Table: Suggested Indications and Approaches for Acupuncture in Veterinary Patients-Merck Veterinary Manual

Suggested Indications and Approaches for Acupuncture in Veterinary Patients

Condition	Treatment Goals	Central or Peripheral Nervous System Points or Regions Treated	Autonomic Nervous System Points and Purported Rationale	Myofascial Component, Assessment, and Treatment Goals
Abdominal pain	Analgesia Address affected viscera Normalize motility Reduce inflammation	Paraspinal points to neuromodulate spinal cord segments that associate with dysfunctional viscus or viscera (BL17-–BL25)	Fibular nerve point (ST36) for parasympathomimetic, anti-inflammatory, and analgesic effects. Consider PC6 for cranial abdominal discomfort and nausea.	Relax truncal tension stemming from and/or contributing to abdominal discomfort. Palpate for and treat myofascial restriction and dysfunction, and needle or otherwise address tissue tension.
Back and neck pain	Identify, characterize, and localize the nature of back or neck pain through observation of movement, palpation, and posture when sitting and standing.	Paraspinal and selective dorsal midline points related to back pain. GV, inner BL line, outer BL line, Huatuojiaji points at relevant and adjacent spinal cord segments.	Sympathetic neuromodulation by means of paraspinal points with resultant anti-inflammatory effects through presumptive lowering of sympathetic tone. Reinforce with popliteal neurovascular point (BL40) and/or ST36.	Relax back, neck, and paraspinal tension as discerned by means of myofascial palpation. This reduces pain and improves range of motion. Needle or otherwise address tissue tension and shortening.
Joint pain	Analgesia Anti-inflammatory effect Endogenous analgesia Reduction of local and referred pain from myofascial dysfunction Improved Function Less joint pain Reduced referred pain Relaxed connective tissue	Select paraspinal points related to spinal cord segments that supply peripheral nerves innervating targeted arthrodial and peri-articular structures to neuromodulate "facilitated" or "wound up" spinal cord segments.	Points at neurovascular locations near and/or distal to the targeted joint(s). For example, ST36, BL40, and LR3 for pelvic limb pain, and LI11, LU7, and LI4 for thoracic limb pain to reduce overactive sympathetic tone.	Palpate for sources of local, regional, and referred pain. Relax tissue, improve range of motion, decompress nerves and vessels affected by myofascial restriction.
Postoperative ileus	Restore proper GI motility Provide analgesia to area affected by surgery to remove additive effects on ileus from overactivation of the sympathetic nervous system.	Paraspinal points to neuromodulate spinal cord segments that associate with involved viscus or viscera (BL17-BL25)	Fibular nerve point (ST36) for parasympathomimetic, anti-inflammatory, and analgesic effects. Consider PC6 for motility disorders involving the esophagus and/or stomach.	Relax truncal tension stemming from and/or contributing to digestive dysfunction. Palpate for and treat myofascial restriction and dysfunction, and needle or otherwise address tissue tension. Address soft-tissue pain related to surgery and/or anesthesia.
Facial nerve injury	Restore function to injured components of the somatic motor fibers of the facial nerve.	Stimulate peripheral/cranial nerve branches from the point of exit from the cranium to the neuromuscular endpoint.	Improve circulation to the face and, in particular, the injured neural tissue, either through local trigeminal nerve activation or through CNS modulation of vascular tone.	Release soft-tissue restrictions impacting involved neural pathways. Activate somatic motor tissue on the head through sensory inputs that restore neural control over muscles of facial expression.
Peripheral nerve injury	Facilitate repair of injured nerve. Remove soft-tissue restrictions that cause neurologic dysfunction by means of neural compression. Improve local circulation to optimize tissue repair.	Activate spinal nerves related to spinal cord origins of involved peripheral nerve(s). Continue treatment along respective axons (that often follow one or more acupuncture channels on a limb).	Normalize circulation through autonomic neuromodulation of vascular tone.	Relax soft-tissue restrictions that are perpetuating neural dysfunction. Activate sensory and motor pathways associated with the injured nerve(s) to expedite return to function.
Spinal cord injury	Neuromodulate/normalize firing patterns in the spinal cord and affected nerves. Protect existing tissues from further decline. Encourage restoration of function of sensory, motor, and autonomic pathways, including control of urination and defecation.	Stimulate spinal nerves related to spinal cord origins of involved peripheral nerve(s). Continue treatment along respective axons (that often follow one or more acupuncture channels on a limb).	Restore healthful circulation through autonomic neuromodulation of vascular tone in the spinal cord through medical acupuncture and related techniques directed to the injured cord levels as well as three segments proximal and distal to the lesion. This takes into account neural divergence by afferent input across multiple levels.	Palpate for sources of local, regional, and referred pain. Relax tissue, improve range of motion, and decompress nerves and vessels affected by myofascial restriction.
Urinary/fecal incontinence	Neuromodulate spinal cord segments and reflex pathway nerves that encourage restoration of voluntary control of urination and defecation.	Stimulate spinal nerves related to CNS components involved in micturition and defecation, ranging from the thoracolumbar to sacral cord segments. Amplify and reinforce the influence of distal peripheral nerves on these reflex systems with acupuncture points such as KI3 and SP6, both strong influencers of the tibial nerve and its role in neuromodulation of genitourinary function.	Normalize reflexive control over micturition and defecation in the brain and spinal cord (thoracolumbar through sacral spinal cord segments and affiliated spinal nerves). Suggested points include BL points from BL19-BL25 and locations over the sacrum to influence dorsal spinal nerves (ie, BL27-BL30).	Palpate for sources of local, regional, and referred pain and aberrant stimuli that are impacting mechanoreceptor control over voiding.
Nonhealing wound	Provide anti-inflammatory, anti-infective, and immune-enhancing support to local tissues through optimization of host defenses and normalization of regional blood and lymph flow.	Improve host health and proper circulation and immune surveillance through neuromodulation of CNS tone that reduces wind-up and stress within the system in general. Acupuncture points that aid in this approach include paraspinal (BL channel) points associated with spinal cord segments that supply the wound.	Improve host health and proper circulation and immune surveillance through neuromodulation of autonomic nervous system tone. This involves, to a great extent, reducing overactive sympathetic drive. Points suggested include LI4 and LI11 on the thoracic limb and LR3 and ST36 on the pelvic limb.	Surround nonhealing wound by needling or otherwise activating resident fibroblasts in the local tissue. Adjunct methods include photonic stimulation (eg, laser therapy or light-emitting diodes [LEDs] and/or stretch via massage). Acupuncturists may refer to this approach as "circling the dragon [the wound]".
Immunologic dysfunction	Instill immune-balancing input to the individual as a whole.	Improve host health and proper circulation and immune surveillance through neuromodulation of CNS tone that reduces wind-up and stress. Acupuncture points that may assist in this manner include GV20, GV14, GV4, BL18, and BL23.	Improve host health and proper circulation and immune surveillance through neuromodulation of autonomic nervous system tone. This involves, to a great extent, reducing overactive sympathetic drive. Acupuncture points that may assist in this manner include LI4, ST36, SP6, and BaiHui at the lumbosacral junction.	Remove nociceptive aggravation borne by soft-tissue dysfunction by relaxing the patient's soft tissues and nervous system through comforting, pain-alleviating interventions.

