Welcome to my blog

Acupuncture specialist for Fertility, Facial rejuvenation, Pain relief, Fatigue.
Based at Harley Street and Kensington Central London.Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Over 25 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, facial rejuvenation, acne, vulvodynia, various pain conditions, chronic fatigue, neurological conditions, digestive problems

Practice contact for appointments and addresses 

Kensington: for appointments at Anamaya center Kensington (Mondays, Tuesdays, Thursdays, Fridays, Saturdays) 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

Harley Street: for appointments  at Harley Street (Wednesdays) please call ALO clinic at 02076368845 or email at info@aloclinic.com
Address
Suite 3 Harmont House
20 Harley Street, London W1G 9PH
5 min walk from Oxford Circus underground station

My background: I became a qualified medical doctor 25 years ago in Western medicine  in China and was well trained in Western medicine together with Chinese medicine in the best Medical University in Beijing, China. Particularly I was trained with Ji-sheng Han famous professor and neuroscientist in China and with Dr Zheren Xuan--famous orthopedics expert and founder of soft tissue surgery in China. Furthermore I had training in dermatology and oral and maxilofacial surgery in China. Also I had training in fertility and had research experiences in uterine smooth muscles and blood vessels in China and the UK. I am dedicated to treat patients with acupuncture and am recognised 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 practising, I have developed unique treatment approaches for infertility, skin aging, acne, vulvodynia, bladder pain, neck pain, headache, migraine, shoulder pain, back pain, fatigue, hot flushes, nerve pain, chronic prostatitis, insomnia, Parkison's disease, MS, acid reflex, IBS etc to achieve best treatment results. 

My devotion and skills are highly praised by my patients. 

My eBooks

Facial acupuncture Facial rejuvenation Acne treatment
Know your ovary to get pregnant
Know fertility and acupuncture to get pregnant
Vulvodynia, is vulval pain in your mind
Energy fatigue and acupuncture
Headaches, Neck pain and shoulder pain

Thursday, 10 October 2013

Anorexia nervosa with acupuncture treatment

Anorexia nervosa is an eating disorder and mental health condition. It is a severely debilitating psychiatric disorder characterized by relentless self-starvation with compulsive behaviour. It is associated with low rates of recovery and has the highest mortality rate of any psychiatric disorder. The neuro basis of anorexia is alteration of part of brain activity, abnormal brain circuit and reduced blood flow. From biochemical point of view, low serotonin level is present in patients with anorexia. The evidence for existing psychological and pharmacological interventions to treat anorexia nervosa is not strong. Use of complementary therapy to treat the condition could improve mental health outcomes for these patients. There was a pilot study for a further trial on acupuncture and acupressure and massage health outcomes for patients with anorexia nervosa. This study was by Smith C et al from Australia. There were 26 patients with anorexia revosia. Their conditions were stable and had treatments as usual. The intervention was given twice a week for the first 3 weeks, and then the interventions was on weekly basis for three weeks. Acupuncture group received acupuncture at the points hegu (LI4), zusanli (ST36), neiguan (PC6), taichong (LR3), yanglingquan (GB34) and additional points which were based on the Traditional Chinese Medicine diagnosis. The control group received acupressure and massage. The clinic outcomes which measure body-mass index (BMI) and eating disorder psychopathology, anxiety and depression, were assessed at baseline and at the 6 weeks following completion of the intervention. Participants described both interventions including acupuncture, acupressure and massage positively and experienced a sense of calmness and relaxation. This study shows positive effect of acupuncture and acupressure and massage on patients with anorexia nervosa, which leads to further research on this issue. The potential mechanism could be that acupuncture changes brain activity, increases brain blood flow and increases serotonin level.

How patients with anorexia nervosa view acupuncture therapy?

There was a study to collect the view of patients with anorexia nervosa who received acupuncture treatments. 26 patients with anorexia nervosa received six weeks acupuncture treatments. These patients highly valued the acupuncture treatments in particular the characteristics of empathy, positive regard, acceptance, non judgemental responses and trust. Having someone to talk to, being less stressed and contact, with study staff were also perceived to be important.

References,
Fogarly S et al Complement Ther Med (2013) 21:675-81
Smith C et al J Altern Complement Med 2013 Oct 8

Sunday, 6 October 2013

Depression and acupuncture

Acupuncture improves your mood

Everyone has mood changes in some degree, however too much mood changes could be caused by ill health and further affects one’s health. Mood expressions include positive scales like "activity, joy, contemplation, calmness" and negative scales like "anger, irritation, depression, fatigue”. Patients with chronic disease supposed to have dominant negative mood scales. Do you know acupuncture can help you improve mood changes. A research has shown that there was an immediate, fast suppression of unusual slow high amplitude EEG waves in response to acupuncture needle rotation. Also there was a significant improvement on positive mood scales and a decline in negative mood scales after 10 acupuncture sessions. Patients with chronic pain reported a significant decrease of pain intensity after 10 sessions.

Acupuncture is cost-effective compared with counselling or usual care alone in treating depression

There is emerging evidence that acupuncture is effective for treating patients with depression. A study from the University of York UK has shown that acupuncture is also cost effective for treating depression. They compared the cost of acupuncture, counselling or usual care for depression based the price of the interventions. They measured quality adjusted life years (QALYs) in analysis. They found that acupuncture and counselling have higher mean QALYs and costs than usual care. They have shown that acupuncture has an increased cost-effectiveness ratio (ICER) of £4,560 per additional QALY and is cost-effective with a probability of 0.62 at a cost-effectiveness threshold of £20,000 per QALY. Counselling compared with acupuncture is more effective and more costly with an ICER of £71,757 and a probability of being cost-effective of 0.36. Acupuncture is cost-effective compared with counselling or usual care alone.

Depression and acupuncture

There is another study about electroacupuncture on personality traits in derpression from China. 48 patients completed the study. The Minnesota Multiple Personality Inventory (MMPI) was used for evaluation. Self-rating depression scale (SDS), self-rating anxiety scale (SAS) and Montgomery asberg depression rating scale (MADRS) were used to assess the psychological state. Assessments were done before and after the treatment. These patients were received lectroacupuncture treatments for 24 weeks in acupuncture group. After treatment, patients psychological state improved significantly in acupuncture group and control group. In treatment group severity of depression had significantly decreased after 24 weeks of treatment compared with that before the treatment. MADRS, SDS and MMPI scores decreased significantly. In control group these scores also decreased. The decrease of these scores was greater in treatment group compared with control group, though there was no significantly difference between the two groups.

References
Acker H et al Med Hypotheses (2015) May 22 pii: S0306-9877(15)00201-7. doi: 10.1016/j.mehy.2015.05.013. [Epub ahead of print]
Spackamn E et al PLoS One (2014) 9:e113726
Wang WD et al Chin J Integr Med 2013 19:777-782

Thursday, 8 August 2013

How does your body temperature help you to know ovulation time?

What is basal body temperature? Basal body temperature (BBT) is the lowest body temperature during rest. It is usually measured in the morning as soon as you wake up and before you engage any physical activity. In women, BBT changes with the menstrual cycles. If you make a daily BBT chart in a full menstrual cycle you can see the BBT chart is biphasic which means there are two temperature phases. Ovulation increases BBT for about up to 0.5 degree Celsius. The average BBT is 36.37 ±0.12 ºC during follicular phase (the phase prior to ovulation) and 36.72 ±0.12 ºC in luteal phase (the phase after ovulation). If conception does not occur, the temperature goes down and then the next menstrual cycle starts. If the conception occurs, the temperature stays at the higher level until the end of first trimester of the pregnancy.

If you are trying to conceive, making your BBT chart is the easiest way to know if or when you are ovulated precisely, though it does not predict ovulation. Your BBT chart also can tell if your body is the best form and is ready to sustain a pregnancy. BBT was regulated by hormones estrogen and progesterone which produced by ovaries. High levels of estrogen lower BBTs while high levels of progesterone increase BBTs. If your BBT chart is normal, this means your ovaries are functioning well and you are ready for pregnancy.

