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 addresses 

Kensington: for appointments (Mondays, Fridays, Saturdays, 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

Harley Street: (Wednesdays)
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 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, fatigue and hot flushes etc to achieve best treatment results. My devotion and skills are highly praised by my patients. 


Tuesday, 22 December 2015

Eating nuts boosts your fertility

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

Do you know that nuts promote your fertility?

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

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

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

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

Tuesday, 15 December 2015

Acupuncture for sleep

Sleep well seems so natural for people. A sound good night sleep is so important to get us refreshed and get our body’s battery recharged for next day’s activity. Why we need sleep? We need sleep because sleep can rest our body and mind. What happens, if we don’t sleep well? We must all have experienced some sleepless nights for some reasons; and then we feel tired and cannot be concentrating well next day. This temporary issue would be over by following a good sleep. Do you ever imagine that someone has never been sleep well for years; every night is sleepless night? About 1 in 2 adults in the UK suffer from some forms of sleep problems and did not get enough sleep.

What is happening to our body, when we are sleeping? When we sleep, our body is going through cycles. Each cycle lasts about one to two hours and consists of four stages: pre-sleep, light sleep, slow wave sleep and rapid eye movement (REM) sleep. In pre-sleep stage, muscles are relaxed; heart rate and breathing slow down. In light sleep stage, it is easy to wake up. In slow wave sleep stage, it is hard to wake up. In REM stage, dream occurs; eyes move from side to side; muscles are completely relaxed. There are up to five cycles during a night sleep lasting about 8 hours in adults.

Insomnia is that sleep problems last for a long time. The symptoms include that 1) it is difficult to fall sleep; 2) it is difficult to stay sleep (often wake up during sleep and difficult to get back to sleep again). 3) Waking up early in the morning. After a sleepless night, one may feel tired, irritable and less concentrating. If this lasts for a long time, it would affect overal heath. The causes of insomnia include two aspects: psychological problems, such as stress, anxiety and depression; physical problems, such as physical chronic pain, asthma, heart problems etc. Recent research showed that people with insomnia have more activities in their central nervous system and/or autonomic nervous system and this keeps them awake.

There are many methods which could self help to improve sleep, such as avoid drinking coffee a few hours before sleep, do regular exercises, take a warm bath before sleep etc. If none of these works, it is easy to turn to sleeping pill for help. However long term taking sleeping pill may lose its effectiveness and cause serious side effects. Here I would recommend acupuncture for you, if you have got insomnia.

Acupuncture is proven to be effective for insomnia because it has direct effects on peripheral nerve system and muscle relaxations; it also regulates autonomic nervous system and central nerve activity. Huang W did a system review for effectiveness of acupuncture in treating insomnia. They analysed 30 clinical trials, 93% of which showed positive treatment effects of acupuncture in improving various aspect of sleep. Acupuncture makes falling sleep faster; increases sleep time; reduces waking up time; improves quality of sleep. Comparing the effects of sleeping pill and acupuncture, they found that sleeping pill has rapid effect, while acupuncture has accumulating effects. Acupuncture can be used for a long time to achieve better effects than that for sleeping pill. The maintenance effects could last as long as 3.5 years at follow-up without side effects.

Tu Jh et al compared the effect of acupuncture and zolpidem in treating primary insomnia. 19 patients received acupuncture once a week and 14 patients received zolpidem treatment. The treatment period was 4 weeks. PSQI was used to evaluate sleep quality. They found that sleep was improved significantly in both groups. Both groups improved over time at a similar rate. They concluded that acupuncture may be an effective alternative treatment compared with zolpidem for primary insomnia.

Insomnia increases in women in menopause period and after this period. Hachul et al studied the effectiveness of acupuncture on women in their postmenopausal period with insomnia. In this study, 18 women aged 50-67 years of age were included. Their period stopped over 1 year and they did not use any antidepressants, hypnotics or hormonal therapy. The participants were divided into two groups: acupuncture group and sham acupuncture group. They received 10 sessions of acupuncture during a period of 5 weeks. Pittsburgh sleep quality index (PSQI) was used to measure the sleep quality before and after the acupuncture treatment. The result showed that women in acupuncture group had better quality of sleep after acupuncture treatment.

Here is a typical case report. A 55 year old woman presents with sleep problem for a year, which related to her stress and knee pain as well. She used some pain killers to help sleep. She had problems of falling sleep as well as staying sleep. Her sleep quality Index was 17 indicating very poor sleep. 2 nights of sleep monitoring showed that 6 hours sleep for the first night using sleeping pill and 4 hours sleep for the second night with fewer amounts of sleeping pills. Her sleep quality is poor. And then she started 12 sessions of acupuncture treatments. Acupuncture was given twice a week for the first 4 weeks and then once a week for the following 4 weeks. Each session lasts for 45-60 minutes. Five days after the start of acupuncture treatment, she slept for 7-5 to 8.0 hours per day without taking sleeping pills. After 8 weeks of acupuncture treatment, she was falling asleep easily and stayed asleep longer. Two days of sleep monitoring showed that 7 hours good sleep per day without taking sleeping pill. The quality of sleep is also improved.

References
Huang W etc (2009) Sleep Med Rev 13:73-104.
Huang W etc Journal of Clinical Sleep Medicine (2011), 7: 95-102
Get sleep problem? Acupuncture could help
Hachul H et al Climacteric (2012)
Tu JH et al Asian Psychiatr. (2012) 5:231-5

Friday, 13 November 2015

There is more chance to get ectopic pregnancy after IVF in women with thin endometrium

Ectopic pregnancy is that the embryo implants elsewhere other than the woman’s uterus where an embryo should do. There is 1% chance of all naturally conceived pregnancy are ectopic. IVF and IUI increased the chance to have ectopic pregnancy to 2-5%. After embryos are transferred to the uterus, they have a greater chance of wandering around and implanting themselves in places where they are not supposed to be, such as the fallopian tubes. What is the risk facto of ectopic pregnancy after IVF? A study has shown that risk of ectopic pregnancy is linked to endometrial thickness. In this study a total of 6465 patients achieved a pregnancy in 8120 cycles via assisted reproduction technology. They found that Following IVF, the risk of ectopic pregnancy is 4-fold increased in women with an endometrial thickness of <9 mm compared with women with an endometrial thickness of >12 mm.

Do you know that acupuncture can help to improve the endometrial thickness by improving the blood flow to the uterus and balance the hormones?

References
Rombauts L et al Hum Reprod (2015) Oct 1. pii: dev249. [Epub ahead of print]

Sunday, 27 September 2015

Frequent urination, acupuncture can help

Urgency-frequency syndrome or overactive bladder (OAB) is one of the most common urinary tract problems in women. Women have to go to bathroom frequently, feeling severe urge to urinate and feeling fullness of the bladder. This condition is not life threatening, but it affects quality of life in women.

At minimum, 11 to 16 million women in the United States cope on a daily basis with symptoms that include sudden strong urges to urinate, difficulty delaying voids, frequent urination, and in many cases involuntary loss of urine when urgency strikes. This causes much stress in women. However the treatments are not satisfactory. A study has shown that six available medications are effective in short term studies and no one drug was definitively superior to others.

In China, urgency-frequency syndrome can be treated using acupuncture. Wang S et al studied long-term efficacy of electrical pudendal nerve stimulation on urgency-frequency syndrome. Long acupuncture needles with deep insertion were used to stimulate pudendal nerve and percutaneous tibial nerve. Long term effects at least 5 years were evaluated. 106 patients participated the study. Evaluation was based on a questionnaire including questions on storage, voiding, and postmictutrition syndromes. The mean treatment sessions were 21.2. The results showed that complete resolution was 42.5% and 50% improvement was 85.5%. 62 patients were followed up for 5-10 years. 35 of these 62 patients maintained the posttreatment effect; 18 changed from better to complete resolution; 7 got back to less than 50% improvement; 4 changed less 25% improvement. From their study, acupuncture stimulating pudendal nerve and percutaneous tibial nerve has a good long-term effect on urgency-frequency syndrome in women.

