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.

在外人看來，針灸（acupuncture?ACP）作為一門經(jīng)驗學(xué)科，與神經(jīng)學(xué)這個高科技領(lǐng)域似乎沒有什么關(guān)系。盡管如此，動物主人對這種治療方式的興趣還是逐漸增加了。此外，也有一些獸醫(yī)醫(yī)生認為有必要對某些神經(jīng)系統(tǒng)疾病的標準療法進行補充（見圖11.1）。基于這些原因，描述針灸作為神經(jīng)系統(tǒng)疾病或疼痛過程的一種保守治療形式的潛力和局限性似乎是合適的，并給出其實際應(yīng)用的一些指示。

11.1.1 Acupuncture in traditional Chinese medicine (TCM) 傳統(tǒng)中醫(yī)藥（TCM）的針灸

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，針灸只是中醫(yī)的一部分。這是一種可能的治療方法，多年來一直在這一醫(yī)學(xué)領(lǐng)域得到逐漸發(fā)展。它可以被定義為通過刺激身體上的特定部位(穴位，分為束或經(jīng)絡(luò))來治療“功能性”紊亂（therapy of “functional” disturbances）。

According to Eastern practice, ACP has the following indications:

根據(jù)東方臨床實踐的做法，針灸有以下適應(yīng)癥：

- Repair of “functional” disturbances 修復(fù)“功能性”障礙

- Treatment of visceral pain 內(nèi)臟疼痛的治療

- Fever reduction 減少發(fā)熱

- Treatment of certain types of lameness 某些類型的跛行的治療

- Relief of neuromuscular pain. 神經(jīng)肌肉疼痛的緩解

11.1.2 The acupoints?針灸穴位

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.

在中國古代文獻中，只描述了動物的主要刺激點（stimulation）(穴位?(acupoints))，與經(jīng)絡(luò)（meridians）沒有任何關(guān)系。因此，從人體解剖中推斷出重要的附加穴位用于獸醫(yī)針灸；然后這些穴位被臨床調(diào)查證實或重新定位。

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.

穴位或經(jīng)絡(luò)的組織學(xué)結(jié)構(gòu)至今還沒有統(tǒng)一的定義。然而，在所有這些穴位上都有相似的結(jié)構(gòu)(神經(jīng)血管束、感覺受體、自主神經(jīng)系統(tǒng)的傳入和傳出纖維、腺體組織、淋巴管)，有時在這些穴位上發(fā)現(xiàn)的數(shù)量比皮膚內(nèi)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，獸醫(yī)學(xué)中使用的許多穴位都有彼此共有的特點；這不僅允許了對患病動物進行精確定位，而且還可以選擇刺激的類型。根據(jù)病程的不同，疼痛的癥狀、腫脹甚至是淺表炎癥的癥狀在所謂的“診斷點（diagnostic points）”是明顯的(11)。在某些情況下(但不是所有物種或點)，可以在疾病過程中測量皮膚阻力的變化(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 e?quin de Roger), but which have not been used for therapy.

這些反應(yīng)是由皮膚和內(nèi)臟的相互作用（cutaneovisceral interactions）引起的，這些相互作用在身體對穴位激活的反應(yīng)中起著重要作用(8)。在某種程度上，這些穴位與西方醫(yī)學(xué)中長期已知的穴位（Head 's或Mackenzie區(qū)，clavier e?quin de Roger區(qū)）相同，但尚未用于治療。

11.1.3 Choice of acupoints 穴位的選擇

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

由于詳細的調(diào)查，許多身體和耳朵的穴位可用于獸醫(yī)針灸的診斷和治療目的（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):

在大多數(shù)情況下，身體的反應(yīng)似乎是基于以下一種或11種以上的影響而出現(xiàn)的（11,23,27）:

- Hormone production 激素的產(chǎn)生

- Local or central endorphin release 局部或中樞內(nèi)啡肽釋放

- Local hypalgesia (gate theory of pain) 局部鎮(zhèn)痛（疼痛的門理論）

- Skeletal muscle relaxation 骨骼肌肉放松

- Smooth muscle relaxation 平滑肌放松

- Promotion of blood perfusion 血液灌注的促進

- 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:

在針灸治療過程中，不同的刺激點可以結(jié)合起來，這樣就可以了解整個有益影響的范圍。以下可能性或組合是可用的:

