Traditional Chinese Medicine (TCM) gives the practitioner a variety of tools and techniques with which the balance the Qi. Acupuncture, acupressure, moxibustion, cupping, and herbal formulas are frequently utilized. They can be used in combination or as stand-alone treatments. I hope that you will have the opportunity to experience them all.
Acupuncture
The art and practice of placing needles in the body for healing and health maintenance has been around for over 5,000 years. Acupuncture today takes many forms in terms of technique and underlying theory. Some styles use just one area of the body to affect the whole, such as hand, scalp and ear acupuncture. Some require manual stimulation of the needle whereas others espouse a light touch without insertion. One thing all the styles have in common is that they do work for most health conditions. Although Asia seems to claim acupuncture as its own, evidence of similar techniques can be found around the world. This is not surprising as it is based on a universality, the biological reaction to stimuli.
As the popularity of acupuncture has spread to the west, science has attempted to explain how acupuncture works. Many studies are based on pain relief. Some studies have concluded that it is a placebo because both the sham and needle patients experienced pain relief. Or that by creating pain, the chief complaint pain receded. These particular researchers are not taking into account that acupuncture is not particularly painful if painful at all. The search to understand goes on. New and sophisticated measurement and imaging technology has provided more data on the biology of acupuncture.
A 2017 study used brain scans to compare the endorphins created in acupuncture to those of placebos. Fibromyalgia patients received real or placebo acupuncture. The placebo needles were retractable and the sites used were non-acupuncture points. Positron Emission Tomography (PET) imaging can’t see endorphins directly, but the opioid receptors that these molecules target can be seen. Opioid receptors are present on the surface of nerve cells in the brain. When “locked” by endorphins or opioid molecules they prevent the cell from sending pain signals. Hence a drop in the number of free, or unlocked, receptors in the patients’ brains would show that endorphins had been released. Fibromyalgia patients have fewer opioid receptors than healthy volunteers. This results in less response to endorphins causing an over sensitivity to pain. After a single acupuncture session and over a month-long course of treatment, both groups of patients reported a similar reduction in pain. PET scans showed in the placebo group, fewer free opioid receptors, suggesting their pain relief was caused by endorphins. In the real acupuncture group, the number of free opioid receptors in the patients’ brains didn’t fall; it increased. The researchers concluded that this does not mean a drop in endorphin levels but rather an increase in the number of receptors. Recall that Fibromyalgia patients have fewer receptors. The study shows acupuncture had a normalizing effect. The receptors returned to normal values and healthy pain control levels. Which is what acupuncturists strive to do, to bring the body back to balance. ( 1 )
Acupuncture is not only for pain relief. Pain is on the far end of tissue dysfunction. Points that relieve pain in a particular area normalize the tissue for other conditions. Acupuncture points are organized into 12 meridians, each of which is associated with an internal organ. Each organ, in turn, has particular characteristics and jobs within the body as a whole. Different points along the meridian have different effects on the meridian, organ and the body as a whole, including the emotions. Just as the sound coming from a guitar changes with the combination of frets in play, so do the points used to change the Qi flow through the body.
Acupuncture is used for chronic and acute conditions. Although almost anything which doesn’t require surgery can be treated with acupuncture, many acupuncturists have a specialty or three. They will be able to tell you more about what to expect from treating your particular condition. In general, the longer a condition has been present the longer it will take to resolve.
A quick word about Qi also spelled Ch’i and pronounced “chee”. Qi is the invisible animating force of the body. There are many kinds of Qi. Each organ has its own brand. A basic principle of Chinese medical theory is that the “Qi is the leader of the Blood and the Blood is the mother of the Qi.” Another way to put it is without Qi the Blood cannot circulate and if the Blood is weak the Qi cannot move. Using pain an example of tissue that needs to be normalized. Pain is either a stagnation of Qi or Blood or a combination of the two. When we move Qi through an area of pain the Blood will follow. The stagnation of both substances is released and tissue healing can commence. It is the same in the area of dysfunction.
