Professional Documents
Culture Documents
Dr. med vet Uwe Petermann, prakt Tierarzt, Akupunktur, Germany e mail: DrUwePetermannMelle@t-online.de
ABSTRACT
105 horses with extreme COPD were treated exclusively using laser acupuncture. No other medicinal or alternative therapy was administered. All
patients had been treated previously over a lengthy period (3 months - 10 years) with conventional therapies such as cortisone, clenbuterol, drugs for
secretion- removal, hyperinfusion, inhalation and so on without success. The acupuncture lasers used were infrared pulsed lasers with 60 and 90 watt peak
pulse power with an impulse width of 200 nsec. As pulse frequencies, those from NOGIER and BAHR (between 100 and 10000 Hz) were used. The horses
were treated 4 - 12 times on each point for 30 sec. (1 case 29 times, on average 6.5 times). The interval between treatments was 4 - 7 days. In most of the
patients (n=79) a clear spontaneous reaction could already be seen during the first session. The horses were able to breath deeper and remove secretion in
a manner similar to that of infusion therapy. 15 patients that had not improved after 3 or 4 treatments, were treated by laser on marked points by their owners
every day for 2 - 3 weeks with a 30mW continuous laser, 30 sec. on each point. After conclusion of the treatment, 73 horses appeared to have been cured.
In other words, there was no more coughing, no more difficulty in breathing; the respiratory tract was clean and showed no signs of inflammation. The horses
seemed to be in excellent physical condition. 17 horses were much better and had no more problems with their stamina, but sometimes had a slight cough
while being ridden. 11 horses were also better than before and could be ridden, but their stamina was not completely restored and they were still coughing
so that the result was not deemed satisfying. Only 4 horses showed no signs of improvement following the treatment.
INTRODUCTION
Although veterinary acupuncture is almost 3000 years old since Sunjang, the father of veterinary acupucture has lived, 900 BC, (KOTHBAUER,
O., MENG, A. 1983) one finds only few scientific articles about acupuncture on horses. Most of the publications in this area are concerned with isolated case
studies which are quickly discounted as a placebo effect or self healing. In the face of the really outstanding work and, above all, the effect (BERGSMANN,
O. 1977, ZEROBIN, K. 1991) of carefully directed and expertly carried out acupuncture (GLARDON, O. and SCHATZMANN, U. 1981, PETERMANN, U.
1989, WESTERMEYER, E. 1993) , this is very difficult to understand. The reason, first and foremost, is that in the universities and clinics, which generally
produce the greatest part of the scientific literature, acupuncture is not established as a method of treatment.
The first known description of chronic obstructive pulmonary disease (COPD) does not go quite as far back as the origins of veterinary
acupuncture. Aristotle described the following symptoms in stable horses in his "Animal Healing": "Symptoms are also incurable in which the heart is
affected, whereby the flanks slowly collapse in a pathological way .. and they draw up their hips" "( GOHLKE 1957 ). It also did not escape him that this was
a domestication illness which was closely connected with being kept in a stable. COPD is unknown in wild horses and horses kept all year round on pasture
(THURLBECK, W.M. and LOWELL, F.C. 1964, GILLESPIE, J.R. and TYLER, W.S. 1969, COOK; W.R. 1976). This fact certainly deserves attention when it
comes to prophylactics and therapy in that very ill patients should be kept in the ideal "all year round on pasture" state as far as circumstances will permit.
This means allowing the patients the maximum possible freedom to move in and outside their stable as they like. In the English-speaking world, the
synonyms for COPD are heaves and broken wind. The term COPD itself ( chronic obstructive pulmonary disease) has been taken from human medicine.
The basic pathological mechanisms of the obstruction take place in the finest branches of the bronchial tree, in the inlet channels to the alveoli, namely the
bronchioles. These passages no longer have a cartilaginous septal framework running through them so that the main effect, the bronchial spasm,
encounters no resistance here. As a further lumen narrowing effect, there are the more or less viscous secretion deposites as a result of dyscrinie and
hypercrinie. The obstruction is finally completed by an often substantial oedema of the mucous membrane (DEEGEN, E. 1979). In the case of serious
COPD, this obstruction leads to a valve effect in which more air is drawn into the alveoli during inspiration as can be pressed out during expiration. This is so
called as "air trapping" (MCPHERSON, E.A. and LAWSON, H.K. 1974). This increasingly distends the alveoli and leads to a functional emphysema.
All the pathological principles described above are vegetatively and humorally controlled so that here a therapy of targeted stimulation of nerve
points, called trigger or acupuncture points, offers itself as a therapy which can act in a regulatory manner (MELZACK, R. and WALL, P.D. 1965, MELZACK,
R. et al. 1977, HEINE, H. 1987, ZOMANN, A. 1990). The so called „Controlled acupuncture" does not just emphasise treating the symptomatic points, e.g.
Lu 7, Bl 13, Bl 17 etc. (see diagram). An attempt should also be made to remove the disorder seen in acupuncture as the joint cause of the allergic reaction.
Here the allergen is seen merely as the trigger, not the cause of the allergic illness. You can find the real cause of allergic reaction by a systematic diagnosis
and treatment of disorders, e.g. scars especially along the line of the lung and kidney meridians and periodontitis. Based on the classical Chinese
acupuncture, controlled acupuncture was further developed in the last 15 years by the Deutsche Akademie für Akupunktur und Auriculomedizin (DAA/AM
german academie for acupuncture and auricular medicine)* .
Whereas classical medicine sees the causes of COPD in infections of the upper pulmonary tracts, especially influenza and herpes, in air
pollution, allergies, lung worm infection and perhaps also genetic factors (GERBER, H. 1968, SCHATZMANN, U. and GERBER, H. 1972, LITTLEJOHN, A.
