Beware! Cough, sneeze can pass on obesity

31 Jan 2009, 1300 hrs IST, ANI


You may find it a bit surprising, but an Indian-origin researcher in the U.S. has revealed other people’s coughs, sneezes and dirty hands can Obesity becomes a communicable bug!
(Getty Images)
infect you with an obesity bug.

Professor Nikhil Dhurandhar, of Pennington Biomedical Research Centre in Louisiana, believes that an airborne “adenovirus” germ may be causing the fat plague that is blighting Britain and other countries.

He reckons that about one in three obese people might have become overweight after falling victim to the highly infectious cold-like virus, known as AD-36.The researcher says that the virus—which is known to cause coughs, sore throats, diarrhoea and conjunctivitis—has of late been found to make fat cells multiply, leading to weight gain.

While genes are thought to make some people more susceptible to weight gain, the current study suggests that infections could also hold the key.

Recent findings in humans suggest that 33 per cent of obese adults had contracted AD-36 at some point in their lives, compared with only 11 per cent of lean men and women.

Professor Dhurandhar said that AD-36 continued to add weight gain long after those infected had seemingly recovered.
His research suggested that the virus lingers for up to three months, during which time it multiplies fat and is contagious to others.

“We now know that this virus goes to the lungs and spreads to various organs such as the liver, kidney, brain and fat tissue,” the Daily Express quoted the researcher, who will make the extraordinary claims on BBC2’s Horizon tonight, as saying.

“When it goes to fat tissue it replicates, making more copies of itself and in the process increases the number of new fat cells, which may explain why people get fat when they are infected with this virus,” he added.

While some medical experts welcomed the findings, others sounded a note of caution.

Dr Shahrad Taheri, clinical director for obesity at the Birmingham Heartlands Hospital, said: “Most people believe obesity is caused by environmental factors. But there is a lot of information about how things like the furring up of arteries could be linked to infections. It is not beyond reason to think about various different factors, including infections, adding into the mix about what causes obesity.”

Tony Barnett, professor of medicine at the University of Birmingham, said: “These associations may give some clues but they detract from the basic message that we all need to take more exercise and eat a bit less. This kind of research needs to go on but we have to be cautious.”

NATURAL RESOURCES OF ANTI-OXIDANTS FOR LONGER LIFE

Natural Protection

We've known for years that antioxidants can help prevent heart disease and cancer, reduce blood pressure and slow the effects of aging. These naturally occurring compounds protect the body from harmful, excess free radicals, sweeping them up before they can cause damage. And the best way to lay an antioxidant-rich foundation that's inhospitable to toxins and free radicals is through a combination of whole foods.

BERRIES

Few fruits have quite the provocative allure, the fragile charm or the nutrients of berries. They're full of fiber, minerals and vitamins, and loaded with healing antioxidants. Blueberries, raspberries and blackberries are rich in proanthocyanidins, antioxidants that can help prevent cancer and heart disease. Strawberries, raspberries and blackberries contain ellagic acid, a plant compound that combats carcinogens. Blueberries also appear to delay the onset of age-related loss of cognitive function.

Quick Tips: Stir raspberries into vanilla yogurt, add whole blueberries to salads, or dress up sliced strawberries with a little honey, balsamic vinegar and black pepper.

BROCCOLI

Maybe you never listened when Mom said, "Eat your broccoli." So listen now. Broccoli and other cruciferous vegetables like cabbage, cauliflower and Brussels sprouts, can help prevent cancer and ward off heart disease. Cruciferous vegetables contain a compound called indole-3-carbinol (I3C - a potent antioxidant that breaks down estrogen in the body) that reduces the risk of breast cancer and other estrogen-sensitive cancers, like cancer of the ovaries and cervix. Other studies have shown that broccoli can help fight cervical dysplasia, a precancerous condition. Broccoli also contains other protective constituents like beta-carotene, which can help prevent cancer and heart disease.

Quick Tips: Wrap cooked, chilled broccoli with roasted pepper strips, or toss steamed broccoli with olive oil, chopped black olives and crushed red pepper flakes.

TOMATOES

Tomatoes are fast becoming one of our favorite modern foods, and for good reason -- they can ward off certain kinds of cancer, prevent macular degeneration and cataracts, and help maintain mental function as we age. Tomatoes contain lycopene, a relatively rare member of the carotenoid family, also found in pink grapefruit and twice as powerful as beta-carotene. Studies have shown that men who eat more tomatoes or tomato sauce have significantly lower rates of prostate cancer. Other studies suggest lycopene can help prevent lung, colon and breast cancers. Tomatoes also contain the antioxidant glutathione, which helps boost immune function. Note: cooked tomatoes are preferable, since heat allows more desirable antioxidants in tomatoes to be made available to the body. And because lycopene is fat-soluble, eating tomatoes with oil can improve absorption.

Quick Tips: Add minced sundried tomatoes to mashed potatoes, or toss Roma tomatoes with chopped fresh basil and olive oil and serve over pasta.

RED GRAPES

A little red wine can keep your heart beating longer and stronger. Why? Mostly because of substances called resveratrol and quercetin found in red grapes. These potent antioxidants boost heart health by acting as free-radical scavengers, reducing platelet aggregation and helping blood vessels remain open and flexible. Resveratrol can also protect against cancer and reduce the risk of inflammatory diseases, gastric ulcers, stroke and even osteoporosis.

Quick Tips: Snack on frozen red grapes for a sweet treat, or heat organic red wine with cinnamon sticks and a few whole cloves.

GARLIC

The "stinking rose," perhaps the world's oldest known medicinal and culinary herb, is packed with antioxidants that can help fend off cancer, heart disease and the effects of aging. The sulfur compounds that give garlic its pungent odor are thought to be responsible for its healing benefits. Studies have shown that garlic keeps the heart healthy by lowering cholesterol levels, reducing blood pressure, fighting free radicals and keeping blood from clotting. Other studies suggest that eating garlic regularly can help prevent cancer. It also has potent anti-fungal properties and can help treat asthma and yeast infections.

Quick Tips: Roast whole heads of garlic until soft, and spread on warm baguette slices or puree roasted peppers with garlic for a fast sauce.

SPINACH

Popeye may have thought eating spinach gave him strength, but it also allowed him to hit a nutritional jackpot. Because lutein (an antioxidant found in spinach) is the main pigment in the macula - the region of maximum visual sensitivity - it can help protect your vision. Studies have shown that people who eat spinach are less likely to develop cataracts and macular degeneration, the two most common causes of vision loss. Lutein appears to work by shielding the retina from sun damage and fighting free radicals that can harm the eyes. Some preliminary studies have suggested that lutein can also help prevent heart disease.

Quick Tips: Stir chopped, fresh spinach and crushed walnuts into steamed brown rice, or lightly wilt baby spinach leaves and toss with olive oil.

TEA

The most frequently consumed beverage in the world may also be one of the best ways to prevent a number of degenerative diseases. Tea has been shown to significantly reduce the risk of cancer, heart disease, stroke and other diseases. It was originally thought that green tea had more antioxidants than black tea, but recent studies suggest that they are equally beneficial. The catechins in green tea are oxidized in the manufacturing process of black tea, forming free-radical fighting theaflavins.

Quick Tips: Poach salmon in an infusion of green tea and ginger. Or boil soba noodles in green tea and toss with sesame seeds and a dash of toasted sesame oil.

CARROTS

Carrots are loaded with a potent antioxidant called beta-carotene, a member of the healing family of carotenoids. Also found in beets, sweet potatoes and other yellow-orange vegetables, beta-carotene provides protection against: cancer, especially lung, bladder, breast, esophageal and stomach cancers; heart disease, and the progression of arthritis by as much as 70 percent. Note: Cooked carrots have considerably higher levels of antioxidants than uncooked, probably because heat breaks down the active compounds and makes them more available.

Quick Tips: Puree cooked carrots with low-fat chicken broth, rosemary and a dash of cream, or steam whole baby carrots and toss with nutmeg, honey and a little butter.

SOY

The enduring favorite of health-foods aficionados, soy can help prevent cancer, lower cholesterol, ward off osteoporosis and lessen the effects of menopause. Most of the health benefits of soy have been attributed to its content of Genistein and other isoflavones, which resemble natural estrogens in the body. Studies have shown that Genistein can help prevent breast, colon and prostate cancers. Additionally, soy can reduce both overall cholesterol levels and LDL (low-density lipoprotein or "bad") cholesterol levels, without affecting the levels of beneficial HDL. Soy can also prevent osteoporosis and help alleviate the symptoms of menopause, such as hot flashes.

Quick Tips: Add cubed tempeh to pasta sauce, spread soy butter on a whole-wheat pita instead of peanut butter or toss soy sprouts on a salad or in stir-fry dishes.

WHOLE GRAINS

Your morning bowl of cereal may be a more potent source of phytochemicals than you think -- as long as it's whole-grain variety. Vitamin E in grains is a potent antioxidant that plays a role in preventing cancer, especially prostate cancer. Other studies have found that it can boost immunity, slow the progression of Alzheimer's disease, treat and possibly prevent arthritis, prevent sunburn and treat male infertility. Grains are also rich in phytic acid, known as IP-6, a potent antioxidant that can help protect against breast, colon and liver cancers.

