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.

Friday, 1 July 2022

Is acupuncture the right treatment for you?

Is acupuncture a treatment for you?

Acupuncture originates from China over 2500 years and is a part of Traditional Chinese Medicine in which fine needles are inserted into the skin at certain acupuncture points. These needles do amazing job. It is popular all over the world.

The effectiveness of acupuncture is still in debate. There was an article that described different persons acupuncture experiences with different conditions from different practitioners, lady 53 with a prolapsed disc had 6 months acupuncture and avoided a surgery and got back to her normal life again.

This is a typical case who benefits from acupuncture treatment. A person said “I have no knowledge of any parallel universe, so I can’t compare what my life without acupuncture would be like to see exactly how much it has helped, but my feeling is that it does help me, so I won’t stop. Equally, I recognise that it is good to meet a qualified doctor on a regular basis for a one-to-one session lasting 45 minutes.”

A 46 year old described that acupuncture worked every time when he had back pain. Acupuncture is magic for some but torture for others. A 48 year old did think acupuncture helped his back pain.

Acupuncture can be beneficial for emotional wellbeing. Many agreed with this. For example, A  59 year old with terrible chest pains on some family stressful event. After he was told there was nothing wrong by the doctors and pain killers didn’t work, he tried seven session acupuncture and he felt better. He believed that the acupuncture sessions unblocked the emotional energy.

Not all types of acupuncture treatment are the same. That is very true.

References

https://www.theguardian.com/commentisfree/2016/apr/04/is-acupuncture-effective-readers-experiences

Regular acupuncture treatment is a new healthy life style

Many people use acupuncture as their lifestyle choice to help their quality of life. For example, everyone is getting older. With increased age, wrinkles are unavoidable which make some people unhappy and losing confidence. Facial acupuncture has anti-aging effects. It can help reduce wrinkles and rejuvenate the face. Regular acupuncture treatments can also prevent wrinkle formation. Facial acupuncture become one of the lifestyle for facial rejuvenation. Another example, with modern fast paced life, there is lot of stress going on in daily life, acupuncture effectively reduces stress to help people relax and get better sleep. Having acupuncture from time to time helps to keep stress level low. Furthermore, acupuncture can help reduce chronic pain and regular treatment can prevent the pain from coming back. This helps people’s quality of life. Adding acupuncture to your new lifestyle keeps you healthy and looking younger.

 

It’s wonderful to live long. But how? A Japanese doctor lived to 105. Here's his advice for a long life.

Dr. Shigeaki Hinohara, the physician, chairman emeritus of St. Luke's International University, and honorary president of St. Luke's International Hospital recommended several basic guidelines for living a long, healthy life.

Energy comes from feeling good, not from eating well or sleeping a lot. He said that We all remember how as children, when we were having fun, we often forgot to eat or sleep. I believe that we can keep that attitude as adults, too. It’s best not to tire the body with too many rules such as lunchtime and bedtime.

All people who live long — regardless of nationality, race or gender — share one thing in common: None are overweight. For breakfast I drink coffee, a glass of milk and some orange juice with a tablespoon of olive oil in it. Olive oil is great for the arteries and keeps my skin healthy. Lunch is milk and a few cookies, or nothing when I am too busy to eat. I never get hungry because I focus on my work. Dinner is veggies, a bit of fish and rice, and, twice a week, 100 grams of lean meat.

Others include always plan ahead and keep working, stay healthy and do exercise.

He believes that pain is mysterious, and having fun is the best way to forget it. 

Science alone can’t cure or help people. Science lumps us all together, but illness is individual. Each person is unique, and diseases are connected to their hearts. To know the illness and help people, we need liberal and visual arts, not just medical ones.

References

https://www.japantimes.co.jp/life/2009/01/29/people/authorphysician-shigeaki-hinohara/#.W73anmhKiUm

Tuesday, 28 June 2022

After failed IVF to get pregnant, What to do to improve?

Infertility and treatment

If you are having difficulty to get pregnant, you are not alone. It is estimated that infertility affects 1 in 7 couples in the UK and this prevalence is increasing.

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.

Current status of Assisted Reproductive Technology (ART) in the US

Since the first infant conceived with Assisted Reproductive Technology (ART) was born in 1981 in the US, the usage of ART for fertility treatment and the ART service provided by fertility clinics are increasing. Senderam S et al in the US did a survey from the data in 2009. A total 146,244 ART procedures were reported. These procedures resulted in 45,870 live-birth deliveries and 60,190 infants. The largest numbers of ART procedures performed were from six states which were California (18,405), New York (14,539), Illinois (10,192), Massachusetts (9,845), New Jersey (9,146) and Texas (8,244). Nationawide the average number of ART procedures performed per 1 million women of reproductive age (15-44 year old). ART contributed to 1.4% of US births. In Massachusetts it was greater than 4%. Infants conceived wit ART accounted for 20% of all multiple-birth infants, 19% of all twin births and 34% of triplet or higher order births. Among infants conceived with ART, 47% were born as multiple-birth infants while among the general birth population it was 3%. Infants conceived wit ART contributed to about 6% of all low birthweight infants. Among ART-conceived infants, 32% were low birthweight, while among general population there was 8% low birth weight. Infants conceived with ART accounted for 3.9% of all preterm and 4.5% of all very preterm births. Among infants conceived with ART, 33.4% were born preterm, while among general population there was only 12.2% preterm. 6.1% of ART infants were very preterm birth, while only 2% among general population.

40% fertility centers offer acupuncture treatments

Women undergoing in vitro fertilization (IVF) commonly use alternative therapies to improve IVF outcomes and reduce stress, anxiety and depression. Acupuncture is a popular choice for women undergoing IVF. Recently Nedeljkovic M et al conducted a survey to study the state of acupuncture treatments in assisted reproductive technology in fertility centers in Swiss, German and Austrian fertility centers. There were 86 fertility center responded the study. 33 of them offered acupuncture treatments which was about 40%. 39.4% acupuncture points selected were standardized. Body acupuncture using needle stimulation was most frequently applied which was 84.8%. Treatments were mainly by physician-acupuncturist.

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.

Failed IVF cycle, acupuncture can help.

In vitro fertilization (IVF) is an important treatment option for couples with infertility problems. However the success rate is low and Average IVF success rate is 30% and lower if you are over 35 year old. Many couple have to repeat the IVF cycles to achieve pregnancy. And the success rate after failed IVF cycle is even lower. Acupuncture was used to treat different conditions for thousands years. Can acupuncture help IVF to achieve higher success rate after failed IVF? many scientists found promising results to show that acupuncture can help IVF after failure of IVF in some way. Recently a research investigated the effectiveness of acupuncture and moxibustion as an additional treatment in women with failed embryo implantation from IVF and has shown that acupuncture increased pregnancy rate in women with previous failed IVF cycles. In this study, there were 84 patients involved. These patients had at least two unsuccessful attempts of IVF cycles. The predicted success rate for these patients was 10% for this groups of patients. In current cycle, they were divided into three groups: acupuncture, control and sham groups with each group 28 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. Acupuncture and moxibustion were applied. In sham acupuncture group needles were inserted in the area that did not correspond to known acupuncture points. 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). This research has shown that acupuncture is an effective treatment for those women who had previously failed IVF cycles.

Acupuncture performed around embryo transfer increases IVF success rate

The most common assisted reproduction therapy is in vitro fertilization (IVF). In IVF a woman's eggs are harvested and fertilized with a man's sperm in a laboratory. intracytoplasmic sperm injection (ICSI) is used where sperm counts are low. In ICSI, sperm is injected into eggs. Embryos obtained from IVF or ICSI are grown from the sperm and eggs and then transferred into the woman's uterus. IVF and ICSI were used for about 40 years to help with couples with difficulty to conceive, but the success rate is still not satisfactory. Other techniques are used to tend to increase their success rate. Acupuncture has been chosen for this purpose. 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.

How does acupuncture help to achieve higher success rate? A woman's uterus typically undergoes several contractions while an embryo is being transferred, which reduces the chances of successful implantation significantly. Relaxing the uterus during embryo transfer could increase a woman's chances of becoming pregnant. Acupuncture seems to be a useful tool for improving pregnancy rate performed around the time of embryo transfer, mainly by relaxing uterus.

Acupuncture helps reducing anxiety in women undergoing IVF

In vitro fertilisation (IVF) provides great chance for those couples who have difficulty to conceive. However IVF does not always produce pregnancy, actually the success rate is not high. It can be physically and emotionally challenging. Isoyama et al studied the effect of acupuncture on symptoms of anxiety in women undergoing IVF. 43patients participated in the study. 22 patients were in acupuncture group while 21 patients were in the control group. The anxiety level of each patient was analysed before and after treatment. Four weekly sessions were performed. Acupuncture points including HT7, PC6, CV17, GV20 and Yingtang were used for the needling. Their result showed that after 4 week treatment the anxiety score for acupuncture group was significantly lower than for the control group. This indicated that acupuncture can reduce anxiety symptoms in women undergoing IVF.

