EXERCISE-INDUCED PULMONARY EXERCISE-INDUCED PULMONARY HAEMORRHAGE IN HORSE: HAEMORRHAGE IN HORSE:

ACUPUNTURE TREATMENT AND ACUPUNTURE TREATMENT AND PREVENTIONPREVENTION

• Barbara Bellomo, DVM, ItVASBarbara Bellomo, DVM, ItVAS• Alessandra Vigliani, DVM, Horse Clinic “Scuderia dei Vet” Milan (Italy) Alessandra Vigliani, DVM, Horse Clinic “Scuderia dei Vet” Milan (Italy) • Francesco Longo, DVM, Repr. Spec. ItVAS – ItVAC Bologna (Italy)Francesco Longo, DVM, Repr. Spec. ItVAS – ItVAC Bologna (Italy)

EIPHEIPHIt occurs in horses:It occurs in horses:Race at high speedsRace at high speeds Many horses with poor Many horses with poor

performance have performance have cytologic evidencescytologic evidences

thoroughbredthoroughbred

standardbredstandardbred

• Tracheobronchial tree Tracheobronchial tree performed 30-90 performed 30-90

minutes after exercise minutes after exercise or racing or racing

• Microscopic examination Microscopic examination of tracheobronchial of tracheobronchial

aspirates or aspirates or bronchoalveolar lavage bronchoalveolar lavage

fluid fluid

Causes of EIPH:Causes of EIPH:

• Rupture of alveolar Rupture of alveolar capillary membranescapillary membranes

• Subsequent haemorrage Subsequent haemorrage into airways and into airways and interstitiuminterstitium

• Cause inflammation of Cause inflammation of both airways and both airways and interstitiuminterstitium

• Development of Development of fibrosis and alteration fibrosis and alteration of tissue complianceof tissue compliance

Structural abnormalitiesStructural abnormalities

CausesCauses

• repetitive damage of the tissuerepetitive damage of the tissue

• haemorrhage and inflammationhaemorrhage and inflammation

+ pulmonary hypertension+ pulmonary hypertension+ large intrathoracic force associated with + large intrathoracic force associated with

respiration during strenous exerciserespiration during strenous exercise

Predisposing factors:Predisposing factors:

• RACERACE

• AGEAGE

• BACTERIAL INFECTIONSBACTERIAL INFECTIONS (OFTEN UNDERESTIMATED)(OFTEN UNDERESTIMATED)

• etcetc

Bacteriological examination Bacteriological examination Cytological examCytological exam

Differential Diagnosis Differential Diagnosis Guttural punchGuttural punchMycosisMycosisEthmoid haematomaEthmoid haematomaRhinitisRhinitis

The most common diagnosis:The most common diagnosis:

Allopathic therapy is based onAllopathic therapy is based on

antibioticsantibiotics

vitamin Cvitamin C

aerosol with hyaluronic acidaerosol with hyaluronic acid

According TCMAccording TCMthe Spleen produces the the Spleen produces the Blood (Xue)Blood (Xue)

The Lung allows the descent of The Lung allows the descent of the Qi and the fluidthe Qi and the fluidit settles the water passageit settles the water passage

both these Zang constitute both these Zang constitute the Tai Yin energetic levelthe Tai Yin energetic level

The Qi empty of Lung determinesThe Qi empty of Lung determines• Xue and fluid stasis with Xue and fluid stasis with

conseguent fullness of the thoraxconseguent fullness of the thorax

• Insufficient blood circulation Insufficient blood circulation in the thoraxin the thorax

• DyspnoeaDyspnoea

• TachycardiaTachycardia

• Purple tonguePurple tongue

• Rapid and superficial pulseRapid and superficial pulse

The Chinese classical formulas derive The Chinese classical formulas derive from three books and they point out the from three books and they point out the

rebalance of Tai Yin level by different rebalance of Tai Yin level by different points:points:

• Ling ShuLing Shu

• Nan JingNan Jing

CV 12 – SP 1CV 12 – SP 1

SP 3 – LU 7SP 3 – LU 7

LU 9 – SP 4LU 9 – SP 4

• Yu Xue Rou Yu Xue Rou MenMen

SP 3 – SP 4 – TH 5SP 3 – SP 4 – TH 5

LU 9 – LU 7 – BL 58LU 9 – LU 7 – BL 58

Acupuncture therapy was based onAcupuncture therapy was based on• Rebalancing Tai Yin levelRebalancing Tai Yin level • Toning Lung QiToning Lung Qi

