Acupuncture Beats Injected Morphine for Pain: Groundbreaking Study

Posted on by Dr. Evan F.J. Murao

An amazing new study has found that acupuncture, the ancient practice of using needles to stimulate bodily self healing, is more effective than intravenous morphine for pain.

A truly groundbreaking study published in the American Journal of Emergency Medicinetitled, “Acupuncture vs intravenous morphine in the management of acute pain in the ED,” reveals that acupuncture — one of the oldest techniques to treat pain — is more effective, faster in relieving pain, and with less adverse effects, than intravenous morphine.

The study was conducted over the course of a 1-year period at the Fattouma Bourguiba University Hospital in Tunisia, a tertiary care facility with over 100,000 Emergency Department (ED) visits per year.

300 ED patients with acute pain were included in the study: 150 in the morphine group (administered up to 15 mg a day) and 150 in the acupuncture group. The two groups were comparable in terms of age, sex, and co-morbidities, with the only significant difference being that there were more abdominal pain patients in the morphine group and more low back pain cases in the acupuncture group.

The striking results were reported as follows:

“Success rate was significantly different between the 2 groups (92% in the acupuncture group vs 78% in the morphine group P b .01). Resolution time was 16 ± 8 minutes in the acupuncture group vs 28 ± 14 minutes in the morphine group. The difference was statistically significant (P b .01). The mean absolute difference in pain score between the 2 groups was 7.7. This difference is not clinically significant because the minimal clinically significant absolute difference reported by Todd et al is 13. In morphine group, the mean total dose of morphine administered was 0.17 ± 0.08 mg/Kg (Table 2).

The pain scale change from baseline at each time point in the 2 groups is shown in Figure. From the 5-minute time point, the acupuncture group reported significantly larger pain decrease compared with the morphine group. This difference persisted during the entire study period. Change of blood pressure, HR, RR, and oxygen saturation was not significant in both groups.

Overall, 89 patients (29.3%) experienced minor adverse effects: 85(56.6%) in morphine group and 4 (2.6%) in acupuncture group; the difference was significant between the 2 groups (Table 3). The most frequent adverse effect was dizziness in the morphine group (42%) and needle breakage in the acupuncture group (2%). No major adverse effect was recorded during the study protocol. (See Table 4.)”

In short, the acupuncture group saw a great pain-relieving effect, which occurred faster, with significantly less side effects.

A graph from the study showing the pain-decreasing differences between morphine and acupuncture

Discussion

Since 1996, the World Health Organization has recognized acupuncture as a safe and effective therapy for the treatment of a wide range of conditions, including pain and discomfort.1 Despite this, the use of acupuncture within the conventional standard of care is still exceedingly rare. A deep skepticism exists for therapeutic modalities that do yet have a clearly characterized mechanism of action, as defined through conventional biomedical understanding and terminology. Often, in lieu of this, its therapeutic effects are written off as merely “placebo.”

Placebo, however, is not as diminutive term as it may first seem.  The placebo effectactually reflects the deep power and regenerative capability of the body-mind to heal itself. And since its power translates directly into real, measurable improvements in terms of clinical outcomes, it does not matter if we fully understand “how” it works. Also, consider that “evidence-based” (EB) medicine not only depends entirely on clinical outcomes as final proof of an intervention’s efficacy, but also, the entire EB medicine model depends on “controlling” for the placebo effect, as it is already tacitly recognized as having immense power in influencing the outcomes in most interventions. And so, whether or not a fully known or plausible “mechanism of action” has been identified is secondary in importance to whether it works or not in clinical practice.

Clearly the new study reveals that acupuncture has a powerful role to play in pain management. With addiction to pain relieving drugs affecting millions around the world, acupuncture is perfectly poised to provide patients a time-tested, drug-free alternative. As you can see from the study’s graph, the adverse effects comparison is staggeringly in favor of acupuncture as the safer modality.

Finally, here are the study’s powerful conclusions:

“Our study demonstrated that in patients with acute pain syndromes presenting to the Emergency Department (ED), acupuncture is at least as efficacious and has a better safety profile than IV morphine. The results of this study suggest that acupuncture has a potential role in controlling acute pain conditions presenting to EDs and appears to be safe and effective. Future studies should be performed in international populations.”

References

1. World Health Organization. Acupuncture: review and analysis of reports on controlled clinical trials; 2002.

Acupuncture and Herbs Stop Shingles Pain, Outperforms Drugs

Posted on by Dr. Evan F.J. Murao
Needles being inserted perpendicular to the paraspinal muscles bilaterally.

Acupuncture and herbs prove effective for the treatment of shingles. Researchers from three independent studies conclude that acupuncture and herbal medicine significantly relieve rashes and pain associated with the herpes zoster virus (shingles). Importantly, acupuncture and herbal medicine outperformed antiviral and anti-inflammatory medications, indicating that usual care protocols are suboptimal without inclusion of acupuncture and herbal medicine.

The shingles viral infection is characterized by painful blisters, usually located in a single strip on either side of the trunk, neck, or face. Even once the blisters have subsided, patients can be left with severe neuralgia (nerve pain), which may last for several weeks or months. According to Traditional Chinese medicine (TCM) principles, this condition usually falls into the category of either excess liver fire, liver and gallbladder damp heat, or spleen deficiency with accumulated pathogenic dampness. Rashes associated with shingles are sometimes referred to as “snake string sores” in TCM, reflecting the nature of their physical presentation.

People’s Hospital

The first study we will look at today was conducted by researchers at the People’s Hospital of Shenyang Economic and Technological Development Zone. [i] A total of 88 patients with a clinical diagnosis of a herpes zoster infection were recruited and randomly assigned to an acupuncture and herbal medicine observation group or a drug control group (including anti-inflammatory and antiviral medications).

The acupuncture and herbal medicine group produced significantly greater patient outcomes. This includes a higher cure rate, a higher overall effective rate, and a lower failure rate. The results indicate that standard procedures to alleviate shingles in hospital and outpatient settings absent acupuncture and herbs are definitively not the most effective means to provide relief to patients.

The observation group comprised 20 male and 24 female participants with a mean age of 43.6 years. Their mean duration of disease was 3.4 days. The control group comprised 18 male and 26 female participants, with a mean age of 42.8 years. The mean duration of disease in this group was 3.6 days. There were no statistically significant differences in baseline characteristics between the two groups at the outset of the investigation.

Treatment Procedures

The control group was treated with conventional drug therapy including:

• Acyclovir (200mg, three times a day)

• Vitamin B1 (10mg, three times a day)

• Ibuprofen slow release capsules (300mg daily)

• Acyclovir topical ointment

The observation group was treated with a modified version of the herbal formula Long Dan Xie Gan Tang containing the following herbs:

• Sheng Di 30g

• Che Qian Zi 30g

• Ban Lan Gen 30g

• Huang Qin 15g

• Chi Shao 15g

• Zhi Zi 15g

• Da Qing Ye 15g

• Long Dan Cao 12g

• Ze Xie 12g

• Chai Hu 10g

• Dang Gui 10g

Modifications

• For patients suffering from concurrent constipation, Da Huang (10g) was added to the formula.

• For patients with symptoms of exuberant heat, Sheng Shi Gao (30g), Zhi Mu (15g), and Mu Dan Pi (15g) were added.

• For patients with pus-filled blisters, Pu Gong Ying (30g) was added.

• For patients with severe pain, Zhi Ru Xiang (10g) and Zhi Mo Yao (10g) were added.

The herbs were decocted in water and one dose was taken daily, divided into two portions for morning and evening consumption. The patients in the observation group were also treated with acupuncture at the following acupoints:

• Huatuojiaji (MBW35)

• Zhigou (TB6)

• Yanglingquan (GB34)

• Yinlingquan (SP9)

Acupuncture was also administered locally in the area of herpetic rashes. Needles were inserted into the spaces between blisters, approximately 1.5 cun apart. The needles were manipulated slightly then withdrawn immediately, and the puncture was not sealed with cotton. The incidental drawing of a small drop of blood was considered a beneficial effect. The affected area was also warmed with a moxa cigar. Treatment was administered once daily. Both groups underwent treatment for a total of ten days, with an initial assessment of rashes after five days.

Clinical Outcomes

Patients with a complete resolution of rashes and clinical symptoms (including pain) were classified as cured. In patients with at least a 30% improvement in rashes and pain reduction, the treatment was classified as effective. In patients showing less than 30% improvement in rashes and no change or worsening of pain, the treatment was classified as ineffective.

In the drug control group, 15 patients were cured, 21 cases were classified as effective, and 8 cases were classified as ineffective, yielding a total effective rate of 81.8%. In the acupuncture and herbal medicine observation group, 25 patients were cured, 18 cases were classified as effective, and one case was classified as ineffective, yielding a total effective rate of 97.7%.

A combination of acupuncture and herbal medicine has been used for the treatment of shingles for over 1,000 years. This modern study confirms the efficaciousness of a common TCM protocol for the treatment of herpes zoster. A rethinking of usual care standards seems appropriate based on the findings. At the Healthcare Medicine Institute (HealthCMi), we examine traditional acupuncture continuing education standards and repeatedly find that an integrative medicine model for the treatment of shingles is superior to drug monotherapy. Let’s take a look at the second study in our review of shingles treatments.

