The FHC Approach to Infertility

Written by Marc Wasserman Ph.D. L.Ac.

Introduction

Infertility is not an uncommon occurrence. In fact, estimates indicate that one in five women, between the ages of 25-40, report using infertility services.* Between the stress of examinations and treatment and the financial pressure, infertility is challenging for many couples. But, in most cases, it is correctable and there are many options available to address the various causes.

At Flow Health Clinic we work with couples who continue attempts at natural conception as well as those undergoing IUI and IVF treatments. Very often we see people who’ve a history of failed IVF and IUI treatments and have gone on to have healthy pregnancies with our assistance.

What is acupuncture and how is it going to help us get pregnant?

Acupuncture involves the insertion of thin gauge needles at locations throughout the body, stimulating responses from the immune, circulatory, and nervous systems and rebooting the body’s communication network. By balancing hormone and neurochemical concentrations as well as improving blood flow to specific tissues, the body becomes more receptive to a pregnancy.

How is Chinese medicine used for infertility?

Chinese medicine is an ancient system of compounding natural medicinals into a precise prescription for each patient’s condition. These clinically proven formulas have evolved over thousands of years of experience and continue to improve with modern day advances in technology and understanding of the human body. Men and women in Asian countries continue, to this day, to rely on natural medicinals before, during and after pregnancies to promote, maintain and restore health.

 

How will my specific situation be addressed?

 At Flow Health Clinic we have three phases of treatment. These provide the basic framework necessary to approach a range of scenarios, additional adjustments are made according to each specific case.

 

Phase I—System Reboot

We begin by reestablishing a regular menstrual cycle, encouraging full clearance of endometrial tissue, and promoting punctual ovulation. This return to a fresh start is an essential step, and especially important for couples who have any history of miscarriage.

Very often this alone is enough to restore fertility.

 

Phase II—Creating a Welcoming Body Environment

To encourage fertilization and implantation we focus on the following strategies:

  1. Promoting healthy growth of the endometrium
  2. Thinning excessively viscous cervical mucus
  3. Preventing auto-immune rejection
  4. Increasing sperm count and motility

These issues vary among couples and treatment plans should be modified accordingly. For those trying to conceive naturally it may be more important to focus on promoting healthy cervical mucus and increasing sperm counts. Whereas full development of endometrial lining and discouraging auto-immune rejection more urgently affects the process and outcome in couples undergoing IUI and IVF therapies.

 

Phase III—Strengthening and Tonifying

Aging, genetic and environmental factors, along with disease exposure may all result in diminished or abnormal endocrine stimulation in the body. This can often be improved with precise stimulation of acupuncture points and supplementation with Chinese medicine. Recent and ongoing research continues to expose these mechanisms. For example, CV4(關元), SP6(三陰交), and ST36(足三里) three commonly prescribed points for infertility, have been shown to regulate reproductive endocrine function through activation of GnRH neurons.**

 

Conclusion

Infertility is a challenge. There are many factors which need to be investigated and corrected carefully. And thankfully there are many treatment options available. As you continue to pursue your goal of a healthy pregnancy, whether just beginning fertility treatments or frustrated to the point of surrender, acupuncture and Chinese medicine should be considered as part of your integrative care plan.

 

 

References

*Chandra, A. PhD. et al. “Infertility Service Use in the United States: Data From the National Survey of Family Growth, 1982–2010.” National Health Statistics Report. 1/22/2014. No.73
Cochrane S, et al. “Prior to Conception: The Role of an Acupuncture Protocol in Improving Women’s Reproductive Functioning Assessed by a Pilot Pragmatic Randomised Controlled Trial.” Evid Based Complement Alternat Med. 2016.
Hullender R, et al. “Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes.” Reprod Biomed Online. 2015 Jun;30(6).
Liu, F et al. “Study on the underlying mechanism of acupuncture in regulating neuroendocrine activity in dysmenorrhea rats.” Zhen Ci Yan Jiu. 2009 Feb;34(1):3-8
Manheimer, E et al. “Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis.BMJ. 2008 Mar 8;336(7643):545-9.
**Wang, SJ. et al. “Experimental study on acupuncture activating the gonadotropin-releasing hormone neurons in hypothalamus.” Journal of Traditional Chinese Medicine. 2010 Mar;30(1):30-9.

 

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Acupuncture and Chinese Medicine for Concussions

Written by Marc Wasserman Ph.D. L.Ac.

 

Introduction

A concussion is a traumatic injury which may develop into a variety of acute and chronic symptoms, including pain, dizziness, nausea, cognitive impairment, changes in mood and emotions, fatigue, etc.

To understand how Chinese medicine and acupuncture can be applied in treatment of concussions it is best to look at both the pathophysiological causes of injury as well as the specific symptoms. We’ll consider both in the sections below.

 

Pathophysiology of Concussions and Understanding Chinese Medicine Theory and Treatment

A concussion occurs when impact to the head causes the brain to strike the inside of the skull, impact and torsion forces damage tissue similar to bruising in any other part of the body. Symptoms at this time may include headache, dizziness, nausea or vomiting, cognitive impairment, fainting, visual disturbance, etc. In Chinese medical theory, at this point the injury is referred to as YuXue (blood stasis) with heat pattern. Treatment focuses on promoting clearance of waste products from the area and improving cerebral blood flow. This minimizes inflammation, improves oxygenation of the area and limits damage to the periphery.

Secondary injury occurs over a period of days and weeks, and is due to a variety of causes resulting from the initial injury and ongoing damage repair. The complexity of possible ongoing symptoms is due to the brain’s functional processes and its role in commanding all activities in the body.

Specific pathophysiological causes of symptoms are listed below with treatment considerations from Chinese medicine.

