C H A P T E R 18

Acupuncture
Leilani Alvarez

A cupuncture is a safe and effective means for complementary pain relief.

It is a sophisticated and complex form of medicine that employs a
whole-body approach and incites the body’s endogenous healing mecha-
nisms. It has been practiced for thousands of years and has very few, if
any, significant side effects. Acupuncture can be used to treat a variety of
medical conditions (Figure 18-1), and there is a growing number of
evidence-based studies to support its use. This chapter will focus on the
use of acupuncture for pain relief.

HISTORY
Acupuncture has been practiced for over 4000 years in China and other
Asian countries. Western cultures rejected acupuncture for many centuries
because of discordance with medical knowledge at the time that seemed to
contradict philosophical and metaphoric theories of acupuncture. It is only
with our more current understanding of neurophysiology that acupuncture
has gained acceptance in the Western world. Acupuncture was introduced to
the United States in the 1950s but gained popular interest in the 1970s when
diplomatic relations with the People’s Republic of China improved.1 The
International Veterinary Acupuncture Society was formed in 1974 and
has been training veterinarians in acupuncture ever since, along with other
organizations.
Traditional Chinese veterinary medicine (TCVM), which encompasses
acupuncture, herbal medicine, and other disciplines, states that disease is
caused by an imbalance of energy. When the body is balanced (understood
as homeostasis in conventional medicine) health is achieved. There are two
principle approaches in TCVM acupuncture: the Eight Principles approach,
which is a derivation of yin-yang, and the Five Elements approach.2 Unim-
peded flow of qi (loosely translated as life force or energy) through channels
or pathways, called meridians, is essential for health. Acupuncture points
along these meridians have specific physiologic functions. Point prescriptions

365
366 PART THREE Application of Concepts and Therapy

FIGURE 18-1 Demonstration of acupuncture treatment in a cat.

TABLE 18-1 Acupuncture Point Selection for Specific Painful

Conditions*
PAINFUL CONDITION ACUPUNCTURE POINT
Mouth or tooth pain LI 4, ST 4, ST 6, SI 19, TH 10, TH 17, GB 20, ST 44
Neck pain or cervical intervertebral GV 14, GV 16, GB 20, BL 10, BL 11, SI 15, TH 10, SI 3,
disk disease (IVDD) LI 4, TH 5, BL 23, LI 15
Shoulder pain LI 15, TH 14, BL 11, LI 11, SI 9, SI 3
Elbow pain LU 5, LI 10, LI 11, TH 10
Carpal pain LI 4, TH 5, LU 7
Metacarpal phalangeal (MCP) pain LI 4, TH 3, Baxie
Back pain or thoracolumbar IVDD Local points on the bladder meridian, BL 62, SI 3
Lumbar pain or lumbosacral disease Bai-hui, shen-shu, shen-peng, shen-jiao, BL 23
Coxofemoral pain GB 29, GB 30, BL 54, jian-jiao
Stifle pain ST 36, ST 35, GB 34, BL 21, xi-yan
Tibiotarsal pain BL 60, KID 3, LIV 3
Metatarsal phalangeal (MTP) pain LIV 3, ST 44, Bafeng, GB 41
*See Appendix 1 for description of point locations.

can be used to address particular painful regions (Table 18-1). There are
more than 360 documented acupuncture points in the body, with more than
150 points identified in companion animal medicine. Each point has a spe-
cific anatomic location and characteristic effects (see Appendix 1). Acupunc-
ture was studied classically in humans and horses. Acupuncture points in
dogs, cats, and other species are transpositional points, in which comparative
anatomy was used to identify their location.
 CHAPTER 18 Acupuncture 367

EVIDENCE-BASED MEDICINE
Critically reviewed, well-designed studies are largely lacking in the field of
veterinary complementary and alternative medicine. As the popularity of
acupuncture has grown in human medicine, so has the interest in judicious
scientific research to support its efficacy. Several recent randomized con-
trolled trials (RCTs) in humans have demonstrated the effectiveness of acu-
puncture for specific painful conditions.3–5
There is a growing body of evidence for the use of acupuncture as a com-
plementary treatment modality in companion animals. Often the challenges
in reporting valid data with regard to acupuncture involve studies with too
few subjects, subjective parameters, absence of appropriate blinding, and
difficult-to-replicate treatment protocols.6 There is also the challenge of
an appropriate control group, as sham acupuncture has multiple physiologic
effects and does not accurately represent a control group.7

