AQUAPUNCTURE. XIX ItVAS/SIAV International Seminar Arezzo Italy 5-7 October 2018 Dr.med.vet. Linda Furter

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1 AQUAPUNCTURE XIX ItVAS/SIAV International Seminar Arezzo Italy 5-7 October 2018 Dr.med.vet. Linda Furter

2 What is aquapuncture? The injection of water under the skin or spraying of a fine jet of water onto the skin surface to relive mild irritation Aquapuncture is an acupoint stimulating technique in which a liquid agent is injected into the acupoint

3 Different methods to stimulate acupuncture points: physical pressure or vacuum (acupressure and cupping) temperature variation (cauterization, moxibustion, electronic heat devices, infrared lamps, ultraviolet lights, ice, dry ice, and surface coolants such as ethyl chloride) ultrasound (sonapuncture) injection therapy (aquapuncture) implantation of various materials into points laser stimulation (laser puncture) electrostimulation of the acupuncture points, with or without needles (electroacupuncture)

4 Why aquapuncture? Greater therapeutic effect, because of: 1. Longer and more intense stimulation of the acupuncture point 2. Additional stimulating effect of the injected drug

5 Neuronal Activity Stimulated by Liquid Substrates Injection at Zusanli (ST36) Acupoint: The Possible Mechanism of Aquapuncture (Chen CY. Et al., Evid Based Complement Alternat Med. 2014;2014: doi: /2014/ Epub 2014 Mar 6) Aquapuncture organically combines acupoint stimulation and the pharmacological effect of drugs with greater therapeutic benefit compared with either routine acupuncture or intramuscular drug injections To investigate the mechanism of action for aquapuncture, this study used Fos expression as a neuronal activity marker. The various substrates used for injection included bee venom, normal saline, vitamin B1, vitamin B12, botulinum toxin A, neostigmine, and medicinal herbs

6 During the acupoint aquapuncture treatment, the injected liquid substrate causes local spatial configuration changes Both the spatial configuration changes and the liquid substrate stimulate the acupoint and activate the neuronal system They postulated that both the spatial configuration changes and the substrate stimulation in aquapuncture play important roles in the transmission of the acupuncture signal The liquid agents they used were bee venom, normal saline, vitamin B1, and vitamin B12, and dry needle stimulation was used as a control group

7 Results of the study In this study, the volume of each liquid injected was the same and induced similar spatial configuration changes The injections of normal saline, vitamin B1, or vitamin B12 induced no significant differences in the number of Fos-expressing neurons By contrast, the bee venom injection induced a greater number of Fos-expressing neurons than the other agents The main ingredients in bee venom, histamine and melittin, can activate neural fibres and spinal dorsal horn neurons

8 Conclusion In aquapuncture 3 things are important for a good effect: 1. The character of the drug we use to inject 2. The acupuncture points we use for the treatment 3. The volume we use for the injection

9 1. What kind of characters can we use? Commonly: - Saline - Vit. B12 - Homeopathic remedies (like Traumeel,.) - Procaine 2% - Blood - Bee Venom - Glucose (50%)

10 Less common: - Stem cells - Pharmacological drugs (sedation, painkiller,..) - Liquide herbs

11 Vitamin B12 Slow absorption in the tissue Long-time stimulation of acupuncture points Don't use it undiluted. It will burn and cause a local inflammation

12 Homeopathic remedies Depending on the case, I use different remedies Mostly from «Heel» Most frequent I use - Traumeel - Solidago - Echinacea - Ubiquinone - Coenzyme A - Hepar comp. - Cutis N comp. - Cerebrum NM comp.

13 Traumeel Used for: - Dilution of Vit. B12 - Anti-inflammatory effect - As a painkiller - To smooth the muscle - Against Stagnation of Qi

14 Solidago Used for: - Kidney problems - Detox - Kidney Qi Problems

15 Echinacea Used for: - Immunsystem booster - Energy booster - Qi Deficiency - Cancer Therapy - External pathogens

16 Ubiquinone & Coenzyme A In combination often used for: - Enhancing the mitochondrial activity - Promoting good cell metabolism - Antioxidative - Chronic illness - Yin deficiency - Spleen Qi deficiency

17 Hepar comp. Used for: - Liver treatment - Detox - Elevated Liver enzymes - Liver Qi Stagnation

18 Cutis N comp. Used for: - Skin problems - Itching - Skin infections

19 Cerebrum NM comp. Used for: - Dementia - Seizures - Brain cancer

20 Aquapuncture with Procaine (= neural therapy) Used for: - disrupt the circle of pain in the reflex arcs - Effective long-term and short-term pain management - Releases muscle tension - Severe Qi and Blood stagnation

21 Neural therapy Long-term results of therapeutic local anaesthesia (neural therapy) in 280 referred refractory chronic pain patients. (study by Egli s. et al, BMC Complement Altern Med Jun 27) Study showed neural therapy helps to: - Break the circle of pain - Reduce the intake of analgetics And neural therapy is cost-effective and has not much adverse effects.