Quick Tips: Combine cooked bulgur wheat with chopped parsley, scallions and olive oil, or add raisins, dried apricots and minced basil to brown rice.

Fluorescent proteins to see cancer molecules

26 Jan 2009, 2203 hrs IST, IANS

WASHINGTON: Novel new tools, developed by researchers, can now spotlight cellular molecules inside a cancer cell, transforming biomedical research.
They are photoactivatable fluorescent proteins (PAFPs) and other fluorescent proteins (FPs), several of which have been developed by Vladislav Verkhusha, associate professor of anatomy & structural biology at Albert Einstein College of Medicine.

It is possible, for example, to follow cancer cells as they seek out blood vessels and spread throughout the body or to watch how cells manage intracellular debris, preventing premature aging.

These new fluorescent proteins add considerably to the biomedical imaging revolution started by the 1992 discovery that the gene for a green fluorescent protein (GFP) found in a jellyfish could be fused to any gene in a living cell.
When the target gene is expressed, GFP lights up (fluoresces), creating a visual marker of gene expression and protein localisation, via light (optical) microscopy. Three scientists won The 2008 Nobel Prize in Chemistry for their GFP-related discoveries.

However, many cellular structures, which could hold the key to managing or curing disease, are a small fraction of that size? Just a few nanometers or more.
Using a sophisticated combination of lasers, computers, and highly sensitive digital cameras, scientists have been able to surmount the barriers of optical imaging.
The first generation of these new imaging devices, collectively known as super-resolution (SR) fluorescence microscopes, were able to capture images as small as 15 to 20 nanometres - the scale of single molecules.

But this could be done only in non-living cells. The addition of PAFPs, more versatile versions of FPs, made it possible to do real-time SR fluorescence microscopy in living cells. Last month, Nature Methods selected SR fluorescence microscopy as the 2008 Method of the Year.

Verkhusha has developed a variety of PAFPs and FPs for use in imaging mammalian cells, expanding the applications of fluorescence microscopy.

Among these are PAFPs that can be turned on and off with a pulse of light, FPs that can fluoresce in different colours, and FPs that have better resolution for deep-tissue imaging, said an Einstein release.

Several studies have employed Verkhusha's PAFPs, revealing new insights into a variety of biological processes.

Genes decide your popularity: Study

27 Jan 2009, 1324 hrs IST, PTI


LONDON: Not all can become popular, but a new study says that those who are actually owe their status to their genes.


An international team has found that people's likely places in social groups are determined by genetics even before they are born, rather than by their upbringing — in fact some have evolved into occupying different social positions.

And, according to researchers, the genes may help in influencing personality but the strength of the connection between genes and standing in a group suggests their influence go much further.

"We were able to show our particular location in vast social networks has a genetic basis. In fact the beautiful and complicated pattern of human connection depends on our genes to a significant measure," Nicholas Christakis of the Harvard University, who led the team, said.

The researchers came to the conclusion after looking at the "social networks" of 1,110 teenage twins.

They found identical twins, who share the same genetic make up, often found themselves in the same position within a group, whether as social outcasts or the centre of attention while non-identical twins were more likely to have differing levels of popularity among their friends.

History of Indian Champissage (Head Massage)

Massage has always played an important part in Indian life. It features in the earliest Ayurvedic texts, which date back nearly 4000 years. These ancient texts describe that, when used in conjunction with herbs, spices and aromatic oils, massage had an important medical function and could not only “strengthen muscles and firm skin”, but also encourage the body’s innate healing energy.

Today, Indian infants often receive a daily massage from birth until they are three years old to keep them supple and in good health. From three to six years of age, they are massaged once or twice a week. After six years of age, they are taught to share a massage with family members. Massage occurs across the generations in India as an integral part of family life. Indian Champissage™ springs from this rich tradition of family grooming.

Head massage has been practised for over a thousand years. The concept was originally developed by women who used different oils according to the season (coconut, sesame, almond, olive oil, herbal oils, buttermilk, mustard oil and henna) and individual needs to keep their long hair strong, lustrous and in beautiful condition.

Barbers practised many of the same skills with their male clients. They used to visit individual homes, cutting hair and often offering champi (head massage) as part of the treatment. It was customary for most people from the king down to have someone attend to them in this manner.

Treatments offered by barbers differed from the massages performed by women. A champiwas an invigorating scalp massage designed to stimulate and refresh the individual and was not considered part of a beauty regime. The word ‘shampoo’ comes from the Hindi word 'champi,’ meaning ‘massage of the head.’ Regular head massage, as practised by woman to beautify their hair, was soothing and relaxing. They would use natural oils to keep their long hair strong and healthy.

The barbers’ skills evolved through the ages. They were handed down from father to son in much the same way that women kept alive the tradition of hair massage and grooming by passing the techniques from mother to daughter.

Nowadays, it is very common to go to a barber’s shop, receive a wet shave and have a head massage thrown in as part of the treatment. Head massage can be seen in many locations in India from Calcutta to Bombay: on street corners, in markets and, of course, on the beach.

Traditional Indian Treatments

Asthangahridaya, an ancient treatise on Ayurveda suggests daily application of oil on head, ears and feet. This is effective against creases on skin, arthritic pain and fatigue

Sweat Lodge: Temazcal - The Traditional Mexican Sweat Bath

Dr. Horacio Rojas Alba
Instituto Mexicano de Medicinas Tradicionales Tlahuilli A.C.
Introduction
Some ten years or so ago, a renewed interest in the ancient sweat bath, still called by the name given to by the Aztecs, the Temazcal, sprang up in Mexico, a part of the movement, now so widespread in this country, to return, once again to the healing practices preserved in their traditional medicine. These sweat baths, still a living tradition in many parts of the country, are usually small round stone or mud structures looking rather like old fashioned bee-hives. Many more began to be constructed everywhere, and more and more often, people who are ailing will turn to them for relief from their complaints.

Sweat baths, of course, are used known in many cultures of the world, both ancient and modern. The sauna of Scandinavia is famous, as is the hamem of north Africa and Turkey. In the ruins of Pompeii there are the remains of sweat baths, and in India, people lay in the sun, covered with leaves to protect themselves from the burning rays of the sun, to bring on sweating. It is, of course, a well-known part of the culture of our own Indians, and in this form, the sweat lodge, they, too, are enjoying renewed popularity.

The traditional Mexican sweat bath, however, differs in several ways from the others. It is not primarily used for ceremonial purposes, as is the sweat lodge of our indians, nor for relaxation or bodily cleansing or for general well-being, as are most of the other sweat baths, It is and was, as far back as we can trace it, a therapeutic instrument, an arm of the medical practices developed in what anthropologists like to call, Mesoamerica, that vast area that now includes Mexico, Guatemala and Belice. We know it best, in its ancient forms, through the Aztecs, and Temazcal, as it is still called in contemporary Mexico, is a Nahuatl word, taken from their language.

It was, when the Spanish conquerors arrived in this, for them, New World, an integral and important part of the medicine which they found here. If was, as best we can make out from the sources still left to us, used in the healing and easing of almost all kinds of medical conditions, including, as we sail see, pregnancy and child birth, it still is.

The Spaniards were appalled and outraged by this, to them, barbaric practice. Not only was it inextricably interwoven with pagan beliefs and ritual, as is all ancient traditional medicine, but, most shocking of all, the bathers entered into these small, dark chambers, all sexes and size together, naked as the day on which they were born. The Spaniards were convinced that some sort of unspeakable orgiastic rites were taking place, and so they set themselves to forbidding the practice and destroying the baths wherever they found them. In the Penal Code and Order for Governing of the Indians, proclaimed by Charles the Fifth, the emperor of Spain, it was declared "that Indians who are not sick shall not bathe in hot baths under penalty of one hundred lashes to be followed by two hours bound in the marketplace..." Later, the proscription was extended to the sick as well.

But there were some among the conquerors who were impressed more favorably by this practice and, fortunately for us, recorded their impressions of what they had seen. It is from these accounts that most of what we know of ancient practice has come down, and it is worth quoting some of their observations. In the Magliabechi Codex, one of the few books which come down to us from those days, a caption under a native drawing of a Temazcal observes, "This is a drawing of the baths of these Indians which they call the temazcalli. At the door of the bath there is an Indian who is the advocate for the sick, and when a sick person goes to the baths he makes an offering and stretches his body on the ground in veneration of the idol which they call Tezcatopocatl and who is one of their principal gods. They used in these baths other Infamous reliquaries and many naked Indians bathed and committed great ugliness and sins in this bath".

Sahagun, the industrious Franciscan friar who recorded so many of the indian customs of his day, tells us that: "It [the Temazcal] is used firstly in the convalescence of many sicknesses, so that they should finish healing more rapidly... All sick people benefit from these baths..." And he goes on to list sicknesses that he throught especially responsive to the sweat bath: traumas, broken bones, contusions, skin problems and growths, among others. He mentions, as well, that it is also good for "pregnant women who are close to giving birth as there the midwives can do certain things so that the birth is easier... ", and it is "good for the mother shortly after giving birth so that she heals and to purify the milk..." Another of the early commentators on indian customs of those times, Clavijero, observes that "...the temazcalli has always been used in many sicknesses, especially in fevers caused by some form of constipation of the pores... and those who have been injured or stung by some poisonous animal. It is also a remedy which is effective for those who need to get rid of thick and tenacious humors. When a more copious sweating is needed, the sick person is placed near the ceiling where the vapor is thicker. It was also used in the treatment of fractured bones, syphilis, lepra, pains in the chest and back, spots and growths on the skin, blows and contusions, stiff necks,..."

