11 Acupuncture 针灸

11.1 Introduction 引文

To the outsider, acupuncture (ACP) as an empirical discipline has little to do with the highly technological field of neurology. Despite this, the interest of animal owners in this type of treatment has increased. Also veterinary surgeons feel the need to complement standard therapies in some neurological diseases (see Fig. 11.1). For these reasons, it seems appropriate to describe the potential and limits of ACP as a form of conservative therapy in neurological disease or painful processes, and to give some indications for its practical application.

在外人看来，针灸（acupuncture ACP）作为一门经验学科，与神经学这个高科技领域似乎没有什么关系。尽管如此，动物主人对这种治疗方式的兴趣还是逐渐增加了。此外，也有一些兽医医生认为有必要对某些神经系统疾病的标准疗法进行补充（见图11.1）。基于这些原因，描述针灸作为神经系统疾病或疼痛过程的一种保守治疗形式的潜力和局限性似乎是合适的，并给出其实际应用的一些指示。

11.1.1 Acupuncture in traditional Chinese medicine (TCM) 传统中医药（TCM）的针灸

Basically, ACP is only a part of TCM. It is one possible method of treatment, which has been developed in this medical field over the ages. It can be defined as a therapy of “functional” disturbances by the stimulation of specific sites on the body (acupoints, which are classified into tracts or meridians).

基本上，针灸只是中医的一部分。这是一种可能的治疗方法，多年来一直在这一医学领域得到逐渐发展。它可以被定义为通过刺激身体上的特定部位(穴位，分为束或经络)来治疗“功能性”紊乱（therapy of “functional” disturbances）。

According to Eastern practice, ACP has the following indications:

根据东方临床实践的做法，针灸有以下适应症：

- Repair of “functional” disturbances 修复“功能性”障碍

- Treatment of visceral pain 内脏疼痛的治疗

- Fever reduction 减少发热

- Treatment of certain types of lameness 某些类型的跛行的治疗

- Relief of neuromuscular pain. 神经肌肉疼痛的缓解

11.1.2 The acupoints 针灸穴位

In ancient Chinese documents, only the main points of stimulation (acupoints) are described in animals without any relationship to the meridians. For this reason, important additional acupoints were extrapolated from human anatomy for use in veterinary acupuncture; these were then either confirmed by clinical investigations or relocated.

在中国古代文献中，只描述了动物的主要刺激点（stimulation）(穴位 (acupoints))，与经络（meridians）没有任何关系。因此，从人体解剖中推断出重要的附加穴位用于兽医针灸；然后这些穴位被临床调查证实或重新定位。

No uniform definition of the histological structure of the acupoints or meridians has been achieved as yet. However, at all of these acupoints there are similar structures (neurovascular bundles, sensory receptors, afferent and efferent fibres of the autonomic nervous system, gland tissue, lymph vessels), which are sometimes found in greater numbers at such points relative to other sites within the skin.

穴位或经络的组织学结构至今还没有统一的定义。然而，在所有这些穴位上都有相似的结构(神经血管束、感觉受体、自主神经系统的传入和传出纤维、腺体组织、淋巴管)，有时在这些穴位上发现的数量比皮肤内其他部位更多。

In addition, many of the acupoints used in veterinary medicine have characteristics in common with each other; these not only allow a precise localisation on the sick animal but also a choice of stimulation type. Depending on the course of disease, signs of pain, swelling or even superficial inflammation are obvious at so-called “diagnostic points” (11). In some cases (but not in all species or points), changes in the skin resistance can be measured during the course of a disease (22).

此外，兽医学中使用的许多穴位都有彼此共有的特点；这不仅允许了对患病动物进行精确定位，而且还可以选择刺激的类型。根据病程的不同，疼痛的症状、肿胀甚至是浅表炎症的症状在所谓的“诊断点（diagnostic points）”是明显的(11)。在某些情况下(但不是所有物种或点)，可以在疾病过程中测量皮肤阻力的变化(22)。

These reactions are induced by cutaneovisceral interactions, which play an important role in the response of the body to the activation of acupoints (8). In part, these points are the same as those which have been known for a long time in Western medicine (Head’s or Mackenzie zone, clavier équin de Roger), but which have not been used for therapy.

这些反应是由皮肤和内脏的相互作用（cutaneovisceral interactions）引起的，这些相互作用在身体对穴位激活的反应中起着重要作用(8)。在某种程度上，这些穴位与西方医学中长期已知的穴位（Head 's或Mackenzie区，clavier équin de Roger区）相同，但尚未用于治疗。

11.1.3 Choice of acupoints 穴位的选择

Thanks to detailed investigations, a number of body and ear acupoints are available for both diagnostic and therapeutic purposes in veterinary ACP (4, 25).

