acupuncture today newspaper
March, 2012, Vol. 13, Issue 03
The Big C: What Are You Doing About It?
It is the rare to meet a person these days that doesn't have a concern about cancer. Between the constant headlines, to pink ribbons on everything from planes to phones, to hearing that Aunt Stacy was just diagnosed, it is impossible to not be aware of cancer's presence. The question is, what are you doing to actually prevent getting a cancer diagnosis? Or if you were diagnosed in the past, that you don't get it again?Because if you're like most people, you're not doing much in the way of prevention — mostly we just hope we can escape a diagnosis. Don't be fooled into thinking that doing regular mammograms is helping — statistics have clearly shown that the mammogram is being oversold in its value. Women who believe "a mammogram saved my life" have not, in fact, been spared — a study published this past October concluded that instead, women are diagnosed early, or over diagnosed.
The P.S.A. test, as another example, has also been shown to not save lives, and leads to increased testing and treatments, and needless pain, impotence and incontinence. Additionally, early detection and screening are not prevention, despite how often people confuse the two.Let's look at a few facts. First, be clear that cancer is a "modern" disease, and that traditional cultures showed little, if any, cancer. Dr. Albert Schweitzer studied over 10,000 traditionally-living Gabon natives in West Africa and never found cancer. Dr. Eugene Payne studied approximately 60,000 people over 25 years in Brazil and Equador and found no incidence of cancer.
The Hunza in northern Pakistan, the Inuit Eskimos — all these cultures, back when they ate their traditional diet, basically had no incidence of cancer, and all of these cultures have seen a huge increase, rivaling our own rates, after Western foods like refined oils, refined flours, processed foods and sugar were introduced into their diets. Secondly, deaths from cancer (the only reliable statistic), have basically stayed unchanged, dropping only 5 percent since 1950 and in some cases rising.
Despite the hype in the news, giving people the impression that finding it early means they'll be fine, that even if they have to get treated, the treatments are so effective now. Rates haven't changed for most cancers, and have gone up for lung cancer (substantially, in that case) as well as prostate and breast. It is often argued that since we have more testing, we therefore have more diagnoses, but that is exactly why death rates are the only reliable measure.Thirdly, the screening for cancer leaves quite a bit to be desired, hence the recommendations that mammograms not be done before the age of 50, and after that, only every two years (those recommendations were not taken, but the studies 3 and research clearly support them), or that healthy men forgo a PSA test — because again and again, the screenings lead to more invasive testing and over diagnosis, without any lives being saved. In fact, you have to screen over 1,900 women in their ‘40s for 10 years in order to prevent one death from breast cancer, and in the process you will have generated more than 1,000 false-positive screens. Not to mention having subjected sensitive tissue to cumulative doses of radiation.
Dr. Samual Epstein, chairman of the Cancer Prevention Coalition at the University of Illinois Chicago School of Public Health, stated: "If a woman follows the current guidelines for premenopausal screening, over a 10-year period she would receive a total dosage of about 5 rads. This approximates the level of exposure to radiation of a Japanese woman one mile from the epicenter of atom bombs dropped on Hiroshima or Nagasaki." I keep mentioning mammograms because they are such a clear example of a screening that people think is effective, is extremely popular and accepted as well as highly marketed, and that people, oddly, think is preventative. But, mammograms find abnormalities that often would not have become cancer, leading to excessive screening and treatments.
Let me explain. It's helpful to think of breast cancer in four categories. First, there are the slow-growing cancers that would be found and treated with or without screening. Second, there are the aggressive cancers that are deadly, regardless if they are found early or late. Women in either of these groups are not helped by screening. Then there are innocuous cancers that wouldn't have become anything dangerous, but because it was a dot on a mammogram, it is treated — these women are considered over diagnosed, meaning they are treated unnecessarily and are harmed by screening. Then the last group are the women whose lives are saved by screening, who find a deadly cancer in time for treatment to be effective, but clinical data says this is less than one woman in a thousand screened over 10 years. If you're looking for an alternative to mammograms, you might try thermography, which doesn't have any radiation risk, and can find cancers long before a mammogram. Where do cancers get their start? Remember that people have abnormal cells quite often, every day — not surprising if you have trillions of cells. Your immune system is designed to manage any abnormalities, which it does until it can't for whatever reason.
