Welcome to my blog

Leading acupuncture specialist for cosmetic acupuncture, pain relief, stress relief, fertility, fatigue, anxiety.
Based at Harley Street and Kensington Central London.Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Over 25 year research and clinical experiences

Doctor who is passionate about acupuncture

I love what I do, I am good at it and I am always there for my patients. If you come and see me, you will know why I am standing out. .

My profile

Practice contact for appointments and addresses

Kensington: for appointments at Anamaya center Kensington (Mondays, Tuesdays, Thursdays, Fridays, Saturdays) please call at 02030110355 or email at info@anamaya.co.uk
Address: 1 Adam and Eve Mews, Kensington, London W8 6UG
2 min walk from High Street Kensington underground station

Harley Street: for appointments at Harley Street (Wednesdays) please call 02076368845 or email at info@aloclinic.com

Address: Suite 3 Harmont House 20 Harley Street, London W1G 9PH

5 min walk from Oxford Circus underground station

My background: I became a qualified medical doctor 25 years ago in Western medicine in China and was well trained in Western medicine together with Chinese medicine in the best Medical University in Beijing, China. Particularly I was trained with Ji-sheng Han famous professor and neuroscientist in China and with Dr Zheren Xuan--famous orthopedics expert and founder of soft tissue surgery in China. Furthermore I had training in dermatology and oral and maxilofacial surgery in China. Also I had training in fertility and had research experiences in uterine smooth muscles and blood vessels in China and the UK. I am dedicated to treat patients with acupuncture and am recognised as one of the world leading acupuncture specialists.


I obtained a PhD degree in the University of Leeds in the UK.
I had post doctoral training and worked as a senior researcher in St George's hospital, London, UK.
I had frequently presented my research findings in the top international conferences in the field.
I have many publications including ebooks and articles.

I have many year clinical experiences. Over the years of practicing, I have developed unique effective treatment approaches for cosmetic acupuncture, acne, pain relief including vulvodynia, bladder pain, pelvic pain, chronic prostatitis, neck pain, headache, migraine, shoulder pain, back pain, stress relief, anxiety, fatigue, fertility, hot flushes, nerve pain, insomnia to achieve best treatment results.

My devotion and skills are highly praised by my patients.

https://www.youtube.com/watch?v=NKdoRpfr0ic

Monday, 10 November 2014

Endometriosis associated infertility with acupuncture treatment

Women’s uterus wall has three layers: inner layer is called endometrium; middle layer is smooth muscle; outer layer is myometrium. Endometrium of uterus is special. It undergoes cyclic change and regeneration. During the period cycle, this layer grows thicker and is full of blood vessels and glands. It provides best hospitable environment for implantation of a fertilised egg. If pregnancy does not occur, the inner layer will shed away causing bleeding and the layer will redevelop. Sometimes, if things go wrong, the endometrial tissue can grow outside of uterus. This is a condition called endometriosis. The most common places where this tissue was mislaid are ovaries, fallopian tubes and the pelvic cavity. This misplaced tissue is also responding women’s period cycles, but it could not shed. As a result it will cause inflammation, scar and adhesion. Endometriosis could present chronic pelvic pain including period pain, and intercourse pain, irregular period and associated with infertility.

Endometriosis affects up to 10% of reproductive age of women. Endometriosis is associated with infertility. At least one third of women with endometriosis have infertility. Women with infertility are 6-8 times more likely to have endometriosis. Some women with endometriosis will conceive without difficulty, while others may have difficulty to conceive. Some controlled trial study showed that women with endometriosis were 10% less likely to conceive than those without the condition. The pregnancy success rate among women with endometriosis associated infertility was lower than those with unexplained infertility. A study of 14 randomised controlled trials showed that women with endometriosis were less likely than women with tubal-factor infertility to conceive by means of IVF. Endometriosis is also associated to lower live birth rate.

The mechanisms of association between endometriosis and infertility are not fully understood. Moderate to severe cases can lead to infertility. The connection between severe endometriosis and infertility is due to severe pelvic adhesions which cause a variety of anatomical abnormalities. This can affect ovum capture and transport. The severe ectopic endometrial lesions is also decreasing implantation rates, decreasing egg retrieval rates and decreasing pregnancy rates.

Most of endometriosis cases are mild. Some women with mild endometriosis have also had infertility and many women with infertility have had mild endometriosis. The cause and effect relationships between mild endometriosis and infertility are not clear. Severe endometriosis can cause reproductive organs scarring and distortion. The association of minimal and mild endometriosis with infertility is also possible. This is because endometriosis causes ovulatory dysfunction, impaired follicle development, defective implantation, eutopic endometrium abnormalities, abnormal immunological environment and luteal phase problems. Luiz Fernando et al collected the data from 1985 -2011 to investigate the association between mild endometriosis and infertility. They found there were two randomized controlled trials for this study. In 1997 Marcoux et al conduceted a randomized controlled trial studied the association between endometriosis and pregnancy rates. They compared pregnancy rates in 172 women with stage I and II endometriosis who underwent laparoscopic removing all visible endometrial lesions with 169 women who underwent diagnostic laparoscopy only. All women were followed postoperatively for 36 weeks. The cumulative pregnancy probability rate for the surgery group was 30.7% while pregnancy rate for the diagnostic group was 17.7%. This result showed significant differences between two groups indicating the association of mild endometriosis and infertility. This suggestion was supported by another study. The conclusion is that minimal to mild stages of endometriosis plays an important role related to infertility and has negative impact on pregnancy rate.

In summary, the association between endometriosis and infertility may be caused a few mechanisms.

Distorted pelvic anatomy: endometriosis could cause pelvic adhesions. These organs can adhere to the uterus, bowel or pelvic wall. This distortion of reproductive organs could cause infertility. if the eggs in the ovaries are damaged by the misplaced tissues egg quantity and quality could be compromised which results ovulation abnormalities which can impair egg release from the ovary and egg pickup after being released; The tubes can be damaged and blocked; ovaries can contain cysts formed from misplaced tissue it also can block sperm entry into the distal tube.

Altered peritoneal environment: Also Altered peritoneal function and impaired endometrium and implantation are also contributing to the infertility. women with endometriosis have increased volume of peritoneal fluid, increased immune cells and concentrations of prostaglandin etc. These may impair egg, sperm, embryo and fallopian tube function.

Altered system immune function: women with endometriosis may have increased antibodies and lymphocytes and this may alter endometrial acceptance to embryo implantation.

Endocrine and ovulatory abnormalities: Women with endometriosis may also present abnormal follicle growth, the luteinized unruptured follicle syndrome, luteal phase dysfunction and premature and multiple LH surges.

Abnormal tubal function: egg capture inhibitor was reported present in peritoneal fluid from women with endometriosis.

Abnormal fertilization and implantation: fertilization and implantation may be impaired in women with endometriosis. Endometrial function may be not normal.

Medications could improve the quality of life for many women with endometriosis; however their contraceptive effects are limited their application. There were many researches showing that acupuncture is effective of releasing pain associated with endometriosis. Acupuncture also stops misplaced tissue growing, regulates period and improves fertility. According to traditional Chinese medicine theory, endometriosis is caused by blood stagnation. Acupuncture improves blood flow; this will release the pain and improve other symptoms.

There was a case report about acupuncture treatment for endometriosis associated infertility from China. 25 patients with endometriosis associated with infertility were treated with acupuncture. After 2 months of treatment, 9 patients achieved pregnancy.

A report in Zhong Guo Zhen Jiu (1996) also studied effectiveness of acupuncture on endometriosis associated with infertility. There were 72 women with endometriosis associated with infertility involved. The acupuncture treatment duration is 3-9 month. 42 women achieved pregnancy. Success rate was 58.33%.

References
Zhou et al (2009) Afr J Tradit Complement Altern Med 6: 494-517
http://www.cnki.com.cn/Article/CJFDTotal-ZGZE602.020.htm
Luiz Fernando et al Rev Assoc Med Bras (2012) 58:607-614

Friday, 7 November 2014

Inflammation plays a role in infertility and acupuncture treatment

Inflammation is a basic reaction that our body responds to infection, irritation or other injury. Inflammation is a complex biological response of vascular tissue to harmful stimuli. Without inflammation, wound and infection would never heal. Inflammation is a defence and has two aspects of effects: beneficial and harmful. If our body suffered from infection or injury, the defence system tend to remove harmful stimuli, initiating healing process for repair and regeneration. This is beneficial effect. The process of acute inflammation is initiated by local blood vessels with related chemicals accumulated into tissue. Increased blood flow causes characteristic swelling, redness and heat. As a consequence, vasodilation and increased permeability cause slowing of blood flow. Inflammation could stimulates nerves causing pain. It also could damage organs and their function if the inflammation is too strong which is harmful. Inflammation has a significant role in gynecology and infertility, affecting the ovary, uterus as well as the embryo and implantation.

Inflammation is present in women’s reproductive system physiology. There is temporary changes reflected inflammation process observed in ovary during follicular development, ovulation and luteal formation. Immune cells accumulate in the inner lining of uterus during the secretary phase of the menstrual cycle indicating inflammation involved in the endometrial cycles in uterus. Recent research found that a special protein which can inhibits immune cell function and has local anti-inflammatory effect prevented immune attack to embryo and created a local hospitable environment in uterus in early pregnancy without compromising maternal system immune function. Inflammation plays an important role in implantation as well.

Inflammation is involved in infertility. There are two major types of problems that account for most of women’s infertility: anatomic abnormality and ovulatory problems. Most anatomic abnormalities such as tube blockage that cause infertility are acquired. Infection, inflammation, ischemia and surgical injury may be the causes. Anatomic abnormalities may be asymptomatic or may be presenting pelvic pain, pelvic adhesions and infertility. Inflammation causes tissue damage and distortion. The most significant cause of inflammatory infertility is Chlamydia trachomatis infection that may result in infertility in 10-30% of infertile couples in developed countries. Inflammation causes ovulatory abnormalities. Premature ovarian failure (POF) is a typical example of the relationship between ovulatory infertility and inflammation. The incidence of POF is 1% of women under the age of 40. About 50% of POF cases have attributed to immune problems which are involved in inflammation. Antiovarian antibodies have been found in some of these cases and accumulation of immune cells in ovaries has been noted as well. Women with endometriosis are also responding to inflammation differently from those women without endometriosis. There are increased immune cells and antibodies against inner lining of uterus.

Acupuncture reduces inflammation to improve fertility. Inflammation is present in infertility. This was noted in ancient Chinese Medicine. The phenomena were explained that dampness and heat accumulate and blood stagnates in pelvis. This blocks meridian and stops energy flow causing infertility. Acupuncture treating infertility has a long history, but the effect of acupuncture is doubted because it relies on concept of changing the flow of energy on meridian which is not accepted by evidence based medicine. Recently researchers provided evidence that needles insertion into the skin and deeper tissues results in a particular pattern of afferent activity in peripheral nerves. This improves blood circulation of ovaries and uterus etc. As a result it reduces local inflammation and improves infertility.

