unstable bladder and function normalised after repeated sessions (234). AP cured "neurogenic" bladder, (incontinence/retention) as in distal symmetrical polyneuropathy (143,235) and in enuresis (21,236,237). SYSTEMIC OR GENERALISED INFECTIONS: AP activates immune reactions and controls the main symptoms in viral, protozoal, bacterial and fungal infectious diseases in humans and animals. It has a role in these conditions, if only as a support-therapy. AP cures the main signs and symptoms of viral diseases and has antiviral effects via the immune responses. Chronic Epstein-Barr Virus (CEBV) syndrome, also called Chronic Fatigue Syndrome (CFS), is caused by a herpes-type virus that causes an infectious mononucleosis. There is no effective medical treatment but AP at the immunostimulant points plus points for the main symptoms is helpful. AP cured mumps within 1-5 sessions (238); early cases of Herpes Zoster (shingles) within 2-7 days, with no post-herpetic sequelae (30,239). Pain eased within minutes of the first session. In chronic cases (more than 3 months old), the dorsal root ganglia may be scarred and prognosis to AP is poor. The most effective points are SI03 and the "Loo Point" (between BL62 and GB40 (240). AP cured or nearly cured 78% of infantile acute infectious multiple radiculitis. There were no deaths and no sequelae. The results were better than in cases treated without AP (241). AP improved 53% of infectious multiple neuritis, classified as a flaccidity syndrome in TCM (242). Saline injection twice/ day for 7 days at BL13 cured 90% of cases of lobar pneumonia, as compared with an 84% cure rate by penicillin and streptomycin (243). LLLT at Earpoint Lung in mice infected with influenza virus completely inhibited virus replication in lung cells but Earpoint Hypothalamus had no effect (244). Very good results were obtained by AP in AIDS and ARC victims in treating fatigue, depression, general malaise, dyspnoea, sinusitis, night sweat, diarrhoea, lymphadenitis, neurological disorders and pain, as in Kaposi's sarcoma. AP may prevent development of opportunistic infection but it was not successful in treating severe anaemia, which required blood transfusions if the PCV fell ) is the Sheng, creative or nourishing cycle. Things of a Fire nature nourish ( --> ) things of an Earth nature in the Sheng Cycle: Fire --> Earth --> Metal --> Water --> Wood --> Fire. In the Sheng Cycle, Fire is the Mother on Earth; Metal is the Son of Earth.

THE SHENG AND KO CYCLE OF THE FIVE PHASES

Fire

Wood

Earth

Water

Metal

The inner clockwise star ( > ) is the Ko, controlling cycle. Things of a Fire nature control or weaken ( X ) things of a Metal nature in the Ko Cycle: Fire X Metal X Wood X Earth X Water X Fire. Each Phase also contains Yin and Yang attributes or correspondences (see paper on the Five Phases). Each Phase also relates to a specific Yin-Yang pair of COSs and Fire relates to 4 COSs (HT, SI, PC, TH). For instance Wood Yin relates to Liver and Wood Yang relates to Gallbladder function, as in the diagram (below). The Yin-Yang pairs in each Phase are called Husband-Wife pairs. For instance ST (Yang) is the Husband of SP (Yin). Each Channel has a special AP point (the Luo (Passage) point). The Luo points are used to shunt Qi between Husband and Wife. Each Phase also has relationships to a specific season, food, emotion, sound, body tissue, secretion etc. (See details in the paper on the Five Phases). Any imbalance of Qi in the Five Phase system can affect the balance in the whole system. For instance, Deficient KI (Water) Qi can cause Deficient LV Qi (the Mother can not feed the Son in the Sheng Cycle), or it can cause Excess HT (Fire) Qi (via the Ko Cycle, Deficient Water allows Excess Fire). Excess KI Qi would have the opposite effect. Five Phase Theory has very practical use in TAP therapy. For instance, if there is a Qi Deficiency in one Channel and an Excess in another, the Qi can be balanced very easily by needling special points (selected from the Five Phase Points and/or the Luo (Passage) points). Each Channel has a special point which relates to each Phase (5 x 12 points = Sixty Phase Points). These points are used to shunt Qi between the Phases.

One stimulates the appropriate TAP point on the Deficient Channel (always the Deficient Channel!) to draw the Excess Qi directly into it (or indirectly via other Channels), thereby balancing the whole system. In the Five Phase relationships (below), the Yang organs (SI, TH, ST, LI, BL, GB) are those on the outside of the diagram and the Yin organs (HT, PC, SP, LU, KI, LV) on the inside. CHANNEL RELATIONSHIPS VIA THE SHENG AND KO CYCLES

SI

TH

HT

PC

Fire GB

ST LV

SP Wood

Water KI BL

Earth

Metal LU LI

Five Phase Theory teaches that disorder in any one COS can directly or indirectly cause disorder in any other COS via Sheng, Ko or other energetic transfer routes. It is essential to the understanding of disease interactions in TCM and in the selection of the primary sites of disease. It also teaches that if the primary disorder is corrected, the secondary disorders may selfcorrect rapidly. A detailed study of Five Phase relationships and the uses of the Phase and Luo Points is essential to the therapeutic use of energetic TAP. The system can give dramatic clinical results

in complex Syndromes but few western acupuncturists have the patience to study the system properly. 5. CONCEPTS of ECOLOGY, SYNDROMES and CAUSES of DISEASE in TCM TCM teaches that Nature (all of creation, macrocosm and microcosm) is a unity which reflects the interplay of Qi, Yin-Yang, the Five Phases, the material and the immaterial. As we are wed to Nature, we feel Her claws or Her caress. And if we ravish Nature, or sow black seed at the time of white seed-sowing, or work against Her changeless Laws, we plant a bastard harvest, which we will reap. And we will weep alone, groan long in the hell of a Manmade night. Health is a relative state. Optimal adaptation to prevailing circumstances (and the ability to adapt to new ones, if needed) are important factors in health. Healthy people adapted to living high up in the Andes mountains may have Packed Cell Volumes which would indicate serious dehydration or disease in people living in, say, Belgium. Adaptation to internal changes are also important. What may be healthy sport for a strong young man may kill a weak old man. Many factors regarded by TCM to be involved in health are discussed below but TCM was also aware of acute causes of illhealth: trauma/wounds; undernutrition, genetic influences. (Modern Chinese medicine also recognises many other causes, as in western concepts: stress, toxicities, infection, parasitism, nutrient imbalances and deficiencies, metabolic and hormonal imbalances, senility etc). Health depends on self-control: Chinese/Japanese parents dote on children, but their children are programmed very early in life to develop a high degree of self-discipline. This helps them to develop self-control of body and mind, which is perfected further in adulthood, to a degree which puts many westerners to shame. Mastery of the self was also part of the training and lifestyle of the oriental monks, who were said to be very healthy and resilient. The secret of good health is to strive for physical and mental control and to live in balance with Nature and with the Laws of Nature. As part of Nature, the human or animal organism is influenced by Natural Laws, forces and energies. We dance or writhe to Nature's rhythmic tune. Conversely, the activities of the organism influences Nature for good or ill. Today's specific problems of environmental pollution (production and preservation of food to be eaten out of season by the use of chemical preservatives; dumping of toxic metals and chemicals, nuclear waste; the ozone hole/greenhouse effect etc) may not have been foreseen by the ancients but the global philosophy of Yin-Yang would have predicted them- we are creators and destroyers, a mixture of good and evil. A more recent law of physics can be adapted and extended to apply to biological systems: "To every action, in due time, there is an equal and opposite reaction". We decorate, or foul, our den, which, in time, empowers, or overpowers, us. Avoidance of attack is the first law of self-defence. This implies that self-training to heighten one's awareness, perception and intuition have a prime defensive role. Strength (Qi) and skill (physical and mental) to deflect or minimise an unavoidable attack is the second law of selfdefence. Rapid adaptation to prevailing circumstances is the key to survival.

Adaptation implies the ability to respond optimally to challenge. Clean air, exercise of mind, good food and a fit mind-body helps to develop Qi and to direct it when and where it is needed. a. Qi IN RELATION TO DISEASE Qi (the vital force and defence energy of the body and mind) comes from different sources: Ancestral Qi (genetic energy), Qi from Heaven (the energy of life) and from earth (vital energy from air, food). Healthy lung and gastrointestinal function are vital to balanced Qi. Deep breathing exercises (imagining the air being drawn down as far as the pelvis) and visualisation of Qi streaming through the Channel system (in the correct direction of Qi flow, and in time with deep, slow breathing) are part of TAI Qi and Qi KUNG exercise systems which are used to counter stress and attain physical/mental wellbeing. Health and disease are determined by the amount and balance of Qi in the organism. The healthy body/mind has a perfect balance of Qi which can circulate freely in the body through the Channel network, the collateral Channels, the deep Channels and the organs. Adepts can direct Qi (by conscious or subconscious control) to circulate to those parts which may need extra Wei (Defensive) Qi. In the body, upset Qi (Excess of Yin or Yang, Deficiency of Yin or Yang etc) is the cause and result of disease. If the Wei (Defensive) Qi is weak, disease can invade from outside (see 4b below). Body Qi can also take many forms: Qi of Kidneys, Qi of life (semen) etc. Blockage of Qi flow, whether caused by trauma, scar tissue or other causes) is followed by functional or organic disease of the affected COS. b. INTERACTION BETWEEN ENVIRONMENT AND THE ORGANISM "Man (the organism) stands between Heaven and Earth". This ancient teaching infers the external environment (extra-terrestrial and terrestrial energy) can influence us and that we can influence the heavens and earth. Natural environmental forces (Qi) include magnetism, gravity, electromagnetic fields, solar, lunar and planetary influences etc. Others include geophysical/geopathological fields, as known to the practitioners of Feng Shui (Chinese diviners, who would shun the valley where no bird sings). We must cope with seasonal changes, which can predispose to their own Syndromes, or types of disease. To dress and work outdoors in the depths of winter as if it were the middle of summer (or vice-versa) can seriously imbalance Qi and cause disease. The wise one wears thick skins in snow, fine silk in sun. In Yin-time live a Yin-type life; in Yang-time, Yang. THE SIX EVILS TCM recognises six climatic causes of disease: Heat, Summer-Heat; Damp, Dryness, Cold and Wind. Each one of the Six Evils (type of perverse energy which attacks the body from the Exterior) has a preference for a specific COS in the Five Phase Cycle: Perverse Energy Heat, Summer-Heat Damp Dryness Cold Wind

Phase attacked Fire Earth Metal Water Wood Yin SYSTEM attacked HT, PC SP LU KI LV Yang SYSTEM attacked SI, TH ST LI BL GB These "devils" gain access to the body via the skin-holes (the AP points). Pathogenic Qi can reach the Interior of the body via the superficial and deep course of the Channels in two ways: a. if, relative to the force of the attack, the Wei Qi is weak (unable to deflect the acute attack), or b. if the condition is not treated successfully (by increasing Wei Qi using TCM/TAP at that stage). Once the inner organs are invaded, the condition is serious and may become chronic, lifethreatening and difficult to treat. Apart from the preferred organ, other organs and functions can be attacked, using routes in the Five Phase Cycle (Sheng and Ko and reverse-Ko routes). For example, Summer-Heat can attack HT-PC (heatstroke, circulatory collapse, heart attack), the mind (febrile hallucination, heatstroke) and also the SI (summer gastroenteritis). Wind can attack LV, the eyes, GB, the muscles and the mind (anger, jealousy) etc and can also counter-attack LU (via a reverse Ko route: Wood (LV) is controlled by Metal (LU)). Treatment at that stage aims to increase the adaptive reactions of the primary organ attacked and the general resistance of the body in an attempt to expel the invader. (Treatment can include induction of vomition, purgation, diuresis, sweating etc if the invader can be expelled by these routes). c. THE ROLE OF THE EMOTIONS IN DISEASE Each of the Five Phases is associated with specific emotions. Balance of the emotions is important, as imbalance in any one of them can imbalance the Qi, to weaken the corresponding COS:

Phase

Emotion

Sound expressed

HT Fire

Pleasure/Joy/Excitement

Laughter

SP Earth Anxiety/Obsession/Meditation Singing/Whistling LU Metal Grief/Sorrow/Melancholia

Weeping

KI Water Fear/Fright

Sighing/Moaning

LV Wood Wrath/anger

Shouting/Screaming

For example, too much excitement/pleasure/joy can weaken the HT COS (angina, heart attack etc) and one of the signs of HT disorder is too much laughter/excitability. Too much anxiety (obsession) can weaken the SP COS and one of the signs of SP disorder is a tendency to obsession and sing (to oneself) a lot. Similarly for the other organs (LU, KI, LV). Psychosomatic disease: The Chinese were among the first people to note an association between the emotions/psyche and disease. They were aware of the importance of psychosomatic disease before the time of Christ. Similarly, in imbalance of a Channel, the appropriate emotions can be fostered and used in the Ko Cycle to redress the imbalance. For instance, in grief (Deficient Metal), stimulation of laughter/joy, pleasure can reduce grief and strengthen LU via the Ko Cycle (Fire controls Metal). Fear (Deficient KI) can be helped by stimulating meditation, singing, or whistling (Earth controls Water). DISEASE CLASSIFICATION BY THE EIGHT PRINCIPLES (the EIGHT TYPES) The Eight Principles classify disease by 4 categories: a. Yin or Yang b. Hot or Cold c. Shi (Excess) or Xu (Deficiency) d. External or Internal. a. Yin and Yang Syndromes Balance of Yin and Yang Qi is the normal state. Disease is classified according to its disturbance of Yin and Yang Qi. However, Yin organs may have Yin or Yang diseases (and Yang organs likewise). If Yin or Yang (or both) deviate from the normal level, a state of relative Excess (Shi) or Deficiency (Xu) exists.

Yin type Yang type* Hypo-withdrawn ,inhibited, Activity Hyper-, excited, fidgety quiet Body and limbs Cold, seeks warmth Hot, avoids warmth Pulse Deep and slow Shallow and fast, bounding Tongue Pale, moist Red, dry, coated Respiration Feeble Rapid and strong Thirst No Yes Urine Clear, copious Scanty, coloured Complexion, Pale Red skin

Attack site** Onset Progression

Interior, deep (internal organs) Cause chronic Inwards and downwards

Exterior, superficial (Channels and their collateral branches) Cause acute Outwards and upwards

* Moxa (heat cautery) is usually contraindicated in Yang and Hot Syndromes. ** Internal or External attack sites can not always be classified as Yin or Yang respectively. Yin organs can be attacked by Yang diseases and vice versa. Collapse of Yang and the Collapse of Yin are other Yin-Yang Syndromes: Collapse of Yang: Profuse cold sweat; respiration feeble; pallor; prefers hot drinks; skin cool; limbs cold; dislikes cold; listless; pulse of Xu type (thready and fading); tongue pale and moist. Collapse of Yin: Sticky sweat; respiration rapid and short; face red; thirst and prefers cold drinks; skin hot; limbs warm; dislikes heat; restless; pulse of Xu type (thready and rapid); tongue red with little saliva. To complicate matters, the law of Yin-Yang implies that change can occur; one Syndrome can change to another: "Cold with fullness moves downwards and transforms into Heat; Heat, with fullness, moves upwards and transforms into Cold" (Turner and Low, 1981). Also, some of the features of Cold and Hot Syndromes can give misleading impressions of YinYang balance- they may be False Yin or False Yang conditions. Collapse of Yang resembles a false Yin Syndrome and Collapse of Yin resembles a false Yang Syndrome. NORMAL BALANCE OF Yin AND Yang Qi

Yang Resistance normal

Yin

..........+++++-----............ |

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b. Hot and Cold Syndromes Hot Syndromes are caused by pathogenic Heat, Summer Heat and Dryness (3 of the Six Evils). Cold Syndromes are caused by pathogenic Cold. Also, Excess (Shi) of Yin or Yang can cause Cold and Hot Syndromes of the Shi type respectively.

Cold Syndrome of the Shi (Excess Yin) type: Chills; limbs cold; no thirst; pallor; excess sputum; asthmatic breathing; indigestion; vomiting; abdominal pain, worse on pressure; stools loose; urine clear and copious; pulse deep and slow; tongue pale with white sticky coating; craves warmth. Cold Syndrome of the Shi (Excess Yin) type (Excess Yin consumes or weakens Yang)

Yang

Yin

----Resistance normal

...............|

|............

+++++|

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Hot Syndrome of the Shi (Excess Yang) type: Continuous high fever; thirst; face flushed, eyes red; abdomen full and distended, worse on pressure; consciousness; delirium; constipation; urine concentrated; pulse rapid; tongue red to deep red, with dry yellow coating; craves cold. Hot Syndrome of the Shi (Excess Yang) type (Excess Yang consumes or weakens Yin)

Yang

Yin

+++++ Resistance normal

..........|

|.................

|

|-----

|

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__________|___||___|____________

c. Shi (Excessive) and Xu (Deficient) Syndromes In TAP, the needling technique depends on whether the Syndrome is Shi or Xu type. In Shi type (Excess) the needling method is Xie (reducing type), to dispel the Excess Qi. In Xu type (Deficiency) the needling method is Bu (reinforcing type), to stimulate the Deficient Qi. The TCM rule of needling is Shi needs Xie but Xu needs Bu: Shi Syndrome needs Xie needling; Xu Syndrome needs Bu needling. Palpation pressure on the affected areas helps to distinguish the Shi and Xu Syndromes. In Shi (Excess), with Yang fullness, pressure aggravates discomfort. In Xu (Deficiency), with Yang emptiness, pressure alleviates discomfort. In Shi Syndromes, body resistance is normal but the body is attacked by an exogenous pathogenic factor. The prognosis is not serious if the attacking factor can be expelled, thereby preventing the disease from reaching the internal organs. Shi (Excess) Syndromes: Disease recent; elation; robust constitution; restless; spastic; voice sonorous; breathing coarse; chest and abdomen full and distended; abdominal pain, worse on pressure or palpation; constipation; tenesmus; urination painful or difficult; urine scanty and concentrated; pulse of Shi type (coarse, rapid, full); tongue red and coated; skin warm. Syndromes of Shi (Excess) type are usually (but not always) of the Hot type: Hot Syndrome of the Shi (Deficient Yin) type (Deficient Yin allows Yang to predominate)

Yang

Resistance lowered

Yin

.........+++++................. |

|

|

|-----

__________|___||___|____________

Xu (Deficiency) Syndromes: Disease chronic; listless, depressed; weak; asthenic appearance; apathy; pallor; lies curled-up; voice weak; breathing feeble; palpitation; shortage of breath; tinnitus; vision blurred; insomnia; memory poor; sweating; night sweats; abdominal pain, relieved by pressure or palpation; loose stool; nocturnal spermatorrhoea; enuresis; copious clear urine; pulse of Xu type (fine, weak, irregular); tongue pale, with thin coating; skin cold.

In Xu Syndromes, body resistance is lowered and the disease can reach the internal organs more easily. The prognosis is more serious. Deficiency (Xu) of Yin or Yang can cause Hot or Cold Syndromes of the Xu type respectively. In both cases, resistance is low. Xu (Deficiency) Syndromes are usually (but not always) of the Cold type: Cold Syndrome of the Xu (Deficient Yang) type (Deficient Yang allows Yin to predominate)

Yang

Yin

Resistance lowered ...............-----............ |

|

+++++|

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__________|___||___|____________

An example of the Yin Xu Syndrome (Cold Syndrome of the Xu type): Chills; limbs cold; pallor; no thirst; listless; apathy; weak; sweating; stool loose; urine copious and clear; pulse slow and deep; tongue pale with white coating. But, as in most aspects of Chinese thought, the paradox exists also, the Yang Xu Syndrome (Hot Syndrome of the Xu type): Afternoon fever; malar flush; mouth and throat dry; insomnia; restlessness; feverish feeling in palms and soles; night sweats; constipation; urine concentrated; pulse rapid and thready; tongue red with little coating. d. External and Internal Syndromes External Syndromes result from invasion of the superficial areas of the body by exogenous factors. Onset is sudden and duration is short. Exterior Syndromes are usually mild. They are the early signs of exogenous disease but may develop to Internal Syndromes. Internal Syndromes result from penetration of exogenous factors to the Interior of the body, as in an External type which was unsuccessfully controlled, or by direct attack of the organs by exogenous factors. Internal Syndromes are usually severe and involve functional or organic damage of the organs. Dysfunction of the organs is also an Internal Syndrome. Both External and Internal Syndromes can be complicated by Cold, Heat, Xu (Deficient) and Shi (Excess) Syndromes. External Syndromes: Cold: Fever; no sweating; chills; pulse superficial and strong; tongue coating thin and white

Hot: Fever; intolerance of wind; may sweat; mild thirst; pulse superficial and rapid; tongue coating thin and yellow. Xu: Sweating; intolerance of wind; pulse superficial and slow Shi: No sweating; general aches; pulse superficial and strong; tongue coating white Internal Syndromes: Cold: Chills; cold limbs; pallor; no thirst; stool loose; urine clear and profuse; pulse deep and slow; tongue pale Hot: High fever; thirst; irritable and restless; face flushed; eyes red; constipation; yellow scanty urine; pulse rapid; tongue red with yellow coating. Xu: Breathing feeble; apathy; lassitude; palpitation; dizziness; pulse deep; tongue flabby and pale, with white coating Shi: Breathing coarse; voice strong; irritability; fullness of chest; distended abdomen; constipation; pulse deep; tongue rough, with thick coating Thus, TCM has a set of 8 criteria (the Eight Principles) to define disease Syndromes (the type (nature) of disease), based on the clinical signs. By combining one type from each of the 4 categories (Yin or Yang; Hot or Cold; Shi or Xu; External or Internal), 8 possibilities arise (1 X 2 X 2 X 2 = 8). Syndrome classification by the Eight Principles is discussed further in Lee and Cheung (1978); The Essentials of Chinese AP (1980); Turner and Low (1981); Porkert (1983). As well as classification by the Eight Principles, Syndromes are classified according to the main organs involved and the energy imbalance in them. Each of the following strangelynamed Syndromes has defined clinical and functional upsets: LU Syndromes: LU Yin Deficiency; Wind attack on LU; LU Damp-Phlegm Retention; LU Heat-Phlegm Retention LI Syndromes: Damp-Heat invasion of LI; LI Obstruction; Blood and Heat Obstruction of LI ST Syndromes: Retention of food; Retention of fluid; ST Fire Excess SP Syndromes: SP Qi Deficiency; Cold-Damp invasion of SP HT Syndromes: HT Qi Deficiency; HT Yin Deficiency; Obstruction of HT Blood; Excess HT Fire; disturbed Shen (mental derangement) SI Syndromes: SI Heat BL Syndromes: Damp-Heat invasion of BL; BL dysfunction KI Syndromes: KI Qi Deficiency; KI Yin Deficiency; KI Yang Deficiency

PC Syndromes: Heat invasion of PC GB Syndromes: Damp-Heat invasion of GB LV Syndromes: LV Qi Deficiency; LV Fire Excess; Cold Obstruction of LV; LV Blood Deficiency; LV Wind stirred by Heat There are many other types of Channel Syndromes (see Porkert 1983). Disease is classified also according to the main Channel involved (LU, LI, ST, SP, HT, SI, BL, KI, PC, TH, GB, LV). It may be classified also by disturbance in the Eight Mai (Vessels or Extra Channels): GV; CV; Chong; Dai; Yang Chiao; Yin Chiao; Yang Wei; Yin Wei). Each of these Channels and Vessels has its own symptomatology. 6. DIAGNOSIS IN TCM TCM Diagnosis was based on four principles: looking, listening, feeling and smelling, i.e. on input signals from 4 of the 5 senses (sight, hearing, touch and smell). LOOKING: The patient is inspected carefully for any abnormalities of gait, posture, swellings (oedema, inflammation etc), atrophy, muscle spasm, paralysis etc. Great attention is paid to the skin and face (colour, texture, sweat), ears (abnormal blotches, scales, flakes, papules), tongue (colour, saliva, coating) and iris. Colour and consistency of stools, urine and other secretions/excretions are noted. LISTENING: The case history is taken. The emotions, symptoms and sounds (strength of voice, respiration, abnormal gut and joint sounds etc) are noted. FEELING: The patient is palpated carefully to check skin temperature (hot or cold); variation in skin temperature, for instance one limb colder than the other; location of abnormal swellings, muscle tension, flaccidity; location of Ahshi (tender) points. Great attention is paid to palpation of the Mu and Shu points, the Xi, Yuan and Luo points. Tenderness at these points can indicate the COS involved. Channel diagnosis by point sensitivity: In severe disorders of a Channel, many points along the Channel may show abnormal tenderness to pressure palpation, electric current or heat. This is especially true for the Ting (most distal) points at the nail of a toe or finger). Ting (Well, near the nail) point sensitivity is the basis of the diagnostic methods of Akabane (Japanese diagnosis by measuring heat sensitivity) and Voll (German electrodiagnosis). The Shu and Mu points may also be tender. Other important points (which may be tender in Channel disorders) lie below the knee or elbow: the Five Phase Points, the Luo, Yuan and Xi points. Pulse Diagnosis is the ultimate in TCM diagnostic palpation. According to TCM, the pulse in the distal, middle and proximal positions on the left radial artery reflects the energy status of the SI, GB and BL Channels on superficial palpation and the HT, LV, KI Channels on deep palpation respectively. The pulse in the distal, middle and proximal positions on the right radial artery reflects the energy status of the LI, ST, TH Channels on superficial palpation and the LU, SP, PC Channels on deep palpation respectively. Porkert (1983) describes 31 different pulse types.

Some TCM practitioners claim to be able to make an accurate energetic diagnosis in human patients (which Channels are involved and whether they are hyper- or hypo-active) on the basis of Pulse Diagnosis alone ! However, many translations of Chinese medical AP texts ignore or pay little attention to the classical pulse types. Classical Pulse Diagnosis is a controversial issue, even in China and Japan. Recent studies (doppler ultrasonography or use of pressure transducers to measure pulse characteristics) cast great doubt on the objective validity of Classical Pulse Diagnosis. Most veterinary AP texts ignore it. In my opinion, pulse diagnosis is not objective but some people can make accurate diagnosis by the Pulses by subjective (psychic, extra-sensory perceptive) means, as in medical radiaesthesia/medical divination and Extra-Somato Projection. SMELLING: In TCM, the practitioner smells the breath, the skin and excreta of the patient. TCM attributes typical smells to various disorders. For instance, in Earth disorders (SP, ST, diabetes), there may be a sweet (ketone) smell; in Water disorders (KI, BL), there may be a putrid smell (uraemia, ammonia) etc. The aim of TCM/TAP diagnosis is to establish (a) the nature of the disease in terms of the Eight Principles and the Six Evils and (b) the COSs involved. Having assessed the patient by the four principles (looking, listening, feeling and smelling), the nature and location of the disorder is defined in traditional terms. Steps are then taken to remove or alleviate the cause, or to enhance the body's Wei (Defensive) Qi, or to re-balance any energetic imbalances which have been diagnosed. TCM diagnosis was developed at a time when knowledge of internal anatomy and physiopathology were primitive. Millennia had to pass before the development of current western concepts of biochemistry, microscopy, immunology, bacteriology, genetics, Selye's concepts of the Stress Reaction, concepts of nutrition (mineral, vitamin and essential aminoacid imbalances etc) and biotechnology. In spite of ignorance of modern medicine, the ancient Chinese had one very important concept: They knew that vital energy (Qi, Vix Naturae) was the key to health and recovery from disease; they taught that the body healed itself by its own natural defense systems; the aim in healing is to stimulate and enhance those mechanisms, thereby attaining balance (homeostasis). 7. THERAPY IN TCM All methods aim to correct imbalances of Qi. Where the cause is bad lifestyle (XS eating; XS work; insufficient food or sleep; XS alcohol etc) steps are taken to advise on moderating this. As far as possible, the patient is advised on environmental, behaviourial or dietary changes etc which may be necessary to alleviate or remove the cause. To restore the normal balance of Qi (resistance), many methods are used alone or in combination. TCM relies heavily on herbal medicine (HM). The Chinese herbal pharmacopoeia is very extensive, running into thousands of plants, herbs, venoms, inorganic compounds, animal byproducts etc. These remedies are prepared as decoctions, concoctions, powders, ointments etc and a typical prescription would contain 4-10+ separate components. Many of the crude extracts have been purified in recent years and the active alkaloids or other compounds have

been isolated. Several HMs, or extracts of them, have potent antitoxic effects in patients on cytotoxic radiotherapy or chemotherapy (cisplatin etc) for cancer. Herbal products and HM extracts have many high-ranking pharmacological properties, including immunomodulators, hypoglycaemic, anticancer, antiinflammatory, antiviral, antibacterial, antiprotozoal, antiasthmatic, antioxidant, antihypertensive and anti-liver disease activities. Other methods include physiotherapy (exercises; massage; moxibustion (cautery of the AP points); Taichi (ritual slow movements to utilise every muscle of the body in conjunction with breathing exercises) and psychotherapy (Qi Kung (visualisation-meditation of the energy flow through the Channel circuits, together with specific slow deep breathing exercises, inhalation for centripetal Channels and exhalation for centrifugal Channels); mental/emotional exercises to balance the emotions). AP is only a small part (maybe 20%) of the total TCM system. 8. AP METHODS For proper use, AP, moxibustion and Chinese massage (acupressure) depend on a detailed knowledge of the point and Channel system. Having selected the points most suitable for the patient, these points are stimulated by many different methods, depending on the training and preferences of the practitioner and the equipment available. The most common type of AP uses fine stainless steel, solid, needles 1-6 cm long and 25-32 gauge. The most common needle is about 3.5 cm long, 30 gauge, but others (including some barbaric-looking instruments) are occasionally used in remote, rural areas. In veterinary AP, the needles vary with the species. For experimental work in small animals and laboratory animals, the finest human-type needles may be used. For clinical work in the dog-cats, one usually uses 1-6 cm, 28-30 gauge needles. In larger animals (pigs, ruminants, horses, mules etc), larger and thicker needles are used (2.5-15 cm needles 18-28 gauge, depending on the preferences of the practitioner and the depth of the points). The skin around the point is prepared as aseptically as possible. Sterile needles are inserted to the correct depth and are stimulated (by twirling and pecking) to obtain DeQi. This phenomenon ("the arrival of Qi") is regarded as crucial to AP success. It is similar to the "funny bone sensation": paraesthesia, tingling, numbness, heaviness, "sour feeling" etc in the vicinity of the point. In humans, the objective and subjective sensations are unmistakable - the verbal feedback from the patient ensures this. It is not uncommon for human patients to invoke the name of the founder of the Christian religion when Qi arrives! In animals, however (because they cannot relate their subjective feelings), the main signs of DeQi are: sudden change in the animal's behaviour: a temporarily fractious animal suddenly standing quite motionless or a quiet animal suddenly beginning to tremble or vocalise. Respiration may be temporarily inhibited or accelerated. Local muscle spasms or twitches may be seen. DeQi is more often obvious when the point is directly over a peripheral nerve (such as with the Great Points of AP, for instance: LI04; PC06; TH05; LI11; ST36; GB34; BL40 etc or directly over motor points (places where the motor nerve plunges into the muscle).

Once DeQi is obtained, the needle is left for 30 seconds to 20 minutes. In general, acute conditions require only short periods of needling and chronic conditions require 20 minutes or more. Before removal of the needle, it is twirled/pecked again. Classical AP demands specific types of needle manipulation depending on whether the condition is diagnosed as a Shi (Excess) or Xu (Deficiency) type. These specific Syndromes of manipulation are described in standard texts but the issue is controversial in that many successful practitioners ignore them still obtain excellent results - the use the simple method described above. The most comprehensive textbook on techniques of AP is "Current AP Therapy" by Lee and Cheung (1978). This is an excellent text and is recommended as ESSENTIAL reading for serious students. Apart from simple needling, cautery and massage, other methods are common. They include electro-AP (with or without needles); injection of the points; ultrasound-, microwave-, laser-, cryo-, faradic-, static field-, magnetic field- and other therapies applied to the specific points. They also include implants, incisions direct massage of the exposed nerves etc. In general, the simple needling technique is adequate for most purposes and expensive pieces of equipment (electro stimulators, lasers etc) are luxuries to impress the public rather than to enhance the results. There are some exceptions to this which will be discussed in other seminars. The number of sessions and the intervals between sessions vary with the condition. Chronic conditions are normally treated 1-2 times per week for 4-20 sessions. In general, if there is not an obvious response by session 4-6, the chances of ultimate success are poor. Acute (but simple) conditions are treated every 6-48 hours, depending on the condition. For instance, acute traumatic pain could be treated for 20 minutes daily (GB34 on the affected side and 1 or 2 local points). Expect 70% success after 1 session and >90% after 3 sessions. Acute conditions usually require 1 to 5 sessions. 9. METHODS OF CHOOSING EFFECTIVE AP POINTS Which methods are chosen will depend on the training, skill and experience of the practitioner. Classical AP has more than 14 laws for consideration, apart from the use of the Five Phase balancing method: a. local points b. distant points c. points on affected Channel d. points on related Channels (Husband-Wife pair of Channels or Channels passing near the affected one) e. one point on each of the 4 limbs f. encircling the affected area

g. Ahshi points h. Mu and Shu points i. the source point of affected Channel and the Passage (Luo) point of its linked Channel j. "Fore and Aft" points ((in front of and behind the affected area) k. a chain of points along the affected Channel l. points long recognised as highly effective for specific symptoms or body areas (eg) PC06, ST36 for nausea and vomiting; LI04 for mouth, nose and throat m. Xi (cleft) points. On top of these, modern AP adds n. needling points in the affected dermatome or along the innervation of the affected area o. needling Scalp, Ear, Face, Nose, Hand or Foot Zone points associated with the affected area (e.g.) Scalp zone "Lower Motor Area" for leg paralysis; Hand point "Loin and leg" for lumbago/sciatica etc. By far the most common prescription is a combination of Ahshi points and local points and distant points on the affected Channel. This may seem to be a simple matter to resolve but a look at any standard chart will show the difficulties. One must limit the number of needles to 6-12 in most sessions. Therefore one must discriminate which local and distant points are most relevant). The textbooks (as individual texts) do not help much either. A careful study of the texts shows that there is major variation between them in their choice of points for specific conditions. One solution to the problem is to construct a database from many textbooks and to use the computer to do a frequency ranking on the points for specific conditions. In this way, the most commonly recommended points for any specific condition can be output in seconds. COOKBOOK AND MODERN AP Although Classical AP is also practised in Europe, USA, Soviet countries, Taiwan and Japan most countries, MODERN AP in those countries is a much simplified version. It needs less study of the more difficult classical concepts but it demands competence in western medicine as the foundation for sound diagnosis good clinical success. The following aspects will be discussed: 1. WESTERN CONCEPTS OF REFLEX DIAGNOSIS AND THERAPY 2. COMPUTER DATABASES 3. COOKBOOKS 4. TAIWANESE/JAPANESE APPROACH TO AP 5. COMBINATION OF MODERN AP AND WESTERN MEDICINE

6. THE FUTURE ? 1. WESTERN CONCEPTS OF REFLEX DIAGNOSIS AND THERAPY The body is a unit. Each organ and part belongs to the whole and can influence the whole. The peripheral, central and autonomic nervous system, together with the endocrine system controls the harmony of the whole. American, German, Scandinavian, Eastern European and Soviet (as well as Oriental) research in recent years has confirmed the enormous potential measuring deviations in of the autonomic-endocrine system as a diagnostic aid and of stimulating the system to obtain therapeutic results. Research with infra-red thermography, Voll-Akabane-Ryodoraku measurements of altered sensitivity at peripheral points etc has confirmed the diagnostic claim of TCM: that organs project information of their dis-ease to the periphery via the autonomic nervous system. Clinical detection of the altered sensitivity aids in diagnosis. Any method (including AP) which speeds up the return to normal sensitivity is a good therapeutic method and monitoring the speed of return to normal sensitivity has prognostic value. 2. COMPUTER DATABASES In every sphere of technology the computer is used to store vast amounts of data. The stored data can then be sorted, searched, analyzed and output (to screen, printer or graphics plotter or screen) as required. Many serious students of AP have observed the variation between texts mentioned in the last section. To overcome the difficulty and to assist in their final selection of points, they have cross-referenced every indication given for every point in as many authoritative sources as possible. This was usually done on a card-index or loose-leaf notebook system. When presented with an unfamiliar problem (say post-CVA aphasia), the practitioner could consult the card or loose-leaf for "Aphasia" and visually assess the most important points by frequency-ranking methods. This procedure can take lO-20 minutes for each condition in a good database. This system worked very well for static databases (i.e.) ones which were not altered by additions or deletions. Every time a new reference goes in or out, the ranking would possibly change. Furthermore, the manual system was rather inflexible, for instance, if a researcher wished to examine the most frequently used points for "head" (using all the conditions coded under "head") it could take hours to get the result. This is a simple problem for modern computers. Having collected data from >50 textbooks and many clinical articles on AP over the past 10 years, I have stored it on computer. The database has >1170 clinical conditions and can generate prescriptions for any or all conditions. Every point listed anywhere in the source material is output and the score is also output. One can see at a glance how well or how badly the point is represented in the database. One can also see how often the condition is cited; conditions with very few citations are less likely to respond to AP therapy than those with many citations. 3. COOKBOOKS Cookbooks usually provide instant details of the ingredients needed to prepare the required dish. They are used mainly by cooks who (a) have bad memories or (b) have not tried to prepare the dish before. Either way, they are very useful and many an enjoyable meal was

prepared in this way. Really expert cooks however, through experience and good memory, seldom need to refer to the cookbook. Cookbook AP is basically "prescription AP". It is suitable for statistical medicine (standardised approach to all "similar" cases). It is quite unsuitable for difficult, complicated or atypical cases, especially in man. To treat such cases successfully by AP would require a deep study of the classical concepts. Having said that, Cookbook AP is ideal for routine and simple cases. It is the quickest, least painful way of introducing busy professionals to the AP techniques. Whether right or wrong, many busy professionals are not prepared to devote the effort and time to a deep study of AP. Without the cookbook approach, most of these would never be able to attempt AP therapy, except for the simplest type (TP therapy or Ahshi therapy). The main problem with Cookbook AP is which book to use. None of the AP texts available (even the most comprehensive ones, such as the "Essentials of Chinese AP", "Barefoot Doctor's Manual", "Acupuncture, a Comprehensive Text" or "Current AP Therapy") lists all the conditions which can be helped by AP, and there are considerable differences within and between texts. Thus, the serious student is forced either to construct a personal database (as already discussed) or to purchase a commercial card-index database (such as that by Shenberger). The latter is good but is very incomplete - being based on only a few textbooks. At this time, micro-computer AP databases are available commercially. One way to use the cookbook method is to select the 6 or 7 points with the highest scores. I have discussed this method with several highly trained and skilled AP practitioners. There is general consensus that while this will give useful clinical success ratios, it will not achieve the success ratio which would be possible if the points were selected from the cookbook not only by their scores but also keeping the Classical concepts and the laws of choosing points in mind. This pre-supposes that the user knows these concepts. Thus, in summary: Cookbook + little AP knowledge = good clinical success Cookbook + good basic AP " = better clinical success 4. TAIWANESE/JAPANESE APPROACH TO AP Having discussed some of the fundamental concepts of TCM and TAP we should now consider how much of the Traditional approach is actually used in modern AP today. This is a very difficult question to answer and it largely depends on the training and experience of the respondent. First, let us examine some of the characteristics of modern AP. Medical diagnosis in China Today: Side by side with traditional systems, highly scientific, western oriented medical systems co-exist. This also applies in India, Japan, Taiwan, and most of the Far East. In the same city, you may find the back-street charlatan, the high-street Oriental Doctor (Traditional) and the western-style trained medical specialist. Many Chinese and Japanese doctors, trained in western medicine but also trained (and expert) in AP ignore or dismiss much of the Five Phase Theory, the Chinese pulse diagnosis method

etc as irrelevant to modern medicine. Lined up against them, as (many or more) of their colleagues hold fast to these concepts. Thus, a westerner asking "How important are the traditional concepts today"? cannot arrive at firm conclusions based on talking to these persons. We can also try to assess the problem by examining the amount of text space devoted to Traditional Concepts in the English versions of the AP textbooks from the far East. In general, few of these texts issued in the past 10 years give more than a cursory nod towards the traditional concepts. Most of them approach the treatment of clinical disorders from a pragmatic viewpoint (i.e.) Cookbook AP. Many modern AP textbooks place little importance on the Six Evils, the Five Phase Theory and its uses etc. Many successful AP practitioners do not use those concepts in diagnosis or therapy. However, one should ask the question: why was the traditional aspect understated? Was it because the authors believed it to be irrelevant or was it because they thought that full discussion would "turn off" western readers? I believe the latter is nearer the truth. Because of conceptual differences, there are no words in our languages for many of the Chinese concepts! Full discussion would be tedious: like trying to discuss nuclear physics with a theology student. In support of this argument, we must note that some of the authoritative texts place considerable emphasis on the traditional (Essentials of Chinese AP; AP a Comprehensive text; Current AP Therapy; Pathogene et Pathologie Energetiques en Medicine Chinoise - Van Nghi 1971). The fact that the Barefoot Doctor's Manual gives little attention to it is probably because it is for the barefoot doctor, whose training is too short to assimilate the complex traditional concepts. Thus, the terminology and concepts used in medical diagnosis depend largely on where the patient becomes ill and which doctor is consulted, as is the case in Ireland! 5. COMBINATION OF MODERN AP AND WESTERN MEDICINE In the Veteran's General Hospital, a huge, excellently equipped Army-Navy-Airforce Hospital in Taipei, one finds specialists in Oriental Medicine, specialists in western medicine and (more significantly) specialists in both systems. It follows that the diagnostic and therapeutic methods depend largely on which doctors are consulted. All the standard lab tests, clinical and neurological tests etc, are available, if required. In China, the Barefoot Doctor is a technician with limited training, capable of diagnosing and treating the common and simple day to day conditions with reasonable accuracy. Where treatment is unsuccessful or the case appears to be more complex, the patient is referred one step higher to persons who have a longer, more formal training in Oriental and/or western medicine. If they need help, the patient is referred further up the pyramid, which is topped by first rate physicians, surgeons and oriental medical specialists. Effective therapy is more important than putting traditional or modern names on the origin and nature of the clinical condition. AP therapy, as is the case with diagnosis, is an artscience as varied as there are practitioners. However, most medical AP practitioners (including those at the Veterans General Hospital, Taipei) use pragmatic or Cookbook AP in the majority of their cases: knee problems GB34, SP09, ST35, Hsi Yen (Knee Eyes), BL40; sciatica BL23,37,40,60, GB30,34 etc. They use their favourite prescriptions for each type of

case, always including any Ahshi points found. This is also the case with practitioners of western medicine or veterinary medicine. Thus, we see marked similarities between the actual field problems of diagnosis and therapy in the East and West. The bottom line for all therapists is "what will I use to treat this case of osteoarthritis?" etc, or "My patient's sciatica did not respond to BL23....GB34; what should I try now?". 6. THE FUTURE ? Computers have invaded social, academic, professional and business aspects of our lives. Information technology is likely to become a commodity as valuable as oil or gold. Clerics are using databases of the Gospels/Bible to construct sermons on "war", "love", justice" etc. Summaries of research papers on medicine, vet medicine, biology etc are already on databases and available to database subscribers for searches using any key-words of interest. In the near future, we will have access at reasonable price to computers of enormous speed and storage space. Voice input and output will replace/supplement the keyboard/screen. With advances in computer graphics, the receptionist will be capable of taking a preliminary case history, to indicate the location of lesions (by interaction with the database and graphic display unit) and to generate a list of possible diagnoses (from by comparison of signs/lesions with the database lists). He/she will be able to output graphic charts of relevant points for the patient's complaints on the plotter. At that stage, the patient and charts will be presented to the doctor, whose job will be to check (or alter) the facts on the computerised case-history. The doctor will scan the patient, using computer-controlled Kirlian-Voll-Akabane methods to determine which Channels are imbalanced. When the most appropriate diagnosis is selected, the appropriate therapy (including the AP point prescription) will be selected and the patient will be directed to the therapy room for treatment. There, computer-controlled robots, assisted by optical scanners, will insert the needles at the appropriate points and will monitor the clinical response using electro-magnetic measurements of the vital energy at the AP points. George Orwell, eat your heart out! Joking aside, to get the best mental satisfaction from Cookbook AP, the practitioner must know the basic rules of choosing points, so that the Cookbook recipe can be best modified to the patient's needs. Computers can store vast amounts of data (more than a human brain can recall accurately) but the "dead" information must be assessed and adapted by a trained human mind to be made really "alive". Finally, the computer can not give the most vital of all therapies: the gift of unselfish love and compassion in response to the plea for help from a suffering patient. CONCLUSION

Rambo attitudes ("Let's kill the Bastards !" or "Attack is the best means of defence" etc) are justified by many governments and generals as sound Defence Policy against perceived attack. Ramboism may succeed for a time but, unless the attacked group and its genetic code is exterminated, that policy usually fails in the long-term, as is shown by the history of invaded lands. The wheel turns and the natives survive to rise again. (Ireland was occupied but won back its independence after more than 800 years). Rambo policy is used in medicine and vet medicine (antibiotics against bacterial diseases, test and slaughter policy against bovine tuberculosis etc). Although it is very successful in some cases, it has failed to eradicate many of the infectious diseases (especially chronic diseases). TCM and holistic medical philosophies of ecology (avoidance of perceived attack and enhancement of apt adaptive responses) are more likely to succeed. In western concepts, Avoidance of the Evitable and Adaptation to the Inevitable imply a fine-tuned balance of the immune, autonomic and neuro-endocrine systems, which can be brought under a degree of voluntary control (even in animals) by conditioning/self training/biofeedback/visceral learning. Active pursuit of passive defence is also in line with Judaeo-Christian guidelines for physical and mental health/wellbeing: a balanced life, in tune with nature; good diet/fasting, physical/mental work, relaxation/meditation, love of self/love of others etc. Yin-Yang concepts were not confined to the East. Non-specific parasites and their reluctant human and animal hosts must learn, or be helped to learn, to co-exist in some form of harmony/balance. Otherwise, it seems the parasites will thrive long after the hosts shall have become extinct. But, as Murphy's Law prevails ("If something can go wrong, it will, at the worst possible time"), Rambo is unlikely to quit. Meanwhile: 1. The basis for AP lies in a knowledge of the position and functions of the AP points and in relationships between the Channels, the direction and time sequence of Qi flow in the Channel circuits and the MASTER (energy transfer) points. 2. Few (if any) Master Acupuncturists know all the points. (There are over 1000 points if all AP systems are included). However, to claim to be an acupuncturist and not know the main points is tantamount to charlatanism, if not fraud. 3. Beginners can get good clinical results by Trigger Point (TP) Therapy, Scar Therapy, Neural Therapy, Dermatomal/Segmental Nerve Stimulation. These are all part of AP therapy but they are the simplest part and need no knowledge of Oriental medical concepts or AP principles. Thus, a TP therapist is not always an acupuncturist but an acupuncturist always uses TP therapy, where appropriate. 4. As a prospective acupuncturist, you can be as good or as mediocre as you wish to be. There are four main options in the study of AP therapy: a. TP and allied therapy (very simple, little study needed).

b. Classical AP therapy (very complex; needs years of study; may not be essential; adequate training difficult to get in some countries). c. Cookbook AP (Incorporates TP therapy. Relatively simple, if you have good charts, system - and a minimum of home study of AP methods). d. Intermediate AP (Cookbook system plus a minimum of formal lectures on basic AP principles, plus a 6-12 months of part-time home study). The minimum requirement for proper use of AP is study of the location, function, uses and contraindications of the main AP points. I suggest that option 4 is the best for most busy professionals. Your National AP association can help you to select a suitable course. ESSENTIAL READING (the most authoritative texts; * = highly recommended)        

Anon (1973) Newest Illustrations of the AP Points (Charts & Booklet). Med. & Health Publ. Co., Hong Kong 100pp. Anon (1977) Basic AP: Scientific Interpretation & Application. Chin. AP Research Foundation. 84-223 Taipei, R.0.C. 313pp. Anon (1980)* Essentials of Chinese AP. Foreign languages Press, Peking 432pp. Anon (1980)* Barefoot Doctor's Manual -Official paramedical Manual. Running Press, Philadelphia. 948pp. Chung, Chien (1983) The Ahshih Point: Illustrated Guide to Clinical AP. Chen Kwan Books, 5-2-1F Chung Ching South Road, Taipei, Taiwan 212pp. Connolly, Dianne (1979) Traditional AP: The Law of the Five Elements. Centre for Traditional AP. American City Bldg. Columbia, Maryland 21044, 197pp. Lee, Jane F. & Cheung, C.S. (1978) Current AP Therapy, Med. Interflow Publ. House, Hong Kong 408pp. O'Connor, J. and Bensky, D.(1983) AP: A Comprehensive Text. Shanghai College of Trad. Med. (Eastland Press, Chicago) 750pp.

OTHER ORIENTAL TEXTS IN ENGLISH (* = highly recommended)        

Anon (1974)* China's New Needling Treatment. Med. & Health Publ. Co., Hong Kong 80pp. Anon (1974) Principles & Practical use of AP Anaesthesia. Med. & Health Publ. Co. Hong Kong 325pp. Anon (1979)* Treatment of 100 Diseases by New AP. Med. & Health Publ. Co., Hong Kong, 89pp. Anon (1980) AP Manual, AP Research Centre, China Medical College, Taichung, Taiwan, R.O.C. 229pp. Anon (1983) Anatomical Atlas of Chinese AP Points, Shandong Scientific & Technical Press, Jinan, China, 256pp. Cheng, W.C. & Yang, C.P. (1976)* Synopsis of Chinese AP. Light Publishing Co. Hong Kong 128pp. Hyodo, Mayayoshi (1980) Recent Advances in AP Treatment. Dept. Anaesthesia, Osaka Med. College, Japan, 245pp. Hyodo M. & Kitade, T. (1980)* Guide to Silver Spike Point Electrotherapy, Dept. Anaesthes. Osaka Med. College, Japan 212pp.

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Kao, F.F. & Kao,J.J. (1973) AP Therapeutics, Eastern Press, New Haven, Connecticut, 98pp. Shen, Chou AI, Stenbaeck, L., Hammond, G.L. & Clausen, T. (1973)* Practical AP, FADL Publishing House, Copenhagen, 160pp. Shui, Wae (1976) A research in AP and its clinical Practice. Commercial Press Ltd., Hong Kong 231pp. Silverstein, M.E, Chang, I.L. & Macon, N. (1975) Handbook for Barefoot Doctors of China. Schocken Books, New York 372pp. Wong and Law (1982) Chinese AP Handbook. Light Publishing Co., Hong Kong, 150pp.

OTHER WESTERN TEXTS (* = highly recommended)                    

Austin, Mary (1974) AP Therapy. Turnstone Books, London. 290pp. Callehr, H. (1976) AP in Psychosomatic Medicine: Diagnostic & Therapeutic Standards Amer. J. Acup. Vol. 4, 101-. Chaitow, Leon (1976) AP Treatment of pain. Thorsons Publ. Wellingborough, Northants, U.K. 160pp. Chan, Pedro (1975) Finger Acupressure. Price, Stern, Sloan Publishers, Los Angeles, California 92pp. Chan, Pedro (1977) Ear Acupressure, Price, Stern, Sloan Publ. Los Angeles, CA. 109pp. Chang, S.T. (1976) Complete Book of AP Celestial Arts, Milbrae, CA. 244pp. Connolly Dianne (1979)* Traditional AP: The Law of the Five Elements. Centre for Traditional AP, American City Building, Columbia, Maryland 21944, USA. 197pp. Dorrigo, Bruno et al (1979)* Fibrositic Myofascial Pain in Intermittent Claudication, Effect of TP block on Exercise Tolerance, Pain, Vol 6, 183-. Fox, W.W. (1975)* Arthritis & Allied Conditions. A New & Successful Approach, Ranelagh Press, Hampstead, London, 9lpp. Houston, F.M. (1974) Healing Benefits of Acupressure. Keats Publ. Inc., New Haven, Connecticut, 76pp. Huneke, F. (1961) Das Sekunden Phanomen. Karl F. Haug Verlag, Ulm, Germany (In German) Hwang F.T.K., Wong, J.S.L. & Chan, P.C.P. (1975) AP made Easy. AP Research Institute, Chan's Books, Alhambra, CA, USA. 97pp. Kajdos, V. (1974) Neural Therapy - Its possibilities in everyday practice. Amer. J. Acup. Vol 2, 113-. Kaptchuk, Ted (1983)* The Web that has no Weaver. Congdon & Weed, New York, USA. Kellgren, J.R. (1939-42) On the Distribution of Pain arising from Deep Somatic Structures & Charts of Segmental Pain Areas. Clin. Sci., Vol 4, 35-. Khoe, Willem (1979)* Scar Injection in AP. Amer. J. Acup. Vol 7, 15-. Lau, P.D. (No Date) Explanatory Manual of AP Hampton Gen. Hospital, Hampton, Virginia, U.S.A Lavier, J. (1974) Points of Chinese AP. Health Science Press, Wellingborough, Northants, U.K. 115pp. Lawson Wood, D. & J. (1973) AP Handbook. Health Science Press, Wellingborough, Northants, U.K. 141pp. Lee, I.J. & Lee, T.D.H. (1975) AP Atlas. Lycee Trading Corp. Melville, New York, 203pp.

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Lewitt, Karel (1979) The Needle Effect in Relief of Myofascial Pain. Pain, Vol 6, 83-. Lu, Henry C. (1974) Complete Textbook of Auricular AP. Acad. Oriental Heritage, Vancouver, Canada, 250pp. Manaka, Y & Urquart, I.A. (1973) Quick and easy Chinese Massage. Japan Publishing Trading Co., 1255 Howard St. San Francisco 31pp. Mann, Felix (1973)* AP cure of many Diseases. Heinemann Medical Books, London, UK. Mann, Felix (1974) Meridians of AP. William Heinemann Med. Books; London 174pp. Mann, Felix (1974) Treatment of Disease by AP. William Heinemann Med. Books Ltd. London 202pp. Matsumoto, Teruo (1973) AP for Physicians, Charles C. Thomas, Springfield, Illinois 202pp. Melzack, Ronald et al (1977)* Trigger Points and AP Points for pain; Correlations and Implications. Pain, Vol 3, 3-. Macdonald, Alex (1983)* Trigger Mechanisms and Myofascial Fain. 3rd Nordic Congress on AP (May 1983) and Annals Roy. Coll. Surg. Eng., Vol 65,44-. Moss, Louis (1972)* AP and You. Paul Elek Books, London, 196pp. Namikoshi, Tokujiro (1974) Shiatsu. Japan Publ. Trading Co., San Francisco, CA, USA. 81pp. Niboyet J.E.H. et al (1973) L'anaesthesie par l'acupuncture, Maisoneuve, Saint Ruffine, France 433pp. Patterson, Margaret (1975)* Addictions can be Cured. Lion Publ. Co., Berkhamsted, Herts, U.K. 95pp. Porkert, M. (1983) The Essentials of Chinese Diagnostics. Acta Medicinae Sinensis, Chinese Medical Publications Ltd., Zurich, Switzerland. 292pp. Rogers, Carole (1982)* AP Therapy for Post-Operative Scars. Amer. J. Acup., Vol 10, 201-. Pontinen, Pekka (1982) AP Seminar for Swedish Physicians, AP Research Dept., Tampere Univ. Finland. Shenberger, R.M. (1980) AP Therapy Prescription Index. Shenco, 205 Pinecroft Drive, Roselle, ILL 60172 U.S.A. Travell, J. and Simons M. (1984) Myofascial pain and dysfunction - the Trigger Point Manual, Part 1. (Williams & Wilkins, Baltimore & London), 713pp. Turner, Roger, N. & Low, Royston, H. (1981)* Principles & Practice of Moxa. Thorson's Publ. Wellingborough, Northants, UK 95pp. Ulett, G. (1982) Principles and Practice of Physiological AP. Warren Greene Inc., 8356 Olive Blvd., Missouri 63132, U.S.A. 220pp. Van Nghi, Nguyen (1971) Pathogenie et Pathologie Energetiques en Med. Chinoise. Imprimerie Ecole Don Bosco, Marseille. 679pp. Warren, F.Z. & Fischman, W.L. (1980) Sexual AP and Acupressure. Unwin Paperbacks, London, Boston, Sydney 238pp. Wu Wei Ping (1973) Chinese AP. Health Science Press, Holsworthy. Devon, UK. 181pp.

SYMPOSIUM PROCEEDINGS, OVERVIEWS, REVIEWS (* = highly recommended) 

Anon (1975) Summaries of Rep. of China (Taiwan) Delegation to 5th World Congress of AP 136pp.

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Anon (1975) Proc. 3rd World Symposium on AP and Chinese Medicine, New York (Amer. J Chin. Med., 3, Supp 1, 54pp. Anon (1979)* Abstracts from Symposium on AP, Moxa and AP analgesia. Peking and Jean Bossy's Synthesis (Doin Editors, Paris) 286pp. Anon (1981)* Symposium on Myofascial Trigger Points (Melzack, Renolds, Rubin, Simons, Travell) Archives of Rehabilitation Medicine, March 1981, 97-117. Lin, J.H. & Rogers, P.A.M. (1980) AP effects on the body's defence systems: a review. Vet. Bulletin, 50, 633-. Rogers, P.A.M. & Ottaway, C.W. (1974) Success claimed for AP in domestic animals: a veterinary news item. Irish Vet. J., 28, 182-. Rogers, P.A.M., White, S.S. & Ottaway, C.W. (1977) Stimulation of the AP points re analgesia and therapy of clinical disorders in animals. Vet. Annual (Wright Scitechnica, Bristol, UK), 17, 258-. Rogers, P.A.M. & Bossy, J. (1981) Activation of the defence systems in animals and man by AP and moxibustion. Acup. Res. Quart., (Taiwan), 5, 47-. Rogers, P.A.M. (1983) The Taiwan Report. Acup. Res. Quart., (Taiwan), 7, 44-.

QUESTIONS 1. One of the following statements is not correct. Indicate the incorrect statement: (a) The diagnostic, therapeutic and preventative value of AP depends totally on a knowledge of the AP points, the Channels and their functional and anatomical relationships with each other (b) AP points are of two main types: (a) Ahshi points and (b) codified AP points (c) Most codified AP points are reactive electro-permeable points (REPP) relative to nearby skin areas (d) Hyper-reactive AP points, whether Ahshi or codified, are hyper-sensitive to pressurepalpation, electric current or heat (e) Ahshi points are abnormally tender to palpation pressure. Human patients are usually aware of their presence even if they are not pressed 2. One of the following statements is not correct. Indicate the incorrect statement: (a) When Ahshi points are pressed, the human patient usually grunts, groans, swears or jerks (b) Ahshi = Ah! Yes !, or "Ouch!" (c) In animals, pressure on Ahshi points elicits definite defensive or aversive behaviour (d) Some Ahshi points are just painful locally, corresponding with "fibrositic nodules", "motor points" and other irritable foci in muscle and fasciae. (e) Ahshi points are never Trigger Points (TPs) 3. One of the following statements is not correct. Indicate the incorrect statement:

(a) Up to 70% of Ahshi points occur at codified AP points (b) Ahshi points are not related to the Shu (paravertebral reflex) and Mu (front alarm) points (c) Ahshi points are usually present in myofascial syndromes (d) Ahshi points are useful in diagnosis and prognosis: in the absence of signs of other pathology, they confirm that muscular spasm is the main problem and that the prognosis is very good if they can be eliminated successfully (e) In heart/pericardial disease, pressure along T4,5,6 (BL14,15,16) or from under the xiphoid cartilage to a point between the nipples (CV14-17) may be painful 4. One of the following statements is not correct. Indicate the incorrect statement: (a) Ahshi points are always treated as part of AP therapy (b) Point tenderness always occurs in clinical disease (c) There are over 1000 codified AP points in humans (d) The "New", "Strange", "Hand", "Ear", "Foot", "Scalp", "Face", "Nose", "Red Doctor Zone" points etc are mainly non-Channel points (e) The average TSUN ("Body Inch") in humans is the width of the joint of phalanx 1-2 of the patient's index finger. However, the length of the TSUN varies slightly with the part of the body being searched 5. One of the following statements is not correct. Indicate the incorrect statement: (a) AP points influence: the organ and associated functions of the Channel; the Channel and areas anatomically close to it; local tissue and functions (b) Thoracic and abdominal AP points, including paravertebral points, influence organs anatomically close to them (c) Point GB34 influences GB function and disorders (cholecystitis, cholelithiasis etc); pain and dysfunction along the course of the Channel from eye, to lateral headache, to neck/shoulder area pain, to lateral thoracic/abdominal pain, to hip, lateral thigh, knee, lateral leg, ankle, to 4th toe pain/sprain/paralysis (d) All AP points on a Channel are equally powerful as regards local and distant effects. For example GB30 is as good as GB34 in stifle/femoro-tibial pain and cholecystitis (e) MASTER POINTS include Shu and Mu points; Five Phase Points; Luo (Passage) Points; Yuan (Source), Xi (Cleft), Tonification, Sedation, Hour Points etc 6. One of the following statements is not correct. Indicate the incorrect statement:

(a) Because of overlap in the spinal nerve supply to the organs, the Shu and Mu points are not as organ-specific as classical theory states (b) Shu and Mu point sensitivity is a guide but not a definitive indication as to the organ affected (c) The Five Phase Points transfer Qi between the Channels in the Five Phase Cycle (d) Luo (Passage) Points transfer Qi between the Husband and Wife Channel within each Yin-Yang pair within each Phase (e) The Chinese term HSIN (HT) relates to the Fire Phase. It controls the heart, tongue and psyche. Neurasthenia, restlessness, insomnia, excitability, rapid speech, angina pectoris, red complexion, dislike of summer weather or heat etc indicate a disorder in Fire, manifest in a disturbance in Heart function. In that case, the diagnosis usually can be confirmed by western methods: abnormal ECG and elevated heart muscle enzymes in serum 7. One of the following statements is not correct. Indicate the incorrect statement: (a) TCM has Eight Principles for defining disease Syndromes, based on the clinical signs: it combines one type from each of 4 categories (Yin or Yang; Hot or Cold; Shi or Xu; External or Internal) (b) Many translations of Chinese medical AP texts ignore or pay little attention to the classical Pulse types. Recent studies (doppler ultrasonography or use of pressure transducers to measure pulse characteristics) cast doubt on the objective validity of Classical Pulse Diagnosis. (c) According to TCM, the pulse in the right radial artery reflects the energy status of the SI, GB and BL Channels on superficial palpation and the HT, LV, KI Channels on deep palpation. (d) A disease of Yang, Hot , Shi, External type has a good prognosis (e) A disease of Yin , Cold, Xu , Internal type has a poor prognosis 8. One of the following statements is not correct. Indicate the incorrect statement: (a) In TCM therapy, AP is more important than herbal medicine (b) All methods of TCM aim to correct imbalances of Qi. Where the cause is bad lifestyle (XS eating; XS work; insufficient food or sleep; XS alcohol etc) steps are taken to advise on moderating this (c) The patient is advised on environmental, behaviourial or dietary changes etc which may be necessary to alleviate or remove the cause

(d) To restore the normal balance of Qi (resistance), many methods are used alone or in combination: herbal medicine; physiotherapy; AP and moxibustion; Taichi; psychotherapy (Qi Kung); mental/emotional exercises to balance the emotions (e) The most common needle used in human AP is about 35 mm long and 30 gauge 9. One of the following statements is not correct. Indicate the incorrect statement: (a) DeQi ("the arrival of Qi") is regarded as crucial to AP success: paraesthesia, tingling, numbness, heaviness, "sour feeling" etc in the vicinity of the point (b) In humans, DeQi is indicated by verbal feedback from the patient. In animals, the main signs of DeQi are: sudden change in behaviour; respiration may be temporarily inhibited or accelerated. Local muscle spasms or twitches may be seen (c) DeQi is more often obvious when the point is directly over a peripheral nerve or directly over motor points (d) It is very difficult to obtain DeQi at LI04; PC06; TH05; LI11; ST36; GB34; BL40 (e) Acute conditions require only short periods of needling and chronic conditions require 20 minutes or more 10. One of the following statements is not correct. Indicate the incorrect statement: (a) By far the most AP common prescription is a combination of Ahshi points and local points and distant points on the affected Channel (b) COOKBOOKS, based on frequency-ranking of point use in specific conditions aid in the selection of AP points for therapy (c) Infra-red thermography, Voll-Akabane-Ryodoraku measurements of altered sensitivity at peripheral points etc has confirmed that organs project information of their dis-ease to the periphery via the autonomic nervous system (d) Clinical detection of the altered sensitivity aids in diagnosis (e) Any method (including AP) which speeds up the return to normal point sensitivity is a good therapeutic method and monitoring the speed of return to normal sensitivity has prognostic value (f) One must use at least 12 needles in most AP sessions 11. One of the following statements is not correct. Indicate the incorrect statement: (a) Few (if any) Master Acupuncturists know all the AP points (b) Beginners can get good clinical results by Trigger Point (TP) Therapy, Scar Therapy, Neural Therapy, Dermatomal/Segmental Nerve Stimulation. These need no knowledge of Oriental medical concepts or AP principles

(c) A TP therapist is not always acupuncturist but an acupuncturist always uses TP therapy, where appropriate. (d) There are four main options in the study of AP therapy: TP and allied therapy; Classical AP therapy; Cookbook AP, with TP therapy; Intermediate AP (Cookbook plus the basics of classical AP) (e) The minimum requirement for proper use of AP is study of the location, function, uses and contraindications of the main AP points. One intensive week's course (such as the Sydney Veterinary Postgraduate Course) is all that is needed. 1 = e 2 = e 3 = b 4 = b 5 = d 6 = e 7 = c 8 = a 9 = d 10 = f 11 = e

FIVE PHASE THEORY AND ITS USE IN MEDICINE SUMMARY Nature and the body are unities, in which mutual control and harmony are maintained by creation (anabolism) and destruction (catabolism). Five Phase Theory extends Yin-Yang Theory, in which all things in nature are classified into five basic types or Correspondences: Fire, Earth, Metal, Water, Wood. The Phases and their Correspondences interact in predictable ways. As Yin and Yang have anabolic and catabolic aspects, so also have the Five Phases. Thus, the Five Phases have a Sheng (Mother-Son, anabolic, creative, nourishing = ->) and a Ko (Grandmother-Grandson, catabolic, controlling, destructive, = X) Cycle. The Sheng Cycle is: Fire -> Earth -> Metal -> Water -> Wood -> Fire. In the Sheng Cycle, Fire is the Mother of (feeds or strengthens) Earth and Metal is the Son of (is nourished by) Earth. The Ko Cycle is : Fire X Metal X Wood X Earth X Water X Fire. In the Ko Cycle, Fire is the Grandmother of (dominates or controls) Earth and Metal is the Grandson of (is brought under control by) Earth. Each Phase (or ELEMENT) relates to a specific Yin/Yang pair of the Channel-Organ System (COS) and to a wide list of Correspondences (function, emotion, excretion, body tissue, season, food etc). Thus, Fire relates to the COSs Heart and Small Intestine (HT and SI) and their Correspondences (sweat, tongue, speech, face, circulation, excitability, psyche, bitter taste, red, summer, south etc). Disease involves imbalance (Excess, Deficiency or Stagnation) of Qi in one or more COSs. Therapy involves restoration of the balance of Qi. Each Channel has 5 special Points, corresponding to each of the Five Phases and a Luo (Passage) Point. These Points are used to transfer Qi between COSs when there is one or more with Qi Excess and an equal number with Qi Deficiency. This restores the balance and harmony of Qi. One usually stimulates the Deficient COS, to draw Qi from its Yin/Yang mate (via the Luo Point) or from another COS (via the Sheng or Ko Cycle). Any Deficiency thus created in the donor COS is filled from an Excess elsewhere. However, if only one COS is involved, it may be Tonified by needling its Mother Point, or Sedated by needling its Son Point.

Five Phase Theory has many implications in medicine. However, the theory is incomplete and it has its limitations. It is a useful guide to aetiology, diagnosis, prognosis and therapy but it is not absolutely necessary for therapeutic success. Knowledge is an ongoing process. While AP can produce good clinical results without a knowledge of the use of Five Phase Theory, the theory enhances the probability of optimal results, especially in complex disease syndromes. INTRODUCTION The Traditional Chinese Medical (TCM) law of Yin-Yang is the UNIVERSAL LAW of mutual control by mutual antagonism and dependence of all things. (See the papers on Holistic concepts of health and disease and on Traditional versus modern AP). The interplay of Yin-Yang is an endless cycle of action and interaction. The concept of cycles is fundamental to TCM. Nothing is static. Nothing is absolute. Everything is dependent on (relative to) everything else. All things must CHANGE. The Five Phase Cycle is another fundamental concept of TCM. In essence, everything and every concept in creation is a manifestation of Qi (energy). Qi has attributes or characteristics of one or more of five basic types, and can transform from one Phase to another. The types or Phases are called: Fire, Earth, Metal, Water, Wood. For instance, suppose you are sitting in your armchair, looking into a fire and meditating on the nature (or type) of Fire. You might see it as primarily heat and light (energy-giving). However, the same fire once was (and still contains an element (Phase) of) living organic material (Wood, peat, coal, methane). As it burns, it produces (and contains an element of) ash (Earth) and mineral residue (Metal) and the hydrogen in most burning fuels is oxidised to Water. Thus Fire also contains aspects (elements, Phases) of the other Phases (Wood, Earth, Metal and Water). In turn, earth and minerals, when fed by Water can produce a new tree (Wood). Thus, all the basic components Fire, Earth, Metal, Water and Wood are needed for (inherent in) every other Phase. Each Phase has typical characteristics or Correspondences. Each has also its Yang and Yin aspects. The Phases create (engender, nourish, help) one another and destroy (control, restrain, dominate) one another in a ceaseless, dynamic cycle, the dance and rhythm of life and death. In TCM, the Two Phase (Yin-Yang) and Five Phase Cycles are universal Laws. They are the source and manifestation of evolving creation and destruction in all its aspects. They apply to every aspect of life and politics, art, music, science, philosophy, sociology and medicine. They are primitive (yet ultra-sophisticated) concepts of the balance and inter-dependence of all things. If one Phase becomes imbalanced (too strong or too weak), the whole cycle is upset and disharmony can arise in other Phases and their Correspondences. Restoration of balance depends on recognition of which Phases are upset and the redistribution of Qi between them so as to restore harmony, if this is possible. The Five Phase Cycle has two major components, the Sheng Cycle (Mother nourishing Son) and the Ko Cycle (Grandmother restraining Grandson). The Sheng is anabolic, creative, nourishing, feeding. The Ko is catabolic, destructive, weakening, controlling. Sheng Cycle: Things of a Fire nature promote (create or nourish) things of an Earth nature, which promote or create things of a Metal nature etc. The Cycle is Fire -> Earth -> Metal -> Water -> Wood -> Fire.