22 Auto blood acupoint injection Used for: - Antiallergic effects - Autoimmune disease - Blood deficiency - Bad wound healing

23 Effects of acupoint injection of auto blood on expression of pulmonary transcription factor GATA 3 and T-bet proteins and genes in asthma rats. (Mo L. et al, Zhen Ci Yan Jiu Oct;37(5): ) Study with 48 male rats 4 groups (aquapuncture, control, dexamethasone and «model») Aquapuncture: 0.4ml auto blood was injected into BL 13 and BL 23 bilateral Results: - Shows that the injection of auto blood into acupoints can have relieving effects on asthma (similar effect to Dexamethasone) - Blood helps to regulate transcription and expression of certain cytokine

24 Effects of acupoint injection of autologous blood on symptoms and plasma motilin and gastrin levels of diabetic gastroparesis patients. (Chen L. et al., Zhen Ci Yan Jiu Jun;37(3):229-32, 246.) Study with 42 diabetes patients 2 groups (aquapuncture vs. Motilium) Aquapuncture: 2ml auto blood into ST 36, CV 12 and BL 21 Results: - Shows that blood injection can have an effect on cytokine and hormones in the body - Similar effect as Motilium

25 Glucose 50% Used for: - Stimulation of acupoints - Acts locally irritating - Acts astringent and tights the connective tissue

26 Comparison of P6 acupoint injection with 50% glucose in water and intravenous droperidol for prevention of vomiting after gynecological laparoscopy. (Yang LC. Et al., Acta Anaesthesiol Scand Feb;37(2):192-4) Study about 120 postoperative patients 3 groups Compared drug to aquapuncture of Pc6 Results: - Aquapuncture has the same antiemetic effect as droperidol - Control group had significant more emesis after the operation

27 Stem cells Used for: - Different indications - New trend in western medicine - Results are mainly fluctuating - Often promoted in tendon - or chronic tissue repair problems

28 Effect of acupoint injection with bone marrow mesenchymal stem cells on the blood flow in rats with hind limb ischemia. (Chu CJ. et al., Zhongguo Zhen Jiu Dec;29(12): ) Study with 24 rats 4 groups («model», control, aquapuncture and normal muscle injection group) Aquapuncture group: bone marrow mesenchymal stem cells (BM-MSCs) injections into ST 36, SP 6, Kid 6, GB 30, GB 34 Results: - Significant increased blood flow in the aquapuncture group - Better cytokine serum and local level in the aquapuncture group and the normal muscle injection group than in the other 2 groups

29 Indications for aquapuncture In general the same as in acupuncture Advantages of aquapuncture over acupuncture: - Long-time stimulation of points (because of that: less costs, less treatments) - Good for young animals (they move to much for needles) - Combination between acupuncture and homeopathy is possible (better results) - Shorter treatment time

30 An update on acupuncture point injection T. Sha L.L. Gao C.H. Zhang J.G. Zheng Z.H. Meng QJM: An International Journal of Medicine, Volume 109, Issue 10, 1 October 2016, Pages , acupuncture point injection emerged in China during the 1950s, and it is a modified acupuncture technique Acupoint injection is an acupoint-stimulating technique in which a liquid agent is injected to prevent and/or to treat diseases variety of indications, such as pain, nausea, vomiting, and urine retention this method is believed to have a more sustained effect than the traditional acupuncture needling or simple intramuscular injection This article aims to analyse the progress and state of acupoint injection in the last 5 years

31 The mechanisms and underlying effects of acupoint injection appear to comprise the changes in spatial configuration that occur within the acupoint and the therapeutic activities of the injected substrates A study indicated that the injection of ST 36 can activate mast cells and increase their degranulation ratio within the acupoint area (Huang M Xie YY Ding GH. Acupoint-injection of histamine induced analgesic effect in acute adjuvant-induced-arthritis rats. Zhen Ci Yan Jiu 2010; 35: ) Some studies also confirmed that the plasma concentrations of injected drugs change significantly after acupoint injection (Wang YM Gao JH Lu B Peng J Bin F Cui JJ, et al.. Comparison of the effects of carbamyl-beta-methylcholine chloride administered by intravenous, intramuscular and intraacupuncture point injections. J Tradit Chin Med 2012; 32:93 8.)

32 Adverse effects of acupoint injection (An update on acupuncture point injection T. Sha L.L. Gao C.H. Zhang J.G. Zheng Z.H. Meng QJM: An International Journal of Medicine, Volume 109, Issue 10, 1 October 2016, Pages , Acupoint injection is relatively safe procedure. However, a few adverse events have been reported serious adverse effects related to trigger point injections have been reported in recent years These includes retrosternal abscess, pneumothorax, cardiac tamponade, epileptic seizure and vasovagal responses The occurrence of these adverse events mainly depends on the risky operation site of cervicothoracic musculature

33 When do I normally use aquapuncture? Skin cases Chronic itching cases Autoimmune diseases If I am short in time and if I cant come back soon for a second treatment Severe pain (disc disease) chronic, therapy-resistant cases

34 Case example: Chelifa, 19 year old appaloosa mare

35 Vasculitis on both hindlegs since 1 year They tried almost everything Nothing helped

36 TCVM Findings: Metal character Had severe lung problems a few years ago Calm, introverted horse Pulse: thin and weak Tongue: pale and wet BL 18 and 13 were sensitive on the left side

37 Treatment Aquapuncture: - Cutis comp. - Ubiquinone - Coenzyme A mixed together I injected 5ml into BL 25 and BL 21, 3ml into ST36 and GB 34

38 Additional treatment Traumeel orally for antiinflammatory effect Mycotherapie: - Reishi - Shitake

39 Second treatment: After 4 weeks I saw Chelifa again She improved a lot So I did the same treatment again

40 Outcome After the second treatment the vasculitis was almost gone Until now, it didn t came back

41 Questions???

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