Triggers that can cause cells to become abnormal and/or cancerous can be narrowed down to these four areas:
- Environmental/toxic overload
- Hormonal imbalances
- Nutritional insufficiencies
- Mental/emotional stresses
Some things may have happened inadvertantly, like radiation exposure you didn't know about or chemicals in drinking water. But many of us do things day after day that stress our systems, like microwave in plastic containers, drink water out of plastic bottles, expose ourselves to chemicals like artificial sweeteners (just because the yellow packet advertises "made from real sugar!" doesn't mean it's not a man-made chemical), eat processed foods (remember, 2% milk is a processed food, low-fat anything is a processed food), and eat way too much sugar and carbohydrates. We don't monitor our vitamin D levels to make sure they're sufficient, we take synthetic supplements that increase our chances of cancers, don't eat enough nutrient-dense food... the list goes on and on.So, what should you do? You should make sure your vitamin D levels are measured with a blood test, with optimal levels over 50 ng/ml. It is estimated that over 85% of Americans are severely deficient, well below lab ranges, never mind being in an optimal range.
There are many studies showing a correlation between good vitamin D status and a reduced rate of cancer. Most people cannot get enough vitamin D from the sun, and the amounts in food are quite small, hence the recommendation to supplement. Most health professionals agree that 5,000 IU per day taken with some fat (with a meal, for example, to help with absorption) is helpful.You should also substantially reduce your sugar and refined carb intake. Both insulin and glucose increase cancerous cell activity by shocking amounts — this is why there is such a huge correlation between diabetes, obesity, metabolic syndrome and cancer. Dr. Craig Thompson, researcher and president of New York's Memorial Sloan-Kettering Cancer Research Center, believes that many pre-cancerous cells would never become malignant if it wasn't for the constant exposure to insulin and needing glucose for their metabolism. Lewis Cantley, director of the Cancer Center at Harvard Medical School, says that up to 80 percent of all human cancers have glucose and insulin as instigating factors. This is not new information; the link between sugar and cancer has been known for decades, but people often do not make changes until after they get a diagnosis, when it's substantially less effective.
The estimation is that by the time something atypical or cancerous is seen on a mammogram, the woman has had that abnormality on average for eight years. If she's like most people, she's been feeding it sugar all that time. What's a "reasonable" amount of sugar to ingest? The average person today eats between 150 and 180 pounds of sugar a year. In the year 1700 it was four pounds. Even if you cut your intake in half, it's probably still more than your body can handle health-wise, because we don't know what a "safe" amount of sugar is for human health.You might also consider doing detox cleanses — one or two a year (obviously talk to a medical professional who knows about them before you do one). I mean a cleanse, not a fast, and something focused on the liver, not just on the colon.
The liver is responsible for conjugating and removing toxins and hormones, and most of us don't have nearly the nutrition necessary in our liver to do its job. Do you eat plenty of cruciferous vegetables? That means more than twice a week. And are you sure they're organic and nutrient-dense? Cruciferous vegetables in particular are effective at helping the liver to remove excess estrogen, and excess estrogen is a huge factor in both breast and prostate cancer. Not to mention the day-to-day toxins we get in the water and air —
we probably can't take enough steps to nutritionally support the liver, but doing a cleanse with some concentrated supplementation is a very solid place to start. Write me if you need suggestions for a good detox cleanse.Someone once wrote on a forum I was reading "But so-and-so did everything right and still got cancer!" The response was this: "Can you ever say that anyone has done everything right? Have they kept their vitamin D levels optimal for years? Did they exercise day-in-and-day-out for decades? Have they always eaten low-carb and restricted their sugar? Done cleanses? Eaten good fats and nutrient-dense food?" Very few, if any of us, can say that. You'll see articles touting an herb, or nutrient or supplement that can reduce your chances of cancer, but there are no quick-fixes here, especially if your basic health is off.
PMS is an indication of hormonal imbalances and high estrogen, gas and bloating are 1indicative of digestive problems (and 80 percent of your immune function is in your gut) — it is examples like these that are the symptoms people often ignore, but indicate that there are problems that should be addressed to help your body function in the long run.So, if you want to take responsibility for your own health, and greatly decrease your chances of a diagnosis, and receiving bad news, these recommendations would be a good foundation and starting point.
|Dr. Shi Xue-Min and the Xing Nao Kai Qiao Legacy
By Jing Liu, OMD, LAc, PhD and Kun Liu, LAc
To the acupuncture community, Dr. Shi Xue-Min is known as a distinguished acupuncturist and academician of the Chinese Academy of Engineering and a supervisor of doctoral candidates in China. Dr. Shi Xue-Min is particularly known for his creation of the stroke acupuncture technique Xing Nao Kai Qiao (XNKQ), which is translated as "activating the brain and opening the orifices." During the Chinese Revolution, he was among a few who survived in his position. After establishing The First Teaching Hospital University of Traditional Chinese Medicine in Tianjin, China, Dr. Shi's leadership allowed the hospital to grow to an astounding degree, from 200 beds to 2,000 beds.
Dr. Shi has nearly 50 years of experience in the field of Traditional Chinese Medicine. He is the recipient of numerous awards and has published extensively. He has been the past recipient of 15 awards and two patents on the state, ministerial and municipal levels. He also published 12 major works, more than 30 theses, and authored more than 40 books. The work he has done has greatly encouraged many doctors to conduct research on the effects of acupuncture and meridians.
