Quit Smoking with Acupuncture

By: Diane Joswick, L.Ac., MSOM

Each year, people across the globe vow to finally quit smoking for good only to watch their resolution go up in smoke. If you have tried to quit smoking, you know how difficult it can be. It is hard because nicotine is a powerful addiction. For some people, it can be as addictive as heroin or cocaine.

Acupuncture as an alternative approach to smoking cessation has a growing number of converts. In fact, acupuncture is often a court mandated treatment for drug addicts because of its ability to curb withdrawal symptoms and manage cravings.

It is estimated that most smokers will attempt to quit 2 or 3 times, or more, before finally kicking the habit. When conventional methods to quit smoking, such as nicotine gum or patches, have failed, smokers often look outside the mainstream and turn to alternative medicine.

Acupuncture is not a panacea or a magic cure in the treatment of any addiction, including smoking. But, acupuncture is effective in making it easier to quit and remain smoke-free. If you are highly motivated and ready to quit, acupuncture can empower you to take control and begin a healthy and smoke-free life!

A Formidable Addiction

More than 50 million Americans smoke, and nearly 7 million more use smokeless tobacco. The numbers are even higher in other parts of the globe, with worldwide statistics showing that one out of three men and women over the age of 18 are smokers.

The reasons to quit smoking are endless. Cigarettes have 4000 known poisons, any of which can kill in high enough doses. One drop of pure nicotinic acid can kill a man. According to the CDC, tobacco kills more than 440,000 people each year, in the US alone. Not to mention the chronic illnesses and diseases that are associated with smoking. Emphysema, lung cancer, high blood pressure, shortness of breath, chronic cough, an increased frequency of colds and flu; these are just a few of the widely known risks associated with smoking.

Many people decide to quit because of the enormous expense of a cigarette habit or are just plain tired of being dependant on a substance. There is also considerable social pressure not to smoke. I am sure that most smokers can recall a dirty look or rude comment from someone that was nearby when they lit up.

How Does Acupuncture Help Break the Cigarette Habit?

Acupuncture has turned a growing number of cigarette cravers into permanent ex-smokers. As said before, acupuncture is not a panacea or a magic cure in the treatment of smoking. It can, however, reduce the cravings and lessen the withdrawal symptoms associated with quitting.

Oriental Medicine aims to treat the specific symptoms that are unique to each individual using a variety of techniques such as acupuncture, Chinese herbs, bodywork, lifestyle/dietary recommendations and energetic exercises to restore imbalances found in the body.

Your acupuncturist may do an interview to learn about your unique smoking habits and perform a physical examination including blood pressure, taking the pulse and observing the tongue. The emotional and physical symptoms that you are experiencing will help create a clear picture on which your practitioners can create a treatment plan specifically for you.

The acupuncture treatments will focus on the jitters, the cravings, the irritability, and the restlessness that people commonly complain about when they quit. It will also aid in relaxation and detoxification.

What Points Are Used?

Each patient is custom-treated according to his or her specific and unique diagnosis. Usually a combination of body acupuncture points and points on the ear are used that are believed to influence the organs and energetic pathways associated with smoking.

Commonly Used Points for Smoking Cessation include:

Ear points:

Shenmen
Kidney
Sympathetic
Lung Upper and Lung Lower
Hunger or Mouth

Body points:

Tim Mee- an extra-meridian point located on the wrist between LU-7 (Lieque) and LI-5 (Yangxi), a specific point to quit smoking.
The Four Gate Points (LI-4, LV-3)- would be used to circulate energy (Qi) throughout the body and calm the nervous system.
Typical treatments last from five to 30 minutes, with the patient being treated one or two times a week. After removing the needles, ear press needles or silver pellets are often applied to stimulate the points between treatments and reduce cravings.

Are There Herbs To Help Me Quit Smoking?

Often you are prescribed herbs or supplements to control cravings or withdrawal symptoms.
There are three areas to address for herbal support; dryness and tissue repair, irritability and cravings.

A Lung Yin Tonic such as Ophiopogonis Combination (Mai Men Dong Tang) is often used to moisten the lungs and mouth which can prevent cravings and repair tissue damage caused by smoking.

A Chinese herbal formula to calm the spirit may be used for irritability. Bupleurum plus Dragon Bone and Oyster Shell (Chai Hu Jia Long Gu Mu Li Tang) can help relieve irritability and anxiety associated with detox. Many people use this formula to help them through stressful situations and prevent relapses.

Lobelia Tea (Ban Bian Lian) or Green Tea can be sipped daily during the detox period to keep tissues flooded with elements that discourage nicotine cravings. (Lobelia is traditionally used to rid the body of a strong toxin such as a snake bite.)
NOTE: The improper use of Chinese Herbs can be dangerous. Please consult with a licensed acupuncturist and herbologist before taking any herbal products.

What Lifestyle and Dietary Changes Should I Make?

Exercise is encouraged and dietary and support systems are recommended to rid the body of toxins and avoid relapses:

Get plenty of fresh fruit and vegetable juices and miso soup to neutralize and clear the blood of nicotinic acid and to fortify blood sugar.
Carrots, Carrot juice, celery, leafy green salads and citrus fruits promote body alkalinity and decrease cravings.

Avoid junk food, sugar, chocolate, coffee and cooked spinach. They can upset blood sugar levels and increase blood acidity which can aggravate smoking-withdrawal symptoms.


Lobelia Tea (Ban Bian Lian) or Green Tea can be sipped daily during the detox period to keep tissues flooded with elements that discourage nicotine cravings. (Lobelia is traditionally used to rid the body of a strong toxin such as a snake bite.)
Drink water - Research shows that dryness causes cravings. Sip water frequently throughout the day.

