Clinical Application of Chinese Herbal Medicine in Equine Practice.

Traditional Chinese herbal medicine has been used for the treatment of equine diseases for thousands of years. Clinical studies have found Chinese herbal medicine to be an effective treatment for a variety of equine conditions, and extensive toxicology studies performed on more than 12,000 Chinese herbs provide guidance for safe administration in the horse. Chinese herbal medicine may be used for preventive medicine as well as an integrative or complementary modality for common equine diseases and injuries.

Clinical Application of Acupuncture in Equine Practice.

Acupuncture is an inexpensive nonpharmacological modality that has a variety of musculoskeletal, neurologic, and internal medicine applications for the equine practitioner. Common uses include back pain colic, laminitis, laryngeal hemiplegia, and suprascapular neuropathy. Although there is a growing body of literature supporting the use of acupuncture in equids, there remains a need for further robust, double-blinded, placebo-controlled clinical efficacy trials.

The scientific basis of acupuncture for veterinary pain management: A review based on relevant literature from the last two decades.

The practice of acupuncture is becoming increasingly popular in veterinary medicine, especially as a method of providing pain relief. Originally based on principles derived from centuries of observation, conventional scientific mechanisms of action for acupuncture as a pain-relieving modality have recently been elucidated. Acupuncture points allow access to multiple regions of the body via the peripheral nervous system and its connection with the central nervous system. Local, segmental (spinal), and suprasegmental (brain) effects of acupuncture involve enhanced release of pain-relieving endogenous substances (e.g., opioids) and mitigated release of pain-inducing substances (e.g., inflammatory cytokines). In addition, there is evidence that acupuncture can induce positive neurochemical and cytoarchitectural change in the central nervous system via the phenomenon of neuroplasticity. Electroacupuncture is considered the most effective type of acupuncture delivery, allowing for more potent and long-lasting pain relief than is achieved via other methods (e.g., dry needling). The purpose of this review article is to summarize the relevant scientific literature from the last two decades relating to the physiological mechanisms of action of acupuncture as a pain-relieving modality.

Survey of Integrative Veterinary Medicine Training in AVMA-Accredited Veterinary Colleges.

A survey approved by the Association of American Veterinary Medical Colleges was sent to the academic deans of all 49 accredited veterinary colleges to obtain information on educational programs offered in integrative veterinary medicine (IVM). Results were compared to a previous survey with a similar design performed 7 years earlier. Survey responses were received from 43 of 49 institutions (87.8%). Thirteen respondents (30.2%) reported offering a formal course in IVM, 33 (76.7%) offered some level of instruction in the curriculum, and 32 (74.4%) provided clinical services in IVM. The most common IVM topics covered in the curriculum were rehabilitation and acupuncture. Dedicated courses in IVM had decreased since the previous survey, although faculty trained in at least one aspect of IVM increased. Clinical services incorporating IVM were present in the majority of veterinary teaching hospitals. Further investigation is required to determine the effectiveness of current IVM training in preparing veterinary graduates to discuss or utilize IVM in practice.

Canine and Feline Patients Referred Exclusively for Acupuncture and Herbs: A Two-Year Retrospective Analysis.

Acupuncture and the administration of herbal supplements are increasingly used in veterinary practice, but no retrospective studies have examined patient characteristics and treatment interventions in a population of dogs and cats presenting exclusively for such therapies. This two-year retrospective analysis of 161 referrals to an integrative medicine service at an academic teaching hospital found that dogs were more frequently treated than cats (91.9% vs. 8.1%, respectively) and that small animal patients most frequently were presented for musculoskeletal (26.7%), neurologic (16.8%), oncologic (14.9%), and dermatologic (10.6%) conditions. Cats were older than treated dogs (12.7 ± 3.7 vs. 9.5 ± 4.3 years) and more likely to be treated for oncologic complaints (odds ratio = 5.6). Patients received acupuncture (95.4%), herbal supplements (76.4%), acupuncture with percutaneous electrical nerve stimulation (electroacupuncture, 26.1%), and/or cyanocobalamin injections in acupuncture points (pharmacopuncture, 23.6%). Some differences were detected between treatment groups. This retrospective analysis provides a foundation for designing future prospective studies using acupuncture and herbs in dogs and cats.

