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.

Wednesday, 30 November 2022

The pain cycle, what is involved?

Pain starts from activation of the nervous system. There are 9 steps of the pain circle:

Step 1: Local inflammation. Anything causing tissue damage such as injury, surgery, or infection can lead to local inflammation. This is the origin of the pain.

Step2: Peripheral sensitization. Local inflammation irritates the nerves lowering the pain threshold causing peripheral sensitization.

Step3: Central sensitization. Nerve signals are transmitted to the brain causing central sensitization.

Step4: Pain sensation. The brain tells you that there is pain in the body somewhere.

Step5: Pain cognitive processes. The brain where is sensing the pain connects other part of the brain where controls emotion causing emotional and behaviour changes.

Step6: Depression and anxiety. The brain where controls emotions is affected by the pain signals and alters its function causing depression and anxiety

Step7: Cortical reorganization. The brain reallocates its task to different parts of the body to reduce pain sensation and help replace the lost function.

Step8: Avoidance and disability. The body will respond the brain demands to redistribute the work causing avoidance and disabililty.

Step9: Muscle spasm deconditioning. Injured and related muscles become spasmed to protect the body from moving and feeling the pain causing muscle waste.

Sunday, 20 November 2022

Pain and acupuncture.

Pain is an unpleasant feeling and a signal in the nervous system that something may be wrong. Pain could be in one area of the body, such as back pain or all over the body such as fibromyalgia.

It could be divided into two types of pain according to the onset and duration.
There are two types of pain: acute and chronic
Acute pain usually comes on suddenly, because of a disease, injury, or inflammation. It can often be diagnosed and treated. It usually goes away, though sometimes it can turn into chronic pain.
Chronic pain lasts for a long time, and can cause severe problems.

There are mainly three types of pain sensations
Pricking pain is caused by a needle, pin prick, skin cut etc. This type of pain is precisely localized from the skin and conducted by the A fibers of the nerves. It is sharp, fast and short duration in nature. This pain is a protection mechanism to the body and warning to the brain that something goes wrong.

Burning or soreness pain is caused by inflammation, burned skin etc. This type of pain is not exact localized and conducted by the C fibers of the nerves. It is characterised as diffuse, slow onset and longer in duration.

Aching pain is a sore pain which is mainly from the viscera and somatic deep structure. It is not precisely localized and carried by the C fibers of the nerves.

There are many ways to release pain. Acupuncture is one of the many treatments for pain relief and it is very efficient.  

Do you know anything about connection among pain, endorphins and acupuncture

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

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

Wednesday, 16 November 2022

What is pain sensitization?

Pain is a sensation of hurt resulting from the activation of pain pathways by harmful stimuli to lead to tissue damage. Detection of the stimuli is a protective process to help the body prevent injury or to avoid further contact with the stimuli. However in many clinical conditions the pain is no longer protective, but causes harm. The pain in these situations arises spontaneously, can be elicited by normally innocuous stimuli, is exaggerated and prolonged in response to noxious stimuli and spreads beyond the site of injury. This is caused by pain sensitization. There are two types of sensitizations: peripheral sensitization is a reduction in threshold and amplification in the responsiveness of pain receptors. This occurs when the receptors are exposed to inflammatory mediators and damaged tissue. Central sensitization is an enhancement in the function of neurons and circuits in pain pathways. This is caused by increases in membrane excitability and synaptic efficacy as well as to reduced inhibition in central nervous system in response to activity, inflammation, and neural injury. As a result previous non harmful stimuli generate amplified signals. Central sensitization is responsible for many of the temporal, spatial, and threshold changes in pain sensibility in acute and chronic clinical pain settings and exemplifies the fundamental contribution of the central nervous system to the generation of pain hypersensitivity.

Tuesday, 15 November 2022

Knee pain and knee arthritis? acupuncture is the most popular CAM treatment.

Knee osteoarthritis (KOA) is the fastest growing health disorder and the most common cause of disability. This is due to gradual loss of joint cartilage and local inflammatory processes. Nonsteroidal anti-inflammatory drugs, NSAIDs and joint replacement surgery are the treatments in Western medicine. Due to undesirable side effects of long-term pharmacological treatments and knee surgery, complementary and alternative medical (CAM) therapies are increasingly used. Acupuncture treatment represents the most popular form of CAM.

Much evidence from clinical trials and systemic reviews has suggested that acupuncture can be effective in treating pain and dysfunction in patients with KOA.