Deep Breathing Exercises – to increase body oxygen

How Many Treatments Will I Need and How Long Do they Take?

The length, number and frequency of treatments will vary. Typical treatments last from five to 30 minutes, with the patient being treated one or two times a week. Some symptoms are relieved after the first treatment, while more severe or chronic ailments often require multiple treatments.

A stop smoking program will often consist of 4-6 initial treatments scheduled in the first few weeks followed by monthly treatments for four to six months.

Electroacupuncture Relieves Cancer Pain in Laboratory Rats

Pain resulting from the spread of cancer to skeletal bone is the most common physical symptom in cancer patients and can severely disrupt their quality of life. Standard opioid treatments used to ease the pain can often cause serious side effects. Electroacupuncture (acupuncture combined with electrical stimulation) has been used to treat cancer pain; however, the existing data on its efficacy and how it works are unclear. In a recent study, NCCAM-funded researchers at the University of Maryland investigated the effects of electroacupuncture on cancer pain in rats and also looked at the underlying biomechanisms.

The researchers injected prostate cancer cells into the tibia (shinbone) of rats to induce cancer in the bone, gave them either electroacupuncture or sham electroacupuncture, and then subjected them to various pain tests. The results showed that compared with the sham control, electroacupuncture significantly reduced cancer-induced bone pain.

The researchers also examined the rats spinal cords to see whether electroacupuncture affected chemical processes thought to play a role in pain. They found that compared with the sham control, electroacupuncture inhibited up-regulation of two substances involved in these processes: spinal cord preprodynorphin mRNA and dynorphin. In a separate experiment, they found that injection of an antiserum against dynorphin also inhibited cancer-induced pain in the rats.

The researchers concluded that electroacupuncture eases cancer pain in rats, at least in part by inhibiting spinal dynorphin. They note that their findings support the clinical use of electroacupuncture in the treatment of cancer pain.

Reference
Zhang RX, Li A, Liu B, et al. Electroacupuncture attenuates bone cancer-induced hyperalgesia and inhibits spinal preprodynorphin expression in a rat model. European Journal of Pain. 2008;12(7):870–878.
Additional Resource
More information from NCCAM on acupuncture
Pain Control: Support for People with Cancer (National Cancer Insitute)

Acupuncture and Pregnancy

Acupuncture Shows Promise in
Improving Rates of Pregnancy Following IVF

A review of seven clinical trials of acupuncture given with embryo transfer in women undergoing in vitro fertilization (IVF) suggests that acupuncture may improve rates of pregnancy. An estimated 10 to 15 percent of couples experience reproductive difficulty and seek specialist fertility treatments, such as IVF. IVF, which involves retrieving a woman's egg, fertilizing it in the laboratory, and then transferring the embryo back into the woman's womb is an expensive, lengthy, and stressful process. Identifying a complementary approach that can improve success would be welcome to patients and providers.

According to Eric Manheimer of the University of Maryland School of Medicine's Center for Integrative Medicine and colleagues who conducted the systematic review, acupuncture has been used in China for centuries to regulate the female reproductive system. With this in mind, the reviewers analyzed results from seven clinical trials of acupuncture in women who underwent IVF to see if rates of pregnancy were improved with acupuncture. The studies encompassed data on over 1366 women and compared acupuncture, given within one day of embryo transfer, with sham acupuncture, or no additional treatment.

The reviewers found that acupuncture given as a complement to IVF increased the odds of achieving pregnancy. According to the researchers, the results indicate that 10 women undergoing IVF would need to be treated with acupuncture to bring about one additional pregnancy. The results, considered preliminary, point to a potential complementary treatment that may improve the success of IVF and the need to conduct additional clinical trials to confirm these findings.

References
Manheimer E, Zhang G, Udoff L, et al. Effect of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilization: systematic review and meta-analysis. British Medical Journal. Published online February 2008.

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.

Brain-Imaging Study Explores Analgesic Effect of Acupuncture

Although acupuncture has long been used to relieve pain, scientific understanding of how acupuncture might achieve an analgesic effect is incomplete. Previous research has linked acupuncture's effects to the neuronal networks and opioid (pain response) systems of the brain. In light of these findings, NCCAM-funded researchers at Massachusetts General Hospital recently used two imaging technologies—functional magnetic resonance imaging (fMRI) and positron emission tomography (PET)—to investigate how specific areas of the brain might be involved in acupuncture analgesia.

In the study, 12 people were exposed to heat pain and received either actual or sham acupuncture. Researchers used fMRI to examine the brain's pain responses before and after acupuncture. They used PET with a radioactive tracing substance to measure changes in opioid receptor binding during acupuncture.

The imaging results showed acupuncture-related changes in both of the brain's pain networks: the lateral network, which is associated with sensory aspects of pain perception, and the medial network, which is associated with affective aspects. However, the fMRI and PET results pointed to different areas in these networks, with one exception: both imaging technologies showed changes in the right medial orbitofrontal cortex—an indication that this area of the brain may be important in acupuncture analgesia.

The researchers note that their preliminary findings demonstrate that imaging studies using more than one imaging technique have potential for clarifying the neural mechanisms of acupuncture. They point out that similar studies with much larger samples might reveal other areas of the brain where fMRI and PET results converge.

Reference
Dougherty DD, Kong J, Webb M, et al. 2008. A combined [11C]diprenorphine PET study and fMRI study of acupuncture analgesia. Behavioural Brain Research. Nov. 2008;193(1):63–68.
Additional Resource
More information from NCCAM about acupuncture is available at nccam.nih.gov/health/acupuncture/.