Talking With Your Doctor About Acupuncture

Hello out there, internet! I hope that you all have been doing well and are enjoying your summer. Today’s topic is an important one- we are going to be talking about how to discuss acupuncture and Traditional Chinese Medicine with your medical providers who aren’t acupuncturists.

It’s estimated that about 1/3 of Americans have tried some form of alternative medicine. This encompasses a wide variety of things including acupuncture, naturopathic medicine, homeopathy, energy work like Reiki, and more. It has become increasingly common for Americans to explore non-traditional methods to address their health concerns. As more and and more people explore these alternative treatments, it is a given that there will be some discourse with regular medical providers (doctors, nurses, surgeons, etc.) about if those modalities are helpful/harmful/useless.

While I can’t speak to other non-TCM therapies, I want to help you figure out how to navigate those conversations about acupuncture and TCM that you might encounter with your regular medical team. Some Western medical providers are very much fans of acupuncture, some don’t know much about it, and some think it is a pointless procedure and a placebo effect at best.

It is part of my job to educate other medical professionals about TCM, and I try to communicate with any healthcare professional that I encounter what I do and and how it works. I have found that the vast majority of medical providers that I talk to about acupuncture are very interested in learning about TCM and what it can treat. I’ve literally had conversations about acupuncture during almost every medical procedure I’ve had in the last decade (only my dentist escapes my blabbering through the silencing power of Novocaine). Because my job is somewhat unusual, I am used to having these discussions and don’t get my feathers ruffled when someone might not have a positive view of acupuncture. That’s on me to explain TCM to those who don’t know much about it, and I like to think I do that pretty well.

But I (and my big mouth) won’t always be there to do that for you and your doctors! It can be intimidating to tell your doctor that you want to try exploring acupuncture. From my patients who have had these discussions with their doctors, I’ve found that the conversation tends to go three different ways:

  1. The doctor gives the patient a high-five and a hell yes! (These are often the same doctors who refer patients to me because they know acupuncture is effective…these are obviously my favorites) More and more doctors are realizing (especially in light of the opioid addiction epidemic sweeping our country) that there is real value to exploring non-medicinal therapies, especially for treating pain. Recent recommendations from the American College of Physicians and the Joint Commission reflect this- these institutions are recommending that doctors learn about acupuncture and possibly recommend it to their patients as a treatment for pain. Indeed, the American College of Physicians now recommends acupuncture as a first-line treatment for both acute and chronic low back pain.
  2. The doctor gives the patient a “meh.” Basically this a neutral response- either they don’t know a lot about acupuncture and/or they aren’t convinced it will help patients. These are the conversations I want to help you feel more confident expressing your opinion in.
  3. The doctor says acupuncture is useless and/or a placebo effect. To be honest, I have heard of very few of these reactions…most doctors are good people who want to do right by their patients, and very few of them would actively discourage their patients from seeking relief from a low-risk procedure like acupuncture. These folks can be tough to convince, but hopefully some of the strategies I’ll discuss next can help.

Alright, so you know you want to get acupuncture or you’re already having it and you want to let your doctor know. Ultimately having this conversation is for your benefit- you want to make sure all members of your healthcare team are on the same page, and everyone is aware of who is doing what to help you, the patient, feel your best.  And, again, most doctors are wonderful people who want to help their patients…very few of them are going to be anything but supportive of your decision, so hopefully these conversations will always be stress-free. It also helps increase the visibility and acceptance of acupuncture and TCM within the medical community when doctors know that their patients are receiving (and benefiting from) acupuncture.

So here are the most important things to do in this conversation:

  • Be confident. It is your health and ultimately your decision to pursue acupuncture, no matter what your doctor personally thinks about it. This is the most important one. There’s a reason you want to explore acupuncture, and you shouldn’t have to justify it to anyone. You’re the captain of the ship here, and you get to make choices involving your health.
  • If possible, have personal and specific stories/experiences to share quickly. Something like, “I have gone for two acupuncture sessions so far- I notice that my low back feels less achy and I am able to fall asleep without as much pain as I was experiencing before.” Or “My husband tried acupuncture for his tennis elbow, and I am going to try it to treat the arthritis in my knee since he had such good results.” This does two things: it provides an immediate example of a benefit or acupuncture, and it makes a more personal connection. You’d be hard pressed at this point to find someone who would say to you, “That’s stupid and your husband wasted his money. I don’t care that he feels better.”
  • Ask your acupuncturist for a quick way to explain what acupuncture does for your particular condition. The acupuncturist can then give you a brief idea of how they are treating your condition and how acupuncture can specifically benefit you (they can even give it you on a sticky note to take with you!). You can then share this information with your doctor.
  • If you feel like your doctor is going to be a hard sell, bring in an article or some examples of research that show the benefits of acupuncture. Feel free to ask your acupuncturist for this- that’s on us to keep up with the research and not something you should have to spend a lot of time exploring. However, if you have a quick article or study on hand, feel free to share it!
  • Ask your acupuncturist and doctor if they would like to discuss anything with each other. I welcome discussing my patients with their other healthcare providers…conversing and getting to know everyone involved in your care only benefits the patient. Ask your acupuncturist if you can share their contact information with your doctor- the doctor can then directly talk to the acupuncturist if they have any questions or concerns about your treatment or about TCM in general.

So hopefully you feel a little more prepared to have a conversation with your medical providers about adding acupuncture to your healthcare! I truly want patients to be able to be able to integrate acupuncture and TCM into their medical care- there’s no reason why patients can’t have their regular doctors and see me for acupuncture as well. Indeed, the needs of a patient are best served by both parties working together on behalf of the patient.

I hope this was helpful, and please share any experiences you’ve had with these types of conversations. And as always, please feel free to share with anyone you think might benefit from this article. Until next time, be well!

 

 

TCM and Infertility

Hello out there! I hope you all have been enjoying the week so far. I am going to be talking today about one of my favorite clinical specialities- fertility! This week is National Infertility Awareness Week (April 23-29), so I think it’s perfect timing to talk a little about infertility and what role Traditional Chinese Medicine can play in the fertility journey.

Although I am a primarily a general practitioner (meaning I see a little bit of everything in my practice), I do have a special place in my heart for working with fertility issues. Back when I was in school, I took additional classes on women’s health and infertility, and I also had the opportunity to work with a very well-known fertility expert as one of my clinical supervisors. Since being in practice, I have helped quite a few women with conceiving healthy babies, and it is always one of the most rewarding parts of my job.

Before we go any further, let’s talk about what I mean when I use the term “infertility.” This is generally defined in the medical world as a failure to conceive after 12 months of trying (this sometimes gets shortened to 6 months, depending on a number of factors, including age, relevant medical history, and how actively you are “trying” to conceive).

I work with women when they are still in this 6 or 12 month period of trying to conceive (I’ll use the abbreviation TTC for this phrase a lot), as well as with women for whom natural methods didn’t work. This means that they may be undergoing any number of medical interventions to help fertility, such as medication to stimulate ovulation, intrauterine insemination/IUI, or ARTs (Assisted Reproductive Technologies) such as IVF (In-Vitro Fertilization). Side note: the infertility world is bonkers for abbreviations…sometimes I look at my chart notes and basically see just a list of letters I’ve assembled. It takes a little while to become fluent in the fertility lingo, so I’ll try not to use too many more abbreviations than necessary.