If you have difficulty to conceive, it may reflex on your BBT chart. For example, if you are not ovulating, your BBT chart does not have two phases. If you have short luteal phase which is difficult to sustain your pregnancy it shows a disturbed BBT chart. If your first three day’s BBT is greater than 36.6 ºC, this may be associated with endometriosis.

Tuesday, 7 May 2013

Acupuncture increases sperm count and improves sperm quality and male fertility

Whenever we talk about infertility, the first thought is women’s problem. Actually this is not true at all. Male infertility explained 40-50% of infertility cases. Sperm defect including low sperm count and/or poor quality of sperm is the main cause of male infertility. Semen analysis is very simple and important test to check male infertility. In this test, sperm concentration (sperm numbers), sperm motility (percentage of them are swimming forward) and shape of sperm are checked. If you have abnormal sperm, this may be the cause of your infertility.

If you have infertility associated with sperm abnormality, acupuncture can help to correct them. Current research provided evidence that acupuncture increased sperm concentration. As early as 1980’s, there was a research on improvement of sperms after acupuncture treatment from Germany. 28 patients with subfertility participated the study. These patients received 10 acupuncture treatments for a period of three weeks. After acupuncture treatments, total sperm count, concentration and motility were improved significantly. They also evaluated subjective parameters by written psychological tests. The psychological test showed no change caused by acupuncture. This excluded that the effect of acupuncture on sperm quality was caused by placebo-mechanisms. Siterman S et al. studied 40 patients with low sperm count in two groups: acupuncture group and control group. They found that after 5 weeks acupuncture treatment sperm numbers were significantly increased compared to the control group. Pei J et al also studied the effect of acupuncture on sperm count. There were 28 patients with low sperm count in acupuncture group and 12 patients with low sperm count in untreated control group. After 5 weeks acupuncture treatment (twice a week) the sperm count was significantly increased in acupuncture group compared to control group. They also found that acupuncture improved sperm quality as well. Siterman S et al and Fischl F et al also investigated the effect of acupuncture on sperm quality. They found that after 10 acupuncture treatments acupuncture treatment, sperm quality was significantly increased compared to the control group.

It is widely accepted that men with low sperm count is associated with high scrotal temperature and this impaired sperm output. Recently Siterman S et al investigated the mechanism of acupuncture increasing sperm count to see if this is related to decrease scrotal temperature. There were 39 patients with low sperm counts in acupuncture group. They found that the result was agreed with previous studies that men with infertility have high scrotal temperature. This was caused by testicular inflammation. After 8-10 acupuncture treatments, the scrotal temperature was significantly decreased and sperm counts were significantly increased. This is because acupuncture increased blood supply of testicular artery and acupuncture stimulated immune response and reduced inflammation.

Acupuncture is effective for treating antisperm antibodies associated male infertility

10% of male infertility is caused by antisperm antibodies. Immune system can respond to produce antisperm antibodies in some circumstances such as infection. These antibodies tend to destroy sperms causing infertility. The antibodies can be present in tail of sperm which may cause mobility problems; they can be found in the head of the sperm as well which may prevent sperm binding to eggs resulting in fertilisation problems. Fu B et al have reported that effectiveness of acupuncture and herbal medicines on male with positive antisperm antibody associated infertility. In this study 50 cases in acupuncture and herbal group and another 50 cases in control group treated with prednisone. Antisperm antibodies were monitored in the two groups for measuring the effect. They found that antibodies were decreased in both groups but acupuncture group had significantly better effect than that for prednisone group.

Acupuncture helps fertilisation of ICSI in male infertility

There was a case report that acupuncture improves sperm quality and the outcome of intracytoplasmic sperm injection (ICSI). 22 male patients with infertility who failed ICSI participated the study. They received acupuncture treatment twice a week for 8 weeks followed by ICSI. At the end of the treatment, sperm motility and normality was improved. The fertilisation rates after acupuncture treatment were 66.2% significantly higher than that before the treatment (40.2%). Embryo quality was also improved. Acupuncture has a positive prospect for men with infertility undergoing ICSI treatment.

A case report: acupuncture increased sperm count

A 31 year old man was diagnosed azoospermia (no measurable level of sperm in his semen). His testis and vasa deferentia were normal. The tests showed that his sperm production was impaired which was difficult to cure. The couple failed one cycle of percutaneous sperm aspiration and intracytosplasmic sperm injection. He was referred for acupuncture treatment. He received a course of 20 session acupuncture treatment (twice a week). After a course of acupuncture treatment, his sperm count was 10 millions/ml with 10% good motility and 60% normal shape of sperms. With continuing another course, his sperm count increased to 18 millions/ml with 30% good motility and 60% normal shape of sperms.

Poor sperm quality could contribute to the causes of recurrent miscarriage.

There was a case control study by Li B et al. They compared semen analysis results from men whose spouses had a history of miscarriage (case group) with those without spouses with recurrent miscarriage (control group). They found that men in case group had lower volume of semen, low sperm concentration and higher misshaped sperms. Other parameters including percentage of grade B sperm, acrosomal enzyme activity and sugar content etc were lower in case group compared to control group. This research finding suggests that there could be a link between poor sperm quality and recurrent miscarriage.

Brahem S et al did a research to evaluate standard sperm parameters and sperm DNA fragmentation by comparing men whose partners had s history of recurrent pregnancy loss (RPL) with control group with proven fertility. They found that there was significant lower sperm motility in RPL group compared to control group. The mean number of sperm cells with fragmented DNA was significantly increased in RPL group compared to control group. The results suggest that poor sperm motility and high incidence of sperms with fragmented DNA could contribute to a cause of recurrent miscarriage.

A systematic review just published in Human Reproduction journal studied the association of sperm DNA fragmentation with miscarriage. There were 16 studies involved in 2969 couples. They found that a significant increase in miscarriage in patients with high DNA damage (DNA fragmentation) compared with those with low DNA damage. Because of this finding, selecting sperm without DNA damage for use in assisted conception treatment may reduce the risk of miscarriage.

References
Siterman S et al Andrologia (2000) 32:31-9
Pei J et al Fertil Steril (2005) 84:141-7
Siterman S et al Arch Androl (1997) 39:155-61
Fischl F Geburtshilfe Frauenheilkd (1984) 44:510-2
Siterman S et al Asian Journal of Adrology (2009) 200-208
Riegler R et al Urologe A (1984) 23:329-33
Bidouee F et al J Kidney Dis Transpl (2011) 22:1039
Li B et al Zhonghua Nan Ke Xue (2011) 17:596-600
Brahem S et al Urology (2011) 78:792-6
Robinson L et al Hum Reprod. (2012) 27:2908-17
Zhang M et al J Huazhong Uni Sci Technology Med Sci (2002) 22:228-30
Fu B et al J Tradit Chin Med (2005) 25:186-9

Monday, 15 April 2013

Acupuncture is one of the most popular treatments in the UK

Conventional medicine is so developed and makes great contribution for people’s health. However in many conditions conventional medicine is found in dilemma, this leaves a room for complementary and alternative medicine (CAM). Many people turn to seek help for their health from CAM. There is a national household survey for England 2005 conducted by Hunt et al about CAM use. This was involved in 7630 respondents. The result showed that 44% of them have used CAM in their life time and 26% used CAM in 12 month. Massage, aromatherapy and acupuncture were the most commonly used therapies. People consuming more than 5 portions of fruit and vegetables a day were significantly more likely to use CAM.

How many people visited complementary and alternative medicine practitioners?

Do you ever think about visiting complementary and alternative medicine (CAM) practitioners, if you have some conditions that affect your quality of life and there are limited medication which could help? Do you know that how many people who visited the CAM practitioners? There was a report by Cooper KL from Sheffield UK that reviewed a 12 months prevalence of visits to five types of CAM practitioners. The data was from countries 12 countries include Europe, North America, Australia, East Asia, Saudi Arabia and Israel and data was included 41 surveys to 2011. The CAM include five therapies acupuncture, homeopathy, osteopathy, chiropractic ad medical herbalism. The prevalence of visits by adults were: acupuncturists 1.4%, homeopaths 1.5%, osteopaths 1.9%, chiropractors 7.5% and medical herbalists 0.9%.

