Neuroanatomic Structure and Function of Acupuncture Points around the Eye Narda G. Robinson, DO, DVM, MS, Jessica Pederson, Ted Burghardt, L. Ray Whalen, DVM PhD ABSTRACT The locations of eight human periocular acupuncture points were transposed to the dog. Canine dissections exposed acupoint-nerve relationships that were compared to those previously identified in the human. Two comparative anatomical differences in periocular points include 1) lack of a complete bony orbit in the dog and absence of cranial nerve foramina, and 2) longer distance between the canine infraorbital foramen and ipsilateral eye than in the human, requiring a different location for ST 2. Traditional Chinese Veterinary Medicine (TCVM) actions assigned to each point were compared to the neurophysiologic results expected after stimulating these nerves. Nerve structure-function relationships of the periocular acupuncture points explain the theoretical TCVM descriptions of point actions. This finding emphasizes the relevance of ensuring that a transpositional point system is based on comparative neuroanatomical precision. Differences exist in periorbital bony anatomy between the dog and the human that call for a re-evaluation of the topographical anatomy of canine periocular acupuncture points. Key Words: Neuroanatomical acupuncture, transpositional points, veterinary acupuncture, Traditional Chinese Veterinary Medicine, TCVM, ophthalmology The effects of acupuncture are associated nervous system and out again through somatic and with “neuromodulation”, which involve the autonomic pathways. Predictable neuromodulation physiologic changes caused by acupuncture that depends upon the accuracy of acupuncture point relate directly to the nerves stimulated.1 Peripheral and nerve stimulation. Obtaining a reliable clinical nerves at acupuncture points impact the body as a outcome with acupuncture requires that the target whole through reflex connections into the central acupuncture point affects the appropriate nerves. Since no comprehensive neuroanatomically accurate acupuncture point atlas yet exists for non- human species, developing such an atlas is a critical From: Narda G. Robinson, DO, DVM, MS first step in upgrading the level of clinical practice 2 Shipley Professorship of Complementary and Alternative and scientific research. Medicine Colorado State University Veterinary Medical Center The head region contains a rich network of 300 West Drake Road cranial nerves and abundance of acupuncture Fort Collins, CO 80523 points. Periocular acupuncture points in particular Jessica Pederson, Professional Veterinary Medicine Student, Colorado State University can serve as a worthwhile first step in creating an Ted Burghardt, Professional Veterinary Medicine Student, anatomically based transpositional canine atlas, Colorado State University given their clinical significance for a variety of L. Ray Whalen, DVM PhD University Distinguished Teaching Scholar conditions. Eight points surrounding the eye in the Department of Biomedical Sciences human selected for study in the dog appear in Table Colorado State University Fort Collins, CO 80523 1. Actions assigned to these eight points focus mainly on eye problems; other actions include Funding Acknowledgement craniofacial pain, sinusitis, and migraine. Made possible by the kind support of the Barry and Savannah French-Poodle Memorial Fund. Examples of periocular and other acupuncture point combinations used for the treatment of some ACUC Approval common conditions in humans are listed in Table 2. Animal Care and Use Committee approval was obtained prior to performing the dissections. The objectives of this study were to (1.) AJTCVM Vol 2, No.1, Summer 2007 33 Table 1: Overview of eight acupuncture points around the eye Acupoint Name Comparative (Chinese Name) Regional Anatomy Associated with the Anatomy Indications TCVM Actions English Translation, Acupoint Concerns Human Location All eye No lacrimal part conditions, of the orbicularis Sensory to upper lid, conjunctiva, and including oculi m has been forehead: redness, found in the dog. Supratrochlear n (CN V1) swelling, In humans, the pain, lacrimal part of Sensory to both eyelids, conjunctiva, epiphora, the orbicularis lacrimal sac, and lacrimal caruncle, and BL-1 blurred oculi brings the part of the nose: (Jingming) vision, eye eyelids and the Infratrochlear n (CN V1), a branch of the Clarity of pupils itching, Benefits and lacrimal puncta nasociliary n lacrimation brightens the eyes. toward a medial Location: on wind Expels Wind. direction, Tear drainage Slightly medial and exposure, Clears Heat. pressing the Nasolacrimal duct superior to the inner aversion to puncta into the canthus of the eye. cold with lacrimal lake. Periocular muscles and their nerve