How the brain and the head get oxygen and food?

Although the brain is only about 2% of the total body weight in humans, it receives 15-20% of the body's blood supply. Because brain cells will die if the supply of blood which carries oxygen is stopped, the brain has top priority for the blood. Even if other organs need blood, the body attempts to supply the brain with a constant flow of blood. The blood brings many materials including oxygen, carbohydrates, amino acids, fats, hormones and vitamins necessary for the brain to function properly. The blood also removes materials including carbone dioxide, ammonia, lactate and hormones from the brain. This function is performed by many blood vessels.

The head’s blood supply comes mainly from the external and internal carotid arteries.

The internal carotid artery travels up from the aortic arch just outside the heart. It travels into the brain to provide oxygenated blood to the eyes, the front of the brain, and portions of the scalp.

The external carotid artery helps supply part of the brain through its many branches, and it also gives blood to the thyroid gland in the neck.

These arteries go through the neck and reach the head.

The vertebral arteries arising from the subclavian arteries and continuing to the basilar artery is another source of the blood vessels to the brain.

In the brain, a circle consisting to of two carotid arteries and the basilar artery form the circle of Willis. This supplies blood in the center of the brain and branches to the cerebrum, pons, medulla oblongata, cerebellum, and the beginning of the spinal cord.

Deoxygenated blood leaves the brain and the head and goes back to the heart through veins accompanied with the arteries.

The cranial venous sinuses also remove blood from the head. Unlike normal veins, these are large channels that drain blood.

What do you know about endorphins and acupuncture?

Endorphins are neurotransmitters produced in the brain known as endogenous opioids and they can be found in the pituitary gland, in other parts of the brain, or distributed throughout the nervous system. They transmit electrical signals within the nervous system by interacting with opiate receptors in the brain. The action is similar to morphine and codeine, but without addiction or dependence. At least 20 types of endorphins have been found in humans. In response to pain and stress, they decrease feelings of pain and also lead to feelings of euphoria, modulate appetite, release sex hormones, and enhance the immune response. As a result, it makes people feel less pain and less stressed.

Many studies in animals and humans have demonstrated that acupuncture can cause multiple biological responses. Endorphins are released during acupuncture and that the analgesic effects of acupuncture are at least partially explained by their actions. That opioid antagonists such as naloxone reverse the analgesic effects of acupuncture further strengthens this hypothesis.

Acupuncture around embryo transfer

Embryo transfer refers to a step in the process of assisted reproduction IVF and ICSI. In this process, the embryos are placed into women’s uterus for them to implant in the uterus. Embryo transfer can be done at day two, day three, or day five. Embryos are all delicate cells and they need to be in precise environment to survive. The most important environment is the uterus of course. The uterine lining (endometrium) needs to be perfect to accommodating the embryos. To assist embryo implantation, acupuncture was used around the time of embryo transfer. The most common protocol used is from a research in Germany known as German protocol. In this study, acupuncture was performed before and after embryo transfer. The acupuncture points are:

Before embryo transfer, the following Acupoints were used:

PC6 (Neiguan), SP8 (Diji), LR3 (Taichong), GV20 (Baihui), and ST29 (Guilai).

After embryo transfer, the following Acupoints were used:

ST36 (Zusanli), SP6 (Sanyinjiao), SP10 (Xuehai), and LI4 (Hegu).

Also some ear points are used including ear point 55 (Shenmen), ear point 58 (Zhigong), ear point 22(Neifenmi), and ear point 34 (Naodian).

Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.

They concluded acupuncture seems to be a useful tool for improving pregnancy rate after ART.

The mechanism of acupuncture used around embryo transfer is to reduce stress, relax uterus and increase uterine blood flow to provide best environment for embryos.

References
Paulus WE et al Fertil Steril. 2002 Apr;77(4):721-4.

How to get rid of dark circles under the lower eyelids naturally?

Dark circles under the lower eyelids are very common. They really make you look much older than your age and make you look tired. The risk factors include

Fatigue and lack of sleep: it can make the skin dull and pale showing dark blood vessels underneath and build up fluids under the lower eyelids causing shadows under the lower eyelids.

Aging: aging is risk factor for those dark circles beneath the eyes. As one gets older, the skin becomes thinner and also loses the fat and collagen needed to maintain your skin’s elasticity. As this occurs, the dark blood vessels beneath your skin become more visible causing the area below your eyes to darken.

Eye strain: Staring at your television or computer screen can cause significant strain one the eyes. This strain blocks the blood circulation around the eyes. As a result, the skin surrounding the eyes can darken.

Dehydration: dehydration is another risk factor for dark eye circles. It makes the skin losing water and dark blood vessels would show.

Sun exposure can cause the skin to produce an excess of melanin, the pigment that provides your skin with color causing pigmentation in the surrounding skin to darken.

Treatments for dark circles under eyelids can be difficult. At most of the time, people use makeup to cover the dark circles which is not ideal solution. 

Facial acupuncture can help blood circulation around the eyes and reduces dark circles under the lower eyelids.

Always feeling bloated? something is not right.

Bloating is when the abdomen feels swollen after eating. Bloating is a symptom that can appear at any age. It is usually caused by excess gas production or disturbances in the movement of the muscles of the digestive system. Bloating can also cause pain, discomfort and a stuffed feeling. It can also make abdomen look bigger. Bloating is often caused by some medical conditions, such as irritable bowel syndrome (IBS), coeliac disease, constipation, etc, or food intolerance and increased sensitivity.

IBS is a common inflammatory condition that affects the digestive system. It causes symptoms like stomach cramps, bloating, diarrhoea and constipation.

Coeliac disease is a common digestive condition where the intestine can't absorb gluten found in wheat, barley and rye. Eating foods containing gluten can also trigger bloating, diarrhoea, abdominal pain and fatigue.

Constipation is common, and it affects people of all ages. It is often accompanied with a stomach ache and feeling bloated or sick.

Food intolerance can lead to bloating when the bowel doesn't empty properly; the food causes gas to be trapped; too much gas is produced as a reaction to the food. Other associated symptoms include tummy pain, bloating, wind and/or diarrhoea or skin rashes and itching. These symptoms are related to eating the food. Finding out which food that you are intolerant to is the first step to solve the problem.

Acupuncture can help reduce bloating by targeting the causes of the bloating.

How to get rid of melasma and make your face brighter naturally?

Melasma is a common skin condition of adults. It presents as brown or greyish patches of pigmentation, usually on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that get lots of sun, such as the forearms and neck. It is more common in women, particularly during pregnancy (when up to 50% of women may be affected), so it is also called as pregnancy mask. Sometimes men may also be affected. The exact cause of melasma is unknown. For some reasons, the skin cells that produce melanin (which colours the skin) make more melanin that they should do, this causes pigmentation on the skin. Several factors can contribute to developing melasma: sun exposure, hormonal changes such as pregnancy, taking contraceptive pills, hormone replacement therapy etc. Skin affected by melasma darkens more than the surrounding skin when exposed to light. One of the most important things to prevent melasma worsening is protecting the skin from UV radiation.

Acupuncture can be used to treat melasma effectively. In a study, patients in the acupuncture treatment group received acupuncture needling on the Yangming meridians. Patients in the control group received oral administration of vitamin C and 3% hydroquinone topical cream. Hydroquinone is a cream used to lighten dark patches of skin. The acupuncture treatment group achieved a total efficacy rate of 82.22% and the drug control group achieved an efficacy rate of 62.50%. The acupuncture treatment did not have any serious adverse effects.

The effect of facial acupuncture on melasma was also studied. In this study, women suffering with melasma were randomly assigned into: 1) facial acupuncture (n = 20); or 2) facial/body acupuncture (n = 21). Each group was given 2 sessions per week for 8 weeks. Melasma area and darkness of its pigmentation were assessed using digital images.

Results have shown that

95.2% and 90% of participants in facial/body and facial acupuncture, respectively, had decreased melasma areas. 66.7% (facial/body acupuncture) and 80.0% (facial acupuncture) of participants had lighter melasma pigmentation compared to their baselines. The conclusion is that facial acupuncture, with or without body acupuncture, was shown to be effective in decreasing the size of melasma areas.

References
https://www.healthcmi.com/Acupuncture-Continuing-Education-News/1869-acupuncture-beats-drug-for-melasma-treatment
https://www.sciencedirect.com/science/article/pii/S1744388115300128

How to get ready for pregnancy

Eat well.

To boost your fertility from food aspect, you don’t have to make a long list for what you eat. To make it simple, what you eat need to include a few resources:

1 proteins: Proteins come from fish, meat, bean, nuts, eggs and milk.

2, minerals and vitamins: They come from fruits and vegetables.

3 fibres: They come from whole grains, some fruits and vegetables.

4, unsaturated fat: they come from nuts and seeds, oliver oil,fish, yogurt.

Sleep well.

Poor sleep damages body function and potentially causes illness. Heart disease, diabetes, obesity and poor brain function are all linked to bad sleep. Disruption of hypothalamus-pituitary-gonadal (HPG) axis function by poor sleep can affect fertility in both in women and men. Getting good sleep will help to boost fertility.

Life style changes

Stop smoking, reduce caffeine and alcohol consumption.

About alcohol affecting. It became common knowledge that alcohol affects health. If a couple are trying to conceive, their fertility could be affected by alcohol. There are studies that show the link between alcohol and infertility. Alcohol has negative impact on men’s fertility, such as testicular atrophy, decreased libido, and decreased sperm count, sperm morphology, sperm motility and semen volume. Alcohol has also negative impact on women’s fertility. Though the amount of alcohol is linked to fertility is not clear yet. Study showed that amounts of alcohol ranging one drink a week to 5 units a day can have various effects on fertility, for example, anovulation, luteal phase dysfunction, increased time to pregnancy, decreased probability of conception rate by over 50% and decreased implantation rate, abnormal blastocyst development, increased both the risk of spontaneous abortion and of fetal death.

Exercise.

Is exercise good for your fertility?

In men moderate amount of exercise can be good for their fertility. Study has shown that all sperm parameters are higher in men who did an hour exercise three times a week compared with those who did more frequent and rigorous exercise. Riding bicycle for over five hours per week has negative impact on sperm. In women excessive exercise can have negative effect on their fertility too. Increased frequency, intensity and duration of exercise were significantly related with infertility in women who exercised every day.