Acupuncture is a form of CAM. In European countries, acupuncture and homeopathic treatments are most used. Doctors have been changing their views towards using acupuncture. There is a survey studying if doctors are intended to use acupuncture for their own diseases in Norway. There was over 10,000 physicians participated. There was 18% physicians used acupuncture for their own diseases in 2004 which is doubled compared to those in 1994 (only 8%). Half of the physicians intended to use acupuncture for their own diseases.

There was a new research across surrey in the UK which studied current situation of acupuncture in health care. The data was collected using questionnaire responded by 330 acupuncture practitioners with professional background including 29% doctors, 29% physiotherapists, 15% nurses and 27% independent acupuncturists. 68% of the practitioners are in independent practice. Patient’s ages are from 9 to 94 year old. The most common visits are for pain conditions including low back, neck, shoulder and knee pain, as well as headaches and migraine. Anxiety, stress and depression were the three most common psychological complaints. Treatment for infertility by independent acupuncturists increased fivefold in 10 years. There are many visits for other conditions including obstetric, gynaecological conditions and digestive, respiratory circulatory and skin complaints etc. In the UK, about 4 million sessions of acupuncture were provided each year, two thirds of which were from independent practice. The style of acupuncture is that 67% is western medical acupuncture and 41% is traditional Chinese medicine. About 90% physiotherapists, nurses and doctors use Western medical acupuncture; while 90% acupuncturists use traditional Chinese medicine.

NHS acupuncture outcome

Most patients pay for private acupuncture treatment, because use of acupuncture in NHS is limited. There is a survey by Robinson TW from Barton House, Beaminster UK published in J Altern Complement Med (2012). This study was to investigate the response to Western acupuncture performed in a National Health Service (NHS) general practice. This is a good survey which included 3 year patient feedback. The outcomes, patient experience, impact on conventional therapies, and appropriateness of acupuncture in general practice were assessed. The patients received acupuncture treatments from all age groups and female to male ratio is 64%:36%. Following the course of acupuncture,

75% of patients noted an improvement in their presenting condition;

26% of patinets were reported complete improvement and 38% major improvement. 24% noted no change.

72% of patients thought that their quality of life was improved.

69% of patients had a reduction or cessation of painkillers and/or anti-inflammatory drugs.

57% of patients thought that referral to hospital specialist or physiotherapist was avoided due to the acupuncture treatment.

23% of patients found acupuncture to be painful; of those 60% said the pain was only mild.

72% of patients were treated within 1 week of being seen by the general practitioner (GP).

81% of patients had one to three treatments.

The patients’ response scores from an anonymised questionnaire showed beneficial outcomes from acupuncture.

Acupuncture is the most available CAM therapy in the EU

Complementary and alternative medicine (CAM) plays an important role in health care field. Von Ammon K et al conducted a study to investigate the current status of CAM practitioners in European Union (EU). They found that about 305,000 registered CAM providers can be identified in the EU (160,000 non medical and 145,000 medical practitioners). Acupuncture (n=96,380) is the most available therapeutic method for both medical (80,000) and non medical (16,380) practitioners. Homeopathy is the second with 45,000 medical and 5,800 non medical practitioners. Herbal medicine (29,000 practitioners) and reflexology (24,600 practitioners) are mainly provided by non medical practitioners. Naturopathy (22,300) is dominated by 15,000 (mostly German) doctors. Anthroposophic medicine (4,500) and neural therapy (1,500) are practised by doctors only.

Complementary and alternative medicine (CAM) offered by hospital in Switzerland

Complementary and alternative medicine (CAM) is offered almost by half of the hospital of the French-speaking part of Switzerland. This report was from a survey from medical directors in the hospitals between June 2011 and March 2012. There were 37 medical responded. 19 medical directors indicated that their hospital offered at least on CAM and 18 reported that they did not. Acupuncture was the most frequently available CAM, followed by manual therapies, osteopathy and aromatherapy. The disciplines that offered CAM most frequently were rehabilitation, gynaecology and obstetrics, palliative care, psychiatry, and anaesthetics. The number of hospitals offering CAM in the French-speaking part of Switzerland seemed to have increased since 2004.

Acupuncture is still the most popular CAM treatment option in the UK

In many countries, complementary and alternative medicine (CAM) usage during the last decade is increasing. Perry R et al from University of Exerter, Devon, UK conducted a survey to study the current situation of usage in CAM. They posted a questionnaire to GPs to ask them if they treat, refer, endose or discuss eight common CAM therapies including acupuncture. They also asked about their views on NHS funding, effectiveness, CAM training needs and theoretical validity of each therapy. They compared the results with those from the similar survey collected in 1999. They found that the response rate from GPs was low (30%) compared with that in 1999 (52%). The result showed that the most popular therapies were still acupuncture, hypnotherapy and chiropractic and the least popular therapies were aromatherapy, reflexology and medical herbalism. They suggested that GPs felt most comfortable with acupuncture, with greater belief in its theoretical validity, a greater desire for training and a greater support for acupuncture to receive NHS funding than for the other CAM therapies under question. Opinions about homeopathy ad become less supportive. In my opinion agreed with GPs, acupuncture indeed does amazing job to many people, as I can see many patients have been benefited from acupuncture treatments.

What do GPs think about acupuncture?

More people recognised that acupuncture can help them to get better and use acupuncture for various reasons. What is the opinion of GPs? There was a survey studied the opinions of GP on acupuncture in Italy. Among the responders of GPs, 95% are in favor ofacupuncture, 84.2% believe that it is scientifically based, 6% practice acupuncture, 25.2% use it on themselves, and 66.2% have sent at least one patient to an acupuncturist in the last year. 82% of responders are in favour of adding acupuncturetraining to their own professional practice, and 71.9% believe it would be useful to include acupuncture in specific training for general practice. 64% believe that acupuncture should be included into the benefits offered by the NHS. Data show that interest for acupuncture is higher than that observed in previous international studies carried out on the same topics in the last 20 years. From this study, we can see an increase in confidence and trust in acupuncture.

What is health professional’s opinion about acupuncture in the UK?

British Medical Acupuncture Society is a registered charity and an association of medical practitioners interested in acupuncture. It was established in 1980. There are over 2700 members who use acupuncture in primary or secondary care. They promote the use and scientific understanding of acupuncture as part of the practice of medicine for the public benefit. It also provides education and training of qualified practitioners. What do these health professionals think what sorts of conditions respond to acupuncture treatment? In their opinion there are many conditions responding to acupuncture treatments. For example, Acupuncture is effective in a broad range of painful conditions such as back, shoulder, neck and leg pain; headaches, migraines, trapped nerves, chronic muscle strains and rheumatic and arthritic pain. Some other conditions include functional bowel or bladder problems such as IBS and urinary incontinence; allergies; sinus problems and chronic catarrh; stopping smoking; weight loss and women’s problems etc. This is not complete list and there are many more conditions that can be treated by acupuncture.

Acupuncture use is increasing in the US

A National Health Interview Survey (NHIS) in the United State was conducted by Upchurch DM & Rainisch BW, UCLA School of Public Health, Los Angeles, CA to study the usage of acupuncture in the US. 22512 adults aged 18 and over were involved in this survey. They showed that from data in 2007 6.8% of adults used acupuncture in their lifetime and 1.5% used in the past 12 months. This showed significantly increased usage of acupuncture compared with previous NHIS survey in 2002 with 4.1% of reported lifetime use of acupuncture and 1.1% use in the past 12 months. Musculoskeletal conditions and pain were the top health conditions treated and integrated conventional and acupuncture were applied to some extent. Negative attitude or scepticism about acupuncture were not common reasons for nonuse among prior and never users. This survey showed a promising result about acupuncture use and recognition in health care in the US population. Indeed acupuncture does have amazing effects on many chronic conditions and does not have severe side effects like many medicines do. Acupuncture could play an important role in health care system.