Human Evidence
Several Cochrane reviews have demonstrated the effectiveness of acupuncture
for a wide variety of painful conditions.4 A systematic review of 29 human
RCTs involving acupuncture for the relief of chronic pain conditions including
chronic headaches and back, neck, shoulder, and osteoarthritic pain found that
acupuncture was superior to sham and no acupuncture control groups.3 A sys-
tematic review of knee osteoarthritis also found that acupuncture was superior
to sham acupuncture and standard treatment.8 Similarly, a Cochrane system-
atic review of 16 RCTs involving nearly 3500 patients with peripheral joint
osteoarthritis showed that patients receiving acupuncture had statistically sig-
nificant benefits over sham control groups; however, the authors concluded
that the benefits were small and likely a result of a placebo effect.9 A systematic
review in 2010, however, concluded that acupuncture is more effective than
placebo for chronically occurring painful conditions.5

Veterinary Evidence
In a recent randomized controlled clinical trial, dogs that received electroa-
cupuncture (EA) were less likely to require rescue analgesia than dogs receiv-
ing sham acupuncture or morphine alone.10
In another small study, dogs receiving EA had significantly elevated b-
endorphin levels 1 and 3 hours after elective ovariohysterectomy, and effects
of analgesia persisted at least 24 hours.11 In a study comparing 80 paraplegic dogs
with thoracolumbar disk herniation that did not undergo surgery, dogs receiving
EA and steroids had a faster and higher return to ambulation, reduced back pain,
and reduced relapse incidence compared with dogs receiving prednisone alone.12
In a controlled clinical trial, dogs undergoing hemilaminectomy for acute
disk herniation that received EA in addition to conventional analgesics
368 PART THREE Application of Concepts and Therapy

required significantly lower doses of fentanyl in the first 12 hours postopera-

tively compared with control groups receiving conventional analgesics alone.13
Earlier studies also demonstrated the effectiveness of EA in conjunction
with standard care over surgery and conventional treatments alone in dogs
with intervertebral disk disease.14,15 Rigorous evidence-based medicine con-
tinues to be insufficient and often inadequate in the veterinary field of com-
plementary and alternative medicine; however, evidence is mounting,
especially in the area of acupuncture, and should continue to expand.16

MECHANISM OF ACTION
The effects of acupuncture on body systems are vast and complex, and
involve multiple pathways that influence the neurologic, musculoskeletal,
endocrine, cardiovascular, and immune systems. The focus in this section will
be on the pain-relieving and analgesic effects of acupuncture.17–20
Anatomy of Acupoints
Acupuncture points are distinct loci in the body that are known to cause spe-
cific physiologic effects. They are shallow depressions in the body, typically
overlying borders between muscles, tendons, or bones. There has been no
definitive evidence demonstrating that acupuncture points (or acupoints)
are specific anatomic entities. Many points, however, correlate with known
anatomic structures, such as motor end points, and may be classified according
to their association with neural structures.21 Histologically, many acupoints
are associated with larger accumulations of mast cells, nerve bundles and plex-
uses, capillaries, venules, and lymphatics as compared with surrounding tis-
sues.17 For example, several acupoints along the bladder meridian
correspond to branches of the median cutaneous nerve as it enters the dermis
along the thoracolumbar spine (Figure 18-2). Acupoints are also known to
have lower electrical impedance than surrounding tissues. For this reason,
hand-held electric point finders are used for locating and stimulating acupoints.
Finally, many acupoints correlate with known trigger point locations.22
Local Effects
• Tissue trauma leading to local inflammatory effects including stimulation
of the coagulation cascade and release of inflammatory mediators includ-
ing prostaglandins, leukotrienes, bradykinin, and platelet activating factor
(Figure 18-3)
• Release of histamine, heparin, and kinin protease from mast cells, leading
to vasodilation
• Stimulation of nociceptive afferent sensory nerve fibers Ad (group III)
and C (group IV)
• Release of trigger points
 CHAPTER 18 Acupuncture 369

FIGURE 18-2 Cutaneous nerve entering the dermis at an acupuncture point along the bladder
meridian. (From Schoen AM: Veterinary acupuncture: ancient art to modern medicine, ed 2,
St Louis, 2001, Mosby.)

Neural Mechanisms
Peripheral Nervous System
Nociceptors respond to the noxious mechanical stimulation of needle inser-
tion by transmitting sharp pain (pinprick) sensations via thinly myelinated
small diameter Ad afferent nerve fibers and aching or burning pain via unmy-
elinated slower-conducting C polymodal fibers (see Figure 18-3). These set
off inhibitory pathways along with Ab afferent stimulation from percutane-
ous stimulation that block further pain transmission to the brain, as
explained by the gate-control theory (see Chapter 3).