Blood flow is reduced in your reproductive system when you exercise

Blood flow (BF) increases with increasing exercise intensity in skeletal, respiratory, and cardiac muscle. In humans during maximal exercise intensities, 85% to 90% of total cardiac output is distributed to skeletal and cardiac muscle. During exercise BF increases modestly and heterogeneously to brain and decreases in gastrointestinal, reproductive, and renal tissues and shows little to no change in skin. If the duration of exercise is sufficient to increase body/core temperature, skin BF is also increased in humans. Because blood pressure changes little during exercise, changes in distribution of BF with incremental exercise are essential approach the body used to supply adequate oxygen to the active skeletal muscles.

Recognise anything unusual related to fertility

In women, if you have irregular cycles, spotting, shorter or longer cycles, chronic abdominal pain, chronic low back pain, severe period pain, these could potentially be a problem of fertility.

In men, sperm checking could identify any problems from sperm.

Acupuncture

Blood supply to the reproductive system is key for eggs and sperm to get nutrients and oxygen. Acupuncture increases blood flow to reproductive system and boosts fertility for both women and men. Acupuncture can reduce inflammation and balance hormone to improve eggs and sperm quality.

Acupuncture possible treatment for dental anxiety

Dental anxiety affects up to an estimated 30% of the adult population in countries world-wide. Patients can experience nausea, difficulty breathing and dizziness at the thought of going to the dentist, during an examination, and following treatment.

Acupuncture possible treatment for dental anxiety

A review of six trials with 800 patients studied this subject. A points scale was used to measure anxiety and studies and the result has shown that anxiety reduced by eight points when dental patients were given acupuncture as a treatment. This suggests that acupuncture could be a possibility for tackling dental anxiety.

references

https://www.york.ac.uk/news-and-events/news/2018/research/acupuncture-possible-treatment-for-dental-anxiety/

How the body get its energy?

Food provide energy to the body. How does it work? Digestive system is the first line to turn food to nutrients and then turn it into energy for body use. Digestive system includes mouth, throat, esophagus (food pipe), stomach, small intestine, large intestine, rectum and anus. They are different sections of a long pipe where food pass through. In addition to this pipe, there are three organs pancreas, liver and gallbladder which are helping food digestion. Digestion starts from as soon as the food are put into mouth. Chewing breaks down the food into small pieces that are easily digested; stomach store the food and grinder them for short time; small intestines continues the breaking down process intensively and absorb them into blood stream. The unwanted food (waste) was moved to the large intestines and store them waiting to excrete. Pancreas produces enzymes to break down the food, gallbladder produce liquid to help food absoption and liver clean the blood from intestine with absorbed food.

Stomach contains acid to digest the food. This acid can burn the lining of the stomach causing inflammation and it can also go backward to the esophagus and causing damage to the esophagus lining. Large intestines also easily get inflamed causing irritable bowel syndrome (IBS). If these happened, abdominal pain, tenderness can be seen. Fatigue is a common symptom for these conditions. Acupuncture can help reduce inflammation and reduce, fatigue, abdominal pain and tenderness.

Acupuncture for chronic pain

Acupuncture is widely used to manage chronic pain, but the effectiveness is still debating. Recent research analysed the data from previous research using large amount of induvial patient data from high quality control trials of acupuncture for chronic pain and. The research studied the effectiveness of acupuncture and the cause of the factors that affects the effects. The available individual patient data set included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck, and shoulder), osteoarthritis of the knee, and headache/migraine. The result has shown that acupuncture is effective to treat these chronic pain condition and reduce the pain significantly. Also the effect of acupuncture lasts over 12 months as far as the research goes. The update to the research has shown that acupuncture was superior to sham as well as no acupuncture control for each pain condition including randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for nonspecific musculoskeletal pain, osteoarthritis, chronicheadache, or shoulder pain. There is clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at 1 year. There is no obvious association between trial outcome and characteristics of acupuncture treatment, but effect sizes of acupuncture were associated with the type of control group, with smaller effects sizes for sham controlled trials that used a penetrating needle for sham, and for trials that had high intensity of intervention in the control arm. Of course, the specific effects of needling at correct acupuncture point locations are most important to the treatment effect. The conclusion is that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. Although factors in addition to, decreases in pain after acupuncture cannot be explained solely in terms of placebo effects. Variations in the effect size of acupuncture in different trials are driven predominantly by differences in treatments received by the control group rather than by differences in the characteristics of acupuncture treatment.

References

Vickers AJ et al J Pain. 2018 May;19(5):455-474. doi: 10.1016/j.jpain.2017.11.005. Epub 2017 Dec 2.

MacPherson H et al Pain. 2017 May;158(5):784-793. doi: 10.1097/j.pain.0000000000000747.

Acupuncture is effective treatment for shoulder impingement syndrome

Shoulder impingement is a very common cause of shoulder pain. It occurs when a tendon or bursa in the shoulder rubs bones of the shoulder. Overhead activity of the shoulder, such as lifting is a risk factor for shoulder impingement syndrome. The main complaint is pain and it is persistent and affects everyday activities. The pain is on the top and outer side of the shoulder, and it is worse at night which can affects the sleep; It causes pain when reaching up behind the back or reaching up overhead. It can affect daily activity such as putting on the top. There is weakness in the arm and shoulder and restricted shoulder movement. Over time, impingement syndrome can lead to inflammation of the rotator cuff tendons (tendinitis) and bursa (bursitis). Rotator cuff tendon extends to the top of the shoulder joint. Shoulder impingement can start suddenly or come on gradually. If not treated appropriately, the rotator cuff tendons can start to thin and tear.

A study investigated acupuncture treatment of shoulder impingement syndrome. Patients with shoulder impingement syndrome were allocated into two groups: acupuncture group and control group. The treatment was carried out over 4 weeks, with the participants receiving a session every week. The results were measured immediately after the treatment (T1) and 3 months later (T2). A total of 68 participants were a mean age at 33.4 years. They found significant differences in the analyzed results between the two groups, a decrease on the intensity of pain for the acupuncture group was significantly greater than that for control group. Shoulder function was better in the acupuncture group. No side effects were found. They concluded that the use of acupuncture to treat impingement syndrome seems to be a safe and reliable technique to achieve clinically significant results and could be implemented in the therapy options offered by the health services.

References
Rueda Garrido JC et al Complement Ther Med. 2016 Apr;25:92-7. doi: 10.1016/j.ctim.2016.01.003. Epub 2016 Jan 21.

Unexplained infertility and acupuncture

Infertility is usually defined as the inability to conceive after 1 year of regular unprotected intercourse. But for women older than 35 years the time will be shorter to for 6 months. The couple need to be assessed clinically

A standard infertility evaluation is performed both for men and women and includes a semen analysis, assessment of ovulation, a hysterosalpingogram, and tests for ovarian reserve and laparoscopy. When the results of a standard infertility evaluation are normal, a diagnosis of unexplained infertility will be made. Approximately 15% to 30% of the couple has unexplained infertility.

Semen analysis is test for evaluating the sperm. Here is the normal range of semen analysis as WHO guidelines. Volume 2.0-5.0 ml, pH 7.2-7.8, sperm concentration 20×106/ml, total sperm counts more than 40×106 spermatozoa, motility ≥ 50% with forward progression or ≥ 25% with rapid linear progression within 60 min after collection, morphology greater than 50% with normal morphology, viability, greater than 75% live, white blood cells less than 1×106/ml, fructose greater than 13 mol/ejaculate. Ovulation issues are present in 40% of infertile women and 15% of couples with infertility. It shows menstrual disturbances in many women. Other tests are available for assessing ovulation problems including basal body temperature (BBT) recordings, urinary luteinizing hormone (LH) ovulation predictor kits, mid luteal serum progesterone testing. Endometrial biopsy to assess for secretory endometrial development, though it is not recommended now. BBT recordings are the least costly tool in a reliable patient. Ovulation predictor kits are useful for women who do not have very long menstrual cycles and can be used by couples to appropriately time intercourse. Mid luteal progesterone levels are measured around day 21 in women with regular (∼ 28 day) cycles. However, they are often poorly timed if they are drawn on cycle day 21 in women with irregular menses. In such women it is better to use an ovulation kit and measure the progesterone levels 7 to 8 days after the LH surge is detected. Assessment of the uterine contour and the tubal patency is an integral part of the basic infertility evaluation and may be achieved by hysterosalpingography (HSG).

How to improve fertility

Life style change is a must including stop smoking, losing weight, reducing caffeine and alcohol consumption etc. Good balanced diet to get enough proteins, vitamins and minerals etc.

IUI: Intrauterine insemination involves the placement of washed sperm into the uterine cavity around the time of ovulation.

COH plus IUI: COH, with or without IUI is used in the treatment of unexplained infertility.

IVF/ICSI: The most expensive, but also most successful treatment of unexplained infertility consists of the spectrum of assisted reproductive technology including IVF, with or without ICSI.

Acupuncture: Acupuncture is used by many women with unexplained infertility. It can help these women conceive naturally or assist other treatments to succeed such as IVF.

References

A Quaas & A Dokras (2008) Rev Obstet Gynecol, 1: 69–76.

The hormones and pain, acupuncture can release pain.

Sex steroid hormones act at a number of sites in both the peripheral and central nervous systems and in both reproductive and non-reproductive tissues. They play a role in pain conditions. Many clinical pain conditions vary with hormonal state. For example, the probability of experiencing a painful condition increases with increasing pubertal development. Sex differences in the prevalence of painful conditions appear after puberty. Variation in symptom severity across the menstrual cycle affected by ovulation and menstruation occurs in a number of clinical pain conditions, such as the pain of dysmenorrhoea, the symptoms of temperomandibular joint (TMJ) dysfunction, fibromyalgia, Irritable Bowel Syndrome (IBS), Interstitial Cystitis (IC) and migraine. The use of the combined oral contraceptive pill (COCP) to give a more constant hormonal level can sometimes improve pain symptoms. During pregnancy, the cyclical fluctuations in hormones stop. Many clinical pain conditions improve during pregnancy such as arthritis, migraine and often pelvic pain. After menopause, hormones level drop, many people develop pain conditions such as low back pain and shoulder pain etc.