In men, infection and inflammation of the reproductive tract including testes are widely accepted as important factors of male infertility. Inflammation is associated with disruption of testicular function leading to low sperm count and low quality of sperms. Acupuncture improves sperm count and quality of sperms. This is because acupuncture increased blood supply of testicular artery and acupuncture stimulated immune response and reduced inflammation.

References
Weiss G et al Reprod Sci (2009) 16: 216-229

Friday, 19 September 2014

How to boost male fertility?

Sperm tests

If you have been trying for conceiving for long time without success, the semen should be tested to check if sperm are good. Sperm are tested by semen analysis. What is semen? Semen is the thick, white fluid released during ejaculation which comes from three sources: the vas deferences, the seminal vesicles and prostate. This liquid protects sperm cells which are comprised in semen. What are sperm cells like? Sperm cells are unique. They have head, neck and tail. The sperm head is oval shape containing highly compact DNA and enzymes required for penetrating egg shell for fertilization. The tail is responsible for sperm movement. Head and tail is connected by neck. Sperm parameters include sperm count over 20 million per ml or more. Over 50% of sperm should show normal forward movement 1 hour after collection. Over 30% of sperms should be in normal shape. Total semen volume is 1.5 ml to 6 ml. Normal semen pH range from 7.2-7.8. Liquefaction time is 20-30 min after collection. There are no white blood cells or bacteria in the semen.

Do you know that semen quality is related to life expectancy?

Semen quality is known to be a marker of fertility, and a sperm concentration of up to 40 million/mL has been found to increase the probability of conception in a menstrual cycle. Is there association between semen quality and long-term health effects? The Copenhagen Sperm Analysis Laboratory analysed semen samples from 51543 men between 1963-2001 and they found that mortality decreased as the sperm concentration increased up to a threshold of 40 million/mL and no further decrease in mortality above the threshold. Mortality decreased as the percentages of motile and morphologically normal spermatozoa increased in a dose-response manner. They suggested that good semen quality may be a more general biomarker of overall health.

Which hormones are involved in sperm production?

Sperm production is hormonally driven. There are four hormones involved in sperm production: gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone. GnRH is produced in hypothalamus and acts on pituitary gland stimulating FSH and LH releasing. FSH is produced in pituitary gland (a part of the brain) and acts on testis stimulating sperm production. LH is also produced in pituitary gland and acts on testis stimulating testosterone production. Testosterone is produced in the testis and it supports sperm production. Without testosterone sperm will not develop and the matured sperm will not be released.

How to boost male fertility?

Male fertility can be reduced by stress. The stress includes emotional, physical and financial. Stress level will increase from frequent travelling, a long illness, long working hours and major life changes. How to get rid of stress? Many things can help reduce stress to help your body relax. For example, exercise, massage or of course acupuncture on a regular basis. Other some simple things are also help reduce stress such as eating well, sleeping well, stop of smoking and stop of drinking alcohol, reducing coffee consumption, losing some weight if you are overweight, avoid hot bath etc.

Keeping good nutrition and balanced diet is the best way to improve male fertility. Whole grains, plenty of fruits and vegetables and plenty of nuts, low fat and low sugar help improving male fertility. Don’t forget acupuncture increases sperm count.

What food and supplements are good to boost male fertility?

One in six couples have difficulty to conceive. Male factors contribute half of the cases. To boost male fertility, some food and supplements can help based on recent research.

Organic food: it is better to go for organic or hormone free food and avoid hormone containing diary products and meats. Synthetic estrogens are widely used in the livestock, poultry, and dairy industries. The synthetic estrogen, diethylstilbestrol (DES), affects male fertility. For example, DES was prescribed from 1945 to 1971 to millions of women during pregnancy. Male offspring from those women had a higher incidence of developmental problems of the reproductive tract, as well as diminished sperm volume and sperm count. Exogenous estrogens impact fetal development by inhibiting the development of Sertoli cells, which determine the lifelong capacity for sperm production. Circulating estrogens also inhibit enzymes involved in testosterone synthesis and may directly affect testosterone production.

Omega-3: A study with two hundred thirty-eight infertile men with idiopathic oligoasthenoteratospermia investigated the effect of omega-3 on fertility. A 32 weeks treatment has shown significant improvement of sperm cell total count and sperm cell concentration in the omega-3 group suggesting the benefit of omega 3 on male fertility.

Zinc: Zinc is essential for normal functioning of the male reproductive system. Enough zinc intake ensures proper sperm motility and production. Zinc deficiency is associated with decreased testosterone levels and sperm count. There was a trend observed for a lower Zn levels in seminal plasma of smokers compared with nonsmokers. Seminal Zn in fertile and infertile (smokers or nonsmokers) males correlated significantly with sperm count and normal morphology of sperm. Poor Zn nutrition may be an important risk factor for low quality of sperm and idiopathic male infertility. Zinc levels are generally lower in infertile men with diminished sperm count. Studies have found supplemental zinc may prove helpful in treating male infertility. Some studies have suggested that male patients with infertility given zinc treatment significantly increased testosterone levels and sperm count, sperm motility and normal sperm morphology.

Vitamin C: Lower levels of vitamin C may lead to infertility and increased damage to the sperm’s genetic material. Study has suggested that reducing vitamin C intake in healthy men increased sperm DNA damage.

Vitamin E: Vitamin E is an antioxidant and has been shown to inhibit freeradical-induced damage to sensitive cell membranes. It improved sperm motility and improved sperm function in the zona binding assay, therefore enhancing the ability of the sperm to penetrate the egg in vitro.

Glutathione/Selenium: Glutathione and selenium are essential to the formation of an enzyme present in spermatids which becomes a structural protein in mature sperm. Deficiency of these two could damage sperm motility.

Coenzyme Q-10: Recent data from patients with idiopathic asthenozoospermia has shown that CoQ10 improves sperm counts and motility.

Vitamin B12: Deficiency of Vitamin B12 has been associated with decreased sperm count and motility.

Keep scrotum cool, if you want to get pregnant

Sperm is produced in testis located in scrotum attached to the body. In this place testis could be kept in low temperature( a few degrees lower than body temperature) which is required for sperm production. This is vital for sperm production in male. If anything elevates the temperature, it could damage sperm production.

If you want to get pregnant, you need to keep the scrotum cool. The question is how? There are some approaches you could take:

1, Wear a loose underwear to keep scrotum away from your body to avoid body heat.

2, Keep laptop away from your thigh to avoid heating up scrotum.

3, Stop riding bycycles to avoid heating up scrotum.

4, Treat varicocele veins to speed up blood circulation to maintain low temperature.

5, Lose weight to reduce excessive fat which warms up testis.

6, Acupuncture can relax scrotal muscles and improve blood circulation to keep temperature down.

Exercises affect sperm count

Physical activity has benefits for human’s general health however its association with male fertility remains unclear. Some researchers have proposed strenuous exercise as a risk factor for male factor infertility because it has been seen there was a reduced semen quality in long-distance runners and endurance cyclists. A recent research from Harvard School of Public Health studied if paternal physical activity associated with semen quality parameters and with outcomes of infertility treatment. In this study, most physical activity was moderate and heavy outdoor activities (38%), followed by running and jogging (24%), weightlifting (16%), bicycling (16%), swimming laps (3%), playing tennis or squash (2%) and aerobics (1%). They found that higher sperm count is related to higher levels of moderate to vigorous physical activity while sperm motility (total and progressive) and morphology were not related to physical activity. They also studied whether specific physical activities were associated with sperm concentration. Men in the highest category of outdoor activity (≥1.5 h/week) and weightlifting (≥2 h/week) had higher sperm concentrations than men with 0 h/week. Bicycling, in contrast, was inversely associated with sperm concentrations. Men who reported bicycling ≥1.5 h/week had lower sperm concentration compared with men who reported no bicycling. Time spent walking, running, jogging or in other specific physical or sedentary activities was not associated with sperm concentration. They also studied the relationship of paternal physical and sedentary activities with outcomes of infertility treatment. They did not find an association between time spent in moderate-to-vigorous or sedentary activities and clinical pregnancy or live birth rates following IUI or ART.

Some modern techniques might decrease your sperm quality

Exposure to radiation, both ionizing and nonionizing, has been shown to be a hormone disruptor. People may not realize that when you are using modern techniques, you are exposed to radiation significantly. Study on cell line has shown that exposure to mobile phone radiation altered gene and protein expression in cell lines. In a recent study, patients who used a cell phone showed significantly higher free testosterone and lower LH levels than those who did not, and sperm quality was negatively affected. A review has suggested that the use of mobile phones may decrease sperm concentration, motility (particularly rapid progressive motility), normal morphology, and viability. The abnormalities seemed to be directly related to the duration of mobile phone use. However, present evidence is inconclusive.

Effect of mobile telephones on sperm quality

Mobile phones produce radiation which may affect male fertility. Another study has shown that donor normozoospermic samples, which were exposed for four hours to a wireless internetconnected laptop showed a significant decrease in progressive sperm motility and an increase in sperm DNA fragmentation. The researchers advised against locating a laptop near the testes. There was a study from the UK has investigated that the effect of mobile phones on sperm quality. In this study, the participants were 1492 from fertility clinic and research centers. There were ten studies included. The findings were exposure to mobile phones was associated with reduced sperm motility and viability. The results from in vitro and in vivo studies suggest that mobile phone exposure negatively affects sperm quality.

Get sperm quality improved before IVF/ICSI

In about 50% of cases, male factors play a role in a couple's infertility. Medical science still has problems determining when and whether a sperm problem is the primary or contributing cause for problems with fertility. Lifestyle, environmental, and psychological factors may affect sperm quantity and quality. A recent study involved in 3106 couples showed that high-level sperm DNA fragmentation has a detrimental effect on outcome of IVF/ICSI, with decreased pregnancy rate and increased miscarriage rate. This study indicated that high sperm DNA damage was related to lower pregnancy rates in IVF but not in ICSI cycles, whereas it was associated with higher miscarriage rates in both IVF and ICSI cycles. It is suggested that before clinical high tech clinical treatments start, changes in lifestyle and environmental and psychological factors in male would improve male fertility, such as stop smoking, stop drinking alcohol, avoiding hot bath and cycling, reducing stress, losing weight et al. Acupuncture can help with improving sperm quantity and quality and reducing stress.

Chronic prostatitis and male infertility

Chronic prostatitis is a very common disease in the male genitourinary system. Some research has shown that chronic prostatitis was linked to male fertility. It was reported that chronic prostatitis was associated reduced sperm production and impairment of semen quality and sperm morphology and motility. Also very recently it was found that men with prostatitis and varicocele had significantly higher DNA fragmentation compared with men in the control group. There was a negative impact of these diseases on the concentration and the percentage of motile sperm cells in the ejaculate. Prostate secretion meets sperm cells during ejaculation and the sperm damage could occur in the short time during ejaculation. Or a direct effect of inflammation on the testis and epididymis could contribute to the damage.

Does prostate abnormality induce antisperm antibody?

