Chinese Medicine Techniques

Acupuncture Microsystems, Cupping, Moxabustion

Acupuncture and herbal medicine are the cornerstones of Chinese Medicine but there are additional therapeutics included in the complex system of medicine used alone or in conjunction with these treatments.

Microsystems
Acupuncture points are commonly known to extend throughout the body along the 12 channels or meridians. There are however, additional points on both the ear and scalp which can be used to treat the entire body.

Ear acupuncture, also known as auricular acupuncture, contains points that in combination can treat obesity, drug addiction, alcoholism, depression, anxiety and hypertension. The ear is rich in blood and nerves and contains many points to treat most areas of the body. Smaller needles and ear seeds are used in the treatment. Ear seeds are used by placing a metal seed with a tape adhesive over an auricular point to apply constant pressure to stimulate the point for the desired effect.

Scalp acupuncture was developed in the 1970's. The theory behind it is to help stimulate areas of the brain to help function and reduce pain. Somewhat like a manual "reset" button. The areas chosen on the scalp are associated with the area of weakness in the brain or body. Scalp acupuncture is often used to treat neurological disorders, strokes, child development disorders and pain.

Moxabustion 
Moxabustion is a technique performed by burning the herb mugwort over the needle to facilitate healing. It helps to strengthen the blood, stimulate the flow of qi and maintain good health. There are two types including direct (on the skin or needle) and indirect (away from the skin). A pleasant heating sensation should be felt on the area being treated. Moxabustion is used to expel cold and move stagnation in the body. Historically, it has even been used to turn breech babies by applying moxabustion to the little toe.

Cupping
Medical texts from Egypt dating back to 1550BC and 1000BC in China describe the use of cupping. Cups are placed on the skin to create suction. The suction helps increase blood flow to promote healing. The cups are left in place for 5-10 minutes or can be moved to massage the underlying tissue. Conditions treated include pain, skin disorders, fertility, lung congestion, anxiety and depression.

Utilizing these additional techniques can enhance your Chinese Medicine therapies and supplement any healthcare plan.

Annual updates

Primary Care Screening

Take Charge Of Your Health Today!

Have you scheduled a visit with your health care provider in the past year? If not, it may be time to do so. Below are updated resources for 2014 to help you know what tests are recommended for your age and sex. Take the opportunity to discuss with your doctor any health concerns, family health history and what the below screening tests can tell you about your level of health.

Screening recommendations are made to assist us in assessing our risk of developing disease and identifying pathology that has arisen in our bodies. The goal is to "catch" any abnormalities in early stages or before the body develops physiologic changes into disease. Identifying abnormalities early allows for better opportunities for the most effective treatments with fewer side effects and generally better outcomes. By getting the best health services, regular screenings and treatments, you will increase your chances of living a longer, healthier, higher quality of life.

Screening recommendations can be confusing at times. They may vary based on gender and age as well by which association is making the recommendation. For best insight I make comparisons between some of the leading organizations including:

American Cancer Society                     
American Gastroenterological Association
American Heart Association
American Medical Association
Center for Disease Control and Prevention
National Institutes of Health/National Cancer Institute
National Osteoporosis Foundation

Primary care screening should include the following: (Variations in screening recommendations vary with a current or past history of disease. Discuss screening guidelines with your doctor.) 

Breast

• Starting at age 40 yearly mammograms continuing until a woman is in good health.
• Clinical breast exam every 3 years for women 20-39 years old and annually thereafter.
• MRI in addition to mammogram may be recommended for women at higher risk due to genetic alterations, family history or other factor. Discuss this with your doctor.

 Breast Cancer: Early Detection

Cervical

• Women ages 21-29 should have a pap every 3 years. HPV test should be added if there is an abnormal pap.
• Women ages 30-65 should have a pap test plus an HPV test every 5 years. A pap alone can also be done every 3 years.
• Women over age 65 who have had regular cervical cancer testing with normal results should not be tested for cervical cancer. Women with a history of serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing continues past 65.
• A woman who has been vaccinated against HPV should still follow the screening for her age group.

