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Modern dairy herds work under continual demand for high performance in terms of milk quality and quantity. Most countries provide veterinary care is on a national scale, with coordination between State- and private- interests. In the State of Israel, the mean annual milk yield for 98, 485 Holstein herd book registered cows is 10, 469 kg/cow with 3.26% fat, and 3.07% protein (1). As in many western modern countries, the Israeli dairy system is centralized, and various organizations are involved and multi-connected (Israeli State Veterinary Services, Israeli Cattle Breeders' Association, Milk Marketing Board, and cooperative and non-cooperative veterinarians). Herd health monitoring is done routinely, and as part of the general data collecting regime each cow is checked once a month for somatic cell counts (SCC) in four quarters.

Normal milk should contain only low levels of somatic cells. High somatic cell counts (SCCs) in milk indicate mastitis, subclinical or clinical, with reduced quality and quantity of milk. Most of the cells are white blood cells, with some epithelial cells from mammary secretory tissue. Epithelial cells in milk are part of normal bodily function; they are shed and renewed in normal bodily processes. Normally occurring white blood cells serve as a defence mechanism to fight disease, and assist in repairing damaged tissue.

The milk market relies on SCC to aid in ensuring a quality product. SCCs are monitored to show compliance with national standards. The SCC is assessed in milk taken from the four quarters and mixed before testing. Most markets pay a premium for milk with a low SCC and penalize farmers for a high SCC (above a mark value, usually >350,000 cells/ml). If the SCC is very high, the milk may be declared unmarketable, and the farmer may face other severe sanctions. During routine activities on dairy farms, cows suffer from repeated minor traumatic events, especially to the udder. This can arise, for example in faults in the milking machinery (liner slip, vacuum faults, incorrect pulsation ratios, stray electric voltages on the milk-line etc.), or teat-treads in badly designed cubicles, in rushing cows with pendulous udders. These traumas can irritate the teats or udder tissues, and can induce subclinical or clinical mastitis and high SCCs.

Our pilot test was done to see if we could reduce a high SCC (>350,000 cells/ml) to normal values (<350,000 cells/ml) by injection of specifically selected homeopathic remedies to particular acupoints, and to compare, injection of saline (saline aquapuncture) or homeopathic remedies (homeo aquapuncture) to real and sham acupoints.

Injectable veterinary remedies should be sterile and ready for use. They should be easily available and should contain normal saline (0.9%) but no alcohol. For repeated use of a remedy, the manufacturer’s quality control should ensure ampoule-to-ampoule and batch-to-batch consistency in composition. The remedies manufactured by Heel GmBH (Germany) meet these characteristics, and we used their solutions. The Appendix lists their composition.

Traumeel is considered to be the primary homeopathic combination remedy to treat and heal trauma-induced injuries in animals (2-7). Due to its homeopathic constituents, Traumeel’s main effects are regenerative, antiexudative and antiinflammatory. Cows with subclinical chronic mastitis cannot repel different exogenous pathogenic factors (EPFs) invading the udder tissue. We add a homeopathic remedy that will stimulate the body's own defence mechanisms to expel any undetected EPFs, as well as having a beneficial action on the mesenchyma, and particularly on the lymphatic system in the udder to repel (detoxify) any possible exogenous factors. For this purpose we used Engystol (8). The third homeopathic combination remedy was Lachesis compositum, a remedy specially indicated to prevent and treat bovine mastitis (9, 10).

The selected acupoints were: BL25, BL23, SP18, SP21 all bilaterally, and GV03. "Veterinary Acupuncture" (11) gives the anatomical description of these acupoints, and their specific indications.

In this pilot test 11 high yield cows were selected for the trial. These cows were chosen due to their excellent past performance, outstanding reputation in the country (good genetics and good performances), and SCC far above the normal range (see table 1).

2 cows (405 and 953) had i/m injections of saline (0.9%) into sham acupoints.

3 cows (156. 466, 816) had injections of saline (0.9%) into acupoints.

3 cows (956, 634, 696) had i/m injections of homeopathic remedies into sham acupoints.

3 cows (166, 275, 946) had injections of homeopathic remedies into acupoints.

On October 11 (Day 1), 10 ml saline, or 10 ml Traumeel, was injected/cow.

On October 15 (Day 5), 10 ml saline, or 10 ml Engystol, was injected/cow.

On October 22 (Day 12), 10 ml saline, or 10 ml Lachesis compositum, was injected/cow.

The saline or homeopathic remedy was injected into each of 9 acupoints or sham points at 1.1 ml/point (total 10 ml). This was done to create the same pattern of injection for both the control and the experimental groups. The selected solutions were injected via 21-gauge, 30-mm needles after each area to be injected was cleaned manually, and washed with 70% alcohol, followed by Povidone-iodine.

