The City Acupuncturist

Diagnosis in Chinese Medicine

2011-11-21T19:26:00.000Z

Imagine a new patient sitting in an acupuncturist’s waiting room. She suffers from headaches and has been given a conventional medical diagnosis of migraine, and is taking medication prescribed by her GP.

Going into the treatment room, the TCM practitioner asks her many questions.

Firstly about the nature of the headaches: how long have been occurring, when she gets them, where on the head get them, how do they feel. After this has occurred the practitioner then asks them a whole range of things about her day to day health, both physical and emotional.

He then asks her to poke out their tongue which he observes carefully. He then asks her present her wrists and he then spends a minute or two pressing the wrists on both sides.

What is going on here?

Well traditional Chinese medicine is truly holistic in nature. By this we mean that when a patient seeks acupuncture or herbal treatment the TCM practitioner will look at every aspect of the patients’ health and well being and not focus on symptoms alone. When we treat patients we are seeking to find a pattern of disharmony. A syndrome, in other words group of symptoms that collectively indicate or characterize a disease, psychological disorder, or other abnormal condition.

How TCM practitioners get to this point is called Bian Zheng Comprehensive diagnosis based on the analysis, identification, and differentiation of symptoms and signs according to the data collection from the four examination methods and basic Chinese medicine theories of viscera, meridian, and pathology.

The 4 elements Bian Zhen

Questioning
Observation
Palpation
Listening and smelling

Diagnosis by Questioning

This is perhaps the most important of the four methods. Traditionally there were 10 questions asked about bodily function. These were:

i. Temperature

ii. Perspiration

iii. Digestion

iv. Sleep/energy

v. Exercise

vi. Urination

vii. Thirst

viii. Appetite

ix. Bowel function

x. Fertility and sexual function

Today many more questions are asked. The number of and diversity of questions asked is often quite surprising for the new patient.

Returning to the example of our lady with headaches, the TCM practitioner needs to know where the headache is on the head. What is the nature of the pain (distended, stabbing, dull, tight etc), when is it better and worse. Is it associated with other symptoms?

In this case she mentions that the pain is on the temple and is stabbing in nature. It can occur any time of the month but is worse before her period. Generally the patient says she is stressed and this makes her feel tired. Already the practitioner is leaning toward a diagnosis but needs more information to confirm this.

Previous medical and family history will also be taken into account

Diagnosis by Observation

Observation is both specific and general. General observation can be such things as the overall demeanor of the patient. Are they restless and fidgety? Do they seem subdued? What is the complexion like? Is it red, pale, waxen? Are there dark rings around the eyes? Etc.

There may be cause to look at specific things such as skin lesions, quality of the hair and nails etc.

One of the unique diagnostic methods in TCM is tongue diagnosis. We believe that the health of the body is reflected in the condition of the tongue. Firstly is the body of the tongue a healthy colour. Too pale may indicate deficiency, redness may be heat, and purple/darkness may be stagnation. Is the tongue an unusual shape thick or thin pointed?

The tongue coating may indicate pathogenic states. A thick yellow tongue coat may be a sign of heat for example. Certain areas of the tongue also relate to the organ systems so cracks, spots, or other signs in a specific area may be clinically significant.

Returning to our imaginary patient she has a tongue body that is darker than the normal especially on the sides. The tongue could be said to be somewhat pointed.

Diagnosis by Palpation

Often the Chinese medicine practitioners will physically examine a patient. Does a pain get better for pressure or is it aggravated. This might tell us if the problem is one of excess or deficiency. For the acupuncture treatment of pain the practitioner will seek out ashi (painful) points. Literally trying to pin-point the pain.

Next comes the taking of the pulse. This is felt on both wrists at three positions at three depths. Traditionally the pulse was taken at various places about the body the throat or ankle for example. Today the pulse is only taken at the wrist. It is used to determine the current state of the organs and meridian function. Basically the practitioner will seek to measure the speed and depth of the pulse and the relative force at each position.

There are 28 ways the pulse reflects pathological changes in the body correlated with Chinese medical pattern discrimination. These 28 pulse images are taught, like so much of Chinese medicine, using a yin-yang dichotomy. Thus we have the floating and deep pulses, the large and small pulses, the fast and slow pulses, the slippery and choppy pulses, the short and long pulses, etc. According to Hua Tuo, a late Han dynasty expert in Chinese medical diagnosis, the majority of these 28 pulse images can be grouped under four headings. These four headings are: floating, deep, fast, and slow. For instance, there are seven floating or superficial pulses: floating, vacuous, drum-skin, spring onion-stalk, scattered, soggy, and surging. The descriptions of these pulses are quite beautiful at times. The slippery pulse is likened to pearls rolling on a plate. Our lady with the headaches has a choppy pulse one that feels like the back of a knife scraping along a piece of bamboo.

Diagnosis by Listening and Smelling

The TCM doctor might be interested in the Lung sounds, rattling of phlegm in the throat, the type of cough etc. There are more subtle things that may be heard. Each of the 5 organ systems has a particular voice associated with it. The Fire element voice is described as laughing the Water element as groaning. This may not be quite so obvious and may show a general tendency to an element type. Smelling might relate to an overall breath/body smell or the smell of a particular discharge. Our patients’ voice seems to have a clipped shouting quality.

Bringing it all Together

If we look at what information we have gathered about our patient.

· Migraine is on the temple and is stabbing in nature

· It is worse before her period

· She is stressed and this makes her feel tired

· She has a tongue body that is darker than the normal especially on the sides. The tongue could be said to be somewhat pointed.

· Choppy pulse

· Clipped shouting quality to voice.

