I.V.A.S. ACUPUNCTURE CASE REPORT
Francesco Longo, D.V.M., Florence.

ABSTRACT
Reining horse affected by infertility was treated with acupuncture to improve his performance at start of breeding season with good results.

HISTORY
The Quarter Horse stallion, 13 years old, was in good body condition.
He was a 'champion' in many reining competitions and for this reason he was assigned to reproduction.
In the past breeding season he was showing signes of reduced fertility, insufficient erection and more mares were returning to heat.
His father and brothers were showing the same problem.
The stallion presented backache and a respiratory problem like an exercise - induced asthma.
He had been housed alone in a stall and in small paddock; diet and nutrition were normal.
In the past the Quarter Horse stallion was treated with GnRH therapy with very little benefit.
He was treated with homeopatic remedies too, but without results.

EXAMINATION FINDINGS
Western. No abnormalities were noted on physical exam; no pain was evident on palpation and testes were freely movable within the scrotal cavity.
Left testicle had appeared thicker at epididymis level; right testicle was size smaller than left.
Penis and prepuce were normal.
Palpation per rectum revealed no abnormalities of the accessory sex glands or inguinal rings; only the prostate gland was a bit hard.
Ultrasonography revealed that parenchyma of the left testicle was a bit hyperechoic compared to right testicle.
It was evident increased abdominal expiratory effort after exercise in paddock and back pain in lumbar area.
Eastern. The stallion showed normal Shen, but he was apathetic and light depressed; eyes were normal, but he had dark complexion with dull skin.
Movements were normal, but the gait was stiff.
Tongue was tended at red colour with thin coating; pulse was thin (xi) and swift (shuo).
He presented loud breath only after exercise.
He had no particular smell.
Anamnesis revealed that the male line of his family was interested in same problem (hereditary predisposition that involved Yuan Qi).
The palpation exam showed remarkable sensitivity on BL 18 (Ganshu), more on right side (sign of endogenous toxicity) and sensitivity on BL 23 (Shenshu).
During sexual act the stallion was really excited, but he had a difficult and unsatisfactory erection.

DIAGNOSTICS
Breeding Soundness Examination (B.S.E.) was performed according to Society of Theriogelogy (see table 1).
The response was oligospermiae with secundary abnormalities in 50% of the sperm (kinked tails, proximal and distal cytoplasmic droplets).

WESTERN MEDICAL DIAGNOSIS
Examination findings and diagnostics suggested oligospermiae.
The palpation exam, ultrasonography and the presence of secundary abnormalities in the sperm suggested an involvement of epididymis.
The diagnosis was infertility.

EASTERN MEDICAL DIAGNOSIS
According to the 1st chapter of So Wen the Kidney support sexual energy (sexual hormones).
In the 9th chapter of So Wen is writing: "Kidney is the receptacle of creating source, is the essence of blood and of all creating matters".
The 17th chapter of So Wen says: "Lumbar area is the seat of the Kidney; if the patient is not able to moving, the Kidney is losing energy".
In the 56th chapter, Qi Bo asserts:"The 57 shu points of Water are concentration points for Yin energy. The body water is beared by these points. It apperars dyspnea and Kidney and Lung are affected at the same time".
This assertions explain the involvement of the Kidney and the Lung and they correspond with pathological pattern in this horse: oligospermiae and respiratory problem.
The 37th chapter of So Wen says: "The perverse Yin invades the Liver".
This assertion explains the Liver involvement that leads remarkable sensitivity on BL 18 (Ganshu); Kidney Yin nourishes Liver Yin (Water is mother of Wood).
Traditionally in the body there are six Qi Heng Zhi Fu (extraordinary Fu organs).
In the male one of these organs is the prostate gland (it corresponds with uterus in female), and take name Jing Shi, 'sperm chamber'.
This chamber stores seminal fluid and it is beared by Kidney and Ming Men ('lifegate') and it depends by two extraordinary vessels: Ren Mai (Conception Vessel - CV) and Chong Mai (Penetrating Vessel - CM).
When there are problems in erection and in sperm production (in quality and quantity) are always involved prostate gland and Stomach (assimilation and alimentary energy - Gu Qi).
At last it is significant the hereditary origin of this pattern that involved Yuan Qi.
When there is an involvement of Anterior Heaven and Posterior Heaven, there is a problem of Yin energy.
According to eastern examination and on the basis of classical texts this infertility is classified as Bu Yun Yin Shen Xu (infertility by Kidney Yin deficiency).