There are three major prostate abnormalities namely, prostatitis, benign prostatic hyperplasia (BPH) and prostate cancer. . In all these abnormalities, infection/inflammation has been involved. As infection/inflammation of the male genital tract can also be involved in production of antisperm antibodies (ASA), Does prostate abnormality induce ASA. There was a study with healthy man and man with prostatis, BPH and prostate cance. They found that chronic prostatitis, BPH and prostate cancer do not induce antibodies to spermatozoa, sperm-specific antigens and seminal plasma components.

Acupuncture can help with prostatitis by improving the local blood flow and reducing inflammation. As a result, it could improve the fertility.

References
Adams JA et al Environ Int (2014) 70:106-12
Jensen TK et al Am. J. Epidemiol. (2009) 170:559-565.
Daniel M Campagne Int J Fertil Steril (2013) 6:214-223
Safarinejad MR Andrologia (2011) 43:38-47
Balercia G J Endocrinol Invest (2009) 32:626-32
Colagar AH et al Nutr Res (2009) 29:82-8
Gaskins AJ et al Hum Reprod (2014) Aug 27
Zhao J et al Fertil Steril (2014) 102:998-1005
Osadchuk LV et al Urologiia (2014 3:37-43
Hoover and Naz Int J Androl (2012) 35:608-15
Sinclair S Altern Med Rev (2000) 5:28-38


Monday, 8 September 2014

Acupuncture is effective on dysfunctional uterine bleeding and restoring ovulation

As we all know, women have menstrual cycles which occurs as a result of cyclic hormonal changes are usually 21-40 days long, with bleeding duration of 3-7 days and an average blood loss of 20-80 ml. Many women experience some kind of menstrual cycle disturbance; this could be minor disorders or a sign of malignant diseases. Malignant endometrial and cervical disorders include endometrial carcinoma, endometrial heperplasia, cervical cancer and cervical intra-epithelial neoplasia which could present abnormal uterine bleeding.

If a woman is pregnant, vaginal bleeding is abnormal. This often occurs in early pregnancy and is often associated with miscarriage or ectopic pregnancy. Ectopic pregnancy is one of the most severe pregnancy related conditions in women with abnormal uterine bleeding. Threatened miscarriage and miscarriage also present abnormal uterine bleeding.

Benign endometrial and cervical diseases: Fibroids is benign smooth muscle tumors in uterus which is either asymptomatic or presenting abnormal uterine bleeding. Endometrial polyps are a significant cause.

More frequent vaginal bleeding could be caused by pelvic inflammatory disease which is caused by sexually transmitted diseases such as Chlamydia or gonorrhoea. This causes inflammation in the uterus. Endometriosis can also cause more frequent vaginal bleeding. Polycystic ovary syndrome is also the underline causes of abnormal uterine bleeding. Irregular interval of vaginal bleeding could be caused by oral contraceptive pills and perimenopause.

Abnormality presents as duration, interval and amount of the bleeding, if a woman is not pregnant and ovulates regularly.

Very heavy vaginal bleeding: This could be caused by benign conditions including uterine fibroids, endometrial polyps, adenomyosis, intrauterine devices, hypothyroidism, an autoimmune disorders, blood clotting disorders and medications disturbing blood clotting.

Lighter vaginal bleeding could be caused by hyperthoroidism, oral contraceptive pills.

Bleeding between periods could be caused by contraceptive pills, intrauterine device, psychological stress and anticoagulant medications.

If a woman does not ovulate reduction of periods or period blood flow could be seen in some conditions, such as, some chronic conditions and physical and psychological stress, hypothalamus dysfunction, anorexia nervosa, and polycystic ovarian syndrome.

Majority of women with abnormal uterine bleeding do not have structural and histological abnormalities fortunately. Dysfunctional uterine bleeding is not due to certain pelvic disease, complications of pregnancy or systemic illness but mostly related to hormonal dysfunction. These affect 30% of women in reproductive age. Dysfunctional uterine bleeding is a common condition in women in reproductive age. This could be caused by psychological and/or physical stress, malnutrition, or systematic disorders which affect hypathalumic-pituitary-ovarian axis. They present with heavy abnormal uterine bleeding patterns: longer bleeding days, heavy blood loss, more frequent period cycles. In such cases, it is likely associated with aovulations. Changes of normal menstrual cycles are normally caused by disturbances of the hypothalamus-pituitary-ovarian axis. Most cases of anovulatory bleeding are caused by estrogen withdrawal or estrogen breakthrough bleeding. This could present midcycle spotting or intermittent spotting. This also could present irregular or prolonged heavy bleeding. In the case of no ovulation, the uterine endometrium at the presence of estrogen stimulation reaches abnormal heights and lacks structural support and it becomes fragile. The fragile endometrium breaks down and bleeding occurs. The fundamental issue in anovulatory bleeding is that the ovary does not function well causing hormonal imbalance. If a woman with anovulatory bleeding is trying to conceive, she would have difficulty to get pregnant because of anovulation. Improving ovary function is the key to treat anovulatory bleeding.

In Traditional Chinese Medicine (TCM) dysfunctional uterine bleeding can be divided into three types

1. Spleen and kidney yang deficiency, the symptoms include prolonged uterine bleeding, heavy periods, light red without clot, excessive vaginal discharge, tireness, lower back pain, feeling cold, cold hands and feet, diarrhoea, swelling tongue with light white coating, and week and sink pulse.

2. liver and kidney yin deficiency, the symptoms include irregular periods, prolonged uterine bleeding, red blood, dizziness tinnitus, lower backpain, dry mouth, red tongue, week and sink pulse.

3. kidney deficiency and liver stagnation, the symptoms include irregular periods, breast pain, lower back pain, lower tummy pain, excessive vaginal discharge, light tongue and week and sink pulse.

Apart from medication and surgery treatments, acupuncture is an effective treatment for dysfunctional uterine bleeding

Acupuncture could stimulate nerve end to improve ovarian blood circulation. This could improve ovarian function, restore hormonal balance and ovulation and stop abnormal vaginal bleeding and improve fertility.

Zeng et al conducted a controlled trial to investigate effectiveness of acupuncture on dysfunctional uterine bleeding. It was involved in 252 patients. These patients were divided into three groups acupuncture group, Chinese medicine group and conventional medicine group with 84 patients in each group. The result showed that acupuncture has the best effect compared with Chinese medicine and conventional medicine groups. Dr Cheng reported 90 cases of dysfunctional uterine bleeding treated with acupuncture or acupuncture and moxbustion. These women were aged between 16-46, most of them were 25-35. Uterine bleeding days were from 9 days to 65 days. They found that acupuncture and moxibustion are effective treatments for women with dysfunctional uterine bleeding.

References
http://www.acumoxj.com/readlist.asp?id=383
Hickey M et al. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD001895.
http://journal.9med.net/html/qikan/zxyjh/zhzxyzz/20047514/zyzy/20080903023004133_2488.html
http://www.cqvip.com/QK/92077A/200404/9576315.html

Thursday, 31 July 2014

Why live with pain? acupuncture helps to have pain free.

Acupuncture is an effective treatment for chronic pain conditions

Acupuncture is called ancient art and has been used in Asia for centuries to treat many conditions and relieve pain. It is now being recognised in western countries, such as USA and European countries. It is used to ease back pain, nerve pain and other pain conditions.

If a pain last over 3 month, it is chronic. Chronic pain is a common condition. It can occur in many places such as low back pain, neck pain, headache, migraine and knee pain. Chronic pain in the muscles and joints can make life miserable. Many simple treatments like ice and heat, anti-inflammatory medications, physical therapy, and appropriate exercises can often ease the pain. If these methods don’t work, not everyone is able or willing to take pain medication every day, and not everyone can or should have surgery for painful conditions.

Chronic pain is very common and difficult to manage. Apart from pain killers, acupuncture is well accepted to treat chronic pain conditions. Complementary and alternative medicine (CAM) plays an important role to reduce pain and improve quality of life for those who suffer from chronic pain. A survey by MG Tan et al from Singapore studied the use of CAM in chronic pain patients in Singapore. They found that 84% of patients used CAM at some point of their life. 30% of patients used CAM for other reasons instead of chronic pain. 35% of patients used for both pain and non pain conditions. Acupuncture was the most utilised which is 49%, followed by Chinese herbs (18%), Tui Na (17%) and massage (16%). Many patients were on more than one form of the CAM. 72% patients thought that CAM helped with their pain. 26% patients used CAM because conventional medicine did not work. 38% thought it was safer and had fewer side effects. 24% of patients thought it was cheaper. 85% of patients were satisfied. Many patients did not discuss the use of CAM with their doctor, mainly because they thought that CAM is more natural and safe.

Acupuncture has little side effects and well tolerated. A survey from people accepted acupuncture treatment has shown that 46% said acupuncture helped greatly, 26% said it helped in some degree and 28% said there was little help. Research showed that lower back pain is the most common reason for visiting acupuncturists. Usage of acupuncture has increased enormously in recent 10 years.

Recently, Mao et al reviewed clinical research of a few chronic pain condition treatments with acupuncture including lower back pain, knee pain, neck pain and headache. Low back pain is the most common reason for visits to acupuncturists. Recent 10 years, using high quality randomized controlled trials study acupuncture has increased enormously. Most of them have shown that acupuncture treatment is effective to lower back pain and it is better than no treatment or equivalent to other conventional treatments. The situation of knee pain with acupuncture treatment is pretty similar to lower back pain which is acupuncture is better than no treatment. For neck pain treatment with acupuncture some controlled trials suggested that acupuncture is better than or equivalent to physiotherapy. Some study suggested that acupuncture is better than massage and dry needling in motion-related neck pain. In a study on headache, it showed that acupuncture reduced headache frequency and severity, and at the same time it also improves headache related quality of life. There is a review about acupuncture for chronic pain by Vickers AJ et al just published in Arch Intern Med (2012). They analysed 29 clinical randomized controlled trials involving in 17922 patients to investigate the effect of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache and shoulder pain. In the primary analysis, including all eligible trials, acupuncture was superior for both sham and no acupuncture control for each pain condition. After exclusion of an outlying set of trials that strongly favoured acupuncture, the effect sizes were similar across pain conditions analysed. Patients receiving acupuncture had less pain. They concluded that acupuncture is effective for the treatment of chronic pain and it is more than a placebo. Acupuncture is clearly a treatment option.

It becomes general knowledge that acupuncture releases pain effectively. However the effectiveness of acupuncture for pain relief is still coming up for debate and there are always some clinical trials showing lack of effect compared with control. What is the reason for this? Macpherson et al analysed clinical trials involving patients with headache and migraine, osteoarthritis, and back, neck and shoulder pain. There were many different types of controls used in the trials including sham controls such as non-needle sham, penetrating sham needles and non-penetrating sham needles and non sham control such as non-specified routine care and protocol-guided care. They analysed the impact of choice of control on effect of acupuncture. They found that acupuncture was significantly superior to all categories of control group. For trials that used penetrating needles for sham control, acupuncture had smaller effect sizes than for trials with non-penetrating sham or sham control without needles. Large effects of acupuncture were seen after exclusion of outlying studies. In trials with non-sham controls, larger effect sizes associated with acupuncture vs. non-specified routine care than vs. protocol-guided care. From this study it can be seen that acupuncture is significantly superior to control irrespective of the subtype of control. Penetrating needles can have positive effects which should be avoided as a control in the study.

