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Pathogens and Pathology

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The search for a vaccine to the corona virus while a worthy endeavour may take a long time, and may even turn out to be chasing the impossible. The guardian newspaper published an article on the 22nd of April implying that the vaccine if it arrives could indeed take a lot longer than we would like. The fastest developed vaccine was the mumps vaccine that took 4 years. In the meanwhile as I write this lockdown is easing off, schools are beginning to open, later this month we will also re open our clinic as everyone else, albeit with some extra precautions, will go back to work.

In the face of still high numbers of infections what can we do besides the sensible precautions of hand washing, wearing masks and [where possible] social distancing? This is good public health policy when considering the problem in terms of a pathogen i.e. the virus. When it comes to Traditional East Asian medicine the emphasis generally shifts from pathogen to pathology.

Although traditional medicine in many ways evolved as a response to epidemics, its approach to treatment focusses not on a causal pathogen such as a virus or bacteria, rather on how that pathology manifests in the patient. In this way we don’t think of treating an illness so much as a person who is ill. So in the case of Covid 19 there is no set formula or combination of points to needle, the treatment is determined by the collection of symptoms that the person is showing. Different combinations of fever, sweating, thirst, cough, sore throat, body aches, digestive issues, chest pain etc. together with specific pulse presentations, will determine what kind of herbal formula or acupuncture treatment will guide the body back to a healthy state. This approach takes the whole body’s systems into account to bring about a recovery irrespective of what has created the problem in the first place. As such it is applicable to Covid 19 or regular seasonal flu or any kind of deviation from a healthy state.

When the normal life promoting processes within us lose their way they can give rise to distressing symptoms, sometimes minor sometimes major. The aim of traditional medicine is to rectify pathology and reinstate physiology; actually this can be done at any time and ideally before pathology sets in. This is where traditional medicine has a role to play in prevention of illness, or at least minimising its risk. Because the focus of treatment is to optimise healthy functioning it can almost always be given as none of us are 100 % healthy. Herbal and acupuncture treatments are given based on pattern differentiation but there is a great deal of latitude in terms of severity of the pattern. Thus the same formula could be given to someone with almost no symptoms, just minor lack of appetite and some congestion under the ribs [not something they would remotely consider a medical problem] or to someone else with a severe sore throat and alternating fevers or migraines. The possibility of treating when things are mild or almost non existent is an opportunity to prevent or reduce the chance of  more serious health crisis.

At the beginning of the lockdown I read a translated blog from a county level hospital in Henan province in China written by traditional Chinese medical doctors describing the herbal medicine regime used at their hospital. In addition to the different formulas used for patients experiencing symptoms of Covid 19 they also had a regime of formulas for the admin staff and doctors and anyone who was healthy but might come into contact with infected people. At the time of writing none of the staff had become infected and this was seen in part due to the preventative treatment they were advocating. Although there is no Chinese medical magic bullet that will stop you getting ill, herbs and / or acupuncture treatments can help to keep your body functioning as well as it can and so minimise getting ill.

Some treatments like the application of direct moxa to an acupuncture point on the leg were specifically designed for the maintenance of health and immunity in later life. This is being utilised today in the treatment of drug resistant TB by the efforts of the group Moxafrica. It’s this approach of strengthening health that is a unique aspect of Chinese medicine and should be utilised as much as possible before we go into autumn and a possible second wave of the virus.

Skin deep

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One of the key features of my treatment style nowadays is the adoption of contact needling which forms a key part of the Toyohari style of acupuncture training. This a technique where the point is needled at the surface of the skin and the skin itself is not broken. It is carried out through slowly approaching the surface with a [usually] silver needle then after waiting for a short while the needle is removed. This seems counterintuitive to the commonly held image of acupuncture where one assumes [or at least I did at first] that a needle needs to penetrate the skin to have effect. Most of my treatments begin with this technique and in a few cases it is all I do; though I was sceptical my self in the beginning, after having used it for a number of years my confidence in the technique has grown through the results I’ve seen and also through feeling the body’s response as I use it.