由于详细的调查，许多身体和耳朵的穴位可用于兽医针灸的诊断和治疗目的（4,25）。

In most cases, the body’s reactions seem to be based on one or 11 more of the following influences (11, 23, 27):

在大多数情况下，身体的反应似乎是基于以下一种或11种以上的影响而出现的（11,23,27）:

- Hormone production 激素的产生

- Local or central endorphin release 局部或中枢内啡肽释放

- Local hypalgesia (gate theory of pain) 局部镇痛（疼痛的门理论）

- Skeletal muscle relaxation 骨骼肌肉放松

- Smooth muscle relaxation 平滑肌放松

- Promotion of blood perfusion 血液灌注的促进

- Local or general immunostimulation. 局部或全身免疫刺激

During the course of ACP therapy, different stimulation points are combined so that the whole spectrum of beneficial influences can be appreciated. The following possibilities or combinations are available:

在针灸治疗过程中，不同的刺激点可以结合起来，这样就可以了解整个有益影响的范围。以下可能性或组合是可用的:

- Local points 局部穴位

- Points on the meridian 经络穴位

- Points on a paired meridian 一对经络的穴位

- Reactive points (so-called Ashi points) 反应性穴位（所谓的“阿是穴”）

- Master points (Mu in acute and Shu in chronic problems) 主穴（募穴用于急性问题，腧穴用于慢性问题）

- Connection points between paired meridians 成对经络之间的连接穴位

- Points with special effects 特殊效应的穴位

- Points along nerves which supply the affected area 沿着受影响区域的神经分布的穴位

- Auricular (ear) points 耳穴

11.1.4 Activation of the acupoints 穴位的激活

It is not only the correct choice of points which plays a major role in ACP treatment, but also the type of stimulation. TCM differentiates between different possibilities depending on the condition of the patient, the type of disease or even the weather conditions. Due to a lack of scientific investigation, it is difficult to set clear-cut guidelines for all indications. Despite this, the following types of activation (inter alia) are generally accepted for body ACP, which can be used depending on the disease, body region, age or condition of the patient (10, 18):

在针灸治疗中起主要作用的不仅是穴位的正确选择，还有刺激方式的选择（type of stimulation）。中医根据病患的情况、疾病的类型甚至天气条件来鉴别不同的可能性。由于缺乏科学调查，很难为所有适应症制定明确的指导方针。尽管如此，以下类型的激活（除其他外）被普遍接受为身体针灸，可根据疾病、身体区域、年龄或病患的状况使用（10,18）:

Simple needling. Bimetal (sterilisable) or disposable needles are inserted manually. The needles are left in situ or are continually manipulated with a turning motion.

简单的针刺/白针。手动插入双金属材料的（可消毒）或一次性针头。针被留在穴位原位或不断地用旋转运动操作（捻针）。

Therapy: 10 to 20 minutes, three to five sittings at an interval of 3 to 7 days.

治疗方法：10 ~ 20分钟，3 ~ 5 次，间隔 3 ~ 7天。

Massage or manual treatment of the points. This form replaces using needles at painful points in very young animals or when the treatment is going to be continued by the owner. This gives a weaker stimulation than a needle, but it has an additional effect on the surrounding muscles, which is useful in paresis or paralysis.

按摩或手动治疗的穴位。这种形式取代了在幼龄动物的疼痛穴位上使用针刺，或者当主人将继续治疗时使用针刺。这比针刺的刺激弱，但它对周围肌肉有额外的作用，这对轻瘫或麻痹很有用。

Therapy: a few minutes per point, use daily.

治疗方法：每个穴位几分钟，每日进行。

Injection of liquids (aquapuncture). Sometimes classical drugs, but mainly vitamin B12 or procaine, are used to cause stimulation of an acupoint. The solution is injected into the point or applied using a Dermojet (percutaneous high pressure injection). Aquapuncture causes a longer stimulation and is simple to use in uncooperative animals.

液体注射（水针）。有时经典的药物，但主要是维生素B12或普鲁卡因（procaine），用于刺激穴位。将溶液注射到穴位或使用Dermojet（经皮高压注射）。水针的刺激时间较长，对不合作的动物也很容易进行。

Therapy: three to five sittings at an interval of 3 to 7 days.

治疗：3-5次坐诊，间隔3-7天。

Heat (moxibustion). Lighted moxa (mugwort herb) rolls are either put on the needles or close to the skin at hairless sites. This causes a mild warming of the acupoint.

热（艾灸 moxibustion）。点燃的艾草卷（Lighted moxa rolls（mugwort herb 艾蒿/艾草））放在针上或靠近皮肤的无毛部位。这会导致穴位的温和升温。

Therapy: as for needling.

