Welcome to my blog

Acupuncture specialist for Fertility, Facial rejuvenation, Pain relief.
Based at Kensington Central London.Qualified as a medical doctor in Western medicine over 20 years ago in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences

Doctor who is passionate about acupuncture

I love what I do, I am good at it and I am always there for my patients. If you come and see me, you will know why I am standing out.
This blog is to introduce latest development and research of acupuncture and offer a chance of awareness of more treatment options for your condition. The blog is for information purpose only.

About Me

My photo

My specialised areas include fertility for women and men, facial rejuvenation, acne, various pain conditions, chronic fatigue and hormone regulation with acupuncture treatment.

Practice contact for appointments and address

Kensington: for appointments (Fridays, Saturdays, Mondays and Thursdays) at Anamaya center Kensington please call at 02030110355 or email at info@anamaya.co.uk

Address: 1 Adam and Eve Mews, Kensington, London W8 6UG

2 min walk from High Street Kensington underground station

My background: I became a qualified medical doctor in Western medicine 20 years ago in China and was well trained in Western medicine together with Chinese medicine in the best Medical University in Beijing, China. Also I was trained with Dr Zheren Xuan--famous orthopedics expert and founder of soft tissue surgery in China. I am dedicated to treat patients with acupuncture and am recognized as one of the world leading acupuncture specialists.

I obtained a PhD degree in the University of Leeds in the UK.

I had post doctoral training and worked as a senior researcher in St George's hospital, London, UK.

I had frequently presented my research findings in the top international conferences in the field.

I have many publications including ebooks and articles.

I have many year clinical experiences. Over the years of practicing, I have developed unique treatment approaches for infertility, skin aging, acne, vulvodynia, neck pain, headache, migraine, shoulder pain, back pain and hot flushes etc to achieve best treatment results. My devotion and skills are highly praised by my patients. 


Monday, 26 November 2012

Suffer from acne, acupuncture can help

What is acne? What causes acne? Acne is a disorder that occurs in the hair follicles in the face, chest and back. This is known as black heads, white heads, pimples, pustules and cysts on the skin. It is a common condition in teenagers and younger adults. Acnes can be on and off for a few years and disappear by mid 20s. Acne can have a big impact on psychological well-being.

Acne is thought triggered by hormone imbalance. Too much androgen secretion is the major trigger. Changing of hormone levels makes glands in the skin produce excessive amounts of an oily substance- sebum. Increased male hormone stimulates the oil gland attached to the hair follicles-small holes in the skin. Increased male hormone alters the oil production which causes the follicular pores clogged and hair follicles enlarged. Bacteria can access to the deeper layers of the skin through these follicles causing inflammation. Inflammation closed to the skin surface causing a pustule; inflammation in deeper layer leads to pimple and a cyst. And sometimes scar can form from abnormal wound healing following inflammatory damage. White head is caused by oil clogging to the skin surface while black head is caused by oxidized oil or accumulated melanin pigment. The factors that don’t cause acne include heredity, food, dirt, or stress.

From Traditional Chinese Medicine point of view, there are several factors causing acne: heat and damp is accumulated in lung and stomach meridians causing skin blockage. Spleen dysfunction makes food transportation, digestion and transformation abnormal and produces more heat. This also makes obstruction in the skin.

Do you know acupuncture helps reduce acne? The principle of treatment is to clear heat in the lung and stomach; to eliminate dampness; to strengthen spleen and stomach. Acupuncture may help with treat acne by reducing inflammation from promoting release of anti-inflammatory factors, modulating immune cell activities including natural killer cell activities and improving local blood circulation. Acupuncture unblocks the lung and stomach meridians and clears the heat.

There were many case reports that acupuncture can treat acne. For example, Son BK et al studied the effect of acupuncture on acne. They found that 12 sessions of acupuncture over 6 weeks reduced inflammatory lesion counts and quality of life in patients with acne. Recently Li B et al studied the current situation in research to evaluate the therapeutic effect and safety for clinical randomized and controlled trials of treatment of acne with acupuncture and moxibustion in China. They analysed 17 papers involving 1613 cases with acne and they found that acupuncture and moxibustion is safe and effective for treatment of acne and it is possibly better than routine western medicine.