Central Nervous System

Stimulation of specific acupuncture points has been shown via magnetic res-
onance imaging (MRI) to incite changes in focal neuronal activity in the hip-
pocampus, hypothalamus, and other areas of the brain.23
The following is a simplistic outline of the central nervous system (CNS)
effects of acupuncture (see Figure 18-3):
• Nociceptive Ad (fast-conducting) and C (slow-conducting) nerve fibers
send a signal to the dorsal horn of the spinal cord.
• The message travels up the spinothalamic tract (STT) and spinoreticular
tract (SRT) to the brainstem and thalamic nucleus.
• Stimulation of the periaqueductal gray (PAG) and thalamus causes
release of multiple endogenous opiate neurotransmitters (endorphins,
enkephalins, and dynorphin).
370 PART THREE Application of Concepts and Therapy

Opiates
Thal

Hypo
PAG
Efferent
HPA
RN

ACTH
Cortisol

5-HT STT
Anti-inflammatory SRT

SG ⫺

A␦
C
Afferent

Tissue Acupuncture
trauma needle

FIGURE 18-3 Acupuncture mechanism of action. When an acupuncture needle pierces the skin, it
causes micro tissue trauma, setting off the coagulation cascade and releasing multiple anti-
inflammatory mediators. Nociceptive afferent nerves, Ad (fast conducting) and C polymodal (slow
conducting), send signals to the dorsal horn of the spinal cord, synapsing and traveling via the
spinothalamic tract (STT) and the spinoreticular tract (SRT), respectively, to the thalamus (Thal). The
periaqueductal gray (PAG) and Thal release opiate peptides in response to ascending nociceptive
pathways. Efferent nerves from the prefrontal cortex synapse at the hypothalamus (Hypo) and
project down the PAG and nucleus raphe (RN), releasing inhibitory mediators serotonin (5-HT) and
monoamines. These stimulate the substantia gelatinosa (SG) region of the dorsal horn of the spinal
cord to release enkephalin or dynorphin and inhibit transmission of nociceptive fibers. (Key: ACTH,
Adrenocorticotropic hormone; HPA, hypothalamic-pituitary-adrenal axis.)

• Activation of the hypothalamic-pituitary-adrenal (HPA) axis releases

adrenocorticotropic hormone (ACTH), cortisol, and anti-inflammatory
mediators with multiple humoral effects.
• Efferent nerves synapse at the hypothalamus and project down the
PAG and nucleus raphe (NR), releasing monoamines, serotonin
(5-hydroxytryptamine [5-HT]), and norepinephrine.
 CHAPTER 18 Acupuncture 371

• Descending pathways activate inhibitory interneurons in the substantia

gelatinosa (lamina II) of the dorsal horn of the spinal cord, releasing
enkephalin or dynorphin binding to opioid receptors of incoming periph-
eral nociceptors.
• Activation of opioid receptors inhibits release of substance P and further
blocks pain.

Autonomic Nervous System

Stimulation of certain acupuncture points is thought to stimulate internal
organs via the sympathetic and parasympathetic nervous systems. Afferent
impulses from somatic nerve endings conduct signals to the spinal cord
ascending to the hypothalamus and activating a somato-autonomic reflex,
which leads to multiple autonomic responses including vasodilation and
changes in cardiac output. The acupoint, GV 26, can be used as a resusci-
tation point because of its sympathetic effects on increasing cardiac output.
Auricular acupuncture and ST 36 (overlying the peroneal nerve motor
point) have strong parasympathetic effects and positively influence gastroin-
testinal (GI) transit time. These effects are inhibited with the administration
of atropine.24

ACUPUNCTURE ANALGESIA
EA may be used effectively to induce analgesia during surgical procedures
and postoperatively to reduce the dosage and frequency of pharmaceutical
drug administration (Figure 18-4). Effects are thought to result primarily
from descending inhibitory pathways. Low-frequency high-intensity EA (2
to 20 Hz) is opioid peptide mediated and has a cumulative effect. High fre-
quency EA (80 to 200 Hz) induces the sympathoadrenal medullary axis,
leading to release of serotonin, epinephrine, and norepinephrine, and is non-
cumulative.22,25 In addition, EA can effectively control neuropathic pain by
disinhibiting central sensitization and wind-up pain.26,27
Acupuncture analgesia may be inhibited via the following19,22:
• Administration of naloxone for low-frequency EA
• Administration of drugs that block serotonergic receptors
• Local anesthetics injected at the site of acupuncture needle insertion
• Needle insertion in areas of segmental nerve damage