It’s only relatively recently that I’ve come across the work of Dr. Denda a Japanese skin scientist through the journal of North American Oriental medicine [Nov 2013, Vol 20, #59, March 2013 Vol. 20 # 57]. Dr. Denda has discovered that the epidermis or outermost layer [0.06mm-0.2mm] of the skin doesn’t just act as a barrier to protect the interior, rather it is able to monitor the external environment, acting like a giant sense organ and processing this information much like an independent brain. He dubs it the “third brain” [I believe elsewhere people have dubbed the gastro intestinal system as a second brain]. According to Dr. Denda the skin cells can act like sensors picking up more detailed information that could be possible using just nerve receptors, rather the keratinocytes in every cells are able to pick up environmental information, process it and transmit it to the nervous system.

According to Dr Denda stimulating the skin can have a positive effect on the mind in times of stress. This is not really news to most of us, massage and touch have a calming effect in a general way but the emphasis on skin over muscle [as in a deep massage or deep needling] perhaps goes some way to explain the growth of skin level acupuncture techniques in japan such as contact needling. Both epidermis and the brain have a common developmental origin in the ectoderm, and it is known that the hormone oxytocin which promotes positive physical and mental states, is released from stimulation of the skin. But it doesn’t end with oxytocin, the epidermis has receptor also for dopamine, acetylcholine, adrenaline, melatonin, glucocorticoids and more. It is believed that the epidermis has a close relationship to the autonomic nervous system, research has shown stress levels of the pituitary gland showing as changes in the skin barrier function, and the adjustment of circadian rhythms can be achieved by shining light on the skin to affect the sleep centre in the hypothalamus. This relationship between the skin surface and the inner centres of the brain can explain the importance of palpation in diagnosing patterns in traditional acupuncture. It’s as if we can locate internal patterns of stress by feeling disturbances on the surface of the skin.

When it comes to needling, inserting a needle to a depth of around 4 mm will be detected by the brain as the local stimulation is transmitted to the somatosensory areas via unmyelinated and myelinated fibers. This way brain can identify the location of the stimulus, this is an effective means of relieving local pain, improving peripheral and therefore whole body circulation. With contact needling however there is no direct transmission through these nerve fibers, its as if the autonomic system is affected directly via the sensory organ aspect of the hypothalamus, namely the skin surface. This is not registered as a local stimulus but a skin initiated whole body effect. The autonomic system is the body’s autopilot, it governs the moment to moment functioning of the the organs either stimulating or dampening their function. It should ideally maintain optimum functioning of the body in differing situations of physical and emotional stress, when this becomes suboptimal it can begin to the the origin of illness and poor health. If this is not corrected then any symptomatic treatment whether western or Chinese will have limited effect so treating this level of imbalance is seen as a key to maintaining good health in traditional East Asian healthcare. This is what acupuncturists call a root treatment, something to create an overall global balance independent of any particular symptom. It manifests during treatment as a deeper sense of relaxation, changes in breathing and in the pulse. The nature of contact needling as a means of stimulation that does not register as coming from any one particular location makes it especially suitable for this aspect of treatment.

Freedom of Movement

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Sotai is a term that was invented by the Japanese physician Keizo Hashimoto, it uses the Chinese characters SO 操 meaning control and the character TAI 体 meaning body. Actually the characters are commonly used in reverse order TAISO meaning exercise but these exercises work as a kind of controlled movement that is used to help the body realign it self and improve its function.

Sotai is founded on the principle of always moving the body in the most comfortable direction. Many of us often have stiff joints or pain in our muscles and its tempting to think we just need to stretch out this stiffness and work against the restrictions head on. The Sotai method is different it directs you to move in the way that is most comfortable and feels nicest, the movements can be done solo for general maintenance but for therapeutical reasons would require a partner to offer mild resistance to the movement.

One example might be if you have backache you might try moving the knees from side to side to see if one direction is more difficult. If so then move from the difficult side towards the easy side and the parter puts light resistance at the end of the movement, then after a count to three the whole body relaxes. This can often be enough to realign the structure and your symptom is relieved.