As most know, Chinese acupuncture has about 5,000 years of history. Dr. Shi Xue-min's theory and techniques known as "Xing Nao Kai Qiao" (XNKQ), is a very effective method of acupuncture for the treatment of stroke. Dr. Shi inherited traditional Chinese medicine, but he also developed the modern concept of quantitative needling manipulation. He was the first doctor in the world to propose the theory of quantitative needling manipulation. He used scientific experimental methods and studied the relationship between clinical effects and needling techniques, including needle retention time, rotation angle and frequency. Moreover, through the efforts of more than 100 of his PhD students, the study of XNKQ has extended even into research at the DNA level. Dr. Shi's concept of quantitative needling manipulation is more valuable than XNKQ alone, and it greatly contributes to the development of acupuncture and research. Thus, Dr. Shi is often referred to as "China's Treasure."
Starting from 1968, Dr. Shi has traveled to countries of all over the world to treat patients and to teach doctors about his XKNQ method of treating stroke patients. He has visited countries such as are Algeria, Germany, Japan, Mexico, France, Italy, and the United States, and he has flown enough miles to circle the Earth about 38 times. Nowadays, even in his seventies, he still flies around the world to spread the word about Traditional Chinese Medicine and his XNKQ method to treat stroke patients.
Last year, Dr. Shi was featured in the acclaimed documentary film 9,000 Needles. The film illustrated the treatment of severe stroke patients by Dr. Shi and his team.
What is Xing Nao Kai Qiao?
The Xing Nao Kai Qiao (XNKQ) method was created by Dr. Shi in 1972, illustrating a new approach to the treatment and rehabilitation of stroke patients. As a result of nearly 40 years of working with stroke patients, the "XNKQ" method has developed into a diagnostic and treatment system.
According to the World Health Organization, stroke is the third leading cause of death in most countries of the world, surpassed only by heart disease and cancer. By the year 2030, it is expected to be the leading cause of death. In the United States, each year 750,000 individuals suffer a stroke and 150,000 people die from stroke. Each year in China, 5-6 million people suffer from stroke and approximately 1.5 million people die from stroke. Stroke affects three times as many women as breast cancer, and it is an important cause of prolonged disability. Survivors of strokes are often unable to return to work. The economic, social and psychological costs of stroke are enormous. In the U.S., each ischemic stroke costs an average of $140,000, according to recent reports.
The theoretical TCM basis of the XNKQ method was based on "spirit-arousing" and "spirit-regulating." Dr. Shi put forward a new conception of the etiology and pathogenesis of stroke, based on a deep understanding the theory of "spirit" in TCM combined with the anatomy and physiology of the brain in biomedicine. Dr. Shi posited that fire, phlegm, blood (stasis), and deficiency carried upwards by wind (internal wind) disturbed the lucid orifices and spirit, leading to closure of the orifices and concealment of the spirit, which in turn caused the spirit to fail to guide the qi, thus stroke occurred.
The XNKQ acupuncture method for treating apoplexy/stroke explained the main pathological keys to etiology, pathogenesis, disease location, and manifestations, and created scientific standards of points selection and acupuncture manipulation. A large amount of clinical practice has confirmed that the treatment method is effective, easy, convenient and practical with a strong scientific standard. The XNKQ method is based on activating and regulating the spirit, restoring qi and spirit, regulating yin-yang and qi-blood, calming, dredging the meridians and supplementing the marrow.
The principles of traditional acupuncture treatment in stroke patients include "calming liver-yang and smoothing liver wind" in the acute period. "Smoothing meridians" is the main principle in stable cases and the sequela period. The points chosen were based on the theories of "using three yang meridians to treat wind" and "using Yang-Ming meridians to treat apoplexy." A comparison of clinical effects and research shows that the traditional acupuncture treatment for stroke patients has a definite effect in stabilizing the disease and improving physical function. However, to improve cerebral circulation and protect the brain cells, the changes in brain function are not obvious. Dr. Shi's XNKQ mainly uses Yin meridians and the Du meridian to activate the brain and open the orifices and nourish the liver and kidney; smoothing the meridians is supplementary.
The theory of quantitative acupuncture manipulation put forward first by Dr. Shi determines a new definition and quantitative manipulation for reinforcing and reducing methods of needle manipulation. Particular attention is given to twirling and rotating, including four important factors. The direction of applied force is an important factor in determining reinforcing vs. reducing technique. The reinforcing or reducing nature of twirling and rotating is directly related to the applied force, the best duration of reinforcing or reducing manipulation based on twirling and rotating the needle is 1-3 minutes for each point. Finally, the best interval between two sessions of acupuncture is three-to-six hours, allowing acupuncture therapy to be more reproducible, standardized, and controlled.