Sheng mnemonic: To remember the Sheng Cycle, visualise a gardener Watering a seed. The seed grows into a tree. The tree is cut down for fireWood. The Fire produces ashes which could be further refined to produce Metal. The sequence is Water -> Wood -> Fire -> Earth -> Metal -> Water. Because a cycle has no beginning and no end, it is not important which Phase is put at the top of the diagram, but it is usual to put Fire on top because (as will be seen later) four COSs are associated with Fire and the top position is the most aesthetic, as will be seen when the COSs are added to the diagram. In this Cycle, things of Fire are Mothers of things of Earth (which are Sons of Fire). In turn, things of Earth are Mothers of things of Metal (which are Sons of Earth). Another Mother and Son concept was discussed elsewhere in relation to the Diurnal Qi Cycle (daily Qi tide) from: LU -> LI -> ST -> SP -> HT -> SI -> BL -> KI -> PC -> TH -> GB -> LV -> LU. In the Qi Cycle, LU is the Qi Mother of LI and BL is the Qi Son of SI etc. The following diagram shows the relationships between the Phases in the Sheng Cycle. The Sheng Cycle is represented by a clockwise circle. It is continuous, having no beginning and no end. Although Fire creates Earth, Earth is necessary for Fire: (without Earth the succeeding Phases (Metal, Water and Wood) would not be, and Fire itself would die!). Fire

Wood

Water Earth

Water

Metal

COMBINATION OF SHENG AND KO CYCLES BALANCES THE FIVE PHASES Without Sheng (nourishment) there can be no growth and development. Without Ko (restraint), excessive development would be harmful. Thus, both the Sheng and Ko Cycles are necessary for balance. They represent a state of continuous dynamic anabolism and catabolism respectively. All things in nature must change. In biology, as in nature, nothing is static (i.e.) the system is in continuous movement, one Phase becoming another. During this movement (rhythm) there are active (Yang) and passive (Yin) phases. The combination of Sheng and Ko is represented in the following diagram: ===> represents Sheng Cycle (nourishing, promoting anabolic); ---> represents Ko Cycle (restraining, controlling, catabolic); +++> represents Counteracting (a Reverse Ko) Cycle: Fire X Water X Earth X Wood X Metal X Fire. Earth restrains (controls) Water (in the Ko Cycle) but Water may Counteract on Earth (in the Reverse Ko Cycle): Fire

Wood -----> Earth

Water ST -> SP -> HT -> SI -> BL -> KI -> PC -> TH -> GB -> LV at 2 a.m. (1-3 a.m.). It then returns to the LU COS to begin a new day. In the diurnal Qi circuit, the LU is called the Mother of LI (because it feeds LI) and LI is called the Son of LU (because it is fed by LU). In turn, LI is Mother of ST and ST is the Son of LI. During the circuit of Qi through its daily cycle, it travels three times around the body (i.e.) each 24-hour cycle it composed or 3 X 8 hour revolutions:   

Circuit 1 (0300-1100 h): The Qi tide is full in LU-LI-ST-SP. Circuit 2 (1100-1900 h): The Qi tide is full in HT-SI-BL-KI. Circuit 3 (1900-0300 h): The Qi tide is full in PC-TH-GB-LV.

Each or these 8-hour circuits is further divided into 4 X 2 hour phases: chest to finger, finger to face, face to toe and toe to chest (where a new, similar revolution around the body begins again). Thus in one day, the Qi travels three times around the body (Chest -> Finger -> Face -> Toe -> Chest in each circuit). LULISTo / SPHTSI / BLaKI-PC / TRI-GALL-LV is the basic memory aid of all AP. It can be arranged in 3 circuits of 4 COSs as shown below. DIRECTION OF FLOW OF Qi

chest to

finger

eye to

toe to

finger

to face

toe

chest

Circuit

1

LU

->

LI

->

ST

->

SP

(revolution 1)

|

(0300 - 1100h)

(------

BL

->

KI

(revolution 2)

|

(1100 - 1900h)

(------

GB

->

LV

(revolution 3)

|

(1900 - 0300h)

(------ Metal >------------->--------X---------->---------->|

Fire

|

Chest to

|

>---->--------X------------>-

|

Finger to

Finger

|

|

Fire

|

|

Face

|

|

>----X--->-

|

|

|

|

|

|

|

|

LU

HT

PC

TH

SI

LI

0400h

1200h

2000h

2200h

1400h

0600h

|

|

|

|

|

|

|

|

|

|

|

|

|

|

Arm

| C

.

.

| GB X LV -> Wood

Note that the underlined one in each-pair is Yin and the other one is Yang. The Yin COS of each pair is called the Wife and the Yang COS called the Husband. The arrow (->) indicates a Change of Phase. Though this paper will not discuss the Five Phase Theory in great detail, the linked pairs are related to the Five Phases as follows:

Limb Arm = = Leg = =

Phase Metal Fire Fire Wood Water Earth

Yin (Wife) Lu HT PC LV KI SP

Yang (Husband) LI SI TH GB BL ST

The Phase-Mates (linked COSs, Wife-Husband pairs within each Phase) are important in classic AP, mainly because: a.points on one of them (for example LI points) can help to treat disorders of the other member of the pair (LU); the Husband helps the Wife, and vice-versa and

b.the Luo-Connecting points (see Master Points later) allow Qi to be transmitted from one member of the Phase-Mates to the other member (for example from ST to SP or vice-versa). For instance, if there are symptoms of Excess Qi in SP and Deficient Qi in ST, needling the Luo-Connecting point of ST will divert the Excess from SP into ST, thus balancing the system. Also, in the Law of the Five Phases (see later), the Luo points are also used in both the creative (SHENG) cycle and the destructive (KO) cycle to balance the cycle. Thus, it is important to know which COSs are linked (the Husband-Wife pairs within each Phase) and the Luo points which allow interchange of Qi between them. (Note: in classic AP one always treats the Deficient COS, drawing Qi directly or indirectly from some other COS which has Excess Qi. To return to the sequence of Qi flow, there are 3 complete Circuits or revolutions of Qi around the body every 24 hours. Then a new cycle begins. Sequence 1 "LULISTo / SPHTSI / BLaKI-PC / TRI-GALL-LV" can be re-written: Qi (ENERGY) CIRCUIT TIME

BODY

SUPERFICIAL PATH THROUGH THE BODY Arm Yin

-> Arm Yang

-> Leg Yang

chest-hand -> hand-face -> eye- toe

REVOLUTION

-> Leg Yin -> toe-chest

0300-1100h

LU

->

LI

->

ST

->

SP

1

1100-1900h

HT

->

SI

->

BL

->

KI

2

1900-0300h

PC

->

TH

->

GB

->

LV

3

The midline Extra Channels, GV (Governor vessel, dorsal) and the CV (Conception Vessel, ventral) are not included in the 12 Main Channels. They are regarded more as reservoirs of Qi and their points are used mainly for local symptoms or disorders anywhere along their course and in some general prescriptions. They are not considered in relation to the Five Phase Laws, body Qi tide etc. LEARNING THE FIRST AND LAST POINTS OF THE CHANNELS One must know the position of the first and last points on the superficial path of each of the 12 main Channels for two reasons: a.It helps to give a mental picture of the general course of the superficial Channel. This is relevant to diagnosis and AP therapy, especially of local problems. b.It reminds you of the direction of Qi flow. In normal circulation, Qi always flows

from the first to the last point. For instance, LU01 is on the chest and LU11 (last point) is on the thumb. (The Qi flow is from Chest to Thumb). INJURY, SCARS ON CHANNELS: If there is a physical blockage along the course of a Channel (for instance strongly fibrosed scar tissue due to injury or surgery), one may see symptoms of Excess COS Qi up-stream (above the blockage) and Deficient COS Qi downstream (below the blockage). Also, the Excess Qi may back-up into the Mother COS (upstream from the blocked Channel in the basic Qi circuit) and the Deficient Qi (downstream of the blocked Channel) may weaken the Qi in the Son COS (Sequence 1)). WHY LEARN CHANNEL ANATOMY AND QI FLOW? The importance of scars/Channel blockage and of knowing the Qi circuits, direction of flow and anatomical/organ/function relationships of COSs is shown by the following: A middle-aged man complained of a bewildering number of symptoms over a period of 8 years. First, he had haematuria and kidney/bladder pain which was treated by hospitalization and antibiotics as nephritis-cystitis. He had a few incidents of right-sided sciatica, which were temporarily relieved by hospitalization, ultrasound and traction. He had interscapular and shoulder-area pain on the right side; tinnitus in the right ear; conjunctivitis and headache on the right side. His most bizarre symptom (which occurred 2 or > times in 8 years) was to wake up at night with his right arm in spasm and a very severe pain shooting down the inner side of the right arm into his little finger. Over an 8-year period, he had been treated by various specialists in urology, orthopaedics, an ear specialist, an eye specialist and a cardiologist. None of these specialists bothered to ask him about his scar! Two years before the first of the above symptoms (nephritis/cystitis), he had a right lobectomy for pulmonary TB. His thorax was incised from the sternum to within a few inches of his spine. Eight years later, when he consulted an acupuncturist, it was found that most of the scar was well healed but that, in the area of the two lines of the BL Channel on the right paravertebral area of the thorax, marked twisting and pulling of the tissues was caused by the scar. The acupuncturist knew that in TCM all the patient's symptoms could be traced to that scar, which was causing a blockage of Qi in the BL Channel. According to TCM, a block at the thoracic level of the BL Channel would cause Excess Qi above the block and Deficient Qi below it. The nephritis/cystitis, sciatica, interscapular pain, headache and conjunctivitis could be traced to the upset in the BL Qi. (The BL Channel begins at the inner canthus of the eye, passes across the head, down by the interscapular area, down over the kidney area and goes down the back of the leg (the classic sciatic area). The tinnitus and the arm spasm/ inner arm pain to the little finger could be traced to Excess Qi in the SI COS. The tinnitus and nephritis also relate to Deficient Qi in the KI COS (KI is the Son of BL and is related to the kidneys and ears, as well as to urogenital function). Note, in the sequence of Qi flow (LU-LI-ST-SP-HT-SI-BL-KI-PC-TH-GB-LV), the SI COS is the Mother of (precedes) the BL and Excess Qi in BL can back-up into SI) and KI is the Son of BL. Weakness in the lower part of BL would weaken the KI COS; the weak Mother can not feed the Son. The SI Channel begins at the little finger, runs the inside of the arm and ends at SI19, at the ear. The KI Channel begins at the sole of the foot and connects to the kidney and ear. The acupuncturist did not believe that he could influence the case very much but he decided to try. Thus, he advised procaine injection of the tender points along the scar, a short course of needles in BL points and regular massage and physiotherapy of the scar and BL Channel, especially in the area of the scar. Although predicted by classic concepts, the outcome was

quite fantastic. All the symptoms disappeared and, to my knowledge, did not return. This was the first time that the acupuncturist had used procaine injection in Scar Therapy. Since then, he has used it many times in patients with trigger points on scars, with excellent results. A friend of mine had bunion-surgery on her big toe. After surgery, she had very severe pain in the toe and medial aspect of the foot. For 18 months she could not put weight on the medial aspect of the foot and was in constant pain. Six sessions of electro-AP at LV03, SP06; KI03, GB34, SP03 and web of toe 1 to 2, with one needle running under the scar give an improvement of 90%. Complete relief of pain followed two procaine therapies of the scar. The pain has not returned since. Mary Austin and Felix Mann also give examples of trauma and scar tissue formation causing blockage of Channels and symptom pictures which were successfully eliminated by treatment of the scar. Also, the German-Austrian system of Neural Therapy and Scar Therapy pays particular attention to scar tissue. There are many examples of bizarre human symptoms which disappear after scar-therapy by massage, injection or other physiotherapy to release the blockage. Be very careful to investigate scars: In taking the case history of a new human patient, a skilled acupuncturist will always inquire about body scars and will examine them for any possible connection between them and the symptom-picture of the patient in relation to Channel paths, the Mother and Son COSs and the symptomatology. This is also important in vet AP and it is advisable to check it out, just in case there may be a cause and effect relationship. If there is any connection, the scar must be treated as part of the therapy. FIRST AND LAST POINTS ON THE CHANNELS: As a memory aid, prepare the following sequence (F = Finger; T = Toe):

F

T

5

5

BODY CIRCUIT

SIX LEVELS OF QI Yang

(2)

5

(5)

-----------4

Yin -------------

4

--------------------Yang

(3)

3

(1)

-----------2

Yin -------------

2

--------------------Yang

(1)

1

1

-----------

Yin -------------

---------------------

Let us call this Sequence 2. The boxes are numbered (2), (3), (1) from top to bottom, indicating which Qi Body Circuit will occupy them. Note that: finger/toe 1 and 3 are Yin; finger/toe 2 and 4 are Yang and finger/toe 5 has 2 Channels each, one Yin and one Yang. Now, using Body Circuit 1 from Sequence 1 (LU-LI-ST-SP), fill in the Channels in the bottom box, as shown below. Then, using Body Circuit 2 from Sequence 1 (HT-SI-BL-KI), fill in the Channels in the top box below. Finally, using Body Circuit 3 from Sequence 1 (PCTH-GB-LV), fill in the Channels in the centre box below: (Body Circuit) Channel Finger

Toe

Arm

Leg

5

5

SI --->--- BL ^ |

5

(5)

SIX LEVELS OF Qi GREAT Yang (Tai Yang)

| (2)

KI

LITTLE Yin (Shao Yin)

------------

-------------

---------------------

4

TH --->--- GB

LITTLE Yang (Shao Yang)

4

HT

|

^ | 3

(1)

| (3)

PC

| LV

EXTREME Yin (Chueh Yin)

------------

-------------

---------------------

2

LI --->--- ST

SUNLIGHT Yang (Yang Ming)

2

^ | 1

1

-----------

LU

| (1)

| SP

-------------

GREAT Yin (Tai Yin) ---------------------

We know from Diagram 1 that LU goes from chest to finger. Sequence 2, therefore, tells us that the last point (LU11) is on F1 (thumb). Similarly, LI goes from finger to face, therefore LI01 is on F2 (index finger). There are two small anomalies in this memory aid. Firstly, KI01 is now shown as being on the sole of the foot (see standard texts). However, in ancient texts, it was shown on the 5th toe. Also, LV01 is not on the 3rd toe, but is on the 1st (big) toe. To distinguish them, think of stubbing the inside of your big toe on a rock. In English, to vent Spleen = to show ANGER . SP01 is on the medial side of the big toe nail. Also, a very important liver point (Tai Chung, LV03) is between the upper ends of metatarsal bones 1 and 2, in the same position as HoKu (LI04) of the hand. Remember LV03 as the HoKu equivalent of the foot. (This helps you remember LV01 as lateral side of big toe nail). Similarly, two COSs are associated with the little finger (F5) (HT and SI). The last point of HT (HT09) is on the thumb-side (radial side) of the nail of F5 and SI01 is on the opposite (ulnar) side of the nail of F5 (the side next to the chopping edge of the hand). Another way to remember this is to hold your hand, palm open, towards your face. Now look at the "Heart Line" of the palm. (This line runs from the little finger side, towards the index finger. Now, if you slowly clench your fist, you will see that the heart line makes a crease which ends at the edge of the fist near the little finger. The end of this crease is SI03 (an important point). Again, open the hand and slowly flex the 4th and 5th fingers. They will touch the "Heart Line" in the palm. This point is HT08. Thus, if you can remember SI03 and HT08 you can work out where HT09 and SI01 should be. The TSUN, CUN, or Chinese INCH: When learning the location of AP points, the TSUN is used as the unit of body measurement. In the human adult 1 TSUN is approximately 1 inch (25 mm), but it varies with body size. It is better understood as a ratio in relation to fixed body landmarks: between the nipples is 8 TSUN; umbilicus to symphysis pubis is 5 TSUN; umbilicus to sternum is 8 TSUN; pubic symphysis to upper edge of patella is 18 TSUN; lower edge of patella to medial malleolus of tibia is 15 TSUN; anterior axillary crease to elbow crease is 9 TSUN; elbow crease to wrist crease is 12 TSUN; see textbooks for further measurements. THE POSITIONS OF THE TWELVE POINTS NEAR THE NAILS ARE: Arm Yin (last points at a finger nail)   

LU11 At root of thumb-nail on the radial side HT09 At nail root or little (5th) finger on the radial side PC09 At tip of third finger

Arm Yang (first points at a finger nail)  

LI01 At nail root of index (2nd) finger, on the radial side SI01 At nail root of little (5th) finger on the ulnar side



TH01 At nail root of ring (4th) finger, on the ulnar side

Leg Yang (last points at a toe nail)   

ST45 At nail root of 2nd toe on lateral side BL67 At nail root of 5th toe on lateral side GB44 At nail root of 4th toe on lateral side

Leg Yin (first points at a toe nail)   

SP01 At nail root of 1st (big) toe on medial side KI01 At sole of the foot, between the midpoints of metatarsals 2-3 LV01 At nail root of 1st (big) toe on lateral side

However, we are still missing 12 more points (the chest and face points). Diagram 1 tells us that LU, HT, PC begin on the chest; LI, SI, TH end on the face; ST, BL, GB begin at the eye and SP, KI, LV end on the chest. The positions of these points are: Arm Yin (first point on chest)   

LU01 In 1st intercostal space, 6 TSUN lateral to CV line (ventral midline) (in animals it is usually in 2nd intercostal space, behind shoulder) HT01 In centre of axilla, just medial to axillary artery PC01 In 4th intercostal space, 1 TSUN lateral to nipple

Arm Yang (last point on face)   

LI20 Between midpoint of outer border of ala nasi and naso-labial groove SI19 In depression between Ear tragus and mandibular joint, with mouth open TH23 On lateral border of orbit at lateral tip of eyebrow

Leg Yang (first point near eye)   

ST01 At border of orbit, directly below pupil of eye BL01 At inner canthus of eye GB01 0.5 TSUN lateral to outer canthus of eye

Leg Yin (last point on chest)   

SP21 6th intercostal space, midway between axilla and free tip of rib 11 KI27 1st intercostal space, 2 TSUN lateral to CV line, midway CV to nipple LV14 6th intercostal space, 2 TSUN directly below nipple (3.5 TSUN lateral to CV14, which is 2 TSUN below xiphoid or 6 TSUN above umbilicus)

THE SUPERFICIAL COURSE OF THE CHANNELS When learning this section, students should consult standard AP texts (see references 1, 1a, 3). Trace the pathways on your body, or that of a friend. Mark in the first and last points, and other "landmark" points.

LU begins at LU01, in 1st intercostal space, travels down the arm to LU05 (on the radial side of the biceps tendon), to LU09 (in the depression on the radial side of the radial artery, at the tip of the transverse crease of the palmar surface of the wrist, to LU11 on the radial side of thumb-nail. LI begins at LI01 on the radial side of the nail on the index finger. It travels up the finger to LI04 (at the middle of the 2nd metacarpal bone, towards the thumb side (at the highest point of the muscle when the thumb and index finger are brought close together) to LI11 (at the lateral aspect of the elbow, half-way between the biceps tendon and the lateral epicondyle of the humerus), to LI15 (at the acromio-clavicular joint) to LI20 near the ala nasi. ST begins at ST01, at the lower edge of the orbit, directly under the pupil of the eye. It runs down the face to the labial canthus (ST04), around to ST06 at the angle of the jaw. It receives a branch from the temple (ST08, Tou Wei). It goes to ST09 on the carotid artery to ST17 on the nipple (forbidden to moxa or needle!!), to ST25 (2 TSUN lateral to umbilicus), to ST36 (4 finger-breaths below patella, one finger breath lateral to anterior crest of tibia), to ST45 on the lateral side of the nail of toe 2. SP begins at SP01 at the medial side of the nail on the big toe. It runs along the side of the foot to the ankle and up the leg to SP06 (3 TSUN above the tip of the medial malleolus of the tibia, just behind the posterior border of the tibia. SP06 is a most important point in AP. Its name (SanYinChiao) means "Three Yins Meeting" (the crossing point of the 3 Yin Channels). This point influences the functions of SP, KI, LV COSs and should be studied. The line then continues up to SP10 (2 TSUN above superior border of patella, at middle of the bulge of the vastus medialis). It then runs up the inside of the thigh to the groin to SP12 (lateral to femoral artery, 3 TSUN lateral to midpoint of upper border of pubic symphysis). From there, it travels up the abdomen to SP20 (in second intercostal space to 6 TSUN lateral to the sternum) and SP21 (in the 6th intercostal space, midway from axilla to free tip of rib 11). HT begins at HT01 in the axilla, travels down the inner aspect of the arm to HT03 (between the medial end of the transverse cubital crease at the medial epicondyle of the humerus when the elbow is bent) to HT07 (on the palmar surface of the wrist at the posterior border of the pisiform bone at the wrist crease) to HT08 (on the heart line of the palm of the hand, where the flexed 4th and 5th fingers meet the palm) to HT09 on the radial side of the nailbed of finger 5. SI begins at SI01 on the ulnar side of the nail on the little (5th) finger, travels up the ulnar side of the finger to SI03* (at the end of the transverse crease proximal to the 5th metacarpalphalangeal joint when the hand is half-clenched). SI03 may also be found by clenching the fist. It is at the end of the "Heart Line" on the palm, where it meets the chopping edge of the fist. It goes to SI06 (flex elbow with palm placed on the sternum; SI06 is in the bony cleft on the radial aspect of the styloid process of the ulna), to SI08 (between the olecranon process of the ulna and the tip of the medial epicondyle of the humerus) to SI09 (1 TSUN above the upper tip of the posterior axillary fold). It then zig-zags over the scapular area, up the posterolateral aspect of the neck to SI18 (in the depression below the lower border of the zygomatic bone, directly below the outer canthus of the eye), to SI19 between the ear tragus and the mandibular joint when the mouth is opened. BL begins at BL01 at the inner canthus of the eye, runs upwards and backwards over the head about 1 TSUN lateral to the midline; it runs down the back of the head to BL10 (about 1.3

TSUN lateral to the midline, level with the space between vertebral spines C1-C2). Here the BL Channel splits into two lines, an inner and an outer line. The inner BL line goes to BL11 (1.5 TSUN lateral to the midline, level with the lower edge of the spinous process of the 1st thoracic vertebra, half-way between midline of the spine and the medial border of the scapula). It continues down to BL30 (1.5 TSUN lateral to midline, level with the 4th sacral foramen. (BL13 to 28 are the Shu points- among the most important points in AP- and each one should be studied in detail). From BL30, the Channel runs upwards to BL31 (level with the 1st sacral foramen, midway between the posterior superior iliac spine and the midline) and passes down through BL32,33,34 at the level of 2nd, 3rd and 4th sacral foramina. Thus, BL27,28,29,30 (over the 4 sacral foramina) are level with BL31,32,33,34. Then the Channel passes down the back of the thigh to join the second BL line at BL40, (WeiZhong) in the middle of the popliteal crease. The outer BL line leaves BL10 to join BL41 (FuFen, 3 TSUN lateral to midline level with the lower border of the spinous process of vertebra T2). This line continues downward 3 TSUN from the midline to BL52, level with BL23 (between L2-3). Between vertebrae T2 and L3 (BL12 to 23), each point on the outer line is paired with a point on the inner line; each pair of points has similar functions. These pairings are easy to remember: the code of the outer point = 29 + the code of the inner point, i.e. BL12 and 41 are paired, BL21 and 50 are paired and BL23 and 52 are paired: Outer BL Points (IVAS BL40=WeiZhong, mid-popliteal

crease)

Thoracic

Lumbar

Sacral 4

Vertebra

-

-

-

-

-

2

3

4

5

6

7

9 10 11 12

Inner line

-

-

-

-

- 12 13 14 15 16 17

Outer line 36 37 38 39 40 41 42 43 44 45 46

1

2

2

18 19 20 21

22 23

28

47 48 49 50

51 52

53

30 54

IVAS Outer No. = Inner No. + 29)

From BL52, the outer line passes back to BL53 (outside BL28, level with foramen S2), to BL54 (outside BL30 and 34, level with foramen S4). From BL54, the Channel passes straight down the back of the thigh to BL40 (WeiZhong), where it joins the first line. From here it passes down the back of the calf to BL57 (8 TSUN below BL40) and then curves outwards towards the lateral malleolus of the tibia to BL60 (between the lateral malleolus and the Achilles tendon. The Channel then passes along the lateral edge of the foot to the last point (BL67) at the outer angle of the nail on the little toe. If you would learn only one Channel, choose the BL Channel!! It has points (Shu points, see later) for all the major organs, is involved in neck and back problems, sciatica, leg problems, reproductive problems and is most important in obstetric analgesia, dystocia etc.

KI begins at KI01, on the sole of the foot between the upper half of the 2nd and 3rd metatarsal-phalangeal joints. It runs up the medial aspect of the foot to KI03 (opposite BL60, i.e. between the Achilles tendon and the medial malleolus). From here it does a loop through KI04,5,6 in the ankle region and then climbs upwards to points KI07,8,9 on the inner side of the leg, to KI10 on the postero-internal thigh and then emerges above the pubis at KI11 (at the superior border of the pubic symphysis 0.5 TSUN lateral to the midline). From here it climbs parallel to the midline to KI21 (0.5 TSUN lateral to midline, level with CV14 (6 TSUN above the umbilicus). From KI21 the line passes to KI22 - KI27, running parallel to midline but 2 TSUN lateral to it. The last point (KI27) is 2 TSUN lateral to midline in hollow between the lower border of the clavicle and rib 1. PC begins at PC01 in the 4th intercostal space, 1 TSUN lateral to the nipple. It passes down the anterior aspect of the arm to PC03 on the ulnar side of the biceps tendon of the elbow crease. It continues down the anterior surface of the forearm to PC06 (2 TSUN above the palmar wrist crease, between the flexor tendons) to PC08 (on the palm of the hand between 2nd and 3rd metacarpal bones, where the fully flexed middle finger meets the palm) to the last point (PC09), at the midpoint of the tip of the middle (3rd) finger. TH begins at TH01 at the nail of the 4th (ring) finger, towards the ulnar side. It climbs the back of the hand, to TH05 (2 TSUN above the dorsal wrist crease, between the radius and the ulna), to TH10 (1 TSUN behind and above the olecranon process of the ulna), to TH14 (between the acromion process of the scapula and the greater tubercle of the humerus), to TH17 (between the mastoid process and the angle of the mandible). It then curves behind the ear and ends at TH23 at the lateral tip of the eyebrow, on the lateral border of the orbit. GB begins at GB01, 0.5 TSUN lateral to the outer canthus of the eye. It goes to GB12 behind the ear, then curves forward again to GB14 (one TSUN above the midpoint or the eyebrow). Then the Channel curves across the head, on a line with the pupil-midpoint of the eyebrow, to GB20 (in the depression between the acromion process and GV14 (between the spinous process of vertebrae C 7 and T 1) on the highest point of the shoulder muscles). From here, the line zig-zags down the lateral aspect of the thorax and abdomen to GB28 (anterior and interior to anterior-superior iliac spine) to GB30 (behind the great trochanter of the femur). From here it passes down the lateral aspect of the thigh and knee to GB34 (in the depression anterior and interior to the little head of the fibula, to GB40 (below and in front of the lateral malleolus of the tibia, to the last point (GB44) on the lateral angle of the nail of the 4th toe. LV begins at LV01 at the lateral angle of the nail of the big toe, passes up to LV03 (between the upper heads of the 1st and 2nd metatarsal bones) to LV04 (1 TSUN antero-lateral to the medial malleolus). From here the line curves up the inner aspect of the leg to points LV07,8,9 in the region of the postero-medial aspect of the knee, to LV11 (on the femoral nerve, just lateral to the artery in the inguinal groove), to LV13 (at the free end of the 11th rib) to LV14 (directly below the nipple, in the 6th intercostal space. CV begins at CV01, between the anus and the scrotum/vulva in the midline. It runs up the midline of the abdomen, through the umbilicus (CV08) to the tip of the xiphoid (CV15) to between the nipples (CV17), to the sternal notch (CV22), to end in the cleft between the chin and the lower lip (CV24). GV begins at GV01 (between the tip of the coccyx and the anus, in the midline). It travels up the back, in the vertebral midline, through GV04 (between spinous processes of vertebrae L2-

L3) to GV14 (between the spinous processes of vertebrae C7-T1) to GV26 (the SHOCK POINT, in the philtrum, 1/3 the distance from the nose to the upper lip), to GV28 (on the frenum between the upper lip and the upper gum). Let us recall once again the number of points on each Channel: LU 11

LI ST 20 36

SP 21

HT 09

SI BL 19 67

KI 27

PC 09

TH 23

GB 44

LV 14

CV 24

GV 28

Beginners need only learn in detail the position and function of only 1 or 2 points on each Channel. The exception is the BL Channel, where BL13-30 (Shu Points) should be studied in detail. Later, as your knowledge increases, try to integrate the position of points in relation to each other. For instance, using the Beijing or Hong Kong or Shanghai charts (1, 1a, 3), study the position of the following points and mark them on your own body:               

Wrist area: see HT07; PC07; LU09; LI05; TH04; SI05 Elbow area: see HT03; PC03; LU05; LI11; TH10; SI08 Clavicle area: see LI16; LU02; CV22; ST11,12 Nipple to nipple line: see SP18; PC01; ST17; KI23; CV17 Navel line: see GB26; SP15; ST25; KI16; CV08 Pubic border: see SP12,13; ST29,30; KI11; CV02 Knee area: see LV08; KI10; BL40; GB33; ST35; Hsi Yen (L 16) Ankle area: see KI03,4,5,6; SP05; LV04; ST41; GB40; BL60,61 Laryngeal prominence: see LI18; ST09; CV23 Point of left to point of right shoulder, through spine of T 2: see LI15; TH14; SI10,12,13,14; BL10; GV13 From lower (caudal) angle of left to right scapula, through spine of T 8: see BL17,46; GV09 From free tip of left to right rib 12, between spines of L1-L2: see LV13; GB25; BL22,51; GV05 Line joining points 1 TSUN below highest points of left and right femoral trochanters, through lower rim of sacral foramen 4: see GB30; BL30,34,54; GV02 Line between left SI09 and right SI10: see relationships with right LI15; TH14; SI10,12,13; BL13,41,42,43; GV12; SI09,11 Join a line from 2 TSUN below highest point of left femoral trochanter and the free end of right 12th (last) rib, via space between spines of L4-L5: see relationship with left GB30; BL26,53; GV03; Right BL24,52; GB25

LEARNING THE MASTER POINTS In the Appendix of the last paper the Master Points were mentioned briefly. The Master Points include Shu-Mu, Luo-Yuan, Five Phase, Xi-Cleft, Hour, Test and RYODORAKU electro-test points. These points are important in AP and some of them, especially the paravertebral Shu points, the Front Mu points, the Luo-Connecting points, the Yuan-Source points and the Xi-Cleft points are very useful in diagnostic and therapeutic AP. They should be learned. Memory aids

help the learning process. Memory aids are given below but if they don't suit you, make up your own versions. THE 18 SHU POINTS There are 18 pairs of Shu points; 12 relate to one of the 12 main COSs (LU-LI / ST-SP / HT-SI / BL-KI / PC-TH / GB-LV) and 6 relate to other functions (see below). The 18 pairs of Shu points are BL13-30, on the 1st BL line, paravertebral from T3 to S4. The Chinese name for each point indicates its function, i.e. FeiShu (BL13) means Lung Shu; HsinShu (BL15) means Heart Shu; KeShu (BL17) means Diaphragm Shu etc. The Shu points (BL13-30 inclusive) are located 1.5 TSUN from the dorsal midline (GV line), at the lower border of the spinous process of the vertebra indicated in the memory aid and tables below. Shu points are called the Back-Association, or Paravertebral Reflex points. (The Mu points are called Front Alarm points, see later). Shu (and Mu) points often are tender to palpation when their associated organs are diseased. Each COS has a corresponding Shu and Mu point. If the Shu and Mu point is tender to light palpation, this indicates hypofunction (Deficiency, Yin) of the associated organ; if tender to heavy palpation, this indicates a hyperfunction (Excess, Yang) of the associated organ. In AP diagnosis, always palpate the Shu and Mu points. Note: Injury/scar on a Shu or Mu point can disturb the function of the corresponding organ! Shu points may be combined with Mu points (see later) in treating disorders of the associated organs. For instance, needling BL13 and LU01 (LU Shu and Mu) helps in asthma; BL18 and LV14 (LV Shu and Mu) helps in hepatitis. Also, Shu and Mu combinations can help in diseases of the sense organs of other functions associated with the corresponding internal organ. For instance, the eye/vision and ear/hearing are associated with the LV and KI COS respectively. In eye diseases, needling BL18 and LV14 (LV Shu and Mu) or in ear diseases BL23 and GB25 (KI Shu and Mu) respectively would be indicated. Bone and throat are also associated with KI function. Thus, BL23 and GB25 could be used in bone and throat diseases. The skin is controlled by LU, so BL13 and LU01 (LU Shu and Mu) can be used in skin diseases. Speech is controlled by HT COS. BL15 and CV14 (HT Shu and Mu) help speech disorders. MEMORY AID FOR THE SHU POINTS: T 3 - T 7 Lung Constricts HearT VeryGood Diana Shu point of

LU

PC

HT

GV

Diaphragm

Name (x-Shu)

Fei

ChuehYin

Hsin

Tu

Ke

T4

T5

T6

T7

Below spine of T3

BL point

13

14

15

16

17

T 9 - T12 Live Gall Splutters & Stutters Shu point of

LV

GB

SP

ST

Name (x-Shu)

Kan

Tan

Pi

Wei

Below spine of T9

T10

T11

T12

BL point

19

20

21

18

L 1 - L 5 Though

Kidney Seas

Colon's Gate

Shu point of

TH

KI

-

LI

Name (x-Shu)

SanChiao

Shen

ChiHai

TaChang KuanYuan

Below spine of L1

L2

L3

L4

L5

BL point

23

24

25

26

22

(Uterus)

S 1 - S 4 Small

Bladder

Midback

White-Circle

Shu point of

SI

BL

-

-

Name (x-Shu)

HsiaoChang PangKuang

ChungLu

PaiHuan

Below spine of S1

S2

S3

S4

BL point

28

29

30

27

THE LOCATIONS AND FUNCTIONS OF THE 18 PAIRS OF SHU POINTS ARE: BL Shu Point point

Location

Organ- function

Sense/other functions

LU Shu

BL13

below T 3

lung/respiration

touch/skin/mucosa

PC Shu

BL14

below T 4

pericardium/circ./sex

HT Shu

BL15

below T 5

heart/circulation

GV Shu

BL16

below T 6

spine/local function

speech/tongue

KeShu

BL17

below T 7

diaphragm

blood, haemorrhage

LV Shu

BL18

below T 9

liver/metabolism

vision/eye/muscles

GB Shu

BL19

below T10

gallbladder

proprioception/tendons

SP Shu

BL20

below T11

spleen/pancreas

taste/mouth/lips/muscle

ST Shu

BL21

below T12

stomach/digestion

TH Shu

BL22

below L 1

respir./digest./reprod.

KI Shu

BL23

below L 2

kidney/gonad

ChiHaiShu

BL24

below L 3

back, general energy

LI Shu

BL25

below L 4

colon/elimination

endocrine ear/throat/bone/brain

KuanYuanShu BL26 below L 5

uterus, back

SI Shu

BL27

below S 1

small intestine

BL Shu

BL28

below S 2

bladder/urination

ChungLuShu BL29

below S 3

back/bladder/urethra

PaiHuanShu BL30

below S 4

back/anus

Six pairs of Shu points (BL16,17,24,26,29,30) do not belong to a specific pair of the 12 main COSs. They have local uses: Shu

Chinese Name

Translation

Therapeutic uses

BL16

Tu Shu

GV Shu

GV problems, spine, endocarditis, borborygmus, abdominal pain, hair loss, pruritus, hiccough

BL17

Ke Shu

Diaphragm Shu

Diaphragm, hiccough, respiration, blood diseases, haemorrhage

BL24

Chi Hai Shu

Sea of Qi Shu

Lumbago, haemorrhoids

BL26

Kuan Yuan Shu

Gate Origin Shu

Uterus, enteritis, cystitis, urinary incontinence, lumbago

BL29

Chung Lu Shu

Middle of Back Shu

Lumbo-sacral pain, sciatica,

enteritis BL30

Pai Huan Shu

White Circle Shu

Anus, sacral pain, sciatica, endometritis

THE 12 MU POINTS As Shu points are called the Back Association or paravertebral reflex points, the Mu points are called Front Alarm points. Mu (and Shu) points often are tender to palpation when their associated organs are diseased. Each COS has a corresponding Mu and Shu point. If the Mu and Shu point is tender to light palpation, this indicates hypo-function (Yin) of the associated organ; if tender to heavy palpation, this indicates a hyper-function (Yang) of the associated organ. In AP diagnosis, always palpate the Shu and Mu points. Note: Injury/scar on a Shu or Mu point can disturb the function of the corresponding organ! Mu points may be combined with Shu points in treating disorders of the related organs and of the local area. For instance, needling LV13 and BL20 (SP Mu and Shu) helps in chronic diarrhoea, with undigested food in the stool (Deficient SP Qi) and GB24 and BL19 (GB Mu and Shu) helps in cholecystitis. In disorders of the large intestine/ appendix, needling ST25 and BL25 (LI Mu and Shu) can help. Similarly, LV14 + BL18 can help in hypochondriac pain and ST25 + BL25 can help in lower abdominal pain. Also, Mu points may be combined with Shu points in diseases of the sense organs of other functions associated with the corresponding internal organ. For instance, the eye/vision and ear/hearing are associated with the LV and KI COSs respectively. In eye diseases, needling LV14 + BL18 (LV Mu and Shu) or in ear diseases GB25 + BL23 (KI Mu and Shu) respectively would be indicated. Bone and throat are also associated with KI function. Thus, GB25 + BL23 could be used in bone and throat diseases. The skin is controlled by LU, so LU01 + BL13 (LU Mu and Shu) can be used in skin diseases. Speech is controlled by HT COS. CV14 + BL15 (HT Mu and Shu) help speech disorders. THE 12 MU-ALARM POINTS: COS

LU

LI

ST

SP

HT

SI

Mu Point

LU01

ST25

CV12

LV13

CV14

CV04

COS

BL

KI

PC

TH

GB

LV

Mu Point

CV02

GB25

CV17

CV05

GB24

LV14

Memory aid for the Mu points (6 of the points are on the CV line): CV03,04,05 = BLoody SIlly THeme (= BL, SI, TH) CV12,14,17 = STuffed HearTs Constrict (= ST, HT, PC)

Lung and Liver, First and Last (LU = LU01, LV = LV14) Spleen before Liver (SP = LV13) KI = free tip of last rib (last costal arch in animals) (KI = GB25) GB before KI (GB = GB24) LI = McBurney (appendicitis) point = ST25 THE NAMES AND LOCATIONS OF THE MU POINTS: COS Mu

Name

Location

BL

CV03 ChungChi

4 TSUN below umbilicus, in midline

SI

CV04 KuanYuan

3 TSUN below umbilicus, in midline

TH

CV05 ShihMen

2 TSUN below umbilicus, in midline

ST

CV12 ChungWan

4 TSUN above umbilicus, in midline

HT

CV14 ChuChueh

6 TSUN above umbilicus, 1 TSUN below xiphoid, in midline

PC

CV17 ShangChung

Midline of sternum, level with 4th intercostal space, midway between nipples

LU

LU01 ChungFu

In 1st intercostal space, 2 TSUN lateral to nipple, below coracoid process. (In animals, LU01 is in 2nd intercostal space, behind the shoulder)

LV

LV14 ChiMen

In 6th intercostal space, directly below nipple (4th intercostal space)

SP

LV13 ChangMen

At free tip of rib 11

KI

GB25 ChingMen

At free tip of last rib

GB

GB24 JihYueh

In 7th intercostal space, 1 rib or 1.5 TSUN below and just lateral to LV14

LI

ST25 TienShu

In rectus abdominis m., 2 TSUN lateral to umbilicus

LUO-CONNECTING POINTS Referring back to Diagram 1, you will remember that each of the Five Phases has a Yin-Yang (Wife-Husband) pair of COSs (the Phase-Mates) and the Fire Phase has two pairs:

Limb Arm = = Leg = =

Phase Metal Fire Fire Wood Water Earth

Yin (Wife) Lu HT PC LV KI SP

Yang (Husband) LI SI TH GB BL ST

Each of the 12 main COSs has a Luo point, used in classic AP to transfer Qi from the Husband to the Wife (or vice versa) of each linked pair of COSs (LU-LI / ST-SP / HT-SI / BLKI / PC-TH / GB-LV). The Luo point for each COS is distal to the elbow or knee. Luo points are used in two main ways in AP: a. the Yuan-Luo combination and b. in balancing Excess Qi in one COS and Deficient Qi in another, using Five Phase Principles. a. The Yuan-Luo combination uses the Yuan-Source point, see below) of the affected COS with the Luo-Connecting point of the linked COS (Wife or Husband), i.e in lung disease, LU09 (Yuan of LU) plus LI06 (Luo of LI). b. In Five Phase Theory, when there is Excess Qi in one COS and Deficient Qi in another, the Luo point of the Deficient COS is always used. For instance, if LU is Deficient and LI has Excess Qi, needle the Luo point of LU (LU07). This will remove the Excess from the Husband (LI) and restore Qi to the Wife (LU). If GB is Deficient and LV has Excess Qi, needle the Luo of GB (GB37). This will remove the Excess from the Wife (LV) and restore Qi to the Husband (GB). (For details of other uses of Luo points, see paper on Holistic Concepts and on The Use of Five Phase Theory in Medicine). NAMES AND LOCATIONS OF THE 12 LUO-CONNECTING POINTS: COS Luo

Name

Location

KI

KI04 TaChung

Just above calcaneus (medial ankle), in front of Achilles tendon (opposite BL60)

SP

SP04 KungSun

On medial side of foot, distal to upper head of metatarsal 1

HT

HT05 TungLi

On the ulnar-palmar forearm, 1 TSUN above pisiform bone

LV

LV05 LiKou

5 TSUN above medial malleolus of tibia, just behind tibia

TH

TH05 WaiKuan

2 TSUN above dorsal wrist crease, between radius and ulna

LI

LI06 PienLi

3 TSUN above LI05 (which is in the "snuff-box", on the radial-dorsal part of the wrist, between the tendons to the thumb and index finger)

PC

PC06 NeiKuan

2 TSUN above the palmar wrist crease, between the flexor tendons of the hand

LU

LU07 LiehChueh

just above the radial styloid process, 1.5 TSUN above the wrist

SI

SI07 ChihCheng

On the ulnar side of forearm, 5 TSUN above the wrist, on a line between SI06 and SI08

GB

GB37 KuangMing

5 TSUN above tip of external malleolus of tibia, just behind the fibula

ST

ST40 FengLung

8 TSUN below patella, 1 TSUN lateral to tibia

BL

BL58 FeiYang

7 TSUN directly above BL60, which is between the Achilles tendon and the lateral malleolus of tibia

MEMORY AID FOR THE LUO-CONNECTING POINTS: 4 = KISP (KI04, SP04) 5 = HTLVTH (HT05, LV05, TH05) 6 = LIPC (LI06, PC06) 7 = LUSI (LU07, SI07) From '37-'40 GreatBritain STarred 58 BLondes (GB37, ST40, BL58) THUS, THE 12 LUO-CONNECTING POINTS ARE:

COS

LU

LI

ST

SP

HT

SI

Luo Point

LU07

LI06

ST40

SP04

HT05

SI07

COS

BL

KI

PC

TH

GB

LV

Luo Point

BL58

KI04

PC06

TH05

GB37

LV05

THE YUAN-SOURCE POINTS Each of the 12 main COSs has a Yuan point, which is often tender to palpation when its COS is diseased. The Yuan point may be used alone (or with the Shu-Mu combination) in disease of its organ. The Yuan-Luo combination uses the Yuan of the affected COS with the Luo of the linked COS (Husband or Wife), i.e in lung disease, LU09 (Yuan of LU) plus LI06 (Luo of LI). MEMORY AID FOR THE 12 YUAN-SOURCE POINTS: They are very easy to memorise if you know the YU point for the COS. (See Five Phase points, next section!) a. For Yin COSs, the Yuan point = 2 points proximal to the most distal point, (i.e. Yuan point = YU point, Position 3, Earth). These are: Arm Yin: LU09, PC07, HT07 Leg Yin: SP03, LV03, KI03 b. For Yang COSs, the Yuan point = 3 points proximal to the most distal point (with the exception of GB, for which the Yuan is 4 points proximal to the most distal point). Thus, for Yang COSs, the Yuan point = one point proximal to the YU, Wood point. These are: Arm Yang: LI04, TH04, SI04 Leg Yang: ST42, GB40, BL64 THUS, THE YUAN-SOURCE POINTS ARE:

COS

LU

LI

ST

SP

HT

SI

BL

KI

PC

TH

GB

LV

Yuan point LU09 LI04 ST42 SP03 HT07 SI04 BL64 KI03 PC07 TH04 GB40 LV03

LEARNING THE FIVE PHASE POINTS AND THEIR USES Each of the 12 main COSs has a point for each Phase (Wood, Fire, Earth, Metal, Water). There are thus 60 points (5 x 12 = 60). The theory of the Five Phases and the use of the 60 Phase POINTS to drain Excess Qi in one COS to augment Deficient Qi in another is covered in detail in the paper The Theory of Five Phases and its use in Medicine, to which the reader is referred. Methods of using the Phase points to balance imbalances of Qi are discussed in that paper. LOCATION OF THE PHASE POINTS: The Five Phase points are located between the digits and the elbow or knee (stifle). Let us call the most distal location (at a nail) Position 1 and the most proximal (near the elbow or knee) Position 5. The Chinese terms and their translation for the 5 positions are: Position

1

2

3

4

5

Chinese term

TSING

YUNG

YU

CHING

HO

TING

YONG

YU

CHING

HO

(Jing)

(Ying)

(Shu)

(Jing)

(He)

Well

Spring

Stream

River

Sea

Translation Location

most distal

(.......

see later .......)

most proximal

at finger/toe nail

at elbow/knee

(LU11, LI01 etc)

(LU05, LI11 etc)

Apart from their use in balancing Qi in the Five Phase Cycle, the TSING points are used in emergencies (shock, collapse etc), in mental disorders and in sensations of suffocation or fullness in the chest. YUNG points are used in fevers. YU points are used in bone and joint rheumatism and in diseases/pain caused by exposure to wind and damp. CHING points are used in asthma, cough and disorders of the throat. HO points are used in disorders of the Yang COSs (LI, ST, SI, BL, TH, GB). The first 3 positions (TSING, YUNG, YU) are easy to remember. They are the 3 most distal points on each of the 12 main COSs, with one exception: GB, in which case the YU point is the 4th point from the end (GB41, not GB42). Channel Position

LU

LI

ST

SP

HT

SI

BL

KI

PC

TH

GB

LV

1 (TSING, most distal)

11

01

45

01

09

01

67

01

09

01

44

01

2 (YUNG, one point proximal) 10

02

44

02

08

02

66

02

08

02

43

3 (YU, one point proximal)

03

43

03

07

03

65

03

07

03

41* 03

09

02

* the only exception to the pattern is GB, in which case the YU point = 4th point from the end (GB41, not GB42). The last 2 positions (CHING and HO), unfortunately, do not form an easily remembered number-pattern, but they lie at or above the wrist/ankle (CHING) and at or near the elbow/knee (HO). The HO position (elbow/knee) is the Earth point for the Yang Channels and the Water point for the Yin Channels. The points are: Channel Position

LU

LI

ST

SP

HT

SI

BL

KI

PC

TH

GB

LV

4 (CHING, near wrist/ankle)

08

05

41

05

04

05

60

07

05

06

38

04

5 (HO, near elbow/knee)

05

11

36

09

03

08

40

10

03

10

34

08

The relationship between the 5 Positions and the Five Phase points is as follows. Note: To grasp these and following principles, beginners should also study the paper on the Five Phases. In the following table, the symbol "->" means "engenders, creates, nourishes, fosters or feeds". The symbol "|" means "controls, restrains, governs, disciplines, brings order to". POSITION

Yang COS

Yin

COS

1

2

3

4

5

Well

Spring

Stream

River

Sea

TSING

YUNG

YU

CHING

HO

Metal ->

Water ->

Wood

|

|

|

|

|

Earth ->

Metal ->

Water

Wood

->

Fire

->

->

Fire

->

Earth

coal !

For Yang COSs, Position 1 is Metal and positions 2 to 5 follow the SHENG (Creative) Cycle of the Five Phases: (Metal -> Water -> Wood -> Fire -> Earth). For Yin COSs, Position 1 is Wood and positions 2 to 5 follow the SHENG (Creative) Cycle of the Five Phases: (Wood -> Fire -> Earth -> Metal -> Water). MEMORY AID FOR THE YIN CHANNELS: Remember a red-hot coal (Fire) in the palm of the hand (YUNG, Position 2)! Therefore, Wood is distal (TSING, Position 1,

fingers) and Earth, Metal, Water are proximal (Positions 3-5, i.e. YU, CHING, HO at wrist, forearm, elbow respectively). MEMORY AID FOR THE YANG CHANNELS: Remember that at each of the 5 positions, the Yang Phase controls the Yin Phase, as in the KO (Controlling) Cycle. In Position 2 (YUNG, opposite the palm of the hand), Water (of Yang Channels) controls Fire (of Yin Channels); in the TSING position, Metal (of Yang Channels) controls Wood (of Yin Channels); in the YU position, Wood (of Yang Channels) controls Earth (of Yin Channels); in the HO position, Earth (of Yang Channels) controls Water (of Yin Channels). From the tables of points corresponding to the 5 positions (above), we can re-write the table for SI and HT as follows: POSITION

Yang COS SI

Yin

COS HT

1

2

3

4

5

Well

Spring

Stream

River

Sea

TSING

YUNG

YU

CHING

HO

Metal ->

Water ->

Wood

SI01

SI02

SI03

SI05

SI08

|

|

|

|

|

HT09

HT08

HT07

HT04

HT03

Earth ->

Metal ->

Water

Wood

->

Fire

->

->

Fire

->

Earth

Rearranging the points by their Phases (starting with Wood), this becomes: Wood

Fire

Earth

Metal

Water

COS HT

HT09

HT08

HT07

HT04

HT03

Yang COS SI

SI03

SI05

SI08

SI01

SI02

Yin

Applying the same principle (rearranging the points for the 5 Positions by Phase rather than by Position), the Five Phase POINTS are: Channel Phase

LU

LI

ST

SP

HT

SI

BL

KI

PC

TH

GB

LV

Wood

11

03

43

01

09

03

65

01

09

03

41

01

Fire

10

05

41

02

08

05

60

02

08

06

38

02

Earth

09

11

36

03

07

08

40

03

07

10

34

03

Metal

08

01

45

05

04

01

67

07

05

01

44

04

Water

05

02

44

09

03

02

66

10

03

02

43

08

Thus, the Earth Point of SI is SI08; the Water Point of ST is ST44; the Fire Point of LV is LV02 etc. The 60 Five Phase points + the 6 Yuan points of the Yang COSs make up the 66 Command Points. (The Yuan Points of the Yin COSs = the YU/Earth Points). THE XI-CLEFT POINTS Each of the 12 main COSs has a Xi-Cleft Point, which may be used in acute disorders of the associated organ and in pain along the course of the affected Channel. MEMORY AID FOR THE 12 XI POINTS: I visualise a lazy Sunday, disrupted by thoughts of pre-war ('34-'36) blabbering between the Kremlin and Whitehall: Sex at 4 (the PC COS is also called Circulation-Sex; PC04) KIds at 5 (KI05) HearTy LUnch of LiVerSI at 6 (HT06, LU06, LV06, SI06) Stoned (LI-TH) (lith = stone) at 7 (LI07, TH07) SParkling wine at 8 (SP08) Between '34 and '36, STalin and GreatBritain / BLabbered 63 times (ST34, GB36, BL63). THE XI-CLEFT POINTS ARE:

COS

LU

LI

ST

SP

HT

SI

BL

KI

PC

TH

GB

LV

Xi Point LU06 LI07 ST34 SP08 HT06 SI06 BL63 KI05 PC04 TH07 GB36 LV06

THE HOUR POINTS Each of the 12 main COSs has an Hour Point, which = the Phase Point for each COS. The Fire points of the Fire COSs are HT08, SI05, PC08, TH06. The Earth points of the Earth COSs are ST36, SP03. The Metal points of the Metal COSs are LU08, LI01. The Water points of the Water COSs are BL66, KI10. The Wood points of the Wood COSs are GB41, LV01. THE HOUR POINTS CAN BE RE-WRITTEN:

COS

LU

LI

ST

SP

HT

SI

BL

KI

PC

TH

GB

LV

Hour POINT LU08 LI01 ST36 SP03 HT08 SI05 BL66 KI10 PC08 TH06 GB41 LV01

LEARNING THE EARPOINTS Human Earpoints: Vets who wish to learn AP are advised to study the human Earpoints. There are good ear charts, such as in the Beijing text (1), the Shanghai charts (6), the Hong Kong charts (3) or Practical Ear-Needling Therapy (5). As one will usually have access to Ear charts, it is not necessary to memorise the locations of all the Earpoints. Certain points are important, as they are frequently used. Their functions are listed in the texts which accompany the charts. The important human Earpoints are: LU, HT, KI, ST, Adrenal, Shenmen, Sympathetic, Internal Secretion (Endocrine), Subcortex, Occiput. If one is interested in treating pain and lameness, one should note the points for the main body regions: Neck, Thoracic vertebrae, Lumbo-sacral vertebrae, Shoulder, Elbow, Hip, Knee, etc. Note also the Dental Analgesia point on the earlobe. Sensitive Earpoints are relatively easy to detect. In practice, rather than using Earpoints listed in Cookbook prescriptions, points which may not be sensitive on probing/electrical detection, one is more likely to use the sensitive/reactive earpoints (irrespective of their location). Animal Earpoints: The ear in animals is anatomically quite different from that in humans. There is little evidence that human Ear-reflex locations (Ear-AP points) can be transposed simply to the animal ear. Some studies have been done in small animals by Jan Still et al (Brno Vet School) and by French, American and other colleagues but documentation of the location and uses of animal Earpoints is incomplete at present. THE MOST IMPORTANT POINTS FOR STUDY An analysis of a database from > 55 textbooks and other articles on AP indicates that certain points are very frequently used in clinical AP. These points should be studied in detail by beginners. They include the following points, with the more important ones underlined: Channel Number and Name of Points for Study       

      

LU 05 ChihTse; 07 LiehChueh; 09 TaiYuan LI 04 HoKu; 11 ChuChih; 15 ChienYu ST 25 TienShu; 36 TsuSanLi; 40 FengLung; 41 ChiehHsi SP 04 KungTsui; 06 SanYinChiao; 09 YinLingChuan; 10 HsuehHai HT 03 ShaoHai; 05 TungLi; 07 ShenMen SI 03 HouHsi; 06 YangLao; 08 HsiaoHai; 11 TienTsung BL 11 TaChu; the Shu points 13-30; especially 23 ShenShu; 41 FuFen; 42 PoHu; 43 KaoHuang; 44 ShenTang; 45 YiHsi; 36 ChengFu; 40 WeiChung; 57 ChengShan; 60 KunLun KI 03 TaiHsi; 08 ChiaoHsin PC 03 ChuTse; 06 NeiKuan TH 05 WaiKuan; 14 ChienLiao; 17 YiFeng GB 20 FengChih; 30 HuanTiao; 34 YangLingChuan; 39 HsuanChung LV 03 TaiChung; 13 ChangMen CV 03 ChungChi; 06 ChiHai; 12 ChungWan; 22 TienTu GV 04 MingMen; 12 FengFu; 14 TaChui; 20 PaiHui; 26 JenChung

In complex cases, if one has difficulty in deciding on a prescription, it is advisable to include a few points from that list. CONCLUSIONS This is probably the most difficult paper, which you will have to study on AP. It contains a lot of (apparently useless) detail, much of which needs to be interpreted against other papers, such as those dealing with classical AP and the Five Phases. However, please read and re-read it, using memory aids (mine or your own). When you master this paper, you will know most of the basics relating to the principles of AP and the relationships of the COSs and points. As aids to your study of AP, the following are suggested: 1. "Skim" a few good textbooks a few times. Then go through them in detail, referring to the notes in this paper. 2. Learn the Channel circuits, the position and function of the first and last points. 3. Study one other point on each COS in detail (LU09, LI04, ST36, SP06, HT07, SI03, BL23, KI03, PC06, TH05, GB34, LV03, CV12, GV26). Add others when you know the location and uses of these. 4. Learn the positions of the Master Points (Shu-Mu, Yuan-Luo, Xi). Add the Five Phase points later. Study the uses of these points. 5. Experiment on yourself, your family and friends, using first-aid AP without needles (transcutaneous electro-stimulation, AP-point massage etc) in common human conditions (headache, toothache, muscle pain etc). 6. Pick a few simple conditions in animals (disc disease, muscle lameness, dystocia, female infertility etc). Study the approach to their treatment, comparing and contrasting the approaches in your reference texts. The student must not expect to become an expert in all aspects of AP in a short time. It is better to study slowly over months and years than to attempt to learn the complete AP system quickly. It is a difficult, deep subject to master. Long-term commitment and great patience are needed. If you have the commitment, the mental rewards are great. APPENDIX GENERAL INFORMATION INTERNET (WWW) SITES ON AP The Medical Acupuncture Web Page (Great site in Greece for medical acupuncture; will open a veterinary acupuncture site there soon) Alternative Vet Medicine American Soc of Dowsers

Osteopathy Links The Mage's Guide to WWW) EMAIL GROUPS : Complementary and Alternative Med and Vet Med (CAM&VM-L): This List is confined to professionals, mainly medics, vets and students of these subjects. To join the group, email your application to: [email protected], or [email protected], or [email protected] IVAS: You may contact IVAS by emailing [email protected] COMPUTER DATABASES OF AP: IVAS (c/o David Jagger, 5139 Sugarloaf Rd., Boulder, CO 80302-9217, USA; Fax +1-303449-8312) has a listing of computerised abstracts on AP (email: [email protected]). Professor Jean Bossy, Centre Hospitallier et Universitaire de Nimes, Nimes-Cedex, France has an extensive computerised bibliography of AP JOURNALS ON AP AND ALLIED FIELDS                

Alternative Therapies in Health and Medicine, InnoVision Communications, 101 Columbia Ave, Aliso Viejo, CA 92656, USA. e-mail: [email protected] Alternative and Complementary Therapies, Bimonthly, Mary Ann Liebert Inc. Publishers, 1651 Third Avenue, New York, NY 10128, USA. Alternative Medicine J, Prime National Publishing Corp, 470 Boston Post Road, Weston, MA 02193, USA. Tel: (617) 899-2702. American Academy of Medical AP, 4126 Southwest Freeway, Suite 200, Houston, TX 77027, USA. American J of Acupuncture, 1840 41st Ave., Suite 102, POB 610, Capitola, CA 95010, USA. American J of Chinese Medicine, Box 555 Garden City, New York, USA. Australian J of AP, POB 417, Mullumbimby, NSW 2482, AUSTRALIA. Australian J of Holistic Nursing, PO Box 5005, East Lismore, NSW 2480, AUSTRALIA. e-mail: [email protected] AP and Electrotherapeutics Research (Pergamon Press, Oxford, UK). AP in Medicine (British Medical AP Society, Newton Lane, Lower Whitley, Warrington, Cheshire WA4 4JA (Tel: (44) 01925 730727; Fax: 01925 730492) AP Research Quarterly (C.A.R.F. Box 84-223, Taipei, Taiwan). Bulletin de l'Association Veterinaires Acupuncteurs de France (3 rue Letellier, Paris 75015, France) California J of Oriental Medicine, 1231 State Street, Suite 208-A, Santa Barbara, CA 93101, USA. Tel: (800) 477-4564; e-mail: [email protected] Chinese Medical J (English). Guozi Shudian, Box 399 Beijing, China. Complementary Therapies in Medicine, Quarterly, Pearson Professional Ltd, PO Box 77, Harlow , Essex, CM19 5BQ, UK. Tel: (44) 01279-623623; Fax: 01279-639609. European J of Oriental Medicine (Biannually), 179 Gloucester Place, London, NW1 6DX, UK. Tel: (44) 0171-724-5756

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



        

FootPrints, J of the Reflexology Association of Australia, P.O. Box 1032, Bondi Junction, NSW 2022, AUSTRALIA. Fax: 612/9913-2815 Guidepoints: AP in Recovery, J&M Reports, 7402 NE 58th Street, Vancouver, WA 98662-5207, CANADA. Tel/Fax: 360/260-8620; e-mail: [email protected] International J Alternative and Complementary Medicine, Monthly, Green Library, Homewood House, Guildford Road, Chertsey, Surrey KT16 0QA, UK. International J Chinese Medicine, 5266 Pomona Blvd., Los Angeles CA 90022, USA. International J Clinical AP. Allerton Press Inc., 150 Fifth Ave., New York, NY 10011, USA. J of Alternative and Complementary Medicine: Research on Paradigm, Practice and Policy, Quarterly, Mary Ann Leibert,Inc, Publishers, 2 Madison Avenue, Larchmont NY 10538, USA. Fax: (914)834-3771, Managing Editor: Jackie Wootton: e-mail: [email protected] J of Chinese Medicine, Quarterly, 22 Cromwell Road, Hove, Sussex, BN3 3EB, UK. Fax: (44) 01273-748588. J of Complementary Medicine, Churchill Livingstone, Maple House 149, Tottenham Court Rd, London, W1P 9LL, UK. Lasers in Surgery and Medicine Newsletters from the various National Vet AP Societies North American J of Oriental Medicine, 896 West King Edward Ave, Vancourver, B.C, V5Z 2E1, CANADA. Oriental Medicine, 3723 N. Southport, Chicago, IL 60613, USA. Tel: (312) 477-1000; e-mail: [email protected]. Research and Information in Complementary Medicine, Quarterly, RCCM, 60 Great Ormond Street, London, WCIN 3JF, UK. e-mail: [email protected] Sciences of TCM, 1835 S. Del Mar Ave, #102, San Gabriel, CA 91776, USA. e-mail: [email protected] Traditional AP J, Suite 100, American City Building, Columbia, MD 21044, USA. World J of AP and Moxibustion, Quarterly, 18 Beixincang, Dongzhimen Nei, Beijing 100700, PR CHINA. Tel: 4014411-2925.

ACUPUNCTURE AS A KEYWORD IN ABSTRACTING JOURNALS    

Current Contents Index Medicus Index Veterinarius Veterinary Bulletin

VETERINARY AP GROUPS/SOCIETIES/ASSOCIATIONS Many of these groups run AP seminars or courses. Contact persons are given.     

Australia: AVAA, c/o Ulrike Wurth, 88 Barrabool Rd., Highton, VIC 3220; Sheila White, Veterinary School, Murdoch University, Murdoch, WA 6153 Austria: Austrian Vet AP Society, c/o Oswald Kothbauer, Windberg 2, 4710 Grieskirchen, Ober-Osterreich. Belgium: BVDA, c/o Luc Janssens, 37 Oudestraat, 2610 Wilrijk. Canada: c/o E.R. Clare Holmes, RR 4, Alliston, Ontario L0M 1N0. Finland: Finnish Vet AP Society, c/o Jukka Kuussaari, 25460 Toija.

           

France: l'AVAF, Headquarters, 115 Rue d'Amiens, 60000 Beauvais; l'AVAF Secretariat, 9 Rue des Ecoles, 92330 Sceaux. Germany: contact Walter Greiff, Donaustrasse 39, Grenzhof, Memmingen, Schwaben. IVAS: International Vet AP Society, Secretary, David Jagger, 5139 Sugarloaf Rd., Boulder, CO 80302-9217, USA. Japan: JVAS, c/o Kaoru Kitazawa, Faculty of Agriculture, Gifu University, Yanagido 1-1, 501-11 GIFU. Netherlands: SNVA, c/o Emil Hovius, Heike 9, 5508 PA Veldhoven. Norway: NVAS, c/o Are Thoresen, Leikvollgt 31, Sandefjord. South Africa: c/o Jan Still, Vet School, MEDUNSA, Pretoria. Sweden: SVAS, c/o Ritva Krokfors, Nasby Sodergard, S-59592 Mjolby. Switzerland: Swiss Vet AP Society, c/o Konrad Zerobin, Vet School, Winterhurerstrasse 260, ZURICH. Taiwan: Contact Lin Jen-Hsou, Dept. Animal Husbandry, National Taiwan University, Taipei, Taiwan UK: c/o Eric Nelson, 32 Painshawfield Rd., Stocksfield, Northumberland, UK NE43 7PX. USA: see IVAS

MEDICAL AP SOCIETIES AND SCHOOLS Many Western countries have specialist AP schools (but whose teachers are not medically qualified). They provide classical training in AP and usually accept vet and med professionals but the courses are too long for most of those professionals. Medical AP Societies and groups hold shorter AP courses and seminars. Most accept vets at these meetings. Other Institutes arrange short or longer crash-courses, as needed by professionals:    

Austria: Ludwig Boltzmann AP Institute, Mariangasse 9, A-1090 Vienna China: Special courses in Beijing for vets: contact IVAS. Taiwan: Chinese AP Research Foundation (CARF), Box 84-223 Taipei, R.O.C. UK: British Medical AP Society, Newton Lane, Lower Whitley, Warrington, Cheshire WA4 4JA (Phone 092-573727)

AP SUPPLY HOUSES (NEEDLES, BOOKS, EQUIPMENT ETC)    

Austria: Richter & Co., Feldgasse 19, A-4600 Wels Hong Kong: Mayfair Medical Supplies, Rm 501-3, 5/F, Far East Consortium Bldg., 204-206 Nathan Rd., KOWLOON (Fax 852-3-721-2851) UK: Acumedic, 101-103 Camden High St., London NW1 7JN (Fax 01-387-5766) UK: John Scarborough & Partners, Orchard Hse, West Bradley, nr Glastonbury, Somerset BA6 8PB (Phone 0458-50491)

VETERINARY AP CHARTS For practical purposes, most AP points in animals are located by transposition from human positions, making allowances for differences in anatomy. Traditional charts and accompanying booklets exist for horses, cattle, pigs, goats and camels. IVAS can supply

charts for many species. (See also the Vet texts below). Although this is an incomplete list, other sources of animal AP charts are: Primate/lab animal charts: by transposition from standard human texts 

                        

 

Horse charts:Traditional (Klide & Kung; Kothbauer; Rubin; Sobin; Weinstein; Westermayer; Yu & Hwang; White) Transposition (Cain; l'AVAF (France); Sutherland; White) Cattle charts: Traditional (Klide & Kung; Rubin; Westermayer; Wheeler; Yu & Hwang) Transposition (Kothbauer, Turnbull, Westermayer) Pig charts: Traditional (Klide & Kung; Lin; Rubin; Yu & Hwang) Dog/cat charts: Transposition method and in-vivo or post-mortem detection with point-finders: Altman; Demontoy; Gilchrist; Janssens; Milin; Molinier; Still. Earpoint charts: Horse (Hill; Hwang; McKibbin; Yu & Hwang) Cattle (Kothbauer) Dog (l'AVAF; Jeannot; Sadowsky; Still) Altman, S. 5647 Wilkinson Ave., N. Hollywood, CA 91505, USA. l'AVAF, Headquarters, 115 Rue d'Amiens, 60000 Beauvais, France; Secretary, 9 Rue des Ecoles, 92330 Sceaux, France. Cain,M.J. Unison Rd., Molehill 20465, VA 22141, USA (Tel: 1-703-5541-8183). Demontoy, A. c/o l'AVAF Headquarters, 115 Rue d'Amiens, 60000 Beauvais, France. Gilchrist, D. c/o Ulrike Wurth, 88 Barrabool Rd., Highton, VIC 3220, Australia. IVAS International Vet AP Society, Secretary, David Jagger, 5139 Sugarloaf Rd., Boulder, CO 80302-9217, USA. Janssens,L.A.A., 37 Oudestaat, 2610 Wilrijk, Belgium. Jeannot,R. 62 Cours Desbiey, 33120 Arcachon, France. Klide,A. Dept. Anaesthesiology, Vet. School, 3800 Spruce St., Philadelphia, PA 19174, USA. Kothbauer,O. Windberg 2, 4710 Grieskirchen, Ober-Osterreich, Austria. Lin,Jen-Hsou Dept. Animal Husbandry, National Taiwan University, Taipei, Taiwan McKibbin,L. Wheatley Hall Farm, Box 28, Wheatley, Ontario, Canada Milin,J. 95 l'Isle Adam, France. Molinier,F. Ecole Veterinaire, 94 Maisons-Alfort, PARIS, France. Rubin,M. (Vet AP Manual) c/o Maloine Publishers, Paris, France. Sobin,J.M. (Sobin International), Sobin Park, Boston, Mass 02210, USA. Still,J. Dept. Surgery, Vet School, MEDUNSA, South Africa. Sutherland,E. POB 12009, Lexington, KY 40579-2009, USA. Turnbull,J. N3653 U.S. HWY. 16, RR 2, La Crosse, WI 54601, USA. Weinstein,W. Equine AP Monograph, c/o Eastwind Publishing Co., North Hollywood, CA, USA. Westermayer,E. The late Erwin's textbooks and charts on equine AP were published posthumously in 1993 by Karl F. Haug Verlag, Heidelberg: Lehrbuch der Veterinarakupunktur (Vol 1 (73 pp) and Vol 2 (302pp)). Wheeler,A.J. Iowa State University, Ames, Iowa 50010, USA. White,S. Veterinary School, Murdoch University, Murdoch, W. Australia 6153.