Recently a study analysed 29 clinical trials involved in 17922 patients with chronic pain treated with acupuncture. This study suggested that acupuncture is effective for the treatment of chronic pain including back and neck pain, osteoarthritis, and chronic headache and acupuncture is a reasonable option. There is scientific evidence how acupuncture works. Many research suggested that acupuncture relives pain by affecting neurotransmitters, hormone levels, or the immune system.

Why can acupuncture be used to relive pain?

Acupuncture can act as a pain killer and it is used in many conditions and helps relieve pain. The mechanism is studied by modern research. Studies have shown that pressure pain threshold is increased after acupuncture treatment. The effect could be long-term and short-term. Studies have also shown that acupuncture reduced sensitivity to noxious thermal stimuli which could be mechanical (such as pinching or tissue deformation), chemical (such as exposure to acid or ittitant) or thermal (such as high or low temperature). Sensory threshold changes were equally frequent reported after manual acupuncture as after electroacupuncture. Acupuncture affects sensory perception. Results are most convincing for the pressure pain threshold, especially in pain conditions associated with tenderness.

Acupuncture for myofascial pain

Myofascial pain syndrome (MPS) refers to pain and inflammation in the body’s soft tissues. This is a chronic condition that affects the fascia which is connective tissue that covers the muscles. Myofascial pain syndrome may involve either a single muscle or a muscle group. The person experiences pain either in the area where the pain originated or in other area where is far from the pain originated. Myofascial pain is mainly caused by injury such as injury to the muscles, excessive strain on a particular muscle or muscle group, ligament or tendon, or injury to muscle fibers. Other causes include repetitive motions or lack of activity. The symptoms of myofascial pain include pain with tender points. The pain can be worse with activity or stress. Pharmacological therapies include anti-inflammatory drugs, antidepressants, and muscle relaxants. Acupuncture can help reduce pain and inflammation to treat myofascial pain. Acupuncture has been widely used for acute or chronic pain management.

Why can acupuncture treat myofascial pain?

Recent research has shown that acupuncture has analgesic effect. Acupuncture at one hand acupoint induced a gradual increase in skin pain threshold. Acupuncture induces endogenous opiates release from the pituitary gland into plasma and cause analgesia in the central nerve system. Acupuncture releases neuropeptides inhibiting the primary sensory neurons in the spinal cord. These substances also help reducing inflammation and reducing inflammation response.

References
Hopton A BMJ Open (2014) 4:e004964
Macpherson H et al PLoS One (2014) 9:E93739
Tan MG et al Ann Acad Med Singapore (2013) 42:133-7
Vikers AJ et al Arch Intern Med (2012) 10:1-10
Mao et al Prim Care (2010) 37:105-117
MacPherson et al PLOS ONE (2013) 8:e77438
J Am Board Fam Med (2013) 26:692-700
Aranha et al Rev Bras Fisioter (2011) 15:371-9
Chou LW et al Evid Based Complement Alternat Med (2012) 2012:705327
Wong Lit Wan D et al Eur J Pain (2015) Feb 17. doi: 10.1002/ejp.671. [Epub ahead of print]
Bastos JL et al J Acupunct Meridian Stud (2013) 6:163-8
Iannuccelli C et al Clin Exp Rheumatol (2012) 30:112-6
http://archinte.jamanetwork.com/article.aspx?articleid=1357513
Baeumler PI et al PLoS One (2014) 9:e113731

Wednesday, 16 July 2014

Not ovulate, acupuncture improves ovulation

There are many factors that cause anovulation and here are some common causes of anovulation.

Hypothalamic-pituitary causes

Hypothalamus-pituitary-ovarian-axis dysfunction. This is caused by problems of hypothalamus or pituitary gland in the brain. As a result the hormones are not balanced which does not trigger ovulation and leads to infertility. The reasons that affect hormone balance include stress (see below); the other common causes are excessive exercises and/or underweight.

As we already known that subtle environmental changes may alter the menstrual cycle and cause anovulation. For example, summer camp menstrual disturbances and exam anovulation. Women in emotional stress could have no ovulation. This is temporary situation. If women get out of the stress environment, menstruation and ovulation could be returned. However if this situation is prolonged, anovulation could be persistent. Finding the causes of stress situation and avoiding the causes are the keys for ovulation to return. Many therapies could help reduce stress, such as psychological therapy, yoga and acupuncture etc.

Ovarian causes. If ovary does not respond to FSH and LH, this also causes ovulation problem.

Polycystic ovary syndrome (PCOS). This is commonest cause of anovulation related infertility. It explained 70% of the cases. Women with PCOS have imbalanced hormone levels. This may produce multiple cysts in ovaries, irregular period cycle, anovulation, infertility, acne and excessive hair growth and other symproms.

Premature ovarian failure (POF). In women with POF, their ovaries fail to function properly before menopause occurs. The ovaries don’t respond to FSH and there is no ovulation. They have difficulty to get pregnant.

Treatments that reduce stress can be effective to improve ovulation. Acupuncture helps treating anovulation by stimulating nerve endings and correcting hormonal imbalance. Acupuncture is very effective treatment for anovulation. Acupuncture reduces stress by regulating response to stress and altering stress related chemical substances levels; improves hypothalamus-pituitary-ovarian axis function and regulates blood hormone level. As a consequence, it improves ovulation and pregnancy rate.

Here are some clinical reports about the effectiveness of acupuncture on anovulation.

There was a control trial with acupuncture group and control group (treated with Clomephene). 25 cases in each group were given 6 cycles treatments. And then ovulation and pregnancy rate were compared between the two groups. Ovulation rate is not significantly different between the two groups. The pregnancy rate is higher (44%) in the acupuncture group than in the control group (16%).

There was a case report from a reproductive health institute center in Sichuan in China. They reported the effectiveness of acupuncture on women with anovulation. Ovulation rate was from 70-80% and pregnancy rate was from 40% - 60%.

Recently Yan and Liu summarised some case reports about effectiveness of acupuncture on increasing ovulation. They collected 21 papers which used acupuncture treated anovulation associated infertility.

Here are some typical cases.

Chen et al treated 42 patients with infertility associated with anovulation. 41 of them ovulated.

Kou et al used acupuncture treatment for 50 cases of anovulation associated infertility. 40 of 50 patients achieved pregnancy.

Chang et al used acupuncture for 32 patients with anovulation associated infertility. 9 patients achieved pregnancy during 1-3 month of acupuncture treatment. 22 patients achieved pregnancy over 4 months of acupuncture treatments.

Case report for effectiveness of acupuncture on infertility caused by anovulation

There was a study about effectiveness of acupuncture for infertility without ovulation. There were 50 women with infertility without ovulation. There women were divided into two groups: acupuncture group and control group. Control group was treated with clomiphere and injection of chorionic gonadotropin. The period of treatment was 6 cycles and ovulation rate and pregnancy rate were measured. The results showed that there was no difference in the ovulation rate between the acupuncture group and clomiphere group. However the pregnancy rate in acupuncture group was significantly higher (44%) than that for control group (16%). In addition the score of mucus and endometrial thickness was greater in acupuncture group.

This is a case report on effect of acupuncture treatment of infertility caused by ovulatory problems. 120 patients with infertility caused by ovulatory problems were divided into two groups: acupuncture group and clomiphene control group. 3 treatment cycles were applied. Result showed that similar ovulation rate was observed in both group, but pregnancy rate was higher and abortion rate was lower in acupuncture group compared to control group.

References
Yan and Liu Shanghai J Acu-mox, (2005) 24:40-42 (针灸促排卵临床概况)
Song FJ et al Zhongguo Zhen Jiu (2008) 28:21-23
Jiang and Ding Zhongguo Zhen Jiu (2009) 29:21-4

Wednesday, 2 July 2014

Varicocele and male infertility

Varicocele and male infertility

Infertility affects about 1 in 6 of the couples of reproductive age1. The male factor is involved in 40% - 50% of infertility cases. The most common type of male infertility is unexplained infertility, which is unknown cause. Another common cause of male infertility is varicocele which is enlarged veins in testicles. 78% - 93% of cases varicocele is located on the left side. The left internal spermatic vein inserts into the left renal vein at a right angle which leads to an increase in the hydrostatic pressure of the left spermatic vein causing its dilation. Also internal spermatic veins lack functional valves, which can lead to regression of blood. Possibly there is a partial obstruction of the left spermatic vein due to the compression of the left renal vein between the aorta and the upper mesenteric artery . Varicocele causes elevated temperature of the scrotum possibly due to reflux of warm blood from the abdominal cavity. High temperature causes thermal damage of the DNA and proteins in the nucleus of spermatic tubules' cells and / or Leydig cells. The increased vein pressure can influence testicular blood flow, cause accumulation of toxic metabolites which leads to chronic vasoconstriction and subsequent dysfunction of the spermatic epithelium. Men with varicocele have high FSH level and low sperm counts. Surgical repair of varicocele has been shown to restore the temperature in both animals and humans. However fertility potential is not always improved after surgical repair of varicocele though semen parameters were improved.

Oxidant stress and male infertility

Half of all cases of infertility have male factor involved. Oxidant stress damage to sperm is a significant contributing pathology in 30–80% of cases. What is oxidant stress? In cellular metabolism, there are free radicals produced and they can damage cells and also there are antixodants against this damage. If balance between free radicals and antioxidants is broken, oxidant stress occurs. If oxidant stress occurs in sperm, it reduces the sperm's motility and ability to fuse with the egg by damaging the sperm membrane and sperm DNA. This may cause male infertility. Oxidant stress is not screened nor treated. The possible causes of oxidant stress come from many sources such as life style including smoking, drinking alcohol, stress, environmental factors including heat, pollutions, infections, autoimmune problems, chronic disorders etc.

Management of oxidant related stress include: change life style, reduce exposure to toxic environment, treat infections and inflammations etc. Taking some supplements such as vitamine C, B complex, and E may help reducing oxidant stress. Acupuncture may help reduce oxidant stress by improving blood circulation and taking toxic free radicals away.

Sperm is impaired by inflammation and acupuncture can help

Semen quality is affected by prostate and genital tract inflammation. There was a study on 382 voluntary male subjects who underwent the screening for prostate health. Sperm motility and prostate-related parameters were significantly impaired in patients with chronic prostatitis syndromes and lower urinary tract symptoms in comparison with controls. Elevated seminal markers of inflammation were in positive association with body mass index, prostate-specific antigen, and estradiol level in serum while in negative association with semen volume, total sperm count, and sperm motility. It was suggested that one of the possible pathways for impaired reproductive quality in male subjects >45 years could be related to infection and inflammation in the genital tract with subsequent (partial) obstruction and damage of prostate and other male accessory glands. Previous study has shown that acupuncture could improve sperm parameter in men with genital tract inflammation.