Temazcaltoci: The grandmother of the bathsThe name Temazcal, or temazcalli is made of two Nahuatl words, temas, which means bath, and calli, meaning house. At the time of the Conquest, they were found everywhere in almost all of central and southern Mexico. They were so common that the same Clavijero was led to remark that "...there is no town, however small it might be, that does not have many of them."

Although the Spanish did their best to wipe out this custom, they failed. The battered Indians preserved the custom secretly in remote places, as they did with so much of the their traditional medical skills and practices. In this way, the Temazcal has come down to modern times, and on the basis of the knowledge so carefully preserved, the contemporary revival of this healing swat bath has taken place.

In the Nahuatl culture of central Mexico, the goddess of the sweat bath was Temazcalteci, "the grandmother of the baths". She was, really, one of the manifestations of the goddess Teteoinan, "the mother of the gods", or, as she is also called, "our grandmother", the principal goddess among the higher Nahuatl divinities. Sahagun says of her that "...this goddess was the goddess of medicine and of the medicinal herbs; she was adored by doctors and surgeons, and bleeders, and also by midwives... She was also adored by those who had baths, or temazcals in their houses. All placed the image of this goddess in their baths". The cult of this goddess of the Temazcal extended throughout Mesoamerica and it is found in the other great cultures of the region --the Mixteca, the Zapoteca and the Maya. It was in great part because of this close relationship between the worship of a goddess and the Temazcal that the Spaniards found it so important to ban the use of the bath.

The Temazcal not only involved the worship of a goddess, but it incorporated all the elements of the ancient cosmology, both in the manner of its construction and the way in which it is used; and most of these conceptions have been preserved in traditional thought and practice down to our own day. The Temazcal is a microcosm reproducing in itself the characteristics of the universe, the macrocosm. So we find in the Temazcal all elements of the different eras or cycles (known as suns) throught which, according to Aztec mythology, the world has passed and continues to pass: earth, wind, fire and water (we now live in the fifth 'sun') and through whose constant movement and life is manifest.

More, the Temazcal is oriented according to the cosmic directions: the fire which heats its stones is placed towards the east where our Father, the sun, the god called Tonatiuh, arises; he is the light or masculine element which comes and fertilizes the womb of the mother earth (the chamber of the Temazcal itself), and so life is conceived. The doorway through which the bathers enter and leave is oriented toward the south, "the pathway of the dead", which begins with birth and ends in death, to the right of the path of Sun. In this way, the ever present duality of traditional Mexican thought is manifested. Just as there are mother and father, sun and earth, hot and cold, so we are born and, in being born, we begin our path towards death.

Aztec cosmology presents us with several different levels of the heavens, and these are considered to be present in the different levels of temperatures found inside the Temazcal: the highest in the upper part of the chamber where the temperature is the lowest.

When we enter the Temazcal, according to this ancient doctrine, we return once again to our mother's womb, presided over by the great goddess, Tonantzin or Temazcaltoci, the great mother of both gods and humans. She is our beloved mother, concerned with the health of the children and she receives us into her womb - of which our own mother's womb is but a microcosmic manifestation - to cure us of physical and spiritual ills. The entrance way is low and small, and through it we enter a small, dark, warm and humid space, in this way recreating the uterus, cutting off the outside world and giving us a chance to look inside and find ourselves again. Our re-emergence through this narrow opening represents our rebirth from the darkness and silence of the womb. It is no wonder that the Spaniards were so shocked by what they found!



Temazcal produces a series of physical reactionsPhysical cleanliness has always, and still continues to be, a matter of great importance to the people of Mexico. When the Spaniards arrived, the people of Mexico bathed daily when it was possible; the Europeans of those days, on the other hand, placed little importance on personal cleanliness and it was not uncommon for a month to pass between baths. Andres de Tapia observed that "Motecuhzoma washed his body every day two times.

"Clavijero noted that bathing in the Temazcal "was only a little less frequent" than regular bathing among the Mexicans.

The practice of inducing sweat has long been known to be beneficial in sicknesses of the skin, liver and circulation, in problems of rheumatism, arthritis, gout, and other chronic diseases, as well as acute problems like muscular pains, colds and congestions, and sweat baths are but of the ways used to bring about healthful sweating. The Temazcal, because of its special methods, is perhaps the most effective of this kind of curative technique, certainly the list of conditions for which it has been used in the course of centuries is the most extensive.

Overheating of the body (during the bath, the body temperature may reach one hundred and four degrees) produces a series of reactions: it stimulates both the superficial and the deep blood circulation, accelerates the frequency of heartbeats, as well as increases their force, calls into action the mechanisms of thermal regulation, activates the metabolism, and promotes sweating. All of these effects produce a great internal movement of energy and liquids, somewhat similar to the way in which strenuous exercise does, bringing increased circulation to all the muscles, organs and tissues. While all sweat baths produce these effects, the Temazcal, because of the way it works and the precision with which it can be regulated by the healer in charge of the bath, controls these body reactions to high heat to maximize the curative effects of the bath.

Its basic advantage as a sweat bath consists in the way high heat and high humidity are combined. The sauna, for example, reaches much higher temperature but the bath is drier and consequently, its curative capacities are lower. Other types of steam bath also combine heat and humidity, but the Temazcal surpasses them in effectiveness for two reasons: the person in charge of the bath can adjust -increase, diminish or direct- both heat and humidity to meet the specific needs of the patient he is treating, and the vapor is made from herbal teas, the herbs chosen for their effects on each individual patient.

The high heat and the high humidity, taken together, produce their healing effects, basically, through reducing or impeding the body's mechanism for cooling itself. The heat, higher than normal body temperature, induces sweating; the high humidity inhibits the evaporation of the sweat, the chief method through which the body normally cools itself, and thereby, blood circulation is increased, sweating is increased, and the elimination of toxins is maximized. It is said that every liter of sweat lost in the Temazcal is equivalent to a full days' work by the kidneys!

There are two others special characteristics of the Temazcal as a sweat bath that must be mentioned. The first is that every bath is directed by a specially trained healer, most often a woman (called in Mexico, the Temazcalera). She examines the patient, makes her diagnosis, chooses the herbs that are indicated, decides on the levels of heat and humidity that are to be used, prepares the Temazcal, and then enters the chamber with the patient to oversee and manage the course of the bath. She can raise or lower the intensity of the heat during the bath through ventilating the chamber using the entranceway or the vent that is in the roof of the Temazcal, or by fanning with the fan made up of branches of a suitable herb that she has chosen, or raising or lowering the height at which the patient is placed to do the bath (heat rise, and the Temazcal is much cooler at floor level than it is towards the root, and with all gradations in between). A good Temazcalera is amazingly skillful in handling her herbal fan; she can bring down heat for the upper parts to the lower parts of the chamber at will, and if she wishes, direct currents of heat to whatever part of the body wants special attention. Extra heat can be put on your leg, for example, to deal with sciatica, or on your back to get rid of back pain. If necessary, she will use her fan to beat gently on any part of the body to increase circulation at that spot, should it be necessary. She is, by the way, trained to do massages using a variety of traditional techniques, in the Temazcal, for any condition that might require such treatment.

The Temazcal is a Mexican pre-Hispanic traditional sweat bath. Its oldest vestiges are found in the Mayan zones of Palenque in Mexico. Its use through history has been as much therapeutic as ritual and ceremonial. Its practice survives at the present time thanks to the oral tradition of the different indigenous communities of Mexico. The nahuatl word “Temazcal” means “House of steam”.


Even that sweat baths are used by many cultures of the world, both ancient, and modern, the traditional Mexican bath differs from others in that, as far as we know, its main purpose was therapeuticall. The Temazcal was an important and integral part of pre-Hispanic medicine. It was used in the healing and easing of almost all kinds of medical conditions.

The practice of inducing sweat has long been known to be beneficial in sicknesses of the skin, liver and circulation, in problems of rheumatism, arthritis, gout, and other chronic diseases, as well as acute problems like muscular pains, colds and congestions, and sweat baths are but of the ways used to bring about healthful sweating. The Temazcal, because of its special methods, is perhaps the most effective of this kind of curative technique, certainly the list of conditions for which it has been used in the course of centuries is the most extensive.


Overheating of the body (during the bath, the body temperature may reach one hundred and four degrees) produces a series of reactions: it stimulates both the superficial and the deep blood circulation, accelerates the frequency of heartbeats, as well as increases their force, calls into action the mechanisms of thermal regulation, activates the metabolism, and promotes sweating. All of these effects produce a great internal movement of energy and liquids, somewhat similar to the way in which strenuous exercise does, bringing increased circulation to all the muscles, organs and tissues. While all sweat baths produce these effects, the Temazcal, because of the way it works and the precision with which it can be regulated by the healer in charge of the bath, controls these body reactions to high heat to maximize the curative effects of the bath.


Its basic advantage as a sweat bath consists in the way high heat and high humidity are combined. The sauna, for example, reaches much higher temperature but the bath is drier and consequently, its curative capacities are lower. Other types of steam bath also combine heat and humidity, but the Temazcal surpasses them in effectiveness for two reasons: the person in charge of the bath can adjust -increase, diminish or direct- both heat and humidity to meet the specific needs of the patient he is treating, and the vapor is made from herbal teas, the herbs chosen for their effects on each individual patient.