AP READING MATERIAL BASIC TEXTS (those asterisked are suggested as essential texts)

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1. Anon (1993). (*) Essentials of Chinese AP. (Coll. Trad. Chin. Med., Beijing, Shanghai, Nanking) Foreign Languages Press, Beijing. 432pp. 1a. Cheng Xinnong et al (1987) (*) Chinese AP and Moxibustion. Foreign Languages Press, Beijing. 432pp. 1b. Ellis,A., Wiseman,N. & Ross,K. (1989) (*) Grasping the Wind. Paradigm Publications, Brookline, Massachusetts, 462 pp. 2. Anon (1977). (*) Basic AP: a scientific interpretation and application. Chinese Acup. Res. Foundation, Box 84 - 223, Taipei, Taiwan. 3. Anon (1975, or later version) (*) Newest illustrations of the AP points (Charts and Booklet). Medicine and Health Publishers, Hong Kong. 4. Anon (1978) Treatment of 100 common Diseases by new AP. Medicine and Health Publishers, Hong Kong. 5. Anon (1977) Practical Ear needling therapy 6. Anon (1976) Anatomical Charts of the AP Points and 14 Meridians. Shanghai People's Publishing House, Shanghai. (Alternative to (3) above). 7. Anon (1974) (*) The Barefoot Doctor's Manual. Running Press, Philadelphia. 948pp. Excellent, but for advanced students only. 7a. Altman,S. (1981) AP for animals (c/o 5647 Wilkinson Ave., North Hollywood, CA 91607, USA, 281pp. Excellent. 7b. Janssens,L. (1984) (*) Atlas of the AP points and Meridians in the dog (c/o Oudestraat 37, Wilrijk 2610, Antwerp, Belgium). 7c. Demontoy,A. (Contact author at French address) 7d. Molinier,F. (Contact author at French address) 8. Brunner,F. (1980) AP fur Tierarzte: AP der Kleintiere. WBV Biologisch Med. Verlag, Ipweg 5, D4070 Schorndorf, Germany, 320pp. 8a. Gilchrist,D. (1981) Manual of AP for small animals. Also: Greyhound AP (1984) Published privately, c/o 219 Byrnes Street, Mareeba, Australia 4880. 9. Klide,A. & Kung,S. (1977) Vet AP. Univ Pennsylvania Press, Philadelphia, USA. 297pp. 10. Rubin,M. (1976) Manuel d'AP Veterinaire pratique moderne. Maloine Publishers, Paris, 85pp (in French). 11. Westermayer,E. (1978) Atlas of AP for cattle. English and German versions. WBV Biologisch Verlag, Ipweg 5, Schorndorf, Germany, 60pp. Excellent. 12. Westermayer,E. (1980) Treatment of Horses by AP. English version. Health Science Press, Holsworthy. Devon, UK, 90pp. Excellent. German version: WBV Biologisch Med. Verlag, Ipweg 5, D4070 Schorndorf, Germany. 12a. Kothbauer,0. (1983) AP in the ox, horse and pig (in German). (WBV Biologisch Verlag, Ipweg 5, Schorndorf D4070, Germany). Excellent. 12b. White,S.S. (1984) Electro-AP in Vet. Med. Chinese Materials Centre, San Francisco. 122 pages. Excellent. 12c. Yu Chuan & Hwang Yann-Ching (1990) Handbook on Chinese Veterinary AP and Moxibustion. FAO Regional Office for Asia and the Pacific, Bangkok, 193pp.

CLASSIC CONCEPTS   

13. Austin, Mary (1974) AP Therapy. Turnstone books, London. 290pp. 14. Wu Wei Ping (1973) Chinese AP. Health Science Press, Holsworthy. Devon, UK. 181pp. 14a. Mann, Felix (1973) (*) AP cure of many Diseases. Heinemann Medical Books, London, UK.

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15. van Nghi, Nguyen (1971) Pathogenie et Pathologie energetiques en medicine chinoise. Imprimerie Ecole Tech. Don Bosco, Marseille, France. 15a. Connolly Dianne (1979) (*) Traditional AP: The Law of the Five Elements. Centre for Traditional AP, American City Building, Columbia, Maryland 21944, USA. 197pp. 15b. Kaptchuk, Ted (1983) (*) The Web that has no Weaver. Congdon & Weed, New York, USA. 15c. Porkert,M. (1983) The Essentials of Chinese Diagnostics. Acta Medicinae Sinensis, Chinese Medical Publications Ltd., Zurich, Switzerland. 292pp. 15d. Wiseman,N. & Ellis,A. (1995) (*) Fundamentals of Chinese Medicine (English translations and amendments of texts by the Beijing, Nanjing and Shanghai Colleges of Chinese Medicine). Paradigm Publications, 44 Linden St., Brookline, Mass 02146, USA, 532 pp.

OTHER TEXTS   

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16. Mann,F. (1977) (*) Scientific aspects of AP. Heinemann Medical Books, London, UK. 17. Moss,L,. (1972) (*) AP and You. Paul Elek Books, London, UK. Excellent text on Trigger-Point Therapy. 18. Fox,W.W. (1975) Arthritis and allied Conditions: a new and successful Approach. Ranelagh Press, S. Hill Park, Hamsted, London, UK. Excellent text on Trigger-Point Therapy. 19. Yau,P.S. (1977) Scalp Needling Therapy. Medicine and Health Publishers, Hong Kong. 20. Kwong,L.C. (1978) Nose, Hand and Foot AP. Medicine and Health Publishers, Hong Kong. 21. Shui Wae (1975) A research into AP and its clinical Practice. Commercial Press Ltd., Hong Kong. 22. Chung,C. (1983) The AH SHIH Point. Illustrated guide to clinical AP (Chen Kwan Books, 5-2, 1F CHUNG CHING SOUTH ROAD, Sect. 3, Taipei, Taiwan), 212pp. 23. Lee,J.F. & Cheung,C.S. (1978) Current AP Therapy, Med. Interflow Publ. House, Hong Kong, 408pp. 24. O'Connor,J. and Bensky,D. (1983) AP - A Comprehensive Text, Shanghai College of Trad. Med. (Eastland Press, Chicago), 750pp. 25. Ulett,G. (1982) Principles and practice of physiological AP. (Warren Green Inc., 8356 Olive Blvd., Missouri 63132), 220pp. 26. Anon (1974) The Principles and practical use of AP Analgesia. Medicine and Health Publishing Co., Hong Kong, 325pp. 27. Niboyet,J.E.H. et al (1973) L'anaesthesia par l'AP. Maisonneuve. 28. Travell,J. and Simons,M. (1984) Myofascial pain and dysfunction: the Trigger Point Manual, Part 1. (Williams & Wilkins, Baltimore & London), 713pp. 29. Travell,J. & Simons,M. (1985) Myofascial pain and dysfunction: the Trigger Point Manual, Part 2. (Williams & Wilkins, Baltimore & London).

MASTER POINTS FOR COS THERAPY Taken together, the 66 Command/Su Points, plus the Shu, Mu, Luo, Xi, Test, Ryodoraku, HE, Hour and SP21 Points are called the Master Points of AP.

1. In disorder of the associated Channel-Organ System (COS), there is usually tenderness on palpation of the Yuan, Mu, Shu and Test points. The Test points may feel cold in Yin states and hot in Yang states. The RYODORAKU points are electro-sensitive diagnostic points used in Japanese diagnosis. Their readings are hypo- in Yin and hyper- in Yang states. 2. All Master Points, except Shu, Mu and HE points, are on their own Channels and lie between the elbow and finger or between the knee and toe. 3. The Yuan-Luo combination uses the Yuan of the affected COS with the Luo of the PhaseMate COS, i.e in lung disease, LU09 (Yuan of LU) plus LI06 (Luo of LI). 4. SP21 is the Great Luo point (Luo point of all the Yin COSs). The Five Phase Points Tonic Sedat. Affected COS Wood Fire Earth Metal Water point point Yuan LV (Wood-Yin ) 01 02 03 04 08 08 02 03 GB (Wood-Yang) 41 38 34 44 43 43 38 40 HT (Fire-Yin ) 09 08 07 04 03 09 07 07 SI (Fire-Yang) 03 05 08 01 02 03 08 04 PC (Fire-Yin ) 09 08 07 05 03 09 07 07 TH (Fire-Yang) 03 06 10 01 02 03 10 04 SP (Earth-Yin ) 01 02 03 05 09 02 05 03 ST (Earth-Yang) 43 41 36 45 44 41 45 42 LU (Metal-Yin ) 11 10 09 08 05 09 05 09 LI (Metal-Yang) 03 05 11 01 02 11 02 04 KI (Water-Yin ) 01 02 03 07 10 07 01 03 BL (Water-Yang) 65 60 40 67 66 67 65 64 XiRYODO HE Cleft HOUR Test -RAKU (SEA) Affected COS Shu Mu point point point point point LV (Wood-Yin ) BL18 LV14 06 01 08 03 GB (Wood-Yang) BL19 GB24 36 41 33-39 40 GB34 HT (Fire-Yin ) BL15 CV14 06 08 07-09 07 SI (Fire-Yang) BL27 CV04 06 05 03-04 05 ST39 PC (Fire-Yin ) BL14 CV17 04 08 04 07 TH (Fire-Yang) BL22 CV05 07 06 04-10 04 BL53 SP (Earth-Yin ) BL20 LV13 08 03 09 02 ST (Earth-Yang) BL21 CV12 34 36 34-36 43 ST36 LU (Metal-Yin ) BL13 LU01 06 08 06 09 LI (Metal-Yang) BL25 ST25 07 01 11 05 ST37 KI (Water-Yin ) BL23 GB25 05 10 07 05 BL (Water-Yang) BL28 CV03 63 66 59-60 65 BL40

Luo 05 37 05 07 06 05 04 40 07 06 04 58

ROUGH GUIDE TO CHANNEL RELATIONSHIPS ON NECK, THORAX AND ABDOMEN This is a guide to the major functions of AP points on the neck, thorax and abdomen. THERE IS CONSIDERABLE OVERLAP IN POINT FUNCTION ! It helps if you use good Channel charts when studying the anatomical relationships between these points and their relationships to vertebrae and spinal innervation. GV NECK

BL

FUNCTIONALLY RELATED Channel POINTS ST SP CV ORGAN/FUNCTIONS CONTROLLED

KI

15

10

THORACIC AREA 14 11-12

-

09

-

27

10-11

-

23 head/pituitary/parathyroid/ thyroid/neck/trachea/oesophagus

22 head/neck/thyroid/parathyoid/ upper limb/trachea/bronchi/ oesophagus 13 13 26 14 20 thorax/upper limb/bronchi/lungs/thymus/heart /oesophagus 12 14 24 16 20 18 same 12 15 22 18 18 16 same 11 16 19 20 21/17 14 thorax/lungs/heart/oesophagus 10 17 17-18 22 16 12 diaphragm/stomach 09 18 16 24 16-15 10 stomach/liver/gallbladder 08 19 15 25 15 08 gastrointestine/spleen/pancreas 07-06 20 14 26 14 07-06 gastrointestine/spleen/pancreas/ urinary/reproductive/adrenal/ pituitary LUMBAR AREA 06-04 21-23 13 27 14 06-04 gastrointestine/urinary/ reproductive/ adrenal/pituitary/ ovary/testis/tubes/kidney/hindlimb 04-03 23-26 12 28 13 04-03 intestinal/urinary/reproductive/ovary/ uterus/cervix/testis/prostate/bladder/hindlimb l/s

26 12 29 13 03 intestinal/urinary/reproductive/uterus/ cervix/prostate/bladder/hindlimb

SACRAL AREA 02 27-30 11 30 12 02 intestinal/urinary/reproductive/cervix/

1

prostate/bladder/urethra/rectum/penis/ vagina/vulva/hindlimb 35 11 30 12 01 cervix/prostate/bladder/urethra/rectum/ penis/vagina/vulva 1.

SELECT the CORRECT CATEGORY for the Master Points KI04, SP04, HT05, LV05, TH05: a. Yuan-Source b. Xi-Cleft c. Luo-Collateral d. Hour e. Shu-Back Association

2. SELECT the CORRECT CATEGORY for the Master Points KI03, HT07, ST42, TH04: a. Yuan-Source b. Xi-Cleft c. Luo-Collateral d. Hour e. Shu-Back Association

3. SELECT the CORRECT CATEGORY for the Master Points KI05, SP08, HT06, LV06, TH07: a. Yuan-Source b. Xi-Cleft c. Luo-Collateral

d. Hour e. Mu-Front Alarm

4. SELECT the CORRECT Statement(s): The following are SHU-MU (Back Association-Front Alarm) combinations: a. GV combination=BL11 + CV22 b. CV combination=BL30 + CV23 c. LU combination=BL13 + LU01 d. GB combination=BL19 + GB24 e. (c + d)

5. SELECT the WRONG Statement as regards LULISTo / SPHTSI / etc as memory aid for the Channel Qi sequence, with 0300-0500h being the time for the Qi High Tide in LU: a. LU-LI, ST-SP, HT-SI etc are Husband-Wife pairs b. The time for HT is 0900-1100h c. LU, HT, PC are the three Arm Yin Channels. Their first point is on the chest & their last points near a finger nail d. TH, SI, LI are the three Arm Yang Channels. Their first point is near a finger nail & their last points are on the face e. GB, BL, ST are the three Leg Yang Channels. Their first point is near the eye & their last points near a toe nail

6. SELECT the WRONG Statement: a. A memory aid for the human Shu (Association, Back Reflex) points is: T3 to T7=Lung Constricts Heart VeryGood Diana, T9 to T12=Live Gall SPlutters & Stutters, L1 to L5=THough KIdney Seas Colon’s Gate, S1 to S4=Small BLadder Midback White b. A memory aid for the human Yuan (Source Points) is: Sex at 4, KIds at 5, HearTy LUnch of SILVca at 6 (etc) c. A memory aid for the human Mu (Front Alarm) is: CV03, 04, 05 BLoody SIlly THeme, CV12, 14, 17 STuffed HearTs Constrict, Lung & Liver First & Last (LU01, LV14), SP before LV (LV13), GB before KI (GB24, GB25), LI=McBurney’s Point (ST25) d. A memory aid for the human Luo-Collateral Points is: 4 KISP, 5 HTLVTH, 6 LIPC, 7 LUSI (etc) e. The Jing-Well (Ting, Tsing) point is always the most distal point on a main Channel. For Yang Channels, it is the Metal point & for Yin Channels, it is the Wood point

7. SELECT the WRONG Statement: a. Many AP texts use point names & alpha-numeric point codes that differ from other texts. Beginners are advised to use one text as their basic reference work for point name & code & to check, point by point, each new text against that reference, making appropriate adjustments to point names & codes in the margins of the new book. b. Because of modern telecommunications, it is easy to query supply houses on equipment, brochures & prices c. Because of the cost of air-freight & import taxes, Hong Kong supply houses are usually much more expensive than European, US or Australian supply houses for AP needles & equipment d. IVAS (founded in 1974) has a policy to run its full course (in English) in any country which can organise enough participants to cover the cost of approved lecturers e. The medical AP groups in most countries run week-end seminars on human AP. Vets are usually welcome as associate members.

8. SELECT the WRONG Statement: The following are HOUR Points: a. BL66 b. ST36 c. GB41 d. LU11 e. LI01

9. SELECT the WRONG Statement: The following are Luo-Collateral Points: a. KI04 b. PC07 c. SP04 d. SI07 e. GB37

10. SELECT the WRONG Statement: The following are SHU-MU (Back Association-Front Alarm) combinations: a. SP combination=BL21 + LV12 b. KI combination=BL23 + GB25 c. LV combination=BL18 + LV14 d. HT combination=BL15 + CV14 e. LI combination=BL25 + ST25 1.

SELECT the CORRECT CATEGORY for the Master Points LI06, PC06, LU07, SI07: a. Yuan-Source b. Xi-Cleft c. Luo-Collateral d. Hour e. Mu-Front Alarm

2. SELECT the CORRECT CATEGORY for the Master Points SP03, LU09, LI04, BL64: a. Yuan-Source b. Xi-Cleft c. Luo-Collateral d. Hour e. Mu-Front Alarm

3. SELECT the CORRECT Statement(s): The Emotion or Spirit Points of the Five Zang [LU, HT, LV, SP, KI] include: a. BL13 - Feishu b. BL20 - Pishu c. BL23 - Shenshu d. BL22 - Sanjiaoshu e. BL52 - Zhishi

4. SELECT the WRONG Statement as regards BLaKI-PC / TriGallLV etc as memory aid for the Channel Qi sequence, with 1500-1700h being the time for the Qi High Tide in BL: a. BL-KI, PC-TH, GB-LV are Husband-Wife pairs b. The time for GB is 2100-2300h c. SP, KI, LV are Leg Yin Channels. Their first point is on the foot & their last points on the chest d. ST, BL, GB are Leg Yang Channels. Their first point is near the eye & their last point is on the foot e. The midline Vessels (GV-Dumai & CV-Renmai) are Qi Reservoirs, but are not in the diurnal Qi circulation sequence

5. SELECT the WRONG Statement(s): The Emotion or Spirit Points of the Five Main Zang [LU, HT, LV, SP, KI] include: a. BL42 - Pohu b. BL44 - Shentang c. BL46 - Geguan d. BL47 - Hunmen e. BL49 - Yishe

6. SELECT the WRONG Statement: a. In the Diurnal Qi Cycle, HT is the Qi Son of SP, & is Qi Mother & Wife of SI; GB is the Qi Son of TH, & is Qi Mother & Husband of LV b. Points SP01 & LV01 are on the big toe & LU11 is on the thumb c. Points LI01 & ST45 are on the second finger & toe respectively d. Points HT09 & SI01 are on the little finger & BL67 is on the little toe e. Points TH01 & GB44 are on the middle finger & middle toe respectively

7. SELECT the WRONG Statement:

a. The only Yin Channel in the set: (LI, ST, SI, BL, KI, TH, GB, GV) is KI b. The only Yang Channel in the set: (LU, SP, HT, KI, PC, TH, LV, CV) is TH c. The Channel in the set: (LU, LV, ST, BL, GB, GV) which has least connection to the Eye is LU d. The Channel in the set: (LU, LI, ST, HT, SI, PC, TH) which has least connection to the Arm is ST e. The Channel in the set: (ST, SP, BL, KI, PC, GB, LV) which has most connection to the Leg is PC

8. SELECT the WRONG Statement: The following are HOUR Points: a. KI10 b. SP03 c. LV01 d. CV09 e. HT08

9. SELECT the WRONG Statement: The following are Luo-Collateral Points: a. LI06 b. PC07 c. HT05 d. ST40 e. BL58

10. SELECT the WRONG Statement: The following are SHU-MU (Back Association-Front Alarm) combinations: a. TH combination=BL24 + LV13 b. BL combination=BL28 + CV03 c. ST combination=BL21 + CV12 d. PC combination=BL14 + CV17 e. SI combination=BL27 + CV04

THE STUDY OF ACUPUNCTURE: POINTS AND CHANNELS IN ANIMALS SUMMARY Successful acupuncture (AP) depends on a good knowledge of the location and functions of the main AP points and Channel-Organ Systems (COSs). The Channels (which used to be called Meridians) are the main pathways for transmission and storage of vital energy (Qi). One may study the AP points and Channels in animals in two main ways: a. The traditional Vet method and b. the transposition method (from human AP). Traditional Vet AP relies on texts translated from Chinese sources and does not describe Channels in animals. Transposition AP relies on the study of human AP points/Channels and their transposition to anatomically comparable positions in animals. Both are used in Vet AP and will be discussed. Advanced students use both systems but the transposition method has the following advantages for beginners: a. It is integrated and relatively easy to learn, whereas the traditional system is not integrated and is more difficult to learn. b. It is easily available through dozens of texts in European languages whereas the traditional system has few texts in European languages. c. Western Vet experience with the transposition system indicates that it is effective. Transposition has some disadvantages, especially where anatomical differences between species make some points difficult or impossible to locate. However, many of the disadvantages can be overcome by choosing alternative combinations of points. INTRODUCTION More emphasis will be put on animal acupuncture (AP) by the transposition method (from human AP) because it is easier to learn and it can be applied to all common species treated in Vet practice. But first, we should discuss the characteristics of the AP) points. THE CHARACTERISTICS OF AP POINTS One of the most bewildering aspects of AP for beginners is the vast number of points which are described in various human texts and the fact (which very quickly emerges from a comparative study of any 10-20 textbooks on the subject) that many different combinations of points can be used to treat any one condition. At first, this may suggest to the student (or the sceptic!) of AP that the system is "unscientific", unstructured and almost a random

system. As we will see later, this is a very superficial view. We will also see why many different combinations of points can exert the same effects. AP points occur on all parts of the human body: the limbs, back, belly, head, ears, face, scalp, nose, hands, foot zones etc. The Chinese name for the AP point is Hsueh which means "hole". They saw the skin as the interface between the internal and external environment and the AP points as entry and exit holes for external and internal energies and also as the means of bringing these energies into balance. AP points may coincide with AHSHI, AnShih, Trigger, "Ouch" or "Ah yes!" points. Many AP points are over peripheral nerve. Needling should cause a sensation of paraesthesia, like an electric shock running away from the needle. Other points are rich in proprioceptors, such as near joints. These are mainly on the extremities. Others are rich in nerve endings. Needling strongly stimulates the cerebral cortex and results in powerful reflex action, for instance the response to GV26; LU11; A01 etc in shock, collapse). Human and animal AP points have electrical properties which distinguish them from surrounding skin. The electrical characteristics of the points have been well established in human cadavers and in experimental animals. The bilateral symmetry of the points has been established also. AP points have high direct-current (DC) potential and low impedance (high conductivity) relative to surrounding skin. Specially adapted voltmeters or resistance meters are used to detect the points. Accuracy of electronic point detection is influenced by: a. Probe application pressure must be constant. Readings vary with the pressure applied. In practice, spring-loaded probes, applied at constant force, reduce this variation. b. Skin lesions, sweat, serum etc can greatly alter the readings. c. In animals the hair coat may interfere with readings. The histological reality of the points has been shown in humans and laboratory animals. Tissue around the points has more free nerve endings, vascular spirals, thickening of the epidermis and more linear alignment of collagen fibres than tissue more distant from the points. Many major points are directly over peripheral nerves running in the subcutaneous tissue or in the muscle. Needling of these points causes direct stimulation of the nerves. Other AP points correspond with places where a peripheral nerve enters or leaves a muscle, the "motor points" as known to physiotherapists. Still other points correspond with "trigger points (TPs)", zones of referred pain and the AHSHI or pressure-sensitive points (pain points). The histological properties of the points and their location vis a vis the peripheral nerves explains the electrical characteristics of the points. The instruments used to locate the points are very similar to neurometers, used to locate peripheral nerves. Provocation experiments have been done on animals by Kothbauer (cattle), Kvirshishvili (rabbits) and Schupbach (pigs). Irritant substances, such as Lugol's iodine or turpentine, were

injected into different organs, body regions or joints. The animals were observed closely to see which points showed increased sensitivity after the challenge. Kothbauer worked mainly on the reflex points of the abdominal viscera of cows (ovary, uterus, kidney, cervix etc). He found that precise (and usually ipsilateral) points reacted when the organ was irritated. Most of the points were in the lumbosacral area and coincided closely with AP points (as transposed from the human BL Channel) known to be effective on these organs. In later clinical use, he confirmed the therapeutic value of these reflex points (the "pain points") in cows. Kvirshishvili observed the ears of rabbits which had been injected with a blue dye. The ears were shaved to make it easy to see vasodilation. Then he injected irritants into specific joints. He confirmed that specific ipsilateral ear points reacted (vasodilated) to pain signals from specific body regions. This reflex vasodilation is controlled by the hypothalamus. AP points have other energetic characteristics, related to reflex vasodilation (hot-spots, YANG, hyperactivity) or vasoconstriction (cold-spots, YIN, hypoactivity). Reactive AP points can be detected by infra-red thermography. For instance, Schupbach (Vet School, Zurich, 1985) injected irritant solution into the body or horn of the uterus of minipigs. Using computer-controlled infra-red thermography, he located specific zones on the skin of the lumbosacral area which became "Hot Spots" within 10-40 minutes (average 25 minutes) after irritation of the body or horn of the uterus. These "Hot Spots" related well with classical AP points known to be related to the uterus and cervix (points over the iliac wing, lumbosacral space, sacral foramina and anterior coccygeal area (BL26.3, 27-34, PAIHUI, WEIKEN etc). In his experiments, Schupbach attempted to correlate "Hot Spots" with points of low electrical resistance. The correlation was NOT significant. Many low resistance points were found but infrared thermography was more accurate at locating the reflex zones. In further experiments, he used electrodes implanted in the uterus of minipigs to monitor myometrial activity following needling of the main "Hot Spot" (BL26.3, over the iliac wing). AP stimulation caused definite increase in uterine contraction. Provocation experiments and stimulation of the reactive points suggest that the AP points are terminals in a bi-directional reflex: viscerocutaneous and cutaneovisceral i.e. (IN = OUT). They confirm the claim of TCM that AP has diagnostic and therapeutic uses. DIAGNOSTIC CHARACTERS OF THE POINTS There is some evidence (yet not complete) that the electrical properties of AP points which are related to specific organs, regions or functions are changed when the organ, region or function is diseased. In disease, the points are more sensitive to heat (Akabane test) and to probing or palpation. In these cases, electrical conductivity and the DC potential of the points usually increase. In deficiency of energy in a Channel, the measurement points may be hyposensitive (decreased conductance). Point sensitivity in disease may be unilateral (especially when the lesion is unilateral) or bilateral. The location of the sensitive points is used by some acupuncturists to assist in diagnosing the location of the disease. For instance, in vague abdominal pains, if the points on

the ST Channel and the Earpoint "stomach" were more sensitive than other points, this would indicate that the lesion or problem was with the stomach or its functions. In humans, Japanese (Nakatani, Motoyama), American and German (Voll) workers have developed electronic diagnostic instruments which use this principle. These instruments are very expensive and their value is not yet adequately proven. Many skilled acupuncturists can locate the points and diagnose the energy imbalance without using these instruments. In animals, Kothbauer's "Painpoint Detector" is of value in locating the sensitive points. It delivers a small electrical current through a search-probe. (A reference electrode is placed on a standard position). When the search probe reaches a sensitive point, more current passes (because of greater conductivity) and the animal reacts by a pain-avoidance response. However, it requires considerable time, patience and experience to use these instruments. Some acupuncturists claim that they can locate the sensitive points faster by standard methods of palpation or probing the skin with a blunt scissors or round-ended plastic test-tube. Sensitive points can also be located quickly by psychic methods, such as by the reaction of a pendulum (dowsing). Another method is to pass the hand slowly over the animal's body at a distance of a few centimetres and to note the subjective sensations of prickling or tremor in the hand as it passes over the sensitive points. A third method is to (mentally) visualise the animal and to scan the body looking for the best points to treat, having programmed the mind, in advance, to be drawn to these points. These sensitive points are important not only to aid diagnosis, but also in therapy. Their use in therapy will be discussed elsewhere. The selective sensitivity which appears at certain points in disease is partly: a. a reflex phenomenon associated with autonomic changes and b. a "primitive nervous system" phenomenon, such as occurs in plants and lower animals when tissues are damaged. As the disease process is controlled and/or eliminated by the body, the point sensitivity returns to its normal baseline levels. In the treatment of soft-tissue injuries or other disorders in which pain-points, AHSHI points etc have been located on initial examination, disappearance of point sensitivity in the first few treatment sessions is a good prognostic sign. This indicates that the condition is improving. However, certain drugs (such as alcohol, mescaline, marijuana) and mental states (excitement, fear, depression etc) may cause general alterations in all major AP points, probably by reflex autonomic effects. ALPHANUMERIC CODE, CHINESE NAME AND NUMBER FOR CHANNEL POINTS, "STRANGE POINTS", "NEW POINTS" AND "HAND POINTS" The alphanumeric code varies between European and American authors. For instance Lung is coded LU, L, P (pulmon) etc by various authors. The code used here for the Channel points is that used by IVAS (International Vet AP Society). The codes for the "Strange Points" (Z, Y, X, A, L), "New Points" (NZ, NY, NX, NA, NL) and "Hand Points" (H) are my own).

Alphanumeric codes are very useful for rapid data storage and retrieval, for instance in prescriptions, in case history files and in computerised records. Chinese point name is that used by Wu Wei Ping and the Hong Kong sources. However, European phonetic expression of the Chinese calligraphic symbols may vary between textbooks and the beginner must be aware of this. Thus, point Hoku may be called Rokou, HeGu (and other names!) in different textbooks. This causes great confusion to the beginner and makes computerization by point names (between multiple authors) difficult or impossible. The Chinese point codes are those used in "The Newest Illustrations of the AP Points", Medicine and Health Publishing Co., Hong Kong (1973), the "Synopsis of Chinese AP" (1974) and the "Principles and practical use of AP Anaesthesia" (1974) and the same publishers. The "Strange", "New" and "Hand" points have no Chinese point codes. Beginners should learn the location of the first and last point on each Channel. this helps to orient the course of the Channel in their minds and, also, the direction of flow of Qi. Students should also learn the position and functions of all the underlined points. These are the most important points, according to the Chinese AP Research Foundation (Taipei, Taiwan): "Basic AP - a scientific interpretation and application", (1977), C.A.R.F., Box 84-223 Taipei, Taiwan. Students should validate the coding system used each new text. The codes used in this paper are not the same as those used in the prescriptions for common diseases (see Appendix 1 of the paper: The Choice of AP points for particular conditions). AP CHANNELS AP Channels are longitudinal lines connecting AP points with similar functional effects in humans. Traditional Vet AP texts do not describe Channels, probably because Vet AP theory was not as well developed as in humans. TCM describes 12 pairs of Channels, which are bilaterally symmetrical in humans. These Channels are Lung (LU); Large Intestine (LI) (sometimes called the Colon (CO); Stomach (ST); Spleen/Pancreas (SP); Heart (HT); Small Intestine (SI); Bladder (BL); Kidney (KI); Pericardium (PC) (also called Heart Constrictor (HC) or Circulation-Sex (CS); Triple Heater (TH) (also called Triple Warmer or San Chiao); Gallbladder (GB); Liver (LV, sometimes written as LI or Liv). Each of these Channels has a specified number of points along its course. In general, all the points on a Channel have some effect on the organ and its function e.g. any one of the BL points influences the bladder, but some are more effective than others. The number of points is as follows: CHANNEL LU LI ST SP HT SI BL KI PC TH GB LV No. Points 11 20 45 21 9 19 67 27 9 23 44 14 Each of the points on the left Channels has its mirror opposite on the right side. As well as the bilaterally symmetrical Channels, there are 2 midline (single) Channels - the Governor Vessel (GV) on the dorsal midline and the Conception Vessel (CV) on the ventral

midline. There are 28 GV points and 24 CV points. Thus, the total number of Channel points = (2 x 309) + 52 = 670 points, or (309 + 52) = 361 positions (if one does not count mirror opposites). Evidence for the physical existence of Channels: In sensitive humans, a stimulus (needling, pressure, electrical stimulus etc) applied to an AP point causes a sensation of paraesthesia (numbness, "pins-and-needles" sensation, "electric-shock" sensation) to radiate proximally or distally along the Channel. Very sensitive subjects can describe the superficial course of the entire channel and may also identify sensations in the related internal organ. TCM uses the term "Propagated Channel Effect" (PCE) to describe this effect. The functional connection between AP points along the Channels has been demonstrated by application of sonic (sound) stimuli which can be measured along the course of the Channel by transducers which amplify and record the sound. More of the sound is detected along the Channel than at other places. ANIMAL AP POINTS AND CHANNELS BY TRANSPOSITION FROM HUMANS The vast majority of western Vets who use AP study, choose and locate the points for therapy by reference to the human system. Therefore, it is most important to learn this system properly. In this talk we will discuss briefly the human point and Channel system. Details of the course of the human Channels and the location of the AP points are in the paper "The study of AP: Sources and Study techniques" (Rogers 1990). The Channel points: Each AP point has a Chinese name, a western alpha-numeric code (e.g. LI04; GB34; ST36), a position and a list of therapeutic indications, with some advice on methods of needling. We will see later that it is not necessary to memorise all the points. For general purposes a thorough knowledge of 60-90 points (in total) can give very valuable results. (These points are underlined in Appendix 1 of this paper). In this seminar, I will retain those codes (LU, LI, ST, SP, HT, SI, BL, KI, PC, TH, GB, LV, CV, GV) as the method of Channel point description. There are many other methods in use and one must adopt one convention to avoid confusion. Other body points: As well as the Channel points, recent Chinese texts describe many other points off the Channels. These points have been proved to be of value in clinical practice and some of them should be studied. They include the "New Points", "Strange Points" and "Hand Points" as listed in the "Newest Illustrations of the AP Points (Hong Kong, 1975). Their names and codes (as used in the therapeutic prescriptions given in the paper on the Choice of points for therapy) are included in Appendix 1 of this paper. Scalp points: There are zones on the scalp for motor and sensory function, speech area, reproductive function etc. These points are especially useful in treating the paralysis which often follows cerebrovascular accidents. Face points, Nose points and Foot Zone points are also described in recent texts. The Chinese concept of the Macrocosm reflected in the Microcosm (the universe in the atom, the whole in the part (Hologram) find its expression also in the fact that every organ, joint, function and region of the body may "refer itself" to (i.e. influence and be influenced by) other parts of the body such as the face, scalp, nose, foot zones etc. However, by far the most well known (and best researched) example of this is in the Earpoints.

Earpoints: Nogier (France), discovered that certain specific points on the ear became sensitive to palpation or showed physical changes (vascular hyperaemia, anaemia, flaky/scaly skin, pustules or other reflex phenomena) in certain specific illnesses. He found that the distribution of these points resembled an inverted human foetus or homonculus, with the head downwards (at the ear lobe) and the back towards the posterior edge and the buttocks/feet at the upper part of the ear. Intensive Chinese research in human clinical and experimental trials confirmed Nogier's findings. The result was the production of Ear maps which show the reflex earpoints for every major organ, joint, region and function of the body. In a paper called "An experimental evaluation of auricular diagnosis: the somatotopic mapping of musculoskeletal pain" (1980), Oleson et al (Pain Management Clinic UCLA School of Medicine, Los Angeles) reported good diagnostic accuracy of human earpoints. The study was designed to evaluate the French and Chinese claims that the body is represented by a somatotopic map on the external ear. Forty patients with musculoskeletal pain were examined by one worker to determine the painful area. Each patient was then covered with a sheet to conceal any visible physical problems. The physician conducting the auricular diagnosis had no prior knowledge of the patient's medical history or condition. He simply examined the ear to locate areas which were sensitive to probe pressure and to DC (electric) current (increased conductivity). Using ear AP maps, he predicted the painful area. The agreement between the established medical assessment and the ear-point diagnosis was 75%. The results support the hypothesis that the body is represented by a somatotopic map on the external ear. A copy of the abstract of that article is attached at the end of this paper. However, the Chinese make even further claims for ear-point sensitivity in diagnosis. Texts from Beijing (Outline of Chinese AP, 1975, Foreign Languages Press) and Hong Kong (Practical Ear Needling Therapy, 1980, Medicine and Health Publishing Co) claim that earpoint sensitivity can help in the diagnosis of the site of human cancer, inflammation and other lesions in the internal organs, such as the lung, liver, uterus, stomach, intestines etc. This is a most astonishing and revolutionary concept to orthodox workers! The EAR may be used to assist in the diagnosis of the location of the condition (lesion, pain etc) and in the therapy of that condition. However, there is controversy over the exact position of the points: for instance, Nogier's ear charts are not identical to modern Chinese ear charts. Kvirshishvili has already shown reflex points on the rabbit ear for the major joints. Still (Brno Vet School), Jeannot (France), Hill (USA) and others have described Ear AP points in animals but more work is needed to document the location and clinical uses of animal earpoints. TRANSPOSITION FROM HUMANS TO ANIMALS In animals, the transposition system has a number of difficulties and disadvantages: a. Many of the important human AP points (the Command Points, see later) occur between the elbow and digit or knee (stifle) and digit. However, few of our animals have 5 digits. Thus, it can be difficult or impossible to locate anatomically comparable positions for these areas in animals. Where would one locate point Shang Yang (LI01) or Hoku (LI04) in the horse? Large animal Vet acupuncturists (Cain, Kothbauer, Thoresen, Westermayer etc) have described locations for these difficult points.

b. Bladder Shu points (organ-associated points) occur along the paravertebral line, in relation to intercostal spaces or the lumbar and sacral vertebrae. These are most important points for therapy in some diseases. Humans have 12 pairs of ribs, 12 thoracic vertebrae, 5 lumbar vertebrae and 5 sacral vertebrae, whereas few of our animal species fit this pattern. Thus, if point Pi Shu (BL20) (the spleen/pancreas associated point) lies between vertebrae T11-12 in man (with 12 pairs of ribs), where does it lie in the horse, with 18 pairs of ribs? c. Other anatomical differences (for instance the absence of a clear umbilicus, the presence of a penis and sheath along the abdomen etc) can make it difficult to transpose points on the CV Channel. d. Earpoints, which are extremely valuable points in man, are not as well researched in animals. Differences in ear anatomy make direct transposition very difficult. How can we overcome these difficulties? a. If one or more points can not be found, use other combinations. It is most important to know that many combinations of AP points can produce the same result. For instance, in man, headache might be treated by needling points Hoku (LI04). Lieh Chueh (LU07) and Tai Chung (LV03), points which could easily be found in the dog but difficult or impossible to find in the horse. However, points Feng Chih (GB20), Yin Tang (between the eyes), Tai Yang (in the temple, lateral to the eye) could produce good success also and could be located in most animals. b. If there is doubt about the exact location of a transposed point, choose a number of points along the nerve trunk or in the same or nearby dermatomal areas. Research evidence most strongly suggests that AP effects are mediated via the nervous system and that nerve points in the same dermatome, along the same nerve trunk or in nearby dermatomes can exert very similar effects. Thus, although point Pi Shu (BL20) is nominally the associated point for the spleen-pancreas, points BL19 or 21 (Tan Shu, Wei Shu) would also have some effect. Similarly, although point BL13 (Fei Shu) is the Lung-associated SHU point (frequently used in treating asthma and bronchitis) points BL12 and 14 (Feng Men and Chueh Yin Shu or Pao Hsin Shu) would have similar effects. In fact, many of the massage, cupping, spooning and cautery techniques would be applied over the whole area of BL12,13,14. c. If the penis is in the way, deflect it to one side. If the exact location of the umbilicus is not clear, make an estimate of its location and use this as the landmark to locate points above or below it. d. In the next few years, research on the points (and especially the Earpoints) will help to define the position and functions of these points. Vet AP by the transposition method is a new art-science and we must expect changes and improvements to be made in the future. It is our privilege to be among the pioneers who will help to develop this most useful therapy in the West. POINT NOMENCLATURE In China, each point in medical and Vet AP has a name which (to a Chinese reader) is in some way descriptive of the function, location or character of the point. For instance point Hsin Shu (BL15) translates as SHU point for the Heart; point Tsu San Li (ST36) translates as

Foot Three Miles (the point is 3 TSUN (Chinese inches) below the patella); point Lan Wei (Hsueh) translates as Appendix (Point) etc. These meanings are lost to most Western readers, as few texts give the translation of the point names. AP texts in European languages may be based on originals from China, Korea, Japan, Taiwan, Hong Kong etc. The European phonetic spelling of the original characters (calligraphic figures) may vary widely for the same points. This may create great confusion for Western readers who are trying to index points under the point names. Therefore, Chinese and Western texts also give an alphanumeric or numeric code to each point. Even then, confusion may arise, as ST01 may be called M01 in Dutch and German texts, E01 in French texts, S01 in other English texts and ST08 or S08 in still more texts! Therefore, it is essential that students should adopt one convention, based on one textbook which they will use as their basic reference work. Each new textbook or reference must be checked point by point against the reference text and, if necessary, the points in the new texts must be renamed and re-coded, if the student hopes to integrate the new material with the old. The codes used in this paper are the IVAS codes, as follows: IVAS code LU LI ST SP HT SI BL KI PC TH GB LV CV GV Rogers old code LU CO ST SP HE SI BL KI HC TH GB LI VC VG During this seminar and in all my papers, I will follow the IVAS convention. There is no guarantee that the IVAS convention is identical to that of the other lecturers. This is because there is no international standard of point coding and nomenclature established at this time. I can not alter the Appendix to Paper 3 (on the Choice of AP Points), as it is not on disk. That Appendix uses the old code (CO for Colon; HE for Heart, HC for Pericardium, LI for Liver etc). TRADITIONAL AP POINTS IN ANIMALS Chinese Vet texts and their translations into European languages show the points used in traditional Vet AP for the main domestic species: horse, ox, goat, pig, camel, duck and fowl. There are incomplete texts from other countries on the elephant. There are no texts available on small animals (dog, cat), laboratory animals (rats, mice, guinea-pigs), zoo animals or primates. In the traditional Vet texts, AP points are shown as isolated positions, in relation to body landmarks, such as bones, joints, body cleavages, orifices or other anatomical landmarks. Each point has a name (denoted by a Chinese or Japanese symbol), an alpha-numeric code (e.g. FL 7) or a Chinese numeric code (81), a position, a list of its therapeutic functions, and advice on the method of stimulation. For instance, in the ox, the Chinese text ("Chinese Vet Handbook", Anon 1972, Lan Chou Vet. Res., Institute, Ganshu, China), from which Klide and Kung prepared their section on the ox, shows the following points: (see Table 1). There are many difficulties in learning the traditional vet AP system:

1. The points are isolated (not on Channels) and bear little relationship to each other in function. Thus, they have to be memorized in great detail. There is little possibility of busy practitioners learning this system properly. 2. Between species differences occur in the symbols, names, codes, positions, functions and method of stimulation. Thus, a Vet could know the points in the ox very well, yet not know the traditional system as applied to other species. 3. Within species differences occur. The Chinese name, symbol and translation for a particular point may vary between texts on the same species of animal. Even if the symbol is the same, the European alphabetic version and the codes may differ. Also, points in a precise position may have different therapeutic indications, depending on which reference text is being used. Part of this problem is due to the difficulty of translating Chinese into precise European equivalents. For instance, T 1 (Tan Tien) might be used for sunstroke (= hyperthermia) or exhaustion (= collapse = shock) depending on the skill of the translator! Similarly, Tan Tien (HN 1) might be used for cerebral congestion (= apoplexy?, collapse?) or epilepsy (= convulsions). HL 1 and FL 1 might be used for twisted pelvic and shoulder joints respectively but these might also translate as strained, sprained or painful joints. The fact is that little or no integration sources and translation has been done between (and even within species). 4. Unacceptable methods of stimulation are often recommended in the traditional texts. The use of thick or spear-like needles, hot irons and severe cautery would not be acceptable to Western Vet surgeons, their clients and their patients. 5. The system can not cater for many species because texts do not exist for them. Over the next few years, Vets and scholars of the Chinese system will attempt to integrate the existing traditional texts. If this is done, a single authoritative text for each species (for which texts exist) may emerge. This should make it easier to study and use the traditional system. Until then, however, most Vets will have to follow one particular school or text of the traditional system. For those of you who wish to study the traditional AP system in animals, I recommend the texts of Klide and Kung; Westermayer; Rubin; Yu & Hwang and any other good translations of modern Chinese or Japanese Vet texts which may appear in the next year or so. CONCLUSIONS AP points and Channels are real physiological and physical entities. General properties of AP points and Channels and their association with peripheral nerves and other nervous structures are discussed. AP points become reactive (hyper- or hypo-sensitive) in disease in their related Channels, organs, body functions on parts. They have diagnostic and therapeutic value. Ear AP in animals is not as well developed at present as body AP but advances are expected. Vet AP uses the traditional and/or transposition methods. Advantages and disadvantages of both are discussed. Beginners are advised to base their study on the human AP system and to include traditional Vet methods later.

Details of the course of the Channels and the location of the more important points in humans are in the paper "The study of AP: Sources and Study techniques" (Rogers 1990). FURTHER READING MATERIAL Anon (1980) Essentials of Chinese AP. Foreign Languages Press, Peking 432pp. Anon (1977) Chinese AP Research Foundation, Taipei: Basic AP - a scientific interpretation and application. C.A.R.F., Box 84-223 Taipei, Taiwan 313pp. Anon (1975) Newest illustrations of the AP points: booklet and charts. Medicine and Health Publishing Co., Hong Kong 105pp. Brunner, F. (1980) Akupunktur fur Tierarzte - Akupunktur der Klientiere. WBV Biologisch Med. Verlag, Ipweg 5, D7060 Schorndorf, Germany 303pp. Gilchrist, D. (1981) Manual of AP for small animals. Box 303, Redcliffe, Queensland 4020, Australia. Oleson, T.D., Kroening, R.J. and Bresler, D.E. (1980) Experimental evaluation of auricular diagnosis: somatotopic mapping of musculo-skeletal pain at ear AP points. Report from Pain Control Unit, Dept. Anaesthesiology UCLA School of Med., Los Angeles, California 90024. (The UCLA group have valuable reports on AP research in many areas - clinical, experimental and theoretical). Klide, A.M. and Kung, S.H. (1977) Vet AP. University of Pennsylvania Press, Philadelphia, 297pp. Rubin, M. (1976) Manuel d'AP veterinaire pratique moderne en Rep. de Chine. Maloine Publishers, Paris. 85pp. Schupbach, M. (1985) Thermographic proof of points with higher temperature after irritation of the uterus in minipigs & the influence of these points on the viscera. Inaugural Dissertation for the degree of DVM. Vet School, Zurich. 106pp. Westermayer, E. (1978) Atlas of AP in horses. Health Science Press, Holsworthy, Devon, U.K. (This is the English version of the original German version, which had 40 pages of charts and text). Westermayer, E. (1979) Atlas of AP in cattle. WBV Biologisch Med. Verlag, Ipweg 5, D7060 Schorndorf, Germany 62pp. Yu Chuan & Hwang Yann-Ching (1990) Handbook on Chinese Veterinary AP and Moxibustion. FAO Office for Asia and the Pacific, Bangkok 193pp. QUESTIONS 1. One of the following statements is not correct. Indicate the incorrect statement: (a) The Chinese name for an AP point is "Hsueh" or "Xue" which means "hole"

(b) AP points very seldom arise over a peripheral nerve and one should be very careful not to needle a nerve (c) AP points may coincide with AHSHI points, Trigger Points (TPs), Motor Points (d) Some AP points are rich in proprioceptors, such as near joints; others are rich in nerve endings. Needling strongly stimulates the cerebral cortex and hypothalamus and results in powerful reflex action, for instance the response to GV26 in shock, collapse (e) Needling should cause a sensation of paraesthesia, like an electric shock running away from the needle. 2. One of the following statements is not correct. Indicate the incorrect statement: (a) Tissue around AP points has more free nerve endings, vascular spirals, thickening of the epidermis and more linear alignment of collagen fibres than tissue more distant from the points. (b) AP points have high direct-current (DC) potential and low impedance (high conductivity) relative to surrounding skin (c) Skin lesions, sweat, serum etc have no effect on the readings of electrical pointfinders. (d) In animals (with hairy skins) the hair may interfere with readings of electrical pointfinders. (e) Spring-loaded probes, applied at constant force, improve the accuracy of electronic point detection.

3. One of the following statements is not correct. Indicate the incorrect statement: (a) Reflex connections between AP points and organs/body parts were proven by provocation experiments. Irritant substances were injected into different organs, body regions or joints. The animals were observed closely to see which points showed increased sensitivity after the challenge. Provocation experiments and stimulation of the reactive points suggest that the AP points are terminals in a bidirectional reflex: viscerocutaneous and cutaneovisceral. They confirm the claim of TCM that AP has diagnostic and therapeutic uses. (b) Kothbauer worked mainly on the reflex points of the abdominal viscera of cows. He found that specific ipsilateral points in the lumbosacral area reacted to ipsilateral irritation of the ovary, uterus, kidney or cervix uteri.

(c) Kvirshishvili injected irritants into specific joints of rabbits. He confirmed that specific ipsilateral Ear points vasodilated in response to pain signals from specific body regions. (d) Reflex vasodilation at AP points can be measured by thermography as coldspots. (e) Schupbach injected irritant solution into the body or horn of the uterus of minipigs. He located specific reflex zones especially over the iliac wing, lumbosacral space, sacral foramina and anterior coccygeal area (corresponding to BL26.3, 27-34, PAIHUI, WEIKEN etc) 4. One of the following statements is not correct. Indicate the incorrect statement: (a) The selective sensitivity which appears at AP points in disease is partly a reflex phenomenon associated with autonomic changes and a "primitive nervous system" phenomenon, such as occurs in plants and lower animals when tissues are damaged. (b) As the disease process is controlled and/or eliminated by the body, AP point sensitivity returns to its normal baseline levels. (c) In the treatment of disorders in which pain-points, AHSHI points etc have been located on initial examination, disappearance of AP point sensitivity in the first few treatment sessions is a good prognostic sign. (d) Certain drugs (such as alcohol, mescaline, marijuana) may cause general alterations in all major AP points, probably by reflex autonomic effects. (e) Mental state (excitement, fear, depression etc) has no effect on AP point sensitivity.

5. One of the following statements is not correct. Indicate the incorrect statement: (a) Vet acupuncturists must know thoroughly at least 150 points before they can expect good clinical results in animals. (b) The 12 Main Channels are bilaterally symmetrical and the CV and GV Channels are in the ventral and dorsal midline respectively (c) There is a total of 361 point positions (if one does not count mirror opposites) on the 14 main Channels of human AP

(d) Ear Points, "New Points", "Strange Points" and "Hand Points", Scalp points, Face points, Nose points and Foot Zone points bring the number of point locations to >1000. (e) Earpoints are found in humans, represented as an inverted homonculus, with the head at the earlobe, the back towards the posterior edge and the buttocks/feet at the upper part of the ear. However, there is controversy over the exact position of the points: for instance, Nogier's ear charts are not identical to modern Chinese ear charts. 6. For each of the following Channels, indicate the letter (a to e) corresponding with the correct number of points on the Channel: #a #b #c #d #e BL

61 63 65 67 69

CV

21 22 23 24 25

GB

44 46 50 52 54

GV

24 25 26 27 28

HT

09 11 13 15 17

KI

19 21 23 25 27

LI

18 20 22 24 26

LU

09 10 11 12 13

LV

13 14 15 16 17

PC

05 07 09 11 13

SI

19 20 21 22 23

SP

13 15 17 19 21

ST

39 41 43 45 47

TH

21 23 25 27 29

1=b

2=c 3=d

4=e 5=a

6: BL=d; CV=d; GB=a; GV=e; HT=a; KI=e; LI=b; LU=c; LV=b; PC=c; SI=a; SP=e; ST=d; TH=b

THE CHOICE OF ACUPUNCTURE POINTS FOR AP THERAPY This paper was written in 1980. For an update, see the attached paper on the Choice of AP points for particular conditions

INTRODUCTION One may use veterinary acupuncture (AP) by the transposition method (from human to animal) or by the traditional vet method. It follows that the choice of points for therapy can be based on either or both of these methods. Some of the AP textbooks on man and animals have therapeutic indices (point prescriptions) for specific disease conditions or symptoms. Other texts have not this facility. We have also seen that many different combinations of points may be used in any one clinical condition. The student is advised to study only a few AP texts initially. However, she/he should know that one text (or even 3-4 texts) does not cover all conditions which may respond to AP. Therefore, over a period of years, the serious student can expect to accumulate and study dozens of different texts. Each of these texts will have to be integrated with material from earlier texts. Therefore the student will need to make out personal prescription lists, using data from many sources. This paper discusses the choice of AP points based on the human transposition system but first we must consider some differences between orthodox and unorthodox concepts of disease. DIFFERENCES BETWEEN ORTHODOX AND UNORTHODOX CONCEPTS OF DISEASE AP is frequently of great value in treating the pain and lameness associated with x-ray evidence of severe osteoarthritis or "intervertebral disc prolapse syndrome", despite the persistence of the lesion. Orthodox practitioners would suggest that this is impossible because they assume that the pain and lameness primarily is caused initially by nerve stimulation from the lesion, but which soon becomes a self-perpetuating system, (i.e., a vicious circle). They claim that if the muscle spasm and tissue oedema is relieved, the locomotor function may be restored despite the persistence of the x-ray lesion. Severe gastric ulcers, even bleeding ulcers, may respond rapidly to AP, with no change in dietary habits. Orthodox concepts would prescribe change of diet, drug therapy with antacids, gastric sedatives, antispasmodics, Zantac or Cimetidine, etc. However, stimulation of certain AP points, especially NeiKuan (PC06); TsuSanLi (ST36), ChungWan (CV12) and WeiShu (BL21) has powerful effects on the autonomic nervous system (anti-nauseous effects), acid secretion and regenerative power of the gastric mucosa. Thus, AP can combat the symptoms of gastric ulcer and promote the ideal environment for self-healing, by reducing acid-secretion and stimulating the defence systems of the body. Similarly, AP can help patients who have lost motor function of an arm or leg following a cerebrovascular accident, encephalitis etc. Orthodox medical concepts claim that damaged neurons cannot regenerate. Acupuncturists agree with this but they claim that many types of paralysis are due to functional rather than organic damage, (i.e.) that the motor-neurons are "asleep but not dead", due to inadequate oxygen or blood supply. AP at certain points has marked effect on brain microcirculation and, thus, can restore nerve function in such cases. Also, the nervous system itself has considerable "plasticity" and new circuits can be established to replace the functions of damaged circuits.

Another difference between orthodox and unorthodox concepts is in the importance of the nature of the lesion. Orthodox clinicians would set great importance on the nature of a toe pain (for example). Is it arthritis, sprain, gout, subluxation etc? To an acupuncturist, such questions are of minor importance, as the point combination used covers all responsive conditions of the toe and the Channel-Organ System (COS) related to the toes. For pragmatic purposes, however, it is helpful to establish a firm diagnosis before attempting to treat the condition. Thus, AP claims to treat or help many conditions which, according to our western training, should be difficult or impossible to treat successfully. How, then, do we go about choosing the best points for therapy? CONSTRUCTION OF AP POINT PRESCRIPTIONS As one accumulates textbooks one may wish to construct a cumulative index of the points recommended by the various authors for each condition. Each reference should be coded, in order to avoid confusion as to the source and to avoid mistakes in the location of the points. As new texts are studied, data can be added to the index, under a new reference code. For example, suppose one were studying Klide and Kung in relation to AP in horses and one were using the Sobin data (p 69 of Klide and Kung), one would find the following data under the various points: Point Indication Head & Neck01 Tetanus, encephalitis, encephalomyelitis, encephaloedema 02 Purulent frontal sinusitis, cerebral hyperaemia 03 Cerebral hyperaemia, cerebral anaemia, neck rheumatism 04 Same as HN03 .. Tail 114 Over-exertion, heat stroke, common cold, bowel spasm First, one would go through the data and pick out the complete list of key-words or pathological conditions, mentioned in the text: Tetanus, Encephalitis, Encephalomyelitis, Encephaloedema, Sinusitis (frontal, purulent), Cerebral hyperaemia, Cerebral anaemia, Neck rheumatism, Overexertion, Heatstroke, Common cold, Bowel spasm etc. One would then go through the data again and enter the identity of each point under the relevant conditions, giving a code (say) (K-S (for Klide/Kung-Sobin) before each point combination and giving an appropriate alphanumeric code to each point, for example HN01 for Head and Neck 1, T114 for Tail 114. Bowel spasm (K-S) T114 (T= Tail)

Cerebral hyperaemia (K-S) HN02,03,04 Encephalitis (K-S) HN01 Encephaloedema (K-S) HN01 Encephalomyelitis (K-S) HN01 Tetanus (K-S) HN01 . . . . etc If a new reference, for example author X, had points under these headings, they would be added later. For example: Cerebral hyperaemia (K-S) HN02,03,04.... (X) 99, 112, 115... Tetanus (K-S) HN01... (X) 115, 119, 126... etc The problem with this system (traditional vet AP) is that there is no standard chart for any one species. It is not possible to relate (K-S) HN02 with (X) 99 etc on the standard chart. Therefore some major integration (referring back to the individual source charts) is necessary either before the cumulative index is attempted or after it is done. Either way, it becomes very time-consuming for the individual practitioner. However, one would expect that research workers interested in vet AP will integrate all existing vet traditional texts into one "standard" text for each species within the next few years. Meanwhile, integration of human texts is much easier, as they are normally based on a standard chart of the AP points (except for a few instances in which points such as BL36-54 and ST01-8 may have different alphanumeric coding in some texts:

Outer BL Points (IVAS BL40=WeiZhong, mid-popliteal crease) IVAS 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54

Other 50 51 52 53 54 36 37 38 39 40 41 42 43 44 45 46 47 48 49 Inner line - - - - - --12 13 14 15 16 17 18 19 20 21 22 23 28 30 Codes for ST01-08 (IVAS ST08=TouWei, on temple) IVAS 01 02 03 04 05 06 07 08 Other 08 07 06 05 04 03 02 01 These differences should be noted and adjusted by the student on the first comparison of his/her "new" text with the reference text. Thus, studying four texts, such as the Beijing text (2), Hongkong text (3), Taipei text (4) and Barefoot Doctor's Manual (5), the student would prepare a therapeutic index in the same way as above. Then, on checking the points listed for gastritis/gastric ulcer; toothache; sciatica/lumbosacral pain, sprain, etc (for example) he/she would find: Gastritis/Gastric ulcer (Pek) ST20,21,25; SP05; CV12,13 (plus Earpoints and other points) (Hkx) ST21,28,36; SP05; NL20,21; CV12,13 (plus earpoints and other points) (TX) ST36,44; SP04; BL21; CV12; local points (Bdm) ST25,36; BL20,21; PC06; CV06,08,12,13 Toothache (Pek) LI02,03,04,05; ST03,05,06,07,42,44; SI18; Kl03; TH09,20; GB03,05,06,10,12,17; CV24; GV27 (plus earpoints and other points) (Hkx) LU02; LI01,02,04,05; ST03,05,06,07,42,44,45; SI18; TH09,20,21; GB02,03,05,06,10,12,17; CV24; GV27,28 (plus earpoints and other points) (TX) LI04,11; ST06,44; TH17 (Bdm) LU09; LI04; ST06,07; SI03; TH17,20 Sciatica, lumbosacral pain, sprain etc (Pek) BL22,23,24,25,26,27,28,29,30,31,32,33,34,37,39,40,52,53,54,55, 57,59,60,63,64; GB30,31,34,39; GV02,03,04; AhShi, (plus earpoints and other points) (Hkx) BL27,28,29,30,31,32,33,34,37,39,40,52,54,58,60; GB30,31,32,34,35,40; GV02,03 (plus earpoints and other points)

(TX) BL23,30,40,60; GB34; AhShi (Bdm) BL23,37,40,52,60; GB30,34; AhShi (plus other points) In the above examples (Pek), (Hkx), (TX) and (Bdm) refer to the Beijing, Hongkong, Taipei and Barefoot Doctor's Manual Sources respectively. Glancing down through the points listed under each condition, one could see some agreement and some alternative point combinations. In choosing points for therapy, the student could pick those which showed the greatest measure of agreement, for example: Gastritis/gastric ulcer: Choose from CV12,13; ST36; BL21 (listed in 3-4/4 of the texts) Toothache: Choose from LI04; ST06,07,44; TH20 (listed in 3-4/4 of the texts) Sciatica/lumbosacral pain: Choose from AhShi; BL23,30,40,60; GB30,34 (listed in 3-4/4 of the texts) The therapeutic index is obviously a dynamic system, which is extended each time new references are studied. Also, one may add data from the clinical experience of colleagues, articles in the journals etc, as it becomes available. The above approach is often called "Cookbook AP" by the purists and is regarded (especially by classically trained members) as inferior AP. However, Cookbook AP works very well in clinical situations with only one or a small number of signs or symptoms. Many recent textbooks from China, Taiwan, Hongkong etc make no mention of classic AP in the old sense and they rely very heavily on the Cookbook approach themselves. The Laws of the Five Phases, the classic use of the Phase Points, Yuan-Source, Luo-Passage, Hour Points, the Chinese Pulse Diagnosis etc are not mentioned in detail (if at all) in most of the modern texts from China and its neighbouring countries. Even if one has access to a comprehensive therapeutic index, one still needs a way to reduce the number of points to a minimum. This is because many comprehensive prescriptions list far more points than are needed to treat the case. In the final choice of points, one usually relies on a few ancient Laws, choosing combinations from the following: 1. Sensitive points 2. TianYing points 3. Local points along affected and nearby Channels 4. Points along the affected Channels 5. Distant points on Channels through the affected area 6. Points on related Channels 7. Master points, including the Five Phase points, Mu/Shu points, Yuan/Luo points and XiCleft points

8. Combination of local and distant points 9. Selection of points according to the symptoms 10. Selection of points according to the innervation 11. Fore and Aft points 12. Earpoints Cookbook AP can be improved greatly by choosing points from an extensive list (based on many, if not dozens of, authoritative texts) so that at least 2 of the basic Laws of choosing points are fulfilled (see example re elbow pain etc later in this paper). DIAGNOSTIC, THERAPEUTIC AND PROGNOSTIC VALUE OF SENSITIVE POINTS AND THE CHOICE OF POINTS FOR THERAPY 1. SENSITIVE POINTS It is important to search for sensitive points. Sensitive points include the AhShi, Trigger Points, motor points and any other points which show abnormal tenderness to palpationprobing. After taking the case history, the acupuncturist usually palpates the entire body, probing the muscles, especially in those areas which the case history may suggest as likely to be sensitive. In musculoskeletal conditions of the upper limb and neck one probes especially the muscles of the upper limb, neck and thorax. In conditions of the lumbosacral area and lower limb, these areas will be probed carefully. Occasionally, sensitive points may be found far away from the problem area and a careful examination would include probing of the whole body, irrespective of the more obvious areas likely to be affected. For example, SP06 may be sensitive in menstrual disorder in women; KI03 may be sensitive in renal disorders; GB34 may be sensitive in cholecystitis; L 13 (LanWei = "Appendix Tail") may be sensitive in appendicitis. Wherever sensitive points are found, their locations are noted carefully for future reference. These points may or may not be codified AP points. Their location can help in the diagnosis and they are also useful in therapy and prognosis. Their disappearance, i.e. return to normal sensitivity, during a course of treatment is taken as a good prognosis. Sensitive points, when present, are always included in the point prescription. However, occasionally a whole area, such as the rectus abdominis, gastrocnemius or gluteal muscles may be sensitive and to needle all of this would require too many needles. In such cases, one or two of the most sensitive areas in the muscle are chosen. If ultrasound or electrostimulation equipment with a roller-electrode is available, the entire muscle can be treated. One also probes scar tissue carefully. Wherever scar tissue is found, great care is taken to check whether or not it may be associated with the symptoms (by reflex effects or by blocking the flow of Qi in one or more Channels). Treatment of problem scars is very important. It is discussed in the paper on "Techniques of stimulation of the AP points". Other areas important to probe include the 66 Command Points (the 60 Phase Points + the 6 Yuan points of the Yang Channels (the Yuan points of the Yin Channels are the same as the

Yu points), see paper on the Study of Points and Channels), the front Mu points, the paravertebral Shu Points" (BL13-30), also the outer line of the BL Channel (BL36-40, 4154)). Sensitive points excluded from needling treatment include cancers, joint cavities, abscesses, infected wounds, parasitized skin areas and ulcers. In the latter case, the use of TianYing points is permitted in certain conditions (see next section). In humans, practitioners who use the Earpoints pay particular attention to those points which show abnormal sensitivity. Point sensitivity can be detected objectively by electronic detectors, as mentioned in an earlier paper. 2. TIANYING POINTS In certain cases it is permissible to needle abnormal masses, such as goitre, synovial cysts, indurated masses in muscle following intramuscular injections etc. The TianYing point is the point of greatest sensitivity in the mass, cyst etc, It is focus of the problem a swollen or enlarged area such as an inflamed muscle or joint or periosteum. One needle is put into the TianYing point and occasionally, 3 or 4 more needles are placed around this one, from the periphery, as in the diagram (a) and (b) below. Cyst diagrams (a) and (b): In the case of varicose leg ulcers, 3-5 needles are sometimes advanced underneath the base of the ulcer as in diagram (c) below. Ulcer diagram (c): In hip arthritis, for example, point GB30 (HuanTiao) is needled but the needle may also be advanced to peck the periosteum of the femoral neck. The intramuscular lump which sometimes follows injection in the biceps brachii or gluteal muscles can be dispersed quickly by dry-needling the centre of the lump. In "Tennis elbow", the lateral epicondyle of the humerus is often pecked with a needle. In headache following epidural injection or lumbar puncture, the pain can be relieved by injecting a needle into the original needle track. (A recent paper in a medical journal reported extraordinary success in such cases by injection of 10 ml of the patient's blood back into the puncture site. The author did not acknowledge the Chinese discovered that simple needling of the same area could get the same result). In general, however, cancer masses, joint cavities, infected wounds and infected abscesses (non-sterile) and parasitised skin areas should not be needled except for biopsy or drainage purposes. 3. LOCAL POINTS In local problems, such as elbow pain, gastritis, tenesmus etc, one or two local points are included in the prescription. For example, include: neck pain: GB20; BL10; X 35 (HuaToChiaChi points);

shoulder pain: LI15; TH14; elbow pain: LI11; HT03; carpal (wrist) pain: LI05; HT07; lumbosacral pain: BL23,25; GV03; hip pain: GB30; knee (stifle) pain: BL40; GB34; L 16 (HsiYen); tarsal (hock) pain: BL60 penetrating to KI03; gastritis: CV12 (CV12 is also the Mu point-for ST); intestinal disease: ST25, CV04 (these are both local and Mu points for the large and small intestine respectively); bronchitis: BL13; CV17; tracheitis: CV22,23. Other examples of local points are in Table 1 (at the end of the paper). 4. POINTS ON THE AFFECTED CHANNEL Where an organ or function controlled by a Channel is disturbed, one or more points on that Channel are chosen. For example, ST36 in gastritis; LI04 in ulcerative colitis; LU09 in pneumonia; SP06 in diabetes (Spleen- pancreas); HT07 in tachycardia; BL23,28 in bladder disorders (these are also the Shu points for KI and BL respectively); KI points in KI disorders; PC points in PC disorders etc. Similarly, where aches or pains are located on or near the course of a Channel, points are chosen on the Channel. For example in pain along the lateral thigh, points GB31 or 32 could be included; for pain along the lateral chest, points GB22 or 25; SP17 or 18 or 19 or 20 or 21 could be included; for pain on the inner aspect of the leg, one might include one or two points from: SP05,06,07,08,09; LV05,06,07; KI08,09,10. 5. DISTANT POINTS ON CHANNELS THROUGH THE AFFECTED AREA In general, the most effective AP points are below the elbow and knee (the areas in which the 66 Command Points lie. Problems at one end of the body may be treated by points at the other end. For example, disorders of the head and its organs may be helped by points below the elbow or below the knee (stifle). Points on the head may help problems below the waist.

Also, a local problem may be helped by needling a point above or below it on its Channel. For example GB34 in hip, flank or lateral, thoracic pain; TH05 in elbow, shoulder and side of neck pain; BL40 or 60 in lumbar pain; SP04 in genital pain etc. A variation of this "Law" is that pain or other disorders at one end of a Channel may be treated by points at the opposite end of the Channel. Examples are: GV20 in haemorrhoids, tenesmus or rectal prolapse; GV26 in low back pain; KI01 in cerebral vascular accident, apoplexy; LI04 in rhinitis, sinusitis, toothache of lower jaw; ST44 in toothache of upper jaw or temporal headache; BL67 or GB37 in eye pain; LU01, HT01 or PC01 in pain in the palm of the hand; TH23, LI20 or SI19 in pain in the dorsum of the hand; SI03, 04 or 05 in tinnitus aurium; LI04, TH05 or SI03 in neck pain. A Beijing text (9) advises that needles or moxa should not be applied to a wound, an ulcer or scar. The nearest local points should be used instead. This is at variance with two well established techniques: the treatment varicose leg ulcers (in Section 2 above) and the treatment of scar tissue in the paper on "Techniques of stimulation of the AP points"). 6. POINTS ON RELATED CHANNELS The Phase-Mate Channels (Husband-Wife pairs, or Linked Pairs in the same Phase) are: LU-LI; ST-SP; HT-SI; BL-KI; PC-TH; GB-LV. One member of each pair influences the other. Disease along one member of a pair or of the main organ of a pair may be helped by points on the other member of the pair. For example, gastric upsets or pain along the ST Channel may be helped by needling points on the SP Channel. LI points influence LU disorders. LV points are used in GB disorders (see below). Also, points on nearby (anatomically related) Channels (for example SP, KI, LV in the leg and thigh area; TH, LI, SI on the forearm etc) influence pain etc in the area. Example, pain along LI Channel in the forearm should be helped by local or distal points TH or SI Channels. 7. MASTER POINTS In Classic AP the Five Phase Points (60 points in total) are very important but these are often ignored in western and modern Chinese AP. They are discussed elsewhere, as are the Master Points of AP. The most important of the Master Points for therapy are the Shu-Back Association points, Mu-Front Alarm points, Yuan-Source, Luo-Passage and Xi-Cleft points. Whether or not these points are sensitive when their respective organs are upset), these points often are used in therapy. Combinations of Shu and Mu Points are prescribed frequently when an organ (or its functions/correspondences) is abnormal: Shu and Mu BL13 and LU01 in disorders of the Lung BL25 and ST25 in disorders of the Colon

BL21 and CV12 in disorders of the Stomach BL20 and LV13 in disorders of the Spleen-pancreas BL15 and CV14 in disorders of the Heart BL27 and CV04 in disorders of the Small Intestine BL28 and CV03 in disorders of the Bladder BL23 and GB25 in disorders of the Kidney BL14 and CV17 in disorders of the Pericardium, Circulation-Sex BL22 and CV05 in disorders of the Triple Heater BL19 and GB24 in disorders of the Gallbladder BL18 and LV14 in disorders of the Liver Combinations of Yuan-Source and Luo-Passage points. In disease of an organ or its Channel, the Yuan point of the affected Channel is used with the Luo point of its PhaseMate Channel, for example in LU disorders (or disorders of the LU Channel), LU09 (Yuan of LU) and LI06 (Luo of LI) could he used: affected Yuan and Luo of Mate in LU disorders: LU09 and LI06 in LI disorders: LI04 and LU07 in ST disorders: ST42 and SP04 in SP disorders: SP03 and ST40 in HT disorders: HT07 and SI07 in SI disorders: SI04 and HT05 in BL disorders: BL64 and KI04 in KI disorders: KI03 and BL58 in PC disorders: PC07 and TH05 in TH disorders: TH04 and PC06 in GB disorders: GB40 and LV05 in LV disorders: LV03 and GB37

The Xi-Cleft points are indicated mainly in acute diseases of their respective Channels or organs. In haemoptysis: LU06 (Xi of LU); in acute colitis: LI07 (Xi of LI); in epigastric pain: ST34 (Xi of ST); in acute lower abdominal pain at menstruation: SP08 (Xi of SP). Various combinations of Master Points are possible. For example, in liver disease, or in problems of the eyes or nails (which are controlled by LV), the LV Shu point (BL18, KanShu), the LV Mu point (LV14, ChiMen), the LV Yuan point (LV03, TaiChung) and the LV Xi-Cleft point (LV06 ChungTo) might be combined. In liver and gallbladder disease (or in problems controlled by LV and GB Channels), the Luo points LV05 (LiKou) and GB37 (KuangMing) might be combined with the Mu, Shu and/or Xi-Cleft points for liver and gallbladder (LV14, GB24; BL18, BL19; LV06, GB36). 8. COMBINATION OF LOCAL AND DISTANT POINTS This is one of the most common methods of choosing points. Examples are: Face and cheek disorders: local points (ST04,06) plus distant points on Channels to the area (e.g.) LI04, ST44. Eye disease: BL01; ST01 (local) plus SI06; GB37 (distant). Ear disease: GB02; SI19; TH17 (local) plus SI03, GB43. Hip arthritis: GB30 (local) plus GB34 (distant). Other examples are shown in Table 1 (below). The "Adjacent" point is another type of point, recommended in recent Chinese texts. This is a powerful point, located 1-20 tsun from the local disorder or problem area. Examples are, GB20 for head and eye; GV20 for forehead; GB25 for lower dorsal area and lumbar area; LV13 in gastric pain. Other examples are given in Table 1 (below). For best results, "Adjacent" points usually are combined with local and distant points as in Table 1. Example: acute gastritis with gastric pain: ST36; PC06 (remote points on the leg and arm) plus CV12 (local point plus Mu point) plus LV13 ("Adjacent point" and Mu of SP). 9. SELECTION OF POINTS ACCORDING TO SYMPTOMS Symptomatic points: Certain points are known to be highly effective for common symptoms, such as vomiting, nausea, fever etc. In treating a clinical syndrome, points are chosen for the main problem and others may be added for the symptoms. For example, in gastritis: CV12 and ST36 might be chosen as the main points. If symptoms of nausea and fever were also present, points PC06 and GV14 might be added. The Beijing text (2) lists the following points for the common symptoms: Cough; CV22; LU07; SP06 Diarrhoea: ST25,36; SP04; CV06 Difficulty swallowing: CV22,23; PC06

Dreams, nightmares: BL15; HT07; LV03 Excess mucus, cough: ST40. Excessive-perspiration: HT06; KI07 Fever: LI04,11; GV14. Hiccough, diaphragmatic spasm: BL17; ST36 Insomnia: HT07; SP06; KI03; CV24. Nausea, vomiting: PC06; ST36. Night sweats: SI03; HT06; Z 01 Pain in the cardiac area: PC06; CV17 Palpitation: PC06,04 Salivation: ST04; CV24,23 Shock: GV26; CV08,04; PC06,09 Other examples of points specific for symptoms are: GB34 in acute, traumatic or muscular pain. (This is the pain point par excellence. It is usually combined with one of two local points for the affected area). ST36 in upper abdominal disorders; SP06 in lower abdominal disorders; GV26; KI01 in anaesthetic emergencies (collapse, apnoea, cardiac arrest); PC06 in disorders of the heart, lungs, thorax; Earpoint Lung in relieving the symptoms of narcotic or alcohol withdrawal. 10. SELECTION OF POINTS ACCORDING TO NERVE SUPPLY For diseases in any region (head, neck, limbs, internal organs), one may select points from areas supplied by the same spinal nerves, nerve plexus or nerve trunks as supply the problem area. Often, direct needling of the nerve trunk or plexus is used. In this respect, the paravertebral BL points and the paravertebral X 35 (HuaToChiaChi) points are especially useful for many conditions which do not appear (on casual examination to have anything to do with the back. This may be the explanation for the success of chiropractic and other manipulative systems which concentrate on spinal massage and pressure manipulation. These systems would concentrate on the same areas as the BL and X 35 paravertebral points.