The great thing about acupuncture is that we can help at pretty much any stage of the conception process. Sometimes if women have been trying but haven’t needed additional specialized support yet, I can do things like help regulate their menstrual cycle, monitor and assist in ovulation, and help them pinpoint the ideal time for sexual intercourse to maximize their chance of conception. This method is really fun because I get to help women become more aware of their cycles and become more in tune with their bodily rhythms. The sometimes odd part for people is that I’m going to talk to you a lot about your period, bodily fluids, and sex life. I am a professional and definitely keep things that way, but I also try and make this process not so scary and introduce a little light-hearted humor into the situation. One of the major stressors for women TTC is that the fun is taken out of your sex life- rather than just enjoying sex for the sake of sex, it often takes on this very clinical aspect (I’M OVULATING NOW, HONEY, SO WE’RE DOING THIS IN 5 MINUTES…THERE’S NO TIME FOR KISSING!!!). By helping increase awareness of what is going on in your body at any given point in your cycle, I can help women to feel a little more in control of the process and to get some support from an outside source in what can be a confusing and stressful time.

If a woman has any underlying condition like PCOS (polycystic ovarian syndrome), endometriosis, or hormone imbalances that might be causing difficulties conceiving, TCM can also help treat those conditions as well. Sometimes with these patients, I’ll ask that they stop TTC for a few months to focus on resolving some of the underlying issues to ensure that there is the best chance for success when active attempts at conception start up again.

If women are undergoing fertility treatments of any nature, there’s a lot that Chinese Medicine can do during that time as well. Depending on what medications/hormones/therapies the woman is undergoing, we can help to support that process along the way. This can mean things like helping to support ovulation for a healthy egg retrieval procedure, thickening the uterine lining for implantation, or helping to maintain an early pregnancy in a woman with a history of miscarriages.This can also mean helping to manage some of the unpleasant side effects the hormonal medications can induce and reducing stress/anxiety about the whole fertility process. The technology involved in the fertility process continues to absolutely astounds me- it’s an incredible advancement in medical science, but it can always be helped by additional support. Several of the fertility centers here in Connecticut recommend their patients get acupuncture because not only has it been shown to help increase success rates in IVF procedures, they have also seen the many benefits of TCM in their patients who get acupuncture. It’s also a really great insight into how acupuncture can work in ways that people don’t even realize. Sometimes acupuncture gets accused of only working through the placebo effect, but it’s hard to explain how the placebo effect can help make a woman’s endometrium thicker or help stimulate egg growth in an ovary that wasn’t working so well before (both are examples of things I have had patients report after acupuncture treatments).

I want to take a moment here and point out that I’ve been talking mostly about treating women for fertility issues. I want to make it very clear that women and men are just about equally affected by conditions that cause infertility. However, I largely only see women in clinical practice for fertility treatments…so I encourage all women to make sure their partners have been tested for any sperm issues (sometimes the little guys are terrible swimmers, there’s just not enough of them, or the sperm can be an abnormal shape that hinders their journey to the egg) and/or hormonal imbalances/deficiencies. The testing process for men is pretty simple, so it’s absolutely something that all couples struggling to conceive should make sure they investigate. Chinese Medicine can also help men with issues leading to infertility as well, although it can take a bit longer and usually involves herbal treatment in order to see positive changes in sperm counts and motility. I’ve also largely been talking about cis-gendered (meaning you identify as the biological sex you were born as) and heterosexual fertility issues here, simply because that it what I largely see in clinical practice. The LGBTQA fertility journey can also have some additional factors at play, and it is a topic I would definitely like to explore more for both my professional knowledge and patients’ benefit. I do encourage those couples to seek out a fertility center/doctor with experience helping this population to make sure you are getting the most supportive and comprehensive fertility care possible.

The last thing I want to talk about is how incredibly common fertility struggles are. 1 in 8 couples will struggle to conceive naturally. It is one of my eternal pet peeves how little infertility is addressed in the country. Women are often made to feel ashamed when they have trouble conceiving, and the physical/emotional/financial burden of the fertility journey is an incredibly tough one. Rarely do women feel they are able to talk freely about their struggles to get pregnant, express their frustration with family and friends around them who easily became pregnant, or share their experiences with miscarriages and failed fertility treatments. That’s part of the reason I write things like this- fertility struggles are very common, and couples undergoing these issues shouldn’t be afraid to discuss them. Additionally, I often recommend my fertility patients find some place where they can talk about what they are going through- either through individual or couples therapy, a support group, or an online community where they can freely express their emotions.

It can be difficult to know how to bring up and discuss fertility issues if you haven’t experienced them yourself. Many people sort of put their foot in their mouth, saying things like “Stop stressing about it and you’ll get pregnant- just relax,” or “Well, this miscarriage was meant to be, obviously there was something wrong,” or “Why don’t you just adopt?” I have never talked to a fertility patient who felt better after hearing one of these phrases, and often, they silently die a little inside due to comments like these. This is a really good list of 12 things not to say to someone trying to conceive and explains why some of those phrases might be really hurtful. Often, people say something just because they feel awkward or they want to “fix” a problem. We’ve all done it- I can guarantee even I have said something thoughtless at one point or another. It’s a learning process, but listening and asking what the person undergoing the fertility process needs is the best choice. Even saying “I don’t know what to say” is the best option sometimes. But don’t be afraid to hold space and support loved ones going through the fertility process- it can be a really isolating time for couples, and it makes a huge difference to know they have support coming from their family and friends.

So that about wraps things up on the baby-making front! Please feel free to ask any questions you might have about all of this, either in the comments or privately at acupoulin@gmail.com. And please don’t hesitate to share this post with anyone you think might be interested or might benefit from reading it. I hope you have found this helpful, and until next time, be well.

Self-Care Tips for Chronic Pain

Hello everyone! I hope everyone had a happy and healthy end of their summer. Fall feels like it is officially on its way here in Connecticut, and I personally am looking forward to consuming as many pumpkin-spice flavored beverages as possible.

Today’s blog post is about how important self-care is for chronic pain patients. Pain is overwhelmingly the most common thing I see in clinical practice (mostly neck and back pain), and it’s also what brought me into the world of Chinese medicine. I know I’ve mentioned in some of my earliest blog posts about how my chronic headaches in high school first introduced me to this amazing medicine. For a long time, my headaches were well controlled, and then they weren’t again. This is pretty typical for chronic pain unfortunately- sometimes what worked for a long time suddenly no longer works. This spring, I found myself in a pretty bleak spot- I have chronic migraines, so when I get a headache, it doesn’t go away with some Advil. I had a migraine pretty much 24/7 from Christmas until July.

Chronic pain is not easy. I can’t emphasize that enough. Chronic pain patients often have to minimize or hide their problems- it’s one of those invisible illnesses that tend to be poorly treated and poorly understood. I also was very hesitant to let anyone know what was going on because I felt like acupuncture and Chinese medicine should have been able to fix me, and they weren’t. In retrospect, I know this is silly- not all treatments work for all people for all things, and I’m no exception to the rule. TCM does wonders for me in many other parts of my health, but chronic migraines just weren’t responding.

So, in April, I wound up going to an amazing headache clinic here in Connecticut and started the process to get approved for Botox for chronic migraine. I know this sounds like hippie blasphemy- injections! Neurotoxins! Insurance-mandated approval process! And I felt like a traitor to my medicine.

This is where I needed to step back, calm my ego down, and try something new. So I waited the two month approval process to get the shots covered, got 31 injections in my face, head, and neck and waited for the Botox shots to do their job (it takes up to two weeks for the shots to work).

And you know what? They did. They really worked. And this is not to recommend any specific medical procedure- that’s a discussion for you to have with your medical provider. But this worked for me. Plus, I had the smooth wrinkle-free forehead of a toddler. It was awesome.

This brings us to now. The shots only have about a three month life-span, and mine are wearing off. I have three more weeks until I can get my next round, and I’m finding myself getting a lot more regular migraines. I came home from a busy day at the office Friday and, although it was a great and productive day at work, I was fried. I had forgotten what it felt like to have to make it through a very full day while managing chronic pain. And, unfortunately, I may have a few more weeks of this ahead of me. But this time around, I’m ready. I have a plan for the next course of treatment and in the meantime, I’m going to do everything I can to help myself as much as possible.

