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As the veterinary assistant holds down a year-old black tabby named Miso,actual sex video she strokes his chin, and he purrs with delight. Dr. Yeumee Song takes the cue and inserts a thin needle on top of Miso’s head. The purring amplifies, and Miso’s eyes scrunch into blissful slits.

“This relaxes cats a lot, who are very strong and resilient creatures,” Dr. Song says as she expertly sticks needles into Miso.

Dr. Song is one of two physicians at Amber Vet in Singapore trained in veterinary acupuncture. The practice has been growing in popularity in the pet world, and more recently in Asian countries outside of China thanks partially to a shrinking globe.

While acupuncture falls under Traditional Chinese Medicine, which is thousands of years old, pet acupuncture started gaining traction in the rest of Asia about five years ago. Because veterinarians are trained mainly in Western medicine, Asian vets outside of China mostly received formal acupuncture training after Western universities and veterinary associations introduced it about two decades ago. Although, it was slow to catch on.

“Acupuncture is more popular now than 10 years ago due to rising demand for integrative care. It has become more mainstream now than in the past where it was thought of more as an alternative to Western medicine,” Deborah Prevratil, executive director of the International Veterinary Acupuncture Society, says.

When the organization introduced an acupuncture course 20 years ago, only students from the United States, Canada, and Mexico enrolled. But now, there are students from over 12 countries, and IVAS has 2,000 members worldwide.

How pet acupuncture works

Trained veterinarians insert between 10 to 40 needles about a quarter of a millimeter thick into different points along nerve channels that run from the head to the back foot of their patients. The number of needles depends on the size of the pet and severity of the ailment. One session lasts about 30 minutes and costs about $70 while treatments for humans in Singapore span 45 minutes at half the cost.

“Most of the needles just go under the skin, just close to some of the nerve endings where you get the best response,” says Dr. Song, who received a certificate in veterinary acupuncture from Chi Institute of Traditional Chinese Veterinary Medicine, which is based in Florida, last year. It took her about a year and half to complete the training.

“The course is definitely getting more popular,” she says.

One of Dr. Song’s regular patients, Sandy, is a 14-year-old Golden Retriever with vestibular disease. It’s a common condition in older dogs that disrupts their balance, which means Sandy can’t walk on her own. Her owner, Yenni Yap, says Sandy wasn’t responding to the usual treatments, so she decided to try something new a year ago.

Before acupuncture, Yap carried Sandy into the clinic. Now Sandy hobbles in on her own, sometimes leaning on walls for support. “Towards the end of the second week, she regained strength in her back legs and was able to get up on her own,” Yap says. On top of mobility, Yap attributes Sandy recovering from skin issues and a minor stroke to acupuncture.

“[Acupuncture] is not only useful for managing pain, but also for treating skin issues, inflammation, and bladder infections. It even helps younger cats with problems like aggression or phobia,” Dr. Song says.

“I’ve had cats on the table fall asleep right after we put a few needles in” --Dr. Song

In order to quickly calm the cats down, Dr. Song pins the first needle in the center of the cats’ heads. Similar with dogs and humans, it’s known as the “calming point."

“I’ve had cats on the table fall asleep right after we put a few needles in,” says Dr. Song.

The owner of Amber Vet, Dr. Brian Loon, added acupuncture to his clinic’s routine practice three years ago. Since then, he’s seen a steady increase in regular acupuncture patients, from fewer than five per month in the first year to 20 per month now.

In severe cases like spinal problems, Amber Vet uses electro-acupuncture. Doctors clip at least two electrodes on the inserted needles. The clips are hooked up to a machine that sends electric currents to increase stimulation.

The critics and supporters

Pet acupuncture, though popular, is not short of critics. Brennan McKenzie, president of the Evidence-Based Veterinary Medicine Associationand author of SkeptVet blog, argues that acupuncture lacks “adequate scientific evidence.”

A study published in the Journal of Veterinary Internal Medicinein 2006 found no compelling evidence to either support or refute the practice citing inconclusive evidence and limited research. The study collected 31 acupuncture trials and concluded they were lacking. For example, trials with house pets included owners standing next to them, which could lead to the caregiver placebo effect. Owners are also more likely to say the health of their pet has improved if they think their pet has been treated.

But in 2015, the American Animal Hospital Association (AAHA) and American Association of Feline Practitioners (AAFP) issued a joint statement saying acupuncture is a “compelling and safe method for pain management.”

Singapore’s Agri-Food and Veterinary Authority(AVA) doesn’t take a position, but a spokesperson said: “Pet owners are encouraged to seek the advice of their veterinarians when considering alternative therapies for their pets,” in an email.

An alternative tool

When vets exhaust all options, Dr. Loon says, Traditional Chinese Medicine is a valuable tool.

The case closest to Dr. Song’s heart was a 10-week-old white ragdoll kitten paralysed from the neck down after an injury he sustained. The breeder, who brought him to Amber Vet, said there was no way he could sell the kitten. Dr. Song adopted him.

For two weeks, the clinic treated him with a combination of Western medicine and acupuncture. Even though at that time the clinic hadn’t introduced acupuncture, Dr. Song got trained veterinarians to try it on the kitten. He slowly regained some nerve function and could move around on his own.

“He will turn eight this year, and is now generally pain free and has good mobility,” says Dr. Song.

She named him Malakas, the Filipino word for “strong.”