Simple Acupoints Prescription Flow Chart Based on Meridian

14 Pages·2015·2.2 MB·English

HindawiPublishingCorporation
Evidence-BasedComplementaryandAlternativeMedicine
Volume2013,ArticleID129315,13pages
http://dx.doi.org/10.1155/2013/129315
Research Article
Simple Acupoints Prescription Flow Chart Based on
Meridian Theory: A Retrospective Study in 102 Dogs
Jong-HoJeong,1Joo-YoungSong,2Hyo-GwonJo,3Ji-MinKim,4
Samuel-S.Yoon,5ChulPark,6SeunghyunKim,7Seong-SooRoh,7BongHyoLee,7
ChaeHaYang,7andHeeYoungKim8
1Boo-YoungAnimalHospital,Gigeum-dong,Namyangju-si,Gyeonggi-do472-080,RepublicofKorea
2SarangAnimalHospital,Guro-3-dong,Gurogu,Seoul152-053,RepublicofKorea
3Jakjeon24HourAnimalHospital,Jakjeon1-dong,Gyeyang-gu,Incheonsi,Gyeonggi-do407-060,RepublicofKorea
4JunAnimalHospital,Galsan-dong,Dongangu,Anyangsi,Gyeonggi-do431-088,RepublicofKorea
5TwinCityAnimalHospital,869SouthStreet,Fitchburg,MA01420,USA
6DepartmentofVeterinaryInternalMedicine,CollegeofVeterinaryMedicine,ChonbukNationalUniversity,Jeonju-si,
Jeollabuk-do561-756,RepublicofKorea
7CollegeofKoreanMedicine,DaeguHaanyUniversity,Daegu706-828,RepublicofKorea
8DepartmentofPhysiology,CollegeofKoreanMedicine,DaeguHaanyUniversity,Daegu706-828,RepublicofKorea
CorrespondenceshouldbeaddressedtoHeeYoungKim;[email protected]
Received8February2013;Accepted9April2013
AcademicEditor:YounbyoungChae
Copyright©2013Jong-HoJeongetal.ThisisanopenaccessarticledistributedundertheCreativeCommonsAttributionLicense,
whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.
Tohelpthecliniciansprescribeacupointseasilyandeffectively,wedevelopedonesimpleflowcharttoselectacupoints.Thisstudy
aimedtoevaluatetheusefulnessofflowcharttoselectacupointsindogs.Total102dogsshowingintervertebraldiscdisease(IVDD)
(𝑛=12),vomiting(𝑛=11),diarrhea(𝑛=2),abdominalpain(𝑛=5),cough(𝑛=66),orepilepsy(𝑛=6)receivedacupuncture
treatmentaccordingtothechart,anditsoutcomeswereevaluatedasregardsclinicalsymptoms,duration,treatmentnumbers,and
recoverytime.Dogs(8/8)withIVDDfromgradesItoIIIrecoveredoverperiodsof5daysto6weeksafter1–12treatments,while1/4
dogswithgradeIVrecoveredover7weeksafter15treatments.Vomitingdogswithacute/subacute(𝑛=8)andchronicsymptoms
(𝑛 = 3)requiredabout1and7treatmentstorecoverfully,respectively.Alldogs(𝑛 = 5)withabdominalpainshowedfastrelief
within24hoursafteracupuncture.Twodiarrheacasesrecoveredover2–9daysafter1-2treatments.Fifty-fourof66coughingdogs
wererecoveredby1-2treatments.And5of6epilepsydogsunderaregularacupuncturetreatmenthadnoepilepticepisodeduring
followupof12months.Theseresultssuggestthatthisflowchartcanhelpthecliniciansprescribeacupointseffectively.
1.Introduction interest about acupuncture in the United States, Europe,
and other countries. Veterinary acupuncture has also been
Acupuncturehadbeenusedinhumanandveterinaryprac- resurrectedanddevelopedrapidlyduringthepast30years.
tice for thousands years in Eastern Asia including China Veterinaryacupunctureorganizationshavebeenestablished
(called traditional Chinese medicine), Republic of Korea in most developed countries including those of North and
(called Korean medicine), Japan (called Kampo medicine), SouthAmerica,Europe,theMiddleEast,AustraliaandNew
andotherAsiancountriesuntilitwasbannedintheircoun- Zealand, South Africa, Republic of Korea, and many Asian
ties to promote Western medicine in the early 1900s. Since countries.Also,someveterinaryschoolshaveincludedclass
the visit of President Nixon to China in 1972 and articles onacupunctureintheircurriculum[1].
aboutsurgeryinconsciouspatientsunderacupunctureanes- The number of certified veterinary acupuncturists and
thesia first hit the West, there has been an explosion of veterinarians wishing to study acupuncture has increased
2 Evidence-BasedComplementaryandAlternativeMedicine
remarkablyinthelastdecade.Now,manyveterinariansand on abdomen. The points at which dogs exhibited the pro-
veterinarystudentsspendmucheffortandexpensetolearn tective abdominal reflex, skin twisting, growling, grunting,
traditional oriental medical (OM) theory in an intensive and head-turning toward the palpated point during palpa-
course.Theyaimatintegratingacupunctureintotheirprac- tion were considered as sensitive Back-Shu or Abdomen-
ticebuttheydiscoverquicklythatOMtheoriesareextremely Mu points, which were diagnosed as the affected internal
complexandconfusingtobeappliedinpractice.Therefore, organs [5] for the next Step 4. Those points were used as
novicesintheartscienceofveterinaryacupuncturetendto treatmentpoints.
relystronglyon“CookbookAcupuncture,”inwhicharoutine In Step 4, according to the diagnostic results from Step
set of acupoints is used to treat certain diseases. Though 3orpatients’mainsymptoms,theassociatedChannelswere
“Cookbook Acupuncture” is very useful for beginners, it is chosen (Figures 5(a) and 5(b)), and two main points, Yuan
not specific for individual cases and its results are not as (source)pointandHe(sea)point,ontheChannelswereused
good as those of acupuncture adapted by experts for each foracupuncture.SomepointsontheChannelfrequentlywere
specific case. Therefore, many practitioners using “Cook- chosen according to the patient’s condition, such as acute/
book Acupuncture” become frustrated when they achieve subacute (<7 days), chronic (>7 days), emergency, or joint
outstandingresultsinsomecasesbutnoresponseinothers. pain.
Toapplyacupuncturemosteffectively,practitionersmust
Lastly,inStep5,localpointsorempiricalpointsforeach
make an OM diagnosis for each case, by using OM theory.
casewereadded.