These signs and symptoms all point to the TCM diagnosis of blood stagnation. Points will be selected on the head because this is main area of complaint. In this case a point on the temple will be used. The main TCM organ/meridians involved are the Liver/Gallbladder/Triple heater and point from these channels are selected especially ones which move blood or Qi (chee) and or affect the head or temple. A herbal formula that moves blood and sedates the uprising Qi is used and this is given daily.

The success of the therapy depends on the ability of the practitioner to find the pattern of disharmony . In this sense TCM is truly holistic, patients are assessed and treated individually not handed a universal treatment based on one complaint alone.

If you would like to find out how TCM could help you please call me on 07724 899 833 or email dudleykent@aol.com

Dudley Kent MBAcC MRCHM MRSS

Acupuncture & Chinese herbs in central London & Salisbury

www.city-acupuncture.com

Autumn Survival Guide: Protect your metal

2011-11-15T22:11:00.000Z

At this time of year I often see many patients coming to the clinic withcolds and coughs. In traditional Chinese medicine (TCM) the Lungs governsomething called the Wei Qi. This is the TCM equivalent of our immune system.What you may not know that is that the Chinese have long said the autumn has aspecial affinity with your Lung meridian. In this guide to I would like tointroduce that link and show you some tips to:

“Protect Your Metal”

In the Chinese tradition, the autumn is allied with the colour white, the sound of crying, theemotions of both bravery and grief, the lung organ, the metal element, and a white tiger. Autumn is also coupled in Chinese thinking with thedirection west, considered tobe the direction of dreams and visions.

The Autumn & The MetalElement fromSept 21 to the winter solstice of December 21

In all seasons change occurs. In the metal phase(autumn) a downward the amount ofdaylight lessens, days grow shorter, and energy descends back into the earthfor the dormant cycle. Leaves fall from the trees, the last fruits ripen, andQi energy contracts.

Preserving our Metal

In the season of autumn, the Metal element is at its pinnacle and particularlyopen to change. Luckily using Chinese medicine, we can revive and rebuild our metalelement - in a physical and on an emotional level.

Acupuncturists often use points located on the Lung and Colonmeridians (energy pathways) when treating the energy of the Metal element. Eachof these points has a spirit and purpose, as do all of the acupuncture pointson the body. When used at the right time, a point's effect is profound.

As well as using herbs and acupuncture to protect or Lungsunderstanding of the metal element means we can help ourselves.

The energy ofthis phase, more than any other, supports our letting go of waste. The organsof metal the Lungs and the Colon both are organs of elimination. It governs theremoval of carbon dioxide from the blood, and waste from the colon.

Some form of gentleexercise that is focused on the breathing is excellent at this time of year tostrengthen the Metal.

Tai Qi, Qi Gong,meditation and yoga can be excellent for this. Particularly when done early inthe morning (between 3am-7am), as this is the time when the Lung & Largeintestines are most active.

On an emotionallevel now this is a good time to be riding ourselves of the old and stale inour lives, leaving us open to the pure and new, giving us an idea of who we arein our essence. Autumn returns us to our core, moves us to eliminate what we nolonger need, revealing what is most valuable in our lives.

Because white is the colourof autumn in the Chinese belief, light white candles against the rising darknessof the season, or put white flowers on your table.

Foods That Benefit the Metal Element

Grain: White, brown, and sweet rice

Vegetables: cauliflower, cabbage, Chinese cabbage,celery, daikon radish, onions, watercress, mustard and turnip greens, turnips,garlic, cucumber, leeks

Beans and Pulses: white beans

Fruits: Banana, pear, apples

Fish: Bass, snapper, cod, haddock, herring,flounder, sole, halibut

Herbs and Seasonings: dill, fennel, thyme, ginger root,horseradish, cinnamon, cayenne, basil, and rosemary

Introduction to the 5 Phases/Elements

2011-11-08T18:32:00.000Z

The ancient Chinese understood the universe was in a constant state of change. They saw that things germinate and begin to expand (spring). Grow and develop (summer) and they mature and ripen (late summer). They then begin to dry and wilt (autumn). They store and conserve (winter). For the ancient Chinese these five seasons (now called the five elements or five phases) were a constant sequence that continued endlessly. Each period of rest at winter was followed by one of new growth in spring. The 5 element/phases system is a traditional Chinese way of explaining the relationships and interactions between all natural phenomena. It is not just particular to Traditional Chinese medicine it is used to understand many different aspects of ancient Chinese thought and society, areas such as politics, astrology, martial arts, and music.

Each one of the phases has its own correspondences, these may be directions, sounds, colours, and importantly for medicine emotions, organs, body parts and tendencies to states of health and illness

	FIRE	EARTH	METAL	WATER	WOOD
Yin Organs	Heart	Spleen	Lung	Kidney	Liver
Yang Organs	Small Intestine	Stomach	Colon	Bladder	Gall Badder
Sense Organs	Tongue	Mouth	Nose	Ears	Eyes
Colors	*red*	*yellow*	*white*	*blue/black*	*green*
Sounds	Laughing	Singing	Crying	Groaning	Shouting
Emotions	Joy	Worry or Pensiveness	Grief or Sadness	Fear	Anger
Seasons	Summer	Late Summer	Autumn	Winter	Spring
Environment	Heat	Dampness	Dryness	Cold	Wind
Tastes	Bitter	Sweet	Pungent	Salty	Sour

To understand how the elements relate to each other we use two models. The generating cycle and the control cycle, which can be used to understand and treat element imbalances.

The Generating Cycle

The strength of an element is dependent of the strength of the previous phase. This is called the mother and child relationship. In TCM if an element is weak we often treat the weakened element and its mother element for added benefit.

As TCM (traditional Chinese medicine) practitioners we remember the generating cycle this way:

§ Wood feeds Fire;

§ Fire creates Earth (ash);

§ Earth bears Metal;

§ Metal carries Water (as in a bucket or tap, or water condenses on metal);

§ Water nourishes Wood.

