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.

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.

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.

Research Shows Acupuncture Can Benefit Both Cognitive Performance and Neural Plasticity

As a former brain scientist I’m well aware of the importance of brain functions and inter-brain connectivity and how that relates to overall physical and mental health.  While the function of individual brain areas is important, the way different areas of the brain communicate with each other is equally, if not more important.  Neural plasticity refers to the ability of the brain to establish new connections, both physical and functional, between brain areas.  As we age neural plasticity is thought to be less, well elastic, and therefore our brains are less responsive to making adaptations and changes that are necessary to maintain optimal mental and physical health.  

Many diseases and disorders result from different areas of the brain failing to communicate properly.  Aging related disorders such as cognitive impairment, dementia, and memory loss, often have no structural component (no brain damage, no interruption of neurotransmitter creation, etc.) and are instead the result of a breakdown of the communication between different brain areas.  This is the result of a breakdown of our neural plasticity.  Therefore to treat these types of disorders we need to be able to restore the communication between the affected brain areas, or in effect restore our neural plasticity.  

A recent study from the Journal of Neural Regeneration Research found that acupuncture treatment resulted in an improvement of cognitive function and furthermore fMRI brain imaging showed corresponding increases in the communication of brain areas associated with higher level cognitive functioning and memory.  The study split patients into a sham acupuncture and a real acupuncture groups.  It is important to note the sham acupuncture was done by needling non acupuncture points – often sham acupuncture uses the same acupuncture points but doesn’t insert the needle which is basically acupressure and therefore not an effective control.  Brain scans and cognitive assessment tests were taken before the study began and again after 4 weeks of treatment.  Those in the true acupuncture group showed both a significant increase in their cognitive testing as well as increases the communication between areas of the brain involved in higher level cognition.  Those in the sham acupuncture group showed no significant performance increase and no changes in the communication between areas of the brain.

There is an important difference between showing acupuncture can influence brain activity (for example this study) while the needles are in versus establishing that acupuncture can have a longer lasting influence on the way the brain functions.  Showing that acupuncture treatment can influence the communication between brain areas both helps to establish that acupuncture does in fact have a lasting effect and the mechanism by which that effect is established – by restoring neural plasticity.  

How LI 11 and ST 37 Acupuncture Points Alleviate Constipation

Acupuncture is used for an extremely wide range of conditions, but in some ways the most important ones are those of a more preventative nature than those involving a last ditch effort.  Paying attention to your colon health through analyzing bowel movements, among other signs, is one such area that is often overlooked.  Constipation is a quite familiar problem to many, but yet as it is so common it is far too easy to avoid giving it much thought until it becomes a major problem or leads to other health issues.

Chinese Medicine, both acupuncture and Chinese herbal medicine, is regularly used to treat both the symptoms and, more importantly, the causal factors of constipation.  In Chinese Medicine there are many possible underlying diagnoses that can all lead to constipation.  In broad terms you have what we call kidney yin deficiency (see “My Kidneys are What?” for general info) which essentially leads to a lack of the fluid/cooling functions of the body leading to dryness in the bowels and perhaps other symptoms such as night sweats, palpitations, anxiety, etc.  Then you have more stress related variants, what we might call spleen qi deficiency with liver qi stagnation, as an example (“My liver is what?“, “My spleen is what?“).  This variant is constipation from overheating the system from poor diet, possibly things like alcohol, etc., and irregular heating and sleeping patterns – along with it you can have any variety of mild to moderate mood disorders, fatigue, cold hands and feet, possibly headaches among other issues.  And, of course, there are many other possible diagnoses from a Chinese Medicine perspective.

Two of the more commonly used acupuncture points for constipation are Qu Chi (LI 11) and Shangjuxu (ST 37).

LI 11 reduces heat in the body, not just in the bowels, but it also has applications for hot skin conditions such as hives and fevers in general.  Because of the heat reducing functions it can also be used for certain types of diarrhea as well as constipation.

ST 37 is used for more acute issues with the colon and the digestive organs in general.  So beyond constipation this point may be useful for abdominal pain, bloating.  Additionally, as with LI 11, this point may equally be applicable to certain types of diarrhea as well as constipation.

Obviously these types of systemic functions of the points (i.e. treating equally well either diarrhea or constipation with the correct usage) leds itself well to the treatment of conditions such as Irritable Bowel Syndrome, as an example.