This summer while in Japan I was lucky to meet the great grandson of Hashimoto sensei, Suzuki Kensuke, who practises and teaches sotai in Tokyo. We received treatment from him and were encouraged to look for more opportunities to study and practice. The simplicity of the ideas behind Sotai and its applicability to a wide range of physical constriction makes it easy to integrate in other kinds of treatment as well as to be adapted to self treatment. Actually there is something to the idea of the path of least resistance as a method of both therapeutic intervention as well as an approach to living that has much to recommend it. In keeping with the Daoist notion of effortless action it is not a call to capitulation but optimising ones outcomes by minimising unnecessary ‘effort’ that impedes as much as it moves. Whatever the situation there is probably a fulcrum around which we can glide into freer more unencumbered state of being.

Travels in Tokyo – study

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We got back this week from 2 1/2 weeks in Japan, part holiday part study work. While there I attended the Toyohari acupuncture society summer school, its a bi annual affair for both Japanese and foreign practitioners, this year was particularly special as it is the 60th anniversary of its founding. In the traditional chinese lunar solar colander 60 years marks the completion of a cycle, so it was a poignant moment to go back to the roots of the association and consider the cyclical nature of learning.

The association was founded by Kodo Fukushima and his close colleagues in 1959 after initially being encouraged to set up study groups for blind practitioners after the war by members of the acupuncture community. Fukushima was blind and there had always been a tradition of blind practitioners in Japan excelling in acupuncture and massage. The sense of touch being seen as paramount in this kind of work being developed to a degree that more than made up for the loss of visual experience. Even though today the association has probably almost as many sighted practitioners as visually impaired ones, the emphasis on touch as the medium for diagnosis and treatment is strong within Toyohari as well as being reflected in the Japanese acupuncture community. The primary modes of diagnosis in this system is palpation of the radial pulse, the abdomen and the meridians located in the limbs.

Another characteristic of study in this association is the need to study among peers. We cannot learn this on our own, we require the feedback of other practitioners to tell us when we have correctly located a point or when the technique is being applied correctly. This is not simply a matter of one more experience person enforcing their opinion but a consensus based feedback based on the real time changes of the person who is being practised on. To this end we try and meet up as often as we can, the Tokyo summer school might happen every two years but there are weekend seminars in Europe and informal study groups in each country.

This brings me to another aspect of this approach that can be described as a continual review of the basics. Perhaps its an aspect of Japanese culture that lends itself to people being willing to regularly turn up and practise what are more or less the same techniques month in month out seemingly without end. It runs counter to the prevailing trend of desiring continual novelty that exists in most aspects of life. We might not be chasing material stimulation but we still often look for a novelty of ideas or techniques to spice up our professional lives. In the UK practitioners graduate from basic colleges then drift around different weekend courses to create a mixed bag of theories and clinical applications. Of course we all like to keep an eye on what’s happening around us but the majority of our study time is really about refining our core skills.

Seeing some of these elderly acupuncturists in Tokyo it is inspiring for someone like me to consider the endless circular nature of study and practice, through repetition we are able to deepen our understanding and experience more novelty in the ordinary.

Stress and Self Harm

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I recently read a headline that shocked me. According to the guardian newspaper [https://www.theguardian.com/society/2018/aug/06/hospital-admissions-for-teenage-girls-who-self-harm-nearly-double ] the number of under 17s reported to GPs for self harm has increased by 68% in 3 years. My eldest daughter is now nearly 12 and  about to go through puberty and adolescence, the prospect of which makes me uneasy not least when I think of the pressures our kids are under these days. Of course the stresses that build up and culminate in the need to self harm can be complex and multi factored and there is probably no one solution to fit everyone. That said because of the nature of my job I can’t help but see a headline like this and ruminate on the way stress is described and treated in Chinese medicine. 

