Coffee, Tea, and Acupuncture for Pain – They May Not Mix

Acupuncture is widely used for any number of health issues. Chronic pain, of any nature, is one of the most common reasons for visiting an acupuncturist. The effectiveness of acupuncture on pain generally has been shown clinically as well as within many published studies. What hasn’t been looked at as strongly is what potential influencers may block the positive effects of acupuncture.

I get asked fairly often can I do “x”, “y” and/or “z” after acupuncture. For the most part my answer is always – yes. I generally counsel people against strongly vigorous exercise right after acupuncture (not that most people feel like doing that) and to avoid heavy meals, but other than that I’m of the opinion that there is little that can be done to strongly block the effect of acupuncture.

An interesting study came out from researchers at the Eastman Institute of Oral Health within the University of Rochester in New York. They looked at the effects of having caffeine in the body when having acupuncture for pain. The researchers were following up on a previous study where they were trying to deeply explore how acupuncture helps with pain. This initial study drew the following conclusion:

Although acupuncture has been practiced for over 4,000 years, it has been difficult to establish its biological basis. Our findings indicate that adenosine is central to the mechanistic actions of acupuncture. We found that insertion and manual rotation of acupuncture needles triggered a general increase in the extracellular concentration of purines, including the transmitter adenosine (Fig. 1), which is consistent with the observation that tissue damage is associated with an increase in extracellular nucleotides and adenosine36

This nucleoside adenosine will help slow down nervous system activity, promotes sleep, dilates blood vessels, etc. These functions will effectively limit or block pain signals. The stimulant effect of caffeine is primarily the result of caffeine binding to these molecules and in effect blocking their downregulating functions – thus waking you up ( 1 ).

In effect, then, the pain relieving effect of acupuncture is due to increasing adenosine (among other factors). So as these researchers speculated, caffeine blocks this effect. They concluded in their study that:

a trace amount of caffeine can reversibly block the analgesic effects of acupuncture, and controlling caffeine consumption during acupuncture may improve pain management outcomes

Interestingly they even tried injecting caffeine at the acupuncture point to see if it was only systemic caffeine that created the issue or if it was locally blocking the door of the acupuncture point so to speak. It appears, at least from this study, that caffeine closes the door to certain functions of acupuncture with particular relation to pain – although possibly many others.

More studies will have to be done to further explore this – both to see what other functions caffeine may be blocking and to see if other acupuncture techniques can override the binding of adenosine by caffeine. For now, it may be a good idea to have patients not have caffeine before their treatment, particularly if they are coming with chronic pain issues.

Successful Long Term Treatment of HIV/AIDS with Only Chinese Herbal Medicine

Traditional Chinese Medicine (TCM) includes acupuncture, Chinese herbal medicine and a host of other techniques. The majority of TCM has numerous studies and thousands of years of clinical information showing positive effects on immunity and inflammation among many other issues. HIV/AIDS is by any standard an extremely complicated condition and proper treatment is absolutely critical. This is in part for the longevity and wellness of the patient but to also reduce the spread of the virus.

What is presented within this article is a series of case studies of poor Chinese villagers with HIV who chose to participate in a TCM only treatment study. By all accounts modern western therapy for much of the world is either difficult to access and/or afford or the side effects are unmanageable with their level of available care making any or complete use of western drugs unfeasible. While the results presented by these practitioners are clinically interesting, much more research would have to be done to understand more defined and reliable Chinese herbal medicine approaches.

TCM has long been used to limit or balance the side effects of many strong western medications and there has always been a place for the combination of the two approaches (at least from the Chinese Medicine side of that equation). Within the world of HIV/AIDS care TCM has played an important role as well around the world. In the US one of the first TCM related public health services for HIV+ patients was the AIDS Care Project in Boston. The AIDS care project (1989-2014) provided biweekly acupuncture treatments along with herbal medicine care by donation via government public health funding. The work of that project is still carried on in satellite clinics and via individual acupuncturists. There are a number of others projects around the country that follow this model as well as projects such as the global acupuncture project who provides training and treatment to communities at need around the world.

While much TCM related research and effective clinical work has been done to alleviate side effects of both AIDS and western medications, not as much has been done to show treatment without western medications. A team of researchers from the Institute of Biomedicine at Jinan University in Guangzhou China and the Public Health Preparedness for Infectious Disease Program at The Ohio State University in Columbus Ohio set out to explore the TCM only/TCM primarily approach.