Acupuncture can effectively release pain from various conditions.

Stress and pain, acupuncture releases stress and pain

Stress is the body's reaction to harmful situations. The symptoms of stress vary from person to person. The symptoms include emotional, physical and behaviour. Emotional symptoms include feeling agitated, frustrated, easily getting crossed, easily losing control, having difficulty relaxing and calming down, feeling anxious, depressed etc. Physical symptoms include low energy, feeling tired, headache, aching or pain in the body, muscles tension, dizziness, insomnia, digestive problems, frequent illness, loss of libido, shaking, clenching jaw, cold hands and feet etc. Behaviour symptoms include always worrying, lack of concentration, poor memory, feeling slow, being pessimistic, unable to stop eating or eating less.

Anxiety is that you feel fearful and tense. You may also have some physical symptoms, such as, increased heart beat, feeling sick, shaking, short of breath, chest pain, headache etc. Most people feel anxious from time to time. It is normal in stressful situation. However if anxiety persists or there is no obvious reason to be anxious, it becomes abnormal.

Stress and pain are two distinguished but overlapping processes presenting multiple conceptual and physiological overlaps. Chronic pain might not only be caused by physical injuries, inflammation, or nerve disorders but also by stress emotionally or physically. Chronic pain is often accompanied by depression and anxiety. Long term stress can result in depression, anxiety, chronic pain and other mental and physical problems.

Why the skin is sensitive to touch? Acupuncture reduces pain

Allodynia is a condition in which someone experiences pain in the skin from non-painful stimuli, such as a light touch to the skin. Allodynia can be a symptom of different conditions, or it can occur on its own.

The main symptom of allodynia is pain from non-painful stimuli.

Some people with allodynia may experience severe pain with gentle pressure. Symptoms can vary from mild to severe. Some people may feel a burning sensation while others feel an ache or squeezing pain. Other symptoms accompanied can be depression, anxiety, insomnia, fatigue, not concentrating etc.

Some underlying conditions can cause allodynia. It’s most commonly linked to fibromyalgia and migraine headaches. Postherpetic neuralgia or peripheral neuropathy can also cause it.

The exact cause of allodynia is not known.

Allodynia may occur due to increased responsiveness or malfunction of sensory nerves and receptors.

Acupuncture can help reduce pain.

Have tendon injury? Acupuncture can help

Tendon is a tough band of fibrous connective tissue that usually connects muscle to bone Tendons are highly organized connective tissues that transmit muscle force to the bone. Tendons are resilient during the development of tension, but flexible enough to carry on its function. In the resting state, the collagen fibrils exhibit a wavy conformation. As a tendon is stretched, collagen fibrils begin to straighten out, and, as a result, the tendon becomes stiffer with increasing application of mechanical strain. The transition from tendon to bone and from tendon to muscle is progressive to allow an efficient load transfer minimizing stress concentrations.

A healthy tendon is up to twice as strong as the muscle, making the body of the tendon unlikely to tear before the muscle unless the tendon has already been weakened by degenerative changes. The effects of ageing, wear and tear, genetic pre-disposition and inflammation are known factors contributing to tendon injuries. Tendons consist of collagens, proteoglycans, glycoproteins, water and cells. In case of injury, repair will take place only through scar tissue. This leads to decreased functional properties of these injured regions and to a greater risk of recurrent injury. Injured tendon can cause pain, loss of limb function and prevent exercise and activities of daily living.

There are ∼2 million Achilles tendon sports-related injuries each year worldwide. Of these, over 250 000 require surgical intervention and prolonged rehabilitation. However, patients with these injuries seldom regain full pre-injury function. These ailments are difficult to manage, frequently resulting in long-term pain and discomfort. The poor repair of tendons is a direct consequence of their limited vascularity and relatively acellular nature. Most frequently injured are the rotator cuff, the patellar and the Achilles tendons, with pathology ranging from tendinopathy and calcific tendinopathy, to partial tears, to complete ruptures. The poor tendon self-repair makes recovery difficult.

Calcification is the accumulation of calcium salt in the tissue. Bone is the common place to occur, but calcification can happen in the soft tissue, such as fascia and tendon causing hardening of the tissue. Soft tissue calcifications happens anytime and any location of the body. The most common place is in the damaged tissue, such as injured tendon causing calcific tendinitis. Calcium phosphate is accumulated in the tendon causing pain and inflammation. Chronic pain is the most common symptom of tendon calcification. Other symptoms include stiffness, snapping, catching or weakness on related tendon and joints. It is involved in abnormal repairment of damaged tissue. Acupuncture can help to reduce the pain, improve stiffness and improve circulation to help reabsorbing the calcium.

Pain and burning in the affected area, decreased strength and flexibility, and pain caused by everyday activities are very common. This is often caused by tendinopathy-tendon injury.

The healing time for injured tendon varies depending on whether treatment starts with early presentation or chronic presentation. Healing time for acute injury can be a few days to 6 weeks. Treatment at an early stage can be as brief as 6–10 weeks. Once it becomes chronic the treatment can take 3–6 months. The effective treatment might take up to 9 months to 36 months when it is chronic. Knowing these timelines is part of creating an effective treatment plan.

Acupuncture helps with tendon injury

Acupuncture is used to treat tendon injury and it improves pain and functional activity in patients with tendinopathy. This is suggested that acupuncture can modulate both anti-inflammatory and mechanotransduction molecular pathways which can increase type I collagen synthesis. Collagen synthesis is the main factor that influences tendon biomechanical properties. Therefore one reason of acupuncture for tendon healing is that acupuncture increases synthesis and subsequent reorganisation of type I collagen during tendon healing process.

References
MacPherson H et al (2016) Pain Oct 17 Epub ahead of print
https://academic.oup.com/bmb/article/117/1/25/1744499

Suffer from low back pain? acupuncture can help

Back pain is a common condition which affects more than 1 million people in the UK. Back pain can be caused by many factors. But some of the causes cannot be found.

95% of back pain occurs in the lower back. It is defined as non-specific low back pain. Non specific low back pain is tension, soreness and stiffness in the lower back region and the specific cause of the pain cannot be identified. The pain is normally as lasted for more than 6 weeks, but less than 12 months. The pain is persistent or recurrent. Joints, discs and connective tissues in the back may contribute to symptoms. Low back pain affects more than 79% of the population in developed countries. It accounts for 13% absences due to illness in the UK. 35-55 year old are affected most. 90% of the episodes of acute low back pain settle within six weeks, up to 7% of patients develop chronic pain. A study from a study with 5000 adults by the British Acupuncture Council to mark 'Acupuncture Awareness Week' (3rd-10th March 2014) show that almost 80 per cent of people suffer with back pain admit to behaviours that put their backs under unnecessary strain. This study found that almost half of the adults admit to eating on their lap, 40 per cent complain they sit at a desk all day and over a third admit to watching TV or films in bed. When asked about their posture, almost a third also admitted they slouch most of the time.

In the case of treatments for back pain, 74 per cent say they repeatedly use painkillers to deal with their discomfort, which would numb the end symptom and mask the problem but do not address many of the combined underlying causes of back pain rather than addressing the root cause of the problem. Statistics show that 41 per cent of people would only consider acupuncture as a last resort and 88 per cent didn't know the National Institute of Clinical Excellence (NICE) recommends acupuncture therapy for persistent, non-specific lower back pain.

Some patients do turn to complementary and alternative medicine for back pain treatments. What do these patients expect from CAM treatments?

There was a study with semi-structured interviews with 64 individuals receiving massage, chiropractic, acupuncture or yoga for chronic low back pain. The findings included that participants' expectations of treatment outcomes were in four key aspects: pain relief, improved function (including an increase in ability to engage in meaningful activities), improved physical fitness, and improved overall well-being (including mental well-being). Typically, patients had modest expectations for outcomes from treatment.

With 2.3 million acupuncture treatments carried out each year, acupuncture is one of the most popular complementary therapies practised in the UK today. By stimulating different points of the body, acupuncture can be extremely beneficial for back pain, providing long term pain relief and reducing inflammation.

Low back pain with acupuncture treatment

Acupuncture is well known for its effectiveness for back pain. Many research data have provided solid evidence that acupuncture is effective for lower back pain.

NHS recommended acupuncture combined with self-care for persistent low back pain.

Acupuncture alone is effective to relieve back pain. Also acupuncture can be one of the combined treatments offered to patients which reduce the use of medications and improve the outcome. Self care and acupuncture can help release low back pain. This is recommended by NICE guidance as treatment options for persistent low back pain. Cheshire A et al reported their survey based in a primary and community care setting, delivering acupuncture, self management and information to patients with chronic low back pain. They evaluated patient outcomes and experiences of the Beating Back Pain Service (BBPS). The questionnaire is at three time points: pre-BBPS, immediately post-BBPS and three months post-BBPS. There were 80 participants with mean age 47 years. 65% of them were female. Their results showed that pain scores were improved between baseline and post treatment, these improvements were maintained at 3 months follow-up. Patients receiving a combination of acupuncture and self-management sessions produced the most positive results. Patients satisfaction with the BBPS was high. They concluded that combining self-management with acupuncture was most effective, though further consideration is needed to engage patients in self-management. Acupuncture has no severe side effects which can be applied over a longer period of time. The National Institute for Heath and Clinical Excellence guidelines on best practice now recommend offering a course of 10 sessions of acupuncture as a first line treatment for persistent, non specific low back pain.