For example,

A randomised trial on acupuncture in patients with osteoarthritis of the knee from Germany investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee. Patients with chronic osteoarthritis of the knee were randomly assigned to acupuncture minimal acupuncture (superficial needling at non-acupuncture points), or a waiting list control. Specialised physicians, in 28 outpatient centres, administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks. After 8 weeks of treatment, pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee.

A systematic review analysed 114 clinical trials (covering 22 treatments and 9,709 patients). The results indicate that acupuncture can be considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term.

Another more recent review analysed 14 randomised control trials involving 3,835 patients and concluded that acupuncture provided significantly better relief from knee osteoarthritis pain and a larger improvement in function than sham acupuncture, standard care treatment, or waiting for further treatment.

A recent multicenter clinical trial studied acupuncture at low pain threshold and high pain threshold patients with knee arthritis. Result showed similar effects in pain reduction at 16 weeks, and acupuncture were more effective than a waiting-list control on all patients regardless of their pain threshold.

References

C Witt et al Clinical Trial Lancet 2005 Jul 9-15;366(9480)

M.S. Corbett et al Osteoarthritis Cartilage. 2013 Sep; 21(9): 1290–1298.

Le Cao et al Saudi Med J. 2012 May;33(5):526-32.

Jiali Liu et al Chin Med. 2022; 17: 67. 

Monday, 14 November 2022

Why are you retaining water? Acupuncture can help reduce water retention.

The body is mostly made up with water. It distributed in the blood, muscles, organs and even bones. Sometimes the body holds on to too much of water at particular places causing water retention which feels puffiness and swelling.

The circulatory system including blood circulation and the lymphatic system, the kidneys, hormonal factors, and other bodily systems all help maintain healthy fluid levels.

Water retention occurs when there is a problem with one or more of the body’s mechanisms for maintaining fluid levels. The main symptoms are swelling and discomfort. Water retention can be found in the legs, ankles, feet, the abdomen and chest as well as the face and hands. The symptoms of fluid retention will depend on the area it affects.

If it is in the limbs, feet, and hands, symptoms can be swelling, changes in skin color, shiny or puffy skin, areas of skin that remain indented when pushed in with a finger, aches and tenderness in the limbs, stiffness in the joints, weight gain. If it is in the abdomen and face, the symptoms can be bloating, puffiness of the abdomen, face, and hips, weight fluctuations. You could feel heavier than usual.

Water retention can be a common issue or a sign of a health condition. Acupuncture can help when not caused by a serious health condition.

Interstitial fluid flow is the movement of fluid through the extracellular matrix of tissues, often between blood and lymphatic vessels. System circulation (blood circulation) is the part of the cardiovascular system. It carries the water around the body. The lymphatic system is a part of the circulatory system.

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

Acupuncture improves blood circulation, and this was proved by scientific research. For example, Sandberg et al investigated the effects of acupuncture on skin and muscle blood flow. Blood flow recordings were performed intermittently from 10 min prior to the intervention to the end of the trial. They found that skin and muscle blood flow increased after acupuncture stimulation. Another example Kuo et al also studied the effect of acupuncture on skin blood flow. After acupuncture treatment skin blood flow and skin temperature increased.

Acupuncture improves blood flow and the movement of fluid of lymphatic system through the body and the acupuncture needle changes the interstitial microenvironment. This helps reduce water retention and decrease joint inflammation, welling of limbs, and stabilise the weight.

References
Wei Yao et al Evid Based Complement Alternat Med. 2012: 853516.
Sandberg et al Eur Appl Physiol (2003) 90:114-9
Kuo et al Am J Chin Med (2004) 32 :117-29

Thursday, 10 November 2022

Fitness Qigong eight pieces of brocade



Qigong is a technique used in Chinese medicine to create Yin Yang balance and improve Qi circulation. It is an ancient Chinese healing technique that combines body movement, breathing and mental focus. It coordinates the body, breath and mind and opens the flow of energy in meridians used in acupuncture.

One of the purposes that people practice qigong throughout China and worldwide is for exercise and relaxation.

The Baduanjin qigong(八段锦) is one of the most popular forms of Chinese qigong used as exercise. It involves the eight individual movements to improve health.

This exercise is originating from the Song Dynasty. It attributes to the Chinese folk hero General Yue Fei. He taught the exercise to his men to help keep their bodies strong and well-prepared for battle.

Monday, 7 November 2022

Acupuncture for dry eyes, does it work?