Decreased cerebral blood flow

Restoring healthy circulation to the brain and removal of metabolic waste should be primary focus. By increasing and maintaining healthy circulation we accelerate damage repair and a return to normal functioning. Herbal medicines with this function are classified as “enlivening blood and transforming stasis” (活血化瘀)or “cooling blood heat” (涼血). These include single herbs like ChuanQi, QianCao, CeBaiYe, DangGui, ShaoYao, ChuanXiong, DanShen, etc. ChuanQi, for example, has long been used to treat vascular and cerebrovascular problems and has shown in research to have antioxidant effects(1). Likewise the commonly used combination of ChuanXiong and ChiShao has demonstrated the ability to limit damage from decreased blood circulation to the neurological system (2). This pairing illustrates how the combination is more effective than individual parts, a governing principle in Chinese medicine. In addition to these combinations, other herbs which clear heat and resolve toxicity can be added in small amounts to clear away lactic acid buildup and quiet down inflammation; these include HuangQin, HuangLian, HuangBai, ZhiZi, ShiGao, DaHuang, etc.

Irregular release and reabsorption of neurotransmitters

Damage to brain often results in irregularity in the chemical signaling systems. Depending on the symptoms, (discussed below) irregularity in neurochemistry falls into the categories of “kidney yang deficiency”(腎陽虛) or “spleen deficiency”(脾虛). Formula choices may  include YouGui Wan, JinGuiShenQi Wan, SiNi Tang, GuiPi Tang, GanMaiDaZao Tang, etc.

Poor clearance of waste products through CSF circulation

Concussion forces can also cause disruption to the brain’s waste removal system. This may lead to chronic and/or delayed symptoms(3). This is known as “phleghm-fluid” (痰飲) or “phlegm reversal”(痰逆). Common formula options include WenDan Tang, BanXiaBaiZhuTianMa Tang, etc.

Free radical damage

This can be addressed with numerous herbal medicine formulas as most provide antioxidants. However, focusing treatment on “tonifying qi”(補氣) will encourage healthy cellular metabolism. A good example is the combination of ChuanXiong, HuangQin and DangGui which has shown protective effects on mitochondrial function and cellular respiration in brain cells. (4)

Of course treatment will likely focus on a combination of these pathomechanisms, to simultaneously restore function and prevent further damage.

 

Symptoms of Concussions and How to Treat with Chinese Medicine and Acupuncture

Headaches

In a large study published in 2016, returning soldiers suffering headaches due to traumatic brain injuries were treated with either acupuncture or the usual treatment modalities. Results showed that patients in the acupuncture treatment group had less pain and less impact on day to day life when compared against those in the conventional treatment group. (5)

As for prescribing Chinese medical formulas, there are several types of headache symptoms or patterns, all with differing diagnosis and treatments according to Chinese medical theory. Following is a list of headache pattern diagnosis and associated treatments:

  1. Blood stasis pattern: Moderate headache pain, nausea, dizziness, occasional eye pain and/or dry eyes, etc. This common pattern is frequently associated with concussions and post concussion syndromes, treatment options include SiWu Tang or BaZhen Tang or similar formulas which enliven blood and transform stasis.
  2. Qi Deficiency Pattern: Headache with lightheadedness or feeling of emptiness in the head, fatigue, diminished appetite, shortness of breath, etc. Treatment options include BuZhongYiQi Tang, SiJunZi Tang, XiangShaLiuJunZi Tang, etc.
  3. Hyperactive Liver Qi Pattern: Severe headache pain, with pain focused on the temples or crown of the head, irritability, outbursts of anger, insomnia, etc. A common prescription for this pattern is YiGanSan or ChaiLing Tang.
  4. Kidney Deficiency Pattern: Mild headache pain, light headedness, tinnitus, extreme fatigue, muscle soreness, etc. Treatment options include LiuWeiDiHuang Wan, YouGuiWan, DaSanWuZi Tang, LiZhongWan etc.
  5. Phlegm Reversal Pattern: Headache pain with dizziness, nausea, heaviness of the eyes or inclination to keep eyelids closed, fatigue, and general discomfort. Treatment choices include BanXiaBaiZhuTianMa Tang, WenDan Tang, etc.

Dizziness or Vertigo

Acupuncture has been shown effective in treating dizziness and vertigo in emergency medicine (6). A simple treatment with manual stimulation of points including NeiGuan, ZuSanLi, TaiChong and others may quickly alleviate acute symptoms of dizziness and nausea.

As for prescribing Chinese herbal medicine many of the patterns for dizziness align with those outlined above regarding headaches. They are as follows:

  1. Liver yang rising: Severe dizziness with nausea, tinnitus, alternating sensations of chills and overheating of the body, outbursts of anger and moodiness. A common prescription for this pattern is JiaWeiXiaoYao San.
  2. Insuffinciency of kidney water: Dizziness with tinnitus, fatigue, lethargy, lack of motivation, night sweats, nausea, etc. Common prescriptions include BaWeiDiHuang Wan, GuiLuErXian Jiao, or many of the variations of LiuWeiDiHuang Wan.
  3. Phlegm accumulation and blockage: dizziness with inability to stand up easily, sensation of fullness in the head, difficulty moving, nausea, stuffiness in the chest. This is commonly treated with BanXiaBaiZhuTianMa Tang or WenDan Tang.
  4. Dual deficiency of qi and blood: dizziness with agitation, interrupted sleep or difficulty falling asleep, lack of strength in the extremeties, poor appetite, and loose bowel movements. Possible prescriptions in this case include ShiQuanDaBu Tang, RenShenYangLaoTang, GuiPi Tang, etc.

Nausea or vomiting

In recent years acupuncture has continued to increase in widespread usage for treatment of nausea and vomiting from a variety of causes. While recovering from a concussion, acupuncture may be an effective choice in alleviating acute symptoms of nausea and vomiting. Simple techniques such as self applied acupressure to the NeiGuan point may help quiet sudden occurrences of nausea.

Leaving off digestive and infective causes of nausea we are left with three common patterns for these symptoms, as listed here.