One of the key differences in Asian thought is the lack of separation between mind and body. The mind is literally seen as being embedded in the body, specifically in the blood and by extension in the muscles [muscles are basically blood in East Asian thought].This is not so unusual an idea, if you stop to think about it. As soon as you get stressed, or irritated, or excited or scared somewhere some part of your muscular system will tighten up; maybe skeletal muscles of the shoulder and neck or, you diaphragm or stomach muscles [‘butterflies’] even smooth muscles around the organs eg your breathing and digestion can be affected. 

Treatment is effectively to try to put the body/mind into a more relaxed state, to soften congestion and let the blood and the mind flow more easily. Needles are used to trigger this through light painless [often largely non inserted] stimulation, though also heat therapy, herbs and even occasionally controlled microbleeding can play a part. I’m not suggesting that acupuncture is necessarily always the only solution to the stresses that our teenagers face today. These will often require multifaceted approaches, East Asian medicine can’t remove many of the external causes, however it can provide a less destructive means of relieving the stresses that build up in the body whatever your age and situation.

example case for the treatment of eczema

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Case example: allergic skin reactions

The patient was a female in her 20s presenting with the following complaints:

  • Allergic reactions triggered by foods, environmental factors, etc. leading to:
    • Red inflamed skin, itchy, dry, bumpy
    • Swollen face, breathing problems
  • Abdominal pain, bloating, intolerance to many kinds of foods
  • Fatigue
  • Headaches, neck and shoulder pain and stiffness
  • Occasional difficulty urinating, irregular or loose bowels

Prior to treatment the skin flares were frequent and could lead to steroids being used to calm the outbreak.

Treatment began January 2017 with beginning of improvement after about a month and continued improvement so that by 2-3 months skin was much clearer and by the summer skin was much better and use of steroids only rarely if at all needed. The following images represent a change in the condition of the skin over this period of treatment.

Before treatment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

After treatment

 

In addition to improvements in the skin there have been  improvements in digestion, less bloating and pain, improved ability to tolerate a much wider range of foods. There is less fatigue, sleep is better, headaches and neck pain is better.

Treatment began with acupuncture and then herbal formulas were added, sometimes as granules and sometimes as ground bulk herbs to be boiled up.

At the time of writing we still treat periodically and there have been some minor relapses but overall improvements have held.

 

More about hair…and Spring time !!

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“The correlate of the kidneys are the bones; their splendor is the hair on the head” SuWen10

The “kidneys” in Chinese medicine symbolize the body’s capacity to store vitality, a bit like a savings account. They are the deep storage of resources, connected to bones, teeth etc. They represent the material aspects of our experience and their health can influence our aging process and our fertility. When our inner vitality is abundant it flows out to the extremities and the “blood of the kidneys” shows in the thickness and quality of our hair. Hence in the East Asia a woman [or man] with good lustrous hair was seen as having inner vitality and good fertility! As we get older our power retreats and so the extremities are less well nourished, the blood of the kidneys no longer nourishes the head hair, which turns white.

Spring time and fertility

“The three months of spring,
 they denote effusion and spreading.
In heaven and earth everything comes to life; the myriad beings prosper…Move through the courtyard with long strides. Dishevel the hair and relax the physical appearance, thereby cause the mind to come to life.
 SuWen2

If the energy of the kidneys is the stored potential for new life, then the liver supplies and distributes the blood to the organs of fertility. For the East Asian mind the region of the lower abdomen is seen as the gate of life; it is the source of vitality for the individual and it is where another life can appear [i.e. the uterus]. It is the focus of countless Yogic practices, meditation, Chi Kung, martial arts etc. If you can make this area strong you will live long and healthy life! In the context of fertility we can think of it as a cozy nest. It needs a good supply of blood to keep it warm and nourished. This is seen as one of the roles of the “liver”. Acupuncture treatments that nourish this aspect can promote the conditions for conception.

When it’s not functioning well, as well as fertility issues, it show up as irregular or painful periods, low libido, erectile dysfunction, PMT and general poor circulation.

Treatments!

We can’t reverse the aging process I’m afraid but we can try to help your body function a little closer to how it was designed to. I haven’t seen dramatic changes in hair colour through treatment [though sometimes the quality and quantity can improve if for example you have alopecia]. However when it comes to fertility management, acupuncture and Chinese medicine have a lot to offer. By helping to smooth out the functioning of the body and mind, its as if the distractions have been lifted and the body can relax and do what it was designed for.