Changjizhou and Jimusa’erxian TCM Hospital

The second study conducted by researchers at the Changjizhou and Jimusa’erxian TCM Hospital (department of acupuncture and moxibustion) determined that acupuncture and herbal medicine are effective for the treatment of shingles. [ii] For this study, a total of 40 patients were recruited and randomly assigned to either an observation or control group.

The observation group was comprised of 12 male and 8 female participants, ages 18–63 years (mean age 35.5 years). Their duration of disease was 1–10 days (mean duration 5.5 days) at the outset. The control group was comprised of 13 male and 7 female participants, ages 18–65 years (mean age 36.5 years). Their duration of disease was 1–8 days (mean duration 4.5 days). There were no statistically significant differences in baseline characteristics between the two groups at the outset of the investigation.

Treatment Procedures

Both groups were treated with herbal decoctions according to their TCM differential diagnoses. Patients diagnosed with excessive heat in the liver channel were prescribed a version of Qing Re Zhi Tong Tang containing the following herbs:

• Lian Qiao 15g

• Jin Yin Hua 15g

• Huang Qin 10g

• Zhi Zi 10g

• Huang Lian 10g

• Long Dan Cao 5g

• Gan Cao 5g

• Da Qing Ye 25g

• Ling Ci Shi 25g

Patients diagnosed with spleen deficiency with accumulation of pathogenic dampness were prescribed a version of Chu Shi Wei Ling Tang containing the following ingredients:

• Cang Zhu 10g

• Chen Pi 10g

• Shao Bai Zhu 10g

• Che Qian Zi 15g

• Ze Xie 15g

• Fu Ling 15g

• Jin Yin Hua 15g

• Long Dan Cao 5g

• Ling Ci Shi 25g

Both decoctions were taken as a daily dose for a total of 21 days. Patients in the observation group also received acupuncture in the area affected by the herpetic rash. Following standard disinfection, 3–6 needles were inserted surrounding the rash at a distance of approximately 0.5–1cm. The needles were inserted transversely to a depth of 20–50mm, angled towards the midpoint of the rash. The needles were manipulated using a balanced reinforcing-reducing method and were retained for 30 minutes. Treatment was administered daily for 14 days.

Clinical Outcomes

For patients whose rash and clinical symptoms fully resolved, treatment was classified as markedly effective. For those whose rash improved by more than 70% and experienced some reduction in pain, treatment was classified as effective. For those whose rash improved by less than 30% and experienced no reduction in pain, treatment was classified as ineffective.

In the control group, there were 10 markedly effective, 6 effective, and 4 ineffective cases, yielding a total effective rate of 80%. In the observation group, there were 15 markedly effective, 4 effective, and one ineffective cases, yielding a total effective rate of 95%.

The patients also rated their pain using a visual analog scale (VAS). VAS scores of 7–10 indicated severe, unbearable pain. Scores of 4–6 indicated severe but tolerable pain, 1–3 indicated mild pain, and scores of 0 indicated a complete absence of pain. At the beginning of the study, mean VAS scores in the control group and observation group were 7.36 and 7.25 respectively. By the end of the study, scores decreased significantly to 4.20 and 2.04 respectively, with significantly greater improvements in the observation group. The results indicate that a combination of acupuncture and herbs is more effective than using only herbal medicine.

Yungang Community Sanitation Service Center

The final study we will examine was conducted by researchers at the Chinese medicine and acupuncture department of the Yungang Community Sanitation Service Center in Beijing. [iii] A total of 36 herpes zoster patients were recruited for the study and were treated with acupuncture, herbs, and cupping therapy. The study group was comprised of 8 male and 28 female patients, ages 25–78 years. Of these participants, 8 had a disease duration of less than 2 days, 11 had a disease duration of 2–14 days, and the remaining 17 participants had a disease duration of over 14 days at the outset of the study.

Treatment Procedure

All patients were treated with a version of Long Dan Xie Tang and Wu Wei Xiao Du Yin. The ingredients were as follows:

• Sheng Di 20g

• Hei Shan Zhi 15g

• Long Dan Cao 10g

• Huang Bai 10g

• Chai Hu 10g

• Huang Qin 10g

• Che Qian Zi 10g

• Ze Xie 10g

• Mu Tong 10g

• Sheng Gan Cao 10g

• Jin Yin Hua 10g

• Lian Qiao 10g

• Ye Ju Hua 10g

• Zi Hua Di Ding 10g

• Pu Gong Ying 10g

Modifications

• For patients suffering from concurrent constipation, Da Huang (10g) and Lai Fu Zi (10g) were added to the formula.

• For patients with symptoms of excessive heat, Huang Lian (10g) was added.

• For patients with severe pain, Chuan Lian Zi (10g) and Yuan Hu (10g) were added.

The herbs were decocted in water on a daily basis and were subsequently divided into three portions to be taken morning, noon, and evening. Acupuncture was administered in the area of the herpetic rashes. Needles were inserted between blisters and were stimulated using a reducing method to elicit a distending pain in the region. Needles were retained for 30 minutes.

Modifications

• For patients whose symptoms originated in the area of the limbs, Quchi (LI11), Taichong (LV3), and Chezi (LU5) were added.

• For those whose symptoms originated on the back of the torso, Huatuojiaji (MBW35) and Hegu (LI4) were added.

• For those with a TCM diagnosis of liver fire blazing, Taichong (LV3), Chize (LU5), and Zhigou (TB6) were added.

• For those with a TCM diagnosis of damp-heat in the Stomach and Spleen, Xuehai (SP10) and Sanyinjiao (SP6) were added.

• For those with a TCM diagnosis of qi stagnation and blood stasis, Geshu (BL17) was added.

Needles at Huatuojiaji points were inserted perpendicularly to a depth of 0.7–0.8mm. The needles were manipulated using a balanced reinforcing-reducing method, and after the arrival of deqi, were retained for 20 minutes. Needles at the remaining acupoints were inserted and manipulated using a lifting, thrusting, and rotating reducing technique. These needles were also retained for 20 minutes. Treatment was administered daily for a total of ten days.

Cupping therapy was administered on every third day of the treatment period. A three-edged needle was used to puncture the skin surrounding the herpetic blisters. For those with a relatively small area affected by the rash, a single puncture was made. For those with a larger rash, the punctures were made approximately 3–5cm apart. A cup was then placed over the puncture(s) and were retained for 10 minutes.

Clinical Outcomes

Patients with a complete resolution of both rashes and associated pain were classified as recovered. For patients whose symptoms resolved almost completely, the treatment was classified as markedly effective. For patients whose symptoms partially resolved, the treatment was classified as effective. For patients whose symptoms did not improve or worsened, the treatment was classified as ineffective.

For patients whose symptoms had been present for less than two days, all 8 were fully recovered, yielding a 100% effective rate. Among those whose symptoms had been present for 2–14 days, 5 were classified as recovered and 2 were classified as markedly effective, yielding a total effective rate of 63.6%. For those whose symptoms had been present for over 14 days, one was classified as recovered and one was classified as effective, yielding a total effective rate of 11.8%.

Results

The results of three independent studies indicate that acupuncture combined with herbal medicine is a highly effective treatment combination for rashes and pain associated with the herpes zoster virus. Additionally, treatment is significantly more effective the earlier it is administered. For more information, contact us at Inner Chi Hawai’i to learn about treatment options tailored uniquely to you.

References

[i] Cao Bo (2018) “Clinical Study of Longdan Xiegan decoction Combined with Acupuncture and Moxibustion for Herpes Zoster” Guide of China Medicine Vol.16(25) pp. 174-175.

[ii] Zhang Qin, Ding Yujie (2018) “Study on the Effect of Dialectical Treatment with Chinese Medicine and Acupuncture on Clinical Symptoms of Herpes Zoster Neuralgia” Cardiovascular Disease Journal of Integrated Traditional Chinese and Western Medicine Vol.6(25) pp. 134.

[iii] Zhao Yun (2018) “Observation on the Effect of Combined Chinese Medicine and Cupping Method on 36 Patients with Herpes Zoster” Traditional Chinese Medicine Vol.16(16) pp.172-174.

Latest science and research reveals more about energy pathways, acupuncture’s effectiveness

Posted on by Dr. Evan F.J. Murao
Artwork by Samuel Farrand at http://www.samuelfarrand.com

By James Madison, L.Ac for the Gazette.

In acupuncture theory, Qi (vital energy – a communication system) circulates through the body in meridians. When the flow of Qi becomes unbalanced or blocked, pain and disease result. Acupuncture points are specific areas where the Qi can be accessed and manipulated to restore balance.

We know acupuncture increases the body’s release of natural pain killers – endorphins and serotonin – in pain pathways. Modern research shows acupuncture affects most of the body’s systems: the nervous system, muscle tone, hormone outputs, circulation, antibody production, allergic responses, as well as respiratory, digestive, urinary and reproductive systems. However, everyone asks how it works, especially as the meridians cannot be seen. Let’s look at the latest science and research.

Numerous theories show we have structured water clusters inside our bodies. Structured water clusters are small particles which line up (as nanotubes) so that they become superconductors. This structured water not only moistens the body and conducts electricity, it is a communication system in the body which communicates instantaneously.

“Super-Conducting Liquid Crystalline Water Aligned with Collagen Fibers in the Fascia as Acupuncture Meridians of Traditional Chinese Medicine” by Dr. Mae-Wan Ho explains the theory as demonstrated in the title. She used supporting evidence from biochemistry, cell biology, biophysics and neurophysiology to reach her conclusions. Another scientist, Dr. Shui-Yin Lo, a theoretical physicist, proposes through biophysics that stable clustered water forms the meridian system. Both arrived at the same conclusion through different pathways of investigation.

