Wild baby elephant Bani was paralyzed after being hit by a train. The calf was traumatized and had rigid back legs and hips. A Wildlife SOS medical care team at the Elephant Hospital massages her back legs to encourage movement and circulation. Photo courtesy WildlifeSOS When a young, critically injured female Asian elephant named Bani arrived at Wildlife SOS (WSOS), she presented with life-threatening traumatic injuries. Rescued on February 4, 2024, after sustaining severe injuries from a train collision, the wild elephant calf presented with a significant lumbosacral injury that rendered her recumbent and unable to use her hind limbs. Bani required immediate intervention for pain management and stabilization, followed by intensive supportive care and a prolonged, carefully structured rehabilitation. Bani demonstrated a slow physical response to conventional treatment protocols. This was concerning, as prolonged immobility in elephants can trigger a cascade of secondary complications. Consequently, an alternative adjunctive approach was considered, leading to the incorporation of a modality not typically associated with elephant care: traditional Chinese veterinary medicine (TCVM), specifically electro-acupuncture.1,2 This decision marked a shift in the organization’s approach to elephant medical management and contributed to the expanded use of integrative therapies within its veterinary program. A new tool in elephant medicine Following Bani’s rescue, acupuncture was integrated into elephant care protocols as an adjunctive therapy. While Western veterinary medicine remains the foundation of treatment, acupuncture has been utilized in cases where conventional treatment alone yields limited results. The objective was not to replace standard veterinary care, but to expand therapeutic options—particularly for conditions involving chronic pain, impaired mobility, and gastrointestinal dysfunction.1-3 Initially, Bani lacked isolated hind limb movement, preventing independent standing and ambulation and necessitating crane-assisted support. Following the introduction of electro-acupuncture, gradual and consistent clinical improvement was observed. At present, the elephant is able to stand and ambulate independently, with residual gait abnormalities. Why elephants are different: Scale, safety, and sensitivity The effectiveness of acupuncture has been documented in companion animal practice.1,3 However, translating acupuncture protocols for elephants presents a distinct set of challenges. One of the primary considerations is safety—for both the animal and the veterinary team. Even elephants accustomed to routine handling may exhibit unpredictable behavior when experiencing pain, stress, or exposure to unfamiliar procedures. As a result, performing acupuncture on a 4,000–5,000-kg animal often requires using an elephant restraining device (ERD), which helps minimize risk and allows consistent, safe access to appropriate acupuncture points. Despite these controls, successful treatment requires meticulous preparation and close coordination among veterinarians, caregivers, and trained elephant handlers. Cutaneous preparation represents an additional challenge. The thick, deeply wrinkled skin of elephants readily traps dust and debris, increasing the risk of contamination at needle insertion sites and necessitating thorough site cleaning prior to treatment. Even under optimal conditions, elephant acupuncture is rarely a single-operator procedure. At WSOS, treatment may require a coordinated team of up to five personnel, underscoring successful implementation depends not only on clinical expertise but also on adequate staffing, training, equipment, and time. What it looks like in practice: Elephant responses to treatment Elephants generally adapt well to acupuncture treatment, particularly when behaviorally conditioned and treated in a controlled environment. However, even when appropriately restrained, elephants may exhibit mild, transient restlessness during the initial phase of treatment. This response is likely associated with the De-Qi sensation, which typically occurs shortly after needle insertion or initiation of electrical stimulation. In humans, De-Qi is commonly described as sensations of heaviness, tingling, or dull pressure; in animals, it may manifest as brief restlessness or shifting behavior.4 Importantly, this restlessness is typically short-lived. Once the initial response subsides, most elephants appear to settle and tolerate the procedure well, without evidence of prolonged distress. Given the species’ high level of cognitive and emotional complexity, the veterinary team emphasizes consistent handling, calm treatment environments, and strong caregiver–elephant relationships, particularly when introducing novel therapeutic modalities. Dr. Rahul (left), Dr. Ilayaraja (right), and Dr. Pramod (foreground) treat injured baby elephant Bani with electro acupuncture. Photo courtesy WildlifeSOS Clinical applications: Where