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Maggie Ju (2014) Current opinion in acupuncture on stroke rehabilitation
The Journal of Chinese Medicine And Acupuncture Volume 21 Issue 2 September 2014 P9
Maggie Ju. (2015) What Part Does Acupuncture Play in IVF?
The Journal of Chinese Medicine And Acupuncture Volume 22 Issue 1 March 2015 P21
Maggie Ju (2020) The Potentiality of COVID-19 Treatment with Chinese Herbal Medicine in the UK
The Journal of Chinese Medicine And Acupuncture Volume 27 Issue 2 November 2020 P9
Monday, 19 March 2018
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.
Chao and Zhang World J Gastroenterol (2014) 20:1871-1877
Shi ZM et al Zhongguo Zhen Jiu (2011) 31:607-9
Tendon is tough fibrous connective tissue which connects muscles to bones. Tendon is made of collagen. Tendon injury includes acute and chronic injury is very common. The symptoms include pain, redness, warmness, swelling, tenderness near the injured tendon. Pain increases with activity. Also pain can radiate to other part of the body. Rest, ice, steroids injection, massage can be used to treat tendon injury. Acupuncture is proven to be effective for tendon injury. Clinical study showed that acupuncture improves pain and functional activity in patients with tendon injury. Recent studies showed that acupuncture can modulate anti-inflammatory and mechanotransduction molecular pathways which subsequently increase collagen synthesis and reorganisation. This underlies acupuncture tendon healing mechanisms.
Effect of acupuncture on chronic Achilles tendinopathy
Achilles tendon is the tendon at the back of the lower legs and it passes posterior to the ankle. It is the thickest and strongest tendon in the body. Achilles tendinopathy (also called Achilles tendonitis) is pain and swelling you can get in your Achilles tendon. Achilles tendonitis is an inflammation in Achilles tendon which is caused by an overuse injury to the thick Achilles tendon at the back of the ankle. It is very common in runners. Achilles tendonitis can be either acute or chronic. Acute Achilles tendonitis is a new injury and usually more painful. Chronic Achilles tendonitis is a prolonged injury and it may follow the acute Achilles tendonitis. The characteristic of this condition is pain and inflammation at Achilles tendon. Many factors contribute to developing the condition. 1, increased activity, for example, suddenly increase distance, speed in running. 2, change to soft training surface, for example running on the soft surface can put on excessive stretch to the tendon. 3, weak calf muscles increases the strain on the Achilles tendon. 4 running on the hill will put on more stretch on the tendon. 5 Wearing high heels constantly shortens the tendon and calf muscles. Sudden change to flat shoes from high heels for exercising will put abnormal stretch to the tendon.
The main symptom is Achilles pain at the back of the ankle, just above the heel bone. There is stiffness in the Achilles tendon especially in the morning or after a long period of rest. This is thought to be due to adhesions between the tendon sheath and the tendon itself. Redness and swelling are often seen in acute stage. Nodules or lumps may be found in the Achilles tendon, particularly 2-4cm above the heel. Tenderness of Achilles tendon can be seen during examination.
Chronic Achilles tendonitis is a difficult condition to treat due to its poor blood supply.
In acute stage, rest is a must. Continuing to train on a painful Achilles tendon could lead to the injury becoming chronic and more difficult to treat. Appling ice within 24-48 hours of injury will reduce pain and inflammation. Wearing a 1cm high heel pad can take some strain away from Achilles tendon. Achilles tendon taping technique which uses elastic bandages to support the tendon can help. Acupuncture can improve blood flow, improve oxygen supply and nutrients supply to the tendon. Also acupuncture can reduce pain and decrease inflammation. In later stage apply heat to the tendon is beneficial. Pain killers can be used in acute stage, but they may not be very effective. Long term use could delay tendon healing. Steroid injection directly into the tendon is not recommended because this can increase the risk of a total rupture of the tendon in future. Right running shoes prevent from future injury.
Once you can perform daily activities pain-free, move on to next stage which focus on improving the flexibility of the calf muscles. Massage will help prevent adhesions forming within the tendon which stop the tendon sliding smoothly in its sheath and help blood flow of calf muscles. Eccentric exercises have been proven to be very effective in the treatment of chronic achilles tendonitis. If the injury has been severe and required a sustained period of rest and the neural control or co-ordination of the ankle has been affected, proprioception which is the neural control or co-ordination of a joint may need to be improved. Finally when the pain has disappeared at least a week and the range of motion at the ankle has improved then you can begin to return to training.
There are some examples of research that suggested that acupuncture is effective to treat Achilles tendinopathy
There was a clinical study of acupuncture for chronic Achilles tendinopathy. This study investigated whether acupuncture treatment would improve outcome in chronic achilles tendinopathy. In this study, 64 patients aged from 18-70 year old with chronic Achilles tendinopathy were recruited and randomly allocated into two groups: acupuncture treatment group and control group (received eccentric exercises). The effects were assessed at the start of the treatments, 8, 16 and 24 weeks after the treatments. They found that 8, 16 and 24 weeks acupuncture significantly improved the pain sensation and activity in patients with chronic Achilles tendinopathy compared with the eccentric exercises. This finding provided an alternative treatment option for patients with chronic Achilles tendinopathy.
A case report of Achilles tendinopathy
There was a case report of conservative treatment of Achilles tendinopathy. This was a 77 year old female patient with chronic Achilles endinopathy. The pain was present in the midportion of the Achilles tendon for 8 months. The pain was progressing. Activity makes the pain worse. Her tight lower leg was swelling around the right Achilles tendon. Right ankle movement was limited. There was tenderness and soft tissue thickening. Acupuncture and electric stimulation were applied for the treatment. Also physiotherapy exercise programme was performed. The treatment was twice a week for 4 weeks and then once a week for 4 weeks. The total treatments were 12. Gradual improvement was seen during each treatment. At the end of week 9, the improvement was significant. The only symptom was the mild tenderness of the Achilles tendon. Other tests were all within normal range. After finish whole course of treatments, the patient was encouraged to continue exercise programme. At 12 month follow-up, there was no recurrence occurred.
How can acupuncture help with Achilles tendinopathy? Studies have shown that acupuncture releases pain, increases in local blood flow and oxygen and nutrients supply to promote tissue healing.
Almeida MD et al Acupunct Med 2013 Dec 11Doi:10.1136
Zhang BM et al Chin J Integr Med (2012) Dec 21
Papa JA J Can Chiropr Assoc (2012) 56:216-24
Kubo K et al Int J Sports Med (2011) 32:807-13
Saturday, 17 March 2018
The main symptoms of POF include no regular periods, low blood oestrogen level and high FSH under the age 40. Anti-Mullerian hormone (AMH) level is low. Oestrogen is produced by follicles and its blood level is low if follicles are short of supply or dysfunctional. FSH is produced in the pituitary gland at the base of the brain and it stimulates follicles growing. If a woman is running out of eggs in ovaries in the case of POF, resulting in low level of oestrogen, the pituitary gland will work hard to produce more FSH in order to stimulate ovaries to make more good eggs. AMH is a substance produced only in small ovarian follicles and its level is quite constant correlating strongly with the number of growing follicles. Since this hormone is not dependent on hypothalamic-pituitary-gonadal axis function and decreased to undetectable level at menopause, it could potentially help assess remaining function of ovaries and egg supply.