So after enough babbling, this is what I want to share with you today. Self-care is instrumental for chronic pain patients. Regardless of whether you are waiting on a new treatment, trying to muddle through what might work for you, or have exhausted most options, you still need to make the effort to put your health, well-being, and sanity first. So here’s my list of things I know make me feel better. By sharing these with you, I’m going to hold myself accountable to following my own advice. I know these may seem simple, but sometimes it’s good to have a reminder of the simple things.

And one more note- I am fortunate that I am generally able to live my life as I want and function at a high level despite pain issues, but I know that is not the case for many others out there. I do not speak for all pain patients, nor am I intending to suggest that because I am out and about in the world that all chronic pain patients can and should do so freely. Everyone’s experience is extremely personal and varied. This is just my perspective.

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And without further ado, …here’s my favorite self-care tips!

  1. Learn to say “no.”

This is a tough one for many people. But you need to protect your health first. Constantly expanding your energy when you have precious little left after doing the very basics of daily living can be downright dangerous to your health. Don’t retreat from life if you can avoid it, but also don’t be afraid to say no. When I turn things down, I tend to be upfront about why I can’t make it- I say I have an especially bad migraine and can’t make it this time but please don’t hesitate to invite me next time! It can be stressful to always feel like you are turning people down, but I’ve found that honesty is usually the best policy. I wouldn’t want one of my loved ones to drag themselves somewhere when they weren’t feeling well, and I think most people would generally agree with that sentiment.

2. Fuel yourself with good things.

This means a number of things. Pain often dulls your body’s awareness of other things it needs. I usually am good about drinking water, but I often won’t eat enough because I simply am not aware of a hunger sensation when my head hurts badly enough. Make sure you are eating regular, nutrient-dense meals. I know it’s tempting to sink into a comfort food routine, but trust me, cheesy pasta does not solve all of life’s woes (although, once in a while, it sure does help). Cooking can seem overwhelming when you don’t feel well, but try to have easy things on hand- rotisserie chicken, pre-cooked beans, minute rice, eggs, frozen veggies, etc to whip up a quick meal. Drink plenty of water. Avoid processed foods, sugar, and alcohol. Get plenty of sleep. Take a nap if you need it during the day!

3. Find your refuge. 

Pain is exhausting, y’all. When I came home from work Friday, I literally stood in the shower in the dark for 15 minutes like a weirdo. I needed absolutely minimal sensory stimulation and to loosen up my tight muscles. The shower usually does it for me. Find your place- a favorite chair by the window, your bed, on the floor next to your dog, wherever. Find that place that makes you feel a little better and seek it out as needed. Take some time there, center yourself with deep breathing, and collect your qi for the next part of your day.

4. Treat yo self.

(Shout out to all my Parks & Rec fans with this tip!) Treating yourself can mean anything that feels good to you. Many times chronic pain patients suffer financial consequences- treatments (especially ones not covered by insurance) can be expensive and sometimes work is limited by pain levels. So treating yourself doesn’t have to be buying something (although it certainly can be!). Listen to a favorite CD, go for a walk, meet up with a friend for lunch, etc. And if you don’t have the energy or finances to do those things, just treat yourself with kindness. Don’t get mad at your body for experiencing pain- think of what you would say to a loved one suffering and then say those words to yourself.

This also means doing other things that make your body feel good- for me it’s also making sure I’m getting chiropractic adjustments, massage, and treating myself with acupuncture whenever possible. It can be helpful to manage pain symptoms through several routes, and obviously, I am a big fan of regularly receiving body work of whatever type floats your boat!

And that’s enough tips to start! I hope everyone has a wonderful weekend, and until next time, be well.

Understanding How Acupuncture Works (A Scientific Perspective)

Hello, friends! My sincere apologies for immediately breaking my promise in my last post to write more regularly. Once again, school and work have been very busy. I’m excited about today’s post, however. This post is actually part of an assignment for one of my classes. Many of the doctoral classes emphasize the importance of evidence-informed practice. This is a fancy way of saying that clinical research and trials should have an influence on how we practice Chinese medicine. This can sometimes be a controversial idea, especially since many in the TCM field feel that we don’t need clinical trials to prove that something that has been done for thousands of years works. However, I think using this type of scientific consideration is actually important. An assignment for one of my classes asked us to write an article or handout of some sort that uses evidence-based medicine to explore a topic in Chinese medicine. So here we are today!

Acupuncture is definitely an art, but there is a very real scientific aspect to it that is being explored more and more frequently. This is personally exciting to me, because the more research that is done in the field of acupuncture, the more information I have to give to patients and other medical professionals about how and why acupuncture should be considered a valid system of medicine. We’ve talked about qi and the meridians here before, and let’s face it- those concepts sound a little odd to most people. If we don’t have a scientific aspect involved, it doesn’t look great for us to say, “Hey, you should totally just trust me that this invisible substance that moves through these invisible channels and can be influenced at these tiny invisible points is super important to your health.” That’s a quick way to alienate people and, frankly, to make us look like a bunch of patchouli-ensconced weirdos within the medical community.

This is where research comes into play. One of the most interesting components I have found within the field of acupuncture research is studies explaining exactly what happens when the acupuncture needles themselves are inserted into the body. There is a doctor named Helene Langevin who is both an M.D. and an acupuncturist who has done a lot of fascinating work on connective tissue and the mechanism of acupuncture. Dr. Langevin has spent much of her career exploring these topics, and she has found that acupuncture has an effect on the cells involved in connective tissues.

Let’s talk about connective tissue for a minute before we go further. Connective tissue is a very broad term, but the most important thing to understand is that it is the most widely found tissue in the body, and it is responsible for holding aspects of the body together, insulating and protecting parts of the body, and moving substances everywhere they need to go. Connective tissue is very adaptable and varies a great deal depending on what it needs to do. The type of connective tissue most important to acupuncture research is what is referred to as “connective tissue proper,” which can be classified as loose or dense. Within the classification of loose connective tissue is the subclass of areolar connective tissue.

Areolar connective tissue

This type of tissue is mostly commonly made up of a type of cell called fibroblasts (this will be important to remember later). The main function of this type of tissue is essential for holding our bodies together- it sort of works like packing peanuts to keep our organs, etc. in place. It keeps our bodies together while simultaneously allowing us to move around freely. It surrounds everything within our body and keeps things safe and well nourished.[i]

“Ok,” (you might say here) “thanks for the science lesson, Sarah. Just what I was hoping for on a holiday weekend- a really fun reminder of high school bio.” Bear with me…understanding just how important connective tissue is makes understanding the mechanism of acupuncture much easier.

In her research, Dr. Langevin discusses the idea that acupuncture points are areas where connective tissue can be easily affected. She proposes the idea of understanding these points as intersections on highways that travel all over the body. This is supported by her findings that acupuncture points themselves seem to often be located at areas of the body where different sections of connective tissue either meet or cross.[ii]

When an acupuncture needle is inserted into the skin, an acupuncturist usually moves it around a little- either we move the needle up and down a bit or we twirl the needle around. Research has shown that this changes the structure of the connective tissue on a cellular level- a “whorl” is shown around the tip of the needle that sort of looks like a whirlpool. The idea then is that this change in the connective tissue around the tip of needle acts as a signal to the cells of other connective tissues.acupuncture110324104147-large

Remember the idea of acupuncture points as intersections; when you have something happen at one of those intersections (i.e. the insertion of an acupuncture needle), information can travel along the connective tissue highways and have an effect on different tissues all over the body. By influencing the connective tissue through a needle insertion, cells such as fibroblasts (see, I told you would see that word again) can potentially change their actions and send out signals to influence other types of cells around them, thus providing an explanation for how inserting a needle at one point can influence all different parts of the body. Because the cells of connective tissue are responsible for keeping everything together, they are also naturally responsible for sharing information between parts of the body. This can further explain how acupuncture might even influence the perception of pain in the body, as causing a change in these cells might influence how pain signals are received and sent.[iii]

Let’s break this down with a food-based analogy (my favorite type of analogy). Picture a delicious plate of spaghetti. That spaghetti is your connective tissue (metaphorically speaking of course, not Hannibal Lector-style). When you twirl a fork into that spaghetti (like an acupuncture needle going into an acupuncture point), more and more strands will start to wind around the tines of the fork. Twirl hard enough and the whole plate of pasta begins to change shape. You might even splatter sauce everywhere as you move the pasta around. This is what happens when you insert the needle and move it around- the connective tissue itself is changed by that mechanical stress and can send out signals to the surrounding areas.