Here is an example of a case. Lily is 30 year old. She had acne on her face on and off for 6 months. There are many newly formed pimples, cysts and some of them are infected by bacteria forming pustules. Scars can be seen on her face. She also had mouth odour and constipation. She heard from a friend that acupuncture may help her and wanted to try acupuncture. After a course of acupuncture, the acne symptoms were improved significantly. Also mouth odour was improved and there was no constipation at all. After 3 courses of treatment, acne was cured.

References
Li B et al Zhongguo Zhen Jiu (2009) 29:247-51
Son BK et al Acupunct Med (2010) 28:126-9
Gong and Qian J Tradit Chin Med )2007) 27:255-7
Acne treatment with acupuncture by [Ju, Dr Maggie]

Wednesday, 14 November 2012

Sperm DNA damage could be the cause for couples with unexplained infertility and miscarriage

Sperm DNA fragmentation is related to infertility

Male fertility is evaluated by sperm count, motility and morphology. This becomes a part of routine semen analyses. The basic semen analysis may provide useful information regarding male fertility potential. Sperm concentration, motility and morphology have been correlated with fertilization rates as a result of normal development during sperm production in the testes, normal maturation in epididymis and normal seminal plasma constituents. Abnormal sperm quality has been linked to several infertility problems. In certain cases, the initial semen examination can reveal some radical forms of sperm dysfunction, eg. azoospermia or globozoospermia that have serious negative consequences to natural conception. However limitations still exist in finding a cause of male infertility and a normal sperm parameter does not necessarily guarantee satisfactory fertilizing potential. An estimated 15% of men with normal basic semen analysis profiles have nonetheless been associated with infertility. A specialised test of sperm is checking sperm DNA damage measured by DNA fragmentation which may be linked to negative clinical outcomes. Recently there has been growing interest in the use of DNA integrity as a marker of male infertility.

DNA damage may exert its effect at different stages of the reproductive procedure, beginning from the pre-implantation development of the embryo to the achievement and sustaining of pregnancy and finally the creation of healthy offspring. An inverse relationship has been reported between the likelihood of achieving pregnancy either by natural intercourse or by application of ART and the presence of high sperm DNA fragmentation levels. Men with abnormal semen parameters have a higher risk of high levels of DNA fragmentation. Men with infertility have increased levels of fragmented sperm DNA and vice versa. Abnormal chromosome rate which triggers DNA fragmentation is higher in poor quality sperm samples. Research has shown that Sperm nuclear DNA fragmentation has been positively correlated with lower fertilization rates in IVF, impaired implantation rates, an increased incidence of abortion and disease in offspring. For example, a study investigated correlation of fertilization rate with sperm DNA fragmentation in A 85 couples undergoing infertility treatment with IVF/ICSI. The result has shown that fertilization rate was inversely correlated with DNA fragmentation. In addition, the slower embryo development and worst morphology on day 6 was correlated with higher sperm DNA fragmentation. There was a negative correlation between DNA fragmentation and the implantation rate. Analysis from a study including 2969 couples has shown that there was a significant increase in miscarriage in patients with high DNA damage compared with those with low DNA damage.

As mentioned above, sperm DNA damage is a useful biomarker for male infertility diagnosis and prediction of assisted reproduction outcomes. It shows more promise than conventional semen parameters from a diagnostic perspective. Another recent study has shown that it is associated with reduced fertilization rates, embryo quality and pregnancy rates, and higher rates of spontaneous miscarriage and childhood diseases; A study involved in 2,756 couples, 965 pregnancies has also shown that high-level sperm DNA fragmentation has a detrimental effect on outcome of IVF/ICSI, with decreased pregnancy rate and increased miscarriage rate. The analysis by type of procedure (IVF vs. ICSI) indicated that high sperm DNA damage was related to lower pregnancy rates in IVF but not in ICSI cycles, whereas it was associated with higher miscarriage rates in both IVF and ICSI cycles.

Sperm DNA damage is often the result of increased oxidative stress in the male reproductive tract, the potential contribution of antioxidant therapy. Do you know that acupuncture improves sperm quantity and quality? Acupuncture could reduce oxidative damage and is a potential useful therapy to treat sperm DNA damage.