Peripheral blood-derived mesenchymal stem cells demonstrate immunomodulatory potential for therapeutic use in horses.

Previously, we showed that mesenchymal stem cells (MSC) can be mobilized into peripheral blood using electroacupuncture (EA) at acupoints, LI-4, LI-11, GV-14, and GV-20. The purpose of this study was to determine whether EA-mobilized MSC could be harvested and expanded in vitro to be used as an autologous cell therapy in horses. Peripheral blood mononuclear cells (PBMC) isolated from young and aged lame horses (n = 29) showed a marked enrichment for MSCs. MSC were expanded in vitro (n = 25) and administered intravenously at a dose of 50 x 106 (n = 24). Treatment resulted in significant improvement in lameness as assessed by the American Association of Equine Practitioners (AAEP) lameness scale (n = 23). MSCs exhibited immunomodulatory function by inhibition of lymphocyte proliferation and induction of IL-10. Intradermal testing showed no immediate or delayed immune reactions to MSC (1 x 106 to 1 x 104). In this study, we demonstrated an efficient, safe and reproducible method to mobilize and expand, in vitro, MSCs in sufficiently high concentrations for therapeutic administration. We confirm the immunomodulatory function of these cells in vitro. This non-pharmacological and non-surgical strategy for stem cell harvest has a broad range of biomedical applications and represents an improved clinically translatable and economical cell source for humans.

Canine Cognitive Dysfunction: Pathophysiology, Diagnosis, and Treatment.

Canine cognitive dysfunction (CCD) is the canine analog of human Alzheimer disease (AD). The pathophysiology of CCD/AD is multifaceted. CCD is common in aged (>8 years) dogs, affecting between 14% and 35% of the pet dog population. Apparent confusion, anxiety, disturbance of the sleep/wake cycle, and decreased interaction with owners are all common clinical signs of CCD. Although there is no cure for CCD, several proven effective therapeutic approaches are available for improving cognitive ability and maintaining a good quality of life; instituting such therapies early in the disease course is likely to have the greatest positive clinical effect.

The serological response in dogs inoculated with canine distemper virus vaccine at the acupuncture point governing vessel-14: A randomized controlled trial.

The improvement of immunity to vaccination has historically focused on manipulation of antigen presentation rather than the host. Immune modulation by stimulating specific acupuncture points along the Meridian System has been practiced in Traditional Chinese Medicine. The purpose of this study was to quantitatively determine whether acupoint vaccination, in which vaccine is administered at an acupuncture point in dogs, has the potential to enhance the immune response. A randomized controlled trial was conducted to compare the effectiveness of acupoint vaccination versus a conventional method, based on humoral immune response in dogs given Canine Distemper Vaccine (CDV). One hundred client-owned dogs were admitted to the study with following characteristics: (1) passed a routine physical exam, (2) aged between 1 and 10 years old, (3) had no history of chronic disease, and (4) were not on immunomodulating medications. Dogs were randomly assigned to either the Acupuncture group inoculated at the acupoint Governing Vessel (GV)-14, or to the Control group inoculated conventionally at a non-acupuncture site. Mean changes from Day0 to Day14 of the response to CDV vaccination, measured by serum neutralization (SN) titers with log-transformation for reducing outlier effects, were compared between groups. No significant difference was found between groups in age, weight, or sex (all p >0.2). Both groups had significant increases of CDV SN titer post-vaccination (p < 0.001). The mean increase in Acupuncture group (0.72; SD = 0.79) was significantly greater than that of the Control group (0.36; SD = 0.67); p = 0.019. Inference on percentage of change in raw SN titer data further revealed that the effects in the Acupuncture group was significantly greater than the Control group (242% vs. 83%; p = 0.02). This study demonstrated that Acupoint vaccination at GV-14 resulted in a significantly elevated humoral immune response to CDV vaccine compared to Controls, which suggests the potential of acupoint vaccination to enhance the immune response.