Acupressure
Needles are not the only way to move Qi around the body and through the meridians. Acupressure has been around for as long as acupuncture. Gentle pressure is applied to various points addressing symptoms and conditions. With acupressure, patients can learn to treat themselves. A 2011 collection of studies found that patients received relief from acupressure for many conditions. All studies included sham points or standard of care as the control group. The conditions favorably addressed were dyspnea, nausea, vomiting, low back pain, anxiety, blood pressure, asthma, and insomnia. ( 2 )
Moxibustion
Moxa or moxibustion is another way to influence the Qi. Moxa is a technique that uses burning Chinese mugwort, Ai Ye, to warm body parts, meridians, and individual points. Special amongst the herbs, Ai Ye enters all 12 of the meridians. Due to its warming nature Moxa is used to balance cold and chronic conditions. As with acupuncture, there is more than one style of Moxa. The most common technique is a Moxa stick. The herb is rolled up inside paper and looks like a large cigar. With one end lighted the target area is heated, this should feel soothing and not uncomfortably hot. Sometimes moxa is burned on a slice of ginger or other herb and placed on the body until the patient decides it is HOT !! A section of the Moxa stick can be attached to an inserted needle and lit for a deeply warming treatment. The odor of burned Moxa is unique, though some think it smells like marijuana.
One could ask if any herb or anything burning close to the body would have the same effect as Moxa. I’ve tried moxa vs a cigar and Moxa does feel like it penetrates more deeply. This plays out in the official laboratory with numbers. Researchers found that moxibustion affects both the shallow and the deep tissues of the skin. The warming effects of moxibustion invigorate the warm receptors and the polymodal receptors. Polymodal receptors are widely distributed over the skin and penetrate to visceral deep tissues. Stimulating the superficial receptors brings the heat deeper. Burning moxa has a radiation spectrum within the near-infrared portion ( 3 ). Infrared therapy reduces pain, increases wound healing, and increase endorphins and neuromodulators ( 4 ). Dopamine, noradrenaline, and serotonin are all neuromodulators. They connected with mental and emotional well being.
In the clinic, Moxa is used for a variety of cold and chronic conditions. Some of these present as arthritis, back pain, headache, migraines, muscle stiffness, menstrual cramps, digestive issues, ulcers, infertility, tendonitis, hot flashes, and breech birth presentation. (4 ) ( 5 )
Cupping
Cupping can leave the patient both pain-free and looking like they have danced the tango with a giant octopus. Technically speaking cupping is inverse massage. The tissue is sucked up into the cup due to a created vacuum. This can be made with fire, a hand pump or a shape change on the vessel ( silicon cup ). Cupping can be stationary or used as a massage tool. Commonly cups are made of glass, plastic, bamboo or silicon. After the cups are placed they are left on between 1 and 10 minutes depending on the condition and constitution of the patient.
Cupping is contraindicated directly on veins, arteries, nerves, skin inflammation, any skin lesion, body orifices, eyes, lymph nodes, or varicose veins. Cupping is also contraindicated on open wounds, bone fractures, and sites of deep vein thrombosis. Cups should be sterilized between patients to avoid cross-contamination.
“Where there is stagnation, there will be a pain. Remove the stagnation, and you remove the pain.” TCM theory says all pain results from the stagnation or blockage of Qi, phlegm, or blood or a combination of those substances. Cupping is an effective way to break stagnation. Often used with acupuncture and moxa, cupping can be a stand-alone treatment. Clinically it is used for arthritic pain, digestive complaints, headaches, hypertension, colds, coughs, back pain, menstrual cramp, limited range of motion, poisonous bites and edema.
Cupping is an ancient and worldwide technique. Its use is seen in Chinese, Native American, European, Egyptian, and Islamic medicine. The first written mention of cupping is from 1550 BC in the Ebers Papyrus, the oldest preserved medical documents of ancient Egypt. An early Chinese mention is found in A Handbook of Prescriptions for Emergencies, which dates from 300AD. Written by Taoist herbalist Ge Hong.