Forde et al from Department of Urology, Weill Cornell Medical College, New York analysed current research data for the role of acupuncture in managing OAB. They analysed two case series and six comparative trials. All studies demonstrated subjective improvement in OAB symptoms, and some reported objective improvement in urodynamic studies. Notably, some comparative trials showed the benefit of acupuncture to be comparable with antimuscarinic treatment. Their conclusion is despite their limitations, existing studies serve as a promising foundation for suggesting a role foracupuncture as an alternative therapy for OAB

Acupuncture protocol for women with pure stress urinary incontinence

Urinary incontinence is the involuntary passing of urine. This is a very common problem affecting millions of people, as mentioned bove. Stress urinary incontinence is cause by weakness of the pelvic floor muscles. These muscles cannot prevent urination causing urine to leak when the bladder is under pressure, for example, when you cough. There was a protocol to treat stress urinary incontinence in women. This protocol is used for a trial to study efficacy and safety of acupuncture on stress urinary incontinence by Liu Z from China. 500 women will be recruited and allocated into two groups acupuncture group and control group. Electroacupuncture will be used for treatment group. Women in acupuncture group will receive deep needling at acupuncture points BL33 and BL35. Control group will receive sham acupuncture with non-penetrating needling at sham location. Acupuncture will be given three sessions a week for 6 weeks. After that a 24 week followup will be conducted. The safety of acupuncture will be evaluated as well. This trial will be help to assess the effectiveness of acupuncture for stress urinary incontinence.

Recurrent urinary tract infections, acupuncture can help

Acute lower urinary tract infections (UTIs) are common in adult women, and as many as 6% of members of the adult female population experience 3 or more episodes during a given year. Women with frequently recurrent cystitis may need prophylactic antibacterial treatment, however if the infection is recurring and this causes development of antimicrobial resistance. Acupuncture is used to treat UTIs. Recently there was a research from Norway which studied the effect of acupuncture on recurring UTIs in women. In this study, it included women aged 18-60 year old who had to have had 3 or more episodes of distal urinary symptoms (i.e., dysuria and frequent urination or suprapubic discomfort) during the previous 12 months, and at least 2 of these episodes had to have been diagnosed and treated as acute lower UTIs by a medical doctor. Acupuncture was offered twice a week for 4 weeks. Acupuncture points were chosen according to the patient’s TCM diagnosis. Points were located on the lower abdomen or back (CV-3 or CV-4 and BL-23 or BL-28) or on the lower extremities (KI-3, SP-6, SP-9, ST-36, or LR-3). Following treatment, 73% of women in the acupuncture group were free of UTIs during the 6-month observation period. Several episodes of acute distal urinary symptoms were noted in which bacterial cultures either were not obtained or were negative. One third as many episodes per person-month occurred in the acupuncture group as in the control group. Women in the acupuncture group experienced a 50% reduction in residual urine after 6 months relative to baseline, whereas women in the untreated group exhibited no significant change in residual urine. This study indicated that acupuncture treatment may be effective in preventing recurrent lower UTIs .

References

Hartmann KE Evid Rep Technol Assess (Full Rep) (2009) 187:1-20

Wang S Int Urogynecol J 2013 [Epub ahead of print]

Liu Z et al Trials 2013 14:315

Alraek T et al Am J Public Health (2002) 92:1609

Forde JC et al Int Urogynecol (2016) Jan.

Tuesday, 18 August 2015

Acupuncture is popular therapy in Norway

Acupuncture is a popular therapy in Norway

Recent years the use of complementary and alternative medicine (CAM) is increasing. A recent Norwegian survey shows that 45 % of the respondents had used CAM within the last 12 months. Massage was the most commonly used CAM method, followed by acupuncture. Acupuncture has been an integrated part of the clinical practice of Norwegian general practitioners (GPs). Many GPs have undergone acupuncture training. A survey involved in 111 GPs has shown that 60 % used acupuncture to treat patients. Fifty-two per cent used acupuncture in more than 5 % of their consultations. Acupuncture was most often used to treat musculoskeletal pain, migraine and tension headache, but was also used in nausea, indigestion, allergies, asthma and sleeping disorders. For the most common disease groups, positive effect was reported in 3 out of 4 patients. From 2001 to 2008 the proportion of Norwegian hospitals offering CAM increased from 25 % to 50.5 % and acupuncture was the therapy most frequently offered.

Who is likely to use acupuncture?

There was a report about characteristics of acupuncture users among internal medicine patients in Germany. 2486 patients were participated the study. The results have shown that 51.49% reported acupuncture use and 39.22% reported no prior use. The use of acupuncture was associated with higher age, i.e. those aged 50-64 were more likely to have used acupuncture, while those younger than 30 were less likely. Patients with spinal pain, fibromyalgia, or headache were more likely to be acupuncture users; while IBS patients were less likely. Patients with good to excellent health status, high external-social health locus of control and current smokers were less likely to have used acupuncture. Among those who had used acupuncture, 42.34% perceived the treatment as helpful, while 35.94% did not. Rated helpfulness was associated with female gender, full-time employment, high health satisfaction, and high internal health locus of control. Those with a diagnosis of osteoarthritis or inflammatory bowel disease were more likely to find acupuncture helpful; those with headache or other types of chronic pain were less likely to find acupuncture helpful. The conclusion was that Acupuncture was used by more than half of internal medicine patients. Prevalence and rated helpfulness of acupuncture use was associated with the patients' medical condition, sociodemography, and health locus of control.

Why patients use acupuncture

Acupuncture is used to treat many conditions in china for thousands years. Acupuncture is now used by many people in Western world for some reasons. Why people use acupuncture? Studies in New Zealand have shown that patients' reasons for using acupuncture are diverse and include dissatisfaction with conventional medicine and attraction to holistic and empowering models of healthcare. Patients mostly accessed acupuncture for musculoskeletal and pain-related conditions. Treatment is thought to relieve symptoms of the presenting concern and a range of other effects that improve well-being. Acupuncture was viewed to be appropriate for treating chronic and quality of life health issues. The barrier to access acupuncture was treatment-associated cost.

References
Jacobsen R et al BMC Complement Altern Med (2015) 15:275
Cramer H et al Complement Ther Med (2015) 23:423-9
Jakes and Kirk (2015) J Prim Helath Care 7:124-9
Jakes et al (2014) J Altern Complement Med 20:663-71

Wednesday, 3 June 2015

Acupuncture is effective for groin and buttocks pain

Acupuncture is effective for groin pain

Groin area is where the inner, upper thigh and lower abdomen meet. Pain can develop in groin. The most common cause of groin pain is muscle, tendon or ligament strain during exercise such as running, skating, kicking in soccer, or playing basketball or during doing work such as lifting, pushing, or pulling heavy objects. Groin pain may occur soon after an injury and it can also have swelling and bruising. The pain may come on gradually over a period of time: weeks or even months. The pain may be worsened by continued use of the injured area. Overuse is another common cause for groin pain. This often happens when you do too much an activity or repeat the same activity day after day. It put too much stress on the area and can lead to muscle strains or tears or may cause swelling.

There are other conditions which can cause groin pain, such as a bone fracture, a hernia, kidney stones, infections or a testicle condition.

Groin pain not caused by an injury to the groin may be coming from other parts of the body such as leg muscles, ligments and tendons injury.