Horses Referred to a Teaching Hospital Exclusively for Acupuncture and Herbs: A Three-Year Retrospective Analysis.

Equine acupuncture and herbal medicine are increasingly popular and have been anecdotally used in the treatment of a number of conditions. There is, however, a lack of data on the most commonly treated conditions in horses. The medical records of 164 horses presented exclusively for acupuncture and herbal therapy over a three-year period from October 2012 to October 2015 were evaluated from a mixed animal integrative medicine service at a veterinary academic teaching hospital. Horses were presented primarily for musculoskeletal conditions (62.0%), gastrointestinal disorders (9.5%), and anhydrosis (6.1%). Nearly half of all treated horses were geldings, and the mean age of treatment was 10.7 ± 6.5 years. The most common breeds were Warmbloods (28.2%), Quarter horses (20.2%), Thoroughbreds (17.8%), and Arabians (8.0%). Treatments included acupuncture (90.2%), herbal supplements (79.8%), electroacupuncture (69.9%), B12 injections (pharmacoacupuncture, 29.4%), or administration of autologous blood at acupuncture points (hemoacupuncture, 8.0%). Thirty-eight (38) different herbal formulas were recommended during the study period. Horses that were not provided herbal recommendations were more likely to present with gastrointestinal complaints (odds ratio = 11.2). Sex, breed, and presenting complaint had no or minimal impact on the types of treatments performed during the visit. However, data regarding patient characteristics and presenting complaints provide novel information which can be used to design prospective clinical trials.

Acupuncture for Small Animal Neurologic Disorders.

Modern research on traditional Chinese veterinary medicine (TCVM), including herbal medicine and acupuncture, has made evident the role of the nervous system as a cornerstone in many of the mechanisms of action of TCVM. Laboratory models and clinical research available are supportive for the use of TCVM in the management of neurologic conditions in small animals, specifically in cases of intervertebral disk disease, other myelopathies, and painful conditions. This article is meant to help guide the use of TCVM for neurologic disorders in small animals, based on available information and recommendations from experienced TCVM practitioners.

Electroacupuncture Promotes Central Nervous System-Dependent Release of Mesenchymal Stem Cells.

Electroacupuncture (EA) performed in rats and humans using limb acupuncture sites, LI-4 and LI-11, and GV-14 and GV-20 (humans) and Bai-hui (rats) increased functional connectivity between the anterior hypothalamus and the amygdala and mobilized mesenchymal stem cells (MSCs) into the systemic circulation. In human subjects, the source of the MSC was found to be primarily adipose tissue, whereas in rodents the tissue sources were considered more heterogeneous. Pharmacological disinhibition of rat hypothalamus enhanced sympathetic nervous system (SNS) activation and similarly resulted in a release of MSC into the circulation. EA-mediated SNS activation was further supported by browning of white adipose tissue in rats. EA treatment of rats undergoing partial rupture of the Achilles tendon resulted in reduced mechanical hyperalgesia, increased serum interleukin-10 levels and tendon remodeling, effects blocked in propranolol-treated rodents. To distinguish the afferent role of the peripheral nervous system, phosphoinositide-interacting regulator of transient receptor potential channels (Pirt)-GCaMP3 (genetically encoded calcium sensor) mice were treated with EA acupuncture points, ST-36 and LIV-3, and GV-14 and Bai-hui and resulted in a rapid activation of primary sensory neurons. EA activated sensory ganglia and SNS centers to mediate the release of MSC that can enhance tissue repair, increase anti-inflammatory cytokine production and provide pronounced analgesic relief. Stem Cells 2017;35:1303-1315.

Connectivity Study of the Neuromechanism of Acute Acupuncture Needling during fMRI in "Overweight" Subjects.