Acupuncture is most often referred by clinicians in the US

Integrative medicine is a relatively new field which combines conventional medicine and complementary and alternative medicine (CAM) such as herb medicine, acupuncture and meditation. In US many academic health centers have established integrative medicine clinics for patient care. Ehrlich from University of Washington conducted a nationwide survey of clinicians who work at academically affiliated integrative health centers to assess who these clinicians are and to characterize the integrative medicine that they practice. Participants included clinicians who practice at 30 different integrative medicine clinics that are affiliated with academic health centers. They found that clinicians most often reported providing themselves were breathing exercises (66%), herbal medicine prescribing (61%), meditation (44%), and functional medicine (34%). The integrative therapies that clinicians most often referred their patients for were acupuncture (96%), massage (92%), yoga (85%), and meditation (79%). 54% clinicians reported having been involved in research related to integrative medicine in the past year. 20% of their time was spend on teaching.

How much training is required for CAM practitioners in Canada?

There is increased interest in complementary and alternative medicine (CAM) which includes naturopathic, chiropractic, massage therapy and acupuncture etc. There is a tendency towards increased usage of these therapies. When you visit these practitioners, do you know how much training they received? There was a survey from Canada about training of CAM practitioners. Overall training length is ranged from 1930 to 5000 hours. Naturopathic and chiropractic schools offer the most training hours (mean 4600 hours) and massage therapy is 2270 hours and acupuncture is 2167 hours. Research methods and evidence-based health care training, and opportunities for collaboration with biomedical peers and continuing education were also offered to a certain extent.

Who is likely to see acupuncture practitioners?

This was a total population health survey HUNTs conducted in 2008. There were 50827 respondents provided the data. The data was analysed. They found that 5.7% for females and 2.2% for male visited acupuncture practitioners in a year. These acupuncture practitioner visitors (both males and females) were five times more likely to have had somatic complaints in the preceding year and were 2-3 times more likely to report poor global health than those non-visitors. Visitors were more likely to do hard physical activities every week and they were less likely to live alone or be daily smokers. Only female visitors were featured by having higher education and they were more likely to have a paid job than other females. It is linked to age only limited in female visitors. Acupuncture practitioner visitors were more actively to promote their health by having healthy lifestyle choices and non-smoking, meanwhile they were having worse overall health and more somatic complaints than others.

Who is using acupuncture and moxibustion in China

Acupuncture was originated from China thousands year ago. Western medicine became mainstream medicine in China as well. Is acupuncture still being used and popular in China? There was a report from the department of acupuncture and moxibustion China which studied the usage of acupuncture and moxibustion in the hospital. There were 6435 cases recorded in eight year from 01/012003 to 31/12/2010. There was a clear upward trend in the eight years. The majority are elderly patients in those cases, involving 309 different conditions. The top 10 condition treated were lumbar spondylosis (17.73%), cerebral infarction (13.77%), cervical spondylosis (13.66%), sequelae of erebral infarction (7.47%), lumba disc herniation (4.41%), osteoarthropathia (3.4%), cerebral hemorrhage (2.9%), herpes zoster (2.33%), postterpetic neuralgia (2.33%), sequelae of cerebral hemorrhage (2.32%).

Complementary and alternative medicine (CAM) in pregnancy health care

Complementary and alternative medicine (CAM) is commonly used by women than men. There are 20-60% of pregnant women who use CAM. Most popular CAM used by pregnant women includes acupuncture, acupressure, aromatherapy, chiropractic, homoeopathy, massage and yoga, for example, chiropractic care for pregnancy related back pain, acupuncture for the management of nausea and vomiting and pelvic and back pain in pregnancy. Recently a study investigated women’s use of health care during pregnancy and birthing in Australia. This survey was conducted in 2010. There were 1835 pregnant women completed the survey. 49.4% of those pregnant women consulted with a CAM practitioner for pregnancy related health conditions. Some participants consulted only with CAM practitioner for assistance with certain conditions such as neck pain (74.6%) and sciatica (40.4%). Some women consulted both CAM practitioners and conventional maternity health professionals including obstetricians, midwives and GPs) for back pain (61.8%) and gestational diabetes (22.2%). Women visiting a GP 3-4 times for pregnancy care were more likely to consult with acupuncturists compared with those consulting a GP less often. Women won had more frequent visits to a midwife were more likely to have consulted with an acupuncturist or a doula than those visiting midwives less frequently for their pregnancy care.

Is acupuncture safe?

For those people who never received acupuncture treatment before, there is always a concern about how safe acupuncture is. There was a report about safety of acupuncture from Witt CM et al Charite University Medical Center Berlin, Germany. This was an observational study including patients who received acupuncture treatment for chronic osteroarthritis pain of the knee or hip, low back pain, neck pain or headache, allergic rhinitis, asthma or dysmenorrhoea. The analysis was based on 2.2 million acupuncture sessions. 13579 physicians practising acupuncture in Germany participated the study. All physicians had least 140 h of acupuncture training and average 6.9 +/- 5.3 years of acupuncture practice. After treatment, all patients documented adverse events associated with acupuncture. A total of 229,230 patients received on average of 10 +/- 3.0 acupuncture treatments. 8.6% (19726) patients reported experiencing at least one adverse effect and 2.2% (4963) patients reported one which required treatment. The most common adverse effects were bleedings which was 58% of all adverse effects reported. 1.7% reported pain and 0.7% reported vegetative symptoms. Two patients had a pneumothorax: one needed hospital treatment and the other was observation only. The longest duration of a side effect was 180 days caused by nerve lesion of the lower limb. They concluded acupuncture provided by physicians is a relatively safe treatment.

References
Robinson TW J Altern Complement Med (2012) 18:555-60
Hunt et al Int J Clin Pract. (2010) 64:1496-502.
Ytrehus J Altern Complement Med. (2010) 16:449-55.
Hopton AK et al BMJ Open. (2012)11:2-9
Upchurch DM & Rainisch BW J Alterm Complement Med (2013) ahead of print
Burke A et al J Alterm Complement Med (2006) 12:639-48
Perry et al Prim Health Care Res Dev (2013) 10:1-6
Zhang Y et al Zhongguo Zhen Jiu (2011) 31:941-4
Cooper KL et al Complement Ther Clin Pract (2013)19:214-20
Lohre A Am J Chin Med (2013) 41:995-1010
von Ammon K et al Forsch Komplementmed (2012) 19 suppl 2:37-43
Carruzzo et al Swiss Med Wkly (2013) 143:w13756
BMC Pregnancy Childbirth (2012) 12:146
Toupin April K and Gabouryl BMC Complement Altern Med (2013) 13:374
Ehrlich G et al Fam Med (2013) 45:330-4
Fani M et al Ann Ig (2014) 26:213-8
http://www.medical-acupuncture.co.uk/Default.aspx?tabid=77
Witt CM et al Forsch Komplementmed (2009) 16:91-7

Wednesday, 27 February 2013

Endometriosis and acupuncture

Uterine inner lining tissue is shedding away from uterus causing monthly uterine bleeding. This particular tissue could grow elsewhere outside of uterus and still remain its characteristics of shedding every month. This misplaced tissue is often found in the ovaries, fallopian tubes and outside of uterus. Also it could be found outside of intestine, bowel, bladder or on the surface of lining of pelvic cavity, peritoneum. These misplaced tissues are responding to hormonal changes, but they can not shed. This causes problems for some women. This condition is called endometriosis. Most women with endometriosis are aged between 25-35.

Pelvic pain and period pain are the most common symptoms for endometriosis. The pain depends on where the misplaced tissues are located. Deeper implants and implanted area with many pain sensing nerves may be more likely to produce pain. Implanted tissues may produce substances causing pain. Scars formed by implanted tissues could cause pain. Heavy and irregular period is also common symptom of endometriosis. Infertility is another common symptom resulted from endometriosis. The reason for decreased fertility caused by endometriosis is not completely understood. This could be anatomical or hormonal reasons. Misplace tissues cause adhesion and distort normal reproductive system anatomy. For example, it blocks tube affecting egg transportation. It may also affect hormone production causing imbalanced hormone affecting fertility. Misplaced tissue causes local inflammation altering environment of reproductive system.