For those science-minded types, you might notice that the research on this is a little old. There are still lots of studies being done to further explore Dr. Langevin’s theories for how acupuncture works. As you know, each small aspect of any biological mechanism must be thoroughly explored before any final conclusions can be made- it’s not as easy as designing one study to definitely confirm how acupuncture works (although that would be terrific). For example, one of her additional studies is really just to confirm that connective tissue, as opposed to muscle, is what is actually affected by needle insertion and manipulation. This study was able to show that needle manipulation does indeed affect the connective tissue, which means that it is very possible that acupuncture then influences the information sent along the connective tissue pathways. Because other research has shown that this sort of mechanical stress influences cellular communication, this experiment supports her earlier theory that by inserting a needle, something happens along that cellular pathway to make a change in the body.[iv] Also important to consider is that, although research done fifteen years ago may be considered “old” within most academic circles, it’s still pretty young for a system of medicine that’s been around for thousands of years. Distilling this much history into neat studies takes a whole lot of time and effort on the part of those researchers.

So research continues to be done in this field, but it takes time. You can check out the hyperlink on Dr. Langevin’s name to see her bio at the University of Vermont and check out some of her latest work in the field if you’re interested in learning more. This is intended to just be a little introduction into the research surrounding how acupuncture works. Thanks for hanging in there with me on this today- I know it’s a little different from my normal posts but I think it’s always a good thing to introduce the harder sciences into discussions about Chinese medicine and acupuncture. I hope everyone has a great rest of your weekend, and be well!

[i] Marieb, E. & Hoehn, K. (2007). Human Anatomy & Physiology (7th ed). San Francisco, CA: Pearson Benjamin Cummings.

[ii] Langevin, H. & Yandow, J. (2002). Relationship of acupuncture points and meridians to connective tissue planes. The Anatomical Record 269(6), 257-265. doi: 10.1002/ar.10185

[iii] Langevin, H., Churchill, D., & Cipolla, M. (2001). Mechanical signaling through connective tissue: A mechanism for the therapeutic affects of acupuncture. The FASEB Journal 15(12), 2275-2282. doi: 10.1096/fj.01-0015hyp

[iv] Langevin, H., Churchill, D., Wu, J., Badger, G., Yandow, A., Fox, J., & King, M. (2002). Evidence of connective tissue involvement in acupuncture. The FASEB Journal (published online). doi: 10.1096/fj.01-0925fje

 

Spring Has Sprung (And So Have Seasonal Allergies)

Hello out there, lovely readers. Spring is upon us, and that means it’s time for everyone’s favorite seasonal arrival- spring allergies! We had a very mild winter here in New England, which means that the allergy season is starting even earlier than normal. I’ve been seeing people sniffling for the last two weeks, which is super early. The last two years have been just miserable for allergies, and this year looks to not be so great either. The last two spring allergy seasons were so bad because of the multiple occurrences of the polar vortex (which apparently causes trees and grass to dump all of their pollen in a massive end-of-days apocalyptic fear). This year is just going to be unpleasant because things are blossoming early, which means there is more pollen to go around! Whee!!

So what’s one to do with this abundance of seasonal allergens? Well, you can find out what Chinese medicine can do to help out with those pesky sniffles, runny noses, itchy eyes, and scratchy throats, of course!

In Chinese medicine, seasonal allergies have a couple different etiologies (I know, another shocking case where TCM diagnostics are complicated…all part of the fun of this system!). Spring allergies are often associated with the element of wind. People may become susceptible to these wind-borne pathogens because of a deficiency of spleen or lung qi (and remember, using organ pathologies in Chinese medicine doesn’t mean there’s a problem with your actual insides- it’s just a way of conceptualizing body functions). When the spleen and/or lung qi is deficient, the body’s wei qi ceases to work as well as it should. What on earth is wei qi, you might ask? Excellent question.

Wei qi is the protective qi that surrounds the outer parts of our body to protect us from pathogens trying to sneak in and cause disease. Think of wei qi as Saran wrap, lightly covering everything and preventing things that shouldn’t be coming in from entering into the body (didn’t know you had so much in common with leftovers, did you? I am a literal fountain of knowledge!).

When this wei qi is weak, unruly little things like allergens sneak into the body and cause unpleasant things- those allergy symptoms that make you curse every flower you see.

Look at those beautiful flowers, mocking you.
Look at those beautiful flowers, mocking you.

So what is one to do? Chinese medicine treatments take a multi-faceted approach. First and foremost, we work on alleviating the major symptoms to get you feeling better fast. There are a number of acupuncture points surrounding the nose, eyes, and sinuses that can help relieve itchy eyes and runny noses. Some people get a little nervous about needles in the face, but we use very small needles for these points, and honestly, the benefits usually way outweigh any hesitations people have. Plus, when I get to put needles on the side of your nose, you look like an adorable cat with whiskers, and it makes me very happy!

We also work on correcting the underlying deficiency- tonifying spleen and lung qi to strengthen wei qi in order to prevent further allergy symptoms from developing.

Lastly, we can also use herbal remedies much like our acupuncture treatments to both help with symptoms of allergies and prevent them from occurring again in the future.

There are some things that you can do at home to help minimize your symptoms as well. Avoiding all pollen in the spring is impossible, unless you can build yourself a hamster-ball like contraption from which to view the world. But there are plenty of things you can do to make things less miserable. Firstly, try to keep your home as allergen-free as possible. If you’re outside working in the yard or garden, wipe off quickly before you come in the house and then go right into the shower. The more pollen you bring into the house, the longer you’re exposed to the allergens. This goes for pets, too. Dogs are essentially walking allergen traps- if your dog is anything like my furry moron, rolling around in grass and flowers is a delight on parallel with a stay at a four-star spa. Give them a quick wipe with a damp towel before they come inside (especially if said furry friends hang out in your bedroom…you want to keep that space as pollen free as possible). You can try using a portable air filter to get some of the junk out of the air you’re breathing. This can especially be helpful in the bedroom- remember that you’re breathing in your bedroom air more than any other room in your house, so that’s a big place to reduce allergen exposure. If you have long hair, try to tie it up when you are working outside and/or wear a hat- hair collects pollen and will just increase your exposure. Check your pollen counts on the weather channel/weather app/whatever you use to tell you what it looks like outside. Pollen counts are pretty standard on most weather systems now- if it’s a really high pollen count, it’s maybe not the day to plant your entire garden. Pollen counts tend to be highest around the middle of the day, so early morning or later in the day may be a better time for you to be outside (but again, confirm this with your local pollen count levels).

Lastly, avoid a lot of dairy, refined sugar, and simple carbohydrates if your allergies are bad. These foods all increase dampness in Chinese medicine, which can in turn increase the production of mucus and phlegm that makes your sinuses achy and stuffy.

Hope you have found this helpful, and I am wishing everyone a sneeze-free spring. If you celebrate Easter, I hope you have a great holiday. Until next time, my friends…be well!