The high heat and the high humidity, taken together, produce their healing effects, basically, through reducing or impeding the body's mechanism for cooling itself. The heat, higher than normal body temperature, induces sweating; the high humidity inhibits the evaporation of the sweat, the chief method through which the body normally cools itself, and thereby, blood circulation is increased, sweating is increased, and the elimination of toxins is maximized.

MethodsEvery bath is directed by a specially trained healer, most often a woman (called in Mexico, the Temazcalera). She chooses the herbs that are indicated, decides on the levels of heat and humidity that are to be used, prepares the Temazcal, and then enters the chamber with the patient to oversee and manage the course of the bath. She can raise or lower the intensity of the heat during the bath through ventilating the chamber using the entranceway or the vent that is in the roof of the Temazcal, or by fanning with the fan made up of branches of a suitable herb that she has chosen, or raising or lowering the height at which the patient is placed to do the bath (heat rise, and the Temazcal is much cooler at floor level than it is towards the root, and with all gradations in between).

A good Temazcalera is amazingly skillful in handling her herbal fan; she can bring down heat for the upper parts to the lower parts of the chamber at will, and if she wishes, direct currents of heat to whatever part of the body wants special attention. Extra heat can be put on your leg, for example, to deal with sciatica, or on your back to get rid of back pain. She will use her fan to beat gently on any part of the body to increase circulation at that spot, should it be necessary. She is, by the way, trained to do massages using a variety of traditional techniques, in the Temazcal, for any condition that might require such treatment.

Found only in the Mexican method of using sweat baths for curative purposes, when the patient comes out of the bath, he is carefully wrapped in a sheet or blanket, and made to lie down and rest, usually in a room or place specially prepared for this purpose, until the body completes its cycle of sweating. Most people fall sleep during this rest period, and awaken feeling refreshed and strengthened.


These two special features of the traditional Mexican sweat bath -the skills of the Temazcalera and the mandatory rest period after the bath- may go a long way in explaining its impressive curative powers.

Roman Baths

Roman baths were a central part of Roman social life, as well as a way for the citizens of Rome to stay healthy. Roman baths were located in almost all Roman cities; most certainly in the largest and most prominent. Far from simply being a place for people to cleanse themselves, Romans baths provided an opportunity for citizens to socialize, exercise, and unwind after a day's or week's work. Today, some of the larger ancient Roman baths can still be viewed at various locations; the largest and most spectacular bath can be found in Bath, England. Transportation to Bath from London is convenient, and a coach makes trips between the cities each day.

The history of the Roman bath began during the height of the Roman Empire. Ancient Roman baths served many community and social functions within Roman society. Everyone in Rome used Roman public baths, regardless of socioeconomic status. Rich folk tended to use the Roman public baths daily, while poorer folk generally visited the Roman public baths on a weekly basis. Entrance fees to the Roman bath houses were moderate, and the houses were owned and operated by the government.

Roman bath houses were a feat of engineering at the time. Drawing on natural hot springs from beneath the ground, a system of pumps brought water up and into the large pool areas, wherever springs existed. Heaters were also created to maintain warm temperatures in the baths. Although Roman bath houses were intended for use by everyone, there were separate houses designated for men and women and regulations in place to keep bathing between the sexes a major taboo.

For the most part, the history of the Roman bath reflects the idea that the baths were a community gathering place. In addition, many bathhouses also had workout equipment nearby for men to strength train with weights or toss around a discus. Men also brought and used oils after bathing, and those in the upper classes brought along servants to carry their towels, oils, and clothing. Most bath houses were quite large (some could hold up to 3,000 people at one time) and theft was always a possibility.

Although the most recent history of the Roman bath does not involve any actual bathers, tourists today can view the baths, and even have lunch or dinner overlooking the most famous bathhouse remains in the city of Bath. The bathhouses were discovered, exhumed, and somewhat restored during the reign of Queen Victoria and have been a popular spot for tourists and residents alike ever since.

The bathhouse in Rome is open daily throughout the year with extended hours during the summer. The Pump Room is the café overlooking the bathhouse where guests can sip coffee and enjoy the view. Tickets to tour the baths can be purchased online, in London, or at the bathhouse itself upon arrival. For any tourists with an interest in ancient Rome, or even the beauty of this gorgeous structure, the baths in England are a great place to stop.

Contemporary Chinese Pulse Diagnosis and Pain

by Ross Rosen and Brandt Stickley


At first glance practitioners may not see the importance or relevance of diagnosing pain, a subjective sensation of one's patient, from reading the pulse as patients tend to report any experience of pain to their practitioner. This article, however, will address pain from multiple approaches and organ systems and demonstrate the value of perceiving the imbalances that lead to, contribute to, and reflect the manifestation of pain directly from the pulse at the radial artery using Contemporary Chinese Pulse Diagnosis (CCPD). Utilizing a diagnostic tool as sensitive as CCPD, one is not limited to the two common explanations of pain, i.e. Qi and/or blood stagnation, and bi obstruction syndrome. While we can indeed diagnose these from the pulse, using the 28 pulse positions and 80 qualities from CCPD, as well as some unique concepts from Contemporary Oriental Medicine® (COM), we can broaden our concepts to include the pulse diagnostic categories for pain as described below.

Before addressing the diagnosis of pain from the pulse, it is incumbent upon us to assert our belief in the intrinsic knowledge of our bodies and the importance of our symptoms as reflecting messages that should not be discarded. Pain, or any other symptom, is not some annoyance to simply be eradicated. It is a clue, a signal of a deeper imbalance that must be understood prior to a treatment strategy designed to eliminate its symptom. Pain has multiple causes and the eradication of the pain with symptomatic branch treatments eliminates a vital message and opportunity to treat a deeper level of imbalance and can be a disservice to our patients. CCPD enables the practitioner to delineate the root cause of one's pain and target treatment accordingly.

This ecological understanding of our symptoms and our bodies is imperative considering that pain treatment is one of the most commonly accepted areas for patients to seek acupuncture. Moreover, there are a variety of different acupuncture pain systems being practiced today, as well as in the continuing education arena, like the Balance Method, western anatomical approaches, medical acupuncture, and others. We are not suggesting these systems aren't effective for pain (indeed, the authors are both trained in and utilize some of these systems on occasion), or even that they can't be used to address underlying root causes, but rather they are often aren't considered from that vantage point. An obvious example is that we can treat a patient's chest pain balancing the meridians or releasing the sinews, yet have no diagnosis or treatment of the potential heart blood stagnation that may be underlying. To treat in this way can be life-threatening to the patient. The chest pain may be eliminated, but we are missing an opportunity to address a potentially life-threatening condition. Understanding the root causes and uncovering the details via CCPD, one can treat pain and simultaneously treat the root with a pointed acupuncture prescription that incorporates the varied facets of the individual's diagnoses. It is also important to note that the following examples of pulse qualities and interpretations are not fixed; they are open to broader interpretations that are explained below. What follows is some of the most common examples found from the collective clinical experiences of CCPD practitioners.

It is by no means an exhaustive list.

1. Tight-Wiry: The Tight-Wiry quality in an individual pulse position can reflect pain, other than the typical association of yin deficiency (Tight) and yin-essence deficiency (Wiry). In this regard, it is usually attributed to (a) an inflammatory process or (b) an excess cold condition. Other presenting signs and symptoms will assist in the differentiation. We note also that the Wiry quality, as we define it "thin, hard and cutting to the touch" (Hammer 2005, p. 349), indicates an extreme level of pain.

2. Choppy: The Choppy quality wherever it is found is indicative of blood stagnation (and under specific conditions suggests an overwhelming burden of chemical toxicity). Wherever this quality is seen, pain can be a likely result. Common positions include: the left distal position with chest and left shoulder pain due to occlusion of the coronary arteries, the Proximal positions and Pelvic Lower Body (PLB) positions with lower abdominal pain due to endometriosis and uterine fibroids, the Oesophagus position with reflux associated pain and/or Barrette's oesophagus, and the Gall Bladder complementary position with abdominal pain [hypochondriac and right shoulder] and the sequel of symptoms resulting from gall stones. The Choppy quality in the proximal positions and PLB has been significant with dyspyrunia.

3. Tense and Robust Pounding: These qualities suggest Qi stagnation with concomitant excess heat that develops from the struggle between the attempt to eradicate the stagnation and an immovable object. Typically, this type of pain will be characteristic of a Qi disorder and present with dissention and a feeling of fullness, whereby the Choppy quality discussed above will reflect more blood stagnation and fixed pain that’s sharp in nature.