Condition

Treatment Goals

Central or Peripheral Nervous System Points or Regions Treated

Autonomic Nervous System Points and Purported Rationale

Myofascial Component, Assessment, and Treatment Goals

Abdominal pain

Analgesia

Address affected viscera
Normalize motility
Reduce inflammation

Paraspinal points to neuromodulate spinal cord segments that associate with dysfunctional viscus or viscera (BL17-–BL25)

Fibular nerve point (ST36) for parasympathomimetic, anti-inflammatory, and analgesic effects. Consider PC6 for cranial abdominal discomfort and nausea.

Relax truncal tension stemming from and/or contributing to abdominal discomfort. Palpate for and treat myofascial restriction and dysfunction, and needle or otherwise address tissue tension.

Back and neck pain

Identify, characterize, and localize the nature of back or neck pain through observation of movement, palpation, and posture when sitting and standing.

Paraspinal and selective dorsal midline points related to back pain. GV, inner BL line, outer BL line, Huatuojiaji points at relevant and adjacent spinal cord segments.

Sympathetic neuromodulation by means of paraspinal points with resultant anti-inflammatory effects through presumptive lowering of sympathetic tone. Reinforce with popliteal neurovascular point (BL40) and/or ST36.

Relax back, neck, and paraspinal tension as discerned by means of myofascial palpation. This reduces pain and improves range of motion. Needle or otherwise address tissue tension and shortening.

Joint pain

Analgesia

Anti-inflammatory effect
Endogenous analgesia
Reduction of local and referred pain from myofascial dysfunction

Improved Function

Less joint pain
Reduced referred pain
Relaxed connective tissue

Select paraspinal points related to spinal cord segments that supply peripheral nerves innervating targeted arthrodial and peri-articular structures to neuromodulate "facilitated" or "wound up" spinal cord segments.

Points at neurovascular locations near and/or distal to the targeted joint(s). For example, ST36, BL40, and LR3 for pelvic limb pain, and LI11, LU7, and LI4 for thoracic limb pain to reduce overactive sympathetic tone.

Palpate for sources of local, regional, and referred pain. Relax tissue, improve range of motion, decompress nerves and vessels affected by myofascial restriction.

Postoperative ileus

Restore proper GI motility

Provide analgesia to area affected by surgery to remove additive effects on ileus from overactivation of the sympathetic nervous system.