1978, HAYER, L. and SASSE, H.H.L. 1980) , controlled acupuncture regards the accumulation of these external disorders together with additional internal
disorders as the central cause of the allergic reaction. Especially periodontitis is responsible for disorders of the vegetative functions or, in the words of
acupuncture, of the meridian functions (KLUGER.L. 1990). In addition, scars in the meridian line which did not heal properly are also a cause. Seen
morphologically, it is a question here of chronic granulomatous inflammation surrounded by demarcation tissue ( KELLNER, G. 1979). As laser therapy has
an outstanding demarcation effect and promotes the healing of wounds (MESTER et al. 1969), it is also understandable that they can also set a demarcation
in motion again that had come to a halt and thus so can eliminate the disorder (PETERMANN, U. 1998, POPP, F.-A. 1984). The organism's ability to adapt
can be reduced through the accumulation of these internal and external stress factors that it is no longer in a position to react sensibly to stimuli (e.g.
allergens). The medical phrase for this changed reaction situation is „adaptation syndrome" (SEYLE, H. 1953). This has been known for almost 50 years
and is confirmed time and again in the treatment of such disorders by the quite spontaneous positive reactions of the patients. The direct reactions of the
patient to laser treatment of such a scar or a periostitis is demonstrated by 3 case studies.
PATIENTS
The following work reports on the effectiveness of controlled laser acupuncture treatment of 105 horses suffering from extreme COPD. Only
patients with pronounced dyspnea in the resting state and an extended lung percussion area at least 4 fingers wide were selected. All horses had been
treated with the usual methods, with mucolytics, bronchodilators, cortisone, inhalation using an ultrasonic mist generator and, to some extent, with
hyperinfusion therapy (DEEGEN, E. LIESKE, R: and FISCHER, J. 1980, DETLEF, E., KÖHLER, L. and ALLMELING, G. 1982, DEEGEN, E. 1988) over a
prolonged period (2 months to several years) without success. The study involved 6 stallions, 40 mares and 59 geldings. The horses were between 4 and 30
years old (average age 12.6 years). In 42 of the horses, the stabling conditions has already been optimised over a longer period of time (sawdust on the
floor, silage feed, hay soaked in salt water, open stabling , access to pasture all the year round).
Examination Procedure
After the report of the owner asking for duration, course run by and seriousness of the illness, stabling and feeding conditions, quality of the feed,
previous treatment, the horses were examined externally (frequency and depth of breathing, type of breathing, breathing through the nostrils, running nose).
The entire body was also examined for any scars of substantial size. Finally, a thorough auscultatory examination and a percussion of the lung area was
carried out. In the process, attention was paid to the lung percussion area and to any areas of unusually loud resonance. Because of the extreme dyspnea of
the patient, no breathing stimulation or inhibition was used during the initial examination. In the post-examination, a inhibition of the breathing was carried out
for about 45 sec. followed by an auscultation (but not for the 4 patients which showed no improvement). A bronchoscopy was carried out on some of the
patients (n=35) as a supplement to the clearly identified clinical findings. Viscosity, amount and distribution of the secretion, mucous membrane oedema in
the neighbourhood of the bifurcation, reddening of the mucous membrane were assessed. Subsequently, the acupuncture diagnosis was carried out using
the method of the Deutsche Akademie für Akupunktur und Aurikulomedizin (BAHR, F. 1997, PETERMANN, U. 1999) to find the optimum acupuncture points
for the treatment. This method makes a consistent and reproducible diagnosis possible so that the points at which the therapy is to be applied and also any
local disorders in the meridian lines can be determined.**
Therapy
For the individual treatment of each patient, each of the points diagnosed by the controlled acupuncture was treated with an acupuncture laser for
30 sec. The following points were most often found: Bl 13, (influence point of the lung meridian), Bl 14, (influence point of the meridian heart/sexuality), Bl 17,
(influence point of the diaphragm), Lu 7 and Ki 6 as cardinal point pair, Bl 40, (allergy point and histamine point of the ear acupuncture), Bl 23, (influence
point of the kidney meridian), CV 17 (respiratory alarm point of the three heaters) and St 40, (mucus dissolving point, beta- agonist point ), Li 13 (ACTH
point) as well as the points TH 5 and Ki 3, important for all inflammation processes in the organism. In addition, the individual scars and periodontitis points
found during the acupuncture diagnosis were also treated with the laser, sometimes up to 5 minutes per point.
Picture 1) little scar found as a disturbing focus in a COPD patient near Lu 11
Picture 2) a bigger scar found as a disturbing focus in another COPD patient also near Lu 11
Picture 3) COPD patient with an iapparent sinusitis in the first maxillar molar tooth, treated with a laser douche (8x 10 watt impulse laser diodes)
The treatment of all acupuncture points were carried out with a 60W and a 90W impuls- acupuncturelaser (Reimers + Janssen Company) for 20 -
30 sec. per point. These are diode impuls- lasers with a wavelength of 904nm and a pulse duration of 200nsec. Picture 4) My 14 years old acupucture laser
used in the treatment of the patients according to this study (untill today my favorite laser machine)
Picture 5) One of my high end modern impuls- acupuncture lasers 50 Watt
Picture 6) One of my high end modern impuls- acupuncture lasers 90 Watt
Essentially, the frequencies A, B and C of the frequency bands according to NOGIER (292, 584, 1168 Hz) as well as the frequency 5 (frequency
for the cardinal points) from the frequency bands according to BAHR (9592 Hz) were used for the cardinal points. 4 - 12 treatments were carried out at
intervals of 4 - 7 days (1 patient had 29 treatments, on the average 6.5 treatments). 15 patients, wheather they reacted immediately to the treatment with a
significant improvement in breathing, they were again experiencing very serious breathing difficulties by the next treatment date. In these 15 patients the
points were marked by scissors and each radiated for 30 sec. using a Handylaser (Reimers and Janssen Company and Schwa-Medico Company, both 50
mW continuse- wave- laser, wavelength 820 nm) applied by the owners themselves over a 2 - 3 week period.