That theory includes Yin-Yang, Zang-Fu organs, Channel
(Meridian) Theory, and point indications. According to the
2.2.Cases(𝑛=102). The102dogsthatreceivedacupuncture
OM diagnosis, two sets of acupoints are chosen: (a) main
treatment by 5 clinicians according to simple acupuncture
(essential) points and (b) helper (supporting) points. This
flow chart were reviewed. Table 1 shows case signalment
combinationofmainandhelperpointsiscalledanacupoints
includingage,sex,anddiseaseduration.Agesofdogsvaried
prescription or combination for each individual case. The
from3monthsto15years(averageage,4.12years).Forty-six
correct choice of points plays a key role in acupuncture’s
percent(47/102)weremales,and54%(55/102)werefemales.
success. When appropriated on combination, the main and
Purebred dogs accounted for 52% (53/102) and were repre-
helper acupoints produce synergic effects that boost the
sentedby9purebreeds(11miniaturePoodles,14Maltese,6
clinicalefficacyofacupuncture.Incontrast,someacupoints
ShihTzus,2Chihuahuas,1Siberianhusky,8Yorkshireterri-
may counter the beneficial effects of the main acupoints
ers,2Englishcockers,5Pugs,and4miniatureSchnauzers).
through opposing actions [2–4]. For clinicians to select
Theremaining48%(49/102)weremixed-breeddogs.Routine
effectiveacupointsforindividualcasesefficiently,itisessen-
diagnostictestsincludingfecalexamination,urinalysis,blood
tial that they understand OM diagnosis, the properties and
tests,and/orradiographywereperformedinprivatepractice
interactionsoftheChannels,thefunctionsofeachacupoint,
todeterminethepossiblecause.
andcombinationmethodsoftheiracupoints.However,itis
Acupuncture was prohibited in cases with evidence of
difficult, especially for new acupuncturists, to comprehend
foreignbodyonradiographyorinfectiousviraldisease(dis-
OMtheoriescompletely,memorizealltheinformationabout
temperorparvovirus)bycommercialELISAkits.Allexcept
acupoints,andbuildeachtreatmentplanaccordingtoindi-
vidual patient’s condition. Therefore, we sought to develop epilepsycasesreceivedacupuncturetreatmentonlywithout
for clinicians one simple acupuncture flow chart based on conventional Western medicine. Cases were classified into
OM theories and diagnosis. Over a 5-year period, this flow 6 groups, according to main symptoms: intervertebral disc
charthasbeenmodifiedthroughitsclinicalapplication.We disease(IVDD)(𝑛=12),vomiting(𝑛=11),diarrhea(𝑛=2),
nowintroduceonesimpleacupointsprescriptionchartand abdominal pain (𝑛 = 5), cough (𝑛 = 66), and epilepsy
itsclinicalcases. (𝑛 = 6)(Table1).IVDDwasfurtherclassifiedasgradeIto
IV:gradeI=noneurologicsignsexceptbackpain,gradeII=
consciousproprioceptivedeficitandambulatoryparaparesis,
2.MaterialsandMethods
gradeIII=nonambulatoryparaparesis,andgradeIV=non-
2.1. Acupoints Prescription Chart (Figure 1). The proposed ambulatoryparaparesiswithlossofdeeppainperception[6].
chartwasdesignedtoselectacupointsinatotalof5steps. Gastrointestinaldisordersincludingvomiting,diarrhea,and
InStep1,accordingtothelocationofdiseaseinthebody abdominal pain were classified by the duration to clinical
(vizinteriororexterior),twoorthreeacupuncturepointsof8 presentation as acute (<2 days), subacute (2–7 days), or
ExtraordinaryChannelpointsand6Commandpointswere chronic(>7days).Applicationofacupunctureforcoughwas
selected(Figures2(a)and2(b)). restrictedtosubacutecases(duration,2–7days),sinceacute
InStep2,oneof8Influentialpointswaschosenaccording cough was often a self-limiting problem that may resolve
tothebodycomponents(Zang,Fu,Muscle,Bone,Qi,Blood, without any symptomatic/supportive therapy, or chronic
Vessel,andMarrow)affectedbydisease(Figure3). caseshadariskofseverebacterialinfectionwithoutantibi-
In Step 3, the Back-Shu or Abdomen-Mu points sen- otics,subsequentlydeath.Inidiopathicepilepsy,onedogwas
sitive to palpation were selected. To find the sensitive Shu 3 months at onset of epileptic seizure and the remaining 5
(Figure4(a))orMu(Figure4(b))pointsonbackandabdo- dogswereover1year,atafrequencyof2–4/monthundercon-
men, the right hand palpated the skin on Back-Shu and trolofphenobarbitalandpotassiumbromidetherapy.Fiveof
Abdomen-Mu points while the left hand was positioned the6dogsshowedgeneralizedandsymmetricalseizureand
Evidence-BasedComplementaryandAlternativeMedicine 3
STEP 1: Find the location of disease [combined therapy of 8 extraordinary channel points and 6 command points]
Location of disease Points Add command points
Dorsal aspects SI3-BL62 ·add ST36 for gastrointestinal disorders,
Exterior
Lateral aspects TH5-GB41 ·add SP6 for urogenital disorders
Heart and gastrointestinal PC6-SP4 ·add BL40 for back disorders
Interior
Respiratory and urological LU7-KI6 ·add LI4 for face, eye, nasal disorders
STEP 2: Find the affected area [8 influential points therapy]
The affected area Point OM name
Liver, heart (pericardium), spleen (pancreas), lung, kidney LV13 Zang(Yinorgans)
Stomach, small intestine, large intestine, bladder CV12 Fu (Yang organs)
Muscle-related diseases GB34 Ji (muscle)
Bone-related diseases, especially in forelimb BL11 Gu (bone)
Thoracic disease (mainly, respiratory) CV17 Qi (life/vital energy)
Blood-related disorders BL17 Xue (blood)
Vascular or circulatory disorders LU9 Mai (vessels)
Neurological diseases, bone marrow disorders, fracture GB39 Sui (marrow)
STEP 3: Find sensitive back-Shu or abdomen-Mu points when palpated [Shu-Mu points therapy]