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.

References

http://www.nice.org.uk/guidance/CG156

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

Isoyama D et al Acupunct Med (2012) 30:85-8

Monday, 27 June 2022

Suffering from fibromyalgia, acupuncture can help

Fibromyalgia, also called fibromyalgia syndrome (FMS), is a long-term condition that causes pain all over the body. It is a chronic disorder characterized by chronic, diffuse and widespread musculoskeletal pain, and its cause is still not clear. Patients with fibromyalgia have increased sensitivity to pain. In addition to widespread pain, there are other symptoms present including debilitating fatigue, sleep disturbance, jointstiffness, headaches and irritable bowel syndrome. People with fibromyalgia have often had depression and anxiety. The cause for fibromyalgia is unknown, but is believed involving psychological, genetic, neurobiological and environmental factors. In fibromyalgia, pain processing and neurotransmitter releasing in the brain are altered leading to lower pain thresholds. Fibromyalgia affects up to 4% of population. The main aims of therapy for this condition are to reduce pain and other symptoms and improve function. Painkillers, antidepressants and antiepileptics are commonly used. As fibromyalgia has a variety of symptoms, no single treatment will work for all of them. You need to find a treatment that suits you. Acupuncture is recommended as an effective option for reducing the pain sensitivity and improving quality of life. There are some evidences emerging showing that acupuncture is a useful treatment option for patients with fibromyalgia and acupuncture may have a great benefit when applied together with medication or other therapeutic options. More recently, Iannuccelli C et al showed that acupuncture could not only control pain but also improve associated symptoms and quality of life. There was a report about the effectiveness of acupuncture on patients with fibromyalgia. These eight women with fibromyalgia received a course of 2 months acupuncture treatments. After the course of acupuncture treatments there was a reduction in the pain threshold and sensitivity and improvement in the of anxiety and depression and quality of life.

A new research has shown that acupuncture is effective on fibromyalgia and the related mechanism. This is randomized controlled clinical trial. 775 women with fibromyalgia participated the study. Treatments were applied twice a week for four weeks. The serum levels of serotonin and SP were evaluated before and after the eight sessions. Patients were clinically assessed by visual analog scale (VAS), the number of tender points (NTP), Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI), and Nottingham Health Profile (NHP) at baseline, after the last treatment, and one and three months after completion of all treatments. The results have shown that serum serotonin values increased significantly and SP levels decreased after treatment. Significant improvements were found in almost all clinical outcomes after treatment. These continued for three months (followup period) after treatments. They concluded that acupuncture may lead to long-term improvements on clinical outcomes and pain neuromediator values.

How does acupuncture work? Acupuncture stimulates nerve endings leading to releasing endorphins and other neurohumornal factors and changing the processing of pain in the brain and spinal cord; acupuncture reduces inflammation by increasing production of vascular and immunomodulatory factors; acupuncture improves muscle stiffness and joint mobility by increasing local microcirculation.

References
Iannuccelli C et al Clin Exp Rheumatol (2012) 30:112-6
Karakay S et al Pain Med (2017) Dec 6. doi: 10.1093/pm/pnx263. [Epub ahead of print]

Friday, 24 June 2022

Need pelvic floor therapy? Acupuncture helps

The pelvis is the lowest part of abdomen. Within the pelvis there are the bowel, bladder, uterus, and ovaries. If something goes wrong with these organs and pelvic surroundings, it can cause pelvic pain. People should know that pelvic pain is not normal. Getting treatment early is important. Pelvic pain can be caused by any of those pelvic organs. Pelvic pain can also originate in the pelvic bones, muscles, nerves, joints, or blood vessels. Pelvic pain from a pelvic floor muscle problem can be helped by a special type of physical therapy known as pelvic floor physical therapy. Pelvic pain sometimes occurs when muscles of the pelvic floor are too tight.


Acupuncture is effective for pelvic floor dysfunction

Pelvic floor consists of muscles and ligaments. These muscles can contract and relax and coordinate with abdominal muscles to assist pelvic organ function. If the pelvic floor muscles and ligaments are impaired and are not be able to contract or relax, this will affect pelvic organ’s function causing pelvic floor dysfunction. For example,50 percent of people with chronic constipation have pelvic floor dysfunction (PFD). The symptoms of pelvic floor dysfunction include urinary problems such as feeling urgent to urinate or painful urination, constipation, low back pain, pain or pressure in the pelvic region, genitals or rectum, discomfort during intercourse, muscle spasms in the pelvis. The common causes of pelvic floor dysfunction are childbirth, pelvic trama, obesity, pelvic surgery, nerve damage. Recent research has shown that acupuncture is an effective treatment for pelvic floor disorders, particularly with respect to pelvic pain.

References

Arnouk A et al Curr Urol Rep. 2017 Jun;18(6):47. doi: 10.1007/s11934-017-0694-7.

What are pelvic floor muscles and pelvic floor

Pelvic floor muscles are the skeletal muscles spread on the bottom of the pelvis. They stretch from front at pubic bone to the back at the tailbone and from one side of the sitting bone to the other side of the sitting bone. They support the pelvic organs including bladder and bowel in men and bladder, bowel and uterus in women. These organs lie on the pelvic floor muscle layer. The pelvic floor muscle layer has holes for passages to pass through. There are two passages in men (the urethra and anus) and three passages in women (the urethra, vagina and anus). The pelvic floor muscles normally wrap quite firmly around these holes to help keep the passages shut. There is also an extra circular muscle around the anus (the anal sphincter) and around the urethra (the urethral sphincter). The sphincters help conscious control over the bladder and bowel so that the release of urine, faeces (poo) and flatus (wind) can be controlled until it is convenient. Pelvic floor muscles are also important for sexual function in both men and women. The pelvic floor muscles in women also provide support for the baby during pregnancy and assist in the birthing process. The muscles of the pelvic floor work with the abdominal and back muscles to stabilise and support the spine.

Pelvic floor muscles have two major functions; they provide 1; support or act as a “ floor” for the abdominal viscera including the rectum and 2; constrictor or continence mechanism to the urethral, anal and vaginal orifices (in females).

Pelvic floor is the area underneath the pelvis and it comprises muscles and connective tissue such as ligaments and fascia. It separates the pelvic cavity above from the perineal region below. It provides support to the bladder, intestines and uterus (in females). It assists with continence through control of the urinary and anal sphincters. It facilitates birth. it helps to maintain optimal intra-abdominal pressure.

Ligaments of the Pelvis

Iliolumbar ligament - from tip of transverse process of L5 to posterior aspect of inner lip of iliac crest; strengthens the lumbo-sacral joint.

Lateral lumbosacral ligament

Sacrotuberous ligament- from sacrum to tuberosity of the ischium

Sacrospinous ligament - from ischial spine to lateral margins of the sacrum

Sacroiliac Ligaments

Ventral/Anterior sacroiliac ligament- from antero-lateral aspect of sacrum to auricular surface of the ilium

Dorsal/Posterior sacroiliac ligament

Upper portion (short posterior sacroiliac ligament) - from 1st and 2nd transverse tubercles of sacrum to tuberosity of ilium

Lower portion (long posterior sacroiliac ligament) - from 3rd transverse tubercle of sacrum to posterior superior iliac spine (PSIS)

Interosseous sacroiliac ligament- lies deep to posterior SI ligament and runs between the tuberosities of the sacrum and ilium

Sacrococcygeal Ligaments

Ventral/Anterio sacrococcygeal ligament -from anterior surface of sacrum to the front of the coccyx; continuation of the anterior longitudinal ligament of the spine

Dorsal sacrococcygeal ligament

Deep portion - from inside sacral canal at the 5th sacral segment to the dorsal surface of the coccyx; continuation of the psoterior longitudinal ligament of the spine

Superficial portion - from free margin of sacral hiatus to dorsal surface of the coccyx; corresponds with the ligamentum flavum of the spine

Lateral sacrococcygeal ligament - from inferior lateral angle of the sacrum to the transverse process of the 1st coccygeal vertebra

Pubic Symphysis Ligaments

Superior pubic ligament - runs between pubic tubercles

Inferior pubic ligament (aka arcuate public ligament) - runs between inferior pubic rami and blends with fibrocartilagnous disc of pubic symphysis

Anterior pubic ligament

Posterior pubic ligament - membranous structure which blends with periosteum

Endopelvic Fascia - Ligaments

Female: Pubovesical ligaments - attach bladder to pubic symphysis

Male: Puboprostatic ligaments - attach bladder to pubic symphysis

Sacrogenital - these are thickenings of the fascia, not specific ligaments

Uterosacral ligaments - attach upper vagina, upper portion of cervix and uterus to the 3rd sacral vertebra

Cardinal ligaments (aka Mackenrodt's) - attach upper vagina, cervix and uterus to the side walls of the pelvis

Round ligaments - attach uterus to mons pubis

Broad ligaments - attach uterus to medial aspect of the ilium

Uracus ligament - attaches bladder to umbilicus (formed from the remnants of the umbilican vein)

Penile Suspensory Ligaments

Penile Suspensory ligament - attaches to anterior aspect of interpubic disc and divides in two to sling around the penis

Fundiform ligament - extends from inferior linea alba and divides to wrap around the penis

Parietal pelvic fascia - lines the internal surface of the muscles of the pelvic floor and walls

Visceral pelvic fascia - invests each pelvic organ

The parietal and visceral fascia are continuous where organs penetrate the pelvic floor. They thicken to form the arcus tendineus, arches of fascia running adjacent to the viscera from the pubis to the sacrum.

