Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Monday, 19 March 2018

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

Wednesday, 14 March 2018

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.

Sunday, 11 March 2018

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.

Saturday, 10 March 2018

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.

Tuesday, 6 March 2018

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]

Friday, 2 March 2018

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

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