Mechanisms of acupuncture for low back pain

Acupuncture needles are used to treat low back pain. The mechanism of this treatment is still not clear. Why some people respond well while others do not. A study examined changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes differ in patients that exhibit improved disability (responders) and those that do not (non-responders). Sixty-six volunteers with mechanical LBP completed the study. Ultrasound measurements and pain algometry of the LM were taken at baseline and repeated immediately following dry needling treatment to the LM muscles and after one week. The percent change in muscle thickness from rest to contraction was calculated for each time point to represent muscle function. Pressure pain threshold (PPT) was used to measure nociceptive sensitivity. Participants were divided into responders and non-responders based on whether or not they experienced clinical improvement using the modified Oswestry Disability Index after one week. Patient responders showed larger improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after the treatment than non-responders. The results suggest that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with acupuncture needle treatment

References

Pach D et al (2013) Evid Based Complement Alternat Med 2013:125937

Hogeboom CJ et al (2001) Complement Ther Med 9:154-66

Tang WJ et al Acupunct Med 2013 Nove 26. Doi:10.1136/acupmed-2013-010423

Cheshire A et al BMC Complement Altern Med (2013)13:300

http://publications.nice.org.uk/low-back-pain-cg88/key-priorities-for-implementation

Lee SH et al Evid Based Complement Alternat Med (2013) 2013:402180

Weiss J et al J Altern Complement Med (2013) 19:935-41

http://www.acupuncture.org.uk/public-content/public-pr-press-releases/3733-couch-potato-culture-causes-a-generation-in-pain.html

Hsu C et al BMC Complement Altern Med (2014) 14:276

Koppenhaver SL et al Man Ther (2015) Mar 13. pii: S1356-689X(15)00051-X. doi: 10.1016/j.math.2015.03.003. [Epub ahead of print]

Chronic abdominal pain, acupuncture can help

Acute abdominal pain

Everyone at some point of their life will experience abdominal pain. Abdominal pain is one of the most complicated symptoms which can be caused by many factors. Most of the causes are not severe and the pain can be diagnosed and treated with good prognosis. However abdominal pain can be a sign of very severe illness. If the abdominal pain is severe or recurrent and there are some other symptoms associated with such as fever, inability to keep food down, signs of dehydration, bloody stools, inability to pass stool and there is persistent nausea and vomiting, painful or unusually frequent urination, severe tenderness when you touch the abdomen, swelling of the abdomen, skin appears yellow, weight loss, pain is caused by injury to the abdomen etc, it is important to recognise the symptoms that are severe and see doctors to get it diagnosed. Be careful if you want to take over the counter pain killer. Pain killers sometimes can mask the severity of the illness. Acupuncture is not recommended for severe acute abdominal pain.

Chronic abdominal pain

Fortunately in most of cases the abdominal pain is not caused by severe illness, but it can be depressing if the abdomen is always painful. There are many problems that can cause abdominal pain.

Smooth muscle is located in the walls of hollow internal organs, such as the arteries, intestines, bladder in the abdomen. When they contract, the organ is squeezed. Most of the abdominal pain is visceral pain which is pain arising from the internal organs. Visceral pain is triggered by smooth muscle distension or contraction, stretching of the capsule surrounding an organ, ischaemia and necrosis, or irritation by chemicals produced during inflammatory processes. If stomach or intestine wall becomes spasm, this may result in pain. So do kidneys, gallbladders and other internal organs. When the uterine smooth muscle becomes spasm, menstrual cramps occur. It is often deep, dull or dragging and is typically diffuse and poorly localised. It can be associated with nauseas, vomiting, and changes in heart rate or blood pressure. It can also evoke strong emotional responses. There can be a referred pain which is pain experienced at a site distant from source of the pain. It is due to the convergence of different afferents on to the same dorsal horn neurones in the spinal cord.

Skeletal muscles are attached to the bones. When the muscle contracts, the related body part moves. As a result, we can move around without problems. The abdominal wall muscles are skeletal muscles which extend from the superior border of the pelvis to the inferior border of the ribcage. There are four pairs of muscles: transverse and rectus abdominis and the internal and external obliques.

Abdominal muscles and chronic abdominal pain

The rectus abdominis muscles

The rectus abdominis muscles are a pair of long flat muscles lie vertically along the middle line of abdomen. Each muscle is divided by narrow bands of tendon into four muscular bodies. It originates from the edge of the pubis bone and thepubic symphysis in the pelvis and ends at the inferior edges of the costal cartilages of the fifth through seventh ribs and at the xiphoid process of the sternum. The rectus sheath is a covering connective tissue surrounding the rectus abdominis muscles where the internal and external oblique muscles attach. The linea alba a thick mass of white fibrous connective tissue is in the mid line of the abdomen and joins the two rectus abdominis together. The important function of rectus abdominis muscles is to flex the spine when they contract. Contraction of the abdomen results in increased pressure within the abdominopelvic cavity and is useful to push substances out of the body during exhalation, defecation, and urination. It helps delivering a baby. If there are trigger points present in these muscles, you could feel the pain at the abdomen, lower and mid back region. The symptoms include pain at the low abdomen, period pain, stomach cramping, heart burn chest pain, indigestion, nauseas, vomiting bloating, genital pain, bladder problem, low and mid back pain etc.

Transverse abdominis muscle

Transverse abdominis muscle is the deepest muscle on the front and side abdominal wall. It lies between the rib cage and pelvic bone. It starts from the back thoracolumbar fascia, from the top inner surface of the lower six ribs, from the bottom front of the iliac crest and inguinal ligament and it ends at the front abdominal midline called linea alba. It is a very important core muscle in compressing the abdomen, providing thoracic and pelvic stability and supporting abdominal visera. It maintains good posture and help to deliver a baby for pregnant women. Trigger points in transverse abdominis could contribute to the abdominal pain and low back pain.

External and internal oblique muscles

The external abdominal oblique muscles are a pair of muscles that lie on the lateral and anterior sides of the abdominal wall. They are broad, thin and on the top layer of the abdominal muscles. They start from ribs 5-12 and end at the midline of the abdomen, pubis and iliac crest of the hip bones. Contraction of this muscle makes lateral bend and rotation of the spine, flexes the spine and also pulls the chest downwards and compress the abdominal cavity.

The internal abdominal oblique muscles lie on the lateral and anterior sides of the abdominal wall just underneath the external abdominal oblique muscles and above the transverse abdominal muscle. It bends the spine forward and bring the shoulder of the side forward and it also bend the spine sideway and rotates it. It compresses abdominal contents and assists digestive process and breathing. If trigger points are present in these muscles, the pain can be felt in following area, in the side, the waist area, the groin area, the low abdomen, across the upper back below shoulder blades, across the low back just above hips, stomach pain, testicle pain, pelvis pain bladder pain.

Chronic abdominal pain may be present for weeks to months, or even years. Acupuncture can help with some chronic abdominal pain such as indigestion, inflammatory bowel diseases or muscular pain, benign ovarian cysts, pain with frequent urination, kidney problem, and muscular pain from the abdominal muscles.

Bloating is a common symptom accompanied with chronic abdominal pain. Most people have experienced this symptom, when the abdomen is stretched, puffy and uncomfortable. The common cause is constipation which is caused by too little fluids and fibers and lack of exercises. Food allergy and intolerance can be caused excess wind production causing bloating. Inflammation in abdomen such as irritable bowel syndrome can lead to bloating. Pain conditions such as low back pain, hip pain, abdominal pain can accompany bloating because of alteration of the nerve activities. Acupuncture can help reduce bloating and chronic abdominal pain.

References

Chao and Zhang World J Gastroenterol (2014) 20:1871-1877

Shi ZM et al Zhongguo Zhen Jiu (2011) 31:607-9

Having pain at the groin area? Acupuncture can help

The groin is the area of the hip between the inner, upper thigh and lower abdomen. Five muscles (adductor brevis, adductor longus, adductor magnus, gracilis and pectineus) from the thigh originated here. Four abdominal muscle including transverses abdominis, rectus abdominis, external oblique and internal oblique muscles end there. Pain can develop in groin. Groin pain can be mild discomfort to severe pain. The most common cause of groin pain is muscle, tendon or ligament strain during exercise such as running, skating, kicking in soccer, or playing basketball or during doing work such as lifting, pushing, or pulling heavy objects. Groin pain may occur soon after an injury and it can also have swelling and bruising. The pain may come on gradually over a period of time: weeks or even months. The pain may be worsened by continued use of the injured area. Overuse is another common cause for groin pain. This often happens when you do too much an activity or repeat the same activity day after day. It put too much stress on the area and can lead to muscle strains or tears or may cause swelling.

There are many other conditions which can cause groin pain, such as a bone fracture, a hernia, kidney stones, bladder infections, prostatitis or a testicle condition.

Groin pain not caused by an injury to the groin may be coming from other parts of the body such as leg muscles, ligments and tendons injury.

If you have groin pain, you need to see doctor and get it checked out. If the groin pain is caused by muscle, tendon and ligament strain, acupuncture is very effective to reduce the pain.

Want face lift? Acupuncture can help

Facial appearance changes with age are inevitable. Aging change not only happens on the surface of the skin, but also underneath the skin surface such as fat muscle and bone etc. With age, features that were previously round may sink ; skin gets loose and sags. Loss fat volume and muscle mass on the face makes the face loss its fullness. Fat pulls downwards and the skin becomes loose and sagging due to gravity and muscle force. Bone also losses its mass and muscles are shortened and straightened. Corners of the eyes and mouth drop, tip of the nose drops as well and ears become longer.

Facial muscles

Muscles on the face contracting pulling the face downwards

The temporal muscle is the muscle at the temples on both sides of the head. This muscle lifts the jaw and retracts the jaw.

The orbicularis oculi muscle is the muscle surrounding the eye. It causes the eye to close or blink. It draws the skin of the forehead, temple, and cheek toward the medial angle of the orbit, and the eyelids are firmly closed. If the muscle contracts constantly, it causes the appearance of folds or crow's feet that radiate out from the outer corner of the eye.

The corrugator supercilii which means wrinkler of the eyebrows in Latin, is a small, narrow, pyramidal muscle at the medial end of the eyebrow. It draws the eyebrows downward and medially,

The procerus muscle is the pyramid-shaped muscle running from the lower part of the nasal bone to the middle area in the forehead between the eyebrows. It pulls the skin between the eyebrows down.

These three muscles including the levator labii superioris alaque nasi muscle, the levator labii superioris and the zygomaticus minor working togetherform the nasolabial furrow from the side of the nose to the upper lip.The zygomaticus major is larger than the minor, but it also lies in the cheek area and extends down to the mouth. It raises the corners of the mouth in smiling.

The risorius muscle draws the angle of the mouth outward and produces smile.

The depressor anguli oris is a muscle that goes from the mandible to angles of the mouth. It depresses the angle the angle of the mouth associated with frowning.