Additionally, Dr. Shi investigated the most commonly used methods of manipulation for reinforcing and reducing in terms of frequency, range, and direction of applied force. His research on quantification of reinforcing and reducing manipulation techniques resulted in two significant definitions: 1) The twelve channels are positioned with the Ren and Du channels in the center; in regard to the right or left direction of needle rotation, directing the rotation towards the heart is reinforcing and directing the rotation away from the heart is reducing. 2) Rotating the needles within a narrow range with light force is reinforcing; the force is light and the range of rotation is narrow, but the frequency is high, the needles are rotated under 90 degrees and the frequency of rotation reaches 120 times per-minute. By contrast, a wide angle of rotation, increased force, and relatively less frequent rotation is reducing; the angle of rotation is greater than 180 degrees and the frequency is approximately 50-60 times per minute.
The manipulation and composition of the XNKQ needling method
One of the main reasons for the efficacy of the XNKQ method lies in its strict application of principles, in particular its special specifications in terms of manipulation technique. The principle points in clinical use are the most important because they free and regulate the spirit; this emphasis is one of the most important differences between the XNKQ method and traditional acupuncture.
The principle points of the XNKQ method include Du 26, P 6, Sp 6, Lu 5, Ht 1, and UB 40. Du 26 is a point that was highly regarded historically for emergency situations; it can directly excite and activate the restrained state of the brain cells. It has a special characteristic of increasing the circulation of the carotid artery, which helps the dynamics of blood circulation and improves cerebral circulation. Thus, the use of this point with sparrow pecking stimulation can open the orifices, arouse the original spirit, and regulate the bowels and viscera. P 6 is the luo point of the pericardium channel, it can benefit stroke patients by improving cardiac output and oxygen supply while calming the heart, regulating the blood, and quieting the spirit. Sp 6 supplements the three yin channels, boosts marrow, regulates qi and blood, and quiets the spirit. Ht 1, Lu 5 and UB 40 can dredge the channels, move qi and blood, and improve the function of the limbs. Within these points, Du 26 is the chief, P 6 and Sp 6 are ministers, and Ht 1, Lu 5, and UB 40 are assistants and couriers; together they regulate and brighten the original spirit, balance yin and yang, regulate qi and blood, and free the channels. One treatment course constitutes 10 days of twice daily treatments; 3-5 treatment courses are used continuously.
Needle Manipulation Techniques Used in XNKQ
The efficacy of XNKQ is closely related to its strict attention to techniques of needle manipulation. One of the key differences between XNKQ and traditional acupuncture methods is the importance placed upon principle points that arouse the spirit and open the orifices in order to achieve the essential effect of regulating and freeing the original spirit.
The principle points used in XNKQ are DU-26 (ren2 zhong1), PC 6 (nei4 guan1), SP 6 (san1 yin1 jiao1), HT 1 (ji2 quan2), LU 5 (chi3 ze2), and BL 40 (wei3 zhong1). Ancient doctors greatly valued DU-26 (ren2 zhong1) as an important point to arouse the brain in emergency situations; it has an excitatory effect on the nervous system and it has an idiosyncratic effect of increasing blood flow in the carotid artery while improving cerebral circulation. Using sparrow pecking technique to drain DU-26 (ren2 zhong1) opens the orifices, arouses the original spirit, and regulates the bowels and viscera.
Photo Courtesy of Seiko Maramba PC 6 (nei4 guan1) is the luo-connecting point of the pericardium channel; it is traditionally said to quiet the heart, regulate the blood, and calm the spirit, and it improves the cardiac output of stroke patients and improves the supply of oxygen to the brain. SP 6 (san1 yin1 jiao1) supplements the three yin channels of the leg and boosts marrow while regulating qi and blood and calming the spirit. HT 1 (ji2 quan2), LU 5 (chi3 ze2), and BL 40 (wei3 zhong1) smooth the channels and network vessels while moving qi and blood to improve movement of the limbs.
DU-26 (ren2 zhong1) is regarded as the sovereign point in the prescription, while PC 6 (nei4 guan1) and SP 6 (san1 yin1 jiao1) are ministers. HT 1 (ji2 quan2), LU 5 (chi3 ze2), and BL 40 (wei3 zhong1) are assistants and couriers. This combination regulates the original spirit and brings out brightness. It creates yin-yang balance and rectifies qi and blood to harmonize the thoroughfare (chong) vessel. By freeing the channels, it promotes uninhibited movement. Treatment is given twice per day for 10 days per treatment course, and three-to-five continuous courses of treatment are recommended.