If you have groin pain, you need to see doctor and get it checked out. If the groin pain is caused by muscle, tendon and ligament strain, acupuncture is very effective.

Buttocks pain, acupuncture can help.

Have you ever suffered from buttock pain? Many conditions and diseases can cause pain in the buttocks, commonly known as butt pain. The causes of pain in the buttocks vary from piriformis syndrome to sciatica, slipped disk or sacroiliac joint pain or cancer. All symptoms related to buttock pain must be evaluated in terms of their intensity, duration, location, and aggravating or relieving factors. If possible, the diagnosis is made.

However, what if there is no cause found. Sometimes, this is a miserable condition. People say that my buttocks are killing me. No causes are found and nothing is shown on tests: the MRI show no problems, no tumor, no slipped disk, no nerve damage, no nothing. Blood test is normal: no sign of infection. No diagnosis. It is suggested that it could be pirifomis syndrome, it could be sciatica and it could be peripheral neuropathy. There is just constant pain which makes one miserable. The pain could spread to the legs and feet. Sitting makes it worse. Tried pain killer, did not work; tried physiotherapy, did not work; tried herbs, did not work; tried injection, did not work; what else to try? If this is your situation, don’t forget to try acupuncture of course. Acupuncture can relieve the buttocks pain quite effectively and help you live with pain free.

Monday, 1 June 2015

What does in vitro fertilisation (IVF) procedure involve? How can acupuncture help?

Before starting the IVF programme ovarian reserve is tested in order to predict how well the ovaries will respond to the drugs. Generally, day 3 FSH, AMH and antral follicle counts are included.

The IVF programme starts by injecting medications to develop multiple follicles in the ovaries. The commonly used reagent is follicle stimulating hormone (FSH). These injections continue to stimulate egg development for about 8-10 days.

When the eggs mature, they will be taken out from the ovaries. This is known as egg retrieval. Sperm sample will be taken before egg collection. After eggs are collected, the eggs will be rinsed and cultured in plastic culture dishes which are kept in specialized IVF incubators in IVF lab. And then sperms were mixed with eggs. If the eggs are fertilised, the embryos will be cultured 2-5 days before embryo transfer. The embryos at the two to eight cell stage will be transferred to the uterus. Some research showed that acupuncture performed on the day of embryo transfer could improve pregnant rate, but this is still in debate. Research showed that acupuncture at luteal phase has benefit; this is because acupuncture improves uterine blood flow.

After 9-11 days after the transfer, blood test could indentify if the pregnancy occurs. The procedure will vary from different protocols used in IVF and in different clinics.

How to choose an IVF clinic?

If you are planning to have IVF, you may want to know which IVF clinic is suitable for you. There are many IVF clinics in the UK for NHS treatment and private treatment. How to choose one? Success rate is an important factor to consider for women to choose a clinic. The success rates showed the number of pregnancies and live births and the numbers of all the treatments offered in the clinic. The National success rate in the UK is about 30%. The majority of clinics’ success rates are around the national average. You can find the success rates on the human fertilisation and embryology authority (HFEA) website http://guide.hfea.gov.uk/guide/ for all clinics it regulates. You can also find break down success rates there, for example, success rates for different age group, different types of treatments, different types of eggs etc. Success rates are affected by a few factors: the type of patients a clinic treats, for example their age, diagnosis and length of infertility; the type of treatment a clinic carries out; a clinic’s treatment practices. They have presented predicted future chances of live birth. From this you can predict your chances of success.

HFEA is the UK’s independent regulator managing the use of gametes and embryos in fertility treatment and research.

IVF is one of the most successful infertility treatments and this treatment brings hope for pregnancy for many people. However, the average IVF success rate per cycle using fresh. The majority of IVF cycles do not result in pregnancy. It is important to maximize the efficiency of the procedure. Many patients have turned to acupuncture treatments to increase the success rate of IVF.

How can acupuncture help IVF success? During the course of egg development, applying acupuncture can improve ovary blood flow to get better egg quality and quantity, meanwhile acupuncture improve uterine blood flow to get better uterine lining.

The first report was by Stener-Victorin et al. 15 years ago suggesting that acupuncture can increase the IVF clinical pregnancy rate (CPR). Since then application of acupuncture to IVF has attracted considerable interest from clinicians to patients themselves. In recent years, there have been many randomized controlled trials (RCTs) evaluating acupuncture in IVF. There were more positive effects from acupuncture during IVF from these researches if treatment times are appropriate, the treatment course is enough.

Acupuncture increased embryo implantation potentials

Kong FY et al investigated the effects of electroacupuncture on embryo implantation potential for patients with infertility. They allocated 210 patients into three groups according to their symptoms differentiated by traditional Chinese medicine. 82 cases of kidney deficiency was group A; 74 cases of liver qi stagnation was group B and 54 cases of phlegm dampness was group C. These patients with infertility were treated with electroacupuncture and in vitro fertilization and embryo transplantation (IVF-ET). Electroacupuncture was applied before controlled ovarian hyperstimulation and during ovarian hyperstimulation. The levels of human leukocytes antigen-G (HLA-G) in the serum were determined for evaluating embryo implantation potentials. HLA-G level was measured on the second day of the menstruation, on the day of human chorionic gonadotropin (hCG) injection and on the day of embryo transfer. HLA-G may play a role in immune tolerance in pregnancy and its presence in embryo is associated with better pregnancy rates. They found that electroacupuncture can increase HLA-G for the patients undergoing IVF-ET; their HLA-G increased on hCG injection day and on embryo transfer day in group A and group B. This increased embryo implantation potential for patients with infertility. Eventually pregnancy rate was improved.

Acupuncture assists IVF to improve live birth rate

In vitro fertilization (IVF) is a costly treatment option for those with infertility. Acupuncture as a complementary technique is applied to assist IVF and increase its success rate. Many researches assessing the effect of acupuncture during IVF were performed. They showed that acupuncture increased pregnancy rate and live birth rate by supporting IVF. But the methods used were varied. Recently a clinical trial protocol of effectiveness of acupuncture to improve live birth rate for women undergoing IVF was published. Smith CA et al conducted a randomized controlled trial to evaluate the effectiveness of acupuncture on assisting IVF. They will recruit women with infertility younger than 43 years of age undergoing IVF or intracytoplasmic sperm injection (ICSI). The treatment protocol will be used. The initial diagnosis and treatment will take 60-90 minutes on days 6-8 of the stimulated IVF cycle. Two treatments will be given immediately before and after embryo transfer (ET). Patients are divided into three groups. 1 acupuncture group: 2 plaebo control: This group will be given placement of non-invasive sham needles. Duration of needling and treatment session is the same as for the acupuncture group. 3 usual care only group: they will receive standard care only. Live birth and pregnancy outcome will be analysed. The research will provide significant evidence for evaluate the effectiveness of acupuncture for assisting IVF.

Effects of electroacupuncture on IVF-ET for patients with poor ovarian response

There was a case report from Zhongguo Zhen Jiu – an acupuncture journal in China. They studied 60 patients with infertility with poor ovarian response and poor ovarian reserve undergoing in vitro fertilization-embryo transfer (IVF-ET). These patients were divided into two groups: with acupuncture or without acupuncture; 30 cases were in each group. The effect was compared after treatment. After treatment, in acupuncture group, the symptoms of kidney deficiency were improved; estrdiol (E2) level was higher; egg maturation rate, fertilization rate and good quality embryo rate and implantation rate were higher on the day of human chorionic gonadotropin (hCG) injection. The level of stem cell factor (SCF) in follicular fluid and serum was higher in the acupuncture group as well. More importantly the pregnancy rate was higher and abortion rate was lower in acupuncture group. This is a promising research for patients with poor ovarian response and poor ovarian reserve.