治疗方法：同针刺。

Low frequency electrostimulation (electroacupuncture, EAP). In comparison to the transcutaneous electrostimulation (TENS) used in physiotherapy, EAP machines produce a biphasic oblong impulse. Frequencies between 8 and 50 Hz are mainly used, whereby a current of between 1 and 10 mA at 4–5 volts is set according to the reaction of the animal. EAP can be used not only for intra- or postoperative analgesia but also therapeutically in lameness.

低频电刺激 （Low frequency electrostimulation）（电针 electroacupuncture, EAP）。与物理治疗中使用的经皮电刺激（TENS）相比，电针机器产生双相椭圆脉冲（biphasic oblong impulse）。主要使用 8-50 Hz的频率，根据动物的反应设定 4-5V 的 1-10mA 的电流。电针不仅可用于术中或术后镇痛，也可用于治疗跛行。

Therapy: 10 to 20 minutes during three to five sittings at an interval of 2 to 3 days.

治疗方法：3 ~ 5次，每次10 ~ 20分钟，每次间隔 2 ~ 3天。

Laser (low level laser therapy). This consists of cold light in the infra red range (600–900 nm) from a gas (He-Ne) or a diode laser (GaAlAs). These types of light have photo-osmotic, photoionic and photoenzymatic effects. For body ACP, either a pulsating light emission (high intensity over a very short time) or a continual sinus radiation is applied. Empirically, a dosage of 4 J (Watt × second) per square centimetre is considered as being optimal for biostimulation.

激光（低能级激光治疗）。这包括来自气体（氦氖 He-Ne）或二极管激光器（GaAlAs）的红外范围内（600-900 nm）的冷光。这些类型的光具有光渗透（photo-osmotic）、光激（photoionic）和光酶（photoenzymatic）作用。对于躯体针灸，采用脉冲光发射（短时间内的高强度）或连续窦腔辐射。在经验上，每平方厘米 4 焦耳（瓦特×秒）的剂量被认为是生物刺激的最佳剂量。

Therapy: in most cases, dosages of 0.05–2.0 J per acupoint and 1.0–4.0 J per pain point are applied.

治疗：大多数情况下，剂量为每个穴位 0.05-2.0 J，每个疼痛学位 1.0-4.0 J。

11.2 The use of acupuncture in neurological disease 神经学疾病的针灸的使用

11.2.1 Choice of therapy 治疗方法的选择

As a medical treatment, ACP usage must follow similar rules and quality control as classical Western medical therapy (1). Accordingly, the acutherapist must have undergone a thorough education in this field. In addition, a general and a neurological examination of the patient according to Western principles are the prerequisites for an ACP therapy; only then can an indication for ACP be provided.

作为一种医学保守治疗，针灸的使用必须遵循与经典西医治疗相似的规则和质量控制（1）。因此，针灸师必须在这一领域接受过全面的教育。此外，根据西方原则对病患进行全面的神经学检查是针灸治疗的先决条件；只有这样才能提供针灸的适应症。

It is possible that an ACP treatment according to the principles of TCM can be undertaken without a prior diagnosis and “concrete” indication (a so-called cookery book approach to ACP). This manner of practising ACP limits, however, the efficacy of body ACP. Therefore before every ACP treatment, an examination and evaluation of the patient according to specific TCM criteria should be done (18).

有可能根据中医原则进行针灸治疗，而无需事先诊断和“具体 concrete”的适应症（所谓的针灸谱方法 cookery book approach to ACP）。然而，这种实施针灸的方式限制了机体针灸的功效。因此，在每次针灸治疗前，应根据特定的中医标准对病患进行检查和评估（18）。

The course of consultation and treatment can be summarised as in Fig. 11.1.

咨询问诊和治疗的过程可总结于图11.1。

Problem-oriented medical case assessment is part of the standards of clinical work. For this reason, this system will be used here as the basis for determining indications for ACP (Table 11.1) (26). The information for the evaluation of ACP as a possible therapy is based primarily on data from specialist literature or papers, as well as personal experience. The following text should only be used as encouragement to look for further information about specific therapy in the literature (3, 6, 13, 16, 19, 21).

以问题为导向的病例评估是临床工作规范的一部分。因此，本文将使用该系统作为确定针灸适应症的基础（表11.1）（26）。评价针灸作为一种可能的治疗方法的信息主要基于来自专业文献或论文的数据，以及个人经验。以下文本仅应用于鼓励在文献中寻找有关特定治疗的进一步信息（3,6,13,16,19,21）。

11.2.3 Combined treatment 结合治疗

Acupuncture is rarely used as a monotherapy even in TCM. Plant medications are prescribed that complete the treatment in the spirit of TCM. In addition, a series of manual techniques are used which have been built into the Eastern medical system. In Western medicine, these methods include massage, physiotherapy, manual medicine or osteopathy. In this sense, the choice of treatment of neurological problems should not just be focussed on ACP; other therapeutic methods should be used which may then guarantee “healing” or at least an improvement in the status of the patient (14, 29). This is especially true in the postoperative rehabilitation of patients, where the highest aim is to attain a rapid improve- ment of the patient’s condition and quality of life.

