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Acupuncture for fertility and miscarriage
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Maggie Ju (2014) Current opinion in acupuncture on stroke rehabilitation
The Journal of Chinese Medicine And Acupuncture Volume 21 Issue 2 September 2014 P9
Maggie Ju. (2015) What Part Does Acupuncture Play in IVF?
The Journal of Chinese Medicine And Acupuncture Volume 22 Issue 1 March 2015 P21
Maggie Ju (2020) The Potentiality of COVID-19 Treatment with Chinese Herbal Medicine in the UK
The Journal of Chinese Medicine And Acupuncture Volume 27 Issue 2 November 2020 P9
Wednesday, 30 January 2013
Egg and sperm quality
High quality of eggs is essential for conceiving. Women are born with millions of follicles. These follicles stay in the cortex of ovaries where they will develop and some of them will be mature and released. This is a long process and it takes about a year for an egg to develop and to be released. The original follicles are preantral type of follicles. These follicles are in deep sleep stage. Some of them will wake up and be recruited to develop. This is preantral development which is a slow process and it takes about 10 months. This process is hormone independent. After 10 months of development, some of them will be selected to develop to dominant follicles. It takes about 2 months for these dominant follicles to develop to a preovulatory stage. This stage is hormone dependent. And then one of the follicles will be mature and released in 15-20 days which is highly depending hormone balance.
Hormonal balance is the key in human reproductive system. In women, there are five hormones involved in reproductive function: gonadotropin-releasing hormone (GnRH) produced in hypothalamus (a part of the brain), follicle stimulating hormone (FSH) and luteinizing hormone (LH) both produced in pituitary gland (another part of the brain), and oestrogen and progesterone both produced in ovaries located in pelvis. To be fertile, these five hormones have to be well balanced, which means they have to be at the right level at the right time. If the balance is disturbed at any points in a cycle, this would affect fertility. Most of the infertility in women is caused by imbalanced hormones. Hormonal imbalance could cause poor egg development; as a result, poor quality egg is produced (fertilization is affected) or no egg is released in the mid-cycle. Hormonal imbalance could also cause poor uterine lining affecting implantation and causing early pregnancy loss.
The hormonal system is very sensitive, even a slightly change can disrupt hormonal production leading to anovulation. Common causes related to hormonal imbalance include stress, anxiety and eating disorders which are associated with inhibition of GnRH production in hypothalamus. Polycystic ovarian syndrome (PCOS) is the most common cause of infertility which is associated with hormonal imbalance. Excessive male hormones (androgens) were produced in women with PCOS. Another hormonal imbalance is excessive production of hormone LH which is involved in stimulating ovary to produce hormones.
Sperm production in men is different. Sperm production and maturation takes about 74 days. Sperm production takes place in testicles where temperature is lower than body temperature. This process is hormone dependent and follicular stimulating hormone (FSH) and Luternizing hormone (LH) are involved in the process. This process takes about 60 days. Sperms produced then mature in epididymis where they obtain motility and it take about 14 days.
In men there are four hormones involved in reproductive function: GnRH, FSH and LH produced in brain, and testosterone produced in testicle located in scrotum. Hormonal imbalance in men causes poor sperm development resulting in low sperm count and/or poor sperm quality. Stress can disturb hormonal balance affecting men’s fertility.
To improve fertility, correcting hormonal imbalance is the key. It takes time (at least a few months) to restore hormonal balance; sometimes it takes much longer than you expected. So determination and patience are needed to achieve the goal. Acupuncture treatment could help restoring hormonal balance by stimulating sympathetic nerve and lowering sympathetic activity. Balanced diet and regular exercises could also help.
Local chronic inflammation is another important factor causing infertility. In women inflammation in pelvic area could cause fallopian tube spasm which blocks the eggs passing through. After lower abdominal surgery, or following pregnancy loss, inflammation could occur in pelvic area. Endometriosis causes inflammation in pelvic area surrounding the misplaced tissue affecting ovulation, egg transportation. Endometriosis is another common cause for infertility. In men inflammation in scrotum could impair sperms. Reducing local inflammation can significantly improve fertility in relatively short time, if there is no hormonal imbalance involved in infertility. Acupuncture can help reducing local inflammation by stimulating nerve endings and improving local blood flow.