The depressor labii inferioris muscle is a muscle below the lips and it draws the lower lip down.

The mentalis muscle elevates and protrudes the lower lip and wrinkles the skin of the chin.

The masseter muscle is a thick muscle in the cheek. It is for chewing and for closing the jaws.

Facial acupuncture helps to relax these facial muscles to stop the pulling force and lift the face up.

Oestrogen dominance to get pregnant, acupuncture can help

You may have oestrogen dominance, if you have following symptoms.

You have difficulty to conceive; your breasts are swollen and getting bigger or your breasts hurt or you have breast cysts; you are getting cramps; your period changes: you no longer get your periods; your periods become irregular; you get large clots during your period; you have fibroids, endometriosis, polycystic ovary syndrome (PCOS) or premenstrual syndrome (PMS); you feel tired all the time; your rings no longer fit on your fingers or your shoes do not fit; you become moody or impatient.

What is oestrogen dominance? Oestrogen dominance is a kind of hormonal imbalance. There are two primary hormones produced by the ovaries in women which are oestrogen and progesterone. These two hormones need to be maintained in well balanced in women body all the time. Too much or too little one of them can cause losing balance and leading to problems for the body. Oestrogen dominance is caused by not only absolute dominant excessive oestrogen but also the relative dominance of estrogen and relative deficiency of progesterone. The lost balance is the main reason of health problems in women.

Absolute oestrogen dominance can be caused by excessive oestrogen in the body. This is a result of excessive external oestrogen intake or excessive internal oestrogen production.

Food we eat could contains unexpected hormones, for example, commercially raised animals and poultries. These animals are fed oestrogen like hormones plus growth hormone. These hormones could pass to us when we eat meat or poultries.

In some conditions, oestrogen can be over produced in the body, such as obesity. Fat has an enzyme that convert adrenal to oestrogen. This results in excessive oestrogen production. Birth control pill with oestrogen alone causes high level of oestrogen in the body.

Ovary cysts and ovary tumours can produce excessive oestrogen.

Relative oestrogen dominance can be caused by lower progesterone in the body.

 
In nature aging process, we can see less progesterone in the body leading to relative oestrogen dominance. Oestrogen and progesterone decline with age gradually. Progesterone declines about twice as faster as oestrogen. The ratio of oestrogen to progesterone is going up. This causes relatively more oestrogen left in the body compared with progesterone.

Anovulation is a common condition that causes relative oestrogen dominance by lack of progesterone. Women’s ovaries release an egg once a month. After an egg is released, the remaining part of follicle forms corpus luteum producing progesterone. This is main source of progesterone production. If there is no egg released, there would be no corpus luteum formation; therefore there would be no progesterone production. The lack of progesterone leads to relative oestrogen dominance and symptoms such as irregular periods, camps, mood changes, tender breasts etc.

Short luteal phase is another common condition that causes relative oestrogen dominance by short of progesterone. In this condition, corpus luteum does not function well, as a result, there is no enough progesterone produced. Without enough progesterone, the chance of getting pregnant is reduced.

Stress can cause adrenal gland exhaustion and reduced progesterone output causing relative oestrogen dominance.

If you suspect you have oestrogen dominance, acupuncture can help. Acupuncture helps restore hormone balance by stimulating nerve endings. This regulates hormone production and helps liver break down excessive oestrogen.

Hormones imbalanced? Acupuncture regulates hypothalamus-pituitary-ovarian axis

The female reproductive system function is controlled by the hypothalamus-pituitary-ovarian (HPO) axis. HPO axis has three organs: the hypothalamus, pituitary gland and ovary and performs its function by releasing hormones. There are five hormones involved in this axis including the gonadotropin-releasing hormone (GnRH), FSH, LH, oestrogen and. GnRH is produced in the hypothalamus, FSH and LH are produced in the pituitary gland and oestrogen and progesterone are produced in the ovary. They are interacted with each other as in a feedback loop and work as an entity to maintain reproductive function and fertility. This feedback loop begins with gonadotrophin-releasing hormone being released from the hypothalamus, resulting in the secretion of the gonadotrophins (LH and FSH) from the anterior pituitary, which in turn controls estrogen and progesterone production in the ovaries. At the start of menstrual cycle when oestrogen level is low, FSH is produced. FSH acts at the ovary. In response to FSH, oestrogen production in the ovary is increased and peaked. This sends signal back to the pituitary gland to reduce FSH production and facilitate LH production. At the mid of the cycle, LH production has reached its peak which triggers egg release. After an egg is released from a follicle the remaining part of the follicle wall converted to the corpus luteum. Progesterone production in the corpus luteum begins. Estrogen and progesterone play a central role in female fertility by stimulating growth, differentiation and maturation of follicles containing eggs and preparing the endometrium for implantation and maintaining embryonic development. They also give feedback to the hypothalamus and pituitary gland to adjust GnRH, FSH and LH production. Altered levels of hormones and other factors that are involved in maintaining control of the HPO axis can have negative effects on fertility and pregnancy

Acupuncture promotes the release of beta-endorphin in the brain, which regulates gonadatrophin releasing hormone from the hypothalamus, follicle stimulating hormone from the pituitary gland, and oestrogen and progesterone levels from the ovary. Acupuncture also improves blood circulation to the brain and blood supply to the ovaries. As a result, it improves the hormone balance. Acupuncture reduces stress to help the hormone balance.

Had ectopic pregnancy, acupuncture can help.

What is ectopic pregnancy? Ectopic pregnancy is that the fertilized egg implanted outside of the uterus. The commonest site is in the fallopian tube. The egg will not develop a baby, but it is threatening condition for the pregnant women. Ectopic pregnancy occurs in 1% pregnancy. The risk factors include pervious pelvic inflammatory disease, infertility, tubal surgery, intrauterine contraceptive device and previous ectopic. Patient has positive urinary pregnancy test. Patient presents lower abdominal pain and slight vaginal bleeding. Ultrasound shows empty uterus and may identify ectopic embryo. If the egg dies before it can grow larger, the pregnancy terminates and the tissue is absorbed in the woman’s body. In this case, the pregnancy test becomes negative. If the pregnancy is left to grow, there is a risk that the fertilized egg grows larger and causes the tube to rupture which can cause life threatening internal bleeding. The signs of tube rupture are sudden severe sharp abdominal pain, feeling faint and dizzy, being sick, diarrhoea and shoulder tip pain. This is a medical emergency condition.

It is recommended that you wait for at least 2-3 menstrual cycles before trying for another pregnancy though many women are not emotionally ready for another pregnancy so soon. The chances of having a successful pregnancy will depend on the underlying health of the fallopian tubes. There are about 50% risks of infertility after ectopic and 20% recurrent rate. In subsequent pregnancy the women should receive early evaluation to confirm that the pregnancy is in the uterus. It is hard to predict what the individual chance is for a successful pregnancy after the ectopic pregnancy surgery. Some research showed that about 65% of women achieved a successful pregnancy 18 months after having an ectopic pregnancy.

There is more chance to get ectopic pregnancy after IVF in women with thin endometrium

There is 1% chance of all naturally conceived pregnancy are ectopic. IVF and IUI increased the chance to have ectopic pregnancy to 2-5%. After embryos are transferred to the uterus, they have a greater chance of wandering around and implanting themselves in places where they are not supposed to be, such as the fallopian tubes. What is the risk facto of ectopic pregnancy after IVF? A study has shown that risk of ectopic pregnancy is linked to endometrial thickness. In this study a total of 6465 patients achieved a pregnancy in 8120 cycles via assisted reproduction technology. They found that Following IVF, the risk of ectopic pregnancy is 4-fold increased in women with an endometrial thickness of <9 mm compared with women with an endometrial thickness of >12 mm.

Do you know that acupuncture can help to improve the endometrial thickness by improving the blood flow to the uterus and balance the hormones?

Appendectomy increases the risk of ectopic pregnancy

Fallopian tube damage is responsible for one third of infertility cases. Ruptured appendicitis has been considered a risk factor in causing scarring, which can lead to infertility and/or ectopic pregnancy. Does appendectomy increase the risk of tubal infertility? A research studied recent data on this subject. They found that previous appendectomy is not associated with increased incidence of infertility in women. However this study found that appendectomy is significantly associated with an increased risk of ectopic pregnancy.

Compromised ovarian function after salpingectomy, acupuncture can help.

After salpingectomy, the ovarian function on the operation side could be compromised because of reduced blood circulation. A study involved in thirty-two patients with unilateral salpingectomy performed for ectopic pregnancy investigated this subject. In this study, ovarian function was assessed by antral follicle count, ovarian volume and ovarian stromal blood flow measured by three-dimensional (3D) power Doppler ultrasonography. Ovarian volume, antral follicle count and 3D power Doppler indices were comparable between the operated and the non-operated sides in the whole group and in the laparotomy group. The antral follicle count and 3D power Doppler indices were significantly reduced on the operated side in the laparoscopy group. It suggested that ovarian function seems to be impaired after laparoscopic unilateral salpingectomy at short-term.

Acupuncture could help the recovering of fallopian tubes by improving pelvic circulation, reducing inflammation and relaxing the tubes to be ready for next pregnancy. Also acupuncture can help to reduce stress in the women after pregnancy loss and surgery.

References

Elraiyah T et al J Surg Res (2014) ii: S0022-4804(14)00784-7. doi: 10.1016/j.jss.2014.08.017.

Chan CC et al Hum Reprod (2003) 18:2175-80

Rombauts L et al Hum Reprod (2015) Oct 1. pii: dev249. [Epub ahead of print]

How age affects fertility? Acupuncture can help

Age affects fertility in women

Women are born with all the eggs they ever have. Women are most fertile between the ages of 18 and 31. When women are getting older, their egg quantity and quality are declining. They become less fertile. There is clear evidence of an age-related decline in female fertility. By the time women reach 35 years of age, their fertility is declining markedly. This presents that the number and quality of eggs decrease; also genetic abnormalities and spontaneous abortion increase noticeably with female age. A study involved in 1000 women in pregnancy showed that 71% of women aged 30 conceived within 3 months whereas only 41% of women aged 36 conceived within 3 months. A negative effect of increasing male age particularly in the late 30s was also found. A study involved 2112 women in pregnancy showed that increasing age for both men and women take longer time to conceive. There were some other studies presented similar results.