Point Lung Heart PericardiumSpleen Kidney Liver inLteasrtgien e inStemstainll e Triple Stomach Bladder Gall
(LU) (HT) (PC) (SP) (KI) (LV) (LI) (SI) heater (ST) (BL) bladder (GB)
Back-Shu point BL13 BL15 BL14 BL20 BL23 BL18 BL25 BL27 BL22 BL21 BL28 BL19
Abdomen-Mu point LU1 CV14 CV17 LV13 GB25 LV14 ST25 CV4 CV5 CV12 CV3 GB24
Step 4: choose the channel and main points on the channel according to main symptoms [channel points therapy]
Location of
Interior Exterior
symptoms
Specific area iPnGatanesscttrrienoaa-sl espiratory UrMtoeLgunievsdnceoilrtena, l dio-vascular UrogenitalBon(interior)e Mental inGtaeFssrttorinona-t laspeFcatsce LEataerral aspeEcatsr ThPluoomsrtabecraoiro-r aSscpaepcutlsa
Blood R (exterior) Car marrow Tooth spine Neck
Channel Hindlimb Forelimb Hindlimb Forelimb Hindlimb Forelimb Hindlimb Forelimb Hindlimb Forelimb Hindlimb Forelimb
Point OM name TaiYin TaiYin JueYin JueYin ShaoYin ShaoYin YangMing Yangming ShaoYang ShaoYang TaiYang TaiYang
indication Organ
SP LU LV PC KI HT ST LI GB TH BL SI
Point
Main Yuan (source) SP3 LU9 LV3 PC7 KI3 HT7 ST42 LI4 GB40 TH4 BL64 SI4
(essential) He (sea) SP9 LU5 LV8 PC3 KI10 HT3 ST36 LI11 GB34 TH10 BL40 SI8
Acute Xi (cleft) SP8 LU6 LV6 PC4 KI5 HT6 ST34 LI7 GB36 TH7 BL63 SI6
Chronic (connLuecot ion) ST40 LI6 GB37 TH5 BL58 SI7 SP4 LU7 LR5 PC6 KI4 HT5
Emergency Jing (well) SP1 LU11 LV1 PC9 KI1 HT9 ST45 LI1 GB44 TH1 BL67 SI1
Heat signs Ying (spring) SP2 LU10 LV2 PC8 KI2 HT8 ST44 LI2 GB43 TH2 BL66 SI2
Joint pain Shu (stream) SP3 LU9 LV3 PC7 KI3 HT7 ST43 LI3 GB41 TH3 BL65 SI3
Cold signs Jing (river) SP5 LU8 LV4 PC5 KI7 HT4 ST41 LI5 GB38 TH6 BL60 SI5
STEP 5: Empirical, local or Ashi points
Tonification Lower Humeral Lumbar
Emergency Fever Head Neck Eye Cough Diarrhea
effect jaw joint & sacral
GV26, KI1, HT9, LI4, LI11, ear tip, tail tip, GV20, GB20, GB20, BL10 ST1, L1, LI15,
ST7 CV22 Baihui GV1
PC9 LV3, ST36 GV14 GV16, Yintang GV16 GB1 TH14
Figure1:Acupointsprescriptionflowchart.
4 Evidence-BasedComplementaryandAlternativeMedicine
Face: LI4
Neck: LU7
Back: BL40
Back: SI3-BL62
Exterior
Urogenital: SP6
Lateral: TH5-GB41
FL HL BL40
Gastrointestinal: ST36
Respiratory and ST36
SP6
urogenital: LU7-KI6
♪
PC6 Heart or chest: PC6
Heart and LU7
Interior gastrointestinal: PC6-SP4 LI4
(a) (b)
Figure2: 8 ExtraordinaryChannel points and 6 Commandpoints (Step 1).(a) Clinicalindications of 8Extraordinary Channelpoints.
The body was simply divided into 4 areas of exterior-back aspects, exterior-lateral aspects, interior-heart/gastrointestinal and interior-
respiratory/urogenitalsystems,andpairedacupoints(underlined)wereusedfordisordersoftheircorrespondingarea.(b)Indicationof
6Commandpoints.FL,forelimb;HL,hindlimb.
Marrow (GB39) miniatureSchnauzer(𝑛 = 2),ShihTzu(𝑛 = 1),andmixed-
breed (𝑛 = 4). Spinal palpation pain (hyperesthesia), when
Qi (CV17) Vessel (LU 9) assessed by manual compression along the thoracolumbar
Blood (BL17) spine,wasdetectedatoneormorelevelsofT11-T12(𝑛 = 2),
T12-T13 (𝑛 = 6), T13-L1 (𝑛 = 5), L1-L2 (𝑛 = 4), L2-L3
(𝑛 = 1),andL3-L4(𝑛 = 1).Incaseswithseveresymptoms
Muscle (GB34)
Zang (LV13) (grade III or IV), diffuse back pain over two spinal levels
wasfrequentlyobserved.Onplainradiographicexamination,
narrowed intervertebral disk space (𝑛 = 3), osteophyte
formation(𝑛=1),ormineralizedintervertebraldisk(𝑛=2)
Bon e (BL11) Fu (CV12) wasfoundingradeIIIorIVcases.Accordingtotheflowchart
(Figure1),thefollowingpointswerechosenforacupuncture:
Figure3:8Influentialpoints(Step2).BasedonOM,bodyconsists SI3,BL62,andBL40(inStep1),GB34(inStep2),Back-Shu
of8componentsandeachofthemcanbecontrolledbyitskeypoint pointsatlevelsshowinghyperesthesiaonthespinalpalpation
(underlined).
(inStep3),andBL40andBL60(inStep4).Acupuncturewas
performed2-3timesaweek.Casesthatreturnedtonormal
or cases with non-ambulatory paraparesis (grade III or IV)
that improved to be able to walk and void urine and feces
one was seen to have unilateral focal motor activity of the
withoutassistancewereconsideredtoberecovered.Alldogs
headwhichspreadtounilaterallimbs.
(8/8, 100%) from grades I to III recovered over periods of
5daysto6weeksafter1–12treatments,whileonly1/4dogs
2.3.AcupunctureTreatment. Acupuncturewasperformedby (25%),diagnosedasgradeIV,recoveredover7weeksafter15
5 veterinarians in their own practice. After selecting acu- treatments.
points according to the flow chart (Figure 1), acupuncture
needles(stainlesssteel,0.24–0.30mmindiameter,15–40mm 3.2. Vomiting (𝑛=11). The vomiting cases, diagnosed as
inlength)wereinserted,asdescribedintext[5]andleftfor unknown causes from diagnostic tests or not responsive to
15–20minuteswith/withoutmanipulation.Acupuncturewas initialmanagementsoffoodwithdrawalsandantiemeticsfor
applied 2-3 times/week. Clinical followup was determined 1–3days,weresubjectedtothisacupuncturetreatment.They
eitherbyaphonecalltotheownersatthetimeofthisstudy were young (𝑛 = 1, 6 months) or young adult dogs (𝑛 =
orbyreturnofthedogtotheveterinaryhospital.Treatment 10, average age = 3.2yrs) and showed commonly vomiting
was discontinued if the owner stated the symptoms had and inappetance. The acupoints were chosen based on the
ceased and if main symptoms were apparently disappeared flow chart: PC6, SP4, and ST36 (in Step 1), LV13 and CV12
onlaboratoryorphysicalexamination. (inStep2),sensitiveBack-Shu,andAbdomen-Mupointsto
palpations(inStep3),ST36,ST42,SP3,andSP9(inStep4).