AMH is short for anti-mullerian hormone. It is a substance made by small follicles in women’s ovaries. When the follicles grow bigger, they are no longer producing AMH. Since AMH is produced only in smaller follicles and its blood levels are constant, AMH has been used to measure the size of the pool of growing follicles in women. AMH blood levels reflect the size of the remaining egg supply. If your AMH is low, it means your egg supply is poor. With increasing women’s age, the size of their pool of remaining small follicles decreases. Their AMH levels and the number of ovarian small follicles visible on ultrasound also decrease. Some women may have problems of recruitment and development of follicles; in this case they have fewer follicles developed and their AMH tends to be low. Women with low AMH would have less chance to have good quality eggs. So they may have difficulty to conceive naturally. Women with low AMH level are likely to have poor response to ovarian stimulation for IVF and have fewer eggs retrieved. This reduces their chance to conceive via IVF.
Tuesday, 29 January 2013
Meridians are like vessels forming a network and connecting skin and muscles to internal organs such as heart, liver etc to make energy and blood flowing freely and maintain balance in the body.
How many meridians are there? There are 12 regular meridians which are the main passageways for energy and blood, six of which are foot meridians and another six are hand meridians. Foot meridians either start on the foot or end on the foot and hand meridians either start on the hand or end on the hand. These 12 meridinas connect to internal organs and are running bilaterally in the body. Apart from 12 regular meridians there are eight extra meridians which are not as regular and do not connect to internal organs directly.
Name of twelve regular meridians
Taiyin Lung Meridian of Hand or Hand's Major Yin Lung Meridian
Shaoyin Heart Meridian of Hand or Hand's Minor Yin Heart Meridian
Jueyin Pericardium Meridian of Hand or Hand's Absolute Yin Heart Protector Meridian
Shaoyang Sanjiao Meridian of Hand or Hand's Minor Yang Triple Burner Meridian
Taiyang Small Intestine Meridian of Hand or Hand's Major Yang Small Intestine Meridian
Yangming Large Intestine Meridian of Hand or Hand's Yang Supreme Large Intestine Meridian
Taiyin Spleen Meridian of Foot or Foot's Major Yin Spleen Meridian
Shaoyin Kidney Meridian of Foot or Foot's Minor Yin Kidney Meridian
Jueyin Liver Meridian of Foot or Foot's Absolute Yin Liver Meridian
Shaoyang Gallbladder Meridian of Foot or Foot's Minor Yang Gallbladder Meridian
Taiyang Bladder Meridian of Foot or Foot's Major Yang Urinary Bladder Meridian
Yangming Stomach Meridian of Foot or Foot's Yang Supreme Stomach Meridian
Feature of meridians
Meridians are channel networks in human body according to Chinese medicine meridian theory. This network with many acupoints did not have anatomy basis. However modern research investigated the characteristics of meridian and acupoints and the achievement was noticeable. For example, the temperature and microcirculation perfusion at the acupoints were higher than that at nonacupoints. Some biochemical reactions were more active such as there was higher ATP, oxygen partial pressure, transcutaneous CO2 emission etc at acupoints. After acupuncture stimulation of the acupoints these parameters were changed. Also there were some researches showing that skin temperature along meridians were different from other skin area. Recently research showed that skin and deep tissue microcirculation was higher along meridians along the governor meridian which is located along the midline of the back was higher in healthy adults than non meridian part. Also blood perfusion along governor meridian was higher than that the two bilateral medial bladder meridians which located at 1.5 body inch bilateral to the midline at the back. Local blood perfusion was important for organ function. The increased microcirculation along governor meridian may represent the common features of all other 12 common meridians. Further research will provide the microcirculation information about differences between meridians and nonmeridians and its role in pathological conditions.
There are 361 acupuncture points along to these meridians. Each acupuncture point has specific effect
Acupuncture produces effect by acting through acupoints. Each acupoint has its specific effect. The mechanism of this specificity was studied. A study compared the effect of ST36, and LR3 acupoints. In this study, 26 healthy subjects were divided into three groups: ST36, LR3 and control groups. Acupuncture was received in ST36 and LR3 groups, but not control group. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), cardiac index (CI), systemic vascular resistance index(SVRI), superior mesenteric artery blood flow volume (SMABFV), and power of each frequency domain calculated from FRV (very low frequency (VLF), low frequency (LF), high frequency (HF) and LF/HF were measured before and 30 min after stimulation. VLF: generally reflects functions such as thermoregulation and rennin-angiotensin system activity. LF generally reflects both the sympathetic and parasympathetic nervous systems. HF generally reflects the parasympathetic nervous system. LF/HL generally reflects the balance between the sympathetic and parasympathetic nervous systems. The changes in these values were found 30 min after acupuncture stimulation at ST36 and LR3 and control groups by comparing to values before the intervention. In stimulation at ST36, VLF, LF, HF and LF/HFsignificantly increased, SBP significantly decreased and SMABFV significantly increased compared with that before the intervention. In LR3 stimulation, HF significantly decreased and LH/HF significantly increased and SMABFV did not change. In control group, VLF and SVRI increased and CI significantly decreased while SMABFV did not change. This study has shown the specific effect from ST36 and LR3 which has its own unique response to acupuncture stimulation.