38 patients which, before the start of the treatment, had not enjoyed any improvement in stabling or had again been neglected, were kept in these
same conditions during the therapy. On the other hand, the conditions of the 25 patients were optimised during the therapy. (see list of patients)
Results
With very many patients (n=79), significant reactions could be observed during the first treatment. An increase in the depth of breathing,
sometimes quite significant, was a regular occurrence when the point Bl.17 ( influence point of the diaphragm) was treated. This was often accompanied by
an increase in coughing. In the meantime it was also noticeable with most of the patients that they took deep breaths a number of times during the
acupuncture - something not previously possible because of the obstruction. At the end of a treatment, or 10 minutes thereafter, a loud secretion mobilisation
could be heard without the aid of a stethoscope in half of the patients, rather similar to that following a hyperinfusion therapy with frequent swallowing of
secretion. After the second or third treatment, in the case of some patients, the previous droning and rattling noises which could be heard by auscultation
had completely and spontaneously disappeared. At the end of the therapy the following results had been achieved: 73 horses appeared to be in a healthy
clinical condition, i.e. while resting and in action coughing no longer occurred and also after inhibition of breathing no pathological breathing noises could be
ascertained by auscultation. Also the previous emphysema which had been determined by percussion had completely receded, insofar as one could
diagnose such by percussion of the lung. The horses were able to be put fully to work again and showed no further cough symptoms. 26 of the 35 patients
which underwent a bronchoscopy and which belonged to this group, no longer showed any pathological bronchoscopy results. The next 17 patients no
longer had any breathing difficulties and could be put to work normally, but they coughed occasionally in the stable and on starting to work. In 11 patients,
the ailments were able to be improved in the end result and the horses put to work again to a certain extent but coughing still persisted at the beginning of,
and also sometimes during work so that one was not able to describe their state as satisfactory. 4 horses showed no lasting improvement although positive
reactions during treatment were observed also in these patients. Of the 14 horses which were treated daily by their owners for a further 2-3 week period, 9
showed in the end no clinical evidence of disease, 2 were "satisfactory" and 2 horses could be put to work "with limitations". Only one horse still had very
serious breathing difficulties following this "intensive treatment" and in the end had to be put down. 1 patient that seemed to be clinically healthy at the end of
the treatment, developed a very serious COPD again after only 3 weeks and ist owner wanted no further treatment after that. 65 horses were examined
again after an observation period of between 6 months and 4 years (average of 1.8 years). All these horses belonged to both of the groups in which a good
or very good result was achieved. No worsening in the good condition of 56 of these patients was observed by the owners over the entire period. 3 patients
started to develop symptoms again after 6 months, in two patients after a year, in two patients after 3 years and in one patient after 4 years. One patient (No.
97) was brought later into the study being free of symptoms for 10 years following acupuncture treatment of very serious COPD and had now developed
once more within a few weeks a similar COPD. However, after 3 further treatments the patient has now enjoyed 1 year complete remission.
Case Studies
These case studies are very interesting and helpfull to show the procedure of the controlled acupuncture and to see the connections between the
disturbing foci as scars or inapperent sinusitis and allergic reaction.
Conclusions
The results show clearly that acupuncture as a vegetative regulating therapy is outstandingly suitable in countering allergic regulatory disorders.
This is all the more noteworthy considering that all patients had a very long history of highly chronic illness and in all cases had been treated intensively
often over a period of years. The results of this study should help spark the debate as to whether one should look at this form of therapy with less scepticism
and greater attention in the future. This is all the more so as it represents, when correctly applied, a substantial enrichment of the whole medical spectrum.
* The DAA/AM is a society which exclusively trains doctors, dentists and veterinary surgeons and has over twelve thousand members in
Germany alone. It has dedicated itself
to scientifically researching the effects of acupuncture, to develop acupuncture further
and to understand the physiological mechanisms behind it. The DAA/AM directs its aims
and endeavours towards a systematic and reproducible diagnosis and therapy in acupuncture.
**controled acupuncture bases on thr RAC or VAS Reflex. When I near e.g. a laser beam
to an active acupuncture point, that means an acupuncture point that is in disorder, the patient reacts with a vegitative reflex. One thing what
happens in this reflex is a changed
pulse quality, you can taste on the pulse. This has nothing to do with chiniese puls diagnosis and is called „Reflex Auricular Cardinal" or „Vaso
Authonom Signal".
Literature review
1 Bahr, F. (1997) Skriptum Systematik und Praktikum der wissenschaftlichen Akupunktur für weit Fortgeschrittene und Experten. Eigenverlag,
München 1997 (Scriptum, systematics and practical course of the scientific acupuncture for progressing and expert acupuncturists. Self-publishing house,
Munich 1997 )
2 Bergsmann, O. (1977 ) : Die biokybernetische Wirkung der Akupunktur im klinischen Versuch. Dtsch. Ztschr. f. Akup. 5, 131ff (The
biocybernetic effect of the acupuncture in the clinical attempt. Dtsch. Ztschr. f. Akup. 5, 131ff
3 Cook, W.R., (1976) : Chronic bronchitis and alveolar emphysema in the horse. Vet. Rec. 99, 448 - 4514
4 Deegen, E. (1979) : Zur klinischen Diagnostik chronischer Lungenerkrankungen dês Pferdes., (To the clinical diagnostics of chronic lung
illnesses of the horse.) Dtsch. Tierärztl. Wochenschr. 77, 616 - 621
5 Deegen, E., Lieske, R., und Fischer, J. (1980) Eine neue Methode der sekretolytischen Therapie bei Pferden mit chronisch obstruktiver
Bronchitis. 7. Arbeitstagung der Fachgr. Pferdekrankheiten DVG, Hamburg, 63-73 (A new method of the secretolytic therapy with horses with chronically
obstructive bronchitis. 7. Work meeting of the practioners Horse diseases DVG, Hamburg, 63-73
6 Deegen, E. (1988) : Infusionstherapie beim Pferd. (Infusion therapy with the horse) Tierärztl. Umschau 43, 766 - 772
7 Detlef, E., Köhler, L. und Allmeling, G. (1982) : Erfahrungen mit der NaCI-Hyperinfusionstherapie bei der Behandlung der COPD beim Pferd.