 

 

Second solar term: Rain Water

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Spring time is beginning!

Chinese new year is the seen as the birth of the year in the Chinese Lunar calendar. We can think of the year in two halves – the yin half in which the days get shorter and colder, and the yang half in which the days get longer and warmer. Though the yang half begins on December 22nd [after the solstice] its only really noticeable from now that nature is beginning to get ready to get out of bed.

In the Chinese solar calendar the year is marked by 24 solar periods of approximately 2 weeks. This was an agrarian calendar for farmers. The first is 4th of Feb which is called the beginning of spring, it doesn’t feel like it in terms of temperature but the increased light and signs of activity in the garden [you have to look close] give a clue or two.

February 19th marks the second solar period known as Rain Water. This suggests that along with the increase of yang there is damp and so one must still protect ourselves, particularly our digestive system and kidneys, so keep warm and eat well!

Traditional East Asian culture places strong emphasis on aligning ourselves with nature, so different seasons require different patterns of behaviour. A lot of this is straight forward; as the year gets going we should get up earlier and move about more, exercise more, eat what’s in season, initiate new plans and unlock creativity, start new projects etc.

There are also more specific actions that may appeal more to Chinese medicine nerds such as stimulating specific points, drinking particular herbs, performing particular exercises etc. One such exercise described in the 16th century Daoist work Tsun –Sheng- Pa- Chien that is suitable for practising during the first two solar terms is as follows:

Sitting cross legged, both hands crossed and pressing on the thighs. Turn the head left and right 15 times, knock the teeth together, breath and gargle the air in the mouth, swallow 3 times.

Knocking the teeth, gargling and swallowing etc. sounds a bit crazy to the uninitiated ! A simpler version that I tried is simply turning the head 15 times each way while pressing on the thighs cross legged then breathing deeply through the nose and out through the mouth [keeping the tongue touching the roof of the mouth behind the teeth]. You can also combine the turning of the head with the breath, just breathe in and turn outwards on the out breath and back to the centre on the in breath. Finish with a long relaxed out breath. Don’t push the air out let it leave you naturally. 

CHI GONG FOR HEALTH

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Tuesday lunch time from 1-2 is now the new time for the chigong class. Beginners welcome, these are simple stretches and breathing exercises, and static postures to develop internal strength and restore vitality. Classes are £45 for 6 first class is free. Why not try it out!

The kika Facebook page had an interesting article uploaded about the history of chi gong within the medical community in China during the 50s and 60s where it was initially first introduced into hospitals. The article deals also with the problems they had in terms of the conflict of having to package it in terms that  were politically acceptable for the the ruling regime whilst still making it clinically effective. Though no doubt some of the claims at the time could be seen as questionable it is still a part of the medical establishment and can be offered to patients, with research continuing to this day in its appellation for specific illnesses.

Click here to get to the Facebook page which also has a post relating to taichi and heart disease.

kika

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Why call it “kika”?  – kika is formed from two Chinese characters, or Kanji as they are known in Japanese. The ‘ki’  [ 喜 ] character means joy or happiness, the ‘ka’ [ 花 ] character means flower. Besides being taken from each of our daughters names the combination reflects a way of treatment. Traditional Chinese medicine is based on a “root and branch” approach. In order to get happy healthy flowers on your branches you need strong and balanced roots. The treatments on offer are to help strengthen your “roots” in order to maintain blossom on your branches!

So typically in acupuncture, treatment is structured in this way. Part is to strengthen the root or constitution and part is to address the symptom. Sometimes these parts of the treatment overlap.

The chi gong exercises can be seen as a kind of home therapy to strengthen one’s vital energy and improve health. Moving exercises co-ordinate the body’s muscle and nervous system and the standing exercises mimic the idea of a tree with strong roots, increasing stamina, circulation and lower body strength while relaxing the mind and lifting the spirit