Originally published in the January 2015 issue of Veterinary Practice News When standard acupuncture needling seems out of the question—a patient is too restless to sit still for 10 to 15 minutes—some acupuncturists turn to a related technique called aquapuncture. Instead of relying on the traditional tapered-tip, stainless steel acupuncture needle, aquapuncture uses a hypodermic needle to introduce fluid into acupuncture points. This makes aquapuncture a relatively new technique in acupuncture chronology, as the hypodermic needle was not invented until the late 1800s. In the much shorter, decades-long history of veterinary acupuncture in North America, many remember old-time practitioners traveling from barn to barn with a bottle of fluid they kept in their hot trucks throughout the summer, injecting their recipe of vitamins, homeopathics and sometimes more questionable substances into horses’ backs through a series of open hypodermic needles standing parallel to the spine.1 Scientific acupuncturists tend to eschew this approach because these open needles offer a ready conduit through which bacteria may migrate deeply into tissues, risking abscess formation. Then there is the problem of chemical incompatibility within the solution. Even today, one hears about some practitioners performing aquapuncture using mixtures of various natures, such as DMSO, lidocaine and vitamin B12. While they may assume this is safe because they witnessed no physical reaction through a precipitate, there is no way to ascertain whether a chemical reaction has occurred. With no stability data or information about interactions in mixtures such as these, it would seem prudent to avoid such approaches. Looking Into It What does research on aquapuncture show? In humans, one study compared the acupuncture point injection of vitamin K1 to saline in women with dysmenorrhea (painful menstrual cramping of the uterus). Those who received vitamin K1 aquapuncture experienced significantly less pain (in terms of duration and intensity) than those who received saline injection at the same point (i.e., SP 6, on the distal pelvic limb, caudal to the tibia).2 To study the mechanism of this effect, researchers reported that plasma phylloquinone (vitamin K1) concentrations increased significantly over the next one to two days after the injection.3 As the vitamin K may have had pharmacologic effects on menstrual discomfort, the following question arises: How much of the effect was due to the location of the injection (at an acupuncture point utilized to treat primary dysmenorrhea in women) and how much was due to the drug itself? Conceivably, vitamin K therapy could have decreased menstrual flow as a result of its effects on prothrombin, a vitamin-K-dependent coagulation protein. It also may reduce the production of pro-inflammatory cytokines, and the injection of vitamin K into a muscular acupuncture point such as SP 6 could have caused a “depot” effect, resulting in slow, sustained release throughout the duration of the menstrual cycle. Wet needling, another aquapuncture approach for primary dysmenorrhea, involved lidocaine injection of myofascial trigger points in the abdominal wall. This intervention afforded reduction in menstrual pain for at least one year following treatment.4 Studies A bovine study conducted in the Philippines reported that injection of a 1 percent chili pepper decoction into two acupuncture points for three consecutive days and repeated weekly helped decrease the incidence of mastitis and increased milk production in cows.5 In Asia, administration of placental extract from humans and other species falls into the Chinese herbal medicine repertoire. Placental extract is another substance injected into acupuncture points for pain with putative, though largely unexplored, anti-inflammatory benefits.6 In dogs, acupuncture point injection with autologous stromal vascular fraction or allogenieic adipose-derived stem cells appeared to safely improve hip function in dogs with hip dysplasia.7 Other substances, such as bee venom, seem to work by affecting local nerves at the acupuncture point itself but may confer systemic changes. One study showed that injection of apitoxin at acupuncture points demonstrated effects similar to antibiotics for the treatment of canine pyoderma.8 Bee venom injection, also known as apitherapy, couples the physiologic effect of the venom itself with the distension of the tissue caused by the instilled fluid to activate both peripheral nerves and associated spinal cord segments.9 Apitoxin exhibits both anti-inflammatory and analgesic effects. It also may suppress the pathologic activation of astrocytes within the central nervous system, which then reduces peripheral inflammatory nociception.10 Repeated stimulation with diluted bee venom provides significantly more analgesic value than single venom treatment.11 Again, however, one may wonder how many of the effects of aquapuncture in the aforementioned studies arose from the injected substance itself versus the significance of neurovascular structures at the site of injection (i.e., acupuncture points). Two studies help shed light on this. In horses, a paper published in 2008 in the Journal of Equine Veterinary Science found that a series of aquapuncture treatments using 5 cc of distilled water increased the anaerobic metabolism of Thoroughbred horses.12 In children, saline injections of an acupuncture point on the distal forearm were as effective as droperidol in controlling early postoperative nausea and vomiting. References Jergler D. Acupuncture, chiropractic offer more options. Veterinary Practice News. 03-13-14. Accessed at http://www.veterinarypracticenews.com/Equine-Large-Animal/Acupuncture-Chiropractic-offer-more-Options/ on 11-18-14. Chao T, Wade CM, Abercrombie PD, et al. An innovative acupuncture treatment for primary dysmenorrhea: a randomized, crossover pilot study. Alternative Therapies. 2014;20(1):49-56. Chao MT, Wade CM, and Booth SL. Increase in plasma phylloquinone concentrations following acupoint injection for the treatment of primary dysmenorrhea. Journal of Acupuncture and Meridian Studies. 2014;7(3):151-154. Huang Q-M and Liu L. Wet needling of myofascial trigger points in abdominal muscles for treatment of primary dysmenorrhea. Acupunct Med. 2014;32:346-349. Daga JD, Acorda JA, and Rayos AA. Effects of conventional white needle acupuncture and aquapuncture on mastitis and milk production in dairy cattle. Philipp J Vet Anim Sci. 2013;39(1):133-140. Cho TH and Park KM, Complex regional pain syndrome Type 1 relieved by acupuncture point injections with placental extract. J Acupunct Meridian Stud. 2014;7(3):155-158. Marx C, Silveira MD< Selbach I, et al. Acupoint injection of autologous stromal vascular fraction and allogeneic adipose-derived stem cells to treat hip dysplasia in dogs. Stem Cells International. 2014; Article ID 391274. Jun H-K, Kim S-H, Kim C-M-H, et al. Therapeutic effects of aquapuncture with bee-venom for canine pyoderma. J Vet Clin. 2008;25(6):471-475. Chen C-Y, Lin C-N, Chern, R-S, et al. Neuronal activity stimulated by liquid substrates injections at Zusanli (ST36) acupoint: the possible mechanism of aquapuncture. Evidence-Based Complementary and Alternative Medicine. 2014; Article ID 627342. Kang S-Y, Kim C-Y, Roh D-H, et al. Chemical stimulation of the ST36 acupoint reduces both formalin-induced nociceptive behaviors and spinal astrocyte activation via spinal alpha-2 adrenoceptors. Brain Research Bulletin. 2011;86:412-421. Kang S-Y, Roh D-H, Yoon S-Y, et al. Repetitive treatment with diluted bee venom reduces neuropathic pain via potentiation of locus coeruleus noradrenergic neuronal activity and modulation of spinal NR1 phosphorylation in rats. The Journal of Pain. 2012;13(2): 155-166. Angeli AL and Luna SPL. Aquapuncture improves metabolic capacity in Thoroughbred horses. JEVS. 2008;28(9):525-531. Wang S-M and Kain ZN. P6 acupoint injections are as effective as droperidol in controlling early postoperative nausea and vomiting in children. Anesthesiology. 2002;97:359-366.