  1. Phlegm-fluid: vomiting following consumption of food and drink, feeling of congestion or stuffiness in the chest, feeling of thirst. Prescriptions might include ErChen Tang, WenDan Tang, XiaoBanXia Tang, etc.
  2. Qi Depression: nausea and vomiting with decreased appetite, fullness of the chest, achiness of the rib cage, intercostal pain, belching, etc. A common prescription is XiaoYao San.
  3. Spleen deficiency: nausea with weakness of the body, fatigue, no desire for food, lack of strength in the body, loose bowel movements. This pattern is often prescribed LiuJunZi Tang or XiangShaLiuJunZi Tang.

Insomnia or Excessive Sleeping

Acupuncture is commonly used for treatment of insomnia. Proposed mechanisms of action include controlling pain, decreasing anxiety through adjustments to hormone secretion and to the sympathetic nervous system, and regulation and improvement of cerebrovascular circulation. A large review study in Korea found acupuncture to be more helpful than conventional methods for treatment of insomnia following a stroke (7). This may also be the case for insomnia following concussions.

Chinese herbal medicine has many common prescriptions including SuanZaoRen Tang a famous formula used for general insomnia without other factors. For symptoms of mild anxiety, palpitations, feeling of stuffiness in the chest, difficulty quieting down the mind we can consider using BanXiaHouPo Tang or WenDan Tang. For severe anxiety, formulas such as JianLing Tang or ZhenGanXiFeng Tang my be preferred.

Depression and Cognitive Impairment

Depression, mood and emotional changes are also not an uncommon occurrence following concussions. The initial trauma may induce irregular secretion of neurotransmitters in affected areas of the brain. For symptoms of depression including sadness, crying, disinterest in activities, and general discomfort of the body, the treatment focuses on tonifying the heart and spleen systems with formulas such as GuiPi Tang, GanMaiDaZao Tang, SiJunZi Tang, etc. This is similar in concept to irregularity in the serotonergic systems.

Other common symptoms include difficulty with mental focus and concentration, memory loss, lack of motivation, fatigue, etc. These mostly fall into the patterns of qi deficiency or kidney yang deficiency. Chinese herbal prescription choices include BuZhongYiQi Tang, LiZhongWan, YouGuiWan, GuiZhiFuZi Tang, etc. This is similar in concept to irregularity in the dopaminergic systems.

More detailed information on depression treatment can be found on a previous post at this link.

Conclusions

Symptoms of concussion are complicated and likewise are the treatments. Nonetheless the various possible symptoms can be classified well within the system of Chinese medical theory allowing for a range of options to restore physical and mental health.

 

References:
  1. Chan P, Tomlinson B.“Antioxidant effects of Chinese traditional medicine: focus on trilinolein isolated from the Chinese herb sanchi (Panax pseudoginseng).” J Clin Pharmacol. 2000 May;40(5):457-61.
  1. Gu J, et al. “Combination of Ligusticum chuanxiong and Radix Paeoniae ameliorate focal cerebral ischemic in MCAO rats via endoplasmic reticulum stress-dependent apoptotic signaling pathway.” J Ethnopharmacol. 2016 Jul 1;187:313-24.
  1. https://www.urmc.rochester.edu/news/story/4213/blows-to-head-damage-brains-garbage-truck-accelerate-dementia.aspx
  2. Dai Y,et al. “Tongluo Xingnao Effervescent Tablet preserves mitochondrial energy metabolism and attenuates cognition deficits in APPswe/PS1De9 mice.” Neurosci Lett.2016 Sep 6;630:101-8.
  1. Jonas, Wayne B. et al. “A Randomized Exploratory Study to Evaluate Two Acupuncture Methods for the Treatment of Headaches Associated with Traumatic Brain Injury.” Medical Acupuncture(2016): 113–130. PMC. Web. 21 Sept. 2016.
  2. Chiu, Chih-Wen et al. “Efficacy and Safety of Acupuncture for Dizziness and Vertigo in Emergency Department: A Pilot Cohort Study.” BMC Complementary and Alternative Medicine (2015): 173. PMC. Web. 19 Sept. 2016.
  3. Sook-Hyun Lee and Sung Min Lim. “Acupuncture for insomnia after stroke: a systematic review and meta-analysis.” BMC Complement Altern Med. 2016; 16: 228.

 

 

 

 

Depression Treatment: Acupuncture and Chinese Medicine

Written by Marc Wasserman Ph.D. L.Ac.

Introduction

Depression, according to the World Health Organization, is the leading cause of disability worldwide. People are affected regardless of gender, ethnicity, age, social standing, lifestyle, etc. Understanding of causation is often complicated due to a mix of factors including genetics, physiology, environment, medication or drug use, infection and chronic disease.

A general outline of depression symptoms can be found on the NIH website by following this link

https://www.nimh.nih.gov/health/topics/depression/index.shtml

Below we’ll go through modern and classical explanation of depression, causes and treatments as well as some practices to keep your brain and body healthy.

What causes depression?

Infection

Recent research has shown that elevations in pro-inflammatory cytokines have been associated with mood disorders and major depressive disorder. An inflammatory response to viruses, parasites, or bacterial infections, as well as any inflammation resulting from auto-immune diseases, myocardial infarction, diabetes, etc. can all induce short term and chronic changes in the body’s neurological and physiological systems.

Ancient Chinese Medical theory explaining this very phenomenon dates back to the Han Dynasty. The famous text ShangHanZaBingLun written around the year 200 C.E. discusses the possible outcomes of acute infections manifesting into chronic health problems. It begins with an introduction to acute stages of disease, progressing from common respiratory tract infections, digestive tract infections all the way on to life threatening infections of the internal organs, nervous and hematological systems. Following the diagnosis and treatment protocols for acute infections, the text compiles the possible outcomes resultant from infections which are not treated successfully or cleared correctly from the body during the acute stage. Depression is one of the possible outcomes in this situation. Below are two diagnoses of depression from this ancient text.

BaiHe Disease

According to the original text “excessive lingering heat” weakens the body leading to yin deficiency of the heart and lungs. Symptoms of BaiHe disease include intermittent dysregulation of appetite, sleep, movement, and mood; including sleeplessness, lack of appetite with occasional binge eating, unexplained discomfort and no desire for activity. Other symptoms may include palpitations, heat or cold intolerance, withdrawal from social interaction, chronic dry cough, dry mouth, etc.