ACUPUNCTURE FOR SPECIFIC CONDITIONS

The practice of acupuncture involves detailed study and advanced clinical
training. Point prescriptions afford ease of treatment, especially for the inex-
perienced acupuncturist; however, the most successful treatments will also
take into account TCVM theories and incorporate knowledge of concurrent
372 PART THREE Application of Concepts and Therapy

BL 23

BL 40
GB 34 LI 11
ST 36
SP 6
BL 60 PC 6
TH 5
LI 4

Bo Ko Ku
In Ko Ten

FIGURE 18-4 Locations of various acupuncture points to induce analgesia in dogs.

diseases and a whole-body approach. The information in Table 18-1 is only a

guideline for possible treatment strategies for specific painful conditions;
other approaches may be successful for particular animals. For all conditions
involving musculoskeletal pain, local trigger points should be treated.

FORMS OF ACUPUNCTURE
Dry Needle
A sterile acupuncture needle is inserted into a known acupuncture location.
Needles may be stainless steel or silicone coated and may come in individual
packages or in bundles of 5 or 10 needle packs (Figure 18-5). A wide variety of
needles is available and range in size from 28 to 36 gauge (which is less than
a millimeter) and ½ inch to 2 inches long for small animals, and 20 to 32 gauge,
½ inch to 3½ inches long for large animals (Figure 18-6).
Aquapuncture
In aquapuncture, sterile solution is injected into acupuncture points via
large-gauge hypodermic needles (typically 25 gauge) to provide prolonged
stimulation to the point. The point is distended with the solution and swells
the point, providing a more subtle but longer-lasting type of stimulation to
the acupoint. Effects are likely to last as long as it takes the body to resorb the
solution, in many cases up to 24 hours (Figure 18-7).
 CHAPTER 18 Acupuncture 373

FIGURE 18-5 Examples of acupuncture needles. Acupuncture needles may be stainless steel (left)
or silicone coated (right) and may come in bulk packages (left) or individually packaged (right).

A B
FIGURE 18-6 Acupuncture needle sizes.

Any sterile solution may be employed. Examples include the following:

• Vitamin B12
• Adequan
• Lidocaine or other analgesics
• Saline
• Homeopathic solutions
• Autologous blood products
374 PART THREE Application of Concepts and Therapy

FIGURE 18-7 Examples of medications used for aquapuncture.

Electroacupuncture
Electrical leads are attached to stainless steel acupuncture needles that are
already in place, and an electric current is applied to provide increased stim-
ulation to the acupuncture points. The current (direct or alternating), fre-
quency (Hz), mode (continuous, intermittent, dispense or disperse), and
amplitude are set according to the specific condition being treated. Electro-
acupuncture (EA) affords a longer-lasting treatment than dry-needle treat-
ment alone and can provide profound analgesic effects (Figure 18-8).

FIGURE 18-8 Demonstration of a dog receiving electroacupuncture treatment.

 CHAPTER 18 Acupuncture 375

Trigger Point Acupuncture

Myofascial trigger points (MTrPs) are hyper-reactive taut bands or nodules
found in skeletal muscles that elicit a characteristic twitch response on palpa-
tion and cause referred pain.6,28 MTrPs may be caused by multiple factors
including direct trauma, chronic or repetitive overuse of the muscle, or psycho-
logical stress. The noxious stimuli relayed by trigger points are known to be
one of the most common causes of musculoskeletal pain, yet they are largely
underdiagnosed and undertreated.22 Inactivation of MTrPs can be achieved
via insertion of an acupuncture needle directly at the site of the trigger point.
Dry needling of MTrPs can offer immediate and long-lasting relief of chronic
soft-tissue pain. Needling of sensitive areas in the body such as MTrPs may
correlate with the acupuncture technique of needling “Ashi” points, which are
defined as tender or sensitive points. As demonstrated by studies by Melzack
and colleagues in 1981 and Dosher in 2006, there is significant overlap
between MTrPs and acupuncture points.28 Although MTrPs can vary in loca-
tion, there are well documented areas in the body where trigger points com-
monly occur. Many acupuncture points have been found to correlate with
common trigger point locations (Table 18-2). In addition, it is likely that most
Ashi points are actually trigger points. Sterile solutions may be injected into
MTrPs to deactivate them in the same manner as aquapuncture.
Laser Acustimulation
Low-level laser therapy (LLLT) devices may be used to stimulate individual
acupuncture points in patients and animals that do not tolerate needling.
Typically, 1 to 2 Joules/cm2 are administered per point, using wavelengths
in the range of 660 to 904 nm. Treatments times are fast, and treatment is
effective and well tolerated. LLLT may also be used to treat trigger points.
Moxibustion
The process of moxibustion involves burning the herb Artemisia vulgaris or
“mugwort,” a species of chrysanthemum. A tightly wound roll, called a moxa
stick, or other forms may be used to provide heat stimulation directly to the