Muscles generate electricity. Electricity is transferred to the fascia. The fascia transfers information, at the speed of light, to your organs or other tissues. The fascia acts as a pump when you move, transferring fluids throughout your body. Fascia is present throughout your body and can transfer pain to different areas readily. Moving your foot moves the fascia, all the way up to your neck! Interestingly, the fascia is not only affected by inflammation, it responds to emotional stress as well, which makes it tighter. Acupuncture meridians tend to be located along connective tissue planes between muscles, or between a muscle and bone or tendon.

The acupuncture system and the Direct Current electrical field detected by western scientists both exist essentially in the continuum of liquid crystalline collagen fibers that make up most of the connective tissues. Water layers on the collagen fibers provide proton conduction pathways for rapid intercommunication throughout the body, enabling the organism to function as a coherent whole. This liquid crystalline continuum constitutes a “body consciousness” working in tandem with the “brain consciousness” of the nervous system.

It has been proven that consciousness resides in all the cells of our body; that the brain converts consciousness to other signals. Water aligned with collagen fibers, as the anatomical and functional basis of the acupuncture meridians, is highly probable. That said, the meridian system may be what integrates or coordinates all body systems and may be the basis of all forms of “subtle energy” medicine, the mechanism of action being mediated via quantum coherent liquid crystalline water

Acupuncture does more than reduce pain; it has a pronounced beneficial effect on health. Not only is the physical body affected, emotional and spiritual aspects are enhanced. Patients often notice an improved sense of well–being after treatment. Traditional Chinese medicine continues to be increasingly popular and has countless applications and benefits.

Acupuncture Low Back Disc Protrusion CT Scan Results

Posted on by Dr. Evan F.J. Murao
Practitioner inserting needle into the paraspinal muscle on lower back

Acupuncture is effective for patients with lumbar disc protrusions. CT scans confirm that acupuncture reduces disc protrusion size and increases healthy space in the spinal canal. Along with relief from nerve compression, investigators conclude that acupuncture improves range of motion and reduces pain for patients with lumbar disc protrusions.

Researchers from the Nanyang Municipal Central Hospital tested two acupoint prescriptions. The results of the investigation demonstrate that both acupuncture point prescriptions that were tested are effective for alleviating lumbar disc protrusions, but one is more effective than the other. We will take a look at both. CT (computed tomography) scans confirm the results, including improvements across multiple parameters (i.e., anteroposterior diameter of the thecal sac, sagittal diameter of the spinal canal, nerve root compression ratio). [1]

Patients were evaluated before and after the treatment course. Both subjective and objective instruments were used to measure patient outcomes. The objective data was gathered using CT scans (also known as CAT scans), which are computer-processed X-ray images. The scans demonstrate that acupuncture reduces disc protrusions and alleviates nerve compression. CT images confirmed improvements in the thecal sac anteroposterior diameter and sagittal diameter of the spinal canal as well as the nerve root compression ratio.

Subjective data was gathered with two instruments. First, the Oswestry Disability Index (ODI) was used to measure functional disability of the lower back. Second, the Japanese Orthopedic Association Lower Back Pain Evaluation Questionnaire (JOABPEQ) was used as an outcome measure for patients with lumbar disc protrusions. Patients demonstrated improvements with both the ODI and JOABPEQ.

Symptoms

The following are results of the ODI and JOABPEQ for two separate groups receiving two different acupuncture treatment point prescriptions. The ODI score for the standard acupuncture control group averaged 23.35 before treatment and 8.34 after treatment. The ODI score for the acupuncture Yao San Zhen (lumbar three needles) treatment group averaged 23.12 before treatment and 5.28 after treatment.

The JOABPEQ score for the standard acupuncture control group was 6.22 before treatment and averaged 17.14 after treatment. The JOABPEQ score for the acupuncture Yao San Zhen (lumbar three needles) treatment group averaged 6.35 before treatment and 21.53 after treatment. The researchers conclude that the Yao San Zhen treatment group outperformed the standard acupuncture control group regarding the improvements of ODI and JOABPEQ scores.

CT Scans

The thecal sac (dural sac) is a sheath around the spinal cord (above L2) and cauda equina. It is composed of dura mater, which is a thick connective tissue membrane. The anteroposterior diameter of the thecal sac for the standard acupuncture control group decreased to an average of 35.72 mm after treatment, from a pre-treatment value of 56.44 mm. The anteroposterior diameter for the Yao San Zhen acupuncture treatment group averaged 56.35 mm before treatment and 26.14 mm after treatment. These measurements indicate a decrease in the size of the disc protrusions.

The sagittal diameter of the spinal canal for the standard acupuncture control group averaged 6.32 mm before treatment and 11.16 mm after treatment. The sagittal diameter for the Yao San Zhen acupuncture treatment group was 6.51 mm before treatment and 14.24 mm after treatment. This parameter is negatively associated with lumbar pain and the improvements are reflected by higher numbers. The Yao San Zhen style of acupuncture outperformed the standard acupuncture protocol.

The nerve root compression ratio for the standard acupuncture control group averaged 0.64 before treatment and 0.48 after treatment. The nerve root compression ratio for the treatment group averaged 0.67 before treatment and 0.32 after treatment. Both groups achieved significant improvements in CT measured parameters. Overall, the improvements were greater for the Yao San Zhen acupuncture treatment group.

Correlation Between ODI and CT

Correlation between ODI and CT parameters (anteroposterior thecal sac diameter, sagittal spinal canal diameter, nerve root compression ratio) for two groups were analyzed. The results showed that the anteroposterior diameter and nerve root compression ratio were positively correlated with ODI scores, while the sagittal diameter of was negatively correlated with ODI scores. The researchers concluded that, “In patients with lumbar disc protrusion, the more severe the nerve root compression, the narrower the sagittal diameter on the CT, and the larger the anteroposterior diameter of the thecal sac, the more serious the clinical symptoms.”

Design

A total of 78 patients participated in the study. They were diagnosed and treated for lumbar disc protrusions between January 2016 and January 2017. The following inclusion criteria were applied:

• Meeting the diagnostic criteria for both western medicine and Traditional Chinese Medicine

• Ages between 20–50 years

• Pain in the lower back and lower extremities

• Confirmed lumbar protrusions by CT or MRI

• Positive straight leg raise (SLR) test

The following exclusion criteria were applied:

• Comorbid tumors, lumbar vertebral spondylolisthesis, spinal stenosis, and spinal compression fractures

• Severe and comorbid blood diseases and coagulation disorders

• Pregnant or lactating

• Neurological or mental diseases

Participants were randomly divided into two groups: Yao San Zhen treatment and standard acupuncture control, with 39 participants in each group. Both groups were equivalent in all relevant demographics. The treatment group was comprised of 26 males and 13 females. The average age of the Yao San Zhen treatment group was 39.21 years. The course of treatment of the Yao San Zhen treatment group was 3.53 months. The control group was comprised of 24 males and 15 females. The average age of the treatment group was 38.37 years. The course of treatment of the treatment group was 3.32 months.

Acupuncture Sessions

Patients from both groups received the following acupuncture points:

• Huatuojiaji

• GB30 (Huantiao) affected side

• BL54 (Zhibian) affected side

• Ashi points

Secondary acupuncture points were added bilaterally based on diagnostic considerations:

• Lower back pain due to cold-dampness: BL39 (Weiyang), GV3 (Yaoyangguan)

• Lower back pain due to damp-heat: GB34 (Yanglingquan), SP6 (Sanyinjiao)

• Lower back pain due to blood stasis: SP10 (Xuehai), BL17 (Geshu)

• Lower back pain due to kidney deficiency: KD3 (Taixi), GV4 (Mingmen)

Acupuncture treatments commenced with patients in a prone position. After disinfection of the acupoint sites, a 40 or 75 mm disposable filiform needle was inserted into each acupoint with a high needle entry speed, reaching a depth of 1–1.5 cun (with the exception of 2–3 cun for Huantiao). After achieving a deqi sensation, the needles were manipulated with the Ping Bu Ping Xie (attenuating and tonifying) technique.

The acupuncture needles were connected to an electroacupuncture device. A low frequency continuous wave (5–10 Hz) was applied with an intensity level set to patient tolerance levels or until muscle contractions were observable. The needles were retained for 30 minutes after the initiation of electric current.

For the treatment group patients, a special acupoint prescription called Yao San Zhen (lumbar three needles) of Jin’s three needling technique was added. This technique was established by Dr. Jin Rui, Ph.D. (chief professor supervisor of Guangzhou University of Traditional Chinese Medicine). The principle of the technique is to use three needle combinations to treat specific diseases. The Yao San Zhen prescription utilized the following acupoints:

• BL23 (Shenshu)

• BL25 (Dachangshu)

• BL40 (Weizhong)

Needles were inserted into each acupoint with a high needle entry speed, reaching a maximum depth of 1–1.5 cun. Upon the arrival of a deqi sensation, the needles were manipulated with the Ping Bu Ping Xie (attenuating and tonifying) technique. A 30 minute needle retention time was observed. For both groups, treatments were applied every two days, 10 sessions as one treatment course, for a total of 8 weeks.