Table 1 summarises the SCCs in all cows before and after the treatments were imposed. Although the number of cows in each group was small, and there was very high between- and within- cow variation in SCCs, the results were encouraging.

The two cows that had saline injections to sham points showed no improvement; their SCCs remained very high.

The three cows that had homeopathic remedies injected at sham points, improved but the SCC did not fall <350,000 cells/ml, as was desired.

The three cows that had saline injections into acupoints improved but the SCC did not fall <350,000 cells/ml, as was desired; the mean fall in SCC (Pre-Post) was 1,249,333 cells/ml.

The three cows that had homeopathic remedies injected at defined acupoints showed remarkable results; their SCC fell below the target of <350,000 cells/ml.

Table 1. Milk SCC (10³ cells/ml) in 4 quarters/cow. The SCC of the first 4 months (July-Sep) were before the injections. The Nov SCC was after the end of the injectons (the treatment-effect).

*Estimate based on the mean of the July and September values

This preliminary clinical trial suggests that, compared to the other therapeutic procedures, acupoint injection with homeopathic combination remedies may reduce the SCCs of high-yield dairy cows with chronic non-responsive mastitis.

In bovine subclinical mastitis, the body's self-healing powers cannot cope well with the influx of different EPFs, as well as many traumas to the udder. By injection of specific homeopathic remedies, an immunological bystander reaction was stimulated (12, 13). In-situ macrophages phagocytise the minute quantities of injected ingredients in amounts too small to produce a complete immunological reaction. After phagocytosis, the macrophages return molecules of the ingested substances to their surface. These molecules ("motifs") are bound to the macrophage's membrane-related Major Histocompatibilty Complexes (MHC's). Nearby naοve and undifferentiated lymphoytes (Th0) recognize the "motifs", remove them from the macrophage, and bind them to their own receptors. This specific action is a signal for the Th0 to be transformed into regulatory lymphocyte (Th3), a committed lymphocyte. The Th3 cells wander into regional lymph nodes, and via cell division multiply to many "motivated and committed" cell clones. They leave the lymph nodes via blood vessels and reach all organs and tissues. The indicated motifs facilitate an increased penetration of the Th3 cells into the relevant area. Chemotactic factors (complement factors, chemokines etc.) from the inflamed area (the cow's udder) support this organo/histotropy. As soon as Th3 reaches their target organ (recognition, similarity between their motifs and the target cells organ), Th3 cells immediately start to synthesise " Transforming Growth Factor- beta" (TGF-beta, the most potent antiinflammatory cytokine in the body) and start inducing Th2 to released interleukin-4 and -10, which support the effect of TGF-beta. This stops inflammatory processes, regenerates normal udder tissue, thereby decreasing the SCCs.

Also, the concentration of mast cells is significantly higher in an acupoint than in "sham points" in control areas (14). Mechanically, by causing local microtrauma, acupuncture per se stimulates the mast cells in-situ to release their mediators (15). These active mediators, including histamines, cause many local changes, such as phagocytosis (16). The released mediators also cause vasodilation, increase capillary permeability, and trigger a cascade reaction. These induce migration of monocytes from the blood vessels into the local tissue. The monocytes become macrophages once they have gained access to the extravascular space, and further enhance phagocytosis, a reaction that is so important in the bystander reaction. It has been shown that the phagocytic activity of the monocytes was increased even before the migration to the local tissue (17). One might say that the acupunctured arena serves as an amplifier for the bystander reaction.

Documented acupuncture effects on immunological responses include increase in white blood cell counts, especially T cells (18, 19, 20) and attraction by chemotaxis of these cells to the punctured area, again, causing T cells to react to the presented "motifs" on the macrophages. Once the primary Th3 cells are "motivated", they begin to clone themselves in the lymph nodes. X-ray microscopy and electrophoretic studies of acupoints indicate direct pathways from the acupoint to the nearest lymph node (21, 22), again providing the best possible terrain for the processing of the bystander reaction. From a very basic scientific understanding of the relationship between homeopathy, immunological bystander reaction, and their amplification by using acupuncture, we can begin to understand the mechanisms behind the success in our specific clinical trial to reduce bovine somatic cell counts to normal values.

These preliminary data suggest that, compared to the other therapeutic procedures, acupoint injection with homeopathic combination remedies reduced the SCCs of high-yield dairy cows with chronic non-responsive mastitis. Further research in this area is needed in relation to reduction of SCCs in chronic subclinical mastitis in highly stressed cows on modern dairy farms, and because of the small number of cows in each group and the very high between- and within- cow variation in SCCs.