TABLE 18-2 Acupuncture Points in the Dog Correlating

With Trigger Points1
ACUPOINT LOCATION OF TRIGGER POINT CORRELATE
GB 34 Peroneus longus trigger point
GB 29 Gluteus medius trigger point
ST 36 Cranial tibialis trigger point
SI 9 Triceps trigger point
Local bladder points Longissimus thoracis and lumborum trigger points
LIV 10 and LIV 11 Adductor-pectineus trigger point
376 PART THREE Application of Concepts and Therapy

acupoint or applied to the needle for secondary warming. Care must be used
to avoid overheating or burning the skin surface.
Acupressure
Digital pressure is applied to the acupoint to stimulate the area. Pressure
should be applied for several minutes to each point. Effects are generally
shorter lasting than with other methods.
Implantation
Gold beads or other sterile products may be implanted at the site of acu-
points for permanent stimulation. Prospective, double-blind clinical trials
in veterinary medicine have failed to demonstrate the benefit of gold wire
or gold bead implantation for the treatment of canine hip dysplasia.29,30

SIDE EFFECTS AND PRECAUTIONS

Acupuncture when practiced by certified and qualified veterinarians is one of
the safest medical modalities for pain relief. Adverse events are rare.
The most common side effects include the following:
• Early return to function and possible overuse of injured or trauma-
tized limb
• Sedation
• Masking of symptoms
• Local pain, soreness, numbing, or a tingling sensation, commonly called
the “de-qi” effect, which is short lasting and usually resolves immediately
after treatment
• Erythema and local skin reaction; less commonly, minor bleeding at the
site of needle insertion
Contraindications and precautions include the following6,27:
• Bleeding tendencies (coagulopathy, thrombocytopathy)
• Needling infected or highly inflamed skin
• Electroacupuncture in those with pacemakers, arrhythmias, or seizure
tendency
• Needling directly through or around a known malignant tumor (NOTE:
Distant needling for palliative pain relief or relief of side effects of chemo-
therapy and radiation is effective and indicated for those with cancer.)
• Caution should be used in fractious or resistant animals to prevent inap-
propriate needle placement that could lead to tissue trauma, organ punc-
ture, or nerve or blood vessel laceration

ACUPUNCTURE TRAINING
Acupuncture on animals should be practiced by qualified veterinarians who
have successfully completed training and acquired certification. Veterinary
 CHAPTER 18 Acupuncture 377

TABLE 18-3 Programs for Veterinary Acupuncture Certification

COURSE
NAME LOCATION LEADER CONTACT
International Varies every year Multiple 1730 South College Ave, Suite 301
Veterinary nationwide Fort Collins, CO 80525
Acupuncture Also offered (970) 266-0666
Society internationally Fax: (970) 266-0777
(IVAS) office@ivas.org
www.ivas.org
Chi Institute Reddick, Florida Huisheng Xie 9700 West Hwy 318
Reddick, FL 32686
(800) 891-1986
Fax: (866) 700-8772
register@tcvm.com
www.tcvm.com
Medical Colorado State Narda Colorado Veterinary Medical
Acupuncture University Robinson Association
for College of 191 Yuma St
Veterinarians Veterinary Denver, CO 80223
Medicine (303) 318-0447
Fax: (303) 318-0450
Narda.Robinson@colostate.edu
www.colovma.org

acupuncture is practiced exclusively by licensed veterinarians, unlike human

acupuncture, in which licensed acupuncturists are generally not medical
doctors. The training involves approximately 6 months of study and addi-
tional clinical practice and may be completed at one of three institutions
(Table 18-3).

CONCLUSION
In a world of rapidly developing pharmaceutical drugs for pain management,
an animal may be subjected to medications that have been used for less than a
decade. The medication may lack formal study in the species receiving the
medication, and often the drug interactions and side effects are significant
or poorly understood. In contrast, acupuncture embodies thousands of years
of safe and effective use, and a growing number of evidence-based studies
support its use. Acupuncture should be part of a multimodal pain manage-
ment program standard for all veterinary patients.