3.Results Acutevomitingcases(<2days;𝑛 = 6)werewellresponsive
tothisacupuncturetreatment.Interestingly,3ofthembegan
3.1. IVDD (𝑛=12). The age of the dogs varied from 2 to 9 to eat food within 1hr after withdrawals of acupuncture
years with an average age of 3.6 years. The affected breeds needlesanddidnotshowanyvomiting.Insubacutecases(2–
were miniature Poodle (𝑛 = 3), Yorkshire terrier (𝑛 = 2), 7days;𝑛 = 2)thatshowedvomiting3–5times/dayandwere
Evidence-BasedComplementaryandAlternativeMedicine 5
Lung BL13 Lung LU1
Pericardium BL14
Pericardium CV17
Heart BL15
Liver BL18 Liver LV14
Gall bladder BL19 Gall bladder GB24
Spleen BL20 Heart CV14
Stomach BL21 Spleen LV13
Triple heater BL22
Kidney GB25
Kidney BL23
Stomach Umbilicus CV12
Large intestine BL25
Large intestine ST25
Small intestine BL27 Triple heater CV5
Urinary bladder BL28 Small intestine CV4
Urinary bladder CV3
(a) (b)
Figure4:Back-ShuandAbdomen-Mupoints(Step3).(a)Back-Shupoints(redcolorpoints)andinternalorgans.(b)Abdomen-Mupoints
(redcolorpoints)andinternalorgans.
Table1:Casesignalment.
Diseases Severity Duration Case(𝑛) Sex Age(year)
Male Female
GradeI 1 1 3.00
GradeII 1 1 2.00
IVDD
GradeIII 6 2 4 2.87
GradeIV 4 2 2 5.25
Acute <2days 6 2 4 2.77
Vomiting Subacute 2–7days 2 2 3.50
Chronic >7days 3 3 3.00
Acute <2days 1 1 1.50
Diarrhea Subacute 2–7days 1 1 0.60
Chronic >7days
Acute <2days 5 2 3 2.54
Abdominalpain Subacute 2–7days
Chronic >7days
Acute <2days
Cough Subacute 2–7days 66 30 36 4.55
Chronic >7days
<1year 1 1 0.6
Epilepsy
>1year 5 2 3 5.76
Total 102 47 55 3.75
6 Evidence-BasedComplementaryandAlternativeMedicine
Body trunk
al
Dors Shaoyin Taiyang
ateral Yin Jueyin Shaoyang Yang Exterior Back: Taiyang (SI, BL)
L
Taiyin SI BL
nt TH GB Lateral: Shaoyang (TH, GB)
Fro Yangming LI ST
Front: Yangming (LI, ST)
Interior Exterior
(a) (b)
Interior
Behavior: Shaoyin (HT)
Urogenital: Shaoyin (KI)
Liver, muscle, genital: Jueyin (LV)
Cardiovascular: Jueyin (PC)
Pancreas or digestion: Taiyin (SP)
Respiratory: Taiyin (LU)
Gastrointestinal: ST
(c)
Figure5:Channelsandtheirclinicalindications(Step4).(a)Ancientanatomicalterms“3Yangs-3Yins”andbody.YangandYinrepresent
exteriorandinteriorofbody,respectively.TheYang (exteriorofbody)isdividedinto3sub-Yangs,namely,Yangming (front),Shaoyang
(lateral),andTaiyang(dorsalorback).Ontheotherhand,theYin(interiorofbody)isdividedinto3sub-Yins,namely,Taiyin(frontorgans;
lung,spleen),Jueyin(middleorgans;pericardium,liver),andShaoyin(dorsalorgans;heart,kidney).(b)ThreeYangChannelsandExterior.
Externalbodyisdividedfront,lateralandback,andtheirassociatedChannels(underlined)wereusedfordisordersofeacharea.(c)ThreeYin
ChannelsandInterior.EachYinChannelisusedfortreatmentoftheirspecificinternalorgans(aandc).OftheYangChannels,thestomach
(ST)Channelisespeciallyusefultotreatgastrointestinaldisorders.ThewordsinItalicareChinesePinyin.LI,largeintestineChannel;ST,
stomachChannel;TH,tripleheaterChannel;GB,gallbladderChannel;SI,smallintestineChannel;BL,urinarybladderChannel;LU,lung
Channel;SP,spleenChannel;PC,pericardiumChannel;LV,liverChannel;HT,heartChannel;KI,kidneyChannel.
notresponsivetoinitialtreatmentoffoodwithdrawals(first days) of mild diarrhea, poor appetite, and frequent vomit-
24hr)andmetoclopramide,oneortwovomitingswerenoted ing. When presented, a complete blood count and routine
up to 12hr after first acupuncture and thereafter no more serumchemistrylevelswerewithinnormallimitsandfecal
vomitingepisodes.Chroniccases(>7days;𝑛 = 3)suffered examinations including parvovirus, distemper virus𝑤 and
fromsporadicvomitingof2-3times/day,frequentlyafterfood parasites were also normal. The patient was first treated
intake, recovered over 18.67 days after 6.7 times treatments withloperamideandamoxicillinfor5days,butthediarrhea
andrequiredlongerperiodsandmoretreatmentsthanacute persisted.Acupuncturewasthenappliedatthesamepoints