What is ICSI?

ICSI stands for intracytoplasmic sperm injection. This procedure can be used in male factor infertility with low concentration of sperm, low sperm motility and low sperm morphology. This procedure involves that individual sperm is picked up manually and injected into the inner part of the egg. The egg is obtained through the same egg retrieval procedure as IVF. This usually results in normal fertilization in about 75-85% of eggs injected with sperm of course depending on the clinics.

Do you know acupuncture can help increase sperm counts and improve sperm motility in men with varicocele?

Acupuncture may help male fertility by lowering scrotal temperature, reducing inflammation, improving circulation and improving sperm maturation.

References
Tremellen K Hum Reprod Update (2008) 14:243-58
Kantartzi PD et al Hippokratia. (2007)11: 99–104.
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/male-infertility.html
Ausmees K et al World J Urol (2013) 31:1411-25
Siterman S et al Asian J Androl (2009) 11:200-8

Tuesday, 24 June 2014

Acupuncture helps improving foot drop

Foot drop, sometimes called drop foot is a muscular weakness or paralysis that makes it difficult to lift the front part of your foot and toes. This causes the toes to drag along the ground while walking. To avoid dragging the toes, people with foot drop may lift their knee higher than normal. Or they may swing their leg in a wide arc. Foot drop can happen to one foot or both feet at the same time. Foot drop is a symptom rather than a condition. The causes could be muscle disorders, nerve damage in the leg, or brain and/or spinal injury. Muscles disorders including muscular dystrophy, amyotrophic lateral sclerosis and polio cause the muscles to progressively weaken causing foot drop. Some conditions including sports injuries, diabetes, spending long hours sitting cross-legged or squatting, hip or knee replacement surgery, childbirth etc could cause peroneal nerve damage or compressed causing foot drop. Brain or spinal disorders including stroke, multiple sclerosis (MS) and cerebral palsy also can cause foot drop.

The treatments depend on the causes of the foot drop which include physiotherapy, wearing an ankle-foot orthosis, electrical nerve stimulation and surgery. Acupuncture was also reported to be useful to help improving foot drop.

References
Jagirdar PC Indian J Lepr (1986 58:618-22
Liu ZP et al Zhongguoe Zhen Jiu (2012) 32:293-6

Wednesday, 11 June 2014

Acupuncture is effective for diabetic and idiopathic peripheral neuropathy

Acupuncture is effective for diabetic peripheral neuropathy

Diabetic neuropathy is that the nerves in the patients with diabetes were damaged which is caused by high blood sugar levels and decreased blood flow. In a high blood sugar environment nerve cells as well as repair mechanisms are more likely to be damaged. About 50% of patients with diabetes will develop nerve damage many years later after they have been diagnosed diabetes. Many nerves could be affected including cranial nerves (nerves in the skull), autonomic nerves (nerves for internal organs such as heart, stomach etc) and of course peripheral nerves (for instance, nerves for arms and legs). Symptoms may vary depending on which nerves are injured

If peripheral nerves (nerves for the arms and legs) are damaged, this is called peripheral neuropathy which occurs in 50% of the diabetes 2 patients. The early sign of peripheral nerve damage is abnormal sensation such as pain and numbness often started in the toes and feet. The symptoms tingling and burning pain and numbness could be present in the arms and legs. Some pain could be very severe. The nerve conduction became slow. Foot ulcer may occur because of poor blood supply to the skin. The symptoms are worsening with times and age.

The treatment for diabetic peripheral neuropathy included two aspects: first is to keep blood sugar controlled in a normal level to prevent further nerve damage; second is to reduce symptoms. Many medicines are available to relive pain symptoms. Long term use of these medicines could cause kidney damage. Recently there are many studies supporting using acupuncture for the treatment of peripheral neuropathy.

Recent research by Chinese clinicians showed that acupuncture helps improving symptoms of peripheral neuropathy. Chen etc (2009) and Ji XQ (2010) used randomized controlled trials to study effect of acupuncture on nerve conduction velocity in patients with diabetic peripheral neuropathy. They found that acupuncture significantly increased nerve conduction speed. Tong Y (2010) etc compared the effect of acupuncture in patients with diabetic peripheral neuropathy with that of sham acupuncture using randomised trials. After 15 sessions of acupuncture treatment, acupuncture significantly improved nerve conduction speed; acupuncture also significantly improved numbness, pain and rigidity in the arms and legs; vibration and temperature sensations were improved after acupuncture treatment. As we already know that acupuncture has analgesic effect and also acupuncture improves local blood flow, these could contribute to the effectiveness of the treatment.

Positive result of acupuncture in the treatment of diabetic painful neuropathy from Manchester

Role of acupuncture in the management of diabetic painful neuropathy (DPN) was studied by Garrow AP et al in Tameside Hospital NHS foundation Trust, Diabetes Center in greater Manchester UK. In this study, there were 45 patients involved and allocated to two groups real acupuncture group and sham acupuncture group which is a control group. A 10 week course acupuncture was offered to these patients and five standardised acupuncture points on the lower limb of each leg were used in the study: LR3, KI3, SP6, SP10 and ST36. Assessment was done before and after acupuncture treatments. Over the 10-week treatment period, small improvements were seen in Visual Analogue Scale which was used to assess lower limb pain, Measure Yourself Medical Outcome Profile and resting diastolic blood pressure in the true acupuncture group and little changes were in sham acupuncture group. They demonstrated the potential practicality and feasibility of acupuncture as an additional treatment for people with DPN. Acupuncture treatment was well tolerated with little side effects.

Peripheral nerve injury with acupuncture treatment

Peripheral nerve injury can occur through various traumas and it became increasingly common condition. Injury to motor nerves may produce symptoms including muscle weakness, atrophy, twitching and paralysis. Injury to sensory nerve may produce symptoms including continuous burning pain, sensitivity, numbness, tingling or pricking and problems with positional awareness. A first degree injury or neuraplaxia will recover quickly within a few months. The recovery will be completed with no lasting muscle or sensory problem. More severe injuries may take longer to recover completely or may not be fully recovered. The recovery depends on the severity of the injury and the time to get the treatment. Nerve injuries should be treated as early as possible. Apart from surgical treatment, nonsurgical treatments for nerve injuries include medication, massage therapy, orthotics, physical therapy and acupuncture. Studies showed that acupuncture has significantly better effect for nerve injuries than those without acupuncture treatment. Acupuncture provided immediate symptom relief for patients with peripheral nerve injuries. Acupuncture has effect to reduce pain sensation. Acupuncture also improves motor nerve recovery. In addition acupuncture improves nerve conduction over the period of treatment and has been shown effective for nerve repair. This indicates that acupuncture may help nerves regeneration. Acupuncture is a promising approach for nonsurgical treatment of peripheral nerve injuries.

Acupuncture helps with peripheral neuropathy

Peripheral neuropathy is a condition affecting nerves causing impaired sensation, movement, or other organ dysfunction. There are many factors causing the condition, such as diabetes, vitamin deficiency, medication, injury or infection etc. If the cause is unknown, this is called idiopathic neuropathy. The symptoms depend on which nerves are affected. For example, if motor nerves are affected, it could present painful cramps, muscle twitching, muscle weekness, muscle loss, bone degeneration, impaired balance and coordination. If sensory nerves are affected, it may present numbness, loss of sensation, poor balance and coordination, tingling, burning pain etc. If autonomic nerves are affected, it may present poor bladder control, abnormal blood pressure and heart rate, sweat changes abnormally.

Acupuncture can help with peripheral neuropathy, by improving blood supply to the nerves, reducing inflammation and increasing nerve conductivity.

Acupuncture helps motor nerve injury recovering

Recent research from China reported the effectiveness of acupuncture for peripheral nerve injury. Xiao GR et al did a control trial study which investigated and compared the effects of acupuncture on peripheral nerve injury with that of function training and no treatment. They recruited 90 patients and allocated them into three groups: acupuncture group, function training group and control group with each group of 30 patients. After three months of treatments basic function, practical function, EMG, nerve conduction velocity were compared among the 3 groups. They found that the acupuncture group achieved the best recovery; the function training group is the second. They suggested that acupuncture plus function training can accelerate nerve repair, promote functional recovery of the muscles.

Another case report was from Millea PJ in Medical College of Wisconsin USA. A 41-year old female with a 1 week history of inability to write or extend the right wrist received 1 session of acupuncture treatment. Wrist motion returned strait away after the treatment. After acupuncture treatment wrist splint was then used. On the same day, the patient reported increasing strength in wrist and finger extension. On the next day, the patient cancelled the second session of acupuncture treatment, because of her hand recovered. 4 month followup found all wrist and finger extension, sensation and return of the brachioradialis reflex were normal. 1 year followup showed fully recovery to normal. Acupuncture potentially facilitates recovery and may accelerate peripheral motor nerve injury recovery. Although evidence that acupuncture is effective for any type of motor nerve injury is limited to case reports and case series, these findings are beneficial.

Common peroneal nerve palsy, acupuncture can help.

Common peroneal nerve palsy is damage to the peroneal nerve which is a branch of the sciatic nerve and supplies movement and sensation to the lower leg, foot and toes. Common peroneal nerve palsy is a type of peripheral neuropathy. This condition can affect people of any age. The peroneal nerve palsy leads to loss of movement or sensation in the foot and leg. There is a loss of feeling, muscle control, muscle tone, and eventual loss of muscle mass because the nerves aren't stimulating the muscles.

The causes include Trauma or injury to the knee, fracture of the fibula (a bone of the lower leg), use of a tight plaster cast (or other long-term constriction) of the lower leg, crossing the legs regularly, regularly wearing high boots, pressure to the knee from positions during deep sleep injury during knee surgery or from being placed in an awkward position during anesthesia, or unknown reasons. People who have diabetes or exposed certain toxins are in high risk.

The symptoms include decreased sensation, numbness, or tingling in the top of the foot or outer part of the upper or lower leg, foot drops, walking problems including slapping gait and toes drag while walking, weakness of the ankles or feet. Examination shows Loss of muscle control in the lower legs and feet, atrophy of the foot or leg muscles, difficulty lifting up the foot and toes and making toe out movements. Nerve conduction tests show reduced conduction velocity.

Treatments including surgery, physiotherapy etc are aimed for improving mobility and independence. Acupuncture helps improve recovery of peroneal nerve function and increase nerve conductivity. Acupuncture can also reduce pain caused to nerve injury.

References
Chen YL Journal of Chinese integrative medicine (2009), 7:273
Ji XQ Zhen ci yan jiu (2010), 35; 443-7
Tong Y J Acupunct Meridian Stud. (2010) 3:95-103.
Millea PJ J Altern Complement Med (2005) 11: 167-9
King JC. Peroneal neuropathy. In: Frontera WR, Silver JK, Rizzo TD, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal disorders, pain and rehabilitation. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 66.
Yao ZH et al J Tradit Chin Med (1984) 4:97-100
Xiao GR et al Zhongguo Zhen Jiu (2007) 27:329-32
Garrow AP et al Acupunct Med (2014) Mar 21. doi: 10.1136/acupmed-2013-010495

Monday, 19 May 2014

Cold feet and hands, acupuncture can help.