Endopelvic fascia* - meshwork of smooth muscle, ligaments, blood vessels and connective tissue lying between the parietal and visceral fascia, sometimes condensing to form fibrous fascial septa which separate and suspend the organs.

Anatomists use the name subserous fascia whereas surgeons refer to this layer of retroperitoneal fascia as endopelvic fascia.

Hypogastric sheath - separates retropubic space from presacral space; conduit for vessels and nerves

Transverse cerical (cardinal) ligaments - part of hypogastric sheath; runs from lateral pelvic wall to uterine cervix and vagina; transmits uterine artery and provides passive support for the uterus

Vesicovaginal septum

Rectovesical septum

Rectovaginal septum

References

https://www.physio-pedia.com/Pelvic_Floor_Anatomy

Thursday, 23 June 2022

Having Bell’s palsy? acupuncture can help.

Bell’s palsy is a rare condition and about 1 in 5000 people in the UK develop the condition each year. Bell’s palsy is facial nerve paralysis caused by facial nerve inflammation with unknown cause. Virus infection is a possible cause. The symptoms include acute unilateral paralysis of all facial muscles. Numbness and pain may be present. They are from mild muscle weakness on side of the face to completely loss of the facial muscle movements of that side. It could affect the eyelid and mouth and make them difficult to open. Other symptoms include irritation of the affected eye, pain underneath the affected ear, increased sensitivity to sound or ringing in the affected ear, drooling from the mouth on the affected side of the face, dryness of the mouth, changed sense of taste, pain around the jaw, difficulty of eating and drinking, impaired speech and headache, dizziness. There is no specific treatment for Bell’s palsy. In most cases of Bell’s palsy, the symptoms will begin to improve within two to three weeks. 70% of patients recover with or without treatments. 30% of patients will continue to have facial muscle weakness in the affected side of the face. 20% will have long term complications including speech problems, reduced sense of taste and permanent tension of the facial muscles. Corticostroids are commonly used to reduce swelling of facial nerve. Acupuncture is used to treat Bell’s palsy in China. How acupuncture help you? Acupuncture can help reduce inflammation by releasing vascular and immunomodulatory factors; acupuncture also help increase local microcirculation by relaxing vascular smooth muscles; acupuncture can stimulate facial nerve and muscles to help nerve recovery.

Many recent researches showed that acupuncture could be effective. For example, Zhou ZL et al studied acupuncture in treating Bell’s palsy. They treated 68 patients using acupuncture and 53 of them were cured. Another example is from Wang Y and Yang J. They studied effects of acupuncture on different stage of Bell’s palsy according to their onset time: active stage, resting stage and recovery stage. They found that acupuncture is effective for all three stages of Bell’s palsy. The best effect is seen in active stage which means the earlier it is treated the better effect it could get. Furthermore, Liang F et al treated 439 patients with Bell’s palsy using acupuncture and moxibustion in four different hospitals in China. They found that acupuncture plus moxibustion had better effects for patients with Bell’s palsy. From thes researches, we can see acupuncture is an treatment option for patients with Bell’s palsy.

References

Zhou ZL et al Zhong Xi Yi Jie He Xue Bao (2012) 10: 997-1002

Wang Y and Yang J Zhongguo Zhen Jiu (2010) 30:23-6

Liang F et al J Tradit Chin Med (2006) 26:3-7

Wednesday, 22 June 2022

How to release pain on the face?

Acupuncture is effective for facial pain

Acupuncture was effective in pain reduction in patients with facial pain. It has immediate effect. A case reported by Goddard G was about effectiveness of acupuncture in patients with orofacial pain. 29 patients with chronic orofacial pain received acupuncture treatment. The pain was assessed before and after acupuncture treatment. Pain score was significantly reduced after the treatment.

Simma I et al studied the effect of acupuncture in patients with craniomandibular disorders, headache and local pain in orofacial, cervical and temporomandibular joint areas using randomized controlled trials. 23 patients were divided into two groups acupuncture group or placebo laser control groups. Pain was assessed immediately before and after the treatment. They found that pain reduction is significantly different between acupuncture group and control group.

Shen YF and Goddard G assessed the effect of acupuncture on chronic myofascial pain. There were 15 patients with chronic myofascial pain. 9 patients received acupuncture and 6 patients received sham acupuncture. Acupuncture was performed at acupoint LI4. The result showed that there was a significant reduction in face pain, neck pain and headache in acupuncture group. Pain tolerance in the masticatory muscles increase significantly more with acupuncture than sham acupuncture.

There was study of dry needling on myofacial trigger points in patients with myofacial syndrome using acupuncture needle. 39 patients were randomized into two groups 22 patients in dry needling group and 17 patients in placebo group. Needles were applied twice a week for two weeks and once a week for one week. They found That dry needling treatment is effective in relieving the pain and improving the quality of life in patients with myofacial pain syndrome.

Case report: Acupuncture for trigeminal neuralgia

Trigeminal neuralgia is a neuropathic pain syndrome. It presents episodic intense pain in the face within the region of the trigeminal nerve. It is often unilateral but can be bilateral. The pain is typically deteriorating which affects quality of life. Various pain killers can be used to treat the pain, but they all have many unwanted effects when they are taken for too long. The effective treatment with fewer side effects is preferred. Acupuncture is one of the effective treatments without side effects. Sert H et al reported a successful acupuncture treatment for a case of trigeminal neuralgia. This was a 66 year old woman with trigeminal neuralgia. She had pain on the left side of her face for 25 year. The pain was triggered by speaking, eating or touching. The pain was severe and on 10 out of scale of 10. The diagnosis by a neurologist was trigeminal neuralgia. All medication she took including carbamasepine, gabapentin and valproic acid did not reduce the pain. Nerve block and radiofrequency rhizotomy of the infraorbital brach of the trigeminal nerve did not work for her either. Based on her existing medication, she was given acupuncture. The points were used including local points TH17 and 21, GB2, SI18, ST2,3 and 7, GV26 and LI20, systemic point included TH5, LI4, ST36, ST44, ST45 and LIV 3. Auricular acupuncture points were also used (Shen Men, neuro face and long points). Needles were not manipulated, and no attept was made to elicit De-Qi. Every session was about 45 min, three times a week, After the fourth session, she reported that she had almost no pain. By the sixth week after 14 sessions of treatment, there was no pain at all. She evaluated the pain 0. There was still no pain at the end of 6 month of follow-up.

Temporomandibular disorder (TMD) is a condition affecting the movement of the jaw. Signs of TMD include: pain around the jaw, ear and temple; clicking noises when moving the jaw; a headache around the temples; difficulty opening the mouth fully; jaw locking when opening the mouth. The pain may be worse when chewing and stressed. TMD can affect sleep. The aim of the treatment is to reduce pain and increase the motion of the joint.

One review analysed the data to study the effectiveness of acupuncture in treating pain from TMD. The data is for 25 years from 1990 t2015. The result has shown that acupuncture treatment appears to relieve the signs and symptoms of pain in myofascial TMD. Another study was from 8 publications involved in 231 patients with TMD. The result indicates that conventional acupuncture therapy is effective in reducing the degree of pain in patients with TMD, especially those with myofascial pain symptoms. Butts R et al reviewed the non surgical treatments for this condition. Based on the research evidence they suggested that acupuncture can help to release the pain and improve the joint movement. For example a study by Gonzalez-perez et al investigated the effect of needling on temporomandibular disorder. 48 patients were divided into two groups needling group and medication group. Dry needling acupuncture was applied once a week for three weeks and assessment was carried out before and after treatment. They found that needling group has better pain reduction than medication group. Pain reduction, maximum mouth opening, laterality and protrusion movements compared with pre-treatment values had significant improvement. There was no side effect found in the needling group.