Surgical treatment focuses on removal of endometrial tissues; medications using birth control pills focuses on regain hormonal balance. Apart from conventional treatment, acupuncture is a new trend to treat endometriosis. Acupuncture reduces pain by its analgesic effect. Acupuncture improves heavy bleeding. Acupuncture also improves fertility for women with endometriosis by reducing local inflammation and restoring hormone balance. Dietary changes by avoiding caffeine, sugar and alcohol consumptions may be recommended. Borage oil or evening primrose oil, vitamine Bs, and vitamin E may be helpful. Regular exercises increase the general well-being in women with endometriosis.

Tuesday, 26 February 2013

llife style, fertility and acupuncture

Your daily life style could affect your health and ovulation. For example, poor sleep damages body function and potentially causes illness. Heart disease, diabetes, obesity and poor brain function are all linked to bad sleep. In women poor sleep is associated with irregular periods, ovulation, negative effect of fertility, and risk of negative pregnancy outcome because of disruption of hypothalamus-pituitary-gonadal (HPG) axis function.

Recently researches showed that poor sleep altered gene activities which instruct protein productions in the body. Also natural body clock is disturbed by poor sleep. Preovulatory LH surge is disturbed by lack of sleep causing anovulation. Immune function in the body is disturbed by poor sleep causing many disorders such as diabetes.

Good sleep is essential for those women who want to conceive. Good sleep improves reproductive function, improves ovulation and conceiving and sustains a pregnancy.

Acupuncture can help sleep by altering brain activities.

Apart from lack of sleep can affects ovulation, your other daily activities can affect ovulation too. Excessive exercise, being under weight or overweight, being stressed all of these affect ovulation. These changes reduce gonadotrophin releasing hormone production in hypothalamus resulting in reduction in luteinising hormone (LH) and follicle stimulating hormone (FSH). Changing your life style could improve ovulation.

Alcohol affects fertility in both men and women

It became common knowledge that alcohol affects health. If a couple are trying to conceive, their fertility could be affected by alcohol. There are studies that show the link between alcohol and infertility. Alcohol has negative impact on men’s fertility, such as testicular atrophy, decreased libido, and decreased sperm count, sperm morphology, sperm motility and semen volume. Alcohol has also negative impact on women’s fertility. Though the amount of alcohol is linked to fertility is not clear yet. Study showed that amounts of alcohol ranging one drink a week to 5 units a day can have various effects on fertility, for example, anovulation, luteal phase dysfunction, increased time to pregnancy, decreased probability of conception rate by over 50% and decreased implantation rate, abnormal blastocyst development, increased both the risk of spontaneous abortion and of fetal death.

Caffeine, infertility and miscarriage

The widely known source of caffeine is coffee and tea. Caffeine became a part of the daily life and an integral part of society. Moderate amounts of daily caffeine about 300 milligrams or three cups of coffee cause no harm in most healthy adults. Increased amount of caffeine intakes cause many health problems, such as addiction, insomnia etc. Caffeine has been reported to have negative effects on female fertility. Caffeine increases the time to pregnancy of over 9.5 months, especially if the amount is over 500 mg per day. There is no link between infertility and consuming less than 100 mg or a cup of coffee. Recent research showed negative effects of caffeine on spontaneous abortion, fetal death and still birth. Women who consumed more than 100 mg of caffeine a day were more likely to have a miscarriage. Research showed that after adjusting for smoking and drinking, women who drank four to seven cups of coffee had nearly an 80% increase in chance of still birth and those who consumed more than 8 cups of coffee a day had nearly a 300% increase.

Vegetable protein promotes fertility

High proteins foods are important for our health. Protein helps to lose weight and make you feeling full. But too much proteins increase burdens to your kidney. Eating right kind of proteins appears more important when you are trying to conceive. A recent study showed that meat intake was positively linked to ovulatory infertility. Adding one serving of meat (red meats, chiken, turkey, processed meats and fish) per day had 32% increased risk of ovulatory infertility. Eating chicken and turkey was mostly related; eating red meats was related to a lesser degree; eating processed meats, fish and eggs were unrelated ovulatory infertility; eating foods with high vegetable proteins decreased the risk of ovulatory infertility in some degree. So it is a good idea to replace chicken and red meats with vegetable proteins if you are trying to conceive.

Is exercise good for your fertility?

In men moderate amount of exercise can be good for their fertility. Study has shown that all sperm parameters are higher in men who did an hour exercise three times a week compared with those who did more frequent and rigorous exercise. Riding bicycle for over five hours per week has negative impact on sperm. In women excessive exercise can have negative effect on their fertility too. Increased frequency, intensity and duration of exercise were significantly related with infertility in women who exercised every day.

Blood flow is reduced in your reproductive system when you exercise

Blood flow (BF) increases with increasing exercise intensity in skeletal, respiratory, and cardiac muscle. In humans during maximal exercise intensities, 85% to 90% of total cardiac output is distributed to skeletal and cardiac muscle. During exercise BF increases modestly and heterogeneously to brain and decreases in gastrointestinal, reproductive, and renal tissues and shows little to no change in skin. If the duration of exercise is sufficient to increase body/core temperature, skin BF is also increased in humans. Because blood pressure changes little during exercise, changes in distribution of BF with incremental exercise are essential approach the body used to supply adequate oxygen to the active skeletal muscles.

Acupuncture increased blood flow in reproductive system and boosts fertility

Study has shown that after 8 sessions of acupuncture treatment blood flow in uterine artery is improved.

Where are steroids hormones produced?

Hormones are fundamental for fertility. There are three types of hormones from the chemical point of view: proteins such as FSH and LH, peptides such as GnRH and ACTH, and steroids such as progesterone, estradiol, androgen and corticosteroids. Proteins are large molecules and water soluble, while steroids are small and fat soluble. Peptides are somewhere between the two.

Steroids hormones are produced mainly in endocrine glands which are the adrenals and ovaries in women and the adrenals and testes in men. Small amount of steroids hormones are also produced in peripheral tissues which are nonendocrine tissues such as the liver, intestine, fat, kidney and brain, though this is main source of oestrogen production in menopausal women. Steroids are inactivated in the liver, and to a lesser degree, the kidney.

Hormones and fertility

Hormones are the driving force of your fertility. If you want to understand your fertility, you really need to understand hormones that are involved in fertility. There are mainly five hormones that are involved in fertility: gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone, luteinizing hormone (LH), estrogen and progesterone. These hormones are produced by hypothalamic-pituitary-ovarian axis which refers to the complex interaction between hypothalamus, pituitary, and ovaries. This axis regulates reproductive cycles and fertility by producing those hormones. These hormones directly and indirectly stimulate egg development and ovulation, endometrial development for embryo implantation and menstruation. Disruption of any parts of this axis could lead to loss of hormone balance. As a result menstrual cycles and the fertility can be affected.

Acupuncture helps to balance your hormones

Acupuncture is used for fertility treatment in China and recognised to improve fertility by modern medicine research. One of the mechanisms is acupuncture normalises dysfunction of hypothalamic-pituitary-ovarian axis. This helps to correct hormone balance. Research suggested that acupuncture affects gene expression of brain, as a result it normalizes production of hormones such as GnRH, LH E2. This is of course specific on acupuncture points. Chen et al studied the effect of acupuncture on gene expression and they found acupuncture at some effective points may activate the production of body estrogen, resulting in a long term increase or suppression at the level of gene expression and normalization on the hypothalamus-pituitary-ovarian axis.

How does Traditional Chinese Medicine (TCM) view infertility?

In TCM healthy kidney essence and Qi are essential for fertility. If there is kidney qi deficiency, it causes loss of qi and blood balance, therefore it causes infertility. So anything damage kidney qi could cause infertility, such as genetic causes, heavy menstrual bleeding, too much sexual intercourse, stress, contraceptive pills etc.

In TCM infertility was divided into four types:

1. Kidney deficiency: this was divided into kidney yang deficiency and kidney yin deficiency.

Kidney yang deficiency symptoms include infertility, light period, dizziness, fast heart rate lower back pain, feeling cold, low libido, diarrhea, light tongue with light white coat, sink and week pulse.

Kidney yin deficiency symptoms include infertility, red menstrual blood, thirsty, feeling hot, dizziness, fast heart rate, lower back pain, red tongue with light coating, weak fast pulse.