 

More Common Questions About Acupuncture

Hello lovely readers! First things first, my apologies for the little hiatus from my writing here. Things have been a little crazy lately- mucho school work, some technological issues, and a busy schedule at the office (which is awesome and about which I will never complain). So something had to give, and this little blog was it. But I’m here now and excited to talk to you guys about some more common questions about acupuncture. If you missed my previous post about acupuncture myths and stereotypes or one of my very first posts on the 5 most common questions I get asked about acupuncture, I encourage you to take a peek at those two. Today’s post will be just a little more information about what acupuncture is and isn’t, based on some common conversations I have had with people about the medicine.

Who can actually give acupuncture?

So this question gets a little complicated depending on where you live. Unfortunately, there is no federal definition or scope of practice for acupuncturists in every state, which means that things vary quite a bit from state to state. In California (where I went to school), acupuncturists are considered primary care providers, which means they get to order things like lab tests and imaging directly. In Connecticut, we aren’t considered primary care providers, but the state does do a good job of protecting the title of “licensed acupuncturist.” To be considered a licensed acupuncturist, you have to have undergone a certain number of educational and clinical training hours and pass a series of board exams. Connecticut requires about 2000 hours to receive the title of licensed acupuncturist, which is pretty good (the school I went to was closer to 4000 hours of study, but California has a really strong educational tradition in the field of Chinese medicine and tends to offer the longest programs).

Where this runs into problems is that other medical providers can technically offer acupuncture- even if they haven’t had the 2000 hours of acupuncture training. This is because their scope of practice covers the insertion of needles, so they can technically do acupuncture. This is actually a HUGE issue in the acupuncture community (and often gets brought up as an issue of what is usually termed “dry needling,” especially when it is done by chiropractors and physical therapists). I’ll save all that background and discussion for another post, but the issue here is that although these medical providers may indeed be able to safely insert acupuncture needles, what they are doing isn’t technically Chinese medicine. Poking needles in someone doesn’t mean you are giving them acupuncture (otherwise, if you follow that train of thought, tattoo artists are also acupuncturists). Often these providers can take weekend seminars or abbreviated courses on acupuncture. Now, in Connecticut, they aren’t allowed to call themselves licensed acupuncturists without meeting the criteria listed above, but nothing prevents them from advertising or offering acupuncture (see the subtle difference?).

So what’s the big deal with that? Chinese medicine is a whole complex system of medicine with its own system of medical philosophy, diagnostic methods, treatment protocols, and even its own language. Going to see a licensed acupuncturist vs. seeing someone who has taken a weekend course on acupuncture means that you are getting a very different and much more thorough course of Chinese medical care from the licensed acupuncturist. Now, this isn’t to say there are physical therapists and chiropractors and doctors out there who have done lots of additional training and acupuncture certifications and can really offer Chinese medicine, but it just means you have to be cautious about who you go to see. I would never feel confident injecting someone with Botox or fillers after taking a couple weekend seminars, even though I legally can put needles in people. Different areas of speciality exist for a reason- it’s not a bad thing to have to go to different providers based on what they are trained for and skilled in. Look for “L.Ac.” after someone’s name if you’re in this state. This means they are a licensed acupuncturist, and they have had thorough training in the field of acupuncture.

How often can I get acupuncture?

I’ve been getting this question a lot recently, and I love it because the answer is AS OFTEN AS YOU LIKE! Acupuncture can’t really be overdone unless you get 100 needles stuck in you daily for weeks (and if you know someone doing that, you need to run, not walk, in the opposite direction). In the hospital I interned at in China, people usually went daily for 10 to 14 days for their treatments. This is very different from the weekly appointments we usually do in America. Especially when you are just getting started with acupuncture or if you have a very acute condition, there is nothing wrong with coming in a couple times a week. Usually if I see you for two visits a week for two weeks, we make faster progress than just doing weekly treatments for four weeks. Now I understand that time and financial constraints are a consideration, so there is nothing wrong with weekly treatments at all. It’s just that there’s nothing wrong with coming more than once a week either!

Ugh. Why do you give me so much stuff to do at home?

I get it. You’re paying me to help you feel better. Why should you have to do homework? Well, my friends, it’s because lifestyle modifications are such a huge part of the Chinese medical tradition. As I have alluded to in other posts, I see you for approximately 0.6% of your total week (that’s no joke…I did math for you guys). There’s 168 hours in a week and let’s say I see you for 1 of those hours. Guess what? No matter how good I am at my job (and I like to think I’m pretty good at it), I can’t fix it all. What you eat, what your sleep is like, how you manage your stress, what you do for exercise, what weather you are exposed to, etc. all influence your health. So part of my job is to help you make improvements to the aspects of your life that are currently affecting your health.

If you’re not doing any stress relief self-care, I might recommend yoga, meditation, or journaling. If you’re eating take-out every night or skipping meals because you don’t have time to cook, I might make some recommendations for fast and easy meals that you can make in a flash. If you’re not sleeping, I might make recommendations about limiting your screen time before bed, making changes to your sleeping environment, or addressing what you can do to calm your mind before bed.

Plus, I like being bossy and telling people what to do.

Usually my bossiness comes in Post-it form
Usually my bossiness comes in Post-it form

Two final quick questions about acupuncture:

Are you a doctor?

Not yet, chickadees. But soon. There are some acupuncturists out there who are doctors and some who are not. Most of us are not. Graduating right away with a doctorate in acupuncture (obtaining what is referred to as a first professional doctorate) is very rare in the  acupuncture field. Most of the time, if you see “Dr.” in front of an acupuncturist’s name, it’s for several reasons:

  • They have a doctorate in another field (Ph.D, MD, ND, DO, DC, etc.)
  • They were educated in China or somewhere else abroad where a first professional doctorate in Chinese medicine is standard.
  • They went back to school and got a DAOM (Doctorate of Acupuncture and Oriental Medicine) or some similar degree- this is what I will have in August (if I don’t go crazy first). Sometimes this is D.Ac. (Doctorate of Acupuncture) or DCM (Doctor of Chinese Medicine), or something along those lines

This lack of doctor titles will change. Many schools are actively pursuing offering a doctorate degree. It makes sense- we go to school for 3 or 4 or 5 years of very intense higher education. A doctorate is the more appropriate degree for this level of education.

Do you speak Chinese?

Regretfully, no. Most acupuncturists do not. Medical Chinese is very intense, and it is a whole separate speciality from reading and speaking regular Chinese (which itself is a very difficult language to learn, especially as an adult).

I can't read this. Let's hope it doesn't say something offensive.
I can’t read this. Let’s hope it doesn’t say something offensive.

I interned in China for a month is 2011 and was blessed with very patient and competent translators in the hospital. I could say “Hello,” “thank you,” count to 10, and order a beer, and surprisingly that got me pretty far. Most people we encountered (and my friends and I did a lot of wandering neighborhoods in Beijing) were either extremely patient with our language fumbles, eager to practice the English they knew, or as excited to play charades as we were in an attempt to converse across the language barrier.

So that’s all for now, everyone! Hope you enjoyed this. Have a wonderful week (or two) until we meet again, and be well!

What A Pain!

Hello everyone! I hope you all enjoyed the last few guest authors here, but today you are stuck with me 🙂 I’m going to talk about pain in this post. Pain is the most common reason that I see patients in my private practice, and it’s probably the most common reason why Americans seek out TCM services and acupuncture in general.

Pain can be divided into two types: acute and chronic. Everyone has experienced acute pain- you have a throbbing headache, you stubbed your toe, or you threw out your back. Acute pain is typically fairly short-lived and uncomplicated. Acupuncture works very well for these types of conditions (in fact, the sooner you come in to get treated, the better results we tend to see), but what I tend to see most often in practice is chronic pain. Chronic pain means pain that is sticking around for quite some time (usually either longer than three months or longer than six months , depending on who you ask), and it is often very difficult to manage effectively. Usually, people come to see me because whatever they have been trying to do to manage their pain either isn’t working, or it isn’t working as well as they would like.