References

Muriel et al Fertil Steril (2006) 85:371-83

Robinson et al HumRepord (2012) 27:2908-17

Zhao et al Fertil Steril (2014) 102:998-1005

Tuesday, 13 November 2012

Ectopic pregnancy, acupuncture helps recovering

What is ectopic pregnancy? Ectopic pregnancy is that the fertilized egg implanted outside of the uterus. The commonest site is in the fallopian tube. The egg will not develop a baby, but it is threatening condition for the pregnant women. Ectopic pregnancy occurs in 1% pregnancy. The risk factors include pervious pelvic inflammatory disease, infertility, tubal surgery, intrauterine contraceptive device and previous ectopic. Patient has positive urinary pregnancy test. Patient presents lower abdominal pain and slight vaginal bleeding. Ultrasound shows empty uterus and may identify ectopic embryo. If the egg dies before it can grow larger, the pregnancy terminates and the tissue is absorbed in the woman’s body. In this case, the pregnancy test becomes negative. If the pregnancy is left to grow, there is a risk that the fertilized egg grows larger and causes the tube to rupture which can cause life threatening internal bleeding. The signs of tube rupture are sudden severe sharp abdominal pain, feeling faint and dizzy, being sick, diarrhoea and shoulder tip pain. This is a medical emergency condition.

It is recommended that you wait for at least 2-3 menstrual cycles before trying for another pregnancy though many women are not emotionally ready for another pregnancy so soon. The chances of having a successful pregnancy will depend on the underlying health of the fallopian tubes. There are about 50% risks of infertility after ectopic and 20% recurrent rate. In subsequent pregnancy the women should receive early evaluation to confirm that the pregnancy is in uterus. It is hard to predict what the individual chance is for a successful pregnancy after the ectopic pregnancy surgery. Some research showed that about 65% of women achieved a successful pregnancy 18 months after having an ectopic pregnancy. Acupuncture could help the recovering of fallopian tubes by improving pelvic circulation, reducing inflammation and relaxing the tubes to be ready for next pregnancy. Also acupuncture can help to reduce stress in the women after pregnancy loss and surgery.

Appendectomy increases the risk of ectopic pregnancy

Fallopian tube damage is responsible for one third of infertility cases. Ruptured appendicitis has been considered a risk factor in causing scarring, which can lead to infertility and/or ectopic pregnancy. Does appendectomy increase the risk of tubal infertility? A research studied recent data on this subject. They found that previous appendectomy is not associated with increased incidence of infertility in women. However this study found that appendectomy is significantly associated with an increased risk of ectopic pregnancy.

Compromised ovarian function after salpingectomy, acupuncture can help.

After salpingectomy, the ovarian function on the operation side could be compromised because of reduced blood circulation. A study involved in thirty-two patients with unilateral salpingectomy performed for ectopic pregnancy investigated this subject. In this study, ovarian function was assessed by antral follicle count, ovarian volume and ovarian stromal blood flow measured by three-dimensional (3D) power Doppler ultrasonography. Ovarian volume, antral follicle count and 3D power Doppler indices were comparable between the operated and the non-operated sides in the whole group and in the laparotomy group. The antral follicle count and 3D power Doppler indices were significantly reduced on the operated side in the laparoscopy group. It suggested that ovarian function seems to be impaired after laparoscopic unilateral salpingectomy at short-term.

Do you know that acupuncture improves blood circulation to the ovaries and other reproductive system? It could help to improve ovarian function.

References

Elraiyah T et al J Surg Res (2014) ii: S0022-4804(14)00784-7. doi: 10.1016/j.jss.2014.08.017.

Chan CC et al Hum Reprod (2003) 18:2175-80

Gynaecological pain, acupuncture can help

Gynaecological pain, acupuncture can help

Chronic pelvic pain (CPP) is recurrent or constant pain in the lower abdominal region that has lasted for 6 months or more. CPP can be caused by many conditions and the symptoms are similar and nonspecific. CPP is a common disorder with 3.8% population occurrence and it is as high as 40% in women with infertility. CPP is a heavy burden in women of reproductive age, with a direct affect of their quality of life. The treatment is focusing on identifying underlying cause and treatment. If there is no underlying cause identified, pain management is essential.

Gynaecological pain

Inflammation and injury can be a problematic for internal organs. The organs become highly sensitive to any stimulation and pain sensation is very common. In women pain associated with their reproductive system is prevalent, such as period pain, labour pain etc. There is a particular sensory receptor that responds to potentially harmful stimuli by sending nerve signals to the spinal cord and brain. The receptors respond not only to intense mechanical stimuli such as distension and overstretching but also to irritant chemicals especially to the products of inflammation. They are very important in signalling pain from inflamed area. The uterus, cervix and adnexa share the same visceral innervations as the lower ileum, sigmoid colon and rectum. Signals from these organs pass through the sympathetic nerves to spinal cord segments T10-L1. Because of the shared pathway, gynaecological pain is difficult to be distinguished from gastrointestinal pain. Gynaecological pain can be felt in places far from the location of the reproductive organs. This is known as referred pain. The pain can be felt in the abdomen, pelvic region, or lower back. This pain sometimes cannot be located very accurately. The pain can be sensitized by altering sensory neurons so that they respond more intensely to the stimuli; and also by enhancing sensitivity of the sensory pathways in the brain that modulate sensation.