即使在中医中，针灸也很少被用作单一疗法。植物药物/草药是按照中医精神完成治疗的处方。此外，还使用了一系列已被纳入东方医疗体系的手法技术。在西医中，这些方法包括按摩（massage）、物理疗法（physiotherapy）、手法疗法（manual medicine ）或整骨疗法（osteopathy）。从这个意义上说，神经问题的治疗选择不应该只关注针灸；应该结合使用其他治疗方法，从而保证“治愈”或至少改善病患的状态（14,29）。在病患的术后康复中尤其如此，其最高目标是迅速改善病患的病情和生活质量。

11.2.4 Acupuncture as a prophylactic measure 针灸作为预防措施

Tradition in China says that the doctor is paid for as long as the patient remains healthy. Without completely adopting this system, ACP provides a good potential for the prevention of relapses in patients with neurological problems. The regulatory influence on the neuromuscular structures and the pain-relieving effects of ACP promote optimal movement and help maintain a correct body or limb posture.

按照中国的传统，只要病患保持健康，医生就会得到报酬。在不完全采用该系统的情况下，针灸为预防神经系统疾病病患的复发提供了良好的潜力。针灸对神经肌肉结构的调节作用和镇痛作用可以促进最佳的运动状态，并有助于保持正确的身体或肢体姿势。

Its direct effects on the metabolism improve the patient’s general condition and its quality of life. Acupuncture helps in the prevention of relapses, especially in neuromuscular problems.

它对新陈代谢的直接作用改善了病患的整体状况和生活质量。针灸有助于预防复发，尤其是神经肌肉问题。

* 1: weak; 2: good; 3: very good

* 1: 弱； 2: 好； 3: 非常好

针灸在外科镇痛中的应用是中医的现代发展。内啡肽（endorphins）作用的发现促进了这一领域的深入研究，这使得建立良好的穴位组合和刺激方案成为可能（2）。最重要的方面是局部穴位的最佳组合，可以根据操作而调整，具有整体或远距离作用的穴位。

Minor cutaneous operations and major abdominal surgeries have been undertaken in domestic animals using ACP to aid analgesia (7, 17). The animals could immediately eat after the operation, a factor which plays an important role in the recovery time. In small animals, the quality of ACP analgesia is not good enough for it to be used as a sole agent routinely for surgery (5, 15, 24).

使用针灸辅助镇痛的家养动物进行了小的皮肤手术和大的腹部手术（7,17）。术后动物可以立即进食，这是影响恢复时间的一个重要因素。在小动物中，针灸镇痛的质量还不够好，不能作为常规手术的唯一镇痛方式（5,15,24）。

The situation in the postoperative period appears to be different, as the effects of ACP do not stop with the removal of the needles but continue for some hours (analgesia) or days (immunosuppression). It is possible, thanks to pre- or intraoperative ACP analgesia, that the patient’s well-being and recovery can be positively influenced after the period of intervention (12, 24). This is especially important in animals that are temporarily unable to walk properly or are more susceptible to infection due to abnormalities in their neurological function (bladder paralysis after disc herniation, faecal incontinence). The general immune-stimulating and anti-inflammatory effects of many ACP points play an important role in such situations (23).

术后的情况似乎有所不同，因为针灸的作用不会随着针头的取出而停止，而是持续数小时（镇痛 analgesia）或数天（免疫抑制 immunosuppression）。由于术前或术中针灸镇痛，干预期后病患的健康和恢复可能会受到积极影响（12,24）。这对于暂时不能正常行走或由于神经功能异常（椎间盘疝出后膀胱麻痹，大便失禁）而更容易受到感染的动物尤其重要。在这种情况下，许多针灸穴位的整体免疫刺激和抗炎作用发挥了重要作用（23）。

When there is an optimal choice of acupoints, it is possible to induce local pain relief (due to similar mechanisms as in TENS) as well as general analgesia (endorphin release) when the acupoints are stimulated by EAP or laser. Combined with physiotherapeutic manipulations, ACP represents a potent rehabilitation measure, especially when it is started at the beginning of the postoperative period (9).

当有一个最佳的穴位选择时，当电针或激光刺激穴位时，可能会诱导局部疼痛缓解（由于与TENS有着相似的机制）以及全身镇痛（内啡肽释放）。与物理治疗手法相结合，针灸是一种有效的康复措施，特别是在术后开始时(9)。

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