When thinking about pain in TCM, we can pretty much boil everything down to a very fundamental statement of Chinese medicine:

If there is free flow, there is no pain. 

If there is no free flow, there is pain. 

Essentially what this means is that pain results from a stagnation of qi and blood in the body.  How exactly does the stagnation occur? This is where things can get a little complicated- as with almost anything in Chinese medicine, there are always lots of different etiologies or potential causes of a pathology. However, for our purposes here, it’s just enough to know that something happens to impede the free flow of qi and blood. This “something” can be an injury or accident, a structural issue with the body, a deficiency of qi and blood, an external pathogen like cold or damp, and even emotional factors like stress and anxiety. Once things stop moving and grooving like they should, you develop a symptom- pain.

The best analogy I have for this is to picture cars moving along on a highway. Suddenly, two cars collide and stop on the side of the road. Almost immediately, the flow of traffic on the road is altered. Cars slow down near the site of the accident and move sluggishly to get around the stopped cars. Traffic begins to back up behind the site of the accident and there’s not enough cars on the road ahead of the accident.

10664883-Car-traffic-jam-Stock-Vector-cars

The same thing happens along the acupuncture channels that cover the whole body. So what do we do to fix this problem? Treatment is going to address whatever caused the obstruction as well as help to get things moving as they should.

The insertion of acupuncture needles at specific points works like the emergency responders and tow trucks at the site of an accident- it helps to resolve the issues at the local area, direct traffic, and get things back to normal as quickly as possible. Tui Na (a form of Chinese medical massage) works in much the same way. Chinese herbal medicines (which can be used internally, topically, or both) also work to reduce pain and inflammation locally and to keep things moving freely in all the acupuncture channels. Once we get things back to moving smoothly, the pain resolves!

You can also do things at home to help manage pain conditions. Meditation, light stretching or exercises, and addressing lifestyle factors such as sleep habits and diet can all contribute towards pain management. Depending on what people are coming in for, I almost always send them home with some personalized recommendations for things that they can do at home until their next appointment.

Chronic pain can take a little longer to make progress on than acute pain. I usually give a gentle reminder that if you’ve had a painful condition for a long time, it can take a little while to get things better. Again, think about the traffic jam example- it’s a lot easier to clean up a fender-bender than it is to clean up a ten car pile up in a snowstorm. Once stagnation has settled in, other pathologies can develop, so it takes a little while to make things right. I always love when I’m conversing with someone and they say, “Oh yeah, acupuncture…I had that once. I had shoulder pain for three years so I tried it once. Didn’t work.” This is akin to licking the outside of an antibiotic pill and assuming it’s going to clear up a bacterial infection. Acupuncture works cumulatively- treatments build upon each other, so that your progress becomes a little more pronounced with each visit. I usually ask chronic pain patients to give me three to five visits before they call it quits- this gives a much better idea than just one visit if their condition is something we can address effectively. I can only think of a very small handful of patients who weren’t seeing progress after a few visits, and in most of those cases, there was some pretty significant structural issues that went beyond what I could fix.

One more quick note about pain…this is in regards to the use of ice for pain. Chinese medicine has a very different perspective on the use of ice than Western medicine does. It has become very common now to use ice packs, cooling patches, or other chilly therapies when you have a painful condition. I don’t mind the use of ice immediately following a trauma, especially if the area is red, swollen, or warm (of course, these signs also mean that you should be getting yourself to a medical provider). What I don’t like seeing is people still using ice eight months after an accident. In TCM terms, cold is said to constrict and contract. This means that it can cause hiccups in the free flow of qi- think of a stream that freezes in winter. Ice formation along the waterway means that the water can’t go where it should. Applying too many cooling treatments can do the same thing to our acupuncture channels.

For those who live in New England, this stagnation can happen in your gutters too...nothing like smashing an ice dam to get things moving!
For those who live in New England, this stagnation can happen in your gutters too…nothing like smashing an ice dam to get things moving!

What we can do instead of using ice is to use cool or cold formulas- these contain herbs that will reduce the redness and inflammation, but they also contain moving herbs to counteract the stagnating nature of cold. If ice is literally the only thing helping someone with their pain, I try to find a way to incorporate it into their treatment plan, but this has very rarely been the case…once we start to get things resolved, the need for ice usually becomes much less.

.I hope you’ve found this little explanation on pain to be helpful! Acupuncture and other TCM modalities are really great for pain, and they can be safely combined with most other treatments that people may be using (injections, most meds, PT,  pre- and post-surgical, etc.) Although I treat a lot of pain conditions, I never really get tired of working on them because it is so rewarding to help someone alleviate some of their suffering. I hope you all have a wonderful week, and as always, fell free to share this blog with anyone you think might enjoy it. Be well!

Stick Out Your Tongue!

Hi there everyone! I hope you all are enjoying this first weekend in December (and our unseasonably lovely weather if you’re based in New England). Today I’m going to talk a little bit about the tongue in Traditional Chinese Medicine (TCM) and why it is such an important diagnostic tool.

In addition to asking lots of questions during an intake, I also take the pulse on both wrists and ask patients to stick out their tongue for me. I’ll talk about the pulse and Chinese medicine in a future post, so today we’re just going to focus on why I want to take a peek at your tongue. It’s always pretty funny to request that someone sticks out their tongue at me, especially if they aren’t familiar with Chinese medicine at all. Reactions range from curiosity to amusement to a particular look on people’s faces I like to interpret as ‘Welp, this one is clearly a nutter. Time to ease on out of this treatment room.”

So why do I ask to look at the tongue? Using the tongue as a diagnostic tool has a very long history in TCM. The tongue is the only muscle that we can see outside of the body, so it gives us sort of a sneak peek into the general state of things. When we look at the tongue, we take note of a number of things but generally are paying attention to three major things: the tongue body, the tongue color, and the tongue coating.

The tongue body refers to the general shape, texture and geography of the tongue itself. We look to see if the tongue is long, short, thick, thin, swollen/puffy, cracked, crooked/deviated to one side, or if it has indentations on the sides, among other things. The tongue body gives us a great deal of information about the general condition of the body, including the state of qi of the body (see last week’s post if you missed my discussion on qi).

With the tongue color, we look to see if the tongue body is red, pink, pale pink, purplish, or any combination of those colors. This tells us a lot about if there is enough qi and nutritive substances in the body, as well as if qi is not flowing as smoothly as it should.

The tongue coat refers to the very thin covering that rests on top of the tongue muscle. Often dentists now encourage brushing of the tongue coat because it eliminates bacteria that can cause dental cavities and bad breath. However, do your friendly neighborhood acupuncturist a favor and refrain from brushing your tongue coat on the morning of your next acupuncture appointment. A good and healthy tongue coat should be thin and “white” (meaning not yellowish in color, not actually. a true bright white). It should be slightly wet, but not thick, greasy, or overly wet. We also check to see if the tongue coating is cracked or peeled, which means there isn’t enough of the proper coating or that it is missing in spots. Additionally, we look for yellowish, grey, or even black discoloration of the tongue coat (Here’s a fun fact- next time you take Pepto-Bismal, take a peek at your tongue a little while after you drink it. The active ingredient makes your tongue coating turn temporarily black-ish). Tongue coating tells us a lot about the presence of fluids in the body and if there is too much heat or cold in the body. Many times if I see a yellow tongue coating on a patient, I will ask if they have recently had coffee. 80% of the time, they will say yes and ask how I earth I knew that. While I like to keep up the illusion that I am some sort of Harry Potter-esque Chinese medical wizard, it’s pretty simple. The tongue coat changes quickly and is easily affected by things we eat or drink. A yellow tongue coat indicates the presence of heat in the body. Coffee is a beverage this is hot both physically (i.e. the temperature of coffee is high) and energetically (in that it strongly affects the energy and movement of the qi). If the patient had a yellow tongue coating but doesn’t have many other heat signs (such as reddish complexion, fever, constipation, infection, etc.), it’s a pretty good guess they’ve recently had a cup of coffee (Try this at your next holiday party! Amaze and astound your friends!)