Publishing in the AIDS research and human retroviruses journal the researchers explored case studies of 9 rural Chinese patients with AIDS. The patients ranging in age from 51 to 67 were from an “AIDS village” in Anhui Province and had contracted HIV around 1994 through the donation of plasma. While there were over 40 patients in the village at the time, only 9 were confident enough in TCM to participate in the study. The patients were treated either with TCM alone for a 9 year span or TCM alone for a 5 year span followed by occasional antiretroviral therapy. The TCM treatment included a formula comprised of 13 herbs including Ren Shen (ginseng) and Huang Qi (astragalus), both of which have effects on digestion/immunity/weakness of the body and Huang Qin (skullcap), which clears heat in the digestive tract and elsewhere.

As a clinical sidenote herbal therapy would ideally be tailored to each individual. While there a host of tonifying herbs that are critical to provide aid to the bodies immune system, treatment would be balanced with others that clear heat, aid digestion, aid the liver, harmonize the digestive tract, and/or clear pathogenic influences.

The researchers found that in 2016 eight of the nine followed patients had undetectable viral loads and the ninth had a very low viral load and they were all in good health overall. Through various diagnostic mechanisms the researchers were able to confirm that these 9 patients were not anomalies such as “long-term non-progressors” or “viremic controllers” – that is they were not by all clinical accounts from the group of people that seem to be HIV+ but display little or none of the clinical symptoms (by some accounts this is between 1% and 5% of all HIV+ patients).

According to the researchers these case studies show that TCM has the potential to “become a functional cure for HIV/AIDS”.

Being far more cost effective than western medications and very likely far less damaging over the long-term, more research towards the TCM only approach is warranted.

Pulse Diagnosis in Chinese Medicine – Starting A Modern Scientific Method

Chinese Medicine is as much an art as it is a science. One of the strongest values of Chinese Medicine is how a practitioner can look deeply into each patient and find the causal factors driving their illnesses and tailor a treatment directly to them. There is an intuitive part to this, an artistic part and a scientific part – all of which are fostered by training and clinical experiences.

To uncover and ultimately treat these underlying diagnostic “patterns” the Chinese Medicine practitioner utilizes many diagnostic tools. The most common ones are described within the “examinations and diagnosis” section on our theory site.

Of these tongue diagnosis and pulse diagnosis are arguably the most important and most clinically valid. Tongue diagnosis has the benefit, in my opinion, of being far less subjective – in other words more practitioners will see the same things on the tongue in the same way when compared with how they might come to different conclusions with the pulse. The pulse, however, will show a wider range of imbalances and can be extremely useful in deciphering the root of mixed patterns.

In pulse diagnosis you are looking for certain qualities of the pulse (not just rate as most would assume). So terms such as “slippery”, “wiry”, etc. are used in conjunction with certain pulse positions. There are a few alternate pulse positions to check on the wrist and then others elsewhere on the body. A common positional understanding includes 3 positions on each wrist along the radial artery starting behind the wrist crease. On the left wrist closest to the crease you see relationships with the heart system, the liver behind that and the kidney behind that and on the right wrist you have the lung system at the crease, the spleen system behind that and the mingmen behind that.

Left Wrist Right Wrist
Cun (inch) - 1st position HT / SI LU / LI
Guan (barr) - 2nd position LV / GB SP / ST
Chi (foot) - 3rd position KD / UB Mingmen / Lower Burner

A basic diagnostic example might be as follows: For someone that we might reference as “stressed out” in the west – they might have what we call “liver qi stagnation” in Chinese Medicine. We wouldn’t, however, just assume they have this diagnosis because they describe being “stressed out” (see “treating the cause and not the symptoms” for more on this) – we would come to this conclusion from using all of the diagnostic tools referenced above. Their tongue might be purple which can indicate “stagnation”
particularly on the sides which is the “liver” area on the tongue, and their pulse might be “wiry” – particularly in the 2nd left wrist position which correlates with the liver system. That, of course, is a very simplified example.

Now one of the problems with pulse diagnosis as I hinted at above is that it can be quite subjective once you get beyond the more simple cases. You could line up 50 tcm doctors and have them all look at the tongue and pulse and with the tongue you would (just guessing here) get probably 40 out of 50 in agreement with only mild nuances differing, but with the pulse you might get 10 out of 50 – partially because it is offering more information admittedly and there are different systems of correlations. But, in my experience and opinion, it would be different (an interesting study to perform for those researchers that might be reading this).

To compensate for this arguable lack of precision a group of researchers from Taiwan recently conducted a study looking at more scientifically measurable pulse variations and trying to group them into diagnostic categories. Involving researchers from the division of cardiology at the Chang Gung Memorial Hospital and the Institute of Traditional Medicine at National Yang-Ming University among others they aimed to correlate a range of pulse wave parameters and heart rate variability with standard TCM diagnoses.