2. Dampness and phlegm blockage symptoms include infertility, light period, sticky discharge, overweight, red tongue with thick white coating, slippery pulse.

3. Liver stagnation symptoms include infertility, irregular period with irregular menstrual bleeding, dark red with clot, depression, breast pain, lower tummy pain, dark tongue with light coating, floating pulse.

4. Blood stasis symptoms include infertility, light periods, dark blood with clot, lower tummy pain, dark tongue with light coating, floating pulse.

Monitoring your menstrual cycles to get pregnant

Uterine endometrium lies on the inner side of uterus. It has cyclic changes each month in response to ovarian hormones estrogen and progesterone. The endometrium is shed off every month and new one grows in a new cycle. This is a menstrual cycle which reflects the health of reproductive system including hypothalamic pituitary and ovarian axis, and uterus. If you want to get pregnant, monitoring your menstrual cycles is very important to evaluate your reproductive function. The typical cycles are 28 days and periods are 3-7 days. You should have ovulation in the mid cycle day 14. If you have difficult to conceive, and all fertility tests are normal, doing basal body temperature chart to monitor your menstrual cycle is a good way to find what is wrong. It takes lots of efforts, but it is worth doing it. This is because general fertility test is only check at one point of your cycles; in order to get pregnant your menstrual cycles are need to be good all the time. You need to ovulate every cycle, not occasionally. If you have difficult to conceive, and all fertility tests are normal, it is a good idea to get help from acupuncture which could help you to improve your menstrual cycles and your fertility.

If you think your fertility is compromised, you need to take some basic tests to evaluate your fertility. Egg quantity and quality could be checked. This is so called ovarian reserve test. There are three tests:

First, day 3 FSH (follicle stimulating hormone) and estradiol (E2) test. FSH is produced in the brain and it is the main hormone involved in producing mature eggs in the ovaries. FSH level keeps changing and day 3 is the lowest level. If you are running out of egg, the brain has to work hard to produce more FSH to stimulate ovaries for egg maturation. Your FSH level will be high. E2 is mainly produced in ovaries. E2 level in day 3 is also low. High level of E2 will indicate a problem ovarian reserve and suppress brain producing FSH which could mask high FSH.

Second, AMH (anti-mullerian hormone) test. AMH is produced by small follicles in ovaries. The levels are constant and the test can be done at any day of a woman’s cycle. Low level of AMH indicates that the remaining microscopic follicles decreases.

Third, antral (resting follicle) follicle count. Antral follicles are small follicle that can be seen, measured and counted under ultrasound. Low number of antral follicles indicates poor egg quantity.

Ovulation could be tested. This is to know if there is egg released from your ovary in the middle of your cycle.

Ovulation test does not increase stress in women trying to conceive

There are some opinions that ovulation test and timing intercourse could increase stress in women trying to conceive. To solve the problem, intercourse every 2-3 days without checking ovulation was recommended. Does home ovulation test have any impact on stress in women trying to conceive? Toplady S et al from Bedford UK studied home ovulation test and stress in women trying to conceive using a randomized controlled trial. 210 women who were seeking to conceive were participated. 115 women were allocated to the test group which was given digital ovulation tests to time intercourse to the most fertile time of the cycle. 95 women were in the control group which was provided with the current National Institute for Health and Clinical Excellence guidelines for increasing the chances of conception (intercourse every 2-3 days) and asked not to use any additional methods to check ovulation. The study was performed for two menstrual cycles. They found that there was no evidence for a difference in stress level between two groups at any point during the study. They concluded that checking ovulation does not affect stress level in women trying to conceive.

There are four methods to test ovulation.

The first is using ovulation prediction kit. The commonly used kit is the kit to test urine LH level. Before ovulation LH level in the urine is increased. This is something that you can do it yourself.

The second is using BBT (basal body temperature) chart. Charting your body temperature could find out if ovulation occurred. After ovulation, your basal body temperature raised about 0.5 degree. Also you can do this at home.

The third is to use ultrasound scan. Emptied follicle after mid cycle indicates ovulation.

The fourth is day 21 progesterone test. Progesterone is produced by copus luteum which is the remaining part of follicle after the egg is released from ovary. Low level of progesterone indicates no ovulation.

Test your tubes and uterus

Hysterosalpingogram-HSG, this is the test to check your tubes and uterus.

Why prevalence of infertility is increasing?

Infertility issue is increasing, what is the reason for this? The main reasons are lifestyle and nutritional factors, epidemic infections and sexually transmitted diseases. Apart from these reasons, other reasons contribute to the factors. First because of widespread use of contraception, delaying the first pregnancy to their thirties in women, women are at high risk for uterine fibroids, endometriosis, polycystic ovary syndrome (PCOS), and chronic anovulation; Second, prolonged exposure to chronic stress and environmental pollutants are also contribute to decreasing fertility; Third, many patients survive cancer because of successful cancer treatments but their fertility is compromised.

What is your chance to get pregnant with diminished ovarian reserve?

There were many studies about IVF success rate in women with difficulty to conceive, but there were relatively less studies on comparisons of pregnancy rate in natural cycles between women with low ovarian reserve and with normal ovarian reserve. There was a new research about pregnancy rate in non IVF cycles. The participants were younger women (age< or =37 years) with diminished ovarian reserve day 3 FSH greater than 15 mIU/ml. The pregnancy rate was compared with women with normal ovarian reserve day 3 FSH less than 8 mIU/ml. These women were given luteal support with progesterone or at most mild FSH stimulation or intrauterine insemination for mild male factor or cervical factor. Success rate was halved with 33.3% with increased day 3FSH compared with normal day 3 FSH with 62.5%.

What do you need to know about seeking acupuncture treatment for infertility?

Though acupuncture is very popular for infertility treatment, there are different opinions in medical fields about if acupuncture helps infertility. If you want to have acupuncture, follow the advice experts offered:

If you decide to try on acupuncture, look for a practitioner who is trained and licensed in acupuncture, and who has a background in treating infertility.

If you are undergoing fertility treatment with a fertility specialist, make sure that he or she knows you are considering acupuncture.

If you are undergoing IVF or any traditional fertility treatment, don’t take any herbs without first discussing this with your doctor.

If you are undergoing an IVF protocol and acupuncture at the same time, once you reach the implantation stage it’s imperative to take a pregnancy test before proceeding with more acupuncture treatments.

References

Laughlin MH et al Compr Physiol (2012) 2:321-447

Check JH and Liss J Clin Exp Obstet Gynecol (2013) 40:27-28

Chen BY Acupunct Electrother Res (1997) 22:97-108

Chen BY et al Sheng Li Xue Bao (1998) 50:495-500

Jorge E etal Am J Obstet Gynecol (2008) 198:210e1-e7

Petraglia F et al Int J Gynaecol Obstet 2013 Sep 7

Tiplady S et al Hum Reprod (2012) Oct

http://www.webmd.boots.com/fertility/features/age-old-infertility-treatment?page=3

http://www.bbc.co.uk/news/health-21572686

Wednesday, 6 February 2013

Acupuncture is effective in treating insulin resistance

Insulin is a hormone produced by pancreas. Insulin resistance (IR) is a condition in which the body’s cells become resistant to the effects of insulin. In this condition, response to a normal amount of insulin is reduced; more insulin is needed to obtain the same degree of response. As a result, pancreas tends to produce more insulin until it can no longer to do so and then blood sugar level increases. Insulin resistance is a risk factor for developing diabetes and heart disease. Insulin resistance may be a part of the metabolic syndrome, for instance, patients with polycystic ovarian syndrome (PCOS) has high insulin resistance. Liang and Koya analysed current available research data to study if acupuncture is effective for treatment of insulin resistance. They analysed 234 English publications listed on the PubMed database between 1979 and 2009 on the effectiveness of acupuncture treatment for IR. They found that these publications provided clinical evidence, in support of the effectiveness of acupuncture in IR. Numerous experimental studies have shown that acupuncture can correct various metabolic disorders, such as hyperglycemia, overweight, inflammation etc. and alter sympathetic nervous system activities and insulin signal defect. Acupuncture potentially improves insulin sensitivity.