The Control Cycle

This cycle is preventing one of the elements from becoming too dominant.

In the clinic we might see a patient with an excess of fire. The main fire organ is the heart which dominates the spirit. This might be seen in problems such as anxiety insomnia etc. To help this we might use points and herbs that benefit the Kidneys (the water organ) to balance out the excess fire. Similarly an element can overact on another such as when wood over acts on earth, this is one of the most common 5 element diagnoses of IBS.

§ Wood Holds Earth (such as roots; or, Trees can prevent soil erosion);

§ Earth channels Water (or an Earth dam can control water);

§ Water quenches Fire;

§ Fire melts Metal;

§ Metal chops Wood.

Chinese herbs in your home: Ginger root

2010-11-01T17:49:00.001Z

My patients often ask me what the herbs in their formulas are. Usually quite a few are exotic and unfamiliar. This is not the case with all of them however, and many commonly used Chinese herbs can be found in our kitchen cupboards or in our gardens. I thought that I would introduce some of them to you.

This is in no way meant to be a guide to self treatment, just for my patients and readers interest.

Hopefully it will bring Chinese herbal medicine a little closer to home.

To start us off I would like to begin with Ginger root, one of the most commonly used herbs in Chinese herbal formulas.

Ginger is used in four forms fresh, the fresh skin, dried, and blackened/carbonated

Fresh Ginger (sheng jiang)

Pharmaceutical name: Rhizoma Zingerberis Recens
Botanical name: Zingiber officinale Willd. Rosc
Common name: Fresh ginger
Part used and method of preparation: The rhizomes are dug from September to November. After the fibrous roots have been removed the rhizomes are washed, cut into slices.

Properties and taste: Warm and pungent.
This is particular to Chinese medicine. A herbs property and tastes defines its therapeutic effect on the body, all herbs and foods have a property and taste. There are four properties (cold,cool,warm, hot) and five tastes (sweet, pungent, salty, sour and bitter).
Pungent herbs are used to promote sweating and encourage circulation.
A warm herb is moderately warming so can be used to treat cold illnesses but also should be avoided in warm or hot diseases.

used in the treatment of colds (to be avoided with any signs of heat such as elevated temperature, inflammation etc)
warms the digestion and eases vomiting
used to prevent irritation of the gastrointestinal tract by other herbs

The other forms of ginger used in Chinese medicine are:

Fresh Ginger peel (Sheng Jiang PI)

This is used to treat edeama and water retention

Dried/Baked Ginger (Gan Jiang)

warms the middle (digestion) treats cold, for stomach pain etc.
warms the lungs and transforms phlegm (for thin watery sputum)
used to treat various kinds of bleeding when accompanied by cold symptoms.

This is quite similar to the powdered dry ginger we might use in baking or in curry powder etc..

Burnt Ginger (Pao Jiang)

Dried ginger is fried until blackened.

it can warm the interior,
stops bleeding and alleviate pain,
treats bleeding due to Yang and Qi deficiency which then fail to control the Blood. Such bleeding may be located in the Stomach, intestines or Uterus.

Choosing your Acupuncturist

2010-10-27T17:57:00.000+01:00

Have you decided to receive or been recommended acupuncture? If its your first time then you probably don’t know much about it , and it may come as a surprise that there are different styles of acupuncture, with quite different approaches to treatment. In this brief piece I hope to go some way to explaining some of the differences between the various schools.

The most radical differences in approaches is between
traditional (oriental styles)acupuncture and medical (western) acupuncture.

Traditional Acupuncture

Traditional acupuncture originated in China , and spread across the whole of East Asia particularly

Japan Korea and

Vietnam

. Traditional acupuncturists may also utilize a number of

adjunctive treatments such as Asian massage therapy (Tuina in China, or Shiatsu in Japan), cupping

therapy, moxibustion (heat treatment of acupuncture points), and importantly some may be qualified
in traditional herbal medicine and Chinese dietary therapy and various oriental medical exercise
regimes (Qi Gong etc).

The following text comes from the British Acupuncture Council website.

The first known book of Chinese Medicine, the Classic of Internal Medicine of the Yellow Emperor, dates back to between the first century BC and the first century AD. All styles of acupuncture currently practiced around the world trace their roots back to this text.

Without the help of modern scientific equipment, ancient Chinese scholars discovered many now familiar aspects of biomedical science, such as the effect of emotional stress on the immune system. Traditional acupuncturists are no less scientific or sophisticated than western clinicians in their understanding of how the body functions, although to this day they use terminology that reflects Chinese medicine's cultural and historic origins.

In China during the early part of the twentieth century traditional medicine fell out of fashion as symptomatic healthcare treatments were imported from the West along with other cultural influences. Calls by western trained doctors to ban traditional Chinese medicine were rejected by the National Medical Assembly in Shanghai on 17 March 1929. This day is still celebrated every year as Chinese Doctors' Day.

Traditional Chinese medicine remained in the shadow of western medicine until the Long March of 1934-5. Without drugs, anesthetics or surgery vast numbers of sick and wounded soldiers faced death until doctors of traditional Chinese medicine achieved amazing results using acupuncture and other traditional methods of treatment.

From this point on, traditional Chinese medicine (TCM) and western medicine were practiced side by side in China. Under the People's Republic of China, established in 1948, all branches of TCM were nurtured and encouraged to grow. By 1978, whole hospitals and research departments were devoted to the practice of TCM.

Today traditional acupuncture is practiced all around the world and clinical trials are now confirming its efficacy. More and more people are able to benefit as traditional acupuncture becomes a recognised option within standard healthcare.

Traditional acupuncturists generally train for 3 years, and many colleges offer courses at undergraduate and postgraduate level.