4. Increased Rate on Exertion and Heart Blood deficiency: Early in one of the author's careers while growing his practice he spent a few days per week treating patients in a physiatrist's office. These patients would generally come in as their last resort in a process that spanned close to a year, first trying numerous pain medications and injections, then at least two rounds of physical therapy, each lasting a few months, then referred to acupuncture. Some had been in the 'system' for many years with no relief of their pain. These were the motor vehicle accident patients that sustained injuries that did not heal, that left their victims in significant chronic constant pain. While all completely unique in their presentations, background, histories, and review of systems, one of the findings that was consistently found in every patient was a moderate to severe Heart blood deficiency as diagnosed by CCPD wherein their heart rates would elevate greater than the normal 8-12 beats after exertion. Typically, these patients would have rates that increased at least 25 to 30 beats above their resting rates, and quite often patients' rates would increase in the 30s and 40s. We measure this by having the patient stand up and swing their arm vigorously 10 times then count their rate for 10 seconds and multiply by 6. It is not uncommon in chronic pain patients for their rate on exertion to increase well above the normal 8-12 beats. This becomes a very significant finding. It suggests inadequate blood supply and circulatory capacity and an impaired ability to heal.

5. Complementary positions on lateral radial aspect: Within CCPD exists a set of pulse locations dedicated to more of the structural aspects of the body wherein the radial aspect of the distal positions will reflect more of the head and upper body; between the distal and middle positions reflects the diaphragm, chest and back; between the middle and proximal positions represents the lower abdomen and back; whilst below the proximal positions represents the knees.

6. Flooding Excess and Infection: This pulse wave when found in an individual position can reflect local pain from an infectious process. One of the more common places to find this is in the Right Proximal Position with a urinary tract infection or a prostate infection. This can often occur with Tight, Robust Pounding and Rapid qualities. Infection in the pelvic area is usually indicated by the Slippery quality in the Pelvic Lower Body positions and usually is venereal in origin. The Flooding Excess quality in the Right Proximal position has also been associated often with Crohn’s disease (Regional Ileitis) as well as bladder infection, and in the Left Proximal Position with ulcerative colitis. All of these can be painful.

7. Complementary positions: There are 22 complementary positions in CCPD in addition to the 6 principal positions of the major organ systems. A few of the most commonly found in the context of pulses signifying pain include:
a) Gall Bladder: Tight-Wiry and Choppy --> indicates presence of pain due to gall stones; Choppy here is a sign of micro bleeding and the deterioration (necrosis) of the GB wall.
b) Oesophagus: Tight, Rough, Inflated and Choppy --> reflux pain;
c) Stomach Pylorus Extension: very Tight-Wiry and Choppy --> pain and micro bleeding probably due to an ulcer; Slippery at the Stomach Pylorus Extension position is the most significant sign of an ulcer.
d) Pelvic Lower Body: Choppy Tight or Muffled --> pain due to fibroids, cysts, endometriosis, etc; dyspyrunia.
e) Neuropsychological: very Tight --> pain due to intractable headache often due to trauma, which is a very important finding due to the gross underestimation of trauma with chronic headaches.

8. Tight Empty and Vertex Headache: The Liver yang rising scenario is a deficient condition; it results from a lack of yin, not an abundance of yang. At the point where the Liver yin is no longer able to anchor the Liver yang, we encounter a Tight Empty quality in the Left Middle position (reflecting a 'separation of yin and yang' in the Liver; see The Separation of Yin and Yang, Part Two, by same authors, Chinese Medicine Times Vol. 3, Issue 2, 2008). One textbook symptom of this condition is the vertex headache.

9. Choppy and Chest pain: While chest pain can have multiple aetiologies, one of the more critical presentations includes a Choppy quality in the Left Distal Position reflecting blood stagnation in the coronary arteries. Being able to identify this configuration is of significant importance. Other presentations include a positive Pleura. It is also important to reiterate the sensitivity of the pulse as a tool for preventive medicine; the pulse often exhibits signs of the underlying condition before the symptoms are advanced. This degree of discernment is considered an indication of advanced clinical skill from the days of Bian Que to the present.

10. Deep or Hidden and Low back pain: We are all familiar with the association of the lumbar area and the spine/skeletal system to the Kidney organ system. When we encounter a Deep or Hidden quality in the proximals it is a sign of Kidney Qi-yang deficiency (8th stage) and trapped cold internally, respectively. A hallmark symptom with this finding will be lower back/sacral pain and/or knee pain. In addition to this association, because of the Kidney Qi-yang deficiency, we will see an overall lack of metabolic heat to drive the Qi and a potential for pain in multiple regions, depending on the patient's underlying constitutional weaknesses, areas of past trauma, etc.

11. Choppy and Endometriosis: When we encounter a Choppy quality in the Liver, Proximal positions and Pelvic Lower Body one can make a fair assumption as to the presence of lower abdominal pain, in women often a sign of endometriosis and/or other signs of blood stagnation in the uterus and pelvic organs.

12. Liver Blood and Heart Qi Deficiency and fibromyalgia. Dr. Hammer has written on this topic (see Medical Acupuncture, September 1, 2008, 20(3): 141-145.) Essentially, this is a function of inadequate Liver Blood to nourish the sinews and/or a Heart Qi deficiency with impaired delivery/circulation to the surface and peripheral nervous system. Signs on the pulse of Liver Blood deficiency include a Thin or Tight quality at the Left Middle position and/or a Hollow quality and/or Reduced Substance and/or Leather. The signs of Heart Qi deficiency were outlined above.

13. Choppy and Pain due to toxicity: One of the principal conditions associated with an overwhelming burden of chemical toxicity is joint pain that moves from large joint to large joint. It is commonly encountered in those exposed through work, where repetitive stress also creates an increased vulnerability, and a further deleterious influence on the circulation. In addition, the symptoms of fatigue can often complicate the picture. Patients with this will find little relief of their symptoms through conventional treatment, either with ubiquitous herbal formulas, such as Bu Zhong Yi Qi tang (Tonify the Middle and Augment the Qi Decoction) for a supposed Qi deficiency, or formulas that are designed to address symptoms of Wind-Cold Damp, such as Du Huo Ji Sheng Tang (Angelica Pubescens and Sangjisheng Decoction). Furthermore, the conventional treatment through Western medicine often further complicates the symptom picture through the administration of pharmaceutical chemicals that are potentially toxic to some degree, and that more importantly, the patient is ill-suited to metabolize. The path out of this lies in identifying the Choppy pulse quality as a First Impression at the onset of the CCPD pulse diagnosis methodology, or at the Left Middle Position (and often at the Special Lung positions and Right Middle position). A novel method of evaluating the pulse while releasing pressure from the Organ through the Blood and Qi depths may also reveal a quality termed Blood Unclear. As one releases pressure, the width of the sensation slightly expands at the Blood Depth reflecting some turbulence and quickly returns to the normal sine wave shape. Over time the pulse becomes Deep. Dr. John Shen likened this pulse quality to a glass of water with some sediment in it. Another confirming sign is observed by assessing the mucosa of the lower eyelid, where the blood vessels will be of varying length and width, and may have a slightly brown hue. Examining the tongue one finds either a slightly red body with a moist yellow coat, or a withered tongue body and a slightly purple colour, and especially dark vertical lines indicating the toxicity. The veracity of these methods for assessing chemical toxicity can often provide an immediate inroad to achieving the correct diagnosis. What follows illustrates the readiness with which it can be readily established.

A patient presents with a history of intractable migraine headaches. After completing a thorough history, which indeed supported a number of potential diagnoses according to normative practice, including Liver Qi Stagnation, attention was focused on the time period when the patient first experienced the migraines. While it also coincided with her marriage, the only other obvious correlation was with the oral contraceptive she continues to take. The pulse revealed immediate evidence of toxicity, as described above, as well as the unique findings in the mucosa of the lower eyelid. The patient was urged to discontinue the oral contraceptive. She declined. Nevertheless, the treatment was based on the principle of relieving this burden of toxicity, and her headaches were readily relieved. The role of the Divergent channels to translocate Retained Toxic Pathogens to joints causing pain is also a significant diagnostic aspect of CCPD.

14. Temporal factors in pain syndromes: There are many approaches to understanding the temporal influences in painful conditions. One of the most prominent relies on an understanding of the daily rhythm of Yin and Yang. But Yin and Yang can also be approached in terms of the level of activity of an individual, and not just in terms of macrocosmic cycles. In this reading, the most telling issue is the balance between the Yang of activity and the Yin of rest. So, in terms of the microcosm, we turn our attention to the Sun of the body: the Heart. Patients often present with pains that are at worst upon waking, and usually marked by stiffness. They will note how the level of pain and stiffness is ameliorated by daily activities, only to become aggravated upon the culmination of activity at the end of the day. Then, fatigued, that patient retires, only to begin the cycle anew the following day without relief. The telling issue here is the role of the Heart in governing the circulation. In effect, this is a pattern that demonstrated the deficiency of Heart Qi, because as the body rests and the heart begins to work less, even against a reduced demand for peripheral circulation, the circulation slows and gives rise to stiffness and pain derived from a lack of movement. Upon awaking, the patient's activity increases giving an almost mechanical boost to the circulation, and thus ameliorating the symptoms. However, again due to the degree of deficiency, the activities of daily living can be taxing to the deficient patient, and the symptoms then worsen by the end of the day. In terms of treatment, it is absolutely necessary to address the Heart Qi deficiency to resolve the pain and stiffness. From the pulse there are many indications of Heart Qi deficiency. Some of the most common include (1) a slow heart rate; (2) an increase in rate on exertion of less than 8 beats per minute (this is a more serious sign of Heart Qi deficiency); (3) Change in Intensity/Amplitude in the Left Distal position of a four or five; (4) any Reduced qualities in the Left Distal position (Reduced Substance, Deep, Diminished, etc.); and (5) the Unstable quality.