There is a significant decline in clinical pregnancy rate, implantation rate and delivery rate per embryo transfer associated with increasing female age in assist reproductive treatment. A recent study of all IVF clinic in Netherland found that the overall live birth rate per cycle decreased by 2% for each additional year of female age. Another study involved in 36483 treatment cycles in assist reproductive treatment reported that women aged 25-29 achieved a live birth rate of 25.9% while women aged 40-44 only achieved 6.1% live birth rate. The poor live birth rate in older women greatly attributes to spontaneous abortion

What is the best marker of reproductive age in women?

Research suggested that genetic factor contributes to women’s fertility. Women whose mothers had an early menopause had much fewer eggs in their ovaries than those mothers had a later menopause. These women with fewer eggs have fewer chances to conceive. At present there is no test that can predict women’s fertility accurately. There are many tests that are used to measure ovary function. What is the best marker to measure reproductive age? GJ Scheffer et al compared several markers. These include that antral follicle counts (2-10mm), total ovarian volume, total follicular volume, mean follicular volume, and volume of either the smallest or largest ovary; FSH, estradiol and inhibin B and the response of estradiol and inhibin B to exogenous GnRH agonist. They tested these markers on 162 healthy female volunteers aged 25-46 years. These women were proved with normal fertility and regular menstrual cycles. All marker tested excerpt inhibin B were correlated with age, but the number of antral follicles was highly correlated with age. Their conclusion is that the number of antral follicles has the closest association with age in normal women with proven fertility.

How old a woman can be to achieve pregnancy with assisted conception approach?

Check JH reported a case that a 46 year old woman with high day 3 estradiol and FSH. She conceived on her third IVF-ET attempt. She delivered a healthy full term baby girl. This was believed to be the first case report of a successful pregnancy in a woman of such an advanced age with diminished ovary reserve using her own eggs. This report showed that pregnancy is possible in similar circumstance.

Fertility declines with aging in men as well

Women are born with all eggs in the ovary which cannot be divided into other cells. The egg numbers are only declining with age. On the contrary, there are gonocytes or primitive germ cells in the normal men’s testes. These cells can split without limitation. The cells split can become another gonocytes which could further divide; or they can become mature sperm cells. Gonocytes supply within testes can be last very long time and mature sperm cells can be produced. This is the main reason why a man’s fertility does not decrease significantly with age as women’s.

However, fertility in men decreases when they reach certain age. In men semen parameters could begin to decline as early as age 35. Semen volume and motility would decrease and morphology could gradually become abnormal. After age 40, there could be notably DNA damage in their sperm; motility and viability continues declining. With an increase in age in men, the time to pregnancy for their partner increases.

Acupuncture can help both men and women to improve their fertility. As a result, this improves their chance to get pregnant.

References

Check JH Clin Exp Obstet Gynecol (2011) 38:209-10

Check ML Clin Exp Obstet Gynecol (2004) 31:299-301

http://www.bbc.co.uk/news/health-20217735

Fotrman EJ et al Maturitas (2011) 70:216-21

GJ Scheffer et al Human Reproduction 18:700-706

http://www.webmd.com/baby/features/getting-pregnant-easy-ways-to-encourage-fertility?page=3

Homan GF et al Human Reproduction Update (2007) 13:209-223

Infertility caused by tube blockage, how can acupuncture help?

The role of fallopian tube is in reproduction

The fallopian tube is a part of the women’s reproductive system. It plays an essential role in gamete transport, fertilization and the early development of the embryo. The tube contains inner lining and smooth muscle wall. In the inner lining there are two major cell types are the ciliated and secretory cells. The fallopian tube goes through cyclical changes responding to estrogen and progesterone levels. The ciliated cells are low in height during the menstrual periods of the cycle, increasing during the follicular phase to reach their maximal height in the periovulatory period. Around the time of ovulation, the secretory cells reach peak activity. In the luteal phase, both cell types reduce in height.

Fallopian tubes are very important for normal fertility. They play a key role in picking up eggs and transporting eggs, sperm and embryo. When an egg is release, it takes about 8 hours to reach the site within fallopian tube. The fallopian tubes are the places where eggs are fertilised and embryo is accommodated there for 72 hours. Once progesterone dominance begins lumen opens and the embryo is transported to the uterus. Fallopian tubes are vulnerable to infection and surgical damage. This may affect tube function and cause infertility. If the tubes are blocked, this will cause infertility. Falllopian tube obstructions are the most common cause of female infertility, accounting for 30%-40% of cases.

Fallopian tube spasm, tubal infertility and acupuncture

As mentioned above, the fallopian tube is essential on sperm, egg and embryo transport and embryo development and it is very important for women who desire to get pregnant naturally. In IVF procedure, the fallopian tube is circumvented. The fallopian tube is not a concrete tunnel. The tube wall is flexible and consisted of smooth muscles which are responding to monthly cyclic hormone changes. Sometimes the tube can be obstructed by debris in the tube and tube muscle spasm. Women with tube spasm will find it difficult to get pregnant.

Fallopian tube smooth muscle contraction is induced by sympathetic nerves. Acupuncture reduces sympathetic activity and relaxes tube muscles and the debris in the tube is flushed away by the tubal fluids. This makes the obstructed tube reopen. In this case, pregnancy occurs quickly after acupuncture treatment.

Pelvic infection is a major cause of tubal infertility. Tubal damage by infection can be caused by sexually transmitted diseases, for example Chlamydia trachomatis accounts for half of the cases of acute inflammatory pelvic infections in developed countries. Tubal damage can also occur after miscarriage, termination of pregnancy, puerperal sepsis, or insertion of an intrauterine contraceptive device. Endometriosis associated adhesions is likely cause tubal distortion. Previous laparotomy is a risk factor for tubal infertility. In addition, ectopic pregnancy and uterine fibroids can also damage the tubes.

Acupuncture help to reduce inflammation; as a result, it releases tube spasms, reduces scar tissue contraction and helps inflammation absorption and helps healing process. There were a few case reports in Chinese that tubal infertility with acupuncture treatment, pregnancy rate was up to 72%.

References

R.A.Lyons et al (2006)Human Reproduction Update, 12: 363–372
Papaioannou S Hum Rreprod (2004) 19:481-5

Suffer from tailbone pain, acupuncture can help

Tailbone or coccyx is the lowest part of the spine and it is the triangular bony structure and consists of three to five different bones that fused together by joints and ligaments. It is surrounded by many tendons and ligaments. If the tailbone area becomes inflamed, it can cause tailbone pain or coccydynia. Soft tissue injury such as tendons and ligaments surrounding tailbone is the common cause of tailbone pain. The main symptom is pain and tenderness around the tip of the tailbone the area just above the buttocks. It is dull and achy most of the time, with occasional sharp pains. The pain is often worsened by sitting down, moving from sitting tostanding, standing for long periods, having sex and going for a poo. It may affect sleep and other daily activities. The pain can radiate to legs, buttocks and hips. Tailbone pain is often caused by an injury, such as sitting for a long time or bike rides, but it may have unknown causes. Vaginal birth in women sometimes is the cause of tailbone pain. The coccyx or pelvic bones injury is a risk factor and obesity is also a risk factor for getting tailbone pain. Secondary tailbone pain includes sciatica, infection such as shingles of the buttocks, sacroiliitis, and fractured bone. The major symptoms are pain and local tenderness at the tailbone. This can lead to difficulty sitting or leaning against the buttocks. Along with the pain with sitting, there is typical tenderness at the tailbone area.

Acupuncture can reduce tailbone pain effectively. Acupuncture points used in the treatment is very important. Recently a study compared two different acupuncture methods with different acupuncture points to treat sacroiliac joint injury which presents low back pain. In one group, 9 Ashi points were used and in another group as a control Huantiao (GB 30), Zhibian (BL 54) and Weizhong (BL 40), etc were used. Treatment durations and frequencies are the same. Two courses with each course containing 10 treatments were given. After the two courses of treatments, the pain scale and function recovery were found in the both groups, but the group with Ashi points had better effects. From this example, we can see acupuncture points selected are very important to achieve the best treatment results.

References

Grgic V Lijec Viesn (2012) 134:49-55

Gataullin IG and Samitov Osh Khirurgiia (Mosk) (1989) 2:64-6

Jordan J et al Clin Evid (Online) (2011) pii:118

Shan YL Zhongguo Zhen Jiu (2011) 31:987-90

How much acupuncture treatment is adequate?

How much acupuncture treatment is adequate? This is the most frequently asked question from patients. This is a good question, but it is difficult to get accurate answers.

The effect depends on the points chosen by the acupuncturists

If you go to see different acupuncturists, you would probably notice that different acupuncturists do acupuncture differently. Many different styles of acupuncture practice exist. Acupuncture is so individualized and there is no agreement on the optimal acupuncture treatment for any particular condition. Birkeflet O et al did a research about the agreement of acupuncture diagnosis and treatment in 30 infertile and 24 previously pregnant women. These women were examined for traditional Chinese medicine (TCM) patterns by two acupuncturists who would independently decide on the TCM patterns and the prescription of acupuncture points. They found that 39 different TCM patterns and 36 different acupuncture points were used. Poor to no agreement was found for the choice of acupuncture points. On one hand this makes acupuncture unique; on the other hand this makes it difficult to be recognised. Some research trials failed to distinguish the differences between acupuncture treatment and sham controlled treatment because of the generalization of acupuncture and inadequate treatment received. There was review by Errington-Evans N on effect of acupuncture for anxiety. They found that there was enormous variety regarding the points used, number of points used in a session, duration of sessions, frequency of treatment and duration of treatment programme; all of these makes conclusion difficult. White A et al analysed 47 acupuncture trials to evaluate the adequacy of acupuncture treatment which leads to reliable conclusion. They recommend the concept of dose of acupuncture treatment. Different doses may be required for different conditions and adequate dose is established by clinical experiences or basic research studies. They found that out of 47 reviews only 6 met the criteria of adequacy of the acupuncture treatment.

The effect also depends on the individual body’s response to the acupuncture treatment

Why different people have different sensitivity to acupuncture?