References
Simma I et al Br Dent J (2009) 207:E26.
Shen YF and Goddard G Pain Pract. (2007) 7:256-64
Goddard G Med Sci Monit (2005) 11:CR71-4
Tekin L et al lin Rheumatol (2012) Nov 9
Sert H et al Clinics (Sao Paulo) (2009) 64: 1225-6
Fermandes AC et al J Oral Facial pain Headache (2017) Summer;31(3):225-232. doi: 10.11607/ofph.1719.
Wu JY et al Medicine (Baltimore) (2017) Mar;96(9):e6064. doi: 10.1097/MD.0000000000006064.
Butts R et al J Bodyw Mov Ther (2017) 21:541-548
Gonzalez-Perez LM et al Med Oral Patol Oral Cir Bucal (2015) 20: e326-33

Tuesday, 21 June 2022

Get repetitive virus infection? Acupuncture can help to boost immunity.

A runny nose, scratchy throat, and nonstop sneezing, sometime fever accompanied-- you can't miss the signs of a cold. One can get a cold year-round, but it is most common to catch cold during autumn and winter. It is known as cold season. People are more likely to get colds when the weather is cold. Do the cold weather makes you sick? Absolutely not. That are the viruses that make one get cold symptoms. The external factors are that viruses that cause colds also spread more easily in colder, drier air- The temperature in autumn and winter is suitable for viruses growing. As a result, in the autumn and winter, there are more viruses. Exposure to viruses is one factor to get cold. In the winter, people spend more time indoors sharing germs with other people. The nasal passages are drier during the winter (due to drier air), allowing cold viruses to gather and grow.

The important internal factor is the immune system function. Why some people don’t get cold while other people who expose to the same viruses do. Why do you seem to get them so often while your friends and family members stay well? This is because some people’s immune function is stronger than others. If you get cold very frequent, you might have weakened immune function.

Acupuncture can help to strengthen the immune function to reduce getting cold.

What is the immune system in the body? Why it is important? The immune system is a defence system in the body containing many organs and cells against diseases such as viral and bacterial infections. Sometimes the immune system does not work well; it can either be underactive or overactive or attack the wrong targets. If the immune system is underactive and low functioning, you could get frequent infections such as viral infection, fungal infection, or chronic inflammation in the body such as aching or pain somewhere in the body or IBS, tiredness etc. If the immune system is overactive, you could get diseases such as allergy, hay fever, eczema, asthma etc. If the immune system targets your own organs, you could get autoimmune disorders such as rheumatoid arthritis. Recent research has shown that acupuncture can help regulate immune system function. For example, a study involved in 34 female patients aged 30-60 with impaired immune function. The result has shown that the improvement of immune function of acupuncture on immune function started from 72 hours after the first acupuncture session and persisted when follow-up time of a month after a year treatments. The impaired immune system in the group was improved significantly to the same level with healthy control group.

References

Arranz L et al Am J Chin Med (2007) 35:35-51

How long it takes for eggs and sperms to grow?

Do you know how follicles (eggs) in women are developed? How long it takes for them to develop? Women are born with millions of follicles. These follicles stay in the cortex of ovaries where they will develop and some of them will be mature and released.

This is a long process and it takes about a year for an egg to develop and to be released. The original follicles are preantral type of follicles. These follicles are in deep sleep stage. Some of them will wake up and be recruited to develop. This is preantral development which is a slow process and it takes about 10 months. This process is hormone independent. After 10 months of development, some of them will be selected to develop to dominant follicles. It takes about 2 months for these dominant follicles to develop to a preovulatory stage. This stage is hormone dependent. And then one of the follicles will be mature and released in 15-20 days which is highly depending hormone balance.

Sperm production in men is different. Sperm production and maturation takes about 74 days. Sperm production takes place in testicles where temperature is lower than body temperature. This process is hormone dependent and follicular stimulating hormone (FSH) and Luternizing hormone (LH) are involved in the process. This process takes about 60 days. Sperms produced then mature in epididymis where they obtain motility and it take about 14 days.

From follicle and sperm production, we can see that it will take about a year to get new eggs and about three months to get new sperms. We can also understand why some of the treatments such as acupuncture for improving fertility take very long time to be effective.

If you are having difficulty to conceive, what could go wrong? Things could go wrong either in women or in men or both. About one-third of infertility is caused by women’s problem. Another one third is due to men’s problem. The remaining one third is caused by both women and men.

Monday, 20 June 2022

70% patients with facial spasm used acupuncture

Hemifacial spasm is an involuntary twitching of the facial muscles on one side of the face. It is a rare condition. In most of cases the spasm starts near the eye and spread down the face over time. The twitching is usually not painful and can interfere with normal expression and vision. The most common cause of facial spasm is that facial nerve was compressed by artery. Facial nerve controls facial muscles that move the eyebrows, close the eyes and move the mouth and lips. The conventional treatments include using anticonvulsants to reduce facial nerve firing and muscle relaxants to make muscles relax.

Acupuncture is an option for facial spasm treatment. A study of effect of acupuncture on facial spasm was published about 10 years ago. In this study 86 patients with facial spasm were involved. They compared the effect of acupuncture with acupressure and they found that acupuncture had better effect than acupressure for facial spasm. Recently Jiang XJ studied the effect of acupuncture on facial spasm. 127 patients with facial spasm were involved in the study. Different acupuncture (fire needle and filiform needle) were used at the same acupoints Taiyang (EX-HN5), Zuanzhu (BL2) and Quanliao (SI18). The effect rate was 92.4% and 87.5% in fire needle group and filiform needle group respectively. This study showed the effectiveness of acupuncture on facial spasm and fire needle method had better effect. Lu ZX used acupuncture combined laser treatment for facial spasm in 190 patients with this condition. They found the effect rate was 93.7% after 30 days treatment which was better than medicine treatment with effect rate 62% (200 cases). From this case report, acupuncture could be a treatment option for patients with facial spasm. A study has shown that most commonly used were acupuncture and facial massage: 71% used acupuncture; 17.6% used facial massage.

References
Jiang XJ Zhongguo Zhen Jiu (2007) 27:509-10
Lu ZX Zhongguo Zhen Jiu (2006) 26:475-6
Li Y and Peng C J Trandit Chin Med (2000) 20:33-5
Int J Clin Pract 2013 67:801-6

Sunday, 19 June 2022

Having PCOS to get pregnant?

We all know women have period cycles, which are normally a month (28 days) with ovulation. Women have two ovaries containing about 1 millions eggs at birth. These are the eggs they ever have and there are no more eggs produced after birth. The existing eggs are lost constantly. By the time at puberty, there are only about 400,000 eggs left. Only 400 to 500 eggs are ovulated in life time. Each month, 15-20 eggs develop and normally only one of them becomes mature (the size of a mature egg is ready to ovulate is about 18-28 mm in diameter) and is released. About 14 days after ovulation the woman would get a period if she is not pregnant. If the eggs in ovaries don’t develop and mature properly, there is no ovulation. This will cause problems in women. Polycystic ovary syndrome (PCOS) is such a condition with ovulation problem. The ovaries in women with PCOS contain many small cysts which are fluid-filled sacs. This is because eggs stop growing and form many cysts; they don’t mature and are not released. Women with PCOS don’t ovulate regularly and they don’t get regular periods either.

If you are diagnosed with PCOS, you are not alone. PCOS is a common ovary disorder affecting 8-10% of women in reproductive age. The symptoms include 1) many small cysts on the ovaries found in the ovary ultrasound scan; 2) irregular period cycles or no periods because of irregular ovulation or no ovulation; infertility and miscarriage; 3) excess body air or thinning hair on the head together with acne because of high levels of testosterone produced by the ovaries. 4) insulin resistance and overweight are common presentation for PCOS.

The infertility rate with PCOS is very high. Although patients with PCOS produce high number of eggs, they are often poor quality, leading to lower fertilization and implantation and higher miscarriage rate. These women have difficulty to conceive and need treatment to improve chances to get pregnant. The reduced fertility is attributed to anovulation, poor egg quality resulting from poor egg development as well as to endometrial abnormalities in women with PCOS. Contribution of endometrial abnormalities and low quality of embryos could explain the higher rate of implantation failure after induction of ovulation or higher risk of spontaneous miscarriage after pregnancy in women with PCOS.

The causes of PCOS are not fully understood. Genetic factor contributes to PCOS. Hormonal imbalance affecting follicle development and maturation is associated with PCOS. hypothalamic pituitary ovarian axis has been disturbed. Pituitary gland is more sensitive to Gonadotropin releasing hormone (GnRH) produced in hypothalamus. The hormone imbalance includes follicle stimulating hormone (FSH) deficiency, hypersecretion of luteinizing hormone (LH), high level of androgen and high blood level of insulin with insulin resistance. Women with PCOS have lower FSH compared with women without PCOS. FSH deficiency results in accumulation of smaller follicles which have undergone premature arrest and failed to become dominant follicle. Women with PCOS produce more LH during the follicular phase in their cycles. Luteinizing hormone (LH) pulse is increased in frequency and amplitude together with low follicle stimulating hormone (FSH) production. Increased LH stimulates androgen production and decreased FSH impairs follicle development, maturation and ovulation. androgen level is elevated which results in the clinical symptoms: hair overgrowth and acne. High level of androgens, are found in the blood circulation. These excessive androgens mainly produced in ovaries. A part of these androgens are produced in adrenal gland. High level of androgen is associated with increase LH level which may block dominant follicle development and cause follicular arrest and degeneration. Insulin may be involved in follicle recruitment and it may be an important mediator in follicle development. Insulin resistance may impair follicle development resulting in compromised fertility and miscarriage.

