Marco TESTA (*) Margherita GAZZOLA Francesco LONGO It.V.A.S. S.I.A.V.

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1 Marco TESTA (*) Margherita GAZZOLA Francesco LONGO It.V.A.S. S.I.A.V. (*) Veterinary Surgeon, MS It.V.A.S. SIAV Via Vanchiglia 27 Torino Italy Tel.: 0039/328/

2 THE AIM OF THIS REPORT IS TO SHOW THE EFFECTIVENESS AND THE ROLE OF ACUPUNCTURE IN TREATING STIFLE JOINT DISEASES

3 ANATOMY THE STIFLE IS THE REGION INCLUDING THE FEMOROTIBIAL JOINT PLUS THE FEMOROPATELLAR JOINT AND SURROUNDINGS STRUCTURES

4 ANATOMY OUTSIDE OF THE JOINT THERE ARE THE EXTERNAL COLLATERAL LIGAMENTS THE FRONT OF STIFLE HAS THREE LARGE PATELLAR LEGAMENTS

5 ANATOMY MENISCI LIE BETWEEN THE CARTILAGE AND HELP PREVENT CONCUSSION INJURIES TO THE JOINT SURFACES

6 BIOMECHANICS LOMBO SACRO -ILIAC JUNCTION/JOINT - RECIPROCAL APPARATUS 6

7 PATHOLOGIES OF THE STIFLE JOINT UPWARD FIXATION OF THE PATELLA GONITIS OSTHEOARTHRITIS THE LAMENESS DEGREE IS RELATED TO SEROIOUSNESS OF THE LESIONS

8 UPWARD FIXATION OF THE PATELLA IT IS DUE TO STRAIGHT LEGGED CONFORMATION WEAKNESS IN THIGH MUSCLES RELAXATION OR STRETCHING OF THE PATELLAR LIGAMENTS CONGENITAL PREDISPOSITION INVOLVEMENT OF POPLITEAL MUSCLE ( STARTER MUSCLE FOR THE BENDING) BLOCK JOINT OF THE LUMBAR VERTEBRAE L 4 L 5

9 GONITIS IT IS AN INFLAMMATORY LESION COMMON REASON FOR STIFLE LAMENESS THIS COULD INVOLVE THE SOFT TISSUES OF THE JOINT: JOINT CAPSULE INTERNAL LIGAMENTS MENISCI CARTILAGE Rx ARE TAKEN TO EVALUATE THE SIGNS OF DEGENERATION OR ARTHRITIS (DJD)

10 GONITIS IT IS DUE TO OCD SUBCHONDRAL CYSTES ON MEDIAL CONDILE OF THE FEMUR

11 OSTEOARTHRITIS IT IS USUALLY OBSERVED IN OLDER HORSES IT IS DUED TO PROLONGED INSTABILITY FROM SPRAIN TRAUMA TO THE COLLATERAL LIGAMENTS OR CRUCIATE LIGAMENTS CHIP FRACTURES CHRONIC SYNOVITIS CAPSULITIS SUBCHONDRAL BONE CYSTIS

12 TCM ALL OF THESE DISEASES ARE CONTEMPLATE IN BI SYNDROMES COMPLEX OBSTRUCTION OF MERIDIANS SLUGGISHNESS OF QI AND XUE CIRCULATION PAIN NUMBNESS AND HEAVINESS OF MUSCLES TENDONS AND JONTS LIMITATION OF JOINTS

13 TCM BI SYNDROME OF DAMPNESS U.F.P. BI SYNDROME OF HEAT GONITIS BONY BI SYNDROME OSTEOARTHRITIS

14 TCM L3 IS INVOLVED AND ITS IRREGULAR SPIN DETERMINES STIFLE IS AN CONSIDERED IRREGULAR MOVEMENT THE LOINS PALACE OF THE STIFLE THE LOINS ARE THE SEAT OF KIDNEY STRAIN AND OVERLOAD ON THE PATELLAR LIGAMENTS THE MOVEMENT OF THE HORSE ORIGINE AS AN IMPULSE FROM THE IMBALANCE OF KIDNEY KIDNEY ZHI WILL IN AN AREA BETWEEN L3 L4 DUED TO STRESS SURMENAGE EXCESSIVE GV3 OR INADEQUATE YAO YANG GUAN MANAGES THIS STIFLE IMPULSE IS SPORT EXERCISE CONSIDERED THIS IMPULSE GOES DOWN THE HINDLIMB THE AND LOINS IT DETERMINES PALACE THE LACK OF ZHI WILL FLEXION OF THE HOCK AND STIFLE UNCERTAINTY AND INSTABILITY THE HINDLIMB PROPEL THE HORSE AND MOST THE OF LOINS THIS ARE WORK IS IN THE MOVEMENT CARRIED OUT BY THE HOCK JOINT AND THE STIFLE SEAT OF KIDNEY WEAKNESS OF STIFLE