Cervical Cancer: Prevention and Early Detection

Endometrium 

• By age 35, if high risk, a woman should be offered an endometrial biopsy.
• Each year a woman should be informed about the risks and symptoms of endometrial cancer, and about the potential benefits, risks, and limitations of early endometrial cancer detection. 
• At menopause women are strongly encouraged to report any unexpected bleeding or spotting to their doctor. 

Endometrial Cancer 

Prostate

• Starting at age 50, men should talk with their doctor about the pro's and con's of testing. If they are African American or have a father or brother who had prostate cancer before age 65, men should have this talk with their doctor starting at age 45.
• Testing includes a PSA blood test with or without a rectal exam. Frequency of testing will depend on their PSA level.

Prostate Cancer: Early Detection

Colorectal

Beginning at age 50, both men and women should follow one of the following:

• Flexible sigmoidoscopy every 5 years, or
• Colonoscopy every 10 years, or
• Double-contrast barium enema every 5 years, or
• CT colonography (virtual colonoscopy) every 5 years
• Yearly fecal occult blood test or fecal immunochemical test

Colorectal Cancer: Early Detection

Lung

Discuss with your doctor the benefits, limitations, and potential harms of lung cancer screening with:

• Individuals ages 55-74, in fairly good health, with at least a 30 pack-year history of smoking (estimated by number of packs per day x number of years smoked), and are still smoking or have quit within the last 15 years.
• If screening is indicated, a low-dose CT scan of the chest yearly through age 74 as long as you remain in good health is recommended. 

http://www.cancer.org/healthy/findcancerearly

Type 2 Diabetes

Clinical judgement and patient preference will determine diabetes screening.

• Beginning at age 45, every 3 years particularly in those with a BMI >/=25kg/mg2  
• Consider testing at a younger age or be carried out more frequently in individuals that are overweight and have one or more other risk factors.      

http://www.care.diabetesjournals.org/content/27 

Osteoporosis

Bone Mineral Density (BMD) should be performed:

• In women age 65 and older and men age 70 and older.
• In postmenopausal women and men age 50-69 based on risk factor profile.
• BMD and vertebral imaging to those who have had a fracture, to determine degree of disease severity.
• At DEXA facilities using accepted quality assurance measures.

http://www.nof.org/files/nof/public/content/file/950/upload/523.pdf

Cholesterol

• Adults aged 20 years and older should have their cholesterol checked every 5 years.

http://www.cdc.gov/features/cholesterolawareness/ 

General Screening

Additional screening includes blood pressure, weight, dental, vision, hearing, immunizations, infectious disease, tobacco, alcohol, depression and physical exams. Based on age, gender and risk factors recommendations vary.

Blood pressure goal is <120/80.

Weight: goal is Body Mass Index (BMI) 18.5-24.9. BMI is calculated using height and weight. 
See link on BMI for more details and to calculate your BMI. http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

Immunizations
See the Center for Disease Control website for a detailed explanation of the recommended vaccine schedule and information about each vaccine.
http://www.cdc.gov/mmwr/preview/mmwrhtml/su6201a3.htm

Infectious disease
For a full look at infectious disease preconception testing recommendations review this link.
http://www.cdc.gov/preconception/careforwomen/disease.html


For more details go to:  http://www.nlm.nih.gov/medlineplus/ency/article/002125.htm

This post has been updated from my posting in April of 2013.
Image courtesy of http://photobucket.com/images/weight%20scale?page=1

Radiation Induced Xerostomia (Dry Mouth)

Acupuncture Can Help

Radiation induced xerostomia is a common side effect 
experienced from radiation therapy to the head and neck region.   

Radiation treatments are often given as a therapy for cancers involving the oral cavity, pharynx, larynx, paranasal sinuses, nasal cavity and salivary glands. 