Do you have icy feet and hands? This sensation is extremely unpleasant. You may feel embarrassed with cold hands when you shake hands with someone. You may have difficulty to fall asleep during the night because of the cold feet. Cold hands and feet can arise due to cold exposure. Cold hands and feet can also be caused by problems with the circulation to the hands and feet or with the nervous system. Conditions causing poor circulation include diabetes, arteriosclerosis, Raynaud’s phenomenon, peripheral vascular disorder and frost bites; neurological disorders such as neuropathy; and decreased metabolism condition such as hypothyroidism. In people with diabetes mellitus, chronic abnormally elevated blood and urine sugar, causes narrowing of arteries and capillaries that impair blood supply to tissues of hands and feet. Arteriosclerosis and peripheral vascular disease result from chronic elevation of blood cholesterol levels that leads to blood vessel narrowing. Raynaud's phenomenon features narrowing of tiny blood vessels as a reaction to nerve sensitivity to cold exposure. Frostbite causes permanent damage to blood vessels that are injured from freezing of tissues. Treating underlying causes are important if there is one found. Other self helps include keep the extremes warm by wrapping them in warm cloth. Stop smoking and reduce caffeine consumption.

Do you know acupuncture can help with your cold feet and hands? Acupuncture can help improve blood circulation in the hands and feet as a result it makes the extremes warm. A study has shown that after acupuncture treatment skin temperature will rise which is probably caused by increased circulation.

References
Svedberg LE et al Complement Ther Med (2001) 9:89-97

Monday, 5 May 2014

Labour induction with acupuncture

Labour induction with acupuncture

Induction of labour is a relatively common procedure. One in every five deliveries in the UK was induced. Acupuncture involves the insertion of very fine needles into designated locations with the purpose of preventing or curing disease. In TCM, it is thought that acupuncture stimulates channels of qi. This energy flows along 12 meridians, with designated points along these meridians. In Western medicine, it is thought that acupuncture may stimulate the release of prostaglandins and oxytocin. Acupuncture is used for induction of labour which is listed on WHO guideline. Recently a study from China analysed data from 2002 to 2008, sixty-five papers were retrieved. The results reveals that the research of acupuncture application in inducing labor focused on clinical practices, acupuncture has remarkable effectiveness and its advantages in facilitating contractions, shortening birth process, and elevating labor pain. A recent study has shown that absence of obstetric complication, higher duration of labor and tendency to a higher satisfaction of the patients were observed among patients in acupuncture group. There was also significantly higher frequency of vaginal deliveries and without occurrence of obstetric complications. Higher frequency of cesarean sections and obstetric complications were observed among patients in control group. A study from Astria has shown that the cervical length in the acupuncture group was shorter than that in the control group suggesting a cupuncture supports cervical ripening at term and can shorten the time interval between the EDC and the actual time of delivery.

Applications of acupuncture on delivery of baby in China

Acupuncture was used in introducing delivery of baby in ancient China. Is acupuncture still used in delivery today in China? Chen et al analysed research about acupuncture on delivery in past ten years from 2002 to 2012. They found that there are many clinical researches on five aspect of delivery including acupuncture for pain relief during delivery, acupuncture for the process of labor, acupuncture for the disorders of postpartum (such as postpartum uroschesis, postpartum abdominal pain, and insufficient lactation), acupuncture for abortion, and the influence of psychological factors in the pain relieving effects of acupuncture during delivery.

For pain relief during delivery, Interventions include body acupuncture, scalp acupuncture, acupressure, combination of auricular acupressure and body acupuncture, acupoint injection, and the combination of acupuncture or moxibustion with herbal or modern medicine. All researchers found that acupuncture can significantly relieve the pain during delivery, without adverse effects to both mother and child and they suggested that acupuncture may be an economic and convenient therapy in relieving pain during delivery.

For induction of labour or shortening the length of delivery, interventions include boy acupuncture and acupressure. They found that that acupuncture can effectively reduce the duration of delivery (the whole length of delivery or second trimester of pregnancy), strengthen the uterine contraction, decrease the amount of oxytocin given during delivery, and significantly extend the length of uterine contraction and shorten the intermittent periods of contraction. No adverse event occurred.

A study compared acupuncture/acupressure with conventional methods to induce labour. The study group consisted of 50 women who received acupressure and/or Acupuncture prior to and/or during hospitalization. The control group consisted of 30 women who received customary hospital labor inducement methods. Result has shown that acupressure/Acupuncture significantly reduced additional interventions throughout the birth process, when these were given during hospitalization or before hospitalization. The birth process time was significantly shortened when combining acupressure/acupunture and conventional inducement methods (medicinal/mechanical). This study suggested that acupressure/acupuncture alone or combined with conventional methods is effective to reduce the extent of intervention throughout the birth process and also to reduce delivery completion interventions.

For disorders of postpartum period, the urine retention was focused on. The interventions include body acupuncture, combination of acupuncture and moxibustion, or herb or Guasha. Their finding was that either the single use of acupuncture or the combination of acupuncture and herbal medicine can relieve urine retention and achieve very high satisfaction. Meanwhile, studies of acupuncture in treating stress urinary incontinence, promoting recovery after cesarean section, treating abdominal pain, vaginal bleeding, and lactation difficulty of postpartum had satisfactory results.

For abortion, acupuncture was all used in the combination of mifepristone and misoprostol in the researches. No acupuncture alone was used in the research.

For psychological factors and acupuncture Effects Researchers investigated the influence of maternal personality type on the pain relieving effects of acupuncture in delivery and they found that personality stability could significantly affect the parturient women’s satisfaction and the effectiveness of acupuncture.

Acupuncture is used for treatment of labour pain.

Acupuncture is an effective treatment for pain management. Acupuncture is also used for treating labour pain. Is there point specificity in labour pain treatment? Recently a study compared the effect of acupuncture with different acupuncture points on labour pain. In this study, Ex-B2 point and SP6 acupuncture points were chosen. Pain is assessed during active phase of labor before and 30, 60, 120 min after intervention. The duration of active phase, the duration of second stage of labor, the duration of third stage of labor, use of oxytocin, neonatal birth weight, neonatal Apgar score at 1 and 5 min. . After 30 min intervention, the mean VAS scores of both EX-B2 group and SP6 group were significantly decreased compared with the control group; however, no significant difference was observed between the two experimental groups. After 60 and 120 min intervention, the mean VAS scores of EX-B2 group were significantly lower than SP-6 group. Both EX-B2 group and SP6 group had significant lower VAS scores after interventions and shorter time used in active phase of labor than the control group. They suggested that the application of electro-acupuncture at EX-B2 and SP6 acupoints could be used as a non-pharmacologic method to reduce labor pain and shorten the duration of active phase of labor.

References

Chen and Zhu Zhongguo Zhen Jiu (2010) 30:877-80

Gribel et al Arch Gynecol Obstet (2011) 283:1233-8

Amir N et al Harefuah (2015) 154:47-51

Rabl M et al Wien Klin Wochenschr 92001) 113:942-6

Chen Y et al Evid Based Complement Alternat Med (2014) 2014:672508

Dong C et al Arch Gynecol Obstet (2014)

Saturday, 26 April 2014

Suffer from vulvodynia and vestibulodynia? Acupuncture can help

If you never had pain on the vulva, you can never imagine how painful it is. Chronic vulvar pain is known as vulvodynia which only obtained the name about 30 years ago. It is not unknown now. Channel 4 a British BAFTA-award winning reality medical television programme Embarrassing Bodies introduced this condition vulvodynia. With up to 15% of women suffering with this condition, you can be sure that you’re not alone, if you have vulvar pain. It is a persistent burning or stinging pain of the vulva. It could be constant pain and get worse when under pressure or it could be only painful under pressure such as using tampon or sex. The pain can be only on the vulvar area. It can also spread to the thigh, tummy or back. Women with vulvodynia could have severe period pain, heavy periods, frequent urination and pain and changed bowel habit. Before vulvodynia is diagnosed, other causes of vulvar burning must be excluded. These include fungal, bacterial and viral infections, inflammatory dermatoses such as lichen sclerosus and lichen planus, contact sensitivity and eczema, and lesions such as surgical scars and recurrent fissuring. Vulvodynia can affect women of all ages. The possible causes of vulvodynia may include nerve irritation, abnormal response in vulvar cells to an infection or trauma, genetic factors that make the vulva respond poorly to chronic inflammation,, hypersensitivity to yeast infections, muscle spasms, allergies or irritation to chemicals or other substances, hormonal changes, history of sexual abuse, frequent antibiotic use. It is a distressing condition and affects women’s quality of life. The treatments are limited. Antidepressant and anti-epilepsy drugs can be used to treat vulvodynia and help reducing pain. However the effect is not satisfactory. NICHD-funded research found that amitriptyline (a tricyclic antidepressant) with or without topical triamcinolone (a corticosteroid used to treat skin conditions) was no more effective than self-management approaches (which included components of education and cognitive-behavioral, physical, and sex therapy) in managing vulvar pain, although the number of people in the study was small. Other NICHD-supported investigators conducted a randomized, controlled trial and found that oral desipramine (a tricyclic antidepressants) and topical lidocaine (an anesthetic), alone or in combination, were no better than placebos in helping women with vulvodynia. These drugs have many side effects. Make sure you know the side effects before you take the drugs.

Acupuncture can help treating the vulvar pain. In 1999, JOURNAL OF THE ROYAL SOCIETY OF MEDICINE published a paper by Powell and Wojnarowska about acupuncture for vulvodynia. They selected twelve patients with vulvodynia aged from 18 to 68 years. All had vulvar pain and burning without other abnormalities on examination. All had experienced severe distress and impairment of sexual function. Many had tried suggested treatment without success. These patients were offered weekly acupuncture for ten weeks. As a result of acupuncture, Two patients felt so much improved that they declared themselves 'cured'; three believed their symptoms had improved and wished to continue acupuncture; four felt slightly better and judged acupuncture more effective than any other treatment; and three noted no effect at all. There were no obvious side effects for the treatment. A study from Sweden investigated the effect of acupuncture on vulva vestibulitis. They found that after three month acupuncture treatment patient’s quality of life was improved significantly. More recently Curran et al were using acupuncture for treatment of provoked vestibulodynia which is also a genital pain condition. There were 80 patients involved in this study. After 10 treatments there were significant decreases in pain with manual genital stimulation and helplessness. There were also strong effects for improved ability to have intercourse and sexual desire. Qualitative analyses were overall more positive and showed an improvement in perceived sexual health, reduced pain, and improved mental well-being in the majority of participants.