Recent research suggested that increased sympathetic nerve activity may be involved in the pathology of this condition. The greater density of sympathetic nerve fibres in polycystic ovaries has been seen and this increased ovarian sympathetic nerve activity might contribute to PCOS by stimulating androgen secretion. Women with PCOS have increased nerve growth factor (NGF) which is a strong marker for sympathetic nerve activity. Women with PCOS have increased muscle sympathetic nerve activity (MSNA), altered heart rate variability and attenuated heart rate recovery post exercises, compared with age and BMI matched controls. This suggests that there is an increased sympathetic nerve activity in women with PCOS. High testosterone was related to high sympathetic nerve activity in women with PCOS and the degree of androgen concentration can reflect the severity of PCOS which indicates that the degree of increased sympathetic activity is related to the degree of PCOS severity. Physical exercise and low frequency electroacupuncture decrease high level of sex steroid precursors, estrogen, adrgens and androgen metabolites. Physical exercises and acupuncture decreased high sympathetic activity in women with PCOS. Renal sympathetic denervation reduced MSNA and blood pressure and improved insulin sensitivity in some patients with PCOS and hypertension. Reduction of sympathetic nerve activity could be new treatment target of PCOS. Also inflammatory substances in blood increased in women with PCOS indicating the involvement of inflammation to PCOS. Stress is a risk factor of PCOS. Changing of follicular fluid microenvironment could impair egg development. Research showed that higher emotional distress was consistently found for women with PCOS compared with control populations.

There is no gold standard long term treatment for women with PCOS. For many years oral contraceptive pills played an important role in treating PCOS which normalises menstrual cycles and reduces excessive hair growth and acne. Antiadrogens also used to treat excessive hair growth. With the increasing understanding the role of insulin resistance associated with PCOS new agents-the insulin sensitizers such as metformin are introduced in the treatment of PCOS. There are other therapeutic options are emerging such as statins are a promising therapies. Vitamin D, B12 and folate may improve insulin resistance which is beneficial for women with PCOS, though this needs more research to confirm. Pharmacological treatment is effective but associated with unwanted side effects. The use of acupuncture for women’s fertility treatment becomes very common. Up to 22% of women use acupuncture for their infertility treatment in the US and about 8% in the UK. Recent research showed that acupuncture improves period cycles and ovulation as well as excessive hair and acne in women with PCOS.

Acupuncture had effect on excessive androgen and period change in women with PCOS. Polycystic ovarian syndrome (PCOS) presents hyperandrogenism which is a medical condition that is characterised by excessive production of androgen. The symptoms include high acne, excessive hair growth and high testosterone level. Less frequent or absent period and polycystic ovaries. Oral contraceptives, metformin and lifestyle change are recommended for the treatment for women who don’t want to improve fertility. Side effect could be the problems for long term treatment. People tend to seek alternative treatment for the condition. Jedel E et al studied the effect of acupuncture in women with PCOS. They allocated 84 women with PCOS aged 18-37 to three groups: acupuncture group, physical exercise group and no intervention group. 16 weeks treatment was carried out for these patients. After 16 weeks treatment, blood testosterone level and acne score were decreased, whereas menstrual frequency increased in the acupuncture group and exercise group compared to no intervention group; acupuncture group improved significantly greater than that for exercise group. Their conclusion was that both acupuncture and physical exercise had effect to treat excessive androgen and less frequent period or absent period and acupuncture had better effect than physical exercise intervention.

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. The first-line medical treatment for women with PCOS to improve fertility outcomes is clomiphene citrate. The second-line medical treatment is donadotrophins, laparoscopic ovarian surgery or metformin, if clomiphene citrate becomes resistant in women with PCOS. Because women with PCOS need prolonged treatments and these medical treatments often accompany numerous side effects. Seeking alternative treatments with less side effects could help ovulation and other symptoms. For example, lifestyle change could help infertile anovulatory PCOS in women who are overweight or obese. Clinical and experimental evidence indicates that acupuncture may be a safe alternative or complement in the treatment in women with PCOS.

Much research evidences has shown that acupuncture helps with PCOS associated infertility and other PCOS symptoms

A study summarized the clinical researches for PCOS treatment with acupuncture from recent years in China. The study showed that ovulation rate with acupuncture treatment was improved about 80% and pregnancy rate achieved was about 60%. Other symptoms were also improved. Stener-Victorin et al studied effect of acupuncture on ovulation in 24 women with PCOS. The result showed that 10-14 acupuncture treatments in 3 months significantly increased ovulation and period cycles in women with PCOS. There were some published randomized controlled trials which studied effectiveness of acupuncture on women with PCOS associated infertility. The results showed significantly higher pregnancy rate in the acupuncture groups compared to the control groups.

There are physiological bases that could explain why acupuncture treatment is effective on PCOS. Acupuncture stimulates autonomic nerve activities. Stimulation of peripheral nerve terminals causes release of neuropeptides which increase blood flow. Stimulation of nerves on abdomen and legs reduced sympathetic nerve activities in ovaries resulting in increasing ovary blood flow. Acupuncture stimulates peripheral nerve and the signals transmit to central nervous system. This improves function of hypothalamic-pituitary-ovarian axis, regulates blood hormone levels, increases antiinflammatory substances and improves ovary ovulation. Also acupuncture could reduce ovarian cyst size and number. Acupuncture helps reduce stress in women with PCOS.

There was study that investigated effect of acupuncture on egg quality and pregnancy rate for patients with PCOS undergoing IVF. They found that egg quality, fertilisation rate and quality of embryo were all higher in acupuncture group than that for control group with no intervention. Higher pregnant rate was achieved in acupuncture group. Acupuncture improved egg quality as well as local environment of ovaries.

PCOS increases risk of depression and anxiety and negatively affects health-related quality of life. Life style change on diet and exercise is essential and proved that this decreased depression and improved quality of life. E Stener-Victorin et al studied the effect of acupuncture and exercises on depression, anxiety and impaired quality of life in women with PCOS. 72 women with PCOS were recruited in the study. 28 women were offered acupuncture and 29 women were offered physical exercise and 15 women were assigned with no intervention. The treatments were lasted for 16 weeks for different interventions. Total 14 acupuncture treatments over 16 weeks were offered. Physical exercise program included regular exercise, such as walking, cycling or any other aerobic exercise at a self-selected pace. The frequency of exercise was at least 30 min and at least 3 times a week. This lasted 16 weeks. The assessment was at the end of 16 week treatment and 16 week follow-up after the last treatment. The results showed that depression and anxiety scores were reduced at the end of the treatment and the follow-up in the acupuncture group; the quality of life such as physical, energy/vitality, general health perception and the mental component was also improved in the acupuncture group. The quality of life such as general health perception, physical functioning and emotion was improved in exercises group.

Acupuncture is beneficial for patients with PCOS and obesity

Obesity is also associated with infertility with anovulation. It also causes pregnancy loss and late pregnancy complications. There is a link between PCOS and obesity. Women with PCOS have increased the chances of obesity and up to 66% of them are obese. Women with obesity are more likely to develop and express PCOS. PCO is present in about 20% women and many of them do not have other symptoms, such as abnormal period, acne, excessive hair growth, insulin resistance, impaired glucose tolerance, type 2 diabetes, cardiovascular diseases. These symptoms are likely to appear if the women become obese or over weight. Obesity could worsen these symptoms increasing the risk of type 2 diabetes and cardiovascular diseases. Weight loss can improve those symptoms. Preventing obesity can reduce the chances of developing PCOS. Abdominal obesity in particular is associated with anovulation and infertility. Obesity in PCOS is related to failure or delayed response to many infertility treatments. Obese women with PCOS were associated with an increased risk of miscarriage. Obese women with PCOS undergoing IVF had fewer eggs collected and lower fertilised eggs resulting in lower pregnancy rate. Study showed that after losing 5% of initial body weight obese women with PCOS improved spontaneous ovulation and spontaneous pregnancy rate. Reducing abdominal obesity is very effective to restore ovulation. Weight loss before conception also improved live birth rate in those women. Weight loss prior to start of infertility treatment can be a good option.