There are treatments that can help some of the symptoms; however women with POF are unlikely to get pregnant without treatments because their ovaries do not work properly. There is no proven medicine to improve a woman’s ability to get pregnant, if she is diagnosed with POF. A number of treatment regimens have been evaluated with the aim of restore fertility; however, treatments with clomiphene, gonadotrophins, GNRH agonists or immunosuppressants do not significantly improve the chance of conception and are not used. Use of donor eggs is only a reliable option from Western medicine point of view. Is there really nothing you can do apart from accepting that you will no longer have a chance to have a child naturally with your own eggs? Why not try acupuncture? There is a chance to conceive naturally with acupuncture treatment.
There was a case report in Chinese acupuncture website about effectiveness of acupuncture treatment for POF. There were 76 patients aged from 26-40 with POF diagnosis for 1-9 years. These cases were treated from 1990-1996. Acupuncture treatment was given for 6 months. 68% patients restored normal period, ovulation or pregnancy. FSH level decreased to normal and oestrogen level increased significantly.
Recently research provided evidence of effectiveness of acupuncture on POF. Kehua Zhou et al investigated the effects of acupuncture on FSH, oestrogen (E2) and LH in women with POF. They also studied the menstruation changes in these women. They recruited 11 women with diagnosed POF for 4 months to 10 years. Ages of these women were from 25-39. These women had no menstrual period for at least four months or longer. They had high FSH over 40 iu/l. Before acupuncture treatment, they stopped all medications that possibly affect hormones. After the treatments, there was three month follow-up. Assessments were done before the treatment, at the end of three month treatment and at the end of three month follow-up. They found that after acupuncture treatment, E2 increased while FSH and LH decreased which last at the end of three month follow-up. 10 out of 11 patients resumed menstruation; 9 of them still had menstruation at the end of follow-up. Other symptoms such as night sweating, hot flashes and mood swings were reduced during acupuncture treatments and at the end of follow-up.
Kehua Zhou et al Evid Based Complement Alternat Med (2013) 2013: 657234 Published on line 2013 Feb 28
Wednesday, 14 March 2018
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.
Neck pain is very common. About 2 in 3 people had neck pain at some point in their life. A survey in the UK has shown that 1 in 4 women and 1 in 5 men between ages 45 and 75 had current neck pain.
The cervical spine and the muscles and ligaments are at the back of the neck. The cervical spine is made up of seven vertebraes between which is a disc. Spinal cord is within the spine and protected by the spine. Nerves come out from the cervical spine and innervated the neck and arms.
Non specific neck is the most common type of neck pain. The exact cause is unknown. It may caused by minor strains to the muscles and ligaments in the neck. Poor posture is often related to the neck pain.
The nuchal ligament and neck pain
The nuchal ligament is a ligament at the midline of the neck which extends from the bottom of the skull to the spinous process of the seventh cervical vertibrae which is the lowest cervical vertebrae on the neck. It forms a septum between the muscles on the either side of the neck. There are four muscles including trapezius, splenius capitis, rhomboid minor and serratus posterior superior attached the nuchal ligament. The nuchal ligament limits flexion of the neck, stabilizes the neck and affects muscular activity in the neck. Trauma and overuse of nuchal ligament can result in ossification of the ligament which causes neck stiffness and pain, progressive cervical spine instability and malalignment and nerve route irritation. Acupuncture can help release neck stiffness and neck pain.
Acupuncture treatment for chronic neck pain
Chronic neck pain is a long-lasting pain on the neck or back. This pain commonly started from improperly healed acute injury. Scar tissues formed during the healing process. These scar tissues are called fibrosis. They can develop inside of the body, under the skin, muscles, tendons or inside of a joint capsule. Fibrosis always occurs at the end stage of inflammation and it causes adhesion which grabs the connective tissue and surrounding muscles together causing pain and tension, limiting the function. There are more pain receptors in the fibrosis tissue making the area more sensitive to protect the area by the body automatically.
Acupuncture can help to release the pain and tension to help the area functioning. Also acupuncture can help the body repair to get rid of the scar tissue and remodel the tissue.
Acupuncture for sudden severe pain in the neck
Acute neck pain is a sudden-onset pain in the neck. It is often due to neck muscles strain and muscle spasm. This can be caused by poor posture, sleep in an awkward position, carrying heavy loads, stay in one position for a prolonged period of time etc. One might not find exactly causes. The pain is sudden and can be very severe. This makes the person with the pain panicking. Movement of the neck is restricted because of the pain. The recovery can take a few days or a week. Acupuncture can help release the pain and speed up the recovery.
Acupuncture helps a stiff neck
Neck pain or a stiff neck is a common problem. The neck becomes sore and tender and movement is limited. it is difficult to move the neck and turn the head to the side. It could be associated with a headache, neck pain, shoulder pain or arm pain. The most common cause of a stiff neck is a muscle strain or soft tissue sprain. The levator scapula muscle located at the back and side of the neck connecting the neck with the shoulder is most affected. These muscles can be strained by everyday activities: for example, sleep in an awkward position, use a computer for a prolonged period of time, have a bad posture or have some sports injury such as swimming sudden fall, hold a phone between the neck and shoulder etc. Anxiety and stress can cause tension in the neck muscles leading to neck pain. Tight muscles are often chronic and need to be treated. Tight muscles block blood circulation of the body and muscles don’t get enough nutrition and become weak and easily get further damage. Because of blocked energy supply, you will feel tired all the time. Poor posture is a common cause of tight neck and shoulders. This causes overuse some groups of muscles and causes micro injury to the muscles which become tight to protect themselves from further injury. Furthermore the tight neck and shoulders will make poor posture worse. It becomes a viscous circle. This needs to be treated, otherwise tight neck and shoulders would not resolve itself. Stretching the muscles, applying heat or warm bath may help. Acupuncture is very effective to release the muscle tension, reduce the tightness, correct poor posture and improve blood circulation. Acupuncture can help stiff neck by relaxing muscles spasm.
How many needles are suitable for neck pain treatment with acupuncture?
How many needle numbers are used to obtain best effect? Ceccherelli F et al from University of Padova Italy studied this subject. They compared the clinical efficacy of different number of needles used in patients with mayofascial pain. There were 36 patients between 29-60 years of age with cervical myofacial syndrome participated the study. These patients were divided into two groups: 18 patients were in the first group and treated with 5 needles; another 18 patients were in the second group and treated with 11 needles. The same of needle stimulating time and the same cycle of treatment were applied to both groups. Pain intensity was evaluated before, immediately after and 1 and 3 months after the treatment. The needles in the two most painful trigger points were inserted deeply and other needles were applied superficially. They found that a good treatment effect was obtained in both groups and this is not associated with the number of needles used. Their conclusion was that the number of needles either 5 or 11 used is not essential to obtain good therapeutic effect when the simulation time remains the same.