Medical Acupuncture

Medical Acupuncture based entirely on western Scientific medicine. Training and registration is open to those with qualifications in western medicine (Doctors physiotherapists, dentists and nurses etc)

Medical acupuncture is a modern creation and is used predominantly for pain relief, although it might be used for other conditions. You may find other practitioners such as osteopaths, physiotherapists and chiropractors use this treatment and it is often labeled dry needling.

Training in Medical acupuncture is much shorter (in the region of five or six days)

Other Types of Traditional Acupuncture

The main style of of acupuncture practiced is undoubtedly the TCM approach that is taught in modern China. There are other traditional approaches that are popular.

Japanese and Korean

Both countries have developed their own style of acupuncture treatment, traditional medicine..Japanese acupuncture uses different diagnostic techniques, especially abdominal diagnosis, and is often characterized by its gentle needling. Korean acupuncturists take a more constitutional approach to treatment and frequently utilize unique points on the hand.

Auricular or Ear Acupuncture

A recent creation which can be used alongside other acupuncture styles, or on its own. It is often used to treat addiction and is often taught to those in the field of substance abuse. Auricular acupuncture uses zones of the ear which correspond to organs or body parts. Regular acupuncture needles can be used or one might even use small pellets which are taped into the ear for continual stimulation.

5 Element Acupunture

5-elements acupuncture was created in the 1950s by an Englishman, JR Worsley, who had trained in different countries in Asia. It focuses on treating constitutional imbalances, and is said to specialise in psychological and emotional conditions (though these can also be treated by other styles of traditional acupuncture). It is quite different in theory and practice to TCM and as such 5 element acupuncturists rarely practice herbal medicine.

Herbal Medicine

In my own practice a large number of my patients receive herbal medicine. This is beneficial in a number of ways. It allows them to have daily treatment, and is better for supplementing deficiency. So herbal medicine may be a useful adjunct to your treatment regime.

Choosing an acupuncturist

The most important distinction for the new acupuncture patient is the difference between the traditional and modern styles.

But what is most important is the practitioners experience, in terms of length of time in practice and experience of dealing with problems such as yours. You might want to ask what percentage of their practice involves acupuncture. In my opinion if a patient is seeking acupuncture treatment it is important that their practitioner sees themselves as primarily an acupuncturist rather than offering it as a secondary technique.

The Basics of Chinese Medicine: the theory of yin & yang

2010-09-09T20:48:00.000+01:00

Many of the theories and principles of Chinese medicine originate from Taoist philosophical thinking and belief systems. One such theory is that of Yin and Yang. Yin and yang is a tool that allows us to understand something or someone’s orientation and position in the world around us.Traditional Chinese practitioners use yin and yang to understand the opposites and correspondences in the human body. It is easy when looking at yin and yang to see the differences (hot/cold, fast/slow etc.). But we must always remember that there can be no day without night, no fast without slow, no hot without cold. Therefore yin and yang is always relative, one cannot exist without the other.

Some basic associations are stated below.

Yin: cold, still, dark, night, descending, internal, substance.

Yang: hot, moving, bright, day, ascending, external, function.

It is a dynamic model. For example during 24 hours, night is yin and day is yang. Just as the sun and moon move above and below the horizon, so yin and yang both wax and wane during 24 hours. This is easy to visualise if we think how less powerful the sun feels as the day progresses eventfully sinking so low as to move from day to night (yang to yin). In ourselves we are more active during the day (yang) but become less active and eventually sleep (yin) as the day progresses.

The yin and yang symbol eloquently illustrates the theories of the model.

The symbol is circular reminding us the whole is composed of both yin and yang equally.
The black and white sections are not straight telling us that at the balance of yin and yang is in a constant state of movement and relativity.
The dots in the symbol tell us that the seed of yang lies within yin and the beginnings of yin are within yang and are therefore one is interdependent on the other.

Chinese medicine holds that human life is a physiological process in constant motion and change. Under normal conditions, the waxing and waning of yin and yang are kept within certain bounds, reflecting a dynamic equilibrium of the physiological processes. When the balance is broken, disease occurs. This may occur for a number of reasons, physical activity, emotional factors, diet and living conditions etc. Practitioners seek to restore harmony in the human body. The key to correct treatment is to identify the source of the disharmony and rebalance. So we must cool if there is heat, promote movement if there is stagnation, and replenish if there is deficiency etc.

Is the patient large or thin? are they slow and lethargic? or are they restless and nervous? These are clues as to the relative balance within the patient. Is the illness of recent onset or chronic and long standing, is there heat or do they feel cold.

It is with yin and yang theory that the practitioner of Chinese medicine will begin the diagnostic process, which will then ultimately decide the treatment plan.

Environmental toxins: a barrier to natural fertility?

2010-09-03T14:19:00.000+01:00

This interesting article from the LA times appeared on my twitter page recently

"Chemicals in plastics can increase testosterone in men"

Every day we are exposed to various different chemicals. We are largely unaware of what the detrimental effects of these substances may be on our health, and in the case of many of my patients, what impact they may have on our fertility.

Xeno-oestrogens

"Xenoestrogens are novel, industrially made compounds, estrogenic effects and differ chemically from ancient naturally occurring oestrogenic substances produced by living organisms. Their potential ecological and human health impact is under study”

source: http://en.wikipedia.org/wiki/Xenoestrogen

Xeno-oestrogens are chemicals that mimic the hormone oestrogen in the human body. Oestrogen is crucial in fertility. It signals the release of other hormones to trigger ovulation. It is needed for a healthy womb lining so that embryos may implant successfully. It stimulates the secretion of cervical mucus, and it causes softening and opening of the cervix facilitating the passage of sperm to egg. Obviously women produce lots of this hormone but men also produce it. For oestogens to do their job they must bind with special oestrogen receptors in the human cell. Unfortunately Xeno-oestrogens might also link with these cell receptors and thus prevent oestrogen from working. Obviously this could have detrimental effects on fertility. It has been speculated by some that xeno-oestrogens may also be affect testicular function. As such they have been linked to decreased sperm count and quality and also increased damage to sperm DNA among other things. They are also being linked to a whole range of issues within female reproductive function and pregnancy, such as PCOS, endometriosis and miscarriage.

