Treating Insomnia by Acupuncture.

Ice or heat for injuries?

acupuncture fire iceA question I am often asked in clinic is “Should I use ice or heat on this injury?”.

The icing controversy

The conventional viewpoint is that it’s best to ice an injury in the first few hours and to apply heat to a chronic (long-lasting) injury. Ice, along with rest, compression and elevation (R-I-C-E), is seen to limit swelling and inflammation for the first 24-48 hours following an injury. However, the use of ice has recently been questioned by some in Western medicine, and has never been advocated in Traditional Chinese Medicine. In clinic, what we tend to see is that people continue to ice injuries long after this initial period, and that this can lead to problems.

This is particularly true for tendons and ligaments, as these structures naturally have less blood supply than muscles. So ligament and tendon injuries are particularly likely to become longstanding if we interfere with the already low blood flow.

So among some sections of the sports injuries world, for tendon and ligament injuries, RICE has been superseded by M-E-A-T (movement – exercise – analgesia (pain relief) – treatments (that promote blood flow).

Conventionally, ice application is recommended immediately after an injury under the premise that it helps the coagulation process, limiting bleeding from damaged blood vessels. The second reason put forward for icing an injury is that ice can ease inflammation. Thirdly, it has a numbing effect so can help relieve pain.

So let’s look at these aspects in turn.

Stopping bleeding immediately after an injury certainly makes sense. But how long is the window of opportunity for this? One animal study suggests that critical period for preventing secondary injury (from swelling due to bleeding around the injury) may be much shorter than we originally thought – somewhere from 30 minutes to 5 hours, with the first 30 minutes being the most critical.

It’s generally accepted that too much inflammation is a bad thing. But some animal research shows that interfering with inflammation after trauma may be detrimental. It could actually slow down healing. Researchers have found that injured cells produce the inflammatory hormone IGF-1 (insulin-like growth factor-1), which significantly increases the rate of muscle repair. In mice bred to not produce IGF-1, healing after an injury was slower than in normal mice.

How about pain relief? In 2004, researchers looked at all the available studies to try to determine the effectiveness of ice after injuries and surgery. As part of this, they looked into pain relief. They found that while ice helped to reduce pain, the majority of studies showed that compression alone was just as effective. They also noted that there wasn’t much good-quality research into this area.


How Traditional Chinese Medicine sees cold

In Chinese Medical theory, too much cold is not a good thing. In fact it is seen as the root of many problems, with the cold becoming lodged in the tissues, leading to ongoing stiffness and pain.

Of course, in ancient China there were no freezers. Only those who lived in cold or mountainous regions would even have had access to ice. So people needed other ways to treat injuries. Traditional Chinese Medicine has a whole toolkit of techniques to help heal injuries. For acute injuries, a form of massage incorporating acupressure points (tui na), as well as acupuncture and moxibustion (a herbal heat treatment on specific points) can help relieve pain and reduce swelling. For chronic injuries that are slow to heal, as well as the above therapies, techniques such as Tai Chi can be very useful in gently promoting movement and freeing up the area. These forms of treatment correspond much better to the MEAT viewpoint than the ICE protocol – Tai Chi for movement and exercise, acupuncture for analgesia (pain relief), and acupuncture/massage and moxibustion for treatments that promote blood flow, thereby promoting rather than hindering the body’s natural healing mechanisms.


How does heat help after an injury?

Heat is certainly useful in the chronic phase of an injury, as it relaxes the area, promotes blood flow and relieves pain. I generally recommend patients apply warm packs after any swelling has gone down. Another approach is to use ginger soaks or compresses, which also have a warming action. [Link to ginger poultice article]

When used correctly, heat is also very useful in the acute phase of an injury. If you come to see me in the first couple of days after minor trauma, I will perform a full assessment of the injury. Then I will usually burn small cones of moxa, derived from the leaf of the mugwort plant, to apply heat to specific points around the site. I can also teach you how to use this technique at home between clinic visits, to maximise the rate of healing. When used in this way, moxa actually has a slight cooling effect (by encouraging local sweating), but is much gentler than ice. It encourages local blood flow and reduces pain, allowing you to gradually get back to the activities you enjoy. Other moxibustion techniques are useful once the inflammation has started to subside and we are concentrating on regaining range of motion.

Gentle acupuncture using very fine needles at specific points is also helpful in triggering the body’s healing mechanisms.


Heat or cold for injuries – summary.