Paraspinal points to neuromodulate spinal cord segments that associate with involved viscus or viscera (BL17-BL25)

Fibular nerve point (ST36) for parasympathomimetic, anti-inflammatory, and analgesic effects. Consider PC6 for motility disorders involving the esophagus and/or stomach.

Relax truncal tension stemming from and/or contributing to digestive dysfunction. Palpate for and treat myofascial restriction and dysfunction, and needle or otherwise address tissue tension. Address soft-tissue pain related to surgery and/or anesthesia.

Facial nerve injury

Restore function to injured components of the somatic motor fibers of the facial nerve.

Stimulate peripheral/cranial nerve branches from the point of exit from the cranium to the neuromuscular endpoint.

Improve circulation to the face and, in particular, the injured neural tissue, either through local trigeminal nerve activation or through CNS modulation of vascular tone.

Release soft-tissue restrictions impacting involved neural pathways. Activate somatic motor tissue on the head through sensory inputs that restore neural control over muscles of facial expression.

Peripheral nerve injury

Facilitate repair of injured nerve.

Remove soft-tissue restrictions that cause neurologic dysfunction by means of neural compression. Improve local circulation to optimize tissue repair.

Activate spinal nerves related to spinal cord origins of involved peripheral nerve(s).

Continue treatment along respective axons (that often follow one or more acupuncture channels on a limb).

Normalize circulation through autonomic neuromodulation of vascular tone.

Relax soft-tissue restrictions that are perpetuating neural dysfunction. Activate sensory and motor pathways associated with the injured nerve(s) to expedite return to function.

Spinal cord injury

Neuromodulate/normalize firing patterns in the spinal cord and affected nerves.

Protect existing tissues from further decline. Encourage restoration of function of sensory, motor, and autonomic pathways, including control of urination and defecation.

Stimulate spinal nerves related to spinal cord origins of involved peripheral nerve(s). Continue treatment along respective axons (that often follow one or more acupuncture channels on a limb).

Restore healthful circulation through autonomic neuromodulation of vascular tone in the spinal cord through medical acupuncture and related techniques directed to the injured cord levels as well as three segments proximal and distal to the lesion. This takes into account neural divergence by afferent input across multiple levels.

Palpate for sources of local, regional, and referred pain. Relax tissue, improve range of motion, and decompress nerves and vessels affected by myofascial restriction.

Urinary/fecal incontinence

Neuromodulate spinal cord segments and reflex pathway nerves that encourage restoration of voluntary control of urination and defecation.

Stimulate spinal nerves related to CNS components involved in micturition and defecation, ranging from the thoracolumbar to sacral cord segments. Amplify and reinforce the influence of distal peripheral nerves on these reflex systems with acupuncture points such as KI3 and SP6, both strong influencers of the tibial nerve and its role in neuromodulation of genitourinary function.

Normalize reflexive control over micturition and defecation in the brain and spinal cord (thoracolumbar through sacral spinal cord segments and affiliated spinal nerves). Suggested points include BL points from BL19-BL25 and locations over the sacrum to influence dorsal spinal nerves (ie, BL27-BL30).

Palpate for sources of local, regional, and referred pain and aberrant stimuli that are impacting mechanoreceptor control over voiding.

Nonhealing wound

Provide anti-inflammatory, anti-infective, and immune-enhancing support to local tissues through optimization of host defenses and normalization of regional blood and lymph flow.

Improve host health and proper circulation and immune surveillance through neuromodulation of CNS tone that reduces wind-up and stress within the system in general. Acupuncture points that aid in this approach include paraspinal (BL channel) points associated with spinal cord segments that supply the wound.

Improve host health and proper circulation and immune surveillance through neuromodulation of autonomic nervous system tone. This involves, to a great extent, reducing overactive sympathetic drive. Points suggested include LI4 and LI11 on the thoracic limb and LR3 and ST36 on the pelvic limb.

Surround nonhealing wound by needling or otherwise activating resident fibroblasts in the local tissue. Adjunct methods include photonic stimulation (eg, laser therapy or light-emitting diodes [LEDs] and/or stretch via massage). Acupuncturists may refer to this approach as "circling the dragon [the wound]".

Immunologic dysfunction

Instill immune-balancing input to the individual as a whole.

Improve host health and proper circulation and immune surveillance through neuromodulation of CNS tone that reduces wind-up and stress. Acupuncture points that may assist in this manner include GV20, GV14, GV4, BL18, and BL23.

Improve host health and proper circulation and immune surveillance through neuromodulation of autonomic nervous system tone. This involves, to a great extent, reducing overactive sympathetic drive. Acupuncture points that may assist in this manner include LI4, ST36, SP6, and BaiHui at the lumbosacral junction.

Remove nociceptive aggravation borne by soft-tissue dysfunction by relaxing the patient's soft tissues and nervous system through comforting, pain-alleviating interventions.