15 TCM STIFLE IS CONSIDERED THE LOINS PALACE THE LOINS ARE THE SEAT OF KIDNEY THE MOVEMENT OF THE HORSE ORIGINE AS AN IMPULSE FROM THE KIDNEY ZHI WILL IN AN AREA BETWEEN L3 L4 GV3 YAO YANG GUAN MANAGES THIS IMPULSE THIS IMPULSE GOES DOWN THE HINDLIMB AND IT DETERMINES THE FLEXION OF THE HOCK AND STIFLE THE HINDLIMB PROPEL THE HORSE AND MOST OF THIS WORK IS CARRIED OUT BY THE HOCK JOINT AND STIFLE 15

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17 -GV 3. Yao- Yang-Guan, Lumbar Yang Pass....on the midline between L4/L5 Here Merges the Ki Qi, regulates lumbar region, and legs, dispel wind damp -GB 29. Ju-liao...between wing of Ilium and greater trocanter of femur...meeting point with Yang Qiao Mai Important local point for disorders of the hip joint, when pain radiates from the hip to the groin and lower abdomen. Also for pain of the back and leg, lumbar pain radiating to the lower abdomen, weakness and paralysis of the leg, sciatica. GB 31, Feng-shi...on the lateral aspect of the thigh...dispels wind-damp in the leg; especially for wandering painful obstruction. GB 34, Yang-ling-quan..craniodistal to the head of the fibula...he-sea and Earth point of the Gall Bladder channel Hui-meeting point of Sinews Ma Dan-yang Heavenly Star point...promotes the smooth flow of Qi 17

18 18

19 BL 62 Shen Mai...in a depression distal to lateral malleolus, opposite to Ki6..Confluent point of the Yang Qiao Mai Sun Si-miao Ghost point Treats disorder of both the Bladder channel and the Yang Motility vessel,pain of both the lumbar region and hip. GB41 Zu-lin.qi..caudolateral aspect of cannon bone Shu stream point, confluent with the Dai channel Trasform phlegm and dissipates nodules BL67. Ting Point BL 61 Pu - Can...caudoventral to Bl 60..Meeting point of the Bladder channel with the Yang Qiao Mai..Relaxes the sinews, activates the channel and alleviates pain KI 6 Zhao-hai...between the calcaneal tuber and the talus..confluent point of the Yin Motility vessel Nourishes the Kidneys and clears deficiency heat Regulates the Yin Motility vessel 19

20 SI 10 LI 11 LU 7 SI 3 SI1 TH5 GV 3 GV8 GV 3 GV8 GV 9 GV 14 GV16 GV 20 GV 9 GV 14 GV16 GV 20 20

21 TCM THE STIFLE SYNDROME MAY BE TO KIDNEY PROBLEMS or STOMACH PROBLEMS or BOTH PROBLEMS DIAGNOSTIC PROCEDURES ALLOW TO DIFFERENTIATE THEM

22 TCM KIDNEY PROBLEMS KI DEFICIENCY / KIDNEY JING DEFICIENCY OCD 22

23 TCM STOMACH / SPLEEN PROBLEMS MOST STIFLE SYNDROMES SP MERIDIAN ST MERIDIAN ANTEROMEDIAL ASPECT OF FTJ ANTEROLATERAL ASPECT OF FTJ 23

24 TCM THE JOINT FUNCTION IS CONNECTED TO STOMACH ENERGY STOMACH SYNDROMES XIE QI - PERTURBED ENERGY FLOW ALONG ST MERIDIAN CLOGS THE STIFLE JOINT L3 IS INVOLVED AND ITS IRREGULAR SPIN DETERMINES AN IRREGULAR MOVEMENT OF THE STIFLE STRAIN AND OVERLOAD ON THE PATELLAR LIGAMENTS STRESS TO THE LUMBOSACRAL NERVE PLEXUS AFFECTING DIGESTIVE SYSTEM

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26 DIAGNOSIS INTEGRATED DIAGNOSIS TCM EXAM DIAGNOSTIC ACUPOINTS BL 37 BL 38 BL 39 ST 10 KI BL 23 ST BL 21 CV 12

27 LOCAL THERAPY ACUPOINTS AROUND JOINT LUN HUAN QIAO TI FA STABILIZING JOINT GENERAL THERAPY ACUPOINTS REBALANCING ENERGY OF THE KI OR ST ORGANS

28 STIFLE SYNDROME BY KIDNEY INVOLVEMENT LOCAL THERAPY SP 9 SP 10 BL 40 KID 10 GB 34

29 SP 9 : Yin-ling-quan; distal border of medial condyle tibia He-Sea and Water point of the Spleen channel Main Spleen channel point to resolve dampness: oedema, swelling of the lower limbs. SP 10 : Xue-hai, Sea of Blood; proximomedial border of patella One of the main points to move blood stasis and cool blood heat, BL 40 : Wei-zhong; popliteal fossa He-Sea and Earth point of the Bladder channel Gao Wu Command point Ma Dan-yang Heavenly Star point Much used for acute or chronic lumbar pain (needled or pricked to bleed), sciatica, knee disorders, weakness of hind legs. KI10 : Yin-gu ; medial side of popliteal fossa He-Sea and water point of the Kidney channel Clears damp and damp-heat from the lower jiao 29

