Traditional Chinese Medicine

Mar 04 2024

Endometriosis Awareness

By Emma Houston Jupp Acupuncture, Chinese herbal medicine, Endometriosis, Fertility, Women's health

March is Endometriosis Awareness Month

What is endometriosis?

Endometriosis is a common chronic gynaecological condition, characterised by growth of endometrial tissue outside of the uterus. This ectopic tissue, most commonly found in the pelvic cavity but also other areas of the body, responds to the hormonal changes of the menstrual cycle which causes bleeding, inflammation and pain. The prevalence of this disease is estimated to vary from 2-22% of women and 40-60% of those suffering from dysmenorrhoea (painful periods). Despite its prevalence, women suffering from endometriosis often wait many years for a diagnosis or fail to receive a diagnosis at all. Sadly, menstrual pain is still wrongly considered normal, and we are often told to grin and bear it, take some ibuprofen and soldier through. However, the reality is that, for many, pain from endometriosis can be unbearable and causes significant disruption to work and personal lives. There may be pain throughout the cycle, severe fatigue and a variety of other symptoms that are often misdiagnosed or ignored.

Current medical interventions for endometriosis have limitations. Surgery to excise lesions has been found often to only produce short-term benefits, with regrowth common. Hormonal treatments such as the Merina coil or contraceptive pill are not suitable for all and often produce unwanted side effects. These are also not an option for those trying to conceive.

Endometriosis in TCM:

In Traditional Chinese Medicine theory, endometriosis is usually thought to involve a pattern of disharmony called Blood Stasis. The aim of treatment is to move the stagnant Blood, thus reducing pain, lesion size and inflammation. However, Blood Stasis is considered a branch of the main problem (the root), and each patient may have a different root cause of their Blood Stasis. TCM treatment with either acupuncture and/or herbs will aim to identify the individual patterns involved and treat both the root and the branch.

Research round up:

Giese, N., Kwon, K. and Armour, M., 2023. Acupuncture for endometriosis: A systematic review and meta-analysis. Integrative Medicine Research, 12(4): 101003.

This study examined the effect of acupuncture on pain levels and quality of life of patients suffering from endometriosis. Six studies that involved a total of 331 patients were included. Evidence for the benefit of acupuncture was found for overall pelvic pain, menstrual pain, and non-specified pelvic pain compared to usual care, and low rates of adverse effects were reported.

Wang, Y. et al., 2023. Acupuncture and moxibustion for endometriosis: A systematic review and analysis. Complementary Therapies in Medicine, 76: 102963.

Included 15 trials involving 1018 patients. Compared to sham acupuncture, acupuncture was more effective in reducing dysmenorrhea (menstrual pain), pelvic pain, dyspareunia (difficult or painful sexual intercourse), reduced size of ovarian cyst and improved quality of life.

Li, P. et al., 2023. Efficacy of acupuncture for endometriosis-associated pain: a multicenter randomized single-blind placebo-controlled trial. Fertility and Sterility, 119(5): 815-823.

106 women were randomised to receive either acupuncture or sham acupuncture treatments. They received 3 30 minute sessions a week for 12 weeks, and daily treatments during their menstrual periods. All test scores (dysmenorrhoea, pelvic pain, pain duration, depression, mood status and endometriosis health profile) were significantly improved in the treatment group compared to sham at 12 weeks. However, effect was seen to reduce at 24 weeks after discontinuation of treatment, suggesting that ongoing treatment is necessary to maintain benefit.

Lin, Y. et al. 2023. Chinese Herbal Medicine, Alternative or Complementary, for Endometriosis-Associated Pain: A Meta-Analysis. American Journal of Chinese Medicine, 51(4): 807-832.

A total of 34 studies involving 3389 participants were included in this meta-analysis. There was a statistically significant benefit of Chinese herbal medicine (CHM) on dysmenorrhoea at the end of 3 month treatment, with benefits lasting at 6 months but not 9 months after treatment was discontinued. Compared with conventional treatment a significant difference was found in levels of pelvic pain, irregular bleeding and hot flushes.