- Local points 局部穴位

- Points on the meridian 經(jīng)絡(luò)穴位

- Points on a paired meridian 一對經(jīng)絡(luò)的穴位

- Reactive points (so-called Ashi points) 反應(yīng)性穴位（所謂的“阿是穴”）

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

- Connection points between paired meridians 成對經(jīng)絡(luò)之間的連接穴位

- Points with special effects 特殊效應(yīng)的穴位

- Points along nerves which supply the affected area 沿著受影響區(qū)域的神經(jīng)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):

在針灸治療中起主要作用的不僅是穴位的正確選擇，還有刺激方式的選擇（type of stimulation）。中醫(yī)根據(jù)病患的情況、疾病的類型甚至天氣條件來鑒別不同的可能性。由于缺乏科學(xué)調(diào)查，很難為所有適應(yīng)癥制定明確的指導(dǎo)方針。盡管如此，以下類型的激活（除其他外）被普遍接受為身體針灸，可根據(jù)疾病、身體區(qū)域、年齡或病患的狀況使用（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.

簡單的針刺/白針。手動插入雙金屬材料的（可消毒）或一次性針頭。針被留在穴位原位或不斷地用旋轉(zhuǎn)運動操作（捻針）。

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

治療方法：10 ~ 20分鐘，3 ~ 5 次，間隔 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.

按摩或手動治療的穴位。這種形式取代了在幼齡動物的疼痛穴位上使用針刺，或者當主人將繼續(xù)治療時使用針刺。這比針刺的刺激弱，但它對周圍肌肉有額外的作用，這對輕癱或麻痹很有用。

Therapy: a few minutes per point, use daily.

治療方法：每個穴位幾分鐘，每日進行。

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.

液體注射（水針）。有時經(jīng)典的藥物，但主要是維生素B12或普魯卡因（procaine），用于刺激穴位。將溶液注射到穴位或使用Dermojet（經(jīng)皮高壓注射）。水針的刺激時間較長，對不合作的動物也很容易進行。

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

治療：3-5次坐診，間隔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.

熱（艾灸 moxibustion）。點燃的艾草卷（Lighted?moxa?rolls（mugwort herb 艾蒿/艾草））放在針上或靠近皮膚的無毛部位。這會導(dǎo)致穴位的溫和升溫。

Therapy: as for needling.

治療方法：同針刺。

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.

低頻電刺激?（Low frequency electrostimulation）（電針 electroacupuncture, EAP）。與物理治療中使用的經(jīng)皮電刺激（TENS）相比，電針機器產(chǎn)生雙相橢圓脈沖（biphasic oblong?impulse）。主要使用 8-50 Hz的頻率，根據(jù)動物的反應(yīng)設(shè)定 4-5V 的 1-10mA 的電流。電針不僅可用于術(shù)中或術(shù)后鎮(zhèn)痛，也可用于治療跛行。

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

治療方法：3 ~ 5次，每次10 ~ 20分鐘，每次間隔 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（低能級激光治療）。這包括來自氣體（氦氖 He-Ne）或二極管激光器（GaAlAs）的紅外范圍內(nèi)（600-900 nm）的冷光。這些類型的光具有光滲透（photo-osmotic）、光激（photoionic）和光酶（photoenzymatic）作用。對于軀體針灸，采用脈沖光發(fā)射（短時間內(nèi)的高強度）或連續(xù)竇腔輻射。在經(jīng)驗上，每平方厘米 4 焦耳（瓦特×秒）的劑量被認為是生物刺激的最佳劑量。

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

治療：大多數(shù)情況下，劑量為每個穴位 0.05-2.0 J，每個疼痛學(xué)位 1.0-4.0 J。

11.2 The use of acupuncture in neurological disease 神經(jīng)學(xué)疾病的針灸的使用

11.2.1 Choice of therapy 治療方法的選擇

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.

作為一種醫(yī)學(xué)保守治療，針灸的使用必須遵循與經(jīng)典西醫(yī)治療相似的規(guī)則和質(zhì)量控制（1）。因此，針灸師必須在這一領(lǐng)域接受過全面的教育。此外，根據(jù)西方原則對病患進行全面的神經(jīng)學(xué)檢查是針灸治療的先決條件；只有這樣才能提供針灸的適應(yīng)癥。

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).

