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Acupuncture in Reproduction: a Primer Kristina Lu VMD, Dipl

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Acupuncture in Reproduction: a Primer Kristina Lu VMD, Dipl Acupuncture in Reproduction: a primer Kristina Lu VMD, Dipl. ACT Hagyard Equine Medical Institute Lexington, KY The word acupuncture is derived from the Latin acus (needle) and pungare (to pierce). The practice of acupuncture is thousands of years old with references to equine acupuncture dating to around 450 BC. The goal of acupuncture using traditional Chinese veterinary medicine (TCVM) theory is to restore the body’s physiological and energy equilibrium in order to resolve disease versus a western approach of focused treatment for a specific disease or specific symptoms. In the practice of acupuncture, needles are placed in specific points, acupoints, on the body. Related acupoints are connected by channels termed meridians. There are 14 major meridians that constitute a system of energy flow (Table 1) with additional meridians that are important for reproduction such as the Penetrating Vessel. Yin Meridians Yang Meridians Lung Large Intestine Heart Small Intestine Pericardium Triple Heater Spleen Stomach Liver Gallbladder Kidney Bladder Conception Vessel Governing Vessel Table 1: 14 major meridians Energy is termed Qi (pronounced “chee”). Every animal has Qi that they are born with and also derive from the environment. Qi has Yin and Yang parts that are normally balanced. When meridians or pathways of Qi flow become obstructed, Yin and Yang become imbalanced manifesting as disease. Acupuncture is used to restore flow and balance. Methods of acupuncture include 1) dry needle, when a solid acupuncture needle is inserted into a point, 2) aquapuncture or injection of a fluid into a point, 3) electroacupuncture, using pulsating electrostimulation between points, 4) moxibustion, when Moxa (made with Artemisia) is burned near a point or applied to a needle to generate deeper heat, and 5) “cold” lasering. Acupuncture points can be chosen based on five-element theory, eight principles of disease, Zang-Fu or organ physiology, anatomical point location and point accessibility. In TCVM, the five elements are wood, fire, earth, metal and water with each element associated with an energy, direction, season, color, taste, feeling, Zang-Fu organ, and tissue. For example, many Thoroughbred broodmares are wood, which is associated with warmth, east, spring, green, sour, anger, liver-gallbladder and tendons and ligaments. Eight principles of disease describe whether the disease is superficial or deep, hot or cold, excessive or deficient and Yin or Yang. Yin disease states tend to be interior, cold and deficient, while Yang diseases tend to be exterior, hot, and excessive. There are 12 Zang-Fu organs (Zang: wife, Yin; Fu: husband, Yang). Each organ pair is associated with an element and a superficial meridian. The organ pairs are lung- large intestine (metal), heart-small intestine (fire), pericardium-triple heater (fire), spleen- stomach (earth), liver-gallbladder (wood), and kidney-bladder (water). In addition, there are six “Extraordinary Fu” organs that have a hollow shape but store essential substances. The uterus is an Extraordinary Fu organ, and is closely associated to the Kidney, Chong Mai (Penetrating Vessel), and Ren Mai (Conception Vessel). From an anatomical standpoint, acupuncture points occur where nerves divide or where nerves penetrate tissue planes. There are four types of acupuncture points: Type I: most common type, where nerves penetrate muscles Type II: where nerves intersect on dorsal and ventral midline Type III: where superficial nerves branch Type IV: where nerves penetrate tendons (Golgi tendon organ) Deep within acupuncture points are free nerve endings, small arterioles, veins, lymphatics and mast cells. Stimulation of an acupuncture point leads to mast cell degranulation, inflammatory cascade activation, blood and lymphatic flow changes, and nerve impulse conduction to the central nervous system. Thereafter, a complex interaction involves endogenous opioids, substance P, acetylcholine, serotonin, norepinephrine, gamma-amino butyric acid and other neurotransmitters. Functional MRI studies have demonstrated different cerebral activation patterns depending on needling techniques and use of sham points. An example of the influence of acupuncture at a specific point is Governing Vessel (GV) 26 located on midline at the base of the nostrils. If a needle is placed and twisted, endorphin is released causing relaxation and calming. If it is rapidly moved in and out, epinephrine is released causing revival. Research in humans has demonstrated that acupuncture can be effective for treating women with infertility. Most convincingly, pregnancy rates are improved after in vitro fertilization and embryo transfer. In traditional Chinese medicine, reproduction is related to the kidney and liver. Thus, points often used for treatment of equine infertility include: Bai-hui Yan-chi Bladder-23 Shen-shu Shen-peng Kidney-3 Kidney-7 Governing Vessel-3 Governing Vessel-4 Conception Vessel-4 Conception Vessel-6 Liver-3 Specific reproductive diseases for which acupuncture seems quite efficacious include urine pooling, poor uterine tone, failure to cycle during the breeding season, and cryptorchidism. Reproduction is a biological function that is only optimized when all other body systems are in good working order. As such, acupuncture can have positive effects by optimizing overall patient health. Recommended Reading Cantwell S.L. Traditional Chinese veterinary medicine: the mechanism and management of acupuncture for chronic pain. Topics in Companion Anim Med 25;53-57; 2009. Kaptchuk T.J. Acupuncture: theory, efficacy, and practice. Ann Int Med 136;374- 383;2002 LeBlanc M.M. and Faber A. An introduction to acupuncture and its incorporation into clinical practice. Clinical Theriogenology 5; 313-319; 2013 Rathgeber, R. Use of Acupuncture in Equine Reproduction. Proceedings of the 57th annual convention of the AAEP. 57, 138-140. 2011. Shmalberg J. and Xie H. The clinical application of equine acupuncture. J Eq Vet Sci 29; 645-652; 2009 Xie, H. and Preast V. Xie’s Veterinary Acupuncture. Blackwell Publishing. 2008. .
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