Yang, X. et al. 2023. Efficacy of Chinese Herbal Medicines on Pregnancy Outcomes in Patients with Endometriosis in Long-Term Management: A Multicenter Retrospective Cohort Study. Chinese Journal of Integrative Medicine, 29(11): 971-979.

Pregnancy and live birth rates in CHM group were significantly higher than non-CHM group for patients with endometriosis.

Gao, Y. et al. 2022. Systemic pharmacological verification of Guizhi Fuling decoction in treating endometriosis-associated pain. Journal of Ethnopharmacology, Oct 28: 297: 115540.

Classic CHM formula Guizhi Fuling decoction, commonly prescribed for treatment of endometriosis, was found to reduce size of lesions, relieve pain symptoms and reduce the serum level of pro-inflammatory cytokines along with their expression in lesion tissue.

May 17 2023

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What makes Chinese herbs so special?

By Emma Houston Jupp Chinese herbal medicine, Traditional Chinese Medicine

In Chinese Herbal Medicine (CHM) we do not simply use the herbs that grow in our gardens. These may be classed as food medicine but would not be potent enough for herbal medicine. In the long, rich tradition of CHM, herbs have been used that have the correct Dao Di. This roughly equates to high quality provenance. Over thousands of years of gathering herbal knowledge, the Chinese established what the best growing locations were for specific herbs, what the correct growth conditions were, and also, crucially, when the best time to harvest was to achieve the maximum therapeutic benefit:

“Daodi medicinal material is defined as medicinal material that is produced and assembled in specific geographic regions with designated natural conditions and ecological environment, with particular attention to cultivation technique, harvesting and processing. These factors lead to quality and clinical effects surpass those of same botanical origin produced from other regions, and thus is widely recognized and has long enjoyed a good reputation.” (Zhao, Guo & Brand, 2012).

The earliest reference to the importance of herbal production regions in the Chinese Materia Medica was in The Divine Husbandman’s Classic of Materia Medica (Shen nong ben cao jing) from the Eastern Han Dynasty 25-220CE. The Newly Revised Materia Medica (Xin xiu ben cao) from the Tang Dynasty (618-907CE) stated “if medicinal material is not produced from its native environment, the effect will be different.” And the Song Dynasty (960-1279CE) text, Extension of the Materia Medica (Ben cao yan yi), declared that “All medicinals must be chosen from suitable production regions”.

It is well understood that plants and their bioactive components are influenced by environmental factors such as topography, climate, soil conditions, light and humidity. The ancient Chinese people said that “tangerine plants grown south of the Huai river produce tangerines, but if they grow north of the Huai river they produce bitter oranges; the leaves are similar but the flavour of the fruit is different.” As Zhao, Guo & Brand note, “Ancient observers recognized that different environments not only produce changes in appearance, they also produce differences in medicinal nature.”

In modern times, we can measure this in labs and ensure that only the highest quality medicinals with the correct levels of active constituent chemicals are used. The approved suppliers of the RCHM all adhere to stringent quality testing to ensure both therapeutic benefit and safety. Herbs are safety-checked for any potentially toxic constituents, adulterants, substitutions or misidentification. We can be sure that the herb is what it claims to be, is of clinical medicinal standard and is safe for human consumption.

But even with our modern quality-controls, in CHM we still adhere to the old traditions of Dao Di. A study from 2003 used high-performance liquid chromatography and spectrophotometry to establish whether there was any difference in the main chemical constituents of San Qi (Panax notoginseng) depending on regional and seasonal variations (Dong et al, 2003). They found that the best quality San Qi was to be found in the southwestern parts of Wenshan and that the best harvest season was September-October which are in line with the traditional Dao Di for this herb.

Further research into Dao Di medicinal material is ongoing: (1) the application of quantitative genetics methods to explore the genetic material basis in order to reveal the molecular mechanism of the formation of Dao Di medicinal material; (2) the application of omics and systems biology to elucidate the contributing factors of Dao Di medicinal material; (3) the application of geographic authentication and protection of the intellectual property rights of Dao Di medicinal material based on its biological, chemical and pharmacological features (Pan, 2011), and this research is one of the key projects sponsored by the National Natural Science Foundation of China.