Summary

The clinical results demonstrate that acupuncture produces positive patient outcomes for the treatment of lumbar disc protrusions. Patients that received acupuncture saw improvements in ODI and JOABPEQ scores and parameters measured by CT (i.e., anteroposterior diameter of the thecal sac, sagittal diameter of the spinal canal, nerve root compression ratio). The data indicates that acupuncture is safe and effective for the treatment of lumbar disc protrusions.

Reference

[1] Fang F, Wei YX. Clinical observation on lumbar three needles in the treatment of lumbar disc protrusion and imaging changes [J]. World Chinese Medicine, 2018(5).

What is Chi Kung?

Posted on by Dr. Evan F.J. Murao

What is Chi Kung?

By George Mera

Kung means mastering something, spending time and dedication till the activity transforms in an art. Kung-Fu is the person who possesses arts and skills and has excelled in any area of expertise so martial artists, musicians, and lawyers are called Kung-Fu.

Experts in Chi Kung have mastered the energy of life; they can control and manipulate Chi in order to exert incredible physical force or to heal a person. The force of Chi is described as the one that crazy people have, people on drugs or a woman that lifts a car in order to rescue her children.  It is an internal force, it is not related with muscles but with Chi.

The philosophy of Chi Kung declares that we are all healers, we all have the potential.  In Chi Kung’s practice we are encouraged, without becoming paranoid or hypochondriac, to constantly scan our bodies, organs, tendons and ligaments trying to detect any stagnancy of Qi in the meridians, to resolve the problem before it becomes serious.

Chi Kung is really a pleasant activity; we see obstacles as opportunities to grow. When Chi is stuck in certain parts of our bodies or organs, the game is to liberate the Chi and using some gentle techniques and patience, the areas of chronic pain will disappear.

After you resolve your physical concerns, many of the emotional tribulations seem possible to overcome.  Then your mind can start trusting itself to disperse the clouds of negative thoughts and you find yourself looking at the future with real contentment and pleasant internal dialog in your mind.

In this game of Chi Kung, the stronger the physical discomfort the more powerful the opportunity to release more Chi. The bigger the emotional scars the more the potential for love. The more doubt and questioning that is experienced by the disturbed mind, the closer we get to enlightenment.

There are thousands of different types of Chi Kung; they are classified in five principal schools:
The school of Stillness.  When the mind becomes like a peaceful lake with no ripples.  Many poses are held and much visualization is taught.
The school of Movement.  Some routines have only few or hundreds of movements.  Some imitate animals, like the white goose, or the movement of the four constellations.  This school is vast and the most popular.
The school of Breathing to have an internal vision of the organs.  For this school we are the microcosm of the macrocosm.  Whatever is happening inside your body is happening in the stars.  To know the universe you need to first know yourself.
The school of Medical Chi Kung consists of exercises prescribed by doctors to treat conditions from simple ailments to hepatitis or cancer. Many studies and research have been compiled all over the world, showing how internal and external (Healing Hands) Chi Kung can effectively help to heal.
The school of Taoism, Confucianism and Buddhism.  The metaphysical Chi Kung.  These spiritual practices are looking for Shien or Satori; spiritual enlightenment or immortality. The Chinese government has generally tried to encourage Chi Kung as a science and discourage religious or supernatural elements.

Dietary Nutrition within an Eastern Perspective

Posted on by Dr. Evan F.J. Murao

Dieting and nutrition are subjects for which there are many differing, often conflicting, viewpoints. Within the debates there are political, sociological, cultural, environmental, scientific, ethical and financial influences which flavor our theories and ultimately our food choices. Eastern medicine provides us with a framework for viewing nutrition which is above all of the debates and choices which we will still have to make for ourselves.

The eastern view of nutrition works in the same way that the eastern view of medicine works. That is to provide a global framework that is flexible enough to be uniquely suited to an individual based on their state of health and also allowing room, in the case of nutrition, for an individuals preferences.

The information in this section is intended to provide you with a clear understanding of the way that a practitioner of eastern medicine may view nutrition as well as to provide you with some clear guidelines to assist in the decisions that we all must make surrounding our food choices.

Within traditional chinese medical theory there are a number of factors which either cause a/or are the result of disease. The factors can be physical/climatic factors such as heat, cold, wind, dampness and dryness. These can be both internal and external such as a cold condition from using too much internal energy or a heat condition from an external source such as radiation. There are also emotional factors which tie into the five element theory above, such as anger effecting the functioning of the liver leading to headaches, for example, or excessive joy effecting the heart leading to insomnia.

From a practitioners perspective an eastern medicine diagnosis does not usually carry any association with the western medical diagnosis. For example, using eastern medical theory we might call a “headache” Qi or Blood stagnation. From a nutritional standpoint it is important to understand what each diagnosis means and how you might aid your healing by choosing appropriate foods.

The following information below describes the food choices which may be helpful for a particular general TCM diagnosis. It should be mentioned that the Spleen is of the utmost importance in the majority of these disorders when looked at from a nutritional perspective. The Spleen is the foundation of digestion and consequently plays a primary role in the production of Qi and Blood in the body. Thus, food choices, cooking styles and eating habits which benefit the Spleen, benefit the person overall regardless of their condition.

In general terms, the Spleen benefits from eating a balanced diet with ample amounts of grains, fruits and vegetables, not eating too much raw food including salads, limiting damp producing foods such as dairy, greasy foods and alcohol, as well as having regular meals which are eaten in as peaceful of an environment as possible.

Qi Deficiency Diagnosis:
» symptoms – fatigue, dizziness, shortness of breath, pale face, weak spirit
» tongue – pale w/thin coat
» pulse – empty

Supportive Foods For Qi Deficient Patients:
– Indicates an imbalance of the Spleen.
– Foods which are easy to digest, warming and nourishing should be used. Those from the Earth element below are helpful choices.
– Millet, Garbanzo Beans
– Pine Nuts
– Figs, Dates
– Squash, Carrots, Cabbage
– Small portions of Meat, if desired
________________________________________

Qi Stagnation Diagnosis:
» symptoms – similar signs as qi deficiency but also pain that is not fixed in the chest a/or hypochondriac areas
» tongue – white coat
» pulse – wiry or tight

Supportive Foods For Qi Stagnation Patients:
– An imbalance of the Spleen.
– Food choices similar to those for Qi Deficiency are good choices.
-Preparing them in ways which are even easier to digest such as soups may also be helpful.
– Adding small amounts of strongly moving substances such as black pepper, aid to support patient’s wellbeing.
________________________________________

Dampness Diagnosis:
» symptoms – poor appetite, chest/epigastric oppression, loose stools
» tongue – thick white or yellow coat
» pulse – slippery and slow or rapid

Supportive Foods For Dampness Patients:
– Dampness is also a Spleen related imbalance.
– Generally it is the result of long-term qi deficiency but may also arise quickly from a diet that contains too many cold, raw foods, excessive dairy products or excessive amounts of greasy foods, animal products and/or alcohol.
– Food choices similar to those above are helpful.
– Adding foods which dry dampness such as rye, scallions and turnips and limiting the foods listed above which contribute to dampness.
________________________________________

Blood Deficiency Diagnosis:
» symptoms – fatigue, palpitations, dizziness, numbness, blurred vision
» tongue – pale w/thin coat
» pulse – thin

Supportive Foods For Blood Deficient Patients:
– Blood deficiency is usually seen as a result of long-term qi deficiency.
– The Chinese term, Blood is used in a much broader way than the western idea of blood. However, blood deficiencies may still arise from traumas, child birth and menstrual issues such as heavy bleeding.
– Generally foods which supplement the Spleen, as above, are considered good choices.
– Dark leafy greens, spinach, grapes, lotus root, cayenne pepper, and small amounts of meat products, especially liver, are beneficial additions to help the production and circulation of Blood.
________________________________________

Blood Stagnation Diagnosis:
» symptoms – dull complexion, petechiae, pain that is fixed in location
» tongue – purple a/or purple spots
» pulse – deep, choppy, maybe wiry

Supportive Foods For Blood Stagnation Patients:
– Often a deeper manifestation of qi stagnation but may also arise from trauma.
– The foods mentioned above for Blood deficiency are useful.
– Adding to those which strongly move the Blood in the body such as turmeric, garlic, scallions, chives, egg plant and aduki beans aid to the patient’s wellbeing.
________________________________________

Heat Condition Diagnosis:
» symptoms – sweating, sore throat, thirst, red face, headache, skin outbreaks, anxiety
» tongue – red, dry, yellow coat
» pulse – rapid, maybe floating a/or wiry

Supportive Foods For Heat Condition Patients:
– Heat may show up in a variety of ways depending on the underlying condition.
– From a nutritional perspective it is most important to understand whether it is a “full-heat” syndrome or a “false-heat” syndrome.
– “Full-heat” is a pure excess condition which can be helped by consuming cool foods.
– “False-heat”, however, indicates heat from an underlying deficiency which could be worsened by an excessive consumption of cool foods.
– Fruits and raw vegetables, including salads, are generally cooling and beneficial for a heat condition.
– Limiting foods which create heat in the body such as dairy, meats and alcohol is also important.
________________________________________

Cold Condition Diagnosis:
» symptoms – fatigue, poor appetite, pain that improves with heat
» tongue – white coat, possibly blue body
» pulse – slow, maybe floating a/or tight

Supportive Foods For Cold Condition Patients:
– As with heat, cold may show up in a variety of conditions and appear as “full-cold” or a “false-cold” condition where a person has a heat condition but is experiencing a sensation of cold (chills with a fever, for example).
– Warming and moving foods such as cayenne, cinnamon, ginger and onions are important for this condition.
– Limiting cooling foods especially raw foods and fruit juices is also important.
________________________________________

Chinese nutrition lies at the root of Chinese medicine and is fully integrated into social eating habits in China. This ancient cultural knowledge is now being spread into western society and with that, greater understanding of how food can be used as nutritional medicine. By applying the ancient theories of Chinese medicine to our modern society, we can learn how to live in better harmony with the surrounding environment, reduce our impact on the climate, improve our health and prevent disease.