TREATMENT
Western. It is indicated GnRH therapy. Some reports based on clinical impression indicate a beneficial effect of this therapy as evidenced by an increase in motility, concentration and normal spermatozoa; negative effects of GnRH therapy appear to be minimal.
Therapy consists of GnRH administartion every two hours, either by subcutaneus injection or by pulsatile pump.
But in this case that therapy was not effective.
About homeopathic therapy they are no data, but in this case that therapy was not effective.
Eastern. In the human medicine many works have demonstrated that acupuncture therapy improve fertility rate, in number, concentration and morphology of spermatozoa.
Bartov et al. and Sinclair have defined acupuncture as a 'valid therapeutic opportuneness in male infertility'.
In TCM many scopes are given to psychic aspects of pathology.

- In So Wen is writing: "In Yin deficiency disease it is necessary to nourish Water of the Kidney" that is to tonify all of Yin by means of Ren Mai.
Ren Mai is the 'sea of Yin meridians', that regularizes the energy of Yin Vessel in the body, and it nourishes the reproduction organs.
Ren Mai is linked to Yin Qiao Mai (Yin QM): both these vessels form the traditional couple 'Prince and Vassal'.
Yin Qiao Mai allows the Yin circulation and take up the hereditary energy towards BL 1(Jingming); it supports the Gu Qi.
These classical information have suggested needling LU 7 (Lieque) and KI 6 (Zhaohai).
The combining of these two acupoints is effective in the treatment of Kidney, Lung, Liver and Heart diseases. There is a linked between Metal meridian (Shou Tai Yin) and Water meridian (Zu Shao Yin); Metal nourishes Water, and therapeutical effects are strengthen.

- In the traditional formulas is mentioned CV 3 (Zhongji).
The name of this point is related to Pole Star, the star involved in conception (the heaven energy spreads between Pole Star and GV 20 - Bai Hui - during coitus); at level of this acupoint the three Yin meridians of the foot (KI, SP, LR) meet CV.

- In the traditional formulas is mentioned GV 3 (Yaoyangguan).
The name of this point is related to his function of hinge between Yin and Yang.

- The 36th Difficulty of Nan Jing says: "The two Kidneys are not both Kidneys. The left one makes up the Kidney, while the right one makes up lifegate. The lifegate is the abode of all the spirit essence. It is the place to which is tied the original qi. In males, it stores the essence".
This information has suggested treating GV 4 (Mingmen) and the surrounding lumbar area.
Cheng Fu Zheng of the Ming Dynasty, an adherent of Immortal Ge's teaching, gave great significance to action of moxibustion in case of deficiency.
So GV 4 (Mingmen) was warmed with Artemisia sinensis arranged in wood box.

- The physiology of prostate gland is related to Chong Mai vessel.
Chong Mai is the 'sea of Blood'', that adjusts energy and blood of twelve meridians and it bears genital functions and regulates endocrine glands.
Chong Mai is linked to Yin Wei Mai (Yin WM): both these vessels form the traditional couple 'Father and Mother'.
Yin Wei Mai distributes the Kidney Jing in the body and it implements the connection between interior (Yin) and exterior (Yang).
These classical information have suggested needling SP 4 (Gongsun) and PC 6 (Neiguan).
The combining of these two acupoints is effective in the treatment of Spleen, Heart, Liver, Stomach.
There is a linked between Fire meridian (Shou Jue Yin) and Earth meridian (Zu Tai Yin); Fire nourishes Earth and the therapeutical effects are strengthen.