andsubacutecases. asthoseofacutediarrheacase.Hebegantorecoverappetite
onthedayofacupuncturetreatmentandreturnedtonormal
3.3. Diarrhea (𝑛=2). A 1.5-month-old female Poodle dog consistentfeces2daysafteracupuncturetreatment.
(acute case) was presented with acute watery diarrhea of
2 episodes within 12hr. Since the patient still kept normal 3.4. Abdominal Pain (𝑛=5). The cases (2 Maltese, 1 Pug, 1
appetite without dehydration and pyrexia and owner was Cocker spaniel, and 1 miniature Poodle) were initially pre-
mostfavorabletowardalternativemedicineuse,acupuncture sentedwithacuteabdominaldiscomfort,increasingabdom-
was first tried without routine laboratory examinations or inal pain, inappetance, and/or bloating, and they all were
Westernmedicine.Thefollowingacupointswereused:PC6, lesser than 2 days at duration. Physical examination was
SP4, and ST36 (in Step 1), LV13, and CV12 (in Step 2), normal, except abdominal pain. There was no radiographic
sensitive Back-Shu and Abdomen-Mu points to palpations evidenceforforeignbodies.Acupuncturewasperformedat
(inStep3),ST42,ST36,SP3,andSP9(inStep4),andGV1(in the acupoints selected according to the flow chart. They all
the last Step 5). Increase of stools consistency and decrease returned to normal within 24 hours after one acupuncture
of stools frequencies were observed within 48hr after first treatment.Interestingly,whenfoodwasoffered30minafter
acupuncturetreatment.Shereturnedtonormalover9days withdrawal of acupuncture needles, 4/5 cases began to eat
aftertwoacupuncturetreatment.A6-month-oldmalemixed immediately and did not show any abdominal pain on pal-
dog (subacute case) was presented with acute onset (<2 pation.
Evidence-BasedComplementaryandAlternativeMedicine 7
Table2:Theacupointsselectedaccordingtoflowchartandtreatmentoutcome.
Case Treatment Recovery Recovered
Diseases Severity (𝑛) Theusedacupoints numbers times(day) animals/cases
GradeI 1 Step1:SI3,BL62,BL40 1.0 5.00 1/1
Step2:GB34
GradeII 1 8.0 49.00 1/1
IVDD Step3:sensitiveBack-Shupoints
GradeIII 6 Step4:BL40,BL64(BLChannel) 12.5 38.67 6/6
GradeIV 4 Step5:Baihui,AshipointsnearlesionalongBLChannel 15.0 49.00 1/4
Step1:PC6,SP4,ST36
Acute 6 1.0 0.84 6/6
Step2:LV13,CV12
Vomiting Subacute 2 1.0 1.00 2/2
Step3:sensitiveBack-Shuand/orAbdomen-Mupoints
Chronic 3 6.7 18.67 3/3
Step4:ST36,ST42,SP3,SP9(ST,SPChannels)
Acute 1 2.0 9.00 1/1
Diarrhea Subacute 1 (Sameasthoseofvomiting)+GV1 1.0 2.00 1/1
Chronic 0
Abdominalpain Acute 5 (Sameasthoseofvomiting) 1.0 0.62 5/5
Step1:LU7,KI6,LI4
Acute 0 Step2:CV17orLV13
Cough Subacute 66 Step3:sensitiveShuand/orMupoints 1.9 7.02 54/66
Chronic 0 Step4:LU5,LU9(LUChannel)
Step5:CV22
Step1:SI3,BL62forposteriorbrainlesionorTH5,GB41for
unilateralbrainlesion
Step2:GB39
<1year 1 Step3:sensitiveShuand/orMupoints 1/week — 1/1
Epilepsy
>1year 5 Step4:SI4,SI8,BL40,BL64forposteriorbrainlesion(SI,BL 1/week — 4/5
Channels)orTH4,TH10,GB34,GB40,forunilateralbrain
lesion(TH,GBChannels)
Step5:GV20,GB20,GV16,Yintang
3.5. Cough (𝑛=66). The coughing cases in this study con- andtheyalldidnotshowanycoughingonthenextvisits(on
sisted of 60 shelter and 6 hospital cases. On August and 7daysafteracupuncturetreatment).
September2007inRepublicofKorea,workersintwoshelters
noticedabruptoutbreaksofcoughingdogsafterrainyspellin 3.6. Epilepsy (𝑛=6). The 6 cases (2 Pugs, 1 Shih Tzu, 1
summer,althoughthemedicationsincludingantibioticswere Maltese, 1 miniature Poodle, and 1 mixed breed) showed
doneunderregularshelterprogram.Themostaffecteddogs recurrentseizureatafrequencyof2–4/monthundercontrol
weresmallpureormixedbreeds.Althoughtheexactageof of antiepileptic drugs. They were diagnosed as presumed
the shelter dogs was usually unknown, ages were estimated idiopathicepilepsybasedonphysicalandneurologicalexam-
tobebetween6monthsand7yearsold,basedondentition inationsandhematologicalandserumbiochemicalanalyses.
and hair coat. The common clinical signs were cough and One Maltese dog of 3 months at onset of epileptic seizure
nasaldischargefor3–7days.Undershelter’sapproval,treat- received only acupuncture treatment once a week without
ment was performed using acupuncture without Western medication,sincehisownerwasreluctanttogiveantiepileptic
medicine, at the following acupoints: LU7, KI6, and LI4 (in drugs. The other 5 dogs over 1 year at onset of epileptic
Step 1), CV17 or LV13 (in Step 2), sensitive Back-Shu and seizurereceivedregularacupuncturetreatmentonceamonth
Abdomen-Mupointstopalpations(inStep3),LU9andLU5 with anticonvulsants. Acupoints were chosen, as shown in
(inStep4),andCV22(inStep5).Twoshelterveterinarians (Table 2). Since acupuncture treatment, 5 of the 6 dogs
observeddailyspontaneouscoughingandnasaldischargein (5/6, 83%) had no epileptic episode during followup of 12
acupuncture-treated dogs. At 7 days after one acupuncture months. However, a 5-year-old male Pug, presented with
treatment,itwasnotedthat48dogsshowednosymptomsof frequent generalized and symmetrical epilepsy during 1.5
coughandnasaldischarge,andtheother12hadstillcough years, did not show any changes in frequencies of epilepsy
ornasaldischargeandthereafterwereprescribedantibiotics. afteracupuncturetreatment.