For practitioners of Traditional Oriental Medicine, nutritional strategies whether TCM based, western nutrition based or other-principle based are common and patients often need guidance on diet and nutrition strategies.  At present, it is difficult to assess from an evidence-based perspective whether classic TCM diets could influence diseases or act in the treatment of any disease or condition.  However in clinical practice, using TCM tenets of nutrition along with individualization of treatment strategies for individuals with conditions that will likely benefit from nutritional interventions are feasible.  This could include many conditions such as gastrointestinal disorders, chronic metabolic conditions and even stress, anxiety and general lifestyle recommendation.

The recommendation is to assess each patient individually in order to determine which nutritional approaches may work best based on both their constitution and current complaint and modify those suggestions appropriately.  Finally regardless of what nutritional strategies you employ or if the foods are native to Asia or not, the most important things for the clinician to suggest are choosing clean, uncontaminated foods when possible, selecting the least processed food, and finally encouraging patients to be in calm and enjoyable settings when preparing and eating food. The longer the shelf life the shorter your life. Eat to live, don’t live to eat.

Eat, Drink, & Be Mindful 🙂

Aloha

Overview of Traditional Chinese Herbal Medicine

Posted on by Dr. Evan F.J. Murao

Traditional Chinese medicine (TCM) is a holistic form of medicine with a 5,000- year history. It comprises traditional Chinese herbal medicine (TCHM), acupuncture, acupressure, massage (Tui Na), energy therapy (Chi Kung) and other practices. The core concepts of TCM have influenced the development of other oriental therapeutic systems, such as Kampo and traditional Korean medicine. TCM was introduced to western countries in the 1970s after US president Richard Nixon officially visited China.

Basic theory of TCM

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TCM concerns harmony of the body, differentiation of symptoms and signs, and holistic treatments. The full theoretical system was established 2,300 years ago, when philosophical theories of yin-yang and the five elements were applied.

Yin-yang theory focuses on the opposite characteristics of different substances and phenomena. Yin represents negative, passive and internal features, while yang represents positive, active and external features. The yin-yang symbol (also called tai chi or tai ji), interprets the relationship between the two: yin (the black part) contains the seed of yang (the white spot), and vice versa. All phenomena in nature have yin and yang features. They are opposite but interdependent and can alternate through a cyclical movement. If yang declines, yin will rise, and vice versa.

In TCM physiology, the stomach is a yang organ because it is in contact with the external environment through the gastrointestinal tract and has yang functions, such as absorbing foods and extracting nutrients (“food essence”) to produce “vital energy” (qi). Yin organs, such as the heart, liver, spleen, kidneys and lungs, are less dynamic and store energy. Symptoms are also categorised as yin (cold, slow, wet, chronic) or yang (hot, rapid, dry, acute). Yin and yang symptoms are trans- formable; at the early stage of illness, cold symptoms (yin) can transfer into heat in the body (yang). In treatment, “cold” conditions are generally treated with herbs having “hot” properties.

The five-element theory further explains the Chinese medical system, using wood, fire, earth, metal and water to describe different substances and phenomena of similar natures. For example, in TCM, the function of the spleen is to transform food essence to produce qi and blood.These are similar to the nature of earth — growing, planting and generating — so the spleen is considered to belong to the earth element. The kidneys, ears, salty taste and fear are associated with water. Thus, chronic tinnitus could be a symptom of kidney deficiency, which could cause anxiety and fear, possibly associated with a salty diet.

The five elements have complex relationships. An excess or deficiency of any one element is believed to disrupt balance and cause disease. Medical language used in TCM needs to be distinguished from that of conventional western medicine, particularly in describing organ function. In TCM, each organ is a holistic complex energy system, (eg, the heart is responsible for the mind and blood circulation, and has a sense of happiness, which does not correspond with western medical thinking).These differences are probably due to the fact that dissecting the human body was prohibited in ancient China.

Another essential concept in TCM is that of vital substances: qi, blood, essence (jing), body fluids and mind. These constitute the human body and maintain the functions of the organs. Deficiency in any of the substances will result in an imbalance of yin- yang and cause disease. Other important principles in the TCM framework include the theories of viscera and meridians (longitudinal pathways across the body, along which acupuncture points are distributed) and the identification of patterns.

Diagnostics and therapeutics Observation (wàng), listening and smelling (wén), interrogation (wèn), and palpation and pulse taking (qiè) are the four principal diagnostic techniques used in TCM. A practitioner will observe the patient’s face and tongue, ask for details of symptoms, medical history and life style, listen to the patient’s voice, palpate the skin and abdomen and feel his or her pulse.

The term “pattern” is used in TCM to describe symptoms and classify disease. Particular patterns are looked for among overall symptoms and the corresponding treatment applied.Treatments are highly individualised, and may include use of TCHMs as well as physical therapies such as acupuncture, acupressure and massage. One prescription could be used for several health problems and similar health problems are treated differently if they are not in the same TCM pattern. Follow-up consultations with prescription changes are common.

Materia medica of TCHM

In China, more than 5,000 species of animals and plants, plus minerals, are used in TCHM. In total, 538 Chinese crude “herbal” medicines were included in the 2005 Chinese Pharmacopoeia. Most are plant parts but animal products make up 9.5 per cent and minerals constitute 4.5 per cent.

Chinese herbal medicines are prescribed by their Chinese common names and different herbal species can be used under one name. For example, Mu Tong, a Chinese herb for promoting diuresis, includes various plant species: Aristolochia manshuriensis, Clematis armandi, C montana, Akebia quinata and A trifoliata. The number of herbal ingredients in a prescription can vary from one to more than 15. Herbs have different functions within a formula. The principal herbs target the main symptoms and associate herbs assist the function of the principal herbs and target other symptoms. Next are adjuvant herbs to strengthen the functions of the principal herb(s) and reduce toxicity, and last is the messenger herb which guides the function of all the ingredient herbs into the right pattern and harmonises the function of the formula.

Chinese herbal formulae are available as mixtures of crude herbs for internal use as a decoction, and Chinese patent medicines (CPMs), which are finished or formulated products (eg, capsules) made from crude herbs. Some modern CPMs combine herbal medicines with pharmaceutical drugs to improve efficacy and reduce the possibility of side effects. In the UK, some of these combination products are supplied by TCHM shops as herbal medicines and this has become an important quality and safety issue.

Efficacy of TCHM

Obtaining scientific evidence for TCM theory is complicated because it is based on abstract philosophy. In China, the reputation of TCHM as a therapeutic option remains strong, possibly due to its history of use and the understanding of its philosophy. In western countries, there is generally uncertainty about its efficacy. In the UK, a House of Lords report classified TCHM as being a traditionally established health care system with a philosophical background, but as having insufficient scientific evidence of efficacy.

Scientific evidence for TCHM is generally achieved through assessing the efficacy of specific herbs or formula. For example, the efficacy of a standardised herbal formula for atopic dermatitis has been assessed in several double-blind, placebo controlled trials. One randomised, double-blind, placebo-controlled trial involving 116 patients with irritable bowel syndrome assessed both individualised TCHM treatment (reflecting how TCHM is prescribed in practice) and standard prepared TCHM products. Patients’ bowel symptoms scale scores improved significantly in both TCHM groups, compared with placebo (P=0.001), but only the individualised TCHMs group still had improvements at 14 weeks. However, it is beyond the scope of this article to review all clinical trials for TCHMs.

A review of randomised controlled trials (RCTs) of TCHMs shows that most trials have been conducted in China and published in Chinese, and that their methodological quality does not meet European criteria. To date, the Cochrane Library has published nine systematic reviews of clinical trials of Chinese herbal medicine or medicinal herbs for atopic eczema, schizophrenia, diabetes, chemotherapy side effects, acute bronchitis, acute pancreatitis, hepatitis B virus infection, chronic hepatitis and influenza. These provide limited evidence of efficacy for TCHM: conclusions of these reviews are generally that there is a lack of high-quality RCTs and that rigorous studies are needed. Eighteen protocols for new systematic reviews of clinical trials of Chinese herbal medicines have been published in the Cochrane database, including herbs or formulas for cancer and gynaecological and digestive problems.

The constituent chemical compounds of Chinese medicinal herbs are diverse. The absence of rigorous toxicological information for many herbs does not necessarily indicate safety. Toxic herbs used in TCHM are traditionally classed as slightly toxic, toxic, extremely toxic and deadly toxic, based on the experiences of ancient Chinese. For example, croton seed (Ba Dou) is classified as extremely toxic and aconite root (Fu Zhi) as toxic. Dosage limitations have been documented for each herb.

Some crude herbs are processed to reduce toxicity. For example, Jiang Ban Xia is a traditional processed product of raw pinellia tuber (Ban Xia), and is boiled with gingers and alum for internal use. Raw pinellia tuber is believed to be toxic and should only be used topically. Tests have demonstrated that the processed pinellia tuber is less toxic than unprocessed tuber.