11. SELECTION OF FORE AND AFT POINTS In local disorders, such as knee pain, arm trauma etc, a combination of Fore and Aft points (in front of and behind) are used. These are almost always local points. Examples are: Knee pain: L 16 (HsiYen) and BL40; Forearm pain: PC06 and TH05. The Mu/Shu combination is also an example. 12. EARPOINTS Sensitive earpoints, plus other earpoints known to be related to the affected areas or functions are used in Ear AP. The system is highly effective in man but needs much more development before it can be recommended for routine use in animals. FINAL SELECTION OF POINTSS In the last two sections, we saw that points can be selected from therapeutic indices (Cookbook Approach) or by reference to the Laws of AP. (There are other Laws not discussed in this seminar). Ideally one should keep the number of points used in any one session to a minimum. In practice, however, western acupuncturists may use up to 10 or often 20 points in certain cases. Usually, the number would be 1100 headings (regions, organs, conditions, symptoms, etc). The printout of the complete listing for the Top Twenty points runs to some 160 pages of fullwidth (132-character) computer paper. In one hour, it is not possible to cover these data. Therefore, I have chosen to list the Top Twenty points for about 130 of the major body regions and their subregions and organs (Appendix 2). The Top Twenty points for about 130 of the more common symptoms are also listed (Appendix 3). PRESCRIPTIONS FOR MAJOR BODY AREAS, FUNCTIONS, SUB-REGIONS AND COMBINATIONS OF SIMILAR CONDITIONS In the database (see Appendices 1,2,3) points are filed under separate condition codes such as: 040201 Shoulder area (unspecified conditions) 040202 Clavicle: APA for fracture reduction 040203 Shoulder: APA for dislocation reduction

040205 Shoulder, scapula : pain .. ache.. .arthritis etc 040211 Shoulder, scapular: paralysis 040219 Deltoid: myofascial syndrome Using the computer, it was possible to combine information to retrieve all points used in, for example, all conditions of "shoulder, clavicle and scapular area" (a total of 181 points from 45 references). In this way, the entire database was summarised by amalgamation of data for major body areas, functions, subregions and combinations of similar conditions. The Top Twenty points and their scores are listed in Appendix 2. These lists should prove useful in the study of AP and as reference material for teaching seminars. They do not, however, supplant the lists of points for specific symptoms but should be seen as general guidelines in the choice of points. PRESCRIPTIONS FOR COMMON SYMPTOMS The database was searched for a cross-section of common symptoms, especially those relating to the musculoskeletal system (pain, paralysis) and to major body functions. The Top Twenty points and their scores for some 130 symptoms or conditions are listed in Appendix 3. It must be remembered that only the Top Twenty points are given here. There are many other points which could be considered, especially if a number of symptoms occur together. In complicated cases, for example, neurogenic vomiting and dehydration in the dog, points for the main symptom (vomiting: PC06; ST36; CV12; ST25) could be combined with supportive therapy (fluid replacement). In cases of anaesthetic emergency or respiratory arrest, main points (GV26, KI01) could be combined with artificial respiration (though the latter is seldom needed if the points are stimulated strongly). In cases where cardiac arrest has also occurred, point PC06 (very powerful on heart and lungs) could be added to GV26, KI01, and open or closed heart massage, defibrillation or other methods would be added. Please scan Appendices 1, 2 and 3 now, and then return to the discussion which follows. MASTER POINTS FOR CHANNEL THERAPY Apart from the 66 Command Points, there are other powerful points to redistribute Qi between imbalanced Channels. These are the Shu-Back Association (Reflex) Points, the MuFront Alarm Points, the Luo-Passage (Connecting Points between the Phase-Mate Channels within one Phase), the Xi-Cleft Points, the Test Points, the Ryodoraku (Japanese Points), and the HE (Sea Points). The latter points are not the same as the HO points on the Channels. In addition there is an Hour Point (the Phase point of a Channel, for example the Earth Point of SP, the Water point of BL etc). SP21 is the Great Luo point (Luo point of all the Yin Channels). Taken together, the 66 Command/Su Points, plus the Shu, Mu, Luo, Xi, Test, Ryodoraku, HE, Hour and SP21 Points are called the Master Points of AP. The Five Phase Points

Tonic Sedat.

Affected COS

Wood Fire Earth Metal Water

point point

Yuan

Luo

LV (Wood-Yin )

01

02

03

04

08

08

02

03

05

GB (Wood-Yang)

41

38

34

44

43

43

38

40

37

HT (Fire-Yin )

09

08

07

04

03

09

07

07

05

SI (Fire-Yang)

03

05

08

01

02

03

08

04

07

PC (Fire-Yin )

09

08

07

05

03

09

07

07

06

TH (Fire-Yang)

03

06

10

01

02

03

10

04

05

SP (Earth-Yin )

01

02

03

05

09

02

05

03

04

ST (Earth-Yang)

43

41

36

45

44

41

45

42

40

LU (Metal-Yin )

11

10

09

08

05

09

05

09

07

LI (Metal-Yang)

03

05

11

01

02

11

02

04

06

KI (Water-Yin )

01

02

03

07

10

07

01

03

04

BL (Water-Yang)

65

60

54

67

66

67

65

64

58

Xi-

RYODO

HE

Cleft

HOUR

Test

-RAKU

(SEA)

point

point

point

point

point

Affected COS

Shu

Mu

LV (Wood-Yin )

BL18

LV14

06

01

08

03

-

GB (Wood-Yang)

BL19

GB24

36

41

33-39

40

GB34

HT (Fire-Yin )

BL15

CV14

06

08

07-09

07

-

SI (Fire-Yang)

BL27

CV04

06

05

03-04

05

ST39

PC (Fire-Yin )

BL14

CV17

04

08

04

07

-

TH (Fire-Yang)

BL22

CV05

07

06

04-10

04

BL53

SP (Earth-Yin ) BL20

LV13

08

03

09

02

-

ST (Earth-Yang) BL21

CV12

34

36

34-36

43

ST36

LU (Metal-Yin ) BL13

LU01

06

08

06

09

-

LI (Metal-Yang) BL25

ST25

07

01

11

05

ST37

KI (Water-Yin ) BL23

GB25

05

10

07

05

-

BL (Water-Yang) BL28

CV03

63

66

59-60

65

BL54

1. In disorder of the associated Channel-Organ System (COS), there is usually tenderness on palpation of the Yuan, Mu, Shu and Test points. The Test points may feel cold in Yin states and hot in Yang states. The RYODORAKU points are electro-sensitive diagnostic points used in Japanese diagnosis. Their readings are hypo- in Yin and hyper- in Yang states. 2. All MASTER points, except Shu, Mu and HE points, are on their respective Channels and lie between the elbow and finger or between the knee and toe. 3. The Yuan-Luo combination uses the Yuan of the affected Channel with the Luo of the Phase-Mate Channel, i.e in lung disease, LU09 (Yuan of LU) plus LI06 (Luo of LI). An examination of most of the listings in Appendices 2 and 3 shows that the Top Ten points obey the basic laws of choosing AP points. In summary, these laws suggest a choice of points from: a. AhShi points (including Trigger Points, tender scars, fibrositic nodules etc) b. Local points (which also meet condition (d)). c. Distant points on the Channel through the affected area or on the Channel of the affected organ. A chain of points on the affected Channel is said to be specially powerful. d. Points on the affected nerve, the nerve supply related to the affected organ or area, or in the same or a nearby spinal nerve segment. e. Encircling the problem area; "Fore and Aft" points; combination of Yin side and Yang side points (medial/lateral; anterior/posterior). f. Combination of Mu and Shu (Front Alarm + Back Association) points. g. Combination of affected Yuan and Luo of Mate (Source Point of the affected Channel plus Passage point of its Phase-Mate Channel (LU-LI; ST-SP; HT-SI; BL-KI; PC-TH; GB-LV). h. Xi-Cleft point of affected Channel. i. One or more of the Five Phase Points (Energetic balancing points). j. Symptomatic points (traditionally known to have marked effect for the specific symptoms, for example, GV26 in shock, emergencies; PC06 in nausea or vomiting). k. Extra-Channel points ("New" or "Strange" points, points not on the Main Channels), especially those effective for the condition, e.g. NX04 (TingChuan) in asthma. l. Points on the Phase-Mate of the affected Channel (e.g.) ST points in spleen diseases; SP points in stomach diseases. m. TianYing point (OT02, centre of the goitre etc).

n. One point on each of the 4 limbs (e.g. LI04 and ST44, both bilateral, in tonsillitis or toothache). Let us examine the Top Ten points from some prescriptions (Appendices 2,3) in detail under three basic headings: 1. Local conditions or regions 2. Conditions of specific internal organs or their functions 3. Generalised conditions and complex syndromes. In each of these conditions, codes (a) to (n) mentioned above are used to show the laws observed by the points in the Top Ten list. 1. LOCAL CONDITIONS OR REGIONS: Let us pick problems of the eye, nose, neck, shoulder, elbow, lowback, hip and knee (stifle) as examples from Appendix 1: EYE: BL01 (b); LI04 (c, as the LI Channel connects to ST Channel at the eye); GB2O (c);also Wood (GB,LV) controls the eyes; ST01 (b); Z09 (b, k); BL02 (b); ST02 (b); GB14 (b,c (Wood)); TH23 (b); BL18 (liver controls eyes. BL18 is Shu point of liver, b). The combination BL01, ST01, Z 09, GB14 meets law (e) above and is very useful in eye diseases. 7/10 of these points are local points. NOSE: LI04 (c,g,i,j); LI20 (b); GB20 (j); GV23 (c); LI11 (c,i,j); GV14 (c,j); Z 03 (b,k); BL07 (c); LI19 (b); ST02 (b). The combination LI20, Z 03, ST02 also meets law (e). 4/10 of these points are local points. NECK: GB2O (b); GV14 (b); LI04 (c,g,i); BL10 (b); SI03 (c,i.j); LI11 (c,i,j); OT01 (AhShi point - a); GB21 (b,c depending on site of problem); GB39 (c,j); SI15 (b). The combination GB20,21, BL10, GV14, SI15 also meets law (e). 5/10 of these points are local. SHOULDER area: LI15 (b,j); LI11 (c,i,j); TH14 (b,j); Sl11 (b); Sl09 (b); LI04 (e,g,j); OT01 (a); Sl10 (b); OT05 (local points, b); BL11 (d ,j ). A combination of SI09, LI15 and a new point l" above anterior axillary crease is known as the "shoulder triplet". The combination meets law (e) above and has powerful effects in shoulder conditions. 6/10 of these points are local points. ELBOW: LI11 (b,i,j); TH05 (c,j); LI04 (c,g,i); HT03 (b,i); LU05 (b,i); LI10 (b); OT01 (a); LI12 (b); TH10 (b); SI07 (c). 6/10 of these points are local. LOWBACK: BL23 (b,j); BL40 (c,i,j); GB30 (c, linked to lowback via BL Channel, d,j); BL60 (c,i,j); GB34 (c (via BL link), i,j); BL25 (b); BL37 (c); GV04 (b); BL57 (c); BL31 (b). 4/10 of these points are local. HIP: GB30 (b,j); GB34 (c,i,j); GB29 (b); GB31 (c); BL40 (c via link to GB Channel, i,j); BL60 (c,i,j); OT01 (a); GB39 (c,i,j); ST36 (d,i); LV08 (-). Although only 2/10 of these points are local, 2 of the top 3 points are local.

KNEE: GB34 (b,i,j); BL40 (b,i,j); L 16 (b,k); ST35 (b); SP09 (b); ST36 (c,i); ST34 (b); LV08 (c); OT01 (a); GB31 (c). The first05 of these points are the most commonly used combination (obeying law e) and all are local points. In the eight local conditions discussed above, seven have a local point as the first in the list (the 8th has a local point as second on the list). 2. CONDITIONS OF INTERNAL ORGANS AND THEIR FUNCTIONS: Let us consider the Top Ten points in five of the conditions in Appendix 2. Close examination of other lists in the appendices will show that they follow similar logic. PLEURA: BL42, BL47, BL43, KI23, KI22, BL13, GB32 (7/10 points) are on the thorax or dorsal paravertebral area (local). Two of the other three (ST12, BL11) are at the thoracic inlet and the 10th point (GB44) obeys law (c). HEART, PERICARDIUM: Only 3 of the Top Ten (BL15, BL14, CV17) are over or near the organs. They obey laws (b), (d), (e) and (f). Six of the remainder (PC06, PC07, HT05, PC05, PC07, PC04) are on the HT or PC Channel (laws c, i, j). The 10th point (ST36) is a Master Point, with many functions, including effects on HT and PC. COUGH, GENERAL: BL13, CV22, GV12, BL12, CV17 (5 of the top 10 points) are over the thorax, trachea or dorsal paravertebral area. They obey laws (b), (d), (e), (f), (j). Three points (LU05,07, 10) are on the LU (lung) Channel (laws c, i). The remaining two points (ST4O, GV14) meet laws c and i. LIVER: 6/10 points (BL18,19,20,48; GV09; LV13) are over or near the liver. They obey laws b, d, e, f, j. The remaining four points (LV03, ST36, GB34, SP06) are master points. They obey laws c, g, i, j. GENITALIA FEMALE AND REPRODUCTION: 6/10 points are in the lumbosacral innervation area (low abdomen or l/s paravertebral area). They are: CV03,04,06; GV04; GB26; BL32. They obey laws (b), (d), (e), (j). The four remaining points (SP06,10; LV03; ST36) are Master Points with major effect on low abdomen and its functions. They obey laws (c), (i), (j). 2a. IF AN ORGAN OR FUNCTION HAS NO NAMED CHANNEL, points can be chosen from combinations relating to the nearest organs, or Channels, or functions. For example, suppose there were no entries for the following organs: Thymus: consider points from combinations for heart, lungs, stomach (nearest organs) and immunity (a closely allied function). Diaphragm, oesophagus: consider heart, lung, stomach combination. Appendix: consider lower right abdomen and large intestine combinations + immunity. Adrenal (beside kidney): consider kidney combinations. Ovary, tubes, uterus: consider kidney, bladder, low abdominal and large intestinal combinations.

Vagina, vulva, scrotum, testicles, penis: these are controlled by the 3 Leg Yin Channels (SP, LV, KI). Consider points on these Channels + points for low abdomen, bladder. 3. GENERALISED CONDITIONS AND COMPLEX SYNDROMES: Generalised conditions include metabolic, hormonal, toxic, general autonomic upsets, etc (such as gout, diabetes, food poisoning, shock, neurasthenia, etc). Although one symptom may be dominant, it is usual to have a number of symptoms and abnormalities occurring together. For example, in gout, the presenting symptom may be pain in the big toe (or other joint), but other symptoms could include liver enlargement + pain; headaches; irritability; blurred vision; tiredness, etc. The comprehensive treatment would entail dietary advice (possibly involving food allergy/intolerance testing) and increased fluid intake. AP would be aimed at the more severe symptom (say toe pain) but other points (especially LV and GB) would be aimed at the other symptoms. The liver is central in gout and many allergies. Treat the liver. In diabetes mellitus, polyuria, neuropathy and other signs can arise. Dietary advice, together with points for diabetes (see Appendix 2) the local regions affected by neuropathy and the kidney (Appendices 1 and 2) would be indicated. In food poisoning, vomiting and diarrhoea would be tackled by points such as CV12, PC06, ST25,36,37 but other symptoms (dehydration, prostration etc) would best be tackled by fluid replacement. Medication (kaolin, chlorodyne) can assist the gastrointestinal symptoms. In shock, points like GV26, KI01, ST36, PC06 can be of immediate help but accurate diagnosis of the pathology is essential and would indicate other interventions (surgery, if severe internal bleeding; fluids, stimulants, warmth, etc where indicated). In neurasthenia, insomnia, excitement etc, the HT and PC Channels control these functions in traditional belief. Consider HT, PC points. DISCUSSION 1. IN MOST LOCAL PROBLEMS (joint, muscle, superficial organ etc) the best prescription combines AhShi points and local points + distant points on the affected or related Channel. It is important to check the location as regards the nerve supply and the Channel. For example, the best combination for pain in the medial epicondyle of the humerus will not be identical to the best combination for the lateral epicondyle. However, in traditional AP, it is not enough to pick any local point. (Some local points are better than others, or, at least, are more frequently recommended than others). Modern neurophysiological concepts of AP stress that adequate stimulation of the affected or related NERVES will produce results as good as the traditional method but adequate clinical or research testing of the traditional versus modern (nerve theory) methods has not been done. For the moment, I give the benefit of the doubt to the traditional system, which has stood the test of time. 2. IN DISEASE OF INTERNAL ORGANS, the most important points lie near the organ in the thoracoabdominal area or in the paravertebral area (the Mu, Shu and Huatochiachi (X 35) points, CV and GV points). Where the organ has a named Channel (LU, LI, ST, SP, HT, SI, BL, KI, PC, GB, LV) it is common to include one or more points on that Channel (distant as

well as local points). Also, the course of the Channel is important. For example, the liver, kidney and spleen Channels traverse the inner thighs and groin area. Distant points on these Channels are important in genital and lower abdominal conditions. In general, if a symptom or abnormal function can be traced to a specific COS, treat that COS. If more than one symptom/organ system is involved, choose a combination of points which will influence all the major symptoms or upset organs. 3. IN ACUTE SERIOUS CONDITIONS, WITH MULTIPLE SYMPTOMS AND PATHOLOGY, it is unwise to rely solely on AP. AP can often give considerable help (using points as indicated by the main symptoms and pathology) but conventional or unconventional (complementary) therapies may need to be used as well. 4. IN CHRONIC COMPLICATED CASES, where immediate life-threatening symptoms or pathology are absent, one can rely more on AP as the main therapy (in cases amenable to treatment). At all times, however, the aim of good medicine is to help the patient to the greatest extent, with the minimum of side effects. Therefore, it is good practice to use whatever complementary therapies seem best indicated. Analysis of the database indicates that points from the list: LI04,11; ST25,36; SP06; HT07; BL23,40; PC06; TH05; GB20,34; LV03; CV06,12; GV04,12,14,20,26 arise in a high proportion of cases. In complex cases, if one has difficulty in deciding on a prescription, it is advisable to include a few points from that list. LIMITATIONS OF COOKBOOK AP: How would one treat the following syndrome? The patient had the following symptoms (at different times) during a period of 6 years, beginning two years after radical right lung surgery: recurrent haemorrhagic nephritis; cystitis; rightsided sciatica; right- sided paravertebral pain (C6 - T4 area); right-sided headache and bouts of acute conjunctivitis (right); right ear tinnitus; waking at night with severe pain along the SI Channel of the arm to the little finger, with the arm in spasm. To try cookbook prescriptions in such a case would be second-rate AP. There was obviously a connection between all these symptoms (all relate to SI, BL, KI) and most were right sided symptoms. On examination, the patient's thoracotomy scar was badly twisted, with adhesions on the right BL line. This was the clue. Blockage of the Qi flow (traditional concept) or reflex irritation effects (Western concept) could cause all of these symptoms via the Chinese SI-BL-KI energy cycle. Treatment was physiotherapy + injection of the scar plus a few AP sessions using BL points. All symptoms were successfully cleared. Cookbooks have their limitations and Chefs do not need them. CONCLUSIONS Cookbooks or computerised prescribing is very valuable for beginners and for those working in a clinic. However, one should not rely too much on machines or computers. Computers need electrical power. In national disaster and warfare, and in many of the developing countries, electrical power, batteries etc may be unavailable where they are needed most. Therefore, it is important for the development of medicine and veterinary medicine that as many professionals as possible should study the basics of AP. This learning process can be accelerated by interaction with a computerised database (Rogers 1984a). Adequate knowledge

of AP will enable it to be used more widely in field work (large animal work, medics and paramedics in the bush). Although the data reported here (Appendices 1,2,3) are but a small fraction of the database, it is obvious that for most conditions, the Top Ten Points usually will be worth considering. However, in some complicated cases, points not in the Top Ten may be most relevant. The statistical method is very useful for population medicine, but it may be disastrous for the unfortunate patients who need individually designed care. As a general rule, if a Cookbook prescription does not produce definite results by 2-3 sessions, it is necessary to (a) change the choice of points, or (b) consider other therapies, or (c) regard yourself as unable to assist. The enthusiastic amateur AP practitioner will get useful results with the COOKBOOK but more complicated or deeply rooted problems require more holistic (traditional + modern + complementary + intuitive) therapy. Therefore, I strongly encourage you to continue your study of Chinese AP in depth. To get the best results, use the cookbook as the first-line of attack (in conditions amenable to AP) but be prepared to fall back on traditional and other methods if results do not follow quickly (Rogers 1984b). This assumes that the user is trained in basic AP and is able to interpret the point selections. When using the prescriptions given in this paper, please note (a) the number of references in the prescriptions, (b) the maximum possible score, (c) the score of each point in the list (calculated by ratio to the maximum possible score), and (d) the variation in scores between points. If there are few references, the prescription may be of doubtful value. If the maximum possible score is (say) .90 and the max. score for any point is (say) less than .40, the prescription may be doubtful. If there is little variation between the scores and all scores are greater than .40, various combinations of points should be equally effective. Remember that the best prescriptions usually combine AhShi points, LOCAL points, DISTANT points and (if internal organs are involved) Mu + Shu + Yuan + Luo combinations. Thus, the wheel turns full circle. The traditional methods of point selection were best after all. Modern technology has merely re-invented the wheel ! REFERENCES Greiff, Walter; Janssens, Luc; Kothbauer, Oswald (1970-1983). Verification of AP point locations in nimals by electrical methods and by experimental and/or clinical results. Kothbauer, Oswald ( 1983). Veterinary AP - Ox, Swine and Horse. Verlag Welsermuhl, Wels, Austria, 334 pp. Krueger, C. (1976). AP point topography in the horse. Am. J. Acup. 4, 276-. Molinier, F. ( 1983). Localisation of veterinary AP points. Rev. d'Acup. Vet. (Paris), No. 17 (4), 6-. Rogers, P.A.M. (1982a). The study of AP: Sources and study techniques IVAS Annual Congress, Cincinnati, Ohio (33pp + appendix).

Rogers, P.A.M. (1982b). The study of AP: Points and Channels in animals. Ibid. (23 pp). Rogers, P.A.M. (1982c). The choice of points for AP therapy. Ibid. (26 pp). Rogers, P.A.M. (1984a). Computer applications in the study and clinical use of AP. IVAS Annual Congress, Austin, Texas, 13 pp. Rogers, P.A.M. (1984b). Traditional versus cookbook AP. Ibid. 40 pp. Westermayer, E. (1981). Channels and ancient points, especially in cattle. IVAS Annual Congress, Cincinnati, Ohio, 21 pp. Yu Chuan & Hwang Yann-Ching (1990) Handbook on Chinese Veterinary AP and Moxibustion. FAO Regional Office for Asia and the Pacific, Bangkok, 193pp. ABSTRACT Backpain is only a sign or symptom. It may be primary, secondary, or as part of a generalised disorder. In practice, it may be difficult to make a specific diagnosis of the cause of human backpain, unless X-ray, myelography and other tests are carried out routinely. The practitioner may be satisfied with clinical remission. In hospitalised patients, AP is successful in treating post-operative pain and complications. It can be successful also in backpain which has not responded to surgery. AP therapy is by stimulation of relevant reflex points in the skin and muscles. Points of tenderness to palpation are important. They are the AhShi or TRIGGER points (TPs). Stimulation is given to the TPs, paravertebral (Shu) points, and points related to specific areas, organs or functions, e.g.local and distant points on Channels through affected area. Data from over 66 textbooks and clinical articles were stored on a Hewlett Packard Minicomputer. Frequency-ranked prescriptions for >1100 clinical headings were generated from the database. Some of those, of relevance to backpain (primary and secondary), were analyzed. Pain of central origin is not included. The "Top Twenty" points for selected body regions/organs related to the neck and back are given. Points for certain common signs/symptoms (thoracalgia, lumbalgia, sciatica etc) are given. Appendix 1 comments on the use of the point index and its structure. It lists the codes and names of all the points. The points for regions and signs are in Appendices 2 and 3. Examples of methods of point selection for simple and more complex conditions (syndromes) are given. Advantages and disadvantages of "Cookbook AP" are discussed in relation to traditional AP concepts. The following combinations are useful guides to pain control: Neck: TPs, GB20,21,39, GV14, LI04,11, BL10, SI03,15, ST38 (or GB34) Thoracic back: TPs, GV09,12,13,14, X 35, BL40,60 Lowback/leg: TPs, GV04, BL23,25,31,37,40,60, GB30,34.

Other methods of point selection (Earpoints, Newpoints, Handpoints etc) must be regarded as experimental at this time. INTRODUCTION Traditionally-trained acupuncturists generally scorn the idea of Cookbook acupuncture (AP), although they often use their own formulae (poor cookbooks! ). They would be horrified at the idea of computerising AP. They claim that the free availability of prescriptions do AP a disservice, allowing it to fall into the hands of untrained, unqualified people. I do not accept this. There is one medicine. The best people to practice AP would be those trained in conventional medicine as well as AP. TP therapy (see below), even without any knowledge of AP, may give 60-70% clinical success. If one adds classical AP points, the success rate can increase by 10-20%. The use of TP therapy brings more professionals into the active AP field than any other arguments or demonstrations. Storage of data on computer makes its analysis and retrieval very easy. Databases can be updated and re-analyzed periodically. Computers do not forget (assuming that files are copied and backed up every time they are updated). Advantages and disadvantages of computer-generated prescriptions are discussed in detail elsewhere (Rogers 1984 a,b). Backpain may be primary (paravertebral muscle pain, thoracolumbar disc disease, vertebral, sacroiliac or arthrotic), secondary (referred from irritation of thoracic or abdominal organs), or as part of a generalised disorder. This paper deals with the selection of points for human backpain, using Cookbook methods, based on computer analysis of textbook and other data. If other symptoms or organs are involved, the selection of points must take these into consideration. It has taken me more than 11 years to set up the database. I ask each of you to treat the material as copyright, not for commercial publication in text, computerised, microfiche form. You are welcome to use it for your own professional purposes and to give it to colleagues, if they agree to respect the copyright. THE BASICS OF AP The alphanumeric code and name of each point is shown in Appendix 1. As there is no internationally agreed coding system, you should check my codes (Appendix 1) with the codes which you use, to prevent confusion and error. In human AP, the paravertebral Shu (reflex points for all major thoracic and abdominal organs) are located on the inner line of the bladder (BL) Channel as follows: Lung (LU), Pericardium (PC), Heart (HT), Governor Vessel (GV), Diaphragm = BL13-17, in area T3-T7 respectively; Liver (LV), Gallbladder (GB), Spleen-pancreas (SP), Stomach (ST) =BL18-21, in area T9-T12 respectively; Triple Heater (TH), Kidney (KI), CHIHAISHU, Large Intestine (LI), KUANYUANSHU = BL22-26, in area L1-L5 respectively; Small intestine (SI), Bladder (BL), CHUNGLUSHU, PAIHUANSHU = BL27-30, in area S1-S4 respectively. These points have diagnostic value (when tender). They help to identify the affected organ. They also have therapeutic value in treating the affected organ and local problems near the points. However, local muscle strain or trauma can also cause Shu point tenderness. Thus, Shu point tenderness need not always indicate disorders of the related organs. Points on the outer line of paravertebral BL points (BL41-54) have similar functions

to the related points on the inner line. Irritation of the thoracic or abdominal organs can refer pain to related skin and muscle segments, especially in the paravertebral area. This can establish TPs, as detailed by Travell and Simons (1984) and in the TP Therapy Symposium (1981). Long after the visceral pain has gone, the TPs can remain active. Unless TPs in the thoracosacral muscles are "removed" by AP or other physiotherapy, the function of the back muscles is impaired and performance is impaired. In human AP, the AhShi point is defined as a point, usually in muscle, which is tender on palpation. AhShi means Ouch! or Ah Yes! There are two kinds of AhShi points: those from which palpation elicits only local tenderness and those which radiate pain to the problem area (the area in which the patient complains of pain). The latter type is the true TP of western medicine. It is the most important point in AP therapy and the patient may unaware of TP tenderness until the point is pressed. TPs may occur almost anywhere in muscle. Scars may also act as TPs. TPs in the paravertebral area often correspond with organ Shu points. For example, in coronary disease, patients may have TPs in the area T3-T6. Patients with kidney or ovary problems may be touchy in the area L1-L3 (BL22-24). The reflex point for the ovary and kidney is BL23. REFERRED PAIN: Pelvic limb lameness is often due to pain referred from thoracolumbar or lumbosacral nerves, as in sciatica. It may arise also in pain referred from abdominal viscera, such as in a painful kidney, ovary, uterus or colon. Thoracic limb lameness may arise in pain referred from cervical or upper thoracic nerves or from pain in thoracic organs (lung, pericardium, heart). Thus, neck- and back-pain often manifest as pain in the thoracic- or pelvic- limb. ASSESSMENT OF PATIENTS BEFORE TREATMENT A complete history is taken, together with any findings of previous investigations. In the clinical examination, attention is paid to any lesions or signs related to all major systems or functions. One tries to identify the primary problem(s) and the location(s) of pain. It is essential to probe or palpate the muscles from head to toe, to locate any TPs. Particular attention is paid to the paravertebral muscles and the large muscles of the neck and limbs. The joints and tendons are also palpated. Patients with signs of pain, stiffness or lameness are seldom free of TPs. Their detection is indicated by an expletives or groans or "Ah Yes! " when they are palpated. Always check for diagonal relationships. Cain stresses that fore-lameness is often accompanied by tenderness at contralateral lumbosacral or hind-limb points in the horse. Also, hind-lameness is sometimes associated with TPs on the contralateral side of the neck. Be careful to check the paravertebral Shu points in relation to the location of limb pathology, for example BL25 (L4-5, large intestine Shu) in radial forearm pain and BL21 (behind last rib, stomach Shu) in anterolateral pain in the pelvic limb etc. In all local problems (neck, shoulder, elbow, back, thoracolumbar, lumbosacral, hip, knee etc), the TPs must be found. They are recorded and marked as they are located. This helps rapid reassessment of the case on later visits. It also makes it easy for the patient to locate them for massage or other physiotherapy (ultrasound, LASER etc) between AP sessions. DATABASE OR COOKBOOK AP

AP points listed under various symptoms, body parts etc were stored on file. Data under sections on point functions were also stored. The data base was sorted and duplicate entries from specific sources were eliminated. Points were scored by a weighted citation frequency method. Prescriptions were generated for each part and symptom and were output with the highest-scoring points first and the lowest-scoring last. The larger the database, the more points are filed under any given region, symptom or condition. However, the first 6-10 points listed (in order of descending citation score) are the most important for routine use. For example, in the most recent summary of the database, 401 points were listed from a base of 44 texts for the treatment of sequelae (hemiplegia, paralysis) of CVA or polio. The Top Ten points were: Ranking Point Score

1

2

3

4

5

6

7

8

9

10

LI04 LI11 ST36 GB34 ST06 GB30 ST04 LI15 TH05 GB39 .86

.79

.77

.74

.73

.72

.68

.66

.62

.62

The Maximum score possible was .964. The bottom 10 points were: Ranking Point Score

392

393

394

395

396

397

398

399

400

401

CV13 CV17 BL65 LI01 ST23 BL07 KI20 GB06 GB43 LV06 .02

.02

.02

.02

.02

.02

.02

.02

.02

.02

The scores have been rounded up or down to the second decimal place. Clearly, the first list would be expected to give better therapeutic results than the second list above. However, selection of the Top Ten points in the above list would not necessarily be the best selection for a CVA sequel which was primarily mutism or aphasia. For such cases, the top 10 points are: Ranking Point Score

1

2

3

4

5

6

7

8

9

10

CV23 GV15 HT05 LI04 Z 21 TH03 GB02 TH17 NZ32 SI19 .82

.72

.44

.37

.27

.23

.23

.21

.20

.18

(From a total of 71 possible points listed by 27 texts, maximum possible score was .952) The computer allows one to COMBINE data, to retrieve ALL points used for ALL conditions of (say) the "thoracic back" or "abdomen" etc. In this way, the entire database was summarised by amalgamation of data for major body areas, functions, subregions and combinations of similar conditions. Appendix 2 gives examples. Regional points, however, do not supplant the need to consider points for specific symptoms. For example, in the selection of points for FACIAL PARALYSIS (OPTIC NERVE), one could search under "Head", "Face", "Facial paralysis", "Facial paralysis, optic branch"(see below). Many of the points are common to all those headings, but the specific heading is probably the best source.

020000 HEAD, ITS ORGANS AND FUNCTIONS LI04 GB20 ST06 ST07 ST36 LI20 TH17 LI11 TH05 LV03 .946 .927 .896 .896 .852 .787 .-779 -.7-77 -.7-77 .-758 (54 references, 458 possible points, max possible score .963)

020-500 FACE, CHEEK (GENERAL POINTS FOR) LI04 ST06 ST04 ST07 ST02 LI20 BL02 GB14 TH-17 ST03 .860 .86-0 .780 -.780 .595 .581 .547 -.532 .513 .487 -(49 references, 198 possible points, max possible score .963)

020507 FACE: NUMB

FACIAL N.

PARALYSIS;

BELL'S PALSY;

FACIAL HEMIPLEGIA;

ST06 ST04 LI04 ST07 TH17 ST02 LI20 GB14 SI18 ST03 .886 .829 .803 -.717 .606 .586 .-529 .529 .4-43 .414(36 references, 111 possible points, max possible score .972)

020508 FACE:

FACIAL N.

PARALYSIS;

BELL'S PALSY, UPPER (OPTIC) BRANCH

LI04 LI20 ST04 ST07 ST06 TH17 GB14 SI18 BL02 Z 09 .664 .664 .588 .580 .504 .504 .504 -.420 .336 -.24-4 (12 references, 46 possible points, max possible score .992)

020509 FACE:

FACIAL N.PARALYS-IS;

BELL'S PALSY, MIDDLE (MAXILLARY) BRANCH

ST04 ST06 CV24 ST07 ST03 GV26 SI18 LI04 LI20 Z 09 .645 .645 .526 .513 .395 .355 .263 .250 .250 .250 ( 8 references, 24 possible points, max possible score .950)

020510 FACE: BRANCH

FACIAL N.

PARALYSIS;

BELL'S PALSY, LOWER (MANDIBULAR)

ST06 CV24 LI04 ST04 ST07 ST03 ST05 TH17 ST18 LI02 .743 .527 .500 .365 .338 .257 .216 .203 .135 .122 ( 8 references, 25 possible points, max possible score .925)

The CVA (aphasia) and Head (optic area paralysis) examples show the necessity of specific (as well as general) searches of the database. Where it is possible, one should search the database for general region (neck area, thoracic back, lumbar area etc), specific region (shoulder, hip, knee, etc), specific nerve (where applicable, e.g. radial, sciatic). Where specific symptoms are marked, they should be searched (e.g. insomnia, dysmenorrhoea, polyuria etc). The data base covers >1100 headings. Only a few are given here, mainly relating to neck, back, associated parts and common symptoms. Appendix 2 covers the parts and Appendix 3 the symptoms. The data base has 452 headings under abdomen/functions/organs/symptoms. The major headings are listed below. 06---- ABDOMEN AND BACK, ITS ORGANS AND FUNCTIONS 0601-- ABDOMEN GENERAL 060101 ABDOMEN:

GENERAL POINTS FOR ABDOMEN AREA AND ORGANS

060102 ABDOMEN:

APA FOR SURGERY OF ABDOMEN AREA AND ORGANS

0602-- THORACOLUMBAR SPINE AND AREA 060201 BACK, POSTERIOR TRUNK: 060202 THORACOLUMBAR:

GENERAL POINTS

(AREA, SPINE AND SPINAL CORD) GENERAL POINTS

0603-- LIVER (INFLAMMATION, CALCULI, JAUNDICE, ACETONAEMIA ETC) 060301 LIVER:

GENERAL POINTS

060302 LIVER:

HEPATITIS;

PAIN

0604-- SPLEEN 060401 SPLEEN:

GENERAL POINTS

060402 SPLEEN:

(AREA) APA FOR SURGERY OF

0605-- GASTROINTESTINAL TRACT:

GENERAL SYMPTOMS

060501 STOMACH, INTESTINE AND GASTROINTESTINAL FUNCTION: 060502 MALABSORPTION:

WEIGHT LOSS**XS;

0606-- STOMACH AND DUODENUM

EMACIATION etc

GENERAL POINTS

060601 STOMACH:

GENERAL POINTS

060602 STOMACH:

(AREA) APA FOR SURGERY OF

0607-- SMALL INTESTINE, APPENDIX, CAECUM, COLON, RECTUM 060701 INTESTINE:

GENERAL POINTS

060702 INTESTINE:

OBSTRUCTION;

P-AIN;

VOLVULUS;

PAIN##ADHESIONS

0608-- UROGENITAL (GENERAL CONDITI-ONS) 060801 URINARY-GENITAL FUNCTION:

GENERAL POINTS

060802 URINARY-GENITAL FUNCTION:

PAIN OR PAIN REFERRED FROM

0609-- URINARY TRACT AND FUNCTIONS 060901 URINARY TRACT:

GENERAL POINTS FOR URINARY TRACT FUNCTION

060902 URINARY TRACT:

(AREA) APA FOR SURGERY OF

0610-- GENITALIA FEMALE AND REPRODUCTION 061001 GENITAL-IA, FEMALE:

GENERAL POINTS

061002 GENITALIA, FEMALE & MALE: etc

PAIN;

NEUR-ALGIA;

SENSATION**BURNING

0611-- PREGNANCY 061101 PREGNANCY:

FORBIDDEN POINTS;

MAY INDUCE MISCARRIAGE

061102 PREGNANCY:

MORNING SICKNESS;

NAUSEA;

VOMITING;

FAINT

0612-- MAMMARY FEMALE 061201 BREAST, MAMMARY GLAND, NIPPLE: 061202 MAMMARY GLAND, NIPPLE:

GENERAL POINTS

APA FOR MASTECTOMY OR COSMETIC SURGERY

0613-- MENSTRUAL CYCLE, CONTRACEPTION 061301 REPRODUCTIVE FUNCTION & GENITALIA (FEMALE): tc 061302 MENSTRUATION:

PSYCHOGENIC UPSETS DUE TO;

MENSTRUAL DISORDE-RS ePREMENSTRUAL SYNDROME

0614-- REPRODUCTION MALE (IMPOTENCE, SPERMATORRHOEA ETC ) 061401 REPRODUCT-IVE FUNCTION & GENITALIA (MALE): 061402 ERECTION:

POOR OR ABSENT;

IMPOTENCE;

GENITAL PROBLEMS etc

PREMATURE EJACULATION etc

0615-- GENITALIA MALE 061501 GENITALIA, MALE: 061502 GENITALIA:

(REPRODUCTIVE FUNCTION) GENERAL POINTS

(AREA) APA FOR SURGERY OF

CHOICE OF POINTS IN AP THERAPY The points for treatment depend on the organs and parts involved. In classical AP, there are many Laws or guides to the choice of points. An examination of most of the listings in Appendices 2 and 3 shows that the Top Ten points obey the basic laws of choosing AP points. In summary, these laws suggest a choice of points from: a. AhShi points (including Trigger Points, tender scars, fibrositic nodules etc) b. Local points (which also meet condition (d)). c. Distant points on the Channel through the affected area or on the Channel of the affected organ. A chain of points on the affected Channel is said to be specially powerful. d. Points on the affected nerve, the nerve supply related to the affected organ or area, or in the same or a nearby spinal nerve segment. e. Encircling the problem area; "Fore and Aft" points; combination of Yin side and Yang side points (medial/lateral; anterior/posterior). f. Combination of Mu and Shu (Front Alarm + Back Association) points. g. Combination of affected Yuan and Luo of Mate (Source Point of the affected Channel plus Passage point of its Phase-Mate Channel (LU-LI; ST-SP; HT-SI; BL-KI; PC-TH; GB-LV). h. Xi-Cleft point of affected Channel. i. One or more of the Five Phase Points (Energetic balancing points). j. Symptomatic points (traditionally known to have marked effect for the specific symptoms, for example, GV26 in shock, emergencies; PC06 in nausea or vomiting). k. Extra-Channel points ("New" or "Strange" points, points not on the Main Channels), especially those effective for the condition, e.g. NX04 (TingChuan) in asthma.

l. Points on the Phase-Mate of the affected Channel (e.g.) ST points in spleen diseases; SP points in stomach diseases. m. TianYing point (OT02, centre of the goitre etc). n. One point on each of the 4 limbs (e.g. LI04 and ST44, both bilateral, in tonsillitis or toothache). Let us examine the top ten points for some of the prescriptions in the database (Appendices 2 and 3) in detail, under 3 categories: 1. Local areas or regions 2. Conditions of specific organs or their functions 3. Generalised conditions and complex syndromes. In each of the following prescriptions, codes (a)-(n) above are used to show the Laws observed by the "Top Ten" points in the database. 1. LOCAL AREAS OR REGIONS (Examples from Appendix 2). NECK: GB20 (b); GV14 (b); LI04 (c, g, i); BL10 (b); SI03 (c, i, j); LI11 (c, i, j); OT01 (TP, a); GB21 (b, c, depending on site of pain); GB39 (c, j); SI15 (b). Combination GB20,21, BL10, GV14, SI15 also meets Law (e). 5/10 of the points are LOCAL. SHOULDER AREA: LI15 (b, j); LI11 (c, i, j); TH14 (b, j); SI11 (b); SI09 (b); LI04 (e.g.j); OT01 (TP, a); SI10 (b); OT05 (Local points, b); BL11 (d, j). Combination of SI09, LI15 and a New Point 1" above the anterior axillary crease is known as the "Shoulder Triplet" (e). That is a powerful combination in shoulder pain. 6/10 points are LOCAL. ELBOW: LI11 (b, i, j); TH05 (c, j); LI04 (c, g, i); HT03 (b, i); LU05 (b, i); LI10 (b); OT01 (TP, a); LI12 (b); TH10 (b); SI07 (c). 6/10 points are LOCAL. THORACIC SPINE, BACK AREA: GV14 (b); BL40 (c); OT01 (TP, a); GV12 (b); OT05 (Local points, b); GV13 (b); X 35 (b, k); GV09 (b); BL60 (c); OT06 (c). 6/10 points are LOCAL. DORSOLUMBAR SPINE AND AREA: BL40 (c, j); BL23 (b, j); X 35 (b); BL60 (c); OT01 (TP, a); BL37 (c); GB30 (c- via BL link); GV14 (b, c); OT05 (Local points, b); OT06 (c). 4/10 points are LOCAL (2 out of the first 3). LOWBACK: BL23 (b, j); BL40 (c, i, j); GB30 (c- linked to lowback via BL Channel, d, j); BL60 (c, i, j); GB34 (c- via BL link-, i, j); BL25(b); BL37 (c); GV04 (b); BL57 (c); BL31 (b). 4/10 points are LOCAL. COCCYGEAL AREA: BL34 (b); BL40 (c, j); SI06 (g, j); BL30 (b); OT01 (TP, a); BL37 (b); X 35 (b, k); OT05 (Local points, b); OT06 (c); BL35 (b). 6/10 points are LOCAL.

HIP: GB30 (b, j); GB34 (c, i, j); GB29 (b); GB31 (c); BL40 (c- via GB30 link-, i, j); BL60 (c, i, j); OT01 (TP, a); GB39 (c, i, j); ST36 (d, i); LV08 (g). Although only 2/10 points are LOCAL, 2 of the top 3 are LOCAL. THIGH, FEMUR: GB30 (b, j); GB31(b); GB34 (c, j); LV08 (c); ST36 (c); BL23 (j); LV11 (b); BL40 (b, c); BL37 (b); SP06 (c, l). 5/10 points are LOCAL. KNEE AND POPLITEAL AREA: GB34 (b, i, j); BL40 (b, i, j); L 16 (b, k); ST35 (b); SP09 (b); ST36 (b, c, i); ST34 (b); LV08 (c); OT01 (TP, a). 9/10 points are LOCAL. The first 5 points are the most commonly used and obey Law (e). In most local problems (joint, muscle, superficial organ etc), as in the 10 examples above, the best prescription combines TPs plus LOCAL points plus DISTANT points on the affected or related Channel. It is important to check the location as regards the nerve supply and the Channel. The best points for the anterior of the shoulder may not be the best ones for the posterior of the shoulder. Furthermore, some local points are more often recommended than others. 2. CONDITIONS OF SPECIFIC ORGANS OR THEIR FUNCTIONS (Examples from Appendix 2). PLEURA: 7/10 points (BL13,42,43,47, KI22,23, GB32) are on the thorax or dorsal/paravertebral area (e.g. are LOCAL points). Two of the other 3 (ST12, BL11) are at the thoracic inlet and one (GB44) obeys Law (c). HEART, PERICARDIUM: Only 3 of the top 10 (BL14,15, CV17) are over or near the organs. They obey Laws (b, d, e, f). Six more (PC04,05,06,07, HT05,07) are on the PC or HT Channel (Laws c, i, j). The 10th point (ST36) is a master point, with many functions, including effects on PC and HT. COUGH, GENERAL: 5 of the top 10 points (BL12,13, CV17,22, GV12) are over the thorax, trachea or dorsal paravertebral area. They obey Laws b, d, e, f, j. Three points (LU05,07,10) are on the LU (lung) Channel (Laws c, i). The last two points (ST40, GV14) obey Laws c, i. LIVER PROBLEMS: 6/10 points (BL18,19,20,48, GV09 LV13) are over or near the liver. They obey Laws b, d, e, f, j. The other four (LV03, ST36, GB34, SP06) are master points. They obey Laws c, g, i, j. FEMALE GENITALIA/REPRODUCTION: 6/10 points (CV03,04,06, GV04, GB26, BL32) are in the lumbosacral innervation area (low abdominal or lumbosacral paravertebral area). They obey Laws b, d, e, j. The other 4 points (SP06,10, LV03, ST36) are master points, with major effects on the low abdomen and its functions. They obey Laws c, i, j. In disease of internal organs, the most important points lie near the organ. The paravertebral points (Shu and X 35), local GV points, the abdominal Mu points and local CV points are the most important. If the organ has a named Channel (LU, LI, ST, SP, HT, SI, BL, KI, PC, GB, LV), one or more local and distant points on that Channel are included. In genital and lower abdominal conditions, distant points on LV, KI, SP Channels can be added, as these Channels pass the inner thighs and the groin area.

If the organ or function has no named Channel, points can be chosen from combinations relating to the nearest Organs/Channels. For example, if there were no data for Thymus, Appendix, Oesophagus, Adrenal etc, one could construct combinations of points: Thymus, oesophagus: points for heart, lungs, stomach (nearest organs) and immunity (a thymus-related function). Appendix: points for lower right abdomen, large intestine, immunity. Ovary, tubes, uterus: points for kidney, bladder, low abdomen, large intestine etc. Vagina, vulva, scrotum, testicles, penis: points for low belly. Also, the 3 YIN Channels of the feet (SP, KI, LV) pass near the groin- use distant points on them. 3. GENERALISED CONDITIONS AND COMPLEX SYNDROMES Generalised conditions include metabolic, hormonal, toxic, autonomic upsets (as in gout, diabetes, food poisoning, shock, neurasthenia etc). Although one symptom may be dominant, it is usual for a number of signs or symptoms to occur together. For example, in gout, the presenting symptom may by PAIN IN THE BIG TOE, but on examination, liver enlargement, headaches, irritability, blurred vision, tiredness etc may be present also. The comprehensive treatment would entail advice on diet (possibly involving food allergy/intolerance tests), alcohol and fluid intake. AP would be aimed at the more severe symptom (say toe pain) but the prescription should also help the other symptoms.The LIVER is central in gout and many allergies. Treating LV and GB points (LV03,14, GB34, BL18,19, GB14,20) would help ALL the symptoms. Neurasthenic patients often complain of backache. Their symptoms may include depression, headache, generalised aches and pains, insomnia, weakness etc. The PC and HT Channels control the spirit, in Chinese belief. Symptoms of neurasthenia can be helped by LOCAL points plus PC/HT points (HT07, PC06, BL14,15) and general points like ST36, LV03, LI04. In treating complex cases, choose point combinations which influence all the major symptoms and the affected organs. If symptoms or signs can be traced to a Channel function, treat that Organ/Channel. In complex cases other methods (conventional medicine, homoeopathy etc) may be needed also. Analysis of the entire database for all parts and functions shows that certain points are very commonly cited. They are: LI04,11, ST25,36, SP06, HT07, BL23,40, PC06, TH05, GB20,34, LV03, CV06,12, GV04,12,14,26. These are Master Points in traditional AP. In complex cases, if one has difficulty in selecting points, it may help to include a few points from the master list. Example of syndrome related to scar tissue/Channel block Beginning 2 years after right pulmonectomy, the following symptoms occurred intermittently, or in combinations, over a 6-year period:

recurrent haemorrhagic nephritis and cystitis (BL, KI) right-sided sciatica (BL) right-sided paravertebral pain (C6-T4) (BL) right-sided headache (BL) right-sided bouts of acute conjunctivitis (BL) right-ear tinnitus (SI) waking up at night with right arm in spasm and severe pain along SI Channel to the 5th finger (SI) Cookbook prescriptions would have been as futile as western medicine in that case. All symptoms related to BL Channel or the Channels upstream (SI) or downstream (KI) from BL in the Channel circuit. All were right-sided, except (possibly) the nephritis/cystitis. There was an obvious connection. The thoracotomy scar was badly twisted, with adhesions on the right BL line. Blockage of "Channel energy" flow in the BL channel could be related to the signs. In western terms, reflex irritation effects could be involved. Treatment was procaine injection of the adhesed part of the scar plus a few sessions of AP on BL points, plus physiotherapy. All symptoms were successfully cleared and did not recur. Cookbooks have their limitations! But cookbook recipes must include TP- (and scar-) therapy. POSTOPERATIVE PAIN Janssens (see Rogers 1987) reported that AP has controlled pain in dogs which did not respond to surgery for disc disease. He has also used AP successfully to control pain and other complications arising after abdominal and other surgery. Papers by Russian workers, in press to Scandinavian J. Acup., confirm that AP has similar effects in humans. Points used in post-operative pain/complications are chosen by the same principles as any other AP point combinations. In addition, one may run long needles subcutaneously, parallel to the wound. CONCLUSIONS In practice, it is difficult to make a specific diagnosis of the cause of backpain, due to the difficulty of routine X-ray, myelography and other tests. Many patients presenting with backpain also have other signs or symptoms. One aims to help the patient towards selfhealing, not to "heal the backpain". The general practitioner may be satisfied with clinical remission. Palpation of the muscles, to locate TPs is an essential part of the clinical examination. The combination of TPs, GB20,21, GV14, BL10, SI15 covers most neck pain. LI04,11, SI03, ST38 (or GB34) are useful distant points.

The combination of TPs, GV09,12,13,14, X 35 covers most thoracic backpain. Local BL points can be used instead of GV points. BL40,60 are useful distant points. The combination of TPs, GV04, BL23,25,31, covers most backpain below the ribs, including radiating sciatic pain. BL37,40,60, GB30,34 are useful distant points. The most common combination of points is: all TPs, plus 1-2 LOCAL points (near the affected organ or part). If an organ is thought to be involved, its Shu point is used, whether tender or not. To this can be added the Mu (abdominal alarm) point. This includes the use of Shu points in superficial problems which may not have direct organic involvement. For example, BL13 and 25 (Shu points for the LU and LI Channels) as part of a prescription to help resolve pain of an inside-forearm pain (in the Channel area of LU and LI). Similarly, BL23,28 (Shu of KI and BL) would be indicated in Achilles/heel pain (Channel area of KI and BL). One or two DISTANT points on a Channel passing through or near the problem area, on the Channel of the affected organ, or a CHAIN of points along an affected Channel or nerve are also helpful. Many point combinations are possible. Points with special or general action may be considered. Useful points are: Neck GB34, LU07 Thoracic limb LI04,11,15, TH05,15, GB21 Spinal column BL16 Lumbosacral and pelvic limb BL21,23,40,60, GB30,34, ST36 Muscles, tendons TH15, GB34, BL19,20 Bones, joints BL11,23 General effects LI04, ST36, BL23 Immunostimulation LI04,11, GV14, ST36 Lung BL13,43 Liver BL18, GV09 Stomach, appetite BL21, ST36 Hind gut BL25,30 Adrenal, stress conditions, urogenital, bones BL23,52, GV04 There are other methods of point selection (Earpoints, Face points etc) but these methods are not as well documented as bodypoint AP. They must be regarded as experimental until adequate documentation and comparative clinical trials are available.

Meanwhile, the database method gives points very similar to those which traditional AP would suggest. The computer has merely re-invented the wheel. The use of other physiotherapies (massage, ultrasound, LASER etc) on the points (between sessions) helps to ensure high success rates. ACKNOWLEDGEMENTS I thank Dr. Pekka Pontinen, Tampere, Finland and the organisers of the Nordic Acupuncture Congress for financing my trip to the Congress. REFERENCES ANON (1974) The Barefoot Doctor's Manual. Running Press, Philadelphia. 948 pp. ANON (1975) Newest Illustrations of the AP points. (Charts and booklet). Medicine and Health Publishers, Hong Kong. ANON (1980) The Essentials of Chinese AP. College of Trad. Chin. Med., Beijing, Shanghai, Nanking. Foreign Languages Press, Beijing. 422 pp. Reissued 1993: Essentials of Chinese AP. (Coll. TCM, Beijing, Shanghai, Nanking) Foreign Languages Press, Beijing 432pp. CHUNG, C. (1983) The Ah Shih Point. Chen Kwan Books, 5-2 1-F Chung Ching South Road, Section 3, Taipei, Taiwan, R.O.C. 212 pp. PONTINEN, P. (1982) AP Seminar for Swedish Physicians. Contact AP and Pain Research Dept., University of Tampere, Finland. ROGERS, P.A.M. (1984a) Computer applications in the study and clinical use of AP. IVAS Annual Congress, Austin, Texas. 13pp. ROGERS, P.A.M. (1984b) Traditional versus Cookbook AP. Ibid 40 pp. ROGERS, P.A.M. (1987) Treatment of backpain in the horse and dog by AP. Nordic Acupuncture Congress, Oslo, Norway, September 1987. TRAVELL, J.G. & SIMONS, D.G. (1984) Myofascial pain & dysfunction: the TP manual. Part 1. Williams & Wilkins, London & Baltimore, 713pp. TRIGGER POINT THERAPY: Symposium on myofascial TPs (1981) Arch. Rehabilitation Med., March, 97-117; Dorrigo et al (1979) Pain, 6, 183-; Kajdos (1974) Amer. J. Acup., 2, 113-.; Kellgren (1939-42) Clinical Sci., 4, 35-; Khoe (1979) Amer. J. Acup., 7, 15-; Lewit (1979) Pain, 6, 83-.; Melzack et al (1977) Pain, 3, 3-.; Macdonald (1983) Annals of Royal Coll. Surg. Eng., 65, 44-,; Rogers, C. (1982) Amer. J. Acup., 10, 201-. COPYRIGHT Philip A.M. Rogers MRCVS

These prescriptions are published as a micro-computer software package. They may not be published or used for commercial purposes without written permission from the author !! However, colleagues are most welcome to use them for their own clinical or research purposes.

Point convention used in the computer outputs : The Channel Points are coded as follows: LU=Lung; LI=Large Intestine; ST=Stomach; SP=Spleen-Pancreas; HT=heart; SI=Small Intestine; BL=Bladder; KI=Kidney; PC=Heart Constrictor, Pericardium, Circulation-Sex; TH=Tri-Heater; GB=GallBladder; LV=Liver; CV=Conception Vessel (Ren Mo) ; GV=Governor Vessel (Du Mo). In this system, the second branch of the BL Channel has BL41 (FuFen) at the T2/scapular area and BL40 (WeiZhong) at the popliteal crease, as in the "Essentials of Chinese AP" 1993 (Coll. TCM, Beijing, Shanghai, Nanking) Foreign Languages Press, Beijing 432pp. The ST Channel has ST01 (ChengChi) infraorbital and ST08 (TouWei) on the meeting of the vertical and the horizontal hairline on the forehead.

Channel Code LU LI ST SP HT SI BL KI PC TH GB LV CV GV no. of points 11 20 45 21 9 19 67 27 9 23 44 14 24 28

The New, Strange & Hand Points are ordered as in the "Newest Illustrations of the AP points" (Med. & Health Publishers, Hongkong, 1973) :

NZ=New Head & Neck; NY=New Abdomen; NX=New Loin & Back; NA=New Upper Limb; NL=New Lower Limb;

Z =Strange Head & Neck; Y =Strange Thorax & Abdomen; X =Strange Loin & Back; A =Strange Upper Limb; L =Strange Lower Limb; H =Hand points.

New Points Strange Points Point code NZ NY NX NA NL Z Y X A L H no. of points 35 6 18 15 36 31 19 35 44 42 18

Category OT (Other) codes : 01=AhShi; 02=TianYing; 03=Segmental nerve; 04=Haemorrhoid point; 05=Local points for region; 06=Distant points for region; 07=points on Channel through area; 08=Periosteal AP; 09=Periincisional pts.; 10=Chieh Kou (Cut ends)

Trigger Points (categories TP, TQ, TR): Trigger Points are located as in "Myofascial Pain and Dysfunction" by Travell & Simons (Williams & Wilkins, Baltimore & London, 1983). Their coding is summarised in the index of point locations, which is appended.

Point code OT TP TQ TR no. of points 10 99 99 3

The total number of points (Channel, New, Strange etc plus Trigger Points) in the database is 871.

The 12 basic laws of selecting points: 1. Treat the main contradiction, adding 1-2 points for the more serious symptoms. 2. Points according to the innervation or in same dermatome as the problem area or function. (The paravertebral and HuaToChiaChi (X 35) points are especially important). 3. AhShi (tender) points (trigger, myalgic, fibrositic, motor, REPP points). 4. Local points or points locally on nearest Channels. 5. Distant points on Channels controlling problem area. 6. Combination of local & distant points or Yin and Yang points (e.g. the YUAN (Source) point of the problem part/organ/Channel and the LUO (Passage) point of its linked Channel). 7. Points "Fore & Aft", "Above & Below", "Left & Right", encircling the problem area. 8. Points well known for their symptomatic effects.

9. Back & Abdomen combination: SHU (BL Reflex) and MU (Front Alarm) or points near the SHU and MU. 10. The XI (Cleft) point of affected organ/Channel in acute diseases. 11. Scar therapy; improving electrical conductivity of scars and soft tissue injury by needling, injection, laser, physiotherapy etc. 12. The TianYing point - under the ulcer base, into the cyst etc.

!! Always seek the tender (trigger) points !!

Final selection of points from this index : 1. High scores with multiple authors indicate the most important points. If the first point listed has a score 80% successful at 4-5 weeks after commencement) as compared with 45-65% success by other acupuncturists using the same points but no tranquilliser. In the treatment of human narcotic addiction, electro-stimulation of Earpoint "Lung" or the mastoid processes has been very successful in detoxification without withdrawal symptoms, but detoxification requires 4-8 days before urine tests are "negative" for the drug. A new development (pioneered by H.L. Wen, Hong Kong) is to combine AP stimulation with repeated i/v injection of naloxone. This reduces the detoxification period to about 10 hours. (Naloxone displaces the drug very rapidly from the opiate receptors and AP prevents the withdrawal symptoms by stimulating the release of endorphin, which had been inhibited by the exogenous drug). DEVELOPMENT OF INTUITIVE DIAGNOSIS AND HEALING As I wrote the first version of this paper (1980), I was on holidays with my family in Fethard, a fishing village on the South East coast of Ireland. A 7-year-old boy was drowned in a large river a few miles away. The river is tidal and the drowning occurred while the tide was rising. Dozens of fishermen with nets, grappling hooks, fishing lines etc dragged the river for 5 days. They had the assistance of a diver also. The body was not recovered. A friend of the boy's father knew of my unorthodox interests. He asked if I could suggest a diviner who might locate the body. Next day, I brought the boy's father and his friend to Sgt. Neil Boyle, an instructor in the Garda Training School, Templemore. This man is one of the most famous diviners in Ireland. He does most of his divining in his own house by divining over a map! Within minutes of our arrival, and working over an accurate navigation chart of the river, the diviner got a reaction some 75 metres west of a fixed marker-buoy in the river. He said that the body would be found there. The boy's father then exclaimed that the boy's teacher had dreamed that the body was near there but the search party had not acted on this dream! The search was switched to that area at 1900h on Friday night but was disrupted 3 times by ships passing up the river. At about 2300h, one of the fishermen hooked a submerged object but lost it. Early next morning, the body was seen floating on the surface of the river within 10 metres of the mark as indicated on the map by a man about 120 km distant from the spot! The search was over. Was the diviner's mark a coincidence? Definitely not! This man has located dozens of missing persons, alive or dead, using this technique. He usually knows immediately if the missing person is dead. He has located them in lakes, rivers, the sea and on land. Development of intuitive diagnosis and healing was discussed in more detail elsewhere (7). Those of you who already have some ability in this area (or who may be interested) will find it very helpful to join groups or societies of professional colleagues (medical and vet) who discuss these topics. Discussions with colleagues who know this reality can accelerate your own growth in the area. AP is only one system! There are many others and combinations are possible.

One such group is the Scientific and Medical Network, c/o: David Lorimer, Lesser Halings, Tilehouse Lane, Denham, Uxbridge, Msex UB9 5DG, UK. (Fax: +44-1985835818; Email: Scientific and Medical Network @smnet.demon.co.uk, or, [email protected]) If one wishes to grow in skill as a healer, one must continue to study many different methods. Study must be a routine part of one's profession, despite the great difficulties that this poses to private practitioners (and their partners and families!). What to study? There is so much in orthodox literature that one could study specialist journals in one small area and never get to the end! I would urge you, however, to read some unorthodox concepts, such as those on osteopathy/chiropractic, homeopathy, food allergy, psychic phenomena, radiaesthesia. Even if you can not yet accept their scientific validity, you will find them highly entertaining! Some of you will know by "gut reaction" that their main claims are valid and you may be stimulated to continue this aspect of your study in greater depth. Special Interest Groups (SIGs) on Email and WWW: Those who want to explore the more esoteric aspects of the psyche in healing can subscribe to SIGs on Email Lists (such as CAM&VM, Holistic, INDHN etc; details on request), or visit specialist Home Pages on the Internet (WWW), such as AltMed, AltVetMed, Dowsing Pages etc. If one can improve one's intuitive or divining ability, it can be of great value in reaching a detailed and accurate diagnosis as to the causes and nature of the problem. This gift alone would be of great value. However, if one can also develop ones psychic (transmitting) healing power, the healer and the patient are doubly blessed. There are a few who have these gifts. If they are latent in you, please do not waste them. If (like me) you have mediocre talent in the intuitive/psychic field, don't worry! The more rational pragmatic methods may be slower in day-to-day use but they also give good results. FOSTERING PUBLIC AWARENESS OF AP TV and press coverage in recent years have informed most people that AP therapy and analgesia for human surgery have definite roles in medical science. However, few people know that AP is equally applicable in vet science. Research in humans and animals has shown that AP is a powerful physiotherapy which involves reflex effects, humoral and neuroendocrine effects (1,2,5,11). While vets are learning the system and trying to integrate it into their approach to animal diseases, they may not wish to enter into much discussion on the topic. Later, as they grow in experience, they should gradually let their clients know that AP is just one more modality in the fight against pain and illness. The mystique and magical image of AP, so often exaggerated in the public press, should be dispelled. In its place, the concept of reflex therapy (activation of the normal defence and healing systems of the body by the stimulation of reflex points) should be fostered. If used properly, AP is the most powerful form of physiotherapy. In incompetent hands, AP may give poor results and in the wrong hands, may spread viral diseases (AIDS, hepatitis etc in humans; swine fever etc in animals). Practitioners new to AP should replace the temptation to be over-enthusiastic with a more pragmatic approach ("let us try it in this case"). Over-enthusiasm can lead to great disappointment when failures occur.

AP, like every other attempt to fight disease, has its failures (2,15). It also can be a costly system in terms of professional time. With orthodox vet medicine, many cases can be treated by one or two visits, leaving appropriate medicines to the owner to administer when the vet has diagnosed the case. This is not applicable with AP therapy, unless the owner has a TENS instrument or Laser and is instructed in their use, or unless he/she is shown which points to massage between sessions. In chronic cases, AP therapy often requires repeated therapy sessions and these cost money. The owner should be warned of this, as some people expect miraculous cures after one or two sessions! In many western countries, physicians and vets, especially those in the academic life, have a strong scepticism towards AP. Some are definitely prejudiced against AP. This is largely due to lack of knowledge on the types of conditions which respond to AP and to the mechanisms involved. We should discuss these topics with our colleagues when suitable opportunities arise and we should be prepared to assist them in their search for factual data and research information, should they require this. It is very helpful to the practitioner and to those colleagues who may require clinical information to keep accurate records of all cases treated by AP. These records should contain details of the clinical examination, the diagnosis, the AP method and the APs used, any other medication used, the dates of treatment and the outcome of the case. If 20-40 vets in each country kept notes of their cases, very valuable information could be made available to their AP society as well as to their State Vet Schools after 1-2 years. I strongly urge you to organise such a study as a group. CONCLUSIONS Integration of AP into your practice will take time and patience. You will need to study AP well and to foster public awareness of its value and mechanisms. Explanation of AP mechanisms in terms of reflex action via the neuroendocrine system is more acceptable to academic colleagues than those based on theories of intangible, undefined Life Forces (Qi). In your early attempts at AP, it is advisable to choose just a few conditions which interest you. Learn the approach to these in depth before you attempt to treat new conditions. If you do not wish your clients and colleagues to know that you are attempting AP methods, you can adapt ultrasound, electrostimulation and laser therapy with little difficulty. You can also use point injection with good success. As you grow in experience, it will be better for you (and for the acceptance of AP as a valid system) if you let your clients and colleagues know that you are using the Chinese system. Integration of AP analgesia as a routine preparation for surgery is not likely to become popular in the West. However, it may be considered in high-risk patients, shock victims and Caesarian section. The analgesia and obstetric effects of lumbosacral points in bovine dystocia and bovine prolapsed uterus require no electro-stimulation and could become routine. A Chinese parable says: "What can a frog in a well know of the outside world?". There is a mighty universe around us! Can we see it all? Can we feel it, taste it , touch it and smell it all? Can we "weigh" (measure) the Energy of Life? I don't believe it! I believe that there are other ways of knowing reality. To grow in knowledge and skill requires study and practice. I urge

you to study unorthodox as well as orthodox concepts. In particular, I urge you to read on psychic methods of diagnosis and healing and to experiment with these systems together with your orthodox methods and other therapeutic systems. Therefore, I urge you to continue your studies, especially in areas of unorthodox concepts. Study and experiment with the area of psychic phenomena such as dowsing or divining in relation to healing. These methods are as applicable to animals as they are to humans. Some of you may possess ability in these areas. I believe that the best therapy will consist of a sound mechanical approach plus the extra benefits of the psychic approach. REFERENCES Further details of AP are in other lectures by the author. These and other manuscripts are based on material presented in 1980 to the teaching seminar at the Veterinary College in Helsinki, organised by Jukka Kuussaari. Most have been updated since 1990. AP is a highly integrated system whose concepts and philosophies are strange to Westerners at first. Thus, Western students of AP should read and re-read these concepts until they become familiar with them. The lectures, listed below, cover many traditional (classical) and modern (scientific) aspects of AP and related topics. This set of lectures will help students of AP to get the "feel" for subject. They complement lectures given at IVAS, BVAS and other organised training courses on AP. Vet or Medical colleagues are most welcome to use this material for study or teaching purposes but the author reserves copyright and does not wish others to use this material for commercial publications. All the papers starred (*) are in one publication (Acupuncture in Animals, Proc 167, 548 pp) available from The Postgraduate Committee in Veterinary Science, University of Sydney, 280 Pitt St., Sydney South, NSW, Australia 2000. Those not starred are available from the author: 1*. A brief History of AP and the Status of veterinary AP outside mainland China 2*. Effects of AP on the Defence Systems and conditions responsive to AP (1980) and AP for immune-mediated disorders (1991). 3*. The Study of AP: Points and Channels in Animals. 4*. The Study of AP: Sources and Study Techniques. 5*. Traditional versus modern AP. 6*. Holistic Concepts of Health and Disease. 7. Psychic methods of Diagnosis and Treatment in AP and Homeopathy 8*. The Theory of the Five Phases and its uses in medicine.