Bai He disease takes it name from the lily (百合BaiHe) which is used in treatment; including the classical prescriptions BaiHeZhiMu Tang, BaiHeDiHuang Tang, BaiHeJiZi Tang, HuaShiDaiZhi Tang, etc.

BaiHe is a common ingredient in Chinese cuisine. It is sweet and nourishing and can be included as part of a healthy diet, it soothes the body and calms the nerves.

ZangZao Disease

According to the original text, symptoms of this pattern include frequent crying spells, sadness and unexplained discomfort of the body. In addition ZangZao disease patients incline towards anxiety and delusions in severe cases. Along with the chronic depletion of the body’s resources as mentioned above, this syndrome may also be brought on by emotional or psychological trauma. The classical pathology is dual deficiency of the heart and spleen.

Heart system deficiency is consistent across both ZangZao and BaiHe diagnoses, manifesting as the classic depression symptoms of sadness, sleeplessness, fatigue, palpitations, excessive sweating, etc. Whereas BaiHe includes lung yin deficiency manifesting as dry mouth, dry cough, and other respiratory issues; ZangZao includes spleen deficiency manifesting as worry, anxiety, delusions, etc.

Treatment involves supplementing the spleen and heart, the classic prescription for this case is GanMaiDaZao Tang.

Both of these patterns, BaiHe and ZangZao, are due to depletion of the body’s resources and chronic inflammation.

Gut Bacteria: Changes due to infection or antibiotics

Infections or treatment of infections that change bacterial colonies in the digestive tract also influence neurochemistry. This takes place due to changes in what is known as the microbiome-gut-brain axis. The digestive tract environment affects mental health and vice versa, taking place through the enteric nervous system which communicates information to the brain and can influence mood and behavior.

Our guts contain and produce the body’s highest concentration of serotonin. This important neurotransmitter is often targeted for treatment of depression and likewise is implicated in both inflammatory and functional bowel disorders.

This draws strong parallels to the traditional Chinese medical theory of emotions correlated to the organ systems, and to one of the more common treatments of mild depression, supplementing the spleen and stomach. The spleen and stomach paired organ system represents the digestive system’s chemical and physiological processes, and the psycho-emotional state of overthinking and excessive worry. Above we discussed “BaiHe Disease” and “ZangZao Disease,” another common Chinese medical diagnosis of depression is deficiency of the spleen or dual deficiency of spleen and heart. Symptoms of this pattern include excessvie worry, fear and anxiety, palpitations, forgetfulness, trouble focusing, dizziness, and fatigue. Treatment entails supplementing the spleen primarily while simultaneously nourishing the heart and blood. This is one of the most common and most effective treatments for depression. Common prescriptions include GuiPi Tang, BanXiaBaiZhuTianMa Tang, SiJunZi Tang, etc.

Genetics and Neuroanatomy

Imaging studies of the brain have started to show irregular activity associated with depression. These include irregularity of the serotonin transporter, decreased size and activation of the habenula, and both increased and decreased activity in areas of the prefrontal cortex. Irregular function and size of brain regions is what is known in Chinese medicine as qi deficiency or yuan qi deficiency. There are many formulas which can be used for treatment including BuZhongYiQi Tang, ShiQuanDaBu Tang, SiJunZi Tang, LiZhong Wan, etc.

We also commonly see hereditary patterns with depression. Research efforts continue to search for answers, but currently there appears to be correlation between depression symptoms and both irregularities of the serotonin transporter gene and brain derived neutrophic factor. Likewise aging of the brain, toxicity, or disease which leads to loss of dopamine neurons is also implicated in depression pathology. These all generally fall into the category of Yang deficiency or Kidney yang deficiency. Possible treatments include SiNi Tang, BanXiaBaiZhuTianMa Tang, LiZhong Wan, GuiZhiFuZi Tang, etc.

 

Treatment

Acupuncture

Acupuncture helps to balance the neurological system through stimulation of acupoints which activate specific regions of the brain. Proper needle sensation and placement is necessary to elicit the effect. Research has shown acupuncture to be just as effective as prozac in treatment of depression and other studies have demonstrated how acupuncture interrupts cortisol levels disrupting conditioned stress responses. Additionally as acupuncture can decrease the inflammatory response of the immune system and reduce pain in the body it limits the likelihood of developing worsening depression.

Chinese Herbal Medicine

Chinese herbal medicine can provide long term results for people suffering from depression. It is important to be evaluated by a licensed practitioner who can diagnose your condition and prescribe the appropriate herbal formula. There are specific prescriptions for varying pathologies, through modern imaging and research techniques, these clinically proven formulas are beginning to demonstrate effects on neurochemistry and brain health.

Activity

Get outdoors and walk one hour everyday. Movement increases circulation to the brain and being in nature has powerful effects on brain health as well.

Diet

Increase intake of nuts, berries, green leafy vegetables, fruits, seafood, eggs, and moderate amounts of wine.

Sleep

Sleep at least 8 hours a night. Ideally bed time should be no later than 11pm.

 

Conclusion

Depression is debilitating and often leads to other onset of more severe disease. It is important to get symptoms under control quickly but also to avoid generating addiction behaviors or other imbalances. Many patients find themselves overwhelmed with constantly changing or multiple pharmaceutical prescriptions, when in many cases lifestyle changes and conservative treatment are all that are needed.

Acupuncture and Chinese herbal medicine have a long history of treating mental health diseases. Effects are quick and compliment other efforts of the patient and health care provider to reclaim quality of life.

 

Indigestion, Acid Reflux, and GERD: Treatment with Chinese Medcine

Written by Marc Wasserman Ph.D. L.Ac.