Physiotherapy and chiropractic treatments are popular options for treating neck pain. Do you know that physiotherapist and chiropractors also use acupuncture to treat neck pain? What treatment options are available for neck pain? There was an international survey with Canada having the largest response to investigate physical medicine, complementary and alternative medicine utilization amongst 360 clinicians treating patients with neck pain. Both physiotherapist and chiropractors used exercise and manual therapies which is 98-99%. Physiotherapists used exercise, orthoses and 'other' interventions more, while chiropractors used phototherapeutics more. 46% acupuncture is used by these professions to treat neck pain. If you go to see a physiotherapist or a chiropractor, you may get an acupuncture treatment from them.
Ceccherelli F et al Clin J Pain 2010 26:807-12
Liang Z et al Complement Ther Med (2011) 19 supple 1:S26-32
Dong WK and Lin XH Zhongguo Zhen Jiu (2012) 32:211-4
Graham N et al Open Orthop J (2013) 7:440-60
Carlesso LC et al Chieopr Man Thera (2014) 22:11
Buttocks muscle strain is a very common condition causing buttocks pain. If buttocks muscles are strained, it can cause muscle spasm and tendon injury and causes pain, swelling, tenderness and stiffness. Trigger points can be found in these muscles.
Many other conditions can also cause pain in the buttock. For example
Piriformis syndrome: Piriformis is a small muscle that is located deep in the buttock region. If this muscle is tense and inflamed, it can irritate and compress the sciatic nerve causing pain and tingling at the buttocks ot numbness.
Sciatica: The sciatic nerve is the longest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and runs through the buttock area down to the lower limb ending at the feet. The pain of sciatica is sometimes referred to as sciatic nerve pain. Sciatica is pain caused by irritating sciatic nerve.
Slipped disk: A slipped disc or prolapsed or herniated disc is a condition in which the disc in the spine is torn and the central part inside comes out. This can cause pain at the buttocks.
Sacroiliac joint pain: sacroiliac joint is the joint between the triangular sacral bone at the base of the spine and the iliac or pelvic bone. If the area becomes inflamed, it causes pain at the buttocks.
Buttocks pain can be distressing especially no causes are found and nothing is shown on tests: the MRI show no problems, no tumor, no slipped disk, no nerve damage, no nothing. Blood test is normal: no sign of infection.
Osteoarthritis: Osteoarthritis in the low back, sacroiliac joint and the hip can cause buttock pain. The pain, when spreading from an arthritic joint, is often non specific.
Ligament and tendon inflammation: There are many ligament s and tendon at the buttocks. If these ligaments and tendons get strained and stretched, it will cause inflammation. A common way of stretching the ligament is by sitting with the low back unsupported in a slumped position. Coccydynia known as tail bone pain can also be caused by ligament and tendon inflammation around the tail bone.
Bursitis: There two main bursa in the buttock area_ the trocanteric bursa and the ischial bursa. If these bursa is inflamed, it can cause pain at the buttocks especially when sitting down.
Hamstring tendonitis: Hamstring tendon is inflamed in this circumstance causing pain at the buttocks which is noticeably when sitting down.
Acupuncture is used to treat buttocks pain effectively.
Monday, 12 March 2018
Migraine is featured as moderate or severe pulsating pain only on one side of the head which is deliberated by physical activity. It is recurring headache with duration 4-72 hours. It could accompany other symptoms including nausea, vomiting and increased sensitivity to light or noise. The diagnosis is based on clinical history and exclusion of other kind of headache, because there is no specific test for migraine. The cause of migraine is not fully understood. The current accepted theory of migraine is that the brain chemical called serotonin level is changing; this leads to blood vessels in brain contracting and then dilating, as a result, it causes symptoms of migraine. Migraine attach could be triggered by many factors, such as stress, tension, depression, not sleep well, tiredness, poor posture, neck or shoulder tension, hunger, caffeine products (coffee, tea), bright light , loud noise etc. Apart from headache, there could be other symptoms present, such as nausea, vomiting, fatigue, dizziness, blurred vision etc. Pain killers and anti-inflammatory drugs are mainly used to treat migraine attacks. Beta-blockers (e.g., propranolol, originally developed to treat high blood pressure), anti-seizure drugs (e.g., topiramate), or tricyclic antidepressants (e.g., amitriptyline), in combination with behavioral therapy or lifestyle adjustments are used to prevent migraine attack. Mauskop A from New York Headache Center USA summarised therapies proven (to various degrees) to be effective for migraine. These include aerobic exercise; other forms of relaxation training; dognitive therapies; acupuncture; and supplementation with magnesium, CoQ10, riboflavin, butterbur, feverfew and cyanocobalamin with folate and pyridoxine.
Recent research showed that acupuncture has effect to treat migraine. For example, Wang et al studied the effect of acupuncture in patients with migraine. This was a randomized controlled trial involving in 150 patients with migraine. They found that acupuncture has significantly better effect in relieving pain and reducing acute migraine attack than sham acupuncture. They also conducted another trial in 140 patients in 5 hospitals in China. They compared the effect of acupuncture with that of flunarizine, a drug used for migraine treatment. They found that acupuncture is more efficient in decreasing days of migraine attacks than flunarizine; acupuncture has similar effect as flunarizine in reducing pain and improving patient’s quality of life.
There are a few types of acupuncture and many acupuncture points applied for the treatments. Which points are more commonly used and which type of acupuncture is more effective? Wang JJ et al studied the optimized schemes for acupuncture treatment of migraine attack. They studied five types of acupuncture: manual acupuncture, electroacupuncture, auricular acupuncture and bloodletting therapies for migraine patients. There were 76 patients with migraine participated the study. Three groups of acupuncture points include group 1: local points including Sizhukong (TE23), Shuaigu (GB8), Taiyang (EX-HN 5), group2: local points plus distal points including Hegu L4 and Taichong LR3, and group3: local points plus distal points plus symptom points including Ganshu (BL18), Yanglingquan (GB34), Qiuxu (GB40) and Taixi (KI3). Different acupuncture types were type 1 no acupuncture stimulation, type 2 manual acupuncture stimulation, type 3 manual plus electroacupuncture, type 4auricular acupuncture, type 5 otopoint manual acupuncture, type 6 otopoint electroacupuncdture, type 7bloodletting. Within 24 hours after the treatment, the headache relief effects from greater to smaller were body-acupoints combination> manual acupuncture or electroacupuncture> bloodletting >auricular acupuncture. The pain relief effects were most stable in the manual acupuncture group with local acupoints plus distal acupoints. Manual acupuncture stimulation of the local plus distal body acupoints combined otopoint-EA and bloodletting at Taiyang (EX-HN 5) plus Ashi points is potentially the best option for relieving migraine during attack.
Why acupuncture is effective to migraine?