9*. The Choice of Points for AP Therapy (1980) and the Choice of AP Points for Particular Conditions (1984). 10*. Techniques of stimulation of the AP Points. 11*. AP analgesia for surgery in animals. 12*. Clinical AP in the horse (2 papers + appendix). 13*. AP in Cattle and Pigs. 14. AP in Small Animal Practice. 15*. Clinical Experiences with AP: Failures and Successes. 16. Physiotherapy, Homeopathy and AP in the Treatment and Prevention of Lameness and the Maintenance of peak Fitness in Horses 17*. Advances and instrumentation in the diagnosis and treatment of trigger points in human myofascial pain: veterinary implications 18. Treatment of Back Pain in the Horse and Dog by AP 19*. Computer Applications in the Study and clinical Use of AP 20*. Serious complications of AP... or AP abuses? 21. Clinical use of low level Laser therapy. QUESTIONS Channel codes used in these questions are: LU, LI, ST, SP, HT, SI, BL, KI, PC, TH, GB, LV, CV, GV. 1. One of the following statements is not correct. Indicate the incorrect statement: (a) Acupuncture (AP) is a reflex phenomenon with therapeutic value. (b) AP points (APs) and Channels (AP meridians) have many applications in routine veterinary practice. (c) AP has little or no diagnostic value. (d) Irritated organs/functions cause reflex changes in sensitivity to pressure, heat and electrical current at specific zones on the body surface (the APs). (e) Adequate stimuli (needling, injection etc) applied to the APs can influence the pathophysiology of the affected organs and functions. 2. One of the following statements is not correct. Indicate the incorrect statement:

(a) A 16-hour intensive crash-course is enough to allow you integrate AP fully into your dayto-day practice. (b) Point injection is the fastest AP method and gives good results. (c) The reflex (neurally-mediated) mechanisms of AP are easily shown by experimental chemical or surgical interference with neural transmission in the peripheral nerves, spinal cord or midbrain or by sympathectomy. (d) In its purest form, AP involves an holistic concept of the organism in relation to its internal and external environments. (e) TCM involves the manipulation of Vital Energies (Qi), some of which are only hinted at in occult or esoteric literature (the Aura, the Etheric body, Kundalini, Prana etc). 3. One of the following statements is not correct. Indicate the incorrect statement: (a) Each AP point has a Chinese name, an alpha-numeric code and an anatomical location. (b) The cun is half of distance between the nipples (c) TsuSanLi (FootThreeMiles, ST36) is 3 cun below the patella, 1.5 cun lateral to the tibial crest in adult humans. (d) Trigger Points (TPs) are always AhShi points AhShi points are not always TPs. (e) Many different nomenclatures are used for the APs. Novices should cross-check the nomenclature in each new reference with that in their standard reference text. 4. One of the following statements is not correct. Indicate the incorrect statement: (a) Laws of Choosing APs for therapy include: sensitive points; TianYing points; combination of Local and Distant points; points along affected and related Channels; Ear Points and APs not on the main Channels (b) Laws of Choosing APs for therapy include: symptomatic points; points along the affected nerve path; "Fore and Aft" points; points encircling the area; a point on each of the 4 limbs; Master Points (c) Master Points include Mu-Shu, Yuan-Luo and Xi points (d) The Mu-Shu is the Source-Passage combination and the Yuan-Luo is the AlarmAssociation combination (e) Point injection is the fastest and most practical method of AP 5. One of the following statements is not correct. Indicate the incorrect statement: (a) DeQi (Teh Ch'i, the Arrival of Qi) is the classical sensation of paraesthesia induced by needle manipulation in the correct points

(b) Where possible, to obtain DeQi, one should peck-twirl the needle for 10-15 seconds, at least after needle insertion and before withdrawal (c) Solutions suitable for injection-AP include 0.9% saline, 0.5% local anaesthetic solution in 0.9% saline, B12, Sarapin or homoeopathic solutions. (d) Injection-AP is ideal for cases in which need intramuscular injection of therapeutic agents (e) Strong stimulation of GV26 + KI01, in combination, can not resuscitate comatose cases refractory to orthodox therapy 6. One of the following statements is not correct. Indicate the incorrect statement: (a) Before AP-treatment of animals, the patient is searched for pain-points (points which are tender to palpation) (b) All pain-points should be marked or noted for future reference (c) It usually is possible to distinguish locally sensitive AhShi points from genuine TPs in animals (d) Prime indications for novice vet-AP therapy in Cattle are hormonal infertility, dystocia, and repositioning of uterine prolapse (d) Prime indications for novice vet-AP therapy in Small Animals are conjunctivitis, rhinitis and gastrointestinal disorders (f) Prime indications for novice vet-AP therapy in All Species are hip lameness; shoulder lameness; low-back syndrome; muscle cramp, soft tissue lameness; anaesthetic emergencies; nephritis, cystitis 7. One of the following statements is not correct. Indicate the incorrect statement: (a) Main APs for obstetrics/uterine reposition are: GV02,03,04, BL32,53, AhShi points at or near BL23,24,26,31,33,34,54 (b) Main APs for hormonal infertility are: YungChi (near BL26); AhShi points in the lumbosacral area (in the area BL23-34 and BL52-53) (c) Main APs for conjunctivitis/rhinitis in small animals are: LI04,20; BL01; GB01,20: ST01,02; LV03; TH23; Z 03,14; GV23,25. (d) Main APs for small animal indigestion are: PC01, ST45, CV01, BL07. (e) Main APs for small animal gastroenteritis, constipation and colic include TH06, BL25,27, CV04,06, ST25 8. One of the following statements is not correct. Indicate the incorrect statement:

(a) Main APs for hip lameness are: AhShi points in lumbosacral area, buttocks, hip, thigh and gastrocnemius muscles; GB30,31,34; BL23,40; LV08,11. (b) In hip dysplasia in dogs, gold-bead implants are excellent but simple needling gives no worthwhile results (c) Main APs for shoulder lameness are: AhShi points in the neck, upper limb and upper thoracic area; BL11; GB21; SI09-14, LI04,11,15,16; TH05,14,15 (d) Main APs for low-back syndrome are: AhShi points from the lumbosacral area to the hock; X 35 (HuaToJiaJi points) near vertebrae L1-S4; GV02,03,04; BL23,25,27,31,52,40,60; GB30,38 (e) Main APs for muscle cramp, soft tissue lameness are: AhShi points + main points for the affected regions. Treat acute cases every 3-7 days for up to 8 sessions. Expect results by the 3rd session in acute cases and by the 4th-5th session in chronic cases 9. One of the following statements is not correct. Indicate the incorrect statement: (a) GV26, the most important emergency point, is in the dorsal midline at the occipitoatlantal junction (b) KI01, another emergency point, is behind the hind toes, between the pad and toes in dogs and between the claws in cattle (c) In apnoea and respiratory arrest, strong stimulation of GV26 + KI01 for 10-60 seconds gives >90% response (d) Main APs for nephritis are: BL22,23,58; GV03,04; SP06,09; ST25; GB25; KI03 and for cystitis are: BL28,52,58; CV03,04; KI02,03; ST28. In both cases, add AhShi points in the lumbosacral and low abdominal area. (e) In cardiac arrest, strong stimulation of PC06 + GV26 + KI01 for 10 minutes gives >70% response 10. One of the following statements is not correct. Indicate the incorrect statement: (a) AP is clinically successful in >60% of chronic nephritis, with marked fibrosis (b) In nephritis, include symptomatic APs for major symptoms (vomiting etc) (c) The disadvantages of AP analgesia may prevent its use in routine surgery, except for patients with high anaesthetic risk, or in Caesarian sections on very valuable dams. (d) AP analgesia for surgery may need supplementary local anaesthesia in 10-30 % of cases (e) An indwelling i/v catheter should be placed before surgery is attempted under AP analgesia 11. One of the following statements is not correct. Indicate the incorrect statement:

(a) One may decide to combine AP with medical therapy, say in acute infections (b) In acute pneumonia with fever, diluted antibiotic solutions may be injected at APs for the lung (BL13; PC06; CV17; NX04; LU01 or 05 or 06) and at AP points for fever (GV14) and immune response (LI04 or 11; ST36) (c) Until well advanced in one's AP study, novices should use AP combined with other therapy in serious cases (d) Drugs which may reduce the effects of AP include: large doses of analgesics, corticosteroids, narcotics, methadone, opiate antagonists, alcohol, tranquillizers and sedatives. (e) High-dose steroid therapy should be terminated abruptly 2 days before AP therapy 12. One of the following statements is not correct. Indicate the incorrect statement: (a) It may be necessary to administer sedatives or tranquillizers to facilitate AP, for example in difficult patients (such as cats, vicious dogs or horses) (b) The alpha-2 agonist, detomidine or medetomidine, is said to enhance AP effects in horses and dogs. (c) Administration of D-phenylalanine for some days before AP analgesia in humans abolishes the analgesic effect of AP and turns "responders" into "non-responders" (d) In AP analgesia, intravenous sedatives (diazepam etc) can be very useful supplementary drugs (e) Use of AP analgesia for surgery greatly reduces the doses of general anaesthetic needed

1=c 2=a 3=b 4=d 5=e 6=c 7=d 8=b 9=e 10=a 11=e 12=c

THE TAIWAN REPORT SUMMARY Section 1 summarises the trip schedule between November 13-28th, 1982. Section 2 summarises the present status of Chinese medicine in Taiwan. Acupuncture (AP) is only one part of Chinese medicine, which also includes "Western" medicine, moxibustion and herbal medicine. AP and allied techniques, as seen there, are discussed under various headings: simple needling versus electro-AP, the use of AhShi ("Ah Yes!", sensitive) points, myofascial syndromes and AhShi points, Earpoints, Local points, Distant points, methods of needling, quick needling of AhShi points, the DeQi (Teh Ch'i) phenomenon, personal experience of "needle sensations", moxibustion, cupping, AP in paralysis/paraplegia. Scar therapy was not seen during this trip. It is discussed in the hope that it may stimulate interest in this valuable therapy. Section 3 discusses 49 of the clinical cases observed at the Veterans' General Hospital, Taipei (VGH) and China Medical College, Taichung (CMC). Many other cases were observed, but details were not noted. Most of the cases presented for treatment involved pain syndromes but I was assured that many syndromes other than pain are also treated successfully. The great majority (69%) were helped markedly or moderately by AP in 1-20 minutes. Cases are discussed under: multiple aches and pains, tension, insomnia, neurasthenia, pain following traumatic injury, head and neck stiffness/ pain, shoulder pain/stiffness, upper limb pain, respiratory difficulty, lowback pain/stiffness + sciatica, lower limb problems, post-CVA cases. Section 4 discusses AP research in Taiwan under the main centres and topics for research listed in the literature and Symposium abstracts, which were made available to me. Section 5 discusses AP training in Taiwan. Courses in English are available for foreign professionals. Emphasis ranges from classical (traditional) concepts to modern concepts of neurophysiology and trigger point therapy, depending on the teaching body and the type of course chosen. What one sees and hears during a 2-week trip is automatically biased by the observer and by the people and places visited. It may not represent the real day-to-day situation of the whole country. Nevertheless, my report may interest open-minded Westerners to go and see for themselves. 1. SCHEDULE Nov 13th: Aircraft Dublin-London-Dubai-Hong Kong. Nov 14th: Landing in Hong Kong Airport was exciting ! Had I not known that this is one of the world's most tricky landing places, I might have thought we were crash-landing in the centre of the city! Coming in, after dark, the aerial view of the city, with its millions of street

lights and multi-coloured advertisements, was astonishing. After a 2-hour stop, I got the China Airlines flight to Taipei. On arrival at Taipei, I heard my name called. What had I done ? No! It was to report to the Airport Authority for VIP treatment! I was whisked through Customs and Immigration before I could say "Jack Robinson". Dr. Jen-Hsou Lin met me at the Arrivals Hall and he had arranged transport to the city. My first impression of the city was the chaotic traffic. Thousands of motor bikes, cars, trucks, bicycles and pedestrians seemed to converge on intersections. Drivers who stay accident-free in Taipei must be among the best in the world. Then Dr. Lin pointed to the Grand Hotel. It is a wonderful sight, a huge hotel in magnificent Chinese style, perched on top of a hill and fronted by a beautiful Chinese gate. So this was Taipei! The car swept up to the main door. We entered the lobby. What a sight! It must have been 50 m x 50 m - the most impressive hotel lobby I have seen. The architecture, sculpture and decoration was quite unlike anything in my previous experience. Nov 15th: A lazy day, spent relaxing with Dr. Lin, his wife and children. We visited Yang Ming Mountain, in beautiful sunshine. The weather was like high summer in Ireland. (I had left Dublin in wet cold November weather). Nov 16th: Down to business. Discussions with Dr. Lin about his work in the Department of Animal Husbandry, National Taiwan University. Introductions to his colleagues and some of his students. Afternoon with Dr. Chien Chung in the AP Department, Veterans' General Hospital, Taipei (VGH). Nov 17th: Attended lectures by Chung at the Chinese AP Research Foundation (CARF) Headquarters, Taipei. The lectures were on his research and clinical effects of needling AhShi points, and on his use of YangLingQuan (GB34) in pain control in acute traumatic injury. These were excellent lectures and were listened to attentively by a group of visiting M.D.'s on a CARF training course. Lunch with Chung. Afternoon in the AP Department, VGH. Nov 18th: Discussions with Dr. Lin at his laboratory. We attempted our first AP analgesia test in the cow. It was 90% successful (see later). Afternoon in the VGH. Lectures to Dr. Lin's students. Nov 19th: Opening of the Taipei AP Symposium. Evening Banquet and Kampe! Nov 20th: Symposium. Banquet and more Kampe! Nov 21st: Symposium closed at 1700h. Banquet and still more Kampe Nov 22nd: Trip to China Medical College, Taichung (CMC). Stayed at Lucky Hotel. Banquet and Kampe, Kampe! Nov 23rd: Veterinary AP Seminar, Taichung Vet School. Another banquet. Kampe, Kampe, Kampe! I'll never survive this!

Nov 24th: Visit AP Department, CMC. Return to Taipei. Farewell to Drs. Ha, Hand, Pomeranz. Stay at YWCA! Dinner at the home of Dr. Lin and his family. Nov 25th: Pig Research Institute, Chunan. Lecture to Institute staff and local vets. Evening meal with Dr. Lin's co-workers (Chang Chia, Shieh Meei Hwa, Tsou Li Mei, Ms. Wang and Chin Sun). Nov 26th: Visit Dr. Sun at the Yang Ming Medical School. See Dr. Ha's research facilities there. Afternoon in Chung's Department, VGH. Nov 27th: Very relaxing day, driving around the Northern coast of Taiwan. Fishing and seafood. Our host was Eddie Tsang. Sulphur baths at Yang Ming Mountain. Final banquet (Mr. Tsang). Nov 28th: Sad farewell to Jen-Hsou and Li-Fei Lin. Flew Taipei-Singapore-London-Dublin. Composed my poem "Taiwan" on the back of the Qantas menu card, leaving Singapore. This poem is dedicated to Jen-Hsou and Li-Fei Lin as a gesture of thanks for their friendship and hospitality and as a memory of a beautiful land and its people. 2. CHINESE MEDICINE IN TAIWAN Four afternoons were spent at the AP Department, VGH, one morning session at CARF, two sessions at the AP Department of CMC and one morning at the Yang Ming Medical School, Taipei. The case load for AP in VGH and CMC clinics was said to be 100-150 patients/day. The following section is based on personal observations in the clinics and on discussions with Drs. Chien C. Chung, Han Ping Lee, Ming T. Lin and Wei Tse Hsiung (VGH), and Drs. Hong Chien Ha, Chung-Gwo Chang and R.T. Chiang (CMC) and Dr. Albert Sun, Yang Ming Medical School, Taipei. 1. Chinese medicine, as practised in Taiwan, combines the best of "Western" and "Traditional Chinese" medicine. Some doctors are trained in "Western" medicine, some in "Chinese" medicine and some in both systems. 2. Traditional Chinese medicine (TCM) involves study of AP, moxibustion and HERBAL MEDICINE. The latter is most important. Although medical theory (Yin-Yang, Five Phases, Perverse Causes of Disease, Disease Syndromes and Diagnostics) is the same for all branches of TCM, some herbalists do not know AP and some acupuncturists do not know herbal medicine. The Chinese herbal pharmacopoeia is very extensive. Some of the plants are cultivated locally and processed in special pharmacies, such as in the CMC. Some of the herbal medicines are imported in crude or processed forms. I did not witness the use or efficacy of these medicines, but I was told by many doctors that they are very powerful and (when used by experts) are extremely valuable in conditions as diverse as CVA, hypertension, neurasthenia and many other internal diseases. Western doctors (and vets!) have much to learn about these medicines. 3. AP and allied techniques in clinical practice: Considerable variation exists in the choice of points for therapy and in the methods of manipulating the needles. In general, I saw very little use of electro-AP (although the stimulators were freely available in every clinic visited).

There was general agreement that manual needling alone was as good as, or better, than electro-needling for most conditions requiring AP. Exceptions are (a) in AP analgesia before surgery (not witnessed) and (b) in certain chronic conditions, especially paralysis/paresis after CVA or nerve injury. 3.1. AhShi points: AhShi means " Ah Yes, or Ouch!", the exclamation from the subject when a painful point is pressed. The best AhShi point for therapy is the Trigger Point (TP), i.e. palpation pressure on the point causes a pain sensation to radiate to the problem area, muscle, or organ. It is seldom located in the area of pain. Patients usually are unaware of its presence until it is palpated. Other pain-sensitive areas (motor points, "fibrositic nodules", local pain-points etc) may be useful in therapy but they are not as powerful as the TPs (the "real AhShi" points). Great emphasis is placed on a careful search for AhShi points. These are usually present in pain conditions, such as headache (esp. neck and shoulder muscles), joint pain (shoulder, elbow, lowback syndrome, hip, knee) and myofascial syndromes. They may also arise in some cases of internal disease (lung, heart, liver, gall bladder, g/i/t, g/u tract). In internal disease the Shu points (organ reflex points on the BL Channel (paravertebral)) are carefully palpated, as are the Mu points (Alarm points on the abdominal/thoracic area). All pressuresensitive areas are AhShi points but AhShi points are not always Trigger Points (TPs)! AhShi points may be located near to or far away from the problem area. AhShi/TP points can recruit new triggers elsewhere, usually in the muscles. Painful areas in scarred tissue may also act as powerful TPs and these areas must be treated to obtain optimum results. Little emphasis was placed on this fact (see section 9 below). AhShi therapy is the best introduction to the value of needle therapy. Unfortunately, AhShi points are not present in every case, and Western doctors who know only the AhShi method are unable to help by needle techniques in such cases. AhShi points disappear when the condition resolves and the disappearance of AhShi points during a course of therapy indicates a good prognosis. Chung did extensive clinical research with AhShi points and published the English version of his book (C. Chung (1983) "AH SHIH Point: The pressure pain point in AP: Illustrated guide to clinical AP", Chen Kwan Book Co., Taipei). This book alone would enable Western MD's (and vets) who know little or nothing about AP to begin AhShi therapy immediately and to get very good clinical results from it. (Although AhShi therapy sometimes gives better results than traditional AP, it was agreed that even better results can be got if a proper study of the AP system is made). 3.1.1. Myofascial syndrome and AhShi points: Chung defines the syndrome as one involving muscle pain/stiffness, especially around joints. The joints often are stiff, but show no inflammatory or X-ray lesions. There often is a history of intermittent recurrence. AhShi (TP) points often are present, but the patient is unaware of them until they are pressed. The diet usually is satisfactory and the neural causes of the pain are obscure. The AhShi points usually show decreased electrical resistance and decreased local skin temperature. Local vasomotor abnormalities and dermatographic changes occur in the AhShi area.

Histology of the AhShi area shows local cell infiltration and non-specific inflammatory changes. There is sometimes a fibrous infiltration of the AhShi area (ropy muscle sign). Pressure on the AhShi often refers pain to the "problem area". Needling the AhShi often causes the "Jump Sign"; local muscle contractions cause the needle to jump. Chung emphasises that some acupuncturists needle the problem (local) area i.e. the area of referred pain. This is inferior AP (although it can help). Much better results can be obtained by a careful search for the TP (AhShi point). In myofascial syndromes, AhShi therapy can give dramatic (and often immediate) relief of pain. AhShi therapy in these cases can give better results than traditional AP using local and distant points. AhShi points may arise anywhere in the muscles, but they are often near the problem area. The most important muscles to search for upper body problems are: the neck muscles, infraspinatus and GB21 area. For lower body problems search the gluteus, vastus medialis, soleus, gastrocnemius. In upper limb pain (shoulder, elbow, arm, etc) the AhShi is often in the infraspinatus of the affected limb. In shoulder pain, the AhShi may be in the GB21 area, or scalenus muscle. In bilateral anterolateral shoulder pain, the AhShi is often in the sternalis muscle. In such cases, one needle in the sternal AhShi can give immediate pain relief. In abdominal and intercostal pain, check the back and sides for AhShi. In heel pain, the AhShi is often in the soleus area, left or right of BL57. In plantar pain, the AhShi is often in the gastrocnemius. In middle finger pain, search muscles near TH08. In lowback/leg pain, search the gluteus muscle. About 33% of all cases of aching pain are myofascial in origin and respond fast and reliably to AhShi therapy. Expect excellent results in 38% and good results in 60% of cases (98% total cases). Disappearance of the AhShi is an excellent prognostic sign. Chung's AhShi findings agree well with Western experiences of TP therapy, as described by Ronald Melzack (Canada), Pekka Pontinen (Finland) and Alex Macdonald (UK). Miscellaneous (Chung): Renal colic pain/spasm: GB34, LV03, SP04,06 Gastric colic/pain/spasm: ST36, CV12 Biliary colic/pain/spasm: GB34 3.2 Earpoints I did not observe a single case of ear-AP. However, I was told by some local doctors that earpoints are sometimes used alone or in combination with body points, with good success (see Symposium report also). 3.3 Body points a. The most commonly used points seen in use were the Channel points, especially LU07, LI04,10,11,15, ST25,36,37,38, SP04,06,09, HT07, SI03,06,09,11,19, BL10,11,23,40,57,60,62, KI03, PC06, TH05,14,15, GB20,21,30,31,34,39, LV03, CV04,12. (GV points were seldom seen used. GV15 (YaMen), needled 2" deep in one patient, appeared

to cause a very severe left-sided headache, needle shock and some loss of power in the legs. The patient, an elderly lady, was being treated for facial paralysis and slurred speech following a minor CVA. She was most unhappy when questioned by me about one hour after treatment. (See CVA, later). b. Extra-Channel Points (points not on the main Channels): These points often were used for their local or distant effects. The most commonly observed were Hand Points "Loin & Leg" between the proximal heads of metacarpals 2-3 and 4-5 respectively. These Hand Points gave immediate relief in some cases of lumbago and lowback/leg pain. Hand Point "Neck" (between the knuckles of fingers 2-3 with fist tightly closed, needled 1" deep towards the wrist. This point gave immediate relief of neck pain/restricted movement in one patient. Other Extra-Channel points used were: LanWei (Appendix point) in abdominal pain/constipation, XiYan (Knee Eyes) in knee pain, YinTang (between eyebrows) and TaiYang (temporal fossa) in headache, sinusitis. c. Distant points: Distant points are often used in VGH (and to a lesser extent in CMC). The clinical response to needling distant points (when no local points are used) can be dramatic and cannot always be explained by short reflexes. It is known that a stimulus via one spinal nerve may activate reflex responses in areas innervated by up to 6 segments above or below the input nerve. Examples are the use of the points "Loin and Leg" or "Lumbar Area" (on the dorsum of hand) or SI06 to treat lowback/leg problems; ST38, GB39 or GB34 to treat shoulder or neck problems; LU07 in headaches. The use of TH03, SI03, Hand point "Neck" is not so inexplicable in neck/shoulder problems because the innervation is related to these areas. In myofascial and some arthrotic syndromes, Chung prefers to use Distant rather than Local points. If patient is not helped within 20 minutes, the needles may be left in situ for up to 40 minutes and other points (AhShi, local points) may be tried also. 4. Needle Manipulation All operators were very careful to cleanse the skin (alcohol swab), use sterile needles (disposable in VGH) and to touch only the handle (not the body) when inserting the needle. Styles of inserting the needle varied between operators. In general, staff at VGH inserted the needle while twirling vigorously clockwise and anticlockwise until the skin was penetrated, and then the needle was advanced with less twirling. "Sparrow pecking" (up and down movement) was fast and strong, often combined with some twirling. Vigorous needle twirling and pecking was continued for 5-30 seconds until definite "DeQi" was reported by the patient and the visible signs were observed by the operator. In contrast, Dr. R.T. Chiang (CMC) inserted the needle through the skin with one, deft halftwirl and push. He then advanced the needle with minimal, if any, twirling to its correct depth. His sparrow-pecking and subsequent twirling was slower and more deliberate than in VGH. He also scratched the handle vigorously and "went around the clock" (moved needle handle like the hands of a clock through 360 degrees) once or twice, to get DeQi. He told me that the classic (traditional) methods of needle manipulation ("tonification" and "sedation" manipulation) are very important in difficult cases. (Staff at VGH do not appear to put importance on the classical needle manipulations used to tonify or sedate Qi).

In both hospitals, needles usually were left in position for 15-30 minutes (estimated average 20 minutes). In VGH, some twirling and pecking was repeated just before needle removal. This was mainly to ensure that the needle was not "caught" in the tissues and to avoid rough removal of a "caught" needle. In contrast, at CMC, a quick check that the needle was "free" was followed by gentle removal of the needle. At VGH, a cotton-bud was used to apply pressure at the point for a few seconds after removal, to prevent local pinpoint bleeding. 4.1. Needling AhShi/TP points: This was one exception to the 20-minute needling time. Chung twirled the needle and pecked very strongly for 15-60 seconds. The patient often had very strong reaction to this (grunts, slight groans, facial grimaces etc). In many cases, the needle was removed within the 15-60 seconds. To my amazement (and that of other observers) the pain or stiffness which the patient had reported before needling seemed to have disappeared (as judged by the consternation or smile on the patient's face and/or visible and marked improvement in neck/shoulder/lumbar/knee movement)!! The immediate responses seen after AhShi needling in some patients at VGH were hard to believe but I witnessed them many times (see case notes later). This is certainly similar to the Huneke "Sekunden phanomen" (instantaneous phenomenon) and is a typical reaction to TP therapy (Melzack, Pontinen, Macdonald, Lewit ). See Section 9. I was told that similar responses are not uncommon at CMC but I did not witness any there, probably, because the total number of cases I observed there were much less than in the VGH, due to shortage of time to stay at CMC. 5. DeQi All experts agreed that it is essential to get DeQi if the best results are to be obtained in needle therapy. In Chinese medical experience, DeQi is known to have subjective (patient), subjective (operator) and objective characteristics. 5.1. Patient's sensations: The patient reports strong sensations running, proximally, or distally from the needle. Sometimes the sensation is said to travel proximally and distally. The sensations are described as: "sore", "heavy", "tingling," "electric shock-like", "running", "aching" (but not painful). The observable reactions of the patient at this time included grunts, groans, flinching of the limb or part being needled, explosive intake or expulsion of breath, facial grimaces and occasionally (in strong reactors) sudden jerks involving all or part of the body, and occasional expletives. During the Symposium, I was needled at left LI10 by a Master. This man claimed that with really expert needle use, the PCS sensation should be felt not only along the needled Channel (LI Channel goes from index finger to nose) but also into its following Channel (ST follows LI, goes from eye to second toe via nipple and anterolateral knee). I felt the classic DeQi sensations and reacted as a typical strong reactor, as described above and in 5.3 below. However, the sensation travelled a maximum of 6" upwards, whereas it travelled distally to the dorsum of the hand and was most marked in the 6" below the point. After 3-4 minutes, the palm of my left hand became very cold and sweaty. My right palm was (normally) warm and was sweating less than the left. I had no queasiness, nausea or other signs of needle shock. The dull ache (6" above, to 6" below LI10) persisted about 2 hours afterwards. The point was

slightly sensitive to local pressure for 2 days afterwards. I have needled many AP points on my body, obtained DeQi most times but without such a strong PCS reaction. 5.2 Operator's sensations: The operator usually has the sensation that the needle is being gripped by the tissue, i.e. especially on withdrawal of the needle, (when a definite "nipple" seems to form at the skin surface) or on twirling of the needle (when the needle seems to "lock" at the end of each twirl). 5.3 Objective signs of DeQi are the "nipple" and the patient's reaction. After a few minutes, a definite zone of hyperaemia (1-3 cm diameter) may appear around the needle in some patients. 5.4 Propagated Channel Sensation (PCS): When needled correctly, certain ("sensitive") patients claim to feel the sensation (PCS) radiating along most or all of the Channel. Some also report sensations radiating to the organ controlled by the Channel! Chung stresses that correct needling of the AhShi point almost always sends strong sensations to the problem area, muscle or organ. 5.5 Over-stimulation of points such as LI04, ST36, etc can cause "needle shock" (weakness, dizziness, nausea, vomiting, fainting, syncope, etc). 6. Moxibustion Although Moxa was available in all clinics, it was not seen in use except once or twice. This is because (a) the smell of moxa smoke is a nuisance in a crowded clinic, and (b) patients are shown by the nurse how to apply moxa at home. The points for moxibustion (if required) are circled with biro or felt pen. Moxa is considered helpful in: Asthma, chronic G/I problems, general malaise, physical development problems (ill-thrift), arthralgia, rheumatism, obstetrics (to turn the baby in-utero) moxa BL67. 7. Cupping Was not observed in VGH. It was seen in two cases in CMC. It was applied for 1-3 minutes (over the needles) until the skin became red-purple. The cups were then removed but the needles were left in situ for the usual 20 minutes. Both were cases of lowback syndrome and the cups were applied bilaterally in the area of BL23-34 (4 x 2 cups in one patient and 3 x 2 in another). 8. AP in paralysis/paraplegia At both VGH and CMC, workers told me that AP and herbal medicine can greatly help many patients suffering from paralysis as a sequel to CVA or in peripheral paralysis due to trauma. They also mentioned facial paralysis as being a good indication for AP. The number of patients which I observed being treated for post-CVA paralysis was small - one in VGH and two in CMC. There was general agreement that sensory paralysis on the affected side abolishes the needle sensation (DeQi) and there is little value in needling the affected side. In that case, needles are put in the unaffected side at key points such as GB34, ST36, BL40, GB30, LI04, TH05, LI11, GB20,21. Facial paralysis, slurred speech or absence of speech, etc are treated by local needles. GV15 (YaMen) is a dangerous point (mutism) if needled too deeply. Scalp motor points on the contralateral side are often combined with body points.

9. Scar therapy "Anything that happens along or near the course of a main Channel influences that Channel and the organ that bears its name" (Felix Mann). Many authors emphasise the role of scars as causes of referred pain, functional disorders and (in late stages) organ disease in man (1,5,6,7,8,9) . Scars also may cause similar problems in animals (2,3). In Germany, scar therapy (especially scar infiltration with procaine solution) has been used for decades to relieve pain and other disorders triggered by the scar (4). The relationship was observed quite independently of AP. The reaction to scar injection was often instantaneous. Problems which had existed for months or years disappeared in seconds, the "Sekunden Phanomen" of Huneke (4). Acupuncturists have noted that injuries, bruises, or bad scars (especially if heavily fibrosed, twisted or keloid) along the course of a Channel may cause functional symptoms associated with the Channel or its organ. If the scar remains untreated, the symptoms may progress to physical (organic) pathology of the organ. Furthermore, the Channel above and below the scarred Channel ("mother" and "son" in the Qi cycle: LU - LI - ST - SP - HT - SI - BL - KI - PC - TH - GB - LV - LU) may be involved as a secondary effect. For example, I treated a man who had a very twisted scar across the BL Channel on the right thorax. He complained of recurrent intermittent symptoms over 8 years including: haematuria, haemorrhagic cystitis, right sciatic area pain and lumbar pain, right scapular and shoulder area pain in the area of BL Channel, right headache near the BL Channel, right eye conjunctivitis, right ear tinnitus, right arm pain/spasm in the SI Channel area and pain in the little finger. Orthodox treatment by eye-, ear-, orthopaedic-, cardiac- and internal disease specialists over years had only temporary effects and symptoms continued to recur (usually singly) at intervals. All the symptoms related to KI, BL, KI, Channels, but mainly to BL. (In the Qi cycle, the sequence is SI->BL->KI. A block in BL would give excess in SI and deficiency in KI, as well as excess in the upper part and deficiency in the lower part of BL Channel). Scar therapy (physiotherapy, massage and needling of the scar), with needling of the BL Channel, eliminated all the symptoms and the patient remained well. This is a most important concept! Bruises, injuries and scars may cause disease. The blockages include: moxa scars, surgical scars (external and internal), injury (external and internal), cuts, local fibrosis (cicatrization due to abscess, carbuncle, etc. Reinhold Voll taught that individual tooth sockets relate to specific areas and that socket inflammation/scars, dental caries, etc may cause reflex pathology in the associated Channels and organs. A routine part of anamnesis should be to question the patient or client as to the existence of any scars, bruises or injuries on the body and to examine the location of these injuries in relation to the location of the other symptoms and the time of occurrence of the injury in relation to the time of onset of the symptoms. Not all scars need cause problems. Longitudinal scars are not as serious as transverse (they are less likely to cut as many nerves or Channels). Well healed (clean) scars are not as dangerous as thickened, twisted, keloid scars, or scars which have painful spots to pressure. Scar therapy can use simple needles (under the scar, or at each end), ultrasound, physiotherapy, laser or procaine injection or B12 injection along the scar. The concept is to

restore energy flow through the scarred area and to reduce size, thickness and adhesion in the scar. One to three treatments are usually sufficient. Seeing many scars on patients in Taiwan, I was amazed that I did not see a single case of scar therapy. On questioning my colleagues in the Clinics, I was told that the concept of scar therapy was not widely known in Taiwan. Perhaps this section may awaken interest in this valuable therapy ? SCAR THERAPY REFERENCES 1) Austin, Mary (1974). AP therapy. Turnstone Books, London, 290 pp. 2) Cain, Marvin (1981,1982) Effects of superficial scars in horses. Personal communication. 3) Gilchrist, David (1981). Manual of AP for small animals. Box 303, Redcliffe, Queensland 4020, Australia. 4) Huneke, F. (1961). Das Sekunden Phanomen (The Instantaneous Phenomenon) Karl F. Haug Verlag, Ulm, Donau, Germany. 5) Kajdos, V. (1974). Neural therapy: its possibilities in everyday practice. Amer. J. Acup. 2, 113-. 6) Khoe, Willem H. (1979). Scar injection in AP: Huneke's "Sekunden" neural therapy. Amer. J. Acup., 7, 15-. 7) Lewit, Karel (1979). The neural effect in the relief of myofascial pain. Pain, 6,3-. 8) Mann, Felix (1973). AP cure of many diseases. William Heinemann Medical Books, London, 123 pp. 9) Rogers, Carole (1982). AP therapy for postoperative scars. Amer. J. Acup., 10, 201-. 3. CLINICAL CASES OBSERVED AT VGH AND CMC I attended 4 long clinics at VGH and two short clinics at CMC. I observed over 100 clinical cases presented for their first treatment. (Repeat treatments were being given in other clinics, but I wished to see each case, as presented, for the first time and to assess the response (if any) to AP at that treatment. The patients, nursing staff and doctors were most helpful and friendly. They discussed freely each case history, allowed me access to the medical records and discussed why a particular combination of points was chosen. I wish to thank these generous people most sincerely for helping me to learn more about AP and human nature. Most cases involved pain syndromes (headache, neck, shoulder, elbow, wrist, hand pain + stiffness, back and lowback rain + stiffness, hip, thigh, knee, ankle or foot pain + stiffness, chest or abdominal pain). A few cases with constipation, asthma, numbness of extremities, muscle tremor, facial paralysis and post CVA paralysis were also seen.

The cases were scored from 0 to (+++) on the result obtained at the end of the first session: (0) = no improvement was noted or reported; (+) = slight improvement; (++) = good improvement; (+++) = excellent improvement; (?) = result unknown. It should be noted that selection of points is not a routine, standardised procedure. It depends on the doctor, the patient and on the response obtained. Furthermore, most of these patients would require further treatment sessions before they could be said to be cured or stabilized. My notes are not complete and many other cases observed were not detailed in writing. Table 1 shows a summary of the responses noted at the end of the treatment session (usually about 20 min) in 39 cases for which my notes had a result indicated (0 to +++). The notes did not record a result in 9 patients. Good or excellent relief occurred in 69.2% of the cases. Slight relief occurred in 23.1%. Only 7.7% reported no relief. In the 39 recorded responses, 13 (33.3%) had a marked response within two minutes (cases 11-14,16,17,24-26,34,40,43 and 45). These rapid responses are comparable to those reported in the Huneke Phenomenon. These results are most impressive, especially when one realises that they were responses to the first session of AP. Most disorders require 1-6 or more sessions of AP to obtain maximum response. A good initial response is usually an excellent prognosis for a satisfactory outcome. Many patients with a poor response to the first session can be helped by further sessions. TABLE 1 Summary of responses noted (0 to +++) and unknown (?) in 48 cases from my notes. (Case 4 was included twice). Problem area and case No.

Response ++

Total

0

+

+++

(?)

Total

Recorded

2

1

1

2

6

4

1

3

1

5

4

9

1

14

13

1

1

General and CVA 1,2,4,45-47 Head/neck 6,8-11 Upper limb 5,7,12-23

3

1

Thorax 24

1

Lowback 3,25-34

1

2

6

2

11

9

1

3

3

11

8

Lower limb 4,35-44

4

Total

3

9

4

23

9

48

39

7.7

23.1

10.2

59.0

-

-

100

% success in recorded cases

Details recorded in my notes 1. Aches and pains "all over the body" Some patients report "wandering pains" or static pains in head, neck, back, upper limbs, lower limbs or "all over the body." These cases would be difficult to treat (too many needles) if each area had to be treated separately. In such cases, the VGH clinic uses needles in LI04 and LV03 (bilateral) for 2-3 sessions, at which time the pain usually "localises" in 1-2 areas and is easier to treat then. In the early stages, many TP/AhShi areas may be found but the real TPs can be isolated after 2-3 sessions of LI04, LV03. Female: "aches and pains all over": (GB area of head, legs, shoulders) with insomnia and malaise. LI04, LV03 (bilateral) needled. Doctor was very gentle and caring with this patient and the "Tender Loving Care" (TLC) had marked effect on her reaction to the staff. Response (?). Tension, insomnia, neurasthenia: In VGH, I was told that AP can help these problems. Main points included LI04, HT07, ST36, LV03. However, many sessions may be required and other causes and therapies must be considered. I saw few such cases during my visits. None could be assessed as to the outcome. 2. Insomnia, tension for 10 years: LI04, LV03 (bilateral). Response (?) AP in pain following local trauma: Many of the pain syndromes presented for AP therapy are caused by local trauma (falls, industrial accidents, car crashes, athletic injury etc). In acute cases, presented soon after the injury, AP is a highly efficient method of controlling the pain. It also has anti-inflammatory and restorative effects which speed up the resolution of the injury, especially where this involves soft tissue injury, bruising, oedema and swelling. Chung has done extensive clinical research in this area. Acute traumatic injury: Ipsilateral GB34 is the pain-point par excellence. On its own, it often controls the pain (and reduces swelling). Sometimes, ipsilateral BL62 or an AP point near the local area may improve the effect. Chung reports that pain relief is more efficient if AP is given on or after day 2 (rather than day 1) of the accident. About 70% of acute traumatic pain (including fracture pain) may be relieved following one 20-min session of AP. Treatment 1-2 times/day for 3 occasions gives pain control in > 95% of cases. In contusions GB34 In abrasions GB34 In fractures GB34 (66% excellent results) In costal trauma, especially lateral GB34

GB34 (ipsilateral) is the key point for traumatic pain anywhere in the body. Because of the marked analgesic effects it is most important to diagnose the cause of the pain and to give supplementary treatment (for example, plaster cast in simple fractures). It is possible to do severe damage in the region of a broken bone if one uses it following AP analgesia, unaware that the fracture was present. To obtain complete relief from chronic pain, caused by trauma some weeks or months previously, AP may be required 1-2 times/week for 1-2 months. GB34 (ipsilateral) is also used in chronic cases, but other points are often added. These include AhShi points, when present. Chronic traumatic pain of: head and neck:GB34 + LU07 + BL62 lumbar area :GB34 + BL40 + SI06 elbow area :GB34 ankle area :GB34

GB34 is also useful for joint and muscle stiffness which often follows removal of a plaster cast. GB34 controls the muscles and sinews. 3. Left lowback pain following trauma: Needling ipsilateral GB34 caused radiating sensation to flank and costal area. SI06 (contra- lateral) needled. 20 min. Pain was greatly eased but not completely gone (+++). 4. Knee and shoulder pain (bilateral) following car accident some weeks previously. Scar on anterior thigh. Bilateral TP/AhShi were located in infraspinatus. Needled AhShi, GB34, BL40,57,62, TH05. Twenty minutes. Pain slightly improved. (+) 5. Elbow pain following local trauma: GB34, LI11 ipsilateral. Twenty minutes. Pain gone completely (+++). 6. Eye pain and swelling following local trauma: GB34 ipsilateral. Within minutes, patient opened eye, Pain gone when needle removed at 20 min. (+++). (One treatment is often sufficient in "black eyes": C.C. Chung). 7. Pain in left palm near HT07, due to local trauma (fall from bicycle) one month before. Left GB34 needled. Marked pain relief in 20 min.(+++) Head and neck problems Many patients are treated for headaches, neck pain and whiplash. (Facial paralysis and trigeminal neuralgia is also treated but few such cases were seen by me).

Headache: In VGH, LU07 is used often as the main point, often combined with GB20 + TaiYang (Z 09), YinTang (Z 03), GV20 (depending on location of headache). Neck pain and stiffness: The Hand point "Neck" is very effective. The patient is asked to close the fist. The point is between the knuckles at the lower end of metacarpals 2-3. It is often combined with SI03. 8. Pain and stiffness in neck, with intermittent headaches (headache not present at presentation). Needled: "Neck" point (knuckles 2-3) plus LU07 (bilateral). Twenty minutes. Great improvement. (+++). 9. Throbbing pain and sensation of tightness in occiput and behind temples for 2 weeks. Worse at night. AhShi found (bilateral) near GB10. Needled. Points GB20, LU07, BL40 needled bilaterally for 20 min. Slight improvement was reported. (+). 10. Tinnitus (Side and duration and causes not recorded). Needled TH17, GB20, ST36, ipsilateral. Response (?). (Note: many authors report poor results with AP in tinnitus). 11. Acute neck pain and rigidity in an in-patient (developed overnight). Hardly any rotation or other movement of neck was possible. One needle was put in the point "Neck" between knuckles 2-3 and was strongly pecked and twirled for one minute. Patient was then asked to try to move his neck slowly. The consternation on his face when he found he had full movement and no pain after 1 minute was hilarious! Immediate result. (+++). Shoulder pain, stiffness, "frozen" shoulder Many patients had these symptoms for up to 5 years before AP treatment. Careful searching of the scapular muscles (especially infraspinatus) often shows up AhShi points. Sometimes AhShi also occur near GB21. The most important distant points for shoulder are SI03, GB34, ST38, plus AhShi points. 12. Frozen shoulder: Very restricted right shoulder movement with pain and stiffness. Duration 5 years. Two AhShi points located in infraspinatus Strong deep needling for one minute. Patient lifted arm much higher immediately. AhShi had disappeared in one minute! Then ST38 was needled (right side) strongly for one minute. Further improvement in arm movement. Then SI03 (right) needled strongly. Needles left in SI03 and ST38 for 20 min. Great improvement in arm movement and pain was much less. However, patient could not put arm behind his head or behind his back and some pain and stiffness remained (++). 13. Shoulder-joint pain/limited movement, with pain in the hand, especially metacarpalphalangeal joint of index finger for 3 months before AP. Left side. AhShi in infraspinatus (left) and AhShi in front of shoulder joint. Both AhShi needled strongly. All pain was gone and movement markedly improved in two minutes. A further AhShi near SI09 was needled. The amazement on the patient's face, on discovering the dramatic improvement within 3 minutes, was a joy to watch! (+++). 14. Pain in shoulder, elbow and wrist, with marked hand tremor which interfered with use of chopsticks and made writing impossible. (Tremor appeared only when pen or chopsticks were grasped). Little limitation of joint movement. Duration two years before treatment. AhShi located in right infraspinatus. Needled strongly for one minute. All pain had

disappeared. Chung asked the patient to write his name. The tremor was gone! No further treatment at that session. (+++ immediate). 15. Shoulder area and neck pain: Needled at GB21, SI09,11, 20 min. Slight relief only. (+). 16. Pain and pulled scapular muscles (right) with difficulty raising, arm for 7 months following golfing incident. (Pain in right temple had been present earlier, but was gone now). No AhShi points located. ST38 caused "sensation of electricity travelling from foot to side of face!" The pain was gone in 1 min. GB34 was added for added effect (2 needles only: ST38, GB34, right side). Patient "could not believe the effect"! (+++, immediate). 17. Shoulder pain (anterior muscles) when arm brought behind body. Duration 1 month. Strong needling at SI03 gave total relief of pain in 1 min. Strong needling at GB34 and LI04 added for extra effect. All needles left in situ for 20 min. (GB34 referred sensations to the shoulder area!). Total pain relief. (+++, immediate). 18. Frozen shoulder: Pain and severe restriction of raising right arm. Needled: right ST38, BL40, GB34 plus left LI15. Twenty minutes. Some improvement in pain but little change in movement. (This case was long-standing and had muscle atrophy) (+). 19. Stiff shoulder: Left side, limitation of movement, with feeling of heaviness to the wrist and also some lowback pain. Duration unknown. AhShi point in infraspinatus needled plus left ST38 and TH03 (for the shoulder). "Loin and Leg" points added for lowback. Response (?). 20. Scapular area pain, left. Duration unrecorded. AhShi not found. Needles in GB34, TH03 , BL40, GB20 (left). Twenty min. Marked improvement (+++). 21. Scapular area pain, with degenerative lesions in cervical spine plus facial palsy. Duration unknown. Needled AhShi (infraspinatus) and TH03 (for shoulder) plus LI04,20 (for the face). Scapular pain greatly improved in 20 min. (+++). Upper limb problems 22. Pain in forearm muscles below lateral epicondyle of humerus on both arms for 6 months. AhShi located in right infraspinatus, also below left GB20 and (bilateral) in forearm muscles near LI10. Needles in all AhShi plus GB34 (bi). Less pain after 20 min. (+). 23. Elbow pain and muscular stiffness: Duration and cause not noted. GB34 + local AhShi point needled, 20 minutes. Good response reported (++). Respiratory difficulty AP is used often to help patients with respiratory problems, such as asthma, dyspnoea, tight sensation in chest, shortage of breath. The main points include: PC06, LI11, BL13, SP04,

ST40. Few such cases were seen during my visit. AP at PC06 was said to be very useful to help to control angina pectoris and improve cardiac microcirculation. 24. Difficult breathing and shortage of breath, with sensation of tightness in chest in patient with history of asthma. Needles put (bilateral) in PC06 and SP04 gave relief within 2 minutes. Left in situ for 20 min. Patient was delighted with response. (+++ immediate). Lowback pain and stiffness + sciatica Lowback pain is often caused by unaccustomed back exercise (lifting, twisting etc). Sometimes it is associated with degenerative disc disease, spondylitis, disc prolapse. The new points "Loin and Leg" (dorsum of hand between the upper heads of metacarpals 4-5 and 2-3) often give immediate or rapid pain relief. Other useful points include: BL23,40,57,60, GB30,31,34, AhShi, SI06, LV03, LI04. 25. Right lumbar and posterior thigh pain associated with X-ray evidence of degenerative disc disease. Had been treated unsuccessfully for 5 months in the Orthopaedic Dept. of the same hospital. Needles in: "Loin and Leg" points (right), SI06 (left). Pain improved within 2 min but extension of leg still caused some pain. After 20 min pain was "95% gone". (+++, immediate). 26. Pain radiating from left thigh to lower leg: Intermittent over 1 year. Left face pain. Worse at night. Slight degeneration of lumbar spine on X-ray. Pain in both shoulders for 3 months. Needled (for lowback/leg): "Loin and Leg" (left). Pain relief was immediate (but not complete) in one minute! AhShi found in left gluteal muscle. Massaged, then needled, plus BL62. For the shoulder pain, SI06 (bilateral) needled. AhShi near GB20 (bilateral) also needled. 20 minutes. Pain in shoulder and lower limb "greatly improved!" (+++ immediate). 27. Lowback and sciatica pain (right thigh, radiating to lower leg) for one month. X-ray indicated degenerative disc disease of low lumbar spine. Straight leg raising test (SLRT) 90 degrees left, 45 degrees right. Disc disease diagnosed in lumbar area. Needled: "Loin and Leg" and GB34 (right side) 20 min. No improvement in pain or SLRT at this session (0). 28. Severe lumbar pain and stiffness following back strain about 1 week previously. Needled: "Loin and Leg", LV03, LI04 bilateral). Greatly improved back movement and pain almost gone in 20 min. (+++). 29. Acute lumbago for past few days. No history of back strain. "Loin and Leg", GB34 (bilateral) needled. 20 min. Stiffness and pain greatly improved. (+++). 30. Acute sciatic-area pain (right). Duration unknown. Suspected lumbar disc on SLRT. Needled: BL23,40,60, GB30,34 (all on right). Response (?). 31. Acute lumbar sprain: Duration unknown. Needles placed in BL23,26,30,34,40 bilateral. The lumbosacral area was cupped (bilateral) over the needles. Good pain relief after 20 min. (CMC). (++). 32. Sciatic area pain (left). Duration unknown. SLRT unknown. Needles in left BL40,60 plus AhShi below wing of left ilium. 20 min. Pain relief reported. (++).

33. Sciatic area pain (right) in patient who earlier complained of numbness and ache in lower leg for one year. Lumbar vertebrae showed bridging on X-ray. AhShi (very sensitive) at GB31 (control point of the tensor fascia lata - Chung). Needles in AhShi plus GB30, BL40,60. Response (?). 34. Lowback stiffness, pain and inability to bend forward: Duration about 3 days. Needles (bilateral) in "Loin and Leg" points, strong stimulation for about 30 seconds each. Patient was then asked to try to bend forward. There was marked improvement in movement and less pain. BL40 and GB34 added (bilateral) 20 min. Marked improvement (+++, immediate). Lower limb problems 35. Ache and tenderness over right lateral ankle following a fall (ballet dancer) 8 months previously. Needled: right SI06 plus left GB34. 20 min. Slight improvement reported (+). 36. Weakness in both legs for 13 years following cystectomy. "Loin and Leg", BL40, GB34, LU07 needled bilaterally. Response (?). 37. Ache in anterior aspect both thighs for one week. AhShi points in muscles of medial and anterior thigh. Needles in AhShi points for 20 min. Marked improvement in pain (+++). 38. Pain in and under left heel for 10 years. Earlier X-ray (some years previously) showed soft tissue calcification behind ankle joint. AhShi located above BL57. Needling sent sensation to gastrocnemius tendon area. Slight improvement in pain after 10 min. (+). 39. Pain in sole of the foot: Duration not recorded. Needled ipsilateral GB34, BL57. Response (?). 40. Pain, spasm in both knees in 74 year old woman. Duration > one month. Also tightness in right gluteal muscles. Needles were placed in LI11 to relax knee muscles. The response was immediate and dramatic (knee movement improved markedly). Then GB34, SP09 (bilateral) added. Marked improvement in movement and pain in 20 min. (+++, immediate). 41. "Cold knees": For some months patient had cold sensations in both knees and used knee warmers in an attempt to "warm" them. Needles in GB31 and ST36 (bilateral) for 20 min. Patient reported "warm sensations" in knees during needling (+). 42. Multiple joint pain in lower limbs, worst in knees, with some lumbar pain. Needles in the hand point "Sciatic area" (between distal heads of metacarpals 3 and 4 on dorsum of hand) plus GB34, SP09, SI06 (all bilateral). Response (?). 43. Pain and swelling in knee and ankle (left), intermittently over 6 months. AhShi found near left SP10. Strong needling of AhShi for one minute gave marked relief of pain. A second AhShi found 2.5 inches below and behind left GB34, bilateral. Needled 1 min. Patient could hardly believe the result! (+++, immediate). 44. Left knee pain (no details). Needles GB34, SP09 (left). Twenty minutes. Good relief of pain (++).

Post CVA cases: Note: If there is sensory paralysis, there is little value in needling that side. In such cases, the "good" side would be used plus the Motor points on the scalp. 45. Right facial paralysis, slurred speech and poor control of tongue in elderly woman. Minor stroke 3 months before. GV15 was needled 2" deep. Within one minute, she had marked improvement in speech and tongue control! CV23 was then added, plus LI04, HT07, GB34 (bilateral). All needles were left in situ. After 10 minutes, patient went pale, developed cold sweat on face/forehead, yawned a lot and complained of severe headache behind right eye. On attempting to get up, she nearly collapsed. She had to be helped to lie down. She felt very tired and weak. (When I saw her one hour later, she was still complaining of leg weakness and a headache) (+++ immediate). 46. Right hemiparesis arm-leg after stroke (hospitalised in CMC). Simple needling on right LI04,11, TH05, GB34, SP06, plus left LI04, GB34. No improvement noted (0). 47. Hemiplegia (left side) (CMC hospital): left LI04, TH05, BL40, GB34, GB20,21, GV16. No improvement noted (0). 4. AP RESEARCH IN TAIWAN, R.0.C. During my visit, I received reprints of their research in AP from medical and vet colleagues. Abstracts of the 1982 International AP Symposium (1982), the Vet AP Seminar (1982) and the National AP Symposium (1979) were also given to me. From these sources, the addresses of the main centres of AP research in Taiwan were compiled. They are: 1. Taipei Chinese AP Research Foundation (Box 84-223). This group attempts to integrate and disseminate the medical and vet AP research in Taiwan. This group produces "AP Research Quarterly", in which some of the current AP research is published. National Taiwan University, College of Medicine (Depts. Physiology and Neurology). National Taiwan University Hospital (Depts. Medicine a Physiology). National Taiwan University, Depts. Animal Husbandry & Zoology. Yang Ming Medical College (Depts. Anatomy & Microbiology and Institute of Neuroscience). National Defence Medical Centre (Depts. Physiology, Biophysics and Biomorphics). National Institute of Preventive Medicine (Dept. Serology). Academia Sinica (Institute of Physics) Taipei Medical College (Pain Clinic) Taipei City Hoping Hospital (Pain Clinic)

Taipei Municipal Drug Addiction Centre Airforce General Hospital (Aerospace Medical Research Laboratory) Tri-Service General Hospital (Depts. AP Research & Pathology) VGH (Depts. AP, Ophthalmology, Obstetrics and Gynaecology). 2. Taichung China Medical College (AP Research Centre; Institute of Chinese Medical Science and Dept. Physiology) Chung Shin Hospital (Dept. Urological Surgery) Veterinary College (Dept. Vet Medicine, and Vet Teaching Hospital) 3. Lungtan Institute of Nuclear Energy Research 4. Hsinchu National Tsing Hua University (Institute of Radiation Biology) 5. Changhua Success Clinic of Chinese Medicine. I visited the research facilities of Yang Ming Medical College (Taipei), VGH (Taipei) and CMC (Taichung). The equipment in these centres was impressive and modern. It included: electron microscopy; automated scintillation and isotope counters; modern histological processing and microscopy; automated spectroscopy; HPLC apparatus; microcomputercontrolled integrators. Yang Ming Medical College also had sophisticated multichannel electronic recorders for physiological monitoring; stereotactic surgical equipment and primate/rodent handling facilities for experimentation in pain research. I was told that Government funding for AP research had been somewhat limited until recently but that increased funding was expected in future, due to (a) positive research results from Taiwanese projects, and (b) a growing awareness of international advances in the field of AP, neurophysiology and neuroendocrinology. Since 1976, or so, the main areas of AP research in Taiwan can be divided into experimental and clinical research. Experimental studies: Experimental AP research in Taiwan is based largely on researching the physiological effects of stimulating some of the Master Points, especially LU07, LI04,11, ST25,36, SP06, HT07, BL23,52,40, PC06, GB20,34, LV03, GV14,26. Drug interactions and the pathways activated in the nervous system are also being studied. The approach is pragmatic. There is great awareness of the need for properly controlled observations.

The ancient concepts of Five Phases, Pulse Diagnosis, the Perverse External Insults, etc receive little (if any) credence from medical or veterinary scientists trained in the "Western" method. These concepts are still held by those doctors whose training is solely in traditional Chinese medicine. However, since few of the Traditionalists are active in AP research, I conclude that current research in Taiwan largely ignores the esoteric aspects of traditional AP and concentrates on the physiological effects and the mechanisms involved from a "Western Scientific" viewpoint. Research areas include: a. AP analgesia: In experimental pain in animals (rats, monkeys), using tail flick test, Jaw opening reflex, Naloxone effects on AP analgesia in animals, Long-term abolition of AP analgesia by severing the dorsolateral funiculus in the cervical 2-3 area in monkeys, AP effects on stimulation evoked potentials in the human cortex - the importance of DeQi (needle feeling), The role of Dorsal Root Antidromic Activity in AP analgesia, AP effects on pain threshold in normal and paraplegic humans. b. Brain sites activated by AP: Sensory projection of AP sites in the cortex of monkeys, AP effects on brain membrane changes, AP effects on the feeding and chewing centres in rabbits. c. Cord sites activated by AP: AP effects on Dorsal Root Antidromic Activity in animals, Horseradish peroxidase retrograde transport to label cord sites activated by AP. d. Brain stimulation effects: Effects of raphe nucleus stimulation on cardiovascular function during painful stimulation, Stimulation-produced analgesia in periaqueductal grey area effects of naloxone. e. AP effects on cardiovascular function, metabolic rate and thermoregulation: AP effects in cardiac function, AP effects on experimental cardiac abnormalities in animals, AP effects on skin temperature/vasomotor responses in normal/paraplegic humans; AP effects on metabolic rate and human body temperature; ST36 implants on thyroxine levels and pulmonary function in rabbits; AP at GV14 on thermoregulation in experimental fever in rabbits. f. The DeQi Phenomenon: The role in DeQi of reflex muscle contraction around the needle; The role in DeQi of mechanical twining of connective tissue around the needle tip; The induction of DeQi in "non-points." g. Miscellaneous physiological effects of AP: at GB20 on bile flow in rabbits and on high density lipoproteins in blood;

on levels of cholesterol and lipoproteins in normal and hyperlipoproteinaemic humans; at GB34 on cholesterol levels in rabbits fed high cholesterol diets; on blood sugar in alloxan-induced diabetes in mice; on experimental alcoholism in pigs & mice; on Kirlian auras in man; on pupil width in cats; on phagocytosis, leucocytosis and lymphoid cells in animals; in recovery from experimental x-irradiation sickness in animals (red cells, white cells; spleen, thymus and bone marrow metabolism); on antibody production to various antigens including cobra toxin in animals.

Clinical studies include: Many studies on effects of AP in clinical pain syndromes in man; Comparison of simple needling with low-frequency electro AP in pain control in man; Comparison of TP/AhShi therapy and AP therapy using distant points in control of clinical pain syndromes; Earpoint AP in control of clinical pain in man; AP analgesia for human surgery; Studies of AP in withdrawal symptoms from narcotics and tobacco; AP effects on blood pressure of normal and hypertensive patients; AP and moxibustion effects in asthmatic patients; Earpoint AP in the treatment of refractive disorders of the eye; EA at SP04 in the prevention of threatened abortion or premature labour in women; Earpoint AP in disorders of the G/I tract; reproductive disorders and psycho-neurological disorders; Effects of AP on T4, LH and IgE levels in blood of human patients; AP in piglet diarrhoea - comparison with antibiotic therapy; AP in bovine infertility (repeat breeders, anoestrus, cystic ovaries). Vet AP research projects planned for the future: Pig production is most important to the agricultural economy of Taiwan. Clinical AP research will be aimed at control of three major problems in pigs: 1. Delayed puberty in gilts; 2. Postpartum anoestrus and infertility in sows; 3. Postpartum agalactia. Milk and beef are less important to the Taiwan economy. However, because of very positive results in preliminary trials, further work will be conducted on AP effects on bovine fertility. These projects will be carried out under the direction of Jen-Hsou Lin from the Dept. Animal Husbandry, National Taiwan University (Taipei) and H.P. Fung, of the Vet School (Taichung), in co-operation with other vets and commercial stockmen.

5. AP TRAINING IN TAIWAN, R.0.C. The quality of AP training in Taiwan varies widely. It ranges from weekend "crash-courses" (which are usually intended as an ongoing part of an integrated study of AP) to formal courses lasting one month to three years. As well as this, one may opt for "self- study" from the human AP textbooks, with or without formal course work. Unscrupulous people who attend one or two weekend crash-courses (and who may happen to be medical or vet graduates!) may use this as their "qualification" to practice AP. Poor clinical results by such people brings AP into disrepute and unsuspecting patients suffer as a result of the incompetence of the charlatans. This problem is not confined to Taiwan - it is now an international problem. Each teaching centre has its own methods of assessing its students but the course content and duration vary widely. Taiwan, as is the case in most other countries, appears to have no standard Examination or Assessment Board at State (National) level to assess and certify the level of competence of AP practitioners. Thus, the level of competence varies from excellent (as observed in the VGH and CMC) to poor. The content (orientation) of courses varies with the teaching centre. In VGH (Taipei) the course content is mainly "Western" oriented - little emphasis is placed on the ancient traditional concepts of Pulse Diagnosis; Five Phase Laws and Points; the Perverse Causes of Disease etc. Because of its closer ties to traditional medicine, CMC (Taichung) places more emphasis on traditional concepts and on traditional needling techniques (tonification/dispersion etc). However, CMC is also very "Western" oriented in its basic undergraduate medical training. Students from this college understand both Eastern and Western concepts. CARF (Taipei) because its faculty numbers include both "traditional" and "Western" doctors, also teaches the two differing concepts. There are many other centres for AP training in Taiwan, but I have no information on them. The foregoing three organisations accept foreign medical graduates and vet surgeons on their courses. Students attending any of these courses can expect to have extensive exposure to clinical material, because VGH/CMC have their own (large) clinics, and CARF can provide clinical instruction in co-operation with Taipei hospitals. The cost of tuition depends on the duration of the course. For example, medical or vet graduates (who have already studied basic AP techniques elsewhere) may enrol for a 1-month intensive advanced course, including clinical work, at any of the above 3 centres. The cost of tuition plus lectures notes etc is approximately 1200 US $. Specialised courses (for example in E.N.T. diseases; internal diseases; myofascial pain, etc) can be arranged by negotiation with the Faculty. The concession to allow vets to attend these courses was granted by CMC and VGH in 1982 on the understanding that the techniques learned there would be used primarily in vet practice, or for research purposes. It is recognised and accepted throughout China, Taiwan, Japan and other Far Eastern countries that knowledge and skill in AP is not confined to medical or traditional doctors. Many people learn it as part of their cultural training in the martial arts, TaiQi, QiGong and other mental and physical disciplines. It is also common that one may have a basic knowledge of AP for self-help, or for use in "First-Aid" in minor problems and for family use, for example, the AP or massage techniques to relieve tension headaches; teething problems in babies; indigestion in children; pulled muscles; tension insomnia etc.

I recommend these courses to vet colleagues who may have the opportunity to take an extended holiday-cum-study trip in a most beautiful country. I would advise them to ask for an outline of the course material (and the fees involved) and to make their reservations in plenty of time. Those interested may contact the AP Dept., VGH, Taipei, the AP Dept., CMC, Taichung or CARF, Box 84-223, Taipei. Accommodation in Taiwan and travel to and from the course is the responsibility of the candidate but each organisation offers assistance and advice, if required. ACKNOWLEDGEMENTS My first trip to the Far East was made possible by Drs. Hong Chien Ha and T.C. Hsu of the Committee of the First International Symposium on AP and Moxibustion, Taipei, and by JenHsou Lin of the Committee of the Veterinary AP Seminar, Vet School, Taichung. These men arranged for my travel to and accommodation in Taiwan. Great credit and thanks are due to them for their organisation of the scientific sessions and their fantastic hospitality during my stay, from 14th to 28th November 1982. My sincere thanks are due to all who helped to make my visit enjoyable and educational; the Taiwan Government, for funding the trip; the organisers of the International Symposium and the Veterinary Seminar, for inviting me; medical colleagues at VGH, Yang Ming Medical College and CARF (Taipei) and CMC (Taichung); vet colleagues, staff and students at the Vet College (Taichung), the Pig Research Institute (Chunan) and the Dept. Animal Husbandry, National Taiwan University (Taipei) for their patience in answering so many questions, and for showing me their skills; to the Tsang brothers for their time, car and generosity; to my friend and colleague, Jen-Hsou Lin, who made it all possible; his wife Li Fei, who fed me, and to their little girls I Chen and I Chien, who made the red-haired barbarian laugh on Yang Ming mountain. AP ANALGESIA (AA) IN COWS Summary from Sheila White's article (1982) Murdoch Vet. School, West Australia 6150. White has recently had good analgesia for 2 abdominal operations in cows. #1 was rumenotomy for rumen/omasal/abomasal impaction. #2 was large (45 cm) abscess with adhesions in the spiral colon (right incision below the paralumbar fossa). Three points were used. Cows were >600 kg. A: BaiHui (GV03, lumbosacral space), depth 5 cm; B: MingMen (GV04), in the space between lumbar 2-3, depth 4 cm; C: YaoPang (Veterinary point, at tip of transverse process of Lumbar 1. A long needle (12 cm) was inserted anteriorly (pointed at body of last thoracic vertebra) and angled downwards, to slide under the wing of the transverse process, aimed at body of last thoracic vertebra. Depth 5.5-6 cm.

Needles B and C were joined by copper wire and connected to one lead of 73-10 stimulator. Needle A was connected to the other lead. Frequency 15-28 Hz, square wave. Analgesia in #cow 1 at 20 minutes. Analgesia in #cow 2 not good at 20 minutes. Needle removed and replaced. Good analgesia 30 minutes later (i.e. at 50 minutes). Both operations were satisfactory under EA, with no other anaesthetic required. The operations lasted 2-3 hours. Both cows recovered uneventfully. Note, for right flank operation, right YaoPang was used. For left operation, left YaoPang was used. AA ATTEMPT IN A COW IN TAIPEI by J.H. Lin and P.A.M. Rogers We attempted to induce AA in a Friesian cow at the Dept. Animal Husbandry, NTU. We have used BaiHui, MingMen and left YaoPang, as described above. The stimulator used was made locally. The frequency was approximately 15 Hz. The pain stimulus used was to (attempt to) transfix a fold of skin grasped between thumb and index finger using a 1.5", 21 gauge needle. The cow had a very nervous temperament. Any quick touching of the skin (of either flank) by the needle, evoked strong, immediate reflex muscle twitch, and defensive action. After 20 min. of stimulation, the cow reacted as before to quick needle stimulus and no penetration of a skin fold was attempted because of this. After 30 min. of stimulation, the reaction to quick stimulus was less active but still present on most sites. Then we realised that (because of the nervous temperament of the cow) the reaction to quick needle stimulus might have been due to touch (rather than pain). We then applied slow, gradual and firm pressure on the needle to a skin fold. There was no reaction and it was possible to completely transfix the fold. In c. 9/10 sites tested on the left flank, perinaeum, vulva and upper (posterior) aspect of the udder, no defensive reaction or rapid muscle twitch was elicited on transfixing the fold. Full sensitivity was still present at this time on the right flank and on the right and left thorax. We concluded that the attempt (our first, using these points) was about 90% effective to the slow transfixion and that the hypoalgesia was limited mainly to the left flank area. TAIWAN

WOOD - BEGINNING 0 terrible orgasm of Mother Earth, Awesome power in aeons past, With mighty roars she came and cameNo pleasure here, no slippery thighs, No gentle fingers, no trembling sighs

But bowels churning with white heatGushing, pouring, spewing, heaving Sulphurous molten rock: Taiwan.

FIRE - BIRTH Alone and unattended She, Her bearing closed by sand and sea, Through gaping wound across Her belly Expelled Her screaming child. Up, up it rose from ocean floor To tower high o'er boiling shore: Taiwan.

EARTH - GROWTH/DEVELOPMENT O'er Yang Ming peak I saw you born. Fierce winds and waves and whistling sprays Scraped and shaped your wondrous bays. On Chunan plains you saved the corn. From little junks you hauled your nets. In alleyways you placed your bets. On crowded streets you hurried by, By taxis, cycles nearly killed. 0 slant-eyed beauty of black eye ! You caused my semen to be spilled Ten billion times: Taiwan.

METAL - MATURITY Young girls proud in country free, Young men summoning TaiQi, Army alert constantly Face the threat from o'er the sea: Taiwan.

WATER - DEATH/REBIRTH Little jewel of the East May your people live in peace. May they never have to see Obscenity like Nag'saki. May the West learn what you teach: Hard work, honour, close family,

Pride of self and history: Taiwan. QUESTIONS Channel codes used in these questions are: LU, LI, ST, SP, HT, SI, BL, KI, PC, TH, GB, LV, CV, GV. 1. One of the following statements is not correct. Indicate the incorrect statement: (a) Chinese medicine, as practised in Taiwan, combines the best of "Western" and "Traditional Chinese" medicine. (b) TCM involves study of AP, moxibustion and Herbal Medicine. The latter is most important. (c) For all branches of TCM, the medical theory (Yin-Yang, Five Phases, Perverse Causes of Disease, Disease syndromes and Diagnostics) is the same. (d) In Taiwan, all herbalists are trained in AP and all acupuncturists are trained in Herbal Medicine. (e) Chinese Herbal Medicine is very valuable in CVA, hypertension, neurasthenia and many other internal diseases. 2. One of the following statements is not correct. Indicate the incorrect statement: (a) "The Red Book of Chinese Medicine" (by Mao Tse Tung) was the basic text used by most Taiwanese experts in acupuncture. (b) Methods of selecting AP points for therapy, and of manipulating the needles, were highly individualistic in Taiwan. (c) There was general agreement that manual needling alone was as good as, or better, than electro-needling for most conditions requiring AP. (d) Though electrostimulators were freely available in every clinic visited, Rogers saw very little use of electro-AP. Exceptions were: AP analgesia before surgery and in certain chronic conditions, especially paralysis/paresis after CVA or nerve injury. (e) Great emphasis was placed on a careful search for AhShi points. 3. One of the following statements is not correct. Indicate the incorrect statement: (a) AhShi points usually are present in pain conditions, such as headache, joint pain and myofascial syndromes. (b) AhShi points may also arise in some cases of internal disease (lung, heart, liver, gall bladder, gastrointestinal and urogenital tracts).