Herb-to-herb interactions are also used to reduce toxicity, to increase potency or to modify properties of herbs in a formula. There are seven basic types of interactions (single use, mutual reinforcement, mutual assistance, mutual detoxication, mutual restraint, mutual inhibition and mutual incompatibility) so it is important to choose the correct herb combination. In addition, there are 18 incompatible herbs and 19 antagonistic herbs.

Awareness of safety issues concerning specific herbs increased following the inadvertent misuse of toxic Aristolochia species by a slimming clinic in Belgium. There were over 100 cases of renal failure in Belgium and at least four cases were identified in the UK. Furthermore, a five-year toxicity study on traditional medicines identified 21 cases of liver problems associated with TCHMs, but no single hepatotoxic herb has been identified.8 In addition to intrinsic toxic effects of some TCHMs, there is a potential for interactions between TCHMs and other medicines, although this has been poorly investigated. However, not all interactions are clinically relevant, and some may even be therapeutically useful.

While TCM theory recognises the potential for adverse effects, including herb-to-herb interactions, traditional descriptions and information on herbal toxicology are largely inadequate from a western scientific perspective. At the same time, there is a lack of reliable information for most herbs on other aspects, including dosage regimens, pharmacokinetics, adverse effects, interactions and effects in special patient groups. Some data are available in primary literature, but pharmacists are likely to require summarised information provided in a familiar format.

Another issue is the use of animal material in TCHM. This carries a latent risk of various infectious diseases passing from animals to humans. Some animal products used in TCHM, such as tiger bone and bear gall, are listed by the Convention on International Trade in Endangered Species (CITES) and despite efforts to stop the practice, some endangered species are still used and included in TCHM textbooks.

Quality Many of the safety problems with TCHMs concern poor-quality products, including contamination with heavy metals, adulteration with prescription drugs, and quantitative variations in constituents.9 For example, in the UK, the CPM Fufang Luhui Jiaonang was found to contain 11.7 percent mercury and, despite attempts to withdraw this product, it is still being sold. Other adulterant drugs include dexamethasone and fen-fluramine.

A phytochemical study of 12 paeoniae samples collected in London, showed the content of paeoniflorin varied from 0.01–4.57 percent.10 The legitimate substitution of Chinese medicinal materials under a given Chinese name brings another difficulty in quality control. For example, the species Aristolochia debilis, Saussurea lappa and Vladimiria souliei can all be supplied under the name “Muxiang”. The latter two herbs are relatively safe but Aristolochia debilis contains toxic aristolochic acids.

Chinese patent medicines with the same formula name can also vary in ingredients when produced by different manufacturers. For example, the number of labelled ingredients in each of the eight CPMs all named “Gui Pi” was found to vary between 2 and 13.11.

Other issues relevant to safety include the behaviors and practices of TCHM practitioners and users. It is common practice in TCHM to change herbal prescriptions as frequently as every few days. TCHM practitioners consider some adverse effects (eg, diarrhea) to be part of the normal response to treatment. Frequent consultations are useful in identifying acute adverse effects, and prescriptions can be modified to reduce these. However, adverse reactions that develop only with chronic use, or that have a delayed onset may not be easily identified.

Pharmacovigilance practices for herbal medicines are still developing. Suspected adverse drug reactions (ADRs) associated with unlicensed herbal medicines have been reportable using yellow cards since 1996. Recognised reporter groups now include doctors, pharmacists, nurses, midwives and health visitors and, recently, patients but not herbal medicine practitioners. Some practitioner groups, for example the Register of Chinese Herbal Medicine, have systems to collect reports of ADRs from their members.

Pharmacists receive information on safety concerns with TCHMs and other herbal medicines in Current Problems in Pharmacovigilance. Further information is available in Herbal Safety News. Despite these initiatives, important safety and quality problems with TCHMs continue and pharmacists should be vigilant to the possibility of their patients experiencing ADRs associated with these products. At present, the distribution and use of TCHMs goes beyond formal surveillance systems; this situation is likely to continue until there is regulation of herbal practitioners.

References

1. House of Lords Select Committee on Science and Technology. Complementary and Alternative Medicine. 6th Report. The Stationery Office; 2000.
2. Koo J, Desai R. Traditional Chinese medicine in dermatology. Dermatologic Therapy 2003;16:98–105.
3. SheehanMP,AthertonDJ.Acontrolledtrialoftraditional Chinese medicinal plants in widespread non-exudative atopic eczema. British Journal of Dermatology 1992; 126:179–84.
4. Sheehan MP, Rustin MHA, Buckley C, Harris DJ, Ostlere L, Dawson A et al. Efficacy of traditional Chinese herbal therapy in adult atopic dermatitis. Lancet 1992;340:13–7.
5. Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable Bowel syndrome with Chinese herbal medicine: A randomised controlled trial. Journal of the American Medical Association 1998;280:1585–9.
6. Tang JL, Zhan SY, Ernst E. Review of randomised controlled trials of traditional Chinese medicine. BMJ 1999;319:160–1.
7. Wu H, Cai BC, Shi XL, Ye DJ. The effect of stimulation and toxicity of rhizoma Pinelliae processed by ginger juice on animals.(In Chinese) China Journal of Chinese Materia Medica 1993;18:408–10.
8. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements: a five-year toxicological study (1991–1995). Drug Safety 1997;17:342–56.
9. Barnes J. Pharmacovigilance of herbal medicine: a UK perspective. Drug Safety 2003;26:829–51.
10. Cai Y, Phillipson JD, Harper JI, Corne SJ.. High performance liquid chromatographic and proton magnetic resonance spectroscopic methods for quality evaluation of paeonia roots. Phytochemical Analysis 1994;5:183–9.

11. Samuel M, Wright C. Chinese herbal patent medicines in the UK. British Pharmaceutical Conference Science Proceedings 2003 15–17 September; Harrogate. S31–S32.

The Metaphysical Aspects of the 5 Elements in Traditional Chinese Medicine

Posted on by Dr. Evan F.J. Murao

The Five Element Theory

Within the TCM (Traditional Chinese Medicine) spectrum, this theory has numerous names that are used when describing the Five Elements Theory. They are the Wu Xing, the Five Movements, the Five Phases, or the Five Steps/Stages. Illustrated below are the elements with their chinese character, color, and their relationship with each other, shown here:

5elements21

Chinese cosmology sees the world as arising from yin-yang and the five primordial powers. From the macrocosm to the microcosm, all natural phenomena can be organized by the five phase theory of systemic correspondence.

The five phases consist of: Wood, Fire, Earth, Metal, Water. In TCM, the five phase theory is used to generalize and explain the nature of the zang fu, the inter-relations between them, and the relation between human beings and the natural world.

Theory of the five elements formed during the Yin and Zhou dynasties (16th c. – 221 B.C.) Each elements has unique characteristics, yet remain interconnected. The Five Elements are five fundamental energies in nature in motion. There is a dynamism between them; they are not static. Within the structure of the Five Elements there are two fundamental relationships: generation and support. Without the balancing nature of these two relationships, things would fall out of order in a flash.

The Five Elements show us how the structures and systems in our bodies are connected to each other; how we are connected to our environment and the natural world; how our world is part of the greater universe. Many people today have lost this deep connection to nature and no longer are able to feel this truth resonate in their being. The Universal principle of connection still exists nonetheless.

Everything within each element is related. While referring to the chart below, let’s take a look at the Water element as an example. Water is related to winter, a cold climate, the north, the color black, the Kidneys, the emotion fear. These are things that share a deep, sometimes invisible, connection to each other. When it is winter there is a cold essence, it relates to and impacts in some way the Kidneys, the emotion fear is linked, though not always in an obvious, visible way.

cycle-2-w-text

The emotions are an extremely important aspect of Traditional Chinese Medicine (TCM). Emotional well being is an integral part of health in the TCM model. Each emotion is associated with an organ, which, if out of balance will cause specific symptoms.  These are what the experienced acupuncturist or practitioner of TCM is looking for when you walk into their office with a complaint.

Emotions are of course a natural part of being human. Feeling joy, sadness and anger and all perfectly normal experiences we have in our day to day lives. It is when these emotions become excessive, or are repressed and turned inward that they can become pathological and cause disease. The belief is that balancing the organ associated with the emotion will balance the emotion. Sometimes the organ is out of balance and produces the emotional imbalance. But sometimes the emotional imbalance can produce the organ imbalance. The difference to the practitioner is important only in preventing a recurrence of the problem.

For example, if a person is experiencing extreme fits of anger, frustration, red eyes, problems sleeping, migraines and constipation, they are seen to be suffering from an imbalance of the Liver. This can be corrected with acupuncture and herbs. The liver returns to balance, the migraines disappear, sleeping improves and the bowels return to normal. But, if the patient is in a job he hates, with coworkers that make him angry and is constantly fighting with his wife, his anger will remain and the Liver imbalance will return. This is why during the diagnostic process, the practitioner asks many questions, and to the patient, it might seem like they have no bearing on the presenting condition. The job of the practitioner is to evaluate all aspects, not just the physical, so that once the imbalance is corrected, the environment that created that imbalance no longer exists.