15. Heart/Circulation: We have written previously about the role of shock to the heart and its effect on circulation. Trauma can be divided into physical and emotional aspects. It is noted that physical traumas usually involves an emotional component. Pulse qualities such as Inflated, Flat, Choppy and Rough Vibration can be used to isolate the location of a physical trauma. Signs such as horizontal lines in the mucosa under the eyelid and purple ecchymosis on the tongue can be found ipsilaterally. In peripheral, physical trauma, the face will be pale when compared to the hands. As the heart works to overcome the stagnating effects of trauma on Qi and Blood, it weakens over time, causing a Slow rate and more deficient qualities as described above. In emotional shock, the effect on the heart is more direct. Signs include Rough Vibration over the whole pulse encountered as a First Impression, an elevated rate, and signs at the Left Distal Position including Flat, Inflated, and even Absent, depending upon other pulse signs and the state of the body condition at the time of the insult. The first effect of shock to the heart is a Yin deficiency. With shock and with very severe pain associated with any organ, solid or hollow, Dr. Hammer has reported the Spinning Bean that feels like a splinter in the affected position (Hammer, personal communication November 2008). Pain conditions often arise secondary to a disruption of circulation and include conditions as varied as myofascial pain syndromes, migraine, reflex sympathetic dystrophy, and Irritable Bowel Syndrome, all of which can be predicated upon a disruption of the Heart's role in circulation, and likewise its role in housing the Shen. In western terms this implies a disruption of the balance between sympathetic and parasympathetic activity as they affect the circulatory system, and cause dilation and constriction of blood vessels (Scaer 2005, p. 213).

16. The Liver: As described above, often imbalances in the Liver can reflect in areas in which the Liver presides. Very often, however, the Liver will not keep its own pathology, but rather attacks wherever it finds a vulnerability. Very common scenarios involve the Liver invading the Spleen and Stomach with digestive symptoms resulting. Another very common clinical scenario is where the Liver will attack the pelvic organs causing an interstitial cystitis. In both pathologies, the Left Middle position will show excess, i.e. significant Robust Pounding, often accompanied by signs of Liver Blood stagnation. In the scenario of Liver invading the digestive system, often a positive Ulnar Liver Engorgement position is found, as well as deficiency in the Right Middle position making the digestive organs vulnerable to the excess Liver energies. With the interstitial cystitis often Tight and Choppy qualities will be found in the Pelvic Lower Body positions as well as in the Proximals, reflecting the Bladder. A note to keep in mind is that Liver Qi deficiency is more of a cause of sluggish digestion [food and Qi stagnation] than Liver Qi stagnation and `attacking’ Liver Qi. Liver Qi controls the vectors of Qi dynamic for all organs, including moving Stomach Qi downward and when it is deficient the Stomach Qi will be hampered.

17. Nervous System Tense: The hyper vigilance that accompanies the Nervous System Tense personality often presents with the ubiquitous aching neck and sore trapezius syndrome. A discussion on Nervous System Tense can be found in our previous article, An Introduction to Contemporary Chinese Pulse Diagnosis, Chinese Medicine Times, Vol. 2, Issue 5, 2007. The CCPD configuration would be a Tense quality in the principal positions as well as a Tight quality at the Qi depth.

18. Sudden cessation of exercise: The Yielding Hollow Full-Overflowing pulse, accompanied by a normal to slightly Rapid rate, indicates the sudden cessation of often intense over-exercise. This is classified as a Qi Wild condition. The aetiology, which is seen with increasing frequency, involves a disruption of the functional relationship between the diameter of the blood vessel and the volume of blood circulating. "The yin blood and the yang vessel walls become functionally dissociated" (Hammer 2005, p. 261). It is often the case that the presenting symptom is migrating joint and muscle sprain that may also accompany cold extremities. As an indication of a Qi Wild state, however, the more pressing concerns are the symptoms that accompany the pain: namely fatigue, anxiety, panic, depersonalization, dissociation and explosive anger.

19. Heart Full and "whole body discomfort": Trapped Qi in the heart is a condition Dr. Shen termed Heart Full. The Inflated pulse, particularly at the Left Distal Position, indicates the condition. The condition evolves from prolonged birth with the head in the birth canal, such as in breech presentations, or from overwhelming experiences at a time when the person is relatively robust or trauma to the chest. One pain condition associated with the disruption of Qi and Blood circulation is a pervasive feeling of whole body discomfort (Hammer 2005, p. 414).

20. Spinning bean: The Spinning Bean quality can often signify extreme pain, typically of a traumatic nature (Hammer 2005, p.375). This quality was also found once by Dr. Hammer with an intractable stomach ulcer (personal communication Dr. Hammer Oct. 2008). Wherever it is found will represent significant pathology. While certainly not exhaustive, our purpose in this article is to demonstrate the role that a thorough going examination of the pulse often reveals causes and effects of typical and commonly encountered pain conditions. As such, CCPD fulfils a need for the practitioner, namely providing the insight that leads from a set of symptoms and signs, especially gleaned from the pulse, directly to a diagnosis, treatment principle and treatment. In other words, it is "the dream of every Chinese medicine practitioner," as Heiner Fruehauf has written of the Six Conformation model (Liujing Bianzheng). The importance of diagnosing in this way brings reverence back to the art of Chinese medicine and eliminates the common misunderstanding that acupuncturists are technicians, but rather that we are clinicians of the highest calibre.

References

Fruehauf, Heiner. retrieved from: http://classicalchinesemedicine.org/scienceofsymbols/six_confirmations.htm

Hammer, Leon I., How Do You Treat Fibromyalgia in Your Practice?, Medical Acupuncture, September 1, 2008, 20(3): 141-145

Hammer, Leon I., Chinese Pulse Diagnosis: A Contemporary Approach, Revised Edition. Eastland, 2005.

Rosen, Ross and Stickley, Brandt, An Introduction to Contemporary Chinese Pulse Diagnosis, Chinese Medicine Times, Vol. 2, Issue 5, 2007

Scaer, Robert. The Trauma Spectrum: hidden wounds and human resiliency. Norton, 2005.

Stickley, Brandt and Rosen, Ross, The Separation of Yin and Yang, Part Two, Chinese Medicine Times, Vol. 3, Issue 2, 2008

The Treatment of Plantar Fasciitis with Traditional Chinese Medicine

by Scott R. Smith


Definition

Plantar fasciitis is the inflammationii of the fascia (fibrous band of connective tissue) that connects the heel bone to the base of the toes. Stretching from the heel bone (calcaneous), the plantar fascia attaches to the bottom of the metatarsal bones around the ball of the foot. Acting as a bowstring, the plantar fascia provides support for the bottom of the foot (arch) (Sauer and Cooper 2007, p478). Pain is usually reported under the medial heel throughout weight bearing (Irving et al, 2007), but may be found along any portion of the plantar fascia. Pain can range from mild to debilitating. Some may use the terms plantar fasciitis and heel spurs interchangeably but this is inaccurate since heel spurs are a result, not the cause of the discomfort (Waller and Maddalo 1995, p351).iii The condition may last a short time, come and go, resolve by itself, or become chronic for unknown reasons. Most cases respond well to conservative treatment eliminating the need for surgery or any other invasive therapy.

Symptoms
Symptoms may develop gradually or come on suddenly and be severe. The classic sign is to feel pain with the first few steps out of bed in the morning due to the fascia tightening overnight. Pain decreases as the fascia loosens up or may hurt more as the day goes on. Pain can be characterized as sharp, stabbing, or burning and most common on the inside bottom of the heel. Pain is not only felt with the first few steps in the morning, but also after long periods of sitting, standing, climbing stairs, and after exercise. If left untreated, plantar fasciitis affects the foot, knee, hip, and back from the change in gait (Wapner and Puri 2004, p189).

Causes
Many causative factors can lead to plantar fasciitis. The most frequent cause is excessive foot pronation (Pribut, 2008). Shoes that are too tight, loose, require arch support, have soles that are too thin and are without sufficient heel cushioning can be the cause and should be changed. Patients should be examined for tight calf muscles as well. A higher risk of developing plantar fasciitis exists for patients with flat feet and high archesiv (AAOS, 2001). Overuse in the form of improper athletic training, certain work or play actions, intense training, prolonged standing, weight bearing for long periods, inactivity, new aggressive training regimens and previous injury can cause plantar fasciitis. Runners and walkers should be aware of the running surface, speed, frequency and distance covered each week particularly if ankle flexion is limited due to tight calf muscles (AAOS, 2001). Also check for limited range of motion of the first metatarsophalangeal joint, ankle dorsiflexion range of motion, leg length incongruity, heel pad thickness and calf strength. Other factors include weight gainv, obesity, elderlyviand pregnancyvii.

Diagnosis
Diagnosis is based on history and symptoms together with a physical examination that involves palpating the foot and observing the patient walk. Reproduction of the pain by palpating the plantar fascia over the medial calcaneal tuberosity or along the course of the plantar fascia is especially important for diagnosis (Richardson 2008, p4816). In severe cases, passive dorsiflexion of the toes may aggravate the symptoms of plantar fasciitis (Foye, 2008). Questions about past and recent injuries, location of pain, when it hurts most, and activities the patient participates in are especially significant. If diagnosis is uncertain then a foot x-ray, bone scan, or nerve conduction test may be performed to rule out a stress fracture or nerve problem (InteliHealth, 2007).