Dioxins

Dioxins are another group of chemicals produced by a variety of industrial processes. Dioxins are linked to a range of problems but with regard to fertility in women they are implicated in endometriosis and miscarriage. In men they are linked to poor semen quality. The main source of of dioxins is diet, and the worst offenders being beef and dairy produce followed by other meats and eggs.

What you can do to help yourself

The main way in which xeno-oestrogens are likely to enter the body is via pesticides and plastics, but they are also present in a wide range of items such as toiletries. I always recommend my patients to eat organically for a whole host of reasons and this is just one more. You may want to evaluate how you prepare, cook and store your food. It may be advisable not to microwave food in plastic containers or covered with plastic wrap, and don't put hot food into plastic containers as this may encourage molecules of plastic to leech into the food.

The Xeno-oestrogen Bisphenol A is present in the lining of canned food and has been linked with polycystic ovary syndrome (PCOS).

Phthalates are present in many cosmetics especially nail varnishes and those products containing some form of scent. If possible look for those that are "phthalate free".

Another product to look out for is parabens this is used as a preservative in certain cosmetics.

Many nutritionists advocate a diet rich in phyto-oestrogens to counteract the effects of of xeno-oestrogens. These may be obtained from many sources, flax seed and soya being especially good. Nuts, seeds and pulses are all excellent.

Dioxins are stored in fat, so reducing the amount of animal products we eat is the most effective way to limit the impact dioxins may make on ones fertility. Dioxins are also stored in our own body fat so losing weight ourselves is again useful.

In conclusion. While the science behind these theories is at best uncertain, the steps we may take to protect ourselves from environmental toxins don't look particularly unreasonable or outlandish.

Basically eat organic produce, reduce the amount of plastic & packaging in our lives, use more products that contain less chemicals and eat less meat and dairy. Even if our bodies dont thank us I'm sure the planet will.

Could acupuncture provide a cure for insomnia?

2010-08-23T09:37:00.000+01:00

Chinese authors have reviewed 46 randomised control trials (RCTs) containing 3811 patients, all the trials were considered to be of a reasonable standard.

Benefits were seen when acupuncture was compared with no treatment, also when real acupressure was compared to sham acupressure.

Acupuncture was superior to medication with regard to the number of patients who's total sleep increased by more than three hours, also acupuncture and medication was shown to be better than medication alone. Acupuncture plus herbs was significantly better than herbs alone with regard to increase in sleep rate. In conclusion the authors recommend that based on these findings acupuncture warrants further investigation for the treatment of insomnia.

(Acupuncture for treatment of insomnia: a systematic review of randomized controlled trials. J Altern Comp Med. 2009 Nov;15(11):1176-86).

Research News

2010-08-10T23:12:00.000+01:00

Chinese herb may prevent bone degeneration

Teams of Vietnamese and Korean biochemists have been looking at the use of the Chinese herb Gou Ji” (Rhizoma Cibotti barometz _ chain fern rhizome) as a possible treatment for osteoporosis. Traditionally this herb is used for lower back pain rheumatism and knee problems. Eight different compounds were isolated from the plant, three of which were shown to limit the activity of osteoclasts (cells which damage and compromise the bone tissue).

Inhibitors of osteoclast formation from rhizomes of Rhizoma Cibotti barometz. JNat Prod. 2009 sep;72(9):1673-7

Ginger does stop nausea and vomiting during pregnancy

Sheng Jiang (fresh ginger root) has been found to be effective against nausea and vomiting during pregnancy. In the study 67 pregnant women received either 1000 mg ginger in capsules or a placebo. The users of ginger showed 85% reduction in symptoms versus 56% in the control. The decrease in actual vomiting was 50% vs 9% .

Effects of ginger capsules on pregnancy, nausea and vomiting. J.Altern comp.Med .2009 mar;15(3):243-6

Reports from the Frontiers of Acupuncture: Dr U Win Ko talks traditional Myanmar medicine

2010-08-05T22:17:00.000+01:00

Dr U Win Ko

traditional Myanmar medicine (TMM). One of the main driving forces behind the success of this project is Dr U Win Ko, a teacher and practitioner of traditional Myanmar medicine with some 30 years experience.

DK: Can you tell me about the history of traditional Myanmar medicine (TMM)?

Dr UWK: I should first explain what TMM is. As defined by the World Health Organisation (WHO), TMM includes a range of diverse health practices, knowledge and beliefs. It incorporates plant, animal and mineral-based medicines, spiritual therapies, manual techniques and exercises, which can be applied individually or in combination.

TMM has four basic principles:

• Desana Naya

• Beithizza Naya (ayurvedic method)

• Netkhatta Naya (medical astrology)

• Vizzadhara Naya (medical alchemy and spiritual powers)

We find written evidence of TMM in votive tablets from the Bagan era (10th century). It is generally believed that basic medical knowledge spread to Myanmar from India with the propagation of Buddhism. However, Desana Naya was invented by the physician U Hmont in the 17th century and has been in use ever since.

DK: What are the main diagnostic methods? What form of treatment do you most often use?