Theabovefavorableeffectswerealsoobservedin6hospital
cases(1Poodle,1Yorkshireterrier,3ShihTzus,and1mixed- 4.Discussion
breed)within2–7daysatonsetdurationofcoughing.They
received acupuncture treatments two times a week at the 4.1. The Present Acupuncture Flow Chart Follows Basic OM
same points as those of shelter dogs. Decrease of coughing Principles for Point Combinations. Although various meth-
frequencies was observed on 3 days after first acupuncture ods can be used to select effective acupoints in OM, good
8 Evidence-BasedComplementaryandAlternativeMedicine
prescriptionsmustsatisfyatleastbasicOMprinciples.These a pair for disorders of the following body areas: (1) SI3-
include(1)bilateralacupuncture,(2)combinationofforelimb BL62-back,spine,neck,head,eye,andbrain;(2)TH5-GB41-
and hindlimb points, (3) ventral and dorsal points, and (4) side of body, lateral sides of the lumbar area, lateral aspect
local and distal points [7]. The present chart follows all of of leg, sides of body, shoulders, hip, eyes, ears, and neck;
theaboveprinciples.First,eachstepisbilateralacupuncture. (3) PC6-SP4-heart, thorax, gastrointestinal disorders, and
Second,Step1includesacombinationofpointsonforelimb reproductive,and(4)LU7-KI6-respiratory,lowerabdominal,
and hindlimb. Third, Step 3 is one technique of combining andurogenitaldisorders[9,10].
Mu-ventralandShu-dorsalpoints.Forexample,invomiting Tosimplifytheabovetheorymore,wedividedthebody
cases,ventralpointCV12anddorsalpointBL21wereselected into4areasofexterior-backaspects,exterior-lateralaspects,
in Step 3. Lastly, a combination of local and distal points is interior-heart/gastrointestinalandinterior-respiratory/uro\-
includedinSteps4and5.Thus,thepresentflowchartiswell genital systems, and assigned paired acupoints to each area
matchedwithOMprinciplesforpointcombination. (Figures1and2(a)).Inourclinicalcases(Table2),apairof
SI3-BL62wasappliedtobackdisorders(IVDD)andbilateral
epilepsy which was considered to be caused by posterior
4.2. The Proposed Chart Lists 164 Important Acupoints and
(or whole) brain lesions. A pair of TH5-GB41 was used for
Is Designed to Select Acupoints in a Total of 5 Steps. There
1 case with unilateral epilepsy which was presumed to be
are approximately 360 acupoints on the 14 main channels
duetolateralbrainlesions,andLU7-KI6waschosenfor66
of the body. Not all these acupoints are used commonly in
coughingcases.AndPC6-SP4pointswereusedforvomiting
veterinaryandhumanclinics.Mostacupuncturistspaygreat
(𝑛 = 11), diarrhea (𝑛 = 2) and abdominal pain (𝑛 = 5).
attentiontotheapplicationofspecialactingacupointswhich
Previousexperimentalandclinicalstudieshavesuccessfully
have special therapeutic effects. These clinically important
applied8ExtraordinaryChannelpoints.Inoneclinicalstudy
acupoints are categorized according to their own special
showingsuccessfuloutcomesofacupunctureinIVDDdogs,
therapeutic properties as follows: 8 Extraordinary Channel
pairedacupointsofSI3-BL62wereusedincombinationwith
points, 6 Command points, 8 Influential points, Back-Shu
otheracupoints[11].TH5-GB41hasbeenusedeffectivelyfor
and Abdomen-Mu points, Yuan (source) points and Luo
unilateralorfocalheadachesinhuman[12,13].LU7and/or
(connection)points,and5Shu(transporting)points,includ-
KI6 in combination with other acupoints has been used
ing He (sea) points, Xi (cleft) points, and empirical points,
successfully for respiratory clinical trials [14–16]. Acupoint
andlocalpoints.Inthepresentchart,theabovepointswere
PC6isextensivelyfortreatmentandpreventionofvomiting
organizedinorderofthefunctionalrangesofacupoints(from
[17–23]andtheenhancementofcardiopulmonaryfunctions
pointswithbroadfunctiontopointsactinglocally)asfollows
[4, 24–26]. Wang et al. reported that acupoints at PC6 and
(Figure1).
SP4enhancecardiacandgastrointestinalfunctionalactivities
Step1:8ExtraordinaryChannelpoints(8points)+6 after acute myocardial ischemia through the mediation of
Commandpoints(6points), nitricoxide(NO)[27].
InStep1,theoretically,toenhancetheeffectsofExtraor-
Step2:8Influentialpoints(8points),
dinary Channel points, 6 Command points therapy were
Step3: Back-Shupoints(12points)+Abdomen-Mu added. In detail, the 6 Command points are 6 individual
points(12points), pointswhichhavebeenusedtocontroldiseasesin6major
body parts, abdomen (ST36), lumbar region (BL40), neck
Step 4: 5 Shu (transporting) points on 12 Channels
(LU7),heart(LI4),chest(PC6),andurogenitalorgan(SP6)
(55 points) + Xi (cleft) points (12 points) + Yuan
[28] (Figure 2(b)). Six Command points originated from 4
(source)points(12points)+Luo(connection)points
Command points (ST36, LI4, LU7 and BL40), described in
(12points),
Chinese classic Qiankunshengyi (Meanings of Life between
Step5:empiricalorlocalpoints(27points). Heaven and Earth; 1402) and formed by adding two points
(PC6 and SP6) later [29]. In the present study, one of
InStep1,ExtraordinaryChannelpointswerecombinedwith 6 Command points was chosen additionally in cases of
Command points because both acupoints groups have the IVDD(BL40)anddiarrhea/abdominalpain(ST36).Previous
widestrangeofactionsamongtheacupointsandhavesimilar experimental and clinical studies support the effect of the
indications in respects of the body areas, when divided the 6 Command points which described in Step 1 of Figure 1.
body into exterior (lateral or back aspects) and interior BL40commonlyinpreviousclinicaltrialsofdogswithIVDD
(heart/gastrointestinal or respiratory/urogenital areas) or [11,30].ST36isaacupoint,wellknowntobemosteffectivefor
upper (face and neck) and lower parts (back). In oriental gastrointestinaldisorderssuchasabdominalpain,diarrhea,
medicine, 8 Extraordinary Channels and their key points andirritableboweldiseases[3,31–38].AcupunctureatSP6,
havebeenconsideredtoplaymostimportantrolesinbalanc- acommonpointforurinarydisorders[39,40],hasshownto
ing body Qi. The medical term “8 Extraordinary Channels decreasesymptomsofurinaryincontinencebystressinrats
points” dates back to 1230s and the detailed indications [41], diurnal symptoms associated with idiopathic bladder
and methods forming 4 pairs of acupoints (i.e., PC6-SP4) instability [42], and symptoms of frequency, urgency, and
werefirstdescribedintheYizongJinjian(GoldenMirrorof dysuriainfemalecases[43].Althoughwecouldnotconclude
Medicine) written by Wu Qian in 1742 [8]. Based on that thattheapplicationofthesecombinedpointsinStep1ledto
book, the Extraordinary Channel points are always used in thepresentfavorableoutcomes,atleastthisflowchartallows
Evidence-BasedComplementaryandAlternativeMedicine 9
aneasyandfastapproachtoapplyclinicallythecomplicated (pericardiumpoint),orBL15(heartpoint)werefound.These
OMtheoryconcerning8ExtraordinaryChanneland6Com- abovepointswerestimulatedbyacupuncture.