Some gynaecological conditions cause acute abdominal pain: ectopic pregnancy which occurs in 1% of pregnancies; pelvic inflammatory diseases; endometriosis, when large chocolate cysts ruptured; ruptured ovarian cysts.

In women, two conditions are very common: endometriosis related pelvic pain and pelvic inflammatory diseases and adhesions.

Endometriosis related pelvic pain. Endometriosis is an estrogen-dependent inflammatory disorder that occurs in women during reproductive years. CPP is one of the most common symptoms of endometriosis. The pelvic pain caused by endometriosis may vary with menstrual cycle, typically with severe pain toward the end of the cycle and pain declined during menstruation. Some women may have constant pain with various severities without association with menstrual cycle changes. Period pain, pain during intercourse, irregular period and infertility may coexist in these women with endometriosis. The causes for CPP in endometriosis are not clear. There are a few theories. One of them is that the lesions cause pain, but how they contributing to the pain remains mystery. Another hypothesis is that local inflammation contributes to the pain in endometriosis in which prostaglandins are activated. This established a foundation for new treatments involving agents and methods that can inhibit immunological and inflammatory factors. Recent studies suggested that innovation by newly sprouted nerve fibres underlies pain in endometriosis. This is supported by some clinical findings and studies from animal experiment. In animal experiment, transplanted pieces of uterine tissue become vascularised and grow rapidly and innervations and pain symptoms are seen. In clinical studies, various neuronal fibre types are found in different types of lesions and nerve fibre densities are associated with severity of pelvic pain.

Pelvic inflammatory diseases and adhesion: If women with pelvic pain have a history of previous sexually transmitted infection, intercourse pain, backache, infertility, ectopic pregnancy or fever, pelvic inflammatory disease is very likely an underlying cause of CPP. If the pain is associated with stretching movements or organ distension, adhesion may exist.

Acupuncture may benefit. There are some good reasons to choose acupuncture to treat CPP. First, acupuncture is effective to treat some underlying causes of CPP, such as endometriosis, pelvic inflammatory diseases; second, acupuncture is effective way to release the pain in CPP; third, acupuncture has no side effect.

Acupuncture reduces back and pelvic pain in pregnant women

More than two-thirds of pregnant women have low back pain (LBP) and one-fifth have pelvic pain. With pregnancy advanced pain increases which could affects work, daily activities and sleep. Pennic V and Liddle SD assessed the effects of different interventions for preventing and treating pelvic and back pain in pregnancy. They studied 26 randomised trials involved in 4093 pregnant women in the review. Usual prenatal care was added to the interventions. For LBP exercises significantly reduced pain and disability, though the evidence was low quality. Water-based exercise significantly reduced LBP-related sick leave. There was no significant difference in pain or function between two types of pelvic support belt, between osteopathic manipulation and usual care or sham ultrasound. Specially-designed pillow may relief night pain better than a regular pillow. For pelvic pain, the quality evidence was moderate which showed that acupuncture significantly reduced evening pain better than exercise; both approaches were better than usual care. A rigid belt plus exercise improved average pain. An eight to twenty wee exercise program reduced the risk of having lumbo-pelvic pain. Exercise and significantly reduced lumbo-pelvic-related sick leave and improved function. Osteopathic manipulation reduced pain and improved physical function. Acupuncture was started at 26 rather than 20 weeks of pregnancy improve pain and function more. Adverse events were minor and transient.

Acupuncture is as effective as pain killers for period pain (dysmenorrhoea).