Dry eye is a common condition. When tears can’t provide adequate lubrication for the eyes, the eyes become dry. This can be caused for many reasons such as not enough tears or poor-quality tears are produced. This leads to inflammation and damage of the eye's surface.

The symptoms of dry eyes may include: a stinging, burning or scratchy sensation in your eyes, stringy mucus in or around your eyes, sensitivity to light, eye redness, a sensation of having something in your eyes, difficulty wearing contact lenses or night-time driving, watery eyes, blurred vision or eye fatigue. Dry eyes symptoms can occur in certain situations, such as on an airplane, in an air-conditioned room, while riding a bike or after looking at a computer screen for a few hours.

If you have dry eyes, you may experience some complications: such as eye infections and eye inflammation causing pain in the eyes.

Treatments for dry eyes are to control the symptoms of dry eyes.

Acupuncture is effective to release dry eye symptoms. This is proved by many clinical research.

Here is some examples of the research analysis for acupuncture on dry eye symptoms.

First, this review compared the effect of acupuncture with artificial tears treatment and included seven studies and 383 patients. They used tear break-up time (BUT), Schirmer I test (SIT), and cornea fluorescein staining (CFS) to measure the effectiveness of the treatments. They found the overall BUT of patients in acupuncture group was significantly longer than that of the artificial tears group after treatment; the SIT was significantly higher in the acupuncture group than that in the artificial tears group after treatment; the CFS of patients in acupuncture group was significantly improved compared to that in artificial group. They concluded that acupuncture therapy is effective for the dry eye patients, partly better than artificial tear treatment.

The second study investigated the effect of acupuncture for dry eye syndrome after refractive surgery. A total of 18 patients with dry eye syndrome occurring after refractive surgery participated in this study. For 4 weeks, the acupuncture plus usual care and usual care only groups received treatment three times a week. They used aseries of assessments, namely the ocular surface disease index (OSDI) to measure the effectiveness of the treatments. There was a significant difference in the trends of OSDI changes between the acupuncture plus usual care and the usual care only groups. No serious adverse events were reported during the study. They concluded that four weeks of acupuncture treatment in addition to usual care is a feasible treatment for dry eye syndrome after refractive surgery.

More recently a review included nineteen studies with 1126 patients and analysed the effectiveness of acupuncture for dry eye symptoms. They found significant improvement of dry eyes from acupuncture treatment and also concluded that acupuncture treatment is more effective than artificial tears treatments.

References

Lei Yang et al Evid Based Complement Alternat Med. 2015; 2015: 143858.

Jun-Hwan Lee et al Integr Med Res. 2021 Mar; 10(1): 100456.

Bong Hyun Kim et al BMC Complement Altern Med. 2018; 18: 145.

Sunday, 6 November 2022

Eating nuts boosts your fertility

There are certain foods associated with Christmas, and nuts including walnuts, brazil nuts, hazelnuts and pecans are one of them. Where are the ideas from? This goes back to pre-Christian time, the shortest day of the year which is often 21st and 22nd of December. It was celebrated by encouraging light to return. Feast is used to celebrate. In Christian time, Christmas became such an important feast and every luxury item was saved up for it. Nuts were harvested in autumn and were available to store for the big festival. Eating nuts at Christmas became such an important part of the celebration.

Do you know that nuts promote your fertility?

Nuts are important part of fertility nutrition; this is because they contain ample protein, minerals and essential fatty acids. Eating nuts provides vegetable proteins you need and this promotes your ovulation. There is high level of selenium, a natural antioxidant in Brazil nuts and this plays a key role in the early stages of conception. Nuts with the highest content of protein are peanuts 6.7g, almonds 6g and walnuts 4g per oz. Best nuts for omega3 are walnuts 2.2g per1/4cup.

Nuts improved sperm vitality, motility, and morphology. In a study, 75g walnuts per day were added to the diet in male aged 21-35 yr old. The group consuming walnuts experienced improvement in sperm vitality, motility, and morphology, but no change was seen in the group continuing their usual diet but avoiding tree nuts.

Don’t forget acupuncture. Acupuncture increases ovarian blood flow in women and testis blood flow in men and brings all nutrients your follicle needs to the ovary and sperm needs to the testis. Without good local blood flow, the nutrients you eat will not reach your ovary or testis.

