Acupuncture Treatment of Pain along the Gall Bladder Meridian in 15 Horses

Abstract

This study reports on clinically significant relief of pain along the gall bladder meridian in 15 sport horses. Both local and distant points were needled in this study. Pain relief was marked not only locally but also in remote areas along the gall bladder meridian. Clinical improvement was observed in all 15 horses within 30 seconds to 2 minutes after the treatment had started. Twelve horses and three horses were rated as “cured” and “improved”, respectively, when they were re-examined 1–8 days after the treatment. The relief of somatic pain was often associated with improved riding performance of the horses. These data are relevant in terms of equine clinical pain relief, as well as in terms of meridian therapy and the scientific theory of acupuncture.

1. Introduction

Linear patterns of pain resembling the pathway of the gall bladder (GB) meridian were described in 100 sport horses by this author [1] (Fig. 1). It was then hypothesized that dry needling of selected acupuncture points (APs) along the meridian might be effective in relieving this particular pattern of soft tissue pain. This paper reports on treatment data in 15 horses.

Figure 1

Pain along the gall bladder meridian in horses. Body areas displaying pain on palpation are depicted using a solid line. The 44 gall bladder points are in locations used by this author. C = cervical vertebra/segment.

Note. From “Pain along the Gall Bladder meridian in 100 horses” by J. Still, 2012, J Acupunct Meridian Studies, 6, p. 169–72. Copyright 2012, J. Still. Reprinted with permission.

2. Material and methods

2.1. Horses

Fifteen horses from the author’s private practice were included in this study. The horses were 11 geldings and four mares; 10 Thoroughbreds, three Warmbloods, one American Saddlebred horse, and one pony; average age 7 years (2–15 years).

The horses were presented for clinical/acupuncture evaluation with various riding problems and poor performance. On the initial assessment, they were showing musculoskeletal tenderness/pain along the GB meridian, as described in an earlier study [1]. The horses were neither displaying signs of any major lameness, active osteoarthritis, or painful hoof conditions, nor were they suffering from any clinically detectable internal, neurological, or skin diseases. No unruly, stressed, excessively anxious, or hyperactive animals in which the clinical examination might be incomplete and the pain assessment unreliable were included in this study. Acupuncture treatment, as described further, was not combined with any other form of orthodox or alternative treatment in these horses.

2.2. Clinical diagnosis: detection and grading of the pain

The entire body of the horses was palpated digitally with the objective to detect and record any signs of pain (tenderness). Additionally, a wooden probe with a rounded tip of a diameter of 5 mm was used to detect pain located in the deep layers of muscles. The applied pressure was within the range of 2–4 kg/cm². As in the previous diagnostic study [1], linear patterns of pain along the GB meridian were recorded in detail before the acupuncture treatment was initiated. The scoring system used in the previous paper by this author [1] was applied in this study as follows: no pain = normal sensitivity; mild pain = slightly sensitive to palpation; moderate pain = a moderately painful response characterized by a purposeful/definitive local muscle spasm; and severe pain = a marked painful response manifested by a major muscle spasm/withdrawal away from the pressure. The intensity and extent of pain was evaluated as follows: (1) on the initial (baseline) evaluation before the treatment; (2) during the acupuncture treatment; and (3) on a subsequent clinical examination carried out several days later.

2.3. Meridian diagnosis

As in the previous study by this author [1], only horses displaying a moderate to severe pain reaction along the course of the GB meridian were included in this study. A large number of GB points, and at least two linear areas along the trajectory of the meridian were detected in the horses. The linear pain sensitivity had to extend over at least two out of five body areas including the head, neck, chest, abdomen, and hind quarter. The course of the meridian and its points were according to Still [1].

2.4. Treatment

Standard stainless steel acupuncture needles were employed. Seirin B type needle No. 8 0.30 × 30 mm (Seirin Corporation, Shizuoka, Japan) acupuncture needles were used to stimulate GB APs situated on the head and lower hind limbs, while the Ding Dragon 0.35 × 75 mm (Wujiang Kangtai Medical, Tuncun Town Wujiang, Suzhou, China) needles were applied into more muscled APs situated on the neck and trunk. Various APs were needled in different horses depending on the initial clinical diagnosis (extent of pain) and the author’s clinical experience.

Bilateral needling was employed in horses displaying bilateral GB pattern. All 12 horses showing the bilateral pattern displayed palpatory tenderness within the chest GB area — therefore, this area was needled in all the horses, plus one to three GB-points on the head (9 horses/60%), within the neck GB territory (5 horses/33%), and/or on the hind limbs (2 horses/13%).

Only the affected branch of the GB meridian was needled in horses showing unilateral GB pain. All three horses displayed tenderness along the cervical section of GB meridian — therefore, two to four needles were inserted into this area; additionally, one to three points were needled on the head (2 horses) and chest (1 horse).

Depending on the local anatomy, the needles were slowly inserted via the skin into the subcutis and deeper tissue layers. It would be beyond the scope of this paper to describe the angle and depth of the insertion, as well as of anatomical details of GB points used in this study. Three examples are given in Table 1. Once the desired depth of insertion was reached, the needles were manually stimulated (rotated in both directions) at the insertion, twice during their retention, as well as at the end of the session lasting 5–8 minutes. The needles were taken out once the pain along GB meridian was relieved, as confirmed by repeated palpation. Particular care was taken so that the insertion, manipulation, and withdrawal of the needles were pain- and stress-free for the horses.