Luteal phase acupuncture increased pregnancy rate

Dieteril S et al studied the effect of acupuncture on the outcome of in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI). Patients with infertility undergo IVF/ICSI. 116 patients received luteal phase acupuncture and 109 patients were in control group receiving placebo acupuncture. They found that the clinical pregnancy rate and ongoing pregnancy rate in acupuncture group were 33.6% and 28.4% respectively which was significantly higher than those for the control group (15.6% and 13.8% respectively). Receiving luteal phase acupuncture is positive for increasing pregnancy rate of IVF and ICSI.

Acupuncture improves egg quality and pregnancy rate for patients with PCOS

Cui W et al investigated effects of acupuncture on egg quality and pregnancy for patients with polycystic ovary syndrome (PCOS) undergoing in vitro fertilization and embryo transfer (IVF-ET). There were 66 patients with PCOS and infertility and undergoing IVF-ET. These patients were divided into two groups randomly: 34 patients were in acupuncture group and other 32 patients were in control group. Ethinylestradiol and cyproterone acetate tablets and gonadotropin-releasing hormone agonist were applied for long-program superovulation in these patients. Electroacupuncture was applied in the acupuncture group. No intervention was applied in control group. They found that kidney deficiency symptom score was improved better in acupuncture group. All fertilization rate, cleavage rate and high quality embryos were higher in acupuncture group than that for control group. Pregnancy rate and stem cell factor (SCF) level were higher in acupuncture group. SCF is an important factor during embryo development. They concluded that electroacupuncture plays an important role in the pregnant outcomes of patients with PCOS undergoing IVF-ET. It reduces kidney deficiency symptoms and improves clinical pregnant rate by adjusting organic endocrinal system and the local micro-environment of ovary and improving egg quality through the up-regulation of SCF level.

Acupuncture indreases live birth in IVF with donor’s eggs

Acupuncture was first reported by Paulus et al to increase clinical pregnancy rate, when a standardized acupuncture protocol was performed immediately before and after fresh, nondonor IVF-ET. 160 patients were participated the study. 80 patients were randomized to the acupuncture group and 80 to the control group. The CPR was higher in the acupuncture group compared to the control group (42.5% versus 26.3%, p=0.03). After this study, similar studies were performed and positive results were also reported to support Paulus et al conclusion. More recently, Hullender Rubin LE et al modified Paulus’s protocol, they found that in donor cycles, live births were higher in the acupuncture group compared with control group.

References
Stener-Victorin E (1999) Hum Reprod 15:2480–2484.
Kong FY et al Zhongguo Zhen Jiu (2012) 32:113-116
Cui W et al Zhongguo Zhen Jiu (2011) 31:687-691
Smith CA et al Trials (2012) 18:13:60
Zhongguo Zhen Jiu (2009) 29:775-9
Dieterle S et al Fertil Steril (2006) 85:1347-51
Hullender Rubin LE et al J Altern Complement Med (2013) 19:637-43

Sunday, 17 May 2015

Natural skin care with acupuncture

Facial skin is constantly damaged by various factors in daily life.

Radiation exposure and facial skin

We all know exposure to the sunlight can accelerate skin aging or cause skin problems. The harm caused by sunlight is the electromagnetic radiation given off by the sun particularly infrared, visible and ultraviolet light. Do you know that computer, laptop and tablet screens also emit electromagnetic radiation? Though the emission is low, but long time exposure can have accumulated effects. Nowaday tablets replaced books. Even bedtime reading is from tablets or ebooks instead of paper books. Such unlimited exposure to screen increases exposure to radiation. It can cause various skin problems and makes skin less brilliance. The face is usually the closest part of the body to the screens and it is affected most. It contributes to facial skin aging, and makes facial skin dry, tired, loss of glowing and wrinkles.

What stress does to your skin?

Stress can affect your whole body including your face. It has a powerful effect on your facial skin. It accelerates aging process though the exact relationship of stress on aging is complex and isn't fully understood. Stress causes a chemical response that makes skin more sensitive and reactive. It also causes skin dryness and dehydration which leads to fine lines and wrinkles. It causes tension of facial muscles which leads to deep wrinkles and facial pain. Stress causes an inflammatory response in the body and leads the pores to become clogged and break causing acne. Skin losses its radiance which is result of skin blood flow slowing down. Skin also losses its elasticity and forms sagging skin.

Take care of your skin to prevent from damaging and rapid skin aging. This will help keep your skin healthy and glowing and delay the natural aging process.

Protect yourself from sun. Sun exposure can cause wrinkles, age spots and increasing skin aging process.

Stop smoking. Smoking damage collagen and elastin of the skin and causes wrinkles on your face and makes your skin age quickly. Smoking reduces blood supply to the skin which depletes skin oxygen and nutrients supply and accumulates toxins in the skin.

Clean your skin using gentle cleansing products to keep your skin clean and healthy. Applying moisturiser helps keep your skin moisturised.

Healthy diet helps you have a healthy skin. Fruits, vegetables, whole grains and lean proteins are good for your skin. Skin dehydration causes wrinkles. Drink plenty of water to prevent skin from dehydration.

Reduce stress. Stress makes wrinkles and accelerates skin aging process. Stress also makes skin more sensitive and causes other skin problems.

What do you know about skin absorption?

Skin can transport chemicals from the outer surface of the skin both into the skin. This is known as skin absorption. Skin absorption can occur from skin exposure to chemicals or cosmetic products. Skin absorption relates to the degree of exposure to and the ability of a particular substance going through the skin.

Absorption of substances through the skin depends on several factors: duration of contact, concentration and solubility of the substance, physical condition of the skin. To be absorbed through the skin, a chemical must pass through several skin cell layers or sweat glands and hair follicles. Some chemicals can be absorbed in enough quantity to cause detrimental systemic effects. The amount of chemical that is absorbed through the skin can be measured. A medication or chemical can be applied on the skin for localised treatment.

Life style and the skin

Foods affect skin aging

Skin cells are constantly turning over. The new cells need vitamins and nutrients to grow. Healthy diet including plenty of fruits, vegetables, whole grains, nuts, seeds, beans and lean proteins including lean meat and fish provides needs to the skin. Some herbs and spices, such as oregano, cinnamon, cloves, ginger, and garlic inhibit toxic products formation in the skin cells which are good to the skin. Processed or refined sugar and saturated fats accelerates skin aging including formation of sagging of skin, and loss of elasticity which are all related to changes in the collagen and elastic fibers of the skin. Healthy foods also promote good overall heath. Skin is the window of good general health.

Good night sleep helps the skin

Sleep makes the body recharge battery. It is as important for the skin. During the wake up, skin is busy to defending the body against harmful invaders such as bacteria, chemicals from environment and stress; blood flow is redirected to the important organs such as brain, heart to make sure these organs are working well. During sleep, blood flow to the skin is increased which provides more nutrients and oxygen supply to the skin. The skin is repairing itself during sleep and making more collagen and elastic proteins to make the skin strong and elastic. During sleep muscles are relaxed, this reduces fine lines and increases blood supply to the skin. During sleep the skin is rehydrated and there is no stress to the body and the skin. A good night sleep makes skin glowing, elastic, and smooth. Poor quality sleepers showed increased signs of intrinsic skin aging including fine lines, uneven pigmentation and reduced elasticity.