This functional connectivity study depicts how acupoints ST 36 and SP 9 and their sham acupoints acutely act on blood glucose (GLU), core body temperature (CBT), hunger, and sensations pertaining to needling (De-qi) via the limbic system and dopamine (DA) to affect various brain areas in fasting, adult, and "overweight" Chinese males using functional magnetic resonance imaging. Functional connectivity (FC) analysis utilized the amygdala (AMY) and hypothalamus (HYP) as regions of interest (ROIs) in the discrete cosine transform and seed correlation analysis methods. There was a significant difference in the spatial patterns of the distinct brain regions between groups. Correlation results showed that increased HYP-hippocampus FC after ACU was positively correlated with ACU-induced change in CBT; increased HYP-putamen-insula FC after ACU was positively correlated with ACU-induced change in GLU; and increased HYP-anterior cingulate cortex FC after ACU was positively correlated with ACU-induced change in HUNGER suggesting that increased DA modulation during ACU was probably associated with increased poststimulation limbic system and spinothalamic tract connectivity. Decreased HYP-thalamus FC after ACU was negatively correlated or anticorrelated with ACU-induced change in HUNGER suggesting that increased DA modulation during ACU was possibly associated with decreased poststimulation limbic system and spinothalamic tract connectivity. No correlation was found for min SHAM. This was an important study in addressing acute acupuncture effects and neural pathways involving physiology and appetite regulation in overweight individuals.

Effects of maropitant, acepromazine, and electroacupuncture on vomiting associated with administration of morphine in dogs.

OBJECTIVE: To evaluate effects of maropitant, acepromazine, and electroacupuncture on morphine-related signs of nausea and vomiting in dogs and assess sedative effects of the treatments. DESIGN: Randomized controlled clinical trial. ANIMALS: 222 dogs. PROCEDURES: Dogs received 1 of 6 treatments: injection of saline (0.9% NaCl) solution, maropitant citrate, or acepromazine maleate or electroacupuncture treatment at 1 acupoint, 5 acupoints, or a sham acupoint. Morphine was administered after 20 minutes of electroacupuncture treatment or 20 minutes after injectable treatment. Vomiting and retching events and signs of nausea and sedation were recorded. RESULTS: Incidence of vomiting and retching was significantly lower in the maropitant (14/37 [37.8%]) group than in the saline solution (28/37 [75.7%]) and sham-acupoint electroacupuncture (32/37 [86.5%]) groups. The number of vomiting and retching events in the maropitant (21), acepromazine (38), 1-acupoint (35), and 5-acupoint (34) groups was significantly lower than in the saline solution (88) and sham-acupoint electroacupuncture (109) groups. Incidence of signs of nausea was significantly lower in the acepromazine group (3/37 [8.1%]) than in the sham-acupoint group (15/37 [40.5%]). Mean nausea scores for the saline solution, maropitant, and sham-acupoint electroacupuncture groups increased significantly after morphine administration, whereas those for the acepromazine, 1-acupoint electroacupuncture, and 5-acupoint electroacupuncture groups did not. Mean sedation scores after morphine administration were significantly higher in dogs that received acepromazine than in dogs that received saline solution, maropitant, and sham-acupoint electroacupuncture treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Maropitant treatment was associated with a lower incidence of vomiting and retching, compared with control treatments, and acepromazine and electroacupuncture appeared to prevent an increase in severity of nausea following morphine administration in dogs.

Introduction to traditional Chinese veterinary medicine in pediatric exotic animal practice.

Exotic animals, both pediatric and adult, are amenable to TCVM diagnosis and respond well to the TCVM treatment including acupuncture and herbal medicine. With more documented clinical experience and experimental studies of the TCVM treatment of exotic animals, more diseases in more species will be identified to be effectively treated with the TCVM.

Acupuncture and Chinese herbal medicine for treating horses.

Acupuncture exerts diffuse analgesic effects through the release of endogenous opioids and other locally and centrally acting mediators. Successful therapeutic interventions for various musculoskeletal conditions in horses are well documented, and acupuncture may significantly enhance performance. The use of acupuncture is specifically supported in treating nonsurgical gastrointestinal disorders, in which specific techniques can alter motility and contribute to visceral analgesia. This article describes the use of acupuncture and Chinese herbal medicine for equine reproductive management and for treating respiratory disease. A careful review of available data and ongoing efforts to enhance unbiased research should continue to guide practitioners of evidence-based medicine in refining the most useful applications of acupuncture and Chinese herbal medicine.