- Liver stores blood (Xue) and it normalizes the function of CV, Lower Burner and genital organs.
According to Tradition: Water nourishes Wood, that is Kidney Jing nourishes Liver Xue; but Liver Xue nourishes Marrow that produces Xue.
Xue and Jing produce themselves mutual.
With purpose to aid Liver functions and to solve endogenous toxicity were needling LR 3 (Taichong) and LR 8 ( Ququan).

- At last, some acupoints with global effects are employed, like ST 36 (Zusanli), LI 4 (Hegu), CV 17 (Tanzhong), BL 40 (Weizhong).
On the basis of these elements, the aim of treatment was tonifying Yin of Kidney (hereditary aspect, endocrine system, prostate, epididymis) and regulating Yang of Kidney (erection, ejaculation, external genitalia).

Used Needles. Acupuncture: GV 3 (Yaoyangguan), BL 18 (Ganshu), BL 47 (Hunmen): needling with Chinese sterile acupuncture needles for single use, gauge 0,30 - length 70mm.
CV 3 (Zhongji), BL 40 (Weizhong): needling with Chinese sterile acupuncture needles for single use, gauge 0,25 - length 40mm.
BL 1(Jingming), LU 7 (Lieque), KI 6 (Zhaohai), LR 3 (Taichong), LR 8 ( Ququan), SP 4 (Gongsun), PC 6 (Neiguan), ST 36 (Zusanli), LI 4 (Hegu), CV 17 (Tanzhong), GV 1 (Changqiang): needling with Chinese sterile acupuncture needles for single use, gauge 0,30 - length 25mm.
Depth of stimulation: needles were insert inside the acupoints for all their lenght (except BL 1 - Jingming -).
All of needles were stimulated untill perceiving De Qi.
Haemoacupuncture: needles gauge 0,60 - length 25mm.
Moxibustion: it was used pure moxa rolls for mild moxibustion by China National Medicine and Health Products.

Acupuncture Treatment in Chronological Order.

17 January 2001

BL 1(Jingming):

• Location: at the medial canthus of the eye, in the indention dorsal to the base of the nictitaing membrane.

• Function: endocrine problem of hypothalamus, hypophysis, and pituitary glands.
• Nature of the point: meeting point of Yin Qiao Mai, Yang Qiao Mai, GV, SI, TH, ST, BL.
• Note: bilateral insertion; it corresponds with Sui (Hexagram 17) that is 'Venere Point', connected with genital diseases.

LU 7 (Lieque):

• Location: craniomedial edge of the radius, immediately proximal to the medial styloid process; 1,5 cun proximal to the transverse crease of the carpal joint; caudal to the extensor carpi radialis and cranial to the tendon of the flexor carpi radialis.
• Function: regularizes Lung Qi, Ren Mai, tonifies Yin of all of body, has an action on penis problem.
• Nature of the point: Luo point of Lung meridian; master point for Ren Mai; master point for head and neck.
• Note: monolateral left insertion; it corresponds with Lu (Hexagram 56) that attends to emotional strains and Liver toxicity (Metal controls Wood).

KI 6 (Zhaohai):

• Location: just distal of the medial malleolus of the tibia.
• Function: tonifies Kidney Yin, treats prostate gland disease and regularizes external genitals.
• Nature of the point: Master point of Yin Qiao Mai; it has an influnce on CV 6 (Qihai).
• Note: monolateral right insertion; it corresponds with Sun (Hexagram 57) involving in lumbar pathology and in diseases of genitalia.

LR 8 ( Ququan):

• Location: behind the medial condyle of the femur, in front of the tendons of the semimembranosus and semitendinosus.
• Function: allows Liver Qi, treats testicle flogosis, removes Xue stagnations with purpose to solve impotence and external genital problems.
• Nature of the point: Water point of Liver meridian; He (sea) point of meridian; tonification point of Liver.
• Note: monolateral left insertion; it is important remembering that from LR 8 ( Ququan) the pathway of Liver meridian surrounds genitals and goes into them; it corresponds with Ting (Hexagram 50) that favours alimentary assimilation for Liver Yang functions.