  • See if you can avoid ice if possible, especially for injuries likely to involve ligaments and tendons rather than muscles – in other words the sinewy parts of the body: ankles, knees, wrists/hands. If you are going to use ice, restrict it to the first 24-48 hours. Make sure any cold compress / ice pack is well wrapped in a towel to avoid injuring the skin from excessive cold. Use for no longer than 20 min at a time.
  • Heat is more useful after this stage, along with gentle mobilisation, depending on the extent of the injury. Be guided by your body and stop any movements that make the pain worse.
  • If you can get in to see an acupuncturist in the first day or so after the injury, this is very useful and may allow you to avoid using ice and speed up recovery.

Acupuncture in Pregnancy

acupuncture and pregnancyAcupuncture is very useful in pregnancy, from alleviating exhaustion and morning sickness in the early weeks to bringing relief from back pain, haemorrhoids and indigestion later in pregnancy. It can even help a breech baby turn head down!

As you approach your due date (from about 35 weeks), we recommend a weekly program of “pre-birth” acupuncture to prepare for labour. Women who have this sort of acupuncture program are less likely to need interventions during labour than those who don’t.

Here are some of the pregnancy-related issues our Acupuncturists use Acupuncture to help with:

  • Morning sickness
  • Tiredness/exhaustion
  • Anxiety
  • Insomnia
  • Swollen ankles and fingers
  • Carpal tunnel syndrome
  • Indigestion, acid reflux
  • Pelvic pain
  • Sciatica and low back pain
  • Breech baby and other malpositions
  • High blood pressure
  • Induction of labour (in some circumstances)

Plus the benefits of Acupuncture extend to helping with recovery from labour, promoting the flow of breast milk and treating mastitis.

Chinese herbal medicine is also helpful during pregnancy, with several thousands of years of safe use in pregnant women

Our Acupuncturists are experienced in working with women at all stages of pregnancy and in the post-birth period. Health-fund rebates are available for Acupuncture treatments.


Acupuncture for Fertility

acupuncture fertilityIf you’re having fertility issues, we recommend you seriously look into having Acupuncture and Chinese Herbal Medicine. Many conditions reducing fertility can be helped with this combination of treatments. These include:

  • Endometriosis
  • Polycystic ovarian syndrome (PCOS)
  • Unexplained infertility
  • Male fertility issues

If you are thinking about starting a family (or adding to it!), our Acupuncturists recommend a 3 month pre-conception programme of Acupuncture (with Chinese Herbal Medicine if required). This allows us to find the root cause of any issues and get you in the healthiest possible state to conceive.

For those with known fertility problems, or those needing assisted reproduction techniques like IVF, Acupuncture really comes into its own. It is very useful in maximising your response to treatment and coping with the stress associated with these procedures. For IVF, there are key times in the cycle that it’s important to have acupuncture treatment for the best results.

Our Acupuncturists are experienced in helping couples boost their fertility naturally, and in working in with an IVF regime. Health-fund rebates are available for Acupuncture treatments.


Acupuncture and Chinese Herbal Medicine in Pregnancy

acupuncture fertilityPart 1 – Early pregnancy

Congratulations, you’re pregnant! While you might be thrilled to bits, you might not yet be experiencing that “glow” everyone talks about. In fact you might be feeling distinctly unglowing! Some women breeze through this stage of pregnancy but many find their energy is at rock bottom and they experience anything from “morning sickness” to all-day queasiness to outright nausea and vomiting. You may also feel anxious about the weeks and months to come, especially if you’ve previously had fertility struggles or a miscarriage.

The good news is that acupuncture and Chinese herbal medicine can help with many of these conditions.

You might be wondering if acupuncture and Chinese Herbal Medicine are safe in pregnancy. The answer is a resounding “Yes”, as long as given by a qualified practitioner who has been trained in the points and herbs to use during pregnancy and those to avoid.


Quell nausea naturally

Some researchers think that the heightened sense of smell and aversion to anything but the blandest of food could be part of an evolutionary mechanism to protect the embryo from food poisoning. Perhaps pregnancy hormones boost our sense of smell to protect us from consuming food that has gone off or would be harmful in another way. This certainly seems to make sense given that we did not have fridges for most of our evolutionary history!

Some women experience disabling nausea to the point where they can barely get out of bed and their diet becomes very restricted. If you are finding it hard to cope with morning sickness, acupuncture can be very useful. Unfortunately this has not yet been well proven by medical research. However, one study looked at 88 women with morning sickness who received either acupuncture plus acupressure or medication plus vitamin B12. The women who had acupuncture/acupressure had similar relief to those who took medication. Although it took longer to gain this improvement, the acupuncture group were actually better able to function in everyday life than those who took the drugs.


Boost your energy levels

Feeling extremely tired in early pregnancy may be another evolutionary adaptation, as it encourages us to rest during this time. That being said, if you are completely wiped out and unable to get out of bed, then treatment is a good idea.