Table 1 Details of acupuncture treatment of pain along gall bladder meridian in three horses.

2.5. Success rate of the treatment

Success rate of the treatment was rated on a second appointment scheduled a few days later as follows: worse - the extent of the GB pain increased, as compared with the initial assessment; no improvement- the extent of pain remained unchanged; improved - the extent of pain along GB meridian decreased by at least 50%; and cured - no pain areas and points along the GB meridian were detected.

3. Results

3.1. Initial clinical evaluation

Moderate bilateral pain within the GB territory was diagnosed in five horses, while severe pain was diagnosed in 10 horses. Twelve horses displayed bilateral GB pain on the initial pretreatment clinical evaluation, while three horses were diagnosed with GB pain along the right-sided branch of the GB meridian.

3.2. Needling

On average six (from 3 to 12) needles were used per horse.

3.3. Pain-relief along GB meridian

3.3.1. During the treatment

A marked reduction of the tenderness along the previously sore sections of the GB meridian was noted within 30 seconds to 2 minutes after the needles had been inserted. The pain relief was complete in all 15 horses by the end of the acupuncture treatment. At this stage, the horses were usually standing quietly and showed no resentment or withdrawal reaction when palpated repeatedly along the previously tender GB areas. Some horses displayed chewing behavior or dropped their heads towards the end of the session.

3.3.2. On the next clinical examination

The horses were re-examined at the average interval of 5 days (1–8 days) after the initial treatment. At this time, 12 horses were rated as “cured”, while three horses were rated as “improved”.

3.3.3. Long-term observations

Most of the horses were repeatedly examined within months to years before and after the GB treatments reported in this study. Pain along the GB meridian was diagnosed only once in one horse.

Three typical cases from this case series have been described in detail in Table 1. Another case report was published elsewhere [2].

4. Discussion

The working hypothesis of this study was that needling of a few local and distant GB points should bring about painrelief within the previously tender GB territory in horses. In order to properly test the meridian hypothesis, two situations had to be avoided. Firstly, it was thought important to avoid noxious needling as this might bring about nonspecific pain-relief via so-called diffuse noxious inhibitory control [3]. Secondly, it is known that stress may induce a temporary state of analgesia as well [4]. In order to avoid the activation of these undesirable and nonspecific painrelieving mechanisms, only a few APs situated along the GB meridian were needled and the stimulation time was short. The needling was pain- and stress-free, as judged from the quiet attitude of the horses - some horses became even distinctly sedated throughout the treatment, as suggested by their relaxed body posture, frequent chewing behavior, and lowering of the head.

Impressive clinical pain-relief of the baseline pain along the GB meridian was observed short-term (during the actual treatment), as well as several days later. The relief of tenderness along the GB meridian was noted within 30 seconds to 2 minutes after the needles had been inserted, suggesting that the pain-relief was linked to the needling. The pain-free GB territory was noted in 12 out of 15 horses on a re-evaluation a few days later, re-affirming the clinical value of the treatment.

Horses of various sex, age, breed, and performance categories were treated successfully. The treatment was effective in treating bilateral, as well as unilateral GB pain. The pain-relief was associated with the improvement of riding performance in a number of the horses (Table 1, Cases 1 and 2). As described elsewhere, a marked improvement of riding performance was noted in two horses treated for pain along the small intestine and GB meridian [2]. Stimulation of end-digit meridian APs (such as GB44) was claimed to be effective in resolving muscle tension, stiffness, and pain in horses. The author found an average success rate of 62% after a single treatment but no further details are provided [5].

Resources of the Traditional Chinese Medicine state that the vital energy Qi travels in one direction along the meridian — that is from GB1 to GB44 [6]. However, in this particular study the pain relief was occasionally spreading in both directions in the same time (Table 1, Case 3). Various local as well as distant GB points were stimulated/tested in this pilot study. The clinically effective points were within the sore areas, as well as outside the tender GB zones. No comparable data are available.

It was interesting to note that the pain relief occurred not only in areas close to the acupuncture needles but also in anatomically distant areas along the GB meridian (Table 1, Cases 1–3). Based on these encouraging clinical observations, one could further speculate that it might be possible to needle even a smaller number of GB distant points in order to achieve pain-relief in anatomically remote areas along the GB meridian. This hypothesis will be tested in a subsequent study.

While the primary concern of this observational clinical study was the phenomenon of the pain along the GB meridian, it was further noted that smaller areas of musculoskeletal pain occurred outside the GB meridian in most of the horses as well (Table 1, Cases 1 and 2). Similar findings were described in the previous research in 100 horses by this author [1]. Indeed, musculoskeletal pain is a common finding in sport horses and can be related to their sport activities [2]. It is not possible to draw any firm conclusions about the effect of the described needling on these extrameridian sites of pain. Usually, it was necessary to deactivate remaining APs using dry needling or acuinjections in the subsequent one or two treatments.

Disclosure statement

The authors declare that they have no conflicts of interest and no financial interests related to the material of this manuscript.