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How does Acupuncture work?

acupuncture-pointsIt might seem bizarre that inserting needles into various points on the body can influence the way our cells work. But a lot of research shows this is the case.

One of the areas most studied is the pain-killing effect of acupuncture. We have known for some time now that acupuncture affects nerve conduction within the spinal cord. The basis of the theory is that acupuncture stimulation ‘closes a gate’ within the spinal cord, preventing pain signals from travelling up the spinal cord and getting to the brain.

Beyond this, we also know that acupuncture has hormonal effects. Researchers initially noted that when people addicted to narcotic drugs (like heroin or morphine) had surgery using acupuncture as anaesthesia, they did not experience the withdrawal syndrome that you’d usually expect when the narcotics were stopped. This is because endorphins, the chemicals released by the brain when you exercise that are responsible for the “feel-good” phenomenon, are also released during acupuncture. This effect can be blocked with an endorphin-blocking drug.

We also know that acupuncture increases blood flow at the site needled, probably through local release of biochemically active substances.

Do meridians really exist?

According to Traditional Chinese Medicine, energy (Qi) flows through the body along pathways or meridians, and acupuncture influences this flow. These meridian lines are depicted in texts that are at least 2000 years old.

Scientists have found that electrical resistance of the skin is much lower at acupuncture points (which are mainly situated along the meridians) than other points. This supports the idea of a flow of electrical energy through the body along meridians, which can be accessed via the skin at the acupuncture points.

 

acupuncture meridiansBut has science found any other evidence that meridians exist?

One study injected radioactive tracer molecules into acupuncture points (on meridians) and random points not on meridians. At the acupuncture points, the tracer travelled in a line consistent with the traditional description of the meridian, whereas it just diffused outwards at the non-meridian point.

When we look down a conventional microscope, meridians have been elusive. But some studies using electron microscopy (giving a much more magnified view in which individual cells can be seen) have shown thread-like structures within lymphatics, within blood vessels, on the surface of organs, and elsewhere. These structures appeared to contain fluid and may be the meridians described in ancient texts.

Although further research into this is required, the preliminary findings are fascinating. Clearly we are only just beginning to understand the science behind what the ancient texts described thousands of years ago.

 

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.

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.

 

Acupuncture Scar Therapy

Health In The Bay Scar TherapyWe all know how stubborn scars can be at healing. What you may not know is that scars can block the free flow of qi (energy) and blood as well as constricting the soft tissue. This can cause a number of seemingly unrelated complications that are not local to the area of scarring, such as neck, shoulder and back pain and headaches.

Do you need Scar Therapy?

Remember, not all scars will cause problems. Many do heal effectively. The best way to decide if a scar needs attention is to inspect it yourself through sight and touch.

Firstly, take note of the appearance of the scar and the skin around it. Is it a different colour? Is it bulging or lumpy looking? A purple or red colour is a good indication of blood or qi stagnation.

Secondly, palpate the scar by feeling around the perimeter (outside) of the scar (never push down on the inside of the scar) at an angle as if pushing underneath the scar. Feel for pain, tenderness, unevenness or numbness. These are indications that the flow of qi and blood are obstructed.

Does it feel itchy at times? This is normal in the first few weeks as the tissue heals after the surgery or trauma. But if it goes on for longer, scar therapy might help. If you do discover anything out of the ordinary this is a good indication that your scar has not healed effectively and you could benefit from Acupuncture therapy.

 

How does it work?

Acupuncture stimulates microcirculation improving blood flow to the area. It draws the body’s attention to the area of concern to encourage re-knitting of scar tissue. Other techniques such as moxibustion, herbal medicine and warming liniments can be used to improve circulation.

 

Does it improve the appearance of scars?

Acupuncture scar therapy can be applied to most scar types including acne, pox, injuries and surgery scars. It can make thick scars thinner, improve the colour and general appearance and reduce pain/numbness/tingling and itching. However, the final results depends on your skin type, the type of surgery or trauma, and how long you’ve had the scar.