Acupuncture is used to treat variety of conditions worldwide. This is a safe intervention and effective treatment for many people, but different people have different sensitivity to acupuncture. Everyone is different, but why is that? Researchers found a scientific explanation for this. Li LM et al in China studied effect of acupuncture stimulation of Zusanli (ST36) on cerebral regional difference in healthy subjects with different acupuncture analgesia sensitivity using MRI techniques. There are 45 healthy subjects with different sensitivity to acupuncture. These people were divided into three groups: insensitive group, normal group and sensitive group. The pressure pain threshold (PPT) of the Zusanli ST 36 region before and after acupuncture stimulation at the point was assessed. And two weeks later after acupuncture stimulation, resting-state fMRI images were obtained using MRI scan to assess the cerebral regional homogeneity (ReHo). They found that there was significant increase in PPT levels in the normal and sensitive groups after acupuncture at ST36 point, while there was no change in insensitive group. In normal group there was a significant increase of ReHo in the regions including left brainstem, the right cerebellum posterior, right parahippocampa gyrus, right fusiform gyrus, left angular gyrus, temperal lobe and the left frontal lobe; and a significant decrease of ReHo in the regions including the occipital lobes and the right superior temperal gyrus after acupuncture at ST36. In sensitive group a marked increase of ReHo was found in the regions includig the left brainstem, bilateral cerebellum posterior lobes, left inferior temporal gyrus, basal ganglia, the left insular lobe, anterior cingutate, frontal lobe, inferior parietal lobule and the right supplementary motor area; decrease ReHo was found in the regions including the bilateral occipital lobes, fusiform gyrus, posterior central gyrus, the right posterior cingutate, the left temporal lobe and the left paracentral lobule. While in the insensitive group, only a significant decrease of ReHo was found in the regions including the left fusiform gyrus, left inferior temporal gyrus, bilateral postcentral gyrus, and left anterior central gyrus. So brain constitution associated needling sensation may be an important factor for acupuncture analgesia effect. Brain react differently in different people which is responsible for different sensitivity to acupuncture.

Acupuncture response is not associated with needle sensations

Needles stimulate nerves at acupuncture points and have been used to treat illness. During the application of needling, people are experiencing different sensations. There was a study that investigated the sensations of the transcutaneous electrical nerve stimulation over acupuncture points (acu-TENS) and the changes of the sensations related to changes in autonomic nervous system activity. There were 36 healthy subjects who were in three groups experimental group which was given acu-TENS on right LI4 and LI11points, control group which was given acu-TENS to bilateral kneecaps, or placebo group (sham acupuncture on right LI4 and LI11 points). There were significantly physiological changes in experimental group and control groups which were given acupuncture at different sites. There was no physiological change in placebo group which was not given active acupuncture. There was significant difference between the groups. There was no association between sensation intensity and physiological responses in any groups. From this study, we can see that even if people experience different sensation during acupuncture, they all have physiological responses to the needling.

Acupuncture dosage comprise two components: the numbers of points selected in a single treatment and total number of the treatments that patients received. It is possible for patients to have beneficial effects from a couple of treatments together with a couple of points selected for stimulation, but this is rather more exceptional than general. The nature and duration of the condition is a very significant determining factor that how many treatments are effective. Acute conditions of short duration in younger patients are most likely to respond to small dosage of acupuncture. On the contrary, chronic conditions of long term duration need larger dosages of acupuncture.

How many sessions of acupuncture are needed for lower back pain?

During the past 40 years, acupuncture, a therapeutic technique of oriental medicine, has become more and more popular, evolving into one of the most utilized forms of complementary integrative medicine interventions in the United States. More than 10 million acupuncture treatments are administered annually in the United States alone. Its rise in popularity, particularly in the West, can be attributed in part to its effectiveness for pain relief and in part to the fact that scientific studies have begun to prove its efficacy.

Non-specific low back pain is the most common application of acupuncture. It is listed in NICE guidelines in the UK. A course of acupuncture needling comprising up to a maximum of 10 sessions may be offered for non specific back pain over a period of up to 12 weeks. In some cases with long history of lower back pain, much more sessions are needed to completely live in pain free life.

What clinical evidences used for NICE guidalines for low back pain treatment with acupuncture?

Five studies were included to support the application of acupuncture: 4 RCTs and 1 systematic review on acupuncture. In these trials patients received 6 x 30min over 6 weeks in one, 20 x 30min over 12 weeks in another, 8 x 30min over 4 weeks in the third trial and 12 x 30min (3 times a week) in the fourth one.

For example, One randomised controlled trial recruited patients through their GPs (a total of 16 GP practices were involved which included 39 GPs) (Thomas, K. J., MacPherson, H., Ratcliffe, J. et al , 2005). Patients included had to be between age 18-65 and had nonspecific low back pain for 4-52 weeks. They also had to have been assessed by their GP to check that primary care management was suitable. A total of 289 patients were identified and approached to join the study, of these 241 accepted and met the criteria. 160 were allocated to receive acupuncture and 81 were allocated to receive usual care, however, 1 patient from each group dropped out, 159 actually received acupuncture (146 were followed up at 3 months, 147 at 12 months and 123 and 24 months) and 80 received usual care (71 were followed up at 3 months, 68 at 12 months and 59 and 24 months). Participants in the acupuncture group received 10 individualised acupuncture treatments over 3 months from one of 6 qualified acupuncturists. The usual care group received 10 NHS treatment sessions according the GPs assessment of the patients clinical need; this was a mixture of interventions, including drugs and recommended back exercises. Half the group also received physiotherapy or manipulation during the first three months. Both groups also received adjunctive care which included massage and advice on diet, rest and exercise. The results showed that acupuncture does give a greater long-term benefit compared to usual care. Acupuncture was significantly more effective in reducing pain at 24 months than usual care. The study also showed that traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain.

Can the effect of acupuncture stay?

People who have acupuncture treatment always like to know that how long the effect of acupuncture stays. A new research has shown that this effect can last very long time. This research used a large individual patient dataset from high quality randomised trials of acupuncture for chronic pain. The available individual patient dataset included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck and shoulder), osteoarthritis of the knee and headache/migraine. In trials comparing a course of acupuncture to no acupuncture control (wait-list, usual care, etc), the result suggests that about 90% of the benefit of acupuncture relative to controls would be sustained at 12 months. The effects of a course of acupuncture treatment for patients with chronic pain do not appear to decrease importantly over 12 months. Longer term outcomes of acupuncture need further research to measure.


References

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Anderson B and Rosenthal L. Complement Ther Clin Pract (2013) 19:1-5

http://www.nice.org.uk/guidance/cg88/resources/cg88-low-back-pain-full-guideline3

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Yu DT et al Acupunct Med 2013 Nov 1.doi10.1136/acupmed-2013-010428

Li LM et al Zhen Ci Yan Jiu (2013) 38:306-13

Acupuncture beyond Ying and Yang, Qi and meridians. Acupuncture alters brain activities

What do you know about the brain?

The brain is the central control organ in the body and is protected by the skull bones of the head. Though the brain function is not fully understood, it is known that it controls the activities of the body including processing, integrating and coordinating the information it receives from the sense organs and takes action accordingly, such as send signal to the body to react. Sensory nervous system is involved in receiving and processing sensory information, such as the skin is a sensory organ and senses touch, pressure, pain vibration and temperature. Motor system controls muscle function and body movement. Emotion and cognition are a part of the brain function. The brain is a big energy consumer and it receives 20% of total body oxygen and energy consumption and 25% of total body glucose utilization. The brain mostly uses glucose for energy, and deprivation of glucose causes loss of consciousness. Sleep can reduce brain oxygen and energy consumption and help restore brain energy supply.

Acupuncture has been accepted globally. Acupuncture stimulates the brain releasing endorphins which is essential in acupuncture analgesic effect.

Acupuncture altered brain activity and releases low back pain

Functional magnetic resonance imaging (fMRI) is a new technology that is used to study brain. Pain stimulus could induce extensive activations in the limbic system [anterior cingulated cortex (ACC), periaqueductal gray (PAG), prefrontal cortex] and somatosensory system (thalamus, primary somatosensory cortex (S1), secondary somatosensory cortex (S2), posterior parietal cortices, insula, supplementary motor area, striatum, and cerebellum) areas as well as the pain matrix (S1, S2, insular, frontal lobe and parietal lobe). The pain matrix showed a strong relationship with pain, which plays an important role in the conduction and communication of pain. This can be seen changes on fMRI. Low back pain (LBP) is one of the most common clinical syndromes and affects 80–85% of people at some point in their life. Most LBP is nonspecific which does not have a definitive cause.

In a recent study, an experimental acute LBP model and fMRI was used to study the neural mechanisms of acupuncture analgesia. All LBP subjects first underwent two resting state fMRI scans at baseline and during a painful episode and then underwent two additional fMRI scans, once during acupuncture stimulation (ACUP) and once during sham stimulation, at the BL40 acupoint. They found that acupuncture induced more deactivations and fewer activations in the brain. Acupuncture can alter brain activity and this contributes to mechanism of analgesia of acupuncture to LBP.

Acupuncture altered brain network function

There was a study about acupuncture stimulating brain functional network. This study was based on sample entropy of electroencephalograph (EEG) under magnetic stimulation at PC6 acupoint which is on your forearm and near your wrist. Magnetic stimulation at acupuncture point is a new method for studying the theory of acupuncture. It helps to investigate brain network and understand how brain works. This study was trying to provide evidence for the mechanism of acupuncture which is a part of traditional Chinese medicine. The magnetic stimulation of PC6 acupoint was performed and EEG signals were recorded. By analysing the results they found the brain network topology was changed after acupuncture at PC6 acupoint, the connection of the network is increased, the efficiency of information transmission is improved and the small-world proper is strengthened through stimulation the PC6 acupoint.

Acupuncture at different acupoints may alter brain activities in different area.