Treatment
Patients must be active participants in treatment. Warn them that failure to do so can result in constant pain when standing or walking. Conservative treatment is recommended for 6 to 8 weeks. Active individuals are encouraged to temporarily eliminate any exercise or sport that has running and jumping. Instead, change to bicycling or swimming to remain active while reducing the strain on the plantar fascia (Jones and Singer 1995, p453). Any delay in treatment or even a lack of compliance by the patient could extend treatment time from 6 months to a year and a half.

Conventional treatment usually begins with recommending rest, ice, compression, elevation (cold compression therapy) and NSAIDs for acute flare-ups. Next, the patient is advised to discontinue any aggravating activity and to stay off the foot to decrease inflammation. Exercises to stretch the Achilles tendon and plantar fascia are shown to the patient and shoes are inspected to consider orthoticsviii, arch support, and heel liftsix (Wapner and Puri 2004, p190). Depending on aetiology, other treatments may include contrast bath therapy, weight loss, physical therapyx, taping, corticosteroid injections, and night splintsxi. When plantar fasciitis does not respond to conservative treatment, extracorporeal shockwave therapyxii (ESWT), surgical release (plantar fasciotomy)xiii, iontophoresisxiv, botulinum toxin type A injection, and cryosurgeryxv (Foye, 2008) maybe used.

Prevention
Maintain a healthy weight. Choose shoes with proper support and discard worn-out athletic shoes. Start all sports activities slow and gradually increase intensity. Wake up with a stretch (see Exercises above) and stretch the calves regularly. Seek treatment with the first signs of pain.

Differential diagnosisTendinitis, arthritis, nerve irritation or a cyst (Mayoclinic.com, 2008), calcaneal neuritis, calcaneal stress fracture, lumbosacral radiculopathy of S1 nerve root (Foye, 2008). Heel spur, plantar fascia rupture, nerve entrapment (Pribut, 2008), insertional Achilles tendonitis, calcaneal apophysitis (Sever’s disease)xvii, sciatica, lower back nerve compression or disc origin, IBS, men under the age of 40 with bilateral symptoms should be examined to rule out Reiter’s disease and ankylosing spondylitis (Richardson 2008, p4815), lateral plantar nerve 1st branch entrapment, tarsal tunnel syndrome, neoplasm, gout, infection (Pribut, 2008).

Risk factors

The underlying cause of plantar fasciitis must be remedied regardless of the type of treatment that is sought. That means shoes must be changed, arches must be supported, activity or work must be modified, a healthy weight be maintained, etc. Many sources contend that the correct shoe wear and orthotics are the foundation for successful long-term resolution of plantar fasciitis (FootPhysicians.com, 2008). Patients must be educated about risk factors, exercises, behaviour changes, and preventive measures in order to stop future occurrence. That means relating to the individual’s activity, sport, and work or health issues.

Pattern differentiation

Chinese medicine breaks plantar fasciitis into several patterns: Wind Cold Damp Obstruction

Weak constitution, intense activity, overuse, trauma; all weaken the channels and involve a deficiency of qi and blood or impair the circulation of qi and blood from the invasion of exterior wind, cold, and damp.

Many outdoor sports are played regardless of the weather condition and can expose athletes to wind, cold, and damp. Intense activity, pre-existing injury and open pores from sweating are possible openings for the invasion of wind, cold, and damp.

Intense or excessive activity or sport leads to strain; standing for prolonged periods without proper rest or footwear; inactivity; certain, unvarying recurring movements.

Symptoms:
Cold feet with a heavy feeling, symptoms worse with cold damp weather and relieved by warmth, aversion to cold, fatigue, and oedema.

Acupuncture points:
Use 0.20mm x 0.25mm needles. Anything less is too flimsy to insert into the foot. The wear on peoples feet varies (some have tougher skin than others) so to make a pain reduced insertion a thicker needle is recommended. That gauge for me is a personal favourite. Insert into Yongquan KID-1 (see figure 1); another approximately 1 cun below Gongsun SP-4 (see figure 2); another approximately 0.5 cun below Jinggu BL-64, all directed towards the centre arch, an ashi point in the proximal heel (perpendicular), an ashi point 3 cun below the tip of the medial malleoulus (perpendicular), and an ashi point approximately 1-1.5 cun below Zhaohai KID-6 (perpendicular). All points should be needled to the depth of 0.5 cun at the minimum. xviii


Moxibustion:
Instead of electro-stimulation, moxa cones or press moxa technique may be applied to the appropriate points. Moxa may also be used after electro-stimulation.


•Zusanli ST-36 Spleen, tonify qi, nourish blood, reduce atrophy and painful obstruction. (moxa)
•Sanyinjiao SP-6 influence the Spleen and Liver, resolves damp and moves the blood.
•Yinlingquan SP-9 resolves damp and painful obstruction. (moxa)
•Qihai REN-6 moves qi and damp and influences yang. (moxa)
•Shangqiu SP-5 Damp obstruction of the ankle and foot, influences sinews and muscles.
•Kunlun BL-60 removes channel obstruction, relaxes sinews.

Qi and Blood deficiency

A deficiency means a lack of nourishment, especially in the channels open to invasion of external wind, cold, and damp. Intense exercise and physical stress without adequate time for recovery depletes the qi and blood as does an intense moment of physical activity in a person who already has a weak constitution. The undernourished tendon, or plantar fascia, becomes overworked resulting in pain and stiffness.

Symptoms:
Stiffness, cramping or numbness of the limbs, fatigue, pallid complexion and lips, insomnia, , dizziness, a pale tongue and a soggy pulse.

Acupuncture points: Using 0.20mm x 0.25mm needles, insert into Yongquan KID-1, (see figure 1); another approximately 1 cun below Gongsun SP-4; another approximately 0.5 cun below Jinggu BL-64, all directed towards the centre arch, an ashi point in the proximal heel (perpendicular), an ashi point 3 cun below the tip of the medial malleoulus (perpendicular), and an ashi point approximately 1-1.5 cun below Zhaohai KID-6 (perpendicular). All points should be needled to the depth of 0.5 cun at the minimum.


•Zusanli ST-36 Spleen, tonify qi, nourish blood and reduce atrophy.
•Sanyinjiao SP-6 influence the Spleen and Liver, qi and blood.
•Pishu BL-20 tonifies the Spleen.
•Yanglingquan GB-34 relieves pain, swelling and numbness of muscles and sinews.
•Pucan BL-61 heel pain.
•Tanzhong REN-17 influential point of qi.

Liver and Spleen
The Spleen is in charge of qi and blood formation and if impaired will not properly nourish the muscles. The blood accessible to the muscles, tendons and sinews is also reliant on the Liver’s ability to store blood.

Symptoms:

Stiffness, spasms, weakness and numbness, decreased muscle and arch strength, atrophy; particularly of the lower limb, impaired ankle joint range of motion from undernourished sinew contraction and relaxation function. Dizziness, dry eyes, fatigue, pallid complexion, hypochondriac pain, irregular menstruation, slightly pale, flabby, dry tongue with pale tapered sides. The pulse is empty, thin, wiry or choppy.

Acupuncture points:

Using 0.20mm x 0.25mm needles, insert into Yongquan KID-1, (see figure 1); another approximately 1 cun below Gongsun SP-4, (see figure 2); another approximately 0.5 cun below Jinggu BL-64, all directed towards the centre arch, an ashi point in the proximal heel (perpendicular), an ashi point 3 cun below the tip of the medial malleoulus (perpendicular), and an ashi point approximately 1-1.5 cun below Zhaohai KID-6 (perpendicular). All points should be needled to the depth of 0.5 cun at the minimum.


•Taichong LIV-3 nourishes Liver blood and Liver yin.
•Ququan LIV-8 nourishes blood and yin.
•Zusanli ST-36 Spleen, tonify qi, nourish blood, reduce atrophy and painful obstruction.
•Sanyinjiao SP-6 influence the Spleen and Liver, resolves damp and moves the blood.
•Ganshu BL-18 nourishes Liver blood and benefits the sinews.
•Pishu BL-20 tonifies the Spleen.

Qi and Blood stagnation

Trauma to the plantar fascia may reduce the flow of qi and blood to the foot and allow external wind, cold, and damp to invade the area. Poor diet and stress can also lead to qi and blood deficiencies which will impact upon the flow of qi and blood in the vessels.

Symptoms:
If qi stagnation predominates, the location of pain may move around the heel and foot and feel distended and sore. In this case the tongue may be pink/purple and the pulse tight. If blood stagnation predominates, the location of pain is fixed, severe and worse with touch. In this case a purple colour is more pronounced on the tongue and the pulse is choppy.

Acupuncture points:Using 0.20mm x 0.25mm needles, insert into Yongquan KID-1; another approximately 1 cun below Gongsun SP-4; another approximately 0.5 cun below Jinggu BL-64, all directed towards the centre arch, an ashi point in the proximal heel (perpendicular), an ashi point 3 cun below the tip of the medial malleoulus (perpendicular), and an ashi point approximately 1-1.5 cun below Zhaohai KID-6 (perpendicular). All points should be needled to the depth of 0.5 cun at the minimum.