References:

Dong, T. et al., 2003. Chemical Assessment of Roots of Panax notoginseng in China: Regional and Seasonal Variations in Its Active Constituents. Journal of Agricultural and Food Chemistry, 51: 4617-4623.

Pan, F., 2011. Doadi medicinal material is the essence of Chinese medicine—a review of the 390th session of Xiangshan Science Conference. Science Times, Feb 28, 2011. Beijing, China.

Zhao, Z., Guo, P. and Brand, E. 2012. The formation of daodi medicinal materials. Journal of Ethnopharmacology, 140: 476-481.

May 11 2015

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Mental Health Awareness Week: Depression according to Chinese Medicine

By Emma Houston Jupp Acupuncture, Depression

A while ago I stumbled across a wonderful cartoon story that so perfectly describes the experience of depression.

While everyone will have a different experience, I think those of us who have suffered with depression can all claim to have felt apathetic, foggy and a distinct lack of joy. For many, the inability to feel anything at all really.

Acupuncture made a big difference for me, and now that I’m a qualified acupuncturist myself I am beginning to understand the hows and whys. Every case is different, the background to the illness, the experience of the illness vary with each individual. So diagnosis and treatment will be different for each individual. There is no “one pill cures all”.

Here is a brief and simplified overview of Depression and its relationship to the Five Elements in Chinese Medicine. Often patients fall clearly into one category, others are spread across several, but it is always interesting to recognise some of these characteristics within ourselves.

Wood

The root emotion of the Wood Element is anger. Anger is a positive and healthy emotion when felt and expressed appropriately and proportionately. The Wood Organ, the Liver, is profoundly affected by stress, frustration and unexpressed emotion. The function of the Liver in TCM is to maintain the free flow of Qi around the body, but when this function is damaged or interrupted Qi Stagnation occurs. Tension in body and mind, constriction of the chest, a lump in the throat, headaches, IBS, irritability are all symptoms of Qi Stagnation. An underactive Wood Element can result in someone lacking purpose and ambition, afraid to speak their feelings, burying everything deep inside. An overactive Wood Element creates rigidity, perfectionism and explosive emotions.

Fire

The root emotion of Fire is Joy. The Organ is the Heart, which in TCM houses the Shen (Spirit). When suffering from depression, there is usually at least a little Fire involvement. An imbalance of this Organ results in sadness, anxiety, low self-esteem, timidity, despondency and a general loss of joie de vivre. Insomnia is a common problem. When somebody looks dead behind the eyes, in TCM the Shen is said to have been extinguished. When over-active, Fire may cause over-excitement, excessive talking, self-centeredness, highly sensitive feelings and nervous exhaustion.

Earth

Over-thinking is the root emotion of Earth. Its Organs are the Spleen and Stomach, which oversee both physical and mental digestion. When we start to obsess on something or find ourselves stuck in a cycle of negative thinking, Earth is often at the root. Earth is also the nurturing Element, and the disproportionate worry and anxiety felt by a parent results from this Element being out of balance. A weak Earth Element may manifest in difficulty concentrating, a fuzzy head, a lack of mental clarity, dependency and neediness. When it overacts, Earth may cause over-protectiveness, constant worry and mental churning.

Metal

Metal is the Element of Grief. Its Organ, the Lung, takes in and lets go. Metal is imbalanced when we lose this ability to let go of something or someone, fail to accept reality and move on with our lives. It is no coincidence that following a great loss many people become ill themselves, feeling run down and often catch colds and other viruses very easily. When the Lungs are weak they are unable to provide Wei Qi, the body’s immunity and leave us vulnerable to infections. Metal is also the Element of connectedness. When it is imbalanced, we may find ourselves withdrawing from people and shutting ourselves off from friends and family.

Water

Fear is the root emotion of Water. Again, this is a healthy emotion when felt at appropriate times – it keeps us safe after all. However, when Water is out of balance we can become too afraid to live our lives fully and lose our sense of Will. Loss of confidence and self-sufficiency, feelings of apathy and powerlessness are those of a weak Water Element. An over-active Water Element creates unsettled, workaholic personalities who demand far too much from themselves resulting in burn out. The Water Organ, the Kidney is the creator of our Yin and Yang and without this energy we become exhausted. We spend more energy than we create.