Dr UWK: Most TMM practitioners use a four-stage diagnostic method:

• analysis of urination based on Karma Smuthana (frequent, infrequent or painful urination related to sheeta (cold) and ushna (hot)

• inspection of abdomen based on sheeta and ushna

• Utu Smuthana (seasonal causes): symptoms are aggravated or improve in cold or hot seasons, times or situations; patient has a feeling of aversion to cold or hot

• Ahara Smuthana (food-related causes): the symptoms are aggravated or improve when cold or hot foods are eaten.

Finally, the practitioner diagnoses and treats according to the following factors:

• the organ affected

• whether the cause of the disease corresponds to hot or cold

• whether the internal Prithvi (earth) element is excessive or deficient

• whether the Apo (water) element is excessively dispersed in the external part of the body.

The form of treatment I use most often is to harmonise the excessive or deficient element first, then regulate the affected organ, and finally reduce the symptoms.

DK: What is your history and connection to TMM?

Dr UWK: Actually, my initial ambition was to be a doctor of western medicine. But I was not eligible to attend the Institute of Medicine after matriculation on account of my score, so I went to the Arts and Science University in

Mandalay. Then I took an entrance examination for the Institute of Traditional Myanmar Medicine, which had been recently opened by the Ministry of Health. This was in 1977 and I was 19 years old. It satisfied my desire to work in medicine, as although I was not a doctor it allowed me to become a practitioner and treat illness.

After a four-year course, I received my diploma in TMM. Following that, I worked for 16 years in the Ministry of Health. I was also in charge of a township’s traditional medicine centre and was an instructor, lecturer and physician. I retired in 1997 and continued to work full time in my own clinic. When I was in government service, I could work in my clinic only in the evening. My grandfather was also a practitioner of TMM, so I was able to inherit some of his knowledge.

DK: What do you think about the future of TMM in your country?

Dr UWK: Well, to answer that I have to briefly continue the history of TMM. Before 1976 knowledge of traditional

medicine was passed on from father to son. In 1976, the government opened the Institute of Traditional Medicine for a four-year diploma course, and in 2001 the University of Traditional Medicine started a five-year degree course.

Some study with experienced practitioners, by practising and observing over a number of years,

whereas others gain their knowledge through courses at the Institute or University, or the Ministry of Health’s Department of Traditional Medicine. These practitioners provide the entire nation with comprehensive traditional medical services through the existing healthcare system, either via Ministry of Health traditional medicine hospitals and township medical centres or via private clinics.

The important thing is people’s belief in TMM. In Myanmar, people respect TMM as our traditional heritage and believe it can treat the root of the disease causing chronic illness. Because local people accept and use traditional medicine, and because the government encourages it, TMM practitioners have a brilliant future.

Acupuncture outreach in Gadaw Village

DK: When did you start learning acupuncture?

Dr UWK: When I was in my final year at the Institute, an acupuncturist who had just come back from China came to speak to us about his experiences and acupuncture’s efficacy. I was very interested to learn more. Fortunately,in 2000, I got the chance in Wachet Jivitadana Sangha Hospital, with the encouragement of Sayadaw U Lakkhana (the abbot of the monastery that supports our hospital). I was taught by Dr Michael Zucker from Hawaii and Dr Daniel Bruce from New Mexico. This teaching programme has continued every year since, with teaching from many foreign acupuncturists.

DK: How much similarity is there between Chinese and Myanmar medicine?

Dr UWK: TCM and TMM are both Oriental medicines and as such share certain understandings of causes of diseases, but they are quite different in their concepts of the five element theory and physiological aspects of the body. For instance, what in western medicine is called hypertension usually corresponds to one of five distinct patterns in TCM: liver fire uprising, deficient yin/excess yang, obstruction of phlegm and dampness, interior liver wind, or

deficient yin and yang. However, inTMM hypertension usually corresponds to functional disorder of one of the five elements, and the concept of these elements is quite different from TCM. In TMM, the human body is believed to be composed of earth (Prithavi), fire(Tezo), wind (Vayu), water (Apo) and space (Akasa). The earth element for instance corresponds to touchable, solid things in the body, such as the skin, the lungs, the heart, whereas in TCM it is believed to correspond to the spleenand stomach. So the two traditionsare quite different in certain aspects.

DK: What are your hopes for the future of acupuncture in Myanmar?

Dr UWK: I think it will depend on four main factors:

• efficacy

• public acceptance

• state encouragement

• integration with TMM.

All four aspects look promising at the moment. For example, the Ministry of Health established a department of acupuncture in the University of Traditional Myanmar Medicine in 2001 and since then every student has a chance to learn acupuncture in their third and fourth year. In terms of integration, at presentsome TMM practitioners have already studied a basic acupuncture course, so they have some experience integrating TMM and acupuncture in their treatments. Based on my experience, integration can reduce the duration of treatment for certain conditions, especially for strokes, post-traumatic injuries and gynaecological problems.

A very big refresher course in Myanmar (Burma)

2010-08-02T16:31:00.000+01:00

In January 2010 I was privileged to be part of a small team of TCM practitioners who travelled to Sagiang in Myanmar (Burma). This was part of an ongoing project that has been teaching acupuncture to doctors of traditional Myanmar medicine (TMM). John Hamwee one of my colleagues has given me permission to publish this article detailing our time there.

This article first appeared in the spring 2010 copy of the acupuncturist the magazine of the British Acupuncture Council

JOHN HAMWEE MBAcC

Acupuncture Practitioner: Cumbria and Oxford

About 20 years ago a young American sat in meditation for long months in the hills of Sagaing, an important centre for Burmese Buddhism, overlooking the Ayeyarwady river near Mandalay. One day he came down to the village and a woman, a perfect stranger, seeing this westerner and apparently taking pity on him, gave him a bottle of C

oca-Cola. He was deeply touched by the gesture and thought, I must give something back. He found many ways to do so, and one of those ways was to institute an annual visit of western acupuncturists to the nearby hospital. This was the tenth annual visit. There were five of us, four from the UK and one from the USA. For one of our party it was her fourth visit, for another the second. It was my

first time, though it won’t be my last. I worked harder than I have ever worked in my life, I paid all my own expenses to get there and back, and I can’t wait to go again.