Introduction

Eating is one of the pleasures of life. Flavors and textures and temperatures of our favorite foods delight and the joys of sharing a meal are the hallmark of community and culture. Yet the complexities of diet can bring both health and disease. When acute and chronic pathological changes to the digestive system arise, our goal through treatment is to return the system to its harmonious state. The body’s innate ability to heal itself and its drive toward homeostasis can be leveraged through medication and diet, yet we should also beware of long-term reliance on medications which may counteract these mechanisms.

 

Acid Reflux Causes

 Reflux comes down to one basic principle…

Stomach acid belongs in the stomach.

We’ve two muscles at the stomach entrance and exit responsible for this job, the lower esophageal sphincter and the pyloric sphincter respectively. There is also some assistance from the diaphragm in supporting the lower esophageal sphincter from above. When stomach acid makes an escape into the esophagus we get heartburn, nausea, and with prolonged exposure erosion of tissue which signifies GERD and Barrett’s esophagus.

 

Healthy Digestion vs. GERD

The healthy mechanisms for digestion in the stomach should sequence as follows:

  1. The lower esophageal sphincter loosens to allow swallowed food and drink to enter
  2. Stomach acid is secreted to break down food
  3. The stomach expands like a balloon to accommodate food volume
  4. Timing and acidity markers initiate the opening and pulsation of pyloric sphincter for food to exit into the small intestine

Whereas acid reflux might look like any of the following:

  1. The lower esophageal sphincter doesn’t close fully after food enters the stomach, allowing for reflux
  2. Stomach acid is secreted in too high a concentration resulting in more severe irritation to the esophagus
  3. Stomach acid is secreted in too low a concentration resulting in delayed gastric emptying
  4. The stomach is overstretched due to overeating, creating pressure which forces contents back up through the lower esophageal sphincter
  5. Delayed emptying of the stomach (gastroparesis) builds up pressure which can reverse stomach contents back through the lower esophageal sphincter
  6. Irregular pulsing of the pyloric sphincter reverses stomach contents back through a weakened lower esophageal sphincter
  7. Weakening of the diaphragm allows the head of the stomach to bulge up into the chest (hiatal hernia)

 

Acid Reflux Symptoms

 Everyone has heartburn and indigestion occasionally. Additionally if you are discontinuing ppi, h2 blocker, or antacid medications a short period of rebound symptoms is expected.

Nonetheless if you experience frequent or ongoing symptoms or if you have any heartburn pain and discomfort that wakes you from sleep or are disruptive of normal daily activities, these are signs you should get in to see your doctor soon.

A comprehensive summary of symptoms of GERD can be found on the IFFGD website.

 

Conventional treatment of GERD and acid reflux

For many years now prescriptions of proton pump inhibitors, H2 receptor blockers, and antacids have been on the rise. A variety of OTC and prescription dosages are now available in the United States. For a list check out the Mayo Clinic website .

Acute side effects of these medications primarily manifest as other imbalances in the digestive system, such as diarrhea, constipation, abdominal pain, nausea, etc. Long term side effects from prolonged use are also beginning to be recognized and they include an increased risk of fractures, pneumonia, dementia, and deficiency of B12 vitamin and other nutrients.

 

Herbal Medicine and Acupuncture Treatment

Acupuncture and Chinese herbal medicine treatments are effective in treating both the symptoms and underlying causes of GERD. The first step is correctly diagnosing the mechanism after which the doctor will give a customized prescription for acupuncture and herbal medicine. Let’s go through the causes of reflux mentioned above and look at what treatment might be prescribed for each case.

 

  1. Weakening of the lower esophageal sphincter is what is known in Chinese medicine as “stomach deficiency with qi reversal.” XiangShaLiuJunZi Tang is a common prescription, and acupuncture focuses primarily on the stomach channel and large intestine channel. The combined effect strengthens and engages the sphincter muscle as well as calms the stomach.
  2. Excessive stomach acidity is known as “exuberant liver fire”. Some common prescriptions for this include, HuangLianWenDan Tang, SiNiSan, BanXiaXieXin Tang, HaiPiaoXiao, etc. Acupuncture primarily focuses on sedating the liver and pericardium channels. The combined effect is to decrease stomach acid secretion and to relieve sensation of burning in the throat and chest.
  3. Insufficient secretion of stomach acid can be treated with prescriptions such as BanXiaBaiZhuTianMa Tang or XiangShaLiuJunZi Tang or ping wei san, or individual herbs such as ShanZha, MaiYa, etc. Acupuncture treatment focuses on tonifying the stomach and spleen channels. The combined effect increases the secretion of digestive enzymes and improves breakdown and delivery of nutrition.
  4. Overeating and bloating is often treated with BaoHe Wan, as well as distal acupuncture on points such as LiNeiTing or the well points of the stomach and large intestine channel. The acupuncture treatment can quickly alleviate the full feeling and combined with the prescription helps food digest more efficiently.
  5. Gastroparesis can be treated with ShengJiangXieXin Tang to increase the secretion of digestive enzymes and propagate the downward movement of food in the digestive tract. The same acupucnture protocol as for overeating will be effective.
  6. Spasms of the pyloric sphincter can be treated with BanXiaHouPo Tang and acupuncture points NeiGuan (PC 6) and TaiChong (LV 3). Stimulation of these two points quickly alleviates muscle spasms, tightness, and pain in the chest and abdomen.
  7. Hiatal hernia can be treated with FuLingZeXie Tang or FuLing Yin. Accordingly acupuncture should be performed with tonifying stimulation or moxibustion and focus on ZuSanLi (ST 36), YinLingQuan (SP 9), HeGu (LI 4), etc. This improves muscle tone and clearance of the stomach contents.

  

Home remedies for heartburn          

Breathing with the diaphragm

Performing abdominal breathing can help to strengthen the diaphragm which in turn helps to strengthen the musculature above the stomach pressing downwards.

The following sequence can be used several times a day to help alleviate symptoms. This also has the added benefit of calming the mind, increasing focus, and energizing the body.