(c) The Shu points (T3 to S4 on the inner line of the BL Channel) are palpated carefully in internal disease, as are the Mu points (Alarm points on the abdomen/thorax). (d) AhShi points often arise in joint pain (shoulder, elbow, lowback syndrome, hip, knee) (e) Headache seldom arises from AhShi points in the neck and shoulder muscles 4. One of the following statements is not correct. Indicate the incorrect statement: (a) All pressure-sensitive areas are AhShi points but AhShi points are not always Trigger Points (TPs). (b) The best AhShi point for therapy is the Trigger Point (TP), i.e. palpation pressure on the point causes a pain sensation to radiate to the problem area, muscle, or organ. (c) The AhShi point seldom occurs within the area of pain. Patients usually are unaware of its presence until it is palpated. (d) AhShi points always occur far away from the problem area. (e) AhShi/TP points can recruit new triggers elsewhere, usually in the muscles. 5. One of the following statements is not correct. Indicate the incorrect statement: (a) Painful areas in scarred tissue may act as powerful TPs and these areas must be treated to obtain optimum results. (b) Taiwanese acupuncturists placed great emphasis on searching for (and treating) TPs in scarred areas. (c) Other pain-sensitive areas (motor points, "fibrositic nodules" etc) are useful in therapy but they are not as powerful as the TPs. (d) AhShi therapy is the best introduction to the benefits of needle therapy. (e) Unfortunately, AhShi points are not present in every case, and Western doctors who know only the AhShi method are unable to help by needle techniques in such cases. 6. One of the following statements is not correct. Indicate the incorrect statement: (a) AhShi points disappear when the condition resolves and their disappearance during a course of therapy indicates a good prognosis. (b) Dr. Chien Chung did extensive clinical research with AhShi points and published the English version of his book ("AhShih point: The pressure pain point in AP - Illustrated guide to clinical AP (1983)". (c) AhShi therapy consistently gives better results than traditional AP.

(d) Myofascial syndrome involves muscle pain/stiffness, especially around joints. The joints are often stiff, but show no inflammatory or X-ray lesions. There is often a history of intermittent recurrence. The diet usually is satisfactory and the neural causes of the pain are obscure. (e) AhShi (TP) points often are present in myofascial syndromes, but the patient is unaware of them until they are pressed. 7. One of the following statements is not correct. Indicate the incorrect statement: (a) AhShi points usually show decreased electrical resistance and decreased local skin temperature. (b) Local vasomotor abnormalities and dermatographic changes occur in the AhShi area. (c) Histology of the AhShi area shows local cell infiltration and non-specific inflammatory changes. There is sometimes a fibrous infiltration of the AhShi area (ropy muscle sign). (d) Pressure on the AhShi often refers pain to the "problem area". Needling the AhShi often causes the "Jump Sign": local muscle contractions cause the needle to jump. (e) Master acupuncturists always needle the area of referred pain (the area of subjective pain). 8. One of the following statements is not correct. Indicate the incorrect statement: (a) In myofascial syndromes, AhShi therapy very seldom gives dramatic or immediate relief of pain. (b) AhShi therapy in myofascial cases can give better results than traditional AP using local and distant points. (c) AhShi points may arise anywhere in the muscles, but they are often near the problem area. (d) The most important muscles to search for upper body problems are: infraspinatus, neck muscles and GB21 area. In upper limb pain (shoulder, elbow, arm, etc) the AhShi is often in the infraspinatus of the affected limb. In shoulder pain, sometimes the GB21 area, or scalenus muscle may hold the AhShi. In bilateral anterolateral shoulder pain, the AhShi is often in the sternalis muscle. In such cases, one needle in the sternal AhShi can give immediate pain relief. In middle finger pain, search muscles near TH08. (e) In abdominal and intercostal pain, check the back and sides for AhShi. For lower body problems search the gluteus, vastus medialis, soleus, gastrocnemius. In heel pain, the AhShi is often in the soleus area, left or right of BL57. In plantar pain, the AhShi is often in the gastrocnemius. In lowback/leg pain, search the gluteus muscle. 9. One of the following statements is not correct. Indicate the incorrect statement:

(a) About 33% of all cases of aching pain are myofascial in origin and respond fast and reliably to AhShi therapy. Expect excellent results in 38% and good results in 60% of cases (98% total cases). (b) Chung's AhShi findings disagree in major respects from Western experiences of TP therapy, as described by Ronald Melzack (Canada), Pekka Pontinen (Finland) and Alex Macdonald (UK). (c) Chung found the following points to be useful: Renal colic pain/spasm: GB34, LV03, SP04,06; Gastric colic/pain/spasm: ST36, CV12; Biliary colic/pain/spasm: GB34 (d) Rogers did not see use of Earpoints in Taiwan, but was told that earpoints are sometimes used alone or in combination with body points, with good success. (e) The most commonly used points use were the Channel points, especially LU07; LI04,10,11,15; ST25,36,37,38; SP04,06,09; HT07; SI03,06,09,11,19; BL10,11,23,40,57,60,62, KI03, PC06, TH05,14,15, GB20,21,30,31,34,39, LV03, CV04,12. 10. One of the following statements is not correct. Indicate the incorrect statement: (a) GV points were seldom seen used. GV15, needled 2" deep in one patient, appeared to cause a very severe left-sided headache, needle shock and some loss of power in the legs. The patient was being treated for facial paralysis and slurred speech following a minor CVA. (b) Extra-Channel Points (points not on the main Channels) often were used for their local or distant effects. The most commonly seen were Hand Points "Loin & Leg" between the proximal heads of metacarpals 2-3 and 4-5 respectively. These Hand Points gave immediate relief in some cases of lumbago and lowback/leg pain. (c) Hand Point "Neck" (between the knuckles of fingers 2-3 with fist tightly closed, needled 1" deep towards the wrist. This point gave immediate relief of neck pain/restricted movement in one patient. (d) Other points used were: LanWei (Appendix point) in abdominal pain/ constipation, XiYan (Knee Eyes) in knee pain, YinTang (between eyebrows) and TaiYang (temporal fossa) in headache, sinusitis. (e) As they seldom give good results, distant points were seldom used. For example, the following points gave poor results: ST38, GB39 or GB34 in shoulder or neck problems; LU07 in headaches; TH03, SI03 in neck/shoulder problems. 11. One of the following statements is not correct. Indicate the incorrect statement: (a) Chung seldom used distant points in myofascial or arthrotic syndromes. (b) If patient was not helped within 20 minutes, the needles were left in situ for up to 40 minutes and other points (AhShi, Local points) were tried also.

(c) In needle use, operators were very careful to cleanse the skin (alcohol swab), use sterile and/or disposable needles and to touch only the handle (not the shaft) when inserting the needle. (d) Styles of inserting and manipulating the needle varied between operators but most operators placed great importance on obtaining DeQi after needle insertion. (e) Chung twirled and pecked the needle very strongly in AhShi/TP points for 15-60 seconds. The patient often had very strong reaction to this (grunts, slight groans, facial grimaces etc). In many cases, the needle was removed within the 15-60 seconds. 12. One of the following statements is not correct. Indicate the incorrect statement: (a) DeQi has subjective (patient and operator) and objective characteristics. (b) The patient reports strong sensations ("sore, heavy, tingling, electric shock-like, running, aching but not painful") running, proximally, or distally from the needle. Sometimes the sensation is said to travel proximally and distally. (c) The patient may grunt, groan, flinch the limb or part being needled. Other responses include explosive intake or expulsion of breath, facial grimaces and occasionally (in strong reactors) sudden jerks involving all or part of the body, and occasional expletives. (d) The operator usually has the sensation that the needle is being gripped by the tissue, i.e. especially on withdrawal of the needle, (when a definite "nipple" seems to form at the skin surface) or on twirling of the needle (when the needle seems to "lock" at the end of each twirl). (e) A clear 1-3 cm diameter blanched zone (vasoconstriction) appears around the needle after a few minutes in some patients.

1 = d 2 = a 3 = e 4 = d 5 = b 6 = c 7 = e 8 = a 9 = b 10 = e 11 = a 12 = e

CLINICAL ACUPUNCTURE IN HORSES This paper is based on published material (textbooks, journals etc), as well as on written and verbal material from colleagues in many countries, together with our own clinical experience with horses. The paper is given in three main parts: 1. Indications and contraindications for AP in horses; 2. Points and methods used in common conditions in equine practice; 3. APPENDIX: Acupuncture point locations and Channel functions.

The Appendix discusses Traditional versus the Transposition systems and the location of the traditional and transposed points in horses. It also contains 26 figures and 26 charts showing the location of the points and the main points used in many common conditions in horses. Those unfamiliar with AP should study the Appendix and the references listed in it.

Rogers wrote the first drafts for seminars in Tokyo and Melbourne in 1985. He sent the drafts to Dr. Cain, who made major changes then. The texts were corrected further and updated for the IVAS Congress (Antwerp 1987) and for courses in Arhus (1988), (Oslo 1988), Sydney (1991) and Dublin (1996). Without Dr. Cain's input, these papers would have been less valuable than excreta from the taurine rectum. Most of the detail on point location and function is his work.

The International Veterinary Acupuncture Society (IVAS) has existed since 1974. Since then, documentation of the effects of acupuncture (AP) in humans, small animals and laboratory animals has been much more extensive than in horses. AP is used today by veterinarians in more than 34 countries and, in most of these, horses are also treated by AP. In an attempt to document the current methods used and to give specific examples of AP in "Western" clinical equine practice, questionnaires were sent to veterinarians experienced in equine AP, especially to colleagues in IVAS. They were asked to indicate conditions which they found were responsive to AP and the points and methods which they use.

The following colleagues gave details of their approach to equine AP, either in formal or informal meetings, discussions or correspondence: Grady-Young,H., (deceased) of Thomasville, Georgia, USA; Jeffries,D., 2612 White Rd., Grove City, Ohio 43123, USA; Johnson,R., 209 Lake Aires Rd., Fairmont, MN 56031, USA; and Kuussaari,J., 25460 Toija, Finland.

Basic texts on large animal AP are scarce. The best include those by Hwang,Y.C., Dept. Anatomy, Veterinary School, Tuskeegee, AL 36088, USA; Klide,A., Dept. Anaesthesia, Veterinary School, Philadelphia, USA; Kothbauer,O., Windberg 2, Grieskirchen, OberOsterreich, Austria; Lin,J.H., Dept. Animal Husbandry, National Taiwan University, Taipei, Taiwan, ROC; van den Bosch,E., G. van Heuvelstraat, Ramsel, Belgium; Westermayer,E., (deceased) Bellamont, Sud Wurttemberg, Germany; and White,S., Dept. Anatomy, Veterinary School, Murdoch University, West Australia. The authors of those texts kindly presented us with copies of their work and explained their methods to us.

To these friends, to many others unnamed, and to our patients who have taught us to listen to the body we give our most sincere thanks. 1. INDICATIONS AND CONTRAINDICATIONS ABSTRACT Acupuncture (AP) has major effects on the autonomic, nervous and endocrine systems. It has immunostimulant, immunosuppressive, analgesic and antiinflammatory effects. It can influence the physiological processes of all major systems. It has therapeutic value when the affected organ or function is capable of responding through the normal response mechanisms. AP is physiotherapy at its most powerful.

The main indications for AP therapy are functional disorders of the musculoskeletal, nervous (central or peripheral), gastrointestinal, reproductive, urinary and respiratory systems. Certain conditions of the skin and eye can be helped. The most important indication is in muscular lameness (neck, back, limb muscles) and in poor athletic performance due to soft tissue involvement. Milder or more acute problems usually respond faster and better than chronic problems. However, many chronic diseases, (including chronic laminitis and navicular disease) and certain serious acute diseases (including severe non-obstructive colic) can respond.

The main contraindications are severe organic disease in which irreversible change has occurred already (calcification, fracture chips, cancer, necrosis, fibrosis, degeneration, degenerative myelopathies). Although AP may help to control symptoms in toxic, infectious, nutritional and neoplastic diseases, its use as a primary therapy in such cases is contraindicated but it could be combined with chemotherapy, other therapies and dietary supplementation.

The cost factor may be an important contraindication. A prolonged course of AP might not be justified on economic grounds in horses of low cash value, whereas it might be justified in horses of great cash- or sentimental- value.

INTRODUCTION Specific areas (Trigger Points (TPs) and the AP points (APs), usually in muscle and skin) often become tender in response to pathogenic irritation of organs or body parts. Segmental, intersegmental, supraspinal and autonomic reflexes mediate this response. Tenderness or increased sensitivity of the TPs and APs may be found by firm palpation or by the response to constant thermal or electrical stimuli applied to the points. Alternatively, electrical resistance-, impedance- or conductance- meters may be used to detect the increased permeability of the skin points. As these points related via the nervous system to the affected parts, stimulation of the points by , TENS, needling, point-injection and other methods can evoke a reflex therapeutic response in the affected organ or part. The diagnostic and therapeutic efficacy of the organ-point relationship is possible only if the nervous system is functional and if the affected part is capable of the desired physiological response.

AP influences all physiological systems, including the nervous (central, autonomic and peripheral), endocrine, musculoskeletal, gastrointestinal, urogenital, respiratory and skin. It has analgesic, antiinflammatory, immunostimulant and immunosuppressive effects. It has antispasmodic effects on striated and smooth muscle. It has marked effect on blood microcirculation, cell metabolism and glandular secretion in organs related to the APs being stimulated.

AP is a most powerful physiotherapy. Its therapeutic effects are mediated by the reflex system and by activation of spinal and central neuroendocrine and systemic responses. Its therapeutic value lies in its ability to induce homoeostasis. For example, needling ST36 (TsuSanLi) can control gastric spasm in one case and gastric atony in another. The same point can have diametrically opposite physiological effects, depending on the homoeostatic needs of the body at that time.

Therapeutic effects of AP are possible only when the normal physiological mechanisms of the body are capable of response. For example, AP can have little or no effect on paralysis due to spinal transection, motor neuron degeneration (German Shepherd syndrome) or severe damage to motor centres in the brain. However, AP can accelerate recovery in paralysis due to peripheral nerve trauma or radiculopathy due to soft tissue inflammation or in CVA cases where paralysis is due mainly to vasospastic ischaemia of the motor centres. AP may be useless in severe fibrosis of the liver or kidney but it can help in early hepatitis or nephritis, before the pathological changes have become severe or irreversible. In humans and animals, AP can be very helpful in bronchospasm but may be of little use in emphysema, in which severe rupture of the alveolar sacs has occurred.

The prognosis for full recovery is very good in paralysis due to cervical radiculopathy, if the symptoms are due to soft tissue swelling with very minor damage to the motor neurons or tracts but the prognosis is very poor if neuronal degeneration is severe.

The contraindications include neoplasia and severe organic disease. Although some claims are made for effectiveness of AP in tendinitis, many experts got poor results in these cases. Tendinitis responds poorly to AP of Local points over the tendon but Laser or "Plum Blossom Needling" may give a better response.

Although AP may help to control symptoms in neoplastic, toxic, infectious and nutritional diseases, its use as a primary therapy in such cases is contraindicated but it could be combined with chemotherapy, other therapies and dietary supplementation.

Table 1 summarises the more important indications for AP in horses but it is not a complete list. For example, AP can help in splints (especially inside splints), curbs, tying-up (azoturia) and skin problems (M.J.C).

CONCLUSIONS AP has many applications in equine practice. The conditions covered in this paper are only some of those which can be helped by AP. The success rate in many conditions is above 70%, especially in many lamenesses, functional diseases and infertility. Success often can be attained in 1-3 sessions at intervals of 1-3 days (acute cases) or in 1-10 sessions at intervals of 4-7 days (chronic cases).

The value of thoroughbred stock, stabling and training costs, the value of a foal in infertility cases are considerable. The AP technique is very safe if it is used properly (Rogers 1981). Therefore, AP must be deemed to be a valuable therapy for use on its own or in combination with other methods in thoroughbred practice.

Part 2 of this paper deals with the points and methods used in many common disorders of the horse. These are good indications for AP in horses but must not be interpreted as an exhaustive list. AP is a very versatile technique and offers much to the busy practitioner, the client and the patient. Table 1. Some of the more important indications for AP in horses. Condition

Author

% Success

Sessions days between

rate MUSCULOSKELETAL Soreback

20-100 1-12 Ca Jo Kl Ko Ku 75-85 (short 2-10 term) Ro Wh Y

(thoracic, lumbar, sacral)

0.5-1

5-7

2-4

1-3

3-4

2-6

1-3

3-7

20-80 (long term)

Saddle-sore

Ca Jo Ro Y

Shoulder lame

Ca Ku Ro Wh

80-100 80-90 (v. few relapse)

(acute, chronic)

Elbow lame

sessions Acute Chronic 0,5-4 3-7

Ca Ro We

70-80 (?)

1-3 recent 1-3 3-7

3-8 chron.

Hip, thigh lame Stifle lame

Ca Ro Ca Je

70-80 (?) > 90

Laminitis

Ca Kl Ku

80-90

same 1-2 1-4 (3)

80-90

1-12 (6) 3-7

same 2-4 2-4

3-7

Navicular Foot abscess PERIPHERAL N. PARALYSIS

Ca Jo Jo

>80 (?) >80 (?)

6 ?

?

Radial n. paralysis

Ca Hw Wh Y

90 (recent)

1-4

1

50-70 (> 2 weeks)

Facial n. paralysis Wobbler, cervical ataxia

Ca Wh Ca Je Ro

same 3-7

3-4 ?

3-7

1-10

? 1-10 50-80 recent 1-10

1 1-3

0-40 chronic 4-30

3-7 4-7 4-7

GASTROINTESTINAL Colic (sand, gas, bloat) Windsucking Cribbing Gastric ulcer Chronic diarrhoea

Ca Ko Ku Wh Ku Ku Ro Ro

80-100 1-2 67 29 100 (2 cases) 2 33 (3 cases) 3-5

0.5 2-6 (3) 2-6 (3) -

1-3 2-5 (4) 2-5 (4) 7 7

RESPIRATORY Heaves (no emphysema) Bleeders Rhinitis

Ko Ku We Y Ca Je Ro Y

Poor 50-85 75-90 > 90

1-6 4-8 1 3-5

1-3 1-3 -

3-7 3-7 3-4

REPRODUCTIVE

We Ca

60-70

2-4

5

Anoestrus Cystic ovary (better in luteal cysts)

Hw Jo Ku Wh Y 50-100

1-10(4)

1-5 (3)

Je Jo Ro Y

2-5 (3)

3-4

1-8 (3)

3-4

?

?

?

1 (implant)

-

75-90

Stallion problems

Ca Je Jo Ro Wh 70-95 Y Jo good

NERVOUS esp. female

Ca

Repeaters

good

Ca=Cain Hw=Hwang Je=Jeffries Jo=Johnson Kl=Klide Ko=Kothbauer Ku=Kuussaari Ro=Rogers We=Westermayer Wh=White Y=Grady-Young 2. POINTS AND METHODS USED IN THERAPY ABSTRACT Acupuncture (AP) therapy is based on stimulation of relevant reflex points. These are the AhShi points, paravertebral (Shu) points and other points with effects on specific organs, areas or functions. The choice of points can be made from traditional horse texts or by transposition of the human AP point system to the equine anatomy, or by combining both systems. Classical AP gives better and more long lasting results than Cookbook AP, especially in complicated cases.

There are other methods of point selection (earpoints, hoof points etc) and of point stimulation (magnets, staples, implants, Dermojet, Laser etc) but these methods must be regarded as experimental until adequate documentation and comparative clinical trials are available. Points and techniques used by leading international experts are described for many common conditions in horses. These include lameness, peripheral nerve paralysis, colic, windsucking, heaves, bleeders, infertility and nervousness.

The points may be stimulated by simple needling, electroneedling, point-injection or other methods. The classical method is simple needling for 20 minutes every 1-3 days in acute cases or every 4-7 days in chronic cases. Point-injection is fast, popular and effective in busy practice.

Most responsive cases show improvement after 1-4 sessions but 4-10 sessions or more may be needed in long standing serious cases.

When AP is accompanied with Herbal Medicine, success rates are higher and longer-lasting, especially in internal problems, such as gastrointestinal and respiratory disorders (bleeders etc) (M.J.C)

The locations of the AP points (APs) mentioned in the text are in an Appendix, together with 26 charts and 26 figures.

INTRODUCTION In classical AP, the practitioner seeks to identify any imbalances in the Jing-Luo (the classical Channel and Collateral) system, now called the Channel-Organ System (COS). These imbalances are corrected by stimulating specific AP points (APs). Unpublished research with thermography in the horse (Cain 1984) suggests that activation of APs causes immediate communication of energy with other points.

It is important to make a correct AP diagnosis before AP therapy is attempted. Cookbook AP is useful for beginners and can give good or excellent results in simple cases but beginners are advised to study AP in depth to get the best results. However, simply selecting tender points (TPs, AhShi points, "sore points") and needling a few points from Cookbook recipes is inferior therapy. Cookbook AP alone, without an adequate knowledge of traditional AP principles (Channel paths, Yin-Yang pairs of Channels, Master Points, Five Phase Theory, Shu-Mu relationships to Channel function etc) gives only mediocre results, at best. For long-lasting results, especially in complicated cases, the practitioner needs to know the classical principles, in order to correct the imbalances in body energies.

Part 2 discusses points and methods used by leading exponents of equine AP. Much of the clinical material was gathered by personal contact with experts and is confirmed by extensive clinical usage. The following areas are discussed:

1.0. Classical tonification and sedation points 1.0.1. Important Shu-Channel relationships 1.0.2. Ting Points in horses 1.1 Musculoskeletal problems 1.1.1. Soreback (thoracic, lumbar and sacral area) 1.1.2. Saddle-sore

1.1.3. Shoulder lameness 1.1.4. Elbow lameness 1.1.5. Hip and thigh lameness 1.1.6. Stifle and hock lameness 1.1.7. Laminitis, navicular disease, foot abscess 1.1.8. Tendinitis, splints, curbs 1.1.9. Azoturia, tying-up syndrome 1.2. Neurological problems 1.2.1. Peripheral nerve paralysis 1.2.2. Radial paralysis 1.2.3. Facial paralysis 1.2.4. Cervical ataxia (the Wobbler Syndrome) 1.3. Gastrointestinal problems 1.3.1. Colic 1.3.2. Windsucking, crib-biting 1.3.3. Gastric ulcer, diarrhoea 1.4. Respiratory problems 1.4.1. Bronchospasm, heaves, bronchitis 1.4.2. Bleeders, lung haemorrhage, epistaxis 1.4.3. Rhinitis, sinusitis 1.5. Reproductive problems 1.5.1. Anoestrus 1.5.2. Cystic ovary 1.5.3. Repeat breeders 1.5.4. Reproductive problems in stallions

1.6. Other clinical uses 1.6.1. Anxiety, nervousness, especially in filly 1.6.2. Skin problems 1.6.3. Cracked Heels

Charts 1-23 (Appendix) show the location of the main APs used in conditions 1.1-1.6.

1.0. CLASSICAL TONIFICATION AND SEDATION POINTS In TCM/Classical AP, the symptom picture, clinical exam, Chinese Pulses, facial and lingual colour etc may suggest energy (Qi) deficiency (hypoactive Qi = Xu) or excess (hyperactive Qi = Shi) in one or more Channels. Deficiency or excess Qi in a Channel can be corrected by many methods (herbal remedies, fasting, feeding, diuretics, bleeding, fluids, laxatives etc, as appropriate) but AP can also be used according to the Mother and Son Law of the Five Phase Cycle.

For Xu (deficiency) use Bu (tonification) needling: To stimulate (tonify) a weak Channel, one can needle its "Mother Point", manipulating the needle in Bu-style ("Tonification Mode", thrusting heavily and rapidly but lifting gently and slowly, while rotating the needle with small amplitude and low frequency).

For Shi (excess) use Xie (sedation) needling: To pacify (sedate) a hyperactive Channel, one can needle its "Son Point", manipulating the needle in Xie-style ("Sedation Mode", thrusting gently and slowly but lifting forcefully and rapidly, while rotating the needle with large amplitude and high frequency).

TONIFICATION AND SEDATION POINTS PHASE METAL EARTH FIRE WATER FIRE WOOD Mother Earth

Fire

Wood Metal

Wood Water

Son

Metal

Earth Wood

Earth Fire

Water

PHASE

METAL EARTH FIRE WATER FIRE WOOD

Channel

LU LI ST SP HT SI BL KI PC TH GB LV

To Tonify: 09

11 41

02 09 03 67

07 09 03 43 08

To Sedate: 05

02 45

05 07 08 65

01 07 10 38 02

For example, in acute bacterial enteritis, with excess Qi in LI and SI Channels (Metal and Fire), one could sedate LI at the Son (Water) point of LI (LI02) and sedate SI at the Son (Earth) point of SI (SI08), needling in Xie-style ("Sedation Mode"). One could also use fluids, demulcents, intestinal sedatives, antibacterials etc, as needed. In chronic bronchitis, with deficient Qi in the LU (Metal) Channel, one could tonify LU at its Mother (Earth) point (LU09), needling in Xu-style ("Tonification Mode"). These principles are explained in more detail in The Essentials of Chinese AP (Beijing 1993).

1.0.1. IMPORTANT SHU-CHANNEL RELATIONSHIPS The AhShi points and sensitivity at the Shu points (BL points in the paravertebral area) are most important in the selection of APs in horses. Shu point sensitivity often gives diagnostic information on the location of Channel problems and helps in the choice of APs for therapy.

If the Shu of one Channel is tender, the Shu of its paired Channel may be used also. The pairs are: Fire (HT-SI/PC-TH); Earth (SP-ST); Metal (LU-LI); Water (KI-BL); Wood (LV-GB). Thus, in hindlimb lameness, if BL23 (kidney Shu) is tender, one can add BL28 (bladder Shu) to the prescription.

The Sheng (Mother-Son) relationship is:

FIRE -> EARTH -> METAL -> WATER -> WOOD Yin Channels: HT, PC -> SP -> LU -> KI -> LV (HT, PC nurtures SP; LV is nurtured by KI etc)

Yang Channels: SI, TH -> ST -> LI -> BL -> GB (SI, TH nurtures ST; GB is nurtured by BL etc).

The Sheng (Mother-Son) relationship can be used clinically via the back Shu (Paravertebral BL) points:

The Mother point of HT is BL18 (LV) and of SI is BL19 (GB). The Son point of HT is BL20 (SP) and of SI is BL21 (ST).

The Mother point of SP is BL15,14 (HT, PC) and of ST is BL27,22 (SI, TH). The Son point of SP is BL13 (LU) and of ST IS BL25 (LI).

The Mother point of LU is BL20 (SP) and of LI is BL21 (ST). The Son point of LU is BL23 (KI) and of LI is BL28 (BL).

The Mother point of KI is BL13 (LU) and of BL is BL25 (LI). The Son point of KI is BL18 (LV) and of BL is BL19 (GB).

The Mother point of LV is BL23 (KI) and of GB is BL28 (BL). The Son point of LV is BL15 (HT) and of GB is BL27 (SI).

The Mother point of PC is BL18 (LV) and of TH is BL19 (GB). The Son point of PC is BL20 (SP) and of TH is BL21 (ST).

If there is weakness (deficiency) in a Channel, the Shu of the Mother Channel can help. If there is hyperactivity (excess energy) in a Channel, the Shu of the Son Channel can help. Thus, in weakness of KI, one could use the LU Shu (BL13) with other points; in weakness of LI, one could add the ST Shu (BL21). In excess of HT, one could add BL20 (SP Shu). In excess of ST, one could add BL25 (LI Shu). (See section 1.0. (above) for the more classical method).

Injury to Shu points, or to key APs, can have effects far more serious than "local injury" in a western sense. It may induce signs and symptoms in the associated organ or Channel and in related Channels. Injury to the paravertebral area from the withers to the tail, whether due to incompetent riding, badly fitting saddle etc must be identified and treated as quickly as possible.

Those who have not used AP in horses should study the references and, if possible, attend professional veterinary AP teaching seminars before trying to use the method. The information which follows is aimed at colleagues who know the basics of AP rather than at complete novices of the technique.

APs seem to have properties like magnetic vortices: they can receive and transmit electromagnetic signals. A point which is too deep to reach by the needle (such as KI24,25,26 on the chest wall medial to the shoulder muscles, or ST29,30 and SP12 in the abdominal muscles medial to the thigh muscles) can be acted upon by inserting a needle pointed towards the point, although the needle may not reach the point (M.J.C). The vortex theory is supported by the powerful effect of superficial implants in lameness of deep tissues or joints in horses and dogs. The implants (gold beads, orthopaedic suture wire etc) are dropped at whatever depth DeQi arrives (usually less than 1.5 inches (M.J.C). (See hip lameness, 1.1.5 below).

See Appendix 1 for details of the points and Channels (figures 1 to 26).

1.0.2. TING POINTS IN HORSES The Ting Zones, located 1-2 cm above the hoof-hair junction, are the most distal points on each Channel. Are Thoresen (Norway) pioneered their diagnostic and therapeutic use in horses. He found that stimulation of a distant reactive body AP point on the affected Channel caused complete disappearance of the pitting in the reactive Ting Zone, within seconds. This effect was visible from several metres away. The speed of this reaction indicates that the reactivity at the Ting Zone is functional and it confirms the connection between the Ting Zone and the Channel concept of TCM.

Stimulation of the correct Ting Zones causes a biological response in the microcirculation and in the affected organ(s), part(s) or function(s) and can influence all other reactive Zones on the affected Channel, especially the Shu points, as well as the parts traversed by the Channel. Thoresen found (and we have confirmed) that needling the appropriate (usually

reactive) Ting Zones can sedate ("satisfy", "cool" or obliterate reactivity from) reactive Shu points, or AhShi points elsewhere on the body within 2-15 minutes (and sometimes within 10 seconds).

Where more than 1 reactive Ting Zone is present, needling of the primary one (according to Five Phase Theory) is often followed by disappearance of the secondary Ting Zones within seconds.

Location of Ting Zones in horses Zones 1 and 7 medial side of the fore and hind hoof respectively, 1-2 cm anterior to a line with the posterior edge of the coronet.

Zones 2 and 8 medial side of the fore and hind hoof respectively, about 1/2 of the distance between Zones 1 and 3 or 7 and 9 respectively.

Zones 3 and 9 anterior midline of the fore and hind hoof respectively.

Zones 4 and 10 lateral side of the fore and hind hoof respectively, about 1/2 of the distance between Zones 3 and 5 or 9 and 11 respectively.

Zones 5 and 11 lateral side of the fore and hind hoof respectively, 1-2 cm anterior to a line with the posterior edge of the coronet.

Zones 6 and 12 in the hollow of the heel of the fore and hind foot respectively, on a line joining the highest point of the horn on the medial and lateral side of the hoof.

Zone 1 (HT09) (forelimb, posterolateral zone) relates to the Heart Channel. The horse often pulls up towards the end of the race for no apparent reason, especially in very hot or very cold weather. There can be lameness in different joints, which may alternate from time to time. Although the HT Channel relates to the forelimb, the lameness may also affect a hindlimb. Zone 1 is often reactive in overexertion. (See Zone 5). It may be reactive in bruised sole/soft horn, laminitis and flexor tendon strain.

Zone 2 (SI01) (forelimb, mid lateral zone) relates to the Small Intestine Channel and arteries, especially the larger vessels. The symptoms may be similar to those of Zone 1 but are less obvious or less severe. There are often intestinal problems, especially jejunal (colic, pain) and these often arise with change in feeding or a new supply of hay. This Zone often reacts in forelimb deep flexor tendon problems. It is often reactive together with Zones 10 and 11 (see below).

Zone 3 (TH01) (forelimb, anterior zone) relates to the Triple Heater Channel, skin microcirculation and especially to mucosae and joint cavities. There tends to be a recurrent sinusitis and the serous fluid in the joints is often too thin. The history often mentions frequent injections of hyaluronic acid. Zone 3 is often reactive in sore heels/heel haemorrhage, cracked heels and hoof-bend bleeders. The lesion in these cases is near Zones 6 and 12.

Zone 4 (LI01) (forelimb, mid medial zone) relates to the Large Intestine (Colon) Channel and to muscles of the forelimb and shoulder area. Faeces may smell sour and their consistency may vary widely. The case often shows purulent nasal discharges. Very often the horse pulls to one side in training or racing and does not want to lead, but prefers to run with a follower group. Trotters (which should not gallop) tend to gallop in the bends and may show signs of pain in the shoulder. Its therapeutic uses include neck problems, (reactive LI16-18, BL25), sinusitis, ankle (forelimb fetlock) problems and inside forelimb splint problems (M.J.C).

Zone 5 (LU11) (forelimb, posteromedial zone) relates to the Lung Channel. This Zone reacts often when the horse is forced to breathe dusty, stale or polluted air, or has been raced in cold weather. Zone 5 indicates whether left or right lung is affected. (The ipsilateral Zone is reactive). Zone 5 is nearly always reactive in overexertion (see Zone 1), in lung disorders and in poor quality horn (soft, easily cracked or too thin), bruised sole. Its therapeutic uses include respiratory problems, respiratory bleeders (reactive BL13, 13a, 41-47), inside forelimb splint problems, infection (M.J.C).

Zone 6 (PC09) (forelimb, between and above heel bulbs) relates to the Pericardium (Circulation-Sex) Channel, which influences the psyche and sexual hormones. The symptoms include changes in sexual behaviour, sweating, nervousness, forelimb superficial flexor tendon problems. Zone 6 is not a diagnostic Zone for beginners, as outlined below. It does not react in ways that can be detected manually by novices. It is included here to complete the systematic AP schema and because it is a valuable therapeutic Zone. Its choice is dictated by the history and symptoms.

Zone 7 (BL67) (hindlimb, posterolateral zone) relates to the Bladder Channel and the paravertebral muscles from neck to tail, in the area from the midline to 20-30 cm laterally. It relates to the hindlimb flexor tendons, especially the superficial flexors. In humans, the BL Channel is often related to headaches. Horses which are seen nodding, headpressing or headbanging often respond immediately to one treatment at Zone 7 and the response is longlasting.

Zone 8 (GB44) (hindlimb, mid lateral zone). The horse has no gallbladder but functions of the Gallbladder Channel in man are similar in the horse. Zone 8 relates to the GB Channel which relates to the back and head lateral to Zone 7, i.e. paravertebral in an area 30-60 cm lateral to the midline. It is strongly related to the hip joint and to the area of insertion of the Longissimus dorsi muscle to the tuber coxae. Marked pain sensitivity in the hip or tuber coxae area is usually associated with reactivity of Zone 8. The horse does not race well and pulls to one side. Trotters may gallop in the straight as well as on bends (see Zone 4). There may be recurrent colic (see Zone 2), especially at night. (Midnight is the hour of the GB energy in TCM).

Zone 9 (ST45) (hindlimb, anterior zone) relates to the Stomach Channel. This Channel relates to appetite, stomach function, mastitis and stamina in humans. Zone 9 is very important in cattle (mastitis) but horses rarely show reactivity at this Zone. It may be reactive in thoracic stiffness and in bone spavin. Its therapeutic uses include stifle problems, (reactive BL21, ST10, 25a, stifle points in the muscle groove below the tuber ischii), colic, toothache (M.J.C).

Zone 10 (LV01) (hindlimb, mid medial zone) relates to the Liver Channel, digestion, food allergies, detoxification, eye diseases, problems of the medial hindleg muscles, also to general musculature and fitness. It is one of the most common to be found reactive in the horse. Its value in therapy is enormous. It is reactive in hindlimb lameness, generalised muscle cramp (azoturia, tying-up syndrome, Monday morning disease, Easter disease, muscular dystrophy etc). Because of the importance of optimum muscle fitness in the horse, the importance of Zone 10 in diagnosis and therapy is obvious. It is also reactive in allergies (urticaria, food allergy etc) but not in dust allergy (see Zone 5). Zone 10 is often reactive together with Zones 2 and 11 (see).

Zone 11 (SP01) (hindlimb, posterolateral zone) relates to the Spleen-Pancreas Channel. In humans, this relates to digestion, reproduction, the muscles and the psyche. In horses, is diffuse. It is often reactive with Zones 2 and 10 (see). It may be used in prognosis with Zone 10 in muscle problems. If both Zones 10 and 11 are reactive together, the prognosis is bad and recovery may take several months. Even in cases where is reactive on its own, the prognosis is bad. The signs often are confined to the hindquarter, especially during racing. A change of diet (especially hay) can shorten the recovery time when is reactive. Homoeopathic

Arsenicum album D12 and Plumbum metallicum D30 (3 pillules each/day) also help to shorten recovery time by about 1 month in these cases.

Zone 12 (KI01) (hindlimb, between and above heel bulbs) relates to the Kidney Channel. The symptoms include stiffness or weakness of the lumbar area, stifle problems, bone problems (tendency to weakening, fracture, bone spavin etc), tendency to abortion and a very unreliable (dangerous) psyche. Nearly all horses with those symptoms benefit from treatment at Zone 12 and most horses between 1 to 2 years of age can also benefit from it. Zone 12 is not a diagnostic Zone for novices, as outlined below, as it does not react in ways that can easily be detected manually. It is included here to complete the systematic AP schema and because it is a valuable therapeutic Zone. Its choice is dictated by the history and symptoms.

Most details on the use of Ting Zones are from Thoresen's paper on the subject. We (Cain & Rogers), Peggy Fleming, Dominique Giniaux, Emiel van den Bosch and others, have confirmed the value of Ting Zone therapy in horses.

Clinical uses of Ting Points in horses Ting points can be used in organic syndromes as well as in functional disorders. Thoreson has treated more than 10 cases of bone spavin. Zones 9 and 12 (ST and KI) were usually reactive. Treatment at these Zones, plus 2 Dermojet treatments of the reactive (pain) point on the ear, gave improvement in all cases and about 90% were clinically cured and remained sound for more than 1 year.

Abortion: Add the relevant Ting point, especially KI

Bone spavin: Add the relevant Ting point, especially ST, KI

Bronchitis/cough/lung disorders: Add the relevant Ting point, especially LU

Colic, acute: Add the relevant Ting point, especially LI, SI, KI, GB

Cracked heels arise when Channel blockage is present over a period. Use of Ting Points predictably cures cracked heels in 5-7 days, even in severe long-lasting cases, especially if LU or LI are involved (M.J.C).

Diarrhoea: Add the relevant Ting point, especially LI, SI, LV, SP, ST

Dust allergy: Add the relevant Ting point, especially LU, LI, TH

Flexor tendon strain: reactive Ting Zones especially from LI, PC, TH, KI, BL, HT, SI. The usual interval to clinical success was 1-35 days, (mean of 2 weeks) and most could resume full training in 3-6 weeks. In acute cases of tendovaginitis, training may be resumed in 1-2 weeks. Tendovaginitis: Add the relevant Ting point, especially TH, LI, SI

Food allergy: Add the relevant Ting point, especially LV

Headache (headpressing, headbanging, nodders): Add the relevant Ting point, especially GB, BL

Joint pain, arthritis, uncomplicated strains: all reactive Ting Zones

Lung bleeders: Add the relevant Ting point, especially LU

Male viciousness, hitter, biter: Add the relevant Ting point, especially SP, PC, KI

Overexertion: Add the relevant Ting point, especially HT, SI, LU

Polyarthritic shifting lameness: Add the relevant Ting point, especially HT, SI, TH

Pulls to one side (check atlas !): Add the relevant Ting point, especially LV, GB

Sexual/reproductive/Female infertility/Nymphomania: Add the relevant Ting point, especially HT, TH, KI, LV, PC

Skin: Add the relevant Ting point, especially LU, TH, SP, LV

Sole haemorrhage/trauma, soft horn: Add the relevant Ting point, especially LU, HT, SI

Tracheitis: Add the relevant Ting point, especially LI, LU

Tying-up syndrome: Add the relevant Ting point, especially LV, SP

Urticaria: Add the relevant Ting point, especially LV, LU 1.1 MUSCULOSKELETAL PROBLEMS (Kothbauer; Westermayer; Jeffries; Hwang; Grady-Young; Kuussaari; White)

The paravertebral Shu are helpful diagnostic points to isolate Channel lameness. Once the Channel(s) are identified, all anatomical structures under or nearest to that Channel path are considered (and palpated). For example, the LI Channel passes through or near the intermediate and 3rd carpal bone, the inside shin, the osselet under the medial digital flexor tendon, the inside splint, anterior branch of suspensory ligament, shoulder bursa etc. In tenderness of BL25 (lumbar 4-5, large intestine Shu), the lameness may lie in those structures, if it is not due to primary strain of the lumbar area, or referred from the organ. Thus BL25 may relate to anterolateral forelimb lameness above the carpus or the anteromedial forelimb below the carpus. In such cases, apart from needling the affected Shu and other key points, one should balance the paired Channel of LI (LU) by needling BL13 (LU Shu).

Check for diagonal relationships. Forelimb lameness is often accompanied by AhShi (tenderness) at contralateral lumbosacral or hindlimb points (M.J.C). Also, hindlimb lameness is sometimes associated with AhShi points on the contralateral side of the neck.

Forelimb lameness: Add the relevant Ting point, especially LI, LU. Hindlimb lameness: Add the relevant Ting point, especially SP, KI, LV.

Search for tender points in all local problems (neck, shoulder, elbow, back, thoracolumbar, lumbosacral, hip, stifle, laminitis etc). These are the Trigger Points (TPs), Pain Points, or AhShi Points. Check especially the paraspinal area (neck and interscapular area in forelimb problems; thoracolumbar and lumbosacral area in hindlimb problems).

Ovarian or uterine irritation in mares and fillies, may cause severe sporadic lameness due to referred pain (hindquarter, hunched or rigid back and, occasionally, forelimb lameness). This may occur in cystic ovary or at the time of ovulation if there is a lot of local haemorrhage. It is essential in such cases to check for AhShi points related to the ovary and uterus (see section 1.5 below).

Experts locate the Channel imbalances and choose points according to Five Phase Theory (Sheng and Ko Cycles) and the relevant Ting and/or Shu points. If the Command Points are dangerous to needle (too distal on the limbs or in other sensitive areas), they can be treated by painless methods (Laser, LACER etc). This minimises the number of needles and sessions needed. It also gives longer lasting results than the Cookbook method.

Use AhShi points, Local points, Region points. Consider points with potent actions: BL11 (bones & joints); BL40 (hindlimb & back); LI04 (forelimb & general effects); ST36 (hindlimb & general effects); ST44 (hindlimb); TH05 (forelimb); GB34 (hindlimb, muscles, tendons, neck, shoulder & elbow); GV03 (BaiHui) (hindlimb, lumbosacral area, general effects); BL23 (lumbosacral and hindlimb, adrenal point (all stress conditions), ovary/kidney/Vitamin D/parathyroid/bone point & general effects).

Problems of the back, sacral- and gluteal- area respond better and longer and need fewer sessions if AP is combined with spinal manipulative therapy (M.J.C).

Treat for 20 minutes, 2-4 times at intervals of 1-2 days (acute) or 3-7 days (chronic). White suggests electro-AP for 20 minutes, repeated every 12-24 hours in acute cases with severe pain or paralysis. Before using electro- AP, ensure that the horse has not had adverse electrical experience in the past (electric goad etc).

1.1.1. Soreback (thoracic, lumbar and sacral area) (Fig. 1) (Cain; Kothbauer; Kuussaari; Klide; Grady-Young; Johnson; Rogers; White)

Search the back and paravertebral muscles for AhShi (tender) points. If the tail twitches during riding, this indicates AhShi at BL23 (kidney Shu). Use all AhShi points. Add BaiHui and points from BL18 (ICS 15) to BL26 (L5-L6) and BL28,30 (foramina S2,4) or points from BL17 (ICS 14) to BL25 (L4-L5) and BL27,29 (foramina S1,3). Use the more anterior points if the pain is more anterior. Consider also GV12; BL31,34,54 and the point at the meeting of the scapula and the anterior edge of the scapular cartilage (TH15 = TCVM PoChien).

Spinal and paravertebral muscle pain (cervical, thoracic, lumbar, sacral): Add the relevant Ting point, especially KI, GB, BL.

Lumbar weakness: Add the relevant Ting point, especially BL, KI, SI.

Treatment: injection, simple needling, electro-AP (20 seconds/needle) or Laser. Treat 1-2 times/week (usually every 5 days) for 2-10 times. In acute cases, with severe pain or paralysis, treat every 12-24 hours. Relapse within 6 months after successful treatment may be 5-50%.

1.1.2. Saddle-sore (Fig. 2) (Cain; Grady-Young; Johnson; Rogers)

In all cases of "saddle-sore", check the design and fit of the saddle and the habits, skill, balance and of the usual rider. Advise on necessary correction of detected faults. Advise the use of high-quality saddle-pads (especially cellular, gel-filled saddle pads, for the first few weeks after treatment.

Pain, stiffness, rigidity in the area of the saddle, is treated as in 1.1.1, above. Tenderness near BL18 (liver Shu) may be associated with a muddy colour of the mucosa of the eye. (The liver controls the eye in TCVM).

Use AhShi points plus BL points, especially BL21,23,25. Add the relevant Ting point, especially ST, SP, GB, LV, HT, LU, as may be indicated by the findings of the AP examination.

Treatment: Inject procaine-B12 (9 ml 1% procaine + 1 ml B12; 3000 units/ml at each point), using 19g needle, depth 3-4 cm (or) needle or electro-AP 20 minutes; 2/week; 2-4 times.

1.1.3. Shoulder lameness (Fig. 3) (Cain; Kuussaari; Rogers; White)

Check for cervical subluxation, especially in the area C6 to T1. See the LI, SI and TH Channels (Appendix). Check TH16 (endocrine), BL22 (TH Shu, endocrine), BL27 (SI Shu), BL25 (LI Shu).

SI10, if still tender after proper Channel balancing, is diagnostic for LOCAL shoulder lameness (OCD). TH14 may be tender in shoulder lameness but true joint lameness (OCD) is rare. More often, the lameness is muscular, referred from subluxation of vertebrae C6-T1, via the brachiocephalicus m., attached to the humeroscapular joint. Painful shoulder or neck can cause spasm of that and other muscles and a choppy forward stride on the ipsilateral forelimb. If the problem is ovarian, treat BL22 (TH Shu) and the sensitivity at TH16 usually disappears. If the problem is shoulder lameness, treat TH14 and SI10, with BL22 and 27 (Shu of TH and SI). If the shoulder pain is referred from the neck, treat the neck, with vertebral adjustments, if needed (see 1.2.4).

The main points are: AhShi points located in the muscles of the neck, scapular, shoulder and paravertebral area, with points from BL11,22,27; GB21; TH05,14,15,16; LI15,17; SI09,10,13,17; LU01,01a; ST10.

Treatment: Electro-AP (10-20 seconds/point) or simple needling (20-30 minutes), 2-6 times (mean 3) at intervals of 3-7 days (mean 4). White suggests 20 minutes electro-AP every day in acute cases.

If the lameness is due to irreversible OCD, gold bead implants at ST10, LI17, SI09,10,13,17, BL22,27 can halt the progress of the condition. If done at 1-2 years of age, the result is very good: most can go on to full training and racing (M.J.C). Few cases relapse after successful treatment.

1.1.4. Elbow lameness (Fig. 4) Lameness associated with AhShi points in the muscles behind the elbow is a good indication for AP. The points used are: AhShi points in the area (check also the scapular and neck muscles) Local points LI10,11,12; TH10; HT03; PC03; SI08 Region points (BL11; LI15; TH14; SI09 etc) additional points from TH05; LI05

Treat by simple AP, electro-AP or point injection every 3-7 days for 1-3 times in recent cases and 3-8 times in chronic cases.

1.1.5. Hip and thigh lameness (Fig. 5) (Cain; Rogers)

Hip and thigh lameness may be due to local muscle strain, hip arthritis, hip dysplasia or pain referred from the thoracolumbar area. Dysplasia is very common in horses. It is often misdiagnosed as stifle or hock lameness. In severe dysplasia, BL19,48 (GB Shu), GB29,30,31 are usually tender, making it possible to diagnose dysplasia pre-purchase (as in yearlings). Tenderness at all those points indicates a poor prognosis, even if the points are implanted. In mild cases, or in other cases of hip and thigh pain, needling those points gives very good results (M.J.C). In coxofemoral lameness of horses and dogs, insertion of gold

beads towards the rim of the acetabulum (using a 16 g 30 mm needle) has powerful clinical effects, even though the beads are inches away from the acetabulum in horses.

Injection of irritant substances (such as copper compounds) over the sciatic nerve may cause sciatica with hip and thigh lameness (Rogers). BL25 may be tender in sciatica.

The points most effective on the hip and thigh are: AhShi points in the thoracolumbar, sacral, hip-thigh and posterior thigh muscles. Local points (GB29,30,31,32; BL30,36,37,38,54; ST31,32,33,34) Region points (BaiHui; BL23,54) Additional points from BL18,19,25,27,47,48, GB21,25a,34,39 Add the relevant Ting point, especially GB.

Treatment: as for elbow lameness.

1.1.6. Stifle and hock lameness (Fig. 6) (Cain; Jeffries; Rogers)

Points BL36,36a,37 are diagnostic/therapeutic for the stifle. ST25a, at the lower, posterior edge of the tuber coxae (origin of tensor fascia lata) is also important. Add BL20,21, SP10, ST10 and point anterior to the origin of the biceps femoris (near BL35). Tenderness at BL18,20,23 (LV, SP, KI) suggests inside stifle. Tenderness at BL19,21,28 (GB, ST, BL) suggests outside stifle.

In stifle wear, Cain injects 10 ml Hypodermin (18g needle, 3 cm) towards BL40 in the intercondyloid fossa and adds SP09, ST36, GB34. Jeffries uses Sarapin (containing Vitamin B12 and C), 3 ml injected below the patella, medial and lateral to the patellar tendon at XiYan

(Knee Eyes = ST35) and the point posteromedial to the patellar tendon; ST36 (12 ml); KI10 (5 ml); BL40 (4 ml, 5 cm deep).

In stifle lameness, point injection is excellent in 1-2 sessions. Walk the horse for 2 days before return to the track.

In hock lameness, tenderness at BL18,20 (LV, SP) can help to diagnose cunean tendon problems (inside hock). Tenderness at BL19,28 (GB, BL), and BL27 (SI Shu, Son of GB) can arise in curbs. Reactive GB can cause spasm of the biceps femoris muscle, resulting in hindlimb lameness.

In hock lameness, Local points (BL60, KI03) and BL30,35,53,38,39,40, ST36 (hock-related points) are used with reactive BL points (M.J.C). In bone spavin, add the relevant Ting point, especially ST, KI.

1.1.7. Laminitis, navicular disease, foot abscess (Fig. 7) AP is successful in 80-90% of cases of laminitis in the short and longterm (Klide; Kuussaari). Acute cases respond faster than chronic cases. The most important points are FL21 and 22 (Klide and Kung's system). They are at the back of the hoof, at the medial and lateral cartilages (FL21) and in the centre of the hollow above the hoof (FL22).

Additional Local points are FL19 (two points on medial and lateral digital veins, dorsocaudal to fetlock) and FL20 (4-8 fen lateral to anterior of the coronet at the hoof-hair junction) (Klide).

Kuussaari also adds a point for the forelimb (behind the humerus in fossa between long and lateral heads of the triceps m. and the posterior edge of the deltoid m.).

Johnson also searches the paravertebral area. In laminitis and navicular disease, BL18 (liver Shu) and BL23 (kidney Shu) are often tender. Johnson adds these AhShi points and SI08 (forelimb) or BL40 (hindlimb). The veins (FL19) are bled only if there is heat in the coronary band. He may add BL11,12,13 as Region points in forelimb cases.

Cain punctures PC09 several times with a 16 gauge needle until the blood changes from tarry and dark to cherry red and normal viscosity. He adds puncture of medial and lateral digital veins or other terminal points (LU11, LI01, ST45, SP01, HT09, SI01, BL67, KI01, PC09, TH01, GB44, LV01) with 18 or 20g needles. These points are at the coronary band. It is helpful to puncture the medial and lateral digital veins with 18 or 20g needle also.

Add the relevant Ting point, especially HT, SI.

Treatment: simple AP or electro-AP, 1-4 times (mean of 3 times) every 2-4 days (mean of 3 days) in recent cases (Kuussaari) or 1-12 times (mean of 6 times) every 3-7 days in chronic cases (Klide, Johnson). Use corrective shoeing, silicone pads and foot care to put pressure on the frog supplements the AP effect.

Laser on LI04; LU07 (10 seconds/session) may help AP treatment (Johnson).

Navicular disease is treated with similar points but success in navicular is not as well documented as in laminitis. One theory of navicular disease is that of poor blood supply to the area. Vasodilators and anticoagulants have been used in attempts to alleviate this. Vasodilation can follow AP at Local points but Region points, can help also:

Forelimb: LI11,15; TH05,14; SI09; BL11 etc Hindlimb: GB30,34; ST36; BL40; BL23; BaiHui

Johnson claims excellent results in navicular disease. Treatment is to a maximum of 6 times in 3 weeks (some need less than this). He uses electro- AP, with 7-8 cm 26g needles. No twitch is necessary in most cases. Laser at LI04 and LU07 helps.

Foot abscess is treated as for laminitis or navicular disease (Johnson).

Hoof-bend bleeders, heelcracks, heel haemorrhage/sores: Add the relevant Ting point, especially TH (Thoresen).

1.1.8. Tendinitis, splints, curbs (Cain)

Tendinitis and sheath inflammation may be helped by application of local Laser. Many veterinarians find that Laser is better than standard AP. Plum Blossom Needling has helped in problems of the superficial flexor tendons. Many cases of injury to the tendon sheath are misdiagnosed as tendon tears. Sheath injuries respond well to stimulation of Local and Channel points. Local circulation is enhanced. Intradermal or dermal needle implants, left in place for several days, help.

Magnets (500 gauss) with gold bead centres (CORIMAGS) may be glued on with Superglue. They are remarkably beneficial if used with Laser or AP.

Splints (especially inside) respond very well when the affected Channels are balanced. Inside splints are usually related to the ipsilateral stifle. The Channels LU, SP are those primarily involved, with LI and ST as secondary.

Curbs respond well to local therapy when the affected Channels (GB, LV) are balanced.

1.1.9. Azoturia, tying-up syndrome (Cain)

Azoturia often accompanies the tying-up syndrome. CPK, SGOT levels usually are elevated in blood. The syndrome occurs especially in spring (season of Wood, GB-LV). It is a common racetrack problem and responds very well if GB-LV, SP-ST, KI-BL can be balanced. These are Wood, Earth, Water in the Five Phase Cycle. See the Sheng and Ko Cycles in classical AP. See section 1.0 and the Appendix.

1.2. NEUROLOGICAL PROBLEMS

1.2.1. Peripheral nerve paralysis (Fig. 8) AP is of no real use in paralysis due to spinal transection, motor neuron degeneration (German Shepherd syndrome) or severe damage to motor centres in the brain. It can accelerate recovery in paralysis with radiculopathy due to soft tissue inflammation or in CVA cases where paralysis is due mainly to vasospastic ischaemia of the motor centres. It helps to establish a cross-spinal reflex arc, which can be important in the salvage of a horse with traumatic "Wobbler Syndrome".

Peripheral nerve paralysis, especially that following trauma, also can be helped by AP. The points are usually along the course of the affected nerve but points are often stimulated on the normal side also.

In brain or spinal paralysis in humans (such as arm paralysis after cerebrovascular accident or leg paralysis after polio), a chain of points along the nerve is used. For example, sciatic nerve:BL31,35,36,36a,37,38,40,57,60; GB30,31,34,39. Add BL19 (GB) and BL28 (BL) to balance Channels if GB and BL points are used. Add ST10 and BL21 if ST points are used.

In paralysis, electro-AP is better than simple needling but great care is needed to avoid electrical burns or electrolytic lesions in areas with sensory paralysis. Alternatively, inject the points with homoeopathic acid substances (ascorbic acid or HCl 9c). If definite improvement is not seen by 10 sessions, further AP is unlikely to be helpful.

1.2.2. Radial paralysis (Fig. 8) (Cain; Hwang; Grady-Young; White)

Expect 90% success if recent case; 50-70% if paralysis is more than 2 weeks old. Use local AhShi points. Add points from LI04,10,11,15; LU01,01a, SI08,10; TH10,14 bilateral. Add

BL27,22,13,25 respectively to balance the Channels if SI, TH, LU, LI points are used (M.J.C).

White suggests electro-AP for 30 minutes every day in acute cases. Others would treat every 3-7 days in chronic cases.

1.2.3. Facial paralysis (Fig. 8) Points such as ST02-06; CV24; GV26; LI20 are used, depending on the nerve affected. In TCVM, the classic points are: SouKou; KaiGuan; BaoSai; FuTu. HouMen and HouYu on the neck (see White 1985) may be added to these. Add BL21 and BL25 to balance ST and LI points, if these are used (M.J.C).

1.2.4. Cervical ataxia (the Wobbler Syndrome) (Fig. 9) (Cain; Jeffries; Rogers)

Early cases of ataxia in young horses can be helped or cured completely by AP. It is one of the most rewarding applications of AP therapy. Wobblers respond better and longer and need fewer sessions if AP is combined with spinal manipulative therapy (M.J.C). Adjustment of the neck vertebrae must accompany AP therapy for good success. Using adjustment and AP, Cain has restored to normal competitive ability many horses which had been sanctioned by insurance companies to be destroyed. In some cases, especially congenital and OCD cases, the ataxia was not fully cured but 90% of these were suitable for breeding, provided there was no history of genetic transmission. Jeffries has had similar success. Longstanding cases, with severe articular damage, have a poor prognosis.

Clinical experience in hundreds of cases suggests that 80% of cases are due to mechanical causes. A further 10-15% are genetically programmed. Gradual onset may be due to nutritional disorders, but these are rare.

The condition usually arises suddenly (overnight), due to trauma (a fall; being pulled up roughly by the training-rope; tie chains; being cast in the box). The earlier the case is treated, the better the success rate. Cure is impossible if the motor neurons are degenerated.

The signs include ataxia (especially of the hindlimbs), inability to turn sharply or to back-up properly (the horse may fall over if forced to do these movements). Some cases show obvious restriction of neck movement. The limbs (especially hind) may be placed heavily, as if the horse does not know when they should make contact with the ground. In milder cases or in cases of spontaneous improvement (rare !), the only signs may be slight awkwardness or restricted ability to turn sharply, (excessive abduction of the hindlimb on turning), toeing of the ground at the walk or turn and heavy placement of the hindlimbs.

There is usually, if not always, vertebral misalignment with consequent pressure on cervical nerves or compression of the spinal cord. The primary sites are at C5, C6, C7, T1, atlas, C2, C3. Rear ataxia relates to an autonomic reflex arc from the C6 sympathetic ganglion. This affects the whole sympathetic chain to the lumbar plexus. Vertebral adjustments must be made to ensure integrity of the cord and nerves. A successful adjustment is confirmed when the horse gives a good "wet dog shake". If this does not occur, the adjustment is not successful. In long-lasting cases, AP must be done first to release the spasticity of the intervertebral muscles and ligaments.

Wobblers are treated similarly to cases of cervical syndrome in humans, with symptomatic treatment for hindlimb problems in the later stages. The initial results can be very dramatic, with marked improvement after 1-3 sessions. However, full cure (full coordination and total elimination of all signs) may take up to 30 sessions. Thus, treatment of wobblers may be impractical on economic grounds except for valuable bloodstock or loved pets.

GB20 and 21 are essential in treating wobblers and neck pain. GB20 can be injured easily by bad riders and by tie-chains in stalls. This can cause subluxation of the atlas, requiring chiropractic adjustment. AP alone, in such cases, gives poor or only temporary relief.

Cervical problems involve one or more of the Yang Channels of the forelimb (LI, TH, SI) or hindlimb (ST, GB, BL) or the GV Channel (see the Appendix below). Check the Shu points of all the Yang Channels and check for AhShi on the GV line. As most of the Yang Channels are involved, careful Five Phase balancing is necessary for full athletic recovery (see section 1.0 above and the Appendix).

A careful search is made for AhShi points (neck, paravertebral, especially thoracolumbar and sacral area). All AhShi points are used. They are often absent in Wobblers.

Points for Neck and Forelimb weakness: JiuWei; GB20,21; TH14,16; BL11; LI16,17; ST10; GV10,11,12 (withers) emergence points of dorsal cervical nerves; emergence of 2nd cervical nerve (SI17); emergence of spinal accessory nerve; Additional points: BL13,19,21,22,23,25,27,28; GV00 (tip of the tail), GV03 (BaiHui),04,

Points for Hindlimb weakness: BL29 (or 30); GB30,31,32,34,39; BL40

These points relate to the deep musculature of the neck, nuchal ligament, supraspinous ligament, lumbosacral plexus and sacral plexus.

In horses under 3 years old, AP and adjustment is combined with Adequan i/m (2 vials initially, 2 at 5 days and 2 at 2 weeks later). If used before 3 years of age, this helps to promote healing of any cartilaginous damage.

Treatment: Simple AP (20 minutes) or electro-AP (20 minutes) every 3-7 days for 4-30 times, as needed. Advise exercise on short and long rope (left and right turning), backing exercise, neck exercise (using carrot to persuade horse to do lateral and vertical movements).

If improvement is noted, allow 3-4 weeks between courses of 3-5 sessions of AP. Full cure may take up to 12 months.

Cain and Jeffries use point injection of the AhShi points plus points on the BL, GB, LV, ST, SP Channels (the hindlimb Channels), as indicated by tenderness at the Shu points for these Channels. Once improvement occurs, point stapling can be used for longterm stimulation (up to 12 months) and to reduce the number of visits needed (Jeffries). Cain usually injects the points with homoeopathic NaOH 10c and uses LACER (light stimulation) in horses over 3 years old.

Rogers' experience with wobblers (4 cases, AP but no adjustment) was that two were destroyed within 18 months. AP did not help sufficiently to ensure the jockey's safety in competitive racing, although it did improve the coordination markedly (Case 1) and completely but with relapse in Case 2. Case 3 was a foal which responded very well. Case 4 was a yearling which responded well to two sessions but was not presented for further treatment, owing to the death of the owner. One year later, the horse was OK. 1.3. GASTROINTESTINAL PROBLEMS (Fig. 10) AP can help in many g/i/t problems, including diarrhoea, constipation, indigestion, colic, windsucking, gastritis, enteritis etc. When AP is accompanied with Herbal Medicine, success rates are higher and last longer (M.J.C).

The most important points for g/i/t problems in the horse are on the BL and GV Channels (area T11-S4). The more anterior points are mainly for LV, SP, ST problems. Intestinal problems are treated mainly by points in the area T18-S4. Rectal problems relate to the sacral points, such as BL29,30,33,34.

In TCVM, GuanYuanShu is placed about 2 hands from the GV line, just behind the last rib. This point is most important in gastric and intestinal problems, including colic and windsucking. It is in the position of BL50 in the transposition system, lateral to BL21 (the Shu point of the stomach). Human GuanYuanShu (BL26) is between the transverse processes of L5-L6. It (with BL25) relates to uterus and large intestine in humans.

1.3.1. Colic (Fig. 11) (Cain; Kuussaari; Kothbauer; White)

AP can give 100% success to a single treatment in acute cases of sand colic and gas colic (but not in surgical cases). It is useful in intestinal distension also.

AP can be by simple needling (20 minutes) or by electro-AP (20 minutes). Cain gives strong, repeated stimulation to all points except GV26. That point should not be overstimulated in conscious animals, as it may cause shock.

The important points are: BL50 (2 hands from GV line, behind last rib); CV12 (midway navel to xiphoid, on ventral midline). To these may be added three points behind BL50, level with vertebrae L3,4,5 (Kothbauer's BL51-1,51-2,51-3 (old 46-1,46-2 and 46-3)), SP21,21a, LI17, BL20,21,25,27, GV01, ST36, GB25a, GV26, ST02.

1.3.2. Windsucking, crib-biting (Fig. 12) Horses which suck wind and are cribbers usually have chronic digestive problems, especially chronic or mild gastritis (Kuussaari). They may show colic, tympany and flatulence. Successful treatment of the digestive disorder is associated with disappearance of windsucking in 67% of cases but longterm success in crib-biters is much less (29%) (Kuussaari). Workers at Tuft's University have shown that windsucking and cribbing causes endorphin release, similar to "runners' high". They have been able to control cribbing by injecting naloxone.

The important points are BL50; PiShu; WeiShu; AnHua; SanChuan; ChiChia (GV12).

Treatment: simple AP (20-30 minutes) or electro-AP (20 seconds/point) for 2-6 times (mean of 3), at intervals of 2-5 days (mean of 4 days) (Kuussaari). White (1985) gives two new points on the upper and lower ends of the brachiocephalic muscle (YINQI 1 and 2) for this condition.

Treatment by strong electro-AP every 12-24 hours for 0.5-4 hours/time, on 9-29 occasions was said to be successful. Relapse was predicted unless a muzzle was used and the feed-pot lowered to the ground.

Thus, at present, Kuussaari's points seem to be a better combination.

1.3.3. Gastric ulcer, diarrhoea P.A.M.R. treated 2 suckling foals with gastric ulcer and 3 adult horses with chronic idiopathic diarrhoea. The important points are BL20,21,25,27; GV03; ST36; PC06; AhShi points in the paravertebral area.

Treatment: electro-AP (20 minutes) for 2-5 times (mean of 3), at intervals of 7 days. Success: 2/2 foals recovered within days (2 sessions) but only 1/3 adults recovered within 2 weeks (3-5 sessions).

1.4. RESPIRATORY PROBLEMS (Fig. 13) See the LU and SP Channels in the Appendix. Despite textbook claims and reports from some clinicians, Kothbauer and Kuussaari had poor success with AP in equine respiratory conditions. When AP is accompanied with Herbal Medicine, success rates are higher and last longer in respiratory disorders (bleeders etc)- (M.J.C)

Important points for upper respiratory problems are in the area of the trachea (CV22,23; ST09,10; GV14,15 etc) or nose (LI20; YinTang; GV26 etc).

Important points for lower respiratory conditions are the BL and GV points in the area T3T10 (BL13-17,42-46; GV09-12 ) and points in the intercostal spaces (ICSs) over the lung area.

1.4.1. Bronchospasm, heaves, bronchitis (Fig. 14) The late Drs. Grady-Young and Westermayer reported good success (50-85%) in early cases of heaves (before alveolar rupture occurs). AhShi points in the lung area were used. BL13 and 43 were usually tender. Points were selected from: BL13,14,15,42,43,44; LU01,01a,07,09; PC06; KI10,27; ST19; GV14,17,19,20; HT01; LI04,20; ST36,45; TH01 (depending on other signs).

Treatment: simple AP, 15-20 minutes at intervals of 3-7 days for 4-8 times. Success depends on the seriousness of the pathology.

Grady-Young used Laser on the Shu points for the lung and on other points in the lung reflex area (behind the scapula) in Pasteurella pneumonia in cattle. He reported good success. He also suggested its use in respiratory conditions in horses but gave no statistics of its success.

1.4.2. Bleeders, lung haemorrhage, epistaxis (Fig. 15) The diagnostic and therapeutic success of AP in bleeders is excellent (Cain; Jeffries). A history of sudden fading in a race, together with tenderness at the Shu and other reflex points for lung (below the posterior edge of the scapula and behind the scapular cartilage in the area of BL17, BL42-46 and GV09) indicates lung or nose bleeder in 95% of cases. The SP Channel points (BL20 (SP Shu), SP21,21a) are always tender in bleeders.

If vertebrae C1-T8 are intact (normal neck movement and no AhShi in the neck and anterior withers area), sensitivity along the outer BL line (BL42-46 (old BL37-41) from T8 through T14, together with sensitivity at BL13 and 20 suggests a lung bleeder. Bleeding usually occurs in the right lung, thus the right side is usually sensitive, especially on BL42-46, although left BL13 and 20 (Mother of LU) are also tender. These points are diagnostic for lung bleeders, even when endoscopic examination may be negative. There is evidence that Bleeding may be transmitted genetically. One of Cain's mares had 5 bleeders. Such mares should not be bred. However, 80-85% of non-genetically determined bleeders in Cain's practice do so because of abuse of drugs (banamine, phenylbutazone, aspirin, androgenic anabolics etc) or due to stress (pain from any source causing hypertension).

Identify and balance all affected Channels; stimulate the lung (BL13) and its Mother (BL20, SP Shu). This is the best treatment. The points used are the AhShi points and TianPing; BaiHui and two other GV points between these points. AhShi points may be injected with 2 ml of Vitamin B12 + C solution and 1 ml in the GV points. BL17 (diaphragm and haemorrhage point) is especially good in haemorrhage, anaemia and blood diseases. BL17 and 18 (liver Shu) influence liver function also and may improve prothrombin formation and blood clot formation. Herbs to strengthen the Qi of LU and SP help also. These methods are not effective in genetically affected cases.

The therapeutic success can reach 90% if AP is given 4-24 hours before the race (Jeffries).

1.4.3. Rhinitis, sinusitis (Fig. 16) Grady-Young claimed c. 95% success with simple AP or Laser. Treatment was 20 minutes, 35 times, every 3-4 days. The points are chosen from CV23; GV25; SP21; LV13; BL18; GB25; ST09; SI16 and AhShi points over the lung and chest area. Other Local points (YinTang; TaiYang, LI20; GV26; ST02,03 etc) can be used also.

1.5. REPRODUCTIVE PROBLEMS (Fig. 17) The Channels most often involved in reproductive problems are SP, KI, TH. Their Shu points are BL20,23,22 respectively. Their Mu points are LV13, GB24, CV05. There is also an ovary point in the paralumbar fossa and point TH16 (endocrine) is a useful distant point. Local points include WeiKen (GV02), BaiHui (GV03), MingMen (GV04), BL51,28,35. Occasionally BL14 (PC Shu) and the GV point in between may be tender in breeding problems. Sensitivity at TH16 usually disappears when BL22 (TH Shu, endocrine) is treated (M.J.C).

The most important points for reproductive disorders and for the genital organs are in the lumbosacral area. A simple guide is to imagine the female organs (ovary to vulva) as a straight tube. The ovaries relate to APs in the area T18-L3 (points such as BL21,22,23,50,51,52; TianPing; GV05,04). The vulva/anus/perinaeum relate to the area from S3 to the tailhead (points such as BL29,30,33,34,35,54; GV01,02). The other organs (tubes, uterine horn, uterine body, cervix, vagina) relate to intermediate points.

Kothbauer recommends BL22,23,52; GV04 for the ovary and BL27,28,31; BaiHui; CV06 for the uterus. Johnson reports excellent results with these points in cases of uterine atony, metritis, embryonic reabsorption etc.

If one had to remember 4 points for reproductive/genital disorders, they should be: BL23 (between transverse wings of L2-L3) for the ovary; BL26 (between transverse wings of L5L6) for the uterus; BaiHui (lumbosacral space) for the cervix and BL28 (lateral to sacral foramen 2) for the vagina/bladder.