The medical perspective of cupping is fraught with difficulty. In general researchers try to narrow down cupping to one mechanism. A 2019 article published in The Journal of Traditional and Complementary Medicine ( 6 ) reviewed the research. No single theory could fully explain cupping. The authors chose four actions that can be attributed to cupping. These were analyzed in terms of pain, which we can apply to other tissue dysfunctions as well.
Pain Gate Theory (PGT) postulates that cupping stimulates pain receptors. This leads to an increase in the frequency of impulses, and ultimately leading to the closure of the pain gates and pain reduction. ( Cupping is not painful, it feels different but not particularly painful. ) This is closely related to the next function.
The Diffuse Noxious Inhibitory Control (DNIC)
DNIC moderates the local damage of the skin and capillary vessels induced by cupping. This causes a pain modulating pathway which inhibits pain; ‘pain inhibits pain’ phenomenon. Also by triggering DNIC oxidants are removed thereby decreasing oxidative stress. Oxidative stress is an imbalance of free radicals and antioxidants in the body, which can lead to cell and tissue damage.
Reflex Zone Theory (RZT)
RZT depends on the premise that signs and symptoms of illness related to one dermatome are reflected in changes in neighboring dermatomes. Zones are linked by the interactions of nerve, muscle and chemical pathways. The process starts with skin receptors being activated when cups are applied to the skin. The end result is an increase of blood circulation and blood supply to the skin and the internal organs through the neural connections.
Nitric Oxide Theory (NO)
Cupping therapy could cause the release of Nitric Oxide (NO ) from endothelial cells and induce certain beneficial biological changes. NO is a signaling gas molecule that mediates vasodilatation and regulates blood flow and volume. This gas regulates blood pressure, contributes to the immune responses, controls neurotransmission. NO participates in cell differentiation and many more physiological functions. Because of NO, cupping increases the level of immune products interferon and tumor necrotizing factor. The effect on the thymus causes increased flow of lymph in the lymphatic system.
Chinese Herbs
Chinese herbalism has a long and well-documented lineage. The first classical Chinese materia medica appeared during the late Han dynasty (25-22- A.D.). The tome contained 365 entries of botanical, zoological, and mineral substances, listing their properties and effects. Chinese herbs are most often used in groups. The development and design of formulas is based on the natures and qualities of each individual herb and their mutual interactions. The following are four popular and useful formulas.
Curing Pills
A popular home herbal remedy in China, Curing Pills are here to help your indigestion. In the bottle, you will find tiny pills. You may wonder why so many tiny pills? They are easier to swallow and dissolve quickly. Many small pills increase the surface area and intestinal exposure to medicine. The herbs in Curing Pills ease a range of digestive conditions. These include upset stomach, motion sickness, bloating, nausea, gas, vomiting, and diarrhea. Hangover care is one of the traditional uses of Curing Pills. Three of the herbs, Ju Hua, Ge Gen, and Tian Hua Fen help absorb alcohol and ease thirst. If boats are your nemesis because of motion sickness, Curing Pills want to help. Take a serving size 30 minutes to an hour before embarking and enjoy the ride.
Usage: Open up the capsule and take the tiny pills with warm or room temperature water. Serving size is 2-3 capsules, three times a day.
Caution during pregnancy. Due to the Qi-regulating aspects of this formula caution is advised during the late stages of pregnancy. Curing Pills are very useful and appropriate for morning sickness in the early stages of pregnancy. Use with caution in Yin deficiency/dryness.