Recent acupuncture research study the effect of acupuncture on brain activity using functional magnetic resonance imaging (MRI). Wang W et al used electro-acupuncture to stimulate the cerebral activated areas. They compared the altered activation areas of the acupuncture point LI4 on the right hand with some non acupuncture points on the face. There were 6 people in the LI4 group and 5 in the facial nonacupoint group. MRI ws performed before and after acupuncture. They found that activation or deactivation was found the multiple cerebral areas in both groups. In the LI4 group, activation was found in the areas including medline nuclear group thalamus, left supra marginal gyrus, left supra temporal gyrus, right precuneous lobe, bilateral temporal pole, left precentral gyrus and left cerebellum; deactivation areas include bilateral hippocampus, parahippocampal gyrus, amygdale body area, rostral side/audal side of ingulate gyrus, prefrontal lobe and occipital lobe as well as left infratemporal gyrus. In the control group, the activation and deactivation areas were different from LI4. They concluded that the deactivation area by LI4 was a similar area distribution of pain area in the brain and closely related to the anatomic structure of limbic system which is possibly related to pain relief. Activation of left anterior gyrus by LI4 represents the movement of facial muscles and activation of cerebellum is possibly related to effect of LI4 in treating facial palsy and facial muscle spasm.

Fang JL et al compared the effects of electroacupuncture at acupoints ST36 and CV4 using MRI in 21 healthy volunteers. The similar deactivation effects in the anterior cingulated and medial prefrontal cortices were induced by acupuncture at ST36 or CV4 acupoint. The functional brain network was significantly changed after acupuncture. The instant postacupuncture effects were mainly found in the ventral medial prefrontal cortex and ventral anterior cingulated cortex in the limbic-paralimbic-neocortical network and the effects were stronger at ST36 than that CV4.

Facial acupuncture increases brain blood flow

A new research studies the effect of facial acupuncture on brain blood flow. In this study brain blood flow and heart rate were measured before and after acupuncture treatment. The result has shown that brain blood flow was significantly greater in the brain more specifically in the prefrontal cortex in the acupuncture group. Heart rate was reduced.

References

Han js Neurosci (2004) 36:258-61

Kim S et al Evid Based Complement Alternat Med (2016) 9874207. doi: 10.1155/2016/9874207. Epub 2016 Jun 14.

Li XM et al Zhen Ci Yan Jiu (2013) 38:297-300

Wang W et al Chin J Integr Med (2007) 13:10-6

Fang JL et al Zhen Ci Yan Jiu (2012) 37:46-52

Yan G et al Evid Based Complement Alternat Med 2013: 2013:429703

Guo L et al Biomed Mater Eng. 2013 23(0):S1115-S1121

Hsiu H et al Microvasc Res (2013) Jun 24

An Y et al Med Devices (Aucl) (2014) 7:17-21

Waki H et al Acupunct Med (2017) Aug 1. pii: acupmed-2016-011247. doi: 10.1136/acupmed-2016-011247. [Epub ahead of print]

Acupuncture beyond Ying and Yang, Qi and meridians. Acupuncture increases blood circulation.

One of the mechanisms of acupuncture effect is increasing blood circulation

Acupuncture is originated from China 2500 thousand years ago and the theory is based on the meridians and energy (Qi) flow through the body. Recent scientific research on acupuncture provided evidence of the mechanisms of acupuncture. In 1950s Chinese government began to invest in research on acupuncture. The interest in acupuncture is increased not only for medical professionals all over the world, but also for researchers. They would like to know how the needles work. Since 70’s, acupuncture becomes more and more popular in US and European countries. In 1971, a report in the New York Times inspired American doctors to China to study analgesia effect of acupuncture. In 1990s there was a remarkable increase in acupuncture research. The publications of acupuncture research continue to increase. Acupuncture has received an enormous boost in the last few years. In 50 years the achievements of acupuncture research is extraordinary. The National Institute of Health consensus conference in 1997 recognised acupuncture (and by extension Traditional Chinese Medicine) as a legitimate branch of scientific medicine. Acupuncture seems very likely to be accepted and incorporated into Western medicine. Acupuncture becomes popular than ever.

Acupuncture increases local blood flow.

Regulating blood flow both centrally and peripherally are important in contributing mechanism of acupuncture.

Recently a study investigated the changes of local blood flow in response to acupuncture stimulation. In this study eight random controlled trials involved 205 participants were included. In most of the selected studies, acupuncture was performed at points located distal to the elbows and knees such as LI4, ST36, and PC6, whereas one study simultaneously used several acupoints on the extremities. In one study the GB21 acupoint on the posterior region of the shoulder was stimulated with an acupuncture needle. All eight studies selected for the present review observed acupuncture-induced changes in blood flow in the skin, whereas three studies observed changes in blood flow in the muscle. Four reported significant increases in blood flow following acupuncture compared with control, whereas one other study observed reductions in microcirculation immediately after acupuncture needling. The studies that assessed patients with either fibromyalgia or trapezius myalgia found significant increases in blood flow in the skin and muscle. Additionally, the degree and duration of increases in microcirculation varied depending on the condition of the subjects and the manipulation technique.

Another study about effect of acupuncture in peripheral tissue perfusion has been done on two healthy subjects. Acupuncture was performed on two acupoints (LI4 and SI3) which are in the hands three treatments within 1 week. Local blood perfusion on the hands was measured before and after acupuncture treatments. The result has shown that the blood perfusion rates of the hands were noticeably increased immediately after acupuncture at the first treatment in both cases. At the third treatment the increased blood perfusion was seen in one case, not the other one.

Hsiu H et al studied the microcirculatory blood flow response following acupuncture stimulation using beat to beat laser Doppler flowmetry (LDF) which could provides important information on the circulatory regulatory activities. Changes in the arterial pulse transmission or the opening condition of arteriolar opening might change the fluctuation pattern of the microcirculatory blood supply. They measured LDF signals to study the microcirculatory blood flow response at the needled site particularly at Hegu LI4 acupuncture point) after acupuncture stimulation. They selected 29 male healthy volunteers to measure microcirculatory blood flow after acupuncture stimulation. The measurements were at three times: before acupuncture stimulation, immediately after acupuncture stimulation and about 1 hour after acupuncture stimulation. They found that acupuncture not only improves local blood supply and but also regulates microciculatory blood flow by altering microcirculatory blood supply parameters. Their findings could help to identify the mechanism underlying the effects of acupuncture stimulation.

Acupuncture increases blood perfusion around the acupoints.

Researchers are using modern techniques to study the mechanisms of acupuncture to explain the phenomenon from modern science aspect. Li XM et al studied influence of different acupuncture manipulations at Zusanli (ST36) on skin microcirculation blood perfusion in healthy subjects. They measured local blood perfusion at ST 36 acupuncture points after acupuncture stimulation at 1min, 5 min, 10, 15min, 20 min, 25 min and 30 min. They also compared blood perfusion levels of microcirculation around the acupoints among the different manipulation techniques. They found that microcirculation around the selected acupoint was significantly increased from 1-10 min following simple needle insertion, from 5 -30 min after uniform reinforcing-reducing manipulation, from 1-30 min after reinforcing manipulation, and from 1-25 min following reducing manipulation respectively. The reinforcing manipulation was superior to other techniques. From this study we can see acupuncture increases local blood perfusion in normal subjects. The reinforcing manipulation had better effect.

Acupuncture dilates blood vessels

Research has shown that there were more of nerve fibers/trunks, blood vessels, hair follicles, and sweat glands as well as density of the gap junction in the acupuncture points. Recent research has shown that nitric oxide (NO) level is elevated in the acupoints and is associated with an enhanced expression of NO synthase endowed with transient receptor potential vanilloid type-1. This suggests that acupuncture induces NO-mediated vasodilatation, which increases local blood flow and allows for a flush of algesic or sensitizing substances, leading to pain relief.

Microcirculation and water retention

Microcirculation is the blood flow in the small blood vessels which spread out in organ tissues. These blood vessels include arterioles, capillaries and venules. The main functions of the microcirculation are the delivery of oxygen and nutrients to the tissues and the removal of CO2 from the tissues. It also regulates blood flow and tissue perfusion. Microcirculation responds to inflammation which is related to swelling. Capillaries are a sector of the microcirculation where gas and fluid exchange take place. About 7% of the blood in the capillaries is continuously exchanges with the fluid outside of the blood vessels. If there is problem with microcirculation, such as compression of the part of the body, the microcirculation is likely to be disturbed and water retention occurs. Acupuncture stimulates the nerve ending and relaxes blood vessels and skeletal muscles, it improves microcirculation and relieves water retention.

Acupuncture helps lymphatic circulation

The lymphatic system is a part of the circulatory system and it also involves immune function of the body as a part of the immune system. It consists of a network of lymphatic vessels which carries lymph-a clear fluid in the body which formed from tissue fluids known as interstitial fluid from the tissues. It carries large amount of lymphocytes and other white blood cells which play a role in the immune function. Its main function is to help tissue fluid circulation. The lymph capillaries absorb the interstitial fluid from the tissues and lymph vessels conduct the fluids to the blood vessels. As a part of the defence system, it also contains waste products and cellular debris together with bacteria and proteins etc which are toxic to the body.

The lymphatic system is responsible for maintaining the balance of the body fluids. Its network of capillaries and collecting lymphatic vessels work to efficiently drain and transport the fluid, along with proteins and antigens, back to the circulatory system. The lymphatic system is not closed system and the vessel walls are not as strong as blood vessels. If the circulation is blocked for various reasons, e.g. there is tension on the body, the transportation is disturbed and the fluids cannot be drained properly causing water retention. Also the toxins could remain in the body longer than they should be causing toxic to the body.

Acupuncture can help lymphatic circulation, improve water retention and help get rid of toxins of the body.

References

Kim S et al Evid Based Complement Alternat Med (2016) 9874207. doi: 10.1155/2016/9874207. Epub 2016 Jun 14.

Li XM et al Zhen Ci Yan Jiu (2013) 38:297-300

Wang W et al Chin J Integr Med (2007) 13:10-6

Fang JL et al Zhen Ci Yan Jiu (2012) 37:46-52

Yan G et al Evid Based Complement Alternat Med 2013: 2013:429703

Guo L et al Biomed Mater Eng. 2013 23(0):S1115-S1121

Hsiu H et al Microvasc Res (2013) Jun 24

An Y et al Med Devices (Aucl) (2014) 7:17-21

Ma SX Chin JIntegr Med (2017) 23:812-815