The set-up was that we worked for a week in the hospital where there are two rooms given over to acupuncture, one with about twelve beds in it and the other with about ten. Then we moved to work in a village where there were no beds, strictly speaking, so we worked on raised platformsin the monks’ dormitory, or outside. I didn’t count but I suppose there were about the same number of spaces available to patients.

And we needed them. There were almost 100 people the first day, more each day afterwards and, we were told, nearly 500on the last day. That may have been an exaggeration but the patients certainly came in waves and we did have to findnew spaces to work. That last day was all abit of a blur, partly because we were sobusy and also because we were all verytired by then, but as far as I can tell I treated 26 people myself and I supervised a further 40 or so treatments.

Which brings me on to how we worked. We had with us three local acupuncturists who had been qualified for some years and about sixteen young practitioners, in their twenties, who had qualified recently. It was a big part of our remit to act as teachers to the young people, mainly in

the clinic but also with a lecture each day.

They were all pretty good, so by the time the

numbers really hit the roof we westerners were

able to spend as little as five or ten minutes with each patient. We’d agree a diagnosis and treatment plan with one of the students and then leave it to her or him to do the treatment, coming back to check the pulses at the end. In that way, the five of us managed five or six patients at once all day long. Although some of the students were delegated to crowd control, and the senior people were usually otherwise occupied, there were still about twenty of us, each treating, say, three people an hour for about seven and a half hours. So that’s how we made up the numbers. Naturally, there were translation problems.Huge numbers of patients complained about ‘numbness’ for example but were normally sensitive as far as we could tell.We never really got to the bottom of what they were trying to tell us. More generally, because we couldn’t take much of a case history, we had to work with a simple diagnosis of the state of the patient’s energy system; it was refreshing to see how much we could do with very few words.

It was a very steep learning curve for me. Normally I have one-hour appointments, and rarely see more than eight people in a day. Also, in my own practice I tend to use zero balancing rather than acupuncture for musculo-skeletal problems, of which there were many, but it wouldn’t have been any use to the students if I had done so there. So I struggled to remember bi syndromes and shoulder points and was pretty rusty for the first day or two, which the students noticed and charmingly forgave. It felt like learning acupuncture all over again. All this reaffirmed my deep respect for this system of medicine. It really did work on conditions for which I would normally use zero balancing or recommend osteopathy. It also seemed to work on conditionswhich I never see at home and which, as a result, I had to treat simply

from first principles. After nearly 20 years in practice I hadn’t realised that I hadbecome very limited in my thinking about acupuncture, assuming, in a rather lazy way, that it was good for what I used it for and a few specialisms like pediatrics and obstetrics but not much else. Wrong! Secondly, it taught me, as if I needed to learn, the value of having to explain a

treatment before doing it. At the beginning of the work the students wanted to know why I was planning to do what I was planning to do. Sometimes, in explaining, I came to understand my rationale; one which I’d never spelt out clearly to myself and which I could then apply to other patients and other conditions. Very satisfying. And sometimes, of course, when pushed to

explain myself I found that my thinking was woolly or inadequate, and it was a

pleasure and a relief to be made to think again and to come up with a better treatment than the one I first thought of. By the end I made the students write

down their proposed treatments before I would tell them what I would do, and I learned a lot from seeing two different but equally plausible sets of points. I often let the students do what they proposed, even when it didn’t seem to me ideal, and it was instructive to see the results of those treatments which, of course, I never do!

Finally, there was the whole process of working in a multi-bed setting. I loved it. I loved the noise and the bustle. I lovedglancing up at one of the students taking pulses on the opposite side and seeing inher eyes an agreement about what we were noticing. I loved people coming round to have a look at me needling Liv 14, Lu 1 (not a treatment they knew) and their

interest in the resulting pulse change. I loved calling a colleague over to assess a hip joint which moved, or rather failed tomove, in a way I’d never felt before. I liked having to talk less (it was tedious to wait for long translations) and having to senseqi more. And I liked the whole idea of seeing more people, more often, more quickly, for less money.

The whole experience has made me a much better practitioner and it will change the way I work from now on. I recommend it to those of you who feel like taking a very big refresher course.

Thanks to all at the Watchet JivitadanaSangha Hospital, especially U Win Ko and U Aung Min, and the students; to Kirsten Germann for leading us, and my colleagues Richard Graham, Dudley Kent and John Renna; and to Oxford Medical for their generous gift of supplies.

The hospital is run as a charity and receives no financial support from the Government. The programme I describe is run under the auspices of the MettaDana project which provides funds to local initiatives, including the hospital.

Contributions welcome

http://www.vipassanahawaii.org/mettadana_projects.php

Easing Migraines Through Acupuncture

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Migraine headaches disrupt the lives of millions of people. Sufferers are only too aware of the recurrent debilitating symptoms that can last for hours to days, from painful throbbing headaches to dizziness, nausea, vomiting and disturbance of vision. Research points to a variety of possible triggers for migraines, both external and internal. Diet, hormonal changes, stress, food sensitivities and certain types of weather can all be factors in setting off a migraine.

For such a widespread problem, migraines have remained frustratingly difficult to treat. Traditional pain relievers such as aspirin, paracetemol and ibuprofen do not alleviate migraine symptoms. Medications developed specifically to treat migraines have uneven results; they work for some people, sometimes, but patients report that their efficacity is variable. In addition, some migraine medications have the downside of unpleasant side effects.

In my practice, I treat many patients for migraines and my experience has been that acupunture can dramatically reduce both the symptoms and the frequency of migraine attacks. I believe this is because acupunture treats the underlying conditions that provoke migraines and rebalances the body’s system.