REFERENCES
1. Schoen AM. Veterinary acupuncture: Ancient art to modern medicine, ed 2, St. Louis,
2001, Mosby.
2. Maciocia G. The foundations of Chinese medicine: A comprehensive text for acupuncturists
and herbalists, ed 2, London, 2005, Churchill Livingstone.
378 PART THREE Application of Concepts and Therapy

3. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: Individual
patient data meta-analysis. Arch Intern Med. 172:1444–1453, 2012.
4. Lee MS, Ernst E. Acupuncture for pain: An overview of Cochrane reviews. Chin J Integr
Med. 17:187–189, 2011.
5. Hopton A, MacPherson H. Acupuncture for chronic pain: Is acupuncture more than an
effective placebo? A systematic review of pooled data from meta-analyses. Pain Pract.
10:94–102, 2010.
6. Filshie J, White A. Medical Acupuncture: A Western scientific approach, London, 1998,
Churchill Livingstone.
7. Maciocia G. The practice of Chinese medicine: The treatment of diseases with acupuncture
and Chinese herbs, ed 2, 2008, Churchill Livingstone.
8. Cao L, Zhang XL, Gao YS, Jiang Y. Needle acupuncture for osteoarthritis of the knee.
A systematic review and updated meta-analysis. Saudi Med J. 33:526–532, 2012.
9. Manheimer E, Cheng K, Linde K, et al. Acupuncture for peripheral joint osteoarthritis.
Cochrane Database Syst Rev: Art. No. CD001977.
10. Gakiya HH, Silva DA, Gomes J, et al. Electroacupuncture versus morphine for the
postoperative control pain in dogs. Acta Cir Bras. 26:346–351, 2011.
11. Groppetti D, Pecile AM, Sacerdote P, et al. Effectiveness of electroacupuncture analgesia
compared with opioid administration in a dog model: A pilot study. Br J Anaesth
107:612–618, 2011.
12. Han HJ, Yoon HY, Kim JY, et al. Clinical effect of additional electroacupuncture on
thoracolumbar intervertebral disc herniation in 80 paraplegic dogs. Am J Chin Med.
38:1015–1025, 2010.
13. Laim A, Jaggy A, Forterre F, et al. Effects of adjunct electroacupuncture on severity
of postoperative pain in dogs undergoing hemilaminectomy because of acute
thoracolumbar intervertebral disk disease. J Am Vet Med Assoc. 234:1141–1146, 2009.
14. Joaquim JG, Luna SP, Brondani JT, et al. Comparison of decompressive surgery,
electroacupuncture, and decompressive surgery followed by electroacupuncture for the
treatment of dogs with intervertebral disk disease with long-standing severe deficits. J Am
Vet Med Assoc. 236:1225–1229, 2010.
15. Hayashi AM, Matera JM, Fonseca Pinto AC. Evaluation of electroacupuncture
treatment for thoracolumbar intervertebral disk disease in dogs. J Am Vet Med Assoc.
231:913–918, 2007.
16. Arlt S, Heuwieser W. Evidence-based complementary and alternative veterinary
medicine—a contradiction in terms? Berl Munch Tierarztl Wochenschr. 123:377–384,
2010.
17. Steiss JE. The neurophysiologic basis of acupuncture. In: Schoen AM, editor: Veterinary
acupuncture: Ancient art to modern medicine, ed 2, St. Louis, 2001, Mosby.
18. Kendall DE. Parts I and II. A scientific model of acupuncture. Am J Acupunct.
17:251–268, 343–360, 1989.
19. Bowsher D. Mechanisms of acupuncture. In Filshie J and White A, editor: Medical
acupuncture: A Western scientific approach, New York, 2006, Churchill Livingstone.
20. Ma YT, Ma M, Cho ZH. Biomedical acupuncture for pain management: An integrative
approach, Philadelphia, 2005, Elsevier.
21. Gunn CC. Acupuncture loci: A proposal for their classification according to their
relationship to known neural structures. Am J Clin Med. 4:183–195, 1976.
22. Baldry PE. Acupuncture, trigger points and musculoskeletal pain. Brookline, 2000,
Churchill Livingstone.
23. Chiu JH, Cheng HC, Tai CH, et al. Electroacupuncture-induced neural activation detected
by use of manganese-enhanced functional magnetic resonance imaging in rabbits. Am J Vet
Res. 62:178–182, 2001.
 CHAPTER 18 Acupuncture 379