Biophysical properties in meridian and acupoints
Acupuncture is an important part of Chinese medicine. It is based on meridian theory. There are 14 meridians in human body. Along the meridians, there are hundreds of acupuncture points. Acupuncture at these acupuncture points was performed. Many acupuncture points on one meridian have similar function. Current research in China showed that gastric electric activity increased when acupuncture was performed at Sibai (ST2) and Dichange (ST4) which are located in the face and on the stomach meridian, but far from stomach. It also showed that there was no effect when acupuncture was performed a nonmeridian point beside ST2 and a point on small intestine meridian. There was a study that investigated acupuncture at acupuncture points on bladder meridian, non acupuncture points on bladder meridian and non acupuncture points of bladder meridian. They found that blood flow increased the most from acupuncture with acupuncture points on bladder meridian and the least from acupuncture with non acupuncture points of bladder meridian. Recently Zhang et al showed that acupuncture off acupuncture point BL57 on bladder meridian increased local blood flow. This effect was higher than that acupuncture off acupuncture points and off bladder meridian. They suggested that keeping needling points on meridian is more important. More research suggested that the density of nerve terminals, blood vessels and mast cells at the acupuncture points is higher and the signals produced by acupuncture are stronger. Acupuncture on the meridians facilitate the signal transporting and increase blood flow.
There was no anatomic evidence to show meridian existence. Recent research demonstrated the existence of meridian using biophysics, biochemistry and molecular biology techniques. Li J et al reviewed the biophysical studies of meridian/acupoints after obtaining the electronic database. Researchers used the resistance measurement to detect the resistance of the acupoints. They found that there was low resistance at some acupoints compared with nonacupoints at some studies. But there were many factors affecting the measurements so there was still in a debate. There were reports that the property of transmitting sound in meridians is better than that of the surrounding areas due to the enrichment of isotropic ions along meridians under the action of bioelectric field. Main and collateral channels are good medium for mechanical vibration wave and infrasonic wave. The high temperature along meridian and acupoints was reported. Also after acupuncture treatment the temperature along the meridian and acupoints was observed. Also characteristic of transmission of light is different between meridians and nonmeridians. A relatively stable circular current of electromagnetic and chemical oscillation was found along the low electric resistance pathway. Magnetic stimulation of acupoints could cause temperature variation along meridians. Migration of isotope along meridians and myoelectric activity were observed.
Acupuncture increases blood perfusion around the acupoints.
Acupuncture is used to treat many conditions worldwide. The mechanism is based on Meridian theory in Traditional Chinese Medicine (TCM) which is not recognized by modern medicine. Researchers are using modern techniques to study the mechanisms of acupuncture to explain the phenomenon from modern science aspect. Li XM et al studied influence of different acupuncture manipulations at Zusanli (ST36) on skin microcirculation blood perfusion in healthy subjects. They measured local blood perfusion at ST 36 acupuncture points after acupuncture stimulation at 1min, 5 min, 10, 15min, 20 min, 25 min and 30 min. They also compared blood perfusion levels of microcirculation around the acupoints among the different manipulation techniques. They found that microcirculation around the selected acupoint was significantly increased from 1-10 min following simple needle insertion, from 5 -30 min after uniform reinforcing-reducing manipulation, from 1-30 min after reinforcing manipulation, and from 1-25 min following reducing manipulation respectively. The reinforcing manipulation was superior to other techniques. From this study we can see acupuncture increases local blood perfusion in normal subjects. The reinforcing manipulation had better effect.
Li XM et al Zhen Ci Yan Jiu (2013) 38:297-300
Zhang WB et al Evid Based Complement Alternat Med (2013) 2013:426052
Li J et al Evid Based Complement Alternat Med (2012):793841
Wednesday, 16 January 2013
Absence of menstruation is called amenorrhea in medical field which is a condition that menstrual periods have stopped for more than three cycles. This is not rare condition and many factors affect menstruation. If your periods are missing, If your periods disappeared for some time, you need to get it checked with your doctor and you need to rule out of pregnancy and menopause depending on your age. If you are not pregnant and you don’t have periods, it is most likely that your ovary is not working.