References

http://www.history.uk.com/christmas/traditional-christmas-food/
http://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2009/May/Follow-Fertility-Diet
Robbins WA et al Biol Reprod (2012) 87:101

Wednesday, 2 November 2022

Do you know that acupuncture can help your posttraumatic stress disorder (PTSD) effectively?

Post-traumatic stress disorder (PTSD) is a mental health condition that's triggered by a very stressful event.

Symptoms may include flashbacks, nightmares, and severe anxiety, as well as uncontrollable thoughts about the event. Someone with PTSD often relives the traumatic event through nightmares and flashbacks. They may experience feelings of isolation, irritability, and guilt; feeling emotional distressed to something that reminds them of the traumatic event; and avoid thinking or talking about the traumatic event and avoid places, activities or people that remind them of the events. They may also have problems sleeping, lack of interest, depression, difficulty to concentrate and poor memory etc.

Symptoms can vary over time or vary from person to person. These symptoms are often severe and persistent enough to have a significant impact on the person's day-to-day life causing significant problems in social or work situations and in relationships.

A key component of posttraumatic stress disorder is traumatic memory which makes a tremendous impact on physiological and mental capacities and consequently on the individual’s ability to function appropriately in the present.

The treatments for PTSD are limited.

There are pilot studies showing acupuncture may be an efficacious, safe, and acceptable treatment for PTSD. Studies demonstrate that acupuncture can regulate the autonomic nervous system, improve sympathetic/ parasympathetic balance and affect parts of the limbic system and cortical regions associated with memory. Acupuncture results in decreased activation of the brain where control emotion and memory and increase resting-state functional connectivity while the strength of this connectivity was positively associated with corresponding clinical improvement.

References
Amir Assouline et al Translational Psychiatry (2022) 12:110

Tuesday, 1 November 2022

How does acupuncture speed up healing process?

Connective tissues in the body

Connective tissue is the tissue between organs and tissues and it provides structural and metabolic support for other tissues and organs. It links whole body together. All connective tissue consists of three main components: elastic and collagenous fibers, ground substance and cells. Cells are spread through an extracellular fluid. Variations of the fibers and ground substance determine the property of the tissues. For example, Bones, tendons, cartilages have specific forms of fibers and ground substance. There are three types of connective tissues: loose connective tissue, dense connective tissue and special connective tissue such as bone, cartilage adipose, reticular connective tissue and blood etc. Loose connective tissue contains many cells, a loose arrangement of fibers and moderately viscous fluid substance such as the tissue in lymph gland. Dense irregular connective tissue contains a dense network of collagenous fibers arranged irregularly, for example the tissues in joint capsules and muscle fascia are this type of tissue. Dense regular connective tissue which is a special connective tissue contains cells and all aligned fibers and it is found in tendons and ligaments.

Loose and dense irregular connective tissue provides a medium for oxygen and nutrients to diffuse from capillaries to cells and carbon dioxide and waste substances to diffuse from cells back into capillaries. They protect organs from stretching and tearing forces. Special connective tissue’s function depend on the types of the tissues.

Fascia is connective tissue made up with collagen. Fascia can be seen between muscles, bones, ligaments and other internal organs.

The deep fascia is a highly vascular structure with a superficial and a deep layer, each with an independent rich vascular network of capillaries, venules, arterioles, and lymphatic channels. The presence of mast cells in deep fascia suggests a protective role similar to other connective tissues. The deep layer has few elastin fibers but does have myofibroblasts, suggesting contractile ability. Any active contraction would need to be controlled by a nerve supply and, indeed, one finds myelinated and unmyelinated nerve axons and Schwann cells in these deep fascial layers.

Any active contraction would need to be controlled by a nerve supply and, indeed, one finds myelinated and unmyelinated nerve axons and Schwann cells in these deep fascial layers. The deep fascia is not just a tough barrier structure of collagen and elastin, but is a metabolically active vascular layer which provides gliding and protective functions(16). Deep fascia has parallel longitudinal collagen bundles and rudimentary elastic laminae, giving it both high tensile strength and elasticity. At the junction between the deep fascia and the muscle, without any special secretory cells, the fascia is able to maintain a lubricating layer of hyaluronic acid (hyaluronan) which, like a hydraulic fluid, allows sliding between the fascia and neighboring muscle. However, when the epimysium is disrupted in surgery, overlying fascia does not remain distinct and does not create a gliding layer over the scar(17). More recent findings show that while hyaluronic acid is a lubricant, breakdown products of this large molecule are themselves tissue irritants(18), and fragments from collagen, elastin, and laminins in the extracellular matrix also modulate activities of inflammatory cells

The architecture of the fascia allows continuity of nerves, blood, and lymph vessels between the sliding tissues. With trauma to the muscle, the overlying fascia no longer produces the sliding layer of hyaluronan. Restoring this natural sliding mechanism becomes the next task for the manual therapist.