Research studies have shown that acupuncture can help reduce weight and improve ovulation and menstrual frequency. For example Zheng et al studied abdominal acupuncture for patients with obesity-type PCOS. They compared the effect of acupuncture with that metformin. After 6 month of treatment body mass index (BMI), waist to hip ratio (WHR), Ferriman-Gallwey score, ovarian volume, LH hormone, ratio of lLH and FSH, testosterone, LDL-C, triglycerides, total cholesterol, fasting blood glucose, 2-hour postprandial blood glucose, fasting insulin, 2-hour postprandial blood insulin, and HOMA-IR were reduced significantly in both groups. Acupuncture had better effect on reducing BMI, WHR and increasing menstrual frequency and had fewer side effects compared with those with metformin.

Lai et al studied the effect of acupuncture on polycystic ovarian syndrome (PCOS). There were 86 patients with PCOS and obesity involved in the study. These patients were divided into two groups: acupuncture group and metformin group. In acupuncture group the patients received abdominal acupuncture for 6 months. Body mass index (BMI), waist-hip ratio (WHR), Ferriman-Galleey score (FGS) which is the method to assess overgrowth hair, menstrual frequency (MF), ovarian volume (OV) were measure and compared before and after the treatments. Hormonal levels including follicle stimulating hormone (FS), luteinizing hormone (LH), testosterone hormone were tested as well. In addition fasting blood glucose and insulin, insulin resistance and blood lipid levels (LDL and HDL) were tested. As a result, they found that BMI, WHR, FGS and OV were significantly reduced after treatment in both groups (acupuncture group and metformin group). Menstrual frequency was significantly increased after treatment in both groups. Hormone levels including LH, LH/FSH and testosterone were decreased after treatment in both groups. Fasting blood sugar and insulin, insulin resistance and LDL were decreased, while HDL was increased in both groups. They concluded that acupuncture was beneficial for patients with PCOS and obesity.

Acupuncture could increase insulin sensitivity and reducing blood sugar levels; it also reduces cortisol levels and helps weight loss and eating disorders. Insulin resistance is closely linked to obesity, type 2 diabetes, hypertension, PCOS etc. Liang F and Koya D analysed 234 publications in English from 1979 to 2009 on the effect of acupuncture for the treatment of insulin resistance. These literatures provided evidence to support the effectiveness of acupuncture for treating insulin resistance.

Current opinions on effect of acupuncture to treat PCOS

Recently Lim CE and Wong WS did a review to investigate the effect of acupuncture on polycystic ovary syndrome (PCOS). They obtained and assessed all available acupuncture studies on women with PCOS from June 1970 to June 2009. From this review they found that acupuncture is effective for PCOS treatment. Several studies showed that acupuncture increased beta-endorphin levels which last up to 24 hours; acupuncture may affect hormone levels including follicle stimulating hormone (FSH), luteinizing hormone (LH) and androgen. Acupuncture affects the hypothalamic-pituitary-adrenal axis to contribute to reducing stress. They concluded that acupuncture is a safe and effective treatment for PCOS and no side effects were found. The possible mechanism of the acupuncture treatment of PCOS includes increasing ovarian blood supply, reducing ovarian volume and ovarian cyst numbers. Acupuncture could increase insulin sensitivity and reducing blood sugar levels; it also reduces cortisol levels and helps weight loss and eating disorders. Insulin resistance is closely linked to obesity, type 2 diabetes, hypertension, PCOS etc. Liang F and Koya D analysed 234 publications in English from 1979 to 2009 on the effect of acupuncture for the treatment of insulin resistance. These literatures provided evidence to support the effectiveness of acupuncture for treating insulin resistance.

Stress is a risk factor for PCOS and acupuncture helps to reduce stress

Polycystic ovary syndrome (PCOS) is a common cause of anovulation leading to infertility. A research analysis showed that emotional distress is a common risk in women with PCOS. This conclusion was drawn from meta-analysis of 28 studies from Veltman-Verhulst SM et al in University Medical Center Utrecht, The Netherlands. They examined emotional distress and its association in women with PCOS. The data was obtained up to November 2011. 28 studies included 2384 patients with PCOS and 2705 women in control population. Higher emotional distress was consistently found for women with PCOS compared with control populations, though distress scores mostly remain within the normal range. More recently Murri M et al analysed data up to June 20120 to study oxidative stress and PCOS. Their results were from 1633 studies including 4933 patients with PCOS and 3671 controls. They found that patients with PCOS have higher circulating markers of oxidative stress compared with controls. Oxidative stress may contribute to the pathophysiology of PCOS.

Acupuncture was effective to treat PCOS and acupuncture was also effective to reduce stress. Research showed that 8 weeks acupuncture intervention could help reduce infertility related stress. Acupuncture treatments help change social and relationship concern and reduce anxiety. They felt more relaxed than those without acupuncture treatment.

Recently there is another study on acupuncture for PCOS. In this study, 101 women with PCOS participated. The main acupuncture points used were Zhibian (BL54) and Shuidao (ST28) together with other acupuncture points which chosen individually. After 5 courses of acupuncture treatments basal body temperature was improved and the follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH and testosterone (T) were significantly reduced.

New research shows acupuncture increases ovulation frequency in women with PCOS

Am J Physiol Endocrinol Metab 2013 published a paper titled Acupuncture for ovulation induction in polycystic ovary syndrome (PCOS): A randomized controlled trial. This research has been done by Stener-Victorin E group. They investigated the effects of acupuncture on ovulation frequency and the mechanism. 32 women with PCOS participated the research. Acupuncture performed twice a week for 10-13 weeks. Previously acupuncture has already been proven to improve menstrual frequency and decrease circulating testosterone in women with PCOS. After 13 weeks of intervention, luteinizing hormone (LH) secretion patterns were changed. Ovulation frequency was higher in acupuncture group compared with control group. Ovarian and adrenal sex hormones Levels decreased significantly in acupuncture group compared with control group.

PCOS takes place when the normal cycle is disrupted due to anovulation. This creates hormonal imbalance with increased oestrogen and androgen in the circulation and without progesterone. Acupuncture increases ovulation frequency and restore hormonal balance.

There are about 10-20% of women have PCOS. The conventional treatments include using birth control pills to inhibit hormone production and using new drugs like metformin a type II diabetes agent to lower insulin resistance. However these treatments are not particularly successful with many side effects. Acupuncture is a promising approach to treat PCOS.

Another study investigated the effects on ovulation and reproduction promotion with acupuncture and clomiphene in PCOS. In this study, 80 patients with PCOS were allocated into two groups: acupuncture plus clomiphene group and control group with clomiphene only. In the control group, since the 5th day of menstruation or medicine-withdrawal bleeding, clomiphene was prescribed for oral administration, continuously for 5 days. In the acupuncture plus medication group, the medication was the same as the medication group. In addition, the acupuncture was added three times a week. The treatments duration was three months. The result has shown that The ovulation rate in the acupuncture plus medication group was higher than that in the medication group; endometrial thickness and morphology in the acupuncture plus medication group were better than those in the medication group; the levels of estrogen and progesterone in the serum in the window period of implantation, the results in the acupuncture plus medication group were higher remarkably than those in the medication group. The pregnancy rate in the acupuncture plus medication group was higher than the medication group in tendency,

A systematic review was to evaluate the current evidence from randomised controlled trials (RCTs) on the efficacy/effectiveness of acupuncture provided during IVF or ICSI at achieving pregnancy in women with PCOS, and to consider its safety. The participants were women with PCOS undergoing IVF or ICSI. Outcomes included the clinical pregnancy rate (CPR), live birth rate (LBR), ongoing pregnancy rate (OPR) and incidence of ovarian hyperstimulation syndrome (OHSS) and adverse events (AEs). Four RCTs including 430 participants were selected. All trials compared acupuncture (MA/EA) against no treatment. The result has shown that acupuncture significantly increased the CPR and OPR and decreased the risk of OHSS ; however, there was no significant difference in the LBR. None of the RCTs reported on AEs. Their conclusion is that acupuncture may increase the CPR and OPR and decrease the risk of OHSS in women with PCOS undergoing IVF or ICSI.


References

Raja-Khan N et al Am J Physiol Endocrinol Metab (2011) 301:E1-E10.

Jedel E et al Am J Physiol Endocrinol Metab (2011)

Stener-Victorin E et al Ata Obstet Gynecol Scand (2000) 79:180-8

Cui W Zhongguo Zhen Jiu (2011) 31:687-91

E Stener-Victorin et al BMC Complement Altern Med (2013) 13:131

Alexandra Bargiota and Evanthia Diamanti-Kandarakis Ther Adv Endocrimol Metab (2012) 3:27-47

Lai MH et al Zhen Ci Yan Jiu (2010) 35:298-302

Lim CE and Wong WS Gynecol Endocrinol (2010) 26:473-8

Liang F and Koya D Diabetes Obes Metab (2010) 12:555-69

Veltman-Verhulst SM et al Hum Reprod Update (2012) 18:638-51

Murri M et al Hum Reprod Update (2013) Jan 16

Zheng YH et al J Altern Complement Med (2013) 19:740-5

Yu L et al Zhongguo Zhen Jiu 2018 Mar 12;38(3):263-8. doi: 10.13703/j.0255-2930.2018.03.009.