GV 3 (Yaoyangguan):

• Location: between the 4th and 5th lumbar vertebrae overlying the supraspinous ligament.
• Function: tonifies Qi and Yang of Kidney, tonifies Yuan Qi, regularizes the 'Water Way', benefits loins, treats impotence and testicle insufficiency, regularizes genital functions.
• Nature of the point: action on thyroid gland; master of lipides and triglycerides.
• Note: it corresponds with Ts'ui (Hexagram 45) that treats illness from internal causation (imbalance of the seven emotions, sexual excess).

CV 3 (Zhongji):

• Location: 4 cun caudal to the umbelicus on the ventral midline.
• Function: regularizes Lower Burner treating all of external genital problems, tonifies Kidney treating prostatitis, male infertility and ejaculate problems.
• Nature of the point: Mu (alarm) point of Bladder; meeting point of LR, SP, KI with Ren Mai; gathering point of three Yin( KI, SP, LR) Tendino - muscolar meridians of the hindlimb; gathering point of ST Tendino - muscolar meridian.
• Note: this acupoint was treated with needle and moxibustion (a piece of moxa roll put on the needle handle); it corresponds with Zhong Fu (Hexagram 61) that controls fertility, sexuality, head and nature (disposition).

GV 4 (Mingmen):

• Location: between the 2nd and 3rd lumbar vertebrae, dorsal to BL 23 (Shenshu), overlying the supraspinous ligament.
• Function: tonifies Qi and Yang of Kidney, tonifies Yuan Qi, regularizes the 'Water Way', benefits loins, treats all of sexual problems, above all impotences and infertility.
• Nature of the point: according to Taoist Medicine it nourishes Kidney and 'Cinnabar Field'.
• Note: this acupoint was warmed with moxa arranged in wood box; it corresponds with Ts'ui (Hexagram 45) that has influence to the spine and Kundalini coils.

Duration of therapy: 25 minutes; at last, after taking off needles and moxa, with purpose supporting stallion energy were performed:

ST 36 (Zusanli):

• Location: one finger's width from the tibial crest and head of the fibula, on the lateral side of the tibia, over the cranial tibialis muscle.
• Function: strengthens Middle and Lower Burner, treats the short breath, tonifies Yang of Kidney treating impotence, has antistress effects increasing Wei Qi.
• Nature of the point: Earth point of the Stomach meridians; He (sea) point of meridian; Ben (horary) point; master point for cranial abdomen and digestive system.
• Note: bilaterl insertion; it corresponds with Chun (Hexagram 3) that is involved with alimentary assimilation and energetic strengthen.

CV 17 (Tanzhong):

• Location: along the ventral midline, at the level of the caudal border of the elbow.
• Function: benefits Lung treating dyspnea, tonifies Yuan Qi, allows the spread of Qi, treats all of disease on ventral surface of the body, has antistress effects.
• Nature of the point: Mu (alarm) point of the Pericardium; Hui (reunion)point of respiratory energy; point 'sea of Qi'.
• Note: in many ancient texts the Pericardium ('Master of Heart') is linked with Sexuality; it corresponds with Kuan (Hexagram 20) that has control on fertility, thyroid and immune system.

Duration of this therapy: 9 minutes; at last, after taking off needles, was performed stretching movements.
At the client was suggested to employ stallion after 4 days since treatment and to take note about horse behaviour.

25 January 2001

The client reported that stallion was employed after 4 days since treatment, once a day, and his sexual performance were better.
A remarkable sensitivity on BL 18 (Ganshu) and along the column were presented, and stallion was showing a light asthenia. The acupuncture treatment was:

BL 1(Jingming):
Note: bilateral insertion.

LU 7 (Lieque):
Note: monolateral left insertion.

KI 6 (Zhaohai):
Note: monolateral right insertion.

CV 3 (Zhongji):
Note: this acupoint was treated with needle and moxibustion (a piece of moxa roll put on the needle handle).