We basically take all the information we get from your tongue and combine it with the questions we ask you, what your pulse feels like, and a physical exam to arrive at a diagnosis. This picture goes into some diagnostic details that we haven’t touched on yet in this blog, but you can get an idea of some of the very different tongue presentations and what they can mean.

 

Pretty cool, huh?
Pretty cool, huh?

 

There is also the idea that different parts of the tongue reflect different areas of the body. It is thought that each region of the tongue refers to a specific organ system and can indicate problems in this area. Important note before we continue: organs in Chinese medicine do not necessarily coordinate to their actual anatomical location and function in the body. Organs tend to refer more to a conceptual and functional idea (i.e. the “spleen” in TCM can mean many things, including referring to process of digestion). I’ll return to this idea in a later post, but just keep in mind that if there’s something weird on the spleen area of your tongue, it doesn’t indicate that you have something crazy happening in your actual spleen.

tongue

So what are we looking for in a nice, healthy tongue? It should be neither especially long or short. It should be a medium thickness (meaning the tongue doesn’t look puffed up or swollen). It should be evenly formed (no indentations on the sides, no deviating to one side of the mouth or the other). A healthy tongue is pinkish-red with a thin coating. There should be no spots, purplish discolorations, or noticeable paleness. The coat shouldn’t be yellow, grey, patchy, or missing entirely, but rather should be white/clear and cover the whole tongue evenly.

Guess how many tongues I see that match the description above? Spoiler alert: not a lot. Most people have at least one or two abnormalities of the tongue. I do see beautifully healthy tongues from time to time, but if I’m seeing patients, they’re usually in my office for a reason so their tongue has some outward indication that something’s not quite right somewhere in the body.

One of the best things about tongue diagnosis in my opinion is that it’s pretty straightforward and relatively easy to interpret. Pulse-taking in TCM is a true art that takes decades to master- it’s much more open to interpretation than tongue diagnosis. A puffy tongue is a puffy tongue no matter who you ask. The tongue also changes pretty fast- it’s a good indicator of how effective the treatments are.

Here’s a hypothetical example of how I would use the tongue to help me diagnose and evaluate how treatments are going. Say you come see me for constipation- lately, you’ve been feeling like you’re just not pooping with the sweet freedom that you used to. Your only other symptom is some lower abdominal discomfort, especially if you haven’t had a bowel movement in a couple days. When I take a look at your tongue, it’s pretty red with a thin and dry yellow coat. This indicates that you’ve got heat in the intestines that is drying up the fluids of the the body that help move things along. Treatment is going to focus on clearing heat, generating fluids, and moving the bowels. I’ll also recommend that you increase your intake of fruits and veggies, to make sure you drink plenty of fluids, and to do some daily abdominal massage to get the qi of the intestines moving. The next treatment, when you come in, you are excited because you’ve been having bowel movements a little more regularly. Your tongue is still reddish but the coat looks lighter and not as yellow as the previous visit. It also looks less dry. Treatments would continue to focus on those principles mentioned above until the tongue is pinkish-red with a nice thin white coat, indicating that the heat and dryness in the intestines has been resolved and things are flowing like they should.

So take a peek at your tongue today! What does it look like? It’s always fun to take pictures and see how it changes over the course of a week or two. As always, feel free to leave questions in the comment section, and please share with anyone who might be interested! Be well!

What is Qi?

Hi all! I hope everyone had a very happy Thanksgiving! As I promised last week, today’s post is going to explain a little bit about a very important concept in Traditional Chinese Medicine (TCM), which is that of “qi.”

Qi (pronounced “chee” and sometimes spelled in English as “chi”) is a foundational concept when talking about Chinese medicine. Unfortunately, it’s also a concept that is hard to explain in something like a short blog post. People far smarter than I have written volumes about qi over the years, but this post is just intended to give a brief introduction to the idea of qi and its use in Chinese medicine.

Qi, when written in Chinese, combines two ideas to indicate something that is both substantial and insubstantial.

The Chinese character for "qi"
The Chinese character for “qi”

Part of the character means “rice” and part of the character means something like “vapor” or “steam.” Thus, when the two parts are combined, it indicates that qi is both something substantial (like rice) and insubstantial (like steam).  I am definitely not an expert in the Chinese language and do not read Chinese, so my apologies to any linguists if I have grossly simplified this concept, but this it how the character of qi was always explained to me in school.

Qi is a very difficult concept to translate directly into English, which is why we almost always leave it as is. Some of the more common translations include phrases like “vital energy” and “life force.” These aren’t necessarily incorrect translations, but they do leave out the idea that qi can also be something more material. Giovanni Maciocia, who is a very well-respected scholar and teacher of Chinese medicine, writes that “Qi is the very basis of of the universe’s infinite manifestations of life.” The way that I usually explain qi to patients is that it is the force that both makes us who we are and helps our body undergo all of its vital functions.

So what does this mean for you when I talk about qi during an acupuncture treatment? During a treatment, we may do different things to affect the different manifestations of qi (but don’t forget that all qi in your body is essentially the thing at its core). Confused yet? Me too. Qi is one of the concepts that the more you think about, the more puzzling it seems. We’re not even going to delve into the many different aspects and subdivisions of qi here. However, what’s important for you to understand is that with the use of acupuncture and Chinese herbs, we basically help the body’s qi do what it’s supposed to. Sometimes this means working with a more substantial form of qi- for example, nourishing what we term “original qi” to benefit what Maciocia calls matters of “growth, reproduction, and development.” It can also mean working with a more insubstantial form of qi- smoothing the general flow of qi in the body to treat headaches, irritability, or PMS or strengthening the qi of the digestive system to increase energy and resolve problems like gas, bloating, or loose stool.

Qi is thought to move along meridians or channels that cover the body. Along these meridians are located the acupuncture points.

A view of some of the meridians and points on my little acu-man model
A view of some of the meridians on my little acu-man model

These points are thought to be areas where qi can easily be accessed or influenced. Once we decide on a treatment plan after careful questioning and physical exam, we use the acupuncture points that we have chosen to help direct the qi of the body into assuming its proper functions.

Thanks for hanging with me on this concept! I know this post was a little less fun than the last one, but I hope this sheds some light on the concept of qi. If you are a practitioner of TCM, you know that I’m barely scratching the surface of the complexity of qi here. But if you’re just learning about Chinese medicine and want to understand what it means when we talk about qi in a treatment, I hope this has made things a little clearer.

Up next on the blog: I’ll be discussing why on earth I make all of my patients stick out their tongues for me! As always, please share this post with anyone you think might enjoy it. Leave any questions, concerns, or things you’d like to see in future posts in the comments. Be well!

All quotations are from The Foundations of Chinese Medicine (2nd edition), by Giovanni Maciocia (Churchill Livingstone Press, 2005). 