30 STIFLE SYNDROME BY KIDNEY INVOLVEMENT GENERAL THERAPY BL 23 GB 25 CV 7 KID 6 KID 8 LIV 3 GV 8 GV 3

31 BL 23: Shen-Shu Back-Shu point of the Kidneys Tonifies the Kidneys and fortifies yang Benefits essence Nourishes Kidney yin Regulates the water passages and benefits urination Strengthens the lumbar region GB 25 :jing-men Shu-Mu Terapy con Shen Shu Front-Mu point of the Kidneys Tonifies the Kidneys, Strengthens the lumbar region CV 7 : Jinjiao Meeting point of the Conception and Penetrating vessels and the Kidney channel KI 6 Zhao-hai...between the calcaneal tuber and the talus..confluent point of the Yin Qiao Mai Nourishes the Kidneys and clears deficiency heat Regulates the Yin Motility vessel Calms the spirit Regulates the lower jiao 31

32 KI 8 :Jiaoxin Xi-Cleft point of the Yin Qiao Maio Clears heat and drains damp from the lower jiao LV 3 : thaichong Shu-Stream, Yuan-Source and Earth point of the Liver channel Ma Dan-yang Heavenly Star point Spreads Liver qi Subdues Liver yang and extinguishes wind Nourishes Liver blood and Liver yin Regulates the lower jiao LV8 : Qu-quan He sea point,water, stifle pain GV 8 : Jinsuo Soothes the Liver, pacifies wind and relieves spasm Stiffness of the spine -GV 3. Yao- Yang-Guan, Lumbar Yang Pass...on the midline between L4/L5 Here Merges the Ki Qi, regulates lumbar region, and legs, dispel wind damp 32

33 STIFLE SYNDROME BY STOMACH INVOLVEMENT LOCAL THERAPY ST 30 ST 35 ST 36 LIV 3 LIV 8 GB 34

34 ST 30. Qichong Meeting point of the Stomach channel with the Penetrating vessel Point of the Sea of Water and Grain Transported on lateral thigh, Picture Regulates qi in the lower jiao ST 35: Calf's Nose Dispels wind-damp and reduces swelling Activates the channel and alleviates pain ST 36 : Zusanli He-Sea and Earth point of the Stomach channel Gao Wu Command point Ma Dan-yang Heavenly Star point Point of the Sea of Water and Grain Harmonises the Stomach Fortifies the Spleen and resolves dampness Supports the correct qi and fosters the original qi Tonifies qi and nourishes blood and yin Clears fire and calms the spirit Activates the channel and alleviates pain Revives the yang and restores consciousness 34

35 35

36 STIFLE SYNDROME BY STOMACH INVOLVEMENT GENERAL THERAPY BL 21 CV 12 ST 40 BL 62 BL 59 GV 8 GV 3

37 Bl 21 : Wei Shu, St Shu, Caudal to the last rib Back Shu Point for St Diagnostic x Stifle CV 12 : Zhong-Wan Shu-Mu terapy with ST Shu Influential point for Fu organs BL62 : Shen Mai,..in a depression distal to lateral malleolus Master Point for Yang Qiao Mai, Ghost Point Treats disorder of both BL channel and the Yang Motility Vessel, pain Lumbar and hip BL 59 : Fu-Yang Xi-cleft point for Yang Qiao Mai. Used with BL62 in order to increase action. Invigorating movementes and agility of the legs 37

38 ACUPUNCTURE TECNIQUES ACUPOINTS ARE STIMULATED BY CHINESE NEEDLES MOXA HAEMOACUPUNCTURE

39 TUINA MO-FA (touching skin and muscles) along ST BL- GB MERIDIANS AN-FA (pressing) on Ming Men AREA TUI-FA (pushing) on ST 41 TUI-FA (pushing) on BL 60 YAO-FA (rocking) on STIFLE JOINT DU-FA (shaking) of the HIND LIMB BA-SHEN-FA (stretching) of the HIND LIMB BA-SHEN-FA (stretching) of the TAIL

40 COMPLEMENTARY THERAPY CHANGING IN FEEDING OAT Cu SOYBEAN Mg NUTRITIONAL SUPPLEMENTS MEAGER YOGURT YEATS HOMEOPATHY GELSEMIUM SEMPERVIRENS 30 CH PHYSICAL MENTAL SHEN FLEXIBILITY

41 PREVENTION FEEDING CORRECT IN QUANTITY and QUALITY FUNCTIONAL GYMNASTICS NATURAL MOVEMENTS SPECIFIC MOVEMENTS IN TRAINING

42 MARCO TESTA * Margherita GAZZOLA * Francesco LONGO THANK YOU!!

DERMATOMES and ACUPUNCTURE in the HORSE

XVI ItVAS INTERNATIONAL SEMINAR X VAM/ECVA MEETING Palermo (I) October 23 24 25, 2015 DERMATOMES and ACUPUNCTURE in the HORSE Francesco LONGO DVM, Repr. Sp. S.I.A.V. It.V.A.S. (Italian Veterinary Acupuncture