Fascia, meridians and acupuncture

Under the skin there is a sheet of connective tissue called fascia. Fascia is mainly made up of collagens and it surrounds the muscles and other internal organs. It can be seen between muscles, bones, ligaments and other internal organs. There are three types of fascia, superficial, deep and visceral fascia. Fascia are flexible and are resistant to tension force, this is because the collagen fibers produced by fibroblasts in the fascia are arranged in a wavy manner. Because of the fascia flexibility, it can transmit mechanical force throughout the body and prevent the body from injury. Fascia also provides support to the nerves and blood vessels in the fascia. Fascia is innervated by sensory nerve endings. If fascia is damaged and/or inflamed, it will lose its wavy pattern and flexibility, fasical adhesion and scaring will cause stiffness and pain.

In Chinese medicine, there is a concept of meridians through which the energy will flow throughout the whole body, but the anatomical basis of meridians is not resolved. The recent research data from scanning connective tissue has suggested that fascia network is clearly matched with meridian network. Disruption of fascia can trigger local inflammation and block energy flow causing pain. Acupuncture can reduce inflammation and unblock the meridians improving energy flow.

Chronic pain recovery, fascia remodelling and acupuncture

Nerve endings are surrounded by fascia tissue and play an important role in pain regulation. Disruption of fascia can stimulate pain receptors and provoke inflammation. Recently chronic low back pain has been suggested starting from the fascia inflammation. Pain-related fear leads to a decreased movement, connective tissue remodeling, inflammation, nervous system sensitization and further decreased mobility. The Lumbar Fascia cross the entire lower back region, and is a key component. The lumbar fascia is thickened in patients with chronic low back pain leading to stiffness of the back. Fascia remodelling is a healing process of recovery. Application of acupuncture helps fascia remodelling and reversing the abnormality of fascia.

How the body heals itself

Tissue repair is involved in the healing process which allows restoration of injured tissue. There are four phases during the healing process: blood clotting, inflammation, tissue growth (proliferation) and tissue remodeling (maturation). Blood clotting is initiated within a few minutes of injury. Plate. The inflammatory phase begins with damage to the capillaries, which triggers the formation of a blood clot and the various recruited cells to migrate into wound, such as inflammatory cells (neutrophils and macrophages), fibroblasts and endothelial cells and damaged tissue and cells, bacteria and other debris are cleared out. In proliferation phase, new blood vessels are formed and new tissue cells are crawling onto the top of the wound bed. Meanwhile the wound contract by gripping the wound edge to reduce the size of the wound and bring the tissues closer; new capillaries deliver nutrients and oxygen for the development of granulation tissue and proliferation of fibroblasts. Fibroblasts differentiate to myofibroblasts which have contractile properties containing stress fibres. The last phase of healing is regeneration and scar formation which is involved in a progressive remodelling of the granulation tissue. In this phase many enzymes and their inhibitors play a major role. Vascular cells and myofibroblasts are reduced in numbers. In the final stage, there are two separate processes: regeneration and replacement. In regeneration process, the new tissue completely restored the portions of damaged tissue to their normal state. collagen is realigned and cells no longer needed are removed. In replacement type of healing, severely damaged tissues are replaced by connective tissue forming scarring.

The healing process can become abnormal. These abnormal repair processes are the result of an impaired remodelling of the granulation tissue. If there is the noxious stimulus, excessive extracellular matrix deposition and the continued presence of myofibroblasts is observed. This excess of extracellular matrix deposition leads to the development of organ fibrosis. The installation and persistence of fibrosis is the consequence of an imbalance between extracellular matrix synthesis and degradation by myofibroblasts.

Acupuncture can stimulate normal healing process and speed up healing process.

References

Ludovic Micallef etc Fibrogenesis & Tissue Repair20125(Suppl 1):S5

Yu Bai et al Evidence-Based Complementary and Alternative Medicine
Volume 2011 (2011), Article ID 260510, 6 pages

Yu Bai et al Evidence-Based Complementary and Alternative Medicine
Volume 2011 (2011), Article ID 260510,

Almeida Mdos S et al  Acupunct Med (2014) 32:178-82.


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