There are other points (Fig. 18). The abdominal Channels include ST, SP, BL, KI, GB, LV, CV, GV. Local points (points nearest the target organs) on ANY of these Channels influence the organs. Although most importance is attached to the GV and BL points (lumbosacral area), GB26-28 (paralumbar fossa and under the external angle of the ilium) are sometimes tender in mares with ovarian problems, especially cysts. Points over the iliac wing (between the tuber coxae and the iliac crest) may also be tender in uterine disorders.

In disorders of the reproductive system and genitalia, (as in all other clinical uses of AP !) Treat the AhShi (tender) points. A few points (whether tender or not) for the affected organ may be added and CV02,03,04; BL54; LV02 may be considered as additional points. SP06 is

regarded as a point with special action on the inguinal area, genitalia and reproductive function of males and females.

Westermayer suggested treatment for 20-30 minutes for 2-4 times (mean of 3), at intervals of 5 days.

1.5.1. Anoestrus (Fig. 9) (Cain; Kuussaari; Hwang; Grady-Young; Johnson; White)

See section 1.5. In anoestrus mares, points in the area L3-S4 (BL23-34; BL52-54), points along the KI Channel and SP06 are palpated for tenderness. AhShi (tender) points are treated. Other points in anoestrus include: BL22,23; SP6; YanChi; YungChi; BaiHui; XieQi; CV01,05,08; GV01.

Treatment: 20-30 minutes simple AP (deep needling to reach the broad ligament in the posterior lumbar points), or electro-AP (20 seconds/point or 20-30 minutes/time). Moxa may be combined with simple AP (Hwang; Johnson). Moxa should not be used where there are inflammable materials (straw bedding etc in stalls, barns etc). Always consider fire hazard before moxa is used. Laser was also good (Grady-Young).

Kuussaari: Treat 1-5 times (mean 2 times) at intervals of 2-5 days (mean 3 days). Hwang: Treat with needle + moxa for 10 minutes for 5-10 times at intervals of 1-2 days and expect oestrus within 2 weeks. Grady-Young: Laser (20 minutes total to do all points) 3-8 times at intervals of 3-4 days. Mares cycled after session 6 (after 3 weeks). Johnson: Needle + moxa (20 minutes) on 10 cm, 20 gauge needles. Inject BL40 and Laser SP06; ST36 and (sometimes) BL11. White: BaiHui (8-10 cm deep); YanChi (18-23 cm deep); GV01 (20-25 cm deep; needle directed forwards and up to lie under the sacrum). Electro-AP, 20-30 minutes, 1-3 times at intervals of 2 days.

1.5.2. Cystic ovary (Fig. 20) (Cain; Jeffries; Grady-Young; Johnson)

See section 1.5.

Luteal cysts often are associated with metritis or pyometra. They may be expressed manually (per rectum) in many cases (Grady-Young). Follicular cysts are usually associated with nymphomania. Cystic ovaries often cause neck and shoulder lameness and thoracolumbar lameness on the same side (M.J.C). See the TH, GB and LV Channels (Appendix). If BL22 is tender, check TH16.

Points in area L2-S1 (BL22-27,51,52; GV04) and in the para-lumbar fossa and under the tuber coxae (GB26,27,28) are examined for tenderness. Check BL18,19 (LV Shu and GB Shu) also and TH16 (endocrine point). All AhShi (tender) points are used. Other points are chosen from: BL22-29; SP06,15; LV14; GB25,25a; ST36; BaiHui; YanChi.

Jeffries and Johnson also inject 10 ml of 2% procaine solution into the broad ligament on each side of the cervix, using a special 50-60 cm needle. This method was successfully used in cows by Kothbauer and Greiff for many years. It is called paracervical injection or neural therapy.

Treatment: Simple AP; injection of homoeopathic NaOH 9d solution + Vit B12 and Ascorbic acid; Laser. The choice is individual preference.

Jeffries: Injection method plus paracervical injection, 2 times. Success is 5-15% better in luteal cysts than in follicular cysts. Grady-Young: Laser (20 minutes total to do all points) 3-5 times at interval of 3-4 days. Skip 3 oestrus periods before breeding. Johnson: Needle + moxa (20 minutes) on 10 cm, 20 gauge needles. Inject BL40 and Laser SP06; ST36 and (sometimes) BL11.

1.5.3. Repeat breeders (Fig. 21) (Cain; Jeffries; Grady-Young; Johnson; Rogers; White)

See section 1.5.

In the investigation and treatment of repeaters, it is assumed that the stallion has been examined and been found to be fertile, potent and that ejaculation is normal.

Repeating may be due to ovarian disease, failure of the ovum to reach the uterus (salpingitis etc), failure to implant (metritis etc) or early death of the embryo.

The lumbosacral area and the paralumbar fossa area are examined for AhShi points, as above. All AhShi points are used. It is not possible to give just one prescription for repeaters, as the cause and the organs involved differ as described. The general principle is: AhShi points + points for the affected organ(s) or function(s).

Thus a selection must be made from points such as: BaiHui; YanChi; BL22-34,51-54,58; GB25,25a,26-28; GV01,02,04; SP06; KI06; LV03; CV02-06 etc.

Treatment: Simple AP; injection of homoeopathic NaOH 9d solution + Vit B12 and Ascorbic acid; Laser. The choice is individual preference.

Jeffries: Treat as for ovarian cysts. Grady-Young: Laser (20 minutes total to do all points) 3-8 times at intervals of 3-4 days. Johnson: needle + moxa (20 minutes) on 10 cm, 20 gauge needles. Inject BL40 and Laser SP06; ST36 and (sometimes) BL11 White: Electro-AP, 20-30 minutes, 1-3 times at GV01,04; BaiHui; YanChi; BL24

1.5.4. Reproductive problems in stallions (Fig. 22) (Cain; Johnson) See section 1.5.

Male disorders (oligospermia, libido loss, reluctance to mount or pain on mounting) can be treated successfully by AP in the stallion and the bull (Kothbauer).

Testicle points correspond with ovary points (see embryology of kidney, testis, ovary). The main points are BL21,22,23,50,51,52; TianPing; GV04,05 and SP06.

Penis points correspond with vagina points (see embryology of these organs). The main penis points are BL29,30,33,34,35,54; GV01,02 and SP06.

The principles of selecting points in male disorders are the same as in the female: : AhShi points in area L2-S4 and in the paralumbar fossa, iliac area : points for the affected organ(s) and functions.

1.6. OTHER CLINICAL USES

1.6.1. Anxiety, nervousness, especially in filly (Fig. 23) Cain found that extremely nervous, "freaked-out" horses may become somnambulistic and impossible to needle because all points become sensitive (flight of fight syndrome). These horses quieten down when injected with 3 ml naloxone solution. They can be needled successfully then (see section 1.3.2).

The main Channels for nervousness are the HT and PC (Fire) Channels. Key points are BL15,14,22; PC06 (M.J.C). SI18 and TH17 are tranquillizer points.

Gold bead implants (using a 16 gauge, 3.5 cm needle) in BL14,15,43,44; LI17; SP21 and CV17 give good results (M.J.C). He used 2 beads/point. The beads were inserted under local anaesthesia or sedation and are left in situ permanently.

Sweating, nervousness: Add the relevant Ting point, especially PC.

1.6.2. Skin problems (Cain)

The skin is Metal (LU, LI). Skin problems are more common in late autumn (Metal) and late winter (Water, KI-BL). Excess activity in TH (Fire) can weaken LU (Metal) (via the Ko Cycle). This manifests as poor hair coat (LU controls skin). Balancing LU, TH and KI enhances local treatment remarkably.

CONCLUSIONS The main methods of stimulating the AP response in horses are point injection (very fast), or simple needling or electroneedling for 20 minutes.

Classical AP gives better and more longlasting results than Cookbook AP, especially in complicated cases. Cookbook AP is useful for beginners and can give good or excellent results in simple cases but beginners are advised to study AP in depth to get the best results. This is not as difficult as it might seem. The classical concepts can be learned from AP courses, such as those given by IVAS.

Point selection for local problems includes the relevant Ting Point(s), plus AhShi (tender) points which remain after that. Other points include: Local points, Region points, points with special or generalised action and (most of all) the paravertebral Shu point(s) for affected organ(s) or function(s). This includes the use of Shu points in superficial problems which may not have direct organic involvement. For example, BL13 and 25 (Shu points for the LU and

LI Channels) are indicated as part of a prescription to help resolve pain of an inside forelimb splint (in the Channel area of LU and LI). Similarly, BL23,28 (Shu of KI and BL) are indicated in capped hock (Channel area of KI and BL). One or two distant points on a Channel passing through the problem area, or a chain of points along an affected nerve also help.

Some key points are: BL11,23 bones, joints; BL13,43 lung; BL18, GV09 liver; BL23, BaiHui adrenal, urogenital, hindquarter; BL25, BaiHui hindgut; GB20,21 neck; GB34, TH15 muscles; LI11, GV14, ST36 immunostimulation. ST36, BL21 stomach and appetite; TH15, GB21 forequarter;

A high clinical success rate can be attained in 1-3 sessions at 1-3 day intervals (recent or acute cases) or in 1-10 sessions at 4-7 day intervals in longstanding or chronic cases. However, beginners should study the principles of AP before attempting to use the system.

Treatment effects last longer when Ting points are used. This has been found to be essential in therapy of long-lasting or chronic cases.

There are other methods of point selection (earpoints, hoof points etc) and of point stimulation (magnets, staples, implants, Dermojet, Laser etc) but these methods must be regarded as experimental until adequate documentation and comparative clinical trials are available.

See the Appendix for point locations and references.

APPENDIX: ACUPUNCTURE POINT LOCATIONS AND CHANNEL FUNCTIONS

TRADITIONAL VERSUS TRANSPOSITION SYSTEM OF AP IN HORSES

Traditional Chinese Veterinary Medicine (TCVM) includes herbal medicine and acupuncture (AP). The TCVM system of AP concentrates on the location and uses (diagnostic and therapeutic) of isolated AP points (APs). TCVM does not show a Channel system in animals. Its concepts of diagnosis and therapy are very difficult for westerners to master.

Texts on the TCVM system in horses are scarce. They include those by Hwang, Klide & Kung, Kothbauer, Lin, White and the late Erwin Westermayer. Readers are referred to those texts for details.

The human AP system is based on Channel concepts. It is much better integrated than the TCVM system. Therefore, it is much easier to learn. Once the human system is mastered, its principles can be applied in animals by transposing the anatomical location and functions of the human AP point system to animals. This transposition system is very useful in the horse, especially in painful local conditions. The greatest difficulty is in locating points below the carpus or tarsus. It may be better to use TCVM points in these areas. The TCVM system differs from the transposition system in some respects but the two systems are basically very similar and either may be used alone or they may be combined.

Cookbook prescriptions for common conditions, body organs and parts in humans are listed in Appendices 1-3 of the paper on "Choice of points for particular conditions" (Rogers 1996). Those prescriptions may be applied in the horse although they are extracted from texts on humans.

The horse has no gallbladder but some GB points have important local uses. These codes are the same as those used in the Cookbook prescriptions, as mentioned above.

In this paper, the transposition system is used mainly, except for some TCVM points, which are described below.

1. TCVM POINTS IN THE HORSE See the texts, listed at the end of the Appendix, for a complete list of names, locations and uses of TCVM points.

The following are a few of the TCVM points mentioned in the paper:

AnHua between spines of T8-T9 BaoSai in jaw muscles behind last molar ChiChia between spines of T3-T4 (= GV12) ZhongFu LU01 in some texts: behind shoulder joint in 2nd intercostal space (ICS 2). AP analgesia point with TH08. FuTu behind occipital protuberance XieQi 2 cun lateral to root of tail, in bicipital groove JiuWei 9 points on the upper lateral neck. Point 1 is 6.5 cm behind the base of the ear, 4 cm from the mane (Fig. 7). Point 9 is 4 cm anterior to scapula, 6 cm from the mane. The other points are at equal intervals between these points KaiGuan in jaw muscles behind molar 3 BaiHui lumbosacral space (GV03) PiShu 1 hand from GV line in 3rd last ICS SanChuan between spines of T4-T5 SouKou behind oral canthus TianPing thoracolumbar space WeiShu 3 spaces in front of PiShu YanChi one third distance from tuber coxae to dorsal midline YinTang midline of forehead, between the eyes YungChi between the free ends of the transverse processes of L5-L6 FL 2 PoChien at anterior junction of scapula and its cartilage (TH15)

FL 4 PoLan one third distance down anterior edge of scapula FL 7 ChangFeng 5 cun post. inf. to shoulder joint point in fossa between long and lateral heads of triceps m., behind humerus, at anterior edge of deltoid m. (LI13) FL12 JianYu hole below upper head of humerus at its anterior edge FL13 JianWaiShu Just behind and below shoulder joint FL19 ChanWan on lat. and med. digital veins dorsoposterior to fetlocks FL20 TiMen midpoint of med. and lat. cartilages at back of hoof. Needle from behind. FL21 TiMen midpoint of lat. and med. cartilages at back of hoof. Needle from behind. FL22 ChienChiu centre of pit in hollow above back of hoof

2. TRANSPOSITION SYSTEM At this time there is no International Standard Chart to show the location of the Channel points (LU, LI, ST, SP, HT, SI, BL, KI, PC, TH, GB, LV, CV, GV) in horses. To locate the Channel points in horses, one can transpose the locations of human points to similar anatomical locations in the horse.

Figures 1-26 respectively show the approximate locations of the equine Channel points. These charts must be taken as provisional. They are for teaching purposes only, as they may help the beginner to locate the more important areas for treatment, especially if using Cookbook Prescriptions (Appendix 1-3 in Rogers 1996) or the points recommended for the conditions discussed in the clinical part of this paper.

From extensive clinical experience in equine AP, MJC made many corrections to earlier charts prepared by PAMR. MJC's locations are often (but not always) similar to those of other experts (Giniaux, Kothbauer; Westermayer etc). Emiel van den Bosch DVM, G. van Heuvelstraat, Ramsel, Belgium (Fax: 32-1656-1374) published very fine charts (Acupuncture Points and Meridians in the Horse, 1995). We recommend those charts to equine acupuncturists.

Location of GV and BL points in the thoracic area must take 18 pairs of ribs into account. Apart from the rib area, transposition of other GV points (GV01-04, 14-28) and BL points (BL01-12, 36-40 (old BL50-54) and 55-60) are similar to human positions:

GV01 Midline between anus and coccyx (as in human) GV02 Dorsal midline in sacrococcygeal space (as in human) GV03 (BaiHui) in midline in lumbosacral space (L4-L5 space in human) GV04 (MingMen) in midline in L2-L3 space, between left and right BL23 (KI Shu) (as in human). Some equine vets put it between left and right BL23a, in L3-L4 space. GV05 Dorsal midline in L1-L2 space (as in human), between left and right BL22 (TH Shu) GV06-10 are located by counting 2 spaces for each point forward from GV05 (below spine of L1), with GV10 below spine T10 GV06 (TianPing): Dorsal midline behind the dorsal spine of T18 (thoracolumbar) space, between left and right BL21 (ST Shu) GV07 Dorsal midline, 2 spaces before GV06 (behind spine of T16), between left and right BL19 (GB Shu) GV08 Dorsal midline, 2 spaces before GV07 (behind spine of T14) GV09 Dorsal midline, 2 spaces before GV08 (behind spine of T12), between left and right BL17 (Diaphragm, Haemorrhage, Blood point) GV10 Dorsal midline, 2 spaces before GV09 (behind spine of T10), between left and right BL15 GV11-12 are found by counting 3 spaces/point forward from GV10 or backward fromGV13. GV11 Dorsal midline, 3 spaces behind GV12 (behind spine of T7) GV12 Dorsal midline, 3 spaces behind GV13 (behind spine of T4), between left and right BL12 GV13 Dorsal midline in T1-T2 space (as in human) GV14 Dorsal midline in C7-T1 space (as in human) GV15-28 as in human

The Shu points (Organ-associated points or paravertebral reflex points) run parallel to the GV line, in humans about 1.5 inches and in horses about 1 hand from the GV line. They are covered under the BL Channel (see below).

The Mu (Abdominal Alarm) points are used in diagnosis and therapy in humans and small animals. The Mu points are: Lung = LU01,01a; Colon, large intestine = ST25; Stomach = CV12; Spleen-Pancreas = LV13; Heart = CV14; Small Intestine = CV04; Bladder = CV03; Kidney = GB25,25a; Pericardium, Heart Constrictor = CV17; Triple Heater = CV05; Gallbladder = GB24; Liver = LV14. Because of the danger to the operator, CV03,04,05 and ST25 are seldom needled in horses but CV12,14,17, GB24,25, LV13,14, LU01,01a are relatively easy to needle. Horses tolerate Shiatsu (deep massage) of awkward points and this can be very useful.

LV13,14 (Mu points of SP, LV) are very powerful points for balancing the Yin Channels, especially when coupled with SP21,21a (linking point for all Yin Channels, the Luo point for all Luo points).

T8 and L4: LU & LI Channels (Metal) (FIGURES 1 & 2) LU (Lung) and LI (Large Intestine, Colon) are related in Metal. When Shu point tenderness or clinical signs indicate Channel imbalance, treat the Shu point and the Shu of the paired Channel. LU Shu is BL13,42 and LI Shu is BL25. LU Mu is LU01,01a and LI Mu is ST25.

When treating LU problems, the Mother (SP) Channel must be balanced and stimulated (BL20) and the Son (KI) Channel must be assessed (BL23) and treated, if needed.

When treating LI problems, the Mother (ST) Channel must be balanced and stimulated (BL21) and the Son (BL) Channel must be assessed (BL28) and treated, if needed.

Metal may be used to support weakness of Water. Thus, BL13 (LU) may help weak KI and BL25 (LI) may help weak BL.

The LU Channel runs from the lung to the anterior edge of the lower third of the scapula (LU01a), level with the base of T1 (M.J.C), to just lateral to the biceps tendon (05). It then runs down the anteromedial edge of the radius (06,07,08) and carpus (09), down the inner splint to the medial sesamoid (10) and medial heel (LU11). Internal branches go to the colon.

Traditional texts place LU01 in ICS 2, just behind the shoulder joint.

BL13,42 (LU Shu) may show acute tenderness with inside forelimb splints, check ligament, inside carpal, inside suspensory and sesamoid problems. They (and BL42-46) are usually tender in acute respiratory problems (see 1.4.2).

LU01,01a relates to the inside forelimb and carpus.

The LI Channel runs from the centre of the medial aspect of the pedal joint (LI01), up the medial side of the pastern, fetlock, to the top of the inner splint (04) and carpus (05). It ascends the forearm, curving anterolaterally, to the front of the elbow joint (11), to the point of the shoulder (15), to the nerve plexus at the base of C6-C7 (17), to the lateral side of the larynx (18), teeth and nostrils (LI20). Internal branches go to the colon and lung.

LI04 is near the upper head of the inner splint.

BL25 (LI Shu) may be tender in problems of the sacroiliac joint/ligament, the iliolumbar ligament, the inside splint, the 3rd and intermediate carpal bones, the elbow and shoulder, misalignment of vertebrae C6-T1, larynx, teeth, sinuses etc. It may be tender also in colic and impaction and in gluteal problems.

LI16 relates to the shoulder and inside carpus, fetlock and pastern.

LI17 has powerful effects, similar to LI04 in humans. It affects the sympathetic ganglion, producing endorphin-like effects and blocking the sympathetic nervous system. It is very tender in subluxation of C6, C7 or T1. Tenderness at LI17 may arise in shoulder, outside arm, inside carpus and fetlock. It may also arise ipsilateral to lumbar pain (BL25, LI Shu) or in contralateral hindlimb lameness.

LI18 relates to the forelimb shins.

T9 and L1: PC & TH Channels (Fire) (FIGURES 9 & 10) PC (Pericardium, Circulation-Sex, Heart Constrictor) and TH (Triple Heater) are related in Fire. When Shu point tenderness or clinical signs indicate Channel imbalance, treat the Shu point and the Shu of the paired Channel. PC Shu is BL14,43 and TH Shu is BL22. PC Mu is CV17 and TH Mu is CV05.

When treating PC problems, the Mother (LV) Channel must be balanced and stimulated (BL18) and the Son (SP) Channel must be assessed (BL20) and treated, if needed.

When treating TH problems, the Mother (GB) Channel must be balanced and stimulated (BL19) and the Son (ST) Channel must be assessed (BL21) and treated, if needed.

Fire may be used to support weakness of Earth. Thus, BL14 (PC) may help weak SP and BL22 (TH) may help weak ST.

The PC Channel arises in the pericardium, runs to the medial side of the olecranon (PC01), to the medial side of the biceps tendon (03), down the medial side of the leg in the ulnar-radial groove (04,05,06,07), down by the inner splint (08), to the coronary band (over the medial plantar digital vein) (PC09). Internal branches go to the Triple Heater.

BL14,43 (PC Shu, pericardium) may show tenderness in cases similar to BL15,44 (see) and in anxiety and psychological problems.

PC points (BL14,43, PC06) are used in nervousness/psychological disorders and PC09 is a useful point to bleed in laminitis (M.J.C). Some females with breeding problems show sensitivity of BL14 (PC Shu) and GV10 (beside BL14). (See TH Channel also).

The TH Channel arises at the lateral side of the coronary band (over the lateral plantar digital vein) (TH01). It ascends the anterolateral side of the metacarpus (3) and carpus (04) and then follows the lateral ulnar-radial groove (05-08) and anterior edge of the olecranon (09,10). It runs behind and parallel to the humerus (10-13) to the lateral side of the shoulder joint (between the joint and the scapular spine, TH14). Then it runs to the anterior edge of the scapula at the junction with the scapular cartilage (15), to the dorsal side of the C3-C4 joint on the brachiocephalicus m. (16), to the posterior side of the ear (17). It runs over the root of the

ear (18-22) and ends behind the lateral canthus of the eye (TH23). Internal branches go to the PC and the endocrine centres.

The TH Channel is important in endocrine disorders, especially in female infertility (M.J.C). TH14,16 are often sensitive in ovarian problems, cyst, oestrus). TH14 may be tender in shoulder lameness, but true joint lameness (OCD) is rare. More often, shoulder lameness is muscular, referred from subluxation of vertebrae C6-T1, via the brachiocephalicus m., attached to the humeroscapular joint. Painful ovary or neck can cause spasm of that and other muscles and a choppy forward stride on the ipsilateral forelimb. If the problem is ovarian, treat BL22 (TH Shu) and the sensitivity at TH16 usually disappears. If the problem is shoulder lameness, treat TH14 and SI10, with BL22 and 27 (SI Shu). If the shoulder pain is referred from the neck, treat the neck (see 1.2.4).

TH16 may be tender in problems of the ovary/testis and in pain of the outside forelimb.

Excess activity in TH (Fire) can weaken LU (Metal) (via the Ko Cycle). This manifests as poor hair coat (LU controls skin) (M.J.C).

BL22 (TH Shu) may be tender in endocrine imbalance (thyroid, gonads, adrenal), in disorders of thermoregulation (non-sweaters), psychological problems, neck problems of the spinal accessory nerve (mid-cervical) and in neck vertebral misalignments. It may be tender in thoracolumbar problems, post-castration pain, cryptorchidism, inguinal ring problems (see BL23) and pain of the outside forelimb.

TH05 is used in shoulder problems and in navicular disease.

TH17 is a tranquillizer point.

T10 and S1: HT and SI Channels (Fire) (FIGURES 5 and 6) HT (Heart) and SI (Small Intestine) are related in Fire. When Shu point tenderness or clinical signs indicate Channel imbalance, treat the Shu point and the Shu of the paired Channel. HT Shu is BL15,44 and SI Shu is BL27. HT Mu is CV14 and SI Mu is CV04.

When treating HT problems, the Mother (LV) Channel must be balanced and stimulated (BL18) and the Son (SP) Channel must be assessed (BL20) and treated, if needed.

When treating SI problems, the Mother (GB) Channel must be balanced and stimulated (BL19) and the Son (ST) Channel must be assessed (BL21) and treated, if needed.

Fire may be used to support weakness of Earth. Thus, BL15 (HT) may help weak SP and BL27 (SI) may help weak ST.

The HT Channel arises in the heart, runs to the posteromedial side of the shoulder joint (HT01), to the anteromedial side of the elbow (medial to the biceps tendon (03) and down the posteromedial side of the arm (04-06) and carpus (07), to the medial sesamoid (08) and the medial bulb of the fore heel (HT09). Internal branches go to the small intestine.

BL15,44 (HT Shu) may be tender in problems of the posterior side of the forelimb, tendons, sesamoids, heel bulb bruises, elbow (rare), circulatory function. BL14,15 (PC, HT) may be tender in anxiety and nervousness.

The SI Channel arises at the back of the outside bulb of the foreleg coronary band (SI01), ascends to the sesamoid (02,03), along the outer splint (04), along the posterolateral edge of the carpus (05), to the lateral side of the ulnar-humeral notch (06,07), to the olecranon (08), to the first muscular groove behind the shoulder joint (09), to a deep hole just below and behind the lower limit of the scapular spine (10). Then it zig-zags up the scapular spine (11,12) to the edge of the scapular cartilage (13) at T4-T5. Then it runs down and forwards to the side of C7 at the centre of the C6-C7 joint (15), to the centre of the C4-C5 joint (16), to the lower edge of the C2-C3 joint (17), to the malar bone (18) and the anterolateral root of the ear (SI19). Internal branches go to the small intestine and heart.

The SI Channel is very important. It is involved in many race-track injuries. It is used to treat bowed tendons, inferior check ligament injury, posterior branch of suspensory at outside sesamoid, "windgalls", and annular ligament damage. Subluxation of the lower neck (C6-T1), or of the atlas, or sacrococcygeal injury (in the starting gate, or in transport, due to backingup), sacral plexus (parasympathetic) damage may involve the SI Channel (BL27, SI15,16). Reflex lameness in the superficial gluteal muscles at GB30 may arise in GB imbalance (GB is the Mother of SI). The SI is often involved in shoulder lameness. SI09,10,13 and the SI Shu

(BL27), its Mother Shu (Wood-GB Shu, BL19) and its Son Shu (Earth-ST Shu, BL21) are indicated in such cases (see 1.1.3).

BL27 (SI Shu) may be tender in problems of the posterior side of the forelimb, tendons, sesamoids, heel bulb bruises, elbow (rare), sacral nerve plexus, biceps femoris, intestinal function.

SI10, if still tender after proper Channel balancing, is diagnostic for LOCAL shoulder lameness (OCD) - see 1.1.3.

SI13, at the edge of the scapular cartilage at the highest point of the withers (see GV11,12 below) is very important in neck and thoracic muscle pain. The bursa between the nuchal and the supraspinous ligaments is very easy to injure. Needling SI13, GV11,12 in such cases is useful but proper Channel balancing, using BL19 (GB, Mother of SI) and BL21 (ST, Son of GB) is important.

SI17 is related to the outside sesamoid, suspensory ligament and lameness at the posterior side of the forelimb. It also relates to ipsi- and contra- lateral lower sacral injury, hindlimb lameness and all neck problems.

SI18 is a tranquillizer point.

BL16 (GV Shu) and BL17 (Diaphragm/blood/haemorrhage Shu) BL16 and 17 are used for local problems as well as special effects. Their helper (outer) points are BL45 and 46 respectively.

BL16 (GV Shu) is used to increase or reduce GV activity. It assists the supraspinous ligament. Problems of the ligament are common in racehorses because they seldom have the opportunity to fully stretch their neck and paraspinal muscles (grazing, drinking from streams, rolling etc are seldom allowed !). Weakness of the supraspinal and nuchal ligaments predispose to neck and back problems and to tender bursae on top of the withers.

BL17 (Diaphragm Shu) is used for diaphragm/blood/haemorrhage problems. It helps in anaemia (increased PCV and Hb), bleeders (prothrombin and reduced blood pressure in lung vessels), other respiratory problems (to stimulate breathing in neonatal foals) (with GV26). It is an immunostimulant point (with GV14, ST36, LI11), useful in viral diseases.

BL19 (GB Shu) is associated with whirlbone, outside stifle, outside hock, outside hind splint, curb. T14 and 15: LV and GB Channels (Wood) (FIGURES 12 and 11) LV (Liver) and GB (Gallbladder) are related in Wood. When Shu point tenderness or clinical signs indicate Channel imbalance, treat the Shu point and the Shu of the paired Channel. LV Shu is BL18,47 and GB Shu is BL19,48. LV Mu is LV14 and GB Mu is GB24.

When treating LV problems, the Mother (KI) Channel must be balanced and stimulated (BL23) and the Son (HT, PC) Channels must be assessed (BL15,14) and treated, if needed.

When treating GB problems, the Mother (BL) Channel must be balanced and stimulated (BL28) and the Son (SI, TH) Channels must be assessed (BL27,22) and treated, if needed.

Wood may be used to support weakness of Fire. Thus, BL18 (LV) may help weak HT or PC and BL19 (GB) may help weak SI or TH. Weakness or excess activity in Wood (LV, GB) can have profound effect on the ovarian/endocrine system (via TH - Fire-, Son of Wood). Such cases often have thoracolumbar pain (near BL18,19,22 - Shu of LV, GB, TH) and may also have spasm and a choppy stride in the ipsilateral shoulder/ forelimb, via TH16 (see TH Channel).

The LV Channel runs from the medial bulb of the hind heel (LV01), up the posteromedial edge of the pastern, medial sesamoid (02), along the inner splint (03), to the anteromedial side of the hock (04), up the inner side of the leg (05-07), to the posterior edge of the medial epicondyle of the femur (08). It runs along the inner thigh behind the femur to the inside of the hip joint. Then it runs to the tip of rib 17 (LV13, SP Mu) and ends behind rib 9, one hand above the level of the olecranon (LV14, LV Mu). Internal branches to the liver, eye and "gallbladder" function.

Deficiencies are more common than excesses in the LV Channel. Therefore, adding more energy (by correct feeding, HERBAL medicine (fresh dandelions in spring) and lipotropic agents) are needed to obtain the optimal response.

The LV Channel is used with GB points in disorders of Wood. BL18,47 (LV Shu), LV13 (SP Mu) and LV14 (LV Mu) helps in myositis, azoturia, tying-up syndrome; to regulate SGOT, CPK, serum albumin and globulin; as immunoregulators; in allergies and eye problems (especially in spring (Wood); to regulate hoof-horn growth (Wood controls the nails) and in breeding problems (Wood is Mother of Fire (TH, PC)).

BL18 (LV Shu) may be tender in allergy (elevated globulin levels), muddy colour of the eye mucosa, lacrimation and conjunctivitis, problems of muscles, tendons, ligaments, azoturia, myositis, (tying-up syndrome), elevated CPK, SGOT in blood. The LV controls the eye in TCVM.

LV13,14 (Mu points of SP, LV) are very powerful points for balancing the Yin Channels, especially when coupled with SP21,21a (linking point for all Yin Channels, the Luo point for all Luo points).

The GB Channel begins at the lateral canthus of the eye (GB01). It runs to the ear (02), loops to the temporal (03-09) and post-auricular area (10-12) to above the eye (14), to the wing of the atlas (GB20). Then it follows the wings of the cervical vertebrae to the upper edge of the body of T1 half- way down the front edge of the scapula (GB21). It follows the lateral thorax to ICS 10 (GB24, SP Mu), then to the tip of rib 18 (GB25, KI Mu), forms a triangle of points (GB26-28) under the external iliac angle, curves around the hip joint (GB29,30), then down the lateral thigh behind the femur (31,32) to the posterior edge of the lateral epicondyle of the femur (GB33), the upper anterior notch between the fibula and tibia (GB34). It follows the lateral side of the leg to the lateral side of the hock (35-40), over the outer splint (41), the outer side of the fetlock (43), to end on the lateral side of the coronary band (GB44). Internal branches go to the liver and "gallbladder" function. A branch joins 25 to 25b just above the tuber coxae and rejoins 30. The tuber coxae point 25b is useful with BL19 in GB Channel problems, when BL19 (GB) is tender. Cain puts GB25a (another KI Mu) half way between the costochondral junction of rib 18 (GB25) and the lumbar muscles.

The GB is one of the most frequently used Channels (after the BL) in the horse. The GB and LV Channels are important in myositis and azoturia (tying- up syndrome), especially in spring (season of Wood). Wood relates to muscle, tendon, ligament and the Krebs cycle (LV). Imbalance of Wood relates to build-up of lactic acid, impaired blood buffering, elevated SGOT, CPK and arginase in blood. Balancing the Wood (GB, LV) is essential for muscle health and liver metabolism. Water (KI, BL), Fire (HT, SI, PC, TH), Earth (SP, ST) and Metal (LU, LI) can all interact with Wood. All must be in balance for full health.

In hindlimb lameness due to reflex spasm of the superficial gluteal muscle (may arise in damage to the sacral plexus, or due to backing up against fixed objects), the local point (GB30) must be balanced by BL19 (GB Shu) and BL27 (SI Shu; Fire is Son of Wood).

BL19 (GB Shu) may be tender in problems of muscles, tendons, ligaments, azoturia, myositis, (tying-up syndrome), elevated CPK, SGOT in blood. In curbs, tenderness can arise at BL19 (GB), BL28 (BL Shu, the Mother of GB) and BL27 (SI Shu, Son of GB). Reactive GB can cause spasm of the biceps femoris muscle, resulting in hindlimb lameness.

GB20 and 21 are essential in treating wobblers and neck pain. GB20 can be injured easily by bad riders and by tie-chains in stalls. This can cause subluxation of the atlas, requiring chiropractic adjustment. AP alone, in such cases, gives poor or only temporary relief.

T17 and T18: SP and ST Channels (Earth) (FIGURES 4 and 3) SP (Spleen-Pancreas) and ST (Stomach) are related in Earth. When Shu point tenderness or clinical signs indicate Channel imbalance, treat the Shu point and the Shu of the paired Channel. SP Shu is BL20,49 and ST Shu is BL21,50. SP Mu is LV13 and ST Mu is CV12.

When treating SP problems, the Mother (HT, PC) Channels must be balanced and stimulated (BL15,14) and the Son (LU) Channel must be assessed (BL13) and treated, if needed.

When treating ST problems, the Mother (SI, TH) Channels must be balanced and stimulated (BL27,22) and the Son (LI) Channel must be assessed (BL25) and treated, if needed.

Earth may be used to support weakness of Metal. Thus, BL20 (SP) may help weak LU and BL21 (ST) may help weak LI.

The SP Channel runs from the medial side of the coronary band of the hind heel (SP01), up the inner side of the pastern (03), by the inner splint (04), along the anteromedial hock (05), up the inside leg behind the tibia (06-08), to the inner stifle behind the tibial head (09). It runs up the inner thigh to the lateral abdomen to the tip if rib 15 (15). It curves along the thorax to

the ICS 4 (SP20) and ends in ICS 10 (SP21, controller of all Yin Channels, the Luo of all Luo points). Internal branches go to the spleen-pancreas, stomach and the muscles.

BL20 (SP Shu) may be tender in disorders of blood, circulation, spleen, pancreas; in digestive disorders, impaction, colic; in lameness of the inside hindlimb/stifle/hock (cunean tendon) and in thoracolumbar injury. The SP points (BL20 (SP Shu), SP21,21a) are always tender in bleeders.

Cain locates a point (SP21a) about 1 hand above the olecranon, in ICS 5. This point has similar diagnostic and therapeutic functions to SP21. It is located on the large plexus of the posterior thoracic nerves at the posterior border of the latissimus dorsi muscle. SP21,21a show extreme sensitivity with imbalance of ANY Channel, especially a Yin Channel (LU, SP, HT, KI, PC, LV). These points can be used with LV13,14 (Mu of SP, LV) to balance all Yin energies. SP21,21a are very powerful points. Be careful that the horse does not fall on you! This has happened to Cain. Check these points after ANY treatment. If the Channels are balanced, SP21,21a should not be tender. If they are, additional therapy is needed.

The ST Channel begins below the eye (ST01), runs to the oral canthus (04), masseter (06), the temporomandibular joint (07). It runs down the neck (09), along the ventral edge of the sternocephalicus to ST10 (about one hand cranial to the point of the shoulder). It runs along the ventrolateral thorax to ST25 (LI Mu, level with navel), into the groin and towards the anterior of the hip joint. It runs down the lateral thigh, parallel with the cranial edge of the femur (31-34), to the hole lateral to the patellar tendon (ST35), to 1 hand below the tibial tuberosity, lateral to the tibia, between the long and lateral digital extensor muscles (36). It continues down the anterolateral leg (37-40), to the anterolateral side of the hock (41), down the anterior side of the shin and pastern (43,44). It ends at the coronary band on the anterolateral side of the hind foot (ST45). Internal branches go to the stomach and spleenpancreas. A branch goes from ST25 to the origin of the tensor fascia lata (25a) (at the lowest, posterior edge of the tuber coxae), to return to ST31. The tensor fascia lata point (25a) is used with BL21 (ST) in stifle lameness when BL21 (ST) is sensitive.

BL21 (ST Shu) may be tender in digestive disorders, impaction, colic, in anterolateral hindlimb lameness, stifle lameness, sacrosciatic ligament, sacral pain at the origin of the biceps femoris, thoracolumbar injury. ST10 (on sternocephalicus m.) relates to BL21. BL21 may be tender in shoulder pain when sternocephalicus is involved. This is common.

ST10 relates to the ipsilateral stifle, especially if BL21 is tender.

ST36 is used as a Local point for the stifle.

L2 and S2: KI and BL Channels (Water) (FIGURES 8 and 7) KI (Kidney) and BL (Bladder) are related in Water. When Shu point tenderness or clinical signs indicate Channel imbalance, treat the Shu point and the Shu of the paired Channel. KI Shu is BL23,52 and BL Shu is BL28,53. KI Mu is GB25,25a and BL Mu is CV03.

When treating KI problems, the Mother (LU) Channel must be balanced and stimulated (BL13) and the Son (LV) Channel must be assessed (BL18) and treated, if needed.

When treating BL problems, the Mother (LI) Channel must be balanced and stimulated (BL25) and the Son (GB) Channel must be assessed (BL19) and treated, if needed.

Water may be used to support weakness of Wood. Thus, BL23 (KI) may help weak LV and BL28 (BL) may help weak GB.

The KI Channel runs from the hollow between the bulbs of the hind heels (KI01), up the back of the metatarsals to the posteromedial side of the hock (02-06). It ascends the inner leg (07-09) to the medial stifle, one hand behind the medial epicondyle of the femur (10). It runs up the inner thigh to the groin (11), and along the ventral abdomen, 3 fingers lateral to the midline, to reach KI16 (lateral to navel) and KI22 (on the rib-cartilage of the 6th rib). From here, it runs inside the forelimb muscles, along the thorax, to end at KI27, in the ICS 1, at the sternum. KI27 can be reached by a 10 cm needle through the anterior superficial pectoral m. Internal branches go to the kidney, bones, ear, spinal cord, adrenal, ovary, bladder.

BL23 (KI Shu) is between the wings of L2-L3. It relates to the inside of the hindlimb. BL23 and 47 may be tender in urogenital (renal, gonadal), adrenal and fertility disorders and in thoracolumbar problems. It may be tender with BL22 (TH) in lameness related to psoas muscles, post-castration pain, cryptorchidism, inguinal ring problems, inside hindlimb problems. In those cases, BL23 is helped by KI03,07,10 and BL28 (BL Shu). If the tail twitches during riding, this indicates AhShi at BL23.

The BL Channel is the most important. Its clinical uses include diagnosis and treatment (via the Shu points). BL points are used in almost every AP prescription. BL points from C1-S4 correspond with superficial branches of spinal nerves in the sympathetic (neck-lumbar) and para-sympathetic (sacral) areas.

The BL Channel runs from the medial canthus of the eye (BL01), up the forehead (02,03), and head medial to the ears (04-09), to the wing of the atlas (10), to the notch at the anterior upper edge of the scapula, just behind the tip of the spine of T2 (BL11) and T3 (BL12) beside the high point of the withers. The inner and outer BL lines run paravertebrally from T3-S4. Key landmarks are BL13,42 below spine of T8, at posterior edge of the scapular cartilage; BL21,50 just behind last rib; BL23,52 between wings of L2-L3; BL32,28,53 (medial to lateral) at 2nd sacral hole. The Channel continues down the posterolateral thigh in the muscle groove from just above the tuber ischii (BL54a) to below the tuber ischii (BL36,36a,37) to the popliteal area (BL38,39,40), down the posterolateral leg (BL55-59), to the notch between the Achilles tendon and the lower head of the tibia (BL60), over the lateral hock (BL61,62), down the outer splint (BL63-65) and sesamoid (BL66), to end at the coronary band at the lateral bulb of the hind heel (BL67). Internal branches go to the kidney, bladder and pelvic functions.

In humans, the sequence of Shu points (BL13-30) is: Below level of spine of T3-T7 (BL13-17): LU, PC, HT, GV, Diaphragm-BloodHaemorrhage Below level of spine of T9-T12 (BL18-21): LV, GB, SP, ST Below level of spine of L1-L5 (BL22-26): TH, KI-ovary, QiHaiShu, LI, GuanYuanShu Below level of spine of S1-S4 (BL27-30): SI, BL, ZhongLuShu, BaiHuanShu

In the horse, pending careful provocation tests, one can transpose BL21 as in humans (just behind the last rib). The area just behind the posterior edge of the junction between the scapula and the scapular cartilage is consistently tender in lung disease (bleeders etc)- M.J.C. This point is below the spine of T8. It is taken to be BL13 (lung Shu). Another BL13 point is directly dorsal to this, at the edge of the scapular cartilage. Thus, it is easy to locate BL13 and BL21. The simplest way to locate BL12-20 is as follows:

There are 9 points between (and including) BL13-21. BL17 can be taken as mid-way between them. The remaining points (BL14-16 and BL18-20) can be located easily by counting forward or backward from BL17.

However, more accurate locations of equine Shu points BL13-21 (LU, PC, HT, GV, Diaphragm-Blood-Haemorrhage, LV, GB, SP and ST respectively) are as follows:

HORSE THORACIC SHU POINTS BL13 FeiShu = LU Shu: Below the dorsal spine of T8, at caudal edge of scapular cartilage in 8th intercostal space (ICS 8) (M.J.C). It relates to the inside of the forelimb. Its partner is BL42 BL14 JueYinShu = PC Shu: Below the dorsal spine of T9 (ICS 9). It relates to the inside of the forelimb. Its partner is BL43. BL15 XinShu = HT Shu: Below the dorsal spine of T10 (ICS 10), lateral to GV10. It relates to the inside of the forelimb. Its partner is BL44. BL16 DuShu = GV Shu: Below the dorsal spine of T11 (ICS 11). It relates to the dorsal surface of the back and local (nearby) organs and their functions. Its partner is BL45. BL17 GeShu = Diaphragm-Blood-Haemorrhage Shu: Below the dorsal spine of T12 (ICS 12). It relates to diaphragm, blood diseases, and immunity. Its partner is BL46. BL18 GanShu = LV Shu: Below the dorsal spine of T14 (14th ICS, or 4th last). It relates to the inside of the hindlimb. Its partner is BL47. BL19 DanShu = GB Shu: Below the dorsal spine of T16 (16th ICS, or 2nd last). It relates to the outside of the hindlimb. Its partner is BL48. BL20 PiShu = SP Shu: Below the dorsal spine of T18 (last ICS). It relates to the inside of the hindlimb. Its partner is BL49.

HORSE LUMBAR SHU POINTS BL21 WeiShu = ST Shu: Below the dorsal spine of L1, just behind last rib. It relates to the anterolateral side of the hindlimb. Its partner is BL50. BL22 SanJiaoShu = TH Shu: A key Endocrine point, behind the wings of L1. It relates to the lateral neck and the outside of the forelimb and to endocrine problems, especially reproductive. Its partner is BL51. BL23 ShenShu = KI Shu: Between the wings of L2-L3. (Cain and Glardon find the latter place the more important. It relates to the inside of the hind limb and to KI-gonad-adrenal and bone function. Its partner is BL52. BL24 QiHaiShu = Qi Sea Shu: Behind the wings of L4.

BL25 DaChangShu = LI Shu: Behind the wings of L5, behind a line between the most anterior point of the left and right external angle of the ilium. It relates to the outside of the forelimb. It may be tender in colic and sciatica. BL26 GuanYuanShu = Gate Origin Shu, Uterus Shu: Behind the wings of L6, before a line between the highest points of the left and right tuber coxae.

HORSE SACRAL SHU POINTS BL27 XiaoChangShu = SI Shu: Lateral to sacral foramen 1; it relates to the back of the forelimb. BL31 is medial to it. BL27a Unnamed = another SI Shu: lateral to GV02 (sacrococcygeal space). This point is more reactive than the classical BL27 in SI problems. It is very close to, if not the same as Cain's sacral hip-stifle point. It has the same functions as BL27. BL28 PangGuanShu = BL Shu: lateral to sacral foramen 2, at the top of the muscle crease. It relates to the posterior side of the hindlimb. BL32 is medial to it. Its lateral partner in humans is BL53. BL28a Unnamed = another BL Shu: lateral to coccygeal 2, in the groove just posterior to the origin of the biceps femoris, about 2 inches behind BL27a. This point is more reactive than the classical BL28 in BL problems (M.J.C). It has the same functions as BL28, as have BL32. BL28,28a (BL) may be tender in urogenital (renal, gonadal) disorders, in sacral problems, in all problems of the spinal column (from the atlas to the sacrum). BL28 is important in cervical misalignment, in sacrococcygeal injury (in transport etc), in stress-related pain of the semimembranosus and semitendinosus muscles. It is used also in GB-related (see BL19) lameness; Water (BL) is the Mother of Wood (GB) in the Sheng cycle. BL29 ZhongLuShu = Middle of Back Shu: lateral to sacral foramen 3. BL33 is medial to it. BL30 BaiHuanShu = White Circle Shu, Anus: lateral to sacral foramen 4. BL34 is medial to it. Its lateral partner in humans is BL54.

In humans, the Outer paravertebral BL line (O = points BL41-52, between vertebrae T2 and L2) has a relationship to the Inner (I) line: O (41 to 52) = I (12 to 23) + 29, i.e. points BL12,41 / 13,42 / ... / 23,52 / are functional pairs.

The outer (O) point is in the SAME ICS, lateral to the inner (I) point. The same relationship applies in the horse. The outer BL line relates to the parasympathetic nervous system. In particular, BL42 (ICS 8 in the horse; partner of BL13) is sensitive in lung bleeders, especially on the right side.

Human points BL53 and 54 are lateral to BL28 and 30 (lateral to sacral foramina 2 and 4 respectively). In horses, BL53 is just behind the anterior edge of the external angle of the ilium, lateral to BL26; BL54 is level with coccygeal 1-2 space, below and in front of BL28a. BL54a is below BL53, in the muscle crease just at the tuber ischii. BL54 and 54a are used in hip and thigh problems.

BL24 (QiHaiShu) and BL26 (GuanYuanShu) These points are used mainly for local effects, as in lumbar and sacral disorders. There is a traditional horse point GuanYuanShu behind last rib. It is active on gastrointestinal problems and should not be confused with BL26, which has effects on the uterus. BL24,26 may be active in disorders of the lumbosacral ligaments, sciatica, pain at the insertion of the longissimus dorsi, iliosacral ligament, middle gluteal muscle, sacrosciatic ligament, sacral nerve plexus.

The lumbar Shu (BL21,22,23,24,25,26: ST, TH, KI, QiHaiShu, LI, GuanYuanShu) reflect the sympathetic nervous (cervicolumbar) and endocrine systems.

The sacral Shu (BL27,28,29,30: SI, BL, ZhongLuShu, BaiHuanShu) reflect the parasympathetic nervous system (craniosacral).

CV Channel (FIGURE 13) The CV (Conception Vessel) Channel runs in the ventral midline, from CV01 (between the anus and the vulva/root of the penis, along the perinaeum above the penis or mammary gland, to the navel (CV08), to the tip of the xiphoid (CV14), to the manubrium sterni (CV22), to the hollow above the larynx (CV23), to the centre of the lower lip (CV24). This Channel is important in humans as Mu points for BL, SI, TH, ST, HT, PC (CV03,04,05,12,14,17 respectively) are on it. In the horse, points CV03-08 can be dangerous to needle but CV12,14,17 are relatively easy to needle. Horses, however, often tolerate Shiatsu (deep massage) of awkward points. CV12 is located midway between the navel and the xiphoid. CV17 is located about 1 hand anterior to the caudal border of the olecranon, on the sternum.

Shiatsu at CV05 can be used with AP at other points in endocrine/autonomic disorders (lack of sweating, breeding problems, thyroid problems). CV08,12 are useful in colic (Shiatsu or massage with heat-producing liniment).

CV01 + GV01 are useful to stimulate initial defecation in neonatal foals.

Stimulation of the clitoris (YinTi) produces a strong extensor reflex of the hindlimbs. This is of clinical use in dogs with posterior paresis: if marked extensor reflex is not produced, the prognosis is poor (M.J.C). In cows, warm Laser stimulation of the clitoris can help in the treatment of infertility.

CV23 (needling or Laser) is useful in pharyngitis (M.J.C).

GV Channel (FIGURE 14) The GV (Governing Vessel) Channel runs in the dorsal midline from GV01, (between the anus and the root of the tail), to the sacrococcygeal space (WeiKen, GV02), to the lumbosacral space (BaiHui, GV03), to the L2-L3 space (GV04), to the T5-T6 space (GV11), to the T3-T4 space (GV12), to the top of the head (GV20), to the midpoint between the nostrils, at their lower limit (GV26). It ends at GV28, between the upper lip and the upper gum.

The GV is a very important Channel in humans. Its points have similar functions to their nearest BL points. In the horse, because it can be difficult to penetrate the dorsal midline between L1 and T8, points GV05-10 are not used often. However, GV01,02,03,04,11,12,14 and 26 are very important points. GV01-04 are used in problems of the hindquarter, genitourinary system and hindgut.

When a Shu point is injured (from trauma, external or internal causes), the GV point or the dorsal spinal process nearest it is usually tender and should be treated. Very superficial picks (just slightly subdermal) are all that is needed.

GV01 + CV01 are useful to stimulate initial defecation in neonatal foals. The tip of the tail (GV00) is a special action point, used in shock and recumbency.

GV11 and 12, at the highest point of the withers, are related clinically to GV14 in humans (antifebrile point, antiasthmatic point, problems of the neck, thoracic limb and upper thoracic spine). GV11,12 often are tender in cervical problems in horses. They are as important to the forequarter as BaiHui (GV03) to the hindquarter. After adjustment of subluxated neck vertebrae (see 1.2.4), balance at GV11,12 can be obtained by pricking superficially with a 22g needle. The points can be injected with 0.1 ml homeopathic NaOH 9d. This releases spasm at the origin of the trapezius, latissimus, rhomboideus, serratus and other deep muscles attached to the withers. Occasionally, BL14 (PC Shu) and the GV point in between may be tender in breeding problems (M.J.C). The withers area is very prone to pressure injury from the pommel of the saddle or from bad riders, who ride too far forward. This is the site of fistulous withers and a point easy to injure the bursae of the supraspinous ligaments/neck muscle attachments.

GV26, the Shock Point, is useful in emergencies in all species. It is effective in stimulating respiration and circulation in the newborn foal. GV01 + CV01 are useful to stimulate initial defecation in neonatal foals.

REFERENCES 1. Hwang,Y.C. (1990) Handbook on Chinese veterinary acupuncture and moxibustion. FAO Regional Office for Asia and the Pacific, Bangkok. 193pp. 2. Klide,A. & Kung,S. (1977) Veterinary AP. University of Pennsylvania Press, Philadelphia, PA, USA. 297pp. 3. Kothbauer,O. & Meng,A. (1983) Veterinary AP: cattle, pigs and horses (in German) Verlag Welsermuhl, Wels, Austria. 334pp. 4. Lin,J.H. & Rogers,P.A.M. (1980) AP effects on the body's defence systems. A veterinary review. Vet. Bulletin 50, 633-640. 5. Lin,J.H. (1985) AP in the ox, pig, horse, goat & dog. (in Chinese). Write c/o Dept. Animal Husbandry, National Taiwan University, TAIPEI, TAIWAN, R.O.C. 6. Rogers,P.A.M. & Ottaway,C.W. (1974) Success claimed for acupuncture in domestic animals. A veterinary news item. Irish Vet. J., 28, 182-191. 7. Rogers,P.A.M., White,S.S. & Ottaway,C.W. (1977) Stimulation of the acupoints in relation to analgesia and therapy of clinical disorders in animals. Vet. Annual (Wright Scitechnica, Bristol) 17, 258-279. 8. Rogers,P.A.M. (1979) Acupuncture in equine practice: a brief review. Irish Vet. J., 33, 19-25. 9. Rogers,P.A.M. (1981) Serious complications of acupuncture... or acupuncture abuses ? Amer. J. Acup., 9, 347-350. 10. Rogers,P.A.M. & Bossy,J. (1981) Activation of the defence systems of the body in animals and man by acupuncture and moxibustion. Acup. Res. Quarterly (Taiwan) 5, 47-54. 11. Rogers,P.A.M. (1996) Choice of points for particular conditions. In: An Introduction to Veterinary AP. Proceedings of a training Course for Irish Veterinaians, Part 1, Dublin. 12. van den Bosch,E. (1995) Acupuncture Points and Meridians in the Horse. Contact the author at G. van Heuvelstraat, Ramsel, Belgium (Fax: 32-1656-1374).

13. Westermayer,E. (1980) Treatment of horses by AP. Health Science Press, Holsworthy, Devon, UK. 90pp. 14. White,S.S., Herbert,P.A. & Hwang,T. (1985) Electro-AP in veterinary medicine. Chinese Materials Centre Publications, San Francisco. 122pp. QUESTIONS Channel codes used in these questions are: LU, LI, ST, SP, HT, SI, BL, KI, PC, TH, GB, LV, CV, GV.

1. One of the following statements is not correct. Indicate the incorrect statement: (a) AP point sensitivity may be found by palpation or by response to thermal or electrical stimuli applied to the points. (b) Electrical resistance-, impedance- or conductance- meters may be used to detect reactive AP points. (c) The therapeutic aspects of AP are mediated by the reflex system and by activation of spinal and central neuroendocrine and systemic responses. (d) AP has analgesic, antiinflammatory, immunostimulant and immunosuppressive effects; antispasmodic effects on striated and smooth muscle; marked effect on blood microcirculation, cell metabolism and glandular secretion in organs related to the stimulated AP points. (e) AP has therapeutic effects on the nervous, endocrine, urogenital, gastrointestinal, musculoskeletal and respiratory systems but has no effect on the skin.

2. One of the following statements is not correct. Indicate the incorrect statement: (a) AP at the same point can have opposite effects, i.e. needling ST36 (TsuSanLi) can control gastric spasm in one case and gastric atony in another. (b) AP can help in early hepatitis or nephritis but may be of little use in severe fibrosis of the liver or kidney. AP can help in bronchospasm but may be of little use in emphysema with rupture of the alveoli. (c) AP is effective in less than 40% of cases of equine lameness. (d) AP is effective in treating paralysis in more than 70% of disc-disease cases and in less than 40% of myelopathy cases. (e) Although claims are made for effectiveness of AP in tendinitis, many experts got poor results in these cases. Tendinitis responds better to local Laser or to Plum Blossom Needling than to AP.

3. One of the following statements is not correct. Indicate the incorrect statement: Acupuncture has powerful therapeutic effects as the sole (only) or main therapy in the horse in: (a) muscle pain (b) radiculopathy due to soft tissue inflammation (c) windsucking (aerophagia) with no other digestive signs (d) early hepatitis (e) bronchospasm (f) early case of foal ataxia (wobbler), if used with neck manipulation

4. One of the following statements is correct. Indicate the correct statement: Acupuncture has excellent therapeutic effects as the sole (only) or main therapy in the horse in: (a) azotaemia/rhabdomyolysis (b) spinal transection (c) motor neuron degeneration (d) colic with intussusception (e) gastric ulcer in foals

5. One of the following statements is not correct. Indicate the incorrect statement: Acupuncture has poor or no therapeutic effects as the sole (only) or main therapy in the horse in: (a) acute laminitis (b) severe damage to brain motor centres (c) severe fibrosis of the kidney (d) alveolar emphysema

(e) female infertility with uterine cysts/fibrosis (f) chronic tendinitis, especially where owner will not rest horse

6. One of the following statements is not correct. Indicate the incorrect statement: (a) If the Shu of one Channel is tender, the Shu of its paired Channel may be used also. Thus, in hindlimb lameness, if BL23 (kidney Shu) is tender, one can add BL28 (bladder Shu) to the prescription. (b) Injury to the paravertebral area from the withers to the tail, whether due to incompetent riding, badly fitting saddle etc has little effect on racing performance. (c) If there is weakness (deficiency) in a Channel, the Shu of the Mother Channel can help. Thus, in weakness of KI, one could use the LU Shu (BL13) (d) If there is hyperactivity (excess energy) in a Channel, the Shu of the Son Channel can help. Thus, in excess of ST, one could add BL25 (LI Shu). (e) Injury to a Shu point, or to any key AP point, can have effects far more serious than "local injury" in a western sense. It may induce signs and symptoms in the associated organ or Channel and in related Channels.

7. Shu point sensitivity may give diagnostic information on the location of Channel problems and helps greatly in the choice of AP points for therapy. One of the following statements is not correct. Indicate the incorrect statement: (a) In mares and fillies, sporadic lameness can arise due to referred pain from ovarian or uterine irritation. It is essential in such cases to check for AhShi points related to the ovary and uterus. The most likely point to be tender in these cases is BL17. (b) Tenderness at BL25 (lumbar 4-5, LI Shu) may relate to lameness of the anterolateral forelimb above the carpus or to anteromedial forelimb below the carpus. (c) Horses with pain of the outside forelimb splint bone are more likely to show tenderness at BL15,22 or 27 (Shu of HT, TH or SI) than at BL13,14 or 25 (Shu of LU, PC or LI) (d) BL23 (between the wings of L2-L3) may be tender in urogenital (renal, gonadal), adrenal and fertility disorders and in thoracolumbar problems, lameness related to psoas muscles. (e) BL23 may be tender in post-castration pain, cryptorchidism, inguinal ring problems, inside hindlimb problems. If the tail twitches during riding, this indicates AhShi at BL23. 8. Shu point sensitivity may give diagnostic information on the location of Channel problems and helps greatly in the choice of AP points for therapy. One of the following statements is not correct. Indicate the incorrect statement:

(a) BL27 (SI Shu) may be tender in problems of the posterior side of the forelimb, tendons, sesamoids, heel bulb bruises, elbow (rare), sacral nerve plexus, biceps femoris, intestinal function. (b) SI10, if still tender after proper Channel balancing, is diagnostic for LOCAL shoulder lameness (OCD) (c) SI17 is related to the outside sesamoid, suspensory ligament and lameness at the posterior side of the forelimb. It also relates to ipsi- and contra- lateral lower sacral injury, hindlimb lameness and all neck problems. (d) BL19 (GB Shu) is associated mainly with spain, periostitis, splints or lameness of the inside forelimb. (e) TH17 and SI18 are tranquillizer points.

9. Shu point sensitivity may give diagnostic information on the location of Channel problems and helps greatly in the choice of AP points for therapy. One of the following statements is not correct. Indicate the incorrect statement: (a) BL20 (SP Shu) may be tender in disorders of the spleen, pancreas; in digestive disorders, impaction, colic; in lameness of the inside hindlimb/stifle/hock (cunean tendon) and in thoracolumbar injury. (b) Spleen points (BL20 (SP Shu), SP21,21a) are seldom if ever tender in bleeders or horses with blood disorders. (c) BL18 (LV Shu) may be tender in allergy (elevated globulin levels), muddy colour of the eye mucosa, lacrimation and conjunctivitis, problems of muscles, tendons, ligaments, azoturia, myositis, (tying-up syndrome), elevated CPK, SGOT in blood. (d) BL19 (GB Shu) may be tender in problems of muscles, tendons, ligaments, azoturia, myositis, (tying-up syndrome), elevated CPK, SGOT in blood. Tenderness at BL19 can arise in curbs. Reactive GB can cause spasm of the biceps femoris muscle, resulting in hindlimb lameness. (e) BL21 (ST Shu) may be tender in digestive disorders, impaction, colic, in anterolateral hindlimb lameness, stifle lameness, sacrosciatic ligament, sacral pain at the origin of the biceps femoris, thoracolumbar injury. BL21 may be tender in shoulder pain when sternocephalicus is involved. This is common. ST10 (on sternocephalicus m.) relates to BL21 and to the ipsilateral stifle, especially if BL21 is tender.

10. Shu point sensitivity may give diagnostic information on the location of Channel problems and helps greatly in the choice of AP points for therapy. One of the following statements is not correct. Indicate the incorrect statement:

(a) The BL Channel is the most important. Its clinical uses include diagnosis and treatment (via the Shu points). BL points are used in almost every AP prescription. (b) BL28,28a (BL Shu) may be tender in urogenital (renal, gonadal) disorders, in sacral problems, in all problems of the spinal column (from the atlas to the sacrum). BL28 is important in cervical misalignment, in sacrococcygeal injury (in transport etc), in stressrelated pain of the semimembranosus and semitendinosus muscles. (c) When a Shu point is injured (from trauma, external or internal causes), the GV point or the dorsal spinal process nearest it is usually tender and should be treated. Very superficial picks (just slightly subdermal) are all that is needed. (d) CV01 + GV01 are useful to stimulate initial defecation in neonatal foals. (e) GV14 (antifebrile point, anti-asthmatic point, problems of the neck, thoracic limb and upper thoracic spine) is located in the midline between the skull and the atlas bone.

11. A horse with poor appetite has a tender point on the left side, 10 cm lateral to the GV Channel, just behind the last rib. Which number (1 to 5) corresponds with: (1) (2) (3) (4) (5) a. the tender point : BL19 BL20 BL21 BL22 BL23 b. the Mother Point of ST: BL23 BL24 BL25 BL26 BL27 c. the Son Point of ST: BL23 BL24 BL25 BL26 BL27

12. A horse with poor stamina, dirty congested eyes, poor quality flaky hooves and tendency to azoturia/rhabdomyolysis is tender on right side on BL18. Which number (1 to 5) corresponds with:

a. the affected organ: b. the Mother Point of LV : c. the Son Point of LV :

(1)

(2)

(3)

(4)

(5)

HT

LV

GB

SP

ST

BL21 BL22 BL23 BL24 BL25 BL12 BL13 BL17 BL15 BL16

13. Two weeks after recovery from rotavirus infection, a 6-week-old foal develops mild colic, poor appetite, pasty dung, grinding of the teeth and dry harsh coat. Three tender points are located on the inner BL line. Which number (1 to 9) corresponds with the affected Channel linked to each tender point:

(1) (2) (3) (4) (5) (6) (7) (8) (9) a. behind last rib : LU LI ST SP HT SI BL TH GB b. at anterior edge of lumbar 6: LU LI ST SP HT SI BL TH GB c. over sacral foramen 1 : LU LI ST SP HT SI BL TH GB

14. The points in 13 above are BL21, BL25, BL27. Which pair of points (a to d) is best for use with those three points in gastrointestinal disorders: a. GB34 + LU07 b. ST36 + PC06 c. ST44 + ST06 d. SP10 + LI11 e. GB20 + GB21

15. A mare with a history of repeat breeding at 20-day intervals is tender bilaterally half way between lumbosacral space and external angle of the ilium. Which number (1 to 5) corresponds with: (1) (2) (3) (4) (5) a. the organ related to the point : KI LV ovary uterus cervix b. the AP point at the tender point: BL23 BL24 BL25 BL26 BL27 c. the TH Shu point: BL20 BL21 BL22 BL23 BL24 d. the KI Shu point: BL20 BL21 BL22 BL23 BL24 e. the SP Shu point: BL20 BL21 BL22 BL23 BL24

16. Which letter (a to e) corresponds with the correct location of GV01: a. between anus and vulva b. between anus and tail c. between tail vertebra 1-2 d. between tail vertebra 2-3 e. sacrococcygeal space 1=e; 2=c; 3=c; 4=e; 5=a; 6=b; 7=a; 8=d; 9=b; 10=e;

11: a=3; b=5; c=3; 12: a=2; b=3; c=4; 13: a=3; b=2; c=6; 14=b; 15: a=4; b=4; c=3; d=4; e=1; 16=b

ACUPUNCTURE IN SMALL ANIMAL PRACTICE INTRODUCTION Acupuncture (AP) literally means needle (acus) puncture. In the past it referred to needling specific points of the body to assist the healing (homoeostatic) power of the human or animal patient. The word AP has a much wider meaning today. It infers diagnostic and prognostic value as well as therapeutic effects.

Many methods can be used to activate the defensive systems of the body via the AP points. These include: simple needling, injection of the AP points (with orthodox or unorthodox medicaments, non-isotonic saline, B12 or local anaesthetic solutions), insertion of surgical staples or other implants at the points, electro-needling, transcutaneous electrical stimulation, ultrasound, low level laser therapy (LLLT), application of heat (microwave; infrared; moxa; thermostatically controlled heat probes) or cold (ice massage; ethyl-chloride or other vapocoolant sprays), massage etc. As long as it is adequate, the method of stimulation is less important than the correct choice of AP points.

This paper, discusses AP in small animal (SA) practice under 6 headings: 1. AP concepts and mechanisms 2. Methods of choosing AP points for therapy 3. Diagnostic prognostic and therapeutic aspects of AP with examples in emergencies, musculoskeletal problems, disc disease and reproductive disorders 4. AP analgesia for surgery 5. Practical methods of AP stimulation, especially in Trigger Point (TP) therapy 6. Further training

1. AP CONCEPTS AND MECHANISMS Traditional Chinese Medicine (TCM) is based on oriental philosophies of Qi, Yin-Yang, Five Phases, Perverse Causes of Disease, the Concept of Change and other concepts which western-style professionals find difficult to understand. These concepts are discussed in detail elsewhere. Those interested may read the basic human texts, listed below.

Briefly, Qi is the vital energy which comes from heaven (air), earth (food) and ancestors (genetic vitality). The Channel-Organ System (COS) is a vast network of superficial Channels (Jing), superficial and deep Collaterals (Luo, pathways connecting one Channel with a specific Phase-Mate Channel) and deep pathways which connect the exterior with the interior, the superficial Channels with their named Organs. The COS comprises an extensive 3-dimensional system of the Channels (Jing), Collaterals (Luo), superficial and deep pathways of Qi and the organs and their TCM Functions. The COS is the anatomical and functional system which controls all body organs, parts and functions and interfaces the interior to the exterior and the exterior to the external world beyond. The Jing-Luo (Channels and Collaterals) used to be called the Meridians and Qi Pathways of TCM.

Yin-Yang is the principle of opposite, yet complementary forces (female/male; hypo-/hyper-; cool/warm; chronic/acute; parasympathetic/sympathetic; diastole/systole etc).

Five Phases (Fire, Earth, Metal, Water, Wood) represented the five basic types, once called the Five Elements. Everything in existence can be categorised by analogy to Yin-Yang and Five Phases. The Sheng Cycle (anabolic, creative) and the Ko Cycle (catabolic, restraining) keeps the Five Phases in perfect harmony and balance. Each body organ and function relates to a specific Phase and disease patterns reflect the Phases. For example, in Winter (Phase = Water), the diseases to expect would be diseases of bladder and kidneys (Water), bones (Water), nervous system (Water).

In TCM, the classical Exogenous Causes of Disease (the Perverse Causes, or External Evils in TCM) are Wind, Damp, Heat, Summer Heat, Dryness and Cold. If the Wei (Defensive) Qi in the skin is weak, the External Evils can penetrate the body via the AP points and Channels. If the Qi in the Jing-Luo is not strong enough to throw off the attack, the Evil Qi can reach the viscera via the Jing-Luo and lead to fatality. Trauma, diet and internal causes are recognised also as causes of disease, as are phycological factors. In modern China, much of this philosophy is replaced by "scientific concepts" of medicine and pathology. However, many aspects of TCM still retain their full value in today's world, especially the holistic concepts of TCM and the validity (objective reality) of the AP points and their diagnostic, prognostic and therapeutic functions.

Two basic types of points are used in AP: Classical AP points and Tender Points which may or may not correspond with documented AP points

Classical AP Points: More than 2500 years ago, TCM described the functions and anatomical positions of hundreds of points on the classical human Jing-Luo System. These points have diagnostic and therapeutic properties. They occur on the head, neck, trunk and

limbs. Specific sets of points relate to and/or have functional connections with each other and with the COS, its TCM Functions and Qi-COS network.

The 12 Main Jing (Channels): In TCM, there are 12 Jing (Qi pathways) which run in the long axis of the body and are bilaterally symmetrical. Each Jing has a superficial path, along which lie its Channel points (close to the skin) and a deep path through the interior of the body, to connect with its organ and other related body parts and functions. Each Jing connects also with one "upstream" and one "downstream" in the daily energy (Qi) circuit. The 12 main Jing are LU (Lung); LI (Large Intestine or Colon); ST (Stomach); SP (Spleen); HT (Heart); SI (Small Intestine); BL (Bladder); KI (Kidney); PC (Pericardium; Circulation-Sex, Heart Constrictor); TH (Triple Heater: respiratory, digestive, reproductive functions); GB (Gallbladder); LV (Liver). Each of these Jing controls both superficial and deep functions.

The Qi in three Channels flows from thorax to fingers (LU, PC, HT); in three from fingers to face (LI, TH, SI); in three from face to foot (ST, BL, GB) and in three from foot to chest (SP, KI, LV).

Diurnal Qi circulation: Qi circulates in the Jing Luo to reach every cell in the body. The Qi tide flows through the Jing-Luo in a definite direction and time sequence: LU -> LI -> ST -> SP -> HT -> SI -> BL -> KI -> PC -> TH -> GB -> LV (and back to LU). The Qi peaks in LU between 0300-0500h and peaks in the other Jing in sequence at 2-hour intervals, to begin a new energy circuit in LU at 0300h next morning. Thus the Qi of each COS has its high- and low- tide.

In TCM, blockage or imbalance in the flow and distribution of Qi is the cause of ill-health. When there is disease, the Channel Qi is disturbed and certain points along the Channel become sensitive to palpation, heat and electric current. Stimuli applied to the sensitive points can normalise the energy flow, helping the adaptive responses to remove the disease (restore ease).

Example of a Channel path: The BL Jing begins at the inner canthus of the eye, goes across the skull, then paravertebral to the sacrum, then down the posterior midline of the buttock, thigh and calf to pass between the lateral malleolus of the tibia and the Achilles tendon and thence to the lateral aspect of the little toe.

Along the course of each Channel, a specific number of points is recognised. Each of these points is said to influence the parts and functions "controlled" by the Channel. For example, there are 67 BL points and BL67 (on the little toe) could influence the eye (BL01) and BL01

could influence the little toe. Each Jing also has a deep course and is "connected" to the organ bearing its name. Thus any BL point could influence BL function.