supply headache. This allows Orbicularis oculi m, palpebral part (supplied Migraine, lacrimal fluid by palpebral part of auriculopalpebral n, frontal to drain into it (from CN VII) headache, more readily Levator palpebrae superioris m (supplied by rhinitis, through a CN III) frontal capillary action.28 sinusitis. Local pain No supraorbital and swelling, foramen exists in frontal the dog. Instead, headache, the supraorbital lacrimation nerve winds on wind Sensory to upper lid, conjunctiva, frontal BL-2 around the exposure, sinus, and forehead: (Zanzhu) zygomatic blepharospas Supraorbital n (CN V1) Gathered Bamboo process of the m, rhinitis, Dispels Wind. frontal bone. facial pain, Periocular muscles and their nerve supply Location: Clears Heat. Because of this manic Orbicularis oculi m, orbital part (supplied by Directly superior to BL- Benefits the Eyes. transpositional behavior, palpebral part of auriculopalpebral n, from 1, in a tender depression Alleviates Pain. issue, BL- 2 in pain and CN VII) near the medial end of the dog tends to stiffness of the eyebrow, at the have a slightly the neck, Frontalis m (supplied by temporalis and supraorbital notch. more lateral blurred auriculopalpebral branch of CN VII) placement on vision. what would be Hallucination the canine s, nightmares, eyebrow. anxiety. M-HN-6 Redness, Sensory to upper lid, conjunctiva, frontal (Yuyao) pain, swelling sinus, and forehead: As Yuyao resides Fish Waist of the eyes. Supraorbital n (CN V1) lateral to BL 2, Blepharospas there is no bone Relaxes the Location: m. Periocular muscles and their nerve supply beneath this sinews. In the center of the Ptosis, or Orbicularis oculi m, orbital part (supplied by point in the dog, Reduces pain. eyebrow, in the eyelid cannot palpebral part of auriculopalpebral n, from unlike in the Benefits the eyes. depression that lies close. CN VII) human. directly above the pupil Frontal when the eye is looking headache, Frontalis m (supplied by temporalis and forward. migraine. auriculopalpebral br of CN VII) CN V-1 = Trigeminal nerve ophthalmic branch CN V-2 = Trigeminal nerve maxillary branch and CN V-3 = Trigeminal nerve mandibular branch 34 AJTCVM Vol 2, No.1, Summer Sensory to skin of lateral upper lid: Lacrimal n (CN V1, CN V2) Supraorbital n (CN V1) TH- 23 No eyebrows in (Sizhukong) dogs; i.e., there is Sensory to lacrimal gland; carries parasympa- Bamboo Headache. no bony rim to the thetic fibers from CN VII: Thread Pain and red- Resolves Heat. orbit at this loca- Lacrimal n (CN V1, CN V2) ness of the Disperses Wind. tion that contains a Location: eyes. Blepha- Alleviates pain. depression at the In the de- rospasm. Epi- Brightens the eyes. end, which in the Periocular muscles and their nerve supply pression at lepsy. Tooth Frees the channel. human defines Orbicularis oculi m, orbital part (supplied by the lateral pain. palpatory aspects palpebral part of auriculopalpebral n, from CN end of the of the eyebrow. VII) eyebrow. Frontalis m (supplied by temporalis and auriculo- palpebral br of CN VII) Dogs lack a com- plete bony orbit; instead, GB-1 oc- curs just dorsal to Sensory to skin of lateral canthus region: the frontal process Lacrimal n (CN V-1, CN V-2) of the zygomatic bone. Supraorbital n (CN V-1) GB-1 Humans lack a (Tongziliao) retractor anguli Zygomaticotemporal n (CN V-2) Pupil Bone oculi lateralis mus- Hole cle. Branches of the Auriculotemporal n (CN V-3) by way of a small Dispels Heat. facial nerve differ Headache, eye communicating branch to the zygomaticotemporal Expels Wind. Location: between humans pain, loss of n or zygomaticofacial n Frees the Qi. Lateral to and dogs; humans visual acuity, Alleviates pain. the lateral lack an auriculo- redness in the Zygomaticofacial n (CN V-2) Brightens the eyes. canthus, in a palpebral nerve; eyes, tearing. Facial n (CN VII) by way of an anastomotic con- depression instead, the pe- nection to the zygomaticofacial n on the lateral riocular muscles of side of the facial expression Periocular muscles and their nerve supply orbit. served by the auri- Orbicularis oculi m, orbital part (supplied by culopalpebral nerve palpebral part of auriculopalpebral n, from CN in the dog receive VII) their motor supply from the zygomatic Retractor anguli oculi lateralis m (supplied by and temporal zygomatic br, auriculopalpebral n, from CN VII) branches of the facial nerve. M-HN-8 (Qiuhou) Sensory to skin of lower orbital region: Behind the Auriculotemporal n (CN V-3) by way of a small Ball communicating branch to the zygomaticotemporal Location: All eye condi- n or zygomaticofacial n Along the tions including Dogs do not have inferior rim short- zygomaticofacial Zygomaticofacial n (CN V-2) of the orbit, sightedness, foramina for local- Facial n (CN VII) by way of an anastomotic