Treatment Treatment acupoints acupoints

are selectedare selected

according to their according to their traditional energetic traditional energetic

indicationsindicationsconsidering considering

experimental and experimental and clinical evidencesclinical evidences

In respect of the In respect of the individual needs of the individual needs of the

treated subjecttreated subject

The authors standardize these acupuncture The authors standardize these acupuncture protocol for 2 specific conditions:protocol for 2 specific conditions:

• Previous race-Previous race-preventive medicinepreventive medicine

• After race in horse After race in horse affected by pulmonary affected by pulmonary haemorrhagehaemorrhage

SP 21 DabaoSP 21 DabaoBL 42 PohuBL 42 PohuGV 12 ShenzuGV 12 ShenzuCV 17 ShanzhongCV 17 Shanzhong

BL 14 JueyinshuBL 14 JueyinshuBL 43 GaohuangBL 43 GaohuangKI 27 ShufuKI 27 ShufuPC 4 XimenPC 4 XimenCV 15 JiuweiCV 15 JiuweiFei PanFei PanQi Hai – Bi GuanQi Hai – Bi Guan

The authors standardize these acupuncture The authors standardize these acupuncture protocol for 2 specific condition:protocol for 2 specific condition:

• After race in horse After race in horse affected by pulmonary affected by pulmonary haemorrhagehaemorrhage

BL 14 JueyinshuBL 14 JueyinshuBL 43 GaohuangBL 43 GaohuangKI 27 ShufuKI 27 ShufuPC 4 XimenPC 4 XimenCV 15 JiuweiCV 15 JiuweiFei PanFei PanQi Hai – Bi GuanQi Hai – Bi Guan

1) AFTER race in horses affected by 1) AFTER race in horses affected by pulmonary haemorrage pulmonary haemorrage **

(*)(*) The authors have treated 12 horses (2012 – 2014) The authors have treated 12 horses (2012 – 2014)

In this group were enclosed horses In this group were enclosed horses with contingent episode of EIPH. with contingent episode of EIPH.

The acupuncture treatment was performed after the The acupuncture treatment was performed after the racerace

Clinical procedure was in five steps:Clinical procedure was in five steps:

1) Western Medical 1) Western Medical DiagnosisDiagnosis2) 2) TCM Medical DiagnosisTCM Medical Diagnosis

3) 3) Acupuncture therapyAcupuncture therapy

4) Collecting the clinical data 4) Collecting the clinical data after Acupuncture Sessionafter Acupuncture Session

5) 5) ResultsResults

Western Western MedicalMedical Diagnosis: Diagnosis:• Medical examinationMedical examination

• Tracheal lavageTracheal lavage

• Cytological exameCytological exame

TCMTCM Medical Diagnosis: Medical Diagnosis:• Diagnostic acupoints testingDiagnostic acupoints testing

• Tongue exameTongue exame

• Pulse examePulse exame

Acupuncture therapy:Acupuncture therapy:

• In all of horses were In all of horses were performed one performed one acupuncture session acupuncture session within one hour after racewithin one hour after race

• Only Chinese needles Only Chinese needles were employedwere employed

• The moxa was applied The moxa was applied on needles putting in on needles putting in BL14 and to warmBL14 and to warm

Qi Hai – Bi GuanQi Hai – Bi Guan

• BL 14 JueyinshuBL 14 Jueyinshu

It is Back Shu Point It is Back Shu Point of Pericardiumof Pericardium

• BL 14 JueyinshuBL 14 Jueyinshu

In ancient acupuncture In ancient acupuncture charts BL14 is charts BL14 is considered theconsidered theBack Shu of the LUBack Shu of the LUIt is involved in It is involved in supporting cardio supporting cardio pulmonary activitypulmonary activity

• BL 43 GaohuangBL 43 Gaohuang

Huang (membranae) point; Huang (membranae) point; it renforces SP, ST andit renforces SP, ST andQi and Yin of the Lung.Qi and Yin of the Lung.

Increase in 24 hours the Increase in 24 hours the number of red blood cellsnumber of red blood cells

• KI 27 ShufuKI 27 Shufu

It replaces LU 1 It replaces LU 1 ((ZhongfuZhongfu) )

in the Shu – Mu in the Shu – Mu technique to treat technique to treat respiratory diseases in respiratory diseases in summersummer

• KI 27 ShufuKI 27 Shufu

We use this point in We use this point in summer time because of summer time because of it bring the Yin of KI it bring the Yin of KI directly to the thorax.directly to the thorax.