It is important to remember that cause and effect in TCM is not linear but circular. We usually think that something is the cause of an act, or effect such as – eating too much will give you a stomach ache. Eating too much is the cause and the stomach ache is the effect. This is linear thinking. In TCM linear cause and effect does occur when symptoms are present, for example – going outside without enough warm clothes on in the middle of winter will cause you to catch cold, resulting in symptoms like a runny nose, achy muscles and a fever. These symptoms are the effect of the cold which was the cause. However, in some cases, the symptoms are not a result of such straightforward reasoning which is especially true when we are dealing with emotions.

One very common cause of emotional imbalance in TCM is repressed emotions. TCM is all about balance and flow. If emotions are not being expressed, they are being stuck which can lead to a blockage of the flow or a stagnation, which is turn can lead to disease. How the disease manifests is completely individualized depending on many factors, and it is up to the practitioner to determine the “how”. Releasing the emotions can heal the disease. Emotions that do not have avenues for expression and release can create disease and disharmony in the body manifesting as physical symptoms. So, it is very important to have a healthy emotional life, expressing your emotions freely and not allowing things to build up.

Below is information about the 5 elemental spirits written in their chinese character. Each elemental spirit is explained by author Lorie Eve Dechar from her book “Five Spirits: Alchemical Acupuncture for Psychological and Spiritual Healing.” You can find her book online for purchase at www.anewpossibility.com.

Click on the links below each Chinese character to read more in detail about each elemental spirit:

hun

Hun: The Spirit of Wood—Vision, Imagination, Direction and Benevolence

shen

Shen: the Spirit of Fire—Inspiration, Insight, Awareness & Compassion

yi

Yi: The Spirit of Earth—Integrity, Intention, Clear Thought & Devotion

po

Po: the Spirit of Metal—Animal Wit, Embodiment, Sensation & Appreciation

zhi

Zhi: The Spirit of Water—Instinctual Power, Aligned Will, Courage & Wisdom

Plantar Fascitis and Plantar Aponeurositis: An Integrated Approach in the Training Room

Posted on by Dr. Evan F.J. Murao

BY RONDA WIMMER, PHD, MS, LAC, ATC, CSCS, CSMS, SPS

Acupuncture Today – January, 2004,

Vol. 05, Issue 01

Western Perspective

Plantar fascitis is inflammation of the plantar fascia located on the sole of the foot. Pain is generated at the attachment of the fascia near the medial tubercle on the calcaneus.

The injury can be caused by overuse as a result of excessive loading, wearing shoes with inadequate support and/or cushioning. Pain is located on the bottom of the foot, and is worse in the morning and with walking.

To treat plantar fascitis and plantar aponeurositis from a Western perspective, one must understand the injury mechanism: an overcontracted muscle progressing through tendonitis stages of severity. Once this is accomplished, one prioritizes whether to treat the inflammation or the cause. Ice, ultrasound at 20 percent intensity (for its non-thermal effect), MENS (microcurrent electrical stimulation) units and anti-inflammatory drugs can be used to reduce swelling. One aspect that must be taken into account is whether the practitioner wants to treat a symptom or take care of what is causing the muscle to contract. Although it may be more important to address the cause in some instances, treating the inflammation might be the only option if a time frame is involved. Once the cause is identified, heat can be applied in the form of ultrasound at 100 percent intensity, stretching, rest and massage.

TCM Perspective

According to traditional Chinese medicine, the bottom of the foot can be related to many patterns of differentiation such as wind, cold, heat and damp (six external pathogens), qi/blood stagnation in the channels, qi/blood deficiency, and Kidney jing/essence deficiency.

The deficiency conditions generally relate to weak constitution, overstrain, poor eating habits, and prolonged chronic diseases. Excessive bleeding may be specific to blood deficiency, and specific Kidney deficiency may be caused by excessive sexual activity and multiple pregnancies. When the qi and blood become deficient, they cannot properly perform their functions of movement and nourishment. Thus, the affected target areas are the channels, bones, muscles and tendons. When the Liver and Kidney become deficient, they can perform neither their primary nor supporting functions, and rely upon the jing/essence for support. This causes jing/essence deficiency, which in turn cannot nourish the muscles, tendons and bones.

Excess conditions generally tend to be related either through the Spleen’s function of transportation of obstructions (transformation transportation) and/or qi and blood. The Spleen, located in the middle jiao, tends to get congested through poor eating habits and consumption of excessive cold or spicy foods, which allows dampness to accumulate. Dampness creates an obstruction, the severity of which is dependent upon the length of the obstruction. Over time, this damp accumulation affects the flow of the qi and blood, and creates deficiency. Another scenario is the qi and blood becoming stagnation due to acute injuries (trauma, operations, infections, etc.). This creates a sudden blockage, restricting the normal flow of qi/blood, affecting the muscles and tendons.

The result of the TCM patterns of differentiation reflects the physiological manifestations within the Western paradigm.

There are more formulas and other acupuncture point combinations that are also effective; this is just one perspective.

In summary, to understand treating sports injuries specific to plantar fascitis and/or plantar aponeurousitis is to understand jargon in both Western and Eastern arenas. Treating with TCM is extremely effective when applied in conjunction with TCM philosophy. The points and formulas are given as an example of what can possibly be used, not as the only method of use. There are a variety of points that can be combined when treating plantar conditions, along with a variety of herbal formula patents on the market. Acupuncture is like geometry. There are many different ways to develop your acupuncture prescription; the key is understanding which access route you choose and why, so you can modify your treatments accordingly. This is the beauty of Oriental medicine: getting results by thinking through the solution, and by being outside of the traditional box. Ultimately, our goal is to provide result-oriented outcomes for the patient. Educating patients and medical professionals preserves the integrity of our professional medical expertise.

References

1 Xinnong C (chief editor). Chinese Acupuncture and Moxibustion. Beijing: Foreign Languages Press, 1990.

2 Maciocoa G. Foundations of Chinese Medicine. New York: Churchill Livingstone, 1989.

3 Kaptchuk T. The Web That Has No Weaver. Ontario: Congdon & Weed, 1983.

4 Wiseman N, Ellis A. Fundamentals of Chinese Medicine. Brookline: Paradigm, 1985.

5 Zhang E (editor-in-chief). Basic Theory of Traditional Chinese Medicine. Publishing House of Shanghai College of Traditional Chinese Medicine, 1990.

6 Chung CS, Lai YK. Principles of Dialectical Differential Diagnosis and Treatment. Traditional Chinese Medical Publisher, 1982.

7 Bensky D, O’Connor J. Acupuncture: A Comprehensive Text. Chicago: Eastland Press, 1981.

8 Zhongan S, Aung S, Deadman P. The Treatment of Pain with Chinese Herbs and Acupuncture. Churchill Livingstone (China), 2002.

9 Bensky D, Barolet R. Chinese Herbal Medicine: Formulas & Strategies. Seattle: Eastland Press, 1990.

10 Booher T. Athletic Injury Assessment, 4th ed. McGraw-Hill, 1994.

11 Hertling D, Kessler RM. Management of Common Musculoskeletal Disorders: Physical Therapy Principles and Methods, 2nd ed. Philadelphia: J.B. Lippincott, 1990.

12 Snider RK. Essentials of Musculoskeletal Care. American Academy of Orthopaedic Surgeons, 1997.

The Emotions and their Relationship with your Body

Posted on by Dr. Evan F.J. Murao

The emotions are an extremely important aspect of Traditional Chinese Medicine (TCM). Emotional well being is an integral part of health in the TCM model. Each emotion is associated with an organ, which, if out of balance will cause specific symptoms.  These are what the experienced acupuncturist or practitioner of TCM is looking for when you walk into their office with a complaint.

Emotions are of course a natural part of being human. Feeling joy, sadness and anger and all perfectly normal experiences we have in our day to day lives. It is when these emotions become excessive, or are repressed and turned inward that they can become pathological and cause disease. The belief is that balancing the organ associated with the emotion will balance the emotion. Sometimes the organ is out of balance and produces the emotional imbalance. But sometimes the emotional imbalance can produce the organ imbalance. The difference to the practitioner is important only in preventing a recurrence of the problem. For example, if a person is experiencing extreme fits of anger, frustration, red eyes, problems sleeping, migraines and constipation, they are seen to be suffering from an imbalance of the Liver. This can be corrected with acupuncture and herbs. The liver returns to balance, the migraines disappear, sleeping improves and the bowels return to normal. But, if the patient is in a job he hates, with coworkers that make him angry and is constantly fighting with his wife, his anger will remain and the Liver imbalance will return. This is why during the diagnostic process, the practitioner asks many questions, and to the patient, it might seem like they have no bearing on the presenting condition. The job of the practitioner is to evaluate all aspects, not just the physical, so that once the imbalance is corrected, the environment that created that imbalance no longer exists.

It is important to remember that cause and effect in TCM is not linear but circular. We usually think that something is the cause of an act, or effect such as – eating too much will give you a stomach ache. Eating too much is the cause and the stomach ache is the effect. This is linear thinking. In TCM linear cause and effect does occur when symptoms are present, for example – going outside without enough warm clothes on in the middle of winter will cause you to catch cold, resulting in symptoms like a runny nose, achy muscles and a fever. These symptoms are the effect of the cold which was the cause. However, in some cases, the symptoms are not a result of such straightforward reasoning which is especially true when we are dealing with emotions.