Natural skin care with acupuncture

Natural skin care is that you care the skin with naturally derived products for example, herbs, roots, essential oils and flowers which are carried with naturally carrier agents, preservatives, surfactants etc. This is based on botanically sourced ingredients being present in nature rather than those synthesized chemicals. This integrity of the ingredients is preserved during manufacturing process. For example, you might have heard some natural skin care ingredients including jojoba, safflower oil, rose hip seed oil, shea butter, beeswax, witch hazel, aloe vera, tea tree oil and chamomile etc. Also egg oil has many applications in skin care and can be used as an excipient/carrier in a variety of cosmetic preparations such as creams, ointments, sun-screen products or lotions where it acts as an emollient, moisturizer, anti-oxidant, penetration enhancer, occlusive skin conditioner and anti-bacterial agent. Honey’s natural antioxidant and antimicrobial effects and ability to absorb and retain moisture have been recognised and used extensively in skin care treatments as they help to protect the skin from the damage of the sun's rays and rejuvenate depleted skin.

However according to the US Food and Drug Administration (FDA) all ingredients are chemicals by definition. And also natural does not have medical meaning to dermatologists.

Acupuncture in skin care. Acupuncture is getting popular in skin care. Acupuncture is absolutely natural in facial skin care. It stimulates skin endogenous metabolisms and improves skin blood circulation and reduces stress.

Acupuncture improves skin blood supply

The skin contains a network of small blood vessels which provides nutrition to the skin. The blood vessel wall can contract and relax to regulate blood supply to the skin. If the blood vessels contract more than normal, less blood passes through them and the skin becomes pale and white. When the blood vessels are completely relaxed, this allows more blood to pass through the skin and the skin appear red. Improving skin blood flow will improve skin nutrition status.

Recently many studies have shown that acupuncture increases blood flow and microcirculation in the skin.

These are examples of the studies

Kuo TC et al Am J Chin Med (2004) 32:117-29

Mori H et al Acupunct Med (2014) 32:167-71
Hsiu H et al Microvasc Res (2013) 89:34-9
Kimura et al Acupunct Med (2013) 31:74-80

Huang T et al J Tradit Chin Med 92012) 32:40-4

Hsiu H etal Evid Based Complement Alternat Med (2011) 2011:435928

Hsiu H et al ConfProc IEEE Eng Med Biol Soc (2008) 2008:2916-9

Hsiu H et al Lasers Med Sci (2009) 24:353-8

Hsiao SH and Tsai LJ J Acupunct Meridian Stud (2008) 1:42-50

Kimura K et al Am J Chin Med (2006) 34:189-96

Sandberg M et al Eur J Appl Physiol (2003) 90:114-9

Zhang D et al Sheng Wu Yi Xue Gong Cheng Xue Za Zhi

Baloqun JA Disabil Rehabil (1996) 18:523-8

In these studies, different acupuncture points are tested and all are found increased skin blood flow. One of the studies measured facial skin blood flow and skin temperature and showed the skin blood flow was increased after acupuncture treatments.

These studies provided scientific evidences for the application of facial acupuncture to improve facial skin blood flow and nutrition. Acupuncture is potentially a new approach to contribute to facial skin care.

Facial acupuncture, a new moisturiser for your face

Nowadays more people have dry skin due to changes in environments such as widespread heating and cooling. This makes skin aging quickly. Moisturising of the skin becomes an important anti-aging skin care. The balance of the water content, oil content and natural moisturising factors in the skin are important factors in maintaining moisturisation. Skin moisturisers are widely used. Skin moisturisers are complex mixtures of chemicals specially designed to make the external layers of the skin softer and more pliable. They increase the skin’s hydration by reducing evaporation. Apart from skin moisturisers is there other way to moisturise skin?

Does facial acupuncture moisturise skin? Is there any scientific evidence for such type of application? A study from Japan has shown that there was increased water and oil content for facial skin after cosmetic acupuncture suggesting that acupuncture can modulate the water and oil content of the skin. Facial acupuncture is a new approach for moisturising your facial skin.

As a result your skin achieves glowing, moisturizing, smooth and healthy, wrinkles disappear and muscles are relaxed. Skin elasticity is also restored. This helps to get rid of the stress and its further impact to the skin. As a result the skin aging slows down.

References
N. Donoyama et al (2012) Acupuncture in Medicine30: 152–153,
http://en.wikipedia.org/wiki/Natural_skin_care

Monday, 11 May 2015

Face lift with facial acupuncture

Facial appearance changes with age are inevitable. With age, features that were previously round may sink because fat loses volume, clumps up, and shifts downward. Skin gets loose and sags. There are wrinkles which are the result of facial muscles contracting and pulling the skin fold and are also because of the way fat decreases and moves around. Finer wrinkles are due to sun damage, smoking, and natural degeneration of elements of the skin.

Facial muscles

Muscles on the face contracting causes wrinkles on the face.

Which muscles on the face cause wrinkles on the forehead and around the eyes?

The frontalis muscle is the muscle on the forehead. This muscle lifts eyebrows and wrinkles the forehead. If this muscle is constant contracted, you get wrinkles on the forehead.

The temporal muscle is the muscle at the temples on both sides of your head. This muscle lifts the jaw and retracts the jaw.

The orbicularis oculi muscle is the muscle surrounding the eye. It causes the eye to close or blink. It draws the skin of the forehead, temple, and cheek toward the medial angle of the orbit, and the eyelids are firmly closed. If the muscle contracts constantly, it causes the appearance of folds or crow's feet that radiate out from the outer corner of the eye.

The corrugator supercilii which means wrinkler of the eyebrows in Latin, is a small, narrow, pyramidal muscle at the medial end of the eyebrow. It draws the eyebrows downward and medially, producing the vertical wrinkles of the forehead.

The procerus muscle is the pyramid-shaped muscle running from the lower part of the nasal bone to the middle area in the forehead between the eyebrows. It pulls the skin between the eyebrows down and is associated with transverse lines over bridge of the nose.

Muscles are on the cheeks

These three muscles including the levator labii superioris alaque nasi muscle, the levator labii superioris and the zygomaticus minor working togetherform the nasolabial furrow from the side of the nose to the upper lip.

The zygomaticus major is larger than the minor, but it also lies in the cheek area and extends down to the mouth. It raises the corners of the mouth in smiling.

Muscles around the mouth

The orbicularis oris muscles are muscles surrounding the mouth. They wrinkle the lips.

The risorius muscle draws the angle of the mouth outward and produces smile.

The depressor anguli oris is a muscle that goes from the mandible to angles of the mouth. It depresses the angle the angle of the mouth associated with frowning.

The depressor labii inferioris muscle is a muscle below the lips and it draws the lower lip down.

The mentalis muscle elevates and protrudes the lower lip and wrinkles the skin of the chin.

The masseter muscle is a thick muscle in the cheek. It is for chewing and for closing the jaws.

Facial acupuncture

Facial acupuncture helps to relax these facial muscles to reduce the wrinkles; it also helps with damaged skin repairing by improving skin circulation and stimulating collagen regeneration.

Facial acupuncture or cosmetic acupuncture, referred to as an acupuncture facelift or facial rejuvenation. It is an alternative way fro botox injection and surgical face lifts to reverse signs of aging in the face. Facial acupuncture helps reduce wrinkles, diminish fine lines, relax facial muscles and reduce stress to lift face and make your face looking more youthful.

Tuesday, 31 March 2015

Acupuncture helps with chronic fatigue syndrome

I am very tired. It is not a rare complaint. Everyone must ever feel tired sometimes, but the tiredness would go away after rest or sleep. If it does not go away, it is a problem. Constant fatigue is the main symptom of chronic fatigue syndrome (CFS). CFS refers to severe exhaustion during and after daily activities or to a lack of energy which is prolonged for 6 or more months and resting and sleeping cannot make fatigue go. CFS affects about 1 in 300 people in the UK. It is about three times as common in women as in men. Most common age group developing CFS is 20-45 and it occurs more in women than in men. Apart from constant fatigue feeling, there are also other symptoms associated with severe fatigue, such as muscle and joint pain, headache, insomnia and poor short term memory etc.