I thank Phil Rogers MRCVS, Dublin, Ireland, for help in the final editing of this article.

1. "Israeli Veterinary Services & Animal Health Information Bulletin". 2001.
2. Serrentino J: "Traumeel intramammary gel for bovine mastitis". Biological Therapy. Winter 2003: 14-15.
3. Ben-Yakir S: "Equine chronic sacroiliac subluxation". Journal of the American Holistic Veterinary Medical Association 2002, Vol. 21, 3: 13-14.
4. Szumlakowski R: "Biological medicine for horses". Biologische Tiermedizin 1985, 1: 7-9.
5. Wiendieck D: "Biological treatment of Equine lameness and flu". Biological Therapy 1989, 7, 1: 23-24.
6. Gratz H: "Traumeel ad us. vet. as basic therapeutic agent in the veterinary medicine treatment of small animals". Biologische Tiermedizin 1991, 8, 4: 115-122.
7. "Veterinary Guide" by Heel, English edition, June 2000: 122-125.
8. "Veterinary Guide" by Heel, English edition, June 2000: 96.
9. "Veterinary Guide" by Heel, English edition, June 2000: 104.
10. Macleod G: "The treatment of cattle by homeopathy" The C.W. Daniel Company Ltd., 1991: 120.
11. Kothbauer O, VanEngelenburg GD: "Acupuncture in cattle". Veterinary Acupuncture - Ancient art to modern medicine ed. Schoen AM, Mosby, second edition, 2001: 565-576.
12. Carvalho CR, Vaz NN: " Indirect effects are independent of the way of tolerance induction". Scand Journal Immunology 1996, 6: 613-618.
13. Weiner L, Meyer F: " Bystander Suppression". Ann New York Acad Sci 1996, 778: 1-418.
14. Song JM: "Preliminary observation on mast cells in acupoint structure". J Trad Chin Med 1980, 3: 26-28.
15. Gao S, Ming CR: " The morphological observation on rat's peritoneal mast cells under electro-acupuncture at point ST36". Acupunct Res 1984, 1: 19-22.
16. Mu X, Xie ZQ: " Review on structure study of acupoint and conjecture on its nature". Chin J Vet Med 1994, 20, 11: 40-43.
17. Petti F et al: " Effects of acupuncture on immune response related to opioid-like peptides". J Transitional Chin Med 1998, 18: 55-63.
18. Chao WK, Loh JWP: " The immunologic responses of acupuncture stimulation". Acupunct Electrother Res 1987, 12;282-283.
19. Pomerantz B: "Scientific basis of acupuncture". Basics of Acupuncture 1998: 6-47.
20. Cheng HP: " Study on acupuncture and moxibustion immunity and its regulation". Acupunct Res 1988: 3: 167-178.
21. Gong CH: " On the relation between the channel and lymphatic system". Shanghi J Tradit Chin Med 1979, 4: 35-40.
22. Gong CH et al: Proc. Sec. National Congress on Vet. Acu 1984; 184.

Heel GmBH, Germany, supplied the homeopathic injections in 5ml ampoules by for veterinary use only. The D (decimal) dilution is equivalent to the X (1 in 10) dilution.

Traumeel ad usum vet.: Each 5ml injection ampoule contained: Aconitum napellus D4 0.3 ml, Aristolochia clematitis D11 0.25 ml, Arnica montana D4 0.5 ml, Atropa belladonna D4 0.5 ml, Bellis perennis D4 0.25 ml, Calendula D4 0.5 ml, Chamomilla D5 0.5 ml, Echinacea angustifolia D4 0.125 ml, Echinacea purpurea ex planta tota D4 0.125 ml, Hamamelis D3 0.05 ml, Hypericum D4 0.15 ml, Millefolium D5 0.5 ml, Symphytum D8 0.5 ml, Hepar sulphuris D6 0.5 ml, Mercurius solubilis Hahnemanni D8 0.25 ml.

Engystol ad usum vet.: Each 5ml injection ampoule contained: Vincetoxicum hirundinaria D6 0.03 ml, Vincetoxicum hirundinaria D10 0.03 ml, Vincetoxicum hirundinaria D30 0.03 ml, Cinis vincetoxici D30 0.005 ml, Sulphur D10 0.015 ml, Sulphur D4 0.015 ml.

Lachesis compositum ad usum vet.: Each 5ml injection ampoule contained: Lachesis mutus D6 0.2 ml, Pyrogenium-Nosode D6 0.2 ml, Echinacea angustifolia D1 0.1 ml, Pulsatilla pratensis D2 0.05 ml, Juniperus sabina D3 0.1 ml.