What acupuncture can and cannot treat.

Acupuncture has been used for over 2000 years to treat a variety of diseases. It is safe and effective, especially for conditions such as pain, geriatric diseases, and exercise-related diseases. There are 361 acupuncture points located throughout the body on meridians. Meridians are the energetic channels that connect all the points to each other. These points are stimulated by various means to produce a physiological effect in the body. All points have various functions throughout the body that can be used to treat different diseases. Certain precautions must be taken when treating weak, debilitated, or pregnant animals.

Evaluation of electroacupuncture treatment of horses with signs of chronic thoracolumbar pain.

OBJECTIVE: To evaluate use of electroacupuncture for treatment of horses with signs of chronic thoracolumbar pain. DESIGN: Prospective study. ANIMALS: 15 horses with signs of chronic thoracolumbar pain. PROCEDURE: Horses were randomly allocated to 1 of 3 treatment groups. Horses in group 1 received electroacupuncture stimulation (once every 3 days for 5 treatments), those in group 2 received phenylbutazone (2.2 mg/kg [1 mg/lb], PO, q 12 h, for 5 days), and those in group 3 received saline (0.9% NaCl) solution (20 mL, PO, q 12 h, for 5 days). Thoracolumbar pain scores (TPSs) were evaluated before (baseline) and after each treatment. RESULTS: Mean +/- SE TPSs in horses receiving phenylbutazone or saline solution did not change significantly during the study. After the third treatment, mean +/- SE TPS (2.1 +/- 0.6) in horses receiving electroacupuncture stimulation was significantly lower than baseline (6.0 +/- 0.6) TPS. Mean +/- SE TPSs in horses receiving electroacupuncture stimulation were significantly lower than baseline TPSs and TPSs in horses receiving phenylbutazone or saline solution after the third treatment to 14 days after the last treatment. CONCLUSIONS AND CLINICAL RELEVANCE: TPSs are useful for evaluating the efficacy of various analgesic methods used for treatment of thoracolumbar pain in horses. Electroacupuncture was effective for treatment of chronic thoracolumbar pain in horses. Results provided evidence that 3 sessions of electroacupuncture treatment can successfully alleviate signs of thoracolumbar pain in horses. The analgesic effect induced by electroacupuncture can last at least 2 weeks. Phenylbutazone administered PO did not effectively alleviate signs of thoracolumbar pain in horses in this study.

Evaluation of a method to experimentally induce colic in horses and the effects of acupuncture applied at the Guan-yuan-shu (similar to BL-21) acupoint.

OBJECTIVE: To evaluate the reliability of a method for inducing colic via small intestinal distention in horses and to examine the analgesic potential of bilateral electroacupuncture (EAP) at the Guan-yuan-shu (similar to BL21) acupoint. ANIMALS: 5 healthy adult horses, each with a gastric cannula. PROCEDURE: A polyester balloon connected to an electronic barostat was introduced into the duodenum via the gastric cannula. At 2 specified intervals (before and after commencement of EAP), the balloon was inflated to a barostat-controlled pressure that induced signs of moderate colic. Each inflation was maintained for 10 minutes. Heart and respiratory rates were continuously recorded. Frequency of various clinical signs of colic was recorded by 2 trained observers during various combinations of balloon inflation and EAP. Each horse received each of 5 treatment protocols (EAP at 20 Hz, sham EAP at 20 Hz, EAP at 80: 120 Hz dense:disperse, sham EAP at 80: 120 Hz dense:disperse, no treatment). Sham EAP was at a point located 2 cm lateral to the Guan-yuan-shu acupoint. RESULTS: Duodenal distention consistently induced a significant increase in frequency of signs of colic. None of the EAP protocols caused a significant reduction in frequency of these clinical signs during distention. CONCLUSIONS AND CLINICAL RELEVANCE: The method described is reproducible and highly controllable method for inducing colic that involved duodenal distention that should be useful in evaluating the efficacy of various analgesic strategies. Bilateral EAP at the Guan-yuan-shu acupoint was ineffective in reducing signs of discomfort induced by this method.