The XNKQ method of needling has a clear effect in stroke patients, with pronounced positive effects in multiple systems. Dr. Shi has studied its clinical effects for over 30 years in numerous systems involving many different disciplines of treatment, prevention, and rehabilitation. He has contributed standards of integration and management for the diagnosis and treatment of stroke, which has been called a unique "chapter on the treatment methods of Master Shi." It has been shown to reduce mortality and enhance rehabilitation in stroke patients, and is widely regarded as an excellent method of treatment.
Another key aspect of the XNKQ method is the emphasis on manipulation techniques for the principle points. Each point has clear specifications on direction, depth, and hand techniques, which have been assessed with numerous scientific studies. Thus, the needling method is based on established science and standards that enhance clinical results.
After Dr. Shi published his work with the XNKQ needling method, a clinical system of stroke diagnosis and treatment was developed. Altogether, more than two million stroke patients have been treated with this system of acupuncture therapy. In recent years, 9,005 patients with stroke at various different stages were assessed based on strict, harmonized diagnostic standards and treated principally with the XNKQ method. Based on their specific condition, patients utilized drug therapies including medication for hypertension, infections, and other concerns based on internationally accepted standards of care. Marked results were seen in 95-98 percent of patients with a variety of different stages and conditions, including acute stages, hemorrhagic stroke, and recovery stages.
Over the past 40 years, Dr. Shi's humble yet highly innovative work has truly entered the history books.
February, 2012, Vol. 13, Issue 02
The Psychobiology of Pain
By Bruce H. Robinson, MD, FACS, MSOM (Hon)
At its worst, acute pain can be unimaginably intense and stressful, and chronic pain can wreck havoc on a person's quality of life. Because pain is such a universal problem Traditional Chinese medical practitioners devote a considerable amount of time treating it. Understanding the powerful psychology involved in the experience of pain, as well as its neurological and biochemical causes is therefore important.
It's sad but true that we need to have pain. Those who have worked in convalescent hospitals know about the bedsores that paraplegic patients who feel no pain often get on their hips or sacral region, or on their ankles. Some of these ulcers can go right down to the bone and can then infect the bone itself.
Patients with many neurological diseases who have diminished or absent pain sensation develop "Charcot joints" in their elbows, knees or ankles. Named after a French physician in the 1800s, these joints have been exposed to repetitive chronic trauma, with dislocations, infection, swelling and severe deformity. There is neurological abnormality known as "congenital absence of pain sensation." Those born with this condition do not feel pain at all. They grow up suffering from dental abscesses, infected joints and bedsores. They often die in their twenties. Some die from a ruptured appendix or a perforated duodenal ulcer they didn't know about until it was too late to save them.
The Elusive Nature of Pain
Observations of Howard Beecher, military surgeon in WWII, contrasted with his civilian surgical practice after the war was over. He noted that on the battlefield soldiers would continue fighting after they had suffered significant wounds. Many would report they had felt almost no pain while they were on the battlefield. Years later as a trauma surgeon in civilian life, Dr. Beecher noted a stunning contrast: he described the severe pain that accident victims complained of, beginning at the time of injury. Athletes in sporting events often continue on after spraining their ankle or falling on the race course and experiencing injuries, reporting later they hardly noticed any pain.
The other side of this coin is overreaction to pain. Physicians and nurses often report pain magnification in shut-in people such as those in nursing homes or other extended care facilities. These individuals focus on their pain and it seems to make it worse. We all know about how hypochondriacs react to pain, and it seems we are all on a spectrum in terms of how much pain we experience and how much or how little it affects us.
Some of this can be cultural. If we come from a society of over reactors we are likely to overreact. I worked as a surgeon in Saudi Arabia for several years, where the culture encourages those who are ill or injured to moan and complain about their physical discomfort. If they are in the hospital the entire village often comes there to sympathize with them, and they all moan and cry together. My experiences in this culture were in stunning contrast to those later on in Michigan, working with many Scandinavian patients. As a rule these patients seemed almost impervious to pain, and they rarely complained about their discomfort.
Amputee patients often develop phantom limb pain - severe discomfort in the hand or foot that is no longer actually there. They cannot rub it to provide comfort because it no longer exists. We must come to the conclusion that pain has a powerful psychological basis as well as a physical one.
The Psychophysiology of Pain Perception
The perception of pain has three aspects: physiological, affective and evaluative. The physiological aspects are based upon the stimulation of nocioceptive pain fibers distributed throughout the body. The actual amount of pain sensation depends on the extent of the injury or illness, and the particular body tissue that is involved. There are far more pain fibers per square centimeter on the cornea of the eye than on the skin of the chest or back, so a small ulcer on the cornea or a tiny grain of sand in the eye can be extremely painful. Partial ablation of pain sensation can often be achieved by ice packs, the application of local anesthetic agents such as oil of wintergreen or by acupuncture. The injection of xylocaine blocks all pain sensation because it blocks the firing of the nocioceptive pain fibers.