Acupuncture is recognised as effective treatment for migraine. It is as effective as drug treatments. Why can acupuncture treat migraine? It became commonly knowledge that acupuncture stimulates body releasing endogenous pain relief substances such as beta-endorphin. Recent research has shown that acupuncture can change response of the blood vessels in the brain. In migraine patients, their artery blood flow in the brain is increased excessively during migraine attack. After acupuncture treatments, the artery blood flow in the brain became normal. The reduction of blood flow reflexes the intensity of the headache.
Here are more examples of acupuncture for headache and migraine
There was a case report that acupuncture together with spinal manipulation was used to treat a patient with a chronic tension-type headache and episodic migraines. That was a 32 year old woman with headaches for 5 months. She also had a history of episodic migraine that started in her teens. She was diagnosed with mixed headaches: migraine and tension type. Her migraine had been controlled with medication. But she had severe gastrointestinal symptoms including vomiting, nausea and stomach cramping after a period of medication and she had to stop taking the medication. After stopping taking the medicines her headaches got worse and happened on a daily basis. To reduce the headache she started acupuncture treatment first. The points that were used for acupuncture were GB1, Tai Yang (M-HN-9), ST36, K3, K7, BL18 and BL19. After first acupuncture treatment, she had headache free for 2 hours and headache intensity was reduced; after the second treatment, her headache intensity was reduced about 90%. She received 5 treatments over 2 weeks: the first two treatments were acupuncture only and the following 3 treatments were acupuncture combined with chiropractic spinal manipulation treatments. After the 5 treatments, her headache had disappeared. Further four treatments were continued for 11 weeks. After 1 year follow-up, there was no recurrence of the headaches. This case report suggested that patient with headache could choose combined treatment methods in order to achieve best results.
Acupuncture is for migraine prevention
Acupuncture is used for migraine prevention. The effectiveness has been reviewed recently. Twenty-two trials including 4985 participants were analysed. Migraine frequency (migraine days, attacks or headache days if migraine days not measured/reported) was measured before and after treatment and at follow-up. The response (at least 50% frequency reduction) was also measured. Comparison with no acupuncture, acupuncture was associated with a moderate reduction of headache frequency over no acupuncture after treatment. After treatment headache frequency at least halved was found in 41% of participants receiving acupuncture comparing to 17% with no acupuncture. There is one trial with post-treatment follow-up found a small but significant benefit 12 months after treatment. Comparison with prophylactic drug treatment, acupuncture reduced migraine frequency significantly more than drug prophylaxis after treatment. Trial participants receiving acupuncture were less likely to drop out due to adverse effects than participants receiving prophylactic drugs. The conclusion from this study is that the available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment.
Acupuncture is effective for the treatment or prevention of migraine, tension-type headache
Recently a study summarizes the current evidence that evaluates the effectiveness of acupuncture for the treatment or prevention of migraine, tension-type headache, and chronic headache disorders. It demonstrate that acupuncture is associated with improved clinical outcomes compared to routine care only, medical management, and sham acupuncture 2 months after randomization. Cost effectiveness analyses conducted in the United Kingdom and Germany suggested that acupuncture is a cost-effective treatment option in those countries.
Wang LP et al (2012) Pain Med 13:623-630
Wang LP et al (2011) Pain 152:1864-71
Mauskop A Continuum (Minneap Minn) (2012) 18: 796-806
Wang JJ, et al Zhen Ci Yan Jiu (2013) 38:234-40.
Lo MY et al J Tradit Complement Med (2013) 3:213-220
Ohlsen BA J Chiropr Med (2012) 11:192-201
Linde K et al Cochrane Database Syst Rev 2016 Apr 19;4:CD007587. [Epub ahead of print]
Linde K et al Cochrane Database Syst Rev (2016) Jun 28;6:CD001218. doi: 10.1002/14651858.CD001218.pub3
Coeytaux RR & Befus D (2016) 56:1238-40
More recently Granato et al analysed the current data about the effectiveness of acupuncture on tension-type headache. There were 11 trials involved in 2317 patients. Two trials compared acupuncture wit routine care only or treatment of acute headache only with a 3 month follow-up. Both studies measured responder rate, headache frequency, pain intensity and pain killer intake. They suggested that effect of acupuncture was better controls. There were five trials compared effect of acupuncture with that of sham acupuncture. Four trials had 6 month follow-up and one trial had 12 months follow-up. Numbers of headache days were significantly decreased in acupuncture group. Headache intensity and frequency of taking pain killers was significantly reduced in acupuncture group compared with sham acupuncture group. Three of the four trials compared the effect of acupuncture with physiotherapy, relaxation. Their conclusion is that there was short term benefit by adding acupuncture to routine care and acupuncture could be a nonpharmacological tool for treating patients with tension-type headache.
Schieapparelli P et al also support the effectiveness of acupuncture in treating primary headache particular tension-type headache and migraine. They suggested that acupuncture is an effective and valuable option for patients suffering from frequent tension-type headache and migraine; also acupuncture is cost-effective treatment.
Hao XA et al analysed five high quality trials. They found that the electro-acupuncture might bemore efficacious; needle retention with 30 minutes was better than no needle retention; twice a week treatment was better than once a week treatment. They suggested that acupuncture stimulation mode, needle retention and treatment frequency could be important factors contributing to the outcome of acupuncture for tension-type headache.
Recent research has suggested that acupuncture is effective for tension-type headache
Acupuncture is used to treat tension-type headache and many people who used this treatment have benefit from it. However its effectiveness is questioned by other people. Recently research from Germany has shown the updated data.
In this review, at least eight weeks of observation period is required and twelve trials are included. There were 2349 participants. In two large high quality trials with 1265 and 207 participants, acupuncture was compared with routine care or treatment of acute headaches. Results have shown that the proportion of participants experiencing at least 50% reduction of headache frequency was much higher in groups receiving acupuncture than in control groups. In seven good quality trials acupuncture group had high reduction of headache frequency compared with sham acupuncture. Withdrawals were low: 1 of 420 participants receiving acupuncture dropped out due to adverse effects.
The conclusion from the data suggested that acupuncture is effective for treating frequent episodic or chronic tension-type headaches, but further trials - particularly comparing acupuncture with other treatment options - are needed.
Granato A et al Neuroepidemiology (2010) 35:160-2
Schiapparelli P et al Neurol Sci (2011) 32 Suppl 1:S15-8
Hao XA et al J Alterm Complement Med (2012)
Sunday, 11 March 2018
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.
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.
Saturday, 10 March 2018
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.
According to traditional Chinese medicine (TCM) theory, luteal phase defect is caused by kidney or spleen qi deficiency. Or it is caused by liver qi stagnation. Qi deficiency and stagnation cause blood stagnation and blockage of channels. As a result corpus luteum dies earlier. This is agreed with recent research. During corpus luteum formation, it becomes one of the most highly vascularised organs in the body. Blood flow in the corpus luteum is important for the development of the corpus luteum and maintenance of luteal function. It is important for progesterone synthesis and release. The corpus luteum blood flow in women with luteal phase defect is significantly lower than women with normal luteal function. Increasing corpus luteum blood flow improves its function.