Dysmenorrhoea is the medical term for the painful period cramps. It is also known as period pain. Period pain is very common affecting about over 50% women. The pains can be mild dull pain which may rarely noticeable or severe which may affect women’s daily life. They can be periodic or continual. It presents cramping pain in the abdomen before or during the menstrual period. Women with period pain may also feel pressure in the abdomen, pain in the hips, lower back and inner thighs. They may have other symptoms including upset stomach with or without vomiting and loose stools or constipation. Period pain may be accompanied by a headache, dizziness, fainting and fatigue and urgent frequent urination. Period pain is caused by uterine muscle contractions in response to prostaglandins and other chemicals. Uterine lining is shed off during menstruation and uterus contracts to squeeze the tissue out of the uterus.

Symptoms could start as early as immediately after ovulation and last until the end of menstruation. Common period pain often starts immediately before or at the beginning of the period and last for one to three days. Period pains generally begin one to two years after a woman starts getting her period and they become less painful as a woman ages and may stop entirely after the woman has a baby.

Why some women get more painful periods than others? Painful period is associated with changing of hormonal levels with ovulation. Prostaglandins produced in the endometrium of uterus cause uterine contraction which causes pain. Compared with other women, women with severe painful periods have increased uterine contractibility and more frequency of contraction. Women with more painful periods have higher level of prostaglandins compared with those with less painful period. Some factors including narrow cervical canal, backward tilting uterus, lack of exercises and emotional stress increase the period pain.

There are two types of period pain: primary period pain and secondary. In primary period pain, there is no cause of underlying gynaecological condition. Normally period pain occurs in the ovulatory cycles. In secondary period pain, some gynaecological conditions such as endometriosis or ovarian cysts are underlying causes of the period pain.

The treatment is aimed reducing pain. Non-steroidal anti-inflammatory drugs (NSAID) known as pain killers are common used to relieve the pain. These drugs decrease prostaglandins production and reduce pain. Contraceptive pills can be used to treat period pain because they stop ovulation.

Can acupuncture help period pain? Yes, acupuncture is well known to reduce pains in various conditions and it is very effective to relieve period pain. Acupuncture at particular points stimulates nerve ends producing pain releasing substances such as endorphins and neuropiptide which acts as endogenous painkillers.; acupuncture reduces inflammation by increasing blood flow and releasing vascular and immunomodulatory fators; acupuncture makes uterus relaxed.

Recently Kiran et al compared the effect of acupuncture and medicines (NSAID) for the treatment of primary period pain. The study is involved in 35 young women with a diagnosis of primary dysmenorrhea. They were divided into two groups: acupuncture group and medicine group. One month treatments were given to these women with dysmenorrhea and then the pain scores were assessed. They found that acupuncture is as effective as NSAID to reduce period pain.

When is a good time of acupuncture treatment for period pain

It is well known that acupuncture is effective in treating period pain. When is the best time to seek acupuncture treatment if you suffer from period pain? Ma YX et al studied this time related treatment. They recruited 600 patients with period pain. They compared the effect of acupuncture treatment with no treatment. They also compared the effect of acupuncture treatment before the period started with the effect of immediate acupuncture treatment as soon as pain occurrence. They found that acupuncture significantly relieves period pain compared with the control group with no treatment. The pain has been relieved within 5 min after acupuncture treatment. By comparing the pain scores used for the pain assessment, they found the acupuncture treatment before period has better effect than that when the pain occurred. This study suggests that acupuncture prevents period pain. Acupuncture reduces period pain by a few mechanisms. Acupuncture regulates hypothalamus-pituitary ovary axis; acupuncture relaxes uterine smooth muscles and inhibits uterine contraction; acupuncture increases relaxation and reduces tension; acupuncture releases endorphins and other neurohumoral factors and changes pain processing in the brain and spinal cord; acupuncture reduces inflammation by increasing release of vascular and immunomodulatory factors.

Which acupuncture points for women’s period pain

If you see an acupuncturist for period pain, you might like to know which acupuncture points were used. There is a lot variation for acupuncture points used. A study analysed research data from January 1978 to April 2014 to assess the acupuncture points for period pain. They found that there were 20 acupuncture points frequently used. Acupoints on lower limbs were most frequently used. Three points including Sanyinjiao (SP06), Guanyuan (CV04), and Qihai (CV06) were used most frequently. The most frequently used meridians were Conception Vessel, Spleen Meridian of Foot Taiyin, and Bladder Meridian of Foot Taiyang. 67.24% of acupoints used were specific acupoints.