It’s possible to stimulate It’s possible to stimulate the acupuncture point the acupuncture point also with Tuinaalso with Tuina

• PC 4 XimenPC 4 Ximen

Xi – cleft point;Xi – cleft point;It is employed in acute It is employed in acute chest problemschest problems

It has great It has great antihaemorrhagic effectantihaemorrhagic effect

• CV 15 JiuweiCV 15 Jiuwei

It is Luo point of It is Luo point of Renmai;Renmai;

It is Yuan point of GaoIt is Yuan point of Gao(fat organic substance)(fat organic substance)

• Fei PanFei Pan

It is an ancient point It is an ancient point very effective in chronic very effective in chronic respiratory diseases like respiratory diseases like COPDCOPD

It treats cough, It treats cough, pneumonia,pneumonia,Heat in the LungHeat in the Lung

Foto

• Qi Hai Qi Hai – – Bi GuanBi Guan

They are stimulated by They are stimulated by moxibustion to moxibustion to eliminate Tan from the eliminate Tan from the respiratory tract.respiratory tract.These are local points These are local points very usefull in treating very usefull in treating respiratory conditions.respiratory conditions.

Collecting the clinical data after race:Collecting the clinical data after race:

Endoscopy was performed Endoscopy was performed 1-2 hours after race1-2 hours after race

TCM diagnosis was madeTCM diagnosis was made

The same collection of data was performed The same collection of data was performed 6 months after the last acupuncture 6 months after the last acupuncture treatment (at the end of races season)treatment (at the end of races season)

ResultsResults::• All of horses treated by All of horses treated by

acupuncture were in good acupuncture were in good clinical conditions after 1 – 12 clinical conditions after 1 – 12 – 24 hours after treatment– 24 hours after treatment

• All of horses have All of horses have shown an almost shown an almost normal endoscopic normal endoscopic picturepicture

• The Collection of data The Collection of data after 24 hours prove after 24 hours prove the effectiveness of the effectiveness of Acupuncture in treating Acupuncture in treating acute EIPHacute EIPH

The authors standardize these acupuncture The authors standardize these acupuncture protocol for 2 specific condition:protocol for 2 specific condition:

• Previous race-Previous race-preventive medicinepreventive medicine

SP 21 DabaoSP 21 DabaoBL 42 PohuBL 42 PohuGV 12 ShenzuGV 12 ShenzuCV 17 ShanzhongCV 17 Shanzhong

2) PREVIOUS RACE – 2) PREVIOUS RACE – PREVENTIVE PREVENTIVE MEDICINEMEDICINE**

(*)(*) The authors have treated 20 horses (2012 – 2014) The authors have treated 20 horses (2012 – 2014)

In this group were enclosed horses with medical history In this group were enclosed horses with medical history (in 6 – 12 months before) of at least one episode of EIPH. (in 6 – 12 months before) of at least one episode of EIPH.

The acupuncture treatment was performed before The acupuncture treatment was performed before three races; the race were a fifteen day intervalthree races; the race were a fifteen day interval

Clinical procedure was in five steps:Clinical procedure was in five steps:

1) Western medical 1) Western medical diagnosisdiagnosis2) 2) TCM medical diagnosisTCM medical diagnosis

3) 3) Acupuncture therapyAcupuncture therapy

4) Collecting the clinical data 4) Collecting the clinical data after raceafter race5) 5) ResultsResults

Western Medical Diagnosis:Western Medical Diagnosis:

• Medical examinationMedical examination

• Tracheal lavageTracheal lavage

• Cytological examCytological exam

TCM Medical Diagnosis:TCM Medical Diagnosis:• Diagnostic acupoints testingDiagnostic acupoints testing

• Tongue examTongue exam

• Pulse examPulse exam

Acupuncture therapy:Acupuncture therapy:

• In all of horses were In all of horses were performed one performed one acupuncture session 24-48 acupuncture session 24-48 hours before every racehours before every race

• Only Chinese needles Only Chinese needles were employedwere employed

• The moxa was applied The moxa was applied on needles putting in on needles putting in BL 42BL 42 • Tuina e manual Tuina e manual

medicine technique medicine technique were employedwere employed

The authors assessed the effectiveness of some The authors assessed the effectiveness of some acupoints for respiratory clinical conditions:acupoints for respiratory clinical conditions:

• SP 21 DabaoSP 21 Dabao

It is the Great Luo of It is the Great Luo of Spleen.Spleen.It treats dyspnoea, It treats dyspnoea, respiratory diseases, wei respiratory diseases, wei syndrome.syndrome.This is a junction of all This is a junction of all Luo vessels .Luo vessels .We can use needles or We can use needles or TuinaTuina

• SP 21 DabaoSP 21 Dabao

It ‘s starting point for the Spleen It ‘s starting point for the Spleen divergent meridian,in this way in divergent meridian,in this way in possible to rebelance the energy possible to rebelance the energy of the SP involving in Tai Yin level; of the SP involving in Tai Yin level; moreover from SP21 starts an moreover from SP21 starts an inner branch to heart: it’s very inner branch to heart: it’s very important tonifying this organ important tonifying this organ before racebefore race

We can apply fists massage:We can apply fists massage:At begin gently and then stronger At begin gently and then stronger clockwise to activate circulation of clockwise to activate circulation of collateral vessels.collateral vessels.