(Experiences with the NaCI Hyperinfusionstherapie with the handling of the COPD with the horse) Tierärztl. Prax. 10, 209 - 217
8 Gerber, H. (1968) : Zur Therapie chronischer Respirationskrankheiten des Pferdes (To the therapy of chronic respiratory disease of the horse)
Schweiz. Arch. Tierheilkd. 110, 139 - 153
9 Gillespie, J.R. and W.S. Tyler (1969) Chronic alveolar emphysema into the horse. Advances in veterinary science and comparative medicine.
Acad. Press, New York, London
10 Glardon, O.; Schatzmann, U. (1981) : Lokalisation einiger Punkte auf dem Blasenmeridian des Pferdes. (Localisation of some points on the
bladdervessel of the horse Dtsch. Zschr. Akup. 24, 115 - 118
11 Gohlke, P. (Hrsg., 1957) : Aristoteles: Tierheilkunde, (Animal- medicine) 366 Zweite Auflage, Paderborn
12 Hajer, R. und H.H.L. Sasse (1980) : Zur Ätiologie, Diagnostik und Therapie der COPD. 7. (To the aetiology, diagnostics and therapy of the
COPD.) Arb.-Tagg. D. Fachgr. Pfd. Krh., DVG Hamburg
13 Heine, H. (1987) : Zur Morphologie der Akupunkturpunkte. (To the morphology of the acupuncturepoints) Dtsch.Zschr.Akup. 30, 75 - 79
14 Kellner, G. (1979) : Der Herd in experimentell-histologischer Sicht. (The focus in experimental-histological view) Österr.Ärzteztg. 34, 933 -
935
15 Kluger, L. (1991) : Odontogene Störfeldmöglichkeiten. (Possibilities of odontogen disturbing focus) In: Österr. Med. Ges. f. Neuraltherapie -
Regulationsforschung (Hrsg.): Herd-Störfeldgeschehen. Facultas, Wien 40 - 46
16 Kothbauer, O., Meng, A.(1983) : Grundlagen der Veterinär-Akupunktur. (Basics of the veterinary acupuncture) Welsermühl, Wels, 1.Aufl. 21
17 Littlejohn, A. (1978) : Studies of the physiopathology of chronic obstructive pulmonary disease in horses. Pretoria, DVSc Thesis
18 Mcpherson, E.A.; H.K. Lawson; J.R. Murphy; J.M. Nicholson; J.A. Fraser; R.G. Breeze; H.M. Pirie (1978) : Chronic obstructive pulmonary
disease (COPD): Identification of affected horses. Equine Vet. J. 10, 47 - 53
19 Melzack, R.; Stillwell, D.M.; Fox, E.J. (1977) : Trigger points and acupuncture points for pain: Correlations and implications. Pain 3, 3- 23
20 Melzack, R.; Wall, P.D. (1965) : Pain mechanisms: A new theory. Science 150, 971 -979
21 Petermann, U. (1989) Behandlung von BWS- und LWS-Beschwerden beim Pferd mit Ohrakupunktur. (Handling of BWS and LWS
complaints in the horse with earacupuncture.) collegium veterinarium 20/91-93
22 Petermann, U. (1997) Systematische Diagnostik von Störherden mit Hilfe dês RAC/VAS (Systematic diagnostics of disturbing focus in the
body with the help of the RAC/VAS) 93 ZÄN-Kongreß, Freudenstadt
23 Popp, F.-A. (1984) Biologie des Lichtes, (Biology of the light) Paul Parey, Berlin/Hamburg
24 Sasse, H.H.L. (1973) Lungenfunktionsprüfung beim Pferd. (Lung functional test with the horse) Tierärztl. Prax. 1, 49 - 59
25 Seyle, H. (1953) Einführung in die Lehre vom Adaptationssyndrom. (Introduction to the science of the adaptation syndrome) Thieme Stuttgart
26 Schatzmann, U. und H. Gerber (1972) Untersuchungen zur Ätiologie chronischer Lungenerkrankungen des Pferdes. (Investigations for the
aetiology of chronic lung illnesses of the horse.) Zentralbl. Veterinärmed., Reihe A 19, 89 - 101
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28 Westermayer, E. (1993) Lehrbuch der Veterinärakupunktur. (Textbook of the veterinary acupuncture) Bd. 2: Akupunktur des Pferdes., Haug,
Heidelberg
29 Zerobin, K.( 1991 ) in Anhang II ( wissenschtl. Originalarb. ), Bahr: Einführung in die wissenschaftl. Akup., Neue Ergebnisse der Akupunktur
in der Veterinärmedizin, (In appendix II (scientific original works), Bahr: Introduction to the scientific acupuncture, new results of the acupuncture in the
veterinary medicine) S 225 ff, Vieweg, Wiesbaden
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and pathophysiological bases of ear -, bodyacupuncture and neuraltherapy) Prakt. Tierarzt >collegium veterinarium< 71, 83 – 84
INTRODUÇÃO
Treinadores, jóqueis, cavaleiros e amazonas estão envolvidos numa constante busca por maneiras de melhorar a
performance de seus cavalos atletas e de obter resultados importantes em competições. Infelizmente para muitos, isto leva à
condição de vencer a qualquer custo, prejudicando diretamente a vida útil destes atletas. Assim como na medicina humana
(PELHAM et al., 2001), inúmeros métodos têm sido aplicados para melhorar a performance de cavalos atletas, como uso
de massagem, fisioterapia, treinamentos diversificados, alimentação e até mesmo uso de fármacos ilegais. A seleção
genética é também forte arma manipulada pela medicina veterinária em busca de grandes atletas. Neste contexto, a medicina
complementar vem ganhando popularidade, com o intuito de melhorar a performance de determinado atleta humano ou eqüino. Por
esta razão, a acupuntura está constantemente sendo avaliada sob este aspecto. O objetivo desta revisão foi
discutir o uso da acupuntura na medicina esportiva eqüina como mais uma alternativa terapêutica visando melhorar a
performance destes atletas.