Patients who receive radiation to the head and neck may experience redness, irritation, and sores in the mouth; a dry mouth or thickened saliva; difficulty in swallowing; changes in taste; or nausea. (1)

Why is dry mouth a problem?
Besides causing the aggravating symptoms mentioned above, dry mouth also increases a person's risk of gingivitis, tooth  decay and mouth infections such as thrush. (2) Irritation to the mouth and thick saliva contribute to difficulty eating which often affects proper nutrition and dietary intake needed to maintain good quality health and healing.

Treatment
Acupuncture is a viable option for prevention and treatment of radiation induced xerostomia. There are several studies showing support for the use of acupuncture to help stimulate the salivary glands in the production of saliva (see below). Most recently however, MD Anderson Cancer Institute along with Fudan University in Shanghai Cancer Center completed a study using acupuncture as a preventative therapy for dry mouth finding there is benefit in using it before symptoms present themselves from radiation therapy.

86 patients with nasopharyngeal carcinoma were treated in the study. Forty patients were randomized to acupuncture and 46 to the standard of care. Those in the treatment arm received acupuncture therapy three times per week during the seven-week course of radiotherapy. Patients were evaluated before radiotherapy, weekly during radiotherapy, and then again one and six months later. The results were based on data derived from two self-report questionnaires and measuring actual saliva flow. Patients completed the Xerostomia Questionnaire (XQ), an eight-item survey which assessed symptoms consistent with the condition.  XQ scores under 30 corresponded to mild or no symptoms of xerostomia. (3) 

The largest group differences in XQ scores were seen by the end of radiotherapy, but the differences persisted over time.  By one month after the end of radiotherapy, 54.3 percent of the acupuncture group reported XQ scores greater than 30, compared to the control group at 86.1 percent. By six months after radiotherapy, the numbers dropped to 24.1 percent in the acupuncture group and 63.6 percent of the control group still reporting symptoms of xerostomia.  Saliva flow rates were also greater in the acupuncture group, starting at three weeks into radiotherapy and persisting through the one and six month follow-up. (3) 

The second measure, MD Anderson Symptom Inventory Head and Neck (MDASI-HN), ranked the severity of cancer-related symptoms, other than xerostomia, and their interference with quality of life. The team also measured saliva flow rates using standardized sialometry collection techniques. (3)

Watch this video discussing how acupuncture works in xerostomia.
http://www3.mdanderson.org/streams/CompactVideoPlayer2.cfm?xml=cfg/Acupuncture-Study-2011--cfg

Supporting research on acupuncture and xerostomia:
1. http://www.ncbi.nlm.nih.gov/pubmed/22072272
2. http://www.ncbi.nlm.nih.gov/pubmed/18532895
3. http://www.ncbi.nlm.nih.gov/pubmed/11920486
4. http://www.ncbi.nlm.nih.gov/pubmed/10673783

For additional tips to support dry mouth go to:
http://www.mayoclinic.com/health/dry-mouth/AN02112

References:
1. http://www.cancer.gov/cancertopics/factsheet/Sites-Types/head-and-neck
2. http://www.webmd.com/oral-health/guide/dental-health-dry-mouth
3. http://www.mdanderson.org/newsroom/news-releases/2011/ut-md-anderson-study-finds-acupuncture-can-prevent-radiation-induced-chronic-dry-mouth.html

Image courtesy of http://www.intelligentdental.com/wp-content/uploads/2011/10/dry-tongue.jpg

Beneficial Estrogen Metabolism in Breast Cancer

The Benefits of Diindolylmethane 
(DIM)

Diindolylmethane is formed in the body through digestion of plant substances contained in “cruciferous” vegetables such as cabbage, Brussels sprouts, cauliflower, and broccoli. Scientists think these vegetables may help to protect the body against cancer because they contain diindolylmethane and a related chemical called indole-3-carbinol. (1)

AFFECTS IN THE BODY

DIM has the biological properties listed in the chart below. Because of its various potential anticancer properties, including estrogen metabolism, the National Cancer Institute of the United States has begun clinical trials of DIM as a therapeutic for numerous forms of cancer including breast cancer. (2) 