Gan Mao Ling “Common Cold Effective Remedy” “Miraculous Cold Pills”
This is a relatively new formula, just three decades or so old. It is very popular in China as a remedy for the common cold and flu. TCM divides these illnesses into cold and hot, depending on the presenting symptoms. Gan Mao Ling is a go-to for the Wind-Heat and Wind-Cold patterns. This latter has sparked controversy amongst some herbalists. All the herbs listed are cold or cooling, so how is it they are treating a Wind-Cold condition? Clinical experience does support the Wind-Cold or Wind-Heat claim. Overall Gan Mao Ling is rife with cooling antivirals. Gang Mei Gan and San Cha Ku make up more than 50% of the formula and they are not your every-day cold herbs. This may explain why clinically this formula also works for Wind-Cold. Gang Mei Gen is effective against the flu virus (7). It clears toxins and regulates and tonifies Lung and body Qi. San Cha Ku is traditionally used for intestinal complaints and strengthening the nervous system. Studies show it decreases inflammation and is a promising therapy for Alzheimer’s. (8)(9). Both these herbs support the body and the nervous system and address back-ground inflammation. In this way, Gan Mao Ling also treats the deficiency that invites Wind-Cold patterns thus making it useful for Heat and Cold Wind.
Usage: If the nose is first to complain. Gan Mao Ling is most effective when started in the early stages of invasion. Taken throughout the illness it will soften symptoms and speed recovery. The formula may be used for a few days to a few weeks. Gan Mao Ling can be used as a preventative. If you feel you have been exposed to a cold or flu or you are going to be around a crowd of people; serve it up.
Use with caution in deficient or cold patients. Contraindicated if strong chills are present.
Liu Wei Di Huang Wan , Six Flavor Teapills,Six Flavor Rehmannia.
This classic Chinese herbal formula was developed by Qian Yi (1032-1113 A.D.) for pediatric use. After a thousand years it continues to bloom. However modern practitioners find uses for Liu Wei Di Huang Wan well beyond the original intent. Qian Yi would be amused to know it is very popular in China to support aging in the over 50 set! Today, Liu Wei Di Huang Wan is used for menopause symptoms, prostate function, blood sugar, high blood pressure, tinnitus, sore low back, hyperthyroid, fertility, adrenal fatigue, and chemotherapy side effects. (10)
Contraindicated in cases of chronic diarrhea due to weak digestion or excessive phlegm.
Great Mender, Jin Gu Die Shang Wan "Tendon and Bone Healing."
This formula is based on an 1842 formula called Qi Li San (10). It is straight out of the tradition of Hit Medicine or Die Da Yao which developed to meet the needs of martial arts schools and the military. Die Da Yao addresses injuries due to training and combat. As with all pain treatments the emphasis is on removing stagnation for pain relief and optimum tissue recovery. There are 22 herbs in Great Mender, however by weight 26% of the formula is Dipsacus or Xu Duan. This herb’s superpower is healing broken bones. The formula is very useful for a fracture confined to a cast. Immobilization causes stagnation of the blood and ultimately the Qi. Because of the mix of moving herbs in the formula healing the immobilized tissue will not suffer and healing time will be shortened. Great Mender will be most effective for trauma or injury which is accompanied by swelling. This includes sprains, strains, tendon tears, and post-surgical pain. The pills can also be powdered and mixed in rice wine or alcohol to make a topical application for traumatic swelling.
Contraindicated during pregnancy, or with hemorrhagic disorders. Caution during heavy menstrual bleeding or patients on anticoagulant therapy.
Chuan Xin Lian
Feeling extra bad or been bitten by a zombie? Chuan Xin Lian to the rescue. Named for a single herb in the formula, Chuan Xin Lian is a trifecta of powerful herbal allies. Chuan Xin Lian, Pu Gong Ying, and Ban Lan Gen. Chuan Xin Lian is traditionally used to cool strong heat disorders of the throat, lungs, and skin. Pu Gong Ying is the fancy Chinese name for the humble dandelion. It is mighty for clearing heat and infections. Ban Lan Gen is the root of the woad plant. The leaf is used as a fabric dye and, file under interesting factoids, an ingredient in mummy wraps. The root of the woad has a strong broad-spectrum antimicrobial effect, especially with viruses. Bring this formula out for more severe symptoms of cold and flu; swollen glands, severe sore throat, yellow phlegm, cough, and fever. It is also used for UTIs and, in a pinch, can be crushed, dissolved in hot water and used topically for skin infections and snake bites. (11)
Caution with patients with weak digestion and a tendency to loose stools, diarrhea, poor appetite or chronic digestive weakness.