mandpoints. InStep4,oneortwoof12regularChannelswerechosen
InStep2,oneortwoof8Influentialpointswereselected accordingtomainsymptomsordiagnosisfromStep3,and
accordingtothebodycomponentsaffectedbydiseases.Eight then two Main points (Yuan and He points) were selected
Influential points are based on a Chinese classic Nan Jing on the chosen Channels (Figure 1). Regular Channels are
(The Classic of Difficulties) written around the 2nd century Qi pathways to connect the external body with internal
AD. It classifies the body as having 8 components: Zang, organs(YinChannels)orhead(YangChannels)[5].Oriental
Fu, Qi, Xue (Blood), Ji (Muscle), Mai (Vessels), Gu (Bone), medicine teaches that diseases occur when the Qi flow is
and Sui (Marrow). Each of these has a most influential disrupted in one or more Channels, which can be relieved
point that exerts a profound effect on the function of each by stimulating acupoints on the affected Channels. To dif-
component[44].Figure3andStep2inFigure1show8body ferentiate the Channels which were likely to be affected by
componentsinOM,interpretationinWesternmedicine,and disorders,weusedthe“3Yang-3Yintheory”whichhasbeen
their corresponding Influential points. For example, CV12 themostimportantfundamentfordiagnosisandtreatment
canbeusedfordisordersofstomach,smallintestineandlarge in acupuncture medicine [56, 57] (Figure 5(a)). In ancient
intestine (Fu organs in OM), such as epigastric distention, anatomicalterms,Yang andYinrepresentexteriorandinte-
abdominalpain,constipation,ordiarrhea,andGB34canbe riorofbody,respectively.Inrespectoftreatment,Yang and
Yinalsorepresentexternal(exterior)andinternal(interior)
selected for muscle-related disorders (muscle in OM) such
disorders,respectively.TheYang(exteriorofbody)isdivided
as muscle spasm, painful tendons, and hemiplegia. In our
into 3 sub-Yangs, namely, Yangming (front), Shaoyang (lat-
presentstudies,wechoseGB34forIVDDcases,LV13/CV12
eral)andTaiyang (backordorsal),andeachofthemisused
forvomiting,diarrhea,andabdominalpain,andCV17/LV13
for its corresponding external disorders (Figures 5(a) and
for cough and GB39 for epilepsy, respectively. Previous
5(b)andStep4inFigure1).Inourpresentstudy,basedon
studieshaveincludedacupoint(s)ofGB34inIVDD[11,30],
“3 Yang-3 Yin theory,” IVDD or epilepsy was diagnosed as
LV13/CV12 in gastrointestinal disorders [34, 45, 46], CV17
exterior-back(Taiyang)disorderandthusTaiyangChannels
in respiratory disorders [47], and GB39 in brain disorders,
(SI and BL) were chosen. Then, two Main points Yuan
respectively[48].
(source) and He (sea) points on SI and BL Channels were
In Step 3, Back-Shu and Abdomen-Mu points showing
selectedforacupuncture.Shaoyang Channels(THandGB)
sensitivitytosurgeon’spalpationwereselectedforacupunc-
werechosenforepilepsywithclinicallypresumedunilateral
ture. Figure 4 and Step 3 in Figure 1 show the Back-Shu
brain lesion (Table 2). On the other hand, the Yin (interior
andAbdomen-Mupointsandtheassociatedinternalorgans.
of body) is divided into 3 sub-Yins, namely, Taiyin (front
Oriental medicine describes that Back-Shu and Abdomen-
organs; lung, spleen), Jueyin (middle organs; pericardium,
Mupointsareconnecteddirectlytotheinternalorgansand
liver) and Shaoyin (dorsal organs; heart, kidney), and each
these points often become tender, tight, or distended when
of them is used for treatment of its specific internal organs
the associated organs are diseased or imbalanced, and so
(Figures 5(a) and 5(c)). Empirically, stomach (ST) Channel
theyare used asdiagnosticandtreatmentpoints[5, 49]. In
of Yang Channels has been used to treat internal organs
support,aretrospectivestudyof175dogsandcatswithBack-
(stomach and intestine), as well as exterior-front disorder.
ShuorAbdomen-Mupointsensitivityandtheirbloodchem-
Inourpresentstudy,coughwasdiagnosedasinterior-front
istryshowed thatthere isat least a single correlationofthe
organ-Lung(TaiyinLU)disorder,andthusTaiyinLUChan-
pointsensitivitywithaconcurrentriseintheinternalorgans-
nelanditsMainpoints(YuanandHepoints)wereselected
associated chemistry values [49]. Back-Shu and Abdomen-
for treatment. Case with vomiting, diarrhea, or abdominal
Mupointsareknowntoberelatedsegmentallytotheinternal
painwasdiagnosedasinterior-frontorgan-spleen(TaiyinSP)
organs[50,51].Visceralpainisreferredtosegmentalsomatic
disorderorstomach(ST)disorder,accordingtosensitivityat
areas. In the referred area, tender points, characterized by
BL20(spleenShupoint)orBL21(stomachShupoint)andtwo
well-definedandlocalizedspotsandanincreasedsensitivity
Main points were selected on SP (spleen) or ST (stomach)
tomechanicalstimuliareoftenfound[52].Thestimulation Channels (Table 2). Although the above Channel theory is
of these tender points can in turn alleviate the visceral mostimportantinacupuncturemedicine,itistruethatthe
pain and inflammation [53–55]. In our present cases, most theory is too difficult for general clinicians to comprehend.
sensitive points were found at Back-Shu and Abdomen-Mu Therefore, we highly simplified clinical indications of each
points around the affected internal organs and frequently ChannelandsummarizeditinStep4(Figure1).