To perform the study they recruited 69 relatively healthy volunteers and utilized a wrist blood pressure cuff called “ANSWatch” and obtained pulse readings at the left guan position (the liver area). Utilizing a range of measurements including blood pressure, augmentation index and subendocardial viability index they tried correlating these to each volunteers diagnosis in Chinese Medicine terms.

The researchers found:

  • Those with qi deficiency had higher augmentation index scores and lower diastolic blood pressure.
  • This with yang deficiency had lower systolic blood pressure, lower pulse pressure and lower dP/dt max (a measure of ventricular contraction strength).
  • This with damp-heat had higher subendocardial viability index scores.

Now there are a million caveats with a study of this nature all indicating that there is much more research to be done before this would lead to clinically valid ways of obtaining or helping to confirm diagnoses in Chinese Medicine. But this is a nice approach to using modern western diagnostic tools with time proven traditional medicine tools. Particularly since proper diagnosis is so crucial within Chinese Medicine to obtain the best clinical outcomes.

Warm Moxibustion Found Most Effective for Irritable Bowel Syndrome (Study)

Irritable bowel syndrome (IBS) is a very commonly treated condition within Chinese Medicine. It along with a host of other digestive issues tend to respond quite well to acupuncture, herbal medicine, and as this study indicates techniques such as moxibustion.

As IBS can be quite debilitating and it seems to affect 15% or more of the general population it is important to work towards resolving this condition in efficient and cost effective terms. While the underlying causes of IBS are poorly understood, there are some factors that likely contribute such as poor dietary choices, high stress levels, influences of medications and other drugs and more. Many people, however, make many positive changes in their diets and lifestyle and still have issues. To explain this, current research has indicated that IBS is at least contributed to by, if not outright caused by, a faulty communication between the brain and the gastrointestinal tract.

I have written previously about IBS and Chinese Medicine. One article explores Tong Xie Yao Fong Wan and its mechanisms for treating IBS and Crohn’s. Another article, which is related to this current study, looked at some general mechanisms for how moxibustion helps IBS. (See “what is moxibustion?” if you are unfamiliar with the technique.)

As always, proper treatment in Chinese Medicine requires proper diagnosis (see “Treating the cause and not the symptoms“). For IBS there are a good number of potential diagnoses from a Chinese Medicine perspective. This is important to understand generally, but in this case it is important to understand the limits of studies like the one I’ll be discussing today. In short, just because you have IBS doesn’t mean that the basic techniques discussed in this article will be directly relevant to you. That said, the value of these studies to practitioners and our general understanding of how Chinese Medicine works is quite high.

In the study I’m discussing today researchers from the Shanghai Institute of Acupuncture-Moxibustion and Meridian publishing in the World Journal of Gastroenterology looked at the biochemical effects of two common stimulation techniques – electro-acupuncture (EA) and moxibustion. Their goal was both to understand the underlying mechanisms of how these techniques help IBS and to also see what worked best.

In the study (using a rat model) researchers used the acupuncture point stomach 37 (ST 37), or “upper great hollow”. ST 37 is commonly used for a range of more “excess” digestive conditions such as diarrhea, abdominal pain, bloating, constipation and more. A recent article “how ST 37 works for constipation” gets into some further details of how that point functions internally.

They compared two types of stimulation to two different degrees – moxibustion at 43ºC vs. 46ºC and electro-acupuncture at 1mA vs. 3mA. Both moxibustion and electro-acupuncture are commonly used treatment mechanisms for a range of conditions. In clinical reality you’d often times be using both or at least regular body acupuncture with moxibustion, but these results may serve to simplify the range, duration and amount of clinical techniques applied.

Researchers looked at a range of changes from stimulating ST 37. These included the following:

  • Mast cells (MC) activity – involved in the inflammatory response and are often elevated in patients with IBS, they modulate nerve activity in the colon. ( 1 )
  • 5-hydroxytryptamine (5-HT) expression – better known as “serotonin” for which the colon is the largest producer – imbalances here are linked with many colon issues including IBS, cancer, diverticulitis and celiac disease, among others ( 2 )
  • 5-hydroxytryptamine 3 receptor (5-HT3R) expression – when activated may lead to nausea, anxiety and other reactions via the central nervous system – as well as 5-HT4R expressions

The researchers found that while all techniques showed to direct the biochemical changes that aid in the reduction of IBS symptoms the warmest moxibustion at 46ºC (114ºF) was the most effective.