The cause is not clear but there are a few theories including: a viral infection, immune system problems, neuroendocrine dysfunction causing hormones imbalance and psychiatric problems, such as stress and emotional trauma, various inflammatory conditions, central nervous system impairments, and stress. Recently a reduced blood flow in some brain region is found. Some biochemical changes were found in the brain. The purpose of the treatment is to improve the symptoms. Treatments include cognitive behavioural therapy, a structured exercise programme called graded exercise therapy, medication to control pain, nausea and sleeping problems. Acupuncture helps improves symptoms such as reducing pain, stress and improving sleep. This will help improve quality of life in patients with CFS.

Effectiveness of acupuncture on chronic fatigue syndrome

There is no known cure for this condition although treatment may help to ease symptoms. Recently much research has been done to show acupuncture is helpful for chronic fatigue syndrome. For example, one study compared the effects of acupuncture, warm needle and non acupoint groups. They have shown that in comparison with pre-treatment, the scores of Chalder Fatigue Scale including physical and mental fatigue and total score were significantly decreased in both acupuncture and warm-needling groups but not in the non-acupoint group. The physical, mental and total scores of the acupuncture and warm-needling groups were significantly lower than those of the non-acupoint group. Another study compared the effect of acupuncture and prednisone. They have shown that after one course of treatment, the BELL's scores of both groups were obviously improved, but there was no significant difference between groups; after two courses of treatment, the BELL's score in acupunctureand cupping group improved more obviously than that in Prednisone group, and the total effective rate of 91.9% (34/37) in acupuncture and cupping group was superior to that of 71.4% (25/35) in Prednisone group. There was a study compared the effect of acupuncture on chronic fatigue syndrome with herb injection. They found that acupuncture had better effect than herb injected on fatigue scores and symptoms improved.

Recently Zhang W et al studied the effect of acupuncture of Back-shu acupoints in patients with CFS. This was a randomised controlled trial involved in 120 patients with CFS. These patients were equally divided into two groups: acupuncture group and control group. General health was measured and fatigue was measured using Chalder fatigue scale. At the end of the treatment and follow up survey at 4 weeks and 3 months after the treatment, mental and physical function, pain sensation as well as Chalder fatigue scale was improved significantly in acupuncture group compared with those control group. They concluded that acupuncture is effective on chronic fatigue syndrome both on immediate and mid- term basis.

Ng SM &Yiu YM studied the effect of acupuncture on chronic fatigue syndrome (CFS). The participants were 99 patients with chronic fatigue syndrome. This study was well designed with randomized, controlled and single blinded methods. These participants were divided into two groups: acupuncture group and control group with sham acupuncture. The interventions were given twice a week for 4 weeks. They found that physical and mental fatigue was significantly decreased after the treatments. Health related quality of life was improved significantly. Surprisingly there was therapeutic effect with sham acupuncture which was considered due to pressure on the acupuncture points from the sham needles in addition to normal placebo effects. However acupuncture has significantly greater effects than that for sham acupuncture.

When is the best time for acupuncture treatment for chronic fatigue syndrome?

Acupuncture is use to treat chronic fatigue syndrome effectively. In modern era, people are busy at work and they usually go to acupuncture treatment in the evening after finish a day’s work. For chronic fatigue syndrome treatment with acupuncture, is there different effect when acupuncture is received during different time of the day? Ling JY et al investigated this aspect using acupuncture in selective time 9:00 am to 11:00 am in the morning and compared the effect with acupuncture at any time apart from the selective time. 80 patients with chronic syndrome are participated the study. The results have shown that the improvements in the scores of the selective-time-acupuncture group were superior to the anytime acupuncture group. More specifically in the anytime acupuncture group, the total score of fatigue and the score of physical fatigue were reduced after treatment as compared with those before treatment. In the selective-time -acupuncture group, the total score of fatigue, the score of physical fatigue and the score of mental fatigue after treatment were reduced obviously as compared with those before treatment. The ratio of CD3+ and CD8+ T cells was increased obviously after treatment in both groups and the ratio of CD4+ and CD8+ T cells was reduced obviously in the selective-time-acupuncture group, which was better than that in the anytime acupuncture group. The total effective rate was 95.0% (38/40) in the selective-time-acupuncture group, which was better than 80.0% (32/40) in the anytime acupuncture group. They concluded that the acupuncture therapy at selective time is effective in the treatment of chronic fatigue syndrome, which is especially better at relieving mental fatigue. The effect of this therapy is achieved probably by improving the immune function via the regulation of the ratios among CD3+, CD4+ and CD8+ T cells.

Recently a clinical trial studied the effect of acupuncture on CFS. The Fatigue Severity Scale (FSS) score, the Stress Response Inventory (SRI), the Beck Depression Inventory (BDI) and the Numeric Rating Scale (NRS) were used to assess the effect. After 5 weeks of acupuncture treatment, FSS score, SRI and NRS were significantly lower in the treatment group compared to the control group. After 13 weeks of treatment BDI score was significantly lower in acupuncture group. Body acupuncture in addition to usual care may help improve fatigue in CFS patients.

References
Ling JY et al Zhongguo Zhen Jiu (2013) 33:1061-4
Zhang W et al Zhen Ci Yan Jiu (2011) 36:437-41
Ng SM & Yiu YM Altern Ter Health Med 2013 19:21-6
Couilliot MF et al J Integr Med (2013) 11:26-31
Lu C et al Zhen Ci Yan Jiu (2014) 39:313-317
Kim JE et al Trials (2015)16:314

Monday, 30 March 2015

Acupuncture needles for low back pain

Acupuncture needles for low back pain

Back pain is a common condition which affects more than 1 million people in the UK. Back pain can be caused by many factors. But some of the causes cannot be found.

95% of back pain occurs in the lower back. It is defined as non-specific low back pain. Non specific low back pain is tension, soreness and stiffness in the lower back region and the specific cause of the pain cannot be identified. The pain is normally as lasted for more than 6 weeks, but less than 12 months. The pain is persistent or recurrent. Joints, discs and connective tissues in the back may contribute to symptoms. Low back pain affects more than 79% of the population in developed countries. It accounts for 13% absences due to illness in the UK. 35-55 year old are affected most. 90% of the episodes of acute low back pain settle within six weeks, up to 7% of patients develop chronic pain. A study from a study with 5000 adults by the British Acupuncture Council to mark 'Acupuncture Awareness Week' (3rd-10th March 2014) show that almost 80 per cent of people suffer with back pain admit to behaviours that put their backs under unnecessary strain. This study found that almost half of the adults admit to eating on their lap, 40 per cent complain they sit at a desk all day and over a third admit to watching TV or films in bed. When asked about their posture, almost a third also admitted they slouch most of the time.

In the case of treatments for back pain, 74 per cent say they repeatedly use painkillers to deal with their discomfort, which would numb the end symptom and mask the problem but do not address many of the combined underlying causes of back pain rather than addressing the root cause of the problem. Statistics show that 41 per cent of people would only consider acupuncture as a last resort and 88 per cent didn't know the National Institute of Clinical Excellence (NICE) recommends acupuncture therapy for persistent, non-specific lower back pain.

Some patients do turn to complementary and alternative medicine for back pain treatments. What do these patients expect from CAM treatments?

There was a study with semi-structured interviews with 64 individuals receiving massage, chiropractic, acupuncture or yoga for chronic low back pain. The findings included that participants' expectations of treatment outcomes were in four key aspects: pain relief, improved function (including an increase in ability to engage in meaningful activities), improved physical fitness, and improved overall well-being (including mental well-being). Typically, patients had modest expectations for outcomes from treatment.