some other points. In the cases with vomiting (𝑛 = 11) InStep5,local,empirical,orAshi(localsensitive)points
or abdominal pain (𝑛 = 5), sensitive points were found at foreachcasewereadded.Acupunctureneedlingisknownto
BL21(stomachShupoint)and/orCV12(stomachMupoint) produce local anti-inflammatory, analgesic, and antipyretic
andfrequentlyseveralotherpointssuchasBL17(diaphragm effectsbypromotingvasodilationandbloodflowlocallyand
point), BL18 (liver point), BL 19 (gall bladder point), BL 20 releasing neuromodulators [58]. In the present cases, we
(spleenpoint),BL22,andBL23(kidneypoint).Twodiarrhea chose GV1 in diarrhea, CV22 in cough, and GV20/GB20/
cases were sensitive at BL23/BL25 or BL21/BL24/BL25. In GV16/Yintang in epilepsy, respectively. GV1 is a single acu-
the cough cases, one or two sensitive points at Back-Shu point in the depression ventral to the base of the tail and
points such as BL12 (wind point), BL13 (lung point), BL14 dorsaltotheanus.Itisoneofthemosteffectiveacupointsto
10 Evidence-BasedComplementaryandAlternativeMedicine
treatdiarrheainhumansandanimals[59–61].Ourprevious abdominalpain(𝑛=5)recoveredafter1–6treatmentsover1–
studies demonstrated that acupuncture at GV1 depressed 19days.Mostacute/subacutecases(<7daysatduration)fully
proximal colonic motility by decreasing the total duration recoveredwithin1dayafteroneacupuncturetreatment,with-
andfrequencyofcontractilestatesinconsciousdogsandalso outWesternmedicine.Interestingly3/6acutevomitingcases
had anti-inflammatory and analgesic effects in colitis rats, begantoeatfoodswithin1hrafterwithdrawalofacupuncture
viaendogenousopioidpathways[54,55,62].CV22hasbeen needles and 4/5 abdominal pain cases showed complete
includedtotreatrespiratorydisorders[63,64].GV20,GB20, relief of abdominal pain within 30min after withdrawal of
GV16,orYintangpointshavebeenusedcommonlyforbrain acupuncture needles, with no recurrence. Similarly, in one
disorderssuchasheadache[65].Previousreportshasshown human clinical study of 190 cases with intestinal colic pain
thatacupunctureatYintangand/orGV20cancausesedative from bacillary dysentery, simple acute appendicitis, simple
effectsandchangebioelectricalbrainactivity[66].Although acuteintestinalobstruction,adhesiveintestinalobstruction,
we could not determine which acupoint in flow chart was orintestinalascariasis,acupunctureatbilateralST36results
in complete pain relief within 30min in 85% of cases,
most effective for the treatment of each case, each step in
decreasedcolicpainin11%,andnoresponsein4%[81].To
this flow chart provides a theoretical rationale for selection
our knowledge, although it has limitations to explain these
ofoptimalacupointsineachcase,basedonOMtheory.
phenomenascientifically,ourresultsshowthatthisflowchart
can help the clinicians prescribe acupoints effectively for
4.3. The Proposed Chart Can Help Clinicians Prescribe Acu- cases with various gastrointestinal symptoms. Acupuncture
points Effectively for Various Diseases. In 1997, the NIH may have beneficial effects on the treatment of respiratory
releasedaconsensusstatementconcludingthatacupuncture diseases including bronchitis and asthma in dogs and cats
iseffectiveoratleastusefulforthetreatmentof13conditions [82]. Although this was an uncontrolled clinical study, and
including low back pain, nausea and vomiting, asthma, not a randomised controlled clinical trial, our results that
strokerehabilitation,headache,addiction,dentalpain,men- acupuncture improved 54/66 coughing cases showed that
strual cramps, tennis elbow, fibromyalgia, myofascial pain, acupuncture methods using this flow chart can be used to
osteoarthritis, and carpal tunnel syndrome [67]. Multiple helpthetreatmentofrespiratorycases.
studies have documented that acupuncture is useful in the
casewithlowbackpainorIVDDwhenadefinitivediagnosis 5.Conclusion
is made or when surgical intervention is not an option
due to patient concerns such as geriatric and other under- Thisacupointsprescriptionchartisbasedonorientalmedical
lying diseases, and acupuncture results are favorable and (OM)theoryandincludesinformationconcerningOMdiag-
comparable to those of surgical treatments [30, 68–75]. In nosis, function of the Channels, Zang-Fu theory, clinically
veterinarymedicine,thesuccess ratesandrecoveryperiods important acupoints, and combination methods of their
byacupunctureinIVDDdogsseemtovaryaccordingtothe acupoints.Ithasbeenmodifiedthroughclinicaltrialssince
severityofdisease.InclinicalreportsofJanssensLA[76],90% first edition in 2003 and used widely and successfully to
of dogs with grade I recovered after 2-3 treatment over 1-2 various clinical cases such as neurological, respiratory, and
week period, 90% of dogs with grade II recovered after 3-4 gastrointestinal disorders in Korean veterinary clinics. We
treatment over a 3-week period, and 80% dogs with grade believethatthischarthelpsbeginnersorclinicianstoselect
IIIrecoveredafter5-6treatmentsovera6-weekperiod.And effective acupuncture points easily and quickly. However,
dogs with grade IV showed poor response to acupuncture more powerful methods of well-designed randomized and
(success rate < 25%). Similarly, in our present study, 100% controlledtrialsareneededtoconfirmtheefficacyofthisflow
in dogs of grades I to III recovered over periods from 5 chartonvariousdiseases.
days to 6 weeks after 1–12 treatments, while only 1/4 dogs
Acknowledgments
in grade IV recovered over 7 weeks after 15 treatments. It
seemedthatastheseverityofIVDDincreased,therecovery
ThisworkwassupportedbytheNationalResearchFounda-
period and number of treatmentsalso increased. Acupunc-
tionofKorea(NRF)grantfundedbytheKoreaGovernment
ture treatment of idiopathic epilepsy has been documented
(MEST) (no. 20120009400). The authors thank Phil Rogers
well in the veterinary and human literature [5, 57, 68]. It
MRCVS,Dublin,foreditingthematerialinthispaper.Hee
wasreportedthatacupuncturereducesseizurefrequencyand
Young Kim also appreciates and acknowledges the support
dosagerequirementsofantiepilepticdrugsinepilepticdogs
for the basic course on veterinary acupuncture (2007-2008,
[77–80].Inourpresentstudy,5/6dogswithepilepticepisode
SanAntonio,USA)providedbytheInternationalVeterinary
at a frequency of 2–4/month showed no seizures under
AcupunctureSociety(IVAS)viatheGradyYoungMemorial
combinationtherapyofacupunctureandanticonvulsants.It
Scholarshipprogram.
indicatesthatthisflowchartmaybeusefulforneurological
caseswithIVDDorepilepsy.
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