Acupuncture improves ovarian and corpus luteum blood flow. It is very effective to regulate period cycle and restore normal luteal phase. There was a report in Chinese Journals showing effectiveness of acupuncture on luteal phase defect with infertility. 50 patients were diagnosed luteal phase defect. Their age range is from 26 to 42 and average age 32. The history of difficulty to conceive is from 6 months to 4 years. Patients were received acupuncture. Pregnancy rate was calculated. Blood eostrogen and progesterone level was tested; egg development, ovulation and inner lining of womb were checked to measure the effectiveness of acupuncture. Result showed that 40% women achieved pregnancy during 3-6 months. In remaining 53% women, dominant matured egg size was increased, womb inner lining was thicker, blood oestrogen and progesterone level was increased comparing to those before the treatment. Follow up study with those pregnant showed that there was no miscarriage occurred.
Another report from China was about effectiveness of acupuncture treatment on patient with recurrent miscarriage. There were 558 cases with recurrent miscarriage 4 times. 211 cases were treated with acupuncture between 1973-1976; success rate was 86%; 347 cases were treated with acupuncture between 1982-1984, success rate was 93.4%.
Takasaki A et al J Ovarian Res. (2009) 14:2:1
Hongwei Yang and Xueyan Huang Shanghai Journal of Acupuncture and Moxibustion (2010) 10:626-628
Downs KA and Gibson M Fertil (1983) 40:466-8
Friday, 9 March 2018
The first report was by Stener-Victorin et al. 15 years ago suggesting that acupuncture can increase the IVF clinical pregnancy rate (CPR). Since then application of acupuncture to IVF has attracted considerable interest from clinicians to patients themselves. In recent years, there have been many randomized controlled trials (RCTs) evaluating acupuncture in IVF. There were more positive effects from acupuncture during IVF from these researches if treatment times are appropriate, the treatment course is enough.
Acupuncture performed around embryo transfer increases IVF success rate
A decade ago a research study from Germany investigated the effect of adding acupuncture on IVF or ICSI. This was a very well-done study and it was reported in a very highly regarded medical journal. In this study, acupuncture was added before and after embryo transfer. Patients with good quality embryos were chosen and divided into acupuncture group and control group. A maximum of three embryos were transferred into each woman's uterus using established transfer procedures, with the same procedure used for every patient in both groups. Patients in the acupuncture group received two acupuncture sessions – first treatment before embryo transfer, the second treatment after. Point selection played a key role in acupuncture's success. A total of nine points were used on patients in the acupuncture group. Before embryo transfer, PC6 (nei guan), SP8 (di ji), LR3 (tai chong), GV20 (bai hui) and ST29 (gui lai) were used; after transfer, needles were inserted at ST36 (zu san li), SP6 (san yin jiao), SP10 (xue hai) and LI4 (he gu). Points on the spleen, stomach and colon meridians were chosen because of their ability to provide "better blood perfusion and more energy in the uterus"; PC6, LI20, GV20, and ear points 34 and 55 were used to sedate the patient; ear point 58 was used to "influence the uterus"; and ear point 22 was stimulated to stabilize the endocrine system. This is well known acupuncture ivf german protocol. This protocol would optimize uterine receptivity."Six weeks after the embryo transfers were performed, all of the women were given an ultrasound examination. In the control group, the presence of a fetal sac, the scientists' criteria for a clinical pregnancy, was found in 21 women (26.3%). In the acupuncture group, the pregnancy rate was "considerably higher" - 34 women (42.5%) were carrying a fetal sac at the time of examination.
Acupuncture increased embryo implantation potentials
Kong FY et al investigated the effects of acupuncture on embryo implantation potential for patients with infertility. They allocated 210 patients into three groups according to their symptoms differentiated by traditional Chinese medicine. 82 cases of kidney deficiency was group A; 74 cases of liver qi stagnation was group B and 54 cases of phlegm dampness was group C. These patients with infertility were treated with acupuncture and in vitro fertilization and embryo transplantation (IVF-ET). Acupuncture was applied before controlled ovarian hyperstimulation and during ovarian hyperstimulation. The levels of human leukocytes antigen-G (HLA-G) in the serum were determined for evaluating embryo implantation potentials. HLA-G level was measured on the second day of the menstruation, on the day of human chorionic gonadotropin (hCG) injection and on the day of embryo transfer. HLA-G may play a role in immune tolerance in pregnancy and its presence in embryo is associated with better pregnancy rates. They found that acupuncture can increase HLA-G for the patients undergoing IVF-ET; their HLA-G increased on hCG injection day and on embryo transfer day in group A and group B. This increased embryo implantation potential for patients with infertility. Eventually pregnancy rate was improved.
Acupuncture assists IVF to improve live birth rate
In vitro fertilization (IVF) is a costly treatment option for those with infertility. Acupuncture as a complementary technique is applied to assist IVF and increase its success rate. Many researches assessing the effect of acupuncture during IVF were performed. They showed that acupuncture increased pregnancy rate and live birth rate by supporting IVF. But the methods used were varied. Recently a clinical trial protocol of effectiveness of acupuncture to improve live birth rate for women undergoing IVF was published. Smith CA et al conducted a randomized controlled trial to evaluate the effectiveness of acupuncture on assisting IVF. They will recruit women with infertility younger than 43 years of age undergoing IVF or intracytoplasmic sperm injection (ICSI). The treatment protocol will be used. The initial diagnosis and treatment will take 60-90 minutes on days 6-8 of the stimulated IVF cycle. Two treatments will be given immediately before and after embryo transfer (ET). Patients are divided into three groups. 1 acupuncture group: 2 plaebo control: This group will be given placement of non-invasive sham needles. Duration of needling and treatment session is the same as for the acupuncture group. 3 usual care only group: they will receive standard care only. Live birth and pregnancy outcome will be analysed. The research will provide significant evidence for evaluate the effectiveness of acupuncture for assisting IVF.
Acupuncture increased IVF success rate
Craig L et al performed a research to investigate the effect of acupuncture on in vitro fertilization (IVF) performed offsite. They recruited two groups: acupuncture group and control group. In acupuncture group the women were received acupuncture at offsite location for 25 minutes before and after embryo transfer. The protocol they used was that the following points before ET: GV-20, CV-6, ST-29, SP-8, PC-6, LV-3; Shenmen and Brain on the left ear; and Uterus and Endocrine on the right ear. After transfer the points were LI-4, SP-10, ST-36, SP-6, KI-3; Uterus and Endocrine on the left ear; and Shenmen and Brain on the right ear. They found that the pregnancy rate was higher in control group than in acupuncture group.
IVF with acupuncture support has higher live birth rate
Though the effectiveness is still in debate, as early as 2008, Eric Manheimer et al did first systematic review and mega analysis to investigate the effects of acupuncture on pregnancy rates and live birth rates among women with infertility undergoing IVF. This review was published in BMJ. They analysed seven trials involved in 1366 women undergoing IVF. All trials were conducted in four different Western countries and published in English since 2002 in two of the leading reproductive medicine journals either in full articles or abstracts. In all trials, women received acupuncture immediately before or immediately after the embryo transfer. The acupuncture points selected in all trials are fixed and the acupuncture sessions lasted 25-30 minutes. No acupunture was involved. They showed that clinical pregnancy, ongoing pregnancy and live birth rates were improved. There was no side effect found. Their conclusion is that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing IVF.