This is interesting to me because some consider EA to provide a stronger stimulation to certain acupuncture points. But here it was the warmth and the possible oil/chemical interactions with moxibustion that provided the best outcome. It may be that the warmth provided and the circulation that increases because of this literally forces the body to turn off the inflammatory markers so that it can respond properly. But these are questions that are not easy to answer, particularly when you are applying stimulation to acupuncture points that are nowhere near where the clinical problems exist. Regardless it may worth exploring both the actual temperature that moxibustion provides to see if warmer stimulation leads to better clinical outcomes as this study indicates.

Study Finds Xiao Chai Hu Tang Offers An Anti-Depressant Effect

Xiao Chai Hu Tang is one of the most important formulas within the extensive offerings of Chinese herbal medicine.  As with many Chinese herbal medicine formulas it offers benefit for a broad range of issues when it is properly used according to the correct underlying diagnosis (see “how to choose an herbal formula” for more on this).  In the case of xiao chai hu tang this range of symptoms falls under what we term shao yang disorders; a term indicating conditions that are affecting the body both externally and internally at the same time.  A common example would be someone who had a flu that cleared perhaps weeks or months ago but they have never felt quite right since that time and still get strange vacillations in temperature and symptoms.  The formula, however, goes much broader than that.


Technically the formula falls into the harmonize category of Chinese herbal medicine which are essentially balancing formulas.  Without getting into too much detail, basically formulas for colds such as yin qiao use heat clearing and outward moving herbs which taken over long periods or with underlying deficiencies can be too weakening over time potentially creating internal issues, then formulas that too strongly strengthen the internal deficiencies can drive external conditions deeper making them harder to resolve.  Xiao Chai Hu Tang is important because it will both help resolve internal issues as well as push out external pathogens without causing problems to either.

In clinical practice Xiao Chai Hu Tang ends up being used for a range of mild conditions such as colds, flus and allergies, through more moderate conditions such as PMS, depression, chronic fatigue syndrome, fibrosis, gastritis and then on to serious conditions such as liver cancer, cirrhosis, pancreatitis and much more.

In the study I’m discussing today we are solely focused on the anti-depressant effects of Xiao Chai Hu Tang.  Researchers from Shenyang Pharmaceutical University in Shenyang China recently used a rat model to more deeply understand the biochemical interactions of Xiao Chai Hu Tang and the hypothalamic-pituitary-adrenal (HPA) axis.  The HPA axis in the most basic terms possible is the interaction between stress related hormones such as cortisol and the chemical changes in the brain that are involved in a variety of mood disorders.  For a lengthy discussion on this phenomena and it’s role in major depressive disorders, see “The Hypothalamic-Pituitary-Adrenal Axis in Major Depressive Disorder: A Brief Primer for Primary Care Physicians“.

Xiao chai hu tang has been used clinically for depression for generations and there is a general consensus that when properly used it is helpful.  It is the “why” and to look specifically at how this formula might modify the HPA axis that is the question these researchers are looking at.

Using a chronic corticosterone induced mouse model (mimicking anxiety and depression in humans) they used a variety of measures including behavioral testing and changes in body weight along with more HPA specific tests such as the dexamethasone suppression test (these HPA tests are described in detail within “Endocrine Testing Protocols: Hypothalamic Pituitary Adrenal Axis“).

The treatment was administered for 30 days and they found that Xiao Chai Hu Tang could “remarkably alleviate chronic corticosterone induced anxiety and depression like behaviors”  in part by “promoting hippocampal neurogensis and remodeling the integrity of the negative feedback loop on the HPA axis”.  Further they found a number of active constituents which may offer further avenues for research.

While the science may be detailed, suffice it to say that this formula fits within the harmonize category for more reasons than that category is traditionally used to indicate.  Our current medical understandings of depression show that there is a deep interplay between the role of our digestion, our elimination and our stress hormones.  Using a formula such as xiao chai hu tang to broadly influence the metabolic and hormonal factors in our mood makes more and more sense the more we understand of these relationships.

Having Massage Therapy Patients More Clearly Describe Touch Sensation Improves Pain Reduction

Along with acupuncture and Chinese herbal medicine, bodywork therapies are an important part of Traditional Chinese Medicine (TCM).  Within the domain of TCM, bodywork techniques form the system of “Tuina” or what could be called Chinese medical massage.  Related you have have “shiatsu” from the Japanese pool of techniques and, of course, western massage therapy which is further divided into techniques ranging from light touch (i.e. craniosacral therapy) to deeper touch (i.e. neuromuscular massage) and a multitude of other techniques.  Bodywork would be one of the first most natural forms of healing; rubbing your arm when you bump into the side of the cave for example.

In modern times, bodywork therapies are used for a broad range of health issues either with other techniques such as acupuncture or western medicine or used completely alone.  They are an important part of pain reduction programs, rehabilitation programs and general stress reduction.  A multitude of studies support their efficacy.