有可能根據(jù)中醫(yī)原則進行針灸治療，而無需事先診斷和“具體 concrete”的適應(yīng)癥（所謂的針灸譜方法 cookery book approach?to ACP）。然而，這種實施針灸的方式限制了機體針灸的功效。因此，在每次針灸治療前，應(yīng)根據(jù)特定的中醫(yī)標準對病患進行檢查和評估（18）。

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

咨詢問診和治療的過程可總結(jié)于圖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).

以問題為導(dǎo)向的病例評估是臨床工作規(guī)范的一部分。因此，本文將使用該系統(tǒng)作為確定針灸適應(yīng)癥的基礎(chǔ)（表11.1）（26）。評價針灸作為一種可能的治療方法的信息主要基于來自專業(yè)文獻或論文的數(shù)據(jù)，以及個人經(jīng)驗。以下文本僅應(yīng)用于鼓勵在文獻中尋找有關(guān)特定治療的進一步信息（3,6,13,16,19,21）。

11.2.3 Combined treatment 結(jié)合治療

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.

即使在中醫(yī)中，針灸也很少被用作單一療法。植物藥物/草藥是按照中醫(yī)精神完成治療的處方。此外，還使用了一系列已被納入東方醫(yī)療體系的手法技術(shù)。在西醫(yī)中，這些方法包括按摩（massage）、物理療法（physiotherapy）、手法療法（manual medicine?）或整骨療法（osteopathy）。從這個意義上說，神經(jīng)問題的治療選擇不應(yīng)該只關(guān)注針灸；應(yīng)該結(jié)合使用其他治療方法，從而保證“治愈”或至少改善病患的狀態(tài)（14,29）。在病患的術(shù)后康復(fù)中尤其如此，其最高目標是迅速改善病患的病情和生活質(zhì)量。

11.2.4 Acupuncture as a prophylactic measure 針灸作為預(yù)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.

按照中國的傳統(tǒng)，只要病患保持健康，醫(yī)生就會得到報酬。在不完全采用該系統(tǒng)的情況下，針灸為預(yù)防神經(jīng)系統(tǒng)疾病病患的復(fù)發(fā)提供了良好的潛力。針灸對神經(jīng)肌肉結(jié)構(gòu)的調(diào)節(jié)作用和鎮(zhèn)痛作用可以促進最佳的運動狀態(tài)，并有助于保持正確的身體或肢體姿勢。

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.

它對新陳代謝的直接作用改善了病患的整體狀況和生活質(zhì)量。針灸有助于預(yù)防復(fù)發(fā)，尤其是神經(jīng)肌肉問題。

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

* 1: 弱；?2: 好；?3: 非常好

針灸在外科鎮(zhèn)痛中的應(yīng)用是中醫(yī)的現(xiàn)代發(fā)展。內(nèi)啡肽（endorphins）作用的發(fā)現(xiàn)促進了這一領(lǐng)域的深入研究，這使得建立良好的穴位組合和刺激方案成為可能（2）。最重要的方面是局部穴位的最佳組合，可以根據(jù)操作而調(diào)整，具有整體或遠距離作用的穴位。

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).

使用針灸輔助鎮(zhèn)痛的家養(yǎng)動物進行了小的皮膚手術(shù)和大的腹部手術(shù)（7,17）。術(shù)后動物可以立即進食，這是影響恢復(fù)時間的一個重要因素。在小動物中，針灸鎮(zhèn)痛的質(zhì)量還不夠好，不能作為常規(guī)手術(shù)的唯一鎮(zhèn)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).

術(shù)后的情況似乎有所不同，因為針灸的作用不會隨著針頭的取出而停止，而是持續(xù)數(shù)小時（鎮(zhèn)痛 analgesia）或數(shù)天（免疫抑制 immunosuppression）。由于術(shù)前或術(shù)中針灸鎮(zhèn)痛，干預(yù)期后病患的健康和恢復(fù)可能會受到積極影響（12,24）。這對于暫時不能正常行走或由于神經(jīng)功能異常（椎間盤疝出后膀胱麻痹，大便失禁）而更容易受到感染的動物尤其重要。在這種情況下，許多針灸穴位的整體免疫刺激和抗炎作用發(fā)揮了重要作用（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).

當有一個最佳的穴位選擇時，當電針或激光刺激穴位時，可能會誘導(dǎo)局部疼痛緩解（由于與TENS有著相似的機制）以及全身鎮(zhèn)痛（內(nèi)啡肽釋放）。與物理治療手法相結(jié)合，針灸是一種有效的康復(fù)措施，特別是在術(shù)后開始時(9)。

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