There was a new review that just came out by Zheng CH et al (July 2012). They did a systematic review to analyse effect of acupuncture during IVF. They found that there were 5 studies involved 463 women who were undergoing IVF. They were given acupuncture twice a week for 2 weeks during the controlled ovarian hyperstimulation period for IVF. All 5 studies showed that pregnant rate was higher in acupuncture group than that in control group for women undergoing IVF.They also analysed other applications of acupuncture during IVF which did not distinguish IVF success rate between acupuncture group and control group which only had one acupuncture treatment around egg collection or embryo implantation. They suggested that most of the courses of acupuncture treatment during IVF were too short to completely correct infertility states caused by long term imbalance. In addition, the acupuncture programs lacked syndrome differentiation and treatment according to individual characteristics. In conclusion, appropriate acupuncture during IVF with suitable time in the cycle, enough treatment courses and individual program is a promising technique to increase IVF success rate.
Effects of acupuncture on IVF-ET for patients with poor ovarian response
There was a case report from Zhongguo Zhen Jiu – an acupuncture journal in China. They studied 60 patients with infertility with poor ovarian response and poor ovarian reserve undergoing in vitro fertilization-embryo transfer (IVF-ET). These patients were divided into two groups: with acupuncture or without acupuncture; 30 cases were in each group. The effect was compared after treatment. After treatment, in acupuncture group, the symptoms of kidney deficiency were improved; estrdiol (E2) level was higher; egg maturation rate, fertilization rate and good quality embryo rate and implantation rate were higher on the day of human chorionic gonadotropin (hCG) injection. The level of stem cell factor (SCF) in follicular fluid and serum was higher in the acupuncture group as well. More importantly the pregnancy rate was higher and abortion rate was lower in acupuncture group. This is a promising research for patients with poor ovarian response and poor ovarian reserve.
Luteal phase acupuncture increased pregnancy rate
Dieteril S et al studied the effect of acupuncture on the outcome of in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Patients with infertility undergo IVF/ICSI. 116 patients received luteal phase acupuncture and 109 patients were in control group receiving placebo acupuncture. They found that the clinical pregnancy rate and ongoing pregnancy rate in acupuncture group were 33.6% and 28.4% respectively which was significantly higher than those for the control group (15.6% and 13.8% respectively). Receiving luteal phase acupuncture is positive for increasing pregnancy rate of IVF and ICSI.
Acupuncture improves egg quality and pregnancy rate for patients with PCOS
Cui W et al investigated effects of acupuncture on egg quality and pregnancy for patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization and embryo transfer (IVF-ET). There were 66 patients with PCOS and infertility and undergoing IVF-ET. These patients were divided into two groups randomly: 34 patients were in acupuncture group and other 32 patients were in control group. Ethinylestradiol and cyproterone acetate tablets and gonadotropin-releasing hormone agonist were applied for long-program superovulation in these patients. Electroacupuncture was applied in the acupuncture group. No intervention was applied in control group. They found that kidney deficiency symptom score was improved better in acupuncture group. All fertilization rate, cleavage rate and high quality embryos were higher in acupuncture group than that for control group. Pregnancy rate and stem cell factor (SCF) level were higher in acupuncture group. SCF is an important factor during embryo development. They concluded that electroacupuncture plays an important role in the pregnant outcomes of patients with PCOS undergoing IVF-ET. It reduces kidney deficiency symptoms and improves clinical pregnant rate by adjusting organic endocrinal system and the local micro-environment of ovary and improving egg quality through the up-regulation of SCF level.
Acupuncture increases live birth in IVF with donor’s eggs
Acupuncture was first reported by Paulus et al to increase clinical pregnancy rate, when a standardized acupuncture protocol was performed immediately before and after fresh, nondonor IVF-ET. 160 patients were participated the study. 80 patients were randomized to the acupuncture group and 80 to the control group. The CPR was higher in the acupuncture group compared to the control group (42.5% versus 26.3%, p=0.03). After this study, similar studies were performed and positive results were also reported to support Paulus et al conclusion. More recently, Hullender Rubin LE et al modified Paulus’s protocol, they found that in donor cycles, live births were higher in the acupuncture group compared with control group.
Stener-Victorin E (1999) Hum Reprod 15:2480–2484.
Kong FY et al Zhongguo Zhen Jiu (2012) 32:113-116
Cui W et al Zhongguo Zhen Jiu (2011) 31:687-691
Smith CA et al Trials (2012) 18:13:60
Zhongguo Zhen Jiu (2009) 29:775-9
Dieterle S et al Fertil Steril (2006) 85:1347-51
Hullender Rubin LE et al J Altern Complement Med (2013) 19:637-43
Evid Based Complement Alternat Med 2012 2012:543924
Craig L et al Fertil Steril (2007) 88 suppl 1:S40
Manheimer E et al (2008) BMJ 8: 545-549
Hopton AK et al BMJ Open (2012)2:e000456
Senderam S et al MMWR surveil Summ (2012) 61:1-23
Nedeljkovic M et al Forsch Komplementmed (2013) 20:112-8
Villahemosa et al Acupunct Med 2013 31:157-62
Paulus et al Fertil Steril (2002) 77:721-4
Hong YL et al Zhongguo Zhong Xi Yi Jie He Za Zhi (2014) 34:1292-6
The main causes of infertility in the UK are unexplained infertility (no identified male or female cause) (25%), ovulatory disorders (25%), tubal damage (20%), factors in the male causing infertility (30%), uterine or peritoneal disorders (10%). In about 40% of cases disorders are found in both the man and the woman.
In 2011, 48,147 women had a total of 61,726 cycles of IVF or intracytoplasmic sperm injection (ICSI) and 2,087 women had a total of 4,091 cycles of donor insemination. A total of 89,648 embryos were transferred during the course of fertility treatment which started in 2011. A total of 13,703 pregnancies were reported as a result of IVF treatment which started in 2011. In the UK, 201,811 babies have been born after IVF treatment between 1991 and 2010. Of the women who received fertility treatment during 2011, they were, on average, 35-years-old and had been trying to conceive for around 4 years (4.6 for IVF, 4 for donor insemination). Four in ten (40.3%) IVF treatment cycles were funded by the NHS in 2011. Acupuncture for infertility treatment is increased from 2.5% in 2002 to 13% in 2009.
Acupuncture helps IVF step by step.
Before egg collection, acupuncture helps follicles (egg) development improving egg quality and uterine lining. Research has shown that IVF egg maturation rate, fertilization rate and good quality embryo rate and implantation rate and the pregnancy rate was increased with acupuncture treatment.
After egg collection, acupuncture continues to help uterine lining development to get ready for embryo implantation. Research has shown that IVF implantation rate and pregnancy rate was higher with acupuncture treatment.