The study I am going to write about today looks at the importance of the engagement of the patient within their massage therapy treatment to increase efficacy.  Researchers from medical institutions in Rome including the Policlinico Umberto I Hospital at the University of Rome recruited 51 patients with chronic low back pain.  As 70% or more of adults will experience low back pain at one point or another in their life and, in the US at least, being the second most common cause of disability, it is critical to find non opiate ways of resolving or at least managing back pain.  Certainly acupuncture has a well described and researched role here as well, but as stated above it is often combined with tuina and/or cupping for better manipulation of the tissue.

The patients in this study were limited to those who have had back pain for more than 3 months and it wasn’t from known causes such as neurological conditions, arthritic conditions, previous surgeries, etc.  They were then divided into two groups, one a more standard massage therapy treatment group and a the other a more experimental treatment group.

The standard massage treatment group, did basically that.  It’s the standard – Oh, hi how are you, what’s going on, ok lay down and we’ll do massage and if you talk I’ll talk a little, but otherwise we’ll just be quiet type massage.

The experimental group, however, handled the interactions quite a bit differently.  Within that group they started the massage treatment with initial “pleasant” (i.e. soft) contact and then worked with the patient to begin describing what they were feeling.  As the patient would feel comfortable contact without pain they would have the patient remember that sensation.  That is, remember feeling that area feeling pain-free, not only remembering it as a painful area.  Further as they continued the therapy they would further allow the patient to describe how the area feels.  Perhaps initially describing the area as “hard as rock” moving on to describing the area has more “adaptable”.

For the bodywork therapists that work in my acupuncture clinic, I stress to never tell the patient that their muscles are tight or anything along those lines really.  Part of this is because it is all relative, one level of tension on a person might be great progress for them while on another person it would indicate a tremendously tense holding pattern.  But the major reason I have always recommended this to my therapists, and practice it myself, is exactly what this study found.  If you tell someone they are tight and let them keep telling themselves they are tight (painful, restricted, whatever) – then they are more likely to continue being that way regardless of what benefit you are offering them through your therapy.

Within this study they found that both the standard massage therapy treatment and the experimental treatment were helpful.  The more engaging feedback therapy treatment, however, did lead to both a larger reduction in pain according to the pain scales used, but perhaps more importantly, led to better maintenance of results at the 3 month followup.

These types of responses have been noted with a range of techniques not just within the realm of massage therapy.  Earlier this year in the US there was a fairly interesting program on national public radio (NPR) entitled “How Meditation, Placebos And Virtual Reality Help Power ‘Mind Over Body’” which covered in detail many of the techniques now showing useful for pain reduction.  Much of this is presented in the text Cure: A Journey into the Science of Mind Over Body byJo Marchant which is a useful read for those dealing with and/or in the role of treating chronic pain.

Acupuncture and Neuroplasticity in Stroke

A recent study from the journal Frontiers in Human Neuroscience looked at the effect of acupuncture and the functional connectivity of the bilateral primary motor cortices in individuals that had ischemic stroke.  A group of normal (i.e. no stroke) subjects was used as a control.  Both groups had brain scans done before and after acupuncture stimulation.  Not surprisingly the stroke group showed a decreased value of functional connectivity between the motor cortices compared to the control group in the baseline scans.   Acupuncture stimulation increased the functional connectivity in the stroke group, but had no effect in the control group.

This is another study that provides evidence that acupuncture achieves clinical results by increasing what is known as neuroplasticity – the ability of the brain to establish new physical and/or functional connections.  The way different brain areas communicate with each other is critically important to our ability to function normally and maintain optimal health.  Therefore treatment methods which can stimulate the communication between brain areas are very important.  For stroke patients in particular it is vital for recovery to restore the communication between brain areas and this study is evidence acupuncture can do exactly that.

The study used only a single acupuncture point, GB 34.  This point is very commonly used clinically to treat tendon, connective tissue, and skeletal-muscle related disorders.  Earlier studies have shown GB 34 to have a modulatory effect on the motor cortex, which in combination with its clinical usage was the reason this point was selected.

This study also provides evidence for one of the fundamental components of TCM theory – that acupuncture treatment is auto-regulatory.  As would be expected, the control group showed no changes in the functional connectivity as there was nothing wrong with that communication in the first place.  The stroke group, whose connectivity was impaired, did show improvement as expected.  In other words this study have provided evidence that acupuncture does not create changes in neural plasticity if there is nothing wrong with the communication between brain areas in the first place.  These results are exactly what is expected from an auto-regulatory mechanism.