With the general background out of the way, researchers in the study that I am writing about today utilized a rat model to figure out exactly what these points are doing in relation to constipation in biochemical and functional terms.  In their study they divided the constipation induced rats into 4 groups – a control, a LI 11 only group, a ST 37 only group, and a LI 11 and ST 37 treatment group.  Electroacupuncture was used on the points, although the results would generally be applicable to regular acupuncture and possibly even acupressure based on what other studies have shown.

Their research indicated that there was no significant difference between LI 11 and ST 37 within the constraints of this study. That is, both individually, and even collectively, brought about positive reductions in constipation relatively equally.  All treated rats has significant improvements in GI transit times, frequency of bowel movements and water content.

On a biochemical level they found that these points increased both TPH and 5-HT expression which are markers for healthy bowel function.  5-HT (serotonin) is a particularly important marker for health of the bowels and ultimately overall health of the body as well as mood.  These biochemical markers alone begin to explain why Chinese Medicine never separates the body from the mind and why many acupuncture points end up having such broad systemic responses.

Meta-Analysis Finds Acupuncture with Moxibustion Most Effective Treatment for Chronic Fatigue Syndrome (CFS)

Chronic Fatigue Syndrome (CFS) is a poorly understood condition in western medical terms.  The person with CFS will generally experience a deep fatigue that is not relieved by rest which will happen for weeks to months to years at a time.  But the rest of the symptoms may be quite varied.  Due to these varied symptoms CFS becomes a diagnosis by exclusion (i.e. when nothing else is found clinically wrong) – which is even more frustrating to the person experiencing these issues.

Chronic Fatigue Syndrome goes by a range of other clinical names including  Myalgic Encephalomyelitis, Systemic Exertion Intolerance Disease and may seem difficult to separate from other conditions such as fibromyalgia.  Besides fatigue, some of the other symptoms are:

  • Signs of nervous system dysfunction – headaches, memory issues/brain fog, sleep issues, etc.
  • Signs of autoimmune related inflammation – pain in multiple joints, tender lymph nodes, sore throat, muscle pain, etc.
  • Feeling poorly for long periods after any kind of physical exertion.

Regardless of the individuals particular version of CFS, it is most often a debilitating syndrome for which western medicine has no real deep answers, instead targeting treatments to any number of symptoms.

Chinese Medicine, however, due to its very nature, generally does quite well with these types of systemic conditions.  There is more on the basics of how diagnoses and treatment work in Chinese Medicine in my article “What Does Acupuncture Treat?“.  To avoid repeating much of what appears in that article, suffice it to say Chinese Medicine focuses on the deepest observable causal relationships and not the end result (i.e. the symptoms).  This has obvious advantages when you are dealing with syndromes that both (a) have a poor understanding of what the mechanisms are in western terms, and (b) may manifest quite differently from person to person.

On our acupuncture for CFS treatment page (which provides fairly basic approaches for practitioners to work from), you will see a few of the more common underlying Chinese Medicine diagnoses that a person may have who is experiencing CFS symptoms.  Without getting into too much detail they can be divided into a few basic groups – one is the person is more tired and wired (what we call “yin deficiency”), another is that their body is truly weak (what we all “qi or yang deficiency”) and another basic version is they are stuck and inflamed (what we call “dampness” or possibly “qi stagnation”).  Each one of these underlying causes can lead to essentially the same symptoms but with enough variance for a Chinese Medicine practitioner (along with other diagnostic signs such as the tongue and pulse) to figure out how to design a treatment plan.

Before I get into the research I’ll be writing about today, I’d like to make one reference to the Chinese Medicine diagnoses listed above.  The vast majority of people will think that because they feel “tired” that they are truly weak.  This “truly weak” would be yang deficiency in Chinese Medicine – or a true deep weakness of the body.  Most often in my clinical experience at least, this is not the case.  Most seem to fall more into the “tired and wire” category.  This is important because all of the self-help items people may do to compensate for the weakness (caffeine, sugar, etc.) will make the “tired and wired” people much worse and more deeply entrench the causal factors – not that those dietary choices help any of the diagnoses.  It is important then to know what diagnostic category you fall into to know what dietary and lifestyle habits will most benefit you and most quickly help to ameliorate your health issues.

The study I’m exploring today is a meta-analysis of 31 randomized controlled trials that was initiated by researchers at the Department of Epidemiology within the College of Preventive Medicine at the Third Military Medical University in Chongqing, China.  They said they wanted to look over all existing research because even though there is ample clinical evidence of acupuncture helping with CFS, there are “certain doubts” due to a perceived “lack of a comprehensive and evidence-based medical proof”.