REVISÃO DE LITERATURA
M EDICINA ESPORTIVA EQÜINA – AVALIAÇÃO DE PERFORMANCE
A performance atlética requer a interação complexa de mecanismos que envolvam os sistemas
musculoesquelético, nervoso, respiratório e cardiovascular. Nenhum dado isolado tem a precisão de predizer a capacidade
de exercício, já que a habilidade atlética é multifatorial. A avaliação de performance atlética com a utilização de esteiras
de alta velocidade tem ganhado popularidade nos últimos anos e pode fornecer informações potencialmente úteis na seleção
de eqüinos para o esporte (HODGSON & ROSE, 1994). Na maioria dos estudos de teste de performance em cavalos atletas
os exercícios são de esforço crescente e rápido. Nestes testes, a velocidade da esteira geralmente é aumentada a cada 60 a
120 segundos até que o cavalo não consiga mais igualar seu andamento com a esteira, o que é conhecido como ponto de
fadiga; ou até que determinada freqüência cardíaca seja obtida (ROSE, 1990; ROSE & HODGSON, 1994a). É necessário
período de aclimatização à esteira antes da realização de testes de performance, já que os níveis de lactato sangüíneo e a
freqüência cardíaca são maiores durante este intervalo. Recomendam-se no mínimo quatro exercícios de aclimatização por animal
num período de dois dias (ROSE & HODGSON, 1994b).
Freqüência cardíaca
A freqüência cardíaca (FC) é um dos testes mais simples de se realizar durante o exercício, fornecendo índice
indireto de capacidade e função cardiovascular. Em geral, há aumento linear na FC que acompanha o aumento da velocidade de
exercício até o ponto em que a FC máxima for obtida (FCmax). A velocidade na qual a FCmax é atingida pode variar de acordo
com o condicionamento do atleta, sendo que o próprio valor da FCmax não sofre alteração (ROSE & HODGSON, 1994b). A
FCmax é determinação individual altamente repetitiva em eqüinos a cada avaliação de performance, porém não é
determinação importante de condicionamento por não ser afetada pelo treinamento apesar de aumentos no consumo máximo
de O2 - VO2max (EVANS & ROSE, 1988a). Persson (1983) sugeriu que um ponto de referência útil para comparar a
capacidade cardiovascular é a velocidade da esteira na qual a FC do animal seja igual a 200 batimentos por minuto (V200). Numa
FC de 200 bpm, a maioria dos cavalos está perto do ponto de acúmulo de lactato sangüíneo. Cavalos puro sangue inglês de melhor
performance têm demonstrado valores de V200 entre 8,0 e 9,0 m/s (ROSE & HODGSON, 1994b). No entanto, segundo Rose
& Evans (1987), numa FC de 200 bpm, o cavalo pode estar se exercitando em diferentes proporções em relação a sua FCmax e,
também suas velocidade de consumo máximo de O2 (VO2max). Outra mensuração da capacidade atlética a ser considerada é a
velocidade em que o cavalo alcança a FCmax (VFCmax), que é melhor indicador da capacidade cardiovascular do que a V200 por
não ser valor relativo (ROSE & HODGSON, 1994b), como discutido acima. A desvantagem da VFCmax é que ao contrário
da determinação do V200, o teste de exercício deve envolver exercícios acima da velocidade máxima do indivíduo para que um
platô de FC seja identificado, enquanto que as determinações da V200 requerem somente quatro velocidades de exercício
submáximo, com a máxima intensidade sendo equivalente a 3/4 da velocidade em pista (ROSE & HODGSON, 1994b).
Captação de O2
A mensuração da captação de O2 (VO2) é determinante na abordagem da performance. O consumo máximo de O2
(VO2max) é indicador chave da capacidade atlética. O VO2 aumenta linearmente com o aumento na velocidade da esteira, e o
VO2max pode ser identificado onde ocorre estabilização do valor de VO2 apesar do aumento na velocidade. Quando não
for possível a identificação do platô, o VO2max equivale ao valor da maior VO2 gravada em teste de exercício de esforço
crescente que leva o eqüino à fadiga (ROSE & HODGSON, 1994b). O exercício em esteira inclinada a 10% utilizando sistema de
colheita de gases de fluxo aberto permite que o VO2, VCO2 e VO2max sejam determinados confiavelmente sem dificultar
a respiração (SEEHERMAN & MORRIS, 1990). Amostras de gases são colhidas e após a retirada da umidade, as concentrações
de O2 e CO2 são determinadas utilizando analisadores apropriados. Com a mensuração do fluxo, a temperatura dos
gases, O2 e CO2, VO2 e produção de CO2 (VCO2) podem ser medidos confiavelmente (ROSE & HODGSON, 1994b).
A determinação do VO2 é melhor realizada através de gases colhidos por máscara de fluxo aberto, porque a
presença de válvulas nesse aparelho dificultaria a respiração (EVANS & ROSE, 1988c; EATON et al., 1995). Esta técnica requer o
uso de máscara de conecção frouxa, acoplada a tubo flexível, a indicador de fluxo, e a bomba de ar centrífuga de alta velocidade.