The affective aspects of pain perception are highly individualized, as the experience of pain varies widely in different individuals, whereas other sensory thresholds are more similar from one person to the next, such as position sense or touch. We are all on spectrum of how much pain we experience with a given injury or illness.
The evaluative aspects of pain perception refer to our learned, interpretive responses to pain. Some of these are broadly cultural, as I described above in my reference to Arab versus Scandinavian patients (I was speaking in general terms, of course). Beyond this we may have familial influences on how we perceive and interpret pain that go back to our early upbringing. These can be very powerful. Lastly, we carry with us our own Gestalt: the sum total of our personality, temperament, the amount of stress currently in our lives and the self-discipline we have developed over the years (or the lack of it).
Chemical aspects of pain
There are pain diminishing endogenous opioids that we all manufacture in our brain tissue. These are secreted by neurons in the central nervous system, and include beta endorphins, enkephalins and dynorphins. These opioids are 80 times more potent than morphine, molecule for molecule. Many of you are familiar with the studies that have been done in China and in this country indicating that acupuncture increases these pain-diminishing opioids in brain tissue. Some of us secrete more of these beneficial substances than others do, and there are many ways to enhance them, as we'll discuss in this article.
Conversely, there are pain enhancing endogenous substances in our nervous systems, including serotonin, substance P, bradykinins, prostaglandins and histamine. In addition, cytokines secreted by white blood cells when we are sick or injured can make our bodies more sensitive to pain. Our immune system seems to be signaling us to pay attention to what is wrong.
Neurological Aspects of Pain
The body has built-in mechanisms to control how much pain we experience, either reducing or increasing it, depending on what is going on in our lives at the moment. There is a gate-like mechanism in the dorsal horns of the spinal column, known as the substantia gelatinosa. This "gate" controls the flow of pain sensations that pass through on their way up to the thalamus and limbic system and then to the cerebral cortex where we actually experience pain.
When we are sick or injured, the initial pain sensations get through this gate in the spinal column and go through the thalamus, and on into the limbic system, the pre-conscious area deep in our brain where we process our feelings and the meaning of sensations we are experiencing. The limbic system communicates with the cortex. This system can stimulate a descending inhibitory signal. The descending signal goes from the limbic system and down the periaqueductal grey tissue to the dorsal horns of the spinal column, and into the substantia gelatinosa (gelatinous substance). These signals can then moderate pain, by closing the gate. Nerve cells in this area secrete endorphins that close the gate. With a closed gate: pain sensation is blocked. With an open gate, pain gets through to the thalamus and on to the sensory cortex.
Anxiety, worry, depression or focusing on an injury or illness open the gate and increase pain. Meditation, relaxation, or positive emotions close the gate and decrease or even block pain.
We know acupuncture increases endorphin secretion in the cerebral cortex. Further research needs to be done to see if acupuncture also increases the secretion of endorphins in the substantia gelatinosa.
This has been proposed as a mechanism of how acupuncture reduces pain, but it needs further study in the research laboratory. This research should also include an analysis of how the myelinated A delta pain fibers and the slower unmyelinated C fibers take part in this closure of the gate.
The actual experience of pain is influenced by many things: the person's activity at the time (running an Olympic marathon; fighting in battle), the level of attention versus distraction at the time, and circulating endorphins versus pain-inducing substances perfusing the brain at the time of the pain event. All of this is also influenced by our advance expectancy that we will experience pain. For example, what are our previous memories of going to the dentist? Was it a highly stressful, painful experience? If so, this primes us for a repeat performance the next time we drive to the dentist.
The meaning of the present event to the person is a strong contributor to how much pain he or she experiences. Our feelings of self-control or self-mastery, and our ability to minimize the pain experience are important contributors to how much pain we experience, and how it affects us.
Psychological treatment and support of patients with chronic pain
Techniques of psychological treatment include hypnosis, progressive muscle relaxation, meditation, guided imagery and biofeedback. Behavior modification with operant conditioning is often surprisingly effective. This psychotherapy reverses the usual rewards of being in pain: sympathy, attention, and relief from work/school responsibilities. The technique is for the therapist to increase the patient's activity level, ignore pain behaviors, and reinforce well behaviors. Cognitive therapy changes the interpretation of the pain, encouraging the patient to go towards the pain! The idea is that we do better if we control the pain, rather than letting the pain control us. This therapy attempts to increase self efficacy beliefs.
Mindfulness based stress reduction, created by Jon Kabat Zinn at the University of Massachusetts, is based on this approach. It includes deep inner self-focusing, muscle relaxation and an awareness of all body sensations. The patient is invited to go toward the pain, and to own it. Each person is bigger and more powerful than his or her pain. With this prevailing attitude, the person can gain control over the pain and place it in proper perspective. Curiously, the pain may then go away!
|Acupuncture Study Brings Hope For Parkinson's Disease Patients
By Brenda Duran, Senior Associate Editor
For people living with Parkinson's disease, the future is full of obstacles and uncertainty.