With 2.3 million acupuncture treatments carried out each year, traditional acupuncture is one of the most popular complementary therapies practised in the UK today. By stimulating different points of the body, traditional acupuncture can be extremely beneficial for back pain, providing long term pain relief and reducing inflammation.

Low back pain with acupuncture treatment

Acupuncture is well known for its effectiveness for back pain. Many research data have provided solid evidence that acupuncture is effective for lower back pain.

NHS recommended acupuncture combined with self-care for persistent low back pain.

Acupuncture alone is effective to relieve back pain. Also acupuncture can be one of the combined treatments offered to patients which reduce the use of medications and improve the outcome. Self care and acupuncture can help release low back pain. This is recommended by NICE guidance as treatment options for persistent low back pain. Cheshire A et al reported their survey based in a primary and community care setting, delivering acupuncture, self management and information to patients with chronic low back pain. They evaluated patient outcomes and experiences of the Beating Back Pain Service (BBPS). The questionnaire is at three time points: pre-BBPS, immediately post-BBPS and three months post-BBPS. There were 80 participants with mean age 47 years. 65% of them were female. Their results showed that pain scores were improved between baseline and post treatment, these improvements were maintained at 3 months follow-up. Patients receiving a combination of acupuncture and self-management sessions produced the most positive results. Patients satisfaction with the BBPS was high. They concluded that combining self-management with acupuncture was most effective, though further consideration is needed to engage patients in self-management. Acupuncture has no severe side effects which can be applied over a longer period of time. The National Institute for Heath and Clinical Excellence guidelines on best practice now recommend offering a course of 10 sessions of acupuncture as a first line treatment for persistent, non specific low back pain.

Effectiveness and acceptance of acupuncture for low back pain

There was a study involved 18000 patients with chronic pain including low back pain. This study showed that the effect of acupuncture was more than placebo. There was a further evidence provided by research from Germany showing that acupuncture is effective for chronic low back pain and acupuncture was highly accepted and had positive effects in patients with chronic low back pain. This was a randomized controlled trial. There were 143 participants with chronic low back pain. 74 patients were offered acupuncture twice a week, while other 69 patients were not given acupuncture as a control. Acceptance of acupuncture, health-related quality of life and pain/symptoms were assessed. The result of the study showed that acceptance of acupuncture was excellent. 89% of the patients would like to have TCM integrated treatment and 83% would have paid for TCM if necessary. Physical functioning, general health, vitality and emotional role were all better in patients with acupuncture treatment compared with control group. Pain relief in acupuncture group was superior to the control group. For instance, pain with sitting/standing, pain upon carrying loads of 10 kg or more and pricking in hands and feet were significantly reduced. Author’s conclusion was that acupuncture was highly accepted and had positive effects in patients with chronic low back pain. Acupuncture can be an effective, well tolerated therapy with no major side events.

Why acupuncture is effective for low back pain?

There are several mechanisms that explained the effectiveness of acupuncture on pain relief. Acupuncture stimulates nerve endings located in muscles and other tissues leading to production of endorphins and other neurohormonal factors. Acupuncture reduces inflammation by releasing vascular and immunomodulatory factors. Acupuncture increases local blood circulation and improves muscle stiffness, joint mobility and swelling. Also how brain and spinal cord processing pain has been altered. In neuroscience, the default mode network (DMN) is a functional network of brain regions that show increased activation during wakeful rest. In patients with low back pain, this DMNconectivity has changed. Acupuncture has been widely accepted for effective low back pain treatment. How acupuncture affect DMN is not clear. Tang et al studied this subject. They used RsfMRI technique to analyse the connectivity of DMN and recruited 20 patients with low back pain and 10 health subjects for controls. They found that there was less connectivity within the DMN in patients with low back pain than healthy subjects, mainly in the dorsolateral, prefrontal cortex, medial prefrontal cortex, anterior cingulated gyrus and precuneus. After 4 weeks acupuncture treatment, patients brain connectivitys were restored almost to the levels seen in healthy controls. Reductions in clinical pain were correlated with increases in DMN connectivity. It can be seen from this data, modulation of the DMN by acupuncture is related to its therapeutic effects.

Standardization of acupuncture points for low back pain

TCM diagnoses and treatment recommendations for specific patients with chronic low back pain vary widely across practitioners. If you go and see a few different acupuncturists, you would get acupuncture at different points. There are no standardized acupuncture points for any conditions. A study has shown that twenty diagnoses and 65 acupoints were used at least once; and only one point UB23 was used for every patient by most acupuncturists. In China standardization of acupuncture points was encouraged to achieve best outcome of the treatment. There was a study compared the efficacy of standardized acupuncture and individualised acupuncture points. In this study up to 15 sessions of acupuncture treatments were offered. The standardized acupuncture was based on the acupuncture intervention from a large multicenter trial previously performed. 78 patients were in the standard acupuncture group and 72 patients were in the individual acupuncture group. Both acupuncture interventions were applied by the same medical doctor specialized in western general medicine (25 years of clinical practice) and trained in Chinese medicine with 20 years' experience in treating low back pain with acupuncture. The result has shown that the average pain severity after 8 weeks and 26 weeks did not differ significantly between both groups. This study has shown the possibility of standardization of acupuncture treatment for chronic back pain patients.

Which acupuncture points are frequently used in lower back pain?

There are over 400 acupuncture points in human body according to Chinese medicine theory. The selection of appropriate acupuncture points is the first step to obtain therapeutic effects. How acupuncturists select acupuncture points? There are three basic principles to select acupuncture points: the first is local acupoints near the area where symptoms occur; the second is distant acupoints along the meridian and the third is distant acupoints based on symptom differentiation. Lee SH et al analysed acupuncture points from 53 studies using modern techniques to extract most commonly used acupuncture points. There were 33 most frequently used acupoints for lower back pain (LBP). The most frequently used acupoints in the treatment of low-back pain were BL23 (51%), BL25 (43%), BL24 (32%), BL40 (32%), BL60 (32%), GB30 (32%), BL26 (28%), BL32 (28%), and GB34 (21%). All local acupoints for LBP are on the Bladder and the Governing vessel especially at the low back position of these meridians. Most of the distant acupoints are on the Bladder and Gallbladder meridians. The acupoints include seven acupoints (BL23, BL24, BL25, BL26, and BL32 as local points and BL40 and BL60 as distal points) on the bladder meridian and two acupoints (GB30 as a local point and GB34 as a distal point) on the gallbladder meridian.

Mechanisms of acupuncture for low back pain

Acupuncture needles are used to treat low back pain. The mechanism of this treatment is still not clear. Why some people respond well while others do not. A study examined changes in lumbar multifidus (LM) muscle function and nociceptive sensitivity after dry needling in patients with LBP and to determine if such changes differ in patients that exhibit improved disability (responders) and those that do not (non-responders). Sixty-six volunteers with mechanical LBP completed the study. Ultrasound measurements and pain algometry of the LM were taken at baseline and repeated immediately following dry needling treatment to the LM muscles and after one week. The percent change in muscle thickness from rest to contraction was calculated for each time point to represent muscle function. Pressure pain threshold (PPT) was used to measure nociceptive sensitivity. Participants were divided into responders and non-responders based on whether or not they experienced clinical improvement using the modified Oswestry Disability Index after one week. Patient responders showed larger improvements in LM muscle contraction and nociceptive sensitivity 1 week, but not immediately, after the treatment than non-responders. The results suggest that there may be lasting and clinically relevant sensorimotor changes that occur in LBP patients that improve with acupuncture needle treatment

References

Pach D et al (2013) Evid Based Complement Alternat Med 2013:125937

Hogeboom CJ et al (2001) Complement Ther Med 9:154-66

Tang WJ et al Acupunct Med 2013 Nove 26. Doi:10.1136/acupmed-2013-010423

Cheshire A et al BMC Complement Altern Med (2013)13:300

http://publications.nice.org.uk/low-back-pain-cg88/key-priorities-for-implementation

Lee SH et al Evid Based Complement Alternat Med (2013) 2013:402180

Weiss J et al J Altern Complement Med (2013) 19:935-41

http://www.acupuncture.org.uk/public-content/public-pr-press-releases/3733-couch-potato-culture-causes-a-generation-in-pain.html

Hsu C et al BMC Complement Altern Med (2014) 14:276

Koppenhaver SL et al Man Ther (2015) Mar 13. pii: S1356-689X(15)00051-X. doi: 10.1016/j.math.2015.03.003. [Epub ahead of print]

Monday, 23 March 2015

What do you know about body fat?