Serving size for all formulas listed can vary depending on the form and brand. Check the label or follow the instructions of your knowledgeable health care practitioner.
Disclaimer
Use herbs wisely. If you have questions or special considerations, work with your practitioner. If symptoms worsen or you have concerns, contact a knowledgeable practitioner. These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease. Please check for interactions if you are taking any medications and intend to ingest herbal products.
References
1 Noah A. Zucker, BS, Alex Tsodikov, PhD, Richard E. Harris PhD, Evoked Pressure Pain Sensitivity Is Associated with Differential Analgesic Response to Verum and Sham Acupuncture in Fibromyalgia Pain Medicine Aug 2017 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6279294/
2 Eun Jin Lee, PhD, RN, ARNP and Susan Frazier, PhD, RN Pain Symptom Management, PMC 2012 Oct 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154967/
3 Deng, H., Shen, X., The Mechanism of Moxibustion: Ancient Theory and Modern Research., Evidence-based Complementary and Alternative Medicine, 2013 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3789413/
4 Gale, G. D., Rothbart, P. J., Li, Y., Infrared Therapy for Chronic Low Back Pain: A Randomized Controlled Trial, Pain Research and Management, 2006, 11 (3), 193-196 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539004/#!po=15.0000
5 Park JE, Lee MS, Jung S, et al. Moxibustion for treating menopausal hot flashes: a randomized clinical trial. Menopause. 2009;16(4):660-5. doi:10.1097/gme.0b013e318198cdf7 https://insights.ovid.com/crossref?an=00042192-200916040-00012
6 Abdullah M.N.Al-Bedaha, Ibrahim S.Elsubaia, Naseem Akhtar Qureshia, Tamer Shaban Aboushanaba, Gazzaffi I.M.Alia, Ahmed Tawfik, El-OlemyabAsim, A.H.KhalilaMohamed, K.M.Khalila, Meshari SalehAlqaeda, The medical perspective of cupping therapy: Effects and mechanisms of action, Journal of Traditional and Complementary Medicine, Volume 9, Issue 2, April 2019, Pages 90-97 https://www.sciencedirect.com/science/article/pii/S2225411018300191
7 Peng MH, Dai WP, Lui SJ, Yu SW, Wu YN, Lui R, Chen XL, Lai XP, Li X, Zhao ZX, Li G. Bioactive glycosides from the roots of Ilex asprella. Pharmaceutical Biology2016 Oct;54(10):2127-34 https://www.ncbi.nlm.nih.gov/pubmed/26957139
8 Ju Young Yoona, Hye Yoon Jeong, Shi Hyoung Kim, Han Gyung Kim, Gyeongsug Nam, Jin Pyo Kim, Deok Hyo Yoon, HyunsikHwang, Tae Woong Kim, Sungyoul Hong, Jae Youl Cho, Methanol extract of Evodia lepta displays Syk/Src-targeted anti-inflammatory activity, Journal of Ethnopharmacology, Vol. 148 Issue 3, 30 July 2013, Pages 999-1007 https://www.sciencedirect.com/science/article/pii/S0378874113003668
9 Sichaem J, Rojpitikul t, Sawasdee P, Lugannanagarm K, Santi TP, Furoquinoline Alkaloids from the Leaves of Evodia lepta as Potential Cholinesterase Inhibitors and their Molecular Docking. Natural Product Communication, 2015 Aug;10(8):1359-62. https://www.ncbi.nlm.nih.gov/pubmed/26434116
10 Bensky, Scheid, Ellis, Barolet Formulas and Strategies. Portable 2nd edition. Eastland Press Inc. 2015 11 Bensky, Gamble, Chinese Herbal Medicine Materia Medica, Revised Edition, Eastland Press, 1993