24. Li H, Wang YP. Effect of auricular acupuncture on gastrointestinal motility and its
relationship with vagal activity. Acupunct Med. 31:57–64, 2013.
25. Gaynor JS, Klide AM. Acupuncture for surgical analgesia and postoperative analgesia.
In Schoen AM, editor: Veterinary acupuncture: Ancient art to modern medicine, ed 2, St.
Louis, 2001, Mosby.
26. Tian S, Wang XY, Ding GH. Repeated electro-acupuncture attenuates chronic visceral
hypersensitivity and spinal cord NMDA receptor phosphorylation in a rat irritable bowel
syndrome model. Life Sci. 83:356–363, 2008.
27. Cantwell SL. Traditional Chinese veterinary medicine: The mechanism and management of
acupuncture for chronic pain. Top Companion Animal Med. 25:53–58, 2010.
28. Dommerholt J, Huijbregts PA: Myofascial trigger points, pathophysiology and
evidence-informed diagnosis and management, Sudbury, Mass., 2011, Jones and Bartlett
Publishers.
29. Hielm-Bjorkman A, Raekallio M, Kuusela E, et al: Double-blind evaluation of implants of
gold wire at acupuncture points in the dog as a treatment for osteoarthritis induced by hip
dysplasia. Vet Rec. 149:452–456, 2001.
30. Bolliger C, DeCamp CE, Stajich M, et al: Gait analysis of dogs with hip dysplasia treated with
gold bead implantation acupuncture. Vet Comp Orthop Traumatol. 15:116–122, 2002.
31. Xie H, Preast V: Traditional Chinese veterinary medicine: Fundamental principles, 2005,
Jing Tang.
380 PART THREE Application of Concepts and Therapy

APPENDIX 1 Select Small Animal Acupuncture Point Locations

and Indications1,31
POINT LOCATION INDICATION
Lung (LU) 5 On the transverse cubital crease, on the Local point for elbow pain,
lateral side of the biceps brachii tendon weakness or paralysis of the front
(elbow flexed) leg, fever, respiratory problems
Lung (LU) 7 Medial carpus, proximal to the styloid Master point of the head and neck
process of the radius and medial to the Respiratory disorders, neck pain
tendon of the extensor carpi radialis and stiffness, local point for
carpal problems
Large Between the second and third metacarpal Master point of the face and mouth
intestine (MC) bones, approximately at the middle Strong analgesic and anti-
(LI) 4 of the third MC bone on the radial side inflammatory point
(Dr. Xie location) Local point for MC and carpal
problems
Large One sixth the distance from the elbow joint Shoulder, elbow, and leg pain
intestine to the carpus, between the extensor
(LI) 10 carpi radialis and the common digital
extensor muscles
Large Lateral depression cranial to the flexed Immune stimulation
intestine elbow, in the transverse cubital crease Local point for elbow and shoulder
(LI) 11 pain
Large At the shoulder, cranial and distal to the Local point for shoulder pain,
intestine acromion, on the cranial margin of the atrophy, and paralysis of the
(LI) 15 acromial head of the deltoid muscle forelimb, cervical stiffness
Stomach On the face, at the lateral corner of the Toothache, trigeminal neuralgia,
(ST) 4 mouth facial paralysis
Stomach On the face, in the depression at the Toothache, facial paralysis,
(ST) 6 middle of the masseter muscle belly masseter myositis
Stomach In the depression below the patella and Local point for stifle pain, cruciate
(ST) 35 lateral to the patellar ligament injuries, patellar luxation, rear
limb weakness
Stomach 1 cun* from the cranial crest of the tibia, in Master point of the abdomen
(ST) 36 the belly of the cranial tibialis muscle All gastrointestinal (GI) disorders,
strong analgesic point, local point
for stifle problems, rear limb
weakness and paralysis
Stomach In the foot, proximal to the web margin Trigeminal neuralgia, local point for
(ST) 44 between the second and third toes, in MTP joints and rear paws
the depression distal and lateral to the
second metatarsophalangeal (MTP) joint
Small Proximal to the metacarpal phalangeal Cervical, neck, and forelimb pain
intestine (MCP) joint on the lateral side, fifth MC Combine with BL 62 to treat entire
(SI) 3 back
Small In the large depression caudal to the Shoulder pain, forelimb lameness
intestine proximal humerus, along the caudal or paralysis, correlates with
(SI) 9 border of deltoid muscle, between the common trigger point location
long and lateral heads of the triceps
muscle
 CHAPTER 18 Acupuncture 381