E ainda, a equipamento de amostra de gases (BAYLY et al., 1987). O pulso máximo de O2 é a relação entre VO2 e FC
(VO2/FC) e é expresso em ml/kg/contração ventricular. Devido à diferença de O2 arteriovenoso ser similar na maioria dos
cavalos atletas se exercitando na VO2max, o pulso de O2 na VO2max gera indicativo do volume máximo de sangue
ejetado pelos ventrículos no momento da contração cardíaca. Este dado apresenta alta correlação com o tempo total de corrida na
esteira (EVANS, 1994).
A acupuntura pode ser definida como a estimulação de pontos predeterminados e específicos no organismo para
alcançar efeito terapêutico ou homeostático (SCHOEN, 1993; DRAEHMPAEHL & ZOHMANN, 1997). O acuponto é definido
geralmente como um ponto da pele com sensibilidade espontânea ao estímulo, caracterizado por resistência elétrica reduzida
(HWANG & EGERBACHER, 2001). Muitos acupontos estão situados em depressões superficiais nas junções musculares e são
áreas cutâneas providas de concentrações altas de terminações nervosas livres, plexos nervosos, mastócitos, vasos linfáticos,
arteríolas e vênulas (HARMAN, 1993; LUNA, 1993). A acupuntura possui vários efeitos fisiológicos em todos os sistemas do
organismo. Nenhum mecanismo isolado pode explicar todos estes efeitos observados (STEISS, 2001). As teorias da medicina
tradicional chinesa têm explicado estes efeitos por 4.000 anos, baseadas em observações empíricas e na descrição de
fenômenos ocorridos na natureza (LUNA, 1993; SCHOEN, 1993). Estas teorias incluem a teoria dos cinco movimentos e a dos oito
princípios. A pesquisa científica tem sido capaz de explicar muitos destes efeitos, através da teoria neural não opióide, teoria
humoral, da bioeletricidade e relações somatoviscerais (HARMAN, 1993; SCHOEN, 1995). A teoria neural não opióide implica
na inibição de impulsos conduzidos através de certas fibras nervosas sendo que, o efeito da acupuntura depende dos
sistemas nervosos periférico e central. Já, a teoria humoral é baseada na evidência de que a acupuntura estimula a liberação de
opióides endógenos. Este mecanismo age em vários locais do sistema nervoso central inibindo a percepção dolorosa e a
transmissão da dor da medula espinhal por meio de inibição descendente (GIDEON, 1977; LUNA & TAYLOR, 1998; LUNA, 2001;
WYNN et al., 2001). Além de opióides, outros hormônios e neurotransmissores são liberados do eixo hipotalâmico-pituitário e outros
locais. A acupuntura facilita a função do sistema neuroendócrino e tem sido demonstrada sua ação na função ovariana, testicular,
tireóidea, paratireóidea e pancreática. Através de seus efeitos no sistema neuroendócrino e suas funções de regulação
homeostáticas, a acupuntura parece afetar a pressão sangüínea, o pulso, a respiração (SCHOEN, 1993), a motilidade
gastrointestinal (LUNA & JOAQUIM, 1998), o sistema reprodutor (ALVARENGA et al., 1998), a coagulação (LUNA et al., 2001;
ANGELI et al., 2001), a produção de leucócitos e o período de cicatrização (XIE et al., 1996). Os mecanismos bioelétricos
propostos demonstram que existe uma condução diferente da inervação padrão, incluindo partes do sistema nervoso central.
Na acupuntura, os canais de energia ou meridianos possuem menor resistência do que a pele adjacente, permitindo o fluxo
de uma corrente bioelétrica através deles. Este fenômeno de propagação de energia através dos meridianos tem sido
muito bem documentado por modelos neurofisiológicos (HARMAN, 1993; SCHOEN, 1993).
Muitos dos reflexos somatoviscerais podem ser explicados através das teorias autonômicas da acupuntura. A
estimulação cutânea por agulhas é transmitida para as vísceras através de sinapses somatoviscerais neurais na medula
espinhal (SCHOEN, 1993). Quando determinado órgão sofre alterações patofisiológicas, um ou mais acupontos a ele
relacionados, podem se tornar sensíveis ou mostrar outros sinais de anormalidade como coloração alterada ou endurecimento
da pele (HWANG & EGERBACHER, 2001). O efeito desejado do estímulo de um acuponto se caracteriza
resumidamente, por indução de inflamação asséptica, estímulo direto de nervos da pele, estímulo do tecido perivascular, estímulo
direto de fusos tendíneos e musculares, ativação do mecanismo inibitório da dor pela liberação de endorfinas e ACTH, melhora
na circulação local, liberação de serotonina, indução de efeitos humorais e imunomodulação trombocitária (DRAEHMPAEHL &
ZOHMANN, 1997).
Há inúmeras técnicas para estimulação de acupontos. Dentre elas, as mais comuns são acupuntura com agulhas,
eletroacupuntura, aquapuntura, moxibustão, estimulação a laser, implantes de ouro e acupressão. O número de
tratamentos necessários depende da doença que está sendo tratada e da cronicidade do problema, e o tempo de cada tratamento
pode variar de 5 a 30 minutos (SCHOEN, 1993). Como exemplo, um dos efeitos da acupuntura é a elevação da
concentração plasmática de cortisol no homem e no cavalo. Esta elevação pode mediar os efeitos antiinflamatórios da acupuntura
(LUNA & TAYLOR, 1998). O alívio da dor com uso da acupuntura é resultado do aumento na perfusão local e diminuição
do espasmo muscular causado por efeitos locais da colocação da agulha e por reflexos somatoviscerais (STEISS, 2001).