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

Wednesday, 30 January 2013

Infertility issue

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

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

Hormonal balance is the key in human reproductive system. In women, there are five hormones involved in reproductive function: gonadotropin-releasing hormone (GnRH) produced in hypothalamus (a part of the brain), follicle stimulating hormone (FSH) and luteinizing hormone (LH) both produced in pituitary gland (another part of the brain), and oestrogen and progesterone both produced in ovaries located in pelvis. To be fertile, these five hormones have to be well balanced, which means they have to be at the right level at the right time. If the balance is disturbed at any points in a cycle, this would affect fertility. Most of the infertility in women is caused by imbalanced hormones. Hormonal imbalance could cause poor egg development; as a result, poor quality egg is produced (fertilization is affected) or no egg is released in the mid-cycle. Hormonal imbalance could also cause poor uterine lining affecting implantation and causing early pregnancy loss.

The hormonal system is very sensitive, even a slightly change can disrupt hormonal production leading to anovulation. Common causes related to hormonal imbalance include stress, anxiety and eating disorders which are associated with inhibition of GnRH production in hypothalamus. Polycystic ovarian syndrome (PCOS) is the most common cause of infertility which is associated with hormonal imbalance. Excessive male hormones (androgens) were produced in women with PCOS. Another hormonal imbalance is excessive production of hormone LH which is involved in stimulating ovary to produce hormones.

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

In men there are four hormones involved in reproductive function: GnRH, FSH and LH produced in brain, and testosterone produced in testicle located in scrotum. Hormonal imbalance in men causes poor sperm development resulting in low sperm count and/or poor sperm quality. Stress can disturb hormonal balance affecting men’s fertility.

To improve fertility, correcting hormonal imbalance is the key. It takes time (at least a few months) to restore hormonal balance; sometimes it takes much longer than you expected. So determination and patience are needed to achieve the goal. Acupuncture treatment could help restoring hormonal balance by stimulating sympathetic nerve and lowering sympathetic activity. Balanced diet and regular exercises could also help.

Local chronic inflammation is another important factor causing infertility. In women inflammation in pelvic area could cause fallopian tube spasm which blocks the eggs passing through. After lower abdominal surgery, or following pregnancy loss, inflammation could occur in pelvic area. Endometriosis causes inflammation in pelvic area surrounding the misplaced tissue affecting ovulation, egg transportation. Endometriosis is another common cause for infertility. In men inflammation in scrotum could impair sperms. Reducing local inflammation can significantly improve fertility in relatively short time, if there is no hormonal imbalance involved in infertility. Acupuncture can help reducing local inflammation by stimulating nerve endings and improving local blood flow.

Low AMH
AMH is short for anti-mullerian hormone. It is a substance made by small follicles in women’s ovaries. When the follicles grow bigger, they are no longer producing AMH. Since AMH is produced only in smaller follicles and its blood levels are constant, AMH has been used to measure the size of the pool of growing follicles in women. AMH blood levels reflect the size of the remaining egg supply. If your AMH is low, it means your egg supply is poor. With increasing women’s age, the size of their pool of remaining small follicles decreases. Their AMH levels and the number of ovarian small follicles visible on ultrasound also decrease. Some women may have problems of recruitment and development of follicles; in this case they have fewer follicles developed and their AMH tends to be low. Women with low AMH would have less chance to have good quality eggs. So they may have difficulty to conceive naturally. Women with low AMH level are likely to have poor response to ovarian stimulation for IVF and have fewer eggs retrieved. This reduces their chance to conceive via IVF.

Tuesday, 29 January 2013

Biophysical properties in meridian and acupoints

What is meridian?

Meridians are like vessels forming a network and connecting skin and muscles to internal organs such as heart, liver etc to make energy and blood flowing freely and maintain balance in the body.

How many meridians are there? There are 12 regular meridians which are the main passageways for energy and blood, six of which are foot meridians and another six are hand meridians. Foot meridians either start on the foot or end on the foot and hand meridians either start on the hand or end on the hand. These 12 meridinas connect to internal organs and are running bilaterally in the body. Apart from 12 regular meridians there are eight extra meridians which are not as regular and do not connect to internal organs directly.

Name of twelve regular meridians

Taiyin Lung Meridian of Hand or Hand's Major Yin Lung Meridian

Shaoyin Heart Meridian of Hand or Hand's Minor Yin Heart Meridian

Jueyin Pericardium Meridian of Hand or Hand's Absolute Yin Heart Protector Meridian

Shaoyang Sanjiao Meridian of Hand or Hand's Minor Yang Triple Burner Meridian

Taiyang Small Intestine Meridian of Hand or Hand's Major Yang Small Intestine Meridian

Yangming Large Intestine Meridian of Hand or Hand's Yang Supreme Large Intestine Meridian

Taiyin Spleen Meridian of Foot or Foot's Major Yin Spleen Meridian

Shaoyin Kidney Meridian of Foot or Foot's Minor Yin Kidney Meridian

Jueyin Liver Meridian of Foot or Foot's Absolute Yin Liver Meridian

Shaoyang Gallbladder Meridian of Foot or Foot's Minor Yang Gallbladder Meridian

Taiyang Bladder Meridian of Foot or Foot's Major Yang Urinary Bladder Meridian

Yangming Stomach Meridian of Foot or Foot's Yang Supreme Stomach Meridian

Feature of meridians

Meridians are channel networks in human body according to Chinese medicine meridian theory. This network with many acupoints did not have anatomy basis. However modern research investigated the characteristics of meridian and acupoints and the achievement was noticeable. For example, the temperature and microcirculation perfusion at the acupoints were higher than that at nonacupoints. Some biochemical reactions were more active such as there was higher ATP, oxygen partial pressure, transcutaneous CO2 emission etc at acupoints. After acupuncture stimulation of the acupoints these parameters were changed. Also there were some researches showing that skin temperature along meridians were different from other skin area. Recently research showed that skin and deep tissue microcirculation was higher along meridians along the governor meridian which is located along the midline of the back was higher in healthy adults than non meridian part. Also blood perfusion along governor meridian was higher than that the two bilateral medial bladder meridians which located at 1.5 body inch bilateral to the midline at the back. Local blood perfusion was important for organ function. The increased microcirculation along governor meridian may represent the common features of all other 12 common meridians. Further research will provide the microcirculation information about differences between meridians and nonmeridians and its role in pathological conditions.

There are 361 acupuncture points along to these meridians. Each acupuncture point has specific effect

Acupuncture produces effect by acting through acupoints. Each acupoint has its specific effect. The mechanism of this specificity was studied. A study compared the effect of ST36, and LR3 acupoints. In this study, 26 healthy subjects were divided into three groups: ST36, LR3 and control groups. Acupuncture was received in ST36 and LR3 groups, but not control group. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), cardiac index (CI), systemic vascular resistance index(SVRI), superior mesenteric artery blood flow volume (SMABFV), and power of each frequency domain calculated from FRV (very low frequency (VLF), low frequency (LF), high frequency (HF) and LF/HF were measured before and 30 min after stimulation. VLF: generally reflects functions such as thermoregulation and rennin-angiotensin system activity. LF generally reflects both the sympathetic and parasympathetic nervous systems. HF generally reflects the parasympathetic nervous system. LF/HL generally reflects the balance between the sympathetic and parasympathetic nervous systems. The changes in these values were found 30 min after acupuncture stimulation at ST36 and LR3 and control groups by comparing to values before the intervention. In stimulation at ST36, VLF, LF, HF and LF/HFsignificantly increased, SBP significantly decreased and SMABFV significantly increased compared with that before the intervention. In LR3 stimulation, HF significantly decreased and LH/HF significantly increased and SMABFV did not change. In control group, VLF and SVRI increased and CI significantly decreased while SMABFV did not change. This study has shown the specific effect from ST36 and LR3 which has its own unique response to acupuncture stimulation.