Each Channel point has local functions also. For example, BL40 (old BL54, in the popliteal crease) is used in knee (stifle) pain, arthritis etc; BL23 (between transverse processes of L2L3) in nephritis; BL01 in acute opthalmitis etc.

Channel points also influence the organs lying close to them. For example, BL13,14,15 (beside vertebrae T3, T4, T5) influence the lungs, pericardium and heart; CV03,4,12,17 influence the bladder, small intestine, stomach and heart respectively because of their proximity to these organs.

The Eight Mo (or Mai): These are called the Eight Extra Vessels. As well as the 12 main (bilaterally symmetrical) Jing, there are 8 special Qi reservoirs. Two of these are in the midline: the Ren Mo (Conception Vessel, CV, in the ventral midline, from perinaeum to lower lip) and the Du Mo (Governing Vessel, GV, in the dorsal midline, from the anococcygeal area to the upper lip). The CV and GV are said to be reservoirs of energy and contain many important AP points for cranial, thoracic and abdominal problems. The six other Mo (Vessels, Qi reservoirs) are the Chong Mo; Dai Mo; Yangqiao Mo; Yinqiao Mo; Yangwei Mo and Yinwei Mo. The Eight Extra Vessels link with some of the main COSs, thereby allowing one COS to influence many other COSs and other body parts.

AP diagnosis: So far, we have discussed the relationship between points and organs mainly as a one-way system (the points influencing the organs). In fact, AP has diagnostic aspects as well as therapeutic aspects. The organs influence the points and the points influence the organs. When an organ or its function is upset, reflex changes occur on the surface of the body and can be detected by careful examination of the points. The best examples of the diagnostic reflex points are the Shu (Back Association, paravertebral) and the Mu (Front Alarm, abdominal/thoracic) points. In disease of the heart, BL15 (Shu) and CV14 (Mu) are frequently tender to palpation, as are HT Channel points. In appendicitis (large intestine, LI), ST25 (Mu, McBurney's point) and BL25 (Shu, paravertebral point between L4-L5) may be tender in addition to LI Channel points.

Thus, via the Jing-Luo of TCM (or via neuroendocrine reflex/hormonal mechanisms in western physiology) AP points have a two-way relationship with the COSs. Channel or Organ pathology alters point sensitivity (diagnostic) and stimulation of the sensitive point helps to normalise the affected organ. Point sensitivity also returns to baseline as the organ or its function is normalised.

The relationships between point sensitivity and diagnostic/therapeutic aspects led to the search (in recent years) for other sensitive points in specific pathologies. This uncovered another 300 or so points not mentioned in the ancient texts. They are described in recent texts as "Extra-Channel, New or Strange Points" and their human positions are described.

In modern physiology, segmental reflexes explain many of the therapeutic and diagnostic relationships between internal organs and their related AP points; the same spinal nerves service both the area of the point and the area of the pathology. However, not all the therapeutic/diagnostic relationships can be explained by segmental reflex. For example, in acute appendicitis, a new point (LanWei: literally gut tail or appendix) on the tibialis anterior muscle (right side) is usually very tender to palpation. This point is very powerful in relieving the pain and spasm of acute appendicitis. Its effect may be explained by short intersegmental reflexes. Other effects, for example between Earpoints and abdominal organs can be explained by supraspinal reflexes.

As well as the documented AP points, Trigger Points (TPs) are another point category of diagnostic and therapeutic value in AP. TPs often occur in pain syndromes, especially in myofascial syndromes. They have no fixed location but may appear in the musculature, where they may be palpated as "nodules" or areas of localised spasm. Heavy pressure on (or needling of) the TP causes severe pain which radiates back to the area of complaint (i.e.) it "triggers" the complaint. Other points can act as triggers, for example scar tissue is frequently a trigger for muscle or organ pain elsewhere. TPs occasionally arise near the Golgi apparatus of tendons and at motor points (where the motor nerve enters the muscle). International experts, such as Melzack (Canada), Pontinen (Finland), MacDonald (UK) and Chung (Taiwan), have done intensive research on TPs in relation to human pain syndromes and a Belgian colleague has recently described TPs in myofascial problems in dogs (Janssens 1987).

In AP, location of tender points (including TPs) is extremely important in diagnosis and stimulation of these points can give pain relief in 50-70% of cases. The quickest and easiest way to convince sceptics of the benefits of AP therapy is to persuade them to experiment with TP therapy. It needs no knowledge of AP points or of the very detailed laws of AP. The clinical success of TP therapy is usually met with disbelief at first. Later the sceptic comes to accept it. It is then be easier to persuade him/her to undertake serious study of the complete AP system. The weakness of TP therapy is that many clinical cases (including some myofascial cases) do not develop triggers. Therefore many of these cases can not be treated successfully by needling unless the practitioner knows classical AP.

AP POINT STIMULATION AP stimulation means the application of a sufficient stimulus to the AP points to activate a desired response. There is not time in this talk to discuss mechanisms in detail. Briefly, AP

effects are mediated by the peripheral and CNS, autonomic, neuroendocrine and endocrine systems. (a)

(b)

(c)

Point ---> sensory nerve ---> spinal cord ---> CNS --->

Neuroendocrine

^

| |

|

|

ENDOCRINE. AUTONOMIC

|

(+) | |

(-)

DISORDER 1100 clinical conditions were generated from the computer database. 3. The Top Twenty Points from each prescription were extracted from the database summary. From this list, the most important points for major body regions (head, neck, thoracic limb, thorax, nose, throat, shoulder, elbow, lung, stomach, etc) and common symptoms (shock, nausea, vomiting, diarrhoea, fever, etc) were extracted. 4. Appendix 1 comments on the use of the point Index, the structure of the Index and the code and name of each point. Appendices 2 and 3 list the points. Examples of methods of point selection for specific conditions and for more complex syndromes (combinations of symptoms) are given in the text. 5. Advantages and disadvantages of the COOKBOOK METHOD of point selection are discussed in relation to holistic (traditional) AP. INTRODUCTION Western veterinary AP is based primarily on transposition of human AP principles to animal patients. To select effective points for therapy, one makes appropriate adjustments for differences in anatomy, location of peripheral nerves, and temperament of the animal (Rogers, 1980b; Molinier, 1983; Westermayer, 1981). There are some texts on traditional veterinary AP and some Western experts have produced texts which are based on traditional points. Others have written texts on the transposition method. Advantages and disadvantages of the transposition method have been discussed elsewhere (Rogers, 1982b). Studies of the electrical resistance of skin in dogs, horses and cattle have confirmed the existence of REPP (reactive electropermeable points) at locations predictable from the human AP system (Janssens; Krueger; Greiff; Kothbauer). In AP research with primates, laboratory animals (mice, rats, guinea pigs, rabbits) and larger species, the human transposition system is the one used routinely to locate points such as LU01; LI04,11,15,20; ST09,25,36; SP06,09; HT07; BL points; PC06; TH05,08,14,17; GB20,30,34; LV03,14; GV26 etc. The clinical and experimental effects of stimulating these points have been confirmed worldwide in the past 10 years in many animal species (laboratory, farm, domestic and zoo). Uses of the computer in AP and the advantages and disadvantages of computer -generated prescriptions were discussed elsewhere (Rogers 1984 a, b). Many professionals still refuse to use a computer. I believe that this refusal stems from fear (that they will not be able to master it) and ignorance of what a modern computer can and cannot do. Traditionally-trained

acupuncturists may scorn the idea of cookbooks (although they use their own favourite prescriptions - a poor Cookbook). They would be horrified at the idea of computerising AP. COOKBOOK AP: Many have told me that "prescription AP", especially the free availability of prescriptions, do AP a disservice. They assume that the cowboys (quacks, charlatans, getrich-quick merchants) will proliferate and thrive if such information is freely available. I do not believe this. I would prefer to see AP develop rapidly. This will not happen if we must wait for a high percentage of the professions to develop to Master Acupuncturist status. The use of AhShi therapy and cookbooks brings more professionals into the active AP field than any other method that I know. This paper discusses computer-based AP prescriptions for selected areas and symptoms under 3 main headings : computer AP databases : prescriptions for major body areas, functions, subregions : prescriptions for common symptoms It has taken me more than 11 years to amass these data. Therefore I ask each of you to treat the material as copyright. You are welcome to use it for clinical, study and research purposes, but not for commercial publication in text, computerised, microfiche form, etc. You are free to make personal copies for friends or colleagues, but only on condition that they also agree to respect the copyright. The Channel and Point coding used throughout this text is: LU, LI, ST, SP, HT, SI, BL, KI, PC, TH, GB, LV, CV, GV; ST08 (TouWei) is on the temple, BL41 (FuFen) is at T2 and BL40 (WeiZhong) is in the popliteal crease. This is the same as that used by IVAS. The alphanumeric code and name of each point is shown in Appendix 1. As there is no internationally accepted coding system to-date, you are urged to check my coding system (Appendix 1) at this stage and to compare it with the one which you use. This is most important to prevent confusion and error. COMPUTER AP DATABASES The larger the database, the more points are filed under any given region, symptom or condition. However, the first 6-10 points listed (in order of descending citation score) are the most important for routine use. For example, in the most recent summary of the database, 401 points were listed from a base of 44 texts for the treatment of sequelae (hemiplegia, paralysis) of CVA or polio. The Top Ten points were: Ranking Point Score

1

2

3

4

5

6

7

8

9

10

LI04 LI11 ST36 GB34 ST06 GB30 ST04 LI15 TH05 GB39 .86

.79

.77

.74

.73

.72

.68

.66

.62

The Maximum score possible was .964. The bottom 10 points were:

.62

Ranking Point Score

392

393

394

395

396

397

398

399

400

401

CV13 CV17 BL65 LI01 ST23 BL07 KI20 GB06 GB43 LV06 .02

.02

.02

.02

.02

.02

.02

.02

.02

.02

The scores have been rounded up or down to the second decimal place. Clearly, the first list would be expected to give better therapeutic results than the second list above. However, selection of the Top Ten points in the above list would not necessarily be the best selection for a CVA sequel which was primarily mutism or aphasia. For such cases, the top 10 points are: Ranking Point Score

1

2

3

4

5

6

7

8

9

10

CV23 GV15 HT05 LI04 Z 21 TH03 GB02 TH17 NZ32 SI19 .82

.72

.44

.37

.27

.23

.23

.21

.20

.18

(From a total of 71 possible points listed by 27 texts, maximum possible score was .952) The differences between the Top Ten points for CVA and the Top Ten points for aphasia underline the need for formulating specific questions for the computer search. Where possible, one should search the database for general data (CVA), general region (head, neck, thoracic limb etc), specific region (arm, leg, hip, etc), specific nerve (mandibular, hypoglossal, radial etc). Where specific symptoms are marked (aphasia, incontinence, etc) they should also be searched. The greatest volume of data refers to the abdomen and its organs/functions. Although there are points listed for "abdomen", "digestive upsets", "reproductive disorders" etc, these lists should be used as guidelines for general study or general consideration. In specific cases, it is preferable to search under the most relevant symptom or condition, such as "vomiting", "diarrhoea", "constipation" etc, rather than "digestive upset" or "metritis", "infertility", "impotence", "oligospermia" etc, rather than "reproductive disorders". The database covers >1100 headings (regions, organs, conditions, symptoms, etc). The printout of the complete listing for the Top Twenty points runs to some 160 pages of fullwidth (132-character) computer paper. In one hour, it is not possible to cover these data. Therefore, I have chosen to list the Top Twenty points for about 130 of the major body regions and their subregions and organs (Appendix 2). The Top Twenty points for about 130 of the more common symptoms are also listed (Appendix 3). PRESCRIPTIONS FOR MAJOR BODY AREAS, FUNCTIONS, SUB-REGIONS AND COMBINATIONS OF SIMILAR CONDITIONS In the database (see Appendices 1,2,3) points are filed under separate condition codes such as: 040201 Shoulder area (unspecified conditions)

040202 Clavicle: APA for fracture reduction 040203 Shoulder: APA for dislocation reduction 040205 Shoulder, scapula : pain .. ache.. .arthritis etc 040211 Shoulder, scapular: paralysis 040219 Deltoid: myofascial syndrome Using the computer, it was possible to combine information to retrieve all points used in, for example, all conditions of "shoulder, clavicle and scapular area" (a total of 181 points from 45 references). In this way, the entire database was summarised by amalgamation of data for major body areas, functions, subregions and combinations of similar conditions. The Top Twenty points and their scores are listed in Appendix 2. These lists should prove useful in the study of AP and as reference material for teaching seminars. They do not, however, supplant the lists of points for specific symptoms but should be seen as general guidelines in the choice of points. PRESCRIPTIONS FOR COMMON SYMPTOMS The database was searched for a cross-section of common symptoms, especially those relating to the musculoskeletal system (pain, paralysis) and to major body functions. The Top Twenty points and their scores for some 130 symptoms or conditions are listed in Appendix 3. It must be remembered that only the Top Twenty points are given here. There are many other points which could be considered, especially if a number of symptoms occur together. In complicated cases, for example, neurogenic vomiting and dehydration in the dog, points for the main symptom (vomiting: PC06; ST36; CV12; ST25) could be combined with supportive therapy (fluid replacement). In cases of anaesthetic emergency or respiratory arrest, main points (GV26, KI01) could be combined with artificial respiration (though the latter is seldom needed if the points are stimulated strongly). In cases where cardiac arrest has also occurred, point PC06 (very powerful on heart and lungs) could be added to GV26, KI01, and open or closed heart massage, defibrillation or other methods would be added. Please scan Appendices 1, 2 and 3 now, and then return to the discussion which follows. MASTER POINTS FOR CHANNEL THERAPY Apart from the 66 Command Points, there are other powerful points to redistribute Qi between imbalanced Channels. These are the Shu-Back Association (Reflex) Points, the MuFront Alarm Points, the Luo-Passage (Connecting Points between the Phase-Mate Channels within one Phase), the Xi-Cleft Points, the Test Points, the Ryodoraku (Japanese Points), and the HE (Sea Points). The latter points are not the same as the HO points on the Channels. In addition there is an Hour Point (the Phase point of a Channel, for example the Earth Point of SP, the Water point of BL etc). SP21 is the Great Luo point (Luo point of all the Yin Channels).

Taken together, the 66 Command/Su Points, plus the Shu, Mu, Luo, Xi, Test, Ryodoraku, HE, Hour and SP21 Points are called the Master Points of AP.

Affected COS

The Five Phase Points

Tonic Sedat.

Wood Fire Earth Metal Water

point point

Yuan

Luo

LV (Wood-Yin )

01

02

03

04

08

08

02

03

05

GB (Wood-Yang)

41

38

34

44

43

43

38

40

37

HT (Fire-Yin )

09

08

07

04

03

09

07

07

05

SI (Fire-Yang)

03

05

08

01

02

03

08

04

07

PC (Fire-Yin )

09

08

07

05

03

09

07

07

06

TH (Fire-Yang)

03

06

10

01

02

03

10

04

05

SP (Earth-Yin )

01

02

03

05

09

02

05

03

04

ST (Earth-Yang)

43

41

36

45

44

41

45

42

40

LU (Metal-Yin )

11

10

09

08

05

09

05

09

07

LI (Metal-Yang)

03

05

11

01

02

11

02

04

06

KI (Water-Yin )

01

02

03

07

10

07

01

03

04

BL (Water-Yang)

65

60

54

67

66

67

65

64

58

Xi-

RYODO

HE

Cleft

HOUR

Test

-RAKU

(SEA)

point

point

point

point

point

Affected COS

Shu

Mu

LV (Wood-Yin )

BL18

LV14

06

01

08

03

-

GB (Wood-Yang)

BL19

GB24

36

41

33-39

40

GB34

HT (Fire-Yin )

BL15

CV14

06

08

07-09

07

-

SI (Fire-Yang)

BL27

CV04

06

05

03-04

05

ST39

PC (Fire-Yin )

BL14

CV17

04

08

04

07

-

TH (Fire-Yang)

BL22

CV05

07

06

04-10

04

BL53

SP (Earth-Yin ) BL20

LV13

08

03

09

02

-

ST (Earth-Yang) BL21

CV12

34

36

34-36

43

ST36

LU (Metal-Yin ) BL13

LU01

06

08

06

09

-

LI (Metal-Yang) BL25

ST25

07

01

11

05

ST37

KI (Water-Yin ) BL23

GB25

05

10

07

05

-

BL (Water-Yang) BL28

CV03

63

66

59-60

65

BL54

1. In disorder of the associated Channel-Organ System (COS), there is usually tenderness on palpation of the Yuan, Mu, Shu and Test points. The Test points may feel cold in Yin states and hot in Yang states. The RYODORAKU points are electro-sensitive diagnostic points used in Japanese diagnosis. Their readings are hypo- in Yin and hyper- in Yang states. 2. All MASTER points, except Shu, Mu and HE points, are on their respective Channels and lie between the elbow and finger or between the knee and toe. 3. The Yuan-Luo combination uses the Yuan of the affected Channel with the Luo of the Phase-Mate Channel, i.e in lung disease, LU09 (Yuan of LU) plus LI06 (Luo of LI). An examination of most of the listings in Appendices 2 and 3 shows that the Top Ten points obey the basic laws of choosing AP points. In summary, these laws suggest a choice of points from: a. AhShi points (including Trigger Points, tender scars, fibrositic nodules etc) b. Local points (which also meet condition (d)). c. Distant points on the Channel through the affected area or on the Channel of the affected organ. A chain of points on the affected Channel is said to be specially powerful. d. Points on the affected nerve, the nerve supply related to the affected organ or area, or in the same or a nearby spinal nerve segment. e. Encircling the problem area; "Fore and Aft" points; combination of Yin side and Yang side points (medial/lateral; anterior/posterior). f. Combination of Mu and Shu (Front Alarm + Back Association) points. g. Combination of affected Yuan and Luo of Mate (Source Point of the affected Channel plus Passage point of its Phase-Mate Channel (LU-LI; ST-SP; HT-SI; BL-KI; PC-TH; GB-LV). h. Xi-Cleft point of affected Channel. i. One or more of the Five Phase Points (Energetic balancing points). j. Symptomatic points (traditionally known to have marked effect for the specific symptoms, for example, GV26 in shock, emergencies; PC06 in nausea or vomiting). k. Extra-Channel points ("New" or "Strange" points, points not on the Main Channels), especially those effective for the condition, e.g. NX04 (TingChuan) in asthma. l. Points on the Phase-Mate of the affected Channel (e.g.) ST points in spleen diseases; SP points in stomach diseases.

m. TianYing point (OT02, centre of the goitre etc). n. One point on each of the 4 limbs (e.g. LI04 and ST44, both bilateral, in tonsillitis or toothache). Let us examine the Top Ten points from some prescriptions (Appendices 2,3) in detail under three basic headings: 1. Local conditions or regions 2. Conditions of specific internal organs or their functions 3. Generalised conditions and complex syndromes. In each of these conditions, codes (a) to (n) mentioned above are used to show the laws observed by the points in the Top Ten list. 1. LOCAL CONDITIONS OR REGIONS: Let us pick problems of the eye, nose, neck, shoulder, elbow, lowback, hip and knee (stifle) as examples from Appendix 1: EYE: BL01 (b); LI04 (c, as the LI Channel connects to ST Channel at the eye); GB2O (c);also Wood (GB,LV) controls the eyes; ST01 (b); Z09 (b, k); BL02 (b); ST02 (b); GB14 (b,c (Wood)); TH23 (b); BL18 (liver controls eyes. BL18 is Shu point of liver, b). The combination BL01, ST01, Z 09, GB14 meets law (e) above and is very useful in eye diseases. 7/10 of these points are local points. NOSE: LI04 (c,g,i,j); LI20 (b); GB20 (j); GV23 (c); LI11 (c,i,j); GV14 (c,j); Z 03 (b,k); BL07 (c); LI19 (b); ST02 (b). The combination LI20, Z 03, ST02 also meets law (e). 4/10 of these points are local points. NECK: GB2O (b); GV14 (b); LI04 (c,g,i); BL10 (b); SI03 (c,i.j); LI11 (c,i,j); OT01 (AhShi point - a); GB21 (b,c depending on site of problem); GB39 (c,j); SI15 (b). The combination GB20,21, BL10, GV14, SI15 also meets law (e). 5/10 of these points are local. SHOULDER area: LI15 (b,j); LI11 (c,i,j); TH14 (b,j); Sl11 (b); Sl09 (b); LI04 (e,g,j); OT01 (a); Sl10 (b); OT05 (local points, b); BL11 (d ,j ). A combination of SI09, LI15 and a new point l" above anterior axillary crease is known as the "shoulder triplet". The combination meets law (e) above and has powerful effects in shoulder conditions. 6/10 of these points are local points. ELBOW: LI11 (b,i,j); TH05 (c,j); LI04 (c,g,i); HT03 (b,i); LU05 (b,i); LI10 (b); OT01 (a); LI12 (b); TH10 (b); SI07 (c). 6/10 of these points are local. LOWBACK: BL23 (b,j); BL40 (c,i,j); GB30 (c, linked to lowback via BL Channel, d,j); BL60 (c,i,j); GB34 (c (via BL link), i,j); BL25 (b); BL37 (c); GV04 (b); BL57 (c); BL31 (b). 4/10 of these points are local. HIP: GB30 (b,j); GB34 (c,i,j); GB29 (b); GB31 (c); BL40 (c via link to GB Channel, i,j); BL60 (c,i,j); OT01 (a); GB39 (c,i,j); ST36 (d,i); LV08 (-). Although only 2/10 of these points are local, 2 of the top 3 points are local.

KNEE: GB34 (b,i,j); BL40 (b,i,j); L 16 (b,k); ST35 (b); SP09 (b); ST36 (c,i); ST34 (b); LV08 (c); OT01 (a); GB31 (c). The first05 of these points are the most commonly used combination (obeying law e) and all are local points. In the eight local conditions discussed above, seven have a local point as the first in the list (the 8th has a local point as second on the list). 2. CONDITIONS OF INTERNAL ORGANS AND THEIR FUNCTIONS: Let us consider the Top Ten points in five of the conditions in Appendix 2. Close examination of other lists in the appendices will show that they follow similar logic. PLEURA: BL42, BL47, BL43, KI23, KI22, BL13, GB32 (7/10 points) are on the thorax or dorsal paravertebral area (local). Two of the other three (ST12, BL11) are at the thoracic inlet and the 10th point (GB44) obeys law (c). HEART, PERICARDIUM: Only 3 of the Top Ten (BL15, BL14, CV17) are over or near the organs. They obey laws (b), (d), (e) and (f). Six of the remainder (PC06, PC07, HT05, PC05, PC07, PC04) are on the HT or PC Channel (laws c, i, j). The 10th point (ST36) is a Master Point, with many functions, including effects on HT and PC. COUGH, GENERAL: BL13, CV22, GV12, BL12, CV17 (5 of the top 10 points) are over the thorax, trachea or dorsal paravertebral area. They obey laws (b), (d), (e), (f), (j). Three points (LU05,07, 10) are on the LU (lung) Channel (laws c, i). The remaining two points (ST4O, GV14) meet laws c and i. LIVER: 6/10 points (BL18,19,20,48; GV09; LV13) are over or near the liver. They obey laws b, d, e, f, j. The remaining four points (LV03, ST36, GB34, SP06) are master points. They obey laws c, g, i, j. GENITALIA FEMALE AND REPRODUCTION: 6/10 points are in the lumbosacral innervation area (low abdomen or l/s paravertebral area). They are: CV03,04,06; GV04; GB26; BL32. They obey laws (b), (d), (e), (j). The four remaining points (SP06,10; LV03; ST36) are Master Points with major effect on low abdomen and its functions. They obey laws (c), (i), (j). 2a. IF AN ORGAN OR FUNCTION HAS NO NAMED CHANNEL, points can be chosen from combinations relating to the nearest organs, or Channels, or functions. For example, suppose there were no entries for the following organs: Thymus: consider points from combinations for heart, lungs, stomach (nearest organs) and immunity (a closely allied function). Diaphragm, oesophagus: consider heart, lung, stomach combination. Appendix: consider lower right abdomen and large intestine combinations + immunity. Adrenal (beside kidney): consider kidney combinations. Ovary, tubes, uterus: consider kidney, bladder, low abdominal and large intestinal combinations.

Vagina, vulva, scrotum, testicles, penis: these are controlled by the 3 Leg Yin Channels (SP, LV, KI). Consider points on these Channels + points for low abdomen, bladder. 3. GENERALISED CONDITIONS AND COMPLEX SYNDROMES: Generalised conditions include metabolic, hormonal, toxic, general autonomic upsets, etc (such as gout, diabetes, food poisoning, shock, neurasthenia, etc). Although one symptom may be dominant, it is usual to have a number of symptoms and abnormalities occurring together. For example, in gout, the presenting symptom may be pain in the big toe (or other joint), but other symptoms could include liver enlargement + pain; headaches; irritability; blurred vision; tiredness, etc. The comprehensive treatment would entail dietary advice (possibly involving food allergy/intolerance testing) and increased fluid intake. AP would be aimed at the more severe symptom (say toe pain) but other points (especially LV and GB) would be aimed at the other symptoms. The liver is central in gout and many allergies. Treat the liver. In diabetes mellitus, polyuria, neuropathy and other signs can arise. Dietary advice, together with points for diabetes (see Appendix 2) the local regions affected by neuropathy and the kidney (Appendices 1 and 2) would be indicated. In food poisoning, vomiting and diarrhoea would be tackled by points such as CV12, PC06, ST25,36,37 but other symptoms (dehydration, prostration etc) would best be tackled by fluid replacement. Medication (kaolin, chlorodyne) can assist the gastrointestinal symptoms. In shock, points like GV26, KI01, ST36, PC06 can be of immediate help but accurate diagnosis of the pathology is essential and would indicate other interventions (surgery, if severe internal bleeding; fluids, stimulants, warmth, etc where indicated). In neurasthenia, insomnia, excitement etc, the HT and PC Channels control these functions in traditional belief. Consider HT, PC points. DISCUSSION 1. IN MOST LOCAL PROBLEMS (joint, muscle, superficial organ etc) the best prescription combines AhShi points and local points + distant points on the affected or related Channel. It is important to check the location as regards the nerve supply and the Channel. For example, the best combination for pain in the medial epicondyle of the humerus will not be identical to the best combination for the lateral epicondyle. However, in traditional AP, it is not enough to pick any local point. (Some local points are better than others, or, at least, are more frequently recommended than others). Modern neurophysiological concepts of AP stress that adequate stimulation of the affected or related NERVES will produce results as good as the traditional method but adequate clinical or research testing of the traditional versus modern (nerve theory) methods has not been done. For the moment, I give the benefit of the doubt to the traditional system, which has stood the test of time. 2. IN DISEASE OF INTERNAL ORGANS, the most important points lie near the organ in the thoracoabdominal area or in the paravertebral area (the Mu, Shu and Huatochiachi (X 35) points, CV and GV points). Where the organ has a named Channel (LU, LI, ST, SP, HT, SI, BL, KI, PC, GB, LV) it is common to include one or more points on that Channel (distant as

well as local points). Also, the course of the Channel is important. For example, the liver, kidney and spleen Channels traverse the inner thighs and groin area. Distant points on these Channels are important in genital and lower abdominal conditions. In general, if a symptom or abnormal function can be traced to a specific COS, treat that COS. If more than one symptom/organ system is involved, choose a combination of points which will influence all the major symptoms or upset organs. 3. IN ACUTE SERIOUS CONDITIONS, WITH MULTIPLE SYMPTOMS AND PATHOLOGY, it is unwise to rely solely on AP. AP can often give considerable help (using points as indicated by the main symptoms and pathology) but conventional or unconventional (complementary) therapies may need to be used as well. 4. IN CHRONIC COMPLICATED CASES, where immediate life-threatening symptoms or pathology are absent, one can rely more on AP as the main therapy (in cases amenable to treatment). At all times, however, the aim of good medicine is to help the patient to the greatest extent, with the minimum of side effects. Therefore, it is good practice to use whatever complementary therapies seem best indicated. Analysis of the database indicates that points from the list: LI04,11; ST25,36; SP06; HT07; BL23,40; PC06; TH05; GB20,34; LV03; CV06,12; GV04,12,14,20,26 arise in a high proportion of cases. In complex cases, if one has difficulty in deciding on a prescription, it is advisable to include a few points from that list. LIMITATIONS OF COOKBOOK AP: How would one treat the following syndrome? The patient had the following symptoms (at different times) during a period of 6 years, beginning two years after radical right lung surgery: recurrent haemorrhagic nephritis; cystitis; rightsided sciatica; right- sided paravertebral pain (C6 - T4 area); right-sided headache and bouts of acute conjunctivitis (right); right ear tinnitus; waking at night with severe pain along the SI Channel of the arm to the little finger, with the arm in spasm. To try cookbook prescriptions in such a case would be second-rate AP. There was obviously a connection between all these symptoms (all relate to SI, BL, KI) and most were right sided symptoms. On examination, the patient's thoracotomy scar was badly twisted, with adhesions on the right BL line. This was the clue. Blockage of the Qi flow (traditional concept) or reflex irritation effects (Western concept) could cause all of these symptoms via the Chinese SI-BL-KI energy cycle. Treatment was physiotherapy + injection of the scar plus a few AP sessions using BL points. All symptoms were successfully cleared. Cookbooks have their limitations and Chefs do not need them. CONCLUSIONS Cookbooks or computerised prescribing is very valuable for beginners and for those working in a clinic. However, one should not rely too much on machines or computers. Computers need electrical power. In national disaster and warfare, and in many of the developing countries, electrical power, batteries etc may be unavailable where they are needed most. Therefore, it is important for the development of medicine and veterinary medicine that as many professionals as possible should study the basics of AP. This learning process can be accelerated by interaction with a computerised database (Rogers 1984a). Adequate knowledge

of AP will enable it to be used more widely in field work (large animal work, medics and paramedics in the bush). Although the data reported here (Appendices 1,2,3) are but a small fraction of the database, it is obvious that for most conditions, the Top Ten Points usually will be worth considering. However, in some complicated cases, points not in the Top Ten may be most relevant. The statistical method is very useful for population medicine, but it may be disastrous for the unfortunate patients who need individually designed care. As a general rule, if a Cookbook prescription does not produce definite results by 2-3 sessions, it is necessary to (a) change the choice of points, or (b) consider other therapies, or (c) regard yourself as unable to assist. The enthusiastic amateur AP practitioner will get useful results with the COOKBOOK but more complicated or deeply rooted problems require more holistic (traditional + modern + complementary + intuitive) therapy. Therefore, I strongly encourage you to continue your study of Chinese AP in depth. To get the best results, use the cookbook as the first-line of attack (in conditions amenable to AP) but be prepared to fall back on traditional and other methods if results do not follow quickly (Rogers 1984b). This assumes that the user is trained in basic AP and is able to interpret the point selections. When using the prescriptions given in this paper, please note (a) the number of references in the prescriptions, (b) the maximum possible score, (c) the score of each point in the list (calculated by ratio to the maximum possible score), and (d) the variation in scores between points. If there are few references, the prescription may be of doubtful value. If the maximum possible score is (say) .90 and the max. score for any point is (say) less than .40, the prescription may be doubtful. If there is little variation between the scores and all scores are greater than .40, various combinations of points should be equally effective. Remember that the best prescriptions usually combine AhShi points, LOCAL points, DISTANT points and (if internal organs are involved) Mu + Shu + Yuan + Luo combinations. Thus, the wheel turns full circle. The traditional methods of point selection were best after all. Modern technology has merely re-invented the wheel ! REFERENCES Greiff, Walter; Janssens, Luc; Kothbauer, Oswald (1970-1983). Verification of AP point locations in nimals by electrical methods and by experimental and/or clinical results. Kothbauer, Oswald ( 1983). Veterinary AP - Ox, Swine and Horse. Verlag Welsermuhl, Wels, Austria, 334 pp. Krueger, C. (1976). AP point topography in the horse. Am. J. Acup. 4, 276-. Molinier, F. ( 1983). Localisation of veterinary AP points. Rev. d'Acup. Vet. (Paris), No. 17 (4), 6-. Rogers, P.A.M. (1982a). The study of AP: Sources and study techniques IVAS Annual Congress, Cincinnati, Ohio (33pp + appendix).

Rogers, P.A.M. (1982b). The study of AP: Points and Channels in animals. Ibid. (23 pp). Rogers, P.A.M. (1982c). The choice of points for AP therapy. Ibid. (26 pp). Rogers, P.A.M. (1984a). Computer applications in the study and clinical use of AP. IVAS Annual Congress, Austin, Texas, 13 pp. Rogers, P.A.M. (1984b). Traditional versus cookbook AP. Ibid. 40 pp. Westermayer, E. (1981). Channels and ancient points, especially in cattle. IVAS Annual Congress, Cincinnati, Ohio, 21 pp. Yu Chuan & Hwang Yann-Ching (1990) Handbook on Chinese Veterinary AP and Moxibustion. FAO Regional Office for Asia and the Pacific, Bangkok, 193pp. 1.3 LOCATION OF IMPORTANT AP POINTS IN CATTLE BY TRANSPOSITION Location of AP points in animals can be by: a. following Traditional Texts (see part 2). b. by reference to charts based on results of provocation experiments or clinical association of reactive points with disease of specific organs c. by Transposition from humans.

Oswald Kothbauer (Austria), documented the paravertebral reflex (Shu) points in cattle. He injected irritant solutions into specific organs (cervix, ovary, uterus, kidney etc) and then searched for provoked reflex changes in the paravertebral area, using an electrical "Pain Point Detector". This instrument detected points of low electrical resistance (high conductivity). High conductance corresponded with reactivity to pressure-probing and the points could also be found by searching with a blunt scissors or other probe. When the reflex points were located by the probe (electrical or mechanical), the cow reacted by kicking or trying to escape or vocalising etc, due to increased reactivity to palpation or pain stimuli applied to the reflex point.

Figures 3a-3c show Kothbauer's diagnostic points. They are in two categories: a. Reflex points and Alarm points. The relationships to the organs are shown in Table 4. The Reflex points are located mainly on the BL Channel in the transposition system. b. Alarm points are located more ventrolaterally.

Both types of points are located in areas linked to the affected organs by the spinal nerves. They are also located at or near areas predictable from a knowledge of the Shu and Mu points in humans. Thus, Kothbauer's points are very similar to paravertebral TPs, Shu and Mu points in humans and have similar diagnostic and therapeutic uses.

Through years of clinical observation, Kothbauer, Greiff, the late Dr. Westermayer and others have documented "pain points" (reactive points, AhShi points, TPs) in the paravertebral area in cases of specific organ pathology. In general, these points agree with Kothbauer's points.

Provocation experiments has been done in pigs also (Schupbach 1985). He injected irritant solution into the body or horn of the uterus of mini-pigs. Using computer-controlled infra-red thermography, he located specific zones on the skin of the lumbosacral area which became "Hot Spots" within 10-40 minutes (average 25 minutes) after irritation of the body or horn of the uterus. These "Hot Spots" related well with classical AP points known to be related to the uterus and cervix (points over the iliac wing, lumbosacral space, sacral foramina and anterior coccygeal area (BL26.3,27-34, BaiHui, WEIKEN etc). Figure 4 shows the reflex "Hot Zone" and the warmest point (WP). In his experiments, Schupbach attempted to correlate "hot Spots" with points of low electrical resistance. The correlation was NOT significant. Many low resistance points were found but infrared thermography was more accurate at locating the reflex zones.

In further experiments (at the Vet School, Zurich), Schupbach used electrodes implanted in the uterus of mini-pigs to monitor myometrial activity following needling of the main "Hot Spot" (BL26.3, over the iliac wing). AP stimulation caused definite increase in uterine contraction.

Pending future systematic, detailed study of reflex points in animals, the human transposition system is still very useful. However, transposition of human point locations to animals is subjective because of anatomical differences between species and because of the experience and individual concepts of the practitioner. Points like BL23, ST36, GB34, LI11, GB20, BaiHui (lumbosacral space) present no problem but points on the digits and points in the intercostal spaces or along the vertebrae are more controversial, because of differences in digital anatomy and vertebrae.

Humans have the following number of vertebrae: Cervical (C) = 7; Thoracic (T) = 12; Lumbar (L) = 5; Sacral (S) = 5.

In cattle/pigs, the number is: C=7/7; T=13/15; L=6/6; S=5/5 respectively. Thus, one author may differ somewhat from another in locating points. I believe that this is not very important for clinical success using AP. All the evidence suggests that AP works via the nervous system. Therefore, AP stimuli given NEAR "correct" points would be expected to have similar effects to those from stimulation of "correct" points. Considerable scope exists for individual preference in location and selection of AP points.

Although the published and personal communications of Kothbauer, Westermayer and Yu & Hwang (1990) have been the main source of my information for cattle AP, the transposition of each point has been mine (taking my Masters' locations as well as human locations into account).

There is no internationally accepted nomenclature or charting for the transposition of points from humans to animals at this time. The International Vet Acupuncture Society (IVAS) plans to produce an agreed set of Standard Charts. Pending this development, each vet must construct a personal set or must use a set, such as by Kothbauer or Westermayer. In this paper, I attempt to construct a transposition for the cow. Thus, in the section that follows, some locations agree closely or exactly with those of my Masters; some do not. Responsibility for any errors is mine.

These locations may be used with the Cookbook prescriptions given in the attached paper ("CHOICE OF POINTS FOR PARTICULAR CONDITIONS").

Figure 5 shows the transposition of the Shu and Mu points from human to cow. Figure 6 shows the transposition of the Shu and Mu points from human to pig. I do not attempt to prepare a complete transposition system for the pig. (Try this yourselves). The same principles may be used in pigs, as in other species.

Some points in humans are not so important to know. Others are essential. The same comment applies to animal AP. In the descriptions of point locations which follow, I have omitted some points. This was for one of four reasons: a. they are inaccessible; b. they are not important (other points can be used instead); c. their location can be estimated from that of points on the same Channel; or d. their location is very uncertain because of anatomical difficulties.

The Chinese names of the more important points are given below but the names of ALL points are given in APPENDIX 1 of the paper on the "Choice of points for particular conditions".

In the sections which follow, the following abbreviations are used: A.= artery ant.= anterior ant. to= in front of C4= 4th cervical vertebra CCJ= chondrocostal junction (rib-cartilage) Co4= 4th coccygeal vertebra ext.= external ICS= intercostal space int.= internal J.= joint, junction L4= 4th lumbar vertebra lat.= lateral M.= muscle med.= medial N.= nerve post.= posterior SCJ= sternocostal junction S4= 4th sacral vertebra T4= 4th thoracic vertebra TMJ= temporomandibular-joint units of measurement: 1H (1 hand) = 4 fingerwidths; 1F=1 fingerwidth "= inch or tsun or cun or Chinese Unit of body measurement V.= vein CV line= Conception Vessel line=ventral midline (anus to navel to lower lip) GV line= Governing Vessel line = dorsal midline (anus to lumbosacral space to inside of upper lip) TRANSPOSITION OF THE HUATOJIAJI (X 35) POINTS TO COWS AND PIGS HuaToJiaJi points, (X 35 in the computer lists), are not on the Channel system of humans. They lie between the GV Channel and the medial line of the BL Channel in the area C1-S5, one pair (left and right) for each vertebra. The HuaToJiaJi points lie over the wing of each vertebra, near the junction with the body of the vertebra. They are most important points, named after Hua-To, a great doctor in ancient China. They are used mainly as LOCAL points, influencing LOCAL problems and also influencing organs or organ functions nearby. For instance, in neck problems, one might use X 35 points at C1 and C7 vertebrae, with TPs and SI03 with BL62 or ST38 or GB39.

In nephritis, one might include X 35 points in the area L1-L4. In fatty liver (hepatic degeneration after calving): include X 35 in area T9-L1. The X 35 points are not shown in the figures, as they are easy to find and to use. As the spinal nerves travel at an angle backwards from the vertebrae, it is better to choose X 35 points anterior (ant.) to the organ or part you wish to influence but always consider reactive points, wherever they are.

TRANSPOSITION OF THE LUNG (LU) CHANNEL TO COWS (CHART 1) LU01 Zhong Fu (Central Storehouse); in ICS3 (human ICS2), behind the shoulder joint. (The tip of the olecranon is over rib 5). LU05 Chi Ze (Elbow Marsh); lat. to biceps tendon at the ant. med. side of elbow joint. LU07 Lie Que (Sequence Broken); 1F above radial styloid, above ant. med. side of carpus. LU09 Tai Yuan (Great Abyss); 1F below radial styloid, ant. to radial A., above med. carpus LU11 Shao Shang (Little Metal-Merchant); at horn-hair junction on post. med. side of forelimb dewclaw...

TRANSPOSITION OF THE LARGE INTESTINE (LI) CHANNEL TO COWS (CHART 2) LI01 Shang Yang (Metal-Merchant Yang); ...?? LI02 Er Jian (Second Space); ...?? LI04 He Gu (Meeting Valley); 2F distal to and behind the proximal head of the medial metacarpal bone. Note: LI04 and LV03 are two of the most often used points in human AP; they have many functions in common and often are combined, especially for wandering aches and pains ("aching all-over") and in generalised or systemic conditions; they have the same relative positions on the hand and foot respectively. LI05 Yang Xi (Yang Cleft); post. med. side of radial-carpal joint, below and behind radial head LI10 Shou San Li (Arm Three Li) (3 Li = 1 mile); at the ant. lat. side of elbow, 2F ant. inf. to lat. condyle of the humerus, 2U distal to LI11 LI11 Qu Chi (Bend Pool); at the ant. lat. side of elbow, just ant. to the joint, in the crease in front of the elbow when the limb is flexed LI13 Shou Wu Li (Arm Five Li); 3 U proximal to LI11, on a line between LI11 and LI15.

LI15 Jian Yu (Shoulder Bone); at the point of the shoulder, in front of the shoulder joint, on the deltoid m., between the acromion and the greater tubercle of the humerus, about 3F anterior to TH14 LI18 Fu Tu (Support the Prominence); lat. neck, 1H above jugular vein and 1H behind mandible, on the sternomastoid m., level with the tip of the Adam's apple. LI20 Ying Xiang (Welcome Fragrance); just post. sup. to lat. canthus of nostril

TRANSPOSITION OF THE STOMACH (ST) CHANNEL TO COWS (CHART 3) ST01 Cheng Qi (Containing Tears); on inf. bony rim of orbit, directly below pupil ST04 Di Cang (Earth Granary); 0.5 U behind the oral canthus ST06 Jia Che (Jaw Chariot); in the masseter m., 2F on line from post. angle of mandible to the eye ST07 Xia Quan (Lower Gate, Below the Joint); at the TMJ, below zygomatic arch, over centre of sup. ramus of mandible ST09 Ren Ying (Persons Welcome); lat. inf. neck, just above carotid A., level with laryngeal projection ST11 Qi She (Qi Abode); just ant. to rib 1 at SCJ. ST12 Que Pen (Empty Basin); just ant. to rib 1 below point of shoulder, on the sup. border of the cutaneous colli m., med. and prox. to LU02 ST18 Ru Gen (Breast Root); in ICS6, 2 spaces behind olecranon, on olecranon-tibial crest line ST19 Bu Rong (Not Contained); in ICS7, 3 spaces behind olecranon, on olecranon-tibial crest line ST20 Cheng Man (Assuming Fullness); in ICS8, 4 spaces behind olecranon, on olecranontibial crest line ST21 Liang Men (Beam Gate); in ICS9, 5 spaces behind olecranon, on olecranon-tibial crest line ST21-01 (Kothbauer's Ma18); on milk vein, 1H behind xiphoid, level with ICS9 ST22 Guan Men (Gate Door); in ICS10, 6 spaces behind olecranon, on olecranon-tibial crest line ST23 Tai Yi (Great Unity); 1/3 distance from ST22 to ST25, on olecranon-tibial crest line

ST24 Hua Rou Men (Slippery Flesh Gate); 2/3 distance from ST22 to ST25, on olecranontibial crest line ST25 Tian Shu (Heavenly Pivot); 2 U lateral to navel, between ICS12 and the navel, on olecranon-tibial crest line ST26 Wai Ling (Outer Mound); 1/3 of the distance ST25 to ST28, on olecranon-tibial crest line ST27 Da Ju (Great Giant); 2/3 of the distance ST25 to ST28, on olecranon-tibial crest line ST28 Shui Dao (Water Path); level with ant. edge of base of udder, on olecranon-tibial crest line ST29 Gui Lai (Return Coming); in abdominal wall, med. to patella ST31 Bi Guan (Thigh Joint); in the tensor fasciae latae, 1H on line ant. edge of hip to patella, ant. to the femur, about midway between iliac wing and patella. ST35 Du Bi (Calf's Nose); between lat. and middle patellar ligaments, below patella ST36 Zu San Li (Foot Three Li); 7F below patella, 1F lat. to ant. edge of tibial crest ST37 Shang Ju Xu (Upper Great Hollow); 11F below patella, lat. to ant. edge of tibia ST38 Tiao Kou (Ribbon/Narrow Opening); midway lat. patella to lat. hock, at ant. edge of tibia ST40 Feng Long (Abundant Bulge); level with ST38 but behind tibia ST41 Jie Xi (Divide Cleft); just below lower head of tibia at ant. lat. hock, between the extensor tendons of the digits ST45 Li Dui (Severe Mouth); midpoint of med. side ... of med. hind claw, at hoof-hair junction

TRANSPOSITION OF THE SPLEEN-PANCREAS (SP) CHANNEL TO COWS (CHART 4) SP01 Yin Bai (Hidden White); ...?? SP04 Gong Sun ("Yellow Emperor"); 3F below upper head of med. metatarsal, med. side, behind metatarsal SP05 Shang Qiu (Shang Hill) (Shang = the sound of Metal); between the tendons, just below lower head of tibia, at ant. med. hock

SP06 San Yin Jiao (Three Yin Crossing); 6F above med. hock, just behind the tibia, opposite GB39 SP09 Yin Ling Quan (Yin Mound Spring); 6F below med. side of patella, behind the tibia SP10 Xue Hai (Blood Sea); 5F above sup. edge of patella on ant. med. thigh SP12 Ru Fang Yan (Ju Feng Yen = Mammary Inflammation); on olecranon-tibial crest line, laterally at the base of the udder, in pit which separates fore- and hind- quarters, on the external pudendal v., where it runs superficially with its artery under the skin (Kothbauer's location) SP13 Fu She (Bowel Abode); on olecranon-tibial crest line, at ant. edge of base of udder SP14 Fu Jie (Abdomen Bound/Knotted); 2 F above olecranon-tibial crest line, 1H behind SP15 SP15 Da Heng (Great Horizontal); 2 F above olecranon-tibial crest line, 6F from the CCJ, between navel and CCJ of rib 13 SP16 Fu Ai (Abdominal Lament); 2 F above olecranon-tibial crest line, 1H ant. to SP15, behind CCJ of rib 11 SP17 Shi Dou (Food Drain); 2 F above olecranon-tibial crest line, in ICS6, above ST18 and below GB23 SP18 Tian Xi (Heavenly Cleft); 3 F above olecranon-tibial crest line, in ICS5, above ST17 and below GB22 SP19 Xiong Xiang (Breast Village); 4 F above olecranon-tibial crest line, in ICS4, above TH10, SI08 and below BL41 SP20 Zhou Rong (Complete Flourishing); on shoulder-femoral trochanter line, in ICS3 SP21 Da Bao (Great Embrace); on shoulder-femoral trochanter line, in ICS8, above GB24 and below BL45

TRANSPOSITION OF THE HEART (HT) CHANNEL TO COWS (CHART 5) HT01 Ji Quan (Supreme Spring); med. to post. edge of shoulder joint, deep, on chest wall HT03 Shao Hai (Lesser Yin Sea); med. to ant. edge of elbow joint, deep, on chest wall HT04 Ling Dao (Spirit-Mind Path); post. lat. side of forelimb, 4F above carpus HT05 Tong Li (Connection Measure); post. lat. side of forelimb, 3F above carpus HT06 Yin Xi (Yin Cleft); post. lat. side of forelimb, 2F above carpus

HT07 Shen Men (Spirit-Mind Door); post. lat. side of forelimb, at carpal-metacarpal J. HT08 Shao Fu (Lesser Yin Mansion); post. lat. side of forelimb, midway down metacarpal HT09 Shao Chong (Lesser Yin Rushing); sup. med. side of lat. dewclaw on forelimb...??

TRANSPOSITION OF THE SMALL INTESTINE (SI) CHANNEL TO COWS (CHART 6) SI01 Shao Ze (Lesser Marsh); post. lat. side of lat. claw of forelimb, at horn-hair J...?? SI03 Hou Xi (Back Ravine); post. lat. side of fetlock J., just behind upper head of phalanx 1 SI06 Yang Lao (Nursing the Old); lat. carpus, just above and behind lower head of radius SI08 Xiao Hai (Small Sea); between med. epicondyle of humerus and olecranon SI09 Jian Zhen (Shoulder Upright); in the fossa caudal to the shoulder on the caudal border of the deltoids and between long and lateral heads of the triceps brachii. SI10 Nao Shu (Humerus Association Point); behind lower end of scapular spine, on the cranial border of the deltoid m. SI11 Tian Zong (Heavenly Gathering); behind scapular spine, 2H below upper edge of scapular cartilage SI12 Bing Feng (Controlling Wind); before scapular spine, 9F below upper edge of scapular cartilage SI15 Jian Zhong Shu (Shoulder Centre Association Point); 2 U lateral to GV14, at level of vertebrae C7-T1, on a line from scapular cartilage to the base of ear SI16 Tian Chuang (Heavenly Window); on lat. neck, 3F behind and 2F below post. angle of mandible SI18 Quan Liao (Cheek Bone-hole, Zygoma Crevice); on face, at lower end of zygomatic arch, on line from lower edge of orbit to post. angle of mandible SI19 Ting Gong (Listening Palace); between ant. edge of root of ear and TMJ

TRANSPOSITION OF THE BLADDER (BL) CHANNEL TO COWS (CHARTS 7, 8) The BL Channel is the most important one for vets. It has applications in nearly every condition which can be helped by AP.

Points BL12-30 inclusive, and their mate points, BL41-54, are most important points in AP. They reflect and control the functions of all the thoracic and abdominal, pelvic and mammary organs. In the transposition system, their locations are relatively easy to remember with the help of the following guidelines:

a. The BL Channel has two lines on the thoracolumbosacral area

b. Line 1, the inner BL line, contains points BL12-35. BL12 lies just medial to the midpoint of upper edge of scapular cartilage. BL13 lies 2F from the GV line just above the posterosuperior angle of the scapular cartilage, level with the posterior edge of the spine of T5. Between BL14-30, the line runs about 1H (4F) from the GV line (dorsal midline). Points 27,28,29,30 lie lateral to the 4 sacral holes (foramina) respectively, about 1H from GV line. Points 31,32,33,34 lie respectively between these points and the GV line, about 2F from the GV line, OVER the 4 sacral holes. Thus, points BL27,31 relate to sacral hole 1 and points 30,34 relate to hole 4 respectively. Point BL35 lies 3F from GV line level with the junction of coccygeal vertebrae 2.

BL21 lies on line 1 (1H from GV line) behind the last rib, in front of the transverse wings of vertebra L1.

BL17 (diaphragm/haemorrhage point) lies midway between BL13 and BL21. It can be used to locate any point between BL13-21 by counting the required number of spaces forwards or backwards from BL17.

BL26 lies on line 1 (1H from GV line) between the transverse wings of vertebrae L5-L6, 3-4 F ant. to the ant. edge of the wing of the ilium.

Between BL21 and 26 inclusive, each BL point falls one vertebral space apart. Thus any point between BL21-26 can be found by counting backwards from BL21 or forwards from BL26.

Between BL26 and 27 is a most important point for the uterus. Kothbauer calls it BL27 but in my system of transposition, I call it BL26.1. It lies just ant. to the ant. edge of the iliac wing, 1H from GV line, at the post. edge of the transverse wing of L6.

Thus, using locations of BL13,17,21,26 and the sacral holes, all points between BL12-35 can be transposed easily.

c. Line 2, the outer BL line, contains points BL41-54 inclusive. For most of its course, it lies about 1H (4F) lat. to line 1 (2H lat. to the GV line). The most difficult points to remember in this set are BL41,42,43,53,54. BL41,42,43 lie in intercostal spaces 4, 5, 6 respectively just below the posterior edge of the scapula. BL53 lies 1H lat. to BL28. BL54 lies 1H lateral to BL30. BL36 (old point BL50) lies 1H below the tuber ischii on the posterior midline of the thigh, 2H from the CV line of the perinaeum. Points BL44-52 are easy to transpose. They lie 2H from the GV line. BL50 lies lat. to BL21, just behind the last rib. All the other points in the series BL44-52 can be located by counting one vertebral space for each point, forwards or backwards, as needed.

Thus, points BL41-52 are easy to find, once you remember that BL52 (beside BL23) is level with the space between the transverse wings of L2-L3 and BL41 is in ICS4, below the scapular edge. (The olecranon lies over rib 5).

Note also that the following pairs of points have similar functions: BL12,41; BL13,42 etc to BL23,52. Each of these pairs is related to the same spinal nerve and the same ICS.

The formula to remember is: S(36 to 47) = F(12 to 23) + 29, where S = BL point number on the second BL (outer) line and where F = BL point number on the second BL (inner) line.

Thus, if you know that BL17,18,19 are useful in haemorrhage/liver disorders, you can be sure that points BL46,47,48 have similar actions. (The numerical difference between the point codes in series 2 and series 1 is 29).

Approximate positions for the main BL points are: BL01 Jing Ming (Eye Brightness); just above med. canthus of eye BL02 Zan Zhu (Collecting Bamboo); 2F above med. canthus of eye BL10 Tian Zhu (Heavenly Pillar); 5F from GV line over the centre of wing of atlas, 1F post. med. to GB20

BL11 Da Shu (Great Shuttle); at J. of scapula and its cartilage, at level of space between spines of C7 and T1 (long needle behind scapula) BL12 Feng Men (Wind Door); just behind midpoint of upper edge of scapular cartilage, just post. to spine of T4, in ICS4; its outer paired point is BL41 BL13 Fei Shu (LU Shu); 2F from GV line just above post. sup. angle of scapular cartilage, level with post. edge of spine of T5, in ICS5; its outer paired point is BL42 BL14 Jue Yin Shu (PC Shu); 1H from GV line, level with post. edge of spine of T6, in ICS6; its outer paired point is BL43 BL15 Xin Shu (HT Shu); 1H from GV line, level with post. edge of spine of T7, in ICS7; its outer paired point is BL44 BL16 Du Shu (GV Shu); 1H from GV line, level with post. edge of spine of T8, in ICS8; its outer paired point is BL45 BL17 Ge Shu (Diaphragm Shu); 1H from GV line, level with post. edge of spine of T9, in ICS9; its outer paired point is BL46 BL18 Gan Shu (LV Shu); 1H from GV line, in 3rd last ICS (10), level with post. edge of spine of T10; its outer paired point is BL47 BL19 Dan Shu (GB Shu); 1H from GV line, in 2nd last ICS (11), level with post. edge of spine of T11; its outer paired point is BL48 BL20 Pi Shu (SP Shu); 1H from GV line, in last ICS (12), level with post. edge of spine of T12; its outer paired point is BL49 BL21 Wei Shu (ST Shu); 1H from GV line, just behind last rib, level with post. edge of spine of T13; its outer paired point is BL50 BL22 San Jiao Shu (TH Shu); 1H from GV line, between lat. wings of L1-L2, 1 space behind BL21; its outer paired point is BL51 BL23 Shen Shu (KI Shu); 1H from GV line, between lat. wings of L2-L3, 2 spaces behind BL21; its outer paired point is BL52 BL24 Qi Hai Shu (Energy Sea Shu) (uterus/reproductive point); 1H from GV line, between lat. wings of L4-L5, 4 spaces behind BL21 BL25 Da Chang Shu (LI Shu); 1H from GV line, between lat. wings of L5-L6, 5 spaces behind BL21 BL26 Guan Yuan Shu (Gate Origin (chief blockage) Shu); 1H lateral to Bai Hui, 6 spaces behind BL21; this is a key point for the uterus and cervix BL26.1 1H from GV line, on post. edge lat. wing of L6, just ant. to iliac wing. It is an important UTERUS point (= Kothbauer's BL27)

BL26.2 2F post. lat. to BL26.1, on ant. edge of iliac wing (=Kothbauer's BL28, Uterus point) BL26.3 1H post.-med. to tuber coxae, over the wing of the ilium. This is a most important uterus point (Kothbauer, Westermayer, Schupbach). It corresponds with Kothbauer's point BL28-1). BL27 Xiao Chang Shu (SI Shu); 1H from GV line, 1 space behind BaiHui, level with sacral hole 1 BL28 Pang Guang Shu (BL Shu); 1H from GV line, 2 spaces behind BaiHui, level with sacral hole 2; its outer paired point is BL53 BL29 Zhong Lu Shu (Middle of Back Shu); 1H from GV line, 3 spaces behind BaiHui, level with sacral hole 3 BL30 Bai Huan Shu (White Circle (anus/perinaeum) Shu); 1H from GV line, 4 spaces behind BaiHui, level with sacral hole 4; its outer paired point is BL54 BL31 Shang Liao (Upper Bone-hole (foramen)); 2F from GV line, 1 space behind BaiHui, over sacral hole 1 BL32 Ci Liao (Second Bone-hole (foramen)); 2F from GV line, 2 spaces behind BaiHui, over sacral hole 2 BL33 Zhong Liao (Central Bone-hole (foramen)); 2F from GV line, 3 spaces behind BaiHui, over sacral hole 3 BL34 Xia Liao (Lower Bone-hole (foramen)); 2F from GV line, 4 spaces behind BaiHui, over sacral hole 4 BL35 Hui Yang (Meeting Yang); 3F from GV line, level with J. of coccygeal vertebrae 2-3 BL36 Cheng Fu (Receiving Support); on post. midline of thigh, 1H below tuber ischii, 2H from CV line BL40 Wei Zhong (Bend Centre or Supporting Middle); post. midline of stifle area, level with centre of patella BL41 Fu Fen (Attached Branch); in ICS4, below post. edge of scapula. (Olecranon is over rib 5). Its inner paired point is BL12. BL42 Po Hu (Corporeal-Soul Door); in ICS5, below post. edge of scapula. Its inner paired point is BL13 BL43 Gao Huang Shu (Subcardiac Diaphragm-Pleural Shu); in ICS6, below post. edge of scapula. Its inner paired point is BL14 BL44 Shen Tang (Spirit-Mind Hall); in ICS7, directly below spine of T5, 2H from GV line, 1H lat. to its inner paired point, BL15

BL45 Yi Xi (Sighing Laughing); in ICS8, directly below spine of T6, 1H lat. to GV line, 1H lat. to its inner paired point, BL16 BL46 Ge Guan (Diaphragm Pass); in ICS9, 2H lat. to GV line, 1H lat. to its inner paired point, BL17 BL47 Hun Men (Ethereal Soul Door); in ICS10, 2H lat. to GV line, 1H lat. to its inner paired point, BL18 BL48 Yang Gang (Yang Head-rope); in ICS11, 2H lat. to GV line, 1H lat. to its inner paired point, BL19 BL49 Yi She (Thought Abode); in ICS12, 2H lat. to GV line, 1H lat. to its inner paired point, BL20 BL50 Wei Cang (Stomach Granary); just behind last rib, 2H lat. to GV line, 1H lat. to its inner paired point, BL21 BL51 Huang Men (Diaphragm-pleural Door); between transverse wings of L1-L2, 2H lat. to GV line, 1H lat. to its inner paired point, BL22 BL52 Zhi Shi (Willpower-Ambition Chamber); between transverse wings of L2-L3, 2H lat. to GV line, 1H lat. to its inner paired point, BL23 BL52.1 over the iliac wing, 1H med. from tuber coxae (uterus point = Kothbauer BL26). BL53 Bao Huang (Bladder Diaphragm-pleura); 2H from GV line, 1H lat. to BL28, level with sacral hole 2. Also paired with BL32 BL54 Zhi Bian (Sequential Limit); 2H from GV line, 1H lat. to BL30, level with sacral hole 4. Also paired with BL34 BL60 Kun Lun (Kunlun (Mountains)); lat. hock, between tibia and Achilles tendon, opposite KI03 BL61 Pu Shen (Slave Root); lat. hock, at upper third of os calcis BL62 Shen Mai (Ninth Vessel); lat. hock, at tibial-tarsal J. BL63 Jin Men (Golden Door); post. lat. hock, at tarsal-metatarsal J. BL65 Shu Gu (Restraining Bone); post. lat. fetlock, 2F above the joint, behind the metatarsal BL66 (Foot) Tong Gu (Passing Valley); post. lat. fetlock, 2F below BL65 BL67 Zhi Yin (Reaching Yin); post. lat. side of lat. claw, at horn-hair J.

TRANSPOSITION OF THE KIDNEY (KI) CHANNEL TO COWS (CHART 9)

KI01 Yong Quan (Bubbling Spring); at lower third of metatarsus, behind the bones, med. side...?? KI03 Tai Xi (Greater Cleft); med. hock, between Achilles tendon and tibia, opposite BL60 KI10 Yin Gu (Yin Valley); 6F behind the stifle J., at post. med. side of limb KI11 Heng Gu (Pubic Bone); 2F from CV line at ant. edge of base of udder KI16 Huang Shu (Diaphragm-Pleural Shu); 2F lat. to the navel (CV08) KI22 Bu Lang (Walking Porch); in ICS7, beside sternum KI27 Shu Fu (Transporting Point Mansion); in ICS1, beside sternum

TRANSPOSITION OF THE PERICARDIUM (PC) CHANNEL (HEART CONSTRICTOR, CIRCULATION-SEX) TO COWS (CHART 10) PC01 Tian Chi (Celestial Pool); in ICS4, med. to olecranon PC03 Qu Ze (Bend Marsh); med. to med. condyle of humerus just above elbow J. PC04 Xi Men (Cleft Gate); meeting of upper and middle third of radius, med. side, behind radius PC05 Jian Shi (Intermediate Messenger), also called Ye Yan (Night Eye, chestnut); midpoint of radius, med. side PC06 Nei Guan (Inner Gate); at lower to middle third of radius, med. side, behind radius, directly opposite TH05 PC07 Da Ling (Great Hill); radial-carpal J., med. side, behind radius PC09 Zhong Chong (Central Hub); at the post. edge of the interdigital cleft...??

TRANSPOSITION OF THE TRIPLE HEATER (TH) CHANNEL TO COWS (CHART 11) TH01 Guan Chong (Door to the Thoroughfare); at the ant. of the lateral front claw, just above the hoof-hair junction...?? TH05 Wai Guan (Outer Gate); at lower to middle 1/3 of radius, posterolat. edge of the radius, directly opposite PC06 TH08 San Yang Luo (Three Yang Connection); on the posterolateral edge of radius, about 1/3 of the distance between the carpus and olecranon

TH10 Tian Jing (Heaven's Well); 1 U proximal to the olecranon. TH14 Jian Liao (Shoulder Bone-hole); directly over the shoulder joint, in line with the scapular spine TH15 Tian Liao (Heavenly Bone-hole); just in front of the junction of the anterior upper angle of the scapula and the scapular cartilage TH16 Tian You (Celestial Window); on the lateral neck, just cranial to the wing of the atlas, level with BL10 and SI17, just caudodorsal to the mastoid, on the dorsal edge of the sternocleidomastoid m., or 2 U caudal to TH17...?? TH17 Yi Feng (Screen from the Wind); behind and below the posteroinferior junction of the ear and the head TH23 Si Zhu Kong (Silken Bamboo Hollow); in temporal fossa, just above and behind the posterosuperior edge of the orbit

TRANSPOSITION OF THE GALLBLADDER (GB) CHANNEL TO COWS (CHART 12) GB01 Tong Zi Liao (Pupil Bone-hole); at the lateral edge of the orbit GB14 Yang Bai (Yang White); directly above the pupil of the eye, in a depression in the supraorbital process (supraorbital foramen). GB20 Feng Chi (Wind Pool); over the wing of the atlas GB24 Ri Yue (Sun Moon); in ICS8, 1 ICS caudal to LV14, on a line between shoulder- and stifle- joints GB25 Jing Men (Capitol's door); at the tip of the last rib GB30 Huan Tiao (Circle Jump); above and behind the hip joint, needled towards hip joint GB31 Feng Shi (Wind Market); on the lateral thigh, 2/3 way down the femur and just behind it, on the cranial border of the biceps femoris GB33 Xi Yang Guan (Knee Yang Joint); just behind lat. condyle of femur, just above tibia, level with LV08 GB34 Yang Ling Quan (Yang Tomb/mound Spring); 1H below stifle J., just behind tibia GB39 Xuan Zhong (Suspended Bell); 6F above lat. hock, just behind tibia, opposite to SP06 GB40 Qiu Xu (Mound of Ruins); ant. lat. hock, at tibial-tarsal J. GB41 Zu Lin Qi (Foot Near Tears); post. lat. hock, at metatarsal-tarsal J., behind metatarsus

GB44 (Foot) Qiao Yin (Orifice/cavity Yin); on the ant. lat. side of the lat. claw, just above the coronary band...??

TRANSPOSITION OF THE LIVER (LV) CHANNEL TO COWS (CHART 13) LV01 Da Dun (Great Pile); on the ant. med. side of the med. claw, just above the coronary band...?? LV03 Tai Chong (Great Surge-pouring); 2F distal to and behind the proximal head of the medial metatarsal bone. Note: LI04 and LV03 are two of the most often used points in human AP; they have many functions in common and often are combined, especially for wandering aches and pains ("aching all-over") and in generalised or systemic conditions; they have the same relative positions on the hand and foot respectively. LV04 Zhong Feng (Middle Mound/seal); ant. med. hock, at tibial-tarsal J., ant. to tibia LV05 Li Gou (Woodworm Canal); 2/5 of the distance from hock to stifle J., at med. side of tibia LV08 Qu Guan (Bend Spring); med. to med. condyle of femur, just above tibia, level with GB33 LV13 Zhang Men (Camphorwood Door); just above CCJ of rib 12, 2F above olecranonpatella line LV14 Qi Men (Cycle Door); in ICS7, 2F above olecranon-patella line

TRANSPOSITION OF THE CONCEPTION VESSEL (CV) TO COWS (CHARTS 14,15) CV01 HuiYin, on the CV line, between anus and vulva; in males, 1F below anus. CV02 on the CV line of the perinaeum, 2H below CV01 CV03 on the CV line of the perinaeum, 3H below CV01 CV04 on the CV line of the perinaeum, 4H below CV01 CV05 on the CV line, just ant. to ant. base of udder CV06 QiHai on the CV line, 1/3 of the distance between ant. edge of ant. base of udder and navel CV07 on the CV line, 2/3 of the distance between ant. edge of ant. base of udder and navel CV08 ChiZhong on the CV line, centre of navel

CV12 ZhongWan on the CV line, midway navel to tip of xiphoid cartilage CV14 on the CV line, tip of xiphoid cartilage CV15 on the CV line, xiphisternal J. CV17 SHANZhong on the CV line, midsternum, at SCJ of rib 6 CV18 on the CV line, midsternum, at SCJ of rib 5 CV22 on the CV line, at the manubrium sterni CV23 on the CV line, below point of jaw, above larynx CV24 in the middle of the lower lip

TRANSPOSITION OF THE GOVERNING VESSEL (GV) TO COWS (CHARTS 16,17) This is also a very important Channel for vets. GV points can be used in problems of the head, thoracic limb, thoracic area and organs, abdominal area and organs, lumbosacral area and pelvic limb. GV points rank second in importance to BL points and have similar effects and uses to the HuaToJiaJi points.

GV01 CHANG CHIANG GV line, between anus and root of tail GV02 WEI KEN on the GV line, in the sacrococcygeal space GV03 Bai Hui in the lumbosacral space on the GV line GV04 MING MEN between the spines of L2-L3 on the GV line GV05 TIAN PING in the thoracolumbar space, on the GV line GV09 between the spines of T8-T9, on the GV line GV12 SAN TAI between the spines of T3-T4, on the GV line GV14 TA CHUI between the spines of C7-T1, on the GV line, 2F ant. to scapular cartilage GV19 between the occiput and the atlas, on the GV line GV26 RenZhong midpoint of line joining the lowest point of each nostril GV28 YU TANG on dental pad, at openings of nasopalatine ducts

Those who study AP should understand that learning the LOCATION of points is merely a MENTAL aid to knowing WHERE to apply the AP stimulus for therapy. The exact location is NOT critical, as long as the stimulus is applied to a relevant nerve pathway or to tissue whose nerve supply is closely linked to that of the affected organ or part. In practice, AP becomes a highly individual art-science. Practitioners develop their own preferences on point location, their own point combinations and their own protocols for AP therapy. It is quite likely that 10 experts, asked to treat the same sick animal, would use 10 different combinations of points. This does not make a mockery of the claim to a scientific basis for AP ! It merely illustrates the richness and variety of the clinical approach.

A close examination of the points used by the experts would show that they ALL follow basic principles of AP: Reactive Points (AhShi points, TPs, sensitive points); Local Points; points in the nerve supply common to affected part; Distant Points on the Channels through affected area etc. Students of Vet AP should begin with basic concepts. These can be adapted with experience and skill later.

1.4 METHODS OF STIMULATION OF THE AP POINTS Point injection (with conventional or less conventional medicines: Kothbauer, Westermayer, Greiff, Turnbull, Piper) is the most common method used in busy practices. A common solution for injection is 1% procaine or Vit B12 (1 mg/ml). These two (procaine + B12) are often mixed and used together. For febrile conditions, Procaine Penicillin (5-10 ml) may be injected at BL40 and 5 ml at BL15,16,17 bilaterally (Piper).

Needling (19-21 gauge hypodermic needles, 10-100 mm long (Westermayer), or special solid AP needles (Kothbauer)) is also commonly used. Moxa may be burned on the needle or applied direct to the skin by taping a moxa cone to the point and lighting it. Cases for moxa include chronic or cold diseases, rheumatism, repeat breeder cows, anoestrous sows etc. However, one may use needling as an alternative, even in such cases.

Implantation of surgical staples at the AP points is another quick and easy method. The staples are left in position until they fall out by themselves. Point stapling is claimed to be successful in horses but there are few references to its use in cattle and pigs. Thus, at this time, stapling must be regarded as an experimental method only.

Laser-AP has given good results in many conditions in horses, small animals and humans. Trials with carbon dioxide 3W mean output power Laser on GV01 gave very good results in lambs with clinical or experimentally- induced dysentery (Yu Chuan et al 1983). Infrared or He-Ne Laser also gave excellent results in infertility in cows (Yu Chuan et al 1983). GradyYoung (1985) also claimed excellent results for cold Laser in cattle with shipping fever

(Pasteurella pneumonia). He irradiated reflex points for lung function. He also claimed good results in virus infection (Herpes) in horses.

As cattle and pigs are large animals with thick skins, it seems likely that lower power Lasers (mean output power