Biological activities of 3,3'-diindolylmethane

HEALTHY ESTROGEN METABOLISM
The standard explanation for the association of cumulative, excessive estrogen exposure and breast cancer risk is that estrogen and perhaps progesterone affect the rate of cell division; and thus manifest their effect on the risk of breast cancer by causing proliferation of breast epithelial cells. Proliferating cells are susceptible to genetic errors during DNA replication which, if uncorrected, can ultimately lead  to a malignant phenotype. (3) Oxidative metabolites of estrogens have been implicated in the development of breast cancer, thus addressing estrogen metabolism can be a method of prevention.

According to National Cancer Institute: “Diindolylmethane promotes beneficial estrogen metabolism in both sexes by reducing the levels of 16-hydroxy estrogen metabolites (“bad estrogens”) and increasing the formation of 2-hydroxy estrogen metabolites (“good estrogens”), resulting in increased antioxidant activity.”

SUPPORTING EVIDENCE
DIM supplementation has been shown to alter estrogen urinary metabolites in women. In a prospective placebo-controlled pilot study 19 post-menopausal women with a history of early stage breast cancer were randomized to receive 108mg DIM or placebo for thirty days. Urinary metabolite analysis was conducted for 2-hydroxyestrone (2OHE-1), 16-alpha hydroxyestrone (16alpha=OHE-1), DIM, estrone (E1), estradiol (E2), estriol (E3), 6beta-hydroxycortisol (6betaOHC) and cortisol. The treatment group demonstrated significant increases in levels of 2-OHE1 (P=0.020), DIM (P=0.045), and cortisol (P=0.039) and a non-significant increase in the 2-OHE1/16alpha-OHE1 ratio from 1.46 to 2.14 (P=0.059). The results of this study demonstrate that DIM supplementation increases 2-hydroxylation of urinary estrogen metabolites. But whether this translates to reduced cancer risk has not been confirmed. (4)

Evidence continues to build supporting the use of DIM and its potential as a therapeutic agent in breast cancer prevention and possible treatment. The standard recommended dosage of bioavailable DIM for women is 100-200 mg of DIM daily. Men typically need a higher dose than women, such as 200-400 mg per day.

A review of active clinical trials involving DIM:
http://clinicaltrials.gov/ct/search?term=diindolylmethane

Additional reading on Healthy Estrogen Metabolism and DIM:
http://www.dimfaq.com/

References:

1. http://www.webmd.com/vitamins-supplements/ingredientmono-1049-DIINDOLYLMETHANE.aspxactiveIngredientId=1049&activeIngredientName=DIINDOLYLMETHANE
2. http://en.wikipedia.org/wiki/3%2C3%27-Diindolylmethane
3. Afr J Reprod Health. 2006 Apr;10(1):13-25.
4. Nutr Cancer. 2004;50(2):161-7.
Image courtesy of http://bonnieplants.com/wp-content/uploads/2011/10/brussels-sprouts-growing-lo.jpg

FLAXSEED USE IN BREAST CANCER

Current Research

Flaxseed, also known as linseed, is prominently known for its high content of omega-3 fatty acids, fiber and lignans. It is mainly because of the lignans however, that the seed has gained popularity and become a food of interest in breast cancer research.

According to a study published in 2011 in The Journal of Nutrition the phytoestrogen lignans are naturally occurring compounds with structural similarity to endogenous estrogens. Lignans are widely available in whole grains, seeds, nuts, legumes, fruit, and vegetables, with the highest concentration in flaxseed and bakery products containing flaxseed.

In human and experimental studies, high lignan intakes (from flaxseed) affect endocrine and growth factor pathways through a number of mechanisms, including modification of steroid hormone metabolism, modification of insulin-like growth factor and epidermal growth factor, and inhibition of aromatase and 17β-hydroxysteroid dehydrogenase. Lignans inhibit cell proliferation in both ER+ and ER− cell lines, reduce tumor growth and metastasis in a number of animal models, and work synergistically with Tamoxifen to reduce tumor growth. 