Jo J & Lee YJ (2017) Acupunct Med 35:162

Saturday, 18 June 2022

Heat wave, chrysanthemum tea helps you to stay cool---Chinese herbal tea

Summer tea: Chrysanthemum tea can help to clear heat, reduce inflammation and remove toxin from the body. It is good for eyes. 

Read more about acupuncture at www.drmaggiejuacupuncture.co.uk

Friday, 17 June 2022

Not ovulating to get pregnant? What to do?

Not ovulate, acupuncture improves ovulation

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

Hypothalamic-pituitary causes

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

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

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

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

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

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

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

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

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

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

Here are some typical cases.

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

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

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

Case report for effectiveness of acupuncture on infertility caused by anovulation

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

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

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

Thursday, 16 June 2022

Acupuncture for Multiple Sclerosis (MS)

Multiple Sclerosis (MS) is a degenerated central (brain and spinal cord) nervous system disorder. The insulating nerve cover in the brain and spine is targeted and damaged by the immune system. This results in loss of function of the nervous system causing various symptoms depending which nerves are affected most. There are 2.3 milion people worldwide suffer MS. Medical management limits the frequency and intensity of disease activity, but only for persons with relapsing-remitting MS. The most common type of MS is relapsing-remitting (RR) MS. In this type, s series of attacks followed by complete or partial disappearance of the symptoms until another attack occurs. It may be weeks to years between the attacks. The symptoms can be from mild to severe. Vision disturbances could be the first sign of MS. Limb weakness with or without difficulty of coordination and balance could be early symptom. Other common symptoms include muscle spasm, fatigue, numbness and pricking pain. Loss of sensation, speech impediment, tremors or dizziness can exist. Mental changes include lack of concentration and attention, memory loss, impaired judgment and performing sequential tasks, depression etc. Sexual dysfunction and reduced bowl and bladder control can develop as the disease worsens. Early treatments are recommended for patients with MS. Apart from medications, patients with MS are seeking complementary and alternative medicine (CAM) as an additional treatment option.

Acupuncture has been used in the management of neurologic conditions such as stroke, spinal cord injury, and Parkinson's disease. Acupuncture is also used in treating MS. There are also some studies on the effect of acupuncture on MS. This study is involved in a few aspects such as MS quality of life, MS fatigue, MS spasticity and MS pain.

A study evaluated the efficacy of acupuncture in treating forty-nine MS patients with chronic pain. Patients received biweekly acupuncture treatments for six months and noticed significant improvements in the Oswestry Disability Index (ODI).

From these studies we can see acupuncture is a potential treatment option for MS patients, though much of the research needed for the efficacy of acupuncture.

There was a report by Kerr Grieve et al from Tayside MS research unit, Ninewells hospital and medical school, Dundee, Scotland. They had positive data to support that acupuncture is an effective treatment for pain and other MS symptoms. There were 20 patients with MS involved in the research. 85% were female aged 20 to 60 years. Duration of diagnosis was 1-29 years. All of the patients had been attending the clinic for between 3 and 24 months. The majority were receiving acupuncture on six weekly bases. 18 patients had some reduction in pain. 9 patients scored the level of pain relief as 8/10 or better. 18 patients had pain relief for four or more weeks. Improvement of sleep pattern, mood, energy levels and mobility was also subjectively improved, though not as much as pain relief. 9 patients had a temporary increase in pain. 55% of patients reduced their use of pain killers and 3 stopped additional pain killers completely. The authors were confident that acupuncture could be a treatment for pain and other MS related symptoms for patients with MS.

Recently a survey conducted by Stoll SS et al from Neurology department in Drexel University College of Medicine Phyladelphia USA about using CAM treatment for patients with MS. 111 patients with MS completed the survey properly. All patients used non disease-modifying agents (non-DMA agents). 65 patients (58.6%) exercised on a weekly basis. 64 patients (57.7%) used CAM therapies such as acupuncture and massage, or osteopathic manipulative treatment and psychotherapy.

Quispe-Cabanillas JG et al investigated the effect of acupuncture in 31 patients with relapsing-remitting type of MS under treatment of immunomodulators. The patient’s quality of life was assessed to evaluate the effectiveness of acupuncture. They found that acupuncture improved various aspect of quality of life for those patients including reduction in pain and depression. Foroughipour M et al also observed the effectiveness of acupuncture in 20 patients with MS. They found that 12 sessions of acupuncture improved the fatigue symptom in patients with MS who were resistant to the medication amantadine.

A recent research found that three months of acupuncture treatment reduce MS symptoms and disability score in 3-month and 6-month follow-up were reduced as compared with those before treatment and annual recurrent rates were also reduced with acupuncture treatment.

References
Quispe-Cabanillas JG et al BMC Complement Altern Med (2012) 12:209
Foroughipour M et al Acupunct Med (2012)
Kerr Grieve et al J Neurol Neurosurg Psychiatry (2013) 84:e2.
Karpakin HI et al Evid Based Completment Alternat Med (2014) 2014:972935
Wang C et al Zhongguo Zhen Jiu (2017) Jun 12;37(6):576-580. doi: 10.13703/j.0255-2930.2017.06.002.

Wednesday, 15 June 2022

Have cold feet and hands in the summer? Is this normal?

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

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

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

Tuesday, 14 June 2022

How does age affect fertility? get help from acupuncture.

Age affects fertility

A more recent study of university students in Sweden found that half of the female students were not aware of the age-related decline in fertility and intended to have children after the age of 35. 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 normal women?

Study showed that a woman’s optimal fertility age is before 30-31 years. And then fertility decreases gradually and this decline is accelerated towards age of late thirties. It is generally accepted that reproductive ageing is ovarian ageing and the quantity and quality of the pool of follicles in the ovary decreases. 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.

Age and mother’s menopause affect women’s fertility

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. 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 two approaches to assess the supply of eggs remaining in the ovary: anti-Mullerian hormone (AMH) and antral follicle count (AFC). Researchers found that both AMH and AFC declined faster in women whose mothers had an early menopause ( before the age of 45) compared with women whose mothers had a late menopause (after the age of 55). Dr Valentine Akande, a consultant gynaecologist and spokesman for the British Fertility Society said that the findings were helpful, but that women should not be overly concerned if their mother did have an early menopause. The variation of egg quantity in women is enormous. The earlier you are trying for a baby the more chances to be successful.

With age disadvantage and high FSH you still have chance to get pregnant

When women reach their forties, their fertility falls down. As mentioned above in humans the follicles in ovaries are fixed at birth and decrease with age. The follicles are constantly disappearing either died or growing to ovulate. From the age of about 35 onwards, fertility declines quickly. This presents that the number and quality of eggs decrease; also genetic abnormalities and spontaneous abortion increase noticeably with female age. The rate of follicular depletion speeds up resulting in a decreasing number of good qualities of follicles. A protein inhibin B produced by follicles dropped and FSH is elevated in circulation. FSH is a hormone produced by pituitary gland which is located in the brain. FSH stimulates ovaries for eggs growth. If your ovaries don’t function well or you run out of eggs, your ovaries do not respond to FSH like normal ovaries do, the eggs don’t grow well. In this circumstance your pituitary gland works hard to produce more FSH trying to stimulate ovaries function and eggs to grow. As a result your FSH level is high, which means that you have poor ovarian response or poor ovarian function or poor ovarian reserve or ovarian failure. Your egg quality and quantity will be poor. Also endometrial lining became impaired as well. All of these contribute to the declined fertility with aging.

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.

How high is FSH that can be treated to achieve pregnancy? There was a case report that a woman with premature ovarian failure and high FSH 164miu/ml was treated and got pregnant in her ninth cycle treatment and delivered a healthy boy.

Is there other treatment available for high FSH? Estrogen or birth control pills will temporarily suppress FSH to normal level. However this does not improve your infertility

Can acupuncture help if your FSH is higher than normal? Acupuncture can stimulate the nerve ends to the ovaries and improve ovarian blood flow and help follicles grow, as a result this restore hormonal balance and lower FSH. Acupuncture also stimulates the brain and rebalances the hormones.

NHS offers IVF to women in age 40-42

New NHS guidelines state that couples struggling to have a baby should get fertility treatment more quickly and older women should gain access to IVF. The guidelines recommend that women aged between 40-42 should be offered one cycle of IVF if it is their first time and they have enough eggs; women aged under 40 are offered three cycles of IVF. It is widely known when a woman reaches her 30s her fertility begins to decline, and this decline in fertility is speeding up in her late 30s. IVF success rate is going down with increased age. IVF success is rare in women over 45.