DISCUSSÃO
A busca por um grande cavalo atleta é incansável dentro dos vários esportes eqüestres existentes. O que leva
determinado cavalo atleta a se destacar como grande campeão é um conjunto de fatores que devem ser avaliados. Exemplo disto,
é que se um cavalo possui excelente linhagem genética, conformação, idade apropriada para realização de determinado
esporte, é submetido a treinamento adequado, possui alimentação balanceada, e mesmo assim não se torna um
grande campeão; não se deve esquecer que o animal pode simplesmente não gostar da atividade que pratica e, neste
caso, diz-se que o animal não possui “coração”. O importante dentro da prática da acupuntura é não considerar somente o
sistema musculoesquelético como causa da queda de performance, deve-se saber identificar a causa da dor com uso dos
pontos Ah Shi, pontos de assentimento e pontos de alarme no diagnóstico o mais preciso possível. Harman (2001) considera
demasiadamente a dor lombar como sendo grande problemática na medicina esportiva. Deve-se ter em mente todos os pontos
diagnósticos das mais diversas lesões como Cain (1997) e Fleming (2001) preconizam quando do exame de palpação. A chave
para resolver qualquer problema está em decifrar a causa e não somente proporcionar o alívio dos sinais. De forma geral em
Medicina Chinesa, dor é a estagnação do fluxo suave de Qi através dos meridianos. Segundo Pelham et al. (2001), a
acupuntura pode ser utilizada para restabelecer este fluxo de energia, aliviando os sinais de fadiga causados pelo
treinamento em excesso. Em humanos, associado ao efeito anti-álgico gerado pela acupuntura, performance excelente
tem sido relacionada ao bom humor causado pela mesma (PELHAM et al., 2001). Em eqüinos, utilizam-se com freqüência os
pontos Ting ou de extremidades para o tratamento destes bloqueios nos meridianos pela sua praticidade e resposta quase
que imediata.
Levando-se em consideração que a maioria dos problemas ligados à medicina esportiva estão relacionados aos
sistemas musculoesquelético, respiratório e imunológico, dentro da teoria dos cinco elementos, os mais envolvidos neste aspecto
são terra, madeira e metal, que englobam respectivamente os meridianos do estômago e baço/pâncreas, fígado e vesícula biliar
e pulmão e intestino grosso. O acúmulo de fleuma nos músculos e pulmão, gerado principalmente pela deficiência do Yang do
BP (MACIOCIA, 1996), também está diretamente relacionada à queda de performance de cavalos atletas. Deste modo, o uso
de pontos que dispersam fleuma são bastante importantes no tratamento, uma vez feito diagnóstico o mais preciso possível.
Algumas vezes torna-se difícil o tratamento pela acupuntura de bloqueios de meridianos ou até de lesões já instaladas em
determinados cavalos atletas, porque há influência direta da qualidade do cavaleiro/amazona e do local onde o mesmo está
*
acostumado a treinar. Segundo Cain (2003) , existem padrões que se repetem em diversos cavalos num determinado local de
treinamento e que desaparecem depois que o animal muda de ambiente. Os pontos utilizados empiricamente para estimular
a performance – BH, E30, BP13 e VB27, estão ligados ao diagnóstico e tratamento das síndromes das articulações
tíbio-tarso-metatarsiana, fêmoro-tíbio-patelar e coxo-femoral, classificadas por Cain (1997). O BH é ponto utilizado para o
tratamento de qualquer afecção que envolva a região caudal à cicatriz umbilical (FLEMING, 2001a). Desta forma, sugere-se que
estes pontos tenham efeito anti-álgico nos membros posteriores o que provocaria melhora na performance de cavalos atletas,
sendo assim conhecidos como pontos de dopagem.
Oposto a Ehrlich & Haber (1992) que demonstraram aumento significativo na capacidade atlética máxima e no limite
anaeróbico de atletas humanos tratados com sessões semanais de acupuntura, durante cinco semanas e utilizando os
pontos F13, VC15, BP6, Pc6 e E36, Karvelas et al. (1996) não encontraram diferença nos parâmetros fisiológicos em
humanos após único tratamento com acupuntura nos pontos F13, Pc6, E36, BP6. Estes trabalhos sugerem que há a
necessidade de fazer-se mais de um tratamento para que haja alguma resposta fisiológica de melhora na performance
de atletas humanos.
*
CAIN, M.J. (Médico Veterinário Acupunturista – Ohio, EUA) Comunicação pessoal, 2003).
Em eqüinos, o uso de determinados pontos para o tratamento de afecções musculoesqueléticas fica comprometido
devido ao temperamento do animal que, com dor, muitas vezes torna-se agressivo. Deste modo, pontos importantes como BP6 e
E36 são pouco utilizados na prática. A aquapuntura é bastante aplicada como técnica de acupuntura em eqüinos quando
comparada, por exemplo, à eletroacupuntura, o que também é devido a sua praticidade e segurança proporcionada ao
acupunturista e ao paciente.
CONSIDERAÇÕES FINAIS
A medicina esportiva é ciência bastante complexa, assim como a acupuntura. Existem muitos indícios que
favorecem o uso da acupuntura na busca de melhora na performance de cavalos atletas. Entretanto, pesquisas são
necessárias para que haja investigação sobre quais são estes efeitos e o quanto eles são benéficos. Estas informações
permitirão que acupunturistas, treinadores e cavaleiros/amazonas façam bom uso desta modalidade terapêutica, sempre
associada neste caso ao melhor condicionamento possível do atleta.
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The Successful Use of Acupuncture to Treat a Case of Chronic Colic in a Horse
Author:
By Dr. William H. McCormick VMD
Abstract: A six year old Thoroughbred gelding was treated for frequently recurrent
abdominal pain that had persisted for more than one year. The horse had on two
occasions been previously hospitalized at a university referral clinic for surgical colic and
colitis. An oriental diagnosis of Spleen Qi Deficiency, Liver Depression Qi
Stagnation and Large Intestine Qi Stagnation was made. The horse was treated with
a single treatment of gold implants. The horse made a complete recovery and
returned to a successful racing career.