  1. Sit upright with the spine straight and shoulders relaxed
  2. Breathe in slowly through your nose
  3. Direct your inhalation down to your belly (you can place a hand on your navel to feel the belly fill to capacity as you do this)
  4. Once completely filled hold the breath for a few seconds
  5. Swallow what saliva you have in your mouth
  6. Begin to exhale the air through your nose by compressing the abdomen (again use a hand to feel the movement of the belly as needed)
  7. Repeat 7-10 times

 

Fermented foods (probiotics)

Foods high in probiotics promote a healthy digestive environment. Some good choices include sauerkraut, miso, fermented tofu, yogurt, some soft cheeses, etc.

Carrot, Daikon, Ginseng

Many foods help to neutralize stomach acid. The alkaline nature of these three make them a good choice. Additionally they all promote secretion of saliva which further neutralizes stomach acid and washes any lingering reflux from the esophagus. A good trick is to take a slice of raw carrot or daikon or ginseng and hold it in your mouth as a chew, slowly swallowing any saliva and replacing as needed.

Other food choices to neutralize stomach acid include cabbage, beets, cucumber, celery, broccoli, etc.

 

Sleep on your left side

Lying on your left side helps keep stomach contents from backing up into the throat.

Press your NeiGuan

Acupressure on this point can quickly alleviate the acute symptoms of heartburn pain. To find the point, place three fingers on the medial side of the wrist. 53bcaf68dd187NeiGuan is located between the two tendons at the distance of three fingers above the wrist.

Use your thumb while gripping the wrist to apply strong steady pressure and combine with the breathing technique explained above for best results.

  

Conclusion

  1. Find digestive homeostasis

Healthy digestion relies on the complex process of physical, chemical, and bacterial systems working in coordination. Irregularity in any of these systems can lead to GERD or other digestive problems. Likewise treatment should focus on the problem at hand and beware of creating imbalances in the other two systems of digestion.

  1. Seek the advice of qualified medical professionals

Having a correct diagnosis from your health care provider is essential. As illustrated above there are many different ways in which GERD manifests and accordingly many different treatments. In order to get the fastest and most effective results a correct diagnosis is necessary.

  1. Pay attention to your body

With treatment and lifestyle changes pay attention to what works for you. In addition to what you’ve read here you’ll find a perpetual list of suggestions elsewhere for how to fix heartburn and acid reflux. Judge for yourself, take what works for you, and use it.

 

 

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Acupuncture and Chinese Herbal Medicine in Maryland

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Flow Health Clinic, LLC

Happy to announce that I’ll now be seeing patients at office locations located in Kensington and Timonium, Maryland. Full consultation, acupuncture, and Chinese herbal medicine services are available. For specifics and to schedule your appointment please visit my website at www.flowhealthlclinic.com


An Apple a Day Keeps the Psychiatrist Away…

fruit-basket-396622_1280A study just published in BMJ Open finds consumption of fruits and vegetables directly related to mental health. In a survey of nearly 14000 participants in England, researchers found that “mental well-being” increased as fruit and vegetable consumption went up, likewise “mental well-being” decreased as fruit and vegetable consumption went down. They also looked at body mass index, alcohol consumption, and smoking as factors affecting mental health.

The novel finding in our study is that, along with smoking, the behavioural risk factor most consistently associated with mental health was fruit and vegetable consumption.

So in addition to all the other reasons to consume fruit and vegetables as part of a healthy diet, add mental well-being to the list.

The full text article can be read on the BMJ Open website: http://bmjopen.bmj.com/content/4/9/e005878.full#T2

S. Stranges, P. C. Samaraweera, F. Taggart, N.-B. Kandala, S. Stewart-Brown.Major health-related behaviours and mental well-being in the general population: the Health Survey for England. BMJ Open, 2014.

Acupressure for Athletes Lesson 2: The knee

Please note that this is the third part of an ongoing series, to read previous posts in this series please click here:
Introduction
Lesson 1: The Foot and Ankle

Knee pain and knee injuries are extremely common among all athletes. Chronic knee pain not only affects our capability for exercise, but also intrudes on daily quality of life. And catastrophic injuries to the knee joint often require surgery with a long recovery time. Thus avoiding injury while protecting the integrity of the knee joint and its’ tissues is critical for everyone.knee

The four main ligaments of the knee prevent the tibia and femur from separating to the front, back, left, or right throughout the full range of motion. Other joints, such as the shoulder have a lot of muscle tissue which helps maintain the structure and stability; or the hip which has a tight ball in socket joint using bone structure to maintain joint integrity. The knee however has little protection from bone structure and the muscles above and below when engaged are all competing to move the bones in different directions. Thus the knee is prone to dislocation injuries resulting in partial or complete tears to one of the four ligaments. These devastating injuries may occur as a result of external forces such as a blow to the knee during contact, or excessive sudden muscle contraction such as when suddenly changing directions or accelerating/decelerating too quickly. This is why it is so important to stretch and warm-up properly before any activity. By adding the techniques below we can further prepare the knee for the stress forces of exercise by alerting the surrounding muscles and awakening neurological connections—thus improving proprioception and recognition of the warning signs of improper positioning.

Moderate misalignment of the knee joint may not cause immediate damage to the ligaments, but nonetheless will lead to inflammation and excessive wear and tear on the tissues of the joint.  Built up over time, this can lead to destruction of the soft tissues and chronic knee pain later in life. The structure of the knee joint and the weight bearing requirements make it impossible to totally eliminate abrasive forces to the tissues, but we should try our best to minimize them. Most of the time the ligaments do a fine job holding the knee on-track and the menisci serve well in dispersing weight and reducing friction. Unfortunately even the slightest of misalignments can lead to exponential damage to these tissues. When the joint is out of alignment weight bearing function will be excessively allocated to one side and abrasive forces will increase. This leads to inflammation, swelling and further destruction of the tissues. Most of the time rest, stretching, and treatment to reduce the inflammation are all that are necessary to recover from these type of problems, but as athletes are often unwilling to interrupt training for any extended period, injury prevention is still the best strategy.