A new research from Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA has shown that acupuncture treatment significantly reduced vulvar pain in women with vulvodynia. In this study, thirty-six women with vulvodynia were involved. The women were randomly assigned either to the acupuncture group or to the wait-list control group. 10 sessions of acupuncture were offered to women in acupuncture group. Reports of vulvar pain and dyspareunia were significantly reduced, whereas changes in the aggregate FSFI scores suggest significant improvement in sexual functioning in those receiving acupuncture vs. those who did not. Their conclusion is that this was the first randomized controlled pilot study to examine the use of acupuncture for the treatment ofvulvodynia. The acupuncture protocol was feasible and appeared to reduce vulvar pain and dyspareunia with an increase in overall sexual function for women with vulvodynia.

There are some cases that are treated with acupuncture successfully

A 34 year old lady had vulvar pain for 3 years. The pain is worse when pressure is applied such as having intercourse. She always had very painful periods. There was tightness in her thigh and back. She was treated with antidepressant and physiotherapy, but the pain has not improved. There was no pain when passing water and no change with bowl habit. She decided to try acupuncture. After 8 acupuncture treatments, the pain was reduced significantly and she was able to stop taking antidepressant.

A 29 year old lady had vulvar pain for 2 years. There was burning sensation when passing water with frequent urination. The vulva pain was unendurable when having intercourse. It was impossible to use tampon. She also had lower back pain. Her periods were very painful. She was treated with various medications, but the pain was not improved at all. She has heard from a friend that acupuncture can help with her condition and decided to try it. After 3 month treatments, the pain has completely gone. There was no pain when passing water and no intercourse pain.

A 43 year old lady had severe vulvar pain for 1 year companied with period pain and intercourse pain. She had irregular periods and she also had frequent urination and urgency. The pain goes to lower abdomen, thigh and lower back. She took antidepressant, but the pain was still there. Local injection of steroids did not have any improvement. She decided to try acupuncture to see if it helps. After 5 treatments the pain significantly improved and another 10 treatments, the pain was completely disappeared.

My book can help you understand more about vulvodynia. http://www.amazon.co.uk/Vulvodynia-vulval-pain-your-mind-ebook/dp/B010R2596K

It is a distressing condition and affects women’s quality of life, however the treatments are limited. My patients told me that they have tried all sorts of possible treatments (such as local anesthetic, vagina injection, pain killers, physiotherapy treatment, dilator, pelvic floor therapy) that they can get, but none of them worked.

I have helped many women with vulodynia with acupuncture treatment. Some of them had severe pain. They could not sit, could not wear trousers, they could not sleep due to the pain. They first came to see me with skirts standing at the reception room, but after treatments with me, in the end they came with jeans sitting on the sofa. Vulvodynia like any other chronic pain is not easy to treat.



References

https://www.nichd.nih.gov/health/topics/vulvodynia/conditioninfo/Pages/treatments.aspx

Powell and Wojnarowska J R Soc Med (1999) 92:579-81

Curran S et al J Sex Med (2010) 7:981-95

Danielsson L et al Acta Obstet Gynecol Scand (2001) 80:437-41

http://www.channel4embarrassingillnesses.com/conditions/vulvodynia/

Schlaeger JM et al J Sex Med (2015) 12: 1019-27

Thursday, 6 February 2014

How many eggs retrieved in IVF are good numbers?

How many eggs retrieved in IVF are good numbers?

IVF becomes a popular technique for infertility treatment since it was invented 30 years ago. During the procedure it is difficult to predict the side effect and success for individuals. IVF success rate is related to egg number retrieved in the procedure. What is the optimum number of eggs for IVF? Is there a connection between egg numbers and live birth rate (LBR)? Ji J et al analysed the data from 2007 and 2011 from total 2455 patients who was undergoing first cycle of IVF treatment. All patients had normal menstrual cycles and were stimulated with a long GnR agonist protocol. Associations between egg number and LBR and miscarriage rate and the rate of moderate-severe ovarian hyperstimulation syndrome (OHSS) were analysed. These patients were divided into four groups according to the egg number retrieved: 0-5, 6-10,11-15 and >15. The fresh embryo transfer LBR and cumulative LBR were assessed. Their data suggested that for IVF cycles stimulated with a long protocol the optimal number of eggs for achieving a live birth is between 6-15. With increased egg number, the incidence of moderate-severe OHSS was increased. There was no significant difference in the miscarriage rates among the patient groups.

There was another research studied the association between egg number and the rates of ovarian hyperstimulation syndrome (OHSS) and live birth in fresh IVF cycles. In this research they analysed data from 256381 IVF cycles. Patients were divided into five groups according to the egg numbers retrieved. The data showed that the LB rate increased up to 15 eggs, then levelled (0-5: 17%, 6-10: 31.7%; 11-15: 39.3%; 16-20: 42.7%; 21-25: 43.8%; and >25 oocytes: 41.8%). While the rate of OHSS became much more clinically significant after 15 eggs (0-5: 0.09%; 6-10: 0.37%; 11-15: 0.93%; 16-20: 1.67%; 21-25: 3.03%; and >25 oocytes: 6.34%). These data showed that retrieval more than 15 eggs significantly inceases OHSS risk without improving LB rate in fresh IVF cycles.


References

Nedeljkovic M et al Forsch Komplementmed (2013) 20:112-8

Manheimer E et al (2008) BMJ 8: 545-549

Zheng CH et al Evid Based Complement Alternat Med (2012)2012:543924

Saturday, 1 February 2014

Acupuncture helps hemiplegia in post stroke patients

Hemiplegia which is severer than hemiparesis is paralysis of one half of the body on the same side. Brain damage is one of the causes. The paralysis occurs on the opposite side of the damaged brain. For example if one has an injury to the right side of the brain, the hemiplegia will be on the left side of the body. It is a common post stroke complication. Acupuncture is used in hemiplegia treatment in China. There was a study that investigated the immediate effects of acupuncture at GB34 acupoint on passive movement in stroke patients with hemiplegia using modern technique MRI to provide reference for clinical treatment. Six patients with right brain stroke and left hemiplegia in recovery stage were selected and scanned during passive fingers movement before and after acupuncture at acupoint GB34. The activated areas of the passive movement in all the patients were mainly motor sensory cortex on the right side. Compared with sham control, acupuncture had better effect on activating brain motor related network. This study used advanced technique and demonstrated that acupuncture is potential treatment method for hemiplegia in post stroke patients.

Treating upper limb hemiparesis with acupuncture and other interventions

Hemiparesis is a common complication for stroke survivors. The intervention for the conditions is aimed to improve quality of life for these patients. Pulman and Buckley from University of Liverpool UK reviewed the efficacy of different upper limb hemiparesis interventions on improving health-related quality of life in stroke patients. This is their findings:

Of the 22 studies, 12 reported significant findings within groups and between control groups. Interventions including BTX-A injections, CIMT, exercise programs, baclofen pump, robotic-assisted therapy, electrical stimulation, and acupuncture were reported to significantly improve either overall health-related QOL or certain individual QOL domains, such as strength, hand function, memory, mood, activities of daily living, mobility, social participation, communication, energy, pain, and sleep.

Example of acupuncture improves limb function in post stroke patients

Scalp acupuncture is that the needles are inserted in the acupuncture points on the scalp, while body acupuncture is that the needles are inserted in acupuncture points on the body. Both types of acupuncture are combined to treat stroke in China. Recent research showed the effectiveness of combined scalp and body acupuncture on limb function in stroke patients. Tang et al studied the effect of acupuncture n limb function in subacute stroke patients using scalp and body acupuncture. These patients were treated by routine neurological therapies. After 20 days, the limb function was better improved in acupuncture plus routine treatment group than that routine treatment only group. There were no significant differences between two groups in the ratios of mortality/disability and recurrence rates at the end of 3 and 6 months follow-up. He et al also studied the combined application of scal and body acupuncture on limb function in stroke patients. They also found better improvement in lower limb function in acupuncture group. After 8 weeks treatment, the walking ability rate in acupuncture group wa higher than that in the control group. The walking speed in the acupuncture group was faster than that in the control group.

Acupuncture point injection of herbal extract and floating acupuncture helps post stroke shoulder pain.

Shoulder pain is very common after stroke. It can be treated with pain killers, steroid injections, positioning and handling, shoulder strapping, electrical stimulation. Recently acupuncture point injection of herbal extract on post stroke shoulder pain was studied. There were 24 patients participated the study. Acupuncture points injection of herbal extract was carried out three times a week for 2 weeks. The effects of treatment were assessed with a numerical rating scale (NRS), painless passive range of motion (PROM) of external shoulder rotation, and the motor function assessment (FMMA). The acupuncture point injection group showed significant improvement on the NRS compared with that for control group after 2 weeks of treatment. PROM decreased significantly in both groups with greater pain reduction in treatment group. This study showed that acupuncture point injection of herbal extract was an option for patients with post stroke shoulder pain. Another study compared acupuncture with medicine and herbs for shoulder pain in post stroke patients. They found that shoulder pain was relived and the daily life activity was improved in the patients with post stroke using floating acupuncture technique. The pain relief was superior to the oral western medicine mobic and local Chinese herbs fumigation.

Current situation of stroke with acupuncture treatment

There is an increase in interest in using acupuncture on stroke and its effectiveness. Much of the recent research has been carried out in the Scandinavian countries and the USA. In China many studies have compared different techniques and point combinations which often involved in very large numbers of patients. The studies carried out so far have developed a variety of methods and are strongly indicative of therapeutic benefit, though the precise details of acupuncture treatment given are not always clearly stated in the studies. And there was lack of standardization in the treatments. Recently Wu et al analysed recent existing data to investigate the spectrum of acupuncture points in post stroke patients treated with acupuncture and moxibustion. They collect 652 clinical research papers. They found 143 nonacupuncture points were used and the application frequency were 737; 253 acupuncture points were used and the application frequency were 5395. According to application frequency, the acupuncture points were divided into often used points (23points); sometime used points (100 points) and less used points (130 points). Apparently there was lack of standardization in stroke treatment with acupuncture. The selected acupuncture points were distributed in fourteen meridians and most common used meridians were Yangming and Shaoyang.

References
Wu et al Zhonguo Zhen Jiu (2013) 33:547-52
Si WJ et al Zhongguo Zhen Jiu (2013) 33:131-6
Seo YR et al Evid Based Complement Alternat Med (2013) 2013:504686
Wang J Zhongguo Zhen Jiu (2013) 33:294-8
Pulman and Buckley Top Stroke Rehabil (2013) 20:171-88
Tang et al Zhen Ci Yan Jiu (2012) 37:488-92
He et al Zhongguo Zhen Jiu (2012) 32:887-90

Tuesday, 28 January 2014

Acupuncture improves spasticity in post stroke patients

Can acupuncture help patients with stroke?