Case report for period pain and endometriosis with acupuncture treatment

Alice is 27 years old. She had severe period pain and sometimes lower tummy pain between periods. She was diagnosed endometriosis one year ago. She took painkillers and antibiotics, but she still had unbearable pain in her lower tummy. And then she was advised to use birth control pills to inhibit ovulation in order to stop the pain and endometriosis. But she still suffers from pain. She never got pregnant before, but she wanted to have a baby some day. So she decided to stop taking birth control pills and seek help from acupuncture for period pain. After a few sessions of acupuncture treatment, her pain reduced markedly. With continuing a few month acupuncture treatments, she was no longer having pain in her periods.

References

Kiran G et al Eur J Obstet Gynecol REprod Biol. 2013 Mar 19

Ma YX J Ethnopharmacol. (2013) 148:498-504

Pennic V & Liddle SD Cochrane Database Syst Rev. (2013) Aug.

Yu S et al Evid Based Completment Alternat Med (2015) 2015:752194

Sunday, 11 November 2012

Acupuncture regulates hypothalamus-pituitary-ovary axis

Acupuncture regulates hypothalamus-pituitary-ovarian axis

The female reproductive system is controlled by the hypothalamus-pituitary-ovarian (HPO) axis. This feedback loop begins with gonadotrophin-releasing hormone being released from the hypothalamus, resulting in the secretion of the gonadotrophins (LH and FSH) from the anterior pituitary, which in turn controls estrogen and progesterone production in the ovaries. Estrogen and progesterone play a central role in female fertility by stimulating growth, differentiation and maturation of follicles, preparing the endometrium for implantation and maintaining embryonic development. Altered levels of hormones and other factors that are involved in maintaining control of the HPO axis can have negative effects on fertility and pregnancy

Acupuncture promotes the release of beta-endorphin in the brain, which regulates gonadatrophin releasing hormone from the hypothalamus, follicle stimulating hormone from the pituitary gland, and oestrogen and progesterone levels from the ovary.

Egg quality

How to you know your egg quality is good or not? It is difficult to know your egg quality until IVF through which eggs can be seen. There are many factors that help estimate egg quality:

ovarian reserve tests including AMH, antral follicle count and FSH test, higher AMH and antral follicle count show good ovarian reserve. FSH from blood test less than 10 iu/l is good.

factors related to your menstrual cycles including cycle length, premenstrual spotting, ovulation day, peak estradiol and peak progesterone. Shorter cycles, spotting and low estradiol and progesterone indicate egg quality may not be good enough.

women’s age: most women under age 35 would have good quality of eggs.

pregnancy loss followed by difficulty to conceive again; This indicates that your egg quality is deteriorating.

IVF results which tests egg quality.

Acupuncture with or without TCM. Minimum 3 month acupuncture could improve egg quality.

Off pills, acupuncture helps resume ovulation

Oral contraceptive pills were developed over 40 years ago and they become the most common approaches of contraception in many countries. About 100 million women worldwide currently rely on this method for contraception. Do you know what the components of contraceptive pills and how they work? Most commonly used pills are called combined oral contraceptive (COC) pills which contain estrogen and progestogen. There are progestogen only pills available as well. These pills mainly inhibit ovulation by disturbing hypothalamus pituitary gland ovary axis ovary function and altering hormone balance. For most women their period will return within a few months once off the pills. But for some women, it might take longer to get their ovaries function again. This is understandable. For example if you fix one of your knee joints for a few months or longer. The knee joint may not function well and the related muscles will shrink and loss their function. When you release the knee, you have to work really hard and do lot of exercises to get the joint and muscles function well as normal again. When you are on pills your ovarian function is suppressed and they will not ovulate immediately. Some women’s ovary may be more sensitive to the pills. Once you are off pills, the ovaries have to work hard to regain their function. This takes some time. If they fail to do so, follicles may not develop and ovulation may not occur.

What you can do to help your ovary function? Acupuncture can help resume ovary function by improving ovary blood flow and regulating hormone balance as mentioned above without taking more medications.

References
Chang K and Tian SL Zhen Ci Yan Jiu (2012) 37:15-9

Monday, 5 November 2012

Tennis elbow, elbow pain, acupuncture can help

Tennis elbow has many alternative names including lateral elbow pain, lateral epicondylitis, rowing elbow, tendonitis of the common extensor origin, and peritendinitis of the elbow. It can affect sufferer’s work and quality of life. Tennis elbow is common and affects up to 3% of the population and it is characterised by pain and tenderness over the outer part of the elbow and pain on resisted dorsiflexion of the wrist, middle finger, or both. This is caused by an overuse injury of the extensors of the forearm which attach at the lateral epicondyle. Patients with tennis elbow are typically over 40 year old and have a history of repetitive activity during work or recreation. Non steroids pain killers and steroids injection have short term effects in improving symptoms such as pain reduction, global improvement, and grip strength compared with placebo and other conservative treatments. Physiotherapy is commonly used though there is lack of evidence of efficacy.