The first report that acupuncture increased IVF success rate was from Stener-Victorin et al in 1999. They applied acupuncture before occytes collection. They found that women in acupuncture group had significantly higher implantation rate, pregnancy rate and live birth rate in IVF embryo transfer. Eric Manheimer et al did first systematic review published in BMJ to investigate the effects of acupuncture on pregnancy rates and live birth rates among women with infertility undergoing IVF. They analysed seven trials involved in 1366 women undergoing IVF. All trials were conducted in four different Western countries and published in English since 2002. In all trials, women received acupuncture immediately before or immediately after the embryo transfer. The acupuncture points selected in all trials are fixed and the acupuncture sessions lasted 25-30 minutes. Clinical pregnancy, ongoing pregnancy and live birth rates were improved. There was no side effect found. Recently a new review found that there were 5 studies involved 463 women who were undergoing IVF. They were given acupuncture twice a week for 2 weeks during the controlled ovarian hyperstimulation period for IVF. The pregnant rate was higher in acupuncture group than that in control group for women undergoing IVF.
Acupuncture helps reducing stress and anxiety in women undergoing IVF.
Research studied the effect of acupuncture on symptoms of anxiety in women undergoing IVF. 43 patients participated in the study. After 4 week treatment the anxiety score for acupuncture group was significantly lower than for the control group. There is perceived stress on the day of embryo transfer (ET). There was a study on the effect of acupuncture on perceived stress and pregnancy rate on the day of ET. In this study, 57 patients with infertility and undergoing IVF or IVF/ISI were involved. Women who received acupuncture treatment achieved 64.7% pregnancy rate while those who didn’t receive acupuncture treatment had 42.5% pregnancy rate. Women with acupuncture had lower stress score both pre-ET and post-ET compared to those without acupuncture. Women with lower stress score had higher pregnancy rate.
Acupuncture helps succeed in first round IVF
A 39 year old woman has been trying to conceive for a year and half. Her husband’s sperm was good. She was very stressed from this. Also she worked very hard and work stress was enormous too. Her fertility test was absolutely normal. Her period was 28-29 days. However she did ovulate a bit early in about day 11 checked by ovulation kit test. Her period was light lasting for 3 days. She also had chronic diarrhea about two to three times a day. She decided to try acupuncture to help with conceiving. She had acupuncture treatment on weekly basis. With the treatment progress, her ovulation was changed to day 12 and then day 13. Her diarrhea was disappeared. Her bowel movement was once a day and no longer loose. Her period last 5 days. Her stress level was decreased and she felt more relaxed. After three month acupuncture treatment, she felt a lot better, but she was still not pregnant. She decided to go ahead for IVF, because age was not on her side and she did not want to wait to get pregnant naturally. She was continuing another two month acupuncture treatment while planning IVF. During the IVF procedure, everything was going smoothly. She had 12 eggs retrieved and 11 of them were fertilised. One of the embryo was transferred and pregnancy test was positive after two weeks waiting.
Acupuncture can help next IVF success after failed IVF.
Recently a research paper has shown that acupuncture increased pregnancy rate in women with previous failed IVF cycles. In this study, there were 84 patients participated the study. These patients had at least two unsuccessful attempts of IVF cycles. The predicted success rate for these patients was 10% for this group of patients. Acupuncture was performed on the first and seventh day of ovulation induction, on the day before egg collection and on the day after embryo transfer. The result has shown that the clinical pregnancy rate in the acupuncture group was significantly higher than that in the control and sham groups (35.7%, 7.1% and 10.7% respectively).
Acupuncture helps decrease ovarian hyperstimulation syndrome during IVF
Ovarian hyperstimulation syndrome (OHSS) is a serious side effect during the procedure of IVF treatment. It occurs in women who are very sensitive to the fertility drugs. Too many eggs develop in the ovaries, which become very large and painful. Abdominal pain, nausea and diarrhoea are common symptoms. Can acupuncture help reduce the chance of OHSS? Recently a research studied the effect of acupuncture on clinical outcomes and the occurrence of OHSS in IVF. 109 patients were divided into two groups: control and acupuncture group. Patients in the control group received controlled ovarian hyperstimulation (COH) referring to GnRH-a long protocol. On the basis of COH, those in the EA group received EA from the day of Gn injection to the day of embryo transfer. Blood tests were monitored on the day of hCG injection, the day of egg collection and the day of embryo transfer. The oocyte retrieval rate, good quality embryo rate, clinical pregnancy rate, the abortion rate, and the occurrence of OHSS were compared between the two groups. Compared with the control group, serum oestrogen E2 levels on the day of egg collection and the day of ET were significantly lower in the EA group. vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) significantly decreased compared with control group on the day of hCG injection, on the day of egg collection and embryo transfer. The occurrence of OHSS and the canceling rate of transplant cycle were significantly lower in the EA group than in the control group. The research suggested that acupuncture as an adjunctive therapy, could reduce the occurrence of OHSS in IVF.
Nedeljkovic M et al Forsch Komplementmed (2013) 20:112-8
Manheimer E et al (2008) BMJ 8: 545-549
Zheng CH et al Evid Based Complement Alternat Med (2012)2012:543924
Kong FY et al Zhongguo Zhen Jiu (2012) 32:113-116
Chen J et al Zhongguo Zhen Jiu (2009) 29:775-9
Cui W et al Zhongguo Zhen Jiu (2011) 31:687-691
Dieterle S et al Fertil Steril (2006) 85:1347-51
Isoyama D et al Acupunct Med (2012) 30:85-8
Balk J et al Complement Ther Clin Pract (2010) 16:154-7
Villahemosa et al Acupunct Med 2013 31:157-62
Meng P et al Zhongguo Zhen Jiu (2008) 28:451-5
Zhang J et al J Tradit Chin Med (2013) 33:294-7
Steward RG et al Fertil Steril (2014) S0015-0282
Ji J et al Hum Reprod (2013) Jul 25
If your AMH is low, there are less small follicles developing in the ovaries which means your egg supply is poor. With increasing women’s age, the size of their pool of remaining small follicles decreases. Low AMH reflects poor egg supply and less chance to get pregnant naturally. Low AMH value means poor response to ovarian stimulation and low IVF success rate. Some women may have problems of recruitment and development of follicles; in this case they have fewer follicles developed and their AMH tends to be low. Women with low AMH would have less chance to have good quality eggs. So they may have difficulty to conceive naturally. Women with low AMH level are likely to have poor response to ovarian stimulation for IVF and have fewer eggs retrieved. This reduces their chance to conceive via IVF.
Low AMH is caused by recruitment problem in follicles development. All eggs in women’s ovaries are at rest, they must be recruited for developing and maturing. If the follicles do not recruit enough there are less follicles developing. For example, in the case of premature ovary failure (POF) the ovary function is damaged and there are less follicles developing, AMH value is low in women with POF. What is important factor in follicle recruitment and development? Ovary microcirculation is the key factor in follicle recruitment and development. Good circulation helps bring nutrients to the follicles and take away the wastes produced in the follicles.