• BL 42 PoshuBL 42 Poshu

It treats bronchitis, It treats bronchitis, pleuritis, it allows the pleuritis, it allows the downword movement of downword movement of the Lung Qithe Lung Qi

• BL 42 PoshuBL 42 Poshu

It is located on the external branch It is located on the external branch of the BL meridian.of the BL meridian.All of points on this branch have All of points on this branch have action on psycological aspect of action on psycological aspect of zang organs and they are related to zang organs and they are related to a specific shen or soul that have a specific shen or soul that have seated in thoseseated in those

It is named Po Ho = Door of the PoIt is named Po Ho = Door of the PoPo = vegetative soul that has seated in Po = vegetative soul that has seated in LULUIt is very effective in treating many It is very effective in treating many behavioural troubles link to Po, like behavioural troubles link to Po, like sandness, excess or deficency of sandness, excess or deficency of sensitivenesssensitiveness

Other important function of the Other important function of the points located on external branch of points located on external branch of the BL is carrying Yang and Wei Qi to the BL is carrying Yang and Wei Qi to the corrispondent organ.the corrispondent organ.

BL42 send Yang and Wei Qi to the LU, BL42 send Yang and Wei Qi to the LU, in this way it is possible strenghten in this way it is possible strenghten this organ before the race effort this organ before the race effort

• GV 12 ShenzuGV 12 Shenzu It improves therapies for bronchitis It improves therapies for bronchitis and asthma;and asthma;

It is Middle Gate of GV It is Middle Gate of GV according to Taoist according to Taoist AcupunctureAcupunctureIt regulates Lung Qi and it It regulates Lung Qi and it disperses the Wind-Heatdisperses the Wind-HeatThere is a tecnique namedThere is a tecnique named““Trasverse ReinforcementTrasverse Reinforcement””that involvesthat involvesBL42BL42--BL13BL13--GV12GV12--BL13BL13--BL42BL42The same points on both The same points on both sidessides

• CV 17 ShanzhongCV 17 Shanzhong

It is Mu point of PC It is Mu point of PC andandInfluencial Point of Influencial Point of Upper BurnerUpper Burner

Collecting the Clinical Data after Collecting the Clinical Data after Acupuncture Session:Acupuncture Session:

It was performed endoscopy It was performed endoscopy 24 hours after acupuncture 24 hours after acupuncture sessionsession

TCM diagnosis was madeTCM diagnosis was madeIn 5 horses the tracheal lavage has shown the In 5 horses the tracheal lavage has shown the presence of bacteriapresence of bacteria

It was made a specific antibiotic therapy based It was made a specific antibiotic therapy based on antibiogram examon antibiogram exam

Results:Results:• All of horses treated All of horses treated

by acupuncture have by acupuncture have shown abnormal shown abnormal endoscopic pictureendoscopic picture

• 17 horses have 17 horses have completed the races completed the races seasonseason

• The collection of data The collection of data after 6 months prove after 6 months prove the effectiveness of the effectiveness of Acupuncture in Acupuncture in preventing EIPHpreventing EIPH

• 3 horses were 3 horses were withdrawn for withdrawn for orthopaedic problemsorthopaedic problems

Acupuncture for the horses Acupuncture for the horses

treated AFTER racetreated AFTER race::has a relevant anti-inflammatory action has a relevant anti-inflammatory action andandeffect on biological functions of the effect on biological functions of the organismorganism

assures the complete wellbeing of the horse andassures the complete wellbeing of the horse andit acts on specific problem and onit acts on specific problem and onglobal energy of the body resulting “naturally” effectiveglobal energy of the body resulting “naturally” effective

Acupuncture for the horses treated Acupuncture for the horses treated

PREVIOUS racePREVIOUS race::It is very effective in controlling the It is very effective in controlling the acute onset and restoring the Qi flow acute onset and restoring the Qi flow in the horsesin the horses

has proven to be particularly effective as a has proven to be particularly effective as a preventive medicinepreventive medicine

It is very effective in normalizing the It is very effective in normalizing the respiratory tract as shown by endoscopyrespiratory tract as shown by endoscopy