In lesson one we learned some techniques to ready the ankle and foot bones for exercise. As these prepare the foot for weight bearing function and encourage proper positioning of the lower leg, they are also key in setting up for healthy knee alignment. In this lesson we will approach the knee from the perspective of surrounding muscles and the neurological connections which alert our body of misplacement.

As we know from Chinese medical theory and modern research, stimulation of acupuncture points along the channels that pass through the knee activate specific areas of the brain. Through use of these points we can improve speed of transmission of these signals, preparing the knee for action and keeping its’ structure secure. Additionally in the post-exercise section we will learn some techniques to loosen stiffness, reduce inflammation, and accelerate post-workout recovery.

 

Pre-Exercise Acupressure

The points and techniques we learned in Lesson 1 are often sufficient to align the lower leg and ready the knee for action. So please give those a try first, then add the following few points to the routine.

  1. XueHai(Sp-10): This point is located on the medial side of the thigh two inches above the knee. To find it place your same side hand on your thigh, locating your middle finger so that the fingertip is positioned just below the knee cap. Your thumb should naturally fall into place on the medial side of the thigh, the tender spot you feel when you apply pressure is XueHai. To stimulate, first feel around for the most tender spot in the area and then simply apply direct pressure with your thumb. You can also massage this point in a front to back motion to help loosen the muscles which attach to the medial aspect of the knee. As this point is located on the vastus medialis muscle it helps to engage the quadriceps tendon, the medial aspect of the patella and the medial collateral ligament. Thus assisting in movement and structural stability.
  2. XiYangGuan(Gb-33): This point is located just above and lateral to the knee joint. It is on the biceps femoris muscle just above the attachment to the knee. To find it use the same method as above, except use your opposite side hand this time. Place your opposite side hand on your thigh, locating your middle finger so that the fingertip is positioned just below the knee cap. Your thumb should naturally fall into place on the lateral side of the thigh. Try to feel for the tender spot, you may even be able to palpate the muscle specifically. To stimulate apply direct pressure or use an up and down massaging motion. This point helps to engage the lateral collateral ligament and the tissues which support the lateral side of the knee. By loosening the muscle and increasing postural awareness it prepares the knee for load bearing activity and impact.
  3. YinLingQuan(Sp-9): This point is located on the medial side of the leg slightly below the knee and posterior to the tibia. To find it move your hand along the inner side of your leg just below your knee, try to feel the tibia bone. Moving your hand along the curvature of the bone and locate where it straightens out—that is YinLingQuan. It is also approximately four fingers breadth below the knee. To stimulate, use your same-side hand and let your thumb fall on the point while the other four fingers grasp the lateral side of the leg. This point is located on the Soleus muscle of the lower leg and is related to functioning of the foot and ankle and stability of the knee. During stimulation sensation spreads to the medial side knee joint engaging the supportive structures of the knee. (Note this was point was previously mentioned in  Lesson 1)
  4. YangLingquan(Gb-34): This point is located on the lateral side of the leg just below and centered between the head of the fibula and the tuberosity of the tibia. To find this point simply slide your hand down from your knee until you feel the two bones which protrude out—these are the heads of the fibula and tibia. Draw an imaginary equilateral triangle between these points with the third point pointing downwards. This third point is YangLingQuan. Again use your thumb to apply direct pressure on this point. This point is located on the fibularis longus muscle, thus it is involved with movement of the foot and ankle as well as stability of the lateral knee joint. (Note this was point was previously mentioned in  Lesson 1)
  5. WeiZhong(Ub-40): Traditionally this point is located on the exact center of the posterior knee. However in this case we will use a location slightly below the back of the knee joint. To find it simply place your thumb or finger on the back of your knee, now slide downwards toward your heel about one inch. Try to feel for the tender spot, and you’ve got it. To stimulate apply direct pressure or perform a circular massaging movement. This point engages the supportive structures and nerves of the posterior knee. It is useful for people who have a tendency for hyperextension of the knee joint or any pain which radiates down the back of the calf.
  6. HeDing: This point is located just above the knee cap on the attachment of the quadriceps to the patella. To find it simply feel for the tender spot on the top edge of the center of the knee cap. Note that this point is located on a tendon so the tissue will feel much firmer. To stimulate simply apply direct pressure or use a side to side massaging motion to loosen the tendon. As this point is located on the quadriceps tendon it readies the supporting structure of the ventral knee, while also engaging the extension and flexion mechanisms of the knee. This is point is very useful for those suffering from patellar tendinitis, though in cases of tendinitis one should not massage the point but rather apply heavy direct pressure.

The above listed points provide stimulation to all aspects of the knee. Used together these points engage the muscles and supportive structures of the knee, while also increasing flexibility and awareness. Use of this pre-exercise routine helps prepare the knee for activity, both increasing performance and reducing risk of injury. Please add these six points to the techniques we learned in Lesson 1, as you feel necessary.

Post-Exercise Acupressure

Firstly your post-exercise routine should include proper cool down and stretching techniques. It is important to relax your muscles after a workout, to be sure that there is not an excessive amount of stress being placed on a specific part of the joint structure.

Below are some techniques you can add to your regular stretching routine to accelerate recovery and maintain proper alignment.