Several, but not all, epidemiologic studies report reduced risks of breast cancer associated with higher exposure to dietary lignans, expressed as either dietary intakes or as plasma, serum, or urinary lignan concentrations. The protective effect of lignans may also be stronger in specific subgroups of women with breast cancer; lower risks have been reported to be limited to premenopausal women, women with specific CYP17 genotypes, and recently for ER− breast cancer (1).

Several studies have found that higher lignan intakes were associated with lower risks of breast cancer with more favorable prognostic characteristics, lower tumor biomarkers and inhibition of the growth and metastasis of human breast cancer (2). 

All this said, Ruth Patterson, PhD who wrote an article entitled: Flaxseed and Breast Cancer: What Should We Tell Our Patients? in the Journal of Clinical Oncology states, "the prudent clinician should be wary of recommending high doses of any dietary compound solely on the basis of laboratory and observational epidemiologic studies". She based this opinion on the fact that in humans, lignans are metabolized by the gut microflora into enterolignans; enterolactone is the main metabolite. Therefore, enterolactone concentrations in serum, plasma, and urine have been used as biomarkers of dietary lignans. Studies indicate that women with higher levels of serum enterolactone have approximate 40% reduced risk of overall mortality and distant disease. 

However positive this seems, there happen to be several variables that must be considered when using enterolactones as a secure indicator Patterson states: "Serum enterolactone concentrations are an imperfect measure of dietary intake because they reflect (in unknown proportions) dietary intake of lignans, other dietary and environmental exposures, and host characteristics" (3). Thus the take home message is baseline levels of enterolactones obtained from our daily diet may be supportive for breast cancer risk reduction but supplementing with higher quantities may or may not achieve this outcome.

Continued research is warranted to support supplemental flaxseed intake for breast cancer prevention and support. I recommend the use of flaxseed to be a part of a balanced diet using 1-2 tablespoon daily and only 1 tablespoon daily as an upper limit in ER+ patients.

Additional reading from leading cancer institutes:

Dana-Farber Cancer Institute 

http://www.dana-farber.org/Health-Library/Phytoestrogen-s-Role-in-Estrogen-Positive-Breast-Cancer-Patients.aspx

Memorial Sloan-Kettering Cancer Center

http://www.mskcc.org/cancer-care/herb/flaxseed

American Institute for Cancer Research

http://www.aicr.org/assets/docs/pdf/education/FlaxseedBreastCancer.pdf

References

1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237232/

2. http://www.mskcc.org/cancer-care/herb/flaxseed

3. http://jco.ascopubs.org/content/29/28/3723

Image courtesy of: http://www.wikihow.com/Prepare-Flax-Seeds

ACNE

TAKE BACK YOUR SKIN

Acne is a disease of Western civilization affecting approximately 50 million individuals in the United States. Skin is our largest organ and the biggest organ of detoxification. It functions to protect us from microorganisms, repel chemicals, prevent excess water loss and guard against UV radiation. It also helps us regulate temperature, produce vitamin D and acts as a sensory organ. The skin has 3 layers including the epidermis, dermis and hypodermis. Our epidermis contains 3 types of cells including basal, squamous and melanocytes. The dermis contains sweat glands, blood vessels, sebaceous (oil) glands, nerve endings and is where vitamin D is synthesized. The hypodermis or subcutaneous layer contains fat cells.

In Naturopathic medicine we look to several different areas to address the cause of acne including bacteria, sebum and terrain.

Bacteria
In acne patients normal flora, Propionibacterium acnes, generates components that cause inflammation and irritate the skin. White blood cells are drawn to the area and which weaken the walls leading to rupture. Pustules and cysts can form from foreign body reaction.

Sebum
Propionibacterium acne proliferates in sebum, altering the epithelial lining which forms plugs called comedones. Sebum in acne patients tends to be of poor quality from consumption of poor quality, heat damaged food such as trans fats and high omega 6/omega 3 ratio. Bacteria living off this poor quality sebum generate byproducts leading to acne.