A scientific study conducted in Italy on the effectiveness of acupuncture versus drugs in treating migraines seems to back up my observations. One group of patients was treated with regular courses of acupunture. Another group received drugs developed to control migraines. The study took place over a year and the results showed that acupunture improved the symptoms twice as well as the drugs tested, based on criteria such as duration and severity of symptoms. On average, the patients receiving acupuncture reported an improvement in their migraine symptoms of over 80%.
Another advantage is that none of the patients in the Italian study reported any unwanted side effects from acupunture treatment (this is borne out in my practice as well), whereas many migraine drugs list wide-ranging secondary effects from nausea to breathing difficulty.
Migraine medications are also extremely expensive, whether the cost is taken in charge by the health service or by the individual. .

Research News

2010-08-01T09:01:00.000+01:00

Acupuncture & Period Pain

Korean researchers have conducted a systematic review into research for the acupuncture treatment of dysmenorrhoea (period pain). Data covering almost 3000 women in twenty seven randomised control trials (RCTs) were included in the study. They found that compared with pharmacological or herbal medicine, acupuncture could be bring about a significant reduction in pain.(acupuncture for primary dysmennorrhoea: a systematic review. BJOG. 2010 Feb 17. [Epub ahead of print])

Chinese Herbs & Endometriosis

UK authors have been looking at the use of traditional Chinese herbs in the treatment of endometriosis (a debilitating gynaecological medical condition in females in which endometrial-like cells appear and flourish in areas outside the uterine cavity). Two high quality RCTs involving 158 subjects concluded that Chinese herbs taken after surgery have effects that are comparable to the drug gestrinone (a synthetic hormone that reduces the production of oestrogen by the ovaries). This came with the added benefit of fewer side effects. They also found that when taken orally Chinese herbal medidine may be a better overall treatment than danazol (another synthetic hormone).
(Chinese herbal medicine for endometriosis. Cochrane database Syst Rev. 2009 Jul8: (3) CD006568)

Acupuncture For Facial Enhancement

2010-07-29T17:00:00.000+01:00

"Beauty From The Inside"

Cosmetic acupuncture is flavour of the month at the moment and certainly gaining in popularity.
Recently the amount of interest and number of requests for this treatment in my practice has encouraged me to offer cosmetic acupuncture in my clinic.
The clinching factor for me was that although obviously a beauty treatment, cosmetic acupuncture still relies on firm Chinese medical principles, and diagnosis led treatment.

In other words treatment is approached in exactly the same way as it would be for any other condition.

What Makes Up the Skin?

Your skin consists of, the epidermis and dermis, plus other structures related to the hair and nails. The epidermis is the top layer of the skin and has up to five layers, reflecting different stages of cell development. The epidermal cells start to divide on the basal cell layer (the bottom layer). As they develop, they move up through the layers, producing the protein keratin, and will eventually disintegrate, leaving behind a layer of keratin held together and protected by fat molecules.
The function of this keratin layer is to give the skin its tough, resilient nature. Dead skin cells are lost from the surface of the skin. It takes around 35 days from the beginning of cell division to cell shedding. Abrasion of the skin surface can speed this process up.
The dermis is the bottom layer beneath the epidermis. Its main function is to provide physical and nutritional support to the epidermis. The dermis consists of bundles of the protein collagen (and to a lesser extent, elastin), blood vessels, lymphatics, nerves, muscle fibers, mast cells, tissue macrophages, hair follicles, and sweat and sebaceous glands. Cells in the dermis provide a structural support for the skin (the extra cellular matrix or ECM). Collagen provides the tensile vigour of the skin, while the elastin gives the skin its suppleness and flexibility. Unlike the epidermis, the dermis does not constantly shed and re grow. Collagen and elastin have longer life spans and regenerate very slowly.
Importantly for acupuncture practice, wounding of the skin can cause a transient regeneration of the dermis.

Skin Aging

Aging, put very simply is changes in the structure of the skin. With age, the rate at which skin cells are replaced slows down, and cells may be lost quicker than they are replaced. As a result the skin becomes thinner and more susceptible to damage. The fat cells beneath the dermis begin to deteriorate leading to less plumpness in the face. Habitual facial expressions such a frowning and squinting form deep wrinkles over time. Gravity makes this worse leading to eye bags and jowls. As we age our blood vessels also become less efficient and there may be less oxygen and nutrition supplied to the skin. Collagen and elastin become scarcer and the skin can sag and be more prone to wrinkles. Our skin becomes more prone to dryness and flaking as our sebaceous and sweat glands work less efficiently to provide us with sufficient protection. The effects of things such as cigarette smoke, alcohol and stress all begin to take their toll and conspire to speed up the aging process.

Exposure to sun is one of the prime causes of premature aging. Sunlight damages the fibres of collagen and causes the production of damaging enzymes. In women another factor is the decline in oestrogen that comes in middle age. This can lead to wrinkling and increased dryness of the skin, poor wound healing and weakness of skin tone.

What can acupuncture do?

Cosmetic acupuncture involves the insertion of extremely fine needles in various points on the face, neck and body with the aim to combat the signs of aging. Points are selected by observing the face for where the skin may be lacking tone and where there might be wrinkles. The treatment of the face is very often combined with body acupuncture to treat underlying imbalances and symptoms.
Acupuncture facial rejuvenation treatment, tightens the pores improves muscle tone and dermal contraction while enhancing and increasing the elasticity of the skin
Although no scientific studies have been conducted into facial enhancement acupuncture, based on what we know of acupuncture we can hypothesise that it improves local blood supply, stimulates the production of collagen by creating micro wounds in the dermis, relaxes the muscles and helps to relieve stress.