GV 3 (Yaoyangguan):
Note: this acupoint was treated with needle and moxibustion (a piece of moxa roll put on the needle handle).

GV 1 (Changqiang):

• Location: in a depression between the anus and ventral tail base, between the coccygeal muscle and anal sphincter.
• Function: treats asthenia, testicle and scrotal problems, fortifies loins, has antistress effects.
• Nature of the point: Luo point of Du Mai; starting point of secundary vessel (Distinct Meridian) of Du Mai; meeting point of Ren Mai, GB, KI with Du Mai.
• Note: it corresponds with Ts'ui (Hexagram 45) with decisive action on all of the spine column.

BL 18 (Ganshu):

• Location: 3 cun laterl to the ventral border of spinous process of the 13th thoracic vertebrae, at the 13th intercostal space in the musculus iliocostalis groove.
• Function: regularizes and tonifies Liver (Qi, Xue and Yang of Liver), treats genital problems.
• Nature of the point: Shu (association) point of Liver.
• Note: bilateral insertion; this acupoint was treated with needle and moxibustion (a piece of moxa roll put on the needle handle); it corresponds with Sui (Hexagram 17) that helps energetic influnce going from spine, treats mental stagnation and sexual problems.

Duration of therapy: 25 minutes; at last, after taking off needles and moxa, with purpose supporting stallion energy were performed:

ST 36 (Zusanli):
Note: bilaterl insertion.

Duration of this therapy: 9 minutes; at last, after taking off needles, was performed stretching movements.
At the client was suggested to employ stallion after 4 days since treatment and to take note about horse behaviour.

1 February 2001

The client reported that stallion was employed after 4 days since treatment, once a day, and his sexual performance were better, but after coitus the horse was appeared tired and with lumbar pain. It is important remember that this stallion was employed as reining horse and that kind of sport engraves on the hip and hind limbs. The horse was showing asthenia and listlessness. The acupuncture treatment was:

CV 3 (Zhongji):
Note: this acupoint was treated with needle and moxibustion (a piece of moxa roll put on the needle handle).

GV 3 (Yaoyangguan):
Note: this acupoint was treated with needle and moxibustion (a piece of moxa roll put on the needle handle).

GV 1 (Changqiang):
Note: only needle.

BL 40 (Weizhong):

• Location: midpoint of the trasverse crease of the popliteal fossa, between the semitendinosus and biceps femoris muscles.
• Function: fortifies loins, treat lumbago, helps elimination of endogenous toxins.
• Nature of the point: Earth point of Bladder meridian; He (sea) point of meridian; master point for caudal back .
• Note: bilateral insertion; according to ancient Taoist Alchemy every subject has three treasures: vitality, energy and spirit; the vitality has seat in the loins, so it is very important tonify this area by means of this acupoint; it corresponds with Hsiao Ch'u (Hexagram 9) that has action on urinary tract and lumbar area, it balances the emotional life.

LR 3 (Taichong):

• Location: on the medial side of the leg, halfway down the cannon bone.
• Function: regularizes Liver (Qi, Xue, Yang and Yin), enlives Xue, regularizes Qi flow, treats lumbar ache, has intense action on testicle.
• Nature of the point: Earth point of Liver meridian; Shu (stream) point of meridian; Yuan (source) point .
• Note: bilateral insertion; it corresponds with Shih (Hexagram 7) that works on mind, disease caused by Kidney vacuity, venereal diseases, genital problems.

BL 18 (Ganshu):
Note: it was performed haemoacupuncture: was taken a blood sample from jugular vein and immediately were injected 0,3ml of fresh blood into both of these acupoints; according to Tradition the erythrocyte is the Emperor Seal - Heart - and it take the imperial order to repaire damage.

Duration of therapy: 25 minutes; at last, after taking off needles and moxa, with purpose supporting stallion energy were performed:

ST 36 (Zusanli):
Note: bilaterl insertion.