  1. WeiZhong(Ub-40) and WeiYang(Ub-39): These two points are both located on the posterior side of the knee joint. WeiZhong is in the direct center of the back of the joint and WeiYang is about two inches off the center towards the lateral side. To find these two points simple bend your knee and feel for the soft spot on the back side of the knee between the two protruding tendons. To stimulate first apply direct pressure to both points followed by side-to-side and up-and-down massage. This will help move away any fluid that has built up in the knee, improve venous return, and promote local circulation.
  2. MCL: Massage the medial side of the knee joint. Again bend your knee and this time feel for the joint space on the inner side of the knee (it may be helpful to continue flexing and extending the knee as you feel for the spot). This spot is at the connection of the femur and the tibia bones, there is a small space with little muscle tissue. Once you’ve found it relax your leg and use thumb or fingers to massage front to back along the joint space. This will help to relax the medial collateral ligament as well as promote local circulation.
  3. LCL: Massage the lateral side of the knee joint. Use the same technique as above but on the outer side of the knee joint. In locating this spot be careful to avoid confusion with the protrusion of the fibula bone, moving the joint while feeling for the spot will help you identify clearly where the joint space is located. Again perform front to back massage. This will help to relax the lateral collateral ligament as well as promote local circulation.
  4. TuBi(St-35) and WaiTuBi: These are the two concave points just below the knee cap on the sides of the patellar tendon. To find them first put your leg in a relaxed position and with your hands feel for the concave space just below the knee cap on the left and right sides of the front of the knee joint. To stimulate apply direct pressure followed by massage in a circular motion. This will help to relax the knee cap, prevent damage to the menisci by removing metabolic waste buildup, eliminate pain, and promote circulation.

 

Here we list only a few points and techniques as they should be used in conjunction with those of lesson one.

Wishing you strong, flexible, and pain free knees…

Acupuncture for Side Effects of Breast Cancer Treatment

pink_ribbonRegarding the side effects of aromatase inhibitors, there was a new study published this week. It concludes that  electroacupuncture provides significant relief of fatigue, anxiety, and depression in patients currently taking this medication. You can read the abstract or full article here.

Research involved 67 post-menopausal breast cancer patients. Electroacupuncture treatment and placebo treatment were conducted alongside a control group for a period of 8 weeks. Self report on symptoms was collected throughout the study and a follow up period totaling 12 weeks.

The most common side effect of aromatase inhibitor usage is joint pain. Pain combined with alterations in hormone levels can lead to psychological distress.

Like tamoxifen, aromatase inhibitors are generally taken continuously for a five year period. Yet many patients discotninue use due to side effects, possibly leading to recurrence. Currently there are no Western medical treatment options for dealing with this issue.

Electroacupuncture and traditional acupuncture can both achieve these results. What is most important is that the patient be treated by an experienced acupuncturist who can needle accurately and maximize stimulation of the acupoints. Electroacupuncture simply reduces the need for accurate placement of needles, thus only improving results for less experienced practitioners.

Aromatase inhibitors induce joint pain through a sudden and persistent decrease in estrogen levels. Declining estrogen levels may directly cause pain through diminishing anti-nociceptive function or indirectly through an increase in systemic inflammatory factors(2). A good review article on aromatase inhibitors can be found here. In Chinese medical theory this can be classified as patterns of heat, yin deficiency, qi stagnation, or a combination pattern. It is important to remember that hormone receptor positive breast cancer is always classified as a heat pattern, thus treatments should use heat-clearing toxin removing methods.

When treating cancer we must attack the tumor while simultaneously keeping the patient as healthy and strong as possible. Both aspects of this balance are critical to treatment success and patient quality of life. Just as in the research mentioned above, if we are able to eliminate some of the discomfort associated with cancer treatments, we will increase patient compliance and further improve success rates.

References:

  1. Jun J. Mao, John T. Farrar, Deborah Bruner, Jarcy Zee, Marjorie Bowman, Christina Seluzicki, Angela DeMichele, Sharon X. Xie. Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: A randomized trial. Cancer, 2014; DOI:10.1002/cncr.28917
  2. Niravath, P. Aromatase inhibitor-induced arthralgia: a review. Ann Oncol, 2013); doi: 10.1093/annonc/mdt037

Tennis Elbow: The Needle Rivals Platelet Injections

There are many explanations for the mechanisms of acupuncture. With regards to the nervous system, acupuncture can stimulate or inhibit transmission of nerve impulses with respect to the needle location and type of stimulation applied by the acupuncturist. It can promote circulation to specific areas in the body, releasing muscle tightness and allowing for both adequate oxygenation of tissues and removal of metabolic waste products. Acupuncture can promote lymphatic return. Likewise it can stimulate an immune reaction, reminding the body to repair damaged tissues. There are more…but for now let us focus on this last mechanism.

In chronic injuries the damaged tissues have not sufficiently recovered, thus leading to weakness, pain, and intermittent inflammation. This may be due to a rushed recovery period or an inadequacy of the body’s own self repair function. In Chinese medicine this is known as Qi deficiency and/or Yang deficiency. Additionally pain without range of motion restriction nor inflammation may be due to pain memory. Acupuncture has been a very useful clinical tool in dealing with these issues. Upon insertion of the acupuncture needle an acute immune reaction is stimulated. This alerts the body to damage locally and promotes a rebooting of the self-repair mechanisms. Clearing away of damaged cells and metabolic waste begins anew, while healthy cell regeneration commences. Additionally chronic pain without signs of inflammation may be due to hypersensitivity changes of the peripheral neurons, “wind up” of the spinal neurons, or cortical changes. Acupuncture both locally and distally can help regulate the nervous system and return the body’s nociceptive mechanisms back to normal.

Last month a study comparing the effects of platelet rich plasma (PRP)  injections against saline injections for treatment of tennis elbow was released by the European League Against Rheumatism. A summary article can be found here. Research results showed no difference in speed of recovery between the two groups. Instead they discovered that both groups recovered at very similar rates. In other words the mechanism that promoted the recovery was not the injected medicine nor placebo, but rather the action of inserting the needle itself.

Acupuncture is effective in just the same way. By reminding the body that there is still need for tissue repair, the healing process can be restored and accelerated.

PRP injections are far more invasive than acupuncture treatment. Hollow, thick gauge, serrated tip needles are required for injection; whereas acupuncture needles are flat tipped and narrow gauge, thus minimizing damage to local and surrounding tissues. Additionally PRP injections may include simultaneous injection of anesthetics. This both mitigates the effect of the needling and may further compromise the nervous system.

The use of acupuncture needles to alleviate chronic injuries has long been known by Chinese medicine doctors and clinically has shown remarkable results. It is safe, dependable, and non-habit forming—qualities which all medical therapies should strive to obtain.