History: A six year old Thoroughbred gelding was presented with a history of weekly
episodes of abdominal pain. The colic episodes were severe enough to usually require a
veterinarian to administer drug treatment (500mg flunixin meglumine or Banamine®,
300mg xylazine Hcl or Rompun®, and 5mg butorphanol tartrate or Torbugesic®). Nine
months previously the horse had had an episode of unrequited abdominal pain so severe
and persistent that abdominal surgery was required. The bowel had been displaced and
had not required resection. However, post-operative recovery involved frequent bouts of
abdominal pain, which required alleviation with drug therapy. During the
weeks following surgery the abdominal incision retained edema for a time longer than
expected, and the hind legs were edematous. The horse lost muscle mass from his
epaxial musculature and acquired a distended appearing abdomen.
Three months prior to presentation for acupuncture and ten months
after abdominal surgery, the horse developed a profuse, watery diarrhea and a fever of
104ºF. Several days of hard, cold February rain preceded the diarrhea. Because of the
threat of Salmonella sp., the horse was isolated at a university referral clinic where
intensive therapy was administered for two weeks. At one time the total protein fell to 4.5
Gm/dl. The horse rallied with plasma transfusions and fluid therapy. Salmonella sp. was
never cultured from this individual. Unfortunately upon return to his stable the weekly
colics continued.
Conventional western therapies and management such as the continual use of
a cribbing strap, larvacidal doses of fenbendazole or Panacur®, and bland diets with
digestion enhancing enzymes did not seem to alter the frequency of the recurrent colics of
unknown origin. The colics typically featured gas distention, dull to sharp pain and
temporary response to conventional drug therapy.
Oriental Diagnosis:
Tongue: Slightly pale with increased fluid and a Qi Deficiency tremor.
Pulse: Floating and widest in the right guan position.
Channels: A sharply reactive Large Intestine Channel in excess.
Patterns: Chronic Spleen Vacuity was determined because of the persistent
leg
and surgical wound edema post surgery. Cold and Damp aggravated the Spleen Vacuity
at the time of the acute colitis when Cold Damp was internally converted by
similar transformation to Damp Heat in the Stomach and Large Intestine.
The horse was a high spirited Fire type individual. His cribbiting was
a manifestation of Stomach Fire. The weak Cold Spleen resulted in Stomach Fire and failed
to nourish Metal, Large Intestine. In turn Metal failed to control Wood, thus leading to
Liver Depression-Qi Stagnation.
Treatment Principles: Supplement and Warm the Spleen, Nourish Stomach Yin,
Dispel Large Intestine Qi Stagnation and secondarily to resolve Liver Qi Depression and
Stagnation.
Treatment: The horse was tranquilized with 300mg xylazine hcl and 5mg butorphanol
tartrate. The following acupoints were surgically scrubbed and bilaterally implanted with
single 24 karat 2 mm gold #22 gauge wire pieces: LI 4 ( Hegu) and San Jiang.
The acupoints ST 36 (Hou San Li), BL 21 (Wei Shu), BL 25 (Da Chang Shu), LI 16 (Ju
Gu) were bilaterally implanted with four Sakamura® gold plated pebbles.
LI 4 (Hegu): Located just axial to McII and medial to the body of the suspensory
ligament at the junction of the proximal third and distal two thirds of McII 1. LI 4
supplements and facilitates Qi flow, dispels Cold, clears Fire and Heat, and transforms
Damp Heat. LI 4 regulates the Large Intestine in conditions of diarrhea due to Heat and
abdominal pain 2.
San Jiang: is located at the fork in the transverse facial vein approximately one
tsun ventral to the medial canthus of the eye. The point is indicated in enterospasm as a
distal point along the ST Channel 3.
LI 16 (Ju Gu): is located in a depression on the cranial border of the scapula , two thirds
of the way between TH 15 and the point of the shoulder 4, an Ashi point.
BL 25 (Da Chang Shu): 3 tsun lateral to the midline, between the fifth and sixth lumbar
vertebrae, at the cranial edge of the wings of the ilium 5. Its functions are to regulate the
intestines , resolves Large Intestinal Damp Heat 6.
BL 21 (Wei Shu): 3 tsun lateral to the midline, just caudal to the last rib 7. Regulates and
supplements Spleen Qi and Yang, and regulates Stomach Qi and Yin, supplements
Middle Burner nutritive Qi, reduces digestive stagnation , clears Stomach Fire and dries
Damp 8.
ST 36 (Hou San Li): The Master point for digestion, Lower Sea and Earth point of the
Stomach Channel on the dorsolateral aspect of the tibial crest 3.5 cm distal to the lateral
tibial condyle and equidistant between the tibial crest and the head of the fibula 9.
Its
functions are to regulate and supplement the Spleen Qi and Yang, and to regulate
the
Stomach Qi and Yin 10.
Discussion: The horse had one mild colic five days after acupuncture and from then on
was free of abdominal pain. The edema of the hind legs took three months to resolve. The
horse returned to racing and won three out of five steeplechase starts that year with no loss
of form. Later that fall he was sold for a price reflecting his racing performance.
Gold implants were chosen because of their long tern effect, in this chronic case.
Gold is the traditional supplementing metal.
The treatment was intended to regulate and supplement Spleen Qi, Stomach Heat,
and resolve Large Intestine Qi Stagnation. No treatment was prescribed for Liver
Depression –Qi Stagnation. Supplementation of Spleen Qi allowed the Liver to
course and discharge Qi, thus alleviating the effects on the Shen of ascendant Liver Qi.
That this pattern resolved with the described treatment suggests that the Liver
component was secondary to Spleen Vacuity.
These patterns are not recognized in western medicine. However, post abdominal
surgical complications are not rare. It would seem that post surgical edema would be a
fruitful field for integrated medicine. The owner of the horse was quite grateful given that
this expensive individual had no value so long as he was having weekly episodes of colic.
After treatment he had a good racing season and realized his full potential.
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