This is the sole reason the second most prevalent neuro-degenerative disease that affects about 1 million people in the U.S., and 5 million worldwide has researchers constantly on the hunt for not only a cure, but also a way to improve the quality of life for patients.
By the year 2013, a current research study involving acupuncture is hoping to find answers for Parkinson's disease patients living with one of the most debilitating side effects – fatigue.
The research study funded by the Michael J. Fox Foundation for Parkinson's Research is currently determining whether alternative Eastern medicine, specifically acupuncture, can help alleviate symptoms of severe fatigue in those living with Parkinson's.
The foundation, which was established in 2000 by actor Michael J. Fox, is the largest funder of Parkinson's research in the world. The organization has funded over $270 million in targeted Parkinson's research to date including the latest study on acupuncture.
Dr. Benzi Kluger, assistant professor of neurology and psychiatry at the University of Colorado Hospital has been leading the study, which began in November 2010. The study is being conducted as a double-blind study to find whether acupuncture has a significant effect on Parkinson's patients living with fatigue in their daily lives.
"Western medicine does not have good treatment for fatigue," said Kluger. "Fatigue for patients with Parkinson's is really different, it doesn't improve with rest and is very disabling."
Fatigue affects approximately half of all Parkinson's disease patients. Many of them do not get relief from medication and research has now focused on ancient Eastern medicine such as acupuncture to find answers, said Kluger.
"We wanted to see if we can come up with alternative strategies that can also later help people with other neurological disorders in the future," said Kluger.
Kluger approached the Parkinson's foundation with his study because he said he was interested in non-motor systems in Parkinson's patients. Non-motor symptoms are the most common symptoms that develop first in patients and one of them is fatigue.
Jamie Eberling, associate director of research programs at the Michael J. Fox Foundation for Parkinson's Research said Kluger's study was chosen based on its merits and because it was something of interest to their donor base.
"We are always interested in different types of approaches," said Eberling. "We are always open to new things, we wish we could see more of these types of studies being presented."
The foundation in the past has funded studies on exercise and even singing for speech problems as well as dancing for motor impairment in Parkinson's disease patients. They review 800 grant proposals a year and are currently supporting more than 300 research projects in industry, academia and government.
Kluger's acupuncture study has a total of 22 patients participating right now. The goal is to have 90-100 patients by the study's end date in 2013.
Patients who joined the study initially came in for a screening visit and filled out a questionnaire about fatigue and their beliefs about acupuncture and alternative medicine. Once people were screened into the study, they were randomized with twice weekly sham or real acupuncture.
Patients in the study are blindfolded while they are receiving acupuncture treatment and Kluger said he doesn't know which patients are receiving acupuncture treatment and which patients are receiving placebo.
Three acupuncturists have been working on the study subjects placing needles in acupuncture points on the patient's face and back. For patients who are in the placebo group, the acupuncturists may place non-penetrating needles in spots that aren't typical acupuncture spots.
Kluger said in the spring, his team is going to try to shell out a paper on the sham acupuncture after spending a lot of time learning how to remove the sham needles to create a really good placebo procedure.
So far, Kluger said he has seen dramatic improvement in fatigue in some of the study subjects. "People have gone back to doing activities that they haven't done in years," he said. Since the statistical data is not yet completed, Kluger said he wouldn't know which group has benefitted the most.
Kluger noted that a large majority of Parkinson's disease patients already use a form of alternative medicine – acupuncture, massage, herbs and chiropractic care, but until now, there weren't many evidence-based studies to determine whether acupuncture is effective for symptoms such as fatigue.
The neuro-degenerative disease affects between 1 percent and 2 percent of people over the age of 65. Those diagnosed with the disease will lose neurons in specific parts of the brain, affecting muscle movement and control over time.
Kluger said if he finds that acupuncture can be used as an alternative form of medicine to alleviate the symptoms of severe fatigue, it might help insurance companies extend their coverage of the treatment.
"We will also be able to see if acupuncture would be effective for people with other diseases like cancer and MS (Multiple Sclerosis)," Kluger said.
Focusing most of his medical career in Western medicine, Kluger said he has really enjoyed doing research on Eastern medicine and finding out about the potential it has to heal people.
"For me it has been a wonderful opportunity to work with acupuncturists to really start to delve into acupuncture. One of my goals is to come out of it with an open mind," he said. "It's been really fun to explore alternative ways to help these patients. We are hopeful."