acupuncture is making the greatest impact While Bani’s case prompted the initial integration of acupuncture, the use of acupuncture and related TCVM modalities has since expanded to a broader range of clinical indications. These approaches are currently being explored for both acute conditions and longer-term management in elephants rescued from abusive or prolonged confinement situations. Several clinical categories have demonstrated encouraging outcomes. Colic and gastrointestinal dysfunction Colic management in elephants is often intensive and highly time-sensitive. Historically, treatment relied on conventional supportive care protocols, including pharmacological interventions, such as prokinetic agents, anti-flatulent medications, laxatives, and analgesics, alongside rectal rehydration therapy. More recently, electro-acupuncture has been incorporated as an adjunct treatment and appears to support faster resolution of clinical signs and recovery.1,3 For veterinarians, this represents a promising area of application, as improved recovery timelines may reduce discomfort, limit secondary complications, and shorten overall treatment duration—an especially important consideration in large mammals, where gastrointestinal disturbances can rapidly become life-threatening.2,3 Idiopathic ventral oedema Another condition addressed is idiopathic ventral oedema, characterized by swelling along the ventral abdomen and lower body. This presentation is frequently observed in elephants with a history of prolonged restraint or chaining. Previously, management consisted primarily of topical therapies and supportive medications. More recently, TCVM approaches have been introduced, with promising results observed through the application of moxibustion along the conception vessel (CV) channel. Moxibustion, while less familiar to many veterinarians than acupuncture, involves the application of heat—often generated from burning Artemisia vulgaris (mugwort)—near acupuncture points to support circulation,5 with proposed mechanisms including localized heat-induced tissue warming and associated vascular effects.6 At WSOS, moxibustion has become a valuable adjunct in select oedema cases, particularly when combined with conventional treatment strategies. Stifle weakness and mobility impairment Musculoskeletal weakness and degenerative joint disease are common challenges in rescued elephants, particularly those with histories of confinement, malnutrition, overwork, or prolonged chaining.7 In cases of stifle joint weakness, electro-acupuncture is employed using the “Circle the Dragon” technique, in combination with additional supportive modalities. This approach has been associated with improvements in joint stability and mobility.1,3 Even modest gains in mobility can have substantial welfare implications for elephant patients, including reduced pressure sore formation, improved circulation, enhanced gastrointestinal function, and increased expression of natural behaviors. The “Circle the Dragon” technique, also known as “surround the dragon,” is a local acupuncture method widely used in veterinary practice in which multiple needles are inserted circumferentially around a pathological site, such as a wound, swelling, tumor, or localized area of pain. Rather than penetrating the lesion itself, the needles are placed along the perimeter in a circular or ring-like pattern, often angled toward the center of the affected area. In animals, the procedure begins with careful identification of the lesion or painful region, followed by the placement of evenly spaced needles surrounding the site. When applied as electroacupuncture, electrodes are connected between opposite or adjacent needles to deliver mild electrical stimulation, with frequency and intensity adjusted according to the species, condition, and therapeutic goal. This technique is primarily used to enhance local blood circulation, reduce pain and inflammation, and promote tissue healing and repair. From a TCVM perspective, it helps to “isolate and disperse” pathogenic factors while restoring the smooth flow of Qi and blood in the affected region. Importantly, direct needling into infected, necrotic, or highly sensitive tissue is avoided to prevent further tissue damage or spread of infection. The “Circle the Dragon” technique is commonly applied in musculoskeletal injuries, abscesses, wounds, and other localized conditions, and is particularly valuable in large animals such as elephants and horses, where lesions are often extensive and require targeted yet minimally invasive therapeutic approaches. References Xie, H., & Preast, V. (2007). Veterinary acupuncture: Ancient art to modern medicine. Wiley-Blackwell. Schoen, A. M. (2001). Veterinary acupuncture. Mosby. Not a replacement, but an integrative approach Acupuncture is framed as one component of an integrative veterinary toolkit rather than a standalone intervention. Elephants receiving acupuncture continue to undergo comprehensive Western veterinary