I find acupuncture very helpful in gently boosting energy levels in early pregnancy. Treatments concentrate on boosting energy production by working on specific meridians (energy pathways) and organs, depending on your symptoms, pulse and tongue pattern. In this way, treatments are tailored to suit your individual circumstances. As well as very gentle needling, we warm key points on the body by applying a herb (moxibustion).


Calm your mind

Acupuncture is fantastic for calming the mind and harmonizing the emotions. Many women find themselves feeling anxious at the change in their circumstances and wondering how they will cope with pregnancy, birth or being a mum. Acupuncture treatments, as well as talking it over with a trusted friend, or if necessary, a counsellor, can really help. It can also help you sleep better at a time when hormonal changes may be interfering with your night’s rest.


Protecting the pregnancy

One of the things you may be concerned about is miscarriage, which is something no-one wants to experience. Most miscarriages are caused by chromosomal abnormalities in the embryo, and cannot be avoided. However, other causes do occur, where something seems to go wrong in the implantation process. So, particularly if you have had more than one miscarriage, acupuncture and Chinese herbal medicine may be of benefit. We theorize that these therapies counteract an over-active immune system or aid implantation in another way. This is certainly borne out by studies on animals. There has not been much research done on this in humans, but one study of 250 women who had become pregnant after IVF showed that those who took a Chinese herbal formula as well as a standard medication (progesterone) to support the pregnancy had a significantly lower miscarriage rate (13% miscarried) than those who just took the progesterone (23% miscarried).

Several acupuncture points are also used to reduce the chance of miscarriage. I recommend that women who’ve had previous miscarriages, especially if a chromosomal cause has been ruled out, have acupuncture weekly from conception (preferably before, as part of a pre-conception program) until about 12 weeks. Herbs would also be useful in this situation.

If you do experience bleeding in pregnancy, as alarming as it seems, remember that reasons other than miscarriage are often found, such as bleeding from the implantation site and hormonal changes affecting the cervix. Get checked out medically (see your obstetrician or ask your GP for a referral to your hospital’s Early Pregnancy Unit) and also see your acupuncturist as soon as you can, and hopefully your mind can be put at rest.


Moving past the first trimester

Once they get past the first 13 weeks, many women find they start to feel much better, with energy levels picking up and nausea subsiding. This is when the glow starts! See next month’s newsletter for more about how acupuncture can help later in pregnancy.


More information?

For more information or to make an appointment to see Toby or Louise, our Acupuncturists, call 9904-1333 or contact us here: Contact.

Oriental medicine and fertility – a personal and professional view.

acupuncture fertilityFacing fertility problems can be a very stressful experience. I have always had an interest in this area of health and have worked with many couples trying to conceive. But it wasn’t until I battled with infertility myself that I really understood how deeply it can affect you. I now know first-hand that it can take you to some very dark places. The experience has made me passionate about helping people in the same predicament.

In my case, a combination of issues meant the odds were not looking good, even with IVF. I’m sure that following a pre-conception program of acupuncture and Chinese herbal medicine, and continuing the acupuncture to support the IVF cycles, was instrumental in having a successful pregnancy. Other things helped too, which I will go into later.


First, let’s look at how Oriental medicine boosts fertility.

Oriental medicine looks at the body as being governed by the flow of energy (Qi), which in turn influences the flow of Blood. (The concept of Blood in Oriental medicine is a bit broader than that in Western medicine, so we are talking about more than just the fluid that we know as blood in the West.) The smooth flow of Qi and Blood in the meridians (energetic channels) is vital to the various organ systems working harmoniously together. This is especially true when it comes to the reproductive system. Oriental medical theory sees the Kidney, Liver and Heart organ and meridian systems as being particularly important, but others can be involved as well.

By regulating Qi and Blood flow, Acupuncture and Chinese herbal medicine help regulate the menstrual cycle and calm the mind, so that your body is in the optimum state to conceive and carry a baby. One way that this works is by increasing the blood flow to the uterus and ovaries, something that has been measured in scientific studies.


Preparing the ground.

In Oriental medicine, we see preparation for pregnancy as being very important. In the same way as a farmer would carefully prepare the soil to grow crops, we work on your internal environment so that it is ideal for an embryo to implant and grow for the next nine months. I recommend a pre-conception program of around 3 months, as this is the time an egg takes to mature in the ovary. During this time we focus on observing your body’s natural signs, regulating the menstrual cycle and calming the mind, as well as looking at any lifestyle changes that may be beneficial.