Acupuncture is an appropriate option for tennis elbow treatment. Previous research showed acupuncture had short term benefit (three days to two months) in pain reduction. The longer term effect still needs to be studied. More recently a study published in a Chinese acupuncture journal. 34 patients with tennis elbow were in two groups for acupuncture treatment in different acupuncture points. Group A was used anti-Ashi-points (points of pain relief or disappearance after local press) and group B was used Ashi-points (pain spots) and surrounded points. Acupuncture was performed once in every two days; 2 courses treatment was given with 10 treatments for 1 course. The effect was assessed at the end of the treatment day, the 7th day, the 30th day, the 6th months and one year after treatment. They found that short term effect was better for group A than group B, but the long term effect (6 months and one year) were similar between the two groups.

Another study analysed the effectiveness of acupuncture on lateral elbow pain (LEP). By comparison of acupuncture and sham acupuncture treatment, patients with LEP received acupuncture treatment had significantly more reduction in pain and greater improvement in elbow mobility, more strength in the arm. There was immediate effect after acupuncture treatment and the effect last for 2 weeks followup period.

By comparison of acupuncture and conventional treatment, it was found from those studies that the acupuncture group had a significantly higher cured rate than conventional therapy, including prednisolone injection, triamcinolone acetonide, lidocaine injection. At 6 month followup, Acupuncture group had significant reduction in VAS pain score when compared with the group that received pulsated ultrasound and massage. Study has shown there was no significant difference between moxibustion and conventional treatment.

By comparison of acupuncture plus moxibustion combination and acupuncture alone, one study has suggested combination of acupuncture with moxibustion had better pain reduction and another study has shown that electro acupuncture had better pain reduction, but there was no clear conclusion because of poor methodology.

About adverse effects, there was no adverse effect reported in acupuncture treatment. One case of permanent scar from blister was reported in moxibustion treatment.

Clinically there were some cases that patients with tennis elbow were completely cured after acupuncture treatments.

Here are some success stories for elbow pain with acupuncture treatment. For example, Lisa who was 42 years of age was diagnosed with tennis elbow for 5 years. Her right elbow pain became persistent after a few years. This affected her daily life. She had terrible pain in her arms around the elbow whenever she used the arm. She tried everything she could to get rid of the pain without success. A friend told her to try acupuncture which she did. After first session of acupuncture, she felt less painful immediately. She was encouraged so much and continued to do a few sessions. She felt much better and could use the arm without feeling too much pain. She did a few more sessions again. The pain was completely gone. After a few years a follow up showed that there was no recurrence of the elbow pain.

Sarah was 50 year old. She had left elbow pain for 10 years. Initially the pain stayed at the lateral part of the elbow and the pain came and went. However the pain spread later to the medial part of the elbow, to the front and the back of the forearm and the arms as well. The pain was getting worse. She could not do anything using the left arm such as writing, combing hair or lifting arm (Because she was left-handed, this causes more problems for her). The examination showed pain at the lateral and medial part of the elbow when she was doing elbow extension and flexion, left arm lifting, left wrist extension and flexion. There were highly sensitive tender points around the elbow. This was a typical case of soft tissue injury around the left elbow or so called tennis elbow. Acupuncture was effective for this case. After a few sessions of acupuncture treatments, she could do things using her left arm without feeling too much pain. With continuing a few sessions of treatments the pain was gone completely. 1 year follow up showed there was no pain at all. She could use the left arm do anything as the right arm. Examination showed there was no pain when she was doing the left elbow extension, flexion or arm lifting. There were no tender points around the elbow.

Acupuncture help relieve symptoms of tennis elbow. It stimulates nerve ends leading to release of analgesic substances such as endorphins to relive the pain. It also reduces inflammation by improving local circulation. It also improves muscle stiffness and joint mobility by increasing local microcirculation.

References
Johnson GW et al Am Farm Physician (2007) 76:843-8
Wan X Zhongguo Zhen Jiu (2011) 31:1078-80
Gadau M et al BMC Complement Altern Med (2014) 14:136