care, including diagnostic evaluation, pain management, supportive therapies, and dietary management. In this context, acupuncture is applied similarly to its use in companion animal practice—as a complementary strategy to support pain modulation, neuromuscular function, and overall welfare.2 Defining the limits: Where evidence is still emerging In companion animal medicine, a growing body of species-specific scientific literature supports the use of TCVM modalities. In elephants, however, the evidence base remains limited and is still developing. Given the limited published experience with these techniques in elephant medicine, continued clinical experience and systematic investigation are necessary to better characterize indications, outcomes, and limitations.3 Such transparency is particularly important in wildlife and rescue medicine, where new approaches must be critically evaluated not only for potential benefit, but also for feasibility, safety, and reproducibility across varied rescue settings. Long-term goals: Reduced pharmacologic dependence and improved welfare The long-term objective is not simply to incorporate acupuncture, but to apply it strategically—particularly in conditions that traditionally require prolonged pharmacologic management. The welfare implications are substantial. Chronic pain in elephants is associated with reduced mobility, behavioral alterations, decreased appetite, and overall diminished quality of life. Many rescued elephants present with long-standing musculoskeletal compromise and cumulative trauma. By improving mobility and reducing pain, integrative approaches may allow for decreased reliance on high-dose or long-term analgesic use.3 Additional goals include developing species-specific acupuncture protocols for elephants and expanding the clinical knowledge base through systematic documentation and publication of outcomes. This is especially critical in taxa for which published treatment guidelines remain scarce. Within the broader veterinary community, such documentation may become increasingly valuable. As integrative approaches are increasingly explored in megafauna medicine, shared clinical experience has the potential to support standardization, improve outcomes, and foster more evidence-based treatment pathways. Today, Bani is growing quickly. Her mobility allows her to express her natural curiosity and explore the environment around the Elephant Hospital Campus in Mathura, India. Photo courtesy WildlifeSOS A future where elephant recovery looks different For Bani, acupuncture was not a singular solution, but one component of a multifaceted rehabilitation plan that included Western veterinary medicine, supportive therapies, and consistent daily care. Nevertheless, her case contributed to expanding therapeutic options for elephants whose recovery might otherwise plateau. In rescue medicine, progress is often incremental—reflected in improved stance, gait symmetry, appetite, or behavior. In elephants, these changes represent more than clinical markers; they are indicators of regained function and improved welfare. As integrative approaches continue to be refined, they may offer additional avenues for supporting recovery in species far beyond the traditional clinical setting. In elephant rescue, where each step toward recovery carries profound significance, acupuncture may be a valuable adjunctive tool to support functional recovery. Ilayaraja Selvaraj, BVSc, MSc, PGDWADM, is deputy director of Veterinary Services for Wildlife SOS in India. He has been with the organization for more than 20 years, treating elephants, sloth bears, reptiles, birds, and other animals. Wildlife SOS operates 13 rescue centers, a mobile elephant clinic, and five 24/7 rescue hotlines throughout India, including India’s first specialized elephant hospital. References Xie H, Preast V. Traditional Chinese Veterinary Medicine: Fundamental Principles. 2nd ed. Reddick, FL: Chi Institute Press; 2013. Schoen AM. Acupuncture in veterinary patients. MSD Veterinary Manual. Merck & Co., Inc.; updated 2023. Bennaim M, Porciello F, Redding WR. What is the evidence for acupuncture in veterinary medicine? Veterinary Evidence. 2020;5(3):1–18. doi:10.18849/ve.v5i3.300 Hui KKS, Marina O, Liu J, et al. Acupuncture, the limbic system, and the anticorrelated networks of the brain. Autonomic Neuroscience. 2010;157(1–2):81–90. World Health Organization. WHO International Standard Terminologies on Traditional Medicine in the Western Pacific Region. Manila: World Health Organization, Western Pacific Region; 2007. Choi TY, Kang JW, Kim JI, et al. Mechanisms of moxibustion: a systematic review. Journal of Ethnopharmacology. 2012;139(1):10–20. Miller MA, Hogan JN, Meehan CL (2016) Housing and Demographic Risk Factors Impacting Foot and Musculoskeletal Health in African Elephants [Loxodonta africana] and Asian Elephants [Elephas maximus] in North American Zoos. PLoS ONE 11(7): e0155223. https://doi.org/10.1371/journal.pone.0155223