Biophysical properties in meridian and acupoints

Acupuncture is an important part of Chinese medicine. It is based on meridian theory. There are 14 meridians in human body. Along the meridians, there are hundreds of acupuncture points. Acupuncture at these acupuncture points was performed. Many acupuncture points on one meridian have similar function. Current research in China showed that gastric electric activity increased when acupuncture was performed at Sibai (ST2) and Dichange (ST4) which are located in the face and on the stomach meridian, but far from stomach. It also showed that there was no effect when acupuncture was performed a nonmeridian point beside ST2 and a point on small intestine meridian. There was a study that investigated acupuncture at acupuncture points on bladder meridian, non acupuncture points on bladder meridian and non acupuncture points of bladder meridian. They found that blood flow increased the most from acupuncture with acupuncture points on bladder meridian and the least from acupuncture with non acupuncture points of bladder meridian. Recently Zhang et al showed that acupuncture off acupuncture point BL57 on bladder meridian increased local blood flow. This effect was higher than that acupuncture off acupuncture points and off bladder meridian. They suggested that keeping needling points on meridian is more important. More research suggested that the density of nerve terminals, blood vessels and mast cells at the acupuncture points is higher and the signals produced by acupuncture are stronger. Acupuncture on the meridians facilitate the signal transporting and increase blood flow.

There was no anatomic evidence to show meridian existence. Recent research demonstrated the existence of meridian using biophysics, biochemistry and molecular biology techniques. Li J et al reviewed the biophysical studies of meridian/acupoints after obtaining the electronic database. Researchers used the resistance measurement to detect the resistance of the acupoints. They found that there was low resistance at some acupoints compared with nonacupoints at some studies. But there were many factors affecting the measurements so there was still in a debate. There were reports that the property of transmitting sound in meridians is better than that of the surrounding areas due to the enrichment of isotropic ions along meridians under the action of bioelectric field. Main and collateral channels are good medium for mechanical vibration wave and infrasonic wave. The high temperature along meridian and acupoints was reported. Also after acupuncture treatment the temperature along the meridian and acupoints was observed. Also characteristic of transmission of light is different between meridians and nonmeridians. A relatively stable circular current of electromagnetic and chemical oscillation was found along the low electric resistance pathway. Magnetic stimulation of acupoints could cause temperature variation along meridians. Migration of isotope along meridians and myoelectric activity were observed.

Acupuncture increases blood perfusion around the acupoints.

Acupuncture is used to treat many conditions worldwide. The mechanism is based on Meridian theory in Traditional Chinese Medicine (TCM) which is not recognized by modern medicine. Researchers are using modern techniques to study the mechanisms of acupuncture to explain the phenomenon from modern science aspect. Li XM et al studied influence of different acupuncture manipulations at Zusanli (ST36) on skin microcirculation blood perfusion in healthy subjects. They measured local blood perfusion at ST 36 acupuncture points after acupuncture stimulation at 1min, 5 min, 10, 15min, 20 min, 25 min and 30 min. They also compared blood perfusion levels of microcirculation around the acupoints among the different manipulation techniques. They found that microcirculation around the selected acupoint was significantly increased from 1-10 min following simple needle insertion, from 5 -30 min after uniform reinforcing-reducing manipulation, from 1-30 min after reinforcing manipulation, and from 1-25 min following reducing manipulation respectively. The reinforcing manipulation was superior to other techniques. From this study we can see acupuncture increases local blood perfusion in normal subjects. The reinforcing manipulation had better effect.

References
Li XM et al Zhen Ci Yan Jiu (2013) 38:297-300
Zhang WB et al Evid Based Complement Alternat Med (2013) 2013:426052
Li J et al Evid Based Complement Alternat Med (2012):793841

Wednesday, 16 January 2013

No periods? acupuncture can help.

Regular menstrual periods are a sign of well functioned reproductive system in women. Menstrual cycles are very important in women not only for reproduction but also for general health. If a woman’s periods are missing, this could cause infertility as well as some other health problems such as cardiovascular problems and osteoporosis.

Absence of menstruation is called amenorrhea in medical field which is a condition that menstrual periods have stopped for more than three cycles. This is not rare condition and many factors affect menstruation. If your periods are missing, If your periods disappeared for some time, you need to get it checked with your doctor and you need to rule out of pregnancy and menopause depending on your age. If you are not pregnant and you don’t have periods, it is most likely that your ovary is not working.

Common conditions that could cause absent periods are those affecting hypothalamus, pituitary gland, ovarian axis. These cause hormonal level changes responsible for reproductive function. For example, extreme weight loss, emotional or physical stress, high intensive exercise and severe illness could affect the hypothalamus and cause absent periods; pituitary gland conditions lead to increasing level of hormone prolactin, hypothyroidism causing missing periods; If you are under extreme stress, this could be the reason for disappeared periods. Though it has long been recognised, there are no specific diagnostic tests for this and diagnosis is usually made by exclusion. The mechanisms how psychological stress affects the women’s period cycle are still not clear. But it is widely accepted that it is linked to hypothalamic pituitary axis. In the situation of stress, corticotrophin-releasing hormone (CRH) production from hypothalamus is increased. The effects of increased CRH on the hypothalamic-pituitary axis reduce circulating luteinising hormone (LH) levels. Absence of period cycle caused by psychological stress may last from a few months to many years. Women with stress related absence of period cycle have increased basal plasma cortisol and decrease response to CRH administration. In many cases, normal periods return after the psychological problems are overcome. But in other cases, missing periods could cause new stress and help is needed to get periods return.

Ovarian conditions can also cause absence of periods, which include premature ovarian failure, polycystic ovary syndrome. It is very common that menstrual period does not return after stop taking contraceptive pills in three months. Infertility is one of the complications of absence of periods. Treatments are also depending on the causes. Correcting hormone imbalance is the target of the treatments to reestablish menstrual cycles and prevent complications.

In traditional Chinese medicine (TCM), missing periods are divided into five types according to the symptoms:

1 kidney and liver deficiency, symptoms include missing menstrual periods or light or less frequent periods, feeling week, lower back pain, dizziness, tinnitus, red tongue and week pulse.

2 qi and blood deficiency, symptoms include missing menstrual periods, dizziness, blur vision, short of breath, tiredness, pale, light tongue and week pulse.

3 yin deficiency, symptoms include missing menstrual periods, hot flashes, fever, night sweating, cough with blood, red tongue, week pulse.

4 qi and blood stasis, symptoms include missing menstrual periods, depression, feeling anger, feeling bloated, lower tummy pain, dark tongue, floating pulse.

5 dampness and phlegm blockage, obesity, cough with phlegm, swelling, excessive vaginal discharge, thick tongue coating, and slippery pulse.

Acupuncture could help correcting hormonal imbalance, reducing stress level and resuming menstrual cycles by stimulating nerve ends at particular acupuncture points and improving hypothalamus function.

There were some researches showing that effectiveness of acupuncture on resuming menstruations. Here are some examples.

There was a study with women with premature ovarian failure. 11 women had absence of periods. They received 3 month acupuncture treatments. 10 women had resumed their periods.

There was a random control clinical trials with women diagnosed with polycystic ovarian syndrome. 16 weeks of acupuncture treatment, menstruation frequency is increased.

There was a case report from China. In this report, 33 women aged from 23 -45 had absence of periods for 3 months to 3 years. They were received acupuncture treatments and 29 women out of 33 resumed their periods; 4 women did not respond to acupuncture treatments. About 63% had regular periods during the course of 6 months followup and about 24% had irregular periods during that time.

Stop taking the pills and no periods, acupuncture could help

When will your periods come back after you stop taking the pills? This is a good question. This is may vary depending on individuals. It could take a while for your periods to come back after you stop taking the pill. Most women will have a period two to four weeks after stopping the pill. It could take longer. Your periods may not be regular when you first stop the pills and this could take six months to become normal again. If your periods never come back, this may suggest a problem in your ovaries and you need to see your doctor to investigate what is wrong. Contraceptive pills suppress ovulation and follicle developments. Acupuncture could help ovarian blood flow to help restoring ovarian function when stopping the pills. Regular periods indicate that your ovaries are functioning well. If your ovaries are functioning well, your periods would come back and become regular.

References
Zhou K Evid Based Complement Alternat Med (2013) 2013:657234
Jedel E et al Am J Physiol Endocrinol Medtab (2011) 300:E37-45
Han Y J Trads Chin Med (2004) 24:42-43