The 5 Most Common Questions I Get Asked About Acupuncture

 

I’m sure you have all heard the phrase “There’s no such thing as a stupid question.” Now, I don’t necessarily believe that’s true in real life (looking at you, deli guy who asked if I was sure I wanted the extra large sub…I know what I ordered, kiddo). However, the saying definitely applies when it comes to acupuncture. Chinese medicine in general is still a pretty new idea to most Americans. Acupuncture was virtually unheard of in this country until the 1970s when President Nixon went to China and one of his aides had surgery done there using acupuncture for an anesthetic. So, I never ever take offense when someone asks me a question about acupuncture. I love being able to teach people about this system of medicine and to help them understand what it is that I do. So, without further ado, here are the most common questions I hear about acupuncture. Most of them are questions I get from patients, but they are also questions I hear from the general public when I tell people what I do (especially the first question- I almost never get that one from patients since they wouldn’t be coming to see me if they didn’t think it would work).

1) Does it work?

Alright, remember how I said I never take offense at a question someone asks me? That’s still true but sometimes the tone this one is asked in makes me want to just yell “YOU’VE FIGURED ME OUT, SIR! THIS IS ALL AN ELABORATE RUSE THAT I USE TO MAKE MY MILLIONS AHAHAHAHAH.”

I get it. Acupuncture looks a little weird and frankly, a lot of published articles about acupuncture make it sound like it’s a nonsensical practice that uses the placebo effect to scam people out of their money. Here’s where I like to come in and point out a few things.

Acupuncture has been around for several thousand years. It is a complete system of medicine that has evolved over millennia to treat essentially every human condition. For millions of people, it is still a first line medical treatment. I wouldn’t have dedicated my life to this medicine if I haven’t seen countless instances where acupuncture works.

The reason that acupuncture often gets a bad name in published articles is that because we are still figuring out how to study it effectively. Most clinical trials have historically been done in China, and some of those may or may not make it into American news outlets. Trials done here in the States historically have relied mostly on testing “real acupuncture” against “sham acupuncture.” A lot of what is published will eventually say that there is not a great deal of difference between the results of real acupuncture vs. the results of sham acupuncture.  Sham acupuncture can be done in several different ways, but is generally intended to mimic a regular acupuncture treatment. It can be done by inserting needles into parts of the body where no acupuncture points are located or by using a device that mimics the feeling of a needle being inserted (so the needle touches the skin but isn’t retained). Couple problems here. Based on theories about meridians/channels (which we will get to in a minute), this is not so good. Inserting needles essentially anywhere on the body will have an effect in some way. And using a very light insertion technique where the needle may or may not go deeply into the body doesn’t work so well either. There are many different systems of acupuncture technique. Especially in Japanese acupuncture, needles are very often inserted extremely shallowly; the idea that needles can’t have an effect just by touching the surface of the skin is not necessarily true.

Luckily, research methods are evolving and changing all the time. Many recent publications I have seen tend to show that acupuncture is indeed effective. Some of these trials pit acupuncture against a standard course of treatment (i.e. treating low back pain with acupuncture vs. pain medication). This is a better design, and I think it is the way of the future with acupuncture research.acupuncture110324104147-large

2) How does it work?

This is a complicated one. My next blog post is going to be called “What is qi?” and will explore more of the basics of Chinese medical theory. Without going into a ton of detail here, acupuncture works on the idea that qi (which often gets translated as “vital energy” or “life force”) moves through a series of meridians or channels throughout the body. These meridians provide access to almost every inch of the body. The flow of qi can become obstructed through illness, injury, weather changes, diet, lifestyle, emotions, and much more. When this flow of qi becomes unbalanced, we use needles to activate acupuncture points, which are areas where it is thought that the flow of qi can be most easily influenced. By restoring the proper flow of qi, we can restore balance and health to the body. There are about 450 acupuncture points located all over the body, from the top of the head to the bottom of the feet. We obviously don’t use all the hundreds of points at once, but instead we pick which ones would best serve the patient that particular day. Usually about 20-25 needles are inserted in total.

Now this acupuncture theory can sound a little woo-woo. Biomedically, we are finding that acupuncture points are different from other random locations on the body. By inserting a needle at a specific point, we create a micro-trauma in the system. This increases blood and lymphatic flow, which in turns reduces inflammation and helps to heal the area. It also causes a release of your body’s natural painkillers. Acupuncture also has an effect on the brain, which releases substances that can reduce pain and regulate the body’s activities.

3) How did you learn how to do this?

Short answer: lots of school.

Here’s the long answer. People are almost always very surprised when they find out how long my schooling was. I have a Bachelor’s degree from The College of William & Mary. I graduated there in 2008 and almost immediately began my education at Pacific College of Oriental Medicine (where I graduated from in 2012). I was in school for four years, full-time, with no summers off. The program I went to is one of the best in the nation. Our education is over 3,700 hours, including extensive clinical training. I currently have a Master’s of Science degree in Traditional Oriental Medicine, and I am exploring the option of continuing my education to receive my doctorate. I have done an intensive internship in Beijing, China as well as specialty training at the San Diego Hospice & Institute for Palliative Medicine. It’s a long haul to become a licensed acupuncturist, and it doesn’t end after we leave school. Like any other medical professional, we have to do lots of continuing education to keep and maintain our license and board certifications.

4) Does it hurt?

This is an understandable one. Needles are extremely common fear, and the idea of having needles stay in you while you relax on a table for twenty minutes makes a lot of people queasy. But have no fear! Acupuncture needles are MUCH smaller than the needles they use to draw blood. On average, 15 acupuncture needles can fit inside the opening on a hypodermic needle (like they one they use to draw blood). Acupuncture needles are very thin and aren’t hollow-bore (which means they are solid and don’t have an opening in them).

See how many needles can fit in a hypodermic needle?
See how many needles can fit in a hypodermic needle?

Everyone experience acupuncture a little differently. Sometimes you might feel a quick prick as the needle goes in, but once it’s in, most people feel nothing at all. Sometimes you can feel an achy or heavy sensation at the site of the needle. This indicates to us that the point is being activated, and as long as it’s not bothering the patient too much, we usually just let things settle down. Some points (like on the ears or tops of the feet) may be a little more uncomfortable going in because there’s not a lot of fat or muscle there, but, again, once the needles are in, most people don’t feel anything at all.

And yes, it is definitely possible to relax while the needles are in. In my treatment room, when I leave, I turn off the overhead lights so all that’s left on is a small pink salt lamp. I also have relaxing music playing, and it’s nice and warm in there. Most people either zone out or fall asleep. And if you don’t want to be left alone, no worries! I’m happy to hang out with you and either silently work on my charting or bore you with stories about my dog.

5) Is there anything on the needles?

This is a surprisingly common one, and a question that I didn’t think I would get asked. But it makes sense! When have you ever had a needle in you that wasn’t either taking something out or putting something in?

The needles we use are sterile, single-use needles made of stainless steel. Nothing else is on the needle: no medicine, no anesthetic, no herbs. They come in a sealed blister pack that we don’t open until right before treatment. The needles are used one time each at one acupuncture point. When the needles are taken out after about 20-25 minutes, I dispose of them in a sharps container. Eventually they go to the great biomedical waste site in the sky where I assume they are melted down.

I use two types of needles in my clinic. Every acupuncturist tends to have their own personal brands of needles they bond with (it’s like Starbucks vs. Dunkin Donuts…I love me some DD and I hate using Carbo needles). I use DBCs, which are a brand of needle from Korea, for most of my needling. I also use Seirins, which are a brand from Japan when I want to get into an area that may be a little more sensitive or on patients who might be a little nervous. These needles are designed to be less invasive than other needles, so while they are considerably more expensive to purchase, I do think they have a definite value.

So that wraps up the five most common questions I hear about acupuncture! Next post will be on explaining the concept of “qi” in Chinese medicine. And a note of frequency of posts: according to the people in charge of the internet (whoever they may be), posting frequently will help more people see this blog as it moves up through the search engine ranks. So my goal is not bore you every day with acupuncture things, but to try and post once or twice a week. Please feel free to share any of these posts anywhere, anytime! And as always, shoot me an email or leave a comment with any questions or suggestions for future posts.

Be well!