AMH is associated with menopause
Anti-mullerian hormone (AMH) is produced in small antral follicles. AMH concentration reflects ovarian aging. Can it be used to predict age at menopause (AMP)? If AMH falls below a critical threshold which corresponds to follicle depletion, will this leads to menopause? There was a large population study to investigate the relationship between AMH and AMP. In this study, there were 27563 women participated. AMH was measured in these women who attended fertility clinics. They found that the critical AMH threshold vary among women; AMH became undetectable about 5 years before the occurrence of menopause. This indicates that declining population average of AMH is associated with menopause.
Does low AMH means that you cannot have children? It is certainly not. Some women with immeasurable AMH still can get pregnant.
Do you need help if your AMH is low? Yes, though low AMH does not mean that you cannot conceive at all, you chance to conceive naturally and via IVF is indeed very low. Some women are trying for years without success.
Women with higher AMH values will tend to have better response to ovarian stimulation for IVF and have more eggs retrieved. Generally, having more eggs with IVF has a higher success rate via IVF.
Contraception pills decrease AMH levels
Women are trying not to get pregnant by different approaches. Contraception pills are one of the popular options. When taking the pills, does anyone ever think how the pills work? Are there any side effects of the pills? Recently Kallio S et al from Oulu University Finland studied the effect of combined contraception on antimulleria hormone (AMH) levels. There were 54 healthy women completed the study. They received combined contraception treatment for 9 weeks. The drugs were given by oral, transdermal and vaginal methods. Blood samples were taken before, at 5 weeks and 9 weeks of the treatments. They found that AMH, FSH, inhibin B, LH and E2 levels had decreased significantly in all study groups after 9 weeks of treatment. Significant reductions were already detected after 5 weeks use of combined contraceptives. This study suggests that the decrease of AMH during the use of all combined contraceptives indicates that follicle development is arrested independently of administration route of the contraceptives.
There was another study by Bentzen JG et al from Copenhagen University Hospital who compared ovarian reserve parameters between users and non-users of hormonal contraception. They compared the AMH value, the antral follicle count (AFC) and the ovarian volume in 228 users versus 504 non-users of hormonal contraception. Users of hormonal contraception had 29.8% lower AMH concentration, 30.4% lower AFC and 42.2% lower ovarian volume than non-users. AFC in all follicle size was lower in user than non-user of hormonal contraception. These findings were more pronounced with increasing duration of hormonal contraception. No dose-response relation was found.
Does acupuncture help follicles recruitment and development? During the follicle recruitment and development process, ovarian blood supply is the key. Good blood supply to follicles helps the process, because this helps provide enough nutrition to follicles and take away waste produced in the follicles. As we have already known that acupuncture improves ovarian blood flow to produce high quality of follicles and increased numbers of follicles and egg quality. This will improve the chance of conceivingnaturally or via IVF.
Case report: Low AMH, conceived naturally with the help of acupuncture
When you heard that your AMH is low and it is not possible to conceive with your own eggs. Is this really that bad? Actually a low AMH value does not necessarily mean that you cannot get pregnant naturally. You need to make more efforts than anyone else. Here is a story that a woman got pregnant naturally with low AMH. This is a simple story, but you can see the efforts that she made under the pressure of uncertainty and the lack of time.
There was a 39 year old woman who had been trying to conceive for a year without success. A fertility test found out that her AMH was very low (below 1) which was nearly immeasurable. She was determined to get pregnant naturally. She had paid attention to her diet and made sure her diet was healthy. She also had moderate exercise to keep healthy. By chance she found out that acupuncture could help and she kept going to acupuncture treatments on weekly basis. She made great effort and really believed herself. By the end of six months of acupuncture treatments, she got pregnant naturally.
Kallio S et al Fertil Steril (2013) 99:1305-10
Bentzen JG et al Reprod Biomed Online (2012) 25: 612-9
Dolleman M et al J Clin Endocrinol Metab (2013) 98:1946-53
Thursday, 8 March 2018
Signs of poor egg quality: The abnormal menstrual cycles are the signs of poor egg quality, such as irregular periods, spotting, short menstrual cycles or long menstrual cycles, short luteal phase, abnormal hormones, such as high FSH, low eostrogen, low progesterone, low AMH, low antral follicle count are also indicating poor egg quality; poor response to IVF stimulation is another sign of poor egg quality. IVF result has hown poor egg quality. Women’s age: Women over age 35 with difficulty to conceive or miscarriage would have good quality of eggs.
Healthy food can help to improve egg quality which many women have already known and had healthy diet.
As mentioned above the key step to improve egg quality is the blood supply to the follicles. Whatever nutrients you take, they need to reach the follicles via blood circulation. If the circulation is poor, the nutrients cannot reach the follicles.
Research data has shown that acupuncture can help to improve blood circulation to the follicles, as a result this improves egg quality. For example, there was a study involved 60 patients with infertility with poor ovarian response and poor ovarian reserve undergoing IVF-ET. After treatment, in acupuncture group, egg maturation rate, fertilization rate and good quality embryo rate and implantation rate were higher than control group. Most importantly the pregnancy rate was increased. In another study there were 66 patients with PCOS and infertility and undergoing IVF-ET. All fertilization rate and high quality embryos were higher in acupuncture group than that for control group.
Tuesday, 6 March 2018
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.
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]
In women progesterone is mainly made in the ovary. The production of progesterone is increasing rapidly after ovulation. Its level is highest during luteal phase especially from day 19 to day 22 of the menstrual cycle. Progesterone prepares uterine inner lining for implantation; it prevents further ovulation and it makes mucus thicker to prevent sperm to penetrate. If fertilization does not occur, progesterone level drops and menstruation takes place. If fertilization happens, much more progesterone is produced during pregnancy by the placenta. During this period, progesterone prevents miscarriage, because it decreases the maternal immune response to accept the pregnancy; it also reduces uterine smooth muscle contractility. It contributes to the survival and development of the embryo and fetus.
Progesterone is also made in adrenal gland under normal physiological condition. It is also a precursor to oestrogen, testosterone and cortisol- an adrenal cortical hormone. Cortisol is essential for stress response, sugar and electrolyte balance, blood pressure and general survival. During chronic stress condition, progesterone secretion is reduced because the body made more cortisol responding to stress using progesterone.
Low progesterone is very common. The symptoms include infertility, miscarriage, spotting, premenstrual syndrome (PMS), breast tenderness, insomnia, unexplained weight gain and anxiety. Blood test will show progesterone level is lower than normal.
Why progesterone level is lower the chance to get pregnant? Low progesterone level is a sign of poor egg quality. Progesterone is produced in follicles (eggs) and corpus luteum which is developed later on from the follicles. Poor quality follicles and corpus luteum will not produce enough progesterone to reach normal level.
Acupuncture can help ovarian circulation to improve egg quality and corpus luteum quality, as a result progesterone production is increased. Acupuncture can improve adrenal gland function and reduce stress to reduce progesterone usage. This will improve the chance to get pregnant.
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