Similarly, it takes between 2 to 3 months for sperm to develop, so this time-frame works well for men too. Ideally, both partners should come in for treatment for best results.


Specific fertility issues.

Many conditions affecting fertility can be helped with Oriental medicine. These include endometriosis, polycystic ovarian syndrome, and sperm problems.
A recently published review of several studies showed that women taking Chinese herbal medicine for fertility problems were 3.5 times more likely to conceive than those having drug therapy alone.


Supporting IVF or ART (assisted reproduction technology).

In some cases, IVF or ART are needed, and acupuncture and Chinese herbal medicine work well with these treatments. In fact, research shows that they can improve the success rate of IVF, particularly in poor responders (when few eggs develop in response to hormonal stimulation) and women over 35.

Again, it is important to prepare the body adequately before having these invasive procedures. During this time, acupuncture and Chinese herbs are useful. When the IVF cycle starts (hormonal injections begin), we usually continue with acupuncture alone, to avoid interactions with fertility drugs. It is important to have acupuncture at key times in the IVF cycle, with a treatment before and after embryo transfer being very important in maximising the chances of implantation. We also tailor the acupuncture program to the type of IVF cycle (long down-regulation, antagonist etc.).

Acupuncture increases blood flow to the reproductive organs, helping follicle development, and preparing the endometrium (lining of the uterus) for implantation. It may also help stop the uterus from contracting after the transfer, thereby helping implantation. It also has a key role in balancing the emotions and counteracting stress. Which is useful, as undergoing IVF can be extremely stressful, and you may find yourself on an emotional rollercoaster.


What else can help with fertility issues?

Here are some of the things I found useful:

  • Research. Spend some time educating yourself about any diagnosed fertility problems, so that you can ask the right questions of your health care team. If further medical help is needed, think carefully about the best specialist and clinic for you. I can help you with some factors to consider.
  • Have your diet looked at by a Naturopath. Many nutrients and supplements are important in boosting fertility. But you need a dietary approach that is sustainable and that doesn’t add to your stress. If you need to lose weight (and this can be important in some types of fertility issues), slow and steady is best.
  • Relaxation / stress reduction. This is important in dealing with infertility, especially if you need ART or IVF. Keeping a balanced frame of mind can be difficult but is important from an Oriental medicine point of view. Yoga worked well for me, but for others the answer might be reflexology or massage. Some people deal with stress through exercise, and this is certainly beneficial. But it’s important not to do intense exercise from a few days after ovulation (or after the embryo transfer if you are doing IVF) until the end of the cycle, as this can be counter productive.
  • Find an outlet. Talking with friends or family that understand, online discussion forums, counselling – these can all save your sanity.


Living The Art Of Breathing.

Health In The Bay Breathing

Since your first breath, breathing has been one of the most important biological functions of your body. The rhythm of breath helps regulate a number of your body’s systems:- Cardiovascular, Respiratory, Gastrointestinal and Metabolic (Endocrine).
When we are stressed or anxious it’s natural for our breathing to become shallow. Simply improving our breath, by breathing deeply and slowly, benefits us at times of stress and anxiety and helps improve restless sleep and insomnia.
The breath is one of the only bodily functions that can be consciously and unconsciously controlled. It’s not surprising that conscious focus on the breath is the foundation of most Buddhist meditation practices.
The average person takes up to 29,000 breaths per day so you’d think we would be experts at breathing. However, it’s common for many people to practice paradoxical breathing. This is an incorrect form of respiration that involves expansion of the upper chest and sucking in the abdominal muscles during inhalation. Paradoxical breathing is linked to many problems including:
  • Reduced oxygen content.
  • Fatigue.
  • Postural problems.
  • Digestive complaints and bloating.
  • Increased muscular tension especially in the neck and shoulders.
  • Lower back pain.

Health In The Bay BreathingHealthy breathing is when the area between the lower ribs bulges out on the in-breath and deflates on the out-breath. This makes sure that air is drawn into the lower parrts of the lungs. The breathing pattern should be slower, even and gentle. Drawing attention to your breath for 20 minutes per day will improve the way you breathe and your general well being, strengthen your lungs, regulate metabolism and help regulate your emotions and response to stress.

In Traditional Chinese Medicine (TCM), the lungs are a source of external Qi (Energy) and are functionally interwoven with the the Heart to regulate flow of blood and Qi around the body. The lungs are also responsible for the nourishment of the exterior body and often dull, lifeless skin or hair can be attributed to poor lung function from a TCM point of view.
Improving lung function, using a combination of Acupuncture, tailored breathing exercises and lifestyle can often have a profound effect on your health and benefit many of the symptoms listed in this article.