Acupuncture Injection Therapy

A critical evaluation

     If injection of herbs or other substances was necessary for successful treatment of patients, Oriental medicine consisting of Acupuncture and Herbs would never have survived the thousand years plus that it has. Obviously, acupuncture injection therapy is a relatively recent development. Does it signify an improvement in Acupuncture treatment therapy? Does it have any legitimate role in patient treatments? If a legitimate role is present, who should be performing acupuncture injection therapy? What kind of training is necessary for those who perform acupuncture injection therapy? How can the patient (consumer) be protected from possible side effects from acupuncture injection therapy? Should medical malpractice for acupuncturists be increased if they perform acupuncture injections? Will medical malpractice be increased for acupuncturists who doníŽt perform this specialized therapy? Unfortunately these questions were not adequately addressed when the Florida Board of Acupuncture passed the rule allowing Licensed Acupuncturists who had completed 60 hours of training to perform acupuncture injection therapy. We think that these issues do need answers and have offered here what information we could find from the existing literature.

    We think it is important to point out that in China Acupuncture training is not the same as here in the United States. There is far more intermingling of Allopathic Medicine with Traditional Chinese Medicine (TCM). It is not uncommon for allopathic practitioners in China to receive further training in TCM so that there remains strictly allopathic hospitals where MDs practice; there are also hospitals where TCM practitioners with allopathic training practice. At these hospitals you can also find MDs with TCM training. Treatments involving parental delivery of medication (injections) are common in allopathic medicine. While the actual action of performing an injection is easily learned (patients are routinely taught to self-administer subcutaneous injections) there is still training needed to order to this mode of medicine delivery. Injections into the muscles require special training because of the possibility of injection into blood vessels increases when injecting into muscles versus into fat. Adverse reactions can occur within seconds following injections. Anaphylactic shock following allergic reactions can occur. While allergic reactions to herbal preparations ingested or applied topically can occur, the speed and severity of reaction is greater when administer parenterally. Currently the Florida Board of Acupuncture requires only a 60-hours training program to allow Licensed Acupuncturists to PRESCRIBE and INJECT any substance. There is no limit as to what may be injected into the patient. There is no provision to indicate where the acupuncturist is obtaining the substances being injected.

    Examination of the literature from China suggests a wide array of substances that can be injected into the patient. (See link) It appears that Sterile Water or Sterile Saline can be injected into acupuncture points in order to stimulate the point. Needing to use an injection to produce Da Qi (the arrival of Qi) suggests that the acupuncturist was unable to elicit an effective response using the traditional needling methods. Absorption of the material will depend upon a number of factors including depth of injection; amount of substance injected and types of tissue injected into. If Da Qi is obtained with injection of water or saline, how long it would be maintained and the effectiveness of treatment over that of traditional needling has been demonstrated. Injection of water of saline into animals can bypass the need to retain the needles decreasing the need of extended restraints. Needling of uncooperative patients shouldn't be done in this country, so needles should be able to be retained for the appropriate length of time.

    Some of the other substances injected are procaine, which is a local anesthetic and reserpine, which has many uses and as many side effects. (see link) We are not sure whether the effect of injection is being sought from the injection into the acupuncture point or from the effect of the drug being injected. We find it difficult to believe that a traditional acupuncturist without an allopathic medical degree and license in the state of Florida, would be injecting either of these substances into patients. We find it difficult to believe that licensed acupuncturists in Florida would be able to even legally obtain these drugs to inject. These two substances appear to be commonly employed in acupuncture injection therapy for a variety of Western Science diagnosed problems in China. We are not going to debate effectiveness of treatment because our training is not in Western Science pathology. We can only diagnose and treat based on Traditional Chinese Medical theory, which does not include the use of Procaine or Reserpine.

     Injection of herbs is also performed in hospitals in China. Generally the herbs are selected based on their TCM properties for the specific condition the patient exhibits. Chai Hui, an herb that clears Wind Heat, is injected intro muscular (IM) to reduce high fevers. We doníŽt believe that many licensed acupuncturists would be treating high fevers in their office, or do we believe that any hospital in Florida would allow injection of Chai Hui for any reason into an inpatient that this time.

    There have been studies from China comparing administration of herbal remedies by injection or ingestion in the treatment of specific conditions. Based on Traditional Chines Medicine Theory, herbs must enter the proper channels in order to be effective. The role of the Spleen as we all know is to Transport the food we consume (of which herbs are included), to the appropriate organs based on the properties of the food. Only then can unbalance be corrected. Injection of herbal solutions into the body either rely on the herbs being directly delivered to the organ or site of unbalance or to eventually enter the blood to be transported to where the acupuncturists hopes it will do the most good. Bypassing the Spleen by not allowing for normal digestive processing removes this critical component from the healing process. One study (see link) comparing these two methods in the treatment of prostitutes, did not show a benefit of injection of herbs over that of ingestion. How many acupuncturists in Florida would be using herbal injection to treat constitutional conditions? If the acupuncturist received training in China to perform these injections, what conditions did he/she treat? Where was this training done? In a hospital setting or private office setting? What benefit over ingestion of herbs was seen? The point we are trying to make here is why is it necessary to perform injections when the ingestion of herbs is so effective? We have heard that patients in this country do not like the raw herb decoctions. We have found that patients wanting to be returned to balance and regain their health will drink the decoctions. We have found this to be the case because as unpleasant as the decoctions can be, the beneficial healing effects far outweigh any unpleasantness. Herbal powders, pills and capsules are also effective. If the patient does not respond to the herbal remedies is it because of the mode of delivery of the formula selected?

    If Florida Acupuncturists are administering Vitamins, other nutritional supplements or prescription drugs, then they have moved away from Traditional Chinese Medicine. If they believe they are practicing Modern Chinese Medicine, then they should be very careful about travelling into the waters of allopathic medicine. If they are allopathic practitioners also practicing TCM, they are outside the scope of this commentary. If however, they are licensed acupuncturists attempting to practice allopathic medicine under the guise of Modern Chinese Medicine, should rethink their position. Perhaps they would be better suited in returning to school to be properly trained in allopathic medicine so that injections would be more appropriate to their practice.

    We ask the Florida Board of Acupuncture to require any licensed acupuncturist that is currently registered as performing acupuncture injection therapy to indicate to the Board the following information:

    1. what is their background and training in addition to the 60 hours mandated by the Board to prepare them to prescribe and inject substances into patients
    2. what substances have they injected and are currently injecting into their patients
    3. where have they obtained the substances they are injecting into their patients
    4. what evidence do they have that the treatments provide a benefit.

   Hai Sha Ni AP , current The Board of Acupuncture members  in Florida .

  Susan Hathaway AP, Westerm Medicine Ph D.