LI 4 (Hegu):

• Location: on the medial side of the leg, on the palmar border, distal of the base of metacarpeus II.
• Function: regularizes Lung, tonifies Yang of all body, has antistress effects increasing Wei Qi.
• Nature of the point: Yuan (source) point of Large Intestine meridian; master point for face and mouth.
• Note: bilaterl insertion; it corresponds with Bi (Hexagram 22) that treats Lower Burner and lower back pain.

Duration of this therapy: 9 minutes; at last, after taking off needles, was performed a transrectal massage of prostate gland.
According to a Taoist classic, the Su Nu Jing, this particular technique restores normal prostatic functions, promote the sperm production,and support the wellbeing of all of male body.
At the client was suggested to employ stallion after 3 days since treatment, to take note about horse behaviour and to repeat B.S.E.

26 February 2001

The client reported that stallion was attended to coitus with more ease and without stress; the respiratory problem was reduced and B.S.E. was better (see table 2); physical exam and ultrasonography of testes were normal; a smaller sensitivity on BL 18 (Ganshu) remained. The acupuncture treatment was:

GV 3 (Yaoyangguan):
Note: this acupoint was treated with needle and moxibustion (a piece of moxa roll put on the needle handle).

CV 3 (Zhongji):
Note: this acupoint was treated with needle and moxibustion (a piece of moxa roll put on the needle handle).

SP 4 (Gongsun):

• Location: in a depression on the hind limb, mediodistal to the head of the medial splint bone.
• Function: regularizes Middle and Lower Burner, enlives Xue, treats asthenia, support Chong Mai regulating genital organs.
• Nature of the point: Luo point of Spleen meridian; master point for Chong Mai.
• Note: right monolateral insertion; it is important to stabilize the achieved energy level; it corresponds with Sung (Hexagram 6) for Yin/Yang disharmony, Qi/Xue disharmony and prostation.

PC 6 (Neiguan):

• Location: 2 cun above PC 7, in front of the chestnut.
• Function: regularizes Liver Qi, tonifies Heart, benefits diaphragm, treats impotence.
• Nature of the point: Luo point of Pericardium meridian; master point for Yin Wei Mai.
• Note: left monolateral insertion; it completes the particular combination on Yin sector; it perform the traditional function of Xin Bao Luo, the protective net from Heart to genitalia; it corresponds with Lü (Hexagram 10) that sures cardiac activity and his emotional aspect, and sexual life.

BL 47 (Hunmen):

• Location: in the 15th intercostal space, lateral to BL 18 (Ganshu).
• Function: regularizes Qi and Yang of the Liver, controls Hun (spiritual soul)that resides into Liver; Hun is associated with sexual life.
• Nature of the point: it is located on external branch of Bladder meridian.
• Note: it corresponds with Wei Chi (Hexagram 64) that treats Kidney vacuity, fatigue, Liver problems.

Duration of this therapy: 25 minutes; at last, after taking off needles and moxa, was performed a transrectal massage of prostate gland.
At the client was suggested to employ stallion after 3 days since treatment, to take note about horse behaviour.

13 March 2001

the client reported that stallion was employed with good results and some mares were covered with success.
The horse was more active and lively. He had no lumbar pain or sensitivity on acupoints. The last acupuncture treatment was:

ST 36 (Zusanli):
Note: bilaterl insertion.

LI 4 (Hegu):
Note: bilaterl insertion.

CV 3 (Zhongji):
Note: this acupoint was treated with needle and moxibustion (a piece of moxa roll put on the needle handle).

GV 3 (Yaoyangguan):
Note: this acupoint was treated with needle and moxibustion (a piece of moxa roll put on the needle handle).

Duration of this therapy: 25 minutes; at last, after taking off needles and moxa, was performed a transrectal massage of prostate gland.

DISCUSSION

Acupuncture is very effective to treat this kind of pathology in which there are many physical (endocrine system, genitalia, endogenous toxicity) and psychic (the horse was retreated from sport and his life was too much monotonous) problems on the basisi of hereditary predisposition.
The study of ancient text, for human too, is very important to understand diseases and their treatments by means of careful choice of the acupoints.

ADDENDUM

Table 1

Table 2