Common conditions that could cause absent periods are those affecting hypothalamus, pituitary gland, ovarian axis. These cause hormonal level changes responsible for reproductive function. For example, extreme weight loss, emotional or physical stress, high intensive exercise and severe illness could affect the hypothalamus and cause absent periods; pituitary gland conditions lead to increasing level of hormone prolactin, hypothyroidism causing missing periods; If you are under extreme stress, this could be the reason for disappeared periods. Though it has long been recognised, there are no specific diagnostic tests for this and diagnosis is usually made by exclusion. The mechanisms how psychological stress affects the women’s period cycle are still not clear. But it is widely accepted that it is linked to hypothalamic pituitary axis. In the situation of stress, corticotrophin-releasing hormone (CRH) production from hypothalamus is increased. The effects of increased CRH on the hypothalamic-pituitary axis reduce circulating luteinising hormone (LH) levels. Absence of period cycle caused by psychological stress may last from a few months to many years. Women with stress related absence of period cycle have increased basal plasma cortisol and decrease response to CRH administration. In many cases, normal periods return after the psychological problems are overcome. But in other cases, missing periods could cause new stress and help is needed to get periods return.
Ovarian conditions can also cause absence of periods, which include premature ovarian failure, polycystic ovary syndrome. It is very common that menstrual period does not return after stop taking contraceptive pills in three months. Infertility is one of the complications of absence of periods. Treatments are also depending on the causes. Correcting hormone imbalance is the target of the treatments to reestablish menstrual cycles and prevent complications.
In traditional Chinese medicine (TCM), missing periods are divided into five types according to the symptoms:
1 kidney and liver deficiency, symptoms include missing menstrual periods or light or less frequent periods, feeling week, lower back pain, dizziness, tinnitus, red tongue and week pulse.
2 qi and blood deficiency, symptoms include missing menstrual periods, dizziness, blur vision, short of breath, tiredness, pale, light tongue and week pulse.
3 yin deficiency, symptoms include missing menstrual periods, hot flashes, fever, night sweating, cough with blood, red tongue, week pulse.
4 qi and blood stasis, symptoms include missing menstrual periods, depression, feeling anger, feeling bloated, lower tummy pain, dark tongue, floating pulse.
5 dampness and phlegm blockage, obesity, cough with phlegm, swelling, excessive vaginal discharge, thick tongue coating, and slippery pulse.
Acupuncture could help correcting hormonal imbalance, reducing stress level and resuming menstrual cycles by stimulating nerve ends at particular acupuncture points and improving hypothalamus function.
There were some researches showing that effectiveness of acupuncture on resuming menstruations. Here are some examples.
There was a study with women with premature ovarian failure. 11 women had absence of periods. They received 3 month acupuncture treatments. 10 women had resumed their periods.
There was a random control clinical trials with women diagnosed with polycystic ovarian syndrome. 16 weeks of acupuncture treatment, menstruation frequency is increased.
There was a case report from China. In this report, 33 women aged from 23 -45 had absence of periods for 3 months to 3 years. They were received acupuncture treatments and 29 women out of 33 resumed their periods; 4 women did not respond to acupuncture treatments. About 63% had regular periods during the course of 6 months followup and about 24% had irregular periods during that time.
Stop taking the pills and no periods, acupuncture could help
When will your periods come back after you stop taking the pills? This is a good question. This is may vary depending on individuals. It could take a while for your periods to come back after you stop taking the pill. Most women will have a period two to four weeks after stopping the pill. It could take longer. Your periods may not be regular when you first stop the pills and this could take six months to become normal again. If your periods never come back, this may suggest a problem in your ovaries and you need to see your doctor to investigate what is wrong. Contraceptive pills suppress ovulation and follicle developments. Acupuncture could help ovarian blood flow to help restoring ovarian function when stopping the pills. Regular periods indicate that your ovaries are functioning well. If your ovaries are functioning well, your periods would come back and become regular.
Zhou K Evid Based Complement Alternat Med (2013) 2013:657234
Jedel E et al Am J Physiol Endocrinol Medtab (2011) 300:E37-45
Han Y J Trads Chin Med (2004) 24:42-43
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