In this meta-analysis they looked at the clinical effectiveness of a variety of treatments for CFS and found acupuncture and moxibustion (see “What is Moxibustion?“) combined or acupuncture or moxibustion alone were the most effective modalities.  Their analyses of existing research culminated in the following list (in order of clinical effectiveness):

  • Combined Acupuncture and Moxibustion
  • Acupuncture or Moxibustion Individually
  • Chinese Herbal Medicine
  • Western Medicine
  • Sham Acupuncture

Another systemic review, carried out by the Center for Evidence-Based Medicine within the Beijing University of Chinese Medicine and others,  came to a similar conclusion after looking at 23 studies involving over 1700 participants with CFS.  This team of researchers concluded that Traditional Chinese Medicine “appears to be effective to alleviate the fatigue symptom for people with CFS”.

From a practitioners perspective these types of broad analyses are helpful and should be motivating from a patients perspective as well.  But they are still a far cry from the type of information that truly benefits practitioners of acupuncture.  These others aspect would potentially be things like what diagnoses were most common, what treatment protocols were most common for those diagnoses and led to the best results, what herbal formulas were most common and for what diagnoses, etc.  Due to the tailored nature of Chinese Medicine, however, it is very hard to study in a linear fashion compared with western pharmaceuticals for example.  Due to this we have to embrace the dynamic tailoring which is ultimately what allows Chinese Medicine to be effective even when it comes at the cost of understanding it in linear terms.

What these meta-analyses provide, as I stated above, is motivation and direction for people to seek help that has true clinical value.  Your practitioner will take this medicine which has tailorability as its very nature and work with your body to alleviate the causal factors behind CFS.  By working deeper you are not only avoiding chasing symptoms with drugs, you are potentially unearthing the imbalance leading over the long-term to a much greater possibility of full resolution of these factors.

 

Acupuncture for Parkinson’s Disease – Mechanisms Explored, Safer Than Rapamycin

Parkinson’s Disease (PD) is a common condition to be seen by an acupuncturist and there is much that can be done to limit the affects of the condition and slow the progress. I have written previously about some of the basics of our particular approach to Parkinson’s. That article also includes some more general information about Parkinson’s from both western and eastern aspects.

That there is benefit from acupuncture and other aspects of Chinese Medicine is fairly clear based on practitioner/clinical outcomes and recent research. What isn’t entirely clear, is “how” acupuncture specifically may help.

In a recent study by researchers from the Shanghai University of Traditional Chinese Medicine and other area institutions, the point GB 34 was explored specifically for its role in modulating the biochemistry behind Parkinson’s.

Using a PD induced mouse model the researchers were able to watch in deeper biochemical terms what exactly happens with stimulation of GB 34 (Yang Ling Quan). They found that use of GB 34 promoted the “authophagic clearance of α-synuclein” in the substantia nigra par compacta of the brain. In layman’s terms this means it clears the communication and biological pathways through which some (or possibly much) of the destruction involved in Parkinson’s and other neurodegenerative diseases occurs.

A drug that has been explored for the prevention and treatment of Parkinson’s is rapamycin (sirolimus) ( 1 ). Rapamycin is an immunosuppressant used primarily to avoid organ transplant rejection but explored in possible uses against autoimmune degenerative conditions such as Parkinson’s. Researchers from the Buck Institute who conducted a study using rapamycin on a rat model of Parkinson’s had this to say… “Given its side effects as an immunosuppressant, there are issues with long-term use of rapamycin, but the results of our study suggest that use of derivatives of rapamycin or other agents with similar biological properties may constitute novel therapeutics for the disorder … our discoveries regarding parkinson’s may provide an even more important therapeutic target for PD.”

Researchers in this acupuncture study compared findings from a rapamycin treated model with those from the acupuncture only model and concluded the following: “acupuncture and rapamycin, a chemical mTOR inhibitor, show comparable α-syn clearance and therapeutic effects in the PD mouse model, the latter adopts a distinctly different, mTOR-dependent, autophagy induction process. Due to this fundamental difference, acupuncture may circumvent adverse effects of the rapamycin treatment”.

They concluded by stating that this finding of the mechanisms of acupuncture on the neurodegenerative process “not only provides a new route to understanding the molecular mechanism of acupuncture but also sheds new light on cost-effective and safe therapy of neurodegenerative diseases”.

Obviously further studies using full collections of points and other Chinese Medicine based treatments as necessary would be warranted. Including other aspects of the Chinese paradigm such as Tai Chi for Parkinson’s. But it is amazing to think that the simple stimulation of a single acupuncture point may have the same affects as a complicated immunosuppressant drug without any adverse effects.