Why this is the case? The ovary aging is the cause of this declined fertility. It has become clear that the decline in fertility with increasing female age is largely due to a rapid decrease in egg quantity and quality with a higher proportion of eggs having genetic abnormalities. On the contrary, the reproductive capacity of the uterus does not decrease with age even in late 40s and 50s. This is seen in the use of younger donor eggs, women who are menopausal can achieve very high rates of conception.

Fertility declines with aging in both men and women and acupuncture can help.

Women are born with all eggs in the ovary which cannot be divided into other cells. The egg numbers are only declining with age. The process is speeded after women turn 35 years of 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 both men and women 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. In women, fertility is significantly lower in the 30s and 40s. The number of eggs decline, woman’s menstrual cycle become shorter, menstrual irregularity begins 6-7 years before menopause, infertility increases, the time to pregnancy increases and also the chances of staying pregnancy becomes lower. If you start trying to get pregnant and there is still no luck, this could be not because something is wrong, but it could simply because you and your partner’s age. It takes longer for you to get pregnant. In this situation, apart from changing life style and exercises etc that you can help yourselves, why don’t you try acupuncture? Acupuncture is recommended as one of the treatments to encourage fertility by some doctors.

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
http://www.bbc.co.uk/news/health-21505578
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

Look after your bowel with acupuncture

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic or recurrent abdominal pain or discomfort, which is associated with disturbed bowel function and feelings of abdominal distention and bloating. The prevalence of IBS reaches up to 10% globally and affects all age groups. It is associated with a significant reduction in health-related quality of life. IBS is caused by multiple factors, including intestinal motility and intestinal smooth muscle functional disturbance, visceral paresthesia, alterations in the brain-gut axis, psychological factors, gastrointestinal hormones, and intestinal infection. This condition is not life-threatening, but leads to significant impairment of health-related quality of life, which causes physical role limitations as well as pain and a lower perception of general health. There is no universally accepted satisfactory treatment for this condition. No drug is effective in treating all the symptoms of IBS. Very recently, A study has analysed existing data and suggested that acupuncture improves the symptoms of IBS, including abdominal pain and distension, sensation of incomplete defecation, times of defecation per day, and state of stool. No serious adverse events associated with acupuncture. Acupuncture might modulate pain in IBS by two actions: (1) modulation of serotonin pathway at insula; and (2) modulation of mood and affection in the higher cortical center via the ascending pathway at the pulvinar and medial nucleus of the thalamus (3) Improvement in pain in IBS was positively associated with increased parasympathetic tone in the acupuncture group. They suggested that acupuncture exhibits clinically and statistically significant control of IBS symptoms.

There was lack of standardization of acupuncture treatments for patients with IBS. A study on 113 patients with IBS has shown that 126 acupuncture points used, a distinct core and supporting group of points was associated with each primary pattern and each practitioner also utilized a distinct core and supporting group of points that reflected his/her preferences.

Recently a clinical trial was performed to study the effect of acupuncture on patients with IBS. In this study, 12 weeks of acupuncture was offered on weekly basis. The result has shown that there was a statistically significant difference between groups at three months favouring acupuncture with a reduction in IBS Symptom Severity Score. The number needed to treat for successful treatment was six, based on 49% success in the acupuncture group vs. 31% in the control group, a difference between groups of 18%. This benefit largely persisted at 6, 9 and 12 months.

References
Chao and Zhang World Gastroenterol (2014) 20:1871-7
Stuardi T and MacPherson H J Altern Complment Med (2012) 18:1021-7
MacPherson H et al BMC Gastroenterol (2012) 12:150

Monday, 13 June 2022

Hot flashes, can acupuncture help?

Because women are so busy all the time, they may not notice that they are growing older. Wrinkles may be already on our face; skin may become loose. Hormone level in the body has changed. Because of this change, it declared the old age’s coming. Some women may have unpleasant symptoms, such as hot flush, night sweaty; these symptoms may exist a few years before menopause starts and may last a few years afterwards. For them, pleasant summer became unbearable hot; night became sleepless nights. What can you do about it? Hormone replacement therapy may relieve the symptoms, but the risk to take is very big which include having breast cancer, stroke and dementia etc. For this reason, alternative treatment is a good choice. Acupuncture was recognised as an effective way to reduce hot flush. Borud et al performed a randomised controlled trial to study effectiveness of acupuncture for hot flush. 10 sessions of acupuncture were given to acupuncture group and advice on self-care was for control group. The results showed that acupuncture group has significant improvements in hot flush, sleep and other symptoms. Borud also analysed 16 clinical trial studies. Some studies showed that acupuncture reduces about 50% in hot flush frequency comparing with no specific treatment; the effect of acupuncture on frequency is smaller than that oestrogen therapy. They concluded that acupuncture reduces hot flush. Sunay D et al carried out a sham controlled clinical trial to investigate effect of acupuncture on hot flush and hormone levels. They not only showed that acupuncture relieved hot flush, but also showed that acupuncture lowered LH levels, increased oestrogen levels.

There are other promising research data supporting the effectiveness of acupuncture in hot flushes in menopausal women. Recently Baccetti et al from Italy conducted a randomized trial to investigate the effect of acupuncture treatment for hot flushes. One hundred women in spontaneous menopause with at least three episodes of hot flushes daily were randomly allocated to two treatment groups (50 per group): Women in group A were given diet, self-massage training, and treatment with acupuncture, and women in group B (the control group) were given the same diet and self-massage training. 6 weeks acupuncture treatments were offered for these women. They found that treatment with acupuncture significantly reduced the occurrence of hot flushes and sudden sweating. They also found that other symptoms including sleep disorders, tightness in the chest, irritability, bone pain, feeling depressed were also significantly improved after acupuncture treatments. They suggested that Acupuncture in an integrated system that includes therapeutic techniques such as diet therapy and Tuina self-massage can be used to treat hot flushes and selected symptoms in postmenopausal women.

A study of acupuncture on hot flushes was performed by Borud EK et al from the National research Center in Complementary and Alternative Medicine University of Tromso Norway in 2006/2007. There were 267 participants with hot flashes. Mean age was 53.8 year old. 134 women were in acupuncture group receiving 10 sessions of acupuncture treatment over 12 weeks. The most frequently used 10 acupuncture points were SP6, HT6, KI7, KI6, CV4, LU7, LI4, LR3, ST36 and KI3. 133 women were in control group receiving self care only. In acupuncture group 67 women responded to the acupuncture treatment. 64 women did not respond to the treatment. There were no serious side effects found in acupuncture treatments.

From this report, we can see that acupuncture could be effective on hot flushes for some people, tough not everyone responded to the treatment. If you have hot flushes, it is worth trying acupuncture to see if it works for you.

Acupuncture is for hot flashes in patients with cancer

Acupuncture is suggested to treat hot flushes in women with breast cancer and men with prostate cancer. How long does the effect last after the end of the acupuncture treatment period? Recently researchers analysed existing data including 172 patients. The data has shown that the average reduction of hot flashes from the start of acupuncture to the end of acupuncture was 43.2%. The 153 of 172 patients were followed up. After 3-9 months (average 5.8 months) from the end of the treatment period 45.6% of the patients remain at the same level of reduction. From this existing data, it can be seen that acupuncture effect on the hot flashes could last at least 3 months.

Acupuncture reduces hot flashes
A research analysed three published trials of nonpharmacological interventions for menopausal hot flashes to compare the effectiveness of interventions. Data from three randomized controlled trials of interventions for hot flashes (two acupuncture trials, one yoga trial) were pooled. All three studies recruited perimenopausal or postmenopausal women experiencing ≥4 hot flashes/d on average. The primary outcome for all three studies was frequency of hot flashes as measured by the Daily Diary of Hot Flashes. Study 1 participants were randomly assigned to 8 weeks of acupuncture treatments (active intervention), sham acupuncture (attention control), or usual care. Study 2 participants were randomly assigned to 10 weeks of yoga classes, health and wellness education classes (attention control), or waitlist control. Study 3 randomly assigned participants to 6 months of acupuncture or waitlist control. To standardize the time frame for these analyses, only the first 8 weeks of intervention from all three studies were used. There results have shown that the three active interventions and the two attention control groups had statistically similar trends in the percentage reduction of hot flashes over 8 weeks, ranging from 35% to 40%. Acupuncture, yoga, and health and wellness education classes all demonstrated statistically similar effectiveness in reduction of hot flash frequency compared with controls.

References
Borud EK et al Acupunct Med (2009) 27:101-10
Borud EK et al Menopause (2009), 16: 484-93
Borud E et al Auton Neurosi (2010), 157: 57-62
Sunday D Acupunct Med (2011), 29: 27-31
Baccetti S et al J Altern Complement Med (2014) May 14
Frisk JW et al Support Care Cancer 2014 Jan 30
Avis NE et al Menopause. 2018 Oct 22. doi: 10.1097/GME.0000000000001255. [Epub ahead of print]


What can you about your health from your tonger?

 Read more about acupuncture at < drmaggiejuacupuncture.co.uk >