Terrain
This encompasses a wide variety of internal and external factors including genetics, diet and environmental toxins. An imbalance in gut flora (dysbiosis), high simple carbohydrate diet, poor quality fats and proteins, food allergies and weak digestion can all contribute to the occurrence of acne.

Taking back your skin!
Skin health is very much in your hands. Here are some suggestions to help balance your digestion to promote a healthy terrain and sebum.

• Avoid high glycemic carbohydrates (see link for further description of these foods). http://whfoods.org/genpage.php?tname=faq&dbid=32
• Eliminate trans fatty acids
• Eat a diet high in omega 3 fatty acids. We tend to get enough omega 6 in our diet and the balance of 6:3 is generally too great. (See link for omega 3 foods) http://www.whfoods.com/genpage.php?tname=nutrient&dbid=84
• Add fermented foods to your diet for the natural probiotics such as sauerkraut, kimchi, kombucha, miso, kefir and tempeh. 

Adding a probiotic, fish oil and certain vitamins, minerals and botanicals through nutritional supplementation can also be an effective method to restore gut health, reduce inflammation, support nutrition and healthy skin.

Detoxification 
Further internal healing of the digestive tract and skin can be achieved by eating an anti-inflammatory diet, cleansing, colonics, sauna and dry skin brushing. Talk with your naturopath to assist you in making a comprehensive plan to promote skin health.


Images courtesy of: Beautiful Young Woman With Clean Skin Of The Face" by posterize

INFLUENZA

                      ' Tis the Season

                                                                       

The season has changed and autumn is upon us. This of course means change in temperature to cooler and more windy, damp weather. It also means it is time to think about protecting ourselves from the seasonal pathogen of influenza.

Western medicine and Naturopathic/Chinese Medicine acknowledge influenza as a seasonal illness but address it in very different ways.

Western Medicine

According to the Center for Disease Control, flu season lasts from October to May with every flu season being a bit different and affecting people in a variety of ways. We know in both Western and Naturpathic/Chinese Medicine that those who are more vulnerable must take extra precaution to prevent illness so not to have serious outcomes from the influenza virus.

Western Medicine recommends the flu vaccine as one of the priority measures of prevention. Take a look at the CDC website for recommendations about who should receive the vaccine, how the vaccine works and when it is recommended to get a vaccine.

http://www.cdc.gov/flu/protect/keyfacts.htm

Chinese Medicine and Naturopathic Medicine

Traditional Chinese Medicine (TCM) and Naturopathic Medicine focus on understanding the patient's underlying constitution and the type of influenza virus and pattern of symptoms. For example a common pattern in TCM manifests as a serious wind-heat or wind-cold pattern, mixed with dampness or food stagnation while the less severe type manifests as a milder wind-heat or wind-cold pattern, and the viral pneumonia type exhibits as heat obstruction of the Lung.

For further explanation of Chinese Medicine patterns and diagnosis, see:

http://drrademacher.blogspot.com/2013/08/chinese-medicine.html

The holistic medicine practitioner must consider the lifestyle and constitution of the patient such as stressful lifestyle, poor dietary habits, inadequate sleep, low immunity or chronic illness that may not allow the person to protect themselves from these climactic factors and seasonal pathogens. Naturopathic Medicine places great importance on supporting the body’s vitality by supporting optimal health with the previous mentioned factors.

Here are some recommendations to prevent acquiring the seasonal flu:

• Cover coughs and sneezes
• Wash hands often
• Stay home when sick
• Clean surfaces and objects in your environment
• Consider taking supportive supplements/herbs for your immune system and at first onset of symptoms. Ask your naturopath or Chinese medicine practitioner for recommendations.
• Acupuncture
• Hydrotherapy
• Lifestyle Modifications: adequate sleep/rest, whole foods diet, stress reduction, regular exercise.

Image courtesy of: http://www.freedigitalphotos.net/images/agree-terms.php?id=100111172. Sick Woman Covered With Blanket At Home" by marin.