Equine clients demand what traditional equine veterinarians cannot always provide: early diagnosis of rider/trainer perceived problems in lameness or other areas of concern. Alternative therapies, such as acupuncture, attempt to provide this service, which is already extremely popular among human athletes. And individuals certified to perform acupuncture are growing rapidly in numbers.
At a recent American Association of Equine Practitioners (AAEP) meeting, acupuncture was a hotly debated issue in the field of alternative medicine. For now, presenters agree to disagree and go on with the dialogue.
Dr. David Ramey, Glendale, Calif., presented a paper at the AAEP entitled "A review of the evidence for the existence of acupuncture points and meridians." This was a fascinating well-presented talk that focused on the evolution of specific acupuncture atlases. He is concerned that acupuncture lacks a sound scientific basis, making his point on several fronts:
- Chinese acupoints disagree with acupoints from other cultures, yet all systems claim therapeutic efficacy.
- Ancient Chinese texts do not clearly state that the points described for animals should be used for treatment or access with dry needling.
- Acupoints and meridians used for acupuncture in the horse were modified and redrawn from ancient texts, which are themselves inconsistent in their representation of these structures.
- A critical appraisal of anatomical structures that correspond to acupoints and meridians has not been conducted, but those done have not demonstrated correlations.
- Acupoints and meridians do not correlate with physiologic phenomena, such as motor points, areas of skin or electrical resistance, areas of concentrated biochemical activity that relieves pain, or trigger points (only a subset of acupoints correlate with trigger points despite the widespread claim of a close correlation).
- Most if not all reports of acupuncture efficacy from China appear to show benefit, which suggests a bias in the literature or belief in its effects.
- There is no scientific evidence that acupuncture works in the horse to treat diseases.
On the other hand, the esteemed acupuncturist Allan Schoen, Veterinary Institute for Therapeutic Alternatives, Sherman, Conn, and editor "Veterinary Acupuncture, ancient art to modern medicine," presented the science behind the benefits in acupuncture, which he uses widely in equine patients. His talk was entitled "Equine Acupuncture: Incorporation into Lameness Diagnosis and Treatment" which urged the importance of integrating these ancient methods with modern but traditional methods of lameness diagnosis, in the fashion of "complementary medicine."
Dr. Schoen presented his perspective on the use of acupuncture to aid diagnosis of lameness and pain-related phenomena. He pointed out that acupuncture points do in fact correlate with either motor points or superficial nerves, and that recent "histologic (microscopic) studies have revealed that small microtubules consisting of free nerve endings, arterioles, and venules penetrate through the fascia at acupuncture points." He also explained "Acupuncture point selection is based on locating points on the body where stimulation will produce a beneficial change in the central nervous system by modulation of ongoing physiologic activity."
Dr. Schoen went on to say, "Acupuncture diagnosis is based on the level of sensitivity upon palpation of particular acupoints that have been found to correspond diagnostically with specific conditions." He demonstrated how acupoints correctly identified painful areas in the neck of a horse that was suffering from myofascial neuritis – an immunologic sequel to Lyme disease that involves inflammation of nerve endings in the subcutis of the neck. In his demonstration, acupuncture relieved the painful signs in the horse.
It is obvious that more research is needed to sort out the physical phenomenal behind the effects of acupuncture, since Dr. Schoen and Ramey appear to disagree on the scientific basis of these complementary methods. In fact, the International Veterinary Acupuncture Society, Morris Animal Foundation, and the AAEP Research Foundation fund projects, and we hope to see the results of controlled studies in upcoming years … that is, if we can agree that controlled studies can even be done.