If you would like to know more about the study or would like to refer a patient, please contact Etta Abaca, Research Coordinator at firstname.lastname@example.org
or call 303-724-2193.
|Acupuncture Solutions for the High Cost of Obesity
By Gregg St. Clair, BA, MSTOM, LAc
In March of this year, AT contributor Sara Calabro had a nice article on acupuncture for weight loss, focusing on Western approaches, Oriental theory and acupuncture protocols. I'd like to take this a step further and look at the cost and environmental impact of obesity. We are a fat nation (33% of adults), getting fatter (17% of our children), and this is something we all have to pay for.
How much do we pay? Healthcare costs associated with obesity are almost $150 billion annually, according to the Center for Disease Control. According to TV personality Dr. Oz, the cost over an obese person's lifetime is $258,000 more than a non-obese person. The World Health Bank estimates 12% of the U.S. healthcare budget is spent treating obesity related diseases. Apparently supersizing a meal has a hidden price.
Obesity also has a direct effect on the environment. Heavier people move less and drive more, not only consuming more fuel, but needing extra fuel to propel them because they are heavier. It is estimated that obesity causes one billion extra tons of greenhouse gas emissions annually because of this. They also use extra fuel for air travel resulting in higher airline costs.
Statistically, obese people consume 19% more foods daily. This means more meat consumption creating higher greenhouse effects; more pesticides and agrichemicals used to produce food; more fuel to transport these extra foods; and more waste such as soda bottles. Unfortunately, obesity is on the rise all over the world and it's estimated that one and a half billion people are obese worldwide. What is going to happen to the environment as the rest of the world adopts our lifestyle and habits?
These costs also extend to lost productivity in the work force. It is estimated $47 billion is lost annually from indirect causes such as inefficiency and absenteeism among overweight workers. These losses affect the overweight as well. Obese people earn less and pay more for insurance.
Obesity in this country exists for some simple reasons and some not so simple reasons. The simple ones include eating too much fast and prepared foods; having excess high-calorie, nutrient-deficient, sugar-laden drinks; too little exercise and too much television and computer time. The not so simple involve the spirit and shen. In most every case there is an emotional component. Food and mood go hand-in-hand.
Our heart center gives us a more conscious soul connection. Heart disease was previously considered the No. 1 killer. This can be viewed as the patient not connected to the shen. But, obesity is now considered the No. 1 killer, because it leads to so many diseases such as high blood pressure, high cholesterol, asthma, sleep apnea and heart diseases. Not only are we not connected to the shen, now we are literally covering it up.
As acupuncturists we have the tools and potential to treat weight loss. I couldn't count how many times I've had someone ask me, "Is there a point for weight loss?" As if there's some secret point that I can needle to make them magically deflate. Can we help obesity? Absolutely! We can strengthen their digestive system (through the Earth systems), work on will power (zhi), reducing cravings and support with herbs, but the needles can only do so much. They're the ones home alone at night in front of the refrigerator making decisions.
Obesity kills over 300,000 people a year in the United States. We have the ability to help save people's lives, protect the environment and save billions of dollars on healthcare. However, telling someone to just lose weight will never work. Almost $60 billion a year are spent in the U.S. for weight loss and weight loss related products. This number goes up every year while the amount of obese people simultaneously rises. Obviously something is not working and people are desperate.
I used to get excited when a patient came to me for weight loss. I'd talk about food choices, treatment and exercise. But just like most diets, people start out strong and end weak, next thing you know they are not coming back to see you. I then went through a period when I didn't get excited and thought, "This isn't worth my time." But, now I get excited again. I've learned that the needles and my enthusiasm aren't enough and the only thing that works is if the patient sees results.
I see my main role now as someone that will hold their feet to the fire, and the acupuncture as a supporting tool. If a new patient will not commit to making at least small changes, I refuse to work with them and tell them to come back when they are ready. This weeds out the ones that are merely playing at losing weight and I'm left with a more exciting patient to work with. I then start slowly asking them to make one change a week or month. Basics include: drinking the proper amount of water; starting to exercise (even if it is only walking one day a week), small changes to their diet, keeping a food journal. I also recommend at least taking a picture of themselves in a bathing suit and hanging it where they can see it, along with a regular weigh-in.
People say all the time, "I can't lose weight, I've tried everything." That really isn't true, they just haven't found what works for them yet. Seeing results moves their mindset from one of discipline and dread to motivation and enthusiasm. Discipline will only take you so far, but when you start to see results, you become motivated. When people start to plateau, think of treating the shen because eventually it will surface, and make the patient responsible for his or her behavior. Only when a patient changes will they see change in their life.
Personal and environmental changes are not easy. In evolutionary terms, the old always fights the new. As we grow aware individually, we grow together as a society. The Earth, food, economics, politics, health and social demographics all go hand in hand; and things are changing. As we heal ourselves we heal the Earth and vice versa. We can be a driving force in this much needed social movement by dealing with the patients that sit down with us everyday.