Stroke is a serious condition which blood supply to the brain is cut off. It is the second most common cause of death worldwide, and the leading cause of adult disability. Patients with mild strokes or rapidly improving symptoms usually have a good prognosis, while patients with major strokes have a poor prognosis. Acupuncture help reduce brain damage and brain recovery. The mechanisms are as follows: Acupuncture has anti-inflammatory effects and increases cerebral blood flow which would protect the brain from ischaemic injury; acupuncture reduces cerebral odema after cerebral ischaemia and protect neuron damage; acupuncture also regulates biochemical changes involved in post stroke condition. Acupuncture acts on brain region which reduces sensitivity to pain and stress and promotes relaxation reducing anxieties. There have been many researches published recently to support the effectiveness of acupuncture on stroke recovery. In China, stroke is treated with acupuncture. A survey of 1095 physicians from 247 hospitals in China between 1993 and 1994 has shown that 66% of Chinese doctors routinely used acupuncture to treat patients with stroke and 63% of them believed its effectiveness. Another survey in 2007 from patients with acute stroke has shown that 63% patients with stroke would choose acupuncture as part of medical intervention. Many researches were carried out to examine the effectiveness of acupuncture on stroke to support the clinical application of the interventions. Some research has shown that acupuncture can slightly help acute stroke by decreasing mortality rate and dependency at the end of long term follow up and improving neurological deficit scores. Acupuncture treatment for strokes has been listed as a proved effective treatment for stroke in world health organisation (WHO) website http://apps.who.int/medicinedocs/en/d/Js4926e/5.html.

Post stroke rehabilitation is an important part of the treatment of stroke to reduce disability and improve quality of life for patients with stroke. Available evidence suggested that acupuncture may be effective for treating poststroke neurological impairment and dysfunction

In Korea, integrative treatment is also used for patients with stroke. For inpatients, integrative management is applied at the request of the primary physician with consent of patients or their families. In the acute stage, neurologists or neurosurgeons take charge as the primary physicians. Korean medicine doctors cooperate as secondary physicians to the neurologists and neurosurgeons. When patients passed the acute stage, responsibilities are changed between primary and secondary doctors. The rehabilitation program is conducted under the supervision of rehabilitation medicine doctors. The most frequently used complementary and alternative medicines are acupuncture including manualacupuncture, electroacupuncture, and intradermal acupuncture, moxibustion, herbal prescriptions and acupuncture point injection. From their experiences, they believe the integration of complementary and alternative medicine and Western medicine have benefit for patients with stroke.

Acupuncture improves spasticity in post stroke patients

Post stroke patients can be seriously affected by many complications as handicaps, unclear consciousness, aphasia, dementia, psychological abnormalities and incomplete bladder emptying. Spasticity is very common in post stroke patients. Spasticity is a condition in which muscles are constantly tight and stiff. It could cause reduced flexibility, posture and functional mobility; it could also cause joint pain, muscle and joint shortening etc. In post stroke patients, muscle spasm in one side of the body are in constant contraction state is very common. The affected side of the body is rigid, weak and has low functional abilities. Treatment includes antispastic medication such as baclofen, diazepam etc. Physiotherapy including muscle stretching and exercises could help preventing muscle shortening and atrophy. Acupuncture is use to help stroke rehabilitation and it improves post stroke motor ability. Some research study showed that acupuncture reduces spasticity by stroke and maintain a reduced level of spasticity. A study showed that combining a 6 week electroacupuncture and standard rehabilitation treatment reduced the spasticity of the elbow for chronic post stroke patients. The effect depends on the acupuncture points chosen for the treatment to improve spasticity.

Recently a study investigated the effect of acupuncture on muscle spasm. In this study, 44 patients were allocated in acupuncture group in which patients received acupuncture combined with rehabilitation treatment while 42 patients were in control group in which patients received only rehabilitation treatment. The key acupuncture points selected were from head, face, chest, abdomen, shoulder, back, hands, feet and ankles. Routine limb rehabilitation program was applied to both groups. One course included 10 treatments and two courses were performed in total. The effective rate of antispasm was 90% in acupuncture group which was superior to control group (73.8%). The improvement of motro function was significantly greater in acupuncture group. This study showed that acupuncture combined with rehabilitation therapy effectively relieves the muscle spams in post stroke patients, improves the limb function and the life activity.

References
Tong S Zhongguo Zhen Jiu (2013) 33:399-402
Bi-huei Wang et al Clin Interv Aging (2014) 9:147-156
Zhang JH et al Neuroepidemiology (2014) 42:50-8
Park SU et al Complement Ther Clin Pract (2014) 20:37-41

Thursday, 16 January 2014

Acupuncture is effective with post-stroke constipation

Acupuncture is effective with post-stroke constipation

Acupuncture could help motor function, cognition, speech problems, shoulder pain, urinary incontinence, constipation, depression, fatigue and dysphagia etc.

Constipation can occur after a stroke. This is because you are not drinking enough liquids and you are in bed most of the time; or you are taking certain medicines as part of your treatment. If you have constipation, drink extra water and set a regular time for using toilet. Acupuncture can help post stroke constipation. There is a case report about treating post stroke constipation using acupuncture. There were 39 patients with post-stroke constipation received acupuncture treatment for 2 weeks and another 35 patients with post-stroke constipation received Chinese herb medicine Shengrue Tongbian Capsules for 2 weeks. After two weeks treatment, constipation symptoms were improved in these patients received both acupuncture and Chinese medicine. The improvement was greater in patients with acupuncture treatment. Acupuncture was potential treatment option for patients with post-stroke constipation.

Acupuncture could help post-stroke urinary incontinence.

Urinary incontinence is the unintentional passing of urine. This is a common problem in patients with stroke. In China, acupuncture is used to treat this problem. Recent clinical research compared the effect of acupuncture with that indwelling catheter. Acupuncture was received 5 times a week. The points used included Qugu (CV2), Zhongji (CV3), Shuidao (ST28, Qihai (CV6) and Guanyuan (CV4) etc. The effect was compared after 4 weeks of treatment. The urinary diary (including the interval of urination, nocturia frequency, urination difficulty, urinary incontinence severity), bladder capacity, patients’s satisfaction were assessed before and after the treatments and compared between the two groups. After treatments, the effects were observed in both groups with better effect in acupuncture group especially in total score, the patients’ satisfaction and bladder capacity. Acupuncture is potential treatment option for post stroke urinary incontinence.

Acupuncture has potential benefit for stroke patients with incomplete bladder emptying

Urinary retention and incomplete bladder emptying (IBE) are not uncommon in patients with stroke rehabilitation. This significantly increased the risk of urinary infection. Recently there was a study investigating the effect of acupuncture on IBE. The patients selected were diagnosed with infarction or hemorrhagic stroke for the first time; they did not suffer from an active urinary tract infection. During the study period, these patients continued to receive conventional therapy without major changes of medication. These patients received acupuncture five times a week for two weeks. Among the 49 patients in the study, nine (18%) had IBE, and seven of the stroke patients with IBE were treated with electroacupuncture. Increased spontaneous voiding volume and decreased PVR urine volume were noted after ten sessions of acupuncutre. They suggested electroacupuncutre may have beneficial effects on stroke survivors with IBE. Acupuncture is a potential intervention to improve urinary function.

Acupuncture for ischemic stroke

Most stroke (87% cases) is ischemic stroke which caused by blood clot blocking blood vessel in the brain. The blood clot can form in the blood vessel in the brain or it formed elsewhere and travelled to the vessel in the brain which cannot pass because the vessel is too narrow to pass. Loss of blood supply damages brain function. The recovery of brain function such as speech and walking was attributed to reduction of inflammation in the brain region of damage and rewire of the area. Recently a randomised controlled trial from China studied efficacy of integrated rehabilitation techniques of Chinese Medicine for ischemic stroke. They used acupuncture combined with massage techniques and compared this with conventional rehabilitation technique. They compared the related parameters on day 0, day 21 and day 90. They found better improvement in acupuncture and massage compared with baseline and conventional technique. They suggested there is potential benefit from acupuncture and massage for ischemic stroke rehabilitation.

Acupuncture is beneficial for cognitive function in post stroke patients

Jing well points are very powerful points located at the end of fingers and toes. These points are very often used to treat stroke. Temple points on the side of the head are also used for stroke in China. Recently a research showed that these points are beneficial for patients with early vascular congnitive impairment in China. They compared acupuncture at Jing well points and temple points and conventional treatment in patients with stroke. They observed improvement with acupuncture treatment but not conventional treatment. This indicates that acupuncture has potential to improve cognitive function in post stroke patients with mild cognitive impairment.

Acupuncture for post stroke depression

Patients with stroke not only suffer from physical disability but also emotional problems. Post stroke depression (PSD) is very common in patients with stroke in different stages. PSD is linked to increased disability, and poor functional and cognitive outcomes of stroke survivors. Reducing PSD could improve quality of life in patients with stroke. Anti-depression drugs could used to treat PSD. Because of their side effects, combination drugs and non drug treatments were recommended. Acupuncture is one of therapies without drugs, but its use in PSD is still in debate. Recently a pilot study investigated whether acupuncture is an effective treatment for PSD and whether the effect of acupuncture differs according to the degree of motor function impairments of the stroke patients. In this study 28 PSD patients were assessed and participated the study. They were treated with acupuncture every day for 16 weeks. Depression status was significantly improved during the treatment sessions. The depression of the good motor function groups was significantly more reduced than that of the poor motor function group. This study indicates that acupuncture therapy can improve PSD and that the effects depend on the degree of motor function impairment.

Another research from China studied the combination of herbs and acupuncture for post stroke depression. They compared herbs plus acupuncture with western medicine fluoxetine hydrochloride for treating post stroke depression. The treatments were given for four weeks. On six month followup, improvement was seen in herbs plus acupuncture and western medicine treatment with greater improvement in herbs plus acupuncture.

There was also study combined acupuncture and moxibustion or antidepression medication (using aroxetine hydrochloride tablets) on post stroke patients with depression. They compared the efficacy of medication only, acupuncture plus moxibustion and acupuncture plus medication. Daily acupuncture except weekends was offered for 4 weeks. The improvement of depression was superior in acupuncture plus medication group and acupuncture plus moxibustion group to medication only group.

Acupuncture helps post stroke swallowing difficulty

Swallowing difficulty can be present in post stroke patients. This problem is treated with acupuncture in China. Recently Zhou et al studied the effect of acupuncture on post stroke swallowing problem using modern research methods to provide evidence from conventional medicine point of view. They combined acupuncture with rehabilitation training program. There were 80 patients with post stroke swallowing difficulty. 40 patients were in control group treated with conventional approach and other 40 patients in acupuncture group treated with acupuncture. After treatment, assessment was carried out. They found there were improvements after the treatments in swallowing tests for both groups compared with those before the treatments. The improvements in acupuncture group were significantly greater. This showed that acupuncture is a potential effective treatment for swallowing difficulty in post stroke patients.

References

Yu KW et al Clin Interv Aging (2012) 7:469-74

Song et al Zhongguo Zhen Jiu (2013) 33:769-73

Ren et al Zhongguo Zhen Jiu (2013) 33:893-6

Youn JI et al J Phys Ther Sci (2013) 25:725-8

Hu JF et al Zhongguo Zhong Yao Za Zhi (2013) 38:2403-5

Nie and Huang Zhongguo Zhen Jiu (2013) 33:490-4

Li F et al Zhongguo Zhen Jiu (2013) 33:784-8

Zhang et al Am J Chin Med (2013) 41:971-81

Zhou XM et al Zhongguo Zhen Jiu (2013) 33:587-90