APPENDIX 1 Select Small Animal Acupuncture Point Locations

and Indications—cont’d
POINT LOCATION INDICATION
Small In the face, rostral to the tragus (center) Temporomandibular joint (TMJ)
intestine below TH 21 at the caudal border of the problems, deafness
(SI) 19 mandible
Bladder On dorsal aspect of the neck, in the Local point for cervical, shoulder,
(BL) 10 depression at the atlantoaxial junction, and back pain
medial to the wing of the atlas
Bladder Midpoint between the spinous process Influential point for bone. Arthritis
(BL) 11 (SP) of the first thoracic vertebra and the anywhere in the body; neck,
medial border of the scapula, 1.5 cun shoulder, and back pain
lateral to the SP
Bladder 1.5 cun lateral to the SP of the second Kidney association point
(BL) 23 lumbar vertebra Low back pain, any arthritis, rear
limb weakness, IVDD, kidney
disease
Bladder Dorsal to the greater trochanter of the Coxofemoral pain, sciatica,
(BL) 54 femur hindlimb weakness and paralysis
Bladder Large depression between the lateral Pain or paralysis of the rear limb,
(BL) 60 malleolus of the fibula and the common low back pain, local point for
calcaneal tendon level tarsal pain
Bladder In the depression directly distal to the Pain or paralysis of the rear limb,
(BL) 62 lateral malleolus of the fibula combine with SI 3 to treat entire
back
Kidney (KID) In the depression between the medial Similar to BL 62; kidney problems,
3 malleolus of the fibula and the common deafness, ear problems
calcanean tendon (opposite and slightly
ventral to BL 60)
Triple On the dorsum of the paw between MC 4 Local point for carpal and MCP joint
heater and 5 bones, in the depression proximal pain, deafness, ear problems
(TH) 3 to the MCP joint
Triple 2 cun proximal to the carpus, at the distal Pain and paralysis of the forelimb,
heater end of the interosseous space between neck and TMJ pain, carpal
(TH) 5 the radius and ulna arthritis, fever
Triple Along the caudal border of the Head, neck, and forelimb disorders,
heater antebrachium, in a depression proximal local point for elbow problems,
(TH) 10 to the olecranon process fever, forelimb paralysis
Triple Caudal and distal to the acromion, on the Local point for shoulder problems,
heater caudal margin of the acromial head of radial nerve paralysis
(TH) 14 the deltoid muscle
Triple On the face, ventral to the ear in the Pain in TMJ and upper cervical
heater depression between the mandible and regions, facial paralysis,
(TH) 17 the mastoid process deafness, ear problems
Gall bladder At the dorsocranial neck, caudal to the Neck pain and stiffness, cervical
(GB) 20 occipital bone, in the depression IVDD, seizures, and brain
between the sternomastoideus and disorders
sterno-occipitalis muscles

Continued
382 PART THREE Application of Concepts and Therapy

APPENDIX 1 Select Small Animal Acupuncture Point Locations

and Indications—cont’d
POINT LOCATION INDICATION
Gall bladder At the hip, one third the distance between Local point for all hip problems,
(GB) 29 the greater trochanter and the cranial hindlimb atrophy and paralysis;
dorsal iliac spine correlates with gluteus medius
trigger point
Gall bladder At the hip, midway between the greater Hip problems, sciatic nerve pain or
(GB) 30 trochanter and the tuber ischii paralysis, biceps femoris muscle
problems
Gall bladder In the depression anterior and distal to the Influential point for tendons
(GB) 34 head of the fibula on the lateral side of Muscle, tendon, and ligament
the hind leg problems; hindlimb pain and
weakness; correlates with trigger
point
Gall bladder In the depression distal to the junction of Local point for pain in the MTP area,
(GB) 41 MT 4 and 5, on the lateral side of the urinary incontinence
tendon of the extensor digitorum longus
muscle
Liver (LIV) 3 On the medial aspect of the second toe Soreness in joints, especially medial
proximal to the MTP joint tibiotarsal joint; liver and
gallbladder problems
Governing On the midline, between the dorsal SPs of Local cervical and back pain
vessel the seventh cervical and first thoracic
(GV) 14 vertebrae
Governing On the dorsal midline at the atlanto- Cervical hyperpathia
vessel occipital joint
(GV) 16
Bai-hui In the depression on the dorsal midline Hip, lumbar, or pelvic limb disorders
just caudal to the wings of the ileum in
the L7-S1 space
Bafeng In the web between the toes of the MTP pain, contracture of hindlimb
hindlimbs toes
Baxie In the web between the toes of the MC phalangeal pain, contracture of
forelimbs forelimb toes
Shen-shu 2 cun lateral to bai-hui Similar to bai-hui
Shen-peng 2 cun cranial to shen-shu Similar to bai-hui
Shen-jiao 2 cun caudal to shen-shu Similar to bai-hui
Jian-jiao Dorsolateral aspect of the hip, in the Coxofemoral pain
depression just ventral to the Aquapuncture at this point can
craniodorsal aspect of the iliac wing provide lasting relief for hip pain
Xi-yan (eye In the depression below the patella, two Stifle problems, rear limb weakness
of the points—one medial and one lateral to
knee) the patellar ligament
*Cun, Unit of measure. In the dog, 8 cun ¼ the distance from umbilicus to xiphoid.