What do you know about body fat?

When we say fat, one might instantly think of obesity. What is fat? Fat is one of the basic components that make up the structure of the body. It is necessary for normal, healthy body functioning. Body fat can be divided into two types: essential fat and storage fat. Essential fat is necessary for normal, healthy functioning. In men, essential fat is approximately 3% of body weight, while in women it is about 12%. This also depends on age. With increased age, the essential body fat increased. Storage fat is the fat increased when you gain weight and this is the fat that you want to lose when you lose weight. Most of people know that too much fat is not healthy. Too much fat increases your risk for developing heart disease, high blood pressure, gallstones, type 2 diabetes, osteoarthritis, certain cancers and for an early death increases.

Do you know too little fat is not healthy either. If a man’s body fat is too low, his health may be compromised and he may become more vulnerable to illness or experience chronic fatigue. If a woman's body fat is too low, her periods may stop and she may experience infertility. Or the other way around if a woman’s periods stops she may have low body fat. Also if a woman’s body fat is too low, the health of her bones, normal hormonal function may be compromised and she may have osteoporosis.

Amenorrhoea is the absence of menstrual periods. Women who are athletes or who exercise excessively on a regular basis are at risk of developing athletic amenorrhoea.

Low levels of body fat and exercise-related hormones, such as beta endorphins and catecholamines, are thought to interfere with the functioning of the sex hormones oestrogen and progesterone. If left untreated, long-term complications include increased risk of broken bones and premature ageing.

For a doctor to diagnose athletic amenorrhoea, all other possible causes, such as certain reproductive disorders, must first be eliminated. Treatment options include exercising less or, in some cases, starting hormone replacement therapy (HRT).

The long-term complications of untreated athletic amenorrhoea include:

Infertility – a woman can’t conceive when she is amenorrhoeic, but athletic amenorrhoea has no effect on long-term fertility once menstruation returns.

High levels of blood cholesterol – are caused by an oestrogen-related fall in the ratio of good cholesterol (high-density lipoprotein or HDL) to bad cholesterol (low-density lipoprotein or LDL).

Osteoporosis – is a disease characterised by brittle bones that break easily.

Premature ageing – the skin loses its elasticity due to low levels of oestrogen.

Unwanted gaining weight, which hormones to check?

If you gain weight unexpectedly and have trouble to lose the weight, you need to get your hormones checked. Imbalanced hormones can make you put on weight. Which hormones do you need to check?

First , thyroid hormones. If your thyroid function is low and you don’t produce enough thyroid hormones, you can put on weight. Thyroid hormone regulates the rate of the metabolism in your body. If it does not work well, you will likely become fat and have low energy. You may have other symptoms of low thyroid including weakness, cold hands or feet, constipation, low immunity and brittle hair.

Second, insulin. Insulin is produced in pancreas and it is a fat-storing hormone released in response to excess blood sugar. If you have insulin resistance, which means that insulin isn't working very well in your body, this leads to weight gain. Apart from weight gain, other symptoms of insulin resistance include excess thirst and urination, hunger and sugar craving, fatigue and poor circulation, cold hands and feet, poor immunity, poor thyroid function, PCOS, heart and liver problem etc. Improving
your insulin response is a great way to reduce body fat, improve energy and overall health.

Third, Cortisol. Cortisol, called stress hormone is produced in adrenal gland. High or low level of cortisol can cause weight gain. High cortisol levels will lead to fat gain around the belly. Low cortisol levels caused by adrenal fatigue will cause weight gain as well. Other symptoms of adrenal fatigue include bloating, fatigue, sleep disturbances, salt cravings.

Finally, Estrogen and others. Estrogen is stored in fat. Excess estrogen stresses the adrenal glands and binds up thyroid hormone, making weight loss very difficult, especially in the hips and thighs.

Wednesday, 25 February 2015

Acupuncture awareness week, acupuncture for Ankle pain

Acupuncture awareness week this year is 2nd March-8th March 2015. What do you know about acupuncture? Do you know anything about acupuncture treating Achilles tendonitis?

Achilles tendonitis is an inflammation in Achilles tendon which is caused by an overuse injury to the thick Achilles tendon at the back of the ankle. It is very common in runners. Achilles tendonitis can be either acute or chronic. Acute Achilles tendonitis is a new injury and usually more painful. Chronic Achilles tendonitis is a prolonged injury and it may follow the acute Achilles tendonitis. The characteristic of this condition is pain and inflammation at Achilles tendon. Many factors contribute to developing the condition. 1, increased activity, for example, suddenly increase distance, speed in running. 2, change to soft training surface, for example running on the soft surface can put on excessive stretch to the tendon. 3, weak calf muscles increases the strain on the Achilles tendon. 4 running on the hill will put on more stretch on the tendon. 5 Wearing high heels constantly shortens the tendon and calf muscles. Sudden change to flat shoes from high heels for exercising will put abnormal stretch to the tendon.

The main symptom is Achilles pain at the back of the ankle, just above the heel bone. There is stiffness in the Achilles tendon especially in the morning or after a long period of rest. This is thought to be due to adhesions between the tendon sheath and the tendon itself. Redness and swelling are often seen in acute stage. Nodules or lumps may be found in the Achilles tendon, particularly 2-4cm above the heel. Tenderness of Achilles tendon can be seen during examination.

Chronic Achilles tendonitis is a difficult condition to treat due to its poor blood supply.

In acute stage, rest is a must. Continuing to train on a painful Achilles tendon could lead to the injury becoming chronic and more difficult to treat. Appling ice within 24-48 hours of injury will reduce pain and inflammation. Wearing a 1cm high heel pad can take some strain away from Achilles tendon. Achilles tendon taping technique which uses elastic bandages to support the tendon can help. Acupuncture can improve blood flow, improve oxygen supply and nutrients supply to the tendon. Also acupuncture can reduce pain and decrease inflammation. In later stage apply heat to the tendon is beneficial. Pain killers can be used in acute stage, but they may not be very effective. Long term use could delay tendon healing. Steroid injection directly into the tendon is not recommended because this can increase the risk of a total rupture of the tendon in future. Right running shoes prevent from future injury.

Once you can perform daily activities pain-free, move on to next stage which focus on improving the flexibility of the calf muscles. Massage will help prevent adhesions forming within the tendon which stop the tendon sliding smoothly in its sheath and help blood flow of calf muscles. Eccentric exercises have been proven to be very effective in the treatment of chronic achilles tendonitis. If the injury has been severe and required a sustained period of rest and the neural control or co-ordination of the ankle has been affected, proprioception which is the neural control or co-ordination of a joint may need to be improved. Finally when the pain has disappeared at least a week and the range of motion at the ankle has improved then you can begin to return to training.