•Hegu L.I.-4 and Taichong LIV-3: move qi and blood
•Zhongwan REN-12 moves qi stagnation.
•Zusanli ST-36 moves qi and blood.
•Geshu BL-17 painful obstruction and dispels blood stasis.
•Sanyinjiao SP-6 nourish and move blood.
•Shuiquan KID-5 promotes blood circulation.

General Acupuncture Points
Using 0.20mm x 0.25mm needles, insert into Yongquan KID-1, (see figure 1); another approximately 1 cun below Gongsun SP-4, (see figure 2); another approximately 0.5 cun below Jinggu BL-64, all directed towards the centre arch, an ashi point in the proximal heel (perpendicular), an ashi point 3 cun below the tip of the medial malleoulus (perpendicular), and an ashi point approximately 1-1.5 cun below Zhaohai KID-6 (perpendicular). All points should be needled to a minimum depth of 0.5 cu.

Points along the Urinary Bladder line as it descends through the calf should be palpated for tenderness; particularly Chengjin BL-56, Chengshan BL-57, Fuyang BL-59 and Kunlun BL-60.

Exercises
Stretching your Achilles tendon and plantar fascia are the foundation of treating the condition and lessening the chance of recurrence.

Towel stretching: This exercise is best for patients with pain that is most severe with the first steps out of bed in the morning. Set the midpoint of a towel in the arch of the foot, just under the fore foot. Using both hands, gently pull the towel toward you to cause passive dorsiflexion of the ankle. Hold stretch for 30 seconds. Follow with massage or foot roller.

Towel grip:Place a towel on the floor and with a barefoot, grip the towel underneath the toes and flex the foot. This strengthens the arch. Follow with massage or foot roller.

Foot roller: A wooden ravioli rolling pinxix is recommended. The notches work especially well for loosening specific tight spots in the arch as well as moving qi and blood stagnation in the heel.

Standing calf/heel stretch:
Face a wall, standing about 3 feet away. Keeping your right foot planted, step forward with your left foot and place both palms on the wall in front of you, shoulder height. Keeping the right leg straight and the heel on the ground, slowly lean forward, bending your elbows, until you feel a stretch in your right calf. Hold 30 seconds and repeat other side.

Other treatments

Electro-stimulation:

Channel 1 connect the black clip (negative) to Yongquan KID-1 and red (positive) to the ashi point in the proximal heel. Channel 2 connects the black clip to the point approximate to Gongsun SP-4 and red to the point approximate to Jinggu BL-64. Channel 3 connect black to the ashi point 3 cun below the tip of the medial malleoulus and red to the ashi point about 1-1.5 cun below Zhaohai KID 6. Use mild stimulation for 20-30 minutes at 2-4Hz.

Massage: Massage starting at the top of the calf and follow the Urinary Bladder channel to the bottom and sides of the heel. Start light and slow, gradually increasing the depth and strength of each stroke, particularly from the bottom of the heel to Yongquan KID-1.

Exercise:
Patients must incorporate at least two of the stretches described above along with the foot roller into their daily routine.

Foot baths:Epsom salt foot baths are recommended at the end of the day to decrease inflammation, move qi and blood and promote healing.

Case study
Main complaint: Plantar fasciitis of the right foot. 51 year-old male. Severity: 6-7/10. Chronic pain from the time he steps foot on the floor in the morning up until bedtime. The heel is stiff; the arch is painful, all worse in the morning. He does a lot of forefoot movements at work and during after work activity. Pain is relieved when shoes are off and when he is off his feet. He reports that stepping on the foot feels like stepping on a marble located lateral to the middle of the arch (perhaps a Morton’s neuroma). Numbness, tingling or any shooting sensations throughout the foot are not present, only pain and stiffness. He reports no other significant health concerns.

History: Since 2004 (4 years duration). Patient is in law enforcement and is on his feet 8-12 hours at a time. A podiatrist administered a cortisone injection which provided 3-4 months relief. A 2nd cortisone injection provided the same results. A custom orthotic insole was added to provide arch support.

Other: Foot pain has decreased the patients’ quality of life due to the severity and duration.

Observations: I noticed that upon standing to walk to the treatment room, he was slow to rise and put weight on the foot. Limping proceeded until he reached the chair in the examining room. Mood was slightly irritated due to annoyance of the right foot pain.

Pulse: Sluggish.

Tongue: Pink red with white coat.

Diagnosis: Qi and blood stagnation, Spleen qi deficiency, Wind, Cold, Dampness painful obstruction.

First Treatment: Acupuncture and electro-stimulation described above plus Zusanli ST-36, Yanglingquan GB-34, Yinlingquan SP-9, Hegu LI-4, Taichong LIV-3.

Post-treatment: Reported immediate improvement.

Advice: Avoid activities that aggravate the condition, use the foot roller every day, towel grip exercise, Epsom salt foot baths and schedule a second treatment for no more than one week.

Second treatment: (5 days later)
60-80% improved overall. Emotions improved as well. He was doing exercises every night, but no foot baths as advised; he just found no time. He reported that the custom orthotics now felt better in his shoes. Decrease in tenderness, marble feeling, stiffness and morning pain.

Treatment: Same protocol as first treatment.

Advice: Continue exercises and schedule another treatment for no more than one week.

Third treatment: (5 days later)

Patient reports feeling improved. Reports a 0/10 pain scale. He has continued with exercises and foot roller but still no foot baths. “Everything has improved and holding” he says. Patient reported that the foot roller was initially painful but has now gotten to be tender with a “good pain” feeling.

Treatment: Same protocol as the first and second treatment.

OutcomeAt a three month follow-up with the patient he reports that plantar fasciitis has resolved. No reoccurrences of pain but occasional tenderness that he now knows how to manage with stretching, foot baths and the foot roller.

Conclusion

Chinese medicine provides lasting relief for a common foot problem with the specific use of acupuncture, electro-stimulation and the appropriate points based on pattern discrimination.

Here is a review of a few points to consider for a successful treatment outcome:


•Plantar fasciitis acupuncture protocol with electro-stimulation and appropriate points based on the pattern.
•Patient advised that they need to have active participation in treatment and to follow advice given in order for the condition to resolve.
•Modify exercise if that is a causative factor.
•Engage in a daily stretching regimen combined with foot baths and the foot roller.
•Schedule weekly visits.

BiographyScott R. Smith is a licensed acupuncturist and herbalist (Dipl. OM, NCCAOM) practicing in Rapid City, SD. He can be emailed at srsmithom@gmail.com.


References

American Academy of Orthopaedic Surgeons (AAOS), (2001). Plantar Fasciitis. http://orthoinfo.aaos.org/topic.cfm?topic=A00149 (Accessed 6 June 2008)

Irving, D.B., Cook, J.L., Young, M.A., Menz, H.B. (2007). Obesity and Pronated Foot Type May Increase the Risk of Chronic Plantar Heel Pain: A Matched Case-Control Study. http://www.medscape.com/viewarticle/559871 (Accessed 19 May 2008)

FootPhysicians.com (2008). Heel Pain. http://www.footphysicians.com/footankleinfo/heel-pain.htm (Accessed 5 June 2008)

Foye, P.M. (2008). Plantar Fasciitis. http://www.emedicine.com/pmr/topic107.htm (Accessed 5 June 2008)

InteliHealth.com (2007). Plantar Fasciitis. http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/10550.html (Accessed 5 June 2008)

Jones, Donald C., Singer, Kenneth M. (1995). The Lower Extremity & Spine in Sports Medicine: Soft Tissue Conditions of the Ankle and Foot. (2nd ed). St. Louis: Mosby.

Mayoclinic.com (2008). Plantar fasciitis. http://www.mayoclinic.com/health/plantar-fasciitis/DS00508 (Accessed 5 June 2008)

Pribut, S.M. (2008). Heel Pain: Plantar Fasciitis and Plantar Heel Pain Syndrome. http://www.drpribut.com/sports/heelhtm.htm (Accessed 9 June 2008)

Richardson, E. Greer. (2008). Campbell’s Operative Orthopaedics. (11th ed). Philadelphia: Mosby Elsevier.

Sauer, Scott T., Cooper, Paul S. (2007). Essentials of Orthopedic Surgery. (3rd ed). New York: Springer.

Waller Jr., John F., Maddalo, Anthony V. (1995). The Lower Extremity & Spine in Sports Medicine: Foot and Ankle Linkage System. (2nd ed). St. Louis: Mosby.

Wapner, Keith L., Puri, Rajeev D. (2004). Orthopaedic Surgery Essentials: Heel and Subcalcaneal Pain. Philadelphia: Lippincott Williams & Wilkins.

Tradition of Turkish Bath

The tradition of the Turkish bath extends far back, to a time before Turks had reached Anatolia. When the Turks arrived in Anatolia, they brought with them one bathing tradition, and were confronted with another, that of Romans and Byzantines, with certain local variants. The traditions merged, and with the addition of the Moslem concern for cleanliness and its concomitant respect for the uses of water, there arose an entirely new concept, that of the Turkish Bath. In time it became an institution, with its system of ineradicable customs.

For the Turkish bath was much more than just a place to cleanse the skin. It was intimately bound up with everyday life, a place where people of every rank and station, young and old, rich an poor, townsman or villager, could come freely. Women as well as men made use of the "hamam", as the bath is known in Turkish, although of course at separate hours.