One very common cause of emotional imbalance in TCM is repressed emotions. TCM is all about balance and flow. If emotions are not being expressed, they are being stuck which can lead to a blockage of the flow or a stagnation, which is turn can lead to disease. How the disease manifests is completely individualized depending on many factors, and it is up to the practitioner to determine the “how”. Releasing emotions can heal disease. Even things that are considered extreme and long standing stagnation in TCM like cancer. Diseases which, in the West, are seen as incurable.  Emotions that do not have avenues for expression and release can create disease and disharmony in the body manifesting as physical symptoms. So, it is very important to have a healthy emotional life, expressing your emotions freely and not allowing things to build up.

Here is a breakdown of the emotions, their related organs and some symptoms when imbalance occurs…

HEART

Emotion – Joy

Emotion out of balance – Lack of enthusiasm and vitality, mental restlessness, depression, insomnia, despair, confusion, anxiety, fidgeting, easily startled

Function – Regulates the heart and blood vessels, responsible for even and regular pulse, influences vitality and spirit. Connected to the tongue, complexion and arteries

Symptoms of organ imbalance – insomnia, heart palpitations, irregular heartbeat, excessive dreaming, poor memory and concentration, dizziness, spontaneous sweating

SPLEEN

Emotion – Worry, over thinking

Emotion out of balance – Dwelling or focusing too much on a particular topic, excessive mental work

Function – Food digestion and nutrient absorption, the first step in the formation of Blood and Qi, holds blood in the vessels, connected to the muscles, mouth and lips, involved in thinking, studying and memory

Symptoms of organ imbalance – Tired, loss of appetite, mucous discharge, poor digestion, abdominal distension, loose stools or diarrhea, weak muscles, pale lips, bruising easily, excessive menstrual blood flow, other bleeding disorders

LUNG

Emotion – Sadness

Emotion out of balance – Excessive sadness, grief, or detachment, uncontrolled crying

Function – Respiration, controls sweat and body hair, creates energy (Qi) from air and redistributes it throughout the body, works with Kidney to regulate the water metabolism, important part of the immune system and helps protect the body from viruses and bacteria, provides moisture to skin

Symptoms of organ imbalance – Shortness of breath, fatigue, cough, catching colds easily, fever with chills, sore throat, runny nose, headache, asthma, chest oppression, pale complexion, dry skin

KIDNEYS

Emotion – Fear

Emotion out of balance – Fearful, no willpower, insecure, aloof, isolated

Function – Responsible for reproduction, growth and development & maturation, connected with lungs in water metabolism and respiration, responsible for bones, teeth, hearing and head hair

Symptoms of organ imbalance – Frequent urination, urinary incontinence, vertigo, night sweats, dry mouth, poor short term memory, low back pain, sore or weak knees, ringing in the ears, hearing loss, hair that turns grey prematurely, hair loss and osteoporosis, lowered libido

LIVER

Emotion – Anger

Emotion out of balance – Explosive anger, resentment, frustration, irritability, bitterness, moodiness

Function – Stores the blood, responsible for the smooth flow of Blood and Qi throughout the body, regulates the secretion of bile, connected with the tendons, nails and eyes

Symptoms of organ imbalance – chest distension, red face, bitter taste in the mouth dizziness, ringing in the ears, jaundice, menstrual problems (cramps, irregular or heavy periods), headaches, tendonitis, nausea, vomiting, sighing, breast tenderness, swelling and/or itching of the genitals, blurred vision, floaters, dry skin and hair

Here are examples of some combination patterns:

Heart & Kidney

If a patient is experiencing extreme mood swings between Joy (mania) and Fear (depression), it indicates an imbalance between the Heart (Joy) and Kidney (Fear). We would see symptoms such as insomnia, dream disturbed sleep, heart palpitations and dizziness.

Liver & Lung

If a patient is experiencing violent mood swings between Anger and Grief, an imbalance between the Liver and Lung is present with symptoms involving breathing problems, issues with bowel movements and waking between 1-5am.

The way the TCM model views emotions is very specific. For example, there are many different types of depression. It depends on which organs are involved. Here are some examples:

Liver

If the depression is actually anger turned inward on itself, which is common with many women, the Liver is out of balance. Symptoms could include PMS symptoms, cramps during the period, vomiting and nausea.

Spleen

If obsessive thinking or worry characterizes the depression, we would suspect the spleen and look for symptoms such as decreased appetite, diarrhea, fatigue, heavy bleeding with the periods, and bruising easily.

Kidney

Sometimes the depression comes with panic attacks (Fear). In this case, we would suspect the Kidneys.  We would look for urinary changes (usually an increase in frequency), low back pain and weakness, tinnitus (ringing in the ears), poor appetite and diarrhea.

Emotions are not the only factor contributing to disease. Another thing to consider is lifestyle. It is difficult to always avoid getting cold, having an umbrella for when it might rain, getting enough sleep and eating properly. We live in a fast paced world full of stresses on both our minds and our bodies. We always seem to be rushing and there never seems to be enough time. And although sometimes we can’t help getting sick or feeling a little under the weather, it is important to remember that the cause of an imbalance may be occurring from events in your life. There is no needle for a bad relationship, stressful job or frustrating coworker. A practitioner can help you to deal with the stress in your life that may be causing the imbalance, but we can’t remove the stress. Only you can do that. Sometimes we feel that we are unable to change the circumstances that are causing stresses in our lives, but a practitioner can help you to deal with that stress by advising on how to eat healthy (eating with the seasons, and the incorporation of the 5 flavours – Sour, Salty, Spicy, Bitter, Sweet), and how to incorporate exercise and meditation techniques such as Tai Chi and Qi Gong into your life. The TCM practitioner is trained in how to live or the “Tao” (which comes from Taoist philosophy) helping both to rebalance a patient and educate him on how to retain that balance by living a healthy balanced life.

We are all living full, busy lives. Imbalance is everywhere, and staying healthy isn’t easy. I have found that in my practice people often feel overwhelmed and exhausted. I always suggest that they be kind and gentle with themselves, and to try to do at least one nice thing for themselves every day, as our happiness is so important for our health. We are living in a time when we are dealing with so much, so it is important to take the time to do things for yourself like have a bath, read a book, spend time with your children, or walk outside in nature. Whatever brings you happiness and makes you feel good. It is these small things that are the keys to wellness. Life is the journey we all share, and if we live it with mindfulness and wisdom, that journey will always lead to balance and happiness.

TREATING LYME DISEASE WITH ESSENTIAL OILS

Posted on by Dr. Evan F.J. Murao

Lyme Disease: The mere phrase invokes a sense of fear and dread of the unknown. This disease is cloaked in mystery, while at the same time, hijacking lives and wreaking havoc on previously healthy bodies. If you’re diagnosed early, your chance of recovery is fairly high, though the symptoms may never completely dissipate. However, if…

via TREATING LYME DISEASE WITH ESSENTIAL OILS

Do You Want Acupuncture But Hate Needles?

Posted on by Dr. Evan F.J. Murao

Wanting to try Acupuncture, yet can’t stand the thought of needles stabbing you? Acupuncture is a procedure that is relatively painless, we use the sterile tool which is made of solid metal and hair-like in thickness. It glides through the spaces between the skin and muscle fibers, so with a skilled practitioner the only thing you’ll feel is your energy being activated, ready to begin your healing process. The following writer briefly goes over 5 things to keep in mind if you are apprehensive on recieving Acupuncture.

By Sara Calabro

Most people, when they hear about the benefits of acupuncture, find themselves thinking, “That would be so good for me!” Less stress, more energy, better sleep and digestion… Who doesn’t want that?

But for many people, there’s one thing that holds them back from enjoying the benefits of acupuncture: Fear of needles.

There’s a spectrum of needle fears, ranging from downright needle phobic to being moderately concerned about the whole voluntarily-being-stuck-with-needles thing. Regardless, fear of needles is the number-one reason people choose to forego acupuncture…

Read More At The Source:  5 things to remember if you’re scared of getting acupuncture

Encapsulating The Ziran Moment

Posted on by Dr. Evan F.J. Murao

Taking myself towards the back of the valley, I had become compelled into taking the compostion of this photo, at this persepective. Hiking in the Forest, I witnessed the balance in nature, as it was seen, and captured the elemental forces of Yin within Yang, and Yang within Yin. A rare moment that I have been manifesting to the universe, in capturing nature being at it’s most “Ziran” harmonious state. Your continued guidance, never ceases to amaze. Dao, Heaven, Earth, and Man coexisting in inextricable bliss 🙂

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Hypertensive patients benefit from acupuncture treatments, study finds

Posted on by Dr. Evan F.J. Murao

Ancient Chinese practice lowers blood pressure, may lessen stroke, heart disease risks

Date: August 19, 2015

Source: University of California – Irvine

“Patients with hypertension treated with acupuncture experienced drops in their blood pressure that lasted up to a month and a half, researchers at UC-Irvine have found. This work is the first to scientifically confirm that this ancient Chinese practice is beneficial in treating mild to moderate hypertension, and it indicates that regular use could help people control their blood pressure and lessen their risk of stroke and heart disease…”

Practicing Acupuncture in a Multi-Disciplinary Setting

Posted on by Dr. Evan F.J. Murao

By Sarah Poulin, DACM, LAc, Dipl. OM

As Americans increasingly look to integrative medicine to serve their needs, multi-disciplinary medical centers in which a variety of health care options are offered are uniquely poised to shape the medical landscape of the future.

These multi-disciplinary practices offer a setting in which the patient in search of more holistic minded healthcare can find numerous qualified professionals who can work both independently and as a team to best serve the needs of both their patients and the community as a